COPD Nursing Care Program

Chronic obstructive pulmonary disease (COPD) refers to a category of lung disorders that involve refractory (non-reversible) asthma, chronic bronchitis, emphysema, and a variety of bronchiectasis types (COPD). Increased breathlessness is a symptom of this condition. Tightness in the chest, wheezing, repeated coughing (with or without sputum), and increased breathlessness are all signs and symptoms of COPD. According to Ford, Croft, and Giles, COPD affects an estimated 30 million Americans, with more than half of them having symptoms but not realizing it (2013). The majority of COPD is caused by dust, chemicals, and fumes found in many workplaces and inhaling contaminants such as second-hand smoke and smoking (cigars, cigarettes, and pipes, among others).
A nurse has a duty of helping a patient to develop a long-term care plan since COPD is a progressive disease and it is imperative to have a care a care plan in place for quality of life and overall health.

Pathophysiology

Oxygen entering is restricted and carbon dioxide is trapped since less air flow is able to flow into and out of the alveoli.

Etiology

The two types of COPD include Emphysema and Chronic Bronchitis. Smoking of any form: second-hand, cigar, pipe, and cigarette are the most common cause of COPD (Weldam, Zwakman, Lammers, & Schuurmans, 2016). COPD can also be caused and exacerbated by any lung irritant.

Desired Outcome

Nurse(s) developing care plan for COPD desire to see non-laboured, even, clear breathing while maintaining patient’s optimal oxygenation.

COPD Nursing Care Plan

Subjective Data: Objective Data

Chest tightness Shortness of breadth

Difficulty in breathing Wheezing

“I am unable to breath” -Tachycardia

-Swelling/edema

-Stopping to breathe (inability

to speak in full sentences).

-Oxygen Saturation

Nursing Interventions and Rationale

Avoid Irritants

Avoiding things that make COPD worse such as allergens (pollen or grain), weather (the bronchi can be aggravated by very cold weather), and quitting smoking or being around smoke is the key to evading flare-up. Weldam et.al connote that a health practitioner has to provide education on smoking with COPD as well as the benefits of quitting (2016).

Breathing Treatments and Medications

Weldam, et.al record that corticosteroids such as Fluticasone work as an anti-inflammatory, bronchospasms are relaxed by administering anticholinergics like Ipratropium, and beta-agonists like albuterol work as bronchodilators (2016).

Monitor Oxygen Saturation

Monitoring oxygen saturation is subjective as the nurse needs to ensure he/she understands the baseline of the patient. The nurse, therefore, needs to make sure oxygen monitoring is planned with the physician. As a general rule, oxygen for COPD patients should be kept around 88%-92% hence oxygen should be given as ordered as well as needed (Doenges, Moorhouse, & Murr, 2014). The nurse should also be careful about turning patient’s drive to breathe off by giving too much oxygen.

Obtain an ECG

A nurse should ensure patient’s heart is in a good state if the patient is having breathing problems since the lungs and the heart are in the same general area. Individuals having a heart attack feel like they cannot breathe due to pain or pressure on their chest in some cases. It is imperative to monitor the heart especially during an episode/exacerbation even if the main problem is breathing as COPD is also stressful on the heart.

Encourage Activity/movement

Less tolerance for movement and increased shortness of breath are caused by sedentary lifestyle. Breathing abilities can, therefore, be improved by helping the patient move more often.

Conclusion

Conclusively, a nurse should be prepared with an airway cart if the patient has been working very hard to breath for a long period and the situation is getting worse. Also, the nurse should have the respiratory therapist aware of the patient for operation and treatment management of the airway. What is more, a nurse should not wait until the impending closure of the airway happens to try to secure the patient’s airway. When correcting any respiratory acidosis or alkalosis, the patient will sometimes be sedated and intubated.

References

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Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for individualizing client care across the life span. FA Davis.

Ford, E. S., Croft, J. B, & Giles, W. H. (2013). COPD surveillance—United States, 1999-2011. CHEST Journal, 144(1), 284-305.

Weldam, S., Zwakman, M., Lammers, J. W., & Schuurmans, M. (2016). Patient perspectives on the COPD-GRIP intervention, a new nursing care intervention for Chronic Obstructive Pulmonary Disease patients. Primary care nursing for COPD patients: a biopsychosocial perspective, 129.