CARDIORESPIRATORY ASSESSMENT CHART

DATA BASE Name: Occupation Address: Age: Gender:

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

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: :