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cardio-Respiratory asessment for physiotherapist

Research · July 2015

DOI: 10.13140/RG.2.1.2737.0080

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Subin Solomen
Governmental Medical College, Kottayam
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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

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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

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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

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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

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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

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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

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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

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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

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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:

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 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

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