FUNDACION UNIVERSITARIA SAN MARTIN
PRESENTADO A: DOCTOR JUAN PABLO TEHELEN CARREÑO
PRESENTADO POR: AURA MARIA GOMEZ PABON
ESTUDIANTE DE SEPTIMO SEMESTRE
SANTIAGO DE CALI, ABRIL/26/2016
HISTORIA CLINICA FAMILIAR # HISTORIA CLINICA:
NIVEL SOCIOECONOMICO:
21021214
ESTRATO 1
NOMBRE: JOAQUIN RAMON DIAZ
ESTADO CIVIL: UNION LIBRE
SALCEDO
ESCOLARIDAD: SEPTIMO DE
ORIGEN/PROCEDENCIA: LA UNION-VALLE
BACILLERATO
PROFESION: CONSTRUCCION
DOCUMENTO DE IDENTIDAD: CC.1112619324
LUGAR DE NACIMIENTO: LA
OCUPACION: O!ICIOS VARIOS GRUPO ETNICO: MESTIZO
UNION-VALLE
RELIGION: CRISTIANA
FECHA DE NACIMIENTO:
INFORMANTE: JOAQUIN RAMON
MAYO/19/1992
DIAZ Y ESTE! ESTE !ANIA DIAZ SALCEDO S ALCEDO
MOTIVO DE CONSULTA: ME SALIERON UNAS ULCERAS EN LOS "LUTEOS# MALESTAR "ENERAL# !IEBRE Y VOMITO ENFERMEDAD ACTUAL: PACIENTE ADULTO JOVEN CON ANTECEDENTES DE UN TRAUMA RAQUIMEDULAR POR ERIDA DE ARMA DE !UE"O CON PARAPLEJIA SECUNDARIA AL EVENTO# A NIVEL T12 ASIA-A# QUIEN IN"RESA AL SERVICIO SERVICIO CON UN CUADRO CLINICO APRO$IMADAMENTE APRO$IMADAMENTE CON 3 MESES DE EVOLUCION# CARACTERIZADO POR ULCERAS DECUBITO SACRAS SOBREIN!ECTADAS# SOBREIN!ECTADAS# ASOCIADO A ALZAS TERMICAS NO CUANTI!ICADAS# ESCALO!RIOS# ESCALO!RIOS# IPORE$IA# DIA!ORESIS# DIA!ORESIS# ASTENIA# ADINAMIA Y VARIOS VARIOS EPISODIOS DE EMESIS CON CONTENIDO ALIMENTICIO.
HISTORIA PERSONAL PERINATALES: P%&'()*( )%&'+, () % U)')- V%( 19/%,/1991# ( ( *(&(, +( *( (%), # %+( )'(% &,5'&%&',)( +%)*( ( (7%%8,# )%&'+, 5, 5%*, )%*% % *'),# () ,5'*% ",)8%, C,)*(%# &,) %+(&%+, 5(, *%% % )%&( # (&'7' %&*%)&'% (:&';% , 5'(, 6 (( +( ;'+%.
INFANCIA:
,% &,)<,%+, 5, = 5(,)%# 5%+( +, (%)%# % % (+%+ +( = %>, 5%+( ( (5%%,) () %, *'),# %<(&*%)+, +?*'&%()*( % %,)@% <%''%. <%''%. A 5%*' +( (*% (+%+ ( 5%+( +(, +( (5,)+( 5, (5,)%7''+%+( %7%)+,)?)+,, ') +(% %*, +( 5%%+(,# +(7'+, % (*, J,%@) (%)%# +(7'(,) (5(8% (5(8% % *%7%% &,) %+( () ( (&'&%( +(+( *(5%)% (+%+ 5%% % %)*()&') +( ,%# ,*';, 5, ( &% ), ,, +'<*% )'>(8 % (;% % &%7, &,(&*, +(%,,# %'*@% % % (&(% +( 5(7,# () ,%', +( % *%+(. !( (5''+, (5''+, &%*'%+, 5, %+(# % ( (% +(%,%7% *,+% <*%&') &,) &%*', <(*(. D(&'+'(,) '( % &('*,- ;%( 5%%
ADOLESCENCIA: E) (*% (*%5% +(&'+( (*'%( +( &,(', &%)+, (*%7% &%)+, 5*', %+, 5, %% %+%5*%&')# ((( ( (*% +(&'') % *, 5,( ), ( *%7% (*+'% %+(? +(&'+( ()*% % *%7%% +(+( , 11 %>, &,, %+%)*( () &,)*&&',).D(7'+, % % '*%&') +( %7%)+,), 5,&, &'+%+, 5, %+(# % %'*%+% ( *;, <(,) 5,&, (&,()+%7( , &%( , ')&'*%,) % ()*% % )+, +( ;'&', +( % %'%)% %&,, % (&%, 12 %>,. P,*(',()*( +(7'+, % % '*%&') ( ;';@% ()*, % )+, +('&*';, ,7,# +%)*( *,+% (*% 5,&% *;, %% (%&') &,) %+(. P%&'()*( ((( ((( ')'&', +( ;'+% (:% % *(5%)% (+%+ &,) F*'5( (( ') 5,*(&&')
ADULTO JOVEN: D%)*( (*% (*%5% &,)*')% () ( )+, +('&*';, ,7, 5, , &% ( &,)+()%+, % 19 %>, () ( 2011 2011 () ( ')*'**, ')*'**, )%&',)% 5()'*()&'%', &%&(%', +( 5(7,# (*;, (*()'+, +%)*( +, %>,# +%)*( ')*%)&'% +(, (7%%8%+% % ),;'% J,%)% ",)8%( +( 1= %>,. A %'+% +( &()*, 5()'*()&'%', &,)*')% &,(*'()+, %&*, +('&*';, )*, % )% 7%)+% &,)<,%+% ( ( +(+'&%7%) % '&,*%&, +( (*5(<%&'()*(# () ) ()<()*%'()*, ()*( 7%)+% (&'7( ;%', '5%&*, +( 7%%# ), +( (, ,&%',)?)+,( *%% %'(+% +(?)+,( &,, (&(% 5%%5('% %&( %5,:'%+%()*( 1= ((# +%)*( (% 5,&% 5%(% (*%7% % % (5(% +( ()+, ',# ,()*, &@*'&, 5%% % <%''% () ()(%. D(7'+, % (*( ')&(, ), % 5,+'+, ;,;( % C('*, 5, %()%8% +( (*(# ,*';, 5, ( &% (*? (5%%+, +( <%''% ( ',. P, ( ,()*, ('+( () P%'% P%'% (*% % &'+%+, F)'&%()*( +( (%)% %,. %,.
ANTECEDENTES
P!"$%&'(): N, ((( *+'-&'(): -A5()+'&(*,@% -L%5%,*,@%- T,%&,*,@% 5, '5%&*, +( %% +( <(, -P'()% '8'(+% &,,&%&') +( 5%*'), 5, '5%&*, +( %% +( <(,
T%.'(): A&,,', +(+( %&( 12 %>, T!+"'(): G I5%&*, +( 7%%# &,) (&(% +( 5%%5('% F!!($%&'(: N, ((( A$&'(): N, ((( O(+!('3!$4): A+%)*( () &,)*&&') H5'"):C,)'+, +( PSA 5('&,# %'%)%
-A&,,
S4.+!$'7!7: ')'&', +( ;'+% (:% % *(5%)% (+%+ &,) F*'5( 5%(% ') ')(% FAMILIOGRAMA
C,, ( (;'+()&'% () % '%() % <%''% +( 5%&'()*( (*? &,)<,%+% 5, 5%+(# (%), (5,% ( ',# ( )F&(, <%''% +( J,%@) R%) D@%8# (*? &,5(*, 5, (5,% J,%)% ",)8%( &,) '()
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
ECOMAPA
E )F&(, <%''% +( J,%@) (*? &,)<,%+, 5, (5,% J,%)% ",)8%( ',# 5, ( ,()*, ), &,);';() )*, 5, <%&*,( (:*(), ( ( , '5'+() # 5(, ', (5,% ;%) % ;''*%, % % ( ('+( &,)*%)*(()*(# J,%@) +(7'+, % (*%+, +( 5%%5('% (*%+, +( +(5(') ), %&(5*%'()*, ( '5'+( *%7%% ;( &(&(# ()(>%# % &,) ', &,) <%''% () (5(&'% &,) %+( % (%&') ( ) 5,&, +'*%)*( ,*'# &,) (5(&*, % &@&, ,&'% ( (*% +(')*((%+, +(&(5&',)%+, (')+,( ( &, ( %(%,) ), ( 7')+%,) %5,, &%)+, , ('' *'()( )% (%&') <(*( &,) % ('') &(( () +', ) ( 5(,# ( % 5(% +( (*%+, () ( (+,# ( %%+(&( % +', ( (*? ;';, %)( &,) ''*%&',)( ( %<(% &, % 5%% 5,&(, +( %&(5*%&') 5%% (5()+( )(;, 5,(&*, %&% %+(%)*( % <%''%
ESCALA DE DEPRESION 8 ANSIEDAD DE GOLBERG
E) % (&%% +( %)'(+%+ ( 5%&'()*( J,%@) R%) D@%8 5(()*, =/9 5()*% %%*';,# () % (&%% +( +(5(') 5(()*, 6/9 5()*% %%*';%. E*, ( +(7( % %) '5%&*, 5'&,,&'% (,&',)% ( <', %&( %5,:'%+%()*( 1= (( +,)+( (*;, % '(, +( % (*(# , &% ( +(, &,, (&(% )% 5%%5('% ''*?)+,, +( %)(% +()'*';% +?*'&% % (%'8%&') +( +';(% %&*';'+%+(# %<(&*%)+, %@ +(%,, 5(,)% ,&'%# %>%+'()+, % (*, % '5,'7''+%+ +( 5,+( &,);';' &,) <%''%# % <%*% +( %5,, (,&',)% +( )') <%''% .
CICLO VITAL INDIVIDUAL 8 FAMILIAR
CICLO VITAL INDIVIDUAL E) % %+,(&()&'% ( ()%,%'()*, , % %'*%+ @)*'% &,) ,*% 5(,)% ';( % ,;() 5%% %% '+()*'+%+. A &,5%*' &,)&(5*, ()*''()*, &,) ,*% 5(,)%# ()*(% 5,5'% '+()*'+%+ ( (( ;(( (H(%+, () ( ( ( %% 5(+( %+% % +(*(')% &,) &%'+%+ '() ( .
E %+*, ,;()# J,%@) R%) D@%8 +( 24 %>, +( (+%+# ( 5(+( &,)&' ( % 5(%+, %+(&%+%()*( % %+,(&()&'% %)( &,) ;%', &(, ( %&%,) ;'+%# (*%5% () % &% +()' '+()*'+%+# (*%5% +%)*( % &% ,, +()' ,% (%&',)( %,,% ? ( &,) ;'') %&'% ( <*,# &,5(()*?)+,( ), % ,*, % 5%(% (5(*%)+, , (5%&', ,7(*';, +( &%+% ),# 5(( % % &'&)*%)&'% <,%,) )% <%''% ( %)( % +'*%)&'% ( ) <%&*, )(%*';, % ,%+, %)*()(( (*%7(
CICLO VITAL FAMILIAR F!'$'! 43 4.!3)'%3 &,) ', +( ) %>, ) 5(&,%# S%( (() (5()*';%()*(# , '5,*%)*( () (*% (*%5% ( ,% &,),'+% 7%( '+% +( )% <%''% &,) ;%,(# %, (5(*, ()*( *,+, , ')*(%)*(# %+(? ,% &,)(' )% %+(&%+% +'*'7&') +( *'(5,# (5%&', +')(,# 5%% %@ 5,+( <,% ) <*, 55(,.
ESCALA DE ULCERAS POR PRESION
E 5%&'()*( *'()( ) 5)*%( +( 14/20 5%% ( '(, +( +(%,% &(% 5, 5(')# +(7'+, % (*%+, +( 5,*%&') % ( (*%+, ('(( +(+'&%&') &,5(*% 5, 5%*( +( &'+%+, (;%)+, %&%7, % (+'+% %)*'(&%%# '() (*? % &%, ), ( 5(+( +% % 5,*(&&') )(&(%'% ( (*( ('(( *'()( %*, '(, 5%% +(%,% &(% 5, 5(')
ESCALA DE NUTRICION 9MINI NUTRITIONAL ASSESSMENT MNA E 5%&'()*( ((( ( 5, (*%+, +( %+')%'% %*()'% % (5(8%+, % &,( (),# +(+( ( (*% 5,*%+, % *()'+, )% 5+'+% +( 5(, ')'&%*';% +(7'+, % % ''*%&') ( 5,+&( ()<((+%+ +( 7%( ( ()(, +(')*( 5, %+# ( 5%&'()*( ( ()&()*% () ) (*%+, +( % )*'&') &,) 5)*%&') (), +( 1G
INDICE DE BARTHEL P%&'()*( ,7*;, )% 5)*%&') +( 1=/100 () (*% (&%% +( ;%,%&')# % &%5%&'+%+ <)&',)% ( ()&()*% &%%()*( &,5,(*'+%# &%*%,?)+,, () )% +(5()+()&'% *,*%.
APGAR FAMILIAR
L% <%''% ( ) 5'% '5,*%)*( ), ,, () ( 5,&(, ()(%+, +( % ()<((+%+ '), () ( +( (%7''*%&')# 5,+(, ,7(;% )% 5)*%&') +( 9/20# , ( ')+'&% (+'%)% %*'<%&&') &,) ( <)&',)%'()*, +( % <%''%
ESCALA DE HOMES 8 RAHE E*% (&%% '+( %&,)*(&''()*, (*(%)*( () % ;'+% ( 5(+() &,)*'7' % ( % 5(,)% +(%,() )% ()<((+%+. E %7( (*%+, () 5'') 63 5)*,# &,), +( +,% , %&,, G0 5)*,# &%7', () % %&(5*%&') +( , &,5%>(, 6G# 5%% ) *,*% +( 5)*, +( 200# 5, , &% *'()( ) '(, +( ()<((+%+ ,+(%+,. REVISION POR SISTEMAS •
SINTOMAS GENERALES: ((( @)*,% 7'8%, +( %+')%'% %*()'%.
•
PIEL 8 FANERAS: 5%&'()*( ((( ;(( 5?'+,# )'(% 5(()&'% +( 5(*('%# ('*(% 5?5%.
•
OJOS: )'(% +'5,5@%# (5'<,%# <,<(),# )'(% 5(+'+% +( % %+(8% ;'%.
•
OIDOS: ((( (&&% 7'() ,)'+, +( %*% 7%% ')*()'+%+# )'(% '5,%&'%# )'(% *'))'*# ;*',.
•
NARIZ: ((( 5(()*% )% %+(&%+% %+(8% ,<%*,'%# )'(% &%*%,.
•
BOCA: )'(% %<*% , %F) *'5, +( (') &(%*';% () &%;'+%+ ,%.
•
SISTEMA CARDIOVASCULAR )'(% *()( +,, 5(&,+'%# 5%5'*%&',)( ,*,5)(%.
•
SISTEMA RESPIRATORIO: ((( %&&(, +( *, (&()*( % , %, +( +@%# +'<,)@%
•
SISTEMA GENITOURINARIO: ((( +'(' +(5,'&',)( ),%(# )'(% @)*,% ')%',.
•
SISTEMA
MUSCULO
ES*UELETICO
)'(% %*(%&',)( () % %&%# ((( +,, *,?&'&, +'<,.
E;AMEN FISICO S'&3) <'"!$4): TA.12=/90
FR.1G
FC=GG
TALLA 1#60
T 3G.=K
PESO =0"
SO29G
GLASGO> 1=/1=
5(()*%
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
PARACLINICOS
CUADRO EMATICO 0=/04/20 10/04/20 11/04/20 14/04/20 1G/04/20 19/04/20 20/04/ 16 16 16 16 16 16 RECUENTO DE LEUCOCITOS NEUTRO!ILOS LIN!OCITOS MONOCITOS EUSINO!ILOS BASO!ILOS REC. DE "LOBULOS ROJOS EMO"LOBINA EMATOCRITO VMC CM CCM ANCO DE DISTRIB. DE LOS ERITROCITOS IDE PLAQUETAS PCR
20.2 91.3 6.4 1.= 0.4 1
9.G 6G.4 19.= 9.2 0.9 1
.1 G=.= 19. 2.= 1.6 6
.3 G9.6 1G.0 1.G 1.= 0.2
9.2 G9. 1=.9 2.= 1.6 0.2
G9.G 16.0 2 2.1 0.2
6.4 G.3 19.0 1.= 1 0.2
4.G 9.0 31.2 66. 19.30 2.0
3. G.6 24.9 66 20.2 30.=
3. G.6 2= 6=.3 19.0 30.40
3.= G.6 23.9 6G.= 21.=0 31.0
3. G. 2=.= 6G.9 21.90 31.G0
3.= G.3 24.1 69.1 20.90 30.30
3. .3 26.G 69.= 21.6 31.1
1=. 3= 36G.0=
1=. =4 99.41
1=.2 6G4 GG.G1
16.9 =10 =4.==
1.2 =3= 2G.2G
19.2 =03
19.G == 3G.3
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
()'7( % (,5(# 5, , &% 04/1/2016 ( ')'&'% (,5( 1 &/ ';
CLORO POTASIO SODIO CREATINI NA BUN
QUIMICA 0=/04/20 11/04/20 14/04/20 1G/04/20 19/04/20 16 16 16 16 16 100 104 101 10= 103 3.G9 3.=G 3.10 3.39 4.0G 13G 1.3 13= 1.3 1.36 0.3 6.9
0.=3 1.90
E) 5%%&@)'&, +( &,)*, +( ((&*,'*, 5(()*, ) '5,%('% +( 3.10 5, , &% ( ')'&' %)(, &,) ',) 5%% ((*%7(&( (*( +(,+() ',) 10 && &%+% &,) , &% 5,(, (, % )';(( ),%( &,) ) ;%, +( 4.0G
-C,, ( (;'+()&'% () % (*% +( (&(&') +( (&%% ( %'%,) +, '&,,%)', 1 P(+,),% %('),% 5, , &% ( ')'&' 5'5(%&'')% *%8,7%&*% ( +(&'+' (;% %*% ( +@% G 2 S*%5,&,&& %( 5, , &% ( ')'&' &')+%'&')% (;% %*% ( +@% G
-
S( ();' +'&, &*';,# 5, (&(&') 5%*';% <*'+% +( 5()(# () ( &% ( %' A&')(*,7%&*( 5 *'('*()*(# ( &% ,*, ()'7''+%+ %'%&')%#''5()( (,5()(
10/04/16 S( ( (%'8, ) 5(7% +( VI 5, %)'<(*% 5?&*'&% (:%( ')(% ') 5,*(&&') %,&'%+, % (*, )% 5+'+% +( 5(, ')'&%*';% F*'5( %+(),5%*@% ')')%( 5%&%;'&%(
DIAGNOSTICOS POR EJES:
EJE 1: CICLO VITAL INDIVIDUAL
CICLO VITAL INDIVIDUAL: A+*, ,;() TAREA: I)*''+% PELIGRO: A'%'()*, LOGRO: S()*'+, +( % )%'+%+
EJE 2: CICLO VITAL FAMILIAR
FAMILIA EN E;PANSION
Fase de expansión, se inicia con el nacimiento del primer hijo, al que pueden seguir otros, Helen de 6 años y Samuel de 1 año. La aparición de nueos miem!ros en la "amilia precisa de los padres un n#mero mayor de reajustes con un eleado n#mero de responsa!ilidades ya que cam!ian las prioridades de la pareja, pro!a!lemente, nos encontremos en la "ase de adaptación m$s di"%cil que su"re la pareja, de tal "orma que uno o am!os padres de!en hacer "rente con decisión a los cam!ios necesarios para lograr una "amilia que progrese y "ormen "undamentos "irmes !asados en amor, responsa!ilidad y respeto. &l reto en este momento consistir$ en equili!rar la pr$ctica ha!itual para el adecuado "uncionamiento "amiliar con la autonom%a, con"ian'a e independencia que reclaman los hijos a esas edades, sin perder la relación de intimidad arraigada en la pareja. ( el peligro que se deria de esta "ase es incurrir en la so!reprotección y excesio control de los hijos, que prooque un sentimiento de descon"ian'a e inseguridad e impida el proceso natural y el correcto desarrollo de los menores FASES DE LA FAMILIA EN EXTENSION •
nacimiento del primer hijo
•
permea!ilidad de agentes externos
•
autonom%a, con"ian'a e independencia de los hijos
•
mantenimiento de la intimidad conyugal
•
Peligros: so!reprotección, descuido de la relación %ntima y del amor conyugal
EJE @: FACTORES DE RIESGO -
?7'*, &,, ( *%7%',# %&,,',# &,), +( PSA# '(, +( <' &(% 5, 5(')# %*'*'
EJE : PROBLEMAS CLINICOS DEL PACIENTE SECUELAS DE TRAUMARA*UIMEDULAR A NIVEL DE T12, ASIAA ULCERAS SACRAS SOBREINFECTADAS GRADO IV ANEMIA MICROCITICA NORMOCROMICA E 5%&'()*( J,%@) R%) D@%8 &,, %)*(&(+()*( '5,*%)*( %&( %5,:'%+%()*( 1= (( <' ) *%% %'(+% 5, ('+% +( %% +( <(, % )';( +( T12- ASIA-A# &,5,(*')+,( *,*%()*( % <)&') ,*,% &,5,)()*( (),'% 5((;%+, 5%% , (()*, S4 S=#+(%)+,( ) (*%+, +( 5,*%&') +(5()+()&'%. E) ( (:%() <@'&, ( ,7(; (5%*'&'+%+ *'5, %)&, () '(7, ')<(',(# 5, , &% % ,()*, +( ((, ( ();' ,+() 5%% *(%5'% <@'&% ')(*'&%# 5%% (;'*% 5,(') +( (*,# (,% () %)% (+'+% &%'+%+ +( ;'+%
D(7'+, % (*%+, +( +(5()+()&'% <%*% +( (&,# ), ( (%'8% , &,)*,( +'&, *(%5'% &,(5,)+'()*(# (*, ''*?)+,, % &%7', +( ,)+% ;('&% &%+% ( &5( &'&, 5(+'5,)')+,, % ')<(&&',)(# )% %'()*%&') %+(&%+% ( ( 7')+( *,+, , ((''()*, )*'&',)%(# () ( (,%% +( ')(, (5,*, )% (,,7')% () 9.0 VCM66. CM19.30 , &% ')+'&% )% %)('% '&,&'*'&% '5,&,'&% &%% 5,+@% +(7(( % )% %)('% <(,5()'&% +( ,'() &%()&'%. E) ( ,()*, ,, (*? % &%, +( # (%)% ( (*? (7%%8%+%# % &% ), ( 5(+( +(+'&% ( *'(5,
, &'+%+, %+(&%+, 5, % &,)+'&',)( *%) 5(&%'% () ( ;';() R((( ( %5,:'%+%()*( G (( ;'()( 5(()*%)+, )% &(% () (') %&% % &%( (*%7%) '()*, *%*%+% +(+( &%% % ,()*, +( ')(, % (;'&', % &(% (*%7%) ,7(')<(&*%+%# &,) ) +'?(*, %5,:'%+%()*( +( 13 & 5,<)+'+%+ +( 10 & 5()*%# <*'+%# &,) &,)*()'+, %),%*,, &,5,', +( (,# &%'&?)+,( () (&%% %&% ,7(')<(&*%+% %+, IV
CLASIFICACION DE LAS ULCERAS POR PRESION 9UPP SEGN EL PANEL EUROPEO DE UPP
L% F&(% 5, 5(') &,)*'*() ) *'5, (5(&'% +( (',)( &%%+% 5, ) *%*,), +( ''%&') %)@)(% )*'&') *'% &,, (*%+, +( 5(') 5,,)%+% ,7( 5,')()&'% (% , &%*'%'),%. AF) ( *''8% ( *'), +( F&(% 5, +(&F7'*,# ( ( (%+,. L% (',)( ), ,, ( 5,+&() () 5,'&') 5')%# '), *%7') () , 5%&'()*( &,))%+, % % '% +( (+%. C,, ( (&%)', 5',+'% ( % 5(')# ( 5(<('7(
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
POLIFARMACIA DE JOA*UIN DIAZ SALCEDO PIPERACILINA TAZOBACTAM M4(!3') 74 !(('%3 L% 5'5(%&'')% ( ) %)*'7'*'&, 7(*%%&*?'&,# 5')&'5%()*( 7%&*('&'+%. I)'7( % *(&(% F*'% (*%5% +( % @)*(' +( % 5%(+ &(% 7%&*('%)% )')+,( 5(<(()*(()*( % % 5,*(@)% +( )') % 5()'&'')% PBP (5(&@&% ( ( ()&()*%) +()*, +( % 5%(+ &(% 7%&*('%)%. C,, *,+, , %)*'7'*'&, 7(*%-%&*?'&,# % &%5%&'+%+ +( 5'5(%&'')% 5%% ')*(<(' &,) % @)*(' +( % 5%(+ &(% PBP (+'%+% () F*'% ')*%)&'% &,)+&( % % '' &(%. E*% '' (*? (+'%+% %*,'')% +( % 5%(+ &(%. L% (%&') ()*( PBP %*,'')% (*? &%%# 5(, ( 5,'7( ( ( %)*'7'*'&, 7(*%-%&*?'&, ')*((% &,) ) ')'7'+, +( %*,'')%. E *%8,7%&*%# ( ) ')'7'+, '(;('7( +( % 7(*%%&*%%%. E *%8,7%&*% (;'*% ( % 5'5(%&'')% ( +(*% 5, 7(*%-%&*%%% *'5, R'&,)+ S( II# III# IV# V# % 5()'&'')% (*%,&&'&% % 7(*%-%&*%%% +( %5', (5(&*,
I37'(!('%3 43 4$ !('43"4: S , <( ')+'&%+, % ( () ( &*';, ( ( (%'8 % % (&(&') +( (&%% ( %' P(+,,)% %('),% # , &%( () ( %)*'7',%% +(,*%,) ( ()'7( % PIPERACILINA TAZOBACTAM#
D)') +"'$'!7! 43 4$ !('43"4: 4#= EV C/6,% E4(") )4(+37!'): I),)',# &(<%(%# &,)<')# &,);',)(# %# 5'*,# (+(%# +'%(%# &,)*'5%&')# )?(%# ;'*,
C3"!'37'(!('34): '5(()'7''+%+ % 5'5(%&'')%# *%8,7%&*%# 5()'&'')%# &(<%,5,')%# ')'7'+,( +( 7(*%%&*%%% , % % ), +( &,5,)()*(
CLINDAMICINA M4(!3') 74 !(('%3: S( )( % % 7)'+%+( =0S +( , '7,,% 7%&*('%),# ')'7'()+, % @)*(' +( 5,*(@)%. D(5()+'()+, +( &,)&()*%&') () ( % +( %&*%&') +( % &(5*'7''+%+ +( '&,,%)',# ( 7%&*(',*?*'&% , 7%&*('&'+%. L% &')+%'&')% ( %&*';% <()*( % )% %5'% ;%'(+%+ +( ()(
I37'(!('%3 43 4$ !('43"4: S , <( ')+'&%+, % ( () ( &*';, +( (&(&') +( (&%% ( *%7') ( %' S5*%,&,&& %( ( ,*, ( ()'7( % % &')+%'&')%
D)') +"'$'!7! 43 4$ !('43"4: A5,% 600 # 1 %5. EV C/6,% E4(") )4(+37!'): +,, () % %*'&%&',)(# %&'+(8 (*,%&%# *'&%'%
C3"!'37'(!('34): ( ()&()*% &,5(*%()*( &,)*%')+'&%+% () 5%&'()*( &,) %)*(&(+()*( , '*,'% +( (%&&',)( %'&% % CLINDAMICINA % ')&,'&')%. E) 5%&'()*( &,) ')&'()&'% (5?*'&% , ()% ( ('(( %*% % +,'
VANCOMICINA M4(!3') 74 !(('%3: S,) %)*'7'*'&, +( (5(&*, (*')'+, <)+%()*%()*( % 7%&*('% "% 5,'*';%. A&*F%) % )';( +( % 7',@)*(' +( % 5%(+ &(% +( 7%&*('% () +';'')# ')'7'()+, % @)*(' +( 5(5*'+,'&%), () ()+% <%(# ) (*%+@, 5(;', % ,()*, +( %&&') +( , 7(*%%&*?'&,# 5, , ( ), % ('*()&'% &8%+% )' &,5(*()&'% 5, , '*', +( )'). S(&)+%'%()*( % ;%)&,'&')% %&*%@% 5, ,*, (&%)', &,, ( % %<(&*%&') +( % 5((%7''+%+ +( % (7%)% &'*,5%?*'&% ( ')'7'&') +( % @)*(' +( ARN# ( ( ((&( +(5 ( (
I37'(!('%3 !$ !('43"4: S , ' <( %5,5'%+, 5, % ,5(&% +( ,*(,'('*'
D)') +"'$'!7! 43 4$ !('43"4 !COS.=00# 2 !COS EV C/12,% E4(") )4(+37!'): *,7,H(7'*' ;'') 7,,%# *')'*# (,%'% , (','
C3"!'37'(!('34) '5(()'7''+%+ % (*( %)*'7'*'&, &,, &,)*%')+'&%&') (%*';% 5%&'()*( &,) ')&'()&'% ()%
MEROPENEM M4(!3') 74 !(('%3: B%&*('&'+%. I)'7( @)*(' +( 5%(+ &(% 7%&*('%)% () 7%&*('% "% "%-# '?)+,( % 5,*(@)% +( )') % 5()'&'')%
I37'(!('%3 !$ !('43"4 S , ' <( ( %+(&%+, +(7'+, % ( () ( &*';, +( % (&(&') +( 5()( ( ', A&')(*,7%&*( 5. Q( () ( %)*'7',%% ,*, ()'7''+%+ % (,5()(
D)') +"'$'!7! 43 4$ !('43"4: 1 &/,% E4(") )4(+37!'): T,7,&'*,5()'%# &(<%(%# )?(%# ;'*,# +'%(%# +,, %7+,')%# %# 5'*,# %()*, +( *%)%')%%# <,<%*%% %&%')% %)@)(% +('+,()%% ?&*'&% %)@)(%
C3"!'37'(!('34): '5(()'7''+%+ % &%7%5()'&, ( '5(()'7''+%+ %;( % -%&*?'&,.
ENO;APARINA M4(!3') 74 !(('%3 : BPM. I)'7( % &,%%&') 5,*()&'%)+, ( (<(&*, ')'7'*,', +( % %)*'*,7')% III ,7( , <%&*,( II% $%. P,(( ((;%+% %&*';'+%+ %)*'-$% +7' %&*';'+%+ %)*'-II%
I37'(!('34) !$ !('43"4 S , ' <( ( %+(&%+, &,, %)(% 5,?&*'&% 5, ( (*%+, +( (*%' +( 5%&'()*( 5,*%&')
D)') +"'$'!7! 43 4$ !('43"4: A5.40 . 1 %5. &/24 E4(") )4(+37!'): (,%'% *,7,&'*,' *,7,&'*,5()'% (%&&',)( %'&% %()*, +( ()8'% (5?*'&% 5')&'5%()*( *%)%')%% *'&%'%# 5'*,# ('*(% (%*,%
C3"!'37'(!('34): '5(()'7''+%+ % 5')&'5', %&*';,# (5%')% , +(';%+, ')&()+, BPM. (,%'% ')*()% %&*';% , &,)+'&',)( +( %*, '(, +( (,%'% ')&()+, '&* (,?'&, (&'()*(. '*,'% +( *,7,&'*,5()'% , *,7,' 2 %'% % (),:%5%')%. E)+,&%+'*' 5*'&%.
FUROSEMIDA M4(!3') 74 !(('%3: D'*'&, +( %%. B,(% ( '*(% +( *%)5,*( N% C - () % %% +(&()+()*( +( %% +( ()(# %()*%)+, % (:&(&') +( N%# # C% M.
I37'(!('34) !$ !('43"4: S , <( ( %+(&%+, 5,( ( 5%&'()*( *;, (+(% ()(%'8%+, () % 4 (:*('+%+( ,*, ),*%7( (,@%
D)') +"'$'!7! 43 4$ !('43"4 A5. 20 # %5'&% &/12 ,% E4(") )4(+37!') '5(()'7''+%+ % <,('+% , <,)%'+%. '5,;,('% , +('+%*%&'). I.R. %)F'&%. '5,5,*%('% , '5,)%*('% %;(. E*%+, 5( &,%*,, &,%*,, %,&'%+, % ()&(<%,5%*@% (5?*'&%. L%&*%)&'%.
C3"!'37'(!('34): A*(%&',)( ((&*,@*'&%# +('+%*%&') ( '5,;,('%# )';( +( &(%*')')% () %)( ((;%+% )';( +( *''&'+, () %)( ((;%+, %()*, +( ;,() +( ,')% '5,*()') ')&()+, '5,*()') ,*,*?*'&%
RANITIDINA M4(!3') 74 !(('%3 A)*%,)'8% , (&(5*,( 2 +( % '*%')% +( % &% 5%'(*%( +( (*%,. I)'7( % (&(&') (*'%+% 7%% +( ?&. ?*'&, (+&( % 5,+&&') +( 5(5')%
I37'(!('34) !$ !('43"4: S , <( &,, 5,*(&&') %*'&% D)') +"'$'!7! 43 4$ !('43"4: TAB. 1=0 # 1 *%7 VO &/24 E4(") )4(+37!') ;'*,# &%%7( %7+,')%(. C3"!'37'(!('34): '5(()'7''+%+. P,'% %+% METOCLOPRAMIDA M4(!3') 74 !(('%3: A)*%,)'*% +( (&(5*,( +,5%')'&, D2 +( (*'%&') ''&,&(5*,% () ( &()*, (*'&, +( % +% '5'&%+% () % %5,,)%
I37'(!('34) !$ !('43"4: D(7'+, % ;%', (5',+', ('' +( &,)*()'+, %'()*%', 5,*(',()*( 7'',,
D)') +"'$'!7! 43 4$ !('43"4: A5. 10 # 1 %5. C/12,% E4(") )4(+37!'): S,),()&'%# +'%(%# %*()'%# *%*,), (:*%5'%'+%(# 5%'),)',# +(5(')# '5,*()').
C3"!'37'(!('%3: (,%'% %*,')*(*')%# ,7*&&') (&?)'&% , 5(<,%&') %*,')*(*')%
ION ?
M4(!3') 74 !(('%3: C,(&&') +( % +(5(&',)( () , )';(( +( 5,*%',
I37'(!('34) !$ !('43"4: S , <( +(7'+, % )% '5,%('%# ( 5,*(',()*( <( &,('+%
D)') +"'$'!7!) 43 4$ !('43"4: I,) (':( 10 && &/,% E4(") )4(+37!'): S'*(% +'(*';, )%(%# ;'*,# +'%(%# %(*% %7+,')% '5(&%('%.
C3"!'37'(!('34): '5(&%('%# &%'(% ( (% &%%# %&'+,' (*%7'&%
ANALISIS Y PLAN
PACIENTE ADULTO JOVEN CON ANTECEDENTES DE TRAUMARAQUIMEDULAR A NIVEL DE T12# ASIA-A# CON SECUNDARIA PARAPLEJIA# QUIEN SE ENCUENTRA OSPITALIZADO EN EL CONTE$TO DE SINDROME !EBRIL DE ETIOLO"IA POR !OCO IN!ECCIOSO A NIVEL DE TEJIDOS BLANDOS POR ESCARAS SOBREIN!ECTADAS EN RE"ION SACRA# CUADRO EMATICO CON !RANCA RESPUESTA IN!LAMATORIA# NEUTRO!ILIA#TROMBOCITOSIS# LEUCOCITOSIS. EL CUAL !UE MANEJADO INICIALMENTE CON ANTIBIOTICOTERAPIA PIPERACILINATAZOBACTAM Y CLINDAMICINA COMPLETANDO ESQUEMA G/G# SE REALIZA EMO"RAMA DE CONTROL EL CUAL PRESENTA LEUCOCITOSIS RECIDIVANTE CON NEUTRO!ILIA#LIN!OCITOSIS Y PCR AUMENTADA. DECIDIO POR ENDE ESCALONAR MANEJO ANTIBIOTICO A VANCOMICINA POR POSIBLE OSTEOMELITIS Y MEROPENEM A LA CUAL ES SENSIBLE ACINETOBACTER SSP AISLADA EN SECRECION URETRAL. AL DIA DE OY EL PACIENTE SE ENCUENTRA EMODINAMICAMENTE ESTABLE# SIN SIRS# SIN SI"NOS DE DI!ICULTAD RESPIRATORIA# LAS ESCARAS EN MEJORES CONDICIONES LIMPIAS SIN SECRECION ACTIVA AUNQUE SON PRO!UNDAS. TIENE ADEMAS UNA COLONIZACION POR ACINETOBACTER BAUMANNII EN SECRECON URETERAL. NO TIENE SI"NOS DE IN!ECCION ACTIVA# EL
EMO"RAMA ESTA DENTRO DE LOS RAN"OS NORMALES. TIENE UNA ANEMIA ASOCIADA DE TIPO !ERROPENICO POSIBLEMENE CARENCIAL.EL PACIENTYE EN EL MOMENTO CUMPLE CRITERIOS PARA SALIDA# SE DA LA ORDEN PARA LA "AMMA"RA!IA OSEA PELVICA DE SER POSITIVA DEBERA SER TRATADA POR ORTOPEDIA DE !ORMA AMBULATORIA# ORDEN DE TERAPIA !ISICA PARA TRATAR ESPASTICIDAD EN MIEMBROS IN!ERIORES# ADEMAS SE DA ORDEN DE TERAPIA ENTEROSTOMAL# SE !ORMULA SUPLEMENTO DE SUL!ATO !ERROSO# SE LE DAN LAS RECOMENDACONES PARA EL MANEJO DE ZONAS DE PRESION Y CUIDAOS DE PIEL.
BIBLIOGRAFA •
•
•
•
•
•
•
•
•
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` !EDESALUD. "@% +( %)(, +( % ()<((+%+ ()% &)'&% ` ERC. 200=. 201= ACC/AA/RS "'+(')( <, *( M%)%(()* ,< A+* P%*'()* a'* S5%;()*'&% T%&&%+'% A R(5,* ,< *( A('&%) C,(( ,< C%+',,/A('&%) (%* A,&'%*',) T% !,&( ,) C')'&% P%&*'&( "'+(')( %)+ *( (%* R* S,&'(*. 201= A)*'*,7,*'& %)%(()* ') 5%*'()* )+(,') ((&*,5',,'&% 5,&(+( % E,5(%) (%* R* A,&'%*',) ERA 5,'*',) +,&()* ()+,(+ 7 *( ESC a,') ",5 T,7,'# (%* R* S,&'(* RS# %)+ A'% P%&'& (%* R* S,&'(* APRS
•
•
•
•
•
•
"@% +( P?&*'&% C@)'&% +( ACC/AA ESC 2006 ,7( ( %)(, +( 5%&'()*( &,) %'*'% ;()*'&%( % 5(;()&') +( % (*( &%+'%&% F7'*%. V(') ('+%. L%W( CMM# V%)+( ,) S# R,+( A# <, *( I)*()%*',)% S,&'(* ,< 5(*()',). ",7% 7+() ,< 7,,+ 5((-(%*(+ +'(%( 2001. L%)&(* 200 3G11=13`1=1. M%)&'% "# +( B%&( "# D,')'&8% A# C'<,;% R# !%%+ R# "(%), "# (* %. 200G "'+(')( <, *( M%)%(()* ,< A*('% 5(*()',)# T( T% !,&( <, *( M%)%(()* ,< A*('% 5(*()',) ,< *( E,5(%) S,&'(* ,< 5(*()',) ES %)+ ,< *( E,5(%) S,&'(* ,< C%+',, ESC. J 5(*() 200G 2=110=`11G. L%)% !# A;(8 A# B%*'*% LE# D@%8 R# L)% M# I% S# (* %. INTEREART I);(*'%*, ') L%*') A('&%. R' <%&*, <, %&*( ,&%+'% ')<%&*',) ') L%*') A('&% *( INTEREART L%*') A('&%) *+. C'&%*',) 200G 11=106G`10G4. P(+')' MT# L(;( AS# L% J# C%( TC# a%) P. T( (b(&* ,< +'(*% 5,*(') (*'&*',) ,) *( 5,(',) ,< +'%7(*'& ()% +'(%( % (*%%)%'. A)) I)*() M(+ 1996 12462G`632. S,W( JR# E5*(') M# !,'& ED. D'%7(*(# 5(*()',)# %)+ &%+',;%&% +'(%( %) 5+%*(. 5(*()',) 2001 3G10=3`10=9.
