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

Join NURSING.com to watch the full lesson now.

Included In This Lesson

Study Tools

Outline

Pathophysiology

A chronic airway obstruction that limits airflow 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 patients.

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 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!
  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 pm NC without orders from a provider.
  This is subjective as you need to make sure to understand the patient’s baseline. Plan 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 weight can be either overweight or underweight
  Having access to 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 the 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 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.

FAQ’s

What is COPD? COPD is a chronic disease where the flow of air in the lungs is obstructed, resulting in less oxygen and more carbon dioxide build-up. The obstruction is caused by a combination of inflamed damaged alveoli and mucus build-up. What are the best interventions for COPD? The best interventions for COPD are smoking cessation to decrease damage, nebulizers, and inhalers to open the lungs and decrease inflammation, careful oxygen supplementation, and a BIPAP or CPAP to blow off built-up carbon dioxide from the body. What causes COPD? Inhaling lung irritants consistently over a long period of time such as cigarette smoking causes COPD. The irritants damage the alveoli and cause inflammation which in turn makes it hard for the lungs to do their job of bringing in oxygen and blowing out carbon dioxide. What does COPD stand for? COPD stands for Chronic Obstructive Pulmonary Disease. Is COPD curable? COPD cannot be cured, but it can be treated. Treatment includes smoking cessation to stop further damage, light exercise to encourage deep breathing, inhaler or nebulizer treatments to open the lungs and decrease inflammation, along with oxygen and a CPAP if needed to improve oxygen and carbon dioxide levels.

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

A Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

Join NURSING.com to watch the full lesson now.

Transcript

Alright everyone, let’s try to put COPD into our nursing care plan. So, first remember we have to collect our data and that is just the assessment stuff. So, nothing too scary here. We have to look at subjective data from the patient and objective data is what the nurse observes. 

 

So, our subjective data for a patient with a COPD diagnosis would be things like difficulty breathing, You might hear them say they cannot breathe so, difficulty breathing, chest tightness, also something that you might have your patient with COPD tell you. Our objective data is the things that we witnessed and we see in the patient. Maybe we assess and we find that the patient has some wheezing, maybe they’re low, O2 Sat, or a low PH and high C02 on their ABG. Um, they could be blue, right? There could be some cyanotic to them, the lips, the fingernails, maybe they can’t speak full sentences or they have to really stop to breathe. Um, swelling and edema can happen also with cor pulmonale, which is that right sided heart failure that happens because of the increased pressure within the lungs. So, you might have that, and symptoms of that would be that barrel chest that the patient gets. This barrel chest is typical with COPD and tachycardia happening. So, those are our objective findings. 

 

Now let’s take that data and look further with it. So, we’re going to analyze, okay, we’re going to analyze that data and that’s going to help us to diagnose and prioritize. So, what’s the problem? So, for my patient, a hypothetical patient that we have, I’m going to say they have low O2 sats. Now remember, a COPD patient typically hangs around 88 and that’s okay, that is just their normal. So, let’s say for my patient, we’ll go that they are around 79% and they have a high amount of CO2. Alright, that’s my problem and obviously there’s some breathing difficulty, always because of this. So, what needs to be improved? Well, oxygenation, right? We need to improve the oxygenation for this patient. Unfortunately, COPD is a chronic thing, right? We’re not going to be able to completely fix that like we can fix other things. So, it’s just helping to fix what we can, the symptoms of it. So what’s our priority? Our priority for this patient is going to oxygenate them, right? Give oxygen. Now, we don’t want to ever give too much to a COPD patient because of the way their receptors are, but a little bit of oxygen, like two liters, no more than that can help this patient since they are 79%. 

 

Alright, so now you are going to ask your how questions and that’s going to help you to plan, implement and evaluate. So, how do we know it was a problem? This is where you will link whatever data that you have found for your patient when you are clinical, you’re going to link it. So, all your assessment findings, your subjective and objective data, link it together and that’s how you knew what was a problem. So for me, my hypothetical patient, they were, I noticed having trouble breathing, or they told me that, and my assessment findings, which were, a low O2 sat and maybe some wheezing. 

 

Alright, now, how am I going to address it? So, I could give my patient medication right? So, meds for COPD,breathing treatment, remember things like bronchodilators, we want to do those first before steroids, because we wanna help bronchodilate and then monitor their oxygen saturation. So I’m going to keep monitoring, keep assessing the patient. And how am I going to know it gets better? Well, unfortunately this is chronic. Like I said, right? We’re not fixing the COPD, but we are going to know that things are better. Maybe the exacerbation of it isn’t as bad because there’s less work of breathing. 

 

Maybe my patient stops wheezing, that would be awesome. Right? So, no more wheezing on my assessment. Maybe they can move better. They can talk in complete sentences without having to pause and stop. My grandmother had COPD and she could not finish a sentence. So, our high level nursing concepts for this patient, I’m going to go ahead and do oxygenation. I’m going to comfort and focus also on patient education. 

 

Alright so, we’re going to take those concepts and put them into a care plan. So we’re going to come up with whatever data is linked to our problem or a priority. We’re going to come up with what we can do about it and our why, so why we expect this intervention to help our assessment piece, and then what we expect to see happen. Alright so, first oxygenation… So, my patient, my data, low saturation, remember, I think I said 79% and just, they were having some hypoxia signs, so having trouble breathing or trouble talking without stopping to breathe, things like that. 

 

So, my intervention, I am going to give some oxygen, but remember, no more than two liters, some meds, maybe those bronchodilators to help, especially for wheezing. For the reason why, to improve my oxygen saturation and to bronchodilate. My expected outcomes are that my O2 sats will be within normal limits for this patient. Remember, for a patient with COPD, we’re not talking like 9,900, we’re talking around 88%. So, that’s important for this patient and they’ll have more of an ease of breathing, not working as hard to breathe comfortably. So, comfort… My patient was showing me signs and symptoms based on being restless and saying that they just couldn’t breathe. So, that is uncomfortable, right? So, what can I do? I can help provide comfort by positioning the patient, right? Sitting them upright helps with that lung expansion. I can give them support. So just offer support, help. No, it’s okay. Like take your time, catch your breath, and then try to talk again. 

 

Our rationale… So, this is just going to help them, the reason why it’s going to help them feel supported and then hopefully make them more comfortable. My expected outcome is that my client will feel supported and be less restless, right? Hopefully, the positioning will help with that and they’ll feel support from the nurse. 

 

Patient education… So, hopefully they don’t, but if they smoke, we can talk about some smoking cessation or some data we collected, let’s say the patient’s smoked, maybe they need some education on medication because they aren’t taking them all properly and then, we can give them education about clustering their care. So, the smoking, to fix that, or intervention will be smoking cessation education, we can give med education about how often they can take bronchodilators, what to do with the oxygen, that kind of thing and then, cluster their tasks together. So, that intervention will just be to get them to cluster their tasks. And our why, so the why is that, well we need them to stop smoking, right, to decrease some of these irritants and understand the meds. And then the clustering to our tasks, the rationale is just because they don’t expend so much energy. If they cluster things together versus going up and down the steps, doing multiple things, they go to one room, they do everything they need to do before they go on to the next thing. Our expected outcomes. So, we just want them to verbalize and demonstrate them and understand them right? That’s going to help show us that they have achieved this outcome. 

 

Alright, let’s look at our key points. So, we are going to collect our information when you’re doing your care plan, which is your data, and that’s going to be your subjective and objective. We are going to analyze information, so diagnose, prioritize, ask how, so that’s gonna help us to plan, implement, and evaluate, and then translate. So, just some concise terms and transcribe. So, whatever form you prefer, just get your care plan on paper. 

 

Alright guys, that was it for COPD care plans. Check out all the care plans that we have for you on this course. They’re awesome. Now go out and be your best selves today and as always, happy nursing!

 

Join NURSING.com to watch the full lesson now.