Collaborative Nursing Plan for COPD Exacerbation Patient

Nursing plans for patients with chronic obstructive pulmonary disease (COPD) exacerbations require collaboration with interdisciplinary team members to ensure effective care. Opportunities for collaboration include bronchoscopy with a respiratory therapist, meal-time management with a dietician, and independent movement and functioning with an occupational therapist. These collaborations enable nurses to provide patient-centered care, educate patients and families on therapeutic dietary needs, and facilitate patient independence.

Running Head: ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING
(COPD)
Essential Nursing Care: Chronic and Complex Nursing (COPD)
Name:
Institution and Affiliations:
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Date:

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
Introduction
Nursing practice in regard to care for patients with chronic and/or complex conditions
requires different guiding principles. The principles are particularly put in place to guide
different aspects to be addressed in the design of a nursing plan for the patients. These principles
are not only paramount in ensuring proper patient care but also inform decision making for
criticize care multi-disciplinary team members, the patient and their family members. In this
regard, it is apparent that nursing plans be in line with set guiding principles. The principles
include the need for: healthcare and support; teaching and coaching; advocacy and co-ordination
and; education, research and evaluation. The guiding principles above are thus the main
framework upon which patient care is centered while within the critical care unit until the patient
returns to a stable condition within the hospital and at home after discharge. In this discussion,
there is a deeper explanation of these guidelines in terms of their importance in the development
of nursing care plans within chronic and/or complex care units, including an examination of the
approaches to be used in the improvement of a patient’s health outcomes. This presentation will
also highlight the specific nursing plan necessary for the patient in the case study, who reportedly
diagnosed of COPD exacerbations. Even further, the discussion will focus on establishing
possible situations where a nurse can obtain opportunities for collaborating with members of a
given interdisciplinary team assigned to the patient within the critical care unit.
The Guiding Principles in Planning Nursing Care for Patients with Chronic and Complex
Conditions
a. Health Care and Support
Under this guideline, a registered nurse has the sole responsibility to engage the
interdisciplinary team to facilitate the provision of required care and support to a patient with

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
complex and chronic condition. In the hospital setting, the nurse should ensure that the patient is
diagnosed for any given body conditions which require attention and also to inform decision
making on additional treatment of the conditions (Straughair, 2011). Under healthcare and
support, the interdisciplinary team under the nurse focuses on managing breathing inefficiency,
imbalanced nutritional status, proper positioning, and on administration of required medications.
In regard to support, the nursing plan must comprise of different approaches of enabling the
patient to manage themselves and independently move, eat, or groom (Elder, 2017). The team
thus avails the necessary support to ensure that in the short or long-run, the patient with a
complex and/or chronic condition is comfortable in the hospital or home environment. There is
also need for environmental modifications to ensure that the patient is position to cope with the
condition, minimize pain and avoid factors that aggravate the condition and or trigger its acute
situation (Straughair, 2011). Healthcare and support thus involves specific approaches depending
on the condition and age of the patient, but is a core requirement evidence-based practice.
b. Teaching and Coaching
Considering the guideline for the need for teaching and coaching, Registered Nurses have the
responsibility to educate the patient, care takers and family; to be able to independently control
their own health (Straughair, 2011). The nurse identifies presents the required educational needs
including responses to specific requested information by the patients and/or clients. For a case of
COPD management as is the case for Angela, the nurse should provide teaching and coaching
materials for self-management to prevent exacerbations (Sciarra, 2012). These educational and
coaching sessions can be formal and informal depending on the convenience of the patients
and/or clients. The nurse can focus on in teaching and coaching on hygiene, patient movement
and/or exercise, meal-time management, required medication, sexuality, death, dying and

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
chronic sorrow (Sonola et al, 2013). While the teaching and coaching sessions can be formally
done in sessions, nurses can identify special “teaching moment’s each day and pass this crucial
information to the patients and family. Coaching and teaching of patients on the above areas help
in promoting their own participation in their health well-being and reduce any risks associated
with chronic and complex ailments.
c. Advocacy and Co-ordination
Nursing practice emphasizes the need for a nurse to advocate for the rights of their
patients and to coordinate the necessary nursing interventions required. In regard to advocacy,
nursing respects human rights which encompass cultural rights, a right to life, right to consent to
treatment, individual dignity among others (Sonola et al, 2013). It calls for the need to; provide a
safe and healthy environment; ensure equity and social justice while allocating resources and
further; enhance accessibility of healthcare and socioeconomic services. For the benefit of the
patients under care, the nurse should also identify and explain any policies and/or practices that
infringe their rights. They should also explain the policies, necessary procedures and specific
guidelines to be followed in case patients’ rights are compromised (Sciarra, 2012). Advocacy in
nursing assures patients and families of quality, safe and ethical healthcare.
On coordination, nurses should collaborate with patient, their family, caretakers, the
multidisciplinary health team, and the hospital management to offer quality healthcare. It is
however important to understand the necessary guidance that each player might require in order
to offer a quality nursing health intervention. It is the nurse’ role to therefore ensure that there is
a multidisciplinary continuity of care to ensure that the patient experiences care as both
connected and coherent (Straughair, 2011). Experience of continuity for a patient and their
family is the perception that healthcare providers understand what occurred before, the different

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
healthcare providers agree on certain management plan, and further that any of the providers that
now knows them will provide care to them in the future.
d. Education, Research and Evaluation
Evidence-based nursing practice requires that the knowledge underpinning different
approaches in nursing intervention be questioned. On education, the nurse needs to take part in
continuing professional development programs to be abreast with the latest information,
research, guidelines on care for patients with chronic and complex health conditions (Straughair,
2011). The nurse requires to have actively participated in this evidence-based practice
professional development by presenting their individual experiences. They can also take part in
short refresher courses offered online by different medical institutions, to sharpen their skills in
interventions on managing chronic and complex complications.
On research, nurses should take part in research studies especially on the required nursing
care plan for individuals with chronic and complex diseases. They can do so by reading and
utilizing existing research in evidence-based clinical practice, participating in relevant research
projects, and be leaders in research projects after identifying any gap in nursing practice (Sonola
et al, 2013). The nurse can thus rely on already existing online research database in Australia to
extract information on research in chronic and complex care. These include the Cochrane
Library, Google Scholar among others. Information acquired from research is important as it
helps in informing the nurse’s decision making on nursing care plan and coordination of the
constituted inter-disciplinary team.
Evaluation involves setting and monitoring an individual’s health goals, clinical
governance aspects and use of reflective practice. A nurse should identify patient’s measurable

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
goals, including those of their caretaker and the multidisciplinary nursing team to determine
whether they are achieved. Clinical governance as part of evaluation requires that clinicians
and/or administrators participate in joint action to ensure that quality of care. Lastly, reflective
practice requires the nurse to engage themselves in continuous critical evaluation when alone,
through journals, research articles and even under a special clinical supervisor. This helps them
to improve healthcare quality and to have a stimulated professional growth.
The role of the registered nurse, Nursing Plan & appropriate Nursing Interventions for a
COPD Patient
a. Solving Knowledge Deficiency
This nursing plan focuses on increasing the patient’s and their family’s cognitive
information on COPD. It is thus in line with the guiding principle of the need for teaching and
coaching (Cramm & Nieboer, 2013). Knowledge deficiency can be evidenced through request
forms, misconceptions, poor instruction follow-through and a development of complications that
are easily preventable. In this regard, the nurse should explain to the patient the disease process
and reinforce these explanations for the message to sink. They should be allowed to ask
questions and this reduces anxiety while boosting their willingness to participate in the nursing
plan. The patient should be instructed on the importance of breathing exercises, effective
coughing among other conditioning exercises (Lau et al, 2017). This exercises increase
respiration muscles strength, prevents collapsing of small airways while at the same time
controlling dyspnea. The nurse should emphasize the need for dental and oral care to prevent any
bacterial growth that could contribute to pulmonary infections. The triggering factors of COPD
exacerbations and the need to avoid them should be explained (Elder, 2017). They include dry

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
air, extreme temperatures, wind, tobacco, aerosol sprays, and pollen among others. The nurse
should also instruct the patient on the dangers of smoking and advice the patient on cessation to
slow and/or halt COPD progression. Teaching and coaching should also focus on the need for
medical follow-up and encouraging regular sputum culture including necessity of chest x-rays.
This is important in altering a patient’s therapeutic regimen. The patient should also be
encouraged to take part in support groups to reduce anxiety and depression due to its therapeutic
emotional support and/or respite care (Lau et al, 2017). There is need to discuss the side effects
and/or adverse reactions related to each respiratory medication to inform change in regimen or
continuity of a particular medication. Further, the nurse should instruct and reinforce information
on inhaler medication and use to enable them self-manage when away from the hospital to
control exacerbations.
b. Managing Patient’s Imbalanced Nutrition
Imbalanced nutrition refers to a situation where the intake of food nutrients is insufficient
in order to meet the patient’s metabolic requirements (Howard & Ceci, 2012). This agrees with
the guideline; to provide healthcare and support to patients. Imbalanced nutrition can result from
dyspnea and sputum production. It can also be caused medical side effects, vomiting, anorexia,
fatigue and nausea. It can be managed first by confirming the whether the patient and caretaker
understand the nutritional requirements so as to ascertain client informational needs (Cramm &
Nieboer, 2013). Lack of information can then be addressed through the teaching and coaching
guideline on nursing plans. The nurse can evaluate patient dietary habits and recent food intake
and ascertain degree of their eating difficulty. Body weight and size evaluation can inform the
dietician on how to stabilize the patient’s nutritional needs. Bowel auscultation should be done to
understand whether there is decreased gastric motility which is an indicator of possible limited

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
intake of fluids, hypoxemia and poor choice of food. The nurse should provide oral care and
promptly remove expectorated secretions to prevent noxious tastes and smells from deterring
patient appetite, trigger nausea and an increase in respiratory difficulty. A rest period of
minimum 1 hour to mealtime should be allowed to decrease fatigue at meal time so that more
calories can be taken up (Kuharic et al, 2015). The time may vary and the nurse can conform
from research tools and any necessary additional directions they can take. Further, there is need
for supplemental oxygen at meal time to reduce dyspnea and boosts energy for eating and thus
enabling food intake.
c. Managing Ineffective Airway Clearance
This involves enabling the COPD patient to clear any secretions and/or obstructions within
the respiratory tract so that the airway remains clear (Ides et al, 2011). In this regard, the nurse
should first auscultate the breath sounds to ascertain wheezing, rhonchi and crackles. Moist
crackles will inform the need to treat patient for bronchitis while expiratory wheezes indicate that
the patient has emphysema and should be treated accordingly (Chin, 2017). The patient should
be assisted to assume a comfortable position with the head elevated to enable easy respiration.
The arms or legs can be supported with pillows to minimize fatigue and enable expansion of the
chest. Environmental pollution should be avoided to avoid triggering of acute COPD through
exacerbations within the ward or at home (Cramm & Nieboer, 2013). The Registered Nurse
should encourage the patient to use pursed-lip and abdominal breath exercises. This will help the
patient to have coping means to dyspnea and also minimize air-trapping, a condition that is
common in COPD. The characteristics of the patient’s cough should be examined as to whether
it is persistent, moist, or hacking so that they can be assisted to improve coughing effort
effectiveness. This is necessary, understanding that cough could be persistent yet ineffective

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
particularly among elderly patients as Angela. The patient should be assisted to take an upright
and/or head-down posture after chest percussion has been done. Further, the patient should be
provided with a minimum of 3000mL daily but within the patient’s cardiac tolerance (Cramm &
Nieboer, 2013). Patient hydration assists in reducing secretion viscosity to aid expectoration.
Opportunities for Collaboration with the Inter-disciplinary Team and Coordination of
Care
Understanding that COPD exacerbation presents with shortness of breath among patients,
this is an opportunity for the nurse to collaborate with a respiratory therapist to ensure the patient
gets enough air circulation. A respiratory therapist will help in solving the patient’s dyspnea and
other respiratory healthcare problems the patient often goes through (Chin, 2017). The therapist
for instance will draw arterial blood gases, ensure the maintenance of patients with mechanical
ventilation, and provide incentive spirometry, among other intermittent respiratory treatments.
They can also give respiratory medications to patients, intubate them, and help in bronchoscopy
(Jan, 2013). Further, the nurse will need a respiratory therapist to offer pulmonary hygiene
services to COPD patients including chest physiotherapy. They also help in preventing and
managing cardiac and/or respiratory arrests.
The second opportunity that calls for collaboration in the nursing plan for a patient with
COPD exacerbation patient is at the point of meal-time management (Chin, 2017). The nurse
will need to collaborate with a dietician within the interdisciplinary team to assess then plan,
implement and later evaluate nursing interventions related to patient therapeutic dietary needs.
At this opportunity, the dietician can educate the patient and family/caretaker on appropriate diet
both in hospital and at home. Understanding that it is imperative for COPD patients to maintain
healthy weight, as excess weight leads to more episodes of shortness of breath. On the other hand

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
malnutrition among COPD patients leads to weakness and weakening of rib muscles that require
energy for breathing (Jan, 2013). The nurse can thus involve the dietician to provide advice on
calories needed to maintain breathing and keep the body muscles strong.
Further, the nurse can collaborate with an occupational therapist to manage the patient
with COPD exacerbation at the point when the patient requires independent movement and
functioning and thus picking on an occupational therapist (Cramm & Nieboer, 2013). The
occupational therapist will thus assess the patient, plan, execute and evaluate any intervention
provided in regard to those which facilitate a patient's ability to attain best level of independence
possible in carrying out routine activities. These include for instance bathing, eating, dressing
and grooming. An occupational therapist will provide the patient with adaptive devices including
for instance sock pulls for him/her to don socks independently (Howard & Ceci, 2012). The
occupational therapist can assess and then recommend necessary Angela’s home and/or ward
environmental modifications to have ramps, handrails among others to ensure the safety and the
independence of the patient.
Conclusion
Conclusively, it is clear that nursing plans in the context of chronic and/or complex care
must be informed by the main guiding principles. It is even more imperative for healthcare
practitioners, patients and family members to understand and grasp these guiding principles. This
is because they are the pillars in regard to ensuring patient safety and the quality of care within
the hospital facility. In the above discussion there are specific highlights on the major guidelines
that need to be used in the development of effective nursing plans within chronic and/or complex
care setting. These include the need for: healthcare and support; teaching and coaching;
advocacy and co-ordination and; education, research and evaluation. The presentation explains

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
the different ways towards improving the health outcomes of a patient. Different nursing
interventions for included in the nursing plan for a patient who presented with exacerbation of
COPD. Even further, the discussion identifies and explains the opportunities which Registered
Nurses can use to collaborate with members of the interdisciplinary team while providing care
for the patient.

ESSENTIAL NURSING CARE: CHRONIC AND COMPLEX NURSING (COPD)
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