A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?
A. Activity intolerance related to fatigue.
B. Anxiety related to actual threat to health status.
C. Risk for infection related to retained secretions.
D. Impaired gas exchange related to airflow obstruction.
Correct Answer: D. Impaired gas exchange related to airflow obstruction.
A patient airway and an adequate breathing pattern are the top priority for any patient, making “impaired gas exchange related to airflow obstruction” the most important nursing diagnosis. Monitor O2 saturation and titrate oxygen to maintain Sp02 between 88% to 92%. Pulse oximetry reading of 87% below may indicate the need for oxygen administration while a pulse oximetry reading of 92% or higher may require oxygen titration. The other options also may apply to this patient but less important.
Option A: Patients with COPD experience progressive activity and exercise intolerance. Evaluation of the patient’s activity tolerance and limitations helps create strategies to promote independent ADLs. Assess the patient’s respiratory response to activity which includes monitoring of respiratory rate and depth, oxygen saturation, and use of accessory muscles for respiration.
Option B: Ineffective Coping may be related to decreased socialization, depression, anxiety, and inability to work. Provide instructions for self-management of COPD. Assessment of the patient’s knowledge and including family members about the therapeutic regimen increases adherence to treatment regimen.
Option C: Respiratory infections that are minor in nature may be threatening to people with COPD. Bronchopulmonary infections must be controlled or prevented to diminish inflammatory edema. Review the importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake.
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