nursing diagnosis essay

The Ultimate Guide to Nursing Diagnosis in 2024

What is a nursing diagnosis.

• NANDA Nursing Diagnosis
• Classification

NANDA Nursing Diagnosis List

Writing a nursing diagnosis.

• Nursing Diagnosis vs Medical Diagnosis
• American vs International

A nursing diagnosis is a part of the nursing process and is a clinical judgment that helps nurses determine the plan of care for their patients. These diagnoses drive possible interventions for the patient, family, and community. They are developed with thoughtful consideration of a patient’s physical assessment and can help measure outcomes for the nursing care plan .

In this article, we'll explore the NANDA nursing diagnosis list, examples of nursing diagnoses, and the 4 types. 

Some nurses may see nursing diagnoses as outdated and arduous. However, it is an essential tool that promotes patient safety by utilizing evidence-based nursing research. 

According to NANDA-I, the official definition of the nursing diagnosis is: 

“Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

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What is the purpose of a nursing diagnosis.

According to NANDA International , a nursing diagnosis is “a judgment based on a comprehensive nursing assessment.” The nursing diagnosis is based on the patient’s current situation and health assessment, allowing nurses and other healthcare providers to see a patient's care from a holistic perspective. 

Proper nursing diagnoses can lead to greater patient safety, quality care, and increased reimbursement from private health insurance, Medicare, and Medicaid. 

They are just as beneficial to nurses as they are to patients.

NANDA Nursing Diagnosis 

NANDA diagnoses help strengthen a nurse’s awareness, professional role, and professional abilities. 

Formed in 1982, NANDA  is a professional organization that develops, researches, disseminates, and refines the nursing terminology of nursing diagnosis. Originally an acronym for the North American Nursing Diagnosis Association, NANDA was renamed to NANDA International in 2002 as a response to its broadening worldwide membership.

According to its website, NANDA International’s mission is to:

• Provide the world’s leading evidence-based nursing diagnoses for use in practice and to determine interventions and outcomes
• Contribute to patient safety through the integration of evidence-based terminology into clinical practice and clinical decision-making
• Fund research through the NANDA-I Foundation
• Be a supportive and energetic global network of nurses, who are committed to improving the quality of nursing care and improvement of patient safety through evidence-based practice

NANDA members can be found worldwide, specifically in Brazil, Colombia, Ecuador, Mexico, Peru, Portugal, Germany, Austria, Switzerland, Netherlands, Belgium, and Nigeria-Ghana.  

NANDA Classification of Nursing Diagnoses

NANDA-I adopted the Taxonomy II after consideration and collaboration with the National Library of Medicine (NLM) in regards to healthcare terminology codes. Taxonomy II has three levels: domains, classes, and nursing diagnoses. 

There are currently 13 domains and 47 classes:

• Health Awareness
• Health Management
• Urinary Function
• Gastrointestinal Function
• Integumentary Function
• Respiratory Function
• Activity/Exercise
• Energy Balance
• Cardiovascular-Pulmonary Responses
• Orientation
• Sensation/Perception
• Communication
• Self-concept
• Self-esteem
• Caregiving Roles
• Family Relationships
• Role Performance
• Sexual Identity
• Sexual Function
• Reproduction
• Post-trauma Responses
• Coping Response
• Neuro-Behavioral Stress
• Value/Belief Action Congruence
• Physical Injury
• Environmental Hazards
• Defensive Processes
• Thermoregulation
• Physical Comfort
• Environmental Comfort
• Social Comfort
• Development

This refined Taxonomy is based on the Functional Health Patterns assessment framework of Dr. Mary Joy Gordon. Furthermore, the NLM suggested changes because the Taxonomy I code structure included information about the location and the level of the diagnosis. 

NANDA-I nursing diagnoses and Taxonomy II comply with the International Standards Organization (ISO) terminology model for a nursing diagnosis. 

The terminology is also registered with Health Level Seven International (HL7), an international healthcare informatics standard that allows for nursing diagnoses to be identified in specific electronic messages among different clinical information systems. 

A full list of NANDA-I-approved nursing diagnoses can be found here .

Additional examples include:

• Dysfunctional ventilatory weaning response
• Impaired transferability
• Activity intolerance
• Situational low self-esteem
• Risk for disturbed maternal-fetal dyad
• Impaired emancipated decision-making
• Risk for impaired skin integrity
• Risk for metabolic imbalance syndrome
• Urge urinary incontinence
• Risk for unstable blood pressure
• Impaired verbal communication
• Acute confusion
• Disturbed body image
• Relocation stress syndrome
• Ineffective role performance
• Readiness for enhanced sleep

Examples of Nursing Diagnoses

The three main components of a nursing diagnosis are as follows.

• Problem and its definition
• Defining characteristics or risk factors 

Examples of proper nursing diagnoses may include:

>> Related: What is the Nursing Process?

NANDA Nursing Diagnosis Types

There are 4 types of nursing diagnoses according to NANDA-I. They are:

• Problem-focused
• Health promotion

1. Problem-focused diagnosis

A patient problem present during a nursing assessment is known as a problem-focused diagnosis. Generally, the problem is seen throughout several shifts or a patient’s entire hospitalization. However, it may be resolved during a shift depending on the nursing and medical care. 

Problem-focused diagnoses have three components. 

• Nursing diagnosis
• Related factors
• Defining characteristics

Examples of this type of nursing diagnosis include:

• Decreased cardiac output 
• Chronic functional constipation
• Impaired gas exchange

Problem-focused nursing diagnoses are typically based on signs and symptoms present in the patient. They are the most common nursing diagnoses and the easiest to identify. 

2. Risk nursing diagnosis

A risk nursing diagnosis applies when risk factors require intervention from the nurse and healthcare team prior to a real problem developing.

• Risk for imbalanced fluid volume
• Risk for ineffective childbearing process
• Risk for impaired oral mucous membrane integrity

This type of diagnosis often requires clinical reasoning and nursing judgment.

3. Health promotion diagnosis

The goal of a health promotion nursing diagnosis is to improve the overall well-being of an individual, family, or community.

• Readiness for enhanced family processes
• Readiness for enhanced hope
• Sedentary lifestyle

4. Syndrome diagnosis

A syndrome diagnosis refers to a cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions.

Examples of this diagnosis include:

• Decreased cardiac output
• Decreased cardiac tissue perfusion
• Ineffective cerebral tissue perfusion
• Ineffective peripheral tissue perfusion

Possible nursing diagnosis

While not an official type of nursing diagnosis, possible nursing diagnosis applies to problems suspected to arise. This occurs when risk factors are present and require additional information to diagnose a potential problem.

Nursing Diagnosis Components

The three main components of a nursing diagnosis are:

• Etiology or risk factors 

1. The problem statement explains the patient’s current health problem and the nursing interventions needed to care for the patient. 

2. Etiology, or related factors , describes the possible reasons for the problem or the conditions in which it developed. These related factors guide the appropriate nursing interventions. 

3. Finally, defining characteristics are signs and symptoms that allow for applying a specific diagnostic label. Risk factors are used in the place of defining characteristics for risk nursing diagnosis. They refer to factors that increase the patient’s vulnerability to health problems.

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Problem-focused and risk diagnoses are the most difficult nursing diagnoses to write because they have multiple parts. According to NANDA-I , the simplest ways to write these nursing diagnoses are as follows:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Nursing Diagnosis vs Medical Diagnosis 

While all important, the nursing diagnosis is primarily handled through specific nursing interventions while a medical diagnosis is made by a physician or advanced healthcare practitioner.

The nursing diagnosis can be mental, spiritual, psychosocial, and/or physical. It focuses on the overall care of the patient while the medical diagnosis involves the medical aspect of the patient’s condition.

 A medical diagnosis does not change if the condition is resolved, and it remains part of the patient’s health history forever. A nursing diagnosis, however, generally refers to a specific period of time. 

Examples of medical diagnosis include:

• Congestive Heart Failure
• Diabetes Insipidus

Collaborative problems are ones that can be resolved or worked on through both nursing and medical interventions. Oftentimes, nurses will monitor the problems while the medical providers prescribe medications or obtain diagnostic tests. 

History of Nursing Diagnoses

• 1973: The first conference to identify nursing knowledge and a classification system; NANDA was founded
• 1977: First Canadian Conference takes place in Toronto
• 1982: NANDA formed with members from the United States and Canada
• 1984: NANDA established a Diagnosis Review Committee
• 1987: American Nurses Association (ANA) officially recognizes NANDA to govern the development of a classification system for nursing diagnosis
• 1987: International Nursing Conference held in Alberta, Canada
• 1990: 9th NANDA conference and the official definition of the nursing diagnosis established
• 1997: Official journal renamed from “Nursing Diagnosis” to “Nursing Diagnosis: The International Journal of Nursing Terminologies and Classifications”
• 2002: NANDA changes to NANDA International (NANDA-I) and Taxonomy II released
• 2020: 244 NANDA-I approved diagnosis 

American vs International Nursing Diagnosis

There is currently no difference between American nursing diagnoses and international nursing diagnoses. Because NANDA-I is an international organization, the approved nursing diagnoses are the same. 

Discrepancies may occur when the translation of a nursing diagnosis into another language alters the syntax and structure. However, since there are NANDA-I offices around the world, the non-English nursing diagnoses are essentially the same. 

What is an example of a nursing diagnosis? 

• A nursing diagnosis is something a nurse can make that does not require an advanced provider’s input. It is not a medical diagnosis. An example of a nursing diagnosis is: Excessive fluid volume related to congestive heart failure as evidenced by symptoms of edema.

What is the most common nursing diagnosis? 

• According to NANDA, some of the most common nursing diagnoses include pain, risk of infection, constipation, and body temperature imbalance. 

What is a potential nursing diagnosis?

• A potential problem is an issue that could occur with the patient’s medical diagnosis, but there are no current signs and symptoms of it. For instance, skin integrity breakdown could occur in a patient with limited mobility. 

How is a nursing diagnosis written?

• Nursing diagnoses are written with a problem or potential problem related to a medical condition, as evidenced by any presenting symptoms. There are 4 types of nursing diagnoses: risk-focused, problem-focused, health promotion-focused, or syndrome-focused.

What is the clinical diagnosis?

• A clinical diagnosis is the official medical diagnosis issued by a physician or other advanced care professional. 

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

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Writing a nursing diagnosis: a complete guide, carla johnson.

• October 2, 2023
• How to Guides

Nursing diagnosis is essential to nursing, providing a structured framework for identifying and addressing patients’ health needs. As nursing students, mastering the art of writing nursing diagnoses is crucial for providing quality patient care. In this comprehensive guide, we will walk you through the process of writing a nursing diagnosis , step by step, ensuring you understand the key components and formatting. By the end of this article, you will have the skills and confidence to create effective nursing diagnoses that will benefit you and your patients.

What You'll Learn

Understanding Nursing Diagnosis

1.1 what is a nursing diagnosis.

A nursing diagnosis is a clinical judgment made by a nurse to identify a patient’s health problem, potential health problems, or wellness status. It serves as a basis for developing a care plan to meet the patient’s needs, improve their health outcomes, and provide individualized care.

1.2 Importance of Nursing Diagnosis

• Patient-Centered Care : Nursing diagnoses help nurses focus on patients’ unique needs and provide personalized care plans.
• Clinical Decision Making: They guide nurses in prioritizing interventions and setting achievable goals.
• Documentation: Nursing diagnoses serve as a record of the patient’s health status, which is vital for communication among healthcare providers.
• Evaluation: They provide a basis for evaluating the effectiveness of nursing interventions.

Writing a Nursing Diagnosis

2.1 gathering data.

The first step in writing a nursing diagnosis is to collect comprehensive patient data . This includes:

• Subjective Data: Information provided by the patient, such as their symptoms, feelings, and perceptions.
• Objective Data: Observations and measurements made by the nurse, like vital signs and physical assessments.
• Medical History: Previous medical conditions, surgeries, and medications.

2.2 Formulating Nursing Diagnoses

A nursing diagnosis typically consists of three components:

• Problem: Describes the patient’s health issue or concern.
• Etiology: Identifies the cause or contributing factors of the problem.
• Symptoms or Defining Characteristics: Lists the signs and symptoms that support the diagnosis.

For example:

• Problem: Impaired Gas Exchange
• Etiology: Ineffective breathing pattern related to pneumonia .
• Symptoms: Shortness of breath, decreased oxygen saturation, increased respiratory rate.

2.3 Using the PES Format

To ensure clarity and consistency in your nursing diagnoses, use the PES (Problem-Etiology-Symptoms) format. This format clearly defines the problem, its cause, and the evidence supporting the diagnosis.

• Problem: The “P” in PES; it is the patient’s health issue.
• Etiology: The “E” in PES; it represents the cause or contributing factors.
• Symptoms: The “S” in PES; these are the observed signs and symptoms.

2.4 Avoiding Medical Diagnoses

Nursing diagnoses should focus on the patient’s response to their health condition, not on medical diagnoses. For example, instead of writing “ Diabetes Mellitus ,” write “Risk for Uncontrolled Blood Glucose Levels related to lack of diabetes management knowledge.”

2.5 Prioritizing Nursing Diagnoses

In clinical practice, nurses often encounter multiple nursing diagnoses for one patient. Prioritize these diagnoses based on the patient’s immediate needs and the severity of their conditions. The most urgent issues should take precedence in your care plan .

Formatting Dialogue in an Essay

3.1 the role of dialogue in nursing essays.

In nursing essays, dialogue is often used to illustrate patient-nurse interactions, convey information, or present case studies. Proper formatting of dialogue is essential for clarity and readability.

3.2 Quotation Marks

When including direct speech or dialogue in your essay, enclose the spoken words within double quotation marks. For example:

Nurse Smith asked, “How are you feeling today?”

Patient Jones replied, “I’m experiencing some chest pain .”

3.3 Paragraphing

Each time there is a change in the speaker or topic, start a new paragraph. This helps readers follow the conversation and identify who is speaking. For example:

Patient Jones replied, “I’m experiencing some chest pain.”

Nurse Smith inquired, “Can you describe the pain? Is it sharp or dull?”

3.4 Punctuation

Use commas and periods correctly within dialogue. Commas should be placed inside the quotation marks, while periods should be placed inside if they are part of the quoted text, but outside if they are not. For example:

Incorrect: “I’m not sure if I can do this.” Nurse Smith hesitated.

Correct: “I’m not sure if I can do this,” Nurse Smith hesitated.

3.5 Attribution

Always attribute the dialogue to the appropriate speaker. This helps maintain clarity in your essay. For example:

Patient Jones stated, “I’m feeling very weak today.”

Nurse Smith reassured him, “We’ll take good care of you.”

Mastering the art of writing nursing diagnoses and formatting dialogue in essays is a crucial skill for nursing students. Effective nursing diagnoses are the foundation of patient-centered care, while well-formatted dialogue enhances the quality of your essays and reports. As you continue your nursing education, remember that practice makes perfect. Regularly assess and refine your nursing diagnosis skills, and pay attention to proper dialogue formatting in your written assignments. By doing so, you’ll enhance your nursing practice and excel in your academic pursuits.

If you ever find yourself struggling with nursing assignments, including writing nursing diagnoses or formatting dialogue in essays, don’t hesitate to seek assistance. Our professional writing services are here to support you on your academic journey. Contact us today to discover how we can help you succeed in your nursing studies.

Q1: What is an example of a nursing diagnosis in nursing?

A1: An example of a nursing diagnosis is “Impaired Physical Mobility related to postoperative pain and restricted range of motion,” which addresses a patient’s mobility issues after surgery.

Q2: What is the correct format for writing a nursing diagnosis and what are Nanda approved diagnoses?

A2: The correct format for a nursing diagnosis is the PES format – Problem, Etiology, and Symptoms. NANDA International (formerly known as North American Nursing Diagnosis Association) is a standardized source of approved nursing diagnoses, offering a comprehensive list of diagnoses for nursing practice.

Q3: How do you write a nursing diagnosis goal?

A3: Nursing diagnosis goals should be specific, measurable, achievable, relevant, and time-bound (SMART). For example, if the nursing diagnosis is “ Risk for Falls ,” a SMART goal might be “Patient will demonstrate proper use of assistive devices within one week to reduce fall risk.”

Q4: What is SMART format in nursing?

A4: SMART format is a goal-setting framework used in nursing to make goals Specific, Measurable, Achievable, Relevant, and Time-bound. It helps ensure that nursing interventions are clear, achievable, and focused on improving patient outcomes.

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Nursing Diagnosis Guide

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Creating a nursing diagnosis is a critical part of providing patient care and is a vital step of the nursing process.

By understanding how to create a nursing diagnosis, you can help improve patient outcomes, improve communication among the medical health team, and organize your day. Both the nursing process and nursing diagnoses help ensure and promote evidence-based, safe practices.

In this guide, you will learn what a nursing diagnosis is, why it is important, and a general overview of how to perform a nursing diagnosis.

The Nursing Process

You can’t discuss a nursing diagnosis without discussing the nursing process. The nursing process has five steps:

Assessment is a thorough and holistic evaluation of a patient. It includes the collection of both subjective and objective patient data such as vital signs, a health history, head-to-toe physical, and a psychological, socioeconomic, and spiritual evaluation.

Diagnosis is formed by the nurse and is based on the data collected during the assessment. The nursing diagnosis directs nursing-specific patient care.

In this step, the nurse forms a diagnosis based on the patient’s specific medical and/or social needs. The diagnosis leads to the creation of goals with measurable outcomes.

The diagnosis must be one that has been approved by NANDA International (NANDA-I), formerly known as North American Nursing Diagnosis Association. NANDA-I is responsible for developing and standardizing nursing diagnoses. Used internationally, the NANDA-I vision and mission is to use evidence-based, universal nursing terminology to promote safe patient care.

NANDA-I defines a nursing diagnosis as follows:

• “a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.”
• A nursing diagnosis generally has three components: a diagnosis approved by NANDA-I, a related to statement which defines the cause of the NANDA-I diagnosis, and an as evidenced by statement that uses specific patient data to provide a reason for the NANDA-I diagnosis and related to statement.
• Risk-related diagnoses only contain a NANDA-I diagnosis and an as evidenced by statement because it is describing a vulnerability, not a cause. For example, a nurse may use a nursing diagnosis such as “risk for pressure ulcer as evidenced by lack of movement, poor nutrition, and hydration.”

Outcomes and Planning

Outcome and planning involves developing a patient care plan based on the nursing diagnosis. Planning should be measurable and goal-oriented for the patient and/or their family members.

Implementation

Implementation is when nurses initiate the care plan and put it into action. This step provides the continuation of care during hospitalization until discharge.

Evaluation is the final step of the nursing process. A patient care plan is evaluated based on specific goals and desired outcomes and may be adjusted based on the patient’s needs.

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How Do Nursing Diagnoses Differ From Medical Diagnoses?

To best understand a nursing diagnosis, it may help to first understand how it differs from a medical diagnosis.

A nursing diagnosis is initiated by a nurse and describes a response to the medical diagnosis. A medical diagnosis is given by a doctor to a patient to define a medical condition/disease or injury.

Nursing Diagnosis

• Based on the patient’s immediate situation
• Initiated to resolve a health problem
• Improves communication among the healthcare teams
• A holistic approach to caring for patients

Example: Ineffective breathing pattern related to impaired inhalation and exhalation as evidenced by the use of accessory muscles

Medical Diagnosis

• Initiated by a medical doctor or specialist
• Defines a medical condition, disease, or injury
• Explains the signs and symptoms of the disease

Example: Asthma

4 Categories of Nursing Diagnoses

The need for standardized language, respecting nurses’ clinical judgment, and providing care for patients with measurable results defines the use of a nursing diagnosis. The nursing diagnosis can be divided into four main categories. Please note all examples are taken from the Nursing Diagnoses Definitions and Classification 2015-2017.

Problem-focused Diagnosis

A nursing diagnosis related to a patient’s problem. It can be used throughout the course of the patient’s hospitalization or be resolved by the end of the shift.

Example: Anxiety related to situational crises and stress (related factors) as evidenced by restlessness, insomnia, anguish, and anorexia (defining characteristics)

Risk Diagnosis

A nursing diagnosis that identifies when the patient is at risk for developing a problem. NANDA-I describes it as a vulnerability the patient has encountered.

Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors)

Health-promotion Diagnosis

A nursing diagnosis used to identify how to help improve the health of a patient. Health-promotion diagnosis includes the patient and their family/community members.

Example: Readiness for enhanced self-care as evidenced by expressed desire to enhance self-care

Syndrome Diagnosis

A nursing diagnosis identifying a cluster of diagnoses for a patient. These nursing diagnoses are best described together. The patient may be experiencing a number of health problems forming a pattern.

Example: Chronic pain syndrome

Nursing Diagnosis Classification

NANDA-I created Taxonomy II after collaborating with the National Library of Medicine. By definition, taxonomy is the “practice and science of categorization and classification.” The NANDA-I Taxonomy currently has 235 nursing diagnoses with 13 categories of nursing practice:

• Health promotion
• Elimination and exchange
• Activity/rest
• Perception/cognition
• Self-perception
• Role relationships
• Coping/stress tolerance
• Life principles
• Safety/protection
• Growth/development

They also have 47 classes related to each category.

How to Perform a Nursing Diagnosis

Nurses complete five steps to carry out a strong, accurate nursing diagnosis. All nurses should follow the nursing process:

Nursing Science

Having a solid understanding of nursing science and theory provides a strong foundation for patient care. It is also the first step in initiating a nursing diagnosis and care plan that is holistic and patient-centered.

During the assessment, nurses gather medical, surgical, and social history. They also perform a physical on the patient. Nurses then ask themselves: What is the current and priority health problem(s) the patient is experiencing? This information is applied to creating a nursing diagnosis.

Identifying Potential Diagnoses

Once the health problem or human response(s) to the health problem is identified, nurses ask another question: What important information is relevant to the health problem and what’s unrelated?

The answer to this question helps create a potential nursing diagnosis. Nurses will then:

• Determine the category of the nursing diagnosis
• Confirm and rule out other diagnoses
• Create new diagnoses

The nursing diagnosis must be validated and critically thought out. NANDA-I advises using an in-depth assessment. This will confirm or rule out a diagnosis.

NANDA-I recommends structuring a nursing diagnosis in “related factors” and “defining characteristics” format, as first published by Marjory Gordon, Ph.D. This can highlight the strength and accuracy of the nursing diagnosis.

Implementing a Care Plan

A nursing diagnosis determines the care plan. Nurses create measurable, achievable goals and related interventions. They then take action, administering the planned interventions.

Nurses are constantly evaluating their patients. A nursing diagnosis is often evaluated to make sure the care plan is working. If it is not, nurses must think about what else can be done to improve the patient’s health.

A Critical Component of Care

Nurses are the eyes and ears of the patient. They are the liaison between the medical health team and the patient and their family. Understanding the power and usefulness of a nursing diagnosis is a critical aspect of patient care. Each patient is unique and complex. The nursing process and nursing diagnosis can help provide safe, individualized, and evidence-based care.

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Community Health Nursing Diagnosis Statement

This essay about community health nursing diagnosis statements highlights their vital role in understanding and addressing the multifaceted nature of community health. Unlike individual diagnoses, these statements consider the broader social, economic, and environmental factors influencing health outcomes. They emphasize holistic assessment, community engagement, and collaborative interventions tailored to each community’s unique needs. Furthermore, these statements serve as advocacy tools, empowering nurses to address health disparities and promote health equity. Overall, they represent a dynamic approach to community health that prioritizes partnership, empathy, and social justice.

How it works

Community health nursing diagnosis statements serve as dynamic blueprints, guiding nurses in decoding the complex tapestry of community health. Unlike traditional medical diagnoses, which focus on individual ailments, these statements illuminate the interconnected web of social, economic, and environmental factors influencing the health of entire populations.

At the heart of community health nursing diagnosis statements lies a commitment to holistic assessment. Nurses don their detective hats, probing not only physical symptoms but also delving into the emotional, mental, and social landscapes of communities.

This panoramic view reveals underlying health determinants, from access to fresh foods and safe housing to the strength of social support networks, guiding nurses towards targeted interventions that address root causes rather than mere symptoms.

Moreover, these diagnostic statements are not stagnant declarations but living documents shaped by community voices. Nurses become co-creators with community members, weaving together narratives of lived experiences, cultural nuances, and local wisdom. This collaborative approach ensures that interventions resonate authentically with the community’s values, fostering trust and empowerment among its members.

Furthermore, community health nursing diagnosis statements serve as compasses in the vast sea of public health initiatives. Nurses navigate through a myriad of options, charting courses towards impactful interventions that promote wellness and prevent disease. Whether it’s launching community-wide health education campaigns, spearheading initiatives to improve access to healthcare services, or advocating for policies that address social inequalities, these statements provide a roadmap for action tailored to the unique needs of each community.

Beyond their practical utility, community health nursing diagnosis statements carry a potent message of advocacy and social justice. Nurses wield them as powerful tools to shine a spotlight on health disparities and structural inequities, challenging policymakers and stakeholders to dismantle systemic barriers to health. Through their tireless advocacy efforts, nurses champion the cause of health equity, striving to ensure that every individual, regardless of background or circumstance, has the opportunity to thrive.

In essence, community health nursing diagnosis statements are not mere bureaucratic documents but catalysts for transformation. They embody the spirit of collaboration, empathy, and resilience that defines the nursing profession. As nurses harness their expertise and passion to uplift communities, they pave the way towards a future where health is not just a privilege but a fundamental human right

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How to write a nursing diagnosis essay paper.

As a nursing student, you must learn how to write a nursing diagnosis paper before you complete your academic program. That is because a nursing diagnosis guides nurses in determining appropriate patient care plans. A nurse writes nursing diagnoses based on the patient’s assessment. It must include the problem and its description, the etiology, and the identified risk factors.

Writing a nursing diagnosis helps students to learn how to prepare for their careers. Mastering this art will help you to communicate your judgment based on the information you gathered after assessment to the physicians, other nurses, patients, families, and the public. A nursing diagnosis is an important part of the nursing process. It’s a fundamental tool for nurses and, even, for a lot of healthcare providers.

In our article, you can read everything you need about nursing diagnosis. Besides learning and being able to answer the question,” What is Nanda’s nursing diagnosis?”  You will understand the different types and differences between various nursing diagnoses, definitions, formats, and comparisons and get nursing diagnosis examples, among others. If you need help writing a nursing diagnosis, contact us.

How to Understand Nursing Diagnosis 

A nursing diagnosis is an integral section of the nursing process that helps nurses assess the patient’s health condition and develop care plans based on their thoughtful consideration and judgment. It determines the possible interventions for the family, patients, and community if it is a community nursing diagnosis.

Nursing diagnosis is usually determined based on the patient’s current situation; hence, interventions are based on evidence-based nursing research. From there, the health care providers, among nurses, consider the kind of care to provide to patients from a holistic poin t of view.

Nanda Approved Nursing Diagnosis 

Nanda-approved nursing diagnoses include;

Actual/problem-focused diagnosis

This diagnosis focuses on specific signs and symptoms that are observable and present during the assessment stage. A nurse prepares a problem statement based on related stressors, complications, or concerns and explains the patient’s current health problem and the nursing interventions needed to develop the patient care plan.

One example of problem-focused nursing diagnosis is recognizing the symptoms of mental distress. The nurse will note behaviors like the patient’s struggle to concentrate, confused thinking, extreme mood changes, and struggle to sleep. The nurse shares this information with other healthcare providers to assist in making a diagnosis that further guides them in making decisions, such as passing it along to the medical provider to assist in making the diagnosis. The nursing diagnosis guides further decisions.

Risk nursing diagnosis 

The risk nursing diagnosis identifies the nursing interventions needed to lower the risk related to a patient’s developing problem. It mainly requires nursing judgment and clinical reasoning because there are no etiological factors for risk diagnoses. A risk nursing diagnosis includes risk factors and diagnostic risk labels.

An example of a risk diagnosis would be the risk of imbalanced body fluid volume.

Health promotion diagnosis 

This nursing diagnosis aims to improve the well-being of the patient, community, or family. This diagnosis only consists of a diagnostic label. Examples include readiness for enhanced family survival.

Syndrome diagnosis

A syndrome diagnosis refers to a group of nursing diagnoses that can be addressed through the same interventions and occurs in the same pattern. An example of this diagnosis is decreased peripheral tissue perfusion.

How Can I Write My Nursing Diagnosis 

For consistency and safe nursing practices, there are standardized ways that you need to pay attention to as you write your nursing diagnosis. Unlike a medical diagnosis that addresses a specific medical condition, a nursing diagnosis addresses patient needs. That is why a nurse needs to personalize a nursing diagnosis to fit the patient’s status and health situation. Ensure it addresses the problem, linked signs and symptoms, and any other related factor that could affect patient care. You can achieve that by:

Data gathering and analyzing

Take time to observe the patient’s symptoms and note their condition. Come up with a description of the critical problem based on the symptoms observed. You can use non-specialist language to write your observations at this point.

Discuss with the patient and relatives about their feeling

As you formulate a nursing diagnosis, remember that you will be using information from the patient and their loved ones. Ask them about the notable changes in patient behavior and how it has affected them and their relationship.

Evaluate the patient’s response to their condition

Understand what the patient has done to eliminate or cope with their situation. Consider the patient, healthcare provider, and relative attitude toward the symptoms. Also, note the behavioral change and patient attitude when these parties are around.

Distinguish between subjective and objective data

Subjective data is acquired from the patient’s complaints about their condition. This kind of data is unverified. On the other hand, objective data is gathered from measurable and verifiable observations using scientific methods. Objective data is crucial in forming a basis for your nursing diagnosis. Subjective data can be used to create a patient care plan.

Identify the problem 

Check for patterns in the data you collected. Symptoms and signs that may lead you to get a proper diagnosis for the patient. Focus on the patient’s experience. Nursing diagnosis is never the same for patients, even those suffering from the same condition. Each problem identified is diagnosed separately.

Identify related factors

Identify the source of the problem and then figure out why the patient is facing such an issue. Once you have an answer, you can develop nursing interventions that will help eliminate or prevent the problem.

Evaluate the patient’s history and overall health

Assess the patient’s past medical records to learn about the factors that could be associated with their current situation. You can share with other healthcare providers to help you learn about the patient’s overall health.

Find the most appropriate nursing diagnosis

At this point, you must research an appropriate term for your observation. You can use your coursebook or Nanda-approved nursing diagnosis list to help you find a word that best fits the condition and needs of the patient. After developing a nursing diagnosis, find potential outcomes and interventions that will work for the patients. Consider how they apply to a specific patient.

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Bring the related factors together for your diagnosis .

List all the causes of the patient’s problem and the related factors. Search for the standardized terms for these factors in your coursebook or other scholarly materials available. Identifying the associated factors helps the nurse in the second section of their diagnosis.

Summarize the data in an “As Evidenced By” statement

Ensure you separate the collected data from the characteristics that indicate the diagnosed problem. Only include the observed features in your AEB statement. Indicate whether the data is objective or subjective.

Difference between Medical Diagnosis and Nursing Diagnosis 

In the medical field, there are a lot of terminologies that are used for simple illnesses, such as running noses. Understanding these terms and what they mean helps nursing students to be able to appropriately apply them in their careers in the future.

Let’s discuss the diagnosis. Medical diagnosis vs nursing diagnosis.

Differences by Definitions and Purpose

What is a medical diagnosis?

A medical diagnosis focuses on a patient’s medical condition, physiological and psychological response. The physician makes this kind of diagnosis based on the illness itself. The sickness is determined through knowledge, experience, and examination of all other possible causes. The doctor then prescribes proper medication that would help cure the disease.

What is a nursing diagnosis?

This diagnosis is based on the patient’s response to the medical condition. A nursing diagnosis is more focused on patient care. Nurses have the autonomy to provide care and treatment using everything linked to human reaction to a specific illness. That could be a spiritual, mental, or physical kind of reaction.

It is essential to understand how each of these diagnoses works to help the patient and other healthcare providers and relatives know how nursing and medical diagnoses complement each other.

Examples of medical diagnoses include:

• Congestive Heart Failure
• Diabetes Mellitus

Community Nursing Diagnosis 

You can conduct a community nursing diagnosis after identifying the problem and analyzing the data gathered. Nursing diagnosis for community health may be formulated concerning the following issues

• Heath hazards
• Airborne diseases
• Covid-19 pandemic
• Inaccessible health services
• Community dysfunction
• Morbidity and mortality rates
• Inaccessible and unavailable services
• Mortality and morbidity rates
• Physical or emotional problems for specific demographics
• Health promotion needs for specific demographics

Below are some community health nursing diagnosis examples that will help you develop a successful nursing care plan.

• Reduced Activity Tolerance
• Hyperthermia
• Chronic Pain
• Risk for electrolyte imbalance
• Bathing/dressing/feeding self-care deficit
• Risk for ineffective childbearing process
• Hypothermia
• Decreased Cardiac activity
• Deficient Body Fluid
• Ineffective Thermoregulation
• Ineffective Breathing Pattern
• Surplus fluid volume
• Hopelessness
• Less Nutrient Than Body Requirements
• Impaired Gas Exchange
• Impaired Skin Integrity
• Impaired Urinary Elimination
• Ineffective Airway Clearance
• Ineffective Respiratory Pattern
• Ineffective Tissue Perfusion

Risk for Falls

• Risk for Impaired Skin Integrity
• Risk for Infection

Risk for Injury

• Risk for Imbalanced Glucose Level
• Dysfunctional ventilatory weaning response
• Impaired transferability
• Activity intolerance
• Situational low self-esteem
• Risk for disturbed maternal-fetal dyad
• Impaired emancipated decision-making
• Risk for poor skin integrity
• Risk for metabolic imbalance syndrome
• Urge urinary incontinence
• Risk for unstable blood pressure
• Impaired verbal communication
• Acute confusion
• Disturbed body image
• Relocation stress syndrome
• Ineffective role performance
• Readiness for enhanced sleep

Safety Nursing Diagnosis 

Accidents and injuries resulting from burns, motor vehicle accidents, falls, drowning, overdoses and poisoning are some of the common cases in health care. When providing care to the victims of accidents and injuries, you are expected to write a safety nursing diagnosis to guide you in developing a plan.

Some of the risk factors that can increase the chances of patient injury are:

Risk for falls may occur due to

• Patients’ cognitive
• Physiological state

As evidenced by : Muscle weakness

The patient’s vulnerability to injury can result from internal and external causes.

Nursing Diagnosis : Risk for Injury

Related to :

• Side effects of medication
• Vision impairment
• Mobility impairment
• Hearing impairment
• Amputated/loss of limbs

As evidenced by:

There are no ‘evidenced by’ symptoms and signs as the issue has not happened. Prevention is the only aim of nursing intervention.

Expected outcomes :

• The patient will be able to identify possible exposures to risk of injury
• The patient will apply safety tips and measure to prevent injury
• The patient will remain uninjured

Assessment :

• Evaluate emotional and physical factors such as amnesia, grief, and recent traumatic experiences, among others, that could affect patient safety.
• Identify possible socioeconomic factors. Inaccessible resources such as housing and transportation can increase the chances of injuries.
• Evaluate for any abuse.  It is the role of the nurse to report any form of abuse. Whether it is physical, emotional, or verbal abuse.

Interventions :

Refer to resources as necessary

Help to prevent injuries by educating patients in self-care and basic safety measures. Such as putting on safety belts to reduce the chances of injury if a motor vehicle accident occurs. For patients with dementia and developmental delays, a nurse should consider providing care in nursing homes and at home.

Administer medications

Ensure you give the right patient the right medication, in proper dosage and at the right time. Double-check the details to make sure everything is clear.

Educate the patient and family on first-aid strategies

This helps them act immediately after the accident to facilitate swift, professional intervention and reduce the risk of complications after the injury.

Do You Need Help with Your Nursing Diagnosis?

Nursing diagnosis is a valuable tool that helps nurses provide quality, safe and evidence-based patient care. Every nurse must learn how a nursing diagnosis template works and master every aspect of health care provision.

You can contact us to hire a tutor that will help you learn a simple nursing diagnosis format and give you a simple step-by-step guide that will aid in formulating and writing a nursing diagnosis seamlessly. Contact us today!

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2023 Nursing Diagnosis: A Complete Guide

Jump to Sections

What is a nursing diagnosis, the 3 components of a nursing diagnosis, nanda nursing diagnosis – the 4 types, how to write a nursing diagnosis, basic nursing diagnosis examples.

As a nurse, you will be expected to develop and implement nursing diagnoses to determine how you will care for your patients and improve their overall health and well-being. This often means using evidence-based nursing practices.

As you prepare for a career in nursing, it’s essential to understand the value of a nursing diagnosis in health management, how it fits into a care plan, and how to write a nursing diagnosis of your own.

We’ll walk you through each part so you can better understand this critical part of your nursing career.

A nursing diagnosis is a clinical judgment you make about an individual’s or group’s health conditions and needs or their vulnerabilities to particular conditions or life processes — in other words, the human responses to those conditions or vulnerabilities.

Using your nursing diagnosis, you’ll determine the nursing interventions that will have the greatest positive impact on this individual or group.

A nursing diagnosis is based on data collected, observations, education, and experience. Carefully creating a nursing diagnosis can help you measure outcomes as you follow your planned interventions. Measuring outcomes allows you to compare the patient’s initial state with their current state and the impact of your interventions so you know when to adjust your actions and how to best help the patient.

This critical component of the nursing process will allow you to create a nursing care plan that will guide how you care for the patient. It’s important to note that a nursing diagnosis isn’t the same as a medical diagnosis!

While a medical diagnosis focuses on the disease or condition, such as pneumonia. The nursing diagnosis focuses more on the patient’s experiences such as, “Ineffective airway clearance.”  Both play a critical role in clinical practice.

What is a nursing diagnosis used for?

A nursing diagnosis calls for a thorough, holistic nursing assessment of the patient — examining their health and condition from a variety of different angles. As nurses carefully assess all of these different data points and create a comprehensive assessment, it can increase patient safety and help patients receive the appropriate care they need.

The diagnosis will then guide patient care moving forward. As a nurse, you’ll use the diagnosis to determine the appropriate interventions and evaluate the patient’s progress. This process will allow you to communicate with other staff members to provide care. 

As you develop nursing diagnoses, you’ll encounter three main components as part of the assessment. Depending on the type of diagnosis you make, you’ll use different combinations of these components.

• The problem and its definition. You’ll need to give a problem statement, also known as the diagnostic label, articulating the patient’s condition. It might include modifiers or qualifiers that give additional information about the diagnosis. You’ll also have a focus. The focus of the diagnosis explains the center point of the diagnosis.
• Etiology. Also known as the related factors, the etiology describes the likely causes of the health problem at hand. It generally uses vocabulary like “related to” to associate the diagnosis with the likely causes. For example, you might note problems like “chronic low self-esteem” or “disturbed thought processes” for a medical diagnosis of depression. For physical issues such as a gastrointestinal bleed, you may find “Ineffective tissue perfusion.”
• Defining characteristics or risk factors offer further information about the diagnosis. If the diagnosis focuses on patient risk, these factors might be listed instead of etiology. A person immobilized in their bed might be at risk for impaired skin integrity. Defining characteristics provide information about the signs that point to the diagnosis, using language such as “as evidenced by immobility,” to connect the characteristics with the diagnosis.

Now that you know the main components of a nursing diagnosis, let’s explore the different types of diagnoses you might encounter throughout your nursing career.

The North American Nursing Diagnosis Association International (NANDA-I) is the organization that articulates the standards used for creating nursing diagnoses. The standards that they create are used worldwide.

The origins of the standards date back to the 1950s when the importance of articulating nursing roles began to emerge. About 20 years later, the first national conference was held to begin classifying the different nursing diagnoses.

The meetings have continued to be held to define diagnoses further. Nurses can also submit new diagnoses that they think should be included to the organization for review.

There are four main categories of nursing diagnoses that you’ll encounter. 

1. Problem-Focused Diagnosis

A problem-focused diagnosis revolves around the symptoms and signs that the patient presents with. This category comprises the largest proportion of nursing diagnoses. The diagnosis in this situation aims to identify a central problem that the patient faces and might be quickly resolved or long-lasting.

The problem-focused diagnosis includes three main parts:

• The nursing diagnosis itself
• Any related factors
• Any defining characteristics

2. Risk Nursing Diagnosis

Risk nursing diagnoses are used to determine the types of nursing interventions needed to prevent certain medical conditions or other problems from developing. Nurses will need to use their training and experience to help them see the risks that will impact their patient.

A risk nursing diagnosis will include:

• The nursing diagnosis
• Any risk factors

3. Health Promotion Diagnosis

A health promotion diagnosis is drafted to help improve the health of the patient or group the nurse treats. These diagnoses take a holistic look at the patient or group being treated and determine how interventions can help the patient improve their condition globally. These diagnoses help to promote self-care in patients.

A health promotion diagnosis will include:

However, the health promotion diagnosis can be done with just a diagnosis label.

4. Syndrome Diagnosis

A syndrome diagnosis looks for patterns or clusters of nursing diagnoses that all call for related nursing interventions. For example, you might note that an elderly person meets the requirements for Frail Elderly Syndrome. 

This syndrome requires related interventions all targeted at helping the patient improve their quality of life while remaining protected from common risks and ailments that come with advanced aging.

A syndrome diagnosis will require only the diagnostic label component.

A nursing diagnosis should be a short, concise statement articulating your understanding of the problem. You’ll use your nursing knowledge to record the issue and how you arrived at your patient’s care plan.

Writing a nursing diagnosis should follow an exact formula. Using this formula means that you ascribe to the standards of the profession. It also makes it easier for others in the medical field, including other nurses contributing to patient care, to understand your diagnosis so they can understand the chosen nursing interventions.

Below are model sentences you can use to help you draft these important sentences for patient care.

Problem-Focused Diagnosis

The statement you create for a problem-focused diagnosis will contain each of your three components:

[Problem/diagnostic label] related to [related factors] as evidenced by [defining characteristics]

Risk diagnosis

The statement for a risk diagnosis will articulate your two main components:

[Risk diagnosis/diagnostic label] as evidenced by [risk factors]

Health Promotion Diagnosis

Your health promotion diagnosis will also include your two main characteristics:

[Health promotion label] as evidenced by [defining characteristics]

Syndrome Diagnosis

A syndrome diagnosis label, as you recall, only needs to list the syndrome diagnosis or diagnostic label. So, all that’s needed for this statement is:

[Syndrome diagnosis/ diagnostic label]

Possible Diagnosis

A possible diagnosis statement is needed when you suspect a particular health problem or situation but don’t have enough information to either confirm or rule out this issue.

As a nurse, you’ll work with others on the health care team to try to collect more information so you can make the appropriate decision about whether this is a valid diagnosis.

To write a possible diagnosis statement, you’ll write:

Possible [diagnostic label]

Now that you know the basic structure of the diagnostic sentences, let’s explore a few examples so you can better understand how these sentences come together to create a nursing diagnosis.

• Problem-focused diagnosis: “Ineffective breathing patterns related to pneumonia as evidenced by ineffective cough and excessive secretions.”
• Risk diagnosis: “Risk for infection as evidenced by a breach of primary defenses and trauma to the vascular area.”
• Health promotion: “Readiness for enhanced nutrition/improved wellness as evidenced by an expressed willingness to improve nutrition.”
• Syndrome: “Chronic Pain Syndrome”

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As you prepare to enter an exciting new career in nursing, you’ll want to ensure you have a thorough understanding of drafting a nursing diagnosis. 

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The Complete Guide to Writing Nursing Diagnoses: Techniques and Examples

• Dr. Huey Logan
• December 8, 2023
• Study Guides

Welcome to our comprehensive guide on developing accurate nursing diagnoses . In this series of articles, we will provide you with the essential techniques, examples, and guidelines to excel in healthcare writing , specifically in nursing care plans and diagnosis formulation. We understand the critical role nursing diagnoses play in delivering optimal patient care, and our aim is to equip you with the knowledge and tools to develop precise and effective nursing diagnoses in your practice.

Here's What You'll Learn

Before we dive into the specifics, let’s first establish the importance of nursing diagnoses and their differentiation from medical diagnoses. Nursing diagnoses are essential for identifying and addressing actual or potential health problems, promoting health, and improving patient outcomes. While medical diagnoses focus on disease pathology, nursing diagnoses center on identifying patient responses to health conditions and providing personalized care plans.

Throughout this series, we will explore the classification of nursing diagnoses according to Taxonomy II . This classification system organizes nursing diagnoses into various categories, including problem-focused nursing diagnoses, risk nursing diagnoses, health promotion diagnoses, and syndrome diagnoses. Understanding these classifications will aid in creating accurate and individualized care plans that address specific patient needs.

Key Takeaways:

• Nursing diagnoses play a crucial role in delivering effective patient care.
• Nursing diagnoses differ from medical diagnoses, focusing on patient responses and personalized care plans.
• Taxonomy II classifies nursing diagnoses into problem-focused, risk, health promotion, and syndrome diagnoses.
• Understanding these classifications enables the development of accurate and individualized nursing care plans.
• Stay tuned for our upcoming articles where we will delve into the definition, classification, and guidelines for writing precise nursing diagnoses.

Understanding Nursing Diagnoses: Definition and Classification

In this section, we will discuss the definition and classification of nursing diagnoses, providing a comprehensive understanding of their role in healthcare. Nursing diagnoses are essential in guiding the nursing process and developing effective care plans for patients. They complement medical diagnoses by focusing on the unique nursing perspective of patient care.

Nursing diagnoses are standardized statements that identify actual or potential health problems and provide the basis for nursing interventions. They are classified according to Taxonomy II , which categorizes nursing diagnoses into different types. These types include problem-focused nursing diagnoses, risk nursing diagnoses, health promotion diagnoses, and syndrome diagnoses.

Problem-focused nursing diagnoses address existing health issues or concerns and guide the selection of nursing interventions. Risk nursing diagnoses, on the other hand, identify potential health problems that the patient may be at risk for developing. Health promotion diagnoses focus on enhancing the patient’s well-being and preventing future health problems. Lastly, syndrome diagnoses identify related clusters of nursing diagnoses that occur together in certain conditions or situations.

Understanding the classification of nursing diagnoses is crucial for healthcare professionals as it aids in accurate assessment, planning, implementation, and evaluation of nursing care. By utilizing the appropriate nursing diagnosis classification, nurses can provide individualized care that meets the unique needs of each patient.

Now, let’s take a closer look at the different types of nursing diagnoses and their application in clinical practice through real-life examples and case studies.

Guidelines for Writing Accurate Nursing Diagnoses

In this final section, we will provide practical guidelines for writing accurate nursing diagnoses. As healthcare professionals, it is crucial that we have a clear understanding of the diagnostic process and the steps involved in formulating precise nursing diagnoses. This knowledge enables us to develop effective nursing care plans and provide optimal patient care.

The diagnostic process begins with a comprehensive analysis of patient data, including medical history, physical assessments, laboratory results, and patient interviews. By carefully examining this information, we can identify health problems and determine their underlying causes.

Once we have identified the health problems, we can formulate a nursing diagnosis using the Problem-Etiology-Symptom (PES) format. The PES format consists of three components: the problem, the etiology or cause of the problem, and the defining characteristics or symptoms. This format provides a clear and concise structure for articulating nursing diagnoses.

Nursing diagnoses are not only essential for individualized patient care but also play a significant role in the development of nursing care plans. By incorporating accurate nursing diagnoses into care plans, we can effectively address the identified health problems and establish goals and interventions to promote patient well-being and recovery.

What is a nursing diagnosis?

A nursing diagnosis is a clinical judgment about a patient’s response to actual or potential health problems. It identifies the patient’s health problem and describes what the nurse can do to address it.

What is the difference between a nursing diagnosis and a medical diagnosis?

A medical diagnosis focuses on the disease or condition itself, while a nursing diagnosis focuses on the patient’s response to the disease or condition. Medical diagnoses are typically made by doctors, while nursing diagnoses are made by nurses as part of the nursing process .

How are nursing diagnoses classified?

Nursing diagnoses are classified according to Taxonomy II , which categorizes them into different domains and classes. This classification system helps nurses identify the specific needs of their patients and develop appropriate care plans.

What are the different types of nursing diagnoses?

There are four main types of nursing diagnoses: problem-focused, risk, health promotion, and syndrome diagnoses. Problem-focused diagnoses address existing health problems, risk diagnoses identify potential health problems, health promotion diagnoses focus on improving overall health and wellness, and syndrome diagnoses are related to a specific cluster of signs and symptoms.

How do I write an accurate nursing diagnosis?

To write an accurate nursing diagnosis, you need to analyze the patient’s data, identify the health problem, and formulate a diagnostic statement. This statement should follow the PES format , which includes the problem, etiology (cause), and signs and symptoms. Nursing diagnoses are then used in the development of nursing care plans.

Source Links

• https://nurseslabs.com/nursing-diagnosis/
• https://nursejournal.org/resources/nursing-diagnosis-guide/
• https://www.nursetogether.com/nursing-diagnosis/

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Last Update: April 10, 2023 .

• Introduction

In 1958, Ida Jean Orlando started the nursing process that still guides nursing care today. Defined as a systematic approach to care using the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EDP) recommendations, and nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate, quality-based care. [1] [2] [3]

The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.

Assessment is the first step and involves critical thinking skills and data collection; subjective and objective. Subjective data involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight.

Data may come from the patient directly or from primary caregivers who may or may not be direct relation family members. Friends can play a role in data collection. Electronic health records may populate data and assist in assessment.

Critical thinking skills are essential to assessment, thus the need for concept-based curriculum changes.

The formulation of a nursing diagnosis by employing clinical judgment assists in the planning and implementation of patient care.

The North American Nursing Diagnosis Association (NANDA) provides nurses with an up-to-date list of nursing diagnoses. A nursing diagnosis, according to NANDA, is defined as a clinical judgment about responses to actual or potential health problems on the part of the patient, family, or community.  

A nursing diagnosis encompasses Maslow's Hierarchy of Needs and helps to prioritize and plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy based on basic fundamental needs innate to all individuals. Basic physiological needs/goals must be met before higher needs/goals can be achieved such as self-esteem and self-actualization. Physiological and safety needs provide the basis for the implementation of nursing care and nursing interventions. Thus, they are at the base of Maslow's pyramid, laying the foundation for physical and emotional health. [4] [5]

Maslow's Hierarchy of Needs

• Basic Physiological Needs: Nutrition (water and food), elimination (Toileting), airway (suction)-breathing (oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABCs), sleep, sex, shelter, and exercise.
• Safety and Security: Injury prevention (side rails, call lights, hand hygiene, isolation, suicide precautions, fall precautions, car seats, helmets, seat belts), fostering a climate of trust and safety (therapeutic relationship), patient education (modifiable risk factors for stroke, heart disease).
• Love and Belonging: Foster supportive relationships, methods to avoid social isolation (bullying), employ active listening techniques, therapeutic communication, and sexual intimacy.
• Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control or empowerment, accepting one's physical appearance or body habitus.
• Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of view of others, reaching one's maximum potential.

The planning stage is where goals and outcomes are formulated that directly impact patient care based on EDP guidelines. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual's unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the healthcare continuum.

Goals should be:

• Measurable or Meaningful
• Attainable or Action-Oriented
• Realistic or Results-Oriented
• Timely or Time-Oriented

Implementation

Implementation is the step that involves action or doing and the actual carrying out of nursing interventions outlined in the plan of care. This phase requires nursing interventions such as applying a cardiac monitor or oxygen, direct or indirect care, medication administration, standard treatment protocols, and EDP standards.

This final step of the nursing process is vital to a positive patient outcome. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. Reassessment may frequently be needed depending upon overall patient condition. The plan of care may be adapted based on new assessment data.

• Issues of Concern

According to a 2011 study conducted in Mekelle Zone hospitals, nurses lack the knowledge to implement the nursing process into practice and factors such as nurse-patient ratios inhibit them from doing so. Ninety percent of study participants lacked sufficient experience to apply the nursing process to standard practice. The study also concluded that a shortage of available resources, coupled with increased workloads due to high patient-nurse ratios, contributed to the lack of the nursing process implementation in the delivery of patient care. [6] [7] [8]

• Clinical Significance

The utilization of the nursing process to guide care is clinically significant going forward in this dynamic, complex world of patient care. Aging populations carry with them a multitude of health problems and inherent risks of missed opportunities to spot a life-altering condition.

As explored by Salmond and Echevarria, healthcare is changing, and the traditional roles of nurses are transforming to meet the demands of this new healthcare environment. Nurses are in a position to promote change and impact patient delivery care models in the future. [9] [10]

• Other Issues

Critical thinking skills will play a vital role as we develop plans of care for these patient populations with multiple comorbidities and embrace this challenging healthcare arena. Thus, the trend towards concept-based curriculum changes will assist us in the navigation of these uncharted waters. 

Concept-Based Curriculum

Baron further explores this need for a concept-based curriculum as opposed to the traditional educational model and the challenges faced with its implementation. A direct impact on quality patient care and positive outcomes. Nursing practice and educational environments form a bond with clinical knowledge and expertise, and that bond facilitates the transition into the current workforce as an indispensable team player and leader in this new wave of healthcare. 

Learning should be the focus and the integration into current practice. Learning is a dynamic process, propelled by a force that must coexist within the same learning milieu between educator and student, preceptor and novice, mentor, and trainee. 

IN the future, nurses must be able to problem-solve in a multitude of situations and conditions to meet these new adversities: challenging nurse-patient ratios, multifaceted approaches to prioritization of care, fewer resources, navigation of the electronic health record as well as functionality within the team dynamic and leadership style.

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Maslow's Hierarchy of Needs for Nursing Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN

Disclosure: Tammy Toney-Butler declares no relevant financial relationships with ineligible companies.

Disclosure: Jennifer Thayer declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Toney-Butler TJ, Thayer JM. Nursing Process. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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How to Write a Nursing Essay for a Nursing Class | Student's Guide

A nursing essay is a focused piece of writing that develops nursing-related ideas using evidence, analysis, and interpretation.

In most cases, the content and length of the nursing essay will depend on the level of study, course requirements, instructor preference, and the type of nursing specialization you are taking. Nevertheless, you will primarily write nursing essays, including persuasive, definition, descriptive, argumentative, reflective, and narrative essays.

The process of writing an essay on a nursing topic is the same as the typical essay writing process; it entails three stages ( pre-writing, writing, and post-writing phases ), each with its steps. Although nursing is a noble career, everyone confuses the process of being easy. Nevertheless, completing nursing essays for a nursing class can be challenging, especially if you don't have a structured approach. Not to worry, though!

In this writing guide, we walk you through the steps to take, the structure to adopt, the top tips to use, and some topics to consider when writing an academic nursing essay.

Types of Nursing Essays Nursing Students Write

If you are wondering what types of essays, you are likely to be assigned when in nursing college or when pursuing a nursing degree from a university, let's introduce you to some of them. Academic writing is an essential skill for nurses that they require attaining proficiency in their careers. And because it is a crucial part of the profession, you will be assigned to write different essays. Here are different writings that you will do in nursing school:

• Nursing School Essays. These are the essays or personal statements written before joining nursing school. It is written to show your zeal, passion, and determination to be a nurse. It includes "why nursing" essays, "why I want to become a nurse" essays, or "the noble nursing profession." These are written as part of the application process.
• Reflective Essays. Nursing reflective essays entail expressing your feelings, thoughts, and experiences about an event, such as a practicum, hospital experience, shadowing experience, research project, or study experience. You can use reflective frameworks such as the Johari window, Gibbs reflective model, Kolb's reflective model, Era Cycle, or Driscoll's what model. Your personal nursing philosophy paper is also written in a reflective tone.
• Nursing Scholarship Essays. These are essays written to explain to a scholarship-selection committee why you deserve a scholarship to study nursing or to advance your degree.
• Nursing case study analysis essays
• Descriptive essays. These essays describe a process, topic, or phenomenon of interest in nursing practice.
• Comparative Essays. These essays compare and contrast two things, places, processes, and objects. You can be asked to evaluate middle-range theories and compare disease intervention processes, articles, texts, or events.
• Persuasive Essays. These essays entail convincing the readers to adopt a certain viewpoint or take a specific action. For example, you can be asked to write a marijuana legalization essay or an essay on why nurses should be involved in disaster management.
• Expository Essays. Expository essays are five-paragraph essays that explain something or educate/inform the reader. For example, you could be asked to write an essay on the advantages of adopting electronic health systems, why nurses should advance their studies, how to address the nursing shortage, or the legislation and legal requirements to become a nurse.
• Narrative Essays. These are essays that tell a story from the perspective of an individual. For instance, you can narrate how you came to love nursing, your nursing philosophy, or your leadership philosophy.

Nursing Essay Writing Process

A typical nursing essay writing process takes three stages: prewriting, writing, and post-writing. Of course, this also applies when writing a nursing research paper or a case study, for that matter.

Note that the time, effort, and dedication required may differ depending on the essay's type, length, and scope.

For example, if you are assigned to write a 3–4-page essay analyzing a healthcare policy, most of your time will be consumed by research, planning, and writing. And if you are to write an essay on why you love nursing, you will most likely spend less time researching because you are writing it from your perspective. In a nutshell, the three stages entail:

Prewriting stage

• Unpacking the question
• Defining and refining the essay topic
• Creating a title
• Researching and gathering sources
• Developing a thesis statement
• Creating an outline

Writing Stage

• Crafting the introduction, body, and conclusion
• Fixing the in-text citations

Post writing stage

• Editing, revising, proofreading, formatting, and polishing the essay.
• Checking for plagiarism
• Submitting the essay on time

Pre-Writing Phase for writing a nursing essay

Before you start writing a nursing essay, you have to ensure that you are clear about what is required of you

Unpack or Dissect the Question

The first step in the process of writing a nursing assignment is to know the question. You can do this by reading the prompt in the portal (Blackboard or Canvas), email from the lecturer, or PowerPoint slide presentations from class.

Understanding the question helps you structure your approach, limit the scope of your research, and write a nursing paper addressing the prompt. You should look for pointers, signal words, or terms such as evaluate, elaborate, explore, discuss, examine, illustrate, compare and contrast, cause and effect, make a case, etc.

When you get it right from the onset, you can achieve the goal of your nursing essay, which is to demonstrate that you have a better grasp of theoretical concepts and research processes and can write a professionally written paper.

Select a suitable topic

In most cases, you will be given a topic to write about because nursing essays focus on the same issues, unlike other subjects.

 The field is leveled in nursing classes. Nevertheless, due to the differences in communities, states, and nationalities that nursing students come from, you might be allowed to select a topic on your own.

After selecting a suitable topic that is neither too broad nor too narrow, submit it for approval by your professor or nurse educator. Ideally, choose a topic that aligns with the course concepts, theories, and readings. For instance, if discussing healthcare determinants in a specific community, focus on a website such as HealthyPeople to get the facts right.

Use the determinants mentioned in class when benchmarking nursing practice and community experiences.

The same applies to other areas such as anatomy, pathophysiology, epidemiology, care planning, assessment, leadership, education, practice, state laws, advocacy, policy analysis, etc.

When choosing the topic, go for the one you are interested in. Probably select a topic that aligns with your future ambitions/specialization.

Related Article: Nursing Research Topics for Essays and Nursing Papers.

Focus your Research and Select Sources

Once you have a topic, you must research widely from credible nursing sources.

Develop an understanding of the topic, understand what nursing scholars are saying about the topic, and select potential nursing references for your paper.

You can use scholarly nursing databases such as PubMed, Medline, Embase, BMC, the Cochrane Library, or the JBI EBP database.

Limit your search to articles and journals published within the last five years unless you have to reference a seminal work that has not been updated through the years.

Develop your thesis

A common question students ask is whether nursing essays have thesis statements. The response is that, like any other essay, you should include a thesis that announces your central aim or idea.

Your thesis statement should be assertive, specific, arguable, precise, and demonstrative. It should round up the gist of your entire paper.  The topic, supporting, and concluding sentences depends on the thesis statement.

Outline your essay

After creating a reasonable and focused thesis statement, map out a rough structure of your essay. Mapping out your essay helps you understand what falls where and stay focused when writing.

The essay outline should have your title, hook statement, thesis statement, and topic sentences. You will be filling this outline in the next step when writing the paper.

Writing stage for the Nursing Essay

In the writing phase, you must focus on filling your outline with content. Follow the following steps.

Write the introduction first

By now, you have identified the direction you want your essay to take, depending on the structured approach you have selected to answer the prompt/question. The introduction of your essay sets the tone, direction, and scope of your essay. since it is the invitation for your readers and the first contact point, it should grab their attention and then inform them what is to come. The introduction should be 15-20% of the word count. It should entail:

• Hook – this is the first sentence in your nursing essay, and it should raise the curiosity of your readers and pique their interests. You can use a statistical, epidemiological, or surprising fact related to the topic. In most cases, when writing essays on disease, epidemiology, and disease processes, shocking statistical/epidemiological facts can do the work. For instance, if you are writing an essay on mental health or illness, state the portion of the affected national, international, regional, or state population.
• Background of the topic – the background is where you give the context that helps your readers understand your arguments. Provide an overview of the topic, the importance of the nursing topic, and if possible, explain the complicated terms.
• Thesis statement – state your thesis statement as stated in the outline. In addition, the thesis should signal your position on the topic.
• Signposting – this is where you map out the content of your essay by stating the content in each section. It is specifically applicable to longer essays.

Develop the body paragraphs

After writing the introduction, you need to write the body paragraphs of your nursing essay. The body is approximately 75-80% of your essay's word count.

It is where you make arguments, give examples, and provide evidence to support the thesis. You should present, analyze, interpret, and organize the sources when supporting your claims and arguments.

In terms of writing the paragraphs, ensure that each body paragraph has an outstanding topic sentence, supporting sentences, and concluding sentences.

 The first sentence is the topic sentence, which announces what the paragraph is about.

The supporting sentences are where you present the facts, information, and examples from scholarly sources. Make sure to cite the information to avoid plagiarism.

Also, have transition words to help you write an essay with a good flow of ideas.

In nursing, you can use AMA, APA, ASA, or Harvard formatting; ensure you stick to the respective rules.

Write the conclusion

 The conclusion is the final paragraph of your nursing essay. You should write it to include 10-15% of the word count of your essay. A strong nursing essay conclusion restates the thesis, ties together the main arguments, has a call to action, or provides a sense of closure to the readers.

It should have an impactful or memorable sentence that lets the reader develop a strong connection and have a positive impression.

Your conclusion should not have any new facts, concepts, or examples. Instead, it should summarize your essay.

If you have a nursing essay that has a concept map, you can hire a concept map writer from our website and fulfil your assignment on time. 

Tips to help you write better Nursing Essays

As we began by saying, writing nursing essays follows the same steps as the essays you have written before. Apart from mastering the citations and structure and following the above steps to write a powerful essay, you can use these tips to ensure that your paper meets the requirements for the top grades in the rubric.

• Make clarifications early enough . When assigned to write a nursing essay, start by reading the instructions and unpacking what is required of you. Then, if you have any questions, contact your nurse educator or professor early enough.
• Allocate adequate time to complete the paper. To write a top-grade nursing essay, you must allocate enough time to research, draft, edit, and polish your essay. Therefore, completing and submitting the essay before the deadline is advisable.
• Research widely . If you are going to write a winning essay, you need to support your ideas with facts and pieces of evidence. Extract this evidence and supporting facts from nursing databases. Use journals, nurse organization websites, and government websites to support your arguments.
• Write first and edit later . When writing the paper, focus on writing first so that all your attention is focused on writing a paper with a good flow of ideas. Then, you can save everything else for later when proofreading and editing to turn the paper into a final draft.
• Incorporate concepts and theories from class . Nursing studies entail the learning and applying of nursing concepts, theories, and practical experiences. Therefore, focus your paper on these theories based on class readings, discussion posts and responses, and experiences during practice.
• Organize your paper well . As you write the essay, think creatively. Remember to present your facts logically and support your arguments using relevant in-text citations.
• Check for plagiarism . Before submitting your paper, check if it has plagiarism. You can do so using free plagiarism checkers such as Plagscan or Grammarly.
• Format your paper well . Ensure that you format and structure your paper according to the formatting and citation styles highlighted in your essay prompt. If you are unsure, refer to the citation machines or websites.
• Hire someone to write . If you cannot write the essay, hire a good nursing essay writer to write a model nursing essay that can demonstrate how to approach your topic. Then, you can edit, use it as a guide, and write an essay that addresses the prompt.

Related: Writing a nursing diagnosis statement.

Writing a nursing essay helps you develop critical thinking, creativity, and decision-making skills. For instance, writing an essay that applies the clinical reasoning cycle or SBAR communication model will help you know how to apply such models in practice. Therefore, ensure that your nursing essay meets your nursing class's content, structural, theoretical constructs, quality improvement models, and facts.

Related Articles:

• How to write a nurse student resume with no experience.
• Nursing theories to consider for your essay.
• Reasons to join the WGU RN to BSN Program.
• Writing a perfect nursing diagnosis.
• Steps for writing a perfect nursing care plan.

When in nursing school, essay writing is a critical aspect. You can hire a nursing essay writer from our website if you are strapped for time to complete your essays. Our experts can craft high-quality essays on any nursing essay topic of your choice. All papers are written in the appropriate format: APA, Harvard, AMA, or ASA. Check out our entire nursing class help package and make a deal today!

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Concept of Nursing Diagnosis Essay (Critical Writing)

Sickle Cell Anemia is a disorder that normally increases blood thickness hence affects the smooth flow of blood. This is caused by the destruction of red cells where the normal shape of red cell becomes a stiff sickle shape. As a result, sufficient oxygen does not reach the vital organs.

A vaso-occlusive crisis arises from hindrance of blood circulation by sickle shaped blood cells. It is characterized by sturdy pains and in some cases; it may cause permanent organ damage. This paper seeks to formulate a nursing diagnosis, as well as a plan of care that includes nursing interventions and the methods to be used to evaluate whether the interventions are successful (American Sickle Cell Anemia Association, 2010).

Nursing diagnosis is a clinical assessment of health problems experienced by a family or an individual and their response to this health problem. It helps in determination of interventions that are to be put in place so as to realize the desired outcome. This diagnosis enables the nurse to come up with a care plan for the patient (National Institute of Health, 2002).

In this case, the nursing diagnosis is probably a sickle cell crisis and the possibility of shift in self perception that is linked to the notion of being different from peers. Outlined herein, are some of the interventions with their rationale and outcomes. Firstly, Maya and the family should be encouraged and helped to alternate the intervals of resting and activity. The rationale is that this could help their bodies reduce the demand for oxygen and hence reduce their hypoxia level.

Maya should also be assisted in taking deep breath movements and mild body turning exercises. The rationale behind procedure is that it promotes chest expansion, which boosts the circulations of secretions thus reducing the risks of blood clotting (Sickle Cell Disease Association of America, n.d.). The outcome is that the patient’s family will know the precautions to be taken and the strenuous activities to be avoided for them to keep fit.

Another intervention is to encourage Maya and her family to take sufficient fluids, like eight glasses per day. The rationale is to keep the body well hydrated to prevent or reduce viscosity of blood so as to have proper circulation. Here the outcome is that the concerned people will know the amount and the exact fluids to be taken (Hockenberry & Wilson, 2007, p. 648).

Another intervention is to monitor Maya’s respiratory rate, the rationale being indicators of sufficient respiratory process. There is also need for the nurse to be around several times in a day in order to monitor the patient’s cardiac regularity. Rationale: changes of cardiac rhythm could imply the effects of hypoxia on cardiovascular.

Also the nurse should analyze reports of chest pains and occurrence of fatigue. The rationale is the possibility of severe chest syndrome development. The outcome is that the people concerned will be given specialized treatment as it may be required (Hockenberry & Wilson, 2007, p. 658). More important, there is need for counseling as an intervention. This will help patient realize that he/she is not different from other children.

Having put up the necessary interventions, the next step is to evaluate whether they are successful. This could be done by observing and recording how the patient is responding to treatment. The question in mind should be, is the patient improving or deteriorating? If the patient is improving, then the nursing diagnosis should continue until full recovery.

In conclusion, nursing diagnosis coupled with medical diagnosis is an effective treatment of patients with sickle cell anemia. However, the choice of interventions should be done carefully so as to realize the desired outcome otherwise it may not be successful. Key among the interventions listed here, is counseling. This may help the patients to have hope and this may aid in quick recovery.

American Sickle Cell Anemia Association. (2010). Research . Web.

Hockenberry, M.J., & Wilson, D. (2007). Wong’s nursing care of infants and children (8th.ed.). New York: Mosby publishing group.

National Institute of Health. (2002). The management of sickle cell disease. Web.

Sickle Cell Disease Association of America. (n.d). Research and screening . Web.

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IvyPanda. (2018, October 12). Concept of Nursing Diagnosis. https://ivypanda.com/essays/nursing-diagnosis/

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1. IvyPanda . "Concept of Nursing Diagnosis." October 12, 2018. https://ivypanda.com/essays/nursing-diagnosis/.

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• Reduce Hospitalization of Nursing Home Residents

8 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans

Utilize this comprehensive nursing care plan and management guide to provide effective care for patients with chronic obstructive pulmonary disease (COPD). Gain valuable insights on nursing assessment , interventions, goals, and nursing diagnosis specifically tailored for COPD in this guide.

Table of Contents

What is chronic obstructive pulmonary disease (copd), nursing problem priorities, nursing assessment, nursing diagnosis, nursing goals, 1. maintaining patent airway clearance, 2. promoting effective gas exchange & oxygen therapy, 3. improving breathing pattern through breathing exercises, 4. administering medications and pharmacological support, 5. promoting infection control & preventing complications, 6. promoting optimal nutrition balance, 7. promoting rest and tolerance to activity, 8. providing patient education & health teachings, recommended resources, references and sources.

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. As with previous editions, the 2018 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) update seeks to provide comprehensive evidence-based guidelines for the diagnosis, management, and prevention of COPD (Mirza et al., 2018).

COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms of dyspnea , cough , sputum production, and exacerbations due to abnormalities of the airways such as bronchitis and/or alveoli that cause persistent, often progressive, airflow obstruction, such as in emphysema (Global Initiative for Chronic Obstructive Lung Disease, 2022).

COPD is a progressive disease that affects the lungs and is associated with chronic inflammation and abnormal inflammatory responses to harmful particles or gases. It leads to narrowing of the airways and changes in lung parenchyma and pulmonary vasculature. In the airways, there are increased mucus production, thickening of the airway wall, and overall narrowing. In the lung parenchyma, alveolar wall destruction and loss of elastic recoil occur. Imbalances of substances in the lung, such as proteinases, can further contribute to airflow limitation. These changes can be influenced by factors like chronic inflammation, environmental exposures, and genetic factors like alpha1-antitrypsin deficiency.

Asthma : Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle , hypersecretion of mucus, and edema . Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections.

Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum and marked cyanosis.

Emphysema: A most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping).

A diagnosis of COPD should be considered in any client who has dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections, and/or a history of exposure to risk factors for the disease, but forced spirometry showing the presence of a post- bronchodilator FEV1/FVC <0.7 is mandatory to establish the diagnosis of COPD (Global Initiative for Chronic Obstructive Lung Disease, 2022).

In the presence of an FEV1/FVC ratio <0.7, the assessment of airflow limitation severity in COPD is based on the post-bronchodilator value of FEV1. The GOLD Grades and Severity of Airflow Obstruction in COPD staging are as follows:

• GOLD 1: Mild (FEV1 >80% predicted)
• GOLD 2: Moderate (50% ≤ FEV1 <80% predicted)
• GOLD 3: Severe 30% ≤ FEV1 <50% predicted)
• GOLD 4: Very severe (FEV1 <30% predicted)

COPD results from gene(G)-environment(E) interactions occurring over the lifetime(T) of the individual (GETomics) that can damage the lungs and/or alter their normal development or aging processes. Appropriate and earlier diagnosis of COPD can have a very significant public-health impact.

Nursing care planning for clients diagnosed with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Most clients diagnosed with COPD receive outpatient treatment, and the nurse should develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease.

For a comprehensive pathophysiology, medical and surgical management, please visit the Chronic Obstructive Pulmonary Disease (COPD) nursing study guide

Nursing Care Plans & Management

Management of patients with COPD should be incorporated with teaching and improving the respiratory status of the patient.

The following are the nursing priorities for patients with COPD:

• Maintain airway patency.
• Assist with measures to facilitate gas exchange.
• Enhance nutritional intake.
• Prevent complications, slow progression of condition.
• Provide information about disease process/prognosis and treatment regimen.

COPD is a progressive disease characterized by chronic cough, sputum production, and worsening dyspnea. It can lead to weight loss and respiratory complications. Advanced stages may cause changes in the thorax and have systemic manifestations. Assessment and treatment of these symptoms are crucial for improving quality of life.

Assess for the following subjective and objective data:

• Difficulty breathing
• Changes in depth/rate of respirations, use of accessory muscles
• Abnormal breath sounds, e.g., wheezes, rhonchi, crackles
• Persistent cough, with/without sputum production
• Confusion, restlessness
• Inability to move secretions
• Abnormal ABG values (hypoxia and hypercapnia)
• Changes in vital signs
• Reduced tolerance for activity
• Wheezes/crackles on auscultation in both lung fields
• Subcostal retraction
• Nasal flaring
• Tachypnea, dyspnea
• Exertional dyspnea
• Shortness of breath
• Excessively increased or decreased respiratory rate

Assess for factors related to the cause of COPD:

• Bronchospasm
• Increased production of secretions; retained secretions; thick, viscous secretions
• Hyperplasia of bronchial walls
• Decreased energy/ fatigue
• Altered oxygen supply (obstruction of airways by secretions, bronchospasm; air-trapping)
• Alveoli destruction or capillary membrane changes
• Retained secretions
• Ineffective inspiration and expiration occurring with chronic airflow constraints
• Increased metabolic demands

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with COPD based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities. 

Goals and expected outcomes may include:

• The client will maintain clear and patent airways, demonstrating effective breath sounds and the ability to effectively cough and clear secretions.
• The client will achieve improved ventilation and optimal tissue oxygenation, as evidenced by ABG values within the normal range and the absence of respiratory distress symptoms.
• The client will demonstrate improved breathing patterns, maintaining a normal respiratory rate, and be free from cyanosis and other signs of hypoxia.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with COPD may include:

Common to many pulmonary diseases is bronchospasm which reduces the caliber of the small bronchi and may cause difficulty in breathing, stasis of secretions, and infection. Mucous gland hyperplasia is the histologic hallmark of chronic bronchitis. Airway structural changes include atrophy, focal squamous metaplasia, ciliary abnormalities, variable amounts of airway smooth muscle hyperplasia, inflammation, and bronchial wall thickening. These changes cause airflow limitation by allowing airway walls to deform and narrow the airway lumen (Mosenifar & Oppenheimer, 2022).

Assess and monitor respirations and breath sounds, noting rate and sounds (tachypnea, stridor, crackles, wheezes). Note the inspiratory and expiratory ratio. Tachypnea is usually present to some degree and may be pronounced on admission or during stress or concurrent acute infectious process. Respirations may be shallow and rapid, with prolonged expiration in comparison to inspiration. Wheezing can be frequently heard on forced and unforced expiration with diffusely decreased breath sounds. Additionally, coarse crackles beginning with inspiration may be heard (Mosenifar & Oppenheimer, 2022).

Auscultate breath sounds. Note adventitious breath sounds (wheezes, crackles, rhonchi). Some degree of bronchospasm is present with obstructions in the airway and may or may not be manifested in adventitious breath sounds such as scattered, moist crackles (bronchitis); faint sounds, with expiratory wheezes (emphysema); or absent breath sounds (severe asthma ). Inspiratory or expiratory wheezes and chest tightness are symptoms that may vary between days, and over the course of a single day. Alternatively, widespread inspiratory or expiratory wheezes can be present during auscultation (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Note the presence and degree of dyspnea for reports of “air hunger” or breathlessness . Respiratory dysfunction is variable depending on the underlying process such as infection, allergic reaction , and the stage of chronicity in a client with established COPD. Chronic dyspnea is the most characteristic symptom of COPD. A dyspnea questionnaire, the modified Medical Research Council (mMRC) dyspnea scale was the first questionnaire developed to measure breathlessness, which is a key symptom in many clients diagnosed with COPD, although it is often recognized (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Observe signs and symptoms of infections. Acute exacerbations of COPD are common and usually occur due to a trigger, such as bacterial or viral pneumonia or environmental irritants. There is an increase in inflammation and air trapping often requiring corticosteroid and bronchodilator treatment (Agarwal, 2022).

Monitor and graph serial ABGs , pulse oximetry, and chest x-ray . This establishes a baseline for monitoring the progression or regression of disease process complications. ABG analysis provides the best clues as to the acuteness and severity of disease exacerbation. Frontal and lateral chest radiographs of clients diagnosed with emphysema reveal signs of hyperinflation, including flattening of the diaphragm and increased retrosternal air space. And a long, narrow heart shadow. Chronic bronchitis is associated with increased bronchovascular markings and cardiomegaly (Mosenifar & Oppenheimer, 2022).

Observe for persistent, hacking, or moist cough. Chronic cough is often the first symptom of COPD and is frequently discounted by the client as an expected consequence of smoking and/or environmental exposures. Initially, the cough may be intermittent, but subsequently, it may be present every day, often throughout the day. Chronic cough in COPD may be productive or unproductive. In some cases, significant airflow obstruction may develop without the presence of a cough (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Educate the client regarding smoking cessation. A significant proportion of people with COPD continue to smoke despite knowing that they have a disease, and this behavior has a negative impact on the prognosis and progression of the disease. Smoking cessation has the greatest capacity to influence the natural history of COPD. If effective resources and time are dedicated to smoking cessation, long-term quit success rates of up to 25% can be achieved (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Provide an incentive spirometer for the measurement of airflow obstruction. Forced spirometry is the most reproducible and objective measurement of airflow obstruction. It is a non-invasive, reproducible, cheap, and readily available test. Good quality spirometry measurement is possible in any healthcare setting and all healthcare workers who care for people with COPD should have access to spirometry. The spirometry criterion for airflow obstruction selected by GOLD remains a post-bronchodilator ratio of FEV1/FVC <0.7 (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Assist the client to assume a position of comfort (elevate the head of the bed, have the client lean on an overbed table, or sit on edge of the bed). Elevation of the head of the bed facilitates respiratory function by use of gravity; however, the client in severe distress will seek the position that most eases breathing. Supporting arms and legs with a table, pillows, and so on helps reduce muscle fatigue and can aid chest expansion.

Keep environmental pollution to a minimum such as dust, smoke, and feather pillows, according to the individual situation. Precipitators of an allergic type of respiratory reaction that can trigger or exacerbate the onset of an acute episode. COPD does occur in individuals who have never smoked. In developing countries, the use of biomass fuels for indoor cooking and heating is likely to be a major contributor to the worldwide prevalence of COPD. Long-term exposure to traffic-related air pollution may be a factor in COPD clients with diabetes and asthma (Mosenifar & Oppenheimer, 2022).

Encourage abdominal or pursed-lip breathing exercises. This provides the client with some means to cope with or control dyspnea and reduce air trapping. Breathing exercises, as a self-management intervention strategy, are complex and diverse. They have been reported to not only effectively improve the strength and endurance of respiratory muscles and correct abnormal chest and abdomen movements but they also reduce dyspnea and pulmonary dynamic hyperinflation (Li et al., 2020).

Assist with measures to improve the effectiveness of cough effort. Cough can be persistent but ineffective, especially if the client is elderly, acutely ill, or debilitated. Coughing is most effective in an upright or in a head-down position after chest percussion. Effective or controlled coughing has just enough force to loosen and carry mucus through the airways without causing them to narrow and collapse. This saves energy for clients diagnosed with COPD (Cleveland Clinic, 2018).

Increase fluid intake to 3000 mL per day within cardiac tolerance. Provide warm or tepid liquids. Recommend the intake of fluids between, instead of during, meals. Hydration helps decrease the viscosity of secretions, facilitating expectoration. Using warm liquids may decrease bronchospasm. Fluids during meals can increase gastric distension and pressure on the diaphragm.

Demonstrate effective coughing and deep-breathing techniques. Not all coughs are effective in clearing excess mucus from the lungs. Explosive or uncontrolled coughing causes airways to collapse and spasm, trapping the mucus. To cough effectively, the client should be sitting on a chair and leaning forward slightly. Both arms should be folded across the abdomen and a slow inhalation through the nose is done. The client should cough two to three times through a slightly open mouth . Coughs should be short and sharp (Cleveland Clinic, 2018).

Assist the client to turn every two hours. If ambulatory, allow the client to ambulate as tolerated. Movement aids in mobilizing secretions to facilitate the clearing of airways. Aerobic activities such as walking can help improve cardiorespiratory fitness by strengthening large muscle groups in the body. Although exercise does not directly improve lung function, it can help strengthen the muscles which helps build up the client’s endurance level (Leader, 2022).

Suction secretions as needed. Suctioning clear secretions that obstruct the airway, therefore, improves oxygenation. Using bronchoscopy to remove sputum is an effective way during invasive ventilation in respiratory failure clients with advanced exacerbation of COPD. Study shows that bronchoscopy sputum suction presents more encouraging results than negative pressure suction with a low mortality rate (Qiao et al., 2018).

Demonstrate chest physiotherapies, such as bronchial tapping when in cough, and proper postural drainage. These techniques will prevent possible aspiration and prevent any untoward complications. Postural drainage and deep breathing-coughing exercises, which are part of the pulmonary rehabilitation program in the care and management of COPD, are effective in increasing oxygen saturation, triFlo volume, and pulmonary function tests (Arik & Cevik, 2021).

Administer medications as prescribed. See pharmacologic interventions below.

The quantity and viscosity of sputum can obstruct the airway and impair pulmonary ventilation and gas exchange. Emphysema is a pathologic diagnosis defined by the permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange. Furthermore, the loss of alveoli leads to airflow limitation by two mechanisms. First, the loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, the loss of alveolar supporting structure leads to airway narrowing, which further limits airflow (Mosenifar & Oppenheimer, 2022).

Assess and record respiratory rate, and depth. Note the use of accessory muscles, pursed-lip breathing, and inability to speak or converse. This is useful in evaluating the degree of respiratory distress or chronicity of the disease process. The respiratory rate increases in proportion to disease severity. The use of accessory respiratory muscles and the paradoxical indrawing of lower intercostal spaces is evident. This manifestation is known as the Hoover sign (Mosenifar & Oppenheimer, 2022).

Assess and routinely monitor skin and mucous membrane color. Cyanosis may be peripheral (noted in nail beds) or central (noted around lips/or earlobes). Duskiness and central cyanosis indicate advanced hypoxemia.  Clients diagnosed with chronic bronchitis are referred to as “blue bloaters” because the body responds to the disease by decreasing ventilation and increasing cardiac output. This ventilation/perfusion mismatch results in rapid circulation in a poorly ventilated lung, leading to hypoxemia and polycythemia. Eventually, hypercapnia and respiratory acidosis develop. With the ensuing hypoxemia and increased CO2 retention, the client takes on a bluish tint to the skin, earning them the name of “blue bloaters” (Mosenifar & Oppenheimer, 2022).

Monitor changes in the level of consciousness and mental status. Restlessness, agitation, and anxiety are common manifestations of hypoxia. Worsening ABGs accompanied by confusion / somnolence are indicative of cerebral dysfunction due to hypoxemia. Symptoms of depression and/or anxiety merit specific inquiry when obtaining the medical history because they are common in COPD, are associated with poorer health status, increased risk of exacerbations, and emergency hospital admissions, and are treatable (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Monitor vital signs and cardiac rhythm . Tachycardia, dysrhythmias, and changes in BP can reflect the effect of systemic hypoxemia on cardiac function. A client diagnosed with chronic bronchitis may have signs of right-sided heart failure such as edema and cyanosis. A client diagnosed with emphysema may have very distant heart sounds due to the gradual destruction of alveolar septae and pulmonary capillary bed, leading to a decreased ability to oxygenate the blood . This results in low cardiac output and relatively limited blood flow to the rest of the body (Mosenifar & Oppenheimer, 2022).

Auscultate breath sounds, noting areas of decreased airflow and adventitious sounds. Breath sounds may be faint because of decreased airflow or areas of consolidation. The presence of wheezes may indicate bronchospasm or retained secretions. Scattered moist crackles may indicate interstitial fluid or cardiac decompensation. An absence of wheezing or chest tightness does not exclude a diagnosis of COPD, nor does the presence of these symptoms confirm a diagnosis of asthma (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Palpate for fremitus. A decrease in vibratory tremors suggests fluid collection or air-trapping. Decreased intensity of tactile fremitus may occur as a result of excessive amounts of air in the lungs, known as hyperinflation. Hyperinflation is commonly seen in clients diagnosed with pulmonary emphysema, COPD, asthma, or severe airway obstruction (Hernández, 2022).

Monitor O 2 saturation and titrate oxygen to maintain Sp0 2 between 88% to 92%. A 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. However, pulse oximetry does not offer as much information as ABG analysis. But when combined with clinical observation, this test can be a powerful tool for instant feedback on the client’s status (Mosenifar & Oppenheimer, 2022).

Monitor arterial blood gas values as ordered. ABG analysis provides the best clues as to the acuteness and severity of disease exacerbation. As the client’s condition progresses, Pa02 usually decreases. A client with chronic carbon dioxide retention may have chronically compensated respiratory acidosis with a low normal pH and a PaCo2 higher than 50 mm Hg. Generally, renal compensation occurs even in chronic CO2 retainers; thus pH usually is near normal. Any pH below 7.3 should be generally considered a sign of acute respiratory compromise (Mosenifar & Oppenheimer, 2022).

Evaluate the client’s level of activity tolerance . Fatigue is the subjective feeling of tiredness or exhaustion and is one of the most common and distressing symptoms experienced by people diagnosed with COPD. Fatigue impacts the ability of the client to perform activities of daily living and their quality of life (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Assess the characteristics of sputum produced. Sputum production can be intermittent with periods of flare-up interspersed with periods of remission. COPD clients commonly raise small quantities of tenacious sputum with coughing. Clients producing large volumes of sputum may have underlying bronchiectasis. The presence of purulent sputum reflects an increase in inflammatory mediators, and its development may identify the onset of a bacterial exacerbation (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Encourage expectoration of sputum; suction when needed. Thick, tenacious, copious secretions are a major source of impaired gas exchange in small airways. Deep suctioning may be required when the cough is ineffective for the expectoration of secretions. In clients diagnosed with acute exacerbation of COPD, sputum accumulates in the lower airways and will inevitably cause severe respiratory obstruction, atelectasis, and pulmonary infection. However blind negative pressure aspiration can damage the airway mucosa and leave sputum in place, worsening the client’s condition. Removing sputum under bronchoscopy could allow the precise removal of all sputum while minimizing mucosa damage (Qiao et al., 2018).

Elevate the head of the bed, and assist the client to assume a position to ease the work of breathing. Include periods of time in a prone position as tolerated. Oxygen delivery may be improved by upright position and breathing exercises to decrease airway collapse, dyspnea, and work of breathing. Use of prone position to increase Pao 2 . A study found that there is a significant improvement in resistance in the prone position in infants and children with obstructive diseases. Prone positioning can be associated with lower resistance values and could have a role in the clinical management of highly obstructed clients as it reduces time constants of the respiratory system (Vendettuoli et al., 2014).

Encourage deep-slow or pursed-lip breathing as individually needed or tolerated. A study found that pursed lip breathing exercises increased oxygen saturation rates in clients diagnosed with moderate to severe COPD. Pulmonary rehabilitation includes physical education programs consisting of client education , psychosocial support, aerobic and empowering exercises, and breathing exercises. Collaborative self-management strategies such as performing regular breathing exercises can be effective in the early and appropriate treatment of COPD exacerbations (Arik & Cevik, 2021).

Provide a calm, quiet environment. Limit the client’s activity or encourage bed or chair rest during the acute phase. Have the client resume activity gradually and increase as individually tolerated. During severe, acute, or refractory respiratory distress, the client may be totally unable to perform basic self-care activities because of hypoxemia and dyspnea. Rest interspersed with care activities remains an important part of the treatment regimen. An exercise program is aimed at increasing endurance and strength without causing severe dyspnea and can enhance a sense of well-being.

Evaluate sleep patterns, note reports of difficulties, and whether the patient feels well rested. Limit stimulants such as caffeine. Multiple external stimuli and the presence of dyspnea may prevent relaxation and inhibit sleep . Poor sleep quality in COPD clients has been reported in various studies with prevalence ranging from 40% to 75%. COPD symptoms such as cough and dyspnea may be responsible for poor sleep quality. Alternatively, disturbed sleep can contribute to poor COPD-related outcomes (Shah et al., 2020). 

Provide humidified oxygen as ordered. Administering humidified oxygen prevents drying out the airways, decreases convective moisture losses, and improves compliance. Oxygen administration also reduces mortality rates in clients with advanced COPD because of the favorable effects on pulmonary hemodynamics. The continuous-flow nasal cannula is the standard means of oxygen delivery for the stable hypoxemic client. It is simple, reliable, and generally well-tolerated. Nasal oxygen delivery is also beneficial for most mouth-breathing clients (Mosenifar & Oppenheimer, 2022).

Administer noninvasive positive pressure ventilation (NIPPV) as ordered. The use of noninvasive positive pressure ventilation can decrease PacO2, increase blood pH, and minimize symptoms of severe dyspnea during the first 4 hours of the treatment.NIPPV allows the delivery of positive-pressure ventilation without the use of an endotracheal tube. In place of the tube is a tight-fitting nasal or facial mask that is attached to a continuous positive airway pressure (CPAP) or a bilevel positive airway pressure (BiPAP) machine (Mosenifar & Oppenheimer, 2022).

Refer the client to pulmonary rehabilitation. A systematic review of RCTs reported a reduction in mortality for clients who had pulmonary rehabilitation initiated during hospitalization or four weeks after discharge compared to those who didn’t have pulmonary rehabilitation. Pulmonary rehabilitation improves dyspnea, health status, and exercise tolerance in stable clients (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Assist with surgical procedures such as lung transplantation and lung volume reduction surgery (LVRS). In LVRS, 20 to 30% of each lung that appeared most diseased is resected. The investigators hypothesized that the removal of a portion of the emphysematous lung would increase radial traction on the airways in the remaining lung, thereby reducing symptoms by improving expiratory airflow and mechanical function. Several studies have demonstrated significant benefits in spirometry, exercise tolerance, dyspnea, health-related quality of life, and mortality in selected clients after LVRS. Clients with COPD are the largest single category of clients who undergo lung transplantation. Whether this procedure has any effect on the survival of clients with COPD is controversial; the main purpose of lung transplantation is to improve symptomatology and quality of life (Mosenifar & Oppenheimer, 2022).

Shortness of breath and ineffective breathing patterns are caused by ineffective respiratory mechanics of the chest wall and lungs resulting from air trapping, ineffective diaphragmatic movement, airway obstruction, the metabolic cost of breathing, and stress. COPD is characterized by expiratory airflow limitation and associated changes such as increased respiratory rate. In general, as metabolic demand increases, so do respiratory rates (Yentes et al., 2020).

Assess the client’s respiratory status every two to four hours as indicated and notify of any abnormal findings. Manifestations of respiratory distress include shortness of breath, tachypnea, changes in mental status and the use of accessory muscles. Chronic dyspnea is the most characteristic symptom of COPD. These symptoms may vary from day to day and may precede the development of airflow obstruction over many years. Airflow obstruction may be present without chronic dyspnea and/or cough and sputum production and vice versa (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Auscultate breath sounds as indicated. Decreased breath sounds, crackles, wheezes, and rhonchi can be observed and must be reported promptly for immediate treatment. A thoracic examination may reveal wheezing on forced and unforced expiration. In chronic bronchitis, coarse rhonchi and wheezing may be heard on auscultation. The chest may be hyper resonant in a client with emphysema, and wheezing may also be heard (Mosenifar & Oppenheimer, 2022). Ineffective breathing patterns and shortness of breath in COPD are caused by altered respiratory mechanics, including air trapping, ineffective diaphragmatic movement, airway obstruction, increased metabolic cost of breathing, and stress.

Monitor for a synchronous respiratory pattern when using a mechanical ventilator . Difficulty breathing with a ventilator or increasing airway pressures suggests worsening of the client’s condition and possibly a development of complications. In facilities with extensive noninvasive ventilation (NIPPV) experience, clients diagnosed with COPD can be considered for a trial of early extubation to NIPPV (Mosenifar & Oppenheimer, 2022).

Assess ventilator settings routinely and readjust, as indicated. Controls or settings are adjusted according to the client’s primary disease and results of diagnostic testing to maintain parameters within appropriate limits. Initially, non-invasive mechanical ventilation is started with low-pressure levels as IPAP 8 to 10 cm H2O and EPAP 4 to 5 cm H2O. According to the client’s clinical status, pressure levels can be increased (Ediboglu, 2021).

Elevate the client’s head of the bed. This provides adequate lung expansion while sleeping. Additionally, elevating the client’s head and helping the client get out of bed while still on a ventilator helps decrease the risk of aspiration and is psychologically beneficial. The prone position can be assumed to reduce resistance and improve breathing patterns, but only if it does not interfere with the client’s condition.

Instruct how to splint the chest wall with a pillow for comfort during coughing exercises as appropriate. This maneuver promotes physiological ease of maximal inspiration. During controlled coughing exercises, the client may also use both arms across the abdomen and breathe in slowly through the nose before coughing two or three times through a slightly open mouth (Cleveland Clinic, 2018).

Promote deep breathing exercises such as diaphragmatic breathing, yoga breathing, and pursed-lip breathing. It was found that pursed-lip breathing was usually selected to control sudden acute symptoms if the client had dyspnea when they were quiet or were experiencing anxiety, panic, and hot flashes. Yoga breathing, known as pranayama, is a real form of breathing training, which has many breathing patterns and specialized techniques to strengthen breathing exercises, such as deep breathing to the abdomen, and holding the breath in different parts of the respiratory cycle (Li et al., 2020).

Maintain a patent airway . Suctioning of secretions may be done as ordered. Bronchoscopy sputum suction shows encouraging results and a great advantage in various indicators, such as shortening the time of invasive ventilation and the length of hospital stay and improving the weaning success of clients on invasive mechanical ventilation (Qiao et al., 2018).

Check tubings for obstruction, kinking, or accumulation of water. Drain tubing as indicated. Kinks in the tubing prevent adequate volume delivery and increase airway pressure. Condensation in the tubing prevents proper gas distribution and predisposes the client to bacterial growth.

Encourage the client to participate in pulmonary rehabilitation. Pulmonary rehabilitation encompasses an array of therapeutic modalities designed to improve the client’s quality of life by decreasing airflow limitation, preventing secondary complications, and alleviating respiratory symptoms. This multidisciplinary approach emphasizes client and family education, smoking cessation, medical management, respiratory and chest physiotherapy, physical therapy with bronchopulmonary hygiene, exercise, vocational rehabilitation, and psychosocial support (Mosenifar & Oppenheimer, 2022).

Administer oxygen supplementation as indicated. Long-term oxygen therapy improves survival 2-fold or more in hypoxemic clients diagnosed with COPD, according to two landmark trials. Specialists recommend long-term oxygen therapy for clients with a PaO2 of less than 55 mm Hg, a PaO2 of less than 59 mm Hg with evidence of polycythemia, or cor pulmonale. Oxygen supplementation during exercise can also prevent increases in pulmonary artery pressure, reduce dyspnea, and improve exercise tolerance (Mosenifar & Oppenheimer, 2022).

Assist in starting the client in non-invasive mechanical ventilation. Non-invasive mechanical ventilation should be the first mode of ventilation used in COPD clients with acute respiratory failure who have no absolute contraindication because it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalization duration, and improves survival (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Administer medications as prescribed . See pharmacological interventions.

Medication regimens for managing COPD are tailored to the severity of the disease. Mild COPD may be treated with a short-acting bronchodilator. Moderate to severe COPD typically requires regular use of short-acting bronchodilators along with long-acting bronchodilators. Severe or very severe COPD may necessitate regular treatment with bronchodilators and/or inhaled corticosteroids to manage exacerbations effectively.

Bronchodilators Bronchodilators play a crucial role in managing COPD symptoms. They widen the airways, improve lung emptying, and alleviate bronchospasm. Inhaled therapy is preferred, and the choice of bronchodilator depends on individual response and side effects. Long-acting bronchodilators are more convenient and may be combined for optimal symptom management. While regular use of bronchodilators does not alter the progression or prognosis of COPD, they are central to its management. Various inhaler devices are available for drug delivery, and proper technique and training are essential. The choice of inhaler device depends on factors such as availability, cost, physician’s prescription, and patient skills. Bronchodilators may also be used prophylactically before activities to prevent breathlessness. Different classes of bronchodilators, including beta- adrenergic agonists , muscarinic antagonists, and combination agents, can be used in combination to enhance bronchodilation. Nebulized medications are an alternative for patients who cannot use inhalers effectively. Bronchodilators improve lung function, reduce hyperinflation, and enhance exercise performance in patients with COPD (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Antimuscarinic drugs Antimuscarinic drugs block the bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors expressed in the airway smooth muscles. Short-acting antimuscarinics (SAMAs), such as ipratropium and oxitropium, also block the inhibitory neural receptor M2, which potentially can cause vagally induced bronchoconstriction. Long-acting muscarinic antagonists (LAMAs), such as tiotropium, aclidinium, glycopyrronium bromide, and umeclidinium have prolonged binding to M3 receptors, with faster dissociation from M2 muscarinic receptors, thus prolonging the duration of bronchodilator effect (Global Initiative for Chronic Obstructive Lung Disease, 2022).

Mucolytics In clients with COPD, regular treatment with mucolytics such as carbocysteine and N-acetylcysteine may reduce exacerbations and modestly improve health status (Global Initiative for Chronic Obstructive Lung Disease, 2022). Mucolytic agents reduce sputum viscosity and improve secretion clearance. When used as an inhalational therapy, N-acetylcysteine should be administered with a bronchodilator in order to counteract the potential induction of bronchospasm (Mosenifar & Oppenheimer, 2022).

Oral corticosteroids such as prednisone and methylprednisolone. The use of oral steroids in the treatment of acute exacerbations is widely accepted and recommended, given their high efficacy. Corticosteroids may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity (Mosenifar & Oppenheimer, 2022).

Inhaled corticosteroids such as budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), beclomethasone (Qvar RediHaler), fluticasone (Flovent HFA) . In acute exacerbations, steroids improve symptoms and lung function. Inhaled corticosteroids provide a more direct route of administration to the airways and, similar to other inhaled agents, are only minimally absorbed. Inhaled steroids have fewer adverse effects than oral agents. These agents may be beneficial in slowing the rate of progression in a subset of clients with COPD who have rapid decline (Mosenifar & Oppenheimer, 2022).

Long-acting bronchodilators such as salmeterol, formoterol, bambuterol, and indacaterol . In clients with more persistent symptoms, a long-acting bronchodilator should be used. These agents increase exercise endurance, prevent nocturnal dyspnea, and improve quality of life. By relaxing the smooth muscles of the bronchioles, long-acting bronchodilators can relieve bronchospasms. The effect may also facilitate expectoration (Mosenifar & Oppenheimer, 2022).

Combination of inhaled corticosteroids and bronchodilators such as Symbicort  (budesonide combined with formoterol fumarate), Advair (fluticasone combined with salmeterol, Breo TM (fluticasone furoate combined with vilanterol trifenatate) . This combination of medications is known to be more effective than any single treatment in decreasing episodes of exacerbations and provides overall improvement of lung function. One disadvantage of their use is the increased risk of pneumonia . Inhaled corticosteroids (ICS) are often used in combination with long-acting bronchodilators (LABA) and long-acting muscarinic agents (LAMA) to decrease inflammation. A combination of ICS and LABA has been shown to be more beneficial than either of the drugs when used alone (Agarwal, 2022).

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. In clients diagnosed with COPD, chronic infection or colonization of the lower airways is common from S. pneumoniae , H. influenzae , and M. catarrhalis . In clients with chronic severe airway obstruction, P. aeruginosa infection may also be prevalent (Mosenifar & Oppenheimer, 2022).

Monitor temperature. Fever may be present because of infection or dehydration . Clients experiencing an exacerbation may have a low-grade fever , but the presence of a fever, especially >101.3°F (>38.5°C) should increase suspicion for an alternate diagnosis such as pneumonia .

Review the importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake. These activities promote the mobilization and expectoration of secretions to reduce the risk of developing a pulmonary infection. Many clients with COPD are unable to enjoy life to the fullest because of shortness of breath, physical limitations, and inactivity. Pulmonary rehabilitation encompasses an array of therapeutic modalities designed to improve the client’s quality of life (Mosenifar & Oppenheimer, 2022).

Observe the color, character, and odor of sputum. Odorous, yellow, or greenish secretions suggest the presence of pulmonary infection. Sputum color is a marker of neutrophilic inflammation and bacterial infection. The Bronkotest 5-point chart is a standardized method of classifying sputum color where 1 to 2 are white to light yellow and 3, 4, and 5 are increasingly purulent- greener colors indicate the presence of bacterial infection. In acute exacerbation of COPD, the presence of green sputum has a negative predictive value of 93%. This suggests a sputum color is a tool with the potential to reduce inappropriate antibiotic use with a low risk of harm (Channa et al., 2021).

Obtain sputum specimens by deep coughing or suctioning for Gram’s stain, culture, and sensitivity. This identifies the causative organism and susceptibility to various antimicrobials. A mixture of organisms often is visible with a Gram stain. The pathogens cultured most frequently during exacerbations are Streptococcus pneumoniae and Haemophilus influenzae (Mosenifar & Oppenheimer, 2022).

Monitor the effectiveness of antibiotic therapy. Signs of an improvement in condition should occur within 24 to 48 hours of therapy. Clients who benefited most from antibiotic therapy were those with exacerbations characterized by at least two of the following: increases in dyspnea, sputum production, and sputum purulence (Mosenifar & Oppenheimer, 2022).

Demonstrate and assist the client in the disposal of tissues and sputum. This prevents the spread of fluid-borne pathogens. Although the client may find expectoration offensive and attempt to limit or avoid it, it is essential that sputum be disposed of safely.

Limit visitors; provide masks as indicated. This reduces potential exposure to infectious illnesses such as upper respiratory infection (URI). Clients diagnosed with COPD have significant impairment of lung defense mechanisms , with the direct consequence of potentially pathogenic bacteria colonization in the bronchial tree (Hogea et al., 2019).

Stress proper hand hygiene to the client, staff, and family members. Hand hygiene is an effective means of reducing the spread or acquisition of the disease. Touching the eyes, nose, or mouth with the hands is the most common way of transmitting infectious organisms. When there is no access to soap and running water, a hand sanitizer is also a good option to perform hand hygiene. The CDC recommends using an alcohol-based hand sanitizer that contains at least 60% alcohol (American Lung Association, 2018).

Encourage a balance between activity and rest. This reduces oxygen consumption or demand imbalance, and improves the client’s resistance to infection, promoting healing. The client may use energy-saving strategies during activities of daily living because it not only facilitates the healing process and enhances natural resistance to disease; it also promotes an increase in self-efficacy and establishes the client’s self-competence (Gloeckl et al., 2018).

Discuss the need for adequate nutritional intake. Malnutrition can affect general well-being and lower resistance to disease. Targeted calorific food supplementation can have a beneficial effect on fat-free mass, especially in malnourished clients, and can furthermore improve physical performance ability, quality of life, and even lung function (Gloeckl et al., 2018).

Recommend rinsing the mouth with water and spitting, not swallowing, or using a spacer on the mouthpiece of inhaled corticosteroids. This reduces the localized immunosuppressive effect of the drug and the risk of oral candidiasis. Deposition of inhaled corticosteroids in the oropharyngeal cavity can cause oropharyngeal candidiasis. This occurs due to decreased local immunity involving inhibition of normal host defense functions at the oral mucosal surface or because of an increase in the salivary glucose level, which stimulates the growth of candida Albicans (Erdogan et al., 2019).

Administer antimicrobials as indicated. These agents may be given for specific organisms identified by culture and sensitivity, or be given prophylactically because of high risk. In a study, the addition of doxycycline to corticosteroids was found to somewhat improve the treatment for acute exacerbation of COPD. Empiric antimicrobial therapy is recommended in clients with an acute exacerbation and evidence of an infectious process, such as fever, leukocytosis, or an infiltrate on the chest radiograph. The antibiotic choice must be comprehensive and should cover all likely pathogens in the context of the clinical setting and local resistance patterns (Mosenifar & Oppenheimer, 2022).

Educate the client regarding vaccination to prevent infection. The injectable trivalent inactivated influenza vaccine is composed of seasonal H3N2, H1N1, and influenza B and is available each year as an annual dose. The trivalent influenza vaccine is effective in preventing hospitalizations and other serious outcomes (Ambrosino & Bertella, 2018). The pneumococcal vaccine should be offered to all clients older than 65 years or to clients of any age who have an FEV1 of less than 40% of predicted. The influenza vaccine should be given annually to all COPD clients (Mosenifar & Oppenheimer, 2022).

Promote smoking cessation and encourage the prevention of environmental pollution. Smoking is widely recognized as the major risk factor for COPD development and progression. Smokers have a faster decline in lung function and a higher mortality rate than non-smokers. Furthermore, the major pollutants shown to affect the respiratory system are represented by ozone, carbon monoxide, particulate matter, and sulfur dioxide. These pollutants could induce oxidative stress and inflammation, resulting in airway injury and dysfunction (Hogea et al., 2019).

The status of nutrition and counseling are essential aspects of the rehabilitation process for clients diagnosed with COPD. Most people with COPD have difficulty gaining and maintaining weight. Recent studies have estimated that 25 to 40% of COPD clients are underweight while 35% of clients have a severely low fat-free mass index. Fat-free mass is associated with muscle mass, and if it is low, it can negatively impact exercise ability and muscle function. As the prevalence of malnutrition appears to be high in COPD clients, better recognition is required in order to optimize management (Keogh & Williams, 2021).

Ascertain understanding of individual nutritional needs. This determines the informational needs of the client and significant others. Nutritional requirements for COPD clients should be assessed individually considering the client’s clinical state (stable or exacerbation) and disease severity (mild, moderate, severe, very severe) as well as their activity levels (Collins et al., 2019).

Assess the client’s socioeconomic status. In a study, COPD clients usually have low social status according to average income and education level parameters all over the world (Mete et al., 2018). Additionally, smokers in low-income countries tend to purchase less food due to tobacco expenditure, and the food they do purchase seems to be of lower quality adversely affecting their nutrition status (Nguyen et al., 2019).

Assess dietary habits and recent food intake. Note the degree of difficulty with eating. Evaluate weight and body size (mass). A client in acute respiratory distress is often anorectic because of dyspnea, sputum production, and medications. In addition, many COPD clients habitually eat poorly, even though respiratory insufficiency creates a hypermetabolic state with increased caloric needs. As a result, the client often is admitted with some degree of malnutrition. People who have emphysema are often thin with wasted musculature.

Auscultate bowel sounds. Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation (a common complication) related to limited fluid intake, poor food choices, decreased activity, and hypoxemia. It was shown that 40% of clients with stable COPD reported constipation and abdominal distention symptoms(Gau et al., 2015).

Weigh the client daily as indicated. This is useful in determining caloric needs, setting a weight goal, and evaluating the adequacy of a nutritional plan. A study about weight loss in COPD showed that most participants experienced weight loss and on average they lost 1.6 kg in the previous six months. Severely malnourished participants experienced greater weight loss than those who were mildly malnourished or well-nourished (Nguyen et al., 2019).

Give frequent oral care, remove expectorated secretions promptly, and provide a specific container for the disposal of secretions and tissues. Noxious taste , smell, and sights are prime deterrents to appetite and can produce nausea and vomiting with increased respiratory difficulty. In a study, clients admitted due to COPD had poorer periodontal health, a higher prevalence of gingival inflammations, and lower tooth brushing frequency. It is the responsibility of healthcare providers to help maintain oral health in individuals and to assist those with poor oral health habits to improve them (Pedersen et al., 2022).

Instruct the client to frequently eat high-caloric foods in smaller portions. COPD clients expend an extraordinary amount of energy simply on breathing and require high-caloric meals to maintain body weight and muscle mass. Recent recommendations in relation to protein requirements and aging suggest a daily intake of 1.0 to 1.2 g protein/kg body weight/day. For older individuals who are malnourished or those with a chronic disease, the recommended intake is 1.2 to 1.5 g protein/kg body weight/day (Collins et al., 2019).

Encourage a rest period of one hour before and after meals. With a decreased dietary intake and increased energy expenditure, COPD is often associated with muscle depletion that is caused by the increased rate of protein degradation and decreased rate of protein synthesis (Nguyen et al., 2019). Providing a rest period before and after meals helps reduce fatigue during mealtime and provides an opportunity to increase total caloric intake. 

Avoid gas-producing foods such as carbonated beverages. This can produce abdominal distension, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea. A full or bloated abdomen can make breathing uncomfortable. Foods that cause gas include carbonated beverages; fried, greasy, or heavily spiced foods; fruits such as apples and melons; and vegetables such as broccoli, beans, and cauliflower (Cleveland Clinic, 2018).

Instruct the client to increase fluid intake (2.5 liters per day or more) as indicated. Avoid caffeine and tea. Fluids aids in decreasing the viscosity of secretions for patients with chronically increased production of sputum. Drinking at least six to eight glasses of water daily as tolerated may aid the client in mobilizing secretions and expectorating them. Coffee and tea should be limited or avoided because they could interfere with some medications (Cleveland Clinic, 2018).

Educate the client about the effects of smoking on malnutrition risk and encourage smoking cessation. Smoking has been identified as a factor influencing malnutrition risk. Previous studies reveal that nicotine in tobacco affects body weight by increasing metabolic rate, decreasing metabolic efficiency through the release of hormones that influence appetite or reduce eating, and decreasing energy absorption, thereby facilitating weight loss. Thus, the longer and more severe the addiction to tobacco, the higher risk of malnutrition. This raises an urgent need for public health efforts to reduce smoking rates and the inclusion of smoking cessation advice during the early stages of COPD diagnosis that should be repeated routinely parallel with nutrition counseling sessions (Nguyen et al., 2019).

Encourage the client to engage in physical activities appropriate for their health condition. Daily physical activity of clients diagnosed with COPD is reduced in the early phases of the disease as compared with health age-matched controls and worsens over time, with important clinical consequences. Moderate-to-high levels of regular physical activity are associated with reduced lung function decline and exacerbations in clients with COPD, and a reduced risk of developing COPD among smokers. Monitoring daily step count and activity time is the most valid measurement of physical activity and may benefit clients in achieving effective daily physical activity (Ambrosino & Bertella, 2018).

Collaborate with a dietician as indicated. The dietician can provide nutritional assessment and counseling applicable to clients diagnosed with COPD. They may also facilitate the initiation of enteral nutrition in those who are intubated or who cannot tolerate oral feeding . The method of feeding and caloric requirements are based on the client’s situation and specific needs to provide maximal nutrients with minimal client effort and energy expenditure.

Administer vitamin supplements as indicated. Several vitamins are able to exert potent anti-inflammatory and antioxidant effects, such as vitamins A, C, and E, which are likely to be protective in the progression of COPD. Vitamin E 400 IU daily for 12 weeks has been found to reduce lipid peroxidation in COPD and supplementation with vitamin A resulted in improvements in forced expiratory volume in one second and forced vital capacity. Given the prevalence of osteoporosis in COPD, vitamin D status also appears to be important due to low intake, limited sun exposure, and reduced pre-vitamin D production associated with skin aging. Vitamin D has also been found to reduce exacerbation rates in COPD (Collins et al., 2019).

Administer supplemental oxygen during meals as indicated. Oxygen supplementation decreases dyspnea and increases energy for eating, enhancing intake. The client may wear their nasal cannula while eating. Eating and digestion require energy, therefore, the body needs oxygen. 

Clients diagnosed with COPD experience progressive activity and exercise intolerance. Evaluation of the client’s activity tolerance and limitations helps create strategies to promote independent ADLs.

Assess the client’s respiratory response to the activity which includes monitoring of respiratory rate and depth, oxygen saturation, and use of accessory muscles for respiration. Clients diagnosed with COPD can experience hypoxia during increased activity and may need oxygenation to avoid hypoxemia which puts them at risk for exacerbations of the condition. Many clients with COPD who are not hypoxemic at rest worsen during exertion. Home supplemental oxygen is commonly prescribed for these clients (Mosenifar & Oppenheimer, 2022).

Assess the client’s nutritional status. Adequate energy reserves are needed during activity. The important role of muscle wasting and decreased muscle oxidative metabolism in impaired physical performance and mortality of clients with COPD has been demonstrated, providing new evidence for nutritional supplementation as an adjunct to exercise training, not only in advanced disease but also in the earlier stages of the disease (Ambrosino & Bertella, 2018).

Assess the level of activity that the client achieves before physical exertion. Daily physical activity of clients with COPD is reduced in the early phases of the disease as compared with healthy age-matched controls and worsens over time, with important clinical consequences (Ambrosino & Bertella, 2018).

Elevate the client’s head of the bed and instruct them to slowly change position. Elevating the head of the bed enhances lung expansion to maximize oxygenation. Postural hypotension or cerebral hypoxia may cause dizziness, fainting, and increased risk of injury; therefore, it is essential for the nurse to advise the client to make slow position changes to avoid these risks.

Maintain prescribed activity levels. This helps in building tolerance and minimizing episodes of dyspnea. Moderate-to-high levels of regular physical activity are associated with reduced lung function decline and a reduced risk of developing COPD among smokers. Focusing on light physical activity might be a potential strategy to make the client less sedentary. The benefits of a low-intensity intervention may be limited to clients with moderate airway obstruction (Ambrosino & Bertella, 2018).

Plan activity progression with the client, including activities that the client views as essential. Increase the client’s activity levels as tolerated. This will promote a gradual return to normal activity levels and improved muscle tone and stamina without undue fatigue as much as possible. Being able to perform at a normal level also increases the client’s self-esteem and sense of control.

Provide at least 90 minutes of undisturbed rest in between activities. Allotment of undisturbed rest reduces the demand for oxygen and allows adequate physiologic recovery. Clients with COPD suffer from pronounced ventilatory limitation, impaired maximal oxygen uptake and energy expenditure, and related symptoms, most commonly dyspnea. These result in severe limitations of exercise capacity, which seriously affects a person’s ability to perform activities of daily living (Karger, 2020).

Teach and assist the client with active ROM exercises. Active ROM exercises may aid in building stamina and avoiding complications of limited mobility . Exercise training is a mandatory component of pulmonary rehabilitation. Clients with COPD should perform aerobic lower extremity endurance exercises regularly to enhance the performance of daily activities and reduce dyspnea. Upper extremity exercise training improves dyspnea and allows increased activities of daily living requiring the use of upper extremities (Mosenifar & Oppenheimer, 2022).

Instruct the client with energy conservation techniques, such as placing frequently used items within easy reach, sitting to do tasks, frequent position changes, and working at an even pace. These techniques reduce oxygen consumption, allowing a more prolonged activity. Performing daily activities while spending as little energy as possible is to be recommended for these clients. The less energy spent on each activity, the more tasks the client is able to perform throughout the day. Energy conservation techniques specifically aim at performing ADL with reduced energy expenditure (Karger, 2020).

Teach the client about exercises that enhance breathing capacity such as diaphragmatic and pursed-lip breathing. These techniques prolong the exhalation period which can decrease the retention of carbon dioxide. Breathing retraining techniques may improve the ventilatory pattern and prevent dynamic airway compression (Mosenifar & Oppenheimer, 2022).

Suggest performing a six-minute walking distance to the client. The distance walked in six minutes (6MWD) is a good predictor of all-cause and respiratory mortality in clients with moderate COPD. Clients diagnosed with COPD who desaturate during 6MWD have a higher mortality rate than those who do not desaturate (Mosenifar & Oppenheimer, 2022).

If needed, assist the client with a referral to a pulmonary rehabilitation program. This program allows the client to learn about nutrition, breathing, and relaxation techniques, medication education, avoiding exacerbations, and ways how to live better while having COPD. A systematic review reported a reduction in mortality for clients who had pulmonary rehabilitation initiated during hospitalization or four weeks after discharge compared to those who didn’t have pulmonary rehabilitation. Pulmonary rehabilitation also leads to a reduction in symptoms of anxiety and depression.

Administer supplemental oxygen as indicated. The long-term administration of oxygen increases survival in clients with severe chronic resting arterial hypoxemia. In clients with stable COPD and moderate resting or exercise-induced arterial desaturation, prescription of long-term oxygen does not lengthen the time to death or first hospitalization or provide sustained benefit in health status, lung function, and a six-minute walk distance.

Once diagnosed, the client would need lifelong treatment and daily management. Especially during the stable period, the client’s self-management behavior would be crucial for halting the progression of the disease. Clients with the lowest socioeconomic status are at least twice as likely to have poor outcomes as those of the highest. Therefore, it is crucial to address the educational deficiency and low health literacy skills in disease management programs, since it has been shown that adequate client education improves health-related quality of life and decreases the hospital admissions of COPD clients (Yang et al., 2019).

Assess the client’s and caregivers ’ educational level and cognitive ability. In a study, the lowest score was observed for information management. This could be due to the fact that COPD clients were mostly older adult clients with low education levels and low levels of literacy. Furthermore, they have limited reading proficiency and access to the internet. Hence, they are unable to take advantage of a large amount of information from the Internet and books. Therefore, hospitals and communities should work to increase the spread of COPD-related knowledge through other channels (Yang et al., 2019).

Assess the client’s knowledge about the disease. The knowledge of the client about the disease is a key factor in determining the behavior of the client toward self-management. The more knowledge they acquire, the more they are likely to make decisions that are beneficial for their health (Yang et al., 2019).

Identify individual factors that may trigger or aggravate conditions (excessively dry air, wind, environmental temperature extremes, pollen, tobacco smoke, aerosol sprays, and air pollution). These environmental factors can induce or aggravate bronchial irritation, leading to increased secretion production and airway blockage. COPD also does occur in individuals who have never smoked. Long-term exposure to traffic-related air pollution may be a factor in COPD in clients with diabetes and asthma (Mosenifar & Oppenheimer, 2022).

Discuss the importance of medical follow-up care, periodic chest x-rays, and sputum cultures. Monitoring the disease process allows for alterations in the therapeutic regimen to meet changing needs and may help prevent complications. A client with a severe or unstable disease should be seen monthly. When their condition is stable, the client can be seen biannually (Mosenifar & Oppenheimer, 2022).

Explain and reinforce explanations of the individual disease process. Information decreases anxiety and can lead to improved participation in the treatment plan. Health education and nursing interventions focused on improving the level of knowledge in COPD clients may be necessary to help the client establish good self-management behavior, in order to potentially reduce the exacerbation rate and complication rate, and improve the quality of life and psychosocial well-being of COPD clients (Yang et al., 2019).

Encourage the client and caregivers to explore ways to control triggering factors in and around the home and work setting. It is important to educate the client, as well as the caregivers or family members, and to encourage their active participation in therapy. The two most essential points for the client to understand are that the dangers of smoking and the improvement in quality of life are attainable with smoking cessation and the need to seek medical care early during an exacerbation and not wait until they are in distress is imperative (Mosenifar & Oppenheimer, 2022).

Instruct and reinforce the rationale for pulmonary rehabilitation, such as breathing exercises, coughing effectively, and general conditioning exercises. Pursed-lip and abdominal or diaphragmatic breathing exercises strengthen muscles of respiration, help minimize the collapse of small airways, and provide the individual with means to control dyspnea. General conditioning exercises increase activity tolerance, muscle strength, and a sense of well-being. As a result of rehabilitation, improvements have been shown in objective measures of clients’ quality of life, well-being, and health status, including a reduction in respiratory symptoms, increase in exercise tolerance and functional activities, reduction in anxiety and depression, and increase in feelings of control and self-esteem (Mosenifar & Oppenheimer, 2022).

Stress the importance of oral care and dental hygiene. Multiple defense mechanisms operate within the healthy respiratory tract to eliminate aspirated bacteria, but their effectiveness can be impaired by a variety of conditions such as malnutrition, smoking, COPD, diabetes, or the use of corticosteroids (Pedersen et al., 2022). Proper oral care decreases bacterial growth in the mouth, which can lead to pulmonary infections. There is a general association between oral microorganisms and respiratory tract infections. 

Discuss the importance of avoiding people with active respiratory infections. Stress need for routine influenza and pneumococcal vaccinations. Infections can lead to COPD exacerbations. Vaccinations are a safe and effective modality to reduce infections in susceptible COPD clients. The pneumococcal vaccine should be offered to all clients older than 65 years or to clients of any age who have an FEV1 of less than 40% of predicted. The influenza vaccine should be given annually to all COPD clients (Mosenifar & Oppenheimer, 2022).

Review the harmful effects of smoking, and advise cessation of smoking by the client and caregivers. Cessation of smoking may slow or halt the progression of COPD. Even when the client wants to stop smoking, support groups and medical monitoring may be needed. Note: Research studies suggest that “side-stream” or “second-hand” smoke can be as detrimental as actually smoking. Nicotine replacement therapies after smoking cessation reduce withdrawal symptoms. Nicotine Polacrilex (Nicorette, Nicorette Plus) is a pack of chewing gum and has a better quit rate than counseling alone. Transdermal nicotine patches are readily available for replacement therapy with long-term success rates of 22 to 42% (Mosenifar & Oppenheimer, 2022).

Provide information about activity limitations and alternating activities with rest periods to prevent fatigue; ways to conserve energy during activities (pulling instead of pushing, sitting instead of standing while performing tasks); use of pursed-lip breathing, side-lying position, and the possible need for supplemental oxygen during sexual activity. Having this knowledge can enable clients to make informed choices or decisions to reduce dyspnea, maximize activity levels, perform the most desired activities, and prevent complications. Upper extremity exercise training improves dyspnea and allows increased activities of daily living requiring the use of upper extremities (Mosenifar & Oppenheimer, 2022).

Instruct the asthmatic client in the use of a peak flow meter, as appropriate. Peak flow level can drop before the client exhibits any signs and symptoms of asthma during the “first time” after exposure to a trigger. Regular use of the peak flow meter may reduce the severity of the attack because of earlier intervention. A peak flow meter with few symptom questions can be effectively used in clinical practice for objective detection of asthma and COPD, in the absence of good-quality spirometry. Peak flow meter and a questionnaire are inexpensive, handy, easy to use, and less time-consuming, and are likely to receive larger acceptance than spirometry and may have a significant effect in improving diagnosis (Thorat et al., 2017).

Discuss respiratory medications, side effects, and adverse reactions. Frequently these clients are simultaneously on several respiratory drugs that have similar side effects and potential drug interactions. It is important that the client understands the difference between nuisance side effects (medication continued) and untoward or adverse side effects (medication possibly discontinued or dosage changed).

Demonstrate techniques for using a metered-dose inhaler (MDI), such as how to hold it, taking two to five minutes between puffs, and cleaning the inhaler. Proper administration of drugs enhances delivery and effectiveness. It is essential to provide instructions and to demonstrate the proper technique when prescribing a device, to ensure that the inhaler technique is adequate, and recheck at each visit that the client continues to use their inhaler correctly (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2022).

Devise a system for recording prescribed intermittent drug and inhaler usage. Having a system reduces the risk of improper use and overdosage of as-needed medications, especially during acute exacerbations, when cognition may be impaired. In a study, tools for ensuring medications were taken included the use of logs or diaries to track when medications were administered. Incorporating medication into the morning routine helped some. Others rely on visual cues, choosing to store inhalers in specific locations as they are used during the day (O’Toole et al., 2022).

Recommend avoidance of sedative antianxiety agents unless specifically prescribed or approved by the healthcare provider treating a respiratory condition. Although the client may be nervous and feel the need for sedatives, these can depress respiratory drive and protective cough mechanisms. Note: These drugs may be used prophylactically when the client is unable to avoid situations known to increase stress or trigger a respiratory response.

Discuss the use of herbal medications, especially when the client is on multiple respiratory medications. Many interactions can occur between herbal medications and agents used to treat respiratory disorders. Although most herbals do not have dangerous side effects, effects can be dangerous or lethal if combined with other substances or when taken in larger doses. Herbs, such as ephedra, should be used in very small doses and for a short time. Echinacea can alter the actions of a variety of drugs and is not recommended for persons with HIV , multiple sclerosis , and other autoimmune diseases.

Review oxygen requirements and dosage for a client who is discharged on supplemental oxygen. Discuss the safe use of oxygen and refer to the supplier as indicated. This reduces the risk of misuse (too little or too much) and resultant complications and promotes environmental and physical safety. Oxygen therapy is generally safe. Little is known about the long-term effects of low-flow oxygen. However, the increased survival and quality-of-life benefits of long-term oxygen therapy outweigh the possible risks of oxygen toxicity (Mosenifar & Oppenheimer, 2022).

Instruct the client and caregivers in the use of non-invasive positive pressure ventilation (NIPPV) as appropriate. Problem-solve possible side effects and identify adverse signs and symptoms  (increased dyspnea, fatigue, daytime drowsiness, or headaches on awakening). Non-invasive positive pressure ventilation (NIPPV) may be used at night or periodically during the day to decrease CO 2 levels, improve the quality of sleep, and enhance functional levels during the day. Signs of increasing CO 2 levels indicate the need for more aggressive therapy. The positive pressure is beneficial in hypercapnic respiratory failure by decreasing the work of breathing, allowing a larger tidal volume for a given respiratory effort, and hence improving alveolar ventilation (Mosenifar & Oppenheimer, 2022).

Provide information and encourage participation in support groups (American Lung Association, public health department). These clients and their caregivers may experience anxiety, depression, and other reactions as they deal with a chronic disease that has an impact on their desired lifestyle. Support groups or home visits may be desired or needed to provide assistance, emotional support, and respite care.

Refer for evaluation of home care if indicated.  Provide a detailed plan of care and baseline physical assessment to the home care nurse as needed on discharge from acute care. This provides for continuity of care and may help reduce the frequency of rehospitalization. Education self-management with the support of a case manager with or without the use of a written action plan is recommended for the prevention of exacerbation complications such as hospital admissions (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2022).

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other nursing care plans related to respiratory system disorders:

• Aspiration Risk & Aspiration Pneumonia
• Airway Clearance Therapy & Coughing
• Bronchiolitis
• Bronchopulmonary Dysplasia (BPD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Cystic Fibrosis
• Hemothorax and Pneumothorax
• Influenza (Flu)
• Ineffective Breathing Pattern (Dyspnea)
• Impairment of Gas Exchange
• Lung Cancer
• Mechanical Ventilation
• Near-Drowning
• Pleural Effusion
• Pulmonary Embolism
• Pulmonary Tuberculosis
• Tracheostomy

References and recommended sources for this care plan guide for Chronic Obstructive Pulmonary Disease (COPD):

• Agarwal, A. (2022, August 8). Chronic Obstructive Pulmonary Disease – StatPearls . NCBI. Retrieved November 15, 2022.
• Ambrosino, N., & Bertella, E. (2018, September). Lifestyle interventions in prevention and comprehensive management of COPD. Breathe , 14 (3).
• American Lung Association. (2018, December 4). Clean Hands, Healthy Lungs . American Lung Association. Retrieved November 20, 2022.
• Arik, S., & Cevik, K. (2021, December). Effect of Postural Drainage and Deep Breathing-Cough Exercises on Oxygen Saturation, Triflo Volume and Pulmonary Function Test in Patients with COPD. Journal of Clinical and Experimental Investigations , 12 (4).
• Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier.
• Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins.
• Carlson, M. L., Ivnik, M. A., Dierkhising, R. A., O’Byrne, M. M., & Vickers, K. S. (2006). A learning needs assessment of patients with COPD. Medsurg Nursing , 15 (4).
• Channa, S., Gale, N., Lai, E., Hall, L., Quinn, M., & Turner, A. M. (2021, March). Colour vision deficiency and sputum colour charts in COPD patients: an exploratory mixed-method study. Primary Care Respiratory Medicine , 31 (13).
• Cleveland Clinic. (2018, September 14). Controlled Coughing for COPD Patients . Cleveland Clinic. Retrieved November 15, 2022.
• Cleveland Clinic. (2018, September 14). COPD: Nutrition Tips, How to Boost Appetite . Cleveland Clinic. Retrieved November 20, 2022.
• Collins, P. F., Yang, I. A., Chang, Y.-C., & Vaughan, A. (2019, October 17). Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update . NCBI. Retrieved November 20, 2022.
• Ediboglu, O. (2021). Mechanical Ventilation for Patients with COPD. In Chronic Obstructive Pulmonary Disease-A Current Conspectus . IntechOpen.
• Erdogan, T., Karakaya, G., & Kalyoncu, A. F. (2019, January 31). The Frequency and Risk Factors for Oropharyngeal Candidiasis in Adult Asthma Patients Using Inhaled Corticosteroids . NCBI. Retrieved November 20, 2022.
• Gau, J.-T., Acharya, U. H., Khan, M. S., & Kao, T.-C. (2015, April 10). Risk factors associated with lower defecation frequency in hospitalized older adults: a case-control study . NCBI. Retrieved November 20, 2022.
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2022). Global Initiative for Chronic Obstructive Lung Disease Pocket Guide to COPD Diagnosis, Management, and Prevention . Global Initiative for Chronic Obstructive Lung Disease (GOLD).
• Gloeckl, R., Schneeberger, T., Jarosch, I., & Kenn, K. (2018, February 23). Pulmonary Rehabilitation and Exercise Training in Chronic Obstructive Pulmonary Disease . NCBI. Retrieved November 20, 2022.
• Hernández, A. (2022). Tactile Fremitus: What Is It, How Is It Assessed, Uses, and More . Osmosis . Retrieved November 16, 2022.
• Hogea, S.-P., Tudorache, E., Fildan, A. P., Fira-Mladinescu, O., Marc, M., & Oancea, C. (2019, December 08). Risk factors of chronic obstructive pulmonary disease exacerbations. The Clinical Respiratory Journal , 14 (3), 183-197.
• Karger, S. (2020, April 9). Effectiveness of Energy Conservation Techniques in Patients with COPD . NCBI. Retrieved November 21, 2022.
• Keogh, E., & Williams, E. M. (2021, January). Managing malnutrition in COPD: A review. Respiratory Medicine , 176 .
• Leader, D. (2022, February 24). The Benefits of Walking for People With COPD . Verywell Health. Retrieved November 15, 2022.
• Li, J., Liu, W., Ding, X., Wang, W., & Li, K. (2020, December 08). Breathing exercises in people with COPD: A realist review. Journal of Advanced Nursing , 77 (4), 1698-1715.
• Mete, B., Pehlivan, E., Gülbas, G., & Günen, H. (2018, October 11). Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity . NCBI. Retrieved November 20, 2022.
• Mirza, S., Clay, R. D., Koslow, M. A., & Scanlon, P. D. (2018, October). COPD Guidelines: A Review of the 2018 GOLD Report. Mayo Clinic Proceedings , 93 (10), 1488-1502.
• Moorhouse, M. F., Murr, A. C., & Doenges, M. E. (2010). Nursing Care Plans : Guidelines for Individualizing Client Care Across the Life Span . F.A. Davis Company.
• Mosenifar, Z., & Oppenheimer, J. J. (2022, June 3). Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology . Medscape Reference. Retrieved November 15, 2022.
• Nguyen, H. T., Collins, P. F., Pavey, T. G., Nguyen, N. V., Pham, T. D., & Gallegos, D. L. (2019, January 14). Nutritional status, dietary intake, and health-related quality of life in outpatients with COPD . NCBI. Retrieved November 20, 2022.
• O’Toole, J., Krishnan, M., Riekert, K., & Eakin, M. N. (2022). Understanding barriers to and strategies for medication adherence in COPD: a qualitative study. BMC Pulmonary Medicine , 22 (98).
• Pedersen, P. U., Uhrenfeldt, L., & Larsen, P. (2022, February 26). Oral hygiene in patients with chronic obstructive pulmonary disease: a scoping review protocol . JBI Evidence Synthesis. Retrieved November 20, 2022.
• Qiao, Z., Yu, J., Yu, K., & Zhang, M. (2018, August 3). The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators: A randomized controlled trial . NCBI.
• Shah, A., Ayas, N., Tan, W.-C., Malhotra, A., Kimoff, J., Kaminska, M., Aaron, S. D., & Jen, R. (2020, January 10). Sleep Quality and Nocturnal Symptoms in a Community-Based COPD Cohort. COPD: Journal of Chronic Obstructive Pulmonary Disease , 17 (1), 40-48.
• Thorat, Y. T., Salvi, S. S., & Kodgule, R. R. (2017). Peak flow meter with a questionnaire and mini-spirometer to help detect asthma and COPD in real-life clinical practice: a cross-sectional study. Primary Care Respiratory Medicine , 27 (32).
• Vendettuoli, V., Veneroni, C., Zannin, E., Mercadante, D., Matassa, P., Pedotti, A., Colnaghi, M., Dellaca, R.L., & Mosca, F. (2014). Positional Effects on Lung Mechanics of Ventilated Preterm Infants with Acute and Chronic Lung Disease. Pediatric Pulmonology .
• Yang, H., Wang, H., Du, L., Wang, Y., Wang, X., & Zhang, R. (2019, February 22). Disease knowledge and self-management behavior of COPD patients in China . NCBI. Retrieved November 21, 2022.
• Yentes, J. M., Fallahtafti, F., Denton, W., & Rennard, S. I. (2020, April 17). COPD Patients Have a Restricted Breathing Pattern That Persists with Increased Metabolic Demands. COPD: Journal of Chronic Obstructive Pulmonary Disease , 17 (3), 245-252. 

4 thoughts on “8 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans”

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Discover a wide range of comprehensive nursing case study examples and solutions that cover various medical specialties and scenarios. These meticulously crafted case studies offer real-life patient scenarios, providing you with a deeper understanding of nursing practices and clinical decision-making processes. Each case study presents a unique set of challenges and opportunities for learning, making them an invaluable resource for nursing education and professional development.

• Nursing Case Study Analysis [10 Examples & How-To Guides] What is a case study analysis? A case study analysis is a detailed examination of a specific real-world situation or event. It is typically used in business or nursing school to help students learn how to analyze complex problems and make decisions based on limited information.
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Pediatric Nursing Case Studies

In this section, delve into the world of pediatric nursing through our engaging and informative case studies. Gain valuable insights into caring for infants, children, and adolescents, as you explore the complexities of pediatric healthcare. Our pediatric nursing case studies highlight common pediatric conditions, ethical dilemmas, and evidence-based interventions, enabling you to enhance your pediatric nursing skills and deliver optimal care to young patients.

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Mental Health Nursing Case Study Examples 

Mental health nursing plays a crucial role in promoting emotional well-being and providing care for individuals with mental health conditions. Immerse yourself in our mental health nursing case studies, which encompass a wide range of psychiatric disorders, therapeutic approaches, and psychosocial interventions. These case studies offer a holistic view of mental health nursing, equipping you with the knowledge and skills to support individuals on their journey to recovery.

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• compare and contrast two mental health theories
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Geriatric Nursing Case Studies

As the population ages, the demand for geriatric nursing expertise continues to rise. Our geriatric nursing case studies focus on the unique challenges faced by older adults, such as chronic illnesses, cognitive impairments, and end-of-life care. By exploring these case studies, you’ll develop a deeper understanding of geriatric nursing principles, evidence-based gerontological interventions, and strategies for promoting optimal health and well-being in older adults.

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• Discuss the types of consideration a nurse must be mindful of while performing a health assessment on a geriatric patient as compared to a middle-aged adult – Solution
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Community Health Nursing Case Studies

Community health nursing plays a vital role in promoting health, preventing diseases, and advocating for underserved populations. Dive into our collection of community health nursing case studies, which explore diverse community settings, public health issues, and population-specific challenges. Through these case studies, you’ll gain insights into the role of community health nurses, interdisciplinary collaboration, health promotion strategies, and disease prevention initiatives.

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Critical Care Nursing Case Study Examples 

Critical care nursing demands swift decision-making, advanced technical skills, and the ability to provide intensive care to acutely ill patients. Our critical care nursing case studies encompass a range of high-acuity scenarios, including trauma, cardiac emergencies, and respiratory distress. These case studies simulate the fast-paced critical care environment, enabling you to sharpen your critical thinking skills, enhance your clinical judgment, and deliver exceptional care to critically ill patients.

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Maternal and Child Health Nursing Case Study Examples

The field of maternal and child health nursing requires specialized knowledge and skills to support the health and well-being of women and children throughout their lifespan. Explore our collection of maternal and child health nursing case studies, which encompass prenatal care, labor and delivery, postpartum care, and pediatric nursing. These case studies provide a comprehensive view of maternal and child health, allowing you to develop expertise in this essential area of nursing practice.

You can also check out Patient Safety in High-Tech Settings PICOT Questions Examples

Surgical Nursing Case Studies

Surgical nursing involves caring for patients before, during, and after surgical procedures. Our surgical nursing case studies cover a wide range of surgical specialties, including orthopedics, cardiovascular, and gastrointestinal surgeries. Delve into these case studies to gain insights into preoperative assessment, perioperative management, and postoperative care. By examining real-life surgical scenarios, you’ll develop a comprehensive understanding of surgical nursing principles and refine your skills in providing exceptional care to surgical patients.

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Obstetric Nursing Case Study

Obstetric nursing focuses on providing care to women during pregnancy, childbirth, and the postpartum period. Our obstetric nursing case studies explore various aspects of prenatal care, labor and delivery, and postpartum recovery. Gain valuable knowledge about common obstetric complications, evidence-based interventions, and strategies for promoting maternal and fetal well-being. These case studies will enhance your obstetric nursing skills and prepare you to deliver compassionate and competent care to expectant mothers.

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Nursing Ethics Case Study

Ethical dilemmas are an inherent part of nursing practice. Our nursing ethics case studies shed light on complex ethical issues that nurses encounter in their daily work. Explore thought-provoking scenarios involving patient autonomy, confidentiality, end-of-life decisions, and resource allocation. By examining these case studies, you’ll develop a deeper understanding of ethical principles, ethical decision-making frameworks, and strategies for navigating ethical challenges in nursing practice.

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Health Promotion Case Study

Community health promotion plays a crucial role in improving the health and well-being of populations. Our community health promotion case studies highlight successful initiatives aimed at preventing diseases, promoting healthy lifestyles, and addressing social determinants of health. Explore strategies for community engagement, health education, and collaborative interventions that make a positive impact on the well-being of individuals and communities.

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• Integrate evidence from research and theory into discussions of practice competencies, health promotion and disease prevention strategies, quality improvement, and safety standards.
• Discuss various theories of health promotion, including Pender’s Health Promotion Model, the Health Belief Model, the Transtheoretical Theory, and the Theory of Reasoned Action.
• What strategies, besides the use of learning styles, can a nurse educator consider when developing tailored individual care plans, or for educational programs in health promotion?
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• Identify a health problem or need for health promotion for a particular stage in the life span of a population from a specific culture in your area. Choose one of the Leading Health Indicators (LHI) priorities from Healthy People 2020: https://www.healthypeople.gov/2020/Leading-Health-Indicators
•   A description of a borrowed theory (expectancy-value theory and social cognitive theory) that could be applied to improve health promotion patient education in primary care clinic. Is this borrowed theory appropriate?
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Nursing Leadership Case Studies

Nursing leadership is essential for driving positive change and ensuring high-quality patient care. Our nursing leadership case studies examine effective leadership strategies, change management initiatives, and interprofessional collaboration in healthcare settings. Gain insights into the qualities of successful nurse leaders, explore innovative approaches to leadership, and learn how to inspire and motivate your team to achieve excellence in nursing practice.

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• The purpose of this assignment is to examine the impact of contemporary challenges in care delivery facing nursing leadership. Select and research a major issue in the delivery of care facing nurse leaders today and write a 1,250-1,500 word paper addressing the following:
• One nursing theory will be presented as a framework to resolve a problem occurring within one of the professional areas of leadership, education, informatics, healthcare policy or advance clinical practice.  The same nursing theory selected in Assignment One may be used to resolve the identified problem. 
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• Analyze one of the following concepts: “Advanced Practice Nursing,” “Leadership in Nursing Practice” or “Holistic Nursing Practice”
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At NursingStudy.org, we strive to provide you with a comprehensive collection of nursing case study examples and solutions that align with the best practices recommended by YOAST and RankMath. By exploring these diverse case studies, you’ll enhance your clinical knowledge, critical thinking abilities, and overall understanding of nursing practice. Take advantage of this valuable resource and elevate your nursing skills to new heights.

Remember, success in nursing begins with knowledge and continues with lifelong learning. Explore our nursing case study examples and solutions today and embark on a journey of professional growth and excellence.

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What is a nursing intervention: a beginner's guide. 2019. https://tinyurl.com/mh2mwhb6 (accessed 1 November 2021)

Butterworth C. How to achieve a person-centred writing style in care plans. Nurs Older People. 2012; 24:(8)21-26 https://doi.org/10.7748/nop2012.10.24.8.21.c9310

Centre for Policy on Ageing. The effectiveness of care pathways in health and social care. 2014. https://tinyurl.com/3t835kfd (accessed 1 November 2021)

Clinical and service integration. The route to improved outcomes. 2010. https://tinyurl.com/whb87xd6 (accessed 1 November 2021)

Department of Health. Refocusing the Care Programme Approach. Policy and positive practice guidance. 2008. https://tinyurl.com/anyrzhy6 (accessed 3 November 2021)

Department of Health. Personalised care planning: improving care for people with Long term conditions. 2011. https://tinyurl.com/uc3u3tkh (accessed 1 November 2021)

Department of Health. Care planning in the treatment of long term conditions: final report of the CAPITOL Project. 2013a. https://tinyurl.com/7399vphc

Department of Health. Mental health payment by results guidance 2013-2014. 2013b. https://tinyurl.com/9zyfmy87 (accessed 1 November 2021)

Dimond B. Exploring the legal status of healthcare documentation in the UK. Br J Nurs. 2005; 14:(9)517-518 https://doi.org/10.12968/bjon.2005.14.9.18078

Foundations of nursing practice: making the difference, 2nd edn. In: Hogston R, Simpson PM (eds). London: Palgrave Macmillan; 2002

Kozier B, Erb G, Berman A, Snyder S, Lake R, Harvey S. Fundamentals of nursing: concepts, process and practice, 8th edn. Harlow: Pearson Education; 2008

Leach M. Clinical decision making in complementary & alternative medicine.Chatswood (NSW, Australia): Elsevier; 2010

Lloyd M. A practical guide to care planning in health and social care.Maidenhead: Open University Press; 2010

Matthews E. Nursing care planning made incredibly easy!.Philadelphia (PA): Lippincott Williams and Wilkins; 2010

Monitor. Delivering better integrated care: A summary of what delivering better integrated care means and how Monitor is supporting the sector. 2015. https://tinyurl.com/825k8kd6 (accessed 1 November 2021)

NHS website. NHS launches accredited suppliers for electronic patient records. 2019. https://tinyurl.com/4fzs4up5 (accessed 1 November 2021)

National Institute for Clinical Excellence. What to expect during assessment and care planning. 2021. https://tinyurl.com/63hm5vvp (accessed 1 November 2021)

NHS England. Personalised care and support planning handbook: the journey to person-centred care: Core information. 2016a. https://tinyurl.com/9fyrtw45 (accessed 1 November 2021)

NHS England. Mental health clustering booklet v5.0 (2016/17). 2016b. https://tinyurl.com/7p6dfnry (accessed 1 November 2021)

NurseChoice. Nursing smart goals: how to set smart goals for Nursing. 2018. https://tinyurl.com/s292baez (accessed 1 November 2021)

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018a. http://tinyurl.com/yddpadva (accessed 1 November 2021)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018b. https://tinyurl.com/gozgmtm (accessed 1 November 2021)

Nursing and Midwifery Council. Keep records of all evidence and decisions. 2021. https://tinyurl.com/4pcabhms (accessed 1 November 2021)

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Assessing the patient's needs and planning effective care

Benjamin Ajibade

Senior Lecturer, Mental Health Nursing, Northumbria University

View articles · Email Benjamin

Nurses have an essential role to play in the assessment and planning of patient care. This is emphasised in the Nursing and Midwifery Council's 2018Future Nurse proficiency standards. In this article, the author discusses the importance of person-centred care in assessing needs and highlights the need for all nursing interventions to be evidence based. The topics covered include assessing people's needs, care planning, stages of care planning, benefits of care planning, models of care, care pathways, and care clustering in mental health care. The article also highlights the significance of record-keeping.

The central role of nurses in assessing patient needs and planning care is one of the core areas emphasised in Future Nurse, the Nursing and Midwifery Council's (NMC) (2018a) nursing proficiency standards. The document categorises ‘assessing needs and planning care’ as the third of seven areas of proficiency, which are grouped into ‘platforms’. Future Nurse emphasises that the delivery of person-centred care and evidence-based nursing interventions are vital components for effective patient assessment and care planning. The standards further highlight that the nurse should understand the need to assess each patient's capacity to make their own decisions and to allow them the opportunity to give and withdraw consent.

An assessment is a form of a dialogue between client and practitioner, in which they discuss the needs of the former to promote their wellbeing and what they expect to happen in their daily life ( National Institute for Health and Care Excellence (NICE), 2021 ). Nursing assessment involves collecting data from the patient and analysing the information to identify the patient's needs, which are sometimes described as problems.

The process of planning care employs different strategies to resolve the needs identified as part of an assessment. Ideally, this will include the selection of appropriate evidence-based nursing interventions. When planning care, the patient's needs and wishes should be prioritised, and the individual must be involved in the decision-making process to ensure a person-centred approach. The planned care must take into account the patient's conditions, personal attributes and choices. It is worth noting that the principles of care planning are transferable between hospital, home and care home settings.

Section 2 of the NMC Code highlights the importance of partnership working with patients to ensure the delivery of effective high-quality care and of involving them in their care, which includes empowering patients by enabling them to make their own decisions ( NMC, 2018b ). The patient should be viewed holistically, with importance placed on the physical, psychological, social and spiritual aspects of the person's life, which are inextricable.

The intrinsic factors of a patient's condition will often affect their concordance with the advice and treatment offered. Consequently, it is important to understand the reasons for non-concordance and to tailor treatments/recommendations to each individual, which will improve the quality of care delivered.

Brooker (2007) developed the acronym VIPS to address some of the confusion surrounding what should or should not be perceived as person-centred care. VIPS stresses the following:

• V is a value base that affirms the value of each human being, irrespective of age and cognitive ability. This is the foundation for individualised care
• I is individualised care that considers the individual's distinctiveness and holistic needs
• P is about seeing the world from the patient's perspective, to ensure that the health professional takes the patient's point of view into account when providing care
• S is about maintaining a social environment that supports the patient's psychological needs, including their mental, emotional and spiritual needs.

Health professionals should endeavour to involve the patient in decision-making and enable them to make choices as much as possible, using a range of approaches to achieve this ( Lloyd, 2010 ). Unless proven otherwise, a nurse must assume that a patient has the capacity to make their own decisions, in line with the Mental Capacity Act 2005.

The following draws on the author's experience in mental health nursing but can be applied to other areas of nursing care.

Care planning

Planning care is essential in the delivery of appropriate nursing care. Following assessment of a patient's needs, the next stage is to ‘plan care’ to address the actual and potential problems that have been identified. This helps to prioritise the client's needs and assists in setting person-centred goals. Planned care will change as a patient's needs change and as the nurse and/or other health professionals identify new needs. Care planning assists professionals to communicate information about the patient's care to others ( Department of Health (DH), 2013a ; NICE, 2021 ), to facilitate continuity of care. Communication may be predominantly verbal, but it will also always involve documentation in a variety of formats, including computer-based, handwritten or preprinted care plans.

It is essential for nurses to consider their consultation style when developing a care plan in order to reduce the risk of paternalism when communicating with the patient and discussing their needs. Collaborative consultation encourages patients to participate in their care and improves rapport, while a paternalistic approach will generally minimise an individual's part in, and responsibility for, their own care needs and may compromise care outcomes and concordance ( Leach, 2010 ). A collaborative/partnership consultation style facilitates a person-centred approach by the practitioners and involves the patient in their care. Such an approach can include asking questions such as: ‘We have different types of treatment approaches that could be considered, what are your preferences?’ This is in contrast to a paternalistic consultation style with the health professional announcing any decisions with a statement such as: ‘I am going to prescribe a certain treatment for you.’

When drawing up a care plan with a patient the nurse should take into account a number of considerations ( Box 1 ).

Box 1.Nursing considerations

• The patient should know the reason for the assessment
• The assessment should be flexible and adaptable to the needs of the individual
• The patient must be fully involved and their dignity, independence, and interests should be paramount
• The patient can have someone with them, if preferred
• Appropriate language and terminologies should be used throughout the consultation
• The diversity of the individual client, their beliefs, values, culture and their circumstances must be considered
• It is essential to consider the patient's gender, sexuality, ethnicity, disability and religion as part of the assessment
• Be open to listening to the patient's personal history and life story
• The entire family's needs should be considered, inclusive of the patient and their carers: remember the importance of providing holistic care
• Cost-effectiveness should also be taken into account

Sources: Department of Health, 2011; National Institute for Health and Care Excellence, 2021

Stages of care planning

Care planning has been described as the third stage of the nursing process ( NMC, 2018a ; Toney-Butler and Thayer, 2021 ). It includes assessing the patient's needs, identifying the problem(s), setting goals, developing evidence-based interventions and evaluating outcomes ( Matthews, 2010 ). This will require the health professional to apply high-level critical thinking, decision-making and problem-solving skills. It is important to note that a care plan can be prescriptive: it is devised after a patient has been assessed through the prescription of nursing actions ( Hogston and Simpson, 2002 ) or through collaborative working involving the multidisciplinary team.

In some situations there will be differences between what the nurse sees as a priority in terms of the patient's needs and what the patient wants. An example of this would be a patient with mental health problems who may be at high risk of self-harm, who may need to be put on intermittent 15-minute observation. In such cases, a patient would be deemed as not having capacity to make decisions and the nurse will need to use their clinical judgement to prescribe the best treatment option. The care plan can still be agreed in conjunction with the patient once the nurse has explained the reasons for the interventions and acknowledged in the care plan that this is not the patient's preferred choice.

In situations where the patient has capacity to make decisions, the care plan should be agreed in collaboration with the service user ( NHS England, 2016a ).

Identifying needs

As part of the care planning process, the nurse will identify a patient's needs/problems and propose a set of interventions to address them in order of priority, ensuring that everything is in agreement with the patient. To ensure that appropriate goals are set, a patient's needs will be classified as high, intermediate and low.

Each goal provides an indication as to the expected outcome, along with the proposed interventions required to meet the patient's problems/needs, all of which must be patient centred. It is important, in collaboration with the patient, to set both short-term, achievable goals and longer-term goals that may take days, weeks or months to accomplish. One way nurses can ensure this is to apply the SMART goal-setting approach to ensure that the goals are ( Revello and Fields, 2015 ; NurseChoice, 2018 ):

• M easurable
• A chievable
• T imely (within a defined time frame).

Interventions

Interventions are nursing actions/procedures or treatments built on clinical judgement and knowledge, performed to meet the needs of patients. The actions should be evidence based and indicate who will carry them out, when and how often ( Hogston and Simpson, 2002 ). The scheduled interventions will have been agreed with the patient with the aim of improving their health condition, and each subsequent action should strive to meet the goals set at the previous stage. Brooks (2019) outlined three types of intervention:

• Those independently initiated by nurses
• Those that are dependent on a physician or other health professionals
• Those that are interdependent, that is, those rely on the experience, skills and knowledge of multiple professionals.

Independent nursing interventions are planned and actioned by nurses autonomously ( NMC, 2018a ), and these actions do not require the nurse to have direction from another health professional. When actioning interventions dependent on other health professionals, the nurses must determine the appropriateness of any directions from other health professionals before carrying them out because the nurse remains accountable for the actions, for example, the administration of prescribed medication ( NMC, 2018a ). Due to developments in the nursing profession, some advanced nurse practitioners can now prescribe interventions, eg prescription of medication can be done by nurse independent prescribers or nurse supplementary prescribers ( Royal College of Nursing, 2014 ). Interdependent interventions are usually recorded in collaborative care plans reviewed in multidisciplinary (MDT) meetings and must be agreed by all parties involved. Both the goals and interventions must be communicated in a timely manner to all those involved in the patient's care.

This is the stage when a planned intervention is evaluated to assess whether or not it has been achieved. This can be an ongoing process, and the care plan should document the frequency and time frame for evaluating the intervention. If the initial goal becomes unachievable, the nurse will be required to reassess the patient's needs, and review and revise the interventions.

Benefits of care planning

The DH (2011) highlighted that the aim of care planning is to improve the quality of care and outcomes by respecting individual wishes and enabling patients to acknowledge the ownership of their condition and ensuring they have the ability to influence the outcomes. Health professionals should engage individuals in decision-making and facilitate them to take control of their health by agreeing common goals to improve outcomes. This will have additional benefits for both the patient and health services as it should reduce the number of GP appointments and emergency admissions the patient may require. Promoting self-management of long-term conditions can also help slow progression of illness.

Care planning empowers patients to care for themselves when they are self-managing their health and when they may have difficulty accessing a health professional. This became evident during the pandemic, with patients often having to go for extended periods between appointments with their health professionals. Care planning has really come into its own in community care in the past few years, which became evident during the pandemic—particularly in the field of mental health—because it leads to better patient concordance with treatment and other care needs without the need for constant input by health professionals. This benefits both health professionals and the NHS: it increases job satisfaction, brings efficiency savings and improves the quality of patient care ( DH, 2011 ).

Model of care

Models of care are used to deliver best practice in health care. An integrated services care model is multifaceted and enables the co-ordination of care by different health and social care professionals to meet individual patient needs. It encompasses patient-centred care and enables care staff across different providers to reduce duplication, confusion, delay and gaps in services ( Monitor, 2015 ). In the modern NHS, this is the preferred model of care.

The care plan is an integral part of this model because it enables the creation of shared care plans that map different care processes. It becomes a point of reference for various providers involved in the care of the patients, ensuring the co-ordination of care across services ( Curry and Ham, 2010 ; World Health Organization, 2016 ).

Care pathways

Care pathways, which are also known as critical pathways, clinical pathways, integrated care pathways, care paths and care maps, are used to describe a specific patient journey that dictates the care to be provided or process to be followed for a patient's particular condition or needs. An evidence-based care process is established for specific conditions by considering expert opinion that takes into account the evidence to recommend interventions that have been shown to achieve better health outcomes cost-effectively ( Centre for Policy on Ageing, 2014 ).

Care pathways are often developed at local level and have been shown to be efficacious at meeting local needs. They are also known to improve cross-setting collaborations. Clinical pathways are aimed at providing effective health care appropriate for the patient group of conditions, thereby reducing hospital stays, leading to cost-effective health care ( Kozier et al, 2008 ).

Care clusters

Care clustering is a needs assessment tool that is used to rate a patient's care need against specific scales:

‘A cluster is a global description of a group of people with similar characteristics as identified from a holistic assessment and then rated using the Mental Health Clustering Tool (MHCT).’

NHS England, 2016b

This framework is used to plan and organise mental health services, including the care and support provided to individuals based on their illness and individual needs. One of the care clustering tools used in the NHS is the Health of the Nations Outcome Scales (HoNOS) ( Wing et al, 1998 ; Yeomans, 2014 ; NHS England, 2016b ).

Mental health services were brought under the scope of Payment by Results (PbR) in the NHS in 2012-2013.

‘Payment by Results (PbR) is the transparent rules-based payment system in England under which commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the patient's healthcare needs.’

Consequently, as part of the care planning process, nurses need to take into account the cost-effectiveness of any interventions in order to consider how much funding is likely to be available for an initial completion of assessments, during scheduled reassessment and at any subsequent reassessment after a significant change in the patient's needs.

Box 2.Importance of complying with guidelines when undertaking assessment and planning care

• You must be compliant with the Nursing and Midwifery Council (2018b ; 2021 ) guidelines for record and record-keeping
• Adhere to the employing local organisation's policy on record-keeping, eg local trust policy
• Follow the NHS trust Care Programme Approach (CPA) policy ( Department of Health, 2008 )
• Collaborate with all those involved in a patient's care planning process

Importance of record-keeping

Accurate record-keeping is essential in the assessment of needs and planning care. This complies with the NMC (2018b) which states that record-keeping is fundamental to nursing practice, emphasising that records must be accurate and precise.

Health professionals should be aware of the need for legal accountability when documenting care in a written record because such records could be used in any legal proceedings ( Dimond, 2005 ). A record refers to not only a patient's record, but encompasses all records related to an individual nurse's range of practice. It is important to include the person being cared for in the record-keeping process, who should be asked to sign the plan of care, if they have capacity to do so ( NMC, 2021 ).

It is good practice to make an entry in the care documentation if a service user is unable to sign or agree to their planned care and state the reason for this ( Butterworth, 2012 ). In addition to paper-based records, care plans can be entered into the electronic health/patient record system used in the practitioner's service ( NHS website, 2019 ).

Best practice in writing care plans

There are some critical factors to consider when writing a focused person-centred care plan. One of these is to clearly document in detail the needs of the patient and to use the patient's language whenever possible, for example: ‘Mr D likes to dress smart every morning, but has been finding it difficult to make the choice of clothing to wear.’ An example of a poor way to record the same issue might be: ‘Mr D is unable to dress by himself’ and the aim is ‘Mr D will appear to dress smartly’.

The documented goal/aim of the care plan should be determined by applying the SMART acronym. It is therefore vital to ensure that the aim is specific by focusing on issues that can be measured, with goals that are achievable and realistic. It is also important to suggest and record a time frame within which a patient's short-term and long-term goals could be achieved. In relations to Mr D's clothing, a daily time frame might be appropriate. To come to an agreement over this issue, Mr D might be asked: ‘Mr D, would you like to be able to make your own choice of clothes to wear every day with the support of staff?’ The projected daily goal would then be recorded as part of the care plan documentation.

An intervention must specify how a goal/aim will be achieved, including who will be responsible for implementing each task. This could be the staff nurse on duty, team nurse, team leader, the nurse in charge and/or the patient (please put the patient's name). Evaluation should be carried out regularly and documented, and should conform with the proposed time frame outlined as part of the suggested intervention. Evaluations should be undertaken whenever actions are performed in accordance with each proposed intervention, and details of the progress of the patient's problem/needs documented.

In conclusion, the article has discussed the importance of assessing patients' needs, emphasising person-centred care using the VIPS acronym devised by Brooker (2007) . It has stressed the notion for all nursing interventions to be evidence based. The stages of care planning were discussed, and the application of the SMART goal-setting approach was highlighted. Record-keeping is an integral part of care planning in the communication of patient's care and progress. The benefits of care planning in improving quality of care and outcomes, respecting individual wishes, thereby empowering the patient was recognised.

LEARNING OUTCOMES

• Nurses must ensure that assessment of patient needs and care planning are always focused on the person
• All nursing interventions must be evidence based
• The goals set out in a patient's care plan must be achievable and measurable, and should include time frames within which both short- and long-term goals can be achieved
• Record-keeping is a vital component of care planning and is part of communicating aspects of a patient's care, and their progress towards their goals, with other health professionals involved in their care

CPD reflective questions

• In the context of a patient's health, what should you aim to do when care planning?
• Who should you involve in the care planning and why? Should the patient have a copy of the care plan?
• Is it acceptable to destroy care plans or other records?
• When should care plans be reviewed?

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