Nursing Care Plan For Chronic Obstructive Pulmonary Disease

Nursing Care Plan For Chronic Obstructive Pulmonary Disease

A nursing care plan describes the process of recognizing a patient’s requirements and supporting holistic care, which is often done in accordance with a five-step structure. Nurses, patients, as well as other healthcare professionals collaborate more effectively when they have a care plan (nurse.org 2022). Nursing care plans are intended to enhance evidence-based nursing care while also creating a comfortable and familiar environment in hospitals or health-care facilities. In addition, nurse care plans promote holistic care, which includes the treatment of the full person, including the physical, mental, social, as well as spiritual aspects of one’s being, in the context of illness management and prevention (Zamanzadeh et al. 2015). In this context, the care plan focused on a respiratory illness which is chronic obstructive pulmonary disease or COPD. Chronic Obstructive Pulmonary Disease (COPD) is a chronic dyspnea disease characterized by expiratory airflow restriction that does not change considerably (Agarwal, Raja and Brown 2020). Chronic Obstructive Pulmonary Illness (COPD) is illustrated by the Global Initiative against Chronic Obstructive Lung Disease” as a preventable as well as treatable illness with some major extra – pulmonary consequences that may lead to the seriousness in individuals.” The study would describe about the disease, the pathophysiological concepts of the disease, two major nursing diagnosis of COPD, the nursing assessment process of the disease and the nursing intervention of the disorder.

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Chronic Obstructive Pulmonary Disease, which is often shortly termed as COPD, can be said as the group of a progressive disorder that occurs in the lungs. The word progressive illustrate that this lung illness might become worse over the time (Agarwal, Raja and Brown 2020). These are long-term, debilitating conditions that cause airflow restriction. People suffering with COPD are at a greater risk to be recognized with additional cardiac issues, lung cancer and several other illnesses (Morgan, Zakeri and Quint 2018). It has no cure, but with correct management and suitable therapy, a person may obtain control over the symptoms, minimize the risk of other linked disorders as well as lead a quality life (Agarwal, Raja and Brown 2020). COPD is the condition which often makes it severely difficult for an affected individual to breathe. At primary level, the symptoms of the disease might be mild, however with the progression of the diseases, the symptoms of the disease become worse as well as continuous (nhs.uk 2022). When it comes to COPD, many people don’t notice the signs and symptoms until the disease has progressed to an advanced level. There are number of signs or indication that a person must give attention such as chest tightening, wheezing, coughing, yielding an excess amount of mucus (phlegm), frequent lung infection such as cold and flu and most important is the dyspnea or shortness of breath after activities (Agarwal, Raja and Brown 2020). A patient with COPD may experience exhaustion, weight loss, blue or grey fingernails (an indication of low oxygen levels in your blood), difficulty to communicate, confusion, and other symptoms that demand prompt medical intervention.

Pathophysiology Of The Disease

From the pathophysiological aspect it can be added that when an infected person coughs or sneezes, the air goes from the windpipe (trachea) to the lungs via two tubes known as bronchi, which are located below the lungs. The bronchi are divided into many smaller tubes, similar to the way a branch of a tree divides into numerous smaller tubes (Medlineplus.gov 2022). The tiny tubes are referred to as bronchioles. Tiny sacs can be found at the end of the small tubes (alveoli). Alveoli have delicate walls made up of a network of small blood arteries (capillaries). During the process of breathing, air flows through these blood arteries and into the body’s circulation while carbon dioxide is expelled from the body. Because the bronchial tubes as well as air sacs are so flexible, the lungs depend on this flexibility to push air out of the body. Damage to these tubes and sacs is caused by COPD, which eventually leads them to overexpand, resulting in some air remaining in the lungs even after a person has exhaled (Anzueto and Miravitlles 2017). COPD is characterized by inflammation of the lungs’ airways, resulting in decreased airflow into and out of the lungs. As an outcome, the body obtains less oxygen and it becomes more difficult to expel carbon dioxide, which causes COPD symptoms.

From various evidence it can be known that the reaction of the host to inhaled stimuli cause the inflammatory responses that is accountable for the modification in the alveoli, airways, as well as pulmonary blood vessels (Anzueto and Miravitlles 2017). Macrophages, neutrophils, and other leukocytes that have been activated are at the center of this process. Chronic inflammation is exacerbated by oxidative damage and an overabundance of proteases. Progression of terminal as well as transitional bronchioles disappears as airways smaller than 2 mm in diameter get thicker as a result of airway remodeling. Inflammation in the inflammatory cascade of COPD may be triggered by eosinophils, which are normally found in the bloodstream of those with allergies (Aghasafari, George and Pidaparti 2019).

A person, family, organization, or community might display a nursing diagnosis as the clinical judgement related to or linked with the human reaction to certain health problems or life processes, or a susceptibility for this response (nurse.org 2022). There are number of nursing diagnosis of COPD. However, in this context two of the nursing diagnosis have been chosen which are: Impaired gas exchange and Ineffective airway clearance.

Ineffective airway clearance which is the first nursing diagnosis often takes place when an artificial airway is utilized since the mechanism of normal mucociliary transport are impaired and bypassed (Chaves et al. 2016). Assessment as well as intervention by nursing professionals are the major options to maintain the airway patency in the individuals with an artificial airway in place.

On other hand, Impaired gas exchange happens as a result of alterations in the alveolar-capillary membrane, which include fluid shifts as well as fluid collecting in the interstitial space as well as alveoli (Pascoal et al. 2015). As a result, there is an excess or shortage of o2 at the alveolar capillary membrane, which results in inefficient carbon dioxide removal at the capillary membrane.

Nursing Diagnosis Of COPD

The assessment phase is the first step in the nursing care and contributes as the foundation for the formulation of a care plan. Having a complete picture and understanding of the patient’s situation is critical to a good evaluation. Individual patient needs and concerns, as well as impediments to care that may affect patient compliance and outcomes, are recognized objectively by nurses through evaluations (Toney-Butler and Unison-Pace 2018). The importance of doing regular health assessments on each patient cannot be overstated. Documenting changes in status and progress toward goals is an important part of any treatment plan. Nurses who do precise assessment should have a great attention to detail as well as a thorough grasp of the body’s processes (Toney-Butler and Unison-Pace 2018). In order to maintain and improve their assessment abilities, nurses should keep learning and refining their skills all across their employment.

The nursing assessment of the first nursing diagnosis impaired gas exchange, which are mentioned below:

• Determine and record the rate and depth of breathing. Take note of the usage of auxiliary muscles, the breathing with a pursed mouth, and the incapacity to talk or interact (Prado, Bettencourt and Lopes 2019). The idea for this procedure is that it is effective in determining the severity of respiratory distress or the duration of the illness process.
• Assess the colour of the skin and mucous membranes and check them on a regular basis. The reasoning behind this is that AS Cyanosis can be either peripheral (as seen in nail beds) or central (as seen around the lips or earlobes) in nature. Acquired hypoxia is shown by duskiness and cyanosis in the central region (Prado, Bettencourt and Lopes 2019).
• Measuring the oxygen saturation and adjust oxygen concentrations to keep Sp02 in the 88-92 percent range (Pilcher and Beasley 2015). A pulse oximetry reading of 87 percent or less may suggest the requirement for oxygen administration, whereas a pulse oximetry reading of 92 percent or more may indicate the need for oxygen titration or delivery.

The nursing assessment for ineffective airway clearance are mentioned below:

• Assessing as well as monitoring the breath sounds and respiration rate, and recording the score as well as sounds such as tachypnea, crackles, stridor, wheezes (Sarkar et al. 2015). The nurse must assess the inspiratory as well as expiratory ratio. The rationale is that tachypnea is generally varied, and it might become more noticeable upon admission, at times of stress, or when there is an acute infectious process occurring at the same time. In certain cases, respirations are shallow and quick, with exhalation lasting longer than inspiration in contrast to inspiration.
• The following assessment is to auscultating the breath sounds and noting the adventitious breath sounds (Sarkar et al. 2015). The rationale is that whenever there is a blockage in the airway, there will be some extent of bronchospasm existing, and this will either be evidenced in adventitious breath sounds such as dispersed, moist crackles (bronchitis) or faint sounds with expiratory wheezes (emphysema), or it will not be evidenced in breath sounds at all (asthma) (severe asthma).

The nursing intervention for the first nursing diagnosis impaired gas exchange, those are mentioned below:

• Lift the head of the bed and help the patient in a posture that will lessen the burden on their lungs (Spooner et al. 2014). As tolerated, incorporate time spent in a prone posture. As needed or acceptable, highly appreciative, slow, or pursed-lip breathing. The most important thing to remember is that breathing exercises and an upright position can help enhance oxygen supply. PaO2 can be raised by lying on your stomach or back.
• The following course of action is an option: Measure the tolerance for physical exertion. Maintain a serene and tranquil atmosphere (O’Donnell and Gebke 2014). During the acute period, restrict the patient’s movement or advise bed or chair rest. Slowly raise the patient’s level of activity until it is safe for him or her to do so. Hypoxia and dyspnea may render a patient incapable of doing even the most basic self-care tasks in cases of severe, acute, or refractory respiratory distress. In the treatment plan, rest and care activities are interwoven throughout the day. It is possible to feel better by participating in an exercise programme that increases endurance and strength without triggering severe dyspnea.
• The next nursing action may be to assess the patient’s sleep habits, take note of any challenges they’re having, to see if they’re feeling refreshed. Limit stimulants like caffeine; support a posture of comfort; and provide a calm atmosphere for unbroken sleep (O’Callaghan, Muurlink and Reid 2018). It would be as crucial as ever. The presence of dyspnea and several environmental stimuli may hinder relaxation and sleep.
• Another nursing intervention in this context could be, administering the noninvasive positive pressure ventilation (NIPPV) as per the prescription of the doctor. The rationale behind this intervention is that during the first four hours of therapy, patients with severe dyspnea may benefit from using noninvasive positive pressure ventilation to reduce PacO2 and raise blood pH.

The nursing intervention for ineffective airway clearance are mentioned below:

• Help the patient in finding a comfortable position (lift the head, help the patient to lean on an overbed table or sit on edge of the bed) (Spooner et al. 2014). However, patients in extreme discomfort will choose the posture that makes breathing the most comfortable, regardless of the rationale that elevating the bed’s head will help respiratory function. Supporting the arms and legs using a table, cushions, or other objects reduces muscular fatigue and may assist expand the chest as well.
• The following course of action is an option: where nurses need to observe the distinct features of a sneeze (persistent, hacking, moist). Assist in the implementation of strategies aimed at increasing the efficacy of coughing (Torres-Castro et al., 2014). Patients who are aged, critically ill, or otherwise incapacitated are more likely to suffer from continuous coughing, which is why this treatment is recommended. After chest percussion, it’s best to cough upright or with your head down.
• Another nursing intervention in this portion could be helping the patient in turning and changing the position every 2 hours (Latimer, Chaboyer and Gillespie 2015). In case ambulatory, the nurse must allow the patient to ambulate as tolerated. The rationale is that movement might contribute in mobilizing the secretions for facilitating clearing of airways.
• Lastly, increase fluid consumption to 3000 mL each day under cardiac tolerance as a possible next step. Providing warm or tepid drinks. Encourage the drinking of fluids between, instead of during, meals (Riebl and Davy 2013). The rationale behind the effect is that hydration helps lower the viscosity of secretions, enabling expectoration (Riebl and Davy 2013). Using warm drinks may lessen bronchospasm. Fluids during meals might enhance stomach distension and strain on the diaphragm.

The outcome can be two types, the first one is the desired outcomes where a specific goal or objective has been established and another outcome can be explained as the evaluation method which is done after the intervention and care that indicates if the desired goals has been fulfilled or not and the patient condition has been improved by the intervention or not.

In this context, the desired outcomes for the first nursing diagnosis, impaired gas exchange are:

• Demonstrating the patient about the improved ventilation as well as sufficient oxygenation of the tissues by ABGs inside the patient’s normal range as well as be rid of the signs of the respiratory distress.
• Another desired outcome is that the patient actively take part in the treatment regimen inside the level of ability.

After the initiation of the care plan, the outcomes which have been expected are:

• Patient involves proper gaseous exchange as demonstrated by normal mental status, primarily driven respirations at 12-20 breaths every minute, oximetry readings within range of normal, blood gases under normal range, as well as baseline heart rate for the patient (all inside the normal range).

In contrast, the desired outcomes for the second nursing diagnosis- ineffective airway clearance are:

• The first nursing outcome is to maintain airway patency with clear breathing sounds.
• The following nursing outcome could be demonstrating the behaviours for improving the airway clearance, that means efficiency of the cough as well as expectorate secretions.

The evaluation or the expected outcome of the desired outcomes are:

• Effective airway clearance and improved breathing sound pattern. The respiratory rate, heart rhythm as well as depth of the patient has been improved and within the normal range. Moreover, the patient is able to effectively remove the airway secretions which indicate about the clearance of the airway.

Nursing diagnosis	SMART goal	Nursing intervention	Outcome evaluation
Impaired gas exchange	Short term: Improving the ventilation and oxygen concentration within 3-4 hours. Long term: Patient is actively taking part into the intervention and following the advices. ORDER YOUR PAPER HERE	1: Lift the head of the bed and help the patient in a posture to improve the gas exchange through improving the lung function. 2: Measure the tolerance for physical exertion. Maintain a serene and tranquil atmosphere 3: Assess the patient’s sleep habits, take note of any challenges they’re having, to see if they’re feeling refreshed. 4: Administering the noninvasive positive pressure ventilation (NIPPV) as per the prescription of the doctor.	Oximetry readings within range of normal, blood gases under normal range, as well as baseline heart rate for the patient
Ineffective airway clearance	Short term: Clearing the airways and minimizing the breathing sounds within 3-4 hours. Long-term: The patient obtains and follow the behaviour to maintain the effective behaviour.	1: Assist the patient in finding a comfortable position such as lift the head of the bed, have patient lean on an overbed table or sit on edge of the bed. 2: Assist in the implementation of strategies aimed at increasing the efficacy of coughing. 3: Helping the patient in turning and changing the position every 2 hours. 4: Increase fluid consumption to 3000 mL each day under cardiac tolerance.	Effective airway clearance and improved breathing sound pattern. The respiratory rate, heart rhythm as well as depth of the patient has been improved

Conclusion

The study was mainly focused on nursing care plan and it was said that nurse care plans promote holistic care, which includes the treatment of the full person, including the physical, mental, social, as well as spiritual aspects of one’s being, in the context of illness management and prevention. In this study, the nursing care plan was based on one of the major respiratory disease COPD. Chronic Obstructive Pulmonary Disease, which is often shortly termed as COPD, can be said as the group of a progressive disorder that occurs in the lungs. These are long-term, debilitating conditions that cause airflow restriction. COPD is a chronic lung disease that frequently makes it extremely difficult for an afflicted people to breathe properly. The symptoms of the disease may be moderate at the beginning of the disease; nevertheless, as the disease progresses, the symptoms of the disease get severe as well as continuous. People suffering with COPD are at a greater risk to be recognized with additional cardiac issues, lung cancer and several other illnesses. in this context two of the nursing diagnosis have been chosen which are: Impaired gas exchange and Ineffective airway clearance. The nursing assessment, intervention, nursing outcome/evaluation all are described in this study and it was found that with the effective intervention process such as elevating the head, changing the patient positioning, Maintain a serene and tranquil atmosphere, improving the patient’s noninvasive positive pressure ventilation (NIPPV), Increase fluid consumption could be very effective intervention strategies that might help the patients to improve the condition and clear the airway and help in effective gas exchange and preventing further complications associated with COPD. 

Reference

Agarwal, A.K., Raja, A. and Brown, B.D., 2020. Chronic obstructive pulmonary disease (COPD).

Aghasafari, P., George, U. and Pidaparti, R., 2019. A review of inflammatory mechanism in airway diseases. Inflammation research, 68(1), pp.59-74.

Anzueto, A. and Miravitlles, M., 2017. Pathophysiology of dyspnea in COPD. Postgraduate medicine, 129(3), pp.366-374.

Chaves, D.B.R., Beltrão, B.A., Pascoal, L.M., Oliveira, A.R.D.S., Andrade, L.Z.C., Santos, A.C.B.D., Moura, K.K.M.D., Lopes, M.V.D.O. and Silva, V.M.D., 2016. Defining characteristics of the nursing diagnosis” ineffective airway clearance”. Revista Brasileira de Enfermagem, 69, pp.102-109.

Latimer, S., Chaboyer, W. and Gillespie, B.M., 2015. The repositioning of hospitalized patients with reduced mobility: a prospective study. Nursing open, 2(2), pp.85-93.

Medlineplus.gov, 2022. COPD | Chronic Obstructive Pulmonary Disease | MedlinePlus. [online] Medlineplus.gov. Available at: <https://medlineplus.gov/copd.html> [Accessed 30 April 2022].

Nursing Care Plan For Chronic Obstructive Pulmonary Disease