Chronic obstructive pulmonary disease or COPD is a long-term lung disease that is progressive and slowly deteriorating. Various risk factors influence the course of this disease, which may lead to many symptoms. The role of a nurse is to create a COPD care plan for each of the following nursing diagnosis for COPD, to be able to help a patient who is suffering from impaired lung function.

1. Ineffective Breathing Pattern

This COPD nursing diagnosis is related to a decrease in the rate and depth of breathing and may be associated with the patient’s weakness, reduced lung expansion, his position, and the effects of some medicines being taken.

Expected outcomes

• Improvement in breathing pattern.
• Use of proper posture and breathing techniques.
• Demonstration of normal respiratory rate and moderate tidal volumes.

Nursing interventions

• Encourage the patient to use proper breathing techniques with pursed-lips to reduce his respiratory rate and increase his expiratory tidal volume.
• Teach the patient to lean forward during exhalation, with his head tilted at a 16-18 degree angle to allow more air to exit the lungs.
• Encourage the patient to use abdominal breathing to improve breathing efficiency by holding a pillow against the abdomen while exhaling.
• Use an air conditioner or a humidifier to increase air humidity and reduce dyspnea.

2. Ineffective Airway Clearance

This nursing diagnosis for COPD may be related to tightening of the airways (bronchospasm), excessive production of thick secretions, allergies, thickening of the bronchial walls, and decreased energy.

Expected outcomes

• Demonstration of satisfactory airway clearance.
• Use of effective coughing methods.
• Appropriate use of medications such as dry powder inhaler, nebulizer, and humidifier.

Nursing interventions

• Assist the patient in assuming a comfortable position by elevating the head of the bed and having him lean on a table or sit at the edge of the bed.
• Teach the patient how to cough effectively while sitting upright.
• Encourage the patient to increase fluid intake.
• Use mechanical or manual chest percussion techniques and postural drainage of sputum.
• Minimize environmental pollution such as smoke, dust, and feather pillows.

3. Impaired Gas Exchange

This COPD nursing diagnosis may be related to bronchospasm, air-trapping and obstruction of airways, alveoli destruction, and changes in the alveolar-capillary membrane. The patient may demonstrate abnormal breathing, difficulty breathing (dyspnea), restlessness, and inability to tolerate activity.

Expected outcomes

• Maintenance of adequate gas exchange.
• No changes in patient’s mental status.
• The patient’s arterial blood gases (ABGs) will exhibit PaO2, PaCO2, and pH levels at baseline levels.
• The patient can explain how to use oxygen therapy and know when to use it.

Nursing interventions

• Monitor the patient’s respirations and regularly assess his breath sounds to be able to determine baseline and effectiveness of treatment.
• Monitor the patient’s ABGs, oxygen saturation, and mental status.
• Administer pulmonary physiotherapy to maintain patency of airways and prevent any complication.
• Assess the patient’s color, warmth and peripheral pulses to detect changes of oxygenation and ventilation.
• Position the patient in high Fowler’s or forward leaning sitting position for maximum ventilation to improve lung expansion. 
• Encourage pursed-lip breathing.

4. Imbalanced Nutrition: Less than Body Requirements

This nursing diagnosis for COPD may be related to fatigue, dyspnea, medication side effects, sputum production, and anorexia. The patient may exhibit weight loss and loss of appetite.

Expected outcomes

• Awareness of the needed dietary changes after his discharge.
• Maintenance of optimal weight.
• Knowledge of dietary plans and how to take frequent, small meals that are easy to chew.

Nursing interventions

• Assess the patient’s dietary habits and recent food intake.
• Evaluate the patient’s understanding of his nutritional needs.
• Counsel the patient and his family about selecting foods that are high in protein and high in calories.
• Advise the patient to take vitamin supplements and food supplements such as snack bars or milk shakes between meals.
• Give oral care and promptly remove expectorated secretions to reduce nausea and vomiting.

5. Activity Intolerance

The COPD care plan for activity intolerance may include a nursing diagnosis of insufficient energy to endure or accomplish daily activities, which may be related to dyspnea and debilitation due to COPD.

Expected outcomes

• Maintenance of optimal activity levels.
• Patient can pace activities.
• The patient can plan for simplification of his activities.
• The patient participates in muscle-conditioning or exercise programs at home.

Nursing interventions

• Encourage the patient to undertake general exercises for conditioning and specific muscle training to strengthen muscles.
• Encourage the patient not to rush but to gradually increase activities.
• Provide positive feedback on the patient’s progress.
• Assist the patient in balancing work, recreation, and rest to regulate expenditure of energy.
• Regularly assess the patient’s sleep and breathing patterns.

6. Ineffective Individual Coping

This nursing diagnosis for COPD may be related to the patient’s anxiety, depression, lack of socialization, low levels of activity and inability to work.

Expected outcomes

• The patient is able to identify coping mechanisms that are effective and those that are ineffective.
• The patient is able to identify stressors, and threats to his role.
• The patient is able to use effective coping strategies such as dialogue with family and discussion with his health care providers.

Nursing interventions

• Encourage the patient to talk about his fears and anxiety with his family members as well as health care providers.
• Make a realistic assessment of the patient’s abilities and limitations to focus on activities the patient is able to do.
• Encourage the patient to participate in vocational rehabilitation and in pulmonary rehabilitation programs to reduce his sense of isolation.
• Refer the patient to professional counseling if indicated.

7. Knowledge Deficit

This nursing diagnosis for COPD may be related to the patient’s lack of information, misinterpretation of information, cognitive limitation, and lack of recall.

Expected outcomes

• The patient can demonstrate an understanding of his condition and treatment.
• The patient can identify causative factors and their relationship with current signs and symptoms.
• The patient can initiate lifestyle changes and is able to participate in his treatment regimen.

Nursing interventions

• Explain to the patient and reinforce knowledge on the COPD disease processes.
• Encourage the patient and his family to ask questions.
• Explain carefully about instructions and rationale for treatments like breathing exercises, how to cough effectively, and other conditioning exercises.
• Explain to the patient and family the importance of avoiding contact with people who have active respiratory infections.
• Explain the need for routine pneumococcal and influenza vaccinations.
• Discuss risk factors that may aggravate the patient’s condition such as pollen, dry air, temperature extremes, tobacco smoke, air pollution, andaerosol sprays.
• Explain activity limitations and how to alternate activities with rest to prevent fatigue, how to conserve energy and use pursed-lip breathing during activity.
• Discuss the importance of getting medical follow-ups, regular chest x-rays, and sputum cultures.
• Refer for home care of evaluation if indicated.
• Recommend the avoidance of sedative drugs unless prescribed by his physician.