1. AVALIAÇÃO FISIOTERAPÊUTICA
Nome: ____________________________________________________________________ Idade: __________
Estado Civil: ___________________________________ Sexo: ____________________ Raça: _____________
Ocupação: ________________________________________ Estrutura Familiar: _________________________
Endereço:__________________________________________________________________________________
Quarto: ____________________ Tel.: __________________ Data da Avaliação: ________________________
Diagnóstico Clínico: ______________________________________________________________________
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Medicamentos em uso: _______________________________________________________________________
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Queixas Principais: __________________________________________________________________________
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Mini-Mental Test: ____________ Clock Task: _____________ Barthel: _____________ PPT: ____________
Sinais Vitais: FC: __________ FR: _________ T: _______ PA: ____________ ____________ ____________
NÍVEL DE CONSCIÊNCIA:
( ) lúcido-orientado ( ) lúcido com momentos de desorientação
( ) desorientado ( ) inconsciente
ESTADO EMOCIONAL:
( ) calmo ( ) agitado ( ) depressivo ( ) ansioso ( ) agressivo
SISTEMA RESPIRATÓRIO:
( ) ventilação espontânea
( ) ventilação espontânea com suporte de O2 _____________________________________________________________________________________
Ritmo: ( ) regular ( ) taquipnéia ( ) bradipnéia ( ) dispnéia
Padrão Muscular Ventilatório:
( ) diafragmático ( ) costo-diafragmático ( ) intercostal ( ) intercostal
( ) acessório ( ) paradoxal
Expansibilidade Torácica:
( ) normal ( ) diminuída ( ) assimétrica ________________________________
Ausculta:
( ) mvbd s/ra ( )mv diminuído ______________________ ( ) mv abolido _____________________
Ruídos Adventícios:
( ) crepitações ( ) roncos ( ) sibilos
Tosse:
( ) ausente ( ) seca ( ) úmida ( ) produtiva
Aspecto da secreção: _________________________________________________________________________
SISTEMA OSTEOMIOARTICULAR:
( ) mov. Voluntário ( ) mov. Involuntário ( ) plegia ( ) paresia
Força Muscular:
( ) normal ( ) diminuída ___________________________________________________________
Tônus:
( ) normal ( ) hipotônico ( ) hipertônico ( ) clônus
Amplitude Articular:
( ) normal ( ) diminuída __________________________________________________________
( ) luxação ___________________ ( ) rigidez ___________________( ) fratura _______________________

2. ( ) desvios posturais _________________________________________________________________________
DEAMBULAÇÃO:
( ) livre ( ) bengala ( ) andador ( ) cadeira de rodas ( ) leito
MARCHA: _________________________________________________________________________________
EQUILÍBRIO/COORDENAÇÃO
( ) normal ( ) anormal ____________________________________________________________
PELE: ____________________________________________________________________________________
EDEMA: Local: ________________________________ Tipo: __________________ Grau: _______________
SEQUELAS de:_____________________________________________________________________________
APARELHO DIGESTÓRIO:
( ) continência ( ) incontinência fecal ( ) obstipação ______________________________________________
Abdomen:
( ) normal ( ) rígido ( ) flácido
( ) distendido ( ) doloroso ____________________________________________________________
APARELHO GENITOURINARIO
( ) continência ( ) função sexual ________________________________________________________
( ) incontinência ____________________________________________________________________________
OBSERVAÇÕES: ___________________________________________________________________________
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DIAGNÓSTICO FISIOTERAPÊUTICO: _________________________________________________________
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OBJETIVOS:_______________________________________________________________________________
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CONDUTAS: ______________________________________________________________________________
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