In this nursing care plan guide are seven (7) nursing diagnosis for Chronic Obstructive Pulmonary Disease (COPD). Get to know the nursing interventions, goals and outcomes, assessment tips, and related factors for COPD. Show
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. As with previous editions, the 2018 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) update seeks to provide comprehensive evidence-based guidelines for the diagnosis, management, and prevention of COPD (Mirza et al., 2018). COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms of dyspnea, cough, sputum production, and exacerbations due to abnormalities of the airways such as bronchitis and/or alveoli that cause persistent, often progressive, airflow obstruction, such as in emphysema (Global Initiative for Chronic Obstructive Lung Disease, 2022). Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum and marked cyanosis. Emphysema: A most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping). A diagnosis of COPD should be considered in any client who has dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections, and/or a history of exposure to risk factors for the disease, but forced spirometry showing the presence of a post-bronchodilator FEV1/FVC <0.7 is mandatory to establish the diagnosis of COPD (Global Initiative for Chronic Obstructive Lung Disease, 2022). In the presence of an FEV1/FVC ratio <0.7, the assessment of airflow limitation severity in COPD is based on the post-bronchodilator value of FEV1. The GOLD Grades and Severity of Airflow Obstruction in COPD staging are as follows: COPD results from gene(G)-environment(E) interactions occurring over the lifetime(T) of the individual (GETomics) that can damage the lungs and/or alter their normal development or aging processes. Appropriate and earlier diagnosis of COPD can have a very significant public-health impact. Nursing care planning for clients diagnosed with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Most clients diagnosed with COPD receive outpatient treatment, and the nurse should develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease. Here are seven (7)nursing care plans (NCP)and nursing diagnoses (NDx) for Chronic Obstructive Pulmonary Disease (COPD): Ineffective Airway ClearanceCommon to many pulmonary diseases is bronchospasm which reduces the caliber of the small bronchi and may cause difficulty in breathing, stasis of secretions, and infection. Mucous gland hyperplasia is the histologic hallmark of chronic bronchitis. Airway structural changes include atrophy, focal squamous metaplasia, ciliary abnormalities, variable amounts of airway smooth muscle hyperplasia, inflammation, and bronchial wall thickening. These changes cause airflow limitation by allowing airway walls to deform and narrow the airway lumen (Mosenifar & Oppenheimer, 2022). Nursing Diagnosis
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess and monitor respirations and breath sounds, noting rate and sounds (tachypnea, stridor, crackles, wheezes). Note the inspiratory and expiratory ratio. 2. Auscultate breath sounds. Note adventitious breath sounds (wheezes, crackles, rhonchi). 3. Note the presence and degree of dyspnea for reports of “air hunger” or breathlessness. 4. Observe signs and symptoms of infections. 5. Monitor and graph serial ABGs, pulse oximetry, and
chest x-ray. 6. Observe for persistent, hacking, or moist cough. Nursing Interventions and Rationales1. Educate the client regarding smoking
cessation. 2.
Provide an incentive spirometer for the measurement of airflow obstruction. 3. Assist the client to assume a position of comfort (elevate the head of the bed, have the client lean on an overbed table, or sit on edge of the bed). 4. Keep environmental pollution to a minimum such as dust, smoke, and feather pillows, according to the individual situation. 5. Encourage abdominal or pursed-lip breathing exercises. 6. Assist with measures to improve the effectiveness of cough effort. 7. Increase fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or tepid liquids.
Recommend the intake of fluids between, instead of during, meals. 8. Demonstrate effective coughing and deep-breathing techniques. 9. Assist the
client to turn every two hours. If ambulatory, allow the client to ambulate as tolerated. 10. Suction
secretions as needed. 11. Demonstrate chest physiotherapies, such as bronchial tapping when in cough, and proper postural drainage. 12. Administer medications as prescribed.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy. References and recommended sources for this care plan guide for Chronic Obstructive Pulmonary Disease (COPD): First published on July 14, 2013. With updates and contributions by M. Belleza, R.N. What should the nurse identify as a complication of COPD?There are two major life-threatening complications of COPD: respiratory insufficiency and failure. Respiratory failure.
Which assessment finding should you expect in the client with COPD?Findings indicating COPD include: An expanded chest (barrel chest). Wheezing during normal breathing. Taking longer to exhale fully.
Which of the following tests measures the volume of air the lungs can hold at the end of maximum inhalation?The most basic test is spirometry. This test measures the amount of air the lungs can hold. The test also measures how forcefully one can empty air from the lungs. Spirometry is used to screen for diseases that affect lung volumes.
Which of the following findings is an indication of a pneumothorax?Physical exam findings for a pneumothorax are unequal breath sounds, hyperresonance with percussion over the chest wall, and decreased wall movement on the affected side of the chest. The chest wall should be palpated and any crepitance or signs of trauma should be noted.
|