Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD)

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Pathophysiology

A chronic airway obstruction that limits air flow into and out of the alveoli – this restricts O2 from entering AND traps CO2 from escaping.

Etiology

There are two types of COPD: Chronic Bronchitis and Emphysema. The most common cause of COPD is smoking of any form: cigarette, pipe, cigar, second hand. Any lung irritant can cause COPD and also exacerbate it.

Desired Outcome

Clear, even, non-labored breathing while maintaining optimal oxygenation for patient.

Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan

Subjective Data:

  • Difficulty Breathing
  • Chest tightness
  • “I can’t breathe”

Objective Data:

  • Wheezing
  • ↓ Oxygen saturation
  • ↓ pH and ↑ pCO2 on ABG
  • Blue/Gray lips/fingernails
  • Inability to speak full sentences (have to stop to breathe)
  • Swelling/edema
    • Caused by Cor Pulmonale (right-sided heart failure due to increased pressures within the lungs).
  • Tachycardia
  • Barrel Chest
  • Congestion on X-ray

Nursing Interventions and Rationales

  • Avoid irritants:
    • Quit smoking or being around secondhand smoke
    • Be mindful of the weather (very cold weather can aggravate the bronchi)
    • Allergens like dust or pollen

 

The key to avoiding a flare up of COPD is to avoid things that make it worse.

If the patient is smoking still this is a priority, they need to quit smoking. Provide education on smoking with COPD and the benefits of quitting.

 

  • If the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient!

 

Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis long before their physical airway becomes compromised..

 

  • Breathing Treatments and medications**Bronchodilators BEFORE corticosteroids

 

  • Beta-Agonists: Such as albuterol work as bronchodilators
  • Anticholinergics: Such as Ipratropium work to relax bronchospasms
  • Corticosteroids: Such as Fluticasone work as an anti-inflammatory

 

  • Monitor Oxygen saturation.Do NOT give > 2 lpm NC without orders from a provider.

 

This is subjective as you need to make sure to understand the patient’s baseline. Plan the oxygen monitoring with the physician.

Give oxygen as ordered and needed. Be careful about turning their drive to breathe off by giving too much O2. As a general rule, COPD patients should be kept around 88%-92%.

 

  • Obtain an ECG

 

The lungs and the heart are in the same general area, if someone is having problems breathing, make sure their heart is ok. Sometimes people having a heart attack can feel like they can’t breathe due to the pressure or pain on their chest.

Also, COPD is stressful on the heart, so even if the main problem is breathing, monitoring the heart, especially during an episode/exacerbation is important.

 

  • Encourage a healthy weightCan be either overweight or underweight

 

Having access weight on the patient decreases the space for the lungs to expand. Plus, generally those who lose weight are also moving more to lose the weight, double win.

Some patients (especially those with emphysema) can be very thin (barrel chested) and it is important to make sure they are getting the proper nutrition so their body is at optimal performance (for that patient).

 

  • Encourage small, frequent meals

 

Patients find it hard to eat large meals or food that needs to be chewed extensively – it is difficult to eat and breathe at the same time. Encouraging them to eat smaller, more frequent meals will help to ensure they get the adequate nutritional intake.

 

  • Encourage movement/activity

 

Sedentary lifestyle causes increased shortness of breath and less tolerance for movement. Helping the patient move more often helps improve breathing abilities.

 

  • Assess for/Administer influenza vaccine and pneumococcal vaccine

 

Preventing complications such as influenza or pneumonia is important because the lungs are already working harder to keep the body balanced with oxygen and CO2. An increased risk of infection only complicates the patient’s ability to breathe.

 


References

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