If your patient has a chronic cough and a barrel chest, it may be time to form a nursing care plan for COPD. Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, affecting more than 16 million adults. There’s no cure, so nursing treatment focuses on managing symptoms and mitigating disease progression.
The nursing process is a standardized workflow that includes assessment, diagnosis, planning, implementation, and evaluation. Remember that NANDA nursing diagnoses are separate from medical diagnoses, and point to interventions that nurses can use independently. Learn more about nursing care for patients with COPD.
What Is COPD?
COPD results from damage to the lungs and airways, which leads to tissue inflammation. It’s most commonly caused by exposure to substances like cigarette smoke. Over time, this inflammation causes the airways to grow narrower and the lungs lose elasticity. Patients may live with symptoms for years and experience periodic COPD exacerbations that lead to hospitalization.
There are two types of COPD, and most adult patients have both:
- Emphysema: Damage to alveolar sacs in the lungs inhibits gas exchange. This leads to shortness of breath and wheezing during physical activity, and can progress to dyspnea even at rest.
- Chronic bronchitis: Inflammation in the airway causes excessive mucus production, which leads to a persistent and productive cough. Inflammation caused by mucus also contributes to airway obstruction.
Acute COPD can cause complete airway collapse — a medical emergency. If your patient feels that they can’t catch their breath, has a blueish tint to the fingers or lips, complains of chest pain, or loses the ability to speak, initiate a call to the rapid response team.
Where are Nurses Likely to Use a COPD Nursing Care Plan?
- Respiratory nursing
- Emergency department (ED or ER)
- Cardiac nursing
- Community health
- Outpatient clinics
- Rehabilitation
- Long-term care
- Home health
Nursing Care Plan for COPD
Nurses in community health, clinic settings, and long-term care may see COPD patients for routine visits. These patients will often have other comorbidities, such as heart disease, endocrine disorders like diabetes, and musculoskeletal issues. The focus for these patients is ongoing health management to prevent disease progression and maintain quality of life.
Let’s explore a nursing care plan for a patient presenting to the clinic with newly diagnosed COPD.
1. Assessment
Randy is a 57-year-old man with a history of type II diabetes. He’s been a two-pack-per-day smoker for 10 years. Last week, his daughter took him to the emergency department because he felt short of breath, and during this stay, he was diagnosed with COPD. Today, he is in the clinic for a follow-up appointment and medication reconciliation.
To assess the COPD patient, the nurse may perform a complete head-to-toe assessment or a focused assessment. These are the essential assessment areas in COPD:
- Respiratory and heart rate
- Oxygen saturation
- Lung sounds and chest shape (barrel chest is common)
- Cough
- Shortness of breath and abnormal posturing
- Extremities for clubbing, cyanosis, and fluid build-up (edema)
- Patient history, including smoking, environmental exposures, and respiratory diseases
- Nutritional status
- Patient’s report of sleep problems and orthopnea (shortness of breath when lying down)
2. Diagnoses
Based on assessment findings, the nurse uses the following nursing diagnoses for Randy. Refer to NANDA resources for a complete list of nursing diagnoses for COPD.
Knowledge deficit: Whether a patient is newly diagnosed or has had COPD for 10 years, the nurse must assess their knowledge of the disease, its contributing factors, and complications. To adequately manage COPD, patients must be involved in their own care to the best of their abilities. Family members and caregivers may also require additional education.
Here are some common nursing interventions for knowledge deficit:
- Using teach-back education methods
- Giving the patient take-home educational materials
- Having the patient demonstrate using their incentive spirometer
Activity intolerance: Patients with COPD may feel uncomfortable when exercising or even completing activities of daily living. Shortness of breath may contribute to anxiety, and they may have low energy due to oxygen levels and sleep problems. Moderate exercise can improve fitness, strength, energy, and dyspnea for these patients.
Nursing interventions may include the following:
- Encouraging the use of an incentive spirometer
- Teaching pursed-lip breathing and pacing to conserve energy
- Encouraging strengthening exercises and walking aids when necessary
Ineffective breathing pattern: In an attempt to meet oxygen demands, patients with COPD may adopt abnormal breathing patterns and increase their respiratory rate. They are also at risk for breathing issues during sleep.
Consider any of these nursing interventions:
- Encouraging the tripod position to increase oxygenation
- Educating on the use of incentive spirometry and medicated inhalers
- Advocating for referral to a sleep clinic
- Administering a COPD assessment test (CAT)
3. Plan
Now it’s time to choose which nursing diagnoses and their interventions are the highest priority, and set goals for the patient. In a single clinic visit, the nurse may not have time to address every diagnosis. When creating a nursing care plan for COPD, Randy’s nurse chooses the following interventions:
- Performing medication management and education
- Encouraging smoking cessation
- Educating the patient on symptoms of exacerbation that may indicate a hospital visit
- Enquiring about pulmonary rehabilitation on the patient’s behalf
- Providing support for anxiety and fear related to diagnosis
The nurse also sets the following goals for Randy:
- The patient will verbalize understanding of smoking risk and demonstrate using his inhaler.
- The patient will reduce smoking habits to one pack per day by the next visit.
4. Intervention
The nurse carries out planned interventions with Randy and his daughter. Randy is reluctant to discontinue smoking and verbalizes that he doubts he can quit at his age. The nurse also reviews how to use Randy’s inhaler, as well as his other medications. At the end of the visit, the nurse gives them both a take-home pamphlet on COPD and smoking.
5. Evaluation
Once you’ve implemented a COPD nursing care plan, evaluation helps you determine its effectiveness. In Randy’s case, the nurse schedules a follow-up appointment for the next month. Randy has gone down to one pack per day and has been using his inhaler and keeping his blood sugar under control. From here, the nurse will assess him to alter the plan of care.
Nursing Care Plan for Patient with COPD Exacerbation
Patients in an acute COPD exacerbation may present to the ER and be admitted to an inpatient acute care unit. These patients are more acutely sick and at risk of an emergent respiratory collapse. They often need oxygen support and round-the-clock nursing care.
1. Assessment
Nancy is a 68-year-old woman who has come into the ER with dyspnea. She was diagnosed with COPD a year ago and states she “has been managing it,” but has had trouble catching her breath for the past month, and her husband notes that she has been increasingly disoriented.
Nancy’s nurse assesses the following:
- Vital signs, including respiratory rate and pulse oximetry
- Lung sounds for crackles, rales, and wheezing
- Observe the work of breathing through the use of accessory muscles
- Cough frequency and severity
- Level of consciousness and orientation
- Recent health status, including illnesses, infections, and environmental changes
2. Diagnosis
Nancy’s assessment findings lead the nurse to apply the following diagnoses:
Impaired gas exchange: The highest priority nursing diagnosis for COPD exacerbation is determined by the ABCs: airway, breathing, and circulation. A patient with a compromised airway is not breathing well and is unable to properly perfuse.
Any of the following nursing interventions may be appropriate:
- Applying oxygen therapy via Venturi mask, cannula, or other means
- Contacting respiratory therapy for bronchodilator treatment
- Educating the patient on breathing techniques
- Repeating vital signs readings until within normal range
Decreased cardiac output: COPD patients tend to have a lower cardiac output, or the amount of blood pumped out to the body per minute. This is caused by structural changes in the chest cavity, as well as changes in intrathoracic pressure. Pulmonary hypertension can also occur in COPD patients, worsening issues with cardiac output.
Nursing interventions may include the following:
- Encouraging awareness of fatigue
- Educating the patient on the use of the call light for assistance to the bathroom
- Provide a quiet environment to limit stress
Ineffective airway clearance: Increased mucus production in COPD can lead to worsening blockages in the respiratory tract, which further inhibit gas exchange.
Consider these nursing interventions for ineffective airway clearance:
- Encouraging cough and incentive spirometer
- Implementing airway suction when appropriate
- Encouraging fluid intake to loosen secretions
3. Plan
The nurse creates a plan for Nancy that includes goals and specific interventions. When creating a nursing care plan for COPD exacerbation, prioritize patient safety and education. For patients in acute distress, consider any of the following emergency nursing interventions:
- Sitting up at the head of the bed for airway management
- Calling the provider for potential intubation and ventilation
Nancy’s goals include the following:
- Improved pulse oximetry reading to 90+% within 20 minutes
- Teach-back on breathing techniques
4. Intervention
Nancy’s nurse implements a continuous pulse oximeter machine and puts Nancy on a Venturi mask for oxygen flow. She also educates Nancy on proper breathing techniques and asks her to limit activity for the next hour. The nurse also educates Nancy’s husband on signs of a worsening condition, ensures that the call light is on and within reach, and plans to round in ten minutes to assess her status.
5. Evaluation
It’s time to evaluate this emergency nursing care plan for COPD. When the nurse returns to the room, Nancy’s respiratory rate has decreased slightly, and her oximetry is reading 90%. Nancy’s breathing remains labored, but she has had several productive coughs and verbalizes that she feels less anxious than before. The nurse continues to monitor Nancy’s status to ensure she is stabilizing.
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