7 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans

September 28, 2019

In this nursing care plan guide are seven (7) nursing diagnosis for Chronic Obstructive Pulmonary Disease (COPD). Get to know the nursing interventions, goals and outcomes, assessment tips, and related factors for COPD.

What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic Obstructive Pulmonary Disease (COPD) is defined as “a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.” (Global Initiative for Chronic Obstructive Lung Disease or GOLD)

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 an 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 planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Most patients 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.

Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD):

Ineffective Breathing Pattern

Shortness of breath and ineffective breathing patterns are caused by ineffective respiratory mechanics of the chest wall and lung resulting from air trapping, ineffective diaphragmatic movement, airway obstruction, the metabolic cost of breathing, and stress.

Nursing Diagnosis

Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.

May be related to

Retained Secretions
Ineffective inspiration and expiration occurring with chronic airflow constraints

Possibly evidenced by

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

Desired outcomes

Improvement of breathing pattern.
Maintain a respiratory rate within normal limits.

Nursing Interventions	Rationale
Nursing Assessment
Assess patient’s respiratory status every 2 to 4 hours as indicated and notify any abnormal findings.	Manifestation of respiratory distress include shortness of breath, tachypnea, changes in mental status and the use of accessory muscles.
Auscultate breath sounds every 2 to 4 hours as indicated.	Decreased breath sounds, crackles, wheezes, and rhonchi can be observed and must be reported promptly for immediatement treatment.
Therapeutic Intervention
Place a pillow when the client is sleeping.	Provides adequate lung expansion while sleeping.
Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over the body as appropriate.	Promotes physiological ease of maximal inspiration.
Maintain a patent airway, suctioning of secretions may be done as ordered.	Remove secretions that obstructs the airway.
Provide respiratory support. Oxygen inhalation is given as ordered.	Aid in relieving the patient from dyspnea.
Administer the following medications as prescribed:
Oral corticosteroids such as beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flovent), mometasone (Asmanex)	Cuts down recovery time, enhance lung function, and arterial hypoxemia, and minimize length of hospital stay.
Inhaled corticosteroids such as budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), beclomethasone (Qvar RediHaler), fluticasone (Flovent HFA)	These medications is given for patient with Forced expiratory volume in 1 second (FEV₁) at less than 30% whose history of exacerbations are poorly managed by the use of long-acting bronchodilators.
Long-acting bronchodilators such as salmeterol, perforomist (formoterol), bambuterol, indacaterol	Decreases hyperinflation, lessen bronchial obstruction and enhances lung emptying.
Combination of inhaled corticosteroids and bronchodilator such as Symbicort (budesonide combined with formoterol fumarate), Advair (fluticasone combined with salmeterol, Breo TM (fluticasone furoate combined with vilanterol trifenatate)	This combination of medications are known to be more effective than any single treatment in decreasing episodes of exacerbations and provides overall improvement of lung function. One disadvantage of its use is the increased prone to pneumonia.

References and Sources

References and recommended sources for this care plan guide for Chronic Obstructive Pulmonary Disease (COPD):

Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. Elsevier Health Sciences.
Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins. [Link]
Carlson, M. L., Ivnik, M. A., Dierkhising, R. A., O’Byrne, M. M., & Vickers, K. S. (2006). A learning needs assessment of patients with COPD. Medsurg Nursing, 15(4). [Link]
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]