cardio pulmonary assessment techniques in physiothrapy

assessment techniques

1. CARDIORESPIRATORY ASSESSMENT 1
Dr. jumana vanwala
MPT(CARDIO-PULMONARY )

2. CARDIORESPIRATORY ASSESSMENT 2
PERSONAL DETAILS:
Name :
Age :
Gender :
Weight :
Life style :
Occupation :
Residence :
Ref. by :
Provisional diagnosis:
Chief complain :

3. Investigation:
•Blood reports
•Chest X-rays
•PFT
•ABG analysis
•ECG
•Sputum
•CT scan
•Bronchoscopy
CARDIORESPIRATORY ASSESSMENT 3

4. CARDIORESPIRATORY ASSESSMENT 4
HISTORY:
a)H/O presenting condition:
i.e. patient’s current problems, including relevant
information from medical notes
b) Previous medical history:
i.e. entire list of medical & surgical problems that the
patient has had in past
written in disease specific grouping or
chronological account

5. c) Family history:
List of any major disease suffered by members of
immediate family
d) Social history:
level of support available at home & to gain idea of
patient’s expected contribution to
household duties
e) H/O smoking & alcohol use:
no. of pack yrs may be calculated as relative risk of
COPD. i.e. (average no. of packs/day) (no. of yrs
smoked)
f) Drug List:
List of patient’s current medication ( with dosage)
Drug allergies should also be noted
CARDIORESPIRATORY ASSESSMENT 5

6. CARDIORESPIRATORY ASSESSMENT 6
SUBJECTIVE ASSESSMENT:
Based on an interview with patient
Starts with open ended questions: what is the main problem?
what troubles you most?
5 main symptoms of respiratory diseases:
• Breathlessness
• Cough
• Sputum & Hemoptysis
• Wheeze
• Chest pain

7. CARDIORESPIRATORY ASSESSMENT 7
BREATHLESSNESS ( DYSPNOEA ) :
Subjective awareness of an increased WOB
Major symptom of cardiac & respi. Dzs.
Scales for assessment:
NYHA grading
Borg’s scale ( RPE )
ATS dyspnoea scale
VAS scale

8. Dyspnoea is normal or
abnormal
CARDIORESPIRATORY ASSESSMENT 8

9. NYHA Grading
I.No symptoms with ordinary activity,
breathlessness only occurs with severe
exertion. e.g. running uphill, fast bicycling
II.Symptoms with ordinary activity. e.g.
walking upstairs, making beds, carrying
large amounts of shopping
III.Symptoms with mild exertion. E.g. bathing,
showering, dressing
IV.Symptoms at rest
CARDIORESPIRATORY ASSESSMENT 9

12. ATS
Grade
1(None)Not troubled by shortness of breath on
level or uphill
2(Mild)Troubled by shortness of breath on
level or uphill
3(Mod) Walks slower than person of same age
4(Severe)Stops after walking 100 yd
5(Very severe)Breathlessness at rest

13. CARDIORESPIRATORY ASSESSMENT 13
Patterns of Dyspnea:
• Orthopnea
• PND
• Platypnea
• Trepopnea
• Functional dyspnea

14. CARDIORESPIRATORY ASSESSMENT 14

15. CARDIORESPIRATORY ASSESSMENT 15
COUGH:
Imp. features are its effectiveness & whether it is productive or dry
Severity : range from occasional disturbance to
continual trouble
A loud - barking cough : laryngeal or tracheal dzs
Recurrent cough after eating : aspiration
Ch. productive cough everyday : ch.bronchitis,
bronchiectasis
Persistent dry cough : ILD

16. •Nocturnal cough : in children/young adults -
asthma
in older pts – cardiac failure
•Drugs – e.g. beta blockers & some
anti hypertensives – ch. Cough
•Post-op. strength & effectiveness of cough is
imp. to assess

17. CARDIORESPIRATORY ASSESSMENT 17
SPUTUM & HEMOPTYSIS:
Colour, consistency & quantity should be determined
It clarifies diagnosis & severity of diseas.

18. 18CARDIORESPIRATORY ASSESSMENT

19. •Grey-chronic bronchitis
•Black-smoke inhalation
•Red-hemoptysis
•Yellow-Lung Abscess(pus)
•Pink-pulmonary odema
•Red current jelly-klebsiella infection
•Green-pseudomonas infection
•White-mucoid-Asthma
•Slightly discolored(pus)-cystic fibrosis
•Purple-neoplasm
CARDIORESPIRATORY ASSESSMENT 19

20. CARDIORESPIRATORY ASSESSMENT 20
Odour signifies infection
Offensive odour – anerobic organism, e.g. lung
abscess, aspiration pneumonia
Sweet smell- Diabetic ketoacidosis

21. •SPUTUM & HEMOPTYSIS:
•Colour, consistency & quantity should be determined
•It clarifies diagnosis & severity of disease
•GRADINGS for sputum by Miller ( 1963 ):
• M1 : mucoid with no suspicion of pus
• M2 : predomi. mucoid, suspicion of pus
• P1 : 1/3 purulent, 2/3 mucoid
• P2 : 2/3 purulent, 1/3 mucoid
• P3 : > 2/3 purulent

22. CARDIORESPIRATORY ASSESSMENT 22
Hemoptysis: presence of blood in sputum
Range from slight streaking to frank blood (life threatening)
Frank bld requires bronchial a. embolisation or surgery
Isolated hemoptysis – 1st sign of bronchogenic carcinoma ( CXR
normal)
Recurrent hemoptysis – ch. Infective lung dzs, e.g.
bronchiectasis, TB, fungal infection

23. CARDIORESPIRATORY ASSESSMENT 23
WHEEZE:
Whistling or musical sound produced by turbulent
airflow through narrowed airways
Sometimes stridor is mistakenly called wheeze
Diff. between two:
stridor wheeze
Inspiratory expiratory
Upperairway obstruction lower airway obstruction
Cause : foreign body asthma, COPD

24. CARDIORESPIRATORY ASSESSMENT 24
CHEST PAIN:
Definitive cause can’t be fully established without
diagnostic medical tests, but origin can be determined
by carefull history taking
•Pleuritic:
Inflammation of parietal pleura
Severe sharp, stabbing pain, worse on inspiration
Not produced by palpation

25. CARDIORESPIRATORY ASSESSMENT 25
•Tracheitis:
Constant burning pain in centre of chest
Aggravated by breathing
•Musculoskeletal (chest wall) pain:
Originate from muscles, bones, joints or nerves of
thoracic cage
Well localised & aggravated by chest or arm movts
Palpation will reproduce pain

26. CARDIORESPIRATORY ASSESSMENT 26
•Angina pectoris:
Ischemia – dull, central, retrosternal gripping or
band like sensation, may radiate to arm, neck, jaw
•Pericarditis:
Pain similar to angina or pleurisy
Sitting up & leaning forward or lying on right side
relieves pain
Pain assessment : VAS scale

27. CARDIORESPIRATORY ASSESSMENT 27
Functional ability:
Inquiry abt his ADL
FIM scale
QOL:
Imp. to measure the impact of disability on pt
& of response to treatment
SF – 36

28. CARDIORESPIRATORY ASSESSMENT 28
OBJECTIVE ASSESSMENT:
General observation:
Is pt breathless?
Is pt comfortable?
Is pt on supplemental O2? If so, how much?
In ICU pt see level of ventilatory support:
Mode & route of ventilation
Level of CV support including drugs to
control BP & C.O., pacemakers & other
mechanical devices

29. CARDIORESPIRATORY ASSESSMENT 29
Level of consciousness should also be noted
It is measured by GCS
Reduced consciousness – risk of aspiration &
retention of secretions
See for presence or absence of ryle’s tube, IV line,
CVP line etc
Signs of respi distress: facial grimace, nasal flaring
etc.
Use of accessory muscles:

30. 30CARDIORESPIRATORY ASSESSMENT

31. CARDIORESPIRATORY ASSESSMENT 31
Body built:
Respiratory function can be compromised by both
obesity & severe malnourishment
BMI should be calculated

32. CARDIORESPIRATORY ASSESSMENT 32
Weakness & wasting of small muscles in hand –
early sign of upper lobe tumour involving brachial
plexus (pancoast’s tumour)
Fingers may show nicotine staining from smoking
Clubbing:
Loss of angle between nail bed & nail itself
Sign of chronic hypoxia
Exact cause is unknown

33. 33CARDIORESPIRATORY ASSESSMENT

34. CARDIORESPIRATORY ASSESSMENT 34
Causes of clubbing:
Lung dzs: Infective (bronchiectasis, lung abscess,
empyema)
Fibrotic
Malignant (bronchogenic ca,
mesothelioma)
Cardiac dzs: Congenital cyanotic ht dzs
Bacterial endocarditis
Others: familial, cirrhosis, GI dzs

35. Grades of Clubbing
1. Fluctuation and softening of the nail bed
(increased ballotability)
2. obliteration of nail bed angle
3. Overlying skin becomes shiny , Parrot
beak/Drumstick appearance
4. Swelling of fingers & pulmonary
osteoarthropathy
CARDIORESPIRATORY ASSESSMENT 35

36. CARDIORESPIRATORY ASSESSMENT 36
Schamroth’s sign:
Normally when 2 fingers are held together with
nails facing each other, a space is seen at the level
of approx. nail fold.
This is lost in case of clubbing

37. CARDIORESPIRATORY ASSESSMENT 37

38. CARDIORESPIRATORY ASSESSMENT 38
Observation of eyes:
It should be examined for pallor (anaemia)
jaundice (yellow colour due to liver or blood
disturbances)
Drooping of one eyelid with enlargement of that pupil
suggests – Horner’s syndromes (Disturbance in
sympathetic n supply to that side of head)

40. CARDIORESPIRATORY ASSESSMENT 40
Cyanosis : Bluish discoloration of skin and
mucous membrane. Increased reduced
Hb
Central : Inadequate uptake of oxygen. Seen in
mouth and tongue which will be warm.
Peripheral : Stagnation of blood seen in extremity
which will be cold.
Mixed:

41. 41CARDIORESPIRATORY ASSESSMENT

42. CARDIORESPIRATORY ASSESSMENT 42
JVP :
On the side of neck it is seen as flickering impulse in
jugular vein
Normally seen at base of neck when lying back at
45 degree
It is measured in relation to sternal angle
Normal JVP at the base of neck corresponds to a
vertical height approx 3 to 4 cm above sternal angle
It provides quick assessment of volume of blood in
great vessel entering the heart

43. CARDIORESPIRATORY ASSESSMENT 43

44. CARDIORESPIRATORY ASSESSMENT 44

45. CARDIORESPIRATORY ASSESSMENT 45
It is elevated in :
Right heart failure
Constrictive pericarditis
SVC obstruction
Ch lung dzs, complicated by cor pulmonale

46. CARDIORESPIRATORY ASSESSMENT 46
Peripheral Edema :
Imp sign of cardiac failure
Also found in : low albumin level
impaired venous or lymphatic
function
high dose steroids

47. CARDIORESPIRATORY ASSESSMENT 47
Observation of chest :
Presence of ICD :
Placed between 2 ribs into pleural space to remove
air, fluid or pus
Used routinely after CT Surgery
Observation must be made of fluid level within the
tube which should oscillate or swing with every
breath
If it doesn’t swing – tube is not patent
Continuous suction – dampens fluid swing

49. CARDIORESPIRATORY ASSESSMENT 49
Chest shape :
It should be symmetrical with the ribs, in adults,
descending at approx 45 degree from spine
Trans dia > AP dia ( 7 : 5 )
Thoracic spine should have slight kyphosis

50. CARDIORESPIRATORY ASSESSMENT 50
Common abnormalities :
Barrel chest : increased AP dia,
ribs less oblique
prominent sternal angle,
arched sternum
Seen in kyphosis of aging or hyper inflation of pul
emphysema

51. 51CARDIORESPIRATORY ASSESSMENT

52. CARDIORESPIRATORY ASSESSMENT 52
Funnel chest (Cobbler’s chest, Pectus excavatum) :
Depression in lower part of sternum
May be congenital, following rickets in childhood or
occupational deformity in cobblers

53. 53CARDIORESPIRATORY ASSESSMENT

54. CARDIORESPIRATORY ASSESSMENT 54
Pigeon chest ( Pectus carinatum, Keeled chest ) :
Sternum displaced ant

55. 55CARDIORESPIRATORY ASSESSMENT

56. 56CARDIORESPIRATORY ASSESSMENT

57. 57CARDIORESPIRATORY ASSESSMENT

58. CARDIORESPIRATORY ASSESSMENT 58
Breathing pattern :
Normal breathing should be regular with 12 to 16
breaths / min
I : E ratio 1 : 1.5
Types :
Rapid shallow breathing ( Tachypnoea )
Causes : Restrictive lung dzs, pleuritic chest pain,
elevated diaph

59. CARDIORESPIRATORY ASSESSMENT 59
Kussmaul breathing ( air hunger ) :
Ataxic breathing
Cheyne stokes breathing

60. Normal & Kussmaul breathing
CARDIORESPIRATORY ASSESSMENT 60

61. CARDIORESPIRATORY ASSESSMENT 61
Obstructive breathing :
I : E = 1 : 3 or 1: 4
Prolonged expiration due to increased airway resi
If RR increases, pt lacks sufficient time for full
expiration
Air trapping occurs

62. CARDIORESPIRATORY ASSESSMENT 62
Types of breathing :
Males : abdominothoracic
Females : thoracoabdominal
Thoracic : diaph paralysis, peritonitis, ascites
Abdominal : pleurisy, collapse of lung

63. CARDIORESPIRATORY ASSESSMENT 63
Chest movement :
Normally both sides move uniformly & there is no
bulging or indrawing
Accessary muscles not required
Unilateral diminished movement :
obstruction of main bronchus
consolidation
fibrosis of lung, pl adhesions
massive collapse
hydropneumothorax, pl effusion

64. 64CARDIORESPIRATORY ASSESSMENT

65. CARDIORESPIRATORY ASSESSMENT 65
Bilat diminished movts :
emphysema
bil fibrosis, collapse, consolidation
hydropneumothorax
bronchial asthma
Paradoxical breathing

66. CARDIORESPIRATORY ASSESSMENT 66
ON EXAMINATION:
Vitals measurement:
Body temp: Normal – 36.5 to 37.5 degrees C
lowest in early morning
highest in afternoon
Can be measured in no. of ways
oral, axillary, rectal

67. CARDIORESPIRATORY ASSESSMENT 67
Heart Rate:
60-100 beats/min
Radial pulse is used to count HR
With the pads of index & middle fingers compress the
radial a. until a maximal pulsation is detected

68. CARDIORESPIRATORY ASSESSMENT 68
Tachycardia: HR > 100 beats/min at rest
Seen in anxiety, exs, fever, anemia, hypoxia,
cardiac dzs
Bronchodilators & some cardiac drugs
Bradycardia: HR < 60 beats/min
Normal finding in athletes
Some cardiac drugs e.g. beta blockers

69. CARDIORESPIRATORY ASSESSMENT 69
Blood Pressure : 95/60 & 140/90 mm Hg
Measured with sphygmomanometer (mercury)
Tech. of measurement:
Pt shd be comfortable, relaxed, arm free of clothing
Centre inflatable bag over brachial a.

71. CARDIORESPIRATORY ASSESSMENT 71
RR: 12-16 breaths/min
measured with pt seated comfortably
Tachypnea: RR > 20
seen in lung dzs, metabolic acidosis,
anxiety
Bradypnea: RR < 10
CNS depression by narcotics or trauma

72. CARDIORESPIRATORY ASSESSMENT 72
ON PALPATION:
Trachea:
Its midline position can be examined anteriorly
The PT places index finger in medial aspect of
suprasternal notch
This is repeated on the opp side
An equal distance between clavicle & trachea shd
exist bilaterally
Tracheal deviation indicates mediastinal shift

74. CARDIORESPIRATORY ASSESSMENT 74
Contralateral deviation: pneumothorax
pl. effusion
Ipsilateral deviation: fibrosis
collapse
atelectasis

75. CARDIORESPIRATORY ASSESSMENT 75
Chest expansion:

76. CARDIORESPIRATORY ASSESSMENT 76
Tenderness:
Areas of tenderness can be assessed for degree
of discomfort & reproducibility
Differentiation of chest pain : angina or
mus.sk. Origin

77. CARDIORESPIRATORY ASSESSMENT 77
TVF:
Fremitus refers to palpable vibrations transmitted
through bronchopulmonary system to the chest wall
when pt speaks
Ask pt to repeat words ‘99’ or ‘one-one-one’

78. CARDIORESPIRATORY ASSESSMENT 78
ON PERCUSSIONON PERCUSSION : :

79. 79CARDIORESPIRATORY ASSESSMENT

80. 80CARDIORESPIRATORY ASSESSMENT

81. CARDIORESPIRATORY ASSESSMENT 81
Dull note:Dull note:
An impaired note of greater degree is a dull note.An impaired note of greater degree is a dull note.
It is found in consolidation, infiltration, fibrosis, It is found in consolidation, infiltration, fibrosis,
collapse, plural thickeningcollapse, plural thickening

82. CARDIORESPIRATORY ASSESSMENT 82
A percussion note completely devoid of A percussion note completely devoid of
resonance or displaying extreme dullness is a resonance or displaying extreme dullness is a
stony dull notestony dull note
It is classically found in PLEURAL EFFUSION It is classically found in PLEURAL EFFUSION
because fluid dampens the vibration of both the because fluid dampens the vibration of both the
chest wall and underlying lungchest wall and underlying lung
It may also occur in lung fibrosis with pleural It may also occur in lung fibrosis with pleural
thickening or with solid intrathoracic tumourthickening or with solid intrathoracic tumour
Stony dull note:Stony dull note:

83. CARDIORESPIRATORY ASSESSMENT 83
Tympany:Tympany:
This is drum like resonance which is normally This is drum like resonance which is normally
encountered over stomach, intestines, larynx and encountered over stomach, intestines, larynx and
tracheatrachea
When it occurs over chest wall it may be due to When it occurs over chest wall it may be due to
PNEUMOTHORAX, SUPERFICIAL EMPTY PNEUMOTHORAX, SUPERFICIAL EMPTY
CAVITY, EMPHYSEMA CAVITY, EMPHYSEMA

84. Subtympany:
A hyper resonant note with a boxy quality which occurs
due to relaxed lung just above level of pleural
effusion.
CARDIORESPIRATORY ASSESSMENT 84

85. CARDIORESPIRATORY ASSESSMENT 85
Hyper resonance:Hyper resonance:
A note in between normal resonance and A note in between normal resonance and
tympany, can be elicited over normal lung tissue tympany, can be elicited over normal lung tissue
by keeping the chest wall in full inspiration during by keeping the chest wall in full inspiration during
percussionpercussion
It occurs in Pneumothorax, emphysema, large It occurs in Pneumothorax, emphysema, large
cavity, congenital lung cyst, emphysematous cavity, congenital lung cyst, emphysematous
bullaebullae

86. CARDIORESPIRATORY ASSESSMENT 86
Bell tympany:Bell tympany:
This is a high pitched tympanic sound, heard over This is a high pitched tympanic sound, heard over
the chest in case of massive pneumothoraxthe chest in case of massive pneumothorax
When a silver coin is placed on affected side and When a silver coin is placed on affected side and
percussed with a second silver coin, the ear or percussed with a second silver coin, the ear or
stethoscope applied over the opposite side of stethoscope applied over the opposite side of
chest may detect a clear bell like soundchest may detect a clear bell like sound

87. CARDIORESPIRATORY ASSESSMENT 87
Cardiac dullness:Cardiac dullness:
On lt. side of chest wall, the lung resonance is On lt. side of chest wall, the lung resonance is
encroached by an area of cardiac dullnessencroached by an area of cardiac dullness
Normal cardiac dullness is in Normal cardiac dullness is in
3rd, 4th lt parasternal line,3rd, 4th lt parasternal line,
5th lt mid clavicular line5th lt mid clavicular line
This area of dullness may be decreased in This area of dullness may be decreased in
emphysema, lt. sided pneumothoraxemphysema, lt. sided pneumothorax
It may be increased with cardiomegaly and push It may be increased with cardiomegaly and push
of heart to lt. sideof heart to lt. side

88. CARDIORESPIRATORY ASSESSMENT 88
Shifting dullness:Shifting dullness:
In case of hydropneumothorax in sitting position, In case of hydropneumothorax in sitting position,
there is a hyper resonant note above followed by there is a hyper resonant note above followed by
dullness belowdullness below
On changing the posture to supine, this area of On changing the posture to supine, this area of
dullness of fluid changed as air and fluid will shiftdullness of fluid changed as air and fluid will shift
This is shifting dullness & signifies presence of This is shifting dullness & signifies presence of
both air and fluidboth air and fluid

89. CARDIORESPIRATORY ASSESSMENT 89
On auscultation:
Auscultation is the art of listening to sound Auscultation is the art of listening to sound
produced by the bodyproduced by the body
1) 1) breath soundsbreath sounds:- Normal:- Normal
AbnormalAbnormal
AdventitiousAdventitious
2) voice sounds2) voice sounds:- egophany:- egophany
bronchophanybronchophany
whispered pectoriloquywhispered pectoriloquy
3) 3) Extrapulmonary soundsExtrapulmonary sounds:- :-
Pleural rubPleural rub
4) 4) Heart soundsHeart sounds

90. CARDIORESPIRATORY ASSESSMENT 90
Breath soundsBreath sounds: :
Normal breath sounds:-Normal breath sounds:-
BronchialBronchial
BronchovesicularBronchovesicular
VesicularVesicular

91. CARDIORESPIRATORY ASSESSMENT 91
Bronchial breath sounds:Bronchial breath sounds:

High pitchedHigh pitched
Heard in inspiratory and expiratory phaseHeard in inspiratory and expiratory phase
Distinguishing feature is the pause that exists Distinguishing feature is the pause that exists
between inspiration and expiration phasebetween inspiration and expiration phase
This sound is also described as tracheal as its This sound is also described as tracheal as its
normal location is over tracheanormal location is over trachea

92. CARDIORESPIRATORY ASSESSMENT 92
Bronchovesicular soundsBronchovesicular sounds: :
High pitchedHigh pitched
Equal inspiratory and expiratory cycles, Equal inspiratory and expiratory cycles,
differentiating feature is lack of pausedifferentiating feature is lack of pause
Heard best where bronchi or central lung tissue is Heard best where bronchi or central lung tissue is
close to the surface close to the surface
This includes superior to clavicle and suprascapular This includes superior to clavicle and suprascapular
and parasternal and interscapularand parasternal and interscapular

93. CARDIORESPIRATORY ASSESSMENT 93
Vesicular breath soundsVesicular breath sounds::

Heard over remaining peripheral lung fieldsHeard over remaining peripheral lung fields
This sound has primarily an inspiratory This sound has primarily an inspiratory
component with only initial one third of expiratory component with only initial one third of expiratory
phase audiblephase audible
Intensity is also softer because of dampening of Intensity is also softer because of dampening of
spongy lung tissuespongy lung tissue

94. CARDIORESPIRATORY ASSESSMENT 94
Infants and childrens have louder, harsher breath Infants and childrens have louder, harsher breath
sound, this is as result of thinness of chest wall sound, this is as result of thinness of chest wall
and the airways being closer to its surface.and the airways being closer to its surface.

95. 95CARDIORESPIRATORY ASSESSMENT

96. CARDIORESPIRATORY ASSESSMENT 96
Abnormal breath sounds:Abnormal breath sounds:
BronchialBronchial
DecreasedDecreased
AbsentAbsent

97. CARDIORESPIRATORY ASSESSMENT 97
Adventitious breath sounds:Adventitious breath sounds:
They are extraneous sound produced over the They are extraneous sound produced over the
bronchopulmonary treebronchopulmonary tree
Adventitious sounds areAdventitious sounds are
crackles (rales, crepitation)crackles (rales, crepitation)
rhonchirhonchi
wheezeswheezes

98. CARDIORESPIRATORY ASSESSMENT 98
Crackles:Crackles:
Crackles are described asCrackles are described as
-discontinuous-discontinuous
-low pitched sound-low pitched sound
-occurs predominantly on inspiration-occurs predominantly on inspiration
-sound of rubbing hair between fingers or -sound of rubbing hair between fingers or
Velcro popping.Velcro popping.
-indicates a peripheral airway process.-indicates a peripheral airway process.

99. CARDIORESPIRATORY ASSESSMENT 99
Rhonchi:Rhonchi:
Rhonchi are, Rhonchi are,
-continuous-continuous
-low pitched -low pitched
-occur both in inspiration and expiration-occur both in inspiration and expiration
-snoring is term used to described its -snoring is term used to described its
qualityquality
-attributed to obstructive process in the -attributed to obstructive process in the
larger more central airways.larger more central airways.

100. CARDIORESPIRATORY ASSESSMENT 100
Wheezes:Wheezes:
Wheezes areWheezes are
- continuous- continuous
-high pitched-high pitched
-hissing or whistling quality-hissing or whistling quality
-occur during expiration -occur during expiration
- it is an indication of bronchospasm- it is an indication of bronchospasm
-also be caused by movement of air -also be caused by movement of air through through
secretionssecretions

101. Voice sounds:
Brochophony-Increased vocal transmission.
Words or letters are louder & clear
Egophony- Increased transmission. Pt is asked
to say “eee”. The underlying process distorts
the “e” sound so that an ”aaa” is heard.
Whispered pectoriloquy- Whispered voice
sounds become distinct and clear.
Pleural rub:
Heart sounds:
CARDIORESPIRATORY ASSESSMENT 101

102. Exe. Tolerance test:
•6 min walk test
•Shuttle walk test
CARDIORESPIRATORY ASSESSMENT 102

103. Plan of treatment:
•Short term
•Long term
CARDIORESPIRATORY ASSESSMENT 103

104. Progress notes:
CARDIORESPIRATORY ASSESSMENT 104

105. Discharge summary:
•Treatment
•Outcome
•Home programmes
CARDIORESPIRATORY ASSESSMENT 105