Nursing Care Plan for COPD – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plan for COPD plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Chronic obstructive pulmonary disease classifies a group of respiratory disorders characterized by chronic and recurrent airways obstruction. COPD is a combination of the three separate diseases; mainly emphysema and bronchitis; however, to a lesser extent, asthma, which come together to create the typical pathophysiological disease process.

Pathophysiology of COPD

The mechanisms involved in COPD development include the inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands, hypersecretion of mucus, destruction of alveoli, and loss of elasticity in the lungs. Inflammation, fibrosis and excess mucus cause obstruction of the airflow and cause a reverse in ventilation and perfusion. Destruction of the alveoli decreases the surface area in the lungs that are available for gas exchange, and loss of elasticity leads to airway collapse. Due to the lack of elasticity, they prevent the lungs from stretching during inspiration, and they cause the retaining of air during expiration, ultimately increasing the risks for airway collapse.

The thickening of airways walls characterizes the progression of COPD. The walls of the airways become infiltrated by various immune and inflammatory cells (phagocytes, CD4 T cells), and with each progression to each further state, more of these cells are noted.

Diseases Related to COPD/ Types of COPD

EMPHYSEMA

• It is characterized by airflow obstruction from changes in the lung tissue

• The walls between the alveoli lose elasticity and break, and the air becomes trapped in the enlarged spaces.

• This impairs gas exchange

• Physical Appearance— Cachectic appearance, weight loss tachypnea, use of accessory muscles, pink skin colour

• Complaints— Persistent SOB, progressive exertional dyspnea

• Progressive deterioration in lung function with disease progression

CHRONIC BRONCHITIS

• Acute Bronchitis is an inflammation of the bronchial tree caused by an infectious organism or irritating agents such as smoke, dust, pollen, or chemical irritants

• Chronic Bronchitis is characterized by repeated attacks of acute bronchitis lasting for at least three months over two years.

• Physical Appearance— Stocky build with no hx of weight loss; use of accessory muscles to breathe in late stages cyanotic; barrel chest

• Complaints— Persistent cough, copious sputum

• Variable with exacerbation related to infection

• Frequent episodes of Cor Pulmonale with dependent edema, elevated hematocrit

Cor pulmonale

• Is a failure of the right side of the heart caused by prolonged high blood pressure in the pulmonary artery and the heart’s right ventricle.

Symptoms/Signs

• Shortness of breath

• Symptoms of underlying disorders (wheezing, coughing, swelling of feet and ankles)

• Exercise intolerance

• Chest discomfort

• Bluish colour to the skin (cyanosis)

• Distension of the neck veins indicating high right-sided heart pressure

• Abnormal fluid collection in the abdomen enlargement of the liver

• Abnormal heart sounds

ASTHMA

• Chronic inflammatory disorder of the airways

• Symptoms include: SOB, chest tightness, wheezing and coughing

• Airflow limitation in asthma is reversible

• Acute asthma episodes can be mild to life-threatening

• Triggers include: irritants, allergens, and viral infections

• Triggers may change over time

Risk factors of COPD

  1. History of smoking or exposure to second-hand smoke
  2. Age – symptoms are typically noticed later in the disease process
  3. Gender is almost the same now in men and women. However, it was more common in men but is now seen more commonly in women.
  4. Pre-existing lung problems (infection, asthma)
  5. Exposure to Occupational hazards (dust, chemicals)
  6. Exposure Indoor and outdoor pollution
  7. Alpha 1-antitrypsin deficiency (genetic predisposition) or AAT is a protein that protects the lungs. This protein is produced in the liver. With deficient levels of this protein, a patient may exhibit the following symptoms:
  8. Shortness of breath and wheezing
  9. Repeated lung infections
  10. Tiredness
  11. Rapid heartbeat upon standing
  12. Vision problems
  13. Weight loss

However, it is essential to note that individuals may exhibit no symptoms at all.

Diagnosis of COPD

  1. family and patient history
  2. chest x-Ray
  3. laboratory studies
  4. respiratory function tests

Signs and Symptoms of COPD

  1. Three primary symptoms – cough sputum, dyspnea, which will worsen with disease progression
  2. Weight loss is common
  3. Prolonged expiratory rate
  4. Dyspnea at rest is expected as the disease progresses
  5. Barrel shape chest
  6. Pursed lip breathing
  7. Clubbing of digits
  8. Pitting peripheral edema

Treatment Options for COPD

Treatment of COPD depends on the stage of the disease.

  1. Education of the disease, its process and various triggers are crucial to managing this disease.
  2. Smoking cessation is the only measure that will slow the disease progression. Thus nicotine replacement via patch, gum or inhalers may be used to reduce the withdrawal symptoms.
  3. In more advanced stages of COPD, patients will often require pharmacological treatments, activities to maintain and improve physical and psychological functioning, and oxygen therapy.

Medications:

Medications for the treatment of COPD include beta-2- adrenoceptor, anticholinergics, oxygen therapy, methylxanthines, and corticosteroids.

Beta-2-adrenoceptor agonists are the first-line therapy for COPD in acute exacerbations. These medications work on the beta 1 receptors, which are located in the heart and beta 2 receptors, which are located in the smooth muscle of the lungs, uterus and other organs. Medications that activate both receptors are called nonselective bronchodilators. Beta-agonists that activate only beta 2 receptors are selective. Selective drugs are common and better in treatment because they produce fewer cardiac side effects. These medications are given as a bronchodilator and are used on an as-needed basis to prevent or reduce obstruction related symptoms. Short and long-acting medications exist. Short-acting drugs have a rapid onset of action and are most frequently prescribed for exacerbations in a disease process, thus known as rescue agents. Long-acting medications have a slower onset of action, and these medications are used in combination with corticosteroids for prevention and disease management.

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Examples of these medications include: Ventolin (albuterol), Brovan (artormoterol), foradil (formoterol), xopenex (levalbuterol), maxair (pirbuterol), salmeterol (serevent), and terbutaline (brethine)

Adverse effects of these medications include headache, dizziness, tremor, nervousness, throat irritation and drug tolerance.

Serious adverse effects: tachycardia, dysrhythmias, hypokalemia, hyperglycemia, paradoxical bronchoconstriction

Anticholinergics are essential in the management of COPD exacerbation. While they are not first-line, they too are bronchodilators. These medications help to reduce airway tone and improve expiratory flow by blocking parasympathetic activity in the large and medium-sized airways. Because the parasympathetic is blocked, it stimulates the sympathetic nervous system. Anticholinergics also block the release of acetylcholine- which is known for its increase in bronchial smooth muscle tone and mucus secretion. Short and long-acting medications exist in this category.

Medications in this category include: ipratropium (Atrovent, Combivent), tiotropium (Spiriva); Atrovent is the most common anticholinergic medication prescribed for the treatment of COPD.

Adverse effects: headache, cough, dry mouth, bad taste, GI distress, anxiety

Serious adverse effects: pharyngitis

Corticosteroids are effective in increasing recovery from an acute COPD exacerbation.

These medications help reduce the swelling in the airways associated with COPD and its disease progress. This is established through the lessened activation of inflammatory cells and an increase in the production of anti-inflammatory mediators. Ultimately this allows for a decrease in mucus, edema and airway obstruction. These medications also increase the sensitivity of the bronchial smooth muscle to beta-agonist medications.

Medications include: beclomethasone (beconase AQ), budesonide (pulmicort), ciclesonide (alvesco), flunisolide (aerobid), fluticasone (flovent), mometasone (asmanex), triamcinolone (azmacort)

Adverse effects: hoarseness, dry mouth, cough, sore throat

Serious Adverse effects: oropharyngeal candidiasis, hypercorticism, hypersensitivity reactions

Mast cell stabilizers act by inhibiting the release of histamine from mast cells. These medications aid in reducing inflammation, and their primary use is in patients with asthma. These medications should be taken daily.

 Medications in this category include: cromolyn (Intal), nedocromil sodium (tilade)

Adverse effects: nausea, sneezing, nasal stinging, throat irritation, unpleasant taste

Severe adverse effects: anaphylaxis, angioedema, bronchospasm

Leukotriene modifiers are used to reduce inflammation and bronchoconstriction. Leukotrienes are mediators of the immune response involved in allergic and asthmatic reactions. When leukotrienes are released, they promote edema, inflammation, and bronchoconstriction.

 Medications: montelukast (Singulair), zafirlukast (accolade), zileuton (zyflo)

Adverse reactions: headache, nausea, diarrhea

Severe adverse reactions: liver toxicity, increased AST.

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Diagnostic Tests for COPD

Chest X-Ray

This is an important test to perform for a complete evaluation of the cardiac and pulmonary system and would be indicated to rule out lung anomalies. Much information can be found in chest x-ray studies, including:

1. Tumors of the lung, heart, chest wall and bony thorax.

2. Inflammation of the lung, pleura and pericardium.

3. Fluid accumulations in the pleura, pericardium and lung.

4. Air accumulations in the lung and pleura.

5. Fractures of the bones of the thorax or vertebrae.

6. Diaphragmatic hernia.

7. Heart size

8. Calcification

9. Location of centrally placed intravenous access devices

Typical findings include normal lungs, heart and surrounding structures.

Due to chronic bronchitis, patients exhibit increased bronchovascular markings and cardiomegaly in patients with COPD. Emphysema on x-ray is associated with a small heart, hyperinflation, flat hemi-diaphragms and possible bullous lung changes.

Bronchoscopy

The larynx, trachea, and bronchi are seen in a bronchoscopy through a fibreoptic bronchoscope. This test can assess inflammation in the lungs and thus contribute to bronchitis diagnosis. Also, infections can be detected by collecting specimens and their culture of them in a lab.

Typical findings for this test include a normal larynx, trachea, bronchi and alveoli.

Lung Scan

Lung scans help determine the blood perfusion of the lungs. It is most helpful in determining the presence of a pulmonary embolism but can be used to diagnose COPD. To evaluate blood flow in the lungs, macro aggregated albumin tagged with technetium is placed into the patient through a vein. Photos are taken which an image of the lung is obtained. Defects in the otherwise smooth and diffusely homogenous pattern indicate a perfusion abnormality. Normal findings include a normal diffusion and uptake of the nuclear material by the lungs, or no defects are noted.

Computed Tomography (Chest)

CT of the chest is a noninvasive, radiographic procedure for diagnosing and evaluating various conditions. In patients with COPD, increased lung space is a normal CT finding.

 A normal finding in patients without disease is the lack of illness.

Electrocardiography

An ECG is a test that records the electrical impulses of the heart. Normal findings include a normal heart rate, rhythm and wave deflections. In patients with respiratory compromise (dependent on the disease), right-sided heart strain is noted and is associated with cor pulmonale. Specifically, this will present on the ECG with an S wave in the lead 1, a Q wave in lead III, and a T wave inversion in the lead III. A patient with COPD may or may not present with cardiac issues.

Oximetry

A healthy individual is expected to maintain oxygen levels above 95%. In a patient with COPD, oxygen should be maintained between 88-92%. Patients with COPD have poor ventilation and perfusion and thus retain O2 and CO2. Because of this poor ability to perfuse O2 and CO2, if patients are given too much oxygen, they will become acidotic.

Oximetry monitors arterial oxygen saturation in levels at risk for hypoxemia.

Oximetry assists to maintain proper oxygenation saturation through the titration of O2.

Due to the obstructive and inflammatory process associated with COPD, I would expect a patients oxygen levels to be below.

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Nursing care plan for copd
Nursing Care Plan for COPD

Laboratory Studies

Creatine Kinase:

Male: 55-170

Female: 30-135

RBC:

Male: 4.7-6.1 x 10

Female: 4.2-5.4 x 10

HgB: 120-16 0 g/L

Hct: (0.37-0.47 %)

WBC: 5-10 x 10 (9)/L

Ferritin: 10-150 mcg/L

Iron: 11-29

Platelets: 150-400 x 10 (9)/ L

If COPD is a result of infection, elevated WBC would be noted.

Blood Gases:

  • Arterial blood gases:
  • PH: 7.35-7.45
  • Pco2: 35-45
  • HCO3 (bicarbonate): 21-28
  • Po2: 80-100
  • O2 saturation: 95-100%
  • Oxygen content: 15-22 volume percent
  • Base excess/deficit: 0-/+2

Venous blood gases:

  • PH: 7.35-7.45
  • Pco2: 40-50
  • HCO3 (bicarbonate): 21-28
  • Po2: 40-50
  • O2 saturation: 95-100%
  • Oxygen content: 11-16 volume percent

Respiratory acidosis is evidenced by a decrease in pH (usually less than 7.25), an increase in PCO2 (>60mmHg), and a normal bicarb. Respiratory acidosis is related to pulmonary disease, including COPD. Acidosis is more prevalent in patients with COPD because of their tendency to retain CO2. Respiratory alkalosis is evidenced by an increase in pH (>7.55), a decrease in PCO2  (<20mmHg), a normal bicarb. This disease is related to hyperventilation.

 Electrolytes:

  • Potassium: 3.5-5.0 (critical value if <2.5 or >6.5mmol/L)
  • Chloride: 98-106 (critical if value <80 or > 115mmol/L)
  • Sodium: 136-145 (critical value < 120 or if >160mmol/L)

Oftentimes, patients who are in later stages of COPD, anorexia and weight loss are common due to the difficulties associated with completing ADLs. Malnourishment may be prevalent.

  • BUN: 3.6-7.1 mmol/L

I would expect elevated levels of Blood Urea Nitrogen (BUN) as a result of dehydration.

  • Glucose Testing: 4-6

Nursing Diagnoses For Patients with COPD:

  1. Ineffective airway clearance
  2. Impaired gas exchange
  3. Activity intolerance

Nursing Care Plan for COPD Based on Diagnosis

Ineffective Airway Clearance

Ineffective airway clearance secondary to a diagnosis of COPD as evidenced by (include assessment findings related to the identified nursing problem such as, but not limited to: airway spasms due to an allergic reaction, presence of secretions on the airway, increased production of thick sputum, hyperplasia of the bronchial walls) as evidenced by (include assessment findings related to the identified nursing problem such as, but not limited to:

  • Patient complaints of difficulty in respiration
  • Complaints about not being able to effectively expectorate sputum
  • Presence of adventitious breath sounds (rales, crackles, or wheezing)
  • Changes in breathing patterns
  • In the worst-case scenario: alterations in one’s level of consciousness
  • Irritability and agitation

Desired Outcomes

The patient is expected to demonstrate the following nursing interventions:

  • The patency of the airways is improved.
  • Demonstrate measures to help clear airways
Nursing ActionRationale
Monitor the patient’s vital signs, especially noting for respiratory function parameters such as depth, rhythm, and rate.  This creates baseline information for patient condition and helps plan for adequate care.
Auscultate lung fields, noting the presence of wheezes, crackles, or other adventitious sounds.The adventitious breath sounds indicate accumulation of sputum, narrowing of the airways, and other complications that may necessitate immediate action.
Monitor the severity of complaints of dyspnea, identifying whether the patient uses accessory muscles to help in respiration and what factors cause dyspnea.  Patients with asthma may experience dyspnea when triggered by a specific stimulus. Knowing how severe episodes of dyspnea are and what causes them helps the murse in planning better care.
Administer oxygen therapy if needed.   Note: This is usually done for patients with moderate to severe airway clearance problems. Always check with the physician’s orders for the flow rate and equipment to use.Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Place the patient in a semi-sitting position if he is conscious. Some patients may feel more comfortable leaning on a table to ease the difficulty of breathing. Provide a pillow for comfort.Placing the patient in a semi-sitting position helps to allow maximal expansion of the lungs and the diaphragm, improving air intake and gas exchange.
Encourage pursed-lip breathing, focusing on doubling the time for the patient to exhale as compared to inhalation.Pursed lip breathing helps the patient regulate gas exchange and improve overall tissue perfusion.
Ensure that the environment is free from dust, pollen, and other allergens which may trigger bronchospasm.These substances trigger an allergic response in some patients and may further exacerbate the current symptoms.
Increase fluid intake to 3 litres daily if not contraindicated. Ensure that these liquids are provided tepid or at room temperature and given in between meals.Warm, room temperature or tepid liquids prevent further bronchospasm from occurring, allowing improved airway clearance. Providing fluids in between meals also helps reduce aspiration and relieves pressure on the diaphragm.
Encourage the patient to turn in bed once every 2 hours or to ambulate several times daily.Movement aids in mobilizing secretions, helping the patient expectorate them or eliminate them via the GI tract.
Involve significant others in instructing patients about how to perform chest physiotherapy and postural drainage. Ask them to demonstrate the steps after the health education.Chest physiotherapy helps loosen secretions, allowing them to be expectorated easier. Demonstrating the proper way to the patient and his significant others and asking them to return-demonstrate ensures that they understand the instructions well.
Perform suctioning when necessary.This procedure is done among patients who have thick sputum that is difficult to expectorate in other ways. Suctioning helps clear the airway of these secretions and improves airway patency.

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Nursing care plan for copd
Nursing Care Plan for COPD

Impaired Gas Exchange

Impaired gas exchange due to a shift in oxygen flow to the airway as a result of COPD-associated air sac inflammation as demonstrated by (including evaluation findings relating to impaired gas exchange such as, but not limited to:

Breathing problems

Irritability and restlessness

Inhalation requires the use of auxiliary muscles.

Breathing that is quick and shallow

Cyanosis of the circum-oral cavity

Oxygen saturation levels lower than 85%

Respiratory acidosis is revealed by ABG measurements.

Desired Outcomes

Following nursing interventions, the patient should be able to:

  • Show that you’ve improved your gas exchange.
  • A substantial increase in ABGs and oxygen saturation
Nursing ActionRationale
Monitor the patient’s vital signs, especially noting respiratory function parameters such as depth, rhythm, and rate.  This creates baseline information for patient condition and helps plan for adequate care.
Auscultate lung fields, noting the presence of wheezes, crackles, or other adventitious sounds.The adventitious breath sounds indicate accumulation of sputum, narrowing of the airways, and other complications that may necessitate immediate action.
Note for any skin colour changes and the mucus membranes’ status, paying close attention to cyanosis.Cyanosis of the nailbeds, the skin, or ear lobes may be due to hypoxemia and needs immediate attention.
Encourage the patient to perform deep breathing and coughing to expectorate sputum.   Note: For patients who are bedridden or cannot expectorate sputum independently, suctioning may be recommended.This action helps establish independence on the part of the patient and helps maintain his optimal functioning. Patients who feel that they are being considered as an essential part of their care are more likely to cooperate with interventions directed to them.
Administer oxygen therapy as prescribed.Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Place the patient in a semi-sitting position if they are conscious. For unconscious or weak patients, elevate the head of the bed and place support to prevent falling.Placing the patient in a semi-sitting position helps to allow maximal expansion of the lungs and the diaphragm, improving air intake and gas exchange.
Encourage pursed-lip breathing, focusing on doubling the time for the patient to exhale as compared to inhalation.Pursed lip breathing helps the patient regulate gas exchange and improve overall tissue perfusion.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.
Nursing ActionRationale
Assess the patient’s activity tolerance prior to diagnosis, noting his perceived limitation due to the diagnosis.  This creates baseline information for patient condition and helps plan for effective care.
Encourage the patient to perform self-care tasks within the level of tolerance, pausing when breathlessness sets in.This helps maintain independent self-care and makes the patient feel in control of his situation.
Add progressive activities and exercises in the patient’s care plan, gradually increasing activity levels within tolerance.Prepares the patient for more complicated tasks but prevents fatigue and tiredness because activity resistance gradually increases.
Alternate periods of activity and rest.Decreases oxygen demands of the patient, allow him to rest, regain strength and prepare to take on additional activities.
Administer oxygen therapy as prescribed.Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.

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Nursing care plan for copd
Nursing Care Plan for COPD

Activity Intolerance

Activity intolerance is related to an imbalance between oxygen supply and oxygen demands of the tissues, as evidenced by

  • Asthma
  • Tiredness
  • Complaints of weakness
  • Fatigue
  • An explicit expression of a profound lack of energy

Desired Outcomes

The patient should display the following nursing interventions:

  • Tolerance for more activities
  • He takes an active role in carrying out his everyday activities.
Nursing ActionRationale
Assess the patient’s activity tolerance prior to diagnosis, noting his perceived limitation due to the diagnosis.  This creates baseline information for patient condition and helps plan for effective care.
Encourage the patient to perform self-care tasks within the level of tolerance, pausing when breathlessness sets in.This helps maintain independent self-care and makes the patient feel in control of his situation.
Add progressive activities and exercises in the patient’s care plan, gradually increasing activity levels within tolerance.Prepares the patient for more complicated tasks but prevents fatigue and tiredness because activity resistance gradually increases.
Alternate periods of activity and rest.Decreases oxygen demands of the patient, allow him to rest, regain strength and prepare to take on additional activities.
Administer oxygen therapy as prescribed.Providing humidified oxygen helps relieve the patient from the strain of having to catch his breath to take in more are, improves oxygenation and gas exchange, and helps reduce dryness of the lung fields.
Arrange for collaborative care, especially after discharge. Refer the patient to a physiotherapist.Arranging for a physiotherapist helps ensure continuity of care and maintenance of the patient’s optimal level of functioning.
Provide diversionary activities to help manage pain, such as guided imagery, use of music, meditation.Allows the patient to focus his attention other than the pain. These activities may also help enhance his mood and response to other measures.

Related FAQs

1. What is a good nursing diagnosis for COPD?

Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): Ineffective Airway Clearance. Impaired Gas Exchange. Ineffective Breathing Pattern.

2. What is the main cause of COPD?

Smoking. About 85 to 90 percent of all COPD cases are caused by cigarette smoking. When a cigarette burns, it creates more than 7,000 chemicals, many of which are harmful.

3. What are the 5 symptoms of COPD?

What Are COPD Symptoms?

  • Chronic cough.
  • Shortness of breath while doing everyday activities (dyspnea)
  • Frequent respiratory infections.
  • Blueness of the lips or fingernail beds (cyanosis)
  • Fatigue.
  • Producing a lot of mucus (also called phlegm or sputum)
  • Wheezing.

4. What are the three stages of COPD?

There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale.

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