Ficha de Avali ação:

FICHA DE AVALIAÇÂO RESPIRATORIA

Nome:__________________________________________________________
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Idade:_______ Sexo:____________________ Raça:____________________
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Ocupação:____________________________ __ Estado Civil:_____________
Endereço:______________________________________________________

Diagnostico Clinico:_______________________________________________________

HDP_______________________________________________________
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HDA___________________________________________________________
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Queixa
principal_________________________________________________________
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Escala EVA: _______ ____ ______ ___ Peso: _______

Remédios em uso: ( ) Sim ( ) Não

Quais___________________________________________________________
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Alimentação: ____________________________________________________
Realiza Atividade Física:
( ) Sim ( ) Não Qual__________________________________________
Frequência:__________

Hábitos diários:
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Doenças Previas: ( ) Sim ( )Não
Quais___________________________________________________________
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Exames Complementares :
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Exame físico:
Sinai s Vitais: FC:_____ ____ ___ _ F R:_ ___ ____ ____ T: ___ ____
Saturação O²:___ ____ ___ __

Nível de consciência:

( ) Lucido- orientado ( )Lucido com momentos de desorientação

( ) Desorientado ( )Inconsciente

Estado Emocional:

( )Calmo ( )Agitado ( )Depressivo ( ) Ansioso ( ) Agressivo

Respiração:

( ) Ventilação Espontânea ( ) Ventilação Espontânea com suporte de O²

( )Nasal ( )Oral

Padrão Respiratório:

( )Torácica/Costal ( ) Diafragmática ( )Mista

Padrão Respiratório Patológico:

( ) Regular ( ) Taquipneia ( ) Bradipneia ( ) Hiperpneia

( ) Ataxica ( ) Apneia ( ) Cheyne -Stoke s

Padrão Muscular Respiratório:

( ) Diafragmático ( ) costo -diafragmático ( ) Intercostal

( )Acessório ( )Paradoxal

Ausculta: ( ) mvbd s/ ra ( )mv diminuído ( )mv abolid o

Ruídos Adventícios:
( ) Crepitação ( ) Roncos ( ) Sibilos ( ) Derrame Pleural

Tosse:
( )Ausente ( ) Presente ( ) Eficaz ( ) Não Eficaz
( )Seca ( )Úmida ( ) Produtiva

Aspecto da Secreção
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Trombos:
( ) Sim ( )Não
Local: __________________________________________________________

DIAGNÓSTICO CINÉTICO FUNCIONAL

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OBJETIVOS DO TRATAMENTO
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