- Activity Intolerance related to inefficient breathing pattern and peripheral muscle fatigue as evidenced by Physical inactivity and Dyspnoea on exertion
- Deficient Knowledge related to Unfamiliarity with information and Information misinterpretation as evidenced by Inaccurate understanding and demonstration of instructions
- Impaired Gas Exchange related to Ventilation perfusion imbalance and Alveolar-capillary membrane changes as evidenced by abnormal respiratory pattern and abnormal ABGs
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: -Patient’s report of decreased activity/weakness -Shortness of breath with exertion -Fatigue -Exertional discomfort Objective data: -Abnormal blood pressure and heart rate response to activity -Changes to ECG -Signs of pain with movement/activity -Difficulty engaging in activity Increased oxygen demands | Activity Intolerance related to inefficient breathing pattern and peripheral muscle fatigue as evidenced by Physical inactivity and Dyspnoea on exertion | Patient will display reduced dyspnoea during regular physical activities. Patient will display respiratory and pulse rates within normal limits during activity. Patient will participate in pulmonary rehabilitation | 1. Encourage exercise as tolerable. In the later stages of emphysema, exercise may not be possible. Exercise should be undertaken as long as possible as it increases lung capacity. 2. Stop smoking. This is the most important intervention to prevent worsening emphysema. Smoking irritates the airways and makes it harder to breathe. Continuing to smoke will significantly limit the patient’s tolerance for activity. 3. Educate the patient on energy conservation techniques. Instruct on working at an even pace, placing frequently used items within reach, resting between tasks, and taking naps to reduce oxygen consumption and fatigue. 4. Encourage pulmonary rehab. Pulmonary rehabilitation will instruct the patient with a lung disease on achieving exercise with less dyspnea. 5. Instruct on inhaler use. Patients with emphysema use steroid inhalers and bronchodilators. Educate that bronchodilators are used first to open the airways, and steroid inhalers are used next to allow the medication to enter the airways. | Patient displayed reduced dyspnoea during regular physical activities. Patient displayed respiratory and pulse rates within normal limits during activity. Patient participated in pulmonary rehabilitation |
| Subjective data: -Verbalizes poor understanding -Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition -Avoiding eye contact or remaining silent during teaching | Deficient Knowledge related to Unfamiliarity with information and Information misinterpretation as evidenced by Inaccurate understanding and demonstration of instructions | Patient will show increased interest and willingly participate in the learning process. Patient will initiate necessary lifestyle changes and adhere to the treatment regimen. | 1. Educate the patient on the importance of regular follow-up consultations. It is essential to monitor the disease process so that necessary changes in the treatment plan can be done to match their changing needs. This includes follow-up with a pulmonologist, pulmonary function tests, and imaging as needed. 2. Encourage vaccinations. Patients with chronic lung diseases should receive pneumococcal and influenza vaccinations to prevent worsening lung health. 3. Prevent infections. Instruct on preventing infections through handwashing, proper nutrition, and avoiding sick people or large crowds. A patient with emphysema is at a higher risk of developing pneumonia. 4. Encourage the patient and their significant others to control risk factors. Second-hand smoke is also a contributor to emphysema. Areas of high air pollutants or workplaces that use fumes are additional risk factors. | Patient shown increased interest and willingly participated in the learning process. Patient initiated necessary lifestyle changes and adhered to the treatment regimen. |
| Subjective data: -Dyspnoea -Diaphoresis -Visual disturbances -Headaches Objective data: -Altered respiratory patterns -Restlessness -Lethargy -Cyanosis -Confusion -Irritability -Impending sense of doom -Abnormal arterial blood gas values or blood pH -Vital signs changes -Increased heart rate -Decreased oxygen saturation | Impaired Gas Exchange related to Ventilation perfusion imbalance and Alveolar-capillary membrane changes as evidenced by abnormal respiratory pattern and abnormal ABGs | Patient will display improved ventilation and adequate oxygenation, as evidenced by ABGs within normal range. Patient will demonstrate two strategies to improve oxygenation. | 1. Elevate the head of the bed and assist with positioning. The client may be most comfortable sitting in a tripod position where they rest their arms on their legs or a table. 2. Encourage pursed lip breathing as tolerated. Breathing exercises help reduce airway collapse, dyspnoea, and work of breathing. 3. Provide supplemental oxygen. Apply oxygen at the lowest concentration first to maintain Spo2 levels within 88-92%. 4. Administer a bronchodilator. Short-acting bronchodilators are administered for acute exacerbations to relax the smooth muscles of the airway, reducing bronchoconstriction. 5. Educate on limiting exposure to lung irritants. Tobacco smoke, dust, pollen, fumes, and air pollution are common causes of emphysema exacerbations. Instruct on avoiding environmental irritants when possible. | Patient displayed improved ventilation and adequate oxygenation, as evidenced by ABGs within normal range. Patient demonstrated two strategies to improve oxygenation. |