During morning rounds, the nurse reviews the electronic health record for a client with a long-standing history of severe chronic obstructive pulmonary disease (COPD). The client is currently resting comfortably while receiving oxygen therapy at 2 L/min via a nasal cannula. The most recent arterial blood gas analysis reveals a pH of 7.36, a PaCO2 of 58 mm Hg, a PaO2 of 62 mm Hg, and a bicarbonate (HCO3-) level of 32 mEq/L. Which of the following actions should the nurse implement based on this data?
- Document the findings as they reflect an expected, fully compensated respiratory acidosis.Answer
- BIncrease the oxygen flow rate to correct the hypoxemia indicated by the low oxygen tension.
- CNotify the rapid response team to initiate emergency noninvasive positive pressure ventilation.
- DPrepare to administer intravenous sodium bicarbonate to address the systemic acid-base disturbance.
Answer
The nurse should document the findings because they represent a fully compensated respiratory acidosis, which is the expected physiological baseline for a client with severe, chronic COPD.
The arterial blood gas values indicate a fully compensated respiratory acidosis. Because the pH is within the normal range (7.35-7.45) despite an elevated PaCO2, the kidneys have physiologically adapted and retained enough bicarbonate to compensate for chronic CO2 retention. This is the expected baseline for a client with severe COPD who is resting comfortably. Therefore, the nurse only needs to document the findings.
Step-by-Step Solution
Key Concept
In severe chronic obstructive pulmonary disease, physiological adaptation to chronic carbon dioxide retention leads to fully compensated respiratory acidosis, which serves as the client's expected baseline.