FICHA DE AVALIAÇÃO

CARDIORRESPIRATÓRIA

Data da Avaliação:_____/_____/______

IDENTIFICAÇÃO:

Nome:________________________________________________________________________
Idade:________Nascimento:_____/_____/_____ Sexo: F( ) M( )
Naturalidade:______________ Estado Civil:__________________
Endereço:__________________________________________________________, N_________
Bairro:_______________________Cidade:_____________________CEP:_________________
E-mail:_____________________________Profissão:__________________________________
Telefone: ( )___________-___________

Diagnóstico Clínico:____________________________________________________________
Medico Responsável:___________________________________________________________
Exames Complementares:_______________________________________________________
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Queixa Principal:______________________________________________________________
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HMA:_________________________________________________________________________
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HMP:_________________________________________________________________________
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H.Familiar/Socioeconômica:_____________________________________________________
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 FICHA DE AVALIAÇÃO
CARDIORRESPIRATÓRIA

*DA: ( )HAS ( )Etilista ( )DM ( )Tabagista ( ) Outros ___________________________________

*AF:__________________________________________________________________________

SINAIS VITAIS
FR:
FC:
PA:
SATO2:
TEMPERATURA:

EXAME FÍSICO - INSPEÇÃO ESTÁTICA:

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ESTADO NUTRICIONAL:
Obeso( )
Emagrecido( )
Caquético( )

PELE
Cianose( )____________________________________________________________________
Palidez( )_____________________________________________________________________
Cicatriz( )____________________________________________________________________
Fistula( )_____________________________________________________________________
Simetria Torácica( )____________________________________________________________
Deformidade Óssea( )__________________________________________________________
Dreno Torácico( )______________________________________________________________
Perda de Massa Muscular( )_____________________________________________________
Acesso Venoso( )______________________________________________________________
Baquete Amento Digital( )______________________________________________________
 FICHA DE AVALIAÇÃO
CARDIORRESPIRATÓRIA

TIPOS DE TÓRAX
Tórax em Tonel( )
Tórax em Quilha (Pombo)( )
Tórax Carinado Sapateiro( )
Tórax Paralítico( )
Tórax Assimétrica(Escoliotico( )
Tórax em Ampulheta( )
Tórax Cifoescoliótico( )
Tórax Cifótico( )
Tórax em Sino( )
Sem alterações( )

RITMOS RESPIRATÓRIOS
Dispnéia( )
Eupneia( )
Taquipnéia( )
Bradipnéia( )
Apinéia( )
Hiperpnéia( )
Hipopnéia( )
Cheyne-Stoke( )
Biot( )
Kussmaul( )
Respiração normal( )

PALPAÇÃO
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ENFIZEMA SUBCUTANEO: Sim( ) Não( )

FORÇA DE MM INTERCOSTAIS: Normal( ) Aumentada( ) Diminuída( )

FORÇA DE MM ABDOMINAIS: Normal( ) Aumentada( ) Diminuída( )

 FICHA DE AVALIAÇÃO
CARDIORRESPIRATÓRIA

AUSCULTA:___________________________________________________________________
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TIPOS DE TOSSE:
Tosse( )
Tosse bitonal( )
Tosse rouca ou afônica( )
Tosse produtiva( )
Tosse não produtiva( )

EXPECTORAÇÃO: Presente( ) Ausente( )

COR: Esbranquiçada( ) Amarelada( ) Esverdeada( ) Marrom( ) Rosea( )
ODOR: Presente( ) Ausente( )
DENSIDADE:__________________________________________________________________
HEMOPTISE:__________________________________________________________________

DIAGNÓSTICO FISIOTERAPEUTICO:
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OBJETIVOS DO TRATAMENTO:
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 FICHA DE AVALIAÇÃO
CARDIORRESPIRATÓRIA

CONDUTAS:
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Fisioterapeuta Responsável:__________________________________________________________

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