COPD Exacerbation
A 66-year-old client with severe COPD comes to the emergency department after three days of increased dyspnea, a change to thick yellow sputum, and using the rescue inhaler around the clock.
Recognize cues
Vital signs: BP 142/84, HR 110, RR 30, SpO2 84% on room air, temperature 37.8 C. The client is drowsy and difficult to arouse. Arterial blood gas: pH 7.26, PaCO2 68 mmHg, HCO3 30 mEq/L.
Which finding requires the most immediate follow-up?
Take action
The provider orders oxygen titrated to an SpO2 of 88 to 92 percent, nebulized bronchodilators, IV corticosteroids, antibiotics and noninvasive positive pressure ventilation if no improvement.
Which two actions should the nurse take first?
Evaluate outcomes
Two hours later the client is alert and conversant. RR 20, SpO2 90% on 2 L/min. Repeat gas: pH 7.34, PaCO2 54 mmHg.
Which finding best indicates the treatment is working?
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