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Cardiopulmonary Assessment

General Information:
Name: Age: Sex: Presenting Complaints:

Subjective Assessment:
History:
History of Present illness: Onset, Duration, Severity Past Medical History/Dru History/Sur ical History: illness/surgeries/injuries/immunizations/allergies/hospitalizations/drugs presently eing ta!en Personal History: Drug a use/ smo!ing/al"ohol #Pa"! years$ !amily " Social History: %amily type/Physi"al, &motional and &"onomi" support in the 'amily %amily health/ hereditary disorders #ccupational History: Parti"les/dusts/'umes/gases pertaining to various o""upations(

$espiratory Symptoms
Dyspnea: )rade/ *ype Cou %: *ype/Chara"teristi"s/Produ"tivity/+, -r Pattern Sputum: .uantity/Color/Consisten"y/Odor C%est Pain: /o"ation, 0adiation, Chara"ter, %re1uen"y, 2ntensity, Aggravating, 0elieving 'a"tors( &ital Si ns: *emperature, -eart 0ate, 0espiratory 0ate, 3lood Pressure(

#bservation/Inspection:
'uilt of t%e patient: &"tomorphi"/ 4esomorphi" /&ndomorphi" Inte umentary system: 2n"ision/S"ar, 5l"ers/ 6ounds, S!in "olor/27 sites/ Catheters/ 2C drainage/Any other e1uipments or tu es "onne"ted to the patient( !acial !eatures: Dilation o' pupil/Nasal %laring/S8eating/Pallor (ec): 9ugular venous Pulse/ A""essory mus"le usage( Cyanosis: Central : 4outh, *ongue, /ips /Peripheral; 'ingers, &ar lo es, toes

Hand: Clu ing : A sent/Present #)rade$

*remor, 6asting o' mus"les, Ni"otine Stain *dema: Pitting/Non Pitting, 3ilateral/ 5nilateral, %a"ial edema C%est appearance and movements: 0espiratory 0ate: *ype o' reathing: *hora"i"/A dominal A normal reathing pattern: *hora"i" index: De'ormities: Spinal/ Chest

#bjective Assessment:
*+amination:
C%est e+pansion/ ,%oracic mobility: Normal/ 2n"reased/Diminished ,run) Mobility -$#M of t%e Spine. : Normal /Diminished S%oulder Mobility -$#M of t%e s%oulder /oint. : Normal /Diminished

Auscultation:
'reat% sounds: 3ron"hial, 3ron"ho;vesi"ular and vesi"ular; Normal/A normal Adventitious 0un sounds: 6heezes and Cra"!les ; Present/A sent &ocal resonance: 3ron"hophony/&gophony/6hispered Pe"torilo1uy; Normal/A normal Heart sounds: S<, S+, and S= > S, Murmur -Systolic/Diastolic.: Present/A sent !riction $ub: Pleural/Peri"ardial

Percussion:
$i %t 0un : 5pper /o e/4iddle /o e//o8er /o e 0eft 0un : 5pper /o e//o8er /o e

Palpation:
,rac%eal/Mediastinal S%ift: Present #0ight//e't$/ A sent C%est 1all *+cursion/,%oracic *+pansion: Normal/Diminished Diap%ra matic *+cursion: 2n"hes o' *hum separation: ? @ Cm / A @ Cm

&ocal fremitus/,actile fremitus: Normal/2n"reased/De"reased Accessory Muscle 2sa e: Present #4us"les 5sed$/ A sent ,enderness: Present #)rade$/A sent 0ocal S)in ,emperature: Normal/Cold/2n"reased 6armth *dema: Pitting/Non Pitting( 5//, 3//, %eet, -and, %a"ial Pulse *+amination: 0adial, 3ra"hial, Carotid, %emoral and Dorsal Pedis artery( Point of Ma+imal Impulse -PMI.: Normal/Shi'ted #right/le't$ Capillary $efill ,ime: ? + se"onds/A + Se"onds

Investi ations:
'lood Study: 03C, 63C, Platelets, &S0, /ipid Pro'ile, &le"trolytes study( Histolo ical3 Cytolo ical3 Microbiolo ical Analysis: Car"inoma, in'e"tions et" 45$ay: *o assess /ung and -eart "onditions *CG: *o analyze the ele"tri"al a"tivity o' -eart Spirometry/P!,: *o 'ind O stru"tive and 0estri"tive lung diseases Pulse #+ymetry: %or oxygen saturation( A'G: *o 'ind the p-, assess a"idosis and al!alosis *c%ocardio rap%y3 C,/M$I Scan3 An io ram3 'ronc%oscopy *+ercise ,olerance test: *o 'ind "ardiopulmonary "apa"ity(

Problem 0ist: S%ort ,erm Goals: 0on ,erm Goals: ,reatment: Home Pro ram

Grades of Dyspnea

Class I Class II Class III Class IV

No symptoms with ordinary activity Symptoms with ordinary activity Symptoms with mild exertion Symptoms at rest

C%aracteristics of Cou %
,ype of Presentation
Dry Produ"tive 2n position "hange Chroni" Persistent 6ith eating or drin!ing 6ith exertion 6ea!/2nade1uate Paroxysmal

Possible Causes
Asthma, 2/D, 0e"ent viral in'e"tions, Pollutants, AC& inhi itors COPD, 3ron"hie"tasis, /ung in'e"tions )O0, asthma, -eart 'ailure )O0, Post nasal drips Aspiration, Neurologi"al illness, elderly people Asthma, COPD, 2/D 4us"le 8ea!ness, Pain, A'ter surgery, &lderly, Poor understanding Asthma, aspiration, 5pper air8ay o stru"tion(

C%aracteristics of Sputum
Appearance %rothy : 4ixed 8ith air 4u"oid Purulent : Bello8, Dar! green, 0usty 3la"! -emoptysis Possible causes Pulmonary edema COPD 8ithout in'e"tion -omophiles, Pseudomonas, Pneumo"o"us, 4y"oplasma Smo!e inhalation, "oal dust *3, 3ron"hie"tasis, in'ar"tion, Car"inoma, 7as"ulitis, *rauma

Grades of Clubbin
)rade < + = , Des"ription So'tening o' nail ed O literation o' angle#/ovi ond angle$ Parrot ea! or drumsti"! appearan"e -ypertrophi" pulmonary osteoarthropathy

Grades of *dema
Grad e <C +C =C ,C Description

2ndentation is arely dete"ta le Slight indentation visi le 8hen s!in is depressed, returns to normal in <@ se"onds Deeper indentation o""urs 8hen pressed and returns to normal 8ithin =D se"onds 2ndentation lasts 'or more than =D se"onds

'reat%in Patterns in $espiratory problem6


Pattern of 'reat%in
Apnea %ish;mouth#gulp$ &upnea 3radypnea *a"hypnea -yperpnea Cheyne; Sto!es#periodi"$ 3iotFs 3reathing Prolonged &xpiration -yperventilation

Description
A sen"e o' ventilation Apnea 8ith mouth opening > "losingE along 8ith ne"! extension > radypnea Normal rate, normal depth, regular rhythm Slo8 rate, shallo8 or normal depth, regular rhythmE asso"iated 8ith drug overdose( 00 less than <D 3P4 %ast rate, shallo8 depth, regular rhythmE asso"iated 8ith restri"ted lung disease Normal rate, in"reased depth, regular rhythm 2n"reasing then de"reasing depth, period o' apnea interspersedE some8hat regular rhythmE asso"iated 8ith "riti"ally ill patients Slo8 rate, shallo8 depth, apnei" periods, irregular rhythm, asso"iated 8ith rain stem disorders %ast inspiration, slo8 and prolonged expiration yet normal rate, depth, and regular rhythm, asso"iated 8ith COPD %ast rate, in"reased depth, regular rhythmE results in de"reased arterial "ar on dioxide, tension E "alled GHussmaul reathingI in meta oli" a"idosis Normal rate and rhythmE "hara"terized y a rupt "essation o' inspiration 8hen restri"tion is en"ounteredE asso"iated 8ith pleurisy

Door Step 3reathing

Grades of ,enderness
Grad e 2 22 222 27 Description Patient "omplaints o' pain Patient "omplaints o' pain and 8in"es Patient 8in"es and 8ithdra8s Patient 8ill not allo8 palpation

Pulse Gradin
Grade D <C +C =C ,C Description No pulse 6ea! pulse, di''i"ult to palpate Palpa le ut not normal, diminished Normal, easy to palpate 3ounding, very strong, possi ility o' an aneurysm

Percussion ,ones
,ones 0esonant Dull %lat *ympani" -yper;0esonant Description /oud or high amplitude, longer duration, heard over air 'illed organs li!e lungs /o8 amplitude, short duration, heard over solid organs li!e liver -igh;pit"hed, short duration, heard over mus"le mass su"h as thigh -igh;pit"hed, medium duration, heard over hollo8 stru"tures li!e stoma"h 7ery lo8;pit"hed, prolonged duration, heard over tissue 8ith de"reased density #in"reased air > tissue ratio$ -eard in emphysema

Mediastinal S%ift Description


Condition Direction of S%ift Ipsilateral Contralater al

Atele"tasis /o e"tomy Pneumone"tomy Pleural &''usion Pneumothorax -erniation o' a dominal vis"era