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A patient with an exacerbation of chronic obstructive pulmonary disease (COPD) is admitted to the hospital. Which of the following nursing diagnoses requires the most collaboration with other health team members to achieve the best outcome for the patient?

 impaired gas exchange
 impaired skin integrity
 activity intolerance
 imbalanced nutrition: less than body requirements

Correct Answer:

impaired gas exchange

Educational Objective:

Describe nursing interventions for a patient with an exacerbation of chronic obstructive pulmonary disease.

Key Point:

Impaired gas exchange is the priority diagnosis for the patient with a COPD exacerbation and requires much interdisciplinary collaboration.

Explanation:

Impaired gas exchange requires collaboration between the nurse, physician, and respiratory therapist to help achieve the best respiratory outcome for the patient. Medications, oxygen, nebulizer treatments, and arterial blood gas analyses all require a physician's order. The respiratory therapist administers the oxygen and nebulizer treatments. The nurse assesses the patient's response to medications and respiratory treatments and provides feedback to the physician and respiratory therapist.

Impaired skin integrity, activity intolerance, and imbalanced nutrition that are less than body requirements (when applied to the patient with COPD) largely require independent nursing interventions without collaboration with other health team members. These interventions include skin care, pacing nursing care to promote rest and minimize fatigue, and providing small, frequent meals.

References:

Gulanick M, Myers J, eds. Nursing Care Plans: Diagnoses, Interventions, & Outcomes. 9th ed., 2017

Potter PA, et al. Essentials for Nursing Practice. 9th ed., 2019:228.

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