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Page | COPD stands for chronic obstructive pulmonary disorder. What leads to this is things like smoking, secondhand smoke, and other inhaled pollutants, which causes destruction of the air sacs in your lungs called alveoli and your airways leading down to your lungs. This makes it difficult for your body to get oxygen to the rest of your body, and can make it very difficult to breathe. H is a 68 y/o Latino M admitted to the hospital today for c/o pneumonia. His daughter found him unresponsive at home. Daughter stated HG has hx of COPD and since his wife died recently, ETOH abuse. as; Pneumonia w COPD exacerbation Complete the following table: ASSESSMENT DATA: NURSING OUTCOME NURSING EVALUATION SUBJECTIVE & DIAGNOSIS CRITERIA INTERVENTIONS OBJECTIVE Subjecti 1. Impaired gas la. Pt. ABGs will A1. Nurse will titrate O2 1a. Pts breathing returned to - Recentlyretired exchange related | return to baseline levels as needed. (Balanced | within normal/acceptable - Recently widowed to COPD and within two days O2 supply and demand, pg. range. - Possible ETOI pneumonia 1544, Harding et al., 2020) abuse | A2. Nurse will encourage Ax of COPD Productive cough Diminished sounds at lung bases BP: 150/49 incentive spirometer use. (Postoperative Care, pg. 335, Harding et al., 2020) A3. Nurse will administer Page 2 B4. Nurse will elevate pt head of bed to a comfortable level. (Postoperative Care, pg. 335, Harding ct al., 2020) BS. Nurse will encourage frequent turning to promote chest expansion. (Postoperative Care, pg. 335, Harding et al., 2020), 1c. Pt RR will return to 12-20 per min by end of shift C1. Nurse will titrate O2 levels as needed (Balanced 2 supply and demand, pg. 1544, Harding et al., 2020) C2. Nurse will encourage incentive spirometer use. (Postoperative Care, pg. 335, Harding ct al., 2020) C3. Nurse will administer medications as ordered. (COPD Drug Therapy, pg. 566, Harding et al., 2020) C4. Nurse will elevate pt head of bed to a comfortable level. (Postoperative Care, pg. 335, Harding et al., 2020) 1c. Pt used incentive spirometer 10 times every 1-2 hour while awake. C5. Nurse will encourage frequent turning to promote chest expansion. (Postoperative Care, pg. 335, Harding ct al., 2020) 2. Incffcctive airway clearance related to increased secretions and abnormal auscultation sounds 2a. Pt will have decrease in adventitious lung sounds by end of shift A1. Nurse will administer and titrate oxygen as needed (Balanced O2 supply and demand, pg. 1544, Harding etal. 2020) A2. Nurse will encourage incentive spirometer use. (Postoperative Care, pg. 335, Harding et al., 2020) A3. Pt will cough and deep breathe. (Postoperative Care, pg. 335, Harding ct al., 2020) Ad, Nurse will administer nebulizer treatment as ordered & needed (COPD Care, pg. 567, Harding et al., 2020) AS. The nurse will encourage smoking 2a. Pts adventitious lung sounds decreased significantly by end of shift. 2¢. Pt will identify possible complications and know when to seek medical attention. C1. The nurse will provide education on colors of sputum. (COPD Care, pg. 567, Harding et al., 2020) C2. Pt will properly and effectively use incentive spirometer 10x per 1-2 hrs. (Postoperative Care, pg. 335, Harding et al., 2020) C3. Nurse will administer nebulizer treatment as ordered & needed. (COPD Care, pg. 567, Harding ct al., 2020) C4. Nurse will provide education on deep breathing. (Postoperative Care, pg. 335, Harding et al., 2020) C5. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020) 2c. Pt was open to discussing smoking cessation with social worker. 3. Risk for depression related to COPD as evidence by activity intolerance and ineffective coping 4, Ineffective Coping 5. Imbalanced Nutrition 3a. Pt will verbalize three coping mechanisms by end of shift. A1. The nurse will provide list of effective coping mechanisms. (COPD Considerations, pg. 574- 575, Harding et al., 2020) A2. The nurse will help facilitate communication with friends, family, and support systems. (COPD Considerations, pg. 575, Harding et al., 2020) A3. The nurse will help pt get in contact with social worker/case manager. (COPD Considerations, pg. 575, Harding et al., 2020) Aa. The nurse will help pt get in touch with support groups. (COPD Considerations, pg. 575, Harding et al., 2020) AS. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020) 3a. Ptis able to verbalize three healthy coping mechanisms. Page 10 end of shift. Considerations, pg. 574- 575, Harding et al., 2020) C2. The nurse will help facilitate communication with fricnds, family. and support systems. (COPD Considerations, pg. 575, Harding ct al., 2020) C3. The nurse will help pt get in contact with social worker/case manager. (COPD Considerations, pg. 575, Harding et al., 2020) C4. The nurse will help pt get in touch with support groups. (COPD Considerations, pg. 575, Harding et al., 2020) C5. The nurse will encourage smoking cessation. COPD Care, pg. 566, Harding et al., 2020) 3c. Pt was interested about smoking cessation options. Professional Growth Reflection: During this COPD clinical, [felt that my weaknesses on this topic were really addressed and Inow am able to feel more confident about this disease. I felt comfortable enough in clinical to speak up and be apart of the class discussion, which is something I have been working on since the start of the program. Iaving the large discussion really helped me open my eyes to ail sorts of nursing diagnoses, patient outcomes, and interventions. The diagnoses I didn't originally think of putting down were impaired nutrition, ineffective coping, and ineffective airway clearance. A few interventions that I didn't think of were patient identifying sputum color changes, elevating the head of the patients bed, and postural changes to help open up the chest. Afier discussing these tn clinical, I have a solid foundation that I will continue to build on over the program and as my future as a nurse. Afier this patient is released, I presume he will go home with his daughter, to his own home, or even to assisted living until he is ableto combat his addictions and cope with the loss of his wife. The education he will need be regarding smoking cessation and any other inhalants. What else the nurse will teach him will be about his disease and what might promote flair ups or exacerbations. The medications he is currently taking or newly prescribed, he shauld be education on haw he should take them, of any side effects that may occur, and of any adverse effects that he would need to seek medical attention for. Since he is grieving the death of his wife, education on support groups should be brought up. The medical equipment needed for him would be his medications, nebulizer with humidifier, and the incentive spirometer. Interprofessional'leam Members: Respiratory Therapis. - Will help encourage the use of medications to open his airways and get rid of secretions. The respiratory therapist might also teach how to use the nebulizer and provide more education on why therapy is important lo continue. Nutritionist: - Will help him learn how he should be eating. COPD patients may not eat enough or not get enough nutrients. The nutritionist can help lead him to foods he likes and can benefit him in the long run. Social Worker: - Lhis team member can facilitate more opportunities to help him healthily grieve the loss of his wife. They can provide informationand education on addiction programs for ETOH and alcohol abuse. Page 11 
