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ANSWER
THE QUESTIONS LISTED
BELOW
FOR YOUR CLIENT’S SPECIFIC PROBLEM
CARDIAC (HEART)
HISTORY
CORONARY ARTERY DISEASE
Types of Impairments: Angina, Arrhythmia, Angioplasty,
Bypass, Heart Murmur,
Heart Attack (Myocardial Infarction)
Any
restrictions on activity? If yes, give details.
Date of last stress test? Results?
Does client carry a pill
(nitroglycerin) or a does client ever where a patch for chest pain? If
yes, date last used?
Has client
ever had any of the following: Syncope
(fainting)? Dizziness? Palpitations? Congestive Heart
Failure (CHF)? If yes, give dates and details.
Answer ALL
questions listed under
#1 General Risk Profile
ANGINA
(Chest pain)
A.
Frequency of attacks?
B.
Date of first episode of chest pain? Date of last episode of
chest pain?
ARRHYTHMIA
A.
What does your client’s Doctor call his/her abnormal heart
rhythm? (Atrial Fibrillation,
Tachycardia, PVC’s, Palpitations)
B.
Was cause given?
C.
Was client ever cardioconverted (shocked with paddles to correct
heartbeat)? Dates?
D.
Does client have a pacemaker? Date inserted and date if replaced?
ANGIOPLASTY / BYPASS
A.
Number of diseased vessels?
B.
Number of vessels ballooned or bypassed?
C.
Any angina (chest pains) since surgery?
D.
Reason for surgery? (ie: heart attack, chest pains, abnormal
stress test)
HEART MURMUR
A.
What type of murmur does your client have? (Aortic Stenosis,
Aortic Regurgitation, Aortic Insufficiency,
Mitral Insufficiency, Pulmonic Stenosis, Flow Murmur, Innocent Murmur)
B.
Any history of Rheumatic Fever?
C.
Any symptoms?
(ie: chest pain, palpitations, dizziness) Dates?
D.
Any surgical procedures?
(ie: repair or valve replacement)? Dates?
HEART ATTACK (Myocardial Infarction)
A.
Date of attack(s)?
If more than 1, give dates of all attacks.
B. Length
of hospital stay?
C. Amount
of time before returning to work? If not presently working explain?
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