Quantcast
Channel: imbalanced nutrition – Nurseslabs
Viewing all articles
Browse latest Browse all 24

7 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans

0
0

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.

What is Chronic Obstructive Pulmonary Disease (COPD)? 

Chronic Obstructive Pulmonary Disease (COPD) is defined as “a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.” (Global Initiative for Chronic Obstructive Lung Disease or GOLD)

Any respiratory disease that persistently obstructs bronchial airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). Chronic Obstructive Pulmonary Disease (COPD) is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction.

The term COPD mainly involves two related diseases — chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of an individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. COPD is also called chronic obstructive lung disease (COLD).

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: 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).

Nursing Care Plans

Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Most patients with COPD receive outpatient treatment, 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 diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD):

  1. Ineffective Airway Clearance
  2. Impaired Gas Exchange
  3. Ineffective Breathing Pattern
  4. Imbalanced Nutrition: Less Than Body Requirements
  5. Risk for Infection
  6. Deficient Knowledge
  7. Activity Intolerance
  8. Other Possible Nursing Diagnosis

Ineffective Airway Clearance

Common to many pulmonary diseases is bronchospasm that reduces the caliber of the small bronchi and may cause difficulty in breathing, stasis of secretions, and infection.

Nursing Diagnosis

  • Ineffective Airway Clearance

May be related to

  • Bronchospasm
  • Increased production of secretions; retained secretions; thick, viscous secretions
  • Allergic airways
  • Hyperplasia of bronchial walls
  • Decreased energy/fatigue

Possibly evidenced by

  • Statement of difficulty breathing
  • Changes in depth/rate of respirations, use of accessory muscles
  • Abnormal breath sounds, e.g., wheezes, rhonchi, crackles
  • Cough (persistent), with/without sputum production

Desired Outcomes

  • Maintain airway patency with breath sounds clear/clearing.
  • Demonstrate behaviors to improve airway clearance, e.g., cough effectively and expectorate secretions.
Nursing Interventions Rationale
Nursing Assessment
Assess and monitor respirations and breath sounds, noting rate and sounds (tachypnea, stridor, crackles, wheezes). Note inspiratory and expiratory ratio. Tachypnea is usually present to some degree and may be pronounced on admission or during stress or concurrent acute infectious process. Respirations may be shallow and rapid, with prolonged expiration in comparison to inspiration.
Auscultate breath sounds. Note adventitious breath sounds (wheezes, crackles, rhonchi). Some degree of bronchospasm is present with obstructions in the airway and may or may not be manifested in adventitious breath sounds such as scattered, moist crackles (bronchitis); faint sounds, with expiratory wheezes (emphysema); or absent breath sounds (severe asthma).
Note presence and degree of dyspnea as for reports of “air hunger,” restlessness, anxiety, respiratory distress, use of accessory muscles. Use 0–10 scale or American Thoracic Society’s “Grade of Breathlessness Scale” to rate breathing difficulty. Ascertain precipitating factors when possible. Differentiate acute episode from exacerbation of chronic dyspnea. Respiratory dysfunction is variable depending on the underlying process such as infection, allergic reaction, and the stage of chronicity in a patient with established COPD. Note: Using a 0–10 scale to rate dyspnea aids in quantifying and tracking changes in respiratory distress. Rapid onset of acute dyspnea may reflect pulmonary embolus.
Observe sign and symptoms of infections. Identify the occurrence of an infectious process.
Monitor and graph serial ABGs, pulse oximetry, chest x-ray. Establishes a baseline for monitoring progression or regression of disease process complications.
Therapeutic Interventions
Position head midline with flexion on appropriate for age/condition. Gain or maintain an open airway.
Assist the patient to assume a position of comfort (elevate the head of the bed, have patient lean on an overbed table or sit on edge of the bed). Elevation of the head of the bed facilitates respiratory function by use of gravity; however, patient in severe distress will seek the position that most eases breathing. Supporting arms and legs with table, pillows, and so on helps reduce muscle fatigue and can aid chest expansion.
Keep environmental pollution to a minimum such as dust, smoke, and feather pillows, according to the individual situation. Precipitators of an allergic type of respiratory reactions that can trigger or exacerbate the onset of an acute episode.
Encourage abdominal or pursed-lip breathing exercises. Provides patient with some means to cope with or control dyspnea and reduce air-trapping.
Observe characteristics of cough (persistent, hacking, moist). Assist with measures to improve the effectiveness of cough effort. Cough can be persistent but ineffective, especially if the patient is elderly, acutely ill, or debilitated. Coughing is most effective in an upright or in a head-down position after chest percussion.
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. Hydration helps decrease the viscosity of secretions, facilitating expectoration. Using warm liquids may decrease bronchospasm. Fluids during meals can increase gastric distension and pressure on the diaphragm.
Demonstrate effective coughing and deep-breathing techniques. Helps maximize ventilation.
Assist the patient to turn every 2 hours. If ambulatory, allow patient to ambulate as tolerated. Movement aids in mobilizing secretions to facilitate clearing of airways.
Suction secretions as needed. Suctioning clear secretions that obstruct the airway therefore improves oxygenation.
Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage. These techniques will prevent possible aspirations and prevent any untoward complications.
Administer bronchodilators if prescribed. More aggressive measures to maintain airway patency.

Impaired Gas Exchange

Quantity and viscosity of sputum can obstruct the airway and impair pulmonary ventilation and gas exchange.

Nursing Diagnosis

  • Impaired Gas Exchange

May be related to

  • Altered oxygen supply (obstruction of airways by secretions, bronchospasm; air-trapping)
  • Alveoli destruction
  • Alveolar-capillary membrane changes

Possibly evidenced by

  • Dyspnea
  • Abnormal breathing
  • Confusion, restlessness
  • Inability to move secretions
  • Abnormal ABG values (hypoxia and hypercapnia)
  • Changes in vital signs
  • Reduced tolerance for activity

Desired Outcomes

  • Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within patient’s normal range and be free of symptoms of respiratory distress.
  • Participate in treatment regimen within the level of ability/situation.
Nursing Interventions Rationale
Nursing Assessment
Assess and record respiratory rate, depth. Note the use of accessory muscles, pursed-lip breathing, inability to speak or converse. Useful in evaluating the degree of respiratory distress or chronicity of the disease process.
Assess and routinely monitor skin and mucous membrane color. Cyanosis may be peripheral (noted in nail beds) or central (noted around lips/or earlobes). Duskiness and central cyanosis indicate advanced hypoxemia.
Monitor changes in the level of consciousness and mental status. Restlessness, agitation, and anxiety are common manifestations of hypoxia. Worsening ABGs accompanied by confusion/ somnolence are indicative of cerebral dysfunction due to hypoxemia.
Monitor vital signs and cardiac rhythm. Tachycardia, dysrhythmias, and changes in BP can reflect the effect of systemic hypoxemia on cardiac function.
Auscultate breath sounds, noting areas of decreased airflow and adventitious sounds. Breath sounds may be faint because of decreased airflow or areas of consolidation. Presence of wheezes may indicate bronchospasm or retained secretions. Scattered moist crackles may indicate interstitial fluid or cardiac decompensation.
Palpate for fremitus. A decrease of vibratory tremors suggests fluid collection or air-trapping.
Monitor O2 saturation and titrate oxygen to maintain Sp02 between 88% to 92%. Pulse oximetry reading of 87% below may indicate the need for oxygen administration while a pulse oximetry reading of 92% or higher may require oxygen titration.
Monitor arterial blood gasses values as ordered. As the patient’s condition progresses, Pa02 usually decreases. For patient’s with chronic carbon dioxide retention may have chronically compensated respiratory acidosis with a low normal pH and a PaCo2 higher than 50 mm Hg.
Therapeutic Intervention
Encourage expectoration of sputum; suction when needed. Thick, tenacious, copious secretions are a major source of impaired gas exchange in small airways. Deep suctioning may be required when the cough is ineffective for expectoration of secretions.
Elevate the head of the bed, assist the patient to assume a position to ease work of breathing. Include periods of time in a prone position as tolerated. Encourage deep-slow or pursed-lip breathing as individually needed or tolerated. Oxygen delivery may be improved by upright position and breathing exercises to decrease airway collapse, dyspnea, and work of breathing. Use of prone position to increase Pao2.
Evaluate the level of activity tolerance. Provide a calm, quiet environment. Limit patient’s activity or encourage bed or chair rest during the acute phase. Have patient resume activity gradually and increase as individually tolerated. During severe, acute or refractory respiratory distress, the patient may be totally unable to perform basic self-care activities because of hypoxemia and dyspnea. Rest interspersed with care activities remains an important part of the treatment regimen. An exercise program is aimed at increasing endurance and strength without causing severe dyspnea and can enhance a sense of well-being.
Evaluate sleep patterns, note reports of difficulties and whether patient feels well rested. Provide quiet environment, group care or monitoring activities to allow periods of uninterrupted sleep; limit stimulants such as caffeine; encourage position of comfort. Multiple external stimuli and the presence of dyspnea may prevent relaxation and inhibit sleep.
Provide humidified oxygen as ordered. Administering humidified oxygen prevents drying out the airways, decrease convective moisture losses, and improves compliance.
Administer noninvasive positive pressure ventilation (NIPPV) as ordered. The use of noninvasive positive pressure ventilation can decrease PacO2, increase blood pH, and minimize symptoms of severe dyspnea during the first 4 hours of the treatment.

Ineffective Breathing Pattern

Shortness of breath and ineffective breathing patterns are caused by ineffective respiratory mechanics of the chest wall and lung resulting from air trapping, ineffective diaphragmatic movement, airway obstruction, the metabolic cost of breathing, and stress.

Nursing Diagnosis

  • Ineffective Breathing Pattern

May be related to

  • Retained Secretions
  • Ineffective inspiration and expiration occurring with chronic airflow constraints

Possibly evidenced by

  • Wheezes/crackles on auscultation on both lung fields
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above the normal range

Desired outcomes

  • Improvement of breathing pattern.
  • Maintain a respiratory rate within normal limits.
Nursing Interventions Rationale
Nursing Assessment
Assess patient’s respiratory status every 2 to 4 hours as indicated and notify any abnormal findings. Manifestation of respiratory distress include shortness of breath, tachypnea, changes in mental status and the use of accessory muscles.
Auscultate breath sounds every 2 to 4 hours as indicated. Decreased breath sounds, crackles, wheezes, and rhonchi can be observed and must be reported promptly for immediatement treatment.
Therapeutic Intervention
Place a pillow when the client is sleeping. Provides adequate lung expansion while sleeping.
Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over the body as appropriate. Promotes physiological ease of maximal inspiration.
Maintain a patent airway, suctioning of secretions may be done as ordered. Remove secretions that obstructs the airway.
Provide respiratory support. Oxygen inhalation is given as ordered. Aid in relieving the patient from dyspnea.
Administer the following medications as prescribed:
  • Oral corticosteroids such as beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flovent), mometasone (Asmanex)
Cuts down recovery time, enhance lung function, and arterial hypoxemia, and minimize length of hospital stay.
  • Inhaled corticosteroids such as budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), beclomethasone (Qvar RediHaler), fluticasone (Flovent HFA)
These medications is given for patient with Forced expiratory volume in 1 second (FEV1) at less than 30% whose history of exacerbations are poorly managed by the use of long-acting bronchodilators.
  • Long-acting bronchodilators such as salmeterol, perforomist (formoterol), bambuterol, indacaterol
Decreases hyperinflation, lessen bronchial obstruction and enhances lung emptying.
  • Combination of inhaled corticosteroids and bronchodilator such as Symbicort  (budesonide combined with formoterol fumarate), Advair (fluticasone combined with salmeterol, Breo TM (fluticasone furoate combined with vilanterol trifenatate)
This combination of medications are  known to be more effective than any single treatment in decreasing episodes of exacerbations and provides overall improvement of lung function. One disadvantage of its use is the increased prone to pneumonia.

Imbalanced Nutrition: Less Than Body Requirements

Status of nutrition and counseling are important aspects in the rehabilitation process for patients with COPD. Most people with COPD have difficulty gaining and maintaining weight.

Nursing Diagnosis

  • Imbalanced Nutrition: Less Than Body Requirements

May be related to

  • Dyspnea
  • Sputum production
  • Medication side effects
  • Anorexia
  • Nausea/vomiting
  • Decrease food intake due to fatigue

Possibly evidenced by

  • Weight loss; loss of muscle mass, poor muscle tone
  • Reported altered taste sensation; aversion to eating, lack of interest in food

Desired Outcomes

  • Display progressive weight gain toward the goal as appropriate.
  • Demonstrate behaviors/lifestyle changes to regain and/or maintain an appropriate weight.
Nursing Interventions Rationale
Nursing Assessment
Ascertain understanding of individual nutritional needs To determine informational needs of the client and significant others.
Assess dietary habits, recent food intake. Note the degree of difficulty with eating. Evaluate weight and body size (mass). Patient in acute respiratory distress is often anorectic because of dyspnea, sputum production, and medications. In addition, many COPD patients habitually eat poorly, even though respiratory insufficiency creates a hypermetabolic state with increased caloric needs. As a result, the patient often is admitted with some degree of malnutrition. People who have emphysema are often thin with wasted musculature.
Auscultate bowel sounds. Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation (a common complication) related to limited fluid intake, poor food choices, decreased activity, and hypoxemia.
Weigh the patient daily as indicated. Useful in determining caloric needs, setting a weight goal, and evaluating the adequacy of nutritional plan.
Therapeutic Interventions
Give frequent oral care, remove expectorated secretions promptly, provide a specific container for disposal of secretions and tissues. Noxious taste, smell, and sights are prime deterrents to appetite and can produce nausea and vomiting with increased respiratory difficulty.
Instruct the patient to frequently eat high caloric foods in smaller portions. COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass.
Encourage a rest period of 1 hr before and after meals. Help reduce fatigue during mealtime and provides an opportunity to increase total caloric intake.
Avoid gas-producing foods and carbonated beverages. Can produce abdominal distension, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea.
Avoid very hot or very cold foods. Extremes in temperature can precipitate or aggravate coughing spasms.
Instruct patient to increase fluid intake (2.5 liters per day or more) as indicated. Fluids aids in decreasing the viscosity of secretions for patients with chronic increased production of sputum.
Collaborate with a dietician as indicated. The dietician can provide nutrional assessment and counseling applicable to patients with COPD. They may also facilitate the initiation of enteral nutrition in those who are intubated or who cannot toletate oral feeding.
Administer supplemental oxygen during meals as indicated. Decreases dyspnea and increases energy for eating, enhancing intake.

Risk for Infection

Respiratory infections that are minor in nature may be threatening to people with COPD. Bronchopulmonary infections must be controlled or prevented to diminish inflammatory edema.

Nursing Diagnosis

  • Risk for Infection

Risk factors may include

  • Inadequate primary defenses (decreased ciliary action, stasis of secretions)
  • Inadequate acquired immunity (tissue destruction, increased environmental exposure)
  • Chronic disease process
  • Malnutrition

Desired Outcomes

  • Verbalize understanding of individual causative/risk factors.
  • Identify interventions to prevent/reduce risk of infection.
  • Demonstrate techniques, lifestyle changes to promote safe environment.
Nursing Interventions Rationale
Nursing Assessment
Monitor temperature. Fever may be present because of infection or dehydration.
Review the importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake. These activities promote mobilization and expectoration of secretions to reduce the risk of developing a pulmonary infection.
Observe color, character, odor of sputum. Odorous, yellow, or greenish secretions suggest the presence of pulmonary infection.
Obtain sputum specimen by deep coughing or suctioning for Gram’s stain, culture, and sensitivity. Identifies the causative organism and susceptibility to various antimicrobials.
Therapeutic Interventions
Demonstrate and assist the patient in the disposal of tissues and sputum. Stress proper handwashing (nurse and patient), and use gloves when handling or disposing of tissues, sputum containers. Prevents spread of fluid-borne pathogens.
Limit visitors; provide masks as indicated. Reduces potential for exposure to infectious illnesses such as upper respiratory infection (URI).
Encourage a balance between activity and rest. Reduces oxygen consumption or demand imbalance, and improves patient’s resistance to infection, promoting healing.
Discuss the need for adequate nutritional intake. Malnutrition can affect general well-being and lower resistance to infection.
Recommend rinsing mouth with water and spitting, not swallowing, or use of a spacer on the mouthpiece of inhaled corticosteroids. Reduces the localized immunosuppressive effect of drug and risk of oral candidiasis.
Administer antimicrobials as indicated. May be given for specific organisms identified by culture and sensitivity, or be given prophylactically because of high risk.

Deficient Knowledge

Provide instructions for self-management of COPD. Assessment of the patient’s knowledge and including family members about the therapeutic regimen increases adherence to treatment regimen.

Nursing Diagnosis  

  • Deficient Knowledge

May be related to

  • Lack of information/unfamiliarity with information resources
  • Information misinterpretation
  • Lack of recall/cognitive limitation

Possibly evidenced by

  • Request for information
  • Statement of concerns/misconception
  • Inaccurate follow-through of instructions
  • Development of preventable complications

Desired Outcomes

  • Verbalize understanding of condition/disease process and treatment.
  • Identify the relationship of current signs/symptoms to the disease process and correlate these with causative factors.
  • Initiate necessary lifestyle changes and participate in the treatment regimen.
Nursing Interventions Rationale
Nursing Assessment
Explain and reinforce explanations of the individual disease process. Encourage patient and SO to ask questions. Decreases anxiety and can lead to improved participation in the treatment plan.
Discuss the importance of medical follow-up care, periodic chest x-rays, sputum cultures. Monitoring disease process allows for alterations in the therapeutic regimen to meet changing needs and may help prevent complications.
Therapeutic Interventions
Instruct and reinforce the rationale for breathing exercises, coughing effectively, and general conditioning exercises. Pursed-lip and abdominal or diaphragmatic breathing exercises strengthen muscles of respiration, help minimize collapse of small airways, and provide the individual with means to control dyspnea. General conditioning exercises increase activity tolerance, muscle strength, and sense of well-being.
Stress importance of oral care and dental hygiene. Decreases bacterial growth in the mouth, which can lead to pulmonary infections.
Discuss the importance of avoiding people with active respiratory infections. Stress need for routine influenza and pneumococcal vaccinations. Decreases exposure to and incidence of acquired acute URIs.
Discuss individual factors that may trigger or aggravate condition (excessively dry air, wind, environmental temperature extremes, pollen, tobacco smoke, aerosol sprays, air pollution). Encourage patient and SO to explore ways to control these factors in and around the home and work setting. These environmental factors can induce or aggravate bronchial irritation, leading to increased secretion production and airway blockage.
Review the harmful effects of smoking, and advise cessation of smoking by the patient and SO. Cessation of smoking may slow or halt the progression of COPD. Even when the patient wants to stop smoking, support groups and medical monitoring may be needed. Note: Research studies suggest that “side-stream” or “second-hand” smoke can be as detrimental as actually smoking.
Provide information about activity limitations and alternating activities with rest periods to prevent fatigue; ways to conserve energy during activities (pulling instead of pushing, sitting instead of standing while performing tasks); use of pursed-lip breathing, side-lying position, and the possible need for supplemental oxygen during sexual activity. Having this knowledge can enable patients to make informed choices or decisions to reduce dyspnea, maximize activity level, perform most desired activities, and prevent complications.
Instruct asthmatic patient in use of peak flow meter, as appropriate. Peak flow level can drop before the patient exhibits any signs and symptoms of asthma during the “first time” after exposure to a trigger. Regular use of the peak flow meter may reduce the severity of the attack because of earlier intervention.
Discuss respiratory medications, side effects, adverse reactions. Frequently these patients are simultaneously on several respiratory drugs that have similar side effects and potential drug interactions. It is important that patient understand the difference between nuisance side effects (medication continued) and untoward or adverse side effects (medication possibly discontinued or dosage changed).
Demonstrate technique for using a metered-dose inhaler (MDI), such as how to hold it, taking 2–5 min between puffs, cleaning the inhaler. Proper administration of drug enhances delivery and effectiveness.
Devise system for recording prescribed intermittent drug and inhaler usage. Reduces the risk of improper use and overdosage of prn medications, especially during acute exacerbations, when cognition may be impaired.
Recommend avoidance of sedative antianxiety agents unless specifically prescribed or approved by the physician treating a respiratory condition. Although the patient may be nervous and feel the need for sedatives, these can depress respiratory drive and protective cough mechanisms. Note: These drugs may be used prophylactically when the patient is unable to avoid situations known to increase stress or trigger respiratory response.
Review oxygen requirements and dosage for a patient who is discharged on supplemental oxygen. Discuss safe use of oxygen and refer to the supplier as indicated. Reduces risk of misuse (too little or too much) and resultant complications. Promotes environmental and physical safety.
Instruct patient and SO in use of Nasal intermittent positive pressure ventilation (NIPPV) as appropriate. Problem-solve possible side effects and identify adverse signs and symptoms  (increased dyspnea, fatigue, daytime drowsiness, or headaches on awakening). Nasal intermittent positive pressure ventilation (NIPPV) may be used at night or periodically during the day to decrease CO2 level, improve quality of sleep, and enhance functional level during the day. Signs of increasing CO2 level indicate the need for more aggressive therapy.
Provide information and encourage participation in support groups (American Lung Association, public health department). These patients and their SOs may experience anxiety, depression, and other reactions as they deal with a chronic disease that has an impact on their desired lifestyle. Support groups or home visits may be desired or needed to provide assistance, emotional support, and respite care.
Refer for evaluation of home care if indicated.  Provide a detailed plan of care and baseline physical assessment to home care nurse as needed on discharge from acute care. Provides for continuity of care. May help reduce the frequency of rehospitalization.

Activity Intolerance

Patients with COPD experience progressive activity and exercise intolerance. Evaluation of the patient’s activity tolerance and limitations helps create strategies to promote independent ADLs.

Nursing Diagnosis

  • Activity Intolerance

May be related to

  • Imbalanced between oxygen supply and demand due to inefficient work of breathing.

Possibly evidenced by

  • Exertional dyspnea
  • Shortness of breath
  • Excessively increased or decreased RR

Desired Outcomes

  • Reports reduced episodes of dyspnea during an activity.
  • Rates perceived exertion at 3 or less on a 0-10 scale.
Nursing Interventions Rationale
Nursing Assessment
Assess the patient’s respiratory response to activity which includes monitoring of respiratory rate and depth, oxygen saturation, and use of accessory muscles for respiration. Patients with COPD can experience hypoxia during an increased activity and may need oxygenation to avoid hypoxemia which put them at risk for exacerbations of the condition.
Assess the patient’s nutritional status. Adequate energy reserves are needed during activity.
Therapeutic Interventions
Maintain prescribed activity levels. Helps in building tolerance and minimizing episodes of dyspnea.
Provide at least 90 minutes of undisturbed rest in between activities. Allotment of undisturbed rest reduces demand for oxygen and allows adequate physiologic recovery.
Teach and assist the patient with active ROM exercises. Aids in building stamina and avoid complications of limited mobility.
Instruct patient with energy conservation techniques, such as:
  • Placing frequently used items within easy reach
  • Sitting to do tasks
  • Frequent position changes
  • Working at an even pace
These techniques reduce oxygen consumption, allowing a more prolonged activity.
Teach the patient on excercises that enhances breathing capacity such as diaphragmatic and purse-lip breathing. These techniques prolong exhalation period which can decrease retention of carbon dioxide.
If needed, assist the patient for a referral to a pulmonary rehabilitation program. This program allows the patient to learn about nutrition, breathing and relaxation techniques, medication education, avoiding exacerbations, and ways on how to live better while having COPD.

Other Possible Nursing Care Plans

Here are other possible nursing diagnoses for nursing care plans for Chronic Obstructive Pulmonary Disease (COPD):

  1. Self-Care Deficit (Specify) may be related to Intolerance to activity, decreased strength/endurance, depression, severe anxiety.
  2. Ineffective Home Maintenance may be related to intolerance to activity, inadequate support system, insufficient finances, unfamiliarity with neighborhood resources.
  3. Ineffective Coping may be related to decreased socialization, depression, anxiety, and inability to work

[td_smart_list_end]

References and Sources

References and recommended sources for this care plan guide for Chronic Obstructive Pulmonary Disease (COPD):

  • Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. Elsevier Health Sciences.
  • Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
  • Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins. [Link]
  • Carlson, M. L., Ivnik, M. A., Dierkhising, R. A., O’Byrne, M. M., & Vickers, K. S. (2006). A learning needs assessment of patients with COPD. Medsurg Nursing15(4). [Link]
  • Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
  • Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]

See Also

You may also like the following posts and care plans:

Respiratory Care Plans

Care plans about respiratory system disorders:

Originally published on July 14, 2013. 


Viewing all articles
Browse latest Browse all 24

Latest Images

Trending Articles





Latest Images