Any respiratory disease that persistently obstructs bronchial airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). Chronic Obstructive Pulmonary Disease (COPD) is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction.
The term COPD mainly involves two related diseases — chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms.
COPD is also called chronic obstructive lung disease (COLD).
Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections.
Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis.
Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping).
Nursing Care Plans
Nursing care for patients with COPD involves introduction of treatment regimen to relieve symptoms and prevent complications. Most because with COPD receive outpatient treatment, the nurse should develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease.
- Ineffective Airway Clearance
- Impaired Gas Exchange
- Ineffective Breathing Pattern
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Infection
- Deficient Knowledge
- Other Possible Nursing Diagnoses
- See Also and Further Reading
Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
May be related to
- Increased production of secretions; retained secretions; thick, viscous secretions
- Allergic airways
- Hyperplasia of bronchial walls
- Decreased energy/fatigue
Possibly evidenced by
- Statement of difficulty breathing
- Changes in depth/rate of respirations, use of accessory muscles
- Abnormal breath sounds, e.g., wheezes, rhonchi, crackles
- Cough (persistent), with/without sputum production
- Maintain airway patency with breath sounds clear/clearing.
- Demonstrate behaviors to improve airway clearance, e.g., cough effectively and expectorate secretions.
|Auscultate breath sounds. Note adventitious breath sounds (wheezes, crackles, rhonchi).||Some degree of bronchospasm is present with obstructions in airway and may or may not be manifested in adventitious breath sounds such as scattered, moist crackles (bronchitis); faint sounds, with expiratory wheezes (emphysema); or absent breath sounds (severe asthma).|
|Assess and monitor respirations and breath sounds, noting rate and sounds (tachypnea, stridor, crackles, wheezes). Note inspiratory and expiratory ratio.||Tachypnea is usually present to some degree and may be pronounced on admission or during stress or concurrent acute infectious process. Respirations may be shallow and rapid, with prolonged expiration in comparison to inspiration.|
|Note presence and degree of dyspnea as for reports of “air hunger,” restlessness, anxiety, respiratory distress, use of accessory muscles. Use 0–10 scale or American Thoracic Society’s “Grade of Breathlessness Scale” to rate breathing difficulty. Ascertain precipitating factors when possible. Differentiate acute episode from exacerbation of chronic dyspnea.||Respiratory dysfunction is variable depending on the underlying process such as infection, allergic reaction, and the stage of chronicity in a patient with established COPD. Note: Using a 0–10 scale to rate dyspnea aids in quantifying and tracking changes in respiratory distress. Rapid onset of acute dyspnea may reflect pulmonary embolus.|
|Assist patient to assume position of comfort (elevate head of bed, have patient lean on overbed table or sit on edge of bed).||Elevation of the head of the bed facilitates respiratory function by use of gravity; however, patient in severe distress will seek the position that most eases breathing. Supporting arms and legs with table, pillows, and so on helps reduce muscle fatigue and can aid chest expansion.|
|Keep environmental pollution to a minimum such as dust, smoke, and feather pillows, according to individual situation.||Precipitators of allergic type of respiratory reactions that can trigger or exacerbate onset of acute episode.|
|Encourage abdominal or pursed-lip breathing exercises.||Provides patient with some means to cope with or control dyspnea and reduce air-trapping.|
|Observe characteristics of cough (persistent, hacking, moist). Assist with measures to improve effectiveness of cough effort.||Cough can be persistent but ineffective, especially if patient is elderly, acutely ill, or debilitated. Coughing is most effective in an upright or in a head-down position after chest percussion.|
|Increase fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or tepid liquids. Recommend intake of fluids between, instead of during, meals.||Hydration helps decrease the viscosity of secretions, facilitating expectoration. Using warm liquids may decrease bronchospasm. Fluids during meals can increase gastric distension and pressure on the diaphragm.|
|Monitor and graph serial ABGs, pulse oximetry, chest x-ray.||Establishes baseline for monitoring progression or regression of disease process an complications. Note: Pulse oximetry readings detect changes in saturation as they are happening, helping to identify trends before patient is symptomatic. However, studies have shown that the accuracy of pulse oximetry may be questioned if patient has severe peripheral vasoconstriction.|
|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.|