A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?
A. Altered nutrition: Less than body requirements related to fatigue.
B. Activity intolerance related to dyspnea.
C. Weight loss related to COPD.
D. Ineffective breathing pattern related to alveolar hypoventilation.
Correct Answer: A. Altered nutrition: Less than body requirements related to fatigue.
The client’s problem is altered nutrition—specifically, less than required. The cause, as stated by the client, is the fatigue associated with the disease process. Instruct the patient to frequently eat high caloric foods in smaller portions. COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass.
Option B: Activity intolerance is a likely diagnosis but is not related to the client’s nutritional problems. Provide at least 90 minutes of undisturbed rest in between activities. Allotment of undisturbed rest reduces demand for oxygen and allows adequate physiologic recovery.
Option C: Weight loss is not a nursing diagnosis. Encourage a rest period of 1 hr before and after meals. Helps reduce fatigue during mealtime and provides an opportunity to increase total caloric intake. Avoid gas-producing foods and carbonated beverages. Can produce abdominal distension, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea.
Option D: Ineffective breathing pattern may be a problem, but this diagnosis does not specifically address the problem of weight loss described by the client. Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over the body as appropriate. Promotes physiological ease of maximal inspiration.
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