A client with COPD reports difficulty breathing. The nurse notes oxygen saturation 88% on room air. What is the appropriate intervention?

COPD clients chronically retain CO2 (carbon dioxide); over time, their respiratory drive may rely on hypoxic drive rather than the normal hypercapnic drive. Giving high-flow oxygen can suppress this hypoxic drive, leading to CO2 retention, hypercapnia, and CO2 narcosis (confusion, sedation, eventual respiratory failure). Goal oxygen saturation for COPD is typically 88-92% (lower than the 95%+ goal for clients without lung disease). Start with low-flow oxygen (1-2 L/min via nasal cannula) and titrate up cautiously. Monitor for signs of CO2 retention: increasing confusion, somnolence, headache, asterixis. Arterial blood gas (ABG) assessment confirms acid-base status. Other management for COPD exacerbation: bronchodilators (albuterol, ipratropium), systemic corticosteroids, antibiotics if infection suspected, non-invasive positive pressure ventilation (BiPAP) for severe distress, possible intubation in respiratory failure. The fundamental principle: 'Treat the patient, not the number' — but for COPD, don't over-oxygenate.