Guide To Perform Cardiopulmonary Evaluation for Physical Therapists (PT)

This is a quick reference guide to perform Physical Therapy Cardiopulmonary evaluation. For details on history taking and general guidelines for PT evaluation reference card, click here.

cardiopulmonary evaluation

Ask for the chief complaint…

Vital Signs measurement:

  • Heart Rate: 220 – Resting HR Or use Karvonen Formula
  • Pulse Rate:
  • Blood Pressure: sBP and dBP
  • SpO2: measure at rest, during activity and after activity
  • Measure recovery period.

Check visible s/s of physical exertion:

This is to define how hard or intense the exercise session is for the patient. In some cases, the patient is unable to define it correctly. The clinician can observe patient’s walking speed and ability as well as breathing pattern in order to know the intensity level for an exercise session.

This is usually done by Borg scale of the rate of perceived exertion (6 – 20)or modified rate of perceived exertion (14 – 20).

Skin changes:

  • Check for pallor
  • Check for cyanosis
  • Presence of Edema
  • DOE or PND

Cyanosis:

It is important to check skin color and changes of color. This is bluish discoloration of the skin. It usually means lack of Oxygen peripherally or centrally.

Peripheral Cyanosis:

The blueish/ purple skin color a clinician will observe on fingernails, lips, nose, the palm of the hands etc.

Central Cyanosis:

This is more severe. Here, the body is lacking O2 throughout. A clinician will observe more systemic symptoms like lethargic, altered mental status. If a therapist observes any of this changes, they need to notify nurse or doctor immediately. If you are working as a home health therapist, calling 911 or EMS is recommended.

Edmea:

This is defined as swelling of part of the body or generalized swelling. Generally, in people with Cardiopulmonary issues has dependent edema on lower extremities. Edema can be pitting and non-pitting edema. Edema can be classified into four grade depending on how long it takes for skin to come back to its normal shape. The grading system goes from 1 defined as no pitting impression and grade 4 that pitting impression takes more than 30 seconds to come to normal state.

Auscultation:

Heart sounds:

Semilunar valve Stenosis or

A-V valve incompetencies

Heard between S1 & S 2Heard after S2 and before S 1

Heart Sounds Representations Location
S1 (“Lub”) Beginning of systole.

Closure of Mitral (& tricuspid) valve

 

Right fifth intercostal space, midclavicular line
S2 (“Dub”) End of systole

Closure of Aortic ( & pulmonary) valve.

2nd intercostal space just right to the sternum.
S3 Ventricular gallop Occurs after S3
S4 Atrial gallop Occurs before S 1
Systolic Murmur Semilunar valve Stenosis or

A-V valve incompetencies

Heard between S1 & S 2
Diastolic Murmur A-V stenosis or

Semilunar valve incompetencies

Heard after S2 and before S 1

A-V = Atrioventricular valve. That is Mitral and tricuspid valve.

Semilunar valves are Aortic valve and pulmonary valve.

The order for Heart sounds with abnormal sounds are S4-S1-S2-S3

Lung sounds:

Normal Lung sounds Definitions Location on body


 

Bronchial loud high pitched sound.

Shorter inspiratory than expiratory duration with a pause between each phase of ventilation.

Close to sternum
Bronchovesicular Soft high pitched sound.

Continuous throughout the ventilation.

On back between scapula

On front between 2nd and 3rd Intercostal space

Vesicular Low pitches muffled the sound

Louder and higher pitch in inspiratory phase than the expiratory phase.

Peripheral lung fields.

Check for Lab values and Diagnostic tests:

This includes:

  1. Laboratory tests
  2. Chest x-ray
  3. ECGs
  4. ETT
  5. Cardiac Catheterization
  6. Hemodynamic monitors
  7. Arterial Blood Gases Study (ABGs)

This summarizes the main areas to look for while performing a cardiopulmonary evaluation for PT.  Click the link below to get access to hand out for this evaluation. 

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NOTE: The contents of this blog are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.