A nurse on a medical-surgical unit is caring for a client who has COPD. For each nursing action, click to specify if the nursing action is indicated or not indicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

This client presents with advanced chronic obstructive pulmonary disease (COPD) with worsening hypoxia, tachypnea, weight loss, purulent sputum, cyanosis, and increased work of breathing, indicating an acute exacerbation on top of chronic disease progression. COPD management prioritizes improving oxygenation, conserving energy, promoting nutrition, preventing respiratory fatigue, and addressing the primary risk factor, which is smoking. Nursing interventions must support ventilation without suppressing respiratory drive or worsening air trapping. Rationale: • Provide four to six small meals per day: Clients with COPD often experience increased work of breathing, which raises metabolic demand and decreases appetite. Small, frequent meals reduce fatigue during eating and prevent diaphragmatic pressure from large meals. This helps maintain adequate nutrition in clients who are already experiencing weight loss. It also reduces the risk of postprandial dyspnea. • Allow for adequate rest periods: Rest periods are essential because COPD increases the work of breathing, leading to rapid fatigue. Allowing rest helps conserve oxygen and reduces energy expenditure. This is especially important during exacerbations when respiratory rate is elevated and oxygen saturation is low. Resting improves tolerance for essential activities. • Encourage participation in community activities: Maintaining social interaction and engagement supports psychological well-being in chronic disease management. Although activity may need to be paced, participation in meaningful activities helps reduce anxiety and depression associated with COPD. This supports long-term quality of life. Activities should be adjusted to the client’s tolerance level. • Educate on smoking cessation: Smoking is the primary cause and progression factor for COPD. Continued smoking worsens airway inflammation, mucus production, and lung function decline. Education on smoking cessation is essential even during acute care because it directly impacts disease progression and survival. This is a key long-term management priority. • Administer supplemental oxygen to maintain oxygen saturation at 98%–100%: In COPD clients, excessively high oxygen levels can suppress the hypoxic respiratory drive and lead to carbon dioxide retention. Oxygen therapy should be carefully titrated, typically targeting saturation levels of 88%–92% depending on provider orders. Maintaining near-normal oxygen saturation (98%–100%) is unsafe in chronic CO₂ retainers. This could worsen respiratory acidosis and lead to CO₂ narcosis. • Maintain client in supine position: The supine position worsens lung expansion and increases work of breathing in COPD clients. It can further reduce diaphragmatic movement and decrease ventilation efficiency. Clients with COPD benefit from upright or high-Fowler’s positioning to maximize lung expansion and oxygenation. Therefore, supine positioning is contraindicated in respiratory distress.