7 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans

By
Matt Vera, BSN, R.N.
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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):

  1. Ineffective Airway Clearance
  2. Impaired Gas Exchange
  3. Ineffective Breathing Pattern
  4. Imbalanced Nutrition: Less Than Body Requirements
  5. Risk for Infection
  6. Deficient Knowledge
  7. Activity Intolerance
  8. Other Possible Nursing Diagnosis
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Deficient Knowledge

Provide instructions for self-management of COPD. Assessment of the patient’s knowledge and including family members about the therapeutic regimen increases adherence to treatment regimen.

Nursing Diagnosis  

May be related to

  • Lack of information/unfamiliarity with information resources
  • Information misinterpretation
  • Lack of recall/cognitive limitation

Possibly evidenced by

  • Request for information
  • Statement of concerns/misconception
  • Inaccurate follow-through of instructions
  • Development of preventable complications

Desired Outcomes

  • Verbalize understanding of condition/disease process and treatment.
  • Identify the relationship of current signs/symptoms to the disease process and correlate these with causative factors.
  • Initiate necessary lifestyle changes and participate in the treatment regimen.
Nursing Interventions Rationale
Nursing Assessment
Explain and reinforce explanations of the individual disease process. Encourage patient and SO to ask questions. Decreases anxiety and can lead to improved participation in the treatment plan.
Discuss the importance of medical follow-up care, periodic chest x-rays, sputum cultures. Monitoring disease process allows for alterations in the therapeutic regimen to meet changing needs and may help prevent complications.
Therapeutic Interventions
Instruct and reinforce the rationale for breathing exercises, coughing effectively, and general conditioning exercises. Pursed-lip and abdominal or diaphragmatic breathing exercises strengthen muscles of respiration, help minimize collapse of small airways, and provide the individual with means to control dyspnea. General conditioning exercises increase activity tolerance, muscle strength, and sense of well-being.
Stress importance of oral care and dental hygiene. Decreases bacterial growth in the mouth, which can lead to pulmonary infections.
Discuss the importance of avoiding people with active respiratory infections. Stress need for routine influenza and pneumococcal vaccinations. Decreases exposure to and incidence of acquired acute URIs.
Discuss individual factors that may trigger or aggravate condition (excessively dry air, wind, environmental temperature extremes, pollen, tobacco smoke, aerosol sprays, air pollution). Encourage patient and SO to explore ways to control these factors in and around the home and work setting. These environmental factors can induce or aggravate bronchial irritation, leading to increased secretion production and airway blockage.
Review the harmful effects of smoking, and advise cessation of smoking by the patient and SO. Cessation of smoking may slow or halt the progression of COPD. Even when the patient wants to stop smoking, support groups and medical monitoring may be needed. Note: Research studies suggest that “side-stream” or “second-hand” smoke can be as detrimental as actually smoking.
Provide information about activity limitations and alternating activities with rest periods to prevent fatigue; ways to conserve energy during activities (pulling instead of pushing, sitting instead of standing while performing tasks); use of pursed-lip breathing, side-lying position, and the possible need for supplemental oxygen during sexual activity. Having this knowledge can enable patients to make informed choices or decisions to reduce dyspnea, maximize activity level, perform most desired activities, and prevent complications.
Instruct asthmatic patient in use of peak flow meter, as appropriate. Peak flow level can drop before the patient exhibits any signs and symptoms of asthma during the “first time” after exposure to a trigger. Regular use of the peak flow meter may reduce the severity of the attack because of earlier intervention.
Discuss respiratory medications, side effects, adverse reactions. Frequently these patients are simultaneously on several respiratory drugs that have similar side effects and potential drug interactions. It is important that patient understand the difference between nuisance side effects (medication continued) and untoward or adverse side effects (medication possibly discontinued or dosage changed).
Demonstrate technique for using a metered-dose inhaler (MDI), such as how to hold it, taking 2–5 min between puffs, cleaning the inhaler. Proper administration of drug enhances delivery and effectiveness.
Devise system for recording prescribed intermittent drug and inhaler usage. Reduces the risk of improper use and overdosage of prn medications, especially during acute exacerbations, when cognition may be impaired.
Recommend avoidance of sedative antianxiety agents unless specifically prescribed or approved by the physician treating a respiratory condition. Although the patient may be nervous and feel the need for sedatives, these can depress respiratory drive and protective cough mechanisms. Note: These drugs may be used prophylactically when the patient is unable to avoid situations known to increase stress or trigger respiratory response.
Review oxygen requirements and dosage for a patient who is discharged on supplemental oxygen. Discuss safe use of oxygen and refer to the supplier as indicated. Reduces risk of misuse (too little or too much) and resultant complications. Promotes environmental and physical safety.
Instruct patient and SO in use of Nasal intermittent positive pressure ventilation (NIPPV) as appropriate. Problem-solve possible side effects and identify adverse signs and symptoms  (increased dyspnea, fatigue, daytime drowsiness, or headaches on awakening). Nasal intermittent positive pressure ventilation (NIPPV) may be used at night or periodically during the day to decrease CO2 level, improve quality of sleep, and enhance functional level during the day. Signs of increasing CO2 level indicate the need for more aggressive therapy.
Provide information and encourage participation in support groups (American Lung Association, public health department). These patients and their SOs may experience anxiety, depression, and other reactions as they deal with a chronic disease that has an impact on their desired lifestyle. Support groups or home visits may be desired or needed to provide assistance, emotional support, and respite care.
Refer for evaluation of home care if indicated.  Provide a detailed plan of care and baseline physical assessment to home care nurse as needed on discharge from acute care. Provides for continuity of care. May help reduce the frequency of rehospitalization.
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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]

See Also

You may also like the following posts and care plans:

Respiratory Care Plans

Care plans about respiratory system disorders:

Originally published on July 14, 2013. 

3 COMMENTS

  1. This is a fantastic site that enrich and enhance nurses knowledge across their area of discipline and practices.

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