The Nightingale Pledge was composed by a committee chaired by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.

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I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

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* Biographic Data -- includes the client's name, address, age, sex, marital status, occupation, religious preference, health care financing, and usual source of medical care

* Chief Complaint or Reason for Visit -- the client's answer to the question "What brought you to the hospital?" or "What is troubling you?" and expressed in the client's own words

* History of Present Illness -- includes the onset of symptoms, when the symptoms started, if their development was sudden or gradual, severity and frequency of occurrence, the site or exact location of distress; the character of the complaint, its intensity or quality of discharge, sputum, etc.; the client's activity which may be involved in the development of the problem, phenomena or symptoms associated with the chief complaint; and the factors that aggravate or alleviate the problem

* Past History -- includes childhood illnesses, immunizations, allergies to drugs, animals, or other environmental agents, accidents and injuries, hospitalizations for serious illnesses, and medications currently used

* Family History of Illness -- obtained to ascertain risk factors for diseases; Particular attention should be given to disorders such as heart diseases, tuberculosis, cancer, diabetes, hypertension, obesity, allergies, arthritis, bleeding, alcoholism, and any mental disorders.

* Lifestyle -- includes personal habits, diet, sleep/rest patterns, activities of daily living, instrumental activities of daily living, and recreation or hobbies

* Social Data -- pertains to quality of family relationships/friendships, ethnic affiliation, educational background, occupational history, economic status, and home and neighborhood conditions

* Psychological Data -- major stressors experienced by the client and his/her perception of them, including how the client copes up with these stressors

* Patterns of Health Care -- includes all the health care resources that the client is currently using and has used in the past

Bronchodilators:

* Beta-adrenergic agonists - reverse bronchospasm
* Theophyllines - reverse bronchospasm
* Anticholinergics - reduce mucus production

Corticosteroids - reduce airway inflammation

Exercise Program - improves patient's ability to cope with COPD

Lung Transplantation - reduces lung hyperinflation; improves diaphragmatic function, airflow, and exercise capacity

Mucolytics - help break up tenacious mucus; ease symptoms

Nutritional Support - combats weight loss that exacerbates advanced COPD

Oxygen Therapy - treats severe and progressive hypoxemia in advanced COPDs

Pneumococcal Vaccination & Yearly Influenza Vaccination - protect lungs from further damage from infection

Pulmonary Therapy - helps mobilize secretions; improves oxygenation

Smoking Cessation Program - reduces risk of cancer and heart disease; prolongs life expectancy