Date:



MU PT 7890 – Case Mgmt I

Cardiovascular and pulmonary response to 6 Minute Walk, Stair climbing

Date: |BP |HR / Rhythm |Resp |SpO2 |RPE /20 |Dyspnea /10 |Lungs

CTA? |AD used?

Rests? #, duration

Gait (GARS score) | |Resting | | | | |X | | | | |HR DURING | | | | | | | | | |

AFTER walking _______ in 6 min

(Norm for age is ______ ) | | | | | | | | | |After resting 5 minutes | | | | | | | | | |After resting ______ | | | | | | | | | |

Date: |BP |HR / Rhythm |Resp |SpO2 |RPE /20 |Dyspnea /10 |Lungs

CTA? |AD used?

Rests? #, duration

Gait (GARS score) | |Resting | | | | |X | | | | |HR DURING | | | | | | | | | |AFTER ascending and descending _____ flight(s) of stairs | | | | | | | | | |After resting 5 minutes | | | | | | | | | |After resting ______ | | | | | | | | | |

Date: |BP |HR / Rhythm |Resp |SpO2 |RPE /20 |Dyspnea /10 |Lungs

CTA? |AD used?

Rests? #, duration

Gait (GARS score) | |Resting | | | | |X | | | | |HR DURING | | | | | | | | | |

AFTER walking _______ in 6 min

(Norm for age is ______ ) | | | | | | | | | |After resting 5 minutes | | | | | | | | | |After resting ______ | | | | | | | | | |

Date: |BP |HR / Rhythm |Resp |SpO2 |RPE /20 |Dyspnea /10 |Lungs

CTA? |AD used?

Rests? #, duration

Gait (GARS score) | |Resting | | | | |X | | | | |HR DURING | | | | | | | | | |AFTER ascending and descending _____ flight(s) of stairs | | | | | | | | | |After resting 5 minutes | | | | | | | | | |After resting ______ | | | | | | | | | |

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