Nursing Assignment: COPD Care Plan and Patient Education

This nursing assignment focuses on creating a care plan for a patient with COPD and providing patient education on self-management strategies. It includes assessment, priority nursing diagnoses, and team care.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Task 1. Consider the patient
The patient in the case study is 44 years old patient, Mr. Peter Newman, a 44 years old man ,
who had been admitted to the hospital ward with infective exacerbation of Chronic Obstructive
Pulmonary Disease (COPD). Mr. Newman is a social drinker and is heavily addicted to smoking.
He is a truck driver with a remote mining company and feels challenging with the increasing
work accountabilities due to the increase breathlessness. He work on a 2 weeks on / 2 weeks off
roster. He lives with his wife Mercy and two teenage children.
Based on this history, the care plan has to made, considering the personal medical history
of the patient, the age and the employment profile of the patient. Any care plan that has to made
should be economic and will help him in meeting his personal and job responsibilities. This
might include, educating the patients and his family about the self-management of COPD. COPD
is an umbrella term that is used to define a number of progressive lung disease includes
emphysema chronic bronchitis and refractory asthma. COPD is a disease that is not curable, but
with a right diagnosis and treatment, COPD can be managed properly (Anzueto & Miravitlles,
2017). Breathlessness is one of the most common clinical manifestation of COPD and decreases
the quality of life and restricts the patient from carrying out his job responsibilities (Anzueto &
Miravitlles, 2017). Since, the patient is a middle aged man, hence more emphasis should be
given on the self-management strategies like quitting or adopting certain lifestyle such as
smoking or drinking, consumption of correct food and other strategies like using the breathing
equipment like the nebulizers (Liu et al., 2016).
Task 2:

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Assessing patients with chronic obstructive pulmonary disease (COPD) is important for
establishing an accurate diagnosis of the disease, helping in the making of therapeutic decisions
and measuring the outcomes for the clinical research purposes and the determination of the
prognosis. A focused assessment for the person with COPD involves documentation of the health
history, like the current symptoms. History taking is an important component of the patient
assessment, enabling the delivery of a high quality of care. Having an insight to the complexity
and the processes involves history taking that allows the nurses to have a better understanding of
the patient problems (LeMone et al., 2015). The patient should be assessed for some common
signs and symptoms such as marked breathlessness, increased respiratory rate, production of
cough, activity tolerance, dyspnea, the patient should also be assessed with previous history of
the emphysema or chronic bronchitis or asthma. It is necessary to assess the characteristics of the
cough (hacking, moist or crackles). This is because chronic bronchitis is associated with
production of sputum and it is reasonable to assume that excess mucus accumulation is the main
driver of cough in COPD (Calverley, 2013). It is necessary to check the respiratory rate as an
increased respiratory rate indicates that the body is trying to increase the level of oxygen or
lower the carbon-dioxide level in the blood. The clinical manifestation of the COPD
exacerbations are variable. Signs of paradoxical breathing and muscle fatigue can be observed in
COPD exacerbations (LeMone et al., 2015). Physical examination of the patient should consider
the general appearance, the weight for the height, the vital signs, including the skin color, the
body temperature, the anterio-posterior and the lateral chest diameter, the sounds of breathing
throughout the assessment (Gupta et al., 2017). The breathing sounds should be assessed due to
the fact that some level of bronchospasm is preset with obstructions in the airways and might not

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be displayed in the adventitious breath sounds like most crackles and faint sounds with
expiratory wheezes.
Another important assessment is smoking history. Smoking has been considered to be
one of the risk factors of COPD. A high prevalence of COPD exacerbations has been found in
patient , who smoke, seeking admission in the emergency department. In a study conducted by
Laniado-Laborín (2019), it has been found that smoking is related to severity of COPD
symptoms, extent of emphysema. Cigarette smoke contains a large concentration of oxidants that
induces inflammation of the lungs and teh airways. An inflammatory process occurs in the
central and the peripheral airways. Increase in the specific inflammatory cell types in the airways
causing structural remodeling of the air ways. Thus smoking triggers the inflammation causing
the exacerbation of the symptoms.
According to the NICE guidelines, nurses should also assess that there are other
conditions that mimics the COPD exacerbations, notable heart failure. It should be remembered
that people suffering from COPD have higher chance of having heart failure, including the left
ventricular systolic dysfunction and corpulmonale, that is right sided hear failure due to chronic
lung disease. The most common feature for these conditions are fatigue, edema and
breathlessness.
Task 3: Care planning
Three priority nursing diagnosis that has been chosen for Mr. Peter Newman is to reduce the
increased breathlessness of the patient, to educate the patients about the self-management
strategies and effective airway clearance of the patient.
Restoring the breathing pattern in patient

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Breathlessness is the most common symptom of the COPD. It is mainly caused due to the
narrowing of the airways due the inflammatory changes occurring in the airway, the remodeling
of the airways and excessive production of mucus. Effective nursing interventions should be
taken to decrease the incidence of dyspnea as it is linked with limited physical activity, increases
rate of anxiety and depression and decreased health related quality of life. Again, it is also
evident that Mr. Newman had been facing with difficulties in work due to the increasing
episodes of breathlessness. Expiratory dyspnea involve stenosis and obstruction at the trachea,
larynx and bronchi. Again the oxygen saturation in patient might get lower than the normal value
and might cause respiratory failure. COPD damages the lungs to a considerable extent and if it
gets damaged seriously, then it might cause hypoxia (Csikesz & Gartman, 2014). Hypoxemia is a
condition that occurs if the oxygen level in the blood decreases so much, that the organs in the
body does not get enough oxygen. Increases breathlessness in the patient should be decreased by
proper pharmacological interventions like the administration of Methylxanthines or leukotriene
receptor antagonists.
Effective airway clearance of the patient
Airway clearance can be referred to as the external application of forces to remove the
sputum from the airways. This is due to the fact that the production of sputum is excessive in
case COPD, that can get complicated and can cause mucus injury and increase the airflow
obstruction, which indicates the role of the airway clearance in the preservation of the pulmonary
function over time (Volsko, 2013). Daily or frequent production of cough are the predictive
factors of COPD exacerbations and patients having frequent exacerbations have low quality of
life and rapid rate of deterioration of the health status. Hence, airway clearance techniques has
been considered to be the cornerstone of the management of COPD in the adults (Volsko, 2013).

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In patients with COPD, the chronic inflammation causes hypersecretion of the mucus and ciliary
dysfunction.
Effective clearance of the airways in the patient will be demonstrated by clear breath
sounds. This includes the assessment of the breathing sounds, monitoring the respirations and the
breath sounds, noting the inspiratory and the expiratory ratio. This is important as tachypnea can
also be due to stress or acute infections (Osadnik, McDonald & Holland, 2013).
Self-management of COPD exacerbations
This considered to be another clinical priority as it is known from the case study that the
Mr. Peter Newman was a chain smoker and a social drinker which might be two important
predisposing factors of the COPD symptoms. Cessation of smoking is smoking is possible only
by educating the patient about the nonsmoking strategies (Gietema et al., 2016). Again, it is
evident from the cases study that the patient is a truck driver and a remote mining company.
According to Mitchell et al., (2014), there is a risk of developing COPD in occupations with
exposure to organic dust and gas vapor. It is often found in considerable levels among the
farmers, the wood carpenters, the welders, the building workers, the painters, the chemical
industry workers. Since, the patient is a truck driver, he is exposed to dust, smokes and other
environmental irritants that can trigger COPD attacks. Hence, the clinical priority would be
teach the patient about the measures that would prevent the exposure to obnoxious smoke and
dust.
Task 4: Patient education
Health education for both the patient and the family is required to ensure self-
management strategies. The idea of self-management education is to teach the patients about

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how to carry out the activities of daily living in the face of physiological impairment and to
prevent or decrease the severity of the disease by opting life style improvement strategies
(Simpson & Jones, 2013). Pulmonary rehabilitation has been found to bring a considerable
increase in the exercise tolerance and the quality of living. However, the drawback is that
pulmonary rehabilitation program is bot expensive and time consuming for the patients. In this
case the patient education would involve cessation of smoking, adherence to the medications and
using of bronchodilators and nebulizers. This helps the patient to maximize the effort. Patient
will be encouraged to use masks while working in mines or anywhere where the patient might be
exposed to irritants. The environmental pollutants shall be kept to minimum like dust, smoke and
fumes in mines. Unintended weightloss has been found to be caused by shortness of breath in
people suffering from advanced lung disease. Inadequate uptake of nutritious food might lead to
nutrition and the capability to fight with infections. Again, the patient should be provided with
education regarding small incidental exercises that increases the lung capacity. Patients should
be encouraged with abdominal and pursed lip breathing exercises (Effing et al., 2016). Exercises
like walk test, shuttle walk can be taught to increase the breathing capacity of the patient.
Furthermore, it is also necessary to educate the families of the patient regarding some common
measures such as the keeping the household free from dust, danders, to keep a check on whether
the patient had been taking the medications.
Task 5: Team care
A proper discharge planning, involving a multidisciplinary care approach reduces the
length of the initial hospital stay and readmission (McMartin, 2013). Some of the allied health
care professionals that are required during the discharge of the patient are the respiratory nurses,
who would educate the patient about the techniques of effective coughing and breathing

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exercises to facilitate ineffective clearance of the airway (Calverley 2013). An occupational
therapist is required to chalk out an exercise plan for the patient and would assist the patient to
know about the working of the nebulizers and the bronchodilators. A registered dietician is
required in the care of Mr. Newman, who would with a proper nutrition chart, as most of the
patients suffering from COPD are not being able to eat due to the episodes of shortness of breath.

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References
Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate
medicine, 129(3), 366-374.
Calverley P. M. (2013). Cough in chronic obstructive pulmonary disease: is it important and
what are the effects of treatment?. Cough (London, England), 9, 17. doi:10.1186/1745-
9974-9-17
Csikesz, N. G., & Gartman, E. J. (2014). New developments in the assessment of COPD: early
diagnosis is key. International journal of chronic obstructive pulmonary disease, 9, 277.
Effing, T. W., Vercoulen, J. H., Bourbeau, J., Trappenburg, J., Lenferink, A., Cafarella, P., ... &
Bucknall, C. (2016). Definition of a COPD self-management intervention: International
Expert Group consensus. European respiratory journal, 48(1), 46-54.
Gietema, H. A., Edwards, L. D., Coxson, H. O., Bakke, P. S., & ECLIPSE Investigators. (2013).
Impact of emphysema and airway wall thickness on quality of life in smoking-related
COPD. Respiratory medicine, 107(8), 1201-1209.
Gupta, N., Pinto, L. M., Morogan, A., & Bourbeau, J. (2014). The COPD assessment test: a
systematic review. European Respiratory Journal, 44(4), 873-884.
Laniado-Laborín R. (2019). Smoking and chronic obstructive pulmonary disease (COPD).
Parallel epidemics of the 21 century. International journal of environmental research
and public health, 6(1), 209–224.

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LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K.
(2015). Medical-surgical nursing. Pearson Higher Education AU.
Liu, Y., Pleasants, R. A., Croft, J. B., Wheaton, A. G., Heidari, K., Malarcher, A. M., ... &
Strange, C. (2015). Smoking duration, respiratory symptoms, and COPD in adults aged≥
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McMartin K. (2013). Discharge planning in chronic conditions: an evidence-based
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Mitchell, K. E., Johnson-Warrington, V., Apps, L. D., Bankart, J., Sewell, L., Williams, J. E., ...
& Singh, S. J. (2014). A self-management programme for COPD: a randomised
controlled trial. European Respiratory Journal, 44(6), 1538-1547.
Osadnik, C. R., McDonald, C. F., & Holland, A. E. (2013). Airway clearance techniques in acute
exacerbations of COPD: a survey of Australian physiotherapy
practice. Physiotherapy, 99(2), 101-106.
Simpson, E., & Jones, M. C. (2013). An exploration of self-efficacy and self-management in
COPD patients. British Journal of Nursing, 22(19), 1105-1109.
Volsko, T. A. (2013). Airway clearance therapy: finding the evidence. Respiratory care, 58(10),
1669-1678.

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