Let’s take a look at our concept map for a patient with a COPD exacerbation. Factors that resulted in the hospitalization include smoking, cold weather, or allergens. Other factors include non-compliance with oxygen or with wearing their CPAP at night. CPAPs ensure that the patient is not only breathing in the oxygen that they need, but also breathing out the CO2 that they don’t need. We would educate this patient to stop smoking as this only worsens the disease. We should encourage them to continue to wear their oxygen and CPAP as ordered by the doctor, even if they don’t like to wear it.

When this patient is admitted to the hospital, the doctor will order a set of ABGs or arterial blood gases. The results will show the arterial oygen, CO2, and PH levels. These will let us know how to treat them. For example, if the CO2 is high, say 100 percent, we will need to put the patient on the BIPAP to blow off CO2.

The doctor will order medications to help improve their lung function. Albuterol nebulizers will be given scheduled and as needed to help open up the airways. Methylprednisolone 125 mg IV will be ordered to decrease inflammation in the lungs. The steroids will be weaned down over time before the patient is discharged

Now let’s discuss the nursing. diagnoses, interventions, and outcomes. Our patient’s first nursing diagnosis is disruption of gas exchange. Our interventions include auscultation of lung sounds,  medication administration, and oxygen administration. The desired outcome is effective gas exchange as evidenced by normal ABG levels.

The next nursing diagnosis is acute confusion due to high CO2 levels. Our interventions include assessing mental status, placing the patient on a BIPAP, and monitor ABG levels. The desired outcome is that the patient will be alert and oriented without confusion.

The last nursing diagnosis is inability to adapt to a change in health status because our patient is still smoking cigarettes and isn’t complying with treatment at home. The nursing interventions include assessing for barriers to compliance,  educating the patient on the purpose of treatment and lifestyle changes, and providing support. The desired outcome is that the patient will express the desire to change poor lifestyle habits to support treatment of disease.

Here is a cleaned up version of our COPD concept map.