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					                                                                                            Plan of Care
     COPD - Chronic Obstructive Pulmonary Disease
     COPD is a destructive, irreversible condition where air passages are obstructed due to chronic bronchitis, emphysema, bronchiectasis & asthma
                   Problem/Need/Strength                                        Goal(s)                                             Approaches                              Rationales
 1   Ineffective breathing/airway clearance             Maximize ventilation and demonstrate effective         Asses and document breath sounds such as dyspnea,
                                                        breathing pattern by _____                             cough, extended expiration and wheezing
                                                                                                               Check for signs of respiratory infrection, such as fever
                                                                                                               and changes in sputum
                                                                                                               Montior breathing pattern; include rate, rhythm,
                                                                                                               depth,pursed lips, nasal flaring and fatigue from
                                                                                                               Check for symptoms related to decreased gas
                                                                                                               exchange, such as confusion, restlesness, irritability and
                                                                                                               easily fatigued
                                                                                                               Keep activities to a minimum, with periods of resting
                                                                                                               Encourage proper posture (stand/sit upright, elevate
                                                                                                               head) to maximize ventilation
                                                                                                               Increase fluids up to 2000cc per day, to liquify
                                                                                                               Administer medications as prescribed by doctor and
                                                                                                               check for side effects from bronchodilators and steroids
                                                                                                               Discourage smoking and discuss avoiding allergens
 2   Impaired gas exchange                              Decrease carbon dioxide levels and maximize            Encourage deep breathing ____ times, every ____
                                                        respiration by _____
                                                                                                               Increase fluid intake up to 2000cc per day
                                                                                                               Administer oxygen ____L/min, as ordered by doctor (not
                                                                                                               to exceed 3L/min)
                                                                                                               Allow rest between scheduled activities
                                                                                                               Monitor for dyspnea, fatigue, weakness and shortness
                                                                                                               of breath
                                                                                                               Provide antibiotics as ordered by doctor, to maintain
                                                                                                               constant blood levels
                                                                                                               Discuss and decrease/eliminate smoking and allergens

 3   Potential for hypoxemia                            Incease levels of oxygen and decrease levels of carbon Administer medications as ordered
                                                        dioxide in the blood by ______
                                                                                                               Monitor oxygen and carbon dioxide saturation levels
                                                                                                               Check for increased or irregular pulse
                                                                                                               Listen for increased respiratory rate followed by a
                                                                                                               decreased rate
                                                                                                               Administer oxygen at ____ L/min, as ordered by
                                                                                                               Monitor patient for cool, pale or cyanotic skin and
                                                                                                               decreased urine output
                                                                                                               Reduce or eliminate smoke and strong odors from
                                                                                                               patient's room
                                                                                                               Monitor ECG for dysrhythmias secondary to altered
 4   Potential for Respiratory infection                 The patient will be free from respiratory infection       Discuss and attempt to decreae smoking and allergens

                                                                                                                   Encourage deep breathing ____times, every ____
                                                                                                                   Perform drainage exercises, as ordered by physician
                                                                                                                   Dispense antibiotics as ordered by doctor
                                                                                                                   Minimize patient's exposure to others with infections
                                                                                                                   Immediately report signs of infection to doctor
                                                                                                                   Keep a room temperature of 75 degrees
                                                                                                                   Follow-up on patient's immunizations against influenza
                                                                                                                   and pneumonia
 5   Episodes of dyspnea                                 Minimize episodes of dyspnea by _____                     Monitor and report signs of dyspnea
                                                                                                                   Reduce stress and anxiety as much as possible
                                                                                                                   Elevate head of bed to ____ degrees
                                                                                                                   Speak to patient in calm, low voice, to help reduce
                                                                                                                   Administer oxygen at ____ L/min as ordered
                                                                                                                   Report signs of respiratory infection to doctor

 6   Potential for activity intolerance due to chronic   Patient will perform _____ activities by _____, without   Determine factors that contribute to intolerance (ie:
     hypoxia                                             becoming fatigued                                         sleep disturbances)
                                                                                                                   Monitor vitals during activities
                                                                                                                   Allow for periods of rest between activities
                                                                                                                   Monitor food intake to ensure that activity is supported

                                                                                                                   Discuss with and encourage patient to conserve energy

                                                                                                                   Slowly increase activity level to _____, continuing to
                                                                                                                   monitor vitals
                                                                                                                   Discourage smoking, as needed


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