Ficha de avaliação GERIATRIA 2021 (1)

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AVALIAÇÃO FISIOTERAPÊUTICA EM GERIATRIA E GERONTOLOGIA 
 
DATA DA AVALIAÇÃO:____/____/________ 
AVALIADOR(ES):_________________________________________________________________________________ 
 
ANAMNESE 
DADOS GERAIS 
Nome:____________________________________________________________________________________________ 
Idade:_____________ DN: ________________ Sexo: ( ) F ( ) M Cor:___________________________________ 
Estado Civil: ( ) Solteiro(a) ( ) Casado(a) ( ) Separado(a) ( ) Viúvo(a) 
Filhos/Dependentes: ( ) Não ( ) Sim, quem?_________________________________________________________ 
Grau de Instrução:___________________________________________________________________________________ 
Peso:______________ Altura:__________________ 
 
HISTÓRIA CLÍNICA 
 
Lista de problemas:__________________________________________________________________________________ 
 
Cirurgia prévia: ( ) Não ( ) Sim, qual? __________________________________________________________ 
Uso de Órteses? ( ) Não ( ) Sim, qual o tipo?_______________________________________________________ 
Uso de Próteses? ( ) Não ( ) Sim, qual o tipo?_______________________________________________________ 
Mobilidade: ( ) Não deambula ( ) Deambula ( ) Sem auxílio ( ) Com auxílio, qual?_________________________ 
 
DOR: ( ) Não ( ) Sim, qual o local?___________________________________________________________________ 
Característica da dor: ____________________________________________________Intensidade (EVA):_____________ 
Duração: _______________________________Frequência:__________________________________________________ 
Medicações em uso:__________________________________________________________________________________ 
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SINAIS VITAIS 
 
PA:_____________ mmHg FC:_______bpm FR:_______ rpm 
 
AUSCULTA 
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QUEIXA PRINCIPAL 
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História familiar___________________________________________________________________________________ 
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Histórico de Quedas (quantas vezes caiu NO ÚLTIMO ANO, tempo desde a última queda, local da queda, traumas, 
lesões)____________________________________________________________________________________________
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EXAME FÍSICO 
INSPEÇÃO______________________________________________________________________________________
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POSTURA 
Estática:__________________________________________________________________________________________
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Dinâmica:________________________________________________________________________________________
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PALPAÇÃO_____________________________________________________________________________________
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TÔNUS__________________________________________________________________________________________ 
 
TROFISMO______________________________________________________________________________________ 
 
GRAU DE FORÇA MUSCULAR DO MEMBRO OU SEGMENTO MUSCULAR (0-5) (Relatar O QUE ESTÁ 
DEFICITÁRIO) 
MSD__________________________________________MSE______________________________________________ 
MID___________________________________________MIE_____________________________________________ 
 
AMPLITUDE DE MOVIMENTO DO MEMBRO OU SEGMENTO MUSCULAR (GRAU, MANTIDA, 
DIMINUÍDA) 
MSD__________________________________________MSE______________________________________________ 
MID__________________________________________MIE______________________________________________ 
 
AVALIAÇÃO GERIATRIA AMPLA 
Incontinência: ( ) Urinária ( ) Fecal ( ) Continente 
Cuidados pessoais nas atividades de vida diária (AVD): ( ) Independente ( ) Dependente ( ) Semi-dependente 
Realiza atividades instrumentais de vida diária (AIVD)? 
( ) Não ( ) Sim, se sim quais?______________________________________________________________________ 
 
ESCALAS E TESTES GERIÁTRICOS E GERONTOLÓGICOS 
Escala Score Interpretação 
Barthel (AVD) 
Lawton (AIVD) 
Mini-Mental (congnitivo) 
Yasavage (depressão) 
Short Physical Performance Battery – 
SPPB: – Equilíbrio 
– Velocidade da marcha 
– Levantar da cadeira 
 
 
 
Teste Timed Up and Go – TUG (teste 
de caminhada de 3 metros, avaliação 
do risco de quedas) 
 
Escala de BERG (equilíbrio estático e 
dinâmico) 
 
Tinneti: – Equilíbrio 
 – Marcha 
 – Total 
 
 
 
OBS: Algumas escalas ou testes serão utilizados dependendo do paciente 
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EXAMES COMPLEMENTARES 
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OBJETIVOS DA FISIOTERAPIA 
 
1) GERAL 
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2) ESPECÍFICOS (2) 
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CONDUTAS 
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OBSERVAÇÕES 
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Acadêmico (s) Preceptor