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NURS 353C COPD Care Plan.Latest Update 2023 Assured A+ Best Rated Solution
Pathophysiology: COPD stands for chronic obstructive pulmonary disorder. What leads to this is things like smoking, secondhand smoke, and other inhaled pollutants, which causes destruction of the air sacs in your lungs called alveoli and your airways leading down to your lungs. This makes it difficult for your body to get oxygen to the rest of your body, and can make it very difficult to breathe. Patient situation and background: HG is a 68 y/o Latino M admitted to the hospital today for c/o pneumonia. His daughter found him unresponsive at home. Daughter stated HG has hx of COPD and since his wife died recently, ETOH abuse. PMHX (past medical history): COPD Final DX: Pneumonia w COPD exacerbation Complete the following table: ASSESSMENT DATA: SUBJECTIVE & OBJECTIVE
NURSING
DIAGNOSIS
OUTCOME
CRITERIA
NURSING
INTERVENTIONS
EVALUATION
Subjective:
_- Recently retired
- Recently widowed
- Possible_ ETOH abuse 1. Impaired gas exchange related to COPD and pneumonia 1a. Pt. ABGs will return to baseline within two days A1. Nurse will titrate O 2 levels as needed. (Balanced O2 supply and demand, pg. 1544, Harding et al., 2020) 1a. Pts breathing returned to within normal/acceptable range. A2. Nurse will encourage
Subjective:
_- Hx of COPD
- Productive cough
- Diminished_ sounds at lung _bases
- BP: 150/_ incentive spirometer use. (Postoperative Care, pg. 335, Harding et al., 2020) A3. Nurse will administer
B4. Nurse will elevate pt head of bed to a comfortable level. (Postoperative Care, pg. 335, Harding et al.,
B5. Nurse will encourage frequent turning to promote chest expansion. (Postoperative Care, pg. 335, Harding et al., 2020) 1c. Pt RR will return to 12-20 per min by end of shift C1. Nurse will titrate O 2 levels as needed (Balanced O2 supply and demand, pg. 1544, Harding et al., 2020) 1c. Pt used incentive spirometer 10 times every 1- hour while awake. C2. Nurse will encourage incentive spirometer use. (Postoperative Care, pg. 335, Harding et al., 2020) C3. Nurse will administer medications as ordered. (COPD Drug Therapy, pg. 566, Harding et al.,
C4. Nurse will elevate pt head of bed to a comfortable level. (Postoperative Care, pg. 335, Harding et al.,
2. Ineffective airway clearance related to increased secretions and abnormal auscultation sounds C5. Nurse will encourage frequent turning to promote chest expansion. (Postoperative Care, pg. 335, Harding et al., 2020) 2a. Pt will have decrease in adventitious lung sounds by end of shift A1. Nurse will administer and titrate oxygen as needed (Balanced O2 supply and demand, pg. 1544, Harding et al., 2020) 2a. Pts adventitious lung sounds decreased significantly by end of shift. A2. Nurse will encourage incentive spirometer use. (Postoperative Care, pg. 335, Harding et al., 2020) A3. Pt will cough and deep breathe. (Postoperative Care, pg. 335, Harding et al., 2020) A4. Nurse will administer nebulizer treatment as ordered & needed (COPD Care, pg. 567, Harding et al., 2020) A5. The nurse will encourage smoking
2c. Pt will identify possible complications and know when to seek medical attention. C1. The nurse will provide education on colors of sputum. (COPD Care, pg. 567, Harding et al., 2020) C2. Pt will properly and effectively use incentive spirometer 10x per 1-2 hrs. (Postoperative Care, pg. 335, Harding et al., 2020) 2c. Pt was open to discussing smoking cessation with social worker. C3. Nurse will administer nebulizer treatment as ordered & needed. (COPD Care, pg. 567, Harding et al., 2020) C4. Nurse will provide education on deep breathing. (Postoperative Care, pg. 335, Harding et al., 2020) C5. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020)
3. Risk for depression related to COPD as evidence by activity intolerance and ineffective coping 4. Ineffective Coping 3a. Pt will verbalize three coping mechanisms by end of shift. A1. The nurse will provide list of effective coping mechanisms. (COPD Considerations, pg. 574- 575, Harding et al., 2020) A2. The nurse will help facilitate communication with friends, family, and support systems. (COPD Considerations, pg. 575, Harding et al., 2020) 3a. Pt is able to verbalize three healthy coping mechanisms.
- Imbalanced Nutrition A3. The nurse will help pt get in contact with social worker/case manager. (COPD Considerations, pg. 575, Harding et al., 2020) A4. The nurse will help pt get in touch with support groups. (COPD Considerations, pg. 575, Harding et al., 2020) A5. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020)
end of shift. Considerations, pg. 574- 575, Harding et al., 2020) C2. The nurse will help facilitate communication with friends, family, and support systems. (COPD Considerations, pg. 575, Harding et al., 2020) C3. The nurse will help pt get in contact with social worker/case manager. (COPD Considerations, pg. 575, Harding et al., 2020) C4. The nurse will help pt get in touch with support groups. (COPD Considerations, pg. 575, Harding et al., 2020) C5. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020) 3c. Pt was interested about smoking cessation options.
Professional Growth Reflection: During this COPD clinical, I felt that my weaknesses on this topic were really addressed and I now am able to feel more confident about this disease. I felt comfortable enough in clinical to speak up and be apart of the class discussion, which is something I have been working on since the start of the program. Having the large discussion really helped me open my eyes to all sorts of nursing diagnoses, patient outcomes, and interventions. The diagnoses I didn't originally think of putting down were impaired nutrition, ineffective coping, and ineffective airway clearance. A few interventions that I didn't think of were patient identifying sputum color changes, elevating the head of the patients bed, and postural changes to help open up the chest. After discussing these in clinical, I have a solid foundation that I will continue to build on over the program and as my future as a nurse. Discharge Plan After this patient is released, I presume he will go home with his daughter, to his own home, or even to assisted living until he is able to combat his addictions and cope with the loss of his wife. The education he will need be regarding smoking cessation and any other inhalants. What else the nurse will teach him will be about his disease and what might promote flair ups or exacerbations. The medications he is currently taking or newly prescribed, he should be education on how he should take them, of any side effects that may occur, and of any adverse effects that he would need to seek medical attention for. Since he is grieving the death of his wife, education on support groups should be brought up. The medical equipment needed for him would be his medications, nebulizer with humidifier, and the incentive spirometer. Interprofessional Team Members: Respiratory Therapist :
- Will help encourage the use of medications to open his airways and get rid of secretions. The respiratory therapist might _also teach how to use the nebulizer and provide more education on why therapy is important to continue. Nutritionist:
- Will help him learn how he should be eating. COPD patients may not eat enough or not get enough nutrients. The nutritionist can help lead him to foods he likes and can benefit him in the long run. Social Worker:
- This team member can facilitate more opportunities to help him healthily grieve the loss of his wife. They can provide information and education on addiction programs for ETOH and alcohol abuse._
