ŞCOALA POSTLICEALĂ SANITARĂ F.E.G. TÂRGOVIŞTE
PROIECT PROIECT DE CERTIFICARE A CALIFICĂRII PROFESIONALE
DOMENIUL: SĂNĂTATE ŞI ASISTENTŢĂ PEDAGOGICĂ CALIFICAREA PROFESIONALĂ: ASISTENT MEDICAL GENERALIST
ÎNDRUMĂTOR AS. MED: Niculescu Sim!" O"!" A#SOLVENT: Necul" V"le!$i!"
TÂRGOVISTE AUGUST %&'(
Î!)*i+i*e" ,"cie!$ei cu -Cis$i$/
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MOTTO: ,, În fiecare in!re n"i, Se a#c$ne !ainic Un %ar ne&'n$i! S' (")i, De *ri+a c$ia #' ("r)i, Ini-a .a fe. #'/ )i &a!' Pen!r$ !")i0 S' fi ac"." (en!r$ cei.a.)i, 1-&in, S' 3!i #' a#c$.)i, #' a$4i, Şi #' (ri-e3!i, "ar D'r$in0 De/ar ec$i 5n .i&er!a!e Ace#! %ar, Mirac".$. (e ('-n! N/ar -ai fi a!! e rar6 7ENRI0 T0M0NO8EN
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CUPRINS I0
NOŢIUNI DE NURSING 0 Defini)ie: n$r#in*$.$i; n$r#ei0 20 R".$. n$r#ei0 90 F$nc)ii.e n$r#ei <0 Car$. c"nce(!$a. a. 5n*ri+iri."r =0 Pr"ce#$. e 5n*ri+ire >0 N")i$ni e N$r#in* ?0 Princi(ii e &a4' a 5n*ri+irii @0 Te"ria .$i Ma#." B0 R".$. a# a#i#! i#!en!ei !ei -e -eica ica.e 5n 5n 5n 5n*ri+ ri+irea &" &".nai." i."r0 II0 ANATOMIA ŞI FILO1OFIA APARATULUI RENAL 0 C'i.e $rinare 20 e4ica $rinar' 90 Carac!eri#!ici.e 3i c"-("4i)ia $rinii <0 F"r-area $rinii =0 Mic)i$nea III0 CISTITA ACUTĂ 0 Defini)ie 20 Prea.en)' 90 E!i"."*ie <0 Ana!"-ie (a!"."*ic' =0 C.a#ificare >0 Si-(!"-a!"."*ie ?0 Dia*n"#!ic @0 Ea-en c.inic 3i ea-en fi4ic B0 E".$)ie 3i (r"*n"#!ic, c"-(.ica)ii 0 Tra!a-en! I0 I0 CA1URI Ca4$. I Ca4$. II Ca4$. III 0 TE7N TE7NIC ICII ŞI ŞI MET METOD ODE E FOL FOLOS OSIT ITE E PEN PENTR TRU U DIA DIAGN GNOS OSTI TIC C ŞI ŞI TRAT TRATAMENT AME NT ÎN CISTITA CIS TITA ACUTĂ ACUT Ă I0 CONCLU1II <
CAPITOLUL I NO0IUNI DE NURSING '. De1i!i2ie: N$r#in*/$. $(' O0M0S0 e#!e " (ar!e i-("r!an!' a #i#!e-$.$i e 5n*ri+ire a #'n'!')ii care c$(rine: a0 Pr"-"area #'n'!')ii &0 Preenirea 5-&".n'iri."r c0 În*ri În*ri+ir +irea ea (e (er# r#"a "ane ne."r ."r &" &".na .nae e fi4ic fi4ic,, (#i% (#i%ic, ic, -en!a -en!a. . e !"a!e !"a!e r#!e.e, 5n !"a!e $ni!')i.e #ani!are, 5n c"-$ni!')i 3i 5n !"a!e f"r-e.e e a#i#!en)e #"cia.e0 N$r#in*/$. $(' ir*inia ir*inia 7ener#"n: H S' a+$)i inii$., fie ace#!a &".na #a$ #'n'!"# #'/3i af.e ca.ea #(re rec$(erare #a$ #'n'!a!e, #'/3i f"."#ea#c' fiecare ac)i$ne (en!r$ a (r"-"a #'n'!a!ea #a$ rec$(erarea c$ c"ni)ia ca ace#!a #' ai&' !'ria, "in)a #a$ c$n"a3!erea c$n"a3!erea nece#are (en!r$ (en!r$ a " face 3i #' ac)i"ne4e ac)i"ne4e 5n a3a fe. 5nc! ace#!a #'/ 3i ("ar!e e *ri+' #in*$r c! -ai c$rn ("#i&i.06 N$r#a e#!e " (er#"an' care a (arc$r# $n (r"*ra- c"-(.e! e f"r-are (r"fe#i"na.', ca(a&i.' #' (rac!ice c$ (r"fe#i"na.i#- n$r#in*$., care acce(!' re#(" re#("n# n#a& a&i.i i.i!' !')i. )i.ee 3i e eerc erci!' i!' a$ a$!" !"ri! ri!a! a!ea ea ne nece ce#a #ar' r' 5n ac"r ac"rar area ea irec irec!' !' a 5n*ri+iri."r 5n*ri+iri."r,, an r'#($nerea r'#($nerea 5n*ri+iri."r 5n*ri+iri."r (e care .e ac"r' 3i n$ eec$!' nici " a.!' (r"ce$r' (en!r$ care n$ e#!e ca.ifica!'0 A#i#!en!a e#!e H c%eia6 ec%i(ei, re#("n#a&i.i!')i.e a#i#!en!ei -eica.e #$n!: a0 Pr"-"area #'n'!')ii &0 Preenirea 5-&".n'iri."r c0 Re#! Re#!a$ a$rar rarea ea #'n' #'n'!') !')ii ii 0 În.'! În.'!$ra $rare reaa #$fe #$ferin rin)ei )ei NURSING/UL e#!e " ar!', ar 3i " 3!iin)' ce nece#i!' 5n)e.e*erea 3i a(.icarea c$n"3!in)e."r #(ecifice i#ci(.inei0 E#!e " ac)i$ne a "-$.$i (en!r$ "- e acea (re#$($ne " -are re#("n#a&i.i!a!e a ace.$ia care " (rac!ic', e"arece ac)i"nea4' (en!r$ " (er#"an' care e#!e afec!a!' n$ n$-ai fi4ic ci 3i (#i%ic 3i #"cia.0 H Un Une e e ei# i#!' !' re( re(!$ !$.. e e/a /a " "r& r&ii e ei# i#!' !' 3i re#( re#("n "n#a #a&i &i.i .i!a !a!e !eaa e e/a /a a#c$.!a06
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H Une ei#!' (r"&.e-e, ei#!' ("#i&i.i!a!ea e/a aea #a$ a *'#i #".$)ii06 H Une #$n! (er#"ane care (.n*, ei#!' "a-eni care .e ("! 3!er*e .acri-i.e06 N$r#in*$. e#!e $n #erici$ care a+$!' "a-enii ca inii4i, fa-i.ii #a$ c".ec!ii!')i #' "&)in' " #!are e #'n'!a!e, #$#)ine "a-eni cn #e af.' 5n!r/" (eri"a' e &"a.' #a$ cn #'n'!a!ea .e e#!e (recar', #("re3!e a&i.i!a!ea inii$.$i (en!r$ a 5nin*e efec!e.e e &"a.' 3i ne($!in)ei0 Prac!ica n$r#in*$.$i inc.$e: / #e#i4area #e#i4area #'n'!')ii "a-eni."r "a-eni."r,, (r"&.e-e.e (r"&.e-e.e ."r e #'n'!a!e 3i re#$r#e.e re#$r#e.e ce .e a$ (en!r$ a .e 5nin*e0 / ecierea; #e ecie ce fe. e a+$!"r e#!e nece#ar (rec$- 3i referirea ace#!$ia .a a.!e #$r#e e #(ecia.i!a!e .a ne"ie0 / (.anifi (.anificare carea; a; (ree (reee e ac"rar ac"rarea ea 3i ea.$ ea.$are areaa (r"*ra(r"*ra-e."r e."r n$r# n$r#in*0 in*0 / 5n' 5n')ar )area ea !$!$r !$!$r"r "r e#(r e#(ree #'n'!a #'n'!a!e !e 3i #!i.$. #!i.$. e ia)' ia)' (en!r$ (en!r$ a c3!i* c3!i*aa e(erien)a 3i 5ne-narea 5n ('#!rarea (r"(riei #'n'!')i0
%.Rlul !u*sei R".$. e#en)ia. $(' 07 c"n#!' 5n a+$!"rarea (er#"ane."r &".nae #a$ #'n'!"a#e #'/3i -en)in' #a$ #'/3i rec3!i*e #'n'!a!ea #a$ #'/. a#i#!e 5n $.!i-e.e #a.e c.i(e (rin 5ne(.inirea 5ne(.inirea #arcini."r #arcini."r (e care .e/ar fi 5ne(.ini! 5ne(.ini! #in*$r ac' ar fi a$! f"r)a, "in)a #a$ c$n"3!in)e.e nece#are0 Ea !re&$ie #'/3i 5ne(.inea#c' ace#!e #arcini a#!fe. 5nc! (acien!$. #'/3i rec3!i*e ine(enen)a c! -ai c$rn ("#i&i.0 R".$. n$r#ei n$r#ei $(' O0M:S O0M:S e#!e #' a#i#!e a#i#!e inii4i, inii4i, fa-i.ii, *r$($ri #' "(!i "( !i-i -i4e 4e4e 4e 3i #' in!e in!e*r *re4 e4ee f$nc f$nc)i )ii. i.ee fi4i fi4ice ce,, -en! -en!a. a.ee 3i #" #"ci cia. a.ee afec afec!a !a!e !e #e-nifica!i (rin #c%i-&'ri a.e #!'rii e #'n'!a!e0 90 Fu!c2iile !u*sei S$n! e na!$r': / ine(enen!' / e(enen!' / in!ere(enen!' A.!e A.!e f$nc f$nc)ii )ii a.e a.e n$ n$r# r#ei ei #$n! #$n!:: (r"fe# (r"fe#i" i"na na.e, .e, e e$c $ca!i a!ie e,, e cerce cerce!ar !aree ec"n"-ice, *e#!i"nare F$nc F$nc)ia )ia e na na!$r !$r'' ine( ine(en ene en!' n!' #e refe refer' r' .a 5n*ri+ 5n*ri+ire ireaa &".na &".na$ $.$i .$i,, #!a&i.irea #!a&i.irea $nei re.a)ii e 5ncreere 5ncreere 5n!re a#i#!en!'/ a#i#!en!'/ &".na/fa-i.ie, &".na/fa-i.ie, (rec$- 3i
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e !ran#!ran#-i!er i!eree a inf"rinf"r-a)i. a)i."r "r,, !"a!e !"a!e f'cn$ f'cn$/#e /#e in (r"(rie (r"(rie ini)ia!i ini)ia!i', ', fie !e-("rar, fie efini!i0 F$nc)ia e na!$r' e(enen!' are 5n eere a#i#!en!a/-eica.', a#i#!en!a "er' -"ific'ri -"ific'ri 5n c"-("r!a-en! c"-("r!a-en!$. $. &".na$.$i, &".na$.$i, e".$)ia &".ii, .e !ran#-i!e !ran#-i!e -eic$ -eic$.$i, .$i, a(.ic' a(.ic' !ra!a-e !ra!a-en!$ n!$.. rec"-a rec"-ana na!! 5n!"c-a 5n!"c-aii e #($ #($#e.e #e.e -eic$ -eic$.$i .$i (en!r$ !")i &".naii 5n -" e*a.0 F$nc F$nc)i )iaa e na na!$ !$r' r' ine ine(e (en nen en!' !' #e refe refer' r' .a c" c".a .a&" &"ra rare reaa c$ a.)i a.)i (r"fe#i"ni3!i in "-eni$. #ani!ar, #c%i-& e e(erien)', (ar!ici(area .a ac!ii!')i in!eri#ci(.inare0 F$nc)ia #(ecia.' a n$r#ei e#!e e a a#i#!a inii$. &".na#'n'!"# 5n a fii ca(a&i. e ac!ii!')ii ac!ii!')ii ce c"n!ri&$ie c"n!ri&$ie .a #'n'!a!e #'n'!a!e #a$ 5n#'n'!"3ire 5n#'n'!"3ire (e care .e/ar face f'r' a+$!"r ac' ar aea ($!erea nece#ar', "in)a #a$ c$n"3!in)e.e0 A!ri&$)ii.e a#i#!en!ei: 0A#i*$rarea 3i "r*ani4area n$r#in*$.$i 5n (rac!ic' inc.$e: / ien ien!i !ifi fica care reaa ne ne"i "i." ."r r / #!a&i.ir i.ireea ne ne"i."r ."r / (.an (.anifi ifica carea rea 3i 3i ac"r ac"rare areaa 5n*ri+ 5n*ri+iri iri." ."rr e n$r#i n$r#in* n* / "c$-en!are / a(.icare 20E$carea (acien)i."r 3i a (er#"na.$.$i e 5n*ri+ire: / e ea. a.$a $are reaa c$n" c$n"3! 3!in in)e )e." ."rr / f$rn f$rni4a i4are reaa inf"rinf"r-a)i a)ii." i."rr .a nie. nie. c"re# c"re#($ ($n4 n4'!" '!"rr / (ar!ici ici(area rea .a ca-(anii (ri riin in e$ca)ia (en!r$ #'n'!a! !a!e 3i ea.$area re4$.!a!e."r / ac)i" ac)i"na nare reaa ca $n $n c"n c"n$c $c'!" '!"rr 5n ca car$. r$. ec% ec%i( i(ei ei / c".a&"ra!"r / #' #e i-( i-(.ic .ice ac!i 5n (.an .anifica icarea (r"&.e-e."r 3i #!a& !a&i.ire .ireaa (ri"ri!')i."r / a(.icar a(.icarea ea #!an #!anar are."r e."r c$.!$ra c$.!$ra.e, .e, e!ice e!ice 3i 3i (r"fe# (r"fe#i"n i"na.e0 a.e0 90Ca.i!')i.e $nei &$ne n$r#e #$n!: / &$ &$n' n' (r"f (r"fe# e#i"n i"ni# i#!', !', %"!' %"!'r! r!'' #' ac)i" ac)i"ne ne4e 4e c$ (r" (r"-! -!i!$ i!$in inee r'&a r'&are re ca.-, 5n)e.e*ere 5n "rice #i!$a)ie, #' ia eci4ii ra(ie, #' ('#!re4e #ecre!e.e (r"fe#i"na.e, #' ai&' re4i#!en)' fi4ic' 3i (#i%ic', c"n3!iinci"a#', c$ra!', "r"na!'0
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3. C"4*ul c!ce,$u"l "l 5!)*i+i*il*. 5!)*i+i*il*. 0 C"nce(!$. e#(re "- $(' 070 a0 C$n"a3!erea fiin)ei $-ane 5n *."&a.i!a!ea #a &0 C$n"a3!erea f$na-en!a.' a "-$.$i c0 Se &a4ea4 &a4ea4'' (e: / 5n)e.e* 5n)e.e*erea erea fiin) fiin)ei ei $-ane $-ane / a.c'!$irea #!ra!e*iei (rac!ice0 ,,Inii$. e#!e " en!i!a!e &i"/(#i%"/ #"cia.' f"r-n $n !"! $ni!ar06 E. are nece#i!')i f$na-en!a.e c$ -anife#!'ri #(ecifice (e care #i .e #a!i #a!i#f #fac acee a ac' c' #e #i-! #i-!ee &ine &ine,, e. !in !inee #( #(re re a$ a$!" !"n" n"-i -iee in #a!i #a!i#f #fac acer erea ea nece#i!')i."r #a.e0 20 C"nce(!$. C"nce(!$. (riin #'n'!a!ea #'n'!a!ea $(' $(' O0M0S0: O0M0S0: HS'n'!a!ea e#!e " #!are e &ine fi4ic, -in!a. 3i #"cia. ce n$ c"n#!' n$-ai 5n aen)a &".ii #a$ infir-i!')ii06 90 C" C"nc nce( e(!$ !$.. e#(re e#(re &"a.' &"a.':: HJ"a.a e#!e r$(erea ec%i.i&r$.$i ar-"niei, $n #e-na. !ra# (rin #$ferin)a fi4ic', (#i%ic', " ific$.!a!e, " inaa(!are .a " #i!$a)ie n"$', (r"i4"rie #a$ efini!i'06 M"e.$. c"nce(!$.$i a. ir*iniei 7ener#"n #e &a4ea4' (e efinirea ce."r < ne"i f$na-en!a.e a.e "-$.$i0 En$-erarea ce."r < ne"i: 0 Ne Ne"ia "ia e a re#(ir re#(iraa 3i a aea " &$n' &$n' circ$. circ$.a)ie a)ie 20 Ne Ne"ia "ia e e a #e a.ia.i-en!a en!a 3i %ira!a %ira!a00 90 Ne Ne" "ia ia e a e.i-in e.i-inaa <0 Ne Ne"ia "ia e e a #e -i3ca -i3ca 3i 3i a aea aea " &$n' &$n' ("#!$r' ("#!$r' =0 Ne Ne"ia "ia e a "r-i "r-i 3i a #e "i%ni "i%ni >0 Ne Ne"ia "ia e e a #e 5-&r 5-&r'ca 'ca 3i 3i e4&r' e4&r'ca ca ?0 Ne"ia e a ('#!ra !e-(era !e-(era!$ra !$ra c"r($.$i c"r($.$i 5n .i-i!e .i-i!e n"r-a.e n"r-a.e @0 Ne"ia e a -en)ine !e*$-en!e.e !e*$-en!e.e c$ra!e 3i in!e*re in!e*re B0 Ne Ne"ia "ia e a ei!a ei!a (eric" (eric".e.e .e.e 0Ne"ia e a c"-$nica 0Ne"ia e a (rac!ica re.i*ia 20Ne"ia e a #e recreea 90Ne"ia e a #e rea.i4a <0Ne"ia e a 5n')a <0E.e-en!e.e ("4i!ie 5n (rac!ica -eica.' 0O(!i-i4area 5n*ri+iri."r 20 Fiare Fiareaa -"!ia -"!ia)iei )iei ac!$. ac!$.$i $i -eica -eica.0.0 @
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6.P*cesul 4e 5!)*i+i*e0 E#!e E#!e " -e!" -e!"' ' "r*a "r*ani ni4a 4a!' !' #i #i#! #i#!ee-a! a!ic ic'' care care (e (err-i! i!ee ac"r ac"ra are reaa 5n*ri+iri."r 5n*ri+iri."r inii$a.i4a!0 inii$a.i4a!0 A(.icarea A(.icarea c"nce(!$.$i c"nce(!$.$i 070 070 5n (r"ce#$. (r"ce#$. e 5n*ri+ire 5n*ri+ire $3$rea4' ien!ificarea ne"i."r (acien!$.$i 3i *'#irea #$r#e."r e ific$.!a!e care care 5-(i 5-(ie eic' ic' #a!i# #a!i#fa face cerea rea ne ne" "i." i."rr0 PerPer-i!e i!e #a!i# #a!i#fa facer cerea ea in!er in!ere en)i n)ii." i."r r ca(a&i.e #' re$c' #$r#e.e e ific$.!a!e 5n #c"($. e a a+$!a (er#"ana e a/3i rec'('!a a$!"n"-ia0 Pr"ce#$. e 5n*ri+ire c$(rine $r-'!"are.e e!a(e: / c$.e*erea a!e."r / ana.i4a 3i in!er(re!area a!e."r/ia*n"#!ic$.$i e 5n*ri+ire0 / (.anificarea 5n*ri+iri."r/ "&iec!ie0 / rea.i4area in!eren)ii."r/a(.icarea 5n (rac!ic' / ea.$area 0C$.e*erea a!e."r e#!e $n (r"ce# care ne (er-i!e " inen!ariere a a!e a !e." ."rr (ri (riin in (a (aci cien en!$ !$.. 5n *."& *."&a. a.i! i!a! a!ea ea #a, #a, a a!e !e e e#( #(re re #$ #$fe feri rin) n)aa .$i, .$i, ne($!in)e.e .$i, "&icei$ri.e .$i, #!area e #'n'!a!e0 Ti($ri e a!e c$.e#e: / a!e (er#"na.e / a!e #" #"cia.e / a!e -eica.e M"a.i!')i e c$.e*ere a a!e."r: / (rin (rin ia ia." ."** ir irec ec!! c$ c$ (ac (acie ien! n!$. $. / (rin (rin ia." ia."** irec irec!! c$ c$ a(a a(ar)i r)in' n'!" !"rii rii / (rin (rin cc"n# "n#$.!a $.!area rea "c$ "c$-en -en!e." !e."rr ce ce 5n#") 5n#")e#c e#c (acien! (acien!$. $. / "& "e #er rar area ea (a (aci cien en!$ !$.$ .$ii 20Ana.i4a 3i in!er(re!area a!e."r (re#$($ne $n ea-en a. a!e."r 3i c.a#ificarea ."r 3i c"n$ce a#i#!en!a .a #!a&i.irea ia*n"#!ic$.$i e 5n*ri+ire (rec$- 3i ne"ia ne#a!i#f'c$!', ar 3i #$r#a e ific$.!a!e0 ific$.!a! e0 Dia*n"#!ic$. e 5n*ri+ire e#!e " f"r-' #i-(.' ar (reci#' care e#crie r'#($n#$. (er#"anei .a " (r"&.e-' e #'n'!a!e0
B
C"-("nen!e: a0 Pr"&.e-a e e(enen)' &0 Ca$4a #a$ #$r#a e ific$.!a!e c0 Se-n Se-nee 3i #i#i-(! (!""-ee Ei#!' !rei !i($ri e ia*n"#!ic: / ac!$a. ac!$a. K -anife# -anife#!'ri !'ri.e .e e e( e(en enen)' en)' #$n #$n!! (re4en!e (re4en!e / (" ("!e !en)i n)ia. a. / cn cn (r"& (r"&.e.e-aa ("a ("a!e !e #$re #$reni ni / (" ("#i #i&i. &i. K cn cn (re4 (re4en en)a )a (r" (r"&.e &.e-e -eii n$ e#!e e#!e cer cer!'0 !'0 90P.anificarea 5n*ri+iri."r c"n#!' 5n #!a&i.irea $n$i (.an e in!eren)ie, (reeerea e!a(e."r e in!eren)ie 3i a -i+."ace."r e e#f'3$rare, (rec$- 3i (reca$)ii.e ce !re&$ie .$a!e0 P.an$. c$(rine "$' c"-("nen!e: a0 "&iec!ie.e e 5n*ri+ire &0 in!eren)ii.e O&iec!ie.e f"r-$.a!e !re&$ie #' r'#($n' .a $r-'!"are.e 5n!re&'ri: 0 Cine face ac)i$nea 20 Ce #e ("a!e face (en!r$ (acien! 90C$- #e face ac)i$nea <0 Cn #e face ac)i$nea >0 În ce -'#$ -'#$r' r' #e #e face face ac)i$ ac)i$nea nea In!eren)ia (er-i!e a#i#!en!ei #' e!er-ine -"$. e a ac)i"na (en!r$ a c"rec!a (r"&.e-a e e(enen)' a (acien!$.$i0 In!ere In!eren)ii n)ii.e .e !re&$ie !re&$ie #' fie: n" n"a!" a!"are, are, (er#"n (er#"na.i4 a.i4a!e, a!e, " "era era&i.e &i.e,, -'#$ra&i.e0 <0A(.ic <0A(.icarea area 5n (rac!ic (rac!ic'' #e efec!$e efec!$ea4' a4' (rin in!eren in!eren)ii )ii a$!"n"a$!"n"-ee 3i in!eren)ii e.e*a!e0 Sc"($. e#!e e a a+$!a (acien!$. #'/3i -en)in' #a$ #'/3i reca(e!e ine(enen)a, aici fiin i-(.ica)ii (acien!$., a#i#!en!a, ec%i(a 3i fa-i.ia0 Pacien!$. eec$!' ac)i$ni.e (.anifica!e (en!r$ e. 5n f$nc)ie e re#$r#e.e (r"(rii0 A#i#!en!a #$(rae*%ea4' ac)i$ni.e ac)i$ni. e (.anifica!e, 5nc$ra+ea4' 5nc$ ra+ea4' (acien!$., 5. inf"r-ea4', 5. a+$!' 3i -anife#!' e-(a!ie fa)' e e.0 Ec%i(a e 5n*ri+ire a#i*$r' c"-(.ec!area c"-(.ec!area 3i eficaci!a!ea eficaci!a!ea 5n*ri+iri."r (r"fe#i"na.e0 (r"fe#i"na.e0 Fiecare (.an e 5n*ri+ire #e a c" c"-( -(.e .ec! c!aa c$ in!e in!er ren en)i )ii, i, e.ee.e-en en!e !e e #$ #$(r (ra ae* e*%e %ea! a!,, reac reac)i )iaa .a -ei -eica ca-e -en!e n!e,, f$nc f$nc)ii )ii.e .e i!a.e i!a.e,, in!er in!ere en)i n)ii.e i.e c$ r". r". e e.e* .e*a! a! ce e ec$ c$r* r* in (re#cri()ii.e -eica.e0 =0Ea.$area 5n*ri+iri."r c"n#!' 5n a a$ce " a(reciere a#$(ra (r"*re#$.$i (ar!ici(an!$.$i 5n ra("r! c$ in!eren)ii.e a#i#!en!e, e#!e c"ni)ia a".$!' a
ca.i! ca.i!') ')i." i."rr 5n*r 5n*ri+i i+iri. ri."r "r,, e ea. a.$a $area rea f'cn f'cn$ $/#e /#e c$ re*$. re*$.ari ari!a! !a!ee 3i .a ier ier#e #e in!era.e0 Se ea.$ea4' re4$.!a!$. "&)in$! #a$ #c%i-&area, #a!i#facerea (acien!$.$i 5n#$3i, a$!"ea.$area0 Ea.$area #e face ("rnin e .a $n ($nc! e referin)' care e#!e e fa(! ($nc!$. e 5n*ri+ire0 Per#"ane.e care ea.$ea4' !re&$ie #' 5nre*i#!re4e "era)ii, #' inice a!a 3i #' #e #e-ne4e0 Pr"ce#$. e 5n*ri+ire e#!e $n (r"ce# c.inic 3i (er-anen! 5nn"i!0 I-("r!an)a (r"ce#$.$i e 5n*ri+ire: a0 A+$!' .a a#i*$rarea ca.i!')ii 5n 5n*ri+irea (acien!$.$i0 &0 A+$!' .a 5-&$n'!')irea ca.i!')ii 5n 5n*ri+irea 5n*ri +irea (acien!$.$i c0 A$ce aan!a+e a#i#!en!ei -eica.e 5n ("#i&i.i!a!ea e 5ncreere 5n #a!i# #a!i#fac fac)ii )ii.e .e -$nc -$ncii, ii, 5n e4" e4".!a .!are reaa 5n (.an (.an (r"fe (r"fe#i #i"n "na. a. 3i a!in* a!in*ere ereaa $n $n"r "r #!anare (e (.an (r"fe#i"na. 3i a!in*erea $n"r #!anare 5n (rac!ica e n$r#in*0 0 A A$c $cee aan! aan!a+e a+e (acien (acien!$ !$.$i .$i (rin fa(!$. fa(!$. c' 5i ' (" ("#i #i&i. &i.i!a i!a!ea !ea e/a (ar!ici(a .a (r"(ria 5n*ri+ire0 >0N")i$ni *enera.e e#(re &"a.'0 H A ineca #a$ ce. ($)in a $3$ra #$ferin)a a f"#! in !"!ea$na #c"($. (rac!ici."r -eica.e0 De aceea 5n e!a(a ac!$a.' (reenirea &".i."r e#!e iea.$. #(re care !ine -eicina06 Un "r*ani#- i$ ("a!e fi efini! ca $n #i#!e- c"-(.e e "r*ane 3i #i#!e-e 5n ec%i.i&r$ ina-ic0 T"a!e c"-("nen!e.e ace#!$i #i#!e- c"-(.e #$n! 5n ac!ii!a!e ec%i.i&ra!', 5n #en#$. c' $ne"ri "-in' f$nc)ia $n$ia in!re #i#!e-e, a.!e"ri a a.!eia0 C""r C" "r" "na nare reaa f$nc f$nc)i )ii. i."r "r #i a aa( a(!a !are reaa "r*a "r*ani ni##-$. $.$i $i .a -ei -ei$$ #$ #$n! n! a#i*$ra!e e #i#!e-$. ner"# 0Nie.$. f$nc)ii."r "r*ani#-$.$i #e -"ific' 5n $r-a reac)ii."r e aa(!are, Ec%i Ec%i.i .i&r &r$. $. &i". &i"."* "*ic ic in in!re !re "r*a "r*ani ni##- 3i -ei -ei$, $, c$ (" ("#i #i&i &i.i .i!a !a!e !eaa -ani -anife fe#!' #!'rii rii reac)ii reac)ii." ."rr e a aa( a(!ar !aree a "r*a "r*ani# ni#-$ -$.$i .$i #e n$ n$-e -e3! 3!ee #!are #!are e #'n'!a!e0 M"ific'ri.e ace#!$i ec%i.i&r$ &i"."*ic #$& inf.$en)a $n"r fac!"ri in!erni #a$ e!erni c$ .i-i!area ca(aci!')ii e aa(!are a "r*ani#-$.$i .a -ei$ #e n$-e3!e #!are e &"a.'0 J"a.a e#!e $n (r"ce# c"-(.e , ina-ic .a care i/a (ar!e 5n!re*$. "r*ani#-, ca re4$.!a! a. c"re.a)i."r care #e #!a&i.e#c 5n!re -ei$. in!ern 3i
-ei$. e!ern, (e e " (ar!e 3i in!re "r*ani#- ca $n !"! $ni!ar 3i iferi!e.e #a.e c"-("nen!e (e e a.!' (ar!e0 Fac!"rii care #!ric' ec%i.i&r$. in!re "r*ani#- 3i -ei$ #e n$-e3!e ca$4' (a!"*en', (a!"*en', iar efec!$. #'$ #e n$-e3!e #!are (a!"."*ic'0 J"a.a e#!e eci " #!are (a!"."*ic'0 ?0Pr ?0Prin incii cii(.e (.e e &a &a4' 4' a 5n*ri 5n*ri+ir +irii ii (e (er#" r#"an anei ei #'n' #'n'!"a !"a#e #e &" &".na .nae e e ir*inia 7ener#"n #$n!: a0 S' a+$)i &".na$. #' re#(ire0 &0 S' a+$)i &".na$. #' -'nnce 3i #' &ea0 c0 S' a+$)i &".na$. #' e.i-ine0 0 S' a+$)i &".na$. #' ('#!re4e " &$n' ("#!$r' cn #e (.i-&', #'/. a+$)i #'/3i #c%i-&e ("4i)ia0 e0 S' a+$)i a+$)i &".na &".na$. $. #' #e "i%ne "i%nea#c a#c'' 3i #' "ar-'0 "ar-'0 f0 S' a+$)i a+$)i &".na$. &".na$. #'/3i #'/3i a.ea*' a.ea*' 5-&r'c 5-&r'c'-i '-in!ea n!ea,, #' #e 5-&race 5-&race 3i #' #e e4&race0 *0 S' a+$)i &".na$. &".na$. #'/3i ('#!re4e ('#!re4e !e-(era!$ra !e-(era!$ra 5n .i-i!e n"r-a.e0 n"r-a.e0 %0 S' a+$) a+$)ii &" &".n .na a$. $. #'/3 #'/3ii (' ('#! #!re re4e 4e c" c"r( r($. $. c$ c$ra ra!, !, 5n*r 5n*ri+ i+i! i!,, #' ai&e ai&e (r"!e+a!e !e*$-en!e.e0 i0 S' a+$)i a+$)i &".na$. &".na$. #' ei!e ei!e (eric".e (eric".e.e .e in -ei$. -ei$. 5nc"n 5nc"n+$r' +$r'!"r !"r,, #' fie (r"!e+a)i cei.a.)i e "rice (eric". in (ar!ea (acien!$.$i, c$- ar fi infec)ia #a$ i".en)a0 +0 S' a+$)i &".na$. #' c"-$nice c$ a.)ii, #'/3i e(ri-e e(r i-e ne"i.e ne"i. e 3i #'/3i e!eri"ri4e4e #en!i-en!e.e0 0 S' a+$)i &".na$. &".na$. #'/3i (rac!ice (rac!ice re.i*ia c"nf"rc"nf"r- c"nce(!$ c"nce(!$.$i .$i (r"(ri$ (r"(ri$ (riin ceea ce e#!e re(! 3i nere(!0 .0 S' a+$)i a+$)i &".na &".na$. $. 5n -$nc -$nc'' #a$ "(er "(era)ii a)ii (r"$ (r"$c!i c!ie0 e0 -0 S' a+$)i &".na$. &".na$. 5n ac!ii!')i recrea!ie0 recrea!ie0 n0 S' a+$)i a+$)i &".na &".na$. $. #' 5ne)e0 5ne)e0
2
CAPITOLUL II NO0IUNI DE ANATOMIE ANATOMIE ŞI FI7IOLOGIE A APARATULUI E8CRETOR %.' ANATOMIA APARATULUI E8CRETOR A(ara!$. ecre!"r, c$ r". 5n f"r-area 3i e.i-inarea $rinii, e#!e f"r-a! in rinic%i 3i c'i.e $rinare0
2.1.1 Rinichiul
Rinic%i$. e#!e $n "r*an (erec%e #i!$a! 5n #(a)i$. re!r"(eri!"nea. a. cai!')ii a&"-ina.e0 Ei #$n! "r*ane (ri-i!i re!r"(eri!"nea.e, a3e4a!e e " (ar!e 3i e a.!a a c"."anei er!e&ra.e, 5n re(!$. $.!i-e."r "$' er!e&re !"raca.e !"raca.e 3i a. (ri-e."r !rei er!e&re ."-&are, ."-&are, 5n ni3!e #(a)ii n$-i!e ."+i rena.e0 Fiecare ."+' e#!e e.i-i!a!' e " f"r-a)i$ne c"n+$nc!i' fi&r"a#' n$-i!' fa#cia rena.' 0 Acea#!a Acea#!a .a rn$. ei e#!e a.c'!$i!a in "$' f"i)e, $na a3e4a!a 5nain!ea rinic%i$.$i, n$-i!' fa#cia (rerena.a T".!, care ine 5n ra("r! c$ (eri!"ne$., 3i a.!a 5na("ia rinic%i$.$i, fa#cia re!r"rena.a re!r"rena.a 1$ceran., 1$ceran., care ine 5n ra("r! c$ (ere!e.e a&"-en$.$i0 Ce.e "$' f"i!e #e $ne#c Ia nie.$. -ar*ini."r 3i a. ni.$.$ ni.$.$ii rinic% rinic%i." i."rr, a.c'! a.c'!$in $in fa#ci fa#ciaa rena rena.', .', care care #e (rin (rinee e f"rf"r-a)i a)i$ni $ni.e .e fi&r"a#e in +$r0 +$r0 În!re fa#cii 3i rinic%i #e *'#e3!e $n #!ra! e *r'#i-e care ("ar!' n$-e.e e *r'#i-ea (erirena.a0 9
Rinic%i$. e#!e fia! 5n ."+a rena.' (rin fa#cia rena.', (eri!"ne$. (arie!a. ("#!eri"r 3i a#e.e rena.e .a care #e aa$*' (re#i$nea a&"-ina.'0 a&"-ina. '0
2.1.2 Configuraţie externă Rinic%i$. are f"r-a $n$i &"& e fa#".e, " .$n*i-e e / 2 c-, .')i-ea e = / > c- 3i *r"#i-ea e 9 / < c-0 E. (re4in!' "$' fe!e, "$' -ar*ini 3i "$' e!re-i!')i #a$ (".i0 Fiecare rinic%i are " fa!' an!eri"ar' care (rie3!e 5nain!e 3i ($)in 5n'$n!r$ fa!a an!eri"ar' a rinic%i$.$i re(! ine 5n ra("r! c$ ."&$. re(! a. fica!$.$i 3i c$ $n*%i$. c".ic re(! iar cea a rinic%i$.$i #!n* ine 5n ra("r! c$ (ancrea#$., #(.in', #!"-ac$. 3i " fa!' ("#!eri"ara care (rie3!e 5na("i 3i 5n afar'0 Rini Rinic% c%i$ i$.. are are " -ar -ar*ine *ine .a!e .a!era ra.' .' c" c"n ne e'' 3i " -ar* -ar*in inee -ei -eian an'' c"nca'0 Pe -ar*inea c"ncaa #e af.a ni.$. rena., " e#(ic'!$r' a.$n*i!' 5n a$. rinic%i$.$i, 5n care #e *'#e#c e.e-en!e.e e.e-en!e.e (eic$.$.$i rena.: ar!er' 3i ena rena.', (e.i#$. rena., .i-fa!ice 3i neri0
2.1.3 Structura internă
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Rinic%i$. e#!e f"r-a! e .a e!eri"r #(re in!eri"r in: ca(#$.a ca(#$.a rena.' / f"r-a)i$ne f"r-a)i$ne c"n+$nc!i' c"n+$nc!i' care care 5ne.e3!e 5ne.e3!e rinic%i$.; rinic%i$.; #$& ea #e *' *'#e #e3! 3!ee $n #!ra #!ra!! i#c i#c"n "n!i !in$ n$$$ e fi&r fi&ree -$#c -$#c$. $.ar aree ne ne!e !ee e ce (e (err-i! i! eca(#$.area0 2 (arenc (arenc%i%i-$. $. rena., c$(rin# c$(rin# 5n!re 5n!re ca(#$.' ca(#$.' 3i #in$#$. #in$#$. rena., (re4in!' (re4in!' (e #$(rafa)a e #ec)i$ne " 4"n' (eriferic' *r"a#' e ? / @ c-, &r$n' / *'.&$ie #$!an)a c"r!ica.' 3i " 4"n' cen!ra.' e c$."are -ai e#c%i#' 3i c$ #!ria)ii e/a e /a .$n* .$n*$. $. ei #$& #$! #!an an)a )a -e$ -e$.a .ar' r'0 0 Ce.e Ce.e " "$' $' 4" 4"ne ne #e 5n!r 5n!re( e('! '!r$ r$n n neei#!n .i-i!e 5n!re e.e0 La nie.$. #$!an)ei -e$.are #e "era $n n$-'r e B/< e arii !ri$n*%i$.are c$ &a4a #(re c"r!ica.a 3i rf$. #(re #in$#$. rena. care $(' a#(ec!$. ."r e (ira-ie ("ar!' n$-e.e e (ira-ie rena.e #a$ (ira-ie Ma.(i*%i, #e(ara!e 5n!re e.e 4"ne e #$!an)a c"r!ica.' ce f"r-ea4' c"."ane.e Jer!in0 Pira-ie.e rena.e #$n! a.c'!$i!e in !$&ii rena.i re()i Je..ini, in !$&ii c".ec!"ri 3i in!r/" (ar!e a an#ei .$i 7en.e0 S!ria)ii.e (ira-ie."r #e a!"rea4' !$&i."r re()i 3i c".ec!"ri0 rf$. fiec'rei (ira-ie are " #$(rafa)a c"nca' n$-i!' (a(i.a rena.', care #e e#c%i 5n ca.ice.e -ici in #in$#$. rena.0 Pe #$(rafa)a ace#!ei (a(i.e #e *'#e#c =/2 "rif5cii n$-i!e ("ri $rinari, care re(re4in!' e#c%ierea !$&i."r c".ec!"ri 5n ca.ice0 În #$!an)a c"r!ica.' #e *'#e#c f"r-a)i$ni e #$!an)a -e$.ar' c$ a#(ec! !ri$n*%i$.ar #a$ c"nic 5n n$-'r e </= e fiecare (ira-i', n$-i!e #!ria)ii -e$.are #a$ (ira-ie.e Ferrein0 Din ($nc! e eere -"rf"f$nc)i"na., rinic%i$. #e c"-($ne in ."&i 3i ."&$.i0L"&$. ."&$.i0L"&$. e#!e f"r-a! in!r/" in!r/" (ira-i' (ira-i' Ma.(i*%i c$ !"a!e f"r-a)i$ni.e f"r-a)i$ni.e care #e af.' ea#$(ra ei (n' .a ca(#$.' fi&rin"a#'0 N$-'r$. ."&i."r e#!e e*a. c$ n$-'r$. (ira-ie."r Ma.(i*%i0 L"&$.$i e#!e f"r-a! in!r/" (ira-i' Ferrein 3i in #$!an)a c"r!ica.' care care " 5nc" 5nc"n+" n+"ar ar'0 '0 N$ N$-' -'r$. r$. ."&$.i ."&$.i."r ."r e#!e e#!e e*a. e*a. c$ n$ n$-' -'r$ r$.. (ira(ira-i ie." e."r r Ferrein0 C"r!ica.a 3i -e$.ara #$n! a.c'!$i!e 5n $.!i-' in#!an)a in !$&i $riniferi 3i a#e.e e #n*e care .a a(ar)in0 Tubul urinifer e#!e a.c'!$i! in nefron 3i tub colector col ector.. Nefronul e#!e $ni!a!ea -"rf"f$nc)i"na.a a rinic%i$.$i0 N$-'r$. nefr"ni."r e#!e e 20>0 (en!r$ a-&ii rinic%i0 În c"n#!i!$)ia nefr"n$.$i in!ra $r-'!"are.e e.e-en!e:
=
a Corpus Corpuscul culul ul renal renal (Malpigh (Malpighi i e#!e f"r-a! in ca(#$.a J"-ann 3i *."-er$.$. a#c$.ar, 3i #e (re4in!' ca " f"r-a)i$ne #feric', c$."are r"3ia!ica care #e *'#e3!e 5n #$!an)a c"r!ica.'0 Ca(#$.a J"-ann e#!e " -e-&ran' e(i!e.ia.' a.c'!$i!a in!r/" f"i)' (arie!a.a f"r-a!' in!r/$n #!ra! e ce.$.e e(i!e.ia.e !$r!i!e, a3e4a!e (e " -e-&ran' &a4a.a; acea#!a f"i!a #e c"n!in$' .a (".$. $rinar a. ca(#$.ei c$ !$&$. c"n!"r! (r"i-a., iar .a (".$. a#c$.ar in (ar!ea "($#', c$ " f"i)' i#cera.' care aer' in!i- e an#e.e *."-er$.$.$i0 În!re ce.e "$' f"i!e #e f"r-ea4' a#!fe. " cai!a!e 5n care #e ac$-$.ea4' $rina (ri-ar'0 Ar!eri".a aferen!a care ('!r$ne (rin (".$. a#c$.ar a. ca(#$.ei a 5nc' e .a in!rare 9/< ra-$ri care #e efac 5n = e an#e ca(i.are, neana#!"-"4a!e 5n!re e.e 3i care #e $ne#c f"r-n ar!eri".a eferen!a0 Di#("4i!i$. e a#e e#cri# f"r-ea4' *."-er$.$. a#c$.ar0 & Tubul .$n* e a( a(r" r"i i-a -a!i !i 9 9--- 3i *% *%ee-$i $i!, !, ubul co cont ntor ortt prox proxi! i!al al"" .$n* c"n!in$a f"i!a (arie!a.' a ca(#$.ei J"-ann0 Pere!e.e .$i e c"n#!i!$i! in ce.$.e c$&ice, care #(re .$-en, (re4in!' -icr"i.i, ce -'re#c #$(rafa)a ce.$.ei (rin care car e #e re#"r&, 5n 5 n ca(i.are.e ca(i.ar e.e in i n +$r, an$-i!e an$-i! e #$!an)e #$!an) e in i n $rina (ri-ar'0 Oa!' c$ re#"r&)ia a$ ."c 3i (r"ce#e e #ecre)ie a #$!an)e."r, f"r-n$/#e $rina $rina fina.'0T fina.'0T$&ii $&ii c"n c"n!"r !"r)i )i 5-(re$n 5-(re$n'' c$ c"r($#c c"r($#c$.ii $.ii rena.i rena.i #$n #$n!! #i!$a$ #i!$a$ 5n c"r!ica.', iar n$-'r$. c"r($#c$.i."r rena.i e#!e e (e#!e -i.i"n0 c #nsa lui $enle c"n!in$a !$&$. c"n!"r! (r"i-a. 3i ('!r$ne 5n (r3 raia!a (ira-ie.e Ferrein, a+$n*n (n' 5n (ira-ie.e rena.e0 Ea e#!e a.c' a.c'!$ !$i! i!aa in! in!rr/" ra-$ ra-$r' r' e e#c #cen ene en! n!', ', " (" ("r) r)i$ i$ne ne #$ #$&) &)ir iree 3i " ra-$ ra-$r' r' a#cenen!'; .$n*i-ea an#ei e#!e e 2/<--0 Tubul ubul contort contort %istal" %istal" .$n* e a(r"i-a!i --, c"n!in$a ra-$ra a#ce a#cen nen en!a !a a an an#e #eii .$i .$i 7e 7en. n.ee 3i e#!e e#!e #i!$ #i!$a! a! 5n c" c"r! r!ic ica. a.aa 5n e eci cin' n'!a !a!e !eaa c"r($#c$.$.$i rena. Tubul colector !rece in c"r!ica.a 5n (ar# raia!a 3i, -ai e(ar!e, 5n (ira-ie.e rena.e, e#c%i4n$/#e 5n !$&ii re()i0
2.1.& 'asculariaţia )i iner*aţia Rinic% ic%ii (riri-e#c #n*e (rin arterele renale" rara-$ri $ri in in a" a"r! r!aa a&"-ina.', 5nain!e e a in!ra 5n ni. ar!ere.e rena.e #e ra-ifica 5n ra-$ri (re(ie.ice 3i " ra-$r' re!r"(ie.ica0 Pe &a4a !i($.$i e ra-ifica!e a ar!erei rena.e 3i a !eri!"ri$.$i in (arenc%i-$. rena. (e care 5. a#c$.ari4ea4', #/a c"n#!a!a!, ca ar!ere.e rena.e
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(re4in!' a(r"a(e c"n#!an! " i#!ri&$)ie #e*-en!ar'0 A#!fe. fiecare rinic%i are cinci #e*-en!e: / #e*#e*-en en!$ !$.. (".a (".arr #$( #$(er eri" i"r r / #e*#e*-en en!$ !$.. (". (".ar ar infe inferi ri"r "r / #e*#e*-en en!$ !$.. (re (re(i (ie. e.ic ic #$ #$(e (eri ri"r "r / #e*#e*-en en!$ !$.. (re (re(i (ie. e.ic ic infe inferi ri"r "r / #e*#e*-en en!$ !$.. re!r re!r"( "(ie ie.i .icc Fiecare #e*-en! ("#ea #(re %i. $n (eic$. #e*-en!ar0 Din #in$#$. rena. ar!ere.e ('!r$n 5n (arenc%i-, n .a nie.$. c"."a/ ne."r Jer!in ra!uri interlobare" i#($#e 5n +$r$. (ira-ie."r; in ace#!ea n$ #e e#(rin ra-$ri (en!r$ (ira-ie, e.e fiin a#c$.ari4a!e (rin ra-$ri eni!e in c"r!ica.a0 D$(' ce a$ ra-$ri 5n 4"na in!re (ira-ie, ace#!ea a+$n* .a &a4a (ira-ie."r $ne ein artere arcuate" in care (.eac' n$-er"a#e ra!uri ra%iare 5n c"r!ica.', en$-i!e artere interlobulare. Din ace#!ea (.eac' arteriolele aferente" care f"r-ea4' capilarele glo!erulului 3i #e c"n!in$a c$ arteriola eferenta" care #e ca(i.ari4e4a in n"$ 5n +$r$. !$&i."r c"n!"r)i (r"i-a.i, i#!a.i 3i a an#ei .$i 7en.e, $(' care $r-ea4' re)ea$a en"a#'0 'enele in -e$.ara 3i c"r!ica.', $rca #(re ene.e #!e.a!e in c"r!e, iar e aici ("rne#c en$.e #(re *enele arcuate" ana#!"-"4a!e 5n!re 5n! re e.e0 ene.e ene.e in +$r$. !$&i."r re()i ai (ira-ie."r #e ar#' 5n ene.e arc$a!e0 Ace#!ea #e c"n!in$a c$ *enele interlobare interlobare 3i, 5n $.!i-' in#!an)a, f"r-ea4' *enele renale %reapta )i st+nga" af.$en)i ai enei cae inferi"are0 ,i!faticele -er* .a *an*.i"nii ."-&ari0 -ner*aţia e#!e a!' e fi&re #i-(a!ice (r"eni!e in nerii #(.an%nici, care, (e ca.eaa#e."r ca.eaa#e."r,, a+$n* .a rinic%i0 rinic%i0 Fi&re.e (ara#i-(a!ice (ara#i-(a!ice a(ar)in ner$.$i ner$.$i a* 3i in in (.e$. ce.iac0
2.2 C-,/ 0R-N#R/ C'i.e $rinare #$n! a.c'!$i!e in: ca.ice.e rena.e, &a4ine!, $re!er, e4ica $rinar' 3i $re!ra0 C#,-C/,/ R/N#,/ / re(re4in!' ("r)i$nea ini)ia.a a c'i."r $rinare0 E.e #$n! e "$' fe.$ri: -ici 3i -ari0 Ca.ice.e rena.e -ici a$ a#(ec! e c$(', care #e af.' 5n +$r$. e#c%ierii fiec'rei (a(i.e rena.e0 Ca.ice.e rena.e -ari re4$.!a in c"nf.$erea ca.ice."r rena.e -ici, #$n! 5n n$-'r e !rei #$(eri"r -i+."ci$ 3i inferi"r0 ?
#-N/T0, / e#!e $n "r*an cai!ar e f"r-' !ri$n*%i$.ar' care re4$.!' in c"nf.$erea ca.ice."r rena.e -ari0 Ja4ine!$. #e af.a (ar)ia. 5n #in$#$. rena. 3i (ar)ia. 5n %i.$. rena.0 E. f"r-ea4' 5-(re$n' c$ ar!era rena.', c$ ena rena.', .i-fa!ice.e 3i c$ nerii rena.i (eic$.$. rena.0 Din ($nc! e eere a. #!r$c!$rii, ca.ice.e 3i &a4ine!$. #$n! a.c'!$i!e in !rei !$nici: -$c"a#a, -$#c$.ar' 3i aen!icea0 0R/T/R0, / e#!e $n c"n$c! .$n* e 2=/9 c-, ce #e 5n!ine e .a &a4ine!, (e care/ c"n!in$a (n' .a e4ica $rinar', 5n care #e e#c%ie0 E. (re4in!' " ("r)i$ne a&"-ina.', ce #e 5n!ine e .a &a4ine! (n' .a . a in!rarea in!r area 5n -ic$. &a4in, 3i " ("r)i$ne (e.ina, ce )ine e .a in!rarea 5n -ic$. &a4in (n' .a e4ica $rinar'0 Ure!er$. (re4in!' $n ca.i&r$ ine*a., c$ "$' re*i$ni -ai 5n*$#!a!e; $na #$& &a4ine! 3i a.!a .a in!rarea 5n -ic$. &a4in0 P'!r$nerea P'!r$nerea $re!er$.$i 5n e4ica $rinar' e#!e "&.ica (e " i#!an)' e /2 c-, c-, ac acea ea#! #!aa f"rf"r-n n c$ (e (ere re!e !e.e .e e e4i 4ici ciii $n $n $n*% *%ii a#c$ a#c$)i )i!0 !0 Ace cea# a#!' !' (ar!ic$.ari!a!e a e#c%ierii e#c%ieri i $re!er$.$i 5n e4ica $rinar' e(.ica e ce 5n !i-($. c"n!rac)iei e4icii, $rina n$ e#!e 5-(in#' 5na("i 5n $re!er0 Pere!e.e $re!er$.$i are !rei !$nici: a e#!e a.c' a.c'!$i !$i!a !a in!r in!r/$ /$nn e( e(i!e i!e.i$ .i$ (ri# (ri#-a -a!ic !ic tuni tunica ca !ucoa ucoasă să / e#!e #!ra!ifica!, care, cn $re!er$. e#!e (.in #a$ e#!in#, 53i (iere acea#!a #!ra!ificare 3i eine (.a! M$c"a#a n$ are -e-&ran' &a4a.' 3i nici -$#c$.ar' a -$c"a#ei 3i, cn $re!er$. e#!e *"., f"r-ea4' c$!e ."n*i!$ina.e0 S!r$c!$ra. #e a#ea-'n' c$ -$c"a#a e4ica.a 3i f"r-ea4' 5-(re$n' a#a/ n$-i!$. e(i!e.i$ e !ran4i)ie #' $r"!e.i$0 & tunica tunica !uscular !uscularăă / #e c"n!in$' .a "ri*ine c$ cea a (e.i#$.$i rena., iar .a ca('!$. !er-ina., c$ -$#c$.a!$ra !ri*"n$.$i e4ica.0 În ("r)i$nea a&"-ina.' a $re!er$.$i e#!e f"r-a!' in!r/$n #!ra! e fi&re circ$.are, .a e!eri"r, 3i a.!$. ."n*i!$ina., #(re -$c"a#a0 În !rei-ea inferi"ar' .a ace#!e "$' #!ra!$ri #e aa$*' a. !rei.ea, f"r-a! !"! in fi&re ."n*i!$ina.e, i#($# .a e!eri"r #(re aen!ice0 c a%*enticea e#!e a.c'!$i!a in )e#$! c"n+$nc!i .a, ce #e c"n!in$a c$ )e#$! c"n+$nc!i #$&(eri!"nea.0 #rterele care %r'ne#c $re!er$. (r"in in ar!ere.e rena.e, !e#!ic$.ara #a$ "ariana, i.iaca c"-$n', rec!a.a -eie, $!erina 3i e4ica.a inferi"ar'0 'enele c"n$c #n*e.e 5n ene.e !e#!ic$.are #a$ "ariene 3i 5n ene.e %i("*a#!rice0 @
!ran#( #("r "r!a !a .i-f .i-faa c'!r c'!ree *a *an* n*.i .i"n "nii ii ."-& ."-&ar arii 3i i.ia i.iacL cL ,i!faticele !ran #i-(a!ic !icii (r"i (r"inn in in (.e (.e$. $. %i("* %i("*a# a#!ri !ric, c, iar iar ce. ce. (a (ara ra#i#i-(a (a!ic !ic in Ner*ii #i-(a (.e$. (e.in0 '/-C# 0R-N#R / e#!e $n "r*an cai!ar a3e4a! 5n -ic$. &a4in, 5n ."+' e4ica.a0 Ea e#!e n$-ai 5n (ar!e 5ne.i!' e (eri!"ne$0 Ea e#!e fia!' 5n ."+a ei (rin!r/$n .i*a-en! (eri!"nea. 3i (rin c"n!in$i!a!ea c$ $re!ra 3i $re!ere.e0 e4ica $rinar' are " f"r-' aria&i.' 5n f$nc)ie e can!i!a!ea e $rin' ei#!en)a 5n in!eri"r0 A#!fe., cn e4ica $rinar' e#!e (.in', are f"r-a ""ia, iar cn e#!e *"a.', " f"r-' #e-i.$nara #a$ e c$(', a c'rei c"ncai!a!e (rie3!e 5n #$#0 Ca(aci!a!ea ei e#!e e 2=/9 -.0 Din ($nc! e ere a. c"nfi*$ra)iei e!erne, e4ica $rinar' (re4in!' $n f$n, $n c"r( 3i $n rf0 e#!e #i!$a! #i!$a! inferi inferi"r "r00 La nie. nie.$. $. f$n f$n$. $.$i $i #e 4un% 4un%ul ul *eic *eicii ii urina urinare re e#!e *'#e#c 9 "rificii / 2 "rificii a.e $re!ere."r 3i "rifici$. in!ern a. $re!rei0 P"r)i$nea c$(rin#' 5n!re ace#!e "rificii n$-i!' !ri*"n$. e4ica. / ine 5n ra("r! c$ (r"#!a!a, cana.$. eferen!, e4ic$.e.e #e-ina.e Ia &'r&a!, (ere!e.e an!eri"r a. a*in$.$i 3i c".$. $!erin .a fe-ei0 Corpul Corpul *eicii *eicii urinare urinare (re4in!' " fa!' an!eri"ar', $na 0("#!eri"ar' 3i "$' fe!e .a!era.e0 Fa!a an!eri"ar' a!! .a &'r&a! c! 3i Ia fe-eie ine 5n c"n!ac! c$ #i-fi4a ($&ian', e care e#!e e#('r)i!a (rin )e#$! c"n+$nc!i .a0 Fe!e.e .a!era.e in 5n ra("r! c$ -$3c%ii riic'!"ri ana.i care f"r-ea4' (ere)ii -$#c$.ari ai (e.i#$.$i0 Fa!a ("#!eri"ara are ra("r!$ri iferi!e .a &'r&a! 3i fe-ei0 La &'r&a! ine 5n ra("r! c$: 5n (ar!ea e #$#, ac"(eri!' e (eri!"ne$, c$ an#e.e in!e#!in$.$i in!e#!in$.$i #$&)ire 3i c$ c"."n$. #i*-"i, iar 5n (ar!ea e +"# c$ rec!$.0 La fe-ei (ar!ea e +"# ine 5n ra("r! c$ c"."n$. 3i c$ i#!-$. $!er$.$i0 '+rful *eicii ur!are #i!$a! #$(eri"r e#!e ac"(eri! e (eri!"ne$. (e.in0 E. ine 5n ra("r! c$ an#e.e in!e#!ina.e0 Pere!e.e e4icii $rinare are (a!r$ !$nici: a tuni tunica ca !uco !ucoas asăă a#e-'n'!"are c$ a $re!er$.$i / e(i!e.i$ e !ran4i)ie #a$ $r"!e.i$ f'r' -e-&rana &a4a.'0 & tunica sub!ucoasa / e#!e a.c'!$i!a in )e#$! c"n+$nc!i .a0 c e#!e c" c"n# n#!i !i!$ !$i! i!'' in in -$3c -$3c%i %i$. $. e e!r !r$# $#"r "r tuni tunica ca !uscu uscula lară ră / e#!e e4ica., a.c'!$i! in !rei (a!$ri e fi&re -$#c$.are ne!ee: $n #!ra! e fi&re ."*i!$ina.e, .a e!eri"r, a.!$. -i+."ci$, e fi&re circ$.are, 3i ce. e/a. !rei.ea, in!ern, f"r-a! !"! in fi&re ."n*i!$ina.e0 Fi&re.e ace#!"r #!ra!$ri #e c"n!in$a0 a.c'!$ !$i! i!aa .a nie nie.$ .$.. rf rf$. $.$i $i e e4i 4ici ciii 3i 5n tuni tunica ca ex exte tern rnăă / a.c' ("r)i$nea ("#!eri"ara a c"r($.$i in (eri!"ne$0 În re#! e4ica $rinar' e#!e $n "r*an e!ra(eri!"nea., a. c'r$i #!ra! e!ern #e c"-($ne in aen!ice f"r-a!' in )e#$!$. c"n+$nc!i .a c$ a#e 3i neri0 B
#rterele care %r'ne#c e4ica $rinar' (r"in in ar!ere.e e4ica.e, fiin ra-$ri irec!e #a$ inirec!e a.e ar!erei %i("*a#!rice 3i a.e ar!erei rec!a.e -eii0 'enele ia$ na3!ere 5n #$&-$c"a#a, a("i f"r-ea4' (.e$. care renea4' #n*e.e c'!re ena i.iac' in!ern'0 ,i!faticele c"n$c .i-fa c'!re *an*.i"nii i.iaci0 Ner*ii si!patici (r"in/in (.e$. %i("*a#!ric, iar ce. (ara#i-(a!ic in (.e$. (e.in0 Fi&re.e #i-(a!ice a$ "ri*inea 5n #i-(a!ic$. ."-&ar LI / L<, iar ce.e (ara#i-(a!ice 5n (ara#i-(a!ic$. #acra. S / S<0
2.3 0R/TR# Ure!ra e#!e $n cana. -$#c$." / -e-&ran"# care ifer' 5n ra("r! c$ #e$.0
2.3.1 0retra la bărbat
0ret 0retra ra la bă bărb rbat at"" n$-i!' $re!ra -a#c$.in' e#!e $n cana. -$#c$."/ -e-&ran"# .$n* e =/2 c- c$ $n !raiec!ca.i&r$ ne$nif"r-0 Ea 5nce(e e .a f$n$. e4cii $rinare 3i #e !er-in' 5n ca('!$. (eni#$.$i (rin!r/$n "rifici$ n$-i! -ea! $rinar0 Ea are r". 5n e.i-inarea $rinei c! 3i a .ic%i$.$i #(er-a!ic 3i e#!e c"n#!i!$i!' in !rei ("r)i$ni: / uretra prostatică" .$n*' e 2/9 c-, #!r'&a!e (r"#!a!' 3i 5n in!eri"r$. ei #e *'#e#c cana.e.e e+ac$.a!"are 3i cana.e.e ecre!"are a.e (r"#!a!ei; / uretra !e!branoasă" .$n*' e /2 c- ,#!r'&a!e iafra*-a (e.ina; / uretra spongioasă" e =/2 c- care #!r'&a!e (eni#$. 5nc"n+$ra!' e " f"r-a)i$ne a#c$.ar' #(ecia.' n$-i!' c"r($. #("n*i"# a. $re!rei0 S!r$c!$ra (ere!e.$i $re!rei -a#c$.ine e#!e iferi!' e/a .$n*$. ei 3i (re4in!': 2
/ tunic tunicaa !uco !ucoas asăă , e#!e $n e(i!e.i$ #!ra!ifica! (ri#-a!ic 5n in!eri"r$. c'r$ia #e *'#e#c fi&re e.a#!ice, *.ane !$&$.are ra-ifica!e, *.ane !$&$."acin"a#e c"-($#e care ('!r$n (n' 5n !$nica -$#c$.ar'; / tunica !usculară" .a nie.$. $re!rei (r"#!a!ice e#!e f"r-a!' in "$' #!ra!$ri e fi&re -$#c$."a#e ne!ee, $n$. in!ern ."n*i!$ina. 3i a.!$. e!ern circ$.ar0 În ("r)i$nea #$(eri"ar' a $re!rei (r"#!a!ice fi&re.e circ$.are f"r-ea4' #finc!er$. ne!e a. $re!rei0 La nie.$. $re!rei -e-&ran"a#e #!ra!$. -$#c$.ar ."n*i!$ina. .i(#e3!e, iar ce. circ$.ar e#!e 5n*r"3a! c$ fi&re -$#c$.are #!ria!e f"r-n f"r-n #finc!e #finc!er$. r$. #!ria! #!ria! a. $re!rei $re!rei00 La nie.$. nie.$. $re!rei $re!rei #(" #("n*i n*i"a# "a#e, e, !$nica !$nica -$#c$."a#' .i(#e3!e0 / tunica externă e#!e a.c'!$i!a in )e#$! c"n+$nc!i0
2.3.2 0retra la fe!ei
0retra la fe!ei e#!e $n cana. -$#c$."/-e-&ran"# .$n* e > c- care 5nce(e e .a f$n$. e4icii $rinare 3i #e !er-in' 5n e#!i&$.$. a*in$.$i0 Are $n ca.i&r$ -ai -are 5n c"-(ara)ie c$ cea -a#c$.in'0 Şi ea (re4in!' !rei !$nici: tunic tunicaa !ucoa !ucoasă să f"r-a!' in e(i!e.i$ e !i( (ai-en!"#, #!ra!ifica! 5n ("r)i$nea #$(eri"ar', a("i )e#$! #!ra!ifica! #!ra !ifica! (ri#-a!ic (rec$( rec$- 3i in!r/$n c"ri"n 5n care #e *'#e#c n$-er"a#e fi&re e.a#!ice, a#e 3i neri0 tuni tunica ca !usc !uscul ular arăă a.c'!$i!a in fi&re -$#c$.are ne!ee i#($#e 5n "$' #!ra!$ri, $n$. in!ern ."n*i!$ina. #i a.!$. e!ern circ$.ar ce f"r-ea4' .a e!re-i!a!ea #$(eri"ara #finc!er$. ne!e a. $re!rei iar inferi"r #finc!er$. #!ria! a. $re!rei tunica externa f"r-a!a in )e#$! c"n+$nc!i0 2.& 4--5,56-# #7#R#T0,0- /8CR/T5R
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R".$.. fi4i" R".$ fi4i"."* ."*ic ic (rin (rinci( ci(a. a. a. a( a(ara ara!$. !$.$i $i e ecre cre!"r !"r e#!e e#!e -en) -en)ine inere reaa c"n#!an!' a c"-("4i)iei c%i-ice 3i a (r"(rie!ari."r fi4ice a.e -ei$.$i in!ern #n*e, #n*e, .ic%i .ic%i in!er#!i in!er#!i)ia. )ia.,, -ei$ -ei$ in!race in!race.$.a .$.ar0 r0 Acea#!a Acea#!a ('#!rar ('#!raree 5n .i-i!e .i-i!e n"rn" r-a. a.ee a ife iferi ri!e !e." ."rr c" c"n# n#!a !an! n!ee fi4i fi4i". "."* "*ic icee a.e a.e -ei -ei$. $.$i $i in!e in!ern rn (" ("ar ar!a !a n$-e.e e %"-e"#!a4ie0 Prin r".$. .$i e a e.a&"ra 3i e.i-ina $rin', a(ara!$. ecre!"r -en)ine c"n# c" n#!an !an!' !' can! can!i!a i!a!ea !ea e a( a('' in in "r*a "r*ani# ni#- / i4"%i i4"%ir ra/ a/ 3i c" c"nc ncen en!ra !ra)ia )ia e ani"n an i"nii 3i ca!i" ca!i"ni ni / i4"i" i4"i"ni nia, a, (rec$ (rec$- 3i (re# (re#i$n i$nea ea "#!"#!-"! "!ica ica a (.a# (.a#-e -eii / i4""#-ia0 De a#ea#e-en enea ea,, e. are are $n r". r". %" %"!' !'r r!" !"rr 5n (' ('#! #!ra rare reaa ec ec%i %i.i .i&r &r$. $.$i $i aci"&a4ic a. "r*ani#-$.$i0 Dac' Da c' f$nc f$nc)ii )ii.e .e a( a(ar ara!$ a!$.$ .$ii e ecr cre!" e!"rr #$n! #$n! (e (er!$ r!$r&a r&a!e !e 5n -" -" n"r-a n"r-a., ., #$!an)e.e care #e e.i-in' in "r*ani#- #e ac$-$.ea4' 5n #n*e, 5n .ic%i$. in!er#!i)ia. 3i 5n ce.$.e 5n c"ncen!ra)ii inc"-(a!i&i.e c$ ia)a0 Prin $r-are, a(ara!$. ecre!"r -en)ine 5n .i-i!e fi4i"."*ice c"ncen!ra)ia !$!$r"r #$!an)e."r care #e e.i-in' 5n -" n"r-a. (rin $rin', c$- #$n!: $reea, crea!inina, aci $ric, #$.fa)ii, f"#fa)ii e!c0 T"! (rin $rina #e e.i-in' 3i $ne.e #$!an)e in!r"$#e 5n "r*ani#-, ca e ee-(.$, -eica-en!e.e0 0R-N# / e#!e " #".$)ie a("a#' 5n care #$n! i4".a!e iferi!e #$!an)e (r"eni!e in (.a#-a #an*in': #'r$ri -inera.e, (r"$3i fina.i ai -e!a&".i#-$.$i -e!a&".i#-$.$i in!er-eiar in!er-eiar 3i #$!an)e #$!an)e care a$ f"#! in!r"$#e 5n "r*ani#"r*ani#- 5n -" accien!a.0 Cantitatea e $rin' (e 2< % e#!e .a $n a$.! e 2/= -. 5n ra("r! c$ can!i!a!ea e .ic%ie in*era!e 3i c$ can!i!a!ea e .ic%ie e.i-ina!e (e ar!e cai0 9ensitatea $rinei 5n c"ni)ii n"r-a.e e#!e e =/22, an ca .i-i!e e!re-e cifre.e =/9=, 5n ra("r! c$ can!i!a!ea e a(' 3i e #'r$ri in*era!e0 Reacţia $rinei e#!e $3"r acia, (7/$. -ei$ fiin 5n +$r e >, iar .i-i!e.e e!re-e fiin e = 3i @0 Culoarea $rinei e#!e $3"r *'.&$ie a!"ri!' $n$i (i*-en!, $r"cr"-$.0 Mirosul $rinei e#!e carac!eri#!ic, $rina -ai ec%e are -ir"# e a-"niac a!"ri!' e#c"-($nerii $reei (rin ac!ii!a!ea en4i-a!ic' a -icr"&i."r0 Co!po Co!poiţia iţia c%i-ic' a $rinei ref.ec!a c"-("4i)ia c%i-ic' a (.a#-ei0 A#!fe., c$ ece()ia (r"!eine."r 3i a *.$c"4ei, !"a!e #$!an)e.e "r*anice 3i an"r*anice in $rina #e *'#e#c 3i 5n (.a#-', c$ e"#e&irea c' 5n $rin' e.e #e af.a 5n c"ncen!ra)ie -$.! -ai -are0 Deci 5n $rin' a(ar $r-'!"are.e #$!an)e: 22
Na/9=-* C./>-* /=-* Uree/@-* Aci $ric / >? -* F"#fa)i / = -* S$.fa)i/= -* Crea!inina / 9 -* Mecani#-e.e f"r-'rii $rinei #$n! e"#e&i! e c"-(.ee 3i #e e#f'3"ar' 5n "i !i-(i: a *."-er *."-er$.ar $.ar & !$&$.ar0 Fi.!rarea *."-er$.ar' c"n#!a 5n !recerea !$!$r"r c"-("nen!e."r (.a#-ei, 5n afar' (r"!eine."r c$ " *re$!a!e -".ec$.ar' -are, in ca(i.are.e *."-er$.are 5n ca(#$.a .$i J"-ann 3i a("i 5n !$&ii rena.i0
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CAPITOLUL III CISTITA ACUTĂ De1i!i2ie: Ci#!i!a ac$!' e#!e $n #inr"- c.inic e!er-ina! e inf.a-a)ia -icr"&ian' a -$c"a#ei e4icii $rinare0 care inf.$en inf.$en)ea )ea4' 4' $n ("!en)ia ("!en)ia.. riica riica!! (en (en!r$ !r$ FACTORI ACTORI DE RISC RISC care ci#!i!a ac$!' infec)i"a#' c"-(.ica!' #$n!: / #e$. fe-inin / r#!a 5nain!a!' / infec)ii.e in!ra#(i!a.ice3!i / #arcina / ($r!'!"ri e ca!e!er $rinar / an"-a.ii ana!"-ice 3i f$nc)i"na.e a.e !rac!$.$i $rinar / $!i.i4area recen!' e an!i&i"!ice / #i-(!"-a!"."*ie care $rea4' -ai -$.! e 3a(!e 4i.e / ia&e!$. 4a%ara! În car car$. $. infe infec) c)ii ii." ."rr !rac !rac!$ !$.$ .$ii $rin $rinar ar e#!e e#!e c" c"n# n#i ier era! a!'' re.e re.ea an! n!aa &ac!eri$ria0 Mai 9 *er-eni -. in!r/" (r"&' e $rin' in +e!$. -i+."ci$ 5n ci#!i!a ac$!' nec"-(.ica!' .a fe-ei0 Mai < *er-eni -. in!r/" (r"&' e $rin' in +e!$. -i+."ci$ 5n (re."nefri!a ac$!' nec"-(.ica!' .a fe-ei0 Mai = *er-eni *er-eni -. in!r/" in!r/" (r"&' (r"&' e $rin' in +e!$. +e!$. -i+."ci$ -i+."ci$ .a fe-eie, #a$ -ai -$.! e < *er-eni -. in!r/" (r"&' e $rin' in +e!$. -i+."ci$ .a $n &'r&a! #a$ 5n ca4$. $nei fe-ei care e#!e #"na!' e4ica. (en!r$ " infec)ie ac$!' e !rac!$. $rinar c"-(.ica!0 Jac!eri$ria a#i-(!"-a!ic' e#!e c"n#iera!' ece.area -ai -$.! e = *er-eni -. 5n "$' c$.!$ri rec".!a!e .a -ai -$.! #a$ e*a. e 2<%0 PREVALEN0A A(r"i-a!i =?,@ in ("($.a)ie, fe-ei c$(rin#e 5n!re 2/< e ani 2=/9=, fe-ei *raie ?0 J"a.a a(are .a "rice r#!' 3i e#!e -ai frecen!' .a fe-ei0 Re(ar!i)ia &".ii (e *r$(e e r#!' e#!e iferi!' 5n ra("r! c$ "ri*inea #a0 ETIOLOGIE Ori*inea ci#!i!ei ("a!e fi: 2<
/ $re!r"(ie."rena.' e aceea 5n "rice ci#!i!' !re&$ie e(."ra!e 3i c'i.e $rinare #$(eri"are care #$n! ca.ice.e, &a4ine!$. 3i $re!ere.e0 / e e4ic 4ica. a.'' !ra$ !ra$-a -a!i# !i#- (r"$ (r"$## c$ "c "ca4 a4ia ia #"n #"na+$ a+$.$ .$ii e e4i 4ica ca., ., #!a4a #!a4a e4ic e 4ica. a.', ', !$-"ri !$-"ri,, c" c"r( r(ii #!r'in #!r'ini, i, rai" rai"ne necr" cr"4' 4' e e4i 4ica ca.', .', &" &".i .i (a (ara4 ra4i!a i!a.e .e,, $.cera)ii0 / În #fera *eni!a.' 5n #(ecia. .a fe-eie $re!ri!e, -e!ri!e, &ar!".ini!e, $."a*ini!e, !ra$-a!i#-e $.are, anei!e0 / .a &'r&a! $re!ri!a ("#!eri"ar', (r"#!a!i!' / (r"c (r"ce# e#ee inf. inf.aa-a! a!"r "rii ii a& a&" "-i -ina na.e .e (e (e. .ie iene ne a&c a&ce# e# a( a(en eni ic$ c$.a .arr, (eri#i*n"ii!' #$($ra!'0 Ca$4 Ca$4e. e.ee *e *ene nera. ra.ee #inr #inr""-$. $. Rei!e Rei!err $re! $re!ri! ri!', ', c" c"n+$ n+$nc nc!i !ii!' i!',, ar!ri ar!ri!' !' ir"!ic' #a$ a.er*ic' A*en)ii e!i" !i"."* ."*ici #$n! #i-i.ar .ari 5n infec)ii. )ii.ee !rac rac!$. !$.$i $rin rinar nec"-(.ica!e 5na.!e #a$ +"a#e0 E0C"..i e#!e a*en!$. (a!"*en 5n a(r"i-a!i 5n ?/B in ca4$ri, #!afi."c"c$. #a(r"fi!ic$# = 5n ca4$ri 3i -ai rar ("a!e fi e!er-ina! e en!er"&ac!eriacee, (r"!e$# -irai.i# 3i .eie..a0 În ca4$. infec)ii."r c"-(.ica!e a.e !rac!$.$i $rinar ce. -ai frecen! #e ece e ce.e .ea4 a4': ': #!af #!afi. i."c "c"c "cii 3i -$.! -$.! -ai -ai rar: rar: Pr"! Pr"!e$ e$## #( #(ec ecii ii;; P#e$ P#e$" "-" -"na na#, #, .eie..a, E0C"..i, en!er"c"ci0
ANATOMIE PATOLOGICĂ: Ci#!i!a ac$!' ("a!e fi: / ca!ara.' / fi&r i&rin" in"($r$. r$.en!' / ($r$.en!' / if!er"i' / %e-"ra*ic' / *an*ren"a#' CLASIFICARE / ci#!i!e ci#!i!e ac$!e ac$!e nec" nec"-(. -(.ica! ica!ee .a fe-ei fe-ei 5nain 5nain!e !e e -en"(a -en"(a$4' $4' / ci#! ci#!i! i!aa ac$! ac$!'' rec$ rec$re ren! n!'' .a fefe-ei ei / ci#! ci#!i! i!aa ac$! ac$!'' .a fe-e fe-eii *ra *rai iee / ci#!i ci#!i!a !a ac$! ac$!'' .a .a fefe-ei ei .a -en" -en"(a (a$4 $4'' / ci#! ci#!i! i!aa ac$! ac$!'' .a &' &'r& r&a) a)ii !ine !ineri ri / ci#! ci#!i! i!'' ac ac$! $!'' .a c" c"(i (iii / ci#!i!a ci#!i!a ac$!' ac$!' c"-( c"-(.ica .ica!' !' K ca$4a! ca$4a!'' e &".i &".i $r"." $r"."*ice *ice00
2=
SIMPTOMATOLOGIE Ci#!i!a #e -anife#!' (rin !rei #e-ne c.inice carac!eri#!ice: 0 (".ai$ (".ai$ria ria $ri $rini ni -ici -ici 3i e#e e#e 20 (i$r (i$ria ia ($ ($r" r"i i 90 $ $re rerea rea a.*$ a.*$ria ria POLAIURIA POLAIURIA re(re4in!' re(re4in!' #i-(!"-$. #i-(!"-$. ce. -ai e# 5n!.ni! 5n (a!"."*ia (a!"."*ia $rinar' 3i #e carac!eri4ea4' (rin -ic)i$ni frecen!e 3i re$#e ca ".$-0 În ci#!i!e.e a!"ra!e *er-eni."r &ana.i (".ai$ria #e a-enea4' 5n c$r#$. n"()ii #(re e"#e&ire e ci#!i!', a!"ri!' &aci.$.$i !$&erc$."# 5n care (".ai$ria e#!e -ai in!en#' 5n !i-($. n"()i0 PIURIA e#!e #e-n$. -a+"r a. infec)iei c'i."r $rinare0 Pi$ria re(re4in!' (re4en)a ($r"i$.$i 5n $rin', $rina e#!e !$.&$re, a#(ec!$. !$.&$re ("a!e aea iferi!e *rae 5n f$nc)ie e can!i!a!ea 3i fe.$. ($r"i$.$i care #e a-e#!ec' 5n $rin', $rina $rina f'r' .$ci$, $rina $rina care 3i/a (ier$! (ier$! !ran#(aren)a, !ran#(aren)a, $rina -a!' -a!' #a$ in!en# !$.&$re, $ne"ri c$ fi.a-en!e care ca (e f$n$. &"rcan$.$i0 Pi$ria ("a!e fi -anife#!a!' #a$ i#cre!', $ne"ri e#!e in!en#' c$ #face.a 3i -ir"# ($!re 5n cancere.e e4ica.e, (i$ria ("a!e fi afir-a!' (rin ea-en$. -icr"#c"(ic ce ara!' (re4en)a $n"r .e$c"ci!e (".in$c.eare a.!era!e, a.!e"ri .a #fr #fr3i 3i!$ !$.. -ic) -ic)i$ i$ni niii a( a(ar aree %e %e-a -a!$ !$ri riaa !er!er-in ina. a.', ', care care 5n *e *ene nera ra.. n$ e#!e e#!e a&$nen!', e#!e f"ar!e frecen!' 5n ca4$. infec)iei c$ Nei##eria *"n"reea 3i c%.a-iia !rac%"-a!i#0 DUREREA DUREREA 5n ca4$. ci#!i!ei ac$!e a(are e "&icei " $rere !er-ina.' !er-ina.' .a care #e aa$*' e "&icei !ene#-e e4ica.e $rer"a#e0 L"ca.i4area $rerii are e a#e-enea " i-("r!an)' e"#e&i!', $rerea %i("*a#!ric' iraia!' (e $re!r' #a$ 5n *.an, are ."ca.i4are e4ica.'0 De a#e-enea " e"#e&i!' i-("r!an)' 5. (re4in!' ea-en$. $rinii .a e-i#ie0 Cn $rina e#!e !$.&$re 3i a#"cia!' c$ $rere 3i (".ai$ria #e c"nfir-' ia*n"#!ic$. e ci#!i!'0 D$rerea e#!e e in!en#i!a!e aria&i.' 5n *enera. e#!$. e ie 3i e#!e (re4en!' (e !"! (arc$r#$. -ic)i$nii, ea*ern$/#e #(re #fr3i!$. ace#!eia0 C$ ece()ia ece()ia ci#!i!ei *an*ren"a#e, *an*ren"a#e, ci#!i!a e#!e e(ire!ic'0 e(ire!ic'0 O ci#!i!' fe&ri.' re(re4in!' e fa(! " (ie."ci#!i!', fe&ra fiin a!"ri!' infec)iei c'i."r $rinare #$(eri"are #a$ a (arenc%i-$.$i rena.0 În f$nc)ie e e!i"."*ia ci#!i!ei, .a !riaa #i-(!"-a!ic' en$n)a!' #e -ai ("a!e a'$*a %e-a!$ria, i#$ria 3i $rerea ."-&ar'0 7EMATURIA 7EMATURIA re(re4in!' (re4en)a #n*e.$i 5n $rin'0 Ea-en$. "&iec!i 5n ca4$. cn #e #$#(ec!ea4' 3i (re4en)a $nei %e-a!$rii 5nce(e c$ ea-en$. $rinii $rinii e-i#ie0 e-i#ie0 Pr"en Pr"enien) ien)aa %e-a!$riei %e-a!$riei #e #!a&i.e3! #!a&i.e3!ee (rin (r"&a ce."r ce."r !rei (a%are0 J".na$. $rinea4' #$cce#i 5n !rei (a%are c"nice, c!ea (ic'!$ri 5n
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(ri-$. (a%ar, (ar!ea cea -ai a&$nen!' a -ic)i$nii 5n a. "i.ea (a%ar, iar $.!i-e.e (ic'!$ri 5n a. !rei.ea (a%ar0 (a%ar0 Dac' Dac' %e-a!$ %e-a!$ria ria a(are n$-ai n$-ai 5n (ri-$. (ri-$. (a%ar (a%ar Q i!i2i"l 5n#ea-n' c' e#!e e "ri*ine $re!ra.'0 Dac' Da c' a( a(ar aree n$ n$-ai 5n $.!i $.!i-$. (a (a%a %arr Q $e*mi!"l e#!e e#!e e "ri*i "ri*ine ne e4ica.'0 Dac' a(are 5n !"a!e ce.e !rei (a%are Q $$"l e#!e e "ri*ine rena.'0 În ca4$ ca4$ri ri.e .e 5n care care e eaa-en en$. $. c.in c.inic ic ' ini inica ca)i )iii a#$( a#$(ra ra "ri* "ri*in inii ii %e-a!$riei, #e ("a!e (re#crie $n !ra!a-en! %e-"#!a!ic, $r-n a c"n!in$a ine#!i*a)ii.e $(' a-e.i"rarea %e-a!$riei0 În ca4$. 5n care e(."rarea c.inic' n$ "fer' nici " inica)ie a#$(ra ."c$.$i e (.ecare a. %e-a!$riei, ci#!"#c"(ia eine $n ea-en e $r*en)', ea !re&$ie f'c$!' .a (re4en!area (re4en!area &".na$.$i 5n (.ina %e-a!$rie0 Ure!r"ci#!"#c"( Ure!r"ci#!"#c"(ia ia 5n (.in' %e-a!$rie ara!' "ri*inea e4ica.' a %e-"ra*iei0 DISURIA re(re4in!' *re$!a!ea .a -ic)i$ne, *".irea c$ ef"r! a e4icii, e#!e $n #i-(!"- frecen! 5n ci#!i!a ac$!'0
DIAGNOSTIC Pen!r$ a e!ic%e!a #$ferin)a $n$i &".na c$ ci#!i!', !riaa #i-(!"-a!ic' (".ai$ria, (i$rie, $re e#!e #$ficien!'0 Pen!r$ #!a&i.irea $n$i ia*n"#!ic c"rec!, e!i"(a!"*enic #$n! nece#are " #erie e ea-ene EAMENUL REGIUNII REGIUNII LOMJARE ("a!e ($ne 5n eien)' $n rinic%i -are, (a.(a&i.0 În re*i$nea %i("*a#!ric' #e e#c"(er' #!a4a e4ica.' #a$ " !$-"are (e.ian'0 La ea-en$. #cr"!$.$i 3i a. $re!rei #e ("a!e (a.(a " .e4i$ne inf.a-a!"rie e(iiie(iii-ar' ar' #a$ " (eri$re (eri$re!ri! !ri!'0 '0 Tac! Tac!$. $. a*ina. a*ina. .a fe-ei 3i !ac!$. !ac!$. rec!a. .a &'r&a)i ea-inea4' #!area "r*ane."r (e.i(erinea.e 3i 5n an#a-&.$, ea-en$. c.inic ("a!e "rien!a e#e "ri ea#$(ra "ri*inii ci#!i!ei0 Pre4en)a e #ecre)ie .a nie.$. -ea!$.$i -ea!$.$i $re!ra. $re!ra. i-($ne rec".!area rec".!area ace#!eia ace#!eia 3i ea-inarea ea-inarea ei, a!! a!! (e fr"!i$ irec! c! 3i (e 5n#'-n)'ri0 Prin Prin e eaa-en en$. $. &a &ac! c!er eri" i"." ."*i *icc a. $rin $rinii ii #e ien ien!i !ifi fic' c' *e *err-en en$. $. 3i #en#i&i.i!a!ea #en#i&i.i!a!ea .$i .a an!i&i"!ice an!i&i"!ice00 Pre4en)a Pre4en)a *er-eni."r *er-eni."r &ana.i &ana.i n$ ara!' 5n#' 3i ca$4a ci#!i!ei, a3a c$- (re4en)a &aci.$.$i "c% ara!' #i*$r " !$&erc$."4'0 Un a.! ea-en e"#e&i! e i-("r!an! (en!r$ #!a&i.irea ia*n"#!ic$.$i e#!e $r"c$.!$ra0 Acea#!a re(re4in!' 5n#'-n)area *er-eni."r (e $n -ei$ e c$.!$r', ac' $r"c$.!$ra efec!$a!' (e -eii "&i3n$i!e e#!e ne*a!i' acea#!' (i$rie H a-icr"&ian'6 ("a!e fi " !$&erc$."4' $rinar', infec)ie f$4"#(iri.ar',
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infe infec) c)ie ie ir" ir"!i !ic' c' #a$ #a$ (a (ara ra4i 4i!a !ar' r' care care a ne nece ce#i #i!a !a e eaa-en enee e .a&" .a&"ra ra!" !"r r c"-(.e-en!are0 În "rice ci#!i!' ea-en$. rai"."*ic e#!e a".$! nece#ar0 R"4i)*"1i" *e!9eic"l ("a!e e#c"(eri $ne"ri ca$4a ci#!i!ei 5n!r/" .i!ia4' e4ica.' #a$ (ie."$re!ra.', $n c"r( #!r'in in!rae4ica., $n rinic%i -are, -e!a#!a4e.e "#"a#e a.e $n$i cancer a. (r"#!a!ei0 U*)*"1i" ("a!e eien)ia ca$4a ci#!i!ei 3i $ne.e .e4i$ni a.e a(ara!$.$i $rinar care n$ a$ f"#! &'n$i!e c.inic: / .e4i .e4i$n $nii ren rena. a.ee !$& !$&er erc$ c$." ."a# a#ee / %i("!"n %i("!"nia ia (ie."ca (ie."ca.ice .icea.' a.' in!r in!r/" /" (ie."ne (ie."nefri! fri!'' / aen) aen)aa i-a*ini i-a*iniii (ie."ca (ie."ca.ice .icea.' a.' a!" a!"ri!' ri!' $nei (i"nefr (i"nefra4e a4e00 / r'#$ r'#$ne ne!$ !$.. $re!e re!er" r"(i (ie. e."r "ren ena. a. a a!" !"ri ri!! $n $n$i $i "& "! #!ac ac". ". e e4i 4ica ca.. #a$ #a$ #$& #$&e4 e4ica ica.. !$-" !$-"are are -a.i* -a.i*n' n' e e4i 4ica ca.' .' 5n e ecin cin'! '!a!e a!eaa "rifi "rifici$ ci$.$ .$ii $re!ra $re!ra., ., ref.$$. e4ic"$re!ra., $re!re, 5n cr.i* e $ni)', a!"ri!' $n$i aen"- a. (r"#!a!ei c$ e".$)ie in!rae4ica.' in!rae4ica. ' !$-"are a (r"#!a!ei, #!ric!$ri $re!ra.e0 Cis$)*"1i" u*)*"1ic ' inica)ii a#$(ra *ra$.$i %i(er!"niei e4ica.e e4ic' r"!$n' #a$ a#$(ra a(ari)iei )e#$!$.$i e #c.er"4' e4ic' a#i-e!ric', 3i $ne"ri ara!' 3i ca$4a ci#!i!ei: / i-a* i-a*in inea ea .ac .ac$n $nar' ar' a $nei $nei !$!$-"r "rii e4i e4ica ca.e .e / (r"e (r"e-i -ine nen)a n)a $ne $neii !$!$-"r "rii a (" ("#! #!a!e a!eii / (re4 (re4en en)a )a ca. ca.c$ c$.i .i." ."rr e aci aci $ric $ric / (r"e-i (r"e-inen nen)a )a a!" a!"ri!' ri!' $ne $neii i.a!a i.a!a)i )i c%i#! c%i#!ice ice $re!era $re!era.e .e / r'#$ r'#$ne ne!$. !$. e4 e4ic ica. a. a. $n$ $n$ii "!ac "!ac". ". #$& #$&e4 e4ica ica.. / ier!ic$.i0 C$ "ca4ia $r"*rafiei #e ("a!e face 3i " $re!r"*rafie -ic)i"na.', care ("a!e ar'!a -"ific'ri.e $re!rei (r"#!a!ice a!"ri!e $n$i aen"- #a$ $n$i cancer a. (r"#!ra!ei, #!ric!$ri $re!ra.e0 O rai"*rafie e4ica.' f'c$!' $(' -ic)i$ne ("a!e ($ne 5n eien)' $n re4ii$ e4ica.0 Ci#!"#c"(ia #a$ $re!r"ci#!"#c"(ia e#!e $.!i-$. ea-en 5n ca4$. cn ce.e.a.!e ine#!i*a)i #$n! nec"nc.$en!e0 Ci#!"#c"(ia ("a!e ar'!a $ne.e ca$4e a.e ci#!i! ci#!i!ei ei care n$ a$ ($!$! ($!$! fi eien eien)ia )ia!e !e (rin ce.e.a ce.e.a.!e .!e e eaa-ene ene 3i e a#ea#e-en enea ea,, a#(e a#(ec!$ c!$.. .e4i$ .e4i$ni. ni."r "r -$c"a -$c"a#e #e 3i ."ca ."ca.i4 .i4are areaa ."r ."r0 A#!fe A#!fe.. #e (" ("!! ien! ien!ifi ifica ca .e4i$ .e4i$ni ni if$4 if$4e, e, *re$ *re$ e in!e in!er(r r(re!a e!a!! 3i care care ne nece ce#i #i!' !' re(e re(e!ar !area ea ci#!"#c"(iei $(' $n !ra!a-en! in!en# c$ an!i&i"!ice 3i in#!i.a)ii c$ #".$)ie e ni!ra! e ar*in! , .e4i$ni ."ca.i4a!e 5n !ri*"n #a$ ca."!' ci#!i!' e "ri*ine rena.' rena.' #a$ #i*-"ii #i*-"iian' an' ."ca.i4a ."ca.i4a!e !e .a c". ci#!i!' ci#!i!' e "ri*ine "ri*ine $re!r"* $re!r"*eni! eni!a.' a.' ."ca.i4a!e (e fe)e.e .a!era.e #a$ (e fa)a ("#!eri"ar' ci#!i!' e "ri*ine (e.ian', aneia.' a(enic$.ar', #i*-"iian' #a$ rec!a.'0
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EVOLU0IE ŞI PROGNOSTIC. E". E".$) $)ia ia $n $nei ei ci#! ci#!i! i!ee e e(i (in nee e ca ca$4 $4e. e.ee (re (rei# i#(" ("4a 4an! n!ee 3i e ("#i&i.i!a!ea !ra!'rii ."r0 Na!$ra *er-eni."r n$ +"ac' ec! $n r". #ec$nar, #e afir-' c' .e4i$ni.e a!"ra!e c".i&aci.$.$i #$n! -ai ($)in (eric$."a#e, ar e $ra!' -ai .$n*' ec! ce.e e!er-ina!e e #!afi."c"c #a$ #!re(!"c"c care #$n! -ai *rae, ar c$ra&i.e 5n!r/$n !i-( -ai #c$r!0 F"r-e.e ac$!e #i-(.e #e ("! ineca 3i #("n!an ca$4e.e fiin !rec'!"are0 Si-(!"-e.e #e a-enea4' 5n c!ea 4i.e, $rina eine c.ar' iar 5n /2 4i.e e".$)ia #e !er-in' (rin H re#!i!$)i" a in!e*r$-60 F"r-e.e ac$!e #i-(.e reciian!e #e "er' -ai a.e# .a fe-ei, nece#i!' e(."r'ri c"-(.e!e (en!r$ a .i #e e#c"(eri "ri*inea 3i a #e ($!ea a(.ica $n !ra!a-en! ca$4a. eficien!0 În f"r-a can*ren"a#' #a$ ef".ian!', care e#!e e#!$. e rar' 3i a(are 5n an$-i!e c"ni)ii ca: / $!er 5ncarcera! / infec)ia ($er(era.' / .a #!ric!$ra)i 3i (r"#!a!ici $(' e(."r'ri in#!r$-en!a.e !ra$-a!i4an!e0 În !"a! !"a!ee ac ace# e#!e !e ca ca4$ 4$ri ri #!ar #!area ea *e *ene nera ra.' .' #e a* a*ra rae ea4 a4'' re(e re(ee e 3i -"r!a -"r!a.i! .i!a! a!ea ea e#!e e#!e e e#! #!$. $. e riic riica! a!'0 '0 D$ D$(' (' c!e c!eaa 4i.e 4i.e e &" &"a.' a.' -$c" -$c"a# a#aa e4ica.' 5nce(e #' fie e.i-ina!' $ne"ri 5n !"!a.i!a!e, .a fe-ei e($.4ia e#!e ("#i&i.', .a &'r&a! !re&$ie !re&$ ie f'c$!' " ci#!"!"-ie 3i e!ra#' -$c"a#a *an*ren"a#' ef".ia!'0 M$c"a#a #e ("a!e re*enera c"-(.e! 3i ra(i, ar $ne"ri r'-n #ec%e.e *rae ca: / e4ic' -ic' #c.er"a#' / #c.er"4a "rificii."r $re!era.e0 Cm,lic"2ii: / Pie."nefri!a a#cenen!' e "&icei (rin ref.$ e4ic" $re!era.0 / Încr Încr$# $#!a !a)i )iii 3i ca.c ca.c$. $.ii e e4i 4ica ca.i .i a a!" !"ri ri!' !' (rec (reci( i(i! i!'r 'rii ii f"#f f"#fa) a)i. i."r "r 3i car&"na)i."r car&"na)i."r e ca.ci$, c"n#ecin)' c"n#ecin)' a a.ca.ini4'rii $rinii (rin #cinarea #cinarea $reei e c'!re $ne.e &ac!erii0 A&ce#e 5n (ere!e.e e4ica. 3i necr"4e ."ca.i4a!e0 Perici#!i!a a(are 5n ca4$. fi#!$.i4'rii a&ce#$.$i0 Peri!"ni!a a(are !"! 5n ca4$. 5n care a&ce#$. e#!e fi#!$.i4a!0 / Infec)ia (ere!e.$i e4ica. 5n ca4$. $nei ci#!i!e *rae 3i e $ra!' / Sc.er Sc.er"4 "4aa 3i re!ra re!rac) c)ia ia (e (ere! re!e.$ e.$ii e e4ic 4ica. a.00 e4ica e4ica $rina $rinar' r' re$ re$#' #',, e i-en#i$ni -ici care n$ 53i -ai ("a!e 5ne(.ini f$nc)ia e re4er"r0 /S!en /S!en"4 "4ar area ea "rifi "rifici cii. i."r "r $re!e $re!era ra.e .e re(r re(re4 e4in! in!'' $n *ra *ra (e (eric ric". ". (e (en!r n!r$$ rinic%i0 Se-ne.e e *rai!a!e a.e ci#!i!ei #$n!: / in!en#i!a!ea $reri."r 2B
/ frecen)a -ic)i$ni."r / e.i-inarea e *r$n+i ($r$.en)i 3i #face.e / a.!erarea #!'rii *enera.e0
TRAT TRATAMENTUL CISTITELOR C ISTITELOR ACUTE re*i- i*ienic"/ie!ic, re(a$# .a (a!, re*i- a.i-en!ar $3"r: Cu*"$i9 ; re*i.ic%ie 5n can!i!a!e -are (rec$- 3i .a(!e, fr$c!e 3i 4ar4aa!$ri / c" c"n! n!r". r".$. $. !ran !ran4i 4i!$. !$.$i $i in!e# in!e#!in !ina. a. a#i* a#i*$r' $r':: e -$.!e -$.!e "ri "ri ine ineca carea rea (r"ce#$.$i ac$!, &'i ca.e e 3e4$! / #('.'!$ri a*ina.e ca.e / c"-(re#e ca.e care $ne"ri a!en$ea4' $reri.e Cn $rina e#!e (rea aci' K (7 #$& =,= #e a-ini#!rea4' &icar&"na! e #"i$ 5n "4' e 2 *4i0 Dac' ei#!' $n re4i$$ e4ica., #"na, e4ica.' a-e.i"rea4' .a rn$. ei $rerea0 În *enera. c$ ace#! !ra!a-en! -eica. #i-(.$ fen"-ene.e e4ica.e #e .ini .ini3! 3!e# e#cc 5n 2/9 2/9 4i.e 4i.e00 În ace# ace#!! !i-( !i-( #e e eec ec$! $!'' $r"c $r"c$. $.!$ !$ra ra 3i e e(. (."r "r'r 'ri. i.ee rai"."*ice (e &a4a c'r"ra #e a ($!ea inica a("i $n !ra!a-en! c"rec! )inn$/#e #ea-a e fa(!$. c' !ra!a-en!$. ca$4a. e#!e "&.i*a!"ri$ 5n "rice f"r-' e ci#!i!'0 Me4ic"me!$s Dac' Da c' *er-e *er-eni niii #$n! #$n! #en#i&i #en#i&i.i .i .a S$.fa!i S$.fa!ia4 a4". ". #a$ Ne Ne" "a4 a4". ". "r fi (refera!e ace#!ea, an!i&i"!ice.e an!i&i "!ice.e r'-nn -eica)ia e re4er'0 Ne"a4".$. #e a (re#crie 5n "4' e , *i."c"r( .a a$.! 3i ,/,9 *i."c"r( .a c"(i.0 În *enera. $n$i a$.! i #e (re#cri$ 5n (ri-e.e "$' 4i.e .a < "re "$' !a&.e!e > *2<% a("i .a !rei "re " !a&.e!' <*2<%0 Dac' $rina 5nce(e #' #e .i-(e4ea#c' #e c"n!in$' !ra!a-en!$. (n' .a #!er #!eri. i.i4 i4ar area ea / /2 2 4i.e 4i.e 5n (re4 (re4en en)a )a $n $n"r "r ca.c ca.c$. $.ii rai rai"# "#c" c"(i (ici ci,, $ $(' (' a-e.i"rarea ci#!i!ei #e a (r"cea .a 5ne('r!area ace#!"ra0 O ci#!i!' a('r$!' .a " fe-e fe-eie ie .a care care $r"* $r"*ra ra-a -a e#!e e#!e n" n"rr-a.' a.' !re&$ !re&$ie ie c" c"n#i n#ie era! ra!'' e "ri*in "ri*inee *eni!a.'0 Cn fen"-ene.e ac$!e a.e ci#!i!ei n$ ceea4' .a !ra!a-en!$. -eica. e#!e inica!' a#"cierea !ra!a-en!$.$i $r"."*ic0 Dac' $rina c$ !"! !ra!a-en!$. a(.ica! #e -en)ine !$.&$re #e ("! face #('.'!$ri e4ica.e c$ #".$)ii an!i#e(!ice #.a&e ni!ra! e Ar*in! Ar*in! 2 *ra-e , Aci Aci J"ric < *rae 0 Dac' $rina e#!e (rea aci' 3i are -$.! -$c$# #e ("a!e f"."#i (en!r$ #('.'!$ri #".$)ie e &icar&"na! e #"i$ < *rae #a$ c%iar: / a(' i#!i.a!' / #".$)ie c."r$r"#"ic' i4"!"nic'0
9
S('.' S('.'!$ !$ri. ri.ee a$ #c"($ #c"($.. #' e e!a3 !a3e4 e4ee fa.#e fa.#e.e .e -e-& -e-&ran ranee 3i e e(" ("4i 4i!e. !e.ee ($r$.en!e e (e -$c"a#a e4ica.'0 În ace.a3i #c"( #e ("! $!i.i4a 3i in#!a.a)ii.e c$: / c%e-"!ri(#in' / #!re(!"ina4a / #!re(!""rna4a În ci#!i!e.e 5ncr$#!a!e #e fac #('.'!$ri c$ #".$)ie G S$&i 3i A.&ri*%! care are $n (7 aci: / Aci ci!ric -"n"%ira! 92,9 *r0 / Oi e -a*ne4i$ an%ir$ 9,@ *r0 / Car&"na! e #"i$ an%ir$ <,< *r0 / A(' i#!i.a!' -.0 / 2.in*$ri .a $n .i!r$ e a(' #!eri.'0 Aci$. ci!ric !ine #' fie4e ca.ci$. i"nic .e*a! e f"#f"r ca f"#fa! e ca.ci$, n ci!ra! e ca.ci$ $3"r #".$&i.0 Ac)i$nea ci!ra!$.$i 5n!r/" #".$)ie #$(ra #$(ra#a #a!$ !$ra! ra!'' e f"#fa f"#fa!! e ca.c ca.ci$ i$ (rei (reine ne (rec (reci( i(i!a i!area rea00 Efec Efec!$. !$. iri!an iri!an!! a. ci!ra ci!ra!$. !$.$i $i e#!e e#!e -ic3 -ic3"r "ra! a! e (re4e (re4en) n)aa " "i i$.$ $.$ii e -a*n -a*ne4 e4i$, i$, care care -en) -en)ine ine in!ac in!ac!' !' ($ ($!e !erea rea #". #".en! en!'0 '0 Prin Prin ace# ace#!e !e #('. #('.'!$ '!$ri ri #e "&)in "&)in re4$ re4$.!a .!a!e !e &$ &$ne ne 5n ci#!i!e.e re&e.e 5n!re)in$!e e (i"*eni &ana.i0 În ci#!i!e.e c$ f$4"#(iri.i #e "&)in re4$.!a!e &$ne ac' #e a-ini#!rea4' (enici.in', n"ar#en"&en4". ne"#a.ar#an 5n "$' in+ec)ii in!raen"a#e .a " 4i in!era. ,=/,9 *r0 În ci#!i!e.e c".$.$i e4ica. frecen!e .a fe-ei, care n$ a$ cea! .a !ra!a !ra!a-e -en! n!$. $. -ei -eica ca.. #e (" ("!! (re#c (re#crie rie in#!i in#!i.a) .a)ii ii e e4ic 4ica. a.ee c$ /= /= -. ".e$ ".e$ *"-en".a! = in!r"$# c$ $n in#!i.a!"r f'r' #"', 4i.nic #a$ .a "$' 4i.e, 5n !"!a. in#!i.a)ii0 Dac' !"!$3i n$ #e "&)ine " a-e.i"rare a-e.i"rare eien!' 3i $r"c$.!$ra e#!e ("4i!i', iar *er-en$. e#!e #en#i&i. .a $n an!i&i"!ic #e "r (re#crie crei"ane $re!era.e c$ an!i&i"!ic$. re#(ec!i5n *enera. =/ -* crei"n, can!i!a!ea can!i!a!ea #e -ic3"rea4' -ic3"rea4' ac' an!i&i"!ic$. e#!e iri!a!, care #e "r in!r"$ce in!r"$ce (e $re!r' 4i.nic #a$ .a "$' 4i.e, $(' !recerea $n$i Jeni*$ee re(! n$-'r$. 9@/ <0 În c" c"nc nc.$4 .$4ie ie !ra!a !ra!a-e -en!$ n!$.. $n $nei ei cin# cin#!i! !i!ee (" ("a! a!ee fi f"ar!e f"ar!e #i-( #i-(.$ .$ #a$, #a$, i-("!ri' f"ar!e c"-(.ica!0 Re4$.!a!e.e #$n! fie &$ne e .a 5nce($!, fie -ei"cre0 De -$.!e "ri &".i #e inec' a!"ri!' c"r!ica.i4'rii #i-(!"-a!"."*i #i-(!"-a!"."*ice ce #a$ (er#i#!en)ei (er#i#!en)ei $nei -ici #(ine ini)ia!ie ini)ia!ie .a nie.$. c".$.$i c".$.$i #a$ $re!rei, ar c$ r'#$ne! -are a#$(ra (#i%ic$.$i $n"r &".nai0 c"n# n#!i! !i!$i $iee -ei -eica ca)ia )ia c" c"-$ -$n' n' a A!$iimi$e*", c>imi$e*",icele icele c" !$!$r"r infec)ii."r $rinare, a(.icn$/#e $(' c$- #/a (re4en!a! an!eri"r #i 5n 9
ca4$. ci#!i!ei ci#!i!ei ac$!e0 Pen!r$ Pen!r$ ca an!i&i"!era(ia an!i&i"!era(ia 3i c%i-i"!era( c%i-i"!era(ia ia #' fie eficien!e eficien!e #$n! nece#are $r-'!"are.e c"ni)ii: / *er-enii #' fie #en#i&i.i .a an!i&i"!ic$. $!i.i4a!0 / S' n$ ei#!e -a.f"r-a)ii c"n*eni!a.e #a$ a.!e ca$4e e #!a4' $rinar' / Dac' ei#!' c"ni)ii care #' fa"ri4e4e #!a4a $rinar' ace#!ea #' fie 5ne('r!a!e .a 5nce($!$. !ra!a-en!$.$i0 / D"4e.e e an!i&i"!ice #' a#i*$re " c"ncen!ra)ie eficien!' 5n #n*e / În f"r-e.e ac$!e, *rae #' #e a#"cie4e -ai -$.!e an!i&i"!ice0 / Tra!a-en!$. #' fie c"n!in$a! (n' .a #!eri.i4area $rinii0 An!i&i"!ice.e 3i c%i-i"!era(ice.e #$n! #$!an)e an!i-icr"&iene care 5n -$.! -$.!ee ca4$ ca4$ri ri (" ("!! "-"r "-"r55 *e *err-en enii ii ac)i ac)i$n $nee &a &ac! c!er eric ici i' ' #a$ #a$ .e (" ("!! "( "(ri ri -$.!i(.icarea ac)i$ne &ac!eri"#!a!ic'0 C$ c"ni)ia ca 5n #n*e #' ei#!e " c"ncen!ra)ie -eica-en!"a#' e#!$. e -are c"ncen!ra)ie in%i&an!' 3i #' ai&' $n !i( e c"n!ac! c$ *er-enii #$ficien! e .$n*, 5n ace#!e c"ni)ii infec)ia ("a!e fi +$*$.a!' ar #inr"-$. ("#!infec)i"# #c.er"4e.e 3i a.!e #ec%e.e #ec%e. e !re&$ie $r-'ri! 3i !ra!a!0 În infec)ii.e ."ca.i4a!e *er-enii care #e af.' 5n )e#$!$ri necr"4a!e, 5n e("4i!e e("4i!e fi&rin"a#e fi&rin"a#e #a$ 5n c".ec)ii ($r$.en!e n$ #$n! inf.$en)a)i e an!i&i"!ice0 an!i&i"!ice0 Ace#!ea Ace#!ea fie c' n$ ("! a+$n*e .a ei #a$ c%iar ac' a+$n*, "4a e#!e (rea -ic' 3i n$ ("a!e aea inf.$en)' a#$(ra ."r a!"ri!' ei#!en)ei $n"r in%i&i!"ri #a$ inac!ia!"ri ai an!i&i"!ice."r0 De a#e-enea (7/$. -ei$.$i ("a!e fi ne(rie.nic -eica-en!e."r0 A#!fe. Cefa."#("rine.e, C."ra-fenic".$. Rifa-(icina, Ne"a4".$., S$.fa-e!in$. #$n! ac!ie .a $n (7 ne$!r$0 Pen!r$ a.cani4area $rinii #e f"."#e3!e &icar&"na! e #"i$ *r 4i 3i ci!ra! e #"i$ 2/< *r 4i0 Cn *er-en$. e#!e &ine c$n"#c$! !ra!a-en!$. a 5nce(e c$ $n #in*$r an!i&i"!ic, e (referin)' ce. -ai ac!i c$ efec! &ac!erici 3i c$ #fera e ac)i$ne cea cea -ai -ai 5n*$# 5n*$#!' !',, c$ ac)i$ ac)i$ne ne irec irec!' !' a#$( a#$(ra ra a* a*en en!$. !$.$i $i (a (a!"* !"*en en ca$4 ca$4a.0 a.0 În infec)ia $rinar' ei#!' ("#i&i.i!a!ea e infec)ii #$cce#ie 3i e #$(rainfec!'ri c$ ie ier3 r3ii *e *err-en eni, i, a ac' c' 5n c$ c$r# r#$. $. !ra! !ra!aa-en en!$ !$.$ .$ii c$ an an!i !i&i &i"! "!ic icee #a$ #a$ c$ c%i-i"!era(ice, ca$4e.e fa"ri4an!e n$ a$ f"#! #$(ri-a!e0 La &" &".n .na aii ii c$ #" #"n nee e e4i 4ica ca.e .e #a$ #a$ $re! $re!er era. a.e, e, ne nefr fr"# "#!" !"-i -ii, i, c'i. c'i.ee ecre!"are fiin 5n .e*'!$r' c$ e!eri"r$. #e (r"$c #c%i-&'ri a.e *er-eni."r (a!"*eni #e 5n!.ne#c .a ace3!i &".nai #$cce#i infec)ia c".i&aci.ar', a("i infec)ie c$ (r"!e$#, (i"ceanic, .eie..a0 De aceea, infec)ii.e $rinare (re4in!' *re$!')i -ari (en!r$ #!eri.i4area f"care."r 3i frecen! ace#!e infec)ii a$ " e".$)ie (re.$n*i!', cr"nic' c$ (eri"ae e a-e.i"r'ri 3i a*raare eenin (n' .a #fr3i! re4i#!en!e .a an!i&i"!ice 3i c%i-i"!era(ie0 E#!e nece#ar ca 5n 92
c$r#$. !ra!a-en!$.$i #' #e re(e!e $r"c$.!$ri.e, #' #e !e#!e4e #en#i&i.i!a!ea *er*e r-en eni. i."r "r 3i #' #e $!i. $!i.i4 i4e4 e4ee an an!i !i&i &i"! "!ic ice. e.ee c$ #fer #fer'' 5n*$ 5n*$#! #!'' e ac)i ac)i$n $ne0 e0 Tra!a-en!$. c$ an!i&i"!ice 3i c%i-i"!era(ie 5n ci#!i!a ac$!' (n' .a c$n"a3!erea re4$. re4$.!a! !a!$.$ $.$ii $r"c $r"c$.! $.!$r $rii0 ii0 În a#ea#e-en enea ea ca4$ ca4$ri, ri, !ra!a !ra!a-e -en! n!$. $. -eic -eicaa-en en!"# !"# an!i-icr"&ian n$ ("a!e fi ec! e-(iric, 5n (rac!ic' ei#!' #i!$a)ii 5n care $r*en)a 3i *rai!a!ea ca4$.$i ("! +$#!ifica ini)ierea $n$i !ra!a-en! e-(iric (n' .a (ri-irea re4$.!a!e."r e .a&"ra!"r0 7i(e 7i(er.e r.e$c $c"c "ci!" i!"4a 4a c$ (" (".in .in$c $c.e" .e"4' 4' inic' inic',, e -$.!e -$.!e "ri infec infec)ii )ii c$ *er-eni (i"*eni care ("! fi een!$a. #en#i&i.i .a (enici.in', eri!r"-icin' 3i ".ean"-icin'0 Le$c"(enii.e c$ f"r-$.e .e$c"ci!are n"r-a.e ("! inica " infec)ie c$ *er-eni *ra-/ ne*a!ii, care ar ($!ea fi #en#i&i.i .a #!re(!"-icin', !e!racic.in', c."ra-fenic"., ne*ra-, ni!r"f$ran!"in0 Tra!a-en!$. a fi 5nce($! c$ an!i&i"!ice c$ #fer' .ar*' e ac)i$ne #a$ c$ a#"cieri e an!i&i"!ice, #(ern ca $n$. in!re e.e #' ai&' ac)i$ne a#$(ra *er-en$.$i, #e "r (refera an!i&i"!ice ne$!i.i4a!e 5nc' e &".na (n' .a acea a!'0 D"4e.e "r fi -ari #a$ -ai-e e .a 5nce($! 3i $r-'rin &".na$. 29> "re #e ("a!e !ra*e " c"nc.$4ie a#$(ra eficaci!')ii !ra!a-en!$.$i0 T*"$"me!$ul ,*1il"c$ic c"n#!' 5n a#anarea !$!$r"r f"care."r e infec)ie ,in!eren)ie ,in!eren)ie c%ir$r*ica.' (en!r$ 5ne('r!area 5ne('r!area "!ac".e."r care (r""ac' (r""ac' #!a4a $rinar', !ra!a-en!$. &".ii ca$4a.e0
99
CAPITOLUL IV CA7URI CA1UL I0 NUME: I"ne#c$0 PRENUME: Sef"ra K Meeea0 DATA NAŞTERII: 2= -ai B==0 DOMICILIU: #!r0 #!r0 TELEGRAFULUI nr0 nr0 2 Ti-i3"ara0 Ti-i3"ara0 STAREA CIILĂ: c'#'!"ri!'0 DIAGNOSTIC: e !ri-i!ere: Ci#!i!a ac$!'0 DIAGNOSTIC DE INTERNARE : Ci#!i!a ac$!'0 MOTIUL INTERNĂRII: Pacien!a #e (re4in!' .a #ec)ia Ur"."*ie a #(i!a.$.$i $e)ean Ti-i3"ara, (en!r$ !$.&$r'ri -ic)i"na.e e !i( (".ai$rie, $#!$ri-i -ic)i"na.e0 Ace#!ea a$ a('r$! 5n $r-' c$ > .$ni 3i #/a$ accen!$a! 5n $.!i-$. !i-( ceea ce a e!er-ina! &".naa #' #e (re4in!e .a -eic$. #(ecia.i#! (en!r$ in!ernare0 Pe &a4a #i-(!"-a!"."*iei 3i a ea-en$.$i c.inic i #e ($ne ia*n"#!ic$. e ci#!i!a ac$!'0 DATE MEDICALE: ANTECEDENTE PERSONALE: / (ri(ri-aa -en -en#! #!r$ r$a) a)ie ie .a 9 an ani0 i0 / A a$ a$!! !"a!e !"a!e &".i.e &".i.e infec!" infec!"/c"n /c"n!a* !a*i"a# i"a#ee a.e c"( c"(i.'r i.'riei0 iei0 / A (re4en (re4en!a! !a! infec) infec)ii ii $rinare $rinare re(e!a! re(e!a!ee c$ E#c%e E#c%eric% ric%ia ia C"..i C"..i ANTECEDENTE 7EREDO/ COLATERALE: / !a!'. 7TA0 / Ma-a Ma-a "( "(era era!' !' e c% c%i# i#!! %e %e(a (a!ic !ic %ia! %ia!ic0 ic0 DATE SOCIALE: c'#'!"ri!', n$ f$-ea4', n$ c"n#$-' a.c""., c"n#$-' cafea, ."c$in)e c"re#($n4'!"are, r"-nc',"r!""a0 IST ISTOR ORIC ICUL UL JO JOLI LII: I: J" J".n .na aaa e#!e e#!e c$ c$n" n"#c #c$! $!'' c$ infe infec) c)ii ii $rin $rinar aree re(e!a!e, c$ < in!ern'ri0 E(i#"$. E(i#"$. ac!$a. a e&$!a! $n $r-' c$ > .$ni 3i #/a accen!$a! accen!$a! 5n $r-' c$ " #'(! #'(!''-n n', ', cn cn a 5nce( 5nce($! $! #' (re4i (re4in!e n!e $#!$ri$#!$ri-ee .a -ic) -ic)i$n i$ne, e, -ic) -ic)i$n i$nii frecen!e 3i re$#e ca ".$-0 P"f!a e -ncare e#!e $3"r #c'4$!', 3i e a#e-enea $rina are $n a#(ec! !$.&$re0 Pacien!a .$crea4' 5n!r/$n -ei$ $-e0
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A!"li" =i i!$e*,*e$"*e" 4"$el* <2i!u$e 5! 1u!c2ie 4e cele '3 ' 3 !e9i 1iil)ice0 Ne9i" 4e " *es,i*" e#!e $3"r inf.$en)a!' e e-")ia 3i !ea-a *enera!e e nec$n"a3!erea &".ii0 afec!a!' e "arece &".naa &".naa !re&$ie #' Ne9i" Ne9i" 4e " !i e#!e (er!$r&a! a!"ri!' nic!$riei, #"-n 5n!rer$(! 5n!rer$ (! 3i #$(erficia.0 Ne9i" 4e " se 5m<*c" =i 4e<*c". Pacien!a e#!e ca(a&i.' ca #'/3i a.ea* a.ea*'' #in*$ #in*$r' r' 5-&r 5-&r'c 'c''-in! in!ea ea a aec eca a!' !' circ$ circ$-# -#!a !an)e n)e."r ."r 3i ne nece ce#i! #i!')i ')i."r ."r "r*ani#-$.$i, ne fiin nece#ar' ec! (re*'!irea .en+eriei .a 5ne-na #a0 N$ (re4in!' ific$.!a!e 5n a #e 5-&r'ca 3i e4&r'ca 3i nici e4in!ere# e4in !ere# fa)' e )in$!'0 Ne9i" 4e "@=i me!2i!e $em,e*"$u*" c*,ului 5! limi$e !*m"le e#!e $3"r $3"r (e (er!$ r!$r& r&a!' a!' e !e-( !e-(er era!$ a!$ra ra -ei -ei$.$ $.$ii a-&ia a-&ian! n! care care e#!e e#!e cre#c cre#c$!' $!' 3i (r""ac' (acien!ei " !ran#(ira)ie a&$nen!'0 Ne9 Ne9i" i" 4e " 1i cu*" cu*"$$ =i "@=i "@=i ,*$ ,*$e+ e+"" $e)u $e)ume me!$ !$el elee e#!e (e e(.in #a!i#f'c$!'0 Pacien!a 53i -en)ine i*iena c"r("ra.' (rin &aie 4i.nic' (e re*i$ni0 Ne9i" 4e " e9i$" ,e*iclele: (acien!a &eneficia4' e $n -ei$ e #i*$ran)' f'r' accien!e 3i infec)ii0 Ne9i" 4e " cmu!ic" e#!e (er!$r&a!' a!"ri!' ne5ncreerii 5n cei in +$r0 Ne9i" Ne9i" 4e " "c2i!" "c2i!" c!1*m c!1*m ,*,*iil ,*,*iil** c*e4i!2e =i 9"l*i: 9"l*i: (acien!a e#!e e re.i*ie "r!""a, crein)a #a inf.$en)n 5n -are -'#$r' -"$. e ia)' ia)',, a!i!$ a!i!$ine ineaa 3i #en! #en!ii-en en!e. !e.ee e &" &"a. a.'0 '0 N$ a$ e ei# i#!a! !a! c"n c"nf.i f.ic!e c!e 5n!re 5n!re rec"-an'ri.e !era(e$!ice 3i crein)a re.i*i"a#'0 9=
Ne9i" 4e *e"li"*e: i-a*inea e #ine a ('cii n$ e#!e (er!$r&a!', e#!e -$.)$-i!' -$.)$-i!' e ("4i)ia #a a!! (e (.an #"cia. c! 3i fa-i.ia.0 E#!e ca(a&i.' ca(a&i.' #' i/a eci4ii ("!rii!e ("!rii!e 5n !i-( $!i. 3i n$ (re4in!' .i(#' .i(#' e in!ere# fa)' e ac!ii!a!ea ac!ii!a!ea c"!iian'0 Ne9i" 4e " se *ec*ee": (en!r$ a -en)ine ine(enen)a 5n #a!i#facerea ace#!ei ne"i a- a.e# -i+."ace e: / a- a#i*$ a#i*$ra! ra! c"ni)i c"ni)iii "(!i-e "(!i-e (en!r$ (en!r$ e#f e#f'3$ '3$rare rareaa ace#!ei ace#!ei ac!ii! ac!ii!')ii ')ii00 / A- ($# ($# .a i#(" i#("4i) 4i)ia ia (ac (acien ien!e !eii c'r)i, c'r)i, rei rei#!e #!e / A- 5nce 5ncerc rca! a! #'/i #'/i cree4 ree4 " #!ar #!aree e &$n' &$n' i#(" i#("4i 4i)i )iee 3i #' 5n.' 5n.'!$ !$r r (.ic!i#ea.a0 "a! a!'' c$ Ne9i" 4e " 5!92" cum s@2i @2i ,s$*e $*ei s!$"$e $"$e"": " a-e.i"rarea &".ii a- $r-'ri! ca: / (a (aci cien en!a !a #' " "& &n nea ea#c #c'' c$ c$n" n"3! 3!in) in)e.e e.e nece#a nece#are re (en (en!r$ !r$ -en)in -en)inere ereaa #!'rii e #'n'!a!e0 / S' fie ca(a& ca(a&i.' i.' e/a e/a f"."# f"."#ii ace# ace#!e !e c$n"3 c$n"3!in !in)e )e (en!r$ (en!r$ "&)in "&)iner erea ea $nei $nei #!'ri e &ine fi4ic 3i (#i%ic0 / Dia* Dia*n" n"#! #!ic ic$. $. e e N$r# N$r#in in** ac!$ ac!$a. a.:: / !$.&$ !$.&$r' r'ri ri -ic)i -ic)i"n "na.e a.e,, $rin $rin'' !$.& !$.&$r $re0 e0 Dia*n"#!ic$. e N$r#in* ("!en)ia.: / ri#c ri#c$. $. c" c"-( -(.i .ica ca)i )ii. i."r "r (rin (rin a#ce a#cen# n#i$ i$ne neaa infe infec) c)ie ieii (rin (rin $re! $re!er er #( #(re re rinic%i
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PLANUL DE ÎNGRIIRE A JOLNAEI JOLNAEI CU CISTITĂ ACUTĂ (e (eri"aa 209/>0902@ 209/>0902@ PROJLEME OJIECTIE 1IUA I / a.!erarea ne"ii / (acien!a #' re#(ire e a re#(ira c$ -ini- e -anife#!a! (rin ific$.!a!e i#(nee e !i( !a%i(neic a !$nicii ca$4a!' e re.a!area e#(re e&$!$. 3i e".$)ia &".ii ac!$a.e
INTERENŢII
EALUARE
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/ (acien!a #' fie
/ a- 5n#")i! &".naa .a 9?
-anife#!a!' (rin iri!a&i.i!a!e, e(re#ie (#i%ic', e-"!ii!a!e ca$4a!' e .i(#a e c$n"a3!ere a &".i a -"$.$i ei e e".$)ie a -anife#!'ri."r care " 5n#")e#c, a !ra!a-en!$.$i (re#cri#
ec%i.i&ra!' (#i%ic 3i #' / re(a$# .a (a! rai"."*ie (en!r$ efec!$area fie inf"r-a!' e#(re / rec".!area $rini (en!r$ ea-ene c%i-ice 3i $nei rai"#c"(ii ($.-"nare &"a.' &ac!eri"."*ice / &".naa e#!e ani"a#' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i#e(!ice $rinar', an!i&i"!ice, an!ia.*ice / #c%i-&area .en+eriei e (a! 3i e c"r( / a#i*$rarea $nei a!-"#fere ca.e / &'i ca.e e 3e4$!
/ a.!erarea ne"ii
/ (acien!a #' (re4in!e
/ (acien!a a a$! in#"-nii in 9@
-anife#!a!' (rin iri!a&i.i!a!e, e(re#ie (#i%ic', e-"!ii!a!e ca$4a!' e .i(#a e c$n"a3!ere a &".i a -"$.$i ei e e".$)ie a -anife#!'ri."r care " 5n#")e#c, a !ra!a-en!$.$i (re#cri#
ec%i.i&ra!' (#i%ic 3i #' / re(a$# .a (a! rai"."*ie (en!r$ efec!$area fie inf"r-a!' e#(re / rec".!area $rini (en!r$ ea-ene c%i-ice 3i $nei rai"#c"(ii ($.-"nare &"a.' &ac!eri"."*ice / &".naa e#!e ani"a#' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i#e(!ice $rinar', an!i&i"!ice, an!ia.*ice / #c%i-&area .en+eriei e (a! 3i e c"r( / a#i*$rarea $nei a!-"#fere ca.e / &'i ca.e e 3e4$!
/ a.!erarea ne"ii
/ (acien!a #' (re4in!e
/ (acien!a a a$! in#"-nii in 9@
e a e.i-ina -anife#!a!' (rin $#!$ri-e .a -ic)i$ne, (re4en)a %e-a!$riei 3i (i$riei, -ic)i$ni frecen!e 3i 5n can!i!a!e re$#', $rere %i("*a#!ric' iraia!' (e $re!r', ca$4a! e inf.a-a)ia e4icii $rinare
-ic)i$ni #("n!ane, ne$rer"a#e, #' n$ (re4in!e c"-(.ica)ii c$!ana!e, re#(ira!"rii, $rinare, #' eac$e4e " $rin' .i-(ee f'r' #n*e 3i ($r"i #' fie ec%i.i&ra!' (#i%ic
1IUA II
/ (acien!a #'
/ -en)inerea c"ni)ii."r nece#are #"-n$.$i (rin: ca$4a nic!$riei, "$a ,!rei re$cerea 4*"-"!$.$i in -ei$. #(i!a.ice#c -ic)i$ni (e n"a(!e / i-in$area in!eren)ii."r e 5n*ri+ire 5n !i-($. #"-n$.$i / a#i*$rarea $nei !e-(era!$ri aeca!e 5n #a."n / aeri#irea #a."n$.$i / (.anif (.anifica icarea rea 5-(re$ 5-(re$n' n' c$ (acien (acien!a !a a $n$ $n$ii (r"*ra- e eerci)ii -"era!e aa(/
/ a-0 -eica)iei (re#cri#e e -eic / (.anificare $n$i (r"*ra- e eerci)ii -"era!e / (.i-&'ri #c$r!e 5n #a."n / -i3c'ri ac!ie a -e-&re."r
/ (acien!a are $n #"-n 9B
e a e.i-ina -anife#!a!' (rin $#!$ri-e .a -ic)i$ne, (re4en)a %e-a!$riei 3i (i$riei, -ic)i$ni frecen!e 3i 5n can!i!a!e re$#', $rere %i("*a#!ric' iraia!' (e $re!r', ca$4a! e inf.a-a)ia e4icii $rinare
-ic)i$ni #("n!ane, ne$rer"a#e, #' n$ (re4in!e c"-(.ica)ii c$!ana!e, re#(ira!"rii, $rinare, #' eac$e4e " $rin' .i-(ee f'r' #n*e 3i ($r"i #' fie ec%i.i&ra!' (#i%ic
1IUA II
/ (acien!a #'
/ -en)inerea c"ni)ii."r nece#are #"-n$.$i (rin: ca$4a nic!$riei, "$a ,!rei re$cerea 4*"-"!$.$i in -ei$. #(i!a.ice#c -ic)i$ni (e n"a(!e / i-in$area in!eren)ii."r e 5n*ri+ire 5n !i-($. #"-n$.$i / a#i*$rarea $nei !e-(era!$ri aeca!e 5n #a."n / aeri#irea #a."n$.$i / (.anif (.anifica icarea rea 5-(re$ 5-(re$n' n' c$ (acien (acien!a !a a $n$ $n$ii (r"*ra- e eerci)ii -"era!e aa(/
/ a-0 -eica)iei (re#cri#e e -eic / (.anificare $n$i (r"*ra- e eerci)ii -"era!e / (.i-&'ri #c$r!e 5n #a."n / -i3c'ri ac!ie a -e-&re."r
/ (acien!a are $n #"-n 9B
/ a.!erarea ne"ii &eneficie4e e $n e a "r-i #i a #e #"-n c"re#($n4'!"r "i%ni -anife#!a!a can!i!a!i 3i ca.i!a!i (rin #"-n (er!$r&a! 5n!rer$(! #i #$(erficia. ca$4a! e nic!$rie
/ re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ (er!$r&a! a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii / re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii aci"4a -e!a&".ic' (re*'!irea &".naei (en!r$ ci#!"#c"(ie ci#!"#c"(ie
/ a.!erar a.!erarea ea ne ne"ii "ii
#a!i#facerea #a!i#facerea ace#!ei ace#!ei <
/ a.!erarea ne"ii &eneficie4e e $n e a "r-i #i a #e #"-n c"re#($n4'!"r "i%ni -anife#!a!a can!i!a!i 3i ca.i!a!i (rin #"-n (er!$r&a! 5n!rer$(! #i #$(erficia. ca$4a! e nic!$rie
/ re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ (er!$r&a! a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii / re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii aci"4a -e!a&".ic' (re*'!irea &".naei (en!r$ ci#!"#c"(ie ci#!"#c"(ie
/ a.!erar a.!erarea ea ne ne"ii "ii
#a!i#facerea #a!i#facerea ace#!ei ace#!ei <
e a #e -i3ca 3i e ne"i a aea " &$n' ("#!$r' -ani -anife# fe#!a !a!' !' (rin (rin aina-ie 3i a#!eni a#!eniee ca$4a! ca$4a! 5n (rinci(a. e $rere
/ a.!erar a.!erarea ea ne ne"ii "ii / -en)inerea e a -en)ine !e-(era!$rii c"r($.$i !e-(era!$ra 5n .i-i!e n"r-a.e c"r($.$i 5n .i-i!e n"r-a.e, -ani -anife# fe#!a !a!' !' (rin (rin !ran#(ira)ii a&$nen!e ca$4a!' e cre3!erea !e-(era!$rii -ei$.$i a-&ian!
/ a- $r-'ri! e".$)ia &".ii / a- -"ni!"ri4a! f$nc)ii.e i!a.e 3i .e/a n"!a! 5n FT0 FT0 / (acien!a (re4in!' / a- e(.ica! (acien!ei r".$. #"na+$.$i e4ica. e(enen)' 5n c"n!in$are / a- efec!$a efec!$a!! !"a.e! !"a.e!aa &".na &".naei ei 3i a- (reen (reeni! i! e#care.e
/ c"-$nicarea c$ (acien!a / n"!area f$nc)ii."r i!a.e 5n f"aia e !e-(era!$r' / re#!a&i.irea !ran4i!$.$i i*e#!i (en!r$ *a4e / -en)inerea #"nei e4ica.e (er-ea&i.e / a *".i! 3i a- #('.a! ($n*a e c".ec!are a $rinii / a- -"&i.i4a! &".naa .a -ar*inea (a!$.$i / a- -a#a! -e-&re.e inferi"are (en!r$ (reenirea !r"-&"f.e&i!ei / a- a-ini#!ra! !ra!a-en!$. (re#cri# e -eic
<
/ !e-(era!$ra c"r($. c"r($.$i $i a reeni reeni!! 5n .i-i!e .i-i!e n"r-a.e
e a #e -i3ca 3i e ne"i a aea " &$n' ("#!$r' -ani -anife# fe#!a !a!' !' (rin (rin aina-ie 3i a#!eni a#!eniee ca$4a! ca$4a! 5n (rinci(a. e $rere
/ a.!erar a.!erarea ea ne ne"ii "ii / -en)inerea e a -en)ine !e-(era!$rii c"r($.$i !e-(era!$ra 5n .i-i!e n"r-a.e c"r($.$i 5n .i-i!e n"r-a.e, -ani -anife# fe#!a !a!' !' (rin (rin !ran#(ira)ii a&$nen!e ca$4a!' e cre3!erea !e-(era!$rii -ei$.$i a-&ian!
/ a- $r-'ri! e".$)ia &".ii / a- -"ni!"ri4a! f$nc)ii.e i!a.e 3i .e/a n"!a! 5n FT0 FT0 / (acien!a (re4in!' / a- e(.ica! (acien!ei r".$. #"na+$.$i e4ica. e(enen)' 5n c"n!in$are / a- efec!$a efec!$a!! !"a.e! !"a.e!aa &".na &".naei ei 3i a- (reen (reeni! i! e#care.e
/ c"-$nicarea c$ (acien!a / n"!area f$nc)ii."r i!a.e 5n f"aia e !e-(era!$r' / re#!a&i.irea !ran4i!$.$i i*e#!i (en!r$ *a4e / -en)inerea #"nei e4ica.e (er-ea&i.e / a *".i! 3i a- #('.a! ($n*a e c".ec!are a $rinii / a- -"&i.i4a! &".naa .a -ar*inea (a!$.$i / a- -a#a! -e-&re.e inferi"are (en!r$ (reenirea !r"-&"f.e&i!ei / a- a-ini#!ra! !ra!a-en!$. (re#cri# e -eic
/ !e-(era!$ra c"r($. c"r($.$i $i a reeni reeni!! 5n .i-i!e .i-i!e n"r-a.e
<
/ a-in a-ini# i#!r !rar area ea e .ic% .ic%i ie, e, ceai, ceai, #$c #$c na!$ na!$ra. ra.,, 4ea-' e c"-("! / a.i-en!a)ie #'rac' 5n (r"!eine / a- -'#$ra! !en#i$nea ar!eria.', ($.#$. 3i .e/an"!a! 5n f"aia e !e-(era!$r'
1i$a III
/ i-in$area
/ i#c"nf"r!$. e#!e i-in$a! <2
/ a-in a-ini# i#!r !rar area ea e .ic% .ic%i ie, e, ceai, ceai, #$c #$c na!$ na!$ra. ra.,, 4ea-' e c"-("! / a.i-en!a)ie #'rac' 5n (r"!eine / a- -'#$ra! !en#i$nea ar!eria.', ($.#$. 3i .e/an"!a! 5n f"aia e !e-(era!$r'
1i$a III
/ i-in$area
/ i#c"nf"r!$. e#!e i-in$a! <2
/ i#c"nf"r! a! e i#c"nf"r!$.$i #"na $re!r"e4ica.' a(.i a(.ica ca!' !' 5n $r-a $r-a efec!$'rii ci#!"#c"(iei
/ ific ific$$.!a! .!a!ee 5n ne"ia e a "r-i 3i a #e "i%ni ca$4 ca$4a! a!'' e #!ar #!aree e(r e(re# e#i i', ', #!re #!re## -ani -anife# fe#!a !a!' !' (rin (rin "re in#$ficien!e e "i%n', "i%n', e($i4are, e($i4are, e#c$ra+are, iri!a&i.i!a!e 1IUA I
/ e$c e$car area ea (aci (acien en!e !eii (en! (en!r$ r$ (re (reen enir irea ea recii reciie." e."r: r: .en+er .en+erie ie c$ra!', c$ra!', i*ien' i*ien' ri*$r" ri*$r"a#' a#' a re*i$ni (eriana.' 3i *eni!a.' / %ira!area c"re#($n4'!"are / a#i*$rarea $n"r c"ni)ii aeca!e f'r' (".$are f"nic', c%i-ic' #a$ -icr"&ian' / !e-(era!$ra c$(rin#' 5n!re @/2C / .$-in"4i!a!e / -"era!' (.a#area (acien!ei 5n!r/$n #a."n #$ferin e aceea aceea3i 3i afec afec)i )i$n $nee (en! (en!r$ r$ a ei! ei!aa c"n! c"n!ac! ac!are areaa &".i."r infec)i"a#e
/ (acien!a #' / (acien!a are $n #"-n .ini3!i! &eneficie4e e "i%n' / a- ($r!a! i#c$)ii (e !e-a (r"&.e-e."r #a.e c"re#($n4'!"are / a- 5nc$ra+a!/" #' fac' fa)' #!re#$.$i crea! e r#!ei &"a.' / a- 5nc$ra+a! (acien!a #' i#c$!e .i&er e#(re *ri+i.e #a.e / i/a- "feri! ("#i&i.i!a!ea e a ($ne 5n!re&'ri / a- 5ncerca! #'/i "fer r'#($n#$ri c! -ai (reci#e / a- inf"r-a!/" a#$(ra -anere."r -e0 / re.$area a.i-en!a)iei
/ e#!e a#i*$ra! a("r!$. ca."ric <9
/ i#c"nf"r! a! e i#c"nf"r!$.$i #"na $re!r"e4ica.' a(.i a(.ica ca!' !' 5n $r-a $r-a efec!$'rii ci#!"#c"(iei
/ ific ific$$.!a! .!a!ee 5n ne"ia e a "r-i 3i a #e "i%ni ca$4 ca$4a! a!'' e #!ar #!aree e(r e(re# e#i i', ', #!re #!re## -ani -anife# fe#!a !a!' !' (rin (rin "re in#$ficien!e e "i%n', "i%n', e($i4are, e($i4are, e#c$ra+are, iri!a&i.i!a!e 1IUA I
/ e$c e$car area ea (aci (acien en!e !eii (en! (en!r$ r$ (re (reen enir irea ea recii reciie." e."r: r: .en+er .en+erie ie c$ra!', c$ra!', i*ien' i*ien' ri*$r" ri*$r"a#' a#' a re*i$ni (eriana.' 3i *eni!a.' / %ira!area c"re#($n4'!"are / a#i*$rarea $n"r c"ni)ii aeca!e f'r' (".$are f"nic', c%i-ic' #a$ -icr"&ian' / !e-(era!$ra c$(rin#' 5n!re @/2C / .$-in"4i!a!e / -"era!' (.a#area (acien!ei 5n!r/$n #a."n #$ferin e aceea aceea3i 3i afec afec)i )i$n $nee (en! (en!r$ r$ a ei! ei!aa c"n! c"n!ac! ac!are areaa &".i."r infec)i"a#e
/ (acien!a #' / (acien!a are $n #"-n .ini3!i! &eneficie4e e "i%n' / a- ($r!a! i#c$)ii (e !e-a (r"&.e-e."r #a.e c"re#($n4'!"are / a- 5nc$ra+a!/" #' fac' fa)' #!re#$.$i crea! e r#!ei &"a.' / a- 5nc$ra+a! (acien!a #' i#c$!e .i&er e#(re *ri+i.e #a.e / i/a- "feri! ("#i&i.i!a!ea e a ($ne 5n!re&'ri / a- 5ncerca! #'/i "fer r'#($n#$ri c! -ai (reci#e / a- inf"r-a!/" a#$(ra -anere."r -e0 / re.$area a.i-en!a)iei
/ e#!e a#i*$ra! a("r!$. ca."ric <9
/ a.!erar a.!erarea ea ne"ii ne"ii (er "# e a &ea 3i a -nca 5n $r-a in!eren)iei
nece#ar "r*ani#-$.$i
/ ("!en)ia. e c"-(.ica)ii ri#c$. e!inerii infec)iei #(re rinic%i
/ (acien!a #' &eneficie4e e $n -ei$ -ei$ e #i*$ #i*$ra ran) n)'' f'r' accien!e 3i infec)ii
/ (acien!a are " #!are *enera.' #!a)i"nar'
1IUA
/ #!a&i.irea $nei re.a)ii
/ <<
i-in$area rea
a(a!iei,
a
/ a.!erar a.!erarea ea ne"ii ne"ii (er "# e a &ea 3i a -nca 5n $r-a in!eren)iei
nece#ar "r*ani#-$.$i
/ ("!en)ia. e c"-(.ica)ii ri#c$. e!inerii infec)iei #(re rinic%i
/ (acien!a #' &eneficie4e e $n -ei$ -ei$ e #i*$ #i*$ra ran) n)'' f'r' accien!e 3i infec)ii
/ (acien!a are " #!are *enera.' #!a)i"nar'
1IUA
/ #!a&i.irea $nei re.a)ii
/
i-in$area rea
a(a!iei,
a
<<
("4i!ie c$ (acien!a / a.!erar a.!erarea ea ne ne"ii "ii care care #' 5-i 5-i (er-i (er-i!' !' e a c"-$n -$nica a!in*erea a!in*erea "&iec!ie." "&iec!ie."r r -ani -anife# fe#!a !a!' !' (rin (rin e 5n*ri+ire a(a!ie, ne5ncreere, efici! e a #e are# are#aa ca$4a! ca$4a! e e(r e(re# e#ie ie fi4i fi4ic' c',, !ri#!e)e
ne5n ne5ncr cre eer erii ii -eica.
5n
(er# (er#"n "na. a.$. $.
CONCLU1II : S$& $n !ra!a-en! c$ Ne"a4". "$' !a&.e!e .a < "re >*2< % a("i .a 9 "re " !a&.e!' <*2<% $rina a 5nce($! #' #e .i-(e4ea#c' 3i #a c"n!in$a! !ra!a-en!$. 5nc' 4i.e (n' .a #!eri.i4area ei0 Si-(!"-e.e #a$ a-e.i"ra! 5nc' in 5nc' in (ri-e.e 4i.e e #(i!a.i4are0 În 4i$a a =/ a e #(i!a.i4are .a i4i!a efec!$a!' 5-(re$n' c$ -eic$. e #a."n, ace#!a ac e#!a a %"!'r! e!ernarea (acien!ei $r-n a reeni .a c"n!r". $(' < 4i.e, !i-( 5n care a c"n!in$a $n !ra!a-en! c$: / Ji#e(!". 2 !a&.e!e i-inea)a, 2 #eara 0 #e a feri e e($nere .a fri* 3i $-e4ea.' / re*i- %iric 2/9 . (e 4i 0
<=
("4i!ie c$ (acien!a / a.!erar a.!erarea ea ne ne"ii "ii care care #' 5-i 5-i (er-i (er-i!' !' e a c"-$n -$nica a!in*erea a!in*erea "&iec!ie." "&iec!ie."r r -ani -anife# fe#!a !a!' !' (rin (rin e 5n*ri+ire a(a!ie, ne5ncreere, efici! e a #e are# are#aa ca$4a! ca$4a! e e(r e(re# e#ie ie fi4i fi4ic' c',, !ri#!e)e
ne5n ne5ncr cre eer erii ii -eica.
5n
(er# (er#"n "na. a.$. $.
CONCLU1II : S$& $n !ra!a-en! c$ Ne"a4". "$' !a&.e!e .a < "re >*2< % a("i .a 9 "re " !a&.e!' <*2<% $rina a 5nce($! #' #e .i-(e4ea#c' 3i #a c"n!in$a! !ra!a-en!$. 5nc' 4i.e (n' .a #!eri.i4area ei0 Si-(!"-e.e #a$ a-e.i"ra! 5nc' in 5nc' in (ri-e.e 4i.e e #(i!a.i4are0 În 4i$a a =/ a e #(i!a.i4are .a i4i!a efec!$a!' 5-(re$n' c$ -eic$. e #a."n, ace#!a ac e#!a a %"!'r! e!ernarea (acien!ei $r-n a reeni .a c"n!r". $(' < 4i.e, !i-( 5n care a c"n!in$a $n !ra!a-en! c$: / Ji#e(!". 2 !a&.e!e i-inea)a, 2 #eara 0 #e a feri e e($nere .a fri* 3i $-e4ea.' / re*i- %iric 2/9 . (e 4i 0
<=
CA1UL II NUME: Ana#!a#i$ PRENUME: Si.ia DATA NAŞTERII: = #e(!e-&rie B=@ DOMICILIU: #!r0 e!erni!')ii nr0 nr0 <= Ti-i3"ara STAREA CIILĂ: c'#'!"ri!' PROFESIA: c"n!a&i.' DATA INTERNĂRI: /=0902@ DIAGNOSTIC DE TRIMITERE: ci#!i!a ac$!' DIAGNOSTIC CLINIC LA INTERNARE: (e &a4a #i-(!"-a!"."*iei 3i a ea-en$.$i c.inic (e a(ara!e i/a f"#! ($# ia*n"#!ic$. e ci#!i!' ac$!'0 MOTIUL INTERNĂRII: (acien!a #/a (re4en!a! .a #ec)ia $r"."*ie a #(i!a.$. #(i!a.$.$i $i +$e)ea +$e)eann Ti-i3"a i-i3"ara ra c$: i#$rie i#$rie,, fe&r' fe&r' -"era -"era!', !', #!are #!are *en *enera. era.'' -"era!'0 J".naa #e in!ernea4' (rin #erici$. e (".ic.inic'0 A- c"n$# (acien!a (e #ec)ie #ec) ie 5n #a."n$. #a. "n$. inica! e -eic, a- a+$!a!/" #' #e in#!a.e4e 3i #' fac' c$n"3!in)' c$ cei.a.)i &".nai in #a."n0 C"nf"r- (r"ce#$.$i e 5n*ri+ire ce are ca (ri-' e!a(' c$.e*erea e a!e e .a (acien!', a- e(.ica! nece#i!a!ea 3i #c"($. $n$i in!eri$ 3i e a#e-enea i-("r!an)a r'#($n#$ri."r #a.e care 5-i "r (er-i!e #'/i c$n"#c -ai &ine (r"&.e-e.e 3i ca a!are #'/i ("! a#i*$ra " &$n'
CA1UL II NUME: Ana#!a#i$ PRENUME: Si.ia DATA NAŞTERII: = #e(!e-&rie B=@ DOMICILIU: #!r0 e!erni!')ii nr0 nr0 <= Ti-i3"ara STAREA CIILĂ: c'#'!"ri!' PROFESIA: c"n!a&i.' DATA INTERNĂRI: /=0902@ DIAGNOSTIC DE TRIMITERE: ci#!i!a ac$!' DIAGNOSTIC CLINIC LA INTERNARE: (e &a4a #i-(!"-a!"."*iei 3i a ea-en$.$i c.inic (e a(ara!e i/a f"#! ($# ia*n"#!ic$. e ci#!i!' ac$!'0 MOTIUL INTERNĂRII: (acien!a #/a (re4en!a! .a #ec)ia $r"."*ie a #(i!a.$. #(i!a.$.$i $i +$e)ea +$e)eann Ti-i3"a i-i3"ara ra c$: i#$rie i#$rie,, fe&r' fe&r' -"era -"era!', !', #!are #!are *en *enera. era.'' -"era!'0 J".naa #e in!ernea4' (rin #erici$. e (".ic.inic'0 A- c"n$# (acien!a (e #ec)ie #ec) ie 5n #a."n$. #a. "n$. inica! e -eic, a- a+$!a!/" #' #e in#!a.e4e 3i #' fac' c$n"3!in)' c$ cei.a.)i &".nai in #a."n0 C"nf"r- (r"ce#$.$i e 5n*ri+ire ce are ca (ri-' e!a(' c$.e*erea e a!e e .a (acien!', a- e(.ica! nece#i!a!ea 3i #c"($. $n$i in!eri$ 3i e a#e-enea i-("r!an)a r'#($n#$ri."r #a.e care 5-i "r (er-i!e #'/i c$n"#c -ai &ine (r"&.e-e.e 3i ca a!are #'/i ("! a#i*$ra " &$n' 5n*ri+ire0 DATE DA TE MEDICALE: ME DICALE: ANTECEDENTE 7EREDO/COLATERALE: / !a!'. K ecea! c$ ne"(.a#- *a#!ric 5n $r-' c$ = ani / -a-a / 7TA ANTECEDENTE PERSONALE: / &".naa a (re4en!a! infec)ii $rinare re(e!a!e c$ c".i&aci.i 5n $r-' c$ !rei .$ni / n$ a f"#! #$($#' nici $nei in!eren)ii c%ir$r*ica.e, na3!eri Q CONDIŢII DE IAŢĂ ŞI DE MUNCĂ: ."c$in)' c"re#($n4'!"are, n$ c"n#$-' a.c""., n$ f$-ea4', c"n#$-' 2/9 cafe.e (e 4i0 COMPORTARE COMPORTARE FAŢĂ FAŢĂ DE MEDIU: &$n' ISTORICUL JOLII: (acien!a #/a (re4en!a! .a in!ernare c$ " #!are *enera.' a.!era!', ac$4' e a(r"i-a!i " #'(!'-n' i#$rie, fe&r' -"era!' 5n#")i!' e $reri 5n re*i$nea ."-&ar', (acien!a a f"#! (.eca!' 5n!r/" ec$r#ie .a -$n!e $ne a f'c$! &aie in!r/$n .ac c$ a(' f"ar!e rece0 În -"-en!$. ac!$a. (acien!a (re4in!' $reri ii .a -ic)i$ne, !ran#(ira)ii !ran#(ir a)ii reci 3i " #!are e i#c"nf"r! *enera.0 <>
ANALI7A ŞI INTERPRETAREA DATELOR O#0INUTE ÎN FUNC0IE DE CELE '3 NEVOI FI7IOLOGICE '. Ne9i" 4e " *es,i*" e#!e $3"r afec!a!' a!"ri!' fri#"ane."r 3i e (re4en)a !ene#-e."r e4ica.e0 %. Ne9i" 4e " !i e#!e a.!era!', (acien!a n$ #e "i%ne3!e c"re#($n4'!"r r#!ei #a.e, #e !re4e3!e e 9/< "ri (e n"a(!e, $rinea4' e# (en!r$ c' e4ica n$ #e *".e3!e 5n 5n!re*i-e0 B. Ne9i" 4e 4e " se se 5m 5m<*c" =i =i 4e 4e<*c" n$ (re4in!' ific$.!a!e 5n #a!i#facerea ace#!ei ne"i 3i nici e4in!ere# fa)' e e#!i-en!a)ia #a0 . Ne9i" 4e "=i me!2i!e $em,e*"$u*" c*,ului 5! limi$e !*m"le, e#!e afec!a!' e (re4en)a fe&rei -"era!' 9@,2C0 (. Ne9 Ne9i" i" 4e " 1i 1i cu*" cu*"$$ =i =i "@= "@=ii ,* ,*$e+ $e+"" $e) $e)um ume! e!$e $ele le n$ e#!e afec!a!' (acien!a 53i -en)ine i*iena c"r("ra.' (rin &aie 4i.nic'0 4i. nic'0 . Ne9i" 4e " e9i$" ,e*iclele (acien!a (re4in!' ri#c e c"-(.ica)ii (rin a#cen#i$nea infec)iei (rin $re!er #(re #(r e rinic%ii0 e#!e afec!a! afec!a!', ', (acien (acien!a !a e#!e an ani"a i"a#' #' '&. Ne9i" 4e 4e " cmu!ic" e#!e a!"ri!' nec$n"a3!erii e".$)iei &".ii 3i #e *ne3!e .a fa-i.ia #/a care #e c"nfr$n!' c$ $ne.e (r"&.e-e e "rin -a!eria.0 ''. Ne9i e9i"" 4e " "c2i "c2i! !"" c!1 c!1* *m m ,*, ,*,*i *iil il* * c*e4 c*e4i! i!2e 2e =i 9" 9"l l*i *i (acien!a 53i ("a!e #a!i#face acea#!' ne"ie 3i n$ ei#!' c"nf.ic!e 5n!re rec"-an'ri.e !era(e$!ice 3i crein)a #a0 '%. Ne9i" 4e 4e *e *e"li"*e n$ e#!e rea.i4a!', (acien!a e#!e -$.)$-i!' e ("4i)ia #a a!! (e (.an fa-i.ia. c! 3i #"cia. n$ (re4in!' e4in!ere# fa)' e ac!ii!')i.e 4i.nice0 '. Ne9i" 4e 4e " se se *e *ec*ee" e#!e #a!i#f'c$!', a- 5ncerca! #'/i cree4 (acien!ei " #!are e &$n' i#("4i)ie0 '3.. Ne9 '3 Ne9i" i" 4e 4e " 5!9 5!92" 2" cum cum s@ s@2i 2i ,s ,s$* $*e eii s! s!$" $"$e $e"" a- $r-'ri! ca (acien!a #' "&nea#c' -ini-$. e c$n"3!in)e nece#are #!'rii #!'ri i e #'n'!a!e0
PLAN DE ÎNGRIIRE A JOLNAEI JOLNAEI CU CISTITĂ ACUTĂ (e (eri"aa /=0902@ PROJLEME OJIECTIE 1IUA I / a.!erarea ne"ii / #' re#(ire c$ -inie a re#(ira e ific$.!a!e -anife#!a!' (rin i#(nee e(ira!"rie ca$4a!' e !ene#-e e4ica.e 3i e fe&r' -"era!'
/ a.!erarea ne"ii / #a!i#facerea ace#!e
INTERENŢII
EALUARE
/ re(a$# .a (a! a- in!r"$# &a4ine!$. ca. #$& &".na' / a- a(.ica! c"-(re#e ca.e (e re*i$nea ($&ian' / a- a-ini#!ra! an!i!er-ice .a inica)ia -eic$.$i / a- -'#$ra! f$nc)ii.e i!a.e 3i .e/a- n"!a! 5n f"aia e !e-(era!$r' / a#i#!en!a a-ini#!rea4' .a inica)ia -eic$.$i !ra!a-en!$. / a#i*$r' (acien!ei " a.i-en!a)ie #'rac' 5n (r"!eine, .ic%ie
/ #!are *enera.' a.!era!' / TA Q<B -- 7* ! Q9@,2C r Q > re#(ira)ii (e -in$!
/ a- rec".!a! $rina (en!r$ ea-en$. &ac!eri"."*ic
/ (acien!a (re4in!' 5n
<@
e a &ea 3i e a ne"i -nca -anife#!a!' (rin ref$4$. (acien!ei e a &ea .ic%ie 3i e a -nca ca$4a!e e $reri -ic)i"na.e
/ a- a#i*$ra! " a!-"#fer' .ini3!i!' 3i ca.' / &'i ca.e e 3e4$! / a- in!r"$# &a4ine!$. ca. #$& &".naa / a- 5n')a! (acien! ("4i)ia c"rec!' (en!r$ $3$rarea -ic)i$nii 3i *".irea c"-(.ec!' a e4icii $rinare 3e4n a(.eca! 5n fa)'
c"n!in$are ina(e!en)' 3i " $3"ar' e#%ira!are
/ a.!erarea ne"i e a e.i-ina -anife#!a!' (rin $rini 5n can!i!a!e -ic', !ran#(ira)ii, e#%ira!are ca$4a!' e i#$rie, infec)ia !rac!$.$i $rinar ."ca.i4a!' .a nie.$. e4icii $rinare / a.!erarea ne"ii
/ #' ai&' " i$re4' n"r-a.' 3i #' (re4in!e -ic)i$ni #("n!ane ne$rer"a#e
/ a#i#!en!a a+$!' .a efec!$area $n"r -i3c'ri / face (.i-&'ri #c$r!e 5n #a."n / -'#"ar' f$nc)ii.e i!a.e 3i n"!area 5n f"aia e !e-(era!$r'
/ (acien!a (re4in!' " $rin' !$.&$re / i$re4a Q 9 -.
/ rec'('!area
/ a#i*$rarea $n$i -ei$ c"nf"r!a&i.
/ (acien!a e#!e e(enen!'
e a &ea 3i e a ne"i -nca -anife#!a!' (rin ref$4$. (acien!ei e a &ea .ic%ie 3i e a -nca ca$4a!e e $reri -ic)i"na.e
/ a- a#i*$ra! " a!-"#fer' .ini3!i!' 3i ca.' / &'i ca.e e 3e4$! / a- in!r"$# &a4ine!$. ca. #$& &".naa / a- 5n')a! (acien! ("4i)ia c"rec!' (en!r$ $3$rarea -ic)i$nii 3i *".irea c"-(.ec!' a e4icii $rinare 3e4n a(.eca! 5n fa)'
c"n!in$are ina(e!en)' 3i " $3"ar' e#%ira!are
/ a.!erarea ne"i e a e.i-ina -anife#!a!' (rin $rini 5n can!i!a!e -ic', !ran#(ira)ii, e#%ira!are ca$4a!' e i#$rie, infec)ia !rac!$.$i $rinar ."ca.i4a!' .a nie.$. e4icii $rinare / a.!erarea ne"ii
/ #' ai&' " i$re4' n"r-a.' 3i #' (re4in!e -ic)i$ni #("n!ane ne$rer"a#e
/ a#i#!en!a a+$!' .a efec!$area $n"r -i3c'ri / face (.i-&'ri #c$r!e 5n #a."n / -'#"ar' f$nc)ii.e i!a.e 3i n"!area 5n f"aia e !e-(era!$r'
/ (acien!a (re4in!' " $rin' !$.&$re / i$re4a Q 9 -.
/ rec'('!area
/ a#i*$rarea $n$i -ei$ c"nf"r!a&i.
/ (acien!a e#!e e(enen!'
e a #e -i3ca 3i e a aea " &$n' ("#!$r' -anife#!a!' (rin re(a$# .a (a! ca$4a!' e (re4en)a $reri."r ."-&are 3i e $reri 5n re*i$nea (e.in'
ine(enen)ei
/ a- 5n')a! (acien!a #' #!ea 5n ("4i)ia c"re#($n4'!"are (en!r$ *".irea c"-(.ec!' a e4icii $rinare
1IUA II =
e (er#"na.$. -eica.
e a #e -i3ca 3i e a aea " &$n' ("#!$r' -anife#!a!' (rin re(a$# .a (a! ca$4a!' e (re4en)a $reri."r ."-&are 3i e $reri 5n re*i$nea (e.in'
ine(enen)ei
/ a- 5n')a! (acien!a #' #!ea 5n ("4i)ia c"re#($n4'!"are (en!r$ *".irea c"-(.ec!' a e4icii $rinare
e (er#"na.$. -eica.
1IUA II =
Pacien!a e#!e e($i4a!a fi4ic / a.!erarea ne"ii / a#i*$rarea $n$i #"-n / re(a$# .a (a! e a "r-i 3i a #e "i%ni!"r a- aeri#i! #a."n$. "i%ni -enife#!a! / a- a-ini#!ra! -eica)ia (re#cri#' e -eic (rin !re4iri e#e 9/< "ri (e n"a(!e ca$4a! e -ic)i$ni frecen!e e"arece e4ica n$ #e *".e3!e 5n 5n!re*i-e / efici! 5n / re#!a&i.irea ne"ia e a/3i !e-(era!$rii c"r($.$i -en)ine !e-(era!$ra c"r($.$i 5n .i-i!e n"r-a.e -anife#!a! (rin fe&re -"era!' ca4a!' e infec)ia c$ E#c%eric%ia
/ a- a#i*$ra! -'#$ri.e i*ien"/ie!e!ice / a- efec!$a! !"a.e!a re*i$nii (erinea.' (en!r$ a ei!a ('!r$nerea -icr"&i."r 5n !rac!$. $rinar / a- a-ini#!ra! !ra!a-en!$. c$ an!i&i"!ice c"nf"ran!i&i"*ra-ei .a re rec"-anarea -eic$.$i 0 a- a#i*$ra! .en+erie e (a! 3i e c"r( c$ra!' / !"a.e!a re*i$ni (erinea.e 4i.nic c$ a(' 3i #'($n
/ a#i*$rarea $n$i c.i-a! aeca!, c"nf"r!a&i. =
/ (acien!a (re4in!' fe&ra -"era!a 9@,2C
Pacien!a e#!e e($i4a!a fi4ic / a.!erarea ne"ii / a#i*$rarea $n$i #"-n / re(a$# .a (a! e a "r-i 3i a #e "i%ni!"r a- aeri#i! #a."n$. "i%ni -enife#!a! / a- a-ini#!ra! -eica)ia (re#cri#' e -eic (rin !re4iri e#e 9/< "ri (e n"a(!e ca$4a! e -ic)i$ni frecen!e e"arece e4ica n$ #e *".e3!e 5n 5n!re*i-e / efici! 5n / re#!a&i.irea ne"ia e a/3i !e-(era!$rii c"r($.$i -en)ine !e-(era!$ra c"r($.$i 5n .i-i!e n"r-a.e -anife#!a! (rin fe&re -"era!' ca4a!' e infec)ia c$ E#c%eric%ia
/ a- a#i*$ra! -'#$ri.e i*ien"/ie!e!ice / a- efec!$a! !"a.e!a re*i$nii (erinea.' (en!r$ a ei!a ('!r$nerea -icr"&i."r 5n !rac!$. $rinar / a- a-ini#!ra! !ra!a-en!$. c$ an!i&i"!ice c"nf"ran!i&i"*ra-ei .a re rec"-anarea -eic$.$i 0 a- a#i*$ra! .en+erie e (a! 3i e c"r( c$ra!' / !"a.e!a re*i$ni (erinea.e 4i.nic c$ a(' 3i #'($n
/ (acien!a (re4in!' fe&ra -"era!a 9@,2C
/ a#i*$rarea $n$i c.i-a! aeca!, c"nf"r!a&i. =
C"..i .a nie.$. e4icii $rinare
/ a- e(.ica! (acien!ei !"a!e in!eren)ii.e ce i #e "r efec!$a 3i r".$. ."r / a- 5nc$ra+a! (acien!a
/ efici! 5n / (r"fi.aia ne"ia e a ei!a c"-(.ica)ii."r (eric".e.e -anife#!a!e (rin ri#c e c"-(.ica)ii (rin a#cen#i$nea infec)iei (rin $re!er #(re rinic%i
a.!erarea ne"ii
/ (acien!a #' ("a!'
/ re(a$# .a (a! / aeri#irea ca-erei / a- a-ini#!ra! -eica)ia (re#cri#' 0 a- a(.ica! c'.$r' ."ca.' c$ %ir"f"r$. / &'i ca.e e 3e4$! 5n ceai e -$3e)e. / a#i#!en!a cre3!e (r"*re#i can!i!a!ea e .ic%ie fa)' e 4i.e.e an!eri"are / a- a-ini#!ra! -eica)ia (re#cri#' e -eic / a- -'#$ra! i$re4a (rin &i.an)$. .ic%iian 3i an"!a!/" 5n f"aia e !e-(era!$r' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i&i"!ice, 3i e4infec!an!e $rinare
/ re(a$# .a (a!
/ (acien!a c""(erea4' &ine c$ (er#"na.$. -eica. G Q ?@ -* S7 Q ? --2 "re UREE Q < -* CREATININĂ S Q ,>@ -*
/ (acien!a 53i reine !re(!a! =2
C"..i .a nie.$. e4icii $rinare
/ a- e(.ica! (acien!ei !"a!e in!eren)ii.e ce i #e "r efec!$a 3i r".$. ."r / a- 5nc$ra+a! (acien!a
/ efici! 5n / (r"fi.aia ne"ia e a ei!a c"-(.ica)ii."r (eric".e.e -anife#!a!e (rin ri#c e c"-(.ica)ii (rin a#cen#i$nea infec)iei (rin $re!er #(re rinic%i
a.!erarea ne"ii
/ (acien!a #' ("a!'
/ re(a$# .a (a! / aeri#irea ca-erei / a- a-ini#!ra! -eica)ia (re#cri#' 0 a- a(.ica! c'.$r' ."ca.' c$ %ir"f"r$. / &'i ca.e e 3e4$! 5n ceai e -$3e)e. / a#i#!en!a cre3!e (r"*re#i can!i!a!ea e .ic%ie fa)' e 4i.e.e an!eri"are / a- a-ini#!ra! -eica)ia (re#cri#' e -eic / a- -'#$ra! i$re4a (rin &i.an)$. .ic%iian 3i an"!a!/" 5n f"aia e !e-(era!$r' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i&i"!ice, 3i e4infec!an!e $rinare
/ re(a$# .a (a!
/ (acien!a c""(erea4' &ine c$ (er#"na.$. -eica. G Q ?@ -* S7 Q ? --2 "re UREE Q < -* CREATININĂ S Q ,>@ -*
/ (acien!a 53i reine !re(!a! =2
e a c"-$nica c"-$nica -anife#!a!' (rin anie!a!e ca$4a!' e nec$n"a3!erea e".$)iei &".ii
/ a- a#i*$ra! $n c.i-a! .ini3!i!, $n -ei$ c"nf"r!a&i. / a- a+$!a! (acien!a #' fac' (.i-&'ri #c$r!e (rin #a."n
1IUA III / a.!erarea ne"ii / (acien!a #' ai&' " e a re#(ira re#(ira)ie n"r-a.' -anife#!a! (rin i#(nee e(ira!"rie, ca$4a!' e !ene#-e e4ica.e 3i fe&r' -"era!'
/ a- a-ini#!ra! -eica)ia: #ea!ie, an!i&i"!ice, e4infec!an!e $rinare, an!ia.*ice / a- 5n')a! (acien!a #' #!ea 5n ("4i)ia 3e4n a(.eca!' 5n fa)' (en!r$ *".irea e4icii $rinare / a- a#i*$ra! (acien!ei " 5-&r'c'-in!e .e+er' / a- re$# in a.i-en!a)ie a.i-en!e.e c$ a."are a."ric' -are / #' c"n#$-e .ic%ie 3i a.i-en!e reci / a- a-ini#!ra! -eica)ia (re#cri#' / a- re$# in a.i-en!a)ie a.i-en!e.e c$ a."are ca."ric' -are
/ #!area *enera.' #e a-e.i"rea4' r Q > re#(ira)ii -in$! T Q <B P Q > ($.#a)ii-in$!
/ a.!erarea ne"ii / cre3!erea a("r!$.$i
/ re#(ec!area -'#$ri."r i*en"/ie!e!ice
/ acea#!' ne"ie e#!e
=9
e a c"-$nica c"-$nica -anife#!a!' (rin anie!a!e ca$4a!' e nec$n"a3!erea e".$)iei &".ii
/ a- a#i*$ra! $n c.i-a! .ini3!i!, $n -ei$ c"nf"r!a&i. / a- a+$!a! (acien!a #' fac' (.i-&'ri #c$r!e (rin #a."n
1IUA III / a.!erarea ne"ii / (acien!a #' ai&' " e a re#(ira re#(ira)ie n"r-a.' -anife#!a! (rin i#(nee e(ira!"rie, ca$4a!' e !ene#-e e4ica.e 3i fe&r' -"era!'
/ a- a-ini#!ra! -eica)ia: #ea!ie, an!i&i"!ice, e4infec!an!e $rinare, an!ia.*ice / a- 5n')a! (acien!a #' #!ea 5n ("4i)ia 3e4n a(.eca!' 5n fa)' (en!r$ *".irea e4icii $rinare / a- a#i*$ra! (acien!ei " 5-&r'c'-in!e .e+er' / a- re$# in a.i-en!a)ie a.i-en!e.e c$ a."are a."ric' -are / #' c"n#$-e .ic%ie 3i a.i-en!e reci / a- a-ini#!ra! -eica)ia (re#cri#' / a- re$# in a.i-en!a)ie a.i-en!e.e c$ a."are ca."ric' -are
/ #!area *enera.' #e a-e.i"rea4' r Q > re#(ira)ii -in$! T Q <B P Q > ($.#a)ii-in$!
/ a.!erarea ne"ii / cre3!erea a("r!$.$i
/ re#(ec!area -'#$ri."r i*en"/ie!e!ice
/ acea#!' ne"ie e#!e
=9
e a &ea 3i a ca."ric -nca -anife#!a! (rin ref$4$. (acien!ei e a &ea .ic%ie 3i e a -nca ca$4a!e e $reri -ic)i"na.e
/ efec!$area !"a.e!ei &".naei / a#i*$rarea .en+eriei c$ra!e / a- e(.ica! (acien!ei r".$. !$!$r"r -anere."r care #e efec!$ea4' / a- a-ini#!ra! -eica)ia (re#cri#'
/ a.!erarea ne"ii / #' fie #a!i#f'c$!' e a e.i-ina acea#!' ne"ie -anife#!a!' (rin $rini 5n can!i!a!e -ic' ca$4a! e i#$rie
#a!i#f'c$!' (acien!a 53i reca('!' !re(!a! ine(enen)a
/ (acien!a $rinea4' .a "re fie / $#!$ri-i.e -ic)i"na.e #$n! i-in$a!e / &".naa $r-ea4' 5n c"n!in$area ace.a3i !ra!a-en!
1IUA I =<
e a &ea 3i a ca."ric -nca -anife#!a! (rin ref$4$. (acien!ei e a &ea .ic%ie 3i e a -nca ca$4a!e e $reri -ic)i"na.e
/ efec!$area !"a.e!ei &".naei / a#i*$rarea .en+eriei c$ra!e / a- e(.ica! (acien!ei r".$. !$!$r"r -anere."r care #e efec!$ea4' / a- a-ini#!ra! -eica)ia (re#cri#'
/ a.!erarea ne"ii / #' fie #a!i#f'c$!' e a e.i-ina acea#!' ne"ie -anife#!a!' (rin $rini 5n can!i!a!e -ic' ca$4a! e i#$rie
#a!i#f'c$!' (acien!a 53i reca('!' !re(!a! ine(enen)a
/ (acien!a $rinea4' .a "re fie / $#!$ri-i.e -ic)i"na.e #$n! i-in$a!e / &".naa $r-ea4' 5n c"n!in$area ace.a3i !ra!a-en!
1IUA I =<
/ a.!erarea ne"ii / -"&i.i4area (acien!ei e a #e -i3ca 3i e a aea " &$n' ("#!$r' -anife#!a! (rin re(a$# .a (a! ca$4a! e (re4en)a $reri."r ."-&are 3i $reri 5n re*i$nea (e.in'
/ (acien!a 3i/a rec'('!a! ine(enen)a
/ a.!erarea ne"i e a "r-i 3i e a #e "i%ni -anife#!a! (rin !re4iri e#e e -ic)i$ni frecen!e
/ (acien!a #' (re4in!e ine(enen)a 5n #a!i#facerea ace#!e ne"i
/ in#"-nia e#!e 5ne('r!a!', (acien!a #e "i%ne3!e c"re#($n4'!"r
/ efici! 5n
/ 5n.'!$rarea fe&rei
/ !e-(era!$ra c"r($.$i e#!e ==
/ a.!erarea ne"ii / -"&i.i4area (acien!ei e a #e -i3ca 3i e a aea " &$n' ("#!$r' -anife#!a! (rin re(a$# .a (a! ca$4a! e (re4en)a $reri."r ."-&are 3i $reri 5n re*i$nea (e.in'
/ (acien!a 3i/a rec'('!a! ine(enen)a
/ a.!erarea ne"i e a "r-i 3i e a #e "i%ni -anife#!a! (rin !re4iri e#e e -ic)i$ni frecen!e
/ (acien!a #' (re4in!e ine(enen)a 5n #a!i#facerea ace#!e ne"i
/ in#"-nia e#!e 5ne('r!a!', (acien!a #e "i%ne3!e c"re#($n4'!"r
/ efici! 5n
/ 5n.'!$rarea fe&rei
/ !e-(era!$ra c"r($.$i e#!e ==
ne"ia e a3i -en)ine !e-(era!$ra c"r($.$i 5n .i-i!e n"r-a.e -anife#!a! (rin fe&r' -"era!' ca$4a!' e infec)ia e4icii $rinare
n"r-a.' 9?C
1IUA / efici! 5n / #a!i#facerea ace#!ei ne"ia e a ei!a ne"i (eric".e.e -anife#!a! (rin ri#c e c"-(.ica)ii
/ (acien!a &eneficia4' e $n -ei$ e #ec$ri!a!e / (acien!a e#!e .ini3!i!' ec%i.i&ra!' (#i%ic
CONCLU1II =>
ne"ia e a3i -en)ine !e-(era!$ra c"r($.$i 5n .i-i!e n"r-a.e -anife#!a! (rin fe&r' -"era!' ca$4a!' e infec)ia e4icii $rinare
n"r-a.' 9?C
1IUA / efici! 5n / #a!i#facerea ace#!ei ne"ia e a ei!a ne"i (eric".e.e -anife#!a! (rin ri#c e c"-(.ica)ii
/ (acien!a &eneficia4' e $n -ei$ e #ec$ri!a!e / (acien!a e#!e .ini3!i!' ec%i.i&ra!' (#i%ic
CONCLU1II =>
Pe (eri"aa #(i!a.i4'rii 5n $r-a !ra!a-en!$.$i a(.ica! c$ S$.fa!ia4". n$ #Ka$ #e-na.a! re4$.!a!e, #a a-ini#!ra! (acien!ei N"ar#en"&en4". 5n 2 in+ec)ii in!raen"a#e .a " 4i in!era., iar $rina c$ !"! !"! !ra!a-en!$. a(.ica! #a -en)in$! !$.&$re, a- f'c$! (acien!ei #('.'!$ri c$ #".$)ie #.a& an!i#e(!ic': Ni!ra! e e ar*in! 2 .a -ie care are r". e e!a3a e("4i!e.e ($r$.en!e ($r$.en!e e (e -$c"a#a e4ica.'0 S!area &".naei #/a a-e.i"ra! 3i &".naa a f"#! e!erna!'0 Fa-i.ia a f"#! inf"r-a!' e -'#$ri.e ce in!ere#ea4' 5n*ri+irea 3i (r"!ec)ia (acien!ei: / re*i- %iric 2.4i / #e a ferii e $-e4ea.' 3i fri*0
=?
Pe (eri"aa #(i!a.i4'rii 5n $r-a !ra!a-en!$.$i a(.ica! c$ S$.fa!ia4". n$ #Ka$ #e-na.a! re4$.!a!e, #a a-ini#!ra! (acien!ei N"ar#en"&en4". 5n 2 in+ec)ii in!raen"a#e .a " 4i in!era., iar $rina c$ !"! !"! !ra!a-en!$. a(.ica! #a -en)in$! !$.&$re, a- f'c$! (acien!ei #('.'!$ri c$ #".$)ie #.a& an!i#e(!ic': Ni!ra! e e ar*in! 2 .a -ie care are r". e e!a3a e("4i!e.e ($r$.en!e ($r$.en!e e (e -$c"a#a e4ica.'0 S!area &".naei #/a a-e.i"ra! 3i &".naa a f"#! e!erna!'0 Fa-i.ia a f"#! inf"r-a!' e -'#$ri.e ce in!ere#ea4' 5n*ri+irea 3i (r"!ec)ia (acien!ei: / re*i- %iric 2.4i / #e a ferii e $-e4ea.' 3i fri*0
=?
CA1UL III NUME: Anree#c$ PRENUME: A.ina0 DATA NAŞTERII: 2< i$.ie B?=0 DOMICILIU: #!r0 #!r0 TELEGRAFULUI nr0 nr0 2 Ti-i3"ara0 Ti-i3"ara0 STAREA CIILĂ: c'#'!"ri!'0 DIAGNOSTIC: e !ri-i!ere: Ci#!i!a ac$!'0 DIAGNOSTIC DE INTERNARE : Ci#!i!a ac$!'0 MOTIUL INTERNĂRII: Pacien!a #e (re4in!' .a #ec)ia Ur"."*ie a #(i!a.$.$i $e)ean Ti-i3"ara, (en!r$ !$.&$r'ri -ic)i"na.e e !i( (".ai$rie, $#!$ri-i -ic)i"na.e0 Ace#!ea a$ a('r$! 5n $r-' c$ > .$ni 3i #/a$ accen!$a! 5n $.!i-$. !i-( ceea ce a e!er-ina! &".naa #' #e (re4in!e .a -eic$. #(ecia.i#! (en!r$ in!ernare0 Pe &a4a #i-(!"-a!"."*iei 3i a ea-en$.$i c.inic i #e ($ne ia*n"#!ic$. e ci#!i!a ac$!'0 DATE MEDICALE: ANTECEDENTE PERSONALE: / (ri(ri-aa -en -en#! #!r$ r$a) a)ie ie .a 9 an ani0 i0 / A a$ a$!! !"a!e !"a!e &".i.e &".i.e infec!" infec!"/c"n /c"n!a* !a*i"a# i"a#ee a.e c"( c"(i.'r i.'riei0 iei0 A !a! infec) infec)ii ii $ri e!a!e e!a!e c$ E#c%e E#c%eric% ric%ia ia C"..i C"..i
CA1UL III NUME: Anree#c$ PRENUME: A.ina0 DATA NAŞTERII: 2< i$.ie B?=0 DOMICILIU: #!r0 #!r0 TELEGRAFULUI nr0 nr0 2 Ti-i3"ara0 Ti-i3"ara0 STAREA CIILĂ: c'#'!"ri!'0 DIAGNOSTIC: e !ri-i!ere: Ci#!i!a ac$!'0 DIAGNOSTIC DE INTERNARE : Ci#!i!a ac$!'0 MOTIUL INTERNĂRII: Pacien!a #e (re4in!' .a #ec)ia Ur"."*ie a #(i!a.$.$i $e)ean Ti-i3"ara, (en!r$ !$.&$r'ri -ic)i"na.e e !i( (".ai$rie, $#!$ri-i -ic)i"na.e0 Ace#!ea a$ a('r$! 5n $r-' c$ > .$ni 3i #/a$ accen!$a! 5n $.!i-$. !i-( ceea ce a e!er-ina! &".naa #' #e (re4in!e .a -eic$. #(ecia.i#! (en!r$ in!ernare0 Pe &a4a #i-(!"-a!"."*iei 3i a ea-en$.$i c.inic i #e ($ne ia*n"#!ic$. e ci#!i!a ac$!'0 DATE MEDICALE: ANTECEDENTE PERSONALE: / (ri(ri-aa -en -en#! #!r$ r$a) a)ie ie .a 9 an ani0 i0 / A a$ a$!! !"a!e !"a!e &".i.e &".i.e infec!" infec!"/c"n /c"n!a* !a*i"a# i"a#ee a.e c"( c"(i.'r i.'riei0 iei0 / A (re4en (re4en!a! !a! infec) infec)ii ii $rinare $rinare re(e!a! re(e!a!ee c$ E#c%e E#c%eric% ric%ia ia C"..i C"..i ANTECEDENTE 7EREDO/ COLATERALE: / !a!'. 7TA0 / Ma-a Ma-a "( "(era era!' !' e c% c%i# i#!! %e %e(a (a!ic !ic %ia! %ia!ic0 ic0 DATE SOCIALE: c'#'!"ri!', n$ f$-ea4', n$ c"n#$-' a.c""., c"n#$-' cafea, ."c$in)e c"re#($n4'!"are, r"-nc',"r!""a0 IST ISTOR ORIC ICUL UL JO JOLI LII: I: J" J".n .na aaa e#!e e#!e c$ c$n" n"#c #c$! $!'' c$ infe infec) c)ii ii $rin $rinar aree re(e!a!e, c$ < in!ern'ri0 E(i#"$. E(i#"$. ac!$a. a e&$!a! $n $r-' c$ > .$ni 3i #/a accen!$a! accen!$a! 5n $r-' c$ " #'(! #'(!''-n n', ', cn cn a 5nce( 5nce($! $! #' (re4i (re4in!e n!e $#!$ri$#!$ri-ee .a -ic) -ic)i$n i$ne, e, -ic) -ic)i$n i$nii frecen!e 3i re$#e ca ".$-0 P"f!a e -ncare e#!e $3"r #c'4$!', 3i e a#e-enea $rina are $n a#(ec! !$.&$re0 Pacien!a .$crea4' 5n!r/$n -ei$ $-e0
=@
A!"li" =i i!$e*,*e$"*e" 4"$el* <2i!u$e 5! 1u!c2ie 4e cele '3 ' 3 !e9i 1iil)ice0 Ne9i" 4e " *es,i*" e#!e $3"r inf.$en)a!' e e-")ia 3i !ea-a *enera!e e nec$n"a3!erea &".ii0 afec!a!' e "arece &".naa &".naa !re&$ie #' Ne9i" Ne9i" 4e " !i e#!e (er!$r&a! a!"ri!' nic!$riei, #"-n 5n!rer$(! 5n!rer$ (! 3i #$(erficia.0 Ne9i" 4e " se 5m<*c" =i 4e<*c". Pacien!a e#!e ca(a&i.' ca #'/3i a.ea* a.ea*'' #in*$ #in*$r' r' 5-&r 5-&r'c 'c''-in! in!ea ea a aec eca a!' !' circ$ circ$-# -#!a !an)e n)e."r ."r 3i ne nece ce#i! #i!')i ')i."r ."r "r*ani#-$.$i, ne fiin nece#ar' ec! (re*'!irea .en+eriei .a 5ne-na #a0 N$ (re4in!' ific$.!a!e 5n a #e 5-&r'ca 3i e4&r'ca 3i nici e4in!ere# e4in !ere# fa)' e )in$!'0 Ne9i" 4e "@=i me!2i!e $em,e*"$u*" c*,ului 5! limi$e !*m"le e#!e $3"r $3"r (e (er!$ r!$r& r&a!' a!' e !e-( !e-(er era!$ a!$ra ra -ei -ei$.$ $.$ii a-&ia a-&ian! n! care care e#!e e#!e cre#c cre#c$!' $!' 3i (r""ac' (acien!ei " !ran#(ira)ie a&$nen!'0 Ne9 Ne9i" i" 4e " 1i cu*" cu*"$$ =i "@=i "@=i ,*$ ,*$e+ e+"" $e)u $e)ume me!$ !$el elee e#!e (e e(.in #a!i#f'c$!'0 Pacien!a 53i -en)ine i*iena c"r("ra.' (rin &aie 4i.nic' (e re*i$ni0 Ne9i" 4e " e9i$" ,e*iclele: (acien!a &eneficia4' e $n -ei$ e #i*$ran)' f'r' accien!e 3i infec)ii0 Ne9i" 4e " cmu!ic" e#!e (er!$r&a!' a!"ri!' ne5ncreerii 5n cei in +$r0 Ne9i" Ne9i" 4e " "c2i!" "c2i!" c!1*m c!1*m ,*,*iil ,*,*iil** c*e4i!2e =i 9"l*i: 9"l*i: (acien!a e#!e e re.i*ie "r!""a, crein)a #a inf.$en)n 5n -are -'#$r' -"$. e ia)' ia)',, a!i!$ a!i!$ine ineaa 3i #en! #en!ii-en en!e. !e.ee e &" &"a. a.'0 '0 N$ a$ e ei# i#!a! !a! c"n c"nf.i f.ic!e c!e 5n!re 5n!re rec"-an'ri.e !era(e$!ice 3i crein)a re.i*i"a#'0 =B
Ne9i" 4e *e"li"*e: i-a*inea e #ine a ('cii n$ e#!e (er!$r&a!', e#!e -$.)$-i!' -$.)$-i!' e ("4i)ia #a a!! (e (.an #"cia. c! 3i fa-i.ia.0 E#!e ca(a&i.' ca(a&i.' #' i/a eci4ii ("!rii!e ("!rii!e 5n !i-( $!i. 3i n$ (re4in!' .i(#' .i(#' e in!ere# fa)' e ac!ii!a!ea ac!ii!a!ea c"!iian'0 Ne9i" 4e " se *ec*ee": (en!r$ a -en)ine ine(enen)a 5n #a!i#facerea ace#!ei ne"i a- a.e# -i+."ace e: / a- a#i*$ a#i*$ra! ra! c"ni)i c"ni)iii "(!i-e "(!i-e (en!r$ (en!r$ e#f e#f'3$ '3$rare rareaa ace#!ei ace#!ei ac!ii! ac!ii!')ii ')ii00 / A- ($# ($# .a i#(" i#("4i) 4i)ia ia (ac (acien ien!e !eii c'r)i, c'r)i, rei rei#!e #!e / A- 5nce 5ncerc rca! a! #'/i #'/i cree4 ree4 " #!ar #!aree e &$n' &$n' i#(" i#("4i 4i)i )iee 3i #' 5n.' 5n.'!$ !$r r (.ic!i#ea.a0 "a! a!'' c$ Ne9i" 4e " 5!92" cum s@2i @2i ,s$*e $*ei s!$"$e $"$e"": " a-e.i"rarea &".ii a- $r-'ri! ca: / (a (aci cien en!a !a #' " "& &n nea ea#c #c'' c$ c$n" n"3! 3!in) in)e.e e.e nece#a nece#are re (en (en!r$ !r$ -en)in -en)inere ereaa #!'rii e #'n'!a!e0 / S' fie ca(a& ca(a&i.' i.' e/a e/a f"."# f"."#ii ace# ace#!e !e c$n"3 c$n"3!in !in)e )e (en!r$ (en!r$ "&)in "&)iner erea ea $nei $nei #!'ri e &ine fi4ic 3i (#i%ic0 / Dia* Dia*n" n"#! #!ic ic$. $. e e N$r# N$r#in in** ac!$ ac!$a. a.:: / !$.&$ !$.&$r' r'ri ri -ic)i -ic)i"n "na.e a.e,, $rin $rin'' !$.& !$.&$r $re0 e0 Dia*n"#!ic$. e N$r#in* ("!en)ia.: / ri#c ri#c$. $. c" c"-( -(.i .ica ca)i )ii. i."r "r (rin (rin a#ce a#cen# n#i$ i$ne neaa infe infec) c)ie ieii (rin (rin $re! $re!er er #( #(re re rinic%i
>
PLANUL DE ÎNGRIIRE A JOLNAEI JOLNAEI CU CISTITĂ ACUTĂ ACUTĂ (e (eri"aa 0=0<02@ 0=0<02@ PROJLEME OJIECTIE 1IUA I / a.!erarea ne"ii / (acien!a #' re#(ire e a re#(ira c$ -ini- e -anife#!a! (rin ific$.!a!e i#(nee e !i( !a%i(neic a !$nicii ca$4a!' e re.a!area e#(re e&$!$. 3i e".$)ia &".ii ac!$a.e
INTERENŢII
EALUARE
/ re(a$# .a (a! / erific (re4en)a *."&$.$i e4ica. / a- 5nce 5ncerc rca! a! #!i#!i-$$.are .areaa eac eac$' $'ri riii (rin (rin in!r"$cerea &a4ine!$.$i ca. #$& &".na' / a- a(.ica! c"-(re#e ca.e (e re*i$nea ($&ian' / n"!area n"!area re4$.!a!$.$ re4$.!a!$.$ii ea-en$.$i ea-en$.$i #$-ar e $rin' rec".!a! 5n i-inea)a 4i.ei / a-ini#!rarea -eica)iei (re#cri#e e -eic 5n $r-a re4$.!a!$.$i $r"c$.!$rii a e0 ec%"0
/ a- rec".!a! &".naei #n*e 3i $rin' (en!r$ $r-'!"are.e ana.i4e: #%, $ree #an*in', crea!inin' #an*in', e #$-ar e $rin', $r"c$.!$r'
/ -en)inerea !e-(era!$rii 5n #a."n 5n!re @/ 22C / a#i*$rarea $nei &$ne en!i.a)i (rin e#c%ierea *ea-$.$i (en!r$ a ei!a c'.$ra ece#i' / -'#$rarea f$nc)ii."r i!a.e 3i n"!area 5n FT / e$carea (acien!ei (en!r$ f"."#irea !e%nici."r e re.aare / -en)inerea $nei ("4i)ii care #' fa"ri4e4e re#(ira)ia / anie!a!e
/ (acien!a #' fie
/ a- 5n#")i! &".naa .a >
-anife#!a!' (rin iri!a&i.i!a!e, e(re#ie (#i%ic', e-"!ii!a!e ca$4a!' e .i(#a e c$n"a3!ere a &".i a -"$.$i ei e e".$)ie a -anife#!'ri."r care " 5n#")e#c, a !ra!a-en!$.$i (re#cri#
ec%i.i&ra!' (#i%ic 3i #' / re(a$# .a (a! rai"."*ie (en!r$ efec!$area fie inf"r-a!' e#(re / rec".!area $rini (en!r$ ea-ene c%i-ice 3i $nei rai"#c"(ii ($.-"nare &"a.' &ac!eri"."*ice / &".naa e#!e ani"a#' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i#e(!ice $rinar', an!i&i"!ice, an!ia.*ice / #c%i-&area .en+eriei e (a! 3i e c"r( / a#i*$rarea $nei a!-"#fere ca.e / &'i ca.e e 3e4$!
/ a.!erarea ne"ii
/ (acien!a #' (re4in!e
/ (acien!a a a$! in#"-nii in >2
-anife#!a!' (rin iri!a&i.i!a!e, e(re#ie (#i%ic', e-"!ii!a!e ca$4a!' e .i(#a e c$n"a3!ere a &".i a -"$.$i ei e e".$)ie a -anife#!'ri."r care " 5n#")e#c, a !ra!a-en!$.$i (re#cri#
ec%i.i&ra!' (#i%ic 3i #' / re(a$# .a (a! rai"."*ie (en!r$ efec!$area fie inf"r-a!' e#(re / rec".!area $rini (en!r$ ea-ene c%i-ice 3i $nei rai"#c"(ii ($.-"nare &"a.' &ac!eri"."*ice / &".naa e#!e ani"a#' / a- a-ini#!ra! -eica)ia (re#cri#' e -eic: an!i#e(!ice $rinar', an!i&i"!ice, an!ia.*ice / #c%i-&area .en+eriei e (a! 3i e c"r( / a#i*$rarea $nei a!-"#fere ca.e / &'i ca.e e 3e4$!
/ a.!erarea ne"ii
/ (acien!a #' (re4in!e
/ (acien!a a a$! in#"-nii in >2
e a e.i-ina -anife#!a!' (rin $#!$ri-e .a -ic)i$ne, (re4en)a %e-a!$riei 3i (i$riei, -ic)i$ni frecen!e 3i 5n can!i!a!e re$#', $rere %i("*a#!ric' iraia!' (e $re!r', ca$4a! e inf.a-a)ia e4icii $rinare
-ic)i$ni #("n!ane, ne$rer"a#e, #' n$ (re4in!e c"-(.ica)ii c$!ana!e, re#(ira!"rii, $rinare, #' eac$e4e " $rin' .i-(ee f'r' #n*e 3i ($r"i #' fie ec%i.i&ra!' (#i%ic
1IUA II
/ (acien!a #'
/ -en)inerea c"ni)ii."r nece#are #"-n$.$i (rin: ca$4a nic!$riei, "$a ,!rei re$cerea 4*"-"!$.$i in -ei$. #(i!a.ice#c -ic)i$ni (e n"a(!e / i-in$area in!eren)ii."r e 5n*ri+ire 5n !i-($. #"-n$.$i / a#i*$rarea $nei !e-(era!$ri aeca!e 5n #a."n / aeri#irea #a."n$.$i / (.anif (.anifica icarea rea 5-(re$ 5-(re$n' n' c$ (acien (acien!a !a a $n$ $n$ii (r"*ra- e eerci)ii -"era!e aa(/
/ a-0 -eica)iei (re#cri#e e -eic / (.anificare $n$i (r"*ra- e eerci)ii -"era!e / (.i-&'ri #c$r!e 5n #a."n / -i3c'ri ac!ie a -e-&re."r
/ (acien!a are $n #"-n >9
e a e.i-ina -anife#!a!' (rin $#!$ri-e .a -ic)i$ne, (re4en)a %e-a!$riei 3i (i$riei, -ic)i$ni frecen!e 3i 5n can!i!a!e re$#', $rere %i("*a#!ric' iraia!' (e $re!r', ca$4a! e inf.a-a)ia e4icii $rinare
-ic)i$ni #("n!ane, ne$rer"a#e, #' n$ (re4in!e c"-(.ica)ii c$!ana!e, re#(ira!"rii, $rinare, #' eac$e4e " $rin' .i-(ee f'r' #n*e 3i ($r"i #' fie ec%i.i&ra!' (#i%ic
1IUA II
/ (acien!a #'
/ -en)inerea c"ni)ii."r nece#are #"-n$.$i (rin: ca$4a nic!$riei, "$a ,!rei re$cerea 4*"-"!$.$i in -ei$. #(i!a.ice#c -ic)i$ni (e n"a(!e / i-in$area in!eren)ii."r e 5n*ri+ire 5n !i-($. #"-n$.$i / a#i*$rarea $nei !e-(era!$ri aeca!e 5n #a."n / aeri#irea #a."n$.$i / (.anif (.anifica icarea rea 5-(re$ 5-(re$n' n' c$ (acien (acien!a !a a $n$ $n$ii (r"*ra- e eerci)ii -"era!e aa(/
/ a-0 -eica)iei (re#cri#e e -eic / (.anificare $n$i (r"*ra- e eerci)ii -"era!e / (.i-&'ri #c$r!e 5n #a."n / -i3c'ri ac!ie a -e-&re."r
/ (acien!a are $n #"-n >9
/ a.!erarea ne"ii &eneficie4e e $n e a "r-i #i a #e #"-n c"re#($n4'!"r "i%ni -anife#!a!a can!i!a!i 3i ca.i!a!i (rin #"-n (er!$r&a! 5n!rer$(! #i #$(erficia. ca$4a! e nic!$rie
/ re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ (er!$r&a! a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii / re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii aci"4a -e!a&".ic' (re*'!irea &".naei (en!r$ ci#!"#c"(ie ci#!"#c"(ie
/ a.!erar a.!erarea ea ne ne"ii "ii
#a!i#facerea #a!i#facerea ace#!ei ace#!ei ><
/ a.!erarea ne"ii &eneficie4e e $n e a "r-i #i a #e #"-n c"re#($n4'!"r "i%ni -anife#!a!a can!i!a!i 3i ca.i!a!i (rin #"-n (er!$r&a! 5n!rer$(! #i #$(erficia. ca$4a! e nic!$rie
/ re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ (er!$r&a! a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii / re$c re$cer erea ea in in a.ia.i-en en!a !a)i )iee a a.ia.i-en en!e !e." ."rr c$ a."are ca."ric' -are
/ c"n#$-$. .ic%ie."r 3i a.i-en!e."r reci / 5-&r'c'-in!e .e+er' e c$."are a.&' / a(.icarea c"-(re#e."r reci (e fr$n!e / aeri#irea #a."n$.$i / %ira!area 3i -inera.i4area &".na$.$i (en!r$ a (reenii aci"4a -e!a&".ic' (re*'!irea &".naei (en!r$ ci#!"#c"(ie ci#!"#c"(ie
/ a.!erar a.!erarea ea ne ne"ii "ii
#a!i#facerea #a!i#facerea ace#!ei ace#!ei ><
e a #e -i3ca 3i e ne"i a aea " &$n' ("#!$r' -ani -anife# fe#!a !a!' !' (rin (rin aina-ie 3i a#!eni a#!eniee ca$4a! ca$4a! 5n (rinci(a. e $rere
/ a.!erar a.!erarea ea ne ne"ii "ii / -en)inerea e a -en)ine !e-(era!$rii c"r($.$i !e-(era!$ra 5n .i-i!e n"r-a.e c"r($.$i 5n .i-i!e n"r-a.e, -ani -anife# fe#!a !a!' !' (rin (rin !ran#(ira)ii a&$nen!e ca$4a!' e cre3!erea !e-(era!$rii -ei$.$i a-&ian!
/ a- $r-'ri! e".$)ia &".ii / a- -"ni!"ri4a! f$nc)ii.e i!a.e 3i .e/a n"!a! 5n FT0 FT0 / (acien!a (re4in!' / a- e(.ica! (acien!ei r".$. #"na+$.$i e4ica. e(enen)' 5n c"n!in$are / a- efec!$a efec!$a!! !"a.e! !"a.e!aa &".na &".naei ei 3i a- (reen (reeni! i! e#care.e
/ c"-$nicarea c$ (acien!a / n"!area f$nc)ii."r i!a.e 5n f"aia e !e-(era!$r' / re#!a&i.irea !ran4i!$.$i i*e#!i (en!r$ *a4e / -en)inerea #"nei e4ica.e (er-ea&i.e / a *".i! 3i a- #('.a! ($n*a e c".ec!are a $rinii / a- -"&i.i4a! &".naa .a -ar*inea (a!$.$i / a- -a#a! -e-&re.e inferi"are (en!r$ (reenirea !r"-&"f.e&i!ei / a- a-ini#!ra! !ra!a-en!$. (re#cri# e -eic / a-in a-ini# i#!r !rar area ea e .ic% .ic%i ie, e, ceai, ceai, #$c #$c na!$ na!$ra. ra.,, 4ea-' e c"-("! / a.i-en!a)ie #'rac' 5n (r"!eine
/ !e-(era!$ra c"r($. c"r($.$i $i a reeni reeni!! 5n .i-i!e .i-i!e n"r-a.e
>=
e a #e -i3ca 3i e ne"i a aea " &$n' ("#!$r' -ani -anife# fe#!a !a!' !' (rin (rin aina-ie 3i a#!eni a#!eniee ca$4a! ca$4a! 5n (rinci(a. e $rere
/ a.!erar a.!erarea ea ne ne"ii "ii / -en)inerea e a -en)ine !e-(era!$rii c"r($.$i !e-(era!$ra 5n .i-i!e n"r-a.e c"r($.$i 5n .i-i!e n"r-a.e, -ani -anife# fe#!a !a!' !' (rin (rin !ran#(ira)ii a&$nen!e ca$4a!' e cre3!erea !e-(era!$rii -ei$.$i a-&ian!
/ a- $r-'ri! e".$)ia &".ii / a- -"ni!"ri4a! f$nc)ii.e i!a.e 3i .e/a n"!a! 5n FT0 FT0 / (acien!a (re4in!' / a- e(.ica! (acien!ei r".$. #"na+$.$i e4ica. e(enen)' 5n c"n!in$are / a- efec!$a efec!$a!! !"a.e! !"a.e!aa &".na &".naei ei 3i a- (reen (reeni! i! e#care.e
/ c"-$nicarea c$ (acien!a / n"!area f$nc)ii."r i!a.e 5n f"aia e !e-(era!$r' / re#!a&i.irea !ran4i!$.$i i*e#!i (en!r$ *a4e / -en)inerea #"nei e4ica.e (er-ea&i.e / a *".i! 3i a- #('.a! ($n*a e c".ec!are a $rinii / a- -"&i.i4a! &".naa .a -ar*inea (a!$.$i / a- -a#a! -e-&re.e inferi"are (en!r$ (reenirea !r"-&"f.e&i!ei / a- a-ini#!ra! !ra!a-en!$. (re#cri# e -eic / a-in a-ini# i#!r !rar area ea e .ic% .ic%i ie, e, ceai, ceai, #$c #$c na!$ na!$ra. ra.,, 4ea-' e c"-("! / a.i-en!a)ie #'rac' 5n (r"!eine
/ !e-(era!$ra c"r($. c"r($.$i $i a reeni reeni!! 5n .i-i!e .i-i!e n"r-a.e
>=
/ a- -'#$ra! !en#i$nea ar!eria.', ($.#$. 3i .e/an"!a! 5n f"aia e !e-(era!$r' / e$c e$car area ea (aci (acien en!e !eii (en! (en!r$ r$ (re (reen enir irea ea recii reciie." e."r: r: .en+er .en+erie ie c$ra!', c$ra!', i*ien' i*ien' ri*$r" ri*$r"a#' a#' a re*i$ni (eriana.' 3i *eni!a.' / %ira!area c"re#($n4'!"are / a#i*$rarea $n"r c"ni)ii aeca!e f'r' (".$are f"nic', c%i-ic' #a$ -icr"&ian' / !e-(era!$ra c$(rin#' 5n!re @/2C / .$-in"4i!a!e / -"era!' (.a#area (acien!ei 5n!r/$n #a."n #$ferin e aceea aceea3i 3i afec afec)i )i$n $nee (en! (en!r$ r$ a ei! ei!aa c"n! c"n!ac! ac!are areaa &".i."r infec)i"a#e
1i$a III
/ i-in$area
/ i#c"nf"r!$. e#!e i-in$a! >>
/ a- -'#$ra! !en#i$nea ar!eria.', ($.#$. 3i .e/an"!a! 5n f"aia e !e-(era!$r' / e$c e$car area ea (aci (acien en!e !eii (en! (en!r$ r$ (re (reen enir irea ea recii reciie." e."r: r: .en+er .en+erie ie c$ra!', c$ra!', i*ien' i*ien' ri*$r" ri*$r"a#' a#' a re*i$ni (eriana.' 3i *eni!a.' / %ira!area c"re#($n4'!"are / a#i*$rarea $n"r c"ni)ii aeca!e f'r' (".$are f"nic', c%i-ic' #a$ -icr"&ian' / !e-(era!$ra c$(rin#' 5n!re @/2C / .$-in"4i!a!e / -"era!' (.a#area (acien!ei 5n!r/$n #a."n #$ferin e aceea aceea3i 3i afec afec)i )i$n $nee (en! (en!r$ r$ a ei! ei!aa c"n! c"n!ac! ac!are areaa &".i."r infec)i"a#e
1i$a III
/ i-in$area
/ i#c"nf"r!$. e#!e i-in$a! >>
/ i#c"nf"r! a! e i#c"nf"r!$.$i #"na $re!r"e4ica.' a(.i a(.ica ca!' !' 5n $r-a $r-a efec!$'rii ci#!"#c"(iei
/ ific ific$$.!a! .!a!ee 5n ne"ia e a "r-i 3i a #e "i%ni ca$4 ca$4a! a!'' e #!ar #!aree e(r e(re# e#i i', ', #!re #!re## -ani -anife# fe#!a !a!' !' (rin (rin "re in#$ficien!e e "i%n', "i%n', e($i4are, e($i4are, e#c$ra+are, iri!a&i.i!a!e 1IUA I
/ a- ($r!a! i#c$)ii (e !e-a (r"&.e-e."r #a.e / a- 5nc$ra+a!/" #' fac' fa)' #!re#$.$i crea! e &"a.' / a- 5nc$ra+a! (acien!a #' i#c$!e .i&er e#(re *ri+i.e #a.e / i/a- "feri! ("#i&i.i!a!ea e a ($ne 5n!re&'ri / a- 5ncerca! #'/i "fer r'#($n#$ri c! -ai (reci#e / a- inf"r-a!/" a#$(ra -anere."r -e0
/ (acien!a #' &eneficie4e e "i%n' c"re#($n4'!"are r#!ei
/ (acien!a are $n #"-n .ini3!i!
/ re.$area a.i-en!a)iei
/ e#!e a#i*$ra! a("r!$. ca."ric >?
/ i#c"nf"r! a! e i#c"nf"r!$.$i #"na $re!r"e4ica.' a(.i a(.ica ca!' !' 5n $r-a $r-a efec!$'rii ci#!"#c"(iei
/ ific ific$$.!a! .!a!ee 5n ne"ia e a "r-i 3i a #e "i%ni ca$4 ca$4a! a!'' e #!ar #!aree e(r e(re# e#i i', ', #!re #!re## -ani -anife# fe#!a !a!' !' (rin (rin "re in#$ficien!e e "i%n', "i%n', e($i4are, e($i4are, e#c$ra+are, iri!a&i.i!a!e 1IUA I
/ a- ($r!a! i#c$)ii (e !e-a (r"&.e-e."r #a.e / a- 5nc$ra+a!/" #' fac' fa)' #!re#$.$i crea! e &"a.' / a- 5nc$ra+a! (acien!a #' i#c$!e .i&er e#(re *ri+i.e #a.e / i/a- "feri! ("#i&i.i!a!ea e a ($ne 5n!re&'ri / a- 5ncerca! #'/i "fer r'#($n#$ri c! -ai (reci#e / a- inf"r-a!/" a#$(ra -anere."r -e0
/ (acien!a #' &eneficie4e e "i%n' c"re#($n4'!"are r#!ei
/ (acien!a are $n #"-n .ini3!i!
/ re.$area a.i-en!a)iei
/ e#!e a#i*$ra! a("r!$. ca."ric >?
/ a.!erar a.!erarea ea ne"ii ne"ii (er "# e a &ea 3i a -nca 5n $r-a in!eren)iei
nece#ar "r*ani#-$.$i
/ ("!en)ia. e c"-(.ica)ii ri#c$. e!inerii infec)iei #(re rinic%i
/ (acien!a #' &eneficie4e e $n -ei$ -ei$ e #i*$ #i*$ra ran) n)'' f'r' accien!e 3i infec)ii
/ (acien!a are " #!are *enera.' #!a)i"nar'
1IUA
/ #!a&i.irea $nei re.a)ii
/
i-in$area rea
a(a!iei,
a >@
/ a.!erar a.!erarea ea ne"ii ne"ii (er "# e a &ea 3i a -nca 5n $r-a in!eren)iei
nece#ar "r*ani#-$.$i
/ ("!en)ia. e c"-(.ica)ii ri#c$. e!inerii infec)iei #(re rinic%i
/ (acien!a #' &eneficie4e e $n -ei$ -ei$ e #i*$ #i*$ra ran) n)'' f'r' accien!e 3i infec)ii
/ (acien!a are " #!are *enera.' #!a)i"nar'
1IUA
/ #!a&i.irea $nei re.a)ii
/
i-in$area rea
a(a!iei,
a >@
("4i!ie c$ (acien!a / a.!erar a.!erarea ea ne ne"ii "ii care care #' 5-i 5-i (er-i (er-i!' !' e a c"-$n -$nica a!in*erea a!in*erea "&iec!ie." "&iec!ie."r r -ani -anife# fe#!a !a!' !' (rin (rin e 5n*ri+ire a(a!ie, ne5ncreere, efici! e a #e are# are#aa ca$4a! ca$4a! e e(r e(re# e#ie ie fi4i fi4ic' c',, !ri#!e)e
ne5n ne5ncr cre eer erii ii -eica.
5n
(er# (er#"n "na. a.$. $.
CONCLU1II : S$& $n !ra!a-en! c$ Ne"a4". "$' !a&.e!e .a < "re >*2< % a("i .a 9 "re " !a&.e!' <*2<% $rina a 5nce($! #' #e .i-(e4ea#c' 3i #a c"n!in$a! !ra!a-en!$. 5nc' 4i.e (n' .a #!eri.i4area ei0 Si-(!"-e.e #a$ a-e.i"ra! 5nc' in 5nc' in (ri-e.e 4i.e e #(i!a.i4are0 În 4i$a a =/ a e #(i!a.i4are .a i4i!a efec!$a!' 5-(re$n' c$ -eic$. e #a."n, ace#!a ac e#!a a %"!'r! e!ernarea (acien!ei $r-n a reeni .a c"n!r". $(' < 4i.e, !i-( 5n care a c"n!in$a $n !ra!a-en! c$: / Ji#e(!". 2 !a&.e!e i-inea)a, 2 #eara 0 #e a feri e e($nere .a fri* 3i $-e4ea.' / re*i- %iric 2/9 . (e 4i 0
>B
("4i!ie c$ (acien!a / a.!erar a.!erarea ea ne ne"ii "ii care care #' 5-i 5-i (er-i (er-i!' !' e a c"-$n -$nica a!in*erea a!in*erea "&iec!ie." "&iec!ie."r r -ani -anife# fe#!a !a!' !' (rin (rin e 5n*ri+ire a(a!ie, ne5ncreere, efici! e a #e are# are#aa ca$4a! ca$4a! e e(r e(re# e#ie ie fi4i fi4ic' c',, !ri#!e)e
ne5n ne5ncr cre eer erii ii -eica.
5n
(er# (er#"n "na. a.$. $.
CONCLU1II : S$& $n !ra!a-en! c$ Ne"a4". "$' !a&.e!e .a < "re >*2< % a("i .a 9 "re " !a&.e!' <*2<% $rina a 5nce($! #' #e .i-(e4ea#c' 3i #a c"n!in$a! !ra!a-en!$. 5nc' 4i.e (n' .a #!eri.i4area ei0 Si-(!"-e.e #a$ a-e.i"ra! 5nc' in 5nc' in (ri-e.e 4i.e e #(i!a.i4are0 În 4i$a a =/ a e #(i!a.i4are .a i4i!a efec!$a!' 5-(re$n' c$ -eic$. e #a."n, ace#!a ac e#!a a %"!'r! e!ernarea (acien!ei $r-n a reeni .a c"n!r". $(' < 4i.e, !i-( 5n care a c"n!in$a $n !ra!a-en! c$: / Ji#e(!". 2 !a&.e!e i-inea)a, 2 #eara 0 #e a feri e e($nere .a fri* 3i $-e4ea.' / re*i- %iric 2/9 . (e 4i 0
>B
CAPITOLUL V. TENICI Ş I METODE FOLOSITE PENTRU DIAGNOSTIC DIAGNOS TIC ŞI TRAT TRATAMENT ÎN CISTITA CISTITA ACUTĂ. 6.' ADMINISTRAREA MEDICAMENTELOR MEDICAMENTELOR PRIN PERFU7IEPEV
CAPITOLUL V. TENICI Ş I METODE FOLOSITE PENTRU DIAGNOSTIC DIAGNOS TIC ŞI TRAT TRATAMENT ÎN CISTITA CISTITA ACUTĂ. 6.' ADMINISTRAREA MEDICAMENTELOR MEDICAMENTELOR PRIN PERFU7IEPEV
De1i!i2ie: (rin (erf$4ie #e 5n)e.e*e in!r"$cerea (e ca.e (aren!era.', (ic'!$r' c$ (ic'!$r' a #".$)ii."r (en!r$ reec%i.i&rare reec%i.i &rare %ir"e.ec!r".i!ic', %ir"/ i"nic' 3i ".e-ic' a "r*ani#-$.$i0
Sc,ul: %ira!area 3i -inera.i4area "r*ani#-$.$i,a-ini#!rarea -eica/ -en! -en!e. e."r "r .a care care #e $r-' $r-'re re3! 3!ee $n efec efec!! (re. (re.$n $n*i *i!, !, e e($ ($ra ra!i !i/ /i i.$ .$n n 3i
?
fa"ri4n ecre)ia in "r*ani#- a (r"$3i."r !"ici,c"-(.e!area (r"!eine."r #a$ a a.!"r c"-("nen!e #an*$ine,a.i-en!a)ia (e ca.e (aren!era.'0
M"$e*i"le M"$e*i"le !eces"* !eces"*e: e: !aa -eica.' ac"(eri!' c$ $n c-( #!eri.,!r$#a (en!r$ (erf$4a!,#".$)ii a-&a.a!e #!eri.,#".$)ii %ira!an!e 5n #!ic.e #a$ ($n*i ri*$r"# #!eri.i4a!e 3i 5nc'.4i!e .a !e-(era!$ra c"r($.$i,*ar"$,!'i)' rena.',#!a!i (en!r$ fiarea f.ac"ane."r,/2 #erin*i e =/ c- c$ ace (en!r$ in+ec)ii in!ra-$#c$.are
3i
in!raen"a#e,"
(ern'
!are,-$3a-a,"
(en#'
%e-"#!a!ic',!a-("n c$ a.c"".,r"-(.a#!0
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(er!$r&a!e ca $r-are a ace#!ei afec)i$ni0 D$(' c$.e*erea, ana.i4area 3i in!er(re!area a!e."r a- e.a&"ra! $n (.an e 5n*ri+ire care #' inf.$en)e4e ("4i!i #!area fi4ic' 3i -en!a.' a (acien)i."r (acien)i. "r00 Pen!r$ a #!a&i.i " "rine a (ri"ri!')i."r 5n ac"rarea 5n*ri+iri."r a- a$! 5n eere -ai 5n!i 5n ce -'#$r' ne"ia #a!i#f'c$!' a-enin)' %"-e"#!a4ia (acien!$.$i #a$ #ec$ri!a!ea #a 3i *ra$. e ine(enen)' Eec$!area 5n*ri+iri."r c"n#!i!$ie $n -"-en! ("!rii! (en!r$ fiecare a#i# a#i#!e !en! n!'' #' inf" inf"rr-e4 e4ee a#$( a#$(ra ra (r"&. r"&.ee-e. e."r "r #a.e #a.e e #'n' #'n'!a !a!e !e,, a#$( a#$(ra ra !ra!a-en!$.$i #'$ "ri a#$(ra "&icei$ri."r e ia)' -ai ($)in ("!rii!e (en!r$ #a!i#facerea ne"i."r f$na-en!a.e0 În')area În')area (acien!$.$i (acien!$.$i e#!e $n ac! e 5n*ri+ire e#en)ia. 3i nece#ar nece#ar0 Înain!e e a 5nce(e 5n')area a- e".$a! c$n"3!in)e.e (acien)i."r 3i "rin)a e a 5n')a 5nc$r 5nc$ra+ a+n n$ $/i /i #' ($ ($n' n' 5n!re 5n!re&' &'ri0 ri0 A- an an!r !rena ena!! (a (acie cien)i n)iii #' #e i-(. i-(.ice ice 5n a(.icarea (.an$.$i e 5n*ri+ire0 Pen!r$ a ($!ea face " a(reciere +$#!' a#$(ra (r"*re#$.$i (acien)i."r 5n ra("r! c$ in!eren)ii.e -e.e a- ea.$a! .a ier#e in!era.e, (e !"! (arc$r#$. 5n*ri+irii, ac' "&iec!ie.e (.anifica!e 3i/a$ a!in# #c"($. 3i ac' (acien)ii a$ f"#! -$.)$-i)i e re4$.!a!e0 În -a+"ri!a!ea )'ri."r ($!e- #($ne c' a#i#!en!a -eica.' e#!e #in*$ra care a#i*$r' #ericii 2< % ce."r ce a$ ne"ie0 Ace#!a e#!e r".$. a#i#!en!ei -eica.e c$ (ar!ic$.ari4'ri 5n 5n*ri+irea &".nai."r 3i a ce."r c$ %anica(0 A#i#!en A#i#!en!a !a -eica.' -eica.' !re&$ie !re&$ie #' H in!re 5n (ie.ea &".na &".na$.$i $.$i H (en!r$ (en!r$ a 5n)e.e*e ce rea acea#!a, care #$n! ne"i.e #a.e (en!r$ a #e -en)ine 5n ia)' 3i (en!r$ a/3i rec3!i*a #'n'!a!ea0
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