VI. Nursing Diagnosis
• Impaired gas exchange related to ventilation-perfusion inequality
• Ineffective airway clearance related to bronchoconstriction, increased mucus production, ineffective cough, and bronchopulmonary infection
• Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants
• Self-care deficit related to fatigue secondary to increased work of breathing and insufficient ventilation and oxygenation
• Activity intolerance due to fatigue, hypoxemia and ineffective breathing patterns
• Ineffective coping related to less socialization, anxiety, depression, lower activity level, and inability to work
• Deficient knowledge related to risks of smoking as evidenced by continuing at-risk behaviors.
VII. Nursing Management
Facilitate removal of secretions
• Ensure fluid intake of at least 3 L/day
• Provide (and teach client) chest physical therapy, coughing and deep breathing, and use of hand nebulizers
• Suction as needed
• Provide oral hygiene after expectoration of sputum
Improve ventilation
• Position client in semi- or high-Fowler’s
• Instruct client to use diaphragmatic muscle to breath
• Encourage productive coughing after all treatments (splint abdomen to help produce more expulsive cough).
• Employ pursed-lip breathing techniques (prolonged, slow relaxed expiration against pursed lips).
Provide client teaching and discharge planning concerning:
Prevention of recurrent infections
• Avoid crowds and individuals with known infection
• Adhere to high-protein, high-carbohydrate, increased vitamin Cdiet.
• Receive immunization for influenza and pneumonia
• Report changes in characteristics and color of sputum immediately.
• Report worsening of symptoms (increased tightness of chest, fatigue, increased dyspnea)
Control of environment
• Use of home humidifier at 30-50% humidity.
• Wear scarf over nose and mouth in cold weather to prevent bronchospasm.
• Avoid smoking and contact with environmental smoke.
• Avoid abrupt changes in temperature.
Avoidance of inhaled irritants
• Stay indoors if pollution levels are high.
• Use air conditioning with high-efficiency particulate filter to remove particles from air.
Increasing activity tolerance
• Start with mild exercises, such as walking, and gradually increase amount and duration
• Use breathing technique (pursed lip, diaphragmatic) during activities/exercises to control breathing.
• Have oxygen available as needed to assist with activities
• Plan activities that require low amounts of energy
• Plan rest periods before and after activities