NUR250: COPD Patient Care Plan - Medical Surgical Nursing, 2019

This report provides a comprehensive care plan for Mr. Peter Newman, a 44-year-old patient with infective exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The care plan addresses various aspects of Mr. Newman's condition, including a thorough assessment of his needs, initiation of breathing exercises, nutritional considerations, and emotional support. The report also outlines three priority nursing diagnoses: ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange, along with corresponding interventions. Furthermore, it emphasizes the importance of patient education, particularly regarding the dangers of smoking and alcohol consumption, and discusses the roles of various allied health team members in managing COPD patients from admission to discharge. This assignment showcases a holistic approach to managing COPD, aiming to improve the patient's quality of life and prevent complications.

Running head: HOLISTIC CARE 1
Holistic Care
Name
Institution

HOLLISTIC CARE 2
Holistic Care
Task 1: Consider the Patient
My chosen patient is Mr. Peter Newman from the first scenario. From the provided case,
we are informed that Mr. Newman has an infective exacerbation of Chronic Obstructive
Pulmonary Disease. He is also a heavy smoker who also drinks a lot. A care plan is
necessary to provide the best care for Mr. Newman. Some of the factors that I may
consider when developing a care plan are described below.
Firstly, I would comprehensively assess Mr. Newman’s needs. This is done to help in
generating all the raw data from which the care plan will be developed. The needs may
include family support, medication, emotional and psychological support, nutrition,
social activities, and instructions on tobacco and alcohol use among others. Infective
exacerbation of Chronic Obstructive Pulmonary Disease is triggered by smoking and
severe airflow limitation among others (Nici & ZuWallack, 2012). Alcohol use also limits
the effectiveness of a medication. It is therefore important to consider these needs when
developing a care plan.
Secondly, I would consider initiating a breathing exercise for Mr. Newman. It is
important to note that infective exacerbation of COPD gets worse with time making it
almost impossible to accomplish daily tasks like in Mr. Newman’s case. It may thus be
important to regularly practice breathing exercises as this helps to strengthen the lungs.
Some of the most common breathing exercises include pursed lips breathing,
diaphragmatic breathing, and deep breathing (Bertella, Zadra & Vitacca, 2013). These
exercises also help to strengthen the heart and thus blood is effectively pumped around
the body.
Another important consideration to be made in the development of a care plan is the
nutritional needs of the patient. A patient like Mr. Newman should be eating a healthy
diet for a long term care plan. It is important that the patient closely monitors his weight
as an extra weight due to being overweight just adds more strain to the body (Rocker &
Cook, 2013). To maintain a healthy weight, Mr. Newman should reduce his salt intake,
eat smaller meals and focus proteins.

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Emotional support is another important aspect in the development of a care plan for
patients with exacerbation of COPD. This condition can have its toll on the mental
status of an individual. The patient may start having feelings of depression and
hopelessness (Rocker & Cook, 2013). A nurse or a caregiver should, therefore,
encourage the patient to challenge negative thoughts. The nurse should also link the
patient with a support group where Mr. Newman may find people going through similar
experiences and talk with them.
Task 2: Nursing Assessment
Chronic Obstructive Pulmonary disease can be suspected in any patient above the age
of 40 years who may show symptoms that may include breathlessness, cough, and
production of sputum among others. The following three nursing assessments may be
recommended for patients having an infective exacerbation of Chronic Obstructive
Pulmonary Disease. Firstly as a nurse, I would assess Mr. Newman’s exercise capacity.
Test for exercise capacity can be assessed by the use of maybe a 6-minute walk test or
the use of an incremental shuttle walk. This assessment will help in studying whether
Mr. Newman’s breathlessness is out of proportion (Puhan et al., 2011). Assessing the
exercise capacity of the patient may also help in choosing the best nursing intervention
and pharmacological treatments for infective exacerbation of Chronic Obstructive
Pulmonary Disease.
I would also assess the presence of increased rates of respiration which is a normal
occurrence if the use if accessory muscle us evident. The term used to describe an
increase in the respiratory rate of a patient is tachypnea. This condition may result from
either very low levels of oxygen or very high levels of carbon (IV) oxide in the blood.
Low oxygen levels or high carbon (IV) oxide levels result in rapid, shallow breathing
(Jolley et al., 2015). It is thus important to perform an assessment of the respiratory rate
of Mr. Newman making it possible to identify the possibility of a potential tachypnea
condition. This assessment may also be necessary to identify other potential risk factors
of tachypnea in patients having COPD such as fevers resulting from infections caused
to the lungs, congestive heart failure that damages the heart, and anxiety related to
dyspnea among others.

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The third nursing assessment that I would perform on Mr. Newman would be assessing
his inability to carry out daily activities as a truck driver. Patients like Mr. Newman who
have an infective exacerbation of Chronic Obstructive Pulmonary disease normally have
a problem with getting adequate amounts of oxygen into their lungs. This shortage in
oxygen which is accompanied by a buildup of carbon (IV) oxide in the lungs leads to a
feeling of fatigue and reduced energy levels (Zwerink, van der Palen, van der Valk,
Brusse-Keizer & Effing, 2013). This feeling of tiredness limits the activities that an
individual may engage in thus leading to a reduction in stamina. This loss of energy also
influences the de-conditioning of the body thus affecting the patient’s ability to perform
daily activities. It is thus important to perform this nursing assessment to establish how
bad the disease has progressed because fatigue is normally noticed as the disease
progresses.
Task 3: Care Planning
Nursing care plans for patients with infective exacerbation of Chronic Obstructive
Pulmonary Disease involves the introduction of a treatment regimen with the aim of
getting rid of symptoms and avoiding complications that may result from this condition. It
is important that a nurse develops a care plan and a teaching plan to help the patient
understand and deal with this disease (Patel, Janssen & Curtis, 2012). In this section,
we will discuss three priority nursing diagnoses to help with caring for Mr. Newman.
The first nursing diagnosis is an ineffective airway clearance. This may be described as
the inability to secretions from the respiratory tract thus making it difficult to maintain a
clear airway. It may be related to fatigue, bronchospasm, and an increase in the
production of secretions among others. This is possibly evidenced by wheezes,
persistent coughs and difficulty breathing (Kaufman, 2013). This nursing intervention is
particularly relevant for Mr. Newman’s scenario due to the fact that he has developed
breathlessness which could be an indication of blocked airways. This diagnosis is aimed
at maintaining airways patency and demonstrating behaviors that can help in clearing
the airways. These behaviors may involve effective coughing and removal of secretions.

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The second priority nursing diagnosis for Mr. Newman is an ineffective breathing
pattern. This may be characterized by wheezes, crackles, non-productive coughs, and
an abnormally high respiratory rate among others. This particular diagnosis is important
in the case of Mr. Newman due to the fact that he exhibits symptoms of increased
breathlessness. This has limited his daily activities due to low supply of oxygen in the
lungs which may thus lead to an increase in the respiratory rate with the aim to get more
oxygen into the lungs (Patel et al., 2012). The aim of this diagnosis is to help Mr.
Newman to improve his breathing pattern and maintain his respiratory rate within
normal rates.
The third priority nursing diagnosis in this scenario is the impaired gas exchange. This
may be described as inefficient oxygenation which may be accompanied by a deficit in
the elimination of carbon (IV) oxide from the lungs. This diagnosis is related to an
alteration in the supply of oxygen which may result from the obstruction of the airways.
It may also result from the obstruction of the alveoli (Roberts, Patel & Partridge, 2016).
From the presented scenario, it is evident that Mr. Newman a COPD patient has a
problem with breathlessness. This may be due to the fact that he has an impaired gas
exchange. Impaired gas exchange may be characterized by abnormal breathing. This
diagnosis aims at demonstrating an improvement in ventilation and adequate
oxygenation of the lungs.
Task 4: Patient Education
Patients like Mr. Newman who have the infective exacerbation of Chronic Obstructive
Pulmonary Disease face a lot of challenges. This condition is progressive in nature and
in most cases if not properly handled can interfere with several aspects of life. It is
important to note that COPD gets worse slowly and may occasionally be accompanied
by some unpredictable flairs. The flairs are known to destroy lungs, reduce exercise
capacity and increase dyspnea (Effing et al., 2012). In some patients like in the case of
Mr. Newman, the disease progression may massively limit activity thus reducing the
quality of life. In other patients, COPD may lead to other diseases like anxiety,
depression, and heart disease. It is thus evident that there is quite a wide variation to
how the disease progresses in different patients. It is important to detect and diagnose

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COPD in its early stages to mitigate the effects its progression may have on the quality
of life. In this section, we will discuss the necessary education required to help a COPD
patient after discharge from the hospital.
From the presented case scenario, we are informed that Mr. Newman is a heavy
smoker and a serial drinker. Studies have revealed that smoking is one of the risk
factors of COPD. In fact, smoking is the leading cause of Chronic Obstructive
Pulmonary `Disease (Janssen, Engelberg, Wouters & Curtis, 2012). Smoking has been
revealed to damage air sacs, the lining of the lungs and airways. Once it has done all
the damage to the lungs, it becomes very difficult for the lungs to move air in and out
thus limiting breathing (Stoilkova, Janssen & Wouters, 2013). Smoking also triggers
patients with COPD thus leading to exacerbations which worsen the symptoms.
Additionally, staying close to someone who smokes may trigger COPD patients and
thus causing harm.
It is also important to note that drinking alcohol like is the case with Mr. Newman lowers
the levels of glutathione thus aggravating the symptoms of COPD. Alcohol may also
lead to a reduction in the lung functions of patients with lung-related diseases by further
reducing the ability to clear the airways. It also lowers the effectiveness of medications
used in treating patients with COPD (Casey, Murphy, Cooney, Mee & Dowling, 2011). It
is thus important to provide COPD education to Mr. Newman about the dangers of
smoking and drinking alcohol. He should quit smoking and avoid hanging around people
who smoke. This will help him in avoiding the complications associated with COPD and
help in the process of healing.
Task 5: Team Care
The management of patients with infective exacerbation of Chronic Obstructive
Pulmonary Disease has become multidisciplinary in recent years. Some of the
healthcare professionals that are tasked with taking care of patients with COPD include
nutritionists, occupational therapists, physiotherapists, psychologists, nurses, and
technologists among others. The allied respiratory professionals are tasked with
preventing, diagnosing, evaluating, treating, and managing respiratory diseases such as

HOLLISTIC CARE 7
COPD ("Allied respiratory professionals - ERS", 2019). These allied health
professionals are normally the patient’s first point of contact and they are involved in the
rehabilitation of patients such as Mr. Newman. In this section, we will discuss some of
the allied health team members who are responsible for the care of the patient from the
moment they are admitted into a hospital up to the time of discharge.
The first Allied Health Team member is the Primary care physician. This individual is
responsible for most of the care during the initial stages of COPD. He/she diagnoses
COPD in the patient. This diagnosis is done through breathing tests, chest X-rays and
measuring oxygen levels in the patient’s blood ("Healthcare Team Who Treat COPD |
COPD.net", 2019). After the diagnosis, a pulmonologist may take over the care of the
patient. The pulmonologist carries out further tests to get more information regarding the
condition. His/her treatment plan may include oxygen therapy, administration of
medication to improve breathing, and pulmonary rehabilitation among others. He may
also advise the patient regarding lifestyle changes such as quitting smoking and
alcohol.
Another Allied Health Team member is a nutritionist. Patients like Mr. Newman who
have COPD face a lot of challenges trying to maintain their weight within normal levels.
You may find instances when a patient weighs below the required weight while in other
cases the patient may be overweight. A nutritionist or a dietician, therefore, helps the
patient to eat a healthy diet and maintain healthy body weight. The nutritionist may
provide advice about diets that can be useful in providing the right amounts of energy
and nutrients for the patient (Janssen et al., 2012). Another member that is important in
the care of COPD patients is an exercise therapist. The exercise therapist helps the
patient in coming up with an appropriate exercise regimen to help in maintaining healthy
body weight. A therapist also helps with tackling depression which is common with
COPD patients. The therapists help the patients in managing and treating their anxiety
and depression symptoms.

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