An OPD is cterized by the acute worsening of a client's baseline symptoms (eg, dyspnea, cough, sputum

color mocharaderate to atory failure is reversed exacerbations and acidosis (pH c7.3) or hypercapnia
(PaCO2 >45 who havsevere COPD eed for tracheal intubation and is administered until the underlying
cause of the ventile tal status chanith pharmacologic therapy (eg, corticosteroids, exacerbation of
Cbronchodilators, antibiotics). mm Hg). bec livers oxygen to the lungs and then removes carbon dioxide
(CO2). CO, retention causes client determine omes drowsy or confused, it is likely that more CO, is being
reevaluation shoutained the n wcan remove; this should be reported to the HCP. Arterial blood gas ld be
obtained to it can men than IPAP ges NIPPV can prevent and production). NIPPV is often prescribed
short-term to support gas exchange in de CO2 level and BIPAP effectiveness. Altered mental status
poses the greatest threat to a client's survival as clients

BIPAP involves the

r the blood glucose level because the client was prescribed the corticosteroid rnethylprednisolone (Solu-
Medrol), which can cause hyperglycemia, ently in this client.

(Option 2) Capillary refill time is indicated to assess poor perfuse of a mewhat Bchanical device and
facemask in a conscious client

spontaneously. BIPAP. If the lead to decreased protective reflexes (eg, gag, swallow, cough), periods of
apnea, especially in clients with diabetes mellitus. However, blood glucose is not the most important
parameter to monitor frequ

who is breathing and airway compromise (Option 4).

(Option 1) The nurse tion, shock, and pBilateral swelling indicates volume overload or venous stasis. This
client was started on enoxaparin (blood thinner) to preripheral vascular disease.

(Option 3) Unilateral extreshould monitousion states, and a value of >3 seconds (delayed refill time) is
seen in conditions such as dehydramity swelling is level of consciousness concerning foevent DVT.
Volume overload is unlikely as the client is not receiving IV fluids.

Educational objective: In a clir

ent with COPD exacerb increased CO, retention deep venous thrombosis (DVT) in a hospitalized client.
ation, it is most important for the nurse to difficult arousal, and confusion to the HCP. These signs may
indicate and worsening hypercapnia, which would monitor mental status frequently and report changes
such as restlessness, decreased, somnolence, necessitate an immediate change in therapy.