See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/279871467

cardio-Respiratory asessment for physiotherapist

Research · July 2015

DOI: 10.13140/RG.2.1.2737.0080

CITATIONS READS
0 80,686

1 author:

Subin Solomen
Governmental Medical College, Kottayam
65 PUBLICATIONS   64 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Electrophysiology View project

electrotherapy View project

All content following this page was uploaded by Subin Solomen on 08 July 2015.

The user has requested enhancement of the downloaded file.

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

DEMOGRAPHIC DATA

 Name:
 Age:
 Gender:
 Address:
 Marital status:
 Religion:
 Occupation:
 Source of referral:
 Date of assessment:
 Source of history:

Chief complaints:

Symptoms Duration

 Breathlessness(SOB)
 Cough with or without expectoration
 Chest pain
 Noisy breathing –Wheezing/stridor

Associated symptoms

 Hemoptysis
 Hoarseness
 Voice changes
 Dizziness/fainty syncope
 Head ache
 Altered sensorium
 Ankle swelling
 Cyanosis

Constitutional symptoms

 Fever
 Excessive sweating
 Loss of appetite
 Nausea
 Vomiting
 Weight loss
 Fatigue
 Weakness
 Exercise intolerance
 Altered sleep pattern

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 1

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

History of presenting illness:

Description of symptoms:

Breathlessness

 Description of onset
o Date
o Time
o Type : sudden/gradual
 Setting
o Cause
o Circumstances
o Activities surrounding onset
 Severity
o How bad it is
o How it affects activities of daily living
 Frequency
o How often
 Duration
o How long
o Constant/intermittent
 Course
o Better/worse/same
 Associated symptoms
o Sweating
o Cough
o Chest discomfort
 Aggravating factors
o Position/weather/temperature/anxiety/exercise
 Reliving factors
o Position/hot/cold/rest
 During the status of episode
o Can you continue to do what you were doing
o Do you have to sit down or lie down
o Can you continue to speak
 Do the attack cause your lips or nail bed to turn blue

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 2

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

 Tick the activities disturbed by breathlessness

o Climbing stairs ( ) if yes how many steps
o Walking ( ) if yes how much distance
o Bathing ( )
o Toileting ( )
o Dressing ( )
o Combing ( )
o Shopping ( )
o Grooming ( )
o Speaking ( )
o Any other activities
 Exposure to the patients with tuberculosis
 Exposure to asbestos/sand blasting/pigeon feeding
 Visual analog scale : ___/10
 Modified Borg scale:
 American thoracic society shortness of breath scale:
 MRC Scale :
 Types of dyspnea
o Restrictive dyspnea
o Obstructive dyspnea
o Cardiac dyspnea
o Psychogenic dyspnea
o Acute dyspnea
o Chronic dyspnea
o Recurrent dyspnea
o Progressive dyspnea
o Paroxysmal dyspnea
o Episodic dyspnea
o Inspiratory dyspnea
o Expiratory dyspnea
o Orthopnea one P / Two P/ Three P
o Treopnea
o Platypnea
o PND

Differential diagnosis:

Cough

 Description of Onset
o Date
o Time
o Type – Sudden or Gradual
 Productive/non productive
 Setting
o Cause
o Circumstances
o Activity surrounding onset
 Severity
o How bad it is?
o How it affects activity of daily living?
 Quantity

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 3

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

o How many?
 Quality
o Characteristics
o Barking/brassy(harsh & dry)/hoarse/with stridor/wheezy/hacking
 Frequency
o How often?
o Particular day/ particular week/particular season
 Duration
o How long it last?
o Constant or intermittent?
 Course
o Better/worse/staying at the same
 Associated symptoms
o Chest pain/wheezing/fever/runny nose/hoarseness/night sweat/weight loss/head
ache/dizziness/ loss of consciousness
 Aggravating factors
o Position/weather/temperature/anxiety/exercise/smoking/eating/drinking/ particular
location
 Relieving factors
o Position/hot/cold/rest/medications
 Pattern of coughing
o Do you usually cough first thing in the morning
o Do you cough at other time during day or night
o Does the cough wakes you up
 Exposure to the patients with tuberculosis
 Exposure to asbestos/sand blasting/pigeon feeding
 Clinical presentation of cough
o Acute
o Sudden
o Paroxysmal
 Description of cough
o Effective-strong enough to clear the airway
o Inadequate –audible but too weak to mobilize secretions
o Productive (mucous or other material is expelled by the cough)
o Dry -moisture or secretions are not produced

Sputum
 Description
o Mucoid /mucopurulent/purulent/blood tinged
o GRADES
 Color
o Clear/colorless like egg white/black/brownish/frothy white/pink/sand
o Greenish/red jelly/rusty/
 Consistency
o Thin/thick/viscous/tenacious/frothy
 Quantity
o Scanty/ ____teaspoon/___cup/copious __ pint or more
 Time of the day
o Morning/evening
 Odor

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 4

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

 Presence of blood
 Other distinguishable material
Differential diagnosis:
Hemoptysis
 Amount : clot/massive
 Odor
 Color
 Appearance
 Acute/chronic
 Frequency
 Streaky/Non streaky/FROTHY BLOOD TINGED
 Associated symptoms
o Warmth
o Bubbling sensation
o With chest pain/dyspnea
o WITHOUT COUGHING
o Nausea/vomit/cough
 History of smoking
 History of nose bleed
 History of accidents
 Traveled lately?
 Exposure to patients with tuberculosis
 History of recent surgery
 Family history-bleeding disorders
 Medications such as aspirin/oral contraceptives

Differential diagnosis

Chest pain
OPQRSTU FORMAT
 Origin
o location
 Onset
o Date
o Time
o Type Sudden/gradual
 Pattern
o Frequency : How often
o Recurrence
o Duration How long it lasts
o Constant or intermittent
o Course :better/worse/staying the same
 Provoked symptoms(aggravating factors)
o Breathing
o Positions :Lying flat/side lying
o Movement with arms
o Rest/exercise
o Sleeping/stress/after eating
o Stress/anxiety
 Quality

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 5

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

o Dull/ aching/pin prickling/throbbing/knife

like/sharp/constricting/sticking/burning/shooting/tearing
 Radiating
 Referred
 Relieving factors
o Rest
o Positions
o Analgesics
o Antacids
o Hot
o cold
 Severity
o How it affects ADL
o VAS scale
 Associated symptoms
o Coughing/breathlessness/palpitations/hemoptysis/vomiting/ leg pain/weakness/muscle fatigue
 Time frame
o Acute/chronic
 Past treatment
o Past history of pain
o How it subsided/rest/medicines
o Past history of heart attack/recent infection /history of pulmonary disease/accidents
o Family history of heart disease
 What do you think is wrong
o Is this different from previous episodes

Differential diagnosis:

Fever
 Description of onset
o Date
o Time
o Type : sudden/gradual
o How did you measure your temperature?
 Frequency
o How often
 Duration
o How long
o Constant/intermittent
o Did it rise then disappear then reappear
 Course
o Better/worse/same
 Associated symptoms
o Chills/head ache/fatigue/cough/diarrhea/pain
o History of sore throat/ear ache/ neck swelling
o Sweating –diaphoresis/night sweats
o Cough
o Chest discomfort
 Aggravating factors
o Position/weather/temperature/anxiety/exercise

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 6

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

 Reliving factors
o Position/hot/cold/rest
 Past history
o History of recent infections/recent wound
o History of tick/insect/spider bite
o History of exposure to high temperature for prolonged time like playing sports/work
o History of surgery/blood transfusion/
o History of medications
o Thyroid/antidepressants/amphetamines/anticholinergics
 Type of fever
o Sustained- continuously elevated for 24 hours
o Remittent- continuously elevated with diurnal variations
o Intermittent- daily elevation with return to normal
o Relapsing- recurring in bouts

Past medical history

o Surgeries & hospitilisation

o Injuries & accidents
o Immunization
o Allergies
o Medications
Past history
SL No Disease Medications duration

1 Diabetes

2 Hypertension

3 Other

Personal history
History of smoking Yes/no
o Types of tobacco
o How old when the patient begin smoking
o How many years the patient smoked
o How many cigarettes smoked each day
o Any variation in smoking habits
o Any attempt to stop smoking
o Date when the patient last smoked
o Pack year:
History of alcohol intake yes/no
o How old when the patient started alcohol
o How many years the patient consumed
o How many pegs each day
o Any variation in alcoholic habits
o Any attempt to quit alcohol
o Date when the patient last taken

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 7

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

Family history:

Occupational history:

Environmental history:

Differential diagnosis from history

Sl Condition Positive Negative
No

Objective assessment
Height:

Weight:

BMI:

Clinical presentation:

o General appearance: cardiopulmonary distress/anxiety/pain

o Awake /alert(conscious)/attentive/comprehensive
o Body type:
Ectomorphic/endomorphic/mesomorphic/sthenic/hypersthenic/hyposthenic/asthenias/cachetic/deb
ilitated/failure to thrive

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 8

Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

Vital signs:
o Temperature
o Pulse rate
o Respiratory rate
o Blood pressure

Pulse Rhythm:

o regular,
o regularly irregular, bigeminy or trigeminy
o irregularly irregular if yes
 check heart rate ___,pulse deficit___
Pulse Volume:
Absent-0
Diminished -Weak, thready-1+
Normal- 2+
Increased –bounding 3+

Apnea/Eupnea/Bradypnea/Tachypnea/Hypopnea/hyperpnea/sighing/intermittent
IPPA format: inspection, palpation, percussion, auscultation
Inspection & observation
HENT (head, eyes, nose, and throat)
Head

o Facial expression
o Forehead
o Eyes-PERRLA
o Eyes-Sclera clear/muddy,palor,ictrus
o Eyelid -ptosis
o Nose –nasal flaring
o Lips- Cyanosis
o Lips-Pursed lip breathing
Neck
o Position of trachea: midline/right/left
o Jugular venous pressure: normal/increased/markedly increased
o Use of accessory muscles- SCM/PMi/Tr
o Prominence of accessory muscles
o Trail sign
o Tracheal tug or oliver sign

Thorax

o COPD Posture: rounded shoulders, protruded neck, kyphosis, outstretched hands

o AP:T Ratio: 5:5/5:6/5:7 barrel chest: present/absent
o Chest wall deformities: Pectus carinatum/Pectus excavatum/ kyphosis/ scoliosis/ kyphoscoliosis
o Type of breathing: rapid/shallow/deep
o Effort of breathing: minimal on inhalation and passive on exhalation
o Pattern of breathing: Thoraco abdominal/abdomino thoracic
o Abnormal breathing pattern: Apnea/Biot’s//Cheyne-stokes/ Kussmauls/ paradoxical/
asthmatic/flail chest
o I:E ratio:
o Labored Breathing signs:

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 9

 Padmashree Institute of Physiotherapy CARDIO-RESPIRATORY ASSESSMENT

 Intercostals indrawing/retractions
 Supra clavicular indrawing
 Sub costal indrawing
 Hoovers sign
 Harrisons sulcus

Abdomen: abdominal paradox

Extremities
 Upper limb
o Clubbing: schamroth window test___, grade___,clubbing index__
o Cyanosis:
o Nicotine stain:
o Capillary filling time:
o Tremor
 Lower limb
o oedema
Palpation
o Tracheal position
o Subcutaneous emphysema
o Tenderness on accessory muscles
o Palpation of lymph nodes: axillary /cervical/supraclavicular
o Symmetry: symmetrical/asymmetrical
 Upper zone
 Middle zone
 Lower zone
o Tactile Vocal fremitus
 Upper zone
 Middle zone
 Lower zone
o Tactile rhonchial fremitus
o Percussion
 Type of note: resonant/hyper resonant/ stony dullness/woody dullness
 Level of right border
 Level of left border
 Level of heart border
 Level of diaphragmatic excursion
o Pedal oedema
 Pitting/non pitting
 Grade
 Level or extent of oedema
o Peripheral skin temperature
Auscultation
 Quantity of breath sound
 Quality of breath sound
 Added sound
o Inspiration : early/mid /late, fine/coarse
o Expiration : wheeze/rhonchi
 Vocal resonance: whispering pectoriloquy,aegophony
 Chest expansion
 Upper zone
 Middle zone
 Lower zone

Prepared by Subin Solomen MPT(M’pal) Cardio-Respiratory Page 10

View publication stats