Proceduri de Nursing Vol 1 Si 2

PROCEDURI DE NURSING vol 1
EX PONTO Constana - 2007

AUTORI:Udma Florica, tanci! "aria , R!#anda "atilda, $!li% Ecat%rina, Ianc! El%na, F%rcal& El%na
CO'A(ORATORI: Olar! )iorica, R&d!can! Oana, Cr%! l!liana , T&nas% Cristina,
RE*ACTARE: $!li% Ecat%rina, Toma Cristina , (idilic& "ir%la
I(N: +7,-+7--.//-702-0 01 A0CIA2IA *E NURIN$ *IN RO"3NIA

CUPRIN
CAPITO'U' I
45 Int%rnar%a 6i 7rimir%a 7aci%nt!l!i
4545 Int%rnar%a 7aci%nt!l!i
4525 Trans8%r!l 7aci%nt!l!i
45-5 E#t%rnar%a 7aci%nt!l!i
CAPITO'U' II
25 I9i%na 6i con8ort!l 7aci%nt!l!i
2545 c:im;ar%a l%n<%ri%i 7at!l!i n%oc!7at =8&r& 7aci%nt>
2525 c:im;ar%a l%n<%ri%i 7at!l!i oc!7at d% 7aci%nt!l imo;ili?at - c! ;olna@!l An 7o?ii% 6%?Bnd 6i An d%c!;it
25-5 c:im;ar%a al%?%i
25/5 c:im;ar%a l%n<%ri%i d% cor7 la 7aci%nt!l imo;ili?at - sc:im;ar%a 7i<amal%i
25C5 c:im;ar%a l%n<%ri%i d% cor7 la 7aci%nt!l imo;ili?at - sc:im;ar%a c&m&6ii
25.5 Toal%ta 7aci%nt!l!i imo;ili?at
25.545 (aia 7arial& la 7at
25.525 Dn9ri<ir%a oc:ilor
25.5-5 Dn9ri<ir%a m!coas%i na?al%
25.5/5 Dn9ri<ir%a !r%c:ilor
25.5C5 Dn9ri<ir%a ca@it&ii ;!cal%
25.5.5 Dn9ri<ir%a 7rot%?%lor d%ntar%
25.575 Dn9ri<ir%a !n9:iilor
25.5,5 Dn9ri<ir%a 7&r!l!i
2575 c:im;ar%a 7o?ii%i 7aci%nt!l!i imo;ili?at adinamic
25,5 "o;ili?ar%a 7aci%nt!l!i
25+5 Ca7tar%a %limin&rilor 8i?iolo9ic% 6i 7atolo9ic%
25+545 Ca7tar%a !rin%i
25+525 Col%ctar%a mat%riilor 8%cal%
25+5-5 Ca7tar%a s7!t%i
25+5/5 Ca7tar%a @&rs&t!rilor
CAPITO'U' III
-5 Alim%ntar%a 7aci%nt!l!i
-545 Alim%ntar%a acti@& 6i 7asi@&
-525 Alim%ntar%a 7rin 9astrostom&
-5-5 Alim%ntar%a 7rin sond& na?o9astric&
CAPITO'U' I)
/5 Control!l in8%ciilor nosocomial%
/545 7&lat!l mBinilor
/525 Am;r&car%a 6i d%?;r&car%a m&n!6ilor
/5-5 Control!l 7ara?itolo9ic 6i d%7ara?itar%a
CAPITO'U' )
C5 "&s!rar%a 6i Anr%9istrar%a 8!nciilor @ital%
C545 "&s!rar%a t%m7%rat!rii cor7!l!i
C525 "&s!rar%a r%s7irai%i
C5-5 "&s!rar%a 7!ls!l!i radial
C5/5 "&s!rar%a 7r%si!nii sBn9%l!i
C5C5 "&s!rar%a An&limii 6i 9r%!t&ii
CAPITO'U' )I
4
.5 Pansam%nt% 6i ;anda<%
.545 Pansam%nt!l
.525 Ti7!ri d% 7ansam%nt%
.5-5 (anda<% =Fi#ar%a 7ansam%nt!l!i>
CAPITO'U' )II
75 onda<%, s7&lat!ri, clism%
7545 A5 T!;a<!l na?o-9astric - introd!c%r%a sond%i
(5 T!;a<!l na?o-9astric - r%tra9%r%a sond%i
7525 T!;a<!l d!od%nal
75-5 onda<!l @%?ical la 8%m%i
75/5 onda<!l @%?ical la ;&r;at
75C5 7&l&t!ra @%?ical&
75.5 7&l&t!ra @a9inal&
7575 Clisma %@ac!atoar%
CAPITO'U' )III
,5 Administrar%a m%dicam%nt%lor
,545 Administrar%a m%dicam%nt%lor la ad!lt
,525 Administrar%a m%dicam%nt%lor la co7il
,5-5 Administrar%a m%dicam%nt%lor 7% s!7ra8aa t%9!m%nt%lor
,5/5 Administrar%a m%dicam%nt%lor 7% m!coasa con<!ncti@al&
,5C5 Administrar%a m%dicam%nt%lor 7% cal% na?al&
,5.5 Administrar%a m%dicam%nt%lor An cond!ct!l a!diti@ %#t%rn
,575 Administrar%a m%dicam%nt%lor 7% cal% @a9inal&
,5,5 Administrar%a m%dicam%nt%lor 7% cal% r%ctal&
,5+5 Administrar%a o#i9%n!l!i 7% sond&
,5405 Administrar%a m%dicam%nt%lor 7% cal% 7ar%nt%ral&
,540545 As7irar%a m%dicam%nt%lor din 8iol&
,540525 In<%cia intrad%rmic&
,5405-5 In<%cia s!;c!tanat&
,5405/5 In<%cia intram!sc!lar&
,5405C5 In<%cia intra@%noas&
CAPITO'U' IX
+5 R%coltar%a 7rod!s%lor ;iolo9ic% 6i 7atolo9ic% 7%ntr! %#am%n% d% la;orator
+545 R%coltar%a sBn9%l!i
+54545 "%tod% d% r%coltar%
a> P!ncia ca7ilar&
;> P!ncia @%noas&5
+54525 R%coltar%a sBn9%l!i 7%ntr! :%mol%!co9ram&
+545-5 R%coltar%a sBn9%l!i 7%ntr! 7ro;% d% coa9!lar%
+545/5 R%coltar%a sBn9%l!i 7%ntr! )E
+545C5 R%coltar%a sBn9%l!i 7%ntr! %#am%n% ;ioc:imic%
+545.5 R%coltar%a sBn9%l!i 7%ntr! %#am%n% s%rolo9ic%
+54575 R%coltar%a sBn9%l!i 7%ntr! %#am%n% ;act%riolo9ic%
+525 R%coltar%a !rin%i
+52545 R%coltar%a !rin%i 7%ntr! %#am%n!l s!mar
+52525 R%coltar%a as%7tic& a !rin%i =!roc!lt!ra>
+5-5 R%coltar%a mat%riilor 8%cal% 7%ntr! %#am%n% d% la;orator
+5/5 R%coltar%a %#!dat!l!i 8arin9ian
+5C5 R%coltar%a s7!t%i 7rin %#7%ctorai%
+5.5 R%coltar%a s%cr%i%i !r%tral% la ;&r;at
+575 R%coltar%a s%cr%iilor 7!r!l%nt% din l%?i!ni
2
CAPITO'U' I5
INTERNAREA I PRIMIREA PACIENTULUI
O(IECTI)E'E PROCE*URII
Primir%a 6i Int%rnar%a 7aci%nt!l!i An c%l mai sc!rt tim7 d% la sosir%a An UPU5
ta;ilir%a !n%i r%laii 7o?iti@% c! 7aci%nt!l sa! 0 6i a7arin&torii
O;in%r%a d% in8ormaii d%s7r% star%a d% s&n&tat% tr%c!t& 6i 7r%?%nt&, d%s7r% sist%m%l% 8!ncional%5 Asi9!rar%a
!n%i An9ri<iri d% calitat% con8orm c! n%@oil% si a6t%7t&ril% 7aci%nt!l!i 0 8amili%i5
PRE$FTIREA "ATERIA'E'OR
R%9istr! d% intr&ri al UPU
Plan!l d% An9ri<ir% 0 Foaia d% o;s%r@ai% clinic&
"at%rial% 6i instr!m%nt% 7%ntr! m&s!rar%a 8!nciilor @ital% 6i @%9%tati@% 6i 7%ntr! %#am%n!l 8i?ic: t%rmom%tr!,
t%nsiom%tr!, st%tosco7, s7at!l& lin9!al&, s!rs& d% l!min&, r%ci7i%nt, r%ci7i%nt 7%ntr! col%ctar%a !rin%i5
PRE$FTIREA PACIENTU'UI0 C'IENTU'UI
a> PIEICF:
O8%rii 7aci%nt!l!i 0 8amili%i in8ormaii clar%, d%s7r% n%c%sitat%a int%rn&rii5
O;in%i consim&mBnt!l in8ormat d% la 7aci%nt 0 8amili%5
;> FIGICF:
A6%?ai 7aci%nt!l An 7o?ii% con8orta;il& ada7tat& st&rii d% s&n&tat%,
Asi9!rai intimitat%a 7aci%nt!l!i5
Intr!d!c%i-@& c! n!m%l% 6i sta;ilii o r%lai% t%ra7%!tic& n!rs&-7aci%nt
O;s%r@ai 6i notai star%a 8i?ic&, %moional& 6i int%l%ct!al& a 7aci%nt!l!i5
O;s%r@ai di?a;ilit&il% sa! limit&ril% 8i?ic% sa! 0 6i 7si:ic%5
E@al!ai 9rad!l d% con8ort sa! discon8ort al 7aci%nt!l!i5
"&s!rai 9r%!tat%a 6i An&lim%a 7aci%nt!l!i5
A7r%ciai s%mn%l% @ital% 6i o;in%i o mostr& d% !rin&5
Fac%i in@%ntar!l ;!n!rilor d% @aloar% al% 7aci%nt!l!i con8orm c! 7olitica s%r@ici!l!i m%dical5
E8%ct!ai anamn%?& 6i o a7r%ci%r% n!rsin9 cat mai com7l%t& a 7aci%nt!l!i5
Id%nti8icai 7ro;l%m%l%, n%@oil% 6i a6t%7t&ril% 7aci%nt!l!i l%9at% d% int%rnar%5
E#7licai 7aci%nt!l!i 0 8amili%i, r%9!lam%nt!l 6i r!tin%l% s7ital!l!i - orar!l m%s%lor 6i al @i?it%lor5
In8ormai 7aci%nt!l d%s7r% 7roc%d!ril% sa! int%r@%niil% n%8amiliar%5
Com7l%tai 7lan!l d% An9ri<ir% a 7aci%nt!l!i c! in8ormaiil% o;in!t% : data 0 ora, n!m% 6i 7ron!m%, @Brst&, star%a
la int%rnar%, @aloril% 8!nciilor @ital%, ori%ntar%a An tim7 6i An s7ai!, m&s!ril% a7licat% la UPU, 7r%l%@&ril% d%
7rod!s% ;io7atolo9ic%, n!m%l% m%dic!l!i car% a 8&c!t int%rnar%a5
R%?!ltat% a6t%7tat%0dorit%:
- Paci%nt!l s% simt% ;in%@%nit, r%la#at 6i ar% Ancr%d%r% An %c:i7a m%dical&5
- C!l%9%r%a d% dat% %st% com7l%tat& An 7rim%l% 2/ or% sa! c:iar mai 7!in d% la int%rnar%5
- Familia s% simt% con8orta;il Antr!cBt 7aci%nt!l %st% An si9!ran&5
R%?!ltat% nod!ril% 0 C% 8ac%i
Paci%nt!l ar% !n ni@%l Analt d% an#i%tat% sa! d%?ori%ntar% car%-i am%nin& si9!rana5
- Com!nicai c! 7aci%nt!l
- Asi9!rai condiii o7tim% d% con8ort
Paci%nt!l sa! alt& 7%rsoan& s%mni8icati@& %st% inca7a;il& s& 8!rni?%?% in8ormaii d%s7r% istoric!l st&rii d% s&n&tat%5
- P!n%i Antr%;&ri sc!rt%, acc%si;il%
- C%rc%tai doc!m%nt%l% @%c:i An ca? d% r%int%rnar%
- Paci%nt!l r%8!?& int%rnar%a %#7rimBnd!-6i dorina d% a 7&r&si UPU An ci!da r%comand&rilor m%dical%
- Cons%mnai r%8!?!l 7aci%nt!l!i An doc!m%nt%l% m%dical% s!; s%mn&t!r&
TRANSFERUL PACIENTULUI
ta;ilir%a condiiilor o7tim% 7%ntr! trans8%r
Asi9!rar%a s%c!rit&ii 7aci%nt!l!i An 7%rioada trans8%r!l!i5
(il%t!l d% trans8%r, s%mnat 6i 7ara8at d% m%dic5
F5O5 a 7aci%nt!l!i, dac& %st% ca?!l5
-
Foaia d% %@id%n& 6i mi6car% ?ilnic& a s%ci%i5
E8%ct%l% 7aci%nt!l!i5
Alt% ;!n!ri d% @aloar% al% 7aci%nt!l!i, car% a! 8ost in@%ntariat% =acolo !nd% %st% ca?!l>5
a> PIEICF:
An!nai 7aci%nt!l08amilia d%s7r% n%c%sitat%a trans8%r!l!i 6i !nitat%a0s%cia d% trans8%r5
O;in%i consim&mBnt!l in8ormat al 7aci%nt!l!i08amilia
;> FIGICF:
E@al!ai star%a 8i?ic& 6i asi9!rai mi<loc!l d% trans7ort ad%c@at 7%ntr! trans8%r!l An si9!ran& al 7aci%nt!l!i5
EFECTUAREA PROCE*URII
O;in%i r%comandar%a m%dic!l!i5
Com!nicai c! !nitat%a0s%cia d% trans8%r 7%ntr! a sta;ili 7%rioada o7tim& d% trans8%r5
In8ormai 6i disc!tai c! 7aci%nt!l08amilia condiiil% a7ro7iat!l!i trans8%r5
Pr%9&tii l!cr!ril% car%-i a7arin 7aci%nt!l!i, ;il%t!l d% trans8%r sa!06i F5O5
Pr%9&tii mi<loc!l d% trans8%r ad%c@at 8otoli! r!lant, ;rancarda sa! c&r!cior!l r!lant5
Aco7%rii 7aci%nt!l 7%ntr! a-l 7rot%<a d% c!r%nii d% a%r, d% 8ri9 6i a %@ita %#7!n%r%a 7% d!rata trans7ort!l!i5
Dnsoii 7%rsonal 7aci%nt!l 7Bn& la s%cia sa! !nitat%a d% trans8%r5
Pr%?%ntai-l 7%rsonal!l!i d% An9ri<ir% cBnd a<!n9%i An s%cia0!nitat%a An car% s-a trans8%rat5
Pr%?%ntai asist%nt%i-6%8% dosar!l 7aci%nt!l!i sa!06i ;il%t!l d% trans8%r5
Notai n!m%l% m%dic!l!i cBnd trans8%r!l 7aci%nt!l!i s-a r%ali?at5
coat%i 7aci%nt!l din %@id%n%l% s%ci%i
E)A'UAREA EFICACITF2II PROCE*URII
- Paci%nt!l08amilia acc%7t& trans8%r!l d!7& c% 7rim%6t% in8ormaii clar%, acc%si;il%5
- Paci%nt!l %st% trans8%rai An condiii d% si9!ran&5
- Paci%nt!l %st% m!l!mit d% mod!l d% or9ani?ar% 6i d%s8&6!rar%, a trans8%r!l!i
R%?!ltat% n%dorit% 0 C% 8ac%i
- Paci%nt!l08amilia r%8!?& trans8%r!l,
- Cons%mnai r%8!?!l 7aci%nt!l!i08amili%i An 8oaia d% o;s%r@ai%, s!; s%mn&t!r&
- Paci%nt!l %st% n%m!l!mit d% mod!l d% or9ani?ar% 0 d%s8&6!rar% a trans8%r!l!i5
- *isc!tai c! 7aci%nt!l 6i %#7licai-i condiiil% d% r%ali?ar% a trans8%r!l!i
- Paci%nt!l s% simt% am%ninat 6i An n%si9!ran& An s%cia0!nitat%a An car% a 8ost trans8%rat
- Com!nicai ;lBnd c! 7aci%nt!l
- Asi9!rai-i !n climat d% Ancr%d%r% 6i si9!ran&
EXTERNAREA PACIENTULUI
ta;ilir%a condiiilor ad%c@at% st&rii 7aci%nt!l!i la %#t%rnar%5
Asi9!rar%a s%c!rit&ii 7aci%nt!l!i An tim7!l %#t%rn&rii5
R%9istr!l d% i%6iri al s%ci%i5
Foaia d% %@id%n& ?ilnic& 6i mi6car% a s%ci%i5
(il%t!l d% %#t%rnar% s%mnat 6i 7ara8at d% m%dic5
R%%ta m%dical&, dac& % ca?!l5
E8%ct%l% 7aci%nt!l!i 6i c%l%lalt% ;!n!ri d% @aloar% in@%ntariat% =acolo !nd% %st% ca?!l>,
a> PIEICF:
An!nai 7aci%nt!l 0 8amilia c! c%l 7!in 42 or% Anaint% d% %#t%rnar%5
Id%nti8icai im7act!l %moional 6i 7si:o-social 7% car% %#t%rnar%a Al ar% as!7ra 7aci%nt!l!i sa! 0 6i 8amili%i5
;> FIGICF:
E@al!ai star%a 8i?ic& la %#t%rnar% 6i asi9!rai mi<loc!l d% trans7ort ad%c@at ac%st!ia5
O8%rii indicaii l%9at% d%: 8ir%l% d% s!t!r& =dac& % ca?!l>, acti@itat%a 8i?ic&, indicaii, control
R%@%d%i d%taliil% %#t%rn&rii Am7r%!n& c! 7aci%nt!l 0 8amilia
Asistai 7aci%nt!l la i9i%n&, Am;r&car%5
/
R%@%d%i instr!ci!nil% 6i r&s7!ns!ril% la Antr%;&ril% l%9at% d% m%dicai%, An9ri<ir%a 8i?ic&, satis8ac%r%a n%@oilor5
*%t%rminai disa;ilit&il% 6i limit&ril% car% @or contin!a d!7& %#t%rnar%5
Id%nti8icai 7!nct%l% 8ort% al% 7aci%nt!l!i5
Fac%i !n in@%ntar al n%@oilor d% An9ri<ir% 6i asist%n& m%dical& la domicili! 6i l!ai l%9&t!ra c! o 8!ndai% d%
An9ri<iri la domicili! dac& %st% n%c%sar5
Or9ani?ai trans7ort!l 7aci%nt!l!i, la n%@oi%5
'!ai-@& la r%@%d%r% d% la 7aci%nt 0 8amili%5
coat%i 7aci%nt!l din %@id%n%l% s%ci%i5
- Paci%nt!l %st% m!l!mit d% An9ri<ir%a 7rimit&5
- tar%a 8i?ic& 6i 7si:ic& la %#t%rnar% %st% ;!n& 8iind o 7r%mis& a r%int%9r&rii socio-7ro8%sional%5
- Paci%nt!l 0 8amilia a! in8ormaii clar%, 7r%cis% d%s7r% An9ri<iril% !lt%rioar% la domicili! 6i d%s7r% n%c%sitat%a
7r%?%nt&rii la control An 7%rioada 7lani8icat& sa! An ca? d% com7licaii
- E#t%rnar%a ar% !n im7act n%9ati@ as!7ra 7aci%nt!l!i, mai al%s dac& %st% sin9!r 6i ar% n%@oi% d% An9ri<ir% la
domicili!5
- '!ai l%9&t!ra c! o 8!ndai% d% An9ri<iri la domicili!
- Familia 0 a7arin&torii s!nt inca7a;ili s& An9ri<%asc& 7aci%nt!l la domicili!5
- P!n%i-i An l%9&t!r& c! o 8!ndai% d% An9ri<iri la domicili!
- Paci%nt!l 0 8amilia r%8!?& %#t%rnar%a5
- Cons%mnai An 8oaia d% o;s%r@ai% r%8!?!l 7aci%nt!l!i08amili%i s!; s%mn&t!r&
CAPITOLUL II
IGIENA I CONFORTUL PACIENTULUI
SCHIMBAREA LENJERIEI DE PAT NEOCUPAT - fr pacient
O(IECTI)U' PROCE*URII
Asi9!rar%a condiiilor d% i9i%n& 6i d% con8ort5
C&r!cior 7%ntr! l%n<%ri%
"&n!6i d% !nic& 8olosin&
C%ar6a8 d% 7at
C%ar6a8 d% 7&t!r&07lic
Faa d% 7%rn&
P&t!r&
Al%?a, m!6ama =mat%rial im7%rm%a;il>
*o!& sca!n% c! s7%t%a?&
EFECTUAREA PROCE*URII =7artici7& do!& 7%rsoan%>
)%ri8icai mat%rial%l% al%s%
Trans7ortai mat%rial%l% An salon
Dnd%7&rtai no7ti%ra d% lBn9& 7at
A6%?ai c%l% do!& sca!n% c! s7&tar, s7at% An s7at% lBn9& 7at!l 7aci%nt!l!i, lat%ral, An 7art%a dr%a7t& s7r% ca7!l
7at!l!i
P!n%i sac!l 7%ntr! l%n<%ria m!rdar& An 7art%a o7!s& a 7at!l!i, la 7icioar%
A6%?ai mat%rial%l% 7r%9&tit% 7% c%l% do!& sca!n% ast8%l: 7&t!ra 6i c%ar6a8!l d% 7&t!r& 7liat% An armonicaH
m!6ama!a 6i al%?a r!lat% din do!& 7&ri %9al% 7Bn& la mi<locH c%ar6a8!l d% 7at r!lat la 8%lH 8aa d% 7%rn&5
Dnd%7&rtai l%n<%ria m!rdar& 6i introd!c%i-o An sac!l s7%cial 7r%9&tit
7&lai-@& 7% mBini, Am;r&cai m&n!6i
P!n%i c%ar6a8!l d% 7at 7%st% salt%a la mi<loc
Dntind%i c! o mBn& o 7art% a c%ar6a8!l!i s7r% ca7, iar c! c%alalt& s7r% 7icioar% =7art%a o7!s&>
Introd!c%i c%ar6a8!l adBnc s!; salt%a la ca7%t%l% 7at!l!i 6i c! mBna d% lBn9& 7at 7rind%i 7art%a li;%r& a
c%ar6a8!l!i la o distan& d% col %9al& c! l!n9im%a mar9inilor car% atBrn& 6i ridicai-o An s!s lBn9& =7at> salt%a
Introd!c%i s!; salt%a 7art%a din tri!n9:i!l 8ormat car% o d%7&6%6t%, a7oi l&sai An <os 7art%a ridicat& 6i introd!c%i
s!; salt%a r%st!l tri!n9:i!l!i Am7r%!n& c! 7art%a lat%ral& a c%ar6a8!l!i r%ali?Bnd !n 7lic
C
Proc%dai la 8%l 6i 7%ntr! c%l%lalt% col!ri
A6%?ai m!6ama!a 6i al%?a la mi<loc!l 7at!l!i 6i d%r!lai-l% ca 7% c%ar6a8!l d% 7at
Introd!c%i m!6ama!a 6i al%?a adBnc s!; salt%a 7% 7&ril% lat%ral% al% 7at!l!i
Intind%i c%ar6a8!l 7lic An l!n9im%a 7at!l!i 6i 7%st% %l 7&t!ra
Introd!c%i 7&t!ra An c%ar6a8 6i 8i#ai col!ril%
Fi#ai c%ar6a8!l 6i 7&t!ra la 7icioar%l% 7at!l!i introd!cBnd!-l% s!; salt%a
E8%ct!ai 7li!l d% con8ort =c! o mBn& d%as!7ra 7at!l!i iar c! c%alalt& d%d%s!;t, tra9%i s7r% 7icioar% 6i 8ormai
ac%ast& c!t&>
Aran<ai col!ril% d% la ca7&t!l distal al 7at!l!i s!; 8orm& d% 7lic
Introd!c%i 7&t!ra 6i c%ar6a8!l 7% 7&ril% lat%ral% al% 7at!l!i
P!n%i la ca7!l 7at!l!i 7%rna An8&6at&
REOR$ANIGAREA 'OCU'UI *E "UNCF
R%a6%?ai no7ti%ra la loc!l %i d% lBn9& 7at
P!n%i c%l% do!& sca!n% la loc
coat%i sac!l c! r!8% m!rdar% din salon
A%risii salon!l
Dnd%7&rtai m&n!6il%
7&lai-@& 7% mBini
NOTAREA PROCE*URII
Notai:
- 7roc%d!ra An 8i6a d% 7roc%d!ri 6i An dosar!l07lan!l d% An9ri<ir%
- data 6i ora
SCHIMBAREA LENJERIEI PATULUI OCUPAT DE PACIENTUL IMOBILIZAT - cu pacientu !n
p"#$ie %e#&n' %i !n 'ecu(it
Asi9!rar%a condiiilor d% i9i%n& 6i con8ort
E@itar%a com7licaiilor la 7aci%nt!l imo;ili?at
C&r!cior 7%ntr! l%n<%ri%
C%ar6a8 7lic
C%ar6a8 d% 7at
Fa& d% 7%rn&
Al%?a, m!6ama =mat%rial im7%rm%a;il>
Dn@%liloar% d% 8lan%l& sa! o 7&t!r& moal%
*o!& sca!n% c! s7&tar
"&n!6i d% !nic& 8olosin&
ac 7%ntr! r!8% m!rdar%
PRE$FTIREA PACIENTU'UI
a> PIEICF
In8ormai 7aci%nt!l 6i asi9!rai-l d% ino8%nsi@itat%a 7roc%d!rii
E#7licai 7aci%nt!l!i mod!l d% d%s8&6!rar% a 7roc%d!rii 6i contri;!ia sa la r%ali?ar%a ac%st%ia O;in%i
consim&mBnt!l in8ormat
;> FIGICF
)%ri8icai dac& s-a m&s!rat t%m7%rat!ra 6i 7!ls!l
c:im;ai l%n<%ria d!7& %8%ct!ar%a toal%t%i
Al%9%i m%toda d% sc:im;ar% An 8!nci% d% 7o?iia An car% 7oat% 8i a6%?at 7aci%nt!l 6i d% limit%l% sal% d%
mo;ili?ar%
EFECTUAREA PROCE*URII =7artici7& do!& 7%rsoan%>
A5 'a 7aci%nt!l car% s% 7oat% ridica An 7o?ii% 6%?and& =s% 8olos%6t% sc:im;ar%a An l&im%>
- Ad!c%i mat%rial%l% An salon
- Dnd%7&rtai no7ti%ra d% lBn9& 7at
- A6%?ai c%l% do!& sca!n% s7at% An s7at%
- Pr%9&tii mat%rial%l% ast8%l:
.
- R!lai c%ar6a8!l d% 7at 7% dim%nsi!n%a mic& =An l&im%> 6i a6%?ai-l 7% s7&tar%l% sca!n%lorH dac&
7aci%nt!l n%c%sit& al%?& 6i m!6ama r!lai-l% Am7r%!n& c! c%ar6a8!l
- Dnd%7&rtai 7&t!ra 6i l&sai 7aci%nt!l aco7%rit c! c%ar6a8!l sa! Anloc!ii c! o 7&t!r& moal%
- Introd!c%i 7&t!ra An c%ar6a8!l 7lic 6i Am7ac:%tai An armonic& An tr%i la Anc%7!t 7% l&im% 6i a7oi Anc& o
dat& r%d!cBnd c%l% do!& dim%nsi!ni =l!n9im%, l&im%> la o tr%im%, a6%?ai 7% sca!n
- Faa d% 7%rn&
- 7&lai mBinil% 6i Am;r&cai m&n!6i
- *%9a<ai c%ar6a8!l m!rdar d% s!; salt%a
- Aco7%rii 7aci%nt!l 6i ridicai-l An 7o?ii% 6%?Bnd&
- R!9ai 7%rsoana car% @& a<!t& s& s7ri<in% 7aci%nt!l
- Dnd%7&rtai 7%rna 6i r!lai c%ar6a8!l m!rdar 7Bn& a7roa7% d% 7aci%nt
- Po?iionai %c:idistant c%ar6a8!l c!rat la ca7&t!l 7at!l!i 6i 7% s!7ra8aa ac%st!ia 7%ntr! a 7!t%a 8i 8i#at s!; salt%a
- *%r!lai c%ar6a8!l c!rat 7Bn& a7roa7% d% c%l m!rdar
- c:im;ai 8aa d% 7%rn& 6i a6%?ai 7%rna 7% 7at
- C!lcai 7aci%nt!l An d%c!;il dorsal 6i r!9ai-l dac& 7oat% s& s% ridic% 7!in 7%ntr! a contin!a sc:im;ar%a
- Introd!c%i mBna dins7r% ca7!l 7aci%nt!l!i s!; r%9i!n%a 8%si%r& 6i ridicai An ac%la6i tim7 c! a<!tor!l
- C! c%alalt& mBn& r!lai s7r% 7icioar%l% 7aci%nt!l!i l%n<%ria m!rdar& 6i Antind%i c%ar6a8!l c!rat
- Ridicai An ac%la6i mod 7icioar%l% 6i contin!ai r!lar%a 6i r%s7%cti@ d%r!lar%a
- Introd!c%i c%ar6a8!l m!rdar An sac
- Dntind%i ;in% c%ar6a8!l d% 7at, %@%nt!al m!6ama!a 6i al%?a 6i 8i#ai s!; salt%a
B. La pacien!l ca"e n! #e poae "i$ica
=s% 8olos%6t% sc:im;ar%a An l!n9im%>
- R!lai c%ar6a8!l d% 7at Antr-o sin9!r& dir%ci%, 7% dim%nsi!n%a mar% =l!n9im%>
- A6%?ai mat%rial%l% 7% sca!n% ca 6i An ca?!l 7r%c%d%nt
- Dnd%7&rtai c%ar6a8!l m!rdar d% s!; salt%a
- Dntoarc%i 7aci%nt!l An d%c!;it lat%ral s7ri<inind!-l s!; a#il&, s!; !m%ri 6i la ni@%l!l 9%n!nc:ilor
- Tra9%i 7%rna s7r% mar9in%a 7at!l!i 6i a6%?ai-o s!; ca7!l ac%st!ia
- R!9ai 7%rsoana car% @& a<!t& s& s7ri<in% 7aci%nt!l s!sin%i-l amBndo!&
- R!lai c%ar6a8!l m!rdar 7Bn& lBn9& 7aci%nt 6i d%r!lai c%ar6a8!l c!rat a@Bnd 9ri<& s& 8i% ;in% 7o?iionat 7%ntr! a
7!t%a 8i 8i#at la ca7%t% 6i 7% lat!ri
- Ad!c%i 7aci%nt!l An d%c!;it dorsal a7oi An d%c!;it lat%ral 7% 7art%a o7!s& s7ri<inind ca7!l 7% ant%;ra
- Tra9%i 7%rna s!; ca7!l 7aci%nt!l!i
- Contin!ai r!lar%a c%ar6a8!l!i m!rdar 6i d%r!lar%a c%l!i c!rat
- Ad!c%i 7aci%nt!l An d%c!;it dorsal
- Dntind%i ;in% c%ar6a8!l c!rat 6i 8i#ai la ca7%t% 6i 7% mar9ini %#%c!tBnd col!l
- c:im;ai 8aa d% 7%rna
c:im;ar%a c%ar6a8!l!i 7lic An am;%l% sit!aii
- A6%?ai c%ar6a8!l c! 7&t!ra d%as!7ra 7aci%nt!l!i AncBt mar9in%a li;%r& d% d%s!;t s& 8i% s!; ;&r;ia ;olna@!l!i, iar
c%a d% d%as!7ra s& 8i% ori%ntat& s7r% 7icioar%l% 7aci%nt!l!i
- R!9ai 7aci%nt!l sa! o alt& 7%rsoan& s& in& mar9in%a c%ar6a8!l!i s!; ;&r;ia ac%st!ia 5 - As%?ai-@& d% o 7art%
a 7at!l!i, iar a<!tor!l d% c%alalt&
- Prind%i c! mBna dins7r% ca7!l 7aci%nt!l!i col!l li;%r al c%ar6a8!l!i c!rat, iar c! c%alalt& 7% c%l al c%ar6a8!l!i
m!rdar
- C! o mi6car% ra7id&, sincroni?at&, Antind%i c%ar6a8!l c!rat Am7r%!n& c! 7&t!ra 6i0sa! An@%litoar%a 6i And%7&rtai-l
7% c%l m!rdar
- )%ri8icai dac& c%ar6a8!l d% 7at 6i l%n<%ria d% cor7 s!nt ;in% Antins%
E8%ct!ai 7li!l d% con8ort la 7icioar%l% 7aci%nt!l!i 6i %@%nt!al 8i#ai s!; salt%a, s& n! al!n%c%
DN$RIIIREA PACIENTU'UI
- A6%?ai 7aci%nt!l An 7o?ii% comod& sa! An c%a r%comandat& d% a8%ci!n%a 6i star%a sa
- O;s%r@ai con8ort!l 6i m&s!rai 8!nciil% @ital%
- Dnd%7&rtai An@%litoar%a 6i aco7%rii 7aci%nt!l c! 7&t!ra
7
- Dnd%7&rtai sac!l c! r!8% m!rdar%
- R%a6%?ai no7ti%ra la loc!l %i d%as%m%n%a c%l% do!& sca!n%
- Dnd%7&rtai m&n!6il%, s7&lai-@& mBinil%
NOTAREA PROCE*URII
- Notai data, ora 6i m%toda 8olosit&
- *%scri%i r%acia 7aci%nt!l!i 6i star%a sa
- Cons%mnai oric% mani8%star% car% ar 7!t%a sc:im;a c%@a An 7lan!l d% An9ri<ir%
R%?!ltat% dorit%
- c:im;ar%a s-a 8&c!t An condiii ;!n%
- Paci%nt!l ar% o star% d% con8ort
R%?!ltat% n%dorit% 0 C% 8ac%8i
- Paci%nt!l ac!?& o;os%al&, d!r%ri
- '!crai ;lBnd, l&sai 7aci%nt!l!i tim7 d% odi:n&
- Paci%nt!l r%8!?& sc:im;ar%a:
- *isc!tai Anc& o dat& c! 7aci%nt!l
- A7%lai la a7arin&tori daca %st% ca?!l
SC%IMBAREA ALE&EI
O(IECTI)
- Asi9!rar%a condiiilor d% i9i%n&, d% con8ort 6i si9!ran&
- Al%?a c!rat&
- ac 7%ntr! l%n<%ri% m!rdar&
- Alcool
- Talc
- "&n!6i d% !nic& 8olosin&
PIEICF
- In8ormai, Anc!ra<ai 6i s!sin%i moral 7aci%nt!l
- E#7licai sco7!l 7roc%d!rii, %8%ct%l% ac%st%ia
- O;in%i consim&mBnt!l in8ormat
FIGICF
- As%?ai 7aci%nt!l An 7o?iia 7otri@it& An 8!nci% d% star%a sa
a> c:im;ar%a al%?%i la 7aci%nt!l car% s% 7oat% a<!ta
- R!lai al%?a c!rat& An laim%
- Ridicai 7&t!ra a6%?Bnd-o An tri!n9:i d% o 7art%
- R!lai al%?a m!rdar&
- Dntind%i c%ar6a8!l 6i mat%rial!l im7%rm%a;il
- *%r!lai al%?a c!rat& 8i#Bnd-o s!; salt%a
- Tr%c%i d% 7art%a o7!s& a 7at!l!i
- C%r%i 7aci%nt!l!i s&-6i ridic% tr!nc:i!l An arc dac& 7oat% sa! s!sin%i r%9i!n%a lom;ar& a 7aci%nt!l!i c! mBna
dins7r% ca7
- Tra9%i al%?a m!rdar& introd!cBnd-o An sac!l d% r!8% m!rdar%
- *%r!lai ra7id r%st!l al%?%i c!rat% 6i 8i#ai-o s!; salt%a d% 7art%a c%alalt& a 7at!l!i
- R%aran<ai 7at!l 7!nBnd tot!l An ordin%
;> c:im;ar%a al%?%i la 7aci%nt!l car% n! s% 7oat% a<!ta
- Proc%dai ca An ca?!l sc:im;&rii c%ar6a8!l!i d% 7at An l!n9im% = FIJA nr5 2525>
- Controlai star%a r%9i!nii sacral%, s% mas%a?& c! alcool si s% 7!dr%a?& c! talc
c> c:im;ar%a al%?%i Am7r%!n& c! mat%rial!l im7%rm%a;il
- Proc%dai ca An ca?!l sc:im;&rii l%n<%ri%i d% 7at c! 7aci%nt!l An d%c!;it lat%ral
- Pr%9&tii al%?a 6i m!6ama!a r!lBnd!-l% Am7r%!n& An laim%
- Introd!c%i l%n<%ria m!rdar& An sac!l s7%cial
,
- E8%ct!ai 7li!l d% con8ort la 7icioar%l% 7aci%nt!l!i =ac%sta da l%<%ritat% mi6c&rilor 7aci%nt!l!i 8ar& s& s%
d%?@%l%asc&>
- Introd!c%i 7&t!ra 6i c%ar6a8!l d% <!r Am7r%<!r!l 7at!l!i
- A6%?ai 7aci%nt!l An 7o?ii% comod&
- O;s%r@ai 8aci%s!l 7aci%nt!l!i 6i m&s!rai 7!ls!l
- Dntr%;ai 7aci%nt!l dac& %st% o;osit sa! dac& ar% d!r%ri
NOTAREA PROCE*URII:
Notai:
- Proc%d!ra An 7lan!l d% An9ri<ir% 6i An 8i6a d% 7roc%d!ri
- N!m%l% 6i 7r%n!m% 7%rsoan%i car% a %8%ct!at 7roc%d!ra
- *ata 6i ora, %@%nt!al% constat&ri 7ri@ind star%a t%9!m%nt%lor, control!l s8inct%r%lor
- Col%ctai l%n<%ria m!rdar& An co6
- R%a6%?ai no7ti%ra 6i sca!n%l% la loc!l lor
- coat%i sac!l c! l%n<%ri% m!rdar& din salon
- A%risii salon!l
- Dnd%7&rtai m&n!6il%
- 7alai-@& 7% mBini
R%?!ltat% dorit%
- Proc%d!ra 6i-a atins sco7!l
- Paci%nt!l!i i s-a asi9!rat con8ort!l n%c%sar
- Paci%nt!l %st% d%stins c! 8aci%s r%la#at, com7ortam%nt ad%c@at, simind!-s% An si9!ran&
R%?!ltat% n%dorit% 0 c% 8ac%i
- Paci%nt n%m!l!mit, mor&c&nos, 7r%?int& discon8ort din ca!?a a9itai%i, s-a! 8ormat c!t% car%-l d%ran<%a?&
- R%?%r@ai mai m!lt tim7 7%ntr! a sta d% @or;a c! 7aci%nt!l
- )%ri8icai c! 9ri<& l%n<%ria s& 8i% ;in% Antins&
- Paci%nt!l r%8!?& s& i s% sc:im;% al%?a
- A7%lai la n%@oi% la o 7%rsoan& s%mni8icati@& 7%ntr! ;olna@, car% s& @& a<!t% s& sta;ilii r%laii d%
cola;orar%5
SC%IMBAREA LEN'ERIEI DE CORP (N CA&UL PACIENTULUI IMOBILI&AT )I)
) Sc*i+,a"ea pi-a+alei)
- "%nin%r%a st&rii d% i9i%n& si con8ort
- Pr%@%nir%a %scar%lor d% d%c!;it
- Cr%6t%r%a d%mnitlii 7aci%nt&ii
- P&strar%a id%ntit&ii
- Pi<ama Anc&l?it&
- C!@%rt!r&
- P!dr& d% talc
- ac 7%ntr! l%n<%ria m!rdar&
a> PIEICF
- In8ormai 7aci%nt!l 6i %#7licaii-i n%c%sitat%a 7roc%d!rii
- E#7licai 7aci%nt!l!i c!m 7oat% 7artici7a la 7roc%d!r&
;> FIGICF
- Asi9!rai intimitat%a 6i r%s7%ctai 7!doar%a
- Dntr%;ai 7aci%nt!l dac& ar% n%@oi% d% 7losc& sa! !rinar inaint% d% 7roc%d!r&
- A6%?ai l%n<%ria c!rat& 7% !n sca!n An a7ro7i%r%a 7at!l!i
+
- O;in%i in8ormaii d%s7r% 7osi;ilit&il% d% mo;ili?ar% a 7aci%nt!l!i
- A7r%ciai r%s!rs%l% 8i?ic% al% 7aci%nt!l!i
- E#7licai-i 7roc%d!ra
- Pliai 7&t!ra la 7icioar%l% 7aci%nt!l!i
- Dn@%lii 7aci%nt!l c! !n 7l%d Anc&l?it
- 7&lai-@& mBinil%, Am;ricai m&n!6i d% ca!ci!c
a> *%?;r&car%a 6i Am;rac&r%a ;l!?%i la 7aci%nt!l car% s% 7oat% ridica An 7o?ii% 6%?Bnd&
- *%sc:%iai nast!rii 7i<amal%i
- Ridicai 7aci%nt!l An 7o?ii% 6%?Bnd&
- R!lai 7i<ama!a d% la s7at% s7r% c%a8& 6i tr%c%i-o 7%st% ca7 r!9Bnd 7aci%nt!l s& 8l%ct%?% ca7!l
- R!lai 8i%car% mBn%c& 6i Am;r&cai 7% rBnd ;ra%l%
- coat%i mBinil% An a8ara mBn%cilor
- Ridicai ;l!?a 7% s7at%l% ;olna@!l!i 6i Am;racai !m%rii
- Fricionai !6or s7at%l% 7aci%nt!l!i
- Dnc:%iai nast!rii
;> *%?;r&car%a 6i Am;r&car%a ;l!?%i la 7aci%nt!l car% n! s% 7oat% ridica
- *%sc:%iai nast!rii
- Dntoarc%i 7aci%nt!l An d%c!;it lat%ral 6i d%?;r&cai ;ra!l %li;%rat
- Dntoarc%i 7aci%nt!l An d%c!;it lat%ral in@%rs 6i d%?;r&cai c%l&lalt ;ra And%7&rtBnd ;l!?a
- "%nin%i 7aci%nt!l An d%c!;it lat%ral
- R!lai mBn%ca 6i Am;r&cai ;ra!l li;%r
- Dntoarc%i c! ;lBnd%% 7aci%nt!l An d%c!;it lat%ral in@%rs 6i Am;r&cai c%lalalt ;ra intin?Bnd ;l!?a 7% s7at%
- Ad!c%i 7aci%nt!l An d%c!;it dorsal
- Dnc:%iai nast!rii
c> Dnd%7&rtar%a 6i Am;r&car%a 7antalonilor
- Ridicai r%9i!n%a lom;osacrat& a 7aci%nt!l!i 6i tra9%i c! 9ri<& 7antalonii s7r% 7icioar%
- As%?ai 7aci%nt!l 7% 7at
- Ridicai !6or m%m;r%l% in8%rioar% 6i contin!ai d%?;r&car%a
- P!n%i 7antalonii m!rdari An sac
- O;s%r@ai as7%ct!l m%m;r%lor in8%rioar%
- R!9ai 7%rsoana car% @& a<!t& s& ridic% m%m;r%l% in8%rioar% al% 7aci%nt!l!i
- Dm;r&cai 7% rBnd 8i%car% m%m;r! 6i tra9%i 7antalonii 7Bn& a7roa7% d% 6%?!t
- Co;orBi 6i a6%?ai 7% 7at m%m;r%l% in8%rioar%
- Ridicai r%9i!n%a 8%si%r& 6i tra9%i An s!s 7antalonii
- )%ri8icai dac& c%ar6a8!l % ;in% Antins
- Dnc:%iai nast!rii
- O;s%r@ai 8aci%s!l, m&s!rai 7!ls!l
- R%8ac%i 7at!l 6i An@%lii 7aci%nt!l c! 7&t!r&
- )%ri8icai dac& 7aci%nt!l s% simt% ;in%
- And%7&rtai sac!l c! l%n<%ri% m!rdar&
- And%7&rtai An@%litoar%a
- And%7&rtai m&n!6il% 6i s7alai-@& mBinil%
NOTAREA PROCE*URII
Notai An 8i6a07lan!l d% An9ri<iri:
- 7roc%d!ra, data, ora
- oric% o;s%r@ai% l%9ata d% star%a 6i r%acia 7aci%nt!l!i
E)A'UAREA PROCE*URII
R%?!ltat% a6t%7tat%
- c:im;ar%a s-a 8&c!t 8&r& incid%nt%
- Paci%nt!l %#7rim& star%a d% con8ort, n! ar% d!r%ri
- N! s% o;s%r@& modi8ic&ri la ni@%l!l t%9!m%nt%lor
R%?!ltat% n%dorit% 0 C% 8ac%ri
40
- Paci%nt!l 7r%?int& %rit%m la ni@%l!l 7!nct%lor d% s7ri<in
- a7licai 7!dra d% talc
- sc:im;ai 7o?iia 7aci%nt!l!i
- Paci%nt!l r%clam& man%@r% ;r!tal% 6i o;os%al&, d!r%ri
- lini6tii 7aci%nt!l, r&mBn%i o @r%m% l&n9a %l
- administrai !n calmant dac& m%dic!l r%comand&
- '%n<%ria n! %st% ;in% Antins&, 7aci%nt!l ac!?& <%n&
- s% r%a6%a?& 7at!l d!7& sc:im;ar%a l%n<%ri%i, s% Antind ;in% c%ar6%a8!ril%
SC%IMBAREA LEN'ERIEI DE CORP (N CA&UL BOLNA.ULUI IMOBILI&AT )II)
) Sc*i+,a"ea c/+/0ii $e noape )
- "%nin%r%a st&rii d% i9i%na 6i con8ort
- Pr%@%nir%a %scar%lor d% d%c!;it
- Cr%6t%r%a d%mnit&ii 7aci%nt!l!i
- P&strar%a id%ntit&ii
- C&ma6a d% noa7t% Anc&l?it&
- C!@%rt!r&
- P!dra d% talc
a> PIEICF
- In8ormai 7aci%nt!l 6i %#7licai-i n%c%sitat%a 7roc%d!rii
- E#7licai 7aci%nt!l!i c!m 7oat% 7artici7a la 7roc%d!r&
;> FIGICF
- Asi9!rai intimitat%a 6i r%s7%ctai 7!doar%a
- Dntr%;ai 7aci%nt!l dac& ar% n%@oi% d% 7losc& sa! !rinar Anaint% d% 7roc%d!r&
- A6%?ai l%n<%ria c!rat& 7% !n sca!n An a7ro7i%r%a 7at!l!i
- O;in%i in8ormaii d%s7r% 7osi;ilit&il% d% mo;ili?ar% a 7aci%nt!l!i
- A7r%ciai r%s!rs%l% 8i?ic% al% 7aci%nt!l!i
- E#7licai 7roc%d!ra
- Pliai 7&t!ra la 7icioar%l% 7aci%nt!l!i
- Dn@%lii 7aci%nt!l c! o c!@%rt!r& Anc&l?it&
- 7&lai mBinil%
A5 'a ;olna@!l car% s% 7oat% ridica An 7o?ii% 6%?Bnd&
a> *%?;r&car%a c&m&6ii
- Ridicai 6%?!t!l 7aci%nt!l!i 6i tra9%i An s!s c&ma6a
- Ridicai a7oi 7aci%nt!l An 7o?ii% 6%?Bnd& dac& %st% 7osi;il
- R!lai c&masa 7Bn& la c%a8& 6i tr%c%i c&ma6a 7%st% ca7
- coat%i mBn%cil% 7rin co;orBr%a ;ra%lor
- Introd!c%i c&ma6a m!rdar& An sac!l d% r!8%
- O;s%r@ai 7!nct%l% d% s7ri<in
- P!drai c! talc
;> Dm;r&car%a c&m&6ii
- R!lai c&ma6a c!rat& d% la 7oal% c&tr% 9!l%r
- R!lai 7% rBnd 8i%car% mBn%c& 6i Am;r&cai ;ra%l%
- Tr%c%i c&ma6a c!rat& 6i cald& d%as!7ra ca7!l!i l&sBnd-o s& al!n%c% 7Bn& lBn9& 6%?!t
- Ridicai 6%?!t!l 6i Antind%i ;in% c&ma6a
- Dnc:%iai nast!rii
- Dntind%ti 6i 8i#ai ;in% c%ar6a8!l d% 7at
(5 'a ;olna@!l car% n! s% 7oat% ridica sc:im;ar%a s% 8ac% d% c&tr% do!a 7%rsoan%:
44
a> *%?;r&car%a c&m&6ii
- Ridicai 6%?!t!l introd!cBnd mBinil% s!; r%9i!n%a 8%si%r& 6i tra9%i cBt mai m!lt c&ma6a s7r% r%9i!n%a lom;ar&
- Dntoarc%i 7aci%nt!l c! ;lBnd%% An d%c!;it lat%ral 6i strBn9%i c&ma6a 7Bn& la a#il&
- R%ad!c%i 7aci%nt!l An d%c!;it dorsal, a7oi d%c!;it lat%ral d% 7art%a o7!s& 6i strBn9%i c&ma6a
- R%ad!c%i 7aci%nt!l An d%c!;it dorsal, ridicai !6or !m%rii 6i tra9%i c&ma6a 7%st% ca7
- *%?;r&cai ;ra%l%
- Dntrod!c%i c&ma6a m!rdar& An sac
;> Dm;r&car%a c&m&6ii
- R!lai c&ma6a d% la 7oal% s7r% 9!l%r
- R!lai 7% rBnd 8i%car% mBn%c& 6i Am;r&cai ;ra%l%
- Ridicai ca7!l 6i !m%rii 7aci%nt!l!i 6i tr%c%i c&ma6a 7%st% ca7
- Dntoarc%i c! ;lBnd%% 7aci%nt!l An d%c!;it lat%ral 6i Antind%i c&ma6a
- R%ad!c%i 7aci%nt!l An d%c!;it dorsal 6i a7oi d%c!;it lat%ral d% 7art%a o7!s& 6i 7roc%dai la 8%l
- A6%?ai 7aci%nt!l An d%c!;it dorsal, ridicai 6i Antind%i ;in% c&ma6a 6i Anc:%iai nast!rii
- Dntind%i 6i 8i#ai ;in% c%ar6a8!l d% 7at
- A6%?ai 7aci%nt!l An 7o?ii% comod& =sa! r%comandat& d% m%dic>
- O;s%r@ai 8aci%s!l 7aci%nt!l!i, m&s!rai 7!ls!l
- Dntr%;ai 7aci%nt!l dac& %st% o;osit sa! dac& ar% d!r%ri
- And%7&rtai An@%litoar%a 6i aco7%rii 7aci%nt!l c! 7&t!ra
- And%7&rtai sac!l c! l%n<%ri% m!rdar&
- And%7&rtai m&n!6il% 6i s7alai-@& mBinil%
NOTAREA PROCE*URII
- 7roc%d!ra, data, ora
- oric% o;s%r@ai% l%9at& d% star%a 6i r%acia 7aci%nt!l!i
R%?!ltat% a6t%7tat%
- c:im;ar%a s-a 8&c!t 8&r& incid%nt%
- Paci%nt!l %#7rim& star%a d% con8ort, n! ar% d!r%ri
-N! s% o;s%r@& modi8ic&ri la ni@%l!l t%9!m%nt%lor
- Paci%nt!l 7r%?int& %rit%m la ni@%l!l 7!nct%lor d% s7ri<in
- a7licai 7!dr& d% talc
- sc:im;ai 7o?iia 7aci%nt!l!i
- Paci%nt!l r%clam& man%@r% ;r!tal% 6i o;os%al&, d!r%ri
- lini6tii 7aci%nt!l, r&mBn%i o @r%m% l!n9a %l
- administrai !n calmant dac& m%dic!l r%comand&
- '%n<%na n! %st% ;in% Antins&, 7aci%nt!l ac!?& <%n&
- s% r%a6%a?& 7at!l d!7& sc:im;ar%a l%n<%ri%i, s% Antind ;in% c%ar6a8!ril%
O;s%r@aii:
- dac& ;olna@!l %st% incon6ti%nt, 8olosii o ;l!?& d% 7i<ama car% s& n! a<!n9& s!; r%9i!n%a 8%si%r& a
ac%st!ia
- d!7& sc:im;ar%a l%n<%ri%i d% cor7 a7licai 7% 7at al%?& 6i m!6ama
TOALETA PACIENTULUI IMOBILI&AT
BAIA PAR)IAL* LA PAT
- "%nin%r%a 7i%lii An star% d% c!r&%ni%
- Pr%@%nir%a a7arii%i l%?i!nilor c!tanat%
- Asi9!rar%a st&rii d% i9i%n& 6i con8ort a 7aci%nt!l!i 7rin s7&lar%a Antr%9!l!i cor7 7% r%9i!ni,d%sco7%rind 7ro9r%si@
n!mai 7art%a car% s% @a s7&la
- Para@an
42
- Jort d% !nic& 8olosin& 7%ntr! n!rs&0%
- "as& mo;il& 7%ntr! mat%rial%, aco7%rit& c! !n cBm7
- Tr%i 7rosoa7% d% c!lori di8%rit%
- "&n!6i d% ;ai% d% c!lori di8%rit% =8a&, tr!nc:i 6i m%m;r%, or9an% 9%nital%>
- &7!n n%!tr! 6i sa7!ni%r&
- P%rii d% !n9:ii
- Foar8%c% 7%ntr! !n9:ii 0 7il& d% !n9:ii
- P%ri% d% dini 0 7ast& d% dini
- Pa:ar 7%ntr! s7&lat 7% dini
- Pa:ar c! sol!i% antis%7tic& 7%ntr! 9ar9ar&
- 'i9:%an0;a?in c! a7& cald& 0 t%rmom%tr! d% ;ai%
- Plosc& =;a?in%t>, 9&l%ata 7%ntr! a7& m!rdar&
- "!6ama, al%?&
- C!@%rt!r& d% 8lan%l& 0!n c%ar6a8
- Alcool m%ntolat
- P!dr& d% talc
- *%odorant
- Pi<amal% 6i l%n<%ri% d% 7at c!rat%
a> PIEICF
- In8ormai 6i %#7licai 7aci%nt!l!i 7roc%d!ra
- ta;ilii d% com!n acord c! 7aci%nt!l ora %8%ct!&rii toal%t%i inBnd s%ama d% orar!l m%s%i, in@%sti9aiilor,
tratam%nt!l!i
- O;in%i consim&mBnt!l in8ormat 6i a8lai 7r%8%rin%l% sal% An l%9&t!r& c! i9i%na
;> FIGICF
- A7r%ciai star%a 7aci%nt!l!i 7%ntr! a %@ita o toal%t& 7r%a l!n9&, o;ositoar%
- *ac& star%a 7aci%nt!l!i Ai 7%rmit% Anc!ra<ai-l s& s7%l% sin9!r, asi9!rBnd!-i ind%7%nd%na 6i a<!tai-l doar la
n%@oi%
- Asi9!rai intimitat%a 7aci%nt!l!i
- Dntr%;ai 7aci%nt!l dac& dor%6t% s& i s% s%r@%asc& !rinar!l sa! 7losca
- Asi9!rai-@& c& t%m7%rat!ra din salon %st% 7%st% 20KC
- Asi9!rai-@& c& 9%am!ril% 6i !6a s& 8i% Anc:is% 7% tot tim7!l 7roc%d!rii
- A6%?ai 7ara@an!l An <!r!l 7at!l!i
- Um7l%i ;a?in!l 20- c! a7a cald& =-7KCL-,KC>, controlBnd t%m7%rat!ra a7%i c! t%rmom%tr!l d% ;ai%
- A6%?ai 7aci%nt!l An 7o?ii% d%c!;it dorsal
- *%?;r&cai 6i aco7%rii c! c%ar6a8 6i 8lan%l&
- Pliai 7&t!ra 6i a6%?ai-o 7% !n sca!n sa! 7% 7at la 7icioar%l% ;olna@!l!i
- *%sco7%rii 7ro9r%si@ n!mai 7art%a car% s% @a s7al&
- Dnd%7&rtai !na dintr% 7%rn%, iar 7% c%alalt& aco7%rii-o c! o m!6ama 6i c%ar6a8, sa! al%?a
- P!n%i An 8aa ;olna@!l!i !n 7roso7 7%ntr! a 7rot%<a An@%litoar%a
REPECTA2I OR*INEA DN CARE E )A EFECTUA TOA'ETA
FA2F JI $3T
- 7&lai-@& mBinil%
- Dm;r&cai 7rima m&n!6& d% ;ai%, !m%?iti-o, 6i s7&lai oc:ii d% la comis!ra int%rn& la c%a %#t%rn&H 8olosii 7ari
s%7arat% din m&n!6& 7%ntr! 8i%car% oc:i
- Jt%r9%i im%diat c! 7rim!l 7roso7
- 7&lai 8r!nt%a d% la mi<loc s7r% tBm7l%
- 7&lai c! mi6c&ri circ!lar% r%9i!n%a 7%rioral& 6i 7%rina?al&
- Insistai la !r%c:i An 6an!ril% 7a@ilion!l!i 6i r%9i!n%a r%troa!ric!lar&
- 7&lai c! 0 8&r& s&7!n, lim7%?ii d% cBt%@a ori c! a7& 6i 6t%r9%i im%diat
- 7&lai 9Bt!l, lim7%?ii
- Uscai 7rin tam7onar% c! 7roso7!l
4-
- c:im;ai a7a 6i m&n!6a
PARTEA ANTERIOARA A TORACE'UI
- 7&lai c! mi6c&ri 8%rm%, %@itBnd 9Bdilar%a 7aci%nt!l!iH insistai la a#il%
- 'im7%?ii 6i !scai 8oart% ;in%: 8olosii d%odorant, dac& 7aci%nt!l dor%6t%
- Insistai la 8%m%i, la 7li!ril% s!;mamar%
- O;s%r@ai r%s7iraia 7aci%nt!l!i 6i %@%nt!al% iritaii al% 7i%lii sa! alt% modi8ic&ri
- Aco7%rii torac%l% 6i m%m;r%l% s!7%rioar%
"E"(RE'E UPERIOARE
"!tai m!6ama!a 6i al%?a 6i intind%i-l% s!; Antr%9 m%m;r!l s!7%rior, d%s!7ra An@%litorii
- 7&lai 7rin mi6c&ri l!n9i 6i ;lBnd%H Anc%7%i d% la artic!laia 7!mn!l!i s7r% !m&r, stim!lBnd ast8%l circ!laia
@%noas&
- 'im7%?ii c! a7& 6i 6t%r9%i im%diat c! al doil%a 7roso7
- *aca %st% 7osi;il a6%?ai mBna 7aci%nt!l!i An ;a?in!l c! a7& cald&, 7%ntr! a t&ia mai !6or !n9:iil% sa! 7%ntr! a
l% c!raa: s7&lai mBna 7aci%nt!l!i c! s&7!n insistBnd An s7aiil% int%rdi9ital%: lim7%?ii c! a7& 6i !scai 8oart%
;in%5
- 7&lai c%lalalt m%m;r! s!7%rior d!7& ac%la6i 7rinci7i!5
A(*O"ENU'
*%?@%lii a;dom%n!l 7aci%nt!l!i
- Insistai la ni@%l!l 7li!rilor in9:inal%, !nd% datorit& trans7irai%i 6i li7s%i d% i9i%na a !nor 7%rsoan% 7ot a7&r%a
8oart% !6or iritaii al% 7i%lii5
- Insistai la ni@%l!l om;ilic!l!i car% la !nii 7aci%ni 7oat% 8i 8oart% m!rdarH 7roc%dai ast8%l:
a> And%7&rtai d%7o?it!l d% m!rd&ri% c! a<!tor!l !n!i tam7on d% @at& An;i;at An ;%n?in& 6i montat 7% !n
7orttam7on
;> s7&lai om;ilic!l c! a7& 6i s&7!n
c> !scai 8oart% ;in% 6i !n9%i r%9i!n%a c! @as%lin&
- Aco7%rii 7aci%nt!l c! c%ar6a8!l 6i 8lan%la
PARTEA POTERIOARF A TORACE'UI JI RE$IUNEA ACRATF
- A6%?ai 7aci%nt!l An 7o?ii% d% d%c!;it lat%ral, 8iind s!sin!t d% o alt& n!rs&
- "!tai m!6ama!a 6i al%?a 6i Antind%ti-l% s!; tr!nc:i!l 7aci%nt!l!i
- 7&lai, lim7%?ii 6i !scai r%9i!n%a
- "asai s7at%l% 7aci%nt!l!i c! alcool m%ntolatH o;s%r@ai 7ro%min%n%l% osoas% 6i @%ri8icai star%a 7i%lii An
7!nct%l% d% s7ri<in
- A7licai 7!dra d% talc Antr-!n strat 8oart% s!;ir%
- Aco7%rii s7at%l% 7aci%nt!l!i
- 7&lai r%9i!n%a anal& dins7r% 8a& s7r% s7at%, ast8%l AncBt s& %@itai contaminar%a r%9i!nii 7%rin%al%H lim7%?ii 6i
!scai 8oart% ;in% r%9i!n%a
- O;s%r@ai at%nt star%a 7i%lii An ?on%l% 7r%dis7!s% a7arii%i %scar%lor
"E"(RE'E INFERIOARE
- Dnloc!ii a7a, m&n!6a d% ;ai% 6i 7roso7!l c! alt%l% c!rat%
- Dntind%i m!6ama!a 6i al%?a s!; <!m&tat%a in8%rioar& a 7aci%nt!l!i
- R%ad!c%i 7aci%nt!l An d%c!;it dorsal,
- Insistai la ni@%l!l 9%n!nc:i!l!i, 7licii 7o7lit%%, An r%9i!n%a t%ndon!l!i l!i A:il% 6i a calcan%!l!i
- 7&lai c! a7& 6i s!7!n 7rin mi6c&ri ;lBnd% dins7r% 9l%?n& s7r% 6old 7%ntr! a stim!lacirc!laia @%noas&H
ATEN2IEM NU E "AEAGFM
- *!7& 8i%car% s&7!nir% lim7%?ii ;in% c! a7& 6i !scai c! 7roso7!l
- O;s%r@ai at%nt star%a 7i%lii An ?on%l% 7r%dis7!s% a7arii% %scar%lor
- 7&lai 7icioar%l% 7rin introd!c%r%a lor Antr-!n ;a?in c! a7&, a6%?at 7% 7atH 7rot%<ai 7at!l c! m!6ama!a, ac%ast&
m%tod& !6!r%a?& c!r&ir%a 6i t&i%r%a !n9:iilorM
- P!drai Antr-!n strat 8oart% s!;ir% 7licil% nat!ral%
- Taiai !n9:iil%
- Aco7%rii 7aci%nt!l c! c%ar6a8!l 6i 8lan%la
OR$ANE'E $ENITA'E JI RE$IUNEA PERIANA'F
Dnc:%i% toal%ta la 7at a 7aci%nt!l!iH dac& star%a 9%n%rala a 7aci%nt!l!i Ai 7%rmit%, ac%sta s% 7oat% s7&la sin9!r, An
tim7 c% asist%nta @a controla dac& s-a %8%ct!at cor%ct
- Dnloc!ii a7a, m&n!6a d% ;aia 6i 7roso7!l c! alt%l% c!rat%
4/
- Dm;r&cai m&n!6a d% !nic& 8olosin&
- A6%?ai ;olna@!l An 7o?ii% 9in%colo9ic&
- I?olai 7at!l c! m!6ama 6i al%?a 7% car% l% introd!c%i s!; r%9i!n%a sacrat&
- Introd!c%i 7losca s!; 7aci%nt
- Dm;r&cai m&n!6a d% ;ai% 7%st% m&n!6a d% ca!ci!c
- 7&lai r%9i!n%a 9%nital& dins7r% ant%rior s7r% 7ost%rior, %@itBnd r%9i!n%a anal&H 8olosii s&7!n n%!tr! =n%iritant
7%ntr! 7i%l% 6i m!coas%>
- 'im7%?ii c! a7& c!rat& 8oart% at%nt 7%ntr! And%7&rtar%a s&7!n!l!iH s% 7oat% 8ac% c! a<!tor!l
!n!i <%t d% a7& t!rnat dintr-o can&
- P!t%i 8olosi tam7oan% 6i o 7%ns& 7orttam7on, a@Bnd 9ri<& s& c!r&ai toat% 7li!ril% 6i s& sc:im;ai d%s
tam7oan%l% 7%ntr! a n! trans7orta 9%rm%ni dins7r% r%9i!n%a anal& s7r% c%a 9%nital&
- Dnd%7&rtai ;a?in%t!l d% s!; 7aci%nt 6i 6t%r9%i 8oart% ;in% or9an%l% 9%nital% 6i r%9i!n%a din <!r 8olosind al tr%il%a
7roso7
+N TIMPUL PROCEDURII E,AMINA)I TE-UMENTELE .I OBSER/A)I E/ENTUALE MODI0IC*RI
1RO.EA)*2 IRITA)IE3
- Fricionai c! alcool m%ntolat, An s7%cial r%9i!nil% 7r%dis7!s% la %scar%, 7%ntr! acti@ar%a circ!lai%i san9!in%
- c:im;ai l%n<%ria d% cor7 6i 7at 6i Antind%i ;in% 7&t!ra 7%ntr! a n! <%na 7aci%nt!l
- Aco7%rii 7aci%nt!l 6i asi9!rai-@& c& %st% Antr-o 7o?ii% d% con8ort 8i?ic 6i 7si:c
- !7ra@%9:%ai 8!nciil% @ital%
- *ac& 7aci%nt!l %st% 7!rt&tor d% sond% asi9!rai-@& c& s!nt 7%rm%a;il% 6i ;in% 7o?iionat%
- trBn9%i mat%rial%l% 8olosit% 6i l%n<%ria m!rdar& An r%ci7i%nt% s7%cial%
- C!r&ai mat%rial%l% An @%d%r%a d%?in8%ci%i 6i d%7o?it&rii
- Dnd%7&rtai m&n!6il% 6i s7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai
- *ata 6i ora %8%ct!&rii, n!m%l% 7%rsoan%i car% acorda An9ri<ir%a
- Oric% 8%l d% modi8ic&ri al% as7%ct!l!i 7i%lii 6i in8ormai m%dic!l
- "&s!ril% d% 7r%@%nir% al% %scar%lor
- Ni@%l!l d% 7artici7ar% al 7aci%nt!l!i la %8%ct!ar%a toal%t%i
- E@%nt!al%l% modi8ic&ri al% 8!nciilor @ital%
R%?!ltat% dorit%
- O;s%r@ai r%acia 7aci%nt!l!i la %8%ct!ar%a toal%t%i
- tar%a d% m!l!mir% 6i d% con8ort a 7aci%nt!l!i r&s7l&t%6t% 7% d%7lin m!nca d!mn%a@oastr&
- Paci%nt!l n! 7r%?int& modi8ic&ri al% t%9!m%nt%lor
R%?!ltat% n%dorit% 0 c% 8ac%iN
- Paci%nt!l ac!?& d!r%ri An tim7!l man%@r%lor
- '!crai ;lBnd, c! mi6c&ri l%nt% 6i com!nicai 7%rman%nt c! 7aci%nt!l
- R%?%r@ai-@& s!8ici%nt tim7 7%ntr! a n! a7%la la man%@r% 9r&;it%0;r!tal%
- Cons!ltai m%dic!l dac& 7oat% 8i administrat !n calmant
- Paci%nt!l 7r%?int& %rit%m la ni@%l!l 7!nct%lor d% s7ri<in 8iind 7r%dis7!s la %scar%
- ta;ilii m&s!ri concr%t% d% 7r%@%nir% 6i com;at%r%H a %scar%lor =masa<, sc:im;ar%a 7o?ii%i, 7!drar%a
c! talc, %tc5>
- Com!nicai in8ormaiil% s%mni8icati@% col%9%lor car% asi9!r& contin!itat%a An9ri<irilor
- Paci%nt!l 7r%?int& iritar% la ni@%l!l 7licilor
- E@itai trans7iraia 6i !m%?%ala
- A7licai !n9!%nt% r%comandat% d% m%dic
(NGRI'IREA OC%ILOR
O(EECTI)E'E PROCE*URII
- Pr%@%nir%a in8%ciilor oc!lar% 6i And%7nrtar%a s%cr%iilor
- "%nin%r%a oc:i!l!i !m%?it =corn%%a %#7!sa la 7aci%nii comato6i sa! 7arali?ai>
4C
- ol!i% d% s%r 8i?iolo9ic, sol!i% acid ;oric
- ol!i% d% )it5 A 6i 7ic!rator
- 'acrimi arti8icial% sa! !n9!%nt o8talmic, 7r%scris d% m%dic
- Tam7oan% d% ti8on 0 com7r%s% st%ril%
- Pansam%nt st%ril 6i ;and& ad%?i@& n%al%r9ic&
a> PIEICF
- In8ormai 7aci%nt!l 6i %#7licai n%c%sitat%a dac& ac%sta %st% cola;orant
;> FIGICF
- A6%?ai 7aci%nt!l An d%c!;it c! ca7!l !6or Antors s7r% oc:i!l car% @a 8i s7&lat 7rim!l
- E8%ct!ai An9ri<ir%a An cadr!l toal%t%i ?ilnic% sa! ind%7%nd%nt
- 7&lai-@& mBinil% 6i Am;r&cai m&n!6il%
- Dnd%7artai s%cr%iil% sa! cr!st%l% ad%r%nt% d% 9%n%07l%oa7% 7rin 6t%r9%r% !6oar& d% la comis!ra %#t%rn& s7r% c%a
int%rn& 8olosind !n tam7on st%ril Am;i;at An s%r 8i?iolo9ic
- Folosii !n no! tam7on st%ril 7%ntr! 8i%car% 6t%r9%r% 7Bn& cBnd oc:i!l %st% c!rat
- R%7%tai 7roc%d!ra 6i 7%ntr! c%lalalt oc:i AnclinBnd !6or ca7!l
- Instilai lacrimi arti8icial% sa! !n9!%nt o8talmic la indicaia m%dic!l!i
- R!9ai 7aci%nt!l s& Anc:id& oc:ii 6i a7oi a7licai sol!i% d% )it5 A 7% 7l%oa7%, 7rot%<Bnd ast8%l
7i%l%a 8ra9il&
- P%ntr! a m%nin% oc:ii !m%?ii, a7licai !n 7ansam%nt st%ril Am;i;at An s%r 8i?iolo9ic 6i 8i#aii
c! ;and& ad%?i@&H 7ansam%nt!l s% @a sc:im;a 8r%c@%nt
Dn ca?!l 7aci%nt!l!i comatos s% !rm%a?& ac%ia6i 7a6i d%scri6i mai s!s, n!rsa 8iind c%a car% @a d%sc:id% 7l%oa7a
7aci%nt!l!i, 8olosind cBt% o com7r%s& st%ril& 7%ntr! 8i%car% 7l%oa7&
- Instilai An sac!l con<!ncti@al cBt% o 7ic&t!r& d% @it5A d% 2ori0?i
- c:im;ai 8r%c@%nt 7ansam%nt!l
- R%7%tai An9ri<ir%a con8orm orar!l!i sta;ilit d% m%dic
- Col%ctai mat%rial%l% 8olosit% An r%ci7i%nt% s7%cial%, mai al%s dac& s%cr%iil% s!nt 7!r!l%nt%
- 7&lai mBinil%
NOTAREA PROCE*URII
- *ata, ora, sol!iil% m%dicam%ntoas% 8olosit%
- As7%ct!l s%cr%iilor, dac& s-a! r%coltat 7ro;% 7%ntr! %#am%n!l d% la;orator
R%?!ltat% a6t%7tat%
- Proc%d!ra s-a d%s8&6!rat 8&r& incid%nt%
- Corn%%a %st% !m%d&
- Paci%nt!l %st% a9itat, %#ist& risc d% l%?ar% a corn%%i
- 'ini6tii 7aci%nt!l 6i solicitai a<!tor
- N! @& a7ro7iai 7r%a m!lt d% oc:i!l 7aci%nt!l!i
- Paci%nt!l 7r%?int& cr!st%
- A7licai com7r%s% !m%?it%, c&ld!% 6i And%7&rtai a7oi c! ;lBnd%%
(NGRI'IREA MUCOASEI NA&ALE
- "%nin%r%a 7%rm%a;ilit&ii c&ilor r%s7iratorii s!7%rioar% 6i 7r%@%nir%a a7arii%i l%?i!nilor la 7aci%nii c! sonda
na?o8arin9ian& sa! na?o9astric&
- Dnd%7&rtar%a s%cr%iilor 6i cr!st%lor
4.
- Ta@& m%dical&
- Tam7oan% st%ril% montat% 7% ;%i6oar%
- ol!i% st%ril& d% s%r 8i?iolo9ic
- ol!i% d% a7& o#i9%nat& dil!at&
- Ta@i& r%nal&
- "an!al d% !nic& 8olosin&
a> PIEICF
- In8ormai 7aci%nt!l 6i r!9ai-l s& n! s% mi6t%
- E#7licai-i 7aci%nt!l!i cola;orant c!m 7oat% 7artici7a la %#%c!tar%a 7roc%d!rii
;> FIGICF
- A6%?ai 7aci%nt!l An d%c!;it dorsal
- R!9ai-l s&-6i Antoarc& !6or ca7!l Antr-o 7art%
- 7&l&i-@& mBinil% 6i Am;r&cai m&n!6il%
- C!r&ai 8i%car% 8os& na?al& c! cBt% !n tam7on st%ril Am;i;at An s%r 8i?iolo9ic
*ac& 7aci%nt!l 7r%?int& sonda na?o8arin9ian& sa! na?o9astric&:
O d%?li7ii rom7last!l c! car% %st% 8i#at& sonda
O r%tra9%i sonda cca C-.cm
O c!r&ai t!;!l c! !n tam7on d% !rm%l% d% rom7last
O And%7&rtai cr!st%l% d% 7% m!coasa na?al& c! !n tam7on !m%?it An E2O2H r%introd!c%i sonda 9astric&H sonda
7%ntr! o#i9%not%ra7i% s% 7oat% r%introd!c% An c%alalt& 8os& na?al&
O 8i#ai sonda
- Controlai 8!ncionalitat%a sond%lor d!7& c!r&ar%a m!coas%i na?al%
- !7ra@%9:%ai r%s7iraia 7aci%nt!l!i
- O;s%r@ai as7%ct!l m!coas%i
- trBn9%i mat%rial!l 8olosit An r%ci7i%nt% s7%cial%
- Dnd%7&rtai mBn!6il%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata 6i ora, o;s%r@aiil% 8&c!t%
- Ora r%introd!c%rii sond%i
R%?!ltat% a6t%7tat%
- Proc%d!ra s-a d%s8&6!rat 8&r& incid%nt%
- C&il% r%s7iratorii s!nt li;%r%, r%s7iraia s% 8ac% normal
- N! s!nt l%?i!ni 7% m!coas&
R%?!ltat% n%dorit% 0 C% 8ac%ti
- "!coasa na?al& sBn9%r%a?&
- In8ormati m%dic!l 7%ntr! a sta;ili cond!ita
- Acionai con8orm 7r%scri7i%i
(NGRI'IREA UREC%ILOR
- "%nin%r%a st&rii d% c!r&%ni% a 7a@ilion!l!i !r%c:ii 6i a cond!ct!l!i a!diti@ %#t%rn
- Dnd%7&rtar%a d%7o?it%lor nat!ral% =c%r!m%n> sa! a c%lor 7atolo9ic%
- Ta@a m%dical&
- Tam7oan% montat% 7% ;%isoar%
- Ta@ia r%nal&
47
- A7& 6i s&7!n
- "&n!6a d% ;ai%
- Proso7
a> PIEICF
- In8ormai 7aci%nt!l 6i %#7licai n%c%sitat%a 7roc%d!rii
;> FIGICF
- A6%?ai 7aci%nt!l An d%c!;it dorsal 6i r!9ai-l s&-6i Antoarc& !6or ca7!l Antr-o 7art%
- C!r&ai cond!ct!l a!diti@ %#t%rn c! !n tam7on !scat %#%c!tBnd c! ;lBnd%% mi6c&ri d% rotai% - C!r&ai 8i%car%
!r%c:% c! !n tam7on s%7arat
- 7&lai 7a@ilion!l !r%c:ii c! m&n!6a d% ;!m;ac c! s&7!n 6i insistai An 6an!ril% 7a@ilion!l!i 6i r%9i!n%a,
r%troa!ric!lara
- O;s%r@ai %@%nt!al% iritaii r%troa!ric!lar% sa! l%?i!nil% 7rod!s% 7rin com7r%si!n% la ;olna@ii imo;ili?ai
- 'im7%?ii 6i !scai ;in% c! 7roso7!l, cond!ct!l 6i 7a@ilion!l !r%c:ii
- Introd!c%i !n tam7on d% @at& a;sor;ant An cond!ct!l a!diti@ %#t%rn
- Asi9!rai con8ort!l 7aci%nt!l!i
- trBn9%i mat%rial!l 8olosit An r%ci7i%nt% s7%cial%
- Dnd%7&rtai-@& m&n!6il% 6i s7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai:
- *ata 6i ora, o;s%r@aiil% 8&c!t%
R%?!ltat% a6t%7tat%
- Paci%nt!l n! ac!?& discom8ort
- Paci%nt!l ac!?& d!r%ri
- Paci%nt!l 7r%?int& s%cr%ii otic%
- an!nai m%dic!l 7%ntr! a solicita !n cons!lt d% s7%cialitat% dac& %st% ca?!l
(NGRI'IREA CA.IT12II BUCALE
- Dnd%7&rtar%a 7l&cii ;act%ri%n%
- E@al!ar%a st&rii d% s&n&tat% oral&
- R%d!c%r%a 7osi;ilit&ilor d% in8%ci%
- Dnd%7&rtar%a 9!st!l!i 6i miros!l!i n%7l&c!t al ca@it&ii ;!cal%
- & 7romo@%?% con8ort!l 7aci%nt!l!i 6i %d!car%a ac%st!ia cBnd %st% 7osi;il
A5 'A (O'NA)U' CONJTIENT
- P%ri!a 7%rsonal&
- Pasta d% dini c! 8l!or
- Pa:ar c! a7a
- Ta@ia r%nal& =r%ci7i%nt> 7%ntr! a7a 8olosit&
- Aa d%ntar&
- J%r@%t%l% d% :Brti%, 7roso7, m!6ama
- A7a d% 9!r&, dac& % solicitat&
- Ta@a 7%ntr! mat%rial%
a> PIEICF
- In8ormai 7aci%nt!l 6i %#7licai n%c%sitat%a m%nin%rii i9i%n%i ca@it&ii ;!cal%
4,
- A7r%ciai r%s!rs%l% 8i?ic% al% 7aci%nt!l!i 7%ntr! a sta;ili mod!l d% 7artici7ar% a ac%st!ia, ca7acitat%a d%
a!tonomi%, star%a mintala
;> FIGICF
- A6%?ai 7aci%nt!l An 7o?iia ad%c@ata:
a> J%?Bnd 6i 7!n%i !n 7roso7 An <!r!l 9Bt!l!i, dac& star%a 7%rmit%
;> *%c!;it lat%ral c! ca7!l !6or ridicat 6i s7ri<init 7% o 7%rn& 7rot%<at& c! 7roso7
- Ad!c%i mat%rial%l% 7r%9&tit% lBn9& ;olna@
- A<!tai 7aci%nt!l s& s% a6%?% An 7o?ii% ad%c@at& st&rii sal%
- %r@ii 7aci%nt!l!i 7%ri!a c! 7asta 6i 7a:ar!l c! a7&
- !sin%i t&@ia r%nal& s!; ;&r;ia 7aci%nt!l!i sa! An a7ro7ri%r%a 8%%i ac%st!ia a6%?at& 7% 7%rna aco7%rit& c!
m!6ama 6i 7roso7
- 8&t!ii 7aci%nt!l s& 7%ri% dinii tim7 d% 2-- min!t% An s%ns @%rtical, 7% am;%l% 8%% 7%ntr! And%7&rtar%a
d%7o?it%lor sa! r%st!rilor d% alim%nt%
- In@itai 7aci%nt!l s&-6i cl&t%asc& 9!ra c! m!lt& a7& 6i la s8Br6it c! a7& d% 9!r& dac& dor%6t%
- O8%rii 7aci%nt!l!i a6%?at An d%c!;it o can& c! cioc sa! c! !n t!; d% s!cti!n%5
(5 'A (O'NA)U' INCONJTIENT
- P%ri!a 7%rsonala
- Pasta d% dini c! 8l!or
- Proso7
- Tam7oan% 7% 7orttam7on
- *%sc:i?&tor d% 9!r&
- Com7r%s% d% ti8on st%ril%
- A7a ;oricat&, 9lic%rin& ;ora#at& 2P, 9lic%rin& ;ora#at& c! stamicin
- 7at!l& lin9!al&
- Ta@i& r%nal&
- )as%lin& 7%ntr! ;!?%
- %rin9& 7%ntr! as7irar%a lic:id!l!i
- '!ai An consid%rar% dia9nostic!l, tratam%nt!l, di%ta
- O;s%r@ai star%a 7aci%nt!l!i 6i a7r%ciai n%@oia d% An9ri<ir%, star%a d% :idratar%, as7%ct!l ;!?%lor
- Paci%nt!l 8iind n%cola;orant, An9ri<ir%a s% r%ali?%a?& d% c&tr% n!rs&
FIGICF
- A6%?ai 7aci%nt!l An d%c!;it lat%ral, c! torac%l% !6or ridicatH dac& n! %st% 7osi;il Antoarc%-i ca7!l Antr-o 7art%
- Ad!c%i mat%rial%l% lBn9& 7aci%nt
- Prot%<ai 7%rna c! !n 7roso7 6i a6%?ai al&t!ri ta@ia r%nal& 6i o s%rin9a 7%ntr! as7irai%
- Dnd%7&rtai ma#ilar%l% c! a<!tor!l !n!i d%sc:i?&tor d% 9!r& 6i 8i#ai Antr% molarii din s7at% 7%ntr! a m%nin% 9!ra
d%sc:is&
- P%riai s!7ra8aa %#t%rn& a dinilor 8olosind o cantitat% mic& d% 7ast& 6i a7&
- As7irai c! s%rin9a lic:id!l 7%ntr! a n! a<!n9% An c&il% r%s7iratorii
- R%n!nai la 7ast& 6i 7%ri!& dac& %#ist& risc!l d% as7irar% An c&il% r%s7iratorii
- Folosii o s7at!l& lin9!al& 6i tam7oan% 7%ntr! a And%7&rta o;ra<ii 6i ;!?%l% 6i 7%ntr! a c!r&i m!coasa ;!cal&
- C!r&ai s!7ra8aa int%rn& a dinilor 6i lim;a, ;olta 7alatin& 8olosind tam7oan% c! 9lic%rin& ;ora#at&
- O;s%r@ai m!coasa oral&, star%a 9in9iilor 6i dinilor, lim;a
- ta;ilii An9ri<iril% !lt%rioar% An 8!nci% d% constatar%
- Un9%i ;!?%l% c! @as%lin&
- Asi9!rai 7aci%nt!l!i o 7o?ii% ad%c@at& An ra7ort c! star%a sa 9%n%ral&
- Asi9!rai :idratar% cor%s7!n?&toar% 7%ntr! a 7r%@%ni !scar%a ;!?%lor 6i m!coas%i ;!cal%
4+
- Dnd%7&rtai mat%rial%l% 8olosit% col%ctBnd An contain%r% s7%cial% 7% c%l% c! 7ot%nial d% in8%ci%
- Plasai o;i%ct%l% ;olna@!l!i An no7ti%r&
- 7&lai mBinil%5
NOTAREA PROCE*URII
- *ata, ora, sol!iil% 8olosit%
- As7%ct!l m!coas%i, %#ist%na %@%nt!al%lor l%?i!ni, sBn9%rar%a 9in9iilor, miros!l, d%7o?it%
R%?!ltat% a6t%7tat%
- Paci%nt!l n! 7r%?int& l%?i!ni la ni@%l!l m!coas%i ;!cal%
- N! s!nt s%mn% d% a7ariia candido?%i ;!cal%
R%?!ltat% n%dorit%0c% 8ac%tiN
- As7irar%a lic:id!l!i An cail% r%s7iratorii
- an!nai m%dic!l5
- '%?ar%a m!coas%i ;!cal% 6i dinilor c! d%sc:i?&tor!l sa! 7orttam7on!l
- '!crai c! at%ni%, solicitai a<!tor la n%@oi%
(NGRI'IREA PROTE&ELOR DENTARE
- "%nin%r%a i9i%n%i 7rot%?%i 6i a ca@it&ii oral%
- Pa:ar mat
- P%ri!&
- Pasta d% dini
R!9ai 7aci%nt!l con6ti%nt s&-6i scoat& 7rot%?a, s& o c!r%% 6i noa7t%a s& o 7!n& Antr-!n 7a:ar 7ro7ri!
n%trans7ar%nt
Asi9!rai intimitat%a ac%st!ia dac& s% <%n%a?& s&-6i scoat& 7rot%?a An 7r%?%na altor 7%rsoan%
Dn ca?!l ;olna@!l!i incon6ti%nt:
O Dm;r&cai m&n!6i d% !nic& 8olosin&
O Prind%i 7rot%?a c! o ;!cat& d% ti8on 6i And%7&rtai-o c! ;lBnd%%
O 7&lai 7rot%?a c! 7ast& 6i 7%ri!&
O P&strai 7rot%?a Antr-!n 7a:ar s7%cial, mat
O R%dai 7aci%nt!l!i 7rot%?a cBnd A6i r%ca7&t& star%a d% con6ti%n& - cl&tii 7rot%?a Anaint% d% a o r%da
(NGRI'IREA UNG%IILOR
% 8ac% An cadr!l ;&ii 7% r%9i!ni sa! s%7arat, d!7& ca? 7%ntr!:
- Dnd%7&rtar%a d%7o?it!l!i s!;!n9:ial
- E@itar%a l%?i!nilor 7rin 9rata< la 7aci%ni, c! 7r!rit
- O;in%r%a !n%i a7ar%n% An9ri<it% a 7aci%nt!l!i
- A7& 6i s&7!n, ;a?in =li9:%an>
- P%ri!& d% !n9:ii
- For8%c!& 6i 7il& d% !n9:ii
- Proso7, al%?&
- "&n!6i d% !nica 8olosina
a>PIEICF
- In8ormai 7aci%nt!l as!7ra n%c%sit&ii 7roc%d!rii
20
;> FIGICF
- A6%?ai 7aci%nt!l An 7o?ii% d% d%c!;it dorsal cBt mai comod
EFECTUAREA PROCE*URII:
- 7&lai-@& mBinil% 6i Am;r&cai m&n!6il%
- Introd!c%i mBna07icior!l 7aci%nt!l!i An ;a?in!l c! a7& calda 6i s&7!n 7%ntr! cca C min!t% - - A6%?ai a7oi
mBna0 7icior!l 7% !n 7roso7, tim7 An car% introd!c%i An ;a?in c%alalt& mBn& , r%s7%cti@ 7icior
- T&iai c! mar% at%ni% !n9:iil%, la ni@%l!l d%9%t!l!i, a7oi 7ilii-l%H 8ra9m%nt%l% t&iat% strBn9%i-l% 7% o ;!cat& d%
7Bn?& =al%?&> sa! !n 7roso7
E)ITA2I 'EGAREA 2EUTURI'OR A*IACENTE5
RIC *E INFEC2II - PANARI2II 'A *IA(ETICI5
- trBn9%i a7oi mat%rial!l 8olosit
- Dnd%7&rtai-@& m&n!6il% 6i s7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, o;s%r@aiil% 8&c!t%
- O;s%r@aii 7ri@ind c!loar%a, %@%nt!al%l% striai!ni, An9ro6&ri, modi8ic&ri d% 8orm&
R%?!ltat% a6t%7tat%
- Paci%nt!l %#7rim& star% d% con8ort
(NGRI'IREA P1RULUI
A5 DN$RIIIREA GI'NICF A PFRU'UI PRIN PIEPTFNARE
- "%nin%r%a i9i%n%i 7&r!l!i 6i a st&rii d% ;in% a 7aci%nt!l!i
- "%nin%r%a !n!i as7%ct 8i?ic 7l&c!t 6i 7&strar%a d%mnit&ii
- Pi%7t%n% 6i 7%ri% 7%rsonal%
- Clam%, 7an9lici
- Un 7roso7 sa! o al%?&
a> PIEICF:
- E#7licai 7aci%nt!l!i07aci%nt%i n%c%sitat%a m%nin%rii i9i%n%i 7&r!l!i
- E@al!ai r%s!rs%l% 7aci%nt!l!i07aci%nt%i 7%ntr! a sta;ili dac& A6i 7oat% 7i%7t&na sin9!r0sin9!r& 7&r!l sa! ar%
n%@oi% d% a<!tor
;> FIGICF:
- A6%?ai 7aci%nt!l07aci%nta Antr-o 7o?ii% An car%-i 7%rmit% star%a 9%n%ral& =6%?Bnd sa! d%c!;it lat%ral>
- Aco7%rii !m%rii sa! 7%rna c! !n 7roso7, o ;!cat& d% 7Bn?&, An 8!nci% d% 7o?iia 7aci%nt!l!i07aci%nt%i
- %r@ii 7aci%nt!l07aci%nta c! mat%rial%l% n%c%sar% 6i a<!tati-i s& s% 7i%7t%n% sin9!ri
- A6%?ai 7aci%nt!l07aci%nta Antr-o 7o?ii% con8orta;il&
- Aco7%rii !m%rii sa! 7%rna 7aci%nt!l!i07aci%nt%i c! !n 7roso7 sa! al%?&
- Dm;r&cai m&n!6i daca 7aci%nt!l 7r%?int& l%?i!ni la ni@%l!l scal7!l!i
- Pi%7t&nai 6i 7%riai 7&r!l sc!rt, 7% rBnd 7% 8i%car% 7art%
- Dm7&rii 7&r!l l!n9 sa! ;!clat An s!@i% 6i 7i%7t&nai dins7r% ca7&t s7r% r&d&cina 8ir!l!i d% 7&r
- Dm7l%tii 7&r!l l!n9 a@Bnd 9ri<& s& n! <%n%?% 7aci%nt!l07aci%nta cBnd st& An d%c!;it
- O;s%r@ai %@%nt!al%l% l%?i!ni al% scal7!l!i cBt 6i as7%ct!l 7&r!l!i
- A6%?ai 7aci%nt!l An 7o?ii% con8orta;il& =dac& %st% ca?!l>
- R%a6%?ai 7ar!l
- Dnd%7&rtai mat%rial%l% 8olosit% 6i %@%nt!al%l% 8ir% d% 7&r c&?!t%
NOTAREA PROCE*URII
Notai:
- Notai An 7lan!l d% An9ri<ir% %@%nt!al% l%?i!ni
24
R%?!ltat% a6t%7tat%:
- N! 7r%?int& l%?i!ni sa! 7ara?ii
- Paci%nt!l 7r%?int& 7ara?ii
- %8%ct!ai d%7ara?itar%a
- Paci%nt!l ar% !rm% d% sBn9% sa! alt% s!;stan%
Q n! t&iai 7&r!l d%cBt dac& %st% a;sol!t n%c%sarH o;in%i consim&mBnt!l
B. (NGRI'IREA &ILNICA A P1RULUI PRIN SP1LARE
- "%nin%r%a i9i%n%i 7&r!l!i 6i a st&rii d% ;in% a 7aci%nt!l!i
- Dnd%7&rtar%a %#c%s!l!i d% s%;!m
- 'i9:%an
- $&l%at& 7%ntr! col%ctar%a a7%i 8olosit%
- )as c! a7& cald&, t%rmom%tr! d% ;ai%
- &7!n lic:id06am7on
- "!6ama 6i al%?&
- Prosoa7%
- Usc&tor d% 7&r
- P%ri%, 7i%7t&n%
- Para@an
a> PIEICF:
- In8ormai 7aci%nt!l07aci%nta 6i sta;ilii d% com!n acord ora s7&l&rii
- E@al!ai r%s!rs%l% 7aci%nt!l!i07aci%nt%i 7%ntr! a 7!t%a a7r%cia contri;!ia ac%st!ia5 O;in%i consim&mBnt!l5
;> FIGICF:
- Asi9!rai 7o?iia An 8!nci% d% star%a 9%n%ral&:
4> 6%?Bnd, 7% sca!n c! s7at%l% sa! c! 8aa s7r% la@oar =sa! An 7icioar% a7l%cat d%as!7ra la@oar!l!i
2> 6%?Bnd 7% !n sca!n c! s7&tar al&t!ri d% car% s% a6%a?& al 2-l%a sca!n 7% car% s% 7!n% li9:%an!l
-> d%c!;it dorsal c! torac%l% !6or ridicat 6i c! salt%a!a Andoit& s!; torac% l&sBnd somi%ra li;%r& s7r% ca7&t!l
7at!l!i
/> d%c!;it dorsal, ori%ntat o;lic, c! ca7!l s7r% mar9in%a 7at!l!i
- Asi9!rai-@& c& t%m7%rat!ra din salon %st% d% 7%st% 20KC, 9%am!ril% 6i !6a s!nt Anc:is%
- Asi9!rai intimitat%a i?olBnd 7at!l c! !n 7ara@an
- 7&lai mBinil% 6i Am;r&cai m&n!6il%
- Proc%dai An contin!ar% An 8!nci% d% 7o?iia al%as& 6i star%a 7aci%nt!l!i
C! 7aci%nt!l An 7o?ii% 6%?Bnd
- A6%?ai 7aci%nt!l 7% !n sca!n sa! An 8aa la@oar!l!i
C! 7aci%nt!l An 7o?ii% d% d%c!;it
- R!lai salt%a!a 6i aco7%rii c! m!6ama 6i al%?& 7% car% s% s7ri<in& s7at%l% 6i ca7!l 7aci%nt!l!i 0 7aci%nt%i5
- A6%?ai li9:%an!l 7% 7art%a d% somi%r& r&mas& li;%r& 6i introd!c%i ca7&t!l li;%r al m!6amal%i 8&c!t s!l An
9&l%ata 7%ntr! a 7%rmit% sc!r9%r%a a7%i
- A6%?ai 7aci%nt!l07aci%nta o;lic 7% 7at c! ca7!l s7r% mar9in%5 Introd!c%i s!; ca7!l 6i !m%rii
7aci%nt!l!i07aci%nt%i m!6ama!a 6i al%?a5 A6%?ai 9&l%ata 7%ntr! col%ctar%a a7%i m!rdar% An @%cin&tat%a 7at!l!i 6i
introd!c%i ca7&t!l li;%r al m!6amal%i 8&c!t s!l
- !sin%i c! o mBn& =dac& %st% ca?!l> ca7!l 7aci%nt!l!i, iar c! c%alalt& !m%?ii 6i 6am7onai 7&r!l5 A7%lai la
a<!tor!l alt%i 7%rsoan% =dac& %st% n%c%sar>
- "asai !6or 7i%l%a ca7!l!i c! @Br8!l d%9%t%lor 6i s7&lai d% 2-- ori
- 'im7%?ii c! m!lt& a7&
- Aco7%rii 7&r!l c! !n 7roso7 cald 6i 6t%r9%i ;in%
22
- A<!tai 7aci%nt!l07aci%nta s& s% a6%?% An 7at
- )%ri8icai dac& %st% ca?!l 8!nciil% @ital%
- E@itai c!r%nii d% a%r
- Aco7%rii ca7!l 7aci%nt!l!i07aci%nt%i dac& %st% n%c%sar sa! solicit&
- Dnd%7&rtai a7a m!rdar& 6i mat%rial%l% 8olosit%
- C!r&ai 6i d%?in8%ctai mat%rial%l% 8olosit%, as%?ai-l% la loc!l d% 7&strar%
- Dnd%7&rtai m&n!6il% 6i s7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- Notai An 7lan!l d% An9ri<ir% data, o;s%r@aiil% 8&c!t%
R%?!ltat% a6t%7tat%
- N! 7r%?int& l%?i!ni al% scal7!l!i
R%?!ltat% n%dorit% 0 C% 8ac%iN
- Paci%nt!l 7r%?int& l%?i!ni al% scal7!l!i:
- in8ormai m%dic!l, %@%nt!al s% @a cons!lta !n d%rmatolo9
SC%IMBAREA PO&I2IEI PACIENTULUI IMOBILI&AT3 ADINAMIC
- Pr%@%nir%a com7licaiilor =%scar%, trom;o?%, Anc%tinir%a tran?it!l!i>
- Promo@ar%a st&rii d% con8ort
- P%rn%
- P&t!ra 8&c!t& s!l, s!l!ri din mat%rial% t%#til%
- 7ri<initor 7%ntr! 7icioar% sa! sac d% nisi7
- In8ormai 7aci%nt!l as!7ra n%c%sit&ii sc:im;&rii 7o?ii%i
- E#7licai 7aci%nt!l!i im7ortana sc:im;&rii 7o?ii%i la an!mit% int%r@al% d% tim7
Partici7& 4 sa! 2 7%rsoan%, !na a@Bnd rol d% coordonator
A.
45 c:im;ar%a 7o?ii%i din d%c!;it dorsal An d%c!;it lat%ral
- Id%nti8icai 7aci%nt!l 6i %@al!ai r%s!rs%l% ac%st!ia
- Ad!c%i mat%rial%l% a!#iliar% lBn9a 7at
- As%?ai-@& d% 7art%a 7at!l!i s7r% car% Antoarc%i 7aci%nt!l
- Ridicai 7&t!ra 6i 7liai-o s7r% 7art%a o7!s&
- Prind%i c! mBna dins7r% ca7 !m&r!l 7aci%nt!l!i, ridicai-l c! ;lBnd%% 6i introd!c%i 7&t!ra s!; s7at% =sa! !n
s!l> 7%ntr! a-l s7ri<ini
- !sin%i torac%l% 7aci%nt!l!i 7%ntr! a-i asi9!ra sta;ilitat% 6i c! mBna dins7r% 7icioar% rotai ;a?in!l 6i m%m;r%l%
in8%rioar%
- 7ri<inii s7at%l% 7aci%nt!l!i c! !n s!l d% c%ar6a8
- Fl%ctai m%m;r!l in8%rior d% d%as!7ra 6i introd!c%i s!; %l o 7%rna
- Aco7%rii 7aci%nt!l c! 7&t!ra 6i an!ntai-l cBnd @a 8i o no!& sc:im;ar%
25 c:im;ar%a 7o?ii%i din d%c!;it lat%ral An d%c!;it dorsal
- A6%?ai-@& d% 7art%a 7at!l!i s7r% car% %st% ori%ntat s7at%l% 7aci%nt!l!i 6i r!9ai o 7%rsoan& s& @& a<!t%
- Prind%i 7aci%nt!l d% s!; a#il& 6i s7ri<inii-i ca7!l 7% ant%;ra
- R!9ai a<!tor!l s& introd!c& o mBn& s!; ;a?in!l 7aci%nt!l!i ,
- incroni?ai-@& mi6c&ril% 6i %#%c!tai o mi6car% d% rotai% ad!cBnd 7aci%nt!l An d%c!;it dorsal
- Introd!c%i s!; r%9i!n%a lom;ar& 6i s!; 9%n!nc:i 7%rn!% s!;iri sa! mat%rial% t%#til% Am7&t!rit% 7%ntr! a
r%s7%cta c!r;!ra 8i?iolo9ic& a coloan%i 6i 7%ntr! a %@ita :i7%r%#t%nsia m%m;r%lor
- Dntind%i l%n<%ria d% cor7 6i d% 7at
- Aco7%rii 7aci%nt!l
2-
- An!nai ora !rm&toar%i sc:im;&ri
B.
45 c:im;ar%a 7o?ii%i din d%c!;it dorsal An 7o?ii% 6%?Bnd
a> d% c&tr% o sin9!r& 7%rsoan&
- Dndoii07liai 7&t!ra 6i d%?@%lii 7aci%nt!l 7Bn& la mi<loc
- As%?ai-@& 8a& An 8a& c! 7aci%nt!l, r!9Bnd!-l s& Antoarc& 7!in ca7!l Antr-o 7art%
- Prind%i c! o mBn& r%9i!n%a a#ilar&
- Dm;r&i6ai c! c%alalt& mBn& s7at%l% 7aci%nt!l!i s7i<inind!-i ca7!l 7% ant%;ra
- R!9ai 7aci%nt!l car% ar% r%s!rs% 8i?ic% s& @& 7rind& d% !m%ri, s&-6i 8l%ct%?% 9%n!nc:ii 6i s& s% s7ri<in% 7% t&l7i
- Comandai mi6car%a d% ridicar% 8olosind !n c!@Bnt d% And%mn =d%5 E#5 Rs!sR>
- A<!tai 7aci%nt!l s& s% ridic% An tim7 c% s% s7ri<in& 6i d%7lasai-l !6or s7r% ca7!l 7at!l!i
- 7ri<inii s7at%l% c! 7%rna sa! c! r%?%m&tor!l mo;il al 7at!l!i
- Asi9!rai m%nin%r%a 7o?ii%i introd!cBnd !n s!l s!; 9%n!nc:i 6i 7!nBnd la t&l7i !n s7ri<initor sa! !n sac d%
nisi7
;> d% catr% do!& 7%rsoan%
- As%?ai-@& d% o 7art% 6i d% alta a 7at!l!i
- Dncr!ci6ai ant%;ra%l% 7% s7at%l% 7aci%nt!l!i
- Introd!c%i c%alalt& mBn& An a#il&
- Comandai mi6car%a d% ridicar% 6i %#%c!tai-o An ac%la6i tim7
- Fi#ai 7o?iia c! 7%rn% sa! c! r%?%m&tor!l mo;il
25 R%a6%?ar%a 7aci%nt!l!i An d%c!;it dorsal din 7o?iia 6%?Bnd
- Dnd%7&rtai 7%rn%l% 6i s!l!ril%
- Prind%i 7aci%nt!l ca 6i An ca?!l ridic&rii
- 'asai !6or 7% s7at%
- R%a6%?ai 7at!l, Antind%i l%n<%ria
- Fi#ai s!l!ril% s!; r%9i!n%a lom;ar& 6i 9%n!nc:i
C5 R%ad!c%r%a 7aci%nilor al!n%cai din 7o?ii% s%mi6%?Bnd sa! 6%?Bnd
- R!9ai 7aci%nt!l s& Antoarc& 8aa s7r% 7art%a o7!s&
- R!9ai-l s& s% s7ri<in% 7% t&l7i 6i s& s% ridic% 7!in la comand&
- Introd!c%i mBna s!; a#il% 6i cond!c%i mi6car%a d% ridicar% a<!tBnd 7aci%nt!l s& s% d%7las%?% !6or s7r% ca7&t!l
7at!l!i
a> daca a@%i !n a<!tor
- A6%?ai-@& d% o 7art% 6i d% alta a 7at!l!i
- Prind%i c! o mBn& din a#il& sa! Ancr!cisai ant%;ra%l% 7% s7at%l% 7aci%nt!l!i
- Introd!c%i c%alalt& mBn& s!; r%9i!n%a 8%si%r& a 7aci%nt!l!i 6i acionai sincron la comand& ridicBnd 7aci%nt!l
7Bn& la ni@%l!l dorit
- Asi9!rai-@& c& 7aci%nt!l %st% r%la#at, s% simt% ;in%5
- )%ri8icai l%n<%ria 6i mat%rial%l% a!#iliar% 8olosit% s& n! <%n%?% 7aci%nt!l
- )i?itai 7aci%nt!l Antr% do!& sc:im;&ri 7%ntr! a @%d%a dac& ac!?& d!r%r%
- "&s!rai dac& %st% ca?!l: 7!ls!lH TAH r%s7iraia
- Dnd%7&rtai mat%rial%l% in!til%
NOTAREA PROCE*URII
- Notai orar!l sc:im;&rii 7o?ii%i 6i com7ortam%nt!l 7aci%nt!l!i An tim7!l 7roc%d!rii
- Notai as7%ct!l t%9!m%nt%lor la ni@%l!l 7!nct%lor d% s7ri<in
R%?!ltat!l a6t%7tat
- Paci%nt!l %#7rim& star% d% ;in%, n! s!nt modi8ic&ri t%9!m%ntar% An 7!nct%l% d% 7r%si!n% 6i al @alorilor 8!nciilor
@ital%
R%?!ltat n%a6t%7tat 0 C% 8ac%i
- Paci%nt!l ac!?& man%@r% ;r!tal% car%-i 7ro@oac& d!r%ri
- Com!nicai c! 7aci%nt!l 7%ntr! a c!l%9% mai m!lt% in8ormaii d%s7r% star%a sa 6i acionai c! mai m!lt&
;land%%
2/
- 'a ni@%l!l 7!nct%lor d% s7ri<in a7ar s%mn% d% com7r%si!n%
- A7licai 6i alt% m&s!ri d% 7r%@%nir% a %scar%lor
MOBILI&AREA PACIENTULUI
- Pr%@%nir%a com7licaiilor
- tim!lar%a ton!s!l!i 8i?ic 6i 7si:ic
- Cadr! mo;il
- A9&&tori
- (aston
- CBr<%
a> PIEICF:
- An!nai 7aci%nt!l 6i d%scri%i mi6c&ril% car% s% @or 8ac%
- E#7licai 7aci%nt!l!i im7ortana mo;ili?&rii 7r%coc%
- E@al!ai r%s!rs%l% 8i?ic% al% 7aci%nt!l!i
;> FIGICF:
- A<!tai 7aci%nt!l s& s% Am;rac% cor%s7!n?&tor
- "&s!rai 7!ls!l
O Cons!ltai m%dic!l 7ri@ind ti7!l d% mo;ili?ar% 6i d!rata
45 "o;ili?ar%a 7asi@&
- Fac%i mi6c&ri d% 8l%#i% 6i rotai% al% ca7!l!i
- Contin!ai s& 8ac%i %#%rciii al% m%m;r%lor s!7%rioar% 6i in8%rioar% 7rin mi6c&ri d% 8l%#i%, %#t%nsi%, a;d!cic,
add!ci%, s!7inai% 6i 7ronai% - mo;ili?ai toat% artic!laiil% c! ;lBnd%%
- Com!nicai c! 7aci%nt!l 7%ntr! a a8la dac& ar% d!r%ri 6i o;s%r@ai 8aci%s!l
- "asai m%m;r%l% An s%ns!l circ!lai%i d% Antoarc%r%
- Controlai 7!ls!l
25 Ridicar%a An 7o?ii% 6%?Bnd
a> Dn 7at
- A<!tai 7asi@ 7aci%nt!l s& s% ridic% 6i s7ri<inii-l c! 7%rn% sa! 8olosii r%?%m&tor!l mo;il
- "ontai d%as!7ra 7at!l!i o a9&&toar% mo;il& 6i stim!lai 7aci%nt!l s& s% ridic%, s7ri<inind!-l c! 7%rn% dac& %st%
n%c%sar
;> 'a mar9in%a 7at!l!i
O E#%c!tar%a d% c&tr% o sin9!r& 7%rsoan&
- Introd!c%i o mBn& s!; r%9i!n%a omo7lailor, iar c%alalt& s!; r%9i!n%a 7o7lit%%
- *ac& %st% ca?!l r!9ai 7aci%nt!l s& s% 7rind& d% 9Bt!l d!mn%a@oastr&
- Rotii 7icioar%l% 7aci%nt!l!i Antr-!n !n9:i d% +0K 6i l&sai-l% s& atBrn% !6or la mar9in%a 7at!l!i
- O;s%r@ai 8aci%s!l 7aci%nt!l!i
O E#%c!tar%a d% c&tr% 2 7%rsoan%
- A6%?ai-@& s7r% ca7!l 7aci%nt!l!i 6i introd!c%i mBinil% s!; omo7lai
- R!9ai a<!tor!l s& introd!c& mBinil% s!; r%9i!n%a 7o7lit%%
- incroni?ai mi6c&ril% 6i ridicai s7at%l% 7aci%nt!l!i rotind 7icioar%l% c! +0K 6i ad!c%i-l% la mar9in%a 7at!l!i
- "%nin%i 7aci%nt!l An ac%ast& 7o?ii% - la Anc%7!t cBt%@a min!t%, a7oi cr%6t%i tr%7tat tim7!l
- R%a6%?ai 7aci%nt!l 7% 7at, %#%c!tBnd mi6c&ril% An s%ns in@%rs
c> A6%?ar%a 7aci%nt!l!i An 8otoli!
- A6%?ai 7aci%nt!l la mar9in%a 7at!l!i
- O8%rii 7aci%nt!l!i 7a7!cii
- A6%?ai 8otoli!l c! r%?%m&toar%a lat%ral& li7it& d% mar9in%a 7at!l!i
- A6%?ai-@& An 8aa 7aci%nt!l!i 6i introd!c%i mBinil% s!; a#il%, r!9Bnd!-l s& in& ca7!l Antors Antr-o 7art%
- *ac& a@%i a<!tor, a6%?ai-@& d% o 7art% 6i d% alta a 7aci%nt!l!i
- Prind%i 8i%car% 7aci%nt!l 7% s!; a#il& 6i ridicai-l An 7icioar%
- Rotii 7aci%nt!l c! s7at%l% s7r% 8otoli! 6i a6%?ai-l c! 9ri<& An 8otoli!
2C
- Aco7%rii 7aci%nt!l c! !n 7l%d dac& sit!aia o c%r% =t%m7%rat!r& mai sc&?!t& An Anc&7%r%>
- R%a6%?ai 7aci%nt!l An 7at %#%c!tBnd mi6c&ril% An s%ns in@%rs
d> Ridicar%a 7aci%nt!l!i An 7o?ii% ortostatic&
- R%7%tai mi6c&ril% d% ad!c%r% a 7aci%nt!l!i An 7o?ii% 6%?Bnd, cBt mai a7roa7% d% mar9in%a7at!l!i
- A6%?ai-@& d% o 7art% a 7aci%nt!l!i 6i s7ri<inii-l d% s!; a#il%
- Ridicai 7aci%nt!l An 7icioar%
- O;s%r@ai 8aci%s!l 7aci%nt!l!i 6i m%nin%i-l An ortostatism cBt%@a min!t%
- Dntr%;ai 7aci%nt!l dac& s% simt% ;in%
- A6%?ai 7aci%nt!l 7% 7at dac& ac!?& am%%li
- R%a6%?ai 7aci%nt!l 7% 7at %#%c!tBnd mi6c&ril% An ordin% in@%rs&
%> E8%ct!ar%a 7rimilor 7a6i
- Dntr%;ai m%dic!l dac& 7aci%nt!l s% 7oat% d%7lasa
- Ridicai 7aci%nt!l mai AntBi An 7o?ii% 6%?Bnd cBt mai a7roa7% d% mar9in%a 7at!l!i 6i a7oi An ortostatism
- 7ri<inii 7aci%nt!l d% ;ra 6i a7oi a<!tai-l s& 8ac& 7rimii 7a6i 7rin salon
- Cr%6t%i distana d% d%7lasar% An 8!nci% d% r%comandar%a m%dical&
- O8%rii 7aci%nt!l!i !n cadr! mo;il dac& star%a 9%n%ral& Ai 7%rmit% s& s% d%7las%?% sin9!r
- !7ra@%9:%ai 7aci%nt!l An tim7!l d%7las&rii
- Dnc!ra<ai 7aci%nt!l s& s% ridic% 6i s& s% d%7las%?% 7% m&s!r& c% star%a 9%n%ral& 7%rmit%
- O;s%r@ai star%a 7aci%nt!l!i 6i m&s!rai P, R, TA, dac& %st% ca?!l
- Dntind%i l%n<%ria 7%ntr! a 7r%@%ni a7ariia %scar%lor
- A6%?ai mat%rial%l% 8olosit% An loc!ril% d% d%7o?itar%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- Ti7!l d% mo;ili?ar%, d!rata, n!m&r!l mo;ili?&rilor, orar!l ac%stora 6i com7ortam%nt!l 7aci%nt!l!i
- In8ormaii !til% l%9at% d% r%comand&ril% m%dical%5
- 7aci%nt!l s% mo;ili?%a?& con8orm 7ro9ram!l!i
- n! 7r%?int& com7licaii 8a@ori?at% d% imo;ili?ar%
R%?!ltat% n%dorit% 0 C% 8ac%m dac&:
O Paci%nt!l r%8!?& mo;ili?ar%a
C%rc%tai ca!?a
- 7r%?int& d!r%ri
- s% t%m% d% d!r%r%
- %st% sl&;it
- 7r%?int& am%%li
Dnc!ra<ai 7aci%nt!l
- acordai-i mai m!lt tim7
- asi9!rai-l c& s!nt%i acolo 7%ntr! a-l a<!ta
Administrai !n calmant Anaint% d% mo;ili?ar% =la r%comandar%a m%dic!l!i>
- acionai c! ;lBnd%%
R%d!c%i d!rata mo;ili?&rii
=dac& 7aci%nt!l s% simt% sl&;it sa! ar% am%%li>
CAPTAREA URINII
- $olir%a @%?icii !rinar% la 7aci%nt!l imo;ili?at
- "&s!rar%a cantit&ii d% !rin& %liminat&
- O;s%r@ar%a as7%ct!l!i !rinii
- O;in%r%a !n%i mostr% d% !rin& 7%ntr! %#aminar%
2.
- Para@an
- Plosc& sa! !rinar
- EBrti% i9i%nic&
- "at%rial% 7%ntr! toal%ta local& =dac& %st% ca?!l>
- "!6ama 6i al%?& 7%ntr! 7rot%cia 7at!l!i
- "at%rial% 7%ntr! s7&lar%a mBinilor 7aci%nt!l!i
a> PIEICF:
- Dnc!ra<ai 7aci%nt!l s&-6i in@in9& <%n& 6i s& solicit% 7losca sa! !rinar!l cBnd ar% n%@oi%
- Asi9!rai 7aci%nt!l c&-i @a 8i r%s7%ctat& 7!doar%a
;> FIGICF:
- I?olai 7aci%nt!l c! !n 7ara@an
- E@al!ai r%s!rs%l% 7aci%nt!l!i ca s& @%d%i dac& 7oat% 7artici7a
- As%?ai 7aci%nt!l Antr-o 7o?ii% ad%c@at& car% s&-i 7%rmit& %@ac!ar%a
45 'a 7aci%nt!l An star% 9ra@&, car% n%c%sit& a<!tor
- 7&lai mBinil%
- Dm;r&cai m&n!6i d% !nic& 8olosin&
- Ridicai 7&t!ra
- Prot%<ai 7at!l c! m!6ama 6i al%?&
- *%?;r&cai 7art%a in8%rioara a cor7!l!i =daca %st% ca?!l>
- Dnc&l?ii 7losca sa! !rinar!l 7rin cl&tir% c! a7& cald& 6i !scai 7rin 6t%r9%r% c! :Brti% i9i%nic&
- Introd!c%i 7losca s!; 7aci%nt r%s7%ctBnd 7a6ii d% la ca7tar%a mat%riilor 8%cal% sa! a6%?ai !rinar!l Antr% coa7s%l%
7aci%nt!l!i
25 'a 7aci%nii d% s%# masc!lin, 7%nis!l s% introd!c% An !rinar sa! s% ori%nt%?a s7r% 7losca =;a?in%t>
- '&sai 7aci%nt!l cBt%@a min!t% sin9!r
- Dnd%7artati 7losca s! !rinar!l
- A<!tai 7aci%nt!l sa-6i s7%l% mBinil%
- A<!tai 7aci%nt!l sa s% Am;rac% =daca %st% ca?!l>
- A6%?ai 7aci%nt!l Antr-o 7o?ii% comod& sa! Antr-o 7o?ii% r%comandat&
- Dntind%i l%n<%ria d% cor7 6i d% 7at
- Dnd%7&rtai al%?a sa! Anloc!ii-o dac& s-a !m%?it
- Dnd%7&rtai 7ara@an!l
- Dnd%7&rtai 7losca sa! !rinar!l An @%d%r%a 9olirii
- "&s!rai cantitat%a 6i o;s%r@ai as7%ct!l d!7& car% 9olii 6i cl&tii 7losca sa! !rinar!l
NOTAREA PROCE*URII
- Notai cantitat%a, c!loar%a 6i as7%ct!l, Antr%r!7%r%a <%t!l!i, %@%nt!al%l% s%n?aii n%7l&c!t% =<%n&, !st!rim%>
REGU'TATU' AJTEPTAT
- Paci%nt!l A6i 9ol%6t% c! !6!rin& @%?ica, %#7rim& star% d% con8ort 6i n! ac!?& <%n&
- Cantitat%a %st% normal&, c!loar%a 9&l;!i%, as7%ct clar
REGU'TATE NE*ORITE0 CE FACE2IN
- Urin%a?& c! di8ic!ltat%, An cantitat% mic&, ac!?& !st!rimi
- Urina %st% t!l;!r%, d%colorat&, :i7%rcrom&, ro6i% =conin% sBn9%>
- % an!na m%dic!l
- % c!l%9 in8ormaii An l%9&t!ra c! m%dicam%nt%l% administrat% car% s% %limin& 7rin !rin& 6i 7rod!c
modi8ic&ri
CAPTAREA MATERIILOR FECALE
- Asi9!rar%a intimit&ii 7aci%nt!l!i imo;ili?at An @%d%r%a %limin&rii asistat% a mat%riilor 8%cal%
27
- Para@an
- (a?in%t =7losc&>
- "at%rial% 7%ntr! %8%ct!%r%a toal%t%i
- EBrti% i9i%nic&
- "at%rial% 7%ntr! s7&lar%a mBinilor 7aci%nt!l!i
- "!6ama, al%?&
- "an!6i d% !nic& 8olosin&
a> PIEICF:
- Dnc!ra<ai 7aci%nt!l s&-6i An@in9& <%na 6i s& solicit% s%r@ir%a 7lo6tii at!nci cBnd ar% n%@oi%
- Asi9!rai 7aci%nt!l c& i s% @a r%s7%cta 7!doar%a 6i intimitat%a
- ta;ilii c! 7aci%nt!l !n orar =d% %#5 dimin%aa 6i s%ara>
;> FIGICF:
- A6%?ai 7aci%nt!l Antr-o 7o?ii% ad%c@at&
- E@al!ai r%s!rs%l% 7aci%nt!l!i 7%ntr! a sta;ili c!m 7oat% 7artici7a
- 7&lai-@& mBinil%
- Dm;r&cai mBn!6il% d% !nic& 8olosin&
- Ridicai 7&t!ra 6i 7rot%<ai 7at!l c! al%?& 6i m!6ama
- *%?;r&cai 7aci%nt!l d% la ;rB! An <os
- Dnc&l?ii ;a?in%t!l m%talic 7rin cl&tir% c! a7& cald&H !scai-l 7rin 6t%r9%r% c! :Brti% i9i%nic&
- Asi9!rai con8ort!l 7si:ic 7rin ridicar%a ca7&t!l!i c%8alic al 7at!l!i dac& star%a 7aci%nt!l!i o 7%rmit%
- A6%?ai m!6ama!a s!; ;a?in!l 7aci%nt!l!i0cli%nt!l!i
- R!9ai 7aci%nt!l s& s% ridic% s7ri<inind!-s% 7% coat% 6i 7lant%
- Introd!c%i o mBn& 7% s!; mi<loc!l 7aci%nt!l!i 7%ntr! a-l s!sin%
- Introd!c%i 7losca0;a?in%t!l s!; 7aci%nt c! c%alalt& mBn& 6i asi9!rai-@& c& %st% ;in% a6%?at
- olicitai a<!tor!l !n%i alt% 7%rsoan% 7%ntr! ridicar%a 7aci%nt!l!i dac& star%a n!-i 7%rmit% s& 7artici7%
- Asi9!rati-@& c& la 7aci%nii d% s%# masc!lin 7%nis!l %st% ori%ntat An ;a?in%t
- Aco7%rii 7aci%nt!l 7an& t%rmina act!l d%8%c&rii
- 'asai 7aci%nt!l sin9!r, dar n! @& And%7&rtai 8oart% m!lt, ast8%l AncBt s& @& 7oat& an!na cBnd t%rmin&
- O8%rii 7aci%nt!l!i :Brti% i9i%nica d!7& d%8%car%, dac& star%a ac%st!ia o 7%rmit%
- Dnd%7&rtai ;a?in%t!l07losca, aco7%rind-o c! !n mat%rial im7%rm%a;il
- E8%ct!ai la n%@oi% toal%ta r%9i!nii 7%rianal% 7% alt ;a?in%t s7%cial 7r%9&tit
- O8%rii a7&, s&7!n 6i 7roso7 7aci%nt!l!i 7%ntr! s7&lar%a mBinilor dac& a 8olosit :Brti% i9i%nic&
- Dnd%7&rtai m!6ama!a
- Co;orBi ca7&t!l c%8alic al 7at!l!i 7Bn& la o 7o?ii% comod& 7%ntr! 7aci%nt
- )%ri8icai l%n<%ria d% 7at 6i d% cor7 s& n! 8i% !m%d& sa! c!tat&
- A<!tai 7aci%nt!l s& Am;rac% 7antalon!l d% 7i<ama
- Dnd%7&rtai 7ara@an!l 6i a%risii salon!l
- Dnd%7&rtai mat%rial%l% !tili?at% 6i asi9!rati-@& c& 7losca a 8ost 9olit& 6i c!r&at&
NOTAREA PROCE*URII
- Notai cantitat%a %liminat& An 8oaia d% t%m7%rat!r& sa! An 7lan!l d% An9ri<iri
- *%scri%i %@%nt!al% as7%ct% 7atolo9ic% al% sca!n!l!i =c!loar%, 8orm&, 7r%?%na sBn9%l!i, 7!roi!l!i, m!c!s!l!i>,
7r%?%na d!r%rii
O Pr%?%ntai la @i?it& sca!n!l c! as7%ct modi8icat
- ca!n!l %liminat d% 7aci%nt %st% d% as7%ct 6i consist%n& normal%
- Paci%nt!l 7r%?int& star% d% con8ort
R%?!ltat% n%dorit%:
O C% 8ac%i dac&:
2,
Paci%nt!l0cli%nt!l n! 7oat% %limina
- )%ri8icai dac& st& An 7o?ii% comod&
- )%ri8icai dac& n! 7r%?int& 8%caloam%
- 'asai 7aci%nt!l sin9!r 7%ntr! a-i r%s7%cta 7!doar%a 6i intimitat%a
- In8ormai m%dic!l
CAPTAREA SPUTEI
- Pr%@%nir%a r&s7Bndirii in8%ci%i
- O;s%r@ar%a as7%ct!l!i
- O;in%r%a !nor mostr% 7%ntr! %#am%n% d% la;orator
- Pa:ar conic 9radat, sc!i7&toar% sa! c!ti% P%tri st%ril&
- ol!i% d%?in8%ctant& =7%ntr! inacti@ar%a 9%rm%nilor>
- J%r@%%l% d% :Brti%
a> PIEICF:
- E#7licai 7aci%nt!l!i im7ortana col%ct&rii s7!t%i 7%ntr! 7r%@%nir%a r&s7Bndirii in8%ci%i 6i 7rot%ci%i m%di!l!i
- Dn6tiinai 7aci%nt!l s& n! An9:it& s7!ta
;> FIGICF:
- Ta7otai !6or torac%l% 6i r!9ai 7aci%nt!l sa t!6%asc& 7%ntr! a s% d%s7rind% mai !6or s%cr%iil%
- Id%nti8icai 7aci%nt!l car% t!6%6t% 6i %#7%ctor%a?&
- 7&lai mBinil% 6i Am;r&cai m&n!6i d% !nic& 8olosina
- *ai 7aci%nt!l!i sc!i7&toar%a sa! c!tia P%tri An car% ai 7!s sol!i% d%?in8%ctanta c! %#c%7ia sit!aiilor An car% s%
!rm&r%6t% r%coltar%a 7%ntr! %#am%n% d% la;orator
- Instr!ii 7aci%nt!l s& %limin% s7!ta n!mai An col%ctor!l 7rimit 6i s& n! ar!nc% 7% <os, s& n! sc!i7% An ;atist&, s&
aco7%r% @as!l d% 8i%car% dat&, s& n! 7!n& r%st!ri d% i9ar&
- c:im;ai sc!i7&toar%a0 c!tia P%tri d% c%l 7!in 2 ori 7% ?i sa! d% cBt% ori %st% n%@oi%
- A<!tai 7aci%nt!l imo;ili?at s&-6i cl&t%asc& 9!ra c! a7& 7%ntr! a And%7&rta s%n?aia d% 9r%a& 6i o8%rii-i 6%r@%t%l%
d% :Brti% 7%ntr! a s% 6t%r9%
- 8&t!ii 7aci%nt!l s& st%a Antr-o 7o?ii% car% s& 8acilit%?% o mai ;!n& r%s7irai% 6i %li;%rar%a c&ilor r%s7iratorii
- Dnd%7&rtai conin!t!l sc!i7&torii d!7& c% ai o;s%r@at as7%ct!l, c!loar%a, cantitat%a
- R%s7%ctai c! strict%% 7r%ca!i!nil% !ni@%rsal% 7%ntr! 7r%@%nir%a transmit%rii in8%ciilor
- Asi9!rai-@& c& d!7& 9olir%, col%ctoar%l% a! 8ost s7&lat% c! a7& r%c% a7oi c! a7& cald& 8olosind o 7%ri% in!t& An
sol!ii d%?in8%ctant%
- P&strai sc!i7&toril% An loc!ri i?olat% 6i asi9!rai-@& c& s% st%rili?%a?& cor%ct An @%d%r%a 8olosirii
NOTAREA PROCE*URII
Notai:
- Cantitat%a =m&s!rat& c! 7a:ar!l 9radat> dac& %st% n%c%sar
- C!loar%a, 8orma 6i com7o?iia =ro6i%, ro?, ;r!n&, s7!moas&, 7!r!l%nt&>
REGU'TATE *ORITE
- Paci%nt!l r%s7%ct& r%comand&ril% 8&c!t%, n! s!nt 7osi;ilit&i d% r&s7Bndir% a in8%ci%i
REGU'TATE NE*ORTTE 0 CE FACE2IN
- Paci%nt!l n! %st% cola;orant, n! r%s7%ct& r%comand&ril% 8&c!t%
- R%?%r@ai-@& mai m!lt tim7 7%ntr! a sta d% @or;& 6i a %d!ca 7aci%nt!l
- olicitai a<!tor!l 8amili%i 7aci%nt!l!i dac& %st% n%c%sar
- E#ist& risc d% in8%cii nosocomial%
- A7licai toat% 7r%ca!i!nil% !ni@%rsal%
- In8ormai m%dic!l
2+
CAPTAREA .1RSATURILOR
O E@itar%a m!rd&ririi l%n<%ri%i
O E@itar%a as7ir&rii conin!t!l!i 9astric An c&il% r%s7iratorii
- 2 t&@i% r%nal% c!rat%, !scat%
- "!6ama
- Al%?&
- Pa:ar c! a7&
- J%r@%%l% d% :Brti%, 7roso7
a> PIEICF:
- Dnc!ra<ai 7aci%nt!l s& r%s7ir% adBnc 7%ntr! a r%d!c% 7!in s%n?aia d% @om&
- Asi9!rai 7aci%nt!l c& s!nt%i lBn9& %l
;> FIGICF:
- Ridicai 7aci%nt!l An 7o?ii% 6%?Bnd dac& star%a 7%rmit% sa! a6%?ai-l An d%c!;it c! ca7!l Antors Antr-o 7art% c! !n
7roso7 sa! o al%?& s!; ca7
- Dnd%7&rtai 7rot%?a d%ntar& dac& %#ist&
- !sin%i c! o mBn& 8r!nt%a 7aci%nt!l!i iar c! c%alalt& t&@ia r%nal& s!; ;&r;i% sa! lBn9& 8aa 7aci%nt!l!i An
8!nci% d% 7o?ii%
- O8%rii 7aci%nt!l!i !n 7a:ar c! a7& s&-6i cl&t%asc& 9!ra 6i col%ctai Antr-o ta@i& r%nal& c!rat&
- Jt%r9%i 9!ra 7aci%nt!l!i c! !n 6%r@%%l sa! o8%rii-i 6%r@%%l!l dac& star%a 7%rmit%
- A<!tai-l s& s% a6%?% Antr-o 7o?ii% comod&
- !7ra@%9:%ai at%nt 7aci%nt!l a6%?at An d%c!;it s& n!-6i as7ir% conin!t!l stomacal dac& @&rs&t!ra s% r%7%t&
- Dnd%7&rtai t&@ia r%nal& din salon
- $olii, s7&lai 6i d%?in8%ctai t&@ia =dac& n! %st% n%@oi% s& 7&strai conin!t!l>
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora
- Conin!t!l =m!cos, alim%ntar, ;ilios, 8%caloid, sBn9%>
- Cantitat%a, miros!l
- im7tom% 7r%m%r9&toar%
- Alt% ac!?% al% ;olna@!l!i
REGU'TATE AJTEPTATE
- Paci%nt!l %#7rim& star% d% con8ort, 8&r& s%n?ai% d% @om&
REGU'TATE NE*ORITE 0 CE FACE"N
- %n?aia d% @om& s% m%nin%, @&rs&t!ra s% r%7%t&
- 8&t!ii 7aci%nt!l s& r%s7ir% adBnc
- N! s%r@ii ac%%a6i t&@i& car% conin% @oma d%oar%c% sim7la @%d%r% d%clan6%a?& r%8l%#!l d% @om&
- An!nai m%dic!l
- )&rs&t!ra conin% sBn9%, r%st!ri d% m%dicam%nt% sa! alim%nt%
- P&strai @&rs&t!ra 6i 7r%?%ntai-o m%dic!l!i
- R%coltai o mostrB din @&rs&t!ril% car% conin r%st!ri d% m%dicam%nt% sa! alim%nt% in9%rat% =dac& %st%
indicat>
CAPITOLUL III
ALIMENTAREA PACIENTULUI
FIJA Nr5 -545
-0
A'I"ENTAREA ACTI)F JI PAI)F
O Asi9!rar%a n%c%sit&ilor caloric% 6i calitati@% An 8!nci% d% @Brsta 6i star%a or9anism!l!i
O Fa@ori?ar%a 7roc%s!l!i d% @ind%car%, consolidar%a r%?!ltat%lor t%ra7%!tic% 6i 7r%@%nir%a cronici?&rii !nor
Am;oln&@iri
- )%s%l& 6i tacBm!ri
- Can& sim7l&
- Can& s7%cial& c! cioc sa! An 8!nci% d% star%a 7aci%nt!l!i, t!; 7%ntr! administrar%a lic:id%lor
- Ta@&, c&r!cior 7%ntr! alim%nt%
- Alim%nt% con8orm r%9im!l!i r%comandat
- J%r@%t%l% d% mas&
- 2 7rosoa7% =6%r@%t%> 7%ntr! 7rot%cia l%n<%ri%i d% cor7 6i 7at
CU'E$E2I *ATE *EPRE:
- A8%ci!n%, r%9im, orar!l m%s%lor, r%7arti?ar%a alim%nt%lor 7% m%s%
- Posi;ilit&il% d% mo;ili?ar%, dac& 7aci%nt!l %st% imo;ili?at, dac& ar% indicai% d% r%7a!s
- Posi;ilitat%a d% a-6i 8olosi m%m;r%l% s!7%rioar% 6i ni@%l!l d% a!tonomi% =s% 7oat% alim%nta sin9!r-acti@, sa! %st%
alim%ntat d% alt& 7%rsoan&- 7asi@>
- E8%ct!ar%a !nor %#am%n% car% im7!n !n an!mit r%9im sa! r%stricii alim%ntar% Anaint% sa! d!7& ac%st%a
- Administrar%a !nor m%dicam%nt% Anaint%, An tim7!l m%s%i sa! d!7& mas&
- Pr%8%rin%l% alim%ntar% al% 7aci%nt!l!i
a> PIEICF:
- tim!lai a!tonomia
- E#7licai 7aci%nt!l!i im7ortana alim%ntai%i 6i a r%s7%ct&rii r%9im!l!i 7%ntr! %@ol!ia 8a@ora;il& a ;olii
;> FIGICF:
- R%s7%ctai r%comand&ril% c! 7ri@ir% la mo;ili?ar%a %i asi9!rai 7aci%nt!l d% a<!tor!l d!mn%a@ostr&
- A<!tai 7aci%nt!l s& s% s7%l% 7% mBini
- A6%?ai 7aci%nt!l Antr-o 7o?ii% con8orta;il& An ra7ort c! star%a sa 9%n%ral&:
O J%?Bnd la mas& An salon sa! An 7at
O %mi6%?Bnd 7%ntr! 7aci%nt!l car% s% 7oat% ridica 7!in
O Dn d%c!;it lat%ral stBn9 dac& 7aci%nt!l %st% dr%7taci, c! ca7!l !6or ridicat
- )%ri8icai dac& s!nt And%7linit% condiiil% 7%ntr! s%r@ir%a m%s%i: salon!l %st% a%risit, a! 8ost And%7&rtat% 7lo6til%
6i !rinar%l%, n! s% 8ac tratam%nt%, n! s% 8ac% c!rat An salon
- Id%nti8icai 7aci%nt!l 6i r%9im!l alim%ntar r%comandat
- A<!tai 7aci%nt!l s&-6i s7%l% mBinil%
- Pr%9&tii alim%nt%l% 7% o ta@& acordBnd at%ni% as7%ct!l!i %st%tic
- Dm;r&cai !n :alat c!rat 6i man!6i
a>Alim%ntar%a acti@&
%r@ir%a m%s%i la 7at An 7o?ii% 6%?Bnd sa! s%mi6%?Bnd
- A6%?ai 7aci%nt!l An 7o?ii% con8orta;il&
- Prot%<ai l%n<%ria 7aci%nt!l!i c! a<!tor!l !n!i 7roso7 dac& %st% ca?!l
- A6%?ai ta@a c! alim%nt% An 8aa 7aci%nt!l!i sa! ada7tai o mas!& s7%cial&
- A<!tai 7aci%nt!l s& tai% alim%nt%l% dac& %st% n%c%sar
- O;s%r@ai dac& 7aci%nt!l cons!m& toat% alim%nt%l%
Alim%ntar%a acti@& la 7at An 7o?ii% d% d%c!;it lat%ral
- A6%?ai 7aci%nt!l An d%c!;it lat%ral l&sBnd li;%r ;ra!l dominant =d% o;ic%i dr%7t>
- Ridicai !6or ca7!l 7aci%nt!l!i 6i 7rot%<ai 7at!l 7aci%nt!l!i c! !n 7roso7 c!rat
- A6%?ai s!; ;&r;ia 7aci%nt!l!i !n 7roso7 c!rat
- P!n%i ta@a c! alim%nt% 7% mar9in%a 7at!l!i, 7% !n ta;!r%t sa! 7% no7ti%r& a6a AncBt 7aci%nt!l s& @ad& c%
m&nBnc&
- Taiai alim%nt%l% An ;!c&i mici
- A<!tai 7aci%nt!l s& ;%a lic:id% 7rin s!ci!n% sa! c! a<!tor!l !n%i c&ni s7%cial%
-4
;> Alim%ntaia 7asi@&
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd =dac& ar% m%m;r%l% s!7%rioar% a8%ctat%> sa! s%mi6%?Bnd =dac& %st%
imo;ili?at, adinamic, %7!i?at, An star% 9ra@&>
- Prot%<ai l%n<%ria d% 7at 6i d% cor7 8olosind 7rosoa7% c!rat%
- Plasai ta@a c! alim%nt% 7% no7ti%r&, 7% !n ta;!r%t sa! 7% o m&s!& ada7ta;il& la 7at
- As%?ai-@& An 7art%a dr%a7t& a 7aci%nt!l!i =d% r%9!l&> 7% !n sca!n, @%ri8icai t%m7%rat!ra alim%nt%lor
- Ridicai c! o mBn& =stBn9a> ca7!l ;olna@!l!i c! 7%rn& 6i administrai s!7a c! lin9!ra 7% <!m&tat% 7lin&
- Asi9!rai-@& c& 7aci%nt!l a An9:iit Anaint% d% a administra o no!& cantitat%
- R%?%r@ai-@& s!8ici%nt tim7 7%ntr! a 7!t%a 8ac% mici 7a!?% dac& %st% n%@oi%
- T&iai alim%nt%l% An ;!c&i mici 8&r& s& l% atin9%i c! mBna
- Dnc!ra<ai 7aci%nt!l s& cons!m% alim%nt%l% 7!rtBnd o disc!i% a9r%a;il&
- Folosii lin9!ria sa! o 7i7%t& dac& 7aci%nt!l %st% An star% 8oart% 9ra@& sa! ar% t!l;!r&ri d% d%9l!tii%
- O;s%r@ai 7%rman%nt 8aci%s!l 7aci%nt!l!i
- A6%?ai 7aci%nt!l An 7o?ii% comod& dac& n! 7oat% sin9!r
- R%8ac%i 7at!l, And%7&rtai %@%nt!al%l% 8irmit!ri sa! sc:im;ai l%n<%ria dac& %st% n%c%sar
- )%ri8icai dac& 7r%?int& c!m@a s%n?ai% d% 9r%a&
- A<!tai 7aci%nt!l s&-6i 8ac& toal%ta ca@it&ii ;!cal%
- Dnd%7&rtai @as%l% m!radar% 6i r%st!ril% alim%ntar%
- A%risii Anca7%r%a
NOTAREA PROCE*URII
- Notai An dosar!l d% An9ri<ir% cantitat%a d% alim%nt% 6i lic:id% in9%rat%
- "odi8ic&ril% d% a7%tit: dis7ariia, dimin!ar%a, %#a9%rar%a, r%8!?!l alim%nt%lor, n!-i 7lac% mBncar%a, r%s7%ct&
r%striciil% r%li9ioas%, r%8!?& an!mit% alim%nt%
- Pr%?int& s%t% %#a9%rat&
- Ac!?& s%n?ai% d% 9r%a&, d% r&! An tim7!l m%s%i sa! d!7& mas&
- Ac!?& s%n?aia d% 7l%nit!din%
- R%8!?& r%9im!l r%comandat, cons!m& alim%nt% n%7%rmis%
- R%comand&ri s7%cial% car% tr%;!i% com!nicat% t!r%i !rm&toar%: m%s% mici 6i d%s%, An tim7!l no7ii, r%strici%
alim%ntar% 7%ntr! %#amin&ril% din ?il%l% !rm&toar%
- Paci%nt!l cons!m& Antr%a9a cantitat% d% alim%nt% 6i s% :idrat%a?& cor%s7!n?&tor
- E#7rim& star% d% con8ort
- R%s7%ct& r%9im!l alim%ntar, o 7art% din sim7tom% a! dis7&r!t
- Paci%nt!l n! cons!ma Antr%a9a cantitat% d% alim%nt%
- C%rc%tai ca!?%l%: a7%tit dimin!at, condiii n%cor%s7!n?&toar% d% s%r@ir% a m%s%i, n!-i 7lac alim%nt%l%,
cons!m& alim%nt% ad!s% d% a7arin&tori, A6i r%s7%cta r%li9ia
- Paci%nt!l r%8!?& an!mit% alim%nt%, ac!?& 9r%a&
- % cons%mn%a?& o;s%r@aiil% 6i s% an!n& m%dic!l
FIJA Nr5 -525
A'I"ENTAREA PRIN $ATROTO"F
- P!n%r%a An r%7a!s a %so8a9!l!i o;str!at sa! l%?at d% in9%stia accid%ntal& sa! @ol!ntar& d% s!;stan% ca!stic%5
- Asi9!rar%a a7ort!l!i :idric 6i n!triional Anaint%a int%r@%ni%i 7%ntr! %so8a9o7lasti%
- O 7Blni% din 7lastic
- R%ci7i%nt!l c! lic:id alim%ntar =s!7&, c%ai>
- R%9im!l d% st%no?& %so8a9ian&: alim%nt% solid% tocat% m&r!nt 6i 7asat%
- (a9:%ta 7%ntr! 7ro7!lsar%a alim%nt%lor 7% sond&
-2
a> PIEICF:
- O8%rii 7aci%nt!l!i in8ormaii clar%, acc%si;il% d%s7r% mod!l d% alim%ntar% 7% stoma 7%ntr! a-i r%d!c% t%ama 6i a
o;in% cola;orar%a sa
- Dnc!ra<ai 7aci%nt!l s& s% alim%nt%?% sin9!r 7%ntr! a-6i r%c&7&ta a!tonomia
;> FIGICF:
- As%?ai 7aci%nt!l An 7o?ii% 6%?Bnd, 7% mar9in%a 7at!l!i sa! 7% !n sca!n c! s7&tar, ast8%l AncBt sonda s& 8i%
m%nin!t& An 7o?ii% @%rtical&, 7aral%l& c! torac%l%
O E#7licai 7aci%nt!l!i car% s% alim%nt%a?& sin9!r:
- s&-6i s7%l% mBinil%
- s& And%7&rt%?% do7!l d% la sond&
- s& ada7t%?% 7Blnia la ca7&t!l sond%i m%ninBnd-o An 7o?ii% @%rtical&
- s& introd!c& 7% rBnd 8%l!ril% d% mBncar% din r%9im!l d% st%no?&, ast8%l:
- lic:id!l s&-l toarn% Anc%t 7% 7Blni%, n! mai m!lt d% 400 ml o dat& 7%ntr! a n! d%stind% ;r!sc stomac!l
- alim%nt!l solid 7asat s&-l @%rs% An 7Blni% 6i s&-l Am7in9& 7% sond& c! a<!tor!l ;a9:%t%i d% 7lastic sa!
l%mn
- s& ada!9% din cBnd An cBnd lic:id alim%ntar, 7%ntr! a !6!ra Anaintar%a alim%nt!l!i 7asat
- s& n! introd!c& la o Rmas&R mai m!lt d% /00 9 d% alim%nt% 7asat% datorit& t!l;!r&rilor d% di9%sti% 6i d%
a;sor;i% %#ist%nt%
- s& t%rmin% totd%a!na RmasaR c! lic:id 7%ntr! a s7&la l!m%n!l sond%i
- s& ast!7% ca7&t!l sond%i c! do7!l d% 7lastic sa! ca!ci!c
- s& 8i#%?% sonda An 7o?ii% @%rtical&, 7aral%l& c! torac%l%
- s& %@it% 7o?iia d% d%c!;it dorsal d!7& mas& Antr!cBt 8a@ori?%a?& Rr%9!r9itar%aR conin!t!l!i 7% sond&
- s&-6i s7%l% mBinil% d!7& mas&
- O;s%r@ai t%9!m%nt!l din <!r!l stom%i
- Prot%<ai 7i%l%a c! !n !n9!%nt c! ?inc 6i r%8ac%i 7ansam%nt!l din <!r!l stom%i An ca?!l r%9!r9it&rii s!c!l!i
9astric5
- Paci%nt!l %st% com7liant 6i r%s7%ct& indicaiil% o8%rit%5
- Tol%rana di9%sti@& %st% ;!n&5
- Cantitat%a d% alim%nt% %st% ada7tat& 7osi;ilit&ilor d% di9%sti% 6i d% a;sor;i% al% stomac!l!i5
- Paci%nt!l n! %st% com7liant5
- Paci%nt!l mani8%st& atit!dini d% r%s7in9%r% a ima9inii cor7oral% modi8icat%5
- Inc!ra<i 7aci%nt!l s&-6i acc%7t% ima9in%a
- Tol%rana di9%sti@& %st% sc&?!t&5
- Ca7acitat%a d% di9%sti% 6i d% a;sor;i% a stomac!l!i %st% r%d!s& iar 7aci%nt!l 7r%?int& s%mn% d% d%n!trii%5
- In8ormai m%dic!l 7%ntr! a sta;ili cond!ita t%ra7%!tic&
FIJA Nr5 -5-5
A'I"ENTAREA PACIENTU'UI PRIN ON*A NAGO-$ATRICF
O Introd!c%r%a alim%nt%lor An stomac 8olosind sonda na?o-9astric& la:
- Paci%nii incon6ti%ni,
- Paci%nii c! t!l;!r&ri d% d%9l!tii%,
- Paci%nii c! n%9ati@ism alim%ntar, c! intol%ran& sa! :%mora9ii di9%sti@%,
- Paci%nii o7%rai 7% t!;!l di9%sti@ 6i or9an%l% an%#%,
- Paci%nii c! strict!ri %so8a9i%n% 6i al% cardi%i, car% Am7i%dica 7&tr!nd%r%a ;ol!l!i alim%ntar din ca@itat%a ;!cal&
An stomac
P% o ta@i& m%dical& s% @or 7r%9&ti:
--
- onda 9astric&, sonda d!od%nal& Ein:orn, sond% int%stinal% din ca!ci!c sa! sond% din 7oli%til%n
- PBlni%, t!; d% ca!ci!c, 7r%st!;
- ol!i% d% cocain& 2P
- $lic%rin& sa! !l%i d% @as%lin& 7%ntr! l!;r%8i%r%
- '%!co7last
- %rin9i
- A7arat d% 7%r8!?i% a alim%nt%lor
- Ta@B m%dical&, m!6ama
- Raia d% lic:id% alim%ntar%
- Am%st%c!ri alim%ntar%: o!& cr!d%, la7t%, ?a:&r, cacao, sar%, @itamin%, !nt, smBntBn&
- 7&lai mBinil% 6i Am;racai m&n!6i
- Introd!c%i sonda 9astric&, @%ri8icai 7o?iia ac%st%ia 6i 8i#ai %#tr%mitat%a li;%r& a sond%i c! l%!co7last d% 8aa 6i
!r%c:%a 7aci%nt!l!i =@%?i t!;a<!l na?o-9astric>
- Controlai conin!t!l 9astric 6i la n%@oi% as7irai sta?a
- Folosii am%st%c!ril% 7r%7arat% 7%ntr! alim%ntar%a 7% sond&, li7sit% d% 9r!n<i sa! alt% con9lom%rat%, car% ar
7!t%a ast!7a sonda =@or 8i str%c!rat% 7rin ti8on Am7&t!rit An , strat!ri>
- Pr%9&tii a7arat!l d% 7%r8!?i%, !m7l%i r%?%r@or!l 7ic!rator!l!i, %liminai a%r!l din t!;!l d% l%9&t!r& 6i racordai
7%r8!?or!l la sond&
- Introd!c%i raia ?ilnica An /-. do?%, 8oart% Anc%t, c! a7arat!l d% 7%r8!?i% ata6at la %#tr%mitat%a li;%r& a sond%i
- Dnc&l?ii lic:id!l alim%ntar la t%m7%rat!ra cor7!l!i
- )%ri8icai @it%?a d% sc!r9%r% a 7ic!rator!l!iH n! s% @a administra mai m!lt d% 200-2C0 ml Antr-o or&
- Administrai 7% sond& 200--00 d% ml d% a7& 7%ntr! s7&lar%a 7%r8!?or!l!i 6i a sond%i, a7oi ins!8lai 7!in a%r,
7%ntr! a o 9oli com7l%t 6i Anc:id%i %#tr%mitat%a li;%r& c! o clam& Eo88mann sa! o 7%nsa P%an, Am7i%dicBnd
7ic!rar%a r&m&6i%lor d% lic:id din sond& An 8arin9% 6i larin9%, ac%st%a 7!tBnd 8i as7irat% d% ;olna@!l incon6ti%nt,
li7sit d% r%8l%#!l t!s%i5
- Asi9!rai-@& c& 7aci%nt!l 7rim%6t% raia ad%c@at&, cantitati@ 6i calitati@ 6i i s% asi9!r& n%c%sar!l d% lic:id%
- A6%?ai 7aci%nt!l Antr-o 7o?ii% comod& 6i incl!d%i sonda Antr% do!& administr&ri
- Urm&rii 7aci%nt!l 7%ntr! a s%si?a a7ariia 9r%!rilor, @&rs&t!rilor, ;alon&rii, cram7%lor, diar%%i
- Dnd%7&rtai sonda cBnd s% t%rmin& indicaia d% alim%ntar% arti8icial&, r%s7%ctBnd 7a6ii d% la t!;a<!l na?o-9astric
sa! la int%r@al% sta;ilit% d% m%dic =2-- ?il% - sond%l% d% ca!ci!c, /-7 ?il% - sond%l% d% 7oli%til%n>
- 'asai !n int%r@al li;%r d% .-, or% 7% tim7!l no7ii 7Bn& la montar%a !n%i noi sond%, 7%ntr! r%8ac%r%a circ!lai%i
la ni@%l!l m!coas%i 6i, dac& n! %#ist& o contraindicai%, sc:im;ai nara
- "o;ili?ai sonda r&mas& 7% loc 7%ntr! a %@ita l%?ar%a m!coas%i
- )%ri8icai dac& s%n?aia d% 8oam% a dis7&r!t sa! a dimin!at
- Dnd%7&rtai m&n!6il% 6i mat%rial%l% 8olosit% An contain%r% s7%cial%H
- 7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai:
- Proc%d!ra 6i n!m%l% c%l!i car% a %8%ct!at-o
- *ata, ora, cantitat%a 6i 8%l!l alim%nt%lor administrat%
- R%acii ad@%rs%, intol%ran& =9r%a&, @om&>
- Paci%nt!l a tol%rat ;in% administrar%a alim%nt%lor 7% sonda 9astric&
- Paci%nt!l %st% satis8&c!t
R%?!ltat% n%dorit% 0 C% 8ac%i:
Paci%nt!l 7r%?int& 9r%a&, @&rs&t!ri
- Cons!ltai m%dic!l
- Poat% 8i o intol%ran& sa! o r%aci% la !n%l% alim%nt%
Paci%nt!l 7r%?int& l%?i!ni la ni@%l!l m!coas%i na?al% 6i !sc&ci!n%a m!coas%i ;!cal%
- Asi9!rai o ;!n& i9i%n& a ca@it&ii ;!cal% ,
-/
- "o;ili?ai sonda
- c:im;ai nara d!7& asi9!rar%a !n!i r%7a!s Antr% And%7&rtar%a 6i r%7!n%r%a sond%i
Paci%nt!l 7r%?int& t!s% 6i s%mn% d% s!8ocar%
- Ati 9r%6it 7roc%d!ra 6i alim%nt%l% a! a<!ns An c&il% a%ri%n%
- R%tra9%i sonda 6i o r%introd!c%i 7% cal% %so8a9ian&
- An!nai m%dic!l 7%ntr! a sta;ili m&s!ri d% 7r%@%nir% a ;ron:o7n%!moni%i d% as7irai%
- Acordai o at%ni% d%os%;it& 7aci%nt!l!i incon6ti%nt
RECO"AN*FRI
- ond%l% d% ca!ci!c 7ot 8i l&sat% 7% loc 2-- ?il%, m%nin%r%a lor 7%st% ac%st t%rm%n 7oat% ca!?a l%?i!ni al%
m!coas%i na?al%
- ond%l% d% 7oli%til%n 7ot 8i m%nin!t% 6i tol%rat% mai m!lt, 7Bn& la /-7 ?il%5
- Est% r%comanda;il ca sonda s& 8i% mo;ili?at& d% mai m!lt% ori An c!rs!l ?il%i, 8a@ori?Bnd 7rin ac%asta circ!laia
san9!in& normal& la ni@%l!l s!7ra8%%lor a7&sat% d% %aH
- 'a --C ?il%, sonda tr%;!i% And%7&rtat& 7%ntr! .-, or% =r%7a!s!l d% noa7t%>, d!7& car% s% @a 7!t%a r%introd!c%,
Ans& 7rin nara d% 7art% o7!s&5
- Est% im7ortant ca al&t!ri d% a7ort!l caloric 6i @itaminic, 7aci%nt!l s& 7rim%asc& 6i raia cor%s7!n?&toar% d%
lic:id% 7%ntr! aco7%rir%a n%c%sit&ilor :idric% car% tr%;!i% calc!lat% %#act5
CAPITOLUL I.
CONTROLUL INFEC2IILOR NOSOCOMIALE
FIA N". 4.1.SP1LATUL M5INILOR
Pr%@%nir%a 6i control!l %#tind%rii in8%ciilor
- d% la 7aci%nt la 7%rsonal
- d% 7% mBinil% 7%rsonal!l!i la 7aci%nt An tim7!l !nor act% d% An9ri<ir% sa! m%dical% in@a?i@%
- d% la !n 7aci%nt la alt!l
- A7& cald&
- &7!n o;i6n!it, s&7!n lic:id sa! s&7!n antimicro;ian
- &7!n!ri antimicro;i%n% car% conin 9l!conat d% clor:%#idin&, alcool 6i iodo8ormH ac%st%a Ans& 7ot irita 7i%l%a
- Proso7, %@%nt!al d% !nic& 8olosin&
- P%ri% 7%ntr! !n9:ii
- Un ;%i6or d% 7lastic 7%ntr! c!tic!l% - ol!ii alcoolic% - 8olosit% An !rm&toar%l% circ!mstan%: 8ocar% d% in8%ci%
An %@ol!i%, %nd%mi%, circ!laia int%ns& a !nor 9%rm%ni r%?ist%ni la condiiil% d% m%di!
- &7!n!l antimicro;ian %st% 8olosit Anaint% d% %#%c!tar%a !n%i 7roc%d!ri in@a?i@% =%#5 ins%ria 6i
An9ri<ir%a cat%t%r!l!i>
- &7!n!l antimicro;ian %st% 8olosit cBnd n!rs%l% tr%;!i% s& r%d!c& n!m&r!l total d% microor9anism%, %#5
at!nci cBnd s!nt An contact c! no! n&sc!ii, co7iii sa! cli%nii mai An @Brst&, c! im!nitat% sc&?!t& sa! cli%nii car%
a! An 7%ricol sist%m!l t%9!m%ntar =7l&9i sa! ars!ri>
- O alt%rnati@& a s7&l&rii mBinilor s!nt sol!iil% alcoolic%
- 7&lai mBinil% An !rm&toar%l% sit!aii
O CBnd s% Anc%7% s%r@ici!l
O CBnd m!rd&ria %st% @i?i;il&
O Dnaint% 6i d!7& contact!l c! cli%nt!l
O *!7& contact!l c! o s!rs& d% microor9anism% =sBn9%, s%cr%ii, %#cr%ii>, m%m;ran% m!coas%, 7i%l%a n%intact&
sa! o;i%ct% car% 7ot 8i contaminat% =%c:i7am%nt%, instr!m%nt%>
O Dn tim7!l An9ri<irilor Antr% 7roc%d!ri a7licat% ac%l!ia6 cli%nt dac& sit!aia o c%r%
-C
O Dnaint% d% %#%c!tar%a 7roc%d!rilor in@a?i@% a6a ca 7lasar%a i5@5 a !n!i cat%t%r
O Dnaint% d% 7r%9&tir%a 6i d!7& administrar%a m%dicam%nt%lor
O Dnaint% d% 7r%7arar%a sa! s%r@ir%a alim%nt%lor
O Dnaint% 6i d!7& s!8lar%a nas!l!i 6i 8olosir%a toal%t%i
O Dnaint% 6i d!7& And%7&rtar%a m&n!6ilor =Am;r&car%a m&n!6ilor n! And%7&rt%a?& n%c%sitat%a s7&l&rii mBinilor>
O *!7& t%rminar%a s%r@ici!l!i
Proc%dai ast8%l:
- tai An 8aa c:i!@%t%i5 N! l&sai !ni8orma s& atin9& c:i!@%ta An tim7 c% @& s7&lai5
- Dnl&t!rai ;i<!t%riil%, dac& %st% 7osi;il 6i asi9!rai-@& c& l% l&sai Antr-!n loc si9!r sa! l&sai doar @%ri9:%ta la
loc!l %i5 Est% d% dorit s& n! 7!rtai ;i<!t%rii An tim7!l s%r@ici!l!i
- Dnl&t!rai c%as!l d% la mBn&
- Pornii a7a 6i a<!stai d%;it!l %i, r%9lai t%m7%rat!ra 7Bn& %st% cald!&
- Udai mBinil% 6i ?ona Anc:%i%t!rii mBinilor5 Tin%i mBinil% mai <os d% cot 7%ntr! a 7%rmit% a7%i s& c!r9& s7r%
@Br8!l d%9%t%lor5
- Folosii a7ro#imati@ o lin9!ri& d% s&7!n lic:id =--Cml> din r%?%r@or!l s7%cial sa! 8olosii s&7!n 6i s&7!nii ;in%,
aco7%rind toat% 7&ril% mBinilor c! s&7!n5
- 'im7%?ii s&7!n!l iar 6i Antoarc%i-@& la r%ci7i%nt!l c! s&7!n5
- 7&lai 7alm%l% 6i s7at%l% mBinilor, 8i%car% d%9%t, ?ona dintr! d%9%t%, Anc:%i%t!ra mBinii 6i ant%;ra!l c! mi6c&ri
8%rm% 6i circ!lar%5
- 7&lai c! cBi@a cm 7%st% ?ona contaminat&5 *ac& mBinil% n! s!nt @i?i;il m!rd&rit%, s7&lai 7Bn& la cBi@a cm
d%as!7ra Anc:%i%t!rii mBinii5
- Contin!ai ac%ast& mi6car% d% 8r%car% 40-4C s%c!nd%
- Utili?ai !n9:iil% c%l%ialt% mBini sa! !n ;a s7%cial 7%ntr! a c!r&a s!; !n9:ii
- 'im7%?ii ;in%5
- Uscai mBniil% c! !n 7roso7 d% :Brti% Anc%7Bnd c! d%9%t%l% 6i mi6cBnd An s!s s7r% ant%;ra, 6i ar!ncai-l im%diat,
sa! 8olosii !n a7arat c! a%r cald5
- O7rii ro;in%t!l 8olosind !n alt 7roso7 c!rat
- Folosii loi!n% d% mBini dac& dorii
- Folosii antis%7tic d!7& s7&lar% dac& Am;r&cai m&n!6i st%ril% 7%ntr! ca microor9anism%l% s& n! s% d%?@olt% s!;
ac%st%a5
- Proc%dai la 8%l d!7& And%7&rtar%a m&n!6ilor 7r%c!m 6i An ca?!l An car% m&n!6il% s% r!7 sa! s% An%a7&5
- N! s-a d%?@oltat nici o in8%ci%
- *!7& %8%ct!ar%a 7roc%d!rilor d% c&tr% n!rs&, 7aci%nt!l0cli%nt!l %st% An si9!rana, la 8%l 6i n!rsa
- Usc&ci!n%a 7i%lii, cr&7&t!ri, 8is!ri 6i iritaiiH ac%st%a s!nt c%l% mai com!n% d!7a !tili?ar%a
r%7%tat& a antis%7tic!l!i, An s7%cial la 7%rsoan% c! 7i%l%a s%nsi;il&
- a7licai o cr%m& %moli%nt& 7% mBini d!7& 8i%car% s7&lar% sa! contact c! a9%ni d% c!r&ar%
- cons!ltai s7%cialist!l An ca? d% d%rmatit&
FIA N". 4.6. (MBR1CAREA I DE&BR1CAREA M1NUILOR
A5 D"(RFCAREA "FNUJI'OR
- F!rni?ar%a !n%i ;ari%r% adiional% Am7otri@a %#tind%rii !n%i in8%cii
- Pr%9&tii m&n!6i st%ril%5
- 7&lai 6i !scai c! 9ri<& mBinil%5
- Po?iionai 7ac:%t!l c! man!6i st%ril% 7% o s!7ra8a& c!rat&, !scat& d%as!7ra tali%i d!mn%a@oastr&5
- *%sc:id%i am;ala<!l d% s!s 7rin l!ar%a c! 9ri<a a strat!l!i d% s!s5 Dnl&t!rai 7ac:%t!l din&!ntr!, atin9Bnd doar
%#t%rior!l5
- *%sc:id%i c! 9ri<& 7ac:%t!l int%rior 6i %#7!n%i m&n!6il% st%ril% cBt mai a7roa7% d% d!mn%a@oastr&5
- C! d%9%t!l mar% 6i c%l ar&t&tor 7rind%i c! mBna n%dominant& m&n!6a 7%ntr! mBna dominant&5
- Ridicai 6i in%i m&n!6a c! d%9%t%l% An <os5 A@%i 9ri<& s& n! atin9& o;i%ct% n%st%ril%5
-.
- Introd!c%i c! 9ri<& m&n!6a 7% mBna dominant& 6i 7!n%i-o ;in%5 '&sai man6%ta An <os 7Bn& 7!n%i 6i c%alalt&
m&n!6&5
- P!n%i d%9%t%l% mBinii c! m&n!6& s!; man6%ta c%l%ilalt% m&n!6i inBnd 7olic%l% An a8ar& 6i tra9%i d% m&n!6& An
s!s5
- Introd!c%i c! 9ri<& mBna n%dominant& An m&n!6&5
- As%?ai0a<!stai m&n!6il% 7% am;%l% mBini atin9Bnd doar 7&ril% st%ril%5
(5 *EG(RFCAREA "FNUJI'OR
- Dnd%7&rtar%a m&n!6ilor 8olosit% 7%ntr! %#%c!tar%a 7roc%d!ri d% An9ri<ir% sa! m%dical% An @%d%r%a 7r%@%nirii
%#tind%rii in8%ci%i
- Prind%i c! mBna dominant& man6%ta m&n!6ii d% 7% c%alalt& mBn& 6i d%?;r&cai inBnd ?ona contaminat& s7r%
int%rior
- Contin!ai s& in%i m&n!6a
- Introd!c%i d%9%t%l% mBinii d%?;r&cat% =n%dominant&> An int%rior!l m&n!6ii r&mas%
- Prind%i m&n!6a din int%rior 6i Anl&t!rai-o AntorcBnd-o 7%st% mBn& 6i 7%st% c%alalt& m&n!6&
- Ar!ncai m&n!6il% An contain%r
- Col%ctai m&n!6il% 8olosit% An contain%r!l s7%cial r%s7%ctBnd 7r%ca!iil% !ni@%rsal%

FIA N". 4.7. CONTROLUL PARA&ITOLOGIC I DEPARA&ITAREA
- Dnd%7&rtar%a 6i distr!9%r%a 7ara?iilor car% 7ot transmit% Am;oln&@iri
- E@itar%a l%?i!nilor d% 9rata< 6i 7&strar%a int%9rit&i t%9!m%nt%lor
- Para@an
- Pi%7t%n 8oart% d%s
- ol!i% ins%cticid&
- (on%t& din mat%rial 7lastic
- O ;!cat& d% 7Bn?&
a> PIEICF:
- An!nai c! tact 7aci%nt!l c& @%ti 8ac% control!l 7ara?itolo9ic
- E#7licai n%c%sitat%a ac%st!i control
;> FIGICF:
- E#aminai 7&r!l 7aci%nt!l!i 7%ntr! a d%7ista o!&l% 6i 7ara?iii ad!li
- *%?;r&cai 7aci%nt!l d% :ain%l% 7ro7rii 6i controlai c!s&t!ril%
- E#aminai c%l%lalt% ?on% 7iloas% al% 7aci%nt!l!i
- Asi9!rai intimitat%a c! a<!tor!l !n!i 7ara@an
- A6%?ai 7aci%nt!l Antr-o 7o?ii% ad%c@ata st&rii sal%
- Asi9!rai o s!rs& d% l!min&
- Aco7%rii ca7!l 6i daca %st% ca?!l d%s7l%tii 7&r!l
- Dm7&rii 7&r!l An s!@i% 6i a7licai ins%cticid!l
- Aco7%rii 7&r!l c! ;on%ta d% mat%rial 7lastic 6i a7oi c! o ;!cat& d% 7Bn?& sa! ;asma 6i m%nin%i c%l 7!in 2/ d%
or% d!7& car% a<!tai 7aci%nt!l s&-6i s7%l% ca7!l
- c!rtai 7&r!l n!mai c! acord!l 7aci%nt!l!i
- % %#amin%a?& c%l%lalt% 7&ri 7&roas%
- )%ri8icai c! at%ni% :ain%l% 6i trimit%i-l% la %t!@ar%
-7
- Plasai 7aci%nt!l Antr-o cam%r& i?olat&
- )%ri8icai %8%ct! ins%cticid!l!i 7rin control!l 7&r!l!i 7%ntr! a o;s%r@a 7%rsist%na sa! And%7&rtar%a lindin%lor
- Pi%7t&nai d%as!7ra !n%i ;!c&i d% 7Bn?& al;&
- Dnd%7&rtai 7ara@an!l 6i mat%rial%l% 8olosit%
- A6%?ai sol!iil% r&mas% la loc!l d% 7&strar%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai An 7lan!l d% An9ri<iri:
- Constat&ril% 8&c!t% c! oca?ia ins7%ci%i
- E#ist%na 6i ti7!l 7ara?iilor
- *ata 6i ora %8%ct!&rii
R%?!ltat% a6t%7tat%
- 'a control!l %8%ct!at n! s% o;s%r@& 7ara?ii
- N! 7r%?int& l%?i!ni d% 9rata<
R%?!ltat% n%dorit%0C% 8ac%iN
- 'a control!l %8%ct!at s% o;s%r@& 7ara?ii @ii sa! o!& =lindini>:
- R%7%tai 7roc%d!ra d% d%7ara?itar%
- Folosii !n am%st%c din ot%t c! acid ;oric 7%ntr! a di?ol@a 7rin car% o!&l% s% 7rind d% 8ir!l d% 7&r
CAPITOLUL ..
M1SURAREA I (NREGISTRAREA
FUNC2IILOR .ITALE
FIA N". 8.1.
M1SURAREA TEMPERATURII CORPULUI
- *%t%rminar%a ni@%l!l!i c!r%nt a c&ld!rii cor7!l!iH
- A7r%ci%r%a %@ol!i%i !nor ;oliH
- *%t%ctar%a r&s7!ns!l!i 7aci%nt!l!i la m&s!ril% iniiat% d% cr%6t%r%a sa! d% sc&d%r%a t%m7%rat!rii cor7!l!iH
- E@al!ar%a r%8ac%rii 7aci%nt!l!i d!7& ;oal&5
Dn 8!nci% d% cal%a al%as& 7%ntr! m&s!rar%, 7r%9&tii 7% o ta@& m%dical&:
- T%rmom%tr! din sticl&, oral sa! r%ctalH
- T%rmom%tr! !?!al 7%ntr! a#il&5
- '!;ri8iant dac& s% 8olos%6t% cal%a r%ctal&H
- "&n!6i d% !nic& 8olosin& =o7ional>, com7r%s% d% ti8onH
- C%as d% mBn&H
- C!loar% al;astr& =cr%ion, 7i#, carioc&>H
- Foai% d% t%m7%rat!r& =85t5>
- Cai%t d% adnot&ri 7%rsonal%H
- R%ci7i%nt c! sol!i% d% cloramin& 4P
a> PIEICF:
- E#7licai 7roc%d!ra 7aci%nt!l!i 7%ntr! a oin% cola;orar%a saH
;> FIGICF:
- A6%?ai 7aci%nt!l An 7o?iia c%a mai ad%c@at& c&ii !tili?at% 7%ntr! m&s!rar%a t%m7%rat!rii cor7oral%:
- *%c!;it dorsal - 7%ntr! m&s!rar%a An ca@itat%a ;!cal& 6i a#ilar&H
- *%c!;it lat%ral - 7%ntr! m&s!rar%a An ca@itat%a r%ctal&5
45 "ETO*A ORA'F
-,
- 7&lai-@& mBinil%
- Cl&tii t%rmom%tr!l c! a7& r%c% dac& a 8ost 7&strat An sol!i% d%?in8%ctant&H
- Jt%r9%i t%rmom%tr!l c! o com7r%s& d% ti8on 7%ntr! a And%7&rta !rm%l% sol!i%i c:imic%H
- Prind%i strBns t%rmom%tr!l c! d%9%t!l mar% 6i c%l%lalt% d%9%t%H
- c!t!rai-l 7rintr-o mi6car% 7!t%rnic& din artic!laia mBinii 7Bn& la co;orBr%a m%rc!r!l!i s!; -.KC =sa!
+CKFa:r%n:%it>H
- Plasai ;!l;!l c! m%rc!r al t%rmom%tr! l!i 7% dr%a7ta sa! stBn9a a ca@it&ii s!;lin9!al%H
- Instr!ii 7aci%nt!l s& Anc:id& 9!ra, a7ro7iind ;!?%l% An <!r!l t%rmom%tr!l!iH
- "%nin%i t%rmom%tr!l s!; lim;& tim7 d% - minH
- Dnd%7&rtai t%rmom%tr!l 6i 6t%r9%i-l c! ti8onH
- Citii 9radaia d% 7% scala t%rmom%tr!l!iH
- Dnr%9istrai t%m7%rat!ra An carn%t!l 7%rsonal notBnd n!m%l%, data Anr%9istr&rii, @aloar%a =%#5 TdS -.,CKC>H
- 7&lai t%rmom%tr!l c! a7& c&ld!& 6i d%t%r9%nt 6i cl&tii c! a7& r%c%H
- Uscai t%rmom%tr!l 6i 7lasai-l 8i% An am;ala<!l s&! din 7lastic, 8i% An r%ci7i%nt!l s7%cial 7%ntr! t%rmom%tr%H
- 7&lai-@& mBinil%H
25 "ETO*A AXI'ARF
- 7&lai-@& mBinil%H
- Asi9!rai intimitat%a 7aci%nt!l!i 6i d%sco7%rii a#ilaH
- 7&lai 6i 6t%r9%i t%rmom%tr!l dac& a 8ost in!t An sol!i% d%?in8%ctant&:
- c!t!rai t%rmom%tr!l 7%ntr! a co;ori m%rc!r!l An r%?%r@or, dac& %st% ca?!lH
- Plasai ;!l;!l t%rmom%tr!l!i An c%ntr!l a#il%i, 7aral%l c! torac%l%H
- A7ro7iai ;ra!l 7aci%nt!l!i d% tr!nc:i 6i 8l%ctai ant%;ra!l 7% torac%H
- "%nin%i t%rmom%tr!l An a#il& 40 min!t%H
- Dnd%7&rtai t%rmom%tr!l 6i citii 9radaiaH
- Dnr%9istrai @aloar%a t%rmic& An carn%t!l 7%rsonal, notBnd: n!m%l% 7aci%nt!l!i, data Anr%9istr&rii, t%m7%rat!ra ca
An %#%m7l!l !rm&tor
*ata Ora TK N!m%
40X 4,KK -7,-KC Ion "i:ail
- 7&lai, cl&tii 6i 6t%r9%i t%rmom%tr!l d!7& 8olosir%H
- Introd!c%i t%rmom%tr!l An am;ala<!l s&! sa! An r%ci7i%nt!l s7%cialH
- 7&lai-@& mBinil%5
-5 "ETO*A RECTA'F
- 7&lai-@& mBinil%H
- Jt%r9%i, sc!t!rai 6i citii 9radaia t%rmom%tr!l!iH
- P!n%i-@& m&n!6i d% !nic& 8olosin& dac& doriiH
- '!;ri8iai ;!l;!l t%rmom%tr!l!i 6i ?ona din a7ro7i%r% 7% o distant& d% T 2,C cm5H
- Asi9!rai intimitat%a 7aci%nt!l!iH
- A6%?ai 7aci%nt!l An d%c!;it lat%ral 6i d%sco7%rii r%9i!n%a 8%si%r&H
- Dnd%7&rtai 8%s%l% 7%ntr! @i?!ali?ar%a ori8ici!l!i analH
- Introd!c%i t%rmom%tr!l 7rin an!s cca5 -,, cm la ad!lt, 2,C cm la co7il 6i 4,2C cm la s!9arH
- "%nin%i t%rmom%tr!l 7% loc - 7Bn& la C min!t%H
- Dnd%7&rtai t%rmom%tr!l 6i 6t%r9%i-l c! o com7r%s& d% ti8onH
- Jt%r9%i oric% !rm& d% l!;ri8iant sa! d% mat%rii 8%cal% din <!r!l an!s!l!iH
- Citii 9radaia t%rmom%tr!l!iH
- 7&lai t%rmom%tr!l An a7& c&ld!& c! d%t%r9%nt 6i cl&tii c! a7& r%c%:
- Uscai-l 6i a6%?ai-l An am;ala<!l s&! din 7lastic sa! An r%ci7i%nt!l s7%cial 7%ntr! t%rmom%tr% r%ctal%:
- 7&lai-@& mainil%H
- Dnr%9istrai t%m7%rat!ra An carn%t!l 7%rsonal, notBnd: n!m%l% 7aci%nt!l!i 6i data Anr%9istr&riiH
- An!ntai oric% modi8ic&ri anormal%5
REPREGENTAREA $RAFICF A TE"PERATURII
- ocotii 7%ntr! 8i%car% lini% ori?ontal& din 8oaia d% t%m7%rat!r& cBt% 2 di@i?i!ni d% 9radH
- Notai 9ra8ic @aloar%a Anr%9istrat&, 7rintr-!n 7!nct d% c!loar% al;astr& a6%?at dir%ct 7% linia ori?ontal& din
r!;rica cor%s7!n?&toar% 7%ntr! dimin%aa =d> sa! s%ara =s> 7%ntr! ci8r%l% c! so =7ar%>H %#%m7l!: -.,2H -7,/H -,,.H
%tc5
-+
- Notai 9ra8ic @aloar%a Anr%9istrat& 7rintr-!n 7!nct d% c!loar% al;astr& a6%?at An mi<loc!l 7&trat!l!i din r!;rica
cor%s7!n?&toar% =d sa! s> dac& ci8r%l% s!nt 8&r& so =im7ar%>, %#%m7l!: -.,4: -.,CH -7,-H %tcH
- Unii 7rim!l 7!nct c! r!;rica 7%ntr! t%m7%rat!ra a8lat& An 7art%a dr%a7t& a sist%m!l!i d% coordonat% din 8oaia d%
t%m7%rat!r&H
- O;in%i c!r;a t%rmic& 7rin !nir%a 7!nct%lor car% indic& @aloril% t%m7%rat!rii m&s!rat% ;icotidian 7% 7arc!rs!l
?il%lor d% s!7ra@%9:%r% 6i An9ri<ir%5
- T%m7%rat!ra Anr%9istrat& %st% con9r!%nt& c! star%a d% s&n&tat% a 7aci%nt!l!iH
- T%9!m%nt%l% s!nt intact%, 8&r& iritaii sa! trans7iraii
R%?!ltat% n%dorit%
- Paci%nt!l 7r%?int& discom8ort, 8risoan%, t%9!m%nt!l %st% con9%stionat, iritat, trans7irat sa! 7alid, r%c%H
- T%m7%rat!ra Anr%9istrat& im7!n% a7licar%a !nor m&s!ri ad%c@at%5
"O*IFICFRI DN ITUA2II'E E'ECTATE
- In8ormai 7aci%nt!l c& t%rmom%tr!l %st% !n instr!m%nt indis7%nsa;il 7%ntr! a7r%ci%r%a st&rii 9%n%ral%, la
domicili!H
- E#7licai 7aci%nt!l!i08amili%i s& s7%l% t%rmom%tr!l c! a7& c&ld!& 6i s&-l introd!c&, !scat 6i sc!t!rat, An
contain%r!l 7rot%cti@% Antr% !tili?&riH
- O8%rii 7aci%nt!l!i !n ta;%l c! @alori t%rmic% ori%ntati@% An 8!nci% d% cal%a 8olosit& 7%ntr! m&s!rar%H ca An
%#%m7l! d% mai <os:
Cal%a d% mas!rar%: cala C%ls!s cala Fa:r%n:%it
Orala -7UC V 0,--0,. +,,.UFV 0,C-4,0
R%ctala -7,CUC V 0,--0,. ++,.UF V 0,C-4,0
A#ilara -.,CUC V 0,--0,. +7,.UFV 0,C-4,0
FIA N". 8.6. M1SURAREA RESPIRA2IEI
- *%t%rminar%a rat%i r%s7iratorii la int%rnar% 7%ntr! a s%r@i ca ;a?& d% com7arar% c! m&s!r&toril% !lt%rioar%H
- "onitori?ar%a %8%ct%lor ;olii, tra!matism!l!i sa! str%ss!l!i as!7ra sist%m!l!i r%s7iratorH
- E@al!ar%a r&s7!ns!l!i 7aci%nt!l!i la m%dicaia sa! tratam%nt%l% car% a8%ct%a?& sist%m!l r%s7irator
Pr%9&tii 7% o ta@& m%dical&:
- C%as c! s%c!ndar, d% mBn& sa! cronom%tr!H
- C!loar% al;astr& =cr%ion, 7i# sa! carioca>H
- Foai% d% t%m7%rat!r& =F5T5>H
- Carn%t d% adnot&ri 7%rsonal%5
- E@itai 7r%9&tir%a 7si:ic& a 7aci%nt!l!i Antr!cBt ac%sta A6i 7oat% modi8ica ritm!l o;i6n!it An mom%nt!l An car%
con6ti%nti?%a?& 7ro7ria r%s7irai%H
- "&s!rai r%s7iraia concomit%nt c! c%l%lalt% s%mn% @ital% dac& a7ar sc:im;&ri An star%a 7aci%nt!l!i, dac&
7aci%nt!l ar% o a8%ci!n% cardio-7!lmonar& sa! 7rim%6t% o#i9%n ori m%dicam%nt% c% a8%ct%a?& 8i?iolo9ia
r%s7irai%i5
- O;s%r@ai mi6c&ril% d% ridicar% sa! d% co;orBr% al% torac%l!i c! 8i%car% ins7irai% sa! %#7irai%H
- "%nin%i, An contin!ar%, d%9%t%l% 7% loc!l d% m&s!rar% a 7!ls!l!i An tim7 c% o;s%r@ai torac%l% 7aci%nt!l!iH
- N!m&rai mi6c&ril% d% ridicar% a torac%l!i =ins7iraiil%> tim7 d% minim!m -0 d% s%c!nd% 6i Anm!lii c! 2
n!m&r!l o;in!t 7%ntr! a a8la rata 7% min!tH
- N!m&rai tim7 d% 4 min!t ins7iraiil% dac& r%s7iraia %st% n%r%9!lat&H
- Dnr%9istrai rata r%s7iratori% An carn%t!l 7%rsonal notBnd: n!m%l% 7aci%nt!l!i, data Anr%9istr&rii, rata r%s7iratori%H
REPREGENTAREA $RAFICF A REPIRATIEI
- ocotii cBt% o r%s7irai% 7%ntr! 8i%car% lini% ori?ontala din F5T5
- Notai 9ra8ic @aloar%a Anr%9istrat& 7rintr-!n 7!nct d% c!loar% al;astr& a6%?at dir%ct 7% linia ori?ontal& din r!;rica
cor%s7!n?&toar% 7%ntr! dimin%a& =*> sa! s%ar& =>H
- Unii 7rim!l 7!nct, 7rintr-o lini% c! s&9%at&, d% r!;rica r%s7irai%i a8lat& An 7art%a dr%a7t& a sist%m!l!i d%
coordonat% din F5T5:
/0
- O;in%i c!r;a r%s7irai%i 7rin !nir%a 7!nct!l!i iniial c! c%l%lalt% @alori al% m&s!r&torilor %8%ct!at% !lt%rior5
REGU'TATE AJTEPTATE 0 *ORITE:
- Rata r%s7irai%i, An r%7a!s, %st% An limit%l% normal% caract%ristic% @Brst%iH
- R%s7iraia s% 8ac% 7% nas, %st% lini6tit&, 8&r& ?9omot%, 8&r& %8ortH
- T%9!m%nt%l% 6i m!coas%l% s!nt normal colorat%, 7aci%nt!l %st% con6ti%nt, ori%ntat An tim7 6i s7ai!
REGU'TATE NE*ORITE
- Rata r%s7iratori% %st% mai mic& sa! mai mar% 8a& d% @aloril% normal% caract%ristic% @Brst%iH
- Paci%nt!l tr%c% 7rintr-o d%tr%s& r%s7iratori% mani8%stat& 7rin: ?9omot% r%s7iratorii anormal%, %8ort r%s7irator,
!tili?ar%a m!6c:ilor r%s7iratorii acc%sorii, orto7n%%, 7i%l% 7alid& sa! cianotic&, 7i%rd%r% d% c!no6tin&H
- Paci%nt!l 7oat% a@%a !na sa! mai m!lt% din !rm&toar%l% 7ro;l%m% d% d%7%nd%na:
- Intol%ran& An acti@itat%H
- An#i%tat%H
- Alt%rar%a con8ort!l!iH
- Cl%aranc% in%8ici%nt al c&ilor r%s7iratoriiH
- Posi;il& ins!8ici%n& r%s7iratori%H
- Alt%rar%a sc:im;!rilor 9a?oas%5
- Pr%@%d%i C-40 min!t% d% r%7a!s Anaint% d% n!m&rar%a r%s7iraiilor dac& a a7&r!t o acti@itat% r%c%nt& c% 7oat%
alt%ra rata r%s7iratori% a 7aci%nt!l!iH
- *%sco7%rii torac%l% 7aci%nt!l!i dac& r%s7iraia %st% s!7%r8icial& 7%ntr! a o;in% c%a mai cor%ct& rat&
r%s7iratori%H
- E@itai m&s!rar%a r%s7irai%i la s!9ar sa! co7il An tim7!l 7lBns!l!iH
- A7licai 7od!l 7alm%i 7% torac%l% co7il!l!i at!nci cBnd doarm% 7%ntr! a n!m&ra %#act mi6c&ril% r%s7iratorii
E*UCAREA PACIENTU'UI
- Dn@&tai 7roc%d!ra d% m&s!rar% 6i Anr%9istrar% a rat%i r%s7iratorii d% c&tr% m%m;rii 8amili%i ca 6i acordar%a d%
An9ri<iri at!nci cBnd %st% n%@oi%H
- A<!tai 7aci%nt!l s& s% An9ri<%asc& la domicili! An 8!nci% d% caract%risticil% r%s7irai%i 6i d% stat!s!l r%s7iratorH
- E#7licai 7arinilor 0 a7arin&torilor c& tr%;!i% s& s% 7r%?int% c! co7iii la m%dic dac& a7ar di8ic!lt&i An ins7irai%
sa! r%s7irai% s!7%r8icial&H
- 8&t!ii 7aci%nii s& !midi8ic%, s& Anc&l?%asc& sa! s& r&c%asc& a%r!l din s7ai!l am;i%ntal 7%ntr! a r%d!c%
incid%na in8%ciilor r%s7iratoriiH
- 8&t!ii 0 instr!ii 7aci%nii s& r%s7%ct% indicaiil% m%dic!l!i l%9at% d% administrar%a m%dicam%nt%lorH d% di%t& 6i
%@itar%a 8actorilor d% risc An sco7!l am%lior&rii sa! dis7arii%i 7ro;l%m%lor r%s7iratoriiH
- In8ormai 7aci%nt!l 0 8amilia d%s7r% @aloril% normal% caract%ristic% @Brst%i =%#5 An ta;%l!l d% mai <os>:
)Brsta Rata m%di%0min!t
No!-nasc!t -0-,0
Co7il mic 20-/0
Co7il mar% 4C-2C
Ad!lt 4/-20
(&r;at 4/-4,
F%m%i% 4.-20
FIA N". 8.7. M1SURAREA PULSULUI
- *%t%rminar%a n!m&r!l!i d% ;&t&i cardiac% 7% min!tH
- O;in%r%a d% in8ormaii d%s7r% acti@itat%a inimii 6i star%a art%r%lorH
- A7r%ci%r%a r&s7!ns!l!i inimii la m%dicaia cardiac&, acti@itat% sa! str%ss5
Pr%9&tii 7% o ta@& m%dical&:
- C%as d% mBn& c! s%c!ndar sa! cronom%tr!
- C!loar% ro6i% = cr%ion, 7i# sa! carioc&>
- Carn%t d% adnot&ri 7%rsonal%
a> PIEICF:
/4
- E#7licai 7aci%nt!l!i 7roc%d!ra 7%ntr! a r%d!c% %moiil%, t%ama 6i a o;in% cola;orar%aH
- Asi9!rai !n r%7a!s 7si:ic d% c%l 7!in C min!t% Anaint% d% m&s!rar%H
;> FIGICF:
- Asi9!rai !n r%7a!s 8i?ic d% c%l 7!in C min!t% Anaint% d% m&s!rar%H
- A6%?ai 7aci%nt!l An 7o?ii% con8orta;il& An 8!nci% d% star%a 9%n%ral&:
- d%c!;it dorsal c! m%m;r!l s!7%rior Antins 7% lBn9& cor7, artic!laia mBinii An %#t%nsi%, mBna An
s!7inai% =7alma ori%ntat& An s!s>H
- 7o?ii% s%mi6%?Bnd& =An 7at sa! An 8otoli!> ant%;ra!l An !n9:i dr%7t s7ri<init 7% s!7ra8aa 7at!l!i, mBna
An s!7inai% 6i %#t%nsi%
- 7&lai-@& mBinil%H
- R%7%rai art%ra radial& la %#tr%mitat%a distal& a ant%;ra!l!i, 7% 8aa ant%rioar& =int%rn&>, An 6an!l radial a8lat An
7r%l!n9ir%a 7olic%l!iH
- Plasai d%9%t%l% ind%#, m%di! 6i in%lar =2,-,/> d%as!7ra art%r%i radial% r%7%rat%H
- E#%rcitai o 7r%si!n% !6oar& as!7ra art%r%i 7% os!l radi!s, ast8%l AncBt s& 7%rc%7%i s!; d%9%t% 7!lsaiil% sBn9%l!iH
- Fi#ai-@& !n 7!nct d% r%7%r 7% cadran!l c%as!l!i d% mBn&H
- N!m&rai tim7 d% 4 min!t 7!lsaiil% 7%rc%7!t% c! d%9%t%, sa! -0 s%c!nd% 6i Anm!lii c! doi n!m&r!l 7%ntr! a
o;in% rata 7!ls!l!i 7% min!tH
- A7r%ciai ritm!l, am7lit!din%a 6i %lasticitat%a 7%r%t%l!i art%rial An tim7 c% m&s!rai 8r%c@%naH
- Dnr%9istrai 8r%c@%na 7!ls!l!i An carn%t!l 7%rsonal notBnd: n!m%l% 7aci%nt!l!i, salon!l, data Anr%9istr&rii, rataH
- 7&lai-@& mBinil%5
REPREGENTAREA $RAFICF A PU'U'UI DN F5T5
- ocotii 7%ntr! 8i%car% lini% ori?ontal& a 8oii d% t%m7%rat!ra cBt% / 7!lsaiiH
- Notai 9ra7:ic @aloar%a Anr%9istrat& 7rintr-!n 7!nct d% c!loar% ro6i%, a6%?at dir%ct 7% linia ori?ontal& din r!;rica
cor%s7!n?&toar% 7%ntr! * =dimin%aa> sa! =s%ara>H 7%ntr! @aloril% car% cr%sc din / An / =%#5 ./, .,, 7., ,0>H
- Notai 9ra7:ic @aloar%a Anr%9istrat& 7rintr-!n 7!nct d% c!loar% ro6i% a6%?at An mi<loc!l 7&trat!l!i din r!;rica
cor%s7!n?&toar% =* sa! > 7%ntr! @aloril% car% cr%sc din 2 An 2 =%#5: .2, .., 70>H
- Unii 7rim!l 7!nct 7rintr-o lini% c! s&9%at& d% r!;rica 7!ls!l!i a8lat& An 7art%a dr%a7ta a sist%m!l!i d%
coordonat% din F5T5H
- O;in%i c!r;a 7!ls!l!i 7rin !nir%a 7!nct%lor car% indic& @aloril% rat%i cardiac% m&s!rat% ;icotidian, 7% 7arc!rs!l
?il%lor d% s!7ra@%9:%r% 6i An9ri<ir%5
REGU'TATE AJTEPTATE0*ORITE:
- P!ls!l %st% ;in% ;&t!t, r%9!lat, iar 8r%c@%na s% Anscri% An limit%l% normal% cor%s7!n?&toar% @Brst%iH
- T%9!m%nt%l% 6i m!coas%l% s!nt normal colorat%H
- Paci%nt!l %st% lini6tit5
REGU'TATE NE*ORITE
- Rata 7!ls!l!i %st% mai mar% sa! s!; normal!l caract%ristic @Brst%iH
- P!ls!l radial n! %st% 7%rc%7ti;ilH
- P!ls!l %st% aritmicH
- Am7lit!din%a %st% mic& sa! cr%sc!t&H
- Paci%nt!l %st% 7alid, an#ios, ac!?& 7al7itaii, %#trasistol%H
- Paci%nt!l ar% !na sa! mai m!lt% dintr% 7ro;l%m%l% d% d%7%nd%n& !rm&toar%:
- intol%ran& la acti@itat%H
- alt%rar%a con8ort!l!iH
- d%8icit d% @ol!m lic:idian:
- %#c%s d% @ol!m lic:idianH
- alt%rar%a 7%r8!?i%i tis!lar%
C&!tai alt% art%r% acc%si;il% dac& 7!ls!l radial n! %st% 7al7a;il 6i m&s!rai 7!ls!l la:
- art%ra t%m7oral& - la !n lat d% d%9%t d%as!7ra 6i lat%ral d% stBnca t%m7oral!l!i, An dr%7t!l 7a@ilion!l!i
a!ric!larH
- art%ra carotid& %#t%rn& =dr%a7t& sa! stBn9&>: - 7% 8aa ant%rioar& a 9at!l!i, An 6an!l d%limitat d% larin9%
=ant%rior> 6i m!6c:i!l st%rnocl%idomastoidian =lat%ral>H
- art%ra 7%dioasa - 7% lata dorsala a 7icior!l!i, An dr%7t!l 7rim!l!i sant int%rm%tatarsianH
/2
- art%ra 8%m!ral& - An r%9i!n%a in9:inal&, la ni@%l!l tri!n9:i!l!i l!i car7a
- a7%# =@Br8!l inimii> - 7!ls!l a7ic!l - An s7ai!l C inl%rcostal =i5c5> 7% linia m%diocla@ic!lar& stBn9&H
- E@itai m&s!rar%a 7!ls!l!i radial la co7iii s!; 2 ani Antr!cBt rata cr%sc!t& 6i aria mic& d% 7al7ar% 7ot d%t%rmina
@alori %ronat%0in%#act%H
- O;in%i rata 7!ls!l!i radial la co7iii 7%st% 2 ani at!nci cBnd s!nt lini6tii sa! dorm, Antr!cBt %st% di8icil s& o;ii
cola;orar%a co7il!l!i d% a r&mBn% c! mBna n%mi6cat&H
- N!m&rai rata 7!ls!l!i tim7 d% 4 min!t, la co7il, 7%ntr! o ac!rat%% ma#im&5
- Dn@&ai 7aci%nt!l s&-6i m&soar% sin9!r 7!ls!l 7%ri8%ric la art%r%l% carotid& sa! t%m7oral& Antr!cBt s!nt mai
acc%si;il% 7%ntr! a!to7al7ar%a la domicili!H
- Instr!ii 7aci%nt!l s& %#%rcit% o 7r%si!n% !6oar& 8olosind - d%9%t% 7%ntr! 7al7ar%H
- In8ormai 7aci%nt!l08amilia car% s!nt @aloril% normal% al% 7!ls!l!i, caract%ristic% @Brst%iH
- Instr!ii 7aci%nt!l08amilia s& ia l%9&t!ra c! m%dic!l c!rant ori d% cBt% ori @aloril% rat%i 7!ls!l!i s!nt d%@iat% d% la
normal 6i star%a 9%n%ral& a 7aci%nt!l!i s% modi8ic&5
- O8%rii, %@%nt!al, !n ta;%l c! @alori ori%ntati@% ca An %#%m7l!l d% mai <os:
)Brsta Rata a7ro#imati@& Rata m%di%
No!-nasc!t 420-4.0 4/0
4- 2l!ni =s!9ar> 400- 4/0 420
42 l!ni - 2 ani ,0-4-0 440
2 ani - . ani 7C-420 400
. ani - 42 ani 7C-440 +C
Adol%sc%nt .0-400 ,0
Ad!lt .0-400 ,0
FIA N". 8.4. M1SURAREA PRESIUNII S5NGELUI 9T.A.:.
- *%t%rminar%a 7r%si!nii sistolic% 6i diastolic% la int%rnar% 7%ntr! a com7ara star%a c!r%nt& c! @aloril% normal%
- E@al!ar%a st&rii 7aci%nt!l!i An c% 7ri@%6t% @ol!m!l d% sBn9%, randam%nt!l inimii 6i sist%m!l @asc!larH
- A7r%ci%r%a r&s7!ns!l!i 7aci%nt!l!i la tratam%nt!l c! 8l!id% sa!06i m%dicam%nt%
Pr%9&tii 7% o ta@a m%dical&:
- t%tosco7 ;ia!ric!larH
- T%nsiom%tr! c! man6%ta ada7tat& @Brst%i
- Com7r%s% c! alcool m%dicinalH
- C!loar% al;astr& = 7i#, carioc&, cr%ion>H
- Foai% d% t%m7%rat!r& =F5T>H
- Carn%t d% adnot&ri 7%rsonal%
a> PIEICF:
- E#7licai 7aci%nt!l!i 7roc%d!ra 7%ntr! a r%d!c% t%ama 6i a o;in% cola;orar%aH
- Asi9!rai !n r%7a!s 7si:ic d% c%l 7!in C min!t% Anaint% d% m&s!rar% Antr!cBt %moiil% in8l!%n%a?& 7r%si!n%a
sBn9%l!iH
;> FIGICF:
- A6%?ai 7aci%nt!l An 7o?ii% con8orta;il& d% d%c!;it dorsal ori s%mi6%?Bnd sa! An ortostatism con8orm indicai%i
m%dical%
- Utili?ai com7r%s% c! alcool 7%ntr! a 6t%r9% oli@%l% 6i 7&ril% m%talic% al% st%tosco7!l!i dac& %st% n%c%sar
- %l%ctai !n t%nsiom%tr! c! man6%ta 7otri@it& st&rii constit!ional% a 7aci%nt!l!iH
- AmBnai m&s!rar%a T5 A5 dac& 7aci%nt!l %st% t!l;!rat %moional ar% d!r%ri, dac& a 8&c!t %#%rciii d% mi6car%,
dac& m&s!rar%a 7r%si!nii art%rial% n! %st% o !r9%n&H
- Al%9%i ;ra!l 7otri@it 7%ntr! a7licar%a man6%t%i =8&r& 7%r8!?i% i5@5, int%r@%ni% c:ir!r9ical& la ni@%l!l sBn!l!i sa!
a#il%i, 8&r& ars!ri, s:!nt art%rio-@%nos sa! r&ni al% mBinii>H
- P%rmit%i 7aci%nt!l!i s& ado7t% 7o?iia c!lcat sa! a6%?at c! ;ra!l s!sin!t la ni@%l!l inimii 6i 7alma Andr%7tat& An
s!sH
/-
- *%sco7%rii ;ra!l 7aci%nt!l!i 8i% 7rin ridicar%a mBn%cii 7rin d%?;r&car% dac& ac%asta =mBn%ca> %st% 7r%a strBmt&
7%ntr! a n! cr%6t% 7r%si!n%a d%as!7ra loc!l!i d% a7licar% a man6%t%iH
- )%ri8icai dac& man6%ta conin% a%rH
- coat%i a%r!l din man6%t&, la n%@oi%, d%sc:i?Bnd @%ntil!l d% si9!ran& 6i com7rimBnd man6%ta An 7alm% sa! 7%
o s!7ra8a& d!r&H
- Dnc:id%i @%ntil!l d% si9!ran& Anaint% d% a !m8la man6%taH
- A7licai man6%ta, circ!lar, An <!r!l ;ra!l!i, ;in% Antins&, la 2,C -C cm d%as!7ra 7licii cot!l!i 6i 8i#ai-o5
- Pal7ai art%ra ;ra:ial& sa! radial& %#%rcitBnd o 7r%si!n% !6oar& c! d%9%t%l%H
- A6%?ai m%m;rana st%tosco7!l!i d%as!7ra art%r%i r%7%rat% 6i introd!c%i oli@%l% An !r%c:iH
- Um8lai man6%ta t%nsiom%tr!l!i 7om7Bnd a%r c! 7ara d% ca!ci!c An tim7 c% 7ri@ii ac!l manom%tr!l!iH
- Contin!ai s& 7om7ai a%r 7Bn& cBnd 7r%si!n%a s% ridic& c! -0 cm d%as!7ra 7!nct!l!i An car% 7!ls!l a dis7&r!t
=n! s% mai a!d ;atai An !r%c:i>H
- *%com7rimai man6%ta, d%sc:i?Bnd !6or @%ntil!l d% si9!ran& 6i r%sta;ilind circ!laia sBn9%l!i 7rin art%r%H
Anr%9istrai m%ntal ci8ra indicat& d% ac!l manom%tr!l!i An oscilai% An mom%nt!l An car%, An !r%c:i, a!?ii 7rima
;&tai% clara =l!7-d!7>H ac%ast& ci8r& r%7r%?int& 7r%si!n%a =t%nsi!n%a> sistolic& sa! ma#im&H
- Dnr%9istrai n!m&r!l car% cor%s7!nd% ;&t&ii d% 8inal An tim7 c% contin!ai d%com7rimar%a man6%t%iH ac%sta
r%7r%?int& T5A5 diastolic& sa! minim&H
- Dnd%7&rtai man6%ta, c!r&ai 6i d%?in8%ctai oli@%l% st%tosco7!l!iH
- Dnr%9istrai @aloril% m&s!rat% An carn%t!l 7%rsonal, notBnd: n!m%l% ;olna@!l!i, data Anr%9istr&rii, @aloril%
o;in!t% =T5A5 S 4-0070 mmE9 sa! T5A5S 4-07 cmE9>5
REPREGENTAREA $RAFICF A T5A5
- ocotii 7%ntr! 8i%car% lini% ori?ontal& din 8oaia d% t%m7%rat!r&, 40 mmE9 sa! 4 cmE95
- R%7r%?%ntai 9ra8ic @aloril% Anr%9istrat% 7rintr-!n dr%7t!n9:i d% c!loar% al;astr&, a6%?at 7% @%rticala tim7!l!i =*
sa! >H lat!ra d% s!s a dr%7t!n9:i!l!i r%7r%?int& T55 =t%nsi!n%a sistolic&> iar lat!ra d% <os a dr%7t!n9:i!l!i
r%7r%?int& T5*5 =t%nsi!n%a diastolic&>5
- T5A5 a 7aci%nt!l!i %st%, An limit%l% normal% cor%s7!n?&toar% @Brst%iH
- Paci%nt!l n! ac!?& c%8al%%, t!l;!r&ri d% %c:ili;r!H
REGU'TATE NE*ORITE
- Pr%si!n%a sistolic& sa! diastolic& %st% mai mar% sa! mai mic& 8a& d% rata normal& a 7%rsoan%lor d% ac%%a6i
@Brst&H
- !n%t%l% o;in!t% 7rin m%toda WOROTWOPF n! s!nt a!di;il% sa! s!8ici%nt d% distinct% 7%ntr! a 8acilita o
a7r%ci%r% %#acta a T5A5
Paci%nt!l 7oat% a@%a !na sa! mai m!lt% din 7ro;l%m%l% d% d%7%nd%n&:
- intol%ran& la acti@itat%
- alt%rar%a randam%nt!l!i inimiiH
- %#c%s d% @ol!m li%;idian
- d%8icit d% c!no6tin%H
- alt%rar%a n!trii%iH
- alt%rar%a m%nin%rii s&n&t&ii
- Ridicai ;ra!l 7aci%nt!l!i d%as!7ra inimii 7%ntr! 4C s%c!nd% Anaint% d% r%@%ri8icar%a 7r%si!nii dac& a!?ii c!
di8ic!ltat% s!n%t%l% =;&t&il% cardiac%> An !r%c:iH
- "&s!rai T5A5 la coa7s& dac& acc%s!l la art%r%l% ;ra!l!i n! %st% 7osi;ilH
- Al%9%i o man6%ta lat& 6i a6%?ai 7aci%nt!l 7% a;dom%n 7%ntr! 7al7ar%a ad%c@at& a art%r%i 7o7lit%%H
- A<!stai %@al!ar%a 7r%si!nii art%rial% inr%9istrat%, dac& 8olosii coa7sa, Antr!cBt %#ist& t%ndina ca T5A5 s& 8i% mai
mar% la %#tr%mitat%a distal& 8&& d% %#tr%mitat%a 7ro#imal =s!7%rioara>5
- "&s!rai 7r%si!n%a art%rial 7rin m%toda 7al7atori%, An li7sa st%tosco7!l!i a!ric!larH Antotd%a!na @%ti o;in%
%#act n!mai t%nsi!n%a sistolic& 7rin ac%asta m%tod&5
- 8&t!ii 7aci%nii ad!li s&-6i m&soar% T5A5 c%l 7!in o dat& 7% anH
- In8ormai 7aci%nii d%s7r% !tilitat%a a!tom&s!r&rii TA5, la domicili!, 7rin %c:i7am%nt di9italH d%6i costisitor %st%
m!lt mai !6or s& cit%6ti @aloril%5
//
- Instr!ii 7aci%nt!l s& s% 7r%?int% c! 7rom7tit!din% la m%dic dac& @aloril% T5A5 s!nt oscilant%H - - Instr!ii
7aci%nt!l c! :i7%rt%nsi!n% art%rial& =ETA> s&-6i ia m%dicam%nt%l% An mod r%9!lat, s& r%d!c& cons!m!l d% sar%, s&-
6i @%ri8ic% 9r%!tat%a 6i s& An@%% t%:nici d% mana9%m%nt!l str%ss!l!iH - In8ormai 7aci%nt!l08amilia car% s!nt
@aloril% An 8!nci% d% @Brst&H o8%rii, %@%nt!al, !n ta;%l c! @alori ori%ntati@% ca An %#%m7l!l d% mai <os5
)Brsta )alori normal% al% T5A: 'imit% s!7%rioar% al% normal!l!i
4 an +C0.C mmE9 N%d%t%rminat%
.-+ ani 4000.C mmE9 44+07+ mmE9 5
40-4- ani 4400.C mmE9 42/0,/ mmE95
4/-47 ani 4200,0 mmE9 4-/0,+ mmE95
4,-ad!lt 4200,0 mmE9 4-+0,+ mmE95
FIA N". 8.8. M1SURAREA (N1L2IMII I GREUT12II
- ta;ilir%a 9r%!t&ii 7aci%nt!l!i 7%ntr! a7r%ci%r%a st&rii d% n!trii% 6i a r%in%rii a7%i An or9anismH - A7r%ci%r%a
ra7ort!l!i dintr% Analim% 6i 9r%!tat%
- CBntar 7%ntr! ad!li
- Antro7om%tr! =sa! cBntar antro7om%tr!>
- Carn%t 7%ntr! notar%a @alorilor
a> PIEICF:
- E#7licai 7aci%nt!l!i n%c%sitat%a m&s!r&torii 6i sta;ilii Am7r%!n& ora 7otri@it& An c!rs!l dimin%ii
- Asi9!rai 7aci%nt!l, dac& %st% ca?!l, c& s% r%s7%ct& intimitat%a
;> FIGICF:
- A<!tai 7aci%nt!l s& s% d%?;rac% d% :alatH
- E#7licai 7aci%nt!l!i s& n! m&nBnc%, sa! !rin%?% 6i s& %limin% sca!n!l Anaint% d% cBnt&rir%
- Instr!ii 7aci%nt!l s& st%a c! c&lcBi%l% li7it% d% ti<a antro7om%tr!l!i
45"&s!rar%a An&limii
- A6%?ai 7aci%nt!l An 7icioar% c! s7at%l% la ti<a 6i s!; c!rsor!l taliom%tr!l!iH
- R!9ai 7aci%nt!l s& st%a c! s7at%l% dr%7t 6i c&lcBi%l% li7it% d% ti<a taliom%tnil!iH
- Co;orBi c!rsor!l 7Bn& la ca7!l ;olna@!l!i 6i citii 7% ti<& - 9radaia An&limii
25 "&s!rar%a 9r%!t&ii
- Ad!c%i ;alana An %c:ili;r! 6i imo;ili?ai ac!l indicator!l!i Anc:i?Bnd ;ra!l ;alan%i
- )%ri8icai dac& s!nt And%7linit% condiiil%
- (olna@ n%mBncat
- )%?ic& !rinar& 9olit&
- ca!n %liminat
- Asi9!rai-@& c& 7oart& ac%l%a6i :ain% la 8i%car% cBnt&rir%
- Folosii ac%la6i cBntar
- Ad!c%i c%l% do!& c!rsoar% 7%ntr! X95 6i 9ram% a7roa7% d% 9r%!tat%a %stimat& a 7aci%nt!l!i
- R!9ai 7aci%nt!l s& !rc% 7% cBntar
- *%sc:id%i ;ra!l =ti<a ;alan%i> 6i mi6cai c%l% do!& c!rsoar% =c!rsor!l> 7Bn& ac!l s% sta;il%6t% din no! la ?%roH
- Fi#ai scara c!rsor!l!i 6i r!9ai 7aci%nt!l s& co;oar%
- Cond!c%i 7aci%nt!l la 7at =dac& %st% n%@oi%>
- A<!tai-l s& s% a6%?% An 7at
- N! %st% ca?!l An 9%n%ralH
- CBntar%l% mo;il% s!nt ad!s% la loc!l lor
NOTAREA PROCE*URII
- Notai @aloril% An&limii 6i 9r%!t&ii
- Pr%ci?ai dac& din di@%rs% moti@% n! 7ot 8i And%7linit% toat% condiiil%
/C
REGU'TATE AJTEPTATE
- CBnt&rir%a s-a 8&c!t cor%ct, r%?!ltat!l at%st& o %@ol!i% ;!n&
REGU'TATE NE *O RITE 0 CE FACE2I
- )aloril% o;in!t% arat& sc&d%r%a 9r%!t&ii la 7aci%nii sl&;ii, d%n!trii, cr%6t%r%a 9r%!t&ii 6i r%in%r%a a7%i An
or9anism
- )%ri8icai r%s7%ctar%a r%9im!l!i
CAPITOLUL .I.
PANSAMENTE SI BANDA'E
FIA N". ;.1. PANSAMENTUL
REPECTA2I CON*I2II'E UNUI (UN PANA"ENT
a> & 8i% 8&c!t An condiii as%7tic%
- Folosii mat%rial% d% 7rot%ci% 6i instr!m%nt% st%ril%
- 7&lai 6i d%?in8%ctai mBinil%, Am;r&cai m&n!6i st%ril%
- %r@ii mat%rial%l% 8olosind 7%ns%
- N! introd!c%i An casol%t& sa! An tr!sa d% instr!m%nt% 7%nsa c! car% ai l!crat An 7la9&H
- N! 8olosii ac%l%a6i instr!m%nt% la alti 7aci%ni
;> & 8i% a;sor;ant
- Asi9!rai a;sor;ia s%cr%iilor 7%ntr! a 8a@ori?a cicatri?ar%a
- Folosii com7r%s% d% ti8on 6i @at& :idro8il&
c> & 8i% 7rot%ctor
- Aco7%rii 7la9a c! com7r%s% st%ril% 6i @at&
- Asi9!rai-@& c& dim%nsi!nil% com7r%s%lor d%7&6%sc mar9inil% 7l&9i c! c%l 7!in 4-2 cm
- *ac& ?ona %st% %#7!s& micro;ilor, 7rot%<ai 7la9a c! !n strat mai 9ros d% ti8on 6i @at&H
d> & n! 8i% d!r%ros
- Acionai c! ;lBnd%% 6i r&;dar%
- Administrai !n calmant la r%comandar%a m%dic!l!i dac& sit!aia o c%r%
- 7&lai 7la9a 7rin t!rnar% 6i a;sor;ii s!r7l!s!l d% lic:id 6i s%cr%iil% 7rin tam7onar%
- N! 8i#ai 7ansam%nt!l 7r%a strBns 7%ntr! a n! <%na circ!laia 6i a n! 7rod!c% d!r%r%
- Asi9!rai limitar%a mi6c&rilor An ac%a ?on& dac& %#ist& indicaii An ac%st s%ns
%> & 8i% sc:im;at la tim7
- )%ri8icai indicaia m%dical& c! 7ri@ir% la sc:im;ar%a 7ansam%nt!l!iH
- c:im;ai cBt mai rar 7ansam%nt!l la 7l&9il% c:ir!r9ical% at!nci cBnd s% m%nin% c!rat 6i !scat
- Dn ca?!l 7l&9ilor s%cr%tant% sc:im;ai 7ansam%nt!l ori d% cBt% ori %st% n%@oi%H
- An!nai m%dic!l 6i controlai 7la9a dac& 7aci%nt!l ac!?& d!r%r% sa! 7r%?int& 8%;r& 8&r& alt& ca!?&, sc:im;ai
7ansam%nt!l c! ac%ast& oca?i%5
REPECTA2I TI"PII PANA"ENTU'UI
a> Cr%ar%a cBm7!l!i o7%rator
- *%9r%sar%a t%9!m%nt%lor din <!r!l 7l&9ii 7%ntr! a And%7&rta !rm%l% d% ad%?i@ d% la 7ansam%nt!l sa! s%;!m!l,
8olosind %t%r sa! ;%n?in& iodat&
- Dnd%7&rtai com7r%s%l% d% la 7ansam%nt!l @%c:i c! ;lBnd%%, !m%?ind!-l% c! sol!i% antis%7tic& dac& s!nt li7it%
- *%?in8%ctai t%9!m%nt!l c! o sol!i% antis%7tic& =Anc%7Bnd dins7r% 7la9& s7r% 7%ri8%ri%, sc:im;ai 8r%c@%nt
tam7on!l>
;> Tratar%a 7l&9ii
- Acionai An 8!nci% d% r%comandar%a m%dic!l!i, d% nat!ra 6i %@ol!ia 7l&9iiH s7&lai 7la9a c! !n <%t sla; d%
sol!i% antis%7tic& dac& 7r%?int& s%cr%ii, And%7&rtai t!;!l d% dr%n, And%7&rtai 8ir%l% 6i a<!tai m%dic!l dac& %st% o
7la9& r%c%nt&
- A7licai m%dicam%nt% con8orm 7r%scri7i%i m%dical%
c> Aco7%rir%a =7rot%cia 7l&9ii>
- A7licai com7r%s% st%ril% car% s& d%7&6%asc& mar9inil% 7l&9ii c! 4-2 cm
- N! a7licai !n strat 7r%a 9ros d% ti8on 7%ntr! a asi9!ra o ;!n& ca7ilaritat%
- 'a 7l&9il% car% s%cr%t&, aco7%rii com7r%s%l% c! strat n! 7r%a 9ros d% @at& 7%ntr! a n! 7%rmit%, sta9nar%a
s%cr%iilor An contact c! t%9!m%nt!l 8a@ori?Bnd iritaia 6i mac%rar%a
/.
d> Fi#ar%a 7ansam%nt!l!i :
- Al%9%i o m%tod& d% 8i#ar% ad%c@at& r%9i!nii 7rin An8&6ar% sa! c! s!;stan% ad%?i@%
- )%ri8icai 7ansam%nt!l 7%ntr! a n! <%na circ!laia d% Antoarc%r% sa! dac& asi9!r& r%7a!s!l An ca?!l An car% %st%
limitat& mi6car%a
- )%ri8icai dac& 7ansam%nt!l <%n%a?& mi6car%a
O(IECTI)E
O Fa@ori?ar%a @ind%c&rii r&nilor
O Pr%@%nir%a in8%ci%i
O A7r%ci%r%a 7roc%s!l!i d% @ind%car%
O Prot%cia 7l&9ii Am7otri@a 8actorilor m%canici
% 8ac% An 8!nci% d% ti7!l d% 7ansam%nt =7rot%ctor, a;sor;ant, com7r%si@, ocl!?i@, !m%d>
- Ta@a m%dical&0c&r!cior 7%ntr! tratam%nt%, m&s!a 7%ntr! 7ansam%nt%H
- Tr!sa c! instr!m%nt% st%ril%: 7%ns% :%mostatic%, 7%ns% anatomic%, 8oar8%ci c:ir!r9ical%, stil%t% ;!tonat%, sond%
can%lat%H
- Com7r%s% st%ril%
- T!;!ri d% dr%n st%ril%
- "&n!6i st%ril%
- Oc:%lari d% 7rot%ci%, masc&
- "!6ama, al%?&
- ol!ii antis%7tic%:
- 7%ntr! t%9!m%nt%
- 7%ntr! 7la9&
- ol!ii d%9r%sant%: ;%n?in& iodat&, %t%r
- "%dicam%nt%: 7!l;%ri, !n9!%nt%
- "at%rial% 7%ntr! 8i#ar%: 8%6i d% ti8on, ;%n?i ad%?i@%, 7las& ad%?i@&, sol!i% ad%?i@&, ac% d% si9!ran&
- T&@ia r%nal&
a> PIEICF
- In8ormai 7aci%nt!l as!7ra n%c%sit&ii %8%ct!&rii 7ansam%nt!l!i
- E#7licai mod!l d% d%s8&6!rar%a al 7roc%d!rii
- O;in%i consim&mBnt!l
;> FIGICF
- Po?iionai 7aci%nt!l An 8!nci% d% s%9m%nt!l c% tr%;!i% 7ansat
- Al%9%i 7o?iia d% d%c!;it 7%ntr! a %@ita li7otimia
- Asi9!rai intimitat%a 7aci%nt!l!i dac& %st% ca?!l
- Al%9%i mat%rial%l% n%c%sar% An 8!nci% d% ti7!l 7ansam%nt!l!i
- )%ri8icai 7r%scri7ia m%dical& 7ri@ind tratar%a 7l&9ii
- Id%nti8icai 7aci%nt!l
- E@al!ai star%a 7aci%nt!l!i 7%ntr! a sta;ili dac& 7ansam%nt!l s% 8ac% la 7at sa! la sala d% 7ansam%nt%
- P!n%i masca, aco7%rii 7&r!l, s7&lai mBinil% 6i d%?in8%ctai-l% c! alcool
- Dm;r&cai m&n!6i st%ril%, l!ai din tr!s& 2 7%ns% st%ril%
- Dnd%7&rtai 7ansam%nt!l @%c:i dac& %st% ca?!l, 8&r& s& 7rod!c%i d!r%r%5 *ac& %st% li7it !m%?ii c! a7& o#i9%nat&
sa! s%r 8i?iolo9icH o;s%r@ai 7la9a
- C!r&ai t%9!m%nt!l din <!r!l 7l&9ii 8olosind tam7oan% Am;i;at% An ;%n?in& sa! %t%r 7%ntr! a %8%ct!a d%9r%sar%a
6i a7oi d%?in8%ctai c! alcool sa! tinct!r& d% iod5 Jt%r9%r%a s% @a 8ac% d% la 7la9& s7r% 7%ri8%ri% sc:im;Bnd d%s
tam7oan%l% 7%ntr! a %@ita contaminar%a
- 7&lai 7la9a 7rin t!rnar% 7%ntr! a n! 7rod!c% d!r%r%, 8olosind !na din sol!iil% d%?in8%ctant% r%comandat%H
- A;sor;ii s%cr%iil% din 7la9& 7rin tam7onar% 7%ntr! a n! 7rod!c% d!r%r%
- C!r&ai din no! t%9!m%nt%l% din <!r!l 7l&9ii 8olosind tam7on 7%ntr! o sin9!r& man%@r& 6i 6t%r9%i a7oi c! !n
tam7on !scat
- E8%ct!ai An contin!ar% tratam%nt!l 7l&9ii An 8!nci% d% nat!ra 6i %@ol!ia ac%st%ia, a7licBnd m%dicam%nt% dac&
s!nt r%comandat%H
/7
- Aco7%rii c! com7r%s% d% ti8on st%ril% car% s& d%7&6rasc& mar9in%a 7l&9ii c! 4-2 cm 6i a7licai d%s!7ra !n strat
s!;ir% d% @at& dac& %st% n%c%sar
- Fi#ai 7rin li7ir% c! mat%rial% ad%?i@% sa! 7rin ;anda<ar% 8olosind !n 7roc%d%! ada7tat r%9i!nii =circ!lar, An
s7iral&, An %@antai, c! 8a6& r&s8rBnt&, An s7ic>
- A6%?ai 7aci%nt!l An 7o?ii% comod& 6i 7!n%i r%9i!n%a l%?at& An r%7a!s
- O;s%r@ai 8aci%s!l 6i com7ortam%nt!l la d!r%r%
- O;s%r@ai as7%ct!l t%9!m%nt%lor 7%ntr! ca 7ansam%nt!l s& n! <%n%?% circ!laia
- Col%ctai d%6%!ril% c! 7ot%nial in8%cios =com7r%s%, m&n!6i, t!;!ri d% dr%n, 8%6i> An r%ci7i%nt% s7%cial%
- C!r&ai instr!m%nt%l% 6i 7r%9&tii-l% 7%ntr! st%rili?ar%
- *%?;r&cai m&n!6il%
- 7&lai mBinil%
NOTAREA PROCE*URII
- Notai ti7!l d% 7ansam%nt, as7%ct!l 6i %@ol!ia 7l&9ii data, ora
- Notai in8ormaiil% car% tr%;!i% transmis% An l%9&t!r& c! 7ansam%nt%l% !rm&toar%
- Paci%nt!l n! ac!?& d!r%r% H
- Pansam%nt!l %st% ;in% 8i#at 6i c!ratH
- Pla9a %st% An c!rs d% @ind%car%
REGU'TATE NE*ORITE 0 CE FACE2I
- Paci%nt!l ac!?& d!r%r%, t%9!m%nt%l% s!nt ro6ii, %d%maiat%, 7la9a s%cr%t&H
- An!nai m%dic!l 6i %8%ct!ai An9ri<iril% r%comandat%
- T%9!m%nt%l% A6i sc:im;& c!loar%a, 7ot a7ar% 8!rnic&t!ri
- Pansam%nt!l %st% 7r%a strBns5 R%8ac%i ;anda<!l
- Pansam%nt!l s% !m%?%6t% din ca!?a s%cr%iilor
- A7licai !n strat 7rot%ctor 6i a;sor;ant d% @at&
- "ontai t!; d% dr%n la r%comandar%a m%dic!l!i sa! s!; s!7ra@%9:%r%a ac%st!ia
- c:im;ai 7ansam%nt!l d% cBt% ori %st% n%@oi%
FIA N". ;.6. TIPURI DE PANSAMENTE
PANA"ENTU' PROTECTOR
O(IECTI)
- Aco7%rir%a !n%i 7l&9i car% n! s%cr%t&, n! 7r%?int& t!; d% dr%n =7la9& o7%ratori%, loc!l !n%i in<%cii sa! 7!ncii,
loc!l !nd% %st% montat !n cat%t%r @%nos> 7%ntr! a r%ali?a 7rot%ci% 8a& d% m%di!l Ancon<!rator
RECO"AN*FRI
- P!t%i 8olosi mat%rial% sint%tic% An loc!l com7r%s%lor mari
PANA"ENTU' A(OR(ANT
O(IECTI)
- Aco7%rir%a 7l&9ilor dr%nat% sa! s%cr%tant% c! !n strat d% com7r%s% 6i !n strat d% @at&
RECO"AN*FRI
- R%s7%ctai %ta7%l% d% %8%ct!ar% a 7ansam%nt!l!i
- !7ra@%9:%ai 7aci%nt!l 7%ntr! a 7!t%a sc:im;a 7ansam%nt!l mai al%s dac& s% Am;i;&
- *ac& m%dic!l mont%a?& t!; d% dr%n notai cantitat%a d% lic:id %liminat&
PANA"ENTU' OC'UGI)
O(IECTI)
- Aco7%rir%a c! com7r%s% 6i @at& a 7l&9ilor Ansoit% d% l%?i!ni osoas% 7%st% car% s% a7lic& a7arat!l 9i7sat 7%ntr!
imo;ili?ar%
RECO"AN*FRI
- P%ntr! An9ri<ir%a 7l&9ii s% 7oat% 8ac% 8%r%astr&
PANA"ENTU' CO"PREI)
/,
O(IECTI)
- Aco7%rir%a !n%i 7l&9i sBn9%rBnd% An sco7 :%mostatic, 7%ntr! imo;ili?ar%a !n%i artic!laii An ca? d% %ntors& sa!
7%ntr! r%d!c%r%a !n%i ca@it&i s!7%r8icial% d!7& 7!ncionar%
RECO"AN*FRI
- R%s7%ctai %ta7%l% d% %8%ct!ar% a 7ansam%nt!l!i 5
- A7licai 7%st% com7r%s% !n strat mai 9ros d% @at& ast8%l AncBt s& s% aco7%r% r%li%8!ril% osoas% 6i com7r%si!n%a s&
8i% r%7arti?at& !ni8orm 7% toat& s!7ra8aa r%9i!nii, s& n! Am7i%dic% circ!laia d% Antoarc%r%
PANA"ENTU' U"E*
O(IECTI)
- *imin!ar%a %d%m!l!i in8lamator
RECO"AN*FRI
- A7licai com7r%s% !m%d% r%ci Am;i;at% An sol!ii r%comandat% d% m%dic =Ri@anol, cloramin&, %tc5>
- Prot%<ai c! o ;!cata d% mat%rial 7lastic
- Fi#ai
- R%!m%?ii din tim7 An tim7 =ma#im la C-40 min> sa! sc:im;ai com7r%s%l% d%oar%c% s% Anc&l?%sc 6i 7rod!c !n
%8%ct contrar5
FIA N". ;.7. BANDA'E FIXAREA PANSAMENTULUI PRIN (NF1ARE 9BANDA'AREA:
O(IECTI)
Fi#ar%a 7ansam%nt!l!i An r%9i!nil% An car% s!;stan%l% ad%?i@% n! asi9!r& ac%ast& c%rin& =%#tr%mit&i, r%9i!n%a
ca7!l!i, r%9i!ni artic!lar%>
- Fi#ar%a 7ansam%nt%lor 7% r%9i!ni s!7!s% tra!matism%lor An tim7!l !nor accid%nt% =mBn&, 7icior>
- E8%ct!ar%a 7ansam%nt!l!i com7r%si@
- Imo;ili?ar%a t%m7orar& An tra!matism%l% m%m;r%lor =%ntors%, l!#aii, 8ract!ri>
- F%i d% ti8on d% m&rimi di8%rit% =l&imi Antr% C 6i 2C cm, l!n9imi Antr% 2 6i C m>
- F%6i %lastic%
- Foar8%cii
- Ac% d% si9!ran&, 7las&, l%!co7last
- Proc%d!ra %st% %8%ct!at& d% r%9!l& d!7& 7ansam%nt =7%ntr! 8i#ar%> c%%a c% 7r%s!7!n% 7r%9&tir%a 7r%ala;il&
- Contin!ai s& com!nicai c! 7aci%nt!l 7%ntr! atin9%r%a o;i%cti@!l!i 6i 7%ntr! cola;orar%a c! ac%sta
- Al%9%i 8%6il% d% dim%nsi!ni cor%s7!n?&toar% r%9i!nii 6i sco7!l!i
- Al%9%i t%:nica d% An8&6ar% An 8!nci% d% ?on&
- tai tot tim7!l c! 8aa la 7aci%nt
- 2in%i 8a6a An mBna dr%a7t& Antr% 7olic% 6i c%l%lalt% 7atr! d%9%t%, iar c! mBna stBn9& 7rind%i ca7&t!l li;%r
- Tra9%i 7rim%l% /-C t!r!ri circ!lar% la o distan& d% 40-4C cm d% 7la9&5 *!7& 7rim!l t!r col!l li;%r al 8%6ii
a6%?at o;lic s% r%strBn9% 6i s% aco7%r& c! a II-a t!r& 7%ntr! a 8i mai ;in% 8i#at
- Contin!ai An8&6ar%a An 8!nci% d% r%9i!n% 8olosind o modalitat% ad%c@at&: circ!lar&, An s7ic, An %@antai, An s7iral&
%tc5
DNFFJAREA CIRCU'ARF
- Folosii t%:nica 7%ntr! r%9i!ni cilindric%: ca7, 9Bt, torac%, a;dom%n, ;ra, artic!laia 7!mn!l!i
- 'a m%m;r%, Anc%7%i An8&6ar%a d% la %#tr%mitat%a s7r% r&d&cin& An s%ns!l circ!lai%i d% Antoarc%r% =d% la 7art%a
mai s!;ir%>
- Aco7%rii 7ansam%nt!l An Antr%9im% 7rin t!r%, s!7ra7!s%
- Fi#ai c! ac d% si9!rana, l%!co7last sa! 7rin nod la distan& d% 7l&9& 7%ntr! a n! 7rod!c% <%n&
DNFFJAREA DN PIRA'F
- Folosii t%:nica 7%ntr! m%m;r% =9am;&, ant%;ra> r%9i!ni tronconic% 6i s!7ra8%% Antins%
- E8%ct!ai d!7& t!r%l% circ!lar% iniial%, t!r% o;lic% An a6a 8%l AncBt t!ra !rm&toar% s& aco7%r% <!m&tat% din c%a
ant%rioar&
- R&st!rnai din cBnd An cBnd 8a6& 7%ntr! a asi9!ra a7ro7i%r%a d% s%9m%nt
DNFFJAREA DN E)ANTAI
/+
- Folosii An8&6ar%a 7%ntr! artic!laii =cot, 9%n!nc:i, c&lcBi>
- Dnc%7%i c! do!& t!r% circ!lar% d%as!7ra artic!lai%i
- Contin!ai c! t!r% o;lic% d%sc%nd%nt% An a6a 8%l AncBt 8a6a s& s% s!7ra7!n& la distan% mai mici An 7lic& 6i mai
mari An 7art%a %#7!s& a<!n9Bnd circ!lar la ni@%l!l lini%i artic!lar% 6i a7oi o;lic% s!; artic!lai%
- Dnc:%iai c! do!& t!r% circ!lar% 6i 8i#ai c! ac d% si9!ran&, l%!co7last
DNFFJAREA RFFR3NTF
- Folosii t%:nica 7%ntr! m%m;r% =9am;&, ant%;ra, r%9i!ni tronconic% 6i s!7ra8%% Antins%> 7%ntr! a asi9!ra o mai
;!n& %tan6ar%
- Dnc%7%i c! 2 t!r% circ!lar%
- Contin!ai o;lic An s!s 7Bn& 7% 8aa ant%rioar& a s%9m%nt!l!i !nd% 8i#ai 8a6a c! 7olic%l% sa! c! a<!tor!l alt%i
7%rsona%, o r&s8rBn9%i 6i contin!ai An <os Anco<!rBnd s%9m%nt!l 7% 8aa 7ost%rioar& aco7%rind Y din t!ra
ant%rioar&
- Contin!ai c! t!ra o;lic& 7% 8aa ant%rioar& 6i r%7%tai man%@ra d% r&s8rBn9%r% a 8%6ii 6i d% aco7%rir% a 8%%i
7ost%rioar% 7Bn& cBnd 7ansam%nt!l %st% 8i#at
- Dnc:%iai 7rin t!r% circ!lar%
- Fi#ai ca7&t!l li;%r c! ac d% si9!ran& sa! l%!co7last
DNFFJAREA DN PICF
- Folosii 7%ntr! r%9i!ni artic!lar%: sca7!lo-:!%ral&, in9:ino-a;dominal&, cot, 7icior, 7!mn
- Dnc%7%i d% r%9!l& d%as!7ra artic!lai%i 7rin t!r% circ!lar%
- Tr%c%i 8a6a d%d%s!7t!l artic!lai%i, An 8orm& d% R,R Ancon<!rBnd ?ona @%cin& aco7%rind t!ra 7r%c%d%nt& <!m&tat%
sa! do!& t!r!ri
- T%rminai 7rin t!r% circ!lar%
- Fi#ai ca7&t!l li;%r
CAPITOLUL .II.
SONDA'E3 SP1L1TURI3 CLISME
FIA N". <.1. INTRODUCEREA I (NDEP1RTAREA UNEI SONDE NA&OGASTRICE
9TUBA'UL NA&OGASTRIC:
A. INTRODUCEREA SONDEI
- Introd!c%r%a !n%i sond% An stomac 7%ntr! %@ac!ar%a conin!t!l!i sa! as7irai% contin!&
- Introd!c%r%a alim%nt%lor An stomac sa! a m%dicam%nt%lor
- E8%ct!ar%a !nor t%st% dia9nostic%
- Ta@& m%dical& sa! c&r!cior H
- ond% din ca!ci!c sa! din mat%rial 7lastic st%ril% H
- %rin9& d% 20 mlH s%rin9& $!Zon st%ril&H st%tosco7H
- T&@i& r%nal&H
- ol!i% 7%ntr! l!;r%8i%r% =a[!a 9%l>H
- )as col%ctor 7%ntr! lic:id!l %@ac!at sa! 7!n9& col%ctoar%
- '%!co7last
- Pa:ar c! a7&
- Prosoa7%, 6%r@%%l% din :Brti%
a> PIEICF:
- E#7licai 7aci%nt!l!i sco7!l 6i n%c%sitat%a t!;a<!l!iH
- O;in%i consim&mBnt!l 6i cola;orar%a H
- In8ormai 7aci%nt!l 7ri@ind mod!l d% d%s8&6!rar% a 7roc%d!rii 6i a d!rat%i ac%st%iaH
- Asi9!rai intimitat%a
;> FIGICF
- Dnd%7&rtai 7rot%?a d%ntar& dac& %#ist& 6i 7lasai-o Antr-!n 7a:ar c! a7&H
- R!9ai 7aci%nt!l s&-6i s!8l% nas!l sa! c!r&ai nas!l dac& %st% n%c%sarH
C0
- Al%9%i nara c%a mai 8!ncional& 7!nBnd 7aci%nt!l s& r%s7ir% alt%rnati@ 7% o nar& 6i 7% c%alalt&H
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd& sa! s%mi6%?Bnd&
- Al%9%i 6i @%ri8icai mat%rial%l% An 8!nci% d% o;i%cti@!l sta;ilitH
- )%ri8icai r%comandar%a m%dical&H
- Id%nti8icai 7aci%nt!l 6i trans7ortai mat%rial%l% An salon
- Instr!ii 7aci%nt!l c!m s& An9:it&
- A6%?ai 7aci%nt!l An 7o?iia al%as& 6i 7lasai s!; ;&r;ia ac%st!ia !n 7roso75
- Estimai l!n9im%a n%c%sar& 7%ntr! ca sonda s& a<!n9& An stomac 7roc%dBnd ast8%l:
- "&s!rai distana dintr% lo;!l !r%c:ii 6i @Br8!l nas!l!i 6i a7oi d% la @Br8!l nas!l!i 7Bn& la a7%ndic%l%
#i8oidian
- Dns%mnai loc!l c%lor do!& m&s!r&tori c! ;%n?i s!;iri d% l%!co7last sa! notai distan%l% dac& sonda
%st% 9radat&
- '!;ri8iai sa! !m%?ii @Br8!l sond%i 7%ntr! a asi9!ra Anaintar%a, 7%ntr! a r%d!c% 8rici!n%a 6i iritaiil%
- Plasai o t&@i& r%nal& s!; ;&r;ia 7aci%nt!l!i %@%nt!al s& o m%nin& sin9!r sa! a7%lai la a<!tor - Introd!c%i
sonda c! d%licat%% 7rin nara s%l%ctat& Andr%7tBnd-o s7r% s7at% 6i An <os AnaintBnd Anc%t 7Bn& a<!n9% An 8arin9%
- A@ansai c! sonda r!9Bnd 7aci%nt!l s& An9:it& 7Bn& a<!n9% la 7rim!l s%mn5 Fa@ori?ai An9:iir%a sond%i dBnd
7aci%nt!l!i cantit&i mici d% a7& c! 7ai!l =dac& %st% ca?!l>
- !7ra@%9:%ai star%a 7aci%nt!l!i d%oar%c% 7ot a7ar%: ciano?a, t!l;!r&ri r%s7iratorii, sit!ai% An car% sonda a a<ins
An tra:%%
- R!9ai 7aci%nt!l s& An9:it& Anc%t 7Bn& la al doil%a s%mn
- Controlai 7o?iia sond%i 7rin !na din !rm&toar%l% m%tod%H
- Con%ctai o s%rin9& la ca7&t!l li;%r al sond%i 6i conin!t!l stomacal
- Con%ctai o s%rin9& la ca7&t!l li;%r al sond%i 6i introd!c%i -0 cm- d% a%r asc!ltBnd c! st%tosco7!l 7lasat
7% %7i9astr!, ?9omot%l% 7rod!s% d% intrar%a a%r!l!i
- Introd!c%i ca7&t!l li;%r al sond%i Antr-!n 7a:ar c! a7a5
N! tr%;!i% s& ias& ;!l% d% a%r5
- )%ri8icai radiolo9ic dac& %st% ca?!l
- Fi#ai sonda 7% nas c! l%!co7last ast8%l AncBt s& n! Am7i%dic% @%d%r%a 6i s& n! 7r%s%?% nas!l
- Fi#ai %@%nt!al 7art%a li;%r& a sond%i a@Bnd 9ri<& s& l&sai o ;!cl& =d% la nas 7Bn& la loc!l 8i#&rii> car% s&-i
7%rmit& 7aci%nt!l!i mi6car%a l%<%r& a ca7!l!i
- A6%?ai 7aci%nt!l Antr-o 7o?ii% comod&
- Contin!ai t!;a<!l con8orm o;i%cti@!l!i !rm&rit
- Clam7ai sonda sa! a7licai !n do7 Antr% do!& 8olosiri, ata6ai 7!n9a col%ctoar% An 8!nci% d% o;i%cti@!l t!;a<!l!i
- O;s%r@ai 8aci%s!l 6i r%s7iraia 7aci%nt!l!i
- Asi9!rai i9i%na oral&, m!coasa s& 8i% c!rat& 6i !m%d&
- O;s%r@ai n&ril% 6i %@%t!al%l% s%mn% d% iritai%
- )%ri8icai 7%rm%a;ilitat%a sond%i
- R%dai 7aci%nt!l!i 7rot%?a, dac& n! %#ist& alt% r%comand&ri al% m%dic!l!i
- Dnd%7&rtai mat%rial%l% 8olosit%
- $olii r%ci7i%nt%l% =dac& %st% ca?!l> 6i c!r&ai
- A6%?ai mat%rial%l% An d!la7!ri sa! An alt% loc!ri d%stinat% 7&str&rii
NOTAREA PROCE*URII
Notai :
- *ata, ora %8%ct!&rii0introd!c%rii sond%i, ti7!l t!;a<!l!i, d!rata 6i m&rim%a sond%i 8olosit%
- Tol%rana 7aci%nt!l!i la 7roc%d!r&
- "%tod% 8olosit% 7%ntr! control
- Cantitat%a, c!loar%a, consist%na, miros!l lic:id!l!i %#tras
- Pr%?%na !nor s%mn% d% iritai% 6i di8ic!lt&i An introd!c%r%a sond%i
- Paci%nt!l %st% cola;orant 6i d%monstr%a?& An%l%9%r%a in8ormaiilorH
C4
- onda %st% introd!s& 8&r& di8ic!ltat%H
- onda %st% 7%rm%a;il&H
- Paci%nt!l n! ac!?& discon8ort ma<or 5
REGU'TATE NE*ORITE0CE FACE2IN
- Paci%nt!l n! cola;or%a?&
- E#7licai-i c! r&;dar% im7ortana 7roc%d!rii 6i la n%@oi% an!nai m%dic!l
- Folosii !n s7raZ an%st%?ic, dac& m%dic!l r%comand&, 7%ntr! a And%7&rta s%n?aiil% n%7l&c!t%
- onda n! Anaint%a?& la ni@%l!l ori8ici!l!i na?al
- Est% 7osi;il& o o;str!ci%H r%tra9%i sonda 6i Anc%rcai din no! c! r&;dar%
- Paci%nt!l t!6%6t%, s% ciano?%a?&, 7r%?int& t!l;!r&ri r%s7iratorii 7%ntr! c& sonda a a<!ns An tra:%%
- R%tra9%i !6or sonda, l&sai 7aci%nt!l s& s% lini6t%asc& 6i Anc%rcai din no! man%@rBnd sonda c! ;lBnd%%
- Paci%nt!l ac!?& discon8ort, iritai%, s%n?ai% d% @om&, 9r%a&
- 8&t!ii 7aci%nt!l s& r%s7ir% 7ro8!nd 7%ntr! a com;at% 9r%aa
- A<!tai 7aci%nt!l s&-6i s!sin& sa! s!sin%i t&@ia r%nal&, An ca? d% @om&
- An!nai m%dic!l An ca? d% iritai% 6i a7licai m&s!ril% sta;ilit% d% ac%sta
- onda s% Ancol&c%6t% An stomac
- A7r%ciai cor%ct 7rin m&s!r&tori 7ro8!n?im%a la car% @a 8i introd!s& sonda
- R%tra9%i 7!in sonda 7Bn& la di@i?i!n%a CC-.0 sa! 7Bn& la al doil%a marca<
B. (NDEP1RTAREA SONDEI
O(IECTI)
- Dnd%7&rtar%a sond%i 8olosit% 7%ntr! t!;a<!l na?o9astric
PRE$FTIREA "ATERIA'E'OR NECEARE
- Ta@& sa! m&s!& 7%ntr! mat%rial%
- J%r@%%l% =7roso7> d% :Brti%
- T&@ia r%nal&
- Al%?&, 7roso7
- "!6ama 7%ntr! 7rot%cia l%n<%ri%i 7aci%nt!l!i 6i a 7at!l!i
- Pa:ar c! a7&
- )%ri8icai indicaia m%dic!l!i 7%ntr! r%tra9%r%a sond%i
- Ad!c%i mat%rial%l% lBn9& 7at!l 7aci%nt!l!i
- E#7licai 7roc%d!ra
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd& sa! s%mi6%?Bnd& An 8!nci% d% star%a ac%st!ia
- P!n%i m!6ama!a 6i al%?a 7% 7i%7t!l 7aci%nt!l!i
- 7&lai mBinil%, Am;r&cai m&n!6i
- Dnc:id%i sonda
- Dnd%7&rtai l%!co7last!l c! ;lBnd%% d% 7% nas
- Instr!ii 7aci%nt!l s& ins7ir% 6i s& r&mBn& An a7n%%
- A7!cai sonda c! o mBn&, 7r%sai 6i r%tra9%i Anc%t c! o mi6car% !6oar&, 7Bn& a7roa7% d% 8arin9%, a7oi mai ra7id
- $:idai sonda c! c%alalt& mBn& 8olosind !n 7roso7 d% :Brti% 6i 7rin?Bnd ca7&t!l sond%i 7% m&s!r& c% %st% r%tras&
- R!9ai 7aci%nt!l s& r%s7ir% normal
- O8%rii 7aci%nt!l!i !n 7a:ar c! a7& 7%ntr! a-6i cl&ti 9!ra
- O;s%r@ai 8aci%s!l 7aci%nt!l!i
- C!r&ai n&ril% 6i o;s%r@ai %@%nt!al%l% iritaii
- "&s!rai =dac& %st% ca?!l> lic:id!l %liminat
- Dnd%7&rtai m&n!6il%, s7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- Ora And%7&rt&rii sond%i 6i com7ortam%nt!l 7aci%nt!l!i, cantitat%a, as7%ct!l lic:id!l!i
C2
REGU'TATE AJTEPTATE
- Dnd%7&rtar%a sond%i a d%c!rs 8&r& incid%nt%
REGU'TATE NE*ORITE0 CE FACE2IN
- Paci%nt!l %#7rim& discom8ort din !rm&toar%l% ca!?%:
- onda n! a 8ost Anc:is& 6i 7%nsat&, conin!t!l s-a sc!rs An 8arin9%
- Pr%@%nii 7rin %#%c!tar%a cor%ct& a %#tra9%riiH
- Pr%?int& iritaii din ca!?a l%?&rii m!coas%i 7rin com7r%si!n% sa! a as7%rit&ilor @Br8!l!i sond%i
- Pr%@%nii 7rin control!l r%7%tat al as7%ct!l!i m!coas%i
- Folosii sond% d% dim%nsi!ni cor%s7!n?&toar% @Brst%i 7aci%nt!l!i, sco7!l!i 6i r%comand&rii
m%dical%
FIA N". <.6. TUBA'UL 9SONDA'UL: DUODENAL
- Introd!c%r%a !n%i sond% 7Bn& An d!od%n =dincolo d% 7ilor> 7%ntr! %#tra9%r%a conin!t!l!i An @%d%r%a !nor t%st%
d% dia9nosticH
- *r%nar%a c&ilor ;iliar%H
- Introd!c%r%a !nor lic:id% :idratant% 6i n!triti@%, a !nor m%dicam%nt%H
- As7irai% contin!& la ;olna@ii c:ir!r9icali5
- Ta@& sa! c&r!cior 7%ntr! mat%rial%H
- ond% st%ril% Ein:orn =sa! "ill%r-A;ott>H
- 2 s%rin9i d% 20 ml, s%rin9& $!Zon, 7%r8!?oar%H
- "&n!6i d% ca!ci!c d% !nic& 8olosin&H
- P%ns& =cl%m&> 7%ntr! clam7ar%a sond%iH
- '%!co7last
- "!6ama, al%?&, 7roso7
- P%rn& cilindric& sa! !n s!l dintr-o 7&t!r&
- T&@i& r%nal&
- "at%rial% An 8!nci% d% o;i%cti@: stati@ c! %7r!;%t%, sol!i% d% !l8at d% ma9n%?i! --P, :Brti% d% t!rn%sol, m%dii
d% c!lt!r&, !l%i d% m&slin%, no@ocnin&, sol!ii 7%ntr! :idratar% sa! alim%ntar%, m%dicam%nt%, r%ci7i%nt% 7%ntr!
col%ctar%a lic:id!l!i d% as7irai% sa! 7!n9i col%ctoar%
- Para@an% 7%ntr! i?olar%
- Pa:ar c! a7&
a> PIEICF:
- E#7licai 7aci%nt!l!i sco7!l 6i n%c%sitat%a t!;a<!l!iiH
- O;in%i consim&mBnt!l 6i cola;orar%a H
- In8ormai 7aci%nt!l 7ri@ind mod!l d% d%s8&6!rar% a 7roc%d!rii 6i a d!rat%i ac%st%iaH
;> FIGICF
- Dnd%7&rtai 7rot%?a d%ntar& dac& %#ist& 6i 7lasai-o Antr-!n 7a:ar c! a7& H
- R!9ai 7aci%nt!l s&-6i s!8l% nas!l sa! c!r&ai nas!l dac& %st% n%c%sarH
- Al%9%i nara c%a mai 8!ncional& 7!nBnd 7aci%nt!l s& r%s7ir% alt%rnati@ 7% o nar& 6i 7% c%alalt& H
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd& sa! s%mi6%?Bnd&
45 Introd!c%r%a sond%i
- Al%9%i 6i @%ri8icai mat%rial%l% An 8!nci% d% o;i%cti@%!l sta;ilitH
- )%ri8icai r%comandar%a m%dical&H
- Id%nti8icai 7aci%nt!l 6i trans7ortai mat%rial%l% n%c%sar% An salon
- Instr!ii 7aci%nt!l c!m s& An9:it&
- A6%?ai 7aci%nt!l An 7o?iia al%as& 6i 7lasai s!; ;&r;ia ac%st!ia !n 7roso7 H
C-
- Estimai l!n9im%a n%c%sar& 7%ntr! ca sonda s& a<!n9& An stomac 7roc%dBnd as8%l:
- "&s!rai distana dintr% lo;!l !r%c:ii 6i @Br8!l nas!l!i 6i a7oi d% la @Br8!l nas!l!i 7Bn& la a7%ndic%l%
#i8oidian
- Dns%mnai loc!l c%lor do!& m&s!r&tori c! ;%n?i s!;iri d% l%!co7last sa! notai distan%l% dac& sonda
%st% 9radat&
- '!;ri8iai sa! !m%?ii @Br8!l sond%i 7%ntr! a asi9!ra Anaintar%a, 7%ntr! a r%d!c% 8rici!n%a 6i iritaiil%
- Plasai o ta@i& r%nal& s!; ;&r;ia 7aci%nt!l!i 6i r!9ai-l %@%nt!al s& o m%nin& sin9!r sa! a7%lai la a<!tor
- Introd!c%i sonda c! d%licat%% 7rin nara s%l%ctat& Andr%7tBnd-o s7r% s7at% 6i An <os AnaintBnd Anc%t 7Bn& a<!n9%
An 8arin9%H
- A@ansai c! sonda r!9Bnd 7aci%nt!l s& An9:it& 7Bn& a<!n9% la 7rim!l s%mn5 Fa@ori?ai An9:iir%a sond%i dBnd
7aci%nt!l!i cantit&i mici d% a7& c! 7ai!l =dac& %st% ca?!l>
- !7ra@%9:%ai star%a 7aci%nt!l!i d%oar%c% 7ot a7ar% : t!s%a, ciano?a, t!l;!r&ri r%s7iratorii sit!ai% An car% sonda
a a<!ns An tra:%%
- R!9ai 7aci%nt!l s& in9:it& Anc%t 7an& la al doil%a s%mn
- Controlai 7o?iia sond%i 7rin !na din !rm&toar%l% m%tod%
- Con%ctai o s%rin9& la ca7&t!l li;%r al sond%i 6i as7irai conin!t!l stomacal
- Con%ctai o s%rin9& la ca7&t!l li;%r al sond%i 6i introd!c%i -0 cm- d% a%r asc!ltBnd c! st%tosco7!l 7lasat
7% %7i9astr!, ?9omot%l% 7rod!s% d% intrar%a a%r!l!i
- Introd!c%i ca7&t!l li;%r al sond%i Antr-!n 7a:ar c! a7&5 N! tr%;!i% s& ias& ;!l% d% a%r5
- )%ri8icai radiolo9ic dac& %st% cai?!l
- As%?ai 7aci%nt!l An d%c!;it lat%ral dr%7t c! ca7!l mai <os, tr!nc:i!l !6or ridicat 6i m%m;r%l% in8%rioar% 8l%ctat%
- Introd!c%i s!; :i7ocondr!l dr%7t 7%rna cilindric& sa! s!l!l r%ali?at din 7&t!ra r!lat&
- A6%?ai An 8aa 7aci%nt!l!i o m!6ama aco7%rit& c! o al%?&H
- lnstr!ii 7aci%nt!l s& An9:it& Anc%t contin!Bnd introd!c%r%a l%nt& a sond%i 4 - 2 cm la --C min5
- Urm&rii 9radaiil% sond%i 7%ntr! a o;s%r@a a<!n9%r%a di@i?i!nii 7C-,0 cm la ori8ici!l narin%i cBnd sonda s% a8l&
An d!od%n =d!7& 4- 4Y : d% la 7&tr!nd%r%a An stomac>
- )%ri8icai 7o?iia sond%i 7rin !na din !rm&toar%l% m%tod%:
45 Introd!c%i ca7&t!l li;%r al sond%i Antr-o %7r!;%t& 6i o;s%r@ai dac& s% sc!r9% ;il& d% c!loar% 9al;%n
a!ri%, dac& n! s% sc!r9% introd!c%i cBi@a ml d% a%r 7%ntr! a And%7&rta %@%nt!al%l% m!co?it&i 6i as7irai c!
s%rin9a5
25 Ins!8lai .0 ml a%r 7rin sond& c! o s%rin9& 6i Anc%rcai s& r%c!7%rai d!7& 4 min5 As7irar%a !n%i
cantit&i mai mici d% 20 ml arat& c& sonda %st% An d!od%n
-5 Introd!c%i 40 ml la7t% car% n! mai 7ot 8i r%c!7%rai dac& sonda %st% An d!od%n
/5 Control!l radiolo9ic
- Contin!ai t!;a<!l con8orm o;i%cti@!l!i !rm&rit
- Fi#ai sonda dac& tr%;!i% s& r&mBn& 7% loc
- "%nin%i sonda 7% d!rata r%comandat& d% m%dic
25 R%tra9%r%a sond%i
- An!nai 7aci%nt!l cBnd tr%;!i% %#tras& sonda
- Introd!c%i cBi@a ml d% a%r 7%ntr! a 9oli l!m%n!l sond%i 6i incl!d%i c! o 7%ns&
- Co;orBi %#tr%mitat%a li;%r& a sond%i s!; ni@%l!l stomac!l!i 7%ntr! a %@ita sc!r9%r%a %@%nt!al%lor r%st!ri din
l!m%n An 8arin9% sa! An ca@itat%a ;!cal&
R%tra9%r%a sond%i An - 7a6i
- R!9ai 7aci%nt!l s& ins7ir% 6i s& r&mBn& An a7n%% tim7 An car% r%tra9%i sonda 7Bn& la ni@%l!l stomac!l!i
- R!9ai din no! 7aci%nt!l s& ins7ir% 6i 7roc%dai An contin!ar% ca la r%tra9%r%a sond%i na?o9astric%
- O8%rii 7aci%nt!l!i !n 7a:ar c! a7& 7%ntr! cl&tir%a 9!rii
- O;s%r@ai 8aci%s!l 6i r%s7iraia 7aci%nt!l!i
- Asi9!rai i9i%na oral& cBt tim7 s% m%nin% sonda
- )%ri8icai 7%rm%a;ilitat%a sond%i
- Dn ca?!l :idrat&rii sa! n!trii%i Anc:id%i sonda Antr% do!& administr&ri
- Asi9!rai-@& c& 7aci%nt!l st& Antr-o 7o?ii% ad%c@at& 6i comod&
- *!7& r%tra9%r%a sond%i a<!tai 7aci%nt!l s&-6i cl&t%asc& 9!ra c! a7& d% mai m!lt% ori
C/
- C!r&ai mat%rial%l% r%8olosi;il% 6i d%7o?itai-l% in loc!l cor%s7!n?&tor
NOTAREA PROCE*URII
- *ata, ora %8%ct!&rii0introd!c%rii sond%i, d!rata
- Tol%rana 7aci%nt!l!i la 7roc%d!r&
- O;i%cti@!l 7roc%d!rii 6i And%7linir%a ac%st!ia
REGU'TATE AJTEPTATE
- Paci%nt!l %st% cola;oram 6i d%monstr%a?& in%l%9%r%a in8ormaiilor
- onda %st% introd!s& 8&r& di8ic!ltat%
- O;i%cti@!l sonda<!l!i %st% And%7linit
REGU'TATE NE*ORITE0CE FACE2IN
- Paci%nt!l n! cola;or%a?&
- E#7licaii c! r&;dar% im7ortana 7roc%d!rii 6i la n%@oi% an!nai m%dic!l
- Folosii !n s7raZ an%st%?ic, dac& m%dic!l r%comand&, 7%ntr! a And%7&rta s%n?aiil% n%7l&c!t%
- onda n! Anaint%a?& la ni@%l!l ori8ici!l!i na?al
- Est% 7osi;il& o o;str!ci%H r%tra9%i sonda 6i inc%rcai din no! c! r&;dar%
- Paci%nt!l t!6%6t%, s% ciano?%a?&, 7r%?int& t!l;!r&ri r%s7iratorii 7%ntr! c& sonda a a<!ns An tra:%%
- R%tra9%i !6or sonda, l&sai 7aci%nt!l s& s% lini6t%asc& 6i Anc%rcai din no! man%@rBnd sonda c! ;lBnd%%
- Paci%nt!l ac!?& discon8ort, iritai%, s%n?ai% d% @om&, 9r%a&
- 8&t!ii 7aci%nt!l s& r%s7ir% 7ro8!nd 7%ntr! a com;at% 9r%aa
- A<!tai 7aci%nt!l s&-6i s!sin& sa! s!sin%i ta@ia r%nal&, An ca? d% @om&
- An!nai m%dic!l An ca? d% iritai% 6i a7licai m&s!ril% sta;ilit% d% ac%sta
- onda s% Ancol&c%6t% An stomac, n! tr%c% d% 7ilor
- Pr%@%nii 7rin An9:iir% 8oart% l%nt&
- Com;at%i s7asm!l 7iloric 7rin administrar%a m%dicam%nt%lor antis7astic% =la r%comandar%a m%dic!l!i>
sa! 7rin n%!trali?ar%a acidit&ii 9astric% c! sol5 d% NaEC0- 40P -20-/0ml
FIA N". <.7. SONDA'UL .E&ICAL LA FEMEIE
O Introd!c%r%a !n%i sond% !rinar% An @%?ica !rinar& 7%ntr! a 8acilita sc!r9%r%a !rinii An @%d%r%a:
- O;in%rii !n%i mostr% d% !rin& 7%ntr! %#am%n% d% la;oratorH
- E@ac!&rii conin!t!l!i @%?icii cBnd ac%asta n! s% 7rod!c% s7ontan sa! An ca? d% incontin%n&H
- 7&l&t!rii @%?ical%H
- Introd!c%r%a !nor m%dicam%nt%5
- Ta@& 7%ntr! mat%rial%
- ond% !rinar% st%ril% =Fol%Z, N%laton> d% di8%rit% dim%nsi!ni
- T&@i& r%nal&
- "&n!6i st%ril% 6i m&n!6i d% !nic& 8olosin&
- ol!ii d%?in8%ctant%, tam7oan% 6i com7r%s% st%ril%
- %rin9i
- %r 8i?iolo9ic sa! a7& st%ril&
- ol!ii st%ril% 7%ntr! l!;ri8i%r%a sond%i
- P!n9i col%ctoar%
- "at%rial% 7%ntr! toal%ta or9an%lor 9%nital%
- "!6ama, tra@%rs%
- 4 -2 %7r!;%t% st%ril%, 4 - 2 %7r!;%t% c!rat% 6i !scat%
PRE$FTIREA PACIENTEI
a> PIEICF:
- In8ormai 7aci%nta c! 7ri@ir% la n%c%sitat%a sonda<!l!i
- O;in%i consim&mBnt!l 6i cola;orar%a ac%st%ia
;> FIGICF:
- A6%?ai 7aci%nta An 7o?ii% 9in%colo9ic&
- Asi9!rai intimitat%a 7aci%nt%i 7rin i?olar% c! 7ara@an
CC
- Id%nti8icai 7aci%nta
- )%ri8icai r%comandar%a m%dical&
- Prot%<ai 7at!l c! al%?& 6i m!6ama
- Dnd%7&rtai 7%rna 6i 7liai 7&t!ra
- '&sai acc%si;il& n!mai r%9i!n%a @!l@ar&
- 7&lai mBinil% 6i Am;r&cai m&n!6i d% !nic& 8olosin&
- E8%ct!ai toal%ta r%9i!nii @!l@ar% c! a7& 6i s&7!n sa! d%?in8%ctai or9an%l% 9%nital% 8olosind . tam7oan%:
tam7oan%l% 4 6i 2 - 7%ntr! la;iil% mari, tam7oan%l% - 6i / - 7%ntr! la;iil% mici, tam7oan%l% C 6i . - 7%ntr! m%at!l
!rinar
- Dnd%7&rtai mat%rial%l% 8olosit% 7%ntr! toal%t& 6i a6%?ai Antr% coa7s%l% 7aci%nt%i t&@ia r%nal&
- c:im;ai m&n!6il% d% !nic& 8olosin& c! c%l% st%ril%
- E@id%niai m%at!l !rinar
- *%?in8%ctai ori8ici!l !r%tral d% s!s An <os, 8olosind 2-- tam7oan%
- Prind%i sonda Antr% d%9%t%l% m%di! 6i in%lar al% mBinii dominant%
- '!;ri8iai An Antr%9im% c! !l%i st%ril
- Ori%ntai @Br8!l sond%i An s!s, inBnd-o ca 7% !n cr%ion An tim7!l scris!l!i
- Introd!c%i sonda An !r%tr& la o adBncim% d% /-C cm
- Contin!ai sonda<!l An 8!nci% d% sco7!l 7ro7!s: %@ac!ar%, r%coltar%, s7&lat!r&
DN$RIIIREA PACIENTEI
- A<!tai 7aci%nta s& s% Am;rac%
- R%a6%?ai 7%rna 6i An@%lii 7aci%nta
- A6%?ai 7aci%nta An 7o?ii% comod&,
- )%ri8icai dac& 7aci%nta ac!?& discon8ort5
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial%
- 7&lai 6i d%?in8%ctai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, sco7!l sonda<!l!i
- N!m%l% 7%rsoan%i car% a %8%ct!at 7roc%d!ra
- As7%ct!l 6i cantitat%a !rinii %liminat% 0 col%ctat%
- Paci%nta %#7rim& star% d% con8ort
- onda<!l s-a %8%ct!at 8&r& incid%nt%
- onda n! s% 7oat% introd!c%
- Al%9%i sonda mai s!;ir%
- Controlai dac& 7o?iia sond%i %st% cor%ct&
- )%ri8icai dac& 7aci%nta n! ar% mal8ormaii al% m%at!l!i !rinar
- onda a 8ost d%st%rili?at& An tim7!l man%@r%lor
- c:im;ai sonda
- Paci%nta ac!?& d!r%ri, sBn9%r%a?&
- An!nai m%dic!l
- onda %st% An8!ndat& c! c:%a9!ri d% sBn9% sa! m!c!s
- Dnc%rcai s& d%s8!ndai 7rin as7irar%
- c:im;ai sonda
FIA N". <.4. SONDA'UL .E&ICAL LA B1RBAT
O Introd!c%r%a !n%i sond% !rinar% An @%?ica !rinar& 7%ntr! a 8acilita sc!r9%r%a !rinii An @%d%r%a: - o;in%rii !n%i
mostr% d% !rin& 7%ntr! %#am%n% la;orator
- %@ac!&rii conin!t!l!i @%?icii cBnd ac%asta n! s% 7rod!c% s7ontan sa! An ca? d% incontin%n&
C.
- %8%ct!&rii s7&lat!rii @%?ical%
- Ta@& 7%ntr! mat%rial%
- ond% !rinar% st%ril% =Fol%Z, N%laton> d% di8%rit% dim%nsi!ni
- T&@i& r%nal&
- "&n!6i st%ril% 6i m&n!6i d% !nic& 8olosin&
- ol!ii d%?in8%ctant%, tam7oan% 6i com7r%s% st%ril%
- %rin9i
- %r 8i?iolo9ic sa! a7& st%ril&
- ol!ii st%ril% 7%ntr! l!;ri8i%r%a sond%i
- P!n9i col%ctoar%
- "at%rial% 7%ntr! toal%ta or9an%lor 9%nital%
- "!6ama, tra@%rs%
- 4-2 %7r!;%t% st%ril%, 4-2 %7r!;%t% c!rat% 6i !scat%
a> PIEICF:
- In8ormai 7aci%nt!l c! 7ri@ir% la n%c%sitat%a sonda<!l!i
- O;in%i consim&mBnt!l 6i cola;orar%a 7aci%nt!l!i
- Asi9!rai intimitat%a c! a<!tor!l !ni 7ara@an
;> FIGICF:
- A6%?ai 7aci%nt!l An d%c!;it dorsal, c! 7icioar%l% Antins% 6i !6or d%7&rtat%, c! o 7%rn& tar% s!; ;a?in
- A6%?ai 7aci%nt!l An 7o?iia r%comandat&
- Prot%<ai 7at!l c! al%?& 6i m!6ama
- 7&lai mBinil% 6i Am;r&cai m&n!6i =d% !nic& 8olosin&>
- E8%ct!ai toal%ta 9land!l!i c! a7& 6i s&7!n
- *%?in8%ctai 9land!l 6i m%at!l !rinar 8olosind - tam7oan%, c! s%r 8i?iolo9ic 6i sol!i% antis%7tic&
- Folosii al 7atr!l%a tam7on 7%ntr! a d%?in8%cta Anc& o dat& n!mai m%at!l !rinar
- Dnd%7&rtai mat%rial%l% 8olosit% 7%ntr! toal%t&
- c:im;ai m&n!6il% d% !nic& 8olosin& c! c%l% st%ril%
- E@id%niai m%at!l !rinar
- Prind%i sonda c! mBna dominant& 6i l!;ri8iai An Antr%9im% c! !l%i d% 7ara8in& st%ril
- Prind%i %#tr%mitat%a li;%r& a sond%i Antr% d%9%t!l mic 6i in%lar
- Introd!c%i sonda An !r%tr& la o adBncim% d% 40-4C cm, inBnd, c! c%alalt& mBn&, 7%nis!l cBt mai ;in% Antins
- Contin!ai sonda<!l An 8!nci% d% sco7!l 7ro7!s: %@ac!ar%, r%coltar%, s7&l&t!r&
- R%calolai 7r%7!!l la s8Br6it!l 7roc%d!rii
- A<!tai 7aci%nt!l s& s% Am;rac%
- )%ri8icai dac& 7aci%nt!l ac!?& discon8ort
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial%
- 7&lai 6i d%?in8%ctai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, sco7!l sonda<!l!i
- N!m%l% 7%rsoan%i car% a %8%ct!at 7roc%d!ra
- As7%ct!l 6i cantitat%a !rinii %liminat% 0 col%ctat%
- onda<!l s-a %8%ct!at 8&r& incid%nt%
C7
- onda n! s% 7oat% introd!c%
- Al%9%i sonda mai s!;ir%
- Controlai dac& 7o?iia sond%i %st% cor%ct&
- )%ri8icai dac& 7aci%nt!l n! ar% mal8ormaii0strict!ri al% m%at!l!i !rinar
- onda a 8oist d%st%rili?at& An tim7!l man%@r%lor
- c:im;ai sonda
- Paci%nt!l ac!?& d!r%ri, sBn9%r%a?&
- An!nai m%dic!l
- onda %st% An8!ndat& c! c:%a9!ri d% sBn9% sa! m!c!s
- Dnc%rcai 6i d%s8!ndai 7rin as7irar%
- c:im;a<i sonda
FIA N". <.8. SP1L1TURA .E&ICAL1
- Introd!c%r%a 7rintr-o sond& a !n%i sol!ii m%dicam%ntoas% An @%?ica !rinar&, 7%ntr! And%7&rtar%a %#!dat%lor
7atolo9ic% 6i 7%ntr! 7r%9&tir%a An @%d%r%a !nor %#7lor&ri =cistosco7ic, 7i%lo9ra8i%>H
- Pro8ila#ia 6i tratam%nt!l com7licaiilor An ca?!l sond%i B d%m%!r%5
Pr%9&tii:
- "at%rial%l% 7%ntr! sonda<!l @%?icalH
- ol!i% 7%ntr! s7&l&t!r& 4l, r%comandat& d% m%dic =Ri@anol 0,4-2P, nitrat d% A9 4-/P
- %rin9a $!Zon
- % 8ac% ca la sonda<!l @%?ical =@%?i 8i6%l% 75/5 6i 75C5>
- E#%c!tai 7a6ii d% la sonda<!l @%?ical %@ac!ator =@%?i 8i6%l% 75/5 6i 75C5>
- Ada7tai la sond& s%rin9a $!Zon 6i introd!c%i ,0- 400ml sol!i% Anc&l?it& la -7K c! o 7r%si!n% mod%rat&
- *%ta6ai s%rin9a 6i l&sai lic:id!l s& s% sc!r9&
- R%7%tai o7%raia d% cBt%@a ori 7Bn& cBnd lic:id!l %liminat %st% lim7%d%
- 'a 8%l ca la sonda<!l @%?ical
- Dnc:id%i sonda Fol%Z sa! ada7tai o 7!n9& col%ctoar% dac& 7aci%nt!l ar% sonda 7%rman%nt&
NOTAREA PROCE*URII
Notai:
- *ata, ora, sol!ia 8olosit&, as7%ct!l lic:id!l!iH
- Com7ortam%nt!l 7aci%nt!l!i An tim7!l 7roc%d!riiH
- Paci%nt!l %#7rim& star% d% con8ort, n! ac!?& d!r%riH
- N! s!nt s%mn% d% in8%ci% !rinar&, !rina %st% lim7%d%H
REGU'TATE NE*ORITE 0 CE FACE2I
- In8!ndar%a sond%i c! %#!dat% sa! c:%a9!ri d% sBn9%H
- Ins!8lai a%r sa! cBi@a ml sol!i% d%?in8%ctant&H
- '%?ar%a !r%tr%i 6i 7osi;il& in8%ci%
- O;s%r@ai as7%ct!l m%at!l!i !rinar 6i as7%ct!l !rinii
- "&s!rai t%m7%rat!ra cor7!l!i
- An!nai m%dic!l dac& constatai @r%!n s%mn d% in8%ci%
- R%coltai o 7ro;& d% !rin& 7%ntr! a 8i %#aminat& la la;orator
FIA N". <.;. SP1LATURA .AGIAL1) 9IRIGA2IA .AGINAL1:
- C!r&ir%a r%9i!nii d% s%cr%ii
- Dnd%7&rtar%a miros!l!i
- Pr%@%nir%a iritai%i 6i %scoriai%i
C,
- Pr%@%nir%a in8%ci%i
- Promo@ar%a con8ort!l!i5
- Can!la @a9inal& c! d!?a 7%r8orat& =7%ntr! r%d!c%r%a 7r%si!nii lic:id!l!i>
- ol!i% la t%m7%rat!ra cor7!l!i =cantitat%a 6i ti7!l r%comandat% d% m%dic>
- Iri9ator c!rat
- P%ns&
- $%l 7%ntr! l!;ri8i%r%
- T!; d% ca!ci!c c! 7%ns& sa! t!; din mat%rial 7lastic c! cl%m&
- Tam7oan% d% @at&
- tati@ 7%ntr! s!s7%ndar%a iri9ator!l!i
- Al%?&, m!6ama
- Pl%d
- "&n!6i st%ril%
a> PIEICF:
- Instr!ii 7aci%nta 6i %#7licai 7roc%d!ra 6i moti@%l% 7%ntr! car% s-a r%comandat
- Instr!ii 7aci%nta s& st%a lini6tit& 6i r%la#at&, s& com!nic% %@%nt!al%l% s%n?aii n%7l&c!t%
;> FIGICF:
- Instr!ii 7aci%nta s&-6i 9ol%asc& @%?ica
- Asi9!rai 7o?iia cor%ct& =9in%colo9ic&>
- Asam;lai %c:i7am%nt!l 6i @%ri8icai t%m7%rat!ra lic:id!l!i
- E#7licai d%s8&6!rar%a 7roc%d!rii
- )%ri8icai dac& 7aci%nta 6i-a 9olit @%?ica
- A6%?ai 7aci%nta 7% masa 9in%colo9ic&
- Dn@%lii 7aci%nta c! !n 7l%d 6i a6%?ai m!6ama!a 6i al%?a s!; 7aci%nt&
- 7&lai mBinil%
- Clam7ai t!;!l 6i 7!n%i An iri9ator sol!ia la t%m7%rat!ra cor7!l!i
- *%clam7ai t!;!l, %@ac!ai a%r!l 6i r%clam7ai
- Dm;r&cai m&n!6i st%ril%
- 7&lai 7%rin%!l c! tam7oan% d% @at& !m%?it% c! a7& cald&
- Dnc%7%i c!r&ir%a dins7r% 7art%a ant%rioar& s7r% s7at%, 8olosind tam7on!l o sin9!r& dat&
- '!;ri8iai can!la c! 9%l sa! @as%lin&
- A9&ai 7!n9a0iri9ator!l An stati@ la o An&lim% d% C0-70 cm d% la sim8i?a 7!;ian&
- Dnd%7&rtai c! o mBn& la;iil% iar c! c%alalt& introd!c%i can!la An @a9in, AnclinBnd-o s7r% 8a& a7oi s7r% s7at%l%
7aci%nt%iH introd!c%i a7ro#imati@ , -40cm =la 40 -44cm s% atin9% 8!nd!l d% sac @a9inal>
- Dnd%7&rtai 7%nsa 6i 7%rmit%i sol!i%i s& c!r9& s!; 8ora 9ra@itai%iH rotii c! ;lBnd%% can!la An tim7!l iri9ai%i
- Clam7ai t!;!l Anaint% d% t%rminar%a lic:id!l!i 6i And%7&rtai can!la c! ;lBnd%%
- P%rmit%i 7aci%nt%i s& st%a 7% mas& cBt%@a min!t% 7%ntr! a %limina lic:id!l An totalitat%
- 7&lai r%9i!n%a @!l@ar& c! a7& 6i s&7!n 6i !scai ;in% c! !n 7roso7
- E#aminai aria 7%rin%al&
- E#aminai as7%ct!l lic:id!l!iH dac& lic:id!l conin% m!c!s, 7!roi sa! sBn9% 7r%?%ntai m%dic!l!i
- Dnd%7&rtni m&n!6il%
DN$RIIIREA PACIENTEI
- Cond!c%i 7aci%nta la 7at 6i a6%?ai-o Antr-o 7o?ii% con8orta;il&
- )%ri8icai dac& 7aci%nta ar% d!r%ri
- Instr!ii 7aci%nta c!m s&-6i 8ac& sin9!r& s7&l&t!ra dac& %st% n%@oi%
- *%?asam;lai mat%rial%l%
- 7&lai mat%rial%l% 8olosit% 6i a6%?ai-l% An d!la7
C+
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, sol!ia 8olosit&, n!m%l% 7%rsoan%i car% a %8%ct!at iri9aia
- Oric% o;s%r@ai% l%9at& d% star%a 7aci%nt%i sa! as7%ct!l localH d!r%r%, iritai%, sc!r9%ri
- *ac& 7aci%nta a An%l%s in8ormaiil%
- 7&l&t!ra s-a d%s8&6!rat 8&r& incid%nt%, 7aci%nta s% simt% ;in%
- Paci%nta %st% coo7%rant& 6i d%monstr%a?& An%l%9%r%a in8ormaiilor 7rimit%
- Paci%nta %st% ca7a;il& s&-6i %8%ct!%?% s7&l&t!ra
O Paci%nta ac!?& s%n?aii n%7l&c!t%, d!r%r%
- )%ri8icai: t%m7%rat!ra sol!i%i, 7r%si!n%a 6i @it%?a d% sc!r9%r%
- )%ri8icai dac& 7aci%nta 6i-a 9olit @%?ica
- cad%i 7r%si!n%a 7rin co;orBr%a iri9ator!l!i s!; C0cm
FIA N". <.<. CLISMA E.ACUATORIE
- Introd!c%r%a 7rin an!s An r%ct 6i colon a !nor lic:id% 7%ntr! And%7&rtar%a mat%riilor 8%cal%
- "as& d% tratam%nt sa! ta@&
- Iri9ator =r%ci7i%nt>, t!; d% ca!ci!c c! diam%tr!l d% 40 mm 6i l!n9im%a d% 4,C - 2m
- Can!l& r%ctal&
- T&@i& r%nal&
- "!6!ama, tra@%rs&
- Dn@%litoar% d% 8lan%l& sa! c%ar6%a8
- !;stan& l!;r%8iant&
- Casol%ta c! com7r%s% st%ril%
- "at%rial 7%ntr! toal%ta 7%rin%al&
- Plosc& =;a?in%t>
- tati@ 7%ntr! iri9ator
- A7& cald& -C - -7KC =C00-4000 ml ad!li, 2C0 ml adol%sc%ni, 4C0 ml co7ii>
- ar% =4 lin9!ri&04 l a7&>0 !l%i =/ lin9!ri04 4 a7&>0 9lic%rin& =/0 90C00 ml a7&>0 s&7!n =4 lin9!ri& ras&04 l a7&>
a> PIEICF:
- E#7licai 7aci%nt!l!i 7roc%d!ra, solicitBnd!-i cola;orar%a
- E#7licai sco7!l 7roc%d!rii, %8%ct%l% a6t%7tat% dar 6i %@%nt!al%l% %8%ct% n%dorit%
;> FIGICF:
- Asi9!rai intimitat%a 7aci%nt!l!i =7ara@an>
- *%?;r&cai 7art%a in8%rioar& a cor7!l!i 7aci%nt!l!i
- Po?iionai 7aci%nt!l An d%c!;it lat%ral stBn9 c! m%m;r!l in8%rior stBn9 Antins 6i m%m;r!l in8%rior dr%7t 8l%ctat
=An 7o?ii% I">, c! an!s!l %#7!s sa! An d%c!;il dorsal c! m%m;r%l% in8%rioar% 8l%ctat% =An 8!nci% d% star%a 6i
con8ort!l 7aci%nt!l!i>
- A6%?ai m!6ama!a 6i al%?a s!; ;a?in!l 7aci%nt!l!i
- A6%?ai ;a?in%t!l s!; r%9i!n%a sacral& 6i aco7%rii 7aci%nt!l c! o An@%litoar%
- )%ri8icai 7r%scri7ia
- 7&lai-@& 7% mBini c! a7& 6i s&7!n
- Dm;r&cai m&n!6il% d% !nic& 8olosin&
- Po?iionai iri9ator!l =r%ci7i%nt!l> 7% stati@ la o An&lim% d% /C cm d%as!7ra ni@%l!l!i an!s!l!i 7aci%nt!l!i 6i
%liminai a%r!l din t!;!l iri9ator!l!i d!7& car% Anc:id%i circ!it!l
.0
- '!;ri8iai can!la r%ctal& 7% o l!n9im% d% C-7 cm =s%t!l d% !nic& 8olosin& 7%ntr! clism& 7oat% a@%a can!la
7r%l!;ri8iat&>
- Dnd%7&rtai 8%s%l% 7aci%nt!l!i c! mBna stBn9& iar c! mBna dr%a7t& introd!c%i can!la 7-40 cm 7rin an!s An r%ct,
7%r7%ndic!lar 7% s!7ra8aa s!;adiac%nt&, c! @Br8!l Andr%7tat Anaint%, An dir%cia @%?icii !rinar%, 7rin mi6c&ri d%
rotai%, 7Bn& An@in9%i r%?ist%na s8inct%r!l!i anal
- *ac& r%?ist%na s% m%nin% 6i d!7& tr%c%r%a d% an!s, l&sai s& s% sc!r9& o cantitat% mic& din sol!ia 7%ntr!
clism&, r%tra9%i 7!in can!la 6i a7oi contin!ai introd!c%r%a, r!9Bnd 7aci%nt!l s& r%s7ir% adBnc d% cBt%@a ori - n!
8orai introd!c%r%a can!l%iM
- Dndr%7tai @Br8!l can!l%i An a#!l am7!l%i r%ctal%
- *%sc:id%i circ!it!l 6i introd!c%i sol!ia Anc%t, 7% o 7%rioad& d% C - 40 min!t%, com!nicBnd An 7%rman%n& c!
7aci%nt!l 7%ntr! a a8la c!m s% simt%
- Dnaint% d% t%rminar%a sol!i%i 7%nsai t!;!l, %#tra9%i can!la r%ctal& 6i a6%?ai-o An t&@ia r%nal&
- E#7licai-i 7aci%nt!l!i c& %st% n%@oi% s& r%in& sol!ia tim7 d% 40-4C min!t%
- Ad!c%i 7aci%nt!l An d%c!;it lat%ral dr%7t 6i 7%st% cBt%@a min!t% An d%c!;it dorsal 7%ntr! a 8acilita 7&tr!nd%r%a
lic:id!l!i la o adBncim% mai mar% =dac& %st% 7osi;il 6i n! %#ist& contraindicaii>
- *ac& 7aci%nt!l s% 7oat% d%7lasa, @a m%r9% la toal%t& -at%nionai 7aci%nt!l s& n! tra9& a7& Anaint% d% a @& c:%ma
7%ntr! a @%d%a r%?!ltat!l clism%iM
- Folosii ;a?in%t!l 7%ntr! ca7tar%a sca!n!l!i, la 7at, An ca?!l 7aci%nilor imo;ili?ai
- Dnl&t!rai m&n!6il% 6i ar!ncai-l% An r%ci7i%nt!l s7%cial d%stinat
- 7&lai-@& 7% mBini
- *!7& %liminar%a sca!n!l!i @%ri8icai star%a d% i9i%n& a ?on%i anal% 6i dac& %st% n%@oi% o8%rii 7aci%nt!l!i a7&,
s&7!n 6i 7roso7
- *ac& 7aci%nt!l %st% imo;ili?at %8%ct!ai toal%ta ?on%i 8olosind !n alt ;a?in%t, !rmBnd 7a6ii d%scri6i An 8i6&
RCa7tar%a mat%riilor 8%cal% An ;a?in%tR =25+52>
- )%ri8icai as7%ct!l, c!loar%a 6i cantitat%a mat%riilor 8%cal% %liminat%
- Dnd%7&rtai 7ara@an!l 6i a%risii salon!l
- Dnd%7&rtai mat%rial%l% !tili?at% iar 7% c%l% r%8olosi;il% c!r&ai-l% 6i a6%?ai-l% An loc!l o;i6n!it d% d%7o?itar%
- Asi9!rai-@& c& 7losca a 8ost 9olit& 6i c!r&at&
- 7&lai-@& 7% mBini c! a7& 6i s&7!n
NOTAREA PROCE*URII
Notai:
- E8%ct!ar%a clism%i
- Cantitat%a, as7%ct!l 6i c!loar%a mat%riilor 8%cal% An 8oaia d% t%m7%rat!r& sa! An 7lan!l d% An9ri<iri
- Cons%mnai %@%nt!al% as7%ct% 7atolo9ic% =c!loar%, consist%n&, 7r%?%na sBn9%l!i, 7!roi!l!i, m!c!s!l!i>
- Com7ortam%nt!l 7aci%nt!l!i 7% d!rata 7roc%d!rii
- 7aci%nt!l %#7rim& con8ort
- conin!t!l int%stinal 9ros %st% %liminat
- mat%riil% 8%cal% a! as7%ct normal
R%?!ltat% n%dorit% 0 C% 8ac%m dac&:
- Can!la AntBm7in& r%?ist%n& d!7& 7&tr!nd%r%a An an!s
- n! 8orai introd!c%r%a can!l%i
- r%tra9%i !6or, l&sai s& c!r9& o cantitat% mic& d% a7& 6i contin!ai introd!c%r%a c! mi6c&ri !6oar% d%
rotai%
- Paci%nt!l ac!?& d!r%ri, cram7%, s%n?ai% 7!t%rnic& d% d%8%cai%
- 7r%si!n%a sa! @it%?a d% introd!c%r% a lic:id!l!i %st% mar% - o7rii cBt%@a mom%nt% introd!c%r%a
lic:id!l!i, co;orBi iri9ator!l sa! r%9lai 7r%si!n%a c! a<!ior!l ro;in%t!l!i =dac& %#ist&>
- Paci%nt!l %st% sl&;it 6i n! 7oat% r%in% lic:id!l
- in%i 8%s%l% 7aci%nt!l!i strBns% a<!tBnd!-l s& in& lic:id!l
CAPITOLUL .III
ADMINISTRAREA MEDICAMENTELOR
.4
FIA N". =.1. ADMINISTRAREA MEDICAMENTELOR PE CALE ORAL1 9LA ADULT:
- Introd!c%r%a An or9anism 7% cal% oral& a !n%i cantit&i d% m%dicam%nt% car% s& acion%?% 9%n%ral sa! local
- Pa:ar% d% !nic& 8olosin&
- Pi7%t&, sticl!a 7ic!r&toar%
- "%dicam%nt% 7r%scris%
- A7&, c%ai, alt lic:id r%comandat
- 'in9!r&, lin9!ri&
- A7&s&tor d% lim;&
- Ta@& sa! m&s!& mo;il&
a> PIEICF:
- In8ormai 7aci%nt!l as!7ra %8%ct!l!i, 9!st!l!i m%dicam%nt!l!i
- In8ormai 7aci%nt!l as!7ra %@%nt!al%lor %8%ct% s%c!ndar% =r%acii ad@%rs%>
- Asi9!rai 7aci%nt!l d% ino8%nsi@itat%a 7roc%d!rii
;> FIGICF:
- Asi9!rai 7aci%nt!l!i o 7o?ii% comod& ast8%l AncBt s& 7oat& ;%a
- )%ri8icai dac& s!nt r%s7%ctat% condiiil% d% administrar% =Anaint%, d!7& mas&, %tc>
- Ta;l%t%l% 6i ca7s!l%l% s!nt dat% c! a7& 7%ntr! a 7r%@%ni anta9oni?ar%a 7ro7ri%t&ilor c:imic% al% m%dicam%nt%lor
- iro7!ril% 6i antiacid%l% lic:id% n! s!nt !rmat% d% in9%stia d% a7a 7%ntr! c& li s% dimin!%a?& %8%ct!l
- Ta;l%t%l% ?dro;it% sa! lic:id%l% 7ot 8i am%st%cat% c! o cantitat% mic& d% mBncar% dac& ac%asta n! %st%
contraindicat& d% di%t&
- A6%?ai mat%rial%l% 7% o ta@& sa! c&r!cior 7%ntr! tratam%nt =m&s!& mo;il&>
- )%ri8icai 7r%scri7ia m%dical& : n!m%l% m%dicam%nt!l!i, do?a, mod!l d% administrar%H
- Id%nti8icai 8i%car% m%dicam%nt 7% car%-l 7rimi6t% 7aci%nt!l: %tic:%ta, am;ala<!l5
- P!n%i do?%l% c% tr%;!i% administrat% Antr-!n 7&:&r%l din mat%rial 7lastic
- )%ri8icai n!m&r!l salon!l!i 6i n!m%l% 7aci%nt!l!i
- *!c%i t&@ia0m&s!a c! m%dicam%nt%l% An salon
- E#7licai 7aci%nt!l!i c% m%dicam%nt 7rim%6t%, aci!n%a ac%st!ia, dac& ar% 9!st n%7l&c!t
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd dac& n! % nici o contraindicai%, sa! o 7o?ii% comod& An car% s& ;%a lic:id!l
An 8!nci% d% star%a ac%st!ia
- %r@ii 7aci%nt!l c! do?& !nic&
- *ai-i 7a:ar!l c! a7&0s!c0c%ai 6i asi9!rai-@& c& 7aci%nt!l a An9:iit toat% m%dicam%nt%l% sa! a<!tai-l dac& n!
7oat% s& ;%a sin9!r
- Instr!ii 7aci%nt!l dac& d!7& administrar% tr%;!i% 7&str%?% o an!mit& 7o?ii%
- Asi9!rai-@& c& 7aci%nt!l %#7rim& star% d% con8ort
- Plasai m%dicam%nt%l% r&mas% An loc!l d% 7&strar% ad%c@at
- Asi9!rai-@& c& s!nt And%7linit% condiiil% d% 7&strar%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, do?a, 6i r%acia 7aci%nt!l!i
- R%8!?!l 7aci%nt!l!i
- N!m%l% 7%rsoan%i car% a administrat m%dicam%nt!l
- *ac& 7aci%nt!l %st% ca7a;il s&-6i administr%?% sin9!r m%dicam%nt%l%
O Transmit%i in8ormaiil% s%mni8icati@% An scris 6i @%r;al la sc:im;!l d% t!r&
.2
- "%dicam%nt%l% a! 8ost administrat% 8&r& incid%nt%
- Paci%nt!l %st% ca7a;il s& in9%r% 6i s& m%ta;oli?%?% 8&r& 9r%a& 6i @&rs&t!ri
- Paci%nt!l acc%7t& m%dicam%nt%l%, %st% coo7%rant
- Paci%nt!l simt% aci!n%a 6i %8%ct!l m%dicam%nt!l!i
Paci%nt!l0cli%nt!l n! coo7%r%a?&, r%8!?& m%dicam%nt%l% o Antr%;ai m%dic!l
- Paci%nt!l0cli%nt!l ac!?& s%n?aii d% 9r%a& 6i @om&
- asi9!rai-@& c& n! s!nt miros!ri n%7l&c!t% An Anc&7%r% - a%risii
- in@itai 7aci%nt!l s& ins7ir% 7ro8!nd
- r&mBn%i c! 7aci%nt!l 7Bn& cBnd s% simt% ;in%
- dac& %st% ca?!l, an!nai m%dic!l
- Paci%nt!l ar% r%aci% al%r9ic& sa! ana8ilactic&
- o7rii administrar%a
- an!nai m%dic!l
- 7r%9&tii m%dicam%nt% anti:istaminic%
- R%acia %st% s%@%r&
- a6%?ai 7aci%nt!l An d%c!;il dorsal c! ca7!l 7!in ridicat
- %@al!ai s%mn%l% @ital% la 40- 4C\
- !rm&rii dac& 7r%?int& :i7ot%nsi!n% sa! ar% di8ic!ltat% An r%s7irai%
- dac& ar% di8ic!lt&i r%s7iratorii administrai O2 7% masc&, .l0min5
- 7r%9&tii o tr!s& d% !r9%n& 7% car% s-o a@%i la And%mBn&
- asi9!rai s!7ort 7si:olo9ic 7aci%nt!l!i 7%ntr! a r%d!c% an#i%tat%a
- notai ti7!l 6i %@ol!ia r%aci%i al%r9ic%
FIA N". =.6. ADMINISTRAREA MEDICAMENTELOR PE CALE ORAL1 9LA COPIL>
O Introd!c%r%a An or9anism 7% cal% oral& a !n%i cantit&i d% m%dicam%nt% car% s& acion%?% 9%n%ral sa! local5
- Pa:ar% d% !nic& 8olosin&
- Pi7%t&, sticl!& 7ic!r&toar%
- "%dicam%nt% 7r%scris%
- A7&, c%ai, alt lic:id r%comandat
- 'in9!r&, lin9!ri&
- A7&s&tor d% lim;&
- Ta@& sa! m&s!& mo;il&
a> PIEICF:
- 8olosii o m%toda d% <oac& 7%ntr! a o;in% coo7%rar%a
- in8ormai co7il!l c& @a 7rimi !n m%dicam%nt 6i n! ;om;oan%
- in8ormai as!7ra %8%ct!l!i 6i r%aciilor ad@%rs%
- %#7licai 7&rinilor rol!l m%dicam%nt!l!i, im7ortana administr&rii, aci!n%a 6i %@%nt!al%l% r%acii ad@%rs%
;> FIGICF:
- Asi9!rai o 7o?ii% cor%s7!n?&toar% An ra7ort c! star%a co7il!l!i
- )%ri8icai dac& s!nt And%7linit% condiiil% 7%ntr! administrar%
- *ac& n! %#ist& nici o contraindicai% Anloc!ii a7a c! alt lic:id, d% 7r%8%rat d!lc% = s!c, c%ai> - n! 8olosii
alim%nt% sa! lic:id% 7r%8%rat% d%oar%c% co7il!l l%-ar 7!t%a r%8!?a mai tBr?i!M
- A6%?ai mat%rial%l% 7% o la@& sa! c&r!cior 7%ntr! tratam%nt =m&s!& mo;il&>
- )%ri8icai 7r%scri7ia m%dical& : n!m%l% m%dicam%nt!l!i, do?a, mod!l d% administrar%, cal%a d% administrar%
- Id%nti8icai 8i%car% m%dicam%nt 7% car%-l 7rim%6t% 7aci%nt!l: %tic:%ta, am;ala<!l5
- P!n%i do?%l% c% tr%;!i% administrat% Antr-!n 7&:&r%l din mat%rial 7lastic
- )%ri8icai n!m&r!l salon!l!i 6i n!m%l% 7aci%nt!l!i
- *!c%i t&@ia0m&s!a c! m%dicam%nt%l% An salon
.-
- E#7licai 7aci%nt!l!i07&rinilor c% m%dicam%nt 7rim%6t%, aci!n%a ac%st!ia, dac& ar% 9!st n%7l&c!t
- A6%?ai 7aci%nt!l An 7o?ii% 6%?Bnd dac& n! % nici o contraindicai%, sa! o 7o?ii% comod& An car% s& 7oat& ;%a
lic:id!l An 8!nci% d% star%a ac%st!ia
- %r@ii 7aci%nt!l c! do?& !nic&
- Gdro;ii sa! 8ra9m%ntai ta;l%t%l% 7%ntr! a 8i mai !6or d% in9%ra;il%
- Folosii o cantitat% mai mic& d% lic:id 7%ntr! a coo7%ra mai !6or
- Asi9!rai-@& c& 7aci%nt!l %#7rim& star% d% con8ort, n! @ars&
- Asi9!rai-@& c& s!nt And%7linit% condiiil% d% 7&strar%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- data, ora, m%dicam%nt!l, do?a 6i r%acia 7aci%nt!l!i
- r%8!?!l 7aci%nt!l!i
- n!m%l% 7%rsoan%i car% a administrat m%dicam%nt!l
- dac& 7aci%nt!l08amilia 7oat% contin!a administrar%a tratam%nt!l!i 8&r& s!7ra@%9:%r%
- Paci%nt!l %st% ca7a;il s& in9%r% 6i s& m%ta;oli?%?% 8&r& 9r%a& 6i @&rs&t!ri
- Paci%nt!l acc%7t& m%dicam%nt%l%, %st% coo7%rant
- Paci%nt!l simt% aci!n%a 6i %8%ct!l m%dicam%nt!l!i
R%?!ltat% n%dorit%
O C% 8ac%m dac&:
45 Paci%nt!l n! coo7%r%a?&, r%8!?& m%dicam%nt%l%
- an!nai m%dic!l
25 Paci%nt!l ac!?& s%n?ai% d% 9r%a& 6i @om&
- asi9!rai-@& c& n! s!nt miros!ri n%7l&c!t% An Anc&7%r% =a%risii>
- in@itai 7aci%nt!l s& ins7ir% 7ro8!nd
- r&mBn%i c! 7aci%nt!l 7Bn& cBnd s% simt% ;in%
- dac& %st% ca?!l, an!nai m%dic!l
-5 Paci%nt!l ar% r%aci% al%r9ic& sa! ana8ilactic&
- o7rii administrar%a
- an!nai m%dic!l
- 7r%9&tii m%dicam%nt% anti:istaminic%
O *ac& r%acia %st% s%@%r&:
- a6%?ai 7aci%nt!l An d%c!;it c! ca7!l 7!in ridicat %@al!ai s%mn%l% @ilal% la 40- 4C\
- !rm&rii dac& 7r%?int& :i7ot%nsi!n% sa! ar% di8ic!ltat% An r%s7irai%
- dac& ar% di8ic!lt&i r%s7iratorii administrai O2 7% masc&, .l0min5
- 7r%9&tii o tr!s& d% !r9%n& 7% car% s-o a@%i la And%mBn&
- asi9!rai s!7ort 7si:olo9ic 7aci%nt!l!i 7%ntr! a r%d!c% an#i%tat%a
- notai ti7!l 6i %@ol!ia r%aci%i al%r9ic%
FIA N". =.7. ADMINISTRAREA MEDICAMENTELOR PE TEGUMENTE
O O;in%r%a !n!i %8%ct local as!7ra t%9!m%nt%lor,
O tim!lar%a circ!lai%i
O *imin!ar%a %8%ct!l!i m%dicam%nt!l!i 7rintr-o a;sor;i% mai l%nt&5
- "%dicam%nt%l%, 7r%scris% =lic:id%, 7!dr%, !n9!%nt%, ali8ii, mi#t!ri, 7last!ri>
./
- "&n!6i d% ca!ci!c
- Com7r%s%, tam7oan%, s7at!l&
- P%ns% 7orttam7on, s7at!l&
- "at%rial 7%ntr! 7rot%cia 7at!l!i
- Ta@& sa! car!cior 7%ntr! m%dicam%nt%
a> PIEICF:
- In8ormai 7aci%nt!l as!7ra %8%ct!l!i m%dicam%nt!l!i
- E#7licai 7aci%nt!l!i m%tod%l% d% administrar% a m%dicam%nt%lor: ;adi<onar%, 7!dra<, com7r%s%
m%dicam%ntoas%
- In8ormai 7aci%nt!l as!7ra s%n?aiilor 7% car% l% 7oatl% simi
- In8ormai as!7ra %@%nt!al%lor al%r9ii
;> FIGICF:
- Asi9!rai im!nitat%a
- Asi9!rai 7o?iia ad%c@at& An 8!nci% d% ?ona 7% car% !rm%a?& s& s% a7lic% m%dicam%nt!l
- 8&t!ii 7aci%nt!l s& st%a r%la#at
- Pr%9atii mat%rial%l% 7% o ta@& sa! !n c&r!cior
- Id%nti8icai 7aci%nt!lH id%nti8icai %@%nt!al%l% l%?i!ni car% contraindic& administrar%a
- A6%?ai 7aci%nt!l An 7o?ii% ad%c@at&
- 7&lai mBinil%
- Dm;r&cai m&n!6i d% ca!ci!c
a> A7licar%a !n9!%nt%lor 6i ali8iilor
- coat%i m%dicam%nt!l din t!; 7rin a7&sar% sa! din c!ti% c! a<!tor!l s7at!l%i
- Dntind%i c! ;lBnd%% !n strat s!;ir% c! mBna Am;r&cat& An m&n!6& sa! c! s7at!l&5
- Prot%<ai 7i%l%a c! !n 7ansam%nt dac& % n%c%sar, ast8%l AncBt m%dicam%nt!l s& n! 8i% And%7&rtat
- C!r&ai s!7ra8aa 7i%lii Antr% do!& a7lic&ri c! %#c%7ia sit!aiilor An car% m%dic!l r%comand& ast8%l5
;> A7licar%a lic:id%lor
- Dntind%i sol!ia m%dicam%ntoas& c! a<!tor!l !n!i tam7on
- '&sai 7i%l%a s& s% !s!c%
- Prot%<ai c! !n 7ansam%nt dac& sol!ia 8olosit& % colorat&
- C!r&ai s!7ra8aa 7i%lii Antr% do!& a7lic&ri c! %#c%7ia sit!aiilor An car% m%dic!l r%comand& alt8%lH
c> A7licar%a m%dicam%nt%lor @asodilatatoar%
- P!n%ni m&n!6i d% ca!ci!c 7%ntr! a 7r%@%ni a;sor;ia m%dicamnt%lor d% 7ro7riil% t%9!m%nt%
- A7licai 7last!r%l% 7% torac%l% ant%rior sa! 7% alt& ?on& a cor7!l!i indicat& d% m%dic
- Alt%rnai loc!ril% la 8i%car% do?& m%dicam%ntoas&
- O;s%r@ai %@%nt!al%l% r%acii local%
- Instr!ii 7aci%nt!l08amilia dac& %st% n%@oi% d% contin!ar%a tratam%nt!l!i la domicili!
- P!n%i m%dicam%nt%l% An loc!l d% 7&strar% 6i asi9!rai-@& c& %#ist& condiii ad%c@at%
- Dnd%7&rtai com7r%s%l%, tam7oan%l% 8olosit%
- 7&lai m&inil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, mod!l d% administrar%, n!m%l% n!rs%i
- Oric% o;s%r@ai% l%9al& d% star%a 7aci%nt!l!i, as7%ct!l local al t%9!m%nt%lor
- R%acia 7aci%nt!l!i la 7roc%d!r&
- C% a An@&at 7aci%nt!l din in8ormaiil% 8!rni?at%
.C
- Paci%nt!l %#7rim& star% d% con8ort, n! ac!?& r%acii n%7l&c!t%
- Paci%nt!l %st% coo7%rant 6i d%monstr%a?& An%l%9%r%a in8ormaiilor 7rimit%
R%?!ltat% n%dorit% 0C% 8ac%i N
- Paci%nt!l ac!?& %8%ct!ar%a c! ;r!talitat% a man%@r%lor
- 'ini6tii 7aci%nt!l =@& c%r%i sc!?% 6i %#7licai, dac& %st% ca?!l, c& man%@ra An sin% 7oat% 8i d!r%roas&>
- Paci%nt!l ac!?& s%n?aii n%7l&c!t%: !st!rim%, An%7&t!ri
- E#7licai 7aci%nt!l!i, dac& %st% ca?!l, c& s%n?aiil% 8ac 7art% din %8%ct!l m%dicam%nt%lor
- P% s!7ra8aa tratat& a7ar% Anro6ir%a sa! alt% s%mn% d% al%r9i%
- O;s%r@ai star%a, an!nai m%dic!l 6i transmit%i in8ormaiil% 7rin ra7ort!l d% acti@itat%
FIA N". =.4. ADMINISTRAREA MEDICAMENTELOR PE MUCOASA CON'UNCTI.AL1
9COLIRURI3 UNGUENTE:

Administrar%a m%dicam%nt%lor An sac!l con<nncti@al 7%ntr! a o;in% !n %8%ct t%ra7%!tic
- Ta@& m%dical&0c&r!cior 7%ntr! m%dicam%nt%
- Pic&t!ri =colir!ri > sa! !n9!%nt% 7r%scris% d% m%dic
- %r 8i?iolo9ic st%ril
- Com7r%s% d% ti8on st%ril%
- J%r@%%l%
- Pi7%t&
- "&n!6i st%ril%
- R%ci7i%nt 7%ntr! col%ctar%a mat%rial%lor 8olosit%
a> PIEICF:
- In8ormai 7aci%nt!l0 cli%nt!l 6i %#7licai 7roc%d!ra
- E#7licai %8%ct!l t%ra7%!tic 6i %@%nt!al%l% r%acii
- In8ormai as!7ra %@%nt!al%lor al%r9ii
- Instr!ii 7aci%nt!l0cli%nt!l s& n! s% mi6t%
- !;liniai 6i clari8icai %#7licaiil% m%dic!l!i d%s7r% ;oal&
- E#7licai oric% alt& r%comandar% t%ra7%!tic& adiional&
;> FIGICF:
- Asi9!rai 7o?iia cor%ct& - d%c!;it dorsal sa! 6%?Bnd c! ca7!l dat 7% s7at%
- Pr%9&tii mat%rial%l% 7% o ta@& m%dical&
- Id%nti8icai 7aci%nt!l0cli%nt!l
- At%nionai 7aci%nt!l0cli%nt!l s& n! s% mi6t% An tim7!l 7roc%d!rii
- Asi9!rai o l!min& ad%c@at&
- Po?iionai 7aci%nt!l 0 cli%nt!l c!lcat sa! 6%?Bnd c! ca7!l dat 7% s7at%
- 7&lai mBinil% c! a7& 6i s&7!n0 Am;r&cai m&n!6i st%ril%
- *%sc:id%i 8anta 7al7%;ral& din int%rior s7r% %#t%rior 8olosind com7r%s% st%ril% Am;i;at% An s%r 8i?iolo9ic
- As7irai c! 7i7%ta cantitat%a d% sol!i% n%c%sar& =d%sc:id%i t!;!l c! !n9!%nt>
- Prot%<Bnd!-@& d%9%t%l% c! com7r%s% st%ril%, tra9%i ;lBnd 7l%oa7a in8%rioar& 7%ntr! a %@id%nia sac!l
con<!ncti@al
- Instr!ii 7aci%nt!l0 cli%nt!l s& 7ri@%asc& An s!s 6i Ana7oi 7%ntr! a 7rot%<a corn%%a, s!; 7l%oa7a s!7%rioar& 6i
7%ntr! a 7r%@%ni cli7it!l An mom%nt!l cBnd @& a7ro7iai c! 7i7%ta sa! t!;!l
- 7ri<inii mBna car% in% m%dicam%nt!l 7% 8r!nt%a 7aci%nt!l!i 7%ntr! a %@ita r&nir%a c! 7i7%ta sa! @Br8!l t!;!l!i
dac& 7aci%nt!l s% mi6c& 7lasai 7i7%ta sa! @Br8!l t!;!l!i c! !n9!%nt d%as!7ra sac!l!i con<!ncti@al la l-2cm
- Instilai n!m&r!l d% 7ic&t!ri 7r%scris sa! a7licai a7ro#imati@ 4cm liniar din !n9!%nt, 7% s!7ra8aa 7l%oa7%i
in8%rioar%H
NU ATIN$E2I PIPETA, TU(U', *E OCEIU' PACIENTU'UI0 C'IENTU'UI
- Eli;%rai 7l%oa7a in8%rioar&
..
- Instr!ii 7aci%nt!l0cli%nt!l s& Anc:id& oc:i!l 6i s&-6i mi6t% 9lo;!l oc!lar 7%ntr! a Am7r&6tia m%dicam%nt!l
- Dnd%7&rtai oric% %#c%s d% m%dicam%nt din <!r!l oc:i!l!i c! o com7r%s& st%ril& sa! !n 6%r@%%l
- 7&lai-@& 7% mBini, sc:im;ai m&n!6il% 6i r%7%tai int%r@%niil% 7%ntr! c%l&lalt oc:i dac& %st% n%c%sar
- O;s%r@ai %@%nt!al%l% r%acii local%: con9%stii, l&crimar%, 7r!rit
- P!n%i m%dicam%nt%l% la loc!l d% 7&strar%
- Asi9!rai-@& c& s!nt condiii o7rim% 7%ntr! 7&star%a m%dicam%nt%lor d%sc:is%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, cal%a d% administrar%
- N!m%l% asist%nt%i car% a administrat m%dicam%nt!l
- Oric% o;s%r@ai% l%9at& d% star%a 7aci%nt!l!i0 cli%nt!l!i sa! as7%ct!l local: s%cr%ii, ro6%at&, s%n?ai% d% cor7
str&in
- R%acia 7aci%nt!l!i0 cli%nt!l!i la 7roc%d!r& 5
- C% a An@&at 7aci%nt!l0cli%nt!l l%9at d% conti!n!itat%a tratam%nt!l!i
- Paci%nt!l0cli%nt!l %#7rim& star% d% con8ort, n! ac!?& r%acii n%7l&c!t%: !st!rim%, l&crimar%, An9lod%al&
- Paci%nt!l0cli%nt!l %st% coo7%rant 6i d%monstr%a?& An%l%9%r%a in8ormaiilor 7rimit%
R%?!ltat% n%dorit% 0 C% 8ac%i N
- Paci%nt!l n! coo7%r%a?& 6i %#ist& risc d% l%?ar% a corn%%i
- Antr%;ai m%dic!l
-Paci%nt!l0cli%nt!l ac!?& s%n?aii n%7l&c!t% =!st!rim%, l&crimar%, An9lod%al&, ars!r&, :i7%r%mi%>
- %#7licai 7aci%nt!l!i0cli%nt!l!i c& s!nt %8%ct% al% m%dicam%nt!l!i
- an!nai m%dic!l dac& ac%st%a n! s!nt o;i6n!it% An ca?!l administr&rii m%dicam%nt!l!i r%comandat>
O %mnalai m%dic!l!i oric% mani8%star% i%6it& din com!n: @%d%r% n%clar&, di7lo7i%, c%8al%%, 7al7itaii5
NU FO'OI2I ACE'EAJI TA"POANE AU CO"PREE 'A A"(II OCEIM

FIA N". =.8. ADMINISTRAREA MEDlCAMENTELOR PE CALE NA&ALA

- Introd!c%r%a m%dicam%nt%lor 7% cal% na?al& 7%ntr! tratar%a 7ro;l%m%lor local%
- "%dicam%nt%l% 7r%scris%
- Ta@& sa! c&r!cior 7%ntr! m%dicam%nt%
- Pi7%t&0sticl& 7ic!r&tor
- J%r@%%l%
a> PIEICF:
- E#7licai n%c%sitat%a 7roc%d!rii 6i a 7o?ii%i 7%ntr! instilaii na?al%
- E#7licai %8%ct!l t%ra7%!tic 6i n%c%sitat%a m%nin%rii 7o?ii%i tim7 d% C\
- Id%nti8icai %@%nt!al%l% al%r9ii c!nosc!t% d% 7aci%nt
;> FIGICF:
- Asi9!rai 7o?iia ad%c@ata 7%ntr! ca m%dicam%nt!l s& n! a<!n9& An 8arin9%, d%oar%c% @a 8i An9:iit iar %8%ct!l @a
8i in8l!%natH
- Ca7!l 7aci%nt!l!i s% a6%a?& 7% o 7%rn& la mar9in%a 7at!l!i An 8!nci% d% ?ona a8%ctat&
- Pr%9&tii mat%rial%l% 7% o ta@& sa! !n c&r!cior 7%ntr! tratam%nt%
- R!9ai 7aci%nt!l s& n! s% mi6t%
.7
- 7&lai mBinil% c! a7& 6i s&7!n
- Asi9!rai l!mina ad%c@at&
- A6%?ai 7aci%nt!l Antr-!na din c%l% tr%i 7o?iii 7%ntr! a 7%rmit% m%dicam%nt%lor s& a<!n9& An ?ona a8%ctat&:
a> Dn d%c!;it dorsal c! ca7!l !6or Anclinat s7r% ?ona a8%ctat& 7%ntr! trom7a l!i E!stac:io
;> Dn d%c!;it dorsal c! !m%rii s7ri<inii 7% o 7%rn&, c! ca7!l An %#t%nsi% 7%ntr! sin!s!ril% %tmoidal 6i s8%noidal
c> Dn d%c!;it dorsal c! !m%rii s7ri<inii 7% 7%rn&, c! ca7!l An :i7%r%#t%nsi% Antors s7r% 7art%a a8%ctat& 7%ntr!
sin!s!ril% 8rontal% 6i ma#ilar%
- *ai 7aci%nt!l!i 6%r@%%l%
- As7irai An 7i7%t& cantitat%a d% m%dicam%nt n%c%sar&
- Introd!c%i @Br8!l 7i7%t%i %#act An nar&
- Instilai cantitat%a n%c%sar& n!m&rBnd 7ic&t!ril%
- Instr!ii 7aci%nt!l s& m%nin& 7o?iia tim7 d% C\ 7%ntr! a 7r%@%ni sc!r9%r%a An a8ar& sa! s7r% 9Bt a
m%dicam%nt!l!i
- A;sor;ii %#c%s!l d% m%dicam%nt% 6i %#7licai 7aci%nt!l!i s& n! s!8l% nas!l
- O;s%r@ai star%a 7aci%nt!l!i
- In8ormai 7aci%nt!l An cBt tim7 s% instal%a?& %8%ct!lH
- Instr!ii 7aci%nt!l08amilia c!m s& 7roc%d%?% dac& @a tr%;!i s& contin!% tratam%nt!l la domicili!
- P!n%i m%dicam%nt%l% 6i 7i7%ta An loc!l d% 7&strar%
- Asi9!rai-@& c& s!nt condiii o7tim% 7%ntr! 7&strar%a m%dicam%nt%lor =sticl!%lor> d%sc:is%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, do?a, cal%a d% administrar%, n!m%l% n!rs%i car% a administrat
- Oric% o;s%r@ai% l%9at& d% star%a 7aci%nt!l!i sa! as7%ct!l local
- Paci%nt!l r%s7ir& 7% nas, c! !6!rin&
- Paci%nt!l n! ac!?& r%acii n%7l&c!t%
- 'a atin9%r%a 8ir%lor d% 7&r din nas s% d%clan6%a?& str&n!t!l:
- Acionai c! 9ri<& An tim7!l administr&rii
- O8%rii 7aci%nt!l!i 6%r@%t%l% 6i instr!ii-l s&-6i aco7%r% nas!l 6i 9!ra c! !n 6%r@%%l dac& Ai @in% s&
str&n!t%
- Paci%nt!l ac!?& s%n?ai% d% An%7&t!r& sa! !sc&ci!n% a m!coas%i:
- E#7licai 7aci%nt!l!i c& s%n?aia %st% tr%c&toar%
- *ac& mani8%st&ril% s% m%nin, an!nai m%dic!l
-Paci%nt!l ac!?& c%8alc%, 7al7itaii, insomnii =mai al%s la ;&trBni 6i co7ii>:
- An!nai m%dic!l
- As7irar%a sol!i%i An 8osa na?al& 8a@ori?%a?& sc!r9%r%a ac%st%ia An larin9% 7ro@ocBnd acc%s% d% t!s% =s7asm%>
- 'ini6tii 7aci%nt!l, an!nai m%dic!l
ATEN2IEM
- Folosii 7i7%ta 7%ntr! !n sin9!r 7aci%ntM
- *%6i ca@itat%a na?al& %st% st%ril&, r%s7%ctai norm%l% d% as%7si% 6i antis%7si% d%oar%c% %#ist& l%9&t!ri c!
sin!s!ril%M
FIA N". =.;. ADMINISTRAREA MEDICAMENTELOR (N CONDUCTUL AUDITI. EXTERN
9INSTILA2IA:
.,
- Introd!c%r%a m%dicam%nt%lor An cond!ct!l a!diti@ 7%ntr! a o;in% !n %8%ct t%ra7%!tic
- Dnm!i%r%a do7!l!i d% c%r!m%n
- "%dicam%nt%l% 7r%scris%, sol!ii la t%m7%rat!ra cor7!l!i
- Pi7%t%
- Tam7oan% d% @at&, com7r%s% d% ti8on
- %r 8i?iolo9ic =o7ional>
- Ta@& m%dical&0c&r!cior d% mat%rial%
a> PIEICF:
- In8ormai 7aci%nt!l 6i %#7licai 7roc%d!ra
- E#7licai %8%ct!l t%ra7%!tic 6i %@%nt!al%l% s%n?aii n%7l&c!t%
- Dntr%;ai 7aci%nt!l dac& %st% al%r9ic
;> FIGICF:
- Po?iionai cor%ct 7aci%nt!l An 8!nci% d% 7art%a a8%ctat&
- Pr%9&tii mat%rial%l% 7% o ta@& sa! !n c&r!cior 7%ntr! tratam%nt%
- )%ri8icai r%comandar%a m%dicala
- Id%nti8icai 7aci%nt!l 6i asi9!rai-@& c& tim7an!l %st% Antr%9
- E#7licai 7aci%nt!l!i 7roc%d!ra An 8!nci% d% ni@%l!l s&! d% An%l%9%r% 6i cola;orar%
- Instr!ii 7aci%nt!l s& n! s% mi6t% An tim7!l 7roc%d!rii
- Asi9!rai l!mina ad%c@at&
- A6%?ai 7aci%nt!l An d%c!;it lat%ral 7% 7art%a s&n&toas&
- C!r&ai 7a@ilion!l !r%c:ii 6i 7art%a %#t%rn& a cond!ct!l!i a!diti@ c! tam7oan% d% @at& !m%?it% c! s%r 8i?iolo9ic
dac& %st% n%c%sar
- As7irai sol!ia An 7i7%t&
- C! o mBn& tra9%i d% 7a@ilion An s!s 6i s7r% s7at% 7%ntr! ad!li, 6i An <os 6i s7r% s7at% 7%ntr! co7ii =inBnd s%ama
d% 7o?iia anatomic& a cond!ct!l!i a!diti@ An 8!nci% d% @Brst&>
- A6%?ai c%alalt& mBn& 7% ca7!l 7aci%nt!l!i 7%ntr! a %@ita l%?ar%a An ca? d% mi6car%
- Instilai cantitat%a d% m%dicam%nt 7r%scris& dir%cionBnd 8l!#!l s7r% canal!l a!diti@
- N! atin9%i c! 7i7%ta
- As7irai %#c%s!l d% m%dicam%nt c! o com7r%s& 6i in%i ca7!l 7aci%nt!l!i An 7o?iia An car% a 8ost 40-4C\ 7%ntr! a
%@ita sc!r9%r%a sol!i%i
- A6%?ai 7aci%nt!l An 7o?ii% comod& d!7& sc!r9%r%a tim7!l!i d% 4C\
- Introd!c%i !n tam7on !scat An !r%c:% dac& tim7an!l %st% int%9r!H dac& tim7an!l %st% 7%r8orat !tili?ai !n
tam7on st%ril
- Dntr%;ai 7aci%nt!l dac& 7r%?int& @r%o mani8%star% n%7l&c!t& mai al%s d!7& administr&ri r%7%tat%
- Instr!ii 7aci%nt!l08amilia c!m s& 7roc%d%?% dac& %st% n%c%sar& contin!ar%a administr&rii la domicili!
- P!n%i m%dicam%nt%l% 6i 7i7%ta An loc!l d% 7&strar% 6i asi9!rai-@& c& s!nt And%7linit% condiiil% o7tim% d%
d%7o?itar%
- Dnd%7&rtai mat%rial%l% 8olosit% r%s7%ctBnd 7r%ca!i!nil% !ni@%rsal% =PU>
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, do?a, n!m%l% n!rs%i car% a administrat
- Oric% o;s%r@ai% l%9at& d% star%a 7aci%nt!l!i 6i ra7ortai cor%ct la sc:im;ar%a t!r%i
- R%acia 7aci%nt!l!i la 7roc%d!r&
- C% a An@&at 7aci%nt!l An l%9&t!r& c! %@%nt!al& contin!ar% a tratam%nt!l!i
.+
- Paci%nt!l %#7rim& star% d% con8ort 6i dimin!ar%a ac!?%lor
- Paci%nt!l n! coo7%r%a?&
- %#7licai Anc& o dat& n%c%sitat%a administr&rii 6i acc%nt!ai r%comandar%a m%dical& - - Paci%nt!l ac!?&
s%n?aii n%7l&c!t%
- sol!ia n! ar% t%m7%rat!ra cor%s7!n?&toar% sa! n! s-a 7o?iionat cor%ct 7a@ilion!l - Paci%nt!l 7r%?int&
s%nsi;ilitat% sa! iritaii local%5
- an!nai m%dic!l
FIA N". =.<.ADMINISTRAREA MEDICAMENTELOR PE CALE .AGINAL1
9GLOBULE3 O.ULE3 COMPRIMATE:
O A7licar%a 7% m!coasa @a9inal& a !nor m%dicam%nt% c! %8%ct local5
- "%dicam%nt%l% 7r%scris%: 9lo;!l%, o@!l%, ta;l%t%
- "at%rial% 7%ntr! s7&l&t!ra @a9inal& =dac& %st% r%comandat&>
- "&n!6i d% ca!ci!c
- Para@an
- Com7r%s% d% ti8on
a> PIEICF:
- E#7licai n%c%sitat%a 6i %8icacitat%a 7roc%d!rii
- E#7licai %8%ct!l t%ra7%!tic
- Asi9!rai 7aci%nta d% ino8%nsi@itat%a 7roc%d!rii 6i d% r%s7%ctar%a intimit&ii
;> FIGICF:
- Asi9!rai 7o?iia 9in%colo9ic& =d%c!;it dorsal c! coa7s%l% 8l%ctat% sa! %@%nt!al d%c!;it lat%ral>
- E8%ct!ai s7&l&t!ra @a9inal& dac& ac%asta %st% r%comandat& d% m%dic Anaint% d% Anc%7%r%a tratam%nt!l!i
- Pr%9&tii mat%rial%l% 7% o ta@& sa! !n c&r!cior 7%ntr! m%dicam%nt%
- )%ri8icai 7r%scri7ia m%dical&
- *!c%i m%dicam%nt%l% An salon
- E#7licai man%@ra
- 7&lai mBinil% 6i Am;r&cai m&n!6i d% ca!ci!c
- A6%?ai 7aci%nta An 7o?ii% 9in%colo9ic& sa! I"
- coat%i m%dicam%nt!l din am;ala<
- C! o man& And%7&rtai la;iil% 8olosind do!& com7r%s% 6i %@id%niai ori8ici!l @a9inal
- Introd!c%i m%dicam%nt!l An canal!l @a9inal Am7in9Bnd!-l !6or c! d%9%t!l Am;r&cat An m&n!6& 7Bn& An 8!nd!l d%
sac
- Instr!ii 7aci%nta s& st%a An d%c!;it 4C\ 7%ntr! a 8a@ori?a to7ir%a 6i a;sor;ia
R%@%nii d!7& 4C\ 7%ntr! a @%d%a star%a 7aci%nt%i
- A6%?ai 7aci%nta An 7o?ii% comod&
- Asi9!rai !n tam7on d% @at& 7%ntr! a 7r%@%ni discon8ort!l
- Instr!ii 7aci%nta c!m s& 7roc%d%?% dac& s% @a contin!a tratam%nt!l la domicili!
- Dnd%7&rtai am;ala<%l%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
70
- *ata, ora, m%dicam%nt!l, do?a, n!m%l% n!rs%i
- E#ist%na iritai%i, a sc!r9%rilor @a9inal%, l%?i!ni, @%9%taii, %@%nt!al r!7t!r& d% 7%rin%!
- "%dicam%nt!l %st% introd!s 8&r& incid%nt%
- Paci%nta r%s7%ct& r%comand&ril%
- Paci%nta %#7rim& star%a d% con8ort
- Paci%nta %st% coo7%rant&, An%l%9% in8ormaiil% 7rimit%
- Paci%nta ac!?& d!r%r% An tim7!l introd!c%rii m%dicam%nt!l!i
- '!crai c! ;lBnd%%
- Paci%nta %st% inca7a;il& s& r%in& m%dicam%nt!l
- % r%comand& 7r%l!n9ir%a r%7a!s!l!i
- % an!n& m%dic!l 7%ntr! a sc:im;a %@%nt!al cal%a d% administrar%
- Paci%nta ac!?& s%n?aii local% n%7l&c!t%
- % an!n& m%dic!l
FIAN".=.=.ADMINISTRAREA MEDICAMENTELOR PE CALE RECTAL1
9SUPO&ITOARE:
O Folosir%a !n%i c&i alt%rnati@% d% administrar% An ca?!l intol%ran%i di9%sti@% =@&rs&t!ri>5
O "%dicam%nt!l ar% 9!st n%7l&c!t, in8l!%n%a?& acti@itat%a :%7atic& sa! ar% %8%ct iritant al m!coas%i 9astric%5
O % inacti@%a?& s!; in8l!%na s!c!rilor 9astric%
- !7o?itoar%l% 7r%scris%
- "&n!6i sa! d%9%t% d% m&n!6&
- Para@an, dra7%ri%
- Ta@&0c&r!cior 7%ntr! m%dicam%nt%
- )as%lin&
- "at%rial% 7%ntr! clism& dac& %st% ca?!l
a> PIEICF:
- E#7licai n%c%sitat%a sa! %8icacitat%a 7roc%d!rii
- E#7licai %8%ct!l t%ra7%!tic 6i a@anta<%l%
- Id%nti8icai %@%nt!al%l% al%r9ii
- Asi9!rai 7aci%nt!l0cli%nt!l c& s% @a r%s7%cta intimitat%a
- E#7licai 7aci%nt!l!i0cli%nt!l!i c& 7oat% a7ar% s%n?aia d% d%8%cai% 7% car% tr%;!i% s& o st&7Bn%asc&
;> FIGICF:
- Asi9!rai 7o?iia d% d%c!;it lat%ral stBn9
- E8%ct!ai clisma %@ac!atoar% la indicaia m%dic!l!i
- Pr%9&tii mat%rial%l% 7% o ta@& 0c&r!cior 7%ntr! m%dicam%nt%
- Id%nti8icai 7aci%nt!l0cli%nt!l
- *!c%i m%dicam%nt%l% An salon
- E#7licai man%@ra
- Asi9!rai intimitat%a c! !n 7ara@an
- 7&lai mBinil% 6i Am;r&cai m&n!6il% =sa! a7licai d%9%t!l d% m&n!6&>
- A6%?ai 7aci%nt!l0cli%nt!l An d%c!;it lat%ral stBn9 c! 7icior!l d% <os Antins 6i c%l d% d%as!7ra 8l%ctat =7o?iia
ims>
- Dnd%7&rtai 8olia d% 7% s!7o?itor
- P!n%i @as%lin& 7% ca7!l s!7o?itor!l!i 7%ntr! a 7%rmit% al!n%car%a ac%st!ia
- C! o mBn& And%7&rtai !6or 8%s%l% 6i %@id%niai ori8ici!l anal
- C! d%9%t!l Am;r&cat An m&n!6& introd!c%i s!7o?itor!l An canal!l r%ctal dincolo d% s8inct%r!l int%rn
74
- Instr!ii 7aci%nt!l0cli%nt!l s& st%a lini6tit 4C min!t% 7%ntr! a 8a@ori?a a;soria m%dicam%nt!l!i
- A6%?ai 7aci%nt!l An 7o?ii% comod& d!7& 4C min!t%
- O;s%r@ai %8%ct!l m%dicam%nt!l!i 6i in8ormai 7aci%nt!l0cli%nt!l cBnd instal%a?& ac%sta 6i cBt d!r%a?&
- Instr!ii 7aci%nt!l0cli%nt!l c!m s% 7roc%d%a?& dac& tr%;!i% s& contin!% tratam%nt!l la domicili!
- Plasai s!7o?itoar%l% r&mas% Antr-!n loc ad%c@at 7%ntr! 7&strar%
- Dnd%7&rtai am;ala<%l%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- *ata, ora, m%dicam%nt!l, do?a, cal%a d% administrar%
- N!m%l% asist%nt%i car% a administrat m%dicam%nt!l
- E#ist%na iritai%i sa! sBn9%r&rii, a :%moroi?ilor
- Contin%na0incontin%na s8inct%r!l!i
- 7!r9aia, calmar%a d!r%rii, at%n!ar%a tran?it!l!i, sc&d%r%a 8%;r%i %#7rimat% 7rin cr%6t%r%a 9rad!l!i d% con8ort
- s!7o?itor!l n! a 8ost %liminat5
- 7aci%nt!l d%monstr%a?& c& a An%l%s in8ormaiil%
- R%?!ltat!l a6t%7tat n! a7ar%
- lini6tii 7aci%nt!l0cli%nt!l, an!nai m%dic!l
- !7o?itor!l %st% %liminat, %8%ct!l n! s% 7oat% instala
- r&mBn%i lBn9& 7aci%nt0cli%nt, Anc!ra<ai-l 6i m%nin%i 8%s%l% strBns% c%l 7!in 4Cmin5
FIA N". =.>.ADMINISTRAREA OXIGENULUI PRIN SOND1
45 A7ro@i?ionar%a %s!t!rilor c! o#i9%n An ca? d% :i7o#i%
- ond& d% ca!ci!c sa! mat%rial 7lastic, st%ril&
- '%!co7last
- "&n!6i d% ca!ci!c
a> PIEICF: - dac& %st% con6ti%nt:
- In8ormai 7aci%nt!l as!7ra n%c%sit&ii administr&rii o#i9%n!l!i
- E#7licai 7roc%d!ra 7%ntr! a o;in% cola;orar%a
- Asi9!rai 7aci%nt!l d% ino8%nsi@itat%a 7roc%d!riiH
;> FIGICF:
- Asi9!rai 7aci%nt!l!i o 7o?ii% comod&
- )%ri8icai li;%rtat%a c&ilor r%s7iratorii
- )%ri8icai 7r%scri7ia m%dical& 6i d%;it!l d% O2 r%comandat 7% min!t
- Id%nti8icai 7aci%nt!l 6i sta;ilii o r%lai% d%o cola;orar%
- "&s!rai distana d% la narin& 7Bn& la lo;!l !r%c:ii =a7ro#imati@ .-, cm>
- Introd!c%i sonda An narin& 7%r7%ndic!lar 7% 7lan!l 8%%i 7%ntr! a n! lo@i corn%t%l% na?al% =cBnd s% Anclin& An
s!s> sa! 7lan6%!l 8os%i na?al% =cBnd s% Anclin& An <os>
- Um%?ii sonda 7%ntr! a 8a@ori?a Anaintar%a
- Asi9!rai-@& c& sonda a a<!ns la 7ro8!n?im%a dorit&
- Fi#ai sonda c! l%!co7last
- Fi#ai d%;it!l =. l0min> con8orm 7r%scri7i%i
- !7ra@%9:%ai ;olna@!l 6i controlai 8r%c@%nt 7%rm%a;ilitat%a sond%i, o;s%r@ai 8aci%s!l
72
- Asi9!rai An9ri<ir%a nas!l!i 6i ca@it&ii ;!cal% d%oar%c% O2 !s!c& m!coasa
- c:im;ai ?ilnic sonda 6i narina 8olosind m&n!6i
- Controlai 8r%c@%na r%s7irai%i
- Dnd%7&rtai sond%l% d% !nic& 8olosin&
- C!r&ai sond%l% d% ca!ci!c 6i 7r%9&tii 7%ntr! st%rili?ar%
- CBnd indicaia d% administrar% a o#i9%n!l!i Anc%t%a?&, And%7&rtai c! 9ri<& s!rsa d% o#i9%n
NOTAREA PROCE*URII
- Notai data 6i ora Anc%7!t!l!i 6i s8Br6it!l!i o#i9%not%ra7i%i
- Notai d%;it!l 0min
- Notai r%acia 7aci%nt!l!i, s%mn%l% @ital% =An s7%cial r%s7iraia>, c!loar%a t%9!m%nt%lor, sc:im;&ri al% st&rii d%
con6ti%n&
- Paci%nt!l ar% r%s7irai% normal& sa! 7r%?int& am%liorar% a st&rii iniial%
- Paci%nt!l %#7rim& star% d% con8ort, 7r%?int& t%9!m%nt% normal colorat%, m!coas%l% s!nt intact%5
R%?ol!t% n%dorit% 0C% 8ac%iN
- onda i%s% An a8ar& d%oar%c% n! a 8ost introd!s& cor%ct
- r%7%tai c! at%ni% man%@ra d% introd!c%r% 6i asi9!rai-@& c& s-a atins 7ro8!n?im%a n%c%sar& - Paci%nt!l
s% ;alon%a?&
- sonda a 8ost introd!s& 7r%a 7ro8!nd 6i O2 a<!n9% An stomacH r%tra9%7i sonda 7Bn& a7roa7% d% @&l!l
7alatin
- "!coas%l% 7aci%nt!l!i s!nt !scat%, iritat%
- r%d!c%i 7r%si!n%a o#i9%n!l!i dac& o;s%r@ai d%7rimar%a 8!nci%i r%s7iratorii 6i an!nai m%dic!l
- @%ri8icai 8!ncionar%a !midi8icator!l!i
- sc:im;ai narina la introd!c%r%a sond%i
- mo;ili?ai din cBnd An cBnd sonda
FIA N". =.1?. ADMINISTRAREA MEDICAMENTELOR PE CALE PARENTERAL1
FIA N". =.1?.1. ASPIRAREA MEDICAMENTULUI DIN FIOL1
- Administrar%a m%ditai%i in<%cta;il% An mod st%rilH
- Administrar%a !n%i sin9!r% do?% din m%dicaia in<%cta;il&
APRECIERE
a> *at% o;i%cti@%
- R%@%d%i 7r%scri7ia m%dical&
- O;in%i oric% in8ormai% d%s7r% m%dicam%nt 7%ntr! a @%d%a dac& %st% %li9i;il, 7%ric!los sa! n%si9!r
- ta;ilii dac& conin!t!l 8iol%i n! %st% %#7irat
- O;s%r@ai 8iola 7%ntr! claritat%a sol!i%i
;> *at% s!;i%cti@%
- Dntr%;ai 7aci%nt!l d%s7r% 7osi;il% al%r9ii la m%dicam%nt%
- *%t%rminai c!no6tin%l% 7aci%nt!l!i 6i %#7%ri%na sa An 7rimir%a m%dicai%i in<%cta;il%
- Ta@& m%dical&0c&r!cior
- Fiol& c! m%dicam%nt!l 7r%scris
- Pr%scri7ia m%dical&, 7ros7%ct!l
- %rin9a 6i ac%l% st%ril% ad%c@at% m%dicai%i 6i cli%nt!l!i
- Com7r%s% sa! tam7oan% c! alcool
- R%ci7i%nt% 7%ntr! col%ctar%a d%6%!rilor
- 7&lai-@& mBinil%
- (at%i !6or 9Bt!l 8iol%i sa! %8%ct!ai o r&s!cir% ra7id& din artic!laia mBinii An tim7 c% in%i 8iola @%rtical
- '!ai o mic& com7r%s& d% ti8on c! alcool 7%ntr! r!7%r%a 9Bt!l!i 8iol%i d%-a l!n9!l lini%i 7r%t&iat%
7-
- Dnd%7&rtai ca7ac!l d% la ac 7rin traci!n%
- Introd!c%i ac!l An 8iol&, c! at%ni% 7%ntr! a n! atin9% mar9in%a 8iol%i
- As7irai sol!ia m%dicam%ntoas& An cantitat%a 7r%scris&, AnclinBnd !6or 8iola
- Eliminai ;!l%l% d% a%r car% s% 8orm%a?& An s%rin9&: r%ca7s!lai ac!l
- Ar!ncai 8iola An contain%r!l s7%cial d!7& c% mai citii odat& inscri7ia
- 7&lai-@& mBinil%
- $Bt!l 8iol%i s% r!7% 8&r& s& s% s7ar9&
- N! s% 7rod!c l%?i!ni al% mBinilor la d%sc:id%r%a 8iol%i
- Paci%nt!l n! ar% istoric d% al%r9i% m%dicam%ntoas&
- ol!ia %st% 7r%ci7itat&, d%colorata sa! %#7i8&l <<5
- Folosii alt& 8iol&
- Cio;!ril% d% sticl& cad An 8iol& cBnd 9Bt!l 8iol%iH s% s7ar9% la d%sc:id%r%
- Ar!ncat 8iola
- Folosii alt& 8iol&
- N!rsa s!8%r& t&i%t!ri al% d%9%t%lor cBnd Anc%arc& s& r!7& 9Bt!l 8iol%i
- Prot%<ai-@& Anaint%
- Pansai-@& st%ril
- Paci%nt!l ar% istoric d% al%r9i% la m%dicam%nt 6i tr%;!i% t%stat
- E8%ct!ai t%st!l la indicaia 6i An 7r%?%na m%dic!l!i
- Paci%nt!l d%?@olt& r%acii d% s%nsi;ili?ar% la t%star%
- Int%r@%nii con8orm 7r%scri7i%i m%dical%
FIA N". =.1?.6. IN'EC2IA INTRADERMICA
- In<%ctar%a d% al%r9%ni An 7i%l% ca m%tod& d% dia9nostic 7%ntr! a7r%ci%r%a r%aci%i la al%r9%ni5
- T%star%a la t!;%rc!lin& sa! PP*5
- T%star%a !nor m%dicam%nt% c! 7ot%nial d% s%nsi;ili?ar% a or9anism!l!i =anti;iotic%, an%st%?ic%>
Pr%9&tii !rm&toar%l% mat%rial%:
- !;stana sa! m%dicam%nt!l 7r%scris
- %rin9i st%ril% d% 4 ml c! do?a< cor%s7!n?&tor
- Ac% st%ril% 8in%, c! ;i?o!l sc!rt
a> PIEICF:
- E#7licai sco7!l in<%ci%i, %8%ct%l% dorit% 6i n%dorit%
;> FIGICF:
- C%rc%tai ?on%l% d% %l%ci%: r%9i!n%a ant%rioar& a ant%;ra!l!i, 8aa %#t%rn& a ;ra!l!i 6i a coa7s%i
- ta;ilii loc!l 7%ntr! in<%ci% %@itBnd ?on%l% 7i9m%ntat%, d%colorat% sa! in8%ctat%
- Po?iionai 7aci%nt!l An 8!nci% d% loc!l s%l%ctat 6i d% star%a sa: d%c!;it dorsal, 7o?ii% 6%?Bnd& sa! s%mi6%?Bnd&
- O;in%i in8ormaii s!7lim%ntar% d%s7r% m%dicam%nt, do?ar%, %8%ct%l% 7osi;il%
- Int%r@i%@ai 7aci%nt!l 7%ntr! a id%nti8ica 7ro8il!l al%r9olo9ic al ac%st!ia 7r%c!m 6i %#7%ri%na l%9at& d% t%star%
- 7&lai-@& mBinil%, 8olosii m&n!6i d% !nic& 8olosin&
7/
- E8%ct!ai dil!ia n%c%sar& 6i sta;ilii do?a cor%ct& con8orm 7roc%d!rii standard, acolo !nd% %st% ca?!l
- As7irai sol!ia An s%rin9& r%s7%ctBnd 7roc%d!ra
- Eliminai a%r!l din s%rin9&
- *%?in8%ctai ?ona al%as& c! alcool 6i l&sai 7i%l%a s& s% !s!c%
- Dntind%i 7i%l%a din ?ona in<%ci%i 8olosind 7olic%l% mBinii n%dominant%
- Po?iionai s%rin9a ast8%l AncBt ac!l s& 8i% a7roa7% 7aral%l =tan9%nt> c! 7i%l%a 7aci%nt!l!i 6i c! ;i?o!l ori%ntat An
s!s
- Introd!c%i ac!l An strat!ril% c%l% mai s!7%r8icial% al% 7i%lii, a7ro#imati@ /mm, ast8%l AncBt @Br8!l s& 8i% @i?i;il
7rin 7i%l%
- In<%ctai l%nt sol!ia Am7in9Bnd 7iston!l, 8&r& s& as7irai
- O;s%r@ai 8ormar%a la loc!l inoc!l&rii, a !n%i 7a7!l% al;% c! diam%tr!l d% C-. mm
- E#tra9%i ra7id ac!l 8&r& s& masai loc!l
- Dnd%7&rtai m&n!6il% d% !nic& 8olosin&
- A<!tai 7aci%nt!l s& ado7t% o 7o?ii% con8orta;il& 6i s& r&mBn& An r%7a!s la 7at
- "%nin%i ?ona in<%ci%i acc%si;il& o;s%r@ai%i
- !7ra@%9:%ai at%nt 7aci%nt!l d!7& t%star%a s%nsi;ilit&ii la an!mit% m%dicam%nt% =anti;iotic%, an%st%?ic%> sa!
al%r9%ni
- Citii r%acia local& d!7& 20 - -0 d% min!t% sa! /, - 72 d% or% =An 8!nci% d% sit!ai%>
- An!nai m%dic!l 6i int%r@%nii d% !r9%n& An ca? d% com7licaii
- Ar!ncai mat%rial%l% 8olosit% An contain%r% s7%cial%H ac!l s% ar!nc& n%ca7isonat
- 7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 8i6a d% 7roc%d!ri sa! An 7lan!l d% An9ri<ir%: n!m%, 7r%n!m%, s!;stana administrat&, do?a, data 6i
ora inoc!l&rii
- Notai data 6i ora citirii r%aci%i local% 7r%c!m 6i caract%risticil%
- "%dicam%nt!l %st% administrat r%s7%ctBnd c%l% cinci r%9!li: 7aci%nt!l id%nti8icat, m%dicam%nt!l 7r%scris, do?a
cor%ct&, cal%a ad%c@at&, tim7!l 7otri@it
- Paci%nt!l %st% lini6tit, r%la#at iar la loc!l inoc!l&rii n! a7ar r%acii ma<or% d% s%nsi;ili?ar%
- )Br8!l ac!l!i n! 7&tr!nd% An d%rm 6i sol!ia s% sc!r9% An a8ar&
- % 7&tr!nd% c! a7ro#imati@ 4 mm mai 7ro8!nd An 9rosim%a d%rm!l!i
- Ac!l 7&tr!nd% 7r%a adBnc, d%t%rminBnd o in8iltrai% di8!?& 8&r& s& s% 8orm%?% 7a7!l& al;& d%limitat&
- % r%tra9% !6or ac!l 6i s% r%7o?iion%n?& An 9rosim%a d%rm!l!i
- 'a loc!l t%st&rii a7ar r%acii 7o?iti@% sa! int%ns 7o?iti@%: @%?ic!l%, !lc%raii, n%cro?a %s!t!l!i
- % an!n& m%dic!l
- 'i7otimi%, risc d% accid%ntar% 7rin c&d%r% dac& 7aci%nt!l n! r&mBn% An r%7a!s la 7at
- % l&m!r%6t% 7aci%nt!l d%s7r% o;li9ati@itat%a m%nin%rii r%7a!s!l!i la 7at -0 d% min!t% d!7& in<%ci%
- R%aci% ana8ilactic& sa! 6oc ana8ilactic car% am%nin& @iaa
- % an!n& m%dic!l
- % int%r@in% d% !r9%n& con8orm 7rotocol!l!i

FIA N".=.1?.7. IN'EC2IA SUBCUTANAT1
- Introd!c%r%a An %s!t!l c%l!lar s!;c!tanat a !nor m%dicam%nt% An do?a 7r%scris&
- Ta@& m%dicala0c&r!cior 7%ntr! tratam%nt
- %rin9i 6i ac% st%ril% ad%c@at%
7C
- "%dicam%nt!l d% in<%ctat
- Pr%scri7ia sa! F5O5
- ol!ii d%?in8%ctantat% =alcool>
- Tam7oan% d% @at& sa! com7r%s% d% ti8on
- "&n!6i d% !nic& 8olosin& = o7ional>
a> PIEICF:
- In8ormai , Anc!r!<ai 6i s!sin%i 7aci%nt!l
- E#7licai sco7!l in<%ci%i, a %8%ct%lor dorit% 6i n%dorit%, a orar!l!i d% administrar% dac& %st% ca?!l
;> FIGICF:
- A6%?ai 7aci%nt!l An 8!nci% d% star%a sa An 7o?ii% 6%?Bnd& c! mBna s7ri<init& 7% 6old sa! An d%c!;it dorsal
- ta;ilii loc!l d% %l%ci% =in<%cia s% 7oat% %8%ct!a 7% 8aa %#t%rn& a ;ra!l!i, 8aa s!7ra%#t%rn& a coa7s%i,
r%9i!n%a s!7ra 6i s!; s7inoas& a omo7lat!l!i, r%9i!n%a d%ltoidian&, 8lanc!ril% 7%r%t%l!i a;dominal, r%9i!n%a
s!;cla@ic!lar&>
- 7&lai-@& 7% mBini, c! a7& 6i s&7!n
- *%?in8%ctai-@& mBinil%
- Dm;r&cai m&n!6i d% !nic& 8olosin&=o7ional>
- Dnc&rcai s%rin9a c! sol!ia m%dicam%ntoas& 7r%scris&
- Eliminai ;!l%l% d% a%r din s%rin9&
- c:im;ai ac!l c! alt!l ca7i6onat, ad%c@at
- *%?in8%ctai loc!l d% %l%ci% c! alcool
- Pliai t%9!m%nt!l Antr% 7olic% 6i ind%# 8i#Bnd!-l 6i ridicBnd!-l d% 7% 7lan!ril% 7ro8!nd%
- P&tr!nd%i c! ra7iditat% An t%9!m%nt c! ;i?o!l ac!l!i An s!s An strat!l s!;c!tanat la /CK sa! +0K
- )%ri8icai 7o?iia ac!l!i 7rin as7irar%
- In<%ctai l%nt sol!ia m%dicam%ntoas&
- R%tra9%i ac!l c! ra7iditat% d!7& a7licar%a tam7on!l!i c! alcool lBn9& ac
- N! r%ca7s!lai ac!l
- "asai loc!l in<%ci%i c! tam7on!l c! alcool %#%rcitBnd o !6oar& 7r%si!n%
- Dnd%7&rtai-@& m&n!6il%
- A6%?ai 7aci%nt!l Antr-o 7o?ii% comod& An r%7a!s
- O;s%r@ai An 7%rman%n& 8aci%s!l 7aci%nt!l!i, t%9!m%nt%l%, com7ortam%nt!l =7osi;il 8rison, a9itai%>
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial% con8orm PU =7r%ca!i!nilor !ni@%rsal%>H ac!l s% ar!nc& n%ca7i6onat
- Dnd%7&rtai-@& m&n!6il%
- 7&lai-@& 7% mBnii
NOTAREA PROCE*URII
Notai:
- Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir% H
- n!m%, 7r%n!m%H
- data 6i ora administr&riiH
- ti7!l sol!i%i administrat%, do?a5
- "%dicam%nt!l %st% in<%ctat l%nt An ?ona s%l%ctat& cBnd n! s% as7ir& sBn9%
- Paci%nt!l 7r%?int& r&s7!ns 8a@ora;il la m%dicam%nt!l in<%ctat, 8&r& %8%ct% ad@%rs% s%c!ndar%H 8aci%s r%la#at,
com7ortam%nt ad%c@at
- Ac!l An%a7& !n @as d% sBn9% at!nci cBnd %st% introd!s An %s!t!l s!;c!tanat5
7.
- Dn ac%st ca? ac!l 6i s%rin9a c! sol!ia r%s7%cti@& s% ar!nc& 6i s% 7r%9&t%sc alt%l% 7%ntr! in<%ctar% An alt
loc
- Gona d%@in% ro6i%, ind!rat& sa! d!r%roas& d!7& in<%ctar%
- % a7lic& com7r%s% r%ci sa! 9:%a&
- *!r%r% @iol%nt& 7rin atin9%r%a !n%i t%rminaii n%r@oas% sa! dist%nsi% ;r!sc& a %s!t!l!i
- R!7%r%a ac!l!i
- % mas%a?& loc!l
- % %#tra9% ac!l
FIA N".=.1?.4. IN'EC2IA INTRAMUSCULAR1
- Introd!c%r%a An %s!t!l m!sc!lar a !n%i do?% m%dicam%ntoas% 7r%scris%5
- Fiol& sa! 8lacon!l c! m%dicam%nt!l 7r%scris
- Pr%scri7ia m%dicala sa! F5O5
- %rin9i 6i ac% st%ril%: m&rim%a d%7ind% d% cantitat%a d% m%dicam%nt 7r%scris 6i d% caract%risticil%
anatomic% al% 7aci%nt!l!i
- "&n!6i d% ca!ci!c = o7ional>
a> PIEICF:
- Int%r@i%@ai 7aci%nt!l 7%ntr! a id%nti8ica !n 7ot%nial al%r9ic
- E#7licai sco7!l in<%ci%i, %8%ct%l% dorit% 6i n%dorit%, orar!l d% administrar% dac& %st% ca?!l5
;> FIGICF:
- ta;ilii loc!l d% %l%ci%: cadran!l s!7%ro-%#t%rn 8%si%r, d%as!7ra mar%l!i tro:ant%rH 8aa %#t%rn& a coa7s%i, An
tr%im%a mi<loci%, 8aa %#t%rn& a ;ra!l!i An m!6c:i!l d%ltoid5
- Po?iionai 7aci%nt!l An 8!nci% d% loc!l al%s 6i d% star%a sa: d%c!;it @%ntral, d%c!;it lat%ral c! m%m;r!l in8%rior
d% d%as!7ra r%la#at, 7o?ii% 6%?Bnd&, ortostatism
- Asi9!rai-@& c& ?ona n! %st% contractat& 6i n! 7r%?int& nod!li
- 7&lai-@& mBinil%, 8olosii m&n!6i d% !nic& 8olosin& =o7ional>
- As7irai sol!ia din 8iol& sa! 8lacon con8orm 7roc%d!rii
- Eliminai ;!l%l% d% a%r din s%rin9&
- c:im;ai ac!l c! alt!l ca7i6onat
- Ins7%ctai loc!ril% 7osi;il% 7%ntr! in<%ci%
- *%?in8%ctai lar9 ?ona al%as&
- Dntind%i 7i%l%a, la loc!l al%s, Antr% 7olic%l% 6i ind%#!l mBinii n%dominant%
- Introd!c%i ra7id ac!l An %s!t!l m!sc!lar, An !n9:i d% +0K inBnd s%rin9a An mBna dominant& Antr% 7olic% 6i
c%l%lalt% d%9%t%
- Fi#ai am;o!l ac!l!i c! mBna n%dominant& 6i 7rind%i 7art%a %#t%rn& a 7iston!l!i c! mBna dominant&
- As7irai l%nt, tr&9Bnd 7iston!l Ana7oi 7%ntr! a @%ri8ica dac& ac!l %st% Antr-!n @as d% sBn9%
- In<%ctai l%nt sol!ia m%dicam%ntoas&: 40 s%c!nd% 7%ntr! 8i%car% ml d% sol!i%, dac& n! s-a as7irat sBn9%
- E#tra9%i ra7id ac!l ada7tat la s%rin9& 8i#Bnd am;o!l
- "asai loc!l in<%ci%i c! !n tam7on c! alcool, %#%rcitBnd o !6oar& 7r%si!n%
- A<!tai 7aci%nt!l s& s% Am;rac% 6i s& ado7t% o 7o?ii% comod&
- Dnc!ra<ai 7aci%nt!l s& 8ac& %#%rciii 8i?ic% 7%ntr! m%m;r!l in8%rior
77
- E@al!ai loc!l in<%ci%i d!7& 2 - / or% d% la administrar%, dac& %st% 7osi;il
- Ar!ncai mat%rial%l% 8olosit% An contain%r% s7%cial% con8onn PU
- Ac!l s% ar!nc& n%ca7i6onat
- 7&lai-@& mBinil% d!7& And%7&rtar%a m&n!6ilor
NOTAREA PROCE*URII
Notai:
Proc%d!ra An 7lan!l d% An9ri<ir% 6i An 8i6a d% 7roc%d!ri :
- N!m%, 7r%n!m%,
- !;stan& administrat&, do?&,
- *ata 6i ora administr&rii
- R%?!ltat% a6t%7tat%0dorit%:
- "%dicam%nt!l %st% in<%ctat l%nt An ?ona s%l%ctat&, cBnd n! s% as7ir& sBn9%
- Paci%nt!l 7r%?int& !n r&s7!ns t%ra7%!tic la m%dicam%nt!l administratH 8aci%s!l %st% r%la#at, com7ortam%nt!l
lini6tit
- Ac!l An%a7& !n @as d% sBn9% at!nci cBnd %st% introd!s An %s!t
- s% sc:im;& 7o?iia ac!l!i sa! s% An%a7& An alt loc
- Ac!l AntBm7in& r%?ist%n& datorit& contact!l!i c! os!l An ca?!l 7aci%nt!l!i d%n!trit, cas%ctic
- s% r%comand& An ast8%l d% sit!aii 8olosir%a !nor ac% mai sc!rt% 6i mai 9roas% 7%ntr! a 7r%@%ni risc!l
r!7%rii ac%stora la contact!l c! os!l
- Gona d%@in% ro6i%, ind!rat& sa! d!r%roas& d!7& in<%ctar%
- % a7lic& com7r%s% r%ci sa! 9:%a&
- A7ar am%%li, 8!rnic&t!ri sa! alt%rar%a 8!nci%i m!sc!lar% An ?ona in<%ci%i, d%t%rminat% c%l mai ad%s%a d% iritaia
n%r@!l!i sciatic sa! a !n!i ram al ac%st!ia
- % r%s7%ct& loc!l d% %l%ci%
- Parali?i% 7rin An%7ar%a n%r@!l!i sciaticH s% r%comand& r%s7%ctar%a cadran!l!i s!7%ro-%#t%rn 8%si%r 7%ntr!
in<%ctar%
- Em;oli% 7rin in<%ctar%a Antr-!n @as d% sBn9% a sol!i%i !l%ioas%
- % an!n& m%dic!l
FIA N".=.1?.8. IN'EC2IA INTRA.ENOAS1
- Administrar%a !n!i m%dicam%nt dir%ct An sist%m!l @asc!lar An sco7 %#7loratorH tratar%a ra7id& a 7ro;l%m%lor
m%dical% al% 7aci%nt!l!iH r%ali?ar%a !n%i conc%ntraii Analt% An sBn9% a m%dicam%nt!l!i, Antr-!n tim7 sc!rt
- Fiol& sa! 8lacon!l c! sol!ia i?oton& sa! :i7%rton&
- Ac% st%ril% c! ;i?o!l asc!it dar sc!rt
- %rin9i st%ril% c! am;o!l %#c%ntric, d% ca7acit&i ad%c@at% cantit&ii d% m%dicam%nt 7r%scris
- "at%rial% 7%ntr! 7!ncia @%noas&
a> PIEICF:
- In8ormai 7aci%nt!l d%s7r% 7roc%d!r&
- E#7licai-i sco7!l in<%ci%i, %8%ct%l% dorit% 6i n%dorit%H
;> FIGICF:
- )%ri8icai loc!ril% d% %l%ci%, %@itBnd ?on%l% c! %c:imo?%, c! 7ilo?itat% acc%nt!at& sa! c! in8%ci%
7,
- ta;ilii loc!l 7%ntr! in<%ci%: @%n%l% d% la 7lic& cot!l!i - ;a?ilic& sa! c%8alic&H @%n%l% d% 7% 7art%a dorsal& a
mBinii, @%n%l% d% 7% 7art%a 7ost%rioar& a 9am;%i, @%n%l% %7icrani%n% =la co7ii>H @%n%l% <!9!lar%
- Po?iionai 7aci%nt!l An si9!ran& An 8!nci% d% loc!l al%s 6i d% star%a saH d%c!;it dorsal,
7o?ii% s%mi6%?Bnd&
- O;in%i in8ormaii s!7lim%ntar% dac& m%dicam%nt!l %st% no!
- As7irai sol!ia din 8iol& sa! 8lacon con8orm 7roc%d!rii standard
- Eliminai ;!l%l% d% a%r din s%rin9& m%ninBnd s%rin9a An 7o?ii% @%rtical&
- c:im;ai ac!l c! alt!l ca7i6onat
- '%9ai 9aro!l, 7al7ai trai%ct!l @%n%i
- *%?in8%ctai lar9 ?ona al%as& 7%ntr! in<%cii
- E8%ct!ai 7!ncia @%noas& con8orm 7roc%d!rii
- )%ri8icai 7o?iia ac!l!i 7rin as7irar%
- *%s8ac%i 9aro!l dac& ac!l %st% An @%n&
- In<%ctai l%nt sol!ia m%dicam%ntoas&, o;s%r@Bnd loc!l 7!ncionat 6i r%aciil% 7aci%nt!l!i
- E#tra9%i ra7id ac!l ada7tat la s%rin9&
- Com7rimai loc!l in<%ci%i c! tam7on c! alcool, - - C min!t% 7%ntr! :%mosta?& com7l%t&
- O;s%r@ai loc!l in<%ci%i 7%ntr! sBn9%rar%
- A<!tai 7aci%nt!l s& oc!7% o 7o?ii% con8orta;il&
- E#7licai-i cond!ita !lt%rioar& dac& m%dicam%nt!l a 8ost administrat An sco7 %#7lorator
- !7ra@%9:%ai 7aci%nt!l 7%ntr! a s!r7rind% !n%l% com7licaii 6i an!nai m%dic!l dac& a7ar
- Col%ctai mat%rial%l% 8olosit% An contain%r% s7%cial%, con8orm PU
- Ac!l s% ar!nc& n%ca7i6onat
NOTAREA PROCE*URII
- Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%H
- n!m%, 7r%n!m%H
- data 6i ora administr&riiH
- ti7!l sol!i%i administrat%, do?a5
- "%dicam%nt!l %st% in<%ctat l%nt cBnd @%na %st% cor%ct 7!ncionat&
- Paci%nt!l 7r%?int& !n r&s7!ns t%ra7%!tic la m%dicam%nt!l administrat An ac%st sco7
- Paci%nt!l n! d%?@olt& r%acii d% s%nsi;ili?ar% la m%dicam%nt!l in<%ctat An sco7 %#7lorator
R%?!ltat% n%dorit% 0 C% 8ac%iN
- Fl%;al9i% 7rin in<%ctar%a 7r%a ra7id& a sol!i%i sa! 7rin introd!c%r%a !nor s!;stan% iritant% 7%ntr! intima @as!l!i
=%#5 ol!iil% :i7%rton%>
- In<%ctai l%nt sol!ia
- %n?aia d% !sc&ci!n% An 8arin9% 6i @al!l d% c&ld!r&
- In<%ctai sol!ia 8oart% l%nt
- Com!nicai c! 7aci%nt!l
- E%matom!l 7rin 7%r8orar%a @%n%i sa! r%tra9%r%a ac!l!i 8&r& And%7&rtar%a 9aro!l!i
- A7licai com7r%s% !m%d% r%ci
- Am%%li, li7otimi%, cola7s
- An!n& m%dic!l
- R%acii ana8ilactic% la sol!iil% in<%ctat% An sco7 %#7lorator
- An!n& m%dic!l
CAPITOLUL IX.
7+
RECOLTAREA PRODUSELOR BIOLOGICE I PATOLOGICE PENTRU EXAMENE DE
LABORATOR
>.1. RECOLTAREA S5NGELUI
FIA N". >.1.1.a PUNC2IA CAPILAR1
- Pr%l%@ar% d% sBn9% ca7ilar 7%ntr! anali?% d% la;orator =E'$, do?ar%a :%mo9lo;in%i, 9lic%mi%>, 7rin An%7&t!r&5
- Ta@& m%dical&0c&r!cior m%dical
- Ac% s%rin9& sa! lam%l& st%ril&
- Tam7oan% d% @at&
- ol!i% d%?in8%ctant&
- EBrti% d% 8iltr!
- "&n!6i d% 7rot%ci%
- 'am% d% sticl&
- T!;!riH 7i7%t%
- %r!ri
a> PIEICF:
;> FIGICF:
- Po?iionai 7aci%nt!l: 6%?Bnd c! mBna s7ri<init& sa! d%c!;it, An 8!nci% d% star%a 9%n%ral&
- Al%9%i loc!l!i d% %l%ci% :
- ad!lt:
- 7!l7a d%9%t!l!i in%lar sa! mi<loci!
- lo;!l !r%c:ii
- co7il:
- 8aa 7lantar& a :al!c%l!i
- c&lcBi
- 7&lai-@& 7% mBini
- Dm;r&cai m&n!6il% d% 7rot%ci%
- "asai !6or loc!l %8%ct!&rii 7!nci%i
- As%7ti?ai r%9i!n%a al%as& c! tam7on d% @at& Am;i;at An d%?in8%ctant
- A6t%7tai %@a7orar%a sol!i%i d%?in8%ctant%
- P% loc!l 7%r8%ct !scat An8i9%i ac!l la 2-- mm 7ro8!n?im% =ca sBn9%l% s& B6n%asc& sin9!r>, 7%r7%ndic!lar 7%
strat!ril% c!tanat%
- Jt%r9%i 7rima 7ic&t!r& c! :Brti% d% 8iltr! sa! !scat&
Pr%l%@ai sBn9%l% An 8!nci% d% sco7!l !rm&rit:
- P% lama 7%r8%ct !scat& 6i c!rat& =8roti!- :%mo9rama, 9r!7a san9!in&, tim7 d% sBn9%rar% 6i coa9!lar%>
- % as7ir& An t!;!ril% =7%ntr! anali?a 9a?%lor san9!in%>
- Pic&t!ra s% 7!n% 7% ;and%l%t& sa! stri7s!ri =9lic%mi%>
- 2-- 7ic&t!ri 7% 8i%car% %#tr%mitat% a lam%i =7icat!ra 9roas&- d95 malari% 6i ti8os %#ant%matic>
- Jt%r9%i c! !n tam7on st%ril
- Fac%i o !6oar& com7r%si!n%
- O;s%r@ai star%a 7aci%nt!l!i
- A7licai !n tam7on st%ril !6or com7r%si@
- Ac%l%, lant%t%l% 8olosit% s% col%ct%a?& An r%ci7i%nt% s7%cial% 7%ntr! o;i%ct% t&i%toar%, An%7&toar% =c! 7%r%ii d!ri>
- Tam7oanl% d% @at& sa! :Brtia d% 8iltr!, m&n!6il% s% col%ct%a?& An r%ci7i%nt% s7%cial% 7%ntr! mat%rial% c!
7ot%nial in8%cios
- *%?;r&cai m&n!6il%
,0
- 7&lai-@& 7% mBini
NOTAREA PROCE*URII
Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%:
- *ata, moti@!l %8%ct!&rii 7!nci%i
- %mn&t!ra
- Paci%nt cola;orant
- Paci%nt!l n! 7r%?int& sBn9%rar%
- Froti!l r%ali?at %st% !ni8orm, n! 7r%?int& 9ol!ri
R%?!ltat% n%dorit% = 7ro;l%m% 7ot%nial%> 0 C% 8ac%i N
- Bn9%rar% la loc!l 7!nci%i
- Com7rimai loc!l An%7&t!rii mai m!lt& @r%m%
- N! s% o;in% s!8ici%nt sBn9%
- trBn9%i d%9%t!l d% la distan&
- A7&sar%a 7% 7!l7a d%9%t!l!i 8a@ori?%a?& %liminar%a lim8%i 6i modi8ic& r%?!ltat%l%
- 'a n%@oi% r%7%tai An%7&t!ra
FIA N". >.1.1., PUNC2IA .ENOAS1
Cr%ar%a acc%s!l!i la o @%n& 7%ntr!:
O r%coltar% d% sBn9% An si9!ran& 7%ntr! %#am%n% d% la;orator
O %#tra9%r%a !n%i cantit&i d% sBn9%
O introd!c%r%a m%dicam%nt%lor An circ!laia @%noas&
- $aro!
- %rin9iH ac%H o can!l& (!t%r8lZ =8l!t!ra6>H sist%m @ac!tain%r =d!7& sco7>
- Tam7on
- Alcool
- "!6ama, al%?&
- Etic:%t&
- E7r!;%t%
- (and& ad%?i@& non al%r9ic&
- Form!lar% 7%ntr! la;orator
- Alt% mat%rial% An 8!nci% d% o;i%cti@!l !rm&rit, t&@ia r%nal&
- R%ci7i%nt 7%ntr! col%ctar%a mat%rial%lor
)%ri8icai indicaia m%dic!l!i 7ri@ind sco7!l 7!nci%i @%noas%
a> PIEICF:
- In8ormai 6i %#7licai 7aci%nt!l!i n%c%sitat%a 7roc%d!rii
- E#7licai 7aci%nt!l!i c!m 7oat% 7artici7a la 7roc%d!r&, an!ntai-l c& % 7!in d!r%roas&
- E#7licai-i 7aci%nt!l!i c& Ai @%i r%colta sBn9% sa! @%i introd!c% m%dicam%nt%
- Dnc!ra<ai 7aci%nt!l 7%ntr! a r%d!c% an#i%tat%a
- Dntr%;ai-l dac& i s-a mai r%coltat sBn9% alt& dat&H dac& a simit l%6in, trans7irai%, star% d% 9r%a&, @&rs&t!r&
- O;in%i consim&mBnt!l in8ormai
;> FIGICF:
- Asi9!rai 7o?iia cor%s7!n?&toar% An con8ormitat% c! star%a 7aci%nt!l!i, c! sco7!l 6i loc!l 7!nci%i =d%c!;it
dorsal sa! mai rar 6%?Bnd>
- E#aminai calitat%a 6i star%a @%n%lor 6i al%9%i loc!l
- 7&lai mBinil% 6i 7!n%i m&n!6il% 7%ntr! a 7r%@%ni contaminar%a
,4
- %l%ctai loc!l 7otri@it =@%n%l% distal% sa! 7ro#imal%>, @%n%l% d% la 7lica cot!l!i, mai rar c%l% d% 7% 8aa dorsal& a
mBinii
- P!n%i m!6ama!a s!; ;ra!l 7aci%nt!l!i
- A7licai 9aro!l la C - , cm d%as!7ra loc!l!i d% 7!nci%H ca7%t%l% 9aro!l!i 8iind dir%cionat% d%7art% d% ?ona d%
7!nci%
- Pal7ai @%na
- )%ri8icai 7r%?%na 7!ls!l!i distal, radial
- "ontai s%rin9a 6i ata6ai ac!l
- R%comandai 7aci%nt!l!i s& strBn9& 7!mn!l
- *ac& @%n%l% n! s!nt @i?i;il% 6i n! s% 7ot simi la 7al7ar% Anc%rcai !rm&toar%a t%:nic&:
a> R!9ai 7aci%nt!l s& Anc:id& 6i s& d%sc:id& 7!mn!l
;> *ai dr!m!l la 9aro! 6i r!9ai 7aci%nt!l s&-6i co;oar% mBna s!; ni@%l!l inimii 7%ntr! a i s% !m7l% @%n%l%, a7oi
r%a7licai 9aro!l 6i ;at%i Anc%t 7% @%n& 7%ntr! a d%@%ni mai @i?i;il&
c> Dnl&t!rai 9aro!l 6i 7!n%i o com7r%s& cald& 6i !m%d& 7% @%n& tim7 d% 40-4C\
- *%?in8%ctai t%9!m%nt!l =c! !n tam7on c! alcool>, .0R 8olosind mi6c&ri circ!lar% d% la c%ntr! An a8ar& c! cBi@a
cm, 7%ntr! a %@ita introd!c%r%a 7ot%nial%i 8lor% d% 7% 7i%l% An int%rior!l @as%lor 7% 7%rioada %8%ct!&rii 7roc%d!rii
- Po?iionai mBna n%dominant& la /-C cm s!; loc!l d% 7!nci% 6i c! 7olic%l% s% Antind% 7i%l%a dr%a7t& 7% @%n&
- 2in%i ac!l c! ;i?o!l An s!s An mBna dominant& 6i introd!c%i-l la !n !n9:i d% 40--0K, d% d%as!7ra @%n%i sa!
dintr-o 7art% a @%n%i, An 7o?ii% o;lic&
- Urm&rii c!rs!l @%n%i 6i cBnd sBn9%l% s% Antoarc% 7rin l!m%n!l ac!l!i a@ansai c! ac!l An @%n& 4-2 cm
- Dn ca?!l r%colt&rii contin!ai 7!ncia con8orm o;i%cti@!l!i
- As7irai sBn9%l% An s%rin9& =cantitat%a n%c%sar& 7%ntr! %8%ct!ar%a anali?%lor indicat% d% m%dic>
- *ac& c!r9%r%a sBn9%l!i %st% ra7id& d%?l%9ai 9aro!l 7%ntr! a 7r%@%ni sta?a 6i :%moconc%ntraia car% 7ot
modi8ica r%?!ltat%l% t%st%lor d% la;orator
- *ac& c!r9%r%a sBn9%l!i %st% l%nt&, n! d%?l%9ai 9aro!l d%cBt Anaint% d% a r%tra9% ac!l c! s%rin9a c! sBn9% =dac&
t%:nica n! im7!n% alt8%l>
- Plasai !n tam7on c! alcool 7% loc!l 7!nci%i @%noas% 6i !6or r%tra9%i ac!l c! s%rin9a
- A7licai o 7r%si!n% ;lBnd& 7% tam7on!l c! alcool, 7% loc!l 7!nci%i 2--\ sa! 7Bn& s% o7r%6t% sBn9%rar%aH ac%asta
7r%@in% %#tra@a?ar%a An %s!t!ril% din <!r, c! ca!?ar%a :%matom!l!i
- *!7& o7rir%a sBn9%r&rii a7licai o ;and& ad%?i@& 7%st% tam7on
- Trans8%rai sBn9%l% din s%rin9& An %7r!;%t%, d!7& c% ai d%ta6at ac!l d% la s%rin9&
- A7licai %tic:%t%l% 7% %7r!;%t%, indicBnd n!m%l% 6i 7r%n!m%l% ;olna@!l!i, 7ro;a r%coltat&, s%cia car% trimit%
7ro;a d% sBn9% la la;orator
- O;s%r@ai 8aci%s!l 7aci%nt!l!i, c!loar%a t%9!m%nt%lor 6i m&s!rai 7!ls!l
- Dntr%;ai 7aci%nt!l dac& ar% star% d% 9r%a& sa! @om&
- )%ri8icai loc!l 7!nci%i @%noas% 7%ntr! a 8i si9!ri c& n! s-a d%?@oltat !n :%matom
- 8&t!ii 7aci%nt!l s& n! 8l%ctr?% ant%;ra!l 7% ;ra
- Col%ctai d%6%!ril% con8orm P5U5 An r%ci7i%nt% s7%cial%
- Dnd%7&rtai mBn!6il%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai 7roc%d!ra An 8i6a d% 7roc%d!ri 6i An dosar!l07lan!l d% An9ri<ir%
- Notai data, ora, loc!l 7!nci%i @%noas%, tim7!l cBnd 7ro;a a 8ost trimis& la la;orator
- Notai oric% o;s%r@ai% l%9at d% star%a 6i r%acia 7aci%nt!l!i
- Notai dac& 7!ncia a 8ost 8ac!t& 7%ntr! r%coltar%a anali?%lor 6i s7%ci8icai c% 7ro;% ai r%coltat, cBnd a! 8ost
trimis% la la;orator
- Paci%nt!l ar% t%9!m%nt% 6i m!coas% normal colorat%
- %mn%l% @ital% s!nt normal%
- Paci%nt!l a An%l%s sco7!l 7!nci%i @%noas%
- Paci%nt!l n! a 7r%?%ntat l%6in, star% d% 9r%aa, @om&, :%matom
,2
R%?!ltat% n%dorit%0c% 8ac%i N
- '%6in!l, star%a d% 9r%a& sa! @oma
- an!nai m%dic!l
- An#i%tat%a
- disc!tai c! 7aci%nt!l 6i Anc!ra<ai-l
- R%8!?!l 7aci%nt!l!i 7ri@ind 7!ncia @%noas&
- an!nai m%dic!l
- E#tra@a?ar%a sBn9%l!i An %s!t!ril% din <!r
- E%matom!l
- com7rimai loc!l c! !n tam7on st%ril
- n! r%7%tai An%7&t!ra An ac%%a6i ?on&
- a7licai com7r%s& r%c%
- a7licai !n9!%nt% car% 8a@ori?%a?& r%sor;ia
- E%moli?a sBn9%l!i r%coltat
- r%7%tai r%coltar%a c! acord!l 7aci%nt!l!i:
- R%coltar%a n! s-a 8&c!t An condiii cor%s7!n?&toar%
- In8%cia
- %@itar%a 7rin %8%ct!ar%a 7roc%d!rii An si9!ran&
CONI*ERA2II PECIA'E
- Niciodat& n! %8%ct!ai 7!ncia @%noas& 7%ntr! r%coltar%a sBn9%l!i dintr-!n ;ra, o @%n& d%<a !tili?at& 7%ntr!
t%ra7ia i5@5 sa! o7rii 7%r8!?ia 6i a6t%7tai C min5
- N! r%coltai din loc!ri a8lat% d%as!7ra lini%i intra@%noas%, risc d% :%modil!i%
- N! %8%ct!ai 7!ncia @%noas& 7% !n loc d%<a in8%ctat
- E@itai @%na car% %st% d!r%roas& la 7al7ar%
- N! %8%ct!ai 7!ncia @%noas&, n! r%coltai sBn9% dintr-o ari% %d%matoas&, s:!nt art%rio@%nos, loc!ri al%
:%matom!l!i ant%rior, sa! r&niri
- *ac& 7aci%nt!l ar% t!l;!r&ri d% coa9!lar% sa! 7rim%6t% t%ra7i% anticoa9!lant&, s% m%nin% o 7r%si!n% 8%rm& 7%
loc!l 7!nci%i @%noas%, minim C\ d!7& r%tra9%r%a ac!l!i din @%n& 7%ntr! a 7r%@%ni 8ormar%a !n!i :%matom
- E@itar%a 8olosirii @%n%lor d% la 7icioar% 7%ntr! 7!ncia @%noas&, d%oar%c% ac%asta cr%6t% risc!l d% trom;o8l%;it&
- 'a ;&trBni, dac& %st% 7osi;il %@itai @%n%l% dorsal% al% mBinii la ;ra!l dominant 7%ntr! 7!ncia @%noas&
d%oar%c% ac%st% loc!ri int%r8%r& m!lt c! ind%7%nd%na @Brstnic!l!i
- 'a co7ii loc!ril% !?!al% 7%ntr! 7!ncia @%noas& s!nt scal7!l sa! 7icior!l
FIA N". >.1.6.RECOLTAREA S5NGELUI PENTRU %LG
- E8%ct!ar%a dia9ram%i sBn9%l!i 7rin car% s% d%t%rmin&: E;, Et, %l%m%nt%l% 8i9!rat%, 8orm!la l%!cocitar&
- %rin9& d% 2ml, ac st%ril sa! :old%r 6i ac d!;l! aco7%rit c! ca!ci!c
- Flacon c! E*TA =cristal%, anticoa9!lant> sa! @ac!tain%r c! E*TA =c! ca7ac mo@ >
- ol!i% d%?in8%ctant& =alcool>H tam7on d% @at&, 9aro!, t&@i& r%nal&
- "&n!6i d% ca!ci!c d% !nic& 8olosin&, m!6ama
a> PIEICF:
- Dnc!ra<ai 6i s!sin%i 7aci%nt!l
;> FIGICF:
- At%nionai 7aci%nt!l s& n! m&nBnc% c%l 7!in 42 or% 6i s& st%a An r%7a!s 8i?ic la 7at
- )%ri8icai dac& a r%s7%ctat r%comand&ril%
- Po?iionai 7aci%nt!l An d%c!;it dorsal c! mBna s7ri<init& ca 7%ntr! 7!nci% @%noas&
- Al%9%i @%na c%a mai 7ro%min%nt&
a> 7rin m%toda clasic&
,-
- *%?in8%ctai mBinil% c! alcool
- Dm;r&cai m&n!6i d% 7rot%ci%
- Pr%9&tii o s%rin9& d% 2ml 7%ntr! r%coltar%
- A7licai 9aro!l 7%ntr! 7!ncia @%noas&
- P!ncionai @%na
- *%s8ac%i 9aro!l
- As7irai An s%rin9a 4,C - 2ml sBn9%
- R%tra9%i ac!l d!7& a7licar%a tam7on!l!i c! alcool
- E#%rcitai o com7r%si!n% as!7ra tam7on!l!i 2-C\ 8&r& ca 7aci%nt!l s& Andoai% ;ra!l
- Trans8%rai sBn9%l% din s%rin9& An 8lacon!l c! E*TA
- A9itai 8lacon!l 7rin mi6car% circ!lar& l%nt& 7% o s!7ra8aa 7lan&
;> 7rin m%toda @ac!%tt%
- 7&lai mBinil%0d%?in8%ctai-l%0Am;r&cai m&n!6il% d% 7rot%ci%
- "ontai ac!l d!;l! la :old%r 7rin An6!r!;ar%
- Dnd%7&rtai ca!ci!c!l d% 7% ac - 7art%a s!7%rioar&
- A7licai 9aro!l
- P!ncionai @%na
- *%?l%9ai 9aro!l
- Fi#ai t!;!l @ac!%tt% d%stinat r%colt&rii E'$
- Um7l%i 7Bn& la s%mn r%ci7i%nt!l c! sBn9%
- E#%rcitai o 7r%si!n% as!7ra tam7on!l!i d% 2- C\
- A9itai l%nt @ac!tain%r!l
- A7licai !n 7last!r% 7%st% tam7on
- )%ri8icai loc!l 7!nci%i
- O;s%r@ai 8aci%s!l, t%9!m%nt%l%, com7ortam%nt!l 7aci%nt!l!i
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial% con8orm PU
- Dnd%7&rtai m&n!6il%0s7&lai mBinil% c! a7& 6i s&7!n
- A6%?ai ta@a An d!la7
NOTAREA PROCE*URII
Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%:
- *ata 6i ora r%colt&riiH
- Notai %@%nt!al%l% mani8%st&ri al% 7aci%nt!l!i
PRE$ATIREA PRO*UU'UI PENTRU 'A(ORATOR
- Etic:%tai r%ci7i%nt!l t!;!l!i @ac!%tt%
- Com7l%tai 8i6a d% la;orator
- Trans7ortai im%diat 7rod!s!l la la;orator
- P!ncia s% d%s8&6oar& 8&r& incid%nt%
- Bn9%l% n! s% coa9!l%a?& 6i n! s% :%moli?%a?&, n! a7ar% :%matom
R%?!ltat% n%dorit% = 7ro;l%m% 7ot%nial%> 0 C% 8ac%iN
- P%r8orar%a @%n%i 6i a7ariia :%matom!l!i
- Paci%nt!l 7r%?int& am%%li, 7aloar% acc%nt!at&, li7ot%mi%
- % 7rod!c% coa9!lar%a sBn9%l!i
- % 7rod!c% :%moli?ar%a sBn9%l!i
- )%ri8icai dac& s-a r%s7%ctat ra7ort!l dintr% sBn9% 6i anticoa9!lant, dac& s-a! r%s7%ctat condiiil% d% r%coltar%
- =)%?i 8isa Nr5 +544 5; P!nctia @%noasa>
FIA N".>.1.7. RECOLTAREA S5NGELUI PENTRU PROBELE DE COAGULARE
,/
- *%t%rminar%a coa9!la;ilit&ii sBn9%l!i 7rin di8%rit% ti7!ri d% in@%sti9aii5
- %rin9i =Cml> 6i ac% st%ril% ad%c@at% sa! :old%r 6i ac d!;l! aco7%rit c! ca!ci!c la am;%l% ca7%t%
- ol!i% anticoa9!lant& =citrat d% sodi!> st%ril& sa! t!;!ri @ac!%tt% c! sol!i% anticoa9!lant&
- tati@ c! %7r!;%t% =ca7ac al;astr!>
- ol!i% d%?in8%ctant& =alcool>
- Tam7oan% d% @at&, com7r%s% d% ti8on
- T&@i& r%nal&
- $aro!
- "!6ama
a> PIEICF:
;> FIGICF:
- At%nionai 7aci%nt!l s& n! m&nBnc% 6i s& st%a An r%7a!s 8i?ic
- A6%?ai 7aci%nt!l An d%c!;it dorsal c! m%m;r!l s!7%rior s7ri<init d% 7at ca 7%ntr! 7!ncia @%noas&
- Al%9%i @%na c%a mai t!r9%sc%nt&
R%coltar%a sBn9%l!i 7%ntr! d%t%rminar%a: Tim7!l!i ]!icX, T5 Eo^%ll, Fi;rino9%n!l!i
a> m%toda clasic&
- )%ri8icai dac& 7aci%nt!l a r%s7%ctat r%comand&ril% 7ri@ind 7roc%d!ra
- *%?in8%ctai mBinil% c! alcool
- P!n%i m&n!6i d% !nic& 8olosin&
- As7irai An s%rin9a d% C ml, 05C ml anticoa9!lant
- Aco7%rii ac!l s%rin9ii c! t%ac& 7rot%ctoar%
- A6%?ai s%rin9a 7% o com7r%s& st%ril&
- A7licai 9aro!l ca 7%ntr! 7!nci% @%noas&
- P!ncionai @%na =con8orm 8i6%i +5445 ;>
- *%?l%9ai 9aro!l
- As7irai An s%rin9& /5C ml sBn9%
- E#%rcitai o 7r%si!n% as!7ra tam7on!l!i 2--\ =8&r& ca 7aci%nt!l s& Andoai% ;ra!l>
- Trans8%rai am%st%c!l sBn9%0anticoa9!lant An %7r!;%t& d!7& r&st!rnar%a d% cBt%@a ori a s%rin9ii
- A6%?ai %7r!;%ta An stati@
;> m%toda @ac!%tt%
- 7&lai mBinil%0d%?in8%ctai0Am;r&cai m&n!6i d% !nic& 8olosin&
- Dnd%7&rtai ca!ci!c!l d% 7% 7art%a s!7%rioar& a ac!l!i
- '%9ai 9aro!l
- P!nciona @%na
- *%?l%9ai 9aro!l
- Fi#ai t!;!l @ac!%tt% d%stinat r%colt&rii tim7!l!i ]!icX, Eo^%ll sa! 8i;rino9%n!l!i
- Um7l%i 7Bn& la s%mn r%ci7i%nt!l c! sBn9%
- E#%rcitai 7r%si!n% as!7ra tam7on!l!i 2--\
- A9itai l%nt 7rin r&st!rnar%a t!;!rilor @ac!%tt% 7%ntr! omo9%ni?ar%
- A7licai !n 7last!r% 7%st% tam7on
,C
- 7&lai mBinil%
NOTAREA PROCE*URII
- Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%
- Notai r%acia 7aci%nt!l!i
PRE$FTIREA PRO*UU'UI PENTRU 'A(ORATOR
- Etic:%tai %7r!;%ta sa! @ac!tain%r!l 7%ntr! la;orator
R%?!ltat% a6t%7tat% 0 dorit%:
- Paci%nt!l n! a 7r%?%ntat star% d% l%6in
- 'a loc!l An%7&t!rii t%9!m%nt%l% a! as7%ct normal
- Bn9%l% %st% r%coltat cor%s7!n?&tor =n%coa9!lat, n%:%moli?at>
- E%matom 7rin 7%r8orar%a @%n%i
- Prod!s coa9!lat 7rin n%r%s7%ctar%a cantit&ii d% sBn9%0anticoa9!lant sa! 7rin n%omo9%ni?ar%
- Am%%li, 7aloar% acc%nt!at&, 7osi;il& li7otimi% =@%?i FIJA Nr5+54 l5;5 P!ncia @%noas&>
FIA N". >.1.4. RECOLTAREA S5NGELUI PENTRU .S%
- d%t%rminar%a ra7idit&ii c! car% s% 7rod!c% s%dim%ntar%a =a6%?ar%a 7ro9r%si@&> :%matiilor 7% 8!nd!l
- %7r!;%t%i din sBn9%l% n%coa9!la;il l&sat An r%7a!s5
PRE$FTIREA "ATERIA'E'OR:
- ta@& m%dical&0c&r!ciorH
- s%rin9& d% 2ml, ac st%ril sa! :old%r 6i ac d!;l! aco7%rit c! ca!ci!cH
- anticoa9!lant sol!i% d% citrat d% Na -,,P sa! t!; @ac!%tt% c! anticoa9!lant st%ril =ca7ac n%9r!>H
- stati@, %7r!;%t% c!rat%, !scat%H
- sol!i% d%?in8%ctant&, tam7oan% d% @at&H
- m&n!6i d% !nic& 8olosin&H
- 9aro!, t&@i& r%nal&, m!6amaH
- r%ci7i%nt% 7%ntr! col%ctar%a d%6%!rilor5
a> PIEICF:
- in8ormai 6i %#7licai 7aci%nt!l!i 7roc%d!raH
- o;in%i consim&mBnt!l in8ormatH
- Anc!ra<ai 6i s!sin%i 7aci%nt!l5
;> FIGICF:
- at%nionai 7aci%nt!l s& n! m&nBnc% 6i s& st%a An r%7a!s 8i?icH
- @%ri8icai dac& a r%s7%ctat r%comand&ril%H
- 7o?iionai 7aci%nt!l An d%c!;it dorsal c! m%m;r!l s!7%rior s7ri<init 7% 7at ca 7%ntr! 7!ncia @%noasaH
- asi9!rai intimitat%a 7aci%nt!l!iH
- al%9%i @%na c%a mai !6or a;orda;il&5
a> 7rin m%toda clasic&:
- s7&lai mBinil% c! a7& 6i s&7!nH
- d%?in8%ctai mBinil% c! alcoolH
- Am;r&cai m&n!6i d% 7rot%ci%H
- as7irai An s%rin9& 0,/ml citrat d% Na -5,PH
- aco7%rii ac!l s%rin9ii c! ca7ac!lH
- a6%?ai s%rin9a 7% o com7r%s& st%ril&H
- a7licai 9aro!l ca 7%ntr! 7!ncia @%noas&H
,.
- 7!ncionai @%naH
- d%?l%9ai 9aro!lH
- as7irai An s%rin9& 4,.ml sBn9%H
- r%tra9%i ac!l d!7& a7licar%a tam7on!l!i c! alcoolH
- %#%rcitai o com7r%si!n% as!7ra tam7on!l!i 2--\H
- tans8%rai am%st%c!l sBn9%0citrat An %7r!;%t& 6i a9itai !6orH
- a6%?ai %7r!;%ta An stati@5
;> 7rin m%toda @ac!%tt%:
- s7&lai mBinil%0d%?in8%ctai-l%07!n%i m&n!6i d% !nic& 8olosin&H
- montai ac!l d!;l! la :old%r 7rin An6!r!;ar%H
- And%7&rtai ca!ci!c!l d% 7% ac - 7art%a s!7%rioar&H
- a7licai 9aro!lH
- 7!ncionai @%naH
- d%?l%9ai 9aro!lH
- 8i#ati t!;!l @ac!%tt% d%stinat r%coltarii )EH
- !m7l%ti 7ana la s%mn r%ci7i%nt!l c! san9%H
- r%tra9%ti ac!l d!7a a7licar%a tam7on!l!i c! alcoolH
- %#%rcitai o 7r%si!n% as!7ra tam7on!l!i d% 2- -\H
- a9itati l%nt t!;!l @ac!%tt%5
- as%?ati 7aci%nt!l in 7o?iti% comoda, a7licati o ;anda ad%?i@a non al%r9ica d%as!7ra tam7on!l!iH
- o;s%r@ai 8aci%s!l, t%9!m%nt%l%, com7ortam%nt!l 7aci%nt!l!iH
- o;s%r@ai loc!l 7!nci%i5
- col%ctai d%6%!ril% An r%ci7i%nt% s7%cial% con8orm PUH
- And%7&rtai mBn!6il%H
- s7&lai mBinil%5
NOTAREA PROCE*URII:
- notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%H
- notai r%acia 7aci%nt!l!i An tim7!l 7roc%d!rii5
- %tic:%tai %7r!;%ta sa! @ac!tain%r!l 7%ntr! la;oratorH
- com7l%tai 8i6a d% la;oratorH
- trans7ortai im%diat 7rod!s!l la la;orator5
- 7!ncia @%noas& s% d%s8&6oar& 8&r& incid%nt%H
- 7aci%nt!l %#7rim& star% d% con8ortH
- sBn9%l% n! s% coa9!l%a?& 6i n! s% :%moli?%a?&H
- n! a7ar% :%matom!l local5
R%?!ltat% n%dorit%
- 7aci%nt!l 7r%?int& am%%li, 7aloar% acc%nt!at&, li7otimi%H
- s% 7rod!c% coa9!lar%a sBn9%l!iH
- s% 7rod!c% :%moli?a sBn9%l!i- 9r%6%ala d% col%ctar%:
- c%r%i acord!l m%dic!l!i 6i 7aci%nt!l!i 7%ntr! r%7%tar%a r%colt&riiH
- 7%r8orar%a @%n%i 6i a7ariia :%matom!l!i:
- a7licai o com7r%s& r%c% 6i a7oi !n !n9!%nt car% 8a@ori?%a?& r%sor;ia5
=)%?i FIJA Nr5 +5445;5 P!ncia @%noas&>
FIA N". >.1.8.RECOLTAREA S5NGELUI PENTRU EXAMENE BIOC%IMICE
- *%t%rminar%a com7on%nt%lor ;ioc:imic% al% sBn9%l!i An @%d%r%a a7lic&rii m&s!rilor com7%t%nt% An tim7 !til An
ca?!l modi8ic&rilor 7atolo9ic%
- Ta@& m%dical& 0 c&r!cior
,7
- %rin9i 6i ac% st%ril% ad%c@at% sa! :old%r c! ac d!;l! =s7%cial> aco7%rit c! ca!ci!c
- T!;!ri @ac!%tt% !n%l% c! 9%l car% a<!t& la s%7arar%a mai ra7id& a s%r!l!i
- tati@, %7r!;%t% c!rat%, !scat%
- Tam7oan% d% @at&
- $aro!, m!6ama
- T&@i& r%nal&
- R%ci7i%nt% s7%cial% 7%ntr! col%ctar%a d%6%!rilor
a> PIEICF:
;> FIGICF:
- At%nionai 7aci%nt!l s& n! m&nBnc% 6i s& st%a An r%7a!s 8i?ic c%l 7!in 42 or%
- Po?iionai 7aci%nt!l An 8!nci% d% star%a sa =6%?Bnd sa! d%c!;it dorsal> c! mBna s7ri<init& ca 7%ntr! 7!nci%
@%noas&
a> 7rin m%toda clasic&
- *%?in8%ctai mBinil%
- Fi#ai ac!l la s%rin9&
- A7licai 9aro!l
- P!ncionai @%na
- R%coltai C - 7 ml d% sBn9%
- *%?l%9ai 9aro!l
- E#%rcitai o 7r%si!n% mod%rat& as!7ra tam7on!l!i 2 --\ 8&r& ca 7aci%nt!l s& Andoai% cot!l =r!9ai 7aci%nt!l
%@%nt!al s& 8i#%?% tam7on!l>
- R%7arti?ai sBn9%l% An %7r!;%t& con8orm 7rotocol!l!i d% r%coltar%
- 7&lai mBinil% 0 d%?in8%ctai 0 Am;r&cai m&n!6i d% !nic& 8olosin&
- "ontai ac!l s7%cial la :old%r 7rin An6!r!;ar%
- Dnd%7&rtai ca!ci!c!l d% 7% 7art%a s!7%rioar& a ac!l!i
- A7licai 9aro!l
- P!ncionai @%na
- Fi#ai t!;!l @ac!%tt% d%stinat r%colt&rilor 7%ntr! %#am%n% ;ioc:imic% =9lic%mi%, cr%atinin&, !r%%, acid !ric,
calc%mi%, %tc>
- Um7l%i 7Bn& la s%mn r%ci7i%nt!l c! sBn9% =C - 7 ml>
- R%tra9%i ac!l d!7& a7licar%a tam7on!l!i c! alcool 6i %#%rcitai 7r%si!n% as!7ra ac%st!ia 2--\
- A7licai o ;and& ad%?i@& non al%r9ic& d%as!7ra tam7on!l!i
- 7&lai mBinil%
NOTAREA PROCE*URII
,,
- Trans7ortai im%diat 7rod!s!l la la;orator An condiii d% si9!ran&
- Pr%l%@ar%a s% 8ac% 8&r& incid%nt%, 7aci%nt!l %st% cola;orant
- Paci%nt!l 7r%?int& star% d% con8ort
- E%matom 7rin in8iltrar%a %s!t!l!i 7ara@%nos
- Am%%li, 7aloar% acc%nt!at&, 7osi;il& li7otimi%
- Bn9% :%moli?at
=)%?i FIJA Nr5+5445; -P!ncia @%noas&>
FIA N". >.1.;. RECOLTAREA S5NGELUI PENTRU EXAMENE SEROLOGICE
- C%rc%tar%a 7r%?%n%i sa! a;s%n%i anticor7ilor An s%r!l 7aci%nt!l!i 7%ntr! dia9nosticar%a ;olilor in8%cioas%
- Ta@a m%dical&0c&r!cior
- %rin9& d% C - 40 ml 6i ac% st%ril% sa! :old%r c! ac d!;l! aco7%rit la am;%l% ca7%t% c! ca!ci!c
- tati@ c! %7r!;%t% c!rat%, !scat% sa! 8lacoan%
- T!;!ri @ac!%tt% sim7l% sa! c! 9%l =ca7ac ro6!>
- Tam7oan% d% @at&
- $aro!, m!6ama
- T&@i& r%nal&
a> PIEICF:
;> FIGICF:
- At%nionai 7aci%nt!l s& n! m&nBnc% 6i s& st%a An r%7a!s la 7at
- Po?iionai 7aci%nt!l An 8!nci% d% star%a sa =6%?Bnd sa! d%c!;it dorsal> c! mBna s7ri<init& ca 7%ntr! 7!nci%
@%noas&
a> 7rin m%loda clasic&
- *%?in8%ctai mBinil%
- Fi#ai ac!l la s%rin9&
- A7licai 9aro!l
- P!ncionai @%na
- R%coltai C - 40 ml d% sBn9%
- *%?l%9ai 9aro!l
- E#%rcitai o 7r%si!n% as!7ra tam7on!l!i 2 --\ 8&r& ca 7aci%nt!l s& Andoai% cot!l =r!9ai %@%nt!al 7aci%nt!l s&
com7rim% loc!l>
- Tr%c%i sBn9%l% An %7r!;%t&
- 7&lai mBinil% 0 d%?in8%ctai 0 Am;r&cai m&n!6i d% 7rot%ci%
,+
- Dnd%7&rtai ca!ci!c!l d% 7% 7art%a s!7%rioara a ac!l!i
- A7licai 9aro!l
- P!ncionai @%na
- Fi#ai t!;!l @ac!%tt% An car% s% 9&s%6t% 9%l d%stinat r%colt&rii 7%ntr! %#am%n% s%rolo9ic% =)*R', A'O, _%ill
F%li#, _al%r Ros%, _idall, E'IA >
- Um7l%i 7Bn& la s%mn r%ci7i%nt!l c! sBn9% cca 40ml
- R%tra9%i ac!l d!7& a7licar%a tam7on!l!i c! alcool 6i com7rimai loc!l 2--\
- 7&lai mBinil%
NOTAREA PROCE*URII
- R%?!ltat% a6t%7tat%0dorit%:
- R%?!ltat% n%dorit%
=)%?i FIJA Nr5 +54545; - P!ncia @%noas&>
FIAN". >.1.<. RECOLTAREA S5NGELUI PENTRU EXAMENE BACTERIOLOGICE )
%EMOCULTUR1
- P!n%r%a An %@id%n& a 9%rm%nilor 7ato9%ni An sBn9% 7rin Ans&mBnar% 7% m%dii d% c!lt!r&
- E8%ct!ar%a anti;io9ram%i
- ol!i% d%?in8%ctant& =;%tadin%, clor:%#idin%, alcool 70K>
- Tam7oan% d% @at& 6i com7r%s% st%ril%
- CBm7 st%ril
- "&n!6i st%ril%
- "asc&
- $aro!
- 2 8lacoan% c! m%dii d% c!lt!r& =!n!l 7%ntr! 9%rm%ni a%ro;i 6i alt!l 7%ntr! 9%rm%ni ana%ro;i>
- Eold%r, ac d!;l! =s7%cial> aco7%rit la am;%l% ca7%t% c! ca!ci!c
a> PIEICF:
- In8ormai 6i %#7licai 7aci%nt!l!i 7roc%d!ra, a@%rti?ai-l c& r%coltar%a s% 7oat% r%7%ta
;> FIGICF:
- Po?iionai 7aci%nt!l An d%c!;it dorsal c! m%m;r!l s!7%rior s7ri<init d%oar%c% 7oat% 7r%?%nta 8risoan%
- 7&lai r%9i!n%a 7licii cot!l!i c! a7& 6i s&7!n
- *%?in8%ctai c! alcool iodat, ;%tadin&
- Partici7& do!& n!rs%
+0
- *%?in8%ctai mBinil%0Am;r&cai m&n!6il% st%ril%
- I?olai loc!l c! cBm7!l st%ril
- "ontai ac!l d!;l! la :old%r
- R!9ai 7%rsoana car% @& a<!t& s& a7lic% 9aro!l
- *%?in8%ctai loc!l d% 7!ncionat c! alcool d% 70K
- P!ncionai @%na
- Ada7tai la ac!l :old%r!l!i 8lacon!l c! m%di! d% c!lt!r& 7%ntr! 9%rm%ni a%ro;i
- R%coltai sBn9% 7Bn& la s%mn!l d% 7% 8lacon
- Ada7tai la ac!l :old%r!l!i c%l d% al doil%a 8lacon c! m%di! d% c!lt!r& 7%ntr! 9%rm%nii anacro;i
- R%coltai sBn9% 7Bn& la s%mn!l d% 7% 8lacon
- R%ra9%i ac!l d!7& a7licar%a tam7on!l!i c! alcool iodat
- Com7rimar%a @%n%i 2 - C\ d% c&tr% a<!tor
- Omo9%ni?ai !6or 7% !n 7lan ori?ontal =sBn9%l% c! m%di!l d% c!lt!r& din 8lacon>
- R%instalai 7aci%nt!l An 7o?ii% comod&
- Aco7%rii 7aci%nt!l 7%ntr! c& 8rison%a?&
- O;s%r@ai 8aci%s!l, t%9!m%nt%l% =%#tr%mitailor>, com7ortam%nt!l 7aci%nt!l!i
- Dnd%7&rtai m&n!6il% 6i masca
- 7&lai mBinil%
- cri%i 7% %tic:%t%l% 8lacoan%lor dat%l% 7aci%nt!l!i
- Trans7ortai im%diat la la;orator 8lacoan%l% 6i introd!c%i-l% An t%rmostat la -7K
NOTAREA PROCE*URII
- Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir% 7rin li7ir%a cod!rilor d% ;on d% 7% 8lacoan%l% An car% s-a 8&c!t
r%coltar%a
- R%coltar%a s-a 8&c!t cor%ct, An condiii d% strict& as%7si% 6i antis%7si%
R%?!ltat% n%dorit%0c% 8ac%iN
)%?i FIJA Nr5 +54545; - P!ncia @%noas&
At%ni%:
R%coltar%a s% 8ac% la d%;!t!l ;olii Anaint% d% administrar%a anti;iotic%lor5
FIA N". >.6. RECOLTAREA URINEI
FIA N". >.6.1. RECOLTAREA URINEI PENTRU EXAMEN SUMAR DE URIN1
- *%t%rminar%a d%nsit&ii, 7:-!l!i, 9l!co?%i, al;!min%i, !ro;ilino9%n!l!i
- E#aminar%a s%dim%nt!l!i !rinar
- R%ci7i%nt c!rat 6i !scat sa! st%ril 7%ntr! 8%m%i%
- %rin9& 6i ac% st%ril%, tam7oan% c! alcool
- P%ns& 7%ntr! clam7ar%a sond%i - cBnd mostra d% !rin&= 40ml> %st% r%coltat& 7% sond& ` d%m%!r%
- "&n!6i d% ca!ci!c 7%ntr! mani7!lar%a !rin%i
a> PIEICF:
- In8ormai 7aci%nt!l con6ti%nt
- E#7licai-i 7roc%d!ra An t%rm%ni acc%si;ili
- O;in%i cola;orar%a
;> FIGICF:
- E8%ct!ai toal%ta 9%nito-!rinar& la 8%m%i%
+4
- Fi#ai 7!n9a col%ctoar% la ni@%l!l or9an%lor 9%nital%, c! ad%?i@, An ca?!l s!9arilor 6i co7iilor mici
E#7licai 7aci%nt!l!i car%-6i r%colt%a?& sin9!r !rina:
- &-6i s7%l% mBinil%, s& 8olos%asc& m&n!6i d% ca!ci!c
- & s% a6%?% Antr-o 7o?ii% An car% <%t!l !rinar s& 8i% diri<at An r%ci7i%nt: ortostatism la ;&r;at 6i 7o?ii% 6%?Bnd& la
8%m%i%
- & col%ct%?% 40 ml !rin& dir%ct An r%ci7i%nt
- & a6%?% ca7ac!l 7% 9!ra r%ci7i%nt!l!i d!7& r%coltar%
- &-6i s7%l% mBinil%
- & %tic:%t%?% r%ci7i%nt!l
Dn ca? d% r%coltar% 7% sonda ` d%m%!r%:
- Clam7ai sonda c! 4C\ Anaint% d% r%coltar%
- *%?in8%ctai sonda
- P!ncionai sonda c! ac!l ada7tat la s%rin9&
- As7irai 40 ml d% !rin& An s%rin9&
- Trans8%rai !rina An r%ci7i%nt
- 7&lai-@& mBinil%
- Etic:%tai r%ci7i%nt!l c!: n!m%l% 6i 7r%n!m%l% 7aci%nt!l!i, s%cia, %#am%n!l c%r!t, data 6i ora r%colt&rii
- Trans7ortai !rina la la;orator im%diat
- Col%ctai mat%rial%l% 8olosit% An contain%r% s7%cial% con8orm PU =7r%ca!ii !ni@%rsal%>
NOTAREA PROCE*URII
Notai:
- *ata 6i ora r%colt&rii
R%?!ltat% a6t%7tat%0dorit%
- "ostra d% !rin& n! %st% contaminat& c! sc!r9%r% @a9insal& sa! c! sBn9% m%nstr!al
- Urina n! conin% al;!min& sa! 9l!co?&, ar% o c!loar% 9al;%n& a!ri% =normocrom&>
- %dim%nt!l !rinar n! conin% c%l!l% d%sc!amat% d% 7% tract!l !rinar
- "ostra d% !rin& %st% contaminat& c! sc!r9%r% @a9inal& sa! c! sBn9% m%nstr!al
- Ar!ncai !rina
- R%coltai An a8ara 7%rioad%i d% m%nstr!ai%
- Fac%i toal%ta local& Anaint%
- Urina %st% :i7%rcrom&, c! !ro;ilino9%n cr%sc!t
- An!nai m%dic!l
- %dim%nt!l !rinar conin% n!m%roas% l%!cocit%, :%matii, c%l!l% d%sc!amat% sa! %7it%lii
- An!nai m%dic!l car% 7oat% s& r%comand% alt% %#am%n%, mai r%l%@ant% din !rin&
- Urina conin% al;!min& sa! 9l!co?a
- An!nai m%dic!l
FiA N". >.6.6. RECOLTAREA ASEPTIC1 A URINEI )UROCULTURA
- t!di!l ;act%riolo9ic al !rin%i 7%ntr! id%nti8icar%a 9%rm%nilor 6i %8%ct!ar%a anti;io9ram%i
a> 7%ntr! 7r%l%@ar%a 8&r& sonda< 7r%9&tii:
- A7& 6i s&7!n 7%ntr! toal%ta 9%nito-!rinar&
- Antis%7tic 7%ntr! d%?in8%cia m%at!l!i !r%tral
- Com7r%s% st%ril%
- R%ci7i%nt 7%ntr! col%ctar%a st%ril& a !rin%i
- (a?in%t dac& %st% n%c%sar
- Contain%r 7%ntr! d%6%!ri
+2
;> 7%ntr! 7r%l%@ar%a 7% sonda !rinar& ` d%m%!r% 7r%9&tii:
- Com7r%s% st%ril%
- Antis%7ticH sol!i% d% clor:%#idin&
- %rin9& 6i ac% st%ril%, t!; d% la;orator TERI'
- Contain%r 7%ntr! ar!ncar%a mat%rial%lor 8olosit%
c> 7%ntr! 7r%l%@ar%a 7rin sonda< int%rmit%nt 7r%9&tii:
- ond& @%?ical& 7%ntr! ;&r;at sa! 8%m%i%
- Com7r%s% st%ril%
- R%ci7i%nt st%ril 7%ntr! r%coltar%a !rin%i
a> PIEICF:
- E#7licai 7aci%nt!l!i n%c%sitat%a 7r%l%@&rii
- Asi9!rai 7aci%nt!l d% ino8%nsi@itat%a 7roc%d!rii
- Instr!ii 7aci%nt!l con6ti%nt 6i @alid c!m s& r%colt%?% sin9!r
;> FIGICF:
- E8%ct!ai toal%ta 9%nito-!rinar& la 7aci%nt!l n%d%7lasa;il
- Asi9!rai condiii 7%ntr! %8%ct!ar%a toal%t%i la 7aci%nt!l @alid
- Asi9!rai intimitat%a 7aci%nt!l!i5
- Pr%l%@ai 7rin !na din m%tod%l% %n!m%rat% mai <os An 8!nci% d% star%a 7aci%nt!l!i sa! r%comandar%a m%dical&
a>7r%l%@ar%a 8&r& sonda<:
- 7&lai-@& mBinil% c! a7& 6i s&7!n =la@a< sim7l!>
- R%coltai !rina d% la ;&r;at sa! 8%m%i% d!7& toal%ta 9%nito-!rinar& c! a7& 6i s&7!n 6i cl&ti % a;!nd%nt&H !scai
r%9i!n%a, d%?in8%ctai m%at!l !r%tral c! com7r%s% st%ril% Am;i;at% An antis%7tic
- Col%ctai !rina, An r%ci7i%nt!l st%ril, din mi<loc!l <%t!l!i
- Aco7%rii t!;!l st%ril
;> 7r%l%@ar%a d% c&tr% 7aci%nt!l con6ti%nt 6i ca7a;il
s& !rin%?% An mod @ol!ntar
- E#7licai 7aci%nt!l!i mod!l d% d%r!lar% a 7roc%d!rii5
- O8%rii-i com7r%s% st%ril% c! antis%7tic 7%ntr! d%?in8%cia m%at!l!i !rinar d!7& s7&lar%
- *ai-i 7aci%nt!l!i 8lacon!l st%ril
- E#7licai-i s& !rin%?% la toal%t&, l&sBnd s& c!r9& 7rim!l <%t 6i r%coltBnd !rina An 8lacon din mi<loc!l <%t!l!i
- C%r%i-i 7aci%nt!l!i s&-6i s7%l% mBinil% d!7& 7r%l%@ar%a !rin%i
c> 7r%l%@ar%a 7% sonda !rinar& ` d%m%!r%
- 7&lai-@& mBinil% c! a7& 6i s&7!n =la@a< sim7l!>
- Folosii m&n!6i d% !nic& 8olosin&
- *%?in8%ctai loc!l d% 7r%l%@ar%, c! com7r%s% st%ril% Am;i;at% An antis%7tic
- P!ncionai t!;!lat!ra 7!n9ii d% col%ctar% c! ac!l st%ril ada7tat la s%rin9& 6i 7r%l%@ai cantitat%a n%c%sar& d%
!rin&
- Trans8%rai !rina din s%rin9& An 8lacon!l 7%ntr! la;orator
- Ar!ncai ac!l 6i s%rin9a An contain%r!l s7%cial
*ac& di!r%?a %st% sc&?!t&:
- Clam7ai sonda s!; loc!l d% 7r%l%@ar% 8&r& s-o l%?ai
- A6t%7tai 40-4C\ ca s& s% ad!n% o cantitat% s!8ici%nt& d% !rin& 7%ntr! %#am%n
d> 7r%l%@ar%a 7rin sonda< int%rimit%nt:
- Introd!c%i sonda @%?ical& r%s7%ctBnd t%:nica sonda<!l!i @%?ical la ;&r;at sa! 8%m%i%
- "%nin%i sonda 7% d!rata %@ac!&rii !rin%i
- '&sai !rina s& c!r9& An ;a?in%t 6i r%coltai a7oi An r%ci7i%nt!l 7%ntr! la;orator
- E@ac!ai tot conin!t!l @%?icii !rinar%
- Dnd%7&rtai sonda 6i d%?in8%ctai m%at!l !rinar
- Ar!ncai mat%rial%l% 8olosit% An contain%r
+-
- 7&lai-@& mBinil%
- A<!tai 7aci%nt!l s& s% Am;rac%
- Paci%nt!l d%7lasa;il n! ar% n%@oi% d% An9ri<iri s7%cial%
- !7ra@%9:%ai 7aci%nt!l 7!rt&tor d% sond&, asi9!rai-@& c& %st% 7%rm%a;il& 6i racordat& la 7!n9a col%ctoar%
- Col%ctai mat%rial%l% 8olosit% An r%ci7i%nt% s7%cial% con8orm 7r%ca!i!nilor !ni@%rsal% =P5U5>
NOTAREA PROCE*URII
- Notai 7roc%d!ra An 8i6a d% 7roc%d!ri 6i An dosar!l07lan!l d% An9ri<ir%
- Notai data, ora, n!m%l% 7%rsoan%i car% a r%colt!t, as7%ct!l !rin%i
R%s7%ctai !rm&toar%l% r%9!li 9%n%ral%:
- Trans7ortai im%diat %6antion!l la la;orator 7%ntr! a %@ita m!lti7licar%a 9%rm%nilor sa! 7&strai-l la 8ri9id%r la
a/KC An ca?!l An car% %#am%n!l s% 8ac% mai tBr?i! =n! mai m!lt d% 42 or%>
- Etic:%tai mostra im%diat d!7& r%coltar% c! n!m%, 7r%n!m%, CNP, data 6i ora r%colt&rii
- Dnsoii monstra d% o 8i6& d% in8ormaii c! dat% clinic% =tK, star%a d% s&n&tat% a 7aci%nt!l!i, moti@!l>
- A;s%na contamin&rii An tim7!l %misi%i 6i r%colt&rii ca !rmar% a toal%t%i 9%nito-!rinar% 6i d%?in8%ci%i m%at!l!i
!rinar
- Contaminar%a !rin%i 7r%l%@at% c! ;act%rii 7r%?%nt% An r%9i!n%a 7%ri!r%tral& An tim7!l %misi%i =;act%ri!ri% sla;& b
400009%rm%ni0ml>
- R%7%tai 7roc%d!ra r%s7%ctBnd norm%l% d% i9i%na local&
- "!lti7licar%a 9%rm%nilor 7rin 7&strar% mai m!lt d% or& An a8ara 8ri9id%r!l!i
- P&strar%a 7r%a m!lt la r%c% d!c% la 7r%ci7itar%a !railor c%%a c% Am7i%dic& anali?a !lt%rioar& a !rin%i
- R%s7%ctai norm%l% 9%n%ral% d% 7r%9&tir% a 7rod!s!l!i 7%ntr! la;orator
- Emisia di8icil& a !rin%i 7rin ;loca< 7si:olo9ic
- O8%rii tim7 sa! r%coltai 7rin sonda< @%?ical =An ca? d% !r9%na>
FIA N".>.7. RECOLTAREA MATERIILOR FECALE PENTRU EXAMENE DE LABORATOR
- E#aminar%a macrosco7ic&, ;ioc:imic&, ;act%riolo9ic& 6i 7ara?itolo9ic&
- ta;ilir%a dia9nostic!l!i ;olilor in8%cioas% 9astroint%stinal%
- *%7istar%a 7%rsoan%lor 7!rt&toar% d% 9%rm%ni 7ato9%ni
Pr%9&tii 7% o ta@& m%dical& 0 c&r!cior :
- Co7roc!ltor st%ril sa! c!rat 6i !scat
- Tam7oan% st%rili?at% montat% 7% 7orttam7oan% 7r%@&?!t% c! do7!ri d% ca!ci!c 6i introd!s% An %7r!l;%t% st%ril%
- onda N%laton nr5 4.-4, st%ril&
- %rin9& d% !nic& 8olosin& d% 40 ml
- (a?in%t =7losca>
- Proso7 d% :Brti%0:Brti% i9i%nic&
- P!n9& d% :Brti%, 8orm!lar d% r%coltar%
a> PIEICF:
- In8ormai 7aci%nt!l sa! 0 6i 8amilia d%s7r% 7roc%d!ra 7%ntr! a o;in% cola;orar%a 6i 7%ntr! a 7r%@%ni o %liminar%
n%cor%s7!n?&toar%
;> FIGICF:
- Administrai 7aci%nt!l!i !n 7!r9ati@ salin =s!l8at d% ma9n%?i! sa! ma9n%?ia !sta> dac& n!ar% sca!n s7ontan
- Instr!ii 7aci%nt!l s&-6i 8ac& toal%ta 7%rianal& An ca?!l r%colt&rii co7roc!lt!rii
- R%comandai o di%t& ;o9at& An 8i;r% @%9%tal% sa! !n r%9im Ral;R An 8!nci% d% %#am%n!l c%r!t5
+/
45 R%coltar%a din sca!n %liminat s7ontan sa! 7ro@ocat 7%ntr! %#am%n co7ro-7ara?ilolo9ic
- Dntr!cBt d%8%car%a n! s% 7oat% 7rod!c% la c%r%r%, instr!ii 7aci%nt!l:
- &-6i s7%l% mBinil%
- & 8olos%asc& m&n!6i d% !nic& 8olosin&
- & d%8%c% An ;a?in%t sa! Antr-!n r%ci7i%nt c!rat =oli&, s7r% %#%m7l!, la domicili! >
- & r%colt%?%, c! lin9!ria co7roc!ltor!l!i cBt%@a 8ra9m%nt% d% 8%cal% =cca C0 9> din di8%rit% ?on%, mai s!s7%ct%,
al% sca!n!l!i
- & introd!c& lin9!ria An co7roc!ltor
- &-6i s7%l% mBinil% d!7& And%7&rtar%a m&n!6ilor
- & %tic:%t%?% r%ci7i%nt!l c! : n!m%, 7r%n!m%, data 6i ora r%coltarii, %#am%n!l c%r!t
- & trans7ort% 7rod!s!l im%diat la la;orator sa! s&-l introd!c& Antr-o 7!n9& d% :Brti% 6i s&-l 7&str%?% An 8ri9id%r n!
mai m!lt d% 42 or%
25 R%coltar%a dir%ct& din r%ct =7%ntr! %#am%n ;act%riolo9ic>
- *%sco7%rii r%9i!n%a in8%rioar& a cor7!l!i
- 7&lai-@& mBinil% 6i 7!n%i-@& m&n!6il% d% !nic& 8olosin&
- A6%?ai 7aci%nt!l An d%c!;it lat%ral c! m%m;r!l in8%rior d% d%as!7ra An 8l%#i!n% ma#im& a coa7s%i 7% a;dom%n
- Dnd%7&rtai 8%s%l% 7aci%nt!l!i
- Introd!c%i tam7on!l st%ril 7rin an!s An r%ct 6i %8%ct!ai cBt%@a mi6c&ri d% rotai%
- Dnd%7&rtai, a7oi, tam7on!l 6i introd!c%i-l An %7r!;%ta st%ril& 8&r& s& atin9%i mar9in%a ac%st!ia
- Dnd%7&rtai m&n!6il% 6i s7&lai-@& mBinil%
- Etic:%tai r%ci7i%nt!l
- Trimit%i-l im%diat la la;orator 7%ntr! Ans&mBnar%
-5 R%coltar%a mat%riilor 8%cal% la co7il!l mic5
- A6%?ai co7il!l, c! ;lBnd%%, An d%c!;it lat%ral sa! dorsal
- )i?!ali?ai ori8ici!l anal
- Introd!c%i sonda N%laton 7% o distana d% c 40 cm, r%s7%ctBnd r%9!lil% d% as%7si%
- As7irai conin!t!l colonic c! o s%rin9& ada7tat& la ca7&t!l sond%i
- Dnd%7&rtai s%rin9a 6i sonda din r%ct
- Trans8%rai conin!t!l s%rin9ii =2-- ml> Antr-!n r%ci7i%nt st%ril 7%ntr! co7r!c!lt!r& sa! c!rat 6i !scat 7%ntr! alt%
%#am%n%
- E8%ct!ai toal%ta r%9i!nii 7%rianal%, la n%@oi%
- 7&lai-@& mBinil%
- Etic:%tai r%ci7i%nt!l
- Trimit%i im%diat 7rod!s!l la la;orator
/5 R%coltar%a mat%riilor 8%cal% 7%ntr! 7ro;a A*'ER =:%mora9ii oc!lt%>5 I!str!ii 7aci%nt!l:
- & in& !n r%9im Ral;R tim7 d% - ?il%, 8&r& carn% ro6i%, l%9!m% 6i 8r!ct% @%r?i, m%dicam%nt% 6i s!7lim%nt%
n!triti@% c! conin!t d% 8i%r, 8&r& colc:icin&, salicilai, 7otasi!, 8%nil;!ta?on&, indom%tacin, st%roi?i sa! com7!6i
d% ;ism!t 7%ntr! a %@ita o 7osi;il& sBn9%rar% ca!?at& d% ac%st% m%dicam%nt%
- & d%8%c% Antr-!n ;a?in%t c!rat
- &-6i s7%l% mBinil% 6i s&-6i 7!n& m&n!6i d% !nic& 8olosin&
- & r%colt%?% c! lin9!ria co7roc!ltor!l!i sa! c! o ;a9:%t& d% l%mn mat%rii 8%cal% d% la s!7ra8aa =2C--0 9> 6i s&
l% introd!c& An co7roc!ltor sa! An alt r%ci7i%nt c!rat 6i !scat
- & aco7%r% r%ci7i%nt!l c! ca7ac!l %tan6
- &-6i s7%l% mBinil% d!7& And%7&rtar%a m&n!6ilor 7%ntr! a 7r%@%ni croscontaminar%a
- & %tic:%t%?% r%ci7i%nt!l 6i s&-l trans7ort% im%diat la la;orator
- N! n%c%sit& An9ri<iri s7%cial% l%9at% d% 7roc%d!r&
- Col%ctai mat%rial%l% 8olosit% An contain%r% s7%cial% con8orm 7r%ca!iilor !ni@%rsal% =P5U5>
- 7&lai-@& mBinil% d!7& And%7&rtar%a m&n!6ilor 7%ntr! a 7r%@%ni croscontaminar%a
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 7lan!l d% An9ri<ir% 6i An 8i6a d% 7roc%d!ri
- *ata, 8%l!l %#am%n!l!i
+C
- N!m%l% 7%rsoan%i car% a r%coltat
- Paci%nt!l %st% com7liant 6i r%s7%ct& Antocmai instr!ci!nil% o8%rit%
- "at%riil% 8%cal% n! s!nt am%st%cat% c! !rina
- Prod!s!l r%coltat %st% ad!s im%diat la la;orator %@itBd!-s% s!7rain8%ctar%a sa! distr!9%r%a o!&l%lor d% 7ara?ii
7rin r%8ri9%rar%
- "at%riil% 8%cal% s!nt am%st%cat% c! !rina
- Instr!ii d% la Anc%7!t 7aci%nt!l s& d%8%c% An 7losc& !sct& 6i c!rat&
- Paci%nt!l n! r%s7%ct& r%9im!l al;, c%%a c% d!c% la o;in%r%a !nor r%acii 8als 7o?iti@%
- E#7licai-i dinaint% cons%cin%l% n%r%s7%ct&rii di%t%i
- "at%riil% 8%cal% s!nt 7&strat% 7r%a m!lt la t%m7%rat!ra: cam%r%i =7%st% o or&> sa! la 8ri9id%r =7%st% 42or%> c%%a
c% modi8ic& ac!rat%%a %st!l!i
- R%s7%ctai condiiil% d% 7&strar% al% 7rod!s!l!i
- Paci%nt!l r%8!?& r%coltar%a:
- *isc!tai Anc& o dat& c! %l
- An!nai m%dic!l
FIA N". >.4. RECOLTAREA EXUDATULUI FARINGIAN
- Id%nti8icar%a a9%nilor 7ato9%ni la 7!rt&tori s&n&to6i 6i ;olna@i
- E8%ct!ar%a anti;io9ram%i
- Ta@& m%dical&0c&r!ciorH
- 7at!l& lin9!al& st%ril&H
- E7r!;%t& c! tam7on 8arin9ian st%rilH
- "&n!6i d% !nic& 8olosin&H
- "asc& d% 7rot%ci%H
- 4-2 t&@i% r%nal%
a> PIEICF:
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i0a7arin&tor!l!i =dac& %st% co7il>
;> FIGICF:
- At%nionai 7aci%nt!l sa! a7arin&tor!l s& n! Anc%a7& nici !n 8%l d% tratam%ntH s& n! m&nBnc%, s& n! ;%a a7&, s&
n! 8ac& 9ar9ar&, s& n! s% s7%l% 7% dini, s& n!-6i instil%?% 7ic&t!ri An nas An dimin%aa r%colt&rii
- A6%?ai 7aci%nt!l 7% sca!n sa! An 7at An 7o?ii% 6%?Bnd&
- A@%rti?ai a7arin&tor!l c& @a tr%;!i s&-6i s!sin& co7il!l An ;ra% 7%ntr! r%coltar%
- )%ri8icai dac& 7aci%nt!l a r%s7%ctat r%comand&ril% 7ri@ind 7roc%d!ra
- Folosii masca d% 7rot%ci%
- In@itai 7aci%nt!l s& d%sc:id& lar9 9!ra
- *%sc:id%i %7r!;%taH scoat%i tam7on!l 8arin9ian
- A7&sai lim;a c! s7at!la lin9!al& st%ril&
- Jt%r9%i d%7o?it!l 8arin9ian 6i ami9dalian =dac& %st% ca?!l d%?li7ii 6i o 7ori!n% din 8alsa m%m;ran&>
- R%tra9c%i tam7on!l 8arin9ian 8ar& a atin9%: dinii, lim;a, o;ra<ii
- Dnc:id%i r%7%d% %7r!;%ta c! do7!l
- R%ali?ai !n 8roti! 8olosind alt tam7on con8orm r%comand&rii m%dic!l!i>
- N! n%c%sita An9ri<iri s7%cial% l%9at% d% 7roc%d!r&5
+.
*ac& ar% s%n?ai% d% 9r%& 6i @om& n! m&nBnc& 6i n! ;%a im%diat d!7& r%coltar%
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial%, con8orm P5U5
- 7&lai 6i c!r&ai instr!m%nt%l% 8olosit%
- Dnd%7&rtai m&n!6il%0masca
NOTAREA PROCE*URII
- Notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%H
- *ata 6i ora r%colt&riiH
- Notai r%acia 7aci%nt!l!i, as7%ct!l local
- Etic:%tai r%ci7i%nt!l An car% s-a 8&c!t r%coltar%a
- Com!nicai la;orator!l!i dac& 7aci%nt!l a l!at m%dicam%nt% 6i car% s!nt ac%l%a
- R%coltar%a s-a 8&c!t 8&r& incid%nt%
- Prod!s!l n! a 8ost s!7rain8%ctat
- % 7ot o;in% r%?!ltat% %ronat% at!nci cBnd An tim7!l r%colt&rii tam7on!l 8arin9ian s% Am;i;& c! sali@& sa! s%
atin9 dinii, lim;a
- R%7%tai r%coltar%a 8olosind alt tam7on
- Paci%nt!l 7oat% 7r%?%nta s%n?ai% d% 9r%a&, @oma 7rin atin9%r%a l!%t%i
- R!9ai 7aci%nt!l s& ins7ir% adBnc 6i a7oi s& st%a n%mi6cat An tim7!l r%colt&rii
FIA N". >.8. RECOLTAREA SPUTEI PRIN EXPECTORA2IE PENTRU EXAMENE DE LABORATOR
- %#aminar%a macrosco7ic&, citolo9ic& 6i ;act%riolo9ic& a s7!t%iH
- dia9nosticar%a !nor ;oli al% a7arat!l!i r%s7irator5
Pr%9&tii 7% o ta@& m%dical& :
- r%ci7i%nt st%ril c! ca7ac 7otri@it, %tan6H
- %tic:%t& 0 8orm!lar c%r!t d% la;oratorH
- a%rosol =clor!r& d% sodi! 40P, ac%tilcist%in&, a7& distilat& sa! st%ril&> 7%ntr! a ind!c% t!s%a, dac& m%dic!l indic&
H
- ;atist% d% :Brti%H
- m&n!6i d% !nic& 8olosin& dac& %st% n%c%sarH
- 7!n9i din mat%rial 7lasticH
- r%ci7i%nt s7%cial 7%ntr! mat%rial%l% 8olosit%5
a> PIEICF:
- %#7licai 7aci%nt!l!i 7roc%d!ra 7%ntr! a r%d!c% an#i%tat%a 6i a o;in% cola;orar%a5
- o;in%i consim&mBnt!l in8ormat5
;> FIGICF:
- instr!ii 7aci%nt!l s& n! m&nBnc% , s& n! 8!m%?%, s& n!-6i 7!n& 7ic&t!ri An nas, s& n! s% s7%l% 7% dini sa! s&-6i
cl&t%asc& 9!ra c! sol!ii d%?in8%ctant% Anaint% d% r%coltar% 7%ntr! a n! in8l!%na r%?!ltat!lH
- a7%lai la dr%na<!l 7ost!ral 6i la ta7ot&ri dac& %#7%ctoraia %st% di8icil&5
- instr!ii 7aci%nt!l s& s% a6%?% 7% !n sca!n, 7% mar9in%a 7at!l!i sa! An 7o?ii% 8o^l%r Analt& dac& star%a 9%n%ral&
n! %st% 8a@ora;il&5
- c%r%i 7aci%nt!l!i s&-6i cl&t%asc& 9!ra c! a7& sim7l& 7%ntr! a r%d!c% risc!l d% contaminar% a s7!t%i c! ;act%riil%
din ca@itat%a ;!cal& sa! c! 7artic!l% d% alim%nt%H
+7
- instr!ii 7aci%nt!l s& ins7ir% 6i s& %#7ir% 7ro8!nd d% cBt%@a ori 7ro@ocBnd!-6i t!s%a =c%l 7!in - ori>H la !ltima
%#7irai% s8&t!ii-l s& t!6%asc&H
- s8&t!ii 7aci%nt!l s& t!6%asc& 7ro8!nd 6i s& %#7%ctor%?% dir%ct An r%ci7i%nt, cca5 4C ml d% s7!t&H
- 7!n%i-@& m&n!6i d% !nic& 8olosina, o7ional - aco7%rii r%ci7i%nt!l c! ca7ac!lH
- 6t%r9%i %#t%rior!l r%ci7i%nt!l!i c! !n 6%r@%%lH
- introd!c%i r%ci7i%nt!l Antr-o 7!n9& d% mat%rial 7lastic5
- o8%rii 7aci%nt!l!i !n 7a:ar c! a7& c!rat& s&-6i cl&t%asc& 9!raH
- a<!tai 7aci%nt!l s& ado7t% o 7o?ii% comod&H
- o;s%r@ai r%s7iraiaH
- %d!cai 7aci%nt!l s& col%ct%?% An contin!ar% s7!ta 7%ntr! a 7r%@%ni dis%minar%a in8%ci%i5
- col%ctai mat%rial%l% 8olosit% An r%ci7i%nt% s7%cial% con8orm PUH
- And%7&rtai m&n!6il%H
- s7&lai mBinil%H
NOTAREA PROCE*URII
- notai 7roc%d!ra An dosar!l07lan!l d% An9ri<ir%H
- notai data, ora, cantitat%a, c!loar%a, miros!l, consist%na5
- %tic:%tai r%ci7i%nt!l c!: n!m%l% 6i 7r%n!m%l% 7aci%nt!l!i, data 6i ora r%colt&rii, %#am%n!l c%r!tH
- com7l%tai 8orm!lar!l c%r!t d% la;orator dac& 7aci%nt!l ar% 8%;r&, dac& a l!at anti;iotic% sa! dac& %#7%ctoraia a
8ost ind!s& 7rin administrar% d% a%rosol =d%oar%c%, An ac%st ca?, s7!ta %st% mai a7oas& 6i s% 7oat% con8!nda c!
sali@a >5
- 7aci%nt!l %st% com7liant 6i r%!6%6t% s&-6i r%colt%?% s7!ta 6i n! sali@aH
- r%s7%ctar%a indicaiilor d% r%coltar% s% r%8l%ct& An ac!rat%%a r%?!ltat!l!i t%st!l!i5
- 7aci%nt!l n! r%!6%6t% s& %#7%ctor%?% 6i An9:it% s7!ta =mai al%s 8%m%il% 6i co7iii>:
- r%?%r@ai-@& mai m!lt tim7 7%ntr! a instr!i 7aci%nt!lH
- an!nai m%dic!l car% @& r%comand& alt& t%:nic& d% r%coltar% =7rin 8roti!, s7&lat!r& 9astric&, s7&lat!r&
;ron6ic&>5
- s7!ta %st% am%st%cat& c! sali@a 6i r%st!ri alim%ntar% din ca@itat%a ;!cal&:
- r%7%tai r%coltar%a instr!ind Anc& o dat& 7aci%nt!l 6i a<!t&nd!-l s& r%s7%ct% indicaiil% d% r%coltar%H
- s7!ta %st% am%st%cat& c! @&rs&t!ra d%clan6at& An tim7!l %8ort!l!i d% t!s%:
- ca7tai @&rs&t!ra 6i acordai An9ri<iri ad%c@at%5
FIA N". >.;. RECOLTAREA SECRE2IILOR URETRALE LA B1RBAT
- O;in%r%a in8ormaiilor r%8%ritoar% la a9%nii 7ato9%ni car% 7rod!c in8%cii !r%tral%5
- Ans& d% 7latin&,
- 'am7& d% s7irt
- 'am% d% sticl&
- "&n!6i st%ril%
- Etic:%t% sa! cr%ion d%rmato9ra8
a> PIEICF:
- In8ormai 7aci%nt!l c! 7ri@ir% la n%c%sitat%a %8%ct!&rii %#am%n!l!i, mom%nt!l r%colt&rii
- E#7licai 7roc%d!ra, an!nai 7aci%nt!l s& n! !rin%?% Anaint% d% r%coltar%
- Asi9!rai 7aci%nt!l c& @%i 7&stra con8id%nialitat%a
;> FIGICF:
+,
- O;in%i cola;orar%a
- Pr%9&tii mat%rial%l% 7% o ta@& sa! m&s!&
- At%nionai 7aci%nt!l as!7ra mod!l!i d% cola;orar%
- 7&lai mBinil%
- Dm;r&cai m&n!6i d% ca!ci!c
- t%rili?ai ansa d% 7latin& 7rin Anc&l?ir% la ro6! 6i a6t%7tai r&cir%a
- C! o mBn& 7rind%i 9land!l 6i %#%rcitai o !6oar& 7r%si!n%
- C! c%alalt& mBn& 7r%l%@ai c! ansa 8lam;at& 7rima 7ic&t!r& matinal& =dac& s%cr%ia %st% ins!8ici%nt& r%coltai din
!r%tra ant%rioar&>
- P!n%i 7ic&t!ra 7% lam& 6i r%ali?ai 8roti!l
- Etic:%tai sa! scri%i n!m%l% c! cr%ion d%rmato9ra8
- Trimit%i lama la la;orator
- E#am%n!l s% %8%ct!%a?& am;!lator 6i ;olna@!l n! ar% n%@oi% d% An9ri<ir% s7%cial&
- O;s%r@ai as7%ct!l local, s8&t!ii 7aci%nt!l s& r%s7%ct% tratam%nt!l r%comandat
- Flam;ai ansa d% 7latin& Anc%7Bnd d% la ti<& c&tr% 8ir
- P!n%i mat%rial%l% An d!la7
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 7lan!l d% An9ri<iri n!rsin9
- *ata, ora 6i o;s%r@aiil% 7ri@ind as7%ct!l local
- Notai c% a An@&at 7aci%nt!l, c!m 6i-a Ans!6it in8ormaiil%
R%?!ltat% a6t%7tat% :
- R%coltar%a s-a 8&c!t cor%ct
- Froti!l a 7%rmis sta;ilir%a dia9nostic!l!i
- Froti!l n! %st% %di8icator, r%?!ltat!l %st% n%9ati@ dar n! %#cl!d% 7r%?%na 9onococilor
- % im7!n% r%ali?ar%a !n%i c!lt!ri
- Paci%nt!l n! r%s7%ct& r%comand&ril% 6i r%coltar%a n! s% 7oat% 8ac% An condiii ad%c@at%
- Instr!ii %#act 7aci%nt!l 6i r%7%tai 7roc%d!ra
Nota:
Dn ca?!l An car% 8roti!l n! %st% %di8icator s% 8ac% c!lt!r&
R%coltar%a s% 8ac% c! ansa st%ril& din !r%tra ant%rioar& 6i s% Ans&mBn%a?& 7% m%di!l d% c!lt!r&
5
RECOLTAREA SECRE2IILOR PURULENTE DIN LE&IUNI DESC%ISE
OBIECTI.ELE PROCEDURII
- Col%ctar%a d% s%cr%ii 7!r!l%nt% dintr-o l%?i!n% d%sc:isa 7%ntr! id%nti8icar%a 7rin %#am%n% d% la;orator a
microor9anism%lor c% 7ro@oac& in8%cia An @%d%r%a 7r%ci?&rii dia9nostic!l!i5
PREG1TIREA MATERIALELOR
- P%ns%
- Com7r%s%
- ol!ii d%?in8%ctant%
- "&n!6i st%ril%
- R%ci7i%nt% st%ril% 7%ntr! col%ctat 7rod!s!l =%7r!;%t% st%ril%>
- Tam7oan% st%ril%
- Ansa d% 7latin&
- Pi7%ta Past%!r
- 'am% d% la;orator, lam7a d% s7irt
- '%!co7last
++
- Ta@& m%dical&0c&r!cior m%dical
PREG1TIREA PACIENTULUI
a: PSI%IC1@
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i0cli%nt!l!i
,: FI&IC1@
) Po?iionai 7aci%nt!l0cli%nt!l An 8!nci% d% loc!l l%?i!nii =7la9& c:ir!r9ical& c! s!7!rai% 7ari%tal&, 7l&9i s%7tic%,
a;c%s, 8l%9mon d%sc:is, @%?ic!l%, 7!st!l%>
- Asi9!rai intimitat%a 7aci%nt!l!i0cli%nt!l!i
EFECTUAREA PROCEDURII@
) Id%nti8icai 7aci%nt!l
- 7&lai mBinil%
- Dm;r&cai m&n!6i st%ril%
- C!r&ai s!7ra8aa l%?i!nii
- R%coltai din s%cr%i%:
O 7rin as7irai% c! 7i7%ta Past%!r st%ril&
O c! ans& d% 7latin& st%rili?at& An 7r%ala;il 7rin Anc&l?ir% la ro6!
O c! tam7on st%ril
- R%ali?ai 2-- 8roti!ri a@Bnd 9ri<& s& Antind%i !ni8orm s%cr%ia
- Introd!c%i 7rod!s!l as7irat sa! tam7on!l c! car% ai r%coltat Antr-o %7r!;%t& st%ril&
- Etic:%tai 6i trimit%i la la;orator An tim7 !til
(NGRI'IREA PACIENTULUI
- Pansai l%?i!n%a 8olosind o t%:nic& ad%c@at& dac& %st% n%@oi%
- !7ra@%9:%ai as7%ct!l 7ansam%nt!l!i
- "onitori?ai 8!nciil% @ital%
REORGANI&AREA LOCULUI DE MUNC1
- Col%ctai com7r%s%l%, m&n!6il% An r%ci7i%nt% s7%cial% 7%ntr! mat%rial% c! 7ot%nial in8%cios r%s7%ctBnd P5U5
NOTAREA PROCEDURII
Notai 7roc%d!ra An 7lan!l d% An9ri<ir% :
- *ata, ora r%colt&rii 6i n!m%l% 7%rsoan%i car% a r%coltat
- As7%ct!l s%cr%i%i
- As7%ct!l l%?i!nii 6i al t%9!m%nt%lor din <!r
E.ALUAREA EFICACIT12II PROCEDURII
- Paci%nt!l n! ac!?& d!r%r%
- R%coltar%a s-a 8&c!t An condiii d% as%7si%, n! %#ist& risc d% s!7rain8%ctar%
R%?!ltat% n%dorit%0C% 8ac%m N
- Ac!?& d!r%r% 6i 7rod!c% sBn9%rar%
- '!crai c! ;lBnd%%
- !7rain8%ctar% c! ali 9%rm%ni
- R%s7%ctai c! strict%% as%7sia 6i antis%7sia
- R%?!ltat!l n! %st% cor%ct 7%ntr! c& 7rod!s!l n! s-a trimis An tim7 !til la la;orator
400
A PROCEDURI DE NURSING B .OL 6
CUPRIN
CAPITO'U' I
45 T%ra7ia intra@%noas&
4545 P%r8!?ia
4525 Administrar%a m%dicam%nt%lor Antr-o sol!i% 7%r8!?a;il&
45-5 Administrar%a m%dicam%nt%lor An ;ol!s Antr-o lini% @%noas& %#ist%nt& =7%r8!?i%>
45/5 Administrar%a m%dicam%nt%lor Antr-o lini% @%noas& %#ist%nt& =can!l&0;ran!l&>
45C5 c:im;ar%a sol!iilor 7%r8!?a;il%
45.5 c:im;ar%a 7%r8!?or!l!i
4575 Com7licaiil% t%ra7i%i intra@%noas%
45,5 N!triia 7ar%nt%ral& total& =NPT> 7rin m%toda 7%r8!?i%i i5@
CAPITO'U' II
25 Trans8!?ia
2545 Trans8!?ia
225 !7ra@%9:%r%a 7aci%nt!l!i c! r%acii ad@%rs% la trans8!?i%
CAPITO'U' III
-5 A7licar%a a9%nilor 8i?ici
4545 A7licaii cald%
4525 A7licaii r%ci
CAPITO'U' I)
/5 Pr%9&tir%a 7r%o7%ratori% 6i An9ri<ir%a 7osto7%ratori%
/545 Pr%9&tir%a 7r%o7%ratori%
/54545 Pr%9&tir%a 7r%o7%ratori% 9%n%ral& din ?i!a car% 7r%c%d% o7%raia
/54525 Pr%9&tir%a 7r%o7%ratori% din ?i!a o7%rai%i
/545-5 Pr%9&tir%a 7r%o7%ratori% s7%cial&5
/545/5 Pr%9&tir%a 7r%o7%ratori% d% !r9%n&
/525 Dn9ri<ir%a intrao7%ratori%
/5-5 !7ra@%9:%r%a 6i An9ri<ir%a 7osto7%ratori%
/5-545 !7ra@%9:%r%a 7osto7%ratori% 7r%coc%
/5/5 Com7licaiil% 7osto7%ratorii
/5/54 Com7licaii 7osto7%ratorii im%diat%
/5/525 Com7licaii 7osto7%ratorii 7r%coc% 6i tardi@%
/5C5 E8%ct!ar%a 7ansam%nt!l!i !n%i 7l&9i dr%nat%
CAPITO'U' )
C5 Partic!larit&i d% administrar% a !nor m%dicam%nt%
C545 Administrar%a anticoa9!lanl%lor
C525 Administrar%a anti;iotic%lor
C5-5 Administrar%a corti?on!l!i
C5/5 Administrar%a ins!lin%i
CAPITO'U' )I
.5 In@%sti9aii Ima9istic%5
.545 E#am%n% radiolo9ic%5 As7%ct% 9%n%ral%
.525 Rol!l n!rs%i An %8%ct!ar%a %#am%n%lor radiolo9ic%
.5-5 E#am%n% c! i?oto7i radioacti@i =radion!cli?i>5 As7%ct% 9%n%ral%
.5/5 Rol!l n!rs%i An %8%ct!ar%a %#amin&rii c! i?oto7i radioacti@i
.5C5 E#am%n% c! !ltras!n%t% =%c:o9ra8ic%>5As7%ct% 9%n%ral%
.5.5 Rol!l n!rs%i An %8%ct!ar%a %#am%n%lor c! !ltras!n%t% =%c:o9ra8ic%>
CAPITO'U' )II
75 E#am%n% %ndosco7ic%
7545 E#am%n% %ndosco7ic% 5As7%ct% 9%n%ral%
752 Rol!l n!rs%i An %8%ct!ar%a %#am%n%lor %ndosco7ic%5
404
CAPITO'U' )III
,545 P!ncii
,525 Partici7ar%a n!rs%i la %8%ct!ar%a 7!nci%i 7%riton%al%
,5-5 Partici7ar%a n!rs%i la %8%ct!ar%a 7!nci%i 7l%!ral% - toracoc%nt%?a
,5/5 Partici7ar%a n!rs%i la %8%ct!ar%a 7!nci%i ra:idi%n%
,525 Partici7ar%a n!rs%i la %8%ct!ar%a 7!nci%i ;io7sic%
CAPITOLUL I ) TERAPIA INTRA.ENOAS1

FIA N". 1.1.PERFU&IA
- Introd!c%r%a i5@5 a !n%i sol!ii 7%r8!?a;il% 7r%scris% 7%ntr! :idratar%, alim%ntar%, m%nin%r%a l%9&t!rii c!
circ!laia @%noas&5
- Ta@& m%dical&0c&r!cior 7%ntr! tratam%nt%
- %rin9i 6i ac% st%ril% ad%c@at%
- "&n!6i st%ril%
- ol!i% 7%r8!?a;il& =7!n9a sa! 8lacon> An t%rm%n d% @ala;ilitat%, c! as7%ct n%modi8icat
- Tr!sa d% 7%r8!?at =7%r8!?or c! 8iltr! sa! 8&r& 8iltr!> An t%rm%n d% @ala;ilitat%, int%9r&
- (ran!l&0can!l& sa! 8l!t!ra6
- ol!i% d%?in8%ctant&, com7r%s% st%ril%
- $aro!, l%!co7last sa! ;and& ad%?i@& non al%r9ic&
- Etic:%t&
- "!6ama, al%?& =o ;!cat& d% 7Bn?&>
- tati@ t%l%sco7ic
- R%ci7i%nt% d% col%ctar% a d%6%!rilor
a> PIEICF:
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i 7as c! 7as =sco7!l ac%st%ia, s%n?aiil% car% 7ot s& a7ar&, risc!ril%
7%r8!?i%i i5@5>
- Instr!ii 7aci%nt!l 7ri@ind:
O s%mn%l% 6i sim7tom%l% in8iltrai%i, in8lamai%i 6i 8l%;it%i
O in8ormar%a n!rs%i dac& s% modi8ic& d%;it!l, dac& sol!ia n! s% mai sc!r9%, dac& An t!;!l 7%r8!?or!l!i a a7ar!t
sBn9%, dac& ar% s%n?ai% d% 8ri9
O 7osi;ilitat%a d% mi6car%0d%7lasar% a@Bnd 7%r8!?i% montat&
O acordai at%ni% 7%rsoan%lor @Brstnic% 6i asi9!rai-@& c& a! a!?it 6i An%l%s c% li s-a s7!s
;> FIGICF:
- Po?iia 7aci%nt!l!i - d%c!;it dorsal
- Al%9%i loc!l 7%ntr! 7!ncia i5@5:
O la ad!li s!nt 7r%8%rat% @%n%l% d% la 7lic& cot!l!i =c%8alica, ;a?ilic& 6i m%dian c!;ital&>H
O %@itai @%na d!r%roas& la 7al7ar%H s%l%ctai @%n%l% ;in% dilatat%H
O la ;&trBni, dac& %st% 7osi;il %@itai:
- @%n%l% dorsal% al% mBinii ;ra!l dominant 7%ntr! 7!nci% @%noas& d%oar%c% ac%st% loc!ri int%r8%r& m!lt
c! ind%7%nd%na @Brstnic!l!i
O %#aminai calitat%a 6i star%a @%n%lor5
- )%ri8icai 7r%scri7ia m%dical& 7ri@ind cantitat%a 6i ti7!l sol!i%i
- 7&lai mBinil%0Am;r&cai m&n!6i st%ril%
- Ad!c%i mat%rial%l% lBn9& 7at!l 7aci%nt!l!i
- Pr%9&tii sol!ia 7%r8!?a;il& 6i tr!sa d% 7%r8!?at
- "%nin%i as%7sia cBnd s% d%sc:id% tr!sa d% 7%r8!?at st%ril& 6i sol!ia 7%r8!?a;il&
- !s7%ndai 7!n9a sa! 8lacon!l c! sol!ia 7%r8!?a;il& An stati@
402
- *%sc:id%i tr!sa d% 7%r8!?at
- Fi#ai cl%ma07r%st!;!l la o distan& d% 2- C cm mai <os d% 7ic!r&tor
- Dnc:id%i cl%ma07r%st!;!l 7%r8!?or!l!i, And%7&rtai ca7ac!l ac!l!i 6i introd!c%i-l An loc!l d% intrar%, An 7!n9i
sa! 8lacon
- Pr%sai !6or 7ic!r&tor!l =cam%ra d% sc!r9%r% a 7%r8!?or!l!i> 6i l&sai s& s% !m7l% 7Bn& la <!m&tat%
- Dnl&t!rai ca7ac!l 7rot%ctor d% la ca7&t!l t!;!l!i 6i d%sc:id%i cl%ma07r%st!;!l
- '&sai lic:id!l s& c!r9& 7Bn& c% s% %limin& ;!l%l% d% a%r, inBnd t!;!l 7%r8!?or!l!i c!r;at c! am;o!l An s!s
7%ntr! a n! s% 7i%rd% m!lt lic:id
- Dnc:id%i cl%ma07r%st!;!l 6i 7!n%i ca7ac!l 7rot%ctor
- %l%ctai loc!l 7otri@it =@%n%l% distal% sa! 7ro#imal%>
- P!n%i m!6ama!a 6i al%?a s!; ;ra!l 7aci%nt!l!i
- A7licai 9aro!l la 40-42 cm d%as!7ra loc!l!i d% ins%ri%H ca7%t%l% 9aro!l!i tr%;!i% dir%cionat% s7r% 7art%a
7ro#imal& - )%ri8icai 7r%?%na 7!ls!l!i distal, radial
- E8%ct!ai 7!ncia @%noas&:
- *ac& @%n%l% n! s!nt @i?i;il% 6i n! s% 7ot simi la 7al7ar%, Anc%rcai 7roc%d%%l%:
a> r!9ai 7aci%nt!l s& Anc:id& 6i s& d%sc:id& 7!mn!l
;> dai dr!m!l la 9aro! 6i r!9ai 7aci%nt!l s&-6i co;oar% mBna s!; ni@%l!l inimii 7%ntr! a i s% !m7l% @%n%l%, a7oi
r%a7licai 9aro!l
c> Anl&t!rai 9aro!l 6i 7!n%i o com7r%s& cald& 6i !m%d& 7% @%n& tim7 d% 40-4C\
- *%?in8%ctai t%9!m%nt!l =tam7on c! alcool tim7 d% .0 s%c!nd%> 8olosind mi6c&ri circ!lar% d% la c%ntr! An a8ar&
c! cBi@a cm5
- Po?iionai mBna n%dominant& la /-C cm s!; loc!l d% 7!nci% 6i c! 7olic%l% s% Antind% 7i%l%a d%as!7ra @%n%i
- Dnd%7&rtai ca7ac!l 7rot%ctor d% 7% am;o!l t!;!l!i d% 7%r8!?or 6i ada7tai 7%r8!?or!l la ac sa!
- Ata6ai ac!l 7%r8!?or!l!i la t!;!l 7%r8!?or!l!i 6i 7!ncionai @%na inBnd ac!l c! ;i?o!l An s!s, An mBna dr%a7t&
6i introd!c%ti-l la !n !n9:i d% 40--0K, d%as!7ra @%n%i sa! dintr-o 7art% a @%n%i =7o?iia o;lic&>
- Urm&rii c!rs!l @%n%i 6i cBnd sBn9%l% s% Antoarc% 7rin l!m%n!l ac!l!i a@ansai ac!l An @%n&, 4-2 cm
- *%?l%9ai 9aro!l 6i c%r%i 7aci%nt!l!i s& d%s8ac& 7!mn!l
- *ac& s% instal%a?& 7%r8!?ia c! ;ran!l&0can!l& sa!, 8l!t!ra6, at!nci 8i#ai c! d%9%t!l ar&t&tor d% la mBna stBn9&
%#%rcitBnd 7r%si!n% la -cm d%as!7ra loc!l!i 7!nci%i
- E#tra9%i mandr%n!l d% 7% l!m%n!l ;ran!l%i 6i ata6ai ca7&t!l ;ran!l%i la t!;!l 7%r8!?or!l!i
- *%sc:id%i cl%ma07r%st!;!l 6i dai dr!m!l sol!i%i s& c!r9&H %#aminai %s!t!l din <!r!l ?on%i d% intrar% 7%ntr!
s%mn% d% in8iltraii
- Fi#ai rata d% c!r9%r% a sol!i%i d% .0 7ic&t!ri0min!t5
- A7licai 7ansam%nt st%ril 7%st% loc!l 7!nci%i
- Fi#ai ac!l, ;ran!la0can!la, 8l!t!ra6!l c! ;%n?i d% l%!co7last, sa! ;and& non al%r9ic&
- A7licai %tic:%ta 7% 7!n9a sa! 8lacon!l d% sol!i%, indicBnd data, ora, m%dicaia ad&!9at& 6i do?a
- Instr!ii 7aci%nt!l - c!m s% 7oat% mi6ca An 7at 6i d%7lasa An salon c! 7%r8!?ia
- O;s%r@ai star%a 7aci%nt!l!i la 8i%car% 4-2 or%: 8aci%s, t%9!m%nt%, 8rison, t%m7%rat!ra local& a t%9!m%nt%lor
d%as!7ra 7ansam%nt!l!i, sc:im;&ri An star%a m%ntal& =n%lini6t%, con8!?i%>, alt%rar%a 8!nciilor n%!rom!sc!lar%,
%d%m%5
- Ins7%ctai loc!l d% ins%ri%, dac& %st% 7osi;il, 7%st% -0 d% min!t% d!7& Anc%7%r%a 7%r8!?i%iH notai c!loar%a
t%9!m%nt!l!i =ro6%a& sa! 7aloar%>
- "&s!rai s%mn%l% @ital%, 9r%!tat%a cor7oral& - 9r%!tat%a ?ilnic& con8irm& r%in%r%a sa! 7i%rd%r%a lic:id%lorH
cr%6t%r%a sa! sc&d%r%a 9r%!t&atii cor7!l!i c! 4X9 cor%s7!nd% la !n litr! d% lic:id r%in!t sa! 7i%rd!t =Eom% 6i
^arin9%n54++7>
- Col%ctai !rina - m&s!rai di!r%?a
- Col%ctai d%6%!ril% An contain%r% s7%cial%, con8orm PU
- 7&lai-@& mBinil%
NOTAREA PROCE*URII
Notai An 7lan!l d% An9ri<ir% :
40-
- Administrar%a 7%r8!?i%i
- Ora cBnd a Anc%7!t 7%r8!?ia, loc!l, ti7!l d% sol!i%, cantitat%a, d%;it!l
- R%acia 7aci%nt!l!i
- E@al!ar%a r&s7!ns!l!i 7aci%nt!l!i Ia administrar%a sol!ilor 7%r8!?a;il% la 8i%car% or& arat& c&
O %mn%l% @ital% s!nt normal%, 9r%!tat%a normal&
O (alana :idro-%l%ctrolitic& normal&
O 'inia @%noas& acc%si;il&
O In8iltraia 6i in8lamaia s!nt a;s%nt%
O A;s%na %d%m%lor 7%ri8%ric%
O A;s%na 8rison!l!i
O Paci%nt!l a An%l%s sco7!l 6i risc!ril% t%ra7i%i i5@5
R%?ol!t% n%dorit%0c% 8ac%i N
- Accid%nt% al% 7!nci%i @%noas% =@%?i Proc%d!ri d% n!rsin9 , 7art%a I >5
- *%8icit!l d% @ol!m al 8l!id%lor mani8%stat 7rin: d%scr%6t%r%a cantit&ii d% !rin&, m!coas% !scat%, :i7ot%nsi!n%,
ta:icardi%5
- E#c%s!l d% @ol!m al 8l!id%lor- :i7%r:idratar%a car% 7oat% d!c% la %d%m 7!lmonar ac!t =r%s7iraii sc!rt%, %d%m%,
ral!ri 7!lmonar%>
- Em;olia 9a?oasa
- In8iltrai% - in8lamai%, 7osi;il %d%m, nici cald nici r%c%, d!r%r%
- Fl%;ita - d!r%r%, cr%6t% t%m7%rat!ra t%9!m%nt%lor, %rit%m d%-a l!n9!l @%n%i - an!nai m%dic!l
- Coa9!lar%a sBn9%l!i 7% ac sa! ;ran!l& - s% 7r%@in% 7rin introd!c%r%a 7% l!m%n a sol!i%i d% :%7arin&
- )%n%l% n! s!nt @i?i;il% - Anc%rcai !rm&toar%l% 7roc%d%% d% la %8%ct!ar%a 7!nci%i @%noas%
- 'ic:id!l n! s% sc!r9%, d%6i ac!l %st% An @%n&:
- @%ri8icai 7o?iia ac!l!i, mo;ili?ai 7!in
- @%ri8icai 7r%si!n%a lic:id!l!i
ATEN2IE
- Frici!n%a @i9!roas& 6i m!lti7l%l% lo@iri !6oar% al% @%n%lor, An s7%cial la 7%rsoan%l% An @Brst& 7ot ca!?a
:%matoam% 6i sa! constricii @%noas%
- )%n%l% mai a;orda;il% s!nt c%l% al% m%m;r%lor s!7%rioar%, n! c%l% al% m%m;r%lor in8%rioar% =7osi;ilitat% d%
trom;o?ar%>
- 'a ;&trBni, dac& %st% 7osi;il %@itai @%n%l% dorsal% al% mBinii, ;ra!l dominant 7%ntr! 7!ncia @%noas& d%oar%c%
ac%st% loc!ri int%r8%r& m!lt c! ind%7%nd%na @Brstnic!l!i
- E@itai @%n%l% dorsal% 8ra9il%, la 7aci%nii An @Brst& sa! @%n%l% d% la o %#tr%mitat% c! circ!lai% com7romis& =An
ca?!ri d% mast%ctomi%, diali?&, 9r%8& sa! 7arali?ii>
- E@itai ?ona car% %st% d!r%roas& la 7al7ar%
- A7licai 7rinci7iil% ;!n%i com!nic&ri, d%oar%c% com!nicar%a clar& la 7%rsoan%l% An @Brst& %st% 8oart% im7ortant&
cBnd 8ac%i instr!ir%a 7aci%nt!l!i
- Fii si9!ri c& 7aci%nt!l a a!?it 6i a An%l%s c% i s-a %#7licat5
- *ac& 7aci%nii s!nt co7ii c! car% s% 7oat% cola;ora, 7%rmit%i-l% s& s%l%ct%?% loc!l 7%ntr! 7!ncia i5@5, d%oar%c%
7oat% cr%6t% coo7%rar%a
FIA N". 1.6. ADMINISTRAREA MEDICAMENTELOR (NTR)O SOLU2IE PERFU&ABIL1
- Introd!c%r%a Antr-!n mod si9!r a do?%i 7r%scris% dintr-!n m%dicam%nt5
- Ta@a m%dical& sa! c&r!cior!l 7%ntr! tratam%nt%
- ol!ii 7%r8!?a;il% indicat% d% m%dic, %tic:%t&
- Tr!sa d% 7%r8!?i%
- "%dicam%nt!l 7r%scris
- ol@%nt dac& %st% n%c%sar
- %rin9i0ac% st%ril% ad%c@at%
- Tam7oan%
40/
- "&n!6i st%ril%
- )%ri8icai indicaia m%dic!l!i 7ri@ind ti7!l d% sol!i% 7%r8!?a;il&
- )%ri8icai am;ala<!l sol!i%i, claritat%a 6i t%rm%n!l d% %#7irar%
a> PIEICF:
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i
- In8ormai 7aci%nt!l d%s7r% m%dicam%nt!l 7r%scris i5@5, Antr-o sol!i% 7%r8!?a;il& 6i 7ot%nial%l% %8%ct% ad@%rs%
;> FIGICF:
- A6%?ai 7aci%nt!l An d%c!;it dorsal
- Id%nti8icai 7aci%nt!l 6i 7r%scri7ia m%dical&
- )%ri8icai com7ati;ilitat%a Antr% m%dicam%nt%l% 7r%scris%
- Trans7ortai mat%rial%l% lBn9& 7at
- 7&lai manil%0m&n!6i st%ril%
a> Introd!c%r%a m%dicam%nt!l!i An sol!ia 7%r8!?a;il& Anaint% d% montar%a 7%r8!?i%i
- *ac& m%dicam%nt!l d% ad&!9at %st% o 7!l;%r%, as7irai cor%ct An s%rin9& cantitat%a d% dil!%nt0sol@%nt 6i in<%ctai
An 8lacon!l c! m%dicam%nt, d!7& d%?in8%cia do7!l!i
- A9itai 8lacon!l Antr% mBini ca s& s% di?ol@% toat% 7artic!l%l%
- As7irai sol!ia m%dicam%ntoas& An s%rin9&
- *%?in8%ctai ca7&c%l!l d% la 7!n9&08lacon!l d% sol!i% 7%r8!?a;il&
- *%s8ac%i ca7&c%l!l d% la 7!n9&08lacon
- Dn%7ai do7!l d% ca!ci!c al 7!n9ii08lacon!l!i c! ac!l ata6at la s%rin9&
- In<%ctai m%dicam%nt!l An 7!n9&08lacon
- Rotii, r&st!rnai !6or 7!n9a08lacon!l 7%ntr! a s% am%st%ca m%dicam%nt!l c! sol!ia 7%r8!?a;il&
- A7licai %tic:%ta 7%st% 7!n9a sa! 8lacon!l d% sol!i%, indicBnd data, ora administr&rii, m%dicaia ad&!9at& 6i
do?a
- E#aminai sol!ia 7%ntr! 7r%ci7itat%, d%colorar%, t!l;!rar% d!7& ad&!9ar%a 8i%c&r!i m%dicam%nt
- "ontai 7%r8!?ia 7arc!r9Bnd 7a6ii din 8isa Nr5 4545
;> Introd!c%r%a m%dicam%nt!l!i Antr-o 7!n9&08lacon d% sol!i% 7%r8!?a;il& car% d%<a a 8ost s!s7%ndat& An stati@ si
la car% a 8ost montat 7%r8!?or!l:
- )%ri8icai dac& @ol!m!l 7!n9ii 08lacon!l!i d% sol!i% %st% ad%c@at
- Dnc:id%i cl%ma07r%st!;!l 7%ntr! a 7r%@%ni in<%ctar%a An ;ol!s a m%dicam%nt!l!i
- *%?in8%ctai 6i An%7ai do7!l d% ca!ci!c al 7!n9ii08lacon!l!i c! ac!l ata6at la s%rin9&
- In<%ctai m%dicam%nt!l An 7!n9&08lacon
- Ridicai 7!n9a08lacon!l d% sol!i% din stati@ si An@Brtii0a9itai Anc%t sol!ia 7%ntr! a s% am%st%ca c!
m%dicam%nt!l 6i s!s7%ndai a7oi An stati@
- E#aminai sol!ia 7%ntr! 7r%ci7itat%, d%colorar%, t!l;!rar% d!7& ad&!9ar%a 8i%c&r!i m%dicam%nt
- *%sc:id%i cl%ma07r%st!;!l 6i r%a<!stai d%;it!l d% c!r9%r% al sol!i%i
- Ata6ai %tic:%ta 7%st% 7!n9& sa! 8lacon!l d% sol!i%, indicBnd data, ora administr&rii, m%dicaia ad&!9at& 6i do?a
- E@al!ai s%mn%l% @ital%
- O;s%r@ai star%a 7aci%nt!l!i, dac& a! a7&r!t r%acii ad@%rs%
- )%ri8icai 7%riodic d%;it!l sol!i%i
- E@al!ai r&s7!ns!l 7aci%nt!l!i la administrar%a m%dicam%nt!l!i, la 8i%car% or&, dac& %st% 7osi;il
- Col%ctai d%6%!ril% An r%ci7i%nt% s7%cial% con8orm P5U5
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai An 7lan!l d% An9ri<ir%:
- Administrar%a m%dicam%nt!l!i An sol!ia 7%r8!?a;il&, ora, do?a, ti7!l d% sol!i% 7%r8!?a;il&, d!rata 7%r8!?i%i
- N!m%l% n!rs%i car% a administrat m%dicam%nt!l
40C
- E@%nt!al%l% r%acii ad@%rs%, al%r9ii
- Administrar%a m%dicam%nt!l!i An sol!ia 7%r8!?a;il& %st% cor%ct&, n! s!nt incom7ati;ilit&i, n! s!nt 7r%ci7itat%
- N! a! a7&r!t r%acii ad@%rs%
- E8%ct!l t%ra7%!tic %st% ra7id sa! s% mani8%st& An tim7!l 7r%coni?at
- 'inia @%noas& r&mBn% acc%si;il& - s% asi9!r& 7%r8!?ar%a sol!i%i An s7ai!l i5@5
R%?!ltat% n%dorit% 0C% 8ac%i dac& :
- Conc%ntraia mar% a do?%i d% m%dicam%nt An sol!ia 7%r8!?a;il& 7oat% ca!?a com7licaii: scl%ro?a, trom;o?a,
8l%;ita, :%moli?a
- E#tra@a?ar%a m%dicam%nt!l!i An %s!t!l s!;c!tanat 7oat% ca!?a n%cro?a %s!t!l!i:
OE@itai administrar%a An ac%%a6i @%n&
O)%ri8icai 8r%c@%nt loc!l
OIn8ormai m%dic!l
- Ritm!l ra7id 7oat% d%t%rmina s!7raAnc&rcar%a inimii mani8%stat& 7rin dis7n%%, d!r%ri 7r%cordial%:
O r%d!c%i d%;it!l sa! Antr%r!7%i 7Bn& dis7ar 8%nom%n%l% s!7raAnc&rc&rii
O r%l!ai administrar%a Antr-!n ritm mai l%nt
O s!7ra@%9:%ai 7%rman%nt 7aci%nt!l
FIA N". 1.7. ADMINISTRAREA MEDICAMENTELOR (N BOLUS (NTR)O LINIE .ENOAS1
EXISTENT19PERFU&IE>
O Introd!c%r%a do?%i 7r%scris% dintr-!n m%dicam%nt dir%ct Antr-o lini% @%noas& %#ist%nt& 7rin in<%ctar% ra7id&,
7%ntr! !n %8%ct ra7id5
- Ta@a m%dical& sa! c&r!cior!l 7%ntr! tratam%nt%
- Etic:%ta
- *il!%nt0sol@%nt dac& %st% n%c%sar
- Tam7oan%
- "an!6i st%ril%
a> PIEICF:
- In8ormai 7aci%nt!l d%s7r% m%dicam%nt!l 7r%scris i5@5, 6i 7ot%nial%l% %8%ct% ad@%rs%
;> FIGICF:
- )%ri8icai 7o?iia 7aci%nt!l!i
- )%ri8icai 7r%scri7ia m%dical& 7ri@ind m%dicam%nt!l d% administrat, dac& %st% m%dicam%nt!l cor%ct 7rin
com7arar%a %tic:%t%i c! 7r%scri7ia m%dical& din 8oaia d% o;s%r@ar% a 7aci%nt!l!i, do?a 6i ritm!l d% administrar%
- )%ri8icai com7ati;ilitat%a m%dicam%nt!l!i c! sol!ia 7%r8!?a;il&
- 7&lai mBinil%0man!6i st%ril%
Introd!c%r%a m%dicam%nt!l!i An ;ol!s 7% o lini% intra@%noas& %#ist%nt& =7aci%nt!l ar% 7%r8!?i%>
An 8lacon!l c! m%dicam%nt!l, d!7& d%?in8%cia do7!l!i
- A9itai 8lacon!l Antr% mBini ca s& s% di?ol@% toat% 7artic!l%l% 6i as7irai sol!ia An s%rin9&
- *%?in8%ctai t!;!l d% lat%# al 7%r8!?or!l!i An loc!l c%l mai a7ro7iat d% c%l al 7!nci%i @%noas%
- Dndoii t!;!l 7%r8!?or!l!i Antr% d%9%t% 7%ntr! a o7ri d%;it!l d% c!r9%r% al sol!i%i 7%r8!?a;il%
40.
- Dn%7ai t!;!l d% lat%# An loc!l c%l mai a7ro7iat d% c%l al 7!nci%i @%noas% 6i introd!c%i sol!ia m%dicam%ntoas&
a6a c!m a 8ost 7r%scris&
- E#tra9%i ac!l c! s%rin9aH n!-i mai 7!n%i ca7ac
- *ai dr!m!l t!;!l!i 6i l&sai s& c!r9& sol!ia la d%;it!l cor%s7!n?&tor
- A7licai %tic:%ta 7%st% 7!n9& sa! 8lacon!l d% sol!i%, indicBnd data, ora administr&rii, m%dicaia ad&!9at& 6i
do?a, mod!l d% introd!c%r% =;ol!s>
- !7ra@%9:%ai d%s8&6!rar%a 7%r8!?i%i An contin!ar%
- O;s%r@ai star%a 7aci%nt!l!i, dac& a! a7&r!t r%acii ad@%rs%, al%r9ii m%dicam%ntoas%, in8iltraii
- Dnd%7&rtai com7r%s%, tam7oan% 8olosit%
- 7&lai mBinil%
NOTAREA PROCE*URII
- Administrar%a m%dicam%nt!l!i An ;ol!s i5@5, ora, do?a, ti7!l d% sol!i% 7%r8!?a;il&, d!rata 7%r8!?i%i
- N!m%l% n!rs%i car% a administrat m%dicam%nt!l
- E@%nt!al%l% r%acii ad@%rs%
- E@al!ar%a r&s7!ns!l!i 7aci%nt!l!i d!7& administrar%a m%dicam%nt!l!i ;ol!s i5@5 im%diat d!7& administrar% 6i la
8i%car% or& arat& c&:
- Administrar%a m%dicam%nt!l!i %st% cor%ct&, n! s!nt t!l;!r&ri a s%mn%lor @ital%
- E8%ct!l t%ra7%!tic %st% ra7id
- 'inia @%noas& r&mBn% acc%si;il& - s% asi9!r& contin!ar%a 7%r8!?i%i sol!i%i An s7ai!l i5@5
R%?!ltat% n%dorit%0C% 8ac%i:
- Aritmia cardiac& datorit& in<%ct&rii ra7id% An ;ol!s i5@5, conc%ntraia mar% a m%dicam%nt!l!i:
- % r%d!c% ritm!l
- % monitori?%a?& 7aci%nt!l
- R%acii al%r9ic%, 6oc ana8ilactic -mani8%stat% 7rin: dis7n%%, ciano?&, con@!lsii, s!8%rina r%s7iratori%
- % an!n& m%dic!l
- % Anc%7% im%diat 7roc%d!ra d% !r9%n& 7%ntr! com;at%r%a mani8%st&rilor
- E#tra@a?ar%a m%dicam%nt!l!i An %s!t!l s!;c!tanat 7oat% ca!?a n%cro?&
- )%ri8icai 7o?iia ac!l!i i5@5
- !7ra@%9:%ai loc!l 7!nci%i
- O7rii 7%r8!?ia dac& loc!l s% !m8l& 6i s% Anro6%6t%, 7aci%nt!l ac!?& !st!rim%
- A7licai o com7r%s& r%c%
- An!nai m%dic!l
- Alt% incid%nt% 8a@ori?at% d% 7!ncia @%noas& =:%matom>, d% conc%ntraia sol!i%i =d!r%ri d%-a l!n9!l @%n%i>
- E@itai 8olosir%a @%n%i tra!mati?at%
FIA N". 1.4.)ADMINISTRAREA MEDICAMENTELOR (NTR)O LINIE .ENOAS1 EXISTENT1
9CANUL1 C BRANUL1:
- Introd!c%r%a do?%i 7r%scris% dintr-!n m%dicam%nt dir%ct Antr-o lini% @%noas& %#ist%nt&, r%ali?at& 7rin int%rm%di!l
!n%i can!l% =;ran!l%>5
- Ta@a sa! c&r!cior 7%ntr! m%dicam%nt%
- Etic:%ta
- %r 8i?iolo9ic
- E%7arin&
407
- *il!%nt0sol@%nt dac& %st% n%c%sar
- Tam7oan%
- "&n!6i st%ril%
a> PIEICF:
- In8ormai 7aci%nt!l d%s7r% introd!c%r%a m%dicam%nt!l!i 7r%scris An ;ol!s i5@5, dir%ct 7% can!l&0;ran!l& 6i d%s7r%
7ot%nial%l% %8%ct% ad@%rs%
;> FIGICF:
- A6%?ai 7aci%nt!l Antr-o 7o?ii% r%la#at& c! ?ona 7% car% %st% montat& ;ran!la acc%si;il&
- )%ri8icai 7r%scri7ia m%dical& 7ri@ind m%dicam%nt!l d% administrat, 7rin com7arar%a %tic:%t%i c! 7r%scri7ia
m%dical& din 8oaia d% o;s%r@ai% a 7aci%nt!l!i, do?a 6i tim7!l d% administrar%
- )%ri8icai com7ati;ilitat%a m%dicam%nt!l!i c! :%7arina
- 7&lai mBinil%0m&n!6i st%ril%
Introd!c%r%a m%dicam%nt!l!i Antr-o lini% @%noas& %#ist%nt& =7aci%nt!l ar% can!l& 0 ;ran!l&>
An 8lacon!l c! m%dicam%nt!l
- R!lai 8lacon!l Antr% mBini ca s& s% di?ol@% toat% 7artic!l%l%
- As7irai sol!ia m%dicam%ntoas& An s%rin9&
- )%ri8icai 7%rm%a;ilitat%a can!l%i 0 ;ran!l%i 8olosind 2 -- ml s%r 8i?iolo9ic, sa! 4 ml :%7arin&, sa! !n am%st%c d%
s%r 8i?iolo9ic c! :%7arin&, con8orm r%comand&rii m%dical%
- *%?in8%ctai c&7&c%l!l d% la can!l& 0 ;ran!l&
- A7&sai c! mBna n%dominant& 6i 8i#ai c! d%9%t!l ar&t&tor %#%rcitBnd 7r%si!n% la -cm d%as!7ra loc!l!i 7!nci%i
a> P%rm%a;ili?ar%a c! s%r 8i?iolo9ic
- Ata6ai s%rin9a c! s%r 8i?iolo9ic la can!l& 0 ;ran!l&
- As7irai 6i o;s%r@ai dac& a a7&r!t sBn9% An s%rin9&, iar dac& n! a a7&r!t a7licai !n 9aro! d%as!7ra loc!l!i d%
7!nci% 6i l&sai-l !n min!t d!7& car% as7irai din no!
- *ac& sBn9%l% n! a a7&r!t An s%rin9& in<%ctai Anc%t s%r!l 8i?iolo9ic sim7l!
- *ac& simii r%?ist%nt&, ac%asta indic& An8!ndar%a ;ran!l%i0can!l%i 6i sto7ai in<%ctar%a s%r!l!i 8i?iolo9ic
- *ac& n! simii r%?ist%n& in<%ctai Anc%t s%r!l 8i?iolo9ic
;> P%rm%a;ili?ar%a c! :%7arin& =dac& :%7arina %st% com7ati;il& c! m%dicam%nt!l c% tr%;!i% in<%ctat>
- As7irai sol!ia m%dicam%ntoas& a6a c!m a 8ost 7r%scris& Antr-o s%rin9&
- As7irai :%7arina sa! am%st%c!l Antr-o s%rin9& 6i ata6ai s%rin9a c! s%r 8i?iolo9ic 6i :%7arina la can!l&0;ran!l& 6i
in<%ctai Anc%t
- *%ta6ai s%rin9a d% :%7arin& d% la can!l& 6i ata6ai s%rin9a c! sol!ia m%dicam%ntoas&
- In<%ctai l%nt sol!ia m%dicam%ntoas&
- Ata6ai c&7&c%l!l la ;ran!l&0can!l&, la s8Br6it!l in<%ct&rii
- % 8i#%a?& ;ran!la c! 7last!r%l% ad%?i@
- O;s%r@ai star%a 7aci%nt!l!i, dac& a! a7&r!t r%acii ad@%rs%, al%r9ii m%dicam%ntoas%
- )%ri8icai dac& a! a7&r!t s%mn%l% d% in8iltrai%0in8lamai%
- Prot%<ai can!la0;ran!la c! o 8a6& d% ti8on
- 7&lai mBinil%
NOTAREA PROCE*URII
40,
- Administrar%a m%dicam%nt!l!i, ora, do?a, ti7!l d% administrar%
- N!m%l% n!rs%i car% a administrai m%dicam%nt!l
- E@%nt!al%l% r%acii ad@%rs%, al%r9ii, in8iltraii, in8lamaii
- E@al!ar%a r&s7!ns!l!i 7aci%nt!l!i la administrar%a m%dicam%nt!l!i i5@5la 8i%car% or& arat& c&:
- Administrar%a m%dicam%nt!l!i %st% cor%ct& 6i %8%ct!l t%ra7%!tic %st% ra7id
- Paci%nt!l %#7rim& star% d% con8ort 6i n! ac!?& d!r%r% sa! <%n& la loc!l in<%ct&rii
- 'inia @%noas& r&mBn% acc%si;il& - s% asi9!r& 7%r8!?ar%a sol!i%i An s7ai!l i5@5 sa! in<%ctar%a
- N! s!nt s%mn% d% 8l%;it& local%
R%?!ltat% n%dorit%0C% 8ac%m dac&:
- )%?i FIJA Nr5l5-5 =administrar%a An ;ol!s Antr-o 7%r8!?i% %#ist%nt&>
FIA N". 1.8. )SC%IMBAREA SOLU2IILOR PERFU&ABILE
O "%nin%r%a t%ra7i%i i5@5 8olosind t%:nica as%7tic&5
- Ta@& m%dical& sa! c&r!cior!l 7%ntr! tratam%nt%
- ol!i% d%?in8%ctant&, tam7oan%, %tic:%t&
- ol!ii 7%r8!?a;il% r%comandat%, An t%rm%n d% @ala;ilitat%, An cantitat%a 7r%scris&
- %rin9i0ac% st%ril% ad%c@at%, m&n!6i st%ril%
a> PIEICF:
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i
- In8ormar%a 7aci%nt!l!i d%s7r% o no!& sol!i% 7%r8!?a;il& 6i 7ot%nial%l% %8%ct% ad@%rs%
;> FIGICF:
- )%ri8icai 7o?iia 7aci%nt!l!i
- Pr%9&tii sol!ia 7%ntr! sc:im;ar% - dac& %st% 7!n9& d% sol!i% s% d%s8ac% am;ala<!l 7rot%ctor 6i s% d%sc:id%
ca7ac!l m%talic, iar la 8lacon s% And%7&rt%a?& ca7ac!l5
- Dnc:id%i 7r%st!;!l 7%r8!?or!l!i 7%ntr! a sto7a c!r9%r%a sol!i%i
- Dnd%7&rtai din stati@ 7!n9a08lacon!l 9ol 7&strBnd cBi@a ml d% sol!i%
- coat%i ra7id ac!l 7%r8!?or!l!i din 7!n9a08lacon!l 9ol 6i introd!c%i-l An 7!n9a08lacon!l 7lin c! sol!i% d!7& c%
d%?in8%ctai do7!l
- !s7%ndai An stati@ 7!n9a08lacon!l c! sol!i%
- R%d%sc:id%i 7r%st!;!l 6i a<!stai d%;it!l
- )%ri8icai 7r%?%na a%r!l!i 7% t!;!l 7%r8!?or!l!i 6i And%7&rtai-l dac& %st% ca?!l ast8%l: Anc:id%i 7r%st!;!l, lo@ii
t!;!l c! d%9%t!l 7%ntr! ca ;!l%l% mici s& s% ridic% An 7ic!r&tor!l 7%r8!?or!l!i
- P%ntr! o cantitat% mar% d% a%r An%7ai c! !n ac 6i s%rin9a t!;!l d% lat%# al 7%r8!?or!l!i, d% la ca7&t!l
7%r8!?or!l!i, d!7& c% a 8ost d%?in8%ctat, 6i as7irai a%r!l An s%rin9&
- R%9lai din no! d%;it!l d% c!r9%r% al sol!i%i
- Asi9!rai-@& c& 7ic!r&tor!l 7%r8!?or!l!i %st% 7lin c! sol!i% o tr%im% sa! <!m&tat%
- A7licai %tic:%ta 7% 7!n9& sa! 8lacon!l d% sol!i%, indicBnd data, ora sc:im;&rii, m%dicaia ad&!9at&, do?a
- O;s%r@ai s%mn%l% 7%ntr! r%:idratar% 6i d%s:idratar%
- 7&lai mBinil%
NOTAREA PROCE*URII
40+
- c:im;ar%a sol!i%i 7%r8!?a;il%
- Ora, cantitat%a
- Ti7!l d% sol!i% 7%r8!?a;il&
- E@%nt!al% modi8ic&ri An star%a 7aci%nt!l!i
- E@al!ar%a r&s7!ns!l!i 7aci%nt!l!i la administrar%a sol!iilor 7%r8!?a;il% la 8i%car% or& arat& c&:
- Administrar%a sol!i%i %st% cor%ct&, 7aci%nt!l 7rim%6t% @ol!m!l d% lic:id% cor%ct
- 'inia @%noas& r&mBn% acc%si;il& - s% asi9!r& 7%r8!?ar%a sol!i%i An s7ai!l i5@5
R%?!ltat% n%dorit%0C% 8ac%i
- *%;it!l d% c!r9%r% al sol!i%i %st% incor%ct
- )%ri8icai 7%rm%a;ilitat%a ;ran!l%i
- )%ri8icai 7r%si!n%a d% sc!r9%r% a lic:id!l!i, modi8icai la n%@oi% An&lim%a
- "i6cai 7!in ac!l 7%ntr! a And%7&rta ;i?o!l ac!l!i d% 7%r%t%l% @%n%i
- Paci%nt!l 7rim%6t% mai 7!in sa! mai m!lt din cantitat%a d% sol!i% 7r%scris&
- R%s7%ctai cantitat%a 7%r8!?a;il& 7r%scris&
FIA N". 1.;.)SC%IMBAREA PERFU&ORULI
- "%nin%r%a t%ra7i%i i5@5 8olosind t%:nica as%7tic&5
- Ta@& m%dical& sa! c&r!cior!l 7%ntr! tratam%nt%
- Etic:%ta
- Tr!sa d% 7%r8!?i% int%9r&, An t%rm%n d% @ala;ilitat%
- Tam7oan%
- "&n!6i st%ril%
a> PIEICF:
- In8ormar%a 6i %#7licar%a 7roc%d!rii 7aci%nt!l!i 6i ino8%nsi@itat%a
;> FIGICF:
- Asi9!rai-@& c& st& An 7o?iia cor%ct&, a@Bnd An @%d%r% c& tim7!l d% m%nin%r% a 7%r8!?i%i cr%6t%
- 7&lai mBinil%0Dm;r&cai m&n!6i st%ril%
- Pr%9&tii tr!sa d% 7%r8!?i% 7%ntr! sc:im;ar%
-*%s8ac%i am;ala<!l 7rot%ctor
- Dnc:id%i cl%ma07r%st!;!l 7%r8!?or!l!i no!
- Dnl&t!rai ca7ac!l 7rot%ctor al ac!l!i t!;!l!i 7%r8!?or!l!i
- Ins%rai ra7id ac!l 7%r8!?or!l!i An 7!n9a08lacon!l c! sol!i%
- A7&sai 7% cam%ra 7%r8!?or!l!i 7%ntr! a 8i !m7l!t& c! c%l 7!in o tr%im% sa! <!m&tat% sol!i% - Dnl&t!rai ca7ac!l
7rot%ctor d% la c%l&lalt ca7&t al t!;!l!i
- *%sc:id%i cl%ma 6i l&sai s& c!r9& sol!ia 7Bn& cBnd ;!l%l% d% a%r a! dis7&r!t
- Dnc:id%i cl%ma07r%st!;!l 6i 7!n%i la loc ca7ac!l 7rot%ctor al t!;!l!i
- Dnc:id%i cl%ma07r%st!;!l @%c:i!l!i 7%r8!?or
- coat%i ra7id ac!l 7%r8!?or!l!i 8olosit
- *%ta6ai t!;!l 7%r8!?or!l!i 8olosit d% la ;ran!l&0can!l& 6i And%7&rtai-l
- "%nin%i st%rilitat%a, And%7&rtai ra7id ca7ac!l 7rot%ctor al t!;!l!i 7%r8!?or!l!i no! 6i ata6ai ;ran!la0can!la
- *%sc:id%i cl%ma07r%st!;!l 6i 8i#ai d%;it!l d% c!r9%r% al sol!i%i
- A7licai 7ansam%nt!l st%ril
440
- Dnc!ra<ai 7aci%nt!l - dimin!%a?& an#i%tat%a 7romo@%a?& coo7%rar%a 6i 7r%@in% mi6c&ril% ;r!6t% al%
%#tr%mit&ilor car% 7ot disloca ac!l sa! cat%t%r!l, ;ran!la0can!la
- !7ra@%9:%ai An contin!ar% 7%r8!?ia
- 7&lai mBinil%
NOTAREA PROCE*URII
- c:im;ar%a 7%r8!?or!l!i
- Ora, data
- Paci%nt!l a An%l%s n%@oia d% contin!ar% a 7%r8!?i%i
- Administrar%a sol!i%i %st% cor%ct&,
- Paci%nt!l 7rim%6t% !n @ol!m d% lic:id% con8orm c! 7r%scri7ia
- P%r8!?or!l %st% acc%si;il
- T!;!l 7%r8!?or!l!i %st% ata6at cor%ct 6i sol!ia n! c!r9% 7% lBn9& t!;
R%?!ltat% n%dorit%0C% 8ac%i
- c&d%r%a sa! a;s%na c!r9%rii sol!i%i car% %st% indicat& 7rin d%scr%6t%r%a rat%i
- ol!ia c!r9% 7% lBn9& t!;
O R%9lai d%;it!l la @aloar%a indicat& d% m%dic
O )%ri8icai racord!l, %@%nt!al sc:im;ai
FIA N". 1.<.)COMPLICA2IILE TERAPIEI INTRA.ENOASE
CO"P'ICA2II'E TERAPIEI INTRA)ENOAE
- Comlicaiil% t%ra7i%i intra@%noas% s!nt:
O In8iltraia
O Trom;o8l%;it%l%
O (act%ri%mia
O !7raAnc&rcar%a circ!latori%
O Em;olia
O E6%c!l m%canic =Anc%tinir%a 8l!#!l!i i5@5>
INFI'TRA2IA
Ca!?a - d%7lasar%a can!l%i0;ran!l%i i5@5 dintr-o @%n& r%?!ltBnd 7%r8!?ar%a d% 8l!id% An %s!t!ril% din <!r5
"ani8%st&ri clinic%:
O Um8lar%a, al;ir%a 6i r&cir%a t%9!m%nt%lor din <!r
O *iscon8ort - d%7ind% d% nat!ra sol!i%i
O Ritm!l d% c!r9%r% %st% mai Anc%t sa! s% o7r%6t%
O A;s%na Antoarc%rii sBn9%l!i An cat%t%r!l i5@5 6i 7% t!;!l 7%r8!?or!l!i
"&s!ri 7r%@%nti@%:
O Asi9!rai-@& c& t!;!lat!ra distal& %st% s!8ici%nt s%c!ri?at& c! ;and& ad%?i@& 7%ntr! a 7r%@%ni d%7lasar%a
can!l%i0;ran!l%i la !n%l% mi6c&ri al% 7aci%nt!l!i
O P!n%i at%l& la ;ra sa! mBn& dac& %st% n%c%sar
O )%ri8icai loc!l 7%ntr! t%ra7ia i5@5 8r%c@%nt An @%d%r%a %@it&rii com7licaiilor
TRO"(OF'E(ITE'E
Ca!?%:
O R&nir%a @%n%i An tim7!l 7!ni%i @%noas%, cali;r!l mar% al ac!l!i0cat%t%r!l!i !tili?at sa! !tili?ar%a 7r%l!n9it& a
ac!l!i0cat%t%r!l!i
O Iritar%a @%n%i datorit& 7%r8!?&rii ra7id% sa! sol!iilor car% 7rod!c iritai% =%#5 ol!ii d% 9l!co?& :i7%rtonic&,
7otasi!>5
O C:%a9 8ormat la ca7&t!l ac!l!i sa! cat%t%r!l!i =din o%l sa! mat%rial 7lastic> datorit& Anc%tinirii ritm!l!i d%
7%r8!?ar%
444
O %nsi;ilitat%, a7oi d!r%r% d%-a l!n9!l @%n%i
O Um8l&t!r&, c&ld!r& 6i ro6%a& la loc!l !nd% %st% instalat& 7%r8!?iaH @%na 7oat% a7ar% ca o d!n9& ro6i% d%as!7ra
loc!l!i d% ins%ri%
"&s!ri 7r%@%nti@%: R
O Fi#ar%a si9!r& a ac!l!i 0 cat%t%r!l!i la loc!l d% ins%ri%
O c:im;ar%a loc!l!i d% ins%ri% c%l 7!in odat& la 72 or%
O Folosir%a @%n%lor mari 7%ntr! 7%r8!?ar%a sol!iilor iritant%, mod%r%a?& iritaia
O *il!ar%a s!8ici%nta a a9%nilor iritani Anaint% d% 7%r8!?ar%
Int%r@%niil% n!rsin9:
O A7licar%a com7r%s%lor r%ci im%diat 7%ntr! a r%d!c% d!r%r%a 6i in8lamaia
O "ai tBr?i! 7!n%i com7r%s% cald% 7%ntr! a stim!la circ!laia 6i 7romo@a a;sor;ia
O Notai int%r@%niil% 6i %@al!ar%a
(ACTERIE"IA
Ca!?%:
O C%l% car% sta! la ;a?a 8l%;it%lor cr%sc d% 4, ori risc!l
O "at%rial% contaminat% sa! sol!ii
O "%nin%r%a 7r%l!n9it& a !n!i dis7o?iti@ I) =cat%t%r, ;ran!l&0can!l&, ac, t!;, 7!n9& c! sol!i%>
O Ins%ria i5@5 sa! sc:im;ar%a 7ansam%nt!l!i nonas%7tic&
O Contaminar%a Anc!ci6at& d% c&tr% 7aci%nt c! alt% ?on% in8%ctat% al% cor7!l!i
O Paci%nt!l c! ;oli critic% sa! im!nod%7r%si@ %st% s!7!s c%l mai m!lt risc!l!i d% ;act%r%mi%
O Cr%6t%r%a t%m7%rat!rii, 8risoan%
O $r%a&, @&rs&t!ri
O Indis7o?ii%, 7!ls cr%sc!t
O *!r%r% d% s7at%, d% ca7
O Poat% d!c% la 6oc!l s%7tic c! :i7ot%nsi!n% art%rial&
O Posi;il% s%mn% al% in8%ci%i local%, la loc!l d% ins%ri% i5@5 =%#5 ro6%a&, d!r%r%, sc!r9%r% mirositoar%>
"&s!ri 7r%@%nti@%:
O Urmai ac%l%a6i m&s!ri s!;liniat% la trom;o8l%;it%
O Utili?ai as%7sia strict& la ins%ria i5@5 sa! la sc:im;ar%a 7ansam%nt!l!i
O Utili?ai 7%r8!?or!l c! 8iltr!
O ol!iil% n! ar tr%;!i in!t% mai m!lt d% 2/ d% or%
O c:im;ai loc!l d% ins%ri% i5@5 la /,-72 d% or%
O c:im;ai 7ansam%nt!l la loc!l d% ins%ri% i5@5 la 2/-/, d% or%
O c:im;ai 7%r8!?or!l la 2/-/, d% or%
O "%nin%i int%9ritat%a sist%m!l!i d% 7%r8!?ar%
Int%r@%nii n!rsin9:
O Dntr%r!7%r%a 7%r8!?i%i 6i r%tra9%r%a can!l%i0;ran!l%i0cat%t%r!l!i
O R%tra9%r%a can!l%i0;ran!l%i0cat%t%r!l!i:
- s% 8ac% An condiii d% as%7si%
- s% tai% c! o 8oar8%c& st%ril& %#tr%mitat%a ac%stora,
- s% introd!c% Antr-o %7!;%t& st%ril&
- s% trimit% im%diat la la;orator 7%ntr! anali?&
O % @%ri8ic& s%mn%l% @ital%
O % Anc!ra<%a?& 7aci%nt!l
O % r%colt%a?& l%!cocito?a, la indicaia m%dic!l!i
O % %@al!%a?& 7%ntr! in8%ci% =!rin&, s7!t&, 7l&9i>
O % not%a?& int%r@%niil%
UPRADNCFRCAREA CIRCU'ATORIE
Ca!?a:
O Introd!c%r%a !n%i cantit&i %#c%si@% d% 8l!id i5@5 =An s7%cial risc!l %st% 7%ntr! 7aci%nii An @Brst&, co7ii 6i 7%ntr!
7aci%nii c! ins!8ici%n& cardiac& sa! r%nal&>
O Cr%6t% TA 6i 7!ls!l
442
O Cr%6t% 7r%si!n%a @%noas& c%ntral&, dist%nsia @%n%lor =@%n%l% <!9!lar%>
O *!r%ri d% ca7, an#i%tat%
O R%s7irai% sc!rt&, ta:i7n%%, t!s%
O *!r%r% An 7i%7t =dac& ar% istoric d% ;oal& coronarian&>
"&s!ri 7r%@%nti@%:
O Tr%;!i% s& 6tii dac& 7aci%nt!l a a@!t ;oli d% inim& sa! rinic:i
O % monitori?%a?& ritm!l d% c!r9%r% al 7%r8!?i%i
O % 7!n% at%l& la ;ra sa! mBn& dac& s!nt 8l!ct!aii mari al% ritm!l!i d% c!r9%r% dat% d% mi6c&ril% 7aci%nt!l!i
Int%r@%niil% n!rsin9:
O % Anc%tin6t% ritm!l 7%r8!?i%i 6i s% an!n& m%dic!l
O % monitori?%a?& And%a7roa7% 7%ntr! s%mn%l% d% s!7raAnc&rcar%
O % in% 7aci%nt!l c! tr!nc:i!l ridicat 7%ntr! a 8a@ori?a r%s7iraia
O % not%a?& int%r@%niil% 6i %@al!ar%a
E"(O'IA
Ca!?%:
O Risc!l %st% mar% An liniil% @%nos% c%ntral%, cBnd a%r!l intr& An cat%t%r0;ran!l&08l%#!r& 7% d!rata sc:im;&rii
7%r8!?or!l!i =a%r!l as7irat 7% d!rata ins7irai%i datorit& 7r%si!nii n%9ati@% intratoracic%>
O (!l%l% d% a%r sc&7at% din t!;!lat!r& 6i Am7ins% An circ!laia @%noas&
"ani8%st&ril% clinic%:
O c&d%r%a TA, cr%6t%r%a 7!ls!l!i
O Ciano?a, ta:i7n%%a
O Cr%6t%r%a 7r%si!nii @%noas% c%ntral%
O c:im;&ri An 7roc%s!l d% 9Bndir%, An star%a d% con6ti%nt&
"&s!ri 7r%@%nti@%:
O % scoat% a%r!l din t!;!lat!r& Anaint% d% a 7%r8!?a 7aci%nt!l
O % sc:im;& 7!n9il% c! sol!i% Anaint% d% a s% t%rmina
O % asi9!r& c& toat% con%#i!nil% s!nt si9!r%
Int%r@%nii n!rsin9:
O Im%diat s% Antoarc% 7aci%nt!l 7% 7art%a stBn9& 6i c! ca7!l mai <os 7% 7at, An ac%ast& 7o?ii% a%r!l s% @a ridica An
atri!l dr%7t
O % an!n& m%dic!l
O % lini6t%6t% 7aci%nt!l
O % not%a?& int%r@%niil% 6i s% %@al!%a?& 7%rman%nt
INCI*ENTE "ECANICE
=DNCETINIREA F'UXU'UI I5)5>
Ca!?%:
O Ac!l 7oat% 7oat% 8i li7it d% 7%r%t%l% @%n%i sa! 7oat% i%6i din @%n& 6i s% o7r%6t% c!r9%r%a sol!i%i
O Ac!l s% 7oat% An8!nda c! !n c:%a9
O R&s!cir%a, c!dar%a t!;!l!i sa! cat%t%r!l!i
E@al!ar%a n!rsin9 6i int%r@%nii:
O % %@al!%a?& s%mn%l% in8iltrai%i local% =!m8l&t!r&, r&cir%a t%9!m%nt!l!i>
O % d%sli7%6t% ;anda ad%?i@& 6i s% @%ri8ic& dac& t!;!lat!ra 6i cat%t%r!l s!nt r&s!cit%
O % r%tra9% can!la0;ran!la dac& ac%st%a s-a! li7it d% 7%r%t%l% @%n%i sa! dac& a i%6it An a8ara @%n%i
O % ridic& sa! s% co;oar& ac!l 7%ntr! a 7r%@%ni ast!7ar%a, ;locar%a 7rin 7o?iia o;lic&
FIA N". 1.=.)NUTRI2IA PARENTERAL1 TOTAL1 9NPT:
PRIN METODA PERFU&IEI I...
O Administrar%a 7% cal% @%noas& a !n%i sol!ii 7r%scris%, d% 9l!co?&, 7rot%in%, %m!lsi% d% li7id%, %l%ctrolii,
@itamin%5
UTI'IGAREA NPT
- R%stricia cantit&ii d% :ran& 6i lic:id% in9%rat% 7% o d!rat& mai mar% d% 7 ?il% =r&niri 7rin tra!matism% m!lti7l%,
ars!ri s%@%r%, anor%#i% n%r@oas&>
- (oli c! o d!rat& mai l!n9& d% 2 s&7t&mBni
44-
- Pi%rd%r% d% 40P sa! mai m!lt din 9r%!tat%a cor7oral& Anaint% d% Am;oln&@ir%
- Ni@%l!l al;!min%i s%ric% mai sc&?!t d% -,C90dl
- Tol%rana sc&?!t& a alim%ntai%i %nt%ral% d% l!n9& d!rat&
- )&rs&t!ri cronic% 6i diar%%
- Contin!ar%a 7i%rd%rii An 9r%!tat%, An ci!da cons!m!l!i oral ad%c@at
- T!l;!r&ri 9astro-int%stinal% c% Am7i%dic& sa! r%d!c s%@%r a;sor;ia =o;str!cia int%stinal&, ;oala Cro:n, colita
!lc%roas&, sindrom!l d% int%stin sc!rt, sindrom!l d% mala;sor;i% An canc%r, 8ist!l% int%stinal%>
- T!l;!r&ri 9astro-int%stinal% in8lamatorii =7ancr%atita, 7%ritonita>
- Ins!8ici%na r%nal& sa! :%7atic&
- Cr%6t%r%a normal& 6i d%?@oltar%a la co7ii c! anomalii con9%nital% =8ist!la tra:%o-%so8a9ian&, atr%?ia d!od%nal&,
:%rnia dia8ra9matic&, @ol@!l!s!l>
- Ta@& 0 c&r!cior
- $aro!, tam7on, alcool
- %rin9i, ac%, m&n!6i st%ril%
- (ran!l&, 7%r8!?or c! 8iltr!, c! am;ala< int%9r!, An t%rm%n d% @ala;ilitat%
- '%!co7last sa! ;and& ad%?i@& non al%r9ic&
- "!6ama, al%?&, %tic:%t&
- tati@ 7%ntr! 7%r8!?i%
- ol!ii 7%r8!?a;il% r%comandat% d% m%dic, An t%rrm%n d% @ala;ilitat% 6i cantitat% ad%c@at&, c! as7%ct n%modi8icat
la t%m7%rat!ra cam%r%i
TIPURI *E O'U2II PERFUGA(I'E
A"INO"IX 4,2,-
- ol!i% 7%r8ti?a;il& o;in!t& 7rin am%st%c d% aminoaci?i 6i %l%ctrolii
P!n9i ;icam%ral%: 2 # C00 ml
2 # 7C0 ml
2# 4000 ml
- Indicaii - a7ort d% aminoaci?i, 9l!co?& 6i %l%ctrolii, cBnd administrar%a oral& sa! c%ntral& n! %st% 7osi;il&
- % administr%a?& An @%n& c%ntral&, n! An @%n& 7%ri8%ric&5
- 'a !nii 7aci%ni s% administr%a?& ins!lina 7%ntr! control!l 9lic%mi%i 6i 9lico?!ri%i5
- R%acii ad@%rs% An ca?!l 7%r8!?i%i ra7id%: 9r%a&, @&rs&t!ri, 8risoan%, :i7%r9lic%mi%, 9lico?!ri%, d!r%ri, 7i%rd%r%
r%nal& d% aminoaci?i5
A"INOP'A"A'
- ol!i% 7%r8!?a;il&, 8lacoan% d% C00 ml - 4000 ml
- N!trii% 7ar%nt%ral& An: sindrom!l d% mala;sor;i%, r%?%cii stomacal%, ;oli in8lamatorii, diar%% 6i @om&
7%rsist%nt&5
- PE)-/0 - .07ic7min
A"INOTERI'
- sol!i% 7%r8!?a;il&, 8lacoan% d% C00 ml -4000 ml
- ol!i% 7%r8!?a;il& 8&r& car;o:idrai, 8&r& %l%ctrolii
- ol!i% 7%r8!?a;il& c! aminoaci?i %c:ili;rai
A"INO)EN -,CP
- ol!i% 7%r8!?a;il&, 8lacoan% d% C00 ml - 4000 ml
- Am%st%c d% aminoaci?i c! -,CP 9l!co?&
- An NPT s% asocia?& c! ali n!tri%ni
- PE) - @%n& 7%ri8%ric&
- @%n& c%ntral& 40-20 ml0X9 cor7
A"INO)EN in8antil 40P - 8lacoan% d% 400 - 2C0- C00 ml
'IPOFUN*IN
- Flacoan% d% C00 ml
- Em!lsi% 7%r8!?a;il&
- N! s% am%st%c& c! alt% s!;stan% m%dicam%ntoas%
- N! s% 7&str%a?& dac& n! s-a administrat toat& cantitat%a
- % a9it& Anaint% d% 8olosir%
- N! s% administr%a?& dac& n! %st% omo9%n
44/
- P%r8!?i% l%nt& - 40--0 ml0X9cor70?i
- % asocia?& c! :idrocar;onaii 7%ntr! a n! s% 7rod!c% acido?&
- R%acii ad@%rs%: dis7n%%, ciano?&, r%acii al%r9ic%, :i7%rli7id%mi%, 9r%a&, @&rs&t!ri, c%8al%%, Anro6ir%a 8%%i,
:i7%rt%nsi!n%, tr%mor5
a> PIEICF:
- In8ormai 6i %#7licai 7aci%nt!l!i n%c%sitat%a 7roc%d!rii
- Dnc!ra<ai 7aci%nt!l 7%ntr! a r%d!c% an#i%tat%a
- In8ormai 7aci%nt!l d%s7r% d!rata a7ro#imati@& a 7roc%d!rii
- Asi9!rai 7aci%nt!l c& @%i 8i al&t!ri 7%ntr! a s!7ra@%9:%a 7%r8!?ia 6i 7%ntr! a-l a<!ta
;> FIGICF:
- Asi9!rai 7o?iia cor%s7!n?&toar% =ac%%a6i ca 7%ntr! 7%r8!?i% sa! 7!ncia @%noas&>, An con8ormitat% c! star%a
7aci%nt!l!i
- E#aminai calitat%a 6i star%a @%n%lor
- Al%9%i @%na ad%c@at&
- Id%nti8icai 7aci%nt!l 6i trans7ortai mat%rial%l% la 7at
- P!n%i-@& masc& dac& 7aci%nt!l ar% im!nod%8ici%n&
- Pr%9&tii sol!ia 7%r8!?a;il& 6i tr!sa d% 7%r8!?at
- Asi9!rai-@& c& sol!ia d% 7%r8!?at ar% c%l 7!in t%m7%rat!ra cam%r%i
- Eliminai a%r!l din circ!it
- E8%ct!ai 7!ncia @%noas& =@%?i RP!ncia @%noas&R>
- Racordai tr!sa d% 7%r8!?i% la ac!l0cat%t%r!l instalat An @%na 7aci%nt!l!i
- R%9lai ritm!l 7ic&t!rilor r%s7%ctBnd r%comandar%a dat& d% m%dicH @alori ori%ntati@%, An 8!nci% d% ti7!l sol!i%i
- O;s%r@ai 8aci%s!l, t%9!m%nt%l% 6i m&s!rai 7!ls!l 6i T5A5
- Dntr%;ai 7aci%nt!l dac& ar% star% d% 9r%a& sa! @om&
- )%ri8icai loc!l 7!nci%i @%noas%
- Col%ctai d%6%!ril% con8orm P5U5An r%ci7i%nt% s7%cial%
- DAnd%7&rtai m&n!6il%
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai:
- Administrar%a 7%r8!?i%i An 7lan!l d% An9ri<ir%
- R%aciil% ad@%rs% dac& a! a7&r!t 7% d!rata 7%r8!?i%i
- Ora cBnd a Anc%7!t 7%r8!?ia, loc!l, ti7!l d% sol!i%, cantitat%a, d%;it!l
- Paci%nt!l ar% t%9!m%nt% 6i m!coas% normal colorat%, n! 7r%?int& s%mn% al% 8l%;it%i d% cat%t%r
- %mn%l% @ital% s!nt normal%
- E@al!ai la 8i%car% ora r&s7!ns!l 7aci%nt!l!i la administrar%a sol!iilor 7%r8!?a;il%
R%?!ltat% n%dorit%
O C% 8ac%m dac&:
45 Paci%nt!l 7r%?int&: 9r%a&, @&rs&t!r&, an#i%tat%, 8rison, d!r%r% 7% trai%ct!l @%n%i
- an!nai m%dic!l
- r%d!c%i ritm!l
- lini6tii 7aci%nt!l
25 Paci%nt!l 7r%?int& in8%ci% local& la local d% 7!nci%
R%s7%ctai m&s!ril% d% as%7si%M
44C
-5 Paci%nt!l 7r%?int& r%acii im%diat% la t%ra7ia c! %m!lsi% d% li7id% =8%;r&, dis7n%%, ciano?&, 9r%a&, @&rs&t!ri,
d!r%ri d% ca7, dia8or%?&, l%tar9i%, sinco7&, d!r%r% An 7i%7t 6i s7at%, o sla;& 7r%si!n% la ni@%l!l oc:ilor, iritai% la
loc!l 7%r8!?i%i, :i7%rli7%mi%, :i7%rcoa9!la;ilitat% 6i trom;ocito7%nia>
- an!nai m%dic!l
- r%coltai 7ro;%l% d% la;orator r%comandat%
- sc:im;ai loc!l cat%t%r!l!i
CAPITOLUL II TRANSFU&IA
FIA N". 6.1.)TRANSFU&IA
- Introd!c%r%a An si9!ran& d% sBn9% sa! d%ri@at% d% sBn9% An circ!laia @%noas&
PRE$FTIREA JI )ERIFICAREA "ATERIA'E'OR NECEARE
- Ta@a m%dical& sa! c&r!cior 7%ntr! tratam%nt%
- %rin9i0ac%, m&n!6i st%ril% ad%c@at%
- P!n9a sa! 8lacon!l d% sBn9% i?o-9r!7, i?o-R:
- Tr!sa d% trans8!?i% =7%r8!?or c! 8iltr!>
- (ran!l&08l%#!r&
- ol!i% d%?in8%ctant&, tam7oan%
- $aro!, l%!co7last sa! ;and& ad%?i@& non al%r9ic&
- Etic:%t&
- "!6ama, r%ci7i%nt% d% col%ctar% a d%6%!rilor
- Flan%l& sa! 7&t!r&, stati@
- )%ri8lcai tr!sa d% 7%r8!?i% 7ri@ind int%9ritat%a am;ala<!l!i, data %#7ir&rii
- )%ri8icai int%9ritat%a 7!n9ii d% sBn9%, t%rm%n!l d% @ala;ilitat%, as7%ct!l macrosco7ic al sBn9%l!i
a> PIEICF:
- In8ormai 6i %#7licai 7roc%d!ra 7aci%nt!l!i 7as c! 7as =sco7!l ac%st%ia, s%n?aiil% car% 7ot s& a7ar&, risc!ril%
trans8!?i%i>
- O;in%i consim&mBnt!l!i in8ormat, 8olosind o 8orm& scris& d% consim&mBnt in8ormat
- In8ormai 7aci%nt!l 7ri@ind: s%n?aia d% 8ri9, mBnc&rim%, iritai%, sa! sim7tom% anormal%
;> FIGICF:
- Po?iia 7aci%nt!l!i - d%c!;it dorsal
- Instr!ii 7aci%nt!l s& n! m&nBnc% c! c%l 7!in 2or% Anaint% sa! d!7& t%rminar%a trans8!?i%i
- Al%9%i loc!l 7%ntr! 7!ncia i5@5 - s% %#amin%a?& calitat%a 6i star%a @%n%lor
- )%n%l% c%l% mai a;orda;il% s!nt c%l% al% m%m;r%lor s!7%rioar%, n! c%l% al% m%m;r%lor in8%rioar% =7osi;ilitat% d%
trom;o?ar%>
- )%ri8icai indicaia m%dic!l!i 7ri@ind trans8!?ia 6i cantitat%a d% sBn9% sa! d%ri@aii ac%st!ia - )%ri8icai
id%ntitat%a 7aci%nt!l!i
- 7&lai mBinil%0m&n!6i st%ril%
- Dn ?i!a %8%ct!&rii trans8!?i%i s% r%colt%a?& 2-/ ml d% sBn9% 7%ntr! 7ro;a d% com7ati;ilitat%IEAN(REAU
- Trimit%i la 7!nct!l d% trans8!?ii o c%r%r% d% sBn9% car% c!7rind%:
O n!m%l% s7ital!l!i
O n!m%l% clinicii !nd% %st% int%rnat 7aci%nt!l
O n!m%l% 6i 7r%n!m%l% 7aci%nt!l!i
O @Brsta
O 9r!7a d% sBn9% a 7aci%nt!l!i
O cantitat%a d% sBn9% c%r!t&
O n!m%l% m%dic!l!i car% a indicat trans8!?ia
O n!m%l% n!rs%i car% administr%a?& sBn9%l%
O ?i!a, l!na, an!l
- Dnc&l?ii sBn9%l% la t%m7%rat!ra cor7!l!i, m%nin%i as%7sia cBnd s% d%sc:id% tr!sa d% 7%r8!?at st%ril&
- A6%?ai 7!n9a sa! 8lacon!l c! sBn9% An stati@
44.
- *%sc:id%i tr!sa d% trans8!?at
- Fi#ai cl%ma07r%st!;!l la o distan& d% 2- C cm mai <os d% cam%ra 7%r8!?or!l!i
- Dnc:id%i cl%ma07r%st!;!l 7%r8!?or!l!i, dai <os ca7ac!l ac!l!i 6i ins%rai-l la loc!l d% intrar% al 7!n9ii sa!
8lacon!l!i
- A7&sai, strBn9%i cam%ra d% sc!r9%r% a 7%r8!?or!l!i 6i l&sai s& s% !m7l% 7Bn& la <!m&tat% c! sBn9%
- Dnl&t!rai ca7ac!l 7rot%ctor d% la c%l&lalt ca7&t al t!;!l!i, d%sc:id%i cl%ma07r%st!;!l 6i l&sai sBn9%l% s& c!r9&
7% t!; 7Bn& c% s% %limin& ;!l%l% d% a%r
- 2in%i 7%r8!?or!l la An&lim%a cor7!l!i 7%ntr! a %limina ;!l%l% d% a%r, n! An <os
- Dnc:id%i cl%ma07r%st!;!l 6i 7!n%i ca7ac!l 7rot%ctor
- %l%ctai loc!l 7otri@it =d% 7r%8%rin& @%n%l% d% la 7lic& cot!l!i>
- P!n%i m!6ama!a s!; ;ra!l 7aci%nt!l!i
- A7licai 9aro!l la 40- 42 cm d%as!7ra loc!l!i 7%ntr! 7!nci%H ca7%t%l% 9aro!l!i tr%;!i% dir%cionat% d%7art% d%
?ona d% 7!nci%
- )%ri8icai 7r%?%na 7!ls!l!i distal, radial
- *%?in8%ctai t%9!m%nt!l =tam7on c! alcool>, .0 d% s%c!nd%
- Po?iionai mBna n%dominant& la /- C cm s!; loc!l d% 7!nci% 6i c! 7olic%l% Antind%i 7i%l%a d%as!7ra @%n%i
- Dnl&t!rai ca7ac!l ac!l!i 6i ca7ac!l 7rot%ctor al 7%r8!?or!l!i
- Ata6ai ac!l la 7%r8!?or 6i 7!nctionai @%na
- Urm&rii c!rs!l @%n%i 6i cBnd sBn9%l% s% Antoarc% 7rin l!m%n!l ac!l!i a@ansai ac!l An @%n&, 4-2 cm
- *%?l%9ai 9aro!l 6i s7!n%i 7aci%nt!l!i s& d%sc:id& 7!mn!l
- *ac& s% instal%a?& trans8!?ia c! ;ran!l&, 8l!t!ra6, at!nci 8i#ai c! d%9%t!l ar&t&tor d% la mBna stBn9& %#%rcitBnd
7r%si!n% la -cm d%as!7ra loc!l!i 7!nci%i
- E#tra9%i mandr%n!l d% 7% l!m%n!l ;ran!l%i 6i ata6ai ca7&t!l ;ran!l%i la t!;!l 7%r8!?or!l!i
- *%sc:id%i cl%ma07r%st!;!l 6i dai dr!m!l sBn9%l!i s& c!r9&
- Fi#ai ac!l =;ran!la, 8l%#!ra, 8l!t!ra6!l> c! ;%n?i d% l%!co7last sa! ;and& non al%r9ic&
- Dnc%7%i administrar%a sBn9%l!i
- E8%ct!ai 7ro;a ;iolo9ic& O%l%cX%rH l&sai s& c!r9& 20 - -0 ml d% sBn9% 6i r%9lai ritm!l la 40- 4C 7ic&t!ri0min!t
tim7 d% C\H s!7ra@%9:%ai 7aci%nt!l 6i dac& n! a7ar s%mn% d% incom7ati;ilitat% r%7%tai o7%raia
- A7licai %tic:%ta 7%st% 7!n9& sa! 8lacon!l d% sBn9% indicBnd ora la car% a Anc%7!t trans8!?ia
- *ac& trans8!?ia s-a t%rminat, Anc:id%i cl%ma07r%st!;!l
- R%tra9%i ac!l 6i a7licai !n tam7on c! alcool sa! !n 7ansam%nt st%ril
- P!n9a sa! 8lacon!l An car% tr%;!i% s& r&mBn& a7ro#5 C-. ml d% sBn9% s% 7&str%a?&, An %@%nt!alitat%a !nor
@%ri8ic&ri An ca? d% accid%nt% 7osttrans8!?ional% tardi@%
- A6%?ai 7aci%nt!l Antr-o 7o?ii% comod& 6i s% aco7%r&
- )%ri8icai s%mn%l% @ital% la 8i%car% 4C\, An 7rima <!m&tat% d% or& d!7& Anc%7%r%a trans8!?i%i, 6i la 8i%car% <!m&tat%
d% or& sa! la o or& d!7& trans8!?i%5
- In8ormai 7aci%nt!l08amilia s& an!n% n!rsa An ca? d% mBnc&rim%, dis7n%%, am%%li, d!r%ri An s7at% sa! An 7i%7t,
d%oar%c% ac%st%a 7ot 8i r%acii al% trans8!?i%i
- Instr!ii 7aci%nt!l s& in8orm%?% n!rsa dac& d!r%r%a sa! ro6%aa a7ar la loc!l 7!nci%i @%noas%, d%oar%c% ac%st%a
s!nt indicati@% al% in8iltrai%i
- T%m7%rat!ra cam%r%i s& 8i% c! 4 -2K mai ridicat&
- O8%rii 7aci%nt!l!i lic:id% cald% 6i aco7%rii-l c! 7l%d!l
- 7&lai mBinil%
NOTAREA PROCE*URII
Notai An 7lan!l d% An9ri<iri:
- Administrar%a trans8!?i%i
- N!m&r!l scris 7% 7!n9a sa! 8lacon!l d% sBn9%, ora la car% a Anc%7!t trans8!?ia, ora la car% s-a t%rminat 6i
%@%nt!al%l% r%acii al% 7aci%nt!l!i
447
- E@al!ai r&s7!ns!l 7aci%nt!l!i la administrar%a sBn9%l!i
- s%mn%l% @ital% s!nt normal%
- a;s%na 8rison!l!i, mBnc&rimii, !rticari%i sa! iritai%i
- anali?%l% d% la;orator An limit% normal%
- m!coas%l% 6i t%9!m%nt%l% s!nt colorat% ro?, 7aci%nt!l a An%l%s sco7!l 6i risc!ril% trans8!?i%i
R%?!ltat% n%dorit%0C% 8ac%i:
- Em;olia 7!lmonar& - mani8%stat& 7rin a9itai%, ciano?&, d!r%ri toracic%, t!s% c:in!itoar%, :%mo7ti?i%
- E%moli?a intra@asc!lar& c! ;loca< r%nal, 6oc 7osttrans8!?ional, acido?a m%ta;olic&, sto7 cardiac 7rin :i7ot%rmi%
- s% 7ot 7rod!c% datorit& sBn9%l!i n%Anc&l?it
O Dnc&l?ii sBn9%l% Anaint% d% a-l 7%r8!?a
O !7ra@%9:%ai 7aci%nt!l
O An!nai m%dic!l
O Dntr%r!7%i 7%r8!?ia
- Joc!l :%molitic - incom7ati;ilitat%a d% 9r!7 - 8rison, ta:icardi%, dis7n%%, ciano?&, d!r%ri lom;ar%, r%trost%rnal%,
star% 9%n%ral& alt%rat&
OAn!nai m%dic!l
- Dn8!ndar%a 7%r8!?or!l!i 6i ac!l!i c! c:%a9!ri - s% sc:im;& 7%r8!?or!l 6i ac!l
- Ei7ot%rmia
O Dnc&l?ii ;olna@!l 7rin s!7lim%ntar%a n!m&r!l!i d% 7&t!ri, a7licar%a d% ;!iot% c! a7& cald&
ATEN2IE
- N! Anc&l?ii sBn9%l% An a7& cald&, sa! d%as!7ra s!rs%lor d% c&ld!r&, %@itai a9itar%a 7!n9ii08lacon!l!i
- *ac& a7ar r%acii 7osttrans8!?ional% r%t!rnai 7!n9a08lacon!l d% sBn9% la 7!nct!l d% trans8!?ii
- R%s7%ctai as%7sia
- N! !m7l%i cam%ra 7%r8!?or!l!i c! sBn9% - n! s% mai 7oat% !rm&ri ritm!l d% c!r9%r%
- *ac& ac!l s-a An8!ndat n! 7%rm%a;ili?ai ac!l 7rin 7r%si!n%
FIA N". 6.6.
SUPRA.EG%EREA PACIENTULUI CU REAC2II AD.ERSE LA TRANSFU&IE
O Pr%@%nir%a r%aciilor ad@%rs% 7% 7%rioada trans8!?i%i si d!7& trans8!?i%5
O Instit!ir%a m&s!rilor 7%ntr! a r%d!c% r%aciil% la trans8!?i%5
REAC2II'E A*)ERE
- R%aciil% ad@%rs% 7ot s& a7ar& An 7rim%l% 4C min al% trans8!?i%i 6i d!7& trans8!?i%5
- !nt r%acii sist%mic% la administrar%a sBn9%l!i 6i d%ri@at%lor d% sBn9%, incom7ati;il% c! c%l al ;%n%8iciar!l!i,
car% conin al%r9%ni, sa! s!nt contaminat% c! ;act%rii
- R%aciil% ad@%rs% 9%n%ral% 7ot a@%a sim7tom% @ariind d% la: 8%;r&, 8rison, !rticari%, :i7ot%nsi!n% 6i sto7 cardiac5
Alt% 7osi;il% r%acii ad@%rs% car% 7ot r%?!lta din t%ra7ia trans8!?i%i incl!d s!7raAnc&rcar%a circ!latori% 6i
transmit%r%a !nor ;oli ca: :%7atit%l%, citom%9alo@ir!6i sa! @ir!s!l im!nod%8ici%n%i !man% =EI)>5
- R%acia :%molitic& ac!t& - incom7ati;ilitat% A(O, R: 6i s% 7rod!c% An 7rim%l% C-4C\ d% la instit!ir%a trans8!?i%i5
Ac%asta Anc%7% c! cr%6t%r%a t%m7%rat!rii, ritm!l!i cardiac, s%n?ai% d% c&ld!r& 6i d!r%r% d%-a l!n9!l @%n%i 7% car%
sBn9%l% %st% trans8!?at, 8rison, d!r%r% d% ca7, 9ra&, d!r%r% An 7i%7t 6i s7at%, dis7n%%, :i7ot%nsi!n%,
:omo9lo;in%mi%, :%mo9lo;in!ri%5 % o7r%6t% trans8!?ia5
- R%acia :%molitic& AntBr?iat& - r&s7!ns!l im!n d%?@oltat d% c&tr% 7rimitor Am7otri@a anti9%nilor donator!l!i non
A(O5 F%;ra %st% in%#7lica;il&, d%scr%6t% in%#7lica;il E;, Et, t%st!l Coom;s %st% 7o?iti@5 % o7r%6t% trans8!?ia5
- R%acia 8%;ril& non:%molitic& - 4 P din trans8!?iiH o 7osi;il& s%nsi;ilitat% a 7rimitor!l!i la l%!cocit%l% 6i
trom;ocit%l% din sBn9%l% donator!l!i5 Ac%asta s% 7rod!c% la -0\ d!7& inii%r%a trans8!?i%i 6i la .: d!7& t%rminar%a
trans8!?i%i5 % mani8%st& 7rin 8%;r& mai mar% c! 4K , Anro6ir%a 8%%i, 8risoan%, d!r%r% d% ca75
- R%acia al%r9ic& =!6oar& sa! mod%rat&> ca!?at& d% al%r9ia 7rimitor!l!i la 7rot%in%l% din 7lasma donator!l!i5
Ac%asta s% 7rod!c% 7% d!rata trans8!?i%i 6i la 4: d!7& trans8!?i%5 A7ar %rit%m local, %r!7i% c!tanat&, !rticari%5
- R%acia al%r9ic& s%@%r& - ca!?at& d% al%r9ia 7rimitor!l!i la !n anti9%n al donator!l!i =!?!al I9A>5 A9l!tinar%a
c%l!l%lor ro6ii o;str!%a?& ca7ilar%l% 6i ;loc:%a?& 8l!#!l san9!in, ca!?Bnd sim7tom% ma<or% la toat% maril% or9an%
d% sist%m5 Ac%asta s% 7rod!c% An 7rim%l% C- 4C\ d% la inii%r%a trans8!?i%i5 A7ar t!s%a, 9r%aa, @&rs&t!ra, distr%s!l
r%s7irator, :i7ot%ns:in%a, 7i%rd%r%a c!no6tin%i 6i 7osi;il sto7!l cardiac5 Ac%asta %st% o r%aci% car% am%nin&
@iaa5 % o7%6t% trans8!?ia, s% m%nin% linia @%noas&, s% in8orm%a?& m%dic!l, s% administr%a?& m%dicam%nt%l%
44,
7r%scris% =anti:istaminic%, corticost%roi?i, %7in%8rina, anti7ir%tic%>5 % m&soar& s%mn%l% @ital% la 8i%car% C- 4C\ 6i
s% iniia?& r%s!scitar%a cardio7!lmonar& dac& %st% n%@oi%5
- !7raAnc&rcar%a circ!latori% - 7oat% cond!c% la %d%m!l 7!lmonar 6i s% 7rod!c% din ca!?a @ol!m!l!i %#c%si@ sa!
ritm!l!i ra7id al trans8!?i%i5 Ac%asta 7oat% a7ar% An oric% mom%nt, sa! la 4 -2: d!7& t%rminar%a trans8!?i%i5 A7ar
dis7n%%a, t!s%a, ta:i7n%%a, ta:icardia, cr%6t%r%a 7r%si!nii @%noas% c%ntral%5 % r%s7%ct& ritm!l d% administrar% d%
2-/ml0X90:5 % acord& at%ni% s7%cial& ritm!l!i 6i @ol!m!l!i d% administrar% la 7aci%nii An @Brst&5 % Anc%tin%6t%
sa! s% o7r%6t% trans8!?ia, s% administr%a?& la indicaia m%dic!l!i di!r%tic%, o#i9%n 6i mor8in&5
- %7sis ;act%rian - datorit& contamin&rii ;act%ri%n% a 7rod!s!l!i trans8!?at5 Ac%asta a7ar% 7% d!rata trans8!?i%i 6i
la 2: d!7& t%rminar%a trans8!?i%i5 % mani8%st& 7rin 8%;r&, 8rison, cram7% a;dominal%, @&rs&t!r&, diar%%,
:i7ot%nsi!n%5 % a7lic& An9ri<iri cor%s7!n?&toar%5 % o7r%6t% trans8!?ia 6i s% m%nin% linia @%noas&, s% in8orm%a?&
m%dic!l, s% monitori?%a?& s%mn%l% @ital%, s% r%colt%a?& :%moc!lt!ra5 'a indicaia m%dic!l!i s% administr%a?&
8l!id% i5@5, anti;iotic% c! s7%ctr! lar9 antimicro;ian, @aso7r%soar% 6i st%roi?i5
E)A'UAREA PACIENTU'UI
- O;s%r@ai 7aci%nt!l 7%ntr! 8%;r& c! sa! 8&r& 8rison5 F%;ra 7oat% indica d%;!t!l !n%i r%acii :%molitic% ac!t%,
r%acii 8%;ril% non:%molitic%, sa! s%7tic%mi% ;act%rian&
- O;s%r@ai 7aci%nt!l 7%ntr! ta:icardi% 6i0sa! ta:i7n%% 6i dis7n%%5 Ac%st%a 7ot indica r%aci% :%molitic& ac!t& sa!
s!7raAnc&rcar% circ!latori%5 Ac%st% sim7tom% 7ot 8i Ansoit% d% t!s% An ca? d% s!7raAnc&rcar% circ!latori%5
- O;s%r@ai 7aci%nt!l 7%ntr! !rticari% sa! %r!7i% c!tanat&5 Ac%st%a 7ot 8i indicii tim7!rii al% !n%i r%acii al%r9ic%,
ana8ilactic%, car% s% 7rod!c d!7& trans8!?i%5
- O;s%r@ai 7aci%nt!l 7%ntr! Anro6ir%a 8%%i5 Inro6ir%a 8%%i 7oat% 8i 7r%?%nt& Antr-o r%aci% :%molitic& ac!t&, sa! o
r%ci% non:%molitic&5
- O;s%r@ai 7aci%nt!l 7%ntr! sim7tom%l% 9astroint%stinal%5 $r%aa 6i @&rs&t!ra 7ot 8i 7r%?%nt% An r%aciil%
trans8!?ional% :%molitic% ac!t%, r%aciil% ana8ilactic%, sa! s%7sis5
- O;s%r@ai 7aci%nt!l 7%ntr! sc&d%r%a TA5 Ei7ot%nsi!n%a 7oat% 8i o r%aci% ac!t& :%molitic&, ana8ilactic&, sa!
s%7sis5
- O;s%r@ai 7aci%nt!l 7%ntr! ^:%%?in9, d!r%r% An 7i%7t 6i sto7 cardiac5 Ac%st%a toat% s!nt r%acii ana8ilactic%5
- Fii at%ni la 7lBn9%ril% 7aci%nt!l!i 7%ntr! d!r%ri d% ca7 sa! d!r%ri m!sc!lar% An 7r%?%na 8%;r%i5 AmBndo!& 7ot
8i indicii al% !n%i r%acii non:%molitic% 8%;ril%5
- "onitori?ai 7aci%nt!l 7%ntr! dis%minar%a coa9!l&rii intra@asc!lar%, ins!8ici%na r%nal&5,
:%mo9lo;in%mi%0:%mo9lo;in!ri%5 Toat% ac%st%a s!nt s%mn% tBr?ii al% r%aci%i :%molitic% ac!t%5
- "onitori?ai @aloril% d% la;orator 7%ntr! an%mia r%8ractar& la t%ra7ia trans8!?i%i5 Ac%asta ar 7!t%a s%mni8ica o
r%aci% :%molitic& AntBr?iat&5
- O;s%r@ai 7aci%nii car% 7rim%sc trans8!?ii masi@% d% sBn9% 7%ntr! :i7ot%rmi% !6oar&, t!l;!r&ri d% ritm cardiac%,
:i7ot%osi!n% si :i7ocalc%mi%, :i7%rXal%mi%5 Prod!s%l% d% sBn9% r%ci 7ot a8%cta sist%m!l d% cond!c%r% cardiac
r%?!ltBnd disaritmii @%ntric!lar%5 Alt% disaritmii cardiac%, :i7ot%nsi!n%a 6i 8!rnic&t!ril% 7ot indica :i7ocalc%mia,
car% a7ar at!nci cBnd citrat!l =!tili?at dr%7t cons%r@ant 7%ntr! 7rod!s%l% d% sBn9%> s% com;in& c! calci!l
7aci%nt!l!i5 Ei7%rXal%mia d!c% la colici int%stinal%, diar%%, oli9!ri%, s7asm% m!sc!lar%, modi8ic&ri 7% EC$,
;radicardi% 7r%m%r9&toar% sto7!l!i cardiac5
CE FACE" DN CAGU' UNOR REAC2II 'A TRANFUGIEN
- O7rir%a trans8!?i%i5 %@%ritat%a r%aciilor %st% l%9at& d% cantitat%a introd!s&5
- c:im;ai 7%r8!?or!l car% conin% c:%a9!ri d% sBn9% 6i Anloc!ii-l c! alt!l no!, %#c%7i% ca?!l An car% %st% n!mai
o r%aci% !6or al%r9ic&55
- In8ormai m%dic!l5 R%aciil% la trans8!?i% c%r im%diat int%r@%nii m%dical%5 Dn ca?!l !n%i r%acii al%r9ic% !6oar%,
trans8!?ia ar tr%;!i sto7at& 6i administrat% anti:istaminic%, la indicaia m%dic!l!i5 Trans8!?ia 7oat% 8i r%l!at&5
- "%nin%i linia @%noas& 7%ntr! administrar%a d% m%dicam%nt% 6i sol!ii la n%@oi%5
- Notai sBn9%l% 6i 7rod!s%l% d% sBn9%, tim7!l An car% a! a7&r!t r%aciil% trans8!?i%i, dar 6i int%r@%niil% n!rs%i5
- R%coltai sBn9% sim7l!5 % r%colt%a?& o 7ro;& sBn9% Anaint% d% trans8!?i% 7%ntr! 7ro;a d% com7ati;ilitat%5 A
do!a 7ro;& =dac& %st% n%c%sar> s% r%colt%a?& din ;ra!l o7!s trans8!?i%i 6i s% @a @%ri8ica :%mo9lo;ina li;%r& An s%r,
indicBnd :%moli?a 6i d%as%m%n%a ar tr%;!i @%ri8icat ni@%l!l ;ilir!;in%i5
- R%t!rnai la 7!nct!l d% trans8!?ii 7!n9a d% sBn9%, o7rind cBi@a ml d% sBn9%, 7%ntr! o %@%nt!al& @%ri8icar% An
ca?!l An car% s% 7rod!c r%acii 7ostrans8!?ional% s%@%r%5
- "onitori?ai s%mn%l% @ital% la 8i%car% 4C\ sa! mai 8r%c@%nt dac& tr%;!i%5 "%nin%i %@al!ar%a contin!& a st&rii
cardio7!lmonar% a 7aci%nt!l!i5
- Administrai m%dicaia 7r%scris& An acord c! ti7!l 6i s%@%ritat%a r%aci%i la trans8!?i%:
44+
O anti:istaminic% - dimin!%a?& !n%l% as7%ct% al% r&s7!ns!l!i al%r9ic 7rin ;locar%a r%c%7torilor :istaminici5 In
!n%l% ca?!ri 7ot 8i administrat% 7r%trans8!?ional, la indicaia m%dic!l!i
Oanti7ir%tic%0anal9%?ic% - s% administr%a?& 7%ntr! a sc&d%a 8%;ra 6i dicon8ort!l An: r%aciil% :%molitic% ac!t%,
r%aciil% 8%;ril% non:%molitic%, s%7sis!l ;act%rian
O corticost%roi?i - sta;ili?%a?& m%m;ran%l% c%l!l%i, d%scr%sc %li;%rar%a :istamin%iH s% administr%?& An r%acii
al%r9ic% s%@%r%
O8l!id%l% - administrar%a ra7id& a 8l!id%lor i5@5 7oat% a<!ta la contracarar%a !nor sim7tom% al% 6oc!l!i ana8ilactic
O di!r%tic%0mor8in& - 7ot 8i administrat% An s!7raAnc&rcar%a circ!latori% 7%ntr! a r%d!c% @ol!m!l intra@asc!lar
O anti;iotic% - s% administr%a?& cBnd %st% s!s7%ctat& contaminar%a ;act%rian&
O An ca?!l !n!i sto7 cardiac - s% iniia?& r%s!scitar%a cardio7!lmonar&
O r%coltai 7rima 7ro;& d% !rin& - s% 7oat% 7rod!c% :%mo9lo;in!ria datorit& r%aciilor :%molitic%5 $rad!l d%
d%t%riorar% al rinic:ilor %st% in8l!%nat d% 7E-!l !rinar 6i d% rata %#cr%i%i !rinar%5 *ac& d%t%riorar%a rinic:ilor
%st% s%@%r&, s% r%comand& diali?&
REGU'TATE AJTEPTATE
- Paci%nt!l @a a@%a m!coas% ro?%5 P%r8!?ia tis!lar& %st% Am;!n&t&it&
- *%;it!l cardiac @a r%@%ni la @aloril% d% ;a?&5 )ol!m!l intra@asc!lar %st% r%sta;ilit
- TA s% @a m%nin% sta;il&5 )ol!m!l intra@asc!lar %st% r%sta;ilit5 A;s%nta r%aciilor trans8!?i%i5
- Paci%nt!l @a 8i calm 6i %#7rim& con8ort5 Dn9ri<iril% n!rsin9 s!nt a7licat% cor%s7!n?&tor 7%ntr! a m%nin%
si9!rana 6i con8ort!l 7aci%nt!l!i5
- Paci%nt!l A6i m%nin% t%m7%rat!ra cor7!l!i An limit% normal%
- Paci%nt!l @a %limina !rin& 0,C - 4 ml0X90: - r%8l%ct& star%a o7tim& a 8l!id%lor5
- Paci%nt!l A6i @a m%nin% sat!raia d% o#i9%n mai mar% d% +CP
CAPITOLUL III. APLICAREA AGEN2ILOR FI&ICI
FIA N". 7.1. )APLICA2II CALDE
- Acti@ar%a circ!lai%i 7rin dilataia @as%lor d% sBn9%
- Calmar%a d!r%rii 7rin r%d!c%r%a s7asm!l!i m!sc!lar
- Cr%6t%r%a s%cr%i%i 9astric% 6i a %#cr%i%i r%nal%
- c&d%r%a in8lamai%i 6i 9r&;ir%a 8orm&rii col%ci%i 7!r!l%nt%
- Promo@ar%a con8ort!l!i 6i 9r&;ir%a 7roc%s!l!i d% @ind%car%
TIPURI *E CF'*URF
C&ld!ra dir%ct& 7oat% 8i:
- !scat&
O 8!rni?at& la o t%m7%rat!r& mai mar% 6i 7%ntr! !n tim7 And%l!n9at c! a<!tor!l !nor dis7o?iti@%: sticla c! a7&
cald&, t%rmo8oar%, 7!n9a c! a7& cald&, 7%rna %l%ctric&
- !m%d&
O %stom7%a?&, at%n!%a?& cr!st%l% 6i %#!dat%l%, 7%n%tr%a?& mai adBnc d%cBt c&ld!ra !scat&, n! !s!c& 7i%l%a,
7rod!c% mai 7!in& trans7irai% 6i !?!al %st% mai con8orta;il& 7%ntr! 7aci%nt
O dis7o?iti@%l% 7%ntr! a7licar%a c&ld!rii !m%d% incl!d: com7r%s% cald% 7%ntr! ?on% mici al% cor7!l!i st%ril% sa!
n%st%ril%, mat%rial% a;sor;ant% Am7&t!rit% 7%ntr! ?on% mai mari al% cor7!l!i =%#5 7%ntr! 7ri6ni!l toracic>
PRECAU2II
- N! s% !tili?%a?& la 7aci%nii c! risc :%mora9iic
- Est% contraindicat& la 7aci%nii c! l!#aii An stadi! ac!t =d%oar%c% @asodilataia 7oat% cr%6t% d!r%r%a 6i !m8l&t!ra,
%d%m!l>, sa! c! 7roc%s% in8lamatorii ac!t% 5
- C&ld!ra s% a7lic& c! 7r%ca!i% la co7ii 6i 7aci%nii An @Brst& c! ins!8ici%n& r%nal&, cardiac&, sa! r%s7iratori%H
art%rioscl%ro?& sa! at%roscl%ro?a5
- % a7lic& c! 7r%ca!i% %#tr%m& An ?on% s%nsi;il% la c&ld!r& =cicatrici sa! stom%, 7rot%?% artic!lar%, ?on% c!
im7lant!ri m%talic%> Antr!cBt cr%6t% risc!l d% ars!ri 6i d%t%rmin& %8%ct% sist%mic% =:i7ot%nsi!n%, 7oli7n%%>5
- T%mom%tr!, 7roso7, ;and& ad%?i@&
- "&n!6i dac& 7aci%nt!l ar% o l%?i!n% d%sc:is&
420
- P%ntr! sticla c! a7& 8i%r;int%: a7& 8i%r;int% d% la ro;in%t, t%rmom%tr! d% ;ai%, mat%rial a;sor;ant t%#til, 7rot%ctor
7%ntr! An@%lir%a sticl%i5
O % a<!st%a?& t%m7%rat!ra: /.,4KC - C4,7KC 7%ntr! ad!li 6i /0,.KC - /.,4KC 7%ntr! co7iii s!; 2 ani 6i
7aci%nii An @Brst&H
O % @%ri8ic& r%?ist%na sticl%i la c&ld!r&5
O % !m7l% sticla 7Bn& la <!m&tat% sa! 20- 6i s% An@%l%6t% c! mat%rial!l t%#til 7%ntr! a n! @%ni An contact
dir%ct c! 7i%l%a5
- P%ntr! o 7%rn& %l%ctric&: mat%rial 7rot%ctor 7%ntr! An@%lir%
O % @%ri8ic& ca;l! s& 8i% int%9r! 6i s& n! 8i% !n d%8%ct d% i?olai%
O % con%ct%a?& la 7ri?& 6i s% control%a?& 7o?iia mont!rii
O % An8&6oar& 7%rna c! o 7Bn?& sa! !n 7roso7 7%ntr! 7rot%ci%
- P%ntr! o com7r%s& cald&: @as c! a7& 8i%r;int% sa! !n r%ci7i%nt c! a7& st%ril&, normal salin& sa! alt% sol!ii, la
indicaia m%dic!l!iH sticl& c! a7& 8i%r;int%5 Ac%st%a 7ot 8i st%ril% sa! n%st%ril%, d%7ind% d% 7rod%d!ra c%r!t&:
com7r%s% sa! mat%rial a;sor;ant, 7roso7 a;sor;ant, ti8on Am7&t!rit, 7%ns&, ;ol sa! ;a?in, t%rmom%tr! d% ;ai%,
7roso7, mat%rial im7%rm%a;il car% aco7%r& com7r%sa, Am;r&c&mint%5
O R%ci7i%nt!l c! a7& st%ril& 8i%r;int% sa! sol!ii st%ril% s% a6%a?& la c:i!@%t&
O % m&soar& t%m7%rat!ra c! !n t%rmom%tr! st%ril d% ;ai%
O *ac& n! %#ist& !n t%rmom%tr! st%ril, s% toarn& sol!i% st%ril& Anc&l?it& Antr-!n @as c!rat 6i s% @%ri8ic&
t%m7%rat!ra c! !n t%rmom%tr! o;i6n!it 6i a7oi s% ar!nc& sol!ia t%stat&
O % a<!st%a?& t%m7%rat!ra !n%i sol!ii st%ril% 7rin ad&!9ar%a d% a7& 8i%r;int% sa! r%c% d% la c:i!@%t&,
7Bn& cBnd sol!ia a<!n9% la CCKC 7%ntr! ad!li sa! /0,4KC 7%ntr! co7ii 6i 7aci%nii An @Brst& 6i 7%ntr! com7r%s%l%
d% 7!s la oc:i5
O $olir%a sol!i%i Antr-!n ;ol sa! ;a?in
O A7oi s% !tili?%a?& t%:nici st%ril%, !m%?ir%a com7r%s%lor An sol!ia 8i%r;int%
- Com7r%s% cald% n%st%ril%
O % !m7l% !n ;ol sa! ;a?in c! a7& 8i%r;int% sa! alt& sol!i% 6i s% m&soar& t%m7%rat!ra c! !n t%rmom%tr!
d% ;ai%
O % a<!st%a?& t%m7%rat!ra - CCKC 7%ntr! ad!li, /0,40KC 7%ntr! co7ii 6i 7aci%ni An @Brsta, 6i 7%ntr!
com7r%s% 7%ntr! oc:i
O % !m%?%6t% com7r%sa An lic:id!l 8i%r;int%, s% stoarc% 6i s% a7lic&
- Pri6nit!l toracic
O % !tili?%a?& 7%ntr! ;olna@ii 8%;rili
O % 8olos%6t% !n c%r6a8 d% 7at din ;!m;ac Am7&t!rit An tr%i
O % !m%?%6t% c! a7& 8i%r;int% 20- din s!7ra8a&, a7oi s% stoarc%
O % stro7%6t% c! alcool sanitar 6i s% a7lic& 7% torac%l% ;olna@!l!i 7rin r!lar% ast8%l AncBt 7art%a !m%?it& s& @in& An
contact dir%ct c! t%9!m%nt%l%, iar 7art%a !scat& a c%ar6a8!l!i sa! mat%rial!l!i 8olosit s& @in& An <!r!l torac%l!i
7%st% 7art%a !m%?it&
- Id%nti8icai 7aci%nt!l 6i 7roc%d!ra indicat&
- E@al!ai star%a 7i%lii !nd% s% @a a7lica c&ld!ra5
- Cam%r% s& 8i% Anc&l?it&
- coat%i a%r!l car% a r&mas An 7!n9a ast8%l 7r%sBnd-o !6or 7% o s!7ra8a& 7lan&, a7oi Anc:id%i 7!n9a, sa! in%i
7!n9a s!s, strBn9%i 7ori!n%a n%!m7l!t& 7%ntr! a i%6i a%r!l, a7oi Anc:id%i 7!n9a5 trBn9%i ;in% ca7ac!l5
)%ri8icai s& n! ai;& 8is!ri5
- A@%rti?ai 7aci%nt!l s& ra7ort%?% d!r%r%a sa! discon8ort!l im%diat, sa! s& And%7&rt%?% sin9!r dis7o?iti@!l, dac&
%st% n%c%sar
- "&s!rai t%m7%rat!ra, 7!ls!l 6i r%s7iraia Anaint% d% a s% 8ac% a7licaia
- *ac& tratam%nt!l cald a 8ost a7licat 7%ntr! a cr%6t% t%m7%rat!ra cor7!l!i 7aci%nt!l!i, s% monitori?%a?& tot tim7!l
a7licai%i t%m7%rat!ra, 7!ls!l 6i r%s7iraia
- % %#7!n% n!mai ?ona tratat& d%oar%c% @asodilataia @a 8ac% ca 7aci%nt!l s& n! ai;& 8rison
- 7&lai mBinil% m%tic!los
- ticla c! a7& cald&, P!n9a c! a7a cald&, 7%rna %l%ctric&
424
O E@al!ai 8r%c@%nt star%a 7i%lii 7aci%nt!l!i 6i And%7&rtai dis7o?iti@!l =sticla c! a7& cald&, 7!n9a c! a7& cald&,
7%rna %l%ctric&> dac& o;s%r@ai !m8lar% %#c%si@& sa! ro6%a& %#c%si@&, @%?ic!l%, mac%rar% sa! 7aloar% 7ron!nat&,
sa! dac& 7aci%nt!l ra7ort%a?& d!r%r% sa! discon8ort
O Um7l%i din no! 7!n9a, sticla dac& %st% n%c%sar 7%ntr! a m%nin% t%m7%rat!ra cor%ct&
O Dnd%7&rtai dis7o?iti@!l %#t%rn =sticla c! a7& cald&, 7!n9a c! a7& cald&, 7%rna %l%ctric&> d!7& 20--0\
O Jt%r9%i 7i%l%a 7aci%nt!l!i c! !n 7roso7
O "&s!rai t%m7%rat!ra, 7!ls!l 6i r%s7iraia 7%ntr! a 8ac% com7arai% c! @aloril% dinaint%a a7licai%i
O Po?iionai con8orta;il 7aci%nt!l An 7at
O *ac& tratam%nt!l tr%;!i% r%7%tat d%7o?itai mat%rial%l% An cam%ra 7aci%nt!l!i, iar dac& n!, d%7o?itai mat%rial%l%
Antr-!n loc ad%c@at
- A7licar%a !n%i com7r%s% cald%
O P!n%i l%n<%ri% d% 7rot%ci% s!; ?ona d% tratam%nt, Antind%i 9%l =st%ril dac& %st% n%c%sar> 7%st% ?ona a8%ctat&5
E@itai a7!car%a dir%ct& 7% !n%l% ?on% distr!s% 6i la ni@%l!l oc:ilor =7!t%i a7lica com7r%s% st%ril%>5 $%lnl r%d!c%
mac%rar%a 6i risc!l d% ars!ri 7rin d%scr%6t%r%a rat%i d% 7%n%trar% a c&ld!rii5
O Ridicai com7r%s%l% cald% din ;ol sa! ;a?in =!tili?ai o 7%ns& st%ril& 7%ntr! o 7roc%d!r& st%ril&>5
O toarc%i %#c%s!l d% sol!i% din com7r%s& =!tili?ai o 7%ns& st%ril& 7%ntr! o 7roc%d!r& st%ril&>5 E#c%s!l d%
!m%?%al& cr%6t% risc!l d% ars!ri5
O A7licai com7r%sa c! ;lBnd%% 7% loc!l a8%ctat 6i d!7& cBt%@a s%c!nd%, ridicai com7r%sa 6i @%ri8icai as7%ct!l
7i%lii, mac%rar% sa! @%?ic!l%5
O "!lai ra7id com7r%sa 7% 7i%l%, ca s& n! intr% a%r, dac& s!nt%i si9!r c& n! s-a! 7rod!s ars!ri5 A7licai !n
mat%rial im7%rm%a;il 7%st% com7r%s& 6i 8i#ai-l c! ;anda ad%?i@&5
O Plasai o sticl&, 7!n9& c! a7& cald& 7%st% com7r%s& 6i im7%rm%a;il 7%ntr! a m%nin% t%m7%rat!ra cor%ct&
O )%ri8icai 7i%l%a 7aci%nt!l!i la 8i%car% C\ 7%ntr! a id%nti8ica s%mn%l% d% intol%ran& al% %s!t!rilor5 Ridicai
com7r%sa cald& dac& 7i%l%a arat& ro6%a& %#c%si@&, mac%rar% sa! @%?ic!l%, sa! dac& 7aci%nt!l simt% d!r%r% sa!
discon8ort5 c:im;ai com7r%sa dac& %st% n%c%sar s& m%nin%i t%m7%rat!ra cor%ct&5
- *!7& 4C-20 d% min!t% ridicai com7r%sa =!tili?ai 7%nsa, dac& %st% n%c%sar>5 Ar!ncai com7r%sa Antr-!n r%ci7i%nt
d% d%6%!ri5
- Jt%r9%i 7i%l%a 7aci%nt!l!i c! !n 7roso7 =st%ril, dac& %st% n%c%sar>: Notai star%a 7i%lii5
- "&s!rai t%m7%rat!ra, 7!ls!l 6i r%s7iraia 7%ntr! a 8ac% com7arai% c! @aloril% dinaint%a a7licai%i
- Asi9!rai con8ort!l 7aci%nt!l!i
- Ar!ncai lic:id%l% 6i mat%rial%l% 8olosit%5 *!c%i la st%rili?ar% mat%rial%l% 7%ntr! st%rili?ar%5
- *ac& tratam%nt!l tr%;!i% r%7%tat d%7o?itai mat%rial%l% An cam%ra 7aci%nt!l!i, iar dac& n! d%7o?itai mat%rial%l%
Antr-!n loc ad%c@at
CONI*ERA2II PECIA'E
- !7rimai tratam%nt!l d!7& -0 d% min!t% d%oar%c%, 7Bn& la ac%st tim7 7ro;a;il @asodilataia s-a 7rod!sH a7oi
!rm%a?& @asoconstricia, %8%ct r%@%rs al tratam%nt!l!i cald5
- N! !tili?ai !n dis7o?iti@ %l%ctric d% c&ld!r& lBn9& o#i9%n d%oar%c% o scBnt%i% d% la !n ca;l! ?dr%n!it 7oat%
7ro@oca %#7lo?i% 6i inc%ndi!5 *% alt8%l 7%ntr! a 7r%@%ni 6oc!l %l%ctric, %@itai !tili?ar%a !n%i 7%rn% %l%ctric% lBn9&
lic:id =incl!?Bnd 7% c%l al 7aci%nt!l!i c! incontin%n&> 6i %@itai mBn!ir%a dis7o?iti@!l!i c! mBinil% !m%d%5
- *ac& 7aci%nt!l %st% incon6ti%nt, an%st%?iat, c! 7ro;l%m% n%!rolo9ic%, sa! ins%nsi;il la c&ld!r&, @%ri8icai
8r%c@%nt loc!l 7%ntr! a %@ita com7licaii ca: %d%m!l, mac%rar%a, 7%t% ro6ii, @%?ic!l%5
- A7licaia tr%;!i% s& aco7%r% o ?on& s!8ici%nt d% mar% 7%ntr! a cr%6t% @ol!m!l d% sBn9% d% la ni@%l!l s!7ra8%%i
7i%lii ar!nci cBnd s% !rm&r%6t% r%d!c%r%a con9%sti%i or9an%lor int%rn%5
- Utili?ai t%:nica st%ril& cBnd a7licai c&ld!r& !m%d& 7% o 7la9& d%sc:is&
- Utili?ai s%7arat mat%rial% 7%ntr! 8i%car% oc:i, 7%ntr! a 7r%@%ni contaminar%a
- Utili?ai m&n!6i st%ril% An loc d% 7%ns& st%ril& 7%ntr! a7licar%a com7r%s%lor !m%d%5
NOTAREA PROCE*URII:
- Notai An 7lan!l d% An9ri<ir%
O tim7!l 6i data a7lic&rii c&ld!rii, ti7!l d% a7licai%
O t%m7%rat!ra, d!rata, loc!l !nd% s% a7lic& c&ld!ra
O t%m7%rat!ra 7aci%nt!l!i, 7!ls!l, r%s7iraia
O star%a 7i%lii Anaint%, 7% d!rata 6i d!7& tratam%nt
O s%mn%l% com7licaiilor
422
FIA N". 7.6. APLICA2II RECI
- Promo@ar%a @asoconstrici%i ca7ilar% 7rin in:i;ar%a circ!lai%i local%
- Controlar%a 6i Anc%tinir%a sBn9%r&rii
- R%d!c%r%a %d%m%lor
- Dnc%tinir%a acti@it&ii ;act%ri%n% An in8%cii
- c&d%r%a in8lamai%i
- R%d!c%r%a d!r%rii
- c&d%r%a t%m7%rat!rii
TIPURI *E AP'ICA2II RECI
- !scat&
O dis7o?iti@%l% 7%ntr! a7licaia r%c% !scat& incl!d: 7!n9a c! 9:%a& sa! colar!l, sa! 7ac:%t% d% 9:%a&
- !m%d&
O %st% m!lt mai 7%n%trant& d%cBt c%a !scat&
O dis7o?iti@%l% 7%ntr! a7licaia !m%d& r%c% incl!d: com7r%s%l% r%ci 7%ntr! ?on% mici al% cor7!l!i 6i
com7r%s% mari r%ci 7%ntr! ?on% mari
PRECAU2II
% a7lic& c! 7r%ca!i!n% tratam%nt%l% r%ci 7%ntr! 7aci%nii c!:
O ins!8ici%n& circ!latori%
O 7%ntr! co7ii 6i ;&trBni
O 7aci%nii c! art%rit& d%oar%c% %#ist& risc!l d% distr!9%r% al %s!t!l!i isc:%mic5
- T%rmom%tr!, 7roso7, ;and& ad%?i@&
- "&n!6i st%ril%
- P%ntr! 7!n9a c! 9:%a& sa! colar: c!;!ri d% 9:%a&, a7& r%c% d% la c:i!@%t&, mat%rial a;sor;ant 7%ntr! 7rot%ci%
- P%ntr! com7r%s% r%ci: r%ci7i%nt c! c!;!ri d% 9:%a&, r%ci7i%nt c! a7& r%c% d% la c:i!@%t&, t%rmom%tr! d% ;ai%,
com7r%s%, l%n<%ri% d% 7rot%ci%, mat%rial im7%rm%a;il 7%ntr! aco7%rir%5
- P%ntr! 7!n9a c! 9:%a& sa! colar
O %l%ctai o 7!n9& d% 9:%aa sa! !n colar d% m&rim% 7otri@it&
O Um7l%i 7!n9a d% 9:%a& sa! colar!l c! a7& r%c% d% la c:i!@%t& 7%ntr! a @%ri8ica int%9ritat%a
O $olii a7a 6i !m7l%i a7oi colar!l 7Bn& la <!m&tat% c! 9:%a& m&r!nit& 7%ntr! a s% 7!t%a m!la 7% cor7!l
7aci%nt!l!i5
O trBn9%i d% 7!n9a c! 9:%a& sa! colar 7%ntr! a %limina a%r!l car% 7oat% r%d!c% cond!c%r%a5
O P!n%i ca7ac!l 6i 6t%r9%i !m%?%ala d% 7% 7!n9a c! 9:%a& sa! colar
O Dn@%lii 7!n9a c! 9:%a& sa! colar!l c! !n mat%rial t%#til 7rot%ctor 6i 7!n%i o ;and& ad%?i@& 7%st% mat%rial5
Aco7%rir%a d% 7rot%cti% 7r%@in% tra!ma %s!t!rilor 6i a;soar;% cond%nsar%a5
- P%ntr! com7r%s% r%ci
O P!n%i a7a r%c% d% la c:i!@%t& Antr-!n r%ci7i%nt c! 9:%a& sa! ad&!9ai 9:%aa An a7&
O Utili?ai !n t%rmom%tr! d% ;ai% 7%ntr! 9:idar%
O A<!stai t%m7%rat!ra a7%i la 4CKC
- )%ri8icai indicaia m%dic!l!i 6i %@al!ai star%a 7aci%nt!l!i
- E#7licai 7roc%d!ra 7aci%nt!l!i
- Cam%ra s& 8i% Anc&l?it&
- "&s!rai 6i notai t%m7%rat!ra, 7!ls!l 6i r%s7iraia Anaint% d% a s% 8ac% a7licaia r%c%
- % %#7!n% n!mai ?ona tratat& 7%ntr! a %@ita 8rison!l
- 7&lai mBinil% ri9!ros
A7licar%a 7!n9ii d% 9:%a& sa! colar!l!i
O Plasai 7!n9a c! 9:%a& sa! colar!l 7% loc!l d% tratat 6i Anc%7%i cronom%trar%a
O O;s%r@ai 8r%c@%nt loc!l 7%ntr! s%mn% d% intol%ran& a %s!t!rilor: al;ir%, marmorar%, 7aliditat%, ciano?&,
mac%rar% sa! @%?ic!l%5
O O;s%r@ai 7aci%nt!l 7%ntr! tr%m!r&t!ri 6i 7%ntr! 7lBn9%ril% 7ri@ind ars!ra sa! amor%lil%5
42-
O O7rii tratam%nt!l dac& a7ar ac%st% s%mn% sa! sim7tom% 6i an!nai m%dic!l
O Ridicai 7!n9a sa! colar!l d!7& 7%rioada d% tratam%nt 7r%scris& =!?!al -0 d% min!t%>5
A7licar%a com7r%s%lor r%ci
O P!n%i l%n<%ri% d% 7rot%ci% s!; ?ona d% tratat
O c!8!ndai com7r%sa An a7&
O coat%i com7r%sa din a7&
O toarc%i com7r%sa 7%ntr! a 7r%@%ni c!r9%r%a 7ic&t!rilor d% a7&
O A7licai com7r%sa 7% loc!l d% tratat 6i Anc%7%i cronom%trar%a a7licai%i
O Aco7%rii com7r%sa c! !n mat%rial im7%rm%a;il
O P!n%i o ;and& ad%?i@&
O )%ri8icai 8r%c@%nt loc!l d% a7licar% 7%ntr! s%mn% 6i sim7tom% d% intol%ran& a %s!t!rilor
O Notai 7lBn9%ril% 7aci%nt!l!i - ars!ri sa! amor%li
O O7rii tratam%nt!l dac& s% d%?@olt& ac%st% s%mn% sa! sim7tom% 6i an!nai m%dic!l
O Ridicai com7r%sa d!7& 7%rioada d% tratam%nt 7r%scris& =!?!al 20 d% min!t%>
CONI*ERA2II PECIA'E
- A7licai r%c% im%diat d!7& o r&nir% 7%ntr! a minimali?a %d%m%l%
- T%m7%rat!ril% r%ci 7ot 8i tol%rat% 7%ntr! !n tim7 l!n9 cBnd loc!l d% tratat %st% mic
- N! contin!ai nici o a7licai% mai m!lt d% o or&, 7%ntr! a 7r%@%ni @asodilataia r%8l%#i@&
- CBnd s% a7lic& r%c% 7% o 7la9& d%sc:is& sa! o l%?i!n% car% s% 7oat% d%sc:id% 7% 7%rioada tratam%nt!l!i, !tili?ai
t%:nica st%ril&
- "%nin%i t%:nica st%ril& 7% d!rata tratam%nt!l!i la oc:i, c! mat%rial st%ril 7%ntr! 8i%car% oc:i s%7arat, 7%ntr! a
7r%@%ni contaminar%a
CAPITOLUL I.. PREG1TIREA PREOPERATORIE I (NGRI'IREA POSTOPERATORIE
FIA N". 4.1. PREG1TIREA PREOPERATORIE
O(IECTI)E PECIFICE
- Pr%9&tir%a 7aci%nt!l!i 7%ntr! o7%rai% 7rin :
O r%stricionar%a a7ort!l!i d% alim%nt% 6i lic:id%
O 7r%9&tir%a cBm7!l!i o7%rator =s!7ra8aa c!tanat&>
O r%coltar%a 7rod!s%lor 7%ntr! %#am%n% d% la;orator
O %8%ct!ar%a i9i%n%i 7%rsonal% 6i a altor n%@oi d% ;a?&
O asi9!rar%a si9!ran%i 7aci%nt!l!i d!7& administrar%a m%dicai%i 7r%an%st%?ic%
- Pr%9&tir%a doc!m%nt%lor 7aci%nt!l!i 7%ntr! o7%rai% 7rin:
O r%@%d%r%a s%mn&t!rii consim&mBnt!l!i c:ir!r9ical
O com7l%tar%a c! ac!rat%% a list%i o7%ratorii
- F!rni?ar%a, 7r%o7%rator, d% in8ormaii 6i instr!ci!ni 7aci%nt!l!i 6i 8amili%i5
PRINCIPII *E DN$RIIIRE
- O7%raia %st% !n %@%nim%nt im7ortant An @iaa 7aci%nt!l!i, 9%n%rator d% str%ss 8i?ic 6i 7si:ic5 - T%ama d% s7ital,
d% an%st%?i%, d% o7%rai%, d% s!8%rina 7osto7%ratori% 8ac ca ;olna@ii s& 8i% an#io6i, a9itai, d%7rimai 7si:ic5
- Inci?ia o7%ratori% d%t%rmin& d!r%r% 6i 7r%dis7!n% la in8%cii5
- An%st%?ic%l% 6i dro9!ril% anal9%?ic% a! %8%ct d%7r%si@ as!7ra or9anism!l!i dimin!Bnd d!r%r%a dar 6i ca7acitat%a
d% r%aci% a 7aci%nt!l!i 8a& d% stim!lii din m%di!l Ancon<!r&tor5
FIA N". 4.1.1. PREG1TIREA PREOPERATORIE GENERAL1 DIN &IUA CARE PRECEDE
OPERA2IA
PRE$FTIREA PIEICF A (O'NA)U'UI
- % r%comand& tact 6i An%l%9%r% %m7atic& An com!nicar%a c! 7aci%nt!l 7%ntr! a r%d!c% discon8ort!l 7si:ic cr%at
d% t%ama d% o7%rai%, an%st%?i%5
- % r%comand& s%l%ctar%a 7aci%nilor 7% saloan%, %@itBnd!-s% contact!l c%lor no! int%rnai c! c%i car% a! a@!t o
%@ol!i% 7osto7%ratori% di8icil&, 9ra@& sa! c! m!ri;!n?ii5
- % lini6t%6t% 7aci%nt!l c! 7ri@ir% la an%st%?i%, d!r%r% 6i 7roc%d!ril% 7r%o7%ratorii
- % r%s7%ct& o7iniil% 7aci%nt!l!i l%9at% d% cr%din% 6i conc%7ii5
- % o8%r& in8ormaii clar%, acc%si;il% l%9at% d% act!l o7%rator 6i d% cons%cin%l% ac%st!ia =limit&ri, m!til&ri>5
42/
- % o;in% consim&mBnt!l scris al 7aci%nt!l!i con6ti%nt, ad!lt sa! al 8amili%i An ca?!l minorilor sa! al 7aci%nilor
incon6ti%ni5
- % sta;il%6t% data int%r@%ni%i 6i s% com!nic& ;olna@!l!i5
- Consim&mBnt!l in8ormat An int%r@%niil% c:ir!r9ical% %st% r%s7onsa;ilitat%a m%dic!l!iH n!rsa %st% r%s7onsa;il&
din 7!nct d% @%d%r% %tic, n! l%9al, acionBnd ca !n a@ocat al 7aci%nt!l!i =@%ri8icBnd dac& 7aci%nt!l a An%l%s
in8ormaiil% 7rimit% 6i dac& s!nt r%s7%ctai toi 7a6ii An 7r%9&tir%a 7r%o7%ratori%>5
- Form%l% d% consim&mBnt tr%;!i% s%mnat% Anaint% ca 7aci%nt!l s& 7rim%asc& m%dicaia s%dati@&, 7r%an%st%?ic&5
- % administr%a?&, la indicaia m%dic!l!i s%dati@%, :i7notic% An s%ara dinaint%a int%r@%ni%i 7%ntr! a asi9!ra o
odi:n& ad%c@at& An tim7!l no7ii
I$IENA PACIENTU'UI
- % 8ac% ;ai%, sa! d!6, sa! toal%ta 7% r%9i!ni, la 7at, An ca?!l ;olna@ilor n%d%7lasa;ili5
- % c!r&& c! at%ni% ?on%l% d% 8l%#i% 6i c%a om;ilical& 7%ntr! a r%d!c% risc!l in8%ci%i 7rin 8lora c!tanat&5
CREAREA C3"PU'UI OPERATOR
- % d%7il%a?& ?ona d% int%r@%ni% 7rin rad%r%a 7ilo?it&ilor c! !n a7arat d% ras indi@id!al, 7% o s!7ra8a& lar9& =4C
0 2Ccm> a@Bnd 9ri<& s& n! s% cr%%?% sol!ii d% contin!itat%5
- % int%r?ic% 8olosir%a cr%m%lor d%7ilatoar% car% 7ot da r%acii al%r9ic% 6i iritaii al% m!coas%lor din ?on%l%
intim%5
- N! s% d%7il%a?& s7rBnc%n%l% An ca?!l int%r@%niilor la ni@%l!l 9lo;!l!i oc!lar5
- % d%?in8%ct%a?& ?ona ras& c! alcool m%dicinal sa! ;%tadin& =s% %#cl!d% risc!l la al%r9i% 7rin anamn%?&>
- % aco7%r& cBm7!l o7%rator c! !n cBm7 st%ril5
- In ca? d% !r9%n& im%diat&, ;olna@!l @a 8i ras la 7at sa! la UPU Anaint% d% a 8i trans7ortat la ;loc!l o7%rator5 %
contraindic&, t%m7orar, act!l o7%rator An ca? d% l%?i!ni c!tanat% An r%9i!n%a !nd% !rm%a?& s& s% d%s8&6oar%
int%r@%nia5
UPRA)E$EEREA DNAINTEA OPERA2IEI
- % m&soar& 6i s% r%7r%?int& 9ra8ic 8!nciil% @ital%: t%m7%rat!ra, 7!ls, T5A, r%s7irai%5
- % cBnt&r%6t% ;olna@!l 6i s% a7r%cia?& talia 7%ntr! do?ar%a 7r%m%dicai%i 6i an%st%?ic%lor5
- % s%mnal%a?& m%dic!l!i %@%nt!al%l% modi8ic&ri al% t%9!m%nt%lor din ?on%l% 7r%@&?!t% 7%ntr! int%r@%ni% c!m
ar 8i s%mn%l% d% in8lamai% sa! d% al%r9i%5
- % not%a?& 6i s% ra7ort%a?& %@%nt!al%l% sim7tom% d% in8%ci% a c&ilor r%s7iratorii s!7%rioar%, 7r%c!m 6i a7ariia
m%nstr!ai%i la 8%m%i5
IN)ETI$AREA PARAC'INICF
- % @%ri8ic&, o;li9atori!, 7%ntr! toat% ti7!ril% d% int%r@%nii c:ir!r9ical%:
O 9r!7!l san9!in 6i 8actor!l R:
O :%mo9rama
O 9lic%mia
O !r%%a
O cr%atinina san9!in&
O %l%ctroliii s%rici
O 7ro;%l% :%7atic%
O 8actorii d% coa9!lar%
O s!mar!l d% !rin&
- % %8%ct!%a?&:
O EC$, radio9ra8i% 7!lmonar&5
$O'IREA INTETINU'UI TER"INA'
- % 8ac% clisma %@ac!atoar% An s%ara dinaint%a 6i An dimin%aa int%r@%ni%i c:ir!r9ical% An ca? d% int%r@%nii 7%
t!;!l di9%sti@5
% administr%a?& !n la#ati@ c! 42-2/ or% inaint%a int%r@%ni%i dac& act!l o7%rator n! s% d%s8&6oar& 7% t!;!l
di9%sti@ 6i tran?it!l ;olna@!l!i %st% normal5
RETRIC2IA A'I"ENTARF
- % scad% a7ort!l alim%ntar oral c! o ?i Anaint% d% o7%rai%5
- % sist%a?& a7ort!l d% alim%nt% 6i lic:id% d% la or%l% 24, An s%ara d% dinaint%a o7%rai%i5
- % int%r?ic% 8!mat!l c! o s%ar& Anaint% d% o7%rai%, 7r%c!m 6i cons!m!l d% ;&!t!ri alcoolic%5
FIA N". 4.1.6. PREG1TIREA PREOPERATORIE DIN &IUA OPERA2IEI
"FURI $ENERA'E
42C
- % s!7ra@%9:%a?& 7aci%nt!l s& r&mBn& n%mBncat 6i s& n! 8!m%?%5
- % m&soar& 8!nciil% @ital% 6i @%9%tati@%: t%m7%rat!ra, 7!ls, TA55
- % a7r%cia?& star%a 9%n%ral& 6i com7ortam%nt!l5
- % com!nic& m%dic!l!i %@%nt!al%l% modi8ic&ri 7atolo9ic% al% 8!nciilor @ital%, t!s%a, cori?a, diar%%a, a7ariia
m%nstr!ai%i la 8%m%i 6i modi8ic&ri din ?ona d% int%r@%ni%5
- % And%7&rt%a?& ;i<!t%riil%, c%as!l, 7%r!ca, 7rot%?%l% =d%ntar%, m%m;r%l% arti8icial%>, a9ra8%l% d% 7&r, l%ntil%l% d%
contact
- % c%r% 7aci%nt%i s&-6i 8ac& toal%ta d% dimin%a& 8&r& 8olosir%a mac:ia<!l!i sa! a lac!l!i d% !n9:ii, a r!<!l!i,
7%ntr! o ;!n& o;s%r@ar% a %#tr%mit&ilor5
- % in@it& 7aci%nt!l s&-6i 9ol%asc& @%?ica !rinar& sa! s% mont%a?& as%7tic o sond& @%?ical&, dac& m%dic!l indic&
- % strBn9% 7&r!l l!n9 Antr-o ;on%t&, sa! s% Am7l%t%6t% An coad&, iar 7aci%nt!l Am;rac& o 7i<ama c!rat&, d%sc:is&,
iar 8%m%il% c&ma6& d% noa7t%5
A*"INITRAREA PRE"E*ICA2IEI
- % administr%a?& m%dicaia 7r%an%st%?ic& =7r%m%dicaia> c! .0 d% min!t% Anaint% d% o7%rai%, dac&
administrar%a %st% oral& 6i c! /C d% min!t% Anaint% d% o7%rai% - An administrar%a 7ar%nt%ral&
- % int%r?ic% 7aci%nt!l!i s& s% mai ridic% din 7at d!7& administrar%a 7r%m%dicai%i d%oar%c% ar% aci!n% s%dati@&
6i d%7rim& circ!laia, d%t%rminBnd :i7ot%nsi!n% art%rial& ortostatic&5
- % 7r%da! o;i%ct%l% d% @aloar%, ;i<!t%riil% ;olna@!l!i 8amili%i sa! n!rs%i-6%8%, Ansoit% d% 7roc%s!l @%r;al5
TRANPORTU' (O'NA)U'UI 'A A'A *E OPERA2IE
- % trans7ort& ;olna@!l la sala d% o7%rai% c! !n mi<loc ad%c@at st&rii sal% - c! ;rancarda, 7at!l r!lant, ;in%
aco7%rit 6i Ansoit d% n!rs&5
- % Anso%6t% ;olna@!l d% doc!m%nt%l% administrati@%: F5O5 c! r%?!ltat%l% in@%sti9aiilor, c! consim&mBnt!l
scris5
- % %@it& trans7ort!l 7r%a d%@r%m% la sala d% o7%rai% 7%ntr! a n! str%sa ;olna@!l5
- % @%ri8ic& lista o7%ratori% =data, ora, r%9i!n%a o7%ratori%>5
PRE$FTIREA A'ONU'UI POTOPERATOR
- % 7r%9&t%6t%, Antr% tim7, salon!l 7%ntr! 7rimir%a An condiii o7rim%, a o7%rat!l!i:
O i9i%na salon!l!i
O a%risir%a salon!l!i
O sc:im;ar%a l%n<%ri%i d% 7at
O asi9!rar%a c! mat%rial d% 7rot%ci% a 7at!l!i5
- % @%ri8ic& s!rsa d% o#i9%n, d% as7irai%5
- % 7r%9&t%sc:
O t%nsiom%tr! 6i st%tosco7 ;ia!ric!lar
O stati@
O tr!sa d% 7%r8!?at
O sol!ii 7%r8!?a;il% 6i m%dicam%nt% 7r%scris% d% m%dic 7%ntr! 7%rioada 7osto7%ratori%
O !rinar
O ;a?in%t
O t&@ia r%nal&
O alt% mat%rial% An 8!nci% d% ti7!l int%r@%ni%i 6i d% An9ri<iri =;orcan d% dr%na<, d% as7irai%, %tc>5
FIA N". 4.1.7. PREG1TIREA OPERATORIE SPECIAL1
O(IECTI)E
- Cor%ctar%a d%8ici%n%lor or9anism!l!i5
- R%sta;ilir%a %c:ili;r!l!i 8i?iolo9ic 7%ntr! a s!7orta act!l o7%rator5
- E@itar%a com7licaiilor 9ra@% An tim7!l sa! im%diat d!7& o7%rai%5
IN*ICA2II
- Paci%ni c! risc o7%rator cr%sc!t cr%at d% a7arat!l sa! or9an!l 7% car% s% @a int%r@%ni5
- Paci%ni c! a8%ci!ni 7r%%#ist%nt% =tarai>: cardio@asc!lar%, 7!lmonar%, :%7atic%, r%nal%, dia;%t ?a:arat5
"FURI PECIFICE
A5 "FURI PECIFICE 'E$ATE *E APARATU' AU OR$ANU' PE CARE E )A *EFFJURA
OPERA2IA
- Dn ca?!l int%r@%nilor 7% a7arat!l r%s7irator s% 7ractic&:
O as7irar%a s%cr%iilor tra:%o-;ron6ic%
42.
O m%dicai% s7%ci8ic&:
- 8l!idi8iant% al% s%cr%ilor
- %#7%ctorant%
- ;ron:odilatatoar%
- int!;aia c! sond% s7%cial% - sonda CAR'EN =7r%?int& do!& ;ra%, cBt% !n!l 7%ntr! 8i%car% ;ron:i%>
cBnd %st% n%c%sar& %#cl!d%r%a t%m7orar& a !n!i 7l&mBn sa! 7%ntr! a 7r%@%ni in!ndaia ;ronsic& c! s%cr%ii =%#5
C:ist :idatic>
- Dn ca?!l o7%raiilor 7%ntr! st%no?a 7iloric& 6i a o7%raiilor 7% stomac:
O montar%a !n%i sond% naso9astric% d% as7irai% a sta?%i 9astric%, c! --/ ?il% Anaint% d% o7%rai%
O s7&l&t!ra 9astric& An s%ara dinaint%a o7%rai%i
- Dn ca? d% ocl!?i% int%stinal&:
O as7irai% naso9astric&
O r%%c:ili;rar% :idro-%l%ctolitic& i5@5
- Dn ca?!l int%r@%niilor 7% colon 6i r%ct:
O 9olir%a conin!t!l!i c! /,-72 d% or% Anaint%a o7%rai%i 7rin:
- r%9im alim%ntar c! 7!in% r%?id!!ri =carn%, o!&, ;rBn?&, la7t%, ia!rt>
- r%9im %#cl!si@ :idric c! 2/ or% Anaint%a o7%rai%i administrar%a d% sol!ii :i7%rton% c! 2/ or% Anaint%a
o7%rai%i: Fortrans =car% n! %st% m%ta;oli?at d% 8lora int%stinal& 6i n! s% a;soar;% 7rin m!coasa int%stinal&>H s%
administr%a?& / 7lic!ri di?ol@at% 8i%car% An cBt% 4 litr! d% a7& =/ litri An total> An s%ara car% 7r%c%d% int%r@%nia,
8i%car% litr! 8iind ;&!t Antr-o or&5
O r%%c:ili;rar%a :idro%l%ctolitic& 7ar%nt%ral&
O clism% %@ac!atorii An ca?!l An car% administrar%a Fortrans-!l!i %st% contraindicat& =star% 9%n%ral&
alt%rat&, ins!8ici%n& cardiac&, ETA, %tc>5
O as%7ti?ar%a colon!l!i 7rin administrar%a 7ar%nt%ral& d% anti;iotic%
(5 "FURI PECIFICE 'E$ATE *E AFEC2IUNI'E PREEXITENTE
- % r%comand& o;in%r%a a@i?!l!i d% la m%dic!l s7%cialist An dom%ni! =dia;%tolo9, cardiolo9, 9astro%nt%rolo9,
n%!rolo9, %tc> c! s7%ci8icar%a risc!l!i an%st%?ico-c:ir!r9ical 6i %@%nt!al a m&s!rilor t%ra7%!tic% n%c%sar% atBt
7r%-, cBt 6i 7osto7%ratorii5
- % @or %@ita int%r@%niil% 7%ntr! a8%ci!ni cronic% An 7rim%l% .-42 l!ni d!7& !n in8arct miocardic ac!t
- % con@%rt%6t% m%dicaia cardiac& 6i anti:i7%rt%nsi@& sa! d% r%9lar% a 9lic%mi%i 7% cal% oral& An t%ra7i%
7ar%nt%ral& 7Bn& la r%l!ar%a tran?it!l!i 6i alim%ntai%i 7osto7%rator5
- % 8ac% r%%c:ili;rar%a :%matolo9ic& 7ar%nt%ral& =trans8!?ii> An ca?!l 7aci%nilor c! an%mi% s%@%r&, 7r%o7%rator5
- % a7lic& m&s!ri s7%ci8ic% 7%ntr! 7aci%nii :%7atici:
O di%ta :i7%rcaloric& 7r%dominant 9l!cidic&
O @itaminot%ra7i%
O r%d!c%r%a a7ort!l!i d% 7rot%in% 7%ntr! a sc&d%a risc!l d% a7arii% a %nc%8alo7ati%i 7ortal% =la cirotici>5
- % r%comand& 7ro8ila#ia risc!rilor: in8%cios, trom;o%m;olic 6i al :%mora9iilor di9%sti@% ac!t% Rd% str%ssR la
7aci%nii c! risc ma<or5
FIA N". 4.1.4. PREG1TIREA PREOPERTORIE DE URGEN21
*EFINI2IE
- Pr%9&tir%a 7r%o7%ratori% 7%ntr! int%r@%nia c:ir!r9ical& %8%ct!at& An 7rim%l% 2-- or% d% la int%rnar% sa! An
7rim%l% /-. or% =An ca? d% s%mi!r9%n&>5
- Pr%9&tir%a 7r%o7%ratori% 7%ntr! !r9%n%l% ma<or% c! risc @ital5
O(IECTI)E
- al@ar%a @i%ii 7aci%nt!l!i5
- Pr%@%nir%a com7licaiilor intra, 6i 7osto7%ratorii im%diat%5
"FURI PREOPERATORII *E UR$EN2F
"&s!ril% s% a7lic& An sala d% o7%rai% 6i s% r%8%r& la:
- toal%ta s!mar& 7% r%9i!ni insistBnd!-s% 7% as%7ti?ar%a r%9i!nii 7%ntr! o7%rai%
- monitori?ar%a 8!nciilor @ital% 6i @%9%tati@%
- d%6ocar%a ;olna@!l!i 6ocat
- r%coltar%a d% !r9%n& a sBn9%l!i 7%ntr!: E'$, ET, 9lic%mi%, !r%%, t%st% d% coa9!lar%, 9r!7 san9!in 6i 8actor R:
- administrar%a 7r%m%dicai%i
427
FIA N". 4.6. (NGRI'IREA INTRAOPERATORIE
O(IECTI)E PECIFICE
- Control!l in8%ci%i 7rin r%s7%ctar%a circ!it%lor 6i a7licar%a t%:nicilor as%7tic%H
- Asi9!rar%a si9!ran%i 6i 7rot%ci%i 7aci%nt!l!i
- Pr%@%nir%a com7licaiilor intrao7%ratorii5
PRE$FTIREA F'II *E OPERA2IE
- N!rsa d% la ;loc!l o7%rator @%ri8ic& c!r&%nia 6i 8!ncionalitat%a a7arat%lor 6i %c:i7am%nt%lor din s7aiil%
m%dical% =s&lil% d% o7%raii c! an%#%l% a8%r%nt%>: s7&l&tor 8iltr! 7%ntr! c:ir!r9i c! ro;in%t% c! a7& st%ril&, s7ai!
7%ntr! 7r%9&tir%a mat%rial%lor 6i 7%ntr! tr%?ir%a o7%rat!l!i, cam%r& 7rotocol o7%rator5
Dn sala d% o7%raii @isc%ral% @%ri8ic&:
- lam7a scialitic&, o#i9%nator!l d% 7%r%t%,
- as7irator!l c:ir!r9ical, as7irator!l d% 7%r%t%, 7ri?%l%5
- s% 7r%9&t%sc: masa c! instr!m%nt% st%ril%, casol%t%l% c! mat%rial moal%, 7ac:%t%l% c! ;l!?% 6i m&6ti st%ril%,
c&r!cior!l c! m%dicam%nt%, masa d% o7%raii
RE$U'I *E (AGF DN A'A *E OPERA2IE
- Dn sal& s% intr& n!mai c! %c:i7am%nt d% 7rot%ci%: :alat, 7a7!ci, ;on%t&, masc&5
- Ealat%l% %c:i7%i s!nt consid%rat% st%ril% An 8a&, d% la !m&r 7Bn& la mi<loc 6i d% la mBn& 7Bn& a7roa7% d% cotH
?on%l% n%st%ril% al% :alat%lor incl!d !m%rii, 9Bt!l, ?on%l% a#ilar% 6i s7at%l%5
- "%s%l% aco7%rit% c! cBm7!ri s!nt consid%rat% st%ril% doar la s!7ra8a&H oric% mat%rial car% atin9% s!7ra8aa
m%s%i %st% consid%rat contaminat5
- P%rsonal!l %c:i7%i st%ril% tr%;!i% s& st%a An a7ro7i%r%a s!7ra8%%lor st%ril%, iar dac&-6i sc:im;& 7o?iiil%, tr%;!i%
s& s% Antoarc& c! 8aa c&tr% 8aa c%l!ilalt sa! c! s7at%l% c&tr% s7at%l% c%l!ilalt
- Tot 7%rsonal!l tr%;!i% s& 8olos%asc& m&6ti car% asi9!r& o 8iltrar% Analt&
- "&6til% tr%;!i% s& aco7%r% com7l%t nas!l 6i 9!ra 6i s& 8i% 8i#at% 6i n! 7!rtat% lar9 An <!r!l 9Bt!l!i5
- CBnd m&6til% s!nt And%7&rtat%, s% atin9 n!mai l%9&t!ril% 7%ntr! a 7r%@%ni contaminar%a mBinilor d% la ?ona
na?o8arin9ian&
- Un9:iil% s% tai% sc!rt 7%ntr! a 7r%@%ni str&7!n9%r%a m&n!6ilor5
A*"ITEREA PACIENTU'UI DN GONA F'II *E OPERA2IE
- Protocol!l d% admit%r% An ?ona An car% 7aci%nt!l %st% in!t 7Bn& a<!n9% An sala d% o7%rai%, 7r%@%d% s& s% @%ri8ic%
d% c&tr% n!rs&:
O n!m%l% 6i n!m&r!l d% salon al 7aci%nt!l!i
O istoric!l st&rii d% s&n&tat% 6i star%a 8i?ic& 7r%?%nt&
O r%?!ltat%l% %#am%n%lor d% la;orator 6i radio9ra8iil%
O 9r!7a d% sBn9% 6i t%st%l% d% com7ati;ilitat%
O al%r9iil% 6i oric% alt% r%acii ant%rioar% la an%st%?i% sa! trans8!?ii
O 7r%?%na ;i<!t%riilor, a l%ntil%lor d% contact, a 7rot%?%lor d%ntar% 6i dac& 7aci%nt!l a cons!mat alim%nt%
O 9r%!tat%a 6i An&lim%a, An @%d%r%a do?&rii cor%ct% a dro9!rilor an%st%?ic%5
POGI2IONAREA PACIENTU'UI PENTRU OPERA2IE
- R%s7onsa;ilitat%a 7%ntr! 7o?iionar%a 7aci%nt!l!i r%@in% Am7r%!n& n!rs%i, c:ir!r9!l!i 6i an%st%?ist!l!i
- Po?iionar%a 7aci%nt!l!i @a in% s%ama d%:
O ti7!l 6i loc!l int%r@%ni%i
O mo;ilitat%a artic!laiilor
O @Brsta 7aci%nt!l!i
O %@itar%a a7arii%i l%?i!nilor d% com7r%si!n% la ni@%l!l %s!t!rilor 6i n%r@ilor
O 8acilitar%a 8!nci%i cardiocirc!latori% 6i 7!lmonar&
- Po?iionar%a cor%ct& %st% im7ortant& 7%ntr!:
O %#7!n%r%a ad%c@at& a ?on%i o7%ratorii
O acc%s!l !6or 7%ntr! ind!c%r%a an%st%?i%i 6i administrar%a d% sol!ii 6i m%dicam%nt% i5@5
O 7romo@ar%a 8!nciilor r%s7iratorii 6i circ!latorii
O asi9!rar%a intimit&ii 7aci%nt!l!i 7rin %@itar%a %#7!n%rilor car% n! s!nt n%c%sar%
- P%ntr! m%nin%r%a An 7o?iia ad%c@at& int%r@%ni%i, 7aci%nt!l @a 8i 8i#at c! c:in9i 7% masa d% o7%rai%5
PRE$FTIREA C3"PU'UI OPERATOR JI ANETEGIA
42,
- % 8ac% c!r&ar%a m%canic& a 7i%lii c! a7& 6i s&7!n
- % d%?in8%ct%a?& c! !n a9%nt antimicro;ian
- % aco7%r& r%9i!n%a c! !n cBm7 st%ril c! 8%r%astr& sa! c! 8oli% ad%?i@&, trans7ar%nt&, 7rin car% s% 8ac% inci?ia 6i
car% Am7i%dic& dis%minar%a 8lor%i c!tanat%H o alt%rnati@& %st% 7!l@%ri?ar%a 7r%o7%ratori% a !n%i 7%lic!l% ad%?i@%
car% Am7i%dic& a7ariia contamin&rii
- % !tili?%a?& di8%rit% an%st%?ic% 6i m%dicaia ad<!@ant& cor%s7!n?&toar% 7%ntr! o;in%r%a st&rii d% incon6ti%nt&,
d% anal9%?i%, r%la#ar% m!sc!lar& 6i dis7arii% a r%8l%#%lor, m%dic!l an%st%?ist %st% a<!tat d% n!rsa d% an%st%?i%5
- N!rsa @a s!7ra@%9:%a: 8!nciil% @ital%, c!loar%a, t%m7%rat!ra 6i !miditat%a t%9!m%nt%lor, t%m7%rat!ra cor7oral&,
com7ortam%nt!l ;olna@!l!i An c!rs!l ind!c%rii an%st%?i%i: %st% 7osi;il ca an%st%?ia s& d%t%rmin% %#cita;ilitat%a
7aci%nt!l!i =rBd%, 7lBn9%, @or;%6t% %#c%si@, s% mi6c& %#c%si@>, c%%a c% n%c%sit& imo;ili?ar% 7%ntr! 7r%@%nir%a
a!totra!mati?&rii5
UPRA)E$EEREA INTRAOPERATORIE
- O;i%cti@%l% 7rinci7al% al% s!7ra@%9:%rii intrao7%ratorii a ;olna@!l!i s!nt:
O asi9!rar%a !n%i an%st%?ii cor%ct%
O m%nin%r%a lini6t%i o7%ratorii
O d%7istar%a la tim7 a incid%nt%lor c% 7ot s& a7ar&
- El%m%nt%l% d% s!7ra@%9:%r%:
O 8a?%l% an%st%?i%i - 7rin m&s!rar%a TA, %8%ct!ar%a EE$ c! dis7o?iti@% %l%ctronic%
O @%ntilaia 7!lmonar& car% 7oat% 8i t!l;!rat& An !rma c!rari?&rii, aci!nii anal9%tic%lor c%ntral% - s% a7r%cia?& 7rin
o;s%r@ar%a t%9!m%nt%lor, m&s!rar%a 8r%c@%n%i r%s7iratorii, do?ar%a 9a?%lor din sBn9%
O constant%l% circ!latorii s% !rm&r%sc clinic 7rin a7r%ci%r%a ritm!l!i cardiac 6i m&s!rar%a T5A5, iar 7araclinic c!
a<!tor!l %l%ctrocardio9ram%i sa! monitoar%lor %l%ctric%5
O a7r%ci%r%a 7i%rd%rilor san9!in% tr%;!i% 8&c!t& cBt mai o;i%cti@ inBnd s%ama d% com7l%#itat%a o7%rai%i 6i d%
9rad!l sBn9%rarii
- E@al!&ril% s% 7ot 8ac% 7rin:
O cBnt&rir%a com7r%s%lor !tili?at% An 7la9& com7arati@ c! !n n!m&r %9al d% com7r%s% 8&c!t% An ac%la6i mod5
O m&s!rar%a sBn9%l!i din as7irator
O d%t%rminar%a :%mo9lo;in%i An lic:id!l d% s7&lar% a mat%rial!l!i moal%
- Cantitat%a sBn9%l!i 7i%rd!t %st% An 8!nci% 6i d% ti7!l o7%rai%iH ast8%l s% a7r%cia?& c& An tim7!l:
O c!r%i o7%ratorii a :%rni%i s% 7i%rd a7ro#imati@ 20--0 ml5 sBn9%
O 9astr%ctomi%i s!;total% - Antr% 2C0-4700 ml
O 7i%lotomi%i - Antr% 42C--00 ml5
O 7n%!m%ctomi%i - Antr% 200-2C00 ml5
O :ist%r%ctomi%i - Antr% 2C0-,00 ml5
NOTE PRI)IN* INTER)EN2IA CEIRUR$ICA'F =PROTOCO'U'>
- "%dic!l c:ir!r9 not%a?& =An 7rotocol!l o7%rator> in8ormaiil% r%8%ritoar% la o7%rai%H dat%l% s!nt r%l%@ant% 7%ntr!
An9ri<ir%a 7osto7%ratori% im%diat& 6i incl!d !rm&toar%l%:
O dia9nostic!l 7osto7%rator
O ti7!l o7%rai%i =clasic&, %ndosco7ic&>- car% 7oat% ori%nta An9ri<ir%a
O an%st%?ic!l !tili?at - ori%nt%a?& An9ri<ir%a n!rsin9 =7o?iionar%a o7%rat!l!i>
O a7r%ci%r%a t!l;!r&rilor r%s7iratorii
O %stimar%a sBn9%l!i 7i%rd!t 6i a com7%ns&rii lic:id%lor 7%ntr! 7r%@%nir%a sa! com;at%r%a d%?%c:ili;r!l!i :idro-
%l%ctrolitic
O t!;!ril% d% dr%n, sond%l% d% as7irai%, sond%l% @%?ical%
- N!rsa @%ri8ic& in@%ntar!l mat%rial%lor 6i instr!m%nt%lor 8olosit%: 7%ns%, com7r%s%, cBm7!ri st%ril%5
APRECIEREA $ENERA'F A TFRII OPERATU'UI DNAINTE *E A FI TRANPORTAT *E 'A A'A *E
OPERA2IE
FIA N". 4.7. SUPRA.EG%EREA I (NGRI'IREA POSTOPERATORIE
*EFINI2IE
- P%rioada 7osto7%ratori% im%diat& S 7%rioada car% d!r%a?& d% la s8Br6it!l int%r@%ni%i c:ir!r9ical% 7Bn& la
r%sta;ilir%a st&rii d% c!no6tin& 6i a 8!nciilor @ital%H s% mai n!m%6t% 7%rioada d% tr%?ir%5 P%rioada 7osto7%ratori%
7r%coc% Anc%7% din mom%nt!l An car% 7aci%nt!l a 8ost com7l%t r%c!7%rat din an%st%?i% 6i s% t%rmin& An mom%nt!l
%#t%rn&rii5
42+
O(IECTI)E
- R%sta;ilir%a :om%osta?i%i 8i?ic% 6i 7si:ic%5
- Pr%@%nir%a 6i tratar%a 7rom7t& a com7licaiilor 7osto7%ratorii im%diat% 6i 7r%coc%5
- "ana9%m%nt!l d!r%rii
UPRA)E$EEREA POTOPERATORIE
- % 8ac% An com7artim%nt!l 7osto7%rator5
- % s!7ra@%9:%a?& 8!nciil% @ital% =R, P, TK, T5A5, star%a d% con6ti%n&, d!r%r%a, 702> din 4C\ An 4C\ 7Bn& d%@in
sta;il% 6i s% not%a?& An 8i6a d% tr%?ir% a o7%rat!l!i5
- % ra7ort%a?& im%diat m%dic!l!i an%st%?ist 6i c:ir!r9!l!i oric% modi8icar% =ciano?a c! trans7iraii, tira<!l
m!6c:ilor int%rcostali, An ca? d% o;str!ci% r%s7iratori%, d% %#%m7l!>5
- % o;s%r@& as7%ct!l 9%n%ral al o7%rat!l!i: An mod o;i6n!it %st% 7alid, c! %#tr%mit&i r%ci, c! 7si:ic l%nt 6i
s%nsi;il la d!r%r%5
- % @%ri8ic& 7%rm%a;ilitat%a 6i 7o?iia cat%t%r%lor, sond%lor, t!;!rilor d% dr%n5
TRANPORTU' *E 'A ('OCU' OPERATOR
- % a7lic& m&s!ri d% 7rot%ci% 6i d% si9!ran& a 7aci%nt!l!i, mai al%s An ca?!l c%lor a9itai5
- % trans7ort& o7%rat!l c! 8!nciil% @ital% 6i @%9%tati@% sta;il% An salon!l 7osto7%rator sa! An TI5
- % %@it&, 7% tim7!l trans7ort!l!i, ?dr!ncin&t!ril%, c!r%nii d% a%r5
- % im7!n% at%ni% s7orit& la t!;!ril% d% dr%n, 7%r8!?i%, sonda d% as7irai%, 7la9a o7%ratori%5
FIA N". 4.7.1. SUPRA.EG%EREA POSTOPERATORIE PRECOCE

A5 UPRA)E$EEREA P'F$II
- % o;s%r@& 7ansam%nt!l: An mod normal %st% c!rat, 8&r& s%cr%ii s%roas% sa! san9!inol%nt%5
- % sc:im;& 7ansam%nt!l la 2/ d% or% 75o5, iar d!7& - ?il% 7la9a o7%ratori% 7oat% 8i l&sat& li;%r& dac& %@ol!ia
%st% ;!n&5
- % sc:im;& 7ansam%nt!l 7r%coc% cBnd:
O %st% !m%d 6i 8a@ori?%a?& contaminar%a ;act%rian& a 7l&9ii5
O 7aci%nt!l 7r%?int& s%mn% clinic% 9%n%ral% 6i local% d% in8%ci% a 7l&9ii =8%;r&, 8risoan%, d!r%r% 6i con9%sti%
local&>H An ac%st ca? s% r%colt%a?& s%cr%i% din 7la9& 7%ntr! %#am%n ;act%riolo9ic 6i anti;io9ram&5
- % sc:im;& m%6%l% - acolo !nd% %#ist& - odat& c! 7ansam%nt!l5
- % scot 8ir%l% d% s!t!r& An a C - a 7 ?i 7arial sa! total An 8!nci% d% indicaia m%dic!l!i 6i d% %@ol!ia 7l&9ii5
- % s!7ra@%9:%a?& racord!l dr%n!l!i la 7!n9a col%ctoar% c% @a 8i m%nin!t& d%cli@ 6i s% not%a?& caract%risticil%
lic:id!l!i d% dr%na< =c!loar%, as7%ct, cantitat%>5
- % 7%ns%a?& sa! s% instr!i%6t% 7aci%nt!l s& m%nin& 7!n9a mai <os d% ni@%l!l d% ins%ri% a dr%n!l!i An tim7!l
mo;ili?&rii5
- % sc!rt%a?& sa! s% And%7&rt%a?& dr%n!l ar!nci cBnd m%dic!l indic&5
(5 UPRA)E$EEREA TFRII TER"ICE
- % m&soar& TK 6i s% r%7r%?int& 9ra8ic An F5T5
- % com;at% 8rison!l - 7rin Anc&l?ir%a 7aci%nt!l!i c! 7&t!ri s!7lim%ntar% sa! ;!iot% c! a7& cald& a6%?at% 7%
7&ril% lat%ral% al% cor7!l!i sa! s% administr%a?& s%dati@% la indicaia m%dic!l!i5
- % s!7ra@%9:%a?& 6i ra7ort%a?& s%mn%l% d% :i7ot%rmi%: somnol%n&, r%acii Anc%tinit%, r%s7irai% rar&, T5A5 6i P
sc&?!t% ca !rmar% a sc&d%rii m%ta;olism!l!i ;a?al, t%m7%rat!ra r%ctal& An <!r d% -/K--CK C5
- % s%mnal%a?& m%dic!l!i oric% cr%6t%r% 7atolo9ic& a TK cor7!l!i 6i s% Anc%arc& sc&d%r%a ac%st%ia 7rin m%tod%
8i?ic% =a7licaii r%ci, Am7ac:%t&ri>5
C5 UPRA)E$EEREA E'I"INFRI'OR
- 'a c%i c! sonda @%?ical& ` d%m%!r% :
O s% @%ri8ic& 7%rm%a;ilitat%a, racord!l sond%i
O s% not%a?& caract%risticil% !rin%i: c!loar%, as7%ct, cantitat%, s% 9ol%6t% la tim7 7!n9a col%ctoar%
- 'a c%i 8&r& sonda @%?ical&:
O s% stim!l%a?& r%l!ar%a mici!nilor5 7ontan An 7rim%l% . - , or% 7osto7%rator
O s% @%ri8ic& 7r%?%na R9lo;!l!i @%?icalR dac& 7aci%nt!l n! !rin%a?& s7ontan
O s% o8%r& ;a?in%t!l sa! !rinar!l 7%ntr! ca7tar%a !rin%i la 7atH at%ni% la ;olna@ii d% s%# masc!lin car% !rin%a?&
mai 9r%! An 7o?ii% d% clinostatism
4-0
O s% an!n& m%dic!l dac& ;olna@!l n! !rin%a?& =%st% An an!ri% din ca!?a R7ost!l!iR 7r%-, 6i 7osto7%rator sa! ar%
R9lo; @%?icalR>5
O s% 8ac% sonda< @%?ical, An condiii as%7tic%, dac& ;olna@!l 7r%?int& R9lo; @%?icalR 6i n! 7oat% miciona s7ontan5
- % s!7ra@%9:%a?& r%l!ar%a tran?it!l!i int%stinal 7%ntr! 9a?%, An a 2 ?i 75o5 6i An a - - a / ?i 75o5, 7%ntr! mat%rii
8%cal% %#c%7tBnd 7aci%nt!l c! int%r@%nii 7%ntr! :%moroi?i sa! 8ist!l& anal& la car% d%8%caia tr%;!i% amBnat& 7Bn&
la @ind%car%a 7l&9ii o7%ratorii, An sit!aii s7%cial% =;olna@!l n! %limin& 9a?% 6i n! ar% sca!n>:
O s% 7!n% t!; d% 9a?%: 4C - 20 min!t%, ma#im 4 or&
O s% 8ac% masa< a;dominal sa! s% 7!n s!7o?itoar% c! 9lic%rin&H clism& %@ac!atoar%, administrar%a d% am%st%c litic
=s%r 8i?iolo9ic a Pl%9oma?in a Pro7ranolol> sa! d% sol!ii :i7%rton% ="anitol> s% 8ac n!mai la indicaia
m%dic!l!i5
*5 UPRA)E$EEREA A'I"ENTA2IEI
- % r%comand& r%l!ar%a alim%ntai%i An 7rima ?i 75o5, dac& int%r@%nia c:ir!r9ical& n! %st% la ni@%l!l a7arat!l!i
di9%sti@ sa! 7% a;dom%nH alim%nt%l% @or 8i !6or di9%ra;il%, n%8lat!l%nt%5
- Dn ca?!ril% o;i6n!it%, d% c:ir!r9i% c!r%nt&, sc:%ma r%l!&rii alim%ntai%i %st% !rm&toar%a:
7r%scris% d% m%dic5
O di%t& :idric& - An 7rima ?i 75o5, dac& ;olna@!l n! @ars&5
O di%t& !6or di9%ra;il& - An a do!a ?i 75o5
O di%t& o;i6n!it& - d!7& c% ;olna@!l a a@!t sca!n5
E5 "ANA$E"ENTU' *URERII
- % id%nti8ic& locali?ar%a 6i int%nsitat%a d!r%rii 7% o scal& d% la 4 la 40, 6i s% Anr%9istr%a?& in8ormaiil% r%8%ritoar%
la d!r%r% %#7rimat% d% 7aci%nt, 7osto7%rator5
- % administr%a?& m%dicaia anal9%?ic& 7r%scris& d% m%dic, r%s7%ctBnd do?a 6i int%r@al!l d% administrar%5
- % s!7ra@%9:%a?& %8%ct%l% t%ra7%!tic% 6i nont%ra7%!tic% al% anal9%?ic%lor =:i7o@%ntilai%, :i7ot%nsi!n%, risc d%
as7irai% a @&rs&t!rilor An c&il% r%s7iratorii>5
- % a7lic& m&s!ri alt%rnati@% al% d!r%rii:
O m%tod% 8i?ic%: a7licaii local% cald% sa! r%ci, sc:im;ar%a 7o?ii%i, 9imnastica r%s7irai%i, masa<, aromat%ra7ia5
O 7si:ot%ra7i%: const& An control!l d!r%rii d% c&tr% 7aci%nt 7rin a!tos!9%sti% 6i 7rin :i7no?& 6i %#%rsar%a,
7r%o7%rator, a t%:nicilor d% r%la#ar% 7%ntr! a sc&d%a cons!m!l d% anal9%?ic% 7osto7%rator5
F5 UPRA)E$EEREA TFRII *E CONJTIEN2F A CO"PORTA"ENTU'UI
- % s!7ra@%9:%a?& star%a d% con6ti%nt&, mai al%s la 7aci%nii An @Brst&, la c%i c! administrar% d% anal9%?ic% 75o5,
c! ant%c%d%nt% d% alco:olism, d%7r%si% sa! c! d%?%c:ili;r% %l%ctrolitic%5
- % cons%mn%a?& 6i s% ra7ort%a?& mani8%st&ri ca: a9itai%, co6mar!ri, insomnia sa! somnol%na, t!l;!r&ri d%
s%nsi;ilitat% =car% Anso%sc d%s%ori con8!?ia>, d%lir c! :al!cinaii5
- % s!7ra@%9:%a?&, An 7%rman%n&, ;olna@!l 6i s% m%nin% o s!rs& d% l!min& 7% tim7!l no7ii, la c%i a9itai car%
a! t%ndin% d% a!toa9r%si!n% mani8%stat% 7rin sm!l9%r%a sond%lor, 7%r8!?i%i, dr%n!rilor5
- % %#7lic&, c! calm 6i r&;dar%, 7aci%nt!l!i sco7!l t!;!rilor, sond%lor, 7%r8!?iilor5
$5 "O(I'IGAREA OPERATU'UI
- % r%comand& mo;ili?ar%a 7r%coc% a o7%rat!l!i %#c%7tBnd ca?!ril% c! int%r@%nii orto7%dic% la ni@%l!l
m%m;r%lor in8%rioar%, coloan%i @%rt%;ral%, int%r@%nii 7% cord, 7aci%ni adinamici, c! com7licaii 75o5 im%diat%5
- % sc:im;& 7o?iia din or& An or& An 7rim%l% 2/ d% or% 75o5 7%ntr! a 8a@ori?a %#7ansi!n%a 7l&mBnilor 6i 7%ntr! a
7r%@%ni 7n%!monia :i7ostatic& sa! at%l%cta?ia =cola;ar%a al@%ol%lor>
- % solicit& 7aci%nt!l!i s& %#%c!t% mi6c&ri acti@% al% m%m;r%lor in8%rioar% din or& An or& sa! s% 8ac mi6c&ri
7asi@% al% artic!laiilor d% la m%m;r%, masa<% An s%ns!l circ!lai%i @%noas%5
E5 EXA"ENE *E 'A(ORATOR JI EXP'ORFRI I"A$ITICE
- !nt r%comandat% d% c&tr% m%dic la ;olna@ii:
O c! 7i%rd%ri mari d% sBn9% An tim7!l int%r@%ni%i c:ir!r9ical%
O c! risc d% :%mora9i% 7osto7%ratori% =%#5 ;olna@i tarai, c! ciro?a :%7atic&, c! t!l;!r&ri d% coa9!lar%, c!
:%mosta?a 7r%car&>
O car% a! s!8%rit int%r@%nii c:ir!r9ical% d% mar% am7loar%
O a8lai An star% critic&
- % %8%ct!%a?& o;li9atori! An 7%rioada 7osto7%ratori% im%diat&, con8orm indicai%i m%dical%, !rm&toar%l%
%#am%n%:
O :%mo9rama com7l%t&
O coa9!lo9rama
O ;ioc:imi% san9!in&
4-4
O 9a?%l% san9!in%
O radio9ra8ia 7!lmonar& la 7at
FIA N". 6.;.;. COMPLICA2IILE POSTOPERATORII
- !7ra@%9:%r%a 6i An9ri<ir%a 7osto7%ratori%, at%nt% 6i com7%t%nt% a! ca o;i%cti@%:
O $r&;ir%a @ind%c&rii 6i r%d!c%r%a 7%rioad%i d% s7itali?ar%
O Pr%@%nir%a s%c:%l%lor 7osto7%ratorii 6i a mortalit&ii
O Pr%@%nir%a cicatricilor in%st%tic% An ca?!l o7%raiilor 7% ?on% %#7!s%
TIPURI *E CO"P'ICA2II POTOPERATORII
a> *!7& 8actor!l t%m7oral:
O Com7licaii im%diat%: a7ar An 7rim%l% or% 7ost-o7%rator
O Com7licaii 7r%coc%: a7ar An 7rim%l% ?il% 7ost-o7%rator
O Com7licaii tardi@%: a7ar d!7& s&7t&mBni, l!ni sa! c:iar ani d% ?il% d% la int%r@%nia c:ir!r9ical& =%#5%@%ntraia>
;> *!7& locali?ar% 6i mod d% mani8%star%:
O Com7licaii local%: la ni@%l!l 7l&9ii o7%ratorii
O Com7licaii 9%n%ral%: la ni@%l!l !nor a7arat% sa! sist%m%, sa! c:iar al Antr%9!l!i or9anism
c> *!7& 9ra@itat%:
O Com7licaiil% minor% - car% s% @ind%c& r%7%d% 6i n! in8l!%n%a?& star%a 9%n%ral&
O Com7licaii ma<or% - car% s% @ind%c& 9r%!, s!nt costisitoar% 6i0sa! las& s%c:%l% c! im7licaii social%,
7ro8%sional% sa! %conomic%
O Com7licaii l%tal% - di8icil d% controlat car% d%t%rmin& d%c%s% 6i a! !n%ori im7licaii <!ridic%5
FIA N". 4.4.1. COMPLICA2IILE POSTOPERATORII IMEDIATE
OCUL
JOCU' s!r@in% c%l mai ad%s%a An 7rim%l% C or% car% !rm%a?& int%r@%ni%i
CAUGE:
- *%8icit!l lic:idian 7r%o7%rator a9ra@at d% @asodilataia d%t%rminat& d% an%st%?i%
- E%mora9i% intrao7%ratori% ins!8ici%nt com7%nsat&
- Pi%rd%r% im7ortant& :idro%l%ctrolitic&
E"NE *E RECUNOAJTERE:
- P!ls ta:icardic, 8ili8orm
- An9oas& 6i t%am&
- 'i7s& d% a%r
- c&d%r%a T55 =t%nsi!nii sistolic%> la +0-,0 mm E95
- Paloar%a 6i r&cir%a 7i%lii, trans7iraii r%ci
- Ciano?a %#tr%mit&ilor, oli9!ri%
- omnol%n&, a7ati% sa! star% d% a9itai%
AC2IUNI DNTREPRINE *E NURF
- !7ra@%9:%r%a strict& a ;olna@!l!i 6i s%mnalar%a im%diat& a s%mn%lor inci7i%nt%
- Dnc&l?ir%a ;olna@!l!i 7rin s!7lim%ntar%a d% 7&t!ri
- O#i9%not%ra7i% d!7& 7%rm%a;ili?ar%a c&ilor r%s7iratorii s!7%rioar%
- Administrar%a tratam%nt!l!i %tiolo9ic 6i sim7tomatic 7r%scris
- "onitori?ar%a 8!nciilor @ital% 6i @%9%tati@%: 7!ls, T5A5, r%s7irai%, di!r%?&
- Administrar%a d% sBn9%, 7lasm&, %l%ctrolii con8orm indicai%i m%dic!l!i
- Com!nicar%a 6i s!sin%r%a 7si:ic& a ;olna@!l!i0a7arin&torilor
ASFIXIA
;olna@!l s% s!8oc& 7rin li7sa d% a%r
CAUGE
- O;str!cia ;ron6ic& 6i :i7o@%ntilaia, mai al%s la c%i o;%?i, c! dist%nsi% a;dominal&, :i7o@ol%miaH
- Ed%m!l 7!lmonar ac!t 7rin s!7raAnc&rcar% lic:idian& 7rin 7%r8!?ii i5@5
- O;stacol An c&il% r%s7iratorii s!7%rioar%: @&rs&r!ra in:alat&, c&d%r%a 7ost%rioar& a lim;ii, %tc5
4-2
- Cons%cina r%c!rari?&rii =an%st%?ic%l% d% ti7 c!rara 7arali?%a?& m!sc!lat!ra r%s7iratori%>
E"NE *E RECUNOAJTERE
- A9itai%, ciano?&
- *is7n%% sa! a7n%%
- Tira<, corna<
- An!nar%a m%dic!l!i
- As7irar%a s%cr%iilor 6i 7%rm%a;ili?ar%a c&ilor r%s7iratorii
- Administrar%a d% O2 sa! car;o9%n =am%st%c d% O2 c! CO2>
- Asi9!rar%a 7o?ii%i 7rocli@% a ;olna@!l!i
- "onitori?ar%a 8!nciilor @ital% 6i @%9%tati@% 6i a conc%ntrai%i 9a?%lor An sBn9%
- Pr%9&tir%a d% !r9%n& a mat%rial%lor n%c%sar% 7%ntr! inc!;ai% sa! tra:%ostomi% acolo !nd% %st% ca?!l
)FRFTURI'E
CAUGE
- E8%ct!l an%st%?i%i ra:idi%n% sa! 9%n%ral%
- Paloar%, trans7iraii r%ci, ta:icardi%
- )&rs&t!ri 7% 9!r& =sa! 7% lBn9& sond& dac& n! s% as7ir& la tim7> car% 7ot d%@%ni inco%rci;il% d!cBnd la dilataia
ac!t& d% stomac
- Plasar%a ;olna@!l!i c! ca7!l mai s!s, ori%ntat lat%ral
- !sin%r%a ;olna@!l!i 6i ca7tar%a @&rs&t!rilor An condiii d% 7rot%ci% a @%stim%ntai%i 6i a l%n<%ri%i d% 7at
- O;s%r@ar%a 6i ra7ortar%a caract%risticilor @&rs&t!rilor
- P!n%r%a !n%i sond% 9astric% dac& m%dic!l indic&
- Administrar%a m%dicai%i anti%m%tic%
- Notar%a 7i%rd%rilor 7rin @&rs&t!r&, !rin&, sca!n An @%d%r%a %8%ct!&rii ;ilan!l!i :idric
- R%:idratar%a ;olna@!l!i con8orm 7r%scri7i%i
EE"ORA$IA EXTERNF 7oat% 8i:
- E%mora9i% la ni@%l!l 7l&9ii o7%ratorii
- E%mora9i% s!;c!tanat& =:%matom 7ari%tal>
CAUGE
- 'i9at!r& d%8%ct!oas&
- *%s8ac%r%a s!t!rii
E"NE
- Pansam%nt Am;i;at c! sBn9%
- Bn9% 7% t!;!l d% dr%n 6i An 7!n9a col%ctoar%
- %mn% d% 6oc
- c:im;ar%a 7ansam%nt!l!i 6i %8%ct!ar%a 7ansam%nt!l!i com7r%si@
- Administrar%a m%dicai%i :%mostatic%
- E8%ct!ar%a tratam%nt!l!i anti6oc con8orm 7r%scri7i%i m%dic!l!i
EE"ORA$II INTERNE
- !nt mai 8r%c@%nt% la ;lon?i 6i ro6cai5
- Pot 8i: intras%roas%: :%motora#, %mo7%riton%!, :%mo7%ricardH intra@isc%ral% =9astroint%stinal%>
CAUGE
- E%mosta?& ins!8ici%nt& intrao7%ratori%
- T!l;!r&ri d% coa9!lar%
- Tra!matism% al% ans%lor int%stinal% =intrao7%rator>
E"NE *E RECUNOAJTERE:
- An9oas&, a9itai%
- Paloar%, s%t%, star% sinco7at&, 6oc
- *is7n%% An ca? d% :%motora#
- (alonar% 6i d!r%r% ;r!sc& An ca? d% :%mo7%riton%!
- Cola7s 6i ciano?& An ca? d% :%mo7%ricard
4--
- E%mat%m%?&, m%l%n& An ca? d% :%mora9i% 9astro-int%stinal&
- An!nar%a d% !r9%n& a m%dic!l!i car% :ot&r&6t% atit!din%a t%ra7%!tic&
- Administrar%a tratam%nt!l!i sim7tomatic 7r%scris
- R%coltar%a sBn9%l!i 7%ntr! ;ilan ;iolo9ic: E'$, ET, t%st% d% coa9!lar% 6i m%nin%r%a lini%i @%noas% An a6t%7tar%
- A7licaii local% r%ci 7% toarc%, a;dom%n, c! aci!n% :%mostatic&
- Administrar%a m%dicai%i :%mostatic%
- Pr%9&tir%a ;olna@!l!i 7%ntr! r%int%r@%ni% acolo !nd% %st% ca?!l
FIA N". 4.4.6. COMPLICA2IILE POSTOPERATORII PRECOCE I TARDI.E
TU'(URFRI PU'"ONARE
a> PNEU"ONIA EIPOTATICF - in8lamaia al@%ol%lor 7rin :i7o@%ntilai%
CAUGE
- Imo;ili?ar%a 7r%l!n9it&
- ta?a s%cr%iilor 6i r%d!c%r%a @%ntilai%i 7!lmonar%
- F%;r&, dis7n%%, ta:icardi%, <!n9:i toracic
- T!s% iniial s%ac&, iritati@&, a7oi c! %#7%ctorai%
- c:im;ar%a 7o?ii%i ;olna@!l!i
- "o;ili?ar%a s%cr%iilor 7rin t!s% asistat&, 7%rc!ii An r%9i!n%a int%rsca7!lar&
- Administrar%a tratam%nt!l!i sim7tomatic 7r%scris: antial9ic%, 8l!idi8iant%, %#7%ctorant%
- Pr%l%@ar%a d% s7!t& 7%ntr! c!lt!r& 6i anti;io9ram&
- Administrar%a anti;iotic%lor 6i a o#i9%n!l!i 7% sonda %ndona?al&
- "onitori?ar%a 8!nciilor @ital% 6i @%9%tati@%: TK, 7!ls, T5A5, r%s7irai%, di!r%?&5
;> E"(O'IA PU'"ONARF - s!r@in% ad%s%a An ?i!a a C a - a .a 7osto7%rator 7rin o;str!cia !n%i art%r%
7!lmonar% 7rintr-!n c:%a9 d% sBn9% 7ro@%nit, c%l mai 8r%c@%nt, din 7%ri8%ri%
CAUGE
- Int%r@%nii a;dominal%, 9in%colo9ic%, orto7%dic%
- A;s%na tratam%nt!l!i 7r%@%nti@ anticoa9!lant
- *!r%r% toracic& atroc%, dis7n%% 6i ciano?&
- T!s% c! %#7%ctorai% san9@inol%nt&
- tar% d% 6oc, o7rir%a inimii 6i d%c%s ra7id
- An!nar%a d% !r9%n& a m%dic!l!i
- Prind%r%a !n%i @%n% 7%ri8%ric% 7%ntr! ;ilan!l ;iolo9ic 6i administrar%a tratam%nt!l!i 7r%scris d% m%dic:
anticoa9!lant%, trom;olitic%, antial9ic%
-Administrar%a o#i9%n!l!i !midi8icat 7% masc&
- Pr%9&tir%a ;olna@!l!i 7%ntr! %8%ct!ar%a radio9ra8i%i 7!lmonar% la 7at
- Pr%9&tir%a ;olna@!l!i 7%ntr! r%int%r@%ni% dac& m%dic!l indic&
c> E*E"U' PU'"ONAR ACUT =EPA> - r%7r%?int& in!ndar%a ;r!tal& c! 7lasm& a al@%ol%lor car% d%t%rior%a?&
ra7id 8!ncia cardio-r%s7iratori%
CAUGE
- R%animar% @asc!lar& %#a9%rat& c! sol!ii sa! sBn9%
- O7%rat tarat, c! cardio7ati%
- *is7n%% c! 7oli7n%%, 7!ls ta:icardic, 8ili8orm
- Cr%6t%r%a T5A5, ciano?a %#tr%mit&ilor
- E#7%ctorai% 7ato9nomonic&, ro?at&, s7!moas& la ni@%l!l ;!?%lor
- (olna@!l %st% an9oasat, aco7%rit d% trans7iraii
- An!nar%a d% !r9%n& a m%dic!l!i
4-/
- Po?iionar%a ;olna@!l!i c! 9am;%l% atBrnat% 7%ntr! r%d!c%r%a circ!lai%i @%noas% =d% Antoarc%r%> 6i a 7r%si!nii An
circ!laia 7!lmonar&
- Administrar%a o#i9%n!l!i 7% sonda %ndona?al&, !midi8icat, c! 20- a7& st%ril& 6i 40- alcool =car% 7r%@in%
s7!mar%a>5
- Prind%r%a !n%i linii @%noas% 7%ri8%ric% 6i administrar%a tratam%nt!l!i 7r%scris d% m%dic: di!r%tic%, tonicardiac%,
@asodilatatoar% 7%ri8%ric%, an#iolitic%
- Pr%9&tir%a ;olna@!l!i 6i mat%rial%lor n%c%sar% 7%ntr! int!;ai% 6i @%ntilai% asistat& dac& m%dic!l indic&5
- "onitori?ar%a 8!nciilor @ital% si @%9%tati@%
TRO"(OF'E(ITA - in8lamaia !n%i @%n%, d% r%9!l& 7%ri8%ric%
CAUGE
- Int%r@%nii 7% mic!l ;a?in
- Imo;ili?ar%a
- O;%?itat%a
- Ro6%a& 6i in8lamai% d%-a l!n9!l @%n%i
- *!r%r% An mol%t, acc%nt!at& d% dorso8l%#ia 7icior!l!i
- Cr%6t%r%a t%m7%rat!rii 6i a 7!ls!l!i =7!ls c&&r&tor>
- Asi9!rar%a r%7a!s!l!i la 7at c! m%m;r!l in8%rior ridicat
- A7licaii local% c! ri@anol, antiin8lamatoar%
- Administrar%a tratam%nt!l!i c! anticoa9!lant%
- "onitori?ar%a 8!nciilor @ital% 6i @%9%tati@%
- !7ra@%9:%r%a %8%ct%lor t%ra7%!tic% 6i nont%ra7%!tic% al% m%dicam%nt%lor administrat%
- )%ri8icar%a t%st%lor d% coa9!lar% 7rin r%coltar%a d% sBn9% @%nos, la indicaia m%dic!l!i
- Instr!ir%a 7aci%nt!l!i s& n! s% lo@%asc&, s& n! s% mas%?% la ni@%l!l mol%t!l!i5
TU'(URFRI *I$ETI)E JI INTETINA'E
a> PERITONITA - in8lamaia m!coas%i 7%riton%al%
E"NE *E RECUNOAJTERE An 7%ritonita 9%n%rali?at&:
- F%;r&, 8risoan%
- Oli9!ri%, @&rs&t!ri
- RA;dom%n d% l%mnR =contract!r& a;dominal&>
- *!r%ri a;dominal% int%ns%, contin!% 6i 7%rman%nt%
- a;s%na sca!n!l!i 6i a 9a?%lor
- "onitori?ar%a 8!nciilor @ital% 6i @%9%tati@%
- Administrar%a tratam%nt!l!i 7r%scris: anti;iotic% - 7% cal% 7ar%nt%ral&, a7licaii r%ci 7% a;dom%n 7rot%<Bnd 7i%l%a
- Pr%9&tir%a ;olna@!l!i 7%ntr! r%int%r@%nia c:ir!r9ical&, ad%s%a n%c%sar& 7%ntr! tratar%a ca!?%i 7%ritonit%i,
dr%na<!l ca@it&ii
;> OC'UGIA INTETINA'F =I'EUU'> - An9!star%a l!m%n!l!i int%stinal car% Am7i%dic& tr%c%r%a 9a?%lor 6i a
mat%riilor 8%cal%
CAUGE
- "%canic%: ;rid% ad%r%nial%, @ol@!l!s, canc%r5
- Paralitic%: atoni% int%stinal&, mai al%s la c%i car% a! a@!t 7%ritonita5
- *!r%r% 7aro#istic& sa! colicati@&
- )&rs&t!ri r%8l%#% la Anc%7!t, l%9at% d% d!r%r%, car% d%@in ra7id st%rcoral%, c! miros 8%caloid - An ocl!?ii Analt%
- O7rir%a tran?it!l!i int%stinal 7%ntr! mat%rii 8%cal% 6i 9a?%
- (alonar%a =m%t%orism!l a;dominal>
- Alt%rar%a st&rii 9%n%ral%
- Ra7ortar%a d% !r9%n& a sim7tomatolo9i%i m%dic!l!i
- P!n%r%a sond%i d% as7irai% naso9astric& la indicaia m%dic!l!i 6i as7irar%a lic:id!l!i int%rmit%nt c! s%rin9a sa!
contin!!
- Notar%a 7i%rd%rilor: lic:id d% as7irai%, di!r%?a
4-C
- Cr%ar%a acc%s!l!i la o @%n& 7%ri8%ric& 6i r%%c:ili;rar%a :idro%l%ctrolitic&
- istar%a alim%ntai%i nat!ral% =7% 9!r&>
- Pr%9&tir%a ;olna@!l!i 7%ntr! r%?ol@ar%a c:ir!r9ical& a o;stacol!l!i at!nci cBnd m%dic!l indic&
c> FITU'E'E *I$ETI)E POTOPERATORII - s!nt com!nic&ri anormal%
CAUGE
- *%s8ac%r%a anastomo?%i sa! a s!t!rii di9%sti@% car% d%t%rmina i%6ir%a conin!t!l!i di9%sti@
- (olna@i d%n!trii, ca6%ctici, tratai c! corti?on
- *ist%nsia int%stinal&
- c!r9%r% anormal& din 7la9& sa! 7% dr%nH caract%risticil% lic:id!l!i s!nt An 8!nci% d% nat!ra 8ist!l%i:
O lic:id int%stinal An 8ist!la di9%sti@&
O lic:id clar, ca Ra7a d% stBnc&R An 8ist!la 7ancr%atic&
O lic:id 9al;%n-@%r?!i An 8ist!la ;iliar&
O im7osi;ilitat%a d% a s% alim%nta 7% cal% oral& An 8ist!l%l% di9%sti@%
- Notar%a 6i ra7ortar%a 7i%rd%rilor 7rin 8ist!l& =calitat%, cantitat%>
- E8%ct!ar%a ;ilan!l!i :idric
- Cr%ar%a acc%s!l!i @asc!lar 7%ntr! r%%c:ili;rar%a :idro%l%ctrolitic& 6i administrar%a m%dicai%i 7r%scris%:
anti;iotic%, ins!lina
- c:im;ar%a 7ansam%nt!l!i An condiii d% as%7si% ri9!roas&
- Prot%<ar%a t%9!m%nt!l!i din <!r!l dr%n!l!i c! o cr%m& 7rot%ctoar%
d> E)ICERA2IA - s!r@in% ad%s%a An a .a - a ,a ?i 7osto7%rator5 R%7r%?int& i%6ir%a @isc%r%lor a;dominal% 7rin
sol!ii d% contin!itat% al% 7%r%t%l!i, total%, car% l% 8ac dir%ct @i?i;il%
CAUGE
- Factori o7%ratori car% in d% ti7!l d% inci?i%, d% s!t!r&, d% dr%n!ril% scoas% 7rin 7la9a o7%ratori%
- Factori 7osto7%ratori:
O Cr%6t%r%a 7r%si!nii intraa;dominal% 7rin t!s%, @&rs&t!ri, il%!s, r%t%ni% d% !rin&
O In8%ctar%a 7l&9ii din int%rior sa! din %#t%rior
- Factori car% in d% t%r%n =;olna@>:
O O;%?itat% sa! d%n!trii%, :i7o7rot%in%mi%
O Canc%r, dia;%t ?a:arat
OTratam%nt% c! citostatic%, corti?on
- Dnd%7&rtar%a ;!?%lor 7l&9ii
- )isc%r%l% s% @&d An 7la9&
- Paci%nt!l ac!?& o s%n?ai% d% r!7t!r& la ni@%l!l a;dom%n!l!i
- Asi9!rar%a r%7a!s!l!i la 7at
- R%8ac%r%a 7ansam%nt!l!i An condiii d% as%7si% 6i 8i#ar%a c! !n ;anda< %lastic An <!r!l a;dom%n!l!i
- Instilar%a la indicaia m%dic!l!i, d% s%r 8i?iolo9ic st%ril An 7l&9i 7%ntr! a 7r%@%ni !scar%a @isc%r%lor
- Pr%9&tir%a ;olna@!l!i 7%ntr! r%int%r@%ni% c:ir!r9ical& dac& s% indic&5
%> E)ENTRA2IA - r%7r%?int& i%6ir%a !nor @isc%r% a;dominal% s!; 7i%l%, 7rin ?on% sl&;it% al% 7%r%t%l!i a7&r!t%
d!7& !n%l% o7%raii sa! tra!matism%5 Est% o com7licai% tardi@&5
CAUGE
- Car% in d% ;olna@: @Brsta Anaintat&, o;%?itat%, dia;%t ?a:arat, car%n% alim%ntar%, consti7ai%, %8ort!ri 8i?ic%
s!sin!t%5
- Car% in d% nat!ra int%r@%ni%i o7%ratorii: inci?ii mari 7% a;dom%n, mat%rial% d% s!t!r& 7roast%, s!7!raii
7osto7%ratorii, il%!s, %tc5
- Pr%9&tir%a ;olna@!l!i 7%ntr! o7%rai%
FIA N". 4.8. EFECTUAREA PANSAMENTULUI UNEI PL1GI DRENATE
- "%nin%r%a 7l&9ii 6i a ori8ici!l!i d% i%6ir% a dr%n!l!i c!rat%
4-.
- Fa@ori?ar%a09r&;ir%a cicatri?&rii 7l&9ii
TIPURI *E *RENAI
- E#ist& 2 ti7!ri d% dr%na<:
O *r%na<!l d%sc:is car% s% r%ali?%a?& d% r%9!l& c! t!;!ri d% dr%n sc!rtat%, s%cr%iil% 8iind a;sor;it% d% 7ansam%nt
O *r%na<!l Anc:is - car% s% r%ali?%a?& c! dr%n!ri l!n9i racordat% la 7!n9& sa! ;orcan!l An car% s% ac!m!l%a?&
s%cr%iil%
PRECAU2II DN EFECTUAREA PANA"ENTU'UI UNEI P'F$I *RENATE
- % And%7&rt%a?& 7ansam%nt!l c! at%ni% 7%ntr! a n! s% d%7lasa dr%n!l
- % c!l%9 in8ormaii d%s7r% ca@itat%a dr%nat&: st%ril&, contaminat&, in8%ctat&
- % o;s%r@& dac& dr%n!l i%s% 7rin contrainci?i% =ca An ma<oritat%a ca?!rilor> sa! i%s% 7rin 7la9a o7%ratori%
- % 7rot%<%a?& 7i%l%a An <!r!l dr%n!l!i 7%ntr! a 7r%@%ni iritaia
- *ac& lic:id!l dr%nat %st% st%ril, s% @a d%?in8%cta mai AntBi loc!l d% intrar% a dr%n!l!i 6i a7oi 7la9a 8iindc&
7rinci7i!l %st% s& n! s% ad!c& 9%rm%nii din 7la9a car% %st% coloni?at& c&tr% ori8ici!l car% tr%;!i% s& r&mBn& st%ril5
- *in contr&, dac& 7% dr%n s% %@ac!%a?& !n lic:id s!s7%ct sa! in8%ctat, s% c!r&& mai AntBi 7la9a 6i a7oi dr%n!l
7%ntr! a %@ita contaminar%a 7l&9ii5
- "&s!& r!lant& 7%ntr! 7ansam%nt%
- Casol%t& c! com7r%s% st%ril%, @at& st%ril&
- Tr!s& 7%ntr! 7ansam%nt%
- "at%rial% 7%ntr! 8i#ar%a 7ansam%nt!l!i
- ol!ii d%?in8%ctant%, antis%7tic%, anti;iotic%
a> PIEICF:
O In8ormar%, %#7licar%, o;in%r%a acord!l!i
;> FIGICF:
O A6%?ar%a Antr-o 7o?ii% comod& car% s& o8%r% acc%s lar9 la 7la9& 6i la dr%n
EFECTUAREA PANA"ENTU'UI UNEI P'F$I CU *REN CARE E CURTEAGF
- % And%7&rt%a?& 7ansam%nt!l m!rdar c! o 7%ns& sa! c! o m&n!6& d% !nic& 8olosin&
- C! o 8oar8%c& st%ril&, s% d%s7ic& com7r%s%l% An RdR, c! condiia s& 8i% 7!s% a7oi Antr-o 7!n9& st%ril& - %
And%7&rt%a?& ac!l d% si9!ran& @%c:i ast8%l:
O % 7rind% ac!l c! o 7%ns& anatomic&
O % 8i#%a?& c! 7%nsa Woc:%r 6i a7oi s% d%sc:id% c! 7%nsa anatomic&
O % d%7!n 7%nsa Woc:%r 6i ac!l d% si9!ran& An r%ci7i%nt!l r%?%r@at
- % c!r&& 6i s% d%?in8%ct%a?& 7la9a Anc%7Bnd c! 7art%a c%a mai c!rat&
- % c!r&& An <!r!l dr%n!l!i 7rin mi6c&ri circ!lar% sa! c%ntri8!9%
- % 8i#%a?& dr%n!l, s% tr%c% ac!l d% si9!ran& 7rin dr%n 6i s% Anc:id% a7oi c! o 7%ns& anatomic&
- % tai% s%9m%nt!l d% dr%n a8lat d%as!7ra ac!l!i d% si9!ran&
- *ac& tr%;!i% s& s% in<%ct%?% !n anti;iotic:
O % d%?in8%ct%a?& dr%n!l
O % clam7%a?& a7oi dr%n!l c! o 7%ns& Woc:%r
O % An%a7& dr%n!l 7% 7art%a lat%ral&, s!; 7%ns& 6i s% in<%ct%a?& sol!ia
O % And%7&rt%a?& s%rin9a 6i ac!l, s% d%clam7%a?& t!;!l d% dr%n
- % Ancon<oar& dr%n!l c! com7r%s% st%ril% cr%stat% 7% mi<loc
- % aco7%r& a7oi 7art%a d% d%as!7ra a dr%n!l!i c! alt% com7r%s% n%cr%stat%
- % 8i#%a?& 7rin ;anda<ar% sa! c! ;%n?i ad%?i@% :i7oal%r9ic%
CAPITOLUL .. PARTICULARIT12I DE ADMINISTRARE A UNOR MEDICAMENTE
FISA 8.1.)ADMINISTRAREA ANTICOAGULANTELOR
*EFINI2IE
- Anticoa9!lant%l% s!nt m%dicam%nt% car% Am7i%dic& 7roc%s!l d% coa9!lar%, 8iind administrat% 7%ntr! 7r%@%nir%a
6i tratar%a di8%rit%lor 8orm% al% maladi%i trom;o%m;olic%5
FACTORII CARE FA)ORIGEAGF (OA'A TRO"(OE"(O'ICF
- Alt%rar%a 7%r%t%l!i @asc!lar
- ta?a circ!latori% din ca!?a imo;ili?&rii
4-7
- Ei7%rcoa9!la;ilitat%a
IN*ICA2II
- Fl%;it%l% m%m;r%lor in8%rioar% An:
O O;st%tric& - d!7& na6t%r% sa! a@ort
O C:ir!r9i% - 7%ntr! ;olna@!l imo;ili?at An a7arat 9i7sat, int%r@%nii 7%l@in% la 8%m%i c! o;%?itat% sa! c! ;oli
@%noas%H d!7& int%r@%nii 7%ntr! 7rot%?& d% 6old sa! 9%n!nc:i
O "%dical& - ;olna@i cardiaci, c! 8l%;it% lat%nt%, An imo;ili?ar%a 7r%l!n9it&
- Em;oli%: 7!lmonar&, 7%ri8%ric& An m%m;r%l% in8%rioar%, An t%ritori!l m%?%nt%ric, An cardio7atii %m;olic%
- Trom;o?a coronarian&: in8arct miocardic
- Art%rit% 6i trom;o?% art%rial% al% m%m;r%lor in8%rioar%
- C:ir!r9ia cardiac&, a @as%lor mari
MEDICAMENTE UTILI&ATE ) FORME DE PRE&ENTARE
A5 O'U2II INIECTA(I'E
EEPARINA
- % administr%a?& strict intra@%nos, An am%st%c c! sol!i% salin& i?oton& !rmat& d% 7%r8!?i% contin!&
- Acion%a?& 7rin ;locar%a !ltim%i 8a?% a coa9!l&rii, in:i;& trom;ina 6i Am7i%dic& trans8ormar%a 8i;rino9%n!l!i An
8i;rin&
- N! s% am%st%c& An 7%r8!?i% c! 7r%7arat% d% calci!, 7a7a@%rin&, sa! c! alt% m%dicam%nt%5
- E%7arina %st% inacti@at& d% s!c!ril% di9%sti@% 6i n! tr%c% 7rin m%m;ran%5
FOR"E *E PREGENTARE:
E%7arin sol!i% in<%cta;il&, 8iol% d% 4ml, Cml - C000!i0ml
E%7arin ando? 2C000!i0Cml - sol!i% in<%cta;il&, 8iol% d% 4ml, Cml - C000!i0ml
E%7arin% sodi[!% - sol!i% in<%cta;il& - 8lacoan% d% Cml - C000!i0ml
R%@i7arin!m, Eno#a7arin!m, Nadro7arin!m, *alt%7arin!m
- ol!ii a7oas% in<%cta;il% 7%ntr! administrar% 5C5 6i I5)5
- P%ntr! administrar% 6i man%@rar% cor%ct& s% cit%6t% c! at%ni% 7ros7%ct!l
- 'oc!ri d% administrar%: d%as!7ra cr%st%i iliac%, la ni@%l!l a;dom%n!l!i =la C cm distan& d% om;ilic>, la ni@%l!l
;ra!l!i 6i coa7s%i
- *!7& d%?in8%cia local& s% 8ac% !n 7li! c!tanat car% @a 8i m%nin!t tot tim7!l in<%ct&rii, 7%ntr! a %@ita
introd!c%r%a sol!i%i intram!sc!lar
- *!7& in<%ctar% s% m%nin% ac!l An %s!t a7ro#imati@ C s%c!nd% 7%ntr! a %@ita r%8!lar%a m%dicam%nt!l!i 7rin
An%7&t!r&
- N! s% mas%a?& loc!l 7%ntr! a n! 8a@ori?a a7ariia :%matoam%lor
- N! s% am%st%c& An sol!i% c! alt% 7r%7arat%
- Administrar%a s% 8ac% la int%r@al d% 42 :, con8orm indicai%i m%dical%
- 'oc!l in<%ct&rii n! in8l!%n%a?& rata d% a;sor;i%
R%@i7arin!m 7r%?%ntat s!; 8orm& d%:
- Cli@arin "U'TI - sol!i% in<%cta;il&, 8lacoan% d% .ml - C72.!nit0ml
- Cli@arin PEN - sol!i% in<%cta;il& C72.!nit0ml, cart!6 7%n !m7l!t c! 40 do?% 0,2C ml, 0,2CmlS 4/-2 !i
O % administr%a?& An 7li!l c!tanat 7rin An%7&t!r& 7%r7%ndic!lar&, 8&r& as7irai%
O *%?in8%cia s% 8ac% Antr-!n sin9!r s%ns
O *!7& in<%ctar% dis7o?iti@!l d% administrar% s% in% An 7o?ii% 40 s%c!nd%, a7oi s% d& dr!m!l la 7li!
- Cli@arin 0,2C ml04/-2 !iH 0,. ml0--/. !iH
O s% 7r%?int& An s%rin9i 7r%!m7l!t% !nido?&
O s% administr%a?& Anaint%a 6%din%i d% diali?& An ;ol!s intraart%rial sa! An 7li! c!tanat Antr% om;ilic 6i cr%asta
iliac&, 7% 8aa ant%rioar& a coa7s%i, 7%r7%ndic!lar, 8&r& as7irai%5 Eno#a7arin!m 7r%?%ntat s!; 8orm& d% :
- Cl%#an% - sol!i% in<%cta;il& - 400 m9 %no#a7arin& sodic&0ml, 8lacoan% d% - ml
- Cl%#an% 40 000 !i0ml - sol!i% in<%cta;il& An s%rin9i 7r%!m7l!t% d% 4 ml =400 m90ml - 4 m9 %no#a7arin& sodic&
S 0504 ml sol!i% in<%cta;il&>
- Cl%#an% in<%cta;il An s%rin9i 7r%!m7l!t% d% 0,2 ml0 2000 !i, 0,/ ml0/000 !i, 0,. ml0.000 !i, 0,, ml0,000 !i
O N! s% administr%a?& i5m5
O N! s% %limin& ;!la d% a%r Anaint% d% in<%ctar%
4-,
- Nadro7arin!m 7r%?%ntat s!; d%n!mir%a d% Fra#i7arin% - 2,C0 !5i500,- ml - s%rin9i 7r%!m7l!t% d% 0,-
ml02,C0!5i5, -,00!5i500,/ mlH C700 !5i00,. mlH 7.00!5i500,, ml
- *%lta7arin!m 7r%?%ntat s!; d%n!mir%a d% Fra9min, s%rin9i 7r%!m7l!t% =40000 !i0ml>
Fra9min : 0,2 ml02C00 !i, 0,2ml0C000 !i, 0,-ml07C00 !i, 0,.ml04C00!i
O % administr%a?& 5C5 An 7%r%t%l% a;dominal 7rin An%7&t!r& 7%r7%ndic!lar&5 % 7oat% administra 6i i5@5 7rin
7%r8!?i% contin!& 6i intrart%rial An ;ol!s, la Anc%7!t!l 6%din%i d% diali?&5
(5 FOR"E PENTRU A*"INITRARE PE CA'E ORA'F
Anticoa9!lant% c!marinic% =Anti@itamin% W>
- Dm7i%dic& sint%?a :%7atic& a 8actorilor coa9!l&rii d%7%nd%nt& d% @itamina W
- % r%comand& An 7ro8ila#ia trom;o?%lor @%noas% 6i accid%nt%lor trom;o%m;olic% d!7& int%r@%nii c:ir!r9ical% la
7aci%nii c! risc cr%sc!t, la ;olna@ii c! 7rot%?% @al@!lar%, 9r%8% @asc!lar%, st%no?& mitral&5
Ac%noc!marol!m 7rod!s s!; d%n!mir%a d%:
- Ac%noc!marol - c75 - 2 m9
- inirom - c75 - / m9
- Trom;osto7 - c75- 2 m9H
O s% 7&str%a?& la 4C-2CK, 8%rit d% l!min&
O at%ni% - @&rs&t!ri - dis8!ncii :%7atic%
R%acii ad@%rs%:
O E%mora9ii - 9astroint%stinal%, c%r%;ral%, la ni@%l!l tract!l!i !ro9%nital =:%mat!ri%>, !t%r =m%nora9ii sa!
m%trora9ii>
O R%acii ad@%rs%: 9r%a&, @&rs&t!ri, r%acii al%r9ic%, !rticari%, d%rmatit%, 8%;r&, alo7%ci% r%@%rsi;il&
PRECAU2IUNI PECIA'E PRI)IN* A*"INITRAREA U(CUTANATF
- In<%ctar%a s!;c!tanat& s% 7r%t%a?& la cantit&i mici d% sol!i%
- % 8olos%sc ac% s!;iri, l!n9i d% 42mm, car% 9arant%a?& in<%ctar%a m%dicam%nt!l!i An %s!t!l s!;c!tanat
- Ac!l s!;ir% scad% risc!l antr%n&rii 9%rm%nilor
- % 7r%8%r& introd!c%r%a @%rtical& la +0K sc&?Bnd risc!l l%?&rii !nor 8il%t% n%r@oas% 6i @as%lor d% sBn9%, c%%a c%
8ac% ca d!r%r%a s& 8i% mai mic& 6i risc!l d% :%matom sc&?!t
- Ac%l% mai l!n9i 7ot 8i introd!s% s!; !n !n9:i d% /CK, c! at%ni%, 7%ntr! a n! a<!n9% An 9rosim%a m!6c:i!l!i5
UPRA)E$EEREA PACIENTU'UI
A5 Dnaint%a tratam%nt!l!i
- % d%t%rmin& 9ro7!l san9!in 6i R:
- "%dic!l sta;il%6t% ;olna@ii c! risc d% :%mora9i%: !lc%r!l 9astrod!od%nal, ;oli :%mora9ic%, ins!8ici%na :%7atic&
6i r%nal&, A)C r%c%ntH 9ra@id%, :i7ot%nsi!n%a art%rial& s%@%r&
- % d%t%rmin& tim7!l d% 7rotrom;in& Anaint%a tratam%nt!l!i c! anticoa9!lant% c!marinic% =%st% cr%sc!t An ciro?&
6i :%7atit&>
(5 Dn tim7!l tratam%nt!l!i
- N! s% 8ac in<%cii i5m5 6i s5c, %#ist& risc d% :%matom
- % s!7ra@%9:%?& a7ariia :%mora9iilor
O 9in9i@ora9ii, %7ista#is
O :%mora9ii d!7& ras
O :%mat!ria - s% col%ct%a?& !rina Antr-!n ;orcan 6i s% %#amin%a?&
O sca!n!l c! sBn9%
- Dn ca?!l sBn9%rBrilor, la r%comandar%a m%dic!l!i, s% administr%a?& PROTA"INA An tratam%nt!l c! E%7arin& 6i
Fitom%nadion& An tratam%nt!l c! trom;osto7
- N! s% 8ac %ndosco7ii 6i nici 7!ncii
- % 8ac% control!l ;iolo9ic al coa9!l&rii: tim7!l Eo^%ll An :%7arinot%ra7i% 6i tim7!l d% 7rotrom;in& An
tratam%nt!l c! anticoa9!lant% oral%
- Dn tim7!l 7%r8!?i%i, r%coltar%a sBn9%l!i s% 8ac% d% la c%l&lalt ;ra
- Dn ca?!l administr&rii s!;c!tanat% r%coltar%a s% 8ac% la .-, or% d% la in<%ci%
- % monitori?%a?& star%a 9%n%ral& Antr!cBt 7ot a7ar%: 8rison, 8%;r&, @om&5
- Paci%nt!l %st% in8ormat s& n! ia alt% m%dicam%nt% 8&r& r%comandar% m%dical& d%oar%c% !n%l% 7ot%n%a?& %8%ct!l
iar alt%l% Al dimin!%a?&
- At%ni% d%os%;it& s% acord& 7aci%nt!l!i tratat c! anticoa9!lant% c!marinic%, d%oar%c% tratam%nt!l s% 8ac%
am;!lator 6i n! 7oat% 8i s!7ra@%9:%at 7%rman%nt
4-+
- "%dicam%nt%l% car% cr%sc %8%ct!l anticoa9!lant%lor: salicilai, 7arac%tamol, 8%nil;!ta?on&, la#ati@%, :ormoni
tiroidi%ni, !n%l% anti;iotic% =t%traciclin&, cloram8%nicol>, s!l8amid%, anal9%tic%
- "%dicam%nt% car% scad %8%ct!l anticoa9!lant% lor: 7ansam%nt%l% 9astric%, antiacid%, ;ar;it!ric%, !n%l%
tranc:ili?ant% 6i n%!rol%7tic%, di!r%tic% m%rc!rial%, di9italic%, in:i;itori tiroidi%ni5
E*UCA2IA PACIENTU'UI
% instr!i%6t% 7aci%nt!l:
- & ia m%dicam%nt%l% d!7& orar!l sta;ilit d% m%dicH administrar%a s% 8ac% mai al%s s%ara 7%ntr! ca m%dic!l s&
7oat& cor%cta la n%@oi% do?a d!7& @aloar%a tim7!l!i d% 7rotrom;in& d%t%rminat An tim7!l ?il%i
- *ac& omit% o do?&, o 7oat% l!a An int%r@al d% , or%, d!7& car% s% sar% 7%st% 7ri?& 6i s% ia do?a la ora o;i6n!it& An
?i!a !rm&toar%
- & n!-6i modi8ic% sin9!r do?%l%
- & n! Antr%r!7& ;r!sc tratam%nt!l, %#ist& risc d% :i7%rcoa9!la;ilitat% 6i trom;o%m;oli%
- & s% a!tos!7ra@%9:%?% 6i s& d%7ist%?% s%mn%l% d% s!7rado?ar% =:%mora9ii>
- & s% 7r%?int% c! r%9!laritat% la m%dic 7%ntr! r%coltar%a 7ro;%lor d% coa9!lar%
- & an!n% stomatolo9!l sa! alt m%dic, dac& %st% ca?!l, c& %st% An tratam%nt c! anticoa9!lant% oral% =ACO>
- & n! 7ractic% s7ort!ri @iol%nt% car% 7r%s!7!n lo@it!ri, c&d%ri sa! m!nci int%ns%
- & contin!% a!tos!7ra@%9:%r%a 7% 7%rioada Antr%r!7%rii tr%7tat% a tratam%nt!l!i =2-/ s&7t&mBni> 7%ntr! c&
aci!n%a s% m%nin% Antr% 2-C ?il% d!7& Anc%tar%a administr&rii, An 8!nci% d% anticoa9!lant!l 8olosit
- & %@it% %#7!n%r%a la c&ld!r&, canic!la cr%6t% %8%ct!l
- & cons!m% o alim%ntai% %c:ili;rat& 6i s& n! %#a9%r%?% c! alim%nt% ;o9at% An @itamina W: ;rocoli, s7anac,
@ar?&, cono7id&, s7aran9:%l, m&rar, ma?&r% @%rd%, soia, tomat%, !r?ici, 9&l;%n!6 d% o!, 8icat =7orc, @it&>, salat&
@%rd%, s!c d% 9ra7%-8r!it5
- & n! cons!m% alcool An %#c%s, 7ot%n%a?& %8%ct!l ACO
- & n! 8olos%asc& 7lant% m%dicinal% car% in8l!%n%a?& %8%ct!l ACO:
O scad tim7!l d% 7rotrom;in&: s!n&toar%a, l!c%rna, c%ai!l @%rd%, 9in9s%n9, coac&?% n%9r%
O cr%sc tim7!l d% 7rotrom;in& sa! risc!l d% :%mora9i%: !st!roi!l, c%ai!l @%rd%, 9inXo ;ilo;a
- & %@it% 8!mat!l, d%oar%c% 8!m!l d% i9ar& 7oat% sc&d%a %8%ct!l ACO
- & in8orm%?% 8amilia as!7ra tratam%nt!l!i anticoa9!lant
- & %@it% t&i%t!ril%H An ca? d% :%mora9i% s& a7lic% !n 7ansam%nt com7r%si@ 6i s& s% 7r%?int% d% !r9%n& la s7ital
- & 7oart% as!7ra l!i cart%a d% id%ntitat%, !n card c! 9r!7a san9!in& 6i anticoa9!lant!l 8olositH data Anc%7%rii
tratam%nt!l!i 6i d!rata 7ro;a;il&, do?a administrat&, mod!l d% administrar% =!n com7rimat s%ara, sa! do!&
administr&ri 7% ?i la 42 or% 7r%8%ra;il la ac%%a6i ora >
FIA N". 8.6. ADMINISTRAREA ANTIBIOTICELOR
*EFINI2IE
- anti;iotic%l% s!nt a9%ni antimicro;i%ni car% introd!s% An or9anism %#%rcit& %8%ct% to#ic% s7%ci8ic% 8a&
d% an!mit% microor9anism%, 7ara?ii sa! c%l!l% ati7ic%, a@Bnd %8%ct% to#ic% m!lt mai r%d!s% sa! a;s%nt% 8a& d%
c%l!l%l% or9anism!l!i 9a?d&5
EFECTE JI "O* *E AC2IUNE
ANTI(IOTICE (ACTERICI*E
O Prod!c distr!9%r%a 9%rm%nilor, s!nt indicat% An in8%cii 9ra@%, s!7raac!t%, sa! cBnd m%canism%l% im!nitar% s!nt
r%d!s% =no! n&sc!i, ;&trBni, in8%cii cronic%>, An !rma administr&rii citoto#ic%lor, corticot%ra7ic%lor, d!7&
radiot%ra7i%5
O Princi7al%l% anti;iotic% ;act%ricid% s!nt: 7%nicilin%l%, c%8alos7orin%l%, amino9lico?id%l%, ri8am7icina,
7olimi#in%l% 6i ;acitracina5
ANTI(IOTICE (ACTERIOTATICE
O In:i;& m!lti7licar%a 9%rm%nilor 6i 8a@ori?%a?& aci!n%a 8or%lor d% a7&rar% al% or9anism!l!i5
OPrinci7al%l% anti;iotic% ;act%riostatic% s!nt: t%rtraciclina, clo8am8%nicol!l, %ritromicina5 !nt r%comandat% An
in8%cii !6oar% sa! m%dii5
Anti;iotic%l% 7ot a@%a:
4 7%ctr! An9!st - as!7ra cocilor 6i ;acililor 9ram-7o?iti@i 6i 9ram-n%9ati@im5 P%rmit t%ra7ia ;in% intit&5
2 7%ctr! lar9 - ti7 t%traciclin& 6i cloram8%nicol car% acion%a?& as!7ra cocilor 6i ;acililor 9ram-7o?iti@i 6i
9ram-n%9ati@i, a ricX%ttsiilor, mico7lasm%lor, c:lamidiilor5
- 7%ctr! limitat =antit!;%rc!loas%> - acti@% n!mai 8a& d% ;act%rii5
E8icacitat%a d%7ind% d%:
4/0
- r%?ist%na 9%rm%nilor - car% r%7r%?int& ins%nsi;ilitat%a la !n an!mit anti;iotic, 6i car% 7oat% 8i nat!ral& sa!
do;Bndit& =!rmar% a !n%i trans8orm&ri 9%n%tic% sta;il% transmis% d% la o 9%n%rai% la alta>5
- r%ali?ar%a conc%ntrai%i acti@% la loc!l d% aci!n% car% tr%;!i% s& s% m%nin& !n tim7 s!8ici%nt 7%ntr! a into#ica
microor9anism%l%, 8iind condiionat& d% a;sor;ia anti;iotic!l!i din t!;!l di9%sti@ sa! d% la loc!l in<%ct&rii5
IN*ICA2II
- 7r%@%nir%a 6i tratam%nt!l in8%ciilor5
Tratam%nt!l 7oat% 8i:
- 7rin t%ra7ia dir%ct& =Am7otri@a !n!i or9anism s7%ci8ic id%nti8icat 7rin c!lt!r& 6i anti;io9ram&>, sa!
- %m7iric =Am7otri@a a9%nilor 7ato9%ni c%l mai 7ro;a;il 7Bn& cBnd or9anism!l s7%ci8ic %st% id%nti8icat>5
Dn 9%n%ral s!nt !tili?at% ca 7ro8ilactic% !rm&toar%l%:
O P%nicilina 7%ntr! 7r%@%nir%a in8%cilor str%7tococic% din 9r!7!l A, a 9onor%%i 6i si8ilis!l!i im%diat d!7&
%#7!n%r%5 Anti;iotic% 7%ntr! a 7r%@%ni %ndocardit%l% ;act%ri%n% la 7aci%nii c! ;oli cardiac% @al@!lar%5
O Anti;iotic% 7%ntr! 7r%@%nir%a in8%ciilor 7osto7%ratorii la 7aci%nii c! r%?ist%n& sc&?!t& datorit& @Brst%i, n!trii%i
d%8icitar%, Anaint%a int%r@%niilor c:ir!r9ical% c! risc cr%sc!t =c:ir!r9ia cardiac&, c:ir!r9ia 9astroint%stinal&,
7roc%d!ri c:ir!r9ical% An orto7%di%>5
PRINCIPII'E TERAPIEI "E*ICA"ENTOAE ANTIINFEC2IOAE
'imit%l% !tili?&rii:
O !nt indicat% n!mai cBnd o in8%ci% ;act%rian& s%mni8icati@& %st% dia9nosticat& sa! s!s7%ctat& 7!t%rnic, sa! cBnd
%#ist& o indicai% sta;ilit& 7%ntr! 7ro8ila#i%5
O N! tr%;!i% !tili?at% 7%ntr! in8%ciil% @iral% 6i in8%cii n%Ans%mnat%5 !nt in%8ici%nt% An in8%ciil% @iral%, 7%rmit
cr%6t%r%a r%?ist%n%i5
- Col%ctar%a 7ro;%lor
O Col%ctar%a 7%ntr! c!lt!r& 6i anti;io9ram& Anaint% d% a s% administra 7rima do?& d% anti;iotic
O C!lt!ril% tr%;!i%sc r%coltat% cor%ct 6i d!s% la la;orator, An tim7 !til5 *ac& s% AntBr?i% 7oat% cr%6t% contaminar%a
%l%ctar%a m%dicam%nt!l!i:
O Al%9%r%a anti;iotic!l!i ar tr%;!i s& 8i% ;a?at& 7% r%?!ltat!l!i d% la c!lt!ra micro;ian& 6i anti;io9ram&, 7% st!dii
7ri@ind s%nsi;ilitat%a, 7%ntr! a 7!t%a d%t%rmina car% m%dicam%nt% s!nt c%l% mai %8ici%nt%5 Un%l% microor9anism%
s!nt An Antr%9im% s%nsi;il% la an!mit% m%dicam%nt% 6i An ca?!l !nor in8%cii, n! mai %st% n%c%sar& %8%ct!ar%a
t%st%lor d% s%nsi;ilitat%5
O C!lt!ril% 6i st!diil% d% s%nsi;ilitat% s!nt im7ortant% 7%ntr! s!s7%ctar%a in8%ciilor 9ram n%9ati@% datorit&
incid%n%i mari a r%?ist%n%i la microor9anism%
O *%oar%c% ac%st% t%st% c%r /, - 72 d% or%, m%dic!l 7r%scri% im%diat administrar%a !n!i m%dicam%nt car% s& 8i%
%8ici%nt
Cal%a d% administrar%:
O *%7ind% m!lt d% s%@%ritat%a in8%ci%i
O Cal%a oral& - administrar%a oral& %st% 7r%8%rat& 7%ntr! inii%r%a t%ra7i%i nomai An in8%ciil% r%lati@% !6oar%
O Cal%a in<%cta;il& =I5"5, I5)5, intrara:idian&> - An in8%ciil% s%rioas% %st% 7r%8%rat& r!ta i5@5
OA7licar% local& =7% t%9!m%nt%>
*!rata t%ra7i%i:
O )aria?& d% la o sin9!r& do?& la ani
O Dn in8%ciil% ac!t% d!rata m%di% %st% d% 7-40 ?il% sa! 7Bn& cBnd 7aci%nt!l %st% a8%;ril 6i asim7tomatic /,-72 :
Utili?ar%a 7r%o7%ratori%:
O s% administr%a?& 7r%@%nti@ c! o or& Anaint% d% o7%rai%5 F!rni?%a?& conc%ntraia %8ici%nt& a %s!t!rilor 7%
7%rioada 7roc%d!rii c:ir!r9ical%, cBnd contaminar%a %st% mar%5 Al%9%r%a m%dicam%nt!l!i d%7ind% d% a9%nt!l
7ato9%n, o sin9!r& do?& %st% s!8ici%nt&, 7!tBnd 8i r%7%tat& dac& int%r@%nia s% amBn& sa! s% 7r%l!n9%6t%
Utili?ar%a An ins!8ici%na r%nal&:
O s% c%r% 7r%ca!i!n% %#tr%m&, d%oar%c% m!lt% m%dicam%nt% s!nt %#cr%tat% 7rimar 7rin rinic:i, !n%l% 8iind
n%8roto#ic%5 Tot!6i An do?% r%d!s% s!nt n%c%sar%5
Utili?ar%a An ;olil% :%7atic%:
O An ;olil% s%@%r% al% 8icat!l!i m%dicam%nt%l% antiin8%cioas% car% s!nt %#cr%tat% 7rin 8icat ar tr%;!i s& 8i% r%d!s%
ca do?&, !n%l% s!nt :%7atoto#ic%5 Ac%st%a incl!d %ritromicina, clidamZcin 6i cloram8%nicol!l5
Utili?ar%a la co7ii:
O m%dicam%nt%l% antimicro;i%n% s!nt !tili?at% An s7ital 6i am;!latori! 7%ntr! otit% m%dii 6i in8%cii al% tract!l!i
r%s7irator5 P%nicilin%l% 6i c%8alos7orin%l% s!nt consid%rat% si9!r% 7%ntr! c%l% mai m!lt% 9r!7% d% @Brst&, tot!6i %l%
4/4
s!nt %liminat% m!lt mai Anc%t la no! n&sc!i datorit& 8!nci%i r%nal% imat!r% 6i d% ac%%a tr%;!i% administrat% c!
7r%ca!i!n%5 Amino9lico?id%l% =%#5 9%ntamicina> 7ot ca!?a n%8roto#icitat% 6i ototo#icitat%5 'a no! n&sc!i risc!l
%st% mar% datorit& 8!nci%i r%nal% imat!r%5 T%traciclin%l% s!nt contraindicat% la co7ii s!; , ani, datorit& %8%ct%lor
as!7ra dinilor =An9&l;%nir%> 6i oas%lor5
Utili?ar%a la 7%rsoan%l% An @Brst&:
O P%nicilin% s!nt si9!r%, dar 7ot 7rod!c% :i7%rXal%mia d!7& administrar%a do?%lor mari i5@5 d% 7%nicilin& $
7otasic& 6i :i7%natr%mia d!7& administrar%a d% car;%nicilin5
O C%8alos7orin%l% s!nt An 9%n%ral consid%rat% si9!r%, dar 7ot ca!?a sa! a9ra@a ins!8ici%na r%nal&, An s7%cial cBnd
s!nt !tili?at% 6i alt% m%dicam%nt% n%8roto#ic%5
O Amino9lico?id%l% s!nt contraindicat%5P%rsoan%l% An @Brst& a! !n risc mar% d% n%8roto#icitat% 6i ototo#icitat%5
O T%traciclin%l% %#c%7tBnd do#icilina 6i nitro8!rantoin!l s!nt contraindicat%5
PRECAU2II PECIA'E
O s% 8ac% o anamn%?& am&n!nit& 7ri@ind 8!nciil% r%nal&, :%7atic&, a!diti@& 6i %@%nt!al% ant%c%d%nt% al%r9ic%H
O s% r%s7%ct& m%dicam%nt!l r%comandat a@Bnd An @%d%r% %8%ct%l% 6i r%aciil% ad@%rs%H
O s% r%s7%ct& orar!l, do?a 6i cal%a d% administrar% 7%ntr! a m%nin% o conc%ntrai% acti@& la loc!l d% aci!n%H
O s% r%s7%ct& d!rata tratam%nt!l!i 7%ntr! 7r%@%nir%a d%?@olt&rii 9%rm%nilor r%?ist%niH
O s% @or !rm&ri r%aciil% ad@%rs%:
O r%acii al%r9ic% mai 8r%c@%nt% la 7%nicilin&, a7ar An cadr!l ac%l%ia6i 9r!7% d% anti;iotic% sa! a7ro7iat% ca
str!ct!r&5 Dntr% C-40P din 7aci%nii s%nsi;ili la 7%nicilin& 7ot 7r%?%nta al%r9i% la c%8alos7orin%5
o r%acii to#ic% - int%r%s%a?& !n%l% or9an%H amino9lico?id%l% s!nt ototo#ic% 6i n%8roto#ic%, iar
t%traciclin%l%, %ritromicin%l% s!nt :%7atoto#ic%, cloram8%nicol!l %st% to#ic 7%ntr! :%mato7o%?a, 7%nicilin%l% An
do?% mari 6i 7olimi#in%l% a! %8%ct n%!roto#ic5
o r%acii idiosincra?ic% - ca !rmar% a !nor %n?imo7atii 9%n%tic% =%#5:%moli?a 7rod!s& d% s!l8amid% sa!
mani8%st&ril% 7olin%@ritic% la i?onia?id&>
o r%acii d% ordin ;iolo9ic:
- r%acii d% %#ac%r;ar% =E%r#:%im%r> - r%?!ltat!l distr!9%rii masi@% d% 9%rm%ni c! %li;%rar% d% %ndoto#in%
in tratam%nt!l c! 7%nicilin& al l!%s!l!i sa! c! cloram8%nicol An 8%;ra ti8oid&5 "%dic!l 7r%scri% la Anc%7!t do?%
mici5
- r%?ist%na micro;ian& la !n an!mit anti;iotic, 8a@ori?at& d% conc%ntraia sc&?!ta la loc!l aci!nii,
tratam%nt d% sc!rt& d!rat&5
- 8%nom%n% d% dismicro;ism - distr!9%r%a !nor 9%rm%ni concomit%nt c! Anm!lir%a c%lor r%?ist%ni car%
7ot 8i sa! 7ot d%@%ni 7ato9%ni, 7ot 7rod!c% s!7rain8%cii 9ra@% mai 8r%c@%nt la co7ii, ;&trBni 6i la anti;iotic% c!
s7%ctr! lar95 Administrar%a local& a anti;iotic%lor tr%;!i% limitat&, %#ist& risc mar% d% s%nsi;ilitat% 6i d%?@oltar%
d% t!l7ini r%?ist%nt%5 % 7r%scri! c%l% car% n! s% administr%a?& 7% cal% 9%n%ral& datorit& to#icit&ii mari, c!
ca7acitat% al%r9i?ant& r%d!s&, ;in% tol%rat& d% %s!t!ri5
INTERAC2IUNI "E*ICA"ENTOAE
O Cloram8%nicol!l r%d!c% m%ta;olism!l anticoa9!lant%lor 6i anticon@!lsi@ant%lorH
O ototo#icitat%a amino9lico?id%lor %st% 7ot%nat& d% di!r%tic% =%#58!ros%mid>H
O com;inar%a s!;stan%lor Rin @itroR 7oat% modi8ica star%a 8i?ico-c:imic& 6i acti@itat%a antimicro;ian&
=am%st%car%a sol!i%i d% m%ticilin& 6i 9%ntamicin& sa! Xanamicin&>H
O sol!iil% c! 7E 7r%a alcalin sa! 7r%a acid 8olosit% 7%ntr! 7%r8!?i% inacti@%a?& anti;iotic!l =%#5 ;%n?il7%nicilina>5
E%7arina 6i :idrocorti?on!l :%mis!ccinat =EEC> s!nt incom7ati;il% c!: 7%nicilina, m%ticilina, Xanamicina,
cloram8%nicol!l, t%traciclina5 *ac& n! s% c!nosc dat% s!8ici%nt% c! 7ri@ir% la incom7ati;ilitat%a anti;iotic%lor c!
ac%st% s!;stan%, %st% 7r%8%ra;il ca ac%st%a s& 8i% administrat% 7% cal% intra@%noas& s%7arat sa! An 7%r8!?ii sc!rt%,
int%rmit%nt%5- !l8amid%l% 7ot%n%a?& %8%ct!l s!l8amid%lor antidia;%tic% c! :i7o9lic%mi% cons%c!ti@&, 7ot%n%a?&
anticoa9!lant%l% c!marinic%H s!;stan%l% acidi8iant% 8a@ori?%a?& 7r%ci7itar%a An c&il% !rinar%5
AC2IUNI'E NURIN$ $ENERA'E
OAdministrar%a c! ac!rat%%
O ta;ilir%a orar!l!i d% administrar% la int%r@al% %9al% - 7%ntr! m%nin%r%a ni@%l!l!i t%ra7%!tic An sBn9%
O % administr%a?& 7% stomac!l 9ol =c! 4: Anaint% d% mas& sa! la 2: d!7& mas&> - 7%ntr! a 7r%@%ni inacti@ar%a d%
c&tr% s%cr%ia 9astric& 6i a 8a@ori?a a;sor;ia
O % cit%sc r%comand&ril% d% am%st%car% 6i stocar% din 7ros7%ct55
4/2
- "%dicam%nt%l% antimicro;i%n% am;alat% s!; 8orm& d% 7!l;%r% s!nt insta;il% An sol!ii, s% di?ol@& Anaint%a
administr&rii 8olosind o cantitat% ad%c@at& d% sol@%nt, conc%ntraia 8iind %#7rimat& An m90ml5 C%l% mai m!lt%
sol!ii s% 7&str%a?& la 8ri9id%r 7%ntr! 7%rioad% l!n9i d% sta;ilitat%5
ONici o sol!i% n! tr%;!i% !tili?at& d!7& t%rm%n!l d% %#7irar% d%oar%c% %st% 7osi;il& d%scom7!n%r%a5
OPar%nt%ral sol!ii c! anti;iotic% s% administr%a?& sin9!r%, n! s% am%st%c& c! nici !n alt m%dicam%nt An s%rin9&
sa! sol!ii i5@5 - 7%ntr! a %@ita incom7ati;ilit&il% c:imic% 6i 8i?ic% car% 7ot ca!?a 7r%ci7itar%a sa! inacti@ar%a
m%dicam%nt%lor
OAnti;iotic%l% s% administr%a?& i5m5, 7ro8!nd An masa m!sc!lar& 6i s% rot%6t% loc!l d% in<%ci%
O P%ntr! administrar%a i5@5 a anti;iotic%lor5
o s% !tili?%a?& sol!ii 7%ntr! dil!i%H
o s% administr%a?& Anc%tH
o d!7& administrar% s% mai introd!c i5@5c%l 7!in 40 ml d% sol!i% 7%ntr! a n! r&mBn% o 7art% din do?a d%
m%dicam%nt An t!;!l 7%r8!?or!l!i =40P din do?a am%st%cat& An 400ml 7oat% r&mBn% 7% t!;!l 7%r8!?or!l!i>5
o %st% d% 7r%8%rat administrar%a s%7arat& 6i int%rmit%nt&, dil!at% c! C0-400 ml s%r 8i?iolo9ic 6i introd!s An
20-.0 min5
o administrar%a l%nt& 6i int%rmit%nt& d%t%rmin& mai 7!in& iritai% la ni@%l!l @%n%lor, %@it& d%?acti@ar%a
m%dicam%nt!l!i 6i asi9!r& ni@%l!l t%ra7%!tic5
O O;s%r@ar%a %8%ct%lor t%ra7%!tic%
o s% o;s%r@i r%d!c%r%a ro6%lii, %d%m!l!i, c&ld!rii 6i d!r%rii5 %mn%l% 6i sim7tom%l% in8lamai%i 6i in8%ci%i
!?!al s% dimin!%a?& sa! dis7ar An a7ro#imati@ /, d% or% d% la Anc%7%r%a t%ra7i%i c! anti;iotic%5
o An in8%ciil% sist%mic% s% o;s%r@& sc&d%r%a 8%;r%i 6i a l%!cocit%lor, cr%6t% a7%tit!l 6i 7aci%nt!l s% simt%
mai ;in%5
o An 7l&9il% in8%ctat% s% o;s%r@& d%scr%6t%r%a s%mn%lor local% d% in8lamai% 6i sc&d%r%a dr%na<!l!i5
'ic:id!l d% dr%na< s% 7oat% sc:im;a d% la 7!r!l%nt la s%ros5
o An in8%ciil% r%s7iratorii s% o;s%r@& sc&d%r%a dis7n%%i, t!s%i 6i s%cr%iilor5 %cr%iil% 7ot s& s% sc:im;% d%
la 9ros la s!;ir% 6i d% la colorat% la al;5
o An in8%ciil% tact!l!i !rinar s% o;s%r@& sc&d%r%a 8r%c@%n%i mici!nilor 6i dis7ariia dis!ri%i5 % @%ri8ic&
r%?!ltat!l %#am%n!l!i d% !rin&, 7%ntr! a o;s%r@a sc&d%r%a ;act%riilor 6i l%!cocit%lor5
O O;s%r@ar%a int%raci!ni m%dicam%nt%lor - c%l% mai s%mni8icati@% int%raci!ni s!nt c%l% car% alt%r%a?& %8ici%na
antiin8%cioas%lor sa! cr%sc to#icitat%a m%dicam%nt%lor
O O;s%r@ar%a %8%ct%lor ad@%rs%:
o :i7%rs%nsi;ilitat%a - s% 7oat% 7rod!c% d!7& administrar%a c%lor mai m!lt% antiin8%cioas%, dar c%a mai
com!n& %st% 7%nicilina5
o ana8ila#ia - :i7ot%nsi!n%, distr%ss r%s7irator, !rticari%, an9io%d%m, @&rsat!ri, diar%%5 Ana8ila#ia !?!al s%
7rod!c% An 7rim%l% min!t% d!7& administrar%a m%dicam%nt% lor5 Ei7%rt%nsi!n%a s% dator%a?& @asodilatai%i 6i
cola7s!l!i circ!lator5 *istr%ss!l r%s7irator s% dator%a?& ;ron:os7asm!l!i 6i %d%m!l!i larin9ian5
o ;oala s%r!l!i - 8%;r&, @asc!lit&, lim8ad%no7ati% 9%n%rali?at&, %d%m% al% artic!laiilor, ;ron:os7asm,
!rticari%5 Ac%asta %st% o r%aci% al%r9ic& AntBr?iat&, car% s% 7rod!c% la o s&7t&mBn& sa! mai m!lt d!7& c% a Anc%7!t
administrar%a m%dicam%nt!l!i5 %mn%l% 6i sim7tom%l% s!nt ca!?at% d% in8lamai%5
O !7rain8%cia %st% o in8%ci% no!& sa! s%c!ndar& car% s% 7rod!c% 7% d!rata t%ra7i%i in8%ci%i 7rimar%5
!7rain8%ciil% s!nt r%lati@ com!n% 6i 7ot%nial 9ra@% d%oar%c% microor9anism%l% r%s7onsa;il% sta8ilococii,
9%rm%nii 9ram n%9ati@ =Prot%!s sa! Ps%!domonas> sa! 8!n9i =Candida> s!nt ad%s%a r%?ist%nt% la m%dicam%nt%5
In8%ciil% c! ac%st% microor9anism% s!nt 9r%! d% tratat5
o stomatit%l% - 9!ra in8lamat&, 7%t% d% c!loar% al;& 7% m!coasa ;!cal&H
o diar%%aH
o @a9inita 7!st!loas& in8%cioas& - iritai% An ?ona 7%rin%al&, mBnc&rim%, sc!r9%ri @a9inal%H
o @%mn% 6i sim7tom% noi locali?at% - ro6%a&, c&ld!r&, %d%m, d!r%r%, dr%na<, %#7%ctorai%5
o r%@%nir%a s%mn%lor 6i sim7tom%lor sist%mic% - 8%;r&, indis7o?ii%5
O Fl%;it& la loc!l 7!nci%i @%noas%, d!r%r% la loc!l in<%ci%i i5m55 ol!iil% 7ar%nt%ral% 6i m!lt% m%dicam%nt%
antiin8%cioas% s!nt iritant% 7%ntr! %s!t!ri5
O im7tom% 9astroint%stinal% - 9r%aa, @&rs&t!ra, diar%%a
Ed!caia 7aci%nt!l!i:
O % in8orm%a?& 7aci%nt!l as!7ra risc!rilor 6i ;%n%8iciilor
O % monitori?%a?& star%a 7aci%nt!l!i
O % instr!i%6t% 7aci%nt!l 7ri@ind administrar%a oral& sa! local&:
4/-
o r%s7%ctar%a do?%i 6i orar!l!i =7%ntr! a m%nin% ni@%l!l %8ici%nt in sBn9%>, a c&ii d% administrar%
o %@itar%a asoci%rii c! alt% m%dicam%nt%
o r%s7%ctar%a administr&rii An ra7ort c! m%s%l%, alim%nt%l% scad a;sor;ia mai m!ltor antin8%cioas% oral%5
*ac& m%dicam%nt%l% ca!?%a?& 9r%a& 6i @&rs&t!r& intol%ra;il&, 7ot 8i l!at% cBt%@a An9:iit!ri d% alim%nt%5
O % %#7lic& 7aci%nt!l!i s& ia m%dicam%nt%l% c! !n 7a:ar 7lin c! a7&, 7%ntr! a sc&d%a iritaia 9astric& 6i a cr%6t%
ritm!l di?ol@&rii 6i a;sor;i%i =ta;l%t% 6i ca7s!l%>5
O % %#7lic& 7aci%nt!l!i %8%ct!l m%dicam%nt!l!i 6i 8a7t!l c& tratam%nt!l n! tr%;!i% Antr%r!7t c:iar dac&
mani8%st&ril% a! dis7&r!t 6i tr%;!i% contin!at 7% toat& 7%rioada indicat&5
O & ia toat% m%dicam%nt%l% antiin8%cioas% 7r%scris% c:iar dac& sim7tom%l% a! dis7&r!t, 7%ntr! a 7r%@%ni
r%@%nir%a in8%ci%i 6i a7ariia r%?ist%n%i microor9anism!l!i la m%dicam%nt5
O % in8orm%a?& 7aci%nt!l car% s!nt r%aciil% ad@%rs% mai 8r%c@%nt%: t!l;!r&ri di9%sti@% =9r%!ri, @&rs&t!ri, !n%ori
sBn9%r&ri int%stinal%>, mani8%st&ri c!tanat% =%r!7ii, !rticari%>, t!l;!r&ri !rinar% =la s!l8amid% - oli9!ri%, an!ri%>,
t!l;!r&ri n%r@oas% =n%@rit% 7%ri8%ric%, c%8al%%, insomni%>, t!l;!r&ri r%s7iratorii =;ron:os7asm>, r%acii ana8ilactic%
O % instr!i%6t% 7aci%nt!l s& ra7ort%?% 9r%aa, @&rs&t!ra, diar%%a, %r!7ia c!tanat&, r%@%nir%a sim7tom%lor 7%ntr!
car% a! 8ost 7r%scris% antiin8%cioas%l%, sa! s%mn%l% !n%i in8%cii noi =%#5 8%;r&, t!s%, 9!r& in8lamat&, dr%na<>5
Ac%st% 7ro;l%m% 7ot indica %8%ct% ad@%rs% al% m%dicam%nt!l!i, li7sa r&s7!ns!l!i t:%ra7%!tic la m%dicam%nt, sa!
s!7rain8%cia5 Un%l% din ac%st%a c%r %@al!ar% 6i 7ot indica sc:im;&ri An t%ra7ia m%dicam%ntoas&5
O % instr!i%6t% 7aci%nt!l:
o s& an!n% m%dic!l dac& %st% An tratam%nt c! alt% m%dicam%nt% 7%ntr! a %@itaincom7ati;ilit&il%H
o s& 7&str%?% m%dicam%nt%l% An condiii r%comandat% d% 7rod!c&tor =An 7ros7%ct>H
o s& s% adr%s%?% m%dic!l!i la a7ariia 7rim%lor s%mn% d% intol%ran& c!nosc!t% sa! a altor mani8%st&ri
i%6it% din com!n5
FIA N". 8.7. ADMINISTRAREA CORTI&ONULUI
*EFINI2IE
- $l!cocorticoi?ii s!nt :ormoni ai corticos!7rar%nal%i sa! analo9i d% sint%?& c! %8%ct antiin8lamator marcat 6i
aci!ni im7ortant% as!7ra m%ta;olism!l!i 9l!co7rot%ic5
EFECTE
- In:i;& 7roc%s%l% in8lamatorii, dimin!%a?& 8ormar%a %d%m!l!i local 6i m%nin r&s7!ns!l @as%lor la cat%colamin%
- A! 7ro7ri%t&i antial%r9ic% marcat%
- !nt %8icac% An toat% ti7!ril% d% 6oc circ!lator
- In8l!%n%a?& constant%l% :%mo9ram%i
- cad a7&rar%a or9anism!l!i la in8%cii intBr?iind cicatri?ar%a
- Cr%sc s%cr%ia 9astric& d% ECl
- tim!l%a?& sist%m!l n%r@os c%ntral cr%Bnd o star% d% ;in% dar 7ot d%clan6a r%acii 7si:otic%
- Fa@ori?%a?& r%t%nia d% sar% 6i a7&
- Fa@ori?%a?& 9licon%o9%n%?a 7% s%ama 7rot%in%lor
IN*ICA2II
- (oli r%!matismal%, l!7!s %rit%matos sist%mic
- cl%ro?a m!lti7l&
- t&ri %d%matoas% =9lom%r!lon%8rita sa! n%8rita l!7ic&>
- (oli n%o7la?ic% An stadi!l t%rminal 7%ntr! Am;!n&t&ir%a calit&ii @i%ii 6i 7%ntr! 7ro8ila#ia st&rilor d% 9r%a& 6i
@&rs&t!ri 7ro@ocat% d% c:imiot%ra7ia antin%o7la?ic&
- (oli al%r9ic%
"E*ICA"ENTE UTI'IGATE5 FOR"E *E PREGENTARE
A5 CORTIGON
45 *%#am%tason!l - sol!i% in<%cta;il&, 8iol% d% 2 ml5
25 Eidrocortison!m
O Fl%;ocortid - 7!l;%r% 400 m9 a 4 8iol& d% 2 ml sol@%nt
O EEC =Eidrocorti?on :%miss!ccinat> - sol!i% in<%cta;il& i5@5 2C m90C ml - 4 8iol& EEC a 4 ml a4 8iol& sol@%nt
d% / ml
O Eidrocortison% Na s!ccin - 7!l;%r% 400m9 - 4 8iol& sol@%nt 2 ml
O Eidrocortison% - lio8ili?at 7%ntr! sol!i% in<%cta;il& 400m9 a 4 8iol& sol@%nt 2 ml
O Eidrocortison% C00 m9 - lio8ili?at 7%ntr! sol!i% in<%cta;il& a 4 8iol& sol@%nt d% / ml5
-5 "%t:Zl7r%dnisolon
4//
- *%7o-m%drol s!s7%nsi% in<%cta;il& i5m5 a7oas& st%ril& /0 m904ml, ,0 m902ml
O N! s% am%st%c& c! alt% m%dicam%nt% ,
- '%mod sol! 20 m9, /0 m9 - 8lacoan% c! lio8ili?at 6i 8iol% d% 4 ml c! sol@%nt
O 42C m9 a 4 8iol& sol@%nt 2 ml
O C00 m9 a 4 8iol& sol@%nt 7,, ml
O ol!ia r%constit!it& s% 7&str%a?& c%l m!lt /, d% or% la 4C - 2CK, 8%rii d% l!min&
- "%drol com7rimat% =c7> d% 4. m9, -2 m9, /m9
- ol! m%drol ACT-O-)IA' =lio8ili?at 6i sol@%nt 7%ntr! sol!i% in<%cta;il&>: /0 m904ml sol@%nt, 42C m902 ml
sol@%nt, 2C0 m90/ ml sol@%nt, C00 m907,, ml5 Flacoan% ;icom7artim%ntat%:
o In8%rior lio8ili?at!l iar An c%l s!7%rior sol@%nt!l
o *i?ol@ar%a s% 8ac% 7rin a7&sar%a 7% acti@ator!l d% 7lastic 7%ntr! a 8ora 7&tr!nd%r%a sol@%nt!l!i An
com7artim%nt!l in8%riorH s% a9it& !6or5
/5 PRE*NIO'ON
O *%cortin - Cm9 6i 20m90c7
O ol!- d%cortin - 7!l;%r% 7%ntr! s!s7%nsi% in<%cta;ili& C0 sa! 2C0 m9, 8lacon a4 8iol& d% Cml sol@%nt
C5 PRE*NION
O N5 Pr%dnison - com7rimat% C m9
O Pr%dnison - com7rimat% Cm9
PRECAU2II PECIA'E
- *o?a %st% strict indi@id!ali?at& d% c&tr% m%dic
- Pr%7arat%l% corti?onic% s% administr%a?& 20- din do?a ?ilnici& dimin%aa 6i 40- d!7& amia?a 7%ntr! a r%s7%cta
ni@%l!l ma#imal al s%cr%i%i 8i?iolo9ic% a corti?ol!l!i
- *o?a d% Antr%in%r% s% administr%a?& dimin%aa
- Dn ;oli r%!matismal%, l!7!s %rit%matos sist%mic ='E>, scl%ro?a m!lti7l& ="> s% 8ac% 7!ls-t%ra7i% 490?i tim7 d%
- ?il% An 7%r8!?i% c! 9l!co?& CP An c%l 7!in -0 min!t%
- *o?%l% s!; 2C0m9 s% 7ot administra i5@5 l%nt An c%l 7!in C\, iar c%l% 7%st% 2C0 m9 An PE), An c%l 7!in -0\
- !s7%nsiil% a7oas% n! s% administr%a?& i5@5 nici IR5
- *o?a s% scad% tr%7tat con8orm r%comand&rii m%dical%
- ol!ia o;in!t& 7rin di?ol@ar%a lio8ili?at!l!i s% 7&str%a?& ma#im!m /,:5
- % monitori?%a?& TA, %#ist& risc d% cr%6t%r% 7rin r%t%ni% :idrosalin&5 % r%comand& di%t& :i7osodat&5
- % cBnt&r%6t% 7%riodic An tim7!l tratam%nt!l!i d% l!n9& d!rat&, %#ist& risc d% o;%?itat%
- A7ar 7iro?is!l 6i %7i9astral9ii, s% administr%a?& in:i;itori ai s%cr%i%i 9astric% 6i r%9im alim%ntar d% 7rot%ci%5
- % s!7ra@%9:%a?& sca!n!l, %#ist& risc d% ac!ti?ar% a !lc%r!l!i 9astro d!od%nal5
- % monitori?%a?& 9lic%mia - cr%6t% 7rin 9l!con%o9%n%?&5 % r%comand& r%9im :i7o9l!cidic, s% s!7ra@%9:%a?&
at%nt 7aci%nii c! dia;%t5 E#ist& risc d% dia;%t corti?onic5
- Paci%nt!l 7oat% ac!?a sl&;ici!n% m!sc!lar&, s% 7i%rd% 7otasi! An tim7!l tratam%nt!l!i5 % r%comand& di%ta
:i7%r7otasic& 6i :i7%r7rot%ic&
- % s!7ra@%9:%a?& com7ortam%nt!l 7aci%nt!l!iH 7ot a7ar% st&ri d% a9itai%, insomni%, t!l;!r&ri 7si:otic%
- % o;s%r@& as7%ct!l t%9!m%nt%lor, 7ot a7ar% %d%m%5
E*UCA2IA PACIENTU'UI
Paci%nt!l tr%;!i% instr!it:
- & ia m%dicam%nt%l% d!7& mas& sa! Am7r%!n& c! 9!star%a
- & r%s7%ct% orar!l d% administrar%: 20- din do?& la ora , 6i 40- din do?& la ora 4.KK
- & n! omit& nici o do?& d% m%dicam%nt%
- & ai;& as!7ra l!i 6i la And%mBn& m%dicam%nt%l% 7%ntr! a 7!t%a 8i 8olosit% An ca? d% !r9%n&
- & %@it% sit!aiil% d% str%s acc%nt!at% =8%;r&, in8%ciil%, l!cr&ri d%ntar%, accid%nt%, cri?% 7%rsonal% sa! 8amilial%>
- & n! modi8ic% do?%l% 8&r& acord!l m%dic!l!i
- &-6i monitori?%?% s%mn%l% 6i sim7tom%l% car% 7ot a7ar%: anor%#i%, 9r%a&, @&rs&t!ri, sl&;ici!n%, d%7r%si%,
am%%al&, 7oli!ri%, 7i%rd%r% An 9r%!tat% 6i s& an!n% m%dic!l
- & s% cBnt&r%asc& 7%riodic, s& o;s%r@% modi8icar%a 8%%i =8a& An l!n& 7lin&>, 7r%?%na %d%m%lor, s&-6i m&soar%
TA5 Dn ca?!l cr%6t%rii 7ond%ral% s& s% adr%s%?% m%dic!l!i
- & cons!m% o di%t& :i7osodat& 6i :i7%r7rot%ic& An tim7!l tratam%nt!l!i 6i s& cons!m% mod%rat 9l!cid%5
- & %c:ili;r%?% %8ort!l 8i?ic c! r%7a!s!l
- & %@it% acti@it&il% s!7rasolicitant%
4/C
- & n! 8ac& @accin&ri, %#ist& risc d% com7licaii n%!rolo9ic%
- & n! Antr%r!7& tratam%nt!l ;r!sc sa! 8&r& acord!l m%dic!l!i, sc&d%r%a do?%lor s% 8ac% tr%7tat
- % at%nion%a?& 7aci%nt!l s& n! ia m%dicam%nt% 8&r& acord!l m%dic!l!i
FIA N". 8.4. ADMINISTRAREA INSULINEI
*EFINI2IE
- Ins!lina %st% m%dicam%ntat!l car% asi9!r& s!7ra@i%!ir%a 7aci%nilor c! dia;%t ?a:arat ti7 4 6i control!l
9lic%miilor 7%ntr! !n n!m&r s%mni8icati@ =An cr%6t%r%> dintr% 7aci%nii c! dia;%t ?a:arat 2 6i 9ra@id% c! dia;%t
9%staional5
O(IECTI)E
- Promo@ar%a 6i m%nin%r%a st&rii d% ;in%, clinic 6i 7si:olo9ic al 7aci%nilor
- E@itar%a :i7o9lic%miilor s%@%r%, a :i7%r9lic%mi%i sim7tomatic% 6i a c%toacido?%i5
IN*ICA2II
- *ia;%t ?a:arat ti7 4 =indicai% a;sol!t&>
- *ia;%t ?a:arat ti7 2:
O At!nci cBnd c! do?%l% ma#im% tol%rat% al% 7r%7arat%lor anti:i7%r9lic%mic% oral% com;inat% c! di%ta n!
s% atin9 o;i%cti@%l% t%ra7%!tic%
O E7isoad% d% str%s m%ta;olic ac!t =in8arct miocardic, A)C, in8%cii mod%rat% sa! s%@%r%>
O Pr%- 6i intra- 6i 7osto7%rator cBnd s% s!s7%nd& m%dicaia oral&
O Dn ca?!l contraindicaiilor 7r%7arat%lor oral% =ins!8ici%na :%7atic& 6i r%nal&>
O R%acii ad@%rs% al% !nor 7r%7arat% oral%
- *ia;%t!l ?a:arat 9%staional car% n! s% r%?ol@& 7rin di%t&
- Ur9%n% :i7%r9lic%mic% =c%toacido?&, :i7%r9lic%mi% osmolar&
TIPURI *E INU'INF
- Ins!lin% ra7id%: Actra7id, E!malo9, c! aci!n% sc!rt& s!nt sin9!r%l% car% s% 8olos%sc An sit!aii d% !r9%n&
m%ta;olic& 7%ntr! c& s% 7ot administra intra@%nos acionBnd An mai 7!in d% 40 min5
- Ins!lin% int%rm%diar% =c! aci!n% 7r%l!n9it&>: "onotard, Ins!latard, E!m!lin ;asal, Ins!man ;asal
- Ins!lin% l%nt%: Ultratard, E!m!lin l%nt%, E!mins!lin 'on95
- Ins!lin% 7r%mi#at% =c! aci!n% ra7id& 6i int%rm%diar&>5 "i#tard5 E!m!lin5 Ins!man Com; 5
FOR"E *E PREGENTARE
INU'INE U"ANE =Prod!c&tor 'I'd Franc% A>
- E!m!lin " -
O !s7%nsi% in<%cta;il& /0 !0ml 6i 400 !0ml - 8lacon d% 40 ml, cart!6% d% - ml, 7%n-!ri 7r%!m7l!t% - ml
- E!m!lin N
O !s7%nsi% in<%cta;il& 400 !0ml-8lacon d% 40 ml, cart!6% d% - ml, 7%n-!ri 7r%!m7l!t% - ml
O !s7%nsi% in<%cta;il& /0!04 ml - 8lacon d% 40 ml
- E!m!lin R
O !s7%nsi% in<%cta;il& 400 !0ml, 8lacon 40 ml, cart!6% d% - ml
O !s7%nsi% in<%cta;il& /0 !0ml - 8lacon 40 ml
INU'INE U"ANE - Prod!c&tor NO)O NOR*IW
- Ins!latard - s!s7%nsi% in<%cta;il& 400 !0ml, 8lacon 40 ml
- Ins!latard No@ol%t 400 !0ml - s!s7%nsi% in<%cta;il& 7%n-!ri =stilo!ri> 7r%!m7l!t% a - ml
- Ins!latard P%n8ill - 400!0ml - s!s7%nsi% in<%cta;il&, cart!6% a - ml
- "i#tard -0 - s!s7%nsi% in<%cta;il& 400 !0ml, 8lacoan% d% 40 ml
- "i#tard -0 No@ol%t - s!s7%nsi% in<%cta;il& 400!0ml, cart!6% a - ml
- "i#tard 20 PENFI'' -400 !0ml, "i#tard -0 7%n8ill, "i#tard 7%n8ill /0, s!s7%nsi% in<%cta;il&, cart!6% - ml5
- Actra7id 400 !0ml - s!s7%nsi% in<%cta;il&, 8lacoan% a 40 ml
- Actra7id no@ol%t 400 !i0ml - s!s7%nsi% in<%cta;il&, stilo!ri in<%ctoar% =7%n-!ri> 7r%!m7l!t% a - ml
- Actra7id 7%n8ill - s!s7%nsi% in<%cta;il& 400 !0ml, cart!6% a - ml
INU'INE U"ANE - Prod!c&tor A)ENTI PEAR"A
- Ins!man ;asal - s!s7%nsi% in<%cta;il& An 8lacon C ml -=400!0ml>
- Ins!man ;asal O7tis%t - s!s7%nsi% in<%cta;il& c! dis7o?iti@ d% administrar% ti7 R7%nR 7r%!m7l!t c! - ml
=-00!0ins!lin& 7%r 7%n>5
4/.
- Ins!man com; 2C 6i Ins!man com; 2C O7tis%t - s!s7%nsi% in<%cta;il& An 8lacon d% C ml, sa! cart!6% d% - ml,
r%s7%cti@ 7%n 7r%!m7l!t c! 400 !0ml5
- Ins!man com; C0, Ans!ma! com; C0 O7tis%t - s!s7%nsi% in<%cta;il& - An 8lacoan% d% C ml 6i cart!6% sa! 7%n-!ri
7r%!m7l!t% d% - ml - 400 !0ml
- Ins!man ra7id si Ins!man ra7id O7tis%t - sol!i% in<%cta;il& An 8lacoan% d% C ml =400 !0ml>, sa! 7%n-!ri
7r%!m7l!t% - - ml =400!0ml>
INU'INU" APART - Prod!c&tor No@o NordisX
- No@omi# -0 - Fl%#7%n, -0 PENFI'' - s!s7%nsi% in<%cta;il& An dis7o?iti@ ti7 7%n 7r%!m7l!t d% - ml 6i r%s7%cti@
cart!6% d% - ml
- No@ora7id, No@ora7id Fl%#7%n, No@ora7id 7%n8ill =400!0ml> - sol!i% in<%cta;il& An 8lacoan% d% 40 ml, 7%n-!ri
c! cart!6 d% - ml
INU'INU" *ETE"IR - Prod!c&tor No@o NordisX
- '%@%mir P%n8ill =400 !0ml>, '%@%mir 8l%#7%n =400 !0ml> - sol!i% in<%cta;il& An 7%n-!ri 7r%!m7l!t% d% - ml,
cart!6% d% - ml
INU'INU" $'AR$INE - Prod!c&tor A@%ntis P:arma
- 'ant!s =400!0ml>, 'ant!s O7tis%t- sol!i% in<%cta;il&, cart!6 d% - ml, 7%n-!ri 7r%!m7l!t% d% - ml
INU'INU" $'U'IGINA
- A7idra =400!0ml>-cart!6 d% - ml
INU'IN 'IPRO - Prod!c&tor Eli 'illZ - N%d%rland
- E!malo9 P%n =400 !0ml>- sol!i% in<%cta;il& An stilo! in<%ctor - 7%n 6i An cart!6% d% - ml5
- E!malo9"i# 2C P%n, E!malo9 "i# 2C, - s!s7%nsi% in<%cta;il&, 7%n-!ri d% - ml, cart!6% d% - ml
- E!malo9 "i# C0 P%n, E!malo9 "i# C0 - s!s7%nsi% in<%cta;il& An 7%n-!ri sa! cart!6% a - ml
PFTRAREA INU'INEI
- % 7&str%a?& d% r%9!l& la 8ri9id%r Antr% 2 - ,K, n! An con9%lator sa! a7roa7% d% ac%sta5
- Dn @%d%r%a administr&rii 8lacon!l s% scoat% din 8ri9id%r c! .0 min Anaint%5 N! s% Anc&l?%6t% Anaint% d%
administrar%5
- Flacon!l int%9r! 6i0sa! c%l din car% s% 8ac% administrar%a s% 7oat% 7&stra s!; -0K la Ant!n%ric, n! mai m!lt d% 2,
d% ?il%5 *ac& tim7!l %st% d%7&6it s% 7i%rd% @ala;ilitat%a5
TA(I'IREA *OGEI JI TIPU'UI *E INU'INF
- % 8ac% d% c&tr% m%dic, indi@id!ali?at
- "%dic!l instr!i%6t% 7aci%nt!l c!m s&-6i a<!st%?% do?%l% An 8!nci% d% conin!t!l d% :idrocar;onai din di%t&
- Ti7!l d% ins!lin& %st% al%s An 8!nci% d% tol%rana 7aci%nt!l!i
- Administrar%a ins!lin%i s% 8ac% con8orm !n%i sc:%m% sta;ilit% d% m%dic
PRECAU2II $ENERA'E
- % @%ri8ic& as7%ct!l 7%ntr! a o;s%r@a dac& n! a! a7&r!t modi8ic&ri: ins!lin%l% ra7id% a! as7%ct lim7%d%, clar,
ins!lin%l% int%rm%diar% sa! l%nt% a! as7%ct lact%sc%nt, t!r;id, 8&r& 8locoan%5 Pr%?%na 8locoan%lor 7r%s!7!n%
sc:im;ar%a 8lacon!l!i5
- Ins!lin%l% int%rm%diar% sa! l%nt% s% omo9%ni?%a?& 7rin c!lcar%a 8lacon!l!i An 7o?ii% ori?ontal& 6i r!lar% ;lBnd&
Antr% 7alm% d% -0-/0 d% ori5 A9itaia An 7o?ii% @%rtical& 7rod!c% ;!l% 6i im7%r8%ci!ni la do?ar%5 *ac& n! s%
omo9%ni?%a?&, n! s% administr%a?&5
- N! s% am%st%c& ins!lin% c! conc%ntraii di8%rit% 6i nici ti7!ri di8%rit% d% ins!lin&5 *ac& %st% n%c%sar s% 8olos%sc
s%rin9i s%7arat%5
PRECAU2II PECIA'E
- Ins!lin%l% ra7id% s!nt sin9!r%l% ins!lin% car% s% 8olos%sc An sit!aii d% !r9%n& m%ta;olic&, An st&ri 8%;ril%, ;oli
in8%cioas%, tra!matism%, int%r@%nii c:ir!r9ical%5
- Ins!lin%l% ra7id% s!nt sin9!r%l% car% s% 7ot administra 7% cal% i5@5 intrBnd An aci!n% An mai 7!in d% 40 min!t%5
*%as%m%n%a s% 7ot administra 7% cal% 5C5 6i I5"5
- Al%9%r%a loc!l!i An 8!nci% d% ti7!l d% ins!lina:
O P%ntr! ins!lin%l% ra7id% - a;dominal - c! %#c%7ia a C cm An <!r!l om;ilic!l!i, ?on& An car% a;sor;ia %
c%a mai ra7id&
O Ins!lin% int%rm%diar%: coa7s&, 8%s&,
O P%ntr! 7aci%nii sla;i, normo7ond%rali, co7ii, in<%ctar%a s% 8ac% An ?ona d%ltoidian& 6i coa7s&, Antr-!n
!n9:i d% /CK
O Dn r%9i!n%a a;dominal& sa! 8%si%r& in<%ctar%a s% 8ac% An%7Bnd s!; !n !n9:i d% +0K
- E#%rcii!l 8i?ic cr%6t% rata a;sor;i%i 7rin cr%6t%r%a 8l!#!l!i san9!in
4/7
- *%as%m%n%a %#7!n%r%a la c&ld!r& =;ai%, masar%a ?on%lor, 7la<&> 8a@ori?%a?& a;sor;ia mai ra7id& 6i 9l!cid%l% s%
administr%a?& c! cBt%@a min!t% mai d%@r%m%
- E#7!n%r%a la 8ri9 Anc%tin%6t% a;sor;ia, alim%nt%l% 8iind administrat% c! cBt%@a min!t% mai tBr?i!5
- Rotaia loc!l!i d% in<%ci% =An ac%%a6i ari% inBnd s%ama d% tim7!l d% a;sor;i% al ins!lin%i> %st% im7ortant&
7%ntr! 7r%@%nir%a com7licaiilor =li7o:i7%rtro8ia - d%7!n%r% %#c%si@& d% 9r&sim% sa! li7oatro8ia - to7ir%a %s!t!l!i
9r&sos s!;c!tanat>5
- *ac& sBn9%r%a?& sa! i%s% lic:id s% a7lic& !n tam7on 7%ntr! C-, s%c!nd% 8&r& s& s% mas%?% 7%ntr! a n! 9r&;i
a;sor;ia ins!lin%i
- R%d!c%r%a d!r%rii %st% 7osi;il& dac&:
O ol!ia s% in<%ct%a?& la t%m7%rat!ra cam%r%i
O A%r!l s% %limin& cor%ct
O Gona s% s7al& sa! s% d& c! alcool 6i s% a6t%a7t& %@a7orar%a
O Gona tr%;!i% s& 8i% r%la#at&
O P&tr!nd%r%a An 7i%l% s% 8ac% ra7id
O N! s% sc:im& dir%cia ac!l!i
O % 8olos%sc ac% ad%c@at% =., ,,42,4. mm> An 8!nci% d% r%9i!n%
- Pot a7ar% com7licaii:
O Ei7o9lic%mia - 7aci%nt!l tr%;!i% s& ai;& as!7ra l!i 4C 9r :idrocar;onai =- ;!c&i d% ?a:&r>
O Ed%m!l ins!lini% - a7ar% la 7aci%nii no! d%sco7%rii din ca!?a r%t%ni%i :idrosalin% la Anc%7!t!l inii%rii
tratam%nt!l!i c! ins!lina
O 'i7odistro8ia :i7%rtro8ic& - cr%6t%r%a An @ol!m a %s!t!l!i adi7os n%@asc!lari?at c%%a c% Anc%tin%6t% m!lt
a;sor;ia ins!lin%i
O 'i7odistro8ia atro8ic& - dimin!ar%a %s!t!l!i adi7os s!;c!tanat la loc!l administr&rii ins!lin%i, mai 8r%c@%nt& la
8%m%il% tin%r%
O Al%r9ia local& - %d%m, nod!li, %rit%m 7r!ri9inos sa! d!r%ros
O Al%r9ia 9%n%rali?at& - d% la !rticari% 7Bn& la 6oc!l ana8ilactic
- C! %#c%7ia :i7o9lic%mi%i 7% car% o s%si?%a?& ;olna@!l, c%l%lalt% @or 8i int%r7r%tat% 6i %@al!at% d% m%dic!l
s7%cialist
CAPITOLUL .I. IN.ESTIGA2II IMAGISTICE
FIA N". ;.1. EXAMENE RADIOLOGICE.
ASPECTE GENERALE
*EFINI2IE
- E#am%n%l% radiolo9ic% s!nt in@%sti9aii ima9istic% r%ali?at% c! a<!tor!l radiaiilor X, car% s!nt @i;raii
%l%ctroma9n%tic% c! l!n9im% d% !nd& 8oart% sc!rt& car% a! ca7acitat%a d% a 7%n%tra s!;stan%l% 8oart% d%ns% 6i d%
a 7rod!c% ima9ini sa! !m;r% c% 7ot 8i Anr%9istrat% 7% 8ilm 8oto9ra8ic
PRINCIPII $ENERA'E
- E#am%n%l% radiolo9ic% s% r%ali?%a?& An s%r@icii s7%cial% d% c&tr% 7%rsonal instr!it
- Ec:i7am%nt%l% 8olosit% !tili?%a?& t%:nici d% Analt& r%?ol!i% - %cran% T), Anr%9istr&ri di9ital%, im7rimant% las%r,
7%ntr! a o;in% ima9ini cBt mai am&n!nit%
- 2%s!t!ril% moi 6i osoas% a! d%nsitat% di8%rit& ast8%l AncBt cantitat%a d% radiaii car% l% str&;at% @aria?& iar
ima9inil% 7ot 8i clar% sa! mai 7!in clar%5
- Oas%l% 8iind d%ns% n! s!nt str&;&t!t% d% radiaii 6i s!nt radioo7ac% An tim7 c% %s!t!ril% moi s!nt str&;&t!t% d%
radiaii 6i da! ima9ini ca ni6t% !m;r% mai m!lt sa! mai 7!in cont!rat%5
*atorit& di8%r%n%i d% d%nsitat% An tim7!l %#amin&rii s% r%ali?%a?& !n contrast nat!ral 7rin a%r, lic:id,
%s!t 9ras, %s!t osos:
O Pl&mBnii 6i o 7art% din t!;!l di9%sti@ conin a%r - d%t%rmin& ima9ini trans7ar%nt%
O Un%l% or9an% a! o ca7s!l& d% 9r&sim% car% cr%%a?& o !m;r& mai m!lt sa! mai 7!in d%ns&
O Oas%l% conin s&r!ri min%ral% 6i s!nt radioo7ac%
P%ntr! @i?!ali?ar%a !nor d%talii s% 7ot administra s!;stan% d% contrast car% s% introd!c 7% cal% oral&,
r%ctal&, in<%cta;il& An 8!nci% d% or9an!l, s%9m%nt!l, sist%m!l car% !rm%a?& s& 8i% %#aminat5 !;stan%l% d%
contrast s!nt: radioo7ac% sa! radio trans7ar%nt%5
4/,
N! %#ist& o s!;stan& d% contrast si9!r&, ino8%nsi@&5 Toat% 7ot d%t%rmina r%acii ad@%rs% car% s!nt
st!diat% 6i 7ot 8i 7r%@%nit% sa! com;&t!t%5
U(TAN2E *E CONTRAT
U'FAT *E (ARIU- radioo7ac
- % 8olos%6t% 7%ntr! %#aminar%a radiolo9ic& a tract!l!i 9astro-int%stinal =%so8a9, stomac, int%stin, colon>
- % 7r%7ar& s!; 8orma !n%i s!s7%nsii coloidal% =%st% insol!;il>
Form% m%dicam%ntoas% 8armac%!tic%:
- Poli;ar - AC( - 7!l;%r% 7%ntr! s!s7%nsi%, o 7!n9& !nido?& c! -+7 9r 7%ntr! s!s7%nsi% r%ctal&
- E-G- CAT - s!s7%nsi% oral& car% conin% s!l8at d% ;ari! /,+P =8lacoan% c! 22C ml>5
- E-G - E* - 7!l;%r% 7%ntr! s!s7%nsi% oral& coninBnd s!l8at d% ;ari! +,P, 8lacoan% c! -/09r
- !l8at d% ;ari! Pro Ront9%n - 7!l;%r% 7%ntr! s!s7%nsi% oral&, 7!n9& trans7ar%nt& c! +0 9r =(a O/ - ,09r>
U(TAN2E CU IO*
- $astro9ra8in - sol!i% a7oas& 9astro %nt%ric& 8olosit& cBnd s!l8at!l d% ;ari! n! s% 7oat% administra - 8lacon c!
400ml, conin% -7 9r iod
- Odiston7C P - 8iol% d% 40 ml, sol!i% in<%cta;il& 7CP, s% 7&str%a?& la t%m7%rat!ra cam%r%i, 8%rit d% l!min&
O % 8ac% t%star%a s%nsi;ilit&ii Anaint% d% in<%ctar%a sol!i%i =4ml l%nt i5@5, s% a6t%a7t& 4- 2\, a7oi s%
in<%ct%a?& r%st!l strict intra@%nos>5
O "odi8ic& r%?!ltat!l scinti9ra8i%i tiroidi%n% tim7 d% 2 -. s&7t&mBni
- Uro9ra8in 7.P - sol!i% in<%cta;il&, 8iol% d% 20 ml =4 ml conin% -70 m9 iod>
O Folosit mai al%s 7%ntr! !ro9ra8ii
- Iodid!m ='i7iodol> - 4+0 m9, ca7s!l% moi, (list%r% c! - ca7s!l% 7%ntr! ;ron:o9ra8i%, :ist%rosal7in9o9ra8i%,
!r%tro9ra8i%, colan9io9ra8i% intrao7%ratori%5
- Iodi#anol!m - sol!i% :idrosol!;il& 7rod!s& s!; d%n!mir%a d% )isi7a[!% 4C0m90ml =8lacoan% d% C0, 200ml>
270m90ml =8lacoan% d% 20, C0, 400, 200ml> 6i -70m90ml=8lacoan% d% 20, C0, 400ml, 200ml>5
O % 8olos%6t% 7%ntr! %#aminar%a radiolo9ic& la ad!li: an9io9ra8i%, !ro9ra8i%, 8l%;o9ra8i%, CT5
- Io:%#ol!m - sol!i% a7oas& in<%cta;il& intra@%nos, intraart%rial, intrat%cal, intraca@itar5
Prod!s 8armac%!tic s!; d%n!mir%a d% Orani7a[!%, 8iol% sa! 8lacoan% c! conc%ntraii d% 4/0, 4,0, 2/0, -00,
-C0m9 iod0ml5
O % 8olos%6t% 7%ntr!: cardioan9io9ra8i%, art%rio9ra8i%, !ro9ra8i%, 8l%;o9ra8i%, CT, mi%lo9ra8ic,
colan9io7ancr%ato9ra8i% %ndosco7ic&, :ist%rosal7in9o9ra8i%5
- Io7amidol!m =Io7amiro -00,-70> - sol!i% in<%cta;il& -0P sa! -7P, 8lacoan% c! -0, C0, 400, 200 ml, 8iol% 20
ml, 8olosit mai al%s 7%ntr! st!di%r%a @as%lor
- Io7romid!m =Ultra@ist - -00> - sol!i% in<%cta;il& -8lacoan% c! C0, 40 ml 6i Ultra@ist -70 - 8lacoan% c! C0, 400,
200, C00ml5
U(TAN2E $AGOAE RA*IOTRANPARENTE =O2, E2, a%r, CO2, NO, N2 > - 8olosit% 7%ntr! %#aminar%a
cr%i%r!l!i, artic!laiilor, s7ai!l!i s!;ara:noidian, s7ai!l!i 7l%!ral, ca@iatat%a 7%riton%al&, s7ai!l!i 7%ricardic
REAC2II A*)ERE POI(I'E 'A U(TAN2E'E *E CONTRAT
- Pot a7ar% din 7art%a !nor sist%m% 6i a7arat%, r%aciil% a@Bnd int%nsitat% di8%rit&: !6oar&, m%di%, 9ra@&5
- R%aciil% din 7art%a a7arat!l!i cardio@asc!lar:
O Paloar%, dia8or%?&
O Ta:icardi%, ;radicardi%, 7al7itaii, aritmi%
O Ed%m 7!lmonar ac!t
O Joc
O Ins!8ici%n& cardiac& con9%sti@&
O to7 cardiac
- R%acii din 7art%a a7arat!l!i r%s7irator5
O tr&n!t, t!s%, rinor%%
O _:%%?in9
O Cri?& d% astm ;ron6ic
O 'arin9os7asm, %d%m% larin9i%n%
O Ciano?&, a7n%%
O to7 r%s7irator
- "ani8%st&ri c!tanat%
O Erit%m
O %n?ai% d% c&ld!r&
4/+
O Urticari%
O Pr!rit
O *!r%ri la loc!l in<%ct&rii
O Ed%m an9ion%!rotic
- "ani8%st&ri 9astroint%stinal%
O $r%a&, @om&, 9!st m%talic
- Cram7% a;dominal%, diar%%
O Il%!s 7aralitic
- "ani8%st&ri n%!rolo9ic%
O An#i%tat%
O C%8al%%
O Am%%li, @%rti<
O A9itai%
O *%?ori%ntar%
O t!7oar%
O Com&
O Con@!lsii
- "ani8%st&ri !rinar%
O *!r%r% An 8lanc!ri
O E%mat!ri%
O Oli9!ri%
O Al;!min!ri%
O Ins!8ici%n& r%nal& ac!t&
PRECAU2II PECIA'E PENTRU U(TAN2E IO*ATE
- R%aciil% ad@%rs% s!nt mai 8r%c@%nt% Antr% 20 6i C0 d% ani 6i scad d!7& 70 d% ani5
- % acord& !n 7l!s d% at%ni% 7%rsoan%lor 7r%dis7!s%
- *ac& !n 7aci%nt a a@!t o r%aci% al%r9ic& tr%;!i% in8ormat, risc!l d% a 8ac% din no! 8iind d% --/ ori mai mar%
- Istoric!l 7ri@ind al%r9ia tr%;!i% cons%mnat An dosar!l n!rsin907lan!l d% An9ri<ir%
- !;stan%l% d% contrast iodat% s% administr%a?& 7% n%mBncat% sa! d!7& c%l 7!in +0 d% min!t% d% la s%r@ir%a
m%s%i5 Fac %#c%7i% !r9%n%l%5
- P%ntr! 7r%@%nir%a accid%nt%lor 9ra@% =sto7!l cardio-r%s7irator> %st% n%c%sar s& 8i% 7r%9&tit% mat%rial% 7%ntr!
r%s!scitar%
- Dn ca?!l r%aciilor mod%rat% s% administr%a?& 7rom7t anti:istaminic% oral% la r%comandar%a m%dic!l!i
- N! s% asocia?& administrar%a s!l8at!l!i d% ;ari! c! s!;stan% d% contrast iodat%
- In<%ctar%a s!;stan%i d% contrast iodat% 7oat% s& d%t%rmin% modi8ic&ri al% 8!nciilor @ital%
- Dnaint% 6i d!7& %#am%n s% m&soar& TA, P, R, 7%ntr! a s%si?a %@%nt!al%l% modi8ic&ri =ta:icardi%, ;radicardi%,
aritmi%, cr%6t%r%a sa! sc&d%r%a TA, t!l;!r&ri r%s7iratorii>5
- Paci%nt!l %st% instr!it s& cons!m% o cantitat% mar% d% lic:id% 7%ntr! a 8a@ori?a %liminar%a iod!l!i din or9anism5
- Pr%9&tir%a 7aci%nt!l!i 7%ntr! %#am%n tr%;!i% 8&c!t& cor%ct 7%ntr! a %@ita n%c%sitat%a r%7%t&rii 6i risc!l d%
iradi%r% sa! d% a7arii% a r%aciilor ad@%rs% la s!;stan%l% d% contrast5
- % r%s7%ct& 7rotocol!l d% 7r%9&tir% An 8!nci% d% %#am%n!l c%r!t
- O;in%r%a consim&mBnt!l!i in8ormat %@it& o s%ri% d% n%a<!ns!ri
PRECAU2II PRI)IN* FO'OIREA (aO/
- E#aminar%a c! ;ari! tr%;!i% 8&c!t& d!7& alt% %#am%n% =radiolo9ic% c! iod, %c:o9ra8ii, c! i?oto7i radioacti@i,
tomo9ra8ii, scinti9ra8ii, %tc5> 7%ntr! a n! modi8ica r%?!ltat%l%
- P%ntr! a 8a@ori?a %liminar%a ;ari!l!i d!7& 7roc%d!r& s% administr%a?& !n la#ati@
- % o;s%r@& 6i s% not%a?& as7%ct!l, c!loar%a, consist%na sca!n!l!i5 Paci%nt!l car% a 8&c!t %#am%n!l am;!lator
%st% instr!it s& s% a!too;s%r@%5 ca!n!l ar% c!loar% al;& a7ro#imati@ 2 ?il%5
- % s!7ra@%9:%a?& at%nt 7%rsoan%l% An @Brst& 6i inacti@% la car% risc!l d% consti7ai% %st% cr%sc!t
- % %@it& 7% cBt 7osi;il administrar%a narcotic%lor, a m%dicam%nt%lor car% Anc%tin%sc tran?it!l5
- !l8at!l d% ;ari! 7oat% a9ra@a colita !lc%roas&, 6i 7oat% 8i ca!?a d% ocl!?i% int%stinal&5
- N! s% administr%a?& ;ari! ;olna@ilor c! s!s7ici!n% d% 7%r8orai%5 !nt in!i s!; s!7ra@%9:%r% 6i s% an!n&
m%dic!l dac& a7ar modi8ic&ri An star%a ac%stora5
- Pr%9&tir%a 7%ntr! %#aminar% s% 8ac% con8orm r%comand&rii m%dical% 6i An 8!nci% d% s%9m%nt!l sa! or9an!l car%
@a 8i %#7lorat
4C0
- Paci%nt!l c! stom& n%c%sit& 7r%9&tir% s7%cial&5 R%?!ltat!l %#am%n!l!i d%7ind% d% 7r%9&tir%a 7aci%nt!l!i5
TIPURI *E EXA"ENE
Radio9ra8ia - Anr%9istrar% a ima9inilor 7% !n 8ilm s7%cial5
X%roradio9ra8ia - Anr%9istrar%a ima9inii 7% o s!7ra8a& d% s%l%ni!5
A@anta<%:
O Ima9in% clar& datorit& contrast!l!i ridicat 7!tBnd 8i int%r7r%tat% ?on% mai mici5
O Est% !til& 7%ntr! %#tr%mit&i 6i mai al%s 7%ntr! %s!t!ri moi
O E#7!n%r%a %st% d% sc!rt& d!rat&
Tomo9ra8ia com7!t%ri?at& =CI>
O Utili?%a?& radiaii # 6i !n sist%m d% scanar%, %limin& s!7ra7!n%ril%5
O "%tod& com7!t%ri?at& car% 7r%?int& ima9ini anatomic% art%rial% %liminBnd oas%l% 6i %s!t!ril%
A@anta<%5
o Risc d% to#icitat% r%d!s 7rin sc&d%r%a cantit&ii d% s!;stan& d% contrast
o Risc d% com7licaii sc&?!t, s% 7oat% 8ac% am;!lator5
o Ima9ini Am;!n&t&it% 7% C* 6i r%7rod!s% 7% !n monitor T)5
o Fac% 7osi;il& %#aminar%a @as%lor mici
'imit%
o % 8olos%6t% Antr% /0 - .C ani
o N! s% 8olos%6t% la ;olna@ii c! star% 9ra@& sa! c! an9in& 7%ctoral&
o Dn ca?!l %#amin&rii m%m;r%lor in8%rioar% sa! a ?on%i a;dominal% m&rim%a cBm7!l!i o;s%r@at n%c%sit& mai
m!lt% in<%cii c! s!;stan& d% contrast
o E#ist& risc as%m&n&tor c! c%l al !ro9ra8i%i
- R%?onana ma9n%tic& n!cl%ar& =R"N>
O T%:nic& non in@a?i@& 7rin car% s% o;in ima9ini trans@%rsal% al% anatomi%i cor7!l!i 7rin %#7!n%r%a Antr-!n cBm7
ma9n%tic, 8&r& radiaii
O O;in%r%a ima9inilor s% ;a?%a?& 7% conin!t!l di8%rit An a7& al %s!t!rilor
RICURI'E IRA*IERII
- "odi8ic&ri 9%n%tic%
O E#7!n%r%a or9an%lor 9%nital% la radiaii 7oat% d%t%rmina modi8ic&ri al% A*N-l!i din cromo?omi, !rmat% d%
m!taii
- "odi8ic&ri somatic%:
O Pot a7ar% An ca?!l iradi%rii %#c%si@% sa! r%7%tat%H 7%ricol!l %#ist& 6i at!nci cBnd iradi%r%a s% 8ac% An tim7
!rm&ril% mani8%stBnd!-s% mai tBr?i!
O Risc!l %st% cr%sc!t An canc%r 6i la 9ra@id% An 7rim!l trim%str! d% sarcin&
- "&s!ri d% s%c!ritat%:
O P!rtar%a %c:i7am%nt!l!i d% 7rot%ci% d% c&tr% 7%rsonal!l car% 7artici7& la %#am%n5
O E@itar%a %#7!n%rii r%7%tat% la radiaii5
O % o;in in8ormaii d%s7r% o %@%nt!al& sarcin&
O Dn ca? d% d!;i! sa! sarcin& con8irmat& %#am%n!l n! s% %8%t!%a?&
FIA N". ;.6. ROLUL NURSEI (N EFECTUAREA EXAMENELOR RADIOLOGICE
O(IECTI)E'E
- %#aminar%a c! a<!tor!l radiaiilor X e a !nor or9an%0a7arat% c! sa! 8&r& s!;stan& d% contrast An 8!nci% d%
ca7acitat%a d% a;sor;i% a %s!t!rilor5
- Anr%9istrar%a ima9inilor 7%ntr! sta;ilir%a dia9nostic!l!i 6i !rm&rir%a %@ol!i%i ;olii5
- s!;stana d% contrast dac& %st% ca?!lH
- mat%rial%l% 7%ntr! administrar%a s!;stan%i d% contrastH
- m%dicam%nt% 7%ntr! 7r%@%nir%a 6i com;at%r%a accid%nt%lor, instr!m%nt% 7%ntr! administrar%5
a> PRE$FTIREA PIEICF
- %#7licai 7aci%nt!l!i n%c%sitat%a %8%ct!&rii %#am%n!l!i r%comandat d% m%dicH
- in8ormai 7aci%nt!l as!7ra risc!l!i 6i ;%n%8iciilor 7% car% l% im7lic& 7roc%d!raH
4C4
- o;in%i consim&mBnt!l sa! @%ri8icai dac& a 8ost o;in!t d% c&tr% m%dicH
- in8ormai as!7ra d!rat%i %#am%n!l!iH
- @%ri8icai Anc& o dat& data !ltim%i m%nstr!aii la 8%m%il% tin%r%5
;> PRE$FTIREA FIGICF
- s% atra9% at%nia, dac& %st% n%c%sar 7ost!l alim%ntar 6i d!rata ac%st!ia sa! o;li9ati@itat%a d% a !rma !n an!mit
r%9imH
- s% %8%t!%a?& 7r%9&tir%a s7%ci8ic& or9an!l!i sa! a7arat!l!i %#aminat, com;at%r%a 9a?%lor, %8%ct!ar%a clism%i sa!
a s7&l&t!riiH
- s% administr%a?& anti:istaminic% la r%comandar%a m%dic!l!iH
- s% a7r%cia?& star%a 7aci%nt!l!i 7%ntr! a sta;ili mod!l d% trans7ort la s%r@ici!l radiolo9icH
- 7aci%nt!l %st% r!9at s&-6i And%7&rt%?% o;i%ct%l% m%talic% dac& ac%st%a s!nt 7lasat% An cBm7!l d% %#aminar%5
PARTICIPAREA 'A EFECTUAREA PROCE*URII
- id%nti8icai 7aci%nt!lH @%ri8icai r%comandar%a An F5O5 sa! 7% ;il%t!l d% trimit%r%H
- @%ri8icai dac& 7aci%nt!l a r%s7%ctat r%comand&ril%H
- 7r%9&tii mat%rial%l% car% @or 8i trans7ortat% la radiolo9i% 7%ntr! administrar%a s!;stan%lor d% contrastH
- Ansoii 7aci%nt!l 6i a<!tai-l s& s% d%?;rac% =dac& %st% ca?!l>H 7r%dai 7aci%nt!l col%9%i d% la radiolo9i% 7%ntr!
administrar%a s!;stan%i d% contrast5
- s% a<!t& 7aci%nt!l s& s% a6%?% 7% 7atH
- s% monitori?%a?&: TK, P, TA, R5,%limin&ril%H
- s% o;s%r@& as7%ct!l t%9!m%nt%lor 7%ntr! a d%7ista mani8%st&ri al%r9ic%=%@%nt!al>H
- s% asi9!r& r%7a!s!l, s% administr%a?& lic:id% 7%ntr! a %limina mai r%7%d% s!;stana d% contrast5
- s% c!r&& mat%rial%l% r%8olosi;il%H
- s% col%ct%a?& mat%rial%l% 8olosit% con8orm P5U5H
- s% a6%a?& mat%rial%l% c!rat% An d!la7!riH
- s%s7al& mBinil%5
NOTAREA PROCE*URII
Notai:
- data %8%ct!&rii %#am%n!l!i 6i com7ortam%nt!l 7aci%nt!l!iH
- dac& 7aci%nt!l tr%;!i% s& r%@in& la radiolo9i%5
O 7aci%nt!l 7r%?int& star% 9%n%ral& ;!n&, %#7rim& con8ortH
O n! s!nt s%mn% d% al%r9i%0s%nsi;ilitat% la s!;stanta d% contrast H
R%?!ltat% n%dorit%0c% 8ac%i :
O 7aci%nt!l 7r%?inta 8%nom%n% d% :i7%rs%nsi;ilitat% =7r!rit int%ns, ros%ata si %d%m al 8%t%i, c%8al%%, dis7n%% c!
9r%t!ri si @arsat!ri> car% 7ot a7ar% mai tar?i!, d!7a %8%ct!ar%a %#am%n!l!iH
- s% an!n& m%dic!l =dac& n! %st% 7r%?%nt>, s% administr%a?& m%dicaia r%comandat&H
- s% monitori?%a?& 7aci%nt!l:
O 7aci%nt!l ac!?& d!r%ri d%-a l!n9!l @%n%i 6i 9!st m%talic:
- %#7licai 7aci%nt!l!i c& mani8%st&ril% s!nt tr%c&toar%5
FIA N". ;.7. EXAMENE CU I&OTOPI RADIOACTI.I
APECTE $ENERA'E
*EFINI2IE
- E#aminar%a c! i?oto7i radioacti@i =radion!cli?i> car% %mit radiaii a, f, g 7!s% An %@id%n& cantitati@ 6i calitati@
c! a<!tor!l d%t%ctoar%lor
O(IECTI)E
- *%t%ctar%a modi8ic&rilor str!ct!ral% al% !nor or9an% 8a& d% car% i?oto7ii 7r%?int& tro7ism =a8initat%> 6i s%
8i#%a?& An or9an!l r%s7%cti@5
- Id%nti8icar%a d%8%ct%lor d% 7%r8!?i% san9!in&5
TIPURI *E EXA"ENE
- cinti9ra8ia cardiac& - s% r%ali?%a?& 7rin in<%ctar%a !n!i radiotrasor =T%c:n%ti!m ++m, T:ali! 204> 6i st!dia?&
7%r8!?ia miocardic&5
4C2
- cinti9ra8ia :%7ato;iliar&- s% st!dia?& 8!nciil% 8icat!l!i 6i @%?icii ;iliar%, 7%rm%a;ilitat%a d!%t!l!i ;iliar5 %
r%ali?%a?& c! T%c:n%ti!m ++m5
- cinti9ra8ia :%7atos7l%nic& - d& r%laii d%s7r% 7o?iia, 8orma 6i dim%nsi!nil% 8icat!l!i 6i s7lin%i5 !;stana
radioacti@& %st% al;!mina coloidal& marcat& c! s!l8!ra d% T%c:n%tin!m5
- cinti9ra8ia osoas& - 7%rmit% dia9nosticar%a !n%i l%?i!ni osoas% =tra!matic&, n%o7la?ic&, %tc>5 !;stana d%
contrast - T%c:n%ti!m ++m administrat& i5@5
- cinti9ra8ia 7aratiroidian& - %@al!%a?& 7aratiroid%l% la 7aci%nii c! :i7%rcalc%mi% s%@%r&, locali?%a?&
ad%noam%l% 7aratiroidi%n%5 % r%ali?%a?& c! T%c:n%ti!m ++m sa! iod 42-5
- cinti9ra8ia 7!lmonar& d% 7%r8!?i% 6i @%ntilai% - %@al!%a?& 8!ncia 7!lmonar& 6i %@id%nia?& a8%ci!ni
7!lmonar% =trom;o%m;olism, T(C, 7n%!monia, %m8i?%m 7!lmonar, t!mori 7!lmonar%, astm ;ron6ic, at%l%cta?i%
7!lmonar&>5 P%ntr! scinti9ra8ia d% 7%r8!?i% s!;stana radioacti@& s% administr%a?& i5@5 iar 7%ntr! c%a d% @%ntilai%
7aci%nt!l in:al%a?& radiotrasor!l5 I?oto7i 8olosii: T%c:n%ti! ++m, iod 4-4, X%non 4--, WrZ7ton ,4m5
- cinti9ra8ia r%nal& - %@al!%a?& str!ct!ra 6i 8!ncia r%nal&, d%t%ct%a?& mal8ormaii con9%nital%, t!l;!r&ri d%
circ!lai% r%nal&, t!mori r%nal%5
- cinti9ra8ia tiroidian&-%@id%nia?& ad%nom!l, canc%r!l, tiroidita, ;oala $ra@%s, :i7%r 6i :i7otiroidia5 Folos%6t%
T%c:n%ti! ++m administrat oral sa! iod 42- administrat i5@5 An 8!nci% d% ca?5
- cinti9ra8ia mamar& - di8%r%nia?& canc%r!l mamar d% :i7%r7la?ia mamar& 6i 8olos%6t% ca s!;stan& d% contrast
Tc - ++m, administrat& intra@%nos5
PROCE*URI $ENERA'E *E CANARE
- Radion!clid%l% s% conc%ntr%a?& An an!mit% or9an% sa! sist%m% mai m!lt d%cBt An alt%l%, distri;!ia An %s!t!ril%
s&n&toas% 8iind di8%rit& d% c%l% ;olna@%5
- % %@id%nia?& do!& ti7!ri d% l%?i!ni:
O ?on% cald% An car% ca7tar%a %st% cr%sc!t& com7arati@ c! distri;!ia Antr-o ?on& normal&
O ?on% r%ci An car% ca7tar%a %st% sc&?!t& An ra7ort c! ima9in%a normal&5
- Administrar%a radion!clid!l!i s% 8ac% intra@%nos sa! oral5 Dnaint%a administr&rii radion!clid!l!i s%
administr%a?& !n a9%nt 7%ntr! a 7r%@%ni conc%ntrar%a i?oto7!l!i An alt or9an d%cBt c%l intit
E#5:
a> '!9ol administrat oral cBnd s% 8olos%sc i?oto7i c! iod %#c%7tBnd st!di%r%a tiroid%i
;> P%rclorat d% W administrat oral 7aci%nilor al%r9ici la iod, ;loc:%a?& 7l%#!ril% din cr%i%r5
- Radion!clid!l tr%;!i% administrat c! s!8ici%nt tim7 Anaint% 7%ntr! a s% 7!t%a conc%ntra An %s!t!l s7%ci8ic car%
!rm%a?& s& 8i% st!diat
- Un a7arat Anr%9istr%a?& 7o?iia 6i conc%ntraia radiaiilor 7%n%trant% car% 7orn%sc din or9an!l st!diat5
- *!rata %#am%n!l!i d%7ind% d%: i?oto7ii !tili?ai 6i tim7!l n%c%sar 7%ntr! a a<!n9% An %s!t!ri, ti7!l d%
%c:i7am%nt 8olosit, 7o?iia 7aci%nt!l!i5
PRINCIPII $ENERA'E
- E#am%n%l% c! i?oto7i s% 8ac n!mai An d%7artam%nt!l d% m%dicin& n!cl%ar&
- % ;a?%a?& 7% %#ist%na !nor di8%r%n% d% conc%ntrai% a mat%rial!l!i radioacti@ An %s!t!ril% normal% 6i
anormal% din ariil% cor7!l!i st!diat%
- P%rmit% @i?!ali?ar%a or9an%lor 6i a !nor r%9i!ni car% n! 7ot 8i @&?!t% 7rin %#am%n%l% radiolo9ic%
- Dn ?on%l% a8%ctat% a7ar a6a n!mit%l% l%?i!ni Anloc!itoar% d% s7ai! An s7%cial t!moral% car% s!nt ;in% %@id%niat%5
Gon%l% c! acti@itat% cr%sc!t& s!nt consid%rat% 7atolo9ic%
- Radiaii %l%ctroma9n%tic% 9amma, s!nt 8olosit% An t%ra7i% 6i 7%ntr! 7roc%d!ri dia9nostic%5
- Ec:i7am%nt%l% com7!t%ri?at% d% d%t%ctar% a radiaiilor =contor d% scintilai%> %@id%nia?& 6i 8oto9ra8ia?&
or9an%l% st!diat% 6i 8!rni?%a?& in8ormaii as!7ra m&rimii, 8orm%i, 7o?ii%i 6i acti@it&ii 8!ncional%5
- !;stan%l% radioacti@% s% distri;!i% An %s!t!ri, or9an% sa! sist%m% An 8!nci% d% a8initat%a sa! s7%ci8icitat%a lor
6i d% mod!l c!m s!nt administrat%5
RA*IONUC'IGI UTI'IGATI
- Al;!min& coloidal& marcat& c! s!l8!ra d% T%c:n%ti!m ++ - 8olosit& 7%ntr! scinti9ra8ia :%7atos7l%nic& 6i
scinti9ra8ia 7!lmonar& d% 7%r8!?i%5
- Analo9 d% acid iminodiac%tic marcat c! Tc ++ - 8olosit 7%ntr! scinti9ra8ia :%7ato;iliar&5 % %#cr%t& 7rin ;il&5
- Tc 7iro8os8at - 8olosit 7%ntr! scinti9ra8ia cardiac&
- T:ali! 204 id%m
- Acid 7%ntaac%tic di%til%n triamin& marcat c! Tc ++ = Tc *TPA> 8olosit 7%ntr! scinti9ra8ia r%nal&5 % mai
8olos%6t% hihI sa! :i7!rat hiiI
- WrZ7ton ,4, X%non /-- 7%ntr! scinti9ra8ia 7!lmonar& d% @%ntilai%
4C-
- Octr%otid =analo9 d% somatostatin& marcat c! iod 42- sa! I!din 444 - 7%ntr! id%nti8icar%a t!morilor %ndocrin%5
- T%c:n%ti!m =Tc> ++ s%stami;i 7%ntr! 9land%l% 7aratiroid%5
- Ihji, Tc ++ 7%ntr! 9landa tiroid&
FIA N". ;.4. ROLUL NURSEI (N EFECTUAREA EXAMIN1RII CU I&OTOPI RADIOACTI.I
O(IECTI)E
- *%t%ctar%a modi8ic&rilor str!ct!ral% 6i 8!ncional% al% !nor or9an%
- *%7istar%a t!l;!r&rilor 7%r8!?i%i tis!lar% la ni@%l!l or9an%lor 6i %s!t!rilor
- *i8%r%ni%r%a t!morilor mali9n% d% c%l% ;%ni9n%
- "onitori?ar%a %@ol!i%i t!morilor 6i a r&s7!ns!l!i la tratam%nt% =iradi%r%, c:imiot%ra7i%>
- % 8ac% d% c&tr% 7%rsonal!l d% la s%r@ici!l d% m%dicin& n!cl%ar&
- !nt n%c%sar%:
O !;stan% marcat% c! i?oto7i radioacti@i indicat% 7%ntr! %#am%n!l c%r!t
O !;stan% 7%ntr! limitar%a 8i#&rii i?oto7ilor =radiotrasorilor> An alt% or9an% =dac& %st% ca?!l>
O "at%rial% n%c%sar% administr&rii radiotrasorilor
O "at%rial% d% 7rot%ci%
CU'E$EREA *ATE'OR
- % 8ac% d% c&tr% m%dic, s% com7l%t%a?& d% n!rs&
- % o;in in8ormaii 7ri@ind %#ist%na sarcinii la 8%m%il% tin%r%, %#am%n!l 8iind contraindicat, d%oar%c% radiaiil%
s!nt noci@% 7%ntr! co7il
- F%m%il% la @Brsta 8%rtil& s!nt s8&t!it% s& ia contrac%7ti@%, s% 8ac% %#am%n 9in%colo9ic
- Al&7tar%a contraindic& administrar%a radiotrasorilor dac& ;%n%8iciil% n! d%7&6%sc risc!ril%5 CBnd %#am%n!l s%
im7!n%, %st% s8&t!it& s& n! al&7t%?% 2-- ?il%
- % cons%mn%a?& in8ormaii d%s7r% ant%c%d%nt%l% d% al%r9i% al% 7aci%nt!l!i dac& radion!clid!l conin% iod
- % @%ri8ic& Anc&rc&t!ra radioacti@& dac& 7aci%nt!l a 8&c!t An !ltim%l% 2/-/, d% or% %#am%n% radiolo9ic% c! s!l8at
d% ;ari! sa! ali radion!cli?i d%oar%c% 7ot in8l!%na r%?!ltat%l%
- E#am%n%l% c! (a Anaint%a scinti9ra8i%i :%7atos7l%nic% sa! c! octr%otid modi8ic& r%?!ltat%l% 6i d%t%rmin& d%8%ct%
scinti9ra8ic%
- % not%a?& 7r%?%na %@%nt!al%lor 7rot%?% An or9anism car% 7ot Am7i%dica tras%!l radiaiilor 9amma
- % not%a?& @Brsta 6i 9r%!tat%a act!al& 7%ntr! calc!lar%a do?%i d% radion!cli?i
- % %@al!%a?& star%a 7aci%nt!l!i 7%ntr! a sta;ili dac&:
O % 7oat% d%7lasa sin9!r sa! ar% n%@oi% d% !n 8otoli! r!lant
O N%c%sit& administrar% d% Oj
O Pr%?int& sond& 6i 7!n9& d% col%ctar% a !rmii
O Pr%?int& can!l& intra@%noas& sa! sond& na?o9astric&
O Est% dia;%tic
O Tr%;!i% s& ia m%dicam%nt%
O N%c%sit& alt% %#am%n% scinti9ra8ic%5 cinti9ra8ia tiroidian& s% 8ac% Anaint%a %#am%n%lor radiolo9ic% c! s!;stan%
car% conin iod
- *ac& ar% mai 7!in d% 4, ani s% an!n& s%r@ici!l d% m%dicin& n!cl%ar& 7%ntr! sta;ilir%a t%:nolo9i%i ad%c@at%
7roc%d!rii d% %#aminar%5
- % %#7lic& risc!ril% 6i ;%n%8iciil% %#am%n!l!i Anaint% d% t%star%
(%n%8icii:
O Radioacti@itat%a s% Anma9a?in%a?& 7%ntr! 7!in tim7, %liminar%a s!;stan%lor 8&cBnd!-s% 7rin !rin& 6i 8%cal%
O T%c:n%ti! - c%l mai !tili?at trasor s% r%d!c% d!7& . or% 6i dis7ar% An 2/ or%5 *!7& %liminar%, 7aci%nt!l n! mai
%st% 7!rt&tor d% radioacti@itat%
O "%tasta?%l% s!nt d%7istat% c! .-42 l!ni Anaint% 8a& d% %#am%n%l% radiolo9ic% o;i6n!it%
O Iradi%r%a %st% mai mic& d%cBt An ca?!l %#amin&rilor radiolo9ic%
Risc!ri:
O Un 7%ricol radioacti@ %#ist& totd%a!na, dar %st% limitat d%oar%c% s% 8olos%sc do?% 8oart% mici
4C/
O E#am%n!l 7r%?int& limit%, locali?ar%a t!morilor 7oat% 8i di8icil& cBnd %s!t!l normal din <!r!l l%?i!nii a;soar;%
radion!clid!l 6i cont!r!ril% s!nt n%clar%
O % o;in% consim&mBnt!l in8ormat
O % com!nic& d!rata %#am%n!l!i
O % in8orm%a?& 7aci%nt!l dac& An tim7!l %#am%n!l!i tr%;!i% s& st%a n%mi6cat 7%ntr! a n! modi8ica r%?!ltat%l%
O % in8orm%a?& 7aci%nt!l dac& s% im7!n r%stricii alim%ntar% sa! d% 8!mat
O % an!n& 7aci%nt!l c& in<%ctar%a radiotrasor!l!i 7oat% 7rod!c% !6or discom8ort
- % @%ri8ic& dac& 7aci%nt!l a r%s7%ctat r%comand&ril%
- % 8ac% t%star%a s%nsi;ilit&ii dac& s% 8olos%sc radioi?oto7i c! iod
- % And%7&rt%a?& o;i%ct%l% m%talic%, ;i<!t%riil% din cBm7!l d% %#aminar%
- % Antr%r!7% m%dicaia =c! acord!l m%dic!l!i> 7Bn& la Anc:%i%r%a st!diilor - la 8%m%il% d% @Brst& 8%rtil& 7%ntr!
si9!ran& s% 8ac% %#am%n!l 9in%colo9ic
- % administr%a?& m%dicaia 7r%7roc%d!ral& 7%ntr! r%d!c%r%a 8i#&rii radiotrasorilor An %s!t!ril% din <!r
PARTICIPAREA 'A EXA"EN
- % id%nti8ic& 7aci%nt!l
- % Anso%6t% 7aci%nt!l la s%r@ici!l d% m%dicin& n!cl%ar& An @%d%r%a administr&rii radiotrasor!l!i 6i %8%ct!&rii
%#am%n!l!i
- Est% a<!tat s& s% d%?;rac% 6i s& s% a6%?% 7% mas&
- Admininistrar%a i?oto7ilor =radiotrasor!l!i> s% 8ac% d% c&tr% 7%rsonal!l d% la s%r@ici!l d% m%dicin& n!cl%ar&
- E#am%n!l n! %st% tra!mati?ant 5
- Paci%nt!l %st% s8&t!it s& cons!m% mai m!lt% lic:id% 7%ntr! a 8a@ori?a %liminar%a s!;stan%lor radioacti@%
- *ac& %st% n%c%sar, 7aci%nt!l @a 8i r%ad!s la s%r@ici!l d% m%dicin& n!cl%ar& 7%ntr! noi Anr%9istr&ri
- Foaia d% o;s%r@ai% a 7aci%nt!l!i s% a6%a?& An dosar
NOTAREA PROCE*URII
- "%dic!l not%a?& An 8oaia d% o;s%r@ai% r%?!ltat!l %#am%n!l!i sa! com7l%t%a?& ;!l%tin!l d% anali?&5
- N!rsa A6i not%a?& An 7lan!l d% An9ri<ir%
E)A'UAREA
R%?!ltat% a6t%7tat%0dorit%
- Paci%nt!l %st% lini6tit, cola;orant
- N! s% 7rod!c incid%nt% An tim7!l in<%ct&rii
- Ima9inil% o;in!t% arat& 8orm&, dim%nsi!ni, 7o?ii% 6i 8!ncii normal%, ca7tar% !ni8orm&
R%?!ltat% n%dorit%
- Gon% d% :i7o sa! :i7%r ca7tar% car% cor%s7!nd a6a n!mit%lor ?on% cald% 6i r%ci =nod!li, c:ist!ri, t!mori,
isc:%mi%, trom;o?%>
FIA N". ;.;. EXAMENE CU ULTRASUNETE 9EC%OGRAFICE:
APECTE $ENERA'E
*EFINI2IE
- Ultrasono9ra8ia %st% %#aminar%a n%in@a?i@& 7%ntr! @i?!ali?ar%a str!ct!rilor din %s!t!ril% moi al% cor7!l!i, 7rin
Anr%9istrar%a r%8l%ct&rii !nd%lor sonor% Andr%7tat% c&tr% %s!t!ri5
PRINCIPII $ENERA'E
- Utili?%a?& !nd% d% Analt& 8r%c@%n& 7%ntr! %#aminar%a 7o?ii%i, 8orm%i, 8!nci%i !nor str!ct!ri anatomic%,
%#ist%na, d%?@oltar%a 6i mi6c&ril% 8%t!s!l!iH
- % ;a?%a?& 7% r%8l%ctar%a di8%rit& a !nd%lor sonor% An 8!nci% d% str!ct!ra %s!t!rilorH
- Fl!#!l 7rin art%r%l% carotid% s% mani8%st& 7rin modi8icar%a 8r%c@%nt& a %co!rilor r%8l%ctat% d% c&tr% c%l!l%l%
san9@in% An mi6car%H
- Und%l% r%8l%ctat% s!nt 7roc%sat% %l%ctronic 6i 7r%?%ntat% 7% !n dis7laZ d% ima9in%H
- Dnr%9istrar%a s% 7oat% 8ac% 7% 8ilm 7olaroid, 8ilm radio9ra8ic, cas%t% @id%o, slid%-!ri sa! Anr%9istr&ri di9ital% c!
ima9ini al; - n%9r! sa! colorH
- '%?i!nil% 7atolo9ic% a! d%nsitat% 6i %lasticitat% di8%rit& com7arati@ c! %s!t!l normal din <!r5 N! 7ot 8i
%#aminat% or9an% 7lin% c! a%r =7l&mBni, int%stin>H
- Contact!l Antr% transd!ctor 6i 7i%l% s% asi9!r& 7rin a7licar%a !n!i 9%lH
4CC
- Transd!ctorii r%ctali =7%ntr! 7rostat& 6i r%ct> 6i @a9inali =7%ntr! %#aminar%a or9an%lor 9%nital% la 8%m%i> s!nt
aco7%rii Antr-!n sac d% lat%# 6i 7%rmit Anr%9istrar%a ima9inilor 7rin %liminar%a s!7ra7!n%rii 9a?%lor sa! a altor
str!ct!ri5
A)ANTAIE 0 *EGA)ANTAIE
A)ANTAIE
- Proc%d!ra %st% n%in@a?i@&, 8&r& risc d% radiaii5
- N%c%sit& 7r%9&tir% minim& din 7art%a 7aci%nt!l!i
- Folosit& An o;st%tric&, %#aminar%a %st% si9!r& 7%ntr! 9ra@id& 6i 8%t!sH
- % 7oat% r%7%ta 8&r& %8%ct% c!m!lati@%
- % %8%ct!%a?& 6i 8&r& s7itali?ar%H
- E#am%n%l% !ltrasono9ra8ic% 7ot 8i 8olosit% 7%ntr! or9an% car% n! 8!ncion%a?& normal, %@id%niind modi8ic&ril%
d% str!c!r&H
- !nt !til% 7%ntr! st!di%r%a or9an%lor An mi6car%H
- N! n%c%sit& s!;stan& d% contrast sa! i?oto7iH
- Post!l n! %st% n%c%sar An c%l% mai m!lt% sit!aii5
- Rata ac!rat%ii atin9% +,5,P mai al%s la 7aci%nii sla;i
- E#am%n!l n! %st% in8l!%nat d% 8!ncia or9an!l!i
*EGA)ANTAIE
- E#aminator!l tr%;!i% sa ai;& com7%t%n& 6i %#7%ri%n&H
- tr!ct!ril% car% conin a%r =7l&mBni,int%stin%> n! 7ot 8i %#aminat% c! !ltras!n%t%H
- P%ntr! co7ii =a9itai>, 7aci%ni n%cola;orani, o;%?i %st% n%@oi% d% 7r%9&tir% s7%cial&H
- !nt di8ic!lt&i d% %#aminar% la 7aci%nii o7%rai !nd% s% im7!n% 7rot%cia 7l&9ii d%oar%c% 9%l!l tr%;!i% a7licat
7% 7i%l%a intact& iar cicatric%l% 7ot modi8ica r%?!ltat!l
TIPURI *E EXA"ENE
- Ecocardio9ra8ia trans%so8a9ian& - %#am%n %ndosco7ic 6i !ltrasonor car% 7%rmit% @i?!ali?ar%a cord!l!i din
7o?iia r%trocardiac&, %liminBnd int%r8%r%n%l% !ltras!n%t%lor c! alt% str!ct!ri: %s!t!l s!;c!tanat, oas%l% torac%l!i,
7l&mBni5 Transd!ctor!l %co9ra8ic %st% introd!s An %so8a9 c! a<!tor!l %ndosco7!l!i
- Ecocardio9ra8ia transtoracic& - 7%rmit% @i?!ali?ar%a 6i a7r%ci%r%a 8!nciilor cord!l!i, d%t%ct%a?& 6i %@al!%a?&
;olil% cardiac% con9%nital%, @al@!lo7atiil% cB6ti9at%, m&soar& dim%nsi!nil% cord!l!i5
- Eco9ra8ia a;dominal& - 7%rmit% @i?!ali?ar%a aort%i a;dominal%, 8icat!l!i, @%?icii 6i c&ilor ;iliar%, 7ancr%as!l!i,
rinic:i!l!i, !r%t%r%lor 6i @%?icii !rinar%
- Eco9ra8ia *o77l%r art%rio@%noas& - %@al!%a?& 7%rm%a;ilitat%a @as%lor san9@in%, dir%cia 6i 8l!#!l san9@in c!
a<!tor!l !ltras!n%t%lor r%8%l%ctat% d% %ritrocit%l% a8lat% An mi6car%
- Eco9ra8ia 7%l@in& - %@al!%a?& or9an%l% 9%nital% 6i id%nti8ic& !t%r!l 8i;romatos, ;oli in8lamatorii 7%l@in%, c:ist%
o@ari%n% =An 9in%colo9i%>H id%nti8ic& sarcina sim7l& 6i m!lti7l&, mal8ormaii con9%nital%, anomalii 7lac%ntar%,
d%t%rmin& @Brsta 6i %@ol!ia sarcinii =An o;st%tric&>H s% 8olos%6t% 7%rinatal, 7r%natal 6i n%onatal5
- Eco9ra8ia d% 7rostat& 6i r%ct - %@al!%a?& 7rostata, @%?ic!l%l% s%minal%, r%ct!l 6i %s!t!l 7%rir%ctalH
- Eco9ra8ia tiroidian& - %#am%n n%in@a?i@ car% 7%rmit% di8%r%ni%r%a nod!lilor tiroidi%ni d% c:ist!ri, t!mori5 Ar%
@aloar% mai mar% cBnd % 8olosit& An com;inai% c! 7al7ar%a 9land%i5
- E#am%n!l %co9ra8ic *!7l%# al art%r%lor carotid% - st!dia?& circ!laia An art%r%l% carotid%, am7lit!din%a 7!ls!l!i
carotidian, @it%?a d% circ!lai% 6i dir%cia 8l!#!l!i san9!in5
- Eco9ra8ia oc:i!l!i - 7%rmit% %#aminar%a 7&rilor 7ost%rioar% at!nci cBnd m%diil% trans7ar%nt% s!nt o7ac%5 Est%
!til& An !rm&rir%a d%?li7irii d% r%tin&
- Eco9ra8ia mamar& - d%c%l%a?& 8ormai!ni t!moral%, solitar%, c! !n diam%tr! mai mari d% 4 cm5 Fac%
di8%r%ni%r%a Antr% 8ormai!nil% c:istic% 6i t!moral%5
FIA N". ;.;. ROLUL NURSEI (N EFECTUAREA EXAMENELOR CU ULTRASUNETE
9EC%OGRAFICE:
O(IECTI)E
- )i?!ali?ar%a An tim7 r%al a or9an%lor a;dominal% =art%ra aorta a;dminal&, 8icat, @%?ic& 6icanal%l% ;iliar%,
7ancr%as!l, rinic:ii, !r%t%r%l%, @%?ica !rinar&>5
- E@al!ar%a motilit&ii !nor or9an%, a 8orm%i, dim%nsi!nilor, str!ct!rii, 7o?ii%i5
- E@al!ar%a str!ct!rilor inacc%si;il% sa! sla; @i?!ali?at% 7rin alt% ti7!ri d% %#am%n% =%#am%n% radiolo9ic%>
4C.
- E@id%ni%r%a 7r%?%n%i, @Brst%i 6i ritm!l!i d% cr%6t%r% a sarcinii, sarcini m!lti7l%, mal8ormaii 8%tal% sa! alt%
anomalii5
- "onitori?ar%a t%ra7%!tic&5
- $%l 7%ntr! r%ali?ar%a contact!l!i c! t%9!m%nt!l
- Proso7 t%#til sa! din :Brti%
- Foaia d% o;s%r@ai% a 7aci%nt!l!i sa! ;il%t!l d% trimit%r% =cBnd %#am%n!l s% 8ac% am;!lator>
a> PIEICF
- % in8orm%a?& as!7ra n%c%sit&ii 6i ino8%nsi@ilBii %#am%n!l!i
- % 7r%?int& a@anta<%l% 6i d%?a@anta<%l%
A)ANTAIE:
O N! 7r%?int& risc d% radiaii
O Pr%9&tir%a 7%ntr! %#am%n %st% minim&
O N! ar% in8l!%n& noci@& as!7ra 8&t!l!i An ca? d% sarcin&
O N! %st% n%c%sar& s7itali?ar%a
O N! n%c%sit& s!;stan% d% contrast c! iod
O % 7oat% r%7%ta 8&r& risc!ri
*EGA)ANTAIE:
O N! 7ot 8i %@al!at% str!ct!ril% 7lin% c! a%r =7l&mBn, int%stin>
O 'a 7aci%nii o;%?i !nd%l% !ltrasonor% s!nt at%n!at%, s-ar 7!t%a s& 8i% n%c%sar& r%7%tar%a %#am%n!l!i
- % com!nic& d!rata %#amin&rii
- % %#7lic& t%:nica 7roc%d!rii 6i mod!l d% cola;orar%, 8olosir%a 9%l!l!i, 7&strar%a 7o?ii%i5
- % o;in in8ormaii d%s7r% %@%nt!al% al%r9ii la lat%#
- % o;in% consim&mBnt!l in8ormat
;> FIGICF
- % ia! mas!ri d% And%7&rtar% a 9a?%lor An ca?!l An car% ac%st%a s% int%r7!n An 8aa 8l!#!l!i !nd%lor !ltrasonic%
- % ins7%ct%a?& ?ona 7%ntr! a n! %#ista r&ni sa! ;anda<%5 =E#am%n!l n! s% 7oat% 8ac%, 8iind n%c%sar& a7licar%a
9%l!l!i 7% 7i%l%a int%9r&>5
- *ac& s% im7!n% %#aminar%a la !n 7aci%nt o7%rat s% %#amin%a?& 7la9a
- % ia! m&s!ri An ca?!l %#amin&rii co7iilor 7%ntr! a sta lini6tii, la n%@oi% s% s%d%a?&5
- Un%l% %#am%n% n%c%sit& 7ost alim%ntar =%c:o9ra8ia @%?icii ;iliar%, %c:o9ra8ia trans%so8a9ian&> 5
- E#am%n%l% radiolo9ic% c! ;ari! s% 8ac Anaint%a %c:o9ra8i%i 7%ntr! a n! in8l!%na ima9in%a =N>
- P%ntr! %c:o9ra8ia 7%l@in&, @%?ica !rinar& tr%;!i% s& 8i% 7lin&
- Dn ca?!l %c:or9a8i%i *o77l%r n! s% 8!m%a?&
- Est% n%c%sar& s%dar%a 7r%7roc%d!ral& An %c:ocardio9ra8ia trans%so8a9ian& An car% s% %8%ct!%a?& 6i t%st% d%
coa9!lar%5
- % @%ri8ic& dac& 7aci%nt!l a r%s7%ctat r%comand&ril%
- % a6%a?& 7aci%nt!l An 7o?ii% ad%c@at&, solicitat& d% m%dic An 8!nci% d% or9an!l %#aminat
- % s!7ra@%9:%a?& co7iii s& st%a n%mi6cai An tim7!l %#am%n!l!i
- E#aminator!l ar% 9ri<& s& asi9!r% contact!l 7%rman%nt Antr% transd!ctor 6i t%9!m%nt, la n%@oi% s% mai a7lic& 9%l5
- % Anr%9istr%a?& ima9inil% 7% 8ilm, 7% C* sa! s% 8ac Anr%9istr&ri di9ital%
- % And%7&rt%a?& 9%l!l la s8Br6it!l %#amin&rii
- % trans7ort& la salon dac& %st% s7itali?at
- N! %st% n%c%sar&, %#am%n!l 8iind n%tra!mati?ant, s% 7oat% 8ac% 6i am;!lator
- % acord& An9ri<iril% im7!s% d% star%a 9%n%ral& a 7aci%nt!l!i 6i d% a8%ci!n%a 7%ntr! car% %st% s7itali?at
- % !rm&r%6t% dac& n! a7ar c!m@a 8%nom%n% al%r9ic% la lat%# An %co9ra8ia trans@a9inal& 6i An %c:o9ra8ia d%
7rostat& 6i r%ct
- Foaia d% o;s%r@ai% a 7aci%nt!l!i s% a6%a?& An dosar
NOTAREA PROCE*URII
- % not%a?& An 8oaia d% o;s%r@ai% r%?!ltat!l %#am%n!l!i sa! s% com7l%t%a?& An ;!l%tin!l d% %#am%n
- N!rsa not%a?& %#am%n!l An 7lan!l d% An9ri<ir% 6i dac& %st% n%c%sar& r%7%tar%a ac%st!ia =la cBt tim7>5
4C7
R%?!ltat% dorit%
- Form& dim%nsi!ni, 7o?ii%, str!ct!r& 6i 8!ncii normal%
R%?!ltat% n%dorit%5
- Ima9ini n%concl!d%nt% An %c:o9ra8ia a;dominal& dac& s-a! 8&c!t %#amin&ri c! (ari! sa! %#ist& 9a?%, ?on% :i7o
sa! :i7%r%co9%n%, modi8ic&ri d% 8orm&, @ol!m, 7o?ii%
CAPITOLUL .II. EXAMENE ENDOSCOPICE
FIA N". <.1. EXAMENE ENDOSCOPICE
ASPECTE GENERALE
*EFINI2IE
- )i?!ali?ar%a 6i %#aminar%a dir%ct& a or9an%lor sa! ca@it&ilor c! a<!tor!l %ndoscoa7%lor - a7arat% c! 8i;r% o7tic%
6i !n sist%m d% l%ntil% ata6at% !n!i t!; 8l%#i;il sa! ri9id5
O(IECTI)E
- E#aminar%a ca@it&ilor 6i or9an%lor 7%ntr! sta;ilir%a dia9nostic!l!i
- Dnd%7&rtar%a !nor cor7i str&ini
- As7irar%a s%cr%iilor
- R%coltar%a !nor tra9m%nt% d% %s!t An @%d%r%a ;io7si%i
- E%mosta?a c! las%r
- E8%ct!ar%a !nor man%@r% c:ir!r9ical%
TIPURI *E EXA"ENE
- Artrosco7ia - @i?!ali?ar%a dir%ct& a int%rior!l!i artic!lai%i 7%ntr! %#aminar%a 6i %8%ct!ar%a !nor 7roc%d!ri
c:ir!r9ical% =%liminar% d% m%nisc sa! 7int%n osos, r%7arar% d% li9am%nt%, r%coltar%a ;io7si%i>
- (ron:osco7ia - @i?!ali?art%a larin9%l!i 6i ar;or%l!i tra:%o;ron6ic An sco7 dia9nostic, ;io7si%r%a l%?i!nilor
s!s7%ct%, as7irar%a s7!t%i din ;ron:ii 7%ntr! %8%ct!ar%a c!lt!rilor5 Dn sco7 t%ra7%!tic 7rin ;ron:osco7i% s%
r%ali?%a?&: control!l sBn9%r&rii din ;ron:ii, And%7&rtar%a cor7ilor str&ini, as7irar%a s%cr%iilor An ca? d% o;str!ci%
sa! at%l%cta?i% 7osto7%ratori%, iradi%r%a %ndo;ron6ic& c! iridi!5
- Citosco7ia - @i?!ali?ar%a dir%ct& a !r%tr%i 6i a @%?icii !rinar% An @%d%r%a sta;ilirii dia9nostic!l!i, %8%ct!ar%a
;io7si%i d% 7rostat&, r%coltar%a !rin%i dir%ct din !r%t%r%, id%nti8icar%a s!rs%i d% :%mat!ri%5 Dn sco7 t%ra7%!tic s%
8olos%6t% 7%ntr! r%?%cia t!morilor mici, 7lasar%a cat%t%r%lor An 7%l@is!l r%nal, :%mosta?&, 7%ntr! iradi%r%a
t!morilor5
- Eist%rosco7ia - %#aminar%a dir%ct& a ca@it&ii !t%rin% c! a<!tor!l !n!i %ndosco7 s!;ir% introd!s 7% cal% @a9inal&
7rin col!l !t%rin5
- Eso8a9o9astrod!od%nosco7ia - =%ndosco7ia 9astroint%stinal& s!7%rioar&, 9astrosco7ia> - 7%rmit% @i?!ali?ar%a
dir%ct& a m!coas%i tract!l!i 9astroint%stinal s!7%rior5 Prin %so8a9o-9astrosco7i% s% 7oat% %8%ct!a o ;io7si%r% a
8ormai!nilor s!s7%ct%, And%7&rtar%a cor7ilor str&ini, o7rir%a sBn9%r&rii5
- 'a7arosco7ia - @i?!ali?ar%a dir%ct& a or9an%lor a;dominal% 6i 7%l@in% 7%ntr! sta;ilir%a dia9nostic!l!i 6i
r%ali?ar%a !nor int%r@%nii c:ir!r9ical% c! minim!m d% discon8ort 6i r%c!7%rar% ra7id&5
- "%diastinosco7ia - @i?!ali?ar%a dir%ct& a s7ai!l!i c!7rins Antr% st%rn 6i c%i doi 7l&mBni !nd% s% a8l& tra:%%a,
%so8a9!l, cord!l 6i maril% @as%, tim!s!l 6i 9an9lionii lim8atici5 P%rmit% %8%ct!ar%a ;io7si%i 9an9lionilor lim8atici5
- Toracosco7ia - @i?!ali?ar%a 7l%!r%i, 7l&mBnilor 6i m%diastin!l!i 7%ntr! id%nti8icar%a 6i stadiali?ar%a
n%o7lasm!l!i, %@id%ni%r%a m%tasta?%lor, %m8i?%m!l!i, in8%ci%i 7!lmonar% 6i o;in%r%a 8ra9m%nt%lor tis!lar%
7%ntr! ;io7sii5
- R%ctosi9moidosco7ia =si9moidosco7ia, 7roctosco7ia, anosco7ia> - %#aminar%a %ndosco7ic& a an!s!l!i, r%ct!l!i
6i si9moid!l!i 6i o;in%r%a 8ra9m%nt%lor d% %s!t 7%ntr! ;io7si%H And%7&rtar%a 7oli7ilor, o;lit%rar%a :%moroi?ilor5
- Col7osco7ia - @i?!ali?ar%a @a9in!l!i, col!l!i !t%rin =c%r@i#!l!i> 6i @!l@%i 7%ntr! %@al!ar%a !nor l%?i!ni 6i
o;in%r%a 8ra9m%nt%lor din ?on%l% s!s7%ct% 7%ntr! ;io7si%5
- Colonosco7ia - @i?!ali?ar%a m!coas%i Antr%9!l!i colon, @al@%i il%oc%cal% 6i il%on!l!i t%rminal 7%ntr!
%@id%ni%r%a canc%r!l!i d% colon, 7oli7ilor, in8lamaiilor int%stinal%, mal8ormaiilor, :%moroi?i 6i 7%ntr!
%8%ct!ar%a !nor man%@r% c:ir!r9ical% %ndosco7ic%5
4C,
FIA N". <.6.)ROLUL NURSEI (N EFECTUAREA EXAMENELOR ENDOSCOPICE
O(IECTI)E
- E#aminar%a ca@it&ilor !nor or9an%
- Dnd%7&rtar%a cor7ilor str&ini
- R%coltar%a ;io7si%i
- E8%ct!ar%a int%r@%niilor c:ir!r9ical%
- A7arat!l %ndosco7ic
- "&6ti, m&n!6i, oc:%lari
- Tam7oan%, com7r%s%
- 7raZ an%st%?ic, m%dicam%nt% r%comandat% d% m%dic
- T&@i& r%nal&
- "at%rial% 7%ntr! ;io7si%
- "at%rial d% d%?in8%ci%
- !rsa d% l!min&
- Id%nti8icai c!no6tin%l% 7aci%nt!l!i r%8%ritoar% la %#am%n
- E#7licai 7aci%nt!l!i n%c%sitat%a %8%ct!&rii %#am%n!l!i r%comandat d% m%dic 6i risc!l
- E#7licai mod!l d% d%s8&6!rar% al %#am%n!l!i
- O;in%i consim&mBnt!l sa! @%ri8icai dac& a 8ost o;in!t d% m%dic
- In8ormai 7aci%nt!l c& s% 8ac% an%st%?i% 6i d%scri%i s%n?aiil% 7% car% l% 7oat% a@%a
- In8ormai as!7ra d!rat%i %#am%n!l!i
- % atra9% at%nia 7aci%nt!l!i as!7ra r%9im!l!i sa! a r%striciilor alim%ntar%
- % @%ri8ic& dac& a! 8ost r%s7%ctat%
- % 9ol%6t% ca@itat%a d% %#aminat, dac& %st% co7il s% 8ac% s7&lar%a dac& m%dic!l r%comand&
- % 8ac% t%st d% s%nsi;ilitat% la #ilin& c! o ?i Anaint%
- % 8ac t%st%l% d% coa9!lar%
- % administr%a?& s%dati@% c! o s%ar& Anaint%, la r%comandar%a m%dic!l!i
- % id%nti8ic& 7aci%nt!l5
- % @%ri8ic& r%comandar%a An 8oaia d% o;s%r@ai%
- % @%ri8ic& dac& 7aci%nt!l a r%s7%ctat r%comand&ril%, 7ri@ind 7r%9&tir%a s7%ci8ic&
- % %@al!%a?& r%s!rs%l% 8i?ic% 6i star%a 7aci%nt!l!i 7%ntr! a sta;ili modalitat%a d% trans7ort la cam%ra d%
%ndosco7i% sa! la sala d% o7%rai%
- % 7r%9&t%sc mat%rial%l% car% Anso%sc ;olna@!l =8oaia d% o;s%r@ai%, dosar!l d% n!rsin9>
- % Anso%6t% 7aci%nt!l la cam%ra d% %ndosco7i%
- % a<!t& 7aci%nt!l s& s% d%?;rac% 6i s& s% a6%?% 7% masa d% %#aminar%
- % asi9!r& 7o?iia cor%s7!n?&toar% %#am%n!l!i
- % s%r@%sc m%dic!l!i instr!m%nt%l% 6i c%l%lalt% mat%rial% An 8!nci% d% %#am%n!l r%comandat 6i sco7!l ac%st!ia
- % sc:im;& 7o?iia 7aci%nt!l!i la c%r%r%a m%dic!l!i 6i s% s!7ra@%9:%a?& star%a ac%st!ia
- % in8orm%a?& m%dic!l c! 7ri@ir% la modi8ic&ril% o;s%r@at%
- % a<!t& 7aci%nt!l s& co;oar% d!7& masa d% %ndosco7i% 6i s& s% Am;rac%
- % a<!t& 7aci%nt!l s& s% a6%?% 7% 7at
- % s!7ra@%9:%a?& 6i s% not%a?& 8!nciil% @ital%
- % at%nion%a?& s& n! m&nBnc% !n tim7 @aria;il An 8!nci% d% %#am%n
- % disc!t& c! 7aci%nt!l d%s7r% <%na r%simit& 7% trai%ct!l introd!c%rii a7arat%lor 6i s% %#7lic& c% tr%;!i% s& 8ac&
- % asi9!r& r%7a!s!l alim%ntar d!7& %#am%n An 8!nci% d% an%st%?i% 6i or9an!l %#aminat
- % @%ri8ic& %limin&ril% =d!7& ca?> 7%ntr! a id%nti8ica sBn9%rar%a, mai al%s d!7& ;io7si%
- % c!r&& mat%rial%l% 8olosit% 6i s% 7r%9&t%sc 7%ntr! st%rili?ar%
4C+
- % a6%a?& mat%rial%l% An d!la7!ri s7%cial%
- % col%ct%a?& mat%rial%l% d% !nic& 8olosin& An contain%r% s7%cial%, con8orm P5U5
- % trimit la la;orator mat%rial%l% r%coltat% 7%ntr! ;io7si%
- 7&lai mBinil%
NOTAREA PROCE*URII
- *ata, ora %8%ct!&rii %#am%n!l!i
- N!m%l% 7%rsoan%i car% a %8%ct!at %#am%n!l
- Com7ortam%nt!l 7aci%nt!l!i
- Paci%nt!l 7r%?int& star% 9%n%ral& ;!n&, n! ac!?& discon8ort
- O;s%r@aiil% 8&c!t% An tim7!l %#am%n!l!i s!nt lini6titoar% 7%ntr! 7aci%nt
R%?!ltat% n%dorit%0c% 8ac%i
- Paci%nt!l ac!?& <%n&
O % %#7lic& 7aci%nt!l!i c& @a dis7ar% An ?i!a !rm&toar% 6i s% s8&t!i%6t% c% ar% d% 8&c!t An 8!nci% d% or9an!l
%#aminat
- Bn9%rar%a tras%!l!i
O % an!n& m%dic!l 7%ntr! a sta;ili cond!ita
O % 7r%9&t%sc la And%mBn& m%dicam%nt% :%mostatic% 6i mat%rial% 7%ntr! administrar%
- Pr%?int& 8%;r&, dis7n%%, d!r%ri a;dominal%
O % %#7lic& 7aci%nt!l!i c& 8%;ra dis7ar% An 2/ d% or%
O % an!n& m%dic!l dac& 7aci%nt!l 7r%?int& dis7n%%, d!r%ri a;dominal%

CAPITOLUL .III. PUNC2II
FIA N". =.1. PUNC2II
*EFINI2IE
- P&tr!nd%r%a c! a<!tor!l !n!i ac sa! trocar Antr-o ca@itat% nat!ral& sa! n%o8ormat& =7atolo9ic&> ori Antr-!n or9an
7ar%nc:imatos c! sco7 %#7lorator sa! t%ra7%!tic5
COPU' PUNC2IEI
E#7lorator:
- Pr%ci?ar%a %#ist%n%i nat!rii, as7%ct!l!i 6i com7o?ii%i lic:id!l!i dintr-o ca@itat%H st!di%r%a ;ioc:imic&,
;act%riolo9ic& 6i citolo9ic&H
- Introd!c%r%a !nor s!;stan% d% contrast =a%r>H
- Pr%l%@ar%a !n!i 8ra9m%nt d% %s!t 7%ntr! %#am%n :isto7atolo9ic5
T%ra7%!tic:
- E@ac!ar%a col%ci%i dintr-o ca@itat% at!nci cBnd 7rod!c% 8%nom%n% d% com7r%si!n% as!7ra or9an%lor din <!r,
cBnd <%n%a?& 8!nciaH
- Introd!c%r%a !nor m%dicam%nt%
PRINCIPII $ENERA'E
- Pr%9&tir%a 7si:ic& a 7aci%nt!l!i An @%d%r%a o;in%rii consim&mBnt!l!i in8ormatH
- R%s7%ctar%a condiiilor d% as%7si% 6i antis%7si%: d%?in8%cia r%9i!nii, 7r%9&tir%a mat%rial%lor st%ril% 6i
man%@rar%a s%7tic&, d%?in8%cia mBinilor m%dic!l!i 6i a<!toar%lor, !tili?ar%a m&n!6ilor st%ril%5
- Pr%9&tir%a 8i?ic& a 7aci%nt!l!i 6i administrar%a m%dicai%i 7r%7roc%d!ral% =s%dar%a, an%st%?i% local&>
- Al%9%r%a loc!l!i 7!nci%i An 8!nci% d% sco7!l !rm&ritH
- Asi9!rar%a 7o?ii%i cor%s7!n?&toar% sco7!l!i 6i loc!l!i 7!ncionatH
- !7ra@%9:%r%a 7aci%nt!l!i An tim7!l 7!nci%i 6i d!7& 7!nci%H
- E@ac!ar%a l%nt& a col%ciilor 7%ntr! 7r%@%nir%a :%mora9iilor 6i t!l;!r&rilor :%modinamic%5
- *%?in8%cia 6i 7ansar%a loc!l!i An%7&t!rii, a7licar%a a 4 -2 8ir% d% s!t!r& dac& %st% ca?!lH
- Notar%a 7!nci%i An F5O5 6i An dosar!l d% An9ri<ir%H
- Etic:%tar%a 6i %#7%di%r%a la la;orator a 7rod!s%lor5
- P!ncia 7l%!ral& =toracic&> L 7&tr!nd%r%a c! a<!tor!l !n!i ac 7rin s7ai!l int%rcostal 7Bn& An ca@itat%a 7l%!ral&
7%ntr! r%coltar%a sa! %liminar%a conin!t!l!i5 =Dn mod normal ca@itat%a 7l%!ral& %st% @irt!al&5>
4.0
- P!ncia 7%riton%al& =a;dominal&> - 7&tr!nd%r%a c! !n ac sa! trocar 7rin 7%r%t%l% a;dominal An 8osa iliac& sa!
7rin 8!nd!l d% sac *o!9las 7Bn& An ca@itat%a 7%riton%al& 7%ntr! d%t%rminar%a 7r%?%n%i 6i nat!rii lic:id!l!i sa!
%@ac!ar%a ac%st!ia5
- P!ncia 7%ricardic& - 7&tr!nd%r%a An ca@itat%a 7%ricardic& 7%ntr! %@ac!ar%a lic:id!l!i car% d%t%rmin&
com7r%si!n% as!7ra miocard!l!i5
- P!ncia artic!lar& - s% 8ac% An: ca@itat%a artic!lar& An artrit% ac!t% 6i cronic% c! col%cii s%roas%, s%ro8i;rinoas%
sa! 7!r!l%nt%, An :%martro?%5 % r%colt%a?& lic:id 7%ntr! %#am%n% d% la;orator, s% com;at% com7r%si!n%a local&,
s% in<%ct%a?& m%dicam%nt%, s% 8ac% artrosco7i%5
- P!ncia osoas& - 7&tr!nd%r%a c! !n ac s7%cial An %s!t!l s7on9ios al !n!i os lat sa! sc!rt 7%ntr! r%coltar%a
m&d!@%i An @%d%r%a %#am%n%lor microsco7ic% 7%ntr! dia9nosticar%a ;olilor d% sBn9%, t!morilor 6i 7%ntr!
trans7lant d% m&d!@&5
- P!ncia ra:idian& - 7&tr!nd%r%a 7Bn& An s7ai!l s!;ara:noidian 7%ntr! m&s!rar%a t%nsi!nii lic:id!l!i
c%8alora:idian, r%coltar%a lic:id!l!i c%8alora:idian 7%ntr! %#am%n% d% la;orator, administrar%a !nor m%dicam%nt%
sa! s!;stan% d% contrast, 7%ntr! r%ali?ar%a an%st%?i%i5
- P!ncia @%?icii !rinar% - r%7r%?int& o m%tod& d% strict& n%c%sitat% An sco7 %@ac!ator at!nci cBnd cat%t%rism!l n!
s% 7oat% %8%ct!a5
- Amnioc%nt%?a - 7!ncia ca@it&ii amniotic% %st% o m%tod& d% o;in%r% a lic:id!l!i amniotic 7rin tra@%rsar%a
7%r%t%l!i !t%rin 7% cal% a;dominal& sa! @a9inal& An @%d%r%a st!di%rii c!lorii 6i constit!%nilor An s!s7ici!n%a d%
sarcin& 7atolo9ic&5
- P!ncia col%ciilor - const& An introd!c%r%a !n!i ac Antr-o ca@itat% 7atolo9ic& c! sco7!l %@ac!&rii sa! r%colt&rii
conin!t!l!i 7%ntr! %#am%n% d% la;orator5
- P!ncia ;io7si%i - 7&tr!nd%r%a c! !n ac s7%cial Antr-!n or9an 7ar%nc:imatos sa! %s!t c! sco7!l 7r%l%@&rii !n!i
8ra9m%nt c% @a 8i %#aminat :isto7atolo9ic5 % %8%ct!%a?& 7!ncia: 8icat!l!i, s7lin%i, 7l%!r%i, 7rostat%i, 9an9lionilor
lim8atici, nod!lilor mamari 5
FIA N". =.6. PARTICIPAREA NURSEI LA EFECTUAREA PUNC2IEI PERITONEALE
9PARACENTE&A:
*EFINI2IE
- P!ncia ca@it&ii 7%riton%al% r%7r%?int& 7&tr!nd%r%a An ac%ast& ca@itat% c! a<!tor!l !n!i ac sa! trocar 7rin
tra@%rsar%a 7%r%t%l!i a;dominal5
IN*ICA2II
- E@ac!ar%a lic:id!l!i d% ascit&H
- 'a 7aci%nt!l 7olitra!mati?atH
- Dn a;dom%n!l ac!t c:ir!r9ical
- P%ntr! sta;ilir%a r%@&rsat!l!i a;dominalH
- P%ntr! diali?a 7%riton%al&
COP
- E#7lorator - 7%ntr! 7r%ci?ar%a dia9nostic!l!i
- T%ra7%!tic - 7%ntr! %@ac!ar%a lic:id!l!i 7%riton%al car% 7ro@oac& t!l;!r&ri r%s7iratorii 6i circ!latorii 7rin
7r%si!n%a %#%rcitat& as!7ra dia8ra9m!l!i
- Ta@& m%dical& 0 c&r!cior d% tratam%nt%H
- Ac% 9roas% sa! trocar% st%ril% d% --/ mm diam%tr!, 7r%@&?!t% c! mandr%nH
- %rin9i st%ril% d% 20 ml, %7r!;%t% st%ril%
- ol!i% antis%7tic& =;%tadin&>H
- Casol%t& c! com7r%s% st%ril%H cBm7!ri st%ril%H
- )as col%ctor d% C-40 4, 4-2 t&@i% r%nal%H
- Xilin& sa! no@ocain& 4PH
- "&n!6i st%ril%H
- C%ar6a8 Am7&t!rit An tr%i An l!n9im%5
a> PIEICF:
- % %#7lic& 7aci%nt!l!i im7ortana 6i n%c%sitat%a 7roc%d!rii, s% com!nic& d!rata =a7ro#5 -0 min>5
- % o;in% consim&mBnt!l in8ormatH
;> FIGICF:
4.4
- % %#7lic& 7aci%nt!l!i 7o?iia din tim7!l 7!nci%iH
- % m&soar& 6i s% not%a?& 8!nciil% @ital% 6i @%9%tati@%H
- % m&soar& circ!m8%rina tali%i 6i s% cBnt&r%6t% 7aci%nt!lH
- % r%comand& 7aci%nt!l!i s&-6i 9ol%asc& @%?ica !rinar& Anaint% d% 7!nci%5
- % a6%a?& 7aci%nt!l An d%c!;it dorsal la mar9in%a stBn9& a 7at!l!i, !6or Anclinat s7r% stBn9a, c! ca7!l 7% 7%rn&5
- % d%?in8%ct%a?& c! ;%tadin& ?ona car% !rm%a?& a 8i 7!ncionat& =la !nir%a 40- int%rn& c! 40- m%di% 7% linia
s7ino-om;ilical& stBn9a - "onro% Ric:t%r>5
- % 7r%9&t%6t% s%rin9a c! #ilin& 4P 6i s% AnmBn%a?& m%dic!l!i car% @a %8%ct!a an%st%?ia local&5
- % o8%r& m%dic!l!i ac!l sa! trocar!l c! car% 7!ncion%a?& 7%r%t%l% a;dominal circa --/ cm, 7%r7%ndic!lar5
- % r%tra9% mandr%n!l d% c&tr% m%dic 6i s% col%ct%a?& lic:id An %7r!;%t% st%ril% 7%ntr! %#am%n%l% d% la;orator5 %
ata6%a?& a7oi la trocar sa! ac !n t!; d% 7oli%til%n& car% asi9!r& sc!r9%r%a lic:id!l!i An @as!l col%ctor, dac&
7!ncia ar% rol %@ac!ator5
- % sc!r9% lic:id!l An <%t datorit& 7r%si!nii intraa;dominal% n%d%7&6ind /-. l la 7rima 7!nci%5
- % scoat% trocar!l sa! ac!l ra7id la t%rminar%a 7!nci%i5
- P% loc!l An%7&t!rii s% a7lic& ;anda< com7r%si@ din c%ar6a8!l Am7&t!rit An tr%i An l!n9im%, 7%ntr! a %@ita
d%com7r%si!n%a ;r!sc&5
- % m&soar& 6i s% not%a?& din no! 8!nciil% @ital% 6i @%9%tati@%5
- % m&soar& circ!m8%rina tali%i 6i s% cBnt&r%6t% 7aci%nt!l 7%ntr! a s% 7!t%a com7ara @aloril% c! c%l% iniial%5
- % monitori?%a?& loc!l 7!nci%i c! at%ni%5
- % %tic:%t%a?& 6i s% trimit im%diat 7ro;%l% la la;orator5
- % a6%a?& 7aci%nt!l An a6a 8%l AncBt loc!l 7!nci%i s& 8i% cBt mai s!s5
- % asi9!r& An salon o t%m7%rat!r& o7tim& d% 20-22 CK 6i lini6t% 7%ntr! 7aci%nt
- % m%nin% ;anda<!l com7r%si@ An <!r!l a;dom%n!l!i C-. or%5
- % s!7ra@%9:%a?& An 7%rman%n& 7aci%nt!l c%l 7!in 2/ d% or% d!7& 7!nci%, an!nBnd!-s% m%dic!l la oric%
s!s7ici!n%5
- % o8%r& la 7at 7aci%nt!l!i toat% mat%rial%l% d% car% ar% n%@oi%5
- % alim%nt%a?& 7aci%nt!l la 7at5
- % administr%a?& m%dicaia 7r%scris& 6i s% !rm&r%sc %8%ct%l% ac%st%ia5
- % col%ct%a?& mat%rial%l% 8olosit% An r%ci7i%nt% s7%cial% con8orm P5 U5
- % And%7&rt%a?& m&n!6il%5
- % s7al& 7% mBini c! a7& c!rat& 6i s&7!n5
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An dosar!l 0 7lan!l d% An9ri<ir%, Foaia d% O;sr@ai%5
- *ata, ora, cantitat%a, as7%ct!l lic:id!l!i
INCI*ENTE JI ACCI*ENTE
a> INCI*ENTE
- P!nci% al;& sa! n%9ati@& 7rin ast!7ar%a ac!l!i sa! a;s%na lic:id!l!i An ca@itat%5
- Dntr%r!7%r%a ;r!sc& a %@ac!&rii ca r%?!ltat al ad%r&rii !n%i ans% int%stinal%, %7i7loon!l!i, 8als% m%m;ran%5
;> ACCI*ENTE
- inco7a - s% 7rod!c% rar 7rin iritai% 7%riton%al& An mom%nt!l 7!ncion&rii sa! %@ac!&rii 7r%a ;r!6t% a lic:id!l!i5
- E%mora9i%:
O 7ari%tal& - 7rin l%?ar%a art%r%lor %7i9astric% in8%rioar%5
O intra7%riton%al&: 7rin l%?ar%a s7lin%i m&rit% la cirotici5
O di9%sti@&: 7rintr-o d%com7r%si!n% ;r!sc& la 7aci%nii c! 7ot%nial :%mora9ic =cirotici, d%n!trii, !lc%ro6i>5
- P!ncionar%a or9an%lor ca@itar% =ans% int%stinal%, @%?ic&>5
- Fist!l& 7ari%tal& - 7rin 7%rsist%na 7aral%lism!l!i 7lan!rilor la loc!l 7!nci%i - r%8ac%rii ra7id% 6i masi@% a
lic:id!l!i d% ascit&5 % %@it& 7rin masar%a loc!l!i 7!nci%i, a7licar%a d% 7ansam%nt st%ril 6i ;anda< a;dominal
com7r%si@5
4.2
FIA N". =.7. PARTICIPAREA NURSEI LA EFECTUAREA PUNC2IEI PLEURALE
TORACOCENTE&A
*EFINI2IE
- Prin toracoc%nt%?& s% An%l%9% 7&tr!nd%r%a An ca@itat%a 7l%!ral& c! a<!tor!l !n!i ac sa! cat%t%r 7rin 7%r%t%l%
toracic
COP
- E#7lorator =d% dia9nostic> : 7%ntr! sta;ilir%a, anali?ar%a 6i d%t%rminar%a ori9inii r%@&rsat!l!i 7l%!ral5
- T%ra7%!tic:
O %@ac!ar%a !n%i cantit&i d% lic:id 7l%!ralH
O la@a<!l ca@it&ii 7l%!ral% sa! introd!c%r%a !nor m%dicam%nt% 7%ntr! am%liorar%a d!r%rii, dis7n%%i 6i c%lorlalt%
sim7tom% asociat% 7r%si!nii cr%sc!t% intra7%riton%al%5
O %@ac!ar%a a%r!l!i 7%ntr! am%liorar%a dis7n%%i
IN*ICA2II
- Dn 7r%?%na r%@&rsat!l!i 7l%!ral d%c%lat clinic si radiolo9ic An:
O 7l%!r%?ii
O :%motora#
O 7n%!motora#
- Ta@& m%dical& 0 c&r!ciorH
- Tr!sa d% toracoc%nt%?& st%ril& car% conin%: com7r%s% st%ril%, cBm7!ri st%ril%H
- ol!i% antis%7tic& =;%tadin&>H
- "&n!6i st%ril%H
- Xilin& lP - 20mlH
- %rin9i st%ril% d% 20 mlH
- Ac% st%ril% l!n9i d% 40-42 cm 6i c! !n diam%tr! d% 4 mm, cat%t%rH
- - %7r!;%t% st%ril%H
- T!; d% 7oli%til%n&H
- (orcan% d% sticl& d% 4-2 lH
- 4-2 t&@i% r%nal%H
- "%dicam%nt% 7r%scris% d% m%dic5
a> PIEICF:
- % in8orm%a?& 7aci%nt!l c! 7ri@ir% la %8%ct!ar%a 7roc%d!rii: n%c%sitat%, im7ortan&, d!rat&H
- % o;in% consim&mBnt!l scris al 7aci%nt!l!i An c!no6tin& d% sit!ai%5
;> FIGICF:
-id%nti8icar%a 7aci%nt!l!i5
- - % a6%a?& 7aci%nt!l An 8!nci% d% star%a sa:
O P% sca!n, An 7o?ii% 6%?Bnd, Am;r&i6Bnd s7&tar!l ac%st!ia 7% car% s% a6%a?& o 7%rn&H
O 'a mar9in%a 7at!l!i c! torac%l% 8l%ctat ant%rior 6i coat%l% s7ri<init% 7% 9%n!nc:iH
O *%c!;it lat%ral c! :%mitorac%l% a8%ctat mai s!sH
O *%c!;it dorsal c! torac%l% ridicat la -0-/C 7%ntr! com;at%r%a dis7n%%iH
- % %8%ct!%a?& 7r%an%st%?ia la r%comandar%a m%dic!l!i c! 4 8 d% atro7in& Anaint% d% 7!nci% c! 4C--0 min
- % administr%a?& !n antit!si@ 7r%scris, dac& 7aci%nt!l %st% t!6itor
- % id%nti8ic& 7aci%nt!lH s% @%ri8ica 7r%scri7tia m%dicala
- s% @or asi9!rar%a conditiilor d% m%di!
- % m&soar& 8!nciil% @ital% 6i @%9%tati@%H
- % a6%a?& 7aci%nt!l Antr-!na din 7o?iiil% amintit%5 % d%?in8%ct%a?& loc!l 7!nci%i c! ;%tadin&H
- % 8i#%a?& cBm7!ri st%ril% d%as!7ra 6i d%d%s!;t!l loc!l!i 7!nci%iH
- % 7r%9&t%6t% s%rin9a c! #ilin& 4P, s% o8%r& m%dic!l!iH
- % o8%r& m%dic!l!i ac!l c! car% s% @a 8ac% 7!nciaH
- % introd!c% ac!l An:
O 7ai!l 2 int%rcostal 7% linia m%diocla@ic!lar& 7%ntr! %@ac!ar%a a%r!l!i
O 7ai!l ,-+ int%rcostal 7% linia a#ilar& 7ost%rioar& 7%ntr! c%l%lalt% sit!aii5
4.-
- % %#tra9% lic:id!l c! a<!tor!l !n%i s%rin9i, 6i al !n!i t!; d% 7oli%til%n& An 8orm& d% TH
- % d%con%ct%a?& s%rin9a d% c&tr% m%dic 6i s% ins%r& cat%t%r!l d% 7lastic r%tr&9Bnd!-s% !6or ac!lH
- % r%colt%a?& circa C0 ml 8l!id An - s%rin9i 7%ntr!: do?ar%a 7rot%in%lor, 9l!co?%i 6i sta;ilir%a c%l!l%lor %#ist%nt%H
- % ata6%a?& la cat%t%r !n t!; d% 7oli%til%n& 7%ntr! col%ctar%a r%st!l!i d% lic:id An @as!l d% sticl&H
- % s!7ra@%9:%a?& ca %@ac!ar%a lic:id!l!i s& s% 8ac& l%nt 8&r& a d%7&6i 4200 ml 7% 7!nci% 7%ntr! a %@ita E5P5A5
- % scoat% l%nt cat%t%r!l la s8Br6it!l 7roc%d!riiH
- % mas%a?& 6i s% 7ans%a?& st%ril loc!l 7!nci%iH
- % %tic:%t%a?& 6i s% trimit% la la;orator lic:id!l col%ctat 7%ntr! %#am%n citolo9ic 6i ;ioc:imicH
- % trans7ort& 7aci%nt!l la radiolo9i% 7%ntr! %8%ct!ar%a radio9ra8i%i d% control =7%ntr! %@id%ni%r%a !n!i %@%nt!al
7n%!motora# sa! !n%i incom7l%t% %@ac!&ri a lic:id!l!i 7l%!ral>5 % m&soar& 6i s% not%a?& 8!nciil% @ital% 6i
@%9%tati@%5
- % a6%a?& 7aci%nt!l com8orta;il An 7atH
- % monitori?%a?& An 7%rman%n& star%a 7aci%nt!l!i 7%ntr! a s!r7rind% o %@%nt!al&: :%mo7ti?i%, %m8i?%m
s!;c!tanat sa! o alt& com7licai%H
- % o8%r& 7aci%nt!l!i la 7at toat% mat%rial%l% d% car% ar% n%@oi%H
- % alim%nt%a?& 7aci%nt!l la 7at mai AntBi c! lic:id%: c%ai, com7ot,
- % administr%a?& m%dicam%nt% 7r%scris% con8orm r%comand&rilor m%dic!l!iH
- % instr!i%6t% 7aci%nt!l 7%ntr! a-6i r%l!a acti@itat%a la circa o or& d!7& %#aminar%a d% c&tr% m%dic5
- % col%ct%a?& mat%rial%l% 8olosit% con8orm P5 U5
- % And%7&rt%a?& m&n!6il%5
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 8i6a d% 7roc%d!ri 6i An dosar!l 0 7lan!l d% An9ri<ir% al 7aci%nt!l!iH
- *ata, ora, as7%ct!l lic:id!l!iH
- P!nci% al;& - n! s% o;in% lic:idH
- Dn%7ar%a coast%iH
- As7irar%a d% sBn9% 7rin l%?ar%a 7ac:%t!l!i @asc!lar int%rcostalH
- Ed%m!l 7!lmonar ac!t 7rin %@ac!ar%a ;r!sc& a col%ci%iH
- inco7& 6i 6oc 7l%!ralH
- Pn%!motora# - 7rin 7&tr!nd%r%a a%r!l!i An cantitat% a7r%cia;il& 7rin ac!l d% 7!nci%H
- In8%ci% %#o9%n& a ca@it&ii dr%nat% sa! a trai%ct!l!i d% 7!nci%: ac%asta im7!n% int%r@%ni% c:ir!r9ical& 7rin
d%s8iinar%a ra7id& a ca@it&ii s!7!rat% 6i anti;iot%ra7i% intit&5
FIA N". =.4. PARTICIPAREA NURSEI LA EFECTUAREA PUNC2IEI RA%IDIENE
*EFINI2IE
- P!ncia ra:idian& r%7r%?int& 7&tr!nd%r%a c! a<!tor!l !n!l ac s7%cial An s7ai!l s!;ara;noidian la ni@%l:
O lom;ar =7!ncia lom;ar&>H
O toracal =7!ncia toracal&>H
O s!;occi7ital =7!ncia s!;occi7ital&>5
COP
a> E#7lorator:
O m&s!rar%a 7r%si!nii lic:id!l!i c%8alora:idian ='5C5R5> 6i 7r%l%@ar%a !n%i cantit&i 7%ntr! %#am%n%: citolo9ic%,
;ioc:imic%, ;act%riolo9ic%H
O An tra!matism%l% cranio-c%r%;ral% 6i accid%nt%l% @asc!lar% c%r%;ral% 7%ntr! a7r%ci%r%a as7%ct!l!i '5C5R5 -
san9!inol%nt - s%mn d% :%mora9i%H 7%ntr! m&s!rar%a 7r%si!nii ac%st!iaH
O in<%ctar%a !nor s!;stan% d% contrast An mi%lo9ra8i%
;>T%ra7%!tic:
O administrar%a d% an%st%?ic%, anti;iotic% sa! a a9%nilor antimitotici =N>
O d%com7rimar%a An ca?!l An car% 7r%si!n%a '5C5R5 %st% cr%sc!t& =asociind c%8al%% 6i %d%m 7a7ilar>
IN*ICA2II
4./
- An m%nin9it%H
- tra!matism% cranio-c%r%;ral% 6i A)CH
- l!%sH
- ra:ian%st%?i%
- C&r!cior r!lant 7%ntr! mat%rial% sa! ta@& m%dical&H
- "&n!6i st%ril%, cBm7!ri st%ril%, com7r%s% st%ril%H
- Ac% st%ril% 7%ntr! 7!nci% l!n9i d% ,-40 cm, s!;iri c! ;i?o! sc!rt, 7r%@&?!t% c! mandr%n 6i !n%ori c!
Rintrod!c%rRH
- ol!ii d%?in8%ctant% =;%tadin& sa! alcool iodat>H
- %rin9i st%ril% d% 2-C mlH
- E7r!;%t% st%ril%H
- 4-2 t&@i% r%nal%H
- monom%tr! Cla!d% 7%ntr! m&s!rar%a 7r%si!nii '5C5R
- ol!ii d% in<%ctat cBnd %st% ca?!lH
a> PIEICF:
- % in8orm%a?& 7aci%nt!l c! 7ri@ir% la %8%ct!ar%a 7roc%d!rii: n%c%sitat%, im7ortan&, d!rat&H
- % o;in% consim&mBnt!l in8ormat scris al 7aci%nt!l!i5
;> FIGICF:
- % asi9!r& 7o?iia cor%s7!n?&toar% An con8ormitat% c! star%a sa, c! sco7!l 6i loc!l 7!nci%i:
O J%?Bnd c! ca7!l 8l%ctat, !m%rii a7l%cai, s7at%l% Andoit, coat%l% s7ri<init% 7% 9%n!nc:i, m%m;r%l% in8%rioar%
s7ri<init% 7% !n sc&!n%lH
O % at%nion%a?& 7aci%nt!l s& m%nin& 7o?iia %#act&, iar An tim7!l 7roc%d!rii s& n! s% mi6t%5
O Dn d%c!;it lat%ral: la mar9in%a m%s%i d% o7%rai% sa! a 7at!l!i, c! coa7s%l% 8l%ctat% 7% a;dom%n 6i 9am;%l%
8l%ctat% 7% coa7s%, ca7!l An 8l%#i% ma#im&, coloana @%tr%;ral& arc!it&, !m%rii An 7lan @%rticalH
O % asi9!r& intimitat%a 7aci%nt!l!i c! 7ara@an dac& 7roc%d!ra s% %#%c!t& la salon
- % id%nti8ic& 7aci%nt!lH
- % a6%a?& 7aci%nt!l Antr-!na din 7o?iiil% amintit% An 8!nci% d% star%a sa 6i r%comandar%a m%dic!l!iH
- % control%a?& ca t%m7%r%rat!ra cam%r%i s& 8i% d% 20KCH
- % d%?in8%ct%a?& loc!l 7!nci%i c! ;%tadin&H
- % o8%r& m%dic!l!i m&n!6i st%ril%H
- % o8%r& m%dic!l!i ac!l d% 7!nci% st%rilH
- % s!7ra@%9:%a?& 7aci%nt!l 7% tot tim7!l 7!nci%iH
- % o8%r& m%dic!l!i monom%tr!l Cla!d% 7%ntr! a m&s!ra 7r%si!n%a '5C5R5H
- % o8%r& m%dic!l!i 7% rBnd %7r!;%t%l% 7%ntr! r%coltar%a '5C5R5 An @%d%r%a di8%rit%lor %#am%n% d% la;oratorH
- % %tic:%t%a?& %7r!;%t%l% 6i s% trimit im%diat la la;orator,
- % o8%r& m%dic!l!i s%rin9il% c! sol!ii m%dicam%ntoas% dac& 7!ncia s% 8ac% An sco7 t%ra7%!ticH
- % %#tra9% ;r!sc ac!l 7!nci%i d% c&tr% m%dic la s8Br6it!l 7roc%d!riiH
- % mas%a?& loc!l 7!nci%iH
% a7lic& o com7r%s& st%ril& 7% loc!l 7!nci%i 6i s% 8i#%a?& c! rom7last
- % a6%a?& 7aci%nt!l 8oart% at%nt 7% c&r!cior An 7o?ii% ori?ontal& 6i la 8%l 6i An 7atH
- % m%nin% 7aci%nt!l 8&r& 7%rn& 6i n%mi6cat c%l 7!in . or% 7Bn& la 2/ or%H
- % alim%nt%a?& 7aci%nt!l la 7at n!mai d!7& . or%H
- % o8%r& 7aci%nt!l!i 7%rn& d!7& 2/ or%H
- % o;s%r@& c! at%ni% mi6c&ril% %#tr%mit&ilor,
- % %@al!%a?& ca7acitat%a d% mici!n% a 7aci%nt!l!iH
- % monitori?%a?& An 7%rman%n& 7aci%nt!l
- % col%ct%a?& mat%rial%l% 8olosit% An r%ci7i%nt% s7%cial% con8orm P5 U5
- % And%7&rt%a?& m&n!6il%5
4.C
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 8i6a d% 7roc%d!ri 6i An dosar!l 0 7lan!l d% An9ri<ir%5
- *ata, ora, cantitat%a, as7%ct!l lic:id!l!i %#tras, 7r%c!m 6i tratam%nt!l %8%ct!atH
- Oric% o;s%r@ai% l%9at& d% star%a 7aci%nt!l!iH
- Dn c% sco7 a 8ost %8%ct!at& 7!nciaH
- % s7%ci8ic& c% 7ro;% s-a! r%coltat 6i cBnd a! 8ost trimis% la la;orator5
- P!nci% al;& d%t%rminat& d% introd!c%r%a d%8%ct!oas& a ac!l!iH
- c!r9%r% 8oart% l%nt& a lic:id!l!i din ca!?a :i7ot%nsi!nii '5C5R5H
- Im7osi;ilitat%a 7!ncion&rii 8oart% 8r%c@%nt& la @Brsnici din ca!?a osi8ic&rii li9am%ntar% 6i la o;%?i =canal!l
ra:idian sit!at 7ro8!nd>H
- P!nci% tra!matic& =7rin ac s% %#t%riori?%a?& sBn9% ca r%?!ltat al %8raci%i !n!i @as m%nin9%al>H - *!r%r% la
ni@%l!l !n!i m%m;r! 7%l@ian 7rin 7!ncionar%a !n%i r&d&cini n%r@oas%H
- 'i7otimi% mai al%s la 7aci%ni car% n! a! 8ost s%dai ant%rior 6i la car% 7!ncia s% r%ali?%a?& An 6%?BndH
- C%8al%% 6i ra:ial9i%, o com7licai% 8r%c@%nt AntBlnit& car% 7ar% a 8i d%t%rminat& d% sc&d%r%a 7r%si!nii '5C5R5H
- inco7a 6i accid%nt%l% mortal% car% a7ar 8oart% rar la 7aci%nii c! tra!matism% c%r%;ral%, 8ract!r& d% ;a?& d%
crani!, %tc5
FIA N". =.8. PARTICIPAREA NURSEI LA EFECTUAREA PUNC2IEI BIOPSICE
*EFINI2IE
- P!ncia ;io7sic& r%7r%?int& introd!c%r%a !n!i ac s7%cial Antr-!n or9an 7ar%nc:imatos sa! %s!t An @%d%r%a
r%colt&rii d% c%l!l% sa! a !n!i 8ra9m%nt tis!lar 7%ntr! %8%ct!ar%a %#am%n!l!i :isto7atoio9ic
COP
- E#7lorator: d% %#aminar% :isto7atolo9ic& 6i ;act%riolo9ic& a 8ra9m%nt!l!i d% %s!t %#tras, 7%ntr! sta;ilir%a
dia9nostic!l!i5
IN*ICA2II
- P!ncia :%7atic&:
O :%7atom%9ali% d% %tiolo9i% n%c!nosc!t&H
O %n?im% :%7atic% 7%rsist%nt cr%sc!t%H
O :%7ato7atii di8!?%:
O :%7atit% ac!t% =7%ntr! dia9nostic %tiolo9ic>H
O :%7atit% cronic% =dia9nostic 7o?iti@ 6i %@ol!ti@>H
O ciro?% :%7atic% =dia9nostic 7o?iti@, %tiolo9ic 6i d% 8orm& acti@& sa! n!>H
O ict%r% d% %tiolo9i% n%7r%ci?at&H
O a7r%ci%r%a r%?!ltat%lor t%ra7%!tic% An :%7atit%l% cronic% 6i a %@ol!i%i 7ost-trans7lant :%7aticH
- P!ncia r%nal&: An di8%rit% ti7!ri d% 9lom%r!lon%8rit% 6i n%8ro7atiiH
- P!ncia 7ancr%atic&:
O n%o7lasm% 7ancr%atic% a7r%ciat% ca n%r%?%ca;il% la %#aminar%a C5T5 =com7!t%r tomo9ra8>H
O s!s7ici!n% d% lim8om 7ancr%aticH
- P!ncia !n!i nod!l mamar: 7%ntr! dia9nosticar%a 8ormai!nilor t!moral% 6i as7irar%a c%l!l%lor t!moral%5
- P!ncia 9an9lionilor lim8atici:
O sta;ilir%a dia9nostic!l!i d% c%rtit!din% An ca?!l ad%no7atiilor d% ca!?& n%c!nosc!t&H
O di@%rs% :%mo7atii5
- C&r!cior d% tratam%nt% 0 ta@& m%dical& aco7%rit% c! cBm7 st%rilH
- Tr!sa 7%ntr! 7!nci% st%ril& car% conin% ac%:
O "%n9:ini c! diam%ntr!l d% 0,,L 4,, mmH
O WlotsXin, Iams:idi - 7%ntr! o;in%r%a d% 8ra9m%nt% tis!lar% mai mariH
O )im-il@%rman-FranXlin - car% 8olos%sc ca mandr%n, sist%m!l d% r%coltar% 8ormat din do!& @al@% s!;iri c!
@Br8!ri t&ioas%H
O sist%m a!tomat d% ;io7si% ti7 7istol c! ac Tr!c!tH
O ac!l Tra@%nol 7%ntr! 7!ncia 7rostat%i sa! 7!ncia r%nal&H
- Com7r%s% st%ril%, cBm7!ri st%ril%H
4..
- ol!i% antis%7tic& - ;%tadin&, Xilin& 4P - 20 mlH
- "&n!6i st%ril% 6i rom7lastH
- %rin9i st%ril% d% 20 ml sa! d% alt% ca7acit&iH
- E7r!;%t% 6i r%ci7i%nt% st%ril%H
- ol!ii 8i#atoar%, lam% d% sticl&H
- 4-2 t&@i% r%nal%H
- "%dicam%nt% 7r%scris% d% m%dic5
a> PIEICF:
- % in8orm%a?& 7aci%nt!l c! 7ri@ir% Ia %8%ct!ar%a 7roc%d!rii: n%c%sitat%, im7ortan&, d!rat&H
- % o;in% consim&mBnt!l in8ormat scris al 7aci%nt!l!i
;> FIGICF:
- % control%a?& tim7!l d% sBn9%rar% 6i d% coa9!lar%, tim7!l d% 7rotrom;in&, n!m&r!l d% trom;ocit%H
- % administr%a?& m%dicai%: coa9!lant&, tonicoca7ilar& sa! s%dati@& 7r%scris& d% m%dic c! 4-2 ?il% Anaint%5
- % a6%a?& 7aci%nt!l An 7o?ii% cor%s7!n?&toar% An 8!nci% d% or9an!l 7!ncionat ast8%l:
O 7%ntr! 7!ncia :%7atic&: d%c!;it dorsal sa! lat%ral stBn9 c! mBna dr%a7t& s!; ca7H
O 7%ntr! 7!ncia r%nal&: d%c!;it @%ntral c! !n s&c!l% d% nisi7 sa! s!l d% mat%rial t%#til s!; a;dom%nH
O 7%ntr! 7!ncia 7rostatic&: 7o?ii% 9in%colo9ic&H
O 7%ntr! 7!ncia s7l%nic&: d%c!;it dorsal sa! lat%ral dr%7tH
O 7%ntr! 7!ncia 9an9lionar& sa! a t!morilor m%dic!l sta;il%6t% loc!l 6i 7aci%nt!l %st% a6%?at An 8!nci% d% ?ona
car% !rm%a?& s& 8i% 7!ncionat&5
- % id%nti8ic& 7aci%nt!lH
- % a6%a?& 7aci%nt!l An 7o?iia cor%s7!n?&toar% An 8!nci% d% or9an!l 7!ncionatH
- % asi9!r& t%m7%rat!ra cam%r%i An <!r d% 20KCH
- Asist%nta s!7ra@%9:%a?& c! at%ni% 7aci%nt!l 7% tot tim7!l 7roc%d!rii, s!sin% ;olna@!l An 7o?iia ad%c@at5
- "%dic!l 6i a<!tor!l s% s7al& 7% mBini c! a7& c!rat& 6i s&7!n, a7oi Am;rac& m&n!6i st%ril%5
- % d%?in8%ct%a?& loc!l 7!nci%i c! ;%tadin&H
- % 7r%9&t%6t% s%rin9a c! #ilin& 6i s% o8%r& m%dic!l!i 7%ntr! a %8%ct!a an%st%?ia5 \
- % %8%ct!%a?& 7!ncia d% c&tr% m%dic 6i s% 7&str%a?& mandr%n!l ac!l!i st%rilH
- % o8%r& m%dic!l!i o s%rin9& d% 20 ml c! car% ac%sta 8ac% 4-2 as7iraii %n%r9ic%H
- % %#tra9% ac!l ;r!sc la s8Br6it!l 7roc%d!rii d% c&tr% m%dicH 5
- % d%?in8%ct%a?& din no! loc!l 7!nci%i c! ;%tadin&5
- % a7lic& o com7r%s& st%ril&, car% s% 8i#%a?& c! rom7lastH
- % And%7&rt%a?& m&n!6il%H
- % s7al& 7% mBini c! a7& c!r%nt& 6i s&7!n5
- % a<!t& 7aci%nt!l s& co;oar% d% 7% masa d% %#aminar% 6i s& s% Am;rac%H
- % trans7ort& 7aci%nt!l la salonH
- % a6%a?& 7aci%nt!l An:
O *%c!;it lat%ral dr%7t =d!7& 7!ncia :%7atic&> 4 -2 or% 7%ntr! a r%d!c% risc!l !n%i :%mora9iiH
O *%c!;it dorsal =d!7& 7!ncia s7l%nic& sa! 7ancr%atic&>H
O *%c!;it dorsal =d!7& 7!ncia r%nal&> controlBnd!-s% !rina 2-- ?il% 7%ntr! d%7istar%a !n%i %@%nt!al% :%mora9iiH
- % a7lic& o com7r%s& r%c% sa! 7!n9& c! 9:%a& 7% r%9i!n%a 7!ncionat&H
- P%ntr! 7r%@%nir%a !n%i %@%nt!al% :%mora9ii 7rin a7ariia t!s%i car% irit& 7l%!ra:
O s% a7lic& o com7r%s& r%c%
O s% administr%a?& m%dicaia 7r%scris& d% m%dic
- % monitori?%a?& An 7%rman%n& star%a 7aci%nt!l!i 6i 8!nciil% @ital% 6i @%9%tati@%5
PRE$FTIREA "ATERIA'U'UI O(2INUT PRIN PUNC2IA (IOPICF
- % And%7&rt%a?& 8ra9m%nt%l% d% %s!t din ac!l d% 7!nci% 7rin ins!8lar% d% a%rH
- % %8%ct!%a?& am7r%nt% 7% lam% d% sticl& c! 8ra9m%nt%l% d% %s!t o;in!t%H
- % introd!c 8ra9m%nt%l% d% %s!t r%coltat Antr-!n r%ci7i%nt c! sol!i% 8i#atoar% sa! s%r 8i?iolo9icH - % trans7ort&
7ro;%l% im%diat la la;orator!l d% :isto7alolo9i%, Ansoit% d% ;!l%tin!l c! dat%l% 7aci%nt!l!i5
4.7
- % strBn9 mat%rial%l% 8olosit%H
- % col%ct%a?& d%6%!ril% con8orm P5U5 An r%ci7i%nt% s7%cial% s%7arat%5
NOTAREA PROCE*URII
Notai:
- Proc%d!ra An 8i6a 7aci%nt!l!i 6i An dosar!l 0 7lan!l d% An9ri<ir%H
- *ata, ora, or9an!l 7!ncionatH
- Oric% o;s%r@ai% l%9at& d% star%a 6i r%acia 7aci%nt!l!iH r%comand&ril% 7ri@ind An9ri<iril%
- co7!l 7!n%i%i, s7%ci8icBnd!-s% 6i c% 7ro;% a! 8ost r%coltat% 6i cBnd a! 8ost trimis% la la;orator5
- E%mora9i%:
O 7!lmonar&H
O 7rin 7!ncionar%a: 8icat!l!i, int%stin!l!i, aort%i, @%n%i ca@% in8%rioar%H
- E%matom intra:%7aticH
- P%ritonit& c:imic& 7rin 7r%?%na ;il%i An ca@itat%a a;dominal&H
- R!7t!r& :%7atic&H
- T!s% instantan%%H
- Pn%!motora#H
- E%motora#H
- Joc n%!ro-@%9%tati@, :i7o@ol%mi% %tcH
- (act%r%mi%, s%7tic%mi% =%nt%rococ>H
- R%acii al%r9ic% la an%st%?i%H
- R%t%ni% !rinar&5
(i;lio9ra8i%
45 *r5 Ramona (&nic&, *r5 "ari!s amoil&, *r5 "ari!s N%9r!
ANA'IGE *E 'A(ORATOR J' A'TE *'A$NOT'CE, Edit!ra "%dicart 20075
25 "arion (5 *olan 6i cola;oratorii
NURIN$ PROCE*URE - st!d%nt @%rsion, Edit!ra 7rin9lio!s% Cor7oration, P%nnsZl@ania - 4++25
-5 Franc%s Fisc:;ac:
A "ANUA' 'A(ORATORd k *IA$NOTIC TET, Edit!ra I5 (5 'i77incortt Com7anZ -4++25
/5 (ar;ara Wo?i%r, $l%nora Er;
TEIINI]UIi IN CU NIC A' N UR INC, Edit!rii Addi#on _%st%Z Pti;lisliin9 Com7anZ L 4+,75
C5 Carol "o?cs
TEENICA DN$RIIIRII (O'NA)U'UI, Edit!ra "%dical& - 200.
.5 anda mit:, *on na *!%ll
FOUN*ATION W''' FOR NURIN$ AN* A'UE* EEA'TE PROFE'ON, Edit!ra National N!rsin9
R%@i%^, Cali8ornia -4+,25
75 (ar;ara W5 Tim;Z
CUN4CA' NUR'N$ PROCE*URE, Edit!ra I5 (5 'i77incortt Com7anZ - P:ilad%l7:ia - '+,+5
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