Nursing Care Plan (NCP) for Restrictive Lung Diseases
Watch More! Unlock the full videos with a FREE trial
Included In This Lesson
Study Tools For Nursing Care Plan (NCP) for Restrictive Lung Diseases
Outline
Lesson Objectives for Restrictive Lung Diseases
- Definition and Classification:
- Understand the definition of restrictive lung diseases and differentiate them from obstructive lung diseases.
- Classify different types of restrictive lung diseases, such as interstitial lung disease, pulmonary fibrosis, and chest wall disorders.
- Pathophysiology:
- Explore the underlying pathophysiology of restrictive lung diseases, focusing on mechanisms that limit lung expansion and reduce lung compliance.
- Understand the role of inflammation, scarring, and structural changes in lung tissues.
- Clinical Manifestations:
- Recognize the common clinical manifestations of restrictive lung diseases, including dyspnea, reduced lung volumes, and impaired gas exchange.
- Differentiate these symptoms from those seen in obstructive lung diseases.
- Diagnostic Tools:
- Learn about diagnostic tools used to assess and diagnose restrictive lung diseases, such as pulmonary function tests (PFTs), chest imaging, and arterial blood gases (ABGs).
- Understand the significance of these tests in evaluating lung function and severity.
- Management and Interventions:
- Explore the management strategies for individuals with restrictive lung diseases, including pharmacological treatments, oxygen therapy, pulmonary rehabilitation, and surgical interventions.
- Understand the importance of a multidisciplinary approach to care.
Pathophysiology for Restrictive Lung Diseases
- Decreased Lung Compliance:
- Restrictive lung diseases are characterized by decreased lung compliance, meaning that the lungs become stiff and less able to expand during inhalation. This reduced compliance makes it challenging for the lungs to adequately fill with air.
- Interstitial Lung Involvement:
- Many restrictive lung diseases primarily affect the lung interstitium, the tissue that surrounds the air sacs (alveoli) and supports the lung structure. Inflammation, scarring (fibrosis), or fluid accumulation in the interstitium can impair lung function.
- Alveolar Wall Thickening:
- Thickening of the alveolar walls is a common feature in restrictive lung diseases. This thickening can result from inflammation, fibrosis, or the deposition of substances such as collagen, impeding the efficient exchange of oxygen and carbon dioxide.
- Reduced Total Lung Capacity:
- Restrictive lung diseases lead to a reduction in total lung capacity, which is the maximum amount of air the lungs can hold. This decrease is primarily due to impaired expansion of the lungs and decreased compliance.
- Impaired Gas Exchange:
- The structural changes in the lungs associated with restrictive diseases compromise the ability of the alveoli to exchange oxygen and carbon dioxide efficiently. This can result in hypoxemia (low blood oxygen levels) and respiratory distress.
- Increased Work of Breathing:
- Due to the stiffening of lung tissue and reduced lung compliance, individuals with restrictive lung diseases may experience increased work of breathing. This can lead to fatigue and difficulty sustaining normal respiratory patterns.
Etiology for Restrictive Lung Diseases
- Interstitial Lung Diseases (ILDs):
- Various interstitial lung diseases, including idiopathic pulmonary fibrosis (IPF), sarcoidosis, and connective tissue diseases (e.g., rheumatoid arthritis, systemic sclerosis), can lead to restrictive lung patterns. These diseases involve inflammation and scarring of the lung tissue.
- Occupational Exposures:
- Prolonged exposure to occupational hazards, such as asbestos, silica, or coal dust, can contribute to the development of restrictive lung diseases. Individuals working in certain industries, like mining or construction, may be at an increased risk.
- Environmental Exposures:
- Exposure to environmental factors such as airborne pollutants, pollutants from biomass fuel combustion, and certain chemicals can contribute to the development of restrictive lung diseases. Individuals living in areas with poor air quality may be more susceptible.
- Radiation Therapy:
- Therapeutic radiation, particularly when used to treat cancers in the chest area, can lead to lung tissue damage and fibrosis, resulting in a restrictive lung pattern.
- Drug-Induced Lung Disease:
- Certain medications, such as chemotherapy drugs, anti-inflammatory medications (e.g., methotrexate), and some antibiotics, may cause lung damage and fibrosis, leading to restrictive lung diseases.
- Inflammatory and Autoimmune Conditions:
- Inflammatory conditions, including rheumatoid arthritis, systemic sclerosis, and sarcoidosis, can trigger an immune response that affects the lungs, leading to inflammation and fibrosis. These autoimmune processes can result in a restrictive lung pattern.
Desired Outcome for Restrictive Lung Diseases
- Improved Gas Exchange:
- Achieve and maintain optimal oxygen saturation levels.
- Minimize hypoxemia and respiratory distress.
- Enhanced Breathing Pattern:
- Attain a more effective and efficient breathing pattern.
- Reduce respiratory muscle fatigue and work of breathing.
- Increased Exercise Tolerance:
- Improve the individual’s ability to engage in activities of daily living without excessive breathlessness.
- Enhance overall physical endurance and stamina.
- Adherence to Medication Regimen:
- Ensure consistent adherence to prescribed medications.
- Optimize the therapeutic effects of bronchodilators, anti-inflammatory drugs, or immunosuppressants.
- Improved Quality of Life:
- Enhance the individual’s overall quality of life by minimizing respiratory symptoms and improving functional capacity.
- Facilitate participation in social, recreational, and occupational activities.
Restrictive Lung Diseases Nursing Care Plan
Subjective Data:
- Feeling SOB
- “Can’t catch my breath”
- Dyspnea on exertion
Objective Data:
- Hypoxia
- Hypercapnia
- Blue skin, lips, nail beds
- Clubbing of fingers
- Shallow breathing
- Excess secretions
- Accessory muscle use
- Decrease SpO2
- Presence of physical disorder (ALS, MD, quadriplegia)
Nursing Assessment for Restrictive Lung Diseases:
- Respiratory Assessment:
- Monitor respiratory rate, depth, and effort.
- Assess for signs of increased work of breathing and use of accessory muscles.
- Oxygen Saturation Monitoring:
- Continuously monitor oxygen saturation levels using pulse oximetry.
- Evaluate the need for supplemental oxygen based on saturation levels.
- Breath Sounds Evaluation:
- Auscultate breath sounds to identify any abnormal sounds, such as crackles or decreased breath sounds.
- Monitor for changes indicating worsening lung function.
- Chest Assessment:
- Evaluate chest movement and symmetry during respiration.
- Assess for any visible signs of chest wall abnormalities or retractions.
- Dyspnea Assessment:
- Assess the individual’s perception of dyspnea using a scale or verbalization.
- Explore factors that exacerbate or alleviate breathlessness.
- Activity Tolerance:
- Assess the individual’s ability to perform activities of daily living.
- Explore any limitations or changes in functional capacity.
- Psychosocial Assessment:
- Evaluate the impact of restrictive lung diseases on the individual’s psychosocial well-being.
- Assess coping mechanisms, emotional responses, and support systems.
Implementation for Restrictive Lung Diseases:
- Oxygen Therapy:
- Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation.
- Positioning and Respiratory Support:
- Assist the individual in finding a comfortable position that optimizes lung expansion.
- Provide respiratory support, such as non-invasive ventilation, as indicated.
- Energy Conservation Techniques:
- Educate the individual on energy conservation techniques to reduce respiratory fatigue.
- Encourage the prioritization of activities to minimize breathlessness.
- Medication Administration:
- Administer prescribed medications, such as bronchodilators and anti-inflammatory drugs, as directed.
- Monitor for side effects and assess the individual’s response to medications.
- Pulmonary Rehabilitation Referral:
- Facilitate a referral to pulmonary rehabilitation programs to enhance exercise tolerance and respiratory muscle strength.
- Collaborate with the healthcare team to coordinate comprehensive care.
Nursing Interventions and Rationales for Restrictive Lung Diseases
| Nursing Intervention (ADPIE) | Rationale |
| Maintain patent airway-cough assist therapy, suctioning secretions | ensures patient is getting adequate oxygen to the body/tissues |
| Full respiratory assessment- baseline lung sounds, labs | you will notice when the condition has worsened or when an intervention has worked. ABG’s can show if interventions are working or if patient is decompensating |
| Provide supplemental O2 as needed | supplemental O2 can help improve the patient’s overall oxygenation needs |
| Cluster Care | helps decrease oxygen demands and patients rest is maximized |
| Patient sitting upright for optimal breathing | sitting up ensures appropriate lung expansion and allows for maximum inspiration/expiration which in turn gets better gas exchange |
| Prevent pneumonia-oral hygiene, suctioning, trach care | most common cause of restrictive lung disease. Prevents any infection from occurring |
| Appropriate nutrition | malnourishment is common with lung disease. Nutrition is essential to support healing |
| Provide Oral Care | helps protect the mucous membrane and prevent infection |
| Educating patient/families | if patient has any of the extrinsic causes, giving coping mechanisms and ways to help improve the patients state of mind and quality of life |
Evaluation for Restrictive Lung Diseases
- Improved Gas Exchange:
- Monitor for improvements in gas exchange, as evidenced by stable or improved oxygen saturation levels.
- Assess changes in respiratory rate and effort.
- Effective Breathing Pattern:
- Evaluate the effectiveness of interventions in promoting an effective breathing pattern.
- Monitor for a reduction in respiratory muscle fatigue and signs of improved respiratory function.
- Adherence to Medication Regimen:
- Assess the individual’s adherence to prescribed medications and any reported side effects.
- Provide education and support for medication management.
- Enhanced Exercise Tolerance:
- Evaluate the impact of pulmonary rehabilitation on exercise tolerance and functional capacity.
- Assess the individual’s ability to perform activities of daily living without excessive fatigue.
- Multidisciplinary Collaboration:
- Assess the effectiveness of collaboration with the healthcare team, including respiratory therapists, pulmonologists, and rehabilitation specialists.
- Ensure that care is coordinated and individualized based on the specific needs of the person with restrictive lung disease.
References
- https://my.clevelandclinic.org/health/diseases/17809-interstitial-lung-disease
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/restrictive-lung-disease
View the FULL Outline
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
Transcript
Hey everyone, Today, we’re going to be creating a nursing care plan for restrictive lung diseases. So, let’s get started. So first we’re going to go over the pathophysiology. So restrictive lung disease is a condition, either intrinsic or extrinsic, that causes the lungs to lose their ability to expand and contract. Some nursing considerations are respiratory status, supplemental O2, maintaining a patent airway, clustering care, giving appropriate nutrition and educating the patient and family. Some desired outcomes: we’re going to optimize oxygenation and ventilation, prevent pulmonary infections, and provide supportive care for the patient and family.
So, we’re going to go ahead and get started on the care plan. Some subjective data, what are we going to see with these patients? So, a lot of patients will complain of having some shortness of breath. That is one of the most common ones. You’ll also see maybe possible clubbing of the fingers, some shallow breathing, or some accessory muscle use. Some other things you might see is dyspnea upon exertion hypoxia. Hypercapnia, some blue skin, lips, or nail beds, shallow breathing, clubbing of fingers, excess secretions, decreased SpO2, and the presence of a physical disorder, such as ALS, MD and, and quadriplegia.
So, interventions, we want to make sure we’re doing a full respiratory assessment. So respiratory assessment. We also want to look at giving supplemental O2. We want to make sure we have a baseline lung sounds. We might want to get some ABGs. You’ll notice when this condition has worsened or when an intervention has worked. ABGs can show if interventions are working or if a patient is decompensating; it can tell if a patient is metabolic or respiratory acidosis. Another intervention we’re going to be doing we want to make sure we’re maintaining a patent airway. And we can help with cough assisting therapy, suctioning, secretions, ensuring that the patient’s getting an adequate amount of oxygen to the body and tissues want to make sure that we’re doing cluster care. This is going to help decrease oxygen demands and the patient’s rest is more maximized. So, the more that we can do in one time when we’re with the patient, the better. We want to make sure that the patient’s sitting upright for optimal breathing. So have the patient in like a high fowler’s position. So, like 90 degrees sitting upright ensures appropriate lung expansion, and it allows for maximum inspiration and expiration, which in turn gets better. gas exchange. Another invention we want to do is we want to make sure that we’re preventing pneumonia as it’s a complication. We want to make sure we’re performing good oral hygiene, making sure we’re suctioning the patient as needed and/or trach care. If they have a trach that’s placed, most common with a restrictive lung disease is pneumonia, and proper care prevents any infection from occurring. Another invention that we’re going to be doing is to make sure that the patient has proper nutrition. Malnourishment is common with lung disease. So, nutrition is essential to support healing. We want to make sure we’re educating the patient and families. So education. If a patient has any of the extrinsic causes, we want to make sure that we’re giving them coping mechanisms and ways to help improve their patient’s state of mind and quality of life.
Okay, we’re going to go over some key points. So, this is a condition, either intrinsic or extrinsic, that causes the lungs to lose their ability to expand and contract. It can be caused by inflammation, sarcoidosis, ARDS, pulmonary fibrosis, and pneumonia. Some subjective and objective data: you’re going to see they’ll complain of some shortness of breath. Dyspnea upon exertion, hypoxemia, clubbing of the fingers, maybe some blue skin lips, nail beds, accessory, muscle use, shallow breathing and decreased SpO2. We’re going to do an assessment. We’re going to make sure we’re doing respiratory assessments, maintaining a patent airway, making sure the patient’s sitting upright, preventing complications, such as pneumonia. We’re going to make sure we’re providing supplemental O2, doing cluster care, giving appropriate nutrition and making sure we’re educating the patients. And there you have it, a completed care plan.
Great job guys. We love you. Go out and be your best self today and as always, happy nursing!
View the FULL Transcript
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
