A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives morphine sulfate, and his spontaneous respirations decrease to 4 breaths/min. Which acid-base disturbance will the nurse anticipate occurring?

A. Bronchodilators, such as short-acting beta-agonists (e.g., albuterol), relax airway smooth muscles, reduce bronchospasm, and improve airflow. This is the primary intervention for acute exacerbations of COPD, as it immediately helps relieve dyspnea, improve oxygenation, and decrease the work of breathing. Administering therapy as prescribed is essential for stabilizing respiratory status.

B. Supine positioning can worsen dyspnea in patients with COPD because it restricts diaphragmatic movement and lung expansion. Patients often feel more comfortable sitting upright or in a tripod position, which facilitates better ventilation and oxygenation.

C. Similar to option B, lying flat increases respiratory effort and can decrease oxygen saturation. Encouraging an upright or semi-Fowler’s position supports effective breathing mechanics and reduces the sensation of shortness of breath.

D. There is no immediate indication to restrict fluids in acute COPD exacerbation unless the patient has a coexisting condition (e.g., heart failure). Proper hydration is important to help thin secretions, making airway clearance easier. Fluid restriction would not improve acute dyspnea.

A. In a COPD exacerbation, the primary concern is respiratory compromise. Monitoring respiratory rate, depth, pattern, and use of accessory muscles provides immediate information about the patient’s ventilatory status and oxygenation. Early recognition of worsening respiratory distress allows for prompt interventions such as supplemental oxygen, bronchodilators, or noninvasive ventilation.

B. While tachycardia may occur due to hypoxemia or stress, it is a secondary indicator and less directly reflective of acute respiratory status. Heart rate alone does not provide sufficient information about ventilation or gas exchange.

C. Fever may indicate infection, which can trigger or worsen an exacerbation, but it is not the most immediate indicator of respiratory compromise. Delaying attention to respiratory distress in favor of temperature assessment can lead to deterioration.

D. Blood pressure monitoring is important for overall hemodynamic status, but it does not directly assess the severity of a COPD exacerbation. It is a secondary consideration compared with respiratory assessment.