Escolar Documentos
Profissional Documentos
Cultura Documentos
Idade:____
Estado Civil:__________Peso:____kgAltura:_____m
Raa: __________
IMC:_______
Naturalidade:________________ Profisso/ocupao:_________________
Endereo:______________________________________ CEP:_______-____
Telefones: (__)_____-______ / (__)_____-______ / (__)_____-______
Mdico Resp.:__________________ Diagnstico mdico:______________
Diagnstico Fisioteraputico:______________________________
Data avaliao atual: ____/____/____
2 - Anamnese:
Queixa
Principal:_________________________________________________
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Histria da Molstia Atual:________________________________________
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Grau de Dispneia de acordo com a Escala de Dispneia de MRC:_______________
Medicamentos em uso
Medicamento
Dosagem
Posologia
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5 Manifestaes Respiratrias Primrias:
Tosse:_________________________________________________________
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Expectorao:____________________________________________________
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Hemoptise:______________________________________________________
Dor Torcica:____________________________________________________
Chieira Torcica:_________________________________________________
Cianose:________________________________________________________
Dispneia:_______________________________________________________
Outros:_________________________________________________________
5.1 Manifestaes Respiratrias Secundrias:
Gerais:_________________________________________________________
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Extratorcica:____________________________________________________
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3 - Exame Fsico:
Sinais Vitais: FC:____bpmPA:____X___mmHg FR:____irpm SpO 2:____%
3.1 Inspeo:
InspeoGeral:______________________________________________
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Medida cintura___________________
Medida Quadril:________________
ndice cintura-quadril:______________________
Inspeo Esttica:
Torx:__________________________________________________________
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Inspeo Dinmica:
Padro Respiratrio:______________________________________________
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Ritmo:__________________________________________________________
Amplitude:_______________________________________________________
Esforo:_________________________________________________________
3.2 Palpao
Sensibilidade:____________________________________________________
Flexibilidade:_____________________________________________________
Expansibilidade:__________________________________________________
Percusso:______________________________________________________
3.3 Fora Musculatura Respiratria:
PEmx: __________ Valor predito:_________ % predito:__________
PImx: ___________ Valor predito:_________ % predito:__________
3.4 Pico de Fluxo Expiratrio:_______ Valor predito:_____ %predito:______
3.5 Ausculta Respiratria: _________________________________________
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4 - Exames Complementares:
4.1 Gasometria arterial:
pH(7,35 a
PaCO2(35 a
PaO2(80 a 100
HCO3(22 a 26
7,45)
45 mmHg)
mmHg)
mmHg)
SpO2(>92%)
BE(-2 a
+2)
Avaliao Postural:
Vista Anterior:
Vista Posterior:
Expansibilidade Torcica:
Lobos Superiores:
Lobos Inferiores:
Exames Complementares:
Tomografia Computadorizada