10 Chronic Obstructive Pulmonary Disease: Bronchitis Nursing Care Plans

• with wheezes/crackles upon auscultation on the BLF
• with subcostal retraction
• with nasal flaring
• presence of non-productive cough
• increase RR above normal range

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.

• 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

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

The patient shall have maintained a respiratory rate within normal limits.

• Appearance of bluish extremities when in cough (cyanosis), lips
• Lethargy
• Restlessness
• Hypercapnea
• Hypoxemia
• Abnormal rate, rhythm, depth of breathing
• Diaphoresis

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

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

• irritability
• restlessness
• lethargy
• changes in posture
• difficulty of breathing which worsens at night

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 midmorning 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 pharmagcologic 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

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

• Body temperature above normal range
• dehydration
• increase WBC count
• presence of increase mucus production

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

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