COPD and Oxygen Therapy

Medical-Surgical · Respiratory / Pulmonology·Updated 2026-10-27

What it is

Chronic obstructive pulmonary disease (COPD) is persistent airflow limitation from chronic bronchitis and emphysema, most often caused by cigarette smoking. Loss of elastic recoil and narrowed airways trap air, so exhalation is the problem. In clients who retain carbon dioxide, high-flow oxygen worsens ventilation-perfusion mismatch and raises PaCO2, so oxygen is titrated to a target of 88% to 92%; it is never withheld from a hypoxemic client.

What the NCLEX focuses on

Findings: barrel chest, prolonged expiration, pursed-lip breathing, tripod position, accessory muscle use, diminished breath sounds, chronic productive cough.
Diagnosis: a post-bronchodilator FEV1/FVC ratio below 0.70.
Rising PaCO2 shows as drowsiness, headache and confusion; assess and obtain an ABG rather than assume the client is resting.
Exacerbation: increased dyspnea and sputum volume or purulence; treated with short-acting bronchodilators, systemic corticosteroids and antibiotics when sputum is purulent.
Noninvasive ventilation (BiPAP) is first-line for acute hypercapnic respiratory failure.
A Venturi mask delivers a precise oxygen concentration.
Small, frequent, high-calorie, high-protein meals offset the work of breathing.

Priority nursing actions

Position the client upright, leaning forward on an overbed table.
Assess respiratory rate, work of breathing, SpO2 and level of consciousness.
Give oxygen titrated to SpO2 88% to 92% and obtain an ABG.
Give prescribed bronchodilators and systemic corticosteroid.
Prepare for noninvasive ventilation if PaCO2 rises with acidosis.
Coach pursed-lip breathing.

Numbers to know

Value	Normal or target	Why it matters
SpO2 target in COPD	88% to 92%	Corrects hypoxemia without raising PaCO2
pH	7.35 to 7.45	Below 7.35 with a high PaCO2 means respiratory acidosis
PaCO2	35 to 45 mm Hg (4.7 to 6.0 kPa)	Above 45 mm Hg with acidosis supports NIV
FEV1/FVC	Below 0.70 after bronchodilator	Confirms airflow limitation
Long-term oxygen indication	PaO2 55 mm Hg or lower, or SpO2 88% or lower	Improves survival
Long-term oxygen use	More than 15 hours a day	Survival benefit

Common exam traps

Choosing to withhold oxygen from a hypoxemic client with COPD: wrong because hypoxemia kills faster than hypercapnia.
Choosing to raise oxygen until SpO2 reaches 100%: wrong because it raises PaCO2 and causes CO2 narcosis.
Choosing semi-Fowler position with arms at the sides: wrong because the tripod position lets the accessory muscles work.
Choosing to let assistive personnel decide the oxygen flow: wrong because that requires nursing judgment.
Choosing to treat new drowsiness as needed rest: wrong because it signals rising carbon dioxide.

What to teach

Pursed-lip breathing: inhale through the nose, exhale slowly through pursed lips about twice as long as inhalation.
Pace activities, rest before meals, and keep supplies within reach.
Home oxygen: no smoking and no open flames near oxygen; never change the flow without a prescription.
Stop smoking, get yearly influenza and recommended pneumococcal and RSV vaccines, and join pulmonary rehabilitation.

Client handout: Living With COPD (nurse guide and printable patient handout).

Try 2 NCLEX-style questions on this topic

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Question 1 · QID B636F249

A client hospitalized for a COPD exacerbation becomes increasingly drowsy after the oxygen flow was increased. Which action should the nurse take first?

Select the best answer.

A. Return the oxygen flow to the previous setting and then reassess the client's mental status
B. Assess respiratory rate, effort, oxygen saturation, and level of consciousness immediately
C. Ask the UAP to obtain a full set of vital signs while the nurse reviews the oxygen prescription
D. Place the client in high-Fowler position and reassess alertness after several minutes

Question 2 · QID 39AC5406

For each finding, identify whether it indicates heart failure or chronic obstructive pulmonary disease (COPD).

For each finding, select Heart failure or COPD.

	Heart failure	COPD
New S3 heart sound
Rapid weight gain and pitting edema
Pink, frothy sputum
Barrel-shaped chest
Prolonged expiration
Long history of productive cough

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Sources

Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Obstructive Pulmonary Diseases.
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2025 Report. GOLD; 2025.

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