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Geriatric Nursing Care Note

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD)

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PATIENT PROFILE (Simulated / Template)

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I. ASSESSMENT

A. Chief Complaint

B. History of Present Illness

C. Past Medical History

• COPD (diagnosed 8 years ago, GOLD Stage III)
• Hypertension
• Type 2 Diabetes Mellitus

D. Physical Assessment

E. Diagnostic Results

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II. NURSING DIAGNOSES (NANDA-I Format)

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NURSING DIAGNOSIS #1 (Priority 1)

Impaired Gas Exchange related to alveolar-capillary membrane changes, ventilation-perfusion mismatch, and air trapping secondary to COPD as evidenced by SpO2 of 84%, PaO2 of 52 mmHg, PaCO2 of 58 mmHg, pH 7.32, restlessness, use of accessory muscles, and peripheral cyanosis.

Subjective Data:

Objective Data:

• SpO2 84% on room air
• ABG: PaO2 52, PaCO2 58, pH 7.32
• RR 26 breaths/min
• Restlessness, mild confusion
• Peripheral cyanosis

Goals / Expected Outcomes (SMART):

1. Patient will maintain SpO2 between 88-92% on supplemental oxygen within 2 hours of intervention.
2. Patient will demonstrate decreased restlessness and improved mentation within 4 hours.
3. ABG values will trend toward baseline (pH >7.35, PaCO2 <55 mmHg) within 24 hours.

Nursing Interventions and Rationale:

Evaluation:

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NURSING DIAGNOSIS #2 (Priority 2)

Ineffective Airway Clearance related to excessive mucus production, bronchospasm, and ineffective cough secondary to COPD and age-related decline in mucociliary function as evidenced by productive cough with thick yellowish-green sputum, bilateral rhonchi and wheezing, and SpO2 84%.

Subjective Data:

Objective Data:

• Productive cough, thick discolored sputum
• Bilateral wheezes and rhonchi on auscultation
• Prolonged expiratory phase
• RR 26/min, increased accessory muscle use

Goals / Expected Outcomes:

1. Patient will demonstrate effective coughing technique (huff cough) within 24 hours.
2. Lung sounds will improve (reduced rhonchi) after airway clearance interventions within 12 hours.
3. Patient will maintain adequate hydration (>1,500 mL/day unless contraindicated) to facilitate sputum thinning.

Nursing Interventions and Rationale:

Evaluation:

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NURSING DIAGNOSIS #3 (Priority 3)

Ineffective Breathing Pattern related to airflow limitation, hyperinflation, and respiratory muscle fatigue secondary to COPD as evidenced by RR 26/min, prolonged expiratory phase, use of accessory muscles, barrel chest, and tripod positioning.

Goals / Expected Outcomes:

1. Patient will demonstrate use of pursed-lip and diaphragmatic breathing within 24 hours.
2. Respiratory rate will decrease to 16-20 breaths/min within 24-48 hours.
3. Patient will report decreased breathlessness (dyspnea scale ≤3/10) within 48 hours.

Nursing Interventions and Rationale:

Evaluation:

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NURSING DIAGNOSIS #4 (Priority 4)

Activity Intolerance related to imbalance between oxygen supply and demand, respiratory muscle fatigue, and deconditioning secondary to COPD and advanced age as evidenced by inability to perform ADLs without dyspnea, SpO2 dropping to 80% on minimal exertion, and fatigue.

Goals / Expected Outcomes:

1. Patient will perform ADLs with minimal dyspnea (≤3/10) and SpO2 ≥88% within 72 hours.
2. Patient will verbalize understanding of energy conservation techniques within 24 hours.
3. Patient will demonstrate safe progressive ambulation (bed to chair to corridor) without SpO2 drop to <88% within 5 days.

Nursing Interventions and Rationale:

Evaluation:

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NURSING DIAGNOSIS #5 (Priority 5)

Deficient Knowledge regarding disease management, inhaler technique, trigger avoidance, and warning signs related to limited exposure to health information and age-related learning challenges as evidenced by patient's incorrect inhaler use, inability to identify COPD exacerbation warning signs, and repeated hospital admissions.

Goals / Expected Outcomes:

1. Patient will correctly demonstrate metered-dose inhaler (MDI) technique within 24 hours.
2. Patient will verbalize at least 3 warning signs of COPD exacerbation that require immediate medical attention before discharge.
3. Patient/family will verbalize understanding of smoking avoidance, air quality, and flu/pneumonia vaccination importance before discharge.

Nursing Interventions and Rationale:

Evaluation:

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III. COLLABORATIVE PROBLEMS / POTENTIAL COMPLICATIONS

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IV. DISCHARGE PLANNING (Geriatric Considerations)

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V. EVALUATION SUMMARY

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REFERENCES

1. Herdman TH, Kamitsuru S, Lopes CT (eds). NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026, 12th ed. Thieme Medical Publishers; 2024.
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report. goldcopd.org.
3. Washington Manual of Medical Therapeutics - Acute Exacerbation of COPD section (Pharmacotherapy Table 9-7; admission criteria).
4. Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology, 10th ed. Elsevier; 2023 - COPD pathology (emphysema, chronic bronchitis, FEV1/FVC changes).
5. Fishman AP, et al. Fishman's Pulmonary Diseases and Disorders, 2-Volume Set. McGraw-Hill - Mucus dysfunction and COPD pathogenesis.
6. Ackley BJ, Ladwig GB. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. Elsevier.

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Note for Student Nurses: This care note is a learning template. In actual clinical practice, always individualize each nursing diagnosis to your patient's actual assessment data. The "related to" and "as evidenced by" clauses must reflect what YOU assessed - not a generic template. NANDA-I nursing diagnoses are distinct from medical diagnoses; they describe the human response to the disease process, not the disease itself.