Problem: M.B. is a 65-year-old male who is being admitted from the emergency department to the cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD).
M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg, heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 38.4° C, and SaO2 85%. He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest.
Which assessments or actions should you take at this time and why?