COPD Nursing Care Plan: Emphysema Management in Older Adults
This care plan documents the clinical assessment and advanced practice nursing intervention plan for a 65-year-old female patient presenting with a persistent dry cough, shortness of breath, fever, and depression. The patient has a confirmed diagnosis of emphysema and a lifelong history of smoking. The plan addresses pharmacological management through bronchodilators, beta2-agonists, anticholinergics, and corticosteroids, as well as diagnostic workup including chest radiography and FEV1/FVC spirometry. It also highlights the importance of patient education, smoking cessation, social support development, and regular follow-up to manage COPD symptoms and prevent hospitalization.
- Patient Overview and Subjective Data: Patient history, complaints, and social context
- Objective Data and Physical Findings: Vitals, physical exam, and support assessment
- Diagnostic Results and ICD-9 Diagnosis: Lab results, imaging, and COPD diagnosis code
- Advanced Practice Nursing Intervention Plan: Pharmacological, educational, and social interventions
- Rationale for Treatment Approach: Evidence-based justification for chosen plan
- References: Cited peer-reviewed sources
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What makes this paper effective
- Follows a structured clinical care plan format, moving logically from subjective complaint through objective findings to an actionable intervention plan.
- Integrates pharmacological specifics (beta2-agonists, anticholinergics, corticosteroids) with non-pharmacological strategies (support system development, patient education), showing a holistic nursing perspective.
- Addresses psychosocial dimensions—particularly the patient's isolation and depression—alongside physical symptoms, which strengthens the comprehensiveness of the plan.
Key academic technique demonstrated
The paper demonstrates evidence-based clinical reasoning by grounding each intervention in cited literature. For example, the rationale for bronchodilator selection references a specific mechanism of action from a peer-reviewed source, and the follow-up protocol for preventing hospitalization is tied directly to a randomized controlled trial. This technique anchors clinical decisions in published evidence rather than assertion alone.
Structure breakdown
The plan opens with subjective patient data (complaints, history, social context), transitions to objective clinical findings (vitals, physical exam, lab results), establishes a formal diagnosis, and then develops a detailed intervention and rationale section. A reference list closes the document. This SOAP-adjacent structure is standard in advanced practice nursing documentation and provides a clear, replicable clinical record.
Patient Overview and Subjective Data
Age: 65 Sex: Female
Subjective Data: The patient feels she may have lung cancer and has been diagnosed with emphysema. She is experiencing the effects of aging and feels that something is wrong with her heart.
Client Complaints: Persistent dry cough, shortness of breath, fever, slight sore throat, and depression.
History of Present Illness (HPI): The patient reports loss of appetite, a dry and unproductive cough, loss of breath, and weakness. Symptoms have been worsening over the past two days.
Past Medical History (PMH): The patient has a confirmed diagnosis of emphysema and has declined to allow physicians to test for pneumonia. She is a lifelong smoker and has previously been prescribed inhalers.
Significant Family History: The patient has two adult daughters living in the area. She has been widowed for 20 years.
Social and Personal History: The patient is a smoker who engages in little to no exercise.
Support System: The patient attends church and sees her two daughters approximately once a month. At its current level, this support system is insufficient for providing the care and emotional support she needs to cope with her increasing depression.
Behavioral and Nonverbal Messages: The patient is not inclined to undergo diagnostic testing.
Client Awareness: The patient is independent and self-sufficient. Although she sees a physician regularly, those visits are not very thorough.
Objective Data and Physical Findings
Objective Data: Shortness of breath with activity. No diaphoresis. The patient has had a fever. No nausea or vomiting. Denies chest pressure with physical activity. No palpitations.
Vital Signs and BMI: BP: 130/72 (left arm, sitting, regular cuff); Temperature: 101°F (oral); Pulse: 100, regular; Respirations: 20, non-labored. BMI: 21.6 (normal weight).
Physical Assessment Findings: White material present on the buccal mucosa; does not wipe off with a tongue blade. Lymph nodes: none palpable. Lungs: decreased breath sounds with dullness to percussion in the right lower lobe; end-expiratory wheeze in the right lower lobe; no rales or rhonchi; increased anterior-posterior chest wall diameter. Heart: regular rate and rhythm without murmur. Carotids: no bruits. Abdomen: benign.
Client Support System (Extended): The patient has two daughters with whom she would like to be closer. They are nearby and, with some encouragement and discussion, could be actively involved in her care and support network.
Locus of Control and Readiness to Learn: The patient is in a position where she could learn more about her health condition and take steps to adjust her behavior if she chooses to do so. Her home is located near a library, and she has easy access to public transportation.
Diagnostic Results and ICD-9 Diagnosis
Laboratory Results: CBC — white blood cell count 15,000 with positive left shift. Pulse oximetry: SaO2 98%.
Radiological Studies: Chest X-ray findings consistent with prior imaging.
EKG: Normal sinus rhythm.
ICD-9 Diagnosis: Chronic obstructive pulmonary disease (COPD) — ICD-9 code 492, emphysema.
Advanced Practice Nursing Intervention Plan
The advanced practice nursing intervention plan should involve the patient in recognizing her COPD condition and the symptoms of emphysema, as well as planning how to cope with and manage the disease. Coping strategies should include complete smoking cessation, as well as the use of bronchodilators and corticosteroids to help reduce complications. Beta2-agonists can relax airway smooth muscle, while anticholinergics provide longer-acting relief by blocking the nerves that constrict breathing (Baldouff, 2012). These medications are particularly appropriate given the patient's persistent cough and ongoing breathing difficulties, and will assist her in managing her symptoms.
Her diagnostic workup should include chest radiography to rule out other diagnoses such as heart failure or lung cancer (Broekhuizen, Sachs, Hoes, Verheij, & Moons, 2012, p. 6). FEV1/FVC ratio testing via spirometry should also be performed to corroborate symptoms and confirm the diagnosis. For information on COPD staging and spirometry criteria, the National Heart, Lung, and Blood Institute provides current clinical guidelines.
The follow-up plan should include monitoring the patient at regularly scheduled visits and preventing hospitalization through active symptom management (Rice, Dewan, Bloomfield, Grill, Schult, & Nelson, 2010). Stage I intervention should also include administration of the influenza vaccine.
The plan should additionally include steps to develop the patient's social support system by engaging her daughters and church community more actively in her daily life. More frequent contact with family and community members can help alleviate the symptoms of loneliness and depression that result from extended periods of social isolation.
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