Avaliação Fisioterapêutica de Respiratória Ambulatorial
Transcript of Avaliação Fisioterapêutica de Respiratória Ambulatorial
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Faculdade Pitágoras Betim
AVALIAÇÃO FISIOTERAPÊUTIA !E RESPIRAT"RIAA#BULATORIAL
$ % !ados Pessoais&
'ome& _________________________________________________________
!ata 'ascime(to)& __/__/____ Idade& ____ Ra*a& __________
Estado i+il& __________ Peso& ____ ,gAltura& _____ m I#& _______
'aturalidade& ________________ Pro-iss.o/ocu0a*.o& _________________
E(dere*o& ______________________________________ EP& _______-____ Tele-o(es& (__)_____-______ / (__)_____-______ / (__)_____-______
#1dico Res0)& __________________ !iag(2stico m1dico& ______________
!iag(2stico Fisiotera03utico& ______________________________
!ata a+alia*.o atual& ____/____/____
4 % A(am(ese&
5uei6a
Pri(ci0al:_________________________________________________
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7ist2ria da #ol1stia Atual:________________________________________
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8rau de !is0(eia de acordo com a Escala de !is0(eia de #R :_______________
Medicamentos em uso
Medicamento Dosagem Posologia
7ist2ria da #ol1stia Pregressa:____________________________________
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7ist2ria Familiar& ________________________________________________
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7ist2ria Psicossocial: ____________________________________________
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9 : #a(i-esta*;es Res0irat2rias Primárias&
Tosse:_________________________________________________________
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Expectoração:____________________________________________________
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Hemoptise:______________________________________________________
Dor Torcica:____________________________________________________
!"ieira Torcica:_________________________________________________
!ianose:________________________________________________________
Dispneia:_______________________________________________________
#utros:_________________________________________________________
9)$ : #a(i-esta*;es Res0irat2rias Secu(dárias&
$erais:_________________________________________________________
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Extratorcica:____________________________________________________
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< % E6ame F=sico&
%inais &itais: '!:____pmP:____*___mmHg '+:____irpm %p#,:____
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0ndice cintura-1uadril:______________________
.nspeção Esttica:
Torx:__________________________________________________________
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.nspeção Din2mica:
Padrão +espirat3rio:______________________________________________ _______________________________________________________________
+itmo:__________________________________________________________
mplitude:_______________________________________________________
Es4orço:_________________________________________________________
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Data do exame: __/__/____
>)4 Radiogra-ia& _________________________________________________
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Data do exame: __/__/____
>)<
Es0irometria& _________________________________________________
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Data do exame: __/__/____
>)> Outros:______________________________________________________
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Data do exame: __/__/____
? % O@eti+os do tratame(to& _______________________________________
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% o(duta Fisiotera03utica&
!urto PraBo:_____________________________________________________
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MCdio PraBo:____________________________________________________
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ongo PraBo:_____________________________________________________
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A+alia*.o Postural&
Vista A(terior& Vista Posterior&
Vista Lateral EsCuerda& Vista Lateral !ireita&
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E60a(si@ilidade Torácica&
Lo@os Su0eriores&
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Lo@o #1dio e l=(gula&
Lo@os I(-eriores&
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E6ames om0leme(tares&
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Tomogra-ia om0utadoriDada
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