Proceduri de Practica Pentru Asistentii Medicali Generalisti - 788 - 1560

ANEXA
PROCEDURI DE PRACTIC
PENTRU ASISTENII MEDICALI GENERALITI
PROCEDURI DE PRACTIC
PENTRU ASISTENII MEDICALI GENERALITI
CUPRINS pag.2-7
1
PARTEA I PREVENIREA INFECIILOR NOZOCOMIALE pag.8
Capitolul 1 CONTROLUL INFECIILOR pag.8
1.1 Definiii, factoi !i "#"e $e conta%inae, c&i $e tan"%itee pag.8
1.2 'o(itici !i poga%e $e "#pa)eg*ee !i conto( a infecii(o pag.+
1., -*i$ $e peca#ii #ni)e"a(e pag.1.
1./ 0p&(aea %1ini(o pag.12
1.2 'eca#ii $e pe)enie a infecii(o tan"%i"e pe ca(e aeian& pag.12
1.3 'eca#ii $e pe)enie a infecii(o tan"%i"e pin pic&t#i(e F(#gge pag.13
1.7 'eca#ii $e pe)enie a infecii(o tan"%i"e pin contact $iect c#
"eceii(e "a# o4iecte(e conta%inate pag.17
1.8 'eca#ii $e pe)enie a infecii(o (a pacieni c# ne#topenie pag.18
1.+ Uti(i5aea ec*ipa%ent#(#i $e i5o(ae pag.1+
2
PARTEA II INTERVENII AUTONOME pag.2.
Capitolul I-IEN6 7I CONFORTUL '6CIENTULUI pag.2.
2.1 0c*i%4aea (en8eiei $e pat f&& pacient pag.2.
2.2 0c*i%4aea (en8eiei $e pat c# pacient i%o4i(i5at pag.21
2., 0c*i%4aea (en8eiei $e cop a pacient#(#i i%o4i(i5at (a pat pag.22
2./ Toa(eta pacient#(#i i%o4i(i5at (a pat pag.2/
2.2 0c*i%4aea po5iiei pacient#(#i i%o4i(i5at, a$ina%ic pag.,1
2.3 9o4i(i5aea pacient#(#i pag.,2
2.7 Captaea e(i%in&i(o pag.,/
Capitolul ! 6LI9ENT6RE6 :OLN6;ULUI pag.,2
,.1 6(i%entaea acti)& pag.,2
,.2 6(i%entaea pa"i)& pag.,2
Capitolul " 9<0UR6RE6 0I 0U'R6;E-=ERE6 FUNCIILOR ;IT6LE
7I 6 6LTOR '6R69ETRI pag ,3
/.1 9&"#aea !i notaea te%peat#ii pag.,3
/.2 9&"#aea !i notaea p#("#(#i pag.,8
/., 9&"#aea !i notaea pe"i#nii "1nge(#i pag./.
/./ 9&"#aea !i notaea e"piaiei pag./,
/.2 9&"#aea >n&(i%ii !i ge#&ii copoa(e pag./2
PARTEA III INTERVENII DELEGATE #$%$&tuat$ 'u( p)$'&)ip*i$ +$,i&ala- pag./3
Capitolul . 'RELE;<RI ?RECOLT<RI@ 'ENTRU EA69ENE DE
L6:OR6TOR pag./3
2.1 Reco(taea "1nge(#i pent# eBa%ene $e (a4oato pag./3
2.2 Reco(taea po4e(o $e #in& pent# eBa%ene $e (a4oato pag.3.
2., Reco(taea %ateii(o feca(e pent# eBa%ene $e (a4oato pag.32
2./ Reco(taea eB#$at#(#i faingian pag.33
2.2 Reco(taea "p#tei pin eBpectoaie pag.37
2.3 Reco(taea "eceiei #eta(e (a 4&4at pag.3+
2.7 Reco(taea "eceiei p##(ente $in (e5i#ni pag.7.
2.8 Reco(taea "eceii(o ce)ico-)agina(e pag.7.
Capitolul / 6D9INI0TR6RE6 9EDIC69ENTELOR pag.7,
3.1 6"pecte genea(e pag.7,
3.2 6$%ini"taea %e$ica%ente(o pe ca(e oa(& pag.7/
3., 6$%ini"taea %e$ica%ente(o pin in8ecii paentea(e pag.73
3./ 6$%ini"taea %e$ica%ente(o pin in8ecii inta%#"c#(ae pag.77
3.2 6$%ini"taea %e$ica%ente(o pin in8ecii inta%#"c#(ae, %eto$a CDE pag.7+
3.3 6$%ini"taea %e$ica%ente(o pin in8ecii "#4c#tnate pag.8.
3.7 6$%ini"taea %e$ica%ente(o pin in8ecii inta$e%ice pag.82
3.8 6$%ini"taea %e$ica%ente(o pin in8ecie inta)enoa"& $iect& pag.8,
3.+ 6$%ini"taea %e$ica%ente(o pe %#coa"a co8#ncti)a(& pag.82
3.1. 6$%ini"taea %e$ica%ente(o pe ca(e na5a(& pin in"ti(aie pag.87
,
3.11 6$%ini"taea %e$ica%ente(o >n con$#ct#( a#$iti) eBten pin in"ti(aie pag.8+
3.12 6$%ini"taea %e$ica%ente(o pe teg#%ente pag.+.
3.1, 6$%ini"taea %e$ica%ente(o pe ca(e ecta(& pag.+2
3.1/ 6$%ini"taea %e$ica%ente(o pe "on$a na5oga"tic& !i ga"to"to%& pag.+,
3.12 6$%ini"taea %e$ica%ente(o pe cae )agina(& pag.+/
Capitolul 0 TER6'II ;60CUL6RE pag.+3
7.1 9ontaea catete#(#i )eno" peifeic pent# pef#5ii pag.+3
7.2 9enineea !i >ngi8iea #nei (inii )enoa"e eBi"tente pag.++
7., Fn$epataea $i"po5iti)#(#i inta)eno" peifeic pag.1.1
7./ 'aticipaea (a p#neea !i >n$epataea catete#(#i )eno" centa( pag.1.2
7.2 Tan"f#5ia "ang#in& pag.1.2
7.3 'otoco( $e in)e"tigaeG>negi"tae a #nei eacii ac#te tan"f#5iona(e pag.1.+
7.7 6ntotan"f#5ia ?tan"f#5ia a#to(og&@ pag.1.+
Capitolul 1 0OND6HE, 0'<L<TURI, CLI09E pag.11.
8.1 T#4a8#( na5oga"tic pag.11.
8.2 0p&(&t#a ga"tic& pag.112
8., T#4a8#( $#o$ena( pag.11/
8./ 0on$a8#( )e5ica( (a fe%eie pag.112
8.2 0on$a8#( )e5ica( (a 4&4at pag.113
8.3 0p&(&t#a )e5ica(& pag.117
8.7 C(i"%a e)ac#atoie pag.11+
8.8 Into$#ceea t#4#(#i $e ga5e pag.121
PARTEA IV INTERVENII LA CARE ASISTENTUL MEDICAL
PARTICIP ALTURI DE MEDIC pag.122
Capitolul 2 '6RTICI'6RE6 60I0TENTULUI 9EDIC6L L6 'UNCII pag.122
+.1 6"pecte genea(e pag.122
+.2 'aticipaea (a toacocente5& pag.12,
+., 'aticipaea (a efect#aea p#nciei peitonea(e ?paacente5a a4$o%ina(&@ pag.12,
+./ 'aticipaea (a p#ncia peica$ic& pag.122
+.2 'aticipaea (a p#ncia a*i$ian& pag.123
+.3 'aticipaea (a p#ncia atic#(a& pag.128
+.7 'aticipaea (a p#ncia o"oa"& ?%e$#(a&@. :iop"ia %e$#(a& pag.1,.
+.8 'aticipaea (a p#ncia )e5icii #inae pag.1,1
+.+ 'aticipaea (a p#ncia 4iop"ic& pag.1,,
a@ '#ncia 4iop"ic& *epatic& pag.1,,
4@ '#ncia 4iop"ic& ena(& pag.1,/
c@ '#ncia 4iop"ic& a #n#i no$#( %a%a pag.1,3
/
Capitolul 13 '6RTICI'6RE6 60I0TENTULUI 9EDIC6L L6 EA69IN<RI
I96-I0TICE
pag.1,8
a@ 'eg&tiea pacient#(#i !i paticipaea (a eBa%inaea a$io(ogic&
a "i"te%#(#i o"teoatic#(a pag.1
/. 4@ 'eg&tiea pacient#(#i !i paticipaea (a eBa%inaea a$io(ogic&
a ogane(o toacice pag.1
/. c@ 'eg&tiea pacient#(#i !i paticipaea (a eBa%inaea a$io(ogic&
a t#4#(#i $ige"ti) ?tan5it 4aitat, eBa%inaea co(on#(#i@ pag.1
/. $@ 'eg&tiea pacient#(#i !i paticipaea (a eBa%inaea co(eci"t#(#i
!i c&i(o 4i(iae pag.1
/2 e@ 'eg&tiea pacient#(#i !i paticipaea (a eBa%inaea a$io(ogic&
a apaat#(#i ena( pag.1
/2 f@ 'eg&tiea !i paticipaea (a eBa%inaea a$io(ogic& a
"i"te%#(#i ne)o" pag.1
/7
1..1 'aticipaea (a eBa%ene a$io(ogice, a"pecte genea(e pag.1,8
1..2 'aticipaea (a eBa%ene c# i5otopi a$ioacti)i ?"cintigafie@ pag.1/8
1.., 'aticipaea (a eBa%ene c# #(ta"#nete ec*ogaficeI
ec*ogafii, ec*oen$o"copii pag.122
Capitolul 11 '6RTICI'6RE6 60I0TENTULUI 9EDIC6L L6
EA69ENE ENDO0CO'ICE pag.122
11.1 6"pecte genea(e pag.122
11.2 'aticipaea (a efect#aea e"ofagoga"to$#o$eno"copie pag.123
11., 'aticipaea (a efect#aea co(ono"copiei pag.128
11./ 'aticipaea (a efect#aea ecto"ig%oi$o"copiei pag.12+
11.2 'aticipaea (a 4on*o"copie pag.13.
11.3 'aticipaea (a toaco"copie pag.131
11.7 'aticipaea (a ci"to"cpie pag.132
11.8 'aticipaea (a ato"copie pag.13/
11.+ 'aticipaea (a (apao"copie pag.132
PARTEA V 4 5NGRI6IRI SPECIALE pag.133
Capitolul 1 FN-RIHIRI FN :OLILE 6'6R6TULUI RE0'IR6TOR pag.133
2
12.1 Ra$iogafie p#(%onaa "tan$a$ pag.133
12.2 :on*ofi4o"copie pag.137
12., Toacocente5a ?p#nctia p(e#a(&@ pag.13+
12./ I.D.R. (a t#4ec#(in& pag.17.
12.2 0pio%etia pag.171
12.3 6"ipiaia ta*eo-4on!ic& pag.172
12.7 Dena8#( p(e#a( pag.17/
12.8 OBigenoteapie pag.177
12.+ 6eo"o(oteapie pag.178
Capitolul 1! FN-RIHIRI FN :OLI C6RDIO;60CUL6RE pag.17+
1,.1 EBa%inaea a$io(ogic& a apaat#(#i ca$io)a"c#(aI
angioca$iogafia, aotogafia, ateiogafia, f(e4ogafia pag.17+
1,.2 To%ogafia co%p#tei5at& pag.181
3
1,., c*ogafia tan"e"ofagiana pag.181
1,./ '#nctia peica$ic& pag.181
1,.2 Fnegi"taea E.C.-. >n epa#" !i >n efot pag.181
1,.3 9onitoi5aea =o(te pag.18,
1,.7 0#pa)eg*eea pacient#(#i tatat c# $i#etice >n ca$io(ogie pag.18/
1,.8 0#pa)eg*eea pacient#(#i tatat c# $igita(ice pag.182
Capitolul 1" FN-RIHIRI FN -60TROENTEROLO-IE pag.182
1/.1 EBa%inaea a$io(ogic& a apaat#(#i $ige"ti) pag.1
82 1/.2 EBa%inaea en$o"copic& a ogane(o $ige"ti)e pag.1
82 1/., EBa%inaea ec*ogafic& a ogane(o $ige"ti)e pag.1
83 1/./ EBa%inaea c# i5otopi a$ioacti)i pag.1
83 1/.2 '#ncia a4$o%ina(& pag.1
83 1/.3 '#ncia 4iop"ic& *epatic& pag.1
83 1/.7 0p&(&t#a ga"tic& pag.1
83 1/.8 6"piaia ga"tic& pag.1
83 1/.+ 6(i%entaia pin "on$a na5o-ga"tic& pag.1
88 1/.1. 6(i%entaia pin ga"to"to%& pag.1
88 1/.11 Fngi8iea pacient#(#i co(o"to%i5at-"c*i%4aea p#ngii pag.1
8+ 1/.12 Efect#aea iigaiei co(ice ?c(i"%a pe co(o"to%&@ pag.1
+1
Capitolul 1. FN-RIHIRI FN URONEFROLO-IE pag.1+,
12.1 EBa%inaea a$io(ogic& a apaat#(#i ena( pag.1
+, 12.2 EBa%inaea en$o"copic& a )e5icii #inae pag.1
+, 12., EBa%inaea ec*ogafic& pag.1
+, 12./ EBa%inaea c# i5otopi a$ioacti)i. 0cintigafia ena(& pag.1
+, 12.2 '#ncia 4iop"ic& ena(& pag.1
+, 12.3 0on$a8#( )e5ica( pag.1
+, 12.7 '#ncia )e5ica(& pag.1
+, 12.8 0p&(&t#a )e5ica(& pag.1
+, 12.+ 0#pa)eg*eea pacient#(#i c# "on$& pe%anent& pag.1
+,
Capitolul 1/ FN-RIHIRI FN :OLI 9ET6:OLICE pag.1+2
13.1 -(ice%ia capi(a& pag.1
+2 13.2 Te"t#( to(eaniei (a g(#co5a oa(& ?TT-O@ pag.1
+3 13., Dete%inaea *e%og(o4inei g(ico5i(ate ?g(icata@ pag.1
+7 13./ 6$%ini"taea in"#(inei pag.1
+7 13.2 Ro(#( a"i"tent#(#i %e$ica( >n cetoaci$o5a $ia4etic& pag.2
.. 13.3 Ro(#( a"i"tent#(#i %e$ica( >n *ipog(ice%ie pag.2
.1
Capitolul 10 FN-RIHIRI FN :OLI DER96TOLO-ICE pag.2./
17.1 'e(e)aea 4acteio(ogic& $in p#"t#(e pag.2
./ 17.2 'e(e)aea po$#"e(o %icotice $e (a ni)e(#( %#coa"e(o pag.2
./ 17., 'e(e)aea c#tanat& >n $e%atofite pag.2
.2 17./ :iop"ia c#tanat& pag.2
.3 17.2 Fngi8ii >n can$i$o5a 4#ca(& pag.2
.7
7
17.3 Fngi8ii >n intetigo %ico5ic pag.2
.7 17.7 Fngi8iea pacient#(#i c# #(ce $e ga%4& pag.2
.8 17.8 Fngi8iea picioae(o (a #n pacient c# ei5ipe( pag.2
.8
Capitolul 11 FN-RIHIRI FN 6FECIUNI NEUROL-ICE pag.2.+
18.1 9ie(ogafia pag.2.+
18.2 E(ectoencefa(ogafia pag.21.
18., E(ecto%iogafia pag.211
18./ 0co#( -(a"goJ pag.211
Capitolul 12 FN-RIHIRI FN 6FECIUNI OFT6L9OLO-ICE pag.21,
1+.1 Dete%inaea ac#it&ii )i5#a(e pag.2
1, 1+.2 Tono%etia oc#(a& pag.2
1/ 1+., Ofta(%o"copia $iect& pag.2
1/ 1+./ Dete%inaea c1%p#(#i )i5#a( pag.2
12 1+.2 Dete%inaea "i%#(#i co%atic pag.2
17 1+.3 Fngi8ii pe !i po"t opeatoii >n afeci#ni oc#(ae c*i#gica(e pag.2
1+
Capitolul 3 FN-RIHIRI FN O.R.L. pag.21+
2..1 9ane)a =ei%(ic* pag.21+
2..2 0p&(&t#a a#ic#(a& pag.22.
2.., Te"te a#$iti)e ?a#$io%etia@ pag.221
21.
1
Fngi8ii peopeatoii pag.2
22 21.
2
Fngi8ii po"topeatoii pag.2
23 21.
,
'i%a %o4i(i5ae pag.2
27 21.
/
Te*nica genea(& a pan"a%ent#(#i pag.2
28 21.
2
64(aia fie(o $e "#t#& "a# a agafe(o pag.2
2+ 21.
3
Dena8#( pag.2
,1
Capitolul 1 FN-RIHIRI FN 6FECIUNI C=IRUR-IC6LE pag.222
Capitolul FN-RIHIRI FN 6FECIUNI -INECOLO-ICE pag.2,2
22.1 Reco(taea "eceii(o ce)ico)agina(e pent# eBa%ene
$e (a4oato pag.2,2
22.2 '#ncia f#n$#(#i $e "ac Do#g(a" pag.2,2
22., EBa%inaea en$o"copic&I *i"teo"copia !i co(po"copia pag.2,,
22./ EBa%inaea a$io(ogic& K *i"teo"a(pingogafia pag.2,3
22.2 0p&(&t#a )agina(& pag.2,8
22.3 6$%ini"taea %e$ica%ente(o pe ca(e )agina(& pag.2,+
Capitolul ! FN-RIHIRI FN 'EDI6TRIE pag.2,+
8
2,.1 0#pa)eg*eea f#ncii(o )ita(e (a copi(, !i a a(to paa%eti pag.2,+
2,.2 'e(e)aea po4e(o pent# (a4oato (a "#ga !i copi(#( %ic pag.2/2
a@ 'e(e)aea "1nge(#i pent# eBa%ene $e (a4oato pag.2/2
- Reco(taea "1nge(#i pin >nep&t#a c&(c1i#(#i pag.2/2
- Reco(taea "1nge(#i pin p#ncie )enoa"& pag.2/,
4@ 'e(e)aea po4e(o $in #in& pag.2//
+
c@ 'e(e)aea po4e(o $in "ca#n pag.2//
2,., Fngi8iea p(&gii o%4i(ica(e pag.2//
2,./ 0#pa)eg*eea no#-n&"c#t#(#i >n inc#4ato pag.2/2
2,.2 0#pa)eg*eea no#-n&"ct#(#i "#4 fototeapie pag.2/7
2,.3 Efect#ae in8eciei inta%#"c#(ae (a "#ga pag.2/8
2,.7 6$%ini"taea %e$ica%ente(o pe ca(e oa(& (a copi( pag.2/+
22.8 9&"#i >n ca5#( #no eacii ap&#te $#p& a$%ini"taea
%e$ica%ente(o (a copi( pag.22.
Capitolul " FN-RIHIRI FN -ERI6TRIE pag.221
2/.1 Noi#ni into$#cti)e pag.2
21 2/.2 E)a(#aea f#nciona(& a )1"tnic#(#i pag.2
21 2/., Fngi8ea pe"oane(o )a1"tnice. 'atic#(ait&i (egate $e
pato(ogia )1"tnic#(#i pag.2
2, 2/./ T#(4#&i $e "o%n pag.2
2, 2/.2 De%ena pag.2
22 2/.3 C&$ei(e pag.2
23 2/.7 0in$o%#( $e i%o4i(i5ae a( )1"tnic#(#i pag.2
3. 2/.8 Fncontinena #ina& pag.2
32
PARTEA I 4 PREVENIREA INFECIILOR NOZOCOMIALE
Capitolul 1 CONTROLUL INFECIILOR
1.1 D$%i7i*i$8 %a&to)i 9i 'u)'$ ,$ &o7ta+i7a)$8 &:i ,$ t)a7'+it$)$
D$%i7i*i$
Infecia no"oco%ia(& ?IN@ e"te infecia contactat& >n #nit&i "anitae c# pat#i ?$e "tat !i pi)ate@,
cae "e efe& (a oice 4oa(& infecioa"& ce poate fi ec#no"c#t& c(inic !iG"a# %ico4io(ogic !i
pent# cae eBi"t& $o)a$a epi$e%io(ogic& a contact&ii >n ti%p#( "pita(i5&ii?act#(#i %e$ica( "a#
%ane)e(o %e$ica(e, cae afectea5& fie pacient#( K $atoit& >ngi8ii(o %e$ica(e pi%ite, fie
pe"ona(#( %e$ica( K $atoit& acti)it&ii "a(e !i e"te (egat& pin inc#4aie $e peioa$a a"i"t&ii
%e$ica(e >n #nitatea e"pecti)&, in$ifeent $ac& "i%pto%e(e 4o(ii apa "a# n# apa pe peioa$a
"pita(i5&ii
Fa&to)i 9i 'u)'$ ,$ &o7ta+i7a)$ i7t)a'pitali&$9ti
1.
6genii e"pon"a4i(i $e conta%inae "#nt foate n#%eo!i. Ei $ete%in& infecii %ai %#(t "a# %ai
p#in ga)e. 6$e"ea $e)in e5i"teni (a tata%ente.
6genii patogeni "a# %ico4ii ?n#%e geneic $at $e 'a"te# ogani"%e(o #nice(#(ae in)i5i4i(e
c# oc*i#( (i4e@ "#ntI
- 4acteii(e aeo4e !i anaeo4e $in gen#( coci(o !i 4aci(i(oL
- ci#peci "a# (e)#i cae $ete%in& %ico5eL
- paa5iii e"pon"a4i(i $e paa5ito5eL
- )i#"#i(e ?*epatotope, ne#otope, etc.@L
- pionii.
0#"e(e $e conta%inae >n "pita( "#nt epe5entate
$eI
- pacieniL
- pe"ona( $e >ngi8ieL
- )i5itatoiL
- ec*ipa%ente !i "#pafee conta%inate, eB. (en8eie $e pat, "a(te(e, toa(ete co%#ne, etc.L
- "eceii, eBceii, po4e $e (a4oato, &niGp(&giL
- %ateia(e #ti(i5ate conta%inateL
- a(i%entaie.
'acienii "pita(e(o "#nt %ai "#"cepti4i( (a infecii $atoit& e5i"tenei nat#a(e $i%in#ate $e 4oa(&
"a# $e #ne(e %e$ica%ente ?i%#no$epe"oae, c*i%ioteapice@.
Toa(ete(e co%#ne "a# poBi%itatea a(to pacieni %&e"c i"c#( infecii(o >nc#ci!ate.
C:i ,$ t)a7'+it$)$
'incipa(e(e c&i $e tan"%itee a infecii(o
"#ntI
- tan"%iteea inte#%an&, cea %ai fec)ent& e"te pin inte%e$i#( %1ini(oL
- ca(ea aeian&, pin t#"e, "t&n#t, eBpectoaie ?pic&t#i(e (#i F(#gge@, e"te e"pon"a4i(& $e
apaiia #n#i pocent $e 1.M $inte infecii(e no"oco%ia(e. 6eo"o(ii $in $i"po5iti)e(e $e
c#&ae "a# $in "eingi pot tan"pota patic#(e %ico"copice a(e ogani"%e(o cae "e
g&"e"c >n "#"pen"ie >n ae !i cae pot fi in*a(ate c# #!#in&L
- inoc#(ae c# ace "a# "o(#ii conta%inateL
- penetaea ogani"%#(#i c# oca5ia "on$a8e(o #inae, int#4aiei oota*ea(e, inci5iei
opeatoii.
1.2 Politi&i 9i p)o;)a+$ ,$ 'up)a<$;=$)$ 9i &o7t)ol a i7%$&*iilo)
'ent# a >n$#%a in"tit#ii(e f#ni5oae $e >ngi8ii %e$ica(e >n efot#i(e (o $e a ine "#4 conto(
infecii(e, >n an#( 1+7., cente(e pent# conto(#( 4o(i(o a# p#4(icat #n %an#a( cae $eta(ia 7
categoii $e poce$#i $e i5o(ae. Reco%an$&i(e a# fo"t e)i5#ite >n an#( 1+8, c# #%&toae(e
"cop#iI
- e$#ceea poce$#i(o in#ti(eL
- #ti(i5aea poce$#i(o in)a5i)e >n #nit&i(e $e >ngi8ie inten"i)&L
- contacaaea &"p1n$iii ageni(o patogeni e5i"teni (a tata%ent.
Fn an#( 1+82, cente(e pent# conto(#( 4o(i(o !i pe)enie into$#c peca#i#ni(e #ni)e"a(e pin
cae "e eco%an$& pe"ona(#(#i %e$ica( "& poate ec*ipa%ent#( $e potecie pent# a e$#ce
po"i4i(itatea contact#(#i $iect c# "1nge(e !i a(te f(#i$e po)enite $e (a pacieni.
11
Fn 1++3, cente(e pent# conto(#( 4o(i(o !i pe)enie a# into$#" peca#i#ni(e "tan$a$ ca 4a5& a
no%e(o $e i5o(ae. 6# fo"t a$&#gate peci5&i pi)in$ a(te , c&i $e conta%inae !i potocoa(e(e
"tan$a$ c# "cop#( pe)eniii tan"%iteii infecii(o >n 1n$#( pacieni(o, pe"ona(#(#i !i
)i5itatoi(o.
Fn pe5ent >n toate "pita(e(e eBi"t& $epata%ent#( $e "#pa)eg*ee !i conto( a infecii(o
inta"pita(ice!ti cae co(ectea5& $ate pi)in$ epi"oa$e(e infecioa"e !i "&n&tatea pe"ona(#(#i !i
cae f#ni5ea5& info%aii pi)in$ i"c#i(e potenia(e. L#na "a# ti%e"tia( fiecae "ecie
apotea5&, c&te ace"t $epata%ent, n#%&#( !i tip#( $e infecii inta"pita(ice!ti. Fn f#ncie $e
po(itica "pita(#(#i "e pop#n %&"#i $e a#$it !i $e co%4atee a ace"to infecii.
'o(itici(e !i poce$#i(e $e conto( a infecii(o te4#ie "& fie c(ae !i c#no"c#te $e >nteg#(
pe"ona( %e$ica(. 'ent# a ine "#4 conto( infecii(e "#nt $i"poni4i(e #%&toae(e %i8(oaceI
$econta%inaea, c#&enia, $e5infecia, anti"ep"ia !i "tei(i5aea.
D$&o7ta+i7a)$a, >n pactica %e$ica(&, "e a$e"ea5& eBc(#"i) %ateia(#(#i %#$a !i "e ap(ic&
%ateia(e(o inete ?"#pafee, in"t#%ente@. 6e $ept "cop $i%in#aea n#%&#(#i $e
%icoogani"%e >nainte $e c#&ae, pote8aea pe"ona(#(#i $e o conta%inae ?in"t#%ente $e (a
"a(a $e pan"a%ente "a# "a(a $e opeaii@ !i e)itaea $i"e%in&ii %icoogani"%e(o >n %e$i#(
>ncon8#&to.
Cu):*$7ia e"te aci#nea cae con"t& >n >n$ep&taea %#$&iei ?"p&(aea po$e(e(o, "#pafee(o
$e (#c#, etc.@ !i pece$e ce(e(a(te opeaii c# eBcepia $econta%in&ii ?eBI in"t#%ente(e %#$ae
"e p#n >n "o(#ie $e5infectant& >nainte $e a fi "p&(ateGc#&ate $e "1nge, "eceii, etc.@
D$>i7%$&*ia e"te opeaia cae "e ap(ic& pe %e$ii inete. E"te teapta "#peioa& a $econta%in&ii
!i "e ap(ic& n#%ai pe %ateia(e !i "#pafee c#ate. N# "e $e5infectea5& $ec1t ceea ce e"te c#at.
C#&enia !i $e5infecia pot fi ea(i5ate >n aceea!i opeaie pe o "#pafa& $atoit& #ti(i5&ii
po$#"e(o $e c#&enieG$e5infecie. C# toate ace"te, $ac& $e5infecia >n(oc#ie!te "tei(i5aea #n#i
o4iect, ea te4#ie, >n %o$ i%peati) "& "e fac& >n 2 ti%pi "epaai ?c#&ie apoi $e5infecie@
#ti(i51n$ po$#"e $ifeite.
A7ti'$p'ia e"te o %eto$& $e co%4atee a infeciei cae "e ap(ic& (a ni)e(#( e"#t#i(o )ii,
e(i%in1n$ "a# $i"t#g1n$ %icoogani"%e(e pe5ente >n %o%ent#( $e#(&ii poce$#ii.
Deconta%inaea, c#&enia, $e5infecia conc#& a"ep"ia cae epe5int& #n an"a%4(# $e %&"#i
pe)enti)e ce >%pie$ic& into$#ceea ge%eni(o patogeni >n ogani"%.
Igiena e"te #n an"a%4(# $e pincipii !i pactici cae )i5ea5& a%e(ioaea "&n&t&ii !i
pe"#p#neI
- o "tae $e "piitL
- (#aea (a c#no!tin& ?info%aea@L
- #n co%pota%ent in$i)i$#a( !i co(ecti)L
- o fi(o5ofie !i o %oa(&L
- #n an"a%4(# $e eg#(i $e %#nc&.
1., G=i, ,$ p)$&au*ii u7i<$)'al$
12
O$in#( 9ini"te#(#i 0&n&t&ii n. +13G2..3 pi)in$ apo4aea No%e(o $e "#pa)eg*ee,
pe)enie !i conto( a( infecii(o no"oco%ia(e >n #nit&i(e "anitae ?6neBa 2@ $efine!te concept#(
$e Cpeca#i#ni(o #ni)e"a(eE !i "ta4i(e!te %o$a(itatea $e ap(icae a ace"toa.
Concept#( $e peca#i#ni #ni)e"a(e "e efe& (a "1nge !i a(te (ic*i$e oganice ?"eceii, eBceii,
$ena8e@ !i (a %#coa"e !i teg#%ent ca !i c#% a fi infectate c# ageni patogeni.
Toate %ane)e(e $e >ngi8ii a(e pacieni(o te4#ie efect#ate ca !i c#% toi pacienii a fi potenia(
infectai c# =I;, =:; !i a(i ageni %ico4ieni c# ca(e $e tan"%itee "ang#in&.
S&opul apli&:)ii p)$&au*iu7ilo) u7i<$)'al$ #PU-
0cop#( ap(ic&ii peca#i#ni(o #ni)e"a(e e"te pe)eniea tan"%iteii infecii(o pe ca(e "ang#in&
(a (oc#( $e %#nc& a( pe"ona(#(#i.
R$;uli ,$ (a>: ?7 apli&a)$a p)$&au*iu7ilo) u7i<$)'al$
1. Con"i$e& toi pacienii potenia(
infectai
2. Con"i$e& c& "1nge(e, a(te f(#i$e 4io(ogice !i e"#t#i(e "#nt conta%inate c# =I;, =:;, =C;
,. Con"i$e& c& ace(e !i a(te o4iecte fo(o"ite >n pactica %e$ica(& "#nt conta%inate $#p&
#ti(i5ae. Contact#( teg#%ente(o !i %#coa"e(o c# #%&toae(e po$#"e te4#ie con"i$eat (a
i"cI
- "1ngeL
- (ic*i$ a%niotic, (ic*i$ peica$ic, (ic*i$ peitonea(, (ic*i$ p(e#a(, (ic*i$ "ino)ia(, (ic*i$
cefa(oa*i$ianL
- "pe%&, "eceii )agina(eL
- e"#t#iL
- oice a(te f(#i$e oganice )i5i4i( conta%inate c# "1nge.
I+pl$+$7ta)$a p)$&au*iu7ilo) u7i<$)'al$
0e efe&
(aI
1. Uti(i5aea ec*ipa%ent#(#i $e potecie a$ec)at, co%p(et, coect"p&(aea %1ini(o !i a a(to p&i
a(e teg#%ente(o.
2. 0p&(aea %1ini(o !i a a(to p&i a(e teg#%ente(o.
,. 'e)eniea acci$ente(o !i a a(to tip#i $e eBp#nee
pofe"iona(&.
/. 'e"ona( infectat c# =I;.
2. E)a(#aea i"c#(#i pe categoii $e (oc#i $e %#nc& !i acti)it&i pe"tate $e pe"ona(#( %e$ica(
>n f#ncie $e contact#( c# "1nge !i a(te (ic*i$e 4io(ogice.
R$&o+a7,:)i p)i<i7, utili>a)$a $&=ipa+$7t$lo) ,$ p)ot$&*i$
CO9'ONENTE RECO96ND<RI
=a(ate o4i!n#ite - >n ti%p#( t#t#o acti)it&i(o $in #nit&i(e
%e$ica(e
1,
7o#i, 4(#5e i%pe%ea4i(e, oc*e(ai $e
potecie
- co%p(etea5& pot#( *a(ate(o at#nci c1n$ "e
anticipea5& po$#ceea $e "topi,
pic&t#i, 8et#i c# po$#"e 4io(ogice
potenia( conta%inate, >n "ecii c# pofi(
c*i#gica(, "e)icii $e #gen&,
(a4oatoae 9&n#!i $e #nic& fo(o"in& - inte)enii cae i%p(ic& contact#( c# egi#ni
1/
a(e cop#(#i >n %o$ no%a( "tei(e
- a4o$ )a"c#(a pin p#ncie
- contact#( c# teg#%ent#( pacient#(#i
cae pe5int& "o(#ii $e contin#itate
?p(&gi@
- %anip#(aea #no %ateia(e
potenia( conta%inate K ne"tei(e,
c#ate 9&n#!i e#ti(i5a4i(e - %anip#(aea $e %ateia(e conta%inate
- c#&enie, >n$ep&taea $e po$#"e
4io(ogice conta%inate
9&n#!i $e #5 genea( - co(ectae %ateia(e
conta%inate
- c#&ie !i $econta%inae
in"t#%enta, "#pafee conta%inate
9&n#!i(e n# "#nt #n "#4"tit#t pent#
"p&(aea %1ini(o, pin #%ae %1ini(e
te4#ie "p&(ate $#p& >n$ep&taea ace"toa :onete G ca(ote
Oc*e(ai $e potecie
- acti)it&i cae pe"#p#n conta%inae "a#
"topie c# $ifeite f(#i$e oganice
- "&(i $e opeaie, >n ti%p#( %anip#(&ii
in"t#%enta#(#i !i a %ateia(#(#i teBti(
"tei( 9&!ti facia(e - contact#( c# pacieni c# %eningit& )ia(&
"a#
4acteian&, c# T:C p#(%ona& cae "#nt :N
po5iti)i
- contact#( c# pacieni cae t#!e"c
- a"piaea "eceii(o ta*eo-4on!ice
pe can#(a ta*ea(&
- >ngi8iea p(&gi(o "#p#ate
- peg&tiea pef#5ii(o c# c*i%ioteapice
- peg&tiea )accin#i(o pent# a$%ini"tae
- $i5o()aea p#(4ei(o (iofi(i5ate
9&!ti(e te4#ie "& fie $e tip fi(t# !i "& fie
4ine fiBate pe fa&
1./ Sp:la)$a +@i7ilo)
S&op
0p&(aea %1ini(o a"ig#& igiena, potecia !i "ec#itatea pe"oanei !i a %e$i#(#i "&#, pe)enin$
tan"%iteea ge%eni(o p#tai pe %1ini, e"pon"a4i(i $e o %ae pate $inte infecii(e
no"oco%ia(e. E"te o "acin& a#tono%&, a"i"tent#( %e$ica( e"te e"pon"a4i( $iect pent#
a"ig#aea ei.
Tipu)i ,$ 'p:la)$ a +@i7ilo)
12
La<aAul 'i+plu e(i%in& f(oa tan5itoie fo%at& $in enteo4acteii, )i#"#i, (e)#i, ci#peci %ai
%#(t "a# %ai p#in patogene !i cae n# "e %#(tip(ic&. Ea "e e(i%in& >n tota(itate $#p& o "p&(ae
%etic#(oa"& !i contact#( c# #n anti"eptic.
La<aAul i;i$7i& "a# anti"eptic e(i%in& >n tota(itate f(oa tan5itoie !i $i%in#ea5& f(oa co%en"#a(&
"a# e5i$ent&, a$ic& ge%enii opot#ni!ti cae "e g&"e"c >n %o$ nat#a( pe pie(e ?"tafi(ococ#( a#i#
$e eBe%p(#@ cae "e %#(tip(ic& ano%a(, >n a4"ena %&"#i(o $e igien& !i $#c (a "c&$eea
e5i"tenei ogani"%#(#i.
F)i&*iu7$a i;i$7i&: c# #n po$#" *i$o-a(coo(ic e(i%in& f(oa tan5itoie !i $i%in#ea5& f(oa
co%en"#a(&.
La<aAul &=i)u);i&al "e pactic& >n "&(i(e $e opeaii, "&(i(e $e na!tee, "&(i(e $e pan"a%ente
"e)icii(e $e #gen&.
I7,i&a*iil$ 'p:l:)ii +@i7ilo) La<aAul
'i+pluB
- (a intaea !i (a ie!iea $in "e)ici#L
- >nainte !i $#p& >n(&t#aea %&n#!i(o "a# a oic&#i tip $e ec*ipa%ent $e potecieL
- $#p& oice ge"t conta%inantL
- $#p& aco$aea >ngi8ii(o igienice $e confot "a# *ote(ieeL
- c# oca5ia >ngi8ii(o nein)a5i)e ?in8ecii, eco(tae $e "1nge, p#neea #nei "on$e ga"tice,
ea(i5aea pan"a%ent#(#i, "on$a8#(#i #ina, etc.@L
- >nainte $e pepaaea !i $i"ti4#iea a(i%ente(o !i a %e$ica%ente(o pe o"L
- $#p& fo(o"iea toa(etei.
La<aAul a7ti'$pti&
- $#p& >ngi8iea #n#i pacient i%#no$epe"i) "a# p#t&to a( #nei infeciiL
- c# oca5ia ea(i5&ii #nei poce$#i in)a5i)eL
- c# oca5ia ap(ic&ii %&"#i(o $e i5o(ae "eptic& "a# a"eptic&L
- $#p& $o#& "ec)ene $e >ngi8ie c# i"c $e conta%inae (a ace(a!i pacient "a# >nte $oi
pacieni.
F)i&*iu7$a i;i$7i&:
0o(#ia *i$oa(coo(ic&, "a# ge(#(, "#nt #ti(i5ate pent# a "#4"tit#i (a)a8#( anti"eptic >n ca5#(
%1ini(o c#ate $in p#nct $e )e$ee %aco"copic.
Fici#nea c# "o(#ie *i$oa(coo(ic& "a# c# ge( "e ap(ic& pe %1ini(e cae n# pe5int& #%e )i5i4i(e
$e %#$&ie "a# p#(4ei. Fn ca5 conta "e ec#ge (a "p&(aea c# ap& !i "&p#n.
La<aAul &=i)u);i&al
- c# oca5ia #no poce$#i c# i"c >na(t $e infecii ?catetei"%#( centa(, p#ncia (o%4a&,
$ena8#( p(e#a(, etc.@L
- pent# inte)enii(e c*i#gica(e (a 4(oc#( opeato "a# >n "e)ici#( $e a$io(ogie
inte)eniona(&L
- >n a(te "e)icii $e in)e"tigaeL
- pent# a"i"taea na!tei(o.
P)$;:ti)$a +at$)ial$lo) La<aA
'i+plu
- c*i#)et& G (a)a4o#L
- "&p#n (ic*i$ c# $i"ti4#itoL
- po"oape $e #nic& fo(o"in& >n $i"ti4#itoL
13
- "ac pent# $e!e#i.
La<aA a7ti'$pti&
- c*i#)et& G (a)a4o#L
- "&p#n (ic*i$ anti"eptic "a# "o(#ie "p#%oa"& anti"eptic& c# $i"ti4#itoL
- po"oape $e #nic& fo(o"in& >n $i"ti4#itoL
- "ac pent# $e!e#i.
F)i&*iu7$a i;i$7i&:
- "o(#ie "a# ge( >n $i"ti4#ito "a# >n a%4a(a8#( $e pe5entae.
La<aAul &=i)u);i&al
- c*i#)et& c# o4inete c# "en5oiL
- ap& conto(at& 4acteio(ogicL
- "o(#ie "p#%ant& anti"eptic& c# "pect# (ag ?c(o*eBi$in& $e eBe%p(#@L
- pei#& "tei(& $e #nic& fo(o"in& i%pegnat& c# "o(#ie anti"eptic& "p#%ant&L
- "o(#ie "a# ge( *i$oa(coo(ic >n $i"ti4#itoL
- !e)ee(e "tei(eL
- "aci pent# $e!e#iL
- p#4e(e c# "en5oi ?neacionate %an#a(@.
R$ali>a)$a p)o&$,u)ii
R$ali>a)$a p)o&$,u)ii La<aAul 'i+plu
- "e $e"cope& %1ini(e !i ante4ae(eL
- "e >n$ep&tea5& 4i8#teii(e, cea"#i(e, "e taie "c#t #ng*ii(eL
- "e #$& %1ini(e !i atic#(aii(e %1ini(oL
- "e ap(ic& o $o5& $e "&p#nL
- "e "pa(& fiecae %1n& pin ficionaeL
- "e in"i"t& >n "paii(e inte$igita(e, >n 8##( #ng*ii(o, (a eBte%itatea $egete(o, (a po(ice !i (a
%an!ete(e %1ini(oL pent# fiecae $in ace"te egi#ni "e eBec#t& c1te 2 %i!c&iL
- "e "pa(& $in a4#n$en& f&& "& (&"&% "& c#g& "&p#n pe o 5on& $e8a c(&tit&L
- "e #"#c& pin ta%ponae c# !e)ee(e $e #nic& fo(o"in& f&& a e)eni a"#pa #nei 5one $e8a
#"cat&L
- "e >nc*i$e o4inet#( ?$ac& n# e"te a#to%atic@ c# #(ti%#( !e)ee( $e %1ini #ti(i5atL
- "e a#nc& !e)ee(e(e (a p#4e(& f&& "& atinge% p#4e(a c# %1na.
O('$)<a*ii
N# "e !tege c*i#)eta $#p& "p&(aea %1ini(o, %ane)a )a %#$&i $in no# %1ini(e.
0e "pa(& %1ini(e >nainte $e a >%4&ca %&n#!i(e $e #nic& fo(o"in&.
R$ali>a)$a p)o&$,u)ii La<aAul i;i$7i& 'au a'$pti&
- "e #$& 4ine %1ini(e !i atic#(aii(eL
- "e ap(ic& o $o5& $e "&p#n anti"epticL
- "e "pa(& fiecae %1n& %a"1n$L
- "e in"i"t& >n "paii(e inte$igita(e, >n 8##( #ng*ii(o, (a eBte%itatea $egete(o $e (a fiecae
%1n& cae "e feac&, pe 1n$ >n po$#( pa(%ei op#"e eBec#t1n$ 2 %i!c&iL
- "e "pa(& pe 1n$, e"pect1n$ Ceg#(a 2E ?cinci %i!c&i cic#(ae@ po(ice(e !i apoi
atic#(aii(e %1ini(oL
- "e c(&te!te $in a4#n$en& $in"pe )1f#( $egete(o "pe atic#(aii(e %1ini(oL
- "e peie #ng*ii(eL
17
- "e %enin pa(%e(e oientate >n "#" pent# a e)ita oice conta%inaeL
- "e #"#c& c# gi8&, pin ta%ponae c# !e)ee(e $e #nic& fo(o"in&L
- "e >nc*i$e o4inet#( ?$ac& n# e a#to%atic@ c# #(ti%#( !e)ee( $e %1ini #ti(i5atL
- "e a#nc& !e)ee(e(e >n p#4e(a c# pe$a(& f&& "& atinge% p#4e(a c# %1na.
O('$)<a*ii
Ti%p#( $e "p&(aeI 2-, %in#te, f&& peiee.
La)a8#( anti"eptic te4#ie efect#at coect >nainte $e ea(i5aea >ngi8iii, #ti(i51n$ "#"a $e ap& cea
%ai apopiat& ?#ng*ii(e te4#ie t&iate "c#t, ia pe $egete "& n# eBi"te ine(e@
0e eBec#t& "p&(aea anti"eptic& a %1ini(o >nainte $e a >%4&ca %&n#!i(e $e #nic& fo(o"in&.
R$ali>a)$a p)o&$,u)ii Sp:la)$a i;i$7i&: a +@i7ilo) p)i7 %)i&*iu7$
- "e p#n apoBi%ati) 2 %( $e "o(#ie >n "co4it#a %1inii #"cate !i "e efect#ea5& fici#nea ti%p
$e ,. "ec#n$e fec1n$ pa(%e(e p1n& (a $egete apoi in"i"t1n$ >n "paii(e inte$igita(e intene
!i eBteneL
- "e feac& fiecae po(ice >n inteio#( %1inii >nc*i"e, apoi eBte%it&i(e $egete(o >%pe#nate
$e (a fiecae %1n& >n po$#( pa(%ei op#"e.
R$ali>a)$a p)o&$,u)ii La<aAul &=i)u);i&al
Nece"it& p#taea #nei %&!ti, ca(ote !i #ti(i5aea $e !e)ee(e "tei(e pent# #"caea %1ini(o.
0e p#n >n pea(a4i( %a"ca !i ca(ota.
0e pepa&Gpeg&te!te peia i%pegnat& c# "o(#ia "p#%ant& anti"eptic&. 0e
efect#ea5& >n , ti%piI
Ti%p#( 1I pe"p&(aea
- "e #$& %1ini(e, atic#(aii(e, ante4ae(e p1n& (a coateL
- "e ap(ic& o $o5& $e "&p#n anti"eptic !i "e face "p#%& $in a4#n$en& pin %a"a8#( efect#at
$e (a eBte%itatea $egete(o p1n& (a coate ti%p $e 1 %in#tL
- "e %enin %1ini(e $ea"#pa coate(o >n ti%p#( ace"tei opeaiiL
- "e c(&te"c $in a4#n$en& %1ini(e, atic#(aii(e, ante4ae(eL
Ti%p#( 2
- "e peie #ng*ii(e t&iate "c#t c# peia "tei(& i%pegnat& c# "o(#ie "p#%ant& anti"eptic& ti%p
$e 1 %in#tL
- "e c(&te"c $in a4#n$en& %1ini(e, >nc*eiet#i(e, ante4ae(eL
Ti%p#( ,
- "e ia >nc& o $o5& $e "&p#n anti"eptic !i "e %a"ea5& ti%p $e 1 %in#t %1ini(e, >nc*eiet#i(e,
ante4ae(e, apoi "e c(&te"cL
- "e #"#c&, pin ta%ponae c# !e)ee(e "tei(e fiecae %e%4#, >ncep1n$ $e (a $egete "pe
coate !i %enin1n$ %1ini(e i$icate.
O('$)<a*ii
D#p& 2 oe e"te nece"a& efaceea igienei %1ini(o.
La)a8#( c*i#gica( poate fi co%p(etat c# fici#ni c*i#gica(e c# "o(#ii *i$oa(coo(ice "a# io$ate.
Co+pli&a*ii 9i )i'&u)i
- De%atite $ete%inate $e #ti(i5aea po$#"e(o anti"epticeI "&p#n (ic*i$ 4(1n$ ?$o#B@,
"&p#n (ic*i$ anti"eptic, "o(#ie "p#%ant& anti"eptic&L >n ace"t ca5, e"te eco%an$at "& "e
18
e$#c& "a# "& "e >nte#p& #ti(i5aea po$#"#(#i e"pecti) !i "& "e ap(ice o ce%&
*i$atant& $#p& fiecae "p&(ae a %1ini(o.
- Fo%aea #nei pe(ic#(e #(eioa"e, (ipicioa"e pin #ti(i5aea epetat& a "o(#ii(oGge(#i(o
*i$oa(coo(iceL "e eco%an$& "p&(aea c# ap& $in a4#n$en& a %1ini(o.
- U"caea !i iitaea pie(ii pin >n$ep&taea g&"i%ii nat#a(e a teg#%ent#(#iL "e eco%an$&
c(&tiea c# ap& $in a4#n$en& !i ap(icaea, $#p& #"cae, a #nei ce%e e%o(iente $e %1ini
cae "& n# $eteioe5e %&n#!i(e $e ca#ci#c >n ca5#( >n cae ace"tea te4#ie p#tate.
1.2 P)$&au*ii ,$ p)$<$7i)$ a i7%$&*iilo) t)a7'+i'$ p$ &al$ a$)ia7:
I7,i&a*ii
6feci#ni(e cae nece"it& a"tfe( $e peca#ii "#ntI
- )aice(aL
- 5ona 5oo"te $i"e%inatL
- 5ona 5oo"te (oca(i5at (a pacienii i%#no$epe"i)iL
- #4eo(&L
- t#4ec#(o5&L
- pacieni ta*eo"to%i5ai.
Li7ii ,i)$&toa)$
6ce"te peca#ii, a(&t#i $e peca#ii(e "tan$a$, pe)in &"p1n$iea ageni(o patogeni ce "e
tan"%it pe ca(ea ae#(#i, pin "t&n#t, t#"e, )o4it, e"piaie.
6ce"te peca#ii nece"it&, efecti), o ca%e& c# pe"i#ne negati)&, c# #!& >nc*i"&, pent# a
%enine o pe"i#ne a$ec)at& a ae#(#i >nte ca%ea $e i5o(ae !i *o(.
'e"i#nea negati)& a ae#(#i $in ca%ea $e i5o(ae, te4#ie %onitoi5at& ia ae#( te4#ie $ii8at >n
eBteio#( c(&$iii "a# fi(tat >nainte $e ecic(ae.
'otecia e"piatoie te4#ie #ti(i5at& $e c&te toate pe"oane(e cae int& >n ca%e& ?"#nt i$ea(e
"apaate(e cae fo(o"e"c fi(t# $e ae@.
'acient#( )a p#ta >n afaa ca%eei ?at#nci c1n$ )a te4#i "-o p&&"ea"c& pent# efect#aea #no
poce$#i@ %a"c& c*i#gica(& a!e5at& pe"te g#& !i na".
P)$;:ti)$a +at$)ial$lo)
0e )o peg&ti toate %ateia(e(e nece"ae e"pect&ii peca#ii(o $e pe)enie a infecii(o
tan"%i"e pe ca(e aeian& pe #n c&#cio, >n antica%e&. 6ce"te
%ateia(e "#ntI
- cate(& pent# #!a ca%eei $e i5o(aeL
- %&!ti c*i#gica(eL
- *a(ate, %&n#!i $e #nic& fo(o"in&L
- %ateia(e pent# igiena %1ini(o.
E%$&tua)$a p)o&$,u)ii
- "e p(a"ea5& pacient#(Gpacienii ?%aBi% 2 pacieni@ >nt-o ca%e& c# pe"i#ne negati)&, c# #!a
>nc*i"& pe)&5#t& c# antica%e& "a# *o(L
- "e )o eBp(ica peca#ii(e $e i5o(ae pacient#(#i !i a fa%i(iei ace"t#iaL
- "e )o %enine >nc*i"e tot ti%p#( at1t #!a ca%eei c1t !i #!a anteca%eei pent# a %enine
pe"i#nea negati)& a ae#(#i !i pent# a n# &"p1n$i agenii patogeni $in aeL
1+
- "e )o afi!a pe #!a ca%eei peca#ii(e "pecifice pe)eniii tan"%iteii infecii(o pe ca(e
aeian& pent# a fi citite $e oice pe"oan& cae int& >n ca%ea $e i5o(aeL
- "e in"t#ie!te pacient#( "&-!i acopee na"#( !i g#a c# !e)ee( $e *1tie at#nci c1n$ t#!e!te
"a# "t&n#t&L
- "e p(a"ea5& #n ecipient ?"ac@ pe #na $in (atea(e(e pat#(#i pent# ca pacient#( "& co(ecte5e
%ateia(e(e fo(o"ite ?!e)ee(e, co%pe"e@L
- "e (i%itea5& %o4i(i5aea pacient#(#i >n afaa ca%eeiL
- $ac& te4#ie "& p&&"ea"c& ca%ea pent# $i)e"e poce$#i, pacient#( )a p#ta o %a"c&
c*i#gica(& ia "e)ici#( $e in)e"tigaiiGtata%ent )a fi an#nat $e"pe peca#ii(e $e i5o(ae
"ta4i(ite pent# ca ace"tea "& fie %enin#te !i aco(o !i pent# ca pacient#( "& fie a$#" >n
ca%ea $e i5o(ae c1t %ai epe$e po"i4i(.
1.3 P)$&au*ii ,$ p)$<$7i)$ a i7%$&*iilo) t)a7'+i'$ p)i7 pi&:tu)il$ Flu;;$
I7,i&a*ii
:o(i(e cae nece"it& a"tfe( $e peca#ii "#ntI
- 'ne#%onia c# *e%op*i(#" inf(#en5ae $e tip 4L
- DifteiaL
- Faingita "teptococic&L
- 'ne#%onii(e 4acteieneL
- 0ca(atina (a copiii %iciL
- 'aoti$ita epi$e%ic&L
- Infecia c# a$eno)i#"#i (a copii.
Li7ii ,i)$&toa)$
- peca#ii(e, >n ace"te ca5#i, n# nece"it& >n %o$ o4(igatoi# ca%ee $e i5o(ae c# pe"i#ne
negati)& !i c# "i"te% $e >nc*i$ee a#to%at& a #!iiL
- e"pectaea ace"to peca#ii pe)ine &"p1n$iea infecii(o ce "e tan"%it pin pic&t#i(e (#i
F(#gge ?"topi $e "a(i)& &"p1n$ii >n ae pin t#"e, "t&n#t, )o4it@L ace"te pic&t#i, >nc&cate
c# ge%eni patogeni, ca$ pe po$ea !i "e #"#c&, tan"fo%1n$#-"e >n paf#( 4acteian cae
e"te apoi in*a(atL
- %ateia(e(e nece"ae ap(ic&ii ace"to peca#ii )o fi p&"tate pe #n c&#cio >n afaa
ca%eei $e i5o(ae.
- pacient#( )a fi p(a"at >nt-o ca%e& pe)&5#t& c# toa(et& co%p(et #ti(at&L
- pacient#( poate >%p&i ca%ea c# #n a(t 4o(na) cae ae aceea!i afeci#neL
- "e )o eBp(ica pacient#(#iGfa%i(iei poce$#i(e $e i5o(aeL
- "e )o afi!a peca#ii(e $e i5o(ae pe #!a ca%eei pent# a info%a, >n pea(a4i(, pe oicine
int& >n ca%e&L
- "e )o "p&(a %1ini(e >nainte !i $#p& ie!iea $in ca%ea $e i5o(ae c1t !i pe pac#"#(
inte)enii(o a"#pa pacient#(#iL
- "e )a fiBa %a"ca pe fa&, pin51n$-o n#%ai $e !iet#i >n ti%p#( %anip#(&iiL
- "e in"t#ie!te pacient#( "& #ti(i5e5e !e)ee(e $e *1tie, co%pe"e pent# a-!i acopei g#a !i
na"#( at#nci c1n$ t#!e!te, "t&n#t& !i "& (e co(ecte5e >n ecipient#( $e (a patL
2.
- )i5itatoii )o fi in"t#ii "& poate *a(ate !i %&!ti pe cae (e )o poc#a $in a#to%at#( c#
ec*ipa%ente $e potecie !i "& p&"te5e $i"tana $e ce( p#in #n %et# fa& $e pacientL
- $ac& pacient#( te4#ie "& p&&"ea"c& ca%ea pent# in)e"tigaii, )a p#ta o %a"c& facia(&
4ine fiBat& pe g#& !i na" ia "e)ici#( e"pecti) )a fi >n!tiinat $e"pe peca#i#ni(e $e
i5o(ae "ta4i(ite.
1.7 P)$&au*ii ,$ p)$<$7i)$ a i7%$&*iilo) t)a7'+i'$ p)i7 &o7ta&t ,i)$&t &u '$&)$*iil$ 'au
o(i$&t$l$ &o7ta+i7at$
0e )o peg&ti %ateia(e(e nece"ae ap(ic&ii peca#ii(o $e contact pe #n c&#cio >n afaa
ca%eei $e i5o(ae. 6ce"te
%ateia(e "#ntI
- *a(ate, %&!ti c*i#gica(eL
- %&n#!i $e #nic& fo(o"in&L
- afi!a8 pent# ca%ea $e i5o(aeL
- etic*eteL
- "aci "a# p#ngi $e p(a"tic.
- "e )o eBp(ica pacient#(#iGfa%i(iei poce$#i(e $e i5o(aeL
- "e )o afi!a pe #!& ace"te peca#ii pent# info%aeL
- "e )o "p&(a %1ini(e >nainte !i $#p& ie!iea $in ca%e&, !i $#p& >n$ep&taea %&n#!i(oL
- po4e(e 4io(ogice eco(tate )o fi p(a"ate >n c#tii i%pe%ea4i(e, etic*etate coect !i "e )o
ti%ite i%e$iat (a (a4oatoL
- "e )o ata!a pe patea eBten& a c#tii(o in"t#ci#ni $e %ane)ae p#$ent&L
- )i5itatoii )o fi in"t#ii "& poate %&n#!i !i *a(ate pe tot pac#"#( )i5itei !i "&-!i "pe(e
%1ini(e $#p& >n$ep&taea ec*ipa%ent#(#i $e potecieL
- toate o4iecte(e cae a# )enit >n contact c# pacient#( )o fi p(a"ate >nt-o "ing#& p#ng&
i%pe%ea4i(& !i "e )o (#a %&"#i(e nece"ae pent# >n$ep&taea "a# pent# $e5infectaea !i
"tei(i5aea (oL
- "e )o #ti(i5a %ateia(e "epaate pent# fiecae pacient >n pate ?te%o%ete, ten"io%ete,
"teto"coape@ pent# a e$#ce i"c#( tan"%iteii infeciei >nc#ci!ateL
- "e (i%itea5& %o4i(i5aea pacient#(#i >n afaa ca%eeiL
- >n ca5#( $ep(a"&ii pacient#(#i (a $ifeite "e)icii $e in)e"tigaii !i tata%ent, "e )o acopei
"tei( &ni(e $ac& eBi"t&, ia "e)icii(e e"pecti)e )o fi info%ate $e"pe peca#ii(e $e
pe)enie "ta4i(iteL
- "e )o "c*i%4a %&n#!i(e $#p& fiecae poce$#& efect#at& pacient#(#i !i "e )o "p&(a
%1ini(e $#p& >n$ep&taea fiec&#i 1n$ $e %&n#!i.
1.8 P)$&au*ii ,$ p)$<$7i)$ a i7%$&*iilo) la pa&i$7*i &u 7$ut)op$7i$
I7,i&a*ii
6ce"te peca#ii "#nt in$icate pent# potecia pacieni(o c#I
- 0in$o%#( i%#no$eficienei $o41n$iteL
- a"#i >ntin"eL
21
- $e%atiteL
- 4o(i infecioa"e c# e#pie )e5ic#(a&L
- (e#ce%ii, (i%foa%eL
- 4oa(a =o$gOinL
- tata%ente i%#no"#pe"oae.
Li7ii ,i)$&toa)$
6p(icaea ace"to peca#ii )aia5& $e (a #n "pita( (a a(t#(, fiin$ inf(#enate !i $e ga$#( $e
e5i"ten& a ogani"%#(#i pacient#(#iL
6ce"te peca#ii patic#(ai5ate >n f#ncie $e pato(ogia pacient#(#i "#ntI
- p(a"aea pacient#(#i "ing# >nt-o ca%e& $e i5o(ae c# pe"i#ne po5iti)& pent# a foa
patic#(e(e af(ate >n "#"pen"ie "& "e $ep#n& "a# "& fie "coa"e afa& $in ca%e&L
- (i%itaea tafic#(#i >n ca%ea $e i5o(aeL
- p#taea *a(ate(o $e potecie, %&!ti(o !i %&n#!i(o $e c&te pe"ona(#( $e >ngi8ie !i $e
c&te toi )i5itatoiiL
- #ti(i5aea $e (en8eie "tei(& !i $e ec*ipa%ent co%p(et $e potecie >n ca5#( >ngi8iii
pacient#(#i cae a "#feit #n tan"p(ant $e oganL
- "p&(aea %1ini(o >n %ai %#(te etape pent# $econta%inaeL
- tiaea epi$e%io(ogic& pin contoa(e ig#oa"e ?eB#$at inofaingian, eBa%en
copopaa5ito(ogic, a$iogafie p#(%ona&@ a pe"oane(o cae >ngi8e"c pacient#(, pent# a
fi i$entificai p#t&toii "&n&to!iL
- e)itaea poce$#i(e in)a5i)e (a pacienii c# ne#topenie >nt#c1t ace"tea pe5int& #n i"c
ce"c#t pent# pacient#( c# i%#nitate "c&5#t&L
- pe"ona(#( $e c#&enie )a fi in"t#it "&-!i p#n& *a(ate, %&!ti !i %&n#!i >nainte "& inte >n
ca%ea $e i5o(ae.
9ateia(e(e nece"ae )o fi p&"tate >n antica%e& pe #n c&#cio "pecia(.
6ce"te %ateia(e "#ntI
- *a(ate potectoaeL
- %&!ti facia(eL
- acopeitoi pent# >nc&(&%inteL
- 4onete.
- "e p(a"ea5& pacient#( "ing# >nt-o ca%e&L
- "e eBp(ic& pacient#(#iGfa%i(iei peca#i#ni(e $e i5o(ae pent# a-i $i%in#a anBietatea !i a-i
"ti%#(a coopeaea c# ec*ipa $e >ngi8ieL
- "e )o afi!a in"t#ci#ni(e pe #!a ca%eeiL
- "e )o "p&(a %1ini(e c# #n agent anti"eptic >nainte !i $#p& >n$ep&taea %&n#!i(o pec#% !i
pe pac#"#( aco$&ii >ngi8ii(oL
- "e )o p#ta *a(ate(e $e potecie !i %&n#!i(e confo% peca#i#ni(o "tan$a$L
- )o fi inte5i"e )i5ite(e pe"oane(o c#no"c#te ca fiin$ 4o(na)e "a# infectateL
- $eoaece pacient#( n# ae o 4oa(& contagioa"&, %ateia(e(e "a# o4iecte(e cae p&&"e"c
ca%ea $e i5o(ae n# nece"it& peca#i#ni "pecia(e >n afaa ce(o "tan$a$.
22
1.+ Utili>a)$a $&=ipa+$7tului ,$ i>ola)$
S&op
- pe)eniea tan"%iteii infecii(o $e (a pe"oana infectat& (a a(i pacieni "a# $e (a %e%4ii
pe"ona(#(#i $e >ngi8ie (a pacieniL
- e$#ceea i"c#(#i infect&ii pacieni(o c# i%#nitate "c&5#t&.
- "e a(ege ec*ipa%ent#( i5o(ato >n f#ncie $e "copL
- toate co%ponente(e ec*ipa%ent#(#i $e potecie ?*a(at (#ng c# %1neci (#ngi, c# !iet#i "a#
fe%oa, %&n#!i, %&!ti, oc*e(ai $e potecie, 4onete@ "e "e(ectea5& $e pe c&#cio#( c#
%ateia(e >n f#ncie $e poce$#a cae #%ea5&L
- "e peg&te!te 5ona $e (#c# c# etic*ete, 4en5i i5o(atoae, "aci $e (#c# "pecia( %acai, "aci
$e p(a"tic pent# $epo5itaea %ateia(e(o fo(o"ite.
E%$&tua)$a p)o&$,u)ii ,$ ?+():&a)$
- "e "pa(& %1ini(e c# #n agent $e c#&ae anti"eptic pent# a pe)eni $e5)o(taea
%icoogani"%e(o >n inteio#( %&n#!i(oL
- "e >%4ac& *a(at#( !i "e >nf&!oa& $e 8##( >%pe8##( cop#(#i pe"te #nifo%a o4i!n#it& pe
cae te4#ie "& o acopee co%p(etL
- "e (eag& 4ine !iet#i(e "a# "e tage fe%oa#( !i apoi "e (eag& 4i$e(e *a(at#(#i >n 8##(
g1t#(#iL
- "e a!ea5& %a"ca confota4i( pe"te na" !i g#& !i "e (eag& !iet#i(e %&!tii >n egi#nea
occipita(&, "#ficient $e "#" ca "& n# a(#neceL
- $ac& "#nt nece"ai oc*e(ai $e potecie, %a"ca "e )a a!e5a "#4 %aginea $e 8o" a
oc*e(ai(oL
- %&n#!i(e "e )o p#ne a"tfe( >nc1t "& acopee %agini(e %1neci(o *a(at#(#i $e potecie.
57,$p:)ta)$a $&=ipa+$7tului ,$ p)ot$&*i$
- "e ine "ea%a $e fapt#( c& p&i(e eBtene a(e ec*ipa%ent#(#i $e potecie "#nt conta%inateL
- c# %1na $o%inant& >n%&n#!at& "e >n$ep&tea5& %&n#!a $e pe %1na ne$o%inant& #(1n$ >n
eBteio %an!eta ace"teiaL
- "e >n$ep&tea5& !i %&n#!a $e pe %1na $o%inant& into$#c1n$ #n#( "a# $o#& $egete pin
inteio#( %&n#!ii !i >n$ep&t1n$-o c# patea inten& >n afa&L
- >n ti%p#( >n$ep&t&ii %&n#!i(o n# "e )a ating pie(ea c# patea eBten& a ace"toaL
- "e a#nc& %&n#!i(e >n "ac#( "pecia( pent# ec*ipa%ente conta%inateL
- "e $e5(eag& %a"ca in1n$-o n#%ai $e !iet#i !i "e $epo5itea5&, $e a"e%enea, >n "ac#(
pent# ec*ipa%ente conta%inateL
- $ac& pacient#( ae o 4oa(& ce "e &"p1n$e!te pe ca(ea ae#(#i, %a"ca "e )a >n$ep&ta #(ti%aL
- "e $e5(eag& *a(at#( $in 8##( g1t#(#iL
- "e pin$e *a(at#( $e patea eBten& $inte #%ei !i "e tage $e pe %1neci >ntoc1n$#-( pe $o"
pe %&"#& ce e"te "co" $e pe cop, pent# a e)ita conta%inaeaL
- "e ine *a(at#( potecto c1t %ai $epate $e #nifo%&, "e >%p&t#e!te pe $o" !i "e
$epo5itea5& >n ecipient#( pent# ec*ipa%ente conta%inateL
- "e "pa(& %1ini(e !i ante4ae(e c# "&p#n !i agent anti"eptic >nainte $e a ie!i $in ca%e& ?$ac&
c*i#)eta "e af(& >n ca%ea pacient#(#i@L
2,
- "e >nc*i$e o4inet#( ?$ac& n# e"te a#to%atic@ fo(o"in$ #n po"op $e *1tie ce "e a#nc& >n
"ac#( pent# $e!e#iL
- "e acionea5& c(ana #!ii, pent# a o $e"c*i$e, fo(o"in$ #n a(t po"op $e *1tie c#atL
- "e )a >nc*i$e #!a ca%eei, pe $inafa&, c# %1na nepote8at&L
- $ac& c*i#)eta e"te >n anteca%e&, "e )o "p&(a %1ini(e !i ante4ae(e c# "&p#n !i agent
anti"eptic $#p& p&&"iea ca%eei $e i5o(aeL
- $#p& fiecae poce$#&, c&#cio#( $e (#c# )a fi c#&at, $e5infectat !i $otat c# %ateia(e(e
nece"ae #nei a(te poce$#iL
- ca%ea $e i5o(ae )a fi co%p(et c#&at& !i $e5infectat& $#p& eBtenaea pacient#(#iI
PARTREA II C INTERVENII AUTONOME Capitolul
IGIENA I CONFORTUL PACIENTULUI
2.1 S&=i+(a)$a l$7A$)i$i ,$ pat %:): pa&i$7t
S&op
- a"ig#aea igienei !i confot#(#i pacient#(#iL
- >n$ep&taea (en8eiei %#$aeGfo(o"ite "a# p&tat& c# "1nge, "eceii, $e8ecii.
Mat$)ial 7$&$'a)
- (en8eie c#at&L
- "ac pent# co(ectaea (en8eiei %#$aeL
- %&n#!i $e ca#ci#c ?pent# (en8eia p&tat& c# $e8ecii@.
- "e "t1nge (en8eia %#$a& >n "ac#( $e co(ectaeL
- "e "pa(& %1ini(e, "e p#n %&n#!iL
- "e >ntin$e ceaceaf#( $e pat foate 4ine pent# a n# &%1ne c#te !i "e fiBea5& (a co(#i(e
"a(te(ei >n fo%& $e p(icL$ac& ceaceaf#( n# ae $i%en"i#ni coe"p#n5&toae fiBaea "e face
(a patea $in"pe picioae(e pacient#(#iL
- "e "c*i%4& faa $e pen& !i ceaceaf#( p(ic.
57&=$i$)$a p)o&$,u)ii
- "e >n$epatea5& (en8eia %#$a&, "e $epo5itea5& >n "aci "pecia(iL
- "e >n$epatea5& %&n#!i(e $e ca#ci#cL
- "e "pa(& %1ini(e.
2.2 S&=i+(a)$a l$7A$)i$i ,$ pat &u pa&i$7tul i+o(ili>at
0c*i%4aea (en8eiei "e )a efect#a >ntot$ea#na $#p& toa(eta pacient#(#i. La "c*i%4aea (en8eiei
te4#ie "& paticipe $o#& pe"oane ia a(egeea %eto$ei $e "c*i%4ae a (en8eiei $e pat, "e face >n
f#ncie $e po5iia >n cae poate fi a!e5at pacient#( ?(i%ite(e "a(e $e %o4i(i5ae@.
S&op
- a"ig#aea igienei !i confot#(#i pacient#(#iL
2/
- e)itaea co%p(icaii(o (a pacient#( i%o4i(i5at.
Mat$)ial 7$&$'a)
- (en8eie c#at&L
- "ac pent# co(ectaea (en8eiei %#$aeL
- %&n#!i $e #nic& fo(o"in&.
E%$&tua)$a p)o&$,u)iiB
E"te >n f#ncie $e "taea pacient#(#i !i $e po"i4i(itatea $e a fi %i!cat.
6"i"tent#( %e$ica( "ta4i(e!te %eto$a $#p& c#(egeea $ate(o efeitoae (a capacitatea acient#(#i $e
a "e i$ica "a# n# >n po5iia !e51n$.
'ent# ea(i5aea "c*i%4&ii (en8eiei e"te ne)oie $e a8#to.
a@ La pa&i$7tul &a)$ '$ poat$ )i,i&aI
Ceaceaf#( $e pat "e #(ea5& pe $i%en"i#nea %ic&.
- "e "pa(& %1ini(e, "e i%4ac& %&n#!iL
- pacient#( &%1ne acopeit c# ceaceaf#( fo(o"it "a# c# a(t p(e$L
- "e $ega8& ceaceaf#( %#$a $e "#4 "a(teaL
- "e i$ic& pacient#( >n po5iia !e51n$ fiin$ "#"in#t c# c1te o %1n& $e ce(e $o#& pe"oane
cae ea(i5ea5& poce$#a #%&toaeI
- c# cea(a(t& %1n& "e #(ea5& ceaceaf#( %#$a !i "e $e#(ea5& c# gi8& ce( c#at p1n& apoape
$e pacientL
- "e "c*i%4& faa $e pen&, "e a!ea5& pena pe patL
- pacient#( e"te c#(cat >n $ec#4it $o"a( !i e"te #gat $ac& poate, "a# e"te a8#tat "&-!i i$ice
egi#nea fe"ie&L
- "e contin#& #(aea ceaceaf#(#i %#$a "pe picioae(e pacient#(#i !i $e#(aea ce(#i c#atL
- "e i$ic& apoi %e%4e(e infeioae contin#1n$ #(aea !i $e#(aeaL
- ceaceaf#( %#$a "e into$#ce >n "ac, ceaceaf#( c#at "e >ntin$e 4ine !i "e fiBea5& (a
co(#i.
4@ La pa&i$7tul &a)$ ):+@7$ ?7 ,$&u(it
Ceaceaf#( $e pat "e #(ea5& pe $i%en"i#nea %ae.
- "e "pa(& %1ini(e, "e >%4ac& %&n#!iL
- ceaceaf#( p(ic "e "c*i%4& !i >%pe#n& c# p(e$#( "e >%pac*etea5& >n a%onic&L
- "e $ega8& ceaceaf#( %#$a $e "#4 "a(teaL
- "e >ntoace pacient#( >n $ec#4it (atea( !i "e tage pena "pe %aginea pat#(#iL
- ceaceaf#( %#$a "e #(ea5& p1n& (1ng& pacientL
- ceaceaf#( c#at a!e5at $e-a (#ng#( pat#(#i "e $e#(ea5& p1n& apoape $e ce( %#$aL
- pacient#( $e >ntoace >n $ec#4it $o"a( apoi >n $ec#4it (atea( pe patea op#"&L
- "e contin#a& $e#(aea ceaceaf#(#i %#$a !i $e#(aea ce(#i c#atL
- ceaceaf#( %#$a "e p#ne >n "ac#( co(ectoL
- pacient#( e"te ea$#" >n $ec#4it $o"a(L
- ceaceaf#( c#at "e >ntin$e !i "e fiBea5&.
S&=i+(a)$a &$a)&$a%ului pli& #&u p:tu)a ?7 i7t$)io)-
- e"te ne)oie $e paticipaea a $o#& pe"oaneL
22
- "e a!ea5& ceaceaf#( c# p&t#a ?>%p&t#it >n a%onic&@ $ea"#pa pacient#(#i a"tfe( >nc1t
%aginea (i4e& $e $e$e"#4t "& fie "#4 4&4ia pacient#(#i, ia cea $e $ea"#pa "pe
picioae(e pacient#(#iL
- ce(e $o#& pe"oane "e po5iionea5& $e o pate !i $e a(ta a pat#(#i, pin$ co(#( ceaceaf#(#i
c#at c# %1na $in"pe cap#( pacient#(#i, !i c# cea(a(t& %1n& co(#( ceaceaf#(#i %#$aL
- c# o %i!cae api$& "e >ntin$e ceaceaf#( c#at !i "e >n$ep&tea5& ce( %#$a.
57&=$i$)$a p)o&$,u)ii
- (en8eia %#$a& "e co(ectea5a >n "aciL
- "e >n$ep&tea5& %&n#!i(e, "e "pa(& %1ini(e.
O('$)<a*ii
6(e5a !i %#!a%a#a pot fi "c*i%4ate $#p& ace(ea!i %eto$e in1n$ cont $e po"i4i(itatea $e
"c*i%4ae a po5iiei pacient#(#i.
2., S&=i+(a)$a l$7A$)i$i ,$ &o)p a pa&i$7tului i+o(ili>at la pat
S&op
- %enineea "t&ii $e igien& !i confotL
- %enineeaGce!teea $e%nit&ii pacient#(#iL
- pe)eniea e"cae(o $e $ec#4it.
'oce$#a ine "ea%& $e tip#( $e >%4&c&%inte ?pi8a%a, c&%a!& $e noapte@ !i $e "taea
pacient#(#i. 0e o4in info%aii $e"pe po"i4i(it&i(e $e i%o4i(i5ae.
S&=i+(a)$a piAa+al$i
- "e eBp(ic& pacient#(#i c#% poate co(a4oa !i "e apecia5& >n ace(a!i ti%p e"#"e(e ace"t#iaL
- "e "pa(& %1ini(e, "e >%4ac& %&n#!i.
D$>():&a)$a (lu>$i +u),a)$ 9i ?+()a&a)$a &$l$i &u)at$
- "e $e"c*eie na"t#iiL
- "e i$ic& pacient#( >n po5iia !e51n$ !i "e >n$ep&tea5& 4(#5a %#$a&L
- "e #(ea5& pe 1n$ fiecae %1nec& a 4(#5ei c#ate !i "e >%4ac& fiecae %e%4# "#peioL
- pacient#( e"te a!e5at >n $ec#4it, "e >ntin$e 4(#5a !i "e >nc*eie na"t#iiL
- $ac& pacient#( n# "e poate i$ica, "e >ntoace >n $ec#4it (atea(, "e $e54ac& !i "e >%4ac&
patea acce"i4i(& $#p& cae pacient#( "e >ntoace pe cea(a(t& pate !i "e poce$ea5& (a fe(
#(1n$ pe 1n$ %1neci(e 4(#5eiL
- (a "f1!it, pacient#( e"te a$#" >n $ec#4it $o"a(, "e >ntin$e 4(#5a !i "e >nc*eie na"t#ii.
5+():&a)$a 9i ,$>():&a)$a pa7talo7ilo)
- "e %ena8ea5& p#$oaea pacient#(#iL
- "e i$ic& egi#nea (o%4o"aca(&, "e tag panta(onii 8o"L
- "e i$ic& %e%4e(e infeioae !i "e contin#& $e54&caeaL
- "e #(ea5& panta(onii c#ai !i "e >%4ac& pe 1n$ fiecae %e%4# infeio, $#p& cae "e
i$ic& egi#nea fe"ie& !i "e tag >n "#" "pe %i8(oc.
23
O('$)<a*ii
Fn toate ca5#i(e $e"ci"e
- "e )eific& p#ncte(e $e "pi8in !i "e an#nt& oice %o$ificae pe%eg&toae e"cae(oL
- "e p#$ea5& c# ta(c p#ncte(e $e "pi8inL
- "e )eific& $ac& (a te%inaea poce$#ii, (en8eia e"te 4ine >ntin"& !i $ac& pacient#(
eBpi%& "tae $e confot.
S&=i+(a)$a &:+:9ii ,$ 7oapt$
0e apecia5& capacitatea pacientei $e a paticipa (a efect#aea poce$#ii.
Dac& pacienta "e poate i$ica >n po5itie !e51n$ "e poce$ea5& a"tfe(I
- "e i$ic& >nt1i egi#nea fe"ie& !i "e tage #!o c&%a!a %#$a&L
- "e "t1nge ?#(ea5&@ c&%a!a %#$a& $e (a "pate !i "e tece pe"te cap $e54&c1n$ %e%4e(e
"#peioaeL
- "e #(ea5& fiecae %1nec& a c&%a!ii c#ate !i "e >%4ac& fiecae %e%4# "#peio $#p& cae
c&%a!a e"te tec#t& pe"te cap !i >ntin"& p1n& apoape $e !e5#t#( pacienteiL
- "e a!ea5& >n $ec#4it, "e i$ic& egi#nea fe"ie& !i "e >ntin$e 4ine c&%a!a.
Dac& pacienta n# "e poate i$icaI 'ent#
$e54&cae
- "e >ntoace pacienta pe o pate !i pe a(ta, "t1ng1n$ $e fiecae $at& c&%a!a p1n& apoape $e
aBi(&L
- pacienta >n $ec#4it $o"a( "e i$ic& #!o !i "e tage c&%a!a pe"te capL
'ent# >%4&cae
- "e #(ea5& c&%a!a $e (a poa(e, "e i$ic& #!o cap#( "e !i tece c&%a!a pe"te capL
- "e #(ea5& fiecae %1nec& !i "e >%4ac& pe &n$ %e%4e(e "#peioaeL
- "e >ntoace apoi pacienta pe o pate !i pe a(ta >ntin51n$ c# gi8& c&%a!aL
- "e >ntin$e 4ine c&%a!aL
- "e >ntin$e !i "e fiBea5& ceaceaf#(.
O('$)<a*ii
La "c*i%4aea (en8eiei $e cop !i pat "e tine cont $e con"t1ngei(e fi5iceI (e5i#ni a(e %e%4e(o,
apaate gip"ate, pef#5ii %ontate.
'atea )&t&%at& "e $e54ac& #(ti%a !i "e >%4ac& pi%a.
6"i"tent#( %e$ica( te4#ie "& fie pe5ent (a "c*i%4aea (en8eiei pacient#(#i c# pef#5ii "a# (a cae
pin p(an#( teape#tic %i!caea e"te (i%itat&Ginte5i"&.
La pacient#( incon!tient e"te $e pefeat ca patea infeioa& a cop#(#i "& n# fie >%4&cat&. Dac&
pacient#( pe5int& $#ei (a %o4i(i5ae "a# $#p& poce$#i "e poate a$%ini"ta ca(%ant.
2./ Toal$ta pa&i$7tului i+o(ili>at la pat
0e ea(i5ea5& inte)enii pent# igiena 5i(nic& !i $#p& ca5 4aia pe egi#ni copoa(e.
S&op
- %enineea igienei teg#%ent#(#iL
- %en ineea "t&ii $e confot a pacient#(#iL
- pe)eniea (e5i#ni(o c#tanateL
27
- acti)aea cic#(aiei.
P)i7&ipii ;$7$)al$
- "e apecia5& pin c#(egeea $ate(o, "taea pacient#(#i pent# a e)a(#a e"#"e(e, $e
ceGc1tGce fe( $e a8#to ae ne)oie, (i%ite(e >n cae poate fi %o4i(i5atL
- "e a"ig#& inti%itatea, "e e"pect& p#$oaea pacient#(#iL
- "e a"ig#& te%peat#a coe"p#n5atoae %e$i#(#i a%4iant pent# a n# cea $i"confotL
- %ateia(e(e "e peg&te"c !i "e a(eg >n f#ncie $e poce$#& !i "#nt a!e5ate >n apopieeL
- "e e"pect& o an#%it& o$ine a "p&(&ii egi#ni(o a"tfe( >nc1t "& pe%it& $e"copeiea,
"p&(aea !i acopeiea 5onei f&& "& cee5e $i"confotL
- $#pa efect#aea >ngi8i(o igienice copoa(e !i "c*i%4aea (en8eiei, pacient#( )a fi a!e5at
>nt-o po5iie c1t %ai co%o$&L
- fiecae 5on& "e #%e5e"te, "e "&p#ne!te, "e c(&te!te !i "e !tege, $#p& cae "e >n)e(e"teL
- "e (#cea5& c# 4(1n$ee !i atenie $ac& pacient#( ae con"t1ngei fi5ice ?apaat gip"at,
pan"a%ent, pef#5ie@.
Mat$)ial$ 7$&$'a)$
9ateia(e(e "e peg&te"c >n f#ncie $e "cop $e tip#( $e >ngi8ieI 4aia (a pat, toa(eta !i >ngi8iea
#nei egi#ni.
'ent# toa(eta co%p(et& (a pat "e peg&te"cI
- %ateia(e pent# potectieI %#!a%a, a(e5&, ceaaf, po"op $e 4aieL
- %ateia(e pent# "p&(atI can& c# ap& ca($& !i ece, (ig*ean, tei %&n#!i $e toa(eta $e c#(oi
$ifeite, , po"oape $e c#(oi $ifeite, fofec#& !i pi(& pent# #ng*ii, piepten, a(coo(, "&p#n
ne#t#, %&n#!i $e #nic& fo(o"in&, a(coo( %ento(at, ta(cL
- %ateia(e pent# toa(eta ca)it&ii 4#ca(eI pei#&, pa"t&, pa*aL
- %ateia(e pent# toa(eta ogane(o genita(eI p(o"c&, pen"e, po"t-ta%pon, ta%poaneL
- (en8eie c#at& $e cop !i patL
- "ac pent# (en8eia %#$a&.
O$inea "p&(&ii
- faa !i g1t#(L
- patea anteioa& a toace(#i, %e%4e(e "#peioae, a4$o%en#(, patea po"teioa& a
toace(#i !i egi#nea fe"ie&, %e%4e(e infeioae ogane(e genita(eL
9&n#!i(e $e 4aie !i ce(e , po"oape $e c#(oi $ifeite, "e "c*i%4& a"tfe(I pi%#( pent# fa& !i g1t, a(
$oi(ea pent# t#nc*i !i %e%4e, a( tei(ea pent# ogane(e genita(e.
P)$;:ti)$a pa&i$7tului
- "e $i"c#t& c# pacient#( !i "e P>%pat "acini(eP "ta4i(in$ conti4#ia ace"t#iaL
- "e "ta4i(e!te oa#( efect#&ii toa(etei >n f#ncie $e acti)itatea $in "ecie ?"e)iea %e"ei,
in)e"tigaii, oa#( tata%ent#(#i@.
0e $e54ac& pe 1n$ fiecae egi#ne !i "e in"i"t& >n an#%ite 5one $#pa c#% #%ea5&I
- (a fa& !i g1t I "e >ncepe c# oc*ii, "e in"i"t& c# %i!c&i cic#(ae >n 5ona peioa(& !i
peina5a(&, "e in"i"t& (a #ec*e >n c#te !i egi#nea etoa#ic#(a&L
- "e "c*i%4& %&n#!aL
- pe patea anteioa& a toace(#i "e in"i"t& >n aBi(e, (a fe%ei >n p(i#i(e "#4%a%aeL
28
- (a %e%4e(e "#peioae, "p&(aea "e face c# %i!c&i (#ngi !i cic#(ae >ncep1n$ $e (a
atic#(aia p#%n#(#i "pe #%& pent# a "ti%#(a cic#(aia $e >ntoacee. 0e in"i"t& (a "paii(e
inte$igita(e !i "e taie #ng*ii(eL
- (a ni)e(#( a4$o%en#(#i "e in"i"t& (a ni)e(#( p(i#i(o ing*ina(e #n$e apa #!o iitaii, (a
ni)e(#( o%4i(ic#(#i cae poate fi %#$aL
- pe patea po"teioa&, c# pacient#( a!e5at >n $ec#4it (atea(, "e in"i"t& >n p(ica intefe"ie&L
- "e conto(ea5a p#ncte(e $e "pi8in, "e ficionea5& #!o c# a(coo( %ento(at !i "e p#$ea5& c#
ta(cL
- "e ea$#ce pacient#( >n $ec#4it $o"a( !i "e contin#& c# "p&(aea %e%4e(o infeioae
in"i"t1n$ (a ni)e(#( gen#nc*i#(#i, p(icii pop(itee, >n egi#nea p(icii ing*ina(e, >n egi#nea
ten$on#(#i (#i 6*i(e !i c&(c1i#(#iL picioae(e "e into$#c >nt-#n (ig*ean c# ap& pent# a t&ia
%ai #"o #ng*ii(eL
- toa(eta ogane(o genita(e "e face c# pacient#( >n po5itie gineco(ogic& fo(o"in$ pen"e
po"tta%pon "a# %&n#!i $e #nic& fo(o"in&. Diecia $e "p&(ae e"te $in"pe patea anteioa&
"pe cea po"teioa&. 'acient#( "e poate "p&(a "ing# $ac& "taea >i pe%ite fiin$ in"t#it c#%
"& poce$e5e coect. La "f1!it pacient#( e"te i$icat >n po5iie !e51n$ ?$ac& "e poate@ "a#
>nto" >n $ec#4it (atea( pent# igiena g#ii. Fngi8iea "e >nc*eie c# pieptanaea p&#(#i.
57;)iAi)$a o&=ilo) S&op
- pe)eniea infecii(o !i >n$ep&taea "eceii(oL
- %enineea oc*i#(#i #%e$ (a pacient#( c# paa(i5ie, >n eBofta(%ie.
Mat$)ial$ 7$&$'a)$
- "e fi5io(ogic, "o(#ie $e aci$ 4oicL
- "o(#ie $e )ita%ina 6L
- "tic(#& c# pic#atoL
- (aci%i atificia(e, #ng#ent ofta(%ic eco%an$at $e %e$icL
- co%pe"e "tei(eL
- %&n#!i "tei(eL
- t&)i& ena(&L
- po"op, %ateia( i%pe%ea4i(.
'acient#( poate fi co(a4oant, con!tient "a# co%ato".
'acient#( con!tient "e info%ea5& !i i "e eBp(ic& $e#(aea poce$#ii. Fngi8iea
"e poate ea(i5a >n ca$#( toa(etei 5i(nice "a#, $#p& ca5, in$epen$ent.
'acient#( "e a!ea5& >n $ec#4it c# cap#( #!o >nto" "pe oc*i#( cae )a fi pi%#( "p&(at.
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(eL
- "e >n$epatea5& "eceii(e "a# c#"te(e !teg1n$ #!o $e (a co%i"#a eBten& "pe cea inten&
fo(o"in$ #n ta%pon "tei( >%4i4at >n "e fi5io(ogicL
2+
- pent# fiecae !tegee "e fo(o"e!te #n ta%pon no#L
- %ane)e(e "e epet& pent# ce(&(a(t oc*iL
- "e in"ti(ea5& (aci%i atificia(e "a# "e ap(ic& #ng#ent ofta(%ic.
Fn ca5#( pacient#(#i co%ato"
- "e #%ea5& aceea!i pa!i, a"i"tent#( %e$ica( $e"c*i51n$ p(eoape(e !i ap(ic1n$ pe fiecae oc*i
c1te o co%pe"& "tei(&L
- "e in"ti(ea5& >n "ac#( con8#ncti)a( c1te o pic&t#& $e )ita%ina 6 $e $o#& oi pe 5iL
- (ip"a c(ipiii i%p#ne in"ti(aea (aci%i(o atifica(e.
Fn ca5#( pacient#(#i c# 4oa(a :60EDOQ "e eco%an$&I
- p#taea oc*e(ai(o f#%#ii pent# e$#ceea inten"it&ii (#%inii, potecia >%poti)a
)1nt#(#i !i a c#eni(o, pe%ite ca%#f(aea eBo(fta%ieiL
- pacient#( e"te "f&t#it "& $oa%& c# cap#( %ai "#" ?$o#& pene@ ceea ce pe%ite e$#ceea
e$e%#(#i pa(pe4a(L
- pent# %enineea #%i$it&ii coneei "e ap(ic& co%pe"e >%4i4ate >n "efi5io(ogic.
57;)iAi)$a +u&oa'$i 7a>al$
S&opDi7,i&a*ii
- %enineea pe%ea4i(it&ii c&i(o e"piatoii "#peioaeL
- pe)eniea (e5i#ni(o >n infecii na5a(e, (e5i#ni $e pe"i#ne $ete%inate $e "on$& pent#
oBigen, pent# e)ac#aea "#c#(#i ga"tic "a# pent# a(i%entaie.
Mat$)ial$ 7$&$'a)$
- ta%poane "tei(eL
- "e fi5io(ogicL
- )a"e(in&L
- ap& oBigenat& $i(#at&L
- t&)i& ena(&L
- %&n#!i $e ca#ci#c.
- "e info%ea5& pacient#(L
- "e eBp(ic& %o$#( $e $e#(ae a poce$#iiL
- e"te a!e5at >n $ec#4it "a# pe "ca#n, c# cap#( $ef(ectat !i #!o >nto" >nt-o pate.
- "e c#&& fo"e(e na5a(e c# ta%poane #%e5ite c# "e fi5io(ogic, "e >n$ep&tea5& c#"te(eL
- pent# fiecae na& "e fo(o"e!te $e fiecae $at& a(t ta%ponL
- c#"te(e "e pot >n$ep&ta pin (#4efiee c# )a"e(in&L
- $ac& "on$a e"te %ontat& "e poce$ea5& a"tfe(I
- "e $e5(ipe!te p(a"t#e(e $e pe na" !i fa&L
- "e etage "on$a 2-3 c% !i "e c#&& #%e(e $e 4an$& a$e5i)&L
- "e "c*i%4& po5iia "on$ei !i "e fiBea5& $in no#L
- c1n$ "on$a "e "c*i%4&, "e ep#ne $#p& o pa#5a $e 3-8 oe.
57;)iAi)$a u)$&=ilo)
,.
S&op
- %enineea "t&ii $e igien& a con$#ct#(#i a#$iti) eBtenL
- >n$ep&taea $epo5ite(o $e ce#%en "a# a ce(o pato(ogiceL
- ap(icaea #no tata%ente.
Mat$)ial$ 7$&$'a)$
- ta%poane c# )at&L
- ta)i& ena(&L
- "o(#ie $e 4ica4onat $e "o$i#L
- %&n#!i $e 4aieL
- po"op.
- "e info%ea5& !i e"te #gat "& co(a4oe5eL
- "e c#(eg $ate >n (eg&t#& c# e)ent#a(e(e tata%ente (oca(e cae te4#ie ap(icate.
- "e c#&& con$#ct#( a#$iti) eBten c# #n ta%pon #"cat, efect#1n$ c# 4(1n$ee %i!c&i $e
otaieL
- "e o4"e)& e)ent#a(e(e iitaii "a# "eceiiL
- "e c#a& pa)i(ion#( #ec*ii c# %&n#!a $e 4#%4acL
- (a "f1!it $ac& pacient#( ageea5&, "e p#ne #n ta%pon $e )at&L
- $ac& pacient#( ae in$icaie $e tata%ent ace"ta "e efect#ea5& confo% eco%an$&i(o.
57;)iAi)$a &a<it:tii (u&al$ La
pa&i$7tul &o79ti$7t
S&op
- e)a(#aea "t&ii $e "&n&tate oa(&L
- >n$ep&taea g#"t#(#i !i %io"#(#i nep(&c#t a( ca)it&ii 4#ca(eL
- po%o)aea confot#(#i.
Mat$)ial$ 7$&$'a)$
- pei#& $e $ini pe"ona(&L
- pa"t& $e $iniL
- pa*a c# ap& pent# "p&(aeL
- pa*a $e ap& pent# pote5&L
- t&)i& ena(& pent# co(ectae ap&L
- a& $enta&L
- !e)ee(e $e *1tie, po"op, %#!a%aL
- ap& $e g#&L
- ta%poane, po"oapeL
- ta)& pent# %ateia(e.
,1
- "e info%ea5& pacient#(L
- "e apecia5& e"#"e(e fi5ice pent# a "ta4i(ii %o$#( $e co(a4oaeL
- "e a!ea5& >nt-o po5iie a$ec)at& "t&ii genea(eI
- !e51n$ c# #n po"op >n 8##( g1t#(#iL
- $ec#4it (atea( c# cap#( #!o i$icat "pi8init pe o pen& pote8at& c# po"op.
- "e $& pacient#(#i pei#a, pa"ta !i pa*a#( c# ap&L
- "e "#"ine t&)ia ena(& "#4 4&4ia pacient#(#i "a# apoape $e faa ace"t#iaL
- "e "f&t#iete pacient#( "& peie "#pafaa eBten& a $ini(o >ncep1n$ $in patea "t1ng& apoi
(a cent# !i apoi patea $eapt&L
- "e peie apoi "#pafaa cooane(o !i "#pafaa inten& a $ini(oL
- peieea "e face >n "en" )etica( 2-, %in#teL
- "e in)it& pacient#( "&-!i c(&tea"c& c# %#(t& ap& !i (a "f1!it c# ap& $e g#&L
- $ac& pacient#( e"te >n $ec#4it "e ofe& o can& c# cioc "a# #n t#4 $e "#ci#ne.
La pa&i$7tul &o+ato'
0e e)a(#ea5& "taea ace"t#ia, "e apecia5& $ac& ae ef(eB $e $eg(#tiie.
Mat$)ial$ 7$&$'a)$
- pei#& pe"ona(&L
- pa"t& $e $iniL
- po"opL
- ta%poane pe potta%ponL
- $e"c*i5&to $e g#&L
- co%pe"e $e tifon "tei(eL
- ap& $e g#&, g(icein& 4oaBat& 2M, g(icein& c# "ta%icinL
- "pat#(& (ing#a(&L
- ta)i& ena(&L
- )a"e(in& pent# 4#5eL
- "eingi pent# a"piaea (ic*i$#(#i.
- "e a!ea5& pacient#( >n $ec#4it (atea(, toace(e #!o i$icatL $ac& n# e"te po"i4i( "e >ntoace
cap#( >nt-o pate.
- "e "pa(& %1ini(e, "e i%4ac& %&n#!i,
- "e pote8ea5& pena c# #n po"op !i "e a!ea5& a(&t#i t&)ia ena(& !i "einga pent#
a"piaie,
- "e fiBea5& %aBi(ae(e c# a8#to#( $e"c*i5&to#(#i $e g#&L
- "e peie "#pafaa eBten& $ini(o fo(o"in$ o cantitate %ic& $e pa"t&L
- "e a"pi& (ic*i$#( c# "eingaL
- "e fo(o"e!te o "pat#(& (ing#a(& !i ta%poane pent# >n$ep&taea o4a8i(o !i 4#5e(o >n
)e$eea c#&&ii %#coa"e 4#ca(eL
,2
- "e c#&& "#pafaa inten& a $ini(o fo(o"in$ ta%poane c# g(icein& 4oaBat& "a# c#
g(icein& c# "ta%icin $ac& eBi"t& can$i$aL
- "e o4"e)& foate 4ine a"pect#( gingii(o, $ini(o !i (i%4iiL
- "e "ta4i(e"c >ngi8ii #(teioae >n f#ncie $e con"tat&i.
O('$)<a*ii
Dac& pacient#( n# ae ef(eB $e $eg(#tiie "e en#n& (a pa"t& !i pei#& eBi"t1n$ i"c $e a"piaie pe
c&i(e e"piatoii.
57;)iAi)$a p)ot$>$i S&op
- 9enineea igienei pote5ei !i a ca)it&ii 4#ca(e.
Mat$)ial$ 7$&$'a)$
- pa*a %atL
- pei#&L
- pa"t& $e $iniL
- %&n#!i $e #nic& fo(o"i&.
- pacient#( con!tient e"te #gat "&-!i "coat& pote5a "& o c#ee !i "& o p#n& >nt-#n pa*a
popi#, %at, netan"paentL
- (a pacient#( incon!tient >ngi8iea "e face $e c&te a(t& pe"oan&I
- "e >%4ac& %&n#!i(e $e #nic& fo(o"in&L
- "e pin$e pote5a c# o co%pe"& $e tifon !i "e >n$ep&tea5&L
- "e "pa(& pote5a c# pei#a !i pa"ta pacient#(#iL
- "e p#ne pote5a >nt-#n pa*a c#at, %atL
- "e e$& pote5a pacient#(#i c1n$ >i ecap&t& "taea $e con!tien&L
- >nainte $e %ontaea pote5ei "e c(&te!te g#a c# ap& c#at&.
57;)iAi)$a p:)ulului S&op
- %enineea igienei
- %enineea "t&ii $e 4ine a pacient#(#i
- p&"taea $e%nit&ii pacient#(#i
a@ 57;)iAi)$a >il7i&: p)i7 pi$pt:7a)$
Mat$)ial$ 7$&$'a)$B
- piepteneGpeieL
- p1n5& "a# po"op pent# potecie.
- "e face $e c&te pacient, $ac& poate "a# $e c&te a(t& pe"oan&L
- p&#( "e >%pate >n !#)ie !i "e piapt&n& $e (a )1f "pe &$&cin&L
- p&#( (#ng "e >%p(ete!te ?eco%an$ae@L
,,
4@ Sp:la)$a p:)ului
0e poate face >n %ai %#(te %o$#iI
- >n pat K "pate(e pacient#(#i fiin$ "pi8init $e "a(tea#a #(at&, (ig*ean#( "pi8init pe "o%ie&L
- >n pat K pacient#( fiin$ oientat "pe %aginea pat#(#i, >n $ec#4it $o"a( oientat o4(ic
- pe "ca#n K $o#& "ca#ne c# "p&ta p#"e c# "p&tae(e apopiate, pe #n#( "t& pacient#( pe
ce(&(a(t "e "pi8in& (ig*ean#(L
- pe "ca#n (1ng& (a)oa K c# faa "a# c# "pate(e >n f#ncie $e "taea genea(& a pacient#(#i.
Mat$)ial$ 7$&$'a)$
- (ig*ean, g&(eat& pent# co(ectaea apei fo(o"iteL
- )a" c# ap& ca($&L
- te%o%et# $e 4aieL
- "&p#n (ic*i$ !a%ponL
- %#!a%a !i a(e5&L
- po"oapeL
- #"c&to $e p&L
- peie, piept&nL
- paa)anL
- "e e)a(#ea5& "taea pacient#(#i pent# a "e "ta4i(i %o$#( poti)itL
- "e info%ea5& pacient#( pi)in$ %ane)e(e ce "e )o face.
C# pacient#( >n po5iie !e51n$, e "ca#n "a# (a (a)oa
- "e pote8ea5& (en8eia pacient#(#i c# %ateia( i%pe%ea4i(L
- p&#( "e #%e5e!te, "e !a%ponea5&L
- "e %a"ea5& #!o pie(ea cap#(#i c# p#(pa $egete(oL
- p&#( "e c(&te!teG(i%pe5e!te p1na (a >n$ep&taea tota(& a !a%pon#(#iL
- "e acope& cap#( c# #n po"op #"cat, ca($L
- p&#( "e #"#c& c# #"c&to#(.
C# pacient#( >n pat
- "e pote8ea5& pat#( c# %ateia( i%pe%ea4i(L
- cap&t#( (i4e a( %#!a%a(ei "e #(ea5& $in a%4e(e p&i !i "e into$#ce >n (ig*ean "a#
g&(eat&L
- %#!a%a#a "e acope& c# a(e5&L
- p&#( "e #%e5e!te, "e !a%ponea5&L
- "e %a"ea5& #!o pie(ea cap#(#i c# p#(pa $egete(oL
- p&#( "e c(&te!teG(i%pe5e!te p1na (a >n$ep&taea tota(& a !a%pon#(#iL
- "e acope& cap#( c# #n po"op #"cat, ca($L
- p&#( "e #"#c& c# #"c&to#(.
2.2 S&=i+(a)$a po>i*i$i pa&i$7tului i+o(ili>at8 a,i7a+i&
S&op
,/
K a"ig#aea confot#(#i pacient#(#iL
K pe)eniea co%p(icaii(o fa)oi5ate $e i%o4i(i5ae ?e"cae, to%4o5e, >ncetiniea
tan5it#(#i@.
Mat$)ial$ 7$&$'a)$
K peneL
K "#(#i $in pat#&, $in a(te %ateia(e teBti(eL
K "pi8inito pent# picioae, "aci $e ni"ip.
K "e info%e5& pacient#(L
K "e e)a(#ea5& e"#"e(e pacient#(#i !i capacitatea ace"t#ia $e a paticipa (a poce$#&.
0e ea(i5ea5& $e 1-2 pe"oane, #na a)1n$ o( $e coo$onato.
a@ S&=i+(a)$a po>i*i$i ,i7 ,$&u(it ,o)'al ?7 ,$&u(it lat$)al
K pe"oana cae face "c*i%4aea "e a!ea5& $e patea pat#(#i "pe cae "e >ntoace pacient#(L
K "e p(ia5& p&t#a "pe patea op#"& pent# a ea(i5a #n "#( $e "pi8inieL
K "e pin$e #%&#( pacient#(#i, "e i$ic& !i "e "pi8in& c# p&t#aL
K "e "pi8in& apoi toace(e pacient#(#i c# o %1na, !i c# %1na $in"pe picioae(e ace"t#ia "e
otea5& 4a5in#( !i %e%4e(e infeioaeL
K %e%4#( infeio $e $ea"#pa "e f(ectea5&, ce( $e $e$e4"#4t &%1ne intin"L
K "e p#ne o pen& "#4 gen#nc*i#( "#peioL
K "e "pi8in& "pate(e c# p&t#a f&c#t& "#(L
K "e ea!ea5& pat#(, "e >ntin$e (en8eiaL
K "e acope& pacient#(.
4@ S&=i+(a)$a po>i*i$i ,i7 ,$&u(it lat$)al ?7 ,$&u(it ,o)'al
K pe"oana cae face "c*i%4aea "e a!ea5& $e patea pat#(#i "pe cae e"te >nto" pacient#(L
K "e >n$ep&tea5& pena $e "#4 gen#nc*i !i "#(#( $in p&t#&L
K "e a!ea5& pacient#( c# %i!c&i 4(1n$e >n $ec#4it $o"a(L
K "e into$#c "#4 egi#nea (o%4a& !i "#4 gen#nc*i penie %ici "a# %ateia(e teBti(e
>%p&t#ite pent# a e"pecta c#4#a fi5io(ogic& a co(oanei !i pent# a e)ita *ipeeBten"ia
%e%4e(oL
c@ S&=i+(a)$a po>i*i$i ,i7 ,$&u(it ,o)'al ?7 po>i*i$ 9$>@7,
De c&te o "ing#& pe"oan&
K "e $e5)e(e!te pacient#( p1n& (a %i8(ocL
K pe"oana "e a!ea5& >n faa pacient#(#i, ace"ta fiin$ #gat "& >ntoac& pi)iea >nt-o pateL
K "e pin$e pacient#( $e "#4 aBi(e !i "e "pi8in& cap#( $e ante4aL
K pacient#( e"te #gat "& "e "pi8ine pe t&(pi !i "& "e i$ice #!o (a co%an$&L
K "e tage "pe cap#( pat#(#iL
K "e "pi8in& "pate(e c# peneL
K "e fiBea5& gen#nc*ii c# #n "#( !i t&(pi(e c# #n "pi8inito.
De c&te $o#& pe"oane
,2
K ce(e $o#& pe"oane "e a!ea5& $e o pate !i $e a(ta a pat#(#i fa& >n fa&L
K 4ae(e $in"pe cap#( pacient#(#i "e >nc#ci!ea5& pe "pate(e ace"t#ia, cea(a(t& %1n& "e
into$#ce >n aBi(&L
K #na $inte pe"oane co%an$& %i!caeaL
K pacient#( e"te ta" "pe cap#( pat#(#i !i "e fiBea5& po5iia.
$@ S&=i+(a)$a po>i*i$i ,i7 po>i*i$ 9$>@7, ?7 ,$&u(it ,o)'al
Rea!e5aea pacient#(#i >n $ec#4it $o"a( $in po5iia !e51n$ "e face $e c&te $o#& pe"onae.
K ce(e $o#& pe"oane "e a!ea5& $e o pate !i $e a(ta a pat#(#i fa& >n fa&L
K #na $inte pe"oane co%an$& %i!caeaL
K "e >n$ep&tea5& o4iecte(e $e "pi8in $e "#4 gen#nc*i !i $in $ept#( t&(pi(oL
K 4ae(e $in"pe cap#( pacient#(#i "e >nc#ci!ea5& pe "pate(e ace"t#ia, cea(a(t& %1n& "e
into$#ce >n aBi(&L
K c# o %i!cae atent& pacient#( e"te ta" p1na a8#nge >n $ec#4it $o"a(, c# cap#( "pi8init pe
pen&L
K "e fiBea5& "#(#i(e $e "pi8in "#4 egi#nea (o%4a& !i gen#nc*iL
e@ R$a,u&$)$a pa&i$7*ilo) alu7$&a*i ,i7 po>i*i$ '$+i9$>@7, 'au 9$>@7,
K pacient#( e"te #gat "& "e "pi8ine pe t&(piL
K "e pin$e $e "#4 aBi(e !i "e tage #!o "pe cap#( pat#(#iL
K $ac& acti)ea5& $o#& pe"oane "e pin$e c# o %1n& $e "#4 aBi(&, ia cea(a(t& $e into$#ce
"#4 egi#ne fe"ie& !i "e acionea5& (a co%an$&L
K "e fiBea5& po5iia.
2.3. Mo(ili>a)$a pa&i$7tului
S&op
K pe)eniea co%p(icaii(oL
K "ti%#(aea ton#"#(#i %#"c#(a, fi5ic !i p"i*ic.
Mat$)ial$ 7$&$'a)$
K ca$# %o4i(L
K agitatoL
K 4a"tonL
K c18e.
P)$;ati)$a pa&i$7tului
0e an#n& pacient#( !i "e eBp(ic& i%potan!a %o4i(i5&ii pecoce.
'ent# an#%ii pacienti "e cee aco$#( %e$ic#(#i pi)in$ tip#( !i $#ata %o4i(i5&ii
?paa(i5ai, opeai, c# infact %ioca$ic@.
Mo(ili>a)$a pa'i<:
K "e fac %i!c&i $e f(eBie, eBten"ie, otaie, a4$#ctie, a$$#cie, "#pinaie, ponaieL
K "e %a"ea5& %e%4e(e >n "en"#( cic#(aiei $e >ntoaceeL
K "e co%#nic& pe%anent c# pacient#( pent# a af(a $ac& ae $#eiL
K "e conto(ea5& p#("#(.
Ri,i&a)$a ?7 po>i*ia 9$>@7,
,3
a@ 57 pat
K "e i$ic& $#p& te*nica "c*i%4&ii po5iieiL
K "e "pi8in& c# peneL
K "e poate i$ica "ing# c# a8#to#( #nei ag&&toi.
4@ La +a);i7$ patului
EBec#taea $e c&te o "ing#& pe"oan&
K "e into$#ce o %1n& "#4 aBi(e !i #na "#4 egi#nea pop(iteeL
K pacient#( "e poate pin$e $e g1t#( pe"oanei cae face %ane)aL
K "e otea5& picioae(e pacient#(#i >nt-#n #ng*i $e +.R !i "#nt (&"ate "& at1ne #!o (a
%aginea pat#(#iL
K "e "pi8in& $ac& pacient#( n# i!i poate %enine po5iia.
EBec#taea $e c&te $o#& pe"oane
K "e into$#ce c1te o %1n& "#4 o%op(ai, ia cea(a(t& "#4 egi#nea pop(iteeL
K "e i$ic& pacient#( >n po5iie !e51n$ !i "e ote!te c# #n #ng*i $e +.R, fiin$ a$#" (a
%aginea pat#(#iL
K ea!e5aea >n pat "e face eBec#t1n$ %i!c&i(e >n o$ine in)e"&.
c@ A9$>a)$a pa&i$7tului ?7 %otoliu
K "e a!ea5& pacient#( (a %aginea pat#(#iL
K "e a$#ce foto(i#( c# e5e%&toaea (atea(& (a %aginea pat#(#iL
K pe"oana "e a!ea5& >n faa pacient#(#i, into$#ce %1ini(e "#4 aBi(&L
K pacient#( "e i$ic& #!o >n picioae ?a8#tat $e c&te #na "a# $o#& pe"oane@L
K "e >ntoace pacient#( c# "pate(e "pe foto(i# !i "e a!ea5& c# gi8&L
K "e acope& c# #n p(e$L
K ea$#ceea >n pat "e face eBec#t1n$ %i!c&i(e >n "en" in)e".
$@ Ri,i&a)$a pa&i$7tului ?7 po>i*i$ o)to'tati&:
K "e a$#ce pacient#( (a %aginea pat#(#iL
K "e "#"ine !i "e i$ic& >n picioae fiin$ "#"in#tL
K "e o4"e)& pacient#(, "e a!ea5& >n pat $aca ae a%ee(iL
K ea!e5aea >n pat "e face eBec#t1n$ %i!c&i(e >n "en" in)e".
e@ E%$&tua)$a p)i+ilo) pa9i
K "e >ntea4& %e$ic#( $ac& pacient#( poate fi %o4i(i5atL
K "e i$ic& >nt1i >n po5iie !e51n$, apoi e"te a$#" (a %aginea pat#(#iL
K "e i$ic& >n picioae !i "e o4"e)& co%pota%ent#(L
K "e "pi8in& $e 4a "a# "e ofe& #n ca$# %o4i( !i "e pac#ge $i"tana eco%an$at& $e
%e$icL
K "e ce!te $i"tana poge"i)L
K pacient#( e"te inc#a8at "a "e $ep(a"e5e !i "ing# pe %&"#& ce "taea "a pe%ite.
2.7. Capta)$a $li+i7:)ilo)
a@ Capta)$a u)i7$i
K "e pote8ea5& pat#( c# a(e5& !i %#!a%aL
K "e $e54ac& patea infeioa& a cop#(#iL
K "e >nc&(5e!te p(o"ca "a# #ina#( c# ap& ca($&, "e !tege c# *1tie igienic&L
K (a 4&4ai peni"#( "e into$#ce >n #ina "a# "e oientea5& "pe p(o"c&L
,7
K pacient#( "e i5o(ea5& !i "e (a"& c1te)a %in#te "ing#L
K "e a8#t& pacient#( "a-!i "pe(e %1ini(e.
4@ Capta)$a +at$)iilo) %$&al$
K "e "pa(& %1ini(e, "e >%4ac& %&n#!i $e #nic& fo(o"in&L
K "e pote8ea5& pat#( c# a(e5& !i %#!a%aL
K "e i5o(ea5& pacient#( c# #n paa)anL
K "e $e54ac& patea infeioa& a cop#(#iL
K "e >nc&(5e!te p(o"caG4a5inet#( c# ap& ca($&, "e !tege c# *1tie igienic&L
K "e into$#ce o %1n& "#4 egi#nea "aca(& a pacient#(#i, "e i$ic& #!oL
K c# cea(a(t& %1n& "e into$#ce p(o"ca "#4 pacientL
K "e acope& pacient#( !i "e (a"& "ing#L
K "e ofe& $#p& $efeca!ie *1tie igienic&, $ac& "taea pacient#(#i >i pe%ite "& o fo(o"ea"c&L
K "e >n$ep&tea5& p(o"ca acopeit&L
K $aca e"te nece"a "e face toa(eta egi#nii pe #n a(t 4a5inetL
K "e ofe& pacient#(#i ap&, "&p#n, po"op pent# a-!i "p&(a %1ini(eL
K "e ea!ea5& pat#(L
K "e aei"e!te ca%ea.
O('$)<a*ii
0e o4"e)& $ac& "ca#n#( e"te %o$ificat ?c#(oae, con"i"ten&, fo%&, cantitate@.
c@ Capta)$a 'put$i
K #%&e!te pe)eniea &"p1n$iii infeciei, o4"e)aea a"pect#(#i "a# o4ineea #no
%o"te pent# eBa%ene $e (a4oatoL
K captaea "e face >n c#tii peti "a# pa*ae conice ga$ate c# "o(#ie $e5infectant& ?c#
eBcepia "it#aiei >n cae "e eco(tea5& pent# (a4oato@L
K pacient#( e"te in"t#it c#% "& co(ecte5e "a# "a eco(te5e "p#ta pent# eBa%en#( $e
(a4oato, e(i%in1n$ n#%ai >n co(ectoae(e ofeiteL
K "c#ip&toaea "e "c*i%4& ce( p#in $e $o#& oi pe 5iL
K "e a8#t& pacient#( "&-!i c(&tea"c& g#a c# ap&L
K "e "f&t#ie!te pacient#( "& "tea >nt-o po5iie cae "& fa)oi5e5e e(i%inaeaL
K "e go(e"c c#tii(e "a# pa*ae(e fo(o"ite !i "e "tei(i5ea5& coect >n )e$eea efo(o"iiiL
K "e notea5& cantitatea, a"pect#(, co%po5iiaL
K "e e"pect& c# "tictee peca#ii(e #ni)e"a(e.
$@ Capta)$a <:)':tu)ilo)
K (a pacient#( cae )a"& "e >n$epatea5a pote5a $enta&L
K "e "#"ine c# o %1n& f#ntea pacient#(#i, ia c# cea(a(t& "e ine t&)ia ena(& "#4 4&4ieL
K $ac& pacient#( e"te >n $ec#4it, "e ote!te cap#( >nt-o pate !i t&)ia "e a!ea5& (1ng& faa
ace"t#iaL
K "e >n$epatea5& i%e$iat t&)ia c# )o%&, $#p& cae "e o4"e)& conin#t#(L
K "e ofe& pacient#(#i #n pa*a c# ap& pent# a-!i c(&ti g#a, !i #n !e)ee(L
K pacient#( >n $ec#4it te4#ie atent "#pa)eg*eat "& n# a"pie )o%aL
K $ac& pacient#( ae $in no# "en5atia $e )o%&I
- e"te "f&t#it "& e"pie a$1ncL
- "e aei"e!te >nc&peeaL
K pacient#( >n $ec#4it te4#ie atent "#pa)eg*eat "& n# a"pie )o%aL
,8
K $ac& pacient#( ae $in no# "en5atia $e )o%&I
- e"te "f&t#it "& e"pie a$1ncL
- "e aei"e!te >nc&peeaL
- "e "e)e!te o t&)i& c#ata ?)e$eea )o%ei poate $ec(an!a ef(eB#( $e )o%&@L
O('$)<a*ii
Fn ca5#( inge"tiei acci$enta(e $e a(i%ente a(teate "a# toBice,"a# $e %e$ica%ente, eco(taea "e
face $in )&"&t#a pent# eBa%en#( $e (a4oato.
Capitolul ! ALIMENTAREA PACIENTULUI
A'p$&t$ ;$7$)al$
K "e c#(eg $ate $e"pe egi%, oa#( %e"e(o, epati5aea pe %e"e, po"i4i(it& i(e
$e %o4i(i5ae, capacitatea pacient#(#i $e a- i fo(o"i %e%4e(e "#peioaeL
K "e o4 in info%a ii $e"pe e"tic ii (egate $e efect#aea #no eBa%ene, a$%ini"taea
#no %e$ica%ente >n f#nc ie $e oa#( %e"e(oL
K "e o4 in info%a ii $e"pe pefein e(e a(i%entae a(e pacient#(#i.
,.1. Ali+$7ta)$a a&ti<:
9a"a poate fi "e)it& (a "a(a $e %e"e, >n "a(on (a %a"&, >n "a(on (a pat >n po5i ie e51n$, "a# >n
$ec#4it (atea(.
Dac& e"te ca5#(, "e pote8ea5& (en8eia c# #n po"op.
6(i%ente(e "#nt "e)ite >n con$i ii igienice pe o ta)&, %a"& pota4i(&, acopeite.
'acient#( e"te a8#tat "& > i po ione5e a(i%ente(e.
0e o4"e)& con"#%#( $e a(i%ente $e c&te pacient, e"pingeea #no
a(i%ente. Fn $ec#4it (atea(I
K "e i$ic& # o cap#( pacient#(#i, "e pote8ea5& pat#(L
K a(i%ente(e "e a ea5& (1ng& pacientL
K pacient#( e"te a e5at c# patea "&n&toa"& acce"i4i(&L
K "e a"ig#& a$%ini"taea (ic*i$e(o c# pai#( "a# $in c&ni c# cioc.
,.2 Ali+$7ta)$a pa'i<:
0e pactic& pent# pacien ii cae n# "e pot a(i%enta "ing#i.
K >n f#nc ie $e "taea genea(a, pacient#( e"te a e5at >n po5i ie e51n$, "a# c# cap#(
i$icatL
K "e pote8ea5& (en8eia $e pat i cea $e copL
K "e p(a"ea5& ta)a (1ng& pacient >n a a fe( >nc1t "& )a$& a(i%ente(eL
K "e )eific& te%peat#a a(i%ente(oL
K "e a$%ini"tea5& cantit& i %ici, )eific1n$#-"e $ac& a >ng*i it cantitatea $e a(i%ente
$at& anteioL
K a(i%ente(e "e taie 4#c& i %ici, n# "e ating c# %1naL
K e"t#i(e $e a(i%ente "e >n$ep&tea5& $in "a(on. %io"#( "a# )e$eea (o poate $ec(an a
ef(eB $e )o%&L
O('$)<a ii
K $ac& %a"a "e "e)e te >n "a(on, ace"ta te4#ie aei"it >nainteL
K "e >n$ep&tea5& p(o ti(e #inaeL
,+
K n# "e a"ocia5& oa %e"ei c# oa $e tata%entL
K pacien ii a i, c# 4o(i $e pie(e, c# a"pect nep(&c#t, "#nt acopei i i i5o(a i
K "e i$entific& %oti)e(e pent# cae pacient#( ef#5& a(i%enta ia "a# an#%ite a(i%enteL
K "e con"e%nea5a toate ac#5e(e $in ti%p#( %e"eiL
K pacient#( inapetent te4#ie "ti%#(at c# tact "& accepte *anaL
K pacien ii c# t#(4#&i $e $eg(# ie "#nt atent o4"e)a i.
K "e fo(o"e"c a(i%ente "e%i"o(i$e $ac& pacient#( ae t#(4#&i $e $eg(# ie.
Capitol "E MSURAREA I SUPRAVEGFEREA FUNCIILOR VITALE I A ALTOR
PARAMETRI
/.1 Ma'u)a)$a 9i 7ota)$a t$+p$)atu)ii &o)po)al$
9&"#aea te%peat#ii copoa(e "e efect#ea5&, (a oa act#a(&, c# te%o%et#( e(ectonic.
6paat#( pe%ite %&"#aea te%peat#ii c#tanate ?>n aBi(&@, ecta(e !i ti%panice. 6cea"t&
%&"#ae a te%peat#ii e"te api$& !i fia4i(&.
I7,i&a*ii
- "#pa)eg*eea "i"te%atic& >n c#"#( "pita(i5&iiL
- "#pa)eg*eea #n#i "in$o% infecio" "a# inf(a%ato.
P)$;:ti)$a Mat$)ial$lo)
0e )o peg&ti pe o ta)& %e$ica(&I
- te%o%et# e(ectonic c#tanat "a# ti%panic c# "on$& $i"poni4i(&L
- co%pe"e c#ate !i "o(#ie $e5infectant&L
- (#4ifiant pent# te%o%et#( ecta(.
0e )o fo(o"i aco$#i $e #nic& fo(o"in& pent# te%o%ete(e ti%panice.
Te%o%et#( )a fi $e5infectat $#p& fiecae pacient.
P)$;:ti)$a Pa&i$7tului
- "e eBp(ic& pacient#(#i poce$#aL
- "e cee pacient#(#i "& &%1n& c#(cat >n patL
'ent# "#pa)eg*eea "i"te%atic& e"te i%potant $e con"i$eat fapt#( c& te%peat#a e"te %ai
%ic& $i%ineaa >nainte ca pacient#( "& "e i$ice $in pat.
E%$&tua)$a p)o&$,u)ii ,$ +:'u)a)$ a t$+p$)atu)ii
Cu t$)+o+$t)ul $l$&t)o7i& ti+pa7i&
- "e into$#ce captato#( a$aptat (a #n capi!on $e #nic& fo(o"in& >n #ec*ea pacient#(#iL
- "e ote!te te%o%et#( c# ,.R >n "pate pent# a fi >n faa ti%pan#(#iL
- apaat#( afi!ea5& te%peat#a >n 1-, "ec#n$e.
Cu t$)+o+$t)ul $l$&t)o7i& &uta7at
- "e $e"cope& aBi(a pacient#(#iL
- "e ta%ponea5& pent# a >n$ep&ta tan"piaiaL
- "e into$#ce "on$a Gcaptato#( te%o%et#(#i >n %i8(oc#( aBi(ei !i "e apopie 4a#( $e
toaceL
- "e a!teapt& ,. "ec. p1n& "e a#$e "e%na(#( "onoL
- "e a8#"tea5& te%peat#a afi!at& c# .,2RC pent# a o4ine te%peat#a copoa(&L
/.
- "e "pa(& %1ini(e.
6ce(a!i te%o%et# poate fi fo(o"it !i pent# %&"#aea te%peat#ii ecta(e.
Cu t$)+o+$t)ul $l$&t)o7i& o)al
- "e into$#ce "on$a Gcaptato#( e(ectonic >nt-#n capi!on $in %ateia( p(a"ticL
- "e p(a"ea5& >n ca)itatea 4#ca(&, "#4(ing#a(L
- "e %enine te%o%et#( pe (oc p1n& (a "e%na(#( "onoL
- "e "coate te%o%et#( !i "e cite!te )a(oaeaL
- "e a#nc& capi!on#( $in p(a"tic >n ecipient#( pent# $e!e#iL
- "e "pa(& %1ini(e.
Cu t$)+o+$t)ul $l$&t)o7i& )$&tal
- "e a!ea5& pacient#( >n po5iia 0I90L
- "e into$#ce "on$a te%o%et#(#i pote8at& $e capi!on#( (#4ifiat ?apoBi%ati) / c%@L
- "e %enine te%o%et#( p1n& (a "e%na(#( "onoL
- "e "coate te%o%et#(, "e cite!te )a(oaeaL
- "e a#nc& capi!on#( >n ecipient#( pent# $e!e#iL
- "e "pa(& %1ini(e.
O('$)<a ii
- %&"#aea te%peat#ii ecta( poate "& antene5e (e5i#ni $ac& e"te pacticat& coti$ianL.
- %&"#aea te%peat#ii ecta( poate po)oca "1nge&i (a copii, #pt#i a(e )ene(o
*e%ooi$a(e, e"cae "a# ectite ?nece"it1n$ inte)enii c*i#gica(e@.
R$p)$>$7ta)$a ;)a%i&: a t$+p$)atu)ii
- "e "ocote"c pent# fiecae (inie oi5onta(& $in foaia $e te%peat#& c1te 2 $i)i5i#ni $e
ga$L
- "e notea5& gafic )a(oaea >negi"tat&, pint-#n p#nct $e c#(oae a(4a"t& a!e5at $iect pe
(inia oi5onta(& $in #4ica coe"p#n5&toae pent# $i%ineaa ?D@ "a# "eaa ?0@ pent#
cife(e c# "o ?pae@L eBe%p(# ,3,2L ,7,/L ,8,3L etc
- "e #ne!te pi%#( p#nct c# #4ica pent# te%peat#& af(at& >n patea $eapt& a
"i"te%#(#i $e coo$onate $in foaia $e te%peat#&L
- "e o4ine c#4a te%ic& pin #niea p#ncte(o cae in$ic& )a(oi(e te%peat#ii %&"#ate
4icoti$ian pe pac#"#( 5i(e(o $e "#pa)eg*ee !i >ngi8ie.
E,u&a)$a pa&i$7tului
- "e info%ea5& pacient#( c& te%o%et#( e"te #n in"t#%ent in$i"pen"a4i( pent#
apecieea "t&ii genea(e (a $o%ici(i#L
- "e eBp(ic& pacient#(#i c#% "& >ntein& !i "& #ti(i5e5e te%o%et#(L
- "e ofe& pacient#(#i #n ta4e( c# )a(oi te%ice oientati)e, >n f#ncie $e ca(ea $e
%&"#ae fo(o"it&, ca >n eBe%p(#( $e %ai 8o".
Ca(ea $e
%&"#ae
0ca(a Ce("i#" 0ca(a Fa*en*eit
Oa(& ,7RC S .,, K .,3 +8,3RF S .,2 K 1,.
Recta(& ,7,2RC S .,, K .,3 ++,3RF S .,2 K 1,.
6Bi(a& ,3,2RC S .,, K .,3 +7,3RF S .,2 K 1,.
/1
/.2 M:'u)a)$a 9i 7ota)$a pul'ului
I7,i&a*ii
- $ete%inaea n#%&#(#i $e 4&t&i ca$iace pe %in#tL
- o4ineea $e info%aii $e"pe acti)itatea ini%ii i $e"pe "taea atee(oL
- apecieea &"p#n"#(#i ini%ii (a %e$icaia ca$iac&, acti)itate "a# "te".
0e peg&te"c pe o ta)& %e$ica(&I
- Cea" $e %ana c# "ec#n$a "a# cono%et#
- C#(oae o!ie ? ceion, piB "a# caioca@
- Canet $e a$not&i pe"ona(e
'eg&tiea p"i*ic&
- "e eBp(ic& pacient#(#i poce$#a pent# a e$#ce e%oii(e, tea%a !i a o4ine co(a4oaeaL
- "e a"ig#& #n epa#" p"i*ic $e ce( p#in 2 %in#te >nainte $e %&"#aeL
'eg&tiea fi5ic&
- "e a"ig#& #n epa#" fi5ic $e ce( p#in 2 %in#te >nainte $e %&"#aeL
- "e a!ea5& pacient#( >n po5iie confota4i(& >n f#ncie $e "taea genea(&I
- >n $ec#4it $o"a( c# %e%4#( "#peio >ntin" pe (1ng& cop, atic#(aia %1inii in
eBten"ie, %1na in "#pinaie ?pa(%a oientat& >n "#"@L
- >n po5iie "e%i!e51n$a ?>n pat "a# >n foto(i#@ ante4a#( >n #ng*i $ept "pi8init
pe "#pafaa pat#(#i, %1na >n "#pinaie !i eBten"ie.
E%$&tua)$a p)o&$,u)ilo)
- "e "pa(& %1ini(eL
- "e epeea5& atea a$ia(& (a eBte%itatea $i"ta(& a ante4a#(#i, pe faa anteioa&
?inten&@,
>n !an#( a$ia( af(at >n pe(#ngiea po(ice(#iL
- "e p(a"ea5& $egete(e in$eB, %e$i# !i ine(a ?2,,,/@ $ea"#pa ateei a$ia(e epeateL
- "e eBecit& o pe"i#ne #!oa& a"#pa ateei pe o"#( a$i#", a"tfe( >nc1t "& "e peceap& "#4
$egete p#("aii(e "1nge(#iL
- "e fiBea5& #n p#nct $e epe pe ca$an#( cea"#(#i $e %1n&L
- "e n#%&& ti%p $e 1 %in#t p#("aii(e pecep#te "#4 $egete, "a# ,. "ec#n$e !i >n%#(ite c#
$oi n#%&#( pent# a o4ine ata p#("#(#i pe %in#tL
- "e apecia5& it%#(, a%p(it#$inea !i e(a"ticitatea peete(#i ateia( >n ti%p ce "e %&"pa&
fec)enaL
- "e >negi"tea5& fec)ena p#("#(#i >n canet#( pe"ona( not1n$I n#%e(e pacient#(#i,
"a(on#(, $ata >negi"t&ii, ataL
- "e "pa(& %1ini(e.
R$p)$>$7ta)$a ;)a%i&: a pul'ului ?7 %oaia ,$ t$+p$)atu):
- "e "ocote"c pent# fiecae (inie oi5onta(& a foii $e te%peat#& c1te / p#("aiiL
/2
- "e notea5& gafic )a(oaea >negi"tat& pint-#n p#nct $e c#(oae o!ie, a!e5at $iect pe
(inia oi5onta(& $in #4ica coe"p#n5&toae pent# D ?$i%ineaa@ "a# 0 ?"eaa@, pent#
)a(oi(e cae ce"c $in / >n / ?eB. 3/, 38, 73, 8.@L
- "e notea5& gafic )a(oaea >negi"tat& pint-#n p#nct $e c#(oae o!ie a!e5at >n %i8(oc#(
p&tat#(#i $in #4ica coe"p#n5&toae ?D "a# 0@ pent# )a(oi(e cae ce"c $in 2 >n 2
?eB.I 32, 33, 7.@L
- "e #ne te pi%#( p#nct, pint-o (inie c# "&geat&, c# #4ica p#("#(#i af(at& >n patea
$eapt& a "i"te%#(#i $e coo$onate $in foaia $e te%peat#&L
- "e o4ine c#4a p#("#(#i pin #niea p#ncte(o cae in$ic& )a(oi(e atei ca$iace
%&"#ate 4icoti$ian, pe pac#"#( 5i(e(o $e "#pa)eg*ee !i >ngi8ie.
E<alua)$a $%i&a&it: ii p)o&$,u)ii
R$>ultat$ a9t$ptat$D,o)it$B
- p#("#( e"te 4ine 4&t#t, eg#(at, ia fec)en a "& >n"cie >n (i%ite(e no%a(e
coe"p#n5&toae )1"teiL
- teg#%ente(e !i %#coa"e(e "#nt no%a( co(oateL
- pacient#( e"te (ini!tit.
R$>ultat$ 7$,o)it$
- ata p#("#(#i e"te %ai %ae "a# "#4 no%a(#( caactei"tic )1"teiL
- p#("#( a$ia( n# e"te pecepti4i(L
- p#("#( e"te ait%icL
- a%p(it#$inea e"te %ic& "a# ce"c#t&L
- pacient#( e"te pa(i$, anBio", ac#5& pa(pitaii, eBta"i"to(eL
- pacient#( ae #na "a# %ai %#(te $inte po4(e%e(e $e $epen$en& #%&toaeI
- into(ean& (a acti)itateL
- a(teaea confot#(#iL
- $eficit $e )o(#% (ic*i$ianL
- eBce" $e )o(#% (ic*i$ianL
- a(teaea pef#5iei ti"#(ae.
Mo,i%i&:)i ?7 'itua*iil$ '$l$&tat$
- $ac& p#("#( a$ia( n# e"te pa(pa4i( "e ca#t& a(te atee acce"i4i(e pent# %&"#aeI
- atea te%poa(&I (a #n (at $e $eget $ea"#pa !i (atea( $e "t1nca te%poa(#(#i, >n
$ept#( pa)i(ion#(#i a#ic#(aL
- atea caoti$& eBten& ?$eapt& "a# "t1nga@I pe fa a anteioa& a g1t#(#i, >n !an#(
$e(i%itat $e (ainge ?anteio@ !i %#!c*i#( "tenoc(ei$o%a"toi$ian ?(atea(@L
- atea pe$ioa"& K pe faa $o"a(& a picio#(#i, >n $ept#( pi%#(#i
!an inte%etata"ianL
- atea fe%#a(& K >n egi#nea ing*ina(&, (a ni)e(#( ti#ng*i#(#i (#i 0capaL
- apeB ?)1f#( ini%ii@ K p#("#( apica(, >n "pai#( 2 inteco"ta( ?i.c.@ pe (inia
%e$ioc(a)ic#(a& "t1ng&L
- (a copiii "#4 2 ani "e e)it& %&"#aea p#("#(#i a$ia( >nt#c1t ata ce"c#t& !i aia %ic& $e
pa(pae pot $ete%ina )a(oi ineBacteL
- (a copiii pe"te 2 ani ata p#("#(#i a$ia( "e o4ine at#nci c1n$ "#nt (ini!tii "a# $o%,
>nt#c1t e"te $ifici( "& o4ii co(a4oaea copi(#(#i $e a &%1ne c# %1na ne%i!cat&L
- (a copi(, pent# o ac#atee %aBi%&, ata p#("#(#i "e n#%&& ti%p $e 1 %in#t.
/,
- "e >n)a& pacient#( "&-!i %&"oae "ing# p#("#( peifeic (a atee(e caoti$& "a#
te%poa(& >nt#c1t "#nt %ai acce"i4i(e pent# a#topa(paea (a $o%ici(i#L
- "e in"t#ie!te pacient#( "& eBecite o pe"i#ne #!oa& fo(o"in$ , $egete pent# pa(paeL
- "e info%ea5& pacient#(Gfa%i(ia cae "#nt )a(oi(e no%a(e a(e p#("#(#i,
caactei"tice
)1"teiL
- "e in"t#ie!te pacient#(Gfa%i(ia "& ia (eg&t#a c# %e$ica( c#ant oi $e cate oi )a(oi(e
atei p#("#(#i "#nt $e)iate $e (a no%a( !i "taea genea(& a pacient#(#i "e %o$ific&.
- "e ofe& pacient#(#i #n ta4e( c# )a(oi oientati)e ca >n eBe%p(#( $e %ai 8o"I
;1"ta Rata apoBi%ati)& Rata %e$ie
No#-n&"c#t 12. -13. 1
/
1- 2(#ni?"#ga@ 1..- 1/. 1
2
12 (#ni K 2 ani 8.-1,. 1
1
2 ani- 3 ani 72-12. 1
.
3 ani K 12 ani 72-11. +2
6$o(e"cent 3.-1.. 8.
6$#(t 3.-1.. 8.
/., M:'u)a)$a 9i 7ota)$a p)$'iu7ii '@7;$lui #t$7'iu7$a a)t$)ial: 4 TEAE-
S&op
- $ete%inaea pe"i#nii "i"to(ice !i $ia"to(ice (a intenae pent# a co%paa "taea c#ent&
c# )a(oi(e no%a(eL
- e)a(#aea "t&ii pacient#(#i >n ce pi)e"te )o(#%#( $e "1nge, an$a%ent#( ini%ii i
"i"te%#( )a"c#(aL
- apecieea &"p#n"#(#i pacient#(#i (a tata%ent#( c# f(#i$e "a#G i %e$ica%ente.
0e peg&te"c pe o ta)& %e$ica(&I
- "teto"cop 4ia#ic#(aL
- ten"io%et# c# %an!et& a$aptat& )1"teiL
- co%pe"e c# a(coo( %e$icina(L
- c#(oae a(4a"t& ?piB, ceion@L
- foaie $e te%peat#&L
- canet $e a$not&i pe"ona(e.
'"i*ic&I
- "e eBp(ic& pacient#(#i poce$#a pent# a e$#ce tea%a !i a o4ine co(a4oaeaL
- "e a"ig#& #n epa#" p"i*ic $e ce( p#in 2 %in#te >nainte $e %&"#ae >nt#c1t e%oii(e
inf(#enea5& pe"i#nea "1nge(#iL
//
Fi5ic&
/2
- "e a"ig#& #n epa#" $e ce( p#in 2 %in#te >nainte $e %&"#aeL
- "e a!ea5& pacient#( >n po5iie confota4i(& $e $ec#4it $o"a( oi "e%i!e51n$ "a# >n
oto"tati"% confo% in$icaiei %e$ica(e.
- "e #ti(i5ea5& co%pe"e c# a(coo( pent# a !tege o(i)e(e !i p&i(e %eta(ice a(e
"teto"cop#(#i $ac& e"te nece"aL
- "e "e(ectea5& #n ten"io%et# c# %an!et& poti)it& )1"tei !i "t&ii con"tit#iona(e a
pacient#(#iL
- "e a%1n& %&"#aea T.6. $ac& pacient#( e"te t#(4#at e%oiona(, ae $#ei, $ac& a f&c#t
eBeciii $e %i!cae "a# $ac& %&"#aea pe"i#nii ateia(e n# e"te o #gen&L
- "e a(ege 4a#( poti)it pent# ap(icaea %an!etei ?f&& pef#5ie inta)enoa"&, inte)enie
c*i#gica(& (a ni)e(#( "1n#(#i "a# aBi(ei, f&& a"#i, !#nt ateio-)eno" "a# &ni a(e
%1inii@L
- "e pe%ite pacient#(#i "& a$opte po5iia c#(cat "a# a!e5at c# 4a#( "#"in#t (a ni)e(#(
ini%ii !i pa(%a >n$eptat& >n "#"L
- "e $e"cope& 4a#( pacient#(#i fie pin i$icaea %1necii fie pin $e54&cae $ac&
%1neca e"te pea "t1%t&, pent# a n# ce!te pe"i#nea $ea"#pa (oc#(#i $e ap(icae a
%an!eteiL
- "e )eific& $aca %an!eta conine aeL
- "e "coate ae#( $in %an!et&, (a ne)oie, $e"c*i51n$ )enti(#( $e "ig#an& !i co%pi%1n$
%an!eta >n pa(%e "a# pe "#pafa& $#&L
- "e >nc*i$e )enti(#( $e "ig#an& >nainte $e a #%f(a %an!etaL
- "e ap(ic& %an!eta, cic#(a, >n 8##( 4a#(#i, 4ine >ntin"&, (a 2,2 -2 c% $ea"#pa p(icii
cot#(#i !i "e fiBea5&L
- "e pa(pea5& atea 4a*ia(& "a# a$ia(& eBecit1n$ o pe"i#ne #!oa& c# $egete(eL
- "e a!ea5& %e%4ana "teto"cop#(#i $ea"#pa ateei epeate !i "e into$#c o(i)e(e in
#ec*iL
- "e #%f(& %an!eta ten"io%et#(#i po%p1n$ ae c# paa $e ca#ci#c >n ti%p ce "e pi)e!te
ac#( %ano%et#(#iL
- "e contin#& po%paea $e ae p1n& c1n$ pe"i#nea "e i$ic& c# ,. c% $ea"#pa p#nct#(#i
>n cae p#("#( a $i"p&#t ?n# "e %ai a#$ 4&t&i >n #ec*i@L
- "e $eco%pi%& %an!eta, $e"c*i51n$ #!o )enti(#( $e "ig#an& pent# e"ta4i(iea
cic#(aiei "1nge(#i pin ateeL
- "e >negi"tea5& %enta( cifa in$icat& $e ac#( %ano%et#(#i >n o"ci(aie >n %o%ent#( >n
cae, >n #ec*i, "e a#$e pi%a 4&taie c(a& ?(#p-$#p@L acea"t& cif& epe5int& pe"i#nea
?ten"i#nea@ "i"to(ic& "a# %aBi%&L
- "e >negi"tea5& n#%&#( cae coe"p#n$e 4&t&ii $e fina( >n ti%p ce "e contin#&
$eco%pi%aea %an!eteiL ace"ta epe5int& T.6. $ia"to(ic& "a# %ini%&L
- "e >n$ep&tea5& %an!eta, "e c#&& !i "e $e5infectea5& o(i)e(e "teto"cop#(#iL
- "e >negi"tea5& )a(oi(e %&"#ate >n canet#( pe"ona(, not1n$I n#%e(e pacient#(#i, $ata
>negi"t&ii, )a(oi(e o4in#te ?T.6. T 1,.G7. %%=g "a# T.6.T 1,G7 c%=g@.
R$p)$>$7ta)$a ;)a%i&: a
TEAE
- "e "ocote"c pent# fiecae (inie oi5onta(& $in foaia $e te%peat#&, 1. %%=g "a# 1 c%
=gL
/3
- "e epe5int& gafic )a(oi(e >negi"tate pint-#n $ept#ng*i $e c#(oae a(4a"t&, a!e5at
pe
)etica(a ti%p#(#i ?D "a# 0@L (at#a $e "#" a $ept#ng*i#(#i epe5int& T.0. ?ten"i#nea
"i"to(ic&@ ia (at#a $e 8o" a $ept#ng*i#(#i epe5int& T.D. ?ten"i#nea $ia"to(ic&@.
/7
E<alua)$a $%i&a&it: ii p)o&$,u)ii
- T.6. a pacient#(#i e"te, >n (i%ite(e no%a(e coe"p#n5&toae )1"teiL
- pacient#( n# ac#5& cefa(ee, t#(4#&i $e ec*i(i4#.
R$>ultat$ 7$,o)it$B
- pe"i#nea "i"to(ic& "a# $ia"to(ic& e"te %ai %ae "a# %ai %ic& fa& $e ata no%a(& a
pe"oane(o $e aceea!i )1"t&L
- "#nete(e o4in#te pin %eto$a NOROTNOFF n# "#nt a#$i4i(e "a# "#ficient $e $i"tincte
pent# a faci(ita o apeciee eBact& a T.6.L
- pacient#( poate a)ea #na "a# %ai %#(te $in po4(e%e(e $e $epen$en&I
- into(eana (a acti)itateL
- a(teaea an$a%ent#(#i ini%iiL
- eBce" $e )o(#% (ic*i$ianL
- $eficit $e c#no!tineL
- a(teaea n#tiieiL
- a(teaea %enineii "&n&t&ii.
- "e i$ic& 4a#( pacient#(#i $ea"#pa ini%ii pent# 12 "ec#n$e >nainte $e e)eificaea
pe"i#nii $ac& "e a#$ c# $ific#(tate "#nete(e ?4&t&i(e ca$iace@ >n #ec*iL
- "e %&"oa& T.6. (a coap"& $aca acce"#( (a atee(e 4a#(#i n# e"te po"i4i(L
- "e a(ege o %an!et& (at& !i "e a!ea5& pacient#( pe a4$o%en pent# pa(paea a$ec)at& a
ateei pop(iteeL
- "e a8#"tea5& e)a(#aea pe"i#nii ateia(e >negi"tate, $ac& "e fo(o"e!te coap"a, >nt#c1t
eBi"t& ten$ina ca T.6. "& fie %ai %ae (a eBte%itatea $i"ta(& faa $e eBte%itatea
poBi%a(& ?"#peioa&@L
- "e %&"oa& pe"i#nea ateia(& pin %eto$a pa(patoie, >n (ip"a "teto"cop#(#i a#ic#(aL
pin acea"ta %eto$& >ntot$ea#na "e o4ine eBact n#%ai ten"i#nea "i"to(ic&.
- "e "f&t#ie!te pacient#( a$#(t "&-!i %&"oae T.6. ce( p#in o$at& pe anL
- "e info%ea5& pacient#( $e"pe #ti(itatea a#to%&"#&ii T.6. (a $o%ici(i#, pin ec*ipa%ent
$igita(L $e!i e"te co"ti"ito e"te %#(t %ai #!o $e citit )a(oi(eL
- "e in"t#ie!te pacient#( "& "e pe5inte c# po%ptit#$ine (a %e$ic $ac& )a(oi(e T.6. "#nt
o"ci(anteL
- "e in"t#ie!te pacient#( c# *ipeten"i#ne ateia(& ?=T6@ "&-!i ia %e$ica%ente(e >n %o$
eg#(at, "& e$#c& con"#%#( $e "ae, "&-!i )eifice ge#tatea !i "& >n)ee te*nici $e
%anage%ent a( "te"#(#iL
- "e info%ea5& pacient#(Gfa%i(ia cae "#nt )a(oi(e no%a(e >n f#ncie $e )1"t&L "e ofe&,
e)ent#a(, #n ta4e( c# )a(oi oientati)e ca >n eBe%p(#( $e %ai 8o"I
;1"ta ;a(oi no%a(e
a(e T.6.
Li%ite "#peioae
a(e no%a(#(#i
1 an +2G32 %%=g Ne$ete%inate
3-+ ani 1..G32 %%=g 11+G7+ %%=g
/8
1.-1, ani 11.G32 %%=g 12/G8/ %%=g
1/-17 ani 12.G8. %%=g 1,/G8+ %%=g
18- a$#(t 12.G8. %%=g 1,+G8+ %%=g
/./ M:'u)a)$a 9i 7ota)$a )$'pi)a*i$i
O(i$&ti<$l$ p)o&$,u)ii
- $ete%inaea atei e"piatoii (a intenae pent# a "e)i ca 4a5& $e co%paae
c# %&"#&toi(e #(teioaeL
- %onitoi5aea efecte(o 4o(ii, ta#%ati"%#(#i, "a# "te"#(#i a"#pa "i"te%#(#i e"piatoL
- e)a(#aea &"p#n"#(#i pacient#(#i (a %e$icaia "a# tata%ente(e cae afectea5& "i"te%#(
e"piato
0e peg&te"c pe o ta)a %e$ica(&I
- cea" c# "ec#n$a, $e %1n&, "a# cono%et#L
- c#(oae a(4a"t& ?ceion, piB@L
- foaie $e te%peat#&L
- canet $e a$not&i pe"ona(e.
- "e e)it& peg&tiea p"i*ic& a pacient#(#i >nt#c1t ace"ta >!i poate %o$ifica it%#( o4i!n#it
>n %o%ent#( >n cae con!tienti5ea5& popia e"piaieL
- "e %&"oa& e"piaia conco%itent c# ce(e(a(te "e%ne )ita(e $ac& apa "c*i%4&i >n
"taea pacient#(#i, $ac& pacient#( ae o afeci#ne ca$io-p#(%onaa "a# pi%e!te oBigen
oi %e$ica%ente ce afectea5& fi5io(ogia e"piaiei.
- "e o4"e)& %i!c&i(e $e i$icae "a# $e co4o1e a(e toace(#i c# fiecae in"piaie "a#
eBpiaieL
- "e %enin, >n contin#ae, $egete(e pe (oc#( $e %&"#ae a p#("#(#i >n ti%p ce "e o4"e)&
toace(e pacient#(#iL
- "e n#%&& %i!c&i(e $e i$icae a toace(#i ?in"piaii(e@ ti%p $e %ini%#% ,. $e "ec#n$e
!i "e >n%#(e!te c# 2 n#%&#( o4in#t pent# a af(a ata pe %in#tL
- "e n#%&& ti%p $e 1 %in#t in"piaii(e $ac& e"piaia e"te neeg#(at&L
- "e >negi"tea5& ata e"piatoie >n canet#( pe"ona( not1n$I n#%e(e pacient#(#i, $ata
>negi"t&ii, ata e"piatoieL
- "e "pa(& %1ini(e $ac& "-a atin" pacient#( "a# pat#( ace"t#ia pe $#ata %&"#&ii.
R$p)$>$7ta)$a ;)a%i&: a TEA
- "e "ocote!te c1te o e"piaie pent# fiecae (inie oi5onta(a $in foaia $e te%peat#&L
- "e notea5& gafic )a(oaea >negi"tat& pint-#n p#nct $e c#(oae a(4a"t& a!e5at $iect pe
(inia oi5onta(& $in #4ica coe"p#n5&toae pent# $i%ineaa ?D@ "a# "eaa ?0@L
/+
- "e #ne!te pi%#( p#nct, pint-o (inie c# "&geat&, $e #4ica e"piaiei af(at& >n patea
$eapt& a "i"te%#(#i $e coo$onate $in foaia $e te%peat#&L
- "e o4ine c#4a e"piaiei pin #niea p#nct#(#i iniia( c# ce(e(a(te )a(oi a(e
%&"#&toi(o efect#ate #(teio.
E<alua)$a $%i&a&it:*i p)o&$,u)ii
- ata e"piaiei, >n epa#", e"te >n (i%ite(e no%a(e caactei"tice )1"teiL
- e"piaia "e face pe na", e"te (ini!tit&, f&& 5go%ote, f&& efotL
- teg#%ente(e !i %#coa"e(e "#nt no%a( co(oate, pacient#( e"te con!tient, oientat >n ti%p
!i
"pai#.
R$>ultat$ 7$,o)it$B
- ata e"piatoie e"te %ai %ic& "a# %ai %ae fa& $e )a(oi(e no%a(e caactei"tice
)1"teiL
- pacient#( tece pint-o $ete"& e"piatoie %anife"tat& pinI 5go%ote e"piatoii
ano%a(e,
efot e"piato, #ti(i5aea %#!c*i(o e"piatoii acce"oii, otopnee, pie(e pa(i$& "a#
cianotic&, pie$ee $e c#no!tin&L
- pacient#( poate a)ea #na "a# %ai %#(te $in #%&toae(e po4(e%e $e $epen$en&I
- into(ean& (a acti)itateL
- anBietateL
- a(teaea confot#(#iL
- c(eaance ineficient a( c&i(o e"piatoiiL
- po"i4i(& in"#ficien& e"piatoieL
- a(teaea "c*i%4#i(o ga5oa"e.
- "e pe)&$ 2-1. %in#te $e epa#" >nainte $e n#%&aea e"piaii(o $ac& a ap&#t
o acti)itate ecent& ce poate a(tea ata e"piatoie a pacient#(#iL
- "e $e"cope& toace(e pacient#(#i $ac& e"piaia e"te "#peficia(& pent# a o4ine cea
%ai coect& at& e"piatoieL
- "e e)it& %&"#aea e"piaiei (a "#ga "a# copi( >n ti%p#( p(1n"#(#iL
- "e ap(ic& po$#( pa(%ei pe toace(e copi(#(#i at#nci c1n$ $oa%e pent# a n#%&a eBact
%i!c&i(e e"piatoii.
- "e >n)a& poce$#a $e %&"#ae !i >negi"tae a atei e"piatoii $e c&te %e%4ii
fa%i(iei ca !i aco$aea $e >ngi8ii at#nci c1n$ e"te ne)oieL
- "e a8#t&Gin"t#ie te pacient#( pi)in$ %o$#( >n cae te4#ie "& "e >ngi8ea"c& (a $o%ici(i#
in f#ncie $e caactei"tici(e e"piaiei !i $e "tat#"#( e"piatoL
- "e eBp(ic& p&ini(oGapain&toi(o c& te4#ie "a "e pe5inte c# copiii (a %e$ic $ac& apa
$ific#(t&i >n e"piaie "a# e"piaie "#peficia(&L
- "e "f&t#ie!te pacient#( "& #%i$ifice, "& >nc&(5ea"c& "a# "& &cea"c& ae#( $in
"pai#( a%4ienta( pent# a e$#ce inci$ena infecii(o e"piatoiiL
- "e "f&t#ie!teGin"t#ie!te pacient#( "& e"pecte in$icaii(e %e$ic#(#i (egate $e
a$%ini"taea %e$ica%ente(o, $e $iet& !i e)itaea factoi(o $e i"c >n "cop#( a%e(io&ii
"a# $i"paiiei po4(e%e(o e"piatoiiL
2.
- "e info%ea5& pacient#(Gfa%i(ia $e"pe )a(oi(e no%a(e caactei"tice )1"tei ?eB. in
ta4e(#( $e %ai 8o"@.
21
;1"ta Rata %e$ieG%in#t
No#-n&"c#t ,.-
8.
Copi( %ic 2.-
/.
Copi( %ae 12-
22
6$#(t 1/-
2.
:&4at 1/-
18
Fe%eie 13-
2.
/.2 M:'u)a)$a ?7:l*i+i 9i ;)$ut:*ii &o)po)al$
O(i$&ti<$l$ p)o&$,u)ii
- %&"#aea ge#t&ii pacient#(#i pent# "ta4i(iea "t&ii $e n#tiie !i a eineii apei >n
ogani"%L
- apecieea apot#(#i $inte >n&(i%e !i ge#tate.
- c1nta pent# a$#(iL
- antopo%et# ?"a# c1nta antopo%et#@L
- canet pent# notaea )a(oi(o.
'"i*ic&I
- "e eBp(ic& pacient#(#i %&"#&toi(e !i "e "ta4i(e!te >%pe#n& oa poti)it& ?>n c#"#( 5i(ei@L
- "e a"ig#& pacient#(, $ac& e"te ca5#(, c& "e e"pect& inti%itatea.
Fi5ic&
- "e a8#t& pacient#( "& "e $e54ace $e *a(at L
- "e in"t#ie!te pacient#( "& n# %&n1nce, "& #ine5e !i "& e(i%ine "ca#n#(.
M:'u)a)$a ?7:l*i+ii
- "e a!ea5& pacient#( >n picioae c# "pate(e (a ti8& !i (a c#"o#( ta(io%et#(#iL
- "e oag& pacient#( "& "tea c# "pate(e $ept !i c&(c1ie(e (ipite $e ti8a ta(io%et#(#i L
- "e co4oa& c#"o#( p1n& (a cap#( pacient#(#i !i "e cite!te pe ti8& ga$aia >n&(i%ii.
M:'u)a)$a ;)$ut:*ii
- "e a$#ce 4a(ana >n ec*i(i4# !i "e i%o4i(i5ea5& ti8a in$icatoae L
- "e )eific& $ac& "#nt >n$ep(inite con$iii(e I
- pacient ne%1ncatL
- )e5ica #ina& go(it&L
- "ca#n e(i%inatL
- "e a"ig#& c& poat& ace(ea!i *aine (a fiecae c1nt&ieL
22
- "e fo(o"e!te ace(a!i c1ntaL
- "e a$a#g& c#"oae(e pe Oi(oga%e !i ga%e, "a# c#"o#( apoape $e ge#tatea e"ti%at& a
pacient#(
#iL
- "e cee pacient#(#i "& #ce pe c1ntaL
- "e $e"c*i$e 4a#( ?ti8a@ !i "e %i!c& ce(e $o#& c#"oae ?c#"o#(@ p1n& ac#( "e "ta4i(e!te $in
no# (a
5eoL
- "e fiBea5& "caa c#"o#(#i !i "e cee pacient#(#i "& co4oae.
Fi7ali>a)$a p)o&$,u)ii
- "e con$#ce pacient#( (a pat ?$ac& e"te ne)oie@L
- "e a8#t& "& "e a!e5e >n pat.
Nota)$a p)o&$,u)ii
- "e notea5& )a(oi(e >n&(i%ii !i ge#t&iiL
- "e peci5ea5& $ac& $in $i)e"e %oti)e n# pot fi >n$ep(inite toate con$iii(e i%p#"e pent#
ea(i5aea $e %&"#&toi eBacte.
E<alua)$a $%i&a&it:*ii
p)o&$,u)ii R$>ultat$
a9t$ptat$
- c1nt&iea "-a f&c#t coectL
- e5#(tat#( ate"t& o e)o(#ie 4#n&.
R$>ultat$ 7$,o)it$
- )a(oi(e o4in#te aat& "c&$eea ge#t&ii (a pacienii "(&4ii, $en#tii, ce!teea ge#t&ii
!i eineea apei >n ogani"%L
- "e )eific& e"pectaea egi%#(#i a(i%enta.
PARTEA III 4 INTERVENII DELEGATE #$%$&tuat$ 'u( p)$'&)ip*i$ +$,i&al:-
Capitolul . PRELEVRI #RECOLTRI- PENTRU EXAMENE DE
LAGORATOR
2.1 R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ ,$ la(o)ato)
Se respect protocolul laboratorului!
S&opul D I7,i&a*ii
- "ceeningL
- "ta4i(iea $iagno"tic#(#i !i %onitoi5aea &"p#n"#(#i teape#ticL
- "ta4i(iea $iagno"tic#(#i !i $ifeenieea tip#(#i $e ane%ieL
- i$entificaea t#(4#&i(o $e coag#(ae, %onitoi5aea *e%o"ta5ei, a "tat#"#(#i to%4o(iticL
- e)a(#aea peopeatoieL
- i$entificaea t#(4#&i(o %eta4o(ice !i en$ocine.
Mo,alit:*i ,$ )$&olta)$
2,
- p#ncia capi(a&L
- p#ncia )enoa"&L
- p#ncia ateia(& ?e"te $e co%peten a %e$ic#(#i@L
- a(te %eto$e pent# f&t !i no# n&"c#t $in co$on#( o%4i(ica( "a# $in "ca(p.
2/
Tipu)i ,$ $Ha+$7$
- eBa%ene *e%ato(ogice,
coag#(aeL
- eBa%ene
4ioc*i%iceL
- eBa%ene
i%#no(ogiceL
- eBa%ene
4acteio(ogiceL
- eBa%ene
)i#"o(ogiceL
- eBa%ene
paa5ito(ogice.
P)$;:ti)$a pa&i$7tului 4 R$;uli ;$7$)al$
- "e ofe& pacient#(#i in"t#ci#ni "i%p(e, peci"e, a$aptate ni)e(#(#i $e >ne(egee, e)it1n$
te%eni %e$ica(iL
- "e eBp(ic& nece"itatea
eBa%en#(#i
- "e o4ine
con"i%&%1nt#(L
- "e info%ea5& pacient#( c# pi)ie (a oa#( eco(t&i(o >n apot c# ce(e(a(te acti)it&i
$in
"ecie ?"e)iea %e"ei, a$%ini"taea %e$ica%ente(o, efect#aea a(to in)e"tigaii@L
- "e in"t#ie!te pacient#( c# pi)ie (a e"ticii(e a(i%entae, peioa$a $e po"t ?oe@,
e)ent#a(a >nte#pee a #no %e$ica%ente (a eco%an$aea %e$ic#(#i. 9a8oitatea
te"te(o "e eco(tea5& >n con$iii 4a5a(e ?pe ne%1ncate, $i%ineaa $e)e%e, $#p& te5ie
!i (a %ini% 8 oe $e (a #(ti%a %a"& >n con$iii $e epa#" fi5ic !i p"i*ic@L
- "e i$entific& e)ent#a(e a(egii (a "#4"tane $e5infectante,
(ateBL
- "e co%4ate
anBietateaL
- "e ofe& info%aii c# pi)ie (a ti%p#( nece"a p1n& (a o4ineea
e5#(tate(o.
E)o)i ,$ )$&olta)$
- pacient#( n# e"te in"t#it coe"p#n5&to pi)in$
poce$#aL
- pacient#( n# e"te peg&tit coect "a# n# "e e"pect& eco%an$&i(e pi)in$ $ieta,
con"#%#(
$e %e$ica%ente, po"t#& incoect&L
- %ane)ae, etic*etae
incoect&L
- ecipient ina$ec)at, cantitate $e po$#"
in"#ficient&L
- tan"pot !i con"e)ae
22
necoe"p#n5&toaeL
- neetan!ei5aea ecipiente(o, conta%inaea
po4e(oL
- >nt15ieea eBpe$ieii po$#"e(o (a (a4oato, p&"taea >n con$iii
necoe"p#n5&toaeL
- nee"pectaea o$inii $e eco(tae ?$e #%p(ee a
f(acoane(o@L
- neo%ogeni5aea coect& a "1nge(#i c# anticoag#(ant#(Ga$iti)#( $in
f(aconL
- %enineea gao#(#i %ai %#(t $e 1 %in#t poate %o$ifica o "eie $e e5#(tate ?po$#ce
*e%oconcentaie, %o$ificaea poteine(o p(a"%atice, acti)aea p(ac*ete(o@L
O('$)<
a ii
Medicul identific medicamente cunoscute a interaciona cu metodele de
testare
(anticoagulante, anticonvulsivante, antihipertensive, antibiotice, antivirale,
hipoglicemiante orale, hormoni, medicamente psihotrope) i hotrte dac trebuie
ntrerupte i cu ct timp nainte!
Mat$)ial$ 7$&$'a)$
9ateia( pent# p#ncie
23
- "eingi, ace "tei(e a$aptate, ace c# f(#t#a!i ?4#ttef(U@L
- )ac##%#i a$ec)ate c# "a# f&& anticoag#(antGa$iti)i >n f#ncie $e po4&L
- pan"a%ent a$e5i)L
9ateia( $e $e5infecie
- ta%poane ?)at&, tifon@L
- a(coo(, 4eta$in&L
- gao#L
- %ateia( $e potecieI %ateia( i%pe%ea4i(, a(e5&Gc1%pL
- containe pent# %ateia(e fo(o"iteL
6(te %ateia(e
- etic*ete, co$ $e 4aeL
- ta)& pent# %ateia(e.
- "e peg&te"c %ai %#(te )ac##%#i pent# a e)ita #ne(e ge!e(iL
- "e a(eg tip#i(e $e )ac##%#i >n f#ncie $e tip#( $e eBa%eneI
Tip $e )ac##% Con in#tGanticoag#(ant Tip $e eBa%ene
capac o!# f&& a$iti)i, f&&
anticoag#(ant
eBa%ene 4ioc*i%ice,
"eo(ogice, $ete%inae $e
g#p "ang#in
capac %o) EDT6 *e%ato(ogice, =L-
capac neg# citat $e Na ;0=
capac a(4a"t# citat $e Na =e%ato(ogie, ti%p $e
poto%4in&, factoi
ai coag#(&ii
capac )e$e *epain& 4ioc*i%ie, e(ecto(ii,
*o%oni, ga5e ateia(e
capac ga(4en citat $e $eBto5& *e%oc#(t#& pent#
ge%eni
anaeo4i capac gi *e%oc#(t#& pent#
ge%eni
aeo4i
- pent# a(coo(e%ie, $ete%inaea 5inc#(#i >n "1nge, a ni)e(#(#i "eic a( #no %e$ica%ente
"e pefe& ecipiente $in "tic(&L
- "e e"pect& #%&toae(e in"t#ci#ni $e fo(o"ie a )ac##%#i(o c# a$iti)i
?anticoag#(ani, acti)atoi ai coag#(&ii@I
- >naintea fo(o"iii "e (o)e!te #!o )ac##%#( "#4 capac pent# a $e"pin$e oice
e"t $e a$iti) $e pe peeii ep#4eteiL
- pent# a a"ig#a apot#( a$ec)at "1ngeGa$iti), ep#4eta "e #%p(e co%p(et
(&"1n$#- "e #n %ic "pai# (i4e (a po(#( "#peio. Dac& acea"t& con$iie n# a fo"t
>n$ep(init& n# "e #%p(e c# "einga $eoaece eBi"t& i"c $e *e%o(i5&. 0e
>n(oc#ie!te c# a(t )ac##%L
27
- pent# a e)ita fo%aea %icoc*eag#i(o "e a%e"tec& "1nge(e c#
anticoag#(ant#(, efect#1n$ 2-3 %i!c&i $e otaie a"ig#1n$ a"tfe( $i5o()aea
co%p(et& a a$iti)#(#iL
- $ac& "e eco(tea5& %ai %#(te po4e, "e a%e"tec& fiecae po4& i%e$iat
$#p& eco(taeL
- ep#4ete(e "e a!ea5& >n "tati) >n po5iie )etica(.
- >n ca5#( )ac##%#i(o f&& anticoag#(aniI
- ep#4eta "e #%p(e co%p(etL
- >nte %o%ent#( eco(t&ii !i efect#aea po4ei >n (a4oato te4#ie "& teac& ,.-3.
%in#teL
- "e e"pect& o$inea $e eco(taeI
- f(acoane pent# *e%oc#(t#iL
- ep#4ete f&& anticoag#(ant ?o!ii@L
- ep#4ete c# anticoag#(ant ?a(4a"te@L
- ep#4ete "epaatoae $e "eL
- ep#4ete c# *epain& ?)e5i@L
- ep#4ete c# EDT6 ?%o)@L
- ep#4ete c# citat $e $eBto5& ?ga(4ene@.
Al$;$)$a lo&ului
- pent# p#ncia capi(a&I )1f#( $egete(o %e$i#" "a# ine(a ?$e (a %1na ne$o%inant&@,
(o4#( #ec*iiL
- pent# p#ncia )enoa"&I )ena $e (a p(ica cot#(#i ?)ena %e$ia(&, c#4ita(&, cefa(ic&
!i 4a5i(ic&@L
u se abordea! braul cu fistula arteriovenoas pentru hemodiali! i cel aflat de aceeai
parte cu mastectomia!
"ac pacientul are montat cateter venos cu perfu!ie i#v# se procedea! n unul din
urmtoarele moduri$
- se puncionea! alt ven# u se recoltea! din locuri situate deasupra
liniei venoase, e%ist risc de dilataie&
- se oprete perfu!ia i se ateapt ' minute&
- se de!infectea! atent capacul cateterului cu betadin i alcool ()*
- folosind mnui sterile se scoate capacul i se detaea! perfu!orul, se ataea! o
sering de '+,) ml la conector&
- se aspir&
- primii ' ml de snge colectai vor fi aruncai&
- se clampea! cateterul, se ataea! o alt sering i se ncepe colectarea propriu+
!is&
- sngele se transfer n eprubete colectoare&
- se pregtete o sering cu heparin pentru heparini!area cateterului prin in-ectare
lent&
- se detaea! seringa&
- se reconectea! perfu!ia#
E%$&tua)$a p)o&$,u)ilo) ,$ )$&olta)$
Pu7&*ia &apila):
0copI o4ineea #nei cantit&i %ici $e "1nge pent# #n n#%& (i%itat $e ana(i5e ?=L-, =4,
28
g(ice%ie capi(a&@.
2+
Mat$)ial$ 7$&$'a)$
- 'ent# p#ncieI
- ace "tei(e "a# (anet& "tei(&L
- t#4#i, pipete, (a%e $e "tic(& pent# foti#L
- *1tie $e fi(t#L
- 'ent# $e5infecie !i potecieI
- ta)& pent# %ateia(eL
- "o(#ii $e5infectanteL
- ta%poane $e )at&, co%pe"e $e tifonL
- containe pent# ace, co(ecto pent# ce(e(a(te %ateia(e fo(o"ite.
- "e i$entific& pacient#(L
- "e info%ea5& !i "e eBp(ic& poce$#a ?>nep&t#a poate fi $#eoa"&@L
- "e o4ine con"i%&%1nt#(L
- "e a!ea5& pacient#( >nt-o po5iie confota4i(& >n f#ncie $e "taea genea(&I
- !e51n$ c# %1na "pi8init&L
- $ec#4it $o"a(L
- "e a(ege (oc#( >n f#ncie $e )1"t& !i po4a ce#t&I
a$#(t - p#(pa $eget#(#i ine(a "a# %i8(oci#L
- (o4#( #ec*iiL
copi( - faa p(anta& a *a(#ce(#iL
"#ga - c&(c1i.
- "e )eific& eco%an$aea %e$ica(&L
- "e "pa(& %1ini(e, "e $e5infectea5&L
- "e >%4ac& %&n#!i $e potecieL
- "e %a"ea5& #!o (oc#( >nep&t#iiL
- "e $e5infectea5& (oc#(L
- "e a!teapt& e)apoaea "o(#ieiL
- c# o %i!cae api$&, pepen$ic#(a& "e >neap& (oc#( p&t#n51n$ (a 2-, %% pof#n5i%eL
- "e !tege pi%a pic&t#& c# o co%pe"& $e tifon "a# *1tie $e fi(t#L
- "e eco(tea5& >ncep1n$ c# a $o#a pic&t#& >n f#ncie $e eBa%en#( "o(icitatL
- $ac& f(#B#( e e$#" n# "e pe"ea5& 5ona eBi"t1n$ i"c $e $i(#ae pin (ic*i$ ti"#(aL
- t#4#i(e co(ectoae te4#ie in#te oi5onta( pent# a pe)eni into$#ceea 4#(e(o $e ae,
ia
%icocontainee(e >nc(inate >n 8o" pent# a faci(ita c#geea "1nge(#i $in
$i"po5iti)#(
co(ectoL
- pent# ea(i5aea foti#i(o "e (a"& o pic&t#& "& ca$& pe o (a%& c#at&, $ege"at& !i "e
>ntin$e c# o (a%& >nc(inat& (a /2R, eBecit1n$ o fo& %o$eat& ?efect#at& coect, ae o
c#(oae #nifo%&@L
- (a te%inaea eco(t&ii "e pe"ea5& #!o (oc#( >n ep&t#ii c# o co%pe"& $e tifon "tei(
p1n& (a opiea "1nge&iiL
3.
- (a ne)oie "e ap(ic& #n %ic pan"a%ent a$e5i)L
31
- foti#i(e !i t#4#i(e co(ectoae "e ti%it etic*etate (a (a4oato, #ne(e e5#(tate
?g(ice%ia capi(a&@ "e cite"c i%e$iatL
- %ateia(e(e fo(o"ite "e co(ectea5& confo% peca#ii(o #ni)e"a(eL
- "e $e54ac& %&n#!i(eL
- "e "pa(& %1ini(e.
Pu7&*ia
<$7oa':
Repe5int& ceaea acce"#(#i (a o )en& c# "cop#( eco(t&ii "1nge(#i pent# eBa%en#(
$e
(a4oato, e)ac#aea #nei cantit&i $e "1nge "a# into$#ceea #no %e$ica%ente >n cic#(aia
)enoa"&. e"te %eto$a cea %ai fo(o"it& pent# toate tip#i(e $e eBa%ene p#t1n$#-"e eco(ta o
cantitate "#ficient& $e "1nge.
S
&
o
p
- pe(e)aea )enoa"& )i5ea5& #n e!antion $e "1nge $int-o )en& "#peficia(& c# a8#to#(
#n#i ac "tei( >n )e$eea eBa%in&ii >n (a4oato.
Mat$)ial$
7$&$'a)$
- gao#L
- "eingiL
- )ac##%#iL
- ace pent# "eingiL
- o can#(& :#ttef(UL
- ta%poane, co%pe"e $e 4#%4acL
- "o(#ii $e5infectanteI 4eta$in& "a# a(coo( 7.M ?a(coo(#( n# e"te fo(o"it pent# eco(taea
a(coo(e%iei@L
- etic*eteGco$ $e 4aeL
- %#!a%a, a(e5&L
- pan"a%ent a$e5i)L
- ecipiente pent# co(ectaea %ateia(e(o fo(o"ite confo% peca#ii(o #ni)e"a(e.
P)$;:ti)$a
pa&i$7tului
- "e info%ea5& pacient#( a"#pa nece"it&ii poce$#iiL
- "e atenionea5& pacient#( c& >nep&t#a e"te $#eoa"& !i e"te nece"a "& co(a4oe5eL
- pe"oana te4#ie info%at& c1t %ai c#1n$ ?(a te5ie $ac& e po"i4i(@ pent# a
e)itaGco%4ate
anBietateaL
- "e >ntea4& pacient#( $ac& i "-a %ai eco(tat "1nge, $ac& a "i%it (e!in, tan"piaie,
gea&, )&"&t#iL
32
- "e )eific& $ac& a e"pectat con$iii(e i%p#"e $e eco(taeI pe"oana n# a %1ncat !i n-a
4&#t ce( p#in 8 oe $ac& eBa%en#( (e nece"it& "a# a >nte#pt a$%ini"taea
%e$ica%ente(o (a eco%an$aea %e$ic#(#iL
- "e o4ine con"i%&%1nt#( info%atL
- "e a"ig#& po5iia coe"p#n5&toae >n confo%itate c# "taea pacient#(#i, "cop#( !i (oc#(
p#nciei ?$ec#4it $o"a( "a# %ai a !e51n$@ c# 4a#( >ntin", "pi8initL
- "e eBa%inea5& ca(itatea )ene(o !i "e a(ege (oc#(.
3,
E%$&tua)$a pu7&*i$i
- "e "pa(& %1ini(e !i "e p#n %1n#!i(eL
- "e peg&te"c )ac##%#i(e, "e etic*etea5&L
- "e a(ege (oc#(I )ene(e $e (a p(ica cot#(#i ?)ena %e$ian&, c#4ita(&, )ena cefa(ic& !i
4a5i(ic&@L
)ene(e ante4a#(#i !i ce(e $e pe faa $o"a(& a %1inii fo(o"in$ ace %ai %iciL
- "e "e(ectea5& )ene(e #5#a(eL
- $ac& )ene(e n# "#nt )i5i4i(e, "e poce$ea5& a"tfe(I
- "e >nc&(5e"c ap(ic1n$ o co%pe"& ca($& "a# "e %a"ea5& 4ae(eL
- "e 4a(an"ea5& 4ae(e >n 8o" ?"#4 ni)e(#( ini%ii@ c1te)a %in#te pent# a "e #%p(e
)ene(eL
- "e (o)e!te #!o c# in$eB#( fo"a anteoc#4ita(&L
- "e p#ne %ateia(#( $e potecie "#4 4a#( pacient#(#i pent# a n# p&ta pat#( c# "1nge "a#
$e5infectantL
- "e pa(pea5& )ena a(ea"& c# in$eB#( ?n# c# po(ice(e pent# a $ifeenia $e ate&@L
- "e peg&te!te )ac##%#( pin >n$ep&taea capac#(#i neco(oat a( ac#(#i $#4(# ?cae
acope&
patea $e ac >n >n)e(i! $e ca#ci#cGpin &"#cie #!oa&L
- "e >n!##4ea5& 4ine >n *o($eL
- "e )eific& po5iia 4a#(#i cae te4#ie "& fie >n$eptat >n 8o"L
- "e ap(ic& gao#( (a 2-8 c% $ea"#pa (oc#(#i p#ncieiL
- "e face $e5infecia (oc#(#i c# %i!c&i cic#(ae $e (a cent# "pe peifeie ?e)it1n$
tan"pot#( ge%eni(o "pe (oc#( >nep&t#ii@L
- "e (a"& "& "e #"#ce "a# "e !tege c# #n ta%ponL
- "e >n$ep&tea5& capac#( co(oat a( ac#(#i $#4(#
- "e fiBea5& )ena ap(ic1n$ po(ice(e %1inii ne$o%inante (a 2-, c%. "#4 a4o$ pent# a e)ita
acci$ente(e $ete%inate $e %i!caea 4#"c& a pacient#(#iL
- "e into$#ce ac#( >n )en& c# 4i5o#( >n "#", oientat o4(ic "#4 #n #ng*i $e 1.-,.R >n
f#ncie $e ca(i4#( !i pof#n5i%ea )eneiL
- $#p& intaea >n )en& "e con"tat& "c&$eea e5i"tenei (a >naintae !i "e p&t#n$e >n
(#%en#( )a"#(#i 1-2 c%.L
- "e a(ege pi%#( t#4 !i "e >%pinge >n *o($e ap&"1n$ c# $egete(e %i8(oci# !i a&t&to pe
%aginea *o($e#(#i p1n& ce patea ac#(#i $#4(# $in"pe t#4 "t&p#nge $iafag%a $e
ca#ci#c a capac#(#i t#4#(#i ?ac#( te4#ie "& >nepe 5ona centa(& a capac#(#i@L
- )ac##%#( $in t#4 eBtage $in )en& cantitatea $e "1nge pe"ta4i(it&L
- "e >n$ep&tea5& gao#( ?n# "e (a"& %ai %#(t $e 1 %in#t@L
- c1n$ pi%#( t#4 e"te p(in !i "1nge(e n# %ai c#ge, "e "coate $in *o($e !i $in ac ?ap&"1n$
c#
$eget#( %ae 4o$#a *o($e#(#i@L
- "e #%p(# c# "1nge ce(e(a(te t#4#i confo% eco%an$&ii !i e"pect1n$ "c*e%a $e
eco(taeL
- t#4#i(e c# anticoag#(ant "e &"toan& c# %i!c&i (ente pent# a ea(i5a #n a%e"tec
o%ogen.
O('$)<a iiB
.n timpul recoltrii, tuburile sunt meninute cu capacul n sus#
3/
/oninutul tubului nu trebuie s ating capacul sau capacul acului pe durata veno+punciei#
0raul pacientului trebuie s fie plasat n -os#
"up umplerea ultimului tub, acul se scoate din ven#
32
Pu7&*ia a)t$)ial: C Ro(#( a"i"tent#(#i %e$ica(
1rocedura este de competena medicului!
S&opulB eco(taea "1nge(#i ateia( pent# ana(i5a ga5e(o >n )e$eea e)a(#&ii f#nciei
e"piatoii !i %&"#aea ec*i(i4#(#i aci$o-4a5ic.
Loc#( p#ncieiI
- atee(eI a$ia(&, 4a*ia(& "a# fe%#a(&.
- "eing& "pecia(& cae conine .,2 %( *epain&, f&& aeL
- ac a$aptat ?c#(oae 4(e#, .,3 %% $ia%et#, 22 %% (#ngi%e@L
- ane"te5ic po%a$& "a# (i$ocain& 1-2M ?"eing&, ace pent# a$%ini"tae@L
- %ateia( $e $e5infecieI ta%poane, "o(#ie $e5infectant& ?confo% potoco(#(#i $in
"ecie@L
- co%pe"e "tei(eL
- t&)i& ena(&L
- pan"a%ent a$e5i)L
- co(ecto pent# ace fo(o"ite.
- "e an#n& pacient#(, "e eBp(ic& i%potana, nece"itatea !i %o$#( $e ea(i5aeL
- "e in"ta(ea5& confota4i(, >n $ec#4it, c# 4a#( >n eBten"ie, %1na "pi8init& pe pat c# pa(%a
>n "#"L
- e"te a)eti5at c& )a fi "i%i o $#ee %ai %#(t $ec1t (a p#ncia )enoa"&L
- e"te #gat "& co(a4oe5e, "& n# "e %i!teL
- %e$ic#( ea(i5ea5& ane"te5ia (oca(&.
E%$&tua)$a pu7&*i$i ,$ &:t)$ +$,i&
- %e$ic#( e)a(#ea5& cic#(aia pin te"t#( 6((en ?co%pi%& atee(e #(na& !i a$ia(&
>n poi#nea infeioa& a ante4a#(#i ap(ic1n$ 2 $egete@L
- "e face ane"te5ia c# (i$ocain&L
- "e >n%1nea5& %e$ic#(#i "einga pent# eco(taea "1nge(#i a)1n$ gi8& "& n# conin& 4#(e
$e aeL
- %e$ic#( efect#ea5& p#nciaL
- "e eBtage cantitatea nece"a& $e "1ngeL
- "e etage ac#( ap(ic1n$ #n ta%pon !i co%pi%1n$ (oc#( ,-2 %in#teL
- "e acope& )1f#( "eingii c# #n capac !i "e 4a(an"ea5& #!o pent# a %iBa "1nge(e c#
*epainaL
- "1nge(e eco(tat "e ti%ite i%e$iat (a (a4oato >n ce( %#(t ,. %in#te.
57;)iAi)$a pa&i$7tului ,up: pu7&*i$
- pe (oc#( p#nciei "e ap(ic& #n pan"a%ent a$e5i) a)1n$ gi8& "& n# "e ea(i5e5e #n t#
co%p(et pent# a n# 4(oca cic#(aiaL
- "e "#pa)eg*ea5& "& n# fac& *e%ato%L
- "e >ntea4& pacient#( $ac& pe5int& $#ee, f#nic&t#i, e$#ceea %o4i(it&ii.
R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ =$+atolo;i&$ 9i p)o($ ,$ &oa;ula)$
33
N.
Ct.
EBa%en#( ce#t Tip#( $e
)ac##%
'eci5&i "pecia(e O4"e)aii
1 =e%o(e#coga%a 9o) - '#ncie )enoa"&
- "e >n$ep&tea5&
gao#( $#p& 1 %in#t
- "e 4a(an"ea5& #!o
ep#4eta $e c1te)a
oi?,-/ 5i@
'#ncia )enoa"&
ta#%ati5a
nt&
%o$ific&
e5#(tate(e,
"ca$e
*e%atocit 2 =e%og(o4ina
feta(&
Ro!# Reco(taea "e face
>naintea
tan"f#5ii(o
0e face pent#
ca(c#(aea
$o5ei $e
i%#nog(o4#(i
n& R*-
"ceening
po"t pat#% , 0i$ee%ia Ro!# 'acient#( n# %&n1nc& c#
ce( p#in 12 oe >naintea
te"t#(#i
N# ia nici #n
%e$ica%ent pe 4a5& $e
fie >n 5i#a $inaintea
te"t&ii / Te"t#( $e agegae
p(ac*eta&
6(4a"t# Reco(taea n# ae
(eg&t#&
c# oa#( %e"e(o 2 Te"t#( Coo%4"
$iect
Ro!#G%o
)
Te"t#( fo(o"e!te eitocite
La no# n&"c#t "e
eco(tea5& $in
co$on#( o%4i(ica(
3 Te"t#( Coo%4"
in$iect
Ro!# 0e fo(o"e!te "e#(
7 Factoii coag#(&ii 6(4a"t# 9enineea gao#(#i %ai
%#(t $e 1 %in#t
%o$ific& )a(oi(e
8 Fi4inogen "eic
?fact.I a(
coag#(&
ii@
6(4a"t# N# ae (eg&t#& c# oa#(
%e"e(o
'oate fi inf(#enat $e
contacepti)e,
e"togeni, tan"f#5ii.
0e fo(o"e!te pe
%onitoi5a
ea
*e%o"ta5ei
+ Ti%p#( paia( $e
to%4op(a"ti
n& ?'TT@ !i
ti%p#(
paia( $e
to%4op(a"ti
n& acti)&
1-2
)ac##%
#i
a(4a"te
- Dac& pacient#( pi%e!te
*epain& inte%itent,
eco(taea "e face c# ,.-
3.P >naintea a$%ini"t&ii
$o5ei
- Dac& a$%ini"taea
*epainei e"te
contin#&, eco(taea "e
face >n oice %o%ent
I%potant
pent#
e)a(#aea
&"p#n"#(#i
(a teapia c#
anticoag#(an
te.
37
1. Ti%p#( $e
poto%4in&
?pt. INR T
apot
no%a(i5at
intenaiona(@
6(4a"t# - La pacient#( tatat c#
anticoag#(ante,
eco(taea "e face
>naintea a$%ini"t&ii
$o5ei
- '#ncia )enoa"& n#
te4#ie "&
ta#%ati5e5e )ena
$eoaece %o$ific&
e5#(tate(e
- 9i!caea
4#ta(& a
ep#4etei
po$#ce
*e%o(i5&
- Re5#(tat#( e inf(#enat
$e con"#%#( $e a(coo(,
$ieta 4ogat& >n g&"i%i
!i $e %e$ica%ente
- U%p(eea inco%p(et&
a ep#4etei $ete%in& 11 ;.0.=. 9o) 9enineea gao#(#i
$ete%in& )a(oi fa("e
12 -#p "ang#in Ro!# N# eBi"t& e"ticii
R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ (io&=i+i&$
N.
Ct.
)ac##%
1 6ci$ #ic Ro!# I%potant >n
g#t&,
(itia5a
ena(&. 2 -.'.T. G T.-.O. Ro!# 0e co%pi%& c#
atenie
)ena, "1ngeaea poate
fi pe(#ngit& >n
in"#ficiena *epatic&
0e e)it& efot#(
6at& cito(i5a
*epatic&
, 6(4#%ina "eic& Ro!# E)a(#ea5&
"tat#"#(
n#tiiona(,
e$e%e(e
/ 6(coo(e%ia Ro!# G
gi
N# "e fo(o"e!te a(coo(
pent# $e5infecia (oc#(#i
Uneoi "#nt
nece"ae
"e%n&t#i(
e ce(#i
cae a
eco(tat !i
38
%ato#(#i
2 6%i(a5a "eic& Ro!# Ni)e(e
ce"c#te
>n panceatite 3 :i(i#4ina "eic& Ro!# 'o4a n# "e eBp#ne (a
(#%in& inten"& %ai %#(t
$e 1 o&
7 Ca tota( ioni5at Ro!# Di%ineaa pe ne%1ncate
9enineea gao#(#i %ai
%#(t $e 1 %in#t poate
$ete%ina ce!teea
)a(oi(o 8 C(o "eic Ro!# G
)e$e
+ Co(e"teo( "eic Ro!# 'o"t 12 oe, n# "e con"#%&
a(coo(, n# "e ia#
%e$ica%ente cae
inf(#enea5& e5#(tat#(.
0e poate con"#%a ap&
N# "c*i%4a
$ieta >n
#(ti%e(e ,
"&pt&%1ni
1. C'N ?ceatin
fo"foOina5a@
Ro!#
11 Ceatinina "eic& Ro!# 'acient#( n# con"#%&
cane,
ceai, cafea,
%e$ica%ente. E)it&
efot fi5ic eBce"i) !i
E)a(#ea5&
f#ncia ena(&
12 Fo"fata5a a(ca(in&
"eic&
Ro!# - "e e)it& con"#%#( $e
g&"i%i ani%a(e >naintea
efect#&ii eco(t&ii
- "e eco%an$& po"t 12 oe
1, -(ice%ie Ro!# G
gi
- pacient#( n# %&n1nc& ce(
p#in 8 oe. 0e
eco(tea5& $i%ineaa
>nainte $e
a$%ini"taea
%e$icaiei
anti$ia4etice oa(e "a#
in"#(inei
- n# "e pe(#nge!te
0ceening
pent#
Dia4et
Da*aat,
ca(c#(aea
nece"a#(#i
$e in"#(in&
1/ =e%og(o4ina
g(ico5i(at&
-i G %o) N# ae (eg&t#& c# %e"e(e E)a(#ea5& pe
te%en (#ng,
ni)e(#i(e
"eice %e$ii
a(e g(#co5ei
12 Tig(icei$e "eice Ro!# - pacient#( n# %&n1nc& ce(
p#in 12 oe, n# con"#%&
a(coo( 2/ oe >nainte
- con"#%#( g&"i%i(o
>n #(ti%e(e 2 "&pt&%1ni
poate inf(#ena
e5#(tate(e
Fn fo%#(a "e
notea5& "eB#(
!i )1"ta
pacient#(#i
N# "c*i%4a
$ieta >n
#(ti%e(e
3+
, "&pt&%1ni
13 Uee "eic& Ro!# - n# ae (eg&t#& c# oa#(
%e"e(o
17 T.T.-.O. 0e a$%ini"tea5& $o5&
"tan$a$ $e g(#co5& K
(a a$#(i
72 g (a ,.. %( ap& !i
1,72 gGNg cop (a copii
18 9agne5i# "eic
0o$i#
"eic
'ota"i#
Ro!# G
)e$e
N# ae (eg&t#& c# oa#(
%e"e(o
1+ 'oteine tota(e
"eice
Ro!# 9enineea ti%p
>n$e(#ngat
a gao#(#i poate
ce!te )a(oi(e 2. Lipopoteine "eice
?LDL,
=DL,
;LDL@
Ro!# 12 oe >nainte "e e)it&
po"t#(
fi5ic inten", po"t 12 oe.
N# "e con"#%& a(coo( 21 Lacto
$e*i$ogena
5a ?LD=@
Ro!# N# e"te nece"a po"t
a(i%enta
E"te
i%potant&
pent#
e)a(#aea
eBtin$eii
I96,
e)a(#aea
c*i%ioteapi
R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ i+u7olo;i&$
1entru unele probe se respect strict protocolul laboratorului!
N.
Ct.
)ac##%
1 Dete%in&i $e
anticopi
Ro!# 'ent# anticopi
anti%e%4an& 4a5a(&
g(o%e#(a& "e i%p#ne
po"t 8 oe
2 6ntigen#( =L6
:27
Ce(
p#in
1.
%( G
0e ti%ite (a (a4oato >n c#"
$e 2/ oe $e (a eco(tae
0e face pent#
"pon$i(o
5&
anOi(o5a , 6nti"tepto(i5in
a
O ?60LO@
Ro!# I%potant& >n
infecii
"teptococice / Ciog(o4#(ine
"eice
1. %( G
Ro!#
- 'acient#( n# %&n1nc& 8 oe
$eoaece inge"tia $e
a(i%ente 4ogate >n g&"i%i
%o$ific& e5#(tat#(
2 E(ectofoe5a Ro!#
3 Facto#(
e#%atoi$
7 %( G
Ro!#
N# ae (eg&t#& c# oa#(
%e"e(o
0e fo(o"e!te pent#
$iagno"ticaea
7.
po(iatitei
e#%atoi$e
7 'oteina C
eacti)&
Ro!# - )a(oi(e pot fi inf(#enate
$e
"c&$eea pon$ea(&,
"#pa"o(icitae fi5ic&,
a$%ini"tae $e fi4ai
!i "tatine
N# "e con"#%& a(i%ente ce(
p#in / oe >naintea te"t#(#i
R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ (a&t$)iolo;i&$
N.
Ct.
EBa%en#(
ce#t
Tip#( $e
)ac##%
1 =e%oc#(t#a F(acoane
"pecia(e
pent#
ace"te
po4e
- "e eco(tea5& ce( p#in
1.-12 %( "1nge
- "e tan"pot& (a
(a4oato >n ce( %#(t
,. %in#te
- eco(taea "e
face >naintea
>ncepeii
tata%ent#(#i c#
anti4iotice
- >n eco(taea "et#(#i
$e po4e, ep#4ete(e
pent# *e%oc#(t#& "e
#%p(# pi%e(e
- po4e(e n# "e in
(a figi$e, pot fi
p&"tate ce( %#(t o
o& (a te%peat#a
ca%eei
- "e notea5& pe 4#(etin
ge%enii "#"pectai
pent# a(egeea
%e$i#(#i
$e c#(t#& a$ec)at
- eco(taea "e face
>n ti%p#( p#"e#(#i
fe4i(
Mat$)ial$ 7$&$'a)$
- 2 f(acoane c# %e$ii $e
c#(t#&?pent#
ge%eni aeo4i !i
anaeo4i @
- ac *o($e
- %ateia(e $e
$e5infecieI "o(#ii,
ta%poane
- co%pe"e
"tei(e, %&n#!i
"tei(e
- c1%p "tei(, %a"c&,
ta)& %e$ica(&
- "e eBp(ic& poce$#a
- "e o4ine
con"i%&%1n
t#(
- "e "pa(& (oc#(
p#nciei c# ap& !i
"&p#n
- "e $e5infectea5& (oc#(
- "e "pa(& %1ini(e c#
ap& !i "&p#n
- "e $e5infectea5&
- "e i5o(ea5& (oc#(
c# c1%p "tei(
- "e ap(ic& gao#(
- "e $e5infectea5& (oc#( 2 :#ce((a, 7-1. %( 0e poate $e%on"ta pin EBa%inaea "e face >n
71
C*(a%i$ia
Ta*o%ati"
Ro!# c#(t#i "a# te"te ELI06 paa(e( c# a(i%ent#(
"#"pect
, C(o"ti$i#%
4ot#(inic#%
,. %(
Ro!#
'o4a con"t& >n
$ete%inaea toBinei
>n "1nge
- "e a"ocia5& c#
$ete%in&i $in
"ca#n, "eceie
ga"tic&, )&"&t#i
/ =e(ico4acte
pi(oU
Confo%
(a4oato#
(#i
potoco(#
(#i
N# e o4(igatoi#
po"t#(,
"1nge(e "e
eco(tea5&
confo%
0e a"ocia5& !i c# a(te
tip#i $e $ete%in&i
?ELI06 pent#
antigeni@
2 Legione((a 2-7 %(
Ro!#
3 Tepone%a
pa((i$#%
7 %(
Ro!#
E)itaea con"#%#(#i $e
a(coo( c# ce( p#in 2/
oe >nainte
R$&olta)$a '@7;$lui p$7t)u $Ha+$7$ <i)u'olo;i&$
0e eco(tea5& 2-7 %( "1nge )eno" >n ep#4eta c# capac a(4a"t# "a# %o).
0e pot i$entificaI
- )i#"#( cito%ega(ic ?eco(tae )ac##% o!#@L
- )i#"#( *epetic ?)ac##% o!#@L
- )i#"#( =I; K 7 %(. "1nge, )ac##% o!#-%o)L
- )i#"#( 'a)o :1+K confo% potoco(#(#i (a4oato#(#iL
- )i#"#( a4ic K capac %o)-a(4a"t#L
- )i#"#( #4eo(ic K 7 %(, o!#L
- )i#"#( #8eo(ic K 7 %(, o!#L
- )i#"#( #(ian K o!#Ga(4a"t#L
- )i#"#( )aice(o 5o"teian K o!#Ga(4a"t#L
- )i#"#( )aio(ei K 2 ep#4ete c# capac o!#L
- )i#"#( Qe"t Ni(e K 2 %( G o!#L
- )i#"#( CoB"aOie K o!#Ga(4a"t#L
- )i#"#i(e *epatitice K 2-7%( G o!#L
- )i#"#( po(io%ie(itic K o!#.
EHa+$7$ pa)a>itolo;i&$
- >n ep#4ete c# capac o!#I "e co(ectea5& "1nge )eno" pent# a"cai5i, ec*inococ#", enta%oe4a
*i"to(itica, "tangU(oi$e" "tecoca(i", toBocaa, toBop(a"%a, tic*ine((aL
- >n ep#4ete c# capac a(4a"t#I eBa%ene >n pic&t#& goa"&, "e co(ectea5& 2-1. %( "1nge.
2.2 R$&olta)$a p)o($lo) ,$ u)i7: p$7t)u $Ha+$7$ ,$ la(o)ato)
S&opulDi7,i&a*ii
- "ceeningL
- e)a(#aea 4a(anei *i$oe(ecto(itice !i aci$o4a5iceL
- i$entificaea infeciei $e tact #inaL
- %onitoi5aea $i)e"e(o teapii.
72
- pe(e)aea $in #in& $e $i%inea& pin e%i"ia "pontan& $in %i8(oc#( 8et#(#i ?#ina $e
$i%inea& e"te %ai concentat& !i ae #n p* %ai "c&5#t@L
- "on$a8 #ina "tei( c1n$ pacient#( n# poate #inaL
- pin p#ncia "#pap#4ian& ?efect#at& $e c&te %e$ic@L
- o %o"t& $in #ina e(i%inat& !i co(ectat& >n 2/ $e oe pent# $o5aea "#4"tane(o a c&o
eBceie )aia5& $e-a (#ng#( 5i(ei.
Tipu)i ,$ $Ha+$7$
- eBa%en "#%a $e #in&L
- eBa%ene 4ioc*i%ice ?Ca, N, Na, #ee, ceatinin&, aci$ #ic, etc.@L
- eBa%en 4acteio(ogic ?#oc#(t#&@.
- "e an#n& pacient#(, "e eBp(ic& "cop#( !i %o$#( $e $e#(ae a poce$#iiL
- "e apecia5& capacitatea pacient#(#i $e a ea(i5a "ing# eco(taeaL
- $ac& pacient#( e"te capa4i( "& eco(te5e coect "e eBp(ic& c(a etape(e cae te4#ie
e"pectateL
- (a eco%an$aea %e$ic#(#i a$%ini"taea #no %e$ica%ente poate fi >nte#pt& pent# /8-
72 oeL
- #ne(e te"te nece"it& e"ticii a(i%entae pent# cae pacient#( )a fi info%at ?pent# #ne(e
eBa%ene 4ioc*i%ice@L
- pent# #ina eco(tat& >n 2/ $e oe, apot#( $e (ic*i$e e"te no%a( eBcept1n$ "it#aii(e c1n$
eBa%en#( o cee ?confo% eco%an$&i(o %e$ic#(#i@L
- pacient#( e"te in"t#it c#% "& co(ecte5e #ina >n 2/ $e oeI pi%a #in& $e $i%inea& "e
a#nc&, "e eco(tea5& >ncep1n$ c# a $o#a %ici#ne inc(#"i) pi%a %ici#ne $in $i%ineaa
#%&toae. 0e p&"tea5& (a ece.
E)o)i ,$ &ol$&ta)$
- pacient#( n# e"te coect info%atL
- co(ectoae(e n# "#nt "tei(eL
- n# "e co(ectea5& coect #ina pe 2/ oeL
- cantitatea eco(tat& n# e"te "#ficient&.
Mat$)ial$ 7$&$'a)$
- co(ectoae "tei(eL
- %&n#!i $e ca#ci#c ?$ac& pacient#( n# poate eco(ta "ing#@L
- %ateia( pent# toa(eta (oca(&LL
- etic*eteGco$ $e 4ae
- %ateia( pent# $e5infecia %1ini(oL
- co%pe"e $e tifonL
- %ateia( pent# $e5infecia %eat#(#i #ina.
O('$)<a ii
9ateia(e(e $ife& >n f#ncie $e "it#aia c(inic& a pacient#(#iI coopeant "a# n#, continent "a# n#,
c# "on$& "a# n#.
7,
La pacient#( c# "on$& "e fo(o"e!te o "eing& $e 1. %( !i #n ac *ipo$e%ic.
E%$&tua)$a p)o&$,u)ii ,$ )$&olta)$ a u)i7ii
a@ R$&olta)$a ,$ &:t)$ pa&i$7t ,i7 +i&*iu7$ 'po7ta7:
- "e face toa(eta peinea(&L
- "e "pa(& %1ini(eL
- "e $ec(an!ea5& %ici#nea !i pi%#( 8et "e e(i%in& >n toa(et&L
- "e ope!te )o(#nta %ici#nea ?$ac& e"te po"i4i(@ !i "e eco(tea5& e!antion#( pent#
eBa%inaeL
- "e contin#& %ici#neaL
- "e >nc*i$e co(ecto#( f&& a atinge inteio#(L
- "e etic*etea5&, "e ti%ite (a (a4oato.
4@ R$&olta)$a ,$ &:t)$ alt: p$)'oa7: ,i7 +i&*iu7$ 'po7ta7: #&@7, pa&i$7tul 7u a)$
&apa&itat$a ,$ a )$&olta 'i7;u)-
- "e face toa(eta peinea(&L
- "e >%4ac& %&n#!i $e ca#ci#cL
- "e in)it& pacient#( "& $ec(an!e5e %ici#nea, "e eco(tea5& $in %i8(oc#( 8et#(#iL
- "e >nc*i$e co(ecto#( f&& a atinge inteio#(L
- "e etic*etea5&, "e eBpe$ia5& (a (a4oato.
c@ R$&olta)$a u)i7ii la pa&i$7tul &u 'o7,:
- "e c(a%pea5& "on$a #ina& (a c1i)a c%. $ea"#pa (oc#(#i pe(e)&iiL
- "e a!teapt& 12-2. %in#teL
- "e $e5infectea5& %1ini(eL
- "e $e5infectea5& "on$a (a (oc#( $e pe(e)ae, fo(o"in$ a(coo( 7.M "a# #n a(t $e5infectant
a$aptatL
- "e >neap& "on$a c# #n ac *ipo$e%ic !i "e a"pi& cantitatea nece"a& c# o "eing& $e 2. %(.
$@ R$&olta)$a u)i7$i p$7t)u u)o&ultu):
'o4a "e eco(tea5& $in #ina $e $i%inea& "a# (a ce( p#in , oe $e (a %ici#nea anteioa&.
;o(#%#( po4ei te4#ie "a fie apoBi%ati) $e 1. %(. Reco(taea
(a fe%ei
- "e >n$epatea5& (en8eia inti%&L
- "e "pa(& %1ini(e c# ap& "i "&p#nL
- "e p#n %&n#"i $e #nic& fo(o"int&L
- "e #"#c& 5ona c# *1tie $e toa(et&L
- "e >nca(ec& )a"#( Jc-#(#i ?"a# #n a(t )a" co(ecto@L
- c# o %1n& "e >n$epatea5& (a4ii(e %ici !i "e %enin >n acea"t& po5iie tot ti%p#( eco(t&iiL
- c# cea(a(t& %1n& "e !tege 5ona )#()a& $in fa& "pe "pate eBec#t1n$ , %ane)e c# c1te #n
ta%pon "tei( >%4i4at >n "&p#n (ic*i$L
- "e "pa(& egi#nea c# ap& fiat& !i acit& pent# >n$epataea "&p#n#(#iL
- "e #"#c& egi#nea )#()a& c# ta%poane "tei(e pint-o "ing#& %ane)& $e !tegee $in fa&
"pe "pateL
- "e $ec(an!ea5& %ici#nea %enin1n$ >n$epatate (a4ii(e %iciL
- #inea5& apoBi%ati) 1.. %( !i f&& a >nte#pe 8et#( "e co(ectea5& >n #oc#(to cantitatea
nece"a& a)1n$ gi8a "& n# "e ating& g#a ecipient#(#iL
- "e etage ecipient#( $in 8et, "e contin#& %ici#nea in1n$ >n contin#ae (a4ii(e $ep&tate.
7/
Reco(taea (a 4&4at
- "e "pa(& %1ini(e c# ap& !i "&p#nL
- "e #"#c& fo(o"in$ po"op $e *1tieL
- "e $eca(otea5a g(an$#(L
- "e !tege g(an$#( c# o %i!cae fe%& $in"pe %eat#( #ina "pe !ant#( 4a(anopep#tia(L
- "e "pa(& 5ona c# co%pe"e "tei(e >%4i4ate >n "&p#n (ic*i$L
- "e c(&te!te c# ap& fiat& !i &cit& pent# a >n$epata e"t#i(e $e "&p#nL
- "e #"#c& g(an$#( pin ta%ponae c# co%pe"e "tei(e !teg1n$ $in fa& "pe fenL
- "e %enine g(an$#( >n contin#ae $eca(otat !i "e $ec(an!ea5& %ici#neaL
- "e e(i%in& apoBi%ati) 1..%(, apoi "e into$#ce #oc#(to#( >n 8et !i "e eco(tea5& 1. %(
f&& "& "e ating& %agineaL
- "e etage ecipient#( !i "e contin#& %ici#nea.
O('$)<a ii
2ecipientul se etichetea! i se trimite la laborator
.n timpul recoltrii capacul urocultorului se mentine steril
2., R$&olta)$a +at$)iilo) %$&al$ p$7t)u $Ha+$7$l$ ,$ la(o)ato)
S&opulDi7,i&a*ii
- $epi"taea pe"oane(o p#t&toae $e ge%eni patogeniL
- $iagno"ticaea 4o(i(o infecioa"e !i ga"tointe"tina(eL
- $iagno"ticaea paa5ito5e(o inte"tina(eL
- e)a(#aea eficacit&tii tata%ent#(#i.
- pe(e)aea $in "ca#n#( e%i" "pontanL
- pe(e)aea "pontan&.
Tipu)i ,$ $Ha+$7$
- eBa%en copopaa5ito(ogicL
- eBa%en 4acteio(ogic ?copoc#(t#&@L
- $ete%inaea "1nge&i(o oc#(te >n "ca#nL
- $ete%inaea (ipi$e(o >n "ca#n.
P)$;:ti)$a pa&i$7tului K eg#(i genea(e
- "e an#n& pacient#( "e eBp(ic& "cop#( !i %o$#( $e $e#(ae a poce$#iiL
- pent# copi( "e info%ea5& fa%i(iaL
- "e apecia5& capacitatea pacient#(#i $e a ea(i5a "ing# eco(taeaL
- $ac& pacient#( e"te capa4i( "& eco(te5e coect i "e eBp(ic& foate c(a etape(e poce$#iiL
- "e atenionea5& pacient#( "& n# a%e"te"te "ca#n#( c# #inaL
- "e info%ea5& pacient#( >n (eg&t#& c# egi%#( a(i%enta, $#ata ace"t#ia $ac& e"te nece"a
po"t#(, $ac& te4#ie "a ia p#gati)L
- "e in"t#ie!te pacient#( "&-!i fac& toa(eta peiana(&.
E)o)i ,$ )$&olta)$ 4 &au>$B
- pacient#( n# e"te in"t#it coe"p#n5&toL
- pacient#( n# e"pect& eco%an$&i(e pi)in$ $ieta, con"#%#( $e %e$ica%enteL
- fo(o"iea ecipiente(o ina$ec)ate, cantitate in"#ficient& eco(tat&, eco(tae incoect&L
72
- con"e)aea necoe"p#n5&toae, neti%iteea >n ti%p #ti( (a (a4oatoL
- etic*etae incoect&.
Mat$)ial$ 7$&$'a)$
'ent# toate tip#i(e $e eco(tae "e pegate"c #%atoae(e %ateia(eI
- copoc#(to "tei(L
- po"op $e *1tieG*1tie igienic&L
- p(o"c&L
- %&n#!i $e #nic& fo(o"in &.
P)$l$<a)$a p)o($lo)
a@ R$&olta)$a +at$)iilo) %$&al$ p$7t)u $Ha+$7 &op)opa)a>itolo;i&
Reco(taea "e face $in %ateii(e feca(e e%i"e "pontan f&& #ti(i5ae $e p#gati)e #(eioa"e "a#
(aBati)e pe 4a5a $e c&4#ne.
P)$;:ti)$a pa&i$7tului 9i )$&olta)$a
- "e >nt#ie!te pacient#( "&-!i "pe(e %1ini(eL
- "e eBp(ic& pacient#( nece"itatea fo(o"iii %1n#!i(oL
- e"te int#it "& e(i%ine >n p(o"c& "a# >nt-#n ecipient c#at ?$e eBe%p(# o(i& (a $o%ici(i#@L
- eco(tea5& c# (ing#ia copoc#(to#(#i c1te)a fag%ente ?cica 2g@ $in $ifeite 5one
"#"pecte ?%#co5it&i, po$#"e ne$igeate@L
- "e into$#ce (ing#ia copoc#(to#(#i >n co(ecto !i "e >nc*i$eL
- "e >n$ep&tea5& %&n#!i(eL
- "e "pa(& %1ini(eL
- "e etic*etea5& ecipient#( c# n#%e(e pacient#(#i $ata, oa eco(t&ii, eBa%en#( ce#tL
- "e ti%ite (a (a4oato >n %aBi% / oe $e (a eco(taeL
- $aca n# e"te po"i4i( "e pa"tea5& (a V/ ga$e ce("i#" !i "e ti%ite (a (a4oato >n %aBi%
2/oe.
O('$)<a ii
- "ac pacientul nu este capabil s recolte!e se instruie te o persoan din familie#
- 3a pacientul internat incapabil s recolte!e, prelevarea se face de ctre o persoan
instruit sau de ctre un asistent medical#
- 4%amenul copropara!itologic trebuie repetat de 5 ori din scaune emise spontan
consecutive (daca pacientul are un scaun pe !i se aduce cte o prob n fiecare !i& dac
are dou scaune n acea i !i se aduc ambele probe n recipiente diferite i nc o prob
din !iua a doua)#
4@ R$&olta)$a +at$)iilo) %$&al$ p$7t)u &op)o&ultu): #$Ha+$7 (a&t$)iolo;i&-
In)e"tigaia #%&e!te i5o(aea !i i$entificaea ageni(o etio(ogici %oti) pent# cae pe(e)aea
te4#ie f&c#t& c1t %ai apoape $e $e4#t#( 4o(ii !i >naintea in"tit#iii oic&#i tata%ent
anti%ico4ian.
'e(e)aea "e face $in "ca#n#( e%i" "pontan "a# $iect $in ect.
P)$l$<a)$a ,i7 '&au7 $+i' 'po7ta7
- "e eco%an$& >n toate fo%e(e $e $iaee ac#t& c1n$ e%i"ia $e %ateii feca(e e"te fec)ent&L
73
- "e eco%an$& pacient#(#i "& fo(o"ea"c& pent# $efecae containee $e #nic& #ti(i5ae $in
%ateia( p(a"tic "a# caton cae pot fi $econta%inate "a# >n$ep&tate c# #!#in& $#p&
fo(o"ieL
- >n (ip"a ace"toa "e fo(o"e"te #n )a" $e %eta( $e5infectat pin fie4eeL
- pacient#( e"te in"t#it "& n# #ine5e >n )a"#( >n cae a $efectatL
- "e eco(tea5& $in %a"a feca(oi$& c# "pat#(a copoc#(to#(#i, >n %o$ $eo"e4it pe(e)aea
f1can$#-"e $in po i#ni (ic*i$e %#coa"e "a# "ag*ino(ente $ac& eBi"t&L
- cantitatea eco(tat& e"te ,-2 c%
,
L
- "e eco%an$& >n infecii (a p#t&toii $e "*ige((a "a# "a((%one(aI pe(e)aea "e poate face c#
"on$a Ne(aton "a# c# ta%poane a$ec)ate.
P)$l$<a)$a )$&tal: 4 R$&olta)$a &u 'o7,a N$lato7
Mat$)ial 7$&$'a)
- "on$e ne(aton "tei(e n ?1/-13@L
- "eing& $e 1. %( "tei(&L
- %&n#!i $e #nica fo(o"in&L
- ep#4ete.
- "e face toa(eta ano-peinea(&L
- "e a!ea5& pacient#( >n $ec#4it (atea( c# picio#( $e 8o" >ntin" ia ce( $e $ea"#pa f(ectat.
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(eL
- "e >n$epatea5& fe"e(e !i "e e)i$enia5& oific#( ana(L
- "e into$#ce "on$a (a o pof#n5i%e $e apoBi%ati) 12 c% !i "e ac(e5& #!o peete(e, n# "e
fo(o"e"c ge(#i (#4ifianteL
- "e fiBea5& "einga (a cap&t#( "on$ei i "e eBec#t& 1-2 a"pia iiL
- "e etage "on$a !i "e into$#ce >nt-o ep#4et& >n %e$i#( $e con"e)ae.
P)$l$<a)$a )$&tal: 4 R$&olta)$a &u aAuto)ul ta+po7ului 't$)il
Mat$)ial$ 7$&$'a)$
- ta%poane "tei(e c# ti8a (#ng&, ta%pon#( fiin$ 4ine ata!at pent# a n# pe%ite etenia
intaecta(&. 0e pot fo(o"i ta%poane co%ecia(e >n t#4#i $e p(a"tic c# "a# f&& %e$i#( $e
con"e)aeL
- "e fi5io(ogic "tei(L
- %&n#"i $e #nic& fo(o"in&L
P)$;ati)$a pa&i$7tului
- "e face toa(eta ano-peinea(&L
- "e a!ea5& pacient#( >n $ec#4it (atea( c# picio#( $e 8o" >ntin" ia ce( $e $ea"#pa f(ectat.
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(eL
- "e >n$epatea5& fe"e(e !i "e e)i$enia5& oific#( ana(L
77
- ta%pon#( te4#ie #%e5it >n "e fi5io(ogicL
- "e into$#ce ta%pon#( >n ect !i "e ote!te #!oL
- "e etage #!o ta%pon#( "e into$#ce >n ep#4et& "tei(&.
O('$)<a ii
Scaunul recoltat se trimite imediat la laborator dup etichetarea corespun!atoare#
N# "e conge(ea5&.
Con"e)aea "e face, $ac& e"te ca5#(, >n "o(#ia ta%pon.
c@ D$t$)+i7a)$a '@7;$):)ii o&ult$ ?7 '&au7
I7,i&a*iiB
- ane%ie c# etio(ogie nec#no"c#t&L
- "ceening (a pe"oane(e c# )1"ta %ai %ae $e 2. $e ani !i antece$ente *ee$o-co(atea(e
pent# neop(a"% ga"tointe"tina(.
Mat$)ial$ 7$&$'a)$
- copoc#(toL
- te"te co(oi%etice.
- e"te in"t#it ca ce( p#in , 5i(e >nainte "& n# con"#%e cane o!ie, "& n# ia %e$ica%ente pe
4a5a $e fieL
- "e o4in info%aii $ac& pacient#( a pe5entat gingi)oagii, eBtacii $entae, epi"taBi"L
- $ac& a fo(o"it )ita%ina C e5#(tate(e pot fi fa(" negati)e.
- %ateii(e feca(e "e pot eco(ta ca !i pent# ce(e(a(te po4eL
- "e pot fo(o"i te"te co(oi%etice (a cae e5#(tate(e "e o4in i%e$iatI
- T$'tul =$+o&ult con"t& >n ap(icaea a $o#a pic&t#i $e eacti) pe o *1tie $in g#iac
c# %ateii feca(eL >n pe5ena "1nge(#i >n "ca#n apae co(oaea >n a(4a"t#L
- T$'tul &u ta(l$ta pe"#p#ne p(a"aea #nei po4(e pe "ca#n pe *1tia $e)e(opatoae,
ap(icaea #nei ta4(ete pe %ateii(e feca(e !i a$a#gaea a 2-, pic&t#i $e ap&. 'e5ena
"1nge(#i $ete%in& %o$ificaea c#(oi(o.
$@ D$t$)+i7a)$a lipi,$lo) ?7 +at$)ii %$&al$ #a('o)*ia 9i ,i;$'tia lipi,$lo)-
EBa%en#( "t#$ia5& a4"oia inte"tina(& in"#ficient& panceatic&, i pe%ite %onitoi5aea teapiei.
Mat$)ial$ 7$&$'a)$
- co(ectoL
- te"te.
78
- "e eco%an$& pacient#(#i "& con"#%e 1.. ga%e (ipi$e ti%p $e , 5i(eL
- n# "e fac c(i"%eL
- n# "e $a# (aBati)eL
- n# "e p#n "#po5itoae.
- "e eco(tea5& "ca#ne(e e%i"e >n , 5i(e con"ec#ti)eL
- "e notea5& $ata !i oa (a cae a fo"t o4in#t fiecae e!antionL
- po4e(e eco(tate "e ti%it i%e$iat (a (a4oato.
'e5ena (ipi$e(o >n "ca#n aat& %a($ige"tie !i %a(a4"oie, "e n#%e!te "teatoee
2./ R$&olta)$a $Hu,atului %a)i7;ia7
S&op D I7,i&a*ii
- i5o(aea !i i$entificaea ge%eni(o cae pop#(ea5& na5ofainge(e >n )e$eea "ta4i(iii
$iagno"tic#(#i "a# a "t&ii $e p#t&toL
- "ta4i(iea "en"i4i(it&ii (a anti4ioticeL
- %onitoi5aea tata%ent#(#i.
- "e ofe& pacient#(#i in"t#ci#ni c(ae, peci"e, a$aptate ni)e(#(#i $e >ne(egeeL
- >n ca5#( >n cae pacient#( e"te copi( in"t#iea te4#ie f&c#t& apain&to#(#iL
- "e eco%an$& efect#aea eco(t&ii >naintea a$%ini"t&ii anti4iotice(o $eoaece %o$ific&
e5#(tate(eL
- >n $i%ineaa eco(t&ii pacient#(I
- n# %&n1nc&, n# 4eaL
- n# face gaga&, n#-!i in"ti(ea5& pic&t#i >n na"L
- n#-!i face igiena oa(&L
- "e atenionea5& pacient#( c& e"te po"i4i( "& ai4& "en5aie $e )o%&.
E)o)i ,$ )$&olta)$
- nee"pectaea con$iii(o $e a"ep"ie !i anti"ep"ie $ete%in& conta%inaea po4eiL
- fo(o"iea anti"eptice(o oa(e poate in$#ce in*i4iia $e5)o(t&ii ge%eni(oL
- atingeea (i%4ii "a# 4#5e(o, a $ini(o c# ta%pon#( poate %o$ifica e5#(tat#( $atoit&
ge%eni(o eBi"teni >n ace"te 5oneL
- atingeea (#etei poate $ec(an!a ef(eB#( $e )o%&.
Mat$)ial$ 7$&$'a)$
- ta)& pent# %ateia(eL
- ep#4et& c# ta%pon "tei(L
- "pat#(& (ing#a(& "tei(&L
- %a"c& $e potecieL
- co(ecto pent# %ateia(eL
- etic*ete.
7+
E%$&tua)$a )$&olt:)ii
- "e )eific& $ac& pacient#( a e"pectat eco%an$&i(e pi)in$ poce$#aL
- pacient#( e"te #gat "& co(a4oe5e !i "& e"pecte >ntoc%ai "fat#i(e ce(#i cae eco(tea5&L
- $ac& pacient#( e"te #n copi(, po5iia "a )a fi a"ig#at& $e apain&to "a# a(t& pe"oan&L
- "e oientea5& pacient#( c# faa "pe (#%in&, >n po5iie !e51n$ pent# a a"ig#a o %ai 4#n&
)i5i4i(itate a 5oneiL
- "e >%4ac& %&n#!i(e $e #nic& fo(o"in&L
- "e p#ne %a"ca $e potecieL
- pacient#( e"te in)itat "& $e"c*i$& (ag g#a, "& in"pie a$1nc !i "& "tea ne%i!catL
- "e "coate ta%pon#( pent# eco(tae $in ep#4et&L
- c# a8#to#( "pat#(ei "e apa"& (i%4aL
- "e !tege $epo5it#( faingian !i a%ig$a(ian, oice 5on& inf(a%at& "a# #(ceat&L
- "e etage ta%pon#( c# atenie pent# a n# atinge (i%4a, $inii "i 4#5e(eL
- "e into$#ce i%e$iat ta%pon#( >n ep#4eta potectoaeL
- "e etic*etea5& !i "e ti%ite (a (a4oato co%#nic1n$ $ac& pacient#( a (#at %e$ica%ente, ce
fe(.
Col$&ta)$a +at$)ial$lo) %olo'it$
- %ateia(e(e fo(o"ite a# #n potenia( infecio" i$icat !i "e co(ectea5& confo% peca#ii(o
#ni)e"a(e.
O('$)<a ii
1entru recoltarea secreiei na!ale se folosete un tampon steril fle%ibil care se introduce n
narin i se terg pereii laterali#
2.2 R$&olta)$a 'put$i p)i7 $Hp$&to)a*i$
S&opD I7,i&a*ii
- i$entificaea ge%eni(o e"pon"a4i(i $e infecii e"piatoii !i te"taea "en"i4i(it&ii ace"toa
fa& $e anti4ioticeL
- $iagno"ticaea t#4ec#(o5eiL
- i$entificaea ce(#(e(o %o$ificate $e poce"e inf(a%atoii "a# neop(a5ice.
Tipu)i ,$ $Ha+$7$
- eBa%en 4acteio(ogicL
- eBa%en cito(ogic.
Mat$)ial$ 7$&$'a)$
- ecipient "tei( c# capac etan!L
- p#ngi $in %ateia( p(a"ticL
- "o(#ie "a(in&L
- ap& "i%p(&L
- pa*a $e #nic& fo(o"in&L
- co(ecto pent# %ateia(e(e fo(o"ite.
8.
- "e eBp(ic& pacient#(#i i%potana efect#&ii $ete%in&ii !i a e"pect&ii in"t#ci#ni(oL
- "e info%ea5& c& po4a "e eco(tea5& $i%ineaa, $eoaece "e atenionea5& pacient#( "& n#
%&n1nce, "& n# f#%e5e, "& n#-!i in"ti(e5e pic&t#i >n na", "& n# "e "pe(e pe $ini, "& n#-!i
c(&tea"c& g#a c# "o(#ii $e5infectante ?ap& $e g#&@ >nainte $e eco(taeL
- "e info%ea5& pacient#( c& $ac& )a fi ne)oie "e )a ape(a (a %eto$e cae "& "ti%#(e5e
eBpectoaia !i "e o4ine co(a4oaeaL
- te"t#( "e efect#ea5& >naintea a$%ini"t&ii $e anti4iotice.
- "e )eific& $ac& pacient#( a e"pectat eco%an$&i(eL
- pacient#( e"te #gat "&-!i c(&tea"c& g#a c# ap& "a# "o(#ie "a(in& pent# a n# conta%ina
"p#ta c# 4acteii $in ca)itatea 4#ca(&L
- pacient#( a!e5at pe "ca#n "a# >n oto"tati"% e"te #gat "& e"pie a$1nc $e 2-, oi !i apoi "&
t#!ea"c& p#tenicL
- "p#ta e(i%inat& ?ec*i)a(ent#( ce( p#in a( #nei (ing#ie@ "e co(ectea5& $iect >n ecipient#(
"tei(L
- fo(o"in$ %&n#!i $e potecie "e >nc*i$e ecipient#(, "e !tege eBteio#( c# #n !e)ee( !i "e
into$#ce >nt-o p#ng& $e %ateia( p(a"ticL
- "e etic*etea5& po$#"#( !i "e ti%ite (a (a4oatoL
- $#p& eco(tae "e ofe& pacient#(#i ap& "&-!i c(&tea"c& g#a.
Da&: pa&i$7tul 7u $Hp$&to)$a>: 'u%i&i$7t
- "e a$%ini"tea5& 2 pa*ae c# ap& cae f(#i$ific& "eceii(eL
- "e ape(ea5& (a #%i$ificaea ae#(#i $in >nc&pee, fo(o"iea aeo"o(i(oL
- (a eco%an$aea %e$ic#(#i "e a$%ini"tea5& #n eBpectoant c# ce( p#in 2 oe >nainte $e
eco(taeL
- (a eco%an$aea %e$ic#(#i "e ape(ea5& (a a(te %eto$e $e eco(taeI
- a"piaie tan"ta*ea(& fo(o"in$ #n catete "#4ie "a# "eing&L
- "p&(&t#& 4on!ic& efect#at& >n ti%p#( 4on*o"copiei.
Col$&ta)$a +at$)ial$lo) %olo'it$8 )$'p$&ta)$a 7o)+$lo)
- "e co(ectea5& %ateia(e(e >n containee "pecia(e confo% peca#ii(o #ni)e"a(eL
- "e "pa(& %1ini(eL
- "e atenionea5& pacient#( "& co(ecte5e "p#ta >n contin#ae >n ecipient#( ofeit $e pe"ona(#(
$e >ngi8ie.
E)o)i ,$ )$&olta)$
- "p#ta e"te a%e"tecat& c# "a(i)& "a# e"t#i a(i%entae c1n$ pacient#( n# e"pect&
eco%an$&i(e
- "p#ta e"te a%e"tecat& c# )o%a $ec(an!at& >n ti%p#( epi"o$#(#i $e t#"e
- po$#"#( a fo"t "#painfectat >n ti%p#( %ane)&ii
O('$)<a ii
1entru e%amenul citologic se recoltea! 5 probe n momente diferite#
81
1entru bacilul 6och se recoltea! 5+' probe matinale#
2.3 R$&olta)$a '$&)$*i$i u)$t)al$ la (:)(at
S&op D I7,i&a*ii
- $iagno"ticaea 4o(i(o c# tan"%itee "eB#a(&L
- te"taea "en"i4i(it&ii ge%eni(o (a tata%ent#( c# anti4iotice.
Mat$)ial$ 7$&$'a)$
- an"& $e p(atin&, (a%p& $e "pitL
- ta%poane "tei(eL
- (a%e $e "tic(&L
- etic*ete.
- "e info%ea5& pacient#( c# pi)ie (a nece"itatea efect#&ii eBa%en#(#i !i %o$#( $e
$e#(aeL
- "e an#n& pacient#( ca )a fi p&"tat& confi$enia(itateaL
- "e a"ig#& inti%itatea.
- "e atenionea5& pacient#( a"#pa %o$#(#i $e co(a4oaeL
- "e "pa(& %1ini(e, "e >%4ac& %&n#!i(eL
- "e e)i$enia5& #etaL
- "e co%pi%a p#in g(an$#( pent# a eBpi%a "eceiaL
- "e eco(tea5& fo(o"in$ an"a $e p(atin& "tei(i5at& "a# into$#c1n$ #n ta%pon "tei( pin
oifici#( #eta( >n #eta anteioa&L
- "e ea(i5ea5& #n foti# cae "e ti%ite (a (a4oato i%e$iat.
O('$)<a ii
Se recomand prelevare n po!iie de decubit dorsal pentru prevenirea sincopei vaso vagale#
"up recoltare se monitori!ea! pacientul e%istnd risc de hipotensiune, bradicardie, paloare,
transpiraie, grea, vrsturi#
Co(ectaea %ateia(e(o "e face confo% no%e(o, %ateia(#( eco(tat a)1n$ potenia( infecio"
i$icat.
2.7 R$&olta)$a '$&)$*iil) pu)ul$7t$ ,i7 l$>iu7i
S&opD I7,i&a*ii
- i$entificaea ge%eni(o e"pon"a4i(i $e infectaea p(&giiL
- "ta4i(iea "en"i4i(it&ii ge%eni(o fa& $e anti4iotice.
Mat$)ial$ 7$&$'a)$
- pen"e "tei(eL
82
- co%pe"eL
- %&n#!i "tei(eL
- ta%poane "tei(e, an"& $e p(atin&L
- pipeteL
- (a%e $e "tic(&, (a%p& $e "pit.
- "e an#n& pacient#(, "e eBp(ic& nece"itatea eBa%en#(#iL
- "e info%ea5& pacient#( c& e"te po"i4i( ca poce$#a "& fie $#eoa"&L
- "e a!ea5& pacient#( >nt-o po5iie co%o$& >n f#ncie $e (oca(i5aea (e5i#niiL
- "e a"ig#& inti%itatea pacient#(#i.
- "e )eific& pe"cipia %e$ica(&L
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(eL
- "e c#&& "#pafaa (e5i#nii pin a4"o4ie c# co%pe"e "tei(eL
- "e eco(tea5& $in "eceieI
- pin a"piaie c# o pipet& "tei(&L
- c# an"a $e p(atin& "tei(i5at&L
- c# ta%pon "tei(L
- "e ea(i5ea5& 2-, foti#iL
- po$#"#( a"piat "a# ta%pon#( "e into$#c >nt-o ep#4et& "tei(&.
57;)iAi)$a pa&i$7tului ,up: )$&olta)$
- "e pan"ea5& (e5i#neaL
- "e %onitoi5ea5& pacient#( >n contin#ae.
Col$&ta)$a +at$)ial$lo)
0e face confo% potoco(#(#i.
2.8 R$&olta)$a '$&)$*iilo) &$)<i&o4<a;i7al$ p$7t)u $Ha+$7$ ,$ la(o)ato)
a@ R$&olta)$a p$7t)u $Ha+$7ul (a&t$)iolo;i& 9i pa)a>itolo;i& al '$&)$tiilo) <a;i7al$
S&opDi7,i&a*iiB
Depi"taea $e ageni patogeni cae po$#c infecii )#()o)agina(eI Tic*o%ona" )agina(i",
Can$i$a a(4ican", c*(a%i$ia, *ae%op*i(#", ga$nee((a, a(ti ge%eni 4ana(i.
Mat$)ial$ 7$&$'a)$
- )a()e )agina(e "tei(e "a# "pec#( K ne(#4ifiateL
- ta%poane $e )at& %ontate pe potta%pon "tei(eL
- pipet& a4"o4ante "tei(eL
- (a%e $e "tic(e c#ate, $ege"ate, #"cateL
- %&n#"i $e #nic& fo(o"in&L
8,
- n# "e fac iigaii )agina(e c# ce( p#tin 2/* >naintea poce$#iiL
- n# "e fo(o"e"c o)#(e "a# ce%e )agina(e c# ce( p#in 2 5i(e >nainteL
- n# "e a$%ini"tea5& tata%ente antiinfecioa"e c# ce( p#in 8 5i(e >naintea pe(e)&iiL
- n# "e face pe(e)ae $ac& eBi"t& "1ngeae )agina(&.
- "e a!ea5& pacient& >n po5iie gineco(ogic& pe %a"&L
- "e %ontea5& )a()e(e "a# "pec#(#(L
- "e #%ectea5& ?$ac& e"te ne)oie@ ta%poane(e c# "e fi5io(ogicL
'i%a pe(e)ae "e face $in f#n$#( $e "ac )agina( po"tein.
- po$#"#( eco(tat "e >ntin$e pe (a%a >nt-#n "tat "#4ie, "e ap(ic& o pic&t#& $e "e
fi5io(ogic !i e)ent#a( o pic&t#& $e a(4a"t# $e Ce"U(, pe"te (a%& "e p#ne o (a%e(&L
- "e ti%ite i%e$iat (a (a4oatoL
6 $o#a pe(e)ae "e face >n ace(a!i %o$ ia $#p& >ntin$eea pe (a%& "e ap(ic& o pic&t#& $e
"o(#ie apoa"& $e *i$oBi$ $e pota"i# 2M-1.M !i apoi (a%e(&.
I7t$)p)$ta)$
Daca e5#(tat#( %ic"copic n# e"te conc(#$ent "e ec#ge (a >n"&%1naea $e pe %e$ii $e c#(t#&
4@ R$&olta)$a '$&)$*iilo) <a;i7al$ p$7t)u $Ha+$7ul &ito<a;i7al =o)+o7al
E"te #n te"t ca(itati) in$iect cae pe%ite e)a(#aea f#nciei o)aiene pe 4a5a %o$ificai(o
*i"to(ogice !i cito(ogice "#feite $e epite(i#( )agina( "#4 inf(#ena *o%oni(o o)aieni.
I7,i&a*iiB
6%enoee pato(ogic&, t#(4#&i a(e cic(#(#i %en"t#a(, %eno%etoagii, "tei(itate, infeti(itate,
$i"f#ncii en$ocine c# epec#"i#ni a"#pa acti)it&ii o)aiene, ?*ipofi5a, tioi$a, "#paena(&@
afeci#ni t#%oa(e 4enigne "a# %a(igne %a%ae, conto(#( eficacit&ii tata%ent#(#i *o%ona(.
Co7t)ai7,i&a*iiB Infecii ac#te !i "#4ac#te genita(e >na(te, inf(a%atii ce)ico)agina(e po(ap"
genita(, cance#( genita(.
Mat$)ial$ 7$&$'a)$
- "pat#(a 6UeL
- (a%e c#ate $ege"ate, #"cateL
- )a()e "a# "pec#( )agina(L
- %&n# i $e #nic& fo(o"in &.
P)$;:ti)$a pa&i$7t$i
- "e e)it& contacte(e "eB#a(e !i "p&(&t#i(e )agina(e c# 2 5i(e >nainte $e >ncepeea pe(e)ai(o
!i pe pac#"#( ace"toaL
- e"te a)eti5at& a"#pa poga%#(#i $e eco(taeI
- (a fe%ei(e c# cic(#( o)aian "c#t ?21-2/ 5i(e@ pe(e)&i(e >ncep >n 5i#a a 7-a (a
inte)a( $e 2 5i(eL
- (a fe%ei(e c# cic(#( $e 28-,2 5i(e "e eco(tea5& >ncep1n$ c# 5i(e(e 8-1. (a inte)a( $e 2
5i(eL
8/
- n# "e eco(tea5& >n ca5 $e "1ngeae )agina(&.
- "e eco(tea5& c# an"a $e (a ni)e(#( f#n$#i(o $e "ac )agina(e (atea(e !i po"teioL
- "e ea(i5ea5& foti#i cae "e ti%it (a (a4oato.
c@ R$&olta)$a '$&)$*iilo) &$)<i&o<a;i7al$ p$7t)u $Ha+$7ul &itotu+o)al Ga($ 4Papa7i&olaou
E"te #n te"t co%p(eB #ti(i5at pent# $epi"taea (e5i#ni(o necanceoa"e !i a cancee(o incipiente
ce)ica(e (a fe%ei(e a"i%pto%atice.
I7,i&a*ii
- o $at& pe an (a fe%ei(e >n )a"t& $e pe"te 18 ani cae a# acti)itate "eB#a(&L
- (a fe%ei(e cae n# pe5int& (e5i#ni ce)ico)agina(e )i5i4i(e pec#% !i (a ce(e c# (e5i#ni cae
e)oc& #n poce" inf(a%ato "a# $i"tofic (a eBa%en#( c(inic "a# co(po"copic.
Mat$)ial$ 7$&$'a)$
- "pat#(a $e (e%n 6Ue ?"e e)it& "pat#(e(e $e %eta(@ pent# pe(e)aea )agina(& i
eBoce)ica(&L
- peie %ic& ci(in$ic& pent# pe(e)aea en$oce)ica(&L
- ta%pon $e )at& %ontat pe #n potta%pon pent# eco(tae en$oce)ica(&L
- (a%e $e "tic(& c# eBte%it&i a"peL
- fiBato, a(coo( K ete >n popoii ega(eL
- )a()e )agina(e "a# "pec#( )agina(.
- e"te a)eti5at& "a n# efect#e5e nici o %ane)& )agina(& c# 72oe >naintea eBa%en#(#i
?toa(eta )agiana(&, ap(ica ii $e o)#(e, ce%e )agina(e@L
- "e e)it& apot#i(e "eB#a(e c# 2/ oe >nainte $e eco(taeL
- n# "e efect#ea5& %ane)e o4"tetica(e c# 2/oe >nainte ?t#"e# )agina(, co(po"copie,
ta%pona%ente )agina(e etc.@L
- pe(e)aea "e face >n afaa %en"t#atiei, >n afaa infeciei (oca(e !i $e pefein& >n peioa$a
$e %i8(oc a cic(#(#i.
- "e e)i$enia5& ca)itatea )agina(& pin into$#ceea )a()#(e(o "a# "pec#(#(#i ne(#4ifiate
- eco(taea "e face $e (a %ai %#(te ni)e(#iI
- $in f#n$#( $e "ac )agina(L
- $e (a ni)e(#( eBoco(#(#i #ti(i51n$ pent# a%4e(e te*nici "pat#(a 6Ue efect#1n$ o
%i!cae $e ac(a8L
- $e (a ni)e( en$oce)ica( #ti(i5&n$ peia ci(in$ic& ?%ai a ta%pon#( cae a4"oa4e
#ne(e ce(#(e@L
- "e fac (a%e pent# fiecae 5on& $in cae "-a efect#at eco(taeaL
- >ntin$eea "eceiei pe (a%a "e face pint-o %i"cae "in#oa"& a "pai#(#i, $e (a #n cap&t (a
ce(&(a(t f&& a ap&"a pea taeL
- (a eBte%it&i(e (a%e(o "e notea5& n#%e(e pacientei pec#% !i tip#( pe(e)&ii ?;-)agina(&,
C-eBoco(, E-en$oco(@L
82
- (a%e(e "e ti%it (a (a4oato.
I7t$)p)$ta)$a )$>ultat$lo)
0e face $#p& %ai %#(te c(a"ific&i ?'apanico(ao#, Ric*a$, :et*e"$a@.
C(a"ificaea 'apanico(ao# >%pate foti#i(e >n 2 c(a"e >n f#ncie $e ga$#( $e $e)iee
%ofo(ogic& $e (a tip#( no%a(I
C(a"a I K a4"ena $e ce(#(e ano%a(e "a# atipiceL
C(a"a a II-a K cito(ogie atipic& $a f&& e)i$en& pent# %a(ignitateL C(a"a
a III-a K cito(ogie "#ge"ti)& $a nec(onc#$ent& pent# %a(ignitateL C(a"a
a I;-a K cito(ogie p#tenic "#ge"ti)& pent# %a(ignitateL
C(a"a a ;-a K cito(ogie conc(#$enta pent# %a(ignitate.
O('$)<a ii
'ent# co%p(etaea info%aii(o "e %ai pot ea(i5aI foti#( )agina( ?(a fe%ei c# *i"teecto%ie
tota(& pent# $i"p(a5ie "a# cacino%@ !i foti#( )#()a ?pent# (e5i#ni )#()ae )i5i4i(e@.
Capitolul / ADMINISTRAREA MEDICAMENTELOR
3.1 A'p$&t$ ;$7$)al$
9e$ica%ente(e "#nt "#4"tane "a# a"ociei $e "#4"tane #ti(i5ate c# "copI
- teape#tic, pent# a%e(ioaea "a#G!i tataea 4o(i(o !i "i%pto%e(oL
- pe)enti), pent# a pe)eni apaiia %anife"t&i(o pato(ogice.
9e$ica%ente(e pot fi $e oigineI
- nat#a(&L
- )egeta(&L
- ani%a(&L
- %inea(&L
- c*i%ice $e "inte5&, o4in#te fie pin con"tit#iea >n (a4oato a "#4"tane(o acti)e nat#a(e,
fie pin co%4inaea #no e(e%ente c*i%ice cae tin$ "pe o "#4"tan& acti)& oigina(&
- %e$ica%ente o4in#te pin %eto$e genetice.
9e$ica%ente(e act#a(e "#nt $in ce >n ce %ai eficace, $a #neoi, c# i"c#i %ai. 6ce"tea pent#
c& e(e te4#ie "& fie pe"ci"e pint-#n $oc#%ent %e$ica(. Fn in"tit#ii(e %e$ica(e, e(e "#nt
pepaate (a fa%acia "pita(#(#i !i $i"ti4#ite $e c&te a"i"tente(e %e$ica(e. 0-a# ceat n#%eoa"e
fo%e $e %e$ica%ente >n "cop#( faci(it&ii a$%ini"t&ii (o !i ce!teii (a %aBi% a eficacit&ii
ace"toa.
Cla'i%i&a)$a +$,i&a+$7t$lo) ,up: u>
M$,i&a+$7t$ ,$ u> i7t$)7 K c#pin$ toate %e$ica%ente(e cae acionea5& $#p& ce a8#ng >n
cic#(aia "ang#in& pe $ifeite c&iI oa(& ?pe o"@ "a# paentea(& ?pe a(t& ca(e $ec1t cea $ige"ti)&@
9e$ica%ente(e $e #5 inten "e pe5int& "#4 #%&toae(e fo%eI p#$e, "iop#i, pic&t#i, poi#ni,
"#"pen"ii, co%pi%ate, ta4(ete, $a8e#i, cap"#(e, gan#(e, "#po5itoae.
M$,i&a+$7t$ ,$ u> $Ht$)7 K #ne(e "#nt ap(icate pe "#pafaa pie(ii "&n&toa"e, a(te(e "#nt
fo(o"ite pent# tataea #no (e5i#ni c#tanate
83
M$,i&a+$7t$l$ ,$ u> lo&al K "#nt $e"tinate tata%ent#(#i afeci#ni(o (oca(e, "pe eBe%p(#
co(i#i(e pent# afeci#ni(e oc#(ae "a# aeo"o(ii >n $ifeite afeci#ni p#(%onae
9e$ica%ente(e n# &%1n acti)e pe peioa$e ne$efinite. EBcipienii ace"toa, a$ic& "#pot#(
pincipii(o acti)e "e $ega$ea5& $#p& #n an#%it ti%p. De aceea, pe a%4a(a8#( %e$ica%ente(o
fig#ea5& $ata eBpi&ii, $ata $e (a cae %e$ica%ent#( n# %ai te4#ie "a fie #ti(i5at.
M$,i&a+$7t$l$ ;$7$)i&$ K "#nt copii a(e %e$ica%ente(o $e efein& cae !i-a# pie$#t
eBc(#"i)itatea $#p& #n n#%& $e ani $e co%ecia(i5ae.
'e#( %e$ica%ente(o geneice e"te $e ,.M p1n& (a /.M %ai %ic fa& $e a( %e$ica%ente(o $e
efein&. 6ct#a(%ente, $in ai#ni econo%ice, "e tin$e "pe po%o)aea %e$ica%ente(o geneice
at#nci c1n$ eBi"t&.
3.2 A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ o)al:
S&op
Into$#ceea >n ogani"%, pe ca(e oa(&, pin >ng*iie "a# "#4(ing#a(, a #nei cantit&i $e
%e$ica%ent cae "& acione5e genea( "a# (oca(.
P)i7&ipii ;$7$)al$
- a$%ini"taea %e$ica%ente(o pe ca(e oa(& "e face pin >ng*iie, "#4(ing#a( !i
tan"(ing#a(L
- "#4(ing#a(, "e a$%ini"tea5& Nitog(icein&, Egota%in&, $e5infectante a(e ca)it&ii 4#ca(e !i
oofainge(#i, #ne(e pan"a%ente ga"tice ?Dica4oca(%@L
- tan"(ing#a( ?pe (i%4&@ "e a$%ini"tea5& "paU-#i %e$ica%entoa"e pe 4a5& $e nitai, pent#
pacienii c# angin& conic&L pacient#( >n ace"t ca5 te4#ie "& a!tepte 1. "ec#n$e $#p&
a$%ini"tae >nainte $e a >ng*iiL
- nece"it& o 4#n& c#noa!tee, $e c&te a"i"tenta %e$ica(&, a tata%ente(o pe"ci"e $e %e$ic, a
efecte(o teape#tice !i a eacii(o a$)e"eL
- a$%ini"taea %e$ica%ente(o te4#ie "& &"p#n$& eBigene(o $e ca(itate !i $e "ec#itate
- a"i"tent#( %e$ica( ae e"pon"a4i(itate >n ace"t ca5.
- pe"cipia %e$ica(&L
- c&#cio c# %e$ica%enteL
- f(acon c# "o(#ie *i$oa(coo(ic&L
- o peec*e $e foafeceL
- pa*ae $e #nic& fo(o"in&Gecipiente "pecia(e pent# %e$ica%ente.
- "e i$entific& capacit&i(e pacient#(#i $e a-!i a$%ini"ta tata%ent#( !i $e a-( "#pa)eg*eaL
- "e eBp(ic& pacient#(#i i%potana (#&ii %e$ica%ente(o confo% pe"cipiei %e$ica(eL
- "e a$aptea5& $e%e"#( e$#cati) (a ni)e(#( $e in"t#ie a( pacient#(#i pent# a a"ig#a
"ec#itatea !i ca(itatea a$%ini"t&ii tata%ent#(#iL
- "e in"ta(ea5& pacient#( confota4i(L
- "e aco$& a8#to pacient#(#i af(at >n $ific#(tate.L
87
E%$&tua)$a p)o&$,u)ii4&o7,i*ii p)$li+i7a)$
- peg&tiea tata%ent#(#i te4#ie "& fie eBte%poanee $e c&te a"i"tenta cae $i"ti4#ie
%e$ica%ente(e
- %e$ica%ente(e pot fi peg&tite $inainte #ti(i51n$ o (i"t& ce )a conine, >n %o$ o4(igatoi#,
%e$ica%ente(e i$entificate pinI
- n#%e(e !i pen#%e(e pacient#(#iL
- $o5aGoa#( $e a$%ini"taeL
- $ata pe"cieiiL
- peg&tiea tata%ent#(#i nece"it& conto(#( ig#o" a( ca(it&ii fiec&#i %e$ica%ent $e c&te
a"i"tenta %e$ica(& ?c#(oae, a"pect ,integitate@L
- "e ap(ic& eBact po"o(ogia pe"ci"& $e %e$ic !i "e e"pect& eg#(i(e genea(e $e a$%ini"tae
a %e$ica%ente(o.
A,+i7i't)a)$a p)op)iu4>i': a +$,i&a+$7tului
- "e )eific& >nc& o $ata pe"cipia %e$ica(& (a pat#( pacient#(#i,in %o%ent#( a$%ini"t&iiL
- "e ea(i5ea5& o fici#ne *i$oa(coo(ic& a %1ini(o "a# "e face #n (a)a8 "i%p(# >nainte $e
fiecae $i"ti4#ieL
- "e p&"tea5& %e$ica%ente(e >n 4(i"tee(e "a# fo%e(e $e con$iionae popii, p1n& c1n$ "#nt
(#ateL
- "e $ec#pea5& 4(i"te#( c# foafeca $ac& %e$ica%ent#( n# e"te con$iionat >nt-o a()eo(&
in$i)i$#a(&L
- "e p#n %e$ica%ente(e pent# oa pe"ci"& int-#n p&*&e( c# >nte4#inae #nic&, >nainte $e
a (e $a pacient#(#iL
- "e eBp(ic& pacient#(#i %o$a(it&i(e $e (#ae a %e$ica%ente(oI
- pe ne%1ncate ?W 8e#n@, >n ti%p#( %e"ei "a# $#p& %a"&L
- c# #n pa*a c# ap&, pent# cap"#(e, ta4(ete, co%pi%ateL
- $i5o()at >n ap&, pent# co%pi%ate(e cae "e $i5o()& "a# pent# p#(4eiL
- f&& $i(#ie , pent# "iop#i,"#"pen"ii "a# pent# co%pi%ate(e cae "e a$%ini"tea5&
"#4(ing#a(L
- "e ap(ic& $e%e"#( e$#cati) $e a#tono%i5ae a pacient#(#i !i $e ce!tee a co%p(ianei (a
tata%ent.
Sup)a<$;=$)$ 9i $<alua)$
0#pa)eg*eea a$%ini"t&ii %e$ica%ente(o pe o" te4#ie "& gaante5e e)a(#aea pinI
- o a$%ini"tae coect&I$o5aGoa,%o$ $e a$%ini"tae confo% eco%an$&ii %e$ica(eL
- %&"#aea f#ncii(o )ita(e >nainte,in ti%p#( iG"a# $#p& a$%ini"tae >n f#ncie $e
%e$ica%ent pent# a i$entifica efecte(e 4enefice "i ce(e in$e5ia4i(eL
- con"e%naea "e%ne(o $e neco%p(ian & (a tata%entL
- apecieea ni)e(#(#i $e con!tien & a( pacient#(#i pe $#ata tata%ent#(#iL
- inc(#$eea ace"to e(e%ente >n ce(e $o#& $i%en"i#ne a(e a$%ini"t&ii tata%ent#(#i oa(
ca(itatea !i "ec#itatea.
3., A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*ii pa)$7t$)al$
88
S&op
Into$#ceea >n ogani"% a #no %e$ica%ente, "#4"tane acti)e, c# a8#to#( #no "eingi !i ace
"tei(e, oco(in$ t#4#( $ige"ti).
Tipu)i ,$ i7A$&*ii
In8ecii(e "e pot faceI
- fie >n e"#t#i(e ogani"%#(#iI inta%#"c#(a, "#4c#tanat, inta$e%icL
- fie $iect >n cic#(aia "ang#in&I in8ecia inta)enoa"&.
I7,i&a*iiB
- ap(icaea tata%ente(o %e$ica%entoa"e in8ecta4i(eL
- ea(i5aea #n#i %onote"t "a# inta$e%oeaciiL
- te"te $e "en"i4i(i5ae "a# c#e $e $e"en"i4i(i5aeL
- in8ectaea $e po$#"e nece"ae ea(i5&ii #no eBa%ene $e in)e"tigae ?po$#"e a$ioopace,
a$ioacti)e, i5otopi@.
- "eingi "tei(e a$aptate )o(#%#(#i $e in8ectatL
- ace "tei(eI pent# a"piaea %e$ica%ent#(#i $e in8ectat, pent# ea(i5aea in8ecieiL
- %e$ica%ente(e pe"ci"eL
- co%pe"e "tei(eL
- "o(#ii anti"epticeL
- #n gao# ?>n ca5 $e in8ecie i.).@L
- o ta)& %e$ica(& c#at&L
- #n containe pent# aceL
- "e ofe& info%aii $e"pe poce$#& !i $e"pe %o$#( $e a$%ini"taeL
- "e eBp(ic& nat#a po$#"e(o in8ectate !i a #ti(it&ii (oL
- "e ea(i5ea5& in"ta(aea confota4i(& !i f&& i"c a pacient#(#i pent# c& in8ectaea "& "e fac&
>n ce(e %ai 4#ne con$iii.
- "e )eific& pe"cipia %e$ica(&, $ata pe"cipiei po$#"#(#i, integitatea a%4a(a8e(o
>nainte $e a >ncepe poce$#aL
- pepaaea %e$ica%ent#(#i $e in8ectat e"te >n f#ncie $e con$iionaea "#4"tanei acti)eI
fio(& c# $o5& #nic&, f(acon c# $o5e %#(tip(e, f(acon c# p#(4ee $e $i5o()at.
57 &a>ul %iol$i D %la&o7ului &u ,o>: u7i&:B
- "e p#ne o co%pe"& >%4i4at& >n "o(#ie anti"eptic& >n 8##( g1t#(#i fio(ei !i "e $e5infectea5&
ti%p $e ,. $e "ec#n$e ?ti%p $e contact eco%an$at $e peca# ii(e #ni)e"a(e@L
- "e #pe g1t#( fio(eiL
- "e %ontea5& ac#( $e a"piaie ?%ai go"@ (a a%4o#( "eingiiL fio(a in#t& >nte in$eB#( !i
$eget#( %ae a( %1inii ne$o%inante e"te po5iionat& c# $e"c*i$eea >n 8o" pent# a a"pia
conin#t#( "&#L
- "e a"pi& n#%ai cantitatea pe"ci"& $e %e$icL
8+
- "e a#nc& fio(aL
- "e tapotea5& #!o "einga !i "e e(i%in& 4#(e(e $e aeL
- "e >n$ep&tea5& ac#( $e a"piaie !i "e a#nc& >n containeL
- "e a$aptea5& (a "eing& ac#( pent# in8ectae !i "e ep#ne "einga >n a%4a(a8L potecia
ac#(#i )a fi (&"at& pe (oc p1n& >n %o%ent#( in8eciei.
57 &a>ul u7ui %la&o7 &u ,o>$ +ultipl$
- "e )eific& $ata $e"c*i$eii f(acon#(#i !i %o$#( $e con"e)aeI ca eg#(& genea(&, #n f(acon
$e"c*i" $e %ai %#(t $e 8 oe, n# %ai e"te #ti(i5atL >n ca5#( in"#(inei, poate fi #ti(i5at& ti%p $e
,. $e 5i(e $e (a $e"c*i$eea f(acon#(#iL
- "e !tege $op#( $e ca#ci#c a( f(acon#(#i c# o co%pe"& >%4i4at& >n "o(#ie anti"eptic& ?>n
ca5#( pi%ei #ti(i5&i te4#ie %ai >nt1i "& "e >n$ep&te5e c&p&ce(#( %eta(ic $e $ea"#pa@L
- "e %ontea5& (a "eing& ac#( $e a"piaieL
- "e a"pi& cantitatea pe"ci"& $in f(acon#( in#t &"t#natL
- "e >n$ep&tea5& 4#(e(e $e ae $in "eing&L
- "e >n$ep&tea5& ac#( $e a"piaie !i "e a#nc& >n containeL "e a$aptea5& (a "eing& ac#(
pent# in8ecie pote8at ?capi!onat@.
57 &a>ul %la&o7ului &u pul($)$ ,$ ,i>ol<at
- "e a"pi& >n "eing& "o()ent#( ?(ic*i$#(@ pent# $i5o()aeL
- "e $e5infectea5& $op#( $e ca#ci#cL
- "e in8ectea5& >n f(acon#( c# p#(4ee "o()ent#(L
- "e a"ig#& f(acon#( p1n& (a $i5o()aea co%p(et& a p#(4eii, f&& "& "e etag& ac#( c#
"eing&L
- "e a"pi& %e$ica%ent#( $i(#at >n "eing& !i "e e(i%in& 4#(e(e $e aeL
- "e >n$ep&tea5& ac#( c# cae "-a a"piat, "e a#nc& >n containe !i "e a$aptea5& ac#( pent#
in8ecie (&"1n$#-( >n teaca potectoae.
3./ A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*ii i7t)a+u'&ula)$ #IEME-
S&op
Into$#ceea #nei "o(#ii %e$ica%entoa"e >n e"#t#( %#"c#(a c# a8#to #nei "eingi !i a #n#i ac
"tei(e.
Li7ii ,i)$&toa)$
- in8ecia i.%. e"te efect#at&, >n genea(, c1n$ "e $oe!te o a4"o4ie api$& "a# c1n$ ca(ea
oa(& e"te contain$icat&L
- "e ap(ic& ce(e C2 eg#(iE $e a$%ini"taeI pacient#( poti)it, %e$icaia poti)it&, $o5a
coect&, ca(ea a$ec)at&, ti%p#( ?oa#(@ poti)itL
- >nainte $e a$%ini"taea %e$ica%ent#(#i, a"i"tent#( %e$ica( "e )a info%a $e"pe aci#nea
%e$ica%ent#(#i, %oti)aia a$%ini"t&ii $og#(#i, $o5a no%a(& !i ca(ea $e a$%ini"tae,
contain$icaii !i eacii a$)e"eL
- cantitatea $e "o(#ie a$%ini"tat& pe ca(e i.%. )aia5& >n f#ncie $e %e$ica%entL >n %o$
no%a(, n# "e a$%ini"tea5& %ai %#(t $e 2 %(. >n ace(a!i (ocL
- a(tenaea (oc#i(o in8ect&ii e"te i%potant& pent# confot#( pacient#(#i, pent#
pe)eniea ta#%e(o a"#pa e"#t#(#i !i faci(itaea a4"o4ieiL
+.
- (oc#i(e $e e(ecie inc(#$I ca$an#( "#peo-eBten fe"ie, tei%ea %e$ie a feei eBtene a
coap"ei, %#!c*i#( $e(toi$L
- "e )o e)ita 5one(e contactate "a# cae pe5int& no$#(iL
- po5iia pacient#(#i )a fi $e "ig#an&, e(aBat& !i co%pati4i(& c# con$iia fi5ic& a
pacient#(#i >nc1t "& ofee o eBp#nee a$ec)at& a (oc#(#i pent# in8ecie ?$ec#4it )enta(,
$ec#4it (atea(, po5iie !e51n$&, oto"tati"%@L
- %&i%ea ac#(#i !i a "eingii $epin$ $e )o(#%#( "o(#iei $e in8ectat, )1"co5itatea "o(#iei,
con"tit#ia pacient#(#i, %#!c*i#( "e(ectat pent# in8ecieL
- >nainte $e a$%ini"taea oic&#i %e$ica%ent no# "e e)a(#ea5& i"c#( $e a(egie a(
pacient#(#i pin ana%ne5&L
- "e te"tea5& pacient#( "& n# fie a(egic, >n "pecia( >naintea a$%ini"t&ii pi%ei $o5e $e
anti4ioticGc*i%ioteapicL
- pent# a pe)eni co(oaea ?p&taea@ "a# iitaea "#peficia(& e"#t#(#i $e c&te %e$ica%ent,
(a "coateea ac#(#i $in %#!c*i, ac#( )a fi "c*i%4at $#p& ce "o(#ia a fo"t a"piat& >n "eing&L
- te*nica >n CDE e"te fo(o"it& pent# a in8ecta >n "ig#an& oice "o(#ie co(oat& "a# cae iit&
"#peficia( pie(eaL %eto$a CDE "e fo(o"e!te n#%ai pent# 5ona %#!c*i#(#i $o"o-g(#tea(.
- "eingi "tei(e $e capacit&i coe"p#n5&toae )o(#%#(#i $e in8ectatL
- ace "tei(e eta(on $e 1+-22 %%. go"i%e, (#ngi $e 2-1. c%.L
- co%pe"e $e tifon G ta%poane $e )at&L
- %&n#!i $e #nic& fo(o"in& ?opiona(@L
- t&)i& ena(&L
- containee "pecia(e pent# co(ectaea %ateia(e(o.
- "e inte)ie)ea5& pacient#( pent# a i$entifica #n po"i4i( i"c $e a(egieL
- "e a"ig#& inti%itatea pacient#(#iL
- "e "ta4i(e!te (oc#( pent# in8ecie $#p& in"pectaea 5one(o $e e(ecieL
- "e po5iionea5& pacient#( >n f#ncie (oc#( a(e" !i $e "taea "a genea(&.
- "e "pa(& %1ini(eL
- "e %ontea5& ac#( (a "eing& fo(o"in$ te*nica a"eptic&L
- "e >n$ep&tea5& capac#( ac#(#i pin taci#neL
- "e "coate ae#(L
- "e $e5infectea5& (oc#( a(e"L
- "e >ntin$e pie(ea fo(o"in$ %1na ne$o%inant&L
- "e into$#ce api$ ac#( >n e"#t >n #ng*i $e +.R in1n$ "einga >n %1na $o%inant& >nte
po(ice !i ce(e(a(te $egeteL
- "e fiBea5& a%4o#( "eingii >nte po(ice(e !i in$eB#( %1inii ne$o%inanteL
- "e a"pi& >ncet t&g1n$ pi"ton#( >napoi c# %1na $o%inant& pent# a )eifica po5iia ac#(#iL
- "e "c*i%4& po5iia ac#(#i $ac& "e a"pi& "1ngeL
- "e in8ectea5& (ent "o(#ia >n e"#t#( %#"c#(a, c1te 1. "ec#n$e pent# fiecae %( "o(#ieL
+1
- "e eBtage api$ ac#( a$aptat (a "eing& fiB1n$ a%4o#(L
- "e a#nc& ac#( necapi!onat >n containeL
- "e %a"ea5& (oc#( in8eciei c# #n ta%pon c# a(coo( eBecit1n$ o #!oa& pe"i#neL
- "e a8#t& pacient#( "& "e >%4ace, "& a$opte o po5iie co%o$&L
- "e e)a(#ea5& (oc#( in8eciei $#p& 2-/ oe $e (a a$%ini"tae, $ac& e"te po"i4i(L
- "e eogani5ea5& (oc#( $e %#nc&L
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n Fi!a $e poce$#i ?n#%e. $ata !i oa a$%ini"t&ii, tip#( "o(#iei,
$o5a@.
I7&i,$7t$DA&&i,$7t$
- a%oe(i, f#nic&t#i "a# a(teaea f#nciei %#"c#(ae >n 5ona in8eciei $ete%inate $e
nee"pectaea (oc#i(o $e e(ecie !i $e iitaea ne)#(#i "ciaticL
- paa(i5ia %e%4#(#i infeio pin >nepaea ne)#(#i "ciaticL
- e%4o(ie pin in8ectaea >nt-#n )a" $e "1nge a "o(#ie #(eioa"eL
- no$#(i pin in8ectaea #no "o(#ii cae pecipit& "a# a #n#i a%e"tec $e "o(#ii
inco%pati4i(eL
- p&taea G pig%entaea pie(ii pin in8ectaea #no "o(#ii co(oate f&& "& "e ap(ice %eto$a
CDEL
- f(eg%on pin nee"pectaea eg#(i(o $e a"ep"ie !i anti"ep"ie.
3.2 A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*ia i7t)a+u'&ula): ,up: +$,o,a IZJ
S&op
- a$%ini"taea "#4"tane(o iitante !i a ce(o cae co(oea5& e"#t#(, c#% a fi po$#"e(e pe
4a5& $e fieL
- a$%ini"taea #no "o(#ii %e$ica%entoa"e (a pacienii )1"tnici "#4n#tii.
- "e "pa(& %1ini(e !i "e >%4ac& %&n#!i $e #nic& fo(o"in&L
- "e peg&te"c "einga !i ac#( poti)ite pent# in8ecia inta%#"c#(a&L
- "e a"pi& "o(#ia %e$ica%entoa"& >n "eing& $#p& %eto$a a"eptic& !i o %ic& cantitate $e
aeL
- "e "c*i%4& ac#( c# cae "-a a"piat !i "e ata!ea5& ce( pent# in8ectat "o(#ia.
- "e a!ea5& pacient#( >n po5iia cae pe%ite eBp#neea 5onei g(#tea(e ?$ec#4it $o"a( "a#
$ec#4it (atea( e(aBat@L
- "e $e5infectea5& ca$an#( "#peo-eBten a( fe"eiL
- "e (a"& "& "e #"#ce pie(eaL
- "e tage pie(ea >n (atea( >n fo%& $e CDE, >n$ep&t1n$-o $e (oc#( a(e" pent# in8ecieL
- "e into$#ce ac#( >n e"#t#( %#"c#(a >n #ng*i $e +.RL
- "e a"pi& pent# a )eifica po5iia ac#(#iL
+2
- $ac& apae "1nge >n "eing& "e etage #!o ac#( !i "e %o$ific& po5iia $#p& cae "e a"pi& $in
no#L $ac& !i $e $ata acea"ta "e a"pi& $in no#L $ac& !i $e $ata acea"ta "e a"pi& "1nge "e
etage co%p(et ac#( !i "e eia te*nica >n a(t (ocL
- "e in8ectea5& "o(#ia (ent, $ac& n# "-a a"piat "1nge, !i apoi, ae#( ta" >n "eing& o$at& c#
"#4"tana %e$ica%entoa"&L
- in8ectaea ae#(#i $#p& te%inaea "o(#iei a8#t& (a pe)eniea "c#geii $e "#4"tan& $in ac >n
e"#t#( "#4c#tanat >n ti%p#( etageiiL
- "e a!teapt& >nc& 1. "ec#n$e $#p& in8ectae !i apoi "e etage ac#(L
- "e e(i4eea5& pie(ea cae a fo"t ta"& >n CDE pent# a acopei (oc#( $e inoc#(aeL
- "e e)it& %a"aea (oc#(#i pent# a n# fa)oi5a p&t#n$eea "#4"tanei iitante >n e"#t#(
"#4c#tanatL
- "e "o(icit& pacient#(#i "& "e %i!te pent# a fa)oi5a a4"o4ia %e$ica%ent#(#iL
- $ac& pacient#( e"te i%o4i(i5at (a pat, $#p& in8ectae )a fi a8#tat "& fac& eBeciii pa"i)e !i
acti)e >n pat, pent# a faci(ita a4"o4ia %e$ica%ent#(#iL
- "e a#nc& ac#( necapi!onatL
- "e co(ectea5& %ateia(e(e fo(o"ite >n containee "pecia(eL
- "e )eific& $#p& 1-2 oe (oc#( in8ect&iiL
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n Fi!a c# poce$#i a pacient#(#i.
3.3 A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*ia 'u(&uta7at: #SEC-
S&op
F#ni5aea #nei c&i $e a$%ini"tae a #no %e$ica%ente caI in"#(ina, anticoag#(ante(e,
%e$ica%ente(e $epot, #ne(e )accin#i.
Li7ii ,i)$&toa)$
- 5one(e $e e(ecie pent# in8ecia ".c. inc(#$I
- egi#nea peio%4i(ica(& (a 2-, c% $i"tan& fa& $e o%4i(ic !i fa& $e (inia $e cent#&L
- faa $o"o(atea(& a 4a#(#i (a 8-12 c% $ea"#pa cot#(#iL
- faa anteo-(atea(& a coap"ei (a 2-3 c% $ea"#pa gen#nc*i#(#iL
- egi#nea "#pa !i "#4"pinoa"e a(e o%op(ai(oL
- (oc#i(e $e in8ecie te4#ie a(tenate >n o$inea %i!c&ii ace(o $e cea"onic pent# a pe)eni
ta#%ati5aea e"#t#(#i !i a fa)oi5a a4"o4iaL
- >nainte $e a$%ini"tae "e i$entific& #n e)ent#a( pofi( a(ego(ogic a( pacient#(#iL
- (a a$%ini"taea *epainei "#4c#tanat, "e )a e)ita %a"aea (oc#(#i pent# a pe)eni
fo%aea *e%ato%#(#iL
- o %ic& cantitate $e .,2 c%X )a fi (&"at& >n "eing& >n ca5#( in8ect&ii "o(#ii(o (i)ate >n
"eing& pe#%p(#t& ia ac#( )a fi into$#" pepen$ic#(a pe c#ta fo%at&, pent# a foa
#(ti%a cantitate $e %e$ica%ent "& p&t#n$& >n e"#tL
- n# "e $e5infectea5& 5ona c# a(coo( >n ca5#( in8eciei c# in"#(in& "a# "e (a"& "& "e e)apoe
>nainte $e in8ectaeL
- n# "e a"pi& at#nci c1n$ "e fac in8ecii c# in"#(in& !i c# *epain& ?>n ace"t #(ti% ca5 a"piaea
poate po$#ce *e%ato%@L
- $ac& apa ec*i%o5e (a (oc#( in8eciei c# *epain&, "e eco%an$& ap(icaea #nei p#ngi c#
g*ea& >n pi%e(e 2 %in#te $#p& in8ectae #%at& $e co%pe"ie (oca(&L
+,
Mat$)ial$ 7$&$'a)$
- "eingi "tei(e $e capacit&i coe"p#n5&toae )o(#%#(#i $e "o(#ie "a# "eingi pe#%p(#teL
- ace "tei(e $e 2-/ c% (#ngi%eL
- "o(#ia $e in8ectat con$iionat& >n fio(&L
- co%pe"e tifon G ta%poane $e )at&L
- %&n#!i $e #nic& fo(o"in& ?opiona(@L
- ecipiente pent# co(ectaea $e!e#i(o.
- "e info%ea5&, "e eBp(ic& poce$#aL
- "e po5iionea5& pacient#( >n f#ncie $e (oc#( a(e"I $ec#4it $o"a(, po5iie !e51n$& c# %1na
"pi8init& >n !o($, $ec#4it )enta( pent# 5one(e "#pa !i "#4 "pinoa"e a(e o%op(ai(oL
- "e peg&te"c toate %ateia(e(eL
- "e "pa(& %1ini(eL
- "e peg&te!te %e$ica%ent#( fo(o"in$ te*nica a"eptic&L
- "e "e(ectea5& 5ona cea %ai poti)it& pent# in8ecie #ti(i51n$ epee(e anato%iceL
- "e $e5infectea5& (oc#( a(e", "e (a"& "& "e #"#ceL
- "e >n$ep&tea5& capac#( ac#(#i fo(o"in$ te*nica a"eptic&L
- "e "coate ae#( c# eBcepia "it#aiei >n cae "o(#ia e"te (i)at& >n "eing& pe#%p(#t&L
- "e a$%ini"tea5& in8eciaI
- "e p(ia5& teg#%ent#( >nte po(ice(e !i in$eB#( %1inii ne$o%inante, fiB1n$#-( !i
i$ic1n$#-( $e pe p(an#i(e pof#n$eL
- "e p&t#n$e c# api$itate >n e"#t#( "#4c#tanat >n #ng*i $e /2R "a# +.R >n f#ncie $e
epe5entaea e"#t#(#i a$ipo" !i $e (#ngi%ea ac#(#iL
- "e )eific& po5iia ac#(#i pin a"piaeL
- "e in8ectea5& (ent "o(#ia %e$ica%entoa"&L
- "e eBtage ac#( c# o %i!cae "ig#& !i api$&L
- "e $e5infectea5& !i "e %a"ea5& (oc#( in8ecieiL
- "e a#nc& ac#( necapi!onat >n containeL
- "e >ngi8e!te pacient#( (a ne)oie ?po5iionae, >%4&cae@L
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n Fi!a $e poce$#i ?n#%e, $at&, oa a$%ini"t&ii, tip#(
"o(#iei, $o5a@.
I7&i,$7t$DA&&i,$7t$
- $#ee )io(ent& pin atingeea #nei te%inaii ne)oa"e "a#G!i $i"ten"ie 4#"c& a e"#t#(#iL
- conge"tia 5onei $e inoc#(ae cae $e)ine in$#at& !i $#eoa"&.
+/
3.7 A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*ia i7t)a,$)+i&: #IED-
S&op
- in8ectaea $e a(egeni >n pie(e ca %eto$& $e $iagno"tic pent# apecieea eaciei (a
a(egeniL
- te"taea (a t#4ec#(in& "a# ''DL
- te"taea #no %e$ica%ente c# potenia( $e "en"i4i(i5ae a ogani"%#(#i ?anti4iotice,
ane"te5ice@.
Li7ii ,i)$&toa)$
- >nainte $e a$%ini"tae "e c#(eg info%aii $e"pe aci#nea %e$ica%ent#(#i, "cop#(
in8eciei, $o5a8#(G$i(#ia no%a(& !i (oc#( $e a$%ini"taeL
- n# "e )o fo(o"i, in$ifeent $e "cop, "o(#ii anti"eptice cae co(oea5& pie(ea !i %a"c*ea5&
eacia (oca(&L
- pent# efect#aea in8eciei "e )o e"pecta (oc#i(e $e e(ecieI egi#nea )enta(& a
ante4a#(#i, faa eBten& a 4a#(#i !i a coap"eiL "e e)it& 5one(e pig%entate, p&oa"e "a#
inten" Oeatini5ate ?>ngo!ate@, infectateL
- "e inte)ie)ea5& pacient#( pent# a i$entifica pofi(#( a(ego(ogic a( ace"t#ia pec#% !i
eBpeiena (egat& $e te"taeL
- "e efect#ea5& $i(#ia nece"a& !i "e "ta4i(e!te $o5a coect& confo% poce$#ii "tan$a$
aco(o #n$e e"te ca5#( ?eBe%p(#I $i(#ie 1G1.... U.I. pent# te"taea (a 'enici(in&, 2 U.I.
''D pent# IDR (a t#4ec#(in&@.
Mat$)ial$ 7$&$'a)$
- "eingi "tei(e $e 1 %(.G"eing& pent# t#4ec#(in&L
- ace "tei(e $e 1-1,2 c% (#ngi%eL
- co%pe"e "tei(eGta%poane $e )at&L
- "o(#ia %e$ica%entoa"& coect $o5at&.
- "e info%ea5& pacient#(, "e eBp(ic& poce$#aL
- "e o4ine con"i%&%1nt#( info%at !i co(a4oaea pacient#(#iL
- "e a(ge (oc#( pent# in8ecie.
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i $e #nic& fo(o"in&L
- "e efect#ea5& $i(#ia !i "e "ta4i(e!te $o5a eBact& confo% poce$#ii "tan$a$L
- "e a"pi& "o(#ia >n "eing& e"pect1n$ poce$#aL
- "e $e5infectea5& 5ona a(ea"&L
- "e >n$ep&tea5& capac#( $e (a ac pin taci#neL
- "e >ntin$e pie(ea $in 5ona a(ea"& fo(o"in$ po(ice(e %1inii ne$o%inanteL
- "e po5iionea5& "einga apoape tangent c# pie(ea pacient#(#i !i c# 4i5o#( >n "#"L
+2
- "e into$#ce ac#( apoBi%ati) / %% a"tfe( >nc1t )1f#( "& fie )i5i4i( pin pie(eL
- "e in8ectea5& (ent "o(#ia >%ping1n$ pi"ton#( f&& "& "e a"pieL
- "e o4"e)& fo%aea (a (oc#( inoc#(&ii a #nei pap#(e a(4e c# $ia%et#( $e 2-3 %%.L
- "e etage ac#( f&& "& "e %a"e5e (oc#(L
- "e a#nc& ac#( c# "einga >n containee "pecia(eL
- "e >n$ep&tea5& %&n#!i(e, "e "pa(& %1ini(e ?"e !teg c# a(coo(@L
- "e "#pa)eg*ea5& atent pacient#( !i eacia (oca(&L
- "e cite!te eacia (oca(& $#p& 2.-,. %% "a# 72 oe ?>n ca5#( IDR (a t#4ec#(in&@L
- "e notea5& poce$#a >n Fi!a c# poce$#i a pacient#(#i ?"#4"tana a$%ini"tat&, $ata, oa
inoc#(&ii, oa citiii eaciei (oca(e pec#% !i caactei"tici(e@L
I7&i,$7t$DA&&i,$7t$
- (ipoti%ie, )&t&%ae copoa(& $ac& pacient#( n# e"te "#pa)eg*eat !i n# &%1ne >n epa#" (a
patL
- eacie anafi(actic& "a# !oc anafi(actic cae a%enin& )iaa $ac& n# "e e"pect& $i(#ia G$o5a
(a #n pacient c# pofi( a(ego(ogic nei$entificat.
3.8 A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7A$&*i$ i7t)a<$7oa': ,i)$&t:
S&op
F#ni5aea #nei (inii pent# a$%ini"taea inta)enoa"& a %e$ica%ente(o >n "cop eBp(oato "a#
teape#tic.
Li7ii ,i)$&t$
- te*nica a"eptic& )a fi e"pectat& at#nci c1n$ "e eBec#t& acea"t& poce$#&L
- in8ecia inta)enoa"& n# )a fi efect#at& >n )ene(e $e (a 4a#( c# fi"t#(& ateio-)enoa"& "a#
"*#nt ateio-)eno", c# %a"tecto%ie, c# paa(i5ie "a# a(te t#(4#&i cic#(atoii !i
ne#o(ogiceL
- )ene(e $in eBte%itatea $i"ta(& ?$e 8o"@ a %e%4#(#i "#peio "a# infeio n# )o fi #ti(i5ate
$ec1t (a eco%an$aea %e$ic#(#i >nt#c1t )ite5a $e cic#(aie a "1nge(#i (a ace"t ni)e( e"te $e
eg#(&, %ai %ic& !i pe$i"p#ne (a e%4o(i"%L
- "e )a e)ita #ti(i5aea 4a#(#i $o%inant pent# in8ecia inta)enoa"&, c1n$ e"te po"i4i(,
pent# a a8#ta pacient#( "&-!i p&"te5e in$epen$enaL
- p#ncii(e )enoa"e )o fi iniiate $e 8o" >n "#", poge"i) centipet ?$eci >n "en"#( cic#(aiei
)enoa"e@ >nt#c1t, $ac& n# "e e"pect& ace"t pincipi#, "1nge(e c#g1n$ $in )ena (e5at& "a#
iitat& poate ca#5a o no#& co%p(icaieL
- t#t#o pacieni(o c# teapie inta)enoa"& (i "e )a face 4i(an#( *i$ic ?int&i-ie!ii@L
- tip#( !i %&i%ea ac#(#i fo(o"it )a fi $ete%inat& $e %&i%ea G ca(i4#( )ene(o pacient#(#i
!i tip#( $e "o(#ie ce #%ea5& a fi a$%ini"tat&.
Lo&u)i ,$ $l$&*i$
;ene(e a4o$ate pot fiI
- )ene(e $e (a p(ica cot#(#i ?eBcept1n$ 5ona %e$ia(&@ K cefa(ic&, 4a5i(ic&L
- )ene(e $e pe patea $o"a(& a %1iniiL
- )ene(e $e pe patea po"teioa& a ga%4eiL
+3
- )ene(e 8#g#(aeL
- )ene(e epicaniene (a no# n&"c#t !i "#ga.
- ta)& %e$ica(& "a# c&#cio #(antL
- "eingi "tei(e c# a%4o#( "it#at peifeic $e capacit&i a$ec)ate cantit&ii $e %e$ica%ent
pe"ci"L
- ace c# 4i5o#( a"c#it $a "c#tL
- fio(& "a# f(acon c# "o(#ia i5oton& "a# *ipeton&L
- %ateia(e pent# p#ncia )enoa"&.
- "e info%ea5&, "e eBp(ic& pacient#(#i poce$#aL
- "e )eific& (oc#i(e $e e(ecie e)it1n$ 5one(e c# ec*i%o5e, pi(o5itate accent#at& "a# c#
"e%ne $e infecieL
- "e "ta4i(e!te (oc#( pent# in8ecieL
- "e po5iionea5& pacient#( >n f#ncie $e (oc#( a(e" !i $e "taea "a genea(&L $ec#4it $o"a(,
po5iie "e%i!e51n$&.
- "e o4in info%aii "#p(i%entae $ac& %e$ica%ent#( e"te no#L
- "e "pa(& %1ini(eL
- "e fo(o"e"c %&n#!i $e #nic& fo(o"in&L
- "e a"pi& "o(#ia $in f(acon confo% poce$#ii "tan$a$L
- "e e(i%in& 4#(e(e $e ae $in "eing& %enin1n$ "einga >n po5iie )etica(&L
- "e "c*i%4& ac#( c# a(t#( capi!onatL
- "e (eag& gao#(, "e pa(pea5& taiect#( )eneiL
- "e $e5infectea5& (ag 5ona a(ea"& pent# in8eciiL
- "e >n$ep&tea5& capac#( $e (a ac pin taci#neL
- "e efect#ea5& p#ncia )enoa"& confo% poce$#iiL
- "e )eific& po5iia ac#(#i pin a"piaeL
- "e $e"face gao#( $ac& ac#( e"te >n )en&L
- "e in8ectea5& (ent "o(#ia %e$ica%entoa"& o4"e)1n$ (oc#( p#ncionat !i eacii(e
pacient#(#iL
- "e eBtage api$ ac#( a$aptat (a "eing&L
- "e co%pi%& (oc#( in8eciei c# ta%pon c# a(coo(, ,-2 %in#te pent# *e%o"ta5a co%p(et&.
I7&i,$7t$DA&&i,$7t$
- f(e4a(gie pin in8ectaea pea api$& a "o(#iei "a# pin into$#ceea #no "#4"tane iitante
pent# inti%a )a"#(#i ?eB.I "o(#ii(e *ipetone@L
- *e%ato% pin pefoaea )enei "a# pin etageea ac#(#i f&& e(i4eaea gao#(#iL
+7
- a%ee(i, (ipoti%ie, co(ap"L
- eacii anafi(actice (a "o(#ii(e in8ectate >n "cop eBp(oato ?"o(#ii io$ate@.
3.+ A,+i7i't)a)$a +$,i&a+$7t$lo) p$ +u&oa'a &o7Au&ti<al:
S&op
In"ti(aea %e$ica%ente(o ?co(i#i, #ng#ente@ pe "#pafaa oc*i#(#i, c# efect teape#tic
?ane"te5ic, %i$iatic "a# $e "t1ngee p#pi(a&, antia(gic, antiinf(a%ato@.
Li7ii ,i)$&toa)$
- >nainte $e a$%ini"taea oic&#i %e$ica%ent, a"i"tent#( %e$ica( te4#ie "& "e $oc#%ente5e
$e"pe aci#nea ace"t#ia, "cop#( pent# cae "e a$%ini"tea5&, $o5a8#( no%a(,
inco%pati4i(it&i, contain$icaii !i eacii a$)e"eL
- toate %ane)e(e $e ap(icae a %e$ica%ente(o pe "#pafaa oc*i#(#i "e )o face c#
4(1n$ee, >n "ig#an&, >nt#c1t oc*i#( !i >n "pecia( coneea e"te o 5on& foate "en"i4i(&
- te*nica a"eptic& )a fi #ti(i5at& oi $e c1te oi "e tatea5& oc*i#( !i ea "e ap(ic& "epaat pent#
fiecae oc*i >n pateL
- n# "e ap(ic& nicio$at& pic&t#i "a# #ng#ente $iect pe coneeL
- >naintea $e a$%ini"taea oic&#i %e$ica%ent no#, "e )a i$entifica pin inte)i# #n
e)ent#a( i"toic $e a(egie %e$ica%entoa"&L
- >n ca5#( a$%ini"t&ii $e "o(#ii c# a4"o4ie "i"te%ic& ?atopina@ "e )a pe"a 4(1n$ c#
$eget#( pe #ng*i#( inten a( oc*i#(#i, ti%p $e 1-2 %in#te $#p& in"ti(ae >n ti%p ce pacient#(
ine oc*i#( >nc*i"L acea"t& %ane)& )a >%pie$ica %e$ica%ent#( "& a8#ng& >n cana(#(
(aci%a(L
- >n ca5#( >n cae pacient#( ae pe"ci"e !i pic&t#i !i #ng#ente, pic&t#i(e "e )o a$%ini"ta
pi%e(e.
- "e )o peg&ti pe c&#cio#( $e (#c#I
- %e$ica%ente(e pe"ci"eI "o(#ii, #ng#ente, $i"c#i oc#(aeL
- %&n#!i $e #nica fo(o"in&L
- co%pe"e "tei(eL
- pan"a%ente oc#(aeG4an$a8eL
- "e )eific& te%en#( $e )a(a4i(itate a( %e$ica%ente(oI c#(oaea a"pect#( "o(#ii(o oc#(ae,
"& n# fie pecipitate, t#(4#iL
- $ac& oifici#( t#4#(#i c# #ng#ent ofta(%ic a f&c#t c#"t& "e >n$ep&tea5& c# o co%pe"&
"tei(&L
- "e notea5& $ata pi%ei fo(o"ii a f(acon#(#i c# "o(#ie oc#(a& ?$#p& $e"c*i$ee, ace"ta n# )a
fi fo(o"it %ai %#(t $e 2-, "&pt&%1ni pent# a e)ita conta%inaea@.
Reg#(i genea(eI
- "e i$entific& pacient#( !i oc*i#( cae te4#ie tatat ?%e$ic#( poate pe"cie %e$ica%ente !i
$o5e $ifeite pent# cei $oi oc*i@L
+8
- "e eBp(ic& poce$#a pacient#(#i !i "e in"t#ie!te "& &%1n& ne%i!cat >n ti%p#( poce$#iiL
- "e "pa(& %1ini(e !i "e >%4ac& %&n#!i(e $e #nic& fo(o"in&L
- "e >n$ep&tea5& pan"a%ent#( G 4an$a8#( $ac& eBi"t&L
- "e "pa(& %1ini(eL
- "e >n$ep&tea5& "eceii(e oc#(ae c# co%pe"e "tei(e >%4i4ate >n "e fi5io(ogicL
- "e c#&& "eceii(e pin %i!c&i $in"pe #ng*i#( eBten "pe ce( inten #ti(i51n$ co%pe"e
$ifeite pent# fiecae oc*iL
- pent# >n$ep&taea c#"te(o "e ap(ic& co%pe"e #%e$e "tei(e $ea"#pa p(eoapei
"#peioae, "e (a"& 1-2 %in#te $#p& cae "e >n$ep&tea5& #!o c#"te(e >n%#iateL
- "e epet& opeaia p1n& c1n$ c#"te(e "#nt >n$ep&tate c# #!#in&.
A,+i7i't)a)$a +$,i&a+$7t$lo) p)i7 i7'tila*ii o&ula)$
- "e a!ea5& pacient#( >n po5iie "e%i!e51n$& c# cap#( $ef(ectat, "pi8init pe "p&ta#( "ca#n#(#i
ofta(%o(ogic "a# c#(cat c# cap#( >nc(inat pe patea c# oc*i#( afectatL
- "e cee pacient#(#i "& pi)ea"c& >n "#" !i >n $ep&tae !i "& e)ite c(ipit#(L
- "e >n$ep&tea5& capac#( f(acon#(#i pe)&5#t c# pic#&to, >n %o$ a"epticL
- "e "pi8in& %1na c# f(acon#( pic#&to pe f#ntea pacient#(#i, ia c# cea(a(t& "e tage >n 8o",
c# 4(1n$ee p(eoapa infeioa& pent# a %&i fanta pa(pe4a(&L
- "e in"ti(ea5& 1-2 pic&t#i pe %#coa"a con8#ncti)a(&, "pe #ng*i#( inte a( oc*i#(#iL
- "e e(i4eea5& p(eoapa infeioa&, "e cee pacient#(#i "& c(ipea"c& pent# $i"ti4#iea
#nifo%& a "o(#ieiL
- "e >n$ep&tea5& eBce"#( $e "o(#ie c# o co%pe"& "tei(&.
A,+i7i't)a)$a u7;u$7tului o%tal+i&
- $ac& pacient#( ae pe"ci" !i #ng#ent ofta(%ic, "e a!teapt& ce( p#in 2 %in#te $#p&
in"ti(aeL
- "e ap(ic& #ng#ent#( $iect $in t#4, "a# c# o 4ag*et&, >n "tat "#4ie $e-a (#ng#( p(eoapei
infeioae, "a# "#4 p(eoapa "#peioa&L
- "e "o(icit& pacient#(#i "& >nc*i$& oc*i#( !i "&-!i %i!te g(o4#( oc#(a pent# a #nifo%i5a
%e$ica%ent#(L
- "e info%ea5& pacient#( c& "en5aia $e cop "t&in )a $i"p&ea $#p& topiea !i $i"ti4#iea
#nifo%& a #ng#ent#(#i pe "#pafaa oc*i#(#iL
- "e "pa(& %1ini(e !i "e epet& poce$#a !i pent# ce(&(a(t oc*i $ac& e"te in$icatL
- $ac& "#nt pe"ci"e %ai %#(te #ng#ente ofta(%ice, "e )a face o pa#5& $e ce( p#in 1.
%in#te >nte ap(ic&i.
Apli&a)$a ,i'&u)ilo) o&ula)$
6"pecte genea(e
- Di"c#i(e oc#(ae "#nt fo%e $e con$iionae a #no %e$ica%ente cae acionea5& (a ni)e(#(
oc*i#(#i. 0#nt fo%ate $in tei "tat#iI $o#& eBteioae !i #n#( (a %i8(oc cae conine
%e$ica%ent#(.
- Into$#" "#4 p(eoape, $i"c#( e"te #%ectat $e (ic*i$e(e oc*i#(#i, e(i4e1n$ %e$ica%ent#( pe
cae >( conine c*ia !i o "&pt&%1n& $e (a ap(icae ?a!a c#% "#nt $i"c#i(e c# pi(ocapin&
fo(o"ite >n tata%ent#( g(a#co%#(#i@.
- Uti(i5aea $i"c#i(o oc#(ae, e"te contain$icat& >nI con8#ncti)ite, Oeatite, $e5(ipie $e
etin&, afeci#ni >n cae con"ticia p#pi(a& te4#ie e)itat&.
++
9o$ $e ap(icaeI
- "e "pa(& %1ini(e !i "e >%4ac& %&n#!i "tei(eL
- "e "coate #n $i"c $in pac*etL
- "e into$#ce $i"c#( oi5onta( "#4 p(eoapa "#peioa& !i apoi "e pe"ea5& c# 4(1n$ee
$ea"#pa p(eoapei "#peioae pent# ca $i"c#( "& "e fiBe5e c1t %ai 4ineL "e poate ap(ica !i
"#4 p(eoapa infeioa&L
- "e a)eti5ea5& pacient#( "& n# "e fece (a oc*i pent# a n#-!i po$#ce (e5i#niL
- "e >n)a& pacient#( "&-!i p#n& "ing# $i"c#i(e oc#(ae, e"pect1n$ te*nica a"eptic&L
- "e eBp(ic& pacient#(#i "&-!i ap(ice ?aca"&@ $i"c#i(e "eaa, >nainte $e c#(cae pent# a
%ini%a(i5a efecte(e !i $i"confot#( $ete%inat $e >nceo!aea )e$eii ce apa $e o4icei $#p&
a$%ini"taeL
- "e a)eti5ea5& pacient#( $e"pe efecte(e a$)e"e a(e #ti(i5&ii $i"c#i(o oc#(ae, >n "pecia(
ce(e c# pi(ocapin&I "en5aie $e cop "t&in, o!eaa oc*i#(#i, p#it, e$e%, (&ci%ae, $#ei
$e capL
- $ac& ace"te "i%pto%e n# $i"pa $#p& /-2 "&pt&%1n&, pacient#( )a fi in"t#it "& an#ne
%e$ic#(.
9o$ $e >n$ep&taeI
- "e "pa(& %1ini(e !i "e >%4ac& %&n#!i(e "tei(eL
- "e $epi%& p(eoapa infeioa& c# o %1n& pent# a e)i$enia $i"c#(L
- c# cea(a(t& %1n& "e tage $i"c#(, pin a(#necae, >nafaa "ac#(#i con8#ncti)a(, "e pin$e c# 2
$egete !i "e >n$ep&tea5&L
- $ac& $i"c#( e"te "#4 p(eoapa "#peioa&, "e ap(ic& %i!c&i cic#(ae 4(1n$e pe p(eoapa
>nc*i"&, $ii81n$ $i"c#( "pe #ng*i#( inten !i "pe p(eoapa infeioa& $e #n$e "e )a >n$ep&ta
c# %1na.
3.1. A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ 7a>al: p)i7 i7'tila*i$
S&op
F#ni5aea #nei (inii $e a$%ini"tae a %e$ica%ente(o pe"ci"e pent# tataea po4(e%e(o
na5a(e.
Li7ii ,i)$&toa)$
- "o(#ii(e teape#tice in"ti(ate na5a(, pot "& e$#c& e$e%#(, "& pe)in& "a# "& conto(e5e
"1ngeaea, "& in$#c& ane"te5ia (oca(& "a# "& tate5e poce"e(e infecioa"eL
- c*ia $ac& ca)itatea na5a(& n# e"te o ca)itate "tei(&, "e eco%an$& ap(icaea a"eptic& a
%e$ica%ente(o pent# a pe)eni infectaea "in#"#i(o c# cae co%#nic&L
- >nainte $e a$%ini"taea oic&#i %e$ica%ent, a"i"tenta %e$ica(& te4#ie "& c#noa"c&
%e$ica%ent#(, "cop#( a$%ini"t&ii, $o5a no%a(& !i ca(ea $e a$%ini"taeL
- >n ti%p#( in"ti(aiei na5a(e, cap#( pacient#(#i )a fi po5iionat pe o pen&, c1t %ai apoape $e
%aginea pat#(#iL $ac& cap#( e"te >nc(inat p# !i "i%p(# pe "pate, "o(#ia %e$ica%entoa"&
poate a8#nge >n fainge, $e #n$e e"te >ng*iit& !i efect#( )a fi n#(L
- "e )a e)ita atingeea "#pafeei intene a na"#(#i c# pic#&to#(, >nt#c1t poate $ec(an!a
"t&n#t#( pacient#(#iL
- >nainte $e a$%ini"taea #n#i %e$ica%ent no#, "e )a face pofi(#( a(ego(ogic a( pacient#(#i.
1..
0e peg&te"c pe c&#cio#( $e (#c#I
- %e$icaia pe"ci"&I co(i#i con$iionate >n "tic(#e c# pic#&to, t#4#i c# #ng#enteGce%e,
"e )eific& ca(itatea ace"toa !i te%en#( $e )a(a4i(itateL
- co%pe"e $e tifonG!e)ee(e $e *1tie.
- "e eBp(ic& poce$#a pacient#(#iL
- "e in"t#ie!te pacient#( "& e)ite %i!c&i(e >n ti%p#( poce$#ii pent# a faci(ita in"ti(aeaL
- "e a"ig#& (#%ina a$ec)at&L
- "e p(a"ea5& pacient#( >n #na $in po5iii(e $e %ai 8o", >n f#ncie $e 5ona afectat&I
- to%pa (#i E#"tac*io K $ec#4it $o"a( c# cap#( >nc(inat #!o "pe 5ona afectat&L
- "in#"#i(e et%oi$a( !i "fenoi$a( K $ec#4it $o"a( c# #%eii "pi8inii pe pen& !i cap#(
>n *ipeeBten"ieL
- "in#"#i(e fonta( !i %aBi(a K $ec#4it $o"a( c# #%eii "pi8inii pe pen&, cap#(
$ef(ectat !i >nto" "pe patea afectat&L
- "e ofe& pacient#(#i !e)ee(e $e #nic& fo(o"in&L
- "e in"pectea5& naina !i "e into$#ce )1f#( pic#&to#(#i ?"a# )1f#( pipetei >n cae "-a
a"piat "o(#ia@ eBact >n nain&L
- "e in"ti(ea5& cantitatea nece"a& n#%&1n$ pic&t#i(eL
- "e in"t#ie!te pacient#( "& &%1n& >n po5iia e"pecti)& ti%p $e 2 %in#te pent# a pe)eni
"c#geea "o(#iei >n afa&L
- "e a4"oa4e eBce"#( $e %e$ica%ent !i "e e$#c& pacient#( "& e)ite "#f(aea na"#(#iL
- "e p#n %e$ica%ente(e (a (oc#( $e p&"taeL
- "e o4"e)& "taea pacient#(#i !i "e info%ea5& >n c1t ti%p "e in"ta(ea5& efect#(L
- "e >n)a& pacient#( G fa%i(ia c#% "& poce$e5e $ac& )a te4#i "& contin#e tata%ent#( (a
$o%ici(i#L
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n fi!a $e poce$#i a pacient#(#i.
3.11 A,+i7i't)a)$a +$,i&a+$7t$lo) ?7 &o7,u&tul au,iti< $Ht$)7 p)i7 i7'tila*i$
S&op
- in"ti(aii(e a#ic#(ae "e fo(o"e"c pent# tata%ent#( infecii(o !i inf(a%aii(o #ec*i(o,
>n$ep&taea ce#%en#(#i, ane"te5ie (oca(&, "a# >n$ep&taea in"ecte(o a8#n"e acci$enta( >n
#ec*eL
In"ti(aii(e a#ic#(ae "#nt >n pincipi# contain$icate pacieni(o c# pefoaie $e ti%pan, $a "e
pot tot#!i efect#a an#%ite %ane)e "tei(eL
In"ti(aii(e c# *i$ocoti5on "#nt contain$icate pacieni(o c# *epe", c# a(te infecii )ia(e, f#ngi
etc.
1.1
Li7ii ,i)$&toa)$
- cana(#( a#$iti) e"te >n %o$ no%a( foate "en"i4i(, ia at#nci c1n$ ae an#%ite afeci#ni,
acea"t& "en"i4i(itate ce!te, $e aceea "e eco%an$& o 4(1n$ee $eo"e4it& >n efect#aea
%ane)e(oL
- ce )o "p&(a %1ini(e >nainte !i $#p& efect#aea in"ti(aii(o c1t !i >nte ap(icaii $ac& "e in$ic&
a$%ini"taea (a a%4e(e #ec*iL
- pent# a pe)eni &niea ti%pan#(#i, n# "e )a into$#ce nicio$at& ap(icato#( c# cap&t $e )at&
$inco(o $e p#nct#( cae "e poate )e$ea c# oc*i#( (i4eL
- $ac& "e in$ic& a$%ini"tae $e pic&t#i !i #ng#ent, "e )o ap(ica >nt1i pic&t#i(eL
- $ac& nece"it& contin#aea tata%ent#(#i aca"&, pacient#( te4#ie >n)&at c# atenie %eto$a
coect& $e a$%ini"taeL
- $ac& pacient#( pe5int& )eti8, "e )o i$ica 4ae(e $e potecie a(e pat#(#i >n ti%p#(
a$%ini"t&ii !i "e )a e)ita i$icaea 4#"c& "a# g&4it& $#p& te%inaea poce$#ii, pent# a
n#-i accent#a )eti8#(L
- pacient#( te4#ie "#pa)eg*eat pent# a o4"e)a e)ent#a(e(e eacii a$)e"e caI )eti8,
gea&, co(ecii, $#ee etc.
- "e )o peg&tiI
- "o(#ii(e pe"ci"e con$iionate >n f(acoane c# pic#&toL
- "#"a $e (#%in&L
- ap(icato c# cap&t $e )at&L
- $op#i pent# #ec*i $in 4#%4acL
- pent# a pe)eni efecte(e a$)e"e ce pot ap&ea (a a$%ini"taea $e in"ti(aii a#ic#(ae pea
eci ?)eti8, gea&, $#ee@ "e )o peg&ti in"ti(aii(e (a te%peat#a ca%eei fie in1n$#-(e
>nt-#n 4o( c# ap& ca($& fie >nc&(5in$ f(acon#( >n %1n&, !i "e )o te"ta pe >nc*eiet#a %1inii
>nainte $e ap(icaeL
- $ac& "e )a fo(o"i pic#&to $e "tic(& "e )a )eifica integitatea ace"t#ia pent# a n# &ni
cana(#( a#$iti).
- "e "pa(& %1ini(eL
- "e )eific& i$entitatea pacient#(#i !i #ec*ea afectat&L
- "e )eific& %e$ica%ent#( cae te4#ie a$%ini"tat ca $at& $e eBpiae !i "e co%pa& >nc& o
$at& c# in$icaia %e$ic#(#iL
- "e a!ea5& pacient#( c#(cat pe patea op#"& #ec*ii afectateL
- "e (&ge!te con$#ct#( a#$iti) t&g1n$ >n "#" !i >n "pate $e pa)i(ion#( a#ic#(a, (a a$#(t,
pent# a faci(ita o %ai 4#n& p&t#n$ee a %e$ica%ent#(#iL
- "e !tege oice "eceie o4"e)at& c# ap(icato#( c# cap&t $e 4#%4ac, $eoaece oice
co(ecie poate e$#ce efect#( %e$ica%ent#(#iL
- c# #ec*ea coect po5iionat& "e ap(ic& n#%&#( in$icat $e pic&t#i in1n$ >n a!a fe(
pic#&to#( >nc1t pic&t#i(e "& ca$& pe peete(e con$#ct#(#i a#$iti) !i n# $iect pe ti%panL
- "e cee pacient#(#i "& &%1n& c#(cat >nc& 2-1. %in#te pent# a (&"a %e$ica%ent#( "& fie
a4"o4itL
- "e c#&& !i #"#c& pa)i(ion#( a#ic#(aL
1.2
- "e p#ne #n $op $e )at& >n %eat#( a#ic#(a, (e8e, pent# a >%pie$ica "c#geea
%e$ica%ent#(#i !i pent# a pote8a pacient#( $e c#enii $e aeL
- $ac& e"te in$icat "e epet& poce$#a pent# cea(a(t& #ec*e (a inte)a( $e ce( p#in 1.
%in#teL
- "e "pa(& %1ini(eL
3.12 A,+i7i't)a)$a +$,i&a+$7t$lo) p$ t$;u+$7t$
S&op
- o4ineea #n#i efect teape#tic (oca(L
- "ti%#(aea cic#(aiei.
Li7ii ,i)$&toa)$
- )eificae 5onei tatate e"te o4(igatoie pent# $epi"taea pecoce a e)ent#a(e(o iitaii,
eacii a(egiceL
- n# "e ap(ic& nicio$at& %e$ica%ent#( f&& a c#&a 5ona tatat& $e )ec*ea ap(icae, pent# a
pe)eni a"tfe( iitaia pie(ii pin ac#%#(ae $e e5i$##i %e$ica%entoa"e )ec*iL
- p#taea %&n#!i(o e"te o4(igatoie pent# a pe)eni a4"o4ia %e$ica%ent#(#i pin pie(ea
%1ini(o a"i"tentei %e$ica(eL
- pent# a p&"ta %e$ica%ent#( pe 5ona tatat& !i pent# a pote8a (en8eia $e cop, "e )a
acopei 5ona tatat& c# #n pan"a%ent "e%ipe%ea4i( tan"paent.
0e peg&te"c pe o ta)& %e$ica(& "a# pe c&#cioI
- %e$ica%ente(e pe"ci"eI "o(#ii, p#$e, #ng#enteGce%e, %iBt#i, p(a"t#iL
- %&n#!i $e ca#ci#c, co%pe"e $e tifonL
- "pat#(e, pen"e pot-ta%ponL
- %ateia( pent# potecia pat#(#i.
Reg#(i genea(eI
- "e )eific& coe"pon$ena >nte %e$icaia pe"ci"& !i cea e(i4eat& $e fa%acieL
- "e )eific& te%en#( $e )a(a4i(itate a( %e$ica%ente(oL
- "e i$entific& pacient#( !i 5ona ce #%ea5& a fi tatat&L
- "e eBp(ic& poce$#a $e ap(icae $eoaece %a8oitatea pacieni(o, $#p& eBtenae, )o
contin#a "&-!i a$%ini"te5e "ing#i %e$ica%ent#(L
- "e "pa(& "i%p(# %1ini(e !i "e >%4ac& %&n#!i $e ca#ci#cL
- "e a!ea5& pacient#( >nt-o po5iie confota4i(& cae "& pe%it& acce"#( (a 5ona ce te4#ie
tatat&L
- $ac& e"te nece"a "e c#&& pie(ea $e "eceii, c#"te, ce(#(e %oate "a# ap(icaii(e
%e$ica%entoa"e )ec*i !i apoi "e "c*i%4& %&n#!i(e.
Apli&a)$a u7;u$7t$lo)D&)$+$lo)B
1.,
- "e $e"c*i$e t#4#( c# #ng#ent p#n1n$#-"e capac#( c# faa eBten& >n 8o" pent# a e)ita
conta%inaea "#pafeei intene a capac#(#iL
- "e ap(ic& ce%a "a# #ng#ent#( pe "#pafaa afectat& $iect $in t#4 "a# c# a8#to#( #nei
"pat#(e !i "e %a"ea5& 5ona pin %i!c&i (ente, #!oae, p1n& c1n$ #ng#ent#( p&t#n$e >n pie(e,
&%1n1n$ #n #!o (#ci# a( pie(iiL
- "e >n$ep&tea5& eBce"#( c# o co%pe"& "tei(&L
- "e e)it& fecaea 5onei pent# a n# po$#ce iitaii.
Apli&a)$a a$)o'olilo) 'p)aKB
- "e agit& f(acon#( pent# a o%ogeni5a co%po5iiaL
- "e ine f(acon#( (a 12-,. c% $e pie(e !i "e p#()ei5ea5& fin %e$ica%ent#( pe 5ona in$icat&.
Apli&a)$a pu,)$iB
- "e #"#c& "#pafaa pie(ii $#p& ce a fo"t c#&at& $e e5i$##iL
- "e ap(ic& #n "tat "#4ie $e p#$& c# a8#to#( p#()ei5ato#(#i "a# c# a8#to#( #n#i ta%pon
$e )at&, pin "c#t#aeL
- "e pote8ea5& oc*ii, c&i(e e"piatoii >n ti%p#( p#()ei5&ii, %ai a(e" $ac& 5ona tatat& "e af(&
>n poBi%itate.
Apli&a)$a pat&=4u)ilo) #pla'tu)ilo)-
- "e eBp(ic& pacient#(#i c& patc*-#( ae %ai %#(te "tat#iI
- "tat#( cae )ine >n contact $iect c# pie(ea !i cae conine o %ic& cantitate $e
"#4"tan& %e$ica%entoa"& acti)&L
- a( $oi(ea "tat K conto(ea5& e(i4eaea teptat& a %e$ica%ent#(#i $in poi#nea
pincipa(& a patc*-#(#iL
- a( tei(ea "tat K conine pincipa(a $o5& $e %e$ica%ent, !i e"te pote8at >n eBteio
pint-#n %ateia( $in po(ie"te !i a(#%ini#L
- "e >n)a& pacient#( "&-!i ap(ice >n (oc#i poti)ite #"cate !i f&& p& ?patea "#peioa& a
4a#(#i, toace(e, etoa#ic#(a@L
- "e )o e)ita egi#ni(e pop(itee, p(ici(e coate(o !i 5one(e c# (e5i#niL
- >n ca5#( >n cae acci$enta( patc*-#( "cap& pe 8o", )a te4#i >n(oc#it c# #n#( no# p(a"at >n a(t
(ocL
- patc*-#( "e ap(ic& (a aceea!i o& pent# a a"ig#a contin#itatea tata%ent#(#iL
- no#( patc* "e ap(ic& c# ,. $e %in#te >nainte $e a-( >n$ep&ta pe ce( )ec*iL
- "e notea5& $ata !i oa ap(ic&ii patc*-#(#i pe "#pafaa (#i eBten& ?$#ata $e ap(icae e"te $e
eg#(& $e 2/ oe@L
- pacient#( )a fi %onitoi5at pent# $epi"taea pecoce a efecte(o a$)e"e ?eB. $#ei $e cap,
*ipoten"i#ne (a a$%ini"taea p(a"t#i(o c# nitog(icein&@.
3.1, A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ )$&tal:
9e$ica%ente(e cae "e a$%ini"tea5& intaecta( "#nt "#po5itoae(e !i #ng#ente(e
0#po5itoae(e "#nt fo%e %e$ica%entoa"e "o(i$e, $e fo%& conic& cae a# "#4"tana acti)&
>ng(o4at& >nt-o %a"& g&"oa"& pe 4a5& $e #nt $e cacao "a# g(icein&. 0e tope"c (a te%peat#a
cop#(#i !i "#nt a4"o4ite (ent.
I7,i&a*ii i Co7t)ai7,i&a*ii
1./
I7,i&a*iiB
- "ti%#(aea pei"ta(ti"%#(#i inte"tina( !i a( $efecaieiL
- e$#ceea $#eii, a inf(a%aiei !i a iitaii(o (oca(eL
- e$#ceea fe4ei !i a "i%pto%e(o "pecifice #no apaate.
Co7t)ai7,i&a*iiB
- pacieni c# t#(4#&i $e it% >nt#c1t into$#ceea "#po5itoae(o intaecta( "ti%#(ea5&
ne)#( )ag !i $ete%in& ait%iiL
- pacieni opeai ecent >n 5ona ect#(#i "a# a po"tateiL
- pacieni c# ectoagie.
0e )o peg&ti pe c&#cio#( $e (#c#I
- "#po5itoae(e ecta(e, p&"tate (a figi$e p1n& >n %o%ent#( a$%ini"t&ii pent# a pe)eni
>n%#ieeaGtopiea (oL
- (#4ifiant pent# "#po5itoaeL
- #ng#ent#( c# #n ap(icato "pecia(L
- co%pe"e $e tifonGpo"oape $e *1tieL
Reg#(i genea(eI
- "e )eific& coe"pon$ena >nte %e$icaia pe"ci"& $e %e$ic !i cea e(i4eat& $e fa%acieL
- "e )eific& ca(itatea !i integitatea "#po5itoae(o, t#4#i(o c# #ng#ente, te%en#( $e
)a(a4i(itateL
- "e "pa(& %1ini(eL
- "e i$entific& pacient#( !i "e a"ig#& inti%itatea ace"toa.
A,+i7i't)a)$a 'upo>itoa)$lo)
- "e a!ea5& pacient#( >n po5iia 0I90 ?$ec#4it (atea( "t1ng c# %e%4#( infeio "t1ng >ntin"
!i %e%4#( infeio $ept f(ectat@L
- "e acope& pacient#( eBp#n1n$#-i $oa 5ona fe"ie&L
- "e >%4ac& %&n#!a $e ca#ci#c >n %1na $o%inant&L
- "e "coate "#po5ito#( $in a%4a(a8 !i "e (#4ifia5& )1f#( (a ne)oieL
- "e >n$ep&tea5& fe"e(e c# %1na ne$o%inant& pent# a e)i$enia 5ona ana(&L
- "e cee pacient#(#i "& in"pie pof#n$ pe g#& >n ti%p#( in"eiei "#po5ito#(#i pent# a
in*i4a "en5aia $e $efecaie !i a e$#ce $i"confot#(L
- "e into$#ce "#po5ito#( pin an#" c# )1f#( conic !i c# %1na pote8at& $e %&n#!&L
- "e >%pinge "#po5ito#( p1n& tece $e "fincte#( ana( inten, apoBi%ati) 3 c%L
- "e c#&& 5ona ana(& c# !e)ee(e $e *1tieL
- "e >n$ep&tea5& %&n#!aL
- "e "o(icit& pacient#(#i "& &%1n& >n aceea!i po5iie !i "& >ncece "& in& c1t %ai %#(t
"#po5ito#( pent# a-!i face efect#( ?#n "#po5ito a$%ini"tat pent# "ti%#(aea $efecaiei
te4#ie ein#t ce( p#in 2. %in#te pent# a-!i face efect#(@L
- $ac& e"te ca5#(, "e eBecit& pe"i#ne pe an#" c# o co%pe"&, p1n& c1n$ "en5aia $e
$efecaie $i"paeL
- "e a#nc& %ateia(e(e con"#%ate >n ecipient#( pent# $e!e#iL
1.2
- "e >n)a& pacient#( !iG"a# fa%i(ia poce$#a $e into$#ce a "#po5itoae(o $ac&
a$%ini"taea ace"toa te4#ie contin#at& !i $#p& eBtenaeL
- "e notea5& poce$#a >n fi!a $e poce$#i.
3.1/ A,+i7i't)a)$a +$,i&a+$7t$lo) p$ 'o7,: 7a>o;a't)i&: 9i ;a't)o'to+:
6$%ini"taea %e$ica%ente(o pe ca(e entea(& >n ca5#( i%po"i4i(it&iiGe"ticiei $e inge"tie pe
ca(e oa(&.
'oce$#a "e efe& (a pacieni cae a# $e8a %ontat& fie "on$a na5oga"tic&, fie ga"to"to%a.
I7,i&a*ii
- o4"t#cie (a ni)e( 4#ca( "a# e"ofagian ?cance, a"#i@L
- t#(4#&i %a8oe $e $eg(#tiie ?paa(i5ie, $i"paiia ef(eB#(#i $e $eg(#tiie, a(teae
)igi(enei@.
Li7ii ,i)$&toa)$
- "e )a e)ita a$%ini"taea %e$icaiei (a oa %e"ei pent# a pe)eni into$#ceea #nei
cantit&i pea %ai $e (ic*i$e o$at& ?pe"te /.. %( (a a$#(i@L
- >n ca5#( >n cae te4#ie a$%ini"tat& !i %e$icaia !i %a"a >n ace(a!i ti%p, "e )a a$%ini"ta
>nt1i %e$icaiaL
- $ac& "on$a na"oga"tic& e"te ata!at& (a o p#ng& co(ectoae "a# "i"te% $e a"piae, ace"ta
te4#ie opit !i "on$a c(a%pat&, ce( p#in ,. %in#te $#p& a$%ini"taeL
- >n ca5#( a$%ini"t&ii %e$icaiei pe ga"to"to%&, "e >nc*i$e cap&t#( eBten a( "on$ei !i "e
po5iionea5& acea"ta )etica(, paa(e( c# toace(eL
- "e )eific& pie(ea $in 8##( "to%ei pent# a o4"e)a e)ent#a(e(e iitaii.
- %e$icaia pe"ci"&L
- a(e5&L
- "eing& -#Uon "a# "eing& o4i!n#it& $e 2.-3. %(L
- co%pe"e $e tifonG!e)ee(e $e #nic& fo(o"in&L
- ecipient pent# %iBaea %e$ica%ente(o, $ac& e"te nece"aL
- pen"& pent# c(a%pat "on$aL
- ap& (a te%peat#a cop#(#iL
- "e "pa(& "i%p(# %1ini(eL
- "e eBp(ic& poce$#a pacient#(#i con!tientL
- "e a!ea5& pacient#( >n po5iie poc(i)& ?cap#( !i toace(e #!o i$icat@ >n ca5#( a$%ini"t&ii
%e$ica%ente(o pe "on$& na5oga"tic&L
- "e %iBea5& %e$ica%ente(e "o(i$e !i "e $i5o()& c# ap&L
- "e a"pi& >n "eing& "o(#ia %e$ica%entoa"& peg&tit& "a# (i)at& ca ataeL
- "e )eific& pe%ea4i(itatea "on$eiL
- "e ata!ea5& "einga (a "on$a na"oga"tic& !i "e into$#ce (ent "o(#iaL
1.3
- "e a$%ini"tea5& "o(#ia %e$ica%entoa"& pe "on$a $e ga"to"to%& $iect $in "eing& "a# pe
p1(nie, pacient#( fiin$ a!e5at >n po5iie !e51n$& "a# "e%i!e51n$&L
- "e "pa(& "on$a na"oga"tic& "a# ga"to"to%a c# ,.-2. %( $e ap& ca($& pent# a >n$ep&ta
#%e(e $e %e$ica%entL
- "e $eta!ea5& "einga !i "e c(a%pea5& "on$a na5oga"tic& pent# 2.-,. $e %in#te $#p&
a$%ini"taea %e$ica%ente(oL "e a"t#p& oifici#( eBten a( ga"to"to%ei !i "e fiBea5& >n
po5iie )etica(&, paa(e(& c# toace(e, c# o fa5& con$#"& cic#(a >n 8##( a4$o%en#(#iL
- "e po5iionea5& pacient#( pe patea $eapt& >nc& ,. %in. pent# a faci(ita p&t#n$eea
%e$ica%ente(o >n "to%ac !i pent# a pe)eni ef(#B#( ga"to-e"ofagianL
3.12 A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ <a;i7al:
S&op
6p(icaea #ng#ente(o, a cap"#(e(o %oi i o)#(e(o, a co%pi%ate(o cae con in "#4"tan e
antipaa5itaeGanti4acteieneGanti%icoticeG*o%ona(e >n inteio#( ca)it& ii )agina(e.
I7,i&a ii i Co7t)ai7,i&a ii
In$ica iiI
K inf(a%a ii a(e %#coa"ei )agina(e po$#"e $e 4acteii paa5ite, tic*o%ona" "a# ci#peci
paa5ite ?can$i$a@L
K atofie )agina(& pin caen & e"togenic&L
K >nt15ieea cicati5&i(o ce)ico-
)agina(e. Contain$ica iiI
K a(egie (a #na $in co%ponente(e %e$ica%ente(oL
K cance e"togeno$epen$ent ?pent# ce(e cae con in *o%oni@L
K "acin&, a(&ptae.
K #ng#entGce%& $e #5 )agina(, o)#(e, cap"#(e %oi, co%pi%ateL
K ap(icato $e ce%&L
K %&n# i $e #nic& fo(o"in &L
K co%pe"e $e tifonL
K %ateia( pent# "p&(&t#& )agina(& ?$ac& e"te nece"a@.
K "e )eific& pe"cip ia %e$ica(& i "e conf#nt& c# %e$ica%ente(e e(i4eateGpoc#ateL
K "e )eific& te%en#( $e )a(a4i(itateL
K "e i$entific& pacientaL
K "e e)a(#ea5& capacitatea ace"teia $e a- i a$%ini"ta "ing#& %e$ica%ente(eL
K "e face in"t#iea pi)in$ a$%ini"taeaL
K "e a"ig#& inti%itateaL
K "e a ea5& pacienta >n $ec#4it $o"a( c# gen#nc*ii f(ecta i, coap"e(e $ep&tate "a# >n
$ec#4it (atea(L
K "e "pa(& %1ini(e i "e >%4ac& %&n# i $e #nic& fo(o"in &L
1.7
? $ac& %e$ic#( eco%an$& "e face (a >ncep#t o "p&(&t#& )agina(&.
a@ A,+i7i't)a)$a o<ul$lo)8 &ap'ul$lo)8 ta(l$t$lo)
K "e "coate %e$ica%ent#( $in a%4a(a8L
K fo(o"in$ $o#& co%pe"e "e >n$epatea5& (a4ii(e %ai e)i$en i1n$ oifici#( )agina(L
K "e into$#ce %e$ica%ent#( >n cana(#( )agina( i "e >%pinge # o p1n& >n f#n$#( $e "ac
po"teioL
K "e in"t#ie te pacienta "& &%1n& >n $ec#4it 12 %in#te pent# a fa)oi5a topiea
i a4"o4 iaL
K #ne(e ta4(ete ?tico%icon@ "e #%e5e"c # o apoBi%ati) ,. $e "ec#n$e >nainte
$e a$%ini"taeL
K a$%ini"taea "e face $e eg#(& "eaa, #neoi i $i%inea a.
4@ A,+i7i't)a)$a &)$+$lo) &u aAuto)ul apli&atoa)$lo)
K "e $e"c*i$e t#4#( $e ce%& pefo1n$ capac#( $e a(#%ini# c# eBte%itatea
op#"& a capac#(#iL
K "e >n ##4ea5& ap(icato#( pe fi(et#( t#4#(#iL
K "e pe"ea5& t#4#( >n patea te%ina(& p1n& (a #%p(eea co%p(et& a ap(icato#(#i c#
ce%&L
K >n ca5 $e e5i"ten & a pi"ton#(#i, ace"ta "e etage p# inL
K "e $eta ea5& ap(icato#( i "e >nc*i$e t#4#(L
K >n po5i ie c#(cat, c# gen#nc*ii f(ecta i, $ep&ta i, "e into$#ce c# aten ie
ap(icato#( pof#n$ >n )aginL
K "e >%pinge pi"ton#( p1n& (a co%p(eta go(ie a ap(icato#(#iL
K "e etage ap(icato#( f&& a atinge pi"ton#(L
K $#p& #ti(i5ae ap(icato#( "e "pa(& c# ap& c&($# & i "&p#n, "e #"#c& i "e p&"tea5& >n
c#tie p1n& (a fo(o"iea #%&toae.
Sup)a<$;=$)$a i i7't)ui)$a pa&i$7t$i ,up: a,+i7i't)a)$ p$7t)u
&o7ti7ua)$a t)ata+$7tului
K pacienta poate ac#5a (oca(, #neoi, feno%ene $e "en"i4i(i5ae ?a"#i, iitaii@ ceea ce
i%p#ne an#n aea %e$ic#(#iL
K tata%ent#( n# "e >nte#pe >n ti%p#( %en"t#a ieiL
K >n ca5#( )aginite(o "e tatea5& i patene#(L
K >n ti%p#( tata%ent#(#i n# "e fac "p&(&t#i )agina(e, $ec1t (a in$ica ia %e$ic#(#iL
K n# "e fo(o"e"c ta%poane inta)agina(e.
Capitolul 0 TERAPII VASCULARE
7.1 Mo7ta)$a &at$t$)ului <$7o' p$)i%$)i& p$7t)u p$)%u>ii
Con"t& >n p#ncionaea #nei )ene peifeice, >n con$iii $e a"ep"ie ig#oa"&, !i a$%ini"taea
#no "o(#ii %e$ica%entoa"e, inte%itent "a# contin##, >n cic#(aia )enoa"&.
6ce"t catete e"te (&"at pe (oc >n f#ncie $e ne)oi !iG"a# >n f#ncie $e $#ata tata%ent#(#i.
P)i7&ipii ;$7$)al$
1.8
- a4(aia catete#(#i "e face n#%ai (a in$icaia %e$ic#(#iL
- etageea "a )a fi i%peati)& !i i%e$iat& >naintea oic&ei "#"pici#ni $e inf(a%aie "a#
infecie a (oc#(#i p#ncionat "a# >n ca5#( #no "e%ne genea(e $e infecie "#"cepti4i(e $e
a fi (egate $e pe5ena catete#(#iL
- catete#( n# poate fi %enin#t ?>n con$iii no%a(e, f&& co%p(icaii@ %ai %#(t $e +3 $e
oe ?8 5i(e@L $e eg#(&, "e "c*i%4& (oc#( in"eiei (a /8-72 oeL
- "o(#ii(e $e 4a5& ce(e %ai #ti(i5ate "#ntI c(o#& $e "o$i# .,+M, g(#co5& 2M, 1.M, "o(#ii
*i$oe(ecto(itice ?"o(#ie inge@I
- toate %e$ica%ente(e !i "o(#ii(e a$&#gate "e a%e"tec& c# "o(#ia $e 4a5&
pin &"t#n&i "#cce"i)e >nainte $e >ncepeea a$%ini"t&iiL
- %e$ica%ente(e a$&#gate >n "o(#ie te4#ie %enionate pe o 4an$& a$e5i)& (ipit& pe
p#ng& "a# f(acon c# $en#%iea coect&, cantitatea pe"ci"&L
- pepaaea #nei pef#5ii %iBte !i %anip#(aea ei, te4#ie efect#ate >n con$iii $e a"ep"ie
$eoaece "o(#ii(e $e pef#5ie "#nt #n %e$i# 4#n pent# $e5)o(taea ge%eni(oL
- "e eBc(#$ $e (a a%e"tec#i $e oice tipI
- "1nge(e !i $ei)ate(e $e "1ngeL
- "o(#ii(e $e a%inoaci5iL
- e%#("ii(e (ipi$iceL
- "o(#ii(e concentate pent# tata%ent o"%otic ?%anito(, o"%of#n$in@L
- "o(#ii %o(ae pent# coectaea ec*i(i4#(#i aci$o-4a5ic ?4ica4onat $e "o$i#
/,8M, 8,/M, c(o#& $e pota"i# 7,/2M@L
- $ata eBpi&ii #nei "o(#ii te4#ie )eificat& >ntot$ea#na pent# a e)ita a$%ini"taea #nei
"o(#ii $e)enit& inacti)& "a# toBic&L
- "i"te%#( $e pef#5ie c# fi(t# $e aei"ie >ncopoat >n ca%ea $e pic&t#i, te4#ie >nc*i"
>nainte $e into$#ceea #no "o(#ii %e$ica%entoa"e >n ecipient#( $e pef#5ie, pent# a
e)ita #%e5iea fi(t#(#i c# (ic*i$#( $e pef#5ie !i a "e p&"ta f#nciona(itatea ace"t#iaL
- "ta4i(iea n#%&#(#i $e pic&t#i $e "o(#ie pe %in#t "e poate face $#p& #%&toae(e
fo%#(eI
- n#%& pic&t#iG%in#t T )o(#%#( tota(Gti%p#( >n %in#te B ,
- n#%& pic&t#iG%in#t T )o(#%#( tota( a( "o(# iei ?>n %(@ B pic&t#iG%( "a# $#ata
pef#5iei ?>n %in#te@
4%emplu de calculare a numrului de picturi dup formula a
doua$ 7olumul total 8 , litru soluie 9luco! '*
"urata perfu!iei 8 :; h (,;;)
min#) , ml# soluie 8 :) picturi
umrul de pic#<minut 8 ,))) ml % :) < ,;;) 8 ,5,== (cca# ,; pic#< minut)
I7,i&a*ii 9i &o7t)ai7,i&a*ii
I7,i&a*ii t$)ap$uti&$
- *i$atae !i apot e(ecto(iticL
- a(i%entaie paentea(&L
- apot $e %e$ica%enteL
- tan"f#5ie c# "1nge !i $ei)ate $e "1nge.
I7,i&a*ii p$7t)u ,ia;7o'ti&
1.+
- pe(e)&i $e "1nge, epetate >nt-#n inte)a( $e ti%p "c#tL
- a$%ini"taea $e "#4"tane $e conta"tL
6ce"te in$icaii te4#ie (i%itate (a "tict#( nece"a !i e)&5#te 5i(nic >n f#ncie $e
"taea pacient#(#i, !i >n patic#(a, >n f#ncie $e aptit#$inea "a $e a pi%i tata%ent#( pe ca(e
$ige"ti)&.
Co7't)ai7,i&a*ii
Co7't)ai7,i&a*ii a('olut$
N# "e )a p#nciona 4a#( caeI
- pe5int& fi"t#(& ateio-)enoa"&L
- i%p(ant otope$icL
- a4(aia gang(ioni(o aBi(ai.
Co7't)ai7,i&a*ii )$lati<$
Fn ca5#( >n caeI
- 4a#( e"te paa(i5at "a# ta#%ati5atL
- eBi"t& (e5i#ni c#tanate !i infecii (a (oc#i(e $e p#ncionae.
- "e info%ea5& $e"pe i%potana !i $#ata poce$#ii !i e)ent#a( $e"pe a"pecte(e (egate
$e i%o4i(i5aeL
- "e a4o$ea5& $e eg#(&, 4a#( ne$o%inant a( pacient#(#iL
- "e in"ta(ea5& confota4i(L
- "e $epi(ea5& 5ona >n ca5 $e pi(o5itate i%potant&L
- "e eBp(ic& ge"t#i(e ce te4#ie e)itate pent# pote8aea a4o$#(#i )eno" pec#% !i
"i%pto%e(e #no co%p(icaii potenia(e.
- "#pot pent# pef#5ie (a picioae(e pat#(#i, $e pefein& %o4i( $ac& pacient#( e"te
a#tono%L
- %ateia( pent# potecia pat#(#iL
- o peec*e $e %&n#!i $e #nic& fo(o"in&L
- #n gao#L
- "o(#ii anti"eptice io$ate "a# c(o*eBi$in& a(coo(ic& $ac& pacient#( e"te a(egic (a io$L
- p#ngi c# "o(#ii $e pef#5at, in$icate $e %e$icL
- %e$ica%ente(e pe"ci"e pent# a$%ini"taea >n pef#5ieL
- t#"a $e pef#5at "tei(& c# $e4it%et# !i #na "a# %ai %#(te c&i $e pef#5atL
- o4inet tifa5ic pent# aco$aea "i%#(tan& a 2 pef#5ii (a aceea!i (inie )enoa"&L
- catetee G 4an#(e $e $i%en"i#ni $ifeiteL
- p(a"t#i, pan"a%ente a$e5i)e $e tip fo(ie "a# p(a"&L
- pene pent# po5iionae, e)ent#a( ate(e pent# o po5iie confota4i(& a 4a#(#i %ai a(e"
(a pacienii agitai.
P)$;:ti)$a li7i$i ,$ p$)%u>i$
11.
- "e a$aptea5& t#4#(at#a pincipa(& (a p#nga c# "o(#ie "tei(&L
- "e a$a#g& o4inet#( (a c&i(e $e pef#5ae a "o(#ii(o, $ac& "#nt nece"ae %ai
%#(te $ei)aii, apoi pe(#ngito#( ce )a fi a$aptat (a catete#( G 4an#(a en$o)enoa"&L
- "e c(a%pea5& t#4#( pef#5o#(#iL
- "e #%p(e ca%ea pic#&to#(#i (a 8#%&tateL
- "e $e"c*i$e pe"t#4#( G c(e%a pent# a p#8a an"a%4(#( (iniei $e pef#5atL
- "e c(a%pea5& apoi t#4#( pincipa( a( pef#5o#(#i !i "e acope& "tei(L
- "e $atea5& t#4#(at#a pincipa(& !i "e "c*i%4& (a fiecae 2/ *. $ac& pef#5ia $#ea5& %ai
%#(te 5i(e.
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(eL
- "e p(a"ea5& 4a#( pacient#(#i $ea"#pa %ateia(#(#i $e potecieL
- "e cecetea5& )ena $e p#ncionat (#1n$ >n ca(c#( pincipi#( poge"iei centipete (a
"c*i%4aea (oc#i(o $e p#ncionaeL
- "e ap(ic& gao#( ?n# "e %enine %ai %#(t $e , %in#te@ !i "e $e5infectea5& (ag 5ona $e
p#ncionaeL
- "e face "ta5& )enoa"& ?p#("#( ateia( peifeic "e pa(pea5&, >n ca5 conta "e %ai "(&4e!te
p#in gao#(@L
- c# %1na ne$o%inant& "e eBecit& o pe"i#ne #!oa& a"#pa pie(ii pent# a "ta4i(i5a )ena
cecetat&L
- "e into$#ce catete#( G 4an#(a c# )1f#( %an$en#(#i oientat >n "#" !i "e p#ncionea5&
)enaL
- "e ope!te >naintaea ac#(#i >n %o%ent#( >n cae pe ac )ine "1ngeL
- "e fiBea5& c# ta%pon#( catete#( >n ti%p ce "e etage %an$en#(L
- "e $e"face gao#(L
- "e a#nc& %an$en#( >n ecipient#( "pecia(L
- "e a$aptea5& a%4o#( pef#5o#(#i (a 4an#(&L
- "e $e"c*i$e t#4#( pef#5o#(#iL
- "e fiBea5& catete#( G 4an#(a c# #n pan"a%ent oc(#"i) "tei(, inc(#51n$ aco$#( te%ina(L
- "e a$aptea5& n#%&#( $e pic&t#i (a pe"cipia %e$ica(& $#p& fo%#(e "tan$a$L
- "e >n$ep&tea5& %&n#!i(e, "e "pa(& %1ini(eL
- "e notea5& poce$#a >n Fi!a $e poce$#i ?n#%e, $at&, oa a$%ini"t&ii, tip#( "o(#iei,
$o5a@.
I7&i,$7t$DA&&i,$7t$
- eBta)a5aea "o(#iei >n afaa )enei !i t#%efieea $#eoa"& a 5oneiL
- neco5a e"#t#(#i >n ca5 $e eBta)a5ae $e "o(#ii *ipetoneL
- infecia (oca(& $etectat& pin "e%ne inf(a%atoii (oca(eI eite%, $#ee, c&($#& (oca(&,
t#%efacie !i (e5aea f#nciei "eg%ent#(#i e"pecti)L
- o4"t#aea catete#(#i G 4an#(ei c# c*eag#i $e "1nge >n a4"ena %ane)e(o "tan$a$ $e
>nteinee 5i(nic&L
111
- e$e%#( p#(%ona ac#t pin *ipe*i$atae >n ca5#( >n cae n# "e ca(c#(ea5& coect
n#%&#( $e pic&t#i pe %in#t !i n# "e e"pect& ti%p#( $e pef#5ae.
7.2 M$7*i7$)$a 9i ?7;)iAi)$a u7$i li7ii <$7oa'$ $Hi't$7t$
Fngi8iea #nei (inii )enoa"e pe"#p#neI
- )eificae pe%ea4i(it&ii catete#(#iL
- pe%ea4i(i5aea catete#(#iL
- "c*i%4aea pan"a%ente(o !i a fiBatoae(oL
- "c*i%4aea pef#5oae(o !i a "o(#ii(o pef#5a4i(e.
Li7ii ,i)$&toa)$
- fiBatoae(e "a#G!i pan"a%ente(e "e "c*i%4& at#nci c1n$ "e #$& "a# "e %#$&e"c, "a#
o$at&
c# in"eia #n#i no#
cateteL
- (a pacienii c# a$%ini"tae inta)enoa"& contin#&, pef#5oae(e "e "c*i%4& (a /8 oe ia
"o(#ii(e (a 2/ oeL
- (oc#( $e in"eie a catete#(#i te4#ie "c*i%4at (a fiecae 72 oe !i te4#ie in"pectat (a
fiecae / oe pin fiBato#( tan"paent "i "e%ipe%ea4i(L
- pe%ea4i(itatea can#(eiG4an#(ei >n ca5 $e pef#5ieGa$%ini"tae inte%itent& "e )eific&
pin a"piae >naintea oic&ei a$%ini"t&i inta)enoa"e.
'ent# )eificaea !i pe%ea4i(i5aea 4an#(eiI
- pa$#i a(coo(i5ateL
- "eingi "tei(e $e 2 %( c# ace "tei(eL
- fio(e c# "e fi5io(ogic, *epain&L
- t&)i& ena(&.
'ent# "c*i%4aea pan"a%ent#(#i G fiBato#(#i
- %&n#!i "tei(eL
- pa$#i a(coo(i5ate "a# c# 4eta$in&L
- 4an$a8 a$e5i)G(e#cop(a"tL
- co%pe"e "tei(e "a# fiBato tan"paent !i
"e%ipe%ea4i(. 'ent# "c*i%4aea "o(#ii(o
- f(acon#(Gp#nga c# "o(#ia $e a$%ini"tatL
- 4en5i a$e5i)e pent# notaea e)ent#a(e(o %e$ica%ente into$#"e >n "o(#ia
pef#5a4i(&. 'ent# "c*i%4aea pef#5o#(#i
- t#"& $e pef#5at "tei(&L
- %&n#!i "tei(eL
- etic*eteL
- co%pe"e "tei(e.
0e peg&te"c %ateia(e(e nece"ae pe c&#cio#( $e (#c# e"pect1n$ eg#(a $e 4a5& >n ce
pi)e!te "epaaea %ateia(e(o "tei(e !i c#ate $e ce(e %#$ae !i $e ecipiente(e $e co(ectae.
112
11,
Reg#(i genea(e
- "e eBp(ic& pacient#(#i, >n te%eni acce"i4i(i, poce$#a pent# a o4ine co(a4oaea "a !i
pent# a-i $i%in#a anBietateaL
- "e "pa(& %1ini(eL
- "e >%4ac&, o4(igatoi#, %&n#!i "tei(e c1n$ "e (#cea5& >n 5ona $e in"eie a catete#(#i.
'e%ea4i(i5aea 4an#(ei c# "e fi5io(ogic
- "e ata!ea5& "einga c# "e fi5io(ogic (a 4an#(& e"pect1n$ te*nica a"eptic&L
- "e a"pi& !i "e o4"e)& $ac& a ap&#t "1nge >n "eing&L
- $ac& n# apae "1nge >n "eing&, ap(ic& #n gao# $ea"#pa (oc#(#i $e in"eie a(
catete#(#i, ti%p $e 1 %in#t, $#p& cae "e a"pi& $in no#L
- $ac& nici $e $ata acea"ta n# apae "1nge >n "eing&, "e in8ectea5& (ent "e#( fi5io(ogic
"i%p(# $#p& ce "e $e"face gao#(L
- $ac& "e >nt1%pin& e5i"ten& (a in8ectae, "e >nte#pe opeaia con"i$e1n$ 4an#(a
>nf#n$at&.
'e%ea4i(i5aea 4an#(ei c# *epain& ?$ac& *epaina e"te co%pati4i(& c# "e#( a$%ini"tat@
- "e ata!ea5& "einga c# *epain& !i "e fi5io(ogic (a 4an#(& e"pect1n$ te*nica a"eptic&L
- "e in8ectea5& (ent "o(#ia p1n& c1n$ e5i"tena (a in8ectae e"te $i%in#at& !i f(#B#( "e eia.
0c*i%4aea pan"a%ent#(#i "a# fiBato#(#i
- "e >n$ep&tea5& )ec*i#( fiBatoL
- "e $e5infectea5& %1ini(e c# #n ge( anti"eptic
- "e >%4ac& %&n#!i(e "tei(eL
- "e peg&te!te no#( fiBatoL
- "e fiBea5& catete#( c# %1na ne$o%inant& pent# a pe)eni %i!c&i(e acci$enta(e #%ate
$e ie!iea $in )en& "a# pefoaea )eneiL
- "e c#&& c# atenie 5ona c# pa$#i a(coo(i5ate "a# c# 4eta$in&, pin %i!c&i cic#(aeL
- "e (a"& pie(ea "& "e #"#ce !i apoi "e ap(ic& fiBato#( no# "a# pan"a%ent#(L
- $ac& (a (oc#( p#ncion&ii "e o4"e)& "e%ne $e inf(a%aie ?conge"tie, t#%efacie, $#ee@
"a# $e to%4of(e4it& ?o!ea&, f(e4a(gie, e$e%@ "e poce$ea5& a"tfe(I
- "e acope& 5ona $e p#ncionae c# #n pan"a%ent "tei( !i "e eBtage catete#( $in
)en&L
- "e co%pi%& (oc#( p1n& "e ope!te "1ngeaeaL
- "e ap(ic& apoi #n 4an$a8 a$e5i), co%pe"i)L
- "e p#ncionea5& o a(t& )en& !i "e %ontea5& #n no# catete.
0c*i%4aea "o(#iei $e pef#5at
- "e "pa(& %1ini(eL
- "e in"pectea5& p#nga "a# f(acon#( c# "o(#ia $e pef#5at pent# a i$entifica e)ent#a(e(e
%o$ific&iI $eco(oaea "o(#iei, a"pect t#(4#e, eBpiaea te%en#(#i $e )a(a4i(itate,
fi"#aea f(acon#(#i "a# p#ngiiL
- "e c(a%pea5& t#4#( pef#5o#(#i pent# a >%pie$ica p&t#n$eea ae#(#i >n
"i"te%#( cic#(ato ?>n ca5#( >n cae pef#5o#( e"te a$aptat (a f(acon@L
1..
- pe c&#cio#( $e (#c# "e peg&te!te f(acon#( "a# p#nga $e "c*i%4I "e >n$ep&tea5&
capac#( "a# $op#( f(acon#(#i !i "e $e5infectea5& c# pa$ a(coo(i5atL
- "e >n$ep&tea5& f(acon#( )ec*i $in "tati) !i "e "coate toca#( pef#5o#(#i $in ace"taL
- "e into$#ce i%e$iat toca#( pef#5o#(#i >n f(acon#( pef#5o#(#i >n f(acon#( "a# p#nga
no#& !i "e "#"pen$& >n "tati)L
- "e $ec(a%pea5& t#4#( pef#5o#(#i ?atenie "& n# eBi"te ae pe t#4@ !i "e (a"& "o(#ia "&
c#g& (a it%#( anteio "a# (a a(t it% pe"ci" $e %e$ic.
0c*i%4aea pef#5o#(#i
- "e c(a%pea5& pef#5o#( c# ca%ea $e pic#ae pe 8#%&tate p(in&L
- "e "coate toca#( pef#5o#(#i $in f(acon !i "e aga& >n "tati)L
- "e $e5infectea5& $op#( f(acon#(#i no# !i "e into$#ce toca#( no#(#i pef#5o >n f(aconL
- "e e)ac#ea5& ae#( $e pe t#4#( pef#5o#(#i !i apoi "e >nc*i$e pe"t#4#(L
- "e "pa(& %1ini(e c# #n agent anti"epticL
- "e >%4ac& %&n#!i "tei(eL
- "e p#ne o co%pe"& "tei(& $ea"#pa (oc#(#i $e in"eie a catete#(#i !i "e pe"ea5& c# #n
$eget pent# a pe)eni "1ngeaeaL
- "e $econectea5&, c# atenie )ec*i#( pef#5o f&& "& "coate% acci$enta( !i 4an#(aL
- "e >n$ep&tea5& capac#( potecto a( no#(#i pef#5o !i "e a$aptea5& (a catete#( )eno"L
- "e fiBea5& catete#( !i t#4#( pef#5o#(#i (a teg#%ent c# #n fiBato tan"paent !i
"e%ipe%ea4i( a)1n$ gi8& "& pe%it& (i4etate $e %i!cae pacient#(#i !i "& pe)in&
ie!iea catete#(#i $in )en& (a o %i!cae 4#"c&L
- "e >n$ep&tea5& pef#5o#( )ec*i !i "e a#nc& >n ecipient#( c# %ateia(e conta%inateL
- "e "#pa)eg*ea5& it%#( $e "c#gee, (oc#( p#ncionat !i co%pota%ent#( pacient#(#i.
7., 57,$p:)ta)$a ,i'po>iti<ului i7t)a<$7o'
p$)i%$)i& S&op
'e)eniea co%p(icaii(o (oca(e.
Mat$)ial$
- co%pe"e "tei(eL
- 4an$& a$e5i)&L
- t&)i& ena(&L
- ecipiente pent# co(ectaea $e!e#i(o.
Li7ii ,i)$&toa)$
- $i"po5iti)e(e inta)enoa"e "#nt "c*i%4ate >n #%&toae(e "it#aiiI
- (a in$icaia %e$ic#(#i cae >nte#pe teapia inta)enoa"&L
- "c*i%4aea (oc#(#i p#nciei (a 72 $e oe pent# a contin#a teapia inta)enoa"&L
- $ac& (a (oc#( p#ncion&ii apa o!ea&, e$e%, $#ee "a# infi(taie "#4c#tanat&L
- $ac& 4an$a a$e5i)& ap(icat& $ea"#pa (oc#(#i p#nciei n# eBecit& "#ficient&
pe"i#neL
- pent# a pe)eni "1ngeaea "a# *e%ato%#(L
112
- n# "e "c*i%4& nicio$at& #n $i"po5iti) inta)eno" >n f#nci#ne (a #n pacient >n "tae
citic& p1n& c1n$ n# "e eBec#t& c# "#cce", o a(t& p#ncie )enoa"&.
E%$&tua)$a
p)o&$,u)ii
- "e peg&te"c toate %ateia(e(eL
- "e )eific& $ac& o$in#( $e te%inae a teapiei i.). a fo"t a(ocatL
- "e eBp(ic& poce$#a pacient#(#i !i "e a)eti5ea5& pacient#( c& )a "i%i o #!oa& "en5aie
$e a"#&L
- "e "pa(& %1ini(eL
- "e >nc*i$e pe"t#4#(Gc(e%a pef#5o#(#i, $ac& pef#5ia e"te >n $e#(aeL
- "e >n$ep&tea5& 4an$a a$e5i)& !i pan"a%ent#( $ac& eBi"t&L
- "e o4"e)& !i "e notea5& "taea (oc#(#i p#ncionat !i a e"#t#(#i $in 8#L
- "e a!ea5& o co%pe"& "tei(& $ea"#pa (oc#(#i p#ncionat, eBecit1n$ o #!oa& pe"i#neL
- "e >n$ep&tea5& ac#( $in )en& !i "e co%pi%& (oc#(L
- "e )eific& $ac& $i"po5iti)#( $in )en& e"te intactL
- "e >n$ep&tea5& co%pe"a c1n$ "1ngeaea "e ope!te !i "e a#nc& >n ecipient#( $e
$e!e#iL
- "e a"epti5ea5& (oc#( !i "e ap(ic& i co%pe"& "tei(&, #ti(i51n$ te*nica a"eptic& !i 4an$a $e
"ig#an&L
- "e a#nc& ec*ipa%ent#(L
- "e )eific& $in no# $#p& 12 %in#te (oc#( p#nciei, pent# a ne a"ig#a c& "1ngeaea "-a
opitL
- "e in"t#ie!te pacient#( "& e)ite oice acti)itate (a ni)e(#( "eg%ent#(#i afectatL
- "e in"t#ie!te pacient#( "& an#ne a"i"tenta %e$ica(& $ac& "1ngeaea eapae (a
(oc#( p#ncionatL
- "e >nc#a8ea5& pacient#( "& cea"c& inge"tia $e (ic*i$e $ac& e"te po"i4i(L
- "e notea5& poce$#a $e >n$ep&tae a $i"po5iti)#(#i inta)eno" >n Fi!a $e poce$#i a
pacient#(#i.
7./ Pa)ti&ipa)$a la pu7$)$a 9i ?7,$p:)ta)$a &at$t$)ului <$7o'
&$7t)al
Teapia )enoa"& centa(& e"te o poce$#& $e %ae te*nicitate cae int& >n ati4#ii(e
%e$ic#(#i.
6"i"tent#( %e$ica( a8#t& efecti) %e$ic#( >n ea(i5aea ace"tei
poce$#i.
Catete#( )eno" centa( e"te #n catete )eno" "tei(, confecionat $in ca#ci#c po(i#etan "a#
"i(icon, cae "e into$#ce tan"c#tan, >nt-o )en& centa(& $e ca(i4# %ae, a!a c#% "#nt )ene(e
"#4c(a)ic#(a& !i 8#g#(a&.
I7,i&
a*ii
- co(ap" cic#(ato peifeic ?)ene(e peifeice "#nt co(a4ate pin p&4#!iea cic#(aiei
113
peifei
ceL
- a$%ini"taea #no cantit&i %ai $e f(#i$e >n #geneL
- tata%ent inta)eno" >n$e(#ngatL
- n#tiie paentea(& c# "o(#ii po(in#titi)e ?eB. Na4i)en@L
- %onitoi5aea pe"i#nii )enoa"e centa(e.
117
D$>a<a7taA$
- e"te %ai co"ti"itoae $ec1t teapia )enoa"& peifeic&L
- i"c ce"c#t $e co%p(icaiiI pne#%otoaB, "ep"i", fo%aea $e to%4iL
- pefoaea $e ogane !i )a"e >n ti%p#( %ont&iiL
- "c&$eea ga$#(#i $e %o4i(i5ae a pacient#(#i.
'ent# in"eia catete#(#i )eno" centa(I
- "e )o peg&ti pe c&#cio#( $e (#c#, "epa1n$ cic#it#( %ateia(e(o "tei(e c#ate c# ce(
a( %ateia(e(o %#$ae, #%&toae(eI
- *a(ateL
- %&n#!i "tei(eL
- %&!ti c*i#gica(eL
- c1%p#i "tei(eL
- t#"& $e pef#5atL
- 2 catetee )enoa"e centa(e $e 1/-13 -L
- "eingi $e $ifeite %&i%i "tei(e ?2, 2, 1. %(@L
- "o(#ii "a(ine "tei(e >n p#ngi "a# f(acoaneL
- "o(#ii ane"te5iceI Ai(in& 1ML
- co%pe"e $e tifon "tei(eL
- a& "tei(& pent# "#t#&L
- foafec& "tei(&L
- fiBato tan"paent !i "e%ipe%ea4i(L
- fio(e c# *epain& !i c# "e fi5io(ogic pent# )eificaea !i "p&(aea catete#(#iL
- (e#cop(a"tL
- etic*eteL
- #ng#ent c# anti4ioticL
9ateia(e(e "tei(e "e )o a!e5a pe #n c1%p "tei(.
'ent# >n$ep&taea catete#(#i )eno" centa(I
- t#"& c# pen"e "tei(e, 4i"t#i#L
- pa$#i a(coo(i5ate G co%pe"e "tei(eL
- pan"a%ent tan"paent, a$e5i)L
- foafece "tei(&, #ng#ent c# 4eta$in&L
- ecipiente "tei(e c# %e$ii $e c#(t#& pent# >n"&%1naea "1nge(#i eco(tat $e pe )1f#(
catete#(#i eBta", $ac& e"te nece"a.
- "e o4ine con"i%&%1nt#( info%at a( pacient#(#iGfa%i(ieiL
- "e face ana%ne5a pacient#(#i $e c&te %e$ic pent# a eBc(#$e #n e)ent#a( i"toic $e
a(egie (a io$, Bi(in&, (ateBL
- "e a!ea5& pacient#( >n po5iie Ten$e(en4#g pent# a po$#ce $i(ataea )ene(o centa(e
!i pent# a pe)eni i"c#( $e e%4o(i"%L
118
- "e a!ea5& o a(e5& "#4 egi#nea cefa(ic& a pacient#(#i pent# a pote8a (en8eia $e patL
- "e >ntoace cap#( pacient#(#i "pe patea op#"& inte)eniei pent# a pe)eni
conta%inaea 5onei $e in"eie a catete#(#i c# e)ent#a(i ageni patogeni po)enii $in
c&i(e e"piatoii !i pent# a face 5ona %ai acce"i4i(& ?o a"i"tent& )a %enine pacient#( >n
acea"t& po5iie@L
- "e peg&te!te 5ona $e inte)enieI a$ee (a ne)oie, $e5infecie G a"epti5ae, e)it1n$#-"e
5one(e iitate, inf(a%ateL
- %e$ic#( e"te a8#tat "& >!i p#n& %a"ca, *a(at#(, %&n#!i(eL
- "e acope& 5ona $e inte)enie c# #n c1%p "tei( $ec#pat (a %i8(oc, a"tfe( >nc1t,
$e"c*i5&t#a "& coe"p#n$& taiect#(#i )eneiL
- "e ofe& %e$ic#(#i "einga c# Bi(in& pent# a efect#a ane"te5ia (oca(&L
- "e $e"c*i$e !i "e ofe& %e$ic#(#i >n %o$ "tei( c#tia c# catete#(L
- >n ti%p ce %e$ic#( into$#ce catete#( >n )en&, a"i"tenta peg&te!te "o(#ia $e pef#5at (a
cae a$aptea5& t#"a $e pef#5at !i e(i%in& ae#( $e pe t#4#( pef#5o#(#iL
- %e$ic#( ata!ea5& apoi a%4o#( pef#5o#(#i (a catete !i "ta4i(e!te it%#( $e "c#geeL
- %e$ic#( fiBea5& pin "#t#& aipioae(e catete#(#i (a pie(eL
- "e c#&& !i "e $e5infectea5& 5ona (&"1n$#-"e "& "e #"#ceL
- "e ap(ic& apoi fiBato#( tan"paent, "e%ipe%ea4i( !i etic*eta c# $ata in"eiei
catete#(#i )eno" centa(L
- "e a!ea5& pacient#( >nt-o po5iie confota4i(& !i "e ee)a(#ea5& "taea "a genea(&L
- pent# a %enine pe%ea4i(itatea !i 4#na f#ncionae a catete#(#i "e fo(o"e"c "o(#ii
$i(#ate $e *epain& ?1. p1n& (a 1.. U.I. *epain& pe %( $e "o(#ie "a(in&@ "a# "e
fi5io(ogic.
Sup)a<$;=$)$a &at$t$)ului 9i a pa&i$7tului
- "e "c*i%4& pan"a%ent#( catete#(#i (a fiecae /8 oe, ia fiBato#( (a , 5i(e "a# o $at& pe
"&pt&%1n& $ac& n# "e #$& "a# "e %#$&e!teL
- pef#5o#( "e "c*i%4& (a 72 oe !i "o(#ii(e pef#5a4i(e $e (#ng& $#at& (a 2/ oe,
#ti(i51n$ te*nici(e a"epticeL
- "e )eific& peio$ic (oc#( $e in"eie pent# a "#pin$e e)ent#a(e(e "e%ne $e inf(a%aie,
$econectae "a# $ena8L
- "e %onitoi5ea5& c# atenie pacient#( pent# a "#pin$e pecoce "e%ne(e #no
co%p(icaiiI
- e%4o(ieI pa(oae, ciano5&, t#"e "eac&, $i"pnee, ta*ica$ie, "incop&, !ocL
- pne#%otoaBI e"piaie "#peficia(&, a"i%etia %i!c&i(o toacice, ta*ica$ie,
8#ng*i toacicL
- "e an#n& %e$ic#( !i "e inte)ine $e #gen& >n ca5 $e co%p(icaii.
57,$p:)ta)$a &at$t$)ului
- "e eBp(ic& poce$#a pacient#(#iL
- "e a!ea5& pacient#( >n $ec#4it $o"a(L
- "e "pa(& %1ini(e, "e >%4ac& %&n#!i !i "e ap(ic& %a"ca pe fa&L
- "e >nte#pe pef#5iaL
- "e >n$ep&tea5& !i "e a#nc& pan"a%ent#( )ec*i, fiBato#(L
- "e >n$ep&tea5& %&n#!i(e !i "e ficionea5& %1ini(e c# #n ge( anti"epticL
- "e >%4ac& apoi %&n#!i "tei(eL
- "e in"pectea5& 5ona $e in"eie a catete#(#i pent# a )e$ea $ac& "#nt "e%ne $e inf(a%aieL
11+
- "e taie fie(e $e "#t#& #ti(i51n$ 4i"t#i#( !i o pen"& "tei(&L
- "e coate catete#( pint-o %i!cae "ig#&L
12.
- "e ap(ic& #ng#ent c# 4eta$in& pe (oc#( $e in"eie, "e acope& c# o co%pe"& "tei(& !i "e
fiBea5& c# #n 4an$a8 a$e5i), tan"paent !i "e%ipe%ea4i(eL
- "e in"pectea5& catete#( >n$ep&tat pent# a )e$ea $ac& e"te >nteg !i $ac& n# pe5int&
"e%ne $e infecieL
- >n ca5#( >n cae "e "#"pectea5& o infecie, "e taie )1f#( catete#(#i c# o foafece "tei(&,
"e into$#ce >n ecipient#( "tei( c# %e$i# $e c#(t#&, "e etic*etea5& !i "e ti%ite (a
(a4oato pent# eBa%inaeL
- "e a#nc& %ateia(e(e fo(o"ite >n ecipiente(e $e co(ectae.
7.2 T)a7'%u>ia 'a7;ui7:
E"te o "#4"tit#ti)& a$%ini"tat& c# "cop#( $e a coecta #n $eficit congenita( "a# c1!tigat >n #n#(
"a# %ai %#(i con"tit#eni ai "1nge(#i.
0e 4a5ea5& pe #ti(i5aea $e $ei)ate "ang#ine pepaate ponin$ $e (a o $onae $e "1nge
efect#at& c# e"pectaea pincipii(o )o(#ntaiat#(#i, 4ene)o(at#(#i, anoni%at#(#i !i a (ip"ei $e
4enefici#. >rice indicaie de administrare a unei terapii transfu!ionale, trebuie fcut de un
medic i documentat n ?oaia de observa ie a pacientului#
2esponsabilitatea medicului se e%tinde att asupra administrrii propriu+!ise a
produsului sanguin ct i asupra monitori!rii posttransfu!ionale a pacientului#
Tipu)i ,$ t)a7'%u>i$
- Fo+olo;: K poce$#& pin cae #n co%ponent "ang#in G "1nge tota( eco(tat $e (a #n
$onato, e"te a$%ini"tat #n#i pacient, a(t#( $ec1t
$onato#(L
- Autolo;: K poce$#a pin cae #n co%ponent "ang#in G "1nge tota( eco(tat $e (a
o pe"oan&, "pecia( >n ace"t "cop e"te a$%ini"tat ace(eia!i pe"oane.
Cla'i%i&a)$a p)o,u'$lo) 'a7;ui7$
'in po$#" "ang#in "e >ne(ege oice "#4"tan& teape#tic& pepaat& $in "1nge.
'o$#"e(e "ang#ine "e >%pat >n $o#& %ai categoiiI
a@ 'o$#"e "ang#ine (a4i(e ?'.0.L.@I "1nge tota(, concentate ce(#(ae "ang#ine,
p(a"%& Caactei"ticiI
- a# )a(a4i(itate e$#"& >n ti%p !i con$iii "ticte $e con"e)aeL
- a$%ini"taea (o (a pi%ito nece"it& e"pectaea eg#(i(o i%#no(ogice $e"tinate a
a"ig#a co%pati4i(itatea >nte pi%ito !i #nitatea "ang#in& $e tan"f#5at.
4@ 'o$#"e "ang#ine "ta4i(eI po$#"e $ei)ate $in "1nge ?a(4#%in&, i%#nog(o4#(in&,
concentate $e facto ;III, facto IA, etc.@
Caactei"ticiI
- )a(a4i(itate eBtin"& >n ti%pL
- con$iii $e con"e)ae %ai p#in "e)eeL
- a$%ini"taea (o n# nece"it& efect#aea pea(a4i(& a te"te(o $e co%pati4i(itate.
I7,i&a*ii 9i p)$&au*ii ?7 utili>a)$a p)o,u'$lo) 'a7;ui7$
a@ S@7;$ total
E"te eco(tat >nt-#n containe $e p(a"tic "tei(, apiogen, $e #nic& fo(o"in& cae conine o
"o(#ie
121
anticoag#(ant&. La a$#(t, o #nitate $e "1nge intega( ae #n )o(#% $e /..G/2.G2.. %(.
122
In$icaii
- %ateie pi%& pent# co%ponente "ang#ine >n ca5 $e ta#%ati"%ne, *e%oagii "a#
a"#i. 'eca#ii $e #ti(i5aeI
- co%pati4i(itatea c# pi%ito#( con"tit#ie 4a5a "e(eciei #nei #nit&i $e "1nge tota( pent#
a fi tan"f#5at& ?pi%ito#( c# g#pa "ang#in& 6 )a pi%i 6, : )a pi%i :, 6: )a pi%i
6:, O )a pi%i O, fiin$ nece"a& !i co%pati4i(itatea $e facto R*.@L
- fi(t# pent# %icoagegate, o4(igatoi# $e #ti(i5at >n ti%p#( tan"f#5ieiL
- ti%p $e a$%ini"taeI >n %ini% ,. %in. $e (a "coateea $in figi$e, %aBi% / oeL
- )eificaea a"pect#(#i p#ngii !i conin#t#(#i >nainte $e a fi a$%ini"tatL
- )eificaea )a(a4i(it&ii ?cca.,2 5i(e@.
4@ Co7&$7t)at $)it)o&ita)
E"te o4in#t $in "1nge tota( $in cae "e eBtage o pate $in p(a"%a #nit&ii. O #nitate a$#(t $e
concentat eitocita conine 2..-22. %(, toate eitocite(e $in #nitatea $e "1nge tota( iniia(&,
%a8oitatea (e#cocite(o, !i o cantitate )aia4i(& $e to%4ocite.
In$icaiiI
- ane%iiL
- *e%oagiiL
- pie$ei "ang#ine
po"tc*i#gica(e. 'eca#ii >n
#ti(i5aeI
- co%pati4i(itatea c# pi%ito#( ?co%pa4i(itate O 6: !i R*@L
- fi(t# pent# %icoagegate o4(igatoi# >n ti%p#( tan"f#5ieiL
- )eificaea a"pect#(#i p#ngii !i a conin#t#(#i >nainte $e a fi a$%ini"tatL
- )eificaea )a(a4i(it&ii ?cca. /2 5i(e@.
c@ Co7&$7t)at t)o+(o&ita) 'ta7,a),
0e o4ine pin concentaea %a8oit&ii to%4ocite(o $int-o #nitate $e "1nge tota( >nt-#n
)o(#%
e$#" $e p(a"%&. O #nitate a$#(t conine 2.-3. %(.
In$icaiiI
- to%4ocitopenie
"e)e&. 'eca#ii >n
#ti(i5aeI
- co%pati4i(itatea O 6: !i R* c# pi%ito#( e"te in$icat& $a n# o4(igatoie, $ec1t
>n a$%ini"t&i(e epetate $e to%4ociteL
- fi(t# pent# %icoagegateL
- ti%p $e a$%ini"taeI %aB. 2. %in.G#nitateL
- )eificaea )a(a4i(it&ii ?cca. 2 5i(e@.
$@ Co7&$7t)at l$u&o&ita)
0e o4ine $in "1nge intega( $in cae "-a# eBta" pin citafee5& eitocite(e !i 8.M $in p(a"%&.
12,
In$icaiiI
12/
- tataea "ep"i"#(#i cae n# &"p#n$e (a tata%ent#( c# anti4iotice !i >n gan#(ocitopenii,
c1n$ "e poate a$%ini"ta o #nitate ?$e o4icei 12. %(@, 5i(nic ti%p $e 2 5i(e "a# p1n& (a
tataea "ep"i"#(#i.
'eca#ii >n #ti(i5aeI
- co%pati4i(itate R*L
- a$%ini"tae $e antipietic >nt#c1t tan"f#5ia $e concentat (e#cocita $ete%in& fe4& !i
fi"oaneL
- agitaea #!oa& a f(acon#(#iGp#ngii >nainte, pent# o%ogeni5ae !i pent#
pe)eniea cong(o%e&ii ce(#(e(o.
e@ Pla'+: p)oa'p:t: &o7;$lat:
0e o4ine fie $int-o #nitate $e "1nge tota(, fie pin p(a"%afee5&. 0e conge(ea5& (a o
te%peat#&
?-22RC@ !i >nt-#n inte)a( $e ti%p cae pe%it %enineea a$ec)at& a factoi(o $e coag#(ae >n
"tae f#nciona(&. O #nitate conine 2..-,.. %(.
In$icaiiI
- t#(4#&i $e coag#(ae ?*e%ofi(ie@L
- !oc#( po"topeatoL
- afeci#ni *epaticeL
- tan"f#5ii
%a"i)e. 'eca#ii >n
#ti(i5aeI
- co%pati4i(itate O 6: !i R*L
- fi(t# pent# %icoagegateL
- ti%p $e a$%ini"taeI %aB. 2. %inG#nitateL
- "e #ti(i5ea5& i%e$iat $#p& $e5g*eae ?"e $e5g*ea& >nt-#n %e$i# c# te%peat#&
conto(at&, (a ,7 RC, >n ,. %in#te@L
- )eificaea )a(a4i(it&ii ?12 (#ni >n ca5 $e con"e)ae (a -22 RC@.
f@ Al(u+i7:
?potein& p(a"%atic&@ >n concentaie $e 2M, 22M
In$icaiiI
- tataea *ipopoteine%iei c# "a# f&& e$e%eL
- pe)eniea *e%oconcentaieiL
- e"ta4i(iea )o(#%#(#i cic#(ant >n ca5 $e ta#%ati"%e, a"#i, infecii
"e)ee. N# e"te nece"a& nici #n fe( $e co%pati4i(itate.
'eg&tiea 9ateia(e(o
- t#"& $e tan"f#5at "1nge, pe)&5#t& c# fi(t# pent# %icoagegate !i c# t#4 "i%p(# "a# >n
CYEL
- %&n#!i "tei(eL
- *a(at c#atL
- p#ng& "a# f(acon c# 0e fi5io(ogicL
- po$#"#( "ang#inI "1nge tota( "a# $ei)ate $e "1nge e(i4eate $e '#nct#( $e tan"f#5ii
"ang#ine ?'T0@ $in "pita( pe 4a5a 4on#(#i ceeeL
- "tati) pent# "#"pen$aea p#ngii c# po$#"#( "ang#inL
122
- ec*ipa%ent pent# %ontaea 4an#(ei, catete#(#i $ac& e"te nece"a.
123
- "e eBp(ic& poce$#a pacient#(#i !i "e o4ine con"i%&%1nt#( "ci"L >n ca5#( %inoi(o
"e%nea5& p&iniiL
- "e %&"oa& f#ncii(e )ita(e a(e pacient#(#iL
- "e )eific& coe"pon$ena $ate(o $e pe p#ng& c# ce(e a(e pacient#(#iL
- "e )eific& a"pect#( po$#"#(#i, te%en#( $e )a(a4i(itateL
- "e efect#ea5& po4a $e co%pati4i(itate Hean4ea# >nte "1nge(e pacient#(#iGpi%ito#(#i
?"e eco(tea5& 2-, %(. "1nge )eno"@ !i ce( a( $onato#(#i ?"1nge(e $in p#ng&@L
- "e >nc&(5e!te "1nge(e (a te%peat#a cop#(#iL
- "e "pa(& %1ini(e, "e >%4ac& %&n#!i "tei(eL
- "e $e"c*i$e t#"a $e tan"f#5at !i "e a$aptea5& (a p#nga c# 0e fi5io(ogicL $ac&
tan"f#5o#( ae 2 capete ?tan"f#5o >n Y@, #n cap&t "e a$aptea5& (a p#nga c# 0e
fi5io(ogic ia ce(&(a(t cap&t (a p#nga c# po$#"#( "ang#inL
- "e "#"pen$& p#ngaGp#ngi(e >n "tati)L
- "e #%p(e ca%ea $e pic#ae (a 8#%&tate c# 0ef fi5io(ogic, >n ti%p ce t#4#( aco$at (a
p#nga c# "1nge e"te >nc*i"L
- "e e(i%in& ae#( $e pe antena tan"f#5o#(#i (&"1n$ "& c#g& c1te)a pic&t#i $in "o(#ia $e
0e fi5io(ogicL
- $ac& t#"a $e tan"f#5ie ae #n "ing# t#4, "e >nc*i$e pe"t#4#(, "e "c*i%4& p#nga c# "e
fi5io(ogic c# cea c# "1ngeL
- "e ata!ea5& apoi, pin te*nica a"eptic&, a%4o#( tan"f#5o#(#i (a 4an#(& "a# catete !i "e
a8#"tea5& it%#( $e "c#gee >n f#ncie $e tip#( po$#"#(#i "ang#inL
- $ac& tan"f#5o#( e"te >n Y, "e poce$ea5& (a fe( n#%ai c& n# %ai e"te ne)oie "& "e
"c*i%4e p#ngi(eL >n ace"t ca5, "e >nc*i$e t#4#( a$aptat (a p#nga c# "e !i "e $e"c*i$e
t#4#( a$aptat (a p#nga c# "1ngeL
- "e efect#ea5& po4a 4io(ogic& Oe(ecOe (&"1n$ "& c#g& >n 8et 2. %( "1nge $#p& cae "e
eg(ea5& it%#( $e "c#gee (a 1.-12 pic.G%in ti%p $e 2 %in#teL
- "e "#pa)eg*ea5& pacient#( >n ace"t inte)a( !i $ac& n# apa "e%ne $e inco%pati4i(itate
"e epet& opeaia ?"e (a"& a(i 2. %( "1nge "& c#g& >n 8et, "e ea8#"tea5& it%#( (a 1.-12
pic.G%in. ti%p $e 2 %in, >n cae "e o4"e)& pacient#(@L
- $ac& nici $e $ata acea"ta n# apa "e%ne $e inco%pati4i(itate "e contin#& tan"f#5ia >n
it%#( "ta4i(itL "e ap(ic& pe p#ng& o etic*et& c# $ata !i oa (a cae a >ncep#t tan"f#5iaL
- $ac& apa eacii a$)e"e G "e%ne $e inco%pati4i(itate "e ope!te tan"f#5ia c# "1nge, "e
contin#& pef#5ia c# "o(#ia "a(in& !i "e an#n& i%e$iat %e$ic#(L
- i"c#( $e apaiie a eacii(o a$)e"e e"te ce"c#t >n pi%e(e 12 %in.L
- n# "e a$%ini"tea5& >n p#nga c# po$#"#( "ang#in %e$ica%ente "a# a(te "o(#ii
pef#5a4i(eL
- "e >negi"tea5& oice e)eni%ent ap&#t >n c#"#( tan"f#5iei ?fe4&, fi"on, e#pie
a(egic&@L
- >n ca5 $e eacie a$)e"& "e ap(ic& poce$#a "tan$a$L
- $#p& te%inaea tan"f#5iei "e notea5& >n fi!a pacient#(#i oa, "taea genea(& a
pacient#(#i, "#4 "e%n&t#a a"i"tentei cae a efect#at tan"f#5iaL
- p#nga "e ti%ite (a #nitatea $e tan"f#5ii "ang#ine >%pe#n& c# o %ic& cantitate $e "1nge
?2-3 %(.@ !i "e p&"tea5& /8 oeL
- "e "#pa)eg*ea5& pacient#( >n #%&toae(e 2/-/8 oe po"ttan"f#5ie.
127
7.3 P)oto&ol ,$ i7<$'ti;a)$D ?7)$;i't)a)$ a u7$i )$a&*ii a&ut$
t)a7'%u>io7al$
128
- "e ope!te tan"f#5ia !i "e p&"tea5& a4o$#( )eno" c# "e fi5io(ogic >n ti%p ce "e face o
e)a(#ae iniia(& a eaciei ac#teL
- "e an#n& %e$ic#(L
- "e apotea5& i%e$iat toate eacii(e tan"f#5iona(e e"pon"a4i(#(#i c# *e%o)igi(ena !i
cent#(#i $e tan"f#5ii $e "1nge f#ni5oL
- "e >negi"tea5& >n foaia $e o4"e)aie a pacient#(#iL
- tip#( eaciei ?fe4i(&, a(egic&, !oc@L
- inte)a(#( >nte >ncep#t#( tan"f#5iei !i apaiia eacieiL
- tip#( !i )o(#%#( p"( tan"f#5atL
- co$#i(e #nice a(e p"( tan"f#5ateL
- i%e$iat $#p& apaiia eaciei "e eco(tea5& #%&toae(e po4e $e "1nge, "e co%p(etea5&
fo%#(a#( $e ceee $e ana(i5e !i "e ti%ite pt"Gct" f#ni5oL
- o po4& f&& anticoag#(ant V o po4& pe anticoag#(ant ?e$ta@ $e (a 4a#( op#"L
- *e%oc#(t#& $ac& "e "#"pectea5& !oc "epticL
- #nitatea p"( V t#"a $e tan"f#5ieL
- pi%a e%i"ie $e #in& po"t eacie V po4a petan"f#5iona(& a pacient#(#i fo(o"it& (a
$ete%inaea g#pei "ang#ine !i a co%pati4i(it&iiL
- "e co%p(etea5& #n fo%#(a $e apotae a eacii(o tan"f#5iona(eL
- $#p& in)e"tigaii(e iniia(e "e ti%it (a pt"Gct"L
- po4e $e "1nge ?1V1Ge$ta@ eco(tate (a 12 oe !i 2/ oe $e (a apaiia eaciei ?$e (a 4a#(
op#"@L
- toate e%i"ii(e $e #in& ?po4e V )o(#%@ $in #%&toae(e 2/ oe.
7.7 Autot)a7'%u>ia #t)a7'%u>ia autolo;:-
6#totan"f#5ia e"te einf#5ia popi#(#i "1nge $#p& ce a fo"t co(ectat !i fi(tat.
E"te efect#at& >nainte, >n ti%p#( !i $#p& inte)enii(e c*i#gica(e "a# ta#%ati"%e.
A<a7taA$
- n# apa eacii po"tan"f#5iona(e $atoit& inco%pati4i(it&i(o "a# ge!e(i(o $e "ta4i(ie a
g#pe(o $e "1ngeL
- n# "e tan"%it 4o(iL
- pie$eea $e "1nge e"te >n(oc#it& i%e$iatL
- "1nge(e a#totan"f#5at conine #n ni)e( no%a( $e 2,, $ipo"fog(iceat cae a8#t& (a
oBigenaea e"#t#i(o.
Li7ii Di)$&toa)$
- eco(taea $e "1nge pent# a#totan"f#5ie "e poate face peopeato !i e"te eco%an$at&
pacieni(o c# inte)enii c*i#gica(e otope$ice, >n ti%p#( c&oa "e pie$e %#(t
"1ngeL
- co(ectaea $e "1nge "e poate face c# / p1n& (a 3 "&pt&%1ni >nainte $e opeaieL
- $e %#(te oi, >n inte)enii(e c*i#gica(e c# pie$ei %ai $e "1nge, "e fo(o"e!te #n
apaat conectat intaopeato !i po"topeato (a t#4#( $e $en a( p(&gii, cae peia "1nge(e
pacient#(#i, >( poce"ea5& !i >( a#totan"f#5ea5&L
- te4#ie %onitoi5at& !i notat& cantitatea $e "1nge cae "e a#totan"f#5ea5&L
- pacienii cae a# $onat peopeato "1nge )o fi "f&t#ii "& &%1n& >n epa#" (a pat >nc&
1. %in#te $#p& $onae, "& 4ea c1t %ai %#(te (ic*i$e >n oe(e i%e$iat #%&toaeL
12+
- pacienii c# a#totan"f#5ie )o fi %onitoi5ai c# atenie >n ti%p#( tan"f#5iei !i $#p&
aceea >nt#c1t pot "& apa& eacii )a"o)aga(e ?*ipoten"i#ne, 4a$ica$ie !i *ipo)o(e%ie
>n "pecia( (a pacienii )1"tnici@.
Capitoul 1 SONDA6E8 SPLTURI8 CLISME
8.1 Tu(aAul
7a>o;a't)i&
S&opDI7,i&a*ii
- a"piaea conin#t#(#i ga"ticL
- a(i%entaia entea(&L
- into$#ceea #no %e$ica%enteL
- o4ineea "p#tei >ng*iite pent# cecetaea 4aci(#(#i Noc*.
Mat$)ial$ 7$&$'a)$
- ta)& "a# c&#cio pent# %ateia(eL
- "on$ea$ioopace $e ca#ci#c "a# $in %ateia( p(a"tic "tei(eL
- "einga $e 2. %(L "eing& -#Uon ?2. %(@ "tei(&L
- t&)i& ena(&L
- "o(#ie pent# (#4ifiee ?aZ#a ge(@L
- co%pe"eL
- ep#4ete, p#ng& co(ectoae pent# co(ectaea conin#t#(#i e(i%inatL
- a(i%ente, %e$ica%ente >n f#ncie $e "cop !i in$icaieL
- pa*a %at, (e#cop(a"t, po"oape, !e)ee(e $e *1tieL
- po"op, c1%p pent# potec ia (en8eiei.
- "e eBp(ic& "cop#( !i nece"itatea, %o$#( $e $e#(ae a poce$#ii, $#at&L
- "e eBp(ic& %o$#( $e co(a4oae, "e o4ine con"i%&%1nt#(L
- "e >n$ep&tea5& pote5a $enta& !i "e p#ne >nt-#n pa*a %at c# ap&L
- "on$a "e poate into$#ce pe ca(e na5a(& "a# 4#ca(&L
- pacient#( e"te #gat "a# a8#tat "&-!i c#ee na"#(L
- "e a(ege naa >n f#ncie $e pe%ea4i(itate, p#n1n$ pacient#( "& e"pie a(tenati) pe o
na& "a# a(ta.
- "e a(eg %ateia(e(e >n f#ncie $e in$icaieL
- "e in"ta(ea5& pacient#( >n po5iie !e51n$ "a# "e%i!e51n$L
- "e "pa(& %1ini(eL
- "e pote8ea5& (en8eia pacient#(#i c# #n po"op "a# #n c1%p p(a"at "#4 4&4ieL
- "e %&"oa& $i"tana $inte (o4#( #ec*ii !i )1f#( na"#(#i p1n& (a apen$ice(e Bifoi$L
1,.
- "e %ac*ea5& (oc#( ce(o 2 %&"#&toi "a# "e notea5& $i"tane(e $ac& "on$a e"te ga$at&L
1,1
- "e $& pacient#(#i "& in& t&)ia ena(& "#4 4&4ieL
- "e #%e5e!te )1f#( "on$ei pent# a a"ig#a >naintaeaL
- "on$a "e into$#ce c# gi8& pin naa "e(ectat& >%ping1n$-o "pe "pate >n 8o"L
- >ng*iiea "e face (ent, $1n$ pacient#(#i (a ne)oie cantit&i %ici $e ap&L
- pacient#( >ng*ite p1n& (a pi%#( "e%nL
- "e o4"e)& "taea pacient#(#i $eoaece pot apae t#"ea, ciano5a, t#(4#&i e"piatoii,
ceea ce aat& c& "on$a a a8#n" >n ta*eeaL
- pacient#( e"te #gat "& >ng*it& >ncet p1n& (a a( $oi(ea "e%nL
- "e )eific& po5iia "on$ei pin #na $in #%&toae(e %eto$eI
- a"piaea conin#t#(#i "to%aca(L
- into$#ceea ae#(#iL
- into$#ceea cap&t#(#i (i4e a( "on$ei >nt-#n pa*a c# ap&L
- pent# a(i%entaie "a# into$#ceea #no %e$ica%ente )eificaea te4#ie f&c#t&
pin conto( a$io(ogicL
- c1n$ "on$a a a8#n" >n "to%ac (a $i)i5i#nea /2 "a# 22, >n f#nc ie $e ca(ea pe cae "-a
into$#", "e fiBea5& c# (e#cop(a"t pe na" a"tfe( >nc1t "& n# >%pie$ice )e$eea !i "& n#
pe"e5e na"#(L
- "e ea(i5ea5& o 4#c(& $in patea (i4e& a "on$ei pent# a pe%ite %i!caea (i4e& a
cap#(#i !i "e face a $o#a fiBaeL
- pacient#( e"te a!e5at >n po5iie co%o$&L
- "e contin#& t#4a8#( confo% "cop#(#i !i in$icaieiL
- >nte $o#& fo(o"iiI
- "on$a "e c(a%pea5&L
- "e ata!ea5& (a "on$& p#nga co(ectoae.
Sup)a<$;=$)$a 'o7,$i
- "e )eific& po5iiaL
- "e )eific& "taea naineiL
- "e "c*i%4& (e#cop(a"t#( $e fiBae !i (oc#(L
- "e a"ig#& igiena oa(&.
M:'u)i p$7t)u &o+(at$)$a i7&i,$7t$lo)
- $ac& pacient#( n# co(a4oea5&, (a eco%an$aea %e$ic#(#i "e poate fo(o"i "paU ane"te5icL
- "on$a a p&t#n" >n c&i(e e"piatoii ?pacient#( t#!e!te, "e ciano5ea5&@ "e etage,
pacient#( e"te (&"at "& "e (ini!tea"c&, "e >nceac& $in no#L
- "en5aia $e )o%& !i gea& "e co%4ate pin e"piaii pof#n$e.
I7,i&a*ii p)i<i7, '&=i+(a)$a 'o7,$iB
- "on$e(e $e ca#ci#c pot fi (&"ate pe (oc 2-, 5i(e ia ce(e $in %ateia( p(a"tic /-7 5i(eL
- c1n$ eBi"t& in$icaia $e "c*i%4ae a "on$ei >nte >n$ep&tae !i ep#nee te4#ie "& eBi"te
#n epa#" >n ti%p#( nopii $e 3-8 oeL
- "on$a "e ep#ne fo(o"in$ cea(a(t& nain&.
57,$p:)ta)$a 'o7,$i
9ateia(e nece"ae
1,2
- ta)& "a# %&"#& pent# %ateia(eL
- !e)ee(e $e *1tieL
- t&)i& ena(&L
- po"opL
- pa*a c#
ap&. Efect#aea
poce$#ii
- "e )eific& eco%an$aea %e$ic#(#i pi)in$ >n$ep&taeaG"c*i%4aea "on$eiL
- "e eBp(ic& poce$#aL
- pacient#( e"te a!e5at >n po5iie "e%i!e51n$& "a# !e51n$ >n f#ncie $e "taea genea(&L
- "e ap(ic& "#4 4&4ia pacient#(#i #n po"opL
- "e "pa(& %1ini(e, "e >%4ac& %&n#!i $e #nic& fo(o"in&L
- "e )eific& $ac& "on$a e"te pen"at&L
- "e >n$ep&tea5& (e#cop(a"t#( c# 4(1n$ee $e pe na" !i fa&L
- pacient#( e"te #gat "& in"pie !i "& &%1n& >n apneeL
- "e pin$e "on$a >nte $egete !i "e pe"ea5& 4ine, apoi "e etage >ncet p1n& apoape $e
fainge, apoi c# o %i!cae api$& "e >n$ep&tea5&L
- >n ti%p#( eBtageii "on$a poate fi g*i$at& c# cea(a(t& %1n& fo(o"in$ !e)ee(e "a#
po"op $e *1tie pin51n$ cap&t#( (i4eL
- pacient#( e"te #gat "& e"pie no%a(L
- "e ofe& #n pa*a c# ap& pent# a-!i c(&ti g#a.
8.2 Sp:l:tu)a
;a't)i&: I7,i&a*iiB
- intoBicaii a(i%entaeL
- "#pa$o5aea %e$ica%ente(oL
- "teno5& pi(oic& pent# >n$ep&taea "ta5eiL
- >naintea #no opeaii pe "to%acL
- >naintea ga"to"copiei.
Mat$)ial$
7$&$'a)$
- "on$a Fa#c*e "a# "on$e ga"tice %ai %ici "tei(e, a$aptate )1"teiL
- p1(nia $e 1( K 1,2 (L
- "einga -#Uon $e 2.. c%XL
- )a" co(ecto ga$atL
- (ic*i$ pent# "p&(&t#a >n f#ncie $e "copL
- t&)i& ena(&L
- pa*a c# ap&L
- can& $e "tic(& "a# %eta( $e 2 (L
- pen"&L
- "ca#nL
- c&4#ne ani%a(, "o(#ii anti$ot $#p& ca5L
- ep#4ete pent# eco(tae, >n ca5 $e intoBicaiiL
- 2 "ot#i i%pe%ea4i(eL
1,,
- 4an$& (e#cop(a"tL
1,/
- po"opL
- !e)ee(e $e *1tieL
- e)ent#a( $e"c*i5&to $e g#&, #"ten"i(e $e int#4aie !i a"piaie.
- "e info%ea5& pacient#( a"#pa nece"it&ii poce$#iiL
- "e eBp(ic& pacient#(#i %o$#( $e $e#(ae a poce$#iiL
- "e info%ea5& pacient#( c& e"te po"i4i( "& ai4e "en5aie $e )o%&L
- "e o4ine co(a4oaea !i con"i%&%1nt#(L
- "e a!ea5& pacient#( pe "ca#n c# faa "pe (#%in&L
- "e pote8ea5& (en8eia c# #n po"op pin" >n 8##( g1t#(#i !i c# #n o $e %ateia( p(a"ticL
- "e >n$ep&tea5& pote5aL
- "e ofe& pacient#(#i t&)ia ena(& !i e"te #gat "& o in& "#4 4&4ie c# a%4e(e %1ini
?i%o4i(i5ea5& %1ini(e !i captea5& "a(i)&@L
- e"te in"t#it "& e"pie pof#n$ pent# a co%4ate e)ent#a(a "en5aia $e )o%&.
E%$&tua)$a P)o&$,u)ii
- "e a$#ce )a"#( co(ecto (1ng& pacientL
- "e "pa(& %1ini(eL
- "e p#ne !o $e %ateia( p(a"tic pent# poce$#&L
- "e #%e5e!te "on$a c# ap&L
- "e a!ea5& >n patea $eapt& a pacient#(#i !i fiBea5& cap#( ace"t#ia >nte toace !i ante4a L
- "e "o(icit& pacient#(#i "& $e"c*i$& g#a !i "& e"pie pof#n$L
- "e into$#ce cap&t#( ot#n8it a( "on$ei p1n& (a peete(e po"teio a( fainge(#i apoape $e
&$&cina (i%4ii, pacient#( fiin$ in)itat "& >ng*it&L
- "e "#pa)eg*ea5& pe%anent "taea pacient#(#i pent# a e)ita p&t#n$eea "on$ei >n c&i(e
e"piatoii ?atenie (a facie", e"piaie, apaiia t#"ei@L
- "on$a >naintea5& >ncet >n e"ofag !i "pe "to%ac p1n& (a $i)i5i#nea /2-2. (a aca$a $enta&L
- "e a$aptea5& p1(nia (a cap&t#( (i4e a( "on$eiL
- "e co4oa& p1(nia "#4 ni)e(#( toace(#i !i "e #%p(e c# (ic*i$ (a te%peat#a $e 22-23R,
,..- 2.. %(L
- "e i$ic& #!o p1(nia $ea"#pa cap#(#i pacient#(#i pent# a pe%ite p&t#n$eea 4(1n$& a
(ic*i$#(#iL
- >nainte $e te%inaea co(oanei $e (ic*i$ $in p1(nie, acea"ta "e co4oa& "#4 ni)e(#(
"to%ac#(#i ?epiga"t#(#i@ pent# a pe%ite (ic*i$#(#i $in "to%ac "& "e >ntoac& >n
confo%itate c# pincipi#( "ifona8#(#iL
- "e go(e!te conin#t#( p1(niei >n )a"#( co(ectoL
.n ca! de into%icaii, primul lichid eliminat se captea! separat pentru a se putea face recoltri[
- "e epet& opeai#nea $e /-2 oi p1n& c1n$ (ic*i$#( e(i%inat e"te c#at, f&&
e"t#i a(i%entae "a# a(te "#4"tane, cantitatea $e (ic*i$ fo(o"it fiin$ $e ,-2 ( >n
intoBicaiiL
- "e $eta!ea5& p1(niaL
1,2
- "e pen"ea5& 4ine cap&t#( (i4e a( "on$ei pent# a n# pe%ite conin#t#(#i $in (#%en#(
"on$ei "a c#g& >n fainge "a# ca)itatea 4#ca(& $e #n$e a p#tea fi a"piatL
- "e etage "on$a (ent p1n& (a ni)e(#( fainge(#i apoi c# o %i!cae api$& "e >n$ep&tea5&L
- "e ofe& pacient#(#i #n pa*a c# ap& "&-!i c(&tea"c& g#aL
- "e !tege g#a !i 4&4ia pacient#(#iL
- "e >n$ep&tea5& t&)ia ena(&.
57;)iAi)$a pa&i$7tului ,up: 'p:l:tu):
- "e "#pa)eg*ea5& f#ncii(e )ita(eL
- e"te po"i4i( "& ac#5e #!oa& $i"fagie cae $i"pae f&& tata%ent.
O('$)<a ii
'o5iia "on$ei "e )eific& a"tfe(I
- "e into$#ce cap&t#( (i4e a( "on$ei >nt-#n pa*a c# ap& !i "e o4"e)& $ac& apa 4#(e $e
aeL
- "e into$#ce ae pin "on$& !i "e a"c#(t& c# a8#to#( #n#i "teto"copL
- "e "#pa)eg*ea5& pacient#(I $ac& "e ciano5ea5&, apae ef(eB#( $e t#"e e"te "e%n c&
"on$a a a8#n" >n c&i(e e"piatoii !i "e etage.
8., Tu(aAul
,uo,$7al
S&opDi7,i&a*iiB
- eBtageea conin#t#(#i $#o$ena( >n )e$eea #no te"te $e $iagno"ticL
- $enaea c&i(o 4i(iaeL
- a$%ini"taea #no (ic*i$e *i$atante !i n#titi)e, a #no %e$ica%enteL
- a"piae contin#& (a pacien ii c*i#gica(i.
Mat$)ial$ 7$&$'a)$
- "on$& Ein*on "tei(&L
- 2 "eingi $e 2. %(, "eing& g#UonL
- pen"&L
- %#!a%a, a(e5&, po"opL
- pen& ci(in$ic& "a# #n "#( $int-o pat#&L
- t&)i& ena(&L
- %ateia(e >n f#ncie $e "cop ?ep#4ete, "o(#ie "#(fat $e %agne5i#, no)ocain&, (ic*i$e
pent# *i$atae !i pent# a(i%entae, %e$ica%ente@L
- pa*a c# ap&.
P)$;:ti)$a pa&i$7tuluiB
- "e eBp(ic& "cop#( !i nece"itateaL
- "e o4tine con"i%&%1nt#(L
- "e >n$ep&tea5& pote5a $enta& $ac& eBi"t& !i "e p(a"ea5& >nt-#n pa*a c# ap&L
- "e a(ege naa f#nciona(&L
1,3
- "e a!ea5& pacient#( >n po5iie !e51n$& "a# "e%i!e51n$&.
1,7
- "e into$#ce "on$a $#p& te*nica t#4a8#(#i ga"tic, p1n& >n "to%acL
- "e a!ea5& apoi pacient#( >n $ec#4it (atea( $ept c# cap#( %ai 8o"L
- "e into$#ce "#4 *ipocon$#( $ept o pen& ci(in$ic& "a# #n "#( ea(i5at $int-o p&t#&
#(at&L
- "e a!ea5& >n faa pacient#(#i o %#!a%a acopeit& c# a(e5aL
- "e in"t#ie!te pacient#( "& >ng*it& incet, (ent, 1-2 c% (a ,-2 %in#teL
- e"te atenionat c& >ng*iiea api$& fa)oi5ea5& >nco(&ciea "on$ei >n "to%acL
- "e )eific& po5iia "on$ei pinI
- into$#ceea cap&t#(#i (i4e a( "on$ei >nt-o ep#4eta - no%a( "e "c#ge 4i(aL
- "e in"#f(& 3. %( ae >n "on$a !i "e >nceac& ec#peaea $#p& 1 %in. $ac& "e o4in
%ai p#in $e 2.%( "on$a e"te >n $#o$enL
- "e into$#c 1. %( (apte cae n# %ai pot fi ec#peai K "on$a e"te #n $#o$enL
- conto( a$io(ogicL
- (a $i)i5i#nea 72 (a aca$a $enta&, "on$a e"te >n $#o$en !i "e contin#& t#4a8#( >n
confo%itate c# "cop#( #%&it.
57;)iAi)$a pa&i$7tului ,up: p)o&$,u):B
- "on$a poate "& &%1n& pe (oc pent# >n$ep(iniea "cop#(#i pop#"L
- "on$a "e poate etage >n , pa iI
- >nt1i p1n& (a ni)e(#( "to%ac#(#iL
- apoi p1n& (a ni)e(#( fainge(#iL
- c# o %i!cae api$& "e eBtage >n ca)itatea 4#ca(&L
- "e ofe& pacient#(#i ap& "&-!i c(&tea"c& g#a.
8./ So7,aAul <$>i&al la
%$+$i$ S&opDi7,i&a*ii
- e)ac#aea conin#t#(#i )e5icii #inae c1n$ acea"ta n# "e %ai po$#ce "pontan, "a#
captaea #inii >n ca5 $e incontinen&L
- "p&(&t#a )e5ica(&.
Mat$)ial 7$&$'a)B
- "on$e #inae "tei(e ?fo(eU, ne(aton@ $e $ifeite $i%en"i#niL
- ta)i& ena(&L
- %&n#i "tei(e i %&n#!i $e #nic& fo(o"in&L
- "o(#ii $e5infectante, ta%poane !i co%pe"e "tei(e, "eingi, "e fi5io(ogic "a# ap& "tei(&,
"o(#ii "tei(e pent# (#4ifieea "on$eiL
- p#ngi co(ectoaeL
- %ateia(e pent# toa(eta ogane(o genita(eL
- %#!a%a, a(e5&L
- 1-2 ep#4ete "tei(eL
- 1-2 ep#4ete c#ate !i #"cate.
P)$;:ti)$a pa&i$7t$iB
- "e info%ea5& pacienta pi)in$ $e#(aea poce$#iiL
1,8
- "e a!ea5& pacienta >n po5iie gineco(ogic&L
- "e a"ig#& inti%itatea.
- "e i$entific& pacienta !i "e )eific& eco%an$aea %e$ica(&L
- "e pote8a5& pat#( c# a(e5a "i c# %#!a%aL
- "e $e54ac& patea infeioa& a cop#(#iL
- "e >%4ac& %&n#!i $e #nic& fo(o"i&L
- "e efect#ea5& toa(eta egi#nii )#()ae c# ap& "i "&p#nL
- "e "c*i%4& %&n#!i(e c# ce(e "tei(eL
- "e e)i$enia5& %eat#( #inaL
- "e $e5infectea5& oifici#( #eta( $e "#" >n 8o" fo(o"in$ 2-, ta%poaneL
- "e pin$e "on$a >nte $egete(e %e$i# !i ine(a a(e %1inii $o%inanteL
- "e (#4ifia5& "on$a c# #(ei "tei(L
- "e ine "on$a cap pe #n ceion >n ti%p#( "ci"#(#i !i "e into$#ce >n #eta (a o a$1nci%e
$e /-2 c%L
- "e contin#& "on$a8#( >n f#ncie $e "cop#( pop#".
57;)iAi)$a pa&i$7t$i ,up: p)o&$,u):
- e"te a8#tat& "& "e i%4ace, "& "e a e5e >nt-o po5i ie co%o$&L
- "e )eific& $ac& ac#5& $i"confotL
- $ac& ac#5& $#ei "a# "1ngeea5& "e an#n & %e$ic#(.
8.2 So7,aAul <$>i&al la
(:)(at S&opDi7,i&a*iiB
- e)ac#aea conin#t#(#i )e5icii #inae c1n$ acea"ta n# "e %ai po$#ce "pontan, "a#
captaea #inei >n ca5 $e
incontinen&L
- "p&(&t#& )e5ica(&.
Mat$)ial 7$&$'a)B
- "on$e #inae "tei(e ?fo(eU, ne(aton@ $e $ifeite $i%en"i#niL
- t&)i& ena(&L
- %&n#!i "tei(e !i %&n#!i $e #nic& fo(o"in&L
- "o(#ii $e5infectante, ta%poane !i co%pe"e "tei(e, "eingi, "e fi5io(ogic "a# ap& "tei(&,
"o(#ii "tei(e pent# (#4ifieea "on$eiL
- p#ngi co(ectoaeL
- %ateia(e pent# toa(eta ogane(o genita(eL
- %#!a%a, a(e5&L
- 1-2 ep#4ete "tei(eL
- 1-2 ep#4ete c#ate !i #"cate.
P)$;:ati)$a pa&i$7tului
- "e info%ea5& pacient#( $e"pe $e#(aea poce$#iiL
1,+
- "e a!a5& pacient#( >n $ec#4it $o"a( c# picioae(e >ntin"e #!o $ep&tate c# o pen& tae
"#4 4a5in.
1rimul sonda- ve!ical la brbat se face de ctre medic, procedura poate fi fcuta de ctre
asistentul medical pe ba!a unui protocol stabilit i semnat de medi#
- "e a!a5& pacient#( >n po5iia eco%an$at&L
- "e pote8ea5& pat#( c# a(e5& !i %#!a%aL
- "e efect#ea5& toa(eta g(an$#(#i c# ap& !i "&p#nL
- "e $e5infectea5& %eat#( #ina fo(o"in$ , ta%poane, "e fi5io(ogic !i "o(#ie anti"eptic&L
- "e "c*i%4& %&n#!i(e c# ce(e "tei(eL
- "e pin$e "on$a c# %1na $o%inant&L
- "e (#4ifia5& >n >ntegi%e !i eBte%itatea (i4e& "e into$#ce >ncet (a o a$1nci%e $e 1.-12
c%L
- >n ti%p#( into$#ceii "on$ei, peni"#( "e ine >n po5iie )etica(&, "e e"pect& taiect#(
fi5io(ogic a( #eteiL
- "e contin#& "on$a8#( confo% "cop#(#i.
57;)iAi)$a pa&i$7tului ,up: p)o&$,u):
- "on$a poate "& &%1n& pe (oc >n f#ncie $e "copL
- pacient#( e"te a!e5at >nt-o po5iie co%o$&L
- "e )eific& $ac& ac#5& $i"confot, $ac& ae "en5aie $e a"#&.
O('$)<a ii
- "ac sonda rmne n ve!ic pentru mai multe !ile, se folosete sonda fole@, la care
dup
introducere folosind ser fi!iologic steril se umfl balonaul care fi%ea! sonda n
interiorul ve!icii&
- /aptul e%terior al sondei se adaptea! la o pung colectoare sau ntre dou miciuni
se clampea! cu o pens#
8.3 Sp:l:tu)a <$>i&al:
E"te into$#ceea #nei "o(#ii %e$ica%entoa"e pin "on$& >n )e5ica #ina&.
S&opDi7,i&a*iiB
- >n$ep&taea eB#$ate(o pato(ogice e5#(tate >n #%a inf(a%aiei %#coa"ei )e5ica(eL
- c#&iea ca)it&ii >n )e$eea ea(i5&ii #no eBp(o&i ?ci"to"copie@, pie(ogafie.
R$'po7'a(ilit:*i
Medicul + recomand efectuarea procedurii i, la brbat, efectuea! primul sonda-
6"i"tent#( %e$ica(I
- %ontea5& "on$aL
- efect#ea5& "p&(&t#aL
- notea5& te*nica.
1/.
Mat$)ial$ 7$&$'a)$
'ent# potecieI
- %#!a%a, a(e5&L
- po"oapeL
'ent# $e5infecie !i toa(et&
eBten&I
- oBician#& $e %ec# 1G2...L
- 4a5inetL
- t&)i& ena(&L
- co%pe"eL
- pen"a potta%pon.
'ent# "p&(&t#&I
- "on$a #ina& ?$ac& n# e"te %ontat&@L
- $o#& pen"e *e%o"taticeL
- "eing& g#Uon, (a ne)oie %e$ii $e c#(t#&L
- "o(#ie $e "p&(&t#& (a te%peat#a cop#(#i eco%an$at& $e %e$icL
- "o(#ie $e i)ano( ..1-2ML
- nitat $e agint 1-/ML
- )a"e(in& "tei(& "a# #(ei $e paafin& pent# (#4ifiee.
- "e an#n&, "e eBp(ic& nece"itatea efect#&ii poce$#iiL
- "e a"ig#& e"pectaea inti%it&iiL
- "e efect#ea5& toa(eta eBten&L
- "e a!a5& >n po5iie gineco(ogic&L
- "e pote8ea5& pat#( c# a(e5& !i c# %#!a%a.
- "e )eific& in$icaia %e$ic#(#iL
- "e >ncepe c# toa(eta ogane(o genita(eL
- "e contin#& c# "on$a8#( )e5ica( e)ac#atoL
- "e a$aptea5& (a "on$& "einga -#UonL
- "e into$#c 8.-1..%( "o(#ieL
- "e $eta!ea5& "einga !i "e (a"& "& "e e(i%ine (ic*i$#( >nt-#n 4a5inet "a# >n t&)& a ena(&L
- "e epet& opeaia p1n& c1n$ (ic*i$#( e)ac#at e"te (i%pe$eL
- "on$a &%1ne pe (oc, fiin$ >nc*i"& c# o pen"& "a# aco$at&, $#p& ca5, (a o
p#ng&
co(ectoa
eL
1/1
- "e o4"e)& a"pect#( %eat#(#i #ina.
1/2
8.7 Cli+a
$<a&uato)i$
S&opDi7,i&a*iiB
- peg&tiea pacient#(#i pent# eBa%in&i en$o"copice !i ca$io(ogiceL
- peg&tiea pent# inte)enii c*i#gica(eL
- e)ac#aea conin#t#(#i ecta( >n ca5 $e con"tipaie.
Mat$)ial$ 7$&$'a)$
- $e potecieI
- paa)anL
- %#!a%aL
- a(e5&L
- >n)e(itoaeL
- pent# c(i"%&I
- iigato, t#4 $e ca#ci#c (#ng $e 1,2-2 %L
- can#(& ecta(& "tei(&L
- pa& $e ca#ci#c pent# "#gaL
- t&)i& ena(&L
- p(o"c&L
- ap& ca($& ?,2-,7R@ 2..-1... %( pent# a$#(i, 12. %( pent# copii, 2.-3. %(
pent# "#gaiL
- "tati) pent# iigatoL
- %ateia(e pent# ce!teea efect#(#i p#gati)I "ae ?1 (ing#i& (a 1 ( $e ap&@, #(ei $e
icin ?/ (ing#i (a 1 ( ap&@, g(icein& ?/. g. (a 2.. %( ap&@, "&p#n ?1 (ing#i& a"&
(a 1 ( ap&@L
- )a"e(in& pent# (#4ifieea can#(eiL
- co%pe"e "tei(e.
- "e an#n& pacient#(L
- "e eBp(ic& $e#(aea poce$#iiL
- "e a"ig#& pacient#( $e e"pectaea p#$oiiL
- "e a(ege po5iia >n f#ncie $e "taea genea(&I
- $ec#4it $o"a( c# %e%4e(e infeioae #!o f(ectate !i coap"e(e $ep&tateL
- $ec#4it (atea( "t1ng c# %e%4#( infeio >ntin" !i ce( $ept f(ectatL
- gen#pectoa(&
- "e i5o(ea5& pat#( c# #n paa)anL
- "e pote8ea5& c# a(e5& !i %#!a%a.
E"te >n f#ncie $e tip#( $e c(i"%&I
- c(i"%& e)ac#atoie "i%p(&L
- c(i"%a >na(t&L
- c(i"%a pin "ifona8L
1/,
- c(i"%& #(eioa"&L
- c(i"%a p#gati)&.
a@ Cli'+a $<a&uato)i$ 'i+pl:
- "e fiBea5& can#(a (a t#4#( iigato#(#i !i "e >nc*i$e o4inet#( ?(a ne)oie "e ap(ic& o pen"&@L
- "e )eific& te%peat#a apeiL
- "e #%p(e iigato#(L
- "e $e"c*i$e o4inet#( !i "e e(i%in& ae#( $#p& cae "e >nc*i$e $in no#L
- "e (#4ifia5& can#(a c# )a"e(in& fo(o"in$ co%pe"e $e tifonL
- "e fiBea5& iigato#( pe "tati)L
- "e "pa(& %1ini(e !i "e >%4ac& %&n#!iL
- "e >n$ep&tea5& fe"e(e pacient#(#i !i "e into$#ce can#(a pin an#" >n ect c# )1f#(
oientat "pe patea anteioa& apoi "pe p(an#( "ac#(#i ?pent# a e"pecta c#4#a
ect#(#i@L
- "e into$#ce can#(a 1.-12 c% >n (#%en#( ect#(#iL
- "e $e"c*i$e o4inet#( "a# pen"a "i "e i$ica iigato#( (a apoBi%ati) 2. c% pent# a
fa)oi5a "c#geea (ic*i$#(#iL
- "e )o4e!te c# pacient#( !i e"te #gat "& in"pie a$1nc, "& "e e(aBe5e !i "& ein& "o(#ia
1.- 12 %in#teL
- $ac& pacient#( ac#5& $#ee "e co4oa& iigato#( pent# a "c&$ea pe"i#nea (ic*i$#(#iL
- "e >nc*i$e o4inet#( >nainte $e te%inaea (ic*i$#(#i ?pent# a n# p&t#n$e ae@L
- "e >n$ep&tea5& can#(a !i "e p#ne >n t&)ia ena(&L
- "e "c*i%4& po5iia pacient#(#i >n $e $ec#4it (atea( $ept, $ec#4it $o"a( pent# ca apoi
"& p&t#n$& %ai pof#n$L
- "e captea5& "ca#n#( >n p(o"c& "a# "e e(i%in& (a toa(et&.
4@ Cli'+a ?7alt:
- "e efect#ea5& (a fe( ca !i c(i"%a "i%p(&L
- "e >n(oc#ie!te can#(a ecta(& c# o can#(& f(eBi4i(& cae poate p&t#n$e >n co(on (a
o pof#n5i%e $e ,.-/. c%L
- iigato#( "e i$ic& (a 1,2 % pent# a ce!te pe"i#nea apeiL
- te%peat#a apei e"te %ai "c&5#t& ?12-13RC@ pent# a ce!te efect#( p#gati).
c@ Cli'+a p)i7 'i%o7aA
- "e efect#ea5& pent# >n$ep&taea, eB#$ate(o, p#oi#(#i $e pe "#pafaa %#coa"e(oL
- can#(a e"te >n(oc#it& c# o "on$& $e ,2-/. c% (#ngi%e c# $ia%et# $e 1,2 c% pe)&5#t&
c# oificiiL
- iigato#( "e >n(oc#ie!te c# o p1(nie $e 1,2 (L
- "e pen"ea5& t#4#( $e ca#ci#c (1ng& can#(&L
- "e (#4ifia5& can#(a ?"on$a@ !i "e into$#ce pin %i!c&i $e otaie p1n& >n co(on#(
"ig%oi$L
- "e i$ic& p1(nia (a >n&(i%ea $e 1 % !i "e $& $#%#( apeiL
- "e ea(i5ea5& "ifona8#( $e 2-3 oi p1n& "e e(i%in& ap& c#at&.
$@ Cli'+a ul$ioa':
- "e fo(o"e"c apoBi%ati) 2.. %( #(ei >nc&(5it (a ,7RC cae "e into$#ce (ent, >n 12-2.
%in#teL
- "e %enine #(ei#( >n ect 3-12 oeL
1//
- "e eBec#t& "eaa, e(i%inaea "e face $i%ineaaL
1/2
- "e fo(o"e!te >n con"tipaii conice, feca(o%L
- "e pote8ea5& (en8eia $e pat, eBi"t1n$ po"i4i(itatea e(i%in&ii neconto(ate a "ca#n#(#i.
e@ Cli'+a pu);ati<:
- efect#( "e 4a5ea5& pe ceaea #n#i %e$i# *ipeton, atage apa $in e"#t#i !i fo%ea5& #n
"ca#n (ic*i$ #!o $e e(i%inatL
- "e fo(o"e!te o "o(#ie concentat& ?22. %( ap& c# 2 (ing#i 9g0O/@L
8.8 I7t)o,u&$)$a tu(ului ,$ ;a>$
S&op
Into$#ceea #n#i t#4 "e%iigi$ $e ,.-,2c% (#ngi%e "i 8-12 %% $ia%et# c# %agini(e ot#n8ite,
c# "cop#( $e a e(i%ina ga5e(e $in co(on in ca5 $e %eteoi"% a4$o%ina(.
R$'po7'a(ilit: i
9e$ic#( - eco%an$& %ontaea t#4#(#i.
6"i"tent#( %e$ica( - poate efect#a poce$#a f&& eco%an$ae %e$ica(& at#nci c1n$ pacient#( n#
poate e)ac#a ga5e(e >n %o$ "pontan.
Mat$)ial$ 7$&$'a)$
- %# a%a, a(e5&L
- t#4 $e ga5e "tei(L
- )a"e(in& "tei(&L
- co%pe"e $e tifonL
- %&n# i $e #nic& fo(o"in &.
- "e an#n & i "e eBp(ic& acient#(#i fapt#( c& $e"c*i$eea "fincte#(#i ana( pent# e)ac#aea
ga5e(o )a ce te "taea $e confotL
- "e a ea5 pacient#( >n po5i ie gineco(ogic& "a# >n po5i ie $e $ec#4it (atea(L
- "e "pa(& %1ini(eL
- "e >%4ac& %&n# i $e #nic& fo(o"in &L
- "e #nge t#4#( c# )a"e(in& "tei(&L
- "e $epatea5& fe"e(e pacient#(#i c# %1na "t1ng ia c# %1na $eapt& "e into$#ce t#4#(
pin an#" 1n ect, pin %i c&i $e ota ie, (a o a$1nci%e $e 12-2. c%L
- pacient#( e"te acopeit c# o >n)e(itoaeL
- "e %en ine %aBi% 2 oeL
- "e etage # o tot pin %i c&i $e ota ieL
- $aca e"te ne)oie "e poate ep#ne 1-2 oe $#pa ce "e e"ta4i(e te cic#(a ia (a ni)e(#(
%#coa"ei.
- "e face toa(eta egi#nii $#a(e pent# a >n$epata )a"e(inaL
- "e a ea5a pacient#( co%o$L
1/3
- "e >n)e(e te pacient#(L
- "e aei"e te "a(on#(L
- "e "#pa)eg*ea5& "taea a4$o%ina(& $#p& >n$epataea t#4#(#i $e ga5e.
PARTEA IV 4 INTERVENII LA CARE ASISTENTUL MEDICAL PARTICIP
ALTURI DE MEDIC
Capitolul 2 PARTICIPAREA ASISTENTULUI MEDICAL LA EFECTUAREA
PUNCIILOR
+.1 A'p$&t$ ;$7$)al$
'&t#n$eea c# a8#to#( #n#i ac "a# toca >nt-o ca)itate nat#a(& "a# neofo%at& ?pato(ogic&@ oi
>nt-#n ogan paen*i%ato" c# "cop eBp(oato "a# teape#tic.
1unciile sunt de competena medicului cu e%cepia punciei venoase#
S&opDi7,i&a*ii
- peci5aea eBi"tenei, nat#ii, a"pect#(#i !i co%po5iiei (ic*i$#(#i $int-o ca)itateL
- eco(taea (ic*i$#(#i pent# eBa%ene 4ioc*i%ice, 4acteio(ogice !i cito(ogiceL
- into$#ceea #nei "#4"tane $e conta"t >n )e$eea eBa%in&iiL
- pe(e)aea #n#i teg#%ent $e e"#t pent# eBa%en *i"topato(ogicL
- e)ac#aea (ic*i$#(#i $int-o ca)itate c1n$ po$#ce co%pe"i#ne !i 8enea5& f#nciaL
- into$#ceea #no %e$ica%ente.
Tipu)i ,$ pu7&*ii
- p#ncia toacic& ?toacocente5a@L
- p#ncia peitonea(& ?paacente5a a4$o%ina(&@L
- p#ncia peica$ic&L
- p#ncia atic#(a&L
- p#ncia o"oa"& ?%e$#(a&@L
- p#ncia a*i$ian&L
- p#ncia )e5icii #inaeL
- p#ncia co(ec ii(o p##(enteL
- p#ncia 4iop"ic&.
R$'po7'a(ilit:*iB
9e$ic#(I
- "ta4i(e!te in$icaii(e !i contain$icaii(eL
- eBp(ic& pacient#(#i $e#(aea poce$#iiL
- o4ine con"i%&%1nt#(L
- efect#ea5& p#ncia.
6"i"tent#( %e$ica(I
- peg&te!te %ateia(e(e pent# p#ncieL
- paticip& (a peg&tiea pacient#(#iL
- paticip& (a act#( p#nciei >n$ep(inin$ #%&toae(e "aciniI
- a"ig#& po5iia pacient#(#i !i "#pa)eg*ea5& f#ncii(e )ita(eL
1/7
- "e)e te %e$ic#(#i %ateia(e(e nece"ae, $#p& ca5 ?%ateia(e pent# ane"te5ie,
%ateia(e pent# ea(i5aea p#nciei popi#-5i"e, %ateia(e pent# eco(t&i@L
- peia %ateia(#( eco(tat, >( peg&te!te pent# ti%iteea (a (a4oatoL
- >n$ep&tea5& !i co(ectea5& %ateia(e(e fo(o"ite confo% peca#ii(o #ni)e"a(eL
- a"ig#& >ngi8iea pacient#(#i $#p& p#ncieL
- notea5& >n p(an#( $e >ngi8ie "a# >n foaia $e o4"e)a ie ?$#p& ca5@, a"pecte (egate $e
p#ncie !i cae in $e co%petena "a.
+.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la to)a&o&$7t$>:
'oce$#a e"te $e"ci"& (a capito(#( 12 ?12., Toacocente5a@
+., Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7&*i$i p$)ito7$al$ #Pa)a&$7t$>a
a(,o+i7al:-
'&t#n$eea >n ca)itatea peitonea(& c# a8#to#( #n#i ac "a# toca, pin ta)e"aea peete(#i
a4$o%ina(.
S&op
E)ac#aea (ic*i$#(#i $e a"cit& c1n$ e >n cantitate %ae !i 8enea5& cic#(aiaI
- (a pacient#( po(ita#%ati5atL
- >n a4$o%en#( ac#t c*i#gica(L
- pent# "ta4i(iea eBi"tenei (ic*i$#(#i a4$o%ina(L
- pent# ea(i5aea $ia(i5ei peitonea(eL
- eBp(oato K peci5aea $iagno"tic#(#i teape#ticL
- teape#tic K pent# e)ac#aea (ic*i$#(#i cae po)oac& t#(4#&i e"piatoii !i cic#(atoii
pin pe"i#ne eBecitat& a"#pa $iafag%#(#i.
Mat$)ial 7$&$'a)
'ent# ane"te5ie (oca(&
- fio(a c# "o(#ie ane"te5ic&L
- ace pent# ".c. !i i.%.L
- "eing& $e 2. %(.
'ent# p#ncia c# "cop $iagno"tic
- ace i.%. "a# "pecificeL
- "eingi $e 2. %(L
- f(acoane "tei(e pent# eBa%en 4acteio(ogic !i anato%ico-pato(ogic.
'ent# p#ncia e)ac#atoae
- ace i.%. "a# "pecifice "a# catete )eno"L
- "eing& $e 2. %(L
- o4inet c# , caiL
- t#4 $e (eg&t#&L
- f(acon "tei( pent# co(ectaea (ic*i$e(oL
- )a" ga$at.
'ent# "#pa)eg*ee
1/8
- ten"io%et#L
- c1ntaL
'ent# a"ep"ie
- %&n#!i "tei(eL
- co%pe"e "tei(eL
- "o(#ie $e5infectant&L
- c1%p#i "tei(eL
- pan"a%ent co(antL
- co(ecto pent# ace fo(o"iteL
- "ac pent# e(i%inaea $e!e#i(o "eptice.
- "e )eific& eco%an$aeaL
- "e eBp(ic& pacient#(#i i%potana poce$#ii !i nece"it&ii %e$ica(e a ace"teiaL
- pacient#( e"te pe)enit, e"te a8#tat "& "e in"ta(e5e >n $ec#4it $o"a( >n ti%p#( p#nc iei !i 2
oe $#p& p#ncieL
- "e info%ea5& pacient#( c& poce$#a $#ea5& apoBi%ati) ,. %in#te pent# p#ncia
eBp(oatoaeL
- "e eBp(ic& po5iia >n ti%p#( p#nciei !i e"te #gat "& n# "e %i!teL
- "e %&"oa& cic#%feina ta(iei !i "e c1nt&e!te pacient#(L
- "e eco%an$& pacient#(#i "&-!i go(ea"c& )e5ica #ina&L
- "e %&"oa& T.6. !i p#("#( >naintea ea(i5&ii eBa%en#(#iL
- "e $ega8& 5ona p#ncionat& K fo"a i(iac& "t1ng& pe (inia "pino-o%4i(ica(& "t1ng& (a (oc#( $e
#nie >nte tei%ea eBten& c# tei%ea %e$ie.
4ste de competena medicului, a-utat de ,+: asisteni medicali#
Pa)ti&ipa)$a a'i't$7tului +$,i&al la p)o&$,u):
- a!ea5& pacient#( >n $ec#4it $o"a( (a %aginea "t1ng& a pat#(#i, #!o >nc(inat "pe "t1ngaL
- "e $e5infectea5& (oc#( #n$e "e face p#ncia ?fo"a i(iac& "t1ng&@L
- peg&te!te "einga c# ane"te5ic !i o >n%1nea5& %e$ic#(#i pent# a face ane"te5ia (oca(&L
- ofe& %e$ic#(#i ac#( "a# toca#( pent# p#ncieL
- %e$ic#( p#ncionea5& peete(e c# ac#( oientat pepen$ic#(a cica ,-/ c%L
- "e etage %an$en#(, "e e)ac#ea5& (ic*i$#(, cae "e co(ectea5& >n ep#4ete "tei(e, pent#
eBa%en $e (a4oatoL
- a"i"tent#( %e$ica( peia ep#4eta c# (ic*i$#( eBta"L
- >n p#nctia c# "cop e)ac#ato (a toca "e ata!ea5& #n t#4 $e po(ieti(en& pent# a a"ig#a
"c#geea (ic*i$#(#i >n )a"#( co(ectoL
- ac#( "a# toca#( "e fiBea5& (a teg#%entL
- a"i"tent#( %e$ica( #%&e!te "c#geea (ic*i$#(#i cae "e ea(i5ea5& "#4 inf(#ena pe"i#nii
inta a4$o%ina(e, f&& "& $ep&!ea"c& /-3 ( (a pi%a p#ncieL
- (a "f1!it#( p#nciei "e "coate ac#( "a# toca#(, "e co%pi%& (oc#( #n %in#tL
- pe (oc#( >nep&t#ii "e ap(ic& #n pan"a%ent "tei(.
1/+
- pacient#( &%1ne >n epa#"L
- "e a!a5& c# (oc#( >nepat p#in %ai "#"L
- "e %onitoi5ea5& (oc#( p#nciei pent# "1ngeae, "c#geea >n contin#ae a (ic*i$#(#i,
apaiia "e%ne(o $e inf(a%aieL
- "e a"ig#& (ini!te !i te%peat#a opti%&L
- "e "#pa)eg*ea5& f#ncii(e )ita(e 2/ oe, "e an#n& %e$ic#( (a oice "#"pici#neL
- pacient#( )a fi "e)it (a pat, "e a(i%entea5& (a patL
- "e %&"oa& cic#%feina a4$o%ina(&, "e c1nt&e!te !i "e co%pa& c# cea $inainte $e
p#ncie.
I7&i,$7t$DA&&i,$7t$
'ot ap&ea >n ti%p#( p#nciei "a# $#p& p#ncieI
- (e5aea )a"e(o $e "1nge "a# a an"e(o inte"tina(eL
- (e5aea )e5icii #inae, %oti) pent# cae acea"ta "e go(e!te >nainte $e p#ncieL
- !oc t#(4#&i *i$oe(ecto(itice cae "#nt pe)enite pin e(i%inae (ent&L
- peitonit&, fi"t#(&.
+./ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7&*i$i p$)i&a),i&$
S&opDi7,i&a*ii
- e)i$enieea (ic*i$#(#i >n ca)itatea peica$ic&L
- e)ac#aea (ic*i$#(#i >n ca)itatea peica$ic& c1n$ pacient#( pe5int& $i"pnee accent#at&,
*ipoten"i#ne ateia(&, p#ncia epe5ent1n$ o inte)enie $e #gen&.
1uncia este efectuat de medic a-utat de dou asistente medicale# 3ocul punciei este ales de
ctre medic n urma unui control radiologic, n funcie de scop i cantitatea de lichid#
Mat$)ial$ 7$&$'a)$
- c1%p pent# potecia pat#(#iL
- %ateia( $e $e5infecieI ta%poane, "o(#ii $e5infectante ?4eta$in&@L
- %ateia(e pent# p#ncieI 2-, ace $e (#ngi%e 8-1. c% !i c# $ia%et#( $e 1 %%, 2-, "eingi
$e 2. K 2. %(, "eing& $e 2 %(, ace pent# ane"te5ieL
- pen"eL
- c1%p c*i#gica(L
- %e$ica%ente pent# pe)eniea acci$ente(oI atopin&, %ofin&, tonica$ice, "o(#ii
ane"te5iceL
- t&)i& ena(& "a# containe pent# co(ectaea %ateia(e(o fo(o"iteL
- ep#4ete pent# co(ectaea (ic*i$#(#i.
- pacient#( e"te info%at !i >nc#a8at, a)1n$ >n )e$ee "taea "a $e 4oa(&L
- "e face #n eBa%en a$io(ogicL
- "e a!a5& pacient#( >n po5iia eco%an$at& $e %e$ic >n f#ncie $e "copI
12.
- "e%i!e51n$ K pent# p#ncia e)ac#atoae c1n$ (oc#( a(e" e"te eBte%itatea
apen$ice(#i Bifoi$L
- $ec#4it $o"a( c1n$ (oc#( a(e" e"te "pai#( 2 inteco"ta( "t1ng (a 3 c% $e %aginea
"t1ng& a "ten#(#i ?pent# p#ncia eBp(oatoae@ "a# "pai#( 3-7 (a 8#%&tatea $i"tanei
$inte (inia aBi(a& anteioa& !i cea %e$io-c(a)ic#(a& "t1ng& c1n$ cantitatea $e
(ic*i$ e"te %ae.
- p#ncia "e face >nt-o >nc&pee c# in"ta(aie $e .2L
- "e i$entific& pacient#(, "e )eific& eco%an$aea %e$ica(&L
- c# ,. $e %in#te >nainte "e a$%ini"tea5& o fio(& $e atopin&L
- "e pote8ea5& pat#(L
- pacient#( e"te a8#tat "& "e $e54ace !i "& "e a!e5e >n po5iia a(ea"& $e %e$icL
- "e "e)e!te %e$ic#(#i "einga c# ane"te5ic pent# a ea(i5a ane"te5iaL
- a"i"tenta "e)e!te c1%p#( c*i#gica( pe cae %e$ic#( >( a!a5& "#4 (oc#( p#ncieiL
- "e $e5infectea5& (oc#( p#nciei !i %e$ic#( eBec#t& p#nciaL
- a"i"tenta "#pa)eg*ea5& pacient#(, $ac& e"te ne)oie >( i%o4i(i5ea5&L
- "e o4"e)& facie"#(, e"piaia, p#("#(, apaiia $i"pneeiL
- (ic*i$#( a"piat e"te tan"feat >n ep#4ete !i etic*etat pent# a fi eBpe$iat (a (a4oatoL
- %e$ic#( etage ac#(L
- a"i"tenta $e5infectea5& (oc#( !i ap(ic& #n pan"a%ent "tei( c# 4an$& a$e5i)&.
- pacient#( e"te a"e5at >n $ec#4it $o"a(, c# toace(e #!o i$icatL
- "e a"ig#& epa#"#( fi5ic !i p"i*icL
- "e %onitoi5ea5& p#("#(, ten"i#nea ateia(&, e"piaia pent# a i$entifica e)ent#a(e(e
feno%ene $e in"#ficien& ca$iac& pin $eco%pi%aea 4#"c& po$#"& $e e(i%inaea
(ic*i$#(#iL
- (a eco%an$aea %e$ic#(#i "e a$%ini"tea5& tonica$ice.
+.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7&*i$i )a=i,i$7$
'#ncia a*i$ian& epe5int& p&t#n$eea c# a8#to#( #n#i ac "pecia( >n "pai#( "#4aa*noi$ian (a
ni)e(I
- (o%4a ?p#ncia (o%4a&@L
- toaca( ?p#ncia toaca(&@L
- "#4occipita( ?p#ncia "#4occipita(&@.
S&opDi7,i&a*ii
- %&"#aea pe"i#nii (ic*i#(#i cefa(o-a*i$ian ?L.C.R.@L
- pe(e)aea #nei cantit&i pent# eBa%eneI cito(ogice, 4ioc*i%ice, 4acteio(ogiceL
- >n ta#%ati"%e(e canio-cee4a(e !i acci$ente(e )a"c#(ae cee4a(e pent# apecieea
a"pect#(#i L.C.R. ?"ang#ino(ent K "e%n $e *e%oagie@ i pent# %&"#aea pe"i#nii
ace"t#iaL
- in8ectaea #no "#4"tane $e conta"t >n %ie(ogafie "a# a i5otopi(o a$ioacti)iL
- a$%ini"taea $e ane"te5ice, anti4iotice "a# a ageni(o anti%itoticiL
121
- $eco%pi%aea >n ca5#( >n cae pe"i#nea L.C.R. e"te ce"c#t&L
- >n %eningiteL
- 6.;.C., 4o(i $egeneati)e a(e 0NC
- ta#%ati"%e canio-cee4a(e !i acci$ente )a"c#(ae cee4a(eL
- $iagno"ticaea "c(eo5ei %#(tip(e, a afeci#ni(o a#toi%#neL
- a*iane"te5ia.
Mat$)ial$ 7$&$'a)$
- c&#cio #(ant pent# %ateia(e "a# ta)& %e$ica(&L
- %&n#!i "tei(e, c1%p#i "tei(e, co%pe"e "tei(eL
- ace "tei(e pent# p#ncie, (#ngi $e 8-1.c%, "#4ii, c# 4i5o# "c#t, pe)&5#te c# %an$en !i
#neoi c# Cinto$#ceEL
- "o(#ii $e5infectante ?4eta$in& "a# a(coo( io$at@L
- "eingi "tei(e $e 2-2%(L
- ep#4ete "tei(eL
- 1-2 t&)ie ena(eL
- %ano%et# C(a#$e pent# %&"#aea pe"i#nii L.C.R.L
- "o(#ii $e in8ectat c1n$ e"te ca5#(.
- "e info%ea5& pacient#( c# pi)ie (a efect#aea poce$#iiI nece"itatea, i%potana, $#ata
poce$#iiL
- "e o4ine con"i%&%1nt#( info%at "ci" a( pacient#(#iL
- "e eco%an$& ca )e5ica !i ect#( "& fie goa(eL
- "e a"ig#& po5iia coe"p#n5&toae >n confo%itate c# "taea "a, c# "cop#( !i (oc#( p#ncieiL
- !e51n$ c# cap#( f(ectat, #%eii ap(ecai, "pate(e >n$oit, coate(e "pi8inite pe gen#nc*i,
%e%4e(e infeioae "pi8inite pe #n "ca#n %icL
- "e atenionea5& pacient#( "& %enin& po5iia eBact&, ia >n ti%p#( poce$#ii "& n# "e %i!teL
- >n $ec#4it (atea( (a %aginea %e"ei $e opeaie "a# a pat#(#i, c# coap"e(e f(ectate pe
a4$o%en !i ga%4e(e f(ectate pe coap"e, cap#( >n f(eBie %aBi%&, co(oana )ete4a(& ac#it&,
#%eii >n p(an )etica(L
- "e a"ig#& inti%itatea pacient#(#i c# paa)an, $ac& poce$#a "e eBec#t& (a "a(on.
1rocedura este de competena medicului#
- "e a!a5& pacient#( >nt-#na $in po5iii(e a%intite >n f#ncie $e "taea !i eco%an$aea
%e$ic#(#iL
- "e eco%an$& pacient#(#i "& e"pie a$1ncL
- "e %&"oa& !i "e notea5& f#ncii(e )ita(e !i )egetati)eL
- "e conto(ea5& ca te%peat#a ca%eei "& fie $e cica 2.
o
Ce("i#"L
- %e$ic#( fiBea5& (oc#( p#nciei >nte L/-L2L
- "e $e5infectea5& (oc#( p#nciei c# 4eta$in&L
- "e ofe& %e$ic#(#i %&n#!i "tei(eL
- "e ofe& %e$ic#(#i ac#( $e p#ncie "tei(L
122
- "e "#pa)eg*ea5& pacient#( tot ti%p#( p#ncieiL
- "e ofe& %e$ic#(#i %ano%et#( C(a#$e pent# %&"#aea pe"i#nii L.C.R.L
- "e ofe& %e$ic#(#i pe 1n$ ep#4ete(e pent# eco(taea L.C.R. >n )e$eea $ifeite(o
eBa%ene $e (a4oatoL
- "e eco(tea5& 2-1. %( L.C.R. >n ce(e , ep#4ete, ia apoi "e acope& ep#4ete(eL
- "e etic*etea5& ep#4ete(e !i "e ti%it i%e$iat (a (a4oatoL
- "e ofe& %e$ic#(#i "eingi(e c# "o(#ii %e$ica%entoa"e $ac& p#ncia "e face >n "cop
teape#ticL
- "e eBtage 4#"c ac#( p#nciei $e c&te %e$ic (a "f1!it#( poce$#iiL
- "e %a"ea5& (oc#( p#ncieiL
- "e ap(ic& o co%pe"& "tei(& pe (oc#( p#nciei !i "e fiBea5& c# o%p(a"tL
57;)iAi)$a pa&i$7tului ,up: pu7& i$
- "e a!a5& pacient#( atent pe c&#cio >n po5iie oi5onta(&, (a fe( !i >n patL
- "e %enine pacient#( f&& pen& !i ne%i!cat ce( p#in 3 oe p1n& (a 2/ oeL
- "e a(i%entea5& pacient#( (a pat n#%ai $#p& 3 oeL
- "e ofe& pacient#(#i pena $#p& 2/ oeL
- "e o4"e)& c# atenie %i!c&i(e eBte%it&i(o, "e an#n& %e$ic#( $ac& apa f#nic&t#i "a#
a%o e(i >n picioaeL
- "e e)a(#ea5& capacitatea $e %ici#ne a pacient#(#iL
- "e %onitoi5ea5& pe%anent pacient#(L
- "e eco%an$& "& con"#%e %#(te (ic*i$e.
I7&i,$7t$DA&&i,$7t$
- p#ncia a(4& $ete%inat& $e into$#ceea $efect#oa"& a ac#(#iL
- "c#gee foate (ent& a (ic*i$#(#i $in ca#5a *ipoten"i#nii L.C.R.L
- i%po"i4i(itatea p#ncion&ii foate fec)ent& (a )1"tnici $in ca#5a o"ific&ii (iga%entae !i
(a pacien ii o4e5iL
- p#ncia ta#%atic& ?pin ac "e eBteioi5ea5& "1nge ca e5#(tat a( efaciei #n#i )a"
%eningea(@L
- $#ee (a ni)e(#( #n#i %e%4# pe()ian pin p#ncionaea #nei &$&cini ne)oa"eL
- (ipoti%ie, %ai a(e" (a pacieni cae n# a# fo"t "e$ai anteio !i (a cae p#ncia "e ea(i5ea5&
!e51n$L
- cefa(ee !i a*ia(gie, co%p(icaie fec)ent >nt1(nit&, cae pae a fi $ete%inat& $e "c&$eea
pe"i#nii L.C.R.L
- "incopa !i acci$ente(e %ota(e cae apa foate a (a pacienii c# ta#%ati"%e cee4a(e,
fact#& $e 4a5& $e cani# etc.
+.3 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7& i$i
a)ti&ula)$ E"te p&t#n$eea c# a8#to#( #n#i ac "a# toca >n ca)itatea
atic#(a&. S&opDI7,i&a ii
- p#neea >n e)i$en & a (ic*i$#(#i atic#(a ?"eo", p##(ent, "ang*ino(ent@L
- eco(taea (ic*i$#(#i pent# "ta4i(iea $iagno"tic#(#i i oientaea tata%ent#(#iL
- e)ac#aea (ic*i$#(#i c1n$ 8enea5& %i caea, po$#ce $i"confot, >n ta#%ati"%e atic#(ae c#
*e%ato5&L
- a$%ini"taea $e %e$ica%ente >n atite ?ac#te i conice@.
12,
Mat$)ial$ 7$&$'a)$
- a(e5&, %# a%a pent# potec ia pat#(#iL
- %ateia(e $e $e5onfec ieI
- ta%poaneL
- 4eta$in&L
- co%pe"eL
- %ateia(e pent# p#nc ieI
- ace $e /-2 c% (#ngi%eL
- "eing& $e 2 %( pent# ane"te5ieL
- ace $e 8-1. c% (#ngi%e c# $ia%et#( $e ..2-2 %% pent# a"pia ieL
- "eing& pent# a"piaea (ic*i$#(#iL
- pen"eL
- %&n# i "tei(eL
- co%pe"e "tei(eL
- ep#4ete pent# co(ectaea (ic*i$#(#iL
- %e$ica%ente ane"te5ice, antiinf(a%atoii anti4iotice, "#4"tan e $e conta"t ?$ac& e"te
ca5#(@L
- o%p(a"tL
- t&)i & ena(&L
- pa*a conic ga$at.
- "e info%ea5& pacient#( c# pi)ie (a "cop#( i %o$#( $e $e#(ae a poce$#iiL
- "e info%ea5& pacient#( c# pi)ie (a efect#aea p#nc iei "#4 ane"te5ie (oca(&L
- "e cee con"i% &%1nt#( info%at a( pacient#(#iL
- "e a ea5& pacient#( >nt-o po5i ie cae "& pe%it& efect#aea p#nc iei, $ac& e"te ca5#(, c#
atic#(a ia pe o pen&.
1rocedura este de competen a medicului#
- "e a ea5& pacient#( >n f#nc ie $e atic#(a ia afectat&. E"te a8#tat "& > i %en in&po5i ia, $aca
n# poate "ing#L
- "e fi5ea5& (oc#( ?atic#(a ia gen#nc*i#(#i, #%&#(#i, cot#(#i, "a# g(e5nei, $#p& ca5@ >n 5ona $e
%aBi%& f(#ct#en &L
- "e $e5infectea5& 5ona, %e$ic#( efect#ea5& ane"te5ia (oca(&L
- "e a ea5& c1%p#( "tei( "#4 (oc#( p#nc iei i "e $e5infectea5& >nc& o $at& (oc#(L
- %e$ic#( eBec#t& p#nc iaL
- a"i"tent#( %e$ica( pi%e te (ic*i$#( eBta" i >( tan"fe& >n ep#4eteL
- a"i"tent#( %e$ica( ti%ite po4a (a (a4oato pent# eBa%en cito(ogic "a# 4acteio(ogicL
- "e %&"oa& cantitatea $e (ic*i$ i "e o4"e)& a"pect#( ?"eo", p##(ent, "ang*ino(ent@L
- "e eBtage ac#(L
- "e $e5infectea5& (oc#( >n ep&t#ii i "e cope"ea5& c# #n ta%pon "tei(L
- e5#(tat#( p#nc iei "e notea5& >n foaia $e o4"e)a ie.
12/
57;)iAi)$a pa&i$7tului ,up: pu7& i$
- "e ap(ic& #n 4an$a8 co%pe"i) (a (oc#( p#nc ieiL
- "e a"ig#a epa#"#( atic#(a iei pe cae "-a ap(icat poce$#aL
- (a eco%an$aea %e$ic#(#i atic#(a ia "e poate i%o4i(i5a c# ate(&L
- 4an$a8#( co%pe"i) i i%o4i(i5aea "e %en in 2/-/8 oeL
- "e "#pa)eg*ea5&"taea genea(&L
- "e o4"e)& e)ent#a(e(e "e%ne $e infec ie.
+.7 Pa)ti&ipa)$a a'i't$7tului +$,i&al la )$ali>a)$a pu7&*i$i +$,ula)$ #o'oa'$-
E't$ p&t#n$eea c# a8#to#( #n#i toca >n 5ona "pongioa"& a #n#i o" "c#t "a# (at.
S&opDi7,i&a*ii
- eBp(oaea ano%a(ii(o *e%ato(ogiceL
- confi%aea $iagno"tic#(#i $e cance ?4oa(a =o$gOin, (e#ce%ia %i(eoi$a conica@ $#p&
e)i$enieea a$enopatiei $if#5e "a# "p(eno%ega(ieL
- confi%aea $iagno"tic#(#i #no 4o(i infecioa"eL
- eco(taea %&$#)ei $e (a pe"oane "&n&toa"e >n )e$eea tan"f#5&iiGtan"p(ant&ii.
Mat$)ial$ 7$&$'a)$
'ent# p#nc ia %e$#(a&
- toca 9a(a%eL
- "eingi $e 2.%(L
- (a%e !i (a%e(e ?pent# eBa%en %ico"copic@L
- "e fi5io(ogic ca($.
- ge( pent# ane"te5ie (oca(&L
- ace pent# in8ecii "#4c#tanatL
- ace pent# in8ecii inta%#"c#(aeL
- "eingi $e 2. %%L
- f(acon $e Bi(ocaina 2M.
'ent# $e5infecie
- %&n#!i "tei(e $e #nic& fo(o"in&L
- co%pe"e "tei(eL
- c1%p "tei( c# $e"c*i$ee centa(&L
- pan"a%ent #"catL
- containe pent# ace fo(o"ite.
- "e face conto(#( *e%o"ta5ei >naintea p#ncieiL
- p#ncia nece"it& peg&tie p"i*o(ogic&, $eoaece po$#ce anBietateL
- e"te $#eoa"& !i nece"it& ane"te5ieL
- "e eBp(ic& $e#(aea !i "cop#( p#ncieiL
122
- #nii pacieni a# ne)oie $e a$%ini"taea #n#i tanc*i(i5ant pent# ce!teea confot#(#iL
- "e peg&te!te (oc#( p#ncieiI
- (a 4&4ai $ac& e"te ca5#( "e face $epi(aea c1n$ (oc#( a(e" e"te "ten#( (a ni)e(#(
%an#4i#(#iL
- pent# p#ncia "tena(& pacient#( e"te a!e5at >n $ec#4it $o"a( c# toace(e #!o i$icat pe
p(an $#.
- "e )eific& in$icaia %e$ica(&L
- "e a!a5& pacient#( >n $ec#4it $o"a(L
- "e peg&te!te (oc#(I "e "pa(&, "e efect#ea5& $e5infeciaL
- %e$ic#( face ane"te5ie (oca(&L
- "e pote8ea5& (oc#( p#nciei c# #n c1%p "tei(L
- "e into$#ce toca#( ta)e"1n$ peio"t#( !i apoi %e$ic#( etage %an$en#(L
- "e a"pi& #n e!antion $in %&$#)& c# a8#to#( #nei "eingiL
- "e p#ne %an$en#( >nainte $e a etage ac#(L
- po$#"#( eBta" "e p#ne pe o "tic(& $e cea"onicL
- a"i"tent#( %e$ica( peia po$#"#( eco(tat !i ea(i5ea5& #n foti# $in e!antion cae )a fi
eBa%inat >nte (a%& !i (a%e(&L
- (a (oc#( >nep&t#ii "e face $e5infecie !i "e ap(ic& #n pan"a%entL
- %&$#)a eBta"& "e ti%ite i%e$iat (a (a4oato, >n con$iii(e ce#te $e %e$ic.
- pacient#( &%1ne >n epa#" (a patL
- "e o4"e)& (oc#( p#nciei "& n# "1ngee5e, "& n# apa& *e%ato%. 0e poate p#ne o p#ng& c#
g*ea&L
- $#ei(e %o$eate "e co%4at c# ana(ge5iceL
- $ac& $#ei(e "#nt p#tenice, "e an#n& %e$ic#(.
+.8 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7&*i$i <$>i&ii u)i7a)$
S&opDi7,i&a*ii
- foate a K pe(e)aea #inei $iect $in )e5ica #ina& pent# eBa%en#( $e (a4oato at#nci
c1n$ te4#ie eBc(#"& tota( po"i4i(itatea conta%in&iiI
- go(iea )e5icii >n etenii(e ac#te $e #in& c1n$ "on$a8#( )e5ica( n# poate fi eBec#tatI
"tict#i #eta(e, *ipetofie $e po"tat&, ta#%ati"%e #eta(e "a# a(e )agin#(#i ?c1n$
"on$a8#( e"te contain$icat@.
Mat$)ial$ 7$&$'a)$
- #n c1%p pent# acopeiea 5onei pe cae "e face p#nc iaL
- %ateia(e $e5infecieI 4eta$in&, ta%poaneL
- %ateia( "tei( pent# p#ncieI
- toca "#4ie c# %an$en "a# #n ac pent# in8ecie inta%#"c#(a& c# (#ngi%e 1.-12
c%L
123
- "eingi $e 2. %(L
- pen"e anato%ice !i *e%o"taticeL
- c1%p c*i#gica( c# $e"c*i$eeL
- co%pe"e "tei(eL
- %&n#!i "tei(eL
- %ateia( pent# ane"te5ieI
- "eing&L
- ace pent# in8ecie ".c.L
- "o(#ie ane"te5ic&L
- %ateia( pent# >n$ep&taea pi(o5it&iiL
- )a" co(ectoL
- ci(in$# ga$atL
- t&)i& ena(&L
- pen& tae.
- "e an#n& pacient#( !i "e eBp(ic& "en5aia $e #!#ae >n ca5 $e etenieL
- "e >n$ep&tea5& pi(o5itatea $in 5ona "#pap#4ian&L
- $ac& "cop#( e"te eco(taea #inei, pacient#( e"te an#nat "& n# #ine5e c1te)a oe "a# $ac&
)e5ica n# e p(in&, e"te #gat "& 4ea 1-2 pa*ae $e (ic*i$, ia c1n$ inic*i#( n# eBcet&
"#ficient, %e$ic#( poate eco%an$a $i#eticeL
- "#4 4a5in "e a!a5& o pen& tae.
1uncia se face de ctre medic a-utat de ,+: asisten i medicali#
9e$ic#(I
- "ta4i(e!te (oc#( K $e $ea"#pa "i%fi5ei p#4iene pe (inia %e$ian& (a 2 c% $ea"#pa "i%fi5eiL
- >%4ac& %&n#!i "tei(eL
- efect#ea5& ane"te5ia (oca(&L
- i5o(ea5& (oc#( pin acopeie c# c1%p#( "tei(L
- eBec#t& p#ncia !i a$aptea5& t#4#( $e "c#gee a( #inei >n )a"#( co(ecto.
6"i"tent#( %e$ica(I
- peg&te!te %a"a pent# p#ncieL
- a8#t& pacient#( "& "e a!e5e >n po5iia coe"p#n5&toae ?$ec#4it $o"a(@ c# o pen& "#4 5ona
"aca(&L
- a8#t& pacient#( "&-!i $e54ace patea infeioa& a cop#(#iL
- $e5infectea5& (oc#(L
- "e)e!te %e$ic#(#i %ateia(#( pent# ane"te5ieL
- "e)e!te %e$ic#(#i "einga !i ac#( pent# p#ncieL
- "#pa)eg*ea5& pacient#( >n ti%p#( p#ncieiL
- #%&e!te "c#geea #ineiGpi%e!te po4e(e eco(tate $ac& e"te ca5#(L
- notea5& cantitatea, a"pect#( #inei.
57;)iAi)$a ,up: pu7&*i$
- $#p& etageea ac#(#i $e c&te %e$ic !i $e5infecia (oc#(#i "e ap(ic& #n pan"a%entL
127
- "e con$#ce pacient#( (a patL
- "e conto(ea5& (oc#( !i pan"a%ent#( pent# a o4"e)a $ac& #ina "e "c#ge pin >nep&t#&L
- "e %&"oa& f#ncii(e )ita(e.
+.+ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pu7&*i$i (iop'i&$
a@ Pa)ti&ipa)$a a'i't$7tului +$,i&al la pu7&*ia (iop'i&: =$pati&:
E't$ into$#ceea #n#i ac "pecia( >n e"#t#( *epatic pent# eBtageea #n#i fag%ent.
1uncia este de compentena medicului#
S&opDi7,i&a*ii
0ta4i(iea $iagno"tic#(#i >nI
- *epato%ega(ie $e etio(ogie nec#no"c#t&L
- en5i%e *epatice ce"c#teL
- "#"pici#ne $e t#%oi, %eta"ta5eL
- icte $e etio(ogie nec#no"c#t&L
- "#"pici#ne $e *epatit&.
C1n$ "e #%&e!te o4ineea #n#i fag%ent $int-o an#%it& 5on& "e poate fo(o"i g*i$a8 CT "a#
R9N.
Mat$)ial$ 7$&$'a)$B
- ac 9eng*ini ?(#ng $e 7 c% c# $ia%et#( $e 1,/ %%@L
- f(acon c# (ic*i$ con"e)antL
- ge( pent# ane"te5ie $e contact "a# f(acon c# po$#" ane"te5iant ?Bi(ocaina 1 "a# 2M@L
- ace pent# in8ecii "#4c#tanateL
- "einga $e 2. %(L
- %&n#!i "tei(e pent# %e$icL
- %&n#!i $e #nic& fo(o"in& pent# a8#toL
- c1%p c# $e"c*i$ee "tei(L
- c1%p pent# ta)a $e %ateia(eL
- %ateia(e $e $e5infecieL
- %ateia(e pent# pan"a%entL
- ta)a pent# %ateia(eL
- t&)i& ena(&L
- containe pent# aceL
- co(ecto pent# ce(e(a(te %ateia(e.
'ent# "#pa)eg*ee
- apaat $e ten"i#ne a#to%aticL
- p#(" oBi%et#L
- c&#cio pent# #gene, po"i4i(itate $e oBigenoteapie.
- "e face >n pea(a4i( #n 4i(an a( coag#(&iiI ti%p =oJe((, ti%p \#icO, =L-, g#p "ang)in
R*, p(ac*ete "ang)ineL
128
- "e )eific& e)ent#a(e tata%ente anticoag#(ante "a# antiagegante p(ac*etae - 9e$ic#(
poate efect#a >n pea(a4i( o ec*ogafie a4$o%ina(& pent# $epi"taea #no conta in$icaii
?a"cit&, (e5i#ni )a"c#(ae@L
- "e (ini!te!te pacient#( eBp(ic1n$#-i $e#(aea eBa%en#(#i !i %o$#( $e co(a4oaeL
- "e o4tine con"i%&%1nt#(L
- pacient#( n# %&n1nc& 12 oeL
- pent# co%4ateea anBiet&ii "e a$%ini"tea5& #n ca(%at c# ,. %in#te >nainte $e poce$#&L
- "e info%ea5& pacient#( c& poce$#a $#ea5& apoBi%ati) 12 %in#te.
- pacient#( e"te a!e5at >n $ec#4it $o"a( "a# >n $ec#4it (atea( "t1ngL
- "e face $e5infecia teg#%ent#(#iL
- "e pote8ea5& 5ona c# c1%p#( "tei(L
- pacient#( e"te p#" "& e"pie a%p(#, apoi e"te #gat "& e"pie foat !i "& &%1n& >n apneeL
- >n eBpi 4(ocat %e$ic#( into$#ce ac#( >n "pai#( intecon"ta( !i c*ia %ai 8o" >n ca5 $e
*epato%ega(ie i%potant&L
- "e etage ac#( !i pe (oc#( p#nctiei "e ap(ic& #n pan"a%ent co%pe"i) "tei(L
- fag%ent#( co(ectat e"te tan"feat $in (#%en#( ac#(#i >n f(acon#( c# (ic*i$ con"e)ant !i
ti%i" (a (a4oato.
- pacient#( e"te in"t#it "& &%1n& >n epa#", 2 oe >n $ec#4it (atea( $ept pent# a e$#ce
i"c#i(e *e%oagiei !i a(e "c#geii 4i(ei, / oe >n $ec#4it $o"a(L
- "e "#pa)eg*ea5& f#ncii(e )ita(e T6, ', R, T !i pe5ena $#eii (a inte)a(e $e 12 %in#te
apoi ,. !i o o&L
- $ac& eBi"t& i"c $e *e%oagie, "e p#ne o p#ng& c# g*ia& (a (oc#( p#nciei >n *ipocon$#(
$eptL
- "e an#n& %e$ic#( $ac& ac#5&I $#ee, ge#tate >n eBpiaie, ciano5& $eoaece pot ap&eaI
*e%oagie, peitonit& c*i%ic&L
- pacient#( poate %1nca $#p& 2 oe $e (a efect#aea poce$#iiL
- (a eco%an$aea %e$ic#(#i "e pot a$%ini"ta *e%o"taticeL
- (a ie!ie e"te "f&t#it "& e)ite efot#( fi5ic ?i$icaea ge#t&i(o@ ce( p#in o "&pt&%1n&.
4@ Pa)ti&ipa)$a a'i't$7tului +$,i&al la pu7&*ia (iop'i&: )$7al:
E't$ eco(taea c# a8#to#( #n#i ac $e p#ncie a #n#i fag%ent $in paen*i%#( ena( pent#
eBa%en *i"topato(ogic.
S&opDi7,i&a*iiB
- "ta4i(iea etio(ogiei in"#ficienei ena(eL
- %onitoi5aea "in$o%#(#i nefoticL
- "ta4i(iea ga$#(#i $e afectae >n (#p#" eite%ato" "i"te%ic ?LE0@L
- "#"pici#nea $e neop(a"% ena(.
Mat$)ial$ 7$&$'a)$B
- ace pent# p#ncieL
12+
- "eingiL
- %ateia(e pent# ane"te5ieL
- f(acon c# "o(#ie fiBatoaeL
- c1%p#i c*i#gica(eL
- %ateia(e pent# $e5infecieL
- %&n#!i "tei(eL
- t&)i& ena(&.
- "e info%ea5& a"#pa nece"it&ii i $e#(&ii poce$#iiL
- "e info%ea5& pacient#(#i a"#pa %o$#(#i $e co(a4oaeL
- pacient#( n# %&n1nc& ce( p#in 1. oe >naintea poce$#iiL
- "e e)a(#ea5& te"te(e $e coag#(ae ?ti%p $e poto%4in&, ti%p paia( $e to%4op(a"tin&,
*e%o4(o4in&, *e%atocitL
- "e $ete%in& g#pa "ang)in&L
- p#ncia "e poate face "#4 conto( ecogaficL
- po5iia e"te $ec#4it )enta( c# o pen& "#4 a4$o%en.
E%$&tua)$a pu7&*i$i
- "e face $e5infecia (oc#(#iI egi#nea (o%4a& >n $ept#( $i"c#(#i, inte)ete4a( L1-L2 (a 8
c% $e (inia %e$ian&L
- $ac& n# eBi"t& o contain$icaie, "e pefe& inic*i#( $ept, pent# a e)ita (e5aea "p(inei !i a
#no )a"e %aiL
- "e acope& 5ona c# #n c1%p "tei( $e"c*i" >n cent#L
- pacient#( e"te in)itat "& e"pie !i "& &%1n& >n apneeL
- %e$ic#( eBec#t& p#ncia, a"pi& e"#t#(L
- "e etage ac#( !i "e eBecit& pe"i#ne a"#pa (oc#(#i >nep&t#ii ce( p#in 2. %in#teL
- fag%ente(e $e e"#t#i "e >n$ep&tea5& $in ac pin in"#f(ae $e ae c# "einga !i "e
peg&te"c pent# (a4oato.
- pacient#( &%1ne >n epa#" (a pat ce( p#in 2/ oe >n $ec#4it $o"a(L
- e"te "f&t#it !i a8#tat "& con"#%e (ic*i$e $in a4#n$en&L
- "e ap(ic& p#nga c# g*ea& pent# pe)eniea *e%oagieiL
- "e conto(ea5& f#ncii(e )ita(eL
- >n pi%e(e 2/ oe poate ap&ea o #!oa& *e%at#ieL
- $ac& apae fe4a "a# *e%at#ia $ep&!e!te 2/ oe "e an#n& %e$ic#(L
- $#p& eBtenae, pacient#( e"te "f&t#it "& e)ite efot#i(e fi5ice eBten#ante.
c@ Pa)ti&ipa)$a la pu7&*ia (iop'i&: a u7ui 7o,ul +a+a)
E"te p&t#n$eea #n#i ac "a# toca (a ni)e(#( #n#i no$#( %a%a c# "cop#( $e a eco(ta ce(#(e "a#
#n %ic fag%ent $e (a ni)e(#( e"pecti).
0e efect#ea5& c# "cop#( "ta4i(iii $iagno"tic#(#i !i a con$#itei teape#tice.
13.
'ent# p#ncionaea #no (e5i#ni infac(inice ?foate %ici@, (a ni)e(#( #no %icoca(cific&i,
poce$#a "e ea(i5ea5& "#4 conto( ecogafic.
Mat$)ial$ 7$&$'a)$
- ace "tei(e $e go"i%e 3G1. K 7G1. %% !i (#ngi%e $e 22-,8 %%L
- "eing& $e 1. %(I
- $e5infectant pent# teg#%entI
- co%pe"eL
- (a%e $e "tic(& c#ate, $ege"ateL
- f(acon f&& fiBatoL
- f(acon c# "#4"tan& fiBatoae pent# fag%ent#( $e e"#t eco(tat.
- "e >nc#a8ea5& pacienta eBp(ic1n$#-i c& "ing##( $i"confot e"te poce$#a $e >nep&t#&L
- pacienta e"te a!e5at& >n $ec#4it $o"a( "a# (atea(, c# 4ae(e i$icate $ea"#pa cap#(#i,
pent# a eta(a g(an$a %a%a& pe p(an#( o"o" a( toace(#i.
4ste de competena medicului#
- "e $e5infectea5& teg#%ente(e c# 4eta$in&L
- >n ca5#( #nei fo%ati#ni c*i"tice, acea"ta "e %o4i(i5ea5& c# %1na "t1ng&, "e p#ncionea5&,
"e a"pi&L
- >n ca5#( fo%ai#nii t#%oa(e "o(i$e, p#ncia "e ea(i5ea5& $#p& i%o4i(i5ae c# %1na
"t1ng&L
- $ac& t#%oa e"te %ae "e fac 2-, p#ncii >n (oc#i $ifeiteL
- "e a"pi& c# o fo& %o$eat& pent# a n# eBtage "1ngeL
- $ac& fo%ai#nea e"te c*i"tic& !i "-a eBta" (ic*i$, $#p& centif#gae "e eBa%inea5&
"e$i%ent#( pe (a%&. Fn ca5#( >n cae (ic*i$#( e"te "ang)ino(ent "a# n# "e poate face a"piaie,
%e$ic#( poate eco%an$a 4iop"ia pin eBci5ieL
- "e ea(i5ea5& #n foti#, (a%a "e #"#c& !i "e p(a"ea5& >n f(acon#( go(L
- fag%ent#( eco(tat "e p#ne >n f(acon#( c# "#4"tana fiBatoaeL
- "e eBpe$ia5& po4a (a (a4oatoL
- "e face co%pe"i#ne pent# a n# pe%ite "c#geea (ic*i$#(#i "a# "1nge(#iL
- pent# a pe)eni *e%ato%#(, "e poate ap(ica pe (oc#( >nep&t#ii #n pan"a%ent.
N# "#nt nece"ae >ngi8i& "pecia(& $#p& p#ncie.
6)anta8e(e %eto$ei
- %eto$& "i%p(&, $a $e"t#( $e eBact&L
- neta#%ati5ant&L
- eco(taea $in %ai %#(te (oc#i pe%ite eBp(oaea apoape co%p(et& a (e5i#nii !i o4ineea
#no e5#(tate e$ificatoaeL
- e"te api$&, e5#(tate(e pot fi o4in#te >n c1te)a %in#te K >n ca5 $e (e5i#ne neop(a5ic&,
pacienta e"te in)e"tigat& eBten"i) pent# a$aptaea ce(ei %ai 4#ne con$#ite teape#ticeL
- e5#(tate(e "e coe(ea5& c# ce(e(a(te in)e"tigaii ?eB. c(inic, %a%ogafia, ecogafia@.
De5a)anta8e
131
- "e poate fo%a #n %ic *e%aton (a (oc#( p#nciei.
$@ Pu7& ia (iop'i&: +$,ula):
E"te o4 ineea #n#i fag%ent ci(in$ic >n cae "e con"e)a "t#ct#a %e$#(a&, apot#i(e
$inte ce(#(e, fo(o"in$ #n toca "pecia(.
S&opDi7,i&a ii
- pe%ite e)a(#aea %ofo(ogiei %&$#)ei, e"ti%aea eitopoie5ei i %ie(opoie5eiL
- "ta4i(e te etio(ogia #no po$#c ii ano%a(e $e eitocite, (e#cocite "a# p(ac*eteL
- i$entific& %ie(on#( afecti#ni (i%fo - "a# %ie(o po(ifeati)e, %eta"ta5a %e$#(a&L
- co%p(etaea $ate(o o4 in#te pin p#nc ieL
- ap(a5ie %e$#(a& ?4i(an $e eBten"ie >n (info%#( =o$gOin "a# non-=o$gOin@.
Mat$)ial$ 7$&$'a)$
- toca Ha%"*i$i "a# 9a5a4an$L
- f(acon c# (ic*i$ con"e)ato pent# fag%ent#( eco(tat.
- ge( pent# ane"te5ie (oca(&L
- ace pent# in8ecii "#4c#tanatL
- ace pent# in8ecii inta%#"c#(aeL
- "eingi $e 2. %%L
- f(acon $e Bi(ocaina 2M.
'ent# $e5infecie
- %&n#!i "tei(e $e #nic& fo(o"in&L
- co%pe"e "tei(eL
- pan"a%ent #"catL
- containe pent# ace fo(o"ite.
- "e face conto(#( *e%o"ta5ei >naintea p#ncieiL
- p#ncia nece"it& peg&tie p"i*o(ogic&, $eoaece po$#ce anBietateL
- e"te $#eoa"& !i nece"it& ane"te5ieL
- "e eBp(ic& $e#(aea !i "cop#( p#ncieiL
- #nii pacieni a# ne)oie $e a$%ini"taea #n#i tanc*i(i5ant pent# ce!teea confot#(#iL
- (oc#( pent# p#nc ie e"te cea"ta i(iac&L
- po5i ia pacient#(#i e"te $ec#4it )enta( pe #n p(an $# c# o pen& "#4 a4$o%en, "a#
$ec#4it (atea( c# gen#nc*i f(ecta iL
- pacient#( e"te a)eti5at c& a"pia ia %a$#)ei poate fi $#eoa"&.
- "e )eific& in$icaia %e$ica(&L
- "e peg&te!te (oc#(I "e "pa(&, "e efect#ea5& $e5infeciaL
132
- "e pote8ea5& (oc#( p#nciei c# #n c1%p "tei(L
- "e into$#ce toca#( ta)e"1n$ peio"t#( !i apoi %e$ic#( etage %an$en#(L
- "e a"pi& #n e!antion $in %&$#)& c# a8#to#( #nei "eingiL
- "e p#ne %an$en#( >nainte $e a etage ac#(L
- po$#"#( eBta" "e p#ne pe o "tic(& $e cea"onicL
- a"i"tent#( %e$ica( peia po$#"#( eco(tat !i ea(i5ea5& #n foti# $in e!antion cae )a fi
eBa%inat >nte (a%& !i (a%e(&L
- (a (oc#( >nep&t#ii "e face $e5infecie !i "e ap(ic& #n pan"a%entL
- fag%ent#( eco(tat e"te tan"feat >n f(acon#( c# "#4"tan a con"e)ant&L
- (oc#( p#nc iei "e pe"ea5& fo(o"in$ #n ta%pon i "e ap(ic& #n pan"a%ent "tei( a$e5i).
- pacient#( &%1ne >n epa#" (a patL
- "e o4"e)& (oc#( p#nciei "& n# "1ngee5e, "& n# apa& *e%ato%. 0e poate p#ne o p#ng& c#
g*ea&L
- $#ei(e %o$eate "e co%4at c# ana(ge5iceL
- $ac& $#ei(e "#nt p#tenice, "e an#n& %e$ic#(.
Co+pli&atii po'i(il$
- *e%oagieL
- infec ieL
- fact#& "tena(&L
- >n epaea acci$enta(& a %ai(o )a"e ca #%ae a pefoaii (a%ei o"#(#i.
Capitolul 13 PARTICIPAREA ASISTENTULUI MEDICAL LA EXAMINRI
IMAGISTICE
1..1 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a $Ha+$7$lo) )a,iolo;i&$
A'p$&t$ ;$7$)al$
EBa%e(e(e a$io(ogice "#nt in)e"tigaii i%agi"tice ea(i5ate c# a8#to#( a$iaii(o A, )i4aii
e(ecto%agnetice c# (#ngi%e $e #n$& foate "c#t&, cae a# capacitatea $e a peneta e"#t#i(e !i
$e a po$#ce i%agini "a# #%4e ?>n f#ncie $e $en"itate@ ce pot fi >negi"tate pe fi(% fotogafic.
S&opDi7,i&a*ii
- o4ineea #no info%aii $e"pe ogane, apaate cae "#nt )i5i4i(e c# "a# f&& "#4"tane $e
conta"tL
- "ta4i(iea $iagno"tic#(#i !i "#pa)eg*eea e)o(#iei #no 4o(iL
- %onitoi5aea tata%ent#(#iL
- e)a(#aea $#eii "a# $i"confot#(#iL
- i$entificaea #no ano%a(ii.
Tipu)i ,$ $Ha+$7$
- a$io"copiaL
13,
- a$iogafiaL
- Beoa$iogafiaL
- to%ogafia co%p#tei5at&.
R$'po7'a(ilit:*i
9e$ic#( c(inicianI
- "ta4i(e!te in$icaii(e !i contain$icaii(eL
- eBp(ic& pacient#(#i $e#(aea poce$#iiL
- paticip& (a #ne(e eBa%ene ?eBI =0-@L
6"i"tent#( %e$ica( $in c(inic&
- paticip& (a peg&tiea "pecific& a pacient#(#i pent# eBa%en >n f#ncie $e ogan#( "a#
apaat#( eBa%inatL
- peg&te!te %ateia(e(e cae )o >n"oi pacient#( (a "e)ici#( $e a$io(ogieL
- >n"oe!te pacient#( (a "e)ici#( $e a$io(ogie, "ta4i(e!te %o$#( $e tan"potL
- "#pa)eg*ea5& pacient#( $#p& eBa%enL
- "e peoc#p& $e o4ineea e5#(tate(o pent# a fi pe5entate %e$ic#(#i.
O('$)<a ii
- eBa%ene(e a$io(ogice "e eBec#t& (a "e)icii(e $e a$io(ogie $e c&te pe"ona( "pecia(i5at !i
"pecia( in"t#itL
- a"i"tenii %e$ica(i $in "ecie !i cei $in "e)icii(e $e a$io(ogie te4#ie "& i$entifice eacii(e
$e "en"i4i(itate fa& $e "#4"tane(e $e conta"tI
- eacii $in patea apaat#(#i ca$io)a"c#(aI pa(oae, $iafoe5&, ta*ica$ie "a#
4a$ica$ie, pa(pitaii, ait%ie, e$e% p#(%ona ac#t, !oc, in"#ficien& cai$ac&
conge"ti)&, "top ca$iacL
- eacii $in patea apaat#(#i e"piatoI "t&n#t, t#"e, inoee, J*ee5ing, ci5& $e a"t%
4on!ic, (aingo"pa"%, e$e% (aingian, ciano5&, apnee !i "top e"piatoL
- %anife"t&i c#tanateI eite%, "en5aii $e c&($#&, #ticaie, p#it, $#ei (a (oc#(
in8ect&ii, e$e% angine#oticL
- %anife"t&i ga"tointe"tina(eI gea&, )o%&, g#"t %eta(ic, ca%pe a4$o%ina(e, $iaee,
i(e#" paa(iticL
- %anife"t&i ne#o(ogiceI anBietate, cefa(ee, a%ee(i, )eti8, agitaie, $e5oientae,
"t#poae, co%&, con)#("iiL
- %anife"t&i #inaeI $#ei >n f(anc#i, *e%at#ie, o(ig#ie, a(4#%in#ie, in"#ficien&
ena(& ac#t&L
- a"i"tenii %e$ica(i te4#ie "& acione5e po%pt (a eco%an$aea !i "#4 "#pa)eg*eea
%e$ic#(#i "a# confo% #n#i potoco( "e%nat $e %e$ic.
a@ P)$;:ti)$a pa&i$7tului p$7t)u $Ha+i7a)$a )a,iolo;i&: a 'i't$+ului o't$oa)ti&ula)
S&opB "t#$ieea %ofo(ogiei oa"e(o !i a f#nciona(it&ii #no atic#(aii pent# "ta4i(iea
$iagno"tic#(#i $e (#Baii, fact#&, t#%oi, $i"tofie o"oa"&.
Deoaece oa"e(e "#nt a$iopace, n# "#nt nece"ae %ateia(e "pecia(e.
13/
- "e $e54ac& egi#nea c# peca#ie, $ac& 5ona e"te (e5at&L
- "e >n$ep&tea5& 4i8#teii(e "a# a(te o4iecte a$iopace "a# cae "#nt >n c1%p#( $e eBa%inae
?%&ge(e, (&ni!oae, cea", te(efoane $#p& ca5@L
- "e >n$ep&tea5& pan"a%ente(e, #ng#ente(e cae a p#tea inf(#ena i%aginea a$io(ogic&L
- "e ca(%ea5& $#eea pin a$%ini"taea #n#i ana(ge5ic $ac& >n ti%p#( eBa%en#(#i 5ona
eBa%inat& e"te %o4i(i5at& ?fact#i, (#Baii, inf(a%aii atic#(ae ac#te@L
- $ac& %e%4#( (e5at n# poate fi %enin#t f&& ate(e, "e pot fo(o"i ate(e a$iotan"paenteL
- >n ca5#( a$iogafii(o oa"e(o 4a5in#(#i, (a eco%an$aea %e$ic#(#i "e face o c(i"%&
e)ac#atoaeL
- pacient#( e"te a8#tat "& a$opte >n ti%p#( eBa%in&ii po5iia in$icat& $e %e$ic.
Fngi8iea $#p& eBa%en
- >ngi8ii(e "#nt >n f#ncie $e afeci#nea $e 4a5& !i ac#5e(e pacient#(#i.
4@ P)$;:ti)$a pa&i$7tului i pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a o);a7$lo) to)a&i&$
'oce$#a e"te $e"ci"& (a capito(#( 12 ?12., Toacocente5a@
c@ P)$;:ti)$a pa&i$7tului i pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a tu(ului
,i;$'ti< S&opDi7,i&a*ii
- "ta4i(iea $iagno"tic#(#i >n ga"tite conice, #(ce, ga"to$#o$ena(, t#%oi a(e t#4#(#i
$ige"ti)
- e)i$enieea )aice(o e"ofagiene, *enie *iata(i !i a ef(#B#(#i ga"to-e"ofagian
9e$ic#( a$io(og eBec#t& eBa%en#(.
6"i"tent#( %e$ica(I
- peg&te!te pacient#( confo% eco%an$&i(o %e$ic#(#i c(inicianL
- peg&te!te %ateia(e(e !i >n"oe!te pacient#( (a "e)ici#( $e a$io(ogieL
- >ngi8e!te pacient#( $#p& eBa%en.
0eg%ente(e t#4#(#i $ige"ti) n# "#nt )i5i4i(e a$io(ogic f&& "#4"tan& $e conta"t.
Pa)ti&ipa)$a la $Hplo)a)$a )a,iolo;i&: ;a't)o4i7t$'ti7al: #t)a7>itul (a)itat-
- pacient#( e"te an#nat c# $o#& 5i(e >nainte $e poce$#&L
- "e eBp(ic& pacient#(#i >n ce con"t& eBa%en#(L
- e"te atenionat ca >nainte c# ce( p#in 8 oe !i >n $i%ineaa eBa%en#(#i "& n# %&n1nce, "&
n# f#%e5e ?ce!te "eceia ga"tic&@L
- e"te info%at c& >naintea eBa%en#(#i, 1-2 5i(e te4#ie "& con"#%e #n egi% nef(at#(ent !i
#!o $e $igeat, fo%at $inI "#p&, o#&, p1ine p&8it&, #nt, f&inoa"e, po$#"e (actateL
- "eaa, >n a8#n#( eBa%en#(#i, "e face pacient#(#i o c(i"%& e)ac#atoaeL
- >n $i%ineaa eBa%en#(#i e"te con$#" (a "e)ici#( $e a$io(ogie a)1n$ a"#pa (#i "#4"tana
$e conta"t ?:a0O
/
@L
- e"te atenionat ca >n ti%p#( eBa%en#(#i "& #%e5e in$icaii(e %e$ic#(#iL
132
- e"te info%at c& "#"pen"ia 4aitat& ae g#"t $e cet&.
57;)iAi)$a pa&i$7tului ,up: $Ha+$7ul )a,iolo;i&
- pacient#( e"te info%at c& "ca#n#( ae c#(oae a(4& 1-2 5i(e $#p& eBa%enL
- pacient#( e"te info%at c& e"te po"i4i( "& apa& con"tipa ie, ca5 >n cae "e a$%ini"tea5& o
(ing#& #(ei $e paafin&, "a# #n (aBati)L
- $ac& %e$ic#( eco%an$&, pacient#( e)ine (a "e)ici#( $e a$io(ogie $#p& 2, 8 "a# 2/ oeL
- pacient#( poate "& %&n1nce $#p& 2 oe.
Pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a &olo7ului
Opacifieea "e faceI
- pe ca(e 4#ca(& ?$e"cen$ent&@ $#p& eBa%inaea "eg%ente(o "#peioae ?"to%ac, inte"tin@
"a# $#p& a$%ini"taea #nei $o5e $e "#4"tan& $e conta"t c# 8-1. oe >nainte $e eBa%enL
- pe ca(e a"cen$ent& pin a$%ini"taea "#4"tanei $e conta"t pin c(i"%a 4aitat& (a "e)ici#(
$e a$io(ogie.
- %ateia(e pent# c(i"%a, "on$a "ta#""L
- "#4"tan& $e conta"t $in cae "e peg&te!te "#"pen"ia ?,..-2.. g :a0O
/
G1...-12..%( ap&
#!o >nca(5it& "a# 2.. g :a0O
/
V 4o(#" a(4a ,..gG 1...%( ap& ca($&@.
- e"te an#nat c# 2-, 5i(e >nainte, eBp(ic1n$#-i i%potana e"pect&ii egi%#(#i a(i%enta $e
c#tae ?neeBcitant, nefe%enti"ci4i(, nef(at#(ent@ fo%at $inI 41n5& $e )aci, "%1nt1n&, o#&
fiete, cane "(a4& fiat&, oe5 fiet, paine #"cat&L
- c# o 5i >nainte "e a$%ini"tea5& egi% "e%i(ic*i$, con"#%& #n pa*a $e (ic*i$ pe o& fa&
(actateL
- >n 5i#a eBa%en#(#i pacient#( n# %ananc&, n# 4ea, n# f#%ea5&L
- >n c#"#( $#p&-a%ie5ii "e face o c(i"%& e)ac#atoae !i apoi "e a$%ini"tea5& $o#& (ing#i $e
#(ei $e icin. Fn confo%itate c# potoco(#( #nit&ii "e poate poce$a !i a(tfe(.
- c# e"pectaea no%e(o i%p#"e (a "e)ici#( $e a$io(ogie, c(i"%a "e face pe %a"a $e eBa%en,
"#"pen"ia fiin$ into$#"& (ent pent# a e$#ce "en5aia $e $efecaieL
- "e >nc*i$e ect#( c# "on$a 0ta#""L
- "e efect#ea5& eBa%en a$io"copic ?iigo"copie@ "a# a$iogafic?iigogafie@ p#n1n$#-"e >n
e)i$en& %o$ificai anato%ice ?po(ipi, $o(icoco(on, t#%oi@.
$@ P)$;ati)$a pa&i$7tului 9i pa)ti&ipa)$a la $Ha+i7a)$a &ol$&i'tului 9i &:ilo) (ilia)$
Pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a &ol$&i'tului 9i &:ilo) (ilia)$ p)i7 opa&i%i$)$
i7t)a<$7oa':
;e5ica 4i(ia& !i c&i(e 4i(iae "#nt )i5i4i(e a$io(ogic n#%ai c# "#4"tana $e conta"t cae contine
io$.
133
Mat$)ial$ 7$&$'a)$B
- "#4"tan a $e
conta"t.
'ent# pe)eniea acci$ente(o po$#"e $e "en"i4i(itatea (a io$, "e ia# %&"#i $e pe)entie
peg&tin$ anti *i"ta%inice, ==C, g(#co5& pent# pef#5ie, t#"& pent# pef#5ie, "eingi, ace
pent# in8ectii i.).
'acient#( n# nece"it& peg&tie a(i%enta&.
Te"taea "en"i4i(itatii (a io$ "e face pin ofta(%oeacie "a# pin in8ectae i.). a 1 %( "#4"tan& $e
conta"t. Dac& apa "e%ne $e "en"i4i(itate, o!ea&, e$e% a( feei, cefa(ee, $i"pnee, ge#i,
)&"&t#i "e co%4at c# pef#5ii c# anti*i"ta%inice, pef#5ii c# g(#co5a !i noatina(.
E%$&tua)$a $Ha+$7uluiB
- pacient#( e"te con$#" (a "e)ci#( $e a$io(ogieL
- $aca n# "#nt "e%ne $e "en"i4i(itate, "e a$%ini"tea5& foate (ent, >n $ec#" $e 1. %in#te,
"#4"tan& $e conta"tL
- "e eBec#t& a$iogafii. C&i(e inta*epatice !i eBta*epatice "e opacifia5& >n 12-,. %in#teL
- $ac& n# "e e)i$enia5& c&i(e 4i(iae, (a /. %in#te $#p& te%inaea in8eciei, "e
a$%ini"tea5& 2-, (ing#i "iop $e co$ein&, 2M >nt-o "ing#& $o5&.
Col$&i'to;)a%ia &u opa&i%i$)$
Co(eci"togafia c# opacifiee pe ca(e oa(& pe"#p#ne
- peg&tiea a(i%enta& c# 2-, 5i(e >nainte ?egi% #"o $igea4i(, f&& ce(#(o5& !i #!o
concentate@ ia >n pe5i#a eBa%en#(#i "e a$%ini"tea5& a(i%ente ga"e ?o#&, "%1nt1n&, #nt
c# p1ine@ pent# a fa)oi5a go(iea )e5icii 4i(iaeL
- >nainte $e a$%ini"tae "e face te"taea "en"i4i(it&iiL
- a$%ini"taea "#4"tanei $e conta"t "e face confo% in$icaii(o (&"1n$ ti%p#( nece"a ca
acea"ta "& fie a4"o4it& !i concentat& >n co(eci"t.
O('$)<a
i
EBa%en#( "e face foate a fiin$ >n(oc#it c# ec*ogafie.
e@ P)$;:ti)$a pa&i$7tului i pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a apa)atului
)$7al
E"te eBa%inaea c# a8#to#( a$iaii(o A ae inic*i(o !i c&i(o #inae.
S&opDi7,i&a*iiB
- e)i$enieea cont##(#i inic*i(o, ca)it&i(o pie(oca(icea(e, a c&i(o #inae, pe5ena
ca(c#(i(o a$iopaci "a# a$iotan"paeni a t#%oi(oL
- "ta4i(iea $iagno"tic#(#i >n %a(fo%aii congenita(e, 4oa(a c*i"tic& ena(&.
Tipu)i ,$ $Ha+$7L
- a$iogafia ena(& "i%p(&L
- pie(ogafieL
- #ogafieL
137
- ci"togafieL
- ateiogafie ena(&L
138
- etopne#%opeitone#L
Co%ponente(e apaat#(#i ena( n# "#nt )i5i4i(e f&& "#4"tane $e conta"t.
R$'po7'a(ilit:*iB
9e$ic#( c(inician
- eco%an$& eBa%en#( !i "ta4i(e!te conta in$icaii(eL
6"i"tent#( %e$ica(
- paticip& (a peg&tiea pacient#(#i !i a %ateia(e(oL
- >n"oe!te pacient#( (a "e)ici#( $e a$io(ogie !i >( "#pa)eg*ea5& $#p& aceea.
P ) $;:ti) $a p a&i$7tu lu i p $7 t)u )a, io;)a% ia )$7 al: 'i +p l:
Mat$)ial$ 7$&$'a)$
- c&4#ne %inea(L
- #(ei $e icinL
- %ateia(e pent# c(i"%& e)ac#atoie.
- "e an#n& !i "e eBp(ic& pacient#(#i i%potana eBa%en#(#iL
- "e eBp(ic& pacient#(#i nece"itatea con"#%&ii #n#i egi% a(i%enta !i a #no %e$ica%ente
pent# co%4ateea ga5e(oI
- 2-, 5i(e "e eco%an$a egi% a(i%enta f&& fi4e ?f#cte, (eg#%e, 5a5a)at#i@ !i
nef(at#(ent, f&& ape ga5oa5eL
- >n pe5i#a eBa%en#(#i pacient#( con"#%& #n egi% *i$ic ?"#pe, (i%ona$e, ceai, ap& p(at&@L
- >n "eaa $inaintea eBa%en#(#i con"#%& n#%ai ceai !i p1ine pa8it&L
- >n $i%ineaa eBa%en#(#i n# %&n1nc& !i n# con"#%& (ic*i$eL
- c# $o#& 5i(e >naintea eBa%inaii "e a$%ini"tea5& c&4#ne %e$icina( !i tife%ent c&te 2 t4
$e , oi pe 5iL
- >n "eaa $inaintea eBa%en#(#i "e a$%ini"tea5& 2 (ing#i #(ei $e icin ?"a# a(t p#gati)
eco%an$at@ ia $i%ineaa "e face c(i"%& e)ac#atoaeL
- "e eco%an$& pacient#(#i "&-!i go(ea"c& )e5ica.
0e eBp(ic& pacient#(#i c& eBa%en#( e"te neta#%ati5ant. 'acient#( "te >n"oit (a "e)ici#( $e
a$io(ogie. Fngi8iea $#pa eBa%en n# e"te nece"a&.
P ) $;:ti) $a p a&i$7tu lu i p $7 t)u p i$lo;)a% i$ #u )o;)a% i$ $H&)$ to)i$ -
E"te eBa%inaea a$io(ogic& a inic*i#(#i !i pe()i"#(#i ena(, #etee(o !i )e5icii #inae c#
a8#to#( "#4"tanei $e conta"t a$%ini"tat& pe ca(e inta)enoa"&.
S&opDi7,i&a*ii
- )i5#a(i5aea inic*i(o !i c&i(o #inaeL
- pent# $iagno"ticaea pie(onefitei i a %a(fo%aii(o congenita(e a(e tact#(#i #inaL
- "#"pici#ne $e t#%o& ena(&L
- *ipeten"i#ne ateia(& $e ca#5& eno)a"c#(a&.
13+
Mat$)ial$ 7$&$'a)$
6ce(ea!i ca pent# a$iogafia ena(& "i%p(& (a cae "e a$a#g&I
- "#4"tant& $e conta"t O$i"ton ,.M, 3.M "a# 72ML
- %e$ica%ente $e #gen& >n ca5#( "en"i4i(it&ii (a io$.
- "e face (a fe( ca pent# a$iogafia ena(& "i%p(&L
- pacient#( e"te a)eti5at "& e$#c& inge"tia $e (ic*i$e ?pent# ca "#4"tanta $e conta"t "& "e
concente5e (a ni)e(#( inic*i#(#i@L
- >n $i%ineaa eBa%en#(#i n# %ananc&, n# 4ea pent# a "ca$ea )o(#%#( $e #in&L
- >naintea efect#&ii in8eciei c# "#4"tana $e conta"t "e face c(i"%& e)ac#atoie.
- pacient#( e"te con$#" (a a$io(ogieL
- e"te $e54&cat !i a!e5at pe %a"a >n $ec#4it $o"a(L
- "e ea(i5ea5& o a$iogafie pe go(L
- "e face te"taea (a io$ pin in8ectae (ent i) a 1 %( "#4"tan& $e conta"t ti%p >n cae "e
o4"e)& "taea pacient#(#i pent# a $epi"ta eacia *ipeegica ?o!eaa !i e$e%#( feei,
cefa(ee, $i"pnee, ge#i !i )&"&t#i@L
- $aca apa a"e%ena %anife"tai, a$%ini"taea "e >nte#pe !i "e a$%ini"tea5& %e$icaia $e
#gen&L
- $aca ogani"%#( to(eea5&, "e a$%ini"tea5&I 2.%( O$i"ton 72M (a a$#(i ?"a# 22%( $in
"o(#ie 3.M@, ia (a copii, >n f#ncie $e )1"t& "e a$%ini"tea5& 2-12%( "o(#ie 72ML
- 0e fac a$iogafii (a 1P, 2P, 1.P, 12P, 2.P, ,.P #%&in$ poge"ia "#4"tanei $e (a ni)e(#(
inic*i#(#i >n )e5ica #ina&. 0e go(e!te )e5ica !i "e face >nc& o a$iogafie.
57;)iAi)$a ,up: p)o&$,u):B
- n# "#nt nece"ae >ngi8ii "pecia(eL
- pacient#( e"te "fat#it "& 4ea %#(te (ic*i$e.
P ) $;:ti) $a pa&i$7tulu i p $7 t)u p i$lo;)a% i$ )$t)o ;)a, :
E"te eBa%inaea a$io(ogic& a "i"te%#(#i co(ecto ena( ?ca(ice, pe()i", #ete@ pin in8ectaea
"#4"tanei $e conta"t $iect >n #etee "#4 conto( ci"to"copic.
S&opDi7,i&a*iiB
- eBa%inaea a$io(ogic& a #etee(o pacien i(o (a cae #ogafia e"te contain$icat&L
- "#"pici#ne $e o4"t#cieL
- inic*i nef#nctiona(.
Mat$)ial$ 7$&$'a)$B
- ace(ea!i ca pent# #ogafieL
- "#4"tana $e conta"tI O$i"ton ,.M "a# io$#a $e Na 1.M.
- "e o4ine con"in&%ant#(L
17.
- aceea!i pent# a$iogafia ena(& "i%p(&L
- n# %&n1nc& 8 oe.
- pent# e$#ceea $in"confot#(#i "e poate a$%ini"ta #n "e$ati)L
- "e face ci"to"copie, "#4 conto(#( ci"to"cop#(#i "e into$#c 2-1. %( "#4"tan& $e conta"t #!o
>nc&(5it& pent# fiecae #eteL
- into$#ceea "o(#iei "e face c# pe"i#ne %o$eat&, pacient#( fiin$ "#pa)eg*eat, "e pot
po$#ce #pt#i a(e 4a5in#(#i "a# ef(#B pie(oena(. E"te tan"potat (a a$io(ogie c# tagaL
- "e efect#ea5& a$iogafii $#pa 2 %in#te $e (a in8ectaea "#4"tanei $e conta"tL
- "e >nceac& ec#peaea #nei p&ti $in "#4"tana $e conta"t pin a"piae.
57;)iAi)$a ,up: $Ha+$7B
- "e %onitoi5ea5& "e%ne(e $e "1ngeae "a# infecie. 'i%e(e #ini pot fi o5, $ac& apa
e"angeaea "a# #ina conine c*eag#i "e an#n& %e$ic#(L
- "e #%ae!te e(i%inaea, "e poate in"ta(a eteniaL
- poate ac#5a o 8ena #!oa& >n a4$o%en#( infeio, "en5aie $e pe"i#ne a"#pa )e5icii,
"pa"%e a(e )e5icii #inaeL
- %e$ic#( eco%an$a "#po5itoae anti"pa"tice "a# ana(ge5iceL
- e"te "f&t#it "& con"#%e %#(te (ic*i$e.
P a)ti&ipa)$a pa&i$7tului la &i'tou)$t)o;)a%i$ #&i'to;)a%i$-
E"te eBp(oaea ea$io(ogic& a )e5icii #inae c# "#4"tana $e conta"t.
S&opDi7,i&a*iiB
- in$entificaea etio(ogiei #no afeci#niL
- infecii #inae fec)enteL
- incontinenta #inaaL
- $i"#ie.
M$to,$ ,$ $Ha+i7a)$B
- a$iogafia "i%p(&, f&& "#4"tan& $e conta"t e)i$enia5& ca(c#(ii inta)e5ica(i. n# nece"it&
peg&tieL
- ci"togafia c# "#4"tan& $e conta"t cae "e poate into$#ce pin "on$a8 "a# "e ac#%#(ea5&
>n )e5ic& $#pa #ogafie ?opacifiee $e"cen$ent&@L
- pne#%oci"togafia K )e5ica "e #%p(e (a >ncep#t c# ae !i apoi "e in8ectea5& "#4"tana $e
conta"t.
Mat$)ial$ 7$&$'a)$B
- "on$a )e5ica(& "tei(a Fo(eU "a# Ne(aton "tei(&L
- pen"a pent# c(a%paeL
- "#4"tana $e conta"tI io$#a $e Na 1.M "a# O$i"ton ,.ML
- "einga -#UonL
- %an#!iL
- aci$ 4aic "o(#ii "tei(eL
- %ateia(e(e "e a(eg >n f#ncie $e %eto$&.
171
- "e an#n& pacient#( !i "e eBp(ic& poce$#a i nece"itatea eBa%en#(#iL
- "e go(e!te inte"tin#( go", "e face c(i"%& ?ect#( p(in !i ga5e(e >%pie$ic& )i5i4i(itatea@L
- pacient#( e"te con$#" (a a$io(ogie.
Fn f#ncie $e %eto$&I
- ci"togafia c# "#4"tan & $e conta"t into$#"& pin "on$a8 DONCI
- "e face "on$a8 )e5ica(, "e go(e!te )e5ica !i "e face "p&(&t#& c# aci$ 4oicL
- c# "einga -#Uon "e into$#c >n )e5ic& 1..-2..%( $in "#4"tana $e conta"tL
- "e >nc*i$e pen"aL
- pacient#( e"te #gat "& n# #ine5e $ec1t $#p& "f1!it#( eBa%en#(#iL
- pne#%oci"togafieI
- "e e"t1nge con"#%#( $e (ic*i$e 1.-12 oe >nainteL
- "e go(e!te )e5ica !i "e "pa(&L
- c# "einga -#Uon "e into$#c 1..-12.%( aeL
- "e >nc*i$e "on$aL
- pin >nepaea "on$ei "e in8ectea5& >n )e5ic& "#4"tana $e conta"tL
- opacifieea $e"cen$ent&I
- $#p& #ogafie "#4"tana $e conta"t "e concentea5& >n )e5ic& $#p& 1-2 oe c1n$ "e
poate face a$iogafia.
57;)iAi)$a ,up: p)o&$,u):
- "e eco%an$& con"#%#( #nei cantit&i %ai $e (ic*i$e.
A)t$ )io;)a% ia )$7 al:
E"te eBp(oaea inic*i#(#i pin a$%ini"taea "#4"tanei $e conta"t pin atea ena(& "a#
fe%#a(&.
- peg&tiea pacient#(#i "e face ca pent# ce(e(a(te eBa%in&i ena(eL
- a$iogafii(e "e fac (a 2-, "ec#n$e, 3 !i 8 "ec#n$e $e (a >ncepeea a$%ini"t&ii "#4"tanei $e
conta"t.
P )$;ati)$a pa&i$7tului p$7t)u $Ha+i7a)$a )a, i olo;i &: p )i7 p 7 $u +op $)ito7$u
E"te eBa%en#( a$io(ogic cae e)i$enia5& cont##i(e inic*i(o $#p& into$#ceea ae#(#i >n
"pai#( etopeitona(.
Pa)ti&ipa)$a la $Ha+$7
- ae#( "e into$#ce c# apaat#( $e pne#%otoaBL
- pacient#( n# %&n1nc& >n $i%ineaa eBa%en#(#iL
- >n "eaa pece$ent& "e face c(i"%a e)ac#atoaeL
- %e$ic#( into$#ce >n (o8a ena(a 1...-12.. %( ga5 $#p& cae "e eBec#t& a$iogafiaL
- (a (oc#( p#nciei "e ap(ic& #n pan"a%ent "tei(.
f@ P)$;:ti)$a pa&i$7tului 9i pa)ti&ipa)$a la $Ha+i7a)$a )a,iolo;i&: a 'i't$+ului 7$)<o'
172
Mi$lo;)a%ia
9ie(ogafia con"t& >n eBp(oaea a$iogafic& a conin#t#(#i a*i$ian pin in8ectaea >n "pai#(
"#4aa*noi$ian a #nei "#4"tane $e conta"t io$ate *i$o"o(#4i(e.
6ce"t eBa%en pe%ite "& "e )i5#a(i5e5e c# peci5ie "t#ct#i(e )ete4a(e !i paa)ete4a(e
(o%4ae ?)ete4e, $i"c#i inte)ete4a(e, (iga%ente %#"c#(ae, %&$#)a "pin&ii@. D#p&
into$#ceea "canne-#(#i !i apoi a e5onanei %agnetice, acea"t& te*nic& e"te $in ce >n ce %ai
p#in #ti(i5at&.
I7,i&a*ii i
Co7t)ai7,i&a*ii
In$ica ii
I
- "in$oa%e ne#o(ogice $ete%inate $e o co%pe"i#ne %e$#(a& "a# a$ic#(a&L
- t#%oi cee4a(e "a# ne#o%eningiene ?at#nci c1n$ "canne-#( !i IR9 "#nt
neconc(#$ente@.
Contain$icaiiI
- a(egie (a "#4"tana io$at&L
- *ipeten"i#ne intacanian&.
- "e face ana%ne5a pent# a eBc(#$e #n e)ent#a( i"toic $e a(egie (a io$L
- "e face f#n$#( $e oc*i pent# a eBc(#$e "e%ne(e $e *ipeten"i#ne intacanian&L
- "e p(anific& (a a$io(ogieL
- "e cee pacient#(#i "& &%1n& ne%1ncat >n $i%ineaa eBa%in&iiL
- "e %ontea5& #n cateteG4an#(& pe o )en& peifeic&L
- "e in8ectea5& "#4"tana io$at& >n cana(#( a*i$ian ?O%nipaZ#e@ pin p#ncie a*i$ian&
efect#at& (o%4a, $iect pe %a"a a$io(ogic&L
- $#p& (oca(i5aea a$io"copic& a "eg%ent#(#i con"i$eat "#"pect, "e efct#ea5& a$iogafii
$in 2 p(an#iI anteopo"teio !i pofi(L
- pent# efect#aea >n 4#ne con$iii a %ie(ogafiei "e eco%an$& #ti(i5aea #n#i apaat $e
a$io$iagno"tic pe)&5#t c# %a"& 4a"c#(ant& te(egi$at&, c# inagine a%p(ificat& pin
a%p(ificato#( $e (#%ino5itate c#p(at c# #n %onito T; !i tan"%i"& >n ca4ina $e
co%an$& 4ine pote8at& conta a$iaii(o A.
R$>ultat$
9ie(ogafia p#ne >n e)i$en&I
- fo%a !i $i%en"i#ni(e cana(#(#i "pina(L
- pe%ea4i(itatea ace"t#ia, e)ent#a(e(e o4"taco(eL
- fo%a, $i%en"i#ni(e !i #neoi, c*ia nat#a o4"taco(#(#iL
- pacient#( )a &%1ne (a pat p1n& ce io$#( )a tece >n cic#(aia "i"te%ic& ?2-3 oe@.
1..2 Rolul a'i't$7tului +$,i&al ?7 $%$&tua)$a $Ha+$7$lo) &u i>otopi )a,ioa&tin e)i$en& cantitati)
!i ca(itati) c# a8#to#( $etectoae(o.
Ra$ion#c(i5ii pe5int& afinitate pent# an#%ite ogane, pent# e"#t#i pa&i$7te >n cae "e
fiBea5&.
17,
S&opDi7,i&a*iiB
- $etectaea %o$ific&i(o "t#ct#a(e a(e #no ogane 4a5at& pe eBi"tena #no $ifeene $e
concentaie a %ateia(#(#i a$ioacti) >n te"#t#i(e no%a(e !i ano%a(e >n aii(e "t#$iateL
- )i5#a(i5aea #no ogane !i egi#ni cae n# pot fi )&5#te a$io(ogicL
- $epi"taea t#(4#&i(o pef#5iei ti"#(ae (a ni)e(#( ogane(o !i e"#t#i(oL
- $ifeenieea t#%oi(o %a(igne $e ce(e 4enigneL
- %onitoi5aea e)o(#iei t#%oi(o !i a a"p#n"#i(o (a tata%ente ?ia$iee, c*i%ioteapie@.
4%amenele cu i!otopi se fac numai n departamentul de medicin nuclear#
4%amenele se fac i ambulator#
1acientul are nevoie de informaii preprocedurale i de educaie post procedural#
Substanele marcate cu i!otopi radioactivi se administrea! de ctre personal instruit, la
serviciul de medicin nuclear#
0e fo(o"e"cI
- "#4"tane(e %acate c# i5otopi eco%an$ate pent# #n an#%it tip $e eBa%enL
- "#4"tane cae (i%itea5& fiBaea i5otopi(o >n a(te ogane ?$aca e"te ca5#(@L
- %ateia(e nece"ae a$%ini"t&ii ta"oi(o ?a$ion#c(i5i(o@L
- %ateia(e $e potecie "pecifice "e)icii(o $e %e$icin& n#c(ea&.
- "e eBp(ic& pacient#(#i i"c#i(e !i 4eneficii(eL
- :eneficiiI
- e(i%inaea "#4"tanei a$ioacti)e "e face e(ati) epe$e pin #in& !i feca(eL
- tec*neti#, ce( %ai #ti(i5at ta"o, "e e$#ce $#pa 3 oe !i $i"pae $#pa 2/ oeL
- %eta"ta5e(e "#nt $epi"tate c# 3-12 (#ni >nainteL
- ia$ieea e"te %ai %ic& $ec1t >n ca5#( eBa%in&ii a$io(ogice
- Ri"c#iI
- #n peico( a$ioacti) eBi"t& $a e"te %ini% $eoaece "e fo(o"e"c $o5e foate
%iciL
- #neoi (oca(i5aea t#%oi(o e"te foate $ifici(&, apa cont##i nec(ae $eoaece
e"#t#( no%a( $in 8# a4"oa4e a$ion#c(i$#(L
- "e e)a(#ea5& "taea pacient#(#i pent# a "e "ta4i(i $ac&I
- "e poate $ep(a"a "ing# "a# ae ne)oie $e foto(i# #(antL
- pe5int& con"tangei fi5iceI "on$a, p#ngi $e co(ectae a #inii, (inie )enoa"&, "on$a
na5oga"tic& !i nece"it& peca#iiL
- e"te $ia4etic i te4#ie "& ia %e$ica%enteL
- nece"it& a(te eBa%ene "cintigafice pent# a "ta4i(i o$inea eBec#t&ii ?"cintigafa "e
face >naintea a(to eBa%ene a$io(ogice c# "#4"tane pe 4a5a $e io$@L
- "e in$epatea5& o4iecte(e %eta(ice, 4i8#teii(e $in c1%p#( $e eBa%inaeL
- (a fe%ei(e $e )1"t& feti(& "e face eBa%en#( gineco(ogicL
- $ac& pacienta a(&ptea5& "e apecia5& i"c#i(e i 4eneficii(e. C1n$ eBa%en#( "e
i%p#ne, pacienta n# )a a(&pta 2-, 5i(e.
Pa)ti&ula)it:*i p$7t)u ,i%$)it$ tipu)i ,$ $Ha+$7B
17/
S&i7ti;)a%ia &a),ia&:
I7,i&a*iiI
- infact#( %iocai$L
- e)a(#aea f#nciei )entic#(aeL
- e)a(#aea pef#5iei %ioca$ice.
0e fo(o"e"c tec*neti# ++, ta(i# 2.1 cae "e a$%ini"tea5& i.). c# 12 %in#te "a# / oe >naintea
eBa%en#(#iL
S&i7ti;)a%ia ,$ p$)%u>i$
- in8ectaea "e face >n ti%p#( efot#(#i a #n#i a$iota"o ?tec*neti# ++ %(, ta(i# 2.1@L
- >negi"taea "e face c1te)a %in#te %ai t15i#L
- "t#$ia5& f#ncia $e po%p& ca$iac& !i %o$ificaea peete(#i %ioca$ic.
S&i7ti;)a+a i7%)a&tului +io&a),i&
- "e ea(i5ea5& c# tec*neti# ++ %L
- (oca(i5ea5& (e5i#nea, $i%en"i#nea !i eBtin$eea (a 2/-+3 oe $e (a $e4#tL
- pent# a faci(ita eBceia 4i(ia& a a$iota"o#(#i "e a$%ini"tea5& (apte $#p& in8ecia c#
tec*neti# ?i5oniti(@.
- n# %&n1nc& ce( p#tin / oeL
- n# f#%ea5& ce( p#in /-3 oeL
- "e >nte#pe %e$icaia ?c# aco$#( %e$ic#(#i@ ce( p#in c# 2/ oe >nainteL
- e"te info%at c& te"t#( $#ea5a >n %e$ie ,. %in#teL
- te4#ie "& con"#%e %#(te (ic*i$e pent# a fa)oi5a e(i%inaea ta"o#(#i.
S&i7ti;)a%ia &u ;aliu
0t#$ia5& eBi"tenta #no 4o(i inf(a%atoii ?pne#%onie, pie(onefit&, T:C, t#%oi
4eningneG%a(igne@I
- "e face c(i"%a e)ac#atoieL
- "e in8ectea5& ga(i#L
- $#pa /-3 oe "e "canea5& >nteg cop#( fiin$ a!e5at a(tenati) >n $ec#4it $o"a(, )enta( !i
(atea(L
- "e face eeBa%inae $#pa 2/, /8 !i 72 $e
oe. Te"t#( $#ea5& ,.-3. %in#te.
S &i7 ti;)a% ia = $p ato(il ia):
Fo(o"e!te ca a$iota"o tec*neti# ++% a$%ini"tat i.).
6pecia5& f#ncii(e ficat#(#i !i )e5icii 4i(iae, pe%ite )i5#a(i5aea )e5icii 4i(iae, i$entific&
$i"f#ncia "fincte#(#i O$$i.
'ent# "ti%#(aea contac iei a%p#(ei ;ate "e a$%ini"tea5& i.). %ofin& "#(fat cae epo$#ce
"i%pto%ato(ogia tipic& co(icii 4i(iae.
Rit%#( o4ineii i%agini(o $epin$e $e pe5enta "a# a4"ena )i5#a(i5&ii )e5icii 4i(iae, $#ct#(#i
4i(ia co%#n "a# $#o$en#(#i.
S&i7ti;)a%ia = $p ato'p l$7i &:
D& e(aii c# pi)ie (a po5iie, fo%& !i $i%en"i#ni(e no%a(e.
172
'oate $etecta t#%oi %eta"ta5e *epatice !i "p(enice, ta#%ati"%e *epatice "a# "p(enice, cio5a
*epatic&.
'oce$#a con"t& >n a$%ini"taea i.). a #n#i a$iota"o ?a(4#%ina co(oi$a(& %acat& c# "#(f#&
$e te*neti#@. Cea %ai %ae pate $e a$io n#c(i$ "e concentea5& >n ficat.
N# nece"it& peg&tie pepoce$#a(& !i >ngi8ie $#p& eBa%en.
S&i7ti;)a%ia &u o&t)$oti,
0e ea(i5ea5& pent# i$entificaea !i (oca(i5aea t#%oi(oG%eta"ta5e(o ne#oen$ocine,
%onitoi5aea t#%oi(o
ne#oen$ocine.
Fo(o"e!te octeoti$ ?#n ana(og $e "o%ato"tatina, %acat c# I
12,
"a# Ii$i#
111
@.
9e$ic#( "ta4i(e!te $ac& e ca5#( "& "e >nte#p& tata%ent#( c# ce( p#in 2 "&pt&%1ni >naintea
eBa%in&ii.
- ti%p $e , 5i(e "e a$%ini"tea5& pacient#(#i c1te 2 pic&t#i L#go( pent# a pe)eni captaea
n#c(i$#(#i $e c&te
tioi$&L
- "e a$%ini"tea5& a$ion#c(i$#( i.).L
- $#p& o o& "e "canea5& >nteg cop#( c# $etecto#( $e a5e. 'acient#( "e a!ea5& "#cce"i) >n
$ec#4it $o"a(, (atea(, )enta( !i "e o4in fi(%eL
- $#p& 2 oe "e $& #n p1n5 ga", pent# a faci(ita eBceia
4i(ia&L
- $#pa / oe "e a$%ini"tea5& #n p#gati)L
- "e epet& "canaea (a 2,/, 2/, /8 $e oe $#p&
in8ectae.
S &i7 ti;)a% ia o'o
a':
- e)i$enia5& pe5ena neop(a"%e(o "a# %eta"ta5e(o o"oa"e, fact#i(o, 4o(ii ato5ice,
po(iatitei e#%atoi$e, o"teo%ot(itei, neco5ei o"oa"e, 4o(ii 'aget. 'e%ite $iagno"ticaea !i
e)a(#aea eBten"iei fact#i(o, neop(a"%e(o !i %eta"ta5e(o o"oa"eL
- "e fo(o"e te tec*neti#% ++, cae "e a$%ini"tea5& i.). c# 1-, oe >nainte $e
>negi"taeL
- pacient#( )a fi c#(cat >n $ec#4it $o"a( !i "canatL
- "e "f&t#ie!te pacient#( ca >nte in8ectae !i eBa%inae "& 4ea ce( p#in 2 (iti $e ap& pent#
e(i%inaea ta"o#(#i
- "canaea $#ea5& ,.-3. %in#te.
S &i7 ti;)a% ia p a)ati)oi,
ia7 :
E)i$entia5& a$enoa%e, cancee, *ipep(agia $e
paatioi$&.
Fo(o"e!te 2 %eto$e "cintigafice a$%ini"tate c# tec*neti#% ++% !i io$ 1,1 !i cea $ea $o#a n#%ai
c# tec*neti#%.
Fnegi"taea i%agini(o "e face $#p& 12 %in#te !i e"pecti) , oe $e (a
in8ectae.
173
N# "e a$%ini"tea5& "#4"tante $e conta"t cae coin io$ pent# c& %o$ific& e5#(tate(e.
S &i7 ti;)a% ia pu l+o7 a): , $ p$)% u
>i$D<$7 tila*i$
0e o4ine con"i%&%1nt#( "ci" a(
pacient#(#i.
Fn '&i7ti;)a%ia ,$ p$)%u>i$ "e a$%ini"tea5& i.). a(4#%ina, %acat& c# a$iota"o.1'acient#( e"te
a!e5at pe an$ >n $ec#i4t $o"a(, (atea( !i )enta( ti%p >n cae $etecto#( $e a5e >negi"tea5& pe
fi(%e a$io(ogice.
177
S&i7ti;)a%ia ,$ <$7tila*i$ fo(o"e"te Aenon 1,, "a# Nipton 81% cae "e in*a(ea5&.
0e >n$ep&tea5& toate 4i8#teii(e "a# o4iecte(e %eta(ice $in 8##( toace(#i.
S &i7 ti;)a% ia )$7 al:
E)a(#ea5& "t#ct#a !i f#ncia ena(&, $etectea5& %a(fo%aii congenita(e, t#(4#&i $e cic#(aie
ena(&, t#%oi ena(e.
Tip#i $e "cintigafii ena(eI
- "cintigafia $e pef#5ieL
- "cintigafia "t#ct#a(&L
- enoga%& ?"t#$ia5& captaea i eBceia #no "#4"tane c# cae apecia5& &"p#n"#(
ten"i#nii ateia(e (a tata%ent@L
Ra$iota"o#( "e in8ectea5& i.).
0e fo(o"e!te tec*neti#% ++%.
Fnaintea te"t#(#i pacient#( te4#ie "& 4ea ce( p#in 2 pa*ae $e ap& !i "& #ine5e.
D#ata te"te(o )aia5a >nte 1-/ oe.
D#pa te"t pacient#( te4#ie "& 4ea %#(te (ic*i$e pent# e(i%inaea "#4"tanei a$ioacti)e.
Te"t#( e"te "(a4 ia$iant, ne$#eo".
S &i7 ti;)a% ia ti)oi, ia7 :
E)i$entia5&I a$eno%#(, cance#(, tioi$ita, 4oa(a -a)e", *ipe !i *ipo tioi$ia.
0e fo(o"e!te Tec*neti#% ++%.
La pacienii c#no"c#i c# cance $e tioi$& (a cae "-a ap(icat tata%ent, eBa%en#( "e face an#a( c#
io$ 12, pent# a i$entifica e)ent#a(e(e %eta"ta5e.
C# c1te)a "&pt&%1ni >nainte pacient#( n# face eBp(o&i c# "#4"tane io$ate, n# con"#%&
a(i%ente cae conin io$.
C# a)i5#( %e$ic#(#i pacient#( >nte#pe #ne(e tata%ente c# antit#"i)e, po(i)ita%ine,
antitioi$iene cae pot inf(#ena f#ncia tioi$ian&.
S &i7 ti;)a% ia +a +a):
0e fo(o"e!te at#nci c1n$ %a%ogafia n# e"te conc(#$ent& !i pent# "ta$ia(i5aea cance#(#i.
Ra$iota"o#( ?tec*neti# ++%@ ae afinitate pent# gang(ionii aBi(ai, %eta"ta5a(i.
- in8ectaea "#4"tanei "e face >n "1n#( conto(atea( "1n#(#i "#"pectL
- >negi"taea "e face $#p& 1. %in#te $e (a in8ectaeL
- n# "e efect#ea5& poce$#a >naintea %en"te(o $eoaece "e po$#ce o *ipep(a5ie 4enign&
!i ce!te captaeaL
- pent# a faci(ita eBceia #ina& e"te nece"a& ce!teea con"#%#(#i $e (ic*i$e
4ste recomandat ca persoanele care au efectuat e%amene cu i!otori$
- S nu vin n contact cu copiii :; ore&
- S nu consume o cantitate mare de ap&
- "up folosirea Ac+ului s trag apa de :+5 ori#
1.., Pa)ti&ipa)$a a'i't$7tului +$,i&al la $Ha+$7ul &u ult)a'u7$t$ #$&=o;)a%i&$-
U(ta"onogafia e"te eBa%inaea nein)a5i)& pent# )i5#a(i5aea "t#ct#i(o $in e"#t#i(e %oi a(e
cop#(#i, pin >negi"taea ef(ect&ii #n$e(o "onoe >n$eptate c&te e"#t#i.
S&opDi7,i&a*iiB
178
- )i5#a(i5aea >n ti%p ea( a ogane(o a4$o%ina(e ?aota a4$o%ina(&, ficat, )e5ic& !i
cana(e(e 4i(iae, pancea"#(, inic*i, #etee(e, )e5ica #ina&@L
- e)a(#aea %oti(it&ii #no ogane, a fo%ei, $i%en"i#ni(o, po5iieiL
- e)a(#aea #no "t#ct#i "(a4 )i5#a(i5ate a$io(ogic "a# inacce"i4i(eL
- "ta4i(iea $iagno"tic#(#i $e "acin&, #%&iea it%#(#i $e ce!tee a "acinii, "acini
%#(tip(e, %a(fo%aii feta(e.
Mat$)ial$ 7$&$'a)$B
- ge( pent# ea(i5aea contact#(#i c# teg#%ent#(L
- po"op teBti( "a# $e *atie pent# >n$ep&taea ge(#(#i.
- "e pe5int& pacient#(#i a)anta8e(e !i $e5a)anta8e(e.
6)anta8eI
- n# pe5inta i"c $e a$iaiiL
- peg&tiea e"te %ini%&L
- n# nece"it& "#4"tane $e conta"tL
- n# inf(#entea5& f&t#(, "e poate epeta f&& i"cL
- n# nece"it& "pita(i5ae, "e poate efect#a a%4#(atoi#.
De5a)anta8eI
- n# pot fi eBa%inate "t#ct#i(e p(ine c# ae ?p(&%1n, inte"tin@L
- (a pacienii o4e5i #n$e(e #(ta"onoe "#nt aten#ate.
- "e eBp(ic& te*nica poce$#ii, %o$#( $e co(a4oaeL
- "e c#(eg info%aii $e"pe e)ent#a(e(e a(egii (a (ateBL
- "e ia# %&"#i pent# >n$epataea ga5e(o $ac& "e >ntep#ne >n fa& f(#B#(#i #n$e(oL
- "e in"pectea5& 5ona pent# a n# eBi"ta (e5i#ni ?ge(#( "e ap(ic& pe pie(ea integ&@
- "e ia# %&"#i pent# a"ig#aea i%o4i(it&ii copii(oL
- #ne(e eBa%ene nece"it& po"t a(i%enta !i >nte#peea f#%at#(#iL
- eBa%ene(e a$io"copice c# 4ai# "e fac >naintea ecogafiei.
- "e a!ea5& >n po5iie a$ec)at& eBa%en#(#iL
- "e a"ig#& contact#( pe%anent >nte tan"$#cto !i teg#%ent.
E &o;)a% ia t)a7 '$'o% a;ia7 :
EBa%en en$o"copic !i #(ta"ono pent# )i5#a(i5aea co$#(#i $in po5iia etoca$iac& e(i%in1n$
intefeene(e c# a(te "t#ct#iI e"#t "#4c#tanat, oa"e(e toace(#i, p(&%1ni.
9e$ic#( p(a"ea5& tan"con$#cto#( ecogafic >n e"ofag c# a8#to#( en$o"cop#(#i.
'acient#( n# te4#ie "& %&n1nce ce( p#in 8 oe.
- "e %ontea5& #n catete inta)eno"L
- "e "e$ea5& pacient#(L
- "e ap(ic& e(ecto5i pent# EC-, "e %onitoi5ea5& co$#(L
- "e %onitoi5ea5& T6 pin ap(icaea #nei %an!ete a ten"io%et#(#iL
17+
- "e %ontea5& #n p#("oBi%et#L
- "e a!ea5& pacient#( >n $ec#4it (atea( "t1ngL
- "e ane"te5ia5& fainge(e !i "e into$#ce en$o"cop#( pin ca)itatea 4#ca(& p1n& (a e"ofagL
- "e face eBa%inaeaL
- "e %onitoi5ea5& atent pacient#( >nc& o o&L
Ecogafia tan"e"ofagiana poate )i5#a(i5aI infact#( %ioca$ic, ca$o%iopatia, $efecte "epta(e.
E &= o;)a% ia t)a7 'to)a&i& :
'e%ite )i5#a(i5aea !i apecieea f#ncii(o co$#(#i.
- pacient#( e"te a!e5at >n $ec#4it $o"a(L
- "e ap(ic& pe toace #n ge( cae "& faci(ite5e tan"%iteea #(ta"#nete(oL
- "e eBa%inea5& co$#(L
- "e >n$epatea5& ge(#(.
N# nece"it& >ngi8ie $#p& poce$#&.
E &= o;)a% ia a(, o+i7 al:
'e%ite )i5#a(i5aea aotei a4$o%ina(e ficat#(, )e5icii !i c&i(o 4i(iae, pancea"#(#i, inic*i(o,
#etee(o !i )e5icii #inae.
N# nece"it& "#4"tan& $e conta"t, poce$#a e"te #ti(& pent# fe%ei(e ga)i$e, pacieni a(egici "a#
c# in"#ficien& ena(&.
'acient#( n# %&n1nc& >naintea te"t#(#i.
'o5iia pacient#(#i e"te >n f#ncie $e ogan#( )i5at, $e o4icei $ec#4it $o"a(.
'e5ena ga5e(o !i 4ai#(#i >n a4$o%en $i"to"ionea5& i%aginea.
E&=o;)a%i$ Doppl$) a)t$)io4<$7 oa':
E)a(#ea5& pe%ea4i(itatea )a"e(o $e "ange, $iecia !i )ite5a f(#B#(#i "ang)in, #(ta"#nete(e fiin$
ef(ectate $e eitocite.
- "e $e"cope& %e%4e(e $e in)e"tigat !i "e ap(ic& ge(#( con$#ctoL
- f(#B#( )eno" poate fi epo$#" ca #n "#net #ie&to ?$ac& )ena e"te to%4o5at& n# "e
pecepe nici #n 5go%ot@L
- 5one(e $e oc(#5ie !i ga$#( $e o4"t#cie "#nt i$entificate pin "canae D#p(eBL
'ent# eBa%en#( atee(o "e poate opi cic#(aia )enoa"& pin ap(icaea %an ete(o $e
ten"io%et# (a coap"&, ga%4&, i g(e5n&L
- tan"$#cto#( "e p(a"ea5& i%e$iat "#4 %an!eta #%f(at& ?pe"i#nea fiin$ (a #n ni)e( "#peio
T6 "i"to(ice >negi"tate >n eBte%intatea no%a(&@L
- "e e(i4eea5& (ent pe"i#nea $in %an!et& !i "e notea5& )a(oaea cea %ai %ae a T6 (a cae
apae a"pect#( caactei"tic $e "e%na( Dopp(e !#ieatoL
- poce$#a "e epet& pent# fiecae ni)e(.
EHa+$7ul $&=o;)a%i& ,upl$H al a)t$)$lo) &a)oti,$
;i5#a(i5ea5& atee(e caoti$e, %&"oa& a%ptit#$inea p#("#(#i caoti$ian, apecia5& )ite5a !i
$iecia f(#B#(#i "ang#in.
- pacient#( e"te a!e5at >n $ec#4it $o"a( c# cap#( fiBat pent# a >%pie$ica %i!caea (atea(&L
18.
- "e ap(ica ge(#( !i "e face eBa%inaeaL
- te"t#( e)i$enia5& oc(#5ia "a# "teno5a ateei caoti$e.
E"te in$icat ca at#nci c1n$I
- eBi"t& "e%ne ne#o(ogice ?t#(4#&i ac#te $e )o4ite, $e )e$ee, "e%i-pae5&, pae"te5ii,
atac#i i"c*e%ice tan5itoii@L
- pacient#( ac#5& cefa(eeL
- "e pecep "#f(#i pe atea caoti$&.
E &= o;)a% ia p
$l<i7 :
D& e(aii a"#pa pe5enei !i e)o(#iei "acinii !i a"#pa pato(ogiei apaat#(#i genita( (a fe%ei.
0e poate ea(i5a pe $o#& c&iI
- a4$o%ina(&L
- )agina(&.
E&=o;)a%ia ?7 o('t$t)i&
:
D& e(aii a"#pa eBi"tenei "acinii, (oc#(#i $e ni$aii ?ca)itatea #tein& "a# >n afaa ace"teia@,
in"eii p(acentae ?p(acenta pae)ia, "acina #nic& "a# %#(tip(&, pe5enta ie, )1"ta "acinii,
a"#pa $e5)o(t&ii >n apot c# )1"ta "acinii, fei %aco5o%i "a# eta$ $e ce!tee inta#tein&@.
Te"t#( e"te inofen"i) pent# f&t.
Fn pi%#( ti%e"t#, ec*ogafia "e ea(i5ea5& pe ca(e tan")agina(&, >n ti%e"t#( 2 !i , "e pefe&
ca(ea a4$o%ina(&.
'acienta "e a!ea5& >n $ec#4it $o"a(.
Cal$a a(,o+i7al: nece"it& #neoi )e5ic& p(in& pent# a "e p#tea $ifeenia $e "ac#( ge"tiona(.
Dac& )e5ica e"te goa(& c# o o& >naintea eBa%en#(#i "e ofe& pacientei , pa*ae %ai $e apa !i
e"te #gata "a n# %ictione5e p1n& (a te%inaea eBa%en#(#i.
Fn ti%e"t# 2 !i , $e "acin& pe5ena "c*e(et#(#i feta( pe%ite 4io%etia !i $epi"taea #no
e)ent#a(e ano%a(ii.
Efect#aea eBa%en#(#i pe"#p#ne ap(icaea ge(#(#i pe 5ona a4$o%ina(&.
Cal$a <a;i7al: n# nece"it& peg&tie, )e5ica poate fi goa(&.
0on$a )agina(& e"te pe)&5#t& c# #n capi on cae conine #n ge( apo", f&& "& "e >ntep#n& ae
>nte eBte%itatea "on$ei !i capi on.
9eto$a "e pefea >n ca5#( pe"oane(o o4e5e, c# %#(tip(e cicatici a4$o%ina(e.
E&= o;)a% ia p $l<i7 : ?7
;i7$&olo;i$
0e efect#ea5& $e eg#(& pe ca(e tan")agina(a.
'e%ite )i5#a(i5aea #te#(#i !i a o)ae(o ?fo%&, "t#ct#&, po5iie@.
To%pe(e n# "#nt )i5i4i(e $ec1t >n ca5#i pato(ogice.
E"te #ti(& pent# $iagno"ticaea fi4o%#(#i #tein, po(ipi(o, c*i"t#i(o $e o)a, e)i$enieea
a4$o%en#(#i >ngo!at, i$entificaea cancee(o.
E &= o;)a% ia , $ p )o'tat: 9i )$&t la
( :)( a*i
'e%ite e)a(#aea po"tatei, )e5ic#(e(o "e%ina(e, ect#(#i !i e"#t#(#i peiecta(.
181
- "e face o c(i"%& e)ac#atoie c# apoBi%ati) o o& >nainte, pe5ena %ateii(o feca(e poate
a(tea )i5#a(i5aeaL
182
- pacient#( e"te a!e5at >n $ec#4it (atea( "t1ng "a# $ec#4it $o"a(L
- pent# eBa%inaea en$oecta(& apaat#( e"te p(a"at >nt-#n "ac $e (ateB (#4ifiat.
EBp(oaea poate )i5#a(i5aI
- *ipetofia 4ening& $e po"tat&, cance#( $e po"tat& "a# ect, po"tatita, t#%oae $e
)e5ic#(e "e%ina(e.
E&=o;)a%ia '&)otal:
'oate )i5#a(i5a t#%oi te"tic#(ae 4eninge "a# %a(igne, o*ita, *i$oce(#(, )aicoce(#(,
epi$i$i%#(, *enia "cota(a, cipto"*i$ia, infact#( te"tic#(a, to"i#nea te"tic#(aa.
0e poate fo(o"i pent# g*i$aea ac#(#i $e 4iop"ie >n ca5#( #nei "#"pici#ni $e cance $e te"tic#(.
Te"t#( e"te neta#%ati5ant, n# nece"it& peg&tie "pecia(&, "e poate face >n oice %o%ent a(
5i(ei, $#ea5& apoBi%ati) 2. %in#te.
E &= o;)a% ia ti)oi, ia7 :
Difeenia5& c*i"te $e no$#(i tioi$ieni, %onitoi5ea5& &"p#n"#( (a tata%ent, poate fi fo(o"it& !i
(a ga)i$e.
'acient#( e"te a!e5at >n $ec#4it $o"a( c# cap#( >n *ipeeBten"ie.
N# nece"it& peg&tie "pecia(&.
E&=o;)a%ia o&=iului
'e%ite eBa%inaea p&i(o eBteioae at#nci c1n$ %e$ii(e tan"paente "#nt opace !i e"te #ti(& >n
#%&iea $e5(ipiii $e etin&.
E &= o;)a% ia +a +a ): K eBa%en f&& i"c pe%ite "t#$ieea "t#ct#i(o "1n#(#i,
$ece(ea5& fo%ai#ni t#%oa(e c# $ia%et#( %ai %ae $e 1 c%.
Face $ifeenieea >nte fo%ai#ni c*i"tice !i t#%oa(e ?t#%oi "o(i$e "a# (ic*i$e@, ofe& citeii
"e%io(ogice pent# %a(ignitate "a# 4enignitate, pe%ite g*i$aea p#nciei cito(ogice.
Capitolul 11 PARTICIPAREA ASISTENTULUI MEDICAL LA EXAMENE
ENDOSCOPICE
11.1 A'p$&t$ ;$7$)al$
EBa%ene(e en$o"copice epe5int& )i5#a(i5aea !i eBa%inaea $iect& a ogane(o "a# ca)it&i(o
c# a8#to#( en$o"coape(o K apaate c# fi4e optice !i #n "i"te% $e (enti(e ata!ate #n#i t#4 f(eBi4i(
"a# igi$.
4ndoscopiile sunt de competena medicului#
S&opDi7,i&a*ii
- eBa%inaea ca)it&i(o !i ogane(o pent# "ta4i(iea $iagno"tic#(#iL
- efect#aea #no %ane)eGinte)enii c*i#gica(eL
- eco(taea #no fag%ente $e te"#t in )e$eea 4iop"ieiL
Tipu)i ,$ $Ha+$7$I
- ato"copiaL
- 4on*ofi4o"copiaL
- ci"to"copiaL
- co(po"copiaL
18,
- co(ono"copiaL
- e"ofagoga"to$#o$eno"copiaL
- *i"teo"copiaL
- (apao"copiaL
- %e$ia"tino"copiaL
- ecto"ig%oi$o"copiaL
- toaco"copia.
R$'po7'a(ilit: i
B
9e$ic#(I
- "ta4i(e!te in$icaii(eL
- i$entific& e)ent#a(e contain$icaiiL
- eBp(ic& pacient#(#i $e#(aea eBa%in&iiL
- o4ine con"i%&%1nt#( info%atL
- efect#ea5& eBa%inaea.
6"i"tent#( %e$ica(I
- peg&te te %ateia(e(e pent# eBa%enL
- paticip& (a peg&tiea pacient#(#iL
- >n"oe!te pacient#( (a (a4oato#( $e en$o"copieL
- a"ig#& po5iia pacient#(#i >n ti%p#( eBa%en#(#iL
- "#pa)eg*ea5& "taea pacient#(#i !i info%ea5& %e$ic#( c# pi)ie (a %o$ific&i(e
o4"e)ateL
- peia po$#"e(e eco(tate ?$ac& e"te ca5#(@ (e etic*etea5& !i (e >naintea5& (a4oato#(#iL
- >ng8ie!te !i "#pa)eg*ea5& pacient#( $#p& eBa%en.
O('$)<a i
i
Fn f#ncie $e ogani5aea "e)ici#(#i #ne(e "acini "#nt >n$ep(inite $e a"i"tent#( $in "ecia c#
pat#i, a(te(e $e ce( cae (#cea5& (a (a4oato#( $e en$o"copie.
11.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a $'o%a;o;a't)o,uo,$7o'&opi$i
E"ofagoga"to$#o$eno"copia e"te eBa%inaea en$o"copica a poi#nii "#peioae a t#4#(#i
$ige"ti) ?e"ofag, "to%ac, $#o$en@.
'oate fi eBa%inat& n#%ai o poi#ne ?e"ofago"copie, ga"to"copie, $#o$eno"copie@ "a# toate ce(e
, "eg%ente.
S&opDi7,i&a*iiB
- "ta4i(iea $iagno"tic#(#i >n t#%oi 4enigne "a# %a(igne, *enia *eata(&, e"ofagita, ga"tit&,
$#o$enit&, )aice e"ofagieneL
- $iagno"ticaea infeciei c# *e(ico4acte pU(oiL
- 4iop"ia fo%a i#ni(o "#"pecteL
- e)a(#aea $#&a $ige"tia $e "#4"tane coo5i)eL
- i$entificaea "#"ei $e "1ngeaeL
- inte)enia c*i#gica(& c# a8#to#( (a"e#(#i.
Mat$)ial$ 7$&$'a)$
18/
- fi4o"cop (#ng f(eBi4i( pe)&5#t c# , cana(e ?#n cana( pent# )i5#a(i5ae, #n#( pent#
in"#f(ae $e ae, !i a"piae $e (ic*i$, i a( tei(ea pent# into$#ceea $i)e"e(o aneBe "a#
in"t#%ente@L
- aneBe(e fi4o"cop#(#iL
- ecipiente pent# eco(t&iL
- f(acoane c# "o(#ie con"e)ant& $aca "e face 4iop"ieL
- %e$ica%ente pent# ane"te5ie !i pent# co%4ateea acci$ente(o confo% eco%a$&ii
%e$ic#(#iI Bi(ocaina "paU, "to%acaina "paU, no)ocaina 1M, Bi(ina pent# 4a$i8onae
(oca(&L
- %ateia( $e potecieI %a!ti, oc*e(ai, !ot#i i%pe%ea4i(eL
- co%pe"e "tei(eL
- %an#!i "tei(eL
- t&)i& ena(&.
- >ncepe $in %o%ent#( an#n&ii nece"it&tii eBa%en#(#iL
- "e >nc#a8ea5& pacient#(, "e (&%#e"c #ne(e te%eiL
- "e eBp(ic& %o$#( $e $e#(ae a poce$#ii !i $e coopeaeL
- $ac& "e eco(tea5& pent# 4iop"ie e"te nece"a #n 4i(an a( *e%o"ta5eiL
- %e$ic#( te4#ie "& "e a"ig#e c& pacient#( n# ia anticoag#(ante "a# antiageganteL
- pacient#( e"te an#nat c& >n "eaa $inainte !i >n $i%ineaa eBa%en#(#i "& n# %&n1nceL
- $ac& f#ncia e)ac#atoie a "to%aca#(#i e"te >ncetinit&, >n "eaa pe%eg&toae eBa%en#(#i
"e face o "p&(&t#a ga"tic&L
- "e a$%ini"tea5& %e$icaie pepoce$#a(& (a pacient#( aBio" ?"eaa !i $i%ineaa@ confo%
in$icaiei %e$ic#(#i.
- eBa%inaea "e face >n (a4oato#( $e en$o"copieL
- pacient#( e"te a!e5at pe %a"& >n $ec#4it (atea( "t1ngL
- "e "e)e"c %e$ic#(#i %ateia(e nece"ae pent# ane"te5ieL
- "e into$#c fi4o"cop#( >ncet p1n& >n "to%acL
- pent# )i5#a(i5ae ca)it&i(o $ige"ti)e "e in"#f(& aeL
- "e eBp(oea5& fiecae "eg%entL
- (a "f1!it#( poce$#ii "e a"pi& eBce"#( $e ae !i "eceii(e ga"tointe"tina(eL
- po$#"e(e eco(tate "e peg&te"c pent# (a4oato.
- pacient#( &%1ne "#4 "#pa)eg*ee (a (a4oato#( $e en$o"cpie ,. %in#teL
- n# %&n1nc&, n# 4ea 2 oe p1n& (a e"ta4i(iea ef(eB#(#i $e $eg(#tiieL
- e"te po"i4i( "& ac#5e #!oa& $i"fagie !i $i"fonieL
- e"te info%at c& %ani"fe"t&i(e $i"pa, "e eco%an$& gaga& !i in*a(aii c# %ento(L
- "en5aia $e 4a(onae e"te no%a(& $#p& e"ofagoga"to$#o$eno"copie. Daca n# $i"pae,
pacient#( n# e(i%in& %#c#"#( !i ae#(, ac#5& $#ei "e an#n& %e$ic#( cae poate "&
eco%an$e a"piaie c# "on$a ga"tic&L
- "e "#pa)eg*ea5& "ca#n#(L
182
- "e %&"oa& te%peat#aL
- "e o4"e)& e"piaiaL
- ac& apa "1ngeae, fe4& "a# $#ei a4$o%ina(e "e an#n& %e$ic#(.
11., Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a &olo7o'&opi$i
Co(ono"copia e"te eBa%en#( )i5#a( $iect a( co(on#(#i c# a8#to#( #n#i co(o"cop f(eBi4i(, (#ng $e
1,2.182 c% cae pe%ite o4"e)aeaG)i5#a(i5aea co(on#(#i "ig%oi$, $e"cen$ent, tan")e" !i
a"cen$ent p1n& (a cec.
S&opDi7,i&a*iiB
- "ta4i(iea $iagno"tic#(#i >n "#"pici#ne $e cance $e co(on, po(ipi co(onici, *e%ooi5iL
- 4o(i inte"tina(e inf(a%atoiiL
- ectoagiiL
- eBci5ia po(ipi(o co(oniciL
- o4ineea 4iop"ii(o ti"#(ae.
Mat$)ial$ 7$&$'a)$B
- %ateia(e $e potecieI a(e5&, %#!a%a, %&n#!i $e #nic& fo(o"in&I
- %ateia(e pent# co(ono"copieI
- co(ono"cop#( c# aneBe >n f#ncie $e "cop#( eBa%en#(#iL
- pen"a pent# 4iop"ieL
- ep#4ete, ecipiente c# "o(#ii con"e)atoae pent# %ateia(#( eco(tatL
- %ateia(e pent# ane"te5ie "a# %e$ica%ente pent# e$#ceea "en"i4i(it&ii !i
anBiet&iiL
- )a"e(in& "tei(& pent# (#4ifieeL
- %ateia(e pent# a"ep"ie !i anti"ep"ieI
- "o(#ii $e5infectate ce#te $e %e$icL
- c1%p#i "tei(e pe)&5#te c# $e"c*i$ee centa(&L
- co%pe"e "tei(e.
- "e eBp(ic& pacient#(#i nece"itatea eBa%en#(#i !i %o$#( $e co(a4oaeL
- e"te info%at a"#pa "en5aii(o nep(&c#te ?$#ee, pe"i#ne@ pe cae (e poate a)ea (a
into$#ceea !i >naintea co(ono"cop#(#iL
- $ac& eBa%en#( e"te >n"oit $e inte)enie c*i#gica(& ?4iop"ie, e5ecie $e po(ipi@ "e face
#n 4i(an a( *e%o"ta5eiL
- e5#(tat#( eBa%en#(#i $epin$e >n %ae %&"#& $e peg&tieaGc#&iea co(on#(#i cae "e
ea(i5ea5& pinI
- egi% a(i%enta f&& e5i$#i , 5i(e >nainte $e eBa%enI "e e)it& (eg#%e(e ?conin fi4e
!i ce"c $e!e#i(e feca(e@, f#cte(e c#$e "a# #"cate, ceea(e(e, 41n5a fe%entat&,
"o"#i(eL
- egi% a(i%enta eco%an$atI po$#"e (actate, cane a(4& ?pe!te, pa"&e f&& "o",
f&inoa"e, p1ine )ec*e, 4i"c#ii, po$#"e $#(ci !i po$#"e ga"e@L
- "e a$%ini"tea5& p#gati) K FORTR6N0 K cae "e pe5int& "#4 fo%& $e p#$&
"o(#4i(& ?/ p(ic#i cae "e $i5o()& >n / (iti $e ap&@. 0o(#ia e"te ingeat& >n pi5a
183
#nic&, / (iti c# o "eaa >nainte >n / oe, "a# facionat 2 (iti "eaa !i 2 (iti $i%ineaa.
0e eco%an$& ca #(ti%#( pa*a "& fie 4&#t c# ,-/ oe >nainte $e eBa%en.
- 'acient#( e"te atenionat c& "o(#ia ae #n g#"t foate $#(ce, poate po$#ce ge #i !i
)&"&t#i.
- c# o "ea& >nainte pacient#( poate poate "e)i o %a"& foate #!oa& K "& n# %&n1nce ce(
p#in / oe >nainte $e eBa%inaeL
- e"te atenionat "& n# ia fie "a# c&4#ne ti%p $e 8 5i(e >nainte $e eBa%inaeL
- $#p& ce pacient#( e"te info%at a"#pa i"c#i(o "e o4ine aco$#( "ci"L
- $ac& eBa%inaea e"te a"ociat& c# inte)enia c*i#gica(& "e con"#(t& #n ane"te5i"t, "e
%ontea5& o (inie )enoa"&L
- "e >n$epatea5& pote5a $enta& $ac& "e face ane"te5ie genea(&L
- eBa%inaea n# "e face, nefiin$ conc(#$ent&, $ac& pacient#( a fac#t #n eBa%en c# "#(fat $e
4ai# >n #(ti%e(e /8 oe.
- "e )eific& $ac& pacient#( a e"pectat in$icaii(e pi)in$ c#&iea co(on#(#iL
- "e a!ea5& pacient#( >n $ec#4it (atea( "t1ng c# gen#nc*ii f(ectaiL
- "e acope& 5ona ano-peinea(& c# #n c1%p "tei( pe)&5#t c# $e"c*i$ee centa(&L
- "e (#4ifia5& )1f#( t#4#(#i c# )a"e(in& "tei(& !i "e into$#ce >ncet pin an#" c# %i!c&i
#!oae $e otaieL
- t#4#( co(ono"cop#(#i e"te into$#" >ncet "#4 conto(#( %onito#(#i $e cae e"te (egatL
- pent# $e"tin$eea peei(o co(on#(#i >n )e$eea eBa%in&ii "e into$#ce aeL
- >n ti%p#( eBa%in&ii a"i"tenta (ini!te!te pacient#(, >i eco%an$& "& "e e(aBe5e i "&
co(a4oe5eL
- #%&e!te f#ncii(e )ita(eL
- "c*i%4& po5iia pacient#(#i $ac& %e$ic#( "o(icit&L
- "e)e!te %e$ic#(#i pie"e(e aneBe >n f#ncie $e "cop#( !i in$icaia eBa%en#(#iL
- pi%e!te %ateia(e(e eBta"e !i (e peg&te!te pent# eBpe$ieea (a eBa%ene $e (a4oato.
57;)iAi)$a pa&i$7tului ,up: &olo7o'&opi$
- $ac& "-a f&c#t ane"te5ie genea(&, pacient#( &%1ne >n "a(& p1n& (a te5ieL
- "e "#pa)eg*ea5& p#("#(, T6, T
o
, $#ei a4$o%ina(eL
- "e *i$atea5& pacient#( $ac& ac#5& "(&4ici#neL
- pot ap&eaI $#ei a4$o%ina(e, fe4&, fi"oane, "ca#n c# "1nge, "it#aii >n cae e"te nece"a&
contin#aea "pita(i5&iiL
- "en5aia $e 4a(onae $ete%inat& $e into$#ceea ae#(#i $i"pae teptat.
11./ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a )$&to'i;+oi,o'&opi$i
Recto"ig%oi$o"copia e"te $n$o"copia poi#nii infeioae a inte"tin#(#i go".
S&opDi7,i&a*iiB
- )i5#a(i5aea $e *e%ooi5ii, po(ipi inte"tina(i, co(it& #(ceoa"&, 4oa(a Ca*n, "in$o%#(
co(on#(#i iita4i(L
- eco(taea #no fag%ente pent# 4iop"ii.
187
Mat$)ial$ 7$&$'a)$
- ecto"ig%oi$o"cop#(L
- )a"e(in& "tei(&L
- ta%poane $e )at&L
- %&n#!i "tei(eL
- c1%p "tei( c# oifici# centa(L
- "o(#ie "at#at& $e 9g0O
/
L
- %e$i# $e c#(t#& pent# eBa%ene 4acteio(ogiceL
- pen"& pent# 4iop"ieL
- pen"& anato%ic&L
- f(acon c# fo%o( pent# fag%ent#( $e 4iop"ie.
- pacient#( con"#%& #n egi% a(i%enta f&& e5i$#iI "e e)it& (eg#%e(e ?conin fi4e !i ce"c
$e!e#i(e feca(e@, f#cte(e c#$e "a# #"cate, ceea(e(e, 41n5a fe%entat&, "o"#iL
- "e face c(i"%a e)ac#atoie >na(t&L
- c# 2-, oe >naintea eBa%en#(#i "e face o no#& c(i"%& >na(t& "a# pin "ifona8 pent# a
>n$ep&ta co%p(et e"t#i(e $e %ateii feca(e !i eB#$ate(e pato(ogiceL
- "e $e54ac& egi#nea infeioa& a cop#(#iL
- "e a!ea5& pacient#( >n po5iie gen#pectoa(& c# #!oa& (o$o5& a egi#nii (o%4aeL
- "e acope& pacient#( c# #n c1%p "tei( c# $e"c*i$ee centa(& >n 5ona an#"#(#iL
- "e #nge t#4#( ecto"cop#(#i c# )a"e(in&L
- "e ofe& %e$ic#(#i %&n#!i "tei(e pent# a efect#a #n t#"e# ecta(, apoi "e ofe& a(te %&n#!i
"tei(e pent# a %ane)a ecto"cop#(L
- %e$ic#( into$#ce ecto"cop#( $#p& ce a fo"t (#4ifiatL
- "e in"#f(& ae $ac& %e$ic#( "o(icit&L
- "e peg&te"c ta%poane c# "#(fat $e %agne5i# !i "e ofe& %e$ic#(#i !i $ac& (e "o(icit& >n
)e$eea co%4ateii "pa"%e(o $in 5one(e eBa%inateL
- $ac& e"te ne)oie, e"t#i(e $e %ateii feca(e "#nt >n$ep&tate c# ta%poane #"cateL
- "e peia# po$#"e(e eco(tate !i "e peg&te"c pent# a fi ti%i"e (a (a4oato.
- "e face toa(eta egi#nii ana(eL
- "e >n$ep&tea5& %#co5it& i(e i e"t#i(e $e "#4"tan & (#4ifiant&L
- $ac& "-a efect#at 4iop"ie, e"te po"i4i( "& "e o4"e)e o # oa& "1ngeaeL
- "e an#n & %e$ic#( >n ca5 $e "1ngeae, fe4& "a# $#ee %ae.
11.2 Pa)ti&ipa)$a la a'i't$7tului +$,i&al la ()o7=o'&opi$
'oce$#a e"te $e"ci"& (a capito(#( 12 ?12.2 :on*ofi4o"copie@.
11.3 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a pl$u)o'&opi$i #to)a&o'&opi$-
'(e#o"copiaGtoaco"copia@ e"te eBa%inaea en$o"copic& a ca)it&ii p(e#a(e, a "#pafeei
p(&%1n#(#i, $#p& con"tit#iea pne#%otoaB#(#i atificia( ?in"#f(aea ae#(#i >n ca)itatea
p(e#a(&@.
188
S&opDi7,i&a*iiB
- )i5#a(i5aea $iect& a p(e#ei paieta(e !i )i"cea(e, p(&%1ni(o !i %e$ia"tin#(#iL
- $enaea e)&"ate(o p(e#a(e, o4ineea $e fag%ente ti"#(aeL
- $iagno"ticaea neop(a"%#(#i p#(%onaGp(e#a(, %eta"ta5e(o p#(%onae, infecii(o p(e#o-
p#(%onae.
Mat$)ial$ 7$&$'a)$B
- p(e#o"cop ?toaco"cop@L
- apaat pent# into$#ceea ae#(#iL
- c1%p#i "tei(e, co%pe"e "tei(eL
- %&n#!i "tei(eL
- ace !i "eingi pent# ane"te5ie, "o(#ie ane"te5ic&L
- %ateia( $e $e5infecieI "o(#ie $e5infectant&, ta%poaneL
- t#"& anti!oc ?pent# pe)eniea acci$ente(o@L
- f(acoane ep#4ete pent# po$#"e eco(tate ?4iop"ie, (ic*i$@.
- "e eBp(ic& pacient#(#i $e#(aea poce$#ii pent# e$#ceea te%eio (egate $e eBa%enaeL
- pacient#( )a fi "e$at >n pe5i#a !i 5i#a eBa%in&iiL
- "e eBp(ic& nece"itatea !i %o$#( $e co(a4oaeL
- pacient#( e"te info%at c& "e )o pac#ge 2 etapeI con"tit#iea pne#%otoaB#(#i !i
eBa%inaea popi#5i"&L
- n# %&n1nc& ce( p#in 8 oe >nainteL
- c# o o& >nainte $e in"tit#ea pne#%otoaB#(#i (a in$icaia %e$ic#(#i !i >n f#ncie $e "taea
pacient#(#i "e a$%ini"tea5& #n tanc*i(i5ant ?%epo4a%at, %e$a5epa%, $ia5epa%@.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la p)o&$,u): 4 p7$u+oto)aH
- pacien#t#( e"te c#(cat pe canapea >n $ec#4it (atea( pe patea "&n&toa"&L
- 4a#( $e $ea"#pa e"te i$icat $ea"#pa cap#(#i, f(ectat a!a >nc1t pa(%a "& ating& #ec*eaL
- "e $e5infectea5& egi#nea in$icat&, "e ofe& %e$ic#(#i %ateia(e pent# ea(i5aea
ane"te5ieiL
- "e face p#ncia !i "e a$aptea5& apaat#( pent# pne#%otoaB c# a8#to#( c&#ia "e into$#c
,..-/.. %( ae >n ca)itatea p(e#a(aL
- "e #%&e!te pe%anent "taea pacient#(#iL
- $#p& 1.-12 %in#te e"te a8#tat "& "e i$ice >n po5iie !e51n$L
- "e "#pa)eg*ea5& e"piaia cae te4#ie "& fie it%ic& !i (ini!tit&L
- "e an#n& %e$ic#( $ac&I e"piaia $e)ine geoaie, pacient#( ac#5& $#ee, "e cian#5ea5&,
T6 "ca$e, p#("#( e"te acce(eat fi(ifo% ?peico( $e !oc p(e#a(@L
- pacient#( poate ac#5a o 8en& $i"cet& pe patea #n$e "-a ceat pne#%otoaB#(L
- $ac& n# apa inci$ente (a eco%an$aea %e$ic#(#i "e poate face #n conto( a$io(ogic.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la p)o&$,u): 4 pl$u)o'&opi$
- pacient#( e"te con$#" (a "a(a $e opeaieL
18+
- e"te a!e5at >n po5iie "e%i!e51n$ "pi8init pe patea "&n&toa"&L
- 4a#( $e patea eBa%inat& )a fi i$icat, pa(%a e"te a!e5at& pe ceaf&L
- po5iia e"te fiBat& $e a"i"tenta cae "pi8in& 4a#( !i "#pa)eg*ea5a pe%anent pacient#(L
- toaco"cop#( e"te into$#" pint-#n toca $e c&te %e$ic, a"i"tenta "e)e!te %ateia(e(e
"o(icitateL
- %e$ic#( efect#ea5& eBa%inaea !i e)ent#a( eco(tea5& (ic*i$ "a# fag%ente pent# 4iop"ieL
- "e "coate toca#( !i "e eeBpan"ionea5& p(&%1n#(L
- %ateia(e(e eco(tate "e etic*etea5& !i "e ti%it (a (a4oatoL
- (a ni)e(#( p(&gii "e ap(ic& fie "a# agafe !i #n pan"a%ent "tei(L
- pe"te pan"a%ent, (a eco%an$aea %e$ic#(#i "e pot ap(ica (a ni)e(#( toace(#i f1!ii $e tifon,
cic#(a.
- "e efect#ea5& a$iogafie p#(%ona& $e conto(L
- "e %onitoi5ea5& pacient#(I pot ap&ea acce"e $e t#"e, *e%aton a( peete(#i toacicL
- (a eco%an$aea %e$ic#(#i "e a$%ini"tea5& ana(ge5ice, "e$ati), ca(%ante a(e t#"ei.
11.7 Pa)ti&ipa)$a a'i't$7tului +$,i&al $%$&tua)$a la &i'to'&opi$i
Ci"to"copiea e"te eBa%inaea en$o"copic& a ca)it&ii )e5icii #inae, #etei, i #etee(o.
S&opDi7,i&a*iiB
- in"pectaea !i 4iop"ieea po"tateiL
- co(ectaea po4(e(o $e #in& $iect $in #eteL
- i$entificaea "#"ei $e *e%at#ieL
- p(a"aea catetee(o #etea(e >n pie(ogafia etoga$&L
- ea(i5aea #no inte)enii c*i#gica(e ?e5ecia #n
o
t#%o
i,
e5eci
a
po"ta
tei *ipetofiate@.
Mat$)ial$ 7$&$'a)$B
- ci"to"cop#( c# aneBe >n f#ncie $e "cop !i in$icaieL
- c1%p#i "tei(e, %&n#!i "tei(e, *a(at, %a"c&L
- "eing& -#Uon c# o(i)&, "tei(&L
- "o(#ie pent# ane"te5ie K no)ocain& ..2M /.-2. %(L
- "eing& $e 2. %( "tei(&L
- pen"e "tei(eL
- $o#& "on$e #eta(e a$iopace (#ngi $e 3.-7. c%L
- "on$e #eto)e5ica(e "tei(eL
- ep#4ete pent# co(ectaea #ineiL
- $o#& ta)ie ena(e.
- "e eBp(ic& pacient#(#i nece"itatea eBa%in&iiL
- >n #ne(e ca5#i %e$ic#( eco%an$& anti4iotice c# o 5i >nainte !i , 5i(e $#p& poce$#&L
1+.
- c# ,. %in#te >nainte "e a$%ini"tea5& #n "e$ati) pent# e$#ceea anBiet&ii
- $ac& "e face ane"te5ie genea(&, n# 4ea, n# %&n1nc& 12 oeL
- e"te an#nat "& n# %&n1nceG4ea 2.. %( >nainte $e eBa%en pent# a a"ig#a f(#B#( #inaL
- e"te in)itat "& >!i go(ea"c& )e5icaL
- e"te a!e5at pe %a"& >n po5iie gineco(ogic&L
- "e efect#ea5& toa(eta ogane(o genita(e !i peine#(#i c# ap& !i "&p#nL
- $aca %e$ic#( eco%an$& "e face c(i"%& e)ac#atoaeL
- e"te atenionat c& (a teceea ci"to"cop#(#i ae "en5aia $e %ici#ne.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a p)o&$,u)ii
- "e a!ea5& pacient#( pe %a"a $e eBa%inaeL
- "e face $e5infecia %eat#(#i #inaL
- %e$ic#( face ane"te5ia (oca(&I (a fe%ei "e face ane"te5ie (oca(&, (a 4a4ati a)1n$ >n )e$ee
(#ngi%ea !i ta"e#( #etei "e face a*iane"te5ie, ane"te5ie genea(& "a# inta)eno"a"&L
- "e )eific& f#nciona(itatea "i"te%#(#iL
- "e (#4ifia5& t#4#( ci"to"cop#(#i c# )a"e(in& "tei(&L
- "e face o "p&(&t#& )e5ica(& c# "o(#ie c# aci$ 4oic ,M p1n& c1n$ (ic*i$#( e(i%inat e"te
c#atL
- "e #%p(e )e5ica c# 12. %( ap& "tei(& "a# c# o "o(#ie "(a4 $e5infectat& (a 4&4ai, 22.%( (a
fe%eiL
- "e >n(oc#ie!te can#(a c# "i"te%#( optic, "e aco$ea5& "i"te%#( $e i(#%inatL
- "e ofe& %e$ic#(#i aneBe(e ci"to"cop#(#i >n f#ncie $e "copL
- "e ofe& ep#4ete pent# po$#"e(e eco(tateL
- >n ti%p#( eBa%in&ii a"i"tenta #%&e!te "taea pacient#(#i !i apotea5& %e$ic#(#i $ac&
con"tat& %o$ificai a(e f#ncii(o )ita(e.
57;)iAi)$a pa&i$7tului ,up: &i'to'&opi$
- pacient#( e"te tan"potat (a "a(on >n f#ncie $e "taea genea(& !i $e ane"te5ia pacticat& ?c#
foto(i# #(ant, c# taga@L
- po5iia >n pat e"te >n f#ncie $e ane"te5ieL
- "e %onitoi5ea5& "e%ne(e )ita(e ti%p $e 2/ oeL
- "e o4"e)& "e%ne $e *e%oagieL
- (a eco%an$aea %e$ic#(#i "e pot face "p&(&t#i po"t poce$#a(e c# "o(#ii i5otone
eco%an$ateL
- "e contin#& $ac& e"te ca5#( a$%ini"taea $e anti4ioticeL
- pacient#( )a fi info%at c& pot apaeaI acce"e fe4i(e tec&toae, fi"oane, $#ei (o%4ae.
La eco%an$aea %e$ic#(#i "e a$%ini"tea5& anti"pa"tice, ana(ge5iceL
- e"te po"i4i(& etenia $e #in&L
- "e eco%an$& ce!teea con"#%#(#i $e (ic*i$eL
- $ac& pacient#( pe5int& $#ei $e "pate "a# a"#& (a %ici#ne, ace"tea "#nt pa"agee !i "e
ca(%ea5& $#p& a$%ini"taea $e ana(ge5iceL
- "e eco%an$& pacient#(#i "& "tea >n epa#" $eoaece pot ap&ea a%ee(i.
1+1
O('$)<a ii
- (a fe%ei cito"copia "e poate face !i a%4#(atoL
- (a "f1"it#( eBa%in&ii pacienta )a fi in"t#it& "& "e a#too4"e)eI #ina poate fi o5, $a $ac&
e"te o!ie "a# conine c*eag#i "e an#n& %e$ic#(.
11.8 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a a)t)o'&opi$i
6to"copia e"te %eto$a en$o"copic& pin cae "e poate )i5#a(i5a $iect inteio#( ca)it& ii
atic#(ae.
S&opDi7,i&a*iiB
- efect#aea #no poce$#i c*i#gica(eI e(i%inae $e %eni"c "a# pinteni o"o i, epaae $e
(iga%ente, 4iop"ieL
- "ta4i(iea $iagno"tic#(#i >n po(iatita e#%atoi$& 4oa(& ato5ic&, afec i#ni a(e %eni"c#(#i,
c*i"t#i, "ino)it&.
Mat$)ial$ 7$&$'a)$B
- ato"cop c# aneBeL
- %ateia( pent# ane"te5ie (oca(&L
- t#"t& c*i#gica(&L
- %an#a( pent# "#t#&L
- %ateia( pent# $e5infecieL
- %&n#!i "tei(eL
- ta)& "a# %&"# & pent# %ateia(e.
- "e eBp(ic& pacient#(#i nece"itatea poce$#iiL
- "e an#n& pacient#( "& n# %&n1nce noaptea $inaintea eBa%in&iiL
- "e info%ea5& pacient#( c& poce$#a $#ea5& 12-,. %in#teL
- "e eBp(ic& pacient#(#i c& "e )a face ane"te5ie, $i"confot#( fiin$ %ini%L
- "e a(ege po5itia >n f#nc ie $e atic#(a ia (a cae "e inte)ine ?cea %ai afectat& atic#(a ie
e"te cea a gen#nc*i#(#i@.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a p)o&$,u)ii
- "e a"ig#& po5iia ce#t& $e %e$icL
- "e $epi(ea5& (oc#( $ac& e"te ca5#(, "e face $e5infecieL
- "e "e)e!te %e$ic#(#i %ateia(#( pent# ane"te5ieL
- "e acope& 5ona c# #n c1%p "tei(L
- %e$ic#( ea(i5ea5& o %ic& inci5ie pin cae "e into$#ce ato"cop#( >n "pai#( atic#(a
i%agini(e fiin$ #%&ite pe %onitoL
1+2
- a"i"tent#( %e$ica( "#pa)eg*ea5& "taea pacient#(#i !i apotea5& %e$ic#(#i oice
%ani"fe"tae
- "e)e!te %e$ic(#(#i %ateia(e(e "o(icitateL
- (a "f1"it#( inte)eniei, $#p& "coateea ato"cop#(#i, %e$ic#( ap(ic& fie $e "#t#& pe (oc#(
inci5ieiL
- 5ona e"te acopeit& c# #n pan"a%ent "tei(Gco%pe"i).
57;)iAi)$a pa&i$7tului ,up: a)t)o'&opi$
- "e %onitoi5ea5& f#cii(e )ita(e !i "e o4"e)& "e%ne $e infecie ?fe4&, t#%efacie, $#ee
inten"&, eite%#(, "c#geea >n contin#ae a (ic*i$#(#i pin inci5ie@L
- pacient#( e"te info%at c& atic#(aia )a fi $#eoa"& c1te)a 5i(e, poate ap&ea t#%efacia !i
"e )o (#a #%&toae(e %&"#iI
- picio#( )a fi po5iionat %ai "#"L
- "& "e e)ite f(ectaea gen#nc*i#(#iL
- "& ap(ic& g*ia&, co%pe"e eci pent# e$#ceea e$e%#(#iL
- "& fo(o"ea"c& %i8(oace $e "pi8in ?4a"ton, c18e@ c1n$ "e $ep(a"ea5&L
- "e an#nt& %e$ic#( $ac& $#eea e"te inten"&, atic#(aia "e ino!e!te, t#%efacia e"te
accent#at&, "a# apae fe4&.
- fie(e "e "cot $#p& 7-1. 5i(eL
11.+ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a lapa)o'&opi$i
Lapao"copia "a# ce(io"copia epe5int& eBp(oaea ca)it&ii peitonea(e c# a8#to#( #n#i
(apao"cop into$#" pin peete(e a4$o%ina(, pint-#n toca.
S&opDi7,i&a*iiB
- eBa%inaea $iect& a "#pafeei ficat#(#i, "p(inei, co(eci"t#(#i, c&i(o 4i(iae eBta*epatice,
t#4#(#i $ige"ti), ogane(o genita(e !i peei(o a4$o%ina(iL
- efect#aea #no inte)enii c# %ini% $i"confot po"t opeato.
Mat$)ial$ 7$&$'a)$B
- c1%p#i !i %&n#!i "tei(eL
- %e$ica%ente "e$ati)eI feno4a4ita(, %epo4a%at , atopin&L "eingi, ace pent#
a$%ini"taeL
- %ateia(e $e $e5infecieI tinct#& $e io$ !i ta%poaneL
- 4i"t#i#, pen"e *e%o"taticeL
- (apao"copL
- anti4iotice, "e fi5io(ogicL
- ta)i& ena(&L
- apaat pent# pne#%opeitone#L
- %ateia(e pent# ane"te5ic.
- "e an#n& pacient#(, "e eBp(ic& %o$#( $e $e"f&"#ae a eBa%en#(#iL
- pacient#( e"te "fat#it ca >n 5i#a $inaintea eBa%en#(#i "& con"#%e egi% *i$icL
- "eaa !i $i%ineaa "e face c(i"%a e)ac#atoieL
1+,
- c# ,. %in#te >nainte $e eBa%en "e a$%ini"tea5& feno4a4ita( o fio(& "a# /..%g
%epo4a%at "i ..2%g atopin&L
- "e >n$ep&tea5& pi(o5itatea a4$o%ina(&L
- "e tan"pot& pacient#( >n "a(a $e eBa%en.
- "e fiBea5& pe %a"&L
- %e$ic#( ea(i5ea5& ane"te5ie pei$#a(& "a# genea(&L
- "e efect#ea5& pne#%opeitone#( pin into$#ceea a ,-3 (iti CO
2
, pan& "e atinge o pe"i#ne
$e 12 %% =g $#pa cae ac#( "e etageL
- (a (oc#( inep&t#ii "e face o inci5ie pin cae "e into$#ce #n toca c# $ia%et#( $e 8-12
%%L
- pin toca, $#p& "coateea %an$en#(#i, "e into$#ce (apao"cop#(L
- "e in"pectea5& ca)itatea a4$o%ina(&L
- pent# 4iop"ie %e$ic#( into$#ce >nc& #n toca pin cae "e into$#ce o pen"& (#ng& "a# #n
e(ectoca#teL
- $#p& te%inaea %ane)e(o, "e "cot (apao"cop#( !i pen"& $e %ane)&, "e e(i%in& CO
2
$in
ca)itatea peitonea(&, "e >n$ep&tea5& can#(e(e toca.
0e "#t#ea5& p(&gi(e pin cae tocae(e a# fo"t into$#"e, apoi "e pan"ea5&.
Fn ti%p#( inte)eniei, a"i"tent#( %e$ica(I
- "e)e!te %e$ic#(#i %ateia(e(e "o(icitateL
- pi%e!te %ateia(e(e fo(o"iteL
- pi%e!te po4e(e eco(tate.
57;)iAi)$a pa&i$7tului ,upa p)o&$,u):
- "e >%4ac&L
- "e ti%ite (a "a(onL
- n# %&n1nc& 2 oe, con"#%& n#%ai (ic*i$eL
- "e p#ne p#ng& c# g*ea&L
- $aca pacient#( n# ae "ca#n, "e face c(i"%&L
- fie(e $e "#t#& "e >n$ep&tea5& a cincea 5iL
- "e %&"oa& T, T6, p#(".
PARTEA V 4 5NGRI6IRI SPECIALE
Capitolul 1 5NGRI6IRI 5N GOLILE APARATULUI RESPIRATOR
12.1 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a )a,io;)a%i$i pul+o7a)$ 'ta7,a),
E"te #n eBa%en a$io(ogic "tatic cae pe%ite )i5#a(i5aea pin Ctan"paen&E a p(&%1ni(o, >n
pincipa(, $a !i a cont##(#i ini%ii pec#% !i a oa"e(o c#tiei toacice ?coa"te !i c(a)ic#(&@.
1+/
In$ica ii
- >n ca5 $e "i%pto%e p#(%onae pe"i"tente ?t#"e, eBpectoeie@L
- *e%opti5ieL
- 4i(an#( peopeatoL
- (oca(i5aea eBact& a p#nct#(#i pent# toacocente5& >n ca5 $e p(e#e5ie >nc*i"&L
- )ia8 t#4ec#(inic (a Reacia 9anto#B.
Contain$icaii
-ga)i$e.
P)i7&ipii t$=7i&$
'ent# a e$a tan"paena "t#ct#i(o p#(%onae !i 4on!ice, c(i!ee(e a$iogafice )o fi efect#ate
c# a5e A ?Roentgen@ $e inten"itate %ic&.
Ra$iogafia p#(%ona& "e face $in $o#& inci$eneI $in fa&, >n ti%p#( in"piaiei !i apoi $in pofi( >n
con$iii $e o4"c#itate.
- "e $e54ac& >n egi#nea "#peioa& a cop#(#iL
- "e >n$ep&tea5& o4iecte(e %eta(ice $e (a g1t cae pot $a fa("e i%aginiL
- "e eBp(ic& >n %ae >n ce con"t& poce$#a, pent# a o4ine co(a4oaea pacient#(#iL
- "e cee pacient#(#i "& eBec#te co%en5i(e %e$ic#(#i a$io(og at#nci c1n$ i "e cee ?"& in"pie
pof#n$, "& &%1n& >n apnee, "&-!i "c*i%4e po5iia@.
Re5#(tate no%a(e
Intepetaea c(i!e#(#i e"te f&c#t& $e %e$ic (a negato"cop ?#n pano# i(#%inat e(ectic@.
'e negato"cop, "t#ct#i(e %ai p#in $en"e apa co(oate >n neg#, ia "t#ct#i(e $en"e ?oa"e(e@ apa
>n a(4.
0e apecia5&I confo%aia toace(#i, >nc(inaia !i "paii(e inteco"ta(e, "i(#eta %e$ia"tina(&,
tan"paena p#(%ona&.
Re5#(tate pato(ogiceI
- opacit&i ?infi(tate@ >n %a"& K >n pne#%opatii )ia(e, T:C p#(%ona&L
- opacit&i "eg%entae K >n pne#%onie, ate(ecta5ieL
- epan!a%ente ?(ic*i$e@ p(e#a(e K >n p(e#e5ii p##(ente, "eofi4inoa"e, *e%otoaBL
- tan"paene $if#5e K >n e%fi5e%#( p#(%onaL
- tan"paene (oca(i5ate K >n ca)ene t#4ec#(oa"e $enate, >n pne#%otoaB.
12.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a ()o7=o%i()o'&opi$i
E"te #n eBa%en en$o"copic ce con"t& >n eBp(oaea %#coa"ei ta*eei !i a 4on*ii(o c# a8#to#(
#n#i en$o"cop ce conine fi4e optice ?4on*ofi4o"cop@.
I7,i&a*ii i &o7t)ai7,i&a*iiB
In$icaii
- *e%opti5ieL
- eBpectoaie pe(#ngit& "a# "ang#ino(ent&L
- copi "t&ini inta4on!iciL
- t#%oi %e$ia"tina(e.
1+2
Contain$icaiiI
- a(egie (a ane"te5ice(e (oca(eL
- tata%ente anticoag#(ante >n c#".
I7&i,$7t$ 9i a&&i,$7t$B
- acci$ente a(egice (a ane"te5ice(e (oca(eL
- agitaia pacient#(#i !i >nte#peea eBa%en#(#i pin into(ean& (a 4on*o"cop.
P)i7&ipii ;$7$)al$B
- "e #ti(i5ea5& 4on*o"coape f(eBi4i(e, $e ca(i4# %ic, 4ine to(eate $e pacient, cae pe%it o
eBp(oae pof#n$&L
- eBa%inaea "e face >nt-o ca%e& "pecia(& $#p& ce pacient#(#i i "-a efect#at ene"te5ia (oca(&.
0e )o peg&ti %ateia(e(e e"pect1n$ eg#(i(e $e a"ep"ieI
- 4on*o"cop#( c# aneBe(e "a(e ?pen"e pent# pe(e)&i $e e"#t, pent# >n$ep&taea copi(o
"t&ini@ "tei(eL
- ecipiente "tei(e etic*etate c# n#%e(e pacient#(#i pent# pe(e)&i $e "eceii 4on!iceL
- #n )apoi5o c# Bi(in& pent# ane"te5ia faingo(aingian&L
- %e$ica%ente pent# inte)enie api$& >n ca5 $e !ocL
- "eingi !i ace $e #nic& fo(o"in&.
- "e eBp(ic& pacient#(#i "cop#( i $e#(aea poce$#iiL
- "e o4ine con"i%&%1nt#( info%at.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a ()o7=o%i()o'&opi$i
- "e cecetea5& te"te(e $e coag#(ae !i "e a$%ini"tea5&, (a in$icaia %e$ic#(#i, anticoag#(ante
pent# a pe)eni *e%oagia >n ca5 $e pe(e)ae $e e"#t 4on!icL
- "e in"t#ie!te pacient#( "& &%1n& ]W 8e#nE !i "& n# f#%e5e >n $i%ineaa eBa%in&iiL
- "e a$%ini"tea5& pe%e$icaia confo% in$icaiei %e$ic#(#iI antit#"i)e, anti"ecetoii,
anBio(itice G tanc*i(i5ante ?c# con$iia ca pacient#( "& n# ai4& g(a#co% "a# a$eno% $e
po"tat&, fiin$c& conin atopin& !i po$#c %i$ia5& !i etenie $e #in&@L
- "e >n$ep&tea5& pote5e(e $entae, $ac& eBi"t&L
- "e into$#ce fi4o"cop#( pe g#& ?$#p& ane"te5ia faingo-(aingian&@ "a# pe #na $in fo"e(e
na5a(eL
- %e$ic#( pi)e!te pe %onito i%aginea inten& %&it& a c&i(o e"piatoii !i $ictea5&
%o$ific&i(eL
- a"i"tent#( %e$ica( notea5& pe 4#(etin#( $e ana(i5& %o$ific&i(e i$entificate $e %e$icL
- "e fac pe(e)&i $e "eceii pent# eBa%en 4acteio(ogic, cito(ogic, 4ioc*i%ic !i $e e"#t
pent# eBa%en anato%opato(ogic.
- 0e in"i"t& ca pacient#( "& n# 4ea ni%ic 2-, oe $#p& eBa%en fiin$c& eBi"t& i"c#( #nei c&i
fa("e $in ca#5a ane"te5ieiL
- 0e "#pa)eg*ea5& t#"ea !i eBpectoaia, pent# a "#pin$e o e)ent#a(& *e%opti5ieL
1+3
- 0e o4"e)& c#(oaea teg#%ente(o !i "e %&"oa& fec)ena e"piaiei !i p#("#(#i.
12., Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a to)a&o&$7t$>$i #pu7& ia pl$u)al:-
Toacocente5a e"te p&t#n$eea c# #n ac "tei(, pint-#n "pai# inteco"ta(, >n ca)itatea p(e#a(&.
In$ica ii
- pe(e)aea !i ana(i5a (ic*i$#(#i p(e#a(, cae oientea5& %e$ic#( "pe o %a(a$ie 4acteian&,
)ia(&, inf(a%atoie, $e oigine ca$iac& "a# neop(a5ic&L
- e)ac#aea (ic*i$#(#i p(e#a( >n p(e#e5ii(e %a"i)eL
- a$%ini"taea $e %e$ica%ente >n "it#.
Contain$icaii - nici #na.
I7&i,$7t$ 9i a&&i,$7t$
- pne#%otoaBL
- !oc p(e#a(.
- ac N#"", (#ng $e 3-8 c% pe)&5#t c# %an$en, "a# #n ac o4i!n#it $e aceea!i (#ngi%e !i c#
$ia%et#( $e ^ 1 c%L
- %ateia(e !i "o(#ii $e5infectanteL
- ecipiente pent# co(ectaea (ic*i$#(#i p(e#a( ?ga$at@ !i pent# pe(e)&i $e (a4oatoL
- %ateia(e pent# Reacia Ri)a(ta >n )e$eea cecet&ii nat#ii (ic*i$#(#i ?eB#$at "a#
tan"#$at@L
- %a"c&L
- "eing& $e capacitate %ae, etan!& pent# a"piaea (ic*i$#(#i p(e#a(L
- "eingi $e #nic& fo(o"in& !i fio(e c# Bi(in& pent# infi(taii (oca(e ?ane"te5ie (oca(&@.
- "e eBp(ic& >n ce con"t& poce$#a !i "e o4ine con"i%&%1nt#( info%atL
- "e a$%ini"tea5& pe%e$icaia ?Dia5epan !i atopina@ pent# a $i%in#a anBietateaL
- "e a!ea5& pacient#( >n $ec#4it (atea( pe patea in$e%n& ?"&n&toa"&@ c# 4a#( i$icat $ea"#pa
cap#(#i pent# >n$ep&taea coa"te(o !i %&iea "paii(o inteco"ta(e "a# >n po5iie !e51n$,
pe %aginea pat#(#i "a# pe #n "ca#n, c# 4ae(e "pi8inite pe "p&ta#( ace"t#ia ?pe cae "e
a!ea5& o pen&, #n %ateia( potecto@.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a to)a&o&$7t$>$i
- "e $e5infectea5& (oc#( a(e" pent# p#ncieL
- "e face ane"te5ie (oca(& ?%e$ic#(@ $#p& ce "e eBc(#$e #n i"toic $e a(egie %e$ica%entoa"&,
pin ana%ne5&L
- %e$ic#( into$#ce ac#(, >n p(in& %atitate, >n "pai#( 7-8 inteco"ta( pe (inia aBi(a&
po"teioa&, $e eg#(& $ea"#pa %aginii "#peioae a coa"tei infeioae pent# a e)ita
atingeea ne)i(o inteco"ta(iL
- "e cee pacient#(#i "& &%1n& >n apnee >n ti%p#( into$#ceii ac#(#i >n ca)itatea p(e#a(&L
1+7
- "e >n$ep&tea5& %an$en#( ?$ac& "-a fo(o"it ac#( N#""@ pent# a pe%ite (ic*i$#(#i "& fie
a"piat c# o "eing&L
- "e a$aptea5& "einga (a ac !i "e a"pi& pi%ii %i(i(iti $e (ic*i$ ce )o fi epati5ai >n %ai
%#(te ep#4ete pent# eBa%ene 4ioc*i%ice, cito4acteio(ogice !i pent# eacia Ri)a(taL
- "e e)ac#ea5& e"t#( $e (ic*i$ ?n# %ai %#(t $e 1( c*ia >n ca5 $e p(e#e5ie %ae@L
- "e eBtage ac#( !i "e pan"ea5& "tei( (oc#( p#ncieiL
- "e "#pa)eg*ea5& a"pect#( pacient#(#i, fec)ena e"piatoie !i p#("#(.
57;)iAi)$a pa&i$7tului ,up: pu7&*i$B
- "e a8#t& pacient#( "& "e >%4aceL
- "e a!ea5& >n pat pe patea p#ncionat&, $ac& to(eea5&, poc(i)L
- "e "#pa)eg*ea5& acti) f#ncii(e )ita(eI fec)ena e"piaiei, p#("#(#i, TR, T6L
- "e o4"e)& t#"ea !i eBpectoaia, c#(oaea !i a"pect#( teg#%ente(o !i %#coa"e(oL
- "e "e%na(ea5& %e$ic#(#i oice %o$ificae ap&#t& >n "taea pacient#(#i.
I7t$)p)$ta)$a )$>ultat$lo)B
- (ic*i$ "eo" "a# "eofi4ino", poate fi eB#$at "a# tan"#$at, nat#a "a $ete%in1n$#-"e pin
eacia Ri)a(taL
- eB#$at *e%oagic K "e >nt1(ne!te >n p(e#e5ia T:C "a# neop(a5ic&L
- eB#$at p##(ent K >n p(e#e5ii %etapne#%onice 4aci(aeL
- (ic*i$ p#ti$, 4#n "a# 4#n-cen#!i# K >n "#p#aii(e p#(%onae.
12./ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a IEDERE la tu($)&uli7:
Into$#ceea >n "tat#( $e%ic, a #nei cantit&i %ici $e t#4ec#(in&, c# a8#to#( #nei "eingi "pecia(e
!i a #n#i ac "tei(.
I7,i&a*iiB
- "#pa)eg*eea )a(i$it&ii )accin&ii antit#4ec#(oa"e pin :C-L
- $epi"taea ca5#i(o $e t#4ec#(o5&.
P)i7&ipii t$=7i&$B
T#4ec#(ina e"te #n fi(tat o4in#t $in c#(t#a $e 4aci(i Noc*. Oice a(egie (a t#4ec#(in& aat&, $e
fapt, #n contact pea(a4i( a( pacient#(#i c# 4aci(#( Noc* ?pi%o-infecia 4aci(a&@ "a# c# 4aci(#(
Ca(%ette - -#ein ?)accinaea :C-@.
'ent# a e(e)a acea"t& a(egie e"te "#ficient "& p#ne% >n contact ogani"%#( pacient#(#i c# o %ic&
cantitate $e t#4ec#(in&.
6ce"t (#c# "e ea(i5ea5& pin II.D.R. (a t#4ec#(in& "a# Reacia 9anto#B.
Do5a $e t#4ec#(in& a$%ini"tat& e"te $e 1.-2. #nit&i.
- "e eBp(ic& >n te%eni acce"i4i(i poce$#a !i "e o4ine con"i%&%1nt#( info%atL
- "e $e"cope& %e%4#( "#peio "t1ng "a# n#%ai ante4a#(.
E%$&tua)$a p)o&,$u)iiB
- "e a(ege 5ona pent# in8ecieL
1+8
- "e $e5infectea5& pie(eaL
- "e in8ectea5& "tict i.$. .,1%( t#4ec#(in& p1n& "e fo%ea5& o pap#(& c# $ia%et#( $e 2-3 %%L
n# "e ta%ponea5&, n# "e feac& (oc#( inoc#(&iiL
- "e e$#c& pacient#( "& n# "e "capine, "& n# "e "pe(e pent# a n# inf(#ena eacia (oca(&L
- "e cite!te, pin %&"#ae, eacia (oca(&, (a 72 $e oe $#p& inoc#(ae.
I7t$)p)$ta)$a )$>ultat$lo) B
R$a&*ia 7$;ati<: - $ac& (a (oc#( inoc#(&ii n# apae nici #n *a(o#, c#(oaea !i a"pect#( pie(ii fiin$
ne%o$ificateL acea"t& eacie negati)& >n"ea%n& c& pacient#( n-a a)#t nici #n contact c# 4aci(#(
Ooc* "a# c# 4aci(i $e tip Ca(%ette - -#ein.
R$a&*i$ po>iti<: 4 "e po$#ce a!a-5i"#( C)ia8 t#4ec#(inicE, c1n$ (a (oc#( inoc#(&ii $ia%et#(
in$#aiei $ep&!e!te 2-3%%. Fn ace"t ca5 "e eco%an$& a$iogafie p#(%ona& pent# $ece(aea
e)ent#a(e(o (e5i#ni po$#"e $e infecia 4aci(a&. 'acient#( e"te (#at >n e)i$ena T:C !i "e ap(ic&
%&"#i $e i5o(ae !i $e pe)enie a &"p1n$iii infeciei (a cei $in 8#.
12.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a 'pi)o+$t)i$i
0pio%etia e"te o %eto$& nein)a5i)& !i foate peci"& $e apeciee a f#nciei p#(%onae.
6ce"t te"t "i%p(# %&"oa& cantitatea $e ae pe cae o pe"oan& o poate in"pia "a# eBpia >nt-o
#nitate $e ti%p.
I7,i&a*ii B
- $iagno"ticaea afeci#ni(o conice a(e 4on*ii(o !i a(e p(&%1n#(#iI a"t%, 4poc,
pne#%opatie inte"tiia(&, e%fi5e%L
- e)a(#aea ga)it&ii !i e)o(#iei ace"to 4o(i.
P)$;:ti)$a +at$)ial$lo)B
- "pio%ete $e $i%en"i#ni !i capacit&i %ai $i"poni4i(e >n (a4oatoae(e $e eBp(o&i
f#nciona(e !i e"piatoiiL
- "pio%ete %ici, pota4i(e $e o4icei, ca(i4ate pin "i"te%e e(ectoniceL
- pie"e 4#ca(e $e #nic& fo(o"in&L
- "pio%et#( e"te aco$at (a #n co%p#te ce >negi"tea5& e5#(tate(e !i (e epe5int& gafic
?"pioga%a@ !i n#%eicL
- "pio%etia "e efect#ea5& n#%ai (a ca4inete %e$ica(e !i >n "e)icii $e eBp(o&i f#nciona(e,
ia te*nica e"te co%p(et $ifeit& $e cea fo(o"it& pent# %&"#aea $e4it#(#i eBpiato $e )1f
?pef@.
- '"i*ic&
- eBp(icaea te"t#(#i !i $e%on"taea poce$#ii coecteL
- o4ineea con"i%&%1nt#(#i info%at.
- Fi5ic&
- "& n# f#%e5e !i "& n# con"#%e 4&#t#i a(coo(ice c# ce( p#in / oe >nainte $e te"taeL
- "& n# fac& efot fi5ic i%potant c# ce( p#in ,. $e %in#te >nainte $e te"taeL
- "& e)ite "& %&n1nce copio" !i "& 4ea 4&#t#i aci$#(ate c# ce( p#in 2 oe >nainte $e
te"taeL
- "& n# poate *aine cae >%pie$ic& eBpan"i#nea toace(#iGa4$o%en#(#i.
1++
- "e >ntea4& pacient#( $e"pe "i%pto%e c#ente, %e$icaie in*a(atoie a$%ini"tat& ecent, $ac&
e"te f#%&toL
- "e cee "&-!i go(ea"c& )e5ica #ina&L
- "e %&"oa& ge#tatea !i >n&(i%ea pacient#(#i ?f&& >nc&(&%inte, c# picioae(e apopiate, cap#(
$ept@L
- "e eco%an$& po5iia !e51n$, ca po5iie $e "ig#an&L
- "e ata!ea5& c(ip#( na5a( pent# pen"aea n&i(oL
- "e cee pacient#(#i "& efect#e5e o in"piaie %aBi%a(& api$& !i co%p(et&L
- "e into$#ce pie"a 4#ca(& >n g#&, a)1n$ gi8& ca 4#5e(e "& fie (ipite >n 8##( t#4#(#i, ia pa#5a
"& $#e5e %aBi% 1-2 "ec#n$eL
- pacient#( "#f(& c# p#tee pin t#4, eBpi1n$ tot ae#( $in p(&%1niL $#ata %ini%& a eBpiaiei
foate te4#ie "& fie $e 3 "ec#n$eL
- "e )a >nc#a8a pe%anent pacient#( "& >n"pie !i "& eBpie p#tenic !i pe(#ngitL >n tot ace"t
ti%p pacient#( )a e"pia n#%ai pe g#&L
- $e o4icei "#nt nece"ae %ini% , %&"#&toi coect eBec#tate, ti%p#( nece"a pent#
"pio%etie )aiin$ >nte 2 %in#te !i ,.-/2 %in#teL
- te"taea "e poate >nc*eia pe%at# $ac& pacient#( n# %ai poate contin#a.
- e"te nece"a& $ep(a"aea c# foto(i#( #(ant (a pat $ac& e"te intenat, "a# c# #n %i8(oc $e
tan"pot "ig# $ac& efect#ea5& te"t#( >n a%4#(atoi#L
- "e eco%an$& epa#" fi5ic >nt#c1t "pio%etia i%p(ic& efot e"piato !i #nii pacieni ac#5&
ge#tate >n e"piaie !i "en5aie $e o4o"ea(&.
Nota)$a )$>ultat$lo) t$'tuluiB
'ent# )a(i$aea te"t&ii f#nciei p#(%onae e"te nece"a& o4ineea a %ini% , %ane)e eBpiatoii
accepta4i(e $in p#nct $e )e$ee te*nic.
0e notea5& ce(e %ai %ai )a(oi o4in#te (aI
- F;C "a# C; ?capacitatea )ita(&@
- FE;1 ?)o(#%#( eBpiato %aBi% >n pi%a "ec#n$& "a# ;E90@
- I': ?in$ice(e $e pe%ea4i(itate 4on!ic&@ cae "e ca(c#(ea5& %an#a( pin fo%#(a I': T
?FE;1 G F;C@_1...
12.3 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a a'pi)a*i$i t)a=$o4()o79i&$
6"piaia ta*eo4on!ic& con"t& >n >n$ep&taea "eceii(o $in ta*ee !i 4on!ii pin into$#ceea
#nei "on$e c#p(ate (a a"piato fie pin ca)itatea 4#ca(&, fie pin fo"e(e na5a(e, pin ta*eo"to%&,
pin can#(a ta*ea(& "a# pin "on$a en$ota*ea(&.
S&op
'e)eniea pne#%oniei $ete%inat& $e "tagnaea "eceii(o >n c&i(e aeiene (a pacienii
i%o4i(i5ai, (a cae ef(eB#( $e t#"e e"te $i%in#at "a# a4o(it "a# cae n# pot "& t#!ea"c&.
- "#"& $e oBigen pota4i(& "a# pe peeteL
- 4a(on R#4en c# %a"c& $eta!a4i(&L
2..
- a"piato $e peete "a# pota4i(L
- "on$e $e a"piae $e $ifeite %&i%iL
- %&n#!i "tei(e !i ne"tei(e, %a"c& facia(&L
- "eing& pent# #%f(aea 4a(ona!#(#iL
- "o(#ie c# "e fi5io(ogic, f(acon c# ap& "tei(&L
- co%pe"e "tei(eL
- "eing& $e 1. %(L
- ecipient $e co(ectae.
Li7ii ,i)$&toa)$
- "e )eific& "e%ne(e )ita(e a(e pacient#(#i ?'., R., T.6.@, 5go%ote(e e"piatoii ?cona8, tia8,
e"piaie "tetooa"&@ !i "taea genea(& pent# a p#tea face co%paaie c# "taea "a $#p&
a"piaeL
- "e )eific&, (a in$icaia %e$ic#(#i, concentaia ga5e(o "ang#ine pin eco(taea $e "1nge
ateia(L
- "e )eific& capacitatea pacient#(#i $e a e"pia pof#n$ !i $e a t#!i, $eoaece ace"te
%ane)e a8#t& (a %o4i(i5aea "eceii(o "pe patea "#peioa& a a4oe(#i ta*eo4on!ic,
faci(it1n$ a"piaea (oL
- >n ca5#( >n cae "e efect#ea5& a"piaie na"ota*ea(&, "e )a face #n i"toic a( pacient#(#i >n
ceea ce pi)e!te $e)iaia $e "ept, po(ipii na5a(i, epi"taBi"#(, ta#%e(e na5a(e, etc.L
- $ia%et#( "on$e(o "e a"piaie te4#ie "& fie %ai %ic $e 8#%&tate $in $ia%et#(
ta*eo"to%ei "a# "on$ei $e int#4aie pent# a %ini%a(i5a *ipoBia >n ti%p#( a"pi&iiL
- a"piaia te4#ie efect#at& eg#(at, $in , >n , oe "a# %ai $e" $ac& pacient#( e"te foate
>nc&cat.
- "e "pa(& %1ini(e !i "e >%4ac& ec*ipa%ent#( $e potecieL
- "e p#ne %a"ca facia(&L
- "e eBp(ic& poce$#a pacient#(#i c*ia $ac& n# e"te tota( con!tientL
- "e a)eti5ea5& pacient#( c& a"piaea >i poate po)oca t#"e tan5itoie !i ef(eB $e )o%&
?#neoi@L
- "e po5iionea5& pacient#( >n po5iie poc(i)& "a# "e%i!e51n$& pent# a #!#a eBpan"i#nea
p(&%1ni(o !i t#"ea po$#cti)&L
- "e peg&te"c $o#& ecipienteI #n#( c# "e fi5io(ogic, a(t#( c# ap& "tei(&L
- fo(o"in$ te*nica a"eptic&, "e $e"c*i$e fo(ia potectoae a "on$ei $e a"piaieL
- "e >%4ac& %&n#!i "tei(e con"i$e1n$ %1na $o%inant& "tei(& !i cea ne$o%inant& ne"tei(&L
- c# %1na $o%inant& "e "coate "on$a $e a"piaie $in a%4a(a8 !i "e >nf&!oa& >n 8##( %1inii
pent# a n# atinge o4iecte "a# "#pafee ne"tei(e c# eaL
- c# cea(a(t& %1n&, ne"tei(& "e conectea5& "e conectea5& cap&t#( "on$ei (a t#4#( $e (a
a"piato !i "e "etea5& ace"ta (a )a(oi c#pin"e >nte 8.-12. %%=gL
- c# %1na "tei(& "e into$#ce )1f#( catete#(#i >n ecipient#( "tei( c# "e fi5io(ogic pent#
a-( #%ectaL
- "e into$#ce apoi c# "einga "tei(&, "o(#ie "tei(& pin (#%en#( "on$ei pent# a faci(ita
teceea "eceii(o pin "on$&L
- "e oBigenea5& pacient#( >nainte $e a"piaeL
2.1
- "e into$#ce "on$a $e a"piaie pe #na $in fo"e(e na5a(e ?$ac& pacient#( e"te neint#4at@ pe
"on$a $e int#4aie ?$ac& e"te int#4at@ "a# pe can#(a ta*ea(& pin %i!c&i 4(1n$e, $e otaie
pent# a-i faci(ita >naintaea, p1n& c1n$ pacient#( >ncepe "& t#!ea"c& ?12-2. c%@L
- "e a"pi& 4(1n$, inte%itent c1te 1.-12 "ec., n# %ai %#(tL pent# a n# ce!te ti%p#( $e
a"piae "e eco%an$& ca ce( cae face a"piaia "& &%1n& >n apneeL
- >nte etagei, "on$a "e )a >nf&!#a >n 8##( %1inii $o%inante pent# a pe)eno infectaeaL
- $ac& "eceii(e "#nt a4#n$ente !i )1"coa"e, "e )a "p&(a "on$a into$#c1n$-o >n ecipient#( c#
ap& "tei(& !i "e )a a"pia $in no#L
- "e a"pi& pe 1n$ fiecae 4on*ie ?$eapt& !i "t1ng&@, 4on*ia "t1ng& fiin$ %ai ge# $e
a"piat >nt#c1t e"te %ai (#ng& !i %ai "#4ie $ec1t cea $eapt&L
- "e epet& poce$#a $e a"piaie a pacient#(#i p1n& c1n$ n# %ai "#nt "eceii !i $i"pa
5go%ote(e *i$oaeice !i "e%ne(e $e tia8L
- "e e)a(#ea5& a"pect#( "eceii(o 4on!ice.
- $#p& a"piae "e a#nc& %ateia(e(e !i ec*ipa%ente(e fo(o"ite >n ecipiente(e $e co(ectae
"pecificeL
- "e notea5& poce$#a >n Fi!a pacient#(#i.
12.7 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a ,)$7aAului pl$u)al
Dena8#( p(e#a( e"te #n $i"po5iti) $e a"piaie a ae#(#i, "1nge(#i, (ic*i$#(#i "eo". E( "e
co%p#ne $int-#n t#4 "#p(# $e 1 c%. $ia%et#, p(a"at >nte ce(e 2 foie p(e#a(e !i $int-#n "i"te%
$e a"piaie eBteio a$aptat (a o "#"& $e )i$.
Dena8#( p(e#a( pe%ite, pin eBecitaea #nei pe"i#ni negati)e, "& "e "o(i$ai5e5e ce(e 2 foie
p(e#a(e, cae, $in %oti)e pato(ogice, "#nt $eco(ate. Fn %o$ no%a(, ce(e 2 foie "#nt "o(i$ai5ate
!i inte$epen$ente. Dena8#( p(e#a( e"te #n $i"po5iti) $e a"piaie p#", >n eBc(#"i)itate, $e c&te
%e$ic.
I7,i&a*ii i
Co7t)ai7,i&a*ii
In$ica i
i
- pne#%otoaB#( "pontan >n cae $eco(aea p(e#a(& e"te pi%a in$icaie $e %ontae a #n#i
$en p(e#a( pent# a"piaea ae#(#i conin#t >nte ce(e 2 foie p(e#a(eL
- eBtene - efacia pin a%& a(4& "a# a(t o4iect conton$entL
- >nepaea acci$enta(& a "ac#(#i p(e#a( >n ti%p#( catetei5&ii )enei "#4c(a)ic#(aeL
- inteneI - t#%o& canceoa"& a p(&%1n#(#i "a# p(e#eiL
- fi4o5& p#(%ona&, cae po)oac& o fi"t#(& p(e#o-p#(%ona&L
- t#4ec#(o5a p#(%ona&.
Contain$icaii
- t#(4#&i $e coag#(ae.
'#neea #n#i $ena8 p(e#a( "e pactic& >n #gen&, ceea ce nece"it& "tocaea %ateia(e(o nece"ae
>nt-#n "ing# (oc, acce"i4i( !i c#no"c#t $e >nteaga ec*ip& %e$ica(&.
'ent# ane"te5ia (oca(&I
- "eingi $e 2. !i 2. %(L
- ace pent# in8ecii "#4c#tanateL
2.2
- ace inta%#"c#(aeL
2.,
- fio(e $e Bi(in& 2ML
- o ce%& ane"te5ic& (oca(&.
'ent# a"ep"ieI
- "o(#ie $e 4eta$in&L
- co%pe"e "tei(eL
- apaat $e a"L
- c1%p "tei( pent# %a"&L
- c1%p "tei( ton`L
- t&)i& ena(&L
- p#4e(& pent# $e!e#iL
- containe pent# aceL
- %&n#!i "tei(eL
- 4(#5& "tei(&L
- ca(ot&, %a"c&.
'ent# p#neea $ena8#(#iI
- 4i"t#i#L
- $en p(e#a( ?2, 1., 13, 18, 2., 22 -@ confo% pe"cipieiL
- ace !i fie $e "#t#&L
- aco$ a$aptat >nte "i"te%#( $e a"piaie !i $enL
- apaat $e a"piaieL
- $o#& f(acoane c# ap& "tei(& $e 2.. %(, pe%i1n$ eg(a8#( pe"i#nii negati)eL
- $i"po5iti)#( $e )i$ae !i t#4#( pent# ae.
'ent# pan"a%entI
- co%pe"e "tei(eL
- o%p(a"tL
'ent# "#pa)eg*eeI
- %onito ca$iacL
- apaat $e %&"#at T.6.L
- p#("oBi%et# pent# %&"#aea "at#aiei $e oBigen.
- info%aea pacient#(#i $e"pe 4eneficii(e i%e$iate a(e $ena8#(#iL
- eBp(icaea $e#(&ii poce$#iiL
- o4ineea con"i%&%1nt#(#i info%atL
- ceaea #n#i c(i%at $e >nce$ee !i $e (ini!teL
- pacticaea #nei ane"te5ii $e "#pafa& c# a - 1 * >nainte pin #ti(i5aea #nei ce%e
ane"te5iante.
'eg&tiea apaat#(#i $e a"piaieI
- "e "coate $in a%4a(a8#( "tei(, "e )eific& integitateaL
- "e #%p(# e5e)oae(e ?4ocane(e@ c# ap& "tei(& ?ce( pent# a"piaie (a ni)e(#( pe"ci" K 2.
c% co(oan& $e ap&, ce(&(a(t cae a"pi& ae#( conin#t >n "pai#( p(e#a(, 2.. %(, >n f#ncie
$e %aca apaat#(#iL
- "e 4an!ea5& (a $i"po5iti)#( $e )i$ae, "e #ne!te c# apaat#( $e a"piaie, "e )eific&
f#nciona(itatea "aL
2./
- "e pote8ea5& eBte%itatea t#4#(#i "tei( cae )a fi aco$at (a $en#( p#" >n "pai#( p(e#a(L
- "e peg&te!te %onito#( pent# "#pa)eg*eea ca$iac&, ten"io%et# !i p#("oBi%et#
'eg&tiea pacient#(#iI
- "e a8#t& pacient#( "& "e a!e5e a"tfe( >nc1t 5ona >n cae "e )a %onta $en#( "& fie $ega8at&I
- >n $ec#4it $o"a(, cap#( #!o i$icat, ante4a#( $e patea $ena8#(#i p(a"at "#4 capL
- po5iie !e51n$& pe %aginea pat#(#i, ga%4e(e at1nate, "pate(e >nco)oiat, ante4ae(e
"pi8inite >n fa& pe o %a"&L
- $ec#4it (atea(, 4a#( i$icat, cap#( pe pen&L
Rea(i5aea c1%p#(#i a"eptic
- "e epeea5& 5ona a(ea"& $e %e$ic pent# $ena8L
- "e $epi(ea5& (ag 5ona toacic& $ac& e"te nece"aL
- "e "pa(&, "e $econta%inea5& (oc#( p#nciei c# 4eta$in&.
'eg&tiea %e$i#(#iI
- "e a!ea5& o %a"& a$apta4i(& (a "#pafaa pat#(#i pe cae "e a!ea5& %ateia(#( "tei(L
- "e peg&te!te c&#cio#( c# %ateia(e $e #gen&L
- toate pe"oane(e pe5ente te4#ie "& poate %a"c& !i ca(ot&L
- "e face "p&(aea c*i#gica(& a %1ini(oL
- "e a8#t& %e$ic#( "& >%4ace *a(at#( "tei( !i %&n#!i(e "tei(e.
'#neea $en#(#iI
- pacient#( e"te a!e5at >nt-o po5iie confota4i(&L
- a"i"tenta ofe& %e$ic#(#i co%pe"a "tei(& >%4i4at& >n "o(#ia anti"eptic& pent# efect#aea
a"ep"iei te%ina(e >n 5ona $e $ena8L
- "e a!ea5& c1%p#( "tei( pent# %a"a a$apta4i(& (a "#pafaa pat#(#iL
- a"i"tenta ofe& %e$ic#(#i "einga c# Bi(in& pent# a face ane"te5ia (oca(& "#4c#tanat& !i
apoi >n p(an#i(e pof#n$e inta%#"c#(aeL
- pent# epeaea coect& a 5onei $e $ena8, %e$ic#( pe(e)ea5& (ic*i$ p(e#a( "a# ae c#
ac#( inta%#"c#(aL
- "e pactic& o inci5ie >n pie(e $e 2 c% c# 4i"t#i#( !i "e into$#ce $en#( p(e#a(L %e$ic#(
a$aptea5& "i"te%#( $e a"piaie (a $enL
- a"i"tenta p#ne >n f#nci#ne "i"te%#(, $e"c*i51n$ o4inet#( a"piaiei $e peeteL
- %e$ic#( fiBea5& $en#( (a pie(e, fo%1n$ o 4#"& >n 8##( $en#(#i pent# a pe%ite
>nc*i$eea pie(ii $#p& etageea $en#(#i, c1te)a 5i(e %ai t15i#L
- %e$ic#( ea(i5ea5& pan"a%ent#( "tei( >n 8##( $en#(#iL
- "e a$#n& %ateia(e(e fo(o"ite !i "e p#n >n containee "pecia(eL
- >n tot ti%p#( p#neii $en#(#i, a"i"tenta "#pa)eg*ea5& facie"#( pacient#(#i, fec)ena
e"piatoie, "at#aia >n oBigen, fec)ena ca$iac&, $#eea, pecepia.
- "e "#pa)eg*ea5& $en#( "& n# fie c#$at, >nco(&cit, $e4an!at, >nc*i" ?c(a%pat@L
- a"piaia "& fie f#nciona(&, "e )eific& pe"i#nea $e a"piaieL
- "e o4"e)& (ic*i$#( a"piat ?"1nge, tan"#$at@ "e notea5& caactei"tici(eL
- 4#(e(e >n co%pati%ent#( $e a"piaie in$ic& pe5ena $e ae >n "pai#( p(e#a(L
- "e face i%e$iat, (a pat, o a$iogafie p#(%ona&, ia e5#(tat#( "e apotea5& %e$ic#(#iL
- "e %onitoi5ea5& f#ncii(e )ita(eI TR, ', T.6., RL
- "e %onitoi5ea5& $#eea !i ni)e(#( $e anBietate a( pacient#(#i.
2.2
12.8 Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a oHi;$7ot$)api$i
Teapia c# oBigen e"te o inte)enie teape#tic& pent# a$%ini"taea #nei cantit&i %ai %ai $e
oBigen $ec1t cea $in at%o"fe&.
I7,i&a*iiB
- *ipoBe%ieL
- *ipoBii e"piatoii !i cic#(atoiiL
- ane%iiL
- co%p(icaii po"topeatoiiL
- infecii "e)ee, etc.
9anife"t&i $e $epen$en& (egate $e oBigenaea in"#ficient&I
- fatiga4i(itate, agitaieL
- e"piaie "#peficia(& ?fec)en& ce"c#t&@L
- otopnee L
- %i!c&i a(e aipi(o na"#(#iL
- ciano5a pie(ii, 4#5e(o !i #ng*ii(oL
- cefa(ee, a%ee(i, "o%no(en&L
- conf#5ie, age"i)itate.
Mat$)ial$ 7$&$'a)$B
- "#"a $e oBigenI pi5a $e peete, $i"po5iti)#( pota4i(, 4#te(ia $e oBigen concentat "a#
#nitatea c# oBigen (ic*i$L
- 4a4oto#( "a# #%i$ificato#( K pent# #%i$ificaea o2L
- $e4it%et# K #n in$icato fo(o"it pent# a eg(a cantitatea $e oBigen f#ni5at& pacient#(#i !i
cae e"te ata!at& "#"ei $e oBigenL
- can#(a na5a(& K cae "e into$#ce >n n&i(e pacient#(#iL
- "on$a en$o-na5a(& K cae "e into$#ce pe #na $in fo"e(e na5a(e pe o $i"tan& ega(& c#
$i"tana $e (a aipa na"#(#i p1n& (a tag#"L
- oc*e(ai $e oBigen, cot $e oBigen ?%ai a@L
- %a"ca 4#co K na5a(& c# "a# f&& ein*a(aea ae#(#i eBpiat, #ti(i5at& pent# pacienii cae
a# ne)oie $e teapie c# oBigen pe te%en %ai (#ng.
- p"i*ic& "e face (a cei con!tieni, !i con"t& >n info%ae, eBp(icae, o4ineea
con"i%&%1nt#(#iL
- fi5ic& I
- "e face $e5o4"t#cia c&i(o e"piatoii "#peioaeL
- "e in"t#ie!te pacient#( "& &%1n& (a pat >n ti%p#( a$%ini"t&ii !i "& e)ite
%anip#(aea #no o4iecte gen 4ic*et&, pent# c& oBigen#( e"te #n ga5 co%4#"ti4i(
cae >nteine a$eeaL
- "e %&"oa& pe o4a5 $i"tana $e (a na& (a tag#"L
- "e into$#ce "on$a na5a(& "tei(& pe $i"tana %&"#at& !i "e fiBea5& c# o%p(a"t pe
o4a5L
- "e ap(ic& %a"ca pe g#& !i pe na" !i "e fiBea5& c# 4an$a e(a"tic& eg(a4i(&L
- "e eg(ea5& pe"i#nea !i $e4it#( $e a$%ini"tae (a /-3(G%in. "a# >n f#ncie $e
eco%an$aea %e$ic#(#iL
2.3
- "e "#pa)eg*ea5& co%pota%ent#( pacient#(#i >n ti%p#( oBigenoteapieiL
- "e %onitoi5ea5& f#ncii(e )ita(e I R, ', T.6., "at#aia >n oBigen a "1nge(#i ateia( c#
a8#to#( p#("oBi%et#(#i.
- "e a"ig#& igiena 4#ca(& !i na5a(&L
- "e o4"e)& p#ncte(e $e pe"i#ne eBecitate $e "on$&, can#(& "a# %a"c& ?"& n# eBi"te
(e5i#ni@.
E<alua)$a )$>ultat$lo)B
0e face >n apot c# #%&toii paa%etiI
- co(oaia pie(ii !i a %#coa"e(oL
- caactei"tici(e e"piaieiL
- ana(i5a ga5e(o !i a "1nge(#i ateia(L
- ni)e(#( $e enegie a pacient#(#i !i to(eana (a efotL
- "taea $e c#no!tin& !i co%pota%ent#(.
12.+ Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a a$)o'olot$)api$i
Teapia c# aeo"o(i con"t& >n into$#ceea >n c&i(e e"piatoii a #nei "o(#ii %e$ica%entoa"e
$i"pe"at& >n patic#(e $e o$in#( %iconi(o c# a8#to#( #n#i $i"po5iti) c# ae co%pi%at "a#
oBigen.
O(i$&ti<$
- #%i$ificaea %#coa"ei c&i(o e"piatoiiL
- f(#i$ificaea "eceii(o !i faci(itaea eBpectoaieiL
- e$#ceea inf(a%aiei !i a e$e%#(#i %#coa"ei c&i(o e"piatoii.
P)$;:ti)$a +at$)ial$lo)B
- "#"& $e ae co%pi%at "a# "#"& $e oBigen $e peeteL
- %ano%et# pent# a conto(a $e4it#( ae#(#iL
- fio(e c# "e fi5io(ogic "a# a(te %e$ica%ente in$icate $e %e$ic K p#()ei5atoL
- %a"ca 4#co K na5a(& "a# pie"a 4#ca(&, $in p(a"tic, $e #nic& fo(o"in&L
- t#4#(at#& $e aco$L
- !e)ee(e, 4ati"te na5a(eL
- "c#ip&toae .
P)$;:ti)$a pa&i$7tului B
- p"i*ic&
- "e eBp(ic& pacient#(#i poce$#aI
- "cop#(
- %o$#( $e $e"f&!#ae
- $#ata ?12-2. %in@
- fi5ic&
- "e p(anific& >ngi8iea >n f#ncie $e I
9e"eI (a o o& >nainte "a# $#p& %e"e >nt#c1t eBi"t& i"c#( $e )&"&t#&L
Oe $e )i5it&, eBa%in&i.
2.7
- "e e)a(#ea5& "taea c(inic& a pacient#(#i $e c&te %e$icL
- "e a"ig#& paticipaea pacient#(#i (a poce$#&L
- "e in"ta(ea5& pacient#( >n po5iia !e51n$ "a# "e%i!e51n$, c1t %ai confota4i(L
- "e ofe& "fat#iI
- "&-!i "#f(e na"#(, "&-!i c#ee g#aL
- "& &%1n& >n aceea!i po5iie pe toat& $#ata !e$inei $e aeo"o(iL
- "& e)ite )o4it#(, $ep(a"aea %&!tii "a# a pie"ei 4#ca(e.
- "e in)it& pacient#( "&-!i "#f(e na"#(, "& eBpectoe5e >nainte $e a >ncepe poce$#aL
- "e face a"piaie 4#co-faingian&, (a ne)oieL
- "e ea(i5ea5& %onta8#( "i"te%#(#iI "#"& $e ae, t#4 $e aco$, ne4#(i5atoL
- "e )eific& 4#na f#nciona(itate a "i"te%#(#iI
- a4"ena pie$eii $e ga5 (a ni)e(#( aco$#(#iL
- pe5ena no#(#i $e 4#(e $e ga5 >n ne4#(i5atoL
- "e conectea5& pacient#( (a "i"te%I
- "e eg(ea5& %a"ca c# a8#to#( e(a"tic#(#i, >n %o$ ata#%aticL
- "e eBp(ic& pacient#(#i "& e"pie no%a(, >n ti%p#( !e$inei, pin %a"ca c# in"piaie
na5a(& !i eBpiaie 4#ca(& "a# pin pie"a 4#ca(& c# in"piaie 4#ca(& !i eBpiaie na5a(&L
- "e p#n (a >n$e%1na pacient#(#iI 4ati"te na5a(e, "c#ip&toaeL
- "e notea5& oa conect&ii (a ne4#(i5atoL
- "e "#pa)eg*ea5& $e c&te a"i"tent&, >n ti%p#( aeo"o(oteapieiI
- ni)e(#( $e #%p(ee c# ap& a ne4#(i5ato#(#iL
- inten"itatea ne4#(i5&ii ?pent# a pe)eni i"c#( $e in#n$ae 4on!ic&@L
- f#ncii(e )ita(eI ',R, t#"e eBpectoaie, co(oaie feei, eacii(e genea(e.
- "e >nc*i$e %ano%et#(L
- "e >n$ep&tea5& %a"ca $#p& faa pacient#(#i "a# pie"a 4#ca(&L
- "e !tege faa $e tan"piaie $ac& e nece"aL
- "e cee pacient#(#i "&-!i "#f(e na"#(L
- "e apecia5& "taea pacient#(#iI a%e(ioaea e"piaiei !i a confot#(#iL
- "e notea5& poce$#a >n fi!a pacient#(#i.
Capitolul 1! 5NGRI6IRILE 5N GOLILE CARDIOVASCULARE
1,.1 P)$;:ti)$a pa&i$7tului 9i pa)ti&ipa)$a a'i't$7tului +$,i&al la $Ha+i7a)$a )a,iolo;i&: a
apa)atului &a),io<a'&ula)
A7;io&a),io;)a%ia
6ngioca$iogafia e"te #n eBa%en a$io(ogic a( )a"e(o !i ca)it&i(o ini%ii c# "#4"tan& $e
conta"t
S&opDi7,i&a*ii
- e)a(#aea #no $efecte )a()#(aeL
- %onitoi5aea pe"i#ni(o p#(%onae !i a $e4it#(#i ca$iac inta !i po"t opeatoL
2.8
- a$%ini"taea #no %e$ica%ente to%4o(itice >n atea o4"t#cionat&L
- angiop(a"tie c# ateecto%ie "a# %ontae $e "tent.
Mat$)ial$ 7$&$'a)$
0#nt >n f#ncie $e "cop !i in$icaiiI
- "#4"tane $e conta"t pent# eBa%inae a$io(ogic&L
- %e$ica%ente pent# pe)eniea !i co%4ateea acci$ente(oL
- catete >n f#ncia $e )ena cateteo5at&L
- %ateia(e $e $e5infecie.
- %e$ic#( eBp(ic& nece"itatea poce$#ii !i %o$#( $e $e#(aeL
- o4ine con"i%&%1nt#( "ci"L
- pacient#( n# %&n1nc& >naintea eBa%en#(#iL
- pacient#( >!i go(e!te )e5icaL
- pacient#( e"te a)eti5at c& >n ti%p#( in8ect&ii "#4"tanei $e conta"t )a "i%i a"#& !i
$#ee $e-a (#ng#( )enei ?12-2. "ec#n$e@ $in ca#5a concentaiei "o(#ieiL
- pacient#( e"te info%at c& poce$#a $#ea5& apoBi%ati) o o&L
- e5#(tate(e "e pi%e"c >n 1-2 5i(e.
- >n f#ncie $e "cop#( #%&it, "e pot p#nciona )ena "#4c(a)ic#(a&, 4a*ia(& "a# fe%#a(&
pent# co$#( $ept, fe%#a(& "a# 4a*ia(& pent# catetei5aea co$#(#i "t1ngL
- $ac& e"te nece"a, pent# catetei5aea )enei fe%#a(e, 5ona e"te >nt1i a"& !i $#p& aceea
$e5infectat& !i p#ncionat&L
- >n ti%p#( poce$#ii, pacient#( e"te %onitoi5atL
- a"i"tent#( %e$ica( "e)e!te %ateia(e(e nece"ae !i o4"e)& pacient#(L
- $#p& p#ncionae "e into$#ce catete#( !i "e a)an"ea5& p1n& >n ca)itatea ca$iac& "a# p1n&
>n atee(e coonaeL
- $#p& in8ectaea "#4"tanei $e conta"t, "e fac a$iogafii cae pot e)i$eniaI %o$ific&i
anato%ice a(e %ai(o )a"e "a# ca%ee(o ini%ii, oc(#5ia ateei coonae, ane)i"%#(
)entic#(a, $efecte "epta(e, )a()#(ae congenita(e "a# $o41n$ite, e%4o(ii p#(%onae,
*ipeten"i#nea p#(%ona&.
57;)iAi)$a ,up: p)o&$,u):
- pacient#( e"te "#pa)eg*eat atent /-8 oe, "e o4"e)& (oc#( p#nciei ?pot ap&ea "1nge&i,
*e%atoane@, p#("#(, ten"i#nea ateia(&L
- pot ap&ea ait%ii "a# a(te co%p(icaii %ai ga)e ?6;C, I96, infecia (oc#(#i $e in"eie a
catete#(#i@L
- pacient#( "t& >n epa#", c# %e%4#( p#ncionat >ntin"L
- $ac& pacient#( n# >!i poate %i!ca %1na "a# picio#(, ac#5& f#nic&t#i !i $#ei, "e an#n&
%e$ic#(L
- "e eco%an$& con"#%#( ce"c#t $e (ic*i$e, pent# a fa)oi5a e(i%inaea "#4"tanei $e
conta"t.
2.+
Alt$ $Ha+$7$ )a,iolo;i&$
- Ao)to;)a%ia K into$#ceea pin p#ncie "a# catete a #nei "#4"tane $e conta"t >n aot&,
pent# "t#$ieea ace"teia.
- A)t$)io;)a%ia p$)i%$)i&: K into$#ceea pin in8ecie intaateia(& a "#4"tanei $e conta"t
pe 4a5a $e io$ >nt-o ate& peifeic&.
- Fl$(o;)a%ia K into$#ceea pe ca(e i.). a #nei "#4"tane $e conta"t $i(#ate pent# a "t#$ia
pe%ea4i(itatea )enei !i %o$ific&i(e peete(#i.
0#nt eBa%ene $e co%pentena %e$ic#(#i, >n ca$#( c&oa a"i"tent#( peg&te!te %ateia(e(e,
>n"oe!te pacient#( !i >( o4"e)& $#p& poce$#&.
1,.2 To+o;)a%ia &o+put$)i>at: to)a&i&:
E"te #n eBa%en a$io(ogic c# "a# f&& "#4"tana $e conta"t, cae ofe& "eci#ni tan")e"a(e a(e
peete(#i !i ogane(o intatoacice pe 4a5a c&oa "e pot $iagno"tica o "eie $e afeci#ni
ne$ecta4i(e pe a$iogafia toacic& "tan$a$.
'ot fi e)i$eniateI
- ca(cific&i %ici $e atee coonaeL
- ane)i"%#( $e aot&L
- to%4oe%4o(i"%#(L
- (i%fa $enopatii *i(ae "a# %e$ia"tina(e.
- pacient#( n# %&n1nc& >nainte $e eBa%enL
- pacient#( "t& ne%i!cat >n ti%p#( eBa%en#(#iL
- poce$#a $#ea5& 3.-+. %in#teL
- poate ap&ea "en5aia $e c(a#"tofo4ie (a intaea >n apaatL
- $ac& "e a$%ini"tea5& "#4"tana $e conta"t, "e %ontea5& o (inie )enoa"a, pacient#( e"te
a)eti5at a"#pa "en5aiei $e c&($#&L
- >n ti%p#( eBa%en#(#i, a"c#(t& in$icaii(e ce(#i cae face >negi"taea.
- n# "#nt nece"ae >ngi8ii "pecia(eL
- $ac& "-a fo(o"it "#4"tana $e conta"t, e"te "f&t#it "& 4ea %#(te (ic*i$e.
1,., E&o;)a%ia t)a7'to)a&i&:
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1.., EBa%ene c# #(ta"#nete@.
1,./ Pu7&*ia p$)i&a),i&:
'oce$#a e"te $e"ci"& (a capito(#( + ?+./ '#nc ia peica$ic&@
1,.2 57)$;i't)a)$a $l$&t)o;)a+$i ?7 )$pau' 9i ?7 $%o)t
E(ectoca$ioga%a ?EN-@ >negi"tea5& acti)itatea e(ectic& a %ioca$#(#i c# a8#to#( #no
e(ecto5i cae captea5& po(ai5aea !i $epo(ai5aea atii(o !i )entic#(e(o.
6"i"tent#( %e$ica( ea(i5ea5& >negi"taea, intepetaea fiin$ f&c#t& $e c&te %e$ic.
Tipu)i ,$ $l$&t)o&a),io;)a+:
- e(ectoca$ioga%a "i%p(&L
21.
- e(ectoca$ioga%a $e efotL
- %onitoi5aea =o(te.
a@ El$&t)o&a),io;)a+a 'i+pl:
- "e info%ea5& pacient#( ca >negi"taea n# co%pot& nici o ga)itate i n# e $#eoa"&L
- e"te #gat "& co(a4oe5e #%1n$ >ntoc%ai eco%an$&i(e a"i"tent#(#i %e$ica(L
- e"te a e5at >n $ec#4it pe o canapea, 4ate(e fiin$ (e8e >ntin"e pe (1ng& copL
- %e%4e(e infeioae "#nt >ntin"e #!o $ep&tate, pent# ca e(ecto5ii "& n# "e ating& >nte eiL
- (eg&t#a >nte pacient !i apaat "e face pin ca4(#i $e c#(oi $ifeite.
57)$;i't)a)$a $l$&t)o&a),io;)a+$i
- "e fi5ea5& e(ecto5ii pent# >negi"taeL
- pent# ea(i5aea #n#i contact 4#n >nte teg#%ent !i e(ecto5i, ace!tia "e #ng c# #n ge( 4#n
con$#c&to $e e(ecticitateL
- %ontaea e(ecto5i(o "e face a"tfe(I
- (a ni)e(#( %e%4e(o
o!# K %1na $eapt&
ga(4en K %1na "t1ng&
)e$e K picio "t1ng
neg# K picio $ept
- >n 5ona poce$#a(&, fiBaea "e face a"tfe(I
;1 K n#%it p#nct paa"tena( $ept "it#at >n "pa i#( I; inteco"ta(, pe %aginea $eapt& a
"ten#(#iL
;2 K p#nct#( paa"tena( "t1ng , "it#a( >n "pai#( I; inteco"ta( , pe %aginea "t1ng& a
"ten#(#iL
;, K "it#at >nte p#ncte(e ;2 !i ;/L
;/ K "it#at >n "pai#( ; inteco"ta( pe (inia %e$io- c(a)ic#(a& "t1ng&L
;2 K "it#at (a inte"ecia $e (a oi5onta(a $#"& $in ;/ !i (inia aBi(a& anteioa& "t1ng&L
;3 K "it#at (a inte"ecia $inte oi5onta(a $#"& $in ;/ !i (inia aBi(a& %i8(ocie "t1ng&.
0e >negi"tea5& I
- , $ei)aii 4ipo(ae "tan$a$ notate c# D1 , D2 , D,L
- , $ei)aii #nipo(ae a(e %e%4e(o a;R , a;L , a;FL
- 3 $ei)aii poco$ia(e I ;1 , ;2 , ;, , ;/ , ;2 , ;3L
- $#p& ce pacient#( "e (ini"te!te , "e face >nt1i te"taea apaat#(#i !i apoi >negi"taea
popi#- 5i"&
- $ac& apaat#( >negi"tea5& coect, "e tece (a efect#aea eBa%en#(#i popi#-5i"L
- pacient#( e"te a)eti5at c1n$ te4#ie "& &%1n& >n apneeL
- e(ectoca$ioga%a e"te o "#cce"i#ne $e
- #n$e notate con)eniona( c# (itee I ' , \ , R , 0 , T , U
- "eg%ente K $i"tana $inte 2 #n$e I '\ , 0T
- inte)a(e K ?#n$a V "eg%ent@ notate \R0, '\ , \T , T'
'e e(ectoca$ioga%& "e notea5&I
- n#%e(e !i pen#%e(e pacient#(#iL
211
- )1"ta, >n&(i%ea, ge#tateaL
- %e$icaia fo(o"it& ?cae inf(#enea5& >negi"taea@L
- $ata !i oa >negi"t&iiL
- "e%n&t#a ce(#i cae e >negi"tatL
Fntepetaea e(ectoca$ioga%ei e"te $e co%petena %e$ic#(#i.
In$icaii I
- angin& pectoa(&L
- "#"pici#ne $e infact "a# peica$it&L
- ait%iiL
- e)a(#ae >n ca$#( te"t#(#i $e efotL
- %onitoi5aea e)o(# iei i a #no tata%ente.
4@ El$&t)o&a),io;)a+a ,$ $%o)t
E"te #n eBa%en ea(i5at "#4 "#pa)eg*eea %e$ic#(#i, cae poate fi a"i"tat $e o a"i"tent&, !i ae
o(#( $e a i$entifica in"#ficiena coonaian& cae "e %anife"t& (a efot.
'acient#( e"te info%at c# pi)ie (a %o$#( $e $e"f&!#ae a te"t#(#i.
Efect#aea poce$#ii
- "e %ontea5& e(ecto5iiL
- "e face %ai >nt1i o e(ectoca$ioga%& "i%p(&L
- e"te p#" apoi "& pe$a(e5e o 4icic(et& egono%ic& "a# "& %eag& pe #n co)o #(antL
- poga%#( $#ea5& >n %o$ no%a( 2.-,. %in#teL
- >n ti%p#( efot#(#i "e >negi"tea5& EC-, pe"i#nea ateia(&L
- pacient#( "& ai4e >%4&c&%inte (e8e&L
- n# f#%ea5& >nainte $e te"tL
- %&n1c& c# 2 oe >nainte $e $e te"tL
- co%#nic& %e$ic#(#i tata%ent#( cae (-a (#at >n 5i#a e"pecti)&L
- pacient#( e"te "f&t#it "& an#ne oice %anife"tae >n ti%p#( eBa%en#(#iI $#ee, pa(pitaii,
8en& e"piatoie.
1,.3 Mo7ito)i>a)$a $l$&t)o&a),io;)a%i&: a+(ulato)i$ #Folt$)-
=o(te#( pe%ite >negi"taea acti)it&ii ca$iace ti%p $e 2/* pin inte%e$i#( #no e(ecto(i5i
%ontai pe toace(e pacient#(#i !i (egat $e o c#tie pe cae ace"ta o poat& tot ti%p#( c1t $#ea5&
>negi"taea.
EBa%en#( e"te foate i%potant pent# >negi"taea feno%ene(o paoBi"tice cae apa "a# $i"pa
4#ta(I ait%ii, %o$ific&i i"c*e%ice.
'e%ite apecieea efecte(o tata%ent#(#i c# antiait%ii.
Mo7ta)$a $l$&t)o>ilo)
- "e >n$ep&tea5& pi(o5itatea, $ac& e"te nece"aL
- "e p#n e(ecto5i a)1n$ gi8& "& fie 4ine %ontai, pent# a (i%ita c1t %ai %#(t paa5itaea
>negi"t&iiL
- "e )eific& $i"po5iti)#( $e >negi"taeL
- "e $ec(an!ea5& >negi"taea.
I7't)ui)$a pa&i$7tului ?7 ti+pul ?7)$;i't):)ii
- pacient#( ae o4(igaia "& "#pa)eg*e5e c#tia apat#(#i >n ti%p#( ce(o 2/oeL
212
- n# face $#!L
- $#ce o )ia& no%a(&Go4i!n#it& tot ti%p#( >negi"t&iiL
- pe o *1tie "pecia(& "e >negi"tea5& $in o& >n o& toate %anife"t&i(e patic#(aeI pa(pitaii,
o4o"ea(& %ae, efot %aeL
- pacient#( notea5& toate acti)it&i(e efect#ate !i toate e)eni%ente(e (a cae paticip& >n
2/oeL
- n# te4#ie "& fo(o"ea"c& apaat#a e(ectic& "a# e(ectonic& ?apaat $e a"@ $eoaece
%o$ific& ta"e#( EC-.
Intepetaea e5#(tate(o "e face $e c&te %e$ic, (a "f1 it#( >negi"t&ii ?$#pp 2/ oe@.
1,.7 Sup)a<$;=$)$a pa&i$7tului t)atat &u ,iu)$ti&$ ?7 &a),iolo;i$
6ci#nea %e$ica%ente(o
- Di#etice(e ce"c eBceia ena(& $e "o$i# !i ap&.
In$icaii genea(e
- in"#ficien& )entic#(a& "t1nga !i $eaptaL
- e$e% p#(%ona !i e$e%e a(e #no %e%4e infeioaeL
- *ipeten"i#ne ateia(&L
- etenia *i$ic& $in "in$o%#( nefotic, cio5a *eptic&L
- in"#ficien& ena(& ac#t& !i conic&.
Reco%an$aea $i#etic#(#i, "ta4i(iea $o5ei !i oa#(#i $e a$%ini"tae "#nt $e co%petena
%e$ic#(#i.
F #o"eni$ ?f#anti(, (a"iB@ K po)oac& e(i%inaea #n#i )o(#% %ae $e #in& i5oton "a# *ipoton c#
o cantitate ce"c#t& $e Na, N, C(, Ca, 9g.
0e fo(o"te!te >n toate tip#i(e $e e$e%I in"#ficien& cai$ac&, cio5&, en$e%e ena(e
Tia5i$e(e "#nt $i#etice c# aci#ne %o$eat&, e(ati) $#a4i(&.
0#nt (ag fo(o"ite pent# tata%ent#( eteniei *i$o"a(ine %o$eate $in in"#ficiena ca$iac&
conic&, cio5&, 4o(i ena(e conice. 0#nt in$icate ca anti*ipeten"i#ne.
0piono(actona !i a(te $i#etice a($o"teonice ce"c e(i%inaea apei !i a c(o#(#i $e "o$oi#
Fa)oi5ea5& eineea pota"i#(#i >n ogani"%.
9anito(#( K face pate $inte $i#etici(e o"%otice, nu se folosete n insuficiena cardiac
decompensat#
Sup)a<$;=$)$a t)ata+$7tului
- c#4a $i#e5eiL
- c#4a ge#t&iiL
- "e%ne(e c(inice !i "taea $e *i$ataeL
- "e eco(tea5& po4e 4io(ogice, #%&in$ pincipa(ii paa%eti ai f#nciei ena(eI #ee
"ang)in&, ceatine%inL "e "#pa)eg*ea5& ionoga%a "ang)in& !i #ina&L
- "e face $o5aea eg#(at& a poteine(o, #ice%ia, g(ice%ia, ca(ce%ia, pe%i1n$ $epi"taea
efecte(o in$e5ia4i(e a(e tata%ent#(#i.
21,
1,.8 Sup)a<$;=$)$a pa&i$7tului t)atat &u ,i;itali&$
Digita(ice(e "#nt g(#co5i$e ca$iotonice cae a# ca efect ce!teea foei $e contacie a
%ioca$#(#i, e$#ceea fec)enei ca$iace, >ncetiniea con$#ceii intaca$iace, i ce"teea
eBcita4i(it& ii %ioca$#(#i )entic#(a.
In$icaii
- in"#ficiena ca$iac&L
- t#(4#&i(e $e it% "#pa)entic#(a.
Recomandarea tonicardiacului, stabilirea dozei i orarului de administrare sunt de
competena medicului.
P)$&au*ii8 'up)a<$;=$)$B
0#pa)eg*eea, $e c&te a"i"tent#( %e$ica(, a pacient#(#i tatat c# $igita(ice #%&e teI
- o4"e)aea "t&ii genea(e a pacient#(#i pe $#ata tata%ent#(#iG"pita(i5&iiL
- tan"%iteea oic&o "e%ne intoBica ie "a# efecte a$)e"e cae pot ap&ea, pec#%I
- "e%ne $ige"ti)eI anoeBie, ge#i, )&"&t#iL
- "e%ne oc#(aeI $i"co%atop"ie (a )e$e !i ga(4enL
- "e%ne ne#o(ogiceI cefa(ee, fatiga4i(itate, )eti8L
- "e%ne ca$iaceI t#(4#&i $e it% !i $e con$#cee e(e)ate pin
e(ectoca$ioga%&L
- %anife"t&i a(egice i to%4openie ?a@L
- efecte a$)e"e a"#pa "i"te%#(#i ne)o"I "(&4ici#ne %#"c#(a&, apatie,
fatiga4i(itate, a"tenie, "tae $e &#, cefa(ee, t#(4#&i $e )e$ee, $epe"ie !i
foate a p"i*o5eL
- gineco%o"tia ?>n a$%ini"taea pe te%en (#ng@.
- $epi"taea intoBicaiei $igita(ice te4#ie "& "e fac& "i"te%atic (a toi pacien ii af(ai "#4
tata%entL
- "e o4in pin inteog&i $ate $e"pe %anife"t&i(e eBtaca$iace, a$e"ea foate pecoce !i pin
EC-, cae e)i$enia5& eBta"i"to(e i5o(ate, 4(oc atio)entic#(a "a# fi4i(aie atia(& !i it%
)entic#(a (entL
- #n %i8(oc "i%p(# $e "#pa)eg*ee e"te #%&iea fec)enei ca$iaceL
- %e$ic#( poate cee #n $o5a8 p(a"%atic a( $igita(ic#(#i >n "#"pici#ne $e "#pa$o5ae
- pacient#( e"te a)eti5at c&, (a apaiia "e%ne(o pecoce $e intoBicaie $igita(ic&, "& %eag&
i%e$iat (a %e$ic pent# o con$#it& teape#tic& a$ec)at&.
CapitolulE 1" 5NGRI6IRI 5N GASTROENTEROLOGIE
1/.1 EHa+i7a)$a )a,iolo;i&: a apa)atului ,i;$'ti<
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1..1.c 'eg&tiea pacient#(#i i paticipaea (a
eBa%inaea a$io(ogic& a t#4#(#i $ige"ti)@.
1/.2 EHa+i7a)$a $7,o'&opi&: a o);a7$lo) ,i;$'ti<$
'oce$#a e"te $e"ci"& (a capito(#( 11 ?11.2 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea
e"ofagoga"to$#o$eno"copiei, 11., 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea co(ono"copiei,
11./ 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea ecto"ig%oi$o"copiei@.
21/
1/., EHa+i7a)$a $&=o;)a%i&: a o);a7$lo) ,i;$'ti<$
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1.., 'aticipaea a"i"tent#(#i %e$ica( (a eBa%en#( c#
#(ta"#nete, ec*ogafice@.
1/./ EHa+i7a)$a &u i>otopi )a,ioa&tin efect#aea eBa%ene(o
c# i5otopi a$ioacti)i, "cintigafie@.
1/.2 Pu7&*ia a(,o+i7al:
'oce$#a e"te $e"ci"& (a capito(#( + ?+., 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea p#nciei
peitonea(e, paacente5a a4$o%ina(&@.
1/.3 Pu7&*ia (iop'i&: =$pati&:
'oce$#a e"te $e"ci"& (a capito(#( + ?+.8.a 'aticipaea a"i"tent#(#i %e$ica( (a p#ncia 4iop"ic&
*epatic&@.
1/.7 Sp:l:tu)a ;a't)i&:
'oce$#a e"te $e"ci"& (a capito(#( 8 ?8.2 0p&(&t#a ga"tic&@.
1/.8 A'pi)a*ia ;a't)i&:
S&op D I7,i&a*ii
- go(iea "to%ac#(#i c# a8#to#( #nei "on$e >n ca5 $e "ta5&L
- oc(#5ie inte"tina(&L
- peg&tiea >naintea #nei inte)enii c*i#gica(eL
- po"topeato pent# pe)eniea )&"&t#i(o.
Mat$)ial$ 7$&$'a)$
- ta)& "a# c&#cio pent# %ateia(eL
- "on$ea$ioopace $e ca#ci#c "a# $in %ateia( p(a"tic "tei(eL
- "einga $e 2. %(L "eing& -#Uon ?2. %(@ "tei(&L
- t&)i& ena(&L
- "o(#ie pent# (#4ifiee ?aZ#a ge(@L
- co%pe"eL
- ep#4ete, p#ng& co(ectoae pent# co(ectaea conin#t#(#iL
- a(i%ente, %e$ica%ente >n f#ncie $e "cop !i in$icaieL
- pa*a %atL
- (e#cop(a"tL
- po"oape, !e)ee(e $e *1tieL
- po"op, c1%p pent# potec ia (en8eiei.
- "e eBp(ic& "cop#( !i nece"itatea, %o$#( $e $e#(ae a poce$#ii, $#at&L
- "e eBp(ic& %o$#( $e co(a4oae, "e o4ine con"i%&%1nt#(L
- "e >n$ep&tea5& pote5a $enta& !i "e p#ne >nt-#n pa*a %at c# ap&L
212
- "on$a "e poate into$#ce pe ca(e na5a(& "a# 4#ca(&L
- pacient#( e"te #gat "a# a8#tat "&-!i c#ee na"#(L
- "e a(ege naa >n f#ncie $e pe%ea4i(itate, p#n1n$ pacient#( "& e"pie a(tenati) pe o na&
"a# a(ta.
- "e a(eg %ateia(e(e >n f#ncie $e in$icaieL
- "e in"ta(ea5& pacient#( >n po5iie !e51n$ "a# "e%i!e51n$L
- "e "pa(& %1ini(eL
- "e pote8ea5& (en8eia pacient#(#i c# #n po"op "a# #n c1%p p(a"at "#4 4&4ieL
- "e %&"oa& $i"tana $inte (o4#( #ec*ii !i )1f#( na"#(#i p1n& (a apen$ice(e Bifoi$L
- "e %ac*ea5& (oc#( ce(o 2 %&"#&toi "a# "e notea5& $i"tane(e $ac& "on$a e"te ga$at&L
- "e $& pacient#(#i "& in& t&)ia ena(& "#4 4&4ieL
- "e #%e5e!te )1f#( "on$ei pent# a a"ig#a >naintaeaL
- "on$a "e into$#ce c# gi8& pin naa "e(ectat& >%ping1n$-o "pe "pate >n 8o"L
- >ng*iiea "e face (ent, $1n$ pacient#(#i (a ne)oie cantit&i %ici $e ap&L
- pacient#( >ng*ite p1n& (a pi%#( "e%nL
- "e o4"e)& "taea pacient#(#i $eoaece pot apae t#"ea, ciano5a, t#(4#&i e"piatoii, ceea
ce aat& c& "on$a a a8#n" >n ta*eeaL
- pacient#( e"te #gat "& >ng*it& >ncet p1n& (a a( $oi(ea "e%nL
- "e )eific& po5iia "on$ei pin #na $in #%&toae(e %eto$eI
- a"piaea conin#t#(#i "to%aca(L
- into$#ceea ae#(#iL
- into$#ceea cap&t#(#i (i4e a( "on$ei >nt-#n pa*a c# ap&L
- pent# a(i%entaie "a# into$#ceea #no %e$ica%ente )eificaea te4#ie f&c#t& pin
conto( a$io(ogicL
- c1n$ "on$a a a8#n" >n "to%ac (a $i)i5i#nea /2 "a# 22, >n f#nc ie $e ca(ea pe cae "-a
into$#", "e fiBea5& c# (e#cop(a"t pe na" a"tfe( >nc1t "& n# >%pie$ice )e$eea !i "& n#
pe"e5e na"#(L
- "e ea(i5ea5& o 4#c(& $in patea (i4e& a "on$ei pent# a pe%ite %i!caea (i4e& a cap#(#i !i
"e face a $o#a fiBaeL
- pacient#( e"te a!e5at >n po5iie co%o$&L
- "e contin#& t#4a8#( confo% "cop#(#i !i in$icaieiL
- >nte $o#& fo(o"iiI
- "on$a "e c(a%pea5&L
- "e ata!ea5& (a "on$& p#nga co(ectoae.
A'pi)a*ia ;a't)i&:
- "e poate face contin## pin into$#ceea cap&t#(#i (i4e a( "on$ei >nt-#n )a" co(ecto a!e5at
%ai 8o" $ec1t "to%ac#( pacient#(#iL
- a"piaia inte%itent& "e face c# a8#to#( #nei "eingiL
- cantitatea $e (ic*i$ a"piat& "e %&"oa&, "e notea5& !i "e ia >n ca(c#( (a 4i(an#( *i$icL
- "e con"e%nea5& a"pect#( (ic*i$#(#i a"piat.
213
Sup)a<$;=$)$a a'pi)a*i$i
- $ac& "on$a "e >nf#n$&, )a fi pe%ea4i(i5at& c# a8#to#( #nei cantit&i %ici $e ae "a# "e
fi5io(ogic into$#"& c# o fo& %o$eat&.
Sup)a<$;=$)$a a'pi)a*i$i ;a't)i&$
- "e pen"ea5& "on$a apoBi%ati) 3 oeL
- "e "#pa)eg*ea5& "taea pacient#(#iL
- "e i$entific& e)ent#a(e(e "e%ne $e into(ean& ga"tic&L
- "on$a "e eBtage c# gi8&, e"pect1n$ eco%an$&i(e %e$ica(e.
1/.+ Ali+$7ta*ia p)i7 'o7,a 7a>o4;a't)i&:
I7,i&a*ii
- pacieni incon!tieniL
- pacieni c# t#(4#&i $e $eg(#tiieL
- pacieni c# negati)i"% a(i%enta,L
- pacieni c# "tict#i e"ofagiene.
- %ateia( pent# t#4a8, $ac& "on$a n# e"te $e8a %ontat&L
- "eing& -#Uon, p1(nie $e "tic(&L
- (ic*i$e a(i%entae (a te%peat#a cop#(#i, f&& g#n8i, cae pot >nf#n$a "on$aL
- %ateia(e pent# potecia (en8eiei.
P)$;:ti)$a pa&i$7tului 9i )$ali>a)$a ali+$7ta*i$i
- "e a!ea5& pacient#( >n po5iie co%o$&L
- (a cap&t#( (i4e a( "on$ei "e poate ata!a, $#p& ca5I p1(nie $e "tic(&, "eing& -#Uon "a# #n
apaat $e pef#5ieL
- "e a$%ini"tea5& /-3 $o5e pe 5i, fiecae $o5& fiin$ >n 8# $e 22.-/.. %(L
- $ac& (ic*i$e(e "#nt a$%ini"tate pin apaat#( $e pef#5ie, cantitatea )a fi $e ce( %#(t 2..-
22. %(Go&L
- $#p& a$%ini"taea a(i%ente(o, "on$a "e "pa(& pin into$#ceea a 2..-,.. %( $e ap& !i
apoi a #nei cantit&i %ici $e aeL
- (a "f1!it, "on$a "e >nc*i$e c# a8#to#( #nei pen"e.
1/.1. Ali+$7ta*ia p)i7 ;a't)o'to+:
-a"to"to%a e"te $e"c*i$eea c*i#gica(& !i fiBaea (a peete a "to%ac#(#i >n "cop#( a(i%ent&ii
c# a8#to#( #nei "on$e, at#nci c1n$ ca(ea e"ofagian& n# e"te a4o$a4i(&.
Fn "to%& "e fiBea5& o "on$& $e ca#ci#c pin inte%e$i#( c&eia a(i%ente(e "#nt into$#"e >n
"to%ac c# o p1(nie "a# "eing&.
I7,i&a*iiB
- p#neea >n epa#" a e"ofag#(#i $#p& opeaii, a"#i c# "#4"tane ca#"tice $#p& inge"tie
)o(#nta& "a# acci$enta(&L
- "tict#i e"ofagiene po"tca#"tice "a# o4"taco(eL
- c1n$ a(i%entaea atificia(& "e i%p#ne )e%e %ai >n$e(#ngat&.
217
Mat$)ial$ 7$&$'a)$B
- a(i%ente pa"ate, c# con"i"ten& foate e$#"&, (a te%peat#a cop#(#iL
- p1(nie "a# "eingi $e ce( p#in 2.-2. %(L
- !e)ee(e $e *1tieL
- 4ag*et& pent# >%pingeea a(i%ente(oL
- %ateia( pent# potecia "to%eiL
P)$;:ti)$a pa&i$7tului 9i $%$&tua)$a p)o&$,u)iiB
- e"te in"t#it c#% "e poate a(i%enta "ing#L
- "&-!i "pe(e %1ini(eL
- "& >n$ep&te5e pen"a cae >nc*i$e "on$aL
- "& a$apte5e p1(nia (a cap&t#( (i4e a( "on$ei "a# "& %onte5e "eingaL
- "e into$#c pe 1n$ a(i%ente(e f&& "& "e $ep&!ea"c& 1.. %( o$at&, pent# a n# $e"tin$e
"to%ac#( !i pent# ca a(i%ente(e "& n# "e "c#g& >nafa&L
- "e a(tenea5& into$#ceea (ic*i$e(o c# "e%i"o(i$e(eL
- $o5a pent# o %a"& n# te4#ie "& $ep&!ea"c& /.. %(L
- (a "f1!it#( %e"ei "e a$%ini"tea5& #n (ic*i$, pent# a "p&(a (#%en#( "on$eiL
- "e >nc*i$e "on$a (a "f1!it#( a(i%entaieiL
- "e fiBea5& "on$a >n po5iie )etica(&L
- pacient#( &%1ne >n po5iie !e51n$& "a# "e%i!e51n$& ?po5iia $e $ec#4it $o"a( fa)oi5ea5&
Ceg#gitaeaE conin#t#(#i pe "on$&@L
- e"te a8#tat "&-!i "pe(e %1ini(e.
57;)iAi)$a pa&i$7tului
- "e o4"e)& teg#%ente(e $in 8##( "to%eiL
- "e pote8ea5& pie(eaL
- "e eface pan"a%ent#(#i $in 8##( "to%ei >n cap#( eg#git&ii "#c#(#i ga"tic.
O('$)<a ii
- a(i%entaea poate fi f&c#t& !i $e a(t& pe"oan& in"t#it& >n ace"t "en"L
- c1n$ in$icaia $e a(i%entae pin ga"to"to%& n# %ai e"te $e act#a(itate, "on$a "e etage !i
"e a!teapt& >nc*i$eea "to%ei. '(aga "e >ngi8e!te >n con$iii $e a"ep"ie !i anti"ep"ie.
1/.11 57;)iAi)$a pa&i$7tului &olo'to+i>at C '&=i+(a)$a pu7;ii
Co(o"to%ia epe5int& $e"c*i$eea !i fiBaea co(on#(#i (a "#pafaa peet#(#i a4$o%ina( pint-o
inte)enie c*i#gica(&.
S&op
Uti(i5aea #n#i $i"po5iti) etan! !i $i"cet pent# co(ectaea %ateii(o feca(e !i %enineea
integit&ii c#tanate, ceea ce pe%ite pacient#(#i "& $e"f&!oae o acti)itate fi5ic& no%a(&.
0to%ii(e pot fi f&c#te, $#p& nece"itate, >n %ai %#(t 5oneI
- ga"to"to%ia, $e"c*i$eea (a ni)e(#( "to%ac#(#iL
- i(eo"to%ia, $e"c*i$eea (a ni)e(#( inte"tin#(#i "#4tie ?i(eon@L
218
- co(o"to%ia, $e"c*i$eea co(on#(#i, cae poate fi f&c#t& >n patea $eapt&, (a ni)e(#(
co(on#(#i tan")e" "a# >n patea "t1ng&, (a ni)e(#( co(on#(#i "ig%oi$.
Co(e"to%ia e"te po)i5oie "a# $efiniti)&.
I7,i&a*iiB
Colo'to+i$ p)oo)i$ ?7 p$,iat)i$
- %a(fo%aie ano-ecta(& >na(t& !i 8oa"&L
- %a(a$ia =i"c*"p#ng ?$o(icoco(on@L
- ate5ia $e co(onL
- ta#%ati"%e.
Colo'to+ia p)oo)i$ la a,ult
- po(ipo5a fa%i(ia(&L
- $i)etic#(o5aL
- cance $e co(on.
Mat$)ial$ 7$&$'a)$
- p#nga pent# co(o"to%ie ?ne)i$an8a4i(&, c# fi(t# $e potecie c#tanat&@L
- %ono(oc ?p#ng& !i "#pot "o(i$a@ "a# 4i4(oc ?p#ng& $eta!a4i(& $e "#pot@L
- %&n#!i "tei(eL
- co%pe"e "tei(eL
- p#$& cicati5ant& !i a4"o4ant&, $ac& pie(ea pei"to%a(& e"te iitat&L
- ta)it& ena(&L
- $oi "aci co(ectoiL
- foafec&, #n %o$e( pent# $ec#pae ?g*i$ $e %&"#ae@L
- ap& !i "&p#n ne#t#L
- pa"t& potectoae, pent# a a"ig#a etan!ietateaL
- "e eBp(ic& pacient#(#i %o$#( $e $e"f&!#ae a >ngi8iiiL
- >n pi%e(e $o#& K tei 5i(e, p(aga a4$o%ina(& "e pan"ea5& ca oice p(ag& c*i#gica(&L
- >n a $o#a K a teia 5i, "e poate e(i%ina pin "to%ie #n "ca#n pa"to" %io"itoL
- pacient#( te4#ie a)eti5at !i a8#tat teptat "& accepte no#a i%agine copoa(&L
- e"te an#nat c& >n a teia 5i )a p#ta o p#ng&L
- e"te "#"in#t !i a8#tat pent# ca >n )iito "a fie capa4i( "a "e a#to>ngi8ea"c& ?"&-!i "c*i%4e
"ing# p#nga@L
- e"te a!e5at >n po5iie $ec#4it (a pi%e(e "c*i%4&i "a# >n po5itie !e51n$& (a #%&toae(e,
c1n$ e"te capa4i( "&-!i pi)ea"c& "to%a !i "&-!i "c*i%4e p#nga "ing#.
- "e p#n %&n#!i $e #nic& fo(o"in&L
- "e >n$epatea5& conin#t#( p#ngii, $ac& p#nga e"te )i$an8a4i(&L
- "e $e"face >ncet p#nga $e "#" >n 8o", f&& "& "e tag&, pent# a e)ita e)i"ceaiaI o %1n&
fiBea5& pie(ea a4$o%ina(&, cea(a(t& $eta!ea5& p#ngaL
- "e c#&& teg#%ente(e $in 8##( "to%ei c# apa !i "&p#n ne#t#L
21+
- "e #"#c& foate 4ine 5ona pei"to%a(&L
- "e o4"e)& "to%a cae >n %o$ no%a( te4#ie "& fie #%e$&, o!iatic& "pe o5L
- "e ap(ic& p#$a cicati5ant& !i a4"o4ant&L
- "e acope& "to%a c# o co%pe"&L
- "e "e(ectea5& %&i%ea $e"c*i$eii "to%ei, fo(o"in$#-"e g*i$#( $e %&"#aeL
- "e $ec#pea5& c# a8#to#( #nei foafeci poi#nea $e a$eae a $i"po5iti)#(#i "to%ic pe pie(e
"#4 fo%& $e cec, a"fte( >nc1t $e"c*i$eea "& fie c# 8#%&tate $e %i(i%et# %ai %ae $ec1t
"to%aL
- "e >n$ep&tea5& co%pe"aL
- "e >n$ep&tea5& *1tia $in poi#nea $e (ipie a $i"po5iti)#(#i "to%ic !i "e ap(ic& pe pie(e
>ncep1n$ $e (a po(#( infeio !i ap&"1n$ p#in p1n& "e (ipe!te. 0e contin#& >n$ep&taea
*1tiei !i (ipiea $i5po5iti)#(#iL
- "e (ipe!te >n contin#ae, pin ap&"ae #nifo%&, >n "en" cic#(a, >n 8##( "to%ei, p1n& "e
fiBea5&L
- "e co(ectea5& !i "e >n$ep&tea5& %ateia(e(e fo(o"iteL
- "e >n$epatea5& %&n#!i(eL
- "e "pa(& %1ini(e.
57;)iAi)i ult$)ioa)$
- "e a!a5& pacient#( >n po5iie !e51n$& "a# $ec#4itL
- "e e)a(#ea5& eacia $#p& "c*i%4aeL
- "e "#pa)eg*ea5& "& n# apa& a"#i, iitaii, neco5&, e)i"ceaiiL
- "e o4"e)& $ac& p#nga e"te (ipit&L
- "i"te%#( $e co(ectae "e "c*i%4& (a 2 5i(e, $ac& n# "e $e5(ipe!te.
1/.12 E%$&tua)$a i)i;ati$i &oli&$ #&li'+a p$ &ol$'to+:-
Into$#ceea #nei cantit&i $e ap& pin co(o"to%ia "t1ng&, pent# go(iea inte"tin#(#i.
S&opDi7,i&a*iiB
- go(iea co%p(et& a inte"tin#(#i $e ga5e, %#c#" !i %ateii feca(e, pent# e)itaea p#t&ii
#nei p#ngi co(ectoae, a"tfe( >nc1t pacient#( "&-!i poat& efect#a acti)it&i(e 5i(niceL
- pi%a c(i"%& "e face a 8-a K a 1.-a 5i po"topeato !i n#%ai (a eco%an$aea %e$ic#(#iL
- cea %ai fa)oa4i(& peioa$& e"te >n con)a(e"cen&, >nte , "&pt&%1ni !i 2 (#ni $#p&
inte)enia c*i#gica(&L
- "e face (a inte)a( $e 2-, 5i(e, >ntot$ea#na (a aceea!i o&.
Mat$)ialul 7$&$'a)
- #n "ca#n $ec#pat (a %i8(oc, a)1n$ $e$e"#4t #n co(ectoL
- iigato pent# co(o"to%ie, t#4 a$aptoL
- can#(a co(otip ?"#4 fo%& conic&, $e p1(nie@ fo(o"it& >n ace"t "copL
- ap& c&($#& 7..-8..%(L
- )a"e(in&L
- #n $eget $e %&n#!& ?$in (ateB@L
- #n %an on $e iigaieL
- ta%pon opt#ato "a# o p#ng& %ic& co(ectoaeL
22.
- %&n#!i $e #nic& fo(o"in&, co%pe"e ne"tei(eL
- #n po"opL
- a(e5&L
- ap&, "&p#n pent# c#&iea 5oneiL
- $oi "aci pent# co(ectaea $e!e#i(o.
- "e in"ta(ea5& pacient#( >n po5iia "e%i!e51n$L
- "e #%&e!te efect#aea e$#caiei pent# a#tono%ie >n )iito.
- "e "pa(& %1ini(eL
- "e >n$ep&tea5& $i"po5iti)#( ap(icat $e pe p(an#( c#tanatL
- "e c#&& pie(ea $in 8##( "to%ei c# ap& !i "&p#n ne#t#, "e #"#c& foate 4ineL
- "e ap(ic& %an on#( ?o p#ng& co(ectoae $e"c*i"& (a ce(e $o#& eBte%it&i@L
- "e >nc*i$e eBte%itatea infeioa& pint-#n no$ "a# pin c(a%pae, "a# "e into$#ce >nt-#n
ecipient co(ectoL
- fo(o"in$ $eget#( $e %&n#!&, "e face #n t#!e# (a ni)e(#( "to%ei, pent# a epea po5iia
p1(niei ?co(otip#(#i@L
- "e peg&te!te iigato#( c# ap& c&($#& ?7..-8.. %(@, "e "#"pen$& pe #n "#pot, apoBi%ati)
(a >n&(i%ea #%&#(#i pacient#(#iL
- "e e(i%in& ae#( $in t#4#( iigato#(#iL
- "e into$#ce co(otip#( (#4ifiat (a ni)e(#( co(o"to%ei pin eBte%itatea "#peioa& a
%an on#(#iL
- "e $e"c*i$e cic#it#( !i apa "e "c#ge >n inte"tin >n apoBi%ati) 3-1. %in#teL
- (a te%inaea iigaiei, "e >n$ep&tea5& co(otip#(, "e >nc*i$e patea "#peioa& a %an on#(#i
c# o pen"& !i "e >n$ep&tea5&L
- "e a!teapt& go(iea tota(& a inte"tin#(#iL
- e)ac#aea "e face "#4 "#pa)eg*eea a"i"tent#(#iL
- "e c#&& "to%a c# ap& !i "&p#nL
- "to%a "e acope& c# pan"a%entL
- >n ti%p#( poce$#ii, pacient#( e"te #gat "& o4"e)e toate etape(e, pent# a "e p#tea
a#to>ngi8i.
57;)iAi)$a ,up: p)o&$,u):
- (a ni)e(#( "to%ei "e face #n pan"a%ent, "e p#ne #n ta%pon o4t#ato "a# o p#ng& %ic&
opac&L
- pot ap&ea $#ei a4$o%ina(e, ge#i $ac& go(iea n# e"te co%p(et&L
- $#ei(e pot fi po$#"e !i $e )ite5a pea %ae a (ic*i$#(#i $e "p&(&t#&, ia ace"tea pot fi
pe)enite pin conto(aea it%#(#i $e "c#gee.
221
Capitolul 1. 5NGRI6IRI 5N URONEFROLOGIE
12.1 EHa+i7a)$a )a,iolo;i&: a apa)atului )$7al
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1..1.e 'eg&tiea pacient#(#i i paticipaea (a
eBa%inaea a$io(ogic& a apaat#(#i ena(@.
12.2 EHa+i7a)$a $7,o'&opi&: a <$>i&ii u)i7a)$
'oce$#a e"te $e"ci"& (a capito(#( 11 ?11.7 'aticipaea a"i"tent#(#i %e$ica( efect#aea (a
ci"to"copiei@.
12., EHa+i7a)$a $&=o;)a%i&:
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1.., 'aticipaea a"i"tent#(#i %e$ica( (a eBa%en#( c#
#(ta"#nete, ec*ogafice@.
12./ EHa+i7a)$a &u i>otopi )a,ioa&ti<iE S&i7t$;)a%ia )$7al:
'oce$#a e"te $e"ci"& (a capito(#( 1. ?1..2 Ro(#( a"i"tent#(#i %e$ica( >n efect#aea eBa%ene(o
c# i5otopi a$ioacti)i, "cintigafie@.
12.2 Pu7&*ia (iop'i&: )$7al:
'oce$#a e"te $e"ci"& (a capito(#( + ?+.+.4 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea
p#nciei 4iop"ice@.
12.3 So7,aAul <$>i&al
'oce$#a e"te $e"ci"& (a capito(#( 8 ?8./ 0on$a8#( )e5ica( (a fe%eie, 8.2 0on$a8#( )e5ica( (a
4&4at@.
12.7 Pu7&*ia <$>i&al:
'oce$#a e"te $e"ci"& (a capito(#( + ?+.8 'aticipaea a"i"tent#(#i %e$ica( (a efect#aea p#nciei
)e5icii #inae@
12.8 Sp:l:tu)a <$>i&al:
'oce$#a e"te $e"ci"& (a capito(#( 8 ?8.3 0p&(&t#a )e5ica(&@.
12.+ Sup)a<$;=$)$a pa&i$7tului &u 'o7,: p$)+a7$7t:
'oce$#a "e efe& (a %ontaea #nei "on$e pe%anente at#nci c1n$ e)ac#aea )e5icii #inae
$e)ine i%po"i4i(&, n# eBi"t& conto(#( "finctee(o "a# "e i%p#ne o %onitoi5ae "tict& a f#nc iei
ena(e.
S&op
- go(iea )e5icii #inae >n etent ia #ina& te%poa&, ac#t& "a# conic& ?afec i#ni
ne#o(ogice, co%&@L
- incontinen a #ina& in)a(i$ant&L
- inte)en ii c*i#gica(e pe apaat#( genito-#ina ?po"tatecto%ie, opea ii pe )e5ic&, pe
peine#, *i"teecto%ie@L
- ta#%ati"%e a(e a4oe(#i #inaL
- ta#%ati"%e a(e %a&$#)ei ?paap(egie@L
222
- (a pacien ii a i, pent# e)a(#aea $i#e5ei oae.
Mat$)ial$ 7$&$'a)$B
- "on$a Fo(eU "tei(&L
- apa $i"ti(at& "a# "e fi5io(ogic, o fio(& ?1. %(@L
- "eing& 1. %(L
- )a"e(in& "tei(&L
- ge( ane"te5iantL
- %&n# i "tei(e i ne"tei(eL
- co%pe"e "tei(eL
- "o(# ie anti"eptic&L
- p#nga )i$an8a4i(&, ga$at& pent# co(ectaea #iniiL
- %ateia( pent# potec ia pat#(#iI a(e5&, %# a%aL
- t&)i & ena(&, 4a5inetL
- co(ecto pent# %ateia(e(e fo(o"ite.
P)$;ati)$a pa&i$7tuluiB
- e"te an#n at i i "e eBp(ic& nece"itatea %ont&ii "on$eiL
- "e a"ig#& inti%itateaL
- "e info%ea5& ?>n %o$ $eo"e4it 4&4a ii@ ca into$#ceea "on$ei po$#ce oaecae 8en&L
- "e in"ta(ea5& pacient#( confota4i( >nt-#n pat peg&tit c# a(e5& i %# a%aL
- "e face o toa(eta ig#oa&a a ogane(o genita(e #ti(i51n$ %&n# i $e #nic& fo(o"in &L
- (a fe%ei "e c#& & i "e $e5infectea5a 5ona peiana(&, (a4ii(e %ai i %ici, %eat#( #inaL
- (a 4&4at "e $eca(otea5& g(an$#( i "e c#& & 5ona foate 4ine in"i"t1n$ a"#pa %eat#(#i
#ina.
- pe"oana cae efect#ea5& poce$#a "e "pa(& pe %1ini c# "&p#n anti"eptic "a# "e
$e5infectea5& c# o "o(# ie a(coo(ic& $#p& cae >%4ac& %&n# i "tei(e ?%&n# i(e n# te4#ie
"a con in& ta(c@L
- "e acope& egi#nea genita(& c# c1%p#( "tei( >n a a fe( >nc1t %eat#( #ina "& fie acce"i4i(L
- "e into$#ce "on$a (#4ifiat& c# )a"e(in& ap(ic1n$ te*nica "on$a8#(#i e)ac#ato "i%p(#L
- $#p& p&t#n$eea >n )e5ic& "e into$#c >n 4a(ona #( "on$ei 1. %( ap& "tei(& "a# "e
fi5i(o(ogic pent# fiBaeL
- "e aco$ea5& "on$a (a p#nga co(ectoae.
3a brbati prima sond se montea! de ctre medic#
57;)iAi)$a ,up: p)o&$,u):B
- $eoaece eBi"t& #n i"c ce"c#t $e infec ie, toate %ane)e(e "e fac >n con$i ii $e "tict&
a"ep"ie i anti"ep"ieL
- "e )eific& pe%ea4i(itatea "on$ei i etan eitatea "i"te%#(#i ?"on$&, p#ng&@L
- "e in"t#ie te pacient#( "& n# co%pi%e "on$aL
- pacient#( e"te aten ionat "& "#" in& p#nga at#nci c1n$ "e $ep(a"ea5&L
- "e )eific& 5i(nic a"pect#( #inii e(i%inate, "e notea5a cantitateaL
22,
- "e %en ine o 4#na igien& (oca(&, a)1n$ >n )e$ee pe5en a #no e)ent#a(e "c#gei )agina(e
i e(i%inaea "ca#n#(#iL
- "e eco%an$& efect#aea toa(etei (oca(e $e $o#a oi pe 5iL
- "e o4"e)& a"pect#( %eat#(#i #ina, o ea a a"ociat& c# 8ena (oca(& fiin$ "e%n $e infec ieL
- $ac& #ina $e)ine t#(4#e, (a eco%an$aea %e$ic#(#i, "e eco(tea5& po4& pent#
#oc#(t#&L
- >n ca5#( inte)en ii(o c*i#gica(e "e e"pect& c# "ticte e toate eco%an$&i(e %e$ic#(#i.
Capitolul 1/ 5NGRI6IRI 5N GOLI METAGOLICE
13.1 Gli&$+ia &apila):
S&op
- conto(#( api$ a( g(ice%iei c1n$ "e i%p#n $eci5iiL
- a#toconto(#( >n ca$#( %onitoi5&ii DD in"#(ino-$epen$ent !i in"#(ino nece"itant
Medicul specialist stabilete orarul i frecvena determinrilor glicemiei#
I7,i&a*ii
- >n DD1 $ete%in&i(e "e efect#ea5& 5i(nic pepan$ia( !i po"tpan$ia( ?(a 2 oe $#p& %a"&@
!i oi $e c1te oi inte)in e)eni%ente nepe)&5#te cae %o$ific& oa#( !i $o5e(e $e in"#(in&
?>n con"ecin& a(i%entaia@L
- ce( p#in o $at& pe "&pt&%1n& "e face pofi( g(ice%ic ?$ete%in&i pepan$ia(, po"tpan$ia(
!i (a , $i%ineaa@L
- >n DD2 $ete%in&i(e "e fac "&pt&%1na(.
- pacient#( e"te in"t#it "&-!i $ete%ine "ing# g(ice%ia fo(o"in$ g(#co%et#(L
- pacient#( e"te a)eti5at c& te*nica $ete%in&ii poate )aia #!o >n f#ncie $e apaatL
- $ac& pacient#( ae t#(4#&i $e )e$ee ?etinopatie@ $ete%inaea )a fi f&c#t& $e #n
apain&to in"t#it "a# $e a"i"tenta %e$ica(&.
Mat$)ial$ 7$&$'a)$
- g(#co%et#L
- te"te eacti)e ?4an$e(ete, "tip"#i@L
- ace "pecia(e ata#%aticeL
- ta%poane #"cate.
- "e "pa(& %1ini(eL
- "e !tege pent# a #"ca foate 4ine pie(ea ?pe pie(ea #%e$& n# "e fo%ea5& pic&t#a@L
- "e >neap& (atea( (a ni)e(#( #(ti%ei fa(angeL
- "e !tege pi%a pic&t#& c# #n ta%pon #"catL
- "e fo%ea5& a $o#a pic&t#& cae e"te $ep#"& c# peci5ie pin atingeea cap&t#(#i eacti) a(
4an$e(eteiL
- $in %o%ent#( atingeii 4an$e(etei c# pic&t#a $e "1nge >ncepe cono%etaea ti%p#(#iL
- fiecae tip $e 4an$e(ete eacti)e e"te >n"oit $e #n potoco( $e (#c# ?pent# citie )i5#a(&
"a# e(ectonic&@.
22/
O('$)<a ii
- te"te(e te4#ie "& fie >n te%en $e )a(a4i(itate, $ata fiin$ >n"ci"& pe f(acon,,,,,,,,,,,,,
- "e p&"tea5& inte 2-,.
o
L
- "coateea fiec&ei 4an$e(ete ?te"t@ e"te #%at& $e >nc*i$eea etan!& a f(acon#(#i, inteio#(
f(acon#(#i fiin$ %enin#t #"catL
- cap&t#( eacti) a( 4an$e(etei n# te4#ie atin"L
- fiecae tip $e 4an$e(eta e"te "pecific& #n#i an#%it tip $e g(#co%et#L
- g(ice%ia eco(tat& $in "1nge capi(a e"te c# apoBi%ati) 2. %g %ai %ae $ec1t cea
eco(tat& $in "1nge(e )eno".
7B3>2C34 93C/4MC/4 >2MB34 C"C?424D "4 M>M4DE3 24/>3DF2CC SED
/E12CS4 .D24 G)+,,) mg<dl
13.2 T$'tul tol$)a7*$i la ;lu&o>:4o)al #TETEGEO-
S&op
- te"taea to(eanei (a g(#co5& >n )e$eea "ta4i(iii $iagno"tic#(#i $e $ia4et 5a*aat (a
pe"oane(e (a cae g(ice%ia 4a5a(& ?pepan$ia(&, a 8e#n@ e"te >nte 11.-123 %gM.
I7,i&a*ii
- "#"pici#ne $e $ia4et 5a*aat ?etinopatie, ne#opatie, nefopatie@, ni)e(e a(e g(#co5ei "eice
]a 8e#nE "a# po"tptan$ia(& (a (i%it&L
- antece$ente fa%i(ia(e $e $ia4etL
- o4e5itate i%potant&L
- i"toic $e infeciiL
- ga)i$& ?"&pt.2/-28 $e ge"taie@ c# i"toic fa%i(ia( $e $ia4et "a# a)ot "pontan, f&t
%aco"o% ?pe"te /... g@>n antece$ente.
Mat$)ial$ 7$&$'a)$
- $o5& "tan$a$I - 72 g g(#co5& $i5o()at& >n ,.. %( ap& pent# a$#(iL
- 1,72 gGOg cop ?ge#tatea i$ea(&@ pent# f&& a $ep&!i 72 g. (a copi(L
- "eingi, ace, f(acoane "a# )ac#teinee pent# eco(taea "1nge(#i ?capac gi "a# o!# pent#
a e)ita *e%o(i5a@L
- f(acoane pent# #in&.
- "e eBp(ic& nece"itatea efect#&ii po4ei !i %o$#( $e $e#(aeL
- "e info%ea5& c& ingeaea "o(#iei $e g(#co5& "e face >n 2 %in#teL
- "e o4in e)ent#a(e info%aii $e"pe egi%#i $e "(&4ieL
- "e e)it& "te"#(L
- "e info%ea5& pacient#( c& e"te po"i4i( "& apa& a%ee(i, te%o, anBietate, tan"piaii cae
te4#ie "e%na(ateL
- "e in"t#ie!te "& n# %&n1nce ce( p#in 1. oe, "& n# f#%e5e, "& n# 4ea ceai "a# cafeaL
- e"te atenionat c& e"ticii(e "e %enin pe ti%p#( $e"f&!#&ii po4eiL
- >naintea po4ei n# "e i%p#n e"ticii a(i%entae, pacient#( con"#%& %ini% 12. g
*i$oca4onateL
- >n ti%p#( po4ei, pacient#( "t& >n epa#".
222
E%$&tua)$a p)o($i ?oa $e $e"f&!#ae 7,,.-1.,..@
Oa 7,,.I - "e )eific& $ac& pacient#( a e"pectat eco%an$&i(eL
- "e eco(tea5& "1nge pent# g(ice%ia a 8e#n
- "e a$%ini"tea5& "o(#ia $e g(#co5& ?,.. %(. ap& V 72 g g(#co5&@ pe cae pacient#(
o 4ea >n 2 %in#teL
- "e notea5& ti%p#( $in %o%ent#( pi%ei >ng*iit#iL
- pacient#( &%1ne >n epa#", n# con"#%& a(i%ente, n# f#%ea5&. 'oate "& 4ea ap&L
D#p& 2 oe ?+,,.@ - "e eco(tea5& "1nge pent# g(ice%ieL
- "e etic*etea5& po4e(e !i "e ti%it (a (a4oato.
Not:B 2ecoltarea se poate face i la , or dac medicul solicit#
57;)iAi)$a pa&i$7tului ,up: p)o(:
- &%1ne "#4 "#pa)eg*eeL
- "e )eific& $ac& apa tan"piaii, "tae $e anBietate, eacii(e fiin$ %ai fec)ente (a
"#papon$ea(i !i "#nt $ete%inate $e ce!teea "eceiei $e in"#(in& "ti%#(at& $e ce!teea
g(ice%ieiL
Dac& %anife"t&i(e apa >n ti%p#( po4ei, acea"ta "e >nte#pe, pacient#( pi%e!te %1ncae.
Pa)ti&ula)it:*i la ;)a<i,:
- eco(taea "1nge(#i "e face (a 1, 2 !i , oeL
- fe%ei(e ga)i$e cae n# a# pe5entat a(teaea to(eanei (a g(#co5& >naintea "&pt&%1nii 2/
)o efect#a #n te"t c# 2. g g(#co5& G 2.. %( ap& >n "&pt&%1ni(e 2/-28L
- $ac& g(ice%ia (a 1 o& e"te ega(& c# 1/. %g G $( "e efect#ea5& TT-O c# 1.. g g(#co5&.
13., D$t$)+i7a)$a =$+o;lo(i7$i ;li&o>ilat$ #;li&at$-
0e efe& (ae)a(#aea pe te%en (#ng a ni)e(e(o "eice %e$ii a(e g(#co5ei.
6"i"tent#( %e$ica( eco(tea5& 2 %( "1nge pin p#ncie )enoa"& >nt-#n )ac##% c# capac gi, (a
eco%an$aea %e$ic#(#i.
'acient#( poate "o(icita #n "e)ici# $e (a4oato "& $ete%ine *e%og(o4ina g(ico(i5at& pent# a
e)a(#a )a(oi(e %e$ii a(e g(#co5ei pe o peioa$& $e / (#ni.
;a(oaea n# e"te afectat& $e )aiaii pe te%en "c#t ?eBI %e"e, efot fi5ic, "te", %e$ica%ente
*ipog(ice%iante@.
13./ A,+i7i't)a)$a i7'uli7$i
S&opDi7,i&a*ii
- pent# a"ig#aea "#pa)ie#iii c# $ia4et 5a*aat tip 1L
- pent# conto(#( g(ice%ii(o (a pacienii c# $ia4et 5a*aat tip 2 c1n$ anti$ia4etici(e oa(e
co%4inate c# $ieta n# ating o4iecti)e(e teape#ticeL
- epi"oa$e $e "te" %eta4o(ic ac#t ?infact %ioca$ic, a)c, infecii %o$eate "a# "e)ee@L
- pe-L inta- !i po"t opeato c1n$ "e "#"pen$& %e$icaia oa(&L
- in"#ficiena *epatic& !i ena(& c1n$ anti$ia4etici(e oa(e "#nt contai$icateL
- >n $ia4et#( 5a*aat ge"taiona( cae n# "e e5o()& pin $iet&L
- >n #gene *ipeg(ice%iceI cetoaci$o5&, *ipeg(ice%ie *ipeo"%o(a&.
223
Tipu)i ,$ i7'uli7:
- In"#(ine api$e c# aci#ne "c#t&, cae "e fo(o"e"c >n "it#aii $e #gen& %eta4o(ic&
"ing#e(e cae "e pot a$%ini"ta I.;. acion1n$ >n %ai p#in $e 1. %in#te ?in"#(ine
pan$ia(e cae "e in8ectea5& >naintea %e"e(o@L
- In"#(ine inte%e$iae c# aci#ne pe(#ngit& !i in"#(ine c# aci#ne (#ng& ?in"#(ine 4a5a(e
cae "e a$%ini"tea5& $i%ineaa !i "eaa@L
- In"#(ine pe%iBate ?4ifa5ice@ a%e"tec >n $ifeite popoii $e in"#(in& c# aci#ne api$& !i
in"#(in& c# aci#ne inte%e$ia&.
R$'po7'a(ilit:*i
Medicul$+ stabilete do!ele, tipul de insulin i orarul de administrare, locul administrrii
6"i"tent#( %e$ica(I
- a$%ini"tea5& in"#(ina confo% in$icaii(oL
- in"t#ie!te pacient#( c#% "&-!i fac& in8ecia c# in"#(in& !i >( a"i"t& pent# "ta4i(iea coect& a
$o5e(oL
- in"t#ie!te pacient#( pi)in$ %o$#( $e p&"tae a in"#(inei,
- in"t#ie!te pacient#( pi)in$ ec#noa!teea "e%ne(o *ipog(ice%iei.
Mat$)ial$ 7$&$'a)$
- in"#(in& in f(acoane, cat#!e "a# pen-#i pe#%p(#teL
- "eingi pent# in"#(in& ?c# capac $e ..22 K 1 %(@L
- ace $e 12 %%, 8%%, 3%%.
0e in"t#ie!te pacient#( c# pi)ie (aI
9o$#( $e p&"tae a in"#(ineiI
- f(acoane, cat#!e, pen-#i ne$e"c*i"e, "e p&"tea5a (a figi$e ?$epate $e conge(ato,
>nte 2-8bC, p1n& (a $ata eBpi&ii@L
- f(acoane, cat#"e pen-#i $e"c*i"e, "e p&"tea5a >n ace(ea!i con$iii ce( %#(t 1-2 (#niL
- f(acoane(e "e pot p&"ta !i (a te%peat#a ca%eei ?>nte 2-,.bC@, f&& "& fie eBp#"e (a
(#%in&, n# %ai %#(t $e 28 $e 5i(e. Dac& ti%p#( e"te $ep&!it, "e pie$e )a(a4i(itatea.
;eificaea a"pect#(#i in"#(inei
- in"#(ine(e api$e a# a"pect c(a, (i%pe$eL
- in"#(ine(e inte%e$iae "a# (ente a# a"pect (acte"cent, t#4i$, f&& f(ocoane.
I7'uli7a &u %lo&oa7$ 7u '$ a,+i7i't)$a>:L
'eg&tiea in"#(inei >n )e$eea a$%ini"t&iiL
- "e "coate in"#(ina $in figi$e c# 3. %in#te >nainte, pent# a "e >nc&(5i (a te%peat#a
ca%eeiL
- in"#(ine(e inte%e$iae "a# (ente "e o%ogeni5ea5& pin c#(caea f(acon#(#i !i #(aea 4(1n$&
>nte pa(%e $e ,. $e oi. agitaea f(acon#(#i >n po5iie )etica(& po$#ce 4#(e !i
i%pefeci#ni (a $o5ae. $ac& in"#(ina n# "e o%ogeni5ea5&, n# "e a$%ini"tea5aL
- n# "e a%e"tec& in"#(ine c# concentaii $ifeite !i nici tip#i $e in"#(in& $ifeiteL
6(egeea (oc#(#i a$%ini"tai >n conco$an& c# tip#( $e in"#(in& !i c# eco%an$aea %e$ica(&.
- pent# in"#(ine api$e K a4$o%ina( K c# eBcepia a 2 c% >n 8##( o%4i(ic#(#iL
- pent# in"#(ine inte%e$iaeI coap"&, fe"eL
Factoii cae inf(#enea5& a4"oia in"#(inei !i, e"pecti), oa#( %e"e(o
227
- efot#( fi5ic $ete%in& ce!teea f(#B#(#i "ang)in !i, e"pecti), a atei a4"o4ieiL
- eBp#neea (a c&($#& ?4aie, %a"a8, p(a8&@ fa)oi5ea5& a4"o4ia %ai api$& !i g(#ci$e(e "e
a$%ini"tea5& c# c1te)a %in#te %ai $e)e%eL
- eBp#neea (a fig po$#ce )a"ocon"t#cie, >ncetine!te a4"o4ia, a(i%ente(e fiin$
a$%ini"tate c# c1te)a %in#te %ai t15i#L
Te*nica a$%ini"t&ii in"#(ineiI
- n# e"te nece"a& $e5infecia c# a(coo(, $a te4#ie ea(i5at& igieni5aea (oc#(#iL
- $ac& "e fo(o"e!te tot#"i a(coo(, "e a!teapt& e)apoaeaL
- "e >ncac& "einga "a# pen-#( c# n#%&#( $e #nit&i eco%an$ateL
- pen-#i(e a# a)anta8#( c& po$#c #n 5go%ot pent# fiecae #nitate $e in"#(in&, pe%i1n$
$o5aea $e c&te pe"oane(e c# po4(e%e $e %an#a(itate ?te%#&t#i@ "a# t#(4#&i $e
ac#itate )i5#a(&, a$%ini"taea p#t1n$#-"e face c# #!#in& in$ifeent $e (oc#( #n$e "e af(&
pacient#( ?>n afaa $o%ici(i#(#i@L
- >n egi#nea a4$o%ina(& "a# fe"ie&, in8ectaea "e face >n p(i# c#tanat, >nepaea fiin$
ea(i5at& >n #ng*i $e +.b $ac& e"#t#( "#4c#tanat e"te 4ine $e5)o(tat "a# >n #ng*i $e /2b (a
pe"oane(e "(a4e !i (a copiiL
- pent# pacienii "(a4i !i copii, in8ectaea "e face >n 5ona $e(toi$ian& "a# coap"&, >n #ng*i $e
/2bL
- "e $& $#%#( p(i#(#i $#p& etageea ac#(#iL
- n# "e %a"ea5& (oc#(, $eoaece g&4e!te a4"o4iaL
I%potana otaiei (oc#(#i $e in8ecie
- otaia "e face >n aceea!i aie, pent# a pe)eni (ipo$i"tofia ?(ipo*ipetofia T $ep#nee
eBce"i)& $e g&"i%e "a# (ipoatofia T topiea e"#t#(#i ga" "#4c#tanat@L
- #%&toaea in8ecie "e face (a %ini%#( 2 c% $e in8ecia anteioa&L
Re"pectaea eg#(i(o cae fa)oi5ea5& e$#ceea $#eii (a in8ectae
- "o(#ia "e in8ectea5& (a te%peat#a ca%eei ?"e "coate $in figi$e c# 3. %in#te >nainte@L
- ae#( "e e(i%in& coectL
- 5ona "e "pa(& "a# "e $e5infectea5& c# a(coo( !i "e a!teapt& e)apoaeaL
- 5ona te4#ie "& fie e(aBat&L
- >nepaea teg#%ent#(#i "e face api$L
- >n ti%p#( in8ect&ii n# "e "c*i%4& $iecia ac#(#iL
- "e fo(o"e"c ace a$ec)ate, >n f#ncie $e go"i%ea e"#t#(#i "#4c#tanat ?3-8-12-13 %%@L
Eec#noa!teea *ipog(ice%iei !i ca#5e(e cae o $ete%in&I
0i%pto%e >n *ipog(ice%ieI
- tan"piaii, pie(e ece !i #%e$&L
- pa(pitaiiL
- te%#L
- e"piaie acce(eat&L
- ce!teea pe"i#nii ateia(eL
- ne(ini!teL
- pa(oaeL
- gea&.
Ca#5eI
- a$%ini"taea #nei $o5e ina$ec)ate $e in"#(in&L
- a4"o4tia ina$ec)at& a in"#(inei >n 5ona c# *ipe$i"tofie ?>ncetine!te poce"#(@L
228
- nee"pectaea inte)a(#(#i $inte a$%ini"taea in"#(inei !i a$%ini"taea a(i%ente(o
?o%iteea %e"e(o, %ai a(e" a ce(o $e "ea&@L
9&"#i $e co%4atee a *ipog(ice%iei
- "e a$%ini"tea5& 1. g $e *i$oca4onai a4"o4a4i(i ?"#c $e f#cte, (apte "a# f#cte@.
13.2 Rolul a'i't$7tului +$,i&al ?7 &$toa&i,o>a ,ia($ti&:
Cetoaci$o5a e"te o "tae pato(ogic& caactei5at& pin pet#4&i ga)e a(e %eta4o(i"%#(#i
g(#ci$ic, (ipi$ic, poti$ic, !i *i$oe(ecto(itic.
=ipeg(ice%ia e"te caactei"tic& cetoaci$o5ei, )a(oaea $ep&!e!te 22.-,.. %gG$( a"ociat&
g(ico5#iei ?apae (a g(ice%ie pe"te 18.gG$(@ !i po(i#ie cae antenea5& e(i%inaea $e "&#i.
Cetoaci$o5a "e poate in"ta(a 4#ta( "a# (ent.
R$'po7'a(ilit:*i
Medicul$+ pune diagnosticul, stabilete planul terapeutic individuali!at
6"i"tent#( %e$ica(I
- ec#noa!te "e%ne(e *ipeg(ice%ieiL
- ap(ic& tata%ent#( confo% p(an#(#i teape#tic "ta4i(it $e %e$icL
- "#pa)eg*ea5& pacient#(.
57;)iAi)$a pa&i$7tuluiB
Rec#noa!teea "e%ne(o
- po(i$ip"ieL
- po(i#ieL
- "c&$ee >n ge#tateL
- $e"*i$ataeL
- ge#i, )&"&t#iL
- *a(ena acetano%ic&L
- e"piaie N#""%a#(L
- ten"i#ne ateia(& "ca5#t&L
- ta*ica$ieL
- t#(4#&i a(e "t&ii $e con!tien&L
- co%& >n cetoaci$e5e(e neg(i8ate.
Ca#5e(e $ec(an!atoae a(e cetoaci$o5ei !i co%ei $ia4etice
- eoaea pi)in$ a$%ini"taea in"#(inei ?opiea 4#"c&, f&& a)i5 %e$ica(@L
- ge!e(i epetate $e egi% a(i%enta, con"#% >n eBce" $e g(#ci$e !i g&"i%iL
- ce!teea ne)oi(o $e in"#(in& K >n ca5#( #no infecii c#ente ?e"piatoii, #inae,
c#tanate@, "t&i fe4i(e, "te", infact $e %ioca$, acci$ent )a"c#(a cee4a(L
- tata%ente c# %e$ica%ente *ipeg(ice%iante ?coticoteapia@L
6p(icaea eco%an$&i(o %e$ica(e
- pacient#( te4#ie "& a8#ng& #gent (a "pita(L
- "e %ontea5& o pef#5ie c# "e fi5io(ogic pent# a *i$ata pacient#(L
- in cetoacci$o5e(e incipiente, $ac& eBi"t& to(ean& $ige"ti)&, "e *i$atea5& pacient#( oa( c#
cantit&i %ici, epetate c# in"i"ten&L
- medicul specialist instituie tratament cu insulin rapid n ; pri!e pe !i&
2..
- a$%ini"taea in"#(inei api$e "e face i.)., i.%. "a# ".c. >n f#ncie $e api$itatea c# cae "e
$oe!te in"ta(aea efect#(#i !i $e )a(oaea g(ice%ieiL
- "e "cot $in a(i%entaie (ipi$e(e !i poteine(eL
- a$%ini"taea *i$ai(o $e ca4on ?*c@ "e )a face "#4 fo%& #!o $ige"ti4i(& ?"e%i(ic*i$e,
(ic*i$e@, c#pin51n$ (actate, "#c#i $e f#cte, f#cte $eco8ite !i pa"ate, f&inoa"eL
- $o5a $e in"#(in&, ca(ea $e a$%ini"tae !i it%#( "#nt *ot&1te $e c&te %e$icL
- %enineea in"#(ine(o api$e "e face p1n& c1n$ cetoaci$o5a $i"pae !i ca#5a e"te >n(&t#at&.
0#pa)eg*eea pacient#(#i >n ti%p#( epi"o$#(#i cetoaci$o5ic !i $#p& aceea, pent# pe)eniea
co%p(icaii(o
- "#pa)eg*eea pef#5ieiL
- $#ata pef#5iei e"te $ictat& $e e(#aea to(eanei $ige"ti)eL
- (ic*i$e(e "#nt "ta4i(ite $e %e$ic.
6$%ini"taea $e o
2
(a ne)oie
- "#pa)eg*eea $i#e5ei ?e)ent#a( "on$a8 )e5ica(@L
- eco(taea po4e(o $e (a4oato >n confo%itate c# eco%an$aea %e$ic#(#iI g(ice%ia,
g(ico5#ia, ionoga%a ?poate ap&ea *ipopota"e%ie@L
- "e "#pa)eg*ea5& e"piaia, ta ?i"c $e co(ap", p#("#(, "tae $e con!tien&@L
- >nc&(5iea pacient#(#i c# 4#iote, $eoaece pacient#( ae ten$ina $e *ipote%ie.
13.3 Rolul a'i't$7tului +$,i&al ?7 =ipo;li&$+i$
=ipog(ice%ia epe5int& "c&$eea g(ice%iei "#4 2. %gG$( a"ociat& c# "i%pto%e caactei"tice
cae $i"pa $#p& a$%ini"taea $e g(#co5&.
Fn ca5#( *ipog(ice%iei e"te i%potant "& c#noa!te%I
- con$iii(e $e apaiieL
- %anife"t&i(e c(inice !i po4e(e $e (a4oatoL
- pe)eniea !i tata%ent#(.
R$'po7'a(ilit:*i
Medicul$
- stabilete diagnosticul de hipoglicemie&
- stabilete planul terapeutic#
6"i"tent#( %e$ica(I
- ec#noa!te "e%ne(e *ipog(ice%iei !i i$entific& ca#5e(eG,
- aco$& pi%#( a8#to >n ca5 $e *ipog(ice%ie, confo% potocoa(e(o eBi"tente !i ap(ic&
p(an#( teape#ticL
- "#pa)eg*ea5& !i >ngi8e!te pacient#(.
57;)iAi)$a pa&i$7tului &u =ipo;li&$+i$
a@ R$&u7oa9t$)$a '$+7$lo) 9i 'i+pto+$lo) =ipo;li&$+i$i
0e%ne !i "i%pto%e $ete%inate $e eacia "i"te%#(#i ne)o" "i%paticI
- tan"piaii, pie(e #%e$& !i eceL
- pa(pitaiiL
- te%#&t#iL
- e"piaie acce(eat&
- ce!teea ten"i#nii ateia(eL
2,.
- ne(ini!teL
- pa(oaeL
- gea& #neoi.
0e%ne !i "i%pto%e $e ne#og(icopenieI
- foa%eaL
- a"teniaL
- "en5aia $e cap ge#L
- cefa(ee ?fonta(& !i etoo4ita&@L
- "(&4ici#ne %#"c#(a&L
- co%pota%ent age"i), t#(4#&i $e co%pota%entL
- "tae $e conf#5ieL
- a%oe(i ?paa"te5ii (a 4#5e, (i%4&, #neoi (a $egete(e %1ini(o@L
- t#(4#&i $e )e$ee ?)e$ee $#4(&, >n cea&@L
- con)#("iiL
- $eficit %otoL
- co%&, $ece".
O('$)<a ii
6tag atenia ant#a8#(#iI
- pa(oaeaL
- tan"piaii(eL
- t#(4#&i $e co%pota%entL
- te%#&t#i(eL
- contacii(eL
- $e5oientaeaL
- conf#5iaL
- co%a.
4@ I,$7ti%i&a)$a &au>$lo) =ipo;li&$+i$i
- eBce"#( $e in"#(in&L
- (ip"a *i$oca4onate(o "a# inge"tia in"#ficient&L
- nea$aptaea $o5ei $e in"#(in& (a efot "a# (ip"a con"#%#(#i "#p(i%enta $e g(#ci$eL
- $o5a $e in"#(in& ina$ec)at& epati5at& pe %e"eL
- a$%ini"taea #no %e$ica%ente.
c@ Apli&a)$a pla7ului t$)ap$uti& 9i &o+(at$)$a =ipo;li&$+i$i >n confo%itate c# potocoa(e(e
$e >ngi8ie !i $e %o%ent#( apaiiei "e%ne(o !i "i%pto%e(o
Dac& g(ice%ia ae )aiaii $e 2.-7. %gG$( ae "i%pto%e $i"cete !i apa c# p#in ti%p >naintea
%e"ei "a# g#"t&iiI
- "e ofe& pacient#(#i "a# "e "f&t#ie!te "& ia 1. g $e g(#ci$e "#4 fo%& $e ta4(ete $e
g(#co5& "a# 5a*&G"#c $e f#cteL
- "e a!teapt& 1.-12 %in#te, apoi "e "e)e!te %a"a "a# g#"taea poga%at&.
Daca *ipog(ice%ia apae noapteaI
- "e a$%ini"tea5& 1.-12 g g(#co5& "a# 5a*&L
- "e contin#& "#pa)eg*eea atent& a pacient#(#iL
Dac& g(ice%ia "ca$e "#4 2. %gG$( c# "tae $e con!tien& p&"tat&
2,1
- "e a$%ini"tea5& oa( 1.-2.g g(#co5a "a# 5a*& $i5o()ate >n ap& !i "e )a epeta (a ne)oieL
- *i$oca4onate(e api$ a4"o4ite cae "e a$%ini"tea5& >n *ipog(ice%ie "#nt >n o$inea
pefeineiI ta4(ete $e g(#co5&, 5a*&, "#c#i $e f#cte >n$#(cite c# 5a*&, 4&#t#i &coitoae
c# 5a*& ?pep"i, coca-co(a, fanta@L
- (a 12-2. %in#te, "e %&"oa& g(ice%ia !i, $ac& n# "-a e"ta4i(it, "e epet& poce$#a p1n& (a
e5o()aea epi"o$#(#i *ipog(ice%icL
Dac& pacient#( $ia4etic c# *ipog(ice%ie e"te conf#5, apatic, pe5int& (entoae >n %i!c&i !i
)o4ieI
- e"te "#pa)eg*eat pe%anent $e pe"oane(e $in ant#a8L
- "e )a ap(ica tata%ent#( in$icatI a$%ini"taea $e g(#co5& "a# g(#cagon.
Dac& pacient#( pe5int& ti"%#", n# poate $e"c*i$e g#a, "o(#ia $e g(#co5& "a# 5a*& "e
into$#ce >n "pati#( $inte o4a5 "i aca$e(e $entae c1n$ pacient#( ae ef(eB $e $eg(#tiie
- a4"ena ef(eB#(#i $e $eg(#tiie ec(a%& a$%ini"taea $e #gen& a tata%ent#(#i in8ecta4i(
c# g(#cagon "a# g(#co5&.
- "e fo(o"e!te "o(#ie $e g(#co5& 1.-2.M cae "e in8ectea5& "tict inta)eno" $e c&te o
a"i"tent& %e$ica(& "#4 "#pa)eg*eea #n#i %e$ic.
6$%ini"taea g(#cagon#(#i
- poate fi f&c#t& inta%#"c#(a >n ca$an#( "#peo-eBten fe"ieL
- g(#cagon#( ?fio(a $e 1%g@ te4#ie "& fie >n te%en $e )a(a4i(itate, "e p&"tea5& >n figi$eL
- fio(a $e g(#cagon e"te >n"oit& $e f(acon#( c# "o()ent !i "eing& a$ec)at&L
- "e into$#ce ae >n f(acon#( c# "o()entL
- "e a"pi& "o()ent#( i "e tan"fe& >n f(acon#( c# g(#cagonL
- "e agit& 4(1n$ p1n& "e $i5o()&L
- "e a"pi& "o(#iaL
- "e in8ectea5&.
$@ Sup)a<$;=$)$a 9i $,u&a*ia pa&i$7tului
'acient#( )a fi in"t#it c#% poate pe)eni *ipog(ice%iaI
- "&-!i note5e >nt-#n canet "i%pto%e(e cae a# a)eti5at *ipog(ice%iaL
- "& $i"c#te c# %e$ic#( ca#5e(e *ipog(ice%iei cae poate %o$ifica "c*e%a $e tata%entL
- "&-!i te"te5e g(ice%ia pent# o an#%it& peioa$& $e ti%p $#p& *ipog(ice%ieL
- "& ai4& pe%anent a"#pa (#i ta4(ete $e g(#co5& "a# 5a*& !i "& con"#%e c1n$ apa "e%ne
$e *ipog(ice%ieL
- "e e)it& a(i%ente(e ga"e
- $ac& $i%ineaa "#nt "e%ne $e ne#og(icopenie, "e cecetea5& g(ice%ia >n ti%p#( nopiiL
- "& con"#%e #n "#p(i%ent $e g(#ci$e at#nci c1n$ face #n efot fi5ic "#"in#tL
- "e ia o g#"tae %ai t15i# "eaa pent# a pe)eni *ipog(ice%ia noct#n&L
- "& "c*i%4e (oc#( in8ect&ii pent# e)itaea (ipo$i"tofiei *ipetofice cae >%pie$ica
a4"o4ia in"#(ineiL
- "&-!i conto(e5e g(ice%ia c1n$ "e #c& (a )o(an "a# pe 4icic(et& !i "& >ncete5e "& con$#c& (a
ce( %ai %ic "e%n $e *ipog(ice%ie.
'acient#( te4#ie atenionat c& *ipog(ice%ii(e "e)ee !i pe(#ngite pot con$#ce (a afectaea
ie)e"i4i(& a "i"te%#(#i ne)o".
2,2
Capitolul 10 5NGRI6IRI 5N GOLI DERMATOLOGICE
17.1 P)$l$<a)$a (a&t$)iolo;i&: ,i7 pu'tul$
0e face >nainte $e anti4ioteapie.
Mat$)ial$ 7$&$'a)$
- ace "#4c#tantate "tei(eL
- %ateia(e $e $e5infectaeL
- "eingi 2 %( "tei(eL
- 4on $e ceee eBa%en 4acteio(ogicL
- "tic(#&, ep#4ete "tei(e.
- "e eBp(ic& i%potana !i $e#(aea poce$#iiL
- "e in"ta(ea5& pacient#( confota4i(L
- "e "pa(& %1ini(eL
- "e a$aptea5& ac#( (a "eing&L
- "e pe(e)ea5& conin#t#( p#"t#(ei, f&& "& "e ating& pie(ea $in 8#, "e "t&p#nge p#"t#(a c#
ac#( !i "e a"pi& conin#t#( >n "eing&L
- n# "e $eta!ea5& ac#( $e (a "eing&L
- "e $e5infectea5& (e5i#neaL
- "e etic*etea5& po$#"#(L
- "e ti%ite epe$e (a (a4oato.
Re5#(tat#( "e poate o4ine $#p& o o& (a eBa%en#( %ico"copic, $#p& 2/ oe pent# c#(t#i !i
i$entificaea ge%eni(o, $#p& /. oe pent# anti4ioga%e.
17.2 P)$l$<a)$a p)o&$,u'$lo) +i&oti&$ ,$ la 7i<$lul +u&oa'$lo)
Reco(taea "e face >naintea tata%ent#(#i antif#ngic "a# c# o feea"t& teape#tic& $e / "&pt&%1ni.
Re"pectaea con$iii(o $e a"ep"ie e"te foate i%potant& pent# e5#(tat coect
Mat$)ial$B
- ta)& c#at&, $e5infectat& !i 2 ta%poane "tei(eL
- t&)i& ena(&L
- %a"c&L
- "&c#(e $#4(# pent# ti%iteea (a (a4oato c# 4#(etin#(L
- etic*eteL
- 4#(etin $e ceee coect co%p(etat.
- 0e "pa(& %1ini(eL
- "e p#n %&n#!i(eL
- "e "coate ta%pon#( $in a%4a(a8#( "&# f&& "& "e ating&L
- "e ea(i5ea5& pe(e)aea foate peci"&, $in 5ona $e (e5i#neL
2,,
- "e p(a"ea5& ta%pon#( >n p#nga $e oigine, f&& a atinge eBteio#( a%4a(a8#(#iL
- "e etic*etea5&, "e notea5& $ata !i oa pe(e)&iiL
- "e $e5infectea5& ta)aL
- "e >n$epatea5& %&n#!i(eL
- "e "pa(& %1ini(eL
- "e ti%ite po$#"#( (a (a4oatoL
- "e notea5& eBa%en#( >n $o"a#( pacient#(#i.
R$&olta)$a ?7 +i&o>a <a;i7al:
- pacienta e"te a!e5at& >n po5iie gineco(ogic&L
- "e %ontea5& #n "pec#( )agina(L
- pe(e)aea "e face $e pe %#coa"a )agina(&, c# a8#to#( #n#i ta%pon $e (a ni)e(#( co(#(#i !i
)agin#(#iL
- eco(taea n# e"te $#eoa"& !i "e eco%an$& ca inainte $e eco(tae "& n# "e fac& toa(eta
)agina(&, pent# c& "e %o$ific& e5#(tat#(L
- (a 4&4at, eco(taea "e face (a ni)e(#( %eat#(#i #ina !i $in (e5i#ni, pacient#( fiin$ >n
po5iia a!e5at "a# "e%i!e51n$, $e pefein& $i%ineaa >nainte $e %ici#ne.
57 +i&o>a a7al:B Reco(taea "e )a ea(i5a $e (a ni)e(#( %aginii ana(e f&& p&t#n$ee in ect.
E,u&a)$a pa&i$7t$i p$7t)u $<ita)$a )$&i,i<$i +i&o>$i <a;i7al$
- e)itaea 4&i(o ca($e >n 8ac#55i !i pi"cin&L
- "e pefe& $#!#(L
- e)itaea *aine(o "inteticeL
- e)itaea $eo$oante(o, "paU-#i(o !i "&p#n#i(o paf#%ateL
- e)itaea ge(#(#i $e $#!L
- fo(o"iea "&p#n#(#i ne#t#L
- #ti(i5aea pe5e)ati)#(#i.
17., P)$l$<a)$a &uta7at: ?7 ,$)+ato%i ii
- "e face >nainte $e >ncepeea tata%ent#(#i "a# $#p& / "&pt&%1ni $e (a >ncetaea
tata%ent#(#i c# antif#ngiciL
- ca(itatea eco(t&ii con$iionea5& e5#(tate(eL
- eBa%en#( $iect e(e)& fi(a%ente %ice(iene >nte (a%& !i (a%e(& $#p& a$a#gaea pic&t#i(o
$e pota"i# !i teceea pin f(aca&L
- c#(t#a ea(i5at& )a pe5enta o co(onie >nte 1.-2. 5i(e.
Mat$)ial$
- ta)& c#at&, $econta%inat&L
- c*i#eta "tei(& pent# o4ineea "c#a%e(o, $ac& (e5i#nea e"te #"cat&L
- $o#& ta%poane "tei(e, $ac& (e5i#nea e"te #%e$&L
- pent# (e5i#ni(e #ng*ii(o, fofec#& "tei(&L
- >n ca5 $e 1ie ?"ca4ie@ "e eco(tea5& p& >nt-o c#tie %ic&, "tei(&L
- %a"c&, $ac& e"te ne)oieL
- "ac $#4(# pent# tan"pot#( po$#"#(#i eco(tatL
2,/
- "tic(#e c# n#%e(e pacient#(#iL
- 4#(etin $e ceee.
- "e "pa(& %1ini(eL
- "e p#n %&n#!i(eL
- pent# (e5i#ni #"cate, "e ac(ea5& (e5i#nea c# a8#to#( c*i#etei !i "e p#n "c#a%e(e >nt-o
c#tie %ic&, "tei(&L
- pent# (e5i#ni #%e$e, "e eco(tea5& c# ta%pon#( >n p#nga $e oigine, f&& contact c#
eBteio#( a%4a(a8#(#iL
- "e etic*etea5& po$#"#( eco(tat, c#pin51n$ oa !i $ata pe(e)&iiL
- "e $e5infectea5& ta)aL
- "e "pa(& %1ini(eL
- po$#"e(e "e $#c (a (a4oatoL
- "e notea5& >n foaie eco(taea f&c#t&.
E,u&a*ia pa&i$7tului
Fn ca5 $e eci$i)& %&"#i(e pe)&$I
- co%p(etaea $ec(aaiei o4(igatoiiL
- tataea ani%a(#(#i conta%inatoL
- i5o(aea e(e)i(oGcopii(o $in !co(iGg&$inie.
17./ Giop'ia &uta7at:
E"te $e co%petena %e$ic#(#i a8#tat $e a"i"tenta %e$ica(& cae peg&te!te %ateia(e(e nece"ae.
'oce$#a con"t& >n pe(e)aea #n#i fag%ent $e pie(e %ai %ic $e , %% "#4 ane"te5ie (oca(&.
Fag%ent#( eco(tat "e p#ne >nt-o "o(#ie fiBatoae eco%an$at&, >n f#ncie $e eBa%en#( ea(i5at.
Mat$)ial$ 7$&$'a)$B
- %&"#& $e in"t#%enteL
- %ateia(e pent# ane"te5ieI "eing& "tei(& c# ac "tei( continan$ (i$ocain& 1M c# "a# f&&
a$ena(in& ?>n f#ncie $e ceeea %e$ic#(#i@, >n f#ncie $e (oc#( 4iop"ieiL
- co%pe"e "tei(e, "o(#ii anti"epticeL
- %ateia( pent# 4iop"ieI co%pe"e "tei(e, anti"eptice, %&n#!i "tei(e, c1%p opeato c#
feea"t&, 4i"t#i# %ecanic, foafec&, o pen"& c# g*eae, fie pent# teg#%ent, foafec& !i o
pen"& *e%o"tatic&L
- %ateia( pent# pan"a%entL
- f(acon c# "o(#ie fiBatoaeL
- etic*ete.
E%$&tua)$ p)o&$,u)ii
- "e )eific& eco%an$aea pent# 4iop"ieL
- "e a!a5& pacient#( >n po5iie confota4i(&, "e e(i4eea5& 5ona 4iop"iei, "e face a"ep"ie
c#tanat& !i "e p(a"ea5& $ea"#pa c1%p#( c# feea"t&L
- %e$ic#( $i"c#t& c# pacient#( pent# $epi"taea contain$icaii(o ane"te5ieiL
2,2
- a"i"tenta a8#t& %e$ic#( !i "#pa)eg*ea5& "e%ne(e )ita(e !i to(eana pacient#(#iL
- p(aga "e pan"ea5&, "e a8#t& pacient#( $ac& pe5int& "tae $e &#L
- po$#"#( eco(tat "e ti%ite (a (a4oato >%pe#n& c# 4#(etin#( $e eBa%enL
- "e co(ectea5& $e!e#i(e confo% peca#ii(o #ni)e"a(eL
- "e "pa(& %1ini(e.
17.2 57;)iAi)i ?7 &a7,i,o>a (u&al:
S&op
0#pi%aea factoi(o fa)oi5ani, $e po(ifeaea (oca(& a can$i$eiI coectaea g(ice%iei, pe5ena
pote5ei $entae, #"c&ci#nea g#ii, %e$ica%ente, %ai a(e" anti4iotice
57;)iAi)iB
- ec*i(i4aea $ia4et#(#iL
- opiea tata%ent#(#i fa)oi5ant, $ac& e"te po"i4i(L
- "p&(aea ca)it&ii 4#ca(e c# o "#"pen"ie antif#ngic&, a pote5ei $entaeL
- pacient#( e"te in"t#it ca $#p& "p&(aea pote5ei acea"ta "& fie in#t& >n "o(#ie na*co
,
L
- "p&(aea $e ,-/ oi pe 5i c# "o(#ie $e 4ica4onat $e "o$i# pent# ce!teea p=-#(#i 4#ca(L
- a$%ini"taea tata%ent#(#i eco%an$at.
17.3 57;)iAi)i ?7 i7t$)t)i;o +i&o>i&
- "e face 4aie 5i(nic& (a picioae ti%p $e 1. %in#te c# pe%anganat $e pota"i# $i(#at
1G1.....L
- "e #"#c& 4ine c# po"op #"catL
- ap(icaea $e antif#ngice "#4 fo%& $e ce%& >nte $egete(e $e (a picioaeL
- p(a"aea #no co%pe"e #(ate >nte $egete pent# a pe%ite p(i#i(o inte$igita(e "& fie
4ine aeate.
C@7, 'u7t a%$&tat$ pli&il$
- "e $e5infectea5& p(i#i(e c# co%pe"e >%4i4ate c# "o(#ie $e c(o*eBi$ina "a# $ac& p(i#i(e
"#nt foate #%e$e "e )a #ti(i5a 4eta$in& "a# nitat $e agint 1M >n confo%itate c#
eco%an$aea %e$ica(&L
- "e #"#c& p(ici(e fo(o"in$ co%pe"e a4"o4anteL
- "e poate (&"a >n p(ic& o co%pe"& #"cat&.
R$&o+a7,a)$a +$,i&uluiB
- "e "c*i%4& *aine(eL
- >ngi8ii(e "#nt efect#ate $e $o#& oi pe 5i >n ca5#( >n cae "ece ii(e "#nt
#%e$e. Tata%ent#( $#ea5& >n 8# $e 12 5i(e
- igiena ig#oa"&L
- con"i(iee $ietetic& $ac& pacient#( pie$e >n ge#tateL
- pacient#( poate "& poate !o"e"te, fo(o"e!te po"oape pe"ona(eL
- "#pi%aea factoi(o fa)oi5ani at#nci c1n$ "e poateL
2,3
17.7 57;)iAi)$a pa&i$7tului &u ul&$) ,$ ;a+(:
Le5i#nea epe5int& pie$eea $e "#4"tan& c#tanat&, $e pof#n5i%e )aia4i(&, p#t1n$ a8#nge (a
o".
E"te co%p(icaia cea %ai ga)& a t#(4#&i(o tofice ca #%ae a $ific#(t&i(o cic#(atoii (oca(e,
ateia(e "a# )enoa"e.
Sup)a<$;=$)$a t)ata+$7tului
- "e e)a(#ea5& $#eea >nainte !i $#p& pan"a%entL
- "e "#pa)eg*ea5&I
- a"pect#( #(ce#(#iI >n%#g#iea ?4#8onaea@ eBce"i)&, neco5a, eBten"ie a (e5i#nii,
"#painfecia, c#(oaea )e$e !i %io"#( caactei"tic aat& o infecie c# piocianic@
"c#geiG"eceiiL
- %oa(#( pacient#(#i, "taea n#tiiona(&, %o4i(itatea pacient#(#iL
- "e apeciea5& eficacitatea tata%ent#(#iG>ngi8iii pinI
- $i%in#aea $#eiiL
- e)o(#ie fa)oa4i(& a p(&giiI a4"ena "eceii(o, a4"ena %io"#i(o,
epi$e%i5aea, c#&ieaL
- %o4i(i5aea pacient#(#iL
- "e o4"e)& efecte(e "ec#n$aeI "taea teg#%ente(o $in 8##( #(ce#(#i, into(eana
pan"a%ent#(#i, "e%ne $e infecie.
E,u&a ia pa&i$7tuluiB
- "& e)ite oto"tati"%#( pe(#ngitL
- "& poate *aine (e8eeL
- "& e)ite "#page#tateaL
- "& e)ite c&($#a.
S$ '%:tui$9t$ pa&i$7tulB
- "& in& picioae(e p#in %ai "#" c1n$ e"te >n $ec#4it $o"a(L
- "& pactice >not#(, %e"#( pe 8o"L
- 4aie (a $#! c# ap& c&($#& pent# a e)ita )a"o$i(ataia.
17.8 57;)iAi)$a pi&ioa)$lo) la u7 pa&i$7t &u $)i>ip$l
'e)eniea ei5ipe(#(#i face ape( (a o 4#n& igien& copoa(& !i (a o fo(o"ie coect& a anti"eptici(o
topice, pent# c& o %ic& (e5i#ne poate fi poata $e intae pent# "teptococ e"pon"a4i( $e
$e%ato5e infecioa"e ga)e.
E,u&a*ia pa&i$7tului
Fn (eg&t#& c# p(&gi(eI
- anti"eptici(e a(e"e n# te4#ie "& fie iitante !i *ipe"en"i4i(i5ante pent# pie(e !i %#coa"eL
Fn (eg&t#& c# igiena >n >ngi8ii(e popi#-5i"eI
- igiena picioae(o "& "e fac& 5i(nicL
- "e "pa(& picioae(e !i "pai#( inte$igita( c# ap& c&($#& !i "&p#n ne#t#L
- "e c(&te"c 4ine !i "e #"#c& pin ta%ponaeL
2,7
- >n a4"ena infeciei "e face o 4aie $e picioae o $at& pe "&pt&%1n&, c# o $#at& $e
apoBi%ati) 2-7 %inL $ep&!iea poate pe$i"p#ne (a #"caea teg#%ente(o !i (a (e5i#niL
- #ng*ii(e te4#ie t&iate $ept, f&& "& fie foate "c#te, pent# a e)ita #ng*ia >ncanat&L
- "e *i$atea5& pie(ea $e pe picioae >n fiecae 5i c# o ce%& n#titi)& ?f&& (ano(in&, $eoaece
e"te a(egi5ant&@, e)it1n$ "paii(e inte$igita(eL
- "e pefe& cioapii $e 4#%4ac, pent# a "e e)ita %aceaia !i t#(4#&i(e cic#(atoiiL
- >n ca5#( >n cae picioae(e tan"pi& "a# e%an& %io" nep(&c#t, %e$ic#( eco%an$& #n
anti"eptic !i #n antitan"piant "pecific pent# a pe)eni #%e5ea(a !i >nc&(5ieaL
- "c*i%4aea eg#(at& a >nc&(&%intei >n f#ncie $e acti)it&i(e coti$ieneL
- a(egeea >nc&(&%intei a"tfe( >ncat "& n# 8ene5e cic#(aia !i "& n# po$#c& (e5i#niL
- e)itaea p(a"t#i(o a#toco(ani !i a "paU-#i(o $eo$oante, cae $eteioea5& pie(eaL
- n# "e %ege >n picioae(e goa(e, pent# a e)ita &nieaL
- "e e)it& toate "#"e(e $e c&($#&, cae poate po$#ce a"#iL
- "e a#too4"e)& picioae(e !i oice %o$ificae ?o!ea&, e$e%, fi"#&, (e5i#ne, "c#gee K "e
apotea5& %e$ic#(#i@.
Capitolul 11E 5NGRI6IREA PACIEN ILOR CU AFECIUNI NEUROLOGICE
18.1 Mi$lo;)a%ia
9ie(ogafia con"t& >n eBp(oaea a$iogafic& a conin#t#(#i a*i$ian pin in8ectaea >n "pai#(
"#4aa*noi$ian a #nei "#4"tane $e conta"t io$ate *i$o"o(#4i(e.
6ce"t eBa%en pe%ite "& "e )i5#a(i5e5e c# peci5ie "t#ct#i(e )ete4a(e !i paa)ete4a(e
(o%4ae ?)ete4e, $i"c#i inte)ete4a(e, (iga%ente %#"c#(ae, %&$#)a "pin&ii@. D#p&
into$#ceea "canne-#(#i !i apoi a e5onanei %agnetice, acea"t& te*nic& e"te $in ce >n ce %ai
p#in #ti(i5at&.
I7,i&a*ii
- "in$oa%e ne#o(ogice $ete%inate $e o co%pe"i#ne %e$#(a& "a# a$ic#(a&L
- t#%oi cee4a(e "a# ne#o%eningiene ?at#nci c1n$ "canne-#( !i IR9 "#nt neconc(#$ente@.
Co7t)ai7,i&a*iiB
- a(egie (a "#4"tana io$at&L
- *ipeten"i#ne intacanian&L
- "e face ana%ne5a pent# a eBc(#$e #n e)ent#a( i"toic $e a(egie (a io$L
- "e face f#n$#( $e oc*i pent# a eBc(#$e "e%ne(e $e *ipeten"i#ne intacanian&L
- "e p(anific& (a a$io(ogieL
- "e cee pacient#(#i "& &%1n& ne%1ncat >n $i%ineaa eBa%in&iiL
- "e %ontea5& #n catete G 4an#(& pe o )en& peifeic&L
- "e in8ectea5& "#4"tana io$at& >n cana(#( a*i$ian ?O%nipaZ#e@ pin p#ncie a*i$ian&
efect#at& (o%4a, $iect pe %a"a a$io(ogic&L
- $#p& (oca(i5aea a$io"copic& a "eg%ent#(#i con"i$eat "#"pect, "e efect#ea5& a$iogafii
$in 2 p(an#iI anteopo"teio !i pofi(L
2,8
- pent# efect#aea >n 4#ne con$iii a %ie(ogafiei, "e eco%an$& #ti(i5aea #n#i apaat $e
a$io$iagno"tic pe)&5#t c# %a"& 4a"c#(ant& te(egi$at&, c# inagine a%p(ificat& pin
a%p(ificato#( $e (#%ino5itate c#p(at c# #n %onito T; !i tan"%i"& >n ca4ina $e co%an$&
4ine pote8at& conta a$iaii(o A.
R$>ultat$
9ie(ogafia p#ne >n e)i$en&I
- fo%a !i $i%en"i#ni(e cana(#(#i "pina(L
- pe%ea4i(itatea ace"t#ia, e)ent#a(e(e o4"taco(eL
- fo%a, $i%en"i#ni(e !i, #neoi, c*ia nat#a o4"taco(#(#i.
'acient#( )a &%1ne (a pat p1n& io$#( )a tece >n cic#(aia "i"te%ic& ?2-3 oe@.
18.2 El$&t)o$7&$%alo;)a%ia #EEEEG-
E"te o %eto$& $e eBp(oae f#nciona(& 4a5at& pe $etectaea, a%p(ificaea !i >n"cieea gafic& a
acti)it&ii 4ioe(ectice cee4a(e c# a8#to#( #no e(ecto5i a%p(a"ai pe "ca(p !i conectai (a
apaate e(ectonice "pecia(e, n#%ite e(ectoencefa(ogafe.
- "e eBp(ic& poce$#a, i%potana ace"teia pent# $iagno"ticL
- "e >nte#pe c# 2/ * >nainte %e$icaia cae inf(#enea5& acti)itatea cee4a(&L
- "e "o(icit& pacient#(#i "&-!i "pe(e p&#( cap#(#i pent# a >n(&t#a eBce"#( $e "e4#% ce poate
paa5ita apaat#(L
- "e in"t#ie!te pacient#( "& &%1n& e(aBat >n ti%p#( >negi"t&ii !i "& >n)ee pe c1t po"i4i(
%i!c&i(e cop#(#i !i a(e oc*i(o.
- "e fiBea5& e(ecto5ii %eta(ici pe pie(ea cap#(#i c# a8#to#( #no 4en5i e(a"tice, $#p& o
$ege"ae pea(a4i(& a ace"teia ?$ac& e"te ca5#(@L
- "e a!ea5& (a $i"tan& ega(& ?,-2 c%@ "i%etic >n egi#ni(e fonta(e, paieta(e, occipita(e,
te%poa(e, pec#% !i pe #ec*e pent# $ei)aii(e efeenia(eL
- 4ioc#enii captai !i a%p(ificai $e $i"po5iti)#( e(ectonic $e a%p(ificae "#nt >negi"tai
pe o *1tie "pecia(&, c# #n o"ci(ogaf %agnetic pe)&5#t c# o peni& in"ciptoae.
R$>ultat$
- 'e o EE- pot fi >negi"tate , #n$e no%a(e ?a(fa, 4eta !i t*eta@ !i o #n$& pato(ogic& >n "tae
$e )eg*e, $a no%a(& pent# an#%ite fa5e $e "o%n K #n$a $e(taL
- Un$e(e c a# o fec)en& $e 8-12 =5 !i "e >n"ci# (a "#4iect#( c# oc*ii >nc*i!iL
- Un$e(e d "e caactei5ea5& pint-o fec)en& $e 1/-,. =5L "e >n"ci# c1n$ "#4iect#( e"te
tea5 !i atentL
- Un$e(e t*eta a# o fec)en& $ /-7 =5. Inci$ena #n$e(o t*eta ce!te poge"i) pe %&"#a
in"ta(&ii fa5e(o $e "o%n pof#n$L
- Fn ca5 $e t#(4#&i cic#(atoii %a8oe, EE- aat& o "c&$ee g(o4a(& a acti)it&ii cotica(e. 0e
po$#ce o "c&$ee a fec)enei !i a%p(it#$inii #n$e(o a(fa >n pincipa(L
2,+
- EE- poate "& pe5inte atefacte cae "#nt feno%ene paa5ite $e nat#& eBtacee4a(&. E(e >!i
a# oiginea fie (a pacient, fie >n %e$i#( >ncon8#&to "a# >n apaat#a #ti(i5at&. Ce(e %ai fec)ente
atefacte "#ntI %i!c&i(e oc#(ae, te%#&t#i(e, *ipe)enti(aia, foto"ti%#(aea, in"ta4i(itatea
e(ecto5i(o $at& $e o fiBae in"#ficient&.
18., El$&t)o+io;)a%ia #EMG-
E(ecto%iogafia e"te #n te"t fo(o"it pent# >negi"taea acti)it&ii e(ectice a %#!c*i(o. C1n$
%#!c*ii "#nt acti)i, ace!tia po$#c i%p#("#i e(ectice $iect popoiona(e c# ni)e(#( acti)it&ii
%#"c#(ae.
I7,i&a*ii
E9- e"te eco%an$at& >n #%&toae(e ca5#iI
- pent# "ta4i(iea ca#5e(o ineBp(ica4i(e $e "(&4ici#ne ?*iptonie@ %#"c#(a&L
- "ta4i(iea $ifeene(o $inte *ipotonia %#"c#(a& po)ocat& $e %iopatii !i cea $ete%inat&
$e afeci#ni a(e "ite%#(#i ne)o"L
- "ta4i(iea $iagno"tic#(#i $ifeenia( >nte *ipotonia $ete%inat& $e afeci#ni(e %#"c#(ae
popi#-5i"e !i cea $ete%inat& $e i%o4i(i5ae $in ca#5a $#ei(o "a# (ip"ei $e %oti)aie.
P)$;:ti)$a Pa&i$7tului
- >n ca5#( a$#(i(o e%g n# pe"#p#ne peg&tii "pecia(eL
- >n ca5#( copii(o "e eco%an$& o $i"c#ie $e"c*i"& c# ace!tia pent# a-i fa%i(iai5a c#
poce$#a ce#t& $e e(ecto%iogafie.
E%$&tua)$a T$'tului
- pent# efectaea e%g-#(#i "e into$#c ace K e(ecto5i >n pie(e p1n& (a ni)e(#( %#!c*i(o c#
"cop#( >negi"t&ii acti)it&ii e(ectice a ace"toaL
- acti)itatea e(ectic& e"te >negi"tat& )i5#a( c# a8#to#( #n#i o"ci(o"cop, ia ac#"tic c#
a8#to#( #n#i "peaOeL
- pento o >negi"tae c1t %ai eficient& a acti)it&ii e(ectice a %#!c*i(o "c*e(etici e"te
nece"a& fo(o"iea %ai %#(to e(ecto5iL
- pe5ena, %&i%ea !i fo%a (inii(o c#4e ?potentia( $e acti#ne@ afi!ate pe o"ci(o"cop
f#ni5ea5& info%aii $e"pe capacitatea %#!c*ii(o $e a &"p#n$e (a "ti%#(i ne)o!iL
- fiecae %#!c*i cae "e contact& po$#ce #n potenia( $e aci#neL
- %&i%ea fi4ei %#"c#(ae inf(#enea5& ata ?fec)ena fo%&ii #n#i potenia( $e aci#ne@ !i
a%pit#$inea potenia(#(#i $e aci#neL
- >n %o%ent#( into$#ceii ace(o K e(ecto5i p1n& (a ni)e(#( %#!c*i(o, pacient#( e"i%te o
"en5aie $e $i"confot fi5ic a"e%&n&toae c# cea $in in8ecii(e inta%#"c#(aeL
- $#p& efect#aea e%g, $#eea $e (a ni)e(#( %#!c*i(o te"tai )a $i"p&ea $#p& c1te)a 5i(e.
18./ S&o)ul Gla';oM #GCS-
0co#( -(a"goJ e"te $e"tinat e)a(#&ii ga)it&ii >n fa5a iniia(& a #n#i ta#%ati"% canian, fiin$
#n citei# pogno"tic. 0e #ti(i5ea5& pent# c#antificaea ni)e(#(#i $e con!tien& >n toate ca5#i(e
$e conf#5ie, in$ifeent $e eti(o(ogie.
Fn pactica c#ent&, !i >n "pecia( >n #gene, "ca(a -(a"goJ epee5int& #n %i8(oc "i%p(# !i api$ $e
e)a(#ae a pacient#(#i co%ato".
2/.
D$'&)i$)$a S&opului Gla';oM
0co#( -(a"goJ ?-(a"goJ Co%a 0ca(e, -C0@ a fo"t concep#t $e Tea"$a(e "i Hennett ?1+7/@
pent# a "ta$ia(i5a t#(4#&i(e "t&ii $e con!tien&a. 0co#( c#pn$e tei categoii $e &"p#n"
?$e"c*i$eea oc*i(o, &"p#n" %oto !i &"p#n" )e4a(@ a c&o p#nctae >n"#%at& geneea5&
"co#( tota( ?%ini%#% ,, %aBi%#% 12@, ca >n ta4e(#( $e %ai 8o"I
'6R69ETRI CRITERII 'UNCT6H
1.DE0C=IDERE6
OC=ILOR ? O@
- "pontan& /p
- (a "ti%#(i )e4a(i ,p
- (a "ti%#(i $#eo"i 2p
- a4"ent&, c*ia (a pe"i#ne
"#pao4ita(&
1p
2.R<0'UN0UL
9OTOR ? 9@
- (a co%an$& "i%p(& 3p
- &"p#n" %oto pin (oca(i5aea
"ti%#(#i $#eo"
2p
- &"p#n" %oto pin etageea #n#i
%e%4# "a# a a%4e(o, (a
"ti%#(ae $#eoa"&
/p
- &"p#n" %oto pin f(eBie ano%a(&
?f&& oientae "pe (oc#( $#eo"@
a #n#i %e%4# "a# a a%4e(o
%e%4e "#peioae, (a "ti%#(aea
,p
- &"p#n" %oto pin eBten"ia
%e%4#(#i (a "ti%#(aea $#eoa"&
2p
- nici#n &"p#n" %oto 1p
,.R<0'UN0
;ER:6L?;@
- a$aptat, pacient oientat 2p
- conf#5 ?&"p#n"#i nec(ae, pacient
$e5oientat@ /p
- incoeent?c#)inte inte(igi4i(e@ ,p
- neinte(igi4i( 2p
- a4"entGf&& &"p#n" )e4a( 1p
0co 12 ?%aBi%#%@ T no%a(
0co 1, T in8#ie cee4a(& #!oa&
0co +-12 T in8#ie cee4a(& %o$eat&
0co 8 T in8#ie cee4a(& "e)e&
0co e7 T co%a ga)&
0co , T %oate cee4a(&
2/1
Capitolul 12 5NGRI6IREA PACIEN ILOR CU AFECIUNI OFTAMOLOGICE
1+.1 D$t$)+i7a)$a a&uit:*ii ual$ #AV-
6c#itatea )i5#a(& "a# )e$eea centa(& epe5int& aptit#$inea oc*i#(#i $e a pecepe $eta(ii
"paia(e. 6ce"tea "#nt %&"#ate pin #ng*i#( "#4 cae "#nt )&5#te. Toate o4iecte(e "#nt )&5#te "#4
#n #ng*i fo%at $in a5e(e cae p(eac& $in eBte%it&i(e o4iect#(#i !i "e >nc#ci!ea5& >n p#nct#(
no$a( a( oc*i#(#i pent# a a8#nge pe etin&.
P)$;:ti)$a +at$)ial$lo) 9i i7't)u+$7t$lo) 7$&$'a)$B
'ent# $ete%inaea 6; "#nt nece"aeI
- optotip#( "ne((en, cae e"te #n pano# i(#%inat e(ectic ce conine 1. 1n$#i $e (itee $e
%&i%i $ifeite $e"tinate a fi )&5#te "#4 #n #ng*i )i5#a( $e 2b $e (a o an#%it& $i"tan&. >n
$ept#( fiec&#i 1n$ e"te peci5at& $i"tana $e (a cae #n oc*i e%etop (e cite!te. pent#
copii !i ana(fa4ei (itee(e "#nt >n(oc#ite $e fig#i geo%etice "a# a(te "e%neL
- t#"a c# (enti(e pent# apecieea $ioptiei $e coecie.L
- oc(#5o.
P)$;:ti)$a pa&i$7tuluiI
'"i*ic&
- info%aea pacient#(#i pi)in$ $e#(aea poce$#iiL
- o4ineea aco$#(#i !i a co(a4o&ii >n ti%p#( eBa%in&ii.
Fi5ic&
- "e cecetea5& 6; a fiec&#i oc*i >n pate, acopein$#-"e pe 1n$ c# #n oc(#5o !i apoi a
a%4i(o oc*i "i%#(tanL
- pacient#( )a fi a!e5at >n fa& optotip#(#i i(#%inat e(ectic, pe #n "ca#n, (a o $i"tan& $e 2 %L
- >n pincipi#,
B7 ?
d
, #n$eI
"
d 8 $i"tana $e (a cae oc*i#( eBa%inat a $eo"e4it o (ite&
" 8 $i"tana $e (a cae oc*i#( e%etop $eo"e4e!te aceea!i (ite&
- 6; "e con"i$e& no%a(&, $e 1 ?2G2@ $ac& pa&i$7t#( ec#noa!te (itee(e #(ti%#(#i 1n$ $e (a
2 %L
- $ac& )e$eea e"te "c&5#t&, pa&i$7t#( )e$e n#%ai 1n$#i(e c# (itee %ai %ai, cae >n %o$
no%a( "#nt )&5#te $e (a $i"tane %ai %aiL $ac&, $e eBe%p(#, )e$e $e (a 2 % 1n$#( pe
cae a te4#i "&-( )a$& $e (a 2. % K 6; T 2G2. T fL
- $ac& 6; e"te %ai %ic& $ec1t 1G2., eBa%inato#( p(i%4& $egete(e pin faa oc*i#(#i,
eBpi%1n$#-"e 6; pin n#%&aea $egete(o ?n.$.@ (a 1 %, 2. c% "a# 2. c% ?"e notea5&
6;
OD
T n.$. 1 %@L
- #neoi pa&i$7t#( pecepe $oa %i!caea %1inii ?p.%.%.@ "a# n#%ai (#%ina poiectat& (a
ni)e(#( oc*i#(#i ?6; T p.(.@, >nt-o ca%e& o4"c#&.
- n# nece"it& >ngi8ii $eo"e4iteL
- e"te a8#tat, >n ca5 $e 6; e$#"&, "& "e $ep(a"e5e >n "a(on "a# p1n& (a apain&to ?c1n$ "e
face a%4#(atoi#@.
2/2
1+.2 To7o+$t)ia o&ula):
E"te o %eto$& $e %&"#ae a pe"i#nii intaoc#(ae c# a8#to#( #n#i apaat n#%it tonometru.
EBi"t& %ai %#(te tip#i $e tono%etii cae a# (a 4a5& ace(a!i pincipi#I %&"#aea $efo%&ii
coneei "#4 aci#nea #nei foe eBtene.
I7,i&a*iiB
- conto( ofta(%o(ogic $e #tin&, %ai a(e" (a pe"oane(e c# )icii $e efacieL
- %onitoi5aea tata%ent#(#i antig(a#co%ato".
P)$;:ti)$a +at$)ial$lo) 7$&$'a)$B
- tono%et# %an#a( ?0c*iot5@ pent# tono%etia pin i$entaie ?pe"i#ne@ "a# tono%et#
e(ectonic cae afi!ea5& pe #n %onito )a(oaea ten"i#nii intaoc#(ae ?TIO@L
- "o(#ii ane"te5ice oc#(aeL
- co%pe"e "tei(e.
'"i*ic&
- o4ineea aco$#(#i !i a co(a4o&ii >n ti%p#(
eBa%in&ii. Fi5ic&I
- n# 4ea %ai %#(t $e /..-2.. %( (ic*i$ >nainte $e te"tL
- n# con"#%& a(coo( c# ce( p#in 12 oe >nainte $e te"tL
- n# f#%ea5&L
- "e >n$ep&tea5& (enti(e(e $e contact, (a ne)oieL
- "e a!a5& pacient#( >n $ec#4it $o"a( pe o canapea, f&& pen&L
- "e in"ti(ea5& >n a%4ii oc*i c1te 1-2 pic&t#i $e "o(#ie ane"te5ic& in$icat& $e %e$ic#(
"pecia(i"tL
- "e cee pacient#(#i "& &%1n& ne%i!cat, "& n# t#!ea"c&, "& n# c(ipea"c& "a# "& "t1ng&
p(eoape(e $eoaece oice %i!cae $e ace"t tip poate %&i pe"i#nea intaoc#(a&L
- pacient#( )a fi #gat "&-!i fiBe5e pi)iea a"#pa #n#i p#nct fiB $e pe ta)an >n ti%p ce
%e$ic#( )a ap&"a #!o coneea c# ti8a tono%et#(#i pent# c1te)a "ec#n$eL
- "e notea5& )a(oaea TIO in$icat& $e tono%et#.
- "e an#n& pacient#( c& "-a p#tea "& ai4& o "en5aie $e f#nic&t#& (a ni)e(#( oc*i#(#i >n
#%&toae(e 2/ oeL
- "e inte5ice p#taea (enti(e(o $e contact ce( p#in 2 oe $#p& efect#aea te"t#(#i.
1+., O%tal+o'&opia ,i)$&t:
E"te #n poce$e# optic $e eBa%inae a po(#(#i po"teio a( g(o4#(#i oc#(a ?cop )ito", cop
ci(ia, papi(a ne)#(#i optic, etin&, cooi$&@.
I7,i&a*iiB
- 4o(i "i"te%iceI =T6, 6;CL
- 4o(i oc#(aeI g(a#co%, etinopatie $ia4etic&, etc.
'"i*ic&
- o4ineea aco$#(#i !i a co(a4o&ii >n ti%p#(
eBa%in&ii. Fi5ic&I
- "e in"ti(ea5& o "o(#ie %i$iatic& ?atopin&, %U$#%@ pent# $i(ataea p#pi(eiL
- "e con$#ce pacient#( >n ca%ea o4"c#& pent# eBa%inae.
E%$&tua)$a p)o&$,u)iiI
- %e$ic#( "e a!a5& apoape $e pacient !i c# ofta(%o"cop#( (a oc*i ?ofta(%o"cop e(ectic@L "e
apopie (a 2 c% $e oc*i#( pa&i$7t#(#i, poiect1n$ fa"cic#(#( (#%ino" pin p#pi(&L
- "e eBa%inea5& oc*i#( $ept a( pacient#(#i c# oc*i#( $ept a( %e$ic#(#i ofta(%o(og !i oc*i#(
"t1ng c# oc*i#( "t1ng a( eBa%inato#(#iL
- i%aginea o4in#t& e"te %&it& $e 12-2. oiL
- "e cecetea5& papi(a ne)#(#i optic, )a"e(e etiniene, egi#nea peipapi(a&, egi#nea
%ac#(a& !i peifeia etinei.
- "e eBp(ic& pacient#(#i c& $in ca#5a p#pi(ei %&ite "-a p#tea "& )a$& $#4(# p1n& (a e"o4ia
"o(#iei %i$iaticeL
- "& poate oc*e(ai f#%#ii pent# c& ae fotofo4ieL
- "& e)ite !ofat#( !i eBp#neea (a "oae ?$ac& eBa%en#( e"te f&c#t a%4#(atoi#@.
1+./ D$t$)+i7a)$a &@+pului ual
C1%p#( )i5#a( e"te epe5entat $e tota(itatea p#ncte(o $in "pai# pe cae #n oc*i i%o4i( (e poate
pecepe
.
C1%p#( )i5#a( %onoc#(a, teoetic cic#(a, e"te (i%itat $e poe%inene(e o"oa"e a(e feei.
Li%ite(e %e$ii a(e c1%p#(#i )i5#a( %onoc#(a "#ntI
- te%poa( K 8.-+. b
- na5a( K 2.-3. b
- "#peio K /2-22 b
- infeio K 3.-7. b
C1%p#( )i5#a( 4inoc#(a e"te epe5entat $e "pai#( pecep#t $e a%4ii oc*i i%o4i(i5ai >n po5iie
>nainte. E"te %ai >ntin" !i coe"p#n$e "pai#(#i eBp(oat $e a%4ii oc*i >n %i!cae, $epin51n$ $e
a%p(it#$inea %i!c&i(o oc#(ae.
C# a8#to#( c1%p#(#i )i5#a( "#4iect#( "e poate oienta >n "pai#, poate apecia eBi"tena !i
%ofo(ogia $ifeite(o e(e%ente %o4i(e "a# fiBe cae-( >ncon8oa&.
I7,i&a*ii
Dete%inaea c1%p#(#i )i5#a( e"te in$icat& pent#I
- $etectaea (e5i#ni(o ne)#(#i optic (a cei c# g(a#co%L
- afeci#ni a(e p(eoape(o fec)ent pto"i"#(L
- $iagno"ticaea 4o(i(o ne)#(#i opticg
- $iagno"ticaea #no afeci#ni cae afectea5& tan"%iteea info%aiei $e (a oc*i (a coteB#(
occipita( a( ceie#(#i, #n$e info%aia e"te poce"at& ca )e$ee.
Co7t)ai7,i&a*ii
- copii %iciL
- 4&t1niL
- pacienti p"i*ici pin (ip"a $e coopeae.
L&gi%ea c1%p#(#i )i5#a( e"te foate i%potant& pent# $e"f&!#aea acti)it&i(o 5i(nice.
Fng#"taea (#i afectea5& ca(itatea )ieii coti$iene, $#c1n$ (a ga)e po4(e%e $e oientae !i #neoi
(a acci$ente.
P)$;:ti)$a +at$)ial$lo)8 a pa&i$7tului8 i $%$&tua)$a p)o&$,u)ii
6paate(e #ti(i5ate >n "t#$i#( c1%p#(#i )i5#a( "e pot c(a"ificaI
- $#p& "#pafaa fon$#(#i pe cae "e poiectea5& te"t#(, >n ecane ca%pi%etice ?cae "#nt
p(ane@ !i pei%ete ?cae "#nt c#po(e@L
- $#p& %aniea $e (#c# pot fi %an#a(e "a# a#to%ate.
Ca%pi%et#( e"te #n ecan p(an, $e c#(oae neag&, a( c&#i cent# e"te %acat $e #n p#nct pe cae
"#4iect#( te4#ie "&-( fiBe5e tot ti%p#( eBa%in&ii. I(#%inaea fon$#(#i te4#ie "& fie "tan$a$i5at&.
Ca%pi%et#( #ti(i5ea5& #n ecan $e 1-2 %h p(a"at (a 1 "a# 2 %eti $e "#4iect. Te"t#( a(4 $e 1-, %%
?p#nct#( pe cae te4#ie "a-( fiBe5e tot ti%p#( "#4iect#(@ e"te %acat pe o 4ag*et& pot-te"t, cae ae
aceea!i c#(oae c# ecan#(.
'ent# efect#aea ace"t#i te"t, pacient#( n# nece"it& peg&tie "pecia(&.
Coopeaea pacient#(#i e"te foate i%potant& pent# a n# co%po%ite )a(oaea >negi"t&ii.
Fnt#c1t fatiga4i(itatea "ca$e coopeaea pacient#(#i, e"te 4ine ca $ete%inaea "& "e fac&
$i%ineaa c1n$ pacient#( e"te o$i*nit, e(aBat.
I "e )a eBp(ica c& eBa%inaea $#ea5& p#in !i e"te ne$#eoa"&. 0#4iect#( )a fi p(a"at (a o $i"tan&
$e 1 "a# 2 %eti >n faa ecan#(#i, >n f#ncie $e ca%pi%et#( fo(o"it, c# coecie a$ec)at& pent#
acea"t& $i"tan&.
Fn ca5#( eBa%in&ii c# pei%et#( ?apaat %#(t %ai pefo%ant !i co%p#tei5at@, pe 4a5a #n#i
a(goit% conto(at $e co%p#te, "e "t#$ia5& "en"i4i(itatea (a (#%in& a oc*i#(#i pent# fiecae 5on&
$in c1%p#( )i5#a(.
'ent# acea"t& %eto$&, #n oc*i e"te acopeit, ia pacient#( e"te #gat "&-!i "pi8ine cap#( pe #n
"#pot. C1n$ pacient#( )e$e (#%ini !i %i!c&i $e $ifeite inten"it&i, te4#ie "& ape"e #n 4#ton. Fn
toate te"te(e "tan$a$, pi%a $at& "e te"tea5& oc*i#( $ept, apoi ce( "t1ng.
P)$>$7ta)$a )$>ultat$lo)
Re5#(tate(e "#nt afi!ate "#4 fo%a #no *&i >n ton#i $e gi ?p#ncte(e %ai >nt#necate aat&
5one(e %ai afectate $e 4oa(&@ !i *&i c# $ate n#%eice cae "#nt pe(#cate "tati"tic !i co%paate
c# ce(e cae apa (a pacienii "&n&to!i. 0e ca(c#(ea5&, $e a"e%enea !i a(i in$icatoi g(o4a(i cae
ofe& o i%agine co%p(eB& a"#pa c1%p#(#i )i5#a(.
O('$)<a*iiB
Te"t#( pent# $ete%inaea c1%p#(#i )i5#a( nece"it& foate p#in ti%p !i n# i%p(ic& "te" pent#
pe"oane(e e(ati) "&n&toa"e, >n"& poate fi o4o"ito "i "te"ant pent# pacienii >n )1"t& !i pacienti.
'in c1%p )i5#a( co%p#tei5at "e poate $iagno"tica g(a#co%#( c# cca. ,-/ ani %ai $e)e%e $ec1t
%eto$e(e )ec*i $e pei%etie.
In)e"tigaea c1%p#(#i )i5#a( pin %eto$a co%p#tei5at& pe%ite %e%oaea e5#(tate(o !i
#%&iea peci"& a %o$ific&i(o ap&#te >n ti%p, (a eBa%in&i "#cce"i)e a(e ace(#ia!i pacient.
1+.2 D$t$)+i7a)$a 'i+*ului &)o+ati&
0i%#( co%atic e"te fac#(tatea etinei $e a pecepe $ifeite(e a$iaii %onoco%atice $in "pect#(
)i5i4i(, e%i"e "a# ef(ectate $e o4iecte(e $in 8#.
V$,$)$a &)o+ati&: 7o)+al:B
O4iecte(e "#nt )&5#te co(oate, >n %&"#a >n cae e(e ef(ect& %ai %#(t an#%ite a$iaii
%onoco%atice !i (e a4"oa4e pe ce(e(a(teL o4iecte(e o!ii ef(ect& a$iaii o!ii, ce(e )e5i ef(ect&
a$iaii )e5i, etc. O4iecte(e a(4e ef(ect& toate c#(oi(e, >n ti%p ce o4iecte(e nege (e a4"o4.
;aiaii(e c#(oi(o "#nt >n f#ncie $e ca(it&i(e caactei"tice fiec&ei c#(oi >n pateI ton#(Gn#ana,
(#%ino5itatea !i "at#aia ?ga$#( $e p#itate a( c#(oii@. 'in co%4inaea ace"to caactei"tici "e
poate o4ine o %ae ga%& $e c#(oi, $in cae oc*i#( $i"tinge n#%ai o pate.
'ent# a "e eBp(ica co%ati"%#( oc*i#(#i, "e a$%ite c& >n etina $i#n& a eBi"ta , fe(#i $e con#i,
conin1n$ fiecae $in e(e #n pig%ent foto"en"i4i( pent# o an#%it& c#(oae f#n$a%enta(&I #n#(
pent# o!#, a(t#( pent# )e$e !i a(t#( pent# )io(et. Oice c#(oae $in nat#& "e poate o4ine pin
a%e"tec#( ce(o tei c#(oi f#n$a%enta(e, )aiin$ cantitatea, (#%ino5itatea !i "at#aia.
Dona pi)i(egiat& a etinei >n e(a4oaea %e"a8#(#i co(oat e"te (a ni)e(#( %ac#(ei.
6no%a(ii(e "en5aiei $e c#(oae "e %anife"t& pin conf#5ia c#(oi(o $e c&te pe"oane(e afectate
cae "ocote"c a"e%&n&toae "a# i$entice c#(oi ce "#nt $ifeeniate $e oc*i#( no%a(.
I7,i&a*iiB
Dete%inaea "i%#(#i co%atic "e face pent# $iagno"ticaeaI
- $i"co%a5ii(o congenita(eI ano%a(ia D6LTON ?(ip"a $e pecepie a "en5aiei $e o!#@L (ip"a
"en5aiei $e )e$e ?$enteanopie@L (ip"a "en5aiei $e )io(et ?titanopie@L
- co%atop"ii(o K t#(4#&i $o41n$ite a(e "en5aiei co%atice >n #%a #no intoBicaii eBogene
"a# pin pet#4aea %e$ii(o tan"paente ?cataact&, afaOie, *e%oagii >n cop#( )ito"@.
M$to,$ ,$ t$'ta)$B
Fn f#ncie $e pincipi#( $e te"tae a "i%#(#i co%atic "#ntI
- co(oi%ete(e !i ano%a(o"coape(e K epe5int& apaat#a #ti(i5at& >n cecetae "a# cente
"pecia(i5ate !i ae ca pincipi# o4ineea #nei "en5aii co%atice i$entice c# aceea a #nei
p(a8e $e efein&, pin a%e"tec#( a(to c#(oi pent# cae "e c#no"c an#%ii paa%eti. ace"te
ega(i5&i "e pot ea(i5a !i pe ca(c#(ato,
- po4e(e $e a"otae !i c(a"ificae pe"#p#n ec#noa!teea $e c&te "#4iect a #no e!antioane
co(oate c# tona(it&i $ifeite !i c(a"ificaea (o >n o$inea tona(it&i(oL e!antioane(e pot fi
4#c&i $e (1n& "a# pioni co(oaiL
- %eto$e(e $e conf#5ie K "#nt ce(e %ai c#no"c#te. "e n#%e"c a"tfe( pent# c& "e 4a5ea5& pe
conf#n$aea tona(it&i(o (a "t&(#cii i$entice $e c&te "#4iecii c# )e$ee co%atic&
$eficita&L eBi"t& %ai %#(te tip#i $e ta4e(e p"e#$oi5oco%atice, ce(e %ai c#no"c#te fiin$
I"i*aa !i Ra4OinL ace"te ta4e(e epe5int& p(an!e >n cae an#%ite "i%4o(#i ?cife, (itee,
fig#i geo%etice@ "#nt fo%ate $in p(a8e co(oate $e aceea!i tona(itate, "at#aie !i
(#%ino5itate $ifeite, pe #n fon$ fo%at $in a(te tona(it&i $e aceea!i "at#aie !i (#%ino5itate
c# "i%4o(#i(e.
0*ino4# I"*i*aa a fo"t ofta(%o(og !i pofe"o a( Uni)e"it&ii $in ToOio. E( a in)entat te"te(e cae-
i poat& n#%e(e pent# )eificaea ec#i(o >n a%at&, c# a8#to#( %e$ic#(#i "&# a"i"tent cae ea
$i"co%at, !i (e-a p#4(icat >n 1+17. De at#nci ace"tea a# $e)enit pincipa(e(e te"te pent#
$epi"taea ano%a(ii(o $e pecepie a c#(oii.
Te"t#( oigina( c# p(an!e $e *1tieGcaton "e face >nt-o ca%e& (#%inat& a$ec)at $e "oae, f&& a5e
$iecte "a# (#%in& atificia(&.
Di"co%aii ?pe"oane(e c# a(te&i a(e "i%#(#i co%atic@ i$entific& $#p& (#%ino5itate ton#i(e pe
cae n# (e )&$, $e ce(e pe cae (e )&$. Te"t#( e"te c# at1t %ai "en"i4i(, c# c1t $ifeene(e >nte ton#i
"#nt %ai %ici.
EBi"t& p(an!e $e contapo4&, pecep#te $oa $e c&te $i"co%ai n# !i $e c&te "#4iecii no%a(i,
#!oaa $ifeen& >nte "e%ne !i fon$ e $at& $e co%ponenta a(4a"t& !i %a"cat& $e o!# !i )e$e@. De
a"e%enea, eBi"t& !i p(an!e $e $e%on"taie- pent# >ne(egeea pincipi#(#i- pecep#te !i $e c&te
no%a(i !i $e c&te $i"co%ai.
Ti%p#( $e ec#noa!tee a( "i%4o(#(#i pe5entat e"te $e 12 "ec.
- 'o4e $e $en#%ieI $in acea"t& categoie fac pate (antene(e co(oate ?"a#
co%ato"coape(e@. 9eto$a con"t& >n pe5entaea $e "ti%#(i co(oai "#4iect#(#i, $e $ifeite
%&i%i ce te4#ie"c ec#no"c#i (a $i"tana $e 2%, "#4iect#( te4#in$ "& peci5e5e ton#(
?c#(oaea@. Inten"itatea c#(oi(o "e poate %o$ifica c# a8#to#( #no fi(te, "i%#(1n$
%o$ificaea c#(oii >n f#ncie $e con$iii(e at%o"feice.
I+po)ta7*a ,$pi't:)ii ,i'&)o+a>iilo)B
O%#( pecepe (#%ea c# ce(e cinci ogane $e "i% a(e "a(e. Dinte ace"tea ce(e %ai %#(te
info%aii (e pi%e!te pin inte%e$i#( )e$eii. La o%#( %o$en tan"%iteea info%aiei pin
ogane(e $e "i% "e face a"tfe(I ;&5 +.M L 6#5 2M L 'ip&it 2ML -#"t 2ML 9io" 1M.
De aceea n# e tot#na $ac& eBp(oat&% (a %aBi%#% po"i4i(it&i(e eBi"tente >n )e$ee. 'ie$ei(e $e
info%aie >n ca5#( pecepiei c#(oi(o $i%in#ea5& ca(itatea )ieii, $ega$ea5& "ig#ana pe(#c&ii
info%aii(o !i pin ace"tea inf(#enea5& >n %o$ negati) ti%p#( $e eacie a ec#noa!teii.
Dinte $i"co%a5ii(e congenita(e, $a(toni"%#( "a# (ip"a $e pecepie a "en5aiei $e o!# e"te cea
%ai i%potant& pin con"ecine(e pe cae (e ae.
- "e c#no"c %ai %#(t $e o "#t& $e oc#paii #n$e $a(toni"%#( ceea5& o "it#aie $efa)oa4i(&. $e
eBe%p(#I $octo, $enti"t, te*nician $enta, coafo, co"%etician, pantofa, )itinie, cea%i"t,
in$#"tia teBti(&, fa4ici $e )op"ea, po$#cia $e %e$ica%ente, in$#"tia a(i%enta&, etc.L
- $a(toni"%#( e"te $e5a)anta8o" %ai a(e" >n copi(&ie. (a acea"t& )1"t& copi(#( e"te >nt-o
"it#aie $efa)oa4i(& (a >n)&&t#& !i >n apecieea $e "ine. copiii $e )1"ta >nte /-1. ani $e
eBe%p(# pot "& co(oe5e ia4a c# o!#, acopei!#( c# )e$e !i $in acea"t& ca#5& pot "&
pi%ea"c& note e(e, ia $#p& toate ace"tea cei(a(i 1$ $e ei. n# )&$ 4ine fig#i(e co(oate $in
%an#a(e, ceta co(oat& $e pe ta4(&, (inii(e co(oate a(e *&i(oL
- >n cic#(aie $a(toni!tii "#nt eBtao$ina $e peic#(o!i at1t pent# popia pe"oan& c1t !i
pent# cei(a(i. pe"oane(e c# pecepee co%atic& coect& o4"e)& $e $epate (#%ini(e
"e%afoae(o !i a (&%pi(o $e "top. "#nt $e"e acci$ente(e >n cae $a(toni!ti tec pe"te !ine >n
pofi$a in$icato#(#i o!# $e (a 4aie&L
- $in p&cate (a )1n&toae toc%ai pent# $a(toni!ti e"te ce( %ai ge# "& $ifeenie5e c# "ig#an&
c#(oi(e. aici oc*e(aii $e coecie pot a8#ta foate %#(tL
- 4&4aii $a(toni!ti "e >%4ac& >n c#(oi nea!teptate !i nepoti)ite, $e (a ca5 (a ca5, >!i p#n
!o"ete $e"peec*eateL
- (a c#%p&&t#i i(#"taii(e !i in"cipii(e co(oate $e pe a%4a(a8 pot $e)ia $e (a no%a(.
1+.3 57;)iAi)i p)$ 9i po't op$)ato)ii i7 a%$&*iu7i o&ula)$ &=i)u);i&al$
57;)iAi)i p)$op$)ato)ii
- "e peg&te!te pacient#( pent# inte)enia c*i#gica(& ?$ac& %e$ic#( in$ic& !i pacient#( >!i
$& aco$#(@ a"tfe(I
- "e peg&te!te pacient#( p"i*ic ?info%ae, eBp(icae, o4ineea con"i%&%1nt#(#i
info%at@L
- "e face peg&tiea peopeatoie (oca(& pinI t#n$eea gene(o c# o fofec#& #n"& c#
)a"e(in&, >n ti%p ce pacient#( "t& >n po5iie "e%i!e51n$& pe "ca#n#( ofta(%o(ogic, c#
oc*ii >nc*i!i ca at#nci c1n$ $oa%eL )eificaea pe%ea4i(it&ii cana(#(#i (aci%a( pin
in8ectaea #nei "o(#ii "a(ine ?"e fi5io(ogic@ pin oifici#( inten infeio a( cana(#(#i
(aci%a(, c# #n ac 4ine a$aptat (a o "eing& $e 1-2 %(L "p&(aea oc*i#(#i pin in"ti(aea
epetat& a #nei "o(#ii i5otone ?"e fi5io(ogic@ pent# >n$ep&taea ci(i(o !i a "eceii(o
oc#(aeL
- "e %&"oa& !i "e notea5& f#ncii(e )ita(e !i )egetati)e ITR, ', T6L
- "e %&"oa& ten"i#nea intaoc#(a& >n ca5 $e g(a#co%L
- "e a$%ini"tea5& "o(#ii %iotice (oca( ia pe ca(e genea(&, $i#etice in$icate $e %e$icL
- "e "i"tea5& a(i%entaia c# ce( p#in 12 oe >nainte $e opeaie ?>n ca5 $e ane"te5ie genea(&@L
- "e face c(i"%& e)ac#atoae $ac& %e$ic#( in$ic& ?>n "eaa pe%eg&toae inte)eniei@L
- "e eco(tea5& po$#"e 4iopato(ogice pent# eBa%ene $e (a4oatoI g(ice%ie, #ee, T0, T-,
eBa%en-"#%a $e #in&, eBa%en cito4acteio(ogic a( "eceiei oc#(aeL
- "e pef#5ea5& i.). 9anito( 1.M, >n $i%ineaa 5i(ei inte)eniei, (a in$icaia %e$ic#(#i.
57;)iAi)i p)$op$)ato)ii
- "e "#pa)eg*ea5& !i "e a8#t& pacient#( >n $e"f&!#aea acti)it&i(o $e 4a5&I a(i%entae,
igien&, e(i%inae >nt#c1t eBi"t& i"c#( $e acci$entae %ai a(e" (a cei c# 4inoc(#L
- "e "c*i%4& pan"a%ent#( oc#(a (a in$icaia %e$ic#(#iL
- "e face tata%ent#( topic pe"ci", c# "o(#ii "a# #ng#ente pent# a pe)eni infecii(e, a
e$#ce inf(a%aia !i a "ti%#(a )e$eeaL
- "e )eific& 6; !i pe"i#nea intaoc#(a& !i "e eco%an$& oc*e(ai, $e eg#(& c# $ioptii %ai
%ici $ec1t >nainte $e opeaieL
- >n ca5#( inte)enii(o pin fac#e%#("ionae, "e face o inci5ie foate %ic& pin cae "e
into$#ce ci"ta(in#( fo($a4i( ?tan"p(ant $e ci"ta(in@, ia pacient#( n# nece"it& intenae >n
"pita(. 0e eco%an$& e)eniea (a conto( a $o#a 5i !i apoi (a inte)a(e fiBate $e %e$ic, >n
f#ncie $e e)o(#ia (oca(&.
Capitolul 3 5NGRI6IRI 5N ORL
2..1 Ma7$<)a F$i+li&=
E"te o %ane)& nein"t#%enta(& ?%an#a(&@ $e $e5o4"t#cie a c&i(o aeiene, efect#at& >n %o$
Cef(eBE (a toi pacienii "#"peci $e o in*a(aie $e cop "t&in.
I7,i&a*ii
- toate "t&i(e $e "#focae pin in*a(ae $e copi "t&ini "o(i5iL
- ce( %ai a$e"ea e"te )o4a $e #n cop "t&in 4(ocat (a ni)e(#( (ainge(#iL
- o4"t#cia c&i(o aeiene poate antena #n "top ca$io-e"piato.
D$'&)i$)$a +a7$<)$i
'incipi#( e"te $e a cea o *ipeten"i#ne a4$o%ina(& 4#"c&, )i51n$ >%pingeea $iafag%ei >n
"#". 'e"i#nea a"tfe( ta"%i"> ae#(#i $in apaat#( e"piato pe%ite %o4i(i5aea cop#(#i "t&in
o4"t#ent, cae e"te pactic e8ectat ca #n C$op $e !a%panieE, >nt#nc1t in*a(aea cop#(#i "tain "e
ea(i5ea5& pin a"piaia acci$enta(&, a)1n$ p(&%1nii p(ini c# ae.
S$+7$l$ ,$ )$&u7oa9t$)$ a o('t)u&*i$i &:ilo) )$'pi)ato)ii p)i7 i7=ala)$ ,$ &o)p 't):i7
a@ pacient#( e"te >n picioae "a# a!e5at, con!tient, $a n# poate e"pie "a# )o4iL
4@ "e agit& pent# a atage atenia ce(o $in 8# !i >!i p#ne %1ini(e >n C)E pe pieptL
c@ tia8#(, "e%n a( efot#(#i in"piato, e"te pe5ent (a ni)e(#( %#!c*i(o ce)ica(iL
$@ )icti%a e"te c&5#t& , incon!tient& !i >n "top e"piato.
E%$&tua)$a t$=7i&ii
C@7, pa&i$7tul $'t$ &o79ti$7t8 ?7 pi&ioa)$ 'au a9$>atB
- "a()ato#( "e p(a"ea5& >n "pate(e )icti%ei, >n contact c# eaL
- #na $inte %1ini e"te p(a"at& c# po(ice(e >n 8o", >n p#nct#( Cpi"tonE "it#at >nte o%4i(ic !i
apen$ice(e Bifoi$, ia cea(a(t& %1n& o acope& pe pi%aL
- "e efect#ea5& /-2 taci#ni 4#!te >n "#" !i >n a$1nci%e pent# a ce!te pe"i#nea
a4$o%ina(& !i a i$ica $iafag%aL
- %ane)a "e poate epeta $e c1te oi e"te ne)oie.
C@7, pa&i$7tul $'t$ ?7 ,$&u(it ,o)'al 'au $'t$ i7&o79ti$7tB
- "a()ato#( "e p(a"ea5& $ea"#pea )icti%ei, >n gen#nc*i, $e o pate !i $e a(ta a coap"e(o
)icti%ei !i co%pi%& 4#"c epiga"t#(, tot$ea#na c# o %i!cae a"cen$ent&L
- "e eBec#t& /-2 co%pe"&i a4$o%ina(e "c#teL
- pacient#(#i incon!tient, p(a"at >n $ec#4it $o"a( (atea( "t1ng, i "e pot ap(ica (o)it#i toacice
po"teioae.
Ca7, <i&ti+a $'t$ u7 'u;a) 'au u7 &opil +i&
- "e pin$e "#ga#( $e picioae, c# cap#( >n 8o"L
- "e ap(ic& ,-/ (o)it#i, >n egi#nea toaca(& po"teioa& >nte o%op(ai "a# "e c#(c& copi(#( c#
cap#( >n 8o" pe"te gen#nc*ii "a()ato#(#i
- "e ap(ic& ,-/ (o)it#i (a ni)e(#( toace(#i po"teio L
- in ca5#( >n cae cop#( "t&in n# e"te e8actat >n afa&, "e ca#t& (a ni)e(#( oofainge(#i $e #n$e
e"te >n$ep&tat.
2..2 Sp:l:tu)a au)i&ula):
0p&(aea con$#ct#(#i a#$iti) eBten pent# >n$ep&taea "eceii(o "a# a copi(o "t&ini
I7,i&a*ii
- $op $e ce#%en "a# $op epi$e%icL
- copi "t&ini intaa#ic#(aiL
- otite conice.
0e peg&te"c pe o %&"#& #(ant&I
- "einga g#Uon c# capacitate $e 12.-2.. %(, "tei(&L
- (ic*i$ $e "p&(&t#&I ap& "tei(& >nc&(5it& (a ,7RCL
- "o(#ia %e$ica%entoa"& pe"ci"& $e %e$icL
- t&)i& ena(&L
- #n po"op $e #nic& fo(o"in&, e)ent#a( $in %ateia( i%pe%ea4i(L
- ta%poane a#ic#(ae.
- "e an#n& pacient#( !i "e eBp(ic& "cop#( poce$#ii, pec#% !i %o$#( $e $e#(ae, pent# a
o4ine co(a4oaea "aL
- "e a!a5& pacient#( >n po5iie !e51n$&L
- "e ap(ic& po"op#( "#4 4&4ia pacient#(#iL
- "e in)it& pacient#( "& in& t&)ia ena(& "#4 #ec*ea afectat& !i "& >nc(ine #!o cap#( "pe
ta)i& pent# ca (ic*i$#( "& "e "c#g& >n acea"taL
- a"i"tenta %e$ica(& "e "pa(& pe %1nini !i >!i p#ne %&n#!i $e #nic& fo(o"in&L
- "e )eific& te%peat#a (ic*i$#(#i $e "p&(&t#& !i "e a"pi& >n "einga g#UonL
- "e "o(icit& pacient#(#i "& $e"c*i$& g#a, pent# (&giea con$#ct#(#i a#$iti)L
- "e tage pa)i(ion#( #ec*ii >n "#" !i >napoi c# %1na ne$o%inant&L
- c# %1na $o%inant& "e in8ectea5& (ic*i$#( $e "p&(&t#& >n con$#ct, "pe peete(e po"teo-
"#peio !i "e a!teapt& e)ac#aeaL
- "e epet& opeai#nea $e %ai %#(te oi, p1n& c1n$ (ic*i$#( e"te c#aL
- "e #"#c& con$#ct#( a#$iti) eBten c# ta%poane a#ic#(aeL
- "e p#ne #!o >n %eat#( con$#ct#(#i a#$iti) #n ta%pon $e )at&L
- "e "o(icit& pacient#(#i "& "tea >n epa#", >n $ec#4it $o"a(, pent# c1te)a %in#te !i "& e)ite
c#ent#( $e aeL
- "e )eific& (ic*i$#( $e "p&(&t#&L
- "e eogani5ea5& (oc#( $e %#nc& "i "e co(ectea5& %ateia(e(e fo(o"ite >n ecipiente "pecia(eL
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n fi!a pacient#(#iL
- "e "#pa)eg*ea5& pacient#( $#p& "p&(&t#&L
- "e an#n& %e$ic#(#i e)ent#a(e(e inci$enteI a%ee(i, $#ei, )&"&t#i $e ca#5& centa(&.
2.., T$'t$ au,iti<$ #au,io+$t)ia-
6#$io%etia face pate $in eBa%inaea #ec*ii !i e)a(#ea5& capacitatea #nei pe"oane $e a a#5i,
pin %&"#aea a4i(it&ii "#nete(o $e a a8#nge (a ceie. 0#nete(e "#nt, $e fapt, )i4aii af(ate >n
%e$i#( >ncon8#&to, $e fec)ene !i inten"it&i $ifeite. 6e#( $in cana(e(e !i oa"e(e $e (a ni)e(#(
#ec*ii !i a( cani#(#i a8#t& ace"te )i4aii "& pac#g& $#%#( $inte #ec*e !i ceie, #n$e "#nt
Ca#5iteE.
I7,i&a*ii
Te"te(e a#$iti)e "#nt efect#ate pent# I
- "ceening#( "#gai(o !i copii(o pent# po4(e%e(e a#$iti)e ce pot intefea c# a4i(itatea
ace"toa $e a >n)&a, )o4i "a# $e a >ne(ege (i%4a8#(L
- "ceening#( copii(o !i a$o(e"centii(o pent# a e)ita o po"i4i(& pie$ee a a#5#(#iL a#5#( a
te4#i )eificat (a fiecae )i5it& (a %e$icL (a copii , #n a#5 no%a( e"te i%potant pent# o
$e5)o(tae coe"p#n5&toae a )o4iii, o pate $in po4(e%e(e $e )o4ie, >n)&ae "a# $e
co%pota%ent a(e copii(o fiin$ $ete%inate $e t#(4#&i a(e a#5#(#iL aca$e%ia a%eican& $e
pe$iatie eco%an$& efect#aea #n#i te"t a#$iti) (a )1"te(e $e /, 12, 12 !i 18 aniL
- ca pate a eBa%in&ii fi5ice $e #tin&, >n genea(, $ac& n# "e "#"pectea5& o *ipoac#5ie e"te
"#ficient n#%ai te"t#( >n cae "e !opte"c c#)inte(eL
- a e)a(#a o po"i4i(& pie$ee a a#5#(#i (a o pe"oan& ce a o4"e)at o po4(e%& pe"i"tent&
a#$iti)& (a #na "a# (a a%4e(e #ec*i, "a# cae ae $ific#(t&i $e a >ne(ege c#)inte(e $int-o
con)e"aieL
- "ceening#( po4(e%e(o a#$iti)e a( a$#(ti(oL $e"eoi e"te $iagno"ticat& ge!it o $i%in#ae a
capacit&ii %enta(e (a )1"tnici ca #%ae a *ipoac#5iei ?$e eBe%p(#, $ac& o pe"oan& pae "&
n# a"c#(te "a# "& a"p#n$& (a o con)e"aie@L
- "ceening#( pe"oane(o ce "#nt "#p#"e >n %o$ epetat (a 5go%ote inten"e "a# cae ia#
an#%ite anti4iotice pec#% genta%icinaL
- $ete%inaea tip#(#i i ga)it&ii *ipoac#5iei ?con$#cti)&, ne#o"en5oia(& "a# a%4e(e@
- >n *ipoac#5ia con$#cti)&, ta"%iteea "#nete(o ?con$#ceea@ e"te 4(ocat& !i n# poate tece
"pe #ec*ea inten&L
- >n *ipoac#5ia ne#o"en5oia(&, "#nete(e a8#ng (a ni)e(#( #ec*ii intene, $a o po4(e%& a
ne)i(o a#$iti)i "a#, %ai a, a ceie#(#i, >%pie$ic& a#5#(.
P)$;:ti)$a pa&i$7tului p$7t)u t$'t$l$ au,iti<$
- e)itaea 5go%ote(o p#tenice c# apoBi%ati) 13 oe inainte $e te"tae
- )eificaea !i >n$ep&taea $op#(#i $e ce#%en $in cana(#( a#$iti) eBtenL
- >n$ep&taea cecei(o, oc*e(ai(o "a# agafe(o $e p& >n te"t#( c# c&!ti, $eoaece ace"te
acce"oii >%pie$ic& po5iionaea coect& a c&!ti(oL
- )eificaea pe"i#nii eBecitate $e c&!ti pe #ec*ea eBten& !i a po"i4i(it&ii $e >nc*i$ee a
con$#ct#(#i a#$iti) pin ap&"ae pe #ec*eL >n ace"t ca5, "e )a p(a"a, >nainte $e te"tae, #n
t#4 "#4ie $e p(a"tic cae )a %enine cana(#( a#$iti) $e"c*i"L
- >n$ep&taea pote5ei a#$iti)e ?aco(o #n$e e"te ca5#(@ >nainte $e te"taeL
- "p&(aea #ec*ii >nainte $e efect#aea te"t#(#i c# potenia(e e)ocate a#$iti)e.
E%$&tua)$a t$'t$lo) au,iti<$
Te"te(e a#$iti)e pot fi efect#ate >n (a4oatoae "pecia(i5ate, $e c&te #n "pecia(i"t ?a#$io(ogi"t@
"a# >n ca4inet#( %e$ica( $e (a !coa(& "a# $e (a (oc#( $e %#nc&, $e c&te o a"i"tent& %e$ica(&, #n
p"i*o(og, (ogope$ "a# $e c&te #n te*nician. Te"te(e a#$iti)e e)a(#ea5& pie$eea a#5#(#i.
T$'tul &u<i7t$lo) 9optit$
Fn te"t#( c#)inte(o !optite, %e$ic#( )a cee pacient#(#i "&-!i acopee #na $in #ec*i c# $eget#(.
6poi ace"ta "e )a po5iiona >nt1i (a ,. c%, apoi (a 3. c% >n "pate(e pacient#(#i !i )a !opti o "eie
$e c#)inte. 'acient#( te4#ie "& epete c#)inte(e pe cae (e a#$e. Dac& ace"ta n# pecepe c#)inte(e
(a o !optie #!oa&, %e$ic#( )a o"ti c#)inte(e $in ce >n ce %ai tae, p1n& c1n$ pacient#( (e )a p#tea
a#5i. Fiecae #ec*e )a fi te"tat& "epaat.
Au,io;)a+a &u to7 pu)
6#$ioga%a c# ton p# #ti(i5ea5& #n apaat $en#%it Ca#$io%et#E ce #(ea5& o "eie $e ton#i
pin inte%e$i#( #no c&!ti. 6ce"te ton#i )aia5& ca ni)e( ?fec)en&, %&"#at& >n =et5i@ !i p#tee
?inten"itate, %&"#at& >n $eci4e(i@. 9e$ic#( )a conto(a )o(#%#( ton#(#i e$#c1n$ p#teea
p1n& c1n$ n# %ai e"te a#5it $e c&te pacient. 6poi )a %&i $in no# p#teea ton#(#i, p1n& c1n$
ace"ta )a p#tea fi a#5it $in no#. 'acient#( )a te4#i "& "e%na(i5e5e, pin i$icaea %1inii "a# pin
ap&"aea #n#i 4#ton, $e fiecae $at& c1n$ a#$e #n ton, c*ia !i at#nci c1n$ ace"ta e"te foate )ag.
9e$ic#( )a epeta $e c1te)a oi acea"t& opeai#ne, fo(o"in$ #n ton c# o fec)en& $in ce >n ce
%ai %ae. Fiecae #ec*e e"te te"tat& "epaat. 6poi c&!ti(e )o fi >n$ep&tate, ia pe o"#( $in
"pate(e #ec*ii )a fi p(a"at #n $i"po5iti) ce )i4ea5&. 'acient#( )a te4#i "& "e%na(i5e5e $e
fiecae $at& c1n$ a#$e #n ton.
T$'tul ,iapa>o7ului
Diapa5on#( e"te #n $i"po5iti) %eta(ic, >n fo%& $e f#c#(i&, ce po$#ce #n ton at#nci c1n$
)i4ea5&. 9e$ic#( )a (o)i $iapa5on#( pent# a-( face "& )i4e5e !i "& e%ita, a"tfe(, #n ton. 6ce"t
te"t "ta4i(e!te c1t $e 4ine cic#(& "#nete(e pin #ec*e Fn f#ncie $e c1t $e 4ine a#$e pacient#(
"#nete(e, %e$ic#( )a "ta4i(i $ac& eBi"t& o po4(e%& a ne)i(o "a# $e con$#cee a "#nete(o c&te
ne)i.
T$'tul ,$ )$&$pti$ a <o)(i)ii 9i ,$ )$&u7oa9t$)$ a &u<i7t$lo)
Te"t#( $e ecepie a )o4iii !i $e ec#noa!tee a c#)inte(o %&"oa& a4i(itatea $e a a#5i !i $e a
>ne(ege o con)e"aie no%a(&. Fn ace"te te"te, pacient#( e"te #gat "& epete o "eie $e c#)inte
"i%p(e, "p#"e (a ga$e $ifeite $e p#tee. 0e %ai poate efect#a #n te"t ce $ete%in& capacitatea
pacient#(#i $e a epeta o "eie $e c#)inte fa%i(iae, a(c&t#ite $in $o#& "i(a4e. 6ce"t te"t face
$ifeena >nte *ipoac#5ia $e tan"%i"ie !i cea ne#o"en5oia(&.
E<alua)$a $+i'i$i otoa&u'ti&$
Te"t#( e%i"iei otoac#"tice e"te fo(o"it $e"eoi pent# "ceening#( *ipoac#5iei (a no#-n&"c#i.
6ce"ta e"te efect#at pin p(a"aea #n#i %icofon %ic >n cana(#( a#$iti) eBten a( copi(#(#i.
0#nete(e "#nt into$#"e apoi pint-o "on$& %ic& !i f(eBi4i(& >n #ec*ea copi(#(#i. 9icofon#(
$etectea5& &"p#n"#( #ec*ii intene (a "#nete. 6cea"t& in)e"tigaie n# face >n"& $ifeena $inte
*ipoac#5ia $e con$#cee !i cea ne#o"en5oia(& ?*ipoac#5ia $e pecepie@.
Au,io;)a+a &u pot$7*ial$
$<o&at$
'ent# a#$ioga%a c# potenia(e e)ocate "#nt p(a"ai ni!te e(ecto5i (a ni)e(#( pie(ii cap#(#i !i pe
fiecae (o4 a( #ec*ii. 'in inte%e$i#( #no c&!ti "#nt ti%i"e 5go%ote a"e%&n&toae #no c(ic#i
!i e"te >negi"tat &"p#n"#(. 6cea"t& in)e"tigaie $iagno"tic*ea5& *ipoac#5ia ne#o"en5oia(&.
Fn %o$ no%a(, ace"te te"t&i n# i%p(ic& nici#n
$i"confot.
0#net#( e"te $e"ci" >n f#ncie $e fec)ena !i inten"itate. Li%ita a#5#(#i e"te $at& $e c1t $e tae
te4#ie "& fie #n "#net $e o an#%it& fec)en& pent# a fi a#5it. Fec)ena "a# ni)e(#( ?in$ifeent
$ac& "#net#( e"te 8o" "a# >na(t@ e"te %&"#at& >n )i4aii pe "ec#n$& "a# *et5i ?=5@. Uec*ea
#%an& poate a#5i >n %o$ no%a( fec)ene $e (a foate 8oa"e, >n 8##( a 13 =5 , p1n& (a foate
>na(te, >n 8# $e 2. ... =5. Fec)ena #nei con)e"aii no%a(e, ce "e $e"f&!oa& >nt-#n (oc
(ini!tit, "e >ntin$e pe o p(a8& $e (a 2.. =5 (a 2... =5. Inten"itatea "a# p#teea e"te %&"#at& >n
$eci4e(i ?$:@. Inte)a(#( no%a( ?(i%ita infeioa&@ a( a#5#(#i e"te >nte . !i 22 $:. Fn ca5#(
copii(o, inte)a(#( no%a( %ini% e"te >nte . !i 12$:. Un e5#(tat no%a( aat& c& a#5#( a%4e(o
#ec*i "e >nca$ea5& >n ace"te inte)a(e.
Li+ita au>ului i7 ,$&i($li G)a,ul ,$ '$<$)itat$ al
=ipoa&u>i$i
Capa&itat$a ,$ a au>i
li+(aAul
.-22$: Nici#n#( F&& $ific#(tate
23-/. $: U!o Dific#(tate (a #n $i"c#"
cae
"e a#$e )ag "a# $e (a
$i"tan& /1-22 $: 9o$eat Dific#(tate >n a a#5i o
con)e"aie
23-7. $: 9o$eat-"e)e Di"c#"#( te4#ie "& fie taeL
$ific#(tate $e a a#5i
con)e"aia >nt-#n
g#p 71-+. $: 0e)e Dific#(tate $e a a#5i #n
$i"c#" )o4it taeL
>ne(ege n#%ai c#)inte
ipate "a# a%pificate
+1V $4 'of#n$ 'oate "& n# >ne(eag& #n
$i"c#" a%p(ificat
Leg&t#a $inte inten"itatea "#nete(o !i ga$#( *ipoac#5iei (a a$#(i e"te e$at& >n ta4e(#( $e %ai
8o"I
No%a( e@ 'acient#( a#$e c#)inte !optite
f@ 6#$e (a fe( >n a%4e(e #ec*i ton#i(e
g@ 'oate "& epete +. K +2M $in c#)inte(e "p#"e (a te"t#(
$e ec#noa!tee
*@ 9icofon#( $etectea5& e%i"ii(e #ec*ii intene (a
te"t#( e%i"ii(o otoac#"tine
i@ 6#$ioga%a potenia(e(o e)ocate aat& o f#ncie
no%a(& a ne)i(o a#$iti)i
6no%a( 8@ N# poate a#5i c#)inte !optite, "a# (e poate a#5i n#%ai c# o
#ec*e
O@ 6#$e >n %o$ $ifeit ton#i(e >n ce(e $o#& #ec*i
(@ 'oate a#5i n#%ai an#%ite "#nete, (a #n n#%& ce"c#t
$e $eci4e(i
%@ 'oate a#5i "#nete(e, $a n# poate >ne(ege c#)inte(e
n@ N# "#nt $etectate e%i"ii >n #ec*ea inten& >n e"#t#(
e%i"ii(o otoac#"tice
o@ 6#$ioga%a poteniona(e(eo e)ocate aat& c& ne)ii
a#$iti)i n# f#ncionea5& no%a(
Factoii cae pot inf(#ena ac#ateea "a# e5#(tat#( te"t#(#i "#ntI
- i%po"i4i(itatea $e a coopea, #%a in"t#ci#ni(e "a# $e a >ne(ege "#ficient $e 4ine
(i%4a8#( pent# a &"p#n$e >n ti%p#( te"te(oL e"te $ifici(& efect#aea te"te(o a#$iti)e (a
copiii %ici "a# (a a$#(ii cae a# ina4i(it&i fi5ice "a# %enta(eL
- po4(e%e a(e apaat#ii, pec#% c&!ti "epaate "a# cae n# "e poti)e"c. #n a#$io%et#
neec*i(i4at "a# pe5ena 5go%ote(o $e fon$L
- $ific#(tate $e a )o4i "a# $e a >ne(ege (i%4a8#( ce(#i cae efect#ea5& te"taeaL
- )io5e e"piatoii "a# o infecie a #ec*ii ecent&.
Capitolul 1E 57;)iAi)i ?7 a%$&*iu7i &=i)u);i&al$
21.1 57;)iAi)i p)$op$)ato)ii
6n"a%4(#( >ngi8ii(o cae "e efect#ea5& (a toi pacienii >nainte $e a fi "#p#!i inte)eniei
c*i#gica(e.
P)i+i)$a pa&i$7tuluiB
Con"t& >n (ini!tiea pacient#(#i eBp(ic1n$ $e#(aea inte)eniei, etape(e opeatoii, ane"te5ia.
6"i"tenta %e$ica(& te4#ie "&-!i aate $i"poni4i(itatea $e a &"p#n$e >nte4&i(o pacient#(#i.
P)$;:ti)$a &uta7at: a op$)atuluiB
S&op
Di%in#aea (a %aBi% a f(oei 4acteiene tan5itoii pe5ente pe pie(ea )iito#(#i opeat pent# a
e)ita infecia >n ti%p#( inci5iei !i conta%inaea %e$i#(#i $in 4(oc#( opeato
I;i$7a &o)po)al:
- "eaa !i >n $i%ineaa inte)eniei, pacient#( )a face $#! c# "&p#n anti"eptic ?tip 4eta$ine
"a# c(o*eBi$in& $ac& e"te a(egic (a io$@L
- "e )a in"i"ta (a ni)e(#( p(i#i(o $e f(eBi#ne, egi#ni(o ing*ina(e, o%4i(ic#(#i !i picioae(o.
acea"t& poce$#& e"te ea(i5at& $e pacient $#p& ce e"te info%at c#% te4#ie "& poce$e5eL
- $ac& pacient#( e"te $epen$ent, igiena copoa(& )a fi efect#at& $e infi%ie&, (a pat, "a# >n
ca%ea $e 4aieL
- $#p& efect#aea igienei copoa(e, pacient#( )a >%4&ca pi8a%a(e c#ate !i "e )a "c*i%4a
(en8eia $e pat.
D$pila)$a
N# e"te o poce$#& "i"te%atic&, ci e"te >n f#ncie $e tip#(, (oc#(, %o$#( $e inte)enie !i $e
potocoa(e(e "ecieiG"e)ici#(#i.
Depi(aea e"te ea(i5at& $e a"i"tent& "a# $e infi%ie&.
Do#& %eto$e pot fi #ti(i5ateI
a@ Ce%a $epi(atoae
- >n pea(a4i(, "e efect#ea5& #n te"t $e to(ean& >n "eaa $inaintea inte)eniei
- "e "pa(& pie(ea !i "e #"#c&
- "e ap(ic& apoi ce%a $epi(atoae
- "e c(&te!te, apoi "e #"#c& pie(ea
4@ T#n"oaea
Ra$eea %ecanic& e"te inte5i"& fiin$c& ce!te i"c#( $e efacie c#tanat& a 5onei opeatoii. 0e
eco%an$& t#n$eea pi(o5it&i(o c# %a!ina $e t#n", apoi "e face $#! pacient#(#i.
Gila7*ul p)$op$)ato)
0e efect#ea5& pe(e)&i $e "1nge pent#I g#p "ang#in !i facto R*, ionoga%& "ang#in&, #ee,
ceatinin&, T0, TC, =L- !i a(te eBa%ene pe"ci"e $e %e$ic.
'ent# inte)enii(e i%potante, "e ea(i5ea5& !i a(te eBa%eneI
- a$iogafia p#(%ona& !i EC-L
- "e notea5& con"tante(e )ita(eI ', T, T6, $i#e5&L
- "e ap(ic& eco%an$&i(e ane"te5i"t#(#iL
- eani%atoI o e)ent#a(& tan"f#5ie, anti4ioteapie, eec*i(i4ae *i$o-e(ecto(itic&.
57 >iua i7t$)<$7*i$iB
- "e (ini!te!te pacient#(, "e "#"ine p"i*icL
- "e )eific& "& fie ne%1ncat, "& n# 4ea, "& n# f#%e5eL
- "e )eific& igiena copoa(& !i $epi(aea 5onei opeatoiiL
- "e )eific& a4"ena (ac#(#i $e pe #ng*ii(e $e (a %1ini !i $e (a picioaeL
- "e >n$ep&tea5& pote5e(e $entae, oc*e(aii, 4i8#teii(e, (enti(e(e $e contactL
- "e notea5& con"tante(e )ita(e pent# a a)ea $ate $e efein&, pe pac#"#( opeaieiL
- "e a$%ini"tea5& pe%e$icaia confo% pe"cipiei %e$ica(eL
- "e )eific& $o"a#( pacient#(#i, "& fie co%p(et c# e5#(tate(e eBa%ene(o efect#ate, tip#( $e
ane"te5ie, tip#( $e opeaie, $ate(e $e i$entificae.
21.2 57;)iAi)i po'top$)ato)ii
6n"a%4(#( >ngi8ii(o aco$ate #n#i pacient cae a "#feit o inte)enie c*i#gica(&
La )$?7toa)&$)$a ,$ la (lo&ul op$)ato)
- "e info%ea5& pacient#( $e"pe tip#( !i %e$i#( $e $e#(ae a inte)enieiL
- "e e)e$e potoco(#( opeato !i "c*e%a inte)eniei pacticateL
- "e in"ta(ea5& pacient#( >n pat >n f#ncie $e tip#( $e ane"te5ie !i $e inte)enieL
- "e o4"e)& "taea pan"a%ent#(#i, "e conto(ea5& !i "e notea5& "i"te%e(e $e $ena8L
- "e aco$ea5& "on$a $e a"piaie $ige"ti)& (a o p#ng& co(ectoae, "e a$%ini"tea5& O2 (a
ne)oieL
- p1n& (a e)eniea "t&ii $e c#no!tin& a pacient#(#i "e )o "#pa)eg*ea $in 12 >n 12 %in#teI
- ', T.6., "at#aia O2, R, $i#e5aL
- ga$#( $e c#no!tin&L
- caactei"tici(e !i )o(#%#( pie$ei(o eBteioi5ate pin $ena8L
- "taea pan"a%ent#(#i.
Sup)a<$;=$)$ 9i ?7;)iAi)i ,up: t)$>i)$a op$)atului
Fn ca5 $e a"piaie $ige"ti)&
- "e info%ea5& pacient#( !i ant#a8#( "&# $e"pe nece"itatea $e a &%1ne ne%1ncatI oice
apot a(i%enta e"te inte5i"L
- "on$a e"te %enin#t& p1n& (a e(#aea tan5it#(#i inte"tina( ?apaiia ga5e(o "a# a %ateii(o
feca(e@ n#%ai c# aco$#( c*i#g#(#iL
- "e %o4i(i5ea5& !i "e fiBea5& "on$a (a ni)e(#( o4a5#(#i pent# a e)ita #(ceaia aipii na5a(eL
- "e )eific& pe%ea4i(itatea "on$ei !i "e conto(ea5& eficacitatea "i"te%#(#i $e a"piaieL "e
"c*i%4& 5i(nic 4ocan#(, p#nga !i aco$#(L
- "e notea5& 5i(nic >n foaia $e o4"e)a ie )o(#%#( a"piatL
- >n ti%p#( po4ei $e c(a%pae a "on$ei, >nainte $e >n$ep&tae, "e notea5& apaiia ge#i(o,
)&"&t#i(o, 4a(on&i(o.
Fn ca5 $e pef#5ie inta)enoa"&
- "e )eific& (oc#( p#ncionat, taiect#( )eno"L
- "e "i"tea5& pef#5ia $ac& apae o inf(a%aieL
- "e a$%ini"tea5& n#%ai %e$ica%ente(e pe"ci"e $e %e$icL
- "e face 4i(an#( int&i-ie!ii, coti$ianI
- int&iI toate int&i(e paentea(eL
- ie!iiI $i#e5&Va"piaie $ige"ti)&-$ena8e.
'e)eniea co%p(icaii(o $e $ec#4it
- "e %o4i(i5ea5& ga%4e(e !i "e "#pa)eg*ea5& %o(ete(eL
- "e a$%ini"tea5& anticoag#(ante "#4 c#tanat confo% pe"cipieiL
- "e i$ic&, $ac& e po"i4i(, pacient#( >n foto(i#, co%pi%1n$ p(aga opeatoie ?pan"a%ent#(,
4an$a8#(@L
- "e ap(ic& >ngi8ii N#"ing pent# pe)eniea e"cae(oI igien&, "c*i%4aea po5iiei, %a"aea
p#ncte(o $e "pi8inL
- "e a"pi& "eceii(e, "e fac aeo"o(i "a# Oine"iteapie e"piatoie $ac& e ne)oie.
Fngi8ii (oca(e, a"ep"ie
- "e eface pan"a%ent#( 5i(nic "a# (a 2 5i(e n#%ai (a in$icaia %e$ica(&L
- "e "cot fie(e, >ncep1n$ c# #n fi "a# $o#&L
- pan"a%ent#( t#4#i(o $e $ena8 "e )a eface 5i(nic !i )o fi >n$ep&tate at#nci c1n$ $ena8#(
)a fi %ini%, (a in$icaia %e$ic#(#i.
0#pa)eg*eea c(inic& !i paac(inic& 0e
"#pa)eg*ea5&I
- "taea $e c#no!tin&L
- ', T.6., TR !i fec)ena e"piatoieL
- "taea p(&giiI a"pect#( pie$ei(o eBteioi5ate pin $en#i "a# pin pan"a%entL
- e(#aea tan5it#(#iL
- con"tante(e 4io(ogice (a in$icaia %e$ic.
R$ali+$7ta)$a
- "e face $#p& e(#aea tan5it#(#i inte"tina( pent# %ateii feca(e, >n genea( $#p& ,-/ 5i(eL
"on$a ga"tic& "e c(a%pea5& $#p& o po4& $e c(a%pa8L
- e(#aea a(i%entaiei "e face >nt-o %anie& poge"i)& >n f#ncie $e inte)enia ea(i5at&, c#
a8#to#( $ietetician#(#i.
21., P)i+a +o(ili>a)$
'i%a %o4i(i5ae a #n#i pacient e"te $eci"& $e %e$ic#( c*i#g, $#p& o inte)enie c*i#gica(&
"a# $#p& o peioa$& (#ng& $e i%o4i(i5ae.
O4iecti)#( po"t opeato e"te, in genea(, ace(a $e a a"ig#a o %o4i(i5ae pecoce pent# a pe)eni
oice co%p(icaii (egate $e $ec#4it. 6%1naea e"te >n f#ncie $e tip#( $e inte)enie, $e "taea
genea(& a pacient#(#i !i n# poate fi $eci"& $ec1t $e ec*ipa %e$ica(&.
I7,i&a*ii
- $#p& oice inte)enie c*i#gica(&L
- $#p& o peioa$& (#ng& $e i%o4i(i5ae ?$e eB. co%a@.
- "e info%ea5& pacient#( $e"pe $ata !i oa pi%ei %o4i(i5&iL
- i "e eBp(ic& $e#(aea poce$#iiL
- i "e eBp(ic&, $e a"e%enea, eco%an$&i(e %e$ica(e cae >n"oe"c pi%a %o4i(i5aeL
- "e aco$& ti%p pent# a-( a"c#(taL
- "e in"ta(ea5& pacient#( >n po5iia "e%i!e51n$&L
- #n ten"io%et#L
- #n foto(i# >n apopieeL
- #n "pi8in pent# picioae.
R$ali>a)$a ?7;)iAi)ii
- pent# a"ig#aea "ec#it&ii pacient#(#i, pi%a %o4i(i5ae )a fi efect#at& $e $o#& pe"oaneL
- "e %&"oa& T.6. a pacient#(#i c#(catL
- "e in"#f(& pacient#(#i >nce$ee >n "ineL
- "e a8#t& pacient#( "a "e "pi8ine >n cot !i "& "e i$ice pe %aginea pat#(#i >n po5iia a!e5atL
- "e cee "& &%1n& >n acea"t& po5iie !i "& pi)ea"c& $ept >nainteL
- "e aco$& ti%p pent# a eBpi%a ceea ce "i%te >nainte $e a $epi"ta )e#n "e%n $e "tae $e
&#L
- "e a8#t& pacient#( "& %eag& p1n& (a foto(i# !i "& "e in"ta(e5e confota4i(L
- "e cee pacient#(#i "& )e4a(i5e5e "enti%ente(e (egate $e acea"t& pi%& %o4i(i5aeL
- "e notea5& poce$#a >n $o"a#( $e >ngi8ieL
- "e tan"%ite oa( %e$ic#(#i %o$#( $e $e#(ae, $ific#(t&i(e "a# co%p(icaii(e ap&#te.
21./ T$=7i&a ;$7$)al: a pa7'a+$7tului
'an"a%ent#( a"eptic "i%p(# con"t& >n pote8aea p(&gii >%poti)a oic&#i agent noci) eBten,
a4"o4ia eB#$at#(#i $in p(ag& !i fa)oi5aea cicati5&ii.
O(i$&ti<$
- "& e)ite !oc#(L
- "& pote8e5e p(aga $e %e$i#( eBtenL
- "& $i%in#e5e a%p(it#$inea %i!c&i(o.
E"te ne)oie $e #n c&#cio #(ant, c# $o#& eta8e $econta%inate.
'e eta8#( "#peio, "e )a peg&ti tot ce e"te "tei( !i c#at pent# pan"aea p(&gi(oI
- t#"& $e pan"a%ente $e #nic& fo(o"in& conin1n$I
- o ta)& %e$ica(&L
- 2 pen"e tip Noc*eL
- co%pe"e "tei(eL
- #n c1%p "tei(L
- #n f(acon c# "&p#n anti"epticL
- #n anti"eptic io$at ?4eta$in&@L
- "e fi5io(ogicL
- %&n#!i $e ca#ci#c ne"tei(eL
- %ateia( $e potecie a pat#(#iL
- o peec*e $e %&n#!i "tei(eL
- 4en5i a$e5i)e "a# fe!i o%p(a"tL
'e eta8#( infeio "e p#nI
- t&)ia ena(&L
- "aci pent# co(ectaea $e!e#i(o.
- "e pe)ine pacient#( !i "e peci5ea5& $#ata >ngi8iiiL
- "e in"ta(ea5& pacient#( confota4i(, e"pect1n$ p#$oaea, >n f#ncie $e (oca(i5aea p(&giiL
- "e in"ta(ea5& %&"#a pent# pan"a%ente >n "a(on e"pect1n$ eg#(i(e egono%iceL
- "e "pa(& %1ini(e ?"p&(ae "i%p(&@L
- "e $e"c*i$e "et#( G Oit-#( pent# pan"a%ente "tei(e !i "e peg&te"c toate %ateia(e(e
nece"ae >ngi8iiiL
- "e >n$ep&tea5& pan"a%ent#( %#$a fo(o"in$ %&n#!i(e $e ca#ci#cL
- "e o4"e)& "taea pan"a%ent#(#iI pe5int& "eceii(e, cantitatea, a"pect#(, c#(oaea, %io"#(L
- "e o4"e)& "taea pie(iiI pe5ena conge"tiei, "taea cicaticeiL
- "e a#nc& pan"a%ent#( !i %&n#!i(e >n p#nga co(ectoaeL
- "e "pa(& %1ini(e ?"p&(ae anti"eptic&@L
- "e >%4ac& %&n#!i(e $e ca#ci#c "tei(eL
- "e c#&& teg#%ente(e $in 8##( p(&gii c# "o(#ie anti"eptic& pent# pie(e, pin %i!c&i
cic#(ae "a# centipeteL
- "e 4a$i8onea5& p(aga c# "o(#ie anti"eptic& ?4eta$in& pent# p(ag&, a(coo( io$at@L
- "e acope& p(aga c# co%pe"e "tei(eL
- "e fiBea5& c# 4en5i(e a$e5i)e "a# pin 4an$a8ae fo(o"in$ #n poce$e# a$aptat egi#nii
?cic#(a, >n "pic&, >n "pia(&, etc.@L
- "e ein"ta(ea5& pacient#(L
- "e p#n, (a ne)oie, in"t#%ente(e fo(o"ite >nt-o "o(#ie pent# $econta%inae ti%p $e 12-2.
%in#teL
- "e c#&& %&"#a $e pan"a%enteL
- "e "pa(& %1ini(eL
- "e notea5& poce$#a >n $o"a#( pacient#(#i not1n$ "taea pan"a%ent#(#i !i a p(&gii.
21.2 A(la*ia %i)$lo) ,$ 'utu): 'au a;)a%$lo)
64(aia fie(o $e "#t#& c#tanat& e"te #n act %e$ica( pe"ci" $e %e$ic, ea(i5at (a ni)e(#(
#nei p(&gi cicati5ate.
Deci5ia $e >n$ep&tae a fie(o $e "#t#& o ia %e$ic#( $#p& ,-1. 5i(e $e (a opeaie, >n
f#ncie $e (oca(i5aea !i e)o(#ia p(&gii, pec#% !i $e te*nica $e "#t#& #ti(i5at& ?fie "a# agafe@
- "e info%ea5& pacient#( $e"pe poce$#& pent# a o4ine coopeaea ace"t#iaL
- "e in"ta(ea5& confota4i(L
- "e a"ig#& pacient#( c& poce$#a e"te in$o(o&, poate "& e"i%t& o foate #!oa& pi!c&t#&L
- "e "o(icit& pacient#(#i "& "e%na(e5e oice $#ee ap&#t& >n ti%p#( poce$#ii !i "& n# p#n&
%1ini(e pe p(aga "#t#at&.
0e peg&te"cI
- #n c1%p "tei(L
- o peec*e $e pen"e "tei(e tip Noc*eL
- #n "ca(pe( "a# o foafece %ic& "tei(&L
- o pen"& pent# "co" agafe, "tei(& >n ca5#( >n$ep&t&ii agafe(oL
- o peec*e $e %&n#!i "tei(eL
- #n f(acon c# "e fi5io(ogicL
- #n f(acon c# "o(#ie io$at& ?tip 4eta$in&@L
- 4an$e(ete a#toa$e5i)e "tei(eL
- o t&)i& ena(& pent# co(ectaea %ateia(e(o fo(o"ite.
- "e )eific& pe"cipia %e$ica(&, >nc& o $at& pent# a ne a"ig#a a"#pa $atei $e >n$ep&tae
a fie(o $e "#t#& "a# a agafe(o pec#% !i a %eto$ei $e ea(i5ae ?$e c&te a"i"tenta
%e$ica(& $e (a "a(a $e pan"a%ente@L
- "e "pa(& %1ini(eL
- "e >%4ac& %&n#!i "tei(e $e ca#ci#cL
- "e >n$ep&tea5& pan"a%ent#( !i %&n#!i(e #ti(i5ateL
- "e "pa(& $in no# %1ini(eL
- "e o4"e)& a"pect#( p(&gii pent# a $ece(a e)ent#a(e p#ncte $e infecie !iG"a# o cicati5ae
poa"t&L
- "e a)eti5ea5& %e$ic#( >n ca5 $e ce( %ai %ic $#4i#L
- "e $e"c*i$e t#"a c# %ateia(e "tei(e con"e)1n$#-"e "tei(itatea ace"toa
- "e >%4ac& %&n#!i "tei(e $e ca#ci#cL
- "e c#&& p(aga c# co%pe"e "tei(e >%4i4ate >nt-o "o(#ie anti"eptic& confo% pe"cipiei
%e$ic#(#i !i "e (a"& (i4e&.
Fn ca5 $e "#t#& >n p#ncte "epaate
- "e (oca(i5ea5& pi%#( fi, %enin1n$ no$#( c# o pen"& "tei(& !i $eco(1n$#-"e #!o $e pie(eL
- "e "ecionea5& cap&t#( fi#(#i p#in %ai "#" $e pie(eL
- "e tage #!o fi#( tot$ea#na "pe cent#( p(&giiL
- "e p#ne fi#( pe o co%pe"& #"cat& pent# a ne a"ig#a $e >n$ep&taea tota(& a fie(oL
- "e poce$ea5& >n aceea!i %anie& pent# fiecae fi p#"L
- (a "f1!it, "e poate ap(ica o 4an$e(et& a#toa$e5i)& pent# a con"o(i$a cicati5aea p(&gii $ac&
acea"ta pae fagi(& >n %o%ent#( >n$ep&t&ii fie(o.
Fn ca5 $e "#t#& c# agafe
- a4(aia "e ea(i5ea5& poge"i), ea nece"it1n$ >n pea(a4i( $e"faceea ace"toaL
- "e >n$ep&tea5& n#%ai o agaf& $in $o#&L
- pent# acea"ta, "e fiBea5& agafa c# o pen"& "tei(& in#t& >nt-o %1n&, ia c# cea(a(t& %1n&
?$e eg#(& %1na $o%inant&@ "e ine pen"a $e p#" agafe a"tfe( >nc1t "& poat& fi $e"c*i"&L
- "e fiBea5& #!o pen"a 9ic*e( pe %i8(oc#( agafei apoi "e >nc*i$eG"t1nge $e(icatL
- eBte%it&i(e agafei te4#ie apoi "& "e eBtag& $in pie(e f&& $#ee pent# pacientL
- "e p#ne agafa pe o co%pe"& #"cat& !i "e poce$ea5& >n aceea!i %anie& pent# fiecae $in
agafe(e e"tanteL
- "e )eific& apoi a4(aia >n tota(itate a agafe(o eco%an$ate $e %e$ic.
R$&o+a7,:)i
- "e "#pa)eg*ea5& p(aga >n c#"#( >n$ep&t&ii %ateia(#(#i $e "#t#& ?"e%ne $e infecie,
$e5#niea %agini(o "#t#ate, $#eea pacient#(#i@L
- "e in"t#ie!te pacient#( "& fac& $#! >n 5i(e(e #%&toae !i n# 4aie >n ca$&L
- "e e$#c& pacient#( "& "#pa)eg*e5e p(aga !i igiena $#p& >ntoaceea (a $o%ici(i#L
21.3 D)$7aAul
D)$7aAul con"t& >n "c#geea (ic*i$e(o conin#te >nt-o p(ag&, >nt-#n ogan "a# >nt-o ca)itate
pato(ogic& c# a8#to#( #n#i $en, #no %e!e cae "e (a"& pe (oc "a# a #no (aniee >n "cop#(
o4ineii #nei cicati5&i api$e
D)$7ul e"te #n t#4 "#p(# "a# igi$, $in ca#ci#c, %ateia( p(a"tic, cae "e)e!te (a e)ac#aea
(ic*i$e(o pato(ogice $int-o p(ag&.
La7i$)$l$ "#nt $in ca#ci#c, on$#(ate, "tei(e !i "#nt p(a"ate >nt-o egi#ne #n$e "e po$#ce o
co(ecie.
M$9a e"te o 4an$& fin& $in p1n5& $e 4#%4ac cae "e into$#ce >nt-o p(ag& "a# >nt-o fi"t#(&,
pent# a >%pie$ica >nc*i$eea pint-o cicati5ae pea api$& !i a faci(ita a"tfe( "c#geea
"eo5it&ii.
I7,i&a*ii
- $enaea p#oi#(#i, a #nei infecii, co(eciiL
- epan!a%ente p(e#a(eL
- e)ac#aea (ic*i$#(#i >n peioa$a po"t opeatoie.
Mat$)ial$
E"te ne)oie $e #n c&#cio "#paeta8at, c#at !i $econta%inat
'e eta8#( "#peio "e a!ea5& tot ce e"te "tei( !i c#at
- t#"& pent# pan"a%ente conin1n$I
- pen"e Noc*eL
- co%pe"e "tei(eL
- c1%p "tei(L
- "o(#ii anti"eptice io$ate tip :eta$in&L
- "e fi5io(ogicL
- %&n#!i ne"tei(eL
- %ateia( potecto pent# patL
- 4en5i a$e5i)eL
- #n 4i"t#i# "a# o foafece "tei(&L
- #n ac $e "ig#an& "tei( >n ca5 $e (anie&
- o peec*e $e %&n#!i "tei(e.
'e eta8#( infeio
- t&)ie ena(eL
- "aci pent# co(ectaea $e!e#i(oL
- #n containe pent# ace.
- "e >n$ep&tea5& pan"a%ent#( %#$a c# o pen"& "a# c# o %&n#!& $e #nic& fo(o"in&L
- c# o foafec& "tei(&, "e $e"pic& co%pe"e(e >n CYE, c# con$iia "& fie p#"e apoi >nt-o p#ng&
"tei(&L
- "e >n$ep&tea5& ac#( $e "ig#an& )ec*i a"tfe(I
- "e pin$e ac#( c# o pen"& anato%ic&L
- "e fiBea5& c# pen"a Ooc*e !i apoi "e $e"c*i$e c# pen"a anato%ic&L
- "e $ep#n pen"a Noc*e !i ac#( $e "ig#an& >n ecipient#( e5e)atL
- "e c#&& !i "e $e5infectea5& p(aga >ncep1n$ c# patea cea %ai c#at&L
- "e c#&& >n 8##( $en#(#i pin %i!c&i cic#(ae "a# centif#geL
- "e fiBea5& $en#(, "e tece ac#( $e "ig#an& pin $en "i "e >nc*i$e apoi c# o pen"&
anato%ic&L
- "e taie "eg%ent#( $e $en af(at $ea"#pa ac#(#i $e "ig#an&L
- $ac& te4#ie "& "e in8ecte5e #n anti4ioticI
- "e $e5infectea5& $en#(L
- "e c(a%pea5& apoi $en#( c# o pen"& Noc*eL
- "e >neap& $en#( pe patea (atea(&, "#4 pen"& !i "e in8ectea5& "o(#iaL
- "e >n$ep&tea5& "einga !i ac#(, "e $ec(a%pea5& t#4#( $e $enL
- "e >ncon8oa& $en#( c# co%pe"e "tei(e ce"tate pe %i8(ocL
- "e acope& apoi patea $e $ea"#pa $en#(#i c# a(te co%pe"e nece"tateL
- "e fiBea5& pin 4an$a8ae "a# c# 4en5i a$e5i)e *ipoa(egiceL
- "e o4"e)& 5i(nic a"pect#( (ic*i$#(#i, cantitatea, i "e notea5& >n foaia $e o4"e)a ieL
.ndeprtarea drenului se face la recomandarea medicului, atunci cnd nu se mai scurge lichid#
Capitolul E 5NGRI6IRI 5N AFECIUNI GINECOLOGICE
22.1 R$&olta)$a '$&)$*iilo) &$)<i&o<a;i7al$ p$7t)u $Ha+$7$ ,$
'oce$#a e"te $e"ci"& (a capito(#( 2 ?2.8 Reco(taea "eceii(o ce)ico)agina(e@
22.2 Pa)ti&ipa)$a a'i't$7tului +$,i&al la pu7&*ia %u7,ului ,$ 'a& Dou;la' #Pu7&*ia <a;i7al:
'au Cul,o&$7t$>a-
'&t#n$eea tan")agina(& c# a8#to#( #n#i ac >n f#n$#( $e "ac Do#g(a".
S&opDi7,i&a*iiB
- in)e"tigaea !i "ta4i(iea $iagno"tic#(#i $e "acin& ectopic&L
- "ta4i(iea $iagno"tic#(#i >n c*i"t#( $e o)a, >n pio"a(pinB.
Mat$)ial$ 7$&$'a)$B
- "pec#( "a# )a()e )agina(e "tei(eL
- ta%poane, co%pe"eL
- pen"e pent# co(L
- pen"e potta%ponL
- "eing& $e 1.%(L
- ace (#ngi $e 1.-12 c% !i goa"e $e ..8-1 %%L
- "e$ati)L
- %ateia( pent# ane"te5ie (oca(&L
- ep#4ete pent# eco(taea (ic*i$#(#i.
- "e an#n& !i "e eBp(ic& nece"itateaL
- "e e"pect& p#$oaea pacienteiL
- "e "o(icit& pacientei "&-!i go(ea"c& )e5icaL
- c# ,. %in#te >nainte "e a$%ini"tea5& o fio(& $e %ia(ginL
- "e a!ea5& >n po5iie gineco(ogic& pe %a"&L
- $ac& "e face ane"te5ie, e"te eco%an$at "& n# %&n1nceL
- "e ap(ic& "pec#(#( "a# )a()e(eL
- "e face $e5infecia )agina(&L
- "e fiBea5& co(#( #tein pent# a e)i$enia f#n$#( $e "acL
- "e face ane"te5ia (oca(& pin infi(taieL
- "e face p#ncia tec1n$ pin peete(e )agina( a( f#n$#(#i $e "ac )agina( po"teioL
- a"i"tena #%&e!te pe%anent "taea pacientei $eoaece "#nt i"c#i $e $ec(an!ae a(e #no
ef(eBe cae pot po$#ce (ipoti%ie, "incop& K 5ona fiin$ foate 4ogat ine)at&L
- a"piaia "e face (entL
- (ic*i$#( eBta" "e p#ne >n ep#4ete cae "e etic*etea5& pent# a fi ti%i" (a (a4oatoL
- "e o4"e)& a"pect#( (ic*i$#(#i cae poate fi "eo", p##(ent, "ang*ino(entL
- "e face $e5infecie, "e etage ac#(, "e >n$ep&tea5& pen"a !i )a()e(e ?"pec#(#(@L
- pacienta e"te a8#tat& "& co4oae $e pe %a"& !i con$#"& (a pat.
I7;)iAi)$a ,upa pu7&ti$
- pacienta a%ane in epa#" pana $i"pae efecte(e ane"te5ieiL
- "e "#pa)eg*ea5a ta%pon#( )#()a e po"i4i( ca (oc#( "a "angeeL
- "e #%ae"te te%peat#a.
I7&i,$7t$DA&&i,$7t$
- p#nc ia negati)&L
- "incopaL
- (e5aea an"e(o inte"tina(e a )e5icii #inae.
- (ic*i$#( "eo" poate fi $e oigine inf(a%atoie, neop(a5ic& "a# poate po)eni $int-#n c*i"t
$e o)aL
- (ic*i$#( p##(ent )a fi ana(i5at $in p#nct $e )e$ee cito(ogic i 4acteio(ogic K aat& o
infec ieL
- (ic*i$#( "eo"ang*ino(ent "#geea5& o en$o%etio5& pe()in&, #peea #n#i c*i"t $e o)a "a#
"acin& eBta#tein&L
- $ac& "1nge(e n# coag#(ea5& $e%on"tea5& eBi"ten a *e%opeitone#(#i ia $ac& ae
%icoc*eag#i $e "1nge "#geea5& "acin& ectopic&L
- p#nc ia a(4& n# eBc(#$e "acina ectopic&.
22., Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a =i't$)o'&opi$i i &olpo'&opi$i
a@ Fi't$)o'&opia
0e efe& (a eBa%inaea en$o"copica a ca)it& ii #te#(#i, apaat#( fiin$ into$#" pin co(#( #tein.
S&opDi7,i&a*iiB
- $igano"ticaea cance#(#i $e en$o%et#, po(ipi(o inta#teini, #te#(#i fi4o%ato",
%a(fo%aii(o #teineL
- i$entificaea ca#5e(o >nI "1nge&i ano%a(e intene, infeti(itate, a)ot#i "pontane
epetateL
- 4iop"ia $e en$o%et#L
- %ici inte)enii c*i#gica(e.
Mat$)ial$ 7$&$'a)$B
- "pec#( )agina( "a# )a()e )agina(e "tei(eL
- *i"teo%et#, *i"teo"cop, $i(atatoae pent# co(L
- pen"e pent# co(L
- %ateia( pent# ane"te5ie (oca(&, egiona(& "a# genea(& >n f#ncie $e "copL
- "o(#ie $e5infectant&, co%pe"e, pen"e potta%ponL
- f(acoane pent# fag%ente(e eco(tateL
P)a;:ti)$a pa&i$7t$i
- (a fe%ei(e %en"t#ate "e eco%an$& efect#aea eBa%en#(#i >n 5i(e 8-1/ a(e cic(#(#iL
- eco%an$aea n# e )a(a4i(& >n #gene !i (a fe%ei(e cae ia# contacepti)e oa(eL
- (a fe%ei(e >n %enopa#5& "e eco%an$& a$%ini"taea $e etini(e"ta$io( c# 8-1. 5i(e >naintea
eBa%en#(#i "a# "e p#ne #n o)#( $e po"tag(an$in& pent# a #!#a $i(ataea co(#(#i. N#
%&n1c& ce( p#in 8 oeL
- "e >n$ep&tea5& pi(o5itatea )#()a&, "e face toa(eta eBten& !i e)ent#a( )agina(L
- pacienta "e a!ea5& pe %a"& >n po5iie gineco(ogic&L
- "e an#n& c& poce$#a $#ea5a apoBi%ati) ,. %in#te.
Pa)ti&ipa)$a la p)o&$,u):
- %e$ic#( %ontea5a "pec#(#( !i face $e5infecia (oca(& ?eBten& !i )agina(&@I
- "e efect#ea5& ane"te5ia (oca(&. Daca e ne)oie $e ane"te5ie genea(& "e cee "pi8in#(
%e$ic#(#i ane"te5i"tI
- %&"oa& ca)itatea #tein& c# *i"teo%et#I
- ea(i5ea5& $i(ataea co(#(#i c# $i(atatoae $e $i%en"i#ni poge"i)eI
- into$#ce *i"teo"cop#( %ai >nt1i >n co( apoi >n ca)itate, %ane)a fiin$ #%&it& pe %onitoI
- pent# )i5#a(i5ae, ca)itatea #tein& te4#ie $e"tin"& pin into$#ceea #n#i (ic*i$
tan"paent "a# ga5I
- a"i"tena #%&e!te pe%anent pacientaL
- "#4 "#pa)eg*ee, a$%ini"tea5& ane"te5ic#( inte)eno"L
- "e)e!te !i pi%e!te %ateia(e(e nece"ae efect#&ii eBa%en#(#i. Ti%ite %ateia(e(e (a
(a4oato.
57;)iAi)$a pa&i$7t$i ,up: =i't$)o'&opi$
- eBa%en#( "e poate efect#a !i a%4#(ato, eBcepie f&c1n$ ca5#i(e >n cae "e pactic&
inte)eniiL
- pacienta e"te in#t& "#4 "#pa)eg*eeL
- e"te a)eti5at& c& poate pe5enta $#ei "#4 fo%& $e ca%pe !i #!oa& "1ngeae 1-2 5i(eL
- $ac& "1ngeaea e"te i%potant&, "e a"ocia5& fe4& !i $#ei(e a4$o%ina(e, "e an#n&
%e$ic#(.
4@ Colpo'&opia
E"te )i5#a(i5aea )agin#(#i, ce)iB#(#i ?co(#(#i@ !i )#()ei c# a8#to#( #n#i %ico"cop 4inoc#(a
"pecia(.
S&opDi7,i&a*iiB
- e)a(#aea (e5i#ni(o ce)ica(e )agina(e "a# )#()aeL
- te"t#( 'apa Nico(a# ano%a(L
- %onitoi5aea cance#(#i intaepite(ia(.
Mat$)ial$ 7$&$'a)$B
- "pec#( )agina(L
- pen"e po"tta%pon (#ngiL
- pen"e pent# co(L
- pen"e pent# 4iop"ieL
- c*i#ete pent# co(L
- ta%poane $e )at&, co%pe"e, %e"eL
- %ateia(e $e $e5infectaie "o(#ii nece"ae eBp(o&ii "#p(i%entae ?co(po"copie (&git&@
aci$ acetic ,M, "o(#ie $e (#go(L
- (a%&, "pat#(e pent# eco(taea "eceii(oL
- f(acon c# fiBato pent# 4iop"ieL
- apaat $e e(ectocoag#(ae.
P)$;:ti)$a pa&i$7t$iB
- eBa%en#( "e eBec#t& pe #n co( neta#%ati5at %oti) pent# cae "e e)it&I
- toa(eta )agina(&, apot#( "eB#a( c# 2 5i(e >nainte eBa%in&iiL
- eBp(o&i en$o#teine ?c*i#eta8e, *i"to"copie, *i"teo"a(pingogafie@
- 4iop"ia ce)ica(&L
- eBa%inaea "e face (a fe%ei(e %en"t#ate >n 5i(e 8-1, a(e cic(#(#iL (a fe%ei(e >n %enopa#5&
%e$ic#( eco%an$& 7 5i(e a$%ini"taea a 22 gG5i et*inU( e"ta$io( pent# a a"ig#a
toficitatea %#coa"eiL
- eBa%en#( n# e ta#%ati5antL
- "e info%ea5& pacienta c# pi)ie (a $e#(aea poce$#ii.
Pa)ti&ipa)$a a'i't$7tului +$,i&al la $%$&tua)$a $Ha+$7ului
- pacienta e"te a!e5at& pe %a"a gineco(ogic&L
- "e %ontea5& "pec#(#( ?n# "e fo(o"e!te (#4ifiant@L
- "e o4"e)& !i "e eco(tea5& "eceie )agina(&L
- "e o4"e)& co(#(L
- "e !teg "eceii(e c# #n ta%pon $e )at&, e)ent#a( c# "e fi5io(ogic, "e eBa%inea5& co(#(L
- "e 4a$ionea5& co(#( c# aci$ acetic ,M, ?te"t#( =in"e(%ann@ pe%ite e)i$enieea >n 12-,.
"ec#n$e a i%agini(o %o$ificateL
- >n contin#ae "e face te"t#( La*% K 0c*i((e cae con"t& >n ap(icaea "o(#iei L#go(.
E)i$enia5& 5one cae n# fiBea5& io$#( !i n#%e"c 5one io$ negati)e !i cae ate"t& o (e5i#neL
- %#coa"& no%a(& "e co(oea5& >n ca"tani# intepetaea i%agini(o co(po"copice "e face $e
cate %e$icL
6"i"tent#( %e$ica(
- #%&e!te pacienta >n ti%p#( eBa%en#(#iL
- "e)e!te %e$ic#(#i %ateia(e(e $e cae ae ne)oieL
- peia po$#"e(e eco(tate ?"eceii, fag%ente $e e"#t@L
- peg&te!te po4e(e pent# eBpe$ieea (a (a4oato.
57;)iAi)$a pa&i$7t$i ,upa p)o&$,u):
N# nece"it& ingi8ie "pecia(&, poce$#a $#ea5& 12 %in#te.
Dac& "-a fac#t 4iop"ie pot ap&ea "1nge&i )agina(e. 0e
eco%an$&I
- fo(o"iea a4"o4ante(o igienice !i %onitoi5aea pie$ei(oL
- inte5iceea contact#(#i "eB#a( p1n& (a )in$ecaea (oc#(#i $e 4iop"ieL
- inte5iceea fo(o"iii ta%poane(o inta)agina(e.
22./ EHa+i7a)$a )a,i&olo;i&:4 =i't$)o'alpi7;o;)a%ia #FSG-
EBa%inaea a$io"copic& a cana(#(#i en$oce)ica(, ca)it&ii #teine !i to%pe(o pin in8ectaea
pe ca(e intace)ica(& a #nei "#4"tane a$iopace ?o%nipaZ#eG*i"teopaZ#e@.
S&opDi7,i&a*ii
- "t#$ieea pe%ea4i(it& ii to%pe(oL
- )eificaea e#!itei inte)eniei c*i#gica(e $#p& inte)enii p(a"tice pent# e"ta4i(iea
pe%ea4i(it&iiL
- $ece(aea #no ano%a(ii #teine "a# t#4ae, peci5aea "e$i#(#i !i ga$#(#i o4"t#cieiL
- >n "1ngeaea inten&, c1n$ a(te eBa%ene n# "#nt e$ificatoae "a# po"i4i(eI "e pot $igno"tica
po(ipi en$o%etia(i, fi4oa%e "#4%#coa"a pe$ic#(ae "a# "e"i(e, a$eno%io5a #tein&,
cance#( $e en$o%et#.
Mat$)ial$ 7$&$'a)$
- apaat 0c*#(t5e ?fo%at $int-o "eing& etan!& $e 2. c%
,
(a cae "e ata!ea5& o can#(& pent#
into$#ceea "#4"tanei !i #n %ano%et# pent# )eificaea pe"i#nii@L
- %an#!i $e #nic& fo(o"in&L
- "#4"tan& $e conta"t a$iopac& ?o%nipaZ#e, *i"teopaZ#e "a# a(t po$#" eco%an$at $e
%e$ic@L
- %ateia(e $e $e5infecieI "o(#ie $e 4eta$in&, ta%poane, pen"a po"tta%ponL
- pen"a pent# co( 'o55iL
- "pec#( )agina( "a# )a()e )agina(eL
- ta)aGca#cio pent# %ateia(eL
- t&)i& ena(&L
- %e$ica%ente "e$ati)e, "eingi pent# a$%ini"tae ?$ac& e"te ca5#(@.
- "e eBp(ic& nece"itatea !i %o$#( $e $e"f&!#ae a eBa%en#(#iL
- (a fe%eia "eB#a( acti)& eBa%en#( "e face $#p& %en"t#aie >naintea o)#(aiei ?>nte 5i(e(e 3-
12 a(e cic(#(#i@ pent# a e)ita oice i"c $e (e5ae a #nei "aciniL
- (a fe%ei(e >n %enopa#5& "e a$%ini"tea5& c# 3-8 5i(e >naintea eBa%en#(#i 22 %icoga%e
et*inU(-e"ta$io( pent# a ce!te pe%ea4i(itatea co(#(#iL
- (a paciente(e %ai anBioa"e, c# ,. $e %in#te >nainte "e poate a$%ini"ta #n anti"pa"tic !i #n
"e$ati)L
- pacienta e"te a)eti5at& c& >n %o%ent#( in8ect&ii )a "i%i o oaecae pe"i#neG8en&L
- >nainte $e a %ege (a a$io(ogie e"te #gat& "&-!i go(ea"c& )e5ica.
- "e i$entific& pacientaL
- e"te con$#"& (a "e)ici#( $e a$io(ogie #n$e #%ea5& "& "e efect#e5e eBa%en#(L
- a"i"tenta efect#ea5& toa(eta )#()a& eBten&L
- "e %ontea5& "pec#(#( "a# )a()#(eL
- "e "e)e!te %e$ic#(#i pen"a pent# co( 'o55i c# cae pin$e 4#5a anteioaa (&"1n$ )i5i4i(
oifici#( #te#(#iL
- "e "e)e!te apoi pen"a po"tta%pon pent# $e5infecia ca)it&ii )agina(eL
- "e "coate ae#( $in apaat !i "e >n%1nea5& %e$ic#(#i pent# a into$#ce "#4"tana $e
conta"tL
- %e$ic#( into$#ce can#(a apaat#(#i pin oifici#( eBten, apoBi%ati) 2 c%L
- "e face pi%#( fi(% >nainte $e in8ectaea "#4"tanei $e conta"t ?"e pot e)i$enia gang(ionii
ca(cific& i $e ce(e %ai %#(te oi $e oigine t#4ec#(oa"&, ca(cific&i intape()ine in$ic1n$
pe5en a #n#i fi4o% ca(cificat, "tei(et, %o$ific&i o"oa"e@L
- "e in8ectea5& "#4"tana $e conta"t !i "e o4"e)& pe 1n$ ca)itatea #tein&, i"t%#( apoi
to%pe(e #teine $#pa 12-2. %in#te $e (a in8ectae ?pacienta "e poate $ep(a"a >n ace"t ti%p,
fiin$ c*ia in$icat@ "e face po4a Cotte cae aat& pe%ea4i(itatea t#4a& $eoaece "#4"tana
io$at& a8#nge >n %o$ no%a( >n ca)itatea peitonea(&, $if#5aea fiin$ "i%etic& ?Cotte
po5iti)@.
Uneoi pacienta e"te c*e%at& (a "e)ici#( $e a$io(ogi# $#pa 2/ oe, c1n$ po4a Cotte e"te
negati)&, eBi"t1n$ po"i4i(itatea ca "#4"tana $e conta"t "& pat#n$& %ai ge# >n to%pe pana >n
ca)itatea peitonea(&.
57;)iAi)$a pa&i$7t$i ,upa $Ha+$7
- "e "#pa)eg*ea5& pacienta $e!i inci$ente(e "#nt ae !i f&& %ai con"ecineI
- *e%oagii(e p#in a4#n$ente $e "c#t& $#at& ce$ea5& (a epa#"L
- (ipoti%ia poate ap&ea (a paciente(e anBioa"e, ege"ea5& (a %&"#i(e o4i!n#iteL
- a(egia (a io$ "e co%4ate c# anti*i"ta%inice !i coti5oniceL
- pot ap&ea contacii #teine $#eoa"e a"ociate c# 4a(onaea cae pot e)oca o inf(a%aie
pe()ian&. 0e an#n& %e$ic#(, "e a$%ini"tea5& anti4iotice confo% pe"cipiei.
I+a;i7i 7o)+al$
- ca)itate #tein& ti#ng*i#(a& c# o 4a5& $e ,.-,2c%, )1f#( "it#at (a ni)e(#( oifici#(#i
inten, %agini (atea(e conca)e "pe eBteioL
- coane(e #teine fac #ng*i#i opt#5e c# #ng*i#( #teinL
- i"t%#( ae a"pect#( #n#i $efi(e# (#ng $e 1. %% i (ag $e ,-/%%L
- to%pe(e pe5int& poi#nea inte"ti ia(& ?"it#at& >n %io%et#@ (#ng& $e 1 c% !i (ag& $e ..,
%%L
- poi#nea i"t%ic& %&"oa& 2-/c%L poi#nea a%p#(ae e"te %ai (ag& 2-8%%L
- (#%en#( to%pe(o >n tota(itate e"te pe%ea4i(.
I+a;i7i a7o)+al$
- $efo%aea %agini(o ca)it&ii #teine. Le5i#ni(e #teine a(#nge"c, tactionea5& !i c#4ea5&
cont##i(e ca)it&iiL
- (a ni)e(#( en$o%et#(#i "e pot o4"e)a i%agini (ac#nae eg#(ate ?po(ipi, fi4oa%e,
"#4%#coa"e@ "a# neeg#(ate ?cancee, "inec*ii, *ipep(a5ie en$o%etia(&@L
- ca(ific&i(e pot fi $ete%inate $e fi4oa%e #teine c*i"te $e%oi$e, t#4ec#(o5& genita(a,
gang(ioniL
- %o$ific&i(e ca)it&ii #teine ?cont#, $i%en"i#ni, fo%&@ pot a&ta o %a(fo%aie.
- i%agini(e ano%a(e a(e to%pe(o pot eBpi%a o4"t#cii, en$o%etio5&, t#4ec#(o5&, po(ipi,
"acina eBta#tein& !i t#%oi.
22.2 Sp:l:tu)a Va;i7al:
S&op
- c#& iea egi#nii )agina(e $e "ece iiL
- >n$ep&taea %io"#(#iL
- pe)eniea iita ii(o i e"coia i(oL
- pe)eniea infec ii(oL
- a"ig#aea igienei i a confot#(#i.
Mat$)ial$ 7$&$'a)$
- can#(& )agina(& c# $#5a pefoat&?pent# e$#ceea pe"i#nii (ic*i$#(#i@L
- "o(# ie ?cantitatea i tip#( "o(# iei "#nt eco%an$ate $e %e$ic@L
- iigato ?4a5in@ c#atL
- a(e5&, %# a%aL
- p(e$L
- %&n# i "tei(eL
- ge( pent# (#4efieeL
- t#4 $e ca#ci#c "a# t#4 $in %ateia( p(a"tic c# c(e%&L
- ta%poane $e )at&L
- "tati) pent# "#"pen$aea iigato#(#i.
- "e info%ea5& pacienta $e"pe nece"itatea poce$#iiL
- "e cee pacientei ca pe $#ata poce$#ii "& fie (ini tit&, e(aBat&, i "& co%#nice e)ent#a(e
"en5a ii nep(&c#teL
- "e a"ig#& inti%itateaL
- "e in"t#ie te pacienta "& > i go(ea"c& )e5ica >nainte $e poce$#&.
- "e a"a%4(ea5& ec*ipa%ent#(L
- "e )eific& te%peat#a (ic*i$#(#iL
- "e eBp(ic& pacientei %o$#( $e $e#(ae a poc$#iiL
- "e a ea5& pacienta pe %a"a gineco(ogic&L
- "e fiBea5& %# a%a#a i "e >n)e(e te pacienta c# #n p(e$L
- "e "pa(& %1ini(eL
- "e #%p(e t#4#( i "e a8#"tea5& te%peat#a "o(# iei ?(a te%peat#a cop#(#i@L
- "e $ec(a%pea5& t#4#(, "e e)ec#ea5& ae#(, i "e ec(a%pea5&L
- "e >%4ac& %&n# i "tei(eL
- "e "pa(& peine#( c# ta%poane $e )at& #%e5ite c# ap& ca($&I "en"#( $e c#& ie e"te $in"pe
patea anteioa& "pe cea po"teioa&, fo(o"in$ ta%pon#( o "ing#& $at&L
- can#(a "e (#4ific& c# ge( "a# )a"e(in&L
- "e aga & iigato#( pe "tati) (a o >n&( i%e $e 2.-7. c% $e (a "i%fi5a p#4ian&L
- c# o %1n& "e >n$ep&tea5& (a4ii(e, ia c# cea(a(t& %1n& "e into$#ce can#(a >n )agin,
>nc(in1n$-o "pe fa &, apoi "pe "pate(e pacientei. 0e into$#ce apoBi%ati) 8-1. c%L
- "e >n$ep&tea5& pen"a pent# a pe%ite "o(# iei "& c#g& ?pin fo a ga)ita iei@L
- "e ote te >ncet can#(a >n ti%p#( iiga ieiL
- "e c(a%pea5& t#4#( >nainte $e te%inaea (ic*i$#(#i i "e >n$ep&tea5& >ncet can#(aL
- pacienta &%1ne pe %a"a c1te)a %in#te pent# a "e e(i%ina (ic*i$#( >n tota(itateL
- "e "pa(& egi#nea )#()a& c# ap& i "&p#nL
- "e #"#c& egi#nea )#()a& c# #n po"op.
22.3 A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ <a;i7al:
'oce$#a e"te $e"ci"& (a capito(#( 3 ?3.12 6$%ini"taea %e$ica%ente(o pe ca(e )agina(&@
Capitolul !E 5NGRI6IRI 5N PEDIATRIE
!E1 Sup)a<$;=$)$a %u7&*iilo) <ital$ la &opil8 i a alto) pa)a+$t)i
a@ M:'u)a)$a t$+p$)atu)ii &o)po)al$
S&op
- "#pa)eg*eea "i"te%atic& >n ca$#( #nei "pita(i5&iL
- "#pa)eg*eea #n#i "in$o% infectio".
Mat$)ial$ 7$&$'a)$
- te%o%et#( e(ectonicL
- co%pe"e, "o(#ie $e5infectant&L
- capi"oane pent# potecia te%o%et#(#iL
- canet pent# notaea )a(oi(o.
P)$;:ti)$a &opilului
- %&"#aea "e face $i%ineaa !i "eaa "a# cofo% eco%an$&ii %e$ica(eL
- pent# "#pa)eg*eea >n ti%p#( "pita(i5&ii %&"#aea "e face >nainte ca pacient#( "& "e i$ice
$in pat.
T$=7i&a +:'u):)ii
9&"#aea >n p(ici ?aBi(a "a# ing*ina(&@
- "e ap(ic& captato#( te%o%et#(#i i%p(icat >n p(ica aBi(a& a)1n$ gi8& "& "e a"ig#e #n
contact 4#n c# pie(eaL
- te%o%et#( te4#ie "& fie 4ine po5iionatL
- "e a"teapt& ,. "ec#n$e c1n$ "e a#$e "e%na(#( "ono "e cite!te te%peat#a afi!at&L
- "e a$a#g& .-2 ga$e pent# a o4ine te%peat#a ea(&.
9&"#aea ecta(&
- te%o%et#( "e into$#ce >n ect $ep&t1n$ fe"e(e copi(#(#iL
- into$#ceea "e face pin %i!c&i $e otaie $#p& ce te%o%et#( a fo"t capi onatL
- >n ti%p#( %&"#&ii te%o%et#( "e "#"ine (a copi(#( "#gaL
- epetaea %&"#&ii poate fa)oi5a apaiia #(ceaii(o (a ni)e(#( peete(#i ecta(L
- %&"#aea "e face >n epa#", (a aceea!i o& $in 5iL
- >n ca5#( infecii(o %&"#aea "e face >n fi"on >n ti%p#( con)#("ii(o >n tan"piaieL
- "e "coate te%o%et# "e cite!teL
- "e >n$ep&tea5& capi on#(.
9&"#aea >n ca)itatea 4#ca(&
- "on$a te%o%et#(#i "e into$#ce >nt-#n capi"on $in %ateia( p(a"ticL
- "e p(a"ea5& "#4(ing#a(L
- "e %enine te%o%et#( p1n& "#n&L
- "e "coate, "e cite!te te%peat#a "e >n$ep&tea5& capi"on#(.
9&"#aea >n con$#ct#( a#$iti)
- captato#( e"te pote8at $e #n capi"on $e #nic& fo(o"in&, "e into$#ce >n #ec*ea
pacient#(#iL
- "e ote!te #"o fiin$ a$#" c1t %ai apoape $e ti%panL
- %&"#aea "e face >nainte $e "c#(ae, copi(#( fiin$ >n po5iie $e $ec#4it.
4@ M:'u)a)$a pul'ului
S&opB
- "ta4i(iea atei p#("#(#iL
- $epi"taea #no %o$ific&i pato(ogice.
T$=7i&a +:'u):)ii
- (a no# n&"c#t !i (a "#ga >n pi%e(e (#ni $e )ia& p#("#( "e poate %&"#a >n ti%p#( "o%n#(#i
(a ni)e(#( fontane(eiL
- p#("aii(e "e pot pecepe !i n#%&a ap(ic1n$ %1na pe egi#nea peco$ia(&L
- (a copii %ai %ai %&"#aea "e poate face pin co%pi%aea #nei atee pe #n p(an $#I
a$ia(&, c#4ita(&, te%poa(&, pe$ioa"&, *#%ea(&, fe%#a(&, caoti$&L
- (a copi(#( "#pa)eg*eat "i"te%atic >n ti%p#( #nei "pita(i5&i %&"#aea "e face $e 2 oi pe 5i
$i%ineaa !i "eaa o$at& c# te%peat#aL
- >n ti%p#( %&"#&ii copi(#( te4#ie "& fie (ini!tit $eoaece agitaia !i p(1n"#( accent#ea5&
4&t&i(e ini%iiL
- )a(oi no%a(eI
- no#-n&"c#t T 1,.G1/. pe %in#tL
- #n an T 1..G12. pe %in#tL
- 2 ani T 1..G11. pe %in#tL
- ,-/ ani T +.G11. pe %in#tL
- 2-7 ani T 8.G1..L
- 8-1. ani T 8.G+. pe %in#tL
- 11-13 T 8. pe %in#t.
c@ M:'u)a)$a 9i 'up)a<$;=$)$a )$'pi)a*i$i
S&opulB $epi"taea %o$ific&i(o ap&#te >n afeci#ni e"piatoii.
T$=7i&a +:'u):)ii
- "e face pin in"pectieGo4"e)aie >n ti%p#( "o%n#(#iL
- "e $e54ac& faa anteioaa& toace(#i !i a a4$o%en#(#iL
- "e ap(ic& %1na pe toace(e copi(#(#iL
- "e a"teapt& 1-2 %in#te $#p& atingeea copi(#(#iL
- "e cono%etea5&, "e n#%&& %i!c&i(e $e i$icae a toace(#iL
- >n afa& $e fec)en& "e %ai #%ae!teI
- "i%etia %i!c&i(o toaciceL
- it%#( !i ap(it#$inea e"piaieiL
- pe5ena #no 5go%oteL
- "e o4"e)& (i4etatea c&i(o e"piatoiiL
- %&"#aea "e face $i%ineaa !i "eaa "a# $#p& #n oa "ta4i(it $e %e$ic >n f#ncie $e "taea
copi(#(#i.
;a(oi no%a(eI
- no#-n&"c#t T /2-22G%in#tL
- 1 anT,.-/.G%in#tL
- , aniT,.G%in#t.
Re"piaia te4#ie "& fie "#p(& f&& gea%&t "a# >n"oit& $e 5go%ot.
Faa copi(#(#i te4#ie "& fie no%a( co(oat&.
$@ M:'u)a)$a t$7'iu7ii a)t$)ial$
N# face pate $inte %&"#ai(e $e #tin&.
6t#nci c1n$ e"te ca5#( %&"#aea "e face c# apaate pent# copii cae a# %an!eta >ng#"t&
a$aptat& %&i%ii 4a#(#i.
Te*nica %&"#&ii e"te a"e%&n&toae c# cea $e (a a$#(t. ?poce$#a e"te $e"ci"& (a capito(#( /,
/., 9&"#aea i notaea pe"in#ii "1nge(#i@.
e@ O('$)<a)$a 9i 'up)a<$;=$)$a '&au7ului la 'u;a) 9i &opilul +i&
6"pect#( !i c#(oaea "ca#n#(#i $ife& >n f#ncie $e )1"ta copi(#(#i, a(i%entaie !i "tae $e
"&n&tate.
S&opB
- apecieea %o$#(#i $e f#ncionae a apaat#(#i $ige"ti)L
- $epi"taea #no 4o(i >n"oite $e $iaee "a# $e con"tipaii.
Fn "it#a ii fi5io(ogiceI
- >n pi%e(e 2-, 5i(e $e (a na!tee, "ca#n#( e"te )e$e-4#n >nc*i" ?%econi#@L
- "#ga#( a(i%entat (a "an e(i%in& "ca#ne $e c#(oae ga(4en a#ie cae >n contact c#
ae#( cap&t& o tent& )e5#ie $in ca#5a oBi$&ii 4i(i#4ineiL
- n#%&#( "ca#ne(o (a >ncep#t e"te fec)ent apoi "ca$e fiin$ $e ,-/ >n 8##( )1"tei $e 3
(#niL
- ae %io" ac#L
- a$e& (a "c#teceL
- n#%a#( "ca#ne(o e"te $ee 1-2 >n 2/ oeL
- c1n$ a(i%entaia "e $i)e"ific& "ca#n#( >!i "c*i%4& c#(oaea.
Copi(#( a(i%entat atificia( e(i%in& #n "ca#n con"i"tent, ga(4en $e"c*i", cae n# a$e& (a
"c#tece.
Fn "it#a ii pato(ogice
0ca#n#( pe5int& %o$ific&i pi)in$ con"i"tena, cantitatea, co%po5iia, c#(oaeaI
- poate conine e(e%ente pato(ogiceL
- "e >n"oe!te $e $#ei, 4o4oi"%e, tene"%eL
- "ca#ne(e %#cog#n8oa"e a# con"i"ten& neo%ogena, "e%i(ic*i$a, c# patic#(e "o(i$e !i %#(t
%#c#" >n fo%a $e fi(a%ente !i f(ocoane, c#(oae ga(4en-)e5#ie. n#%a#( poate a8#nge (a
2-1. >n 2/ oeL
0ca#ne(e (ic*i$e !i "e%i-(ic*i$e
- a# a"pect "p#%o"L
- "#nt e(i%inate >n 8etL
- pot conine g#n8i !i %#c#"L
- n#%&#( (o a8#nge (a ,. >n 2/ oe.
0ca#ne(e %#coa"eI
- "#nt (ic*i$e c# %#c#" "#4 fo%& $e g&%e5i )1"coa"e, g&(4#i cen#!i, a"e%&n&toae #no
p(&giL
0ca#ne(e %#cop##(ente
- conin %#c#" !i p#oiL
- a# c#(oae ga(4en )e(5#iL
0ca#ne %#co"ang*ino(ente
- coninI %#c#" g#n8#( $e %ateii feca(e, "ange >n cantit&i )aia4i(e "a# n#%ai %#c#" !i
"ange
Nota)$a '&au7ului
N#%&#( !i a"pect#( "ca#n#(#i e(i%inat "e notea5& fo(o"in$ "e%ne con)eniona(eI
- 0ca#n no%a( ?i@
- 0ca#n "e%icon"i"tentG"e%i(ic*i$ ?G@
- 0ca#n apo" ?-@ , g#n8o" ?5@L %#c#" ?B@
- 0ca#n c# "1nge ?"@ !i "e notea5& c# o!#
C1n$ "ca#n#( conine %ai %#(te e(e%ente "e fo(o"e"c toate "i%4o(#i(e $e eBe%p(# ?B5@
%#cog#n8o"L ?B"@ %#co"ang*i(onet etc.
2,.2 P)$l$<a)$a p)o($lo) p$7t)u la(o)ato) la 'u;a) 9i &opilul +i&
a@ P)$l$<a)$a '@7;$lui p$7t)u $Ha+$7ul ,$ la(o)ato) la 'u;a)
R$&olta)$a '@7;$lui p)i7 ?7*$pa)$a &:l&@iului
S&opB
- o4ineea #nei %o"te $e "ange pent# $ete%inaea g(#co5ei !i *e%atocit#(#iL
- efect#aea te"te(o $e (a4oato pent# feni(ceton#ie, ga(acto5e%ie, *ipotioi$i"%.
Mat$)ial 7$&$'a)B
- (a%e !i (a%e(e $e (a4oatoL
- a(coo( $e 7. ga$eL
- pipeta ?)a" capi(a@L
- co%pe"e "tei(eL
- ac pent# >nep&t#a "a# (a%a pent# "caificaeL
- %an#!i $e #nic& fo(o"in&.
P)$;ati)$a &opilului
- "e )eific& i$entitatea copi(#(#iL
- "e a!ea5& copi(#( >nt-o po5iie co%o$&L
- "e $e5)e(e!te picio#( a(e" pent# eco(tae.
- "e eBa%inea5& (oc#( ?%aginea (ateoeBten& a c&(c1i#(#i@L
- "e "pa(& %1ini(e !i "e p#n %&n#!iL
- "e $e5infectea5& (oc#( c# #n ta%pon c# a(coo(L
- "e !tege "#p(#"#( $e "pit c# o co%pe"& #"cat&L
- "e "caific& 5ona c# (a%a "a# "e >neap& c# #n ac "tei(L
- pi%a pic&t#& $e "1nge "e !tege c# #n ta%pon #"catL
- "e co(ectea5& "1nge(e c# a8#to#( pipete(o capi(aeL
- (a "f1!it "e ap(ic& #n ta%pon apoi #n pan"a%ent "tei(L
- "e etic*etea5& !i "e ti%ite po4a (a (a4oatoL
- "e (ini!te!te copi(#( $#p& eco(tae.
R$&olta)$a '@7;$lui p)i7 pu7&*i$ <$7oa': S&opB
O4ineea #nei cantit&i %ai %ai $e "1nge pent# eBa%ene $e (a4oato.
Mat$)ial 7$&$'a)B
- p&t#a pent# >nf&!aea ?i%o4i(i5aea@ copi(#(#iL
- "eingiGace $e #nic& fo(o"in&L
- )ac#taineeL
- %ateia( $e $e5infecieI a(coo( 7. ga$eL
- ta%poane "tei(eL
- "e >nfa!& copi(#( $#p& te*nica %#%iei cae pe%ite i%o4i(i5ae f&& "& 8ene5e !i "e (a"&
acce" (a 5ona 8#g#(a&.
- "e "ta4i(e!te (oc#(
- )ena 8#g#(aa eBten&, copi(#( fiin$ a!e5at c# cap#( %ai 8o" $ec1t cop#( fo(o"in$ #n
po"op #(at "a# %aginea %e"eiL
- )ena fe%#(a& Cpo5iia 4oa!teiE copi(#( fiin$ fiBat (a ni)e(#( gen#nc*i(o c# %1na
e)it1n$ pe"i#nea pe coap"eL
- "e $e5infectea5& (oc#( !i "e face p#ncia )enoa"&L
- $#p& eco(tae pe (oc#( >nep&t#ii "e ap(ic& #n ta%pon c# cae "e face co%pe"ieL
- "peci%ene(e eco(tate "e ti%it (a (a4oato.
O('$)<a ii
- p#ncia poate fi efect#at& $e c&te %e$ic "a# $e #n a"i"tent %e$ica( "pecia( in"t#it pe 4a5a
#n#i potoco( e(a4oat !i "e%nat $e c&te %e$ic.
4@ P)$l$<a)$a p)o($lo) ,$ u)i7: la &opil
- "e face toa(eta ogane(o genita(eL
- "e fiBea5& >n 8##( peine#(#i "a# )#()ei o p#ng& "tei(& $in %ateia( p(a"ticL
- >n (ip"a p#ngii "e #%ae!te atent copi(#( pent# a "#pin$e %o%ent#( %ici#nii.
9ateia(e(e pent# eco(tae, ecipiente "tei(e, te4#ie "a fie pe%anent peg&tite.
c@ P)$l$<a)$a p)o($lo) ,i7 '&au7 la &opil
- pent# eBa%en#( copopaa5ito(ogic "e eco(tea5& $in "ca#n#( e%i" "pontan f&& "#po5itoL
- pe(e)aea "e face $in 5one cae pe5int& %#c#", fag%ente ne$igeate cantitatea fiin$
apoBi%ati) 2 gL
- $ac& "ca#n#( n# pe5int& %o$ific&i, eco(taea "e face $in %ai %#(te 5oneL
- pent# copoc#(t#& eco(taea "e face $iect $in ect c# "on$a %e(aton "tei(a.
9ateia(e(e pent# eco(tae, ecipiente "tei(e, te4#ie "a fie pe%anent peg&tite.
'oce$#a $e eo(tae e"te $e"ci"& (a capito(#( 2 ?2., Reco(taea %ateii(o feca(e pent#
eBa%ene(e $e (a4oato, a@ Reco(taea %ateii(o feca(e pent# eBa%en copopaa5ito(ogic@.
2,., 57;)iAi)$a pl:;ii o+(ili&al$
S&opB %#%ificaea co$on#(#i !i pe)eniea infeciei.
Fngi8ii(e >ncep (a %atenitate !i "e contin#& (a $o%ici(i#. 0e eBec#t& $e pe"ona( $e "pecia(itate
"a# $e c&te %a%&G"#4"tit#t %aten (a $o%ici(i# $#p& o pea(a4i(& info%aeGin"t#ie.
57;)iAi)i ?7ai7t$a &:,$)ii (o7tului o+(ili&al
- no%a( 4ont#( o%4i(ica( "e %#%ific& $#pa 3-8 5i(e $e (a na!tee !i "e $eta!ea5&L
- >n pi%e(e oe "e conto(ea5& pan"a%ent#( pent# a $epi"ta e)ent#a(e *e%oagiiL
- >n 5i(e(e #%atoae "e eface pan"a%ent#( !i "e o4"e)& e)o(#ia ?e)ent#a(e "e%ne $e infeciiI
o!ea&, "eceii, fe4&@L
- pent# pe)eniea infeciei !i g&4iea %#%ific&ii pe"te 4ont "e ap(ic& co%pe"e "tei(e
>n4i4ate >n a(coo(L
- "e an#n& %e$ic#( $ac& 4ont#( $e)ine %oa(e, apae "eceia.
57;)iAi)$a pl:;ii o+(ili&al$ ?7 &a> ,$ i7%$&*ii
- "e an#n& %e$ic#(, "e e"pect& eco%an$&i(eL
- "e c#&& p(aga c# ap& oBigenat&L
- "e atinge p(aga c# 4eta$in&L
- "e ap(ic& p#(4ee $e 4aneocin.
Dac& p(aga pe5int& gan#(o% "e atinge %#g##( c# "o(#ie $e nitat $e agint 2M. 0e ap(ic&
pan"a%ent "tei(.
2,./ Sup)a<$;=$)$a 7ou47:'&utului ?7 i7&u(ato)
I7%o)+a*ii ;$7$)al$
Inc#4ato#( e"te #n *a4itac(# ?(&ca @ >nc*i" c# peei $in %ateia( p(a"tic tan"paent cae pe%ite
o4"e)aea no# na"c#t#(#i, ea(i5aea >ngi8ii(o !i (ini!tiea pin atingee.
'e5int& oificii cae pe%it teceea t#4#i(o !i "on$e(o nece"ae aco$&ii >ngi8ii(o.
Fn inteio ae#( a%4iant e"te ca($, #%i$ificat !i e>%po"p&tat pe%anent.
I7,i&a*ii
- no#-n&"c#ii pe%at#i "a# c# ge#tate %ic& (a na!teeL
- no#-n&"c#ii fagi(i, "#4 "#pa)eg*ee c(inic& "tict& K $e5ec*i(i4a i *e%o$ina%ic,
e"piato, in"ta4i(i te%ic, (a cae te4#ie o4"e)ate %i!c&i ano%a(e, co(oaia
teg#%ent#(#i, "e%ne $e aga)ae a "t&ii $e "&n&tateL
- no#-n&"c#ii "#4 fototeapie.
Mat$)ial$ 7$&$'a)$
- inc#4ato c#at $econta%inat, pe>nc&(5itL
- ga$#( $e #%i$itate eg(at ?/.M@.
P$7t)u i7&u(ato)
- o Cpie(e $e oaieE "intetic& pent# acopeiea "a(te(eiL
- #n ceaceafL
- #n "c#tec >%p&t#it "#4 capL
- #n "acL
- o p1n5& pent# acopeiea cop#(#i copi(#(#iL
- o p1n5& pent# acopeiea inc#4ato#(#i.
P$7t)u &opil
- #n "c#tec "a# p(e$L
- o c&%&!#& !i e)ent#a( !o!ete.
- "e info%ea5& fa%i(iaL
- "e eBp(ic& nece"itatea p#neii >n inc#4ato, %o$#( $e f#ncionae !i po"i4i(itatea $e contact
c# copi(#(.
In"ta(aea copi(#(#i
- "e $e54ac& no#-n&"c#t#(L
- "e eg(ea5& te%peat#a $in inc#4ato c# a8#to#( #nei "on$e c#tanateL
- "e in"ta(ea5& "a# "e )eific& "on$a $e ga)a8, pef#5ia !i oBigen#( $ac& e"te ne)oieL
- "e %ontea5& a(a%aL
- "e in"ta(ea5& o p#ng& $e #in&L
- "e (a"& (i4ee faa, %1ini(e !i picioae(e ?pent# "ec#itate@L
- "e acope& c# o (en8eie %oa(eL
- "e e"pect& it%#( "o%n-)eg*e. Fn ti%p#( "o%n#(#i "e acope& inc#4ato#( c# #n ceaceaf
- fa%i(ia )a fi info%at& a"#pa confot#(#i copi(#(#i !i c#% poate paticip& (a >ngi8ie.
0#pa)eg*eea copi(#(#i
- "e o4"e)& !i "e notea5& te%peat#a (a oe eg#(ate $in 3 >n 3 oeL
- "e a"ig#& po5iia "on$ei c#tanate cae &%ane tot ti%p#( c1t copi(#( "t& >n inc#4atoL
- "e )eific& #%i$itateaL
- po5itionaea copi(#(#i (a fiecae >ngi8ie ?>n ti%p#( peioa$ei $e )eg*e@, e"pecti) $eapta-
"t1nga-pe "pateL
- c#&iea e5e)o#(#i $e ap& !i "c*i%4aea (a 2/ oe e"te $e $oit ca at#nci c1n$ p&inii ia#
(egat#a c# copi(#( "& poate ec*ipa%ent $e potecie.
Fnteineea coti$ian& a inc#4ato#(#i
- "e face c1n$ copi(#( e"te "co" pent# toa(et&L
- "e >n$ep&tea5& (en8eiaL
- "e c#&& acce"oii(e, peeii inteioi apoi cei eBteioiL
- "e $e5infectea5& eBteio#(, "e pefe& ap& "tei(& "a# "e#( fi5io(ogic pent# inteioL
- pent# $e5infecie n# "e fo(o"e"c po$#"e toBice ?feno(i, a($i*i$e, *a(ogeni, aci5i, a(co(@L
- "e eface p&t##(.
Ie!iea $in inc#4ato
Copi(#( p&&"e!te inc#4ato#( c# a)i5#( %e$ic#(#i $ac&I
- "taea c(inic& !i te%ic& e"te "ta4i(&, "-a po$#" o %at#i5ae "#ficient&L
- $ac& no#-n&"c#t#( e"te (a te%en !i ae te%peat#a "ta4i(&L
- $ac& e"te pe%at# "a# ae ge#tate %ic&I te%peat#a cop#(#i "& fie "ta4i(& ia cea a
%e$i#(#i >n 8# $e 28-,. ga$eL
- >nainte $e a fi "co" $in inc#4ato "e face aco%o$aea c# te%peat#a eBteioa&.
'&inii )o fi in"t#ii c#% "& >ngi8ea"c& copi(#(
La "f1!it "e c#a& !i "e $econta%inea5& inc#4ato#(.
- t#(4#&i $e te%oeg(ae $in ca#5aI
- pie$ei(o $e c&($#& ?>nc*i$eea !i $e"c*i$eea epetat& a inc#4ato#(#i@L
- te%peat#ii nea$aptateL
- #%i$it& ii nea$aptate.
- infecii no5oco%ia(e $in ca#5aI
- (ip"ei $e igien& a inc#4ato#(#iL
- inconfot#( copi(#(#i
- po5iia inco%o$&
- (#%ina p#tenic&, 5go%otL
- in*a(aea eg#gitaii(oL
- a"#i ca #%ae a (ip"ei cic#(&ii ae#(#i >n inteio. 0e po5iionea5& "a(tea#a $e a!a
%anie& >nc1t "& "e %enin& cic#(aia ae#(#i, "e e)it& c#enii cae pot po)oca
"#pa>nc&(5ii.
NOT C/E0BD>2E3 4SD4 E B1B2BD 434/D2C/ C 4/4SCDF SE12B749H424
142MB4DF
2,.2 Sup)a<$;=$)$a 7ou 7:'&utului 'u( %otot$)api$
Fototeapia e"te eBp#neea (a a$ia ii (#%inoa"e.
I7,i&a ii
- Icte#( (a copi( ?ga(4en& teg#%ente(o ca #%ae a #n#i eBce" $e 4i(i#4in& "ang)in&@.
I7%o)+a*ii ;$7$)al$
Icte#( fi5io(ogic "a# *ipe4i(i#4ine%ia tan5itoie neonata(&
- apae >n popoie $e 3.M-7.M (a no# n&"c#ii (a te%en !i +2M $in pe%at#iL
- e"te o con"ecin& a *e%o(i5ei fi5io(ogice po"t-nata(eL
- $e4#tea5& a $o#a, a teia 5i $e )ia&L
- e"te p#in inten", n# e"te >n"oit $e fe4&, #neoi apae o #!oa& "o%no(en&L
- "taea genea(& e"te 4#n&L
- #ina e"te $e a"pect no%a(, n# p&tea5& "c#tece(e, n# conine pig%eni 4i(iai,
#o4i(inogen#( #!o ce"c#t, feca(e(e a# a"pect no%a(.
E)o(#ia e"te fa)oa4i(&, icte#( "ca$e api$ >n inten"itate !i $i"pae "pontan $#p& 2-7 5i(e %ai a
$#p& 1.-1/ 5i(e.
N# nece"it& tata%ent, n#%ai $ac& e"te foate inten" %e$ic#( eco%an$& feno4a4ita( "a#
fototeapie.
Ictee(e pato(ogice
- a# n#%eoa"e ca#5eL
- "#nt con"ecine a(e t#(4#&i(o %eta4o(i"%#(#i 4i(i#4inei cae pot intee"a po$#ceea,
captaea *epatic&, con8#gaea "a# eBceia "aL
- 4oa(a *e%o(itic& a no# n&"c#t#(#i $en#%it& !i icte ga) pin inco%pati4i(itate = "a#
eito4(a"to5& feta(& e"te #na $in ca#5e(e *ipe4i(i#4inei pato(ogice.
Fototeapia epe5int& tata%ent#( *ipe4i(i#4ine%iei neonata(e !i a icte#(#i pin eBp#neea
teg#%ente(o copi(#(#i (a a$iaie (#%inoa"& inten"&. 0pect#( #(ta)io(et $in a$iaia (#%inoa"&
conti4#ie (a e(i%inaea 4i(i#4inei $in pie(ea copi(#(#i.
Mat$)ial 7$&$'a)
- inc#4atoL
- (a%p& $e fototeapieL
- oc*e(ai $e fototeapie pent# potecia oc*i(o copi(#(#iL
- a(e5& $e #nic& fo(o"in&L
- p#ng& $e #in& pent# 4aieiL
- "c#tec pent# ea(i5aea #n#i >n)e(i! ?cocon@.
- "e i$entific& copi(#( pent# a fi "ig# c& poce$#a "e ap(ic& ce(#i cae te4#ieL
- "e $e54ac& copi(#(L
- "e %ontea5& o p#ng& $e #in& $ac& e"te 4&iatL
- "e pote8ea5& oc*ii c# oc*e(aii "pecia(i.
Rolul a'i't$7tului +$,i&al
;eific&I
- $i"tana >nte "#"a $e fototeapie !i pie(ea copi(#(#i ?,.-/.c%@L
- po5iia coect& a oc*e(ai(o $e fototeapieL
- eg(aea te%peat#ii inc#4ato#(#i !i #%i$itateaL
- te%peat#a copoa(&L
- fec)en& ca$iac& !i e"piatoie a copi(#(#iL
Notea5&I
- $i#e5a, c#(oaea #inii, a "ca#n#(#i !i ge#tatea copi(#(#iL
- co%pota%ent#( copi(#(#iL
O4"e)&I
- co(oaia !i *i$ataea pie(ii, "e $& copi(#(#i "& 4ea (a ceee "e "#p(i%entea5& (ic*i$e(e pin
pef#5ie "#4 pe"cipii(e %e$ica(e
6(te ingi8ii
- ca(%ea5& copi(#( pin c#)inte 4(1n$e $ac& e"te agitatL
- "e $& o tetin& copi(#(#i, c# aco$#( p&ini(oL
- "e e)it& te5iea !i "e a"ig#& confot#(L
- "e e)it& a$iatii(e (#%inoa"e pin acopeiea inc#4ato#(#i ?"e a"ig#& a"tfe( !i potecia
pent# cei(a(i copii cae "#nt >n >nc&pee@L
- pent# ea(i5aea >ngi8ii(o igienice ?"c*i%4ae, a(i%entaie@ "e pofit& $e peioa$a $e
)eg*e a copi(#(#i, "e >nte#pe (a%pa $e fototeapie, "e >n$epatea5& oc*e(aiiL
- "e )eific& eficacitatea fototeapiei.
Sup)a<$;=$)$a ,up: %otot$)api$
- ti%p#( $e eBp#nee (a fototeapie e"te pe"ci" $e %e$ic#( pe$iat# >n f#nc ie $e ga)itatea
icte#(#iL
- "e *i$atea5& >n contin#ae copi(#( pe cae oa(& "a# i).
- peico(#( ia$ieii oc#(ae e"te atent e(i%inat pin pote8aea oc*i(o copi(#(#iL
- eBi"t& i"c $e apnee ceea ce i%p#ne "#pa)eg*eea fec)enei ca$iace !i "at#aia >n oBigen
a copi(#(#iL
- *ipete%ia "e pe)ine pin "#pa)eg*eea contin#& a te%peat#ii c#tanate.
2,.3 E%$&tua)$a i7A$&*i$i i7t)a+u'&ula)$ la 'u;a)
S&op
Into$#ceea #nei "o(#ii %e$ica%entoa"e eco%an$ate $e %e$ic >n e"#t#( %#"c#(a
Mat$)ial 7$&$'a)B
- %e$ica%ent#( eco%an$atL
- ace pent# a"piaea %e$ica%ent#(#i $in fio(&Gf(aconL
- ac "#4ie !i %ic a$aptat go"i%ii %#!c*i#(#iL
- "eing& $e capacitate coe"p#n5&toae cantit&ii $e "o(#ie %e$ica%entoa"& eco%an$at&L
- %ateia( $e $e5infecieL
- ecipient pent# co(ectaea %ateia(e(o fo(o"ite.
- "e )eific& >nc& o$at& pe"cipia %e$ica(&L
- "e i$entific& copi(#(L
- "e a(ege (oc#(I tei%ea %e$ie a feei eBtene a coap"ei ?%#!c*i#( )a"t (atea(@ %ai a faa
anteioa&. 9#!c*i#( g(#tea( po"teio #n$e "e fac $e o4icei in8ecii inta%#"c#(ae e"te
foate p#in $e5)o(tat (a "#ga !i foate apoape $e ne)#( "ciatic, n# "e eco%an& (a (oc
pent# in8ec ieL
- c# o %1n& "e fiBea5& picio#( copi(#(#iL
- c# o %i"cae api$& "e 1neap& %# c*i#(, ac#( fiin$ # o oientat o4(icL
- "e )eific& po5iia ac#(#i !i "e in8ectea5& "o(#iaL
- $#pa in8ectae "e ap(ic& #n ta%pon c# "o(#ie $e5infectant& !i "e etage ac#(L
- "e co(ectea5& %ateia(e(e fo(o"ite confo% peca#ii(o #ni)e"a(e.
57;)iAi)$a &opilului ,up: p)o&$,u):
- "e (ini!te!te copi(#(L
- "e a!ea5& >nt-o po5iie co%o$&L
- "e o4"e)& (oc#(.
2,.7 A,+i7i't)a)$a +$,i&a+$7t$lo) p$ &al$ o)al: la &opil
E"te into$#ceea >n ogani"% pe ca(e oa(& #nei cantit&i $e %e$ica%ente cae "& acione5e
genea( "a# (oca(.
Mat$)ial$ 7$&$'a)$
- pa*ae $e #nic& fo(o"in&L
- pipet&, "tic#(& pic#&toaeL
- %e$ica%ente pe"ci"eL
- ap&, ceai, a(t (ic*i$ eco%an$atL
- (ing#&, (ing#i&L
- ap&"&to $e (i%4&L
- ta)& "a# %a"#!& %o4i(&L
- %&n#!i $e #nic& fo(o"int&.
- "e fo(o"e!te %eto$a $e 8oac& pent# a o4ine coopeaeL
- "e info%ea5& copi(#( c& )a pi%i #n %e$ica%ent !i n# 4o%4oaneL
- "e info%ea5& a"#pa efect#(#i !i eacii(o a$)e"eL
- "e eBp(ic& p&ini(o o(#( %e$ica%ent#(#i, i%potana a$%ini"t&ii, aci#nea !i e)ent#a(e(e
eacii a$)e"eL
- "e a"ig#& o po5iie coe"p#n5&toae >n apot c# "taea copi(#(#iL
- "e )eific& $ac& "#nt >n$ep(inite con$iii(e pent# a$%ini"taeL
- $ac& n# eBi"t& nici o contain$icaie "e >n(oc#ie!te apa c# #n a(t (ic*i$, $e pefeat $#(ce
?"#c, ceai@. N# "e fo(o"e"c a(i%ente "a# (ic*i$e pefeate $e copi( $eoaece (e-a p#tea
ef#5a %ai ta5i#[
- "e a!ea5& %ateia(e(e pe o ta)& "a# c&#cio pent# tata%entL
- "e )eific& pe"cipia %e$ica(&I n#%e(e %e$ica%ent#(#i, $o5a, %o$#( $e a$%ini"tae,
ca(ea $e a$%ini"taeL
- "e in$entific& fiecae %e$ica%ent pe cae-( pi%e!te pacient#(I etic*eta a%4a(a8#(L
- "e p#n $o5e(e ce te4#ie a$%ini"tateI >nt-#n p&*&e( $in %ateia( p(a"ticL
- "e )eific& n#%&#( "a(on#(#i !i n#%e(e pacient#(#iL
- "e a$#ce t&)iaG%a"#!a c# %e$ica%ente(e >n "a(onL
- "e eBp(ic& pacient#(#iGp&ini(o ce %e$ica%ent pi%e!te, aci#nea ace"t#ia, $ac& ae g#"t
nep(&c#tL
- "e a!ea5& pacient#( >n po5iie !e51n$ $ac& n# e nici o contain$icaie, "a# o po5iie co%o$&
>n cae "& poat& 4ea (ic*i$#( >n f#ncie $e "taea ace"t#iaL
- "e "e)e!te pacient#(#i $o5a #nic&L
- "e 5$o4e!te "a# "e fag%entea5& ta4(ete(e pent# a fi %ai #!o $e ingeat !i >n %o$
$eo"e4it (a copii %iciL
- "e fo(o"e!te o cantitate %ai %ic& $e (ic*i$ pent# a coopea %ai #!o.
La 'u;a)i '$ p)o&$,$a>: a't%$l
- "e 5$o4e!te %e$ica%ent#( !i "e p#ne >nt-o (ing#i& c# ceaiL
- "e into$#ce (ing#ia >n g#a copi(#(#i "e apa"& #!o (i%4a !i "e &"toan& conin#t#(L
- "e a!teapt& p1n& c1n$ copi(#( >ng*ite !i apoi "e etage (ing#ia.
Sup)a<$;=$)$a &opilului ,up: a,+i7i't)a)$
Copi(#( n# te4#ie (&"at "ing#.
- "e #%&e!te a"pect#( teg#%ent#(#i, pot apae e#pii, ca5 >n cae "e an#n& %e$ic#(L
- (a apaiia t#(4#&i(o e"piatoii "e a$%ini"tea5& oBigen, oi "e an#n& %e$ic#(. 0e
peg&te!te t#"a $e #gen&L
2,.8 M:'u)i ?7 &a>ul u7o) )$a& ii ap:)ut$ ,up: a,+i7i't)a)$a +$,i&a+$7t$lo) la &opil
Dac& ac#5& "en5aie $e gea& !i )o%&
- "e aei"e te >nc&peeaL
- "e cee copi(#(#i "& in"pie pof#n$ ?$ac& e"te (a o )1"t& (a cae poate >n e(ege@L
- "e "t& c# copi(#( p1n& c1n$ "e "i%te 4ineL
- $ac& e"te ca5#(, "e an#n &
%e$ic#(L Dac& )a"& o pate $in
%e$ica%ent
- "e an#n& %e$ic#(L
Dac& ae eacie a(egic& "a# anafi(actic&
- "e ope te a$%ini"taea %e$ica%ent#(#iL
- "e an#n & #gent %e$ic#(L
- "e peg&te"c %e$ica%ente anti*i"ta%ice.
Dac& eacia e"te "e)e&I
- "e a ea5& copi(#( >n $ec#4it c# cap#( p#in i$icatL
- "e e)a(#ea5& "e%ne(e )ita(e $in 12P >n 12PL
- "e #%&e te $ac& pe5int& *ipoten"i#ne "a# ae $ific#(tate >n e"piaieL
- $ac& ae $ific#(t&i e"piatoii "e a$%ini"tea5& oBigen pe %a"c&, 3(G%inL
- "e peg&te te o t#"& $e #gene ?(a >n$e%1n&@L
- "e a"ig#& "#pot p"i*o(ogic copi(#(#i pent# a e$#ce anBietateaL
- "e notea5& tip#( !i e)o(#ia eaciei a(egice.
Capitolul " 5NGRI6RI 5N GERIATRIE
2/.1 No*iu7i i7t)o,u&ti<$E
F%4&t1niea e"te #n poce" caactei5at pin %o$ific&i teptate !i "pontane, a)1n$ ca efect
%at#i5aea >n ti%p#( copi(&iei, p#4et&ii !i peioa$ei $e a$#(t t1n&, !i apoi $ec(in#( %#(to
f#ncii a(e ogani"%#(#i >n ti%p#( )1"tei a II-a !i a III-a.
F%4&t1niea e"te #n poce" contin## cae $e4#tea5& (a na!tee !i contin#& >n toate etape(e )ieii.
6e at1t co%ponenta po5iti)& a $e5)o(t&ii, c1t !i co%ponenta negati)&, $ec(in#(.
Ta$iiona(, )1"ta $e 32 ani e"te con"i$eat& #n CpagE $eoaece e"te )1"ta (a cae oa%enii "#nt
pen"ionai.
2/.2 E<alua)$a %u7&*io7al: a <@)'t7i&ului
I7,i&a*ii
- e"te efect#at& pent# a e)a(#a ni)e(#( "t&ii $e 4ine a( pe"oanei c1t !i capacitatea, ca a$#(t
)1"tnic, $e a-!i p#ta >n %o$ a#tono% $e gi8&L
- )a a8#t& (a i$entificaea ne)oi(o pe"ona(e !i a p#ncte(o "(a4e >n >ngi8iea pe"ona(&, )a
f#ni5a 4a5a $e (a cae "e )a poni >ntoc%iea p(an#(#i $e >ngi8ie a c&#i "cop "& fie
ce!teea ga$#(#i $e a#tono%ie a )1"tnic#(#i, )a ofei #n fee$-4acO >n pi)ina
tata%ent#(#i !i ea4i(it&iiL
- e)a(#aea "e )a fo(o"i pent# a i$entifica !i "#p(ini ne)oi(e )1"tnic#(#i c# "e)icii(e
poti)ite c#% a fi a"ig#aea %ena8#(#i, >ngi8iea (a $o%ici(i#, >ngi8iea 5i(nic& cae "&
a8#te pacient#( "&-!i %enin& a#tono%ia. 0#nt $i"poni4i(e n#%eoa"e %eto$e $e >ntoc%ie a
#nei e)a(#&i %eto$ice f#nciona(e.
9eto$e $e e)a(#ae f#nciona(& a )1"tnic#(#iI
I7,$Hul Nat>I pi)in$ acti)it&i(e tai#(#i $e 5i c# 5i e"te o %eto$& foate $e" fo(o"it& pent#
e)a(#aea a4i(it&i(o $e a ea(i5a 3 acti)it&i 5i(nice $e >ngi8ie pe"ona(&I >%4&iee, >%4&cae,
a"ig#aea igienei, tan"fe#(, conto(#( "finctee(o, *&niea. De"cie ni)e(#( f#nciona( a(
pacient#(#i (a #n an#%it %o%ent >n ti%p !i p#nctea5& o4iecti) pefo%ane(e "a(e.
S&ala LaMto7I e)a(#ea5& capacitatea $e a ea(i5a acti)it&i(e $e >ngi8ie pe"ona(& %ai
co%p(eBe. 0e efe& (a acti)it&i(e nece"ae pent# a-!i "#"ine tai#( a#tono% c#% a fiI
capacitatea $e a fo(o"i te(efon#(, $e a g&ti, $e a face c#%p&&t#i, $e a "p&(a #fe, $e a ge"tiona
e"#"e(e financiae, $e a-!i a$%ini"ta %e$icaia !i $e a-!i peg&ti %a"a. 6cti)it&i(e "#nt cotate
pe o "ca(& $e (a 1 (a , >ncep1n$ c# a#tono%ia ?capacitate tota(& $e a ea(i5a acti)it&i(e@,
contin#1n$ c# a a)ea ne)oie $e #n oaecae "pi8in !i "f1!in$ c# incapacitatea tota(&.
S&ala 9i i7,$Hul Ga)t=$lI e)a(#ea5& #%&toae(e 1. f#ncii >n a#to>ngi8ieI *&niea, %#taea $in
c&#cio#( c# oti(e >n pat !i in)e", efect#aea igienei pe"ona(e, $ep(a"aea p1n& !i $e (a toa(et&,
>%4&ieea, $ep(a"aea pe "#pafee $epte, f&& $eni)e(&i, >%pingeea c&#cio#(#i c# oti(e,
#caea !i co4o1ea "c&i(o, >%4&cae G $e54&cae, %enineea continenei inte"tina(e,
conto(aea )e5icii #inae. Fiecae ite% e"te notat confo% c# ga$#( $e a"i"ten& nece"a&L $#p&
#n ti%p, e5#(tate(e )o a&ta o >%4#n&t&ie "a# #n $ec(in. O "ca(& "i%i(a& n#%it& 0ca(& $e
e)a(#ae a a#to>ngi8iii :at*e(, e o "ca(& %ai $eta(iat& pi)in$ e)a(#aea f#nciona(&. 6%4e(e
in"t#%ente f#ni5ea5& info%aii cae a8#t& (a $ete%inaea tip#(#i $e >ngi8ie nece"a&.
0ca(a $e Re"#"e 0ocia(e O6R0 ?Cecet&i !i "e)icii pt. )1"tnicii $in 6%eica@ e"te #n
in"t#%ent $e e)a(#ae $e5)o(tat (a Uni)e"itatea D#Oe >n 1+78. E"te o %eto$&
%#(ti$i%en"iona(& !i e)a(#ea5& ni)e(#( f#ncion&ii >n #%&toae(e 2 $o%eniiI e"#"e "ocia(e,
e"#"e econo%ice, "&n&tate fi5ic&, "&n&tate p"i*ic& !i acti)it&i a(e tai#(#i $e 5i c# 5i.
'incipa(e(e acti)it&i a(e tai#(#i $e 5i c# 5i inc(#$ %o4i(itatea, >%4&caea, igiena pe"ona(&,
*&niea, %e"#( (a toa(et& !i factoi (egai $e incontinen&. Tot#!i, ace"te acti)it&i pot fi eBtin"e
pent# a inc(#$e !i acti)it&i in"t#%enta(e ?c#%p&&t#i, >ngi8iea (oc#inei, #ti(i5aea
te(efon#(#i, p(ata fact#i(o, a$%ini"taea %e$icaiei, g&tit#( !i "p&(aea #fe(o@ c1t !i a(te
acti)it&i %ai co%p(eBe ?acti)it&i "ocia(e, )o(#ntae, oc#paiona(e, eceati)e@. Fiecae $o%eni# e
%acat pe o "ca(& $e (a 1 (a 3. La "f1!it#( e)a(#&ii e"te $ete%inat #n "co c#%#(ati) pi)in$
$eficiene(e. C# c1t "co#( e"te %ai %ic, c# at1t %ai %ae e"te ni)e(#( $eficienei.
Mat$)ial$ 7$&$'a)$B
- $oc#%entaia ?fo%#(ae tip $e co%p(etat@ nece"a& #neia $in %eto$e(e $e e)a(#ae
f#nciona(& cae "e fo(o"e!te >n "pita(.
P)$;:ti)$a $&=ipa+$7tuluiB
- "e )a eBp(ica te"t#( pacient#(#i !i i "e )a co%#nica (ocaia efect#&ii "a(e ?ca%ea $e "pita(
"a# $e tata%ent@.
I+pl$+$7ta)$B
- "e )a e)e$ea i"toic#( >n %ateie $e "&n&tate a( pacient#(#i pent# a o4ine $ate in$i)i$#a(e
$e"pe pacient !i pent# a >ne(ege po4(e%a >n pof#n5i%e c1t !i %o$ific&i(e fi5ice "#4ti(eL
- "e )o o4ine $ate 4iogafice, inc(#"i) n#%e(e pacient#(#i, )1"ta, $ata na!teii !i a!a %ai
$epate $ac& ace"tea n# eBi"t& $e8aL
- fo(o"in$#-"e in"t#%ente $e e)a(#ae f#nciona(&, pacient#( )a fi #gat "& &"p#n$& (a
>nte4&i. Dac& pacient#( n# poate &"p#n$e, "e )o o4ine &"p#n"#i(e $e (a cei cae-i
aco$& >ngi8ie.
Co7'i,$)a*ii 'p$&ial$B
- e)a(#aea f#nciona(& a )1"tnic#(#i te4#ie f&c#t& c1t %ai epe$e $in %o%ent#( inten&ii
"a(eL
- >nteaga e)a(#ae )a fi e)i5#it& !i act#a(i5at& $e fiecae $at& c1n$ o %o$ificae i%potant&
apae >n "taea fi5ic& !i %enta(& a pacient#(#iL
- c1n$ e"te fo(o"it& "ca(a LaJton, e)a(#aea pacient#(#i "e )a face >n te%eni "pecifici
"ig#aneiI $e eBe%p(#, o pe"oan& poate fi capa4i(& "& g&tea"c& o %a"& "i%p(& pent# "ine
$a poate #ita aaga5#( apin" $#p& ce a g&titL
- at1t in$eB#( :at*e( c1t !i 0ca(a $e e)a(#ae a a#to>ngi8iii :at*e( "#nt fo(o"ite ca
in"t#%ente %ai $e" >n ec#peaea )1"tnici(o !i >n >ngi8ii(e pe te%en (#ng pent# a
con"e%na >%4#n&t&iea capacit&i(o pacient#(#i.
Fn ci#$a %o$ific&i(o ce apa >n ogani"% o$at& c# >naintaea >n )1"t&, %a8oitatea f#ncii(o
&%1n a$ec)ate pe pac#"#( )ieii, $eoaece ce(e %ai %#(te ogane a# o capacitate f#nciona(&
%#(t %ai %ae $ec1t cea nece"a& ogani"%#(#i ?e5e)& f#nciona(&@.
:oa(a, %ai $ega4& $ec1t >%4&t1niea no%a(&, e"te e"pon"a4i(& pent# "c&$eea "a# pie$eea
capacit&ii f#nciona(e a ogane(o.
C*ia !i a!a, $ec(in#( f#nciona( >n"ea%n& c& pe"oane(e >n )1"t& a# $ific#(t&i (a a$aptaea (a
)aiaii(e factoi(o $e %e$i#, "#nt %ai "en"i4i(e (a agenii patogeni !i (a infecii !i a# o
pe$i"po5iie %ai %ae (a eacii a$)e"e a(e %e$ica%ente(o.
'e"oane(e )1"tnice n# %ai "#nt capa4i(e $e pefo%ane fi5ice.
0c*i%4&i(e in$#"e $e )1"t& "#nt inf(#enate !i $e %o$#( >n cae pe"oana a t&it. Un "ti( $e )ia&
"e$enta, $ieta necoe"p#n5&toae, f#%at#( !i a4#5#( $e a(coo( !i $og#i, pot afecta %#(te ogane
pe pac#"#( ti%p#(#i, a$e"eoi %ai %#(t $ec1t >%4&t1niea "ing#&.
2/., 57;)iAi)$a p$)'oa7$lo) <@)'t7i&$E Pa)ti&ula)it:*i l$;at$ ,$ patolo;ia <@)'t7i&uluiE
Fn ca5#( )1"tnici(o, ne af(&% >n faa a $o#& poce"e cae pot coeBi"taI poce"#( no%a(, nat#a(
$e in)o(#ie !i poce"#( pato(ogicL $e aceea e"te foate i%potant "& "ta4i(i% $ac& ne af(&% >n faa
#n#i Cpacient >n )1"t&E "a# >n faa #nei Cpe"oane c# %o$ific&i $e >%4&t1nieE.
6$e"ea )1"tnicii cae "o(icit& a"i"ten& %e$ica(&, ac#5& n# "#feine %o4i$e, ci Cfeno%ene
ege"i)e "o%atice !i f#nciona(e, in"#ficiene, i%potene a c&o etio(ogie e"te >n"#!i poce"#( $e
"ene"cen&E cae n# poate a)ea #n tata%ent an#%e.
6na%ne5a pacient#(#i )1"tnic ae #ne(e patic#(ait&iI
- $ate(e f#ni5ate $e )1"tnic n# "#nt >ntot$ea#na "#ficiente !i e(e)ante, ceea ce nece"it&
oientaea inte)i#(#i "pe fa%i(ie "a# "pe pe"oana cae >ngi8e!te )1"tnic#(L
- 4&t1n#(#i te4#ie "& i "e )o4ea"c& %ai tae !i %ai a(e" %ai a !i %ai c(a $in ca#5a
*ipoac#5iei $e tip centa( ?a#$e $a n# >ne(ege@L
- pe"#p#ne ti%p !i &4$ae $e a a"c#(ta )o4e(e pacient#(#i, $e ce(e %ai %#(te oi "t#foa"e,
c# e(#&i, %ici a%ne5iiL
- o4"e)aia ae o( i%potant >n apecieea "ta$i#(#i $e >%4&t1nie, a )1"tei cono(ogice "a#
4io(ogice, %ai a(e" pent# a )e$ea $ac& )1"ta ea(& ?>n ani@ a pacient#(#i coinci$e c# )1"ta
4io(ogic& ?fe(#( c#% aat&@L
- >n ca5#( >n cae apecieea ne "#geea5& o )1"t& %ai %ae $ec1t cea ea(&, ne af(&% >n faa
#nei >%4&t1nii pecoce "a# acce(eateL
- foate i%potant& e"te cecetaea ana%ne"tic& a tata%ente(o efect#ate anteio, "#feine(e
iatogene fiin$ fec)ente (a )1"tnic ca #%ae !i a ten$inei ace"t#ia $e a (#a %#(te
%e$ica%enteL
- o i%potan& $eo"e4it& o ae o4"e)aea %e"#(#iL
- "e%io(ogia geiatic& e"te >ntot$ea#na %ai 4ogat&, (a "e%ne(e c(inice a$&#g1n$#-"e !i
"tig%ate(e >%4&t1niii.
2/./ Tul(u):)i ,$ 'o+7
Ogani"%#( #%an ae ne)oie $e o$i*n& !i "o%n pent# a-!i con"e)a enegia, a pe)eni o4o"ea(a,
a a"ig#a o pa#5& >n f#ncionaea ogane(o !i a e(i%ina ten"i#nea.
O$i*na $epin$e $e ga$#( $e e(aBae fi5ic& !i %enta(&. 0e pe"#p#ne c&, $ac& "tai >ntin" >n pat
>n"ea%n& o$i*n& $a, gi8i(e !i a(i factoi a"ociai $e "te" fac ca %#!c*ii $in tot cop#( "&
contin#e "& "e contacte c*ia $ac& acti)itatea fi5ic& a >ncetat. Rea(i5aea o$i*nei $epin$e $e
acea"t& e(aie >nte p"i*ic !i "o%atic.
F#ncii(e cop#(#i a# peioa$e $e acti)itate !i o$i*n& >nt-#n cic(# contin## $e acti)itate
?4ioit%#i@.
O$i*na Cpin eBce(en&E >n"ea%n& "o%n ne>nte#pt, e)igoant !i ec#peato.
Ca(itatea "o%n#(#i "e $eteioea5& c# )1"ta.
Di""o%nia ea(& a )1"tnic#(#i, cae te4#ie $ifeeniat& $e fa("a in"o%nie ?n# $o% noaptea
pent# c& $o% 5i#a@, inc(#$e at1t t#(4#&i cantitati)e, *ipo"o%nia, c1t !i t#(4#&i a(e it%#(#i
no%a( ?"o%n noct#n K )eg*e $i#n&, >n "en"#( in)e"&ii@.
0t#$ii(e efect#ate pe (ot#i $e pe"oane )1"tnice aat& c&I
- ne)oi(e $e "o%n a(e )1"tnic#(#i "#nt %ici co%paati) c# a$#(t#(, c# toate ace"tea ti%p#( $e
"o%n tota( n# "ca$e o$at& c# >naintaea >n )1"t&L
- co%paati) c# a$#(t#(, (a )1"tnic, n#%&#( $e te5ii poate >n"#%a 1-2 oe $e )eg*e
noct#n&, co%paati) c# c1te)a %in#te (a a$#(t#( t1n&L
- #n a(t paa%et# a( "o%n#(#i, eficacitatea, pin cae "e >ne(ege apot#( $inte ti%p#( $e
"o%n tota( "a# ea( !i ti%p#( petec#t >n pat, c# (#%ina apin"&, "#fe& %o$ific&i o$at& c#
>naintaea >n )1"t&L eficacitatea "o%n#(#i ae o c&$ee %acat& "pe 7. $e ani at1t (a
4&4ai c1t !i (a fe%eiL
- "-a o4"e)at c& 4&t1n#( >!i ec#peea5& pin "o%n $i#n, inc(#"i) "ie"ta, pie$ei(e $atoate
)eg*ei noct#neL $o%in$ 5i#a, e( )a $o%i %ai ge#, %ai p#in noaptea, ceea ce $#ce (a #n
cec )icio".
Cau>$l$ ,i''o+7i$i la <@)'t7i&E
- *ipetofia $e po"tat&, pin feno%en#( $e po(aOi#ie noct#n& pe cae-( $ete%in&L
- in"o%nia $in acea"t& ca#5& ae epec#"i#ni i%potante a"#pa ogani"%#(#i )1"tnic pin
ep#i5ae p"i*ic&, inte(ect#a(&, $ete%inat& $e i%po"i4i(itatea $e efacee a "i"te%#(#i
ne)o"L
- ef(#B#( ga"to-e"ofagian ce poate fi coectat pin %&"#i $e igien& !i a(i%entaie coect&
"eaa ?cina c# 2-, oe >nainte $e c#(cae, e)itaea %e"e(o copioa"e@ !i c#(cae >n po5iie
poc(i)& ?pe pen& %ai >na(t&@L
- e#%ati"%#( atic#(a $#eo", c# oa %ai a(e" noct#n, ca%pe %#"c#(ae a(e %e%4e(o
infeioae pin t#(4#&i cic#(atoiiL
- t#"ea e4e(& (a )1"tnicii f#%&toi, c# 4on!it& conic&L
- in"o%nia iatogen&, %e$ica%entoa"& ?%e$ica%ente "ti%#(ente a(e "nc, *ipnotice@L
- apneea noct#n& cae "e >n"oe!te $e "fo&it p#tenic !i peio$ic, "o%n >nte#pt c#
fec)ente te5ii, acti)it&i noct#ne neo4i!n#ite c#% "#nt i$icaea >n !e5#t,
"o%na%4#(i"%#( !i c&$eea $in pat.
E<alua)$a &alit:*ii 'o+7ului la <@)'t7i&i
Info%aii(e pi)in$ i"toia "o%n#(#i "#nt i%potante !i "e efe& (aI
- c1t $e 4ine $oa%e pacient#( aca"&L
- $e c1te oi "e "coa(& pe noapteL
- (a ce o& "e c#(c&L
- ce $epin$ei ae >nainte $e c#(caeI "e)e!te o g#"tae, #%&e!te poga%e(e T;, a"c#(t&
%#5ic&, (ect#ea5& ce)a, face eBeciii fi5iceL
- po5iia fa)oit& >n pat, con$iii(e $e %icoc(i%at $in ca%e& ?tb, )enti(aie, i(#%inae@L
- "o%nifee "a# a(te %e$ica%ente (#ate >n %o$ o4i!n#it cae-i pot afecta capacitatea $e a
a$o%iL
- an#%ite *o44U-#iL
- "taea $e %#(#%ie eBi"tenia(&L
- pecepia "t&ii $e "&n&tate ?pent# a $etecta po"i4i(e $epe"ii@.
Date(e o4in#te $e (a pe"oana )1"tnic& te4#ie conf#ntate c# a(e >ngi8ito#(#i "a# a(e
%e%4i(o fa%i(iei.
O pate i%potant& a e)a(#&ii, nece"a& pent# i%p(e%entaea #no inte)enii a$ec)ate e"te
ineea #n#i 8#na( a( "o%n#(#i. 6ce"ta )a a"ig#a o >negi"tae eBact& a po4(e%e(o (egate $e
"o%n !i )a i$entifica ca#5e(e.
I7t$)<$7*ii
Inte)enii(e )o a)ea (oc $#p& o e$ificae co%p(et& a"#pa i"toic#(#i "o%n#(#i.
9&"#i(e ap(icate pent# a"ig#aea #n#i "o%n $e ca(itate pent# pacient#( >n )1"t& )i5ea5&I
- %enineea con$iii(o cae fa)oi5ea5& "o%n#( ?factoi $e %e$i# !i o4i!n#ine(e $inainte
$e c#(cae@L
- a8#to#( ofeit pacient#(#i pent# e(aBae >nainte $e c#(cae pin %a"aea "pate(#i,
picioae(o "a# "e)iea #no g#"t&i $ac& "e "o(icit& ?(apte ca($, )in, coniac@L
- po5iionae >n pat, ca(%aea $#ei(o !i a"ig#aea c&($#ii !tiin$ c& )1"tnicii "#nt %ai
fig#o!i@L
- e(i%inaea cafeinei !i a teinei $#p& a%ia5a !i "eaa ?cafea, ceai, cioco(at&@L
- >nc#a8aea eBeciii(o 5i(nice !i e$#ceea "o%n#(#i $e 5i (a %ai p#in $e 2 oeL
- efect#aea #nei 4&i ca($e $ac& )1"tnic#( o ageea5& !i n# "e p(1nge $e a%ee(i $#p& 4aie.
2/.2 D$+$7*a
No iu7i
i7t)o,u&ti<$
De%ena e"te o $i"f#ncie inte(ect#a(& $o41n$it&, pe"i"tent& !i c# e)o(#ie poge"i)&, afect1n$
ce( p#in $o#& $in #%&toae(e poce"e %enta(eI (i%4a8#(, %e%oia, oientaea te%poo-"paia(&,
co%pota%ent#( e%oiona( !i pe"ona(itatea, cogniia ?ca(c#(#(, aiona%ent#(, g1n$iea a4"tact&,
etc.@
Cea %ai pecoce %anife"tae a $e%enei e"te $e o4icei #itaea. U%ea5& apoi pie$eea %e%oiei
ecente %ai a(e", !i >n fina( $e5oientaea !i $e5in"eia "ocia(&.
'acientii "e "i%t "t1n8enii !i f#"tai $e pie$eea a4i(it&i(o, ef#51n$ "& fie a8#tai. 6ce"t fapt
$#ce (a >ncecaea $e a-!i a"c#n$e $ific#(t&i(e, (a e5i"ten& >n a pi%i a8#to !i (a ef#5#( $e a
%ai face #ne(e acti)it&i.
Tip#( $e $e%en& ?6(5ei%e, $e%ene )a"c#(ae@ inf(#enea5& e)o(#ia !i tata%ent#( ace"teia. In
n#%eoa"e ca5#i $e%ena coeBi"t& c# $epe"ia !i c# $e(i#(. Diagno"tic#( "e 4a5ea5& peI
- i"toic#( 4o(ii
- eBa%en#( fi5ic !i a( "t&ii %enta(e
- e)i5#iea atent& a %e$icaiei a$%ini"tate !i a con"#%#(#i $e a(coo(
- in)e"tigaii $e (a4oato pent# a e(i%ina a(te ca#5e a(e $i"f#ncii(o cogniti)eI $o5aea
*o%oni(o tioi$ieni, ;DRL, te"te *epatice !i ena(e, R9N-#( "a# TC "#nt eco%an$ate >n
ca5#i(e c# "e%ne pecoce $e $e%en& ap&#te >nt-#n inte)a( $e ti%p e(ati) "c#t, $e c1te)a
(#ni p1n& (a 1-2 aniL a%4e(e in)e"tigaii "#nt #ti(e pent# eBc(#$eea #no 4o(i ce pot %i%a
$e%ena $e tip 6(5*ei%e c#% "#nt *e%atoa%e(e !i t#%oi(e cee4a(e, acci$ente(e )a"c#(ae
i"c*e%ice "a# *e%oagice.
P)i7&ipii ,$ ?7;)iAi)$ a pa&i$7tului &u ,$+$7*:
- 0e %enine in$epen$ena pacient#(#i pin >nc#a8aea ace"t#ia "& fac& "ing# an#%ite
acti)it&i cae "#nt %ai #!o $e e5o()atL a8#t& (a %enineea "ti%ei $e "ine !i pe)ine
f#"taea.
- 0e e)it& conf#nt&i(e $e c1te oi e"te po"i4i(. 0e >nceac& "& n# fie conta5i i $ac& "p#n
(#c#i ci#$ate "a# po"te!ti. Li "e $i"tagei atenia $ac& $oe"c "& fac& ce)a nepoti)it,
"c*i%41n$ "#4iect#( "a# >n$ep&t1n$#-( $e "#"a intee"#(#i "&# a4"#$.
- 0e "ta4i(e"c #tine >n >ngi8iea pe"oanei c# $e%en&, f&c1n$ ace(ea!i (#c#i (a ace(ea!i oe
!i a"ig#1n$ o an#%it& pe$icti4i(itate >n >n$ep(iniea acti)it&i(o.
- 0e a"ig#& #n %e$i# "ig# pent# pacient#( c# $e%en&. Conf#5ia, pie$eea coo$on&ii
fi5ice ce"c po"i4i(itatea $e a c&$ea, $e aceea te4#ie )eificate 5one(e peic#(oa"e ca
po$e(e(e a(#necoa"e, %o4i(a p(a"at& inco%o$, %oc*ete(e fiBate necoe"p#n5&to.
6cti)it&i(e 5i(nice a# #n i"c ce"c#t pent# pacientiI ace!tia pot $e"c*i$e ga5#(, (&"a
(#%ina apin"&, a#nca c*i4it#i apin"e >nt-#n co! c# *1tie, etc. De aceea, an#%ite
atenion&i "ci"e ?C>nc*i$ei ga5#(E, Copii apaE@ ca !i e(i%inaea o4iecte(o peic#(oa"e
pot $i%in#a i"c#( acci$ente(o ca"nice.
- 0e %enin cana(e(e $e co%#nicae $e"c*i"e. 'e %&"#& ce 4oa(a e)o(#ea5&, po4(e%e(e $e
co%#nicae >nte pacient !i cei(a(i )o fi $in ce >n ce %ai %ai. 'acien ii )o a)ea
$ific#(t&i >n a "e eBpi%a !i a p#ta o con)e"aie. 'ent# a %enine cana(e(e $e co%#nicae
$e"c*i"e "e eco%an$&I
- "& "e )eifice $ac& pacient#( n# e"te afectat $e t#(4#&i $e a#5, )e$ee, "a# $e
po4(e%e "to%ato(ogiceL
- "& "e )o4ea"c& "i%p(#, c(a, a, n#%ai $e"pe #n "ing# "#4iectL
- "& "e aco$e pe"oanei %ai %#(t ti%p pent# a &"p#n$eL
- $ac& pe"oana e"te conf#5&, "& i "e a%intea"c&, c# &4$ae, info%aii(e e"enia(e
fo(o"in$ #n o4iect "a# o i%agineL
- "& "e >ncece, pin )oca4#(a a$ec)at, "& n# "e "i%t& conta5i i "a# "&-i 8ignii,
coect1n$#-i c# 4#"c*ee.
- 0& "e fo(o"ea"c& pi)iea !i atingeea pent# eBpi%aea "enti%ente(o.
2/.3 C:,$)il$ #i7'ta(ilitat$a %i>i&:8 +$)'ul i7'ta(il8 &:,$)il$-
C&$ei(e epe5int& o po4(e%& %a8o& pent# )1"tnici, %ai a(e" pent# fe%ei.
Ec*i(i4#( !i %i!caea nece"it& o inteconeBi#ne co%p(eB& a con!tient#(#i, a f#ncii(o
ne#o%#"c#(ae !i ca$io)a"c#(ae, pec#% !i capacitatea $e a$aptae api$& (a o "c*i%4ae
a%4ienta(&. ;#(nea4i(itatea (a c&$ee a pe"oane(o )1"tnice, ce!te at#nci c1n$ oicae $inte
ace"te "i"te%e e"te "#pa"o(icitat $e #n facto "#p(i%enta, inten "a# eBten.
Cau>$l$ &:,$)ilo)
Factoii $e i"c cae pe$i"p#n (a c&$ei, pot fi intin"eci ?t#(4#&i "en5oia(e, afeci#ni %#"c#(o-
"c*e(eta(e, $e%ene(e, efect#( "ec#n$a a( #no %e$ica%ente, etc.@ $a !i factoi $e %e$i#, cae
in $e 5ona a%4ienta(& , $e o4"taco(e(e $in %e$i#( >ncon8#&to ca >n ta4e(e(e $e %ai 8o".
Ta4e(#( n.1. Fa&to)ii ,$ +$,iu &a)$ i7%lu$7*$a>: )i'&u)il$ ,$ &:,$)$
Zo7a a+(i$7tal:
'au %a&to)ul
,$ +$,iu
O(i$&ti<$ 9i )$&o+a7,:)i
Toate 5one(e 'e)eniea i"c#(#i pinI
a. a"ig#aea $e >nc#ietoi acce"i4i(e (a toate #!i(e $e (a ca%ee
4. i(#%inat#( noct#n a( *o(#(#i, 4&ii, $o%ito#(#i
'o$e(e(e c. Do"#i anti$eapante pent# capete, #ti(i5aea $e capete c# fi#(
"c#t
$. FiBaea capete(o capete(o
e. 6p(icaea $e cea& anti$eapant& pe po$e(e
f. Fn$ep&taea o4iecte(o %&#nte ?eB. >nc&(&%inte@
0c&i(e g. I(#%inae "#ficient& c# co%#tatoae (a ce(e $o#& capete a(e
"c&i(o
*. :a(#"ta$e 4i(atea(e 4ine fiBate !i (a o $i"tan& "#ficient& $e
peei
i. 9acaea c# 4en5i ef(ectoi5ante a pi%ei !i a #(ti%ei tepte
8. E)itaea $epo5it&ii #no o4iecte pe tepte(e "c&i(o inteioae :#c&t&ia O. 6!e5aea o4iecte(o ca"nice >n a!a fe( >nc1t "& n# fie nece"a&
>ntin$eea "a# ap(ecaea
(. Fo(o"iea #nei "c&i-"ca#n pent# #cat
%. FiBaea %e"e(o pent# a n# "e $ep(a"a
:aia n. :ae $e "pi8in pent# ca$&, $#!#i !i toa(et&
o. '(a"aea $e co)oa!e anti$eapante "a# $e ca#ci#c >n ca$& "a#
(a $#!
p. Uti(i5aea $e "ca#ne $e $#! c# cap $e $#! %ane)a4i(
Z. Capete anti$eapante, "ca#n $e toa(et& >n&(at
. Fn$ep&taea >nc#ietoi(o $e (a #!i pent# a >n(e"ni acce"#( >n
ca5 $e #gen&
C#tea !i int&i(e ". Repaaea "p&t#i(o $in pa$o"ea(&, a gopi(o $in c#te
t. Fn$ep&taea piete(o, "c#(e(o !i a a(to o4"taco(e, pec#%
!i a f#n5e(o #%e$e !i a g*eei
In"tit#ii #. 6%ena8&i ca >n eBe%p(e(e $e %ai "#"
). 'at#( "& ai4& o >n&(i%e con)ena4i(& ?cica 3. c%.@
J. C#&aea po%pt& a pete(o !i (ic*i$e(o )&"ate pe po$ea
B. Fo(o"iea coe"p#n5&toae a %i8(oace(o $e "pi8in pent# %e"
!i a c&#cioae(o #(ante
Fnc&(&%intea U. Uti(i5aea $e pantofi c# t&(pi $#e, nea(#necoa"e !i nea$eente
5. '#taea $e >nc&(&%inte c# toc#i 8oa"e
aa. E)itaea %e"#(#i >n cioapi "a# >n pap#ci (agi $e cae "e
pot >%pie$ica
Ta4e(#( n. 2 Fa&to)i ,$ )i'& i7t)i7'$&i &a)$ p)$,i'pu7 la &:,$)i 9i po'i(il$ i7t$)<$7*ii
?$#p& Tinetti 9E, 0peec*(eU 9I 'e)ention of fa((" a%ong t*e e($e(U@
Fa&to) ,$ )i'& I7t$)<$7*ii
M$,i&al$ ?$e(egate@ Rec#peatoii "a# a"#pa
%e$i#(#i
?a#tono%e !i $e(egate@ Re$#ceea ac#it&ii
)i5#a(e, a a$apt&ii
(a >nt#neic !i a
pecepiei >n
pof#n5i%e
- oc*e(ai coectoiL
tata%ent#(
cataactei
- e)a(#aea "ig#anei (oc#inei
Di"f#ncii )e"ti4#(ae - e)itaea %e$icaiei cae
afectea5& "i"te%#( )e"ti4#(a
- eBa%en ne#o(ogic,
eBa%en ORL $ac& e"te
nece"a
- eBeciii $e a$aptae
De%ena - $ece(aea ca#5e(o
e)e"i4i(e
!i tata4i(e c#% a
fi $e"*i$ataea
- e)itaea "e$ati)e(o "a# a
%e$icaie c# aci#ne pe
- eBeciii !i $ep(a"&i
"#pa)eg*eate
- e)a(#aea "ig#anei >n %e$i#
ca"nic !i >n$ep&taea
e)ent#a(e(o o4"taco(e
6feci#ni $egeneati)e
ce)ica(e,
ne#opatie
peifeic&, ane%ii,
o"teopoo5&
- e)a(#aea $eficit#(#i $e
)ita%ina :12 !i a ga$#(#i
$e o"teopoo5&
- e)a(#aea "ta$i#(#i $e
"pon$i(o5& ce)ica(& !i a
afect&ii cic#(aiei
cee4a(e
- a%e(ioaea $en"it&ii o"oa"e
- eBeciii $e ec*i(i4#
- coecia a$ec)at& a %e"#(#i
- coecia >nc&(&%intei c#
t&(pi $#e
- e)a(#aea "ig#anei >n
%e$i#( ca"nic
6feci#ni %#"c#(o-
"c*e(eta(e
- e)a(#aea integit&ii !i
f#nciona(it&ii
apaat#(#i (oco%oto
- i$entificaea
afeci#ni(o picio#(#i
cae pe$i"p#n (a
in"ta4i(itateaI ca(#"#i,
$#ioane, $efo%&i,
e$e%e
- c#&aea ca(#"#i(o,
eBtageea $#ioane(o,
tataea e$e%e(o
- antena%ent#( ec*i(i4#(#i !i a
%e"#(#i
- eBeciii $e tonifiee %#"c#(a&
- "pi8iniea )1"tnic#(#i >n
ti%p#( %e"#(#i "a# #ti(i5aea
#n#i "#pot ?4a"ton, ca$#@ >n
ti%p#( $ep(a"&ii
- e)a(#aea "ig#anei >n
%e$i# ca"nic
- >ngi8iea #ng*ii(o,
>nc&(&%inte a$ec)at&
=ipoten"i#ne po"t#a(& - e)a(#aea %e$icaiei pi%ite
- e*i$ataea
- %o$ificaea factoi(o
"it#aiona(i ?eBe%p(#I
%e"e(e, %o$ificaea
po5iiei@
- eBeciii $e $o"of(eBie,
- p#taea $e cioapi e(a"tici
c# pe"i#ne eg(a4i(&,
- i$icaea eBte%it&ii
cefa(ice a pat#(#i,
- fo(o"iea %&"#e(o a$apta4i(e
(a "#pafaa pat#(#i $ac&
afeci#nea e"te ga)&
9e$ica%ente
?"e$ati)e,
anti$epe"i)e,
anti*ipeten"i)e,
antiait%ice,
anticon)#("i)ante
, $i#etice,
*ipog(ice%iante@
!i a(coo(
- e$#ceea n#%&#(#i tota( $e
%e$ica%ente a$%ini"tate
- e)a(#aea i"c#i(o !i
4eneficii(o pent#
fiecae %e$ica%ent >n
pate
- "e(ecionaea %e$icaieiI "e
a(ege agent#( fa%aco(ogic
ce( %ai p#in acti) a"#pa
0NC, ce( %ai p#in a"ociat
c# *ipoten"i#nea po"t#a(& !i
ce( c# ti%p#( $e aci#ne ce(
%ai "c#t
- pe"cieea ce(ei %ai
e$#"e $o5e eficace
- ee)a(#&i fec)ente
a(e i"c#i(o !i
a)anta8e(o %e$icaiei
- "#pa)eg*eea )1"tnic#(#i
pent# e)itaea ten$inei (a
a#to%e$icaie
- e$#caia
)1"tnic#(#iGfa%i(iei pi)in$
efecte(e "ec#n$ae a(e #no
%e$ica%ente !i i"c#( $e
c&$ee
2/.7 Si7,)o+ul ,$ i+o(ili>a)$ al <@)'t7i&ului
0in$o%#( $e i%o4i(i5ae e"te #n "in$o% "pecific geiatic cae a$#ce o con$iionae etio(ogic&
co%p(eB& !i i%p(icaii %e$ica(e !i econo%ice i%potante.
Fn po$#ceea "in$o%#(#i $e i%o4i(i5ae "e $i"ting factoii etio(ogici fa)oi5ani !i factoii
$ete%inani, >n ea(itate "t1n" inticai, >n popoii !i c# pon$ei )aia4i(e $e (a ca5 (a ca5
Fa&to)ii %a<o)i>a7*i
- ;1"ta - c# c1t )1"ta e"te %ai >naintat&, c# at1t "#4iect#( e"te %ai eBp#" "& fac& "in$o%
$e i%o4i(i5ae.
- Teen#( K c# efeie >n$eo"e4i (a 4o(i(e ne#op"i*ice, "#4iecii anBio!i, $epe"i)i, cei
pe$i"p#!i (a >%4o(n&)ii p"i*o-"o%atice fiin$ %ai eBp#!i (a a face #n "in$o% $e
i%o4i(i5ae.
Con$#ita ant#a8#(#i fa%i(ia(, "ocia(, $e >ngi8ie %e$ica(&, poate con"tit#i #n facto fa)oi5ant "a#
c*ia $ete%inant >n an#%ite "it#aii. Retageea $in acti)itatea pofe"iona(& ?pen"ionaea@
pie$eea e"pon"a4i(it&i(o, a "tat#t#(#i !i o(#i(o "ocio-pofe"iona(e, "#4%inea5& teen#(
pe$i"p#n1n$ (a ege"ie inte(ect#a(&, fi5ic& "a# p"i*ic&. Dac& fa%i(iaGant#a8#( pe"oanei >n ca#5&
n# %anife"t& o con$#it& $e e"pect !i integae, ci #na $e e"pingee "a# $i%poti)& $e
*ipepotecie, "e ceea5& pe%i5e(e )iitoae i%o4i(i5&i.
I%o4i(i5aea e"te #n concept cae "e efe& !i c#pin$e toate $i%en"i#ni(e fiinei #%aneI "ocia(&,
fi5ic&, p"i*ic&, inte(ect#a(& !i "piit#a(&.
Fa&to)ii ,$t$)+i7a7*i
- 6feci#ni(e ga)e, "e)ee, in)a(i$ante cae i%p#n i%o4i(i5&i $e (#ng& $#at&I acci$ente(e
)a"c#(ae cee4a(e, acci$ente(e coonaiene, fact#i(e, inte)enii(e c*i#gica(e,
t#(4#&i(e e"piatoii, ci5e(e p"i*ice, a(te&i(e "t&i(o genea(e pin 4o(i intec#ente.
Fn %#(te $in ace"te ca5#i, in"ta(aea "in$o%#(#i $e i%o4i(i5ae, a p#tea fi e)itat& $ac&, $#p&
peioa$a $e eani%ae, $e epa#" "a# i%o4i(i5ae $e nece"itate, anBietatea pa&i$7t#(#i pe $e o
pate !i neg(i8ena pe"ona(#(#i $e >ngi8ie pe $e a(t& pate, n# a pepet#a acea"t& "tae.
- 6feci#ni p"i*iceI "t&i $e $epe"ie c# apatie-a4#(ie, negati)i"%, cae netatate coect "e
co%p(ic& e(ati) epe$e c# "in$o% $e i%o4i(i5ae, pacient#( $e)enin$ ca!ectic, incontinent
!i conf#5.
- Cic#%"tane p"i*ice >n cae )1"tnicii >!i i%p#n e"ticii $e %o4i(i5ae, c#% a fiI tea%a
eBageat& pe cae (e-a po)ocat-o o ci5& epi"o$ic& intega( e)e"i4i(&, )eti8e(e 4enigne,
atac#i(e i"c*e%ice tan5itoii, o c&$ee "o($at& c# o (e5i#ne o"teo-atic#(a& f&& ga)itate
?cont#5ie, ento"&@. Dac& n# "e inte)ine enegic, $a !i c# tact !i &4$ae, ace"t Cfa("
"in$o% $e i%o4i(i5aeE, a#toi%p#", poate $#ce "pe Cogani5aeaE i%o4i(i5aii !i $eci "pe
o in)a(i$itate ge# $e ea4i(itat.
- 6feci#ni 4enigne c# e)o(#ie "c#t&, "i%p(e in$i"po5iii, pot "ta (a 4a5a in"ta(&ii #n#i
"in$o% $e i%o4i(i5ae. 'acient#( "e ef#gia5& >n 4oa(&, ef#5& "& "e i$ice i%e$iat ce
epi"o$#( ac#tGin$i"po5iia a# tec#t !i #(teio n# "e %ai poate i$ica >nt#c1t fa("a
i%o4i(i5ae a $e)enit ea(&, pin "o%ati5ae.
In$ifeent $e ca#5e, "in$o%#( $e i%o4i(i5ae o$at& con"tit#it, ae o "i%pto%ato(ogie !i o e)o(#ie
4ine $ete%inate, c# patic#(ait&i in$i)i$#a(e, in f#ncie $e ca5 !i $e pato(ogia eBi"tent&. 0e
apecia5& c& inte)a(#( $e ti%p "c#" $e (a $e4#t#( i%o4i(i5&ii p1n& (a in"ta(aea in)a(i$it&ii e"te
>n %e$ie $e 2,2 (#ni c# (i%ite eBte%e >nte 1. 5i(e !i 2 ani. Fa%i(iaGant#a8#( conti4#ie, $e
%#(te oi, (a CfiBaeaE (a pat a pacient#(#i pin ap(icaea #nei teapii eBc(#"i)
fa%aco(ogice !i n# o Ccon$#it& eacti)i5atoaeE, $e "ti%#(ae, a8#toae a )1"tnic#(#i "& "e
%o4i(i5e5e.
Fn e)o(#ia "in$o%#(#i $e i%o4i(i5ae "e $e"ci# , g#pe $e "i%pto%eI p"i*ice, "o%atice !i
%eta4o(ice.
Si+pto+$ p'i=i&$
Ce(e %ai fec)ente "#ntI anBietatea, $epe"ia, $e5oientaea, $a !i $epen$ena ege"i)&,
infanti(&, %anife"tat& pin $e5intee", apag%ati"%, negati)i"%, p(1n", in"o%nie.
Si+pto+$ 'o+ati&$
Un "i%pto% i%potant cae "e in"ta(ea5& api$ !i poge"i), a$1ncin$ in)a(i$itatea, e"te
a%iotofia cae (i%itea5& iniia( %i!c&i(e acti)e, apoi %i!c&i(e pa"i)e, $#c1n$ (a in"ta(aea $e
etacii %#"c#(ae !i e$oi atic#(ae. 0in$o%#( $e)ine $#eo", "e in"ta(ea5& fica !i e5i"tena (a
%i!c&i, ceea ce >nteine i%o4i(i5aea.
6(te t#(4#&i "o%atice ce "e $e5)o(t& tot pe fon$#( i%o4i(i5&ii "#ntI (e5i#ni(e c#tanate,
$i%in#aea pei"ta(ti"%#(#i inte"tina( !i fa)oi5aea con"tipaiei !i a feca(o%#(#i, t#(4#&i
e"piatoii, cic#(atoii, infecii #inae !i p#(%onae.
S$+7$ +$ta(oli&$B
De%inea(i5aea o"oa"& !i o"teopoo5a con"ec#ti)&, negati)aea 4a(anei a5otate, pecipitaea
ca(c#(i(o #inai.
T)ata+$7tul 'i7,)o+ului ,$ i+o(ili>a)$
- e"te pe)enti) !i c#ati).
T)ata+$7tul p)$<$7ti< inc(#$e #%&toae(e pincipiiI
- Tata%ent#( 4o(ii ca#5a(e, iniiat $e #gen& !i contin#at >n "cop#( $ep&!iii fa5ei $e
$ec#4it o4(igatoii. Fnc& $in peioa$a $e ap(icae a teapiei inten"i)e, "e i%p#n %&"#i $e
N#"ing con)eniona( pent# pe)eniea co%p(icaii(o (egate $e i%o4i(i5ae !i an#%eI
- toa(eta pe egi#ni (a pat pent# %enineea pie(ii !i %#coa"e(o c#ate !i intacteL
- toa(eta ca)it&ii 4#ca(e !i a oc*i(o (a pacient#( incon!tient, 5i(nic, pent# pe)eniea
"to%atite(o !i a (e5i#ni(o coneeneL
- "c*i%4aea po5iiei (a inte)a( $e 2 oe 5i#a !i , oe noaptea, o4"e)1n$ !i %a"1n$
p#ncte(e $e "pi8in pent# acti)aea cic#(aieiL
- efect#aea $e %a"a8e (a ni)e(#( %e%4e(o infeioae pent# pe)eniea to%4o5e(o !i
%o4i(i5aea pa"i)& a atic#(aii(o pent# pe)eniea anc*i(o5e(oL
- conto(#( "finctee(o pin #ti(i5aea $e 'a%pe" "a# pin "on$& W $e%e#eL
- *i$ataea a$ec)at& a pacient#(#i pe ca(e paentea(& "a# entea(& p1n& (a e$o41n$iea
ef(eB#(#i $e $eg(#tiieL
- #ti(i5aea $e "a(te(e anti$ec#4it "a# 4(&nie "intetice $e oaie pent# pe)eniea
e"cae(o.
- CEgoteapie $e f#ncieE K c1n$ pacient#( $e)ine con!tient !i coopeant, cae con"t& >nI
- "ti%#(aea !i "pi8iniea pacient#(#i pent# a tece (a efect#aea ge"t#i(o coti$ieneI
toa(et&, a(i%entae, "c*i%4aea acti)& a po5iiei, teceea $in pat >n foto(i# pent#
peioa$e poge"i) ce"c1n$eL
- Oine5iteapie $e ec#peae c# #n "pecia(i"tL
- C1n$ fo%a ac#t& e"te (#ng& "a# 4oa(a a "#)enit pe #n teen c# %#(te a(te tae, (a #n "#4iect
$epi%at, ec*ipa $e >ngi8ie te4#ie "& ape(e5e, a(&t#i $e Oine5iteapie !i egoteapie, !i (a
p"i*oteapie $in patea #n#i "pecia(i"t c# eBpeien& >n geop"i*o(ogie.
T)ata+$7tul &u)ati<E 0e ap(ic& ce( %ai 4ine >n #nit&i(e "pecia(i5ate ?"e)icii $e conici,
con)a(e"cen& "a# po"t-c#&, ec#peae, geiatie@ cae a# con$iii(e nece"ae "& ap(ice %&"#i(e
$ifici(e $e teapie ec#peati)&. Tata%ent#( c#ati) "e efe& (aI
a@T)ata+$7tul +$,i&a+$7to' 9i i;i$7o4,i$t$ti&. 6e in$icaii genea(e !i "pecia(e pent#
fiecae pacient >n f#ncie $e "taea genea(&, $e 4o(i(e a"ociate, $e ga$#( a!a-5i"ei
C#5#i $e )1"t&E.
0e #%&e!te co%4ateea $en#tiiei pin apot $e poteine, )ita%ine, ana4o(i5ante, (ic*i$e,
coectaea t#(4#&i(o %eta4o(ice, conto(#( infecii(o #inae, coectaea ane%ii(o !i a
"t&i(o $e *ipecoag#(a4i(itate, acti)aea %eta4o(i"%#(#i ce(#(ei ne)oa"e pin
a$%ini"taea $e p"i*oenegi5ante.
4@ R$a(ilita)$a <@)'t7i&ului. 0e ap(ic& "#4ieci(o c# $eficiene fi5ice !i p"i*ice !i
pe"#p#neI
- $e5)o(taea ace(o capacit&i !i foe cae "& (e pe%it& in$epen$ena >n a#to"e)ie,
pent# ne)oi(e $e 4a5&L
- %o4i(i5aea $in pat >n foto(i#L
- %e"#( popi#-5i" "a# c# c18e, ca$# %eta(ic, 4a"ton.
Rea4i(itaea "e face at1t >n intee"#( )1"tnic#(#i c1t !i a( "ociet&ii, c*ia $ac& Ce"tit#tio a$
integ#%E n# %ai e"te po"i4i(&. Rea4i(itaea e"te "inoni%& c# a(i 2 factoiI ea$aptaea !i
ec#peaea.
Rea$aptaea pe"oane(o )1"tnice, >n )i5i#nea eBpei(o O90, ae >n )e$ee , aci#niI
- eacti)aea - pe"oana )1"tnic&, pa"i)&, i%o4i(i5at&, te4#ie >nc#a8at& "&-!i eia )iaa
coti$ian& >n %e$i#( "&# no%a(.
- ein"eia "ocia(& - $#p& 4oa(& "a# c*ia >n ti%p#( 4o(ii, )1"tnic#( eia contact#( c#
fa%i(ia, pietenii, )ecinii, >ncet1n$ "& %ai fie i5o(at.
- eintegaea - )1"tnic#( >!i eia (oc#( >n "ocietate, paticip& $in p(in (a )iaa no%a(&,
>!i eia a$e"ea acti)itatea pofe"iona(& "a# a(te acti)it&i coe"p#n5&toae capacit&ii
e"tante.
Rea4i(itaea geiatic& "e >ntin$e pe o peioa$& %ai (#ng&, $e /-2 (#ni !i o4(ig& (a o a4o$ae
inte$i"cip(ina&I %e$ica(&, p"i*i(ogic&, "ocio(ogic& !i e$#caiona(&.
2/.8 57&o7ti7$7*a u)i7a):
No iu7i i7t)o,u&ti<$
E"te o t#(4#ae f#nciona(& a apaat#(#i #ina >nt1(nit& fec)ent (a )1"tnici. 6(&t#i $e $e%en&
!i $e i%o4i(i5ae, incontinena #ina& epe5int& o ca#5& %a8o& $e in"tit#iona(i5ae.
Tatat& fie >n "pita( fie (a $o%ici(i#, incontinena #ina& a )1"tnic#(#i e"te #n feno%en >n ce!tee
cae nece"it& co"t#i i$icate pent# ec*ipa%ente(e #ti(i5ate, tata%ent#( e)ent#a(e(o co%p(icaii
ca !i pent# pe"ona(#( $e >ngi8ie.
E,u&a)$a pa&i$7tuluiDa7tu)aAului p$7t)u p)$<$7i)$a 9i t)ata+$7tul i7&o7ti7$7 $i u)i7a)$
9&"#i(e $e pe)enie a incontinenei #inae (a )1"tnici te4#ie "& in& "ea%a $e caactei"tici(e
anato%o-fi5io(ogice, p"i*o(ogice !i $e %o4i$itate a(e ogani"%#(#i )1"tnic. 6"tfe(, "e !tie c&
)1"tnicii a# o capacitate )e5ica(& %ai e$#"&, ia go(iea ace"teia "e face (a inte)a(e %ai "c#te
$ec1t (a a$#(t.
C1te)a a"pecte pactice te4#ie c#no"c#te at1t $e )1"tnic c1t !i $e ant#a8 pent# a pe)eni
incontinenaI
- go(iea co%p(et& a )e5icii >nainte !i $#p& %e"e, !i (a c#(caeL
- #inae $e c1te oi e"te ne)oieL
- $epin$eea $e a #ina (a fiecae 2 oe >n ti%p#( 5i(ei !i (a fiecae / oe noaptea, #ti(& >n
antena%ent#( )e5iciiL ace"t (#c# poate pe"#p#ne fo(o"iea #n#i cea" $e!tept&to
- "e 4ea >nte 1a - 2 ( (ic*i$e pe 5i >nainte $e oe(e 18,..L a8#t& (a f#ncionaea no%a(& a
inic*i(oL
- "e e(i%in& "a# e$#c con"#%#( $e cafea, ceai, Co(a !i a(coo( >nt#c1t a# efect $i#eticL
- $i#etice(e pe"ci"e "e ia# $i%ineaa, $#p& %ic#( $e8#nL
- "e (i%itea5& fo(o"iea "o%nifee(o, "e$ati)e(o !i a(coo(#(#i $eoaece "ca$ "en5aia $e
%ici#ne !i pot po$#ce incontinen& %ai a(e" noapteaL
- pe"oane(e "#papon$ea(e te4#ie "& "(&4ea"c&L
- "e fac facei eBeciii cae "& >nt&ea"c& %#!c*ii pe()ieni ce "#"in )e5ica #ina& ?fe%ei(e@L
- "e a"ig#ai c& toa(eta e"te apoape, #!o acce"i4i(& !i (#%inat& noapteaL pot fi nece"ae 4ae
$e "pi8in "a# o toa(et& "#pa>n&(at&L
- "e fo(o"e te (en8eie potectoae $e 4#%4ac, ta%poane igienice pent# fe%ei "a# "(ip#i
potectoae pent# 4&4ai $ac& e"te nece"aL
- 5i(nic "e ia )ita%ina C "a# "e con"#%& citice pent# a a8#ta (a aci$ifieea #inei !i a $i%in#a
i"c#( #nei infecii #inae.
M:'u)i ;$7$)al$ ,$ ?7;)iAi)$
- atit#$ine a$ec)at&. o(#( a"i"tent#(#i %e$ica( e"te $e a $a pe"oane(o %at#e info%aii
!i %i8(oace cae "& pe%it& ace"toa "&-"i %enin& conto(#( copoa(L
- acce"i4i(itatea toa(etei. e"te o inte)enie a$e"ea neg(i8at&. "e !tie c& cic#%"tane(e
$e %e$i# pot conti4#i (a incontinen& >n %&"#a >n cae $i"tana cae te4#ie pac#"& pe 8o"
e"te %ai %ae $ec1t ti%p#( $inte apaiia "en5aiei $e %ici#ne !i %ici#nea poi#- 5i"&.
ca5#i(e ne$ep(a"a4i(e )o fi "e)ite c# p(o"c& (a patL
- e)itaea co%p(icaii(o iatogene $ete%inate $e %e$ica%ente c# efecte a$)e"e pe
- )e5ic& !i #et&L
- (en8eie $e cop potectoae cae "& fo%e5e #n "tat potecto >nte pie(e !i %ateia(#(
#%e$L
- #ti(i5aea $e "a(te(e a4"o4anteL
- te*nici co%pota%enta(e - con"ta# >n poga%eea o4i!n#ine(o $e a fo(o"i toa(eta $#p&
#n oa fiB, eBeciii $e aten#ae a "en5aiei $e %ici#ne !i a "te"#(#i ca#5at $e incontinen&,
eBeciii Oege( $e >nt&ie a %#"c#(at#ii p(an!e#(#i pe()in !i a "fincte#(#i )e5ica(.
- >ngi8iea pie(ii, e"te e"enia(& >nt#c1t %enine intact& pi%a (inie $e ap&ae >%poti)a
infecii(o. 'ie(ea cae )ine >n contact c# #ina te4#ie "p&(at& !i apoi #"cat& co%p(et, $#p&
cae "e )a ap(ica #n "tat potecto (#4ifiant. N# )o fi neg(i8ai nici pacienii cae a#
>%4&c&%inte $e potecie ?'a%pe", "(ip potecto@.

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