Cardiopulmonary Assessment

General Information:

Name:

Age:

Sex:

Presenting Complaints:

Subjective Assessment:

History:

History of Present illness: Onset, Duration, Severity

Past Medical History/Drug History/Surgical History: illness/surgeries/injuries/immunizations/allergies/hospitalizations/drugs presently being taken

Personal History: Drug abuse/ smoking/alcohol (Pack years)

Family & Social History: Family type/Physical, Emotional and Economic support in the family

Family health/ hereditary disorders

Occupational History: Particles/dusts/fumes/gases pertaining to various occupations.

Respiratory SymptomsDyspnea: Grade/ Type

Cough: Type/Characteristics/Productivity/24 Hr Pattern

Sputum: Quantity/Color/Consistency/Odor

Chest Pain: Location, Radiation, Character, Frequency, Intensity, Aggravating, Relieving factors.

Vital Signs: Temperature, Heart Rate, Respiratory Rate, Blood Pressure.

Observation/Inspection:

Built of the patient: Ectomorphic/ Mesomorphic /Endomorphic

Integumentary system:

Incision/Scar, Ulcers/ Wounds, Skin color/IV sites/ Catheters/ IC drainage/Any other equipments or tubes connected to the patient.

Facial Features: Dilation of pupil/Nasal Flaring/Sweating/Pallor

Neck: Jugular venous Pulse/ Accessory muscle usage.

Cyanosis: Central – Mouth, Tongue, Lips /Peripheral- fingers, Ear lobes, toes

Hand:

Clubbing – Absent/Present (Grade)

Tremor, Wasting of muscles, Nicotine Stain

Edema: Pitting/Non Pitting, Bilateral/ Unilateral, Facial edema

Chest appearance and movements:

Respiratory Rate:

Type of breathing: Thoracic/Abdominal

Abnormal breathing pattern:

Thoracic index:

Deformities: Spinal/ Chest

Objective Assessment: Examination:Chest expansion/ Thoracic mobility: Normal/ Increased/Diminished

Trunk Mobility (ROM of the Spine) – Normal /Diminished

Shoulder Mobility (ROM of the shoulder Joint) – Normal /Diminished

Auscultation:

Breath sounds:

Bronchial, Broncho-vesicular and vesicular- Normal/Abnormal

Adventitious Lung sounds:

Wheezes and Crackles - Present/Absent

Vocal resonance:

Bronchophony/Egophony/Whispered Pectoriloquy- Normal/Abnormal

Heart sounds: S1, S2, and S3 & S4

Murmur (Systolic/Diastolic): Present/Absent

Friction Rub: Pleural/Pericardial

Percussion:

Right Lung: Upper Lobe/Middle Lobe/Lower Lobe

Left Lung: Upper Lobe/Lower Lobe

Palpation:Tracheal/Mediastinal Shift: Present (Right/Left)/ Absent

Chest Wall Excursion/Thoracic Expansion: Normal/Diminished

Diaphragmatic Excursion: Inches of Thumb separation: > 5 Cm / < 5 Cm

Vocal fremitus/Tactile fremitus: Normal/Increased/Decreased

Accessory Muscle Usage: Present (Muscles Used)/ Absent

Tenderness: Present (Grade)/Absent

Local Skin Temperature: Normal/Cold/Increased Warmth

Edema: Pitting/Non Pitting. U/L, B/L, Feet, Hand, Facial

Pulse Examination: Radial, Brachial, Carotid, Femoral and Dorsal Pedis artery.

Point of Maximal Impulse (PMI): Normal/Shifted (right/left)

Capillary Refill Time: > 2 seconds/< 2 Seconds

Investigations:

Blood Study: RBC, WBC, Platelets, ESR, Lipid Profile, Electrolytes study.

Histological, Cytological, Microbiological Analysis: Carcinoma, infections etc

X-Ray: To assess Lung and Heart conditions

ECG: To analyze the electrical activity of Heart

Spirometry/PFT: To find Obstructive and Restrictive lung diseases

Pulse Oxymetry: For oxygen saturation.

ABG: To find the pH, assess acidosis and alkalosis

Echocardiography, CT/MRI Scan, Angiogram, Bronchoscopy

Exercise Tolerance test: To find cardiopulmonary capacity.

Problem List:

Short Term Goals:

Long Term Goals:

Treatment:

Home Program

Grades of Dyspnea

Class I No symptoms with ordinary activity

Class II Symptoms with ordinary activity

Class III Symptoms with mild exertion

Class IV Symptoms at rest

Characteristics of Cough

Type of Presentation Possible Causes

Dry Asthma, ILD, Recent viral infections, Pollutants, ACE inhibitors

Productive COPD, Bronchiectasis, Lung infections

In position change GOR, asthma, Heart failure

Chronic Persistent GOR, Post nasal drips

With eating or drinking Aspiration, Neurological illness, elderly people

With exertion Asthma, COPD, ILD

Weak/Inadequate Muscle weakness, Pain, After surgery, Elderly, Poor understanding

Paroxysmal Asthma, aspiration, Upper airway obstruction.

Characteristics of Sputum

Appearance Possible causes

Frothy – Mixed with air Pulmonary edema

Mucoid COPD without infection

Purulent – Yellow, Dark green, Rusty Homophiles, Pseudomonas, Pneumococus, Mycoplasma

Black Smoke inhalation, coal dust

Hemoptysis TB, Bronchiectasis, infarction, Carcinoma, Vasculitis, Trauma

Grades of Clubbing

Grade Description1 Softening of nail bed

2 Obliteration of angle(Lovibond angle)

3 Parrot beak or drumstick appearance

4 Hypertrophic pulmonary osteoarthropathy

Grades of Edema

Grade Description

1+ Indentation is barely detectable

2+ Slight indentation visible when skin is depressed, returns to normal in 15 seconds

3+ Deeper indentation occurs when pressed and returns to normal within 30 seconds

4+ Indentation lasts for more than 30 seconds

Breathing Patterns in Respiratory problem.

Pattern of Breathing Description

Apnea Absence of ventilation

Fish-mouth(gulp) Apnea with mouth opening & closing; along with neck extension & bradypnea

Eupnea Normal rate, normal depth, regular rhythm

Bradypnea Slow rate, shallow or normal depth, regular rhythm; associated with drug overdose. RR less than 10 BPM

Tachypnea Fast rate, shallow depth, regular rhythm; associated with restricted lung disease

Hyperpnea Normal rate, increased depth, regular rhythm

Cheyne-Stokes(periodic) Increasing then decreasing depth, period of apnea interspersed; somewhat regular rhythm; associated with critically ill patients

Biot’s Breathing Slow rate, shallow depth, apneic periods, irregular rhythm, associated with brain stem disorders

Prolonged Expiration Fast inspiration, slow and prolonged expiration yet normal rate, depth, and regular rhythm, associated with COPD

Hyperventilation Fast rate, increased depth, regular rhythm; results in decreased arterial carbon dioxide, tension ; called “Kussmaul breathing” in metabolic acidosis

Door Step Breathing Normal rate and rhythm; characterized by abrupt cessation of inspiration when restriction is encountered; associated with pleurisy

Grades of Tenderness

Grade Description

I Patient complaints of pain

II Patient complaints of pain and winces

III Patient winces and withdraws

IV Patient will not allow palpation

Pulse Grading

Grade Description0 No pulse1+ Weak pulse, difficult to palpate2+ Palpable but not normal, diminished3+ Normal, easy to palpate4+ Bounding, very strong, possibility of an aneurysm

Percussion Tones

Tones Description

Resonant Loud or high amplitude, longer duration, heard over air filled organs like lungs

Dull Low amplitude, short duration, heard over solid organs like liver

Flat High-pitched, short duration, heard over muscle mass such as thigh

Tympanic High-pitched, medium duration, heard over hollow structures like stomach

Hyper-Resonant Very low-pitched, prolonged duration, heard over tissue with decreased density (increased air & tissue ratio) Heard in emphysema

Mediastinal Shift Description

Condition Direction of ShiftIpsilateral Contralateral

Atelectasis Lobectomy Pneumonectomy Pleural Effusion Pneumothorax Herniation of abdominal viscera