رجل عمره ٦٧ سنة عنده انسداد رئوي مزمن، جاء بتفاقم بسبب التهاب صدري. على أكسجين بقناع فنتوري ٢٨٪، والتنفس ٣٠، والتشبع ٨٩٪. غاز الدم: pH ٧٫٢٩، PaCO2 ٦٨. هو واعٍ ويتعاون ويستطيع حماية مجرى هوائه. أي تدخل تنفسي يتوقعه الممرض أولاً؟

A 67-year-old man with COPD has an infective exacerbation. On a 28% Venturi mask RR is 30 and SpO2 89%. ABG: pH 7.29, PaCO2 68. He is alert, cooperative and protecting his airway. Which respiratory intervention does the nurse expect first?

1. A strong sedative to slow his breathing
2. Non-invasive ventilation (BiPAP)
3. 15 L oxygen by non-rebreather
4. Immediate intubation with no other trial

Answer: B) Non-invasive ventilation (BiPAP). Respiratory acidosis in a COPD exacerbation with an alert, cooperative client is a key indication for BiPAP, which reduces intubation and mortality. Intubation follows if it fails or consciousness falls. High oxygen may raise CO2 further.