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CUPRINS

ARGUMENT 2CAPITOLUL I. INTRODUCERE ÎN GERIATRIE 5

I.1. DEFINI II. GENERALITĂ I.Ț Ț 5I.2. AFECŢIUNI MAI FRECVENTE ÎN PRACTICA GERIATRICĂ. BOLILE

BĂTRÂNE IIȚ 6I.3. BĂTRÂNEŢEA - ETAPĂ FIZIOLOGICĂ - NU BOALĂ 8I. . ROLUL I POZIŢIA MEDICULUI I A!I!TENTEI FAŢĂ DE BOLNAVULȘ Ș

VÂR!TNIC. "I.5. EDUCAŢIA !ANITARĂ "

CAPITOLUL II. ELEMENTE DE ANATOMIE #I FIZIOLOGIE A ARTERELOR 11CAPITOLUL III. PREZENTAREA BOLII ARTERIOPATIE OBLITERANTĂ 1

III.1. DEFINIŢIE 1III.2. FIZIOPATOLOGIE 1III.3. ETIOLOGIE 15

III. . CLA!IFICAREA ANATOMO-CLINICĂ A I!C$EMIILOR PERIFERICEIII. .1. C%&'()(*&+,& *%( (* & ('*/,0(,( &* , ,+(),+(*, 15III. .2. C%&'()(*&+,& ('*/,0((%4+ *+4 (*, L,+(*/,-F4 &( , 16

III.5. FORME CLINICE 16III.6. !IMPTOMATOLOGIE 1"III. . DIAGNO!TIC 1"

III. .1 D(&7 4' (* *%( (* 1"

III. .2. D(&7 4' (* (),+, (&% 25III. .3. D(&7 4' (* % (),+, (&% &% *%& (*& (,(

III.8. COMPLICAŢII 26III.". TRATAMENT 2

CAPITOLUL IV. ROLUL A!I!TENTEI MEDICALE ÎN PREGĂTIREA BOLNAVULUIPENTRU E9PLORĂRI !PECIFICE. 31

PLANUL DE ÎNGRI:IRE 31

CAPITOLUL V. INTERVEN IILE A!I!TENTEI MEDICALE PRIVIND ;NGRI:IREAȚBOLNAVULUI CU ARTERIOPATIE OBLITERANTĂ 3

1


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CAPITOLUL VI. CAZ CLINIC 3VI.1. CULEGEREA DATELOR 3VI.2. NEVOILE FUNDAMENTALE DUPĂ MODELUL CONCEPTUAL AL

VIRGINIEI $ENDER!ON <

VI.3. PLAN DE ÎNGRI:IRE A PACIENTULUI !.Z. 2VI. . EVALUAREA FINALĂ

CAPITOLUL VII. EDUCAŢIA PENTRU !ĂNĂTATE 8CONCLUZII 5<ANE9A 1 51ANE9A 2 52ANE9A 3 53

ANE9A 5BIBLIOGRAFIE 55

2


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MOTTO

"Mai important decat sa dai ani vietii, este sa dai viata anilor"

A & A'%&

ARGUMENT

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CAPITOLUL I.

INTRODUCERE ÎN GERIATRIE

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;0@ +? (+((.

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I.!. AFEC"IUNI MAI FREC#ENTE ÎN PRACTICA GERIATRICĂ. $OLILE$ĂTR%NE II.Ț

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V4+ )( +,'*+(', ,+& (( ,&7+,'(>, @%? , (, , (*, >( &0( , , +4)( & ,>& )&*, '(/4 ,+& (, ', >4+ & %(*& *4+,* ((%, ,*,'&+, 4*/,%&+( +4 ,=&+,& &' &@(%( +,7(0 % , >(& .ț

A &0 , ,( +,@ (, ' ( ', &'(7 +, (0 ' )(*(, ,4&+,*, &' ),% ', 4 4@ ( , ț(0 4+ & ,. D&* ', 4@ ( ( )4+0& ((%, 4+( , ', +,* +7, %& )&0(%(, '& %& &ț ț(0 4+ & ( ),% % ; *&+, 0, (* % &+ (*( & %& *4 >4+@(+,& * @4% &> %ș)+,*>, +,@ (, ' ', >4+@,&'* @4% &> % ( 0&( &+, 0&( +&+ ( 0&( *%&+ ș

; +,@ +(( * + @ &+, ( &* . T+,@ (, 7 '( (0 , + & &'* % & , ; ,%ș @4% &> % ,>( , ( *4,+, '& &0 , (*. I0 4+ & ,' , ( ( ' ,* (& 4@',+>& (&ș ț ț

)&*(,' % & ( ( ,& ; & 0,+' % 0(0(*& >4+@(+,& ,*( $&@( ' % >?+' (*)( '4%(*( & ( , + '(0 40, 7404 4&', ),@+& )+('4& , , * ( 0&( )+,*>, ,ț ș

() , ( +& ( , &%, ' +(( 7, ,+&%,.șD(&7 4' (* % +,@ (, ' )(, % +( (0, '(4 &% & (* ( *%( (* ( 7,+4ș ș

, ,0 % )4+0 %&+,& *%&'(* H*&+ (4 & (, ('*/,0(* '& /( ,+ , '( , &+ ,+(&

*40 %, & * (&7 4' (*, *& ;0@ +? (+,& +,0& + '( +40 , (04@(%(+, +&7,+, , , '(4 &+, '4*(4 , , , & , *.ț

I./. EDUCA"IA SANITARĂ

!, +0 +, , 4 ( ' + (+, %&+7 & >?+' (*(%4+ 4 ,4 *4%&+( &+, ,ș ș ș* 4 ( ,%4+ +(>( +4*,' % , ;0@ +? (+, ; ')?+ ( +,7 (+,& , + ș ș ș

;0@ +? (+,. P, + &*,&' & '-& ; )(( & (>,+'( ( 7,+(& +(*,. ; *& +(%, , ;ț ț+0 +, , * 4& ,+,& , * +, @4% &> & +('* % ( *40 %(*& ((%4+ * (%, , ,>ș ș ț

1


11/57

+,*4*, , ;0@4% >(+, ( (*& (( ,+& , (*, ( (, , (*, * %, , 0, ( ,+, & *&ț ș ț ț)( (*, ( ( ,%,* &%,. P+,4* +(%, +(>,'* & & &+,& &* ( (%4+ *4+,' 4ș ț>?+' . A% ,%, ', & +,',& 4 %& (,( >?+' (*, ' 4&', ( >?+' (*(%4+ @4% &ț ș& +,*(& * , *& (& '& ( &+ *4 ' ( (, +,' +'& *,& 0&( (0 4+ & , ț

;0@& +? (+(( 7+,>& , @4%( , , , , . !, +0 +, , *& @ +? (( ' ,>( *ț ș ț 4'(@(%( (%, %4+ +,&%, +( *40@& ,+,& )+(*(( , @& +? , , ( 04&+ , ( 0(* 4+&ț ț ș ș ș

( +, 7, ,+& ((. ; ')?+ ( ', >& ( '(' & &' +& +4% % ( ( +('* +(%4+ 4%(0ț ș ș ț ș& 40, (*& (,(.ț

11


12/57

CAPITOLUL II.ELEMENTE DE ANATOMIE ŞI FIZIOLOGIE A ARTERELOR

Î *4 ' ( (& '(' ,0 % ( &+ ,+(&% )(7.II.1 ( + 0&( 0 % , ( +( , >&',,%&' (* &+ ,+, , ( 0 '* %&+ &+ ,+, 0(*( &+ ,+(4%,.

A+ ,+,%, , ( ,%&' (* & *& +4 4 ( &4+ &. E%, & *&%(@+ 0&+, ' ', *4+ ( ', *&+&* ,+( ,& +( +, 40( , (& ,%,0, ,%4+ ,%&' (*, ; ' + * +

F(@+,%, ,%&' (*, +, 40( %& (>,% % 0, (,( ( ; ' +& % ' @, 4 ,%(&%%(0( & & ,%&' (* ( ,+ . L& &*,' , &+ ,+, 0&+( %(0( & & ,%&' (* ( ,+

', &+& , (*& 0, (, * 0 ,' , *& % %& &+ ,+,%, , ( 0 '* %&+ & 4& +4 (& , & &*,' 4+& &0@,%, )(( &%* ( , ( %&0, ' **,'(>, , ,' ,%&' (*.

Ţ,' % ,%&' (* &+, +4% +( 0 % ( %,- ,+0( , ,)4+0&+,& &+ ,+,%4+ ; (0 % '(' 4%,( >, +(* %&+, , + & H

>4% 0 0&( 0&+, , '? 7,- ; 0&7& ( ,& 4 &+ , ( , ,+7(& 0,*& (* +, % & ( *4 +&* (& >

)4+0 , , '( , &'(> *&+, +( +,>, (+,& &+ ,+,( %& )4+0& ( ( (&% *4 ' ( (, 4& * +, % ( '& 7>( ; (0 % (&' 4%,( >, +(* %&+, &'(7 +? *4 ('? 7,% ( &+ ,+(&% ; ,+( 4+( % *& (%&+. A*,' ), 40, , ,*4 40('(+, & , ,+7(,( ', 0&

( '(' 4% &+ ,+(&% .D,)4+0&+,& &+ ,+(&% +& '0(' *, +() 7 ,-& % 7 % & % ( >&'* %&+

%'& (% ,%,0, ' ,*()(* * +7,+(( ; +,7(0 &+ ,+(&%.A+ ,+,%, , ( H0 '* %&+H 0( , ( &+ ,+, , (' +(@ (, ', *&+&*

+, 40( & & )(@+,%4+ 0 '* %&+, , , , %4 7( ( &%, ( *(+* %&+, %& (>,%&+ ,+(&%. L& ( ,+(4+ % 0, (,( ', 7 ', , %(0( & & ,%&' (* ( ,+ (&+ %& ,& >, (*, %(0( & & ,%&' (* , ,+ . F(@+,%, 0 '* %&+, , , , ) * (4 ,&

& 4+( 0,+4&',%4+ =4 * ( ( *40 (*& , ( ,+*,% %&+,. A* (>( & ,& &*,'' @ *4 +4% ,+>4' ( , +4 04+&% *& ,*4%&0( ,%, &>? +4% *, +&%.

R ' ' % &*,' 4+ >&', %& ' (0 %&+,& *& ,*4%&0( (* , ( , , ,+( 4+(7 ','*. A*,' , (),+, , & %& @& (' +(@ (& (),+( ,%4+ ( +( , +,*, 4+( & +, %(* >&'4*4 ' +(* (& & + & & & (> %& (>,% % (,%(( 0 '* %& +((&@ 40( &%, ) + & ( ,+,'& >&',%, *,+,@+&%, *4+4 &+,%, ( >&',%, ' +&+, &

/( 4 , '( ( &+ ,+(&%, &0, ( 4&+, ' +, , ,0 % ; *& % ,( /,04+&7(( , *. . E&+ ,+, , ( 0 '* %&+ ' &+ ,+,%, *4+4 &+, *&+4 ( , & (%&+, ),0 +&%, , *.

12


13/57

A+ ,+,%, 0(*( & 4 ' + * + &',0 4&+, &+ ,+,%4+ , ( 0 '* %&+. E%, ', +,*,+, ; +, &+ ,+,%, , ( 0 '* %&+ ( &+ ,+(4%,. N 0 + % %4+ 0&+, ,+0

*(+* %& (,( & &' 404 (*, *4%& ,+&%, , ' %,,+, ; *& % ( 4@' &*4% , &A+ ,+(4%,%, &+ ,+(4%,%, ,+0( &%, '( 0, &&+ ,+(4%,%, ' ,+0( & ((%, '('

!, *&+&* ,+( ,& (0, '(4 &% +( +& 4+ % & +4& , , ,7&%( & , ; +, % 0 ,+, ,% ( &+ ,+(&%. A*,' , >&', & (*& 0, (, '%&@ +, +, , & &+ ,& +,; &( , , ,'*/( ,+,& ; *& (%&+, ; 7+4 &+, *&+, 4&+ , 0(+,& , ')( * ,+ T4 ' % &*,' ( ')( * ,+ +,7%,& *& ( & ,& , ' 7, *&+, >& + , ; & % 4& , & & % *& (%&+ +( 0,+4&',%, & &' 404 , &+ ,+(4%4->, %&+, '&% * +4+ *&%(@+ ', &)% , &',0, ,& ' @ *4 +4% , +4- 04+&% & &' 404*? 4 ' % ')( * ,+ % ( +,*& (%&+ ,' , *+,'* ( ( >,+' .

P,+, ,%, &+ ,+(&% ,' , @47& ; ,%,0, , ,+>4&',. L& (>,% % & >, (*,( &*,')4+0,& 4 +, ,& ; ( ' , , +&0 +( ,+>4&', %,&* ( &= 7 ? ; >,, 4 ,%( % (. D, &(*( +, % 4'(@(%( & ,& + ' ' % ( +40 &% '(' ,0 % ( &%& *40, (%, ,+>4&', ( , 4+ ( 04+&%.

N +( (& ,+, ,% ( ', )&*, ( ' +, & >, (*, +( >&'& >&'4+ 0 ( ( ' +, , 4 ,+0,& (,. Î +, *,%, 4 * +, , ', &)% 4 4 '%&@ >&'* %&+( & +, +, ,0, (, , + &+ ,+,%, 4+0&%, ( ' +& +(%, +4) , &%, , &+ ,+,( ; ,%, '( &

!(' ,0 % &+ ,+(&% ,' , '(' ,0 @ %&+ ; */(' (0 ,+0,&@(% , + & 7&*40 4 , ,%, 4+7& (*, ( ,%,0, ,%, )(7 +& , &%, '? 7,% (. P+( *( &%& '& ) *&'(7 +& * +7,+,& '& 7>( ,+0& , ( * 0&( 4047, . D, +,' ,* &+,& &+)( (4%47(*( &( *(+* %& (,( , ( , ,+) (& (' %&+ ( ,&% .

C(+* %& (& '? 7,% ( ,' , *&+&* ,+( & +( +,( 0 +(0( ,@( +,'( ,D,@( % , '? 7, %& (>,% % ( & 0( ,' , ( , ; +(0 % +? , *4 ' 0 %

,' % ( +,' ,* (>. EI ,' , (+,* +4 4+ (4 &% * +,'( ,& ( ( >,+' +4 4+ (4 &%%& * +7,+,. R, (' , & %& * +7,+, ,' , ( )% , & ; 04 ,', (&% , +& & % 0,0&( ,' , ( )% , & ( , &% ( )&* 4+( +,* 0 *&+&* ,+(' (*(%, )% ( % ( ; ' ,

13


14/57

Figura II.1 . !(' ,0 % &+ ,+(&%

1


15/57

CAPITOLUL III.PREZENTAREA BOLII ARTERIOPATIE OBLITERANTĂ.

III.1. DEFINI"IEArterio,atia o0literant- '& HarteritaH * 0 , 0( ,4+( (0 +4 +( ,' , 4 @4&%

&+ ,+(&% *&+, , ,+0( +, *,+,& +47+,'(> & (&0, + % ( &+ ,+,%4+ * '*'& 7 ( *, &= 7, %& ,' +(.

A+ ,+(4 & (& 4@%( ,+& ,' , 0&( )+,*>, %& ,+'4& ,%, >?+' (*, ,' , >& ( - 18 8 )& , ,+'4& ,%, ' @ 6< , & ( - 2 5 )&* &+ ,+( . D, &',0, ,& )+,*>, %& @ +@& ( &+ ( ),0,(%, * )&* 4+( , +('* 4 )( &),* & ,.

B4&%& &),* ,& ; +(0 % +? &+ ,+,%, 0,0@+,%4+ ( ),+(4&+, (*(4&+&+ ,+,%, 0,0@+,%4+ ' ,+(4&+,.

Arteriopatia obliterantă este o boală cu evoluţie gravă, putându-se ajunge în stadiile

avansate la amputaţia membrului afectat şi chiar la deces.

III.!. FI4IOPATOLOGIE.

!* ,+,& )% % ( &+ ,+(&% * +, ,' +( +4 *, %@ + +( *&+, ,>4%%@ + +( ) * (4 &%, &'&7,+, ? & %& *,%, 4+7& (*, 7+&>, *& ,*+4 & , ,'

A*,' , %@ + +( 4 &>,& 4 ,>4% (, %, +47+,'(> '& &* +&0& (* , & 0( ( )&* 4+(

', ( % 4@' &*4% % ( %4*&%( &+,& 4@' &*4% % ( ,&' +& 4+ *4 +4 *, %@ + +( 7+&>, 0,+7? ? %& ( ' &%&+,& +& ( & 7& 7+, ,( &),0 +&% *40 ( &. 4 %( ,, , + 0,0@+ % ,%>( ( &. & (%&+ , + 0,0@

; ( ,+,& 4@' &*4% % ( * *? 4@' &*4% % ,' , 0&( ; ( ' * & ? >& 0&( 0&+, , *4%& ,+&%, @%4*? -%,.

04 % , ( ' &%&+, & 4@' &*4% % ( ( ' &%&+,& &* & ( 4@' &+& 0& ('0,%4+ '& ,0@4%((%4+ , ,+0( ('*/,0(& &* & * ,>4% (, +&0& (* '

*4%& ,+&%,%, )(( ( ' )(*(, , *& 0 + ( *&%(@+ . Î &+ ,+(4 & ((%, *+4( ' &%,& +, & *,,& *, ,+0( , , >4% &+,& ; &*,' ( ,+>&% & 0,*& ('0,%4*&+, 0, ( >(&@(%( & ,& 0,0@+ % (.

' &+,& *4%& ,+&%,%4+ *4%& ,+&%,%, 4 &'(7 +& 4 *(+* %& (, +,%&4@' &*4% )&*? ('*/,0(& 4%,+&@(% (' + 7,+,& %4+ & & * 0 ', ; ?0 % ;

15


16/57

(%&*,+ +( 0 '* %&+, (0 4+ & , /,0& 4&0, >4% 0( 4&', *40 +,'(>, +40@4 , ,+, *, 4'(@(%( (%, , *40 , '&+, & ('*/,0(,(.

7+& % , 0 %,+, & '(' ,0 % ( &+ ,+(&% +,' &@(%(+,& >4%,0(,( ( , '(4 *40 4 , ,', (&% & ' +& ,7(,( ,+& , (*,.

' &+,& ,+, (%4+ &+ ,+(&%( ; *& % , (' , ,( 04 ()(* +(%4+ & ,+40& 4&4@%( ,+&+,& ,' , 0&( )+,*>, ( * 7+& 0&( 0&+,.

('*/,0(& 4& , )( &7+&>& , 04 ()(* +(%, >&'404 4+(( ' +&& & 7& , , *&0&( &%,' >&'4*4 +(* (&.

III.2. ETIOLOGIE.A),* ( (%, >&'* %&+, ,+(),+(*, ' +, 40( & , , (4%47(, & ,+4'*%,+4 (ț

& +4 (0& (> "< ', ; ?% ,'* * +,* ,+, %& @ +@& ( ,' , 85 >?+'( ; 0&+,& 0&=4+( & , & *& +(%4+ %4*&%( &+,& +,),+, (&% ,' , %& (>,% %

A+ ,+(4 & ((%, ,& ,+4'*%,+4 (*, +, +, ( *(+*& 1< & (( & 4+, (4%47(& ,' , 40( & , +40@& 7,( & 4@%( ,+& *&+, +0,& ,0@4%&+ ,+(4 & ((%, >&'4-' &' (*,.

III.5. CLASIFICAREA ANATOMO3CLINICĂ A ISC6EMIILOR PERIFERICEIII.5.1. Cla'i*i&area &lini&- a i'& e(iei a&ute ,eri*eri&e.

Ta0elul III.1.C%&'()(*&+,& *%( (* & ('*/,0(,( &* , ,+(),+(*,Nu a(enin7- 8ia0ilitatea(e(0rului9Gr.I:

A(enin7-8ia0ilitatea(e(0rului9Gr.II:

Ire8er'i0il-

9Gr.III:D,'*+(,+,*%( (*

N &0, ( ,' % , ,+0,'* +

R,>,+'(@(% ;*4 ( ((%, (

+& &0, +& (

P(,+ ,+, (' %&+(0 4+ & *

,*,'( & ,&&0 & (,(

F% % *& (%&+ 4+0&% ; *, ( ( &@',P&+&%( (,0 '* %&+

&@', 04 ,+& 4 &%

P(,+ ,+,&', '(@(%( ((

&@', 04 ,+&( *40 %,

+4) *& ,' , (,

!,0 &% %D4 %,+ A+ ,+(&%

V, 4'

!, & , +,'. (' &% 3


17/57

III.5.!. Cla'i*i&area i'& e(iilor &roni&e )u,- leri& e3*ontaine;Sta)iul I '(0 40& 4%47(& *%( (* %( ', , '& ,' , 0( (0 ,' ,*()(* ( *4

+ *,&%& , +,0( (%4+ '& (0 4 +(> ', & (& , * % + &+,' , (( 0(&),* & )+,*>, &*,' , &* , ' @(%& ,+&%, ( & %,7& + * ,)4+ %

,*,%&@(%, &+ ,+(47+&)(*.Sta)iul II ', *&+&* ,+( ,& +( & &+( (& *%& (*& (,( ( ,+0( , ,

*&+ ( &% ; &+ ,+(4 & ((%, ,+(),+(*, &+, *&+&* ,+ , *+&0 & &+, ; 4+'& %& +(0(( & ( *+, , +47+,'(> ; ( , '( & , 4 & * ,)4+ % (' &+,)4&+ , +&+ @(%& ,+&% ( ; &*,&' '( & (, ,' , 0&( ( , ' ; & ( , +,0(*& +( ,' , %4*&%( & %& 04%, 0&( +&+ ,' , ( 4%& ; ),' 7%, '& (*(4

+,+(( ', 4& , ' ' ,* & ', ( % 4@' + * (,( +,+,& ; ),' '& ; +,7( ,& & ,+4-'

*4& ',( +,' , 4 %, ( , ; ,+( 4+( % &4+ 4-(%(&* +,+,& ; +,7( ,& 4' ,+(4( ; 7&0@ +,' , 4 %, ( , ; &+ ,+,%, (%(&*, '& ),0 +&%, *40 , +,+,&

+,' , ' , 4 & & % ( ),0 +4- 4 %( , . ! & ( % II ,' , ' @;0 + ( ;'ta)iul II &u&lau)i&a7ie inter(itent- u oar- < +,+,& & &+, %& ,' , 34% (, +& ( * +, ' & ( % III '& IV. N , (' 4 *4+,%& (, ' +(* ;'(0 40& 4%47(,( ' & ( % ( II ( 7+&>( & ,& ('*/,0(,( ,>&% & &+ ,+(47+&)(*.

Sta)iul III & &+ +,+(%, , +, & ' *&+, ' +,% 7( , , + & &)(+0&+& & +,@ (, ' , ,&'* *? ,>& ' 0? ( ( >&%( & , %'& ((%, (' &

& 4+( +4 4 & &+, & ' & ( % ( III'u0'ta)iul u or *? @4% &> % &+, 4 =, ; '40&+ 4&+0, * 0,0@+,%, ( ),+(4&+, ; ( ', ; &'u0'ta)iul (e)iu *? @4% &> % 4&+0,

* (*(4+ % & ?+ & %& 0&+7( ,& & % ( ('u0'ta)iul 'e8er *? @4% &> % 4&+0, ; )4 4%(L& (&@, (*( +,+(%, , +, & ' ' *4 ) & , * +,+(%, , 4+(7( , , +4 & (

Sta)iul I# & &+ %@ + +(%, +4)(*, %*,+ % ('*/,0(* '& 7& 7+, & & '&; ( '& %'& ((%, (' &%, &@4%( ,. L& (&@, (*( ', ( ' &%,& &@%4 %

(&@, (* ; *&+, +,+(%, ', 4 &0,%(4+& & 4+( , +4 & (,( (&@, (*, /( 4,' , (&.

III./. FORME CLINICE.C,% 0&( )+,*>, 04 (> , + *&+, @4% &> % >&'* %&+ ', & +,',& %&

+,+,& *&+, 4& , )( ( , ' ( ( ' &%& @+ '* ; *& % 4*% ((%4+ &+)4+0& *%& (*& (,( ( ,+0( , , ( +,+(%4+ , +, & ' ; ('*/,0((%, *+4 (*,.

1


18/57

Durerea în ischemia acută , 4@(*,( & &+, @+ '* ,' , ( , ' ,' , %4*&%( & ',+( 4+( ('*/,0(* ', *&%0,& '& ', *&%0,& )4&+ , ( +( 0, (*& (, & (

', 4& , 7 '( , +,0( (( &),* & , 4 4 ( (, *&+, ' (0( , , ' ),+( &.laudicaţia intermitent *%&'(* & &+, %& 0,+' ( ,' , %4*&%( & , 4@(*,( %

04%, % ( 0&( +&+ %& (>,% % *4& ',( ),',( '& @4% (( %& &+, ( &+, 0 '* %&+ , +, ( *&+&* ,+ % , ,)4+ &% +,+(( +,* 0 ( +,>,+'(@(%( &%& +, & '.

Durerea ischemic de repaus ,' , , 4@(*,( 4 +,+, 4* + '& *4 ( (&4& ,& ', &0 %()(* ,' , %,7& , 4 ( (& 4+( 4 &% & 0,0@+ % ( ('*/,0(* ( ',

+40 ; 4 ( (, ,*%(> & ?+ &+,& 0,0@+ % ( %& 0&+7( ,& & % ( 4+0,+' % 4+ ,' , '?*?( 4&+, ,4+( ( , ' +, (' , & %& & &%7, (*,.

!"amenul obiectiv #fig$.% 4& , , ; ,>( , &%4&+,& '& &' ,* % & 0&% ,7 0, % ( 04 ()(*&+( +4)(*, + +(+,& '& (' &+( (& (%4 ( (( % *(4&', ,+( +4 & ,*%(> (' +4)(( 7/(&%, & +4)(& 0 '* %&+ ( & ,'',0 % % ( BQ+7,+ &%4&+, 0&+*& ; 4 ( (, +( (*& ( +4 ,& ; 4 ( (,('*/,0(* %( '& %' % ( &% &+,& %' % ( ; &( , ( ,)4+ 0 +, , '

(&7 4' (* , (' &+,& 4+ ' )% +( %& & '* % & (, *&+, ( (* ' , 4 , &+ ,+( Examenul obiectiv * +( , +,( , & ,

• I ' ,* (&

• P&% &+,&

• A'* % & (&.

1. In',e&7ia ,>( , (& & ( ( ,& 04 ()(* +(%, , * %4&+, &%, ,7 0, ,%4+ +4)(*, ('*/,0(*,.

a)Atitudinea. Î ('*/,0((%, ',>,+, @4% &> % ; ( & ?+ (*(4+ % &),* & , 0 & % ( ; +-4 , & 0&( &>& '& ; ( +( , , +,0( & ,& @4% &> * &

+( (*? -4 ' +, (, 4 ( (, & &%7(* .b)Modificările de culoare ale tegumentelor , & + ('*/,0(* '

P&%4&+,& & + ' 4 & '& , ,+, %& )+(7 '& %& ,)4+

+( (*&+,& 0,0@+ % ( +,' ,* (>' +, 4 ( (& >,+ (*&% ,' , 4' +'* ,+,& ,0 ,+& +(( ,7 0, ,%4+ & &+, ; 4& , ' & ((%, ,>4% (>,P&%4&+,& ( ' +&+,& '& *+, ,+,& ,0 ,+& +(( * & & , ', ;

& ,+4'*%,+4 ( ,'*+(' , T&+'*/4 *& S (*(4+ % *&% &%>?+' (* % (

C4%4+& (& +4 (, ; &+ ,+(4 & ((%, 4@%( ,+& , ; '4 ( , , ), 40, , (%(0)& 7( , )%,@( ,

18


19/57

Z4 , 0(*( ,+,7 %& , ,*4%4+& (, +4 (,-@+ ' & 4+& , /,04+&

( )&+* ,%4+ ; ,7 0, '& ' @ ,7 0, ( ', ; ?% ,'* ; %@ +,*(+* %& (, &'4*(& , )+,*>, * , +4 & (& ('*/,0(* .

A*,' , 04 ()(* +( , * %4&+, ,7 0, &+ 4 + 0? , *4 ' & , 4 >&+(& *

4 ' ),+( 04 ()(* +( *(*%(*, ; &),* ( (%, >&'4' &' (*,.M4 ()(* +(%, , * %4&+, ( ; ?+ (,+,& (+(7& (,( %4*&%, 4 )( ,' (0& , +(

4' + . T,' % B ,+7,+ +0 +, , + ' ' % ,' +(%4+ ('*/,0(*, %& +( (*&+,& ( ),+(4&+,.

c)Tulburările trofice ale pielii şi ţesuturilor adiacenteP(,%,& 0,0@+ % ( &),* & ,>( , % *(4&' '*& (%4 ( & ,& ',

(' &+, 7/((%, +, ( ' +(& (( %4 7( ( &%, '& +&'>,+'&%, ', ;

0& , )+&7(%, )+(&@(%,M '* %& +& 7&0@,( ( & *4& ',( ', & +4)(&

Î ' & (( ,>4% (>, &>& '& , & &+ %*,+& (( %& (>,% % * ,%4+

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20/57

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21/57

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T,' ,%, 4 ( >& (>, +, +, ( ,%,0, (0 4+ & ; ' &@(%(+,& (&7 4' (( ; ' &@(%(+,& %& % ( ,+& , (*. A*,' ,& 4 4),+( ( )4+0& (( +(>(ț

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3. P%, ('047+&)(& ',70, &% '& ; +,7(' +&+,& %'‐>4% 0.. I , % ,7,‐ @+& .ț

5. A &%( &+,& * +@,%4+ , >,%4*( & , D4 %,+. &ndicele gle'nă ‐ braţ

D(&7 4' (* % , @4&% &+ ,+(&% ,+(),+(* 4& , )( ' &@(%( , @& & ,( (*,% (‐7%, ‐ @+& .ț

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(ăsurarea presiunii sistolice segmentare la diferite nivele.

M ' +&+,& +,'( (( '(' 4%(*, %& (),+( , (>,%, %& (>,% % 0,0@+,%4+ ,' , '*&+ %&+7 , + , ,* &+,& ( %4*&%( &+,& ',70, &% & %, ( (%4+ ',0 ()(*%& (>,% % 0&+,%4+ >&',. ! +, ,4',@(+, , ( (*,%, 7%,‐ @+& 0 ' +&+,& +,'( ((ț',70, &+, 4& , , ,+,0( & %4*&%( &+,& %, ( ((.

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21


22/57

(>,% % &+ ,+,%4+ 0&+(. L4*&%( &+,& %, ( (( ,' , , ,+0( & ; ) * (, , & &ț ț, +,'( ,. U 7+& (, 0&( 0&+, , 2< 00$7 ; +, 4 ',70, , & (&*, , ( (*

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)letismografia segmentară sau determinarea puls ‐ volum*

Î >, ,+,& ,),* +(( &*,' ( ,' 0& , & ,' , %&'& %& & 0( (>,% &

( ),+(4+ ( ', *4 ,* ,& %& %, ('047+&) , + & , ,+0( & 04 ()(* +(%, M& , & ', 0)% ? %& 64% 0 ) + & , ,+0( & 4*% (, &+ ,+(&% ( ', 0 '4&+ * +@& +,'( ,‐>4% 0.

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C40 &+& (> * & 7(47+&)(& %, ('047+&)(& ',70, &% ( , ,+0( &+,'(' 4%(*, %& (),+( , (>,%, & 4 &* +& , , , 85 ; , ,+0( &+,& ( %4*&%( &+,ț',0 ()(*& (>,. U (%( & , ; *40@( & (, &* +& , ,& %4+ & ( 7, "5 .ț

(ăsurarea presiunii la nivelul degetului şi indicele bra ț ‐ deget

P&*(, (( * (&@, ; ,>4% (, ; ,% 7& ( ' )(*(, +, &% '& &%ț ț ț ț, ,+0( *&%*()(* +( >&'* %&+, 4 &>,& &+ ,+, (@(&%, ( *40 +,'(@(%, , ,+

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, )% . D, 4@(*,( +,'( ,& %& (>,% % ,7, % ( ,' , * *(+*& 3,% % 7%, ,(. I (*,%, ,7,‐ @+& & 4+0&% , ,)( ( *& )(( 0&( 0(* , < . R, %ț)&%' 4 ( (>, (%( ? ( (*,%, ,7,‐ @+& ' +&+,.

22


23/57

P+( *( &%& %(0( &+, & 0, 4 ,( 4 +, +, ( )& % * %& &*(, (( * (&ț 4& , )( ,4+( )( & %& (>,% % ,7, ,%4+ 1 ( 2 & 4+( %, ( (%4+ ( )%&0&ș ț%, ( (%4+ * & & ,.

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23


24/57

• Angiogra*ia

A 7(47+&)(& ,' , *4 '( ,+& ' & &+ % , & + , + ,>&% &+,& @4%(( &+ ,+(*,& 0&( &**,'(@(% ( %&+7 + ' ? ( ,/ (* (0&7(' (* . T4 ( &*,&' 0, 4

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>, 4&' . C4' +( (*& .

• E&ogra*ia Do,,ler &olor

E*47+&)(& D4 %,+ *4%4+ & )4' +4 ' *& ,' (0&7(' (* &% ,+ & (> &*40 &+& (, * & 7(7+&)(& &*,' ,' ,' , ) + +('* 0&( (,) ( ( 4& , 4),+( 0&=4+( &ț& & 40(*, ,', (&%, +,* 0 ( ( )4+0& (( ) * (4 &%, 7+& (, (( , >,%4*( & , ț ț ț ț' , 4 ,( .

A+@4+,%, &+ ,+(&% , %& (>,% % 0,0@+,%4+ ( ),+(4&+, 4& , )( >( &%( &7+& % ( ( %4*&%( &+,& ' , 4 ,( +,* 0 ( 0 ' +&+,& >,%4*( (%4+ &+ ,+(&ț0, 4 ,( ' ; %,7 + * (0 % % 7 , , &0( &+, , , , & , 4 ,+& 4+ ț>( &%( &+, & &+ ,+,%, *+ +&%, ; 4 &%( & ,.

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• Angiogra*ia ,rin re onana - (agneti&- nu&lear-.ț

R, 4 & & 0&7 , (* *%,&+ & ,>, ( 4 0, 4 &**, & , (&7 4' (* (ț %& % ( , +& &0, ; *& % @4%(( &+ ,+(&%, ,+(),+(*, ; 0 % , *, +,. E' %& % ( ,+& , (* +,( ,+>, (, ( ; ,*( (& +(>( 04 &%( & ,& 4 (0 , țA>& &= % 0, 4 ,( , +, +, , & , 4),+(+,& (0&7( (%4+ , ; &% +, 4% (, 3&@ 40, ,%>(' ( 0,0@+, ( ),+(4&+,. D, &',0, ,& (0&7( (%, 4 )( >( &%( & ,

7/( +( +( +4 & (, ( ',* (4 & , %& (>,+', (>,%,.țRe onan a (agneti&-ț *, (%( ,& ' @' & & , *4 +&' 7& 4%( ( 0 & ; %4* (ț

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25/57

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25

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26/57

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O'&ilo(etria +,%& (( 4+(, & (>, &' +& ,+0,&@(%( (( >&',%4+ ,+(),+(*!, , ,+0( *%&'(* * 4'*(%40, + % P&*/4 -R,* %( 7/& ', '& * & &+& , ,%,* +4*& &*( & , , ; +,7(' +&+,. O'*(%& ((%, 0& (0, ; +,7(' +& , %& (>,% % +,'( (*4 ' ( (, ( (*,%, 4'*(%40, +(*. A*,' ( (*, '*& , %& &+ ,+,%, &),* & , , %&

+4 (0&%. M, 4 & ) + ( ,& (*( 4 +,%& (, ; %,7 + * ; ( ,+,& %, %' % ( >&'* %&+ (' &% '& * ' &+,& *(+* %& (,( *4%& ,+&%,.

III.>.!. Diagno'ti& )i*eren7ial.E (4%47(& 4@' + * ((%4+ >&'* %&+, &%, 0,0@+,%4+ ( ),+(4&+, ,' , ; *,& 0&

& ,+4'*%,+4 (* ; ' ,*(&% %& & % (( ,' , 5< , & (. P, + , (4%47(& & ,+4'*% +, , & *&+ (4 & (,( ('*/,0(*, &% , %4*&%( +( & ,+4'*%,+4&', ',0

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Ta0elul III.1. E%,0, , , (&7 4' (* (),+, (&% ; +( *( &%,%, &+ ,+(4 & (( 4@' +E. A , +,(

Ele(ente )e )iagno'ti&)i*eren7ial

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27/57

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&% , *& , , +,+,. C%& (*& (& ( ,+0( , +,@ (, (),+, (& ,Durerile )in regiunea *e'ier- Bi a &oa,'ei +4 ', , '*(& (* &*,' ,& '

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Durerile ,ro)u'e )e in'u*i&ien7a 8enoa'- &roni&- a (e(0relor in*erioare*%& (*& (, >, 4&' & &+ %& 0,+' &+ ', *&%0,& %& ; +,+ ,+,& ,)4+,* @( * 0,0@+,%, ( ),+(4&+, +( (*& ,. C4, (' , ,0, ,+(),+(*, *(& 4 (

' ,+)(*(&%, ; , '( , & 4+( 4@' + * (,( & % ( >, 4' +4)• D +,+(%, 0 '* %&+, ( @4%( 0 '* %&+, ', &'4*(& , 4@(*,( * ,)(*( 0 '* %

• D +,+,& , +, & ' &+, 0,+4&', &% , *& , ; &)&+& ('*/,0(,(

• B4%(%, &+ (* %&+, &+ +4 &+ +( , 4 )( 4+ , *% ', %& , &0, % 4

• B4%(%, 0 '* %&+, ', &'4*(& ,',4+( * & +4)(( 0 '* %&+, ,)(*( 04 4+

• B4%( , +4%47(*, '*(& (* , * .

III.?. COMPLICA"II! & (' (*( * 0 %& , &+& * ; 5 ( *& +( *%& (*& (& ( ,+0( ,

'& */(&+ ', &0,%(4+,& . A +4& , = 0 & , ( @4% &>(( * *%& (*& (, &'(0 40,%, )(( ,,>4% (>, , ,+(4& , , & (.A0,%(4+&+,& '(0 40,%4+ ', 4& ,

, >4% +(( *(+* %& (,( *4%& ,+&%, '& & & +(( +( 0 % ( , &* (>( & , +, ' %& *&+, 0 */(( ' ),+ ('*/,0(, '(0 40& (* .O +4 4+ (, , 25 ( @4%&7+&>,& * >( , >&+(&@(% ' ),+( & ('*/,0(* ,+(),+(* ( 0& (),' +(%, *%

, &% , %4*&%( +( & ,+4'*%,+4 (*,.

2


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( ),+(4+ &),* & . Î +, 5 ( 1< ( @4% &>(( * *%& (*& (, +, ( &7+&>(0 4+ & & @4%(( , + & ,*('( & 4 ( ,+>, (, , +,>&'* %&+( &+, *( ,+>, (4 &% ( 0&( 1 2-1 6 ,*,'( &0 & (, 0&=4+ 7&0@ '& *4&%& F+&0( 7/&0 .

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(&@, (* . D( +, *,(%&% ( )&* 4+( , +('* ) 0& % , ,+*( 4 ( )% , ,)

,34+( 0&( )+,*>, * &7+&>&+,& &+ ,+(4 & (,( %&0&+(( ) 0 4+(.M4+ &%( & ,& *&+ (4>&'* %&+ & @4% &>(%4+ * *%& (*& (, ,' , , 2

& *,%4+ ) + *%& (*& (,. B4% &>(( &+ ,+( (*( &0 & ( & 4 04+ &%( & , ,3&*,&' & 4& , &= 7, %&25-5< 2 & (.

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• T+& &0, % *4+,* &% @4%(%4+ &'4*(& , &+ ,+(4 & ((%4+ DZ $TA

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, & ( *&+, +, ( )&* 4+( , +('* , + & ,+4'*%,+4 .• Trata(entul (e)i&al

E' , ( (*& ; 4& , )& ,%, @4%(( '( 7 + '& ; &'4*(,+, * +& &0, % */*40 %, (7(, 4- (, , (* 0, (*&0, 4' )( (4 ,+& (*.

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• D,+(>& ( , /(' &0( T&%& 4%( P+('*4%

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0( ,.

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Durata C(*% % % , ,+*( ( )( (*ț +, & ' ', +, , , 0&( 0 % , 4+( ; *& + % ,( ','( ( D +& & ( ( (&% ,' , , 35 , 0( , , 0,+' ( ,+0( , ( ,' , *+,'* %& )(,*&+, ','(ț ș

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,' , 04 ()(*& +( *+, ,+,& & 7 %& (,( '& >( , ,( &' ),% ; *? ' & &+ +,+ș ț, ,+*( ( % (.ț

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• C%& (*& (& ' )(*(, , ',>,+ , + & &),* & *&%( & ,& >(, ((. F(7

Trata(entul )e re8a'&ulari are L& &*(, (( * '(0 40, *&+, & &+ %& 4 (' & 0&( 0(* , 2, (4 &%

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4 +4 , *&+, ' ,+0( 0,+' %.

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CAPITOLUL IV

ROLUL ASISTENTEI MEDICALE ÎN PREGĂTIREABOLNAVULUI PENTRU EXPLORĂRI SPECIFICE.

PLANUL DE ÎNGRI IRE1. E#ALUAREA DIAGNOSTICULUI DE ARTERIOPATIE O$LITERANTĂ

• E>&% &+,& *%( (* & '(0 40,%4+ ( ',0 ,%4+

• E>&% &+,& ',>,+( (( ' & (&%( &+,& L,+(*/,-F4 &( ,

• A +,*(,+,& +4)(% % ( '(/4-'4*(&% &% &*(, % ( 7+& , ( ' ++,%(7(4&', ( , ,+'4 &%( & , & ,+, & %& %& % ,+& , (* .

!. O$IECTI#ELE TERAPEUTICE• A0,%(4+&+,& *(+* %& (,( &+ ,+(&%, ,+(),+(*,

• R, *,+,& *4 7,' (,( >, 4&',

• F&>4+( &+,& >&'4 (%& & (,( ( +,>, (+,& *40 +,'(,( >&'* %&+, &+ ,+

• R, *,+,& +,+((

• P+,>, (+,& %, ( (%4+ * & & ,

• D(&%47 % * &*(, % , %(*&+,& *& ,( @4%(( ' +(( +, , ,

(&7 4' (*, ( ,+& , (*,• O@ ( ,+,& *40 %(& ,( &*(, % ( %& +47+&0 % ,+& , (*.

2. ETAPELE PRACTICEA0,%(4+&+,& *(+* %& (,( ,+(),+(*,

3 4 ( (4 &+,& , +,0( (%4+ ' @ (>,% % *4+ % ( +( (*? *& % & %-04@(%( &+,& &* (> K &'(> & & & & , +,0( (%4+-, ,+*( (( 4' +&%, &* (>, 7(0 &' (* B +7,+-A%%,R, *,+,& *4 7,' (,( >, 4&',-,>( &+,& 4 ( ((%4+ +,% 7( , ,*%(>,-; * +&=&+,& 0,+' % (F&>4+( &+,& >&'4 (%& & (,( ( +,>, (+(( *40 +,'(,( >&'* %&+, &+ ,+(&%,-0, ( ,+,& ,( ,0 ,+& +( %4*&%, & ,*>& , * ,>( &+,& )+(7 % (-,>( &+,& ' +,' % (-,>( &+,& /&( ,%4+ ( &**,'4+((%4+ ' +?0 ,

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-,>( &+,& *40 +,'( (%4+ +( 4 ( (4 &+,& ,& ,*>& & 0,0@+,%4+ R, *,+,& +,+((-&0,%(4+&+,& *(+* %& (,( &+ ,+,%4+ ,+(),+(*, , ,+*( (( )( (*, ( 0, (*& (, >&'-& 0( (' +&+,& & &%7, (*,%4+ +,'*+(', , 0, (*.

P+,>, (+,& %, ( (%4+ * & & ,-,>( &+,& +& 0& ( +(( , +,0( (%4+ 0,+' ; * % 0( ,-(7(, & ,*>& & (*(4&+,%4+ @&(, (& % 7/((%4+ 4', , @ 0@&*-,>( &+,& '* + ( & % ( ( & )+,*& % ( (*(4&+,%4+-&%(0, & (, & ,*>& * ' %(0, >( &0( (* B C ( +4 ,(*-*40@& ,+,& 4@, ( ((.O@ ( ,+,& *40 %(& ,( &*(, % ( %& +47+&0 % ,+& , (*.

-( *% ,+,& & &+ ( 4+(%4+ ; +47+&0 % , , *& (, '& ( &+-( ' + * ( ( , &%(& , +(>( (7(, & (*(4&+,%4+ ( ; * % 0( ,(-&@& 4 &+,& ) 0& % (-( *% ,+,& &*(, % ( ; +- 7+ , ' +(=( 0 &%.

5. PREGĂTIREA PACIEN"ILOR PENTRU IN#ESTIGA"II SPECIFICE.E %4+&+,& >&',%4+ ,+(),+(*, +0 +, , ' &@(%(+,& 7+& % ( ; *&+, >&

) * ( (( , (+(7&+, & ,' +(%4+ ( 4+7& ,%4+.P+,7 (+,& @4% &> % ( ( & 0, ( % ( &0@(& & 4 ,4',@( (0 4+ &

>&',%4+ ,+(),+(*,. C&0,+& ; *&+, & %4* , %4+ +(%, +,@ (, ' &(@ 4 ,0 ,+&2 % ; (0 % , %4+ +(%4+ )(( , @+ *& . E' , @( , *& ( >,

(0( ,& & , ,0? *& , '& *,% ( %& 2-3 4+, , %& % (0& &%(0, & (,. Î ( @4% &> % ' ) 0, ,. Î &( , , , &0( &+, @4% &> % ' ' ,& = 0 & , , 4+ 4 ( (, , ,* @( .

Arteriogra*ia,' , 0, 4 & , +,),+( ; ,>&% &+,& ' +(( & % ( &+ ,+(&% %&+ ,+(4 & (, 4@%( ,+& . E& ,' , ; 4 ,& & ' )(*(, *& 0, 4 (* (*40 %, &+,& +( +-4 &% 0, 4 . D& 4+( +('* +(%4+ 4 , (&%, , *&+, %

+,@ (, ('* & %& )(,*&+, *& ; &+ , ( ' &@(%( ; ) * (, , (%(*4 +&( (*& ((%, , (' , ,.

P+,7 (+,& &*(, % ( ,' , )4&+ , (0 4+ & . P&*(, % +,@ (, ' )(, ,0?4+,. P+,0, (*& (& * & (4%( (*, ( ,4+( * & (/(' &0( (*, ( *4+ (*4( ( & ,*, , , &%,+7(*, ', (0 ,. P, + & ,>( & *40 %(*& ((%, /,04+&7(*, ', ( (*

+& &0, % ( & (*4&7 %& '& & (&7+,7& %&*/, &+ &* &*,&' & ,,),* &+,& ( @(%& &% /,04' & ,( ( 4 /,047+&0 . D, &',0, ,& ', ,),* ,&

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,%,* +4*&+ (47+&0 4 +& (47+&)(, 4+&*4- %04 &+ ( & &%( ,%, , %&@4+ +, , ,( ,( ( ' )(*(, , +, &%, +,/( +& &+,& ,' , )4&+ , (0 4+ & . D, 4@(*,( ', ,),* ,& %& &*(, % ( ,+ & ; ' ( &%. Î & 0( , *4 ( (( , ',* +( & ,

,+, % &*(, % ( , ,/ (*& (%( & ( , 4'(@(%( & ,& ' +&>,7/,+

( >,' (7& (& 4& , )( ,),* & ; ' ( &% % , (.Do,,ler3ul 8a'&ular ,+0( , , (' &+,& ; 7 ' +(%4+ ' , 4 ,%4+ +4 ', , %

& ,+40 %, ( ( *&+, (0 %(* , ,+( , *4%,' ,+4% 4*% ((%4+ &+ ,+,%4+ (E &0, % ', +&* (* ; 7, ,+&% ; +- *&@( , 0, (*&% ' ,*(&%( & '& ; '&& ' ( &% % (.

Î (0 % , &0, % ( 0, (* % & %(* , 4 & *4+,' 4&+, >&',%4+ *, ( >,' (7& , 7,% ) + 7+ '(0( *&+, ,+0( , 4 0&( @ () &+, & % +&' , ,%

&*(, ' ', & , , ; 4 ( (& *,& 0&( *4 >, &@(% &*,' ,( ( >,' (7& (( * %*& (*(4&+,%4+. M, (* % , %&',& & 4( '4 & , +&', % >&',%4+ ; (0 *, & &+&>( , & '? 7,% ( *&+, *(+* % +( &*,% %4*. E &0, % +,& ; +, 2< ( < 0(*, '-&)( &%( & ( >,' (7& (& &'(' , & 0, (*&% ,+7, 7,% % (&+ &*(, % 4&+,% & &* (>( (%, 4@( ( ,.

O'&ilo(etriaM, 4 , ,>&% &+, ( (+,* & ,+0,&@(%( (( &+ ,+,%4+ 0,0@+,%4+. E' , 0

, '*+,, ( 7 ; &+ ,+(4 & ((%, ,+(),+(*,. !, ,),* ,& * &= 4+ % & &+& % ( P( +- *& +& 7+& & ; ( ( 4 0, , , 0& (* * 4 *&0,+, ; *&+

* 4 &+ , *& *( *. M& , & & &+& % ( ', )( ,& %& (>,% +(%, 4+( @4% &> % ( , , %'& ((%, ', +& '0( ; 0& 40, + . A0 %( ( ,& 4'*(%&4@',+> , *& +& 7+& & &% & &+& % (.

Preg-tirea 0olna8ului• C&0,+& , , &0( &+, +,@ (, ' &(@ *%(0& *4+,' 4+

• B4% &> % ,' , * %*& ; +, & *,% ( 15 0( , ; &( ,

• !, ,'*4 ,+ 0,0@+,%, ' ,+(4&+, ( ( ),+(4&+,.

Fi area a,aratului• M& , & & &+& % ( ', )( ,& %& (>,% % 4+( , 0,0@+ % , , &0(

M-'urarea• !, 40 ,& &,+ ? *, (' &+, %' % ,+(),+(*

• !, *( , , &0 %( ( ,& 4'*(%& ((%4+ , *& +& % 0& 40, + % (

• !, '*& , +,'( ,& * 1< 00$7 ( ', *( ,'* ( 4 4'*(%& ((%, &+ ,+(&%,.• !, '*& , & 4( +,'( ,& ( 1< 00$7 ; 1< 00$7 * *( (+( ' **,'(>, ? ',

3


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7 ',' , >&%4&+,& 0& (0 & &0 %( ( (( *,,& *, ', 0, , S(4'*(%40, +(* .

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CAPITOLUL #INTER#EN"IILE ASISTENTEI MEDICALE PRI#IND ÎNGRI IREA

$OLNA#ULUI CU ARTERIOPATIE O$LITERANTĂ

A'(' , & 0, (*&% &+, +4% , & &'(7 +& *4 ( ((%, 4 (0, , *4 )4+ ,*,'&+, * &+ ,+(4 & (, 4@%( ,+& . I ,+>( % &+, *& '*4 ; *, ,+,& +,%& (,( &'(' ,)&>4+( & , '*/(0@ % , ( )4+0& (( ( ,( ( ,04 ((. F + ( &+,& , & , * +,

, ,+0( & ' ; +,@ +( ( ' &+ (*( , %& ' &@(%(+,& 4@(,* (>,%4+ ( %& ,),A'(' , & 0, (*&% >& ( )4+0& >& , *& ( ', >& 4* & , +,7 (+,& &*(,

( >,' (7& (( ( , ; 7+(=(+(%, % ,+(4&+,. Asistenta medicală are ca obiective Internarea ,a&ientului n ',ital

I ,+ &+,& ; ' ( &% ', ,),* ,& ; 7, ,+&% +( @(+4 % , ( ,+ +( , +(0( ,+, , %& 0, (* % , )&0(%(, ( & 4>, (( , &'(7 +& .

B(+4 % , ( ,+ &+( >& ( 4*0( F4&(& , O@',+>& (, C%( (* G, ,+&% FOC, ! ( &%( &+, , Z( F!Z *& .

D, %& @(+4 % , ( ,+ +( &*(, % >& )( ; '4 ( %& 7&+ ,+4@ ( %& /&( ,%4+ ( , + ;0@ (,+, ( ', >& '*/(0@& ; /&( ,%, , ' ( &%. D & %(*&+,+,),+( 4&+, %& +,>, (+,& ( *40@& ,+,& ( ),* ((%4+ ( +&' ( &%(*, ( &*(,',* (& , '-& ) * ( ,+ &+,& &*4%4 , >& )( +(0( , * +, &'(' , & ,); 0? & ( )4&(& , 4@',+>& (,.

Re,arti area ,a&ientului n 'alon Bi a'igurarea &on)i7iilor )e (e)iu- &*(, % ,' , *4 ' ; '&%4 , ( ', +, &+ ( ,& & * 4 (,+

+,@ (, ' )(, % 0( 4&', @( , &,+('( , ) + * +, ( , &,+ ' )(*(, ; * % ( ,- & +(%, +,@ (, ' )(, *404 , +, (' , , * %, =,+(, * +& ) + * , '&

, + & ', +,>, ( & &+( (& ,'*&+,%4+ 0&( &%,' %& &*(, (( (04@(%( & ( %& &- )(,*&+, & +,@ (, ' )(, +,> * '&% ,& ,+ , + %, =,+(, 2

), , ,+ 0 &0& &%, (%&= & (%(&+. A'igurarea re,au'ului *i i& Bi ,'i i&

A'(' , & >& &'(7 +& *4 )4+ % &*(, ,( +(−

+, *,+,& , *? 4'(@(% & 7404 % (− & , &+,& +,+((− ,0 ,+& +& & ,*>&

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− (7(, & *4+ 4+&% ( %, =,+(, , & * +&− & 4 &+,& ,( 4 ( (( *404 ,− (0( &+,& ( ,+>, ((%4+ , ; 7+(=(+, ; ,+(4& ,%, , '40− , ,+*( (( , +,%& &+,.

YÎngri iri )ieteti&eD(, & ,' , 4 &+ , (0 4+ & & +& &0, % ( ;0 4 +(>& &+ ,+(4 & (,(.

+( *( (( &+ (* %&+, , &%(0, & (, ' 4&' ; &( , ; (0 % ( +&(0 4+ & , + & %(0( & ,),* ,%, ,7& (>, &%, ,+& (,( ;0 4 +(>& &+ ,+(4 &

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38


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CAPITOLUL VICA4 CLINIC

#I.1. CULEGEREA DATELOR $ume A !renume Z%ex 0&'* %(&'rsta 6" & ( (omiciliul M, ( +@&#cupaţia , '(4 &+ (ata internării 2 . 3 % (

Ana(e -;A ,*, , , /,+, 4*4%& ,+&%, ( & ,*, , , ,+'4 &%,A$C ,',0 ()(*& (>,APP 2


40/57

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& (@(4 ,+& (& ) + +,0( ,+,+,& '( +40 % ( ),@+(%. P&*(, % ,' , ; + 0&' ,*(&%( & ,.

M, (4 0 * &*(, % & +0& +& &0, &0@ %& 4+ * >&'4 (%&& (*4&7 %& 4+&%.

E a(enul o0ie&ti8 la internare;

-' &+, 7, ,+&% &% ,+& T 3 34

CT 1 2 *0 G 5 7 IMC 18 25 7K02 ' @ 4 ,+&%T,7 0, , ( 0 *4&',- %( ,-*(*& +(*, 4' &), ,* 40(, %& (>,% % ),0 + % ( ' ?

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Examen clinic generalA &+& % *&+ (4>&'* %&+- 7404 , *&+ (&*, +,7 %& , &' + ( ,-' ) '(' 4%(* 7+& % IIKVI ; )4*&+

(+& (,+, ; & ( - TA 1,% % @(%& ,+&% IGB + 35K"< < 38 IGB' 7 -&@ 40, 04&%, , +,+4' ' 4 & ( %& &% &+, - +& ( ( ,' ( &%

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$IOC6IMIED, 0(+,& & &%( ,( V&%4+( 4@ ( , V&%4+( , +,),+(

G%(*,0(, "2 07 65-11


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