Cardiorespiratory Assessment Chart

CARDIORESPIRATORY ASSESSMENT CHART DATA BASE

Name:

Age:

Occupation Address:

History

History of the presenting condition: Chief complaints: Previous medical history: Medical Surgical Drug history: Drugs and their dosage Family history: Social history: Support from family Home layout Socioeconomic status Smoking and alcohol use SUBJECTIVE ASSESSMENT

Duration Breathlessness Cough Sputum/hemoptysis Wheeze Chest pain

Severity

Pattern

Associated factors

Gend

Dyspnoea grade: Incontinence: Fever: Headache: Peripheral oedema: OBJECTIVE ASSESSMENT

General observation Body built: Hands and fingertips: Eyes: Cyanosis: Jugular venous pressure: Observation of chest: Chest shape: Breathing pattern: Chest movement: Palpation of chest: Trachea: Chest expansion: Surgical emphysema: Vocal fremitus: Percussion Auscultation Breath sounds Added sounds Vocal resonance: Sputum Exercise capacity PROBLEM LIST GOALS Short term goals: Long term goals:

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