Comprehensive Respiratory System Disorders Q 11

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For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

  

     A. Encouraging the patient to drink three glasses of fluid daily.

     B. Keeping the patient in semi-Fowler's position.

     C. Using a high-flow venturi mask to deliver oxygen as prescribed.

     D. Administering a sedative, as prescribed.

    

    

Correct Answer: C. Using a high-flow venturi mask to deliver oxygen as prescribe

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The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately.

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Option A: Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Increase fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or tepid liquids. Recommend the intake of fluids between, instead of during, meals. Hydration helps decrease the viscosity of secretions, facilitating expectoration.

Option B: Patients with COPD and respiratory distress should be placed in high-Fowler’s position. Elevation of the head of the bed facilitates respiratory function by use of gravity; however, the patient in severe distress will seek the position that most eases breathing. Supporting arms and legs with table, pillows, and so on helps reduce muscle fatigue and can aid chest expansion.

Option D: They should not receive sedatives or other drugs that may further depress the respiratory center. Assess the patient’s respiratory response to activity which includes monitoring of respiratory rate and depth, oxygen saturation, and use of accessory muscles for respiration. Patients with COPD can experience hypoxia during increased activity and may need oxygenation to avoid hypoxemia which puts them at risk for exacerbations of the condition.

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