Ficha de Avaliação Geriatria

AVALIAO FISIOTERAPUTICA
Nome: ____________________________________________________________________ Idade: __________

Estado Civil: ___________________________________ Sexo: ____________________ Raa: _____________
Ocupao: ________________________________________ Estrutura Familiar: _________________________
Endereo:__________________________________________________________________________________
Quarto: ____________________ Tel.: __________________ Data da Avaliao: ________________________
Diagnstico Clnico: ______________________________________________________________________
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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: ____________ ____________ ____________
NVEL DE CONSCINCIA:
( ) lcido-orientado
( ) desorientado
ESTADO EMOCIONAL:
( ) calmo
( ) agitado
( ) lcido com momentos de desorientao

( ) inconsciente
( ) depressivo
( ) ansioso
( ) agressivo
SISTEMA RESPIRATRIO:
( ) ventilao espontnea
( ) ventilao espontnea com suporte de O2 _____________________________________________________________________________________
Ritmo: ( ) regular
( ) taquipnia
( ) bradipnia
( ) dispnia
Padro Muscular Ventilatrio:
( ) diafragmtico
( ) costo-diafragmtico
( ) intercostal
( ) intercostal
( ) acessrio
( ) paradoxal
Expansibilidade Torcica:
( ) normal
( ) diminuda
( ) assimtrica ________________________________
Ausculta:
( ) mvbd s/ra
( )mv diminudo ______________________ ( ) mv abolido _____________________
Rudos Adventcios:
( ) crepitaes ( ) roncos
( ) sibilos
Tosse:
( ) ausente
( ) seca
( ) mida
( ) produtiva
Aspecto da secreo: _________________________________________________________________________
SISTEMA OSTEOMIOARTICULAR:
( ) mov. Voluntrio
( ) mov. Involuntrio
( ) plegia
( ) paresia
Fora Muscular:
( ) normal
( ) diminuda ___________________________________________________________
Tnus:
( ) normal
( ) hipotnico
( ) hipertnico ( ) clnus
Amplitude Articular:
( ) normal
( ) diminuda __________________________________________________________
( ) luxao ___________________ ( ) rigidez ___________________( ) fratura _______________________
( ) desvios posturais _________________________________________________________________________

DEAMBULAO:
( ) livre
( ) bengala
( ) andador
( ) cadeira de rodas
( ) leito
MARCHA: _________________________________________________________________________________
EQUILBRIO/COORDENAO
( ) normal
( ) anormal ____________________________________________________________
PELE: ____________________________________________________________________________________
EDEMA: Local: ________________________________ Tipo: __________________ Grau: _______________
SEQUELAS de:_____________________________________________________________________________
APARELHO DIGESTRIO:
( ) continncia ( ) incontinncia fecal ( ) obstipao ______________________________________________
Abdomen:
( ) normal
( ) rgido
( ) flcido
( ) distendido
( ) doloroso ____________________________________________________________
APARELHO GENITOURINARIO
( ) continncia
( ) funo sexual ________________________________________________________
( ) incontinncia ____________________________________________________________________________
OBSERVAES: ___________________________________________________________________________
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DIAGNSTICO FISIOTERAPUTICO: _________________________________________________________
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OBJETIVOS:_______________________________________________________________________________
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CONDUTAS: ______________________________________________________________________________
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Ficha de Avaliação Geriatria

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AVALIAO FISIOTERAPUTICA

Nome: __________________________________________________________ Idade:

( ) lcido com momentos de desorientao

( ) desvios posturais _________________________________________________________________________

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