CARDIORESPIRATORY ASSESSMENT

MEDICAL CHART READING:

• Name, Age, Sex
• H\O Present Illness
• Past Medical History
• Past Surgical History
• Drug History
• Social/Occupational History
• Further Queries For Subjective Assessment
• Investigation (same as Performa)

BED CHART READING

¾ Vital Signs
• Temperature >37.5? Source of temperature
• PR >100 tachycardia & <60 Bradycardia? Cause
• Tachy? Septic Brady? Medication
• BP – varies with age, fitness, HT
• SpO >95% normal unless respiratory impairment
• Hb -- <8 (careful while mobilizing the pt)
¾ Other Readings
• Fluid Balance-Important Post Op, CRF, CCF & MI
• Peak Flow Readings
• Pain Scales- Post Op Cases
• Medications

SUBJECTIVE ASSESSMENT
• What is the main problem?
• What brought them to hospital?
• Cough - how much, when, triggering factor, productive/non-productive?
• SOB/Dyspnoea -? Cause duration, aggravating factors
• Sputum - colour, quantity, quality
• Pain - area, type, pain scale, relate to present condition
• Ex Tolerance - distance, flat surface, stairs
• Smoking History - no. of cigarettes/no. of years
• Sleeping Position/Recovering Position
 • Home Program - airway clearance techniques, peak flows, medications,
walking program.

OBJECTIVE ASSESSMENT
¾ OBSERVATION
• Pt’s appearance/posture/position in bed
• Effect on SOB while moving in bed/talking
• Breathing Pattern - RR, resp ms use, accessory ms use, purse lip breathing
• Colour/Cyanosis
• Signs of distress
• Audible Wheeze
• Chest Shape - kyphosis, kyphoscoliosis, pectus excavatum, pectus
carinatum, barrel chest

• Calf check - redness, swelling

• Incision - length, pus, infection
• Sputum
• Lines, Tubes, Drains
h PALPATION

Position of Trachea
 Chest Excursion

Middle lobe & lingula motion Upper lobe motion

Lower lobe motion

• Hand Placement - below clavicle bilaterally for Upper Lobe

• Laterally below axilla for Middle Lobe
• Laterally over 7-10 ribs for Lower Lobe
• Note symmetrical chest wall movement
• Also note while hand placement - Temperature, Sweating,
Subcutaneous Emphysema
Percussion

• With the middle finger over the intercostals spaces.

Compare bilaterally
-Hyper resonant - air/hyperinflation/pneumothorax
-Dull - fluid/soft tissue/consolidation

Vocal Fremitus

• Hand placement same as chest excursion. Compare

bilaterally
--Ask pt to say ‘k’ or ‘99’
--Note sound transmission under palm
-Decrease transmission = air/emphysema
-Increase transmission = consolidation, fluid
Calf Check
• Temperature
--Remove DVT stockings
--Check for increase in temp bilat wit dorsum of hands
• Tenderness
--Squeeze the calf gently from proximal to distal wit
both the hands
--If +ve immediately inform the Doctor or sister
--Do not move the lower extremity and make pt to stand
and walk.

Auscultation

A – Chest B – Back

• Instructions
--Explain what you are going to do
--Take slightly deeper breaths than normal &breath in &
out through your mouth slowly and gently
--Request the pt not to talk while auscultation
--Ask the pt to turn his/her head away
• If pt becomes SOB during auscultation
--Stop auscultation
--Position pt
--Commence relaxed deep breathing
• Try not to auscultate for more than 2 breaths per area.
REASSESSMENT
1) Response to technique
2) Tolerance for treatment
3) Change of objective signs
4) Re-auscultate the involved lung segment
5) Question pt how they feel