T3 · Lung disease flare-ups
Actual Long-term illness
Definition
Breathing worsens suddenly in chronic lung disease.- Infection
- smoking
- pollution
- missed inhalers
- Cough
- wheeze
- breathlessness
- change in sputum
📋 Scenario
A COPD patient becomes more breathless and coughs more.
Subjective (S): "I'm more breathless and coughing more."
Objective (O): Wheeze; sputum increased and green; oxygen saturation 90%.
Assessment tools for this scenario: CP-LONG Long-Term Condition Check CP-BREATH Breathing & Circulation Check
Validated scales to consider: Self-management review, NEWS2, SpO₂, ECG
**CarePath diagnosis:** Lung disease flare-ups related to infection, as evidenced by cough and wheeze.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Give medications as ordered. | Bronchodilators open narrowed airways and steroids or antibiotics, if ordered, treat inflammation or infection, which eases breathlessness and shortens the flare-up. |
| Give oxygen. | Oxygen raises low blood oxygen levels. In COPD it is given carefully to reach the ordered target, because too much can cause carbon dioxide to build up. |
| Position. | Sitting upright or leaning forward lets the lungs expand more easily and the breathing muscles work better, which relieves breathlessness. |
| Teach early signs. | Spotting early signs such as more cough, a change in sputum or more breathlessness allows treatment sooner, which can prevent hospital admission. |
| Vaccinate. | Vaccines such as those for influenza and pneumonia lower the chance of infections that trigger flare-ups. |
| Support stopping smoking. | Smoking damages the airways and triggers flare-ups. Support to stop slows lung damage and lowers the number of future flare-ups. |
**Expected outcomes**
- Breathing returns to baseline.
- Oxygen at target.
- Flare-up resolves.
- Patient knows early signs.
**Linking the data to the diagnosis**
This is an actual problem because the flare-up has already begun. The patient with COPD says, "I'm more breathless and coughing more." The nurse finds wheeze, increased green sputum and oxygen saturation of 90%. The green sputum suggests infection as the trigger. This fits a flare-up, not a stable chronic condition, because breathing has worsened suddenly. The plan gives medicines and oxygen as ordered, positions him to ease breathing and teaches early signs. The aim is that breathing returns to baseline, oxygen is at target, the flare-up resolves and the patient knows early signs.
CarePath diagnosis
Lung disease flare-ups related to infection, as evidenced by cough and wheeze.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Give medications as ordered. | Bronchodilators open narrowed airways and steroids or antibiotics, if ordered, treat inflammation or infection, which eases breathlessness and shortens the flare-up. |
| 2. Give oxygen. | Oxygen raises low blood oxygen levels. In COPD it is given carefully to reach the ordered target, because too much can cause carbon dioxide to build up. |
| 3. Position. | Sitting upright or leaning forward lets the lungs expand more easily and the breathing muscles work better, which relieves breathlessness. |
| 4. Teach early signs. | Spotting early signs such as more cough, a change in sputum or more breathlessness allows treatment sooner, which can prevent hospital admission. |
| 5. Vaccinate. | Vaccines such as those for influenza and pneumonia lower the chance of infections that trigger flare-ups. |
| 6. Support stopping smoking. | Smoking damages the airways and triggers flare-ups. Support to stop slows lung damage and lowers the number of future flare-ups. |
Expected outcomes
- Breathing returns to baseline.
- Oxygen at target.
- Flare-up resolves.
- Patient knows early signs.
Linking the data to the diagnosis
This is an actual problem because the flare-up has already begun. The patient with COPD says, "I'm more breathless and coughing more." The nurse finds wheeze, increased green sputum and oxygen saturation of 90%. The green sputum suggests infection as the trigger. This fits a flare-up, not a stable chronic condition, because breathing has worsened suddenly. The plan gives medicines and oxygen as ordered, positions him to ease breathing and teaches early signs. The aim is that breathing returns to baseline, oxygen is at target, the flare-up resolves and the patient knows early signs.