Ficha de avaliação fisioterapêutica pediátrica

Ficha de avaliação fisioterapêutica pediátrica IDENTIFICAÇÃO: Nome:________________________________________________________________ Data de nascimento: nascimento : ____/_____/_____ ____/_____/____ _ Sexo: F( ) M ( ) Idade:________ Idade:_____ ___ raça:_______________ raça:__________ _____ peso: ________ altura:_________ altura:________ _ Naturalidade:__________________ Procedência:____________________________ Nome do responsável_____________________________________________________ Endereço:_____________________________________________________________ Data da admissão: ____/_____/__ ____/_____/_____ ___ Data da avaliação: ____/_____/_____ ____/_____/_____ ANAMNESE QP:____________________________________________________________________ HDA:__________________________________________________________________  __________________  __________________________ _______________ ______________ ________________ __________________ __________________ _____________ ____  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____  __________________  ___________________________ __________________ ________________ ________________ ________________ __________________ _____________  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____  __________________  ___________________________ _________________ ________________ ________________ _________________ _________________ ___________ ___ HPP/HF:________________________________________________________________  __________________  ___________________________ ____________________ ____________________ __________________ ________________ _______________ ________  __________________  ___________________________ __________________ ________________ _________________ __________________ ________________ __________ __ História do parto, gestação e pós-parto:______________________________________  __________________  ___________________________ __________________ __________________ _________________ _______________ _________________ __________ História do desenvolvimento:_______________________________________________  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____ ALimentação:__________________________________ ALimentação:________________________ ______________________ _________________________ ____________________ _______  _______________________  ___________________________________ _______________________ ______________________ _______________________ ____________________ ________

EXAME FÍSICO SINAIS VITAIS FC: ________ bpm

FR:________ irpm

Tax: ______° C

INSPEÇÃO______________________________________________________________  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____  __________________  ___________________________ __________________ ________________ ________________ ________________ _______________ ____________ ____  __________________  ___________________________ __________________ ________________ _________________ _________________ ________________ ___________ __

PALPAÇÃO______________________________________________________________  _______________________________________________________________________ OBS:___________________________________________________________________  _______________________________________________________________________ AVALIAÇÃO RESPIRATÓRIA AP:____________________________________________________________________  _______________________________________________________________________  _______________________________________________________________________ TIPO DE TÓRAX:__________________________________________________________ PADRÃO RESPIRATÓRIO:___________________________________________________ SINAIS DE DESCONFORTO RESPIRATÓRIO:_____________________________________ PERCUSSÃO DO TÓRAX:___________________________________________________ OBS:___________________________________________________________________  _______________________________________________________________________ AVALIAÇÃO NEUROLÓGICA Tônus Muscular:_________________________________________________________ Coordenação e equilíbrio__________________________________________________ Sensibilidade:___________________________________________________________ Reflexos superficiais:______________________________________________________ Reflexos profundos:______________________________________________________ Outras Informações:______________________________________________________  _____________________________________________________________________________ AVALIAÇÃO TRAUMATO-ORTOPÉDICA______________________________________________  _____________________________________________________________________________  _____________________________________________________________________________

Exames complementares  _______________________________________________________________________  _______________________________________________________________________ DIAGNÓSTICO CLÍNICO:__________________________________________________________ DIAGNÓSTICO FISIOTERAPÊUTICO:________________________________________________  _____________________________________________________________________________ CONDUTA TERAPEUTICA:  _____________________________________________________________________________  _____________________________________________________________________________  _____________________________________________________________________________  _____________________________________________________________________________

Acadêmica de fisiotera ia