Here are some examples of nursing care plans for COPD patients.
Nursing Care Plan For COPD #1
Impaired Gas Exchange related to altered oxygen delivery and alveoli destruction
After 8 hours of nursing intervention patient will demonstrate improved ventilation and oxygenation.
- 1. Monitor vital signs. With initial hypoxia and hypercapnia, blood pressure (BP), heart rate, and respiratory rate all rise. As the hypoxia and/or hypercapnia becomes more severe, BP may drop, heart rate tends to continue to be rapid with arrhythmias, and respiratory failure may ensue with the patient unable to maintain the rapid respiratory rate.
- 2. Assess for changes in orientation and behavior. Restlessness is an early sign of hypoxia. Chronic hypoxemia may result in cognitive changes such as memory changes.
- 3. Monitor ABGs and note changes. Increasing PaCO2 and decreasing PaO2 are signs of respiratory failure. As the patient begins to fail, the respiratory rate will decrease and PaCO2 will begin to rise. Some patients, such as those with COPD, have a significant decrease in pulmonary reserves, and any physiological stress may result in acute respiratory failure.
- 4. Maintain oxygen administration device as ordered, attempting to maintain oxygen saturation at 90% or greater. This provides for adequate oxygenation.Avoid high concentration of oxygen in patients with COPD. Hypoxia stimulates the drive to breathe in the chronic CO2 retainer patient. When applying oxygen, close monitoring is imperative to prevent unsafe increases in the patient’s PaO2, which could result in apnea.
NOTE: If the patient is allowed to eat, oxygen still must be given to the patient but in a different manner (e.g., changing from mask to a nasal cannula). Eating is an activity and more oxygen will be consumed than when the patient is at rest. Immediately after the meal, the original oxygen delivery system should be returned.
- 5. Position with proper body alignment for optimal respiratory excursion (if tolerated, head of bed at 45 degrees). This promotes lung expansion and improves air exchange.
- 6. Pace activities and schedule rest periods to prevent fatigue. Even simple activities such as bathing during bed rest can cause fatigue and increase oxygen consumption.
- Encourage deep breathing, using incentive spirometer as indicated. This reduces alveolar collapse.
- 8. Encourage or assist with ambulation as indicated. This promotes lung expansion, facilitates secretion clearance, and stimulates deep breathing.
- Administer medications as prescribed
Nursing Care Plan For COPD #2
Ineffective airway clearance related to bronchospasm and increased mucus secretions
After 8 hours of nursing intervention patient will demonstrate adequate airway clearance and will use effective methods of coughing.
- 1. Assist patient in performing coughing and breathing maneuvers. These improve productivity of the cough.
2. Instruct patient in the following:
- Optimal positioning (sitting position)
- Use of pillow or hand splints when coughing
- Use of abdominal muscles for more forceful cough
- Use of quad and huff techniques
- Use of incentive spirometry
- Importance of ambulation and frequent position changes
Directed coughing techniques help mobilize secretions from smaller airways to larger airways because the coughing is done at varying times. The sitting position and splinting the abdomen pr
- 2. Use positioning (if tolerated, head of bed at 45 degrees; sitting in chair, ambulation). These promote better lung expansion and improved air exchange.
- 3. Encourage oral intake of fluids within the limits of cardiac reserve. Increased fluid intake reduces the viscosity of mucus produced by the goblet cells in the airways. It is easier for the patient to mobilize thinner secretions with coughing.
- 4. Consult respiratory therapist for chest physiotherapy and nebulizer treatments as indicated (hospital and home care/rehabilitation environments). Chest physiotherapy includes the techniques of postural drainage and chest percussion to mobilize secretions in smaller airways that cannot be removed by coughing or suctioning.
- Administer medications (e.g., mucolytic agents, bronchodilators, expectorants) as ordered, noting effectiveness and side effects.
Nursing Care Plan For COPD #3
Ineffective breathing pattern related to decreased energy and airway changes
After 8 hours of nursing intervention patient will demonstrate effective breathing pattern.
1.Position patient with proper body alignment for optimal breathing pattern. If not contraindicated, a sitting position allows for good lung excursion and chest expansion.
2.Ensure that oxygen delivery system is applied to the patient. The appropriate amount of oxygen is continuously delivered so that the patient does not desaturate.
3.Encourage sustained deep breaths by:
- Using demonstration (emphasizing slow inhalation, holding end inspiration for a few seconds, and passive exhalation)
- Using incentive spirometer (place close for convenient patient use)
- · Asking patient to yawn This simple technique promotes deep inspiration.
- Maintain a clear airway by encouraging patient to clear own secretions with effective coughing. If secretions cannot be cleared, suction as needed to clear secretions.
- 2. Pace and schedule activities providing adequate rest periods. This prevents dyspnea resulting from fatigue.
Nursing Care Plan For COPD #4
Activity Intolerance related to imbalance between oxygen demand and requirement
After 8 hours of nursing intervention patient will maintain or work toward an optimal activity level.
- 1. Establish guidelines and goals of activity with the patient and caregiver. Motivation is enhanced if the patient participates in goal setting. Depending on the etiological factors of the activity intolerance, some patients may be able to live independently and work outside the home. Other patients with chronic debilitating disease may remain homebound.
- 2. Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and ambulation. Rest between activities provides time for energy conservation and recovery. Heart rate recovery following activity is greatest at the beginning of a rest period.
- Ensure that the chronic pulmonary client has oxygen saturation testing with exercise. Use supplemental oxygen to keep oxygen saturation 90% or above or as prescribed with activity. Supplemental oxygen increases circulatory oxygen levels and improves activity tolerance (Casaburi and Petty, 1993).
- Monitor a COPD client’s response to activity by observing for symptoms of respiratory intolerance such as increased dyspnea, loss of ability to control breathing rhythmically, use of accessory muscles, and skin tone changes such as pallor and cyanosis.
- Instruct and assist a COPD client in using conscious controlled breathing techniques such as pursing their lips and diaphragmatic breathing. Training a client with COPD to slow his or her respiratory rate with a prolonged exhalation (with or without pursed lips) helps control dyspnea and results in improved ventilation, increased tidal volume, decreased respiratory rate, and a reduced alveolar-arterial oxygen difference. This breathing pattern not only helps relieve dyspnea but also can improve the ability to exercise and carry out ADLs (Casaburi and Petty, 1993).
- Provide emotional support and encouragement to the client to gradually increase activity. Fear of breathlessness, pain, or falling may decrease willingness to increase activity.
- 7. Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self. Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the patient’s activity tolerance and self-esteem.
- 8. Provide bedside commode as indicated. This reduces energy expenditure. NOTE: A bedpan requires more energy than a commode
- 9. Encourage verbalization of feelings regarding limitations. Acknowledgment that living with activity intolerance is both physically and emotionally difficult aids coping.
Nursing Care Plan For COPD #5
Altered nutrition: less then body requirement
After 8 hours of nursing intervention patient will explain plan for frequent, small feedings that are easily chewable, allowing increased time for eating, and use of supplemental oxygen as indicated.
- 1. Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Elevating the head of bed 30 degrees aids in swallowing and reduces risk of aspiration.
- 2. Maintain oxygen administration device as ordered, attempting to maintain oxygen saturation at 90% or greater. This provides for adequate oxygenation.
If the patient is allowed to eat, oxygen still must be given to the patient but in a different manner (e.g., changing from mask to a nasal cannula). Eating is an activity and more oxygen will be consumed than when the patient is at rest. Immediately after the meal, the original oxygen delivery system should be returned.
- Encourage frequent, small feedings. Larger meals require more energy to digest and limit the downward movement of the diaphragm during inspiration.
- Encourage patient to select foods that are easy to chew and swallow. To further conserve energy.
- Suggest liquid drinks for supplemental nutrition.
- 6. Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support. Dietitians have a greater understanding of the nutritional value of foods and may be helpful in assessing specific ethnic or cultural food
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