R & R Exam

[KCnTexas, ADN]

I need help with a question on COPD, I am at a total loss with this one, nothing in my textbook or notes helps with this question.

A patient was admitted to the hospital with chronic obstructive pulmonary disease. His PaO2 was 55 and PaCO2 was 65. A new resident orders 54% oxygen via mask. One hour after the oxygen was placed, the nurse finds the patient with no respiration or pulse. She calls for a Code Blue and begins cardiopulmonary resuscitation (CPR). Explain why the patient stopped breathing.

Thanks!

[EricJRN, MSN, RN]

You should do a search for "hypoxic drive" for the answer your instructor wants. For the real answer, Google "hypoxic drive myth."

The theory is that a COPD patient depends on low O2 levels in order to maintain his/her respiratory drive and that by giving the patient too much oxygen, you can induce respiratory arrest.

In reality, research since the early 1990's has shown that only a small percentage of COPD patients will rely on hypoxic drive - and that even in those rare cases, it takes hours or days of high-flow oxygen to knock out respiratory drive.

There is still a great deal of confusion, even among nursing educators, related to the hypoxic drive theory.

[SmetRN2008]

Yes, Eric is right. They need a low O2 level. Giving a person with COPD too much O2 sends the message to their brain to stop breathing.

[Eirene, ASN, RN]

taken from brunner and suddarths textbook of medical surgical nursing:

because hypoxemia stimulates respiration in the patient with copd, increasing the oxygen flow to a high rate may greatly raise the patient's blood oxygen level. at the same time, this will suppress the respiratory drive, causing increased retention of co2 and co2 narcosis.

for patient with a pao2 of 55 mmhg or less on room air, maintaining a constant and adequate oxygen saturation (>90%) is associated with significantly reduced mortality and improved quality of life.

i hope that helps!