Management of chronic obstructive pulmonary disease (COPD)

Impairments:

1. An increase in the amount and viscosity of mucus production.
2. A chronic and productive cough.
3. Frequent episodes of Dyspnea.
4. Labored breathing pattern that results in:
1. Increased respiratory rate (tachypnea)
2. Use of accessory muscles of inspiration and decreased diaphragmatic excursion
3. Upper chest breathing
4. Inadequate exchange of gases in the lower lobe
5. Difficulty during expiration
5. Changes in pulmonary function:
1. Increase residual volume 
2. Decreased vital capacity 
3. Decreased exploratory flow rates
6. Decreased mobility of chest wall; a barrel chest deformity develops
7. Abnormal posture: forward head and rounded and elevated shoulders
8. Decreased endurance during functional activities.

Plan of Care

1. Decrease the amount and viscosity of secretions and prevent respiratory infections.

2. Remove or prevent the accumulation of secretion (emphysema, chronic bronchitis)

3. Promote relaxation of accessory muscles of inspiration.

4. Improve the patient's breathing pattern and ventilation.

5. Minimize or prevent episodes of dyspnea.

6. Improve the mobility of chest thorax.

7. Improve posture.

8. Increase exercise tolerance.

Intervention

1. Use of bronchodilators, antibiotics, humidification therapy, and encourage to being a non-smoker.

2. Coughing and Postural drainage to the areas where secretions are identified.

3. Positioning for relaxation:

1. Relaxed head-up position in bed 

2. Sitting: leaning forward, resting forums on the thigh, or on a table.

3. Standing: leaning forward on an object, with hands-on the thighs or leaning backward against the wall.

4. Relaxation exercise for shoulder:

1. Active shoulder shrug.

2. Shoulder and arm circle.

3. Horizontal abduction and adduction of shoulders.

5. Breathing exercises

6. Have the patient assume a relaxed, forward bent posture, that stimulates diaphragmatic breathing and reduced the respiratory rate by using pursed-lip breathing during expiration. 

7. Administer supplemental oxygen in a severe episodes of dyspnea.

8. Exercises for chest mobility provides the moment of the lower rib cage during the breathing.

9. Exercises and postural training to decrease forward head and rounded shoulder.

10. Graded endurance exercises. Can