COPD (Emphysema & Chronic Bronchitis) Nursing Care Plan

1. Improving gas exchange

• 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.

2. Clearing the airway

• 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.

3. Preventing infection and exacerbation

• 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.

4. Improving nutrition

• 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.

5. Activity, energy conservation and anxiety

• 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.

What are the nursing diagnoses for COPD?

Priority nursing diagnoses for COPD: Impaired gas exchange; Ineffective airway clearance; Activity intolerance; Imbalanced nutrition.

What are the nursing interventions for COPD?

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.

What are the nursing care goals for COPD?

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.

What should you assess in a patient with COPD?

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); 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