trab.acup.anamnese

IPESSP – INSTITUTO DE PESQUISA E EDUCAÇÃO EM SAÚDE DE SÃO PAULO

TRABALHO DE ACUPUNTURA

LUCIENE HELENA DA SILVA

MARÇO - 2015SÃO PAULO

Clínica SHEN TIDra Luciene Helena da Silva

Biomédica Acupunturista - CRBM 11943R Brilhante, 71 – Jd dos Camargos – Barueri, SP

SHEN TI

ANAMNESE

Nome: _______________________________________________________________________

Idade: _________________ Sexo: ______________ Estado Civil: _____________________

Profissão: _____________________________________________________________________

Endereço: ____________________________________________________________________

Cirurgias Realizadas: ____________________________________________________________

Alergia a medicamentos: ________________________________________________________

Se mulher:

Quantidade e Tipo de Partos: _____________________________________________________

DUM: (data da última menstruação) _______________________________________________

TPM: (vontade de morrer ou matar?) ______________________________________________

Menstruação regular: ___________________________________________________________

Menopausada: ________________________________________________________________

1- Doença de Base? ______________________________________________________________________________________________________________________________________________Local da dor?______________________________________________________________________________________________________________________________________________Tipo da dor?Pontiaguda, Tensional, Latejante, outras ___________________________________________________________________________________________________________________________________________________________________________________Hematomas? _________________________________________________________________________________________________________________________________Inchaço? ______________________________________________________________________________________________________________________________________



Tempo da dor, recente ou antiga? ________________________________________________________________________________________________________________________________________________________________________________________Horário da dor? ________________________________________________________________________________________________________________________________

2- Principal sentimento que descreve sua personalidade?Preocupado / Triste / Irritado / Tímido / Alegre (excesso= incoveniente)______________________________________________________________________________________________________________________________________________

3- Transpiração: Muito ou Pouco? ________________________________________________________ _______________________________________________________________________Horário: _______________________________________________________________Local: ________________________________________________________________________________________________________________________________________

4- Preferência por alimentos:Quente ou Frio? _________________________________________________________ _______________________________________________________________________Doce, Salgado, Amargo, Picante ou Ácido? ___________________________________________________________________________________________________________Horário: _______________________________________________________________

5- Sede:Geralmente mais de dia ou de noite? _______________________________________________________________________________________________________________Horário: _______________________________________________________________Tipo: insaciável ou basta? ________________________________________________________________________________________________________________________

6- Como é a sua Digestão?Normal, Sensação de Vazio ou de Empachamento? _____________________________________________________________________________________________________________________________________________________________________________________________________________________Sente sono após refeições? ______________________________________________________________________________________________________________________________________________________________________________________________

7- Excreções:- Urina: Mais de dia ou mais de noite? _____________________________________________________________________________________________________________________



Cheiro normal ou forte? _________________________________________________________________________________________________________________________Cor: amarelo claro, amarelo escuro, outras? _________________________________________________________________________________________________________Dor ao urinar? ________________________________________________________________________________________________________________________________

- Fezes:Todos os dias? _________________________________________________________________________________________________________________________________Quantas vezes ao dia? ___________________________________________________________________________________________________________________________Formato de “charutinho”, “bolinha” ou “pastosa”? ____________________________________________________________________________________________________Cor: (clara ou escura?)___________________________________________________________________________________________________________________________

8- Respiração:Ofegante / Curta / Normal? ______________________________________________________________________________________________________________________________________________________________________________________________Apresenta dificuldade para respirar? ____________________________________________________________________________________________________________________________________________________________________________________

9- Sono: Dorme bem ou apresenta dificuldade para dormir?___________________________________________________________________________________________________________________________________________________________________________Insônia: ______________________________________________________________________________________________________________________________________________________________________________________________________________Precisa levantar a noite? ________________________________________________________________________________________________________________________________________________________________________________________________Horário: _____________________________________________________________________________________________________________________________________________________________________________________________________________Muitos sonhos? _______________________________________________________________________________________________________________________________________________________________________________________________________ Bons ou ruins?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Apnéia? ____________________________________________________________________________________________________________________________________________________________________________________________________________

Faz uso de algum medicamento para dormir? Qual? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10- Sentidos:- Visão / Olhos: Vermelhos? ___________________________________________________________________________________________________________________________________Fotofobia? ____________________________________________________________________________________________________________________________________

- Audição / Ouvidos:Surdez? _______________________________________________________________________________________________________________________________________Zumbido? _____________________________________________________________________________________________________________________________________

- Olfação / Nariz: Secreções? ___________________________________________________________________________________________________________________________________________________________________________________________________________Dificuldade p sentir cheiros? _____________________________________________________________________________________________________________________________________________________________________________________________

- Paladar / Boca:Geralmente apresenta gosto amargo, azedo, metálico, doce ou salgado na boca? __________________________________________________________________________________________________________________________________________________

- Tato / Sensação:Transpiração?__________________________________________________________________________________________________________________________________Horário? ______________________________________________________________________________________________________________________________________Queimaduras? _________________________________________________________________________________________________________________________________Anomalias / deformidade? ________________________________________________



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