Help with care plan for COPD patient

  1. I am having trouble, I have been working on this careplan for 12 hours....
    I need 3 nursing diagnosis, I have 2 and I think I may have the third, but I am having trouble with the goals for it.

    My patient was admitted for unstable angina, however they are addressing her lung issues before sending her for a cardiac cath. The day I took care of her however, she had no chest pain. Clear lungs, however decreased lung sounds bilat. No cough, or sputum. She is on 2 liters o2, even at home due to her copd. No edema. She does have dyspnea on exertion. pt has hypertension, and anxiety as previous diag. Pulse is in high 90. pt did report palpitations on admission.

    So the 2 I have for sure are
    1. Imparied gas exchange r/t aveolar capillary membrane changes secondary to COPD
    2. Activity intolerance r/t imbalance between oxygen supply and demand

    Now the third I am thinking is Decreased cardiac output r/t altered heart rate/rhythm and hypertension
    Goals I can't figure out, I think one could be patient will remain free of side effects from the medications used to achieve adequate cardiac output. (patient on digoxin)

    If anyone can help, I would really appreciate it!!
    May God bless you all!!
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    About Hischild777

    Joined: Apr '08; Posts: 21; Likes: 6
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  3. by   kind-hearted08

    Are you allowed to use care plan books? I know that this helped be out a great deal when I was in nursing school. I think any type of care plan book will give you some direction.

    Hope this helped.
  4. by   Daytonite
    when i saw copd i would have automatically had impaired gas exchange and either ineffective airway clearance or ineffective breathing pattern. copd is a very nonspecific medical diagnosis. somewhere in her chart, hopefully, her doctor specified the type of lung disease as being emphysema, chronic obstructive bronchitis or chronic obstructive asthma. those would give you more direction to look for more respiratory symptoms in this patient.

    angina due to atherosclerosis is a very serious condition. atherosclerosis, if that is what this patient has, is progressive and irreversible. i would use ineffective tissue perfusion (cardiopulmonary) for the patient's chest pain and decreased oxygen until heart pathology is established. decreased cardiacoutput is specifically used for poor perfusion in the heart structure itself and that hasn't been established yet.

    did you consider deficient knowledge (diagnostic procedures) r/t lack of information aeb patient asking questions about what would happen during a cardiac cath? there is lots of patient teaching literature for this on the internet. there is also a nursing diagnosis of anxiety.

    your goals are always the predicted results of your nursing interventions.
  5. by   Hischild777
    Thanks Day! I do know the pts COPD is emphysema. I do not know anything about the heart since there was nothing done about it yet. The pt came in for chest pain, she stated she was having palpitation and sob more than usual. Thats all I know.
    I hate these things! I do not know what to use now? So you don't think decreased cardiac output can be used? How can I prove the other diag. you gave me?? I am sorry so many questions, I am just overwhelmed!
    Thanks in advance for your help!
  6. by   Daytonite
    the heart problem is to be determined. if the doctors don't know what is going on, how can you? i would have no problem care planning for either acute pain or risk for acute pain. if using one of these diagnoses is a problem for you, discuss it with your instructors.

    you determine diagnoses from the patient's symptoms. to diagnose the medical conditions the doctor would have picked up on all the patient's symptoms. the question is, did you? the way you double check yourself is to look up information about emphysema, particularly the signs and symptoms, and compare it with what you got with the physical assessment you did.

    based on what you posted this patient has no known perfusion problem in the heart. if you look at the defining characteristics (symptoms) for decreased cardiac output they just are not there. decreased cardiac output is generally associated with congestive heart failure and this patient has not been diagnosed with that. you prove any diagnosis by showing that the patient has the symptoms of that diagnosis. that is why you assess a patient. during assessment you are always looking for what is abnormal about the assessment because what is abnormal is evidence of a problem. do you have a care plan or nursing diagnosis book? if not, here is the nursing diagnosis page for [color=#3366ff]ineffective tissue perfusion specify type: renal, cerebral, cardiopulmonary, gastrointestinal, peripheral from nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig and the one from nursing care plans: nursing diagnosis and intervention, 6th edition, by meg gulanick and judith l. myers: each one lists the nanda taxonomy information including the defining characteristics (symptoms) for a cardiopulmonary perfusion problem. look at them and see if your patient doesn't have a lung perfusion problem. from the ackley/ladwig page you can get to other nursing diagnosis pages by clicking on the "diagnoses) links at the top right of the page. to view the other diagnoses on the gulanic/myers site click on "add new diagnosis" at the left side of the page.

    you yourself said "my patient was admitted for unstable angina, however they are addressing her lung issues before sending her for a cardiac cath. the day i took care of her however, she had no chest pain." obviously, the respiratory problems are a priority. other than chest pain you have no other cardiovascular symptoms listed. you did not list her blood pressure reading. blood pressure is classified as severe at 180/110 and the patient is not having any of these symptoms of severe hypertension: claudication in the legs, weakness, fatigue, shortness of breath, dizziness, headaches upon arising in the morning, visual disturbances. nosebleeds, lightheadedness when changing positions. there would also be risk factors: coronary artery disease, angina, heart failure or stroke, a history of smoking, family history of hypertension, atherosclerosis, heart disease, diabetes, cerebrovascular or kidney disease, patient is of african or asian descent. where is that information on this patient other than they have been having angina? i suspect a history of smoking because of the emphysema.
  7. by   janis9799
    I hated careplans because at least in my school they didn't really show us how to write one...just kinda said go write one. Once you get the hang of it you will laugh at how hard this was for you. My very wonderful clinical instructor gave me this website during medsurge.

    At the top of the webpage click on Library, under Library catergories click careplans, page down past some of first paragraphs (all advertising stuff) you will see Activity Tolerance and then a bunch of other careplan topics. Click on some you might think will work. It will give you each part of the careplan, several options for each part to fit your client. I think the best ones you can use are Ineffective Breathing, Impaired Gas Exchange, Pain, Anxiety (a big thing with COPD people is because they can't breathe most have anxiety), Impaired skin integrity (if mobility is an issue),Knowledge Deficit. There are a bunch on the website that will apply to COPD, Cardiac issues. Keep paging down to see all of them. This helped me my first year of school. My second when I had OB and Psych I had to buy the careplan book...make sure you buy one with all catergories of nursing so you don't buy a psych careplan book and then wind up buying another all purpose one when you take OB like I did LOL! Good Luck!
  8. by   pinay'70
    can someone help me to pick 4 nursing diagnosis priorities for my copd pt who have shortness of breath on exertion,with cough and has increased yellow sticky sputum and with pedal edema I really need it now so badly coz I'm doing my care plan right now.Can somebody please help me.
  9. by   Daytonite
    Quote from pinay'70
    can someone help me to pick 4 nursing diagnosis priorities for my copd pt who have shortness of breath on exertion,with cough and has increased yellow sticky sputum and with pedal edema I really need it now so badly coz I'm doing my care plan right now.Can somebody please help me.
    Are you forgetting where you post? You asked about this on this thread the other day and got several responses:
  10. by   obicurn
    I would go with Anxiety as a nursing diagnosis. Our instructor made a good point last week. Think about how you feel when you dive into a pool. Kicking to the surface, almost before you reach the top and you feel like you can't get all the way to the top before you need to take a breath. That intense anxiety is what COPD patients feel all the time. Not being able to breathe is a very scary and frustrating thing.