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# 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.

Updated Nov 13, 2026

## Key points

- Patients at risk of hypercapnic respiratory failure, such as most people with COPD, usually have a target saturation of 88–92 % until blood gases are known.
- Every patient on oxygen should have a written target range; the nurse adjusts within it and records SpO2, device and flow.
- New drowsiness, confusion, headache or worsening breathlessness in a patient on oxygen is reported at once: blood gases are usually needed.
- Never stop oxygen suddenly in a patient at risk of hypercapnia: rebound hypoxaemia can follow.
- Pursed-lip breathing: in through the nose for about 2 counts, out slowly through pursed lips for 4 or more.
- Stopping smoking is the single most important step; yearly influenza and other recommended vaccines reduce flare-ups.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/nursing-care-of-the-patient-with-copd-exacerbations-controlled-oxygen-breathing/)

## Elsewhere in DurgiPedia

- [Hypoxemic and hypercapnic respiratory failure](https://durgical.com/en/physiology/hypoxemic-and-hypercapnic-respiratory-failure/)
- [Pulmonary hyperinflation syndrome (emphysema)](https://durgical.com/en/clinical-exam/pulmonary-hyperinflation-syndrome/)

## Connections

## Related 4

- [Oxygen therapy: devices, flows and safety](https://durgical.com/en/nursing/oxygen-therapy-devices-flows-and-safety/)
- [Airway clearance: incentive spirometry, deep breathing, coughing and oscillating devices](https://durgical.com/en/nursing/airway-clearance-incentive-spirometry-deep-breathing-coughing-and-oscillating-de/)
- [Other routes: inhaled, topical, eye, ear, rectal and vaginal](https://durgical.com/en/nursing/other-routes-inhaled-topical-eye-ear-rectal-and-vaginal/)
- [Pulse oximetry at the bedside: placement and pitfalls](https://durgical.com/en/nursing/pulse-oximetry-at-the-bedside-placement-and-pitfalls/)

## Related conditions 1

- [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/)

[← All of nursing](https://durgical.com/en/nursing/)

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](https://pmc.ncbi.nlm.nih.gov/articles/PMC5531304/) (BMJ Open Respiratory Research (open access, PMC), 2017); [Chronic obstructive pulmonary disease (COPD), fact sheet](https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)) (World Health Organization (WHO), 2026); [COPD flare-ups](https://medlineplus.gov/ency/patientinstructions/000698.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Nursing Fundamentals, 8.2: Oxygenation basic concepts](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/08%3A_Oxygenation/8.02%3A_Oxygenation_Basic_Concepts) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/nursing-care-of-the-patient-with-copd-exacerbations-controlled-oxygen-breathing/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/nursing-care-of-the-patient-with-copd-exacerbations-controlled-oxygen-breathing/