What is a short term goal for a patient with COPD?

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What is Chronic Obstructive Pulmonary Disease (COPD)?
Nursing Care Plans
Recommended Resources
References and Sources

In this nursing care plan guide are seven (7) nursing diagnosis for Chronic Obstructive Pulmonary Disease (COPD). Get to know the nursing interventions, goals and outcomes, assessment tips, and related factors for COPD.

What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic Obstructive Pulmonary Disease (COPD) is defined as “a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.” (Global Initiative for Chronic Obstructive Lung Disease or GOLD)

Any respiratory disease that persistently obstructs bronchial airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). Chronic Obstructive Pulmonary Disease (COPD) is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction.

The term COPD mainly involves two related diseases — chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of an individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. COPD is also called chronic obstructive lung disease (COLD).

Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections.

Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum and marked cyanosis.

Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping).

Nursing Care Plans

Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Most patients with COPD receive outpatient treatment, the nurse should develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease.

Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD):

Common to many pulmonary diseases is bronchospasm that reduces the caliber of the small bronchi and may cause difficulty in breathing, stasis of secretions, and infection.

Nursing Diagnosis

Ineffective Airway Clearance

May be related to

Bronchospasm
Increased production of secretions; retained secretions; thick, viscous secretions
Allergic airways
Hyperplasia of bronchial walls
Decreased energy/fatigue

Possibly evidenced by

Statement of difficulty breathing
Changes in depth/rate of respirations, use of accessory muscles
Abnormal breath sounds, e.g., wheezes, rhonchi, crackles
Cough (persistent), with/without sputum production

Desired Outcomes

Maintain airway patency with breath sounds clear/clearing.
Demonstrate behaviors to improve airway clearance, e.g., cough effectively and expectorate secretions.

Nursing Interventions	Rationale
Nursing Assessment
Assess and monitor respirations and breath sounds, noting rate and sounds (tachypnea, stridor, crackles, wheezes). Note inspiratory and expiratory ratio.	Tachypnea is usually present to some degree and may be pronounced on admission or during stress or concurrent acute infectious process. Respirations may be shallow and rapid, with prolonged expiration in comparison to inspiration.
Auscultate breath sounds. Note adventitious breath sounds (wheezes, crackles, rhonchi).	Some degree of bronchospasm is present with obstructions in the airway and may or may not be manifested in adventitious breath sounds such as scattered, moist crackles (bronchitis); faint sounds, with expiratory wheezes (emphysema); or absent breath sounds (severe asthma).
Note presence and degree of dyspnea as for reports of “air hunger,” restlessness, anxiety, respiratory distress, use of accessory muscles. Use 0–10 scale or American Thoracic Society’s “Grade of Breathlessness Scale” to rate breathing difficulty. Ascertain precipitating factors when possible. Differentiate acute episode from exacerbation of chronic dyspnea.	Respiratory dysfunction is variable depending on the underlying process such as infection, allergic reaction, and the stage of chronicity in a patient with established COPD. Note: Using a 0–10 scale to rate dyspnea aids in quantifying and tracking changes in respiratory distress. Rapid onset of acute dyspnea may reflect pulmonary embolus.
Observe sign and symptoms of infections.	Identify the occurrence of an infectious process.
Monitor and graph serial ABGs, pulse oximetry, chest x-ray.	Establishes a baseline for monitoring progression or regression of disease process complications.
Therapeutic Interventions
Position head midline with flexion on appropriate for age/condition.	Gain or maintain an open airway.
Assist the patient to assume a position of comfort (elevate the head of the bed, have patient lean on an overbed table or sit on edge of the bed).	Elevation of the head of the bed facilitates respiratory function by use of gravity; however, patient in severe distress will seek the position that most eases breathing. Supporting arms and legs with table, pillows, and so on helps reduce muscle fatigue and can aid chest expansion.
Keep environmental pollution to a minimum such as dust, smoke, and feather pillows, according to the individual situation.	Precipitators of an allergic type of respiratory reactions that can trigger or exacerbate the onset of an acute episode.
Encourage abdominal or pursed-lip breathing exercises.	Provides patient with some means to cope with or control dyspnea and reduce air-trapping.
Observe characteristics of cough (persistent, hacking, moist). Assist with measures to improve the effectiveness of cough effort.	Cough can be persistent but ineffective, especially if the patient is elderly, acutely ill, or debilitated. Coughing is most effective in an upright or in a head-down position after chest percussion.
Increase fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or tepid liquids. Recommend the intake of fluids between, instead of during, meals.	Hydration helps decrease the viscosity of secretions, facilitating expectoration. Using warm liquids may decrease bronchospasm. Fluids during meals can increase gastric distension and pressure on the diaphragm.
Demonstrate effective coughing and deep-breathing techniques.	Helps maximize ventilation.
Assist the patient to turn every 2 hours. If ambulatory, allow patient to ambulate as tolerated.	Movement aids in mobilizing secretions to facilitate clearing of airways.
Suction secretions as needed.	Suctioning clear secretions that obstruct the airway therefore improves oxygenation.
Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage.	These techniques will prevent possible aspirations and prevent any untoward complications.
Administer bronchodilators if prescribed.	More aggressive measures to maintain airway patency.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.

References and Sources

References and recommended sources for this care plan guide for Chronic Obstructive Pulmonary Disease (COPD):

Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. Elsevier Health Sciences.
Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins. [Link]
Carlson, M. L., Ivnik, M. A., Dierkhising, R. A., O’Byrne, M. M., & Vickers, K. S. (2006). A learning needs assessment of patients with COPD. Medsurg Nursing, 15(4). [Link]
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]

Originally published on July 14, 2013.