Nursing Care Plan (NCP) for Restrictive Lung Diseases

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Outline

Pathophysiology

A condition, either intrinsic or extrinsic, causes the lungs to lose their ability to expand and contract. If the lungs can’t expand, they cannot bring in enough air for adequate oxygenation and ventilation (gas exchange). Patients will also struggle to cough because they are unable to inflate or forcefully deflate (cough) their lungs – therefore secretions may build up. 

Etiology

Intrinsic – this means the problem came from within the lungs themselves. There has been some sort of inflammation and scarring of the lung parenchyma (tissue) and therefore it has lost its elasticity. Some examples are sarcoidosis, ARDS, pulmonary fibrosis, and pneumonia. Also, despite many of the causes being terminal, not all of them are. 

Extrinsic – this means the problem is coming from outside the lungs. Something is restricting the lungs from physically expanding like they need to.  Most commonly this is caused by some sort of neuromuscular disorder like Amyotrophic Lateral Sclerosis (ALS), Muscular Dystrophy, Quadriplegia, or obesity.

Desired Outcome

Optimize oxygenation and ventilation, prevent pulmonary infections (common cause of death), and provide supportive care for patient and family.

Restrictive Lung Diseases Nursing Care Plan

Subjective Data:

  • Feeling SOB
  • “Can’t catch my breath”
  • Dyspnea on exertion

Objective Data:

  • Hypoxia
  • Hypercapnia 
  • Blue skin, lips, nail beds
  • Clubbing of fingers
  • Shallow breathing
  • Excess secretions
  • Accessory muscle use 
  • Decrease SpO2
  • Presence of physical disorder (ALS, MD, quadriplegia)

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Maintain patent airway-cough assist therapy, suctioning secretions ensures patient is getting adequate oxygen to the body/tissues 
Full respiratory assessment- baseline lung sounds, labs  you will notice when the condition has worsened or when an intervention has worked. ABG’s can show if interventions are working or if patient is decompensating 
Provide supplemental O2 as needed  supplemental O2 can help improve the patient’s overall oxygenation needs 
Cluster Care  helps decrease oxygen demands and patients rest is maximized
Patient sitting upright for optimal breathing  sitting up ensures appropriate lung expansion and allows for maximum inspiration/expiration which in turn gets better gas exchange 
Prevent pneumonia-oral hygiene, suctioning, trach care  most common cause of restrictive lung disease. Prevents any infection from occurring 
Appropriate nutrition  malnourishment is common with lung disease. Nutrition is essential to support healing 
Provide Oral Care  helps protect the mucous membrane and prevent infection 
Educating patient/families  if patient has any of the extrinsic causes, giving coping mechanisms and ways to help improve the patients state of mind and quality of life 

Writing a Nursing Care Plan (NCP) for Restrictive Lung Diseases

A Nursing Care Plan (NCP) for Restrictive Lung Diseases 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

  • https://my.clevelandclinic.org/health/diseases/17809-interstitial-lung-disease
  • https://www.hopkinsmedicine.org/health/conditions-and-diseases/restrictive-lung-disease
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Transcript

Hey everyone, Today, we’re going to be creating a nursing care plan for restrictive lung diseases. So, let’s get started. So first we’re going to go over the pathophysiology. So restrictive lung disease is a condition, either intrinsic or extrinsic, that causes the lungs to lose their ability to expand and contract. Some nursing considerations are respiratory status, supplemental O2, maintaining a patent airway, clustering care, giving appropriate nutrition and educating the patient and family. Some desired outcomes: we’re going to optimize oxygenation and ventilation, prevent pulmonary infections, and provide supportive care for the patient and family. 

So, we’re going to go ahead and get started on the care plan. Some subjective data, what are we going to see with these patients? So, a lot of patients will complain of having some shortness of breath. That is one of the most common ones. You’ll also see maybe possible clubbing of the fingers, some shallow breathing, or some accessory muscle use. Some other things you might see is dyspnea upon exertion hypoxia. Hypercapnia, some blue skin, lips, or nail beds, shallow breathing, clubbing of fingers, excess secretions, decreased SpO2, and the presence of a physical disorder, such as ALS, MD and, and quadriplegia. 

So, interventions, we want to make sure we’re doing a full respiratory assessment. So respiratory assessment. We also want to look at giving supplemental O2. We want to make sure we have a baseline lung sounds. We might want to get some ABGs. You’ll notice when this condition has worsened or when an intervention has worked. ABGs can show if interventions are working or if a patient is decompensating; it can tell if a patient is metabolic or respiratory acidosis. Another intervention we’re going to be doing we want to make sure we’re maintaining a patent airway. And we can help with cough assisting therapy, suctioning, secretions, ensuring that the patient’s getting an adequate amount of oxygen to the body and tissues want to make sure that we’re doing cluster care. This is going to help decrease oxygen demands and the patient’s rest is more maximized. So, the more that we can do in one time when we’re with the patient, the better. We want to make sure that the patient’s sitting upright for optimal breathing. So have the patient in like a high fowler’s position. So, like 90 degrees sitting upright ensures appropriate lung expansion, and it allows for maximum inspiration and expiration, which in turn gets better. gas exchange. Another invention we want to do is we want to make sure that we’re preventing pneumonia as it’s a complication. We want to make sure we’re performing good oral hygiene, making sure we’re suctioning the patient as needed and/or trach care. If they have a trach that’s placed, most common with a restrictive lung disease is pneumonia, and proper care prevents any infection from occurring. Another invention that we’re going to be doing is to make sure that the patient has proper nutrition. Malnourishment is common with lung disease. So, nutrition is essential to support healing. We want to make sure we’re educating the patient and families. So education. If a patient has any of the extrinsic causes, we want to make sure that we’re giving them coping mechanisms and ways to help improve their patient’s state of mind and quality of life. 

Okay, we’re going to go over some key points. So, this is a condition, either intrinsic or extrinsic, that causes the lungs to lose their ability to expand and contract. It can be caused by inflammation, sarcoidosis, ARDS, pulmonary fibrosis, and pneumonia. Some subjective and objective data: you’re going to see they’ll complain of some shortness of breath. Dyspnea upon exertion, hypoxemia, clubbing of the fingers, maybe some blue skin lips, nail beds, accessory, muscle use, shallow breathing and decreased SpO2. We’re going to do an assessment. We’re going to make sure we’re doing respiratory assessments, maintaining a patent airway, making sure the patient’s sitting upright, preventing complications, such as pneumonia. We’re going to make sure we’re providing supplemental O2, doing cluster care, giving appropriate nutrition and making sure we’re educating the patients. And there you have it, a completed care plan. 

Great job guys. We love you. Go out and be your best self today and as always, happy nursing!

 

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