INTRODUCTION
A careful and detailed clinical assessment is essential in order to assess the likely cause and severity of symptoms, arrange appropriate investigations and referral, avoid unnecessary investigations, and to assess individual risk of cardiovascular disease or cardiomyopathy.
PREPARATION OF PATIENT • Room that is warm & “quiet” • Examining table positioned so you can stand on the patient’s right side • Explain the procedure to the patient and obtain consent. • Make the patient in a comfortable position. • Arrange and keep the articles at bedside. • Wash the hand.
ARTICLES REQUIRED • A watch with a second hand • Stethoscope with diaphragm & bell • Centimeter ruler, Penlight • Tape measure • Sphygmomanometer
STEPS I. History collection II. Physical examination
I.HISTORY COLLECTION
a. Socio demographic data Name: Age: Sex: Occupation: Address: Date of admission: Diagnosis: Date of physical assessment:
b. Symptoms & history of present illness
Dyspnea - Assess ➢ onset & duration acute or sudden ( acute MI, MS, AF)
- Severity / grade ➢ Grade I – No limitation of any physical activity but occur on more than ordinary exertion ➢ Grade II – Dyspnea on less than ordinary daily activity ➢ Grade III - Dyspnea on less than ordinary daily activities ➢ Grade IV – limitations of all activities (Dyspnea at rest) - Paroxysmal nocturnal Dyspnea (PND): CARDIAC ASTHMA Main factors contributing – pulmonary venous congestion - Orthopnea Indicate presence of severe left heart failures [pulmonary edema] - Wheeze [seen in left sided cardiac failure due to bronchial mucosal congestion]
Chest pain ➢ Site ➢ Type - Squeezing - Burning - Heaviness - Constricting