- Demonstrate a comprehensive understanding of the pathophysiology of COPD, including the mechanisms of airflow limitation, chronic inflammation, and the impact on respiratory function.
- Acquire proficiency in implementing respiratory interventions aimed at improving ventilation, promoting effective airway clearance, and managing respiratory distress in individuals with COPD.
- Assist individuals with COPD in adopting and maintaining lifestyle modifications, including smoking cessation, proper nutrition, and regular exercise, to enhance overall respiratory health.
- 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.
- 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 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.
- 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.
- 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.
- 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.
- 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 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 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.
- 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, 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.
- Facilitate effective breathing patterns and reduce respiratory distress, enabling individuals with COPD to achieve and maintain adequate oxygenation and ventilation.
- 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.
- 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 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
Subjective Data:
- Difficulty Breathing
- Chest tightness
- “I can’t breathe”
Objective Data:
- Wheezing
- ↓ Oxygen saturation
- ↓ pH and ↑ pCO 2 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).
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.
- Monitor oxygen saturation levels through pulse oximetry to assess the adequacy of oxygenation. Document any fluctuations and response to supplemental oxygen if prescribed.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Inquire about current and past occupational exposures, environmental pollutants, and home conditions that may contribute to respiratory symptoms. Provide education on minimizing environmental triggers.
- 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
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
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 as tolerated
A 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.
- Educate patient on home oxygen safety, if applicable
Evaluation for Chronic Obstructive Pulmonary Disease (COPD):
- Respiratory Function Assessment:
- Regularly assess respiratory function through measures such as spirometry, peak expiratory flow rates, and arterial blood gas analysis. Monitor for changes in airflow limitation and oxygenation.
- Evaluate breathing patterns and respiratory distress by observing the individual’s respiratory rate, effort, and the use of accessory muscles. Assess for signs of dyspnea and intervene accordingly.
- Monitor and track the frequency and severity of exacerbations. Assess the effectiveness of preventive measures and interventions in reducing exacerbation rates.
- Assess the individual’s quality of life by considering factors such as symptom burden, functional capacity, and psychosocial well-being. Use standardized tools to measure health-related quality of life.
- Evaluate the individual’s proficiency in COPD self-management, including adherence to medication regimens, lifestyle modifications, and the ability to recognize and respond to worsening symptoms.
- Collaborate with the interdisciplinary healthcare team, including respiratory therapists, dietitians, and mental health professionals, to review the overall effectiveness of the care plan and make adjustments based on the individual’s evolving needs.
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.
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
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Example Nursing Diagnosis for Chronic Obstructive Pulmonary Disease (COPD)
- Ineffective Breathing Pattern: COPD often leads to breathing difficulties. This diagnosis addresses respiratory issues.
- Activity Intolerance: Patients with COPD may have limited tolerance for physical activity due to reduced lung function. This diagnosis helps plan appropriate activity levels.
- Risk for Impaired Gas Exchange: COPD can result in inadequate oxygen exchange. This diagnosis reflects the risk of poor oxygenation.
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!
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