ICU PHYSIOTHERAPY BEDSIDE ASSESSMENT FORMAT
1. Patient Details
- Name:
- Age/Sex:
- Hospital ID:
- Date of Assessment:
- ICU Type:
- Diagnosis:
- Date of admission:
- Surgery/Procedure:
2. Patient Status
- Level of Consciousness:
- RASS Score:
- GCS Score:
- Sedation/Analgesia:
- Ventilation Status:
- Airway:
3. Vital Signs
HR:
BP:
RR:
SpO2:
Temp:
FiO2:
MAP:
4. Respiratory System Assessment
Airway:
Secretions:
Cough:
Breathing Pattern:
Chest expansion:
Auscultation:
Ventilator Mode/Settings:
5. Cardiovascular Assessment
Perfusion:
CRT:
Edema:
ECG:
Hemodynamic Support:
6. Musculoskeletal Assessment
ROM:
Tone:
Strength:
Joint Integrity:
Pain:
7. Neurological Assessment
Orientation:
Pupils:
Reflexes:
Motor Control:
Sensation:
8. Functional Status
Bed Mobility:
Sitting Balance:
Standing Balance:
Ambulation:
ICU Mobility Scale:
9. Investigations
X-Ray:
ABG:
Lab Values:
EF:
10. Lines & Tubes
IV/Central line:
Catheter:
Ryles tube:
Chest drains:
Wound drains:
Monitors:
11. Physiotherapy Problem List
- Impaired gas exchange
- Retained secretions
- Reduced mobility
- ICU-AW risk
- Pain
12. Treatment Plan
- Positioning
- ACT
- Breathing exercises
- Lung expansion techniques
- Suctioning
- Early mobilization
- Strengthening
13. Goals
Short-term:
Long-term: