Roteiro de Anamnese Adulto Ou Idoso

Roteiro de anamnese (adulto / idoso)  Nome:_____  Nome:_________ ________ _________ _________ ________ _________ __________ _________ ____ Idade: ______ ___________ ______  _  DN: ______________________ Escolaridade: _________________________  _________________________  Médico solicitante: solici tante: _____________________________  _____________________________  Queixa principal:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ ________  ____  História da doença:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________  ____ 

Queixas cognitivas:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Personalidade prévia: (como é seu jeito de ser? Continua assim ou ocorreu alguma mudança?)  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Alterações comportamentais: (mudou de comportamento após ser acometido pela doença?)  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __ 

Escolaridade/Profissão: (qual o nível de escolaridade e em que trabalha, como foi a trajetória profissional)  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Vida social: (convive com quem, atividades fora de casa, participa de algum tipo de grupo (igreja, clube, etc.))  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________  ____  Dinâmica familiar (com quem mora, irmãos (idades e profissões), pais (idades e  profissão),  profissão), arranjo familiar, familiar familiar de referência):  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Hábitos e rotina (o que gosta de fazer, preferências, alimentação, sono):  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Antecedentes familiares (algum familiar tem alguma doença relacionada com a do  paciente?):  paciente?):  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _______  __  Medicação:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ ______  __  Outras condições médicas: (perguntar se tem colesterol alto, pressão ou algum outro tipo de doença)  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ ________  ____ 

Exames:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ ______  __  Tratamentos:  _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ _________ ________  ___   _________  ______________ __________ __________ _________ ________ _________ __________ _________ _________ _________ _________ _________ ______  __