- Deficient Knowledge related to inadequate information and inadequate participation in care planning as evidenced by inaccurate follow-through of instructions and development of pneumonia or other complications
- Impaired Gas Exchange related to COPD and poor airway clearance as evidenced by Productive cough and Abnormal rate, rhythm, and depth of breathing
- Impaired Spontaneous Ventilation related to altered O2/CO2 ratio and respiratory muscle fatigue as evidenced by adventitious breath sounds and Dyspnoea
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes poor understanding Seeks additional information Denial of a need to learn 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 inadequate information and inadequate participation in care planning as evidenced by Inaccurate follow-through of instructions and development of pneumonia or other complications | Patient verbalized understanding of the causes of bronchitis and its treatment. Patient implemented two strategies to prevent the recurrence of bronchitis. | 1. Provide accurate information about the disease process, prognosis, and treatment regimen. Ensure the information provided is correct and delivered in easy-to-understand language. Provide brochures and reading materials as appropriate. 2. Reinforce learning through the provision of repetitive and follow-up sessions. Frequent and regular education sessions can help improve medication and self-care management outcomes for those who have chronic conditions like chronic bronchitis and COPD. 3. Encourage vaccinations. There isn’t a vaccination for bronchitis, but vaccinations for influenza can prevent the development of bronchitis, especially for those with weakened immune systems or who have a chronic respiratory condition. 4. Do not smoke or inhale toxins. Smoking triggers airway inflammation. Keep children with asthma or cystic fibrosis away from air pollutants and second-hand smoke. 5. Wash hands and wear a mask. Hand washing is the best way to prevent the introduction of viruses. Those with chronic respiratory conditions should consider wearing a mask in public places. 6. Educate that antibiotics won’t help. Educate patients and families that bronchitis is rarely caused by bacteria but is often related to a virus in which antibiotics will not be helpful. 7. Include family members in patient education sessions. Children and older adults diagnosed with bronchitis can benefit from the support they get from family members. | Patient verbalized understanding of the causes of bronchitis and its treatment. Patient implemented two strategies to prevent the recurrence of bronchitis. |
| Subjective data: Dyspnoea Diaphoresis Visual disturbances Headaches Objective data: -Altered respiratory patterns -Restlessness -Lethargy -Cyanosis -Confusion -Irritability -Abnormal arterial blood gas values or blood pH -Decreased oxygen saturation | Impaired Gas Exchange related to COPD and poor airway clearance as evidenced by Productive cough and Abnormal rate, rhythm, and depth of breathing | Patient will display improvement in ventilation and oxygenation as evidenced by ABGs within normal limits. Patient will verbalize the causative factors contributing to poor oxygenation. Patient will demonstrate effective breathing and coughing exercises. | 1. Instruct on breathing techniques and devices. Pursed-lip breathing is especially useful in clients with COPD to help control shortness of breath. Instruct on the use of an incentive spirometer or flutter valve to strengthen the lungs and mobilize mucus. 2. Discuss exposure to lung irritants. Chronic bronchitis is commonly associated with smoking but may also occur due to exposure to chemical fumes or air pollution. Discuss smoking cessation or other ways to reduce exposure to irritants. 3. Limit activities and encourage rest. Rest periods help conserve energy, limit oxygen consumption, and are imperative for recovering from bronchitis. 4. Administer medications as prescribed. Cough medications, expectorants, corticosteroids, bronchodilators, and more may be prescribed to relieve bronchitis symptoms. | Patient displayed improvement in ventilation and oxygenation as evidenced by ABGs within normal limits. Patient verbalized the causative factors contributing to poor oxygenation. Patient demonstrated effective breathing and coughing exercises. |
| Subjective data: Verbalizes difficulty in breathing Objective data: -Dyspnoea -Decreased SpO2 -Decreased PO2 -Increased PCO2 -Accessory muscle use -Restlessness | Impaired Spontaneous Ventilation related to altered O2/CO2 ratio and Respiratory muscle fatigue as evidenced by adventitious breath sounds and Dyspnoea | Patient demonstrated ABGs within normal parameters. Patient maintained an effective airway. Patient demonstrated effective coughing and expectoration of secretions | 1. Maintain a high Fowler’s position, as tolerated. A sitting position helps maximize chest expansion and is usually a position of comfort with respiratory difficulty. 2. Administer oxygen. Severe cases of hypoxia may call for supplemental oxygen. 3. Use a 0-10 scale for dyspnoea. The nurse can ask the patient to self-report their dyspnoea using a 0-10 scale, just like they would assess pain. 4. Prepare for invasive intervention. In the event of respiratory obstruction where coughing or suctioning is ineffective, the healthcare team must prepare for intubation or even tracheostomy. | Patient demonstrated ABGs within normal parameters. Patient maintained an effective airway. Patient demonstrated effective coughing and expectoration of secretions |