NursingLevel: Advanced

Nursing Care Plan for a Patient With a COPD Exacerbation

Prepared by the Assignment Achievers nursing team.

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Problem Statement / Assignment Scope

Mr K, 68, has smoked for 40 pack-years. He arrives in the emergency department breathless, with a productive cough bringing up thick yellow sputum, a barrel-shaped chest, SpO2 of 86% on room air and a respiratory rate of 28. Write an evidence-based nursing care plan for his first day of admission.

Prerequisites: Respiratory physiology, writing NANDA-I diagnoses, and reading an arterial blood gas.

Step-by-Step Worked Solution

1. Assessment

What the patient tells you: he gets short of breath walking a few metres, feels exhausted and can't cough up the sticky sputum.
What you observe and measure: barrel chest, long expiratory phase, wheeze on both sides, SpO2 86%. Arterial blood gas shows respiratory acidosis: pH 7.32, PaCO2 52 mmHg, PaO2 58 mmHg.

2. Priority nursing diagnoses (NANDA-I)

Ineffective airway clearance related to bronchospasm and thick, plentiful secretions, as shown by a weak, unproductive cough and wheeze.
Impaired gas exchange related to damaged alveolar-capillary membranes and air trapping, as shown by low oxygen (SpO2 86%) and raised carbon dioxide.

3. Goals (specific and measurable)

SpO2 stays between 88% and 92% on low-flow oxygen by nasal cannula (1–2 L/min) within an hour of admission.
Before discharge, Mr K can show huff coughing and pursed-lip breathing correctly.

4. Interventions and rationales

Intervention	Why
Sit him upright (high Fowler's) or leaning forward over a table.	Lets the diaphragm move further and the lungs expand more, which eases the work of breathing.
Give controlled oxygen (1–2 L/min) as prescribed, aiming for SpO2 88–92%, and repeat the blood gas.	Corrects dangerous hypoxaemia while avoiding the rise in carbon dioxide that too much oxygen can cause in people who retain CO2.
Coach pursed-lip and diaphragmatic breathing.	Breathing out against pursed lips keeps small airways open for longer, so less air is trapped.

Key Takeaways & Core Principles

For patients at risk of CO2 retention, the usual oxygen target is 88–92%, not 94–98%.
Sitting upright improves lung expansion and reduces breathlessness.
Pursed-lip breathing slows breathing out and stops airways collapsing early.
Each intervention in a care plan needs a rationale linked to the evidence.

Frequently Asked Questions

Why not give high-flow oxygen to a COPD patient?

Some people with advanced COPD retain carbon dioxide. Giving too much oxygen can raise their CO2 further, mainly by worsening the mismatch between ventilation and blood flow in the lungs, which can lead to respiratory acidosis and drowsiness. That's why oxygen is given in controlled amounts to a target range.

Academic References & Standards

[1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2024). Global Strategy for the Diagnosis, Management, and Prevention of COPD. Source Link

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