CURSO DE FISIOTERAPIA

Ficha de Avaliao Cardiorespiratria

Clnica Escola
Identificao:
Nome: _____________________________________Data: _____________________________________
Idade: ________________ DN: ____/_____/_____ Sexo: _____________________________________
Endereo:_______________________________________________________ _____________________
Cidade: ______________________________ Tel.: ___________________________________________
Profisso: ____________________________________________________________________________
Nome do Responsvel: __________________________________________________________________
Mdico: ______________________________________________________________________________
Diagnstico mdico: ____________________________________________________________________
Queixa Principal:
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Histria da Doena Atual:
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Histria Familiar: (ICC, HAS, ACV, TB, DPOC, Asma)
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Histrico Social e Fatores de Risco:
Tabagismo:
( ) Sim
( ) No
Tempo: ________________________
Etilismo:
( ) Sim
( ) No
Estresse:
( ) Sim
( ) No
Diabetes:
( ) Sim
( ) No
Hipertenso:
( ) Sim
( ) No
Obesidade:
( ) Sim
( ) No
Controle alimentar:
( ) Sim
( ) No
Capacidade fsica:________________________________________________ ________________
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AVD: ___________________________________________________________________________

Exames Complementares: (ECG, Rx, TCC,...)

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Medicamentos:
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Exame Fsico
Inspeo Fsica: (postura, pele e anexos, hidratao, mucosa, nutrio,...)
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Tipos de Marcha:
( ) Anserina
( ) Parkinsoniana
( ) Ceifante

( ) Atxica
( ) Tesoura

( ) Claudicante
( ) Escavante

Inspeo Especfica:
Tipo de Trax:
( ) Chato
( ) Pectus carinatum
( ) Sino

( ) Tonel/Barril
( ) Escolitico
( ) Ciftico

( ) Paraltico
( ) Cifoescolitico

Biotipo:
( ) Normolneo

( ) Brevelneo

( ) Longilneo

Respirao:
( ) Costal

( ) Diafragmtica

( ) Mista

Ritmo:
( ) Normal

( ) Anormal __________________________________________

( ) Pectus scavatum

( ) Paradoxal

( ) Apical

Palpao: (mobilidade, ndulos, gnglios, fraturas, aderncias, enfisema subcutneo, pontos de dor,
frmito,...)
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Percusso:
Som normal: ( )
Sons anormais:

( ) Hipersoridade
( ) Submacicez

( ) Timpnico
( ) Macicez

Ausculta:
Som normal: MV ( )
Sons anormais: Estertores secos
( ) Roncos
( ) Sibilos
Estertores midos
( ) Bolhosos
( ) Crepitantes
Localizao: _____________________________________________________
Avaliao da Tosse e Expectorao: (eficcia, perodo, quantidade, cor, odor, consistncia,..)
Tosse mida ( )
Tosse seca ( )
Tosse eficaz ( )
Tosse ineficaz ( )
Dispnia:
Grau I
Grau II
Grau III
Grau IV

(
(
(
(

)
)
)
)

Diagnstico Fisioterpico:
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Objetivos de Tratamento:
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Conduta:
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___________________________
Supervisor

__________________________
Estagirio

Testes Especficos

1
Avaliao

Valores
Previstos

PA
FC
Sat O2
Espirometria
VEPI
CVF
VEFI/CVF
Peak Flow
Manovacuometria
PI Mx
PE Mx
Fora Muscular 0 - II
Diafragma
Intercostais
Abdominais
Cirtometria
Esttica
Axilar
Processo Xifide
Basal
Cirtometria
Dinmica Axilar
Inspiratria
Expiratria
Diferena
Cirtometria
Dinmica Xifide
Inspiratria
Expiratria
Diferena
Cirtometria
Dinmica Basal
Inspiratria
Expiratria
Diferena

Data da 1 Avaliao:___________________________
Data da 2 Avaliao: __________________________
Data da 3 Avaliao: __________________________

2 Avaliao

Valores
Previstos

3 Avaliao

Valores
Normais