Chapter 28
Respiratory Care
575
Nursing Care Plan for a Patient With COPD and Pneumonia—cont'd
Lung Congestion Crackles in bilateral lower lobes Weak cough; rarely productive Rusty sputum Shortness of breath
Poor Activity Tolerance ↑ SOB when amb to BR ↑ SOB with personal care
Give frequent
Teach techniques for conservation of energy
Suction nose + mouth PRN
rest breaks Do not rush
↑ Fluid intake
Huff cough Q 2 hr
60-year-old male with bilateral pneumonia + COPD
Abnormal VS + SaO2 ↓ SaO2, ↑ pulse, ↑ resp + ↑ temp
Poor Nutritional Intake Too short of breath to eat ↑ carbs = ↑ carbonic acid
Encourage Pulmocare supplement
Encourage frequent small meals
↑ HOB O2 at 24 Nc
Watch for hypoxia
FIGURE 28.11 Concept map care plan for a patient with COPD and pneumonia.
Nursing Diagnosis: Ineffective airway clearance related to secretions in the airways as evi- denced by ineffective cough and adventitious breath sounds Expected Outcomes: Patient will demonstrate effective huff coughing before discharge. Patient will verbalize the importance of drinking 8 ounces of fluid every 2 hours while awake to thin mucus by discharge. Interventions Evaluations
Day 1: Likes to drink apple juice and iced tea. Taking fluids every 2 hours. Suctioned and obtained thick rust-colored secretions from the nasopharynx. Instructed on huff cough- ing, but effort still weak. Day 2: Coughing better, able to bring up some sputum that is now a greenish-yellow color. Continues to take fluids well. Doing better with huff coughing. Day 3: Breath sounds clearer, fewer coarse crackles in the bases of the lungs. Huff coughing well, without being prompted.
Encourage fluid intake to help thin mucus, making it easier to cough up and expectorate. Find out what liquids the patient prefers to drink and offer 8 ounces every 2 hours. Obtain an order to perform oropharyngeal and nasopharyn- geal suctioning as needed until the patient can cough more effectively. Use a Yankauer catheter for oral suctioning. Teach the patient how to huff cough and encourage him to do so every 2 hours.
(nursing care plan continues on page 576)
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