Nursing care of the patient with COPD: exacerbations, controlled oxygen, breathing techniques and inhaler teaching
- Safe practice
The nurse spots a COPD flare-up early, gives oxygen to a lower target, teaches calm breathing and checks that the patient uses the inhaler well.
What it is
Chronic obstructive pulmonary disease is a long-term lung disease that is treatable but not curable; the condition page explains it. On the ward the nurse's job is to recognise an exacerbation (a sudden worsening that lasts days, often after a respiratory infection), to give oxygen to the prescribed target range, which is usually lower (88–92 %) because many of these patients are at risk of retaining carbon dioxide, and to watch for drowsiness or confusion. Between treatments the nurse teaches pursed-lip breathing, positions that ease breathing, correct inhaler technique, stopping smoking, vaccination and the action plan for flare-ups. Oxygen equipment and inhaler routes have their own pages and are not repeated here.
What it requires
- A written target saturation range in the order or medication chart, usually 88–92 % for patients at risk of hypercapnia.
- Controlled oxygen devices, most often a Venturi mask, set as ordered (see the oxygen therapy page).
- Respiratory assessment at the start of the shift and after every change: rate, effort, accessory muscles, lung sounds, SpO2, level of consciousness.
- Inhaler technique checked by watching the patient, not by asking.
- Teaching: the flare-up action plan, smoking cessation, vaccination, activity and pulmonary rehabilitation.
Components
- Recognising an exacerbation: more breathlessness, wheeze and cough, more sputum or a change in its colour, lasting 2 days or more.
- Controlled oxygen: the lowest concentration that keeps SpO2 within the prescribed range.
- Breathing control: pursed-lip breathing and upright or tripod positioning.
- Medicines by inhalation: correct technique and timing, as prescribed.
- Prevention: no tobacco or smoke exposure, vaccines, physical activity and education.
How it is applied (and why)
- Check the prescribed target range before starting or adjusting oxygen: the target, not a fixed flow, guides the dose.
- Watch SpO2 for at least 5 minutes after any oxygen change and record device and flow: this shows the effect and keeps the early-warning score correct.
- Assess alertness, headache, flushed skin and breathing pattern each round: confusion or drowsiness may mean carbon dioxide is rising.
- Sit the patient upright, or leaning forward on a bedside table (tripod): this helps the chest and diaphragm expand.
- Coach pursed-lip breathing during effort or anxiety: slow exhalation reduces air trapping and the work of breathing.
- Give nebulised treatments as the protocol states; in COPD they are usually driven by air with oxygen by nasal cannula if needed.
- Ask the patient to show their inhaler technique and correct each error: the medicine only works if the technique is right.
- Plan rest between care activities: fatigue and breathlessness limit how much the patient can do at once.
- Before discharge, review the flare-up plan, smoking cessation support, vaccines and when to seek help.
In nursing practice
- Saturation above the target in a patient at risk is not «better»: the nurse lowers the oxygen within the prescription.
- A patient who needs more oxygen than before to stay in range needs a clinical review to find the cause.
- Anxiety is common in COPD and is often undertreated; a calm approach and breathing control help.
- Clubbing and a barrel chest are signs of long-standing disease, not of the acute episode.
Common mistakes
- Saturation kept at 94–98 % in a patient whose target is 88–92 %.
- Stopping oxygen abruptly, or removing it to «check on room air» in a patient who clearly needs it.
- Asking «do you know how to use your inhaler?» instead of watching the patient use it.
- Forgetting to record the device and flow, so that the early-warning score is calculated wrongly.
Test yourself
Think of the answer, then tap the question to see it.
What target saturation is usually prescribed for a patient with COPD at risk of hypercapnia?
Usually 88–92 % until blood gases are known, or the range the team writes for that patient.
A patient with COPD on oxygen becomes drowsy and confused. What does the nurse do?
Treats it as a warning sign of possible rising carbon dioxide: checks the oxygen device and SpO2 and calls the doctor at once, as blood gases are usually needed.
How is pursed-lip breathing taught?
Relax the shoulders, breathe in through the nose for about 2 counts, then breathe out slowly through pursed lips for 4 or more counts without forcing the air.
Why is oxygen never stopped suddenly in a patient at risk of hypercapnia?
Because sudden withdrawal can cause rapid rebound hypoxaemia; oxygen is stepped down gradually and SpO2 is rechecked.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: British Thoracic Society guideline for oxygen use in adults in healthcare and emergency settings (BMJ Open Respiratory Research (open access, PMC), 2017); Chronic obstructive pulmonary disease (COPD), fact sheet (World Health Organization (WHO), 2026); COPD flare-ups (MedlinePlus, U.S. National Library of Medicine, 2026); Nursing Fundamentals, 8.2: Oxygenation basic concepts (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021).
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Representative model, for educational purposes only.