Nursing Process

History

1. Character of onset and duration of cough, sputum production, dyspnea, pain in right upper quarant. 
2. Smoking history. 
3. Past illness - Influenza pneumonia, repeated R.T.I., Chronic sinusitis 
4. Past or present exposure to environmental irritants at home or at work 
5. Self-care used to treat symptoms 
6. Medication taken and their effectiveness.

Physical Examination 

1. Assess - General appearance 
2. Overweight or bloated 
3. Dependent ocdema 
4. Distended jugular veins/neck veins 
5. Hepatomegaly 
6. Vital signs 

Pulmonary Assessment

1. Posture, use of accessory muscle for breath, clubbing of fingers, central cynosis and altered sensorium. 
2. Increased tactile fiemitus 
3. On auscultation inspiratory crackles (rales), inspiratory and expiratory bronchi 

Assess Lab Findings 

1. ABG for respiratory acidosis and hypoxemia 
2. Hematology; increased Hb and PCV, increased' WBC count 
3. PFT; decreased FEV