SISTER NIVEDITA GOVT.

NURSING COLLEGE
IGMC SHIMLA

SUBJECT – ADVANCE NURSING PRACTICE

PHYSICAL ASSESSMENT ON COPD

SUBMITTED TO: SUBMITTED BY:

MRS. PRABHAT KIRAN MS. POOJA KAUNDAL

ASSOCIATE PROFESOR M.Sc. (N) 1ST YEAR

COMMUNITY HEALTH NURSING ROLL NO.- 14

SNGNC IGMC, SHIMLA SNGNC IGMC, SHIMLA

SUBMITTED ON:-10/04/2025
 IDENTIFICATION DATA OF THE PATIENT

Patient’s Name: Mrs Vidya devi

Age: 55yrs
Gender : female
Husband Name: Mr. Delu Ram
IPD No.:921002240024300
Ward: Female Medicine Unit /02
Bed No. 20
Marital Status: Married
Address: VPO – Banjar, Teh and Distt_ Kullu (H.P)
Education: 10th pass
Occupation: house wife
Income per Month: 15,000
Religion: Hindu
Date of Admission: 26 /03/2025;09:23:45
Informant: Son
Diagnosis: COPD with RHF (Right heart failure)
Doctor’s Name: Dr Malaya sarkaar

CHIEF COMPLAINTS WITH DURATION:

Pain in upper left quadrant radiating to back × 2days

Shortness of breath × 2days

fatigue × 2days

HISTORY OF PRESENT ILLNESS: Pt was apparently well before two days when she
started having pain in left upper quadrant radiating to back with no aggravating or relieving
factors. Patient has complaints of shortness of breath while walking and fatigue for last 2 days

PAST HEALTH HISTORY

 Adult illness: No history of previous illness

  Child hood illnesss: History of chickenpox at 12 years of age, no H/O mumps,
Tuberculosis, or any other diseseses,
 Accidents/injuries: no H/O any accident and injury.
 Hospitallizations: patient has history of previous hospitalization 3 months back in
Kullu for similar kind of problem.
 Allergies: No history of any kind of allergy found to any drug, food etc.
 Medications: patient has history of ATT intake 10 years back.

FAMILY HISTORY

 Family composition- joint family

 Number of family members- 6 family members

S.no Name Age Gender Relationship Education Occupation Health

with patient and income status

1. Delu Ram 62 Male Husband 10th pass Farmer / 10,000 Healthy

yrs

2. Vidya devi 55 Female Patient 8th pass housewife Unhealthy

yrs

3. Santosh 37 Male Son Graduate Private job/ Healthy

yrs 15,000

4. Geeta 32yr Female Daughter-in- Undergradu housewife Healthy

law ate

5. Rahul 15 MCH Grand Son 10th Student healthy

yrs

6. Ankita 12yr FCH Grand 7th class Student healthy

s daughter

FAMILY TREE-
 Delu Ram Vidya Devi
GENOGRAM KEY-
Female =

Santosh Geeta
Male =

Deceased male =

Rahul Ankita
Deceased female =

 History of any recent death in the family- No H/O recent death in the family .
 History of consanguinity- No H/O any consanguinity in the family .
 Any other significant data- No H/O CAD , DM ,HTN , Renal disease, cancer , psychiatric
history in the family .

VI. LIFESTYLE AND HEALTH PRACTICES

 Dietary Pattern- patient is non vegetarian and take meal three time in a day .
 Bowel and bladder habit- Patient drink 6-8 glass of water/ day and take meal three time per
day ( Bowel and bladder habit normal ) .
 Physical activities and exercise- Patient cannot perform even household work (patient is
unable to perform physical activities and exercise)
 Work pattern- no work routine is followed
 Use of any addictive substance/drugs- patient was smoker and alcoholic but now she don’t
smoke &drink.
 Sleeping and rest pattern- patient is not able to sleep at night properly due to breathless while
in lying down position.
 Hobbies- Singing, & cooking
 Relationship with family, friends, significant others- Patient has good interpersonal
relationships with family, friends and other significant peoples.
 Social activities for fun and relaxation- patient social activities for fun and relaxation is
cooking food for family, & singing for relaxation.
VII. ENVIRONMENTAL HISTORY
 Environmental hygiene- patient live in village i.e . Less polluted and good environment
 Sources of drinking water- Tap water supply
 Environmental pollution- No pollution in the village
 Disposal of excreta- there is proper disposal of waste and sanitation facility.
 Presence of flies/ mosquitoes / rodents- No flies / mosquito and rodents in her house
 Health care facilities- [PHC/CHC/ Nursing home]- CHC
 Any other- Other type of significant data not found .

VII. PHYSICAL EXAMINATION

General Appearance

 Level of consciousness- conscious

 Orientation- Oriented to time, place & person
 Pallor/ cyanosis / Jaundice / Edema / Clubbing- Pt has clubbing of fingers
 Mood- sad
 Activity- Dull
 Body built- Thin

Anthropometric Measurment

 Weight [kg]- 52 kg
 Height - 154 cm
 BMI- 21.9 (normal)

VITAL SIGNS

Day/ date Temperature Pulse Respirations Blood pressure Pain on

VAS

26 /03/25 100° F 120 b / min 24 br/ min 110/70mmHg 8

27/03/25 99.4 °F 104 b /min 22 br / min 130/ 80 mmHg 7

28/ 03/ 25 99° F 94br / min 20 br / min 114/ 78 mmHg 7

 SYSTEMIC EXAMINATION:

SUBJECTIVE DATA OBJECTIVE DATA

 Level of consciousness- concious

 Orientation- oriented to time place person
LEVEL OF
 Speech: Clear
CONCIOUSNESS
 Memory (Immediate/Recent/Remote): immediate/ recent/ remote
AND memory of patients is good .

MENTAL STATUS  Mood, feelings - Sad

 Dress and grooming- well groomed
 Hygiene- hygiene maintained
 Facial expression- anxious
 Abstract reasoning & Judgement: abstract reasoning and judgment of
patient is good

HEAD AND NECK HEAD

Inspection and palpation

 Hair- well distribute & grey, clean and dry .

 Any abrasions/wound- there is no abration and wound .
 Size, shape and configuration- Normocephalic
 Any involuntary movements- involuntary movement absent
  Palpate for uniformity- on papation head is smooth no lesion and lump
.

FACE

Inspection and palpation

 Shape, movement, expression and skin- oval shape , no involuntary

movement , anxious expression and skin colour is fair .
 On palpation of temporal artery- palpable, normal findings
 Palpation of temporomandibular joint- normal findings

NECK

Inspection

 Position, symmetry, lumps or mass- Central, midline no lump and mass

present .
 Movements of neck structure: normal flexion, extension and rotation
 Cervical vertebrae: normal
 Range of motion- flexion extension lateral abduction and is possible.

Palpation

 Trachea- position is Central and no mass is there

 Thyroid gland- normal landmaks no lump and no mass
Findings : No abnomality found related to head face and neck all findings
are normal .

SUBJECTIVE DATA OBJECTIVE DATA

EYES INSPECTION OF EXTERNAL EYE STRUCTURE

 Use of contact lenses/glasses- patient don't use glasses

 Eyelids and eyelashes- symmetrical and well distributed
 Lid margin- normal findings
 Any redness, swelling, discharge or lesion- no redness, no swelling , no
 discharge and no lesion .
 Sclera- white in colour
 Lacrimal apparatus- normal findings
 Cornea: normal
 Iris : round and brown

PUPIL-

 Pupillary reaction to light- pupils are reacting to light

 Size and shape- round and 3 mm .

Test distant visual acuity-6/6 normal findings

Test near visual acuity-6/6 normal findings

EARS EXTERNAL EAR STRUCTURE

Inspection

 Size and Shape: Normal size and shape of patients ear.

 Position And Alignment: Normaly positioned and symmetrical
 Redness/Abnormal discharge/Foreign Body: No redness/ no abnormal
discharge / No foreign body .
 Use of Hearing Aids: No use of hearing aids

Palpation

 Auricle and mastoid process: no pain and tenderness present.

INTERNAL EAR STRUCTURE

Inspection

 Auditory canal: No nodule and earwax .

 Tympanic membrane and eardrum: normal findings.

Hearing and equilibrium tests

  Whisper test- not performed
 Weber’s test - not performed
 Rinne test- not performed

NOSE AND SINUSES NOSE

Patient have no problem  Nasal septum- Central

or complaint regarding  Nasal polyps- Absent
nose .  Nasal discharge- Absent
 Nasal flaring- not present, no complaints
 Sense of smell- normal findings
 Sinuses: no pain, non tender and normal findings.

SUBJECTIVE DATA OBJECTIVE DATA

MOUTH AND THROAT

MOUTH AND Inspection and palpation

THROAT
 Lips- the lip tissue are resilient, smooth and pink in color .
Patient have no  Teeth- 25 teeth,white in colour and dental carries present.
complaints regarding  Gums- pink in colour and no lesion and mass present.
mouth and throat  Buccal mucosa- No lesion and mass .
 Tongue- Pink in colour and dry .
 Sense of taste: normal
 Hard and soft palate and uvula- normal consistency and no lesion
present.
 Odour from mouth- Halitosis present
 Tonsils- no abnormality found .
AXILLA AND AXILLA
BREAST (in case of
Inspection and palpation
female)
 Mass/ tenderness / lesions- no mass tendernesss and lesion present .
No complaints regarding
 Axillary nodes- no abnormality found.
axilla and breast
BREAST
  Size and symmetry: normal size
 Colour and texture: normal
 Superficial venous pattern: normal
 Areola (colour/size/shape/texture): normal size shape and texture
 Nipples (size/direction/discharge/lesion/etc.): No discharge is present.
 Retraction or dimpling: normal findings
 Any other (masses): no mass and lesions

RESPIRATORY Inspection
SYSTEM
 Size/shape of chest- barrel shape chest, with increased anterior
Patient says that she have posterior diameter
difficulty in breathing and  Observe colour of face, lip and shape of nails: face colour fair, lip
shortness of breath colour is blackish, nails are rounded (clubbing)
present.  Patient is on room air/ oxygen/ Bi PAP/ventilator: patient is on oxygen
therapy, Oxygen given by venturi mask @ 10-14 L/hr
 Respiratory pattern: shortness of breath present
Palpation
 Tenderness: tenderness is present over left upper quadrant
 Abnormal masses: no masses felt on palpation
Percussion

 Any fluid or air filled cavity: no fluid and air cavity seen
Auscultation

 Breathing sound – prolongrd expiration, adventitious lung sounds i.e.

wheeze and crackle sounds present

SUBJECTIVE DATA OBJECTIVE DATA

CARDIOVASCULAR HEART [PRECORDIUM]

SYSTEM
Inspection

 Jugular venous pulses- 6 to 8 cm H2O.

Patient have no Palpation
complaints regarding
 Apical impulses- apical pulse is palpable
cardiovascular system.
 Any pulsation or vibrations present in the area of apex, left sternal
 border or base- no pulsation or vibration present in the area of Apex,
left sternal border or base .
Auscultation

 Rate- 120 beats per minute

 S1 and S2 sound- S1 and S2 ( lub and Dub ) sound are normal
 Extra heart sound- No extra heart sound is there .

GASTROINTESTINAL ABDOMEN

SYSTEM  Abdominal girth- 78cm

 Bowel pattern- patient has bowel movement 1 time a day usually in the
Patient have no
morning but altered due to disease conditions.
complaints regarding
Inspection
gastrointestinal system.
 Colour of skin- pale
 Vascularity of skin- normal
 Assess for lesion/ scars and rashes- no lesion and scare and rashes
 Observe for umbilicus for skin colour, location- yellowish colour
normally located .
 Abdominal contour and symmetry - typically flat or rounded and
symmetrical
 Peristaltic waves- 8–9 seconds
 Observable mass- no mass seen
Auscultation

 Bowel sound- 2 bowel sounds per minute

Percussion

 Any fluid filled cavity (Ascites): not present

Palpation

 Light palpation to find tenderness and muscular resistance- no

tenderness
 Liver- not palpable
 Spleen- not palpable
 Kidney- not palpable
 Urinary bladder- not palpable
 SUBJECTIVE DATA OBJECTIVE DATA

SKIN, HAIR AND SKIN

NAILS
Inspection
Patient says that her skin
 Skin colour- hyperemia present on inspection of skin
colour is normal .
 Any odour from skin- not present
 Skin integrity- intact
 Presence of lesion/ abrasion- no lesion and abrasion present
Palpation

 Thickness- normal
 Moisture/Temperature: normal
 Skin mobility and turgor- normal
 Presence of oedema- no edema or swelling

HAIR

Inspection

 Distribution of hair over body, scalp, axilla, and pubic area- properly
distributed
NAILS

Inspection

 Grooming and cleanliness- well groomed and cleaniness is present

 Colour and marking- colour is pink
 Shape of nails - oval
CRANIAL NERVES

NEUROLOGIC 1. C.N-1[Olfactory]-smell- Patient is able to describe odor

SYSTEM 2. C.N-2[optic]-vision- Patient has 20/20 near and far vision.
3. C.N-3,4,6[oculomotor, trochlear and abducens]
Patient have no complaint
- Assess eyelid margin- Pupils are equal and round
regarding neurological
system Pupil assessment

RIGHT EYE LEFT EYE

 1. Equal or Unequal Pupils are equal Pupils are
and round equal and
round

2. Reactive or Nonreactive Reactive to light Reactive to

light

3. Brisk or Sluggish Brisk Brisk

4. Size (mm) 4 mm 4mm

Nystagmus and drooping of upper eyelid [ptosis]- not seen

SUBJECTIVE DATA OBJECTIVE DATA

4. C.N.5[trigeminal]
Motor function
 Ask the patient to clench the teeth, then palpate the temporal and
masseter muscle- normal findings
Sensory function
 Test for light touch with the wisp of cotton- normal findings
 Test for corneal reflex- normal findings

5. C.N.7[ facial]
 Motor function- normal motor function
 Sensory function- normal sensory function
6. C.N. 8[ vestibulocochlear]
 Whispered test- normal
 Weber and Rinne test- normal
7. C.N. 9 and 10 [ glossopharyngeal and vagus]
Motor function- normal

Gag reflex- normal

Patient ability to swallow- patient is able to swallow food

8. C.N.11 [ spinal accessory]

 Assess the trapezius muscles for contraction against resistance-
 normal findings
Assess the sternocleidomastoid muscle against resistance- normal
findings

9. C.N. 12[ hypoglossal]

MOTOR AND CEREBELLAR SYSTEM

Inspection

 Muscles; size symmetry, strength, tone, unusual involuntary

movements- symmetrical size strength tone normal no involuntary
movement seen
 Gait and balance: normal gait and balance
 Romberg test- normal
SENSORY SYSTEM

Assessment of co-ordination

 Finger to toe test- normal

SUBJECTIVE DATA OBJECTIVE DATA

 Heel to shin test- normal

 Assessment of light touch, pain, and temperature- no abnormality
found.
 Vibratory sensation test- normal findings
 Tactile discrimination- normal findings
Deep tendon reflex

Biceps Tricep Brachioradiali Patella Achille

s s r s

LEFT Norma Normal Normal Normal Normal

l

RIGH Norma Normal Normal Normal Normal

T l
 Superficial reflexes

Test for meningeal irritation-

 Brudzinski’s sign- normal findings

 Kerning’s sign- normal findings
MUSCULOSKELETAL Inspection
SYSTEM
 Gait: normal
Patient have no problem  Patient’s ability to walk and move around- patient is able to move
or complaint regarding around and walk properly
muskuloskeletal system  Foot position, posture and arm swing during walk- foot position and
posture and arm swing during walk is normal .
ARMS

Inspection

 Colour, size: fair in colour and symmetrical

 Venous pattern and oedema/swelling- venous pattern normal and no
edema and Swelling.
 Any lesion/scar or ulcer: no lesion scar and ulcer seen in patient
 Movement: flexion and hyperextension, adduction and abduction,
external and internal rotation normal .
Palpation

 Tenderness, and warmness- no tenderness

 Capillary refill time- 2 sec
 Radial pulse- normal
 Brachial pulse- normal
 Allen test- normal findings

LEGS

Inspection

 Colour, size: pale and symmetrical

SUBJECTIVE DATA OBJECTIVE DATA

 Venous pattern and oedema/swelling- edema and swelling of legs

 present
 Any lesion/scar or ulcer: no lesion and scar
 Distribution of hairs- normal distribution of hairs
 Movement: normal findings
Palpation

 Tenderness and temperature of feet and legs- tenderness present and

temperature of feet and legs is raised
 Superficial inguinal lymph nodes- not seen
 Femoral pulses- normal
HIPS

Inspection and palpation

 Assess patient’s ability to stand, symmetry- Patient is able to stand ,

and symmetrical.
 Tenderness and pain: no tenderness and pain
 Movements flexion and hyperextension adduction and abduction
normal .

SUBJECTIVE DATA OBJECTIVE DATA

FEMALE GENITALIA EXTERNAL GENITALIA

Patient have no problem Inspection

or complaints regarding
 Urinary catheter present / absent: urinary catheter present
genitourinary system.
 Assess the mons pubis, inguinal lymph: no complaints
 Labia majora, clitoris, minora and perineum: normal findings

Palpation
 Bartholin’s gland (swelling, pain, discharge): no swelling,pain and
discharge seen in bartholin s gland
  Urethra (discharge, tenderness): no discharge and tenderness seen .

INTERNAL GENITALIA

Inspection
 Observe the size and angle of vaginal opening: not assessed
 Assess vaginal musculature: normal
 Assess the vagina (redness, lesion, colour, discharge): no redness,
lesion , normal colour and no discharge.
 Bimanual examination (tenderness, lesions, pain): no tenderness, lesion
or pain

ANUS AND RECTUM

Inspection
 Inspect anal opening area for lump, ulcer, lesion, rashes, haemorrhoids
and fissures,: no Lump ,ulcer , rashes , redness, fissure or hemorrhoids
are present.
 Assess sacrococcygeal area for swelling, redness, dimpling or hair, etc:
no swelling, redness and dumplings of hair present.
Palpation

Patient has. No  Anus: any sphincter tightness, bleeding, pain, etc: No such complaint
complaints regarding present in case of patient
anus and rectum.  Rectum: presence of smoothness, tenderness, nodules, irregularities,
etc.—not present
 Prostate gland: (normally nontender and rubbery): __
 Inspect stool, if available: not available.
IX. LABORATORY INVESTIGATIONS

S.NO INVESTIGATIONS PATIENT NORMAL REMARKS

VALUE VALUE

1. Complete blood count

Red blood cells count 3.08 3.8-4.8 mol / ul Normal

Hb 17.1 g/dl 12.0 - 15.0g/ dl Increased

Hematocrit 52.80 36-48% Increased

Mean corpuscular volume 93.80 83.0-101/l Normal

Mean corpuscular HGB 34.1 27-35 pg Normal

Mean corpuscular Hb 32.4 31.5-34-5 g/ dl Normal

conc.

Red cell distribution width 11.4 11.6- 14.0 % Normal

2. WBC differential count

Lymphocytes 27 20-40 % Normal

Neutrophils 63 40-70% Normal

Eosinophils 3.0 0-6% Normal

5. Lipid profile

Total cholesterol 155 150-200mg/ dl Normal

 Triglyceride 188 75-150mg/ dl Raised

HDL cholesterol 40 35-55mg/ dl Normal

LDL cholesterol 77 0-100mg/dl Normal

6 Thyroid function test

T3 0.25 0.7-2.04 Normal

T4 5.71 5.0-14.10 Normal

TSH 60.24 0.30-5.50 Increased

7 Electrolytes

Na 127 135-145 mmol/l Decreased

K 3.70 3.5-5.1mmol/l Normal

Cl 106 101- 109 mmol/ l Normal

ABG-

PaO2 -77.2 mmHg

PaCO2 -80.6 mmHg

PH - 7.322

HCO3 – 40.8mmol / l.

Reports of radiological investigation:

X-RAY CHEST: hyperinflated lungs

ECG: Shows sinus tachycardia

MEDICATIONS
SN Drug Dose, Action Indications contraindicati Nursing
O Route,Frequ ons responsibility
ency

01. Inj ceftriaxone 1g, IV, BD Antibiotic- to treat Allergy to Right patient
cepahlospori certain ceftriaxone
Right dose
n infections
GI bleeding
Right route
*Ceftriaxone *before
Nasal polyps
is a surgery to Right time

bactericidal prevent
agent that infection
acts by
inhibition of
bacterial cell
wall
synthesis

02. Inj 500MG,IV,O Antibiotics: *COPD *hypersensitiv Observe for

azithromycin, D inhibition of ity sign and
Pneumonia
bacterial symptoms of
*pt on
protein *pharyngitis/
antipsychotic anaphylaxis
synthesis, tonsilitis

inhibition of *urethritis/
proinflamma sinusitis
tory
cytokine
production,
inhibition of
neutrophil
infestation,
and
macrophage
polarization
alteration,
gives it the
ability to act
 against a
wide range
of
microorgani
sms

03. Inj. Lasix 20mg, IV, Diuretic: *fluid *hypersensitiv *monitor

BD works by retention in ity daily weight
inhibiting CHF, Liver
*anuria & maintain
electrolyte disease,
intake and
reabsorption
*nephrotic output
from the
syndrome
kidneys and *notify if

enhancing hypotension,

the excretion oliguria,

of water weakness

from the occur.

body.
04. INJ Pantop 40mg, IV, Protone * Protone hypersensitivit Check
OD pump pump y physician
inhibitor -in inhibitor -in order.
the gastric the gastric
*Monitor
parietal cell parietal cell
vital sign.
of the of the
stomach, stomach, *check for

pantoprazole pantoprazole hypersensitivi

covalently covalently ty

binds to the binds to the

H+/K+ ATP H+/K+ ATP
pump to pump to
inhibit inhibit
gastric acid gastric acid
and basal and basal
acid acid
secretion. secretion.

05 Inj 500mg, it inhibits intestinal *hypersensitiv *administer

Metronidazole IV,TDS protein amebiasis, ity oral dose with
synthesis by *liver food
interacting amebiasis,
*check liver
with DNA, bacterial
enzymes
and causes a septicemia,
regularly in
loss of bone and
case of liver
helical DNA joint
disorder
structure and infections,
strand *meningitis, *teach pt

breakage . brain about the side

abscess, effects like

endocarditis, dry

*lower mouth,nausea

respiratory ,vomiting

tract
infections,
06 Neb 6 hrly, Budesonide *COPD *hypersensitiv *assess lung
foracort(formet : on ity sounds,pulse,
inhalation *Asthma
rol+budesonid inhalation BP before
route.
e) reduces administration
inflammatio
With *monitor PFT
n in the
Duolin(levolin before
airways in a
+ipratropium)S initiating and
dose-
OS during
dependent
therapy
manner

Formetrol:
bronchodilat
or,works by
relaxing
muscles and
widening the
airways of
lungs

HEALTH EDUCATION

1. Stop Smoking

 Smoking hurts your lungs and makes COPD worse.

 If you smoke, try your best to quit. Ask your doctor for help, or use things like
nicotine gum or patches.
 Stay away from other people’s smoke, too — it can also harm your lungs.

2. Avoid Dust, Pollution, and Strong Smells

 Try to stay indoors on days when the air is dirty or smoky.

 Avoid dust, strong perfumes, cleaning sprays, and smoke from fire or cooking.
 Keep your windows open when cleaning or cooking, or use a fan.
 You can wear a mask to protect yourself from dust or smoke when needed.

3. Stay Active (Move Your Body)

 Doing light exercise helps you breathe better and feel stronger.
 Try walking, stretching, or slow dancing — something you enjoy.
 Don’t overdo it — rest when you feel tired and breathe slowly.
  Ask your doctor about pulmonary rehab, a program that teaches safe ways to move
and breathe better.

4. Eat Healthy Food

 Eat small meals if large ones make it hard to breathe.

 Choose fruits, vegetables, lean meat, fish, eggs, rice, and whole grains.
 Drink plenty of water to help thin mucus so it’s easier to cough up.
 Avoid too much salt, which can cause swelling and make breathing harder.

5. Stay Away from Germs

 Get your flu shot every year, and get pneumonia and COVID-19 vaccines.
 Wash your hands often and stay away from sick people.
 Wear a mask in crowded places.
 If you feel like you’re getting sick (fever, more cough, or trouble breathing), see a
doctor early.

6. Take Your Medicine the Right Way

 Take your medicine every day, just as your doctor told you.
 Learn how to use your inhaler or breathing machine (nebulizer) properly.
 Keep your rescue inhaler with you in case you suddenly feel breathless.

7. Take Care of Your Feelings

 Feeling worried, anxious, or sad is common with COPD.

 Try deep breathing, relaxing music, or talking to someone you trust.
 Join a support group — it helps to talk to people who understand what you’re going
through.

8. See Your Doctor Regularly

 Go to your check-ups, even if you feel okay.

 Tell your doctor if you feel more tired, more breathless, or if you’re coughing more.
 Make a plan with your doctor for what to do if you have a flare-up (when symptoms
suddenly get worse)

9. Save Your Energy

 Rest between tasks — don’t rush.

 Sit down while cooking or showering.
 Ask for help when you need it.