COPD Nursing care plan

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Hi ! I am a second year nursing student having some difficulties accompanied with low grades in constructing care plan. so basically this is my last care plan for this semester and i want to do extremely well in it. My patient 58 year old was admitted to ER for COPD exacerbation with SOB and chest discomfort accompanied with dyspnea. he has edema in his feet non- productive cough constipation for 8 days and hes known to be HTN DL COPD diabetic and asthmatic so basically i came up with a nursing diagnosis which is Constipation related to decreased peristalsis secondary to pulmonary hypoxia and lack of exercise , obesity manifested by absence of bowel sounds and inability to void is this diagnosis good enough ??? I need its pathophysiology and interventions with rationales and outcomes as soon as possible . Can u find me any good alternative but i prefer to stick to this diagnosis . Thank youuuu !!

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Hi !

I am a second year nursing student having some difficulties accompanied with low grades in constructing care plan.

so basically this is my last care plan for this semester and i want to do extremely well in it.

My patient 58 year oldwas admitted to ER for COPD exacerbation with SOB and chest

discomfort accompanied with dyspnea.

he has edema in his feet non- productive cough constipation for 8 days

and hes known to be HTN DL COPD diabetic and asthmatic

so basically i came up with a nursing diagnosis which is

Constipation related to decreased peristalsis secondary to pulmonary hypoxia and lack of exercise , obesity manifested by absence of bowel sounds and inability to void;

is this diagnosis good enough ??? I need its pathophysiology and interventions with rationales and outcomes as soon as possible . Can u find me any good alternative but i prefer to stick to this diagnosis .

Thank youuuu !!

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Specializes in Med Surg.

You said its an ER? Did they want you to do a care plan on constipation? Was just curious why you wouldn't address the more immediate issues. I'm a student also, so don't take what I say as etched in stone, just curious.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

threads merged......

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome to AN! The largest online nursing community!

We are happy to help with homework but we won't do it for you...(I know you know that ;))...What do you have so far.......What do you resourced say? What resources do you use for disease process/pathophysiology?

If you have been getting low grades...maybe you need to rethink your nursing process. Is the patient constipation the priority right now? What brought them to the ED. What is your assessment? Many nursing student fall into this trap of medical diagnosis versus nursing diagnosis. Maybe you need to rethink your process.

Here is what I know.....Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

What is your assessment? What are the vital signs? What is your assessment. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly. I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Now tell me bout your patient....What do they complain about? What are your vital signs? What is your assessment? What care plan book do you use?

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Sadala well i think ur right i may want to choose an alternative diagnosis

as for Esme12 thanks alot for the info it really helped me alot concerning the care plan i submited it with two diagnosis the first is

ineffective breathing patterns related to immobility and stasis of secretionsand ineffective cough secondary to pneumonia manifested by the presence of diffuse expiratory wheezes and rhonchi on right lower lobe and the use of accessory muscles when breathing and increased anterioposterior chest diameter ( you may find it a little bit long because my instructor loves details and thats what i gave her ! )

the second diagnosis which was supposed to be on constipation i did it on

Impaired Gas exchange related to alveolar - capillary membrane changes manifested by inability to move secretions, restlessness, and somnolence

Emphasizing the first diagnosis took me three hours while the second two hours I really hope i did a good job because i really accomplished it from the buttom of my heart

Thank You all again :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You're welcome.....let us know how you did!

Happy Holidays!

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Yes I will surely let you know what my grade is !

Thanks You too Merry Christmas and Happy New Year :)

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I understand what u mean but my instructor told me one related factor and defining characteristic is not enough so i really did what u said i put everything that is related top a copd patient in order to convince my instructor im aware of what u are talking about but i didn't find any other convincing diagnosis

thanks for the comment but its too late for now because i submitted the care plan already :)

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Care Plans keep coming up in class after class and GrnTea is trying very hard to help you understand the parts of a nursing diagnosis, what allowable components can be used and how the 3 parts work together to form a cohesive picture that someone can look at and have a good idea of what the main issues going on are.

Even if you already submitted your assignment, I don't think you really have it implanted in your head how to construct and use a nursing diagnosis. If I were you, I'd keep working here to build some good diagnosis samples regardless of this single assignment, as it will make things easier for you in the long run.

I'm a student too, and was lucky enough to read through Esme and GrnTea's posts on this topic before care plans even came up in school. The way they explain the 3 parts and refer students to NANDA as the difinative source set me up to do very well once care plan assignments started hitting my plate.

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I would like to add some of my thus so far knowledge base to this discussion, even though it's too late to change the nursing care plan.

1) Priority Nursing Diagnoses: utilize the ABC's. Ineffective gas exchange is clearly more important than constipation.

2) Use the NANDA book. Its not that expensive and your schools library should have it on reserve. The book is a lifesaver!

3) Nursing Diagnoses can be ordered in terms of precedent/priority using Maslow's Hierarchy of Needs. As for myself, I prefer to use Dr. Calista Roy's Adaptation Model when ordering nursing diagnoses. The Roy Adaptation Model

[TABLE=width: 350]

[TR]

[TD=bgcolor: #d7cbae]Physiologic-physical[/TD]

[TD=bgcolor: #d7cbae]Five needs - oxygenation, nutrition, elimination, activity and rest, protection

Four complex processes-senses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function[/TD]

[/TR]

[/TABLE]

4) You absolutely must differentiate between different nursing diagnoses using your diagnostic data (Green tea illustrated this point perfectly when comparing Ineffective Breathing Pattern to Ineffective Gas Exchange).

Not to brag, but I received 190/200 points on my first ever care plan this past semester using the above tips as a starting point.

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