Conventional mechanical ventilation: indicated for patients with severe respiratory distress despite initial therapy, life-threatening hypoxemia, severe hypercarbia and/or acidosis, markedly impaired mental status, respiratory arrest, hemodynamic instability, or other complications. Patient who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease. Hire expert. Show More COPD. Coarse crackles beginning with inspiration may be heard. (2007). Mild COPD patients may have mild to moderate hypoxemia without hypercapnia. Twopeoplemight have COPD, however one might have more signs of chronic bronchitis while … BODE index: The BODE index is a multidimensional scoring system used to test patients who have been diagnosed with COPD and to predict mortality. Obtain a clear history of the disease process and assess for exposure to risk factors. The overall goals are that the patient with COPD will have: Desired outcome: Patient maintains a clear airway by effectively coughing as evidenced by clear lung sounds on auscultation. While all questions may be used in the order given, … However, the x-ray may show over-inflation of the lungs, which is common in emphysema. Two-Dimensional Echocardiography: Even with severe COPD, the degree of pulmonary hypertension is usually only mild to moderate and hence, findings of severe pulmonary hypertension on echocardiogram or cardiac catheterization warrant further workup. Prevention of infections: COPD patients are extremely susceptible to pulmonary infections. The therapeutic management for a patient with COPD. ROM exercises help build stamina and prevent complications of decreased mobility. Patients with advanced disease may experience tachypnea and respiratory distress with simple activities. COPD Nursing Care Plan 2 Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion To determine a need for ventilatory assistance. 22, In Papadakis, M. A., In McPhee, S. J., & In Rabow, M. W. (2020). Mosby Publications, Page no 580-590. Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). If you continue to use this site we will assume that you are happy with it. Excess mucus production:  Chronic productive cough is a feature of COPD with predominant chronic bronchitis. You may also access the full report here. 1. Written by: Beverley Bostock-Cox ... having stopped when he was diagnosed with COPD, but he has a significant pack-year history of 60 years. COPD has emerged as the third leading cause of chronic morbidity and mortality worldwide. A diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat is recommended and can be divided into five or six small meals a day. Airway Clearance Techniques: ACTs include effective coughing, chest physiotherapy, airway clearance devices, and high frequency chest ventilation. These include cough, worsening dyspnea, progressive exercise intolerance, sputum production, and alteration in mental status. A variety of procedures, tests, and questionnaires can be used to evaluate patients with chronic obstructive pulmonary disease (COPD) for clinical and research purposes. Peripheral airway remodeling: The hallmark feature of COPD is airflow limitation during forced exhalation. Robert Orben Learning Outcomes 1. Good patient preparation is needed for accurate spirometry and, as it becomes a more routine test in both primary and secondary care, nurses working with COPD patients need to understand why and how it is carried out. Oxygen Therapy: Long-term continuous O2 therapy-LTOT (more than 15 hr/day) increases survival and improves exercise capacity and mental status in hypoxemic patients. COPD is a various condition from asthma, however it can be challenging to identify in between COPD and chronic asthma. How much restriction on the patient's activity tolerance? Safety and Comfort. Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan, Nursing Care Plan Chronic Obstructive Pulmonary Disease, Hypertension Nursing Management and The New Guidelines of Classification, Nursing Management of Pneumonia and Disease Process, Acute Glomerulonephritis (AGN) Nursing Intervention, Diary Of a COVID Nurse: The Fear and The Hope, The Importance of Nurses Being Diagnosed for Mental Health Issues, NCLEX-RN: Fluids and Electrolytes Questions with Rationale, Thinking Like a Nurse: The Critical Thinking Skills in the Nursing Practice, Cyanosis (2º to hypoxemia and hypercapnia), Forced expiratory volume in the first 1 second of expiration. Request consultation from pulmonary rehabilitation. Monitor serial ABG values as indicated by the patient’s condition. Severe AAT deficiency leads to destruction of lung tissues by proteases and can cause premature bullous emphysema. Desired Outcome: Following treatment/intervention, the patient’s breathing pattern improves as evidenced by reduction in or absence of reported dyspnea and related symptoms. Assessment and management of an exacerbation of COPD. Discuss with the patient and significant others the importance of good nutrition in the treatment of COPD. Inflammation of central airways: Chronic exposure to cigarette smoke, noxious particles and gases causes abnormal inflammatory response throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature. This assessment provides data that will determine need for dietary consultation. SpO2 at 93% or more can indicate need for decreasing O2 therapy. COPD (Chronic Obstructive Pulmonary Disease) nursing management with interventions and treatment with medications. In this phase the effectiveness of nursing care to meet the set goals are evaluated. In advanced cases, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed. Is there any use of accessory respiratory muscles during breathing? What color, number and consistency of sputum of patients. Brunner & Suddarth’s. Beta-adrenergic agonists, theophylline and diuretics, act to lower potassium levels. As the disease advances, the structure of the pulmonary arteries changes, resulting in the thickening of the vascular smooth muscle. Pharmacological interventions include both short-acting and long-acting bronchodilators to open airways. In chronic CO2 retainers, renal compensation occurs and thus, pH usually is near normal. A decrease in breath sounds or presence of adventitious breath sounds may indicate respiratory status change and necessitate prompt intervention. For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. The amount of air remaining in the lungs after a maximal expiration. Assess for signs and symptoms of hypoxia and report significant findings. Monitor the effectiveness of O2 therapy (e.g., pulse oximetry, ABGs). High-protein, high-calorie nutritional supplements can be offered between meals. Regulate fluid intake to optimize fluid balance. Improvement in breathing pattern. I. Administer noninvasive positive pressure ventilation (NIPPV) as prescribed. Patients may have a predominance of chronic bronchitis or emphysema, and it is often difficult to determine because the conditions usually coexist. Administer medications (e.g., bronchodilators and inhaled/oral corticosteroids or a combination of these). Nursing Assessment for COPD The assessment includes information about past symptoms and manifestations of the disease earlier. Longer acting β2-agonists (e.g., salmeterol, formoterol and indacaterol), or the anticholinergic tiotropium bromide, are more appropriate for patients with moderate to severe disease. (COPD) Care Management Assessment The questions in this brochure, based on the 2010 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report,1 are designed to help healthcare professionals (specifically case/care managers) assess individuals with a known diagnosis of COPD during a telephone or face-to-face interview. Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). The pathogens cultured most frequently during exacerbations are Streptococcus pneumonia, Haemophilus influenzae and Pseudomonas aeruginosa. Appropriate assessment of patients with COPD can be used to Make an accurate diagnosis, Assist in making decisions and choices of the most appropriate therapeutic interventions, SABA + anticholinergic, e.g. Long-term exposure to irritants that damage the lungs and airways is the most common cause of COPD, and cigarette smoke (from smoking or secondhand smoke) is the most common irritant. 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