Conditions › Respiratory
COPD Nursing Care Plan and Interventions
COPD nursing care targets an SpO2 of 88 to 92% and watches for rising CO2 (drowsiness, headache, confusion). Give bronchodilators and steroids for an exacerbation, teach pursed-lip breathing and energy conservation, and help the client quit smoking.
COPD nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Impaired gas exchange | SpO2 88 to 92%, no signs of CO2 narcosis. | |
| Ineffective breathing pattern | Uses pursed-lip breathing; RR and dyspnea ease with activity pacing. | |
| Activity intolerance | Completes daily activities with rest periods and no distress. | |
| Health maintenance: needs teaching | Uses inhalers correctly and knows the early signs of an exacerbation. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
COPD: what it is
Long-term inflammation from inhaled irritants narrows the airways and damages the alveoli. The airflow limit is persistent. 1
Most cases come from smoking, but people who never smoked can get it too.
Emphysema vs chronic bronchitis
Emphysema: alveolar walls lose their stretch, so air gets trapped. Chronic bronchitis: inflamed bronchi, mucus and a wet cough. 1,2
Chronic bronchitis: productive cough 3 months a year, 2 years in a row. Many have both.
Assessment: what you will see
Classic COPD cues
A chronic cough with sputum, shortness of breath that slowly worsens, wheezing, and a long, slow exhale. 1
Symptoms often flare in winter, when cold air irritates the airways.
Long-standing COPD signs
Barrel chest from trapped air, clubbed fingers, muscle wasting and weight loss. Pursed lips and tripod position in distress. 1
The work of breathing burns energy, and eating leaves clients breathless.
Spirometry: FEV1/FVC
An FEV1/FVC ratio under 0.7 confirms obstruction. FEV1 as a percent of predicted sets severity, GOLD 1 (mild) to 4 (very severe). 1
The lower the FEV1, the worse the disease. Repeat tests track change over time.
ABGs: CO2 retention
Damaged lungs can't clear CO2. PaCO2 over 45 mm Hg with pH under 7.35 is respiratory acidosis, the most common ABG change. 3,1
Compare with the client's earlier ABGs: a falling pH means CO2 is building up.
COPD exacerbation cues
More shortness of breath, more sputum, and sputum turning purulent (yellow or green). Wheeze, cough and breathing rate rise. 1,2
Most flares follow a bacterial or viral infection.
Complications and red flags
Late complication: cor pulmonale
Advanced COPD can overload the right ventricle and cause right-sided heart failure, seen as swelling in the legs. 1
New ankle swelling in a client with COPD: think right-sided heart failure and report it.
Priority: what the nurse does first
Oxygen goal: SpO2 88 to 92%
Give low-flow oxygen as ordered, titrated to an SpO2 of 88 to 92%. Never withhold oxygen from a hypoxic client. 4,2
Too little oxygen is the bigger danger. Give it, then watch closely for rising CO2.
Nursing interventions and treatment
Exacerbation treatment
Oxygen, albuterol with ipratropium, a short course of oral or IV steroids, and antibiotics if infection is likely. Some need BiPAP. 1,2
BiPAP is noninvasive ventilation: a tight mask that helps the tired client breathe.
Long-acting bronchodilators
Daily LAMA (tiotropium) and LABA (salmeterol) keep airways open long term. Albuterol stays the quick-relief inhaler. 5
Anticholinergics cause dry mouth and urinary retention. Caution: glaucoma, enlarged prostate.
Steroids in COPD
Inhaled steroids reduce airway swelling long term. Oral or IV steroids are a short course for a flare. 1,2,6
Rinse the mouth after inhaled steroids. Watch blood glucose on oral steroids, especially with diabetes.
Evaluation: is care working?
Watch for rising CO2
New drowsiness, confusion or headache can mean CO2 is climbing. Check for these 30 to 60 minutes after starting oxygen. 1,2
A COPD client who is suddenly sleepy is not just resting. Check the ABG and report.
Client teaching
Pursed-lip breathing
In through the nose, out slowly through pursed lips, with a longer exhale. It keeps airways open and lets trapped air out. 7
Teach it for activity, like climbing stairs, to ease breathlessness.
COPD teaching
Quit smoking, get flu and pneumococcal vaccines, pace activity with rest, eat high-calorie foods, use oxygen safely, try pulmonary rehab. 1
Quitting smoking is the foundation of COPD care. Offer help at every visit.
NCLEX traps
Asthma vs COPD
Asthma: trigger-driven attacks, and the airways open back up between them. COPD: mostly from smoking, persistent and slowly worsening. 2,1
Asthma narrowing is reversible. COPD damage stays, so the goal is to slow it down.
Try a copd question
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Physiological Adaptation
A client with COPD has an oxygen saturation of 86% on room air. The healthcare provider prescribes supplemental oxygen. Which target oxygen saturation range should the nurse maintain?
Show answer and rationale
Answer: C. Clients with COPD are treated with controlled low-flow oxygen titrated to a target saturation of 88% to 92% because, in clients who retain CO2, higher oxygen levels can push the CO2 even higher (mostly by worsening ventilation-perfusion matching), leading to drowsiness and respiratory acidosis. Targeting 95-100% or 93-97% risks that rise in CO2. A target of 80-85% is too low and would leave the client hypoxic. This careful titration gives enough oxygen without driving the CO2 up.
Checked against: OpenStax Fundamentals of Nursing, 7.2
Keep studying copd in NurseLingo Pro
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Test yourself: free med-surg practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for copd?
Common nursing problems for copd include impaired gas exchange; ineffective breathing pattern; activity intolerance; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for copd?
Give low-flow oxygen as ordered, titrated to an SpO2 of 88 to 92%. Never withhold oxygen from a hypoxic client.
More respiratory
Related cheat sheets
Sources
- OpenStax Medical-Surgical Nursing, 11.5
- merckmanuals.com
- OpenStax Medical-Surgical Nursing, 10.4
- OpenStax Fundamentals of Nursing, 7.2
- OpenStax Pharmacology for Nurses, 25.1
- OpenStax Pharmacology for Nurses, 25.2
- OpenStax Fundamentals of Nursing, 19.4
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.