Ficha de Avaliação fisioterapêutica:

Data da avaliação: 07 / 06/ 2021

Nome:
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Idade: _______ Sexo: _________ Estado Civil: ___________________
Peso: ___________ Altura: ___________
Endereço:
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Telefone: __________________ Celular: _________________________
E-mail: _____________________________________________________
Profissão: _______________ Área de atuação: _____________________
Aposentado (a): Sim ( ) Não ( )
Pratica atividade física: Sim ( ) Não ( )
Qual? ____________________________
Fumante: Sim ( ) Não ( )
Faz uso de álcool: Sim ( ) Não ( )
Dieta especial: Sim ( ) Não ( )
Como está a alimentação:
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Fala/Dicção:
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Nível de Consciência: ____________________________________________________

Pele/unhas:
( ) Rubor normal
( ) palidez
( ) cianose
Observações: -
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Queixa Principal:
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Medicações em uso:
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HDA:
( ) Diabetes
( ) Hipertensão
( ) Colesterol Alto
( ) Arritmia
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HDP:
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História familiar:
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Sinais Vitais:
PA.: ____________ (120X80)
FC: _____________ (60-100 BPM)
FR: _____________ (12-20 IPM)

SISTEMA RESPIRATÓRIO:
( ) ventilação espontânea
( ) ventilação espontânea com suporte de O2 _________________________________

Ritmo: ( ) regular ( ) taquipnéia ( ) bradpnéia ( ) dispnéia

Expansibilidade Torácica:
( ) normal ( ) diminuída ( ) assimétrica ______________________________

Ausculta:
( ) mv normal ( ) mv diminuído ______________

Ruídos adventícios:
( ) crepitações ( ) roncos ( ) sibilos ( ) ausentes

Tosse:
( ) ausente ( ) seca ( ) úmida ( ) produtiva
Avaliação física:
Tônus (contração natural)
( ) atonia ( ) hipotonia ( ) normotonia ( ) Clônus

Coordenação (presente ou ausente)

index-index ( ) index-nariz ( ) calcanhar-joelho ( )

Sensibilidade (+) presente / (-) ausente

Membro Superior D ( ) ___________________________________________________
Membro Superior E ( ) ___________________________________________________
Membro Inferior D ( ) ___________________________________________________
Membro Inferior E ( ) ___________________________________________________

Relato de dor:
Escala de dor 1-10:
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Locais que paciente relata a dor:
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Força Muscular:
Observações e comparações;
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Dor ao movimento:
( ) Sim ( ) Não
Em quais articulações
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Limitação de movimento:
( ) Sim ( ) Não
Em quais articulações
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Equilíbrio:
Paciente sentado (a):
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Paciente de pé:
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Observações e mudança de decúbito:

Independente ( ) Com auxilio ( ) Dependente ( )
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Observações adicionais: ____________________________________________________
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OBJETIVOS: ______________________________________________________________
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Evoluções do paciente:
Data: _________
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