An elderly patient with a history of COPD presents at a clinic with dyspnea on slight exertion. The SpO2 monitor reads 88 percent. To facilitate an optimal plan of care, the nurse should
1. immediately place oxygen at 6 liters on the patient.
2. prepare for imminent endotracheal intubation.
3. offer the patient morphine intravenously to calm the breathing.
4. ask the patient how today's breathing compares with the usual.
4
Rationale: Patients with COPD may demonstrate dyspnea with slight exertion. Therefore, it would be important to assess how today's breathing compares with "normal" for the patient. Because ventilatory drive for patients with COPD depends on low oxygen levels, it is not advisable to place these patients on more than 1 to 3 liters of oxygen via nasal cannula. Even then, it would be important to monitor PaO2 levels to ensure that they do not rise enough to suppress the patient's ventilatory drive. Endotracheal intubation is a last resort for patients with COPD because it is very difficult to wean them from mechanical ventilation. IV morphine would not be an appropriate choice for this patient because there is no indication that the patient is in respiratory distress.
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