What are the nursing priorities for education to prevent further exacerbations of COPD?

COPD Nursing Care Plans Diagnosis and Interventions

COPD NCLEX Review and Nursing Care Plans

Chronic obstructive pulmonary disease (COPD) is a long-term lung disease that involves the obstruction of airflow due to an inflammation of the lungs. COPD further branches into three specific lung conditions: emphysema, chronic bronchitis, and refractory asthma.

Emphysema occurs when the air sacs in the lungs called alveoli become damaged, causing them to have destroyed walls.

Eventually, the tiny alveoli merge into one big air sac. As a result, the alveolar walls are unable to absorb oxygen normally, which then affects the oxygen level of the blood.

In addition to this, the lungs lose their springiness. This traps the air inside the lungs, making it difficult for the patient to breathe.

Chronic bronchitis happens when the hair-like fibers (cilia) lining your bronchial tubes are lost.

This reduces the ability to move the mucus out of the lungs. Coughing and shortness of breath are the physical signs related to this.

Eventually, the coughing mechanism triggers the lungs to produce more mucus, causing the patient to try and expectorate more of it.

Refractory asthma is a severe type of asthma that is non-reversible and does not respond to usual medical treatments for asthma.

It is characterized by low lung function, frequent asthma attacks, and persistent symptoms.

Signs and Symptoms of COPD Chronic Obstructive Pulmonary Disease

• Shortness of breath – this becomes more severe upon physical exertion
• Chest tightness
• Wheeze (emphysema), crackles (bronchitis), or absent breath sounds (refractory asthma)
• Chronic productive cough
• Phlegm – can be white, clear, greenish or yellowish and can last for months or years
• Fatigue

In the long run, COPD patients may show unexplained weight loss and may have frequent respiratory infections, as well as swelling of the limbs.

They are also prone to worsening of the above signs and symptoms for several days. This episode is called COPD in Exacerbation.

Causes of COPD Chronic Obstructive Pulmonary Disease

1. Tobacco smoking: Most COPD cases in developed countries are caused by smoking. Although these are big risk factors, not all smokers suffer from COPD. Second hand smoking, marijuana smoking, and pipe smoking can also cause COPD.
2. Exposure to fumes: In developing countries, people still burn fuel to cook and to heat their homes. This creates fumes which are harmful when inhaled. Some occupations also involved being exposed to chemical vapors and fumes.
3. Alpha-1-antitrypsin deficiency: A small number of COPD patients has this genetic disorder where in there is a deficiency of the AAt, a protein that the liver secretes to the bloodstream and goes to the lungs to help protect these organs.

Complications of COPD

1. Higher risk of recurrent respiratory infections: COPD patients are highly vulnerable to bacteria and viruses that may cause infection. The frequent infections may cause more damage to the tissues of the lungs, making it more difficult to breathe.
2. Pulmonary hypertension: COPD may increase the blood pressure in the arteries that carry blood to the lungs.
3. Lung cancer: The study by Durham and Adcock in 2015 showed the relationship between COPD and lung cancer. COPD can contribute to the development of lung cancer as it increases oxidative stress, which causes DNA damage and increase in cellular proliferation.
4. Cardiac issues: COPD may increase the risk for cardiovascular disease, particularly myocardial infarction. The connection between COPD and cardiac problems has not been fully studied.

Diagnostic Tests for Chronic Obstructive Pulmonary Disease

• Medical history taking – especially tobacco use, family history, occupation, and exposure to lung irritants
• Arterial blood gas (ABG) analysis – to measure the gas exchange in the lungs
• Pulmonary function tests – to measure the level of air during inhalation and exhalation. The most common one is spirometry. Other tests include pulse oximetry and six-minute walk test.
• Imaging – chest x-ray and/or CT scan
• Genetic testing for AAt deficiency – if the patient has a family history of COPD

Treatments for COPD

COPD is generally irreversible, but through proper treatment, therapy, and lifestyle changes, the patient can have better pulmonary function and thus, experience partial recovery and optimal quality of life. These treatments include:

1. Smoking cessation: Quitting smoking is one of the crucial steps to combat COPD. This also includes avoiding second-hand smoking.
2. Medications: Bronchodilators such as Ventolin and Ipratropium (Atrovent) work by relaxing the muscles of the airways, making breathing much easier. These usually come in the form of inhalers. On the other hand, inhaled corticosteroids such as Budesonide and Fluticasone alleviate inflammation in the airways, which effectively prevent exacerbation episodes. There are also inhalers that combine bronchodilators and steroids, such as Combivent and Bevespi. During acute or severe exacerbations, patients may be prescribed a short course of oral steroids. Antibiotics may be prescribed for pulmonary infections which may worsen the symptoms of a patient with COPD.
3. Oxygen therapy: Supplemental oxygen may be needed if there is a low level of oxygen in the blood. It is normal for most COPD patients to have an oxygen level between 88 to 92% via pulse oximetry. Oxygen therapy may be required if the patient’s SpO2 drops to less than 88%.
4. Pulmonary rehabilitation program: A healthcare plan for exercise, nutrition advice, counselling, and education need to be customized for each COPD patient.
5. Bilevel Positive Airway Pressure (BiPAP): This is a non-invasive, in-home ventilation therapy that comes with a mask and helps improve breathing as well as reduce hypercapnia (the retention of carbon dioxide in the lungs).
6. Surgical intervention: Lung volume reduction surgery, lung transplant, bullectomy (removal of bullae or large air spaces) are the most common surgical procedures performed to treat COPD.

Nursing Care Plan for COPD 1

Ineffective Airway Clearance related to COPD and pneumonia as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive cough, difficulty to expectorate greenish phlegm

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

Nursing Care Plan for COPD 2

Nursing Diagnosis: Ineffective Breathing Pattern related to COPD and pneumonia as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and greenish phlegm

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

Nursing Care Plan for COPD 3

Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance

Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation of at least 88%.

Nursing Care Plan for COPD 4

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of COPD as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of COPD and its management.

Nursing Care Plan for COPD 5

Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Care Plan for COPD 6

Nursing Diagnosis: Risk for Infection due to chronic disease process

Desired Outcome: The patient will be able to avoid the development of an infection.

Nursing Care Plan for COPD 7

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake due to fatigue and dyspnea as evidenced by weight loss, poor muscle tone and lack of appetite

          Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

More COPD Nursing Diagnosis

• Anxiety related to COPD in Exacerbation

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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