Ficha de avaliação fisioterapia respiratória

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FICHA DE AVALIAÇÃO – PACIENTE RESPIRATÓRIO 
 
Avaliador:___________________________________________________________________________ 
Data:____/____/____ 
__Anamnese__ 
 
Nome:_________________________________________________________________________________ 
Sexo: F M Estado Civil:_______________________________________ 
Data de nascimento:____/____/_____ Naturalidade:___________________________________________ 
Endereço:______________________________________________________________________________ 
Profissão:_______________________________Religião:___________________________________ 
 
Diagnóstico médico: 
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Queixa principal:________________________________________________________________________ 
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História da Moléstia Atual (HMA) 
 
1. Cronologia: 
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2. Localização Corporal: 
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3. Qualidade: ______________________________________________________________________ 
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Quantidade:______________________________________________________________________ 
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4. Circunstâncias: ____________________________________________________________________ 
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5. Fatores agravantes e atenuantes: 
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6. Manifestações 
associadas:________________________________________________________________________
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7. Consultas, exames e tratamentos anteriores e resultados obtidos: 
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Hábitos e vícios 
 
 
 
 
 
 
Antecedentes Pessoais 
 
Antecedentes Familiares 
 
__Sinais e sintomas__ 
 
 
Dispneia: sim não Obs.: 
 
 
 
Tosse: sim não Obs.: 
 
 
 
Escarro: sim não Obs.: 
 
 
 
Hemoptise: sim não Obs.: 
 
 
 
Dor torácica: sim não Obs.: 
 
 
 
Cianose: sim não Obs.: 
 
 
 
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Baqueteamento digital: Obs.: 
 sim não 
 
 
Sinais de aumento do Obs.: 
trabalho respiratório: 
 sim não 
 
 
 
__Exame físico__ 
 
Antropometria 
Peso:_________kg Altura:_________cm IMC:_____________ 
Tipo de tórax: Normolíneo Longilíneo 
 Brevilíneo 
Config. Torácica anormal: sim não Obs.: 
 
Percussão torácica 
D:____________________________________________________________________ 
E:____________________________________________________________________ 
Expansibilidade 
Torácica:_______________________________________Abdominal:_______________________________ 
Avaliação Postural 
 
Ausculta pulmonar 
D:____________________________________________________________________ 
E:____________________________________________________________________ 
PA:______________(PAS/PAD) 
 
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Frequência cardíaca e pulso: 
FC =_________bpm Classificação:_________________ 
FP =_________bpm Classificação:_________________ 
Frequência respiratória: ________rpm Classificação:________________ 
Ritmo respiratório:________________________________ 
Padrão respiratório: Normal Apical Abdominal Paradoxal 
 
 
Exame de cabeça e pescoço: _________________________ 
Obs.: 
 
 
__Exames complementares__ 
Radiografia de tórax:_____________________________ 
Obs.: 
 
 
Tomografia computadorizada (TC):_______________________________ 
Obs.: 
 
 
 
Broncoscopia:_______________________________________ 
Obs.: 
 
 
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1ª:_______________ ________________ 
2ª:_______________ ________________ 
3ª:_______________________________ 
4ª:_______________________________ 
1ª:________________________________ 
2ª:________________________________ 
3ª:________________________________ 
4ª:________________________________ 
 
Exame de escarro 
 Análise macroscópica Análise microscópica 
 
 
 
 
 
Medida dos mediadores inflamatórios:_________________________________ 
Obs.: 
 
 
 
 
_Testesfuncionais__ 
 
Espirometria:_______________ Manovacuometria:____________ 
 
 
 
 
 
Teste de caminhada de seis minutos (TC6min):_____________________________ 
Obs.: 
 
 
 
 
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Shuttlewalk teste incremental (SWTI):___________________________________ 
Obs.: 
 
 
 
Shuttlewalk teste endurance(SWTE):___________________________________ 
Obs.: 
 
 
 
Teste do degrau:___________________________________ 
Obs.: 
 
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