A client with a history of COPD is prescribed oxygen therapy at 2 L/min via nasal cannula. The nurse finds the client has increased their own flow rate to 6 L/min because they felt short of breath. What should the nurse do?

OXYGEN THERAPY IN COPD — RATIONALE: Clients with chronic CO2 retention (type 2 respiratory failure) may rely partly on hypoxaemia to drive respiration (hypoxic drive); high-flow O2 can blunt this drive, causing hypoventilation and CO2 retention; TARGET SpO2 in COPD: 88-92% (NOT 95-100% as in normal patients);

Current evidence: The 'hypoxic drive' concern is real but somewhat overstated; high-flow O2 also causes V/Q mismatch effects in COPD; the clinical consensus remains: use the lowest effective O2 to achieve SpO2 88-92%.

What to do: Return to prescribed 2 L/min; assess SpO2, respiratory rate, work of breathing, level of consciousness (CO2 narcosis signs: somnolence, confusion, decreased respiratory effort); notify RN with assessment findings; the client's dyspnoea needs investigation (infection, bronchospasm, anxiety, other cause); do not leave the client without assessing the reason for discomfort.

Patient education: Explain the reason for specific O2 settings in COPD.