Last updated on June 12th, 2023 at 10:16 pm
Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease that involves the obstruction of airflow due to an inflammation of the lungs. COPD further branches into three specific lung conditions: emphysema, chronic bronchitis, and refractory asthma.
Emphysema occurs when the air sacs in the lungs called alveoli become damaged, causing them to have destroyed walls.
Eventually, the tiny alveoli merge into one big air sac. As a result, the alveolar walls are unable to absorb oxygen normally, which then affects the oxygen level of the blood.
In addition to this, the lungs lose their springiness. This traps the air inside the lungs, making it difficult for the patient to breathe.
Chronic bronchitis happens when the hair-like fibers (cilia) lining your bronchial tubes are lost.
This reduces the ability to move the mucus out of the lungs. Coughing and shortness of breath are the physical signs related to this.
Eventually, the coughing mechanism triggers the lungs to produce more mucus, causing the patient to try and expectorate more of it.
Refractory asthma is a severe type of asthma that is non-reversible and does not respond to usual medical treatments for asthma.
It is characterized by low lung function, frequent asthma attacks, and persistent symptoms.
Causes of Chronic Obstructive Pulmonary Disease COPD
Chronic Obstructive Pulmonary Disease (COPD) is primarily caused by long-term exposure to irritants that damage the lungs and airways. The most common cause of COPD is cigarette smoking, accounting for approximately 80-90% of cases. However, other factors can also contribute to the development of COPD, including:
Smoking: Smoking is the leading cause of COPD. The chemicals present in tobacco smoke irritate and inflame the airways, causing chronic bronchitis and emphysema. Both active smoking (smoking cigarettes directly) and passive smoking (exposure to secondhand smoke) can increase the risk of developing COPD.
Environmental Factors: Prolonged exposure to environmental pollutants, such as industrial dust, chemicals, fumes, and biomass fuel smoke, can contribute to the development of COPD. Occupational exposure to substances like silica, asbestos, and coal dust in certain work environments (mining, construction, manufacturing) can also increase the risk.
Genetics: A small percentage of COPD cases are linked to genetic factors. Alpha-1 antitrypsin deficiency (AATD) is an inherited disorder that affects the production of a protein called alpha-1 antitrypsin. AATD can lead to the development of early-onset emphysema, particularly in individuals who smoke or are exposed to other lung irritants.
Respiratory Infections: Repeated respiratory infections, such as pneumonia and bronchitis, especially during childhood or early adulthood, can contribute to lung damage and increase the risk of developing COPD later in life.
Asthma: Long-term, uncontrolled asthma can lead to remodeling of the airways and chronic inflammation, increasing the likelihood of developing COPD. This is known as the asthma-COPD overlap syndrome.
Signs and Symptoms of Chronic Obstructive Pulmonary Disease (COPD)
- Shortness of Breath (Dyspnea)
- Chronic Cough
- Wheezing
- Chest Tightness
- Increased Respiratory Rate
- Reduced Exercise Tolerance
- Fatigue
- Weight Loss
- Cyanosis
- Recurrent Respiratory Infections
In the long run, COPD patients may show unexplained weight loss and may have frequent respiratory infections, as well as swelling of the limbs.
Expected Outcomes of Chronic Obstructive Pulmonary Disease (COPD)
Improved Respiratory Function: The primary goal is to improve or maintain the patient’s respiratory function. This includes optimizing lung capacity, reducing airway obstruction, and enhancing gas exchange. With proper management and adherence to treatment, patients may experience decreased dyspnea, improved oxygenation, and increased exercise tolerance.
Reduction in Symptoms: Effective management of COPD aims to alleviate symptoms such as coughing, wheezing, chest tightness, and shortness of breath. The goal is to minimize the frequency and intensity of these symptoms, enabling patients to perform daily activities with greater ease and comfort.
Prevention of Exacerbations: COPD exacerbations, characterized by a sudden worsening of symptoms, can lead to hospitalizations and complications. The goal is to reduce the frequency and severity of exacerbations through strategies such as smoking cessation, adherence to medication regimens, vaccination against respiratory infections, and early recognition and management of symptoms.
Improved Quality of Life: COPD can significantly impact a patient’s quality of life, limiting their ability to engage in physical activities, causing social isolation, and affecting mental well-being. By managing symptoms, optimizing lung function, and providing support, nurses aim to enhance the patient’s overall quality of life, enabling them to participate in meaningful activities and maintain emotional well-being.
Self-Management and Patient Education: Empowering patients with knowledge and self-management skills is crucial in COPD care. The expected outcome is for patients to understand their condition, adhere to prescribed treatments, recognize early signs of exacerbations, and take appropriate actions. Education on medication use, inhaler techniques, breathing exercises, nutrition, and lifestyle modifications helps patients actively participate in their care and make informed decisions.
Prevention and Management of Complications: COPD can lead to various complications, including respiratory infections, pulmonary hypertension, and respiratory failure. Nurses aim to prevent and manage these complications through strategies such as infection control measures, pulmonary rehabilitation, oxygen therapy, and close monitoring of the patient’s respiratory status.
Nursing Assessment and Rationales
- Respiratory Assessment:
- Auscultate lung sounds: Assess for adventitious breath sounds such as wheezes, crackles, or diminished breath sounds. Rationale: This helps identify airway obstruction, presence of secretions, or lung hyperinflation.
- Observe respiratory rate and pattern: Note any signs of increased work of breathing, use of accessory muscles, or pursed lip breathing. Rationale: These signs indicate respiratory distress and can guide intervention and treatment.
- Oxygenation Assessment:
- Monitor oxygen saturation levels: Use pulse oximetry to assess oxygen saturation. Rationale: This helps evaluate the adequacy of oxygenation and guides the need for supplemental oxygen therapy.
- Observe for cyanosis: Note any bluish discoloration of the lips, fingertips, or skin. Rationale: Cyanosis suggests insufficient oxygenation and may require immediate intervention.
- Cough and Sputum Assessment:
- Assess the characteristics of the cough: Note the frequency, intensity, and productive/non-productive nature of the cough. Rationale: This helps determine the severity of airway inflammation and secretion production.
- Observe sputum characteristics: Assess color, consistency, and odor of sputum. Rationale: Changes in sputum can indicate infection, exacerbation, or other respiratory complications.
- Activity and Exercise Assessment:
- Assess activity tolerance: Determine the patient’s ability to perform activities of daily living and exercise without experiencing excessive dyspnea. Rationale: This helps evaluate the impact of COPD on functional capacity and guides interventions for improving exercise tolerance.
- Observe signs of fatigue: Note the patient’s level of fatigue during activities. Rationale: COPD can cause fatigue due to increased work of breathing and reduced oxygenation.
- Psychological Assessment:
- Assess anxiety and depression symptoms: Screen for signs of anxiety, depression, or altered mood. Rationale: COPD can impact mental health, and identifying these issues allows for appropriate support and intervention.
- Assess coping strategies and social support: Evaluate how the patient is managing their condition and the availability of support systems. Rationale: This helps identify coping strengths and potential areas requiring additional support.
- Education and Knowledge Assessment:
- Assess the patient’s understanding of COPD, its management, and medication use. Rationale: This helps identify knowledge gaps and tailor education to the patient’s specific needs.
Nursing Interventions and Rationales
Provide oxygen therapy as prescribed: Rationale: Oxygen therapy helps improve oxygenation and relieve dyspnea in patients with COPD who have low oxygen levels. It can reduce respiratory distress and improve overall well-being.
Administer prescribed bronchodilator medications: Rationale: Bronchodilators help relax the airway smooth muscles, open up the airways, and improve airflow. This can alleviate symptoms such as wheezing and dyspnea, allowing patients to breathe more easily.
Assist with airway clearance techniques: Rationale: Techniques like postural drainage, chest percussion, vibration, and controlled coughing help mobilize and remove respiratory secretions. This can reduce the risk of infection, improve airway clearance, and decrease the frequency of exacerbations.
Teach and encourage effective breathing techniques: Rationale: Teaching techniques such as pursed-lip breathing and diaphragmatic breathing can help patients control their breathing pattern, reduce dyspnea, and improve oxygen exchange.
Educate on proper use of inhalers and nebulizers: Rationale: Correct inhaler and nebulizer technique ensures that medications are delivered effectively to the lungs. Proper use maximizes the therapeutic benefits, enhances symptom control, and reduces the risk of medication-related complications.
Promote smoking cessation: Rationale: Smoking cessation is crucial in managing COPD as it slows disease progression and reduces exacerbations. Supporting patients in quitting smoking, providing resources, and offering behavioral interventions can significantly improve their long-term outcomes.
Encourage regular physical activity and exercise: Rationale: Regular physical activity and exercise, tailored to the patient’s abilities, can improve cardiovascular fitness, strengthen respiratory muscles, enhance overall stamina, and reduce breathlessness during daily activities.
Monitor respiratory status and oxygen saturation: Rationale: Regular monitoring of respiratory rate, oxygen saturation levels, and breath sounds helps assess the effectiveness of interventions, identify potential complications, and guide treatment adjustments.
Provide emotional support and counseling: Rationale: COPD can have a significant impact on a patient’s emotional well-being. Providing emotional support, active listening, and counseling can help patients cope with anxiety, depression, and lifestyle adjustments associated with the disease.
Collaborate with the interdisciplinary healthcare team: Rationale: Collaboration with healthcare providers, respiratory therapists, dietitians, and other team members ensures comprehensive care planning, effective management of exacerbations, and individualized interventions to optimize patient outcomes.
COPD Nursing Diagnoses and Care Plans
Here are some similar NANDA nursing diagnoses that can be applicable to patients with Chronic Obstructive Pulmonary Disease (COPD):
Ineffective Airway Clearance: Related to increased production of respiratory secretions, bronchospasm, and weakened respiratory muscles as evidenced by cough, sputum production, and adventitious breath sounds.
Impaired Gas Exchange: Related to altered oxygen supply and carbon dioxide removal as evidenced by dyspnea, decreased oxygen saturation levels, and abnormal arterial blood gas values.
Activity Intolerance: Related to inadequate oxygenation, decreased lung function, and muscle weakness as evidenced by dyspnea during exertion, fatigue, and limited physical activity tolerance.
Anxiety: Related to the fear of breathlessness, disease progression, and lifestyle limitations as evidenced by restlessness, irritability, increased respiratory rate, and difficulty sleeping.
Risk for Infection: Related to impaired airway clearance, decreased immune response, and frequent exposure to respiratory pathogens as evidenced by chronic cough, purulent sputum, and fever.
Ineffective Breathing Pattern: Related to airflow limitation, increased work of breathing, and altered respiratory mechanics as evidenced by irregular or rapid breathing, use of accessory muscles, and dyspnea.
Impaired Coping: Related to chronic illness, lifestyle restrictions, and uncertainty about the future as evidenced by feelings of helplessness, social withdrawal, and difficulty adapting to changes.
Imbalanced Nutrition: Less Than Body Requirements: Related to increased energy expenditure, dyspnea during eating, and poor appetite as evidenced by unintended weight loss, low BMI, and inadequate dietary intake.
Deficient Knowledge: Related to lack of information regarding the disease process, treatment modalities, and self-care management as evidenced by questions, confusion, and inadequate adherence to prescribed therapies.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care
This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.
This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
Nursing Care Plans: Nursing Diagnosis and Intervention
It contains more than 200 care plans that adhere to the newest evidence-based recommendations.
Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.
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