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CUPRINS
ARGUMENT 2CAPITOLUL I. INTRODUCERE ÎN GERIATRIE 5
I.1. DEFINI II. GENERALITĂ I.Ț Ț 5I.2. AFECŢIUNI MAI FRECVENTE ÎN PRACTICA GERIATRICĂ. BOLILE
BĂTRÂNE IIȚ 6I.3. BĂTRÂNEŢEA - ETAPĂ FIZIOLOGICĂ - NU BOALĂ 8I. . ROLUL I POZIŢIA MEDICULUI I A!I!TENTEI FAŢĂ DE BOLNAVULȘ Ș
VÂR!TNIC. "I.5. EDUCAŢIA !ANITARĂ "
CAPITOLUL II. ELEMENTE DE ANATOMIE #I FIZIOLOGIE A ARTERELOR 11CAPITOLUL III. PREZENTAREA BOLII ARTERIOPATIE OBLITERANTĂ 1
III.1. DEFINIŢIE 1III.2. FIZIOPATOLOGIE 1III.3. ETIOLOGIE 15
III. . CLA!IFICAREA ANATOMO-CLINICĂ A I!C$EMIILOR PERIFERICEIII. .1. C%&'()(*&+,& *%( (* & ('*/,0(,( &* , ,+(),+(*, 15III. .2. C%&'()(*&+,& ('*/,0((%4+ *+4 (*, L,+(*/,-F4 &( , 16
III.5. FORME CLINICE 16III.6. !IMPTOMATOLOGIE 1"III. . DIAGNO!TIC 1"
III. .1 D(&7 4' (* *%( (* 1"
III. .2. D(&7 4' (* (),+, (&% 25III. .3. D(&7 4' (* % (),+, (&% &% *%& (*& (,(
III.8. COMPLICAŢII 26III.". TRATAMENT 2
CAPITOLUL IV. ROLUL A!I!TENTEI MEDICALE ÎN PREGĂTIREA BOLNAVULUIPENTRU E9PLORĂRI !PECIFICE. 31
PLANUL DE ÎNGRI:IRE 31
CAPITOLUL V. INTERVEN IILE A!I!TENTEI MEDICALE PRIVIND ;NGRI:IREAȚBOLNAVULUI CU ARTERIOPATIE OBLITERANTĂ 3
1
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CAPITOLUL VI. CAZ CLINIC 3VI.1. CULEGEREA DATELOR 3VI.2. NEVOILE FUNDAMENTALE DUPĂ MODELUL CONCEPTUAL AL
VIRGINIEI $ENDER!ON <
VI.3. PLAN DE ÎNGRI:IRE A PACIENTULUI !.Z. 2VI. . EVALUAREA FINALĂ
CAPITOLUL VII. EDUCAŢIA PENTRU !ĂNĂTATE 8CONCLUZII 5<ANE9A 1 51ANE9A 2 52ANE9A 3 53
ANE9A 5BIBLIOGRAFIE 55
2
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MOTTO
"Mai important decat sa dai ani vietii, este sa dai viata anilor"
A & A'%&
ARGUMENT
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CAPITOLUL I.
INTRODUCERE ÎN GERIATRIE
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I.!. AFEC"IUNI MAI FREC#ENTE ÎN PRACTICA GERIATRICĂ. $OLILE$ĂTR%NE II.Ț
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I.5. ROLUL I PO4I"IA MEDICULUI I ASISTENTEI FA"Ă DE $OLNA#ULȘ Ș#%RSTNIC.
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+('* ,+4+( , (&7 4' (* ( +& &0, ,4+( 7+&>,. P+(0 % 7,' ,+& , (* &% 0, (*ș& ' &@(%( &* ', &)% ; )& & ( H@4% &> ; >?+' H '& & ( H>?+ț)( (4%47(*, , ;0@ +? (+,H. A*,&' & , + * ,4+( )&0(%(& '& */(&+ &*(0, (* % ( 0 ' +( , + +,* ,+&+,& 4+ ) * (( ( ,+)4+0& , *&+&* ,+(' (*, ț ș ț0&( ( ,+,. D,*( ,%(0( &+,& H' +(( , @4&% H , H' &+,& , ;0@ +? (+,H ,' , 4@%(7& 4+(,. M, (* % +,@ (, ' *4 >( 7 ' @(,* % ( & +&= % *& '(0 4ș' )(+, ( ( , >?+' ,*( +,@ (, ' ; 7+(=4+, ,.ș ț
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I./. EDUCA"IA SANITARĂ
!, +0 +, , 4 ( ' + (+, %&+7 & >?+' (*(%4+ 4 ,4 *4%&+( &+, ,ș ș ș* 4 ( ,%4+ +(>( +4*,' % , ;0@ +? (+, ; ')?+ ( +,7 (+,& , + ș ș ș
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+,*4*, , ;0@4% >(+, ( (*& (( ,+& , (*, ( (, , (*, * %, , 0, ( ,+, & *&ț ș ț ț)( (*, ( ( ,%,* &%,. P+,4* +(%, +(>,'* & & &+,& &* ( (%4+ *4+,' 4ș ț>?+' . A% ,%, ', & +,',& 4 %& (,( >?+' (*, ' 4&', ( >?+' (*(%4+ @4% &ț ș& +,*(& * , *& (& '& ( &+ *4 ' ( (, +,' +'& *,& 0&( (0 4+ & , ț
;0@& +? (+(( 7+,>& , @4%( , , , , . !, +0 +, , *& @ +? (( ' ,>( *ț ș ț 4'(@(%( (%, %4+ +,&%, +( *40@& ,+,& )+(*(( , @& +? , , ( 04&+ , ( 0(* 4+&ț ț ș ș ș
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CAPITOLUL II.ELEMENTE DE ANATOMIE ŞI FIZIOLOGIE A ARTERELOR
Î *4 ' ( (& '(' ,0 % ( &+ ,+(&% )(7.II.1 ( + 0&( 0 % , ( +( , >&',,%&' (* &+ ,+, , ( 0 '* %&+ &+ ,+, 0(*( &+ ,+(4%,.
A+ ,+,%, , ( ,%&' (* & *& +4 4 ( &4+ &. E%, & *&%(@+ 0&+, ' ', *4+ ( ', *&+&* ,+( ,& +( +, 40( , (& ,%,0, ,%4+ ,%&' (*, ; ' + * +
F(@+,%, ,%&' (*, +, 40( %& (>,% % 0, (,( ( ; ' +& % ' @, 4 ,%(&%%(0( & & ,%&' (* ( ,+ . L& &*,' , &+ ,+, 0&+( %(0( & & ,%&' (* ( ,+
', &+& , (*& 0, (, * 0 ,' , *& % %& &+ ,+,%, , ( 0 '* %&+ & 4& +4 (& , & &*,' 4+& &0@,%, )(( &%* ( , ( %&0, ' **,'(>, , ,' ,%&' (*.
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)4+0 , , '( , &'(> *&+, +( +,>, (+,& &+ ,+,( %& )4+0& ( ( (&% *4 ' ( (, 4& * +, % ( '& 7>( ; (0 % (&' 4%,( >, +(* %&+, &'(7 +? *4 ('? 7,% ( &+ ,+(&% ; ,+( 4+( % *& (%&+. A*,' ), 40, , ,*4 40('(+, & , ,+7(,( ', 0&
( '(' 4% &+ ,+(&% .D,)4+0&+,& &+ ,+(&% +& '0(' *, +() 7 ,-& % 7 % & % ( >&'* %&+
%'& (% ,%,0, ' ,*()(* * +7,+(( ; +,7(0 &+ ,+(&%.A+ ,+,%, , ( H0 '* %&+H 0( , ( &+ ,+, , (' +(@ (, ', *&+&*
+, 40( & & )(@+,%4+ 0 '* %&+, , , , %4 7( ( &%, ( *(+* %&+, %& (>,%&+ ,+(&%. L& ( ,+(4+ % 0, (,( ', 7 ', , %(0( & & ,%&' (* ( ,+ (&+ %& ,& >, (*, %(0( & & ,%&' (* , ,+ . F(@+,%, 0 '* %&+, , , , ) * (4 ,&
& 4+( 0,+4&',%4+ =4 * ( ( *40 (*& , ( ,+*,% %&+,. A* (>( & ,& &*,'' @ *4 +4% ,+>4' ( , +4 04+&% *& ,*4%&0( ,%, &>? +4% *, +&%.
R ' ' % &*,' 4+ >&', %& ' (0 %&+,& *& ,*4%&0( (* , ( , , ,+( 4+(7 ','*. A*,' , (),+, , & %& @& (' +(@ (& (),+( ,%4+ ( +( , +,*, 4+( & +, %(* >&'4*4 ' +(* (& & + & & & (> %& (>,% % (,%(( 0 '* %& +((&@ 40( &%, ) + & ( ,+,'& >&',%, *,+,@+&%, *4+4 &+,%, ( >&',%, ' +&+, &
/( 4 , '( ( &+ ,+(&%, &0, ( 4&+, ' +, , ,0 % ; *& % ,( /,04+&7(( , *. . E&+ ,+, , ( 0 '* %&+ ' &+ ,+,%, *4+4 &+, *&+4 ( , & (%&+, ),0 +&%, , *.
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A+ ,+,%, 0(*( & 4 ' + * + &',0 4&+, &+ ,+,%4+ , ( 0 '* %&+. E%, ', +,*,+, ; +, &+ ,+,%, , ( 0 '* %&+ ( &+ ,+(4%,. N 0 + % %4+ 0&+, ,+0
*(+* %& (,( & &' 404 (*, *4%& ,+&%, , ' %,,+, ; *& % ( 4@' &*4% , &A+ ,+(4%,%, &+ ,+(4%,%, ,+0( &%, '( 0, &&+ ,+(4%,%, ' ,+0( & ((%, '('
!, *&+&* ,+( ,& (0, '(4 &% +( +& 4+ % & +4& , , ,7&%( & , ; +, % 0 ,+, ,% ( &+ ,+(&%. A*,' , >&', & (*& 0, (, '%&@ +, +, , & &+ ,& +,; &( , , ,'*/( ,+,& ; *& (%&+, ; 7+4 &+, *&+, 4&+ , 0(+,& , ')( * ,+ T4 ' % &*,' ( ')( * ,+ +,7%,& *& ( & ,& , ' 7, *&+, >& + , ; & % 4& , & & % *& (%&+ +( 0,+4&',%, & &' 404 , &+ ,+(4%4->, %&+, '&% * +4+ *&%(@+ ', &)% , &',0, ,& ' @ *4 +4% , +4- 04+&% & &' 404*? 4 ' % ')( * ,+ % ( +,*& (%&+ ,' , *+,'* ( ( >,+' .
P,+, ,%, &+ ,+(&% ,' , @47& ; ,%,0, , ,+>4&',. L& (>,% % & >, (*,( &*,')4+0,& 4 +, ,& ; ( ' , , +&0 +( ,+>4&', %,&* ( &= 7 ? ; >,, 4 ,%( % (. D, &(*( +, % 4'(@(%( & ,& + ' ' % ( +40 &% '(' ,0 % ( &%& *40, (%, ,+>4&', ( , 4+ ( 04+&%.
N +( (& ,+, ,% ( ', )&*, ( ' +, & >, (*, +( >&'& >&'4+ 0 ( ( ' +, , 4 ,+0,& (,. Î +, *,%, 4 * +, , ', &)% 4 4 '%&@ >&'* %&+( & +, +, ,0, (, , + &+ ,+,%, 4+0&%, ( ' +& +(%, +4) , &%, , &+ ,+,( ; ,%, '( &
!(' ,0 % &+ ,+(&% ,' , '(' ,0 @ %&+ ; */(' (0 ,+0,&@(% , + & 7&*40 4 , ,%, 4+7& (*, ( ,%,0, ,%, )(7 +& , &%, '? 7,% (. P+( *( &%& '& ) *&'(7 +& * +7,+,& '& 7>( ,+0& , ( * 0&( 4047, . D, +,' ,* &+,& &+)( (4%47(*( &( *(+* %& (,( , ( , ,+) (& (' %&+ ( ,&% .
C(+* %& (& '? 7,% ( ,' , *&+&* ,+( & +( +,( 0 +(0( ,@( +,'( ,D,@( % , '? 7, %& (>,% % ( & 0( ,' , ( , ; +(0 % +? , *4 ' 0 %
,' % ( +,' ,* (>. EI ,' , (+,* +4 4+ (4 &% * +,'( ,& ( ( >,+' +4 4+ (4 &%%& * +7,+,. R, (' , & %& * +7,+, ,' , ( )% , & ; 04 ,', (&% , +& & % 0,0&( ,' , ( )% , & ( , &% ( )&* 4+( +,* 0 *&+&* ,+(' (*(%, )% ( % ( ; ' ,
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Figura II.1 . !(' ,0 % &+ ,+(&%
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CAPITOLUL III.PREZENTAREA BOLII ARTERIOPATIE OBLITERANTĂ.
III.1. DEFINI"IEArterio,atia o0literant- '& HarteritaH * 0 , 0( ,4+( (0 +4 +( ,' , 4 @4&%
&+ ,+(&% *&+, , ,+0( +, *,+,& +47+,'(> & (&0, + % ( &+ ,+,%4+ * '*'& 7 ( *, &= 7, %& ,' +(.
A+ ,+(4 & (& 4@%( ,+& ,' , 0&( )+,*>, %& ,+'4& ,%, >?+' (*, ,' , >& ( - 18 8 )& , ,+'4& ,%, ' @ 6< , & ( - 2 5 )&* &+ ,+( . D, &',0, ,& )+,*>, %& @ +@& ( &+ ( ),0,(%, * )&* 4+( , +('* 4 )( &),* & ,.
B4&%& &),* ,& ; +(0 % +? &+ ,+,%, 0,0@+,%4+ ( ),+(4&+, (*(4&+&+ ,+,%, 0,0@+,%4+ ' ,+(4&+,.
Arteriopatia obliterantă este o boală cu evoluţie gravă, putându-se ajunge în stadiile
avansate la amputaţia membrului afectat şi chiar la deces.
III.!. FI4IOPATOLOGIE.
!* ,+,& )% % ( &+ ,+(&% * +, ,' +( +4 *, %@ + +( *&+, ,>4%%@ + +( ) * (4 &%, &'&7,+, ? & %& *,%, 4+7& (*, 7+&>, *& ,*+4 & , ,'
A*,' , %@ + +( 4 &>,& 4 ,>4% (, %, +47+,'(> '& &* +&0& (* , & 0( ( )&* 4+(
', ( % 4@' &*4% % ( %4*&%( &+,& 4@' &*4% % ( ,&' +& 4+ *4 +4 *, %@ + +( 7+&>, 0,+7? ? %& ( ' &%&+,& +& ( & 7& 7+, ,( &),0 +&% *40 ( &. 4 %( ,, , + 0,0@+ % ,%>( ( &. & (%&+ , + 0,0@
; ( ,+,& 4@' &*4% % ( * *? 4@' &*4% % ,' , 0&( ; ( ' * & ? >& 0&( 0&+, , *4%& ,+&%, @%4*? -%,.
04 % , ( ' &%&+, & 4@' &*4% % ( ( ' &%&+,& &* & ( 4@' &+& 0& ('0,%4+ '& ,0@4%((%4+ , ,+0( ('*/,0(& &* & * ,>4% (, +&0& (* '
*4%& ,+&%,%, )(( ( ' )(*(, , *& 0 + ( *&%(@+ . Î &+ ,+(4 & ((%, *+4( ' &%,& +, & *,,& *, ,+0( , , >4% &+,& ; &*,' ( ,+>&% & 0,*& ('0,%4*&+, 0, ( >(&@(%( & ,& 0,0@+ % (.
' &+,& *4%& ,+&%,%4+ *4%& ,+&%,%, 4 &'(7 +& 4 *(+* %& (, +,%&4@' &*4% )&*? ('*/,0(& 4%,+&@(% (' + 7,+,& %4+ & & * 0 ', ; ?0 % ;
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(%&*,+ +( 0 '* %&+, (0 4+ & , /,0& 4&0, >4% 0( 4&', *40 +,'(>, +40@4 , ,+, *, 4'(@(%( (%, , *40 , '&+, & ('*/,0(,(.
7+& % , 0 %,+, & '(' ,0 % ( &+ ,+(&% +,' &@(%(+,& >4%,0(,( ( , '(4 *40 4 , ,', (&% & ' +& ,7(,( ,+& , (*,.
' &+,& ,+, (%4+ &+ ,+(&%( ; *& % , (' , ,( 04 ()(* +(%4+ & ,+40& 4&4@%( ,+&+,& ,' , 0&( )+,*>, ( * 7+& 0&( 0&+,.
('*/,0(& 4& , )( &7+&>& , 04 ()(* +(%, >&'404 4+(( ' +&& & 7& , , *&0&( &%,' >&'4*4 +(* (&.
III.2. ETIOLOGIE.A),* ( (%, >&'* %&+, ,+(),+(*, ' +, 40( & , , (4%47(, & ,+4'*%,+4 (ț
& +4 (0& (> "< ', ; ?% ,'* * +,* ,+, %& @ +@& ( ,' , 85 >?+'( ; 0&+,& 0&=4+( & , & *& +(%4+ %4*&%( &+,& +,),+, (&% ,' , %& (>,% %
A+ ,+(4 & ((%, ,& ,+4'*%,+4 (*, +, +, ( *(+*& 1< & (( & 4+, (4%47(& ,' , 40( & , +40@& 7,( & 4@%( ,+& *&+, +0,& ,0@4%&+ ,+(4 & ((%, >&'4-' &' (*,.
III.5. CLASIFICAREA ANATOMO3CLINICĂ A ISC6EMIILOR PERIFERICEIII.5.1. Cla'i*i&area &lini&- a i'& e(iei a&ute ,eri*eri&e.
Ta0elul III.1.C%&'()(*&+,& *%( (* & ('*/,0(,( &* , ,+(),+(*,Nu a(enin7- 8ia0ilitatea(e(0rului9Gr.I:
A(enin7-8ia0ilitatea(e(0rului9Gr.II:
Ire8er'i0il-
9Gr.III:D,'*+(,+,*%( (*
N &0, ( ,' % , ,+0,'* +
R,>,+'(@(% ;*4 ( ((%, (
+& &0, +& (
P(,+ ,+, (' %&+(0 4+ & *
,*,'( & ,&&0 & (,(
F% % *& (%&+ 4+0&% ; *, ( ( &@',P&+&%( (,0 '* %&+
&@', 04 ,+& 4 &%
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+4) *& ,' , (,
!,0 &% %D4 %,+ A+ ,+(&%
V, 4'
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III.5.!. Cla'i*i&area i'& e(iilor &roni&e )u,- leri& e3*ontaine;Sta)iul I '(0 40& 4%47(& *%( (* %( ', , '& ,' , 0( (0 ,' ,*()(* ( *4
+ *,&%& , +,0( (%4+ '& (0 4 +(> ', & (& , * % + &+,' , (( 0(&),* & )+,*>, &*,' , &* , ' @(%& ,+&%, ( & %,7& + * ,)4+ %
,*,%&@(%, &+ ,+(47+&)(*.Sta)iul II ', *&+&* ,+( ,& +( & &+( (& *%& (*& (,( ( ,+0( , ,
*&+ ( &% ; &+ ,+(4 & ((%, ,+(),+(*, &+, *&+&* ,+ , *+&0 & &+, ; 4+'& %& +(0(( & ( *+, , +47+,'(> ; ( , '( & , 4 & * ,)4+ % (' &+,)4&+ , +&+ @(%& ,+&% ( ; &*,&' '( & (, ,' , 0&( ( , ' ; & ( , +,0(*& +( ,' , %4*&%( & %& 04%, 0&( +&+ ,' , ( 4%& ; ),' 7%, '& (*(4
+,+(( ', 4& , ' ' ,* & ', ( % 4@' + * (,( +,+,& ; ),' '& ; +,7( ,& & ,+4-'
*4& ',( +,' , 4 %, ( , ; ,+( 4+( % &4+ 4-(%(&* +,+,& ; +,7( ,& 4' ,+(4( ; 7&0@ +,' , 4 %, ( , ; &+ ,+,%, (%(&*, '& ),0 +&%, *40 , +,+,&
+,' , ' , 4 & & % ( ),0 +4- 4 %( , . ! & ( % II ,' , ' @;0 + ( ;'ta)iul II &u&lau)i&a7ie inter(itent- u oar- < +,+,& & &+, %& ,' , 34% (, +& ( * +, ' & ( % III '& IV. N , (' 4 *4+,%& (, ' +(* ;'(0 40& 4%47(,( ' & ( % ( II ( 7+&>( & ,& ('*/,0(,( ,>&% & &+ ,+(47+&)(*.
Sta)iul III & &+ +,+(%, , +, & ' *&+, ' +,% 7( , , + & &)(+0&+& & +,@ (, ' , ,&'* *? ,>& ' 0? ( ( >&%( & , %'& ((%, (' &
& 4+( +4 4 & &+, & ' & ( % ( III'u0'ta)iul u or *? @4% &> % &+, 4 =, ; '40&+ 4&+0, * 0,0@+,%, ( ),+(4&+, ; ( ', ; &'u0'ta)iul (e)iu *? @4% &> % 4&+0,
* (*(4+ % & ?+ & %& 0&+7( ,& & % ( ('u0'ta)iul 'e8er *? @4% &> % 4&+0, ; )4 4%(L& (&@, (*( +,+(%, , +, & ' ' *4 ) & , * +,+(%, , 4+(7( , , +4 & (
Sta)iul I# & &+ %@ + +(%, +4)(*, %*,+ % ('*/,0(* '& 7& 7+, & & '&; ( '& %'& ((%, (' &%, &@4%( ,. L& (&@, (*( ', ( ' &%,& &@%4 %
(&@, (* ; *&+, +,+(%, ', 4 &0,%(4+& & 4+( , +4 & (,( (&@, (*, /( 4,' , (&.
III./. FORME CLINICE.C,% 0&( )+,*>, 04 (> , + *&+, @4% &> % >&'* %&+ ', & +,',& %&
+,+,& *&+, 4& , )( ( , ' ( ( ' &%& @+ '* ; *& % 4*% ((%4+ &+)4+0& *%& (*& (,( ( ,+0( , , ( +,+(%4+ , +, & ' ; ('*/,0((%, *+4 (*,.
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Durerea în ischemia acută , 4@(*,( & &+, @+ '* ,' , ( , ' ,' , %4*&%( & ',+( 4+( ('*/,0(* ', *&%0,& '& ', *&%0,& )4&+ , ( +( 0, (*& (, & (
', 4& , 7 '( , +,0( (( &),* & , 4 4 ( (, *&+, ' (0( , , ' ),+( &.laudicaţia intermitent *%&'(* & &+, %& 0,+' ( ,' , %4*&%( & , 4@(*,( %
04%, % ( 0&( +&+ %& (>,% % *4& ',( ),',( '& @4% (( %& &+, ( &+, 0 '* %&+ , +, ( *&+&* ,+ % , ,)4+ &% +,+(( +,* 0 ( +,>,+'(@(%( &%& +, & '.
Durerea ischemic de repaus ,' , , 4@(*,( 4 +,+, 4* + '& *4 ( (&4& ,& ', &0 %()(* ,' , %,7& , 4 ( (& 4+( 4 &% & 0,0@+ % ( ('*/,0(* ( ',
+40 ; 4 ( (, ,*%(> & ?+ &+,& 0,0@+ % ( %& 0&+7( ,& & % ( 4+0,+' % 4+ ,' , '?*?( 4&+, ,4+( ( , ' +, (' , & %& & &%7, (*,.
!"amenul obiectiv #fig$.% 4& , , ; ,>( , &%4&+,& '& &' ,* % & 0&% ,7 0, % ( 04 ()(*&+( +4)(*, + +(+,& '& (' &+( (& (%4 ( (( % *(4&', ,+( +4 & ,*%(> (' +4)(( 7/(&%, & +4)(& 0 '* %&+ ( & ,'',0 % % ( BQ+7,+ &%4&+, 0&+*& ; 4 ( (, +( (*& ( +4 ,& ; 4 ( (,('*/,0(* %( '& %' % ( &% &+,& %' % ( ; &( , ( ,)4+ 0 +, , '
(&7 4' (* , (' &+,& 4+ ' )% +( %& & '* % & (, *&+, ( (* ' , 4 , &+ ,+( Examenul obiectiv * +( , +,( , & ,
• I ' ,* (&
• P&% &+,&
• A'* % & (&.
1. In',e&7ia ,>( , (& & ( ( ,& 04 ()(* +(%, , * %4&+, &%, ,7 0, ,%4+ +4)(*, ('*/,0(*,.
a)Atitudinea. Î ('*/,0((%, ',>,+, @4% &> % ; ( & ?+ (*(4+ % &),* & , 0 & % ( ; +-4 , & 0&( &>& '& ; ( +( , , +,0( & ,& @4% &> * &
+( (*? -4 ' +, (, 4 ( (, & &%7(* .b)Modificările de culoare ale tegumentelor , & + ('*/,0(* '
P&%4&+,& & + ' 4 & '& , ,+, %& )+(7 '& %& ,)4+
+( (*&+,& 0,0@+ % ( +,' ,* (>' +, 4 ( (& >,+ (*&% ,' , 4' +'* ,+,& ,0 ,+& +(( ,7 0, ,%4+ & &+, ; 4& , ' & ((%, ,>4% (>,P&%4&+,& ( ' +&+,& '& *+, ,+,& ,0 ,+& +(( * & & , ', ;
& ,+4'*%,+4 ( ,'*+(' , T&+'*/4 *& S (*(4+ % *&% &%>?+' (* % (
C4%4+& (& +4 (, ; &+ ,+(4 & ((%, 4@%( ,+& , ; '4 ( , , ), 40, , (%(0)& 7( , )%,@( ,
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Z4 , 0(*( ,+,7 %& , ,*4%4+& (, +4 (,-@+ ' & 4+& , /,04+&
( )&+* ,%4+ ; ,7 0, '& ' @ ,7 0, ( ', ; ?% ,'* ; %@ +,*(+* %& (, &'4*(& , )+,*>, * , +4 & (& ('*/,0(* .
A*,' , 04 ()(* +( , * %4&+, ,7 0, &+ 4 + 0? , *4 ' & , 4 >&+(& *
4 ' ),+( 04 ()(* +( *(*%(*, ; &),* ( (%, >&'4' &' (*,.M4 ()(* +(%, , * %4&+, ( ; ?+ (,+,& (+(7& (,( %4*&%, 4 )( ,' (0& , +(
4' + . T,' % B ,+7,+ +0 +, , + ' ' % ,' +(%4+ ('*/,0(*, %& +( (*&+,& ( ),+(4&+,.
c)Tulburările trofice ale pielii şi ţesuturilor adiacenteP(,%,& 0,0@+ % ( &),* & ,>( , % *(4&' '*& (%4 ( & ,& ',
(' &+, 7/((%, +, ( ' +(& (( %4 7( ( &%, '& +&'>,+'&%, ', ;
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Î ' & (( ,>4% (>, &>& '& , & &+ %*,+& (( %& (>,% % * ,%4+
,7, , +,* 0 ( *+ +( ,&' +& * %*?( % (. U%*,+& ((%, ('*/,0(*, '& 0 */(( ; *%( & , ' +&)& & &*4 ,+( * *+ ' , ( ,' , 7+& % @& . ! +, ,4',@(+, , &*,' ,& %*,+ % >&+(*4' ,' , , * %4&+, +4 +,
, 7+& %& (, &@ , ( ,' , %4*&%( & ,&' +& 0&%,4%,( 0, (&%,
G& 7+, & & &+, ; ' & ( % )( &% &% &+ ,+(4 & ((%4+ *+4 (*, 4@' ++4)(*, 4 >&+(& , %& 7& 7+, & '*& & (,%(( >?+) +(%4+ ,7, ,%
, ( ' & 0,0@+ % ( ( ),+(4+ +,' ,* (>.!. Pal,area 4),+ ( )4+0& (( &' +& ,0 ,+& +(( * & & , *&%( (( ,+, (%
%' % ( &+ ,+(&%.- T,0 ,+& +& * & & ,' , '* ; 4 & &),* & ,>&% &+,& ,0 ,
+( *40 &+& (, * 0,0@+ % ( ),+(4+ 4 '.
- P&% &+,& %' % (.P %'& ((%, &+ ,+(&%, ' (0( & ,'& &@',, +,0( (%4+ &),* & ,. Î 4@%( ,+ +(%, ; &% , +( +, 0 %,+,& >&',%4+ , ' @*(+* %& (, *4%& ,+&% ,),*(, ', 4 ,+*, , %'& (( &%, &+ ,+,( , (4&',. A 4& , %'& */(&+ ( ; +, , & 7& 7+, ,( (*(4+ % ( +,' ,* (> %& @4% &>(( ' &),* & , >&',%, 0(*( .2. A'&ulta7ia arterelor 4& , ,>( , (& ' )% '(' 4%(* %& (>,% % &+ ,+,%4+ 0&&4+ &+ ,+,%, (%(&*, ),0 +&%& *40 ( ' ,+)(*(&% &+ ,+& 4 %( ,, .
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• P+4@& C4' *,'* . !, +( (* 0,0@+ % @4% &> , ' ' ( ? =4' ; 4 &
,+047+&)('0 % ,' , 4 ( (> , *? ; 4 & ,(+(7& (,%,& % ? 4 , • P+4@& M4' 4 (* . !, +( (* 0,0@+ % @4% &> %& >,+ (*&% ( ', ; ) 4&+
@& ,%&' (* E'0&+*/ 5 0( , ', , (*(4+ % , '4% ( & 4( ', ,')&*
C4%4& & , '? 7, >& *4@4+; ? %& 4 & &),* & +,*4%4+? ',70,4 & @4% &>
• P+4@& :(& . !, @& (=4 ,& 0,0@+ % &),* & * ( * + , (4 .D 2
' 4&' +,'4&+@, ( * +& , (4 , *? *,& @4% &> 4 +,'4&+@,• P+4@& I.P4 D.P4 &. !, ,' ,& &% ,+ & (>', '(@(%( & ,& ,7 0, &+ &
(%( ? &0 4 % , >& ( &* % , ( =,* (( ', 4@ ( , 4 @ ,%(0(&),* & , , *,%, ' 4&',.
III.=. SIMPTOMATOLOGIE.C,% 0&( & ,',& &*(, (( ', %? 7 , & &+( (& ,( +,+( ( , ', %& *( &
% ,%4+ *4& ',%4+ '& ),',%4+ ; (0 % 0,+' % ( +,+( *&+, ;( 4@%(7 '*%& (*& , ( ,+0( , . !, ( % +,+(( ,' , ; (+,* +,%& (, * %4* %
*(+* %& (&.L& ; *, @4&%& ,' , &'(0 40& (* */(&+ &* +4*,' % 4@%( ,+& &
P, 0 ' + *, @4&%& ,>4% ,& +,+,& & &+, %& ,)4+ +( 0&+( & 4( %& ,)4+0(*( ? *? &= 7, ' )(, +, , */(&+ ( ; +, & '. A* (>( (%, , ( * ( >(, (( ' ',0 ()(*& (> &),* & ,.
D& 4+( ('*/,0(,( ,+>(( 4 ' ),+( ( ,( +4 *? -', %@ + +( ', ( (>, (D(0( &+,& ', '(@(%( & (( *4+,%& * +4&' & (+(7&+, *4 +(@ (, %& *+, ,+* ( ),* (, ( ', '(' *&+, ' )4&+ , 7+, , +& & ( 4 ,*,'( & &0 & ((. T %
( 0( ( %*,+& ((%, ' )+,*>, ,.
Î *& % ,( ('*/,0(( &* , *? *(+* %& (& ,' , *40 %, ( @+ &% ; +0,0@+ % ( ,' , , +,0 ( ,' , &'4*(& * &04+ ,&%& %4&+, + *,&%& &+& %' % (. A*,&' '( & (, *4 ' ( (, 4 +7, ( ', 4& , '4% & * &0 &+,& 0,0
III.>. DIAGNOSTICIII.>.1. Diagno'ti& &lini&E (' 4 ( +( , , %4+ +( &+&*%( (*, )4%4'( , , + (&7 4' (* %ț
@4&% &+ ,+(&% ,+(),+(* T,' , 4 ( >&'(>, >&'* %&+, T,/ (*( (0&7(' (*,
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T,' ,%, &+&*%( (*, ; *& % &*(, (%4+ * @4&% &+ ,+(&% ,+(),+(*ț(&7 4' (* % 7+& % , ',>,+( & , & @4%(( %4*&%( &+,& & & 40(* & %,0 4+&% & @4%(( ( + ' ' % %& +& &0, .
• TESTELE NONIN#A4I#E #ASCULARE
T,' ,%, 4 ( >& (>, +, +, ( ,%,0, (0 4+ & ; ' &@(%(+,& (&7 4' (( ; ' &@(%(+,& %& % ( ,+& , (*. A*,' ,& 4 4),+( ( )4+0& (( +(>(ț
',>,+( & ,& @4%(( &+ ,+(&%,. P4 )( 4+ +, , & , ; (0 , + +0 +(+,& +47+>( &%, ' 4@ ( , +( *4+4@4+&+,& & ,%4+ ,' ,%4+ ,( >& (>, * *,%, (0&7(ț
P+( *( &%,%, ,' , ,( >& (>, '1. I (*,%, 7%,‐ @+& .ț2. P+,'( ,& ',70, &% '(' 4%(* %& (),+( , (>,%,.
3. P%, ('047+&)(& ',70, &% '& ; +,7(' +&+,& %'‐>4% 0.. I , % ,7,‐ @+& .ț
5. A &%( &+,& * +@,%4+ , >,%4*( & , D4 %,+. &ndicele gle'nă ‐ braţ
D(&7 4' (* % , @4&% &+ ,+(&% ,+(),+(* 4& , )( ' &@(%( , @& & ,( (*,% (‐7%, ‐ @+& .ț
I (*,%, 7%, @+& ', ,)( , , *& +& 4+ % ( +, , '( ,& &+ ,+(&% '('
7%, ,( '( *,& %& (>,% @+&/(&%. !, 4& , +,&%( & (%( ? ')( 740& 40, + D4 %,+. !, *&%* %,& ;0 + ( +,'( ,& , %& (>,% % 7%, ,( %& *,& 0&( ț'(' 4%(* , %& (>,% @+&/(&% ' ? 7 '& +,& .
O >&%4&+, 0&( 0(* , < " ,' , *4 '( ,+& & 4+0&% . P&*(, (( * 4 >&%4&+ț, 1 4 &>,& &+ ,+, *&%*()(*& , ( ,*,'( , &0( +( ' %(0, &+, , , ,0 %,7, ‐ @+& .ț
D&* ( (*,%, 7%,‐ @+& ,' , 4+0&% &+ ' ' (*( ,& *%( (* , 0&+, ', >& +,&ț( (*,%, 7%,‐ @+& ,)4+ ( ( (&% , 0 ' +& ; +, & ' *&+, &*(, % , ț ț , *4>4+ % + %& ? *, & &+, *%& (*& (& ( ', +, , 0 ' + 4&+,& ,)ț( (*,% ( , 15‐2< ( (* @4&%& &+ ,+(&% ,+(),+(* .
(ăsurarea presiunii sistolice segmentare la diferite nivele.
M ' +&+,& +,'( (( '(' 4%(*, %& (),+( , (>,%, %& (>,% % 0,0@+,%4+ ,' , '*&+ %&+7 , + , ,* &+,& ( %4*&%( &+,& ',70, &% & %, ( (%4+ ',0 ()(*%& (>,% % 0&+,%4+ >&',. ! +, ,4',@(+, , ( (*,%, 7%,‐ @+& 0 ' +&+,& +,'( ((ț',70, &+, 4& , , ,+,0( & %4*&%( &+,& %, ( ((.
M, 4 & ', +,&%( ,& &' ),% 0& , & ( ')( 740& 40, + ,' , %&'&(>,%, ( ', (%( ,& +,*, 4+ D4 %,+ (' &% 0 ' +?‐', &' ),% +,'( ,& '(' 4%(* %&
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(>,% % &+ ,+,%4+ 0&+(. L4*&%( &+,& %, ( (( ,' , , ,+0( & ; ) * (, , & &ț ț, +,'( ,. U 7+& (, 0&( 0&+, , 2< 00$7 ; +, 4 ',70, , & (&*, , ( (*
' , 4 ' @(&*, . G+& (, % ; +, *4& ' ( ),+(4+ ( 7&0@ ' ,+(4+ ( (* %,),0 +&% ' ,+)(*(&% (' &% '& &+ ,+ 4 %( ,,. G+& (, % ; +, 7&0@ '
( (* %, ( , ( )+& 4 %( ,,.L(0( ,%, 0, 4 ,( ' +, +, , & , , , , ,* &+,& ' , 4 ,( 04 ,+& , ( 4%& ,‐ 0&( &%,'
%& (>,% (%(&* *&+, , ,+0( 7+& (, , +, & ' +, ' '& */(&+ % +,'( ( * &*(, (( * (&@, ( &+ ,+, *&%*()(*& , ( *40 +,'(@(%, (0 4'(@(%( & ,& , &ț ț @& & &*,' ,( 0, 4 , ; +, ' , 4 ( 4*% (,.
)letismografia segmentară sau determinarea puls ‐ volum*
Î >, ,+,& ,),* +(( &*,' ( ,' 0& , & ,' , %&'& %& & 0( (>,% &
( ),+(4+ ( ', *4 ,* ,& %& %, ('047+&) , + & , ,+0( & 04 ()(* +(%, M& , & ', 0)% ? %& 64% 0 ) + & , ,+0( & 4*% (, &+ ,+(&% ( ', 0 '4&+ * +@& +,'( ,‐>4% 0.
P%, ('047+&)(& ',70, &+ +, +, ( 4 ,/ (* (% & ? ( (&7 4' (* % @4&%& &+ ,+(&% ,+(),+(*& *& '( ( +0&+(+,& & +,>&'* %&+( &+, & &*(, 4& , +, (*, +('* % , ('*/,0(, *+( (*& '( , &0 &+,.
C40 &+& (> * & 7(47+&)(& %, ('047+&)(& ',70, &% ( , ,+0( &+,'(' 4%(*, %& (),+( , (>,%, & 4 &* +& , , , 85 ; , ,+0( &+,& ( %4*&%( &+,ț',0 ()(*& (>,. U (%( & , ; *40@( & (, &* +& , ,& %4+ & ( 7, "5 .ț
(ăsurarea presiunii la nivelul degetului şi indicele bra ț ‐ deget
P&*(, (( * (&@, ; ,>4% (, ; ,% 7& ( ' )(*(, +, &% '& &%ț ț ț ț, ,+0( *&%*()(* +( >&'* %&+, 4 &>,& &+ ,+, (@(&%, ( *40 +,'(@(%, , ,+
'(' 4%(*, )&%' *+,'* ,.M ' +&+,& +,'( (( %& (>,% % 4+ &+ ,+, ( *40 +,'(@(%, ', ,)( , , *& 4 +,'(7%, ,( 0&( 0&+, , 25< 00$7 '& ( (*, 7%,‐ @+& 0&( 0&+, , 1. . Î &*,' , '( & ((ț ț,' , +,*40& & 0 ' +&+,& +,'( (( %& (>,% % ,7, % ( 0 ' + 4&+, * 4 &ț0&+, ,4&+,*, , 4@(*,( >&',%, , %& &*,' (>,% ,>( ,*40 ,'(@(%,.
!, (%( ,& 4 0& , ' ,*(&% , (0, '( ( 0(*( *&+, ', 04 ,& %& +(0 % ( '& *,% ( ,‐&% 4(%,& ,7, , %& (>,% % 0,0@+,%4+ ( ),+(4&+, *4 ,* & *
, )% . D, 4@(*,( +,'( ,& %& (>,% % ,7, % ( ,' , * *(+*& 3,% % 7%, ,(. I (*,%, ,7,‐ @+& & 4+0&% , ,)( ( *& )(( 0&( 0(* , < . R, %ț)&%' 4 ( (>, (%( ? ( (*,%, ,7,‐ @+& ' +&+,.
22
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P+( *( &%& %(0( &+, & 0, 4 ,( 4 +, +, ( )& % * %& &*(, (( * (&ț 4& , )( ,4+( )( & %& (>,% % ,7, ,%4+ 1 ( 2 & 4+( %, ( (%4+ ( )%&0&ș ț%, ( (%4+ * & & ,.
Fig.III.?. A &%( & * +@,( , >,%4*( & ,
C +@& >,%4*( (( &+ ,+(&%, 4& , )( 4@ ( % (%( ? ,*47+&)(& D4ț ț(),+( , (>,%, &%, *(+* %& (,( ,+(),+(*,.ț
U & 4+0&% & >,%4*( (( D4 %,+ ,' , +()& (* *4+,' ? *,%4+ ț&%, )& ,%4+ )% % ( &+ ,+(&% )% % +& ( *, & ( 7, >?+) ( (0 % '('; (0 % (&' 4%,( ( )% % & ,+47+& '%&@ ; (0 % ,%, (&' 4%,(. C4+, +47+& , +,'(, & +, (' , ,( ,+(),+(*, >&'* %&+, ,' , &@', ; +, , & ,(ț ț',0 ()(*& (>,. D,*( * +@& D4 %,+ ', 04 ()(* , %& * +@& 4+0&% +()& (* @()& (* ( % ,+(4+ 04 4)& (* ; *& % &*(, (%4+ * @4&% &+ ,+(ț/,04 ( &0(*. L(0( &+,& 0, 4 ,( 4 +, +, ( )& % * , , , , , 4 ,+& 4+. A0, 4 4& , )( (%( & ; *& % &*(, (%4+ * &+ ,+, (@(&%, *&%*()(*& ,.ț
TE6NICILE IMAGISTICET,' ,%, (0&7(' (*, ' )4%4'( , , + & , ,+0( & %, ( (%, &+ ,+(&%, *&+, ț
, +,>&'* %&+( &+, , 4>&'* %&+ '& */(+ +7(*&% .T,' ,%, (0&7(' (*, )4%4'( , '1. A 7(47+&)(&2. E*47+&)(, D4 %,+ C4%4+
3. A 7(47+&)(& +( +, 4 & 0&7 , (* *%,&+ț. A 7(47+&)(& +( *40 ,+ 4047+&)
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• Angiogra*ia
A 7(47+&)(& ,' , *4 '( ,+& ' & &+ % , & + , + ,>&% &+,& @4%(( &+ ,+(*,& 0&( &**,'(@(% ( %&+7 + ' ? ( ,/ (* (0&7(' (* . T4 ( &*,&' 0, 4
, , &>& &=,
R('* +(%, ' ,*()(*, &'4*(& , +4*, +(%4+ ( >& (>, *, +,' *& , ,+( &+, '? 7,+&+, ( ),* (, %, ( ( %& (>,% % >&' % ( , &**,'.ț
A ,+4,0@4%('0. R,&* (( &%,+7(*, %& ' @' & & , *4 +&' < 1 .ț ț N,)+4 4 (*( & ,& ' @' & ,( (4 & , , *4 +&' .ț M4+ &%( & , < 16 . C40 %(*& (( %& %4* % , * (, &+ ,+(&% ', 4& ,>+('0 /,0& 40 )('ț ț
>, 4&' . C4' +( (*& .
• E&ogra*ia Do,,ler &olor
E*47+&)(& D4 %,+ *4%4+ & )4' +4 ' *& ,' (0&7(' (* &% ,+ & (> &*40 &+& (, * & 7(7+&)(& &*,' ,' ,' , ) + +('* 0&( (,) ( ( 4& , 4),+( 0&=4+( &ț& & 40(*, ,', (&%, +,* 0 ( ( )4+0& (( ) * (4 &%, 7+& (, (( , >,%4*( & , ț ț ț ț' , 4 ,( .
A+@4+,%, &+ ,+(&% , %& (>,% % 0,0@+,%4+ ( ),+(4&+, 4& , )( >( &%( &7+& % ( ( %4*&%( &+,& ' , 4 ,( +,* 0 ( 0 ' +&+,& >,%4*( (%4+ &+ ,+(&ț0, 4 ,( ' ; %,7 + * (0 % % 7 , , &0( &+, , , , & , 4 ,+& 4+ ț>( &%( &+, & &+ ,+,%, *+ +&%, ; 4 &%( & ,.
C4 *% (4 ? ,*47+&)(& D4 %,+ *4%4+ ,' , 0&( &%,' (% ; , ,+0( &+%, ( (( ( ; (),+, (,+,& %, ( (%4+ ' , 4 (*, , *,%, 4*% (>,.ț
• Angiogra*ia ,rin re onana - (agneti&- nu&lear-.ț
R, 4 & & 0&7 , (* *%,&+ & ,>, ( 4 0, 4 &**, & , (&7 4' (* (ț %& % ( , +& &0, ; *& % @4%(( &+ ,+(&%, ,+(),+(*, ; 0 % , *, +,. E' %& % ( ,+& , (* +,( ,+>, (, ( ; ,*( (& +(>( 04 &%( & ,& 4 (0 , țA>& &= % 0, 4 ,( , +, +, , & , 4),+(+,& (0&7( (%4+ , ; &% +, 4% (, 3&@ 40, ,%>(' ( 0,0@+, ( ),+(4&+,. D, &',0, ,& (0&7( (%, 4 )( >( &%( & ,
7/( +( +( +4 & (, ( ',* (4 & , %& (>,+', (>,%,.țRe onan a (agneti&-ț *, (%( ,& ' @' & & , *4 +&' 7& 4%( ( 0 & ; %4* (ț
,+(4& & RMN % ) + ' @' & , *4 +&' 4),+( (0&7( ( ' ,+(4&+, *&ț&+ ,)&* ,. )(7.III. ".
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L(0( ,%, 0, 4 ,( ' %,7& , , (%( &+,& *?0 % ( 0&7 , (* *, ,+0( , , & &*(, (%4+ * ,)(@+(%& 4&+, +( *,+,@+&%, (0 %& +( *4/%,&+, '& ț +,* 0 ( , , &0( &+,& ()(*(% & &*(, (%4+ *, ' ),+ , *%& ' +4)4@(, '& & *ț 4 )( ', & (. O &% %(0( &+, ,' , +, +, , & , &+ ,)&* ,%, *, & &+ ; *&ț
0, &%(*, *, , ( , ( % , 0, &% )4%4'( ,%, * 0 &+ )( ' , +(%, , ( (&+ ,)&* , 0( (0, .
Î0@ (+,& +, 4% (,( (0&7( (( +,* 0 ( , >4% &+,& 0 % (ț ț '%(*, , ,* 4+ & ,+0('(%( &+,& *40 ,+ % ( 4047+&) ; (&7 4' (* % ( ' &@(%(+,& '*/,0,( ,+&
&+ ,+(&%, ,+(),+(*,. )(7.III.1<Co(,uterul to(ogra* 0 % ( , ,* 4+ 4),+ (0&7( ( +& ( , & 0,0@+,%4+ ( ),+(4&
&@ 40, % ( %& 4 +, 4% (, ; &% . L(0( +(%, 0, 4 ,( ' +, +, , & , , (%ț ț
, *4 +&' (4 & , , ,+,& %& +& (& (( ( ()(* % (%, , ( ,+ +, &+, ț ț ț, ,+(%4+ , *&%*( . P+, , & ' , +(%4+ +, +, ( , &',0, ,& 4 ' +' , &+ ,)&
25
Fig. III.@. RMN& 7(47+&)(& CT Fig. III.1 . A 7(47+&)(& +( *40 ,+ 4047+&)
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Arteriogra*ia ,' , 4 +4*, + ( >& (> ', H; ,& H >&' % ,*/(+ +7(*&%,),* ,& * & ,' , (, %4*&% * ( =,* &+, , ' @' & , *4 +&' (4 & ,&+ ,+,%4+. P4& , &>,& +('* +( , *40 %(*& (( %4*&%, %& %4* % , * (, /,0&0& ,+(&% & ,+40& 4' +, &%, ( ' )(*(, +, &% &* ( *& & ' @' &
+,&* (( &%,+7(*, %& ' @' & & , *4 +&' *40 %(*& (( *&+, & &+ %& 0&*,' , *& , &*(, % ,*,'( +0 +(+, & , ( 0& ,>+& ', ,),* ,& ; *' ( &%( &+,.
O'&ilo(etria +,%& (( 4+(, & (>, &' +& ,+0,&@(%( (( >&',%4+ ,+(),+(*!, , ,+0( *%&'(* * 4'*(%40, + % P&*/4 -R,* %( 7/& ', '& * & &+& , ,%,* +4*& &*( & , , ; +,7(' +&+,. O'*(%& ((%, 0& (0, ; +,7(' +& , %& (>,% % +,'( (*4 ' ( (, ( (*,%, 4'*(%40, +(*. A*,' ( (*, '*& , %& &+ ,+,%, &),* & , , %&
+4 (0&%. M, 4 & ) + ( ,& (*( 4 +,%& (, ; %,7 + * ; ( ,+,& %, %' % ( >&'* %&+ (' &% '& * ' &+,& *(+* %& (,( *4%& ,+&%,.
III.>.!. Diagno'ti& )i*eren7ial.E (4%47(& 4@' + * ((%4+ >&'* %&+, &%, 0,0@+,%4+ ( ),+(4&+, ,' , ; *,& 0&
& ,+4'*%,+4 (* ; ' ,*(&% %& & % (( ,' , 5< , & (. P, + , (4%47(& & ,+4'*% +, , & *&+ (4 & (,( ('*/,0(*, &% , %4*&%( +( & ,+4'*%,+4&', ',0
*&+4 ( (, , &**( , , >&'* %&+, *,+,@+&%, , * .A% , & (4%47(( &%, 4@' + ,+(),+(*, ( *% &+ ,+( , ( )%&0& 4+(( @4%( *4 7, ( &%, ( 0, &*4 7, ( &%, &+ ,+( & , (+& (,+,.O &+ , ( &*,' , &), ( ( 4 )( ( , ()(*&7, ,+&% &% @4% &> % ( &@,% % III.1
Ta0elul III.1. E%,0, , , (&7 4' (* (),+, (&% ; +( *( &%,%, &+ ,+(4 & (( 4@' +E. A , +,(
Ele(ente )e )iagno'ti&)i*eren7ial
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M& (),' +( ('*/,0(*, %&0,0@+,%, ' ,+(4&+,
P+, , , )+,*>,5
&@', , +&+,
O*% (& &* & &+ ,+,( ),0 +&%,'& (%(&*,
R&+ P+, , %&& +4 .2< ( @4% &>(
+&+,
P+, , & ',0 ,%4+ *%( (*, R&+ F+,*>,& +4 .5< (*& +(%, * ,@
,+(),+(* &%& ,+4'*%,+4 ,(
A@,', &+ ,' , < &FA (%& & (, A!
A ,*, , , ,+, 4*4%& ,+&%, ,$TA DZ & ,+4'*%,+4 4@, ( & ,
R&+ F+,*>,& +4 .5<
+&+
III.>.2. Diagno'ti&ul )i*eren7ial al &lau)i&a7iei.C%& (*& (& , 4+(7( , &+ ,+(&% ,' , , 4@(*,( ,' % , ( (* , + &
&% , *& , , +,+,. C%& (*& (& ( ,+0( , +,@ (, (),+, (& ,Durerile )in regiunea *e'ier- Bi a &oa,'ei +4 ', , '*(& (* &*,' ,& '
&**, & , , 0& ,>+,%, , ,%4 7& (, ,+'(' ; +, & ' '& 4& ,& ( ', ;04 ()(* +( ,+(),+(*, , ( ('*/,0(*
Durerile ,ro)u'e )e in'u*i&ien7a 8enoa'- &roni&- a (e(0relor in*erioare*%& (*& (, >, 4&' & &+ %& 0,+' &+ ', *&%0,& %& ; +,+ ,+,& ,)4+,* @( * 0,0@+,%, ( ),+(4&+, +( (*& ,. C4, (' , ,0, ,+(),+(*, *(& 4 (
' ,+)(*(&%, ; , '( , & 4+( 4@' + * (,( & % ( >, 4' +4)• D +,+(%, 0 '* %&+, ( @4%( 0 '* %&+, ', &'4*(& , 4@(*,( * ,)(*( 0 '* %
• D +,+,& , +, & ' &+, 0,+4&', &% , *& , ; &)&+& ('*/,0(,(
• B4%(%, &+ (* %&+, &+ +4 &+ +( , 4 )( 4+ , *% ', %& , &0, % 4
• B4%(%, 0 '* %&+, ', &'4*(& ,',4+( * & +4)(( 0 '* %&+, ,)(*( 04 4+
• B4%( , +4%47(*, '*(& (* , * .
III.?. COMPLICA"II! & (' (*( * 0 %& , &+& * ; 5 ( *& +( *%& (*& (& ( ,+0( ,
'& */(&+ ', &0,%(4+,& . A +4& , = 0 & , ( @4% &>(( * *%& (*& (, &'(0 40,%, )(( ,,>4% (>, , ,+(4& , , & (.A0,%(4+&+,& '(0 40,%4+ ', 4& ,
, >4% +(( *(+* %& (,( *4%& ,+&%, '& & & +(( +( 0 % ( , &* (>( & , +, ' %& *&+, 0 */(( ' ),+ ('*/,0(, '(0 40& (* .O +4 4+ (, , 25 ( @4%&7+&>,& * >( , >&+(&@(% ' ),+( & ('*/,0(* ,+(),+(* ( 0& (),' +(%, *%
, &% , %4*&%( +( & ,+4'*%,+4 (*,.
2
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P+47+,'( ,& '(0 40,%4+ , ('*/,0(, ', )&*, %, '& 0&( ,' +( ',, ,('*/,0(, ' @&* +( 4@' + * (( &+ ,+(&%, ',70, &+, '& , *4%& ,+&%,. E>4*40 %(*& ( * , ('4& , , ('*/,0(, &* +( +40@4 &+ ,+(&% ' +& '& ,+4'*%,+4 (*, 4@' + * (>, ( *&+, ', 4& , '4% & * 7& 7+, ( ,>, &% &0
( ),+(4+ &),* & . Î +, 5 ( 1< ( @4% &>(( * *%& (*& (, +, ( &7+&>(0 4+ & & @4%(( , + & ,*('( & 4 ( ,+>, (, , +,>&'* %&+( &+, *( ,+>, (4 &% ( 0&( 1 2-1 6 ,*,'( &0 & (, 0&=4+ 7&0@ '& *4&%& F+&0( 7/&0 .
D( +, 4 ( )&* 4+(( *&+, +, (' %& &7+&>&+,& @4%(( DZ &+, ,) +,7 & & 4+( *40@( & (,( ; +, &),* &+,& & ,+4'*%,+4 (* , >&', 0&+( *
(&@, (* . D( +, *,(%&% ( )&* 4+( , +('* ) 0& % , ,+*( 4 ( )% , ,)
,34+( 0&( )+,*>, * &7+&>&+,& &+ ,+(4 & (,( %&0&+(( ) 0 4+(.M4+ &%( & ,& *&+ (4>&'* %&+ & @4% &>(%4+ * *%& (*& (, ,' , , 2
& *,%4+ ) + *%& (*& (,. B4% &>(( &+ ,+( (*( &0 & ( & 4 04+ &%( & , ,3&*,&' & 4& , &= 7, %&25-5< 2 & (.
III.@. TRATAMENT.T+& &0, % ,' , +4)(%&* (* ( * +& (> &*,' & ( +0 )(( 0, (*&% (
• Trata(entul ,ro*ila&ti&
C4 ' ( +- *40 %, , 0 ' +(• I ,+ (*,+,& ) 0& % (
• !* ,+,& +& ,( , 7% *( , ( %( ( , ( &%(0, & (,
• E>( &+,& ( ),* ((%4+ *&+, 4 ( *, &% ,+ +( &%, ,+, (%4+ &+ ,+(&%(
• T+& &0, % *4+,* &% @4%(%4+ &'4*(& , &+ ,+(4 & ((%4+ DZ $TA
• A 0( (' +&+,& , 0, (*&0, , & (&7+,7& , A' (+( T(*%( %& ,+'4&
, & ( *&+, +, ( )&* 4+( , +('* , + & ,+4'*%,+4 .• Trata(entul (e)i&al
E' , ( (*& ; 4& , )& ,%, @4%(( '( 7 + '& ; &'4*(,+, * +& &0, % */*40 %, (7(, 4- (, , (* 0, (*&0, 4' )( (4 ,+& (*.
T+& &0, % (7(, 4- (, , (* ', +,),+ %& )& % * &+ ,+( (* % +,@ (, ' +,) 0& ' (%( , , 4 &%(0, & (, ' +&* ; 7% *( , ( 7+ '(0( ' ,>( , , ,+,
0, ,&% ' 4&+ , ; * % 0( , *404 ' ,>( , ( ),* ((%, %4*&%,
*4+,' 4&+, ' +0, , +47+&0 (% (* , , ,+*( (( )( (*,. A+, 4 ,)(*&*( & , 04' & ( % , *%& (*& (, ( ,+0( , ? *+, ,.
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T+& &0, % 0, (*&0, 4' +0 +, , ' &0,%(4+, , 7+& % , ('*/,0(, &, +,0( +,>( & &+( (& %@ + +(%4+ +4)(*,. A+, 4 ,)(*&*( & , 04 ,+& ; ' &( ,+0( , ? *+, , 4%,+& & %& 0,+' ( +,>, ( +,+,& ; +, & '. Î ' &&*,' +& &0, ', )4%4', , *40 %,0, &+ ( ,+>, ((%4+ */(+ +7(*&%,. !,
0, (*&0, , & 0( (' +& , 4+&% ( &+, ,+&%.V&'4 (%& & 4&+, P, 4 ()(%( P& &>,+( $ ,+7( , * , 4 ()(%( 4&
&*(, (( * *%& (*& (, ,4&+,*, '*& , >?'*4 ( & ,& '& 7>( ( *+, , )%('*/,0(*, &0,%(4+? &' ),% (' & & , 0,+' ? %& & &+( (& +,+((.
• D,+(>& ( , /(' &0( T&%& 4%( P+('*4%
• D,+(>& (( , >( &0( & PP !& &0( V& (*+,(
• A (&7+,7& , A' (+( T(*%( &' (+( & &+, +4% ; +,>, (+,& )4+0 +
*/,&7 +( , '? 7, ; ( ,+(4+ % >&',%4+ ,' , +,*40& & %& 4 ( &&+ ,+(4 & (, 4@%( ,+& . D, ( &*,' +& &0, 4& , ;0@ ('(0 40& 4%47(& &+, @, ,)(*(( *,+ , +( +, *,+,& ,*,'&+ % ( , (*/(+ 7(*&%, ( +, *,+,& +('* % ( , ( )&+* 0(4*&+ (* &**( , >&'* %&
,*,' , *& *&+ (4>&'* %&+ . Î *& , ( 4%,+& '& *4 +&( (*&>4+ (%( & &% , & (&7+,7& , *%4 ( 47+,% (*%4 ( ( & . D, & 7(4 %&' (, ,' , ,*,'&+ &'4*(,+,& &' (+( ,( * *%4 ( 47+,% '& (*%4 ( ( &
, (0 *4 )4+0 ( (*& (,( 0, (* % (.• E (0, )(@+( 4%( (*, W&%(*+,( V& (*+,(
• A (&%7(*, A%74*&%0( P(&), T+&0&%.
Fi iotera,ia )4%4', , 7(0 &' (*& 0, (*&% @ ( *&+@47& 4&', ( * +, ,+0&%, B (& V& +& D4+ ,( C4>&' & , + &* (>&+,& *(+* %& (,( ( 4@ ( ,+,&
G i)ul )e e er&i ii ,entru &lau)i&a ieț ț P,+(4& & , ; * % (+, ,' , * +( ' ; +, 5 ( 1< 0( ,.ș
Ti,ul )e e er&i iuț M,+' % , @& + %& '& , (' ' *,%, 0&( ,)(*(, , , ,+*( (( , + *%&ț ț E ,+*( ( % )( (* ( 40, +(* & 4),+( @, ,)(*(( ; *& % &% 4+ &),* ( ( *&+ (4ț ț >&'* %&+, &*,'( , , ,+*( ( ,' , *40 %,0, &+ &+ 4& , ; %4* ( 0,+' % , =4' ; *%& (*& (,.ț ț
Inten'itatea I ( (&% *4>4+ % + %& ,' , ', & %& 4 & 7 %& (, ( >( , *&+, ' +4>4&*, *%ț ț ș ț
0( ,.
P&*(, (( >4+ )&*, &*,' , ,+*( ( ? %& & &+( (& *%& (*& (,( 04 ,+& , &ț ț ț ț+, & ' % , + 4 '* + ,+(4& ? %& (' &+( (& '(0 40,%4+.ț
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Durata C(*% % % , ,+*( ( )( (*ț +, & ' ', +, , , 0&( 0 % , 4+( ; *& + % ,( ','( ( D +& & ( ( (&% ,' , , 35 , 0( , , 0,+' ( ,+0( , ( ,' , *+,'* %& )(,*&+, ','(ț ș
0( , ? *, ', &= 7, %& 5< , 0( , , 0,+' ( ,+0( , .
Fre&8en aț !,'( , ', +, , , 3 5 4+( , '& &0? .
R4% % *44+ 4 & 4+ % ( (+,* P, 0 ' + *, &*(, % ; ( ;0@ , , ,+(0, + % , 0,+' *4 +&'&+*( & *4>4ț ș
,' , 04 ()(*& +( *+, ,+,& & 7 %& (,( '& >( , ,( &' ),% ; *? ' & &+ +,+ș ț, ,+*( ( % (.ț
P, 0 ' + *, &*(, % ; ( ;(0@ , , ,+(0, + % , 0,+' 4 ' & &+ '(0ș ț ș
*&+ (&*, & 7( &+( 0(( *&+, ,*,'( +,,>&% &+, *&+ (4%47(* .Trata(entul & irurgi&al ', &'4*(& ; 4 ,& & * +& &0, % 0, (*&0, 4'.• Î ' & ((%, III ( IV &%, @4%(( +,+, , +, & ' %@ + +( +4)(*,
• C%& (*& (& ' )(*(, , ',>,+ , + & &),* & *&%( & ,& >(, ((. F(7
Trata(entul )e re8a'&ulari are L& &*(, (( * '(0 40, *&+, & &+ %& 4 (' & 0&( 0(* , 2, (4 &%
'& */(+ +7(*&% .Angio,la'tia ,er&utan-
A 7(4 %&' (& ,+* & (%& &+,& &+ ,+,%4+ ,' , 4 +4*, + ,* +,' , 0)%&+,& , + *? ,>& ',* , & ( @&%4 & %& (>,% % 4 ,%&+ ,+(&% &>? *& +, % & +,% &+,& ( )% '& 7 ( &**, &@(%. U ,4
@ 0, &%(* )( *, ', 04 ,& ; ( ,+(4+ % >&' % ( , + 0, ( ,+,& &*,' (&(%& &+, .
M& ,>+& ', )&*, ; (0 % ' ( &%( +(( ; %&@4+& 4+ % , *& , ,+('0 *&+* & ,' , (, %4*&% ( ,*,'( +, & ' % ,+(4+ %& & , 12 4+, , + +,>, (+,&%4*&%,. F(( 4 +4*, + ( >& (> ', (0 &*,%,& ( +,*& (( *& ; *& % &+
Trata(entul & irurgi&al L& (( &*(, ( * &+ ,+(4 & (, 4@%( ,+& ,' , ,*,'&+ ( ,+>, (& *+,>&'* %&+( &+, &+ ,+(&% . )(7.12 E (' 0&( 0 % , ,/ (*( */(+ +7(*&%,
@ - &'' &+ ,+(&% ', @& ,& , '* + *(+* ( &+,& ',70, % ( &+ ,+(&% 4@ +4 , >&'* %&+ &+ ()(*(&% '& & +&% >, 4&' - >, & '&), ( ,+ &*(,
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+40@, &+ ,+,* 40(& - *4 ' ; * + &+,& 4 ,( * , ,+, , 7+ '(0( , %&+ ,+,( 4&+ ; *& % &+ ,+,( ),0 +&%,
'(0 & ,* 40(& %40@&+ &+, ; +, , ( (*& (( %(0( & , &0 & (& 0,0@+ % ( ( ),+(4+ ,' , % (0& '4% (, */(+ +7(*&% ; *& +(%
, @4&% * 7& 7+, . I ,+>, (& 4& , )( %(0( & %& &0 & (& ( ,(>,% % 7&0@,( '& ; *& +(%, 0&( ',>,+, %& (>,% % *4& ',(. D >( ,*&+,
4 +4 , *&+, ' ,+0( 0,+' %.
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CAPITOLUL IV
ROLUL ASISTENTEI MEDICALE ÎN PREGĂTIREABOLNAVULUI PENTRU EXPLORĂRI SPECIFICE.
PLANUL DE ÎNGRI IRE1. E#ALUAREA DIAGNOSTICULUI DE ARTERIOPATIE O$LITERANTĂ
• E>&% &+,& *%( (* & '(0 40,%4+ ( ',0 ,%4+
• E>&% &+,& ',>,+( (( ' & (&%( &+,& L,+(*/,-F4 &( ,
• A +,*(,+,& +4)(% % ( '(/4-'4*(&% &% &*(, % ( 7+& , ( ' ++,%(7(4&', ( , ,+'4 &%( & , & ,+, & %& %& % ,+& , (* .
!. O$IECTI#ELE TERAPEUTICE• A0,%(4+&+,& *(+* %& (,( &+ ,+(&%, ,+(),+(*,
• R, *,+,& *4 7,' (,( >, 4&',
• F&>4+( &+,& >&'4 (%& & (,( ( +,>, (+,& *40 +,'(,( >&'* %&+, &+ ,+
• R, *,+,& +,+((
• P+,>, (+,& %, ( (%4+ * & & ,
• D(&%47 % * &*(, % , %(*&+,& *& ,( @4%(( ' +(( +, , ,
(&7 4' (*, ( ,+& , (*,• O@ ( ,+,& *40 %(& ,( &*(, % ( %& +47+&0 % ,+& , (*.
2. ETAPELE PRACTICEA0,%(4+&+,& *(+* %& (,( ,+(),+(*,
3 4 ( (4 &+,& , +,0( (%4+ ' @ (>,% % *4+ % ( +( (*? *& % & %-04@(%( &+,& &* (> K &'(> & & & & , +,0( (%4+-, ,+*( (( 4' +&%, &* (>, 7(0 &' (* B +7,+-A%%,R, *,+,& *4 7,' (,( >, 4&',-,>( &+,& 4 ( ((%4+ +,% 7( , ,*%(>,-; * +&=&+,& 0,+' % (F&>4+( &+,& >&'4 (%& & (,( ( +,>, (+(( *40 +,'(,( >&'* %&+, &+ ,+(&%,-0, ( ,+,& ,( ,0 ,+& +( %4*&%, & ,*>& , * ,>( &+,& )+(7 % (-,>( &+,& ' +,' % (-,>( &+,& /&( ,%4+ ( &**,'4+((%4+ ' +?0 ,
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-,>( &+,& *40 +,'( (%4+ +( 4 ( (4 &+,& ,& ,*>& & 0,0@+,%4+ R, *,+,& +,+((-&0,%(4+&+,& *(+* %& (,( &+ ,+,%4+ ,+(),+(*, , ,+*( (( )( (*, ( 0, (*& (, >&'-& 0( (' +&+,& & &%7, (*,%4+ +,'*+(', , 0, (*.
P+,>, (+,& %, ( (%4+ * & & ,-,>( &+,& +& 0& ( +(( , +,0( (%4+ 0,+' ; * % 0( ,-(7(, & ,*>& & (*(4&+,%4+ @&(, (& % 7/((%4+ 4', , @ 0@&*-,>( &+,& '* + ( & % ( ( & )+,*& % ( (*(4&+,%4+-&%(0, & (, & ,*>& * ' %(0, >( &0( (* B C ( +4 ,(*-*40@& ,+,& 4@, ( ((.O@ ( ,+,& *40 %(& ,( &*(, % ( %& +47+&0 % ,+& , (*.
-( *% ,+,& & &+ ( 4+(%4+ ; +47+&0 % , , *& (, '& ( &+-( ' + * ( ( , &%(& , +(>( (7(, & (*(4&+,%4+ ( ; * % 0( ,(-&@& 4 &+,& ) 0& % (-( *% ,+,& &*(, % ( ; +- 7+ , ' +(=( 0 &%.
5. PREGĂTIREA PACIEN"ILOR PENTRU IN#ESTIGA"II SPECIFICE.E %4+&+,& >&',%4+ ,+(),+(*, +0 +, , ' &@(%(+,& 7+& % ( ; *&+, >&
) * ( (( , (+(7&+, & ,' +(%4+ ( 4+7& ,%4+.P+,7 (+,& @4% &> % ( ( & 0, ( % ( &0@(& & 4 ,4',@( (0 4+ &
>&',%4+ ,+(),+(*,. C&0,+& ; *&+, & %4* , %4+ +(%, +,@ (, ' &(@ 4 ,0 ,+&2 % ; (0 % , %4+ +(%4+ )(( , @+ *& . E' , @( , *& ( >,
(0( ,& & , ,0? *& , '& *,% ( %& 2-3 4+, , %& % (0& &%(0, & (,. Î ( @4% &> % ' ) 0, ,. Î &( , , , &0( &+, @4% &> % ' ' ,& = 0 & , , 4+ 4 ( (, , ,* @( .
Arteriogra*ia,' , 0, 4 & , +,),+( ; ,>&% &+,& ' +(( & % ( &+ ,+(&% %&+ ,+(4 & (, 4@%( ,+& . E& ,' , ; 4 ,& & ' )(*(, *& 0, 4 (* (*40 %, &+,& +( +-4 &% 0, 4 . D& 4+( +('* +(%4+ 4 , (&%, , *&+, %
+,@ (, ('* & %& )(,*&+, *& ; &+ , ( ' &@(%( ; ) * (, , (%(*4 +&( (*& ((%, , (' , ,.
P+,7 (+,& &*(, % ( ,' , )4&+ , (0 4+ & . P&*(, % +,@ (, ' )(, ,0?4+,. P+,0, (*& (& * & (4%( (*, ( ,4+( * & (/(' &0( (*, ( *4+ (*4( ( & ,*, , , &%,+7(*, ', (0 ,. P, + & ,>( & *40 %(*& ((%, /,04+&7(*, ', ( (*
+& &0, % ( & (*4&7 %& '& & (&7+,7& %&*/, &+ &* &*,&' & ,,),* &+,& ( @(%& &% /,04' & ,( ( 4 /,047+&0 . D, &',0, ,& ', ,),* ,&
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,%,* +4*&+ (47+&0 4 +& (47+&)(, 4+&*4- %04 &+ ( & &%( ,%, , %&@4+ +, , ,( ,( ( ' )(*(, , +, &%, +,/( +& &+,& ,' , )4&+ , (0 4+ & . D, 4@(*,( ', ,),* ,& %& &*(, % ( ,+ & ; ' ( &%. Î & 0( , *4 ( (( , ',* +( & ,
,+, % &*(, % ( , ,/ (*& (%( & ( , 4'(@(%( & ,& ' +&>,7/,+
( >,' (7& (& 4& , )( ,),* & ; ' ( &% % , (.Do,,ler3ul 8a'&ular ,+0( , , (' &+,& ; 7 ' +(%4+ ' , 4 ,%4+ +4 ', , %
& ,+40 %, ( ( *&+, (0 %(* , ,+( , *4%,' ,+4% 4*% ((%4+ &+ ,+,%4+ (E &0, % ', +&* (* ; 7, ,+&% ; +- *&@( , 0, (*&% ' ,*(&%( & '& ; '&& ' ( &% % (.
Î (0 % , &0, % ( 0, (* % & %(* , 4 & *4+,' 4&+, >&',%4+ *, ( >,' (7& , 7,% ) + 7+ '(0( *&+, ,+0( , 4 0&( @ () &+, & % +&' , ,%
&*(, ' ', & , , ; 4 ( (& *,& 0&( *4 >, &@(% &*,' ,( ( >,' (7& (( * %*& (*(4&+,%4+. M, (* % , %&',& & 4( '4 & , +&', % >&',%4+ ; (0 *, & &+&>( , & '? 7,% ( *&+, *(+* % +( &*,% %4*. E &0, % +,& ; +, 2< ( < 0(*, '-&)( &%( & ( >,' (7& (& &'(' , & 0, (*&% ,+7, 7,% % (&+ &*(, % 4&+,% & &* (>( (%, 4@( ( ,.
O'&ilo(etriaM, 4 , ,>&% &+, ( (+,* & ,+0,&@(%( (( &+ ,+,%4+ 0,0@+,%4+. E' , 0
, '*+,, ( 7 ; &+ ,+(4 & ((%, ,+(),+(*,. !, ,),* ,& * &= 4+ % & &+& % ( P( +- *& +& 7+& & ; ( ( 4 0, , , 0& (* * 4 *&0,+, ; *&+
* 4 &+ , *& *( *. M& , & & &+& % ( ', )( ,& %& (>,% +(%, 4+( @4% &> % ( , , %'& ((%, ', +& '0( ; 0& 40, + . A0 %( ( ,& 4'*(%&4@',+> , *& +& 7+& & &% & &+& % (.
Preg-tirea 0olna8ului• C&0,+& , , &0( &+, +,@ (, ' &(@ *%(0& *4+,' 4+
• B4% &> % ,' , * %*& ; +, & *,% ( 15 0( , ; &( ,
• !, ,'*4 ,+ 0,0@+,%, ' ,+(4&+, ( ( ),+(4&+,.
Fi area a,aratului• M& , & & &+& % ( ', )( ,& %& (>,% % 4+( , 0,0@+ % , , &0(
M-'urarea• !, 40 ,& &,+ ? *, (' &+, %' % ,+(),+(*
• !, *( , , &0 %( ( ,& 4'*(%& ((%4+ , *& +& % 0& 40, + % (
• !, '*& , +,'( ,& * 1< 00$7 ( ', *( ,'* ( 4 4'*(%& ((%, &+ ,+(&%,.• !, '*& , & 4( +,'( ,& ( 1< 00$7 ; 1< 00$7 * *( (+( ' **,'(>, ? ',
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7 ',' , >&%4&+,& 0& (0 & &0 %( ( (( *,,& *, ', 0, , S(4'*(%40, +(* .
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CAPITOLUL #INTER#EN"IILE ASISTENTEI MEDICALE PRI#IND ÎNGRI IREA
$OLNA#ULUI CU ARTERIOPATIE O$LITERANTĂ
A'(' , & 0, (*&% &+, +4% , & &'(7 +& *4 ( ((%, 4 (0, , *4 )4+ ,*,'&+, * &+ ,+(4 & (, 4@%( ,+& . I ,+>( % &+, *& '*4 ; *, ,+,& +,%& (,( &'(' ,)&>4+( & , '*/(0@ % , ( )4+0& (( ( ,( ( ,04 ((. F + ( &+,& , & , * +,
, ,+0( & ' ; +,@ +( ( ' &+ (*( , %& ' &@(%(+,& 4@(,* (>,%4+ ( %& ,),A'(' , & 0, (*&% >& ( )4+0& >& , *& ( ', >& 4* & , +,7 (+,& &*(,
( >,' (7& (( ( , ; 7+(=(+(%, % ,+(4&+,. Asistenta medicală are ca obiective Internarea ,a&ientului n ',ital
I ,+ &+,& ; ' ( &% ', ,),* ,& ; 7, ,+&% +( @(+4 % , ( ,+ +( , +(0( ,+, , %& 0, (* % , )&0(%(, ( & 4>, (( , &'(7 +& .
B(+4 % , ( ,+ &+( >& ( 4*0( F4&(& , O@',+>& (, C%( (* G, ,+&% FOC, ! ( &%( &+, , Z( F!Z *& .
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CAPITOLUL VICA4 CLINIC
#I.1. CULEGEREA DATELOR $ume A !renume Z%ex 0&'* %(&'rsta 6" & ( (omiciliul M, ( +@&#cupaţia , '(4 &+ (ata internării 2 . 3 % (
Ana(e -;A ,*, , , /,+, 4*4%& ,+&%, ( & ,*, , , ,+'4 &%,A$C ,',0 ()(*& (>,APP 2
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I'tori&ul 0olii;P&*(, % ; >?+' , 6" , & ( * &+ ,+(4 & (, *+4 (* 4@%( ,+& 0,0@
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%& 0, (* % , )&0(%(, *&+, (-& +,'*+(' A 7 0, ( 17 2 1 * +K ( (0 , (%+& &0, % ( * & (@(4 (* '( +40 % ),@+(% & ,+'(' & 0, (* % , )&0(
& (@(4 ,+& (& ) + +,0( ,+,+,& '( +40 % ( ),@+(%. P&*(, % ,' , ; + 0&' ,*(&%( & ,.
M, (4 0 * &*(, % & +0& +& &0, &0@ %& 4+ * >&'4 (%&& (*4&7 %& 4+&%.
E a(enul o0ie&ti8 la internare;
-' &+, 7, ,+&% &% ,+& T 3 34
CT 1 2 *0 G 5 7 IMC 18 25 7K02 ' @ 4 ,+&%T,7 0, , ( 0 *4&',- %( ,-*(*& +(*, 4' &), ,* 40(, %& (>,% % ),0 + % ( ' ?
)+&* + - *(*& +(*, %& (>,% % %( (,( &@ 40( &%, & ,+(4&+, 4' ; %4* (+, +4 , , D&*+4 , + & ,>+('0 &4+ (*.
Examen clinic generalA &+& % *&+ (4>&'* %&+- 7404 , *&+ (&*, +,7 %& , &' + ( ,-' ) '(' 4%(* 7+& % IIKVI ; )4*&+
(+& (,+, ; & ( - TA 1,% % @(%& ,+&% IGB + 35K"< < 38 IGB' 7 -&@ 40, 04&%, , +,+4' ' 4 & ( %& &% &+, - +& ( ( ,' ( &%
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$IOC6IMIED, 0(+,& & &%( ,( V&%4+( 4@ ( , V&%4+( , +,),+(
G%(*,0(, "2 07 65-11
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TGL 5 5
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