SHARE

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.

Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range

Nursing Diagnosis

  • Ineffective Airway Clearance

Outcomes

  • Patient will demonstrate effective clearing of secretions.
  • Patient will maintain effective airway clearance.
Nursing Interventions Rationale
Position head midline with flexion on appropriate for age/condition To gain or maintain open airway
Elevate HOB To decrease pressure on the diaphragm and enhancing drainage
Observe S/Sx of infections To identify infectious process
Auscultate breath sounds & assess air mov’t To ascertain status & note progress
Instruct the patient to increase fluid intake To help to liquefy secretions.
Demonstrate effective coughing and deep-breathing techniques. To maximize effort
Keep back dry To prevent further complications
Turn the patient q 2 hours To prevent possible aspirations
Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage. These techniques will prevent possible aspirations and prevent any untoward complications
Administer bronchodilators if prescribed. More aggressive measures to maintain airway patency.

Ineffective Breathing Pattern

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.

Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range

Nursing Diagnosis

  • Ineffective Breathing Pattern RT Retained Secretions

Outcomes

  • Patient will improve breathing pattern.
  • Patient will maintain a respiratory rate within normal limits.
Nursing Interventions Rationale
Place patient in semi-fowlers position To have a maximum lung expansion
Increase fluid intake as applicable To liquefy secretions
Keep patient back dry To avoid stasis of secretions and avoid further complication
Change position every 2 hours To facilitate secretion mov’t and drainage
Perform CPT To loosen secretion
Place a pillow when the client is sleeping To provide adequate lung expansion while sleeping.
Instruct  how to splint the chest wall with a pillow for comfort during coughing and elevation of head over body as appropriate To promote physiological ease of maximal inspiration
Maintain a patent airway, suctioning of secretions may be done as ordered To remove secretions that  obstructs the airway
Provide respiratory support. Oxygen inhalation is provided per doctor’s order To aid in relieving patient from dyspnea
Administer prescribed cough suppressants and analgesics and be cautious, however, because opioids may depress respirations more than desired. To promote deeper respirations and cough

Impaired Gas Exchange

 

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.

Assessment

Patient may manifest

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

Nursing Diagnosis

  • Impaired Gas Exchange RT Altered Oxygen Balance

Outcomes

  • Patient will improve ventilation and adequate oxygenation of tissues
  • Patient will minimize or totally be free of symptoms of respiratory distress.
Nursing Interventions Rationale
Monitor level of consciousness or mental status Restlessness,anxiety, confusion, somnolence are common manifestation of hypoxia and hypoxemia.
Assist the client into the High-Fowlers position The upright position allows full lung excursion and enhances air exchange
Increase patient’s fluid intake To help liquefy secretions
Encourage expectoration To eliminate thick, tenacious, copious secretions which contribute for the impairment of gas exchange.
Encourage frequent position changes To promote drainage of secretions
Encourage adequate rest & limit activities to within client tolerance Helps limit oxygen needs/consumption
Promote calm/restful environments To correct/improve existing deficiencies
Administer supplemental oxygen judiciously as indicated May correct or prevent worsening of hypoxia.
Administer meds as indicated such as bronchodilators To treat the underlying condition

Sleep Pattern Disturbance

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

Assessment

Patient may manifest

  • Irritability
  • Restlessness
  • Lethargy
  • Changes in posture
  • Difficulty of breathing which worsens at night

Nursing Diagnosis

  • Sleep Pattern Disturbance RT Difficulty of Breathing

Outcomes

  • Patient will identify individually appropriate interventions to promote sleep.
  • Patient will be able to report improvements in sleep/rest pattern.
Nursing Interventions Rationale
Monitor level of consciousness or mental status Restlessness, anxiety,confusion, somnolence are common manifestation of hypoxia and hypoxemia.
Promote comfort measures such as back rub and change in position as necessary To provide non pharmacologic management
Observe provision of emotional support Lack of knowledge and problems, relationships may create tension. Interfering with sleep routines based on adult schedules may not meet child’s needs.
Provide quiet environment. To promote an environment conducive to sleep.
Increase patient’s fluid intake To help liquefy secretions
Encourage expectoration To eliminate thick, tenacious, copious secretions which contribute for the DOB
Limit the fluid intake in evening if nocturia is a problem To reduce need for nighttime elimination
Obtain feedback from SO regarding usual bedtime, rituals/routines To determine usual sleep patterns & provide comparative baseline
Provide safety for patient sleep time safety To promote comfort/safety
Recommend mid morning nap if one required Napping esp. in the afternoon can disrupt normal sleep pattern
Administer pain medication as ordered. To relieve discomfort and take maximum advantage of sedative effect

Risk for Spread of Infection

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

Assessment

Patient may manifest

  • Body temperature above normal range
  • Dehydration
  • Increase WBC count
  • Presence of increase mucus production

Nursing Diagnosis

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

Outcomes

  • Patient will identify interventions  to prevent and/or reduce the risk of infection
  • Patient will have minimize or totally be free from the risk of infection.
Nursing Interventions Rationale
Review importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake These activities promote mobilization and expectoration of secretions to reduce the risk of developing pulmonary infection.
Turn the patient q 2 hours To facilitate secretion mov’t and drainage
Encourage increase fluid intake To liquefy secretions
Stress the importance of handwashing to SO’s Handwashing is the primary defense against the spread of infection
Teach the SO’s how to care for and clean respiratory equipment Water in respiratory equipment is a common source of bacterial growth
Teach the SO’s the manifestations of pulmonary infections (change in color of sputum, fever, chills) , self-care and when to call the physician Early recognition of manifestations can lead to a rapid diagnosis.
Recommend rinsing mouth with water To prevent risk of oral candidiasis.
Administer antimicrobial such as cefuroxime as indicated. Given prophylactically to reduce any possible complications

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)

2 COMMENTS

LEAVE A REPLY