modelo ficha de avaliação

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<p>FICHA DE AVALIAÇÃO CINÉTICO FUNCIONAL</p><p>AVALIADOR :</p><p>Data: / /</p><p>Nome:</p><p>Idade:</p><p>Telefone:</p><p>Profissão/Ocupação</p><p>Diagnóstico Clínico:</p><p>ANAMNESE</p><p>QP:</p><p>HDP e HDA ( Porque está aqui, como aconteceu, quando, como,datas, patologias associadas, antecedentes patológicos, antecedentes cirúrgicos, medicamentos, etc)</p><p>História Social ( AVDs, lazer, etilismo, tabagismo, atividade física – frequência/ quantidade, antecedentes familiares)</p><p>Exames Complementares: (RX, ECG, TC, Laboratório,...):</p><p>Sinais Vitais:</p><p>PA:________________________FC _____________________________FR_________________________________________</p><p>Exame Físico</p><p>INSPEÇÃO (estática e dinâmica)</p><p>· Observação do paciente (estado geral e emocional)</p><p>· Marcha, Postura, uso de Meios auxiliares de Locomoção (Qual)</p><p>· Verificação do estado geral da pele, alterações cutâneas e articulares detalhadas e localização, cicatrizes, edemas.</p><p>· Presença de curativos, fixadores. Cicatrizes,</p><p>___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>PALPAÇÃO:</p><p>· Tônus, trofismo, presença de triggers points, dor a palpação (localização), edema-local</p><p>_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>AVALIAÇÃO SUBJETIVA DA DOR ( graduação de 0 à 10)</p><p>Característica: pontuada, agulhada, queimação, latejante, irradiada, etc.</p><p>Data</p><p>Grau</p><p>Local</p><p>Característica</p><p>Quando ocorre</p><p>Data</p><p>Grau</p><p>Local</p><p>Característica</p><p>Quando ocorre</p><p>_____________________________________________________________________________________</p><p>ADM Ativa/passiva</p><p>_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>Goniometria</p><p>__________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>TMM – Teste Muscular Manual</p><p>___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>Funcionalidade</p><p>______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p><p>Testes especiais de Ortopedia</p><p>Diagnóstico cinéticofuncional:</p><p>Objetivos de tratamento:</p><p>Curto Prazo:</p><p>Médio Prazo:</p><p>Longo Prazo:</p><p>Condutas do Programa de Tratamento:</p><p>Curto Prazo:</p><p>Médio Prazo:</p><p>Longo Prazo:</p><p>________________________</p><p>Acadêmico</p><p>image1.png</p><p>image2.jpeg</p><p>image3.png</p><p>image4.jpeg</p>