Chronic Obstructive Pulmonary Disease ( COPD) is an umbrella term for a group of diseases that limits airflow to the lungs. It’s also known as Chronic Obstructive Lung disease ( COLD).
It consists of chronic bronchitis and emphysema.
You can read the NCLEX review on COPD, its risk factors and treatment here.
A Nursing care plan assists the nurse to identify the patient’s needs based on assessment.
After assessment has been done, the patient is “diagnosed” by the nurse (a nursing diagnosis is different from a medical diagnosis), a plan is formulated, with interventions and the rationale for each intervention. There are expected outcomes for each plan of care carried out.
Most COPD patients are prone to various various complications like:
- Respiratory failure
- Pulmonary hypertension
- Pneumonia
- Asthma
- Pneumothorax
It’s important to be observant of the patient’s vital signs and be alert when the patient’s health is at risk.
The nurse would also educate the patient on the risk factors and prevention of COPD. Educate the patient on a balanced diet, healthy lifestyle, to avoid further complications.
Note: A Nursing care plan is written and documented. It helps not only the nurse but also the other healthcare workers to provide adequate care to the patient.
5 Nursing Care Plans For Chronic Obstructive Pulmonary Disease ( COPD)
1. Nursing Diagnosis: Ineffective Airway Clearance
COPD patients have over production of mucus by goblet cells in the lungs. This impairs the lung function to perform gaseous exchange and conduct air in the lungs.
Related To:
- Excessive mucus secretions
- Smoking/ Second hand smoke
- Airway spasm
As Evidenced By:
- Cyanosis – bluish-purple hue to the lips, mouth, earlobes, fingernails
- Dyspnea – shortness of breath
- Absent/ ineffective cough
- Change in rate and depth of respiration
Nursing Interventions
- Auscultate breath sounds
Monitor vital signs and pulse oximetry. Bronchospasm can be present with obstructions in the airway.
Check for adventitious sounds such as moist crackles, scattered ( bronchitis), faint sounds, expiratory wheeze (emphysema).
Note: Adventitious sounds are abnormal sounds heard on the chest during auscultation. It includes wheezes, crackles or pleural friction rub.
- Assess and Monitor Respiratory Rate
Tachypnea( fast and shallow breathing) is usually present and may increase during stress and acute infection.
- Allay Anxiety
Educate the patient on COPD , the risk factors and clinical manifestations.
- Increase Fluid Intake
Copious fluid intake helps the patient to be hydrated and loosen mucus secretions. Warm liquids to decrease bronchospasm.
- Administer Medication
Bronchodilators help relax the lungs smooth muscles and inhibit excessive mucus secretions.
Methylxanthines are used to prevent dyspnea( shortness of breath).
Corticosteroids reduce local airway inflammation and edema by inhibiting the effect of histamine and other chemical mediators.
Learn more about pharmacological treatment for COPD here.
2. Nursing Diagnosis: Impaired Gas Exchange
The bronchi and alveoli are either inflamed or blocked by mucus secretions. This makes it difficult for gas exchange to occur at the alveoli.
The patient experiences dyspnea, tachycardia( heart rate > 100bpm), cyanosis.
Related To
- Alveolar- Capillary membrane changes ( e.g Obstructive Lung disease)
- Ventilation- perfusion imbalance ( retained secretions, air- trapping)
As Evidenced By
- Dyspnea
- Confusion
- Abnormal ABG levels which leads to hypoxia, hypercapnia.
- Cyanosis
Expected Outcome
- Demonstrate improved gas exchange
Nursing Interventions
- Assess Respiratory Rate And Depth
Observe the use of accessory muscles, pursed lips.
- Assess and Monitor Skin and Mucous Membrane Color
Peripheral cyanosis may occur in the nail bed or central cyanosis may occur around the lips or earlobe.
- Auscultate Breath Sounds
Observe for adventitious sounds or decreased airflow. Breath sounds may be faint because of decreased airflow.
- Monitor Vital Signs
Cardiac rhythm must be monitored closely. Signs of tachycardia, dysrhythmias ( abnormal heart rhythm), and change in blood pressure point to systemic hypoxemia on cardiac function.
- Administer Oxygen
Oxygen is administered to correct or prevent hypoxemia ( low oxygen saturation in the body). It improves gaseous exchange.
3) Nursing Diagnosis: Ineffective Breathing Pattern
COPD patients’ breathing patterns can be faster or slower than usual due to obstructions of the bronchi, mucus secretions or chemical irritants.
It causes them to use the accessory muscles to breathe properly.
Related To:
- Dyspnea – shortness of breath
- Oversecretion of mucus
- Chemical irritants
As Evidenced By:
- Tachypnea (fast breathing)
- Use of accessory muscles
- Abnormal ABG levels – respiratory acidosis
Expected Outcomes:
- Maintain patent airway
- Improve breathing pattern
- Show signs of decreased respiratory effort.
Nursing Interventions:
- Auscultate lung sounds
Monitor vital signs and pulse oximetry. Bronchospasm can be present with obstructions in the airway.
Check for adventitious sounds such as moist crackles, scattered ( bronchitis), faint sounds, expiratory wheeze (emphysema).
- Assess Respiratory Rate and Depth
Observe the use of accessory muscles, pursed lips.
- Assess for Mucous Secretion and suction if necessary
Check the color and consistency of the mucus secretions. Suctioning the mucus helps to relieve the lungs and ensure an effective breathing pattern.
- Educate the patient on diaphragmatic and pursed lips breathing
This would help the patient breathe effectively and efficiently. It decreases air trapping.
- Assist the patient with self care activities
This would help the patient to rest and avoid stress.
4. Nursing Diagnosis: Acute Pain
Maybe related to:
- Lung parenchyma inflammation
- Persistent coughing
As Evidenced By:
- Restlessness
- Verbalization
- Grimacing, guarding and moaning
Expected Outcome:
Verbalize relief
Nursing Interventions:
- Assess the pain characteristics- note location, triggers and intensity of the pain
- Educate the patient in chest splinting technique during coughing episodes
It helps control chest movement while enhancing the efficiency of coughing effort
- Provide diversional therapy
This is a non-pharmacological measure for treating pain. It includes back rubs, quiet music, conversation, change of position and deep breathing exercise.
- Administer prescribed analgesics
These medications are given to suppress the pain center situated in the hypothalamus of the brain. It promotes rest and comfort.
5) Nursing Diagnosis: Activity intolerance
Related to: General weakness
As Evidenced By: Tachypnea and verbalization of weakness
Expected Outcome:
- Patients will demonstrate an increase in tolerance to activity with absence of dyspnea and excessive fatigue.
Nursing Interventions
- Assess clients response to activity
- Provide a quiet environment
- Assist the patient with self care activities
- Assist the patient in a comfortable position
Read and download a FREE NCLEX review on COPD here!
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References
Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing. 15th edition. Philadelphia, PA: Wolters Kluwer Health.
Moorhouse, M. F., & Moor, A. C. (2019). Nursing care plans: guidelines for individualizing client care across the life span. Philadelphia, PA: F.A. Davis Company.
Nurse labs. https://nurseslabs.com/chronic-obstructive-pulmonary-disease-copd-nursing-care-plans
Nurse Together. https://www.nursetogether.com/chronic-obstructive-pulmonary-disease-copd-nursing-diagnosis-care-plan
