A chronic airway obstruction that limits airflow into and out of the alveoli – this restricts O2 from entering AND traps CO2 from escaping.
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.
Clear, even, non-labored breathing while maintaining optimal oxygenation for patients.
Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan
- Difficulty Breathing
- Chest tightness
- “I can’t breathe”
- ↓ Oxygen saturation
- ↓ pH and ↑ pCO2 on ABG
- Blue/Gray lips/fingernails
- Inability to speak full sentences (have to stop to breathe)
- Caused by Cor Pulmonale (right-sided heart failure due to increased pressures within the lungs).
- 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%.
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.
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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell