- Activity Intolerance related to Imbalance between oxygen supply and demand, weakened diaphragm as evidenced by Fatigue, Weakness and Abnormal rise in BP or HR in response to activity
- Deficient Knowledge related to lack of information provided and Misinterpretation of education as evidenced by request for additional information or clarification and poor follow-through with tests or treatment
- Impaired Gas Exchange related to alveolar-capillary membrane changes and COPD exacerbation as evidenced by Dyspnoea and Altered 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 Imbalance between oxygen supply and demand, weakened diaphragm as evidenced by Fatigue, Weakness and Abnormal rise in BP or HR in response to activity | Patient will participate in exercise while maintaining respiratory pattern and vital signs within normal limits. Patient will report an increase in tolerance in performing tasks, ADLs, and exercise. Patient will verbalize techniques that aid in improved activity tolerance. | 1. Teach conservation techniques. Increase activity gradually. Perform tasks that require the most effort when feeling the most energized. Take frequent rest breaks. Go at a slower pace. Perform tasks sitting such as brushing teeth or folding laundry. 2. Keep track of physical activity. Many devices exist now that can track physical activity, known as accelerometers. They can be worn around the arm or waist and track posture, energy expenditure, and the quantity and intensity of body movements. Even simple pedometers can be useful in measuring physical activity over time. 3. Instruct on diaphragmatic breathing. Diaphragmatic breathing can be useful to implement during daily activities such as climbing stairs, showering, and going on long walks. It takes time to learn but will strengthen the diaphragm. As you inhale, your abdomen should rise, and lower as you exhale. Placing your hands on your chest and abdomen will show if this is occurring. 4. Educate on medications to improve tolerance. Long-acting bronchodilators such as Spiriva have been shown to increase exercise endurance as patients reported an increase in participation in physical activities, which consequently improved quality of life. | Patient participated in exercise while maintaining respiratory pattern and vital signs within normal limits. Patient reported an increase in tolerance in performing tasks, ADLs, and exercise. Patient verbalized techniques that aid in improved activity tolerance. |
| 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 Lack of information provided and Misinterpretation of education as evidenced by request for additional information or clarification and poor follow-through with tests or treatment | Patient will verbalize factors that contribute to worsening COPD. Patient will demonstrate appropriate use of inhaler and oxygen. Patient will verbalize symptoms that warrant assessment and intervention. | 1. Instruct on how to prevent and recognize exacerbations. COPD exacerbations refer to a worsening in symptoms for days or weeks and often require hospitalization. Respiratory infections, pollution, and allergies can cause a flare-up. If the patient notices an increase in coughing, dyspnea, changes in sputum, and difficulty sleeping they should contact their provider. 2. Educate on hygiene practices. Staying healthy will keep the immune system strong to prevent infections and viruses. Frequent hand washing, staying away from sick people, regular exercise, keeping the airways clear, and eating healthy should be encouraged. 3. Recommend pulmonary rehab. Pulmonary rehabilitation educates on exercise training, nutrition advice, and counselling specific to controlling COPD. Pulmonary rehab can help reduce exacerbations and hospital readmissions. 4. Quit smoking. If the patient smokes, this is one of the most important instructions that can be given. Quitting smoking is difficult but is essential in preserving lung function and preventing exacerbations. | Patient verbalized factors that contribute to worsening COPD. Patient demonstrated appropriate use of inhaler and oxygen. Patient verbalized symptoms that warrant assessment and intervention. |
| Subjective data: Dyspnoea Diaphoresis Objective data: -Altered respiratory patterns -Cyanosis -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 alveolar-capillary membrane changes and COPD exacerbation as evidenced by Dyspnoea and Altered ABGs | Patient will demonstrate an improvement in ventilation and oxygenation as evidenced by ABGs within normal limits. Patient will verbalize signs of acute COPD exacerbation. | 1. Administer supplemental oxygen. Oxygen should be administered at the lowest concentration indicated, usually 2-4L continuously via nasal cannula. 2. Encourage pursed-lip breathing. Pursed lip breathing helps bring more oxygen into the lungs while removing carbon dioxide. 3. Administer medications. Beta2-agonists are administered first to relax the smooth muscles of the airways. Inhaled corticosteroids are given after to improve inflammation and lung function. 4. Prepare for assisted ventilation. If oxygenation or ventilation worsens and the patient experiences worsening hypoxemia or respiratory acidosis, consider non-invasive positive-pressure ventilation (NIPPV) or intubation with mechanical ventilation. | Patient demonstrated an improvement in ventilation and oxygenation as evidenced by ABGs within normal limits. Patient verbalized signs of acute COPD exacerbation. |