Chronic Bronchitis Nursing Care Plan

 

Ineffective Airway Clearance
Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range
Nursing Diagnosis
  • Ineffective Airway Clearance
Outcomes
  • Patient will demonstrate effective clearing of secretions.
  • Patient will maintain effective airway clearance.
Nursing Interventions
  • Position head midline with flexion on appropriate for age/condition
    • Rationale: To gain or maintain open airway
  • Elevate HOB
    • Rationale: To decrease pressure on the diaphragm and enhancing drainage
  • Observe S/Sx of infections
    • Rationale: To identify infectious process
  • Auscultate breath sounds & assess air mov’t
    • Rationale: To ascertain status & note progress
  • Instruct the patient to increase fluid intake
    • Rationale: To help to liquefy secretions.
  • Demonstrate effective coughing and deep-breathing techniques.
    • Rationale: To maximize effort
  • Keep back dry
    • Rationale: To prevent further complications
  • Turn the patient q 2 hours
    • Rationale: To prevent possible aspirations
  • Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage.
    • Rationale: These techniques will prevent possible aspirations and prevent any untoward complications
  • Administer bronchodilators if prescribed.
    • Rationale: More aggressive measures to maintain airway patency.

Ineffective Breathing Pattern
Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range
Nursing Diagnosis
  • Ineffective Breathing Pattern RT Retained Secretions
Outcomes
  • Patient will improve breathing pattern.
  • Patient will maintain a respiratory rate within normal limits.
Nursing Interventions
  • Place patient in semi-fowlers position
    • Rationale: To have a maximum lung expansion
  • Increase fluid intake as applicable
    • Rationale: To liquefy secretions
  • Keep patient back dry
    • Rationale: To avoid stasis of secretions and avoid further complication
  • Change position every 2 hours
    • Rationale: To facilitate secretion mov’t and drainage
  • Perform CPT
    • Rationale: To loosen secretion
  • Place a pillow when the client is sleeping
    • Rationale: To provide adequate lung expansion while sleeping.
  • Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over body as appropriate
    • Rationale: To promote physiological ease of maximal inspiration
  • Maintain a patent airway, suctioning of secretions may be done as ordered
    • Rationale: To remove secretions that obstructs the airway
  • Provide respiratory support. Oxygen inhalation is provided per doctor’s order
    • Rationale: To aid in relieving patient from dyspnea
  • Administer prescribed cough suppressants and analgesics and be cautious, however, because opioids may depress respirations more than desired.
    • Rationale: To promote deeper respirations and cough

Impaired Gas Exchange
Assessment

Patient may manifest

  • Appearance of bluish extremities when in cough (cyanosis), lips
  • Lethargy
  • Restlessness
  • Hypercapnea
  • Hypoxemia
  • Abnormal rate, rhythm, depth of breathing
  • Diaphoresis
Nursing Diagnosis
  • Impaired Gas Exchange RT Altered Oxygen Balance
Outcomes
  • Patient will improve ventilation and adequate oxygenation of tissues
  • Patient will minimize or totally be free of symptoms of respiratory distress.
Nursing Interventions
  • Monitor level of consciousness or mental status
    • Rationale: Restlessness,anxiety, confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  • Assist the client into the High-Fowlers position
    • Rationale: The upright position allows full lung excursion and enhances air exchange
  • Increase patient’s fluid intake
    • Rationale: To help liquefy secretions
  • Encourage expectoration
    • Rationale: To eliminate thick, tenacious, copious secretions which contribute for the impairment of gas exchange.
  • Encourage frequent position changes
    • Rationale: To promote drainage of secretions
  • Encourage adequate rest & limit activities to within client tolerance
    • Rationale: Helps limit oxygen needs/consumption
  • Promote calm/restful environments
    • Rationale: To correct/improve existing deficiencies
  • Administer supplemental oxygen judiciously as indicated
    • Rationale: May correct or prevent worsening of hypoxia.
  • Administer meds as indicated such as bronchodilators
    • Rationale: To treat the underlying condition

Sleep Pattern Disturbance
Assessment

Patient may manifest

  • Irritability
  • Restlessness
  • Lethargy
  • Changes in posture
  • Difficulty of breathing which worsens at night
Nursing Diagnosis
  • Sleep Pattern Disturbance RT Difficulty of Breathing
Outcomes
  • Patient will identify individually appropriate interventions to promote sleep.
  • Patient will be able to report improvements in sleep/rest pattern.
Nursing Interventions
  • Monitor level of consciousness or mental status
    • Rationale: Restlessness, anxiety,confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  • Promote comfort measures such as back rub and change in position as necessary
    • Rationale: To provide non pharmacologic management
  • Observe provision of emotional support
    • Rationale: Lack of knowledge and problems, relationships may create tension. Interfering with sleep routines based on adult schedules may not meet child’s needs.
  • Provide quiet environment.
    • Rationale: To promote an environment conducive to sleep.
  • Increase patient’s fluid intake
    • Rationale: To help liquefy secretions
  • Encourage expectoration
    • Rationale: To eliminate thick, tenacious, copious secretions which contribute for the DOB
  • Limit the fluid intake in evening if nocturia is a problem
    • Rationale: To reduce need for nighttime elimination
  • Obtain feedback from SO regarding usual bedtime, rituals/routines
    • Rationale: To determine usual sleep patterns & provide comparative baseline
  • Provide safety for patient sleep time safety
    • Rationale: To promote comfort/safety
  • Recommend mid morning nap if one required
    • Rationale: Napping esp. in the afternoon can disrupt normal sleep pattern
  • Administer pain medication as ordered.
    • Rationale: To relieve discomfort and take maximum advantage of sedative effect

Risk for Spread of Infection
Assessment

Patient may manifest

  • Body temperature above normal range
  • Dehydration
  • Increase WBC count
  • Presence of increase mucus production
Nursing Diagnosis
  • Risk for Spread of Infection RT Stasis of Secretions & Decreased Ciliary Action
Outcomes
  • Patient will identify interventions to prevent and/or reduce the risk of infection
  • Patient will have minimize or totally be free from the risk of infection.
Nursing Interventions
  • Review importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake
    • Rationale: These activities promote mobilization and expectoration of secretions to reduce the risk of developing pulmonary infection.
  • Turn the patient q 2 hours
    • Rationale: To facilitate secretion mov’t and drainage
  • Encourage increase fluid intake
    • Rationale: To liquefy secretions
  • Stress the importance of handwashing to SO’s
    • Rationale: Handwashing is the primary defense against the spread of infection
  • Teach the SO’s how to care for and clean respiratory equipment
    • Rationale: Water in respiratory equipment is a common source of bacterial growth
  • Teach the SO’s the manifestations of pulmonary infections (change in color of sputum, fever, chills) , self-care and when to call the physician
    • Rationale: Early recognition of manifestations can lead to a rapid diagnosis.
  • Recommend rinsing mouth with water
    • Rationale: To prevent risk of oral candidiasis.
  • Administer antimicrobial such as cefuroxime as indicated.
    • Rationale: Given prophylactically to reduce any possible complications

Other Possible Nursing Care Plans
  • High risk for suffocation
  • High risk for aspiration
  • Anxiety RT acute breathing difficulties
  • Activity Intolerance RT inadequate oxygenation
  • Imbalanced Nutrition: Less than body requirements RT reduced appetite and dyspnea (for emphysema)