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AFB - Avaliação Funcional Breve
Nome:
Data: / / Prontuário:
Áreas de teste Procedimento Resultado anormal
1. Visão
Testar a visão com cartão de Jaeger enquanto o(a)
paciente usa lentes corretoras (se aplicável)
Não lê melhor que
20/40
2. Audição
Sussurrar a pergunta “qual é o seu nome?” em cada
ouvido, com a face do examinador fora da visão direta
do paciente
Não responde
3. Incontinência
urinária
Perguntar: “No último ano, o(a) senhor(a) perdeu urina e
molhou roupas íntimas sem querer?”. “Isso aconteceu
em, pelo menos, 6 dias separados?”
Sim à 2a pergunta
4. AVD/AIVD
Perguntar: “O(a) senhor(a) pode levantar-se da cama sem
ajuda? Pode vestir-se sozinho(a)? Pode preparar suas
refeições? Pode fazer compras sozinho(a)?”
Não a qualquer
pergunta
5. Braço
Pedir: “Toque a nuca com ambas as mãos”; “pegue a
colher”.
Não consegue um ou
outro
6. Perna
Observar o(a) paciente após pedir: “Levante-se da
cadeira, ande 3 metros, retorne e sente-se”. Tempo
de percurso: __________
Não anda, levanta ou
faz o percurso em t
> 12 s
7. Nutrição Peso: ______ kg Alt.: ______ IMC: ______ kg/m2 IMC < 22 kg/m2
8. Estado mental
Memorize as palavras: carro, vaso, bola. Pedir para repetir
depois de 1 min
Não repetir uma das
palavras
9. Depressão
Perguntar: “O(a) senhor(a) sente-se muitas vezes triste ou
deprimido(a)?”
Sim
10. Ambiente no
domicílio
Perguntar: “O(a) senhor(a) tem dificuldades em
subir/descer escadas em seu domicílio? Tem banheira ou
tapete solto?
Há algum lugar na sua casa com pouca iluminação?”
Sim a qualquer
pergunta
11. Apoio social
Perguntar: “O(a) senhor(a) tem familiares, amigos ou
vizinhos com quem possa contar em caso de doença ou
emergência?”
Ninguém

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Afb

  • 1. AFB - Avaliação Funcional Breve Nome: Data: / / Prontuário: Áreas de teste Procedimento Resultado anormal 1. Visão Testar a visão com cartão de Jaeger enquanto o(a) paciente usa lentes corretoras (se aplicável) Não lê melhor que 20/40 2. Audição Sussurrar a pergunta “qual é o seu nome?” em cada ouvido, com a face do examinador fora da visão direta do paciente Não responde 3. Incontinência urinária Perguntar: “No último ano, o(a) senhor(a) perdeu urina e molhou roupas íntimas sem querer?”. “Isso aconteceu em, pelo menos, 6 dias separados?” Sim à 2a pergunta 4. AVD/AIVD Perguntar: “O(a) senhor(a) pode levantar-se da cama sem ajuda? Pode vestir-se sozinho(a)? Pode preparar suas refeições? Pode fazer compras sozinho(a)?” Não a qualquer pergunta 5. Braço Pedir: “Toque a nuca com ambas as mãos”; “pegue a colher”. Não consegue um ou outro 6. Perna Observar o(a) paciente após pedir: “Levante-se da cadeira, ande 3 metros, retorne e sente-se”. Tempo de percurso: __________ Não anda, levanta ou faz o percurso em t > 12 s 7. Nutrição Peso: ______ kg Alt.: ______ IMC: ______ kg/m2 IMC < 22 kg/m2 8. Estado mental Memorize as palavras: carro, vaso, bola. Pedir para repetir depois de 1 min Não repetir uma das palavras 9. Depressão Perguntar: “O(a) senhor(a) sente-se muitas vezes triste ou deprimido(a)?” Sim 10. Ambiente no domicílio Perguntar: “O(a) senhor(a) tem dificuldades em subir/descer escadas em seu domicílio? Tem banheira ou tapete solto? Há algum lugar na sua casa com pouca iluminação?” Sim a qualquer pergunta 11. Apoio social Perguntar: “O(a) senhor(a) tem familiares, amigos ou vizinhos com quem possa contar em caso de doença ou emergência?” Ninguém