NORCET 1 - 2020: In a COPD patient given O2 by Venturi mask, what is the nursing priority action?

NORCET 1 - 2020

Medical & Surgical Nursing

Hard

Appeared in: NORCET 1 - 2020

Explanation

The priority action is to monitor for signs of carbon dioxide (CO2) narcosis, a life-threatening complication of oxygen therapy in some COPD patients.
In patients with chronic hypercapnia (chronically high CO2), the main stimulus to breathe can become low oxygen levels, known as the 'hypoxic drive'.
Administering too much oxygen can suppress this drive, leading to hypoventilation and a dangerous rise in blood CO2 levels.
The earliest and most significant signs of CO2 narcosis are neurological changes, such as decreased alertness, confusion, and lethargy.

Option A: Assessing for nasal dryness is a comfort and skin integrity measure. While important for long-term care, it is not a life-threatening priority.
Option B: Providing any fluid, especially hot liquid, is not a priority and is dangerous if the patient's level of consciousness is declining, as it poses a significant aspiration risk.
Option C: The supine position is contraindicated as it hinders lung expansion and increases the work of breathing for a patient with COPD.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Nursing priorities in oxygen therapy for COPD patients in the correct sequence, documenting the action clearly, and monitoring for the expected response.
For COPD patients requiring oxygen, the goal is to use the lowest possible FiO2 to maintain a target SpO2, typically between 88-92%, to prevent both severe hypoxia and CO2 narcosis.
A Venturi mask is often the device of choice because it delivers a precise, fixed oxygen concentration, which is crucial for safely managing these patients.
What if? The patient's SpO2 is 98%, but they are becoming drowsy. This is a classic sign of CO2 narcosis. The nurse's priority is not to be reassured by the high SpO2 but to immediately assess the patient's respiratory rate and LOC, notify the provider, and anticipate an order to decrease the FiO2.

How to Approach the Question

First, identify the core clinical scenario: a COPD patient receiving oxygen. This combination should immediately trigger a recall of the key associated risk: CO2 retention (narcosis).
Second, frame the question in terms of 'priority'. This requires using a framework like ABCs (Airway, Breathing, Circulation) and safety.
Third, evaluate each option against this priority. A change in alertness ('Check alertness') is a primary indicator of a neurological and respiratory emergency (CO2 narcosis), directly impacting the 'Breathing' component.
Fourth, systematically eliminate the other options. Nasal dryness is a comfort/skin issue, not an ABC problem. Supine position is actively harmful to breathing. Liquids are an aspiration risk if alertness is compromised.
Conclude that checking alertness is the most critical assessment to ensure immediate patient safety.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 38-40

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 4-6