FICHA DE AVALIAÇÃO CARDIORRESPIRATÓRIA

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FICHA DE AVALIAÇÃO CARDIORRESPIRATÓRIA 
Identificação:
Nome:_______________________________________ Idade:______ Sexo: ( )F ( ) M
1. HMP: ___________________________________________________________________
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2. HMA____________________________________________________________________
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3. Doenças Associadas: _______________________________________________________
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4. Histórico Familiar: _________________________________________________________
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5. Hábitos de Vida: ___________________________________________________________
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6. Diagnóstico Clinico: ________________________________________________________
7. Queixa principal: _________________________________________________________
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Sinais Vitais 
FR: 
FC: 
PA: 
SatO2:) 
Temperatura: 
Exame Físico/Inspeção Estática: __________________________________________
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Estado Nutricional: ( ) Obeso ( ) Emagrecido ( ) Caquético 
Pele e Mucosas: 
( ) Sistema Venoso visível
( ) Palidez
( ) Cianose (Periférica/Central)
( ) Deformidade Óssea 
( ) Perda de Massa Muscular
Tipo do Tórax
( ) Normal ( ) Tonel ( ) Carinatum ( ) Escavado ( ) Cariniforme (Pombo) Outros: ________________________________________________________________________
Padrão Muscular Ventilatório: ( ) Apical ( ) Diafragmático ( )Misto ( ) Paradoxal
Tipo de Ventilação: ( ) Nasal ( ) Oral ( ) Traqueostomia ( )Ar ambiente ( ) Oxigenoterapia: ________________________________________________________________________
Ritmo Ventilatório: ( ) Regular ( ) Irregular 
Musculatura Acessória:
Grau : _______________________________________________________________________ Abdome:_____________________________________________________________________
Sinais: 
( ) Tiragem 
( )Batimento da Asa do Nariz 
( )Cianose 
Outros: ______________________________________________________________________
Sintomas: 
( ) Dispneia ( ) Tontura ( ) Dor Outros: ____________________________________
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Avaliação Motora: Tônus: _____________________________________________________________________________ Reações e Reflexos: _____________________________________________________________________________
ADM: _____________________________________________________________________________ Força Muscular: _____________________________________________________________________________Sensibilidade: _____________________________________________________________________________Controle Motor: _____________________________________________________________________________
Exames Complementares: RX: __________________________________________________________________________________________________________________________________________________________ ( )Tomografia ( ) Ressonância: __________________________________________________________________________________________________________________________________________________________Gasometria: pH: ___ PaCO2: ___ PaO2: ___ Sat O2: ___ HCO3: ___ ECG:_________________________________________________________________________Ecocardiograma:_______________________________________________________________CAT:_________________________________________________________________________Hemograma:__________________________________________________________________Espirometria: CVF:____ VEF1: ____ VEF1/CVF:_______________________________________
Outros:_______________________________________________________________________
Diagnóstico Cinético-funcional: 
Problema: ____________________________________________________________________
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Objetivo: _____________________________________________________________________
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Conduta: _____________________________________________________________________
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Evolução do Paciente: __________________________________________________________
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