Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)

Lesson Objective for COPD Nursing Care Plan:

Upon completion of this nursing care plan for Chronic Obstructive Pulmonary Disease (COPD), nursing students will be able to:

• Understand COPD Pathophysiology:
  • Demonstrate a comprehensive understanding of the pathophysiology of COPD, including the mechanisms of airflow limitation, chronic inflammation, and the impact on respiratory function.
• Implement Respiratory Interventions:
  • Acquire proficiency in implementing respiratory interventions aimed at improving ventilation, promoting effective airway clearance, and managing respiratory distress in individuals with COPD.
• Facilitate Lifestyle Management:
  • Assist individuals with COPD in adopting and maintaining lifestyle modifications, including smoking cessation, proper nutrition, and regular exercise, to enhance overall respiratory health.
• Educate Patients on Medication Management:
  • Provide education on medication management, including the correct use of bronchodilators, anti-inflammatory agents, and supplemental oxygen therapy, to optimize symptom control and enhance daily functioning.
• Address Psychosocial and Quality of Life Factors:
  • Develop skills in addressing psychosocial factors associated with COPD, such as anxiety and depression, and implement strategies to improve the overall quality of life for individuals managing this chronic respiratory condition.

Pathophysiology

• Airflow Limitation:
  • COPD is characterized by persistent and progressive airflow limitation. This limitation results from the narrowing of airways, primarily due to chronic inflammation, bronchoconstriction, and structural changes, such as thickening of bronchial walls.
• Chronic Inflammation:
  • Chronic inflammation in the airways and lung parenchyma is a key feature of COPD. Exposure to irritants, especially cigarette smoke, leads to an inflammatory response that contributes to tissue damage, mucus hypersecretion, and the recruitment of inflammatory cells.
• Alveolar Destruction (Emphysema):
  • Emphysema, a component of COPD, involves the destruction of alveoli and the enlargement of air spaces. Loss of alveolar elasticity reduces the ability of the lungs to recoil during expiration, contributing to airflow limitation and trapping of air in the lungs.
• Mucus Hypersecretion:
  • Increased production of mucus in the airways is common in COPD. The excessive mucus, combined with impaired clearance mechanisms, leads to airway obstruction and contributes to symptoms such as cough and dyspnea.
• Oxidative Stress and Antioxidant Imbalance:
  • Prolonged exposure to noxious particles and gases, particularly in cigarette smoke, induces oxidative stress in the lungs. An imbalance between oxidants and antioxidants contributes to tissue damage and inflammation in COPD.
• Pulmonary Vascular Changes:
  • COPD affects the pulmonary vasculature, leading to pulmonary hypertension. Increased resistance in the pulmonary arteries can result from vascular remodeling and inflammation, further complicating respiratory function.

Etiology

• Tobacco Smoke Exposure:
  • The most significant risk factor for COPD is exposure to tobacco smoke, either through active smoking or passive exposure. The toxic substances in tobacco smoke contribute to chronic inflammation and airway damage.
• Occupational Exposures:
  • Occupational exposure to dust, chemicals, and pollutants can increase the risk of developing COPD. Individuals working in industries such as mining, construction, and certain manufacturing sectors may be at higher risk.
• Genetic Factors:
  • Genetic predisposition can influence an individual’s susceptibility to COPD. Alpha-1 antitrypsin deficiency, a hereditary condition, is a known genetic factor that increases the risk of developing emphysema.
• Indoor Air Pollution:
  • Exposure to indoor air pollutants, such as biomass fuels used for cooking and heating in poorly ventilated spaces, can contribute to the development and exacerbation of COPD, particularly in certain regions and socioeconomic contexts.
• Recurrent Respiratory Infections:
  • Recurrent respiratory infections, especially during childhood, can impact lung development and increase the risk of COPD later in life. Infections can lead to chronic bronchitis and contribute to airway damage.

Desired Outcome

• Optimize Respiratory Function:
  • Aim to optimize respiratory function by implementing interventions that improve airflow, reduce airway obstruction, and enhance overall lung function in individuals with COPD.
• Promote Effective Breathing Patterns:
  • Facilitate effective breathing patterns and reduce respiratory distress, enabling individuals with COPD to achieve and maintain adequate oxygenation and ventilation.
• Prevent Exacerbations:
  • Implement strategies to prevent and minimize exacerbations of COPD, including proactive management of triggers, adherence to prescribed medications, and patient education on early recognition of worsening symptoms.
• Enhance Quality of Life:
  • Work towards enhancing the overall quality of life for individuals with COPD by addressing symptoms, improving functional capacity, and providing support for psychosocial well-being.
• Empower Self-Management:
  • Empower individuals with COPD to actively participate in their care by providing education on self-management, including medication adherence, lifestyle modifications, and recognizing and responding to worsening symptoms.

Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan

Nursing Assessment for Chronic Obstructive Pulmonary Disease (COPD):

• Respiratory Status:
  • Conduct a thorough assessment of respiratory status, including respiratory rate, rhythm, and effort. Note any signs of increased work of breathing, such as the use of accessory muscles or pursed-lip breathing.
• Oxygen Saturation:
  • Monitor oxygen saturation levels through pulse oximetry to assess the adequacy of oxygenation. Document any fluctuations and response to supplemental oxygen if prescribed.
• Cough and Sputum:
  • Evaluate the nature of the cough, including frequency and productive or non-productive characteristics. Document sputum color, consistency, and any changes, as it provides insights into the severity of inflammation and potential infections.
• Activity Tolerance:
  • Assess the patient’s ability to perform activities of daily living and any limitations due to breathlessness. Use a standardized scale, such as the Modified Medical Research Council (mMRC) Dyspnea Scale, to quantify the impact on daily functioning.
• Nutritional Status:
  • Evaluate the patient’s nutritional status, as malnutrition can impact respiratory muscle strength and overall health. Assess weight changes, dietary intake, and the presence of any nutritional deficits.
• Smoking History:
  • Obtain a detailed smoking history, including the number of pack years and current smoking status. Discuss smoking cessation strategies and provide support if the patient is still smoking.
• Medication Adherence:
  • Review the patient’s adherence to prescribed medications, including bronchodilators, corticosteroids, and antibiotics. Identify any barriers to adherence and provide education on the importance of consistent medication use.
• Psychosocial Assessment:
  • Assess the patient’s psychosocial well-being, addressing factors such as anxiety, depression, or social isolation that may impact COPD management. Collaborate with mental health professionals if necessary.
• Environmental Exposures:
  • Inquire about current and past occupational exposures, environmental pollutants, and home conditions that may contribute to respiratory symptoms. Provide education on minimizing environmental triggers.
• Education Needs:
  • Evaluate the patient’s understanding of COPD, its pathophysiology, and the importance of self-management strategies. Identify knowledge gaps and tailor education accordingly.

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

• If the patient has been working very hard to breathe for a long period 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!

• Breathing Treatments and medications**Bronchodilators BEFORE corticosteroids

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

• Obtain an ECG

• Encourage a healthy weight 

• Encourage small, frequent meals

• Encourage movement/activity as tolerated

• Assess for/Administer influenza vaccine and pneumococcal vaccine

References

• http://www.lung.org/about-us/blog/2016/11/copd-what-you-should-know.html
• http://www.lung.org/assets/documents/copd/copd-action-plan.pdf