A nurse is caring for a client.

Exhibits

Which of the following actions should the nurse take? (Select all that apply.)

A. pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L: This ABG finding indicates respiratory alkalosis, as evidenced by the elevated pH and decreased PaCO2. In progressive COPD, clients typically retain carbon dioxide rather than blow it off, so this finding would not be expected in a patient with chronic respiratory issues.
B. pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L: This is the most consistent finding for a client with progressive COPD. The low pH indicates acidosis, and the elevated PaCO2 suggests respiratory acidosis due to carbon dioxide retention, a common problem in COPD. The elevated HCO3 indicates a compensatory metabolic response, as the body attempts to retain bicarbonate to buffer the acidosis.
C. pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L: These values indicate a normal ABG, which would not be expected in a client with progressive COPD. Patients with chronic lung disease typically present with acid-base imbalances due to respiratory failure, so this finding suggests the client is not exhibiting the expected complications of COPD.
D. pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L: Although these findings show mild acidosis, the PaCO2 is within normal limits, indicating that this patient may not be experiencing significant respiratory failure. In advanced COPD, one would expect to see a higher PaCO2 and more pronounced acidosis, making this option less characteristic of a patient with progressive COPD compared to option B.

A. Encourage the client to take breaks from oxygen use to prevent tolerance. Oxygen therapy does not cause "tolerance," and taking breaks can lead to hypoxemia in COPD clients. Continuous low-flow oxygen is essential to maintaining adequate oxygenation while avoiding hypercapnia. Stopping oxygen therapy intermittently can increase the risk of respiratory distress.
B. Assess cheeks and posterior ears for signs of skin breakdown. While it is important to monitor for pressure injuries from nasal cannula tubing, this is a general nursing consideration for all patients receiving oxygen therapy. It is not the highest priority when managing oxygen therapy in clients with COPD, where maintaining appropriate oxygen levels is critical.
C. Maintain nasal oxygen at a 1 to 2 liter/minute flow rate. Clients with COPD often have chronic CO₂ retention and rely on hypoxic drive for ventilation. Administering high-flow oxygen can suppress their respiratory drive, leading to CO₂ narcosis and respiratory failure. To prevent this, oxygen should be administered at the lowest effective flow rate, typically 1 to 2 L/min via nasal cannula, while closely monitoring oxygen saturation and blood gases.
D. Teach the client how to safely increase oxygen flow when they deem necessary. Allowing a client with COPD to adjust their oxygen flow independently can be dangerous, as excessive oxygen can lead to hypercapnia and respiratory depression. Oxygen adjustments should be made based on clinical assessments and healthcare provider orders.