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.