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Assessment Format - Cardio

The document outlines a comprehensive cardio-respiratory assessment form used at Padmashree Dr. D.Y. Patil College of Physiotherapy, detailing sections for demographic information, chief complaints, history of present illness, and various physical examination findings. It includes specific assessments for symptoms like dyspnea, cough, sputum, chest pain, and fever, along with vital signs and general observations. Additionally, it provides space for treatment plans, outcome measures, and physiotherapy management strategies.

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chavanpratiksha933
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183 views8 pages

Assessment Format - Cardio

The document outlines a comprehensive cardio-respiratory assessment form used at Padmashree Dr. D.Y. Patil College of Physiotherapy, detailing sections for demographic information, chief complaints, history of present illness, and various physical examination findings. It includes specific assessments for symptoms like dyspnea, cough, sputum, chest pain, and fever, along with vital signs and general observations. Additionally, it provides space for treatment plans, outcome measures, and physiotherapy management strategies.

Uploaded by

chavanpratiksha933
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PADMASHREE Dr. D.Y.

PATIL COLLEGE OF PHYSIOTHERAPY


Dr. D.Y.PATIL VIDYAPEETH, PUNE
(DEEMED UNIVERSITY)
(Accredited by NAAC with ‘A’ grade)
CARDIO-RESPIRATORY ASSESSMENT

DEMOGHAPHIC DETAILS

Name: Age:

Gender: Address:

Occupation: IP no.:

Date of admission: Date of assessment:

CqHIEF COMPLAINTS:



HISTORY OF PRESENT ILLNESS:

DESCRIPTION OF SYMPTOMS:

1) Dyspnea :
 Duration
 Severity
 Pattern
 Diurnal variation
 Positional variation
 Aggravating factors
 Relieving factors
 Level of functioning
 Associated with exposure to allergens

DYPCPT – Cardio-Respiratory Assessment Page 1


Grades of Dyspnea:

 NEWYORK HEART ASSOCIATION CLASSIFICATION


(OR)
 MEDICAL RESEARCH COUNCIL CLASSIFICATION
(OR)
 AMERICAN THORACIC SOCIETY CLASSIFICATION

2) Cough:
 Type:
 Frequency:
 Duration:
 Aggravating factor:
 Relieving factor:
 Nature:
 Has cough since________ years _____months.

3) Sputum:
 Colour
 Consistency
 Volume
 Odour
 Haemoptysis (if present, check the following):
 Duration
 Recurrent
 Nature
 Severity
4) Chest Pain:
 Onset:
 Duration:
 Nature:
 Area:
 Aggravating factor:
 Radiation:

DYPCPT – Cardio-Respiratory Assessment Page 2


5) Fever:
 Duration:
 High grade/Low grade:
 Intermittent:
 Associated with chills or rigors/sweating:
 Diurnal variation:

HISTORY OF PAST ILLNESS:

CURRENT MEDICATION HISTORY:



SURGICAL HISTORY:

PERSONAL HISTORY:

 Diet:
 Appetite:
 Sleep:
 Bowel/bladder:
 Alcohol history:
 Smoking (pack years):

DYPCPT – Cardio-Respiratory Assessment Page 3


FAMILY HISTORY:

SOCIOECONOMIC HISTORY:

OCCUPATIONAL HISTORY & ENVIRONMENTAL HISTORY:

VITALS: B.P: Temp.:

R.R: SpO2:

P.R:

Level of consciousness: GCS

GENERAL OBSERVATION :-

Built:

Posture:

Head and neck:

Head: Facial expression

Bobbing of head:

Nasal flaring

Cyanosis :

Pursed lip breathing:

Pallor :

Oedema and puffiness:

DYPCPT – Cardio-Respiratory Assessment Page 4


Neck: -

Tracheal position:

Trail sign:

Tracheal tugging:

JVP:

Use of accessory muscles:

Thorax:

Hollowness or retraction

Thoracic configuration

Deformities

Breathing pattern

I:E ratio

Symmetry

Epigastric excursion

Incision/scars/wounds

Extremities-

Cyanosis Clubbing:

Nicotine stains Tremors:

Wasting and weakness

Peripheral /pedal edema

Presence of varicose veins.

Presence of equipments

DYPCPT – Cardio-Respiratory Assessment Page 5


EXAMINATION:

Inspection:-

 Thoracic configuration
 Chest expansion
 Chest symmetry
 Extension of scar
 JVP

Palpation:-
 Lymph nodes(Inflammation and carcinoma)
 Tracheal position
 Tenderness
 Subcutaneous emphysema
 Point of maximal impulse/ Apex beat-
 Tactile fremitus
 Capillary perfusion
 Oedema

Percussion:-

 Flatness/Dullness/Resonant/Hyper-resonant/Tympany
 Diaphragmatic Excursion:

Auscultation:

 Breath sounds:
 Adventitious sounds:
 Vocal resonance:
 Heart sounds:

Measurements:

Incision/Scar measurement:
Oedema/girth measurement:
Pressure sore:

DYPCPT – Cardio-Respiratory Assessment Page 6


NEUROLOGICAL EXAMINATION:

MUSCULOSKELETAL EXAMINATION:

INVESTIGATIONS:

 X-RAY:
 PFT:
 ABG:
 ECG:
 BLOOD PROFILE:
 ABI:

PROBLEM LIST:

IMPAIRMENTS:

 Structural:

 Functional:

ACTIVITY LIMITATION:

PARTICIPATION RESTRICTION:

DYPCPT – Cardio-Respiratory Assessment Page 7


OUTCOME MEASURES USED:

Exercise tolerance tests:

Scales/Questionnaire:

TREATMENT PLANS:

Short term goals:

Long term goals:

PHYSIOTHERAPY MANAGEMENT:

DYPCPT – Cardio-Respiratory Assessment Page 8

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