Ficha de Avaliação Neonato

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Ficha de Avaliação Fisioterapia Neonatal
Nome RN: ____________________________________________________________Data: _____/______/______
Data Nasc.: _______________________ Sexo: □ F □ M Internação: _______/______/________
Apgar: 1º min.:________ 5º min.:_________
Nome da Mãe: ________________________________________________________________________________
Endereço:______________________________________________________________ Zona: □ Rural □ Urbana
Cidade: _______________________________ Raça/Cor:________________________Tel.: __________________
Profissão: ________________________________________________________________ Enfermaria/Leito:_________________ Nº de Gestações: ____________________________________
Estado Civil: □ Solteiro □ Casado □ Divorciado □ Viuvo Instrução: _________________________________
Médico: _______________________Diagnóstico médico:______________________________________________
Queixa Principal: 
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História Materna: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
História Gestacional: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
História do Parto:
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História do RN: _____________________________________________________________________________________________
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Inspeção Física: _____________________________________________________________________________________________
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Palpação:_____________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Nível de Consciência: _______________________________________________________________
Pupilas: ______________________________ Face:_______________________________________
Mobilidade: Ativa ( ) Passiva ( ) Reflexos Adequados : sim ( ) não ( )
Tônus Muscular:___________________________________________________________________
ADM: _____________________________ Sensibilidade:__________________________________
Outras Informações: ________________________________________________________________
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Padrão Respiratório:________________________________________________________________________
Ausculta Pulmonar:_________________________________________________________________________
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□PA: ________x________mmHg □FR: _________ipm □FC_______________bpm □SaO2 ___________% 
Temperatura:_______________________________
Perimetria
Cefálica: ________________________________________
Torácica: _______________________________________
Abdominal: ______________________________________
Postura: ____________________________________________________________________________________
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Reflexos Arcaicos Presentes:
□ Voracidade (piper) □Preensão reflexa palmar □Preensão reflexa plantar □Cutaneo plantar
□Reação automática □Sucção □Galant □Moro
Obs: ________________________________________________________________________________________
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Exames Complementares: ____________________________________________________________________________________________
Medicamentos:________________________________________________________________________________ _____________________________________________________________________________________________
Evolução: __________________________________________________________________________________________________________________________________________________________________________________________
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Conduta: _____________________________________________________________________________________________
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Diagnóstico Fisioterápico e Objetivos de Tratamento: 
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