Free Simple Cardiac Assessment Checklist Template
Simple Cardiac Assessment Checklist
Prepared by: [YOUR NAME]
I. PATIENT INFORMATION
# |
Task |
Status |
---|---|---|
1 |
Record the patient's full name and age. |
|
2 |
Document presenting symptoms. |
|
3 |
Note the patient's medical history. |
|
4 |
Gather family history of cardiac issues. |
|
5 |
List current medications and allergies. |
|
II. VITAL SIGNS
# |
Task |
Status |
---|---|---|
1 |
Measure and record heart rate. |
|
2 |
Measure and record blood pressure (both arms). |
|
3 |
Record respiratory rate and pattern. |
|
4 |
Assess and record oxygen saturation levels. |
|
5 |
Take and note temperature if relevant. |
|
III. PHYSICAL EXAMINATION
# |
Task |
Status |
---|---|---|
1 |
Perform chest auscultation to detect heart sounds. |
|
2 |
Assess peripheral pulses for strength and rhythm. |
|
3 |
Check for signs of edema in extremities. |
|
4 |
Observe for cyanosis in lips, nail beds, or skin. |
|
5 |
Inspect the jugular vein for distension. |
|
IV. DIAGNOSTIC TESTS
# |
Task |
Status |
---|---|---|
1 |
Conduct an Electrocardiogram (ECG/EKG). |
|
2 |
Schedule and perform an echocardiogram. |
|
3 |
Collect and analyze lab tests (e.g., troponin, cholesterol). |
|
4 |
Obtain imaging studies if necessary (e.g., chest X-ray, CT scan). |
|
5 |
Review results with the patient or team. |
|
V. RISK FACTOR ASSESSMENT
# |
Task |
Status |
---|---|---|
1 |
Evaluate for smoking or tobacco use. |
|
2 |
Check for a history of diabetes or hyperglycemia. |
|
3 |
Measure and record Body Mass Index (BMI). |
|
4 |
Assess for hypertension and its management. |
|
5 |
Discuss lifestyle factors, including diet and exercise. |
|
VI. CLINICAL NOTES AND RECOMMENDATIONS
# |
Task |
Status |
---|---|---|
1 |
Summarize key findings from the assessment. |
|
2 |
Provide initial treatment recommendations. |
|
3 |
Determine if a specialist referral is needed. |
|
4 |
Document patient education provided. |
|
5 |
Schedule follow-up or additional diagnostic tests. |
|