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Nursing Care Plan for COPD (Chronic Obstructive Pulmonary Disease)

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Nursing Care Plan for COPD (Chronic Obstructive Pulmonary Disease)

NCP - Nursing Care Plan for COPD (Chronic Obstructive Pulmonary Disease)

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the fourth leading cause of death in this country. Patients typically have symptoms of both chronic bronchitis and emphysema, but the classic triad also includes asthma. Most of the time COPD is secondary to tobacco abuse, although cystic fibrosis, alpha-1 antitrypsin deficiency, bronchiectasis, and some rare forms of bullous lung diseases may be causes as well.


Causes

In general, the vast majority of chronic obstructive pulmonary disease (COPD) cases are the direct result of tobacco abuse. While other causes are known, such as alpha-1 antitrypsin deficiency, cystic fibrosis, air pollution, occupational exposure (eg, firefighters), and bronchiectasis, this is a disease process that is somewhat unique in its direct correlation to a human activity.


Signs and Symptoms

Essentials of diagnosis include:
  • History of cigarette smoking.
  • Chronic cough and sputum production (in chronic bronchitis)
  • Dyspnea (in emphysema)
  • Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination
  • Airflow limitation on pulmonary function testing that is not fully reversible and most often progressive
One of the most common symptoms of COPD is shortness of breath (dyspnea). People with COPD commonly describe this as: "My breathing requires effort," "I feel out of breath," or "I can't get enough air in". People with COPD typically first notice dyspnea during vigorous exercise when the demands on the lungs are greatest. Over the years, dyspnea tends to get gradually worse so that it can occur during milder, everyday activities such as housework. In the advanced stages of COPD, dyspnea can become so bad that it occurs during rest and is constantly present.

Other symptoms of COPD are a persistent cough, sputum or mucus production, wheezing, chest tightness, and tiredness.

People with advanced (very severe) COPD sometimes develop respiratory failure. When this happens, cyanosis, a bluish discoloration of the lips caused by a lack of oxygen in the blood, can occur. An excess of carbon dioxide in the blood can cause headaches, drowsiness or twitching (asterixis). A complication of advanced COPD is cor pulmonale, a strain on the heart due to the extra work required by the heart to pump blood through the affected lungs. Symptoms of cor pulmonale are peripheral edema, seen as swelling of the ankles, and dyspnea.

There are a few signs of COPD that a healthcare worker may detect although they can be seen in other diseases. Some people have COPD and have none of these signs. Common signs are :
  • tachypnea, a rapid breathing rate
  • wheezing sounds or crackles in the lungs heard through a stethoscope
  • breathing out taking a longer time than breathing in
  • enlargement of the chest, particularly the front-to-back distance (hyperaeration)
  • active use of muscles in the neck to help with breathing
  • breathing through pursed lips
  • increased anteroposterior to lateral ratio of the chest (i.e. barrel chest).


Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD)

Assessment
  1. The identity of the client
    Name, place of birth date, age, gender, religion / tribe, the people of the State, the language used, the responsible include: name, address, relationship with the client.
  2. Patterns of health perception
    Review the status of a medical history of having experienced the client, what efforts and where clients get medical help, then what makes the client's health status declined.
  3. The pattern of metabolic nutrients.
    Ask the client about the type, frequency, and amount of eating and drinking in a day. Assess client's excessive appetite or reduced, assess nausea or vomiting or any intravenous therapy, use of enteric tube, also measuring weight, measure height, upper arm circle and calculate the ideal weight client to obtain nutritional status.
  4. The pattern of elimination :
    • Review of rekuensi, characteristics, difficulties / problems and also the use of assistive devices such as catheters Folly, also measuring intake and output every shift.
    • Elimination of the process, review the frequency, characteristics, difficulties / problems defecation.
  5. The pattern of activity and exercise
    Assess the ability of activities both before illness or condition now and also the use of aids such as canes, wheel chairs and others. Ask the client about the use of leisure time. Does the client complain of breathing, such as pounding heart, chest pain, weak body.
  6. The pattern of sleep and rest
    Ask the client's daily sleep habits, how long sleep, a nap. How sleep the client whether in light or dark. Often wake up during sleep caused by pain, itching, urination, difficulty and others.
  7. The pattern of cognitive perception
    Ask the client whether to use tool for seeing, hearing. Is there any client trouble remembering things, how clients cope with discomfort: pain. Is there a perception of sensory disturbances such as blurred to see, hearing impaired. Assess the level of orientation to time place and person.
  8. Patterns of perception and self-concept
    Review about his behavior, whether the client has experienced despair / frustration / stress.
  9. The pattern of role relationships
    What is the role of clients in the community and family, how client relationships in society and family and coworkers. Assess whether there is disruption and disturbance of verbal communication in interactions with family members and others.
  10. The pattern of sexual production
    Ask the client about the use of contraception and the problems that arise. How many children of clients and client's marital status.
  11. The pattern of sexual production
    Ask the client about the use of contraception and the problems that arise. How many children of clients and client's marital status. The pattern of coping mechanisms and tolerance to stress.
    Assess the factors that make the client angry, where clients exchange opinions and coping mechanisms that are used for this. Assess client's current situation against conformity, expression, denial / rejection of self.
  12. he pattern of belief system
    Assess whether the client is often worship, clients follow a religion?. Assess whether there are values on which clients embrace religion contrary to health.


Nursing Diagnosis and Nursing Intervention

Ineffective airway clearance related to the disruption of production increased secretions, retained secretions

Goal : Ventilation / oxygenation to the needs of clients.

Outcome : Maintain a patent airway and breath sounds clean

Intervention
  • Review / monitor respiratory frequency, record the ratio of inspiration / expiration.
  • Assess the patient to a comfortable position, such as raising the head of the bed, seat and backrest of the bed.
  • Auscultation for breath sounds, record the sound of breath for example: wheezing, and rhonchi krokels.
  • Note the presence disepnea, for example: complaints restlessness, anxiety, respiratory distress
  • Help the abdominal breathing exercises or lip.
  • Observation of the characteristic cough, for example: persistent, hacking cough, wet, auxiliary measures to improve the effectiveness of the airway.
  • Increase fluid intake to 3000 ml / day according to tolerance of the heart.
  • Bronchodilators, eg, β-agonists, efinefrin (adrenaline, vavonefrin), albuterol (Proventil, Ventolin), terbutaline (brethine, brethaire), isoeetrain (brokosol, bronkometer).
  • (Doenges, 1999. P. 156).

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Physical Assessment for COPD

Ineffective Airway Clearance related to - COPD

Activity Intolerance related to - COPD

Nursing Care Plan for Chronic Obstructive Pulmonary Disease

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