Quick Answer
Priority COPD-exacerbation diagnoses: impaired gas exchange → ineffective breathing pattern → ineffective airway clearance → activity intolerance → anxiety. Target SpO₂ 88–92%. Core interventions: nebulized albuterol/ipratropium, 5-day prednisone, antibiotics if purulent sputum, BiPAP for pH < 7.35 / PaCO₂ > 45. Smoking cessation and pulmonary rehab are the highest-yield long-term interventions.
Assessment
Subjective: worsening dyspnea, ↑ sputum volume/purulence, wheezing, fatigue.
Objective: tachypnea, accessory-muscle use, tripod position, prolonged expiration, wheezes, SpO₂ ↓, ABG respiratory acidosis, FEV1 ↓, barrel chest.
Priority NANDA-I diagnoses
- Impaired gas exchange AEB SpO₂ 86%, PaCO₂ 58, pH 7.31.
- Ineffective breathing pattern.
- Ineffective airway clearance.
- Activity intolerance.
- Anxiety related to dyspnea.
NOC outcomes
- SpO₂ 88–92% (COPD target — higher risks CO₂ retention).
- pH ≥ 7.35 within 24 h; PaCO₂ trending toward baseline.
- Uses pursed-lip breathing during activity.
- Demonstrates correct MDI/spacer technique.
- Verbalizes smoking-cessation plan.
NIC interventions and rationale (GOLD 2024)
- O₂ to SpO₂ 88–92% (Venturi mask preferred) — higher SpO₂ suppresses hypoxic drive and worsens hypercapnia.
- Nebulized albuterol + ipratropium q4–6 h — first-line bronchodilators in exacerbation.
- Systemic corticosteroids (prednisone 40 mg × 5 days) — shortens recovery, reduces relapse.
- Antibiotics if Anthonisen criteria met (↑ dyspnea + ↑ sputum volume + ↑ purulence).
- NIV (BiPAP) for pH < 7.35 and PaCO₂ > 45 — reduces intubation and mortality.
- Tripod / upright positioning.
- Teach pursed-lip and diaphragmatic breathing.
- Smoking cessation + NRT/varenicline + behavioral support — single most important long-term intervention.
- Refer to pulmonary rehab; vaccinate (flu, pneumococcal, RSV).
Evaluation
Day 4: SpO₂ 90% on 2 L NC, pH 7.38, PaCO₂ 48. Correct MDI + spacer technique; committed to nicotine patch and pulmonary rehab.