A patient with chronic obstructive pulmonary disease (COPD) is feeling short of breath and has an oxygen saturation of 86% on room air. The nurse auscultates inspiratory and expiratory wheezes. The nurse applies a nasal cannula at a rate of 2L per minute. What should the nurse do next?

Call respiratory therapy to administer the prescribed levalbuterol nebulizer treatment.


•The patient's situation needs to be addressed immediately. Since the nurse has already administered oxygen, the next action would be to administer a prescribed bronchodilator such as Levalbuterol (Xopenex) to open the airway.

•Respiratory therapy should be called immediately to administer a treatment. Some facilities do allow RNs to do this so always check specific protocols. 

•The physician does not need to be informed of the situation immediately. If a bronchodilator has not been prescribed, the nurse would need to obtain an order from the physician.

•Although the nurse should stay with the patient to provide support if able, action is needed to improve the patient's status.

•Intubation with an endotracheal tube is not necessary in this situation.

•Of note, in severe cases of COPD, a baseline O2 saturation reading might be 88-92%. Arterial blood gasses are likely a more accurate indication of the patient's respiratory status than pulse oximetry. Also, some COPD patients retain carbon dioxide, and administering too much oxygen can actually worsen their respiratory failure. Always notify the provider when initiating administration of oxygen or increasing the rate of flow.

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