MINISTERUL EDUCAŢIEI NATIONALE
ŞCOALA POSTLICEALĂ POSTLICEA LĂ SANITARĂ SANITARĂ „CAROL DAV DAVILA” BUCURESTI
PROIECT PROIECT DE ABSOLVIRE ABSOLVIRE DOMENIU: SANATATE SI ASISTENTA PEDAGOGICA CALIFICARE PROFESIONALA: PROFESIONALA : SANATA SANATATE SI ASISTENTA PEDAGOGICA
COORDONATOR: PROF. ALBU LUIZA ABSOLVENT: Defta Ma!a" A#!a" A#!a" CLASA III$F BUCURESTI %&'(
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INGRI)IREA INGRI)I REA PACIENTULUI PACIENTULUI CU AFECTIUNI ALE GLANDEI TIROIDE
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INGRI)IREA INGRI)I REA PACIENTULUI PACIENTULUI CU AFECTIUNI ALE GLANDEI TIROIDE
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CUPRINS MOTTO INTRODUCERE CAPITOLUL 1 1.1 NOŢIUNI DE ANATOMIE SI FIZIOLOGIE 1.2HORMONII TIROIDIENI 1.3HORMONII HIPOTALAMICI HIPOTALAMICI SI HIPOFIZARI 1.4HIPERTIROIDISMUL 1.4HIPERTIROIDISMUL ŞI HIPOTIROIDISMUL
CAPITOLUL 2 2.1 GLANDA TIROIDA 2.2 DEFINITIE 2.3 SIMPTOMATOLOGIE 2.4 DIAGNOSTIC 2.5 EVOLOUTIE,COMPLICATII SI PRONOSTIC 2.6 TRATAMENT 2.7 PROFILAIE
CAPITOLUL 3! 3.1 INGRI"IRI SPECIFICE ACORDATE PACIENTULUI CU AFECTIUNI ALE GLANDEI TIROIDE 3.2STUDIU
CONCLUZII #I#LOGRAFIE ANEE
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MOTTO
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NOŢIUNI DE ANATOMIE SI FIZIOLOGIE
5
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GLANDA TIROIDA DEFINIŢIE G)%&% '$+'> (( -(% %' %$( *)%&> % '(0)0' (&+-$'& 0%&, %$( + *$(0%(% ( 5=6 * )% &+0= &>-0, %'&*& + *$(0%( ( 15=1 * )% %0) ;(( %' %$( )% ((' (- )% 8%$8%' ș' (( '0%> @& $(*'0&(% %&($+=)%($%)> % *%0)0'. G)%&% '$+'> ;*)%&0)% J$+'(%< (( 0& +$*%& &(($(-( ( -0)+%$( *>)80'(=$+9, -0 + -+&'(& ț> +%)(, -&>$'& 1=3 *$, %& +' )+8' ( +$> +%)>, -( ( '0& ( + %$( ș' ( %)% % )%$'&*()0' ș' $%('', 0&'ț' $'&$=0& ' @& 5=6B '& -%90$', + $()0&*'$(, )+80) '$%'%), ( @&'&( @&$( +0) '+'. A$( + -%0)> $+$'( -( $''( $()0&*'$' @& '&($'+$0) *)%&('. E% (( @&()'> @&$=+ (08)%$( % %-'(' -($'-%)( '/)+-'', %($(&> ( $%((, (%-% %-0)+&($+%> @& -%$( ( %)> %$($% -%$+'>, (&% /0*0)%$> ș' &($0) %*. A&($'+$, *)%&% '&( @& $%+$ -0 0ș-'' 08'+''(&'. &$( -%0)% $+$'( ș' -%0)% '8$+%>, ((&(&> % %-'(' -($'-%)( '/)+-'', ( %)> +($'+$, *)%&()( %$%'$+'(. I$'*%ț'% %$($'%)> (( %'*0$%> ( %$($()( '$+''(&( 0($'+%$> ș' '&($'+%$> (&()( ( (-' @& (&()( /0*0)%$( ș' $0&-'0) (&+ 8$%'+-(%)'- &*. L'%'-()( ($* @& *%&*)'+&'' -($'-%)' $+0&9' ș' $($%(%)'. I&($%ț'% (( %> ( $%0$' '& &($'' )%$'&*'(&' 0($'+$ ș' '&($'+$ ș' '& -(' $(' *%&*)'+&' '%'-' -($'-%)'. ETIOPATOGENIE & '0&+%+*(&(9% %-((' 8+)' 0& $+) -('( @) /+%-> %&'-+$'' @+$'% $(-(+$0)0' (&$0 TSH ;TRA8, TSH $(-(+$ %&'8+'(<. A-('% 0& '&('9%?' )% &'()0) )'+-'()+$ # '$+''(&( ' + %(% 0& ((- '0)%+$ (($'&& -$(($(% '&(9(' ' (-$(?'(' ( HT %$ ' $+)'($%$(% -()0)%$> ' -%%$(% '+0)0'. E:'> ' %&'-+$' 8)+-%&?' %0 &(0$'' %' $(-(+$0)0' (&$0 TSH, 0&'' %-'(&?' %& -+&-+'(& @& ($ % %&'-+$' 8)+-%&?' - ' -0 ((- '0)%+$, %00) )+$ -)'&'- ('&9& ( $%+$0) '&$( %-('%. & '$+'% 8+)&%')+$ ( $(*>(- +%( '0$')( ( )'+-'( T ;LT< @&> $(+'&> LT ()($ ;-0 $+) ((&?'%) @& '0)%$(% $+0-?'(' ( %&'-+$'< @& ($'(&0) LT -'++:'-(. 11
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
DIAGNOSTIC D'%*&+'-0) = %$( 0$>+%$()( (%(! 1. D'%*&+'-0) +9'' %&%&(9%, (:%(&0) -)'&'- ' (:%'&>$')( %$%-)'&'-( 2. D'%*&+'-0) '($(&?'%). 1 D'%*&+'-0) +9'' : ( %8')(( ( 8%9% %&%&(9(' ;(80 8$0- ( ' '&(-?'+<, (:%(&0)0' )+-%) ;(&()( -()'(&(< ' (:%(&()( 8'+)+*'-( ;)(0-+-'+9%, VSH -$(-0, P#I +($% -$(-0, RIC +%$( -%90<. ! P0&-?'% 8'+'( %8')(( ( $(*0)> '%*&+'-0). 14
A&%&(9% ! '+$'-0) 8+)'' E:%(&0) -)'&'- ! S'+()( )+-%)( -+&%0 '& ($%% -)%'-> % +$'->$(' '&)%%?'' ! = 0+$! '($$+'( '$+''%&% %((% %$-%>, -0 '&($(%$( *)+8%)> %0 )+8%$>, -0 -+&'(&?% 1 0&'+$> ' $(&'(&> '& -()( &(00$%'(, %0 -0 9+&( ( )0-0(&?>, -0 (&'&?% )% %8-(%$( '& -()( 00$%'( = +)+$! '$+'% (( 0$($+%> +&%& %0 )% %)%$(, 0$($( '$(- $++$'+&%)> -0 '(9% -0 -%$( '&)%%?'% (($'&> + $('0&( (:%*($%> %0$% -%0)(' '$+''(&(. M+8')'9%$(% *)%&(' $'& (*)0'?'( %0 %)%$( '&(&''-> 0$($(% = -%)+$! $(*'0&(% %(-%> (( -%)> = $08+$! -0)+%$(% (*0(&()+$ '& 9+&% '&)%%> (( $+0=%$'&, %$'%8')> '& 0&-?'( ( (+)0?'% '&)%%?'(' ', ((&0%), % $+8+)(8'(' (&()+$ /0*0)%$( (:($&(. = S'+( $(*'+&%)(: %(&+%'(, 0&(+$' (($> ' 0$($+%> % )%&?0)0' *%&*)'+&%$ )%($+-($'-%), '$%'($(% 0$($'' '& 9+&()( ( (-'&>%(, $(*'0&(% %&($'+%$> % *%0)0', 0$(-', %$'&*(, -%, (&+(&( ( -+$('( %0$% %()+$, $%((', (+%*0)0' (-. = S'+( *(&($%)(: %-(&'0&( ($'-> 34, $'+%&( '&(&( ' $((%(, -0$8%0$>, -(%)((, '%)*'', %$$%)*'', %(&'(. G)%&% %$'> ( +)0 -0 (*0(&( ((%?'%(, ($'(%+%(, -0 '($($'( )+-%)>. P%)%$( = '$+'% ( -+&'(&?> -$(-0>, 0$($+%> F)0-0(&% %8-( E:%(&()( %$%-)'&'-( 1. L(0-+-'+9> -0 &(0$+')'( 2. V%)+$' -$(-0( VSH ;VSH 1 < 3. V%). -$(-0( *%% ' %)% 2=*)+80)'&(. 4. S-'&'*$%% '$+''%&> = 9+&% &(-%%&>, '09>. 5. E-+*$%'( = '&'?'%) '+(-+*(&, $%&+&'- )% -+&'0'$(% %8-(0)0'. 6. H(+-0)0$% +%( '9+)% 0&(+$' %*(&0) %+*(&. 7. R%'+'++-%%$(% '& )''( &+$%)(. . P0&-'( . P$()(%$( 0$+' ' '9+)%$( %*(& ('+)+*'D'%*&+'-0) '($(&?'%) ( %-( -0! = %)( '$+''( %-0(, 08%-0( ;%)( 08'0$'<, -$+&'-( =-%$-'&+0) '$+''%& =-'( (+$%*'-(;%%$0( ( +8'-(' 0% $%0%'(< =0+$' 8(&'*&( %0 %)'*&( '& $(*'0&(% -($'-%)> =-' ($+' =-' '$(+*)+ ='&)%%?'' (-''-( '$+''(&( =)'+ =)'+ =-' '%'=%)( %(-?'0&' %)( +$*%&()+$ '& $(*'0&(% -($'-%)> INVESTIGATII 1. P%)%$(%. P$'& '&(-'% '90%)% %
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