8/12/2019 terminat!!!!!!!!!!!

1/60

MINISTERUL EDUCATIEI NATIONALESCOALA POSTLICEALA HENRI COANDA CONSTANTA

SPECIALIZAREA: ASISTENT MEDICAL GENERALIST

PROIECT PENTRU EXAMENUL DECALIFICARE A COMPETENTELOR

PROFESIONALE NIVEL III AVANSAT

CALIFICAREA: ASISTENT MEDICAL

GENERALIST

COORDONATOR:

ASISTENT MEDICAL, COLEASA LIDIA

ABSOLVENT: IOSIF(DINU) FLORENTINA

CONSTANTA2014

8/12/2019 terminat!!!!!!!!!!!

2/60

MINISTERUL EDUCATIEI NATIONALESCOALA POSTLICEALA HENRI COANDA CONSTANTA

SPECIALIZAREA: ASISTENT MEDICAL GENERALIST

PROIECT

INGRIIREA BOLNAVULUI CU TROMBOFLEBITA

COORDONATOR:ASISTENT MEDICAL, COLEASA LIDIA

ABSOLVENT:

IOSIF( DINU) FLORENTINA

CONSTANTA2014

2

8/12/2019 terminat!!!!!!!!!!!

3/60

MOTTO ,

,, ngrijirea mei!a"# e$%e & ar%#' Ne!e$i%# e(&%amen% e)!"*$i(+,reg#%ire %emeini!#+ %a"en%+ !a &ri!e ,i!%*r# $a* $!*",%*r#' Ce e$%e mai m*"%- S#ai e.a /a!e !* ,0n1# e ,i!%*r# $a* !* marm*r# $a* $# ai e.a /a!e !*&rgani$m*" (i*+ !* /iina *mana . %em,"*" *3*"*i "*i D*mne1e* !

FLORENCE NIG4TINGALE""#

5

8/12/2019 terminat!!!!!!!!!!!

4/60

CUPRINS:

M&%%&Mem&ri* j*$%i/i!a%i(

Ca,i%&"*" I: . N&%i*ni e ana%&mie $i /i1i&"&gie $i$%em*"*i (en&$ a" mem6re"&r in/eri&are

Ca,i%&"*" II : . 2'7 De/ini%ie

. 2'2 E%i&"&gie .2'5 C"a$i/i!are . 2'8 Sim,%&ma%&"&gie

. 2'9 E)amene ,ara!"ini!e im,&r%an%e .2'9'7 U"%ra$&n&gra/ia D&,,"er C&n%in*a .2'9'2 U"%ra$&n&gra/ia D&,,"er P*"$a%a .2'9'5 F"e6&gra/ia'.2' E)amene e "a6&ra%&r.2'; Diagn&$%i! i/eren%ia". 2'< E(&"*%ie. 2'= Pr&gn&$%i!. 2'7> C&m,"i!a%ii. 2'77 Tra%amen% .2'77'7 Pr&/i"a)ia

.2'77'2. Prin!i,a"e"e me%&e /&"&$i%e in ,r&/i"a)ie . 2'77'5. mei!amen%e an%i!&ag*"an%e

. 2'77'8. mei!amen%e %r&m6&"i%i!e . 2'77'9. mei!amen%e /i6rin&"i%i!e'Ca,i%&"*" III:

. 5'7. R&"*" a$i$%en%*"*i mei!a" in ingrijirea 6&"na(*"*i !*%r&m6&/"e6i%a

. 5'2. E*!a%ie ,en%r* $ana%a%e

. 5'5. P"an genera" e n*r$ing

. 5'8 ?i6"i&gra/ie

. 5'9 D&$ar e ingrijire

. 5' Fi$a %e3ni!a. inje!%ia $*6!*%ana%a

. 5'; Mem&ri* j*$%i/i!a%i('

8

8/12/2019 terminat!!!!!!!!!!!

5/60

CAPITOLUL I

ANATOMIA I FIZIOLOGIA

SISTEMULUI VENOS AL MEMBRELORINFERIOARE

Vene"e $e /&rmea1# in !ana"e"e ana$%&m&%i!e ar%eri&(en&a$e @i !a,i"are @i !are $e %ermin# "ainim#+ n a%rii' Prin e"e $0nge"e !ir!*"# e "a ,eri/erie $,re inim#'

n /*n!ie e i$,&1iia "&r n &rgani$m+ (ene"e $*n%: ,r&/*ne @i $*,er/i!ia"e' Ce"e,r&/*ne $*n% i$,*$e n a0n!imea &rgani$m*"*i @i n$&e$! ar%ere"e+ iar !e"e $*,er/i!ia"e $*n%a@e1a%e $*6 ,ie"e @i n* n$&%e$! ar%ere"e'

n /*n!ie e gr&$imea "&r+ (ene"e $*n%: mari+ mij"&!ii @i mi!i' Ce"e mai $*6iri ram*ri a"e(ene"&r $e n*me$! (en*"e @i $e /&rmea1# ,rin *nirea !a,i"are"&r'

Vene"e in *nirea !#r&ra $e /&rmea1# (ene mai mari $e n*me$! (ene e &rigine+ iar(ene"e !are $e e$!3i ,e %raie!%*" *nei (ene !&"e!%&are $e n*me$! a/"*eni'

Vene"e $*n% (a$e $ang(ine ,rin !are $0nge"e !ir!*"# in$,re !a,i"are $,re inima @i a* *n(&"*m e %rei &ri mai mare e!0% !e" a" ar%ere"&r'

S%r*!%*ra ,erei"&r (en&@i !*,rine %rei %*ni!i !a @i !ea a ar%ere"&r+ ar !* an*mi%eaa,%#ri a%&ra%e !&niii"&r 3em&inami!e $,e!ia"e in $e!%&r*" (en&$ B,re$i*ne $!#1*%#+"i,$a (ariaii"&r ,re$i&na"e+ $*,ra/a# mai mare+ (i%e1# e !ir!*"aie mai re*$#' De a!eea(ene"e a* ,ereii mai $*6iri e!0% ai ar%ere"&r @i $e e$%in !* *@*rin#'

Vene"e $i%*a%e $*6 ni(e"*" !&r*"*i $*n% ,re(#1*%e !* (a"(*"e en&%e"ia"e B,"i*ri @i a*m*$!*"a%*r# mai e1(&"%a%#'

Pere%e"e (ene"&r+ a" !#r&r !a"i6r* !re@%e e "a ,eri/erie $,re in%im#+ are n $%r*!%*ra $aa!e"ea@i %rei %*ni!i !a @i "a ar%ere+ !* !0%e(a e&$e6iri'

Pere%e"e *nei (ene e$%e /&rma% in %rei %*ni!i'Tunica intern sau endovena sau intimae$%e /&rma%# in%r.*n en&%e"i* @i in%r.*n $%ra%

!&nj*n!%i( e"a$%i!' Ea /&rmea1# n in%eri&r*" *n&r (ene ni@%e ,"i*ri $emi"*nare+ n*mi%e (a"(*"e(en&a$e' Vene"e !are a* (a"(*"e $e n*me$! (ene (a"(*"are'

Va"(*"e"e "i,$e$! n (ene"e n !are $0nge"e !ir!*"# e $*$ n j&$+ iar a!e$%ea $e n*me$!(ene a(a"(*"are'

Tunica mijlocie sau mezovena sau mediae$%e /&rma%# in e$*% !&nj*n!%i( "a)+ n !are$*n% !*,rin$e @i /i6re m*$!*"are' e$*%*" !&nj*n!%i( !&nine /i6re !&nj*n!%i(e @i /i6re e"a$%i!e'

Tunica externa sau perivenasau adeventiceae$%e !&n$%i%*i%# in %e$*% !&nj*n!%i( "a)+ n!are $e g#$e$!+ ,e "0ng# /i6re !&nj*n!%i(e @i e"a$%i!e+ @i e"emen%e m*$!*"are'

T&%a"i%a%ea (ene"&r /&rmea1# $i$%em*" (en&$+ !are e$%e a"!#%*i% in: $i$%em*" (ene"&r

,*"m&nare $a* a" mi!ii !ir!*"aii @i $i$%em*" (ene"&r !a(e $a* a" marii !ir!*"aii'Si$%em*" (en&$ a" marii !ir!*"aii $e !&"e!%ea1# n (ena !a(# $*,eri&ar# @i (ena !a(#in/eri&ar# !are $e e$!3ie n a%ri* re,%'

Si$%em*" (en&$ a" marii !ir!*"aii e$%e re,re1en%a% e &*# (ene mari:.(ena !a(# $*,eri&ar#.(ena !a(# in/eri&ar#'Vena !a(# in/eri&ar# a*n# $0nge"e (en&$ e "a mem6re"e in/eri&are+ e "a ,ereii @i

(i$!ere"e in 6a1in+ e "a rini!3i+ $*,rarena"e+ %e$%i!*"eB re$,e!%i( &(are+ e "a ,ere%e"e,&$%eri&r a" a6&men*"*iB(ene"e "&m6are+ !0% @i e "a /i!a% B(ene"e 3e,a%i!e'

Cir!*"aia $% n%&ar!ere a mem6r*"*i in/eri&r $e /a!e &' in%ermei*" a 2 $i$%eme(en&a$e:

7 . $i$%em*" (en&$ $*,er/i!ia" B,re/a$!ia" . 7>.2> in e6i%*" $ang*in+ *+(ena $a/en#in%ern# B$a/ena mare (ena $a/en# e)%ern# B$a/ena mi!#

9

8/12/2019 terminat!!!!!!!!!!!

6/60

2 . $i$%em*" (en&$ ,r&/*n B$*6/a$!ia" . .=> in e6i%*" $ang*in (en&$ a"mem6r*"*i in/eri&r /&rma% in (ene !are n$&e$! ar%ere"e mem6r*"*i in/eri&r' Ce"e 2 $i$%eme (en&a$e !&m*ni!# n%re e"e ,rin (ene"e !&m*ni!an%e' Vene"e mem6r*"*iin/eri&r $*n% ,re(#1*%e !* (a"(e 6i. %ri!*$,ie $i%*a%e e.a "*ng*" %r*n!3i*ri"&r (en&a$e .(a"(e a)ia"e+ "a ni(e"*" !&m*ni!an%e"&r "a ni(e"*" &ri/i!ii"&r $%(#r$are a (ene"&r $*,er/i!ia"e

. (a"(e &$%ia"e'A,ara%*" (a"(*"ar -.$i$%em*"*i (en&$ a$ig*r# $en$*" !ir!*"aiei (en&a$e . in$,re (ene"e$*,er/i!ia"e $,re !e"e ,r&/*ne @i in$,re ,eri/erie $,re (ena !a(# in/eri&ar#+ m,iei!#re/"*)*" $ang*in in (ene"e ,r&/*ne n !e"e $*,er/i!ia"e' Si$%em*" (en&$ $*,er/i!ia" e$%e $i%*a% n e$*%*" $*6!*%ana% iar $i$%em*" (en&$ ,r&/*n e$%ere,re1en%a% e (ene !e n$&e$! ar%ere"e'

Da%&ri%# $i$%em*"*i e !*rgere an%igra(i%ai&na"+ am6e"e $i$%eme (en&a$e $*n% ,re(#1*%e!* (a"(*"e'

1#V%%.% /+&%'*-.%Vene"e $*,er/i!ia"e a* ,ereii gr&@i+ 6&gai n /i6re !&nj*n!%i(e @i m*@!3i @i $*n%

,re(#1*%e !* (a"(*"e a@e1a%e "a 5.8 !m i$%ana *na e a"%a' A!e$%e (a"(*"e n* ,ermi%

!ir!*"aia $0nge"*i e j&$ n $*$ @i $*n% e$%*" e "argi ,en%r* a ,ermi%e i"a%aia (ene"&r e &a%# @i j*m#%a%e+ /#r# a e(eni in$*/i!ien%e'

R&"*" (ene"&r $*,er/i!ia"e n n%&ar!erea (en&a$# e$%e m&e$%+ e"e %ran$,&r%0n &ar

8/12/2019 terminat!!!!!!!!!!!

7/60

/a$!iei "a ni(e"*" m*@!3i*"*i ga$%r&!nemian' n /&$a ,&,"i%ee e$!rie & !r&$# &rien%a%# (en%ra"@i $e (ar$# n (ena ,&,"i%ee' L&!*" e (#r$are e$%e (aria6i" Bj&$ $a* na"%+ !3iar $,re !&a,$# @i*ne&ri e)i$%# & (en# $*,er/i!ia"# n !&n%in*area $a/enei e)%erne'

Vena $a/en# in%ern# @i (ena $a/en# e)%ern# $*n% "ega%e ,rin m*"%i,"e ana$%&m&1e' Marea(ena ana$%&m&%i!# Gia!&mini e$%e & ana$%&m&1a /em*r&.,&,"i%ee !are !&6&ar# &6"i! n e@ar/#

,e /aa ,&$%eri&ar# a !&a,$ei'2#V%%.% &'+$%Vene"e ,r&/*ne n$&e$! ar%ere"e @i ram*ri"e a!e$%&ra+ ,re1en%0n n*mer&a$e (a"(*"e'

E"e a* ,ereii $*6iri+ e$e&ri $*n% *6"e $a* !3iar %ri,"e'n!e, "a ni(e"*" /eei ,"an%are @i &r$a"e a ,i!i&r*"*i' A* r&"*" ,rin!i,a" n n%&ar!erea

(en&a$#+ =2 in $0nge /iin rena% ,e a!ea$%a !a"e'F*n!i&na"i%a%ea $i$%em*"*i (en&$ ,r&/*n e$%e ire!% e,enen%# e !&n%ra!ia

m*$!*"a%*rii mem6re"&r in/eri&are+ a!ea$%a j*!0n *n ae(#ra% r&" e ,&m,#'Si$%em*" (ene"&r ,er/&ran%e a$ig*r# "eg#%*ra in%re $i$%em*" (en&$ ,r&/*n @i !e"

$*,er/i!ia"' Vene"e ,er/&ran%e $*n% ,re(#1*%e !* (a"(*"e a$%/e" &rien%a%e n!0% ,ermi% $0nge"*i$# !ir!*"e n*mai e "a $*,ra/aa $,re ,r&/*n1ime' n %im,*" !&n%ra!iei m*$!*"are (a"(*"e"e $e

n!3i erme%i! @i n* ,ermi% re/"*)*" $0nge"*i $,re e)%eri&r'Va"(e"e (en&a$e m,iei!# $0nge"e$# !*rg# na,&i n j&$' E"e /*n!i&nea1# !a ni@%e (a"(e /#r# !a"e e n%&ar!ere @i !are n* ,ermi%n%&ar!erea $0nge"*i+ !i &ar !ir!*"aia a!e$%*ia n%r.& $ing*r# ire!ie+ @i an*me !#%re inim#'

A!e$%ea ara%# !a ni@%e !&r#6ii mi!i !are $*n% an!&ra%e n j*r*" ,ere%e"*i (enei @i $en%0"ne$! "a mij"&!*" (enei' Da!# $0nge"e !ir!*"# n $*$ a%&ri%# ,re$i*nii ,&m,#rii rea"i1a%# em*@!3i+ (a"(e"e $e e$!3i' Da!#+ in !a*1a gra(i%#ii+ $0nge"e n!ear!# $# !*rg# na,&i+a!e$%ea $e n!3i'

Fig' 7 (a"(e"e (en&a$e

Vene"e ,r&/*ne j&a!# *n r&" e&$e6i% n !ir!*"aia (en&a$# a mem6re"&r in/eri&are'Di$%r*gerea "&r ,rin ,r&!e$e /"e6i%i!e $a* e(ierea in$*/i!ien%# ,rin i"a%aia (ene"&r+e%ermin# re/"*)*" $0nge"*i in ,r&/*n1ime $,re $i$%em*" $*,er/i!ia" n %im,*" !&n%ra!iei

m*$!*"are @i a$%/e" $e in$%a"ea1# in$*/i!iena (en&a$#'Pe /aa %ar# a ,i!i&r*"*i $e a/"# venele digitale tare+ $i%*a%e ,r&/*n @i ,ara"e" !* ar%ere"e

&m&nime+ (ar$0n*.$e n ar!*" (en&$ %ar a"#%*ra% ar%erei %are'De "a ni(e"*" ar!*"*i (en&$ ,&rne$! (ene"e %are meiane @i (ene"e %are "a%era"e' A!e$%ea $ere*ne$! n @an*ri"e ina,&ia ma"e&"ei %i6ia"e re$,e!%i( ,er&niere @i /&rmea1# venele tibiale

posterioareB!e" ,*in &*# @i venele peroniereB!e" ,*in &*# !are n$&e$! ar%ere"e&m&nime'

Venele tibiale anterioare$*n% a"#%*ra%e ar%erei n "&ja m*$!*"ar#' De!i "a gam6# $*n% %rei,ere!3i e (ene ,r&/*ne !are n$&e$! ar%ere"e' Vene"e %i6ia"e ,&$%eri&are ,rime$!,er/&ran%e"e C&!Je%%'

Din *nirea (ene"&r %i6ia"e !* (ene"e ,er&niere $e /&rmea1# trunchiul tibio-peronier !are,rime@%e @i (ene"e m*@!3i*"*i $&"ear'

;

8/12/2019 terminat!!!!!!!!!!!

8/60

Venele muchiului gastrocnemian$*n% re,re1en%a%e e &*# (ene+ e(en%*a" !ea meian#e$%e *6"#' A!e$%ea $e (ar$# n (ena ,&,"i%ee "a a!e"a@i ni(e" !* (ena $a/en# e)%ern# e)i$%#/re!(en% & (arian%# n !are (#r$area e$%e !&m*n#'

Vene"e m*@!3i*"*i ga$%r&!nemian $*n% (a"(*"a%e'Venele muchiului solearen*mi%e $in*$&ie"e $&"eare $*n% e &6i!ei "argi+ $in*&a$e @i

a(a"(*"a%e' V#r$area (ene"&r $&"eare $e ,&a%e /a!e n (ene"e %i6ia"e ,&$%eri&are+ n ,er&niere$a* *ne&ri ire!% n (ena ,&,"i%ee'De "a ar!*" %enin&$ a" $&"ear*"*i (ene"e $e !&n%in*# !* (ena ,&,"i%ee+ a"a%*ra%# ar%erei+ @i

$%ra6a%e a$!enen% ,e mij"&! regi*nea ,&,"i%ee ,0n# "a a*!%&ri ,rime@%e vena safenextern.

De "a ine"*" a*!%&ri"&r $e !&n%in*# !* vena femural superficial!are "a = !m ear!a# ,rime@%e @i vena femural profund@i e(ine vena femural comun;(ena /em*ra"#mai ,rime@%e venele circumflexe femurale i vena safen intern.

Vena iliac extern!&n%in*# (ena /em*ra"# @i $e &rien%ea1# a$!enen% @i ,&$%eri&r $,rear%i!*"aia $a!r&i"ia!# *ne ,rin *nire !* (ena i"ia!# in%ern# B3i,&ga$%ri!# /&rmea1# venailiac comun'

Ce"e &*# (ene i"ia!e !&m*ne $e &rien%ea1# ,r&)ima" @i meia" /&rm0n ,rin *nire (ena!a(# in/eri&ar#+ !are e$%e a@e1a%# e.a "*ng*" "a%*rei re,%e a !&"&anei (er%e6ra"e' #V%%.% $% .%35+'

La ni(e"*" mem6re"&r in/eri&are e)i$%# n*mer&a$e !&ne)i*ni n%re (ene+ !are /a(&ri1ea1#renaj*" $0nge"*i in$,re $*,ra/a# n$,re ,r&/*n1ime @i in$,re ,eri/erie $,re !&r'

Vene"e e "ega%*r# $*n% e mai m*"%e %i,*ri: (ene ana$%&m&%i!e !are *ne$! (ene e a!e"a@i %i,: ,r&/*ne n%re e"e+ $a/ene"e

n%re e"e+ n ar! ,e a!e"ai %r*n!3i (en&$ (ene"e !&m*ni!an%e $a* ,er/&ran%e *ne$! $i$%em*" (en&$ $*,er/i!ia" !* !e"

,r&/*n ,er/&rea1# a,&ne(r&1a $*,er/i!ia"# ,en%r* a aj*nge n ,r&/*n1ime' C3iar !e"e &*#

$a/ene ar ,*%ea /i !&n$iera%e ,er/&ran%e maj&reH'Vene"e ,er/&ran%e $a/eniene *ne$! (ene"e $a/ene !* (ene"e ,r&/*ne' Vene"e ,er/&ran%ee)%ra$a/eniene *ne$! reea*a (en&a$# e)%ra$a/enian# !* (ene"e ,r&/*ne' Per/&ran%e"e ire!%e"eag# !&"e!%&r*" (en&$ $*,er/i!ia" e (ene"e ,r&/*ne iar ,er/&ran%e"e inire!%e "eag#!&"e!%&r*" (en&$ $*,er/i!ia" e (ene"e m*$!*"are ,r&/*ne' Vene"e ,"&njan%e De"a%er /a!"ega%*ra ire!%# n%re (ene"e %eg*men%*"*i Be)%ra$a/eniene !* $i$%em*" (en&$ ,r&/*n'

La mem6r*" in/eri&r $e !&n$%a%a a,r&)ima%i( 79> (ene ,er/&ran%e+ ar n*mai !0%e(a a*im,&r%an# !"ini!#' La ni(e"*" ,i!i&r*"*i (ene"e ,er/&ran%e $*n% a(a"(*"a%e iar "a ni(e"*"gam6ei $*n% ,re(#1*%e !* 2.5 (a"(e' Vene"e ,er/&ran%e n&rma"e a* (a"(e"e in%egre @i $*n%!&n%inen%e+ ai!a renea1# $0nge"e in$,re $*,ra/a# $,re ,r&/*n1ime' Vene"e ,er/&ran%e $*n%!&n$iera%e in$*/i!ien%e $a* in!&n%inen%e a!# renea1# $0nge"e in$,re ,r&/*n1ime n$,re

$*,ra/a# e!i in(er$ !ir!*"aiei n&rma"e' In$*/i!iena ,er/&ran%e"&r e$%e e%ermina%# ei"a%area (ene"&r e "ega%*r# $i%*aie n !are (a"(e"e n* $e mai a%ing $a* $*n% re1*"%a%*" *neii$%r*!ii ire!%e a (a"(e"&r ,rin me!ani$m*" e re,ermea6i"i1are *,# & %r&m6&/"e6i%# a!*%#'

Prin!i,a"e"e (ene ,er/&ran%e $*n%: grupul Cocett+ !&n$%an% @i /&ar%e im,&r%an% /a!e "ega%*ra n%re ar!*" (en&$

,&$%eri&r a" gam6ei B(ena Le&nar& !* (ene"e %i6ia"e ,&$%eri&are' De &6i!ei $*n% %rei,er/&ran%e $i%*a%e "a !m+ 75+9 !m @i 7

8/12/2019 terminat!!!!!!!!!!!

9/60

perforanta !assi$$i%*a%# ,&$%eri&r+ *ne@%e $a/ena e)%ern# !* (ena ,er&nea"# perforanta %ach+ $i%*a%# ,&$%eri&r *ne%e $i$%em*" $*,er/i!ia" !* (ena /em*ra"#

,r&/*n# perforante &inton i 'osinsi $*n% $i%*a%e n a,r&,ierea !r&$ei (ena $a/ena

e)%ern# grupul punctului gastrocnemian i vena perforant (a" perforanta punctului solear!&ne!%ea1# (ene"e $*,er/i!ia"e a"e gam6ei !* (ena

$&"ear*"*i'Prin!i,a"e"e /*n!ii a"e $i$%em*"*i (en&$ $*n% *rm#%&are"e: !&n*!erea $0nge"*i $,re

inim#+ $%&!area $0nge"*i+ @i %erm&reg"area'Fi1i&"&gia !ir!*"aiei (en&a$e a mem6re"&r in/eri&are e$%e !&m,"e)# @i i/er# m*"% n

/*n!ie e !&niii: &r%&$%a%i$m+ e!*6i%+ e"e(area mem6r*"*i'Fa!%&ri m&%&ri !are a$ig*r# !ir!*"aia (en&a$# e ren%&ar!ere $*n%:

/&ra e ,r&,*"$ie a (en%ri!*"*"*i $%0ng B(i$.a.%erg& /&ra a$,iran%# a inimii @i a m*@!3i"&r re$,ira%&ri B(i$.a./r&n%a ,&m,a m*$!*"ar# a ,i!i&r*"*i @i mai a"e$ a gam6ei "a mer$ Binima ,eri/eri!#H ,*"$area im,rima%# e ar%ere"e ,ara(en&a$e %&n*$*" a*%&n&m a" ,ere%e"*i (en&$ a!i*nea (a"(e"&r (en&a$e !are m,iei!# re/"*)*"

V&"*m*" (en&$ e$%e e %rei &ri mai mare e!0% !e" ar%eria"+ e!i n %eri%&ri*" (en&$ $e a/"a!ir!a ;9 in (&"*m*" $ang(in'

Da%&ri%# $%r*!%*rii ,erei"&r "&r+ !e !&nin !an%i%#i mi!i e e$*% e"a$%i! @i m*$!*"ar ne%e+(ene"e ,re1in%# i$%en$i6i"i%a%e @i !&n%ra!%i"i%a%e'

Di$%en$i6i"i%a%ea e$%e ,r&,rie%a%ea (ene"&r e a.@i mari ,a$i( !a"i6r*" $*6 a!i*nea,re$i*nii $0nge"*i' Prin i$%en$ie+ !a,a!i%a%ea $i$%em*"*i (en&$ !re@%e+ (ene"e ,*%0n

nmaga1ina (&"*me $,&ri%e e $0nge' De&$e6i% e i$%en$i6i"e $*n% (ene"e 3e,a%i!e+ $,"eni!e @i$*6!*%ana%e+ !are ne,"ine$! r&" e re1er(&are e $0nge'

C&n%ra!%i"i%a%ea e$%e ,r&,rie%a%ea (ene"&r e a.@i (aria n m& a!%i( !a"i6r*" ,rin!&n%ra!ia $a* re"a)area m*@!3i"&r ne%e1i in ,ere%e"e "&r' Prin !&n%ra!ia (ene"&r a* "&!m&6i"i1area $0nge"*i in &rgane"e e re1er(# @i e,"a$area "*i !#%re inim#+ !eea !e e%ermin#!re@%erea e6i%*"*i !aria!'

Ca*1a ,rin!i,a"# a n%&ar!erii $0nge"*i "a inima e$%e n$#@i a!%i(i%a%ea e ,&m,a !aria!#a a!e$%eia'

Inima !reea1# @i menine ,ermanen% & i/eren# e ,re$i*ne n%re a&r%# B7>> mm4g @ia%ri*" re,% B1er& mm4g ' De@i ,re$i*nea $0nge"*i $!ae m*"% "a %re!ea ,rin ar%eri&"e @i!a,i"are+ mai r#m0ne & /&r# e m,ingere e 7> mm4g !e $e mani/e$%# "a n!e,*%*"

$i$%em*"*i (en&$' Inima /*n!i&nea1# $im*"%an !a & ,&m,a a$,ir&.re$,ing#%&are' Ea re$,inge$0nge $,re a&r%#+ n %im,*" $i$%&"ei (en%ri!*"are+ @i !&n!&mi%en%+ a$,ir# $0nge"e in (ene"e !a(en a%ri*" re,%'

A$,iraia a%ria"# rea,%# $e a%&rea1# !re@%erii 6r*@%e a !a,a!i%#ii a%ri*"*i+ !a *rmare ae,"a$#rii n j&$ a ,"an@e*"*i a%ri&.(en%ri!*"ar+ n %im,*" /a1ei e eje!ie a $i$%&"ei (en%ri!*"are'

A"i /a!%&ri !are mai e%ermin# n%&ar!erea $0nge"*i "a inima $*n%: a$,iraia %&ra!i!# 6 /a!%&r !are a!i&nea1# mai a"e$ n %im,*" in$,iraiei @i

in/"*enea1# ,re&minan% ,re$i*nea in (ene"e mari+ rea"i10n & a$,iraie a $0nge"*i $,re !&r+$e /&rmea1# *n (i !e !reea1# & ,re$i*ne nega%i(# !e a$,ir# $0nge"e in (ene"e ,eri/eri!e $,reinim#' n %im,*" in$,iraiei a!i&nea1# @i !&6&r0rea ia/ragm*"*i !are m#re@%e ,re$i*nea

in%raa6&mina"#+ m,ing0n $0nge"e $,re !&r'

=

8/12/2019 terminat!!!!!!!!!!!

10/60

,re$i*nea $0nge"*i in !a,i"are m,inge $0nge"e in$,re (en*"e $,re (ene"e maimari+ n !are $!ae ,r&gre$i( !* !0% $e a,r&,ie e !&r'

,&m,a m*$!*"ar# 7 n %im,*" !&n%ra!ii"&r m*$!*"are+ (ene"e ,r&/*ne $*n% g&"i%ee $0nge+ iar n ,eri&ae"e e re"a)are in%re &*# !&n%ra!ii e"e a$,ir# $0nge"e in (ene"e$*,er/i!ia"e' Re/"*)*" $ang(in e$%e m,iei!a% e ,re1ena (a"(*"e"&r B"a ni(e"*" (ene"&r

mem6re"&r in/eri&are' gra(i%aia 7 are e/e!% nega%i( a$*,ra n%&ar!erii $0nge"*i in (ene"e mem6re"&r

in/eri&are' Ea /a(&ri1ea1# !*rgerea $0nge"*i in (ene"e $i%*a%e ea$*,ra a%ri*"*i re,%+ "ani(e"*" gam6ei ,re$i*nea 3ir&$%a%i!# /iin e 7>> mm 4g+ !0n ,er$&ana $%# n ,i!i&are+nemi@!a%# ea $!ae "a 2>.29 mm 4g n %im,*" mer$*"*i'

ma$aj*" ,*"$a%i" 7 e/e!%*a% e ar%ere a$*,ra (ene"&r &m&nime+ a/"a%e m,re*na na!e"a@i ,a!3e% (a$!*"ar+ are e/e!% /a(&ra6i" a$*,ra n%&ar!erii (en&a$e'

n%&ar!erea $0nge"*i "a inim# are & mare im,&r%ana ,en%r* reg"area e6i%*"*i !aria!+e&are!e & inim# $#n#%&a$# ,&m,ea1#+ !&n/&rm "egii inimii a%0% $0nge !0% ,rime@%e ,rin a/"*)(en&$'

S0nge"e !ir!*"# n $i$%em*" (en&$ e %rei &ri mai n!e% e!0% n !e" ar%eria"'Cir!*"aia (en&a$# a mem6re"&r in/eri&are e$%e in/"*ena%a n m& /a(&ra6i" e ma$aj*",*"$a%i" e/e!%*a% e ar%ere a$*,ra (ene"&r+ a/"a%e m,re*n# n a!e"a@i ,a!3e% (a$!*"ar+ @i e!&n%ra!ia m*$!*"a%*rii $%ria%e a mem6re"&r in/eri&are+ !are e)er!i%# & !&m,re$ie e)%ernaa$*,ra (ene"&r ,r&/*ne ,r&,*"$0n $0nge"e irija% e $i$%em*" (a"(*"ar !#%re inim#'

Mer$*" !&n$%i%*ie /a!%&r*" ,rin!i,a" !are a!%i(ea1# !ir!*"aia (en&a$#'Or%&$%a%i$m*" $%a%i! agra(ea1# $%a1#' La /e" a/e!i*ni"e &$%e& ar%i!*"are !e m,iei!#

$a* ngre*nea1# !&n%ra!ia m*$!*"a%*rii gam6e"&r /a(&ri1ea1# $%a1#'C&n%ra!ia (ene"&r+ e/e!%*a%# e m*$!*"a%*ra ,r&,rie+ a !#rei !&n%ra!ie e$%e e!"an@a%#

e !re@%erea ,re$i*nii en&(en&a$e j&a!a *n r&" im,&r%an%+ n $,e!ia" n $i$%em*" $*,er/i!ia"'De%eri&rarea m*$!*"a%*rii (ene"&r ,rin ,r&!e$e e $!"er&1#+ a%r&/ie $a* i"a%aie e)!e$i(#+ /a!e

!a a!e$% me!ani$m $# $e egrae1e'

Reglarea nervoas a circulaiei sangvine

Si$%em*" ner(&$ a/e!%ea1# n $,e!ia" /*n!ii"e g"&6a"e+ !a+ e e)em,"*+ rei$%ri6*ia$ang(in# n i(er$e %eri%&rii a"e &rgani$m*"*i+ !re@%erea a!%i(i%#ii ,&m,ei !aria!e+ @i a$ig*r#n $,e!ia" !&n%r&"*" ra,i a" ,re$i*nii ar%eria"e'

Si$%em*" ner(&$ !&n%r&"ea1# !ir!*"aia e)!"*$i( ,rin in%ermei*" $i$%em*"*i ner(&$(ege%a%i(+ mai a"e$ ,rin $i$%em*" ner(&$ $im,a%i! $i$%em*" ner(&$ ,ara$im,a%i! e$%e im,&r%an%n reg"area /*n!ii"&r !&r*"*i'

Ner(ii $im,a%i!i !&nin *n n*m#r /&ar%e mare e /i6re (a$&!&n$%ri!%&are @i &ar ,*ine/i6re (a$&i"a%a%&are' n $*6$%ana re%i!*"a%# 6*"6ar# @i n %reimea in/eri&ar# a ,*nii+ 6i"a%era"+

$e a/"# !en%r*" (a$&m&%&r' A!e$% !en%r* %ran$mi%e im,*"$*ri e/eren%e ,rin m#*(a $,in#rii @i+e ai!i+ ,rin /i6re $im,a%i!e (a$&!&n$%ri!%&are+ "a a,r&a,e %&a%e (a$e"e $ang(ine+ !are ,re1in%#& 1&n# (a$&!&n$%ri!%&are @i & 1&n# (a$&i"a%a%&are'

7>

8/12/2019 terminat!!!!!!!!!!!

11/60

CAPITOLUL II

TEMA: TROMBOFLEBITA

2#1 D%5%

T'89.%95- '%&'%5- 9/5'+*5- 55-.- /-+ &-'5-.- - +% ;%% &' '8-'%- $%*

8/12/2019 terminat!!!!!!!!!!!

12/60

2#2 E5.3%:

Fa!%&rii ,a%&geni $*n% *rma%&rii :S%a1a (en&a$aLe1i*nea ,ere%e"*i (en&$4i,er!&ag*"a6i"i%a%ea $ang*ina'

In genera" !&e)i$%a &i $a* %rei /a!%&ri+ e/e!%e"e "&r /iin !*m*"a%i(e'F-*5' -;'-5 %>5%'$*n%:

S!3im6area e %em,era%*raS!3im6area e a"%i%*ine in $!*r% %im,B/"e6i%a e a(i&n

F-*5' 8%$*-8%5/: (i%amina + igi%a"a+ i*re%i!e+ ACT4+ !&r%i1&n+,eni!i"ina!&n%ra!e,%i(e"e &ra"e

F-*5' -;'-5 5%'$*n%: Erei%a%e Var$%a Se) O6e1i%a%e'

F-*5' $% '/*$*n%: Tra*ma%i$me"e maj&re $a* /ra!%*ri"e !are im,"i!a &,era%ii $i im&6i"i1ari ,re"*ngi%e F*ma%*" In%er(en%ii"e !3ir*rgi!a"e mai a"e$ !e"e ,e mi!*" 6a1in $i !e"e &r%&,ei!e In$*/i!ien%a !aria!a'

F-*5' $% .-9'-5'$*n%: An&ma"ii %ran1i%&rii $i *ra6i"e Cre$%erea /i6rin&"i%i!a !&ag*"an%a ,"a!3e%ara'

Ri$!*" /ie!arei ,er$&ane in ,ar%e %re6*ie e(a"*a% *,a ien%i/i!area a!e$%&r /a!%&ri'

2# C.-/*-'%

T&m6&/"e6i%a e$%e e &*a /e"*ri $i an*me:7'Tr&m6&/"e6i%a $*,er/i!ia"a2'Tr&m6&/"e6i%a ,r&/*na'

1# T'89.%95- /+&%'*-.-a/e!%ea1a (ene"e $i$%em*"*i (en&$ $*,er/i!ia"+ !e" mai ae$ea"a ni(e"*" mem6r*"*i in/eri&r+ ar ,&a%e a/e!%a $i (ene"e mem6r*"*i $*,eri&r' De a$emenea+%r&m6&/"e6i%a $*,er/i!ia"a a,are /re!(en% "a ,er$&ane"e !* (ari!e' Tr&m6&/"e6i%a $*,er/i!ia"a in$eamna /&rmarea *n&r %r&m6iB!3eag*ri e $ange "a ni(e"*"*nei (ene $*,er/i!ia"e !&n!&mi%en% $e ,r&*!e in/"ama%ie "a ni(e"*" ,ere%e"*i (en&$ $i a%e$*%*ri"&r ,eri(en&a$eB rea!%ii in/"ama%&rii + r&$ea%a (e"e"&r $*,er/i!ia"e' Tr&m6&/"e6i%a $*,er/i!ia"a *rea1a in meie &*a.%rei $a,%amani $i !eea1a ,rin a,"i!areae *ng*en%e "&!a"e+ a$aar gra(i%a%ea e$%e mai mi!a' 2'T'89.%95- &'+$- a/e!%ea1a (ene"e $i$%em*"*i ,r&/*n+ e!i. !e" ,rin!i,a"'In !a1*" %r&m6&/"e6i%ei ,r&/*ne+ $e i$%ing &*a $%aii:

S%ai*" ,reeema%&$ B /e6ra ,e$%e 5< grae Ce"$i*$+ %a3i!arie+ !re$%erea

%em,era%*rii "&!a"e Tr&m6&1a (en&a$a Ba,ari%ia *n*i eem *r+ !a" "a ni(e"*" gam6ei'

72

8/12/2019 terminat!!!!!!!!!!!

13/60

Pe "anga !e"e ,re1en%a%e mai $*$+ $e mai in%a"ne$! $i %r&m6&/"e6i%e migra%&are $a*re!ii(an%e+ /ie!are in%re e"e a(an gra(i%a%e $i %ra%amen%e i/eri%e'

2#4 S8&58-5.3%

Sim,%&ma%&"&gia a,are 6r*$!+ n*min*.$e :F*"ger ,e !er $enin + iar e6*%*" 6&"ii im6ra!a%rei /&rme $i an*me:

A*+5 : . *rere $,&n%ana "a ni(e"*" m&"e%*"*i $a* regi*nii ,"an%are . "a !a%e(a &re a,are eem*" e $%a1a+ !ian&1a %eg*men%e"&r'BGam6ier

S+9-*+5 : . $e in%ane$%e e &6i!ei "a 6&"na(ii &,era%i+ a!!ien%a%i+ "e3*1e+ $emne"e "&!a"ee %r&m6&1a a,aran *,a e)%ernarea in $,i%a"A/8&58-5* : . a6$en%a !&m,"e%a a $im,%&me"&r $i ,re1en%a $emn*"*i $i$im,%&me"&r "a i$%an%a + !*m ar /i !e" a" *nei em6&"ii ,*"m&nare'

Sinr&m*" !"ini! $*6ie!%i( e$%e &mina% e *rere $,&n%ana+ e in%en$i%a%e (aria6i"a+ !e!re$%e in &r%&$%a%i$m+ "a mer$' De a$emenea. e$%e re$im%i%a !a & gre*%a%e $a* %en$i*ne m*$!*"ara

"a ni(e"*" ,ar%i"&r m&i a"e gam6ei+ $a* !a & !ram,a !are !*,rine m&"e%*"'Can ,r&!e$*" %r&m6&"i! in!e,e "a ni(e"*" ar!aei (en&a$e ,"an%are+ *rerea e$%e "&!a"i1a%a

"a a!e$% ni(e"'Pe ma$*ra !e %r&m6*$*" $e ,r&,aga in a)*" (en&$ a" mem6r*"*i in/eri&r+ *rerea$e e)%ine e "a gam6a !a%re !&a,$a+ iraiin e.a "*ng*" ,a!3e%*"*i (a$!*"ar+ aj*ngan inregi*nea ing3ina"a+ *ne are ma)im e in%en$i%a%e'Une&ri *rerea $,&n%ana !&n*!e "a !ri1e*rer&a$e e in%en$i%a%e e)%rema+ !*,rin1an %&% mem6r*" in/eri&r+ *rere /iin ,r&(&!a%a e$,a$m*" (en&$+ e%ermina% e iri%area en&(enei e !a%re %r&m6*" !are $e !&m,&r%a !a *n !&r,$%rain'

Semne"e $*6ie!%i(e $*n% *rma%&are"e : . ne"ini$%e . /e6ra: 5< grae Ce"$i*$B,&a%e $a n* !ee1e "a an%i6i&%i!

. a"%erarea $%arii genera"e . ,*"$ !a%ara%&rBa!!e"erare ,r&gre$i(a'

A"%e $im,%&me ,&% /i : am&r%e"i+/*rni!a%*ri+ $en1a%ie e ra!ea"a "a ni(e"*" mem6r*"*iin/eri&r+ eem*" (&"*min&$ !*,rin1an %&% mem6r*" ,e"(ian'

In %r&m6&/"e6i%a $*,er/i!ia"a%raie!%*" (enei 6&"na(e e$%e $*6 /&rma *n*i !&r&n *r+e!*"&are r&$ie+ !* %eg*men%e in(e!ina%e r&$ii+ eema%ia%e $i !a"e'Beem in/"ama%&r'In %r&m6&/"e6i%a ,r&/*na e)i$%a eem*" e $%a1a+ "&!a"i1a% ee$*6%*" 1&nei &6$%r*a%e+e)%in1an*.$e a,&i "a in%reg*" mem6r*+ e !&n$i$%en%a m&a"e+ $en$i6i" $i ,a"i $a* e !*"&area"6a$%ra'

2#? E>-8%% &-'-*.*%

2#?#1 U.5'-/3'-- D&&.%' *5+

Ve"&!ime%re"e D&,,"er !* emi$ie !&n%in*# ,ermi% nregi$%rarea (i%e1ei e !ir!*"aie a

$0nge"*i n (a$e' A,ara%e"e $*n% ,re(#1*%e !* $&ne emi#%&are e *"%ra$*ne%e !* /re!(ena e

8M4 ,en%r* (a$e"e in ,r&/*n1ime @i e

8/12/2019 terminat!!!!!!!!!!!

14/60

i1&e"e!%ri!e ,en%r* /"*)*" n $en$*" ire!iei $&nei @i nega%i(e+ e!i $*6 "inia i1&e"e!%ri!# ,en%r*

/"*)*" &rien%a% in(er$ ire!iei $&nei' U"%ra$&n&gra/*" D&,,"er e 6*1*nar e$%e *n a,ara% e

mi!i imen$i*ni ,&r%a6i" /#r# ,&$i6i"i%a%e e nregi$%rare @i !are $emna"i1ea1# a*i%i( a!# e)i$%#

!ir!*"aie n (a$*" e)amina%' A(an%aje"e a!e$%*i *"%im a,ara% $*n% $im,"i%a%ea e)amin#rii+

,&$i6i"i%a%ea e)amin#rii *rgene"&r (a$!*"are /#r# a m&6i"i1a 6&"na(*"'

E)aminarea ,a!ien%*"*i $e e/e!%*ea1# n e!*6i% (en%ra"+ &r$a" @i n &r%&$%a%i$m+ n re,a*$ @i

n inami!#' S&na $e a,"i!# e"i!a% ,e %eg*men% /#r# a,#$are ,en%r* a n* !&"a6a (ena+ !&n%a!%*"

/iin in%ermeia% e *n $%ra% e ge" e 7.2mm !are $# !&n*!# *"%ra$*ne%e"e' La ni(e"*"

mem6re"&r in/eri&are $e ,&% e)amina ire!% $a* inire!% (ene"e $i$%em*"*i (en&$ ,r&/*n+ a"e

$i$%em*"*i (en&$ $*,er/i!ia"+ iar n a6&men (ene"e i"ia!e @i (ena !a(# in/eri&ar#' A6$ena

/"*)*"*i n $i$%em*" (en&$ ,r&/*n ini!# /ie &6$%a!&" "a ni(e"*" (enei re$,e!%i(e+ ,rin %r&m6&1#

a!*%#+ $e!3e"e a"e %r&m6&1ei n !ar*" $inr&m*"*i ,&$%/"e6i%i! /ie $i$%area /"*)*"*i ,rin

!&m,re$i*ne'

2#?#2 U.5'-/3'-% D&&.%' &+./-5: $emna"*" D&,,"er e$%e i$!&n%in** @i e$%e re/"e!%a%

n*mai "a m&i/i!area e$*%*"*i' Prin DUPLEX.DOPPLER @i DOPPLER DUPLEX COLOR $e

(i1*a"i1ea1# n !&niii /&ar%e 6*ne m&r/&"&gia (ene"&r @i !*rgerea $0nge"*i+ !* ,&$i6i"i%a%ea

re!*n&a@%erii re/"*)*"*i @i a ,er/&ran%e"&r in$*/i!ien%e' Se e%e!%ea1# !* mare a!*ra%ee ,re1ena

%r&m6i"&r n (ene !are n* mai ,&% /i !&m,rima%e !* $&na' Dea$emenea $e e(ienia1# ,ere%e"e

(en&$ !* e!&* an&rma" @i "*men re!ana"i1a%'

2#?# F.%93'--

Me% e re/erin# @i $%anar*" e !&m,araie Bg&" $%anar . e$%e & me% in(a1i(#'

Ne!e$i%# ,*n!ie (en&a$# @i inje!%area *nei $*6$%ane e !&n%ra$% i&a%e ,en%r* a &6ine !* aj*%&r*"

ra1e"&r R&en%gen /&%&gra/ia (ene"&r n !are ,#%r*ne a!ea$%a' Prin e),*neri $*!!e$i(e "a

angi&gra/ $e ,&a%e *rm#ri e,"a$area $*6$%anei e !&n%ra$% @i $e (i1*a"i1ea1# ,r&gre$i( (ene"e

re$,e!%i(e' Se e$!ri* /"e6&gra/ii a$!enen%e Binje!%are i$%a"# @i *rm#rirea a(an$#rii $*6$%anei+

e$!enen%e Binje!%area ,r&)ima"# e e)em,"* n (ena /em*ra"# @i *rm#rirea re/"*)*"*i "amane(ra VALSALVA $a* "a &r%&$%a%i$m' Vi1*a"i1area (ene"&r in $i$%em*" $*,er/i!ia" @i

,r&/*n ,rin /"e6&gra/ie e$%e /&ar%e 6*n#' E)i$%# ri$!*" @&!*"*i ana/i"a!%i! "a inje!%area

$*6$%anei e !&n%ra$% iar mane(ra e$%e ne,"#!*%# $a* *ne&ri *rer&a$# ,en%r* ,a!ien%'

F.%93'--in%r&*!erea in%ra(en&$ !* $ering# a*%&ma%# e ,re$i*ne+ a 2> 5> m" e$*6$%an# e !&n%ra$%+ e !&n!e%raie re*$# B ,en%r* a n* "e1a ,ereii (a$*"*i' Rai&gra/ii"e $ee)e!*%# !* (i%e1# e 28 imagini ,e $e!*n# Brai&!inema%&gra/ie' C* & 1i nain%ea e)amin#rii+

6&"na(*" e$%e $*,*$ *nei mei!aii $ea%i(e !* Fen&6ar6i%a"' A!ea$%a $e re,e%# n imineaae)amin#rii @i $e !&m,"e%ea1# e(en%*a" !* R&mergan $a* !* & a"%# $*6$%an# an%ia"ergi!#'E)aminarea $e (a /a!e ,e nem0n!a%e' Te$%area $en$i6i"i%#ii /a# e i& $e /a!e "a /e" !a @i n!a1*ri"e an%eri&are' Inje!%area $*6$%anei e !&n%ra$% $e /a!e ,e !a"e in%ra(en&a$#+ ame$%e!a%# !*

78

8/12/2019 terminat!!!!!!!!!!!

15/60

$0nge+ ra,i n e!*r$ e !0%e(a $e!*ne+ ,en%r* !a $# n* /ie ,rea i"*a%# e $0nge"e !ir!*"an%'Can%i%a%ea e $*6$%an# inje!%a%# (a /i !a"!*"a%# e mei! ,e 6a1a gre*%#ii !&r,&ra"e a

6&"na(*"*i' A$i$%en%a mei!a"# (a a(ea "a nem0n# %r*$a $,e!ia"# ,en%r* a a!&ra ,rim*" aj*%&rn !a1 e @&! ana/i"a!%i!'

T'89/5& 7 an%i!&ag*"an% !*marini!

Ini!aii: a/e!i*ni %r&m6em6&"i!e a!*%e+ ,r&/i"a)ia a!!ien%e"&r em6&"i!e *,# in%er(enii!3ir*rgi!a"e @i "a !aria!i+ %r&m6&1a (en&a$# ,r&/*n#+ in/ar!% e mi&!ar+ ,r&/i"a)ia %r&m6&1ei!ere6ra"e

M& e amini$%rare: &ra": 7>.2> mgK1i B9.7> !&m,rima%e %im, e 2 1i"e+ !a &1a e a%a!+a,&i 7.7> mgK1i ,en%r* n%reinerea e/e!%*"*i B n /*n!ie e %im,*" e ,r&%r&m6ina . a!%i(i%a%ea

,r&%r&m6ini!# %re6*ie menin*%# "a 2>.8> + &1area %re6*ie $%ri!% ini(i*a"i1a%aB (ariaiiini(i*a"e mari

Rea!ii a(er$e: $0nger#ri i(er$e+ re"a%i( gre* e !&n%r&"a%B $e inje!%ea1# /i%&menai&na$%&ma%i%a *"!er&a$#+ %*"6*r#ri ige$%i(e+ a"&,e!ie+ *r%i!arie

C&n%raini!aii: ia%e1e 3em&ragi!e+ 4'T'A ,e$%e 2>> mm 4g n* $e /&"&$e@%e n ,rime"e 51i"e *,# in%er(enii"e !3ir*rgi!a"e $a* *,# na@%ere+ ni!i n *"%ime"e "*ni e $ar!ina ,r*en%a @i

&1e mi!i "a 3e,a%i!i+ rena"i+ 3i,er%ir&iieni+ n $%#ri /e6ri"e+ "a en*%rii @i n 6&"i $i$%emi!egra(e' Tra%amen%*" e$%e $%ri!% !&n%raini!a% a%*n!i !0n n* e$%e ,&$i6i" !&n%r&"*" e/e!%*"*i ,rinana"i1e e "a6&ra%&r ,eri&i!e B a!%i(i%a%ea ,r&%r&m6ini!# %re6*ie e%ermina%# 1i"ni! n ,rime"e1i"e e %ra%amen%+ a,&i e 2.5 &ri ,e $#,%#m0n# @i n !&n%in*are "a in%er(a"e e !e" ,*in 5$#,%#m0ni'

2#@ E>-8%% $% .-9'-5':

4em&grama "e*!&!i%&1a

. %r&m6&!i%e 29> mii. !&ag*"&grama

VS4

Tim, *i!J

Fi6rin&gen

Tim, e $angerare

Tim, e !&ag*"are

2## D-3/5* $%'%5-.

Diagn&$%i!*" i/eren%ia" $e /a!e !* *rma%&are"e a/e!%i*ni: (a$!*"i%a+ (ene"e (ari!&a$e+

in$*/i!ien%a (en&a$a !r&ni!a+ 3ema%&m*"+ "im/eem*"'

In /a1a e in!e,*%+ !an eem*" n* e$%e !&n$%i%*i% ,e e,"in+ iagn&$%i!*" i/eren%a" $e /a!e

!* : re*ma%i$m+ ,&"ine(ri%e+ eri1i,e"*"'

79

8/12/2019 terminat!!!!!!!!!!!

16/60

2## E;.+5%

S!3ema%i!+ e(&"*%ia *nei %r&m6&1e (en&a$e a mem6re"&r in/eri&are+ ,&a%e /i im,ar%ia% in:

7'Prim*" $%ai* i" re,re1in%a $%area a!*%a a 6&"ii+ in !are &6$%a!&"*" !ir!*"an% re,re1in%a & $*r$a

e im,*"$*ri ,a%&"&gi!e !e e%ermina a$,e!%*" !"ini! a" 6&"ii+ a(an & *ra%a e "a !a%e(a 1i"e "a

!a%e(a $a,%amani. *,a gra(i%a%ea 6&"ii'

2'A" &i"ea $%ai* i" re,re1in%a ,eri&aa e !&n(a"e$!en%a in !are %em,era%*ra+ ,*"$*" re(in "a

n&rma"+ e a$emenea i$,ar eem*" in ,&1i%ie &ri1&n%a"a ar+ in &r%&$%a%i$m. rea,are eem*" $i

!ian&1a'

5'A" %rei"ea $%ai* e$%e re,re1en%a% e /a1a e $%a6i"i1are+ !are e$%e %em,&rara'Ai!i i$,are

$im,%&ma%&"&gia+ a,&i *rman $e!3e"e"e B$inr&m ,&$%%r&m6i!+ !* ,&$i6i"e !&m,"i!a%ii ,e

,ar!*r$'

2## P'3/5*

Pr&gn&$%i!*" e,ine e a,ari%ia !&m,"i!a%ii"&r $i ine&$e6i e em6&"ia ,*"m&nara+ e

marimea %r*n!3i*"*i (en&$ a/e!%a%+ e "&!a"i1area $*,er/i!ia"a $a* ,r&/*na $i e %ra%amen%*"

a,"i!a%'Pr&gn&$%i!*" e$%e in genera" 6*n+ ar ,r&!e$*" ,a%&"&gi! (a mai ,er$i$%a 5.8 $a,%amani'

Da!a a,are in a$&!iere !* (ari!e"e+ ri$!*" e re!*ren%a e$%e mare a!a (ene"e n* $*n%

e)!i1a%e'Rar !&n*!e "a em6&"i$m ,*"m&nar+ &ar a!a ,r&!e$*" n* $e e)%ine "a (ene"e

,r&/*ne+ !an a!e$%a e$%e ine(i%a6i"'

2#10 C8&.*-:

. Em6&"ia ,*"m&nar#

. Gangrena (en&a$#

. Sinr&m*" ,&$%%r&m6&%i! B,&$%/"e6i%i!

. In$*/i!iena (en&a$# !r&ni!#: *"!ere e gam6#+ !e"*"i%e+ eeme

. U"!er*" e gam6a

7

8/12/2019 terminat!!!!!!!!!!!

17/60

. S&!*"'

. E89.- &+.8-'C&m,"i!aia !ea mai rama%i!# @i gra(# !e a,are ,rin e$,rinerea *n*i %r&m6

in $i$%em*" (en&$ ,eri/eri! an%rena% e !*ren%*" $ang*in ,rin inim# ,n# "a ar%ere"e

,*"m&nare $a* ram*ri"e "&r+ !* &6"i%erarea "&r %&%a"# $a* ,aria"#' Re1*"%# & !re@%ere a

,re$i*nii ar%eria"e ,*"m&nare !* re,er!*r$i*ni ,e !&r*" re,% @i $%a1# (en&a$# !re@%e

,re$i*nea (en&a$# !en%ra"# @i a,are *n e/i!i% e (&"*m' A,&i a,ar mani/e$%#ri re/"e)e !*

&6$%r*!ie re/"e)# !* ar%eri&"& @i 6r&n3&!&n$%ri!ie+ re/"e)e !&r&nar&.!aria!e+ $in!&,#

!3iar a$/i)ie @i e!e$'

P*n!% e ,"e!are . !e" mai /re!(en% %r&m6&/"e6i%a e gam6# +!&a,$# $a* ,e"(in#' Ri$!*"

ma)im e a,ariie n 1i"e"e

8/12/2019 terminat!!!!!!!!!!!

18/60

(en&a$#

. !* re/"*): a%&ri%# a(a"(*"#rii (en&a$e $e in(er$ea1# !ir!*"aia $0nge"*i

. mi)%: a$&!ierea $inr&ame"&r an%eri&are $a* in%er(en%ri!*"ar %r&m6*" ,&a%e ,r&(eni @iin !&r*" $%0ng'

A"%e !&m,"i!a%ii ,&% /i: I%*.% ,rin $*,ra(eg3erea e(&"*iei ,"#gii @i a renaj*"*i' P"aga (a /i !&n%r&"a%#1i"ni! "a (i1i%#' Da!# e(&"*ia e$%e n&rma"#+ ea e$%e $*,"#+ ne*rer&a$#+ iar ,an$amen%*"e$%e !*ra%' n a!e$% !a1 ,an$amen%*" $e $!3im6# "a &*# 1i"e' Pan$amen%*" m6i6a% !*$e!reii $e $!3im6# 1i"ni!+ iar a!# $e!reia e$%e a6*nen%#+ $e $!3im6# e mai m*"%e &ri ,e1i+ ,en%r* a e(i%a iri%area ,ie"ii ,rin $%agnarea $e!reii"&r'

n !a1*" *nei e(&"*ii ne/a(&ra6i"e a ,"#gii+ n a %reia $a* a ,a%ra 1i e "a &,eraie+a,are /e6ra n$&i%# e $en1aia e %en$i*ne+ *rere+ *$%*rime "a ni(e"*" ,"#gii' La rii!area

,an$amen%*"*i $e !&n$%a%# & 1&n# !&nge$%i&na%# Br&@ie+ 6&m6a%# !* %eg*men%e "&!a"e!a"e' Une&ri ,rin%re /ire $e $!*rge "i!3i $er&,*r*"en%' E),"&rarea ,"#gii $e /a!e !* *n$%i"e% $a* !* ,en$a+ !&n$%a%0n*.$e a,ariia *nei $er&1i%#i+ $0nge $a* ,*r&i'

A,ariia ,*r&i*"*i im,*ne $!&a%erea /ire"&r+ e6riarea ,"#gii+ $,#"area !* a,#&)igena%# @i !"&ramin#+ @i e(en%*a" renarea ei' Se (a re!&"%a ,*r&i n%r.& e,r*6e%# $%eri"#

,en%r* e)amen*" 6a!%eri&"&gi! @i an%i6i&gram#'P"#gi"e $*,*ra%e ,&% !&n*!e "a !&m,"i!aii $e(ere B$e,%i!emii+ gangrene+ e(i$!eraii

e%!''

2#11 T'-5-8%5

2#11#1 P'.->- $e /a!e "a 6&"na(ii !* ri$! %r&m6&gen+ mai a"e$ "a ,a!ienii

&6e1i !* &,eraii mari Bne&$e6i in%er(enii &r%&,ei!e+ *r&"&gi!e+ gine!&"&gi!e mari

$a* n !a1 e im&6i"i1are ,re"*ngi%# "a ,a% ,rin 6&a"# $a* n g3i,$'

M%5$%.% $% 5'-5-8%5 &'.-*5*$*n%:

.3e,arin# n &1e mi!i B9'>>> *'i' $!K < &re *,# me%&a aJJar

.3e,arine !* gre*%a%e m&"e!*"ar# mi!# in ,eri&aa ,re&,era%&rie @i a,&i amini$%ra%# "ain%er(a"e e 72 $a* 28 &re ,&$%&,era%&r

.e!3i"i6rare !&re!%# 3ir&e"e!%r&"i%i!# ,en%r* a ,re(eni !re@%erea (0$!&1i%#ii $nge"*i

.m&6i"i1#ri . mi@!#ri a!%i(e in!"*$i( ,e ma$a e &,eraie ,en%r* m&6i"i1area $0nge"*i in

e,&1i%e"e (en&a$e gam6iere

.!i&ra, e"a$%i! $a* 6anaj !&m,re$i( &6"iga%&ri* ,re&,era%&r @i menin*% ,&$%&,era%&r

,n# "a re"*area m&6i"i1#rii

.a$,irin# 7K2 %a6K1i B!&n%raini!a%# "a ,a!ienii !* *"!er.e)%ran

7

8/12/2019 terminat!!!!!!!!!!!

19/60

2#11#2 P'*&-.%.% 8%5$% ./5% &'.->- 9. 5'89%89.*%:.C&m6a%erea $%a1ei (en&a$e.M&6i"i1are ,re!&!e+ mi@!ari a!%i(e @i ,a$i(e

.C&m,re$ie e)%erna B!i&ra,i e"a$%i!i !* !&m,re$ie gra*a"a+ !&m,re$ie ,ne*ma%i!ain%ermi%en%a

.S%im*"are m*$!*"ara e"e!%ri!a+ in%ra&,era%&r

.S!Qerea !&ag*"a6i"i%aii $ang(ine

.An%i!&ag*"an%e B3e,arine+ an%i(i%amine '

2#11# M%$*-8%5%.% -5*-3+.-5% a* r&"*" e a $!aea !a,a!i%a%ea e

!&ag*"are a $ange"*i' De$i a!e$%e mei!amen%e n* ,&% e%ermina "i1a *n*i !3eag,ree)i$%en%+ a!e$%ea ,re(in marirea !3eag*"*i $i e a$emenea re*! ri$!*" /&rmarii$e!*nare a !3eag*ri"&r'

Ti,i!+ $e (&r amini$%ra in ,rime"e 1i"e inje!%ii *n ,r&*$ ,e 6a1a e 3e,arina+ iar a,&i $e(&r amini$%ra mei!amen%e Ban%i!&ag*"an%e !*marini!e: $in%r&m' F&"&$irea a!e$%&rmei!amen%e ne!e$i%a & $*,ra(eg3ere $%ri!%a+ e&are!e & &1a ,rea mare ,&a%ee%ermina 3em&ragii+ iar &1e"e ,rea mi!i ,&% /i ine/i!ien%e !* men%inerea !re$%eriiri$!*"*i e /&rmare e !3eag*ri' Pen%r* a!ea$%a+ %re6*ie e/e!%*a%e %e$%e $ang(ine

,eri&i!e !are in(e$%ig3ea1a !&ag*"area $ange"*i' Femei"e in$ar!ina%e n* ,&% 6ene/i!iae %ra%amen%*" !* an%i!&ag*"an%e &ra"e'T'-5-8%5 8%$*-. -5*-3+.-5

A5*-3+.-5%.%,re(in ,r&,agarea %r&m6*"*i @i ,ermi% $i$%em*"*i "i%i! en&gen

$Q &,ere1e :

.3e,arin# 9>>> *'i' a,&i !%e 9>>.7>>> *'i' K &r# amini$%ra% !&n%in** ,e !a"e

in%ra(en&a$# %im, e ;.7> 1i"e $e a$&!iea1# minim ;2 e &re 3e,arina !* i!*marini!e"e

,n# "a &6inerea ini!e"*i *i!J 2>.5> $a* a (a"&ri"&r INR BIn%erna%i&na" N&rma"i$e

Ra%i& e 2.8+9' A,&i $e !&n%in*# %ra%amen%*" i!*marini! 5 "*ni Ba!# !a*1a e$%e

!*n&$!*%# @i re(er$i6i"# $a* !3iar ,0n# "a "*ni+ $e aj*$%ea1# !&re!% &1e"e e

in%reinere ,rin m&ni%&ri1area %im,*"*i *i!J $a* INR "a in%er(a"e reg*"a%e ,en%r* a e(i%a

$*,ra&1area !* 3em&ragii $a* $*6&1area !* %r&m6&1e' In !a1*" a,ariiei $nger#ri"&r $e/&"&$e$! 9m" ,r&%amin $*"/a% in%ra(en&$ @i 7>mg (i%amina in%ra(en&$' Tr&m6&/"e6i%a

gam6ier# ne!e$i%# re,a*$ "a ,a% !* mem6r*" in/eri&r n e"e(aie 2> . 29!m+ "&!a"

!&m,re$e @i ana"ge%i!e ,e !a"e genera"#' D*,# !e $!ae eem*" $e /a!e m&6i"i1area

%re,%a%#'

S*n% mai m*"%e $!3eme e %ra%amen% Be)' &1# e a%a! 29>'>>> *'i'K5>min'+ a,&i

7>>'>>> *'i'K1i n ,er/*1ie 1i"e !* !&n%r&"*" ini!e"*"*i e %r&m6in# n $,i%a" a,&i

3e,arin# 5>>.7>>> *'i K&r# i'('@i i!*marini!e !* !&n%r&"*" ini!e"*"*i *i!J' Ri$!*ri"e/i6rin&"i1ei: a"ergie+ 3em&ragii+ em6&"ii ,rin /ragmen%e e %r&m6'

7=

8/12/2019 terminat!!!!!!!!!!!

20/60

Pre(enirea em6&"i$m*"*i ,*"m&nar e$%e !e" mai im,&r%an% &6ie!%i( a"%ra%amen%*"*i ,a!ieni"&r !* TVP+ n%r*!a% n $%aii"e ,re!&!e+ %r&m6*" e$%e ,*inaeren% "a ,ere%e"e (a$!*"ar' Pa!ienii (&r /i im&6i"i1ai n ,a% @i e)%remi%a%ea a/e!%a%Q(a /i rii!a%Q ea$*,ra ni(e"*"*i !&r*"*i ,0nQ !0n eem*" @i $en$i6i"i%a%ea imin*Q'

4e,arina (a /i amini$%ra%a in%ra(en&$ $*6 /&rma *n*i 6&"*$ iniia" e ;'9>>.

7>'>>> UI *rma% e & ,er/*1ie !&n%in*a !* 7'>>>.7'9>> UIK3' Ri%m*" ,er/*1iei !*3e,arina (a /i aj*$%a% a$%/e" n!0% aPTT $a /ie e a,r&)ima%i( 2 &ri /aQ e (a"&ri"en&rma"e' La mai ,*in e 9 in%re ,a!ieni %ra%amen%*" !* 3e,arina ,&a%e e%ermina%r&m6&!i%&,enie' Tra%amen%*" !* 3e,arina (a /i menin*% %im, e !e" ,*in 9.; 1i"e'4e,arine"e !* gre*%a%e m&"e!*"ara mi!Q B8'>>>.'>>> a"%&ni+ a* e/i!a!i%a%e ega"a $a*mai mare e!0% 3e,arina !&n(eni&na"a+ ne/ra!i&na%a n ,re(enirea e)%en$iei $a*re!*renei %r&m6&1ei (en&a$e' n /*n!ie e ,re,ara% 4GMM $e amini$%rea1Q$*6!*%ana% n &1a /i)a & a%Q $a* e &*a &ri ,e 1i' In!iena %r&m6&!i%&,eniei e$%emai mi!Q ,en%r* 4GMM e!0% ,en%r* ,re,ara%e"e !&n(eni&na"e' An%i!&ag*"an%e"e&ra"e $*n% amini$%ra%e n %im,*" ,rimei $a,%amani e %ra%amen% !* 3e,arina @i ,&% /in!e,*%e n!Q in ,rima 1i a %ra%amen%*"*i !* 3e,arina a!a aPTT e$%e n "imi%e

%era,e*%i!e' E$%e im,&r%an% $a $*,ra,*nem %ra%amen%*" !* 3e,arina @i %ra%amen%*" !*an%i!&ag*"an%e &ra"e %im, e !e" ,*in 8.9 1i"e+ e&are!e e/e!%*" an%i!&ag*"an% !&m,"e%a" an%i!&ag*"an%e"&r &ra"e Ban%i(i%amine e$%e n%0r1ia%' D&1a e an%i!&ag*"an%e &ra"e(a /i aj*$%a%Q ,en%r* a menine IP "a & raie in%ernai&na"Q n&rma"i1a%a BINR e 2+>.5+>' Tra%amen%*" an%i!&ag*"an% (a /i !&n%in*a% 5. "*ni "a ,a!ienii !* TVP a!*%Q @i "a%&i !ei !* /a!%&ri e ri$! %em,&rari ,en%r* %r&m6&1Q (en&a$a+ ,en%r* a $!aea ri$!*"re!*renei @i a imin*a $inr&m*" ,&$%%r&m6&%i!' D*ra%a %ra%amen%*"*i e$%e ne"imi%a%an !a1*" ,a!ieni"&r !* TVP re!*ren%a @i a" !e"&r !* 3i,er!&ag*"a6i"i%a%e ,ermanen%a'

2#11#4 M%$*-8%5%.% 5'89.5*% + !*m ar /i $%re,%&Jina1a BS @ia!%i(a%&r*" %i$*"ar re!&m6inan% a" ,"a$min&gen*"*i Br%.PA+ a* ini!aii n: TVPe)%en$i(e+ !* mare ri$! em6&"igen TVP ,r&)ima"e B/em*r&i"ia!e $a* !a(e+ /ie e "an!e,*%+ /ie n $i%*aia n !are a!e$%ea n* rQ$,*n $a%i$/a!a%&r "a %ra%amen%*"an%i!&ag*"an% /"e6i%a a"6a$%rQ TVP ,r&)ima"e "a ,er$&ane"e %inere+ ,en%r* e(i%area$inr&m*"*i ,&$%%r&m6&%i!' Amini$%rarea ,re!&!e a mei!amen%e"&r %r&m6&"i%i!e

,&a%e a!!e"era "i1a %r&m6*"*i+ ,&a%e !&n$er(a (a"(*"e"e (en&a$e @i ,&a%e imin*a $a*an*"a ,&$i6i"i%a%ea e1(&"%Qrii $inr&m*"*i ,&$%/"e6i%i!'Se amini$%rea1Q S Bn ,er/*1ie i'(' iniia" 29> >>>UI %im, e 5> min+ a,&i 7>>>>>UIK&ra %im, e 28 &re+ $a* r%.PA B7>> mg i'('+ 6&"*$ iniia" e 7> mg+ a,&i => mgn ,er/*1ie %im, e 2 &re a!a $e &,%ea1Q ,en%r* S $e amini$%rea1Q !&r%i!&$%er&i1ii'(' n ,rea"a6i"+ ,en%r* a ,re(eni e(en%*a"e"e rea!ii a"ergi!e'

C&m,"i!aii"e %era,iei %r&m6&"i%i!e $*n% n ,rin!i,a" !e"e 3em&ragi!e+ e 2 &ri mai/re!(en%e a!0% n !a1*" %era,iei an%i!&ag*"an%e'S!&,*ri"e %ra%amen%*"*i $*n% &,rirea ,r&gre$iei imen$i*ni"&r !3eag*"*i+

,re(enirea /ragmen%arii !3eag*"*i $i ,re(enirea migrarii *n*i !3eag B%r&m6 in!ir!*"a%ia ,*"m&nara !* e1(&"%area *nei em6&"ii ,*"m&nare'

2#11#? M%$*-8%5%.% 9'.5*%Da!a %r&m6&1a (en&a$a e$%e $e(era+ $i an%i!&ag*"an%e"e n* in/"*en%ea1a e(&"*%ia

%r&m6&1ei+ mei!*" ,&a%e e!ie $a amini$%re1e mei!amen%e mai ,*%erni!e:%r&m6&"i%i!e"e' A!e$%e mei!amen%e $e amini$%rea1a in%ra(en&$ $i a* ,r&,rie%a%eae a i$%r*ge B"i1a !3eag*"' E/e!%e"e a(er$e ,&% /i /&ar%e $e(ere !* $angerare

a6*nen%a+ $i e a!eea $e amini$%ra1a &ar in !a1*ri"e gra(e+ !are amenin%a (ia%a'

2>

8/12/2019 terminat!!!!!!!!!!!

21/60

De a$emenea+ !i&ra,ii e"a$%i!i !&m,re$i(i ,re(in marirea e (&"*m amem6re"&r a$&!ia%a !* %r&m6&1a'

C&m,"i!aii"e maj&re a"e %ra%amen%*"*i !* an%i!&ag*"an%e $*n%: 3em&ragii"e+ !e$*r(in !an $e amini$%rea1# &1e ,rea mari e an%i!&ag*"an%e' A!e$%e mani/e$%ari a,ar@i "a &1e &6i@n*i%e n !a1*" 6&"na(i"&r !* in$*/i!ien# 3e,a%i!# $a* rena"a' Ri$!*" e m*"%

!re$!*% n e/i!i%e !&ngeni%a"e $a* &6ani%e a"e 3em&$%a1ei' Var$%a nain%a%a+,ree)i$%ena *n&r "e1i*ni !are $angerea1#+ a *"!er*"*i ga$%r&.*&ena"+ a a!!ien%e"&r(a$!*"are !ere6ra"e+ in%er(enii"&r !3ir*rgi!a"e+ a %ra*ma%i$me"&r $*n% /a!%&ri e ri$! !e!&n%aini!# mei!aia an%i!&ag*"an%#'

27

8/12/2019 terminat!!!!!!!!!!!

22/60

CAPITOLUL III

#1 R.+. -//5%5% 8%$*-.% 3'='%- 9.-;+.+ *+ 5'89.%95-

1# P'%35'%- &/.22 grae Ce"$i*$

. *mii%a%e: 9>

. aeri$ire /ara !*ren% e aer re!e. A$ig*rarea re,a*$*"*i "a ,a% !* aj*%&r*" a 2.5 ,er$&ane a!a e$%e ne!e$ar

. P&1i%ia ,a!ien%*"*i. $e $!im6a "a 2 &re ,en%r* a ,re(eni e$!are"e e e!*6i%

. S!3im6area "enjeriei

. T&a"e%a 1i"ni!a a ,a!ien%*"*i :

. $e e1in/e!%ea1# ,ie"ea !* *n an%i$e,%i! Ba"!&&"+ %in!%*r# e i&

.$e ,*ne ,an$amen%+ !are ,r&%ejea1# ,"aga B "e1i*nea e /a!%&ri n&!i(i B me!ani!i%ermi!i+ !"ima%eri!i @i in/e!i&@i ai mei*"*i n!&nj*r#%&r+ a$ig*r# & 6*n# a6$&r6ie a$e!reii"&r+ *n re,a*$ ,er/e!% a" regi*nii "e1a%e @i /a(&ri1ea1# !i!a%ri1area'

M-5%'-.% %*%/-'%:. %a(a mei!a"# $a* m#$*a e in$%r*men%e. %r*$a !* in$%r*men%e $%eri"i1a%e: 7.2 ,en$e 3em&$%a%i!e+ 7.2 ,en$e ana%&mi!e+ 7.2

/&ar/e!e. !a$&"e%a !* !&m,re$e @i %am,&ane e %i/&n @i (a%a $%eri"e+ (a%a 3ir&/i"a $%eri"a %#ia%a n

re,%*ng3i*ri. %#(ia rena"#. m*@ama @i a"e1a Bn /*n!ie e regi*ne. $&"*ii an%i$e,%i!e: a"!&&" ;>+ %in!%*ra e i& $a* a"!&&" i&a% 2+ ,ermangana% e

,&%a$i* 7K8>>>+ ni%ra% e argin% 7.2+ a!i 6&ri! 8+ 6r&m&!e% 7+ ri(an&" 7+ a,a&)igena%a

. *ng*en%e @i ,*"6eri !* an%i6i&%i!e+ $*"/amie

. /e$i e i/eri%e m#rimi. ga"i/i) $a* "e*!&,"a$%'

22

8/12/2019 terminat!!!!!!!!!!!

23/60

. ,reg#%irea in$%r*men%e"&r @i ma%eria"e"&r ne!e$are:

. $e ,reg#%e$! ma%eria"e"e @i in$%r*men%e"e ne!e$are ,e %a(a mei!a"# $a* ma$*a ein$%r*men%e

P'%35'%- &/

8/12/2019 terminat!!!!!!!!!!!

24/60

Pen%r* ,#$%rarea a$e,$iei $e ,&a%e n%re6*ina & ,en$# n*mai ,en%r* $er(ireama%eria"*"*i ne!e$ar B a"%a "a /ie!are ,an$amen%' n !a1*" ,an$amen%e"&r !are ,r&*! *reri$e amini$%rea1# $ea%i(e a"e $i$%em*"*i ner(&$'

A$i$%en%a mei!a"a. e a$emenea: .a$ig*ra a"imen%a%ia+ aa,%an.& ,r&6"eme"&r ,e !are "e ,re1in%a ,a!ien%*":

. regim 3i,&!a"&ri!+ a!a ,a!ien%*" e$%e &6e1

. regim 3i,&$&a% in ,eri&aa %ra%amen%*" !* an%iin/"ama%&are ne$%er&iiene .n%#rirea re1i$%enei &rgani$m*"*i+ ,rin ree!3i"i6rare 3ir&e"e!%r&"i%i!#+ n&rma"i1area

,r&%einemiei+ (i%amini1area @i "a ne(&ie a"imen%area $,e!ia"# . & a%enie e&$e6i%# (a /i a!&ra%# regim*"*i a"imen%ar+ !are+ ,e "0ng# a$ig*rarea*n*i a,&r% !a"&ri! @i (i%amin&.minera" !&re$,*n1a%&r+ (a %re6*i $# ,re(in# !&n$%i,aia @i&6e1i%a%ea+ ,rin%r.& ie%# 6&ga%# n "eg*me @i /r*!%e' Da!# e$%e !a1*"+ ,en%r* reg"area%ran1i%*"*i in%e$%ina"+ (&r /i /&"&$i%e @i !eai*ri "a)a%i(e $a* $*,&1i%&are !* g"i!erin#'

. a"imen%aia $e n!e,e !* "i!3ie: !eai+ 1eam# e /r*!%e+ "im&na#+ "a,%e a,&i $e!&n%in*# !* $*,e $%re!*ra%e' n!e,0n in a 5.a 1i+ a!# $.a re$%a6i"i% /*n!ia ige$%i(# @i%ran1i%*" in%e$%ina" $.a n&rma"i1a% $e ,&a%e a ,i*re*ri e !ar%&/i+ e "eg*me+ @i a"%e a"imen%e$emi"i!3ie: gri@ !* "a,%e e%!' D*,# a .a 1i $e ,&a%e %re!e "a a"imen%aia n&rma"#'

A"imen%aia ,a!ien%*"*i *rm#re@%e :.S# a!&,ere !3e"%*ie"i"e energe%i!e e 6a1# a"e &rgani$m*"*i+ !e"e ne!e$are !re@%erii Bn!a1*" !&,ii"&r+ !0% @i !e"e ne!e$are re/a!erii ,iereri"&r ,rin !3e"%*ie"i e)agera%e'.S# a$ig*re a,&r%*" e (i%amine @i $#r*ri minera"e ne!e$are e$/#@*r#rii n&rma"e ame%a6&"i$m*"*i+ !re@%erii @i !e"&r"a"%e /*n!ii a"e &rgani$m*"*i'.S# /a(&ri1e1e !&niii"e ,rie"ni!e ,r&!e$*"*i e (ine!are+ !r*0n &rgane"e m6&"n#(i%e@i a$ig*r0n *n a,&r% e $*6$%ane ne!e$are &rgani$m*"*i' A"imen%aia rai&na"# e$%e @i

*n /a!%&r %era,e*%i! im,&r%an%' Ea ,&a%e in/"*ena %a6"&*" !"ini! a" maj&ri%#ii 6&"i"&r+!ara!%er*" ,r&!e$*"*i ,a%&"&gi! @i ri%m*" e(&"*iei a!e$%*ia'.S# ,re(in# & e(&"*ie ne/a(&ra6i"# n !a1*" *nei m6&"n#(iri "a%en%e+ $# m,iei!e%ran$/&rmarea 6&"i"&r a!*%e n !r&ni!e+ ,re!*m @i a,ariia re!ii(e"&r'.S# !&n$&"ie1e re1*"%a%e"e %era,e*%i!e &6in*%e ,rin a"%e me%&e e %ra%amen%'in0n $eama e !e"e e mai $*$+ regim*" ie%e%i! a" ,a!ieni"&r %re6*ie a$%/e" a"!#%*i%+

n!0% $# $a%i$/a!#+ a%0% ne!e$i%#i"e !an%i%a%i(e+ !0% @i ,e !e"e !a"i%a%i(e a"e &rgani$m*"*i'A,&r%*" !an%i%a%i( a" $*6$%ane"&r a"imen%are ne!e$are &rgani$m*"*i e$%e irija%+ n $%are

n&rma"#+ e /a!%&ri /i1i&"&gi!i !a : $e%ea+ /&amea+ &6i@n*ina e%!' n !a1*" ,a!ieni"&r+ a!e@%i/a!%&ri n* $*n% %&%ea*na ja"&ane e$%*" e $ig*re ,en%r* irijarea a,&r%*"*i a"imen%ar' n%r.&$erie e 6&"i+ "i,$a ,&/%ei e m0n!are e$%e *n $im,%&m ,re!&!e @i &minan% $a* $e%ea ,&a%e /i

e)agera%# n /&ar%e m*"%e !a1*ri' Pa!ienii in!&n@%ieni+ !&ma%&@i+ ,re!*m @i !ei $&mn&"eni$*n% !&m,"e% "i,$ii e $en1aii"e e $e%e @i /&ame ei n*.@i ,&% irija @i a$ig*ra a,&r%*" ne!e$are a"imen%e' De a!eea+ ,er$&na"*" !are ngrije@%e ,a!ien%*" are *n r&" /&ar%e im,&r%an% na"imen%area "*i'

A,&r%*" e $*6$%ane a"imen%are %re6*ie a$ig*ra% ,e 6a1a ne!e$i%#i"&r rea"e e !a"&rii' n!a1 !# n* $e a$ig*r# !an%i%a%ea ne!e$ar# e a"imen%e+ &rgani$m*" re!*rge "a re1er(e"e ,r&,rii%i$*"are' Ne!e$i%#i"e !a"&ri!e a"e *n*i ,a!ien% a*"% (aria1# n%re 2 9>> @i 5 >>> e !a"&riia!# &rgani$m*" e$%e $*,*$ *n*i regim e /&ame+ (a !&n$*ma in e$*%*ri"e $a"e ,r&,rii !ir!a7 Jg n 28 e &re+ !eea !e $e %ra*!e ,rin%r.& $"#6ire ra,i# n gre*%a%e+ ma$!a%# e(en%*a"

,rin%r.& re%enie e)agera%# e a,#'Ne!e$i%#i"e !a"&ri!e "a ,a!ien%*" n re,a*$ a6$&"*% "a ,a% $e a,re!ia1# n j*r*" !i/rei e

29 !a"&riiKJi"&!&r,'Die%a e$%e /&ar%e im,&r%an% n ,re(enia (ari!e"&r' Se (&r !&n$*ma a"imen%e 6&ga%e n

28

http://www.medicas.ro/estetica/obezitatea/http://www.medicas.ro/estetica/obezitatea/

8/12/2019 terminat!!!!!!!!!!!

25/60

/i6re ,re!*m /r*!%e @i "eg*me+ !erea"e in%regra"e @i $e (a e(i%a !&n$*m*" e)agera% e $are' O!&n!en%raie ,rea mare e $are /a(&ri1ea1# re%enia e a,# @i !re@%erea ,re$i*nii (en&a$e'

n ngrijirea ,a!ien%*"*i a"imen%aia e$%e *n &6ie!%i( im,&r%an%' De&are!e ,rina"imen%aie $e menine energia &rgani$m*"*i+ ngrijirea ,a!ien%*"*i are n (eere a%0% $%a6i"irea*n*i regim a"imen%ar e!3i"i6ra% !&re$,*n1#%&r 6&"ii !0% @i amini$%r#rii "*i' A"imen%aia$#n#%&a$# @i grija /a# e !*m @i !e m0n!#m $*n% !e"e mai im,&r%an%e me%&e e a ne a,aram,&%ri(a (ari!e"&r' C&n$*m*" e a"imen%e !are !&nin !an%i%#i mari e /i6re @i an%i&)ianina%*ra"i+ n%#re$! e$*%*ri"e @i "e menin $#n#%&a$e+ ,re(enin a$%/e" a,ariia (ari!e"&r' Se (a e(i%a !&n$*m*" e a"imen%e ,re"*!ra%e+ ,re!*m @i a"imen%e"e !are i"a%# @i &6&$e$!!e"*"e"e Be)' "a!%a%e"e+ 1a3ar*"+ a"!&&"*" @i !a/ea*a'

Pe ,eri&aa $,i%a"i1#rii+ n %im,*" (i1i%ei mei!a"e mei!*" ,re$!rie regim*" a"imen%ar a",a!ien%i"&r !&n$emn0n*." n F'O @i ,e 6a1a a!e$%&r !&n$emn#ri a$i$%en%a mei!a"a n%&!me@%e/&aia e a"imen%aie n&mina"# !e $e %ran$mi%e 6"&!*"*i a"imen%ar'

n /*n!ie e %ra%amen%*" ,e !are " *rmea1# ,a!ien%*" @i n /*n!ie e 6&"i"e a$&!ia%e !are/a(&ri1ea1# a,ariia (ari!e"&r+ regim*" ie%e%i! ,&a%e /i:

.3i,er,&%a$i!Ba/e!i*ni !aria!e+ eeme+ %ra%amen% !* !&r%i1&n

.3i,&$&a%B4TA+ in$*/i!iena !aria!a+ $!"er&1a+ in$*/i!iena 3e,a%i!a

.!ari&.(a$!*"ar Bar%eri&$!"er&1a+ angina ,e!%&ra"a+ %*"6*r#ri e ri%m !aria!

.ia6e%i!'Regim*" e$%e /#!*% ,en%r* /ie!are !a1 n ,ar%e+ 6a1a% ,e a%e"e /i1i&,a%&"&gi!e+ @i

!&m,&nen%e"e ini(i*a"e a"e ,a!ien%*"*i' E" %re6*ie a$%/e" a"!#%*i% n!0% $# $a%i$/a!# a%0%ne!e$i%#i"e !an%i%a%i(e !0% @i ,e !e"e !a"i%a%i(e a"e &rgani$m*"*i'

E$%e /&ar%e im,&r%an% !a ,a!ien%*" $# n* !&n$*me a"%e a"imen%e e!0% !e"e ,re$!ri$e'A$i$%en%a mei!a"# %re6*ie $# e),"i!e @i $# im,rime ,a!ien%*"*i ne!e$i%a%ea meninerii

,re$!ri,ii"&r mei!a"e re"a%i(e "a a"imen%aia %era,e*%i!#+ ,en%r* !a a!e$%a $# n* ,re%in#

$er(irea *n&r a"imen%e in%er1i$e'C0n a"imen%area ,a!ieni"&r ,e !a"e 6*!a"# n* e$%e ,&$i6i"#+ $e (a !&n%in*a ,rin ,er/*1ii

in%ra(en&a$e'

De a$emenea:

. ,a!ien%*" e$%e aj*%a% $a manan!e "a ,a%+ ,e ma$*%a $,e!ia"a $i !* (e$e"a aa,%a%a+,en%r* !a e$%e im&6i"i1a% "a ,a%

. n!*rajarea a!%i(i%#i"&r $,&r%i(e *@&are+ in!"*$i( n&%*" $a* mer$*" ,e j&$+ e$%en%&%e*na 6ene/i!#'

. ,rin m&6i"i1area ,re!&!e $e ,&% e(i%a m*"%e !&m,"i!aii %ari(e !a %r&m6&1e"e

(en&a$e+ ,ne*m&nii"e 3i,&$%a%i!e+ e$!are"e' . in *rma mi@!#ri"&r+ !ir!*"aia $ang*in# e(ine mai a!%i(#+ ,eri$%a"%i$m*" in%e$%ina"

@i /*n!ia e)!re%&are $e m6*n#%#e$!+ $!3im6#ri"e n*%ri%i(e $*n% mai a!%i(e+ (en%i"aia,*"m&nar# $e in%en$i/i!# @i $e ,*ne n mi@!are n%reaga m*$!*"a%*r#' Pe "0ng# a!ea$%a+,a!ienii e(in mai n!re1#%&ri n /&re"e ,r&,rii @i n (ine!area "&r'

. Aj*%a ,a!ien%*" e,enen% ,en%r* $a%i$/a!erea ne(&ii e a e"imina+ a /i !*ra%+ a $eim6ra!a $i e16ra!a

. A$ig*rarea !&m*ni!arii e/i!ien%e a ,a!ien%*"*i+ in !are a$i$%en%a mei!a"a e),"i!a $a*in$%r*ie$%e ,a!ien%*" $a ge$%i&ne1e me!ani$me"e *rerii+ ,ri(in !ara!%er*" ei !&m*ni!area

,&a%e *!e "a re!*,erare ,$i3i!a $i /i1i!a a $%arii e $ana%a%e' . Aj*%area ,a!ien%*"*i in $a%i$/a!erea ne(&i"&r /*namen%a"e . S*,&r% ,$i3i! ,en%r* ,a!ien%

. Crearea a,&r%*"*i (en&$ ,en%r* re!&"%ari+ %ra%amen%

29

8/12/2019 terminat!!!!!!!!!!!

26/60

8/12/2019 terminat!!!!!!!!!!!

27/60

P'.->% /%*+$-'-:are !a $!&, ,re(enirea a,ari%iei $e!3e"e"&r+ mai a"e$ !an a!e$%ea$*n% in(a"ian%e: . m&6i"i1ari mi$!ari a!%i(e ,en%r* m&6i"i1area $ange"*i in e,&1i%e"e(en&a$e gam6iere'

P'.->- 5%'5-'-: 6 -* %/5% ;'9- $%/&'%,rega%irea ,en%r* in%er(en%ie !3ir*rgi!a"a'Re,a*$*" genera" e$%e & ini!a%ie *,a $%a6i"irea iagn&$%i!*"*i e %r&6&/"e6i%a'

De a$emenea: . m&6i"i1area ,re!&!e ,&$%&,era%&r. ,a!ien%*" %re6*ie $a $%ie !a a!e$% "*!r*e$%e e)%rem e im,&r%an% ,en%r* ,re(enirea e(en%*a"e"&r !&m,"i!a%ii'Per$&ane"e !are a* %enin# "a (ari!e %re6*ie $# e(i%e ,&1iia &r%&$%a%i!#+ m*"% ,re"*ngi%#

@i !* mi@!#ri /&ar%e "imi%a%e' Se re!&man# !a a!e@%ia $# ,&ar%e ,eri&i! *n 6anaj!&m,re$i( $a* !i&ra,i e"a$%i!i' Ori e !0%e &ri e$%e ,&$i6i"+ ,er$&ane"e ,rei$,*$e $# /a!# 6&a"a(ari!&a$# %re6*ie $# $%ea !* mem6re"e in/eri&are mai rii!a%e /a# e ,"an*" !&r,*"*i' A!e$%&ra"i $e re!&man# n m& $,e!ia" @i n&%*"+ ,en%r* !# a!e$% $,&r% $e ,ra!%i!# n ,&1iie&ri1&n%a"# @i /&"&$e@%e m*"% m*@!3ii gam6ei !are !&m,re$ea1# (ene"e' Pre$i*nea a,ei aj*%# @iea "a e)er!i%area *nei !&m,re$i*ni a$*,ra (ene"&r' Can&%aj*" @i !i!"i$m*" Bm&era%e+ $*n% ea$emenea $,&r%*ri re!&mana6i"e !e"&r ,rei$,*@i "a 6&a"a (ari!&a$#'

## P.- 3%%'-. $% +'/3 &%5'+ 5'89.%95-

D-3/5* $%3'='%

O9%*5; &% 5%'8%8%$+

A*5+

A"%erarea m&6i"i%#ii

in !a*1a in%er(eniei

!3ir*rgi!a"e

mani/e$%a%# ,rin

im,&%en#

/*n!i&na"#+

i/i!*"%a%e n

e,"a$are'

. Pa!ien%*" %re6*ie $a,re1in%e & !re@%ere agra*"*i eine,enen#'

. *,# in%er(enia !3ir*rgi!a"# ,a!ien%*" (a $%a n

e!*6i% &r$a"+ !* ,i!i&are"e mai $*$ ,en%r* 28 e

&re+ *,# ra3iane$%e1ie+ @i !* !a,*" nemi@!a% &re

. e"a6&re1 m,re*n# !* ,a!ien%*" *n ,r&gramae!(a% e m&6i"i1are

. m&ni%&ri1e1 %&"erana "a a!%i(i%a%e /i1i!# B,*"$+%en$i*ne+ re$,iraie

. e),"i! ,a!ien%*"*i a(an%aje"e m&6i"i1#rii,re!&!e B/a(&ri1area %ran1i%*"*i in%e$%ina"+!&m6a%erea $%a1ei (en&a$e+ a !&m,"i!aii"&r ee!*6i% @i ,*"m&nare

. e(a"*e1 a6i"i%#i"e e mi@!are n /ie!are 1i

amini$%re1 *n !a"man% nain%e e m&6i"i1are

. n(# ,a!ien%*" $# /a!# e)er!iii a!%i(e @i ,a$i(e'

. aj*% ,a!ien%*" ,en%r* a.i !&n$er(a energia+

2;

8/12/2019 terminat!!!!!!!!!!!

28/60

,en%r* a e(i%a &6&$ea"a'

. a$ig*r igiena %eg*men%e"&r @i a "enjeriei e ,a%@i e !&r,'

. e),"i! ,a!ien%*"*i !&n$e!ine"e $,rijinirii

,re!&!e ,e mem6r*" a/e!%a%+ @i " n(# $# $e

e,"a$e1e !* aj*%&r*" *nei !0rje ,en%r* !0%e(a

1i"e

. /e"i!i% ,a!ien%*" ,en%r* /ie!are ,r&gre$ ,e !are "/a!e n m&6i"i1are'

A"%erarea

$&mn*"*i in

!a*1a *rerii

,&$%&,era%&rii

mani/e$%a%# ,rin

%re1iri

/re!(en%e'

Pa!ien%*" %re6*ie $a

&6anea$!a *n

$&mn $a%i$/#!#%&r n

%rei 1i"e'

. a$ig*r !&niii &,%ime e mei*+ (&i *rm#rii !a

a%m&$/era in j*r*" ,a!ien%*"*i $# /ie !a"m#+ $# /ie

"ini@%e+ /#r# !&n(er$aii 1g&m&%&a$e+ /#r# (i1i%a%&ri

m*"i'

. n ,rima 1i ,&$%&,era%&rie menin ,a!ien%*" n e!*6i%

&r$a" @a$e &re e "a in%er(enie+ *,# !are ,"a$e1,erna $*6 !a,*" ,a!ien%*"*i ,en%r* a.i a$ig*ra

!&n/&r%*"'

. e(a"*e1 $&mn*" ,a!ien%*"*i !a"i%a%i( @i !an%i%a%i('

. n(# ,a!ien%*" %e3ni!i e re"a)are+ e)er!iiire$,ira%&rii nain%e e !*"!are'

. &/er ,a!ien%*"*i *n ,a3ar !* !eai !a" $a* "a,%e

nain%e e !*"!are'. n%&!me$! ,"an*" e ngrijire a$%/e" n!0% $# n*

,er%*r6 $&mn*" ,a!ien%*"*i n %im,*" n&,ii'

. rea"i1e1 *n ,r&gram n $a"&n !are $# ,ermi%# $&mn*"B$%ingerea "*minii "a &ra 22+ meninerea "ini@%ii'

. amini$%re1 *n an%ia"gi! nain%e e !*"!are+

&6$er( e/e!%*" a!e$%*ia a$*,ra &rgani$m*"*i'

. a$ig*r & %em,era%*r# ae!(a%# n $a"&n'

2

8/12/2019 terminat!!!!!!!!!!!

29/60

. e),"i! r&"*" $&mn*"*i @i &i3nei ,en%r* re/a!erea

&rgani$m*"*i+ ne!e$i%a%ea e(i%#rii /a!%&ri"&r !are

in/"*enea1# $&mn*" @i &i3naB!a/ea*a+ $%re$*"+

&6&$ea"a'

. &6$er( ,eri&aa $&mn.&i3n#+ !&m,&r%amen%*"

,a!ien%*"*i'

Di/i!*"%a%e n a

$e m6r#!a @i

e16r#!a

a%&ri%#

im&6i"i1#rii

mani/e$%a%# ,rin

in!a,a!i%a%ea e

a $e m6r#!a @i

e16r#!a'

Pa!ien%*" %re6*ie $#

$e ,&a%# m6r#!a @i

e16r#!a $ing*r'

. ien%i/i! !a,a!i%a%ea @i "imi%e"e /i1i!e a"e ,a!ien%*"*i'

. $*gere1 /ami"iei $#.i ,r&!*re ,a!ien%*"*i 3aine "argi*@&r e m6r#!a%+ n!#"#min%e /#r# @ire%'

. ,reg#%e$! "enjeria "a nem0na ,a!ien%*"*i'

. e),"i! %&a%e ge$%*ri"e !e *rmea1# a /i e/e!%*a%e+

e),"i! ,a!ien%*"*i !# e16r#!a%*" ,an%a"&n*"*i n!e,e!* ,i!i&r*" $#n#%&$+ iar m6r#!a%*" !* !e" &,era%'

. aj*% ,a!ien%*" "a e/e!%*area %e3ni!ii'

. /e"i!i% ,a!ien%*" ,en%r* /ie!are ,r&gre$ rea"i1a%'

A"%erarea

in%egri%#ii

%eg*men%e"&r

"ega%# e

in%er(enia

!3ir*rgi!a"#

mani/e$%a%# ,rin

,re1ena ,"#gii

.Pa!ie%*" %re6*ie $a

ai6a ra6are in :

.(ine!area

,"#gi"&r'

. ,re(enirea

!&m,"i!aii"&r'

. imin*area

i$!&n/&r%*"*i

. a$ig*r !&n/&r%*"*i /i1i! @i ,$i3i!'

. *rm#rirea a,ariiei $en$i6i"i%#ii n mem6re"e

in/eri&are @i n&%area &rei !0n a,are n 3a"*!e'

. an*narea mei!*"*i "a a,ariia gre*ri"&r+ re&rii

!e/ei'

. amini$%re1 mei!aiei ,re$!ri$e @i *rm#rirea

e/e!%*"*i a!e$%eia'

2=

8/12/2019 terminat!!!!!!!!!!!

30/60

&,era%&rii' ,&$%&,era%&r' . m&ni%&ri1e1 ,"aga &,era%&rie'

. e/e!%*e1 !&re!% ,an$amen%e"e @i. n !&niii e

$%ri!%a a$e,$ie'

. e/e!%*e1 %&a"e%a ,aria"a a ,a!ien%*"*i ,en%r*

meninerea igienei %eg*men%e"&r'

De/i!i% e

a*%&ngrijire

"ega% e

re,a*$*" "a ,a%

mani/e$%a% ,rin

i/i!*"%a%e n a

re$,e!%a

,re$!ri,%ii"e e

igiena'

Pa!ien%*" %re6*ie $a

&6anea$!a

!a,a!i%a%ea e a $e

a*%&ingriji'

. e(a"*e1 gra*" e ine,enen# a" ,a!ien%*"*i

. e(a"*e1 $%area $a e $#n#%a%e

.e(a"*e1 gra*" e igien# ini(i*a"#+ a,re!ie1

!a,a!i%a%ea ini(i*"*i e a.@i menine $ing*r igiena

%eg*men%e"&r

. aj*% ,a!ien%*" $#.@i /a!# %&a"e%a !a(i%#ii 6*!a"e ,rin

$,#"area ini"&r+ gargar# !* !eai e m*@ee"+ a$*,ra

!*r#irii !&re!%e @i ,r&%e!ia narine"&r

. aj*% ,a!ien%*" n $a%i$/a!erea ne(&i"&r /*namen%a"e

. aj*% ,a!ien%*" n rea"i1area %&a"e%ei 1i"ni!e+ ,e !are &

!&m,"e%e1 !* ,ie,%#na%*"+

. a$ig*r re$,e!%area in%imi%#ii ,a!ien%*"*i ,rin

i1&"area ,a%*"*i !* *n ,ara(an e re$%*" $a"&n*"*i'

. $!3im6 "enjeria e !&r, @i ,a% 1i"ni!+ $a* &ri e !0%e&ri e$%e ne(&ie'

. e(i% &6&$ea"a n %im,*" e/e!%*#rii igienei ,a!ien%*"*i

. !&n@%ien%i1e1 ,a!ien%*" n "eg#%*r# !* im,&r%anameninerii !*ra%e a %eg*men%e"&r+ ,en%r* ,re(enirea

5>

8/12/2019 terminat!!!!!!!!!!!

31/60

m6&"n#(iri"&r @i !&m,"i!aii"&r'

. a$ig*r re$,e!%area m#$*ri"&r e ,re(enire a e$!are"&r'

'

A"%erarea

!&n/&r%*"*i

"ega%# e in!i1ia

&,era%&rie

mani/e$%a%# ,rin

*reri "a ni(e"*"

mem6r*"*i

in/eri&r

Dimin*area @i

!&m6a%erea *rerii

n %rei 1i"e'

. a$ig*rarea *nei ,&1iii n ,a% a 6&"na(*"*i /a(&ra6i"a

!ir!*"aiei (en&a$e @i !are $# m,iei!e $%a1a (en&a$# .

e!*6i% &r$a" !* gam6e"e rii!a%e ,e & ,ern#+

,r&%eja%# !* & m*@ama

. aj*% ,a!ien%*" $# e$!rie !&re!% *rerea @i $# a&,%e

,&1iii !are $# imin*e1e *rerea

. e(a"*e1 !ara!%eri$%i!i"e *rerii+ in%e$i%a%e+ *ra%a+

/re!(en#+ /a!%&rii !are.i !re$! $a* imin*ea1#

in%en$i%a%ea

. (&i mani/e$%a ne"egere /a# e $*/erina ,a!ien%*"*i'

. re*!erea in%en$i%#ii *rerii ,rin a,"i!area *n&r

%e3ni!i e re"a)are'

. i$%ragerea a%eniei ,rin /i)area ,e a"%e ,r&6"eme

e!0% a"e *rerii re$,e!%i(e'

. re!&manarea re,a*$*"*i "a ,a% !0% mai m*"% %im,'

. &/er ,a!ien%*"*i in/&rmaii e$,re m&*" e

,r&*!ere a *rerii+ e$,re mei!amen%e"e an%ia"gi!e+

57

8/12/2019 terminat!!!!!!!!!!!

32/60

e$,re ri%m*" e amini$%rare+ e/e!%

. &6$er( *rerea ,&$%&,era%&rie "a *na.&*# &re *,#

amini$%rarea mei!amen%e"&r

. e(a"*e1 e/e!%*" an%ia"gi!e"&r amini$%ra%e ,en%r*

!&m6a%erea *rerii @i nain%e e m&6i"i1are

Di/i!*"%a%ea

im,iei!arii

ri$!*"*i e

!&m,"i!a%ii

"ega%a e in/e!%ii

$i 3em&ragii+

a%&ri%a !aeri"&r

a!!ien%a"e'

Pa!ien%*" $# $e

(ine!e /#r#

!&m,"i!aii+ $#

6ene/i!ie1e e *n

mei* $e!*ri%ar

. re,a*$ "a ,a%+ a$ig*rarea *nei ,&1iii n ,a% a

6&"na(*"*i /a(&ra6i"# !ir!*"aiei (en&a$e @i !are $#

m,iei!e $%a1a (en&a$# . e!*6i% &r$a" !* gam6e"e

rii!a%e ,e & ,ern#+ ,r&%eja%# !* & m*@ama

. a$ig*r *n !"ima% e ,r&%e!ie ,$i3i!# @i /i1i!#

a$ig*r !&niii e mei* ae!(a%e+ ,en%r* a e(i%a

,eri!&"e"e ,rin a!!ien%are

. m&ni%&ri1area /*n!ii"&r (i%a"e @i (ege%a%i(e

. !a"!*"e1 6i"an*" 3iri! ,e 28 e &re

. *rm#re$! mi@!#ri"e $egmen%e"&r i$%a"e Bege%e"e

mem6re"&r in/eri&are

. &6$er( !*"&area %eg*men%e"&r B!ian&1#+ ,a"&are

. $e$i1e1 mei!*" n !a1*" n !are ,a!ien%*" a!*1#

52

8/12/2019 terminat!!!!!!!!!!!

33/60

/*rni!#%*ri+ am&re"i+ ,re$i*ne "a ni(e"*" mem6r*"*i

a/e!%a%

. $e$i1e1 a,ari%ia &ri!#r*i mir&$ emana% e "a ni(e"*"

,"#gii &,era%&rii Bin/e!ia ,"#gii

. e),"i! ,a!ien%*" !# m&6i"i1area ,re!&!e+ ,r&gre$i(#+

re,re1in%# me%&a !ea mai e/i!a!e ,en%r* ,re(enirea

!&m,"i!aii"&r (en&a$e+ ,en%r* /a(&ri1area %ran1i%*"*i

in%e$%ina" @i /a(&ri1area (ine!#rii

. e*! ,a!ien%*" ,ri(in m&*" e /&"&$ire a mij"&a!e"&r

a*)i"iare ,en%r* $!3im6area ,&1iiei @i e,"a$are'

An)ie%a%e "ega%#

e "i,$a e

in/&rmaie

mani/e$%a%# ,rin

%eam#

. !&m6a%erea

an)ie%#ii

. /a(&ri1e1 aa,%area ,a!ien%*"*i "a mei*" $,i%a"i!e$!+

a$ig*r0n *n !"ima% e !a"m @i $e!*ri%a%e /i1i!# @i

,$i3i!#

. n!*raje1 ,a!ien%*" $# i$!*%e e$,re %eama @i

an)ie%a%ea "*i !* ,ri(ire "a e(&"*ia 6&"ii

. mi re1er( 1i"ni! %im, ,en%r* ,a!ien% ,en%r* a.i

,ermi%e $#.@i e),rime $en%imen%e"e

. i e),"i! !* !a"m+ /&"&$in !*(in%e $im,"e+ %e3ni!a

%*%*r&r e)amin#ri"&r !"ini!e @i ,ara!"ini!e ,en%r* a e(i%a

$%area e an)ie%a%e

. a$ig*rar ,a!ien%*" e e(&"*ia /a(&ra6i"# a in%er(eniei

!3ir*rgi!a"e ,re!*m @i a e(&"*iei /a(&ra6i"e

,&$%&,era%&rie

. i ,re1in% ,a!ieni !* a!eea@i a/e!i*ne @i in%er(enie

55

8/12/2019 terminat!!!!!!!!!!!

34/60

!3ir*rgi!a"# !* e(&"*ie /a(&ra6i"#

. rea* n!reerea n $ine+ n"#%*rarea $%#rii e

$ing*r#%a%e @i a $en%imen%*"*i e in*%i"i%a%e

. $*gere1 *%i"i1area g0nirii ,&1i%i(e ,ri(in $%area $a

e $#n#%a%e

. " a%rag n i$!*ii !are $#." $*$%rag# e "a g0n*ri"e

!are @i "e /a!e n "eg#%*r# !* e(&"*ia 6&"ii @i a $%#rii e

$#n#%a%e

. a$ig*r *n*i mi!r&!"ima% !&re$,*n1#%&r

. a$ig*rarea !&niii"&r ne!e$are e$/#@*r#rii

a!%i(i%#i"&r

. re!&man /&"&$irea %e3ni!i"&r e rea")are+ a

e)er!iii"&r re$,ira%&rii @i a me"&%era,ieiDe/i!i% e

!*n&@%ine

e$,re 6&a"a+

%ra%amen% @i

a*%&ngrijiri"e "a

&mi!i"i*

. ,a!ien%*" $a ai6#

n&i*ni e$,re

6&a"a @i %ra%amen%

@i a*%&ngrijiri"e "a

&mi!i"i*'

. e),"&re1 ni(e"*" e !*n&@%ine a" ,a!ien%*"*i ,ri(in

6&a"a+ m#$*ri"e e ,re(enire @i !*ra%i(e+ m&*" e

,ar%i!i,are "a ,r&!e$*" e re!*,erare

. !&n@%ien%i1e1 ,a!ien%*" a$*,ra ,r&,riei re$,&n$a6i"i%#i

,ri(in $#n#%a%ea

. in/&rme1 ,a!ien%*"*i e$,re 6&a"a @i %ra%amen%

. e*! ,a!ien%*" @i /ami"ia ,ri(in ,re(enirea in/e!ii"&r

@i a re!ii(e"&r'

. e*! ,a!ien%*" $# a,e"e1e "a mei!*" e /ami"ie &ri e

!a%e &ri a,ar m&i/i!#ri+ !3iar @i min&re n $%area e

58

8/12/2019 terminat!!!!!!!!!!!

35/60

8/12/2019 terminat!!!!!!!!!!!

36/60

7' Ti%ir!# L*!reia . ngrijiri $,e!ia"e a!&ra%e ,a!ieni"&r e !#%re a$i$%enii mei!a"i+ E'

Viaa Mei!a"# R&m0nea$!#+ ?*!*re@%i 2>>5

2' Ti%ir!# L*!reia. G3i e n*r$ing !* %e3ni!i e e(a"*are $i ingrijiri !&re$,*n1a%&are

ne(&i"&r /*namen%a"e+ Ei%*ra Via%a Mei!a"a R&manea$!a. 2>>77

'Ange"e$!* N'+ Tra%a% e ,a%&"&gie !3ir*rgi!a"a . V&" II'+ E' Mei!a"a ?!*re$%i 2>>5'

;'S!3ar%1 . Prin!i,ii"e C3ir*rgiei+ E' Te&ra+ ?*!*re$%i+ 2>>9'

8/12/2019 terminat!!!!!!!!!!!

37/60

SECTIA: C-'$.3%

OSAREINGRIJIRE

ATE E I ENTITATE

NUMELE: P PRENUME: A

VARSTA: 54 SEXUL: M/F F DOMICILIUL-LOC. : Constanta

STRADA: Zor!!or NR.: "#

$L.:D %

SC.: A ET.: & AP.: ' (UDET:Constanta

ATE ESPRE SPITALIZARE

DATA INTERNARII6 ANUL: 2014 LUNA: 02 ZIUA: 10 ORA:1 0

DATA ETERNARII6 ANUL: 2014 LUNA: 02 ZIUA: 1 ORA: 12 0

MOTIVELE INTERNARII: 6 $+'%'% 5%/- - 8%89'+. %'' $'%&5

-,e%*r6area $&mn*"*i- astenie

- anxietate

- stare generala alterata.

DIAGNOSTICUL LA INTERNARE: T'89.%95- -*+5- *+ /$'8 *-5*#

SITUATIA FAMILIALA SI SOCIALA

SITUATIA FAMILIALA: C-/-5'5- NR# COPII: 2

SITUATIA SOCIALA: S-.-'-5- PROFESIA: P'%/'

CONDITII DE LOCUIT: L*+%/5% .- 9.* 8&'%+- *+ /5+., *$5 '8-.%#

5;

8/12/2019 terminat!!!!!!!!!!!

38/60

PERSOANE CU CARE SE IA LEGATURA

NUME: D PRENUME: MADRESA: V-'+. *+ D', ' 4 TEL#: 02416414?

NUME: PRENUME:

ADRESA: TEL#:

ANTECEDENTE

HEREDO6COLATERALE: M-8- %/5% /+%'$- $% -*%%-/ 9-.-#

PERSONALE6FIZIOLOGICE: M%-'

8/12/2019 terminat!!!!!!!!!!!

39/60

PRESCRIPTII MEDICALE LA INTERNARE

TRATAMENTUL: 6 H%&-'- ?000 +# 6 ;

- Aspirina '() tab(zi

- *trepto+inaza )5# ### u.i-perfuzie-iv - "# min, apoi'## ### u.i( ora - )4 !.

- Clexane-id

- Algocalmin- "(zi.

EAMINARI: H%83'-8-6 .%+**5-, 5'89*5%#

* imp /uic+

0ibrinogen imp de sangerare imp de coagulare

REGIMUL: R%38

8/12/2019 terminat!!!!!!!!!!!

40/60

04# A TE MISCA: P-*%5- %/5% $%*+95 $'/-.6 &-5, &'%5- $+'%' .- ;%.+. 8%89'+.+%'' $'%&5, /5-'% 3%%'-.- &'%*-'-#

0?# A DORMI, A TE ODIHNI: P-*%5- + /% &-5% $

8/12/2019 terminat!!!!!!!!!!!

41/60

14# A6TI PRACTICA RELIGIA:P-*%5- %/5% '5$>- /% '-3- %*-'% /%-'-#mei!amen%e$a*

ALERGIC LA: N* $e $%ie a"ergi!a "a mei!amen%e $a* a"imen%e'

ASPECTE PSIHOLOGICE

STAREA DE CONSTIENTA: P-*%5- %/5% */5%5- / *.-9'%-- +/' *+ 5-5- .+8%-#

COMPORTAMENT:6 N'8-., /% /+&+% 5'-5-8%5+.+ / 3'='.'#

MOD DE INTERNARE6 SINGUR DA# SALVARE: FAMILIA: ALTUL:

PARTICULARITATI:

Pacienta s-a prezentat cu sotul, cu biletul de trimitere de la medicul de familiein sectia de Cardiologie.

ASPECTE SOCIALE

MOD DE VIATA6SINGUR: DE FAMILIE: $- ALTUL:

MEDIUL (HABITAT)6 RURAL: URBAN:$-

OCUPATII (HOBB):*5%/5% *-'5

PARTICULARITATI:A'% '%.-5 -'8-/% *+ 8%89' -8.%#

PROBLEME SOCIALE:

u are.

INTERPRETAREA DATELOR

NEVOI NESATISFACUTE# DIAGNOSTICE DE NURSING INITIALE:

,,A 7 89*CA:- 9mobilitate redusa din cauza procesului trombolic,manifestata prindiminuarea miscarilor

in ortostatism.

,, A 79A P719C;%7%7: -ulnerabilitatea pacientului, legata de slabiciunea zica,manifestata prin nepu-

87

8/12/2019 terminat!!!!!!!!!!!

42/60

tinta mersului fara a$utorul unei alte persoane.

,, A &;189, A 7 ;&99:- 9mposibilitatea de a dormi si - odi!ni din cauza dureriimembrului inferior

drept, manifestata prin treziri dese.

,, A 09 C

8/12/2019 terminat!!!!!!!!!!!

43/60

MOMENTE IMPORTANTE ALE SPITALIZARII

'#.#).)#'4 ora '3 "#- pacienta se interneaza in sectia de Cardiologie?

''.#).)#'4 ora @ 45 - se realizeaza examenele paraclinice si de laborator?

'5- se realizeaza administrarea tratamentului?

'".#).)#'4 ora ') "#- se realizeaza externarea.

OBIECTIVUL GLOBAL

Pacienta - sa se refaca complet dupa perioada de tratament,pentru a-si reluaactivitatea normala.

85

8/12/2019 terminat!!!!!!!!!!!

44/60

NUME:P SECTIA:C-'$.3%

PRENUME:A DIAGNOSTIC:T'89.%95- -*+5- *+/$'8 *-5*

ALIMENTE PERMISE:P-*%5- &-5% */+8- $% 5-5%, /- /- '%/&%*5% '%38+.

8/12/2019 terminat!!!!!!!!!!!

45/60

## corect.

-piure de carto cu legume?

-compot de caise

'3

##

-gris cu lapte

NUME:P SECTIA:C-'$.3%

PRENUME:A DIAGNOSTIC:T'89.%95- -*+5- *+/$'8 *-5*#

TRATAMENT

D-5- O'- P'%/*'&5 M$ $%-$8/5'-'%

SEMNATURA

'#.#) ' "# Algocalmin -" ori(zi intravenos

Clexane ) ori(zi subcutanat

rombostop ') mg ( zi dozade atac

per os

89

8/12/2019 terminat!!!!!!!!!!!

46/60

- ) mgpentru '5B-)5B

- apoi )-6mg( zi

Aspirina '() ( zi per os

*trepto+inaza2- )5# ### uifaza deatac, apoi '## ### ui ( ora -)4 !.

perfuzieintravenos

''.#) "# Algocalmin -" ori(zi intravenos

Clexane ) ori(zi subcutanat

rombostop " mg ( zi per os

Aspirina '() ( zi per os

*trepto+inaza2 '## ### ui- )4!

perfuzieintravenos

').#) Algocalmin -" ori(zi intravenos

Clexane ) ori(zi subcutanat

rombostop " mg ( zi per os

Aspirina '() ( zi per os

*trepto+inaza2 '## ### ui- )4!

perfuzieintravenos

'".#) Algocalmin -" ori(zi intravenos

Clexane ) ori(zi subcutanat

rombostop " mg ( zi per os

Aspirina '() ( zi per os

*trepto+inaza2 '## ### ui- )4!

perfuzieintravenos.

NUME:P SECTIA:C-'$.3%

PRENUME:A DIAGNOSTIC:T'89.%95- -*+5- *+/$'8 *-5*

EAMENE BIOLOGICE

&AA ;1A 7A877C719C7

''.#).)#'4 3 "# 78;>1A8A-%7

8/12/2019 terminat!!!!!!!!!!!

47/60

1;8E;C97 coagulograma

*

imp/uic+F')-'5secunde

mai mare de'5 secunde

0ibrinogenF)4#-)#( '##ml

mai mici de)4#( '## ml.

sF"-4 min mai mare de 5min

c F3-') min mai mic de 5min

NUME:P SECTIA:C-'$.3%

PRENUME:A DIAGNOSTIC:T'89.%95- -*+5- *+/$'8 *-5*

EAMENE PARACLINICE

DATA ORA EAMENE CERUTE REZULTATE SEMNATURA

''.#) 3 "#

8/12/2019 terminat!!!!!!!!!!!

48/60

e)amina%e N* e)i$%ani!i& &(aa a *n*i!3eag in &ri!are in(ene"e e)amina%e'Dimen$i*nea $i

,&1i%ia (ene"&r $*n%n&rma"e'

8/12/2019 terminat!!!!!!!!!!!

49/60

''.#) 3 ## "@,6C

3#b '3r '')(6#mm(g

')##ml '

'3##

"@,"C

3#b '3r '')(6#mm(g

').#) 3 ## "6,5C

3#b '3r '')(6#mm(g

##ml '

'3##

"6,5C

3#b '3r '')(6#mm(g

'".#) 3 ## "6,5C

3#b '3r '')(6#mm(g

"##ml '

DATA ORA OBSERVATII SI INTERVENTII

'#.#@ '3 "# M5;%.% 5%'-' :6$+'%'% 5%/- - 8%89'+. %'' $'%&5,,e%*r6area $&mn*"*i+ astenie, anxietate,stare generala alterataAF'"#(@#mm(g , PF3# b(min, 1F'3r, F"3,'Cratament2 Algocalmin , Clexane, rombostop- ') mg ,Aspirina '() , *trepto+inaza2 '## ### ui

''.#@ @ 45 - sunt recoltate probe biologice din sange pentru examen delaborator 2 !emograma, *, imp /uic+, 0ibrinogen, imp

de sangerare, imp de coagulare.- sunt efectuate examene paraclinice2

8/12/2019 terminat!!!!!!!!!!!

50/60

&oppler continua si pulsata,0lebograa.

') "# - ratament2 Algocalmin -" ori(zi, Clexane- ) ori( zi,rombostop- " mg( zi , Aspirina '() ( zi, *trepto+inaza2 '##### ui ( )4 ore.

AF'')(6# mm(g, PF3# E(min, 1F'3 r , F "@,6C.

').#@ 3 ## - acuza durere la nivelul membrului inferior drept- ratament2 Algocalmin -" ori(zi, Clexane- ) ori( zi,rombostop- " mg( zi , Aspirina '() ( zi, *trepto+inaza2 '##### ui ( )4 ore.

'".#@ 3 ## Pacienta prezinta o ameliorare vizibila a starii de sanatate.ratament2 Algocalmin -" ori(zi, Clexane- ) ori( zi,rombostop- " mg( zi , Aspirina '() ( zi, *trepto+inaza2 '##### ui ( )4 ore.

') "# Pacienta se externeaza in conditii optime.

9>

8/12/2019 terminat!!!!!!!!!!!

51/60

CONCLUZII GENERALE

EVOLUTIA NEVOILOR FUNDAMENTALE, TRATAMENTUL SI EFECTELE,EVOLUTIA VALORILOREAMENELOR MEDICALE ETC#

Pacienta P.A. in varsta de 54 ani, se prezinta cu bilet de trimitere de la mediculde familie - in vederea

ineternarii in sectia de Cardiologie, prezentand durere intensa la nivelulmembrului inferior drept, aste-

nie,anxietate , stare generala alterata, perturbarea somnului manifestata printreziri frecvente din cauza

durerii spontane regiunii plantare si - edemului de staza.

Pacienta arma ca primele simptome au aparut in urma cu 6 luni in care aaparut o inamatie minora la

membrul inferior drept cu edem de consistenta moale.Pentru a diminua aceste

simptome, pacienta s-a odi!nit cu picioarele ridicate la "# grade, membrul ind

usor ectat la nivelul ge-nunc!iului , a facut $ogging, a evitat expunerea prelungita la soare, s-a masat cu%asonil si a combatut du-

rerea cu Algocalmin.&atorita programului incarcat, pacienta a stat in ortostatismprelungit ,fapt care a dus

la reaparitia simptomelor, de data aceasta- cu o intensitate mai mare.

Antecedente personale2menar!a la '" ani si varice !idrostatice.

Prescriptii medicale la internare2H%&-'- ?000 +# 6 6 ;

- Aspirina '() tab(z - *trepto+inaza )5# ### u.i-perfuzie-iv -

"# min, apoi '## ### u.i( ora - )4 !. 6Clexane-id

- Algocalmin " ori( zi.

7xaminari paraclinice2 F@# Gg- stare normala.

%a internare, pacientei ii erau afectate nevoile2 ,,A 7 89*CA:, HA 79A

P719C;%7%7:, HA &;189, A 7;&99:, HA 09 C

8/12/2019 terminat!!!!!!!!!!!

52/60

98E1ACA(&7DE1ACA:.

Pacienta a fost comunicativa si a colaborat in intregime cu ec!ipa medicala.&easemenea, pacientei i s-a

impus sa respecte indicatiileregim !iposodat si !idratare.

&atorita starii generale bune, pacienta a fost externata din spital dupa " zile, curecomandarile de rigoare.

PLAN DE NURSING

DATA

DIAGNOSTIC DENURSING

OBIECTIVE

''.#@

A"%erarea m&6i"i%#iiin !a*1a in%er(eniei!3ir*rgi!a"e mani/e$%a%#

,rin im,&%en#/*n!i&na"#+ i/i!*"%a%en e,"a$are'

Pa!ien%*" %re6*ie $a ,re1in%e & !re@%ere agra*"*i e ine,enen%a

A"%erarea $&mn*"*i in

!a*1a *rerii,&$%&,era%&rii

Pa!ien%*" %re6*ie $a &6anea$!a *n $&mn

$a%i$/#!#%&r n %rei 1i"e'

92

8/12/2019 terminat!!!!!!!!!!!

53/60

mani/e$%a%# ,rin %re1iri/re!(en%e'Di/i!*"%a%e n a $em6r#!a @i e16r#!aa%&ri%# im&6i"i1#rii

mani/e$%a%# ,rinin!a,a!i%a%ea e a $em6r#!a @i e16r#!a'

Pa!ien%*" %re6*ie $# $e ,&a%# m6r#!a @ie16r#!a $ing*r

A"%erarea in%egri%#ii%eg*men%e"&r "ega%# ein%er(enia !3ir*rgi!a"#mani/e$%a%# ,rin

,re1ena ,"#gii&,era%&rii'

Pa!ie%*" %re6*ie $a /ie ra6a%&r in(ine!area ,"#gi"&r+ ,re(enirea !&m,"i!a.%ii"&r+ imin*area i$!&n/&r%*."*i ,&$%&,era.%&r'

De/i!i% e a*%&ngrijire

"ega% e re,a*$*" "a ,a%mani/e$%a% ,rini/i!*"%a%e n a re$,e!%a

,re$!ri,%ii"e e igiena'

Pa!ien%*" %re6*ie $a &6anea$.!a

!a,a!i%a%ea e a $e a*%&ingriji'

A"%erarea !&n/&r%*"*i"ega%# e in!i1ia&,era%&rie mani/e$%a%#

,rin *reri "a ni(e"*"mem6r*"*i in/eri&r

Dimin*area @i !&m6a%erea *rerii n %rei1i"e'

Di/i!*"%a%eaim,iei!arii ri$!*"*i e!&m,"i!a%ii "ega%a ein/e!%ii $i 3em&ragii+a%&ri%a !aeri"&ra!!ien%a"e'

Pa!ien%*" $# $e (ine!e /#r# !&m,"i!aii+ $#6ene/i!ie1e e *n mei* $e!*ri%ar'

An)ie%a%e "ega%# e"i,$a e in/&rmaiemani/e$%a%# ,rin %eam#

. P!ien%*" %re6*ie $a !&m6a an)ie%a%ea'

De/i!i% e !*n&@%inee$,re 6&a"a+ %ra%amen%@i a*%&ngrijiri"e "a

&mi!i"i*

. ,a!ien%*" $a ai6# n&i*ni e$,re 6&a"a @i%ra%amen% @i a*%&ngrijiri"e "a &mi!i"i*'

').#@

Alterarea starii debine a pacienteidin cauzaprocesuluitrombolic,manifestata pringreutatea indeplasare.

Pacienta trebuie sa prezinte ocrestere a gradului deindependenta.

Perturbarea

somnului dincauza durerii.

Pacienta trebuie sa aiba un somn

odi!nitor calitativ si cantitativ.

95

8/12/2019 terminat!!!!!!!!!!!

54/60

1iscul alterariiintegritatiitegumentelor dincauza neputinteirealizarii ingri$irilor.

Pacienta trebuie saisi mentinaintegritatea tegumente-lor prin realizarea igieneicorporale, prevenind escarele.

&icultatea de aseimbraca(dezbraca,de a-si mentinetegumentelecurate din cauzagreutatiimobilitatii.

Pacienta trebuie sa poata sa seimbrace(dezbrace - partial.

'".#@

Pacienta nu maiprezinta nevoi

alterate.

SECTIA:

BOLNAVUL:

DIAGNOSTIC:

SPITAL: BOLNAV:

SECTIA: DIAGNOSTIC:

PLAN DE NURSING

98

8/12/2019 terminat!!!!!!!!!!!

55/60

&AA&9A>;*9C &7

AC9

8/12/2019 terminat!!!!!!!!!!!

56/60

MODUL DE EXTERNARE- SIN)UR: CU FAMILIA: ALTUL:

MI(LOC DE TRANSPORT:

RECOMANDARI LA EXTERNARE :

Pacienta P.A in varsta de 54 ani, se interneaza cu biletul de trimitere de lamedicul de familie in sectia de Car-

&iologie, unde a fost diagnosticata cu tromboebita acuta cu sindrom cianotic,

administrandu-i-se tratamentmedicamentos.

9n urma tratamentului efectuat, starea pacientei s-a imbunatatit vizibil.

1ecomandari2 -regim !iposodat

- tratamentul in continuare

- evitarea ortostatismului prelungit

- evitarea traumatismelor de orice fel.

MODUL DE EXTERNARE: CU FAMILIA: DA ALTUL:

MILOC DE TRANSPORT: A*%&%*ri$m '

OBSERVATII LA ETERNARE

Pa!ien%a $e e)%ernea1a !* $%area genera"a ame"i&ra%e' S%are genera"a 6*na+ a/e6ri"a+ $i.a re!a,a%a% ine,enen%a "a mer$' Pa!ien%a e$%e r*ga%a $a re$,e!%e ini!a%ii"e mei!a"e e "a e)%ernare '

9

8/12/2019 terminat!!!!!!!!!!!

57/60

FISA TEHNICA

INECTIA SUBCUTANATA

D%5%:

E$%e in%r&*!erea *n&r $*6$%an%e mei!amen%&a$e Bi1&%&ni!e+ "i!3ie+ ne*rer&a$e ,rinin%ermei*" *n*i a! in %e$*%*" !e"*"ar $*6!*%ana%'

S*&5%'-&%+5*: . inje!%area in$*"inei "a ia6e%i!i+ %ra%amen% an%i!&ag*"an%'

BS*6$%an%a in%r&*$a /&rmea1a *n e,&$i% in !are i/*1ea1a "en% $,re $i$%em*" !a,i"ar in !aree re$&r6i% $i %ran$,&r%a%

L*+. $% %.%*5%:

/a%a e)%erna a 6ra%*"*i

/a%a $*,rae)%erna a !&a,$ei Ban%eri&r $i "a%era"

/a%a $*,ra $i $*6$,in&a$a a &m&,"a%*"*i

regi*nea e"%&iiana

regi*nea $*6!"a(i!*"ara

/"an!*ri"e ,re%e"*i a6&mina" Bregi*nea ,eri&m6i"i!a"a

regi*ni"e !en%ra"e /e$iere

M-5%'-.% %*%/-'%:$eringi Y a!e B2.5 mi!i $i $*6%iri !* 6i1&* "*ng'

Pen%r* in%r&*!erea &6"i!a B"a 89> $e /&"&$e$! a!e "*ngi e 25.52mm+ iar ,en%r*in%r&*!erea ,er,eni!*"ara L72mm' C* !a% e$%e mai $!*r% r*m*" ,e !are (ar/*" a!*"*i i"are e ,ar!*r$+ !* a%a% $!ae ri$!*" "e1arii e ner(i $i (a$e+ *rerea e$%e mai mi!a $i 3ema%&m*"

rar'

S%ra%*ri"e ,ie"ii $*n%:

e,ierm*" Bgr&$imea >+>>;.7+5mm

erm*" Bgr&$imea 7mm

3i,&erm*" Bi/eri% in /*n!%ie e regi*ne

Prega%irea ,a!ien%*"*i: $e a$ea1a ,e $!a*n !* mem6r*" $*,eri&r $,rijini% in $&" $i $ee$!&,era 1&na B/a%a e)%erna a 6ra%*"*i+ regi*nea a6&mina"a+ e%!'

9;

8/12/2019 terminat!!!!!!!!!!!

58/60

E>%*+5%:

$,a"area maini"&r

m&n%area $eringii $i a!*"*i+ /ara a a%inge am6&*" $eringii

$e (eri/i!a /i&"e"e+ $e %aie $e in!ar!a $eringa

$e e"imina aer*"+ $e $!3im6a a!*"

$e %ine $eringa in mana rea,%a !a ,e *n !rei&n

$e !*%ea1a !* ,&"i!e"e $i ine)*" Bara%a%&r*" mainii $%angi & ,&r%i*ne mai mare e,ie"e /i)an.& $i rai!an.& e ,e ,"an*ri"e ,r&/*ne' Se (a %ine a$%/e" ,ana "a in%r&*!ereain%regii !an%i%a%i B$e e(i%a a$%/e" ,a%r*nerea in%ra m*$!*"ara

$e ,a%r*ne ,rin %eg*men% ea"*ng*" a)*"*i "&ngi%*ina" a" !*%ei+ in ,r&/*n1imea$%ra%*"*i $*6!*%ana% "a I aan!ime e 2.8 !m' Se (eri/i!a a!a a!*" n* a aj*n$ in%r.*n (a$Ba$,iran' Tenina e a ren*n%a "a a$,ira%ie+ in%r.& 1&na $"a6 (a$!*"ari1a%a'

$e inje!%ea1a "en% ,rin a,a$area !* ine)*" ,e ,i$%&n

"a %erminare $e re%rage $i $e %am,&nea1a !* (a%a $i a"!&&"

"a in%r&*!erea *n&r !an%i%a%i mai mari e >+9 m" $e men%ine a!*" in %e$*% in!a 9

$e!*ne *,a inje!%are ,en%r* a im,iei!a re/*"area $*6$%an%ei in !ana"*" e ,*n!%ie'

$e ma$ea1a "&!*" inje!%arii ,en%r* a /a(&ri1a !ir!*"a%ia "&!a"a in (eerea a!!e"erariire1&r6%iei'

E/e!%*area !&re!%a a inje!%iei $*6!*%ana%e Bre$,e!%an *ng3i*" e 89

A**$%5% / *$%5%:

#*+,+,: ,rin "e1area *n&r %ermina%ii ner(&a$e $a* ,rin i$%en$ia 6r*$!a a %e$*%*ri"&r' A!*"(a /i re%ra$ !a%re $*,ra/a%a'

+*,+, C*&*/: $e e)%rage man*a" $a* !3ir*rgi!a"

%,(T0($,rin ,er/&rarea *n*i (a$ $a* "a amini$%rarea 3e,arinei'

O9/%';-5:

n* $e amini$%rea1a $*6!*%ana% C"&r*ra e Na+ !&m,*$i ai me%a"e"&r

n* $e amini$%rea1a $*6!*%ana% $*n6$%an%e *"ei&a$e B&ar e)!e,%i&na"

n* $e amini$%rea1a $*6!*%ana% . in 1&ne e in/i"%ra%ie a a"%&r inje!%ii

9

8/12/2019 terminat!!!!!!!!!!!

59/60

. in 1&ne in/e!%a%e B/*r*n!*"+ /&"i!*"i%a

. 1&ne !* m&i/i!ari erma%&"&gi!e'

Pen%r* in$*"ina+ $e a"ege "&!*" in /*n!%ie e %im,*" e re1&r6%ie e$%ima%e' S%*ii"e a*

ara%a% !a "a ni(e"*" a6&men*"*i $e re1&ar6e e 2 &ri mai re,ee e!a% "a ni(e"*" !&a,$ei iar "ani(e"*" 6ra%*"*i e$%e e 2 &ri mai mi!a e!a% a6&mina"+ ar mai mare !a "a !&a,$a' La 6ra%$*n% i/eren%e e ,ana "a 5> e a!eea ,are $!*r%a a%&ri%a re1&r6%iei &$!i"an%e'

Se (a %ine $eama e m&men%*" amini$%rarii:

E),"* :. &ra ; a6&mina"

. &ra < in !&a,$a '

Se /&"&$e$%e a! e 72 mm ,en%r* in%r&*!erea ,er,eni!*"ara $i e 72.7< mm "a inje!%area in

*ng3i e 89>

9=

8/12/20