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Wednesday, December 5, 2012

Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease, also knwon as chronic airflow limitation (CAL), chronic obstructive lung disease (COLD), chronic obstructive respiratory disease (CORD), chronic obstructive airway disease(COAD) is a group of conditions that obstruct pulmonary airflow, resulting in air being trapped in the alveoli and then make difficult to breathe.

There are two main forms of COPD :

    Chronic obsturctive bronchitis, a productive cough that persisting for 3 months of the year for at least 2 consecutive years, causes inflamed airways that lead to increased mucus production and bronchospasms. Mucus plugs entrap air and result in alveolar hyperventilation. Patient will have severe hypoxemia and polycythemia, with hematrocit values from 50 % to 55 %.

    Emphysema, characterized by enlargment of the alveoli distal to the terminal bronchioles, leads to alveolar wall destruction. obstructed expiratory airflow and irreversible loss of the lung elasticity. It is causes less hypoxemia and hematrocit values commonly normal.
The causes COPD :
  • Allergens.
  • Smoking.
  • Alpha-1 antitrypsin deficiency.
  • Chronic respiratory tract infection.
  • Airborne irritants and pollutants, like certain gases or fume in the workplace and using cooking fire without proper ventilation.
Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD).



Assesment findings in COPD :
  • Anatomic changes (such as barrel chest and clubbing) in late disease.
  • Cough (evaluate characther, frequency and time of day).
  • Decreased breath sounds, hyperresonant breath sounds on percussion and wheezing.
  • Cor pulmonale (right-sided heart failure).
  • Prolonged expiration.
  • Dyspena.
  • Jugular vein distention.
  • Peripheral edema.
  • Use of accessory muscles.
  • Pursed-lip breathing.
  • Sputum (amount, color and consistency).
  • Use of accessory muscles.
  • Risk factors.
Diagnostic evaluation for COPD :
  • ABG levels show hypercapnia and hypoxemia. Bicarbonate levels may increase to compensate for chronic hypercapnia and the resultant respiratory acidosis.
  • Pulmonary function test, especially spirometry, reveal diminished lung function.
  • Pulse oximetry may show a decrease in arterial oxygen saturation, which indicates impending hypoxia.
  • Complete blood count shows elevated hemoglobin level and hematocrit.
  • Chest X-ray provides baselines norms; in late disease, the patient's diaphragms appears flat.
  • ECG shows signs of right ventricular hyperthrophy in late disease.
Treatment for COPD :
  • O2 therapy at 2 to 3 L per minute and transtracheal therapy for home O2 therapy.
  • Fluid intake up to 3 L per day if not contraindicated by heart failure.
  • Chest physiotherapy, postural drainage and incentive spirometry.
  • Diet high in protein, vitamin C. calories and nitrogen. Patients with advanced disease may require a diet thats's low in carbohydrates and higher in fats.
Drug therapy option for COPD :
  • Antibiotic : infecting organism determines which drugs is used.
  • Bronchodilator : aminophylline, terbutaline, theophylline; by nebulizer: albuteral (proventil), ipratropium bromide (atrovent), metaproterenol sulfate (alupent).
  • Expectorant : guaifenesin.
  • Steroid : hydrocortisone, methylprednisolone sodium succcinate; by nebulizer : beclomethasone, triamcinolone.
  • Antacid : aluminum hydroxide gel.
  • Diuretic : furosemide (lasix).
  • Alpha-1 antitrypsin.
  • Vaccine : influenza, pneumovax.
Nursing Diagnoses for COPD :
    1.Ineffective airways clearance.
    2.Impaired gas exchange.
    3.Fatigue.
    4.Chronic low self esteem.
Planning and goals of nursing care plan for COPD :
  • The client will have an adequately clear airway.
  • The client will establish an effective breathing pattern.
  • The client will maintain adequate gas exchange.
  • The client will remain free from infection.
  • The client will understand why he should avoid respiratory irritants.
Nursing intervention for COPD :
  • Assess respiratory status and ABG and pulse oximetry studies to evaluate oxygenation.
  • Administer low-flow oxygen, if indicated, ussually 1 to 2 L per minute in 24 % to 28 % concentrations (Client with emphysema respond only to low oxygen tension, if it too much oxygen reduces the drive to breathe and contributes to respiratory failure)
  • Monitor cardiovascular status to detect arrhythmias related to hypoxia or adverse response to medications.
  • Monitor and record amount, color and consistency of sputum.
  • Encourage the cllient to drink plenty of fluids and weight patient daily to monitor for fluid overload and right -sided heart failure.
  • Monitor electrolytes levels, blood counts and drug levels for indications of possible toxic reaction.
  • Encourage activity as tolerated to help the client to avoid fatigue.
  • Provide chest physiotherapy, including postural drainage and percussion, incentive spirometry and suction as needed- to aide in removal of secretions.
  • Administer medications as prescribed to relieve symptoms and prevent complications.
Nursing evaluation for COPD :
  • The patient remain free from respiratory tract infection.
  • The patient will regularly practices breathing exercises and his breathing efficiency increases.
  • The patient will stop smoking and obtains a job with little or no exposure to respiratory irritants.

6 comments:

  1. Hi you people are really doing an awesome. I was looking for assisted living in Denver Co, and found your post. Very Impressive.

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  2. I am not sure of the cause of COPD emphysema in my case. I smoked pack a day for 12 or 13 years, but quit 40 years ago. I have been an outdoor person all my adult life. Coughing started last summer producing thick mucus, greenish tint to clear. I tried prednisone and antibiotics, but no change. X-rays are negative, heart lungs and blood and serum chemistries all are normal. I have lung calcification from childhood bout with histoplasmosis. I am 75 years old and retired.My current doctor directed me to totalcureherbsfoundation .c om which I purchase the COPD herbal remedies from them ,they are located in Johannesburg, the herbal treatment has effectively reduce all my symptoms totally, am waiting to complete the 15 weeks usage because they guaranteed me total cure.

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  3. I'm 59 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 59 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of  Dr Akhigbe   total cure herbal medicine. my husband saw his testimony on the internet he used his powerful medicine to cured differents diseases. we contacted his email   [drrealakhigbe@gmail.com}   He has the right herbal formula to help you get rid and repair any lung conditions and others diseases, will cure you totally and permanently with his natural organic herbs,We received the medicine through courier delivery service. I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life.
    Dr Akhighe also cured diseases like, HERPES, DIABETES, HIV/AIDS, COPD, CANCER,ASTHMA,STROKE,LUPUS,JOINT PAIN,CHRONIC DISEASES,PARKINSON DISEASES,TUBERCULOSIS,HIGH BLOOD PRESSURE,BREAST INFECTION,WOMEN SEXUAL PROBLEM, ERYSIPELAS,STAPHYLOCOCCUS,HERPATITIS A/B, QUICK EJACULATION,GONORRHEA,SYPHILIS,WAST/BACK PAIN,PELVIC INFLAMATORY, DICK ENLARGEMENT,HEART DISEASES,TERMINAL ILLNESS,SHIFT IN FUCUS,ATAXIA,COMMON COLD,CROHN'S DISEASES,ALCOHOL SPECTRUM DISORDER,GRAVES DISEASE,HEARING LOSS, INTERSTITIA CYSTITIS,LEUKEMIA,MULTIPLE SCLEROSIS,OBESITY,RABIS,SCOLIOSIS,INFLUENZA, POLIO,JACOB,ETC. If you are out there looking for your cure please  contact  dr Akhigbe  by his email    drrealakhigbe@gmail.com     or contact his whatsapp number   +2349010754824
    God bless you Dr Akhigbe for your good hand work on my life

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  4. After years of working in construction and smoking cigarettes,I was diagnosed with COPD and pulmonary fibrosis. As my illness progressed, I found myself  relying on supplemental oxygen around the clock. Even getting out of bed became a challenge.My doctors and specialists recommended a lung transplant, but after researching the pros and cons of such a drastic procedure, I decided to try something less invasive. I contacted multivitamin herbal cure cape town for organic natural treatment you can search for them on google. Following the COPD and pulmonary fibrosis herbal treatment procedure , my lung function has improved dramatically after my first four weeks of the herbal formula .My quality of life has gotten a lot better. I was amazed that I could breathe without any dead air. I no longer need oxygen and look forward to continued improvement because a specialist told me already I have a 99% chance of getting my condition totally due to the herbal treatment effectiveness . If you or someone you love has COPD, pulmonary fibrosis or another chronic lung disease, and would like to see improvements like mine they even guarantee me totally cure once the treatment is done , their website is www.multivitamincare.org Call (or SMS) them : +1 (786) 544-5148 they will put you through on the herbal process .

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  5. “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
    Denise F. lived with COPD and chronic asthma for many years. When her quality of life continued to decline, Denise decided to try something different.While being with her horses brought her peace and joy, not being able to breathe made spending time with them challenging. When her grandchildren would visit, she couldn’t even participate in their activities.
    After the herbal recommendation at the multivitamincare .org, Denise my best friend no longer needs oxygen or a walker and has seen many improvements. She can walk, clean her house, go shopping, enjoy a vacation, ride her horses, lift hay bales and do anything she wants to do.
    Now, when her grandchildren visit, they can ride horses together and make wonderful memories. And, Denise wants to lead the way, “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
    If you or someone you love has COPD, emphysema, pulmonary fibrosis or another chronic lung disease and would like to see results like Denise’s, contact them at +1 (956) 758-7882 or their website to learn more about your lung disease treatment options.

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  6. I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their website at www.ultimatelifeclinic.com I can breath much better and It feels comfortable!

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