A patient with COPD has PaO2 58 mmHg on room air. What should the nurse do first?

• A. Initiate supplemental oxygen to achieve target SpO2 (88-92%), and monitor for CO2 retention.
• B. Maintain room air and monitor.
• C. Administer diuretics.
• D. Start CPAP.

Answer: (A)

In COPD with significant hypoxemia, the priority is to correct oxygenation while avoiding suppressing the drive to breathe. Initiating supplemental oxygen and titrating it to achieve an SpO2 of about 88–92% provides enough oxygen to tissues without pushing the patient into CO2 retention, which COPD patients can be vulnerable to because their hypoxic drive is often relied upon for respiration. After starting oxygen, closely monitor the patient’s SpO2 and respiratory status, and reassess with ABG or capnography as available to ensure CO2 isn’t rising.

Maintaining room air would leave the hypoxemia untreated and risk organ dysfunction. Diuretics don’t address the underlying gas exchange problem in this scenario. Starting CPAP isn’t the first step for isolated COPD hypoxemia; CPAP is used for sleep-disordered breathing or certain acute conditions, and it would be incorrectly applied before ensuring safe oxygenation and ventilation.