Pulmonary fibrosis is a chronic, progressive lung disease characterized by the formation of scar tissue in the lungs. This leads to decreased lung function and impaired gas exchange. This nursing diagnosis is crucial for healthcare providers to understand, as it guides the development of comprehensive care plans for patients with this condition.
Causes (Related to)
Pulmonary fibrosis can result from various factors that cause damage to lung tissue. The following are common causes of pulmonary fibrosis:
- Occupational and environmental exposures (silica dust, asbestos, coal dust)
- Radiation therapy to the chest
- Certain medications (chemotherapy drugs, some heart medications)
- Autoimmune disorders (rheumatoid arthritis, scleroderma)
- Viral infections
- Genetics (familial pulmonary fibrosis)
- Idiopathic pulmonary fibrosis (unknown cause)
Signs and Symptoms (As evidenced by)
Patients with pulmonary fibrosis may present with various signs and symptoms. During a physical assessment, a nurse may observe:
Subjective: (Patient reports)
- Shortness of breath (dyspnea), especially with exertion
- Dry, hacking cough
- Fatigue and weakness
- Chest discomfort or pain
- Unexplained weight loss
Objective: (Nurse assesses)
- Clubbing of fingers and toes
- Cyanosis (bluish discoloration of lips, skin, or nail beds)
- Crackles or “Velcro-like” sounds when listening to lung sounds
- Rapid, shallow breathing
- Use of accessory muscles for breathing
- Decreased oxygen saturation levels
- Abnormal pulmonary function test results
- Chest X-ray or CT scan showing fibrotic changes in the lungs
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for pulmonary fibrosis:
- The patient will demonstrate improved oxygenation and gas exchange.
- The patient will report a reduction in dyspnea and improved exercise tolerance.
- The patient will maintain optimal nutritional status.
- The patient will demonstrate effective coping mechanisms and improved quality of life.
- The patient will adhere to the prescribed medication regimen and oxygen therapy.
- The patient will demonstrate an understanding of pulmonary fibrosis and its management.
Nursing Assessment
The first step in providing care for patients with pulmonary fibrosis is a thorough nursing assessment. This includes gathering physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to pulmonary fibrosis.
Assess respiratory status:
- Monitor respiratory rate, depth, and pattern
- Note the use of accessory muscles and the presence of pursed-lip breathing
- Observe for signs of respiratory distress (e.g., nasal flaring, intercostal retractions)
Auscultate lung sounds:
- Listen for crackles (especially in the lower lung fields)
- Note any wheezing or diminished breath sounds
Monitor oxygen saturation:
- Use pulse oximetry to assess oxygen levels
- Note any desaturation, especially with activity
Assess for signs of hypoxia:
- Check for cyanosis, confusion, or changes in mental status
- Note any restlessness or anxiety
Evaluate exercise tolerance:
- Assess the patient’s ability to perform activities of daily living
- Note any limitations in physical activity due to breathlessness
Review diagnostic test results:
- Pulmonary function tests (PFTs)
- Chest X-rays and CT scans
- Arterial blood gas (ABG) analysis
Nursing Interventions
Nursing interventions for patients with pulmonary fibrosis focus on improving oxygenation, managing symptoms, and enhancing quality of life. The following interventions are essential for the care of patients with pulmonary fibrosis:
Oxygen therapy management:
- Administer oxygen as prescribed
- Monitor oxygen saturation levels and adjust flow rates as needed
- Educate the patient on the proper use of oxygen equipment
Positioning techniques:
- Assist the patient in finding comfortable positions that facilitate breathing
- Teach pursed-lip breathing and diaphragmatic breathing techniques
Medication administration:
- Administer prescribed medications (e.g., antifibrotic drugs, corticosteroids)
- Monitor for side effects and effectiveness
- Provide patient education on medication purpose and proper use
Pulmonary hygiene:
- Encourage deep breathing and coughing exercises
- Teach airway clearance techniques if appropriate
Nursing Care Plans
The following nursing care plans provide a framework for addressing the key nursing diagnoses associated with pulmonary fibrosis.
Nursing Care Plan 1: Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to alveolar-capillary membrane changes secondary to pulmonary fibrosis as evidenced by dyspnea, decreased oxygen saturation, and abnormal arterial blood gas values.
Related factors/causes:
- Thickening and scarring of alveolar walls
- Decreased lung compliance
- Ventilation-perfusion mismatch
Nursing Interventions and Rationales:
- Monitor oxygen saturation levels and arterial blood gases.
Rationale: Provides objective data on oxygenation status and helps guide oxygen therapy. - Administer oxygen therapy as prescribed.
Rationale: Improves oxygenation and reduces the work of breathing. - Position the patient to maximize lung expansion (e.g., semi-Fowler’s position).
Rationale: Facilitates optimal lung inflation and improves ventilation. - Teach and encourage pursed-lip breathing and diaphragmatic breathing techniques.
Rationale: These techniques can help improve gas exchange and reduce dyspnea. - Encourage frequent position changes and early mobilization as tolerated.
Rationale: Promotes better ventilation-perfusion matching and prevents complications of immobility.
Desired Outcomes:
- Patient will maintain oxygen saturation >92% on prescribed oxygen therapy.
- The patient will demonstrate improved arterial blood gas values within normal limits.
- Patient will report decreased dyspnea during activities of daily living.
Nursing Care Plan 2: Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand secondary to pulmonary fibrosis as evidenced by dyspnea on exertion and fatigue with minimal activity.
Related factors/causes:
- Decreased lung function
- Impaired gas exchange
- Generalized weakness
Nursing Interventions and Rationales:
- Assess the patient’s baseline activity tolerance using a standardized tool (6-minute walk test).
Rationale: Provides a baseline for measuring improvement and guides activity planning. - Implement a gradual activity progression plan in collaboration with physical therapy.
Rationale: Gradually increasing activity improves endurance and prevents overexertion. - Teach energy conservation techniques (e.g., sitting while performing tasks, using assistive devices).
Rationale: Helps the patient accomplish necessary activities with less energy expenditure. - Administer prescribed medications (e.g., bronchodilators) before activities as ordered.
Rationale: It may improve breathing and increase activity tolerance. - Encourage participation in pulmonary rehabilitation programs.
Rationale: Structured exercise and education programs can improve functional capacity and quality of life.
Desired Outcomes:
- Patient will demonstrate increased activity tolerance as evidenced by improved 6-minute walk test results.
- The patient will report decreased fatigue and dyspnea during activities of daily living.
- The patient will successfully implement energy conservation techniques in their daily routine.
Nursing Care Plan 3: Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to decreased lung compliance secondary to pulmonary fibrosis as evidenced by tachypnea, shallow breathing, and use of accessory muscles.
Related factors/causes:
- Fibrotic changes in lung tissue
- Increased work of breathing
- Anxiety related to breathlessness
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern regularly.
Rationale: Provides early detection of changes in respiratory status. - Teach and encourage diaphragmatic breathing and pursed-lip breathing techniques.
Rationale: These techniques can help improve breathing efficiency and reduce dyspnea. - Position the patient in a semi-Fowler’s or high Fowler’s position.
Rationale: Promotes lung expansion and eases the work of breathing. - Implement relaxation techniques (e.g., guided imagery, progressive muscle relaxation).
Rationale: Helps reduce anxiety and may improve breathing patterns. - Collaborate with respiratory therapists for breathing exercises and incentive spirometry if appropriate.
Rationale: It can help improve lung function and prevent atelectasis.
Desired Outcomes:
- Patient will demonstrate a respiratory rate within normal limits (12-20 breaths per minute).
- The patient will exhibit decreased use of accessory muscles when breathing.
- Patient will successfully perform diaphragmatic and pursed-lip breathing techniques.
Nursing Care Plan 4: Anxiety
Nursing Diagnosis: Anxiety related to chronic disease process and dyspnea as evidenced by expressed feelings of apprehension, restlessness, and increased respiratory rate.
Related factors/causes:
- Progressive nature of pulmonary fibrosis
- Fear of suffocation
- Lifestyle changes due to disease
Nursing Interventions and Rationales:
- Assess the patient’s level of anxiety using a standardized tool (e.g., GAD-7).
Rationale: Provides a baseline for measuring improvement and guides intervention planning. - Provide a calm and supportive environment.
Rationale: Reduces external stressors that may exacerbate anxiety. - Teach and practice relaxation techniques (e.g., deep breathing, mindfulness meditation).
Rationale: It can help reduce anxiety and improve overall well-being. - Encourage expression of feelings and concerns.
Rationale: Allows for identification of specific anxiety triggers and promotes coping. - Provide accurate information about the disease process and management.
Rationale: Knowledge can help reduce fear of the unknown and promote a sense of control.
Desired Outcomes:
- Patient will report decreased feelings of anxiety as evidenced by improved GAD-7 scores.
- The patient will demonstrate using at least two relaxation techniques when feeling anxious.
- Patient will verbalize understanding of the disease process and management strategies.
Nursing Care Plan 5: Ineffective Health Management
Nursing Diagnosis: Ineffective Health Management related to knowledge deficit regarding pulmonary fibrosis management as evidenced by verbalized misconceptions and non-adherence to the treatment plan.
Related factors/causes:
- Lack of exposure to accurate information about pulmonary fibrosis
- Complexity of treatment regimen
- Misunderstanding of the chronic nature of the disease
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge and understanding of pulmonary fibrosis.
Rationale: Identifies knowledge gaps and guides education planning. - Provide comprehensive education about pulmonary fibrosis, including its progression, management, and prognosis.
Rationale: Accurate information promotes informed decision-making and treatment adherence. - Teach proper use of medications and oxygen therapy.
Rationale: Ensures safe and effective use of prescribed treatments. - Instruct on avoiding respiratory irritants (e.g., smoke, air pollution).
Rationale: Minimizing exposure to irritants can help prevent exacerbations. - Encourage participation in support groups or connect with other patients with pulmonary fibrosis.
Rationale: Peer support can provide practical tips and emotional support.
Desired Outcomes:
- The patient will verbalize an accurate understanding of pulmonary fibrosis and its management.
- Patient will demonstrate proper use of medications and oxygen therapy.
- The patient will adhere to the prescribed treatment plan as evidenced by regular follow-up visits and medication compliance.
References
- Raghu, G., Remy-Jardin, M., Myers, J. L., et al. (2018). Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 198(5), e44-e68.
- Kolb, M., Vasakova, M., et al. (2019). Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. New England Journal of Medicine, 381(18), 1718-1727.
- Spruit, M. A., Singh, S. J., Garvey, C., et al. (2013). An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13-e64.
- Kreuter, M., Bendstrup, E., Russell, A. M., et al. (2017). Palliative care in interstitial lung disease: living well. The Lancet Respiratory Medicine, 5(12), 968-980.
- Swigris, J. J., Brown, K. K., et al. (2018). Assessing and Improving Health-Related Quality of Life in Patients with Interstitial Lung Disease. Lung, 196(2), 173-180.
- Buendía-Roldán, I., Mejía, M., Navarro, C., & Selman, M. (2017). Idiopathic pulmonary fibrosis: Clinical behavior and aging associated comorbidities. Respiratory Medicine, 129, 46-52.
