The nurse admits the client with exacerbation of chronic obstructive pulmonary disease (COPD). Which should the nurse implement after reading the prescription for oxygen at 7 L/min by simple facemask?
1. Suction the oropharynx before applying the mask.
2. Check with provider about prescription for a mask.
3. Substitute a Venturi mask for the simple facemask.
4. Ask the nursing assistant to assemble equipment.
2
2. The nurse checks with the provider before implementing the prescription for a client with COPD because a simple facemask is likely to aggravate carbon dioxide retention. A simple facemask does not allow the escape of carbon dioxide, a chronic problem for a client with COPD. In addition, the nurse confirms that the number 7 is correct because the provider can write a 7 that is similar in appearance to a 1 or a 2, depending on the provider's penmanship. Seven liters per minute are excessive for the client because clients with COPD stimulate breathing with hypoxemia compared with most other people who breathe from hypercarbia.
1. The nurse avoids suctioning the client with COPD without justification because it removes inspired oxygen from a typically hypoxemic client. In addition, this client is in distress, so the nurse optimizes oxygen tension of inspired air for the client within limits.
3. The nurse cannot use a Venturi mask with the prescription as written because it delivers oxygen by FiO2.
4. The nurse is not sure which equipment the client needs, so the nurse clarifies the prescription first and then delegates to the assistant.
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