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RR: 30 bpm

HR: 120 bpm

BP: 148/78 mmHg

SpO₂: 90%

Blood glucose: not repeated

Temperature: not repeated

GCS: 15/15

4 lead ECG: atrial fibrillation

Allergies: nil

1  When the nebuliser has finished, you notice that the patient’s SpO 2 is dropping so you decide to keep the patient on oxygen. What percentage of oxygen would you administer to this patient and why?28% oxygen through a nasal cannula. The patient is at risk of developing hypercapnia respiratory failure, so it is important the oxygen is titrated to maintain saturations between 88 and 92%. Research suggests that over‐oxygenation increases the mortality and morbidity of COPD patients and that titration of oxygen administration can reduce mortality.

2  What is meant by the term hypercapnia? ‘A condition of abnormally elevated carbon dioxide (CO2) levels in the blood, caused by hypoventilation, lung disease, or diminished consciousness’ (NAEMT, 2015, p. 92).‘Alveolar hypoventilation with increased alveolar carbon dioxide limits the amount of oxygen available for diffusion into the blood, leading to secondary hypoxemia’ (McCance et al., 2010, p. 1269).