COPD

Nursing Care Plans for Chronic Obstructive Pulmonary Disease COPD

COPD Nursing Care Plans

Chronic obstructive pulmonary disease (COPD) involves the inflammation of the lungs, resulting to the obstruction of airflow through the airways.

The three types of COPD are chronic bronchitis, emphysema, and refractory asthma. Productive cough, shortness of breath, chest tightness, and fatigue are the most common signs and symptoms of COPD.

Effective healthcare management of COPD patients is geared towards ensuring that the patient has a balanced oxygen supply and demand, maintaining patient’s safety, and preventing exacerbation of COPD.  Aside from Ineffective Airway Clearance and Ineffective Breathing Pattern (as discussed in our nursing study guide on COPD), the following nursing care plans can be used in the care of a patient with COPD.

  1. Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance

Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation of at least 88%.

InterventionsRationales
Assess the patient’s vital signs, especially the respiratory rate and depth. Auscultate the lungs and monitor for wheezing or other abnormal breath sounds.To create a baseline set of observations for the COPD patient, and to monitor any changes in the vital signs as the patient receives medical treatment.
Monitor the color of skin and mucous membrane.Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxemia. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels.
Encourage the patient to cough to expectorate thick sputum. Suction as needed.Impaired small airways experience impaired gas exchange primarily due to thick, tenacious mucoid secretions. The patient may be unable to cough the phlegm, therefore deep suctioning may be required.
Provide humidified oxygen as prescribed.To reduce the risk of drying out the lungs.
Reposition the patient by elevating the head of the bed and encouraging him/her to sit on an upright position. Encourage pursed lip breathing and deep breathing exercises.To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse.
Refer the patient to a chest physiotherapist.To enable to patient to receive more information and specialized care in the removal of thick lung secretions and enabling of improved gas exchange.
COPD Nursing Care Plan 1
  • Nursing Diagnosis: Deficient Knowledge related to new diagnosis of COPD as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of COPD and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).To address the patient’s cognition and mental status towards the new diagnosis of COPD and to help the patient overcome blocks to learning.
Explain what COPD is, its types (emphysema, chronic bronchitis, or refractory asthma). Avoid using medical jargons and explain in layman’s terms.To provide information on COPD and its pathophysiology in the simplest way possible.
Educate the patient about lifestyle changes that can help manage COPD, particularly the cessation of smoking. Refer to smoking cessation team.Smoking cessation may stop or slow down the progression of COPD. A smoking cessation team can provide further help and advice on how to stop smoking and can also monitor the patient’s progress when he/she is back in the community.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat COPD. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about pursed lip breathing and deep breathing exercises. Explain the importance of coughing up phlegm.To strengthen the respiratory muscles, reduce shortness of breath, and lower the risk for airway collapse.
COPD Nursing Care Plan 2
  • Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent exacerbation of COPD by allowing the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.
COPD Nursing Care Plan 3

4. Nursing Diagnosis: Risk for Infection due to chronic disease process

Desired Outcome: The patient will be able to avoid the development of an infection.

InterventionsRationales
Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress.Sepsis or infection of the blood may be evidenced by fever accompanied by respiratory distress.
Observe the color of the sputum.Greenish or yellowish pulmonary secretions may indicate the development of an infection.
Obtain a sputum sample for culture if infection is suspected.To confirm the presence of an infection and its causative agent.
Teach the patient how to perform proper hand hygiene, covering the mouth when coughing, and oral care.To maintain patient’s safety. To prevent spreading airborne or fluid borne pathogens and reduce the risk of contamination.
COPD Nursing Care Plan 4
  • Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake due to fatigue and dyspnea as evidenced by weight loss, poor muscle tone and lack of appetite

          Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.  
Help the patient to select appropriate dietary choices to follow a high caloric diet.COPD patients tend to expend a significant amount of energy by overusing respiratory muscles to breathe. High caloric diet may help provide the energy he/she needs and combat fatigue and weight loss.  
Instruct the patient to avoid carbonated beverages and gas-producing food.To reduce abdominal distention which can hinder the optimal expansion of the diaphragm thereby worsening dyspnea.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnoses diabetes.  
COPD Nursing Care Plan 5

COPD is a long-term medical condition, but it is both preventable and treatable. With the use of the nursing care plans above, the patient will have an improved oxygenation and will be able to perform his/her activities of daily living optimally.

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. Link

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Link

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