Understanding Nursing Problems And Care Planning For COPD Patient

Ineffective Airway Clearance

This problem occurs when the respiratory system is unable to clear the pathway in order to undertake normal and healthy breathing procedure. There exists an inability of lungs to prevent the obstructions in the respiratory tract in order to provide smooth pathway for breathing. Coughing is a natural phenomenon that undertakes cleaning of the airway but COPD contributes to ineffectiveness of this. Prolonged coughing due to COPD leads to weakening of the respiratory muscles inhibiting the respiratory function of the body (Sousa, Carvalho, Lopes, & Silva, 2015).

Ineffective exchange of gas occurs when body is unable to get rid of carbon dioxide at the terminal of alveolar-capillary membrane. The optimal exchange of gas occurs with the help of diffusion process that maintains the concentrations of oxygen and carbon dioxide in the body. Furthermore, both flows passively throughout the body but have difference in the concentrations in the alveolar-capillary membrane. This difference is required to be maintained with optimal ventilation in accordance with the blood flow. In addition to this, alteration to the passive flow of gas leads to imbalance or impaired gaseous exchange (Weinreich, Thomsen, Brock, Karbing, & Rees, 2015).

Optimal ventilation is essential to maintain effective flow of air between the outside environment, alveoli and dispensation of air to the lungs for the effective regulation of further functioning of the body. Furthermore, the difference in the pressure occurs between the airway and alveoli conducts the inspiratory muscles to contract further lowering the intrathoracic pressure and formulating a distending pressure. In response to this, alveoli expand and the pressure residing there gets lowered leading to inspiration. This whole process affects the breathing process ultimately leading to ineffective breathing (Sainaghi, Re, Bellan, Navalesi, & Pirisi, 2016).

Degrading alteration to required body dietary intake leads to deficiency of the nutrients that are essential to meet the regulatory functioning of the body in terms of metabolic procedures. This disease makes the breathing extremely tough for the patient ultimately affecting the dietary consumption as it is extremely tough to eat along with shortness of breath, excessive sputum production, dyspnoea and medication (Guo, Liu, Lin, & Chen, 2012).

The patients suffering from COPD are much more exposed to infection by pathogens than the normal individuals. The possible reason of this can be impairment and lack of efficiency of the innate immune system of the body. Furthermore, such inability is experienced due to colonization by foreign bacteria, virus and other pathogens that are harmful for the body. This colonization mainly targets the respiratory tract of the body affecting the smooth breathing procedure (Wark, Tooze, Powell, & Parsons, 2013).

Impaired Gas Exchange

Nursing Care Plan:   Neville

Note:  Dot points recommended in care plan.   Click and type in each cell, click enter in a cell to make it longer

A reminder that all information must be referenced  

Nursing problem: Ineffective Airway Clearance due to COPD
Underlying cause or reason: COPD leads to blockage of the airway inhibiting the smooth regulation and flow of purified oxygen throughout the body.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Provision of mobility to determine the functioning of lungs	· Auscultation of the lungs to analyse the sound coming while breathing. · Further analysis is required to determine the physical assessment (Ali, Schreiber, Matthews, & Rhynders, 2016).	· Auscultation will determine the condition of the lungs with the help of sounds such as wheezing, crackling and others. · Furthermore, physical assessment as determination of rate of respiration, pulse rate, breathing rate, blood pressure and others will help in formulating the intervention plan (Ali, Schreiber, Matthews, & Rhynders, 2016).	· Effective and timely documentation of the auscultation and physical assessment of Neville.
Nursing problem: Impaired Gas Exchange
Underlying cause or reason: This condition arises when effective diffusion of carbon dioxide and oxygen does not occur in the alveolar-capillary membrane.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Provision of rest to provide relief to lungs	· Intervention will require providing quiet and calm environment to provide him complete rest. · Relaxation must be enhanced in order to provide relief from the shortness of breath and dyspnoea (Ali, Schreiber, Matthews, & Rhynders, 2016).	· Shortness of breath or dyspnoea leads to sever excitement and respiratory distress in the patient. · Optimal relaxation leads to regulation of sleep and prevents the patient from any external pathogenic stimuli (Sunde, et al., 2014).	· Optimal monitoring is conducted with the help of analysing the signs and symptoms in Neville. · Extent of calmness, optimal oxygen saturation level, analysis of membrane colour and lesser coughing and others determines balance in the severe condition of Neville.
Nursing problem: Risk of Impaired Ventilation
Underlying cause or reason: This condition is due to ineffective inspiration and expiration of airflow.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Provision of warm and comfortable environment for maximum rest	· Intervention requires providing provision of warm and comfortable environment. · This can be conducted with the help of providing friendly environment by undertaking optimal communication (Duncan & Laurie., 2017).	· Alteration to breathing pattern leads to hyper activity in the patient. Additionally, hypoxemia also inhibits optimal functioning of the various organs of the body. · Provision of friendly environment will ensure effective imparting of the medication required to control the inspiration and expiration in Neville (Duncan & Laurie., 2017).	· The possible indicator of this intervention is the normal breathing pattern without much acute exacerbation.
Nursing problem: Risk of Infection
Underlying cause or reason: This condition arises when the COPD attacks the immune system of the body with foreign pathogens such as bacteria, virus and others.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Provision of safety in terms of hygiene	· Regular monitoring of the temperature, effectiveness of exercise and fluid intake level. · Optimal hand hygiene must be undertaken by the nurses and hygiene must be maintained (Weldam, Lammers, Zwakman, & Schuurmans., 2017).	· Regulation of hand hygiene and bodily hygiene will prevent any extrinsic pathogenesis. · Regular monitoring of the temperature will determine if the practices are compatible enough or not (Weldam, Lammers, Zwakman, & Schuurmans., 2017).	· The possible indicator of prohibited pathogenesis will be the stabilized condition and controlled temperature.
Nursing problem: Imbalanced Nutrition
Underlying cause or reason: COPD leads to shortness of breath and dyspnoea that hinders the optimal dietary intake of Neville.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Provision for optimal dietary intake	· To treat the degrading levels of nutrition in the body regular meals must be provided at the regular intervals. · Non-oily and light food must be provided. · Certain food such as gas producing, very hot, carbonated drinks, very cold and other must not be provided (Weldam, Lammers, Zwakman, & Schuurmans., 2017).	· Consumption of light food at continual intervals will provide regular source of nutrients to the body. · Gas producing or carbonated drinks can lead to enhanced dyspnoea. · Extreme temperature of food such as extremely cold or hot can aggrandize cough (Weldam, Lammers, Zwakman, & Schuurmans., 2017).	· No abnormal signs and symptoms in terms of breathing distortion and gain in weight are the indicators of the enhanced condition.

Prednisone is an immunosuppressant drug that is prescribed to Neville for oral consumption. This drug is a corticosteroid that inhibits the inflammatory reactions that occurs due to certain allergic reactions. Prednisone provides relaxation by weakening the immune system of the body and further regulates the treatment of autoimmune diseases such as COPD. Additionally, ipratropium bromide is also provided to Neville with the help of a nebulizer. ipratropium bromide provides instant relief to Neville from shortness of breath, dyspnoea and wheezing. This drug works by providing relaxation to the muscles under stress allowing the airway pathway to breathe more efficiently. Furthermore, the direct intake of ipratropium bromide with the help of a nebulizer provides instant relief from the attack that Neville faces due to shortness of breath. Besides this, Amoxicillin is an antibiotic drug that works to prevent the effects of bacteria on the respiratory tract. COPD mainly leads to colonization of pathogenic bacteria, virus and others that affects the normal breathing procedure. This drug reduces the pathogenic effects of colonization contributing to normal breathing pathway (Pérez, Llano, Mengual, & Golpe., 2017).

The nurses must undertake timely administration of prednisone in Neville. This drug has many side effects if not consumed appropriately as per the prescription by the doctor. Additionally, this drug reacts with other others in the body degrading the condition much more. Besides this, it can affect the extent of infection as this drug lowers the immunity standards of the body. Furthermore, this drug has side effects of restlessness, confusion, vomiting, weight loss and many others (Gt, M, L, & Lj., 2013).

The nurses are required to check if Neville is allergic to ipratropium bromide or not. Additionally, the administration of the medication must be conducted in accordance with the prescription of the doctor. Furthermore, side effects such as dizziness, constipation, nausea, dry mouth, irregular heartbeat, swelling and many others must be checked regularly. The nurses must impart the amoxicillin at the same time every day as per the prescription of doctors. Additionally, in order to monitor the effects of amoxicillin regular blood test analysis must be undertaken by the nurses. In addition to this, regular analysis of the functioning of other organs must be undertaken such as kidney or liver in order to determine the extent of effects of amoxicillin. Certain side effects related to amoxicillin allergy can be pain, vomiting, rash, nausea, diarrhoea, severe weakness and others (Adams & Peters, 2013).

Risk of Impaired Ventilation

Nursing for the treatment of Neville requires experienced intervention based on the concoction of pharmacological and non-pharmacological interventions. Additionally, optimal awareness is essential to be instilled in Neville regarding his condition and the medication he is been provided with. Primarily, COPD is a disease that targets the respiratory tract of the patient providing ultimate discomfort in breathing. This information and related issue Neville is facing must be provided to him in order to increase awareness regarding the severe condition and its implications on him. In addition to this, it has been observed by various healthcare professionals that providing awareness allows the patient to respond better to the imparted treatment. Besides this, importance of stopping smoking is a must requirement to be imparted to Neville as smoking aggravates the prevalent degrading condition of him. Smoking aggrandizes the effects of COPD to an extreme level. COPD is an incurable disease and can be controlled or slowdown in order to live a healthy life. Prolonged smoking enhances the degrading quality of lungs. The smoke that enters the lungs and degrades the quality by blocking the passage of inspiration and expiration (Christenhusz, Prenger, Pieterse, Seydel, & Van der Palen, 2012).

This is essential to make Neville understand the degrading effects of smoking as he has a family to look upon to. Furthermore, optimal confirmatory awareness needs to be created and can be conducted by undertaking various fun activities, meeting Neville with other patients who are also recovering from same condition and others. In addition to this, establishment of friendly relationship between healthcare professionals and Neville is essential in order to regulate remedial treatment based on mutual understanding and respect (Brandt, 2013).

The abnormal signs and symptoms as shown by Neville are of acute exacerbation. This condition determines sudden worsening of the signs and symptoms of COPD that can be triggered due to alteration to pathogenic microorganisms or pollutant environment. The immediate nursing intervention requires administration of ipratropium bromide or salbutamol with the help of nebulizer and initiation of oxygen therapy if the level of oxygen is low by maintaining the oxygen saturation level. Besides this, medication is required to be instilled such as antibiotics, corticosteroids, bronchodilators and usage of mechanical intubation must be provided in order to clear the airway. The nebulizer of ipratropium bromide or salbutamol will instantly reduce the imbalanced symptoms of acute exacerbation and will provide relief to Neville. Additionally, the oxygen therapy is required to be provided in order to maintain the low oxygen saturation level in Neville. Oxygen is essential in order to regulate various metabolic activities of the body. Antibiotics are provided in order to reduce the level of pathogenic microorganisms in the body of Neville. Furthermore, corticosteroid such as prednisone is also provided in order to reduce inflammation of the airway that prevents optimal regulation of the airflow in the respiratory tract. Besides this, mechanical ventilation is also required preferably non-invasive in order to maintain the continual airway pressure throughout the body (Johnston, 2012).

Imbalanced Nutrition

Neville is an elder person who is 62 years old and is suffering from COPD and has a habit of smoking for past many years. 2 days back he has been admitted to the hospital with the case of COPD having signs and symptoms of cough, dyspnoea and excessive sputum. Additionally, he has reduced smoking but is unable to stop it completely. Recently he has suffered from acute exacerbation and is under the interventions of prednisone, ipratropium bromide, amoxicillin as antibiotic and is kept on mechanical ventilation. Additionally, oxygen therapy has also been provided to him to maintain the level of oxygen saturation (Hinds, Disantostefano, Le, & Pascoe, 2016).

References

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