NURS2004: Person-Centered Care Plan for COPD & Pneumonia Patient

This assignment presents a patient-centered care plan for Albert Clarke, a 72-year-old patient admitted with an acute exacerbation of COPD and bilateral lower lobe pneumonia. The care plan addresses two primary nursing diagnoses: impaired gas exchange and ineffective airway clearance. The assessment, diagnosis, planning, implementation, and evaluation phases of the nursing process are detailed for each diagnosis, including specific nursing interventions such as oxygen administration, assisted ambulation, medication management, and airway suctioning. The plan also identifies the need for a multidisciplinary team, including a physiotherapist, respiratory physiologist, and pulmonologist. Furthermore, the assignment discusses the ethical and legal standards relevant to Albert's care, emphasizing respect for autonomy, beneficence, non-maleficence, duty of care, and avoiding negligence. The ultimate goal is to improve Albert's respiratory function, maintain clear airways, and ensure his overall well-being while adhering to professional and ethical guidelines.

Running head: NURSING CARE 1
Care Plan
Name
Institution

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Care Plan
Introduction
Albert Clarke is 72 years old and stays in a family home with his wife Sandra who is 65
years old. Their two children are adults and live interstate. He weighs 60kg and has a
height of 182cm and a BMI of 18.1. Albert went to the hospital and was presented at the
emergency department in a local metropolitan hospital with the following vital signs:
respiratory rate of 25, temperature of 39, hear rate of 143, blood pressure of 135/70,
and SaO of 80% at room temperature and pressure. He was admitted to the respiratory
ward after being diagnosed with an acute exacerbation of COPD. His vital signs at the
respiratory ward included: respiratory rate of 23, temperature of 37, hear rate of 112,
blood pressure of 130/68, and SaO of 83% after 2L oxygen treatment. Prescribed
medications included paracetamol, aspirin, ceftriaxone, azithromycin, atorvastatin,
salbutamol, budesonide, and prednisolone.
At the hospital, it is established that Albert is oriented to place, time, and person.
Indications show that he might be breathless and tired and does not want to sit on the
bed. His pain score is 0/10. Dr. Tara Line reviews Albert and notices that he cannot
speak in full sentences and appears lethargic and diaphoretic. An x-ray reveals that he
has pneumonia of the bilateral lower lobe.
He has a history of hypercholesterolemia, myocardial infarction, and chronic obstructive
pulmonary disease that was diagnosed 5 years ago. His current cholesterol reading is
5mmol/L. He had an appendectomy surgery at the age of 15 and had a coronary artery
stent insertion 3 years ago for his myocardial infarction. He quit smoking 10 years ago.

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He takes medications for his conditions and they include Atorvastatin, 40mg, Aspirin
100mg, Salbutamol, and Sprivia (inhales 1 capsule per day). He is allergic to Micropore
tape because it causes him blisters.
This paper aims to design a patient-centered care plan and discuss the nursing
interventions based on the above condition of Albert Clarke. The paper will also identify
members of a multidisciplinary team that may be relevant to the patient’s case. The
paper will finally address the legal and ethical standards that are relevant to the case
scenario. The essay is based on the following two diagnoses: impaired gas exchange
and ineffective airway clearance.
Impaired Gas Exchange
Assessment
Impaired gas exchange can be described as a deficit of oxygenation and carbon (IV)
oxide elimination from the lungs. The assessment for this condition involves assessing
the rate of respiration, respiratory depth, nasal flaring, use of accessory muscles, and
unusual patterns of breathing (Kennedy, 2011). From the provided case, it is stated that
Albert’s rate of respiration is 25 breaths per minute at the time of presentation to the ED
and 23 breaths per minute in the respiratory ward. He also appears breathless. This
assessment is important because it helps in identifying hypoxia in situations of
increased respiratory rate. Another nursing assessment involves monitoring the
patient’s blood pressure and heart rate. This is because heart rate, respiratory rate, and
blood pressure increase initially with hypoxia (Sunde et al., 2014). However, blood
pressure and heart rate decrease with severe hypoxia thus potentially leading to

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dysrhythmias. Monitoring oxygen saturation is also necessary for assessing an impaired
gas exchange. SaO2 that is less than 90 is an indication of problems with oxygenation.
Diagnosis
Albert is at risk of an impaired gas exchange as evidenced by a respiratory rate of 23
and 25 at the respiratory ward and ED respectively; Sao2 of 80% at room air and 83%
after addition of 2L of oxygen; heart rate of 143 and 112 at ED and respiratory ward
respectively; blood pressure of 135/70 and 130/68 at ED and respiratory ward
respectively. The normal breathing rate for an adult at rest ranges between 12 and 20
breaths per minute. Normal SaO2 should be between 95% and 100% (Sunde et al.,
2014). Normal resting heart rate for an adult such as Albert should not exceed 100
beats per minute. Additionally, the systolic pressure under normal circumstances should
not exceed 120.
Planning
After several necessary nursing interventions, Albert will maintain an optimal gas
exchange in addition to unlabored respirations that will range between 12 breaths per
minute and 20 breaths per minute. This can be achieved through assisted ambulation.
His oximetry results will also show a normal range for SaO2 (95%-100%). This is done
through oxygen administration as recommended by the nurse in charge. Furthermore,
his heart rate will be within the normal range. It is also important to note that the plan
will ensure that the patient maintains clear lung fields and take part in activities and
procedures that increase oxygenation. Finally, Albert will manifest an absence of
symptoms related to respiratory diseases.

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Implementation
The care plan can be implemented appropriately by the use of appropriate nursing
interventions thus improving health outcomes. Firstly, since the patient’s oxygen
saturation is very low, it may be necessary to maintain an oxygen administration device
to ensure that the oxygen saturation is above 90%. Additionally, it is important to avoid
a high concentration of oxygen because Albert has been diagnosed with COPD and
therefore hypoxia may stimulate his urge to breathe. Failure to monitor his oxygen
intake may raise the concentration of oxygen in the body to unsafe levels (Sunde et al.,
2014). It is also important that Albert is assisted with ambulation to facilitate the
expansion of lungs, encourage clearance of secretions, and enhance deep breathing.
Medication should also be administered as prescribed according to the etiological
factors of the patient’s condition.
Evaluation
After the implementation of the above care plan, a team involved with the care of Albert
can evaluate whether the expected outcomes of the care plan were achieved. This can
be evidenced by an increase in the patient’s saturation of oxygen to more than 90%.
Additionally, Albert should be able to experience unlabored respirations for the care
plan to be passed as a success. Goals are also met when there is evidence that Albert
can maintain clear lung fields and eliminate signs and symptoms of any form of
respiratory distress. Finally, goals and expected outcomes are achieved if the patient
shows that they indeed do not have any further signs and symptoms of COPD or any
other form of respiratory distress.

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Ineffective Airway Clearance
Assessment
Assessment is important in identifying the potential causes of ineffective airway
clearance. Firstly, it is necessary to assess the airway for patency. The number one
priority in situations of ineffective airway clearance is usually the maintenance of a
patent airway. Secondly, it is important to assess the rate and depth of breathing
(Kennedy, 2011). This helps in identifying conditions such as tachypnea that is
characterized by more than 24 breaths per minute. Additionally, an assessment of the
heart rate, temperature, and blood pressure is required to not any changes. This is
because an increase in the work of breathing can potentially lead to hyperventilation.
Additionally, retained secretions is an indication of an inflammation that is normally
characterized by an increase in temperature (Rooddehghan, 2018). Another
assessment is lung auscultation that helps in identifying the presence of any
adventitious breath sounds such as wheezing and crackle sounds.
Diagnosis
Evidently from the provided scenario, Albert has a very high respiratory rate of 25
breaths per minute. At some point, he feels breathless and is unwilling to sit out of bed.
It is also indicated that he loves playing golf but he has a golf cart due to his
breathlessness. Additionally, his heart rate is very high probably due to an increase in
the work of breathing as shown by 143 beats per minute at the emergency department.
He also has an elevated blood pressure of 130/68. He has a productive cough that is

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characterized by increased production of sputum. His body temperature is elevated at
around 39.
Planning
It is expected that Albert will demonstrate an improvement in air exchange. Additionally,
he will maintain open and clear airways. This is evidenced by normal respiratory rates
and an ability to effectively cough up secretions (Choi, Chung & Han, 2014). Albert
should also be able to identify some significant changes in the color, amount, and odor
of sputum. Finally, he will identify the factors that contribute to ineffective airway
clearance and avoid them. These outcomes can be achieved with the implementation of
the following nursing interventions. Firstly, it is important to educate the patient on deep
breathing and coughing (Li et al., 2014). This helps Albert in understanding the right
techniques of keeping his airway clear and free of secretions. Nasotracheal suctioning
may also be required because it helps when the amount of sputum being produced has
excessively increased and the patient cannot get rid of them by coughing (Choi, Chung
& Han, 2014). Albert should also be advised to take deep breaths after nasotracheal
suctioning. These deep breaths are accompanied by supplementation of oxygen to
enhance hyper-oxygenation and prevent hypoxia.
Implementation
The use of appropriate medication that helps in maintaining an open and clear airway is
needed to ensure that Albert can demonstrate an increase in gas exchange. Patient
education on the factors that contribute to ineffective airway clearance and how to

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appropriately get rid of secretions is also important (Li et al., 2014). Albert should also
be added 2L of oxygen to increase oxygen saturation in his body.
Evaluation
From the series of the above nursing interventions, the care plan goals are achieved
when Albert demonstrates an increase in air exchange due to constantly opened
airways. Additionally, his cough continues to be productive with the production of
sputum. He further identifies the factors that contribute to ineffective airway clearance
and avoid them.
Multidisciplinary Team Referral
One member of a multidisciplinary team required due to impaired gas exchange is a
physiotherapist. A physiotherapist helps the patient with physical therapy thus reversing
the potential pathological progression of Albert’s condition and improving gas exchange
(Zhu, Cui, Wu, Huang & Wan Xia, 2013). As a result, artificial ventilation is avoided. For
the care and treatment of ineffective airway clearance, a multidisciplinary team made up
of a respiratory physiologist and a pulmonologist is required. A respiratory physiologist
helps in investigating several signs and symptoms that include abnormal x-rays, chest
pains, and breathing difficulties (Zhu et al., 2013). A pulmonologist is responsible for the
treatment of lungs and respiratory-related complications.
Ethical and Legal Standards
The ethical standards that are required in the care for Albert include respect for
autonomy, beneficence, and non-maleficence. It is important that Albert retains control
of his body and a clinician can only advise and suggest the best interventions but the

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decision must be left for the patient to make. Beneficence requires that all actions taken
by healthcare providers benefit the patient and improve health outcomes (Barnes,
Calverley, Kaplan & Rabe, 2013). The above interventions should benefit the patient
and ensure that the desired outcomes are met. The end goal of the interventions should
be that no harm comes to the patient and this is made possible by the principle of non-
maleficence (Barnes et al., 2013). Legal standards in the care for Albert are based on
four legal elements that include a duty of care, breach of the duty of care, damages, and
causation. A nurse has a duty of care to provide safe and competent care to Albert.
Breach of duty of care occurs when the nurse fails to observe the standards of care thus
leading to damages such as injuries (Barnes et al., 2013). Causation argues that the
damages only occurred as a result of the breach of duty of care.
Conclusion
COPD is a serious respiratory complication that is characterized by elevated blood
pressure, increased heart rate, increased respiratory rate, elevated temperature, and
difficulty breathing among other symptoms. Some of the nursing diagnoses related to
this condition include ineffective airway clearance and impaired gas exchange. Impaired
gas exchange and ineffective airway clearance can be characterized by an increase in
heart rate, blood pressure and respiratory rate. It is also evidenced by a reduction in the
saturation of oxygen. Interventions should be aimed at maintaining optimal gas
exchange, increasing saturation of oxygen, reducing heart rate, maintenance of open
airways, and identifying ways of avoiding ineffective airway clearance. Evaluation
should aim at identifying whether the desired outcomes have been achieved. In some
instances, a multidisciplinary team may be required to provide extensive care and

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improve health outcomes. The provision of care should be guided by ethical and legal
standards of nursing practice.

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References
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pulmonary disease and exacerbations: patient insights from the global Hidden
Depths of COPD survey. BMC pulmonary medicine, 13(1), 54.
Choi, J. Y., Chung, H. I. C., & Han, G. (2014). Patient outcomes according to COPD
action plan adherence. Journal of clinical nursing, 23(5-6), 883-891.
Kennedy, S. (2011). Caring for a patient newly diagnosed with COPD: a reflective
account. Nursing standard, 25(49).
Li, J. M., Cheng, S. Z., Cai, W., Zhang, Z. H., Liu, Q. H., Xie, B. Z., & Wang, M. D.
(2014). Transitional care for patients with chronic obstructive pulmonary
disease. International Journal of Nursing Sciences, 1(2), 157-164.
Rooddehghan, Z. (2018). Nursing Care in COPD. Iranian Journal of Allergy, Asthma &
Immunology, 17.
Sunde, S., Walstad, R. A., Bentsen, S. B., Lunde, S. J., Wangen, E. M., Rustøen, T., &
Henriksen, A. H. (2014). The development of an integrated care model for
patients with severe or very severe chronic obstructive pulmonary disease
(COPD): the COPD–Home model. Scandinavian journal of caring
sciences, 28(3), 469-477.
Zhu, M. L., Cui, W., Wu, C. H., Huang, Y., & Wan Xia, D. R. (2013). Study on the role of
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