INGRIJIREA PACIENTILOR CU AFECTIUNI/ DEFICIENTE PSIHIATRICE

Psihiatria (din limba greac! psych ("#$%& ' ()iri*+ (,-le* i iatros (./0123& ' medic& e(*e 4
ram,r a medicinei care (e 4c,) c, )re5enirea+ diagn4(*icarea+ *ra*amen*,l i reabili*area
)er(4anel4r c, b4li min*ale6 N4 i,nea Psihiatrie a -4(* in*r4d,( 7n *ermin4l4gia medical 7n
89:9 de medic,l german J4;ann C;ri(*ian Reil din Halle (ini ial Psychiaterie+ de5eni* mai
*<r=i, Psychiatrie&6
Dezvoltarea psihiatriei n Romnia
N, e>i(* in-4rma ii (,-icien*e a(,)ra de=54l*rii )(i;ia*riei 7n rile r4m<ne 6 Primele
a e=min*e ()i*alice *i ( "bolni e" & a, a)r,* )e l<ng bi(erici (a, mn(*iri+ ,nde ,ne4ri (e
g(ea 4 ic4an ?-c*4are de min,ni?+ ca la bi(erica ?S-6 S)irid4n? din Ia i 6 @n ace(*e b4lni e
n, (e ),*ea 54rbi de 4 7ngrAire medical )r4)ri, =i(+ )re4 ii (a, cl,grii -4l4(ea, leac,ri
*radi i4nale (?bbe *i?& -c,*e din )lan*e+ (,b -4rm de -ier*,ri i ,n(4ri+ al*,ri de r,gci,ni+
(l,Abe i arderea ,n4r e(en e mir4(i*4are6 @n )rima A,m*a*e a (ec4l,l,i al BCIIIDlea+ la
En(*irea Neam (e 7n-iin ea= 4 ?b4lni ? )en*r, b*r<ni6 Pr4babil d,) incendi,l din 89F8+
4 da* c, c4n(*r,irea ,nei n4i cldiri 7n 89FG+ (e amenaAea= aici ,n 4()ici, )en*r, b4lna5i
"lipsi i de minte i chinui i de duhuri rele" 6
@n H,c,re *i+ )e l<ng bi(erica ?Erc, a?+ c*i*4rie 5ec;e din 8I9J+ (e 7n-iin ea= 7n 898G ,n
la=are* )en*r, b4lna5i de ci,m+ care ),*ea ad)4(*i G:DF: de b4lna5i6 @n 89KL de5ine (edi,l
,n,i 4()ici, )en*r, aliena i min*al+ care -,nc i4nea= )<n 7n 8LKF6 P4e*,l Ei;ai Emine(c, a
-4(* 7ngriAi* din n4iembrie 899J la En(*irea Neam + iar )e da*a de G -ebr,arie 899L m4are 7n
4()ici,l d4c*4r,l,i S, , din H,c,re *i6
@n an,l 89G9 Eforia Spitalelor Civile 7n-iin ea= ,n 4()ici, )en*r, b4lna5i
)(i;ic la Sc;i*,l Ealam,ci de l<ng c4m,na Ealam,c+ A,de ,l Pra;45a+
la ca6 F: Mm n4rd de H,c,re *i6 @nce)<nd c, an,l 89FI+ b4lna5ii a, -4(*
*ran(-era i la Erc, a6 A e=m<n*,l era n,mi* i ?Halam,ci?+ de ,nde
c,5<n*,l "balamuc"+ de5eni* (in4nim c, "cas de nebuni"6 A*<* la
Erc, a+ c<* i la Ealam,ci+ b4lna5ii era, 5i=i*a i la in*er5ale di-eri*e de
medici+ 7n(+ 7n a-ar de 7ngriAire+ n, (e ),*ea 54rbi de ,n *ra*amen*
medical6 nv mntul psihiatric universitar n Bucure ti
@n5 m<n*,l de )(i;ia*rie 7nce)e 7n 89JN c, ,n c,r( liber ini ia* de Dr6 Ale>andr, S, , la
? c4ala Na i4nal de Eedicin i Farmacie?6 @n 89LG (e 7n-iin ea= la Fac,l*a*ea de Eedicin
din H,c,re *i 4 ca*edr de ?Eedicin Legal i P(i;ia*rie? (c4nd,( de Ale>andr, , ,&+ care
7n 89LN (e (cindea= 7n*rD4 ca*edr inde)enden* de "Psihiatrie i Clinica Bolilor Mintale" +
c4nd,( de Al6 , ,+ i ,na de Eedicin Legal 4c,)a* de Pr4-6 Eina Ein45ici6 Ale>andr,
, , 5a c4nd,ce ca*edra )<n la )en(i4nare 7n 8L8:+ c<nd e(*e )rel,a* de c*re ele5,l (,+
Ale>andr, Obregia6 Ace(*a+ 7n 8LKG+ 5a m,*a clinica 7n n4,l ?S)i*al Cen*ral de H4li Ner54a(e
i Ein*ale?+ care a(*=i 7i )4ar* n,mele6
Ale>andr, Obregia+ remarcabil )r4-e(4r i e- de c4al+ (e re*rage 7n 8LKF+ ca*edra -iind
)rel,a* de ele5,l (,+ Pe*re T4me(c,6 @nl*,ra* din 7n5 m<n*+ 7m)re,n c, c4n-eren iar,l
(, Seba(*ian C4n(*an*ine(c,+ i 7n*emni a* 7n 8LFI (-,(e(e Eini(*r, al Sn* ii i Ocr4*iril4r
S4ciale 7n *im),l r=b4i,l,i 7n g,5ern,l An*4ne(c,&+ l4c,l (, e(*e 4c,)a* )rin *ran(-er de la
Cl,A de C6 Urec;ia 7n )eri4ada 8LFID8LF9 i de C6 I6 Par;4n 7n )eri4ada 8LF9D8LI86
@n c4n*in,are ca*edra e(*e c4nd,( (,cce(i5 de C4n(*an a Par;4nD *e-ne(c, (8LIKD8LNG&+
Ca(ile Prede(c,+ -4rma* 7n Uni,nea S45ie*ic (8LNGD8LLJ&+ Ge4rge I4ne(c, (8LLNDK::K&6 @n*re
8LLJ i K::8 a, -,nc i4na* la Uni5er(i*a*ea de Eedicin i Farmacie ?Car4l Da5ila? d4,
ca*edre de )(i;ia*rie+ ,na c4nd,( de Ge4rge I4ne(c,+ cealal* de A,rel R4mil6 @n )re=en* la
c4nd,cerea ca*edrei (e a-l )r4-6 ,ni56 dr6 Dan Preli)cean,6
EDUCATIA SANITARA PENTRU PRECENIREA HOLILOR PSIHICE
O D igiena (arcinii
O Da(ig,rarea ,n,i clima* -amilial cald+ a-ec*4( +ec;ilibra*
O Dab4rdarea ad4le(cen*,l,i c, in*elegere (i (-a*,ri c4m)e*en*e in *im) ,*il
O Da(ig,rarea ,nei a*m4(-ere de in*elegere (i re()ec* in -amilie (i la l4c,l de m,nca
O De5i*area c4n-lic*el4r rela*i4nale+ a (*aril4r c4n-lic*,ale
O Din-4rmarea *ineril4r ca(a*4ri*i a(,)ra cerin*el4r 5ie*ii de -amilie )en*r, a e5i*a *ra,me
)(i;ice ,l*eri4are
O D4rien*are )r4-e(i4nala c4n-4rm a)*i*,dinil4r (i d4rin*ei indi5iDd,l,i+ )en*r, a e5i*a
*ra,mele lega*e de (c;imbarea l4c,l,i de m,nca (a, recali-icare
O D)rega*irea )en*r, (c;imbari -i=i4l4gice (a, e5enimen*e din 5ia*a()en(i4nare+
men4)a,=a&
O De5i*area (,rmenaA,l,i )(i;ic
O Dregim de 5ia*a ec;ilibra*! al*ernarea )eri4adel4r de ac*i5i*a*e c, )eri4adele de re)a,(
O De5i*area c4n(,m,l,i de alc44l+ dr4g,ri+ ca-ea in e>ce( e*c6
O D*ra*area )rec4ce a a-ec*i,nil4r 4rganice(end4crine+ me*ab4lice+ renale+ cardiace+
ne,r4l4gice
ECALUAREA FUNCTIILOR PSIHICE
O 1. ivel !e constienta"
D ,n )acien* c4n(*ien* ra(),nde )r4m)* la in*rebari (i )erce)e ceea ce (e in*am)la in A,r,l l,i
D )e ma(,ra ce c4n(*ien*a l,i (e dimin,ea=a e(*e mai ),*in ca)abil (a (e )4a*a c4ncen*ra (i (a
-ie mai ),*in c44)eran*
D )en*r, e5al,area ni5el,l,i de c4n(*ien*a (e )4a*e ,*ili=a (cara Gla(g4P
Definitie D Scala Gla(g4P (GCS+ Gla(g4P C4ma Scale& (a, (c4r,l Gla(g4P+ e(*e ,n
in(*r,men* de(emna* )en*r, m4ni*4ri=area ni5el,l,i de c4n(*ienQa (i )en*r, a)recierea
)r4n4(*ic,l,i d,)a ,n *ra,ma*i(m crani4cerebral6 Elab4ra*a 7n 8LNF de ca*re ne,r4c;ir,rgii
irlande=i Gra;am Tea(dale (i HrRan J6 Jenne**+ acea(*a a de5eni* re)ede cea mai ,*ili=a*a (cala
de a)reciere a (*arii de c4n(*ien*a6 La m4men*+ )e l<nga a)licarea 7n medicina de ,rgen*a+
(cala Gla(g4P (e mai ,*ili=ea=a (i 7n (er5iciile de (*a*i4nar+ 7n ()ecial )en*r, m4ni*4ri=area
)acien*il4r cr4nici 7n (ec*iile de *era)ie in*en(i5a6
Calculul scorului #las$o%
Scala Gla(g4P c,)rinde *rei c4m)ar*imen*e! m4*4r+ 5erbal (i 4c,lar6 Pen*r, -iecare din ace(*e
ra(),n(,ri (e a*rib,ie ,n an,mi* n,mar de ),nc*e6 S,ma ),nc*el4r )en*r, -iecare din cele *rei
ra(),n(,ri alca*,ie(*e (c4r,l Gla(g4P6 Cal4area minima a (c4r,l,i Gla(g4P e(*e de G ),nc*e
(i e(*e a*rib,i*a )acien*il4r 7n c4ma )r4-,nda6 Per(4anele (ana*4a(e ac,m,lea=a (c4r,l ma>im
de 8I ),nc*e6
Raspunsul ocular &!eschi!erea ochilor' &('
N, de(c;ide 4c;ii ' 8 ),nc*
De(c;ide 4c;ii 7n ra(),n( la d,rere ' K ),nc*e6 (d,rerea e(*e )r454ca*a )rin a)a(area )e l4Aa
,ng;iei+ )e arcada 4rbi*ar (a, )e ram,ra a(cedenden* a mandib,lei&
De(c;ide 4c;ii la 54rbire (c4manda 5erbala& ' G ),nc*e6
De(c;ide 4c;ii ()4n*an
Raspunsul ver)al &*'
N, ra(),nde 5erbal ' 8 ),nc*6
S,ne*e inc4m)re;en(ibile (geme*e& ' K ),nc*e6
C,5in*e ne)4*ri5i*e (e>clama*ii (a, c,5in*e nec4rela*e 7n*re ele& ' G ),nc*e6
Ra(),n( c4n-,= ' F ),nc*e6 (ra(),nde la 7n*rebari c4eren* 7n(a c, 4 an,mi*a 7n*<r=iere (i
de=4rien*are&
Ra(),n( 5erbal 4rien*a* ' I ),nc*e6
Raspunsul motor &+'
Li)(a ra(),n(,l,i m4*4r (areac*i5& ' 8 ),nc*6
Ra(),n( e>*en(4r la d,rere (reac*ie de decerebrare& ' K ),nc*e6 (abd,c*ia bra*,l,i+ r4*a*ia
in*erna a ,mar,l,i+ )r4na*ia an*ebra*,l,i+ e>*en(ia 7n ar*ic,la*ia radi4car)ian&6
Ra(),n(,l -le>4r la d,rere (reac*ie de dec4r*icare& ' G ),nc*e6 (add,cQia bra*,l,i+ r4*a*ia
in*erna a ,mar,l,i+ )r4na*ia an*ebra*,l,i+ -le>ia 7n ar*ic,la*ia radi4car)ian
Fle>ia nec44rd4na*a/re*ragerea membr,l,i la d,rere ' F ),nc*e6 (la a)licarea )re(i,nii
(,)ra4rbi*are D -le>ia c4*,l,i+ (,)inarea an*ebra*,l,i+ -le>ia 7n ar*ic,la*ia radi4car)ian6 La
)re(i,ne )e l4Aa ,ng;ial (e mai a(4cia=a (i re*ragerea membr,l,i&
L4cali=ea=a d,rerea ' I ),nc*e6 (Ei(cari 7ndre)*a*e ()re (edi,l (*im,l,l,i d4l4r&
@nde)line(*e in(*r,c*i,nile ' J ),nc*e6
,nterpretarea rezultatelor
In*er)re*area re=,l*a*el4r (e -ace a*<* )en*r, -iecare ra(),n( 7n )ar*e c<* (i )en*r, (c4r,l gl4bal6
De(crierea n,merica a re=,l*a*,l,i ara*a a(a! GCS L ' OK CF EG6
Fiind ,*ili=a* )en*r, e5al,area )r4n4(*ic a *ra,ma*i(mel4r crani4cerebrale (TCC&+ (cala
Gla(g4P le di5ide 7n *rei ca*eg4rii!
DTCC (e5er+ (c4r Gla(g4P ' 9 ),nc*e
DTCC m4dera*+ (c4r Gla(g4P LD8K ),nc*e
DTCC ,(4r+ (c4r Gla(g4P '8G
Sc4r,l Gla(g4P e(*e ,*il 7n e5al,area c4mel4r+ c4rela*iile 7n ace(* ca= -iind!
GCS ' 9 'S c4ma grd6I
GCS ' NDJ 'S c4ma grd6II
GCS ' IDF 'S c4ma grd6III
GCS ' G 'S c4ma grd6IC (de)a(i*a&
@n (i*,a*ia 7n care )acien*,l e(*e in*,ba* (a, e(*e )re=en* edem,l )al)ebral+ a)recierea
ra(),n(,l,i 5erbal (i re()ec*i5 4c,lar e(*e im)4(ibila6 @n ace(* ca= )en*r, ace(*e ra(),n(,ri (e
a*rib,ie ),nc*aA 8 (i ,n indici, a*a(a*! O 8i (i C 8*+ ,nde ?i? e(*e ?7nc;i(? (i ?*? e(*e ?*,b
end4*ra;eal6
-. Comportament si infatisare"
D (e 54r 4b(er5a a*i*,dinile (i reac*iile )acien*,l,i in *im),l e>amen,l,i -i=ic
D a()ec*,l (a, re-lec*a m4d,l in care (e )erce)e((e 5a 4b(er5a daca 5e(min*ele (,n* )4*ri5i*e
l4c,l,i (i (e=4n,l,i&
.. *or)ire/ lim)a0
D (e 5a cere )acien*,l,i (a n,me(ca 4biec*ele care ii (,n* ara*a*e (i (a ci*ea(ca c, 54ce *are
-ra=e (im)le
1. Capacitatea !e a intele$e si a rezolva pro)leme"
D )rin *e(*e
D )rin c4n54rbiri
2. (rientare"
D (a redea c4rec* l4c,l ,nde (e a-la+ de cand+ da*a )re=en*a
3. ,nvatare"
D e>6 Sa dem4n(*re=e m4d,l de e-ec*,are a igienei ca5i*a*ii b,cale
4. +emorie&ime!iata/ recenta/ trecuta'"
D (e 5a cere )acien*,l,i (a re)e*e 4 (erie de n,mere+ cre(cand )r4gre(i5 n,mar,l ci-rel4r
D (e 5a cere (aD(i amin*ea(ca e5enimen*ele )e*rec,*e in =i,a re()ec*i5a
D (e 5a cere )acien*,l,i (a n,mea(ca an*eceden*e medicale (a, -amilialeT (aD(i (),na da*a
na(*erii
5. #an!ire"
D (e 5a cere (a in*er)re*e=e+ (a e>)lice -ra=e (im)le
6. 7u!ecata"
D 5a -i ),( (a e>)lice ce 5a -ace in an,mi*e (i*,a*ii
e>6 Ce 5a -ace daca (e 5a imb4lna5ii (i ar -i (ing,r aca(a
18. 9unctia senzorialasi !e perceptie"
D (e 54r 4-eri di5er(i (*im,li l,min4(i+ a,di*i5i+ 4l-ac*i5i+ *ac*ili (i (e 5a 4b(er5a m4d,l de
reac*ie a )acien*,l,i
11. :fectivitate"
D)rin 4b(er5area )acien*,l,i U *ri(*+ an>i4(+ agre(i5
RECUNOASTEREA EODIFICARILOR CLINICE IN AFECTIUNILE PSIHIATRICE
S,DR(:+E
a& a(*enic! 4b4(eala+ (caderea a*en*iei 54l,n*are+ ;i)4mne=ie+ iri*abili*a*e+ ce-alee+
(,)er-iciali=area (4mn,l,i+ in*4leran*a la =g4m4*+ (*im,li l,min4(i+ (4mn ne4di;ni*4r
b& 4b(e(i54D-4bic! 4b(e(ii+ -4bii
c&i(*eric! cri=e e>ci*4Dm4*4rii+ )arali=ii+ *,lb,rari de -4na*ie+ ane(*e=ie+ *,lb,rari ne,r4D
5ege*a*i5e mani-e(*a*e in m4d *ea*ral+ dem4n(*ra*i5+ (*ari cre),(c,lare
d& de agi*a*ie )(i;4Dm4*4are! (,re(ci*area -,nc*iil4r )(i;ice+ agi*a*iei+ 5i5aci*a*ea cre(c,*a+
nerebdare 5i=ibila+ *4n mai ridica* al 54cii+ -ara )ierderea c4n*r4l,l,i gandirii (i ac*el4r+ c;iar
(,re(ci*are idea*i5a+ e>acerbarea mem4riei+ imagina*iei+ge(*,ri m,l*i)le+ )ara=i*an*e
D in (*adiile a5an(a*e! inc44rd4nare m4*4rie (e5era
e& (*ari reac*i5e de 4rigine a-ec*i5a! e>arcerbarea a-ec*i5a de*ermiDna*a de manie+ ,ra+ gel4=ie+
)al4are (a, c4nge(*ie a -e*ei+ *rem,ra*,ri+ *ran()ira*ii+ 5aria*ii ale ),l(,l,i(-rec5en* *a;icardie&+
ale *en(i,nii(-rec5en* HTA&
D ,ne4ri len*4are+ di()erare+ gr4a=a+ )anica )ana la ++(en=a*ia ca am rama( im)ie*ri*VV
-& maniacal! e,-4rie+ accelerarea idea*iei+ in;ibi*ia ac*i5i*a*ii
g& de)re(i5! di()4=i*ie de)re(i5a+ ince*inirea idea*iei+ in;ibi*ia ac*i5i*a*ii
;& ca*a*4nic! aMine=ie((*,)4are& ca*a*4nica (a, agi*a*ie ca*a*4nica+ nega*i5i(m+ (*ere4*i)ii+
imi*a*ie )a*4l4gica
i& C;arle( H4nne*! ;al,cina*ii 5i=,ale la )er(4ane in 5ar(*a+ -ara de-icien*e min*ale
A& )aran4ic! delir (i(*ema*i=a* de gel4=ie+ )er(ec,*ie
M& )ara-renic! delir+ ;al,cina*ii (i(*ema*i=a*e
l& ;i)4c4ndriac! 4b(e(ia (a, c4n5ingerea e>i(*en*ei ,nei b4li+ m4di-icari ale -i=ic,l,i (i
)(i;ic,l,i+ an>ie*a*e+ e>agerarea (im)*4ma*4l4giei carac*eri(*ica ,n4r a-ec*i,ni benigne
m& deliran*! de=4rien*area *em)4r4D()a*iala+ ;al,cina*ii+ inc4eren*a+ agi*a*ie )(i;4Dm4*4rie+
delir
n& 4ner4id! *rairi -an*a(*ice+ ;al,cina*4rii+ il4=4rii+ deliran*e
4& amen*ia! de=4rien*are *em)4r4D()a*iala+ *,lb,rari de gandire+ al*erarea 54rbirii )ana la a
54rbi in (ilabe+ (a, -4l4(ind (,ne*e near*ic,la*e+ agi*a*ie m4*4rie(de 4bicei in limi*a )a*,l,i&+
di()4D=i*ie labila+ inc4n*inen*a a-ec*i5a+ amne=ie lac,nara
)& (*are cre),(c,lara! ing,(*are a ca)aci*a*ii de gandire+ inca)aci*a*e de a di-eren*ia
(,biec*i5,l de 4biec*i5+ an>ie*a*e+ idei deliran*e+ *,lb,rari de c4nd,i*a+ a,*4ma*i(m
amb,la*4ri,(ac*e m4*4rii ,rma*e de amne=ie lac,nara&+ -,ga )a*4l4gica+ (4mnamb,li(m
r& W4r(aM45! c4m)4r*amen* a)aren* n4rmal+ dar d,)a 4 ac*i5i*a*e mai in*en(a a)are amne=ia+
de=4rien*are *em)4r4D()a*iala+ -al(e rec,n4a(*eri+ c4n-ab,la*ii
(& demen*ial! red,cere )r4gre(i5a+ gl4bala+ ire5er(ibila a ac*i5i*a*ii )(i;ice+ amne=ie
an*er4grada+ red,cerea 54cab,lar,l,i+ em4*ii labile+ red,cerea ac*i5i*a*ii+ inca)aci*a*ea de
ingriAire+ *,lb,rari de mem4rie (i A,deca*a
*& )(e,d4demen*ial! mani-e(*ari a(emana*4are c, cele din (indr4m,l demen*ial+ dar da*4ri*a
ine>i(*en*ei le=i,nil4r 4rganice m4di-icarile (,n* re5er(ibile
E9EC;<:RE: :C;E=(R DE ,*ES;,#:;,E
D *4a*e e>amenele de e>)l4rare a -,nc*iil4r )(i;ice (,n* e-ec*,a*e de ca*re ()eciali(*iD
)(i;4l4gi+ medici )(i;ia*ri
D a(i(*en*a medicala are r4l,l de a )rega*i )acien*,l )en*r, ace(*e e>aminariT nee>i(*and 4
)rega*ire -i=ica ()eciala+ ,n l4c )rim4rdial il 4c,)a )rega*irea )(i;ica a )acien*,l,i
D a(i(*en*a medicala 5a in-4rma )acien*,l a(,)ra e>aminaril4r+ lini(*ind,Dl+ e>)licand,Di ca
ace(*e e>aminari n, (,n* *ra,ma*i=an*e (in -,nc*ie de ni5el,l in*elec*,al& (i )4* -i in*rer,)*e in
m4men*,l in care 4b4(e(*e
D )acien*,l 5a -i a(ig,ra* ca i (e 5a ac4rda *4* (,)4r*,l m4ral nece(ar
1.E>amenul somatic
D de)i(*area (im)*4mel4r )(i;ice (i ,rmarirea m4d,l,i in care )acien*,l in(,(i in*er)re*ea=a
(i*,a*ia in care (e a-la!
a&6 da*ele 54r -i c,le(e a*a* de la )acien* ca* (i de la a)ar*ina*4ri+ c,m ar -i a-ec*i,ni
gene*ice+ me*ab4lice+ inc4m)a*ibili*a*e de R;+ l,e(+ alc44li(m+ *ra,me 4b(*re*icale+ b4lile
c4)ilariei (i deb,*,l b4lii ac*,ale
b&6e>amen,l clinic )e a)ara*e
D e>amen,l ne,r4l4gicD (,-erin*ele )(i;ice in(4*e(c ade(ea (,-erin*ele ne,r4l4gice! *,lb,rari
de mer(+ ;i)er*4nie m,(c,lara+ *ic,ri+*,lb,rari de 54rbire+ *,lb,rari (-inc*eriene U c, ra(,ne*
)(i;ic -4ar*e ),*ernic
D e>amen,l 4rganel4r de (im* U 4bliga*4ri, in a-ec*i,nile )(i;iceD in ()ecial in 4lig4-renie
(i ne5r4=e
D *,lb,rarile (en=4riale )4* genera!ne5r4=a+ -al(e 4lig4-reniiT(a, )4* -i e>)re(ia ,nei
ence-al4)a*ii
-.Evaluarea statusului mintal
a&6e5al,area generala a indi5id,l,i
Dimbracamin*eaDingriAi*a/(a, n,+)4*ri5i*a/e>cen*rica+r,)*a
De>)re(ia -e*ei!-i>a/m4bila+5e(ela/*ri(*a+de ma(ca+di(*ra*a+di(c4rD
dan*a+ban,i*4are+an>i4a(a+m,l*,mi*a+4(cilan*a
D4c;i!-ic(i+a*en*i+()eria*i+,me=i+mira*i+5i4i+)er)lec(i
Da*i*,dine!)rie*en4a(a+c44)eran*a+indi-eren*a+)re4c,)a*a+(c;imDba*4are
Dmi(careaDince*ini*a+in;iba*a/e>agera*a+manieri(me+*ic,ri+mi(cari (*ere4*i)e
D54rbireaD()4n*aieni*a*e+5i*e=a ra(),n(,l,i
Dc4m)4r*areDada)*abili*a*e+i=4lare
b&6E5al,area -,nc*iil4r )(i;iceDe>amen,l )(i;4l4gicDc4n*rib,ie la c,n4a(*erea mai e>ac*a a
)er(4nali*a*ii )er(4anei e>amina*e (i la elab4rarea ,n,i )(i;4Ddiagn4(*ic )reci(
8&6r4l,l e>amen,l,i )(i;4l4gic !
Dde)i(*area (i e5al,area -4rmel4r de ac*i5i*a*e )(i;ica de-ici*ara
De5al,area ca)aci*a*ii de ada)*are la e-4r*,ri )(i;ice
D4rien*area )r4-e(i4nala (a, re4rien*area )r4-e(i4nala
De5al,area e-ec*,l,i ,n4r (,b(*an*e )(i;4*r4)e
D)reci=area diagn4(*ic,l,i ,n4r a-ec*i,ni )(i;ia*rice
K&6e5al,area min*ala a (*a*,(,l,i em4*i4nal
Dcine e(*iXcand *eDai na(c,*X,ndeXca*i ani aiX,nde l4c,ie(*iX cand ai 5eni*X(*ii ,nde *e a-liX
De5al,area gradel4r de c4n(*ien*a
De5al,area 4rien*arii *em)4r4D()a*iale
De5al,area -acie(,l,iDm4bili*a*e +grad,l de *ri(*e*e (a, b,c,rie e*c6
De5al,area ge(*,ril4rDmi(ca*i de=4rd4na*e+-recarea mainil4r e*c6
De5al,area )4(*,riiDrela>a*a /*en(i4na*a
De5al,area imbracamin*ii!grad de igiena+a(4r*area ;ainel4r
De5al,area mi(caril4r!*rem,ra*,ri+mi(cari ca*a*4nice
De5al,area m4d,l,i c,m c4m,nica!*4nali*a*e+b4ga*ia limbaA,l,i+
De5al,area (*arii a-ec*i5e!e,-4rie+e>al*are+de)re(ie+an>ie*a*e+*eaDmaagre(i5i*a*e+indi-eren*a
De5al,area ca)aci*a*ii de a gandi!red,cerea ca)aci*a*ii de a -ace a(4cia*ii+-,ga de
idei+delir+-4bii+e*c
De5al,area ca)aci*a*ii de )erce)*ie!;al,cina*ii+il,=ii
De5al,area *,lb,raril4r in(*inc*,ale
G&6E5al,area 5ar(*ei )(i;ice a c4)il,l,i
DG aniDdeb,*,l (4ciali=arii+4rien*area in ()a*i, )en*r, ()a*iile (im)le+cri=a de 4)4=i*ie
DF aniDa)are n4*i,nea de *im)+in*elegera ,nei (i*,a*ii )rac*ice (im)le
DI aniD(,cce(i,nea ac*i5i*a*il4r+cla(i-icarea 4biec*el4r in -,nc*ie de ,*ili*a*e+cre(*erea
in*ere(,l,i )en*r, al*ii
DJ aniDre=4l5a (i*,a*ii de 5ia*a elemen*ara+ince)e )erce)*ia (c;eDmei c4r)4rale
DND9 aniDrela*iile de gr,)+calc,l ari*me*ic+cla(i-icarii+c4m)ara*ii
DLD8: aniD de=54l*area in*eligen*ei )rac*ice+ 4)era*ii de c4m)ara*ie a l,cr,ril4r a(emana*4are+
re=4l5a )r4bleme c, grad de ab(*rac*i=are
D8K aniD c4nce)e *im),l i(*4ric
F&In5e(*igarea a*en*iei
D ,rmare(*e ca)aci*a*ea de c4ncen*rare (i di(*rib,*ie a a*en*iei
D )r4ba T4,l4,(eDPier4n! *im),l de reac*ie la a)ari*ia ,n,i (*im,l
D *e(*,l de baraA H4,rd4n! bararea ,n4r li*ere in*rD,n *e>*+ (a, *e(*,l de barare a ,n4r -ig,ri
D *a;i(*4(c4)ia! di(*ingerea ,n,i de(en+ ci-ra (a, n,mar in mi(care
D (caderea a*en*iei! a-ec*i,ni ne,r4l4gice+ (*ari )(i;4*ice+ ne5r4=e+ 4lig4-renii+(,rmenaA
D cre(*erea a*en*iei! (*ari de e>ci*a*ie in ),(e,ri maniacale
I&In5e(*igarea mem4riei!
D mem4ria imedia*a
D mem4ria recen*a
D mem4ria e5enimen*el4r inde)ar*a*e
D )r4ba ReR! in5e(*ig;ea=a mem4ria imedia*a+ ca)aci*a*ea de -i>are+ de re)r4d,cere (i
mem4rie 5i=i4D()a*iala
J&In5e(*igarea gandirii (i limbaA,l,iD*e(*e de in*eligen*aDe5al,area grad,l,i de de*eri4rare
men*ala
D *e(*e 5erbale (a, de 54cab,lar
D *e(*e de gandire c4nce)*,ala
D *e(*e de gandire ab(*rac*a+ c4rec*a (i )rac*ica
N&E5al,area ni5el,l,i in*elec*,alD*e(*e de in*eligen*a+ (e (*abile(*e YI(5ar(*a men*ala/5ar(*a
cr4n4l4gica > 8::&
D S8F: in*eligen*a e>*rem de ridica*a
D 8K:D8F: in*eligen*a (,)eri4ara
D 88:D88L in*eligen*a )e(*e medie
D 8::D8:L in*eligen*a b,na
D L:DLL in*eligen*a la ni5el medi,((laba&
D 9:D9L in*eligen*a (,bmedie
D N:DNL in*eligen*a la limi*a
D I:DJL debili*a*e min*ala
D K:DFL imbecili*a*e
D :D8L idi4*ie
9&E>amen,l )er(4nali*a*ii!
D carac*eri(*icile )rinci)ale ale )er(4nali*a*ii (,n* *em)eramen*,l+ a)*i*,dinile (i carac*er,l
D (e e-ec*,ea=a mai m,l*e *e(*e )en*r, aceea(i -,nc*ie )(i;ica
D me*4dele )rin care (e *e(*ea=a )er(4nali*a*ea (,n*! me*4de (,biec*i5e()er(4ana 54rbe(*e
de()re ea&+ me*4de 4biec*i5e (de*erminarea m4di-icaril4r bi4elec*rice in (*arile em4*i4nale&+
me*4de )r4iec*i5e! *e;nici a(4cia*i5e(*e(* a(4cia*i5 5erbal+ *e(* R4r(c;ac;&T *e;nici
c4n(*r,c*i5e(*e(*,l )erce)*iei *ema*ice&T *e;nici de c4m)le*are(*e(*,l R4(en=PeigD,rmare(*e
e5al,area *4leran*ei (i a m4d,l,i de reac*ie la (*re(&T *e;nici de 4rd4nare (e>6 *e(*,l L,(c;erD
4rd4narea in m4d )re-eren*ial a 9 car*4ane c4l4ra*e&
D *e(*e de )er(4nali*a*eDc;e(*i4nare de )er(4nali*a*e
G&Anamne=a
D la c4)iimani-e(*arile de(cri(e ca an4rmale (e a)recia=a e5al,ind,D(e rela*iile c4)ii )arin*i
D c,)rinde ala*,ri de in-4rma*iile ,=,ale a()ec*e )ri5ind c4ndi*iile de 5ia*a+ )er(4nali*a*i
)rem4rbide+ ada)*are (4ciala+ (c4lari*a*e
F&An*eceden*e ;ered4Dc4la*erale
D 5ar(*a )arin*il4r
D (i*,a*ia ci5ila
D b4li e>i(*en*e in -amilie
I&APF
D m4d,l de ac;i=i*ie a limbaA,l,i+ c4n*r4l,l (-inc*erian+ *i),l de )er(4nali*a*e+ ec;ilibr,l
e-ec*i5+ in*en(i*a*ea mani-e(*aril4r em4D*i4nale+ grad,l de (4ciabili*a*e+ ca)aci*a*ea de ada)a*re
in -amilie+ (c4ala+ la l4c,l de m,nca
J&APP
D (*ari m4rbide ne5r4*ice+ )(i;4*ice+ (*re(,ri em4*i4nale+ in*er5en*ii c;ir,rgicale+ *ra,ma*i(me
crani4Dcerebrale
N&C4ndi*ii de 5ia*a (i de m,nca
D da*e de()re l4c,in*a+ (*are ma*eriala+ c4m)4nen*a -amiliei
9&E>aminari )araclinice
D rec4l*ari (ang,ine+ reac*ii (er4l4gice(CDRL+ H4rde*DZa((erman&+ d4=area elec*r4li*il4r
(ang,ini
D rec4l*area ,rinei
D e>)l4rarea -,nc*iei ;e)a*ice
D e>)l4rari end4crine(*ir4ida+ de*erminarea )r4lac*inei&
D EWG+ EEG+ e>amen,l LCR+ e*c
L&In5e(*iga*ie de *eren
D ,n,l din cele mai ,*ile miAl4ace de c,legere a da*el4r+ in ca=,l )acien*il4r c, a-ec*i,ni
)(i;ia*rice6
Acea(*a (e )4a*e e-ec*,a!
D la d4micili,l )acien*il4rDin (c4),l c,n4a(*erii (*arii de (ana*a*e (i de 5ia*a a )acien*,l,i (i
membril4r -amiliei (ale!
D m4men*,l imb4lna5irii
D i(*4ric,l b4lii
D *ra*amen*e e-ec*,a*e (i re=,l*a*,l ace(*4ra
D c4ncedii )rimi*e
D *recerea la in5alidi*a*e
D ac*i5i*a*i in )eri4ada de in5alidi*a*e
D m4d,l de )e*recere a *im),l,i liber
D e>i(*en*a )r4blemel4r -amiliale((*ari c4n-lic*,ale&
D caren*e ec4n4mice U alimen*a*ie
D )rega*ire )r4-e(i4nala
D d4rin*a )acien*,l,i de a (e reincadra in ac*i5i*a*e (i ,nde ar d4rii (a l,cre=e
D la ,ni*a*ile (ani*are U la ,ni*a*ile medicale ,nde a -4(* *ra*a* (a, in5e(*iga* )acien*,l!
D *im),l de 4b(er5a*ie (i ri*m,l c4n(,l*a*iil4r U de la medic,l c,ran*
D diagn4(*ic,l (i )r4gn4(*ic,l
D ra)4r*area da*el4r medicale la cele (4ciale )en*r, (*abilirea da*ei a)ari*iei in5alidi*a*ii
D e>*ra(e din -i(ele medicale (i -4ile de 4b(er5a*ieT (e men*i4Dnea=a c4ncediile de b4ala
D la l4c,l de m,nca!
D in-4rma*ii a(,)ra c4ndi*iil4r de m,nca! (4lici*ari )(i;ice+ (enD=4riale+ energe*ice+
micr4clima*+ n4>e )r4-e(i4nale (i ri*m,l de m,nca
D rela*iile )acien*,l,i c, c4legii de m,nca
D a*i*,dinea )acien*,l,i -a*a de m,nca
D )r4d,c*i5i*a*e din ),nc de 5edere cali*a*i5 (i can*i*a*i5
D ini*ia*i5a in m,nca+ )re4c,)ari )r4-e(i4nale (a, e>*ra)r4-e(i4nale
8:&Sc4lari=area (i ada)*area (4ciala a )acien*,l,i
D daca a rama( re)e*en*+ in ce cla(a+ la ce ma*erii a a5,* e(ec,ri (i la care a a5,* )er-4rman*e
D grad,l de ada)*are la 5ia*a inde)enden*a
88&Anc;e*a (4ciala
Din5e(*igarea micr4clima*,l,i (4ci4D-amilialT (e e-ec*,ea=a la ni5el!
D-amilial! a()ec*,l l4c,in*ei+ camerei )acien*,l,i+ grad,l,i de igiena+ aranAamen*,l,i
m4bilier,l,i+ *i),l dec4ra*i,nil4r
D gr,),l )r4-e(i4nal! la m,nca+ in(*i*,*ii de in5a*aman*
8K&E>amen,l )4ligra-ic
D me*4da de e>)l4rare a m4di-icaril4r bi4elec*rice+ ce a)ar in ca=,l e>i(*en*ei ,nei (*ari
em4*i4nale
D gr,),l )r4-e(i4nal! la m,nca+ in(*i*,*ii de in5a*aman*
ASPECTE ALE INGRIJIRII PACIENTILOR PSIHICI
Cule$erea !atelor
8&Circ,m(*an*e de a)ari*ieT -ac*4ri de ri(c
D c4ndi*ii ne-a54rabile ale medi,l,i e>*ern
D -ac*4ri gene*ici
D a-ec*i,ni in *im),l (arcinii(l,e(+ r,be4la&
D *ra,ma*i(me 4b(*e*ricale
D *ra,ma*i(me (i in-ec*ii care )r4d,c le=i,ni ale creier,l,i
D (*ari c4n-lic*,ale+ *en(i4na*e! in -amilie+ la l4c,l de m,nca
D e5enimen*e )e )arc,r(,l 5ie*ii(dece(,l )er(4anel4r dragi+ di54r*+ (c;imbarea l4c,l,i de
m,nca+ )en(i4nare+ (4maA&
D )r4-e(ii c, re()4n(abili*a*i cre(c,*e+ de(-a(,ra*e in =g4m4* (i inc4rdare )(i;ica
D(,rmenaA in*elec*,al
D)eri4ade cri*ice ale 5ie*ii(),ber*a*e+(arcina+lac*a*ie+men4)a,=a&
Db4li me*ab4lice+end4crine+ne,r4l4gice+in-ec*i4a(e+in*4>ica*ii
D4re in(,-icien*e de (4mn
Dc4n(,m de alc44l+dr4g,ri
K&Eani-e(*ari de de)enden*a
a&T,lb,rari ale (*arii de c4n(*ien*a!
D n, reac*i4nea=a la (*im,li
D reac*i4nea=a d4ar la a)licarea di5er(il4r(*im,li a(,)ra (a
D mani-e(*a de=in*ere( -a*a de l,mea e>*eri4ara
D in*elege c, di-ic,l*a*e ce (e in*am)la in A,r,l (a,
D e(*e de=4rien*a*+ c4n-,=
b&T,lb,rari de )erce)*ie
D ;i)ere(*e=ie
D ;i)4e(*e=ie
D il,=ii
D ;al,cina*ii(a,di*i5e+ *ac*ile+ 4l-ac*i5e&
c&T,lb,rari de gandire
D idei deliran*e lega*e de )er(4ana (a((en*imen* de 5in45a*ie -a*a de cei din A,rT (e c4n(idera
de4(ebi* de ceilal*iT (e c4n(idera -4ar*e b4lna5& (a, de medi,l inc4nA,ra*4r(e(*e c4n5in( ca
(emenii a, ce5a c, el+ ca 54r (a ii -aca ra,+ ca e(*e (,)ra5eDg;ea* (i 4b(er5a* )ermanen*+ ca
e(*e in(ela*+ amenin*a*&
D -,ga de idei(manie+ i(*erie&
D idei )re5alen*e(ne5r4=e+ )(i;4)a*i&
D idei 4b(e(i5e((*ari de)re(i5e+ ne5r4=e&
D li)(a c4eren*ei in 54rbire
D 4)rirea br,(ca in *im),l e>),nerii
d&T,lb,rari de mem4rie
D ;i)4mne=ia (a, amne=ia U )4* a5ea dre)* c4n(ecin*a de=4rienD*area in *im) (i ()a*i,T -a*a de
)r4)riaDI )er(4ana
e&T,lb,rari ale di()4=i*iei
D de)re(ie
D e,-4rie neA,(*i-ica*a c, ,n c4m)4r*amen* agi*a*+ ;a4*ic
D (*are de ()iri* (c;imba*4are
-&T,lb,rari a-ec*i5e
D -,rie
D agre(i5i*a*e
D 5i4len*a
D a)a*ie
D labili*a*e em4*i4nala
g&T,lb,rari de 54in*a
D di-ic,l*a*e in l,area ,nei deci=ii
D ac*i5i*a*i ne-inali=a*e
D in(,(irea c, ,(,rin*a a c4n5ingeril4r cel4r din A,r
;&T,lb,rari de ac*i5i*a*e(cali*a*i5a (a, can*i*a*i5a&
D dimin,area (a, accelerarea mi(caril4r
D e),i=area ra)ida d,)a ac*i5i*a*i rele*i5 ,(4are
D e-ec*,area mai m,l*4r ac*i5i*a*i in acela(i *im)
D agi*a*ie )(i;4m4*4rie
D ca*a*4nie+ ca*ale)(ie
D nega*i5i(m
D cle)*4manie
D )ir4manie
D (*ere4*i)ie
i&T,lb,rari de c4m,nicare(5erbala (a, (cri(a&
D l4g4ree
D m,*i(m
D balbaiala
D er4are 5erbala
D ,*ili=area ,n,i *4n )rea ridica* (a, )rea m4n4*4n
D gra-4ree
D re-,=,l (ci(,l,i
D de-icien*e de caligra-ie+ di(),nere in )agina+ ,*ili=area ,n4r (emne )er(4nale
A&T,lb,rari de c4m)4r*amen* in(*inc*,al
D e>agerarea (a, dimin,area in(*inc*,l,i alimen*ar(b,limie (a, an4re>ie ner54a(a&
D )er5er(i,ni (e>,ale
D e>agerarea (a, (caderea in(*inc*,l,i ma*ern
M&Dimin,area in(*inc*,l,i de c4n(er5are
D *en*a*i5a de a,*4agre(i,ne
D (,icid
l&T,lb,rari 4rganice in ab,= de alc44l+ dr4g,ri
Pen*r, a ),*ea 4b*ine in-4rma*ii )er*inen*e in *im),l in*er5i,l,i e(*e nece(ar (a (e ca(*ige
increderea )acien*,l,i )rin! a(c,lD*are a*en*a+ e>aminare -ara )re=en*a al*4r )er(4ane+ e5i*area
c4men*ariil4r -a*a de )acien*+ nen*rer,)erea e>),nerii
G&E>aminari )araclinice
D radi4l4gice
D elec*r4ence-al4grama
D e>amen gene*ic
D e>aminari de lab4ra*4r U (ange+ ,rina+ LCR
D e>amen )(i;4l4gic U *e(*e de )er(4nali*a*e+ de in5e(*igare a a*en*iei+ mem4riei
INGRIJIREA PACIENTILOR AGITATI SI PSIHICI
Se re-era la a-ec*i,ni carac*eri=a*e )rin agi*a*ie+agre(i,ne+care (e )4* mani-a(*a )rin a,*4 (a,
;e*er4agre(i,ne6
Se in*alne(c in !
Da-ec*i,ni )(i;ice!marea cri=a an>i4a(aTc4n-,=ie min*alaTi(*erieT
manieTmelanc4lieT(c;i=4-renieT(indr4m di(c4rdan*((c;i=4-renia )aran4ida&
Db4li (4ma*ice!i(c;emie cerebralaTe)ile)(ie
Din-ec*ii
Din*4>ica*ii
D(*ari -ebrile
D(*ari )rec4ma*4a(e
Dc4me(;i)4glicemica&
+anifestari"
D54rbire inc4eren*a
Dde=4rien*are *em)4r4D()a*iala (i/(a, a(,)ra )r4)riei )er(4ane
Dl4g4ree
D*i)e*e
Dac*e )eric,l4a(e
Dl45iri
Draniri
Dmi(cari nec4n*r4la*e+nec44rd4na*e
D-,ga )e c4rid4areDdelir
+ateriale necesare"
Dma*erial de im4bili=are!8DK cear(a-,ri+cama(i de )r4*ec*ie+c;ingi
Dma*eriale nece(are )en*r, *ra*amen*e )aren*erale
Ea(,ri de ,rgen*a!
D)(i;4*era)ie +re*inand )acien*,l la )a*
Dim4bili=are -4r*a*aD la ne54ie!
[ cama(a de )r4*ec*ieD *reb,ie (,)ra5eg;ea* indea)r4a)e )en*r, ca (e )4a*e a,*4a(-i>ia
[ c, cear(a- U (e a)lica )e ()a*e+*ran(5er(alT c, ca)e*ele libere (e in-a(4ara membrele
(,)eri4are+ a)4i (e incr,ci(ea=a )e *4race+iar cear(a-,l (e leaga la ()a*eT c, ,n al* cear(a- (e
im4bili=ea=a membrele in-eri4are
[ c, c;ingiD garni*,ra (e c4m),ne din F man(e*e (i K ben=i la*e (K man(e*e (,n* a)lica*e
)e gle=ne+ iar K (,n* a)lica*e )e inc;eie*,ra ),mn,l,iT 8 banda (e *rece )e(*e )ie)*,l
)acien*,l,i iar cealal*a dea(,)ra gen,nc;il4r&T (e a)lica c, griAa )en*r, a n, im)iedeca
circ,la*ia membrel4r6
[ im4bili=are man,alaD -ara br,*ali*a*e +la ni5el,l inc;eie*,ril4r )acien*,l e(*e a(e=a* in
dec,bi* d4r(al + (e a)a(a ,merii )e (,D)ra-a*a )a*,l,i +(e e>erci*a )re(i,ne a(,)ra gen,nc;il4r
(i (e e-ec*,ea=a )(i;4*era)ie(n, (e -4l4(e(*e *4n,l ridica* (i n, (e c4nD*ra=ice )acien*,l&
D(e inde)ar*ea=a 4biec*ele ce )4* -i -4l4(i*e )en*r, l45ire
D(e an,n*a medic,l )rin*rD4 al*a )er(4ana
Dc,legere de da*e )en*r, 4 c4nd,i*a ,l*eri4ara ca* mai c4rec*a((e ,rmare(c *4a*e mani-e(*arile
de de)enden*a )ana la 5enirea medic,l,i +a)4i (,n* ra)4r*a*e ace(*,iaT 4rice b4ala (4ma*ica +
im),ne )ri4ri*a*e in *era)ieT n, (e admini(*rea=a calman*e )enD*r, a n, m4di-ica *abl4,l
clinicT in limi*a )4(ibili*a*il4r +m4bili=aDrea -,nc*iil4r 5i*ale6
D(e inla*,ra (*im,lii inc4nA,ra*4riD (emi4b(c,ri*a*e+i=4lare -4nica
Dm4ni*4ri=are! ),l(+re()ira*ie+TAD)re5enirea c4m)lica*iil4r!c4la)(+ li)4*imie
,n$ri0iri $enerale"
Dim4bili=areaDdaca (i*,a*ia 4 im),ne
Dadmini(*rarea *ra*amen*,l,iDn,mai d,)a im4bili=areTmedicamen*ele n, (,n* la(a*e la
indemana )acien*,l,iT medicamen*ele 54r -i d4=a*e (i admini(*ra*e )er(4nalT e-ec*,area
)r4cedeel4r *eraD )e,*ice indica*e de medic
Dinde)ar*area 4biec*el4r ce )4* -i -4l4(i*e )en*r, l45ire
Di=4larea )ri=el4r
Da(ig,rarea -ere(*rel4r c, gra*ii
DRala elec*rica in(*ala*a la ,(a de ie(ire din (ec*ie
Dm4ni*4ri=area -,nc*iil4r 5i*ale
Dn4*area *,*,r4r mani-e(*aril4r de de)enden*a ce a)ar (i an,n*aDrea imedia*a a medic,l,i!
*a;icardie+ HTA+ *a;i)nee+ m4di-icari ),)ilare
De-ec*,area de e>erci*ii de re()ira*ie(a*,nci cand e(*e )4(ibil&
D++*a)ing\ )en*r, m4bili=area (ecre*iil4r br4n(ice
Da(ig,rarea ,nei )4=i*ii c4m4de in )a*
Daeri(irea (al4n,l,i
D,midi-icarea aer,l,i din (al4n
D)re=en*area me(ei ca* mai a*raga*4r+ (*abilirea im)re,na c, )acien*,l a g,(*,ril4r alimen*are
Dinla*,rarea din (al4n a *,*,r4r -ac*4ril4r indi()4=an*i(,rinar+)l4(ca+ (c,i)a*4are&
Dma(,rarea gre,*a*ii c4r)4rale =ilnic
Da(ig,rarea a)4r*,l,i nece(ar de lic;ideDadmini(*rarea )er 4( (a, )rin )er-,=ii i656
De-ec*,area bilan*,l,i inge(*ie/e>cre*ie U=ilnic
Dn4*area (i an,n*area medic,l,i in ca=,l a)ari*iei mani-e(*aril4r de de)enden*a !
di(,rie+)4li,rie+)4laMi,rie+edeme e*c6
D,rmarirea *ran=i*,l,i in*e(*inal
Dcli(ma in ca= de c4n(*i)a*ie
D(c;imbarea lenAeriei de )a* (i de c4r) 4ri de ca*e 4ri e(*e ne54ie
D*4ale*a rig,r4a(a a ca5i*a*ii b,cale
De-ec*,area *4ale*ei la )a* U a*,nci cand e(*e nece(ar
D(,)ra5eg;erea )acien*,l,i inde)enden* in e-ec*,area *4ale*ei (generale (a, )ar*iale&+ ed,carea
ace(*,ia in ace(* (en(
Dim)re,na c, )acien*,l +54r -i de(c4)eri*e cali*a*ile ace(*,ia+realiD =arile a5,*e
Di (e a(ig,ra )acien*,l,i acce(,l la -ri=eria ()i*al,l,i
D(e 5a (*abili im)re,na c, )acien*,l +ac*i5i*a*i care (aDi -aca )laceDre
Din -a=a ac,*a a b4lii+ 5i=i*ele a)ar*ina*4ril4r 54r -i )e ca* )4(ibil limi*a*e
D(e 5a incerca (a (e (*abilea(ca 4 rela*ie a(i(*en* medicalD)acien*+ ba=a*a )e incredere
D(e 54r inle(ni 5i=i*ele a)ar*ina*4ril4r a*,nci cand (*area 4 )ermi*e
Da)ar*ina*4rii 54r -i lam,ri*i in )ri5in*a b4lii (i 54r -i ()riAini*i in aD(i mani-e(*a (en*imen*ele
)4=i*i5e -a*a de )acien*
D)acien*,l 5a -i calma*+lini(*i*+e>)licand,Di ca e(*e in (ig,ran*a
D(e 5a a(ig,ra lini(*ea in (al4n
D(e e-ec*,ea=a )limbari (c,r*e in aer liber inain*e de c,lcare
D i (e a(ig,ra m4dali*a*i de rela>arem,=ica+lec*,ra+=iare+re5i(*e (lec*,ri ,(4are&+
*ric4*a*+im)le*i*
Ea(,ri de ,rgen*a!
Dadmini(*rarea medicamen*el4r )re(cri(e de medic!
a&6in ca=,ri ,(4areDEe)r4bama*+Cl4rdela=in+Hal4)erid4l (a, Ami*al+Pleg4ma=inDin ca=,l in
care )acien*,l 4),ne re=i(*en*a
b&6in agi*a*ie e>*rema!*ranc;ili=an*e(Dia=e)am i6m6&T ne,r4le)*ice (R4m*ia=in i6m6 (a, i656&T
(a, c4mbina*ii li*ice ! Dia=e)am+ Le54me)r4ma=in+ Ra,ner5il
c&6in -4rme ,(4are de an>ie*a*e !Ni*ra=e)am+ Hidr4>i=in
d&6Hal4)erid4l,l (e a(4cia=a c, R4m)arMin,l )en*r, e5i*area (indr4m,l,i e>*ra)iramidal
)r4d,( de ne,r4le)*ice
e&6in alc44li(m n, (e admini(*rea=a barbi*,rice+ br4m,ri (a, ami*al (4dic
IngriAiri generale!
Din ca= de nega*i5i(m alimen*ar + (e in(*i*,ie (4nda end4Dna=ala+ )acien*,l 5a -i alimen*a* )rin
(4nda
Pacien*ii agi*a*i (i )(i;ici nece(i*a 4 ingriAire ()eciala +de4arece )4* 5eni in c4n-lic* c,
an*,raA,l (i )4* de5eni )eric,l4(i
Da(i(*en*a medicala *reb,ie (a (e )r4*eAe=e )e (ine
INGRIJIREA PACIENTILOR CU SCHI]OFRENIE
A-ec*i,ne )(i;4*ica c, e54l,*ie indel,nga*a carac*eri=a*a )rin di(4ciere a,*i(*a a
)er(4nali*a*ii+)rin di(-,nc*ie (4ci4D4c,)a*i4nala6
Fac*4ri de ri(c!
D)redi()4=i*ie gene*ica
D*ra(a*,ri de carac*er de *i) (c;i=4id !ne(4ciabil+re=er5a*+li)(i* de ,m4r+li)(i* de a-ec*i5i*a*e
D*i),l le)*4(4m (a(*enic&
D-ac*4ri (*re(4ri c, )4*en*ial c, )4*en*ial declan(a*4r! )ierderea ,nei )er(4ane dragi+ m,*area
in*rD,n al* l4c+ de)ri5area de (4mn
Eani-e(*ari de de)enden*a!
Ddeb,* )4lim4r- ()(i;4=a ac,*a+ *en*a*i5a de (,icid+ manie+ -en4mene de de)er(4nali=are&
D*,lb,rari de )erce)*ie! ;al,cina*ii a,di*i5e54ci ,nice (a, m,l*i)le+ -al(e rec,n4a(*eri
+;i)ere(*e=ie
D*,lb,rari de a*en*ie! de-ici* de a*en*ie (i c4ncen*ra*ie + de*a(are de ambian*a
D*,lb,rari de mem4rie! ;i)ermne=ie (e>ci*a*ie e>ce(i5a+)a*4l4gica a mem4riei &+;i)4mne=ie de
-i>are
D*,lb,rari de gandire! inc4eren*a+ inc4n(ec5en*a+ *,lb,rari de a(4Dciere a n4*i,nil4r+baraA,l
-l,>,l,i min*al+ delir
D*,lb,rari de limbaA! 5erbirgara*ie (a, m,*i(m+ne4l4gi(me
D*,lb,rari de a-ec*i5i*a*e!indi-eren*a a-ec*i5aT inca)aci*a*e de m4d,lare a a-ec*i5i*a*ii
D*,lb,*ari de 54in*a (i a-ec*i5i*a*e! ab,lie+ inac*i5i*a*e+ e-ec*,area ,n4r ac*i5i*a*i da*4ri*a
in-l,en*ei e>erci*a*a )rin (,ge(*ie+ )4(eD dare+ ;i)n4=a+ *endinda de imi*are!ec4lalie
+ec4mimie6
D*,lb,rari de mi(care! ca*a*4nie+ )erna )(i;icac4n(*a in men*inerea in a ca),l,i ridica*
(b4lna5,l -iind c,lca* in )a*&+ ca (i c,m ar (*a )e 4 )erna (ine>i(*en*a&T (emn,l e(*e de(cri( de
D,)ree (i in*alni* mai ale( in (c;i=4-renia ca*a*4nica6
D*,lb,rari de c4n(*iin*a
D*,lb,rari de )er(4nali*a*e! -en4mene de de)er(4nali=are
In*er5en*ii!
Ddi()en(ari=area )acien*,l,i
Dlimi*area de-ici*,l,i de )er(4nali*a*e
D()riAinirea rein*egrarii in -amilie (i (ana*a*e
Ded,carea membril4r -amiliei (a -aca -a*a (i*,a*iil4r ind,(e de b4lD na5
Ded,carea )acien*,l,i (a acce)*e erg4*era)ia (i (a decida ce -el de ac*i5i*a*e 5rea (a e-ec*,e=e
D()riAinirea )acien*,l,i (aD(i c4n*r4le=e -,ria
Da(ig,rarea ,n,i medi, de (ig,ran*a
Diden*i-icarea (*aril4r c4n-lic*,ale (i c4mba*erea l4r
Dinc,raAarea )acien*,l,i (a -aca e>erci*ii -i=ice =ilnic+ )limbari+ (a aiba )re4c,)ari
Dm4ni*4ri=area ;al,cina*iil4r(cand a)ar+ c,m (,n* )erce),*e de )acien*+ ca* d,rea=a&
Dcre(*erea a,*4re()ec*,l,i (i increderii )acien*,l,i in )r4)ria )er(4ana
D()riAinirea )acien*,l,i (a (e reada)*e=e la e>igen*ele 5ie*ii de -aD milie+(4ciale
Dc4m,nicare (im)la + ,(4r de in*ele(
De5al,area abili*a*ii )acien*,l,i de a -ace -a*a ac*i5i*a*il4r =ilnice
D(,)ra5eg;erea c, ma>ima a*en*ie a )acien*il4r in )eri4adele c, ri(c mare de a,*4agre(i,ne
(a, ;e*er4agre(i,ne
Ded,carea )acien*,l,i (a *ina ,n A,rnal =ilnic )en*r, a (e 4rien*a *em)4ral
D)re=en*area reali*a*ii in*rD,n m4d -erm +dar -ara a crea 4 (*are de c4n-4r*
Dadmini(*rarea *ra*amen*,l,i )re(cri(
D)ar*ici)area la e-ec*,area elec*r4(4c,l,i+ (4c,ril4r in(,linice
Dc4lab4rarea c, )(i;4*era)e,*,l+ erg4*era)e,*,l+ (4ci4l4g,l+ )(i;4l4g,l