10 COPD: Bronchitis Nursing Care Plans

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Definition

Chronic Obstructive Bronchitis is an inflammation of the bronchi (chronic obstructive bronchitis) causes increase mucus production and chronic cough. The clinical manifestations of Chronic Bronchitis continue for at least 3 months of the year for 2 consecutive years. Chronic bronchitis is also known the blue bloater. It is characterized by the following:

  • An increase in the size and number of submucosal glands in the large bronchi which causes increase mucus production
  • An increased number of goblet cells, which also secrete mucus
  • Impaired ciliary function, which reduces mucus clearance

Nursing Care Plans

Ineffective Airway Clearance

COPD is an inflammatory response to the offending microorganism. The defense mechanisms of the lungs lose effectiveness and allow organisms to penetrate the sterile respiratory tract, as a result inflammation develops. The inflammation and increased secretions make it difficult to maintain a patent airway.

AssessmentPlanningNursing Inter­ventionsRationaleExpected Outcome
S:O: The may patient manifest the ffg.:

  • with wheezes/crackles upon auscultation on the BLF
  • with subcostal retraction
  • with nasal flaring
  • presence of non-productive cough
  • increase RR above normal range
Short term:After 4-5 hours of nursing interventions the patient will demonstrate effective clearing of secretions.Long term:After 2 days of nursing interventions, the patient will maintain effective airway clearance.
  1. Establish rapport to the pt. and SO
  2. Assess the patient condition
  3. Monitor and record V/S
  4. Position head midline with flexion on appropriate for age/condition
  5. Elevate HOB
  6. Observe S/Sx of infections
  7. Auscultate breath sounds & assess air mov’t
  8. Instruct the patient to increase fluid intake
  9. Demonstrate effective coughing and deep-breathing techniques.
  10. Keep back dry
  11. Turn the patient q 2 hours
  12. Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage.
  13. Administer bronchodilators if prescribed.
  1. To gain trust and active participation
  2. To know the condition of the pt
  3. To have a baseline data.
  4. To gain or maintain open airway
  5. To decrease pressure on the diaphragm and enhancing drainage
  6. To identify infectious process
  7. To ascertain status & note progress
  8. To help to liquefy secretions.
  9. To maximize effort
  10. To prevent further complications
  11. To prevent possible aspirations
  12. These techniques will prevent possible aspirations and prevent any untoward complications
  13. More aggressive measures to maintain airway patency.
Short term:The patient shall have demonstrated effective clearing of secretions.

Long term:

The patient shall have maintained effective airway clearance.

Ineffective Breathing Pattern

NDx: Ineffective Breathing Pattern RT Retained Secretions

The presence of microorganisms in the lungs causes body to increase the secretory activity of goblet cells to get rid of the invading organism but the mechanism is not enough which allows the stasis of mucus secretion leading to ineffective breathing pattern.

AssessmentPlanningNursing Inter­ventionsRationaleExpected Outcome
S:

  • Reports of dyspnea

O:  The patient may manifest the manifest the ffg.:

  • with wheezes /crackles upon auscultation on BLF
  • increase RR above normal range
  • presence of productive cough
  • use of accessory muscle when breathing
  • presence of nasal flaring and retractions
Short term:After 4-5 hours of nursing interventions the patient will improve breathing pattern.Long term:After 2 days of nursing interventions the patient will maintain a respiratory rate within normal limits.
  1. Establish rapport to the pt. and SO
  2. Assess the patient condition
  3. Monitor and record V/S especially RR
  4. Provide rest periods
  5. Place pt in semi-fowlers position
  6. Increase fluid intake
  7. Keep patient back dry
  8. Change position every 2 hours
  9. Perform CPT
  10. Place a pillow when the client is sleeping
  11. Instruct  how to splint the chest wall with a pillow for comfort during coughing and elevation of head over body as appropriate
  12. Maintain a patent airway, suctioning of secretions may be done as ordered
  13. Provide respiratory support. Oxygen inhalation is provided per doctor’s order
  14. Administer prescribed cough suppressants and analgesics and be cautious, however, because opioids may depress respirations more than desired.
  1. To gain trust and active participation
  2. To know the condition of the pt
  3. To have a baseline data.
  4. To reduce fatigue and obtain rest
  5. To have a maximum lung expansion
  6. To liquefy secretions
  7. To avoid stasis of secretions and avoid further complication
  8. To facilitate secretion mov’t and drainage
  9. To loosen secretion
  10. To provide adequate lung expansion while sleeping.
  11. To promote physiological ease of maximal inspiration
  12. To remove secretions that  obstructs the airway
  13. To aid in relieving patient from dyspnea
  14. To promote deeper respirations and cough
Short term:The patient shall have improved breathing pattern.Long term:The patient shall have maintained a respiratory rate within normal limits.

Impaired Gas Exchange

NDx: Impaired Gas Exchange RT Altered Oxygen Balance

The disruption of the mechanical defenses of cough and ciliary motility leads to colonization of the lungs and subsequent infection leading to inflammation and accumulation of secretions. Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively.

AssessmentPlanningNursingInter­ventionsRationaleExpected Outcome
S:O: The patient may manifest the ffg.:

  • Appearance of bluish extremities when in cough (cyanosis), lips
  • Lethargy
  • Restlessness
  • Hypercapnea
  • Hypoxemia
  • Abnormal rate, rhythm, depth of breathing
  • Diaphoresis
Short term:After 4-5 hours of nursing interventions the patient will improve ventilation and adequate oxygenation of tissues

Long term:

After 2 days of nursing interventions the patient will minimize or totally be free of symptoms of respiratory distress.

  1. Establish rapport to the pt. and SO
  2. Assess the patient condition
  3. Monitor and record V/S
  4. Monitor level of consciousness or mental status
  5. Assist the client into the High-Fowlers position
  6. Increase patient’s fluid intake
  7. Encourage expectoration
  8. Encourage frequent position changes
  9. Encourage adequate rest & limit activities to within client tolerance
  10. Promote calm/restful environments
  11. Administer supplemental oxygen judiciously as indicated
  12. Administer meds as indicated such as bronchodilators
  1. To gain trustand active participation
  2. To know the condition of the pt
  3. To have a baseline data.
  4. Restlessness,anxiety, confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  5. The upright position allows full lung excursion and enhances air exchange
  6. To help liquefy secretions
  7. To eliminate thick, tenacious, copious secretions which contribute for the impairment of gas exchange.
  8. To promote drainage of secretions
  9. Helps limit oxygen needs/consumption
  10. To correct/improve existing deficiencies
  11. May correct or prevent worsening of hypoxia.
  12. To treat the underlying condition
Short term:The patient shall have improved ventilation and adequate oxygenation of tissues

Long term:

The patient shall have minimized or totally be free of symptoms of respiratory distress.

Sleep Pattern Disturbance

NDx: Sleep Pattern Disturbance RT Difficulty of Breathing

COPD patients need a comfortable position such as the High-Fowler’s position during sleeping in order to promote lung expansion. Lying flat on bed promotes the occurrence of DOB and makes the patient uncomfortable due to the impaired alveolar ventilation which the body processes at night can’t be controlled

AssessmentPlanningNursing
Interventions
RationaleExpected Outcome
S:
O:The patient may manifest the ffg.:

  • irritability
  • restlessness
  • lethargy
  • changes in posture
  • difficulty of breathing which worsens at night
Short term:After 4-5 hours of nursing interventions the patient will identify individually appropriate interventions to promote sleep.Long term:After 2 days of nursing interventions, the patient will be able to report improvements in sleep/rest pattern.
  1. Establish rapport to the pt. and SO
  2. Assess the patient condition
  3. Monitor and record V/S
  4. Monitor level of consciousness or mental status
  5. Promote comfort measures such as back rub and change in position as necessary
  6. Observe provision of emotional support
  7. Provide quiet environment.
  8. Increase patient’s fluid intake
  9. Encourage expectoration
  10. Limit the fluid intake in evening if nocturia is a problem
  11. Obtain feedback from SO regarding usual bedtime, rituals/routines
  12. Provide safety for patient sleep time safety
  13. Recommend mid morning nap if one required
  14. Administer pain medication as ordered.
  1. To gain trust and active participation
  2. To know the condition of the pt
  3. To have a baseline data
  4. Restlessness, anxiety,confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  5. To provide non pharmacologic management
  6. Lack of knowledge and problems, relationships may create tension. Interfering with sleep routines based on adult schedules may not meet child’s needs.
  7. To promote an environment conducive to sleep.
  8. To help liquefy secretions
  9. To eliminate thick, tenacious, copious secretions which contribute for the DOB
  10. To reduce need for nighttime elimination
  11. To determine usual sleep patterns & provide comparative baseline
  12. To promote comfort/safety
  13. Napping esp. in the afternoon can disrupt normal sleep pattern
  14. To relieve discomfort and take maximum advantage of sedative effect
Short term:The patient shall have identified individually appropriate interventions to promote sleepLong term:

The patient shall have reported improvements in pt.’s sleep/rest

Risk for Spread of Infection

NDx: Risk for Spread of Infection RT Stasis of Secretions & Decreased Ciliary Action

Once the bacteria, virus, or fungus enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus as the body attempts to fight the infection. Disruption of the mechanical defenses of cough and ciliary motility leads to colonization of the lungs and subsequent infection

AssessmentPlanningNursing InterventionsRationaleExpected Outcome
S:O:The patient may manifest:

  • Body temperature above normal range
  • dehydration
  • increase WBC count
  • presence of increase mucus production
Short term:After 4-5 hours of nursing interventions the patient will identify interventions  to prevent and/or reduce the risk of infectionLong term:

After 2 days of nursing interventions the patient will have minimize or totally be free from the risk of infection.

  1. Establish rapport to the pt. and SO
  2. Assess the patient condition
  3. Monitor & record V/S
  4. Review importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake
  5. Turn the patient q 2 hours
  6. Encourage increase fluid intake
  7. Stress the importance of handwashing to SO’s
  8. Teach the SO’s how to care for and clean respiratory equipment
  9. Teach the SO’s the manifestations of pulmonary infections (change in color of sputum, fever, chills) , self-care and when to call the physician
  10. Recommend rinsing mouth with water
  11. Administer antimicrobial such as cefuroxime as indicated.
  1. To gain trust and active participation
  2. To know the condition of the pt
  3. To have a baseline data and fever may be present because of infection and/or dehydration
  4. These activities promote mobilization and expectoration of secretions to reduce the risk of developing pulmonary infection.
  5. To facilitate secretion mov’t and drainage
  6. To liquefy secretions
  7. Handwashing is the primary defense against the spread of infection
  8. Water in respiratory equipment is a common source of bacterial growth
  9. Early recognition of manifestations can lead to a rapid diagnosis.
  10. To prevent risk of oral candidiasis.
  11. Given prophylactically to reduce any possible complications
Short term:The shall have identified interventions to prevent and/or reduce the risk of infectionLong term:

The patient shall have minimized or totally be free from the risk of infection.

Other Possible Nursing Care Plans

  • High risk for suffocation
  • High risk for aspiration
  • Anxiety RT acute breathing difficulties
  • Activity Intolerance RT inadequate oxygenation
  • Imbalanced Nutrition: Less than body requirements RT reduced appetite and dyspnea (for emphysema)

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