A client with a history of chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via nasal cannula. The nurse notes the client is becoming increasingly drowsy and confused, with a respiratory rate of 10 breaths/min. Which of the following is the most appropriate initial nursing action?
- AAdminister a prescribed bronchodilator.
- BLower the head of the bed to a supine position.
- CIncrease the oxygen flow rate to 4 L/min.
- DDecrease the oxygen flow rate and notify the provider.
Show answer & explanationAnswer & explanation
Correct answer: D. Decrease the oxygen flow rate and notify the provider.
In COPD clients, the respiratory drive is often based on hypoxemia (hypoxic drive). Administering excessive oxygen can suppress this drive, leading to hypoventilation, CO2 retention, and respiratory acidosis, manifested by drowsiness, confusion, and decreased respiratory rate. The priority is to reduce the oxygen to avoid further respiratory depression and notify the provider for further assessment and orders.
Why the other options are wrong
- A. While bronchodilators are used in COPD, an acute change in mental status and respiratory rate with oxygen therapy points to CO2 narcosis from over-oxygenation, not bronchospasm as the primary issue.
- B. Lowering the head of the bed would impede lung expansion and worsen breathing for a client with respiratory compromise.
- C. Increasing oxygen would further suppress the hypoxic drive and worsen hypoventilation and CO2 retention.
Hypoxic Drive in COPD & Oxygen Therapy
In some COPD clients, the primary stimulus for breathing shifts from CO2 levels to oxygen levels (hypoxic drive). Excessive oxygen administration can suppress this drive, leading to hypoventilation and CO2 retention.
- Normal respiratory drive is based on CO2 levels.
- Chronic hypercapnia in COPD can shift the drive to hypoxemia.
- High-flow oxygen can remove the hypoxic stimulus, leading to respiratory depression.
Memory trick: Too much O2, COPD's plight, slows the breath, dims the light!