NECESITILE FIZIOLOGICE FUNDAMENTALE

3Excreta. Necesitatea asigurrii ei!i"ri#r

Ei!i"rie $i%i##gice& $eca' uri"ar' cuta"at'
ge"ita
Ei!i"ri (at##gice& )iaree' *rsturi' s(ut
*Funcia excretorie
Fi%i##gic exist
ei!i"are $eca
ei!i"are uri"ar
ei!i"ri cuta"ate
ei!i"ri ge"itae
ei!i"ri res(irat#rii
ei!i"ri (ri" ga")ee !a!are
*Rapel anatomic. Elemente de fiziologie
1.Eliminarea de materii fecale
Noiuni anatomice& *e%i cursu a"teri#r
+
Materiile fecale c#",i"&
o -. / a(
o 3. / su0sta",e s#i)e 1ceu#% 2 ate !aterii "e)igerate' $#s$a,i 3i sruri a"#rga"ice' #
ca"titate !ic )e i(i)e' ceue !uc#ase )escua!ate' !ucus' e"%i!e )igesti*e'
(ig!e",i 0iiari' 0acterii4
o (ri" ga")ee )igesti*e ex#cri"e se ei!i" 3i u"ee su0sta",e t#xice
Defecaia 5 act c#!(ex' 6" s(ecia *#u"tar' (ri" care !ateriie $ecae su"t ei!i"ate )i"
a!(ua recta a exteri#r.
7egare
o ce"trii sacra,i& seg!e"tee 8 9 :
o e$ere",a&
"er*ii ru3i"#3i i"ter"i 1i"er*a,ia *#u"tar a s$i"cteruui a"a4
$i0re (arasi!(atice sacrate 1S8 9 S:4 ; e$ect i"<i0it#r asu(ra s$i"cteruui i"ter"
$i0re si!(atice )i" L+ 9 L8 ; e$ect t#"ic asu(ra s$i"cteruui i"ter" ; c#"trac,ia sa
3i rete",ia !aterii#r $ecae
o 6" $i"a ; re$ex c#!(ex c#")i,i#"at 3i "ec#")i,i#"at
2.Eliminarea urinar
Aparatul urinar
o 8 ri"ic<i 1c#rtica' !e)uar' (a(ie' caice re"ae' (e*isu re"a4
8
o ci uri"are
8 uretere 13= 9 3.c!4 (#r,iu"e a0)#!i"a
(#r,iu"e (e*i"
*e%ica uri"ar
uretra
>ascuari%a,ia
o ri"ic<i&
artere re"ae 1ra!uri )i" A#4
*e"e re"ae& )re"ea% 6" >CI
i!$aticee& 3cure"te care )re"ea% 6" "#)uii #!0ari
o caice 3i (e*is re"a& ra!uri )i" arteree re"ae
o uretere
ra!uri arteriae )i"
arteree re"ae
arteree #!0are
arteree testicuare sau #*arie"e
artera iiac c#!u"
artera <i(#gastric
artera *e%ica i"$eri#ar
circua,ia *e"#as& *e"e sateite artere#r
i!$aticee ae ureteruui a0)#!i"a )re"ea% 6" i!$#"#)uii #!0ari
ae ureteruui (e*i" )re"ea% 6" cei iiaci i"ter"i
o *e%ica uri"ar
artere
*e%icae su(eri#are& ra!uri )i" arteree #!0iic#*e%icae
*e%icae i"$eri#are& ra!uri )i" iiacee i"ter"e
u" (e)icu a"teri#r& )i" art. ru3i"#ase i"ter"e 3i e(igastrica i"$eri#ar
3
u" (e)icu (#steri#r& ra!uri )i" rectaa !i?#cie 10r0a,i4 sau )i"
uteri"e 3i *agi"ae 1$e!ei4
*e"ee $#r!ea% (exuri& su0!uc#s' !uscuar 3i su0ser#s ; 6" *e"ee
ru3i"#ase i"ter"e
i!$aticee ; 6" "#)uii iiaci i"ter"i
I"er*a,ia
o ri"ic<i& (exu re"a
o uretere& )i" (exu re"a' a#rtic' <i(#gastric
o *e%ica uri"ar
ra!uri si!(atice 1)i" (exu <i(#gastric4
ra!uri (arasi!(atice 1)i" (arasi!(aticu sacrat4
Formarea urinei are #c (ri" trei (r#cese $u")a!e"tae&
$itrarea (as!ei a "i*e g#!eruar
rea0s#r0,ia tu0uar
secre,ia u"#r a"u!i,i c#"stitue",i 6" tu0i
7egare
o "eur#*egetati*
(arasi!(atic
si!(atic& acti*itate (re)#!i"e"t *as#c#"strict#are' ac,i#"@") !ai aes asu(ra
arteri#e#r a$ere"te 3i e$ere"te ; !#)i$ic *a#area $itrrii g#!eruare
acea3i e$ect 6 au catec<#a!i"ee 1"#ra)re"ai"a 3i a)re"ai"a4& n cantiti
!ici ; e$ect *as#c#"strict#r (re)#!i"a"t asu(ra arteri#ei e$ere"te ; cre3te
*a#area $itrrii g#!eruare
& n cantiti
!ari ; *as#c#"stric,ie (uter"ic a a!0e#r arteri#e g#!eruare ; sca)e sau
c<iar se #(re3te $itrarea
o e")#cri"&
ceuee !uscuare !#)i$icate )i" a(aratu ?uxtag#!eruar se c#!(#rt ca
(res#rece(t#ri ; siste!u re"i"9a"gi#te"si"9a)#ster#"
<#r!#"u ADA
:
<#r!#"ii <i(#$i%#9c#rtic#su(rare"aie"i
cacit#"i"a' (arat<#r!#"u& regarea ei!i"rii )e Ca' B
<#r!#"ii tir#i)ie"i
estr#ge"ii
$act#ru "atriuretic atria
o siste!e u!#rae #cae& BG' Caicrei"a90ra)iCi"i"a
o !eca"is! )e $ee)90acC tu0u#9g#!eruar 1acti*itatea tu0uar se a)a(tea% $itrrii 3i
i"*ers4
Miciunea 5 act re$ex' (ar,ia c##r)#"at *#u"tar' )eca"3at )e cre3terea (resiu"ii
i"tra*e%icae a u" a"u!it "i*e ;
; Sti!uarea (res#rece(t#ri#r )i" stratu !uscuar ;
; I!(usuri (ri" $iete *egetati*e a ce"trii !e)uari S8 9 S: ;
; Be ci "es(eci$ice ; a sc#ar,a cere0ra ; se"%a,ia c#"3tie"t )e !ic,iu"e 1La *@r$u
ariei !#t#rii )i" (artea !e)ia a e!is$erei cere0rae 9 #0u (arace"tra 9 este situat ce"tru
c#rtica care c#"tr#ea% acti*itatea *#u"tar *e%ica4 ;
; Fi0re (ri" $ascicuee (ira!i)ae 3i extra(ira!i)ae ctre !)u*a sacrat' 6" c#ar"ee
a"teri#are' u")e se a$ ce"trii re$exuui )e !ic,iu"e 1S8 9 S:4 ;
; Fi0re (e"tru !uscuatura "ete) a )etrus#ruui 3i a s$i"cteruui i"ter" 1(arasi!(atice4 2
(ri" "er*ii ru3i"#3i s#!atici 1S8 9 S:4 sti!uii *#u"tari care reaxea% s$i"cteru exter"
2Z#"a )e regare su(eri#ar 5 %#"a $aciita"t a !ic,iu"ii& 6" regiu"ea (r#tu0era",ei'
<i(#taa!us (#steri#r' girus ci"gui 3i su(ra$a,a #r0ita a #0uui $r#"ta 2 %#"a i"<i0it#are&
6" !e%e"ce$a
Nu uitai Rolul rinic!iului nu "e reduce numai la excreie# el inter$ine %prin
retenia# excreia unor ioni &i "ecreie' &i (n ec!ili)rul acido * )azic
+.Eliminrile cutanate
,ielea %tegumentul' 5 6"*ei3 "e6"treru(t care se c#"ti"u a "i*eu !ari#r #ri$icii 1gur'
"as4 cu # se!i!uc#as 1(ar,ia Cerati"i%at4 3i care 6" i"teri#ru ca*it,ii res(ecti*e )e*i"e #
!uc#as (r#(riu9%is.
Su(ra$a,a (ieii "u e u"i$#r!& are
(r#e!i"e",e' cute c#"ge"itae
$u"c,i#"ae
#ri$icii
!ari
!ici $#icui (i#3i 1a0s#r0,ia !axi! a a(ei' eectr#i,i#r' !e)ica!e"te#r4
ga")e su)#ri(are
Structur&
e(i)er! 1.straturi4
)er! 18straturi4
<i(#)er!
Ga")e
o se0acee 1aci"#ase4
situate 6" )er!
se0u!u secretat ia "a3tere (ri" )ege"eresce",a gras a ceue#r care
c(tu3esc (ere,ii ga")ei
$u"c,ie e")#cri"#9)e(e")e"t 1siste!u <i(#$i%# ster#i)ic su(rare"a 3i
sexua4
o su)#ri(are 1tu0uare' ter!i"ate cu u" aci" secret#r4
6" "u!r )e 8'. 9 :'. !ii#a"e
.
situate 6" <i(#)er!
(#t $i&
!ici
o(e t#at su(ra$a,a c#r(uui
osu)#are a(#as' 0#gat 6" sruri' cu (A aci)' $r c#",i"ut
(r#teic sau (r,i )i" ceuee secreta"te
o#0struc,ia #r ; su)a!i"a
!ari
oa "i*eu axie#r' 6" ?uru !a!e#"uui 3i a "i*eu
(eri"euui
osecre,ia& (ri" ei!i"area u"ei (r,i )i" ceua secreta"t
oi"tr 6" $u"c,ie )e a (u0ertate ; e")#cri"#)e(e")e",a #r
osu)#are !ai *@sc#as' !ai 0#gat 6" (r#tei"e' cu (A
"eutru ; i"$ec,ii $rec*e"te
U!i)itatea su(ra$e,ei cuta"ate D su)#area 1(ers(ira,ie *i%i0i4 2 e*a(#rarea tra"se(i)er!ic
a a(ei 1(ers(ira,ie i"se"si0i4
Se0u!u 2 su)#area 5 $i! 0i##gic i(#(r#teic 3i aci) )e (e su(ra$a,a e(i)er!uui 1(A 5 :9.4
-.Eliminrile genitale %&i prin glandele mamare'
Aparatul genital feminin
o #rga"ee ge"itae exter"e
$#r!a,iu"ie a0iae
a0iie !ari
a0iie !ici
a(aratu erecti& cit#risu 3i 0u0ii *agi"uui
ga")ee a"exe& ga")ee Eart<#i" 3i ga")ee *esti0uare !ici
o #rga"ee ge"itae i"ter"e
#*aree
tu0ee uteri"e 1tr#!(ee4
uteru
circua,ia arteria&
uteri"& ra! )i" iiaca i"ter"
acces#r )i" arteree #*arie"e 3i arteree
iga!e"tuui r#tu")
circua,ia *e"#as& )re"ea% $ie 6" *e"ee iiace i"ter"e' $ie&
6" )rea(ta 6" >CI
6" st@"ga 6" *e"a re"a
*agi"u
-
Acti$itatea endocrin o$arian
O*aree (arcurg 3 ti(uri )e cicuri
*ita 1$a%a (re(u0ertar' )e !aturitate 3i )e !e"#(au%4
!e"strua 1estra& se re(et a $iecare #*ua,ie4
)e sarci" 1)urea% )e a(r#xi!ati* += #ri !ai !ut ca ce !e"strua4
A#r!#"ii #*arie"i 5 estr#ge"ii 2 (r#gester#"u
7egarea secre,iei #r& )e ctre g#"a)#tr#(ii <i(#$i%ari
FSA ; !atura,ia $#icuar
LA. ; #*ua,ia' i"i,ierea $#r!rii c#r(uui ga0e"
Tra"s$#r!rie $u"c,i#"ae uteri"e (e (arcursu u"ui cicu !e"strua&
F La $i"ee !e"strua,iei straturie su(er$iciae ae !uc#asei uteri"e su"t ei!i"ateG
F Di" %iua . ; +:' su0 i"$ue",a estr#ge"i#r are #c 6"gr#3area e")#!etruui' cre3terea
*ascuari%a,iei sae' au"girea ga")e#r' )iatarea #r 6" (#r,iu"ea (r#$u")' 5 FAZA
B7OLIFE7ATI> sau )e B7EO>ULAIE
F Su0 i"$ue",a LA ca*itatea $#icuar (i" cu u" c<eag )e s@"ge )u( #*ua,ie *a ge"era
c#r(u ga0e" care secret estr#ge"i 3i (r#gester#" ; cu)area ga")e#r uteri"e' 6"c#cirea
#r 3i secre,ia acti* 5 FAZA SEC7ETO7IE A CICLULUI 1+8 %ie4
F Dac $ecu")area "u are #c' )u( regresia c#r(uui ga0e" 1; $#r!ea% c#r(us a0ica"s4
arteree s(iraate )i" !i#!etru i"tr 6" *as#c#"stric,ie 3i straturie su(er$iciae $u"c,i#"ae ae
e")#!etruui su"t )istruse (ri" isc<e!ie
H
F A(#i arteri#ee s(iraate se )iat 3i (ere,ii #r "ecr#%a,i se ru( ; <e!#ragii cu ei!i"area
straturi#r su(er$iciae ae !uc#asei ; se i"staea% $uxu !e"strua 1ZIUA + A CICLULUI
MENST7UAL 5 ZIUA + A FLUIULUI MENST7UAL J4.
.landele mamare
6" "r. )e 8G u"e#ri se c#"stat (re%e",a )e ga")e su(ra"u!erare 1(#i!astie4 sau
a0se",a #r 1a!astie4' u"i9 sau 0iatera
)i!e"siu"ie 3i *#u!u *aria% cu
*@rsta
starea $i%i##gic 1sarci"' e<u%ie4
*aria,ii a"at#!ice
structura 1ga")e su)#ri(are !#)i$icate4
5 ,esut ga")uar ti( tu0u#aci"#s 1u" gru( )e aci"i ; #0uG u" gru( )e
#0ui ; #0 ga")uar4
6"tr9# !as )e grsi!e )is(us (re9 3i retr#!a!ar
*ascuari%a,ie
arteria& )i" artera !a!ar i"ter" 1ra! )i" su0ca*icuar4' artera
!a!ar exter" 1ra! )i" axiar4' )i" arteree i"terc#stae (ri" ra!urie
(er$#ra"te
*e"#as& *e"e sateite artere#r
i!$atice& 3 gru(uri 1ext.' i"t.' i"$er.4
i"er*a,ie
"er*ii i"terc#stai' ra!uri su(raca*icuare )i" (exu cer*ica' ra!uri
t#racice )i" (exu 0ra<ia
*egetati*& )i" $i0re care !erg )e9a u"gu *ase#r
/.Alte eliminri 0 eliminri re"piratorii %122# 322# "u)"tane toxice'
*E$aluarea pacientului Anamneza &i examenul clinic
Factorii care influeneaz "ati"facerea nece"itii a"igurrii eliminrilor
Ei##gici
ai!e"ta,ia' i"gestia )e ic<i)e
(ier)erie 1!asi*e4 )e ic<i)e
(#%i,ia c#r(uui 1a!ei#rarea (er$u%iei re"ae 6" )ecu0it' (#%i,ia 6"
!#!e"tu !ic,iu"ii4
exerci,iie $i%ice
*@rsta 1c#"tr#u s$i"cteria"4
#0iceiuri& (r#gra!u )e ei!i"are i"testi"a
Bsi<##gici
stres' a"xietate' e!#,ii
asigurarea i"ti!it,ii
sc<i!0area re3e)i",ei' ct#rii' i"ter"ri 6" s(ita
S#ci##gici
"#r!e )e sau0ritate
e)uca,ie
cutur
4ur"e de dificultate
)e #r)i" $i%ic
K
aterarea !uc#asei i"testi"ae' trau!atis!e rectae' e%iu"i 1ru(turi4 ae
uretrei' aterarea (are"c<i!uui re"a' i"$ec,ii cr#"ice #cai%ate a
"i*eu a(aratuui ge"ita' etc.
!a$#r!a,ii c#"ge"itae 1!ega)#ic#c##"' !a$#r!a,ii ae ci#r uri"are'
i!(er$#ra,ie a"a' $istue rect#9*agi"ae' etc.4
tu!#ri i"testi"ae' a)e"#! sau ca"cer )e (r#stat' tu!#ri uteri"e'
#*arie"e sau #cai%ate a "i*eu s@"i#r
)e%ec<ii0re !eta0#ice' eectr#itice' e")#cri"e
)i!i"uarea sau acceerarea (eristatis!uui i"testi"a' )i*erticui *e%icai
!e)ica,ie care are e$ecte a)*erse care se re$ect 6" ei!i"rie )igesti*e'
uri"are sau asu(ra ei!i"ri#r cuta"ate 1C#)ei"a (r#*#ac c#"sti(a,ie'
Sc#0utiu 3i Atr#(i"a (r#*#ac rete",ie )e uri" a cei cu a)e"#! )e
(r#stat' uscciu"ea tegu!e"te#r 3i !uc#ase#r' etc.4
reaxarea' )e$icitu )e c#"tr# 1)e #rigi"e cere0ra sau !e)uar4 a
s$i"ctere#r
)e #r)i" (si<ic
a"xietate' $rica )e )urere 6" !#!e"tu actuui )e$eca,iei sau !ic,iu"ii
stres
)e #r)i" s#ci##gic
ai!e"te aterate' (#uarea a(ei
i"sau0ritatea !e)iuui
ci!at
sc<i!0area !#)uui )e *ia,
(r#gra! )e ucru i"a)ec*at
ig"#ra",a
Manife"tri de dependen
)iaree' c#"sti(a,ie' !ee"' <e!ate!e%' *rsturi' i"c#"ti"e",a )e !aterii $ecae
rete",ia acut )e uri"' i"c#"ti"e",a uri"ar' e"ure%isu' <e!aturia 1ei!i"area )e
<e!atii 6" uri"& !acr#sc#(ic sau !icr#sc#(ic 9 a ex. su!ar uri"4' a0u!i"urie'
gic#%urie' <i(erste"urie 1)e"sitate uri"ar crescut4' <i(#ste"urie 1)e"sitate uri"ar
sc%ut4' i%#ste"urie 1)e"sitate uri"ar 5 cu a (as!ei' i")i$ere"t )e a(#rt& I7C4'uri"i
tu0uri 1cristae' (iurie4' (re%e",a )e c#r(i cet#"ici uri"ari' se)i!e"t uri"ar (at##gic
1!icr#sc#(ic4' e)e!e re"ae
)ia$#re%a 1tra"s(ira,ii a0u")e"te4' tegu!e"te 3i !uc#ase uscate 1)es<i)ratri4
ei!i"area !e"strua i"a)ec*at ca $rec*e",' ca"titate' #rar sau caractereG secre,ii
(at##gice a "i*eu tractuui ge"ita sau s@"i#r
s(uta
1.Eliminarea de materii fecale
1aracteri"tici fiziologice
ca"titatea 1+.= L 8== 9 3== g M %i4
$rec*e",a ei!i"ri#r
oa a)ut& + L 8 M %i' (@" a + a 8%ie
oa "#u9"scut& !ai !ute scau"e' 6" $u"c,ie )e ai!e"ta,ie 13 L : M %i (e"tru "#u9
"scut ai!e"tat "atura' iar ce ai!e"tat arti$icia& + L 8 M %i4
osugar (este - u!i& 8 L 3 M %i 1sugaru ai!e"tat cu a(te (ra$ 2 )i*ersi$icare& + L
8 M %i4
#raru& (e c@t (#si0i $ix 1)i!i"ea,a a tre%ire4
N
c#"siste",a 1(st#as' #!#ge"4
$#r!a 1cii")ric' )ia!etru 3 9 . c!4
cu#area
o0ru" sau !#)i$icat 6" $u"c,ie )e ai!e"ta,ie a a)ut
oga0e"9auriu' *er%ui 9 a sugaru ai!e"tat a s@" 9 ' ga0e" )esc<is 9 a sugaru
ai!e"tat arti$icia 9 '0ru" )u( i"tr#)ucerea $i"#suui 6" ai!e"ta,ie
!ir#su
o"#r!a 9 sa0 a a)ut' 3i !#)i$icat 6" $u"c,ie )e ai!e"ta,ie
ou3#r acru cu reac,ie aci) a sugaru ai!e"tat a s@"
o$a)' cu reac,ie acai" sau "eutr a sugaru ai!e"tat arti$icia
Anamneza
>@rsta
tu0urrie tra"%it#rii 5 $rec*e"te a sugar
"e#(as!u i"testi"a& !ai $rec*e"t a *@rst"ici
A"tece)e"te (ers#"ae (at##gice
0#i i"$ec,i#ase 1)i%e"terie4
a$ec,iu"i )igesti*e 1(ara%it#%e i"testi"ae' (a"creatita4
0#i extra)igesti*e 1<i(ertir#i)ia' <i(#tir#i)ia4 ; acceerarea' res(ecti* 6"ceti"irea
tra"%ituui
A"tece)e"te <ere)#9c#aterae
(#i(#%a i"testi"a
c#"sti(a,ia cr#"ic
C#")i,ii )e *ia, 3i !u"c
se)e"taris!u $a*#ri%ea% c#"sti(a,ia
stresu $a*#ri%ea% )iareea
#0iceiurie ai!e"tare 1c#",i"utu 6" $i0re a ai!e"ta,iei' #raru !ese#r' i"gestia )e
ai!e"te irita"te' ai!e"te "e(re(arate ter!ic' etc.4
Durerea
te"es!e rectae 1)i%e"terie4
)ureri a )e$ecare 1$isuri a"ae' a0ces (eria"a' tr#!0#$e0ita <e!#r#i)a4
Bruritu 1(ara%it#%e i"testi"ae 9 #xiur#%a 9 ; (rurit "a%a 3i a"a' icter c#estatic ; (rurit
cuta"at4
Examenul o)iecti$
Mee"a 5 ei!i"area )e s@"ge )igerat 1scau" se!ic#"siste"t' "egru 3i uci#s Oca (curaP& ca
ur!are a tra"s$#r!rii A0 6" <e!ati"4 16" FO se "#tea%& M4
(e"tru ca # ADS 1s@"gerare )i" tu0u )igesti* (@" a "i*eu iga!e"tuui Treit%4 s se
!a"i$este (ri" !ee" este "e*#ie )e # s@"gerare )e !i"i! K= ! )e s@"ge 3i u" tra"%it
i"testi"a )e !i"i! K #re
6" ca%u ADI 1<e!#ragii )igesti*e i"$eri#are4' !ai $rec*e"t 6" ca%u s@"gerri#r )e a
"i*eu i"testi"uui su0,ire' !ai rar 6" ca%u s@"gerri#r c##"ice 1)ac s@"gerarea este
su$icie"t )e !are ca s (#at c##ra 6"treg scau"u' s@"gerarea "u este ra(i) 3i !#tiitatea
c##"uui este re)us4
Ae!at#c<e%ia 5 s@"gee ei!i"at este (ar,ia )igerat' uci#s 16" ca%u ADS cu s@"gerri
!asi*e 3i tra"%it su0 K #re' sau 6" ca%u ADI& !ai aes )e a "i*eu iga!e"tuui Treit% (@" a
*a*ua ie#9ceca 5 $#stu ter!e"& AD i"ter!e)iare4
7ect#ragia 5 ei!i"are )e s@"ge r#3u 6" scau"
ADS& 6" ca%u (ier)eri#r !asi*e )e (este +=== !' 3i tra"%it acceerat
+=
s@"gerare a "i*eu c##"uui )esce")e"t' sig!#i)uui' rectuui 1s@"ge r#3u )esc<is4
sau a "i*eu c##"uui )re(t sau tra"s*ers 1s@"ge cu c<eaguri' 0ru"4
s@"gerare recta& s@"ge (e <@rtia )e t#aet sau (icuri care a(ar 6" *asu )e t#aet a
s$@r3itu scau"uui
s@"gerare )i" %#"a ca"auui a"a& (ier)ere )e s@"ge as#ciat cu scau" )e as(ect
"#r!a
e%iu"i (eria"ae& (icturi )e s@"ge )u( ei!i"area )e scau" "#r!a
as#cierea cu ate si!(t#!e& )ureri a )e$eca,ie 2 (ier)ere )e s@"ge r#3u 5 $isuri a"ae'
<e!#r#i%i tr#!0#%a,iG )iareee 2 s@"gerare 5 0#a i"$a!at#rie a c##"uui
1rect#c#it <e!#ragic' 0#a Cr#<"4G etc.
Se "#tea%
*#u!u 3i "r. scau"e#r 1N& a a)ut& + L 8 M %i' a sugaru ai!e"tat a s@"& : L - M %i4
cu#area
)ec##rate 1#0struc,ii ci 0iiare 5 scau"e ac#ice' exa!e" rx. 0aritat 5
scau" c##rat 6" a0 )e 0ariu4
*er%i 1tra"%it i"testi"a acceerat4
$#r!a
Ocrei#"P 1ste"#%e rectae4
Oexcre!e"te )e ca(rP 1c##" s(astic4
$eca#a!e 1c#"sti(a,ii re0ee4
c#"siste",a 1)ur' "#r!a& I' se!ic#"siste"t& M' ic<i)& Q4
(re%e",a )e !ucus' (ur#i' s@"ge 1I' B' S4G !ee"a 1M4
!ir#su
sa0 a ai!e"ta,ie *egeta
(utri) a ai!e"ta,ie 0#gat 6" car"e
r@"ce) 6" steat#ree
$eti) 6" ca"cer )e c##" 3i )iaree i"$ec,i#as
)e P*ar% stricatP 6" i"$ec,ii cu c#i0acii
(re%e",a )e (ara%i,i sau #u )e (ara%i,i
I"c#"ti"e",a )e !aterii $ecae
cau%e #cae
cau%e "eur##gice
C##st#!ie' ie#st#!ie
2.Eliminarea urinar
1aracteri"tici fiziologice
ca"titatea
oa)ut 1N 5 +=== L +.== ! M %i4
oc#(i 1N 5 : ! M Cg M #r !i"i!4
$rec*e",a !ic,iu"i#r
"#u9"scut& !ic,iu"i $rec*e"te
a)ut& : L - M %i
*@rst"ic& - L K M %i
rit!u& 8 M 3 )i" "r. !ic,iu"i#r M 8: #re& 6" cursu %iei
cu#area
oga0e"9)esc<is
o!#)i$icat 6" $u"c,ie )e ai!e"te 3i !e)ica!e"te
++
6"c<is& 6" ca%u u"ui regi! 0#gat 6" car"e
)esc<is& regi! *egetaria"
trata!e"t cu Fura%#i)#"' 7i$a!(ici"
!ir#su&
N 9 )e 0ui#"
!#)i$icat 6" $u"c,ie )e ai!e"te 1(a"te ar#!atice4 3i !e)ica!e"te
1a"ti0i#tice'etc.4
reac,ia&
N L aci) 1(A :'H 9 H' !ax. K4
regi!u 0#gat 6" car"e aci)i$ic uri"aG ce 0#gat 6" *egetae #
acai"i%ea%
as(ectu& N 5 car 1uri"a (r#as(t4G )u( u" ti!( 9 tu0ure (#si0i
)e"sitatea se )eter!i" (e"tru uri"a (r#as(t& N 5 +=+. L +=8. 1*aria,ii !ax.& +==+ L
+=3. L 6" $u"c,ie )e a(#rt4
Anamneza
>@rsta
GNDA (#ststre(t#c#cic& !ai $rec*e"t a c#(ii
a)e"#!u )e (r#stat& a)ut
ca"ceru )e (r#stat& *@rst"ic
Sexu
BN& !ai $rec*e"t a $e!ei
GNDA& !ai $rec*e"t a 0r0a,i
A"tece)e"te (ers#"ae (at##gice
0. i"$ec,i#ase acute 1i"$. stre(t#c#cice i!(icate 6" ge"e%a GNDA' ate i"$ec,ii4
0. i"$ec,i#ase cr#"ice 1si$iis' TEC' !aarie4
0. )igesti*e 1cir#%a <e(atic4
0. res(irat#rii 1TEC' su(ura,ii cr#"ice care (#t ge"era a!i#i)#%a re"a4
0. car)i#*ascuare 1ATA' ICCr#"ica' SM4
0. !eta0#ice 1DZ4
0. <e!at##gice 1euce!ii4
0. )e siste! 1BAN' LES4
3#cu 1a$ectarea ri"ic<iuui (ri" <i(#(er$u%ie4
t#xice 1B0' Ag' a"tige' etc.4
a"este%ice 1c#r#$#r!4
!e)ica!e"te 10ar0iturice' su$a!i)e4
A"tece)e"te <ere)#9c#aterae
ri"ic<iu (#ic<istic
itia%a re"#uri"ar
C#")i,ii )e *ia, 3i !u"c
regi! cu exces (r#teic sau )e sare& su(ras#icit ri"ic<iu
c#"su!u )e ai!e"te 0#gate 6" #xaa,i 1r#3ii' s(a"ac4 3i (uri"e 1ci#c#ata4 $a*#ri%ea%
itia%a re"a
!u"ca 6" !e)iu excesi* )e ca) "ecesit su(i!e"tarea ic<i)e#r i"gerate
Durerea
c#ica "e$retic 1)e0ut' se)iu' ira)iere' )urat' $act#ri (reci(ita",i' $act#ri ca!a",i4 2
as#cierea cu se!"e uri"are' )igesti*e 1*rsturi4' car)i#*ascuare 10ra)icar)ie'
(a#are4' tra"s(ira,ii
+8
)urerea #!0ar "ec#icati* )e cau% re"a 1acut sau cr#"ic4
cistagia 1)urere a "i*eu *e%icii uri"are& <i(#gastru4' a)esea as#ciat cu te"es!e
*e%icae
)urerea (e*i(eri"ea' cu ira)iere (e uretr' as#ciat cu tu0urri )e !ic,iu"e 1a$ectri
ae (r#statei 3i uretrei4
Examenul o)iecti$
E)e!ee re"ae
a0e' (u$#ase
(a(e0rae' uteri#r ge"erai%ate
!ati"ae
Tu0urri ae )iure%ei
(#iurie
otra"%it#rie
$i%i##gic 1i"gestie )e ic<i)e 6" ca"titate !are' $rig4
(at##gic 1ta<icar)ie (ar#xistic' )u( 0#i i"$ec,i#ase acute4
o(er!a"e"t 1)ia0et i"si(i)' DZ' I7C c#!(e"sat4
#igurie 5 )iure% su0 .== ! M 8: #re a a)ut
o$i%i##gic 1sc)erea a(#rtuui' cre3terea (ier)eri#r4
o(at##gic 13#c' ICar)iac' cacui ureterai' etc.4
a"urie 5 )iure%a su0 +== ! M 8: #re a a)ut
o6"t#t)eau"a e (at##gic 1I7A' I7C 6" sta)iu ter!i"a4
Nicturie
cau%e re"ae& (r#statit' I7C
cau%e extrare"ae& ICar)iac' Cir. Ae(. 9 (ri" a!ei#rarea circu. re"ae 6" ci"#statis!
B#aCiurie 1!ic,iu"i "u!er#ase4
Mic,iu"ea rar 5 su0 3 !ic,iu"i M 8: #re 1#igurie' !ega*e%ic4
Disurie 5 !ic,iu"ea )i$ici 1e$#rt !ic,i#"a' 6"treru(erea ?etuui' re)ucerea (resiu"ii 3i
cai0ruui ?etuui !ic,i#"a4
cau%e *e%icae& tu!#ri' cacuiG
cau%e extra*e%icae& e%iu"i !e)uare' a)e"#! )e (r#stat' Ca (r#stat' ste"#%e
uretrae' etc.
Mic,iu"ea )urer#as 1)urere "et sau usturi!e4
Mic,iu"ea i!(eri#as 1te"es!e *e%icae4
7ete",ia )e uri"
cu g#0 *e%ica 1c#!(et4& rete",ia acut )e uri"
cu reziduu (incomplet)
oa)e"#!' ca"cer )e (r#stat
oe%iu"i !e)uare
I"c#"ti"e",a uri"ar
a)e*rat 1*e%ica g#a4& e%iu"i !e)uare S3 9 S.
$as
o(acie",i cu rete",ie )e uri" care reai%ea% # !ic,iu"e (ri" P(rea (i"P 1a$ec,iu"i
ae (r#statei' e%iu"i !e)uare4 5 retenie de urin cu reziduu
o$e!ei *@rst"ice
E"ure%is 1e!isia i"*#u"tar )e uri" a # *@rst a care c#(iu c#"tr#ea% *#u"tar
s$i"cteree 9 cau%e *ariate& )e a (si<ice (@" a i"$ec,i#ase 3i !a$#r!ati*e4
Ur#st#!ii 1ureter#st#!ii' "e$r#st#!ii' cist#st#!ie4
Ba(area #?e#r re"ae' (u"ctee )urer#ase
+3
Bercu,ia a "i*eu #!0e#r 1se!"u Gi#r)a"#4
+.Eliminarea cutanat
1aracteri"tici fiziologice
ca"titatea& !i"i!' (e"tru a !e",i"e $i!u 0i##gic cuta"at 3i u!i)itatea (iuri#r
reac,ia& aci)
!ir#su& 6" $u"c,ie )e ci!at' statusu <#r!#"a 3i )e(ri")erie igie"ice
Anamneza
*@rsta 1ga")e e")#cri"# 9 )e(e")e"te4
sexu
a"tece)e"te (ers#"ae (at##gice 1TEC' ra<itis!' acr#cia"#%' <i(er9 M <i(#tir#i)ie' etc.4
c#")i,ii )e *ia, 3i !u"c 1te!(eratura' u!i)itatea )i" !e)iu4
igie"a
Examenul o)iecti$
Ai(ersu)#ra,ie' <i(er<i)r#%
tu0urri "eur#*egetati*e' stres
0#i i"$ec,i#ase 1TEC' ("eu!#"ie4
0. "eur##gice 1BarCi"s#"4
0. e")#cri"e 1<i(ertir#i)is!4
!e)ica!e"te 1As(iri"a4
<i(#gice!ia
0. car)i*ascuare& TBS>' cri%a ATA 6" $e#cr#!#cit#!
Ai(#su)#ra,ie <i(#<i)r#%
a$ec,iu"i )er!at##gice 1scer#)er!ie' (s#ria%is4
<TA #rt#static
!e)ica!e"te 1extracte )e atr#(a 0ea)#"a4
0. "eur##gice 1(#i"e*rite4
Su)a!i"a 1c#(ii' #0e%i' *ag#t#"i4
Ai)r#sa)e"ita 1i"$a!a,ia acut sau cr#"ic a ga")e#r su)#ri(are4
-.Eliminri genitale
1aracteri"tici fiziologice5 men"tra
rit!& a 8K 9 3. %ie
)urata& 3 L . 9 H %ie
ca"titatea
as(ectu& s@"ge a!estecat cu !ucus 3i )etritusuri ceuare' $r c<eaguriG "u
c#aguea%
cu#area& r#3u90ru" a 6"ce(ut' a(#i r#3u )esc<is
!ir#su& sa0' )e%agrea0i
$r )ureri' u3#ar ?e" $i%i##gic
Anamneza
a"tece)e"te (ers#"ae $i%i##gice 1!e"ar<a' "u!ru )e sarci"i' a*#rturi' "a3teri' ti(u
"a3teri#r' c#(ii )ece)a,i (eri"ata4
a"tece)e"te (ers#"ae (at##gice
o0#i ge"etice
o!a$#r!a,ii c#"ge"itae
oa$ec,iu"i )#0@")ite
+:
a"tece)e"te <ere)#9c#aterae 1ex.& ca"cer #*aria" M uteri"4
C>M 1stres4
)urerea
o)urerea (e*i" cr#"ic M acut
o)is!e"#reea
Examenul o)iecti$
I"s(ec,ia OGE 3i ga")e#r a"exe
i"tersexuaitate
a!astie' (#i!astie
M#)i$icri ae rit!uui 3i $uxuui !e"strua
!e"#ragii' !etr#ragii
<i(#9 sau <i(er!e"#ree
#ig#!e"#ree' a!e"#ree 1(ri!ar sau secu")ar4' (#i!e"#ree
Ate !#)i$icri
euc#ree 2 rec#tarea 3i "#tarea caractere#r scurgeri#r *agi"ae
acta,ia
*E$aluarea pacientului5 explorri paraclinice
1.Eliminarea de materii fecale
ex(#rri i!agistice
rx. P(e g#P
tra"%it 0aritat' irig#gra$ie' c#a"gi#gra$ie
rect#sig!#i)#sc#(ie' e*e"tua (ree*area )e 0i#(sii
CT
I7M
ex.c#(r##gic
!acr#sc#(ic 1"r. scau"e' ca"titate' as(ect& #!#ge" sau "u' c#"siste",'
cu#are' !ir#s4
ex. !icr#sc#(ic
(r@"% )e (regtire 2 ex. !icr#sc#(ic& $i0re "e)igerate
ex. (ara%it##gic
ex. c#(r#cit##gic 10acterii' !ucus' ceue )istruse4
ex. c<i!ic
)#%are caitati*& <e!#ragii #cute
ex. 0acteri##gic 1c#(r#cutur4
2.Eliminarea urinar
ex(#rri i!agistice
rx. re"a Psi!(P
ur#gra$ie i.*.
arteri#gra$ie
ec#gra$ie
exa!e" sc#(ic
sci"tigra$ie
ex. CT9sca"
I7M
ex(#rare a"at#!#9(at##gic 5 (u"c,ia90i#(sie
+.
i"*estiga,ii i!u"##gice
ex. uri"ei 1rec#tarea a sugar 3i c#(iu (@" a 3 L : a"iJ4
as(ect !acr#sc#(ic
ca"titate
se)i!e"t uri"ar' testADDIS
ex. 0acteri##gice& ur#cutur' <e!#cutur' exu)at $ari"gia"
ex. 0i#c<i!ice
(r#tei"urie
gic#%urie
(A uri"ar
#s!#aritate uri"ar
i#"#gra!a uri"ar
(r#)u3i )e rete",ie a%#tat 6" uri"
i(i)urie
cet#"urie
(ig!e",i 0iiari uri"ari
teste t#xic##gice caitati*e
ex. s@"ge
(r#tei"e (as!atice
i(i)e serice
creati"i"' uree
aci) uric
(A sa"g<i"
i#"#gra!
ASLO
teste )i"a!ice& ceara"ce9uri re"ae
+.Eliminarea cutanat
)#%ri <#r!#"ae
)#%ri t#xic##gice 1(seu)#c#i"estera%a seric4
testu su)#rii
-.Eliminrile genitale
Ex(#rarea a(aratuui ge"ita
ex(#rri i!agistice
<ister#sa(i"g#gra$ie
exa!e" sc#(ic
ec#gra$ie
CT
I7M
exa!e" a"at#!#9(at##gic a (r#0e#r 0i#(tice
exa!e" !icr#sc#(ic 3i 0acteri##gic )i" secre,iie *agi"ae
cur0a ter!ic
i"*estiga,ii ge"etice
)#%ri <#r!#"ae
Ex(#rarea ga")e#r a"exe 1s@"u4
ex(#rri i!agistice
+-
ter!#gra$ie
!a!#gra$ie
CT
I7M
ex. cit##gic a scurgeri#r !a!e#"areG cit##gie (ri" (u"c,ie
*E$aluarea pacientului Diagno"tice de nur"ing apro)ate de NANDA %266/'
===K8 Ma"age!e"t i")i*i)ua e$icie"t a rec#!a")ri#r tera(eutice
===HK Ma"age!e"t i")i*i)ua i"e$icie"t a rec#!a")ri#r tera(eutice
===K= Ma"age!e"t $a!iia i"e$icie"t a rec#!a")ri#r tera(eutice
===K+ Ma"age!e"t c#!u"itar i"e$icie"t a rec#!a")ri#r tera(eutice
===K: C#!(#rta!e"t (r#9sa"#ge" 1s(eci$icat4
===NN Me",i"ere i"e$icie"t a s"t,ii
==+-8 I"teres (e"tru a!ei#rarea rec#!a")ri#r tera(eutice
==+8- De$icit )e cu"#a3tere 1cu s(eci$icarea )e$icituui4
==+-+ B#te",ia (e"tru a!ei#rarea cu"#a3terii 1cu s(eci$icarea )#!e"iuui4
===HN N#"c#!(ia", 1s(eci$icarea "#"c#!(ia",ei4
===8H& De$icit a *#u!uui $ui)ic
===8K& 7isc (e"tru )e$icit a *#u!uui $ui)ic
===8-& Exces a *#u!uui $ui)ic
===8.& 7isc (e"tru )e%ec<ii0ru a *#u!uui $ui)ic
===+-& Deteri#rare a ei!i"rii uri"are
===83& 7ete",ie uri"ar
===8+& I"c#"ti"e", uri"ar t#ta
===8=& I"c#"ti"e", uri"ar $u"c,i#"a
===+H& I"c#"ti"e", uri"ar )e stres
===+N& I"c#"ti"e", uri"ar i!(eri#as
===+K& I"c#"ti"e", uri"ar re$ex
===88& 7isc (e"tru i"c#"ti"e", uri"ar i!(eri#as
==+--& I"teres (e"tru a!ei#rarea ei!i"rii uri"are
===+:& I"c#"ti"e", i"testi"a
===+3& Diaree
===++& C#"sti(a,ie
===+.& 7isc (e"tru c#"sti(a,ie
===+8& C#"sti(a,ie (erce(ut
==+38 Durere acut
==+33 Durere cr#"ic
==+3: Grea,
*,lanul de (ngri7ire
8nter$eniile a"i"tentei pentru meninerea independenei (n "ati"facerea nece"itii
a"igurrii eliminrilor
cercetea% )e(ri")erie )e i"cret 3i acti*itate $i%ic ae (acie"tuuiG rec#!a")
i"gestia u"ei ca"tit,i !i"i!e "ecesare sau !axi!e a)!ise )e ic<i)e 3i a u"#r
ai!e"te care $a*#ri%ea% ei!i"area )igesti*& $i0re
+H
cercetea% )e(ri")erie )e ei!i"are ae (acie"tuui 3i (a"i$ic (r#gra!u )e
ei!i"are' ,i"@") c#"t )e acti*it,ie (acie"tuui
(a"i$ic (r#gra!u )e acti*it,i $i%ice
6 6"*a, te<"ici )e reaxare
8nter$eniile a"i"tentei pentru recuperarea independenei (n "ati"facerea nece"itii
a"igurrii eliminrilor
1.Diaree
igie"a strict #ca 3i ge"era 1e*itarea tra"s!iterii )iareei i"$ec,i#ase4
(r#te?area (atuui 1!u3a!a' ae%4
a)!i"istrarea !e)ica,iei (rescriseG 6" ca%u a)!i"istrrii )e I!#)iu! se *a (re*e"i
(acie"tu asu(ra $a(tuui c acesta i!(ietea% asu(ra ca(acit,ii )e c#"ce"trare
re(aus )igesti* sau ai!e"ta,ie <i)ric 6" (ri!ee 8: #re
regi! cu !#rc#* $iert 3i #re%' ceai )e !e"t "e6")ucit sau 6")ucit cu guc#% 2
e*itarea ai!e"te#r "et#erate )e (acie"t
reec<ii0rare <i)r#eectr#itic 1(.#. cu sruri (e"tru re<i)ratare sau Ges# M (.e.*. 6"
ca% )e *rsturi as#ciate4
(regtirea (acie"tuui (e"tru ex(#rri' rec#tarea )e (r#0e 0i##gice (e"tru a"ai%e
(araci"ice
ec<ii0rare (si<ic
e)uca,ia (acie"tuui 3i $a!iiei
ei!i"area )i" regi! a ai!e"te#r "et#erate )e (acie"t 1i"t#era",a a
act#%' gute"4
e*itarea i"gestiei )e ai!e"te $ier0i",i M c#")i!e"tate 16" ca%u
(acie",i#r care au ex(eri!e"tat e(is#a)e a"teri#are )e )iaree 6" aceste
c#")i,ii4
e*itarea i"gestiei )e ca"tit,i !ari )e sucuri )e $ructe 16" ca%u u"#r
(acie",i acestea (#t (r#*#ca e(is#a)e )iareice4
(re(ararea' (strarea 3i c#"ser*area 6" c#")i,ii a)ec*ate a ai!e"te#r
1(e"tru (re*e"irea )iarei#r i"$ec,i#ase 3i t#xii"$ec,ii#r ai!e"tare4
regi! ai!e"tar cu !#rc#* $iert 3i #re%' e*e"tua a)!i"istrarea )e
a"ti)iareice 3i sus(e"sii 0acterie"e 1act#0acius aci)#(<ius4 6"
(eri#a)ee )e a)!i"istrare a u"#r a"ti0i#tice care (#t a*ea )re(t e$ect
a)*ers )iareea
2.1on"tipaie
igie"a strict' a(icare )e cre!e (r#tect#are a "i*eu #ri$iciuui a"a
rec#!a")are )e regi! a)ec*at 1ai!e"te cu $i0re' !iere )e a0i"e cu a( M (ru"e
uscate re<i)ratate 6" a(' <i)ratare su$icie"t %i"ic& +.== L 8===!4 2 ai!e"tee
0#gate 6" $i0re "u se *#r i"tr#)uce 0rusc 6" ai!e"ta,ie 1(#t cau%a $atue",' )iaree4
sta0iirea u"ui (r#gra! reguat )e ei!i"are
e*itarea ig"#rrii se"%a,iei )e )e$eca,ie 1a(a *a c#"ti"ua s se a0s#ar0 )i" !ateriie
$ecae )i" c##" 3i rect4 2 trata!e"tu a)ec*at a (at##giei #cae 1<e!#r#i%i' $isuri
a"ae4 (e"tru a (re*e"i ig"#rarea se"%a,iei )e )e$eca,ie )e $rica )urerii 2 6" ca%u
e<u%e#r se rec#!a")' )u( # "a3tere "atura' regi! ai!e"tar $r re%i)uuri 6"
(ri!ee %ie 1$rica )e )urere 6" !#!e"tu )e$eca,iei )u( e(i%i#t#!ie (#ate )uce a
c#"sti(a,ie secu")ar4
sta0iirea u"ui (r#gra! )e exerci,ii $i%ice
ec<ii0rarea (si<ic a (acie"tuui a crui !a"i$estare a $#st )eca"3at )e sc<i!0area
stiuui )e *ia, 1excursii' str!utare' sc<i!0area #cuui )e !u"c' etc.4
+K
regi! ai!e"tar a)ec*at 3i a)!i"istrarea )e axati*e 6" (eri#a)ee 6" care (acie"tu
(re)is(us a c#"sti(a,ie (ri!e3te !e)ica!e"te care au )re(t e$ect a)*ers 6"ceti"irea
tra"%ituui 1"arc#tice4 sau este i!#0ii%at a (at
(e"tru (acie"tu s(itai%at&
o!e)iu c#"$#rta0i ter!ic' 0a%i"et ca)' a(ica,ii ca)e
oasigurarea i"ti!it,ii (acie"tuui
oe*e"tua axati*e 1"u a (acie",ii cu )ureri a0)#!i"ae )e cau%
"e)iag"#sticat4' su(#%it#are cu giceri"' cis! e*acuat#are
ocis!a e*acuat#are *a $i e$ectuat cu a( a te!(eratura c#r(ui 1a(a rece
(r#*#ac <i(#ter!ie' a(a $ier0i"te (r#*#ac e%iu"i ae !uc#asei i"testi"ae4
o(regtirea (acie"tuui (e"tru ex(#rri' rec#tarea )e (r#0e 0i##gice (e"tru
a"ai%e (araci"ice
oec<ii0rare (si<ic
oJBACIENTUL CU AFECIUNI CA7DIO>ASCULA7E G7A>E "u se as a
0aie $r !eca"is! )e aertare L risc )e arit!iiJ
o!a"e*ra >asa*a 5 !a"e*r *aga ; se i"struiesc (acie",ii cu a$ec,iu"i
car)i#*ascuare' AIC' gauc#!' s ex(ire e"t 6" !#!e"tu )e$eca,iei
+.8ncontinena inte"tinal %de materii fecale' 0 encoprezi"
igie"a strict' a(icare #ca )e cre!e (r#tect#are
(urtare )e e"?erie s(ecia care a0s#ar0e ei!i"rie
exerci,ii (e"tru !uscuatura (eri"ea 1)ac (acie"tu "u are e%iu"i "eur##gice care
$ac i!(#si0i executarea #r4
ec<ii0rare (si<ic
-..rea# $r"turi 9 *e%i cursurie a"teri#are
/.Flatulen# meteori"m a)dominal
regi! ai!e"tar cu e*itarea ai!e"te#r $atue"te 1$as#e' !a%re' *ar%' cart#$' 6"
u"ee c##(atii a(te' etc.4 3i 0uturi#r car0#ga%#ase
trata!e"tu c##(atii#r )e $er!e"ta,ie M (utre$ac,ie' e"terite#r' )is(e(sii#r (#st
a"ti0i#tera(ie
a)!i"istrarea )e !e)ica!e"te a"ti$atue"te 1Cr0u"e !e)ici"aR' Es(u!isa"R4
(asarea )e tu0uri rectae 1tu0 )e ga%e4' e*e"tua cis! e*acuat#are
cre3terea acti*it,ii $i%ice a (acie"tuui
e)uca,ie 6" se"su (re*e"irii aer#$agiei 1i"gestie 6" gra0' cu a(etit exagerat4
9.Retenia de urin
*eri$icarea (re%e",ei g#0uui *e%ica
asigurarea u"ui !e)iu c#"$#rta0i 3i a i"ti!it,ii' 6"c%irea 0a%i"etuui a)us
(acie"tuui
a(icarea u"ei 0ui#te ca)e 6" regiu"ea <i(#gastric' i"tr#)ucerea !@i"i#r (acie"tuui
6" a( ca)
e*e"tua se as a(a a r#0i"et s curg 16" *eci"tatea (acie"tuui4
)ac aceste !a"e*re "u )au re%utate 1sau 6" $u"c,ie )e (at##gie4& s#")a? *e%ica'
e*e"tua s#") uri"ar Pa )e!eureP 2 6"gri?irea (urtt#ruui )e s#") uri"ar 1igie"
#ca' g#irea (u"gii c#ect#are' a*a? *e%ica' (#%i,i#"area c#rect a (u"gii c#ect#are
6" ti!(u #)i<"ei a (at4
6"*,area (#%i,iei c#recte (e"tru u3urarea e*acurii *e%icae 3i g#ire c#!(et
6" ca%u (acie",i#r cu e%iu"i "eur##gice& c#!(resie a0)#!i"a !a"ua a "i*e
<i(#gastric 1cu )egetee #rie"tate 6" ?#s4 2 reaxarea !uscuaturii (eri"eae 2 !a"e*ra
>asa*a& 6" !#!e"tu !ic,iu"ii
+N
e)ucarea (acie"tuui 9 c#"tr# (araci"ic (eri#)ic 3i 6" ca% )e $e0r 1risc )e ITU'
$a*#ri%at 3i )e !a"e*ra >asa*a a !ic,i#"are care (#ate i")uce re$ux *e%ic#9
uretera4
ec<ii0rare (si<ic
:.8ncontinena urinar
igie"a strict
(urtare )e e"?erie s(ecia care a0s#ar0e ei!i"rie
exerci,ii (e"tru !uscuatura (eri"euui 1)ac "u are e%iu"i "eur##gice care $ac
i!(#si0i executarea #r4& )e : #ri M %i 3i 6"ai"te 3i )u( !ic,iu"e' 6" serii )e +=
re(etri' $iecare c#"trac,ie cu )urat )e c@te : secu")e' 2 #(rirea ?etuui uri"ar 6"
ti!(u !ic,iu"ii 3i reuarea !ic,iu"ii )e !ai !ute #ri (e"tru )e(ri")erea c#"tr#uui
s$i"cteria" 2 cre3terea ca(acit,ii *e%icii uri"are (ri" a3te(tarea ti!( )e . !i"ute )e a
a(ari,ia se"%a,iei )e !ic,iu"e (@" a ei!i"are
sta0iirea u"ui #rar a ei!i"ri#r
e*e"tua !#"tarea u"ei s#")e uri"are Oa )e!eureP
re)ucerea i"gestiei )e ca$ea' ac##' ceai 1e$ect )iuretic4
ec<ii0rare (si<ic
;.<rinare prin prea plin
igie" strict
!#"tarea u"ei s#")e uri"are Oa )e!eurePG 6"gri?irea a)ec*at a acesteia 1igie"' a*a?
*e%ica' g#irea (u"gii c#ect#are' sc<i!0area s#")ei' su(ra*eg<erea as(ectuui uri"ei'
<i)ratare a)ec*at4
(regtirea (acie"tuui (e"tru trata!e"tu a)ec*at a a$ec,iu"ii cau%at#are 1cura
c<irurgica a a)e"#!uui )e (r#stat4
=.Enurezi" nocturn
(acie"tu "u 0ea ic<i)e )u( #ra +K
==
"u i"ger ai!e"te srate M (ica"te a !asa )e sear 1cresc se"%a,ia )e sete4
*a $i tre%it 6" cursu "#(,ii a #re $ixe 1# )at sau )e 8 #ri (e "#a(te4 (e"tru a uri"a
(r#te?area (atuui 1!u3a!a' ae%4
(regtirea (acie"tuui (e"tru !a"e*re ex(#rat#rii 9 i"*estigarea cau%e#r )e e"ure%is
1s(i"a 0i$i)a' etc.4
a)!i"istrarea !e)ica,iei rec#!a")ate
ec<ii0rare (si<ic
16.4ediment urinar patologic %!ematii# cilindri# leucocite# etc.'
6" $u"c,ie )e cau% se (rescriu
)urata re(a#suui a (at 16" GNA 2 (@" a "#r!ai%area $u"c,iei re"ae'
TA 3i se)i!e"tuui uri"ar4
uteri#r 1GNA4 L res(ectarea re(ausuui a (at (@" a "#r!aiSarea >SA
3i )is(ari,ia e)e!e#r 1a(r#xi!ati* 3 u"i4G cu e*itarea e$#rtuui $i%ic'
#rt#statis!uui (reu"git 3i ex(u"erii a $rig4
regi!u ai!e"tar 16" GNA L <i(#s#)at' <i(#(r#teic' cu a(#rt crescut )e
guci)e4
a(#rtu <i)ric 1GNA L 6" $u"c,ie )e sete4
!e)ica,ia a)ec*at 1i!u"#su(res#are' 6" GNDA (#ststre(t#c#cic L
Be"icii"a G')u( testare (reaa0i4
6" ca%u GNA L i"ter%icerea ser#tera(iei 3i i!u"i%ri#r 6" ur!t#ru a"
8=
)is(e"sari%are 3i c#"tr#ae (eri#)ice 1GNA' "e$r#(atii g#!eruare
cr#"ice L cu su(ra*eg<erea (eri#)ic a G' TA' exa!e"uui su!ar uri"'
ureei' creati"i"ei4
(re*e"irea i"$ec,ii#r uri"are
igie" #ca
e*itarea c#"ta!i"rii )e a "i*e a"a 6" ca%u (acie"te#r
6" ca%u (urtt#ri#r )e s#")& (u"ga c#ect#are se !e",i"e 6"t#t)eau"a a
u" "i*e i"$eri#r *e%icii uri"are
i"gestie ic<i)ia" crescut 6" a0se",a c#"trai")ica,ii#r
11.>ngri7irea pacientului dializat
<e!#)iai% M )iai% (erit#"ea& e)uca,ia (acie"tuui 6" (ri*i",a !a"e*re#r 6" si"e'
c@t 3i 6" (ri*i",a regi!uui )e *ia, 1<e!#)iai%a i!itea% i0ertatea )e !i3care a
(acie"tuui4 3i a c#!(ica,ii#r (#te",iae ae 0#ii 3i trata!e"tuui
a(#rt <i)ric %i"ic 5 )iure% 2 .== ! 2 (ier)erie extrare"ae
restric,ie )e T 6" ca% )e #igurie 1ai!e"te 0#gate 6" T L ci#c#at' 0a"a"e' etc.4
e)uca,ia (acie"tuui (e"tru 6"*,area 3i res(ectarea regi!uui )e restric,ie (r#teic
RE.8M DE RE4?R81@8E ,R2?E81A
0000000000000000000000000000000000000000
AB8MEN?E 1< 12N@8N<? 1RE41<? >N ,R2?E8NE
Fiecare porie indicat conine / g. de proteine.
Ca tre)ui " con"umai DD. porii# deci DD.g. proteine pe zi.
1antitile indicate "e refer la alimentele cEntrite (n "tare crud &i curate.
(@i"e a0 "esrat .= g u" #u 1 .= g4 + 0uc.
(@i"e "eagr "esrat -= g ci#c#at !e"a? -= g
$ai" )e gr@u .= g s(ara"g<e 8== g
$ai" )e (#ru!0 .= g $as#e *er)e 8== g
#re% H. g cart#$i "#i 3== g
a(te )e *ac +.= g cart#$i *ec<i 8.= g
iaurt +:= g $as#e uscat 8. g
s!@"t@" 8== g i"te 8= g
0r@"% )e *ac 3. g !a%re *er)e H. g
$ri3c 88. g !a%re uscat 8= g
car"e (r#as(t 8. g !a%re c#"ser*at +.= g
(e3te )e r@u 8. g ciu(erci +.= g
0000000000000000000000000000000000000000000000000000000000
AB8MEN?E 1< 12N@8N<? 41AF<? 4A< B8,48?E DE ,R2?E8NE
,ot fi con"umate fr re"tricie. %atenie la coninutul (n pota"iu al unor fructe'
r#3ii !ere %a<r
s(a"ac (ere (r#)use %a<ar#ase
*ar% struguri )uce,uri
!#rc#*i (iersici !iere )e a0i"e
car#te caise uei )e !si"e
s$ec r#3ie 0a"a"e u"t
,ei" (#rt#cae u"tur
ri)ic<i !@i ceai
castra*e,i gre($rut ca$ea
)#*ecei a"a"as
(tuci cur!ae
8+
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12.Diaforeza
igie"a strict' !e",i"erea uscat a tegu!e"te#r
sc<i!0area e"?eriei )e (at 3i c#r( $rec*e"t
se rec#!a") e"?erie 3i <ai"e )i" 0u!0ac' cu e*itarea $i0re#r arti$iciae
<i)ratare su$icie"t 1c#!(e"sarea (ier)eri#r4
trata!e"tu a$ec,iu"ii cau%at#are 1a)!i"istrarea !e)ica,iei rec#!a")ate4
6" ca%u 6" care "u se )eceea% sau "u se (#ate trata a$ec,iu"ea cau%at#are 9
trata!e"te )er!at#c#s!etice 1i"?ectri cu t#xi" 0#tui"ic L a i")ica,ia
)er!at##guui4
ec<ii0rare (si<ic
1+.?egumente u"cate
igie"a strict
e*itarea ex(u"erii (reu"gite a *@"t M s#are
<i)ratare c#res(u"%t#are #ra
a(icarea )e cre!e <i)rata"te 3i (r#tect#are
1-.Eliminri genitale patologice
igie"a strict
(regtirea (acie"tei (e"tru ex(#rri
rec#tarea )e (r#0e 0i##gice (e"tru a"ai%e (araci"ice
a)!i"istrarea !e)ica,iei rec#!a")ate 1(re(arate <#r!#"ae' a"ti0i#tice' a"ti!ic#tice'
a"tagice4
1/.Eliminri genitale inadec$ate5 menoG H metroragii
igie"a strict
(a"sa!e"t a0s#r0a"t
re(a#s a (at
(r#te?area (atuui 1!u3a!a' ae%4
reec<ii0rare *#e!ic (. #. ' reec<ii0rare *#e!ic (.e.*.' tra"s$u%ii 1)e s@"ge
i"tegra' !as eritr#citar' c#"ce"trat euc#9(ac<etar' (as! (r#as(t4
a i")ica,ia !e)icuui& !e)ica,ie <e!#static' e*e"tua (regtirea (e"tru !e3a? uteri"
a)!i"istrarea at#r !e)ica!e"te' a i")ica,ia !e)icuui 1(re(arate <#r!#"ae'
a"ti0i#tice' a"tagice4
(regtirea (acie"tei (e"tru ex(#rri
rec#tarea )e (r#0e 0i##gice (e"tru a"ai%e (araci"ice
(regtirea (acie"tei (e"tru actu c<irurgica tera(eutic 1e*e"tua4
19.>ngri7irea "tomelor
1olo"tomii
igie" c#res(u"%t#are
6"gri?irea tegu!e"te#r )i" ?uru st#!ei& a(icare' )u( t#aet #ca' )e cre!e
(r#tect#are
regi! ai!e"tar a)ec*at (#st#(erat#riu 1*e%i cursu a"teri#r4
a(#i 9 regi! ai!e"tar (e"tru #0,i"erea u"ui scau" c#"siste"t& cu a?ut#ru #0ser*a,ii#r
(acie"tuui 2 ai!e"tee srace 6" grsi!i 3i $i0re *#r $i (re$erate' *a e*ita ic<i)ee
reci 3i cru)it,ie
g#irea (u"gii )e c##st#!ie 6" !#!e"tu 6" care aceasta este (i" (e ?u!tate sau 3
s$erturi
88
sc<i!0area (u"gii )e c##st#!ie atu"ci c@") ei!i"area este ce !ai (u,i" (r#0a0i
1)i!i"ea,a' 6"ai"tea i"gestiei )e ic<i)e M ai!e"te4
!e)iu c#"$#rta0i' asigurarea i"ti!it,ii (acie"tuui 6" ti!(u !a"e*re#r
e)ucarea (acie"tuui 1igie"a' g#irea 3i 6"#cuirea (u"gi#r' (r#gra! a ei!i"ri#r 6"
ca% )e c##st#!ie (e c##"u tra"s*ers sau )esce")e"t4
rei"tegrare s#cia
ec<ii0rare (si<ic 1i"cusi* c#"siiere sexua4
e)uca,ia $a!iiei
<ro"tomii
igie" a)ec*at
(u"ga c#ect#are se !e",i"e 6" (er!a"e", su0 "i*eu st#!ei (e"tru a (re*e"i
re$uxu 3i ast$e i"$ec,iie uri"are
6" cursu "#(,ii& (#%i,i#"area c#rect a (u"gii c#ect#are (e"tru a (re*e"i #0struc,ia
(ri" c#!(resie asu(ra cateteruui
su(ra*eg<erea as(ectuui uri"ei
g#irea c#rect a (u"gii c#ect#are
a*a? *e%ica 16" ca%u cist#st#!ii#r4
i"gestie <i)ric a)ec*at
rei"tegrare s#cia
ec<ii0rare (si<ic
e)uca,ia $a!iiei
83
Ii)liografie cur"
+. A"t#<e Iea"a' Fer!e3a"u Mi<aea Car!e" Elemente de nursing clinic E). Uu"i!ea Ia3i
8==3
8. Eru""er LS' S!it< Su))art< D Textbook of Medical-Surgical ursing -
t<
E)iti#"' UE
Li((i"c#tt C#!(a"S' B<ia)e(<ia +NKK
3. Ua!ies#" EM' McCa UM' ESt<e 7 !uidelines for "linical ursing #ractices C<urc<i
Li*i"gst#"e E)i"0urg<' +NKK
:. Sta"ciu Car# Semiologie medical $ "%&S E)i,ia a 8a +NN8
.. Te#)#rescu Exarcu I' Ea)iu G 'iziologie E). Me)ica Eucure3ti +NN3
8: