COPD

• early manifestations

  chronic intermittent cough, progressive dyspnea, chest heaviness
• late manifestations

  dyspnea at rest, chest breathing (accessory muscle use), wheezing, chest tightness, fatigue, weight loss, anorexia, hypoxemia, polycythemia, cyanosis
• complications

  pulmonary hypertension, cor pulmonale, acute exacerbations, acute respiratory failure, pneumonia, heart failure
• nursing interventions & teaching

  incentive spirometer, huff cough, pursed-lip breathing, diaphragmatic breathing, nutrition therapy, long-term oxygen, high fowlers or tripod positioning, increase fluids
• nutrition considerations

  rest 30 minutes before eating, prepare meals in advance, high calorie high protein diet, eat more smaller meals, cold foods, increase fluids
• objective data - assessment

  CV: tachycardia, dysrhythmias, JVD, right-sided heart failure, cor pulmonale, pedal edema

  general: debilitation, restlessness, upright position

  GI: ascites, hepatomegaly

  musculoskeletal: muscle atrophy, barrel chest

  respiratory: rapid / shallow breathing, prolonged expiration, pursed-lip breathing, accessory muscle use, crackles

  skin: cyanosis, pallor, digital clubbing, poor skin turgor, peripheral edema
• monitoring

  vitals, lung sounds, ABGs, hypoxia, nutrition status, ambulation