COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) NURSING CARE PLAN

Keywords: COPD, CHRONIC OBSTRUCTIVE PULMONARY DISESAES, NURSING DIAGNOSIS

Nursing Diagnosis: #1 – Insufficient airway clearance related to increase mucus production as evidenced by profuse coughing and forced breathing.

Goal: Maintain clear airway by effective coughing.

Intervention:

  • Access lung sound at least every 4 hours.
  • Monitor amount, color and consistency of sputum.
  • Proper position should be provided i.e. fowler’s/semi fowler’s position to prevent aspiration of secretions.
  • Provide adequate oral fluid if indicated, if not then IV fluid may be provided as per physician’s order.
  • Encourage patient to cough and deep breath
  • Administer expectorants and antibiotic as ordered.
  • If patient is unable to cough up secretions, suction should perform as per prescription.
  • Request for chest physiotherapy as per physician’s order.

Rationale:

  • Wheezes and crackle sound may indicate excess secretions in airway.
  • Thick purulent sputum indicates infection.
  • Movement mobilizes secretion and helps in breath properly.
  • Hydration decreases viscosity of secretion.
  • Controlled coughing and deep breathe is more effective for clearing airway.
  • To liquefy secretion and trigger cough reflex.
  • Suction is necessary to remove secretions and clear airway.
  • To mobilize secretions.

Evaluation:

  • Does lung sound indicate retained secretion?
  • Does sputum indicate infection?
  • Is patient mobile?
  • Are secretions thin and easily expectorated?
  • Does patient cough and breathe effectively?
  • Are medications effective?
  • Is patient feeling comfortable after suctioning?
  • Is physiotherapy is well tolerated by the patient?

 

Nursing Diagnosis: #2- ineffective breathing patterns related to shortness of breath and airway irritation as evidenced by high respiratory rate.

Goal: Patient should maintain an effective breathing pattern i.e. respiratory rate in between 12 to 24 per minute.

Intervention:

  • Access respiratory rate, depth and rhythm.
  • Monitor blood gas and oxygen saturation value.
  • Place patient in fowlers or Semi fowler’s position.
  • Diaphragmatic breathing training/ deep breathing training should be given to patient.
  • Administer oxygen as prescribed.

Rationale:

  • Respiration less than 12 and more than 24 may indicate an ineffective pattern.
  • An ineffective breathing pattern will not maintain oxygenation.
  • This allows for maximum chest expansion.
  • Breathing exercise promotes relaxation and CO2
  • To maintain optimal cellular function.

Evaluation:

  • Is respiratory pattern ineffective?
  • Is breathing pattern adversely affecting oxygenation?
  • Is patient comfortable in this position?
  • Is patient able to demonstrate an effective breathing pattern?
  • Is oxygen administration restored normal breathing pattern?

Nursing Diagnosis: #3 – impaired gas exchange related to decrease ventilation or perfusion as evidenced by headache, restlessness and improving ABG.

Goal: The patient will experience improved gas exchange.

Intervention:

  • Access lung sound, respiratory rate and effort, use of accessory muscles.
  • Observe skin and mucus membrane for cyanosis.
  • Access degree of dyspnea on scale of 0 to 10, 0 = no dyspnea, 10 = worst dyspnea.
  • Monitor for confusion and change in mental status.
  • Monitor ABG value and pulse oximetry as ordered.
  • Elevate head of bed or help patient to lean on over bet table.
  • Administer supplemental oxygen at ≤ 2L per minute if ordered.
  • Teach patient relaxation exercise, diaphragmatic (deep) and pursed lip breathing (a breathing technique that consist of exhaling through tightly pressed lip & inhaling through the nose with closed mouth).
  • Encourage patient to stop smoking.
  • For severe dyspnea, ask physician about an order for intravenous morphine sulfate.

Rationale:

  • Respiratory rate less than 12 or more than 24 or use of accessory muscles indicates distress. Diminished lung sound indicates poor air movement and impaired gas exchange.
  • Cyanosis indicates poor oxygenation. Oral mucus cyanosis indicates serous hypoxia.
  • The patient’s subjective report is the best measure of dyspnea.
  • Change in mental status can signal impaired gas exchange.
  • PaO2 < 80 mmHg, PaCO2 > 45 mmHg or SaO2 < 90 indicate impaired gas exchange.
  • Upright position promotes lung expansion.
  • Supplemental oxygen decreases hypoxia.
  • Relaxation exercise and breathing exercise decrease perceived dyspnea and promote relaxation with increase CO2
  • Smoking is damaging to lungs and respiratory function.
  • Low doses of IV Morphine cause vasodilation which helps relieve pulmonary edema and anxiety.

Evaluation:

  • Are lung sounds clear and audible? Is respiratory rate 12 to 24/min?
  • Are skin and mucus membrane pink?
  • Is patient’s degree of dyspnea within parameters that are acceptable to patient?
  • Is patient alert and oriented?
  • Are values within patient’s base line value?
  • Did change of position relieve some distress?
  • Does oxygen provide relief from dyspnea?
  • Do breathing exercises help?
  • Does it have any impact on client?
  • Does morphine provide relief from dyspnea?

Nursing Diagnosis: #4 – Altered nutrition less than body requirement related to reduce appetite as evidenced by poor muscle tone and lack of interest in food.

Goal: Patient should have normal body weight.

Intervention:

  • Assess dietary habit & recent food intake.
  • Auscultate bowel sound.
  • Give frequent oral care & remove expectorated secretions.
  • Encourage a rest period of 1 hour before and after meal.
  • Provide frequent and small feeding.
  • Avoid gas producing food and carbonated beverages.
  • Avoid very hot and very cold food.
  • Weight, as indicated.
  • Consult dietitian or nutritional support team to provide easily digested nutritionally balanced meals by mouth if patient can take orally.
  • If not then any supplemental or tube feeding and parental nutrition must be provided.

Rationale:

  • Respiratory distress is often anorectic because of dyspnea, sputum production and medication effect. As a result, client often admitted with some degree of malnutrition.
  • Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation related to limited fluid intake, decrease activity and hypoxia.
  • Noxious tastes, smells and sights can reduce appetite and can produce nausea and vomiting with increased respiratory difficulties.
  • Helps reduce fatigue in meal time and provide opportunities to increase total calorie intake.
  • May help in enhance intake and easy digestion even though appetite is slow.
  • Can produce abdominal distention.
  • Extreme in temperature can precipitate coughing spasm.
  • Useful in determining caloric needs, setting weight goal & evaluating adequacy of nutritional plan.
  • Methods of feeding and caloric requirements are based on individual’s situation and specific need to provide maximum nutrients.

Evaluation:

  • Is any impact of dietary habit due to respiratory distress observed?
  • Is any deviation of bowel sound detected?
  • Is patient feeling better after removal of secretions?
  • Is 1-hour gap before and after meal is effective?
  • Does frequent and small feeding helps in food intake pattern?
  • Is patient feeling good and no abdominal distention is there?
  • Does it have any impact on patient’s cough reflex?
  • Is patient maintaining the normal caloric need?
  • Does patient take oral feeding? Does nutritional plan work?

Nursing Diagnosis: #5 – Activity intolerance related to ineffective breathing pattern as evidenced by fatigue and abnormal heart rate response to activity.

Goal: The patient will accomplish activities of daily living without dyspnea or excessive fatigue.

Intervention:

  • Evaluate client’s response to activity. Note reports of dyspnea, increase weakness and fatigue & changes in vital signs during and after activities.
  • Provide a quite environment and limit visitors during acute phase and encourage use of stress management and diversional activities.
  • Explain importance of rest in treatment plan and necessity of balancing activities with rest.
  • Assist client to assume comfortable position for rest and sleep.
  • Assists with self-care activities as necessary.

Rationale:

  • Establish client’s capabilities and need.
  • Reduce stress and excess stimulation & promote rest.
  • Minimizes exertion and helps in balancing oxygen supply and demand.
  • Will help the patient to reduce exertion.
  • Reduce client’s effort and maintains normal heart rate and breathing.

Evaluation:

  • Is any dyspnea and weakness identified?
  • Are stress management and diversional activities helpful?
  • What is the condition of the client after balanced activity and rest?
  • After positioning does the patient feels good?
  • What is the impact of this on client’s exertion and heart rate?

Nursing Diagnosis: #6 – Risk for infection related to the chronic disease condition.

Goal: To prevent and reduce risk and spread of secondary infection.

Intervention:

  • Monitor vital sign, sputum color and body temperature.
  • Encourage fluid intake.
  • Protect patient from people with respiratory infections and limit visitors as indicated.
  • Demonstrate and encourage hand washing technique.
  • Change position frequently.
  • Promote adequate nutritional intake.
  • Investigate sudden changes and deterioration in condition such as increasing chest pain, recurring fever and changes in sputum characteristics.
  • Administer antimicrobial as prescribed.

Rationale:

  • During this period potentially, fatal complication such as hypertension and shock may develop.
  • Hydration decreases viscosity of secretion.
  • Effective means of reducing spread of infection.
  • Best way to avoid and reduce infection.
  • Improves respiratory function and releases pressure from pressure points.
  • Minimizes the risk of unusual weight loss and provide adequate energy, hence improve pulmonary status.
  • Helps in early detection and treatment of secondary infections.
  • Reduce infectious pathogens.

Evaluation:

  • Does vital sign and sputum color indicate any complication?
  • What is the consistency of secretion now?
  • What is the breathing rate of the client after limiting visitors?
  • Are client and family members following hand washing technique?
  • Is client comfortable with changing position?
  • Is client taking adequate nutrition?
  • Does client feel any deterioration in health condition?
  • Is patient getting antimicrobial regularly and timely?

Nursing Diagnosis: #7 – -deficient knowledge of self-care strategies related to lack of exposure as evidenced by inaccurate follow through of instruction.

Goal: Client will understand the condition, disease process and prognosis and will initiate necessary life style changes & participate in treatment program.

Intervention:

  • Provide information in written and verbal form.
  • Emphasize importance of continuing effective coughing and deep breathing exercises.
  • Assist patient to identify ways to incorporate changes related to illness and its treatment into lifestyle.
  • Explain importance of cessation of smoking.

Rationale:

  • Provides patient with information that can be used for further clarification at home.
  • It relieves dyspnea, increasing strength and endurance of the respiratory muscles, and optimizing the pattern of thoraco-abdominal motion.
  • Patient can see that his or her life does not have to revolve around the disease.
  • Smoking cessation enables loss of breath to be stabilized and reduces the frequency of coughing and expectoration.

Evaluation:

  • Is this method helpful to client and its family members?
  • Does client understand the effectiveness of coughing and deep breathing exercise?
  • Does this give psychological support to the client?
  • Does this have any impact on client?

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