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 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 Airway Clearance
- Impaired Gas Exchange
- Ineffective Breathing Pattern
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Infection
- Deficient Knowledge
- Activity Intolerance
- Other Possible Nursing Diagnosis
Imbalanced Nutrition: Less Than Body Requirements
Status of nutrition and counseling are important aspects in the rehabilitation process for patients with COPD. Most people with COPD have difficulty gaining and maintaining weight.
- Imbalanced Nutrition: Less Than Body Requirements
May be related to
- Sputum production
- Medication side effects
- Decrease food intake due to fatigue
Possibly evidenced by
- Weight loss; loss of muscle mass, poor muscle tone
- Reported altered taste sensation; aversion to eating, lack of interest in food
- Display progressive weight gain toward the goal as appropriate.
- Demonstrate behaviors/lifestyle changes to regain and/or maintain an appropriate weight.
|Ascertain understanding of individual nutritional needs||To determine informational needs of the client and significant others.|
|Assess dietary habits, recent food intake. Note the degree of difficulty with eating. Evaluate weight and body size (mass).||Patient in acute respiratory distress is often anorectic because of dyspnea, sputum production, and medications. In addition, many COPD patients habitually eat poorly, even though respiratory insufficiency creates a hypermetabolic state with increased caloric needs. As a result, the patient often is admitted with some degree of malnutrition. People who have emphysema are often thin with wasted musculature.|
|Auscultate bowel sounds.||Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation (a common complication) related to limited fluid intake, poor food choices, decreased activity, and hypoxemia.|
|Weigh the patient daily as indicated.||Useful in determining caloric needs, setting a weight goal, and evaluating the adequacy of nutritional plan.|
|Give frequent oral care, remove expectorated secretions promptly, provide a specific container for disposal of secretions and tissues.||Noxious taste, smell, and sights are prime deterrents to appetite and can produce nausea and vomiting with increased respiratory difficulty.|
|Instruct the patient to frequently eat high caloric foods in smaller portions.||COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass.|
|Encourage a rest period of 1 hr before and after meals.||Help reduce fatigue during mealtime and provides an opportunity to increase total caloric intake.|
|Avoid gas-producing foods and carbonated beverages.||Can produce abdominal distension, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea.|
|Avoid very hot or very cold foods.||Extremes in temperature can precipitate or aggravate coughing spasms.|
|Instruct patient to increase fluid intake (2.5 liters per day or more) as indicated.||Fluids aids in decreasing the viscosity of secretions for patients with chronic increased production of sputum.|
|Collaborate with a dietician as indicated.||The dietician can provide nutrional assessment and counseling applicable to patients with COPD. They may also facilitate the initiation of enteral nutrition in those who are intubated or who cannot toletate oral feeding.|
|Administer supplemental oxygen during meals as indicated.||Decreases dyspnea and increases energy for eating, enhancing intake.|
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]
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- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
Respiratory Care Plans
Care plans about respiratory system disorders:
- Asthma | 8 Care Plans
- Bronchiolitis | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 5+ Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 8+ Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
Originally published on July 14, 2013.