{ "name": "COPD (Emphysema & Chronic Bronchitis)", "slug": "copd", "url": "https://nursingplex.com/care-plans/copd", "category": "Respiratory", "summary": "Chronic airflow limitation; pursed-lip breathing, controlled oxygen and energy conservation.", "nursing_diagnoses": [ "Impaired gas exchange", "Ineffective airway clearance", "Activity intolerance", "Imbalanced nutrition" ], "overview": [ "Chronic obstructive pulmonary disease is persistent, largely irreversible airflow limitation from chronic inflammation of the airways and alveoli, most often caused by smoking. It blends two processes. Chronic bronchitis is defined clinically — a productive cough on most days for at least three months in two consecutive years — with mucus gland hypertrophy, chronic sputum, hypoxemia, cyanosis and right-sided heart failure. Emphysema is defined structurally, with destruction of alveolar walls, loss of elastic recoil and air trapping, producing a barrel chest, marked dyspnea, pursed-lip breathing and a thin, tripod-sitting patient.", "The core physiologic problem is air trapping on exhalation. The patient can get air in but cannot get it out, so the chest hyperinflates, the diaphragm flattens and every breath takes more work for less gas exchange. This is why pursed-lip breathing helps: it creates back-pressure that keeps small airways open long enough to empty.", "Chronically retained carbon dioxide means the respiratory center becomes less responsive to CO2 in advanced disease. Oxygen is still given whenever the patient is hypoxemic, but it is titrated to a modest target — commonly about 88–92 percent — rather than pushed high. Exacerbations, usually infectious, drive the disease's step-down course, so preventing them is the single most valuable long-term nursing goal." ], "key_facts": [ { "label": "Diagnostic test", "text": "Spirometry showing a post-bronchodilator FEV1/FVC ratio below 0.70; FEV1 grades severity." }, { "label": "Oxygen target", "text": "Typically 88–92 percent saturation with controlled low-flow oxygen; avoid high uncontrolled flow." }, { "label": "Signature breathing techniques", "text": "Pursed-lip breathing for exhalation and diaphragmatic breathing for efficiency; tripod position eases accessory muscle work." }, { "label": "Late complication", "text": "Cor pulmonale — right heart failure from pulmonary hypertension, showing edema, JVD and hepatomegaly." }, { "label": "Highest-yield interventions", "text": "Smoking cessation, vaccination, pulmonary rehabilitation and correct inhaler technique." } ], "nursing_priorities": [ "Improve gas exchange and relieve hypoxemia safely.", "Clear airway secretions and reduce airflow obstruction.", "Prevent and treat respiratory infections and exacerbations.", "Improve nutrition against the high work of breathing.", "Increase activity tolerance through paced conditioning and energy conservation.", "Reduce anxiety associated with breathlessness." ], "assessment": { "subjective": [ "Shortness of breath, worse with exertion and progressively at rest", "Chronic cough with sputum, usually worst in the morning", "Fatigue, weight loss and early satiety", "Anxiety or panic during breathless episodes and fear of suffocation", "Sleep disruption, morning headache (a clue to nighttime CO2 retention)" ], "objective": [ "Prolonged expiration, wheezing, diminished breath sounds, coarse crackles, hyperresonance on percussion", "Barrel chest, use of accessory muscles, tripod positioning, pursed-lip breathing", "Tachypnea, tachycardia, clubbing of fingers, central cyanosis in advanced disease", "Purulent, increased or thickened sputum during exacerbation", "Arterial blood gases showing hypoxemia with chronic compensated respiratory acidosis and elevated bicarbonate", "Polycythemia on CBC from chronic hypoxemia; hyperinflation on chest x-ray", "Peripheral edema, JVD and hepatomegaly with cor pulmonale", "Low body weight, temporal wasting and reduced muscle mass" ], "related_factors": [ "Alveolar destruction and ventilation-perfusion mismatch", "Excessive, thickened bronchial secretions with impaired ciliary clearance", "Bronchoconstriction and airway inflammation", "Increased work of breathing raising caloric expenditure while dyspnea limits intake", "Fatigue and imbalance between oxygen supply and demand", "Continued smoking or occupational and environmental exposure" ] }, "goals": [ "The client will maintain oxygen saturation within the individualized target range with arterial blood gases at their compensated baseline.", "The client will maintain a patent airway with effective cough, clearer breath sounds and manageable sputum.", "The client will demonstrate pursed-lip and diaphragmatic breathing and use them during dyspneic episodes.", "The client will remain free of respiratory infection and will state early exacerbation warning signs.", "The client will maintain or gain weight toward the individualized goal.", "The client will perform activities of daily living with tolerable dyspnea using energy conservation techniques." ], "interventions": [ { "title": "1. Improving gas exchange", "points": [ "Assess respiratory rate, depth, effort, breath sounds, saturation and color at least every shift and with any change; increasing accessory muscle use is an early warning even before saturation drops.", "Give oxygen at the prescribed low flow and titrate to the ordered saturation range; monitor for increasing drowsiness, which can signal carbon dioxide narcosis.", "Position upright, leaning forward on an over-bed table with the arms supported — this fixes the shoulder girdle and lets accessory muscles work efficiently.", "Teach and coach pursed-lip breathing: inhale through the nose for a count of two, exhale through pursed lips for a count of four or longer, which prevents airway collapse and relieves trapping.", "Monitor arterial blood gases and remember the patient's compensated baseline; a normal pH with high CO2 and high bicarbonate is their normal, while a falling pH means acute decompensation.", "Report a rising respiratory rate followed by a falling rate with somnolence — that is fatigue and impending respiratory failure, not improvement." ] }, { "title": "2. Clearing the airway", "points": [ "Encourage 2–3 liters of fluid daily unless restricted to thin secretions; hydration is the most accessible mucolytic.", "Teach controlled coughing: sit up, breathe in slowly through the nose, hold briefly, then two short forceful coughs with the mouth slightly open — far more effective and less exhausting than repeated hacking.", "Give bronchodilators before mucolytics or airway clearance so the airways are open when clearance begins.", "Verify inhaler technique at every opportunity, including spacer use and rinsing the mouth after inhaled corticosteroids to prevent thrush.", "Use humidification, chest physiotherapy or a flutter device where prescribed, and time treatments away from meals to avoid nausea.", "Document sputum amount, color, consistency and any change — a change in sputum character is often the first sign of exacerbation." ] }, { "title": "3. Preventing infection and exacerbation", "points": [ "Teach the exacerbation warning triad: more breathlessness, more sputum, and a change in sputum color.", "Encourage influenza vaccination annually and pneumococcal and other recommended vaccinations.", "Advise avoiding crowds during respiratory illness season, close contact with sick people, smoke, strong fumes, aerosols and very cold or very humid air.", "Give antibiotics and systemic corticosteroids promptly during an exacerbation as ordered, and teach any prescribed action plan for early home treatment.", "Emphasize smoking cessation at every visit with concrete support — pharmacotherapy, counseling, quit lines — because it is the only intervention that slows decline." ] }, { "title": "4. Improving nutrition", "points": [ "Weigh regularly and assess intake; the work of breathing can raise caloric needs substantially while dyspnea and early satiety cut intake.", "Offer small, frequent, calorie- and protein-dense meals with rest before eating, and avoid gas-producing foods that press on a flattened diaphragm.", "Provide oral care before meals and encourage the patient to eat slowly with oxygen in place if prescribed during meals.", "Suggest soft, easy-to-chew foods when chewing itself is tiring, and use oral supplements between meals rather than with them." ] }, { "title": "5. Activity, energy conservation and anxiety", "points": [ "Build a graded walking or activity program with rest intervals; deconditioning worsens dyspnea, so protecting the patient from all exertion is harmful.", "Teach conservation: sit for grooming, exhale during the effortful part of any task, use a shower chair and long-handled tools, organize supplies at waist height.", "Refer to pulmonary rehabilitation, which improves exercise capacity and quality of life even when lung function does not change.", "Coach a paced breathing routine for panic episodes and stay with the patient; anxiety and dyspnea feed each other in a loop.", "Assess for depression and social isolation, both very common in advanced disease, and refer accordingly." ] } ], "patient_teaching": [ "Stop smoking and avoid all secondhand smoke; ask for medication and counseling support rather than trying alone.", "Use pursed-lip breathing whenever short of breath and diaphragmatic breathing during activity.", "Take inhalers in the prescribed order, use a spacer if provided, and rinse your mouth after steroid inhalers.", "Do not change your oxygen flow rate on your own, and never smoke or allow open flame near oxygen.", "Call for increasing shortness of breath, more sputum, sputum turning yellow, green or bloody, fever, ankle swelling, or confusion and drowsiness.", "Drink plenty of fluids unless told otherwise, and eat small high-calorie meals throughout the day.", "Get vaccinated every year and avoid crowds and sick contacts during flu season.", "Pace all activity, rest before and after meals, and keep going to pulmonary rehabilitation." ] }