Proceduri de Practica Pentru Asistentii Medicali Generalisti_788_1560

7/18/2019 Proceduri de Practica Pentru Asistentii Medicali Generalisti_788_1560

1/251

ANEXA

PROCEDURI DE PRACTIC PENTRU ASISTENII MEDICALI GENERALITI

PROCEDURI DE PRACTIC PENTRU ASISTENII MEDICALI GENERALITI

CUPRINS pag.2-7

PARTEA I PREVENIREA INFECIILOR NOZOCOMIALE pag.8Capito! "CONTROLUL INFECIILOR pag.81.1 Definiii, factoi !i "#"e $e conta%inae, c&i $e tan"%itee pag.81.2 'o(itici !i poga%e $e "#pa)eg*ee !i conto( a infecii(o pag.+1. *i$ $e peca#ii #ni)e"a(e pag.11./ 0p&(aea %ini(o pag.121. 'eca#ii $e pe)enie a infecii(o tan"%i"e pe ca(e aeian& pag.11.3 'eca#ii $e pe)enie a infecii(o tan"%i"e pin pic&t#i(e F(#gge pag.131.7 'eca#ii $e pe)enie a infecii(o tan"%i"e pin contact $iect c#

"eceii(e "a# o4iecte(e conta%inate pag.17

1.8 'eca#ii $e pe)enie a infecii(o (a pacieni c# ne#topenie pag.181.+ Uti(i5aea ec*ipa%ent#(#i $e i5o(ae pag.1+PARTEA II INTERVENII AUTONOME pag.#$Capito! #IIEN6 I CONFORTUL '6CIENTULUI pag.22.1 0c*i%4aea (eneiei $e pat f&& pacient pag.2

1


2/251

2.2 0c*i%4aea (eneiei $e pat c# pacient i%o4i(i5at pag.212. 0c*i%4aea (eneiei $e cop a pacient#(#i i%o4i(i5at (a pat pag.222./ Toa(eta pacient#(#i i%o4i(i5at (a pat pag.2/2. 0c*i%4aea po5iiei pacient#(#i i%o4i(i5at, a$ina%ic pag.12.3 9o4i(i5aea pacient#(#i pag.22.7 Captaea e(i%in&i(o pag./

Capito! %6LI9ENT6RE6 :OLN6;ULUI pag..1 6(i%entaea acti)& pag..2 6(i%entaea pa"i)& pag.

Capito! &9


3/251

Capito! 4TER6'II ;60CUL6RE pag.+37.1 9ontaea catete#(#i )eno" peifeic pent# pef#5ii pag.+37.2 9enineea !i >ngiiea #nei (inii )enoa"e e?i"tente pag.++7. n$epataea $i"po5iti)#(#i inta)eno" peifeic pag.117./ 'aticipaea (a p#neea !i >n$epataea catete#(#i )eno" centa( pag.127. Tan"f#5ia "ang#in& pag.17.3 'otoco( $e in)e"tigae>negi"tae a #nei eacii ac#te tan"f#5iona(e pag.1+7.7 6ntotan"f#5ia tan"f#5ia a#to(og& pag.1+

Capito! 80OND6GE, 0'


4/251

$ 'eg&tiea pacient#(#i !i paticipaea (a e?a%inaea co(eci"t#(#i!i c&i(o 4i(iae pag.1/2

e 'eg&tiea pacient#(#i !i paticipaea (a e?a%inaea a$io(ogic&a apaat#(#i ena( pag.1/2

f 'eg&tiea !i paticipaea (a e?a%inaea a$io(ogic& a "i"te%#(#ine)o" pag.1/7

1.2 'aticipaea (a e?a%ene c# i5otopi a$ioacti)i "cintigafie pag.1/81. 'aticipaea (a e?a%ene c# #(ta"#nete ec*ogafice

ec*ogafii, ec*oen$o"copii pag.12

Capito! ""'6RTICI'6RE6 60I0TENTULUI 9EDIC6L L6EH69ENE ENDO0CO'ICE pag.1

11.1 6"pecte genea(e pag.111.2 'aticipaea (a efect#aea e"ofagoga"to$#o$eno"copie pag.1311. 'aticipaea (a efect#aea co(ono"copiei pag.1811./ 'aticipaea (a efect#aea ecto"ig%oi$o"copiei pag.1+11. 'aticipaea (a 4on*o"copie pag.1311.3 'aticipaea (a toaco"copie pag.13111.7 'aticipaea (a ci"to"cpie pag.13211.8 'aticipaea (a ato"copie pag.13/11.+ 'aticipaea (a (apao"copie pag.13 PARTEA V 6

7NGRIIRI SPECIALE pag.133 Capito! "#NRIGIRI N :OLILE 6'6R6TULUI RE0'IR6TOR pag.133

12.1 Ra$iogafie p#(%onaa "tan$a$ pag.13312.2 :on*ofi4o"copie pag.13712. Toacocente5a p#nctia p(e#a(& pag.13+

12./ I.D.R. (a t#4ec#(in& pag.1712. 0pio%etia pag.17112.3 6"ipiaia ta*eo-4on!ic& pag.17212.7 Dena#( p(e#a( pag.17/12.8 O?igenoteapie pag.17712.+ 6eo"o(oteapie pag.178

Capito! "%NRIGIRI N :OLI C6RDIO;60CUL6RE pag.17+1.1 E?a%inaea a$io(ogic& a apaat#(#i ca$io)a"c#(a

angioca$iogafia, aotogafia, ateiogafia, f(e4ogafia pag.17+1.2 To%ogafia co%p#tei5at& pag.181

1. Ec*ogafia tan"e"ofagiana pag

181

1./ '#nctia peica$ic& pag

181

1. >negi"taea E.C.. >n epa#" !i >n efot pag

181

1.3 9onitoi5aea =o(te p 1

/


5/251

ag

8

1.7 0#pa)eg*eea pacient#(#i tatat c# $i#etice >n ca$io(ogie pag

18/

1.8 0#pa)eg*eea pacient#(#i tatat c# $igita(ice pag

18

Capito! "&NRIGIRI N 60TROENTEROLOIE pag

18

1/.1 E?a%inaea a$io(ogic& a apaat#(#i $ige"ti) pag

18

1/.2 E?a%inaea en$o"copic& a ogane(o $ige"ti)e pag

18

1/. E?a%inaea ec*ogafic& a ogane(o $ige"ti)e pag

183

1/./ E?a%inaea c# i5otopi a$ioacti)i pag

183

1/. '#ncia a4$o%ina(& pag

183

1/.3 '#ncia 4iop"ic& *epatic& p

ag

1

83

1/.7 0p&(&t#a ga"tic& pag

183

1/.8 6"piaia ga"tic& pag

183

1/.+ 6(i%entaia pin "on$a na5o-ga"tic& pag

188

1/.1 6(i%entaia pin ga"to"to%& pag

188

1/.11 ngiiea pacient#(#i co(o"to%i5at-"c*i%4aea p#ngii pag

18+

1/.12 Efect#aea iigaiei co(ice c(i"%a pe co(o"to%& pag

1+1

Capito! "3NRIGIRI N URONEFROLOIE p 1


6/251

ag

+

1.1 E?a%inaea a$io(ogic& a apaat#(#i ena( pag

1+

1.2 E?a%inaea en$o"copic& a )e5icii #inae pag

1+

1. E?a%inaea ec*ogafic& pag

1+

1./ E?a%inaea c# i5otopi a$ioacti)i. 0cintigafia ena(& pag

1+

1. '#ncia 4iop"ic& ena(& pag

1+

1.3 0on$a#( )e5ica( pag

1+

1.7 '#ncia )e5ica(& pag

1+

1.8 0p&(&t#a )e5ica(& pag

1+

1.+ 0#pa)eg*eea pacient#(#i c# "on$& pe%anent& p

ag

1

+

Capito! "2NRIGIRI N :OLI 9ET6:OLICE pag

1+

13.1 (ice%ia capi(a& pag

1+

13.2 Te"t#( to(eaniei (a g(#co5a oa(& TTO pag

1+3

13. Dete%inaea *e%og(o4inei g(ico5i(ate g(icata pag

1+7

13./ 6$%ini"taea in"#(inei pag

1+7

13. Ro(#( a"i"tent#(#i %e$ica( >n cetoaci$o5a $ia4etic& pag

2

13.3 Ro(#( a"i"tent#(#i %e$ica( >n *ipog(ice%ie p 2

3


7/251

ag

1

Capito! "4NRIGIRI N :OLI DER96TOLOICE pag

2/

17.1 'e(e)aea 4acteio(ogic& $in p#"t#(e pag

2/

17.2 'e(e)aea po$#"e(o %icotice $e (a ni)e(#( %#coa"e(o pag

2/

17. 'e(e)aea c#tanat& >n $e%atofite pag

2

17./ :iop"ia c#tanat& pag

23

17. ngiii >n can$i$o5a 4#ca(& pag

27

17.3 ngiii >n intetigo %ico5ic pag.2717.7 ngiiea pacient#(#i c# #(ce $e ga%4& pag.2817.8 ngiiea picioae(o (a #n pacient c# ei5ipe( pag.28

Capito! "8NRIGIRI N 6FECIUNI NEUROLICE pag.2+18.1 9ie(ogafia pag.2+18.2 E(ectoencefa(ogafia pag.2118. E(ecto%iogafia pag.21118./ 0co#( (a"goJ pag.211

Capito! "5NRIGIRI N 6FECIUNI OFT6L9OLOICE pag.211+.1 Dete%inaea ac#it&ii )i5#a(e pag.211+.2 Tono%etia oc#(a& pag.21/1+. Ofta(%o"copia $iect& pag.21/1+./ Dete%inaea c%p#(#i )i5#a( pag.211+. Dete%inaea "i%#(#i co%atic pag.2171+.3 ngiii pe !i po"t opeatoii >n afeci#ni oc#(ae c*i#gica(e pag.21+

Capito! #$NRIGIRI N O.R.L. pag.21+2.1 9ane)a =ei%(ic* pag.21+2.2 0p&(&t#a a#ic#(a& pag.222. Te"te a#$iti)e a#$io%etia pag.221

Capito! #"NRIGIRI N 6FECIUNI C=IRURIC6LE pag.2221.1 ngiii peopeatoii pag.2221.2 ngiii po"topeatoii pag.22321. 'i%a %o4i(i5ae pag.22721./ Te*nica genea(& a pan"a%ent#(#i pag.228

7


8/251

21. 64(aia fie(o $e "#t#& "a# a agafe(o pag.22+21.3 Dena#( pag.21 Capito! ##

NRIGIRI N 6FECIUNI INECOLOICE pag.2222.1 Reco(taea "eceii(o ce)ico)agina(e pent# e?a%ene

$e (a4oato pag.2222.2 '#ncia f#n$#(#i $e "ac Do#g(a" pag.2222. E?a%inaea en$o"copic& *i"teo"copia !i co(po"copia pag.222./ E?a%inaea a$io(ogic& - *i"teo"a(pingogafia pag.2322. 0p&(&t#a )agina(& pag.2822.3 6$%ini"taea %e$ica%ente(o pe ca(e )agina(& pag.2+

Capito! #%NRIGIRI N 'EDI6TRIE pag.2+2.1 0#pa)eg*eea f#ncii(o )ita(e (a copi(, !i a a(to paa%eti pag.2+2.2 'e(e)aea po4e(o pent# (a4oato (a "#ga !i copi(#( %ic pag.2/2

a 'e(e)aea "nge(#i pent# e?a%ene $e (a4oato pag.2/2- Reco(taea "nge(#i pin >nep&t#a c&(ci#(#i pag.2/2- Reco(taea "nge(#i pin p#ncie )enoa"& pag.2/

4 'e(e)aea po4e(o $in #in& pag.2// c 'e(e)aeapo4e(o $in "ca#n pag.2//

2. ngiiea p(&gii o%4i(ica(e pag.2//2./ 0#pa)eg*eea no#-n&"c#t#(#i >n inc#4ato pag.2/2. 0#pa)eg*eea no#-n&"ct#(#i "#4 fototeapie pag.2/72.3 Efect#ae ineciei inta%#"c#(ae (a "#ga pag.2/82.7 6$%ini"taea %e$ica%ente(o pe ca(e oa(& (a copi( pag.2/+22.8 9&"#i >n ca5#( #no eacii apte $#p& a$%ini"taea

%e$ica%ente(o (a copi( pag.2

Capito! #&NRIGIRI N ERI6TRIE pag.212/.1 Noi#ni into$#cti)e pag.212/.2 E)a(#aea f#nciona(& a )"tnic#(#i pag.212/. ngiea pe"oane(o )a"tnice. 'atic#(ait&i (egate $e

pato(ogia )"tnic#(#i pag.22/./ T#(4#&i $e "o%n pag.22/. De%ena pag.22/.3 C&$ei(e pag.232/.7 0in$o%#( $e i%o4i(i5ae a( )"tnic#(#i pag.232/.8 ncontinena #ina& pag.232

8


9/251

PARTEA I 6 PREVENIREA INFECIILOR NOZOCOMIALE

Capito! " CONTROLUL INFECIILOR

"." D()i9ii(: )a*to-i ;i +!-+( 0( *o9ta/i9a-(: *n #nit&i "anitae c# pat#i $e "tat !i pi)ate, cae "eefe& (a oice 4oa(& infecioa"& ce poate fi ec#no"c#t& c(inic !i"a# %ico4io(ogic !i pent# cae e?i"t&$o)a$a epi$e%io(ogic& a contact&ii >n ti%p#( "pita(i5&iiact#(#i %e$ica( "a# %ane)e(o %e$ica(e, cae

afectea5& fie pacient#( - $atoit& >ngiii(o %e$ica(e pi%ite, fie pe"ona(#( %e$ica( - $atoit& acti)it&ii"a(e !i e"te (egat& pin inc#4aie $e peioa$a a"i"t&ii %e$ica(e >n #nitatea e"pecti)&, in$ifeent $ac&"i%pto%e(e 4o(ii apa "a# n# apa pe peioa$a "pita(i5&ii

Fa*to-i ;i +!-+( 0( *o9ta/i9a-( i9t-a+pitai*(;ti6genii e"pon"a4i(i $e conta%inae "#nt foate n#%eo!i. Ei $ete%in& infecii %ai %#(t "a# %ai p#inga)e. 6$e"ea $e)in e5i"teni (a tata%ente.6genii patogeni "a# %ico4ii n#%e geneic $at $e 'a"te# ogani"%e(o #nice(#(ae in)i5i4i(e c# oc*i#((i4e "#nt

- 4acteii(e aeo4e !i anaeo4e $in gen#( coci(o !i 4aci(i(oK- ci#peci "a# (e)#i cae $ete%in& %ico5eK- paa5iii e"pon"a4i(i $e paa5ito5eK- )i#"#i(e *epatotope, ne#otope, etc.K- pionii.

0#"e(e $e conta%inae >n "pita( "#nt epe5entate $e- pacieniK

- pe"ona( $e >ngiieK- )i5itatoiK- ec*ipa%ente !i "#pafee conta%inate, e?. (eneie $e pat, "a(te(e, toa(ete co%#ne, etc.K- "eceii, e?ceii, po4e $e (a4oato, &nip(&giK- %ateia(e #ti(i5ate conta%inateK- a(i%entaie.

'acienii "pita(e(o "#nt %ai "#"cepti4i( (a infecii $atoit& e5i"tenei nat#a(e $i%in#ate $e 4oa(&"a# $e #ne(e %e$ica%ente i%#no$epe"oae, c*i%ioteapice.Toa(ete(e co%#ne "a# po?i%itatea a(to pacieni %&e"c i"c#( infecii(o >nc#ci!ate.

C


10/251

".# Poiti*i ;i p-og-a/( 0( +!p-a=(g>(-( ;i *o9t-o a i9)(*iio-

'ent# a >n$#%a in"tit#ii(e f#ni5oae $e >ngiii %e$ica(e >n efot#i(e (o $e a ine "#4 conto( infecii(e,>n an#( 1+7, cente(e pent# conto(#( 4o(i(o a# p#4(icat #n %an#a( cae $eta(ia 7 categoii $e poce$#i $ei5o(ae. Reco%an$&i(e a# fo"t e)i5#ite >n an#( 1+8 c# #%&toae(e "cop#i

- e$#ceea poce$#i(o in#ti(eK- #ti(i5aea poce$#i(o in)a5i)e >n #nit&i(e $e >ngiie inten"i)&K- contacaaea &"pn$iii ageni(o patogeni e5i"teni (a tata%ent.

n an#( 1+8, cente(e pent# conto(#( 4o(i(o !i pe)enie into$#c peca#i#ni(e #ni)e"a(e pin cae "eeco%an$& pe"ona(#(#i %e$ica( "& poate ec*ipa%ent#( $e potecie pent# a e$#ce po"i4i(itatea

contact#(#i $iect c# "nge(e !i a(te f(#i$e po)enite $e (a pacieni.n 1++3, cente(e pent# conto(#( 4o(i(o !i pe)enie a# into$#" peca#i#ni(e "tan$a$ ca 4a5& a no%e(o$e i5o(ae. 6# fo"t a$gate peci5&i pi)in$ a(te c&i $e conta%inae !i potocoa(e(e "tan$a$ c# "cop#(pe)eniii tan"%iteii infecii(o >n n$#( pacieni(o, pe"ona(#(#i !i )i5itatoi(o.

n pe5ent >n toate "pita(e(e e?i"t& $epata%ent#( $e "#pa)eg*ee !i conto( a infecii(o inta"pita(ice!ticae co(ectea5& $ate pi)in$ epi"oa$e(e infecioa"e !i "&n&tatea pe"ona(#(#i !i cae f#ni5ea5& info%aiipi)in$ i"c#i(e potenia(e. L#na "a# ti%e"tia( fiecae "ecie apotea5&, c&te ace"t $epata%ent, n#%(!i tip#( $e infecii inta"pita(ice!ti. n f#ncie $e po(itica "pita(#(#i "e pop#n %&"#i $e a#$it !i $eco%4atee a ace"to infecii.

'o(itici(e !i poce$#i(e $e conto( a infecii(o te4#ie "& fie c(ae !i c#no"c#te $e >nteg#( pe"ona( %e$ica(.'ent# a ine "#4 conto( infecii(e "#nt $i"poni4i(e #%&toae(e %i(oace $econta%inaea, c#&enia,$e5infecia, anti"ep"ia !i "tei(i5aea.

D(*o9ta/i9a-(a:>n pactica %e$ica(&, "e a$e"ea5& e?c(#"i) %ateia(#(#i %#$a !i "e ap(ic& %ateia(e(oinete "#pafee, in"t#%ente. 6e $ept "cop $i%in#aea n#%(#i $e %icoogani"%e >nainte $ec#&ae, poteaea pe"ona(#(#i $e o conta%inae in"t#%ente $e (a "a(a $e pan"a%ente "a# "a(a $eopeaii !i e)itaea $i"e%in&ii %icoogani"%e(o >n %e$i#( >ncon#&to.C!-n >n$ep&taea %#$&iei "p&(aea po$e(e(o, "#pafee(o $e (#c#,etc. !i pece$e ce(e(a(te opeaii c# e?cepia $econta%in&ii e? in"t#%ente(e %#$ae "e p#n >n "o(#ie$e5infectant& >nainte $e a fi "p&(atec#&ate $e "nge, "eceii, etc. D(?i9)(*iae"te opeaia cae "e ap(ic&pe %e$ii inete. E"te teapta "#peioa& a $econta%in&ii !i "e ap(ic& n#%ai pe %ateia(e !i "#pafee c#ate.N# "e $e5infectea5& $ect ceea ce e"te c#at. C#&enia !i $e5infecia pot fi ea(i5ate >n aceea!i opeaie pe o"#pafa& $atoit& #ti(i5&ii po$#"e(o $e c#&enie$e5infecie. C# toate ace"te, $ac& $e5infecia >n(oc#ie!te"tei(i5aea #n#i o4iect, ea te4#ie, >n %o$ i%peati) "& "e fac& >n 2 ti%pi "epaai c#&ie apoi $e5infecie#ti(i5n$ po$#"e $ifeite.A9ti+(p+iae"te o %eto$& $e co%4atee a infeciei cae "e ap(ic& (a ni)e(#( e"#t#i(o )ii, e(i%inn$ "a#$i"t#gn$ %icoogani"%e(e pe5ente >n %o%ent#( $e#(&ii poce$#ii.

Deconta%inaea, c#&enia, $e5infecia conc#& a"ep"ia cae epe5int& #n an"a%4(# $e %&"#i pe)enti)e

ce >%pie$ic& into$#ceea ge%eni(o patogeni >n ogani"%.

Igiena e"te #n an"a%4(# $e pincipii !i pactici cae )i5ea5& a%e(ioaea "&n&t&ii !i pe"#p#ne- o "tae $e "piitK- (#aea (a c#no!tin& info%aeaK

1


11/251

- #n co%pota%ent in$i)i$#a( !i co(ecti)K- o fi(o5ofie !i o %oa(&K- #n an"a%4(# $e eg#(i $e %#nc&.

".% G>i0 0( p-(*a!ii !9i=(-+a(O$in#( 9ini"te#(#i 0&n&t&ii n. +1323 pi)in$ apo4aea No%e(o $e "#pa)eg*ee, pe)enie !iconto( a( infecii(o no"oco%ia(e >n #nit&i(e "anitae 6ne?a $efine!te concept#( $e @peca#i #ni(o#ni)e"a(eB !i "ta4i(e!te %o$a(itatea $e ap(icae a ace"toa.

Concept#( $e peca#i#ni #ni)e"a(e "e efe& (a "nge !i a(te (ic*i$e oganice "eceii, e?ceii, $enae!i (a %#coa"e !i teg#%ent ca !i c#% a fi infectate c# ageni patogeni.

Toate %ane)e(e $e >ngiii a(e pacieni(o te4#ie efect#ate ca !i c#% toi pacienii a fi potenia(infectai c# =I;, =:; !i a(i ageni %ico4ieni c# ca(e $e tan"%itee "ang#in&.

S*op! api*


12/251

o#i, 4(#5e i%pe%ea4i(e, oc*e(ai $epotecie

- co%p(etea5& pot#( *a(ate(o at#nci cn$ "eanticipea5& po$#ceea $e "topi, pic&t#i,et#i c# po$#"e 4io(ogice potenia(conta%inate, >n "ecii c# pofi( c*i#gica(,"e)icii $e #gen&, (a4oatoae

9&n#!i $e #nic& fo(o"in& - inte)enii cae i%p(ic& contact#( c# egi#ni

a(e cop#(#i >n %o$ no%a( "tei(e- a4o$ )a"c#(a pin p#ncie

- contact#( c# teg#%ent#( pacient#(#i cae pe5int&"o(#ii $e contin#itate p(&gi

- %anip#(aea #no %ateia(e potenia(conta%inate - ne"tei(e, c#ate- $e5o4"t#&i $e #gen& a(e c&i(o e"piatoii

9&n#!i e#ti(i5a4i(e - %anip#(aea $e %ateia(e conta%inate- c#&enie, >n$ep&taea $e po$#"e 4io(ogiceconta%inate

9&n#!i $e #5 genea( - co(ectae %ateia(e conta%inate- c#&ie !i $econta%inae in"t#%enta, "#pafee

conta%inate9&n#!i(e n# "#nt #n "#4"tit#t pent# "p&(aea%ini(o, pin #%ae %ini(e te4#ie "p&(ate$#p& >n$ep&taea ace"toa

:onete ca(ote Oc*e(ai $e potecie - acti)it&i cae pe"#p#n conta%inae "a# "topiec# $ifeite f(#i$e oganice

- "&(i $e opeaie, >n ti%p#( %anip#(&ii

in"t#%enta#(#i !i a %ateia(#(#i te?ti( "tei(9&!ti facia(e - contact#( c# pacieni c# %eningit& )ia(& "a#4acteian&, c# T:C p#(%ona& cae "#nt :Mpo5iti)i- contact#( c# pacieni cae t#!e"c

- a"piaea "eceii(o ta*eo-4on!ice pe can#(ata*ea(&

- >ngiiea p(&gi(o "#p#ate- peg&tiea pef#5ii(o c# c*i%ioteapice- peg&tiea )accin#i(o pent# a$%ini"tae- $i5o()aea p#(4ei(o (iofi(i5ate9&!ti(e te4#ie "& fie $e tip fi(t# !i "& fie 4inefi?ate pe fa&

".& Sp


13/251

Tip!-i 0( +pn tota(itate $#p& o "p&(ae %etic#(oa"& !icontact#( c# #n anti"eptic.La=aB! igi(9i*"a# anti"eptic e(i%in& >n tota(itate f(oa tan5itoie !i $i%in#ea5& f(oa co%en"#a(& "a#e5i$ent&, a$ic& ge%enii opot#ni!ti cae "e g&"e"c >n %o$ nat#a( pe pie(e "tafi(ococ#( a#i# $e e?e%p(#cae "e %#(tip(ic& ano%a(, >n a4"ena %&"#i(o $e igien& !i $#c (a "c&$eea e5i"tenei ogani"%#(#i.F-i*i!9(a igi(9i*i-!-gi*a"e pactic& >n "&(i(e $e opeaii, "&(i(e $e na!tee, "&(i(e $e pan"a%ente "e)icii(e $e#gen&.

I90i*aii( +pngiii(o nein)a5i)e inecii, eco(tae $e "nge, p#neea #nei "on$e ga"tice, ea(i5aea

pan"a%ent#(#i, "on$a#(#i #ina, etc.K- >nainte $e pepaaea !i $i"ti4#iea a(i%ente(o !i a %e$ica%ente(o pe o"K

- $#p& fo(o"iea toa(etei. La=aB! a9ti+(pti*- $#p& >ngiiea #n#i pacient i%#no$epe"i) "a# p#t&to a( #nei infeciiK- c# oca5ia ea(i5&ii #nei poce$#i in)a5i)eK- c# oca5ia ap(ic&ii %&"#i(o $e i5o(ae "eptic& "a# a"eptic&K- $#p& $o#& "ec)ene $e >ngiie c# i"c $e conta%inae (a ace(a!i pacient "a# >nte $oi pacieni.

F-i*i!9(a igi(9i*na(t $e infecii catetei"%#( centa(, p#ncia (o%4a&, $ena#(p(e#a(, etc.K

- pent# inte)enii(e c*i#gica(e (a 4(oc#( opeato "a# >n "e)ici#( $e a$io(ogie inte)eniona(&K- >n a(te "e)icii $e in)e"tigaeK- pent# a"i"taea na!tei(o.

P-(gn $i"ti4#itoK

- "ac pent# $e!e#i. La=aB a9ti+(pti*- c*i#)et& (a)a4o#K- "&p#n (ic*i$ anti"eptic "a# "o(#ie "p#%oa"& anti"eptic& c# $i"ti4#itoK- po"oape $e #nic& fo(o"in& >n $i"ti4#itoK

- "ac pent# $e!e#i. F-i*i!9(a igi(9i*n $i"ti4#ito "a# >n a%4a(a#( $e pe5entae. La=aB! *>i-!-gi*a- c*i#)et& c# o4inete c# "en5oiK- ap& conto(at& 4acteio(ogicK- "o(#ie "p#%ant& anti"eptic& c# "pect# (ag c(o*e?i$in& $e e?e%p(#K- pei#& "tei(& $e #nic& fo(o"in& i%pegnat& c# "o(#ie anti"eptic& "p#%ant&K- "o(#ie "a# ge( *i$oa(coo(ic >n $i"ti4#itoK- !e)ee(e "tei(eK- "aci pent# $e!e#iK- p#4e(e c# "en5oi neacionate %an#a(.

R(ai?a-(a p-o*(0!-iiR(ai?a-(a p-o*(0!-ii La=aB! +i/p!

- "e $e"cope& %ini(e !i ante4ae(eK- "e >n$ep&tea5& 4i#teii(e, cea"#i(e, "e taie "c#t #ng*ii(eK- "e #$& %ini(e !i atic#(aii(e %ini(oK- "e ap(ic& o $o5& $e "&p#nK- "e "pa(& fiecae %n& pin ficionaeK- "e in"i"t& >n "paii(e inte$igita(e, >n ##( #ng*ii(o, (a e?te%itatea $egete(o, (a po(ice !i (a %an!ete(e

%ini(oK pent# fiecae $in ace"te egi#ni "e e?ec#t& cte %i!c&iK- "e "pa(& $in a4#n$en& f&& "& (&"&% "& c#g& "&p#n pe o 5on& $ea c(&tit&K- "e #"#c& pin ta%ponae c# !e)ee(e $e #nic& fo(o"in& f&& a e)eni a"#pa #nei 5one $ea #"cat&K- "e >nc*i$e o4inet#( $ac& n# e"te a#to%atic c# #(ti%#( !e)ee( $e %ini #ti(i5atK

- "e a#nc& !e)ee(e(e (a p#4e(& f&& "& atinge% p#4e(a c# %na. O,+(-=aiiN# "e !tege c*i#)eta $#p& "p&(aea %ini(o, %ane)a )a %#$&i $in no# %ini(e. 0e "pa(&%ini(e >nainte $e a >%4&ca %&n#!i(e $e #nic& fo(o"in&.

R(ai?a-(a p-o*(0!-ii La=aB! igi(9i* +a! a+(pti*- "e #$& 4ine %ini(e !i atic#(aii(eK- "e ap(ic& o $o5& $e "&p#n anti"epticK- "e "pa(& fiecae %n& %a"n$K- "e in"i"t& >n "paii(e inte$igita(e, >n ##( #ng*ii(o, (a e?te%itatea $egete(o $e (a fiecae %n& cae

"e feac&, pe n$ >n po$#( pa(%ei op#"e e?ec#tn$ %i!c&iK- "e "pa(& pe n$, e"pectn$ @eg#(a B cinci %i!c&i cic#(ae po(ice(e !i apoi atic#(aii(e %ini(oK- "e c(&te!te $in a4#n$en& $in"pe )f#( $egete(o "pe atic#(aii(e %ini(oK- "e peie #ng*ii(eK- "e %enin pa(%e(e oientate >n "#" pent# a e)ita oice conta%inaeK- "e #"#c& c# gi&, pin ta%ponae c# !e)ee(e $e #nic& fo(o"in&K- "e >nc*i$e o4inet#( $ac& n# e a#to%atic c# #(ti%#( !e)ee( $e %ini #ti(i5atK- "e a#nc& !e)ee(e(e >n p#4e(a c# pe$a(& f&& "& atinge% p#4e(a c# %na.

O,+(-=aii

Ti%p#( $e "p&(ae 2- %in#te, f&& peiee.La)a#( anti"eptic te4#ie efect#at coect >nainte $e ea(i5aea >ngiiii, #ti(i5n$ "#"a $e ap& cea%ai apopiat& #ng*ii(e te4#ie t&iate "c#t, ia pe $egete "& n# e?i"te ine(e0e e?ec#t& "p&(aea anti"eptic& a %ini(o >nainte $e a >%4&ca %&n#!i(e $e #nic& fo(o"in&.

1/


15/251

R(ai?a-(a p-o*(0!-ii Spn "co4it#a %inii #"cate !i "e efect#ea5& fici#nea ti%p $e

"ec#n$e fecn$ pa(%e(e pn& (a $egete apoi in"i"tn$ >n "paii(e inte$igita(e intene !i e?teneK- "e feac& fiecae po(ice >n inteio#( %inii >nc*i"e, apoi e?te%it&i(e $egete(o >%pe#nate $e (a

fiecae %n& >n po$#( pa(%ei op#"e.

R(ai?a-(a p-o*(0!-ii La=aB! *>i-!-gi*aNece"it& p#taea #nei %&!ti, ca(ote !i #ti(i5aea $e !e)ee(e "tei(e pent# #"caea %ini(o. 0e p#n >npea(a4i( %a"ca !i ca(ota.0e pepa&peg&te!te peia i%pegnat& c# "o(#ia "p#%ant& anti"eptic&. 0e efect#ea5& >n ti%pi Ti%p#( 1pe"p&(aea

- "e #$& %ini(e, atic#(aii(e, ante4ae(e pn& (a coateK- "e ap(ic& o $o5& $e "&p#n anti"eptic !i "e face "p#%& $in a4#n$en& pin %a"a#( efect#at $e (a

e?te%itatea $egete(o pn& (a coate ti%p $e 1 %in#tK- "e %enin %ini(e $ea"#pa coate(o >n ti%p#( ace"tei opeaiiK

- "e c(&te"c $in a4#n$en& %ini(e, atic#(aii(e, ante4ae(eK Ti%p#( 2- "e peie #ng*ii(e t&iate "c#t c# peia "tei(& i%pegnat& c# "o(#ie "p#%ant& anti"eptic& ti%p $e 1

%in#tK- "e c(&te"c $in a4#n$en& %ini(e, >nc*eiet#i(e, ante4ae(eK Ti%p#(

- "e ia >nc& o $o5& $e "&p#n anti"eptic !i "e %a"ea5& ti%p $e 1 %in#t %ini(e, >nc*eiet#i(e, ante4ae(e,apoi "e c(&te"cK

- "e #"#c&, pin ta%ponae c# !e)ee(e "tei(e fiecae %e%4#, >ncepn$ $e (a $egete "pe coate !i%eninn$ %ini(e i$icate.

O,+(-=aiiD#p& 2 oe e"te nece"a& efaceea igienei %ini(o.La)a#( c*i#gica( poate fi co%p(etat c# fici#ni c*i#gica(e c# "o(#ii *i$oa(coo(ice "a# io$ate.

Co/pi*aii ;i -i+*!-i- De%atite $ete%inate $e #ti(i5aea po$#"e(o anti"eptice "&p#n (ic*i$ 4(n$ $o#?, "&p#n (ic*i$

anti"eptic, "o(#ie "p#%ant& anti"eptic&K >n ace"t ca5, e"te eco%an$at "& "ee$#c& "a# "& "e >nte#p& #ti(i5aea po$#"#(#i e"pecti) !i "& "e ap(ice o ce%& *i$atant& $#p&fiecae "p&(ae a %ini(o.

- Fo%aea #nei pe(ic#(e #(eioa"e, (ipicioa"e pin #ti(i5aea epetat& a "o(#ii(oge(#i(o*i$oa(coo(iceK "e eco%an$& "p&(aea c# ap& $in a4#n$en& a %ini(o.

- U"caea !i iitaea pie(ii pin >n$ep&taea g&"i%ii nat#a(e a teg#%ent#(#iK "e eco%an$& c(&tiea c#ap& $in a4#n$en& !i ap(icaea, $#p& #"cae, a #nei ce%e e%o(iente $e %ini cae "& n# $eteioe5e%&n#!i(e $e ca#ci#c >n ca5#( >n cae ace"tea te4#ie p#tate.

".3 P-(*a!ii 0( p-(=(9i-( a i9)(*iio- t-a9+/i+( p( *a( a(-ia9n e?teio#(c(&$iii "a# fi(tat >nainte $e ecic(ae.'otecia e"piatoie te4#ie #ti(i5at& $e c&te toate pe"oane(e cae int& >n ca%e& "#nt i$ea(e "apaate(ecae fo(o"e"c fi(t# $e ae.'acient#( )a p#ta >n afaa ca%eei at#nci cn$ )a te4#i "-o p&&"ea"c& pent# efect#aea #no poce$#i%a"c& c*i#gica(& a!e5at& pe"te g#& !i na".

P-(gn antica%e&. 6ce"te %ateia(e "#nt

- cate(& pent# #!a ca%eei $e i5o(aeK- %&!ti c*i#gica(eK- *a(ate, %&n#!i $e #nic& fo(o"in&K- %ateia(e pent# igiena %ini(o.

E)(*t!a-(a p-o*(0!-ii- "e p(a"ea5& pacient#(pacienii %a?i% 2 pacieni >nt-o ca%e& c# pe"i#ne negati)&, c# #!a >nc*i"&

pe)&5#t& c# antica%e& "a# *o(K- "e )o e?p(ica peca#ii(e $e i5o(ae pacient#(#i !i a fa%i(iei ace"t#iaK

- "e )o %enine >nc*i"e tot ti%p#( att #!a ca%eei ct !i #!a anteca%eei pent# a %enine pe"i#neanegati)& a ae#(#i !i pent# a n# &"pn$i agenii patogeni $in aeK- "e )o afi!a pe #!a ca%eei peca#ii(e "pecifice pe)eniii tan"%iteii infecii(o pe ca(e aeian&

pent# a fi citite $e oice pe"oan& cae int& >n ca%ea $e i5o(aeK- "e in"t#ie!te pacient#( "&-!i acopee na"#( !i g#a c# !e)ee( $e *tie at#nci cn$ t#!e!te "a#

"t&n#t&K- "e p(a"ea5& #n ecipient "ac pe #na $in (atea(e(e pat#(#i pent# ca pacient#( "& co(ecte5e %ateia(e(e

fo(o"ite !e)ee(e, co%pe"eK- "e (i%itea5& %o4i(i5aea pacient#(#i >n afaa ca%eeiK- $ac& te4#ie "& p&&"ea"c& ca%ea pent# $i)e"e poce$#i, pacient#( )a p#ta o %a"c& c*i#gica(&

ia "e)ici#( $e in)e"tigaiitata%ent )a fi an#nat $e"pe peca#ii(e $e i5o(ae "ta4i(ite pent# caace"tea "& fie %enin#te !i aco(o !i pent# ca pacient#( "& fie a$#" >n ca%ea $e i5o(ae ct %ai epe$epo"i4i(.

".2 P-(*a!ii 0( p-(=(9i-( a i9)(*iio- t-a9+/i+( p-i9 pi*


17/251

- 'ne#%onii(e 4acteieneK- 0ca(atina (a copiii %iciK- 'aoti$ita epi$e%ic&K- Infecia c# a$eno)i#"#i (a copii.

Li9ii 0i-(*toa-(- peca#ii(e, >n ace"te ca5#i, n# nece"it& >n %o$ o4(igatoi# ca%ee $e i5o(ae c# pe"i#ne negati)& !i

c# "i"te% $e >nc*i$ee a#to%at& a #!iiK- e"pectaea ace"to peca#ii pe)ine &"pn$iea infecii(o ce "e tan"%it pin pic&t#i(e (#i F(#gge

"topi $e "a(i)& &"pn$ii >n ae pin t#"e, "t&n#t, )o4itK ace"te pic&t#i, >nc&cate c# ge%enipatogeni, ca$ pe po$ea !i "e #"#c&, tan"fo%n$#-"e >n paf#( 4acteian cae e"te apoi in*a(atK

- %ateia(e(e nece"ae ap(ic&ii ace"to peca#ii )o fi p&"tate pe #n ccio >n afaa ca%eei $ei5o(ae.

E)(*t!a-(a p-o*(0!-ii- pacient#( )a fi p(a"at >nt-o ca%e& pe)&5#t& c# toa(et& co%p(et #ti(at&K- pacient#( poate >%p&i ca%ea c# #n a(t 4o(na) cae ae aceea!i afeci#neK- "e )o e?p(ica pacient#(#ifa%i(iei poce$#i(e $e i5o(aeK- "e )o afi!a peca#ii(e $e i5o(ae pe #!a ca%eei pent# a info%a, >n pea(a4i(, pe oicine int& >n

ca%e&K- "e )o "p&(a %ini(e >nainte !i $#p& ie!iea $in ca%ea $e i5o(ae ct !i pe pac#"#( inte)enii(o

a"#pa pacient#(#iK- "e )a fi?a %a"ca pe fa&, pin5n$-o n#%ai $e !iet#i >n ti%p#( %anip#(&iiK- "e in"t#ie!te pacient#( "& #ti(i5e5e !e)ee(e $e *tie, co%pe"e pent# a-!i acopei g#a !i na"#(

at#nci cn$ t#!e!te, "t&n#t& !i "& (e co(ecte5e >n ecipient#( $e (a patK- )i5itatoii )o fi in"t#ii "& poate *a(ate !i %&!ti pe cae (e )o poc#a $in a#to%at#( c# ec*ipa%ente

$e potecie !i "& p&"te5e $i"tana $e ce( p#in #n %et# fa& $e pacientK- $ac& pacient#( te4#ie "& p&&"ea"c& ca%ea pent# in)e"tigaii, )a p#ta o %a"c& facia(& 4ine fi?at&

pe g#& !i na" ia "e)ici#( e"pecti) )a fi >n!tiinat $e"pe peca#i#ni(e $e i5o(ae "ta4i(ite.

".4 P-(*a!ii 0( p-(=(9i-( a i9)(*iio- t-a9+/i+( p-i9 *o9ta*t 0i-(*t *! +(*-(ii( +a!o,i(*t(( *o9ta/i9at(

P-(gnainte !i $#p& ie!iea $in ca%e&, !i $#p& >n$ep&taea %&n#!i(oK

17


18/251

- po4e(e 4io(ogice eco(tate )o fi p(a"ate >n c#tii i%pe%ea4i(e, etic*etate coect !i "e )o ti%itei%e$iat (a (a4oatoK

- "e )o ata!a pe patea e?ten& a c#tii(o in"t#ci#ni $e %ane)ae p#$ent&K- )i5itatoii )o fi in"t#ii "& poate %&n#!i !i *a(ate pe tot pac#"#( )i5itei !i "&-!i "pe(e %ini(e $#p&

>n$ep&taea ec*ipa%ent#(#i $e potecieK- toate o4iecte(e cae a# )enit >n contact c# pacient#( )o fi p(a"ate >nt-o "ing#& p#ng& i%pe%ea4i(&

!i "e )o (#a %&"#i(e nece"ae pent# >n$ep&taea "a# pent# $e5infectaea !i "tei(i5aea (oK- "e )o #ti(i5a %ateia(e "epaate pent# fiecae pacient >n pate te%o%ete, ten"io%ete, "teto"coape

pent# a e$#ce i"c#( tan"%iteii infeciei >nc#ci!ateK- "e (i%itea5& %o4i(i5aea pacient#(#i >n afaa ca%eeiK

- >n ca5#( $ep(a"&ii pacient#(#i (a $ifeite "e)icii $e in)e"tigaii !i tata%ent, "e )o acopei "tei(&ni(e $ac& e?i"t&, ia "e)icii(e e"pecti)e )o fi info%ate $e"pe peca#ii(e $e pe)enie "ta4i(iteK- "e )o "c*i%4a %&n#!i(e $#p& fiecae poce$#& efect#at& pacient#(#i !i "e )o "p&(a %ini(e $#p&

>n$ep&taea fieci n$ $e %&n#!i.

".8 P-(*a!ii 0( p-(=(9i-( a i9)(*iio- a pa*i(9i *! 9(!t-op(9i(

I90i*aii6ce"te peca#ii "#nt in$icate pent# potecia pacieni(o c#

- 0in$o%#( i%#no$eficienei $o4n$iteK- a"#i >ntin"eK- $e%atiteK- 4o(i infecioa"e c# e#pie )e5ic#(a&K- (e#ce%ii, (i%foa%eK- 4oa(a =o$ginK- tata%ente i%#no"#pe"oae.

Li9ii 0i-(*toa-(6p(icaea ace"to peca#ii )aia5& $e (a #n "pita( (a a(t#(, fiin$ inf(#enate !i $e ga$#( $ee5i"ten& a ogani"%#(#i pacient#(#iK6ce"te peca#ii patic#(ai5ate >n f#ncie $e pato(ogia pacient#(#i "#nt

- p(a"aea pacient#(#i "ing# >nt-o ca%e& $e i5o(ae c# pe"i#ne po5iti)& pent# a foa patic#(e(eaf(ate >n "#"pen"ie "& "e $ep#n& "a# "& fie "coa"e afa& $in ca%e&K

- (i%itaea tafic#(#i >n ca%ea $e i5o(aeK- p#taea *a(ate(o $e potecie, %&!ti(o !i %&n#!i(o $e c&te pe"ona(#( $e >ngiie !i $e c&te toi

)i5itatoiiK- #ti(i5aea $e (eneie "tei(& !i $e ec*ipa%ent co%p(et $e potecie >n ca5#( >ngiiii pacient#(#i cae a

"#feit #n tan"p(ant $e oganK- "p&(aea %ini(o >n %ai %#(te etape pent# $econta%inaeK- tiaea epi$e%io(ogic& pin contoa(e ig#oa"e e?#$at inofaingian, e?a%en copopaa5ito(ogic,

a$iogafie p#(%ona& a pe"oane(o cae >ngie"c pacient#(, pent# a fi i$entificai p#t&toii

"&n&to!iK- e)itaea poce$#i(e in)a5i)e (a pacienii c# ne#topenie >nt#ct ace"tea pe5int& #n i"c ce"c#tpent# pacient#( c# i%#nitate "c&5#t&K

- pe"ona(#( $e c#&enie )a fi in"t#it "&-!i p#n& *a(ate, %&!ti !i %&n#!i >nainte "& inte >n ca%ea $ei5o(ae.

18


19/251

P-(gn antica%e& pe #n ccio "pecia(.6ce"te %ateia(e "#nt

- *a(ate potectoaeK- %&n#!i $e #nic& fo(o"in&K- %&!ti facia(eK- acopeitoi pent# >nc&(&%inteK- 4onete.

E)(*t!a-(a p-o*(0!-ii- "e p(a"ea5& pacient#( "ing# >nt-o ca%e&K

- "e e?p(ic& pacient#(#ifa%i(iei peca#i#ni(e $e i5o(ae pent# a-i $i%in#a an?ietatea !i a-i "ti%#(acoopeaea c# ec*ipa $e >ngiieK- "e )o afi!a in"t#ci#ni(e pe #!a ca%eeiK- "e )o "p&(a %ini(e c# #n agent anti"eptic >nainte !i $#p& >n$ep&taea %&n#!i(o pec#% !i pe

pac#"#( aco$&ii >ngiii(oK- "e )o p#ta *a(ate(e $e potecie !i %&n#!i(e confo% peca#i#ni(o "tan$a$K- )o fi inte5i"e )i5ite(e pe"oane(o c#no"c#te ca fiin$ 4o(na)e "a# infectateK- $eoaece pacient#( n# ae o 4oa(& contagioa"&, %ateia(e(e "a# o4iecte(e cae p&&"e"c ca%ea $e

i5o(ae n# nece"it& peca#i#ni "pecia(e >n afaa ce(o "tan$a$.".5 Utii?a-(a (*>ipa/(9t!!i 0( i?oa-(

S*op- pe)eniea tan"%iteii infecii(o $e (a pe"oana infectat& (a a(i pacieni "a# $e (a %e%4ii

pe"ona(#(#i $e >ngiie (a pacieniK- e$#ceea i"c#(#i infect&ii pacieni(o c# i%#nitate "c&5#t&.

P-(g%4ac& *a(at#( !i "e >nf&!oa& $e ##( >%pe##( cop#(#i pe"te #nifo%a o4i!n#it& pe cae

te4#ie "& o acopee co%p(etK- "e (eag& 4ine !iet#i(e "a# "e tage fe%oa#( !i apoi "e (eag& 4i$e(e *a(at#(#i >n ##( gt#(#iK- "e a!ea5& %a"ca confota4i( pe"te na" !i g#& !i "e (eag& !iet#i(e %&!tii >n egi#nea occipita(&,

"#ficient $e "#" ca "& n# a(#neceK- $ac& "#nt nece"ai oc*e(ai $e potecie, %a"ca "e )a a!e5a "#4 %aginea $e o" a oc*e(ai(oK- %&n#!i(e "e )o p#ne a"tfe( >nct "& acopee %agini(e %neci(o *a(at#(#i $e potecie.

790(pipa/(9t!!i 0( p-ot(*i(- "e ine "ea%a $e fapt#( c& p&i(e e?tene a(e ec*ipa%ent#(#i $e potecie "#nt conta%inateK

1+


20/251

- c# %na $o%inant& >n%&n#!at& "e >n$ep&tea5& %&n#!a $e pe %na ne$o%inant& #(n$ >n e?teio%an!eta ace"teiaK

- "e >n$ep&tea5& !i %&n#!a $e pe %na $o%inant& into$#cn$ #n#( "a# $o#& $egete pin inteio#(%&n#!ii !i >n$ep&tn$-o c# patea inten& >n afa&K

- >n ti%p#( >n$ep&t&ii %&n#!i(o n# "e )a ating pie(ea c# patea e?ten& a ace"toaK- "e a#nc& %&n#!i(e >n "ac#( "pecia( pent# ec*ipa%ente conta%inateK- "e $e5(eag& %a"ca inn$-o n#%ai $e !iet#i !i "e $epo5itea5&, $e a"e%enea, >n "ac#( pent#

ec*ipa%ente conta%inateK- $ac& pacient#( ae o 4oa(& ce "e &"pn$e!te pe ca(ea ae#(#i, %a"ca "e )a >n$ep&ta #(ti%aK- "e $e5(eag& *a(at#( $in ##( gt#(#iK

- "e pin$e *a(at#( $e patea e?ten& $inte #%ei !i "e tage $e pe %neci >ntocn$#-( pe $o" pe%&"#& ce e"te "co" $e pe cop, pent# a e)ita conta%inaeaK- "e ine *a(at#( potecto ct %ai $epate $e #nifo%&, "e >%p&t#e!te pe $o" !i "e $epo5itea5& >n

ecipient#( pent# ec*ipa%ente conta%inateK- "e "pa(& %ini(e !i ante4ae(e c# "&p#n !i agent anti"eptic >nainte $e a ie!i $in ca%e& $ac& c*i#)eta

"e af(& >n ca%ea pacient#(#iK- "e >nc*i$e o4inet#( $ac& n# e"te a#to%atic fo(o"in$ #n po"op $e *tie ce "e a#nc& >n "ac#( pent#

$e!e#iK- "e acionea5& c(ana #!ii, pent# a o $e"c*i$e, fo(o"in$ #n a(t po"op $e *tie c#atK- "e )a >nc*i$e #!a ca%eei, pe $inafa&, c# %na nepoteat&K- $ac& c*i#)eta e"te >n anteca%e&, "e )o "p&(a %ini(e !i ante4ae(e c# "&p#n !i agent anti"eptic $#p&

p&&"iea ca%eei $e i5o(aeK- $#p& fiecae poce$#&, ccio#( $e (#c# )a fi c#&at, $e5infectat !i $otat c# %ateia(e(e nece"ae

#nei a(te poce$#iK- ca%ea $e i5o(ae )a fi co%p(et c#&at& !i $e5infectat& $#p& e?tenaea pacient#(#i

PARTREA II 6 INTERVENII AUTONOME Capito! #

IGIENA I CONFORTUL PACIENTULUI

#." S*>i/,a-(a (9B(-i(i 0( pat )n "ac#( $e co(ectaeK- "e "pa(& %ini(e, "e p#n %&n#!iK- "e >ntin$e ceaceaf#( $e pat foate 4ine pent# a n# &%ne c#te !i "e fi?ea5& (a co(#i(e "a(te(ei >n

fo%& $e p(icK$ac& ceaceaf#( n# ae $i%en"i#ni coe"p#n5&toae fi?aea "e face (a patea $in"pepicioae(e pacient#(#iK

2


21/251

- "e "c*i%4& faa $e pen& !i ceaceaf#( p(ic.

79*>(i(-(a p-o*(0!-ii- "e >n$epatea5& (eneia %#$a&, "e $epo5itea5& >n "aci "pecia(iK- "e >n$epatea5& %&n#!i(e $e ca#ci#cK- "e "pa(& %ini(e.

#.# S*>i/,a-(a (9B(-i(i 0( pat *! pa*i(9t! i/o,ii?at0c*i%4aea (eneiei "e )a efect#a >ntot$ea#na $#p& toa(eta pacient#(#i. La "c*i%4aea (eneiei te4#ie "&paticipe $o#& pe"oane ia a(egeea %eto$ei $e "c*i%4ae a (eneiei $e pat, "e face >n f#ncie $e po5iia >ncae poate fi a!e5at pacient#( (i%ite(e "a(e $e %o4i(i5ae.

S*op- a"ig#aea igienei !i confot#(#i pacient#(#iK

e)itaea co%p(icaii(o (a pacient#( i%o4i(i5at.

Mat(-ia 9(*(+a-- (eneie c#at&K- "ac pent# co(ectaea (eneiei %#$aeK- %&n#!i $e #nic& fo(o"in&.

E)(*t!a-(a p-o*(0!-iiE"te >n f#ncie $e "taea pacient#(#i !i $e po"i4i(itatea $e a fi %i!cat.6"i"tent#( %e$ica( "ta4i(e!te %eto$a $#p& c#(egeea $ate(o efeitoae (a capacitatea acient#(#i$e a "e i$ica "a# n# >n po5iia !e5n$.'ent# ea(i5aea "c*i%4&ii (eneiei e"te ne)oie $e a#to.

a1 La pa*i(9t! *a-( +( poat( -i0i*aCeaceaf#( $e pat "e #(ea5& pe $i%en"i#nea %ic&.

- "e "pa(& %ini(e, "e i%4ac& %&n#!iK- pacient#( &%ne acopeit c# ceaceaf#( fo(o"it "a# c# a(t p(e$K- "e $ega& ceaceaf#( %#$a $e "#4 "a(teaK- "e i$ic& pacient#( >n po5iia !e5n$ fiin$ "#"in#t c# cte o %n& $e ce(e $o#& pe"oane cae

ea(i5ea5& poce$#a #%&toae- c# cea(a(t& %n& "e #(ea5& ceaceaf#( %#$a !i "e $e#(ea5& c# gi& ce( c#at pn& apoape $e

pacientK- "e "c*i%4& faa $e pen&, "e a!ea5& pena pe patK- pacient#( e"te c#(cat >n $ec#4it $o"a( !i e"te #gat $ac& poate, "a# e"te a#tat "&-!i i$ice egi#nea

fe"ie&K- "e contin#& #(aea ceaceaf#(#i %#$a "pe picioae(e pacient#(#i !i $e#(aea ce(#i c#atK- "e i$ic& apoi %e%4e(e infeioae contin#n$ #(aea !i $e#(aeaK- ceaceaf#( %#$a "e into$#ce >n "ac, ceaceaf#( c#at "e >ntin$e 4ine !i "e fi?ea5& (a co(#i.

,1 La pa*i(9t! *a-( -%pac*etea5& >n a%onic&K

21


22/251

- "e $ega& ceaceaf#( %#$a $e "#4 "a(teaK- "e >ntoace pacient#( >n $ec#4it (atea( !i "e tage pena "pe %aginea pat#(#iK- ceaceaf#( %#$a "e #(ea5& pn& (ng& pacientK- ceaceaf#( c#at a!e5at $e-a (#ng#( pat#(#i "e $e#(ea5& pn& apoape $e ce( %#$aK- pacient#( $e >ntoace >n $ec#4it $o"a( apoi >n $ec#4it (atea( pe patea op#"&K- "e contin#a& $e#(aea ceaceaf#(#i %#$a !i $e#(aea ce(#i c#atK- ceaceaf#( %#$a "e p#ne >n "ac#( co(ectoK- pacient#( e"te ea$#" >n $ec#4it $o"a(K- ceaceaf#( c#at "e >ntin$e !i "e fi?ea5&.

S*>i/,a-(a *(a-*(a)!!i pi* '*! pntin$e ceaceaf#( c#at !i "e >n$ep&tea5& ce( %#$a.

79*>(i(-(a p-o*(0!-ii- (eneia %#$a& "e co(ectea5a >n "aciK- "e >n$ep&tea5& %&n#!i(e, "e "pa(& %ini(e.

O,+(-=aii6(e5a !i %#!a%a#a pot fi "c*i%4ate $#p& ace(ea!i %eto$e inn$ cont $e po"i4i(itatea $e "c*i%4ae apo5iiei pacient#(#i.

#.% S*>i/,a-(a (9B(-i(i 0( *o-p a pa*i(9t!!i i/o,ii?at a pat S*op- %enineea "t&ii $e igien& !i confotK- %enineeace!teea $e%nit&ii pacient#(#iK- pe)eniea e"cae(o $e $ec#4it.

'oce$#a ine "ea%& $e tip#( $e >%4&c&%inte pia%a, c&%a!& $e noapte !i $e "taea pacient#(#i. 0eo4in info%aii $e"pe po"i4i(it&i(e $e i%o4i(i5ae.

S*>i/,a-(a piBa/a(i- "e e?p(ic& pacient#(#i c#% poate co(a4oa !i "e apecia5& >n ace(a!i ti%p e"#"e(e ace"t#iaK- "e "pa(& %ini(e, "e >%4ac& %&n#!i.

D(?,-n po5iia !e5n$ !i "e >n$ep&tea5& 4(#5a %#$a&K- "e #(ea5& pe n$ fiecae %nec& a 4(#5ei c#ate !i "e >%4ac& fiecae %e%4# "#peioK- pacient#( e"te a!e5at >n $ec#4it, "e >ntin$e 4(#5a !i "e >nc*eie na"t#iiK- $ac& pacient#( n# "e poate i$ica, "e >ntoace >n $ec#4it (atea(, "e $e54ac& !i "e >%4ac& patea

acce"i4i(& $#p& cae pacient#( "e >ntoace pe cea(a(t& pate !i "e poce$ea5& (a fe( #(n$ pe n$%neci(e 4(#5eiK

22


23/251

- (a "f!it, pacient#( e"te a$#" >n $ec#4it $o"a(, "e >ntin$e 4(#5a !i "e >nc*eie na"t#ii.

7/,-n "#" "pe %i(oc.O,+(-=aiin toate ca5#i(e $e"ci"e

- "e )eific& p#ncte(e $e "piin !i "e an#nt& oice %o$ificae pe%eg&toae e"cae(oK- "e p#$ea5& c# ta(c p#ncte(e $e "piinK

- "e )eific& $ac& (a te%inaea poce$#ii, (eneia e"te 4ine >ntin"& !i $ac& pacient#( e?pi%& "tae $econfot.

S*>i/,a-(a *nti egi#nea fe"ie& !i "e tage #!o c&%a!a %#$a&K- "e "tnge #(ea5& c&%a!a %#$a& $e (a "pate !i "e tece pe"te cap $e54&cn$ %e%4e(e

"#peioaeK- "e #(ea5& fiecae %nec& a c&%a!ii c#ate !i "e >%4ac& fiecae %e%4# "#peio $#p& cae c&%a!a

e"te tec#t& pe"te cap !i >ntin"& pn& apoape $e !e5#t#( pacienteiK- "e a!ea5& >n $ec#4it, "e i$ic& egi#nea fe"ie& !i "e >ntin$e 4ine c&%a!a.

Dac& pacienta n# "e poate i$ica 'ent# $e54&cae

- "e >ntoace pacienta pe o pate !i pe a(ta, "tngn$ $e fiecae $at& c&%a!a pn& apoape $e a?i(&K- pacienta >n $ec#4it $o"a( "e i$ic& #!o !i "e tage c&%a!a pe"te capK 'ent# >%4&cae- "e #(ea5& c&%a!a $e (a poa(e, "e i$ic& #!o cap#( "e !i tece c&%a!a pe"te capK- "e #(ea5& fiecae %nec& !i "e >%4ac& pe &n$ %e%4e(e "#peioaeK- "e >ntoace apoi pacienta pe o pate !i pe a(ta >ntin5n$ c# gi& c&%a!aK- "e >ntin$e 4ine c&%a!aK- "e >ntin$e !i "e fi?ea5& ceaceaf#(.

O,+(-=aiiLa "c*i%4aea (eneiei $e cop !i pat "e tine cont $e con"tngei(e fi5ice (e5i#ni a(e %e%4e(o,apaate gip"ate, pef#5ii %ontate.'atea )&t&%at& "e $e54ac& #(ti%a !i "e >%4ac& pi%a.6"i"tent#( %e$ica( te4#ie "& fie pe5ent (a "c*i%4aea (eneiei pacient#(#i c# pef#5ii "a# (a cae pinp(an#( teape#tic %i!caea e"te (i%itat&inte5i"&.La pacient#( incon!tient e"te $e pefeat ca patea infeioa& a cop#(#i "& n# fie >%4&cat&. Dac& pacient#(pe5int& $#ei (a %o4i(i5ae "a# $#p& poce$#i "e poate a$%ini"ta ca(%ant.

#.& Toa(ta pa*i(9t!!i i/o,ii?at a pat

0e ea(i5ea5& inte)enii pent# igiena 5i(nic& !i $#p& ca5 4aia pe egi#ni copoa(e. S*op

- %enineea igienei teg#%ent#(#iK

2


24/251

- %enineea "t&ii $e confot a pacient#(#iK- pe)eniea (e5i#ni(o c#tanateK

- acti)aea cic#(aiei. P-i9*ipii g(9(-a(

- "e apecia5& pin c#(egeea $ate(o, "taea pacient#(#i pent# a e)a(#a e"#"e(e, $e cectce fe( $ea#to ae ne)oie, (i%ite(e >n cae poate fi %o4i(i5atK

- "e a"ig#& inti%itatea, "e e"pect& p#$oaea pacient#(#iK- "e a"ig#& te%peat#a coe"p#n5atoae %e$i#(#i a%4iant pent# a n# cea $i"confotK- %ateia(e(e "e peg&te"c !i "e a(eg >n f#ncie $e poce$#& !i "#nt a!e5ate >n apopieeK- "e e"pect& o an#%it& o$ine a "p&(&ii egi#ni(o a"tfe( >nct "& pe%it& $e"copeiea, "p&(aea !i

acopeiea 5onei f&& "& cee5e $i"confotK- $#pa efect#aea >ngii(o igienice copoa(e !i "c*i%4aea (eneiei, pacient#( )a fi a!e5at >nt-opo5iie ct %ai co%o$&K

- fiecae 5on& "e #%e5e"te, "e "&p#ne!te, "e c(&te!te !i "e !tege, $#p& cae "e >n)e(e"teK- "e (#cea5& c# 4(n$ee !i atenie $ac& pacient#( ae con"tngei fi5ice apaat gip"at, pan"a%ent,

pef#5ie.

Mat(-ia( 9(*(+a-(9ateia(e(e "e peg&te"c >n f#ncie $e "cop $e tip#( $e >ngiie 4aia (a pat, toa(eta !i >ngiiea #nei egi#ni.'ent# toa(eta co%p(et& (a pat "e peg&te"c

- %ateia(e pent# potectie %#!a%a, a(e5&, cea!af, po"op $e 4aieK- %ateia(e pent# "p&(at can& c# ap& ca($& !i ece, (ig*ean, tei %&n#!i $e toa(eta $e c#(oi $ifeite,

po"oape $e c#(oi $ifeite, fofec#& !i pi(& pent# #ng*ii, piepten, a(coo(, "&p#n ne#t#, %&n#!i $e#nic& fo(o"in&, a(coo( %ento(at, ta(cK

- %ateia(e pent# toa(eta ca)it&ii 4#ca(e pei#&, pa"t&, pa*aK- %ateia(e pent# toa(eta ogane(o genita(e p(o"c&, pen"e, po"t-ta%pon, ta%poaneK- (eneie c#at& $e cop !i patK

- "ac pent# (eneia %#$a&. O$inea"p&(&ii

- faa !i gt#(K- patea anteioa& a toace(#i, %e%4e(e "#peioae, a4$o%en#(, patea po"teioa& a toace(#i !i

egi#nea fe"ie&, %e%4e(e infeioae ogane(e genita(eK9&n#!i(e $e 4aie !i ce(e po"oape $e c#(oi $ifeite, "e "c*i%4& a"tfe( pi%#( pent# fa& !i gt, a( $oi(eapent# t#nc*i !i %e%4e, a( tei(ea pent# ogane(e genita(e. P-(gn f#ncie $e acti)itatea $in "ecie "e)iea %e"ei, in)e"tigaii,

oa#( tata%ent#(#i.

E)(*t!a-(a p-o*(0!-ii0e $e54ac& pe n$ fiecae egi#ne !i "e in"i"t& >n an#%ite 5one $#pa c#% #%ea5&

- (a fa& !i gt "e >ncepe c# oc*ii, "e in"i"t& c# %i!c&i cic#(ae >n 5ona peioa(& !i peina5a(&, "e

in"i"t& (a #ec*e >n c#te !i egi#nea etoa#ic#(a&K- "e "c*i%4& %&n#!aK- pe patea anteioa& a toace(#i "e in"i"t& >n a?i(e, (a fe%ei >n p(i#i(e "#4%a%aeK

2/


25/251

- (a %e%4e(e "#peioae, "p&(aea "e face c# %i!c&i (#ngi !i cic#(ae >ncepn$ $e (a atic#(aiap#%n#(#i "pe #%& pent# a "ti%#(a cic#(aia $e >ntoacee. 0e in"i"t& (a "paii(e inte$igita(e !i "etaie #ng*ii(eK

- (a ni)e(#( a4$o%en#(#i "e in"i"t& (a ni)e(#( p(i#i(o ing*ina(e #n$e apa #!o iitaii, (a ni)e(#(o%4i(ic#(#i cae poate fi %#$aK

- pe patea po"teioa&, c# pacient#( a!e5at >n $ec#4it (atea(, "e in"i"t& >n p(ica intefe"ie&K- "e conto(ea5a p#ncte(e $e "piin, "e ficionea5& #!o c# a(coo( %ento(at !i "e p#$ea5& c# ta(cK- "e ea$#ce pacient#( >n $ec#4it $o"a( !i "e contin#& c# "p&(aea %e%4e(o infeioae in"i"tn$ (a

ni)e(#( gen#nc*i#(#i, p(icii pop(itee, >n egi#nea p(icii ing*ina(e, >n egi#nea ten$on#(#i (#i 6*i(e !ic&(ci#(#iK picioae(e "e into$#c >nt-#n (ig*ean c# ap& pent# a t&ia %ai #"o #ng*ii(eK

- toa(eta ogane(o genita(e "e face c# pacient#( >n po5itie gineco(ogic& fo(o"in$ pen"e po"tta%pon "a#%&n#!i $e #nic& fo(o"in&. Diecia $e "p&(ae e"te $in"pe patea anteioa& "pe cea po"teioa&.'acient#( "e poate "p&(a "ing# $ac& "taea >i pe%ite fiin$ in"t#it c#% "& poce$e5e coect. La "f!itpacient#( e"te i$icat >n po5iie !e5n$ $ac& "e poate "a# >nto" >n $ec#4it (atea( pent# igiena g#ii.ngiiea "e >nc*eie c# pieptanaea p(#i.

79g-iBi-(a o*>io-

S*op- pe)eniea infecii(o !i >n$ep&taea "eceii(oK- %enineea oc*i#(#i #%e$ (a pacient#( c# paa(i5ie, >n e?ofta(%ie.

Mat(-ia( 9(*(+a-(- "e fi5io(ogic, "o(#ie $e aci$ 4oicK- "o(#ie $e )ita%ina 6K- "tic(#& c# pic#atoK

- (aci%i atificia(e, #ng#ent ofta(%ic eco%an$at $e %e$icK- co%pe"e "tei(eK- %&n#!i "tei(eK- t&)i& ena(&K- po"op, %ateia( i%pe%ea4i(.

P-(g


26/251

- "e #%ea5& aceea!i pa!i, a"i"tent#( %e$ica( $e"c*i5n$ p(eoape(e !i ap(icn$ pe fiecae oc*i cte oco%pe"& "tei(&K

- "e in"ti(ea5& >n "ac#( con#ncti)a( cte o pic&t#& $e )ita%ina 6 $e $o#& oi pe 5iK- (ip"a c(ipiii i%p#ne in"ti(aea (aci%i(o atifica(e. n ca5#( pacient#(#i c# 4oa(a :60EDOP "e

eco%an$&- p#taea oc*e(ai(o f#%#ii pent# e$#ceea inten"it&ii (#%inii, potecia >%poti)a )nt#(#i !i a

c#eni(o, pe%ite ca%#f(aea e?o(fta%ieiK- pacient#( e"te "f&t#it "& $oa%& c# cap#( %ai "#" $o#& pene ceea ce pe%ite e$#ceea e$e%#(#i

pa(pe4a(K

- pent# %enineea #%i$it&ii coneei "e ap(ic& co%pe"e >%4i4ate >n "efi5io(ogic. 79g-iBi-(a

/!*oa+(i 9a?a(

S*opi90i*aii

- %enineea pe%ea4i(it&ii c&i(o e"piatoii "#peioaeK- pe)eniea (e5i#ni(o >n infecii na5a(e, (e5i#ni $e pe"i#ne $ete%inate $e "on$& pent# o?igen,

pent# e)ac#aea "#c#(#i ga"tic "a# pent# a(i%entaie.

Mat(-ia( 9(*(+a-(- ta%poane "tei(eK- "e fi5io(ogicK- )a"e(in&K- ap& o?igenat& $i(#at&K- t&)i& ena(&K- %&n#!i $e ca#ci#c.

P-(gnt-o pate.

E)(*t!a-(a p-o*(0!-ii- "e c#&& fo"e(e na5a(e c# ta%poane #%e5ite c# "e fi5io(ogic, "e >n$ep&tea5& c#"te(eK- pent# fiecae na& "e fo(o"e!te $e fiecae $at& a(t ta%ponK- c#"te(e "e pot >n$ep&ta pin (#4efiee c# )a"e(in&K- $ac& "on$a e"te %ontat& "e poce$ea5& a"tfe(

- "e $e5(ipe!te p(a"t#e(e $e pe na" !i fa&K- "e etage "on$a -3 c% !i "e c#&& #%e(e $e 4an$& a$e5i)&K- "e "c*i%4& po5iia "on$ei !i "e fi?ea5& $in no#K- cn$ "on$a "e "c*i%4&, "e ep#ne $#p& o pa#5a $e 3-8 oe.

79g-iBi-(a !-(*>io-S*op

- %enineea "t&ii $e igien& a con$#ct#(#i a#$iti) e?tenK- >n$ep&taea $epo5ite(o $e ce#%en "a# a ce(o pato(ogiceK- ap(icaea #no tata%ente.

23


27/251

Mat(-ia( 9(*(+a-(- ta%poane c# )at&K- ta)i& ena(&K- "o(#ie $e 4ica4onat $e "o$i#K- %&n#!i $e 4aieK- po"op.

P-(gn (eg&t#& c# e)ent#a(e(e tata%ente (oca(e cae te4#ie ap(icate.

E)(*t!a-(a p-o*(0!-ii- "e c#&& con$#ct#( a#$iti) e?ten c# #n ta%pon #"cat, efect#n$ c# 4(n$ee %i!c&i $e otaieK- "e o4"e)& e)ent#a(e(e iitaii "a# "eceiiK- "e c#a& pa)i(ion#( #ec*ii c# %&n#!a $e 4#%4acK- (a "f!it $ac& pacient#( ageea5&, "e p#ne #n ta%pon $e )at&K- $ac& pacient#( ae in$icaie $e tata%ent ace"ta "e efect#ea5& confo% eco%an$&i(o.

79g-iBi-(a *a=itn$ep&taea g#"t#(#i !i %io"#(#i nep(&c#t a( ca)it&ii 4#ca(eK- po%o)aea confot#(#i.

Mat(-ia( 9(*(+a-(

- pei#& $e $ini pe"ona(&K- pa"t& $e $iniK- pa*a c# ap& pent# "p&(aeK- pa*a $e ap& pent# pote5&K- t&)i& ena(& pent# co(ectae ap&K- a& $enta&K- !e)ee(e $e *tie, po"op, %#!a%aK- ap& $e g#&K- ta%poane, po"oapeK- ta)& pent# %ateia(e.

P-(gnt-o po5iie a$ec)at& "t&ii genea(e

- !e5n$ c# #n po"op >n ##( gt#(#iK- $ec#4it (atea( c# cap#( #!o i$icat "piinit pe o pen& poteat& c# po"op.

E)(*t!a-(a p-o*(0!-ii- "e $& pacient#(#i pei#a, pa"ta !i pa*a#( c# ap&K- "e "#"ine t&)ia ena(& "#4 4&4ia pacient#(#i "a# apoape $e faa ace"t#iaK

27


28/251

- "e "f&t#iete pacient#( "& peie "#pafaa e?ten& a $ini(o >ncepn$ $in patea "tng& apoi (a cent# !iapoi patea $eapt&K

- "e peie apoi "#pafaa cooane(o !i "#pafaa inten& a $ini(oK- peieea "e face >n "en" )etica( 2- %in#teK- "e in)it& pacient#( "&-!i c(&tea"c& c# %#(t& ap& !i (a "f!it c# ap& $e g#&K- $ac& pacient#( e"te >n $ec#4it "e ofe& o can& c# cioc "a# #n t#4 $e "#ci#ne.

La pa*i(9t! *o/ato+0e e)a(#ea5& "taea ace"t#ia, "e apecia5& $ac& ae ef(e? $e $eg(#tiie.Mat(-ia( 9(*(+a-(

- pei#& pe"ona(&K- pa"t& $e $iniK- po"opK- ta%poane pe potta%ponK- $e"c*i5&to $e g#&K- co%pe"e $e tifon "tei(eK- ap& $e g#&, g(icein& 4oa?at& 2, g(icein& c# "ta%icinK- "pat#(& (ing#a(&K- ta)i& ena(&K- %&n#!i $e #nic& fo(o"in&K- )a"e(in& pent# 4#5eK- "eingi pent# a"piaea (ic*i$#(#i.

P-(gntoace cap#( >nt-

o pate.

E)(*t!a-(a p-o*(0!-ii- "e "pa(& %ini(e, "e i%4ac& %&n#!i,- "e poteea5& pena c# #n po"op !i "e a!ea5& a(&t#i t&)ia ena(& !i "einga pent# a"piaie,- "e fi?ea5& %a?i(ae(e c# a#to#( $e"c*i5&to#(#i $e g#&K- "e peie "#pafaa e?ten& $ini(o fo(o"in$ o cantitate %ic& $e pa"t&K- "e a"pi& (ic*i$#( c# "eingaK- "e fo(o"e!te o "pat#(& (ing#a(& !i ta%poane pent# >n$ep&taea o4ai(o !i 4#5e(o >n )e$eea

c#&&ii %#coa"e 4#ca(eK- "e c#&& "#pafaa inten& a $ini(o fo(o"in$ ta%poane c# g(icein& 4oa?at& "a# c# g(icein& c#

"ta%icin $ac& e?i"t& can$i$aK- "e o4"e)& foate 4ine a"pect#( gingii(o, $ini(o !i (i%4iiK- "e "ta4i(e"c >ngiii #(teioae >n f#ncie $e con"tat&i.

O,+(-=aii

Dac& pacient#( n# ae ef(e? $e $eg(#tiie "e en#n& (a pa"t& !i pei#& e?i"tn$ i"c $e a"piaie pe c&i(ee"piatoii.

28


29/251

79g-iBi-(a p-ot(?(i

S*op- 9enineea igienei pote5ei !i a ca)it&ii 4#ca(e. Mat(-ia( 9(*(+a-(

- pa*a %atK- pei#&K- pa"t& $e $iniK- %&n#!i $e #nic& fo(o"i&.

E)(*t!a-(a p-o*(0!-ii- pacient#( con!tient e"te #gat "&-!i "coat& pote5a "& o c#ee !i "& o p#n& >nt-#n pa*a popi#,

%at, netan"paentK- (a pacient#( incon!tient >ngiiea "e face $e c&te a(t& pe"oan&

- "e >%4ac& %&n#!i(e $e #nic& fo(o"in&K- "e pin$e pote5a c# o co%pe"& $e tifon !i "e >n$ep&tea5&K- "e "pa(& pote5a c# pei#a !i pa"ta pacient#(#iK- "e p#ne pote5a >nt-#n pa*a c#at, %atK- "e e$& pote5a pacient#(#i cn$ >i ecap&t& "taea $e con!tien&K- >nainte $e %ontaea pote5ei "e c(&te!te g#a c# ap& c#at&.

79g-iBi-(a pn !#)ie !i "e piapt&n& $e (a )f "pe &$&cin&K- p( (#ng "e >%p(ete!te eco%an$aeK

,1 Spn pat - "pate(e pacient#(#i fiin$ "piinit $e "a(tea#a #(at&, (ig*ean#( "piinit pe "o%ie&K- >n pat - pacient#( fiin$ oientat "pe %aginea pat#(#i, >n $ec#4it $o"a( oientat o4(ic

- pe "ca#n - $o#& "ca#ne c# "p&ta p#"e c# "p&tae(e apopiate, pe #n#( "t& pacient#( pe ce(&(a(t "e"piin& (ig*ean#(K

- pe "ca#n (ng& (a)oa - c# faa "a# c# "pate(e >n f#ncie $e "taea genea(& a pacient#(#i.

Mat(-ia( 9(*(+a-(

- (ig*ean, g&(eat& pent# co(ectaea apei fo(o"iteK- )a" c# ap& ca($&K- te%o%et# $e 4aieK- "&p#n (ic*i$ !a%ponK- %#!a%a !i a(e5&K- po"oapeK

2+


30/251

- #"c&to $e p&K- peie, piept&nK- paa)anK- %&n#!i $e #nic& fo(o"in&.

P-(gn po5iie !e5n$, e "ca#n "a# (a (a)oa

- "e poteea5& (eneia pacient#(#i c# %ateia( i%pe%ea4i(K- p( "e #%e5e!te, "e !a%ponea5&K- "e %a"ea5& #!o pie(ea cap#(#i c# p#(pa $egete(oK- p( "e c(&te!te(i%pe5e!te pna (a >n$ep&taea tota(& a !a%pon#(#iK- "e acope& cap#( c# #n po"op #"cat, ca($K

- p( "e #"#c& c# #"c&to#(. C# pacient#( >n pat- "e poteea5& pat#( c# %ateia( i%pe%ea4i(K

- cap&t#( (i4e a( %#!a%a(ei "e #(ea5& $in a%4e(e p&i !i "e into$#ce >n (ig*ean "a# g&(eat&K- %#!a%a#a "e acope& c# a(e5&K- p( "e #%e5e!te, "e !a%ponea5&K- "e %a"ea5& #!o pie(ea cap#(#i c# p#(pa $egete(oK- p( "e c(&te!te(i%pe5e!te pna (a >n$ep&taea tota(& a !a%pon#(#iK- "e acope& cap#( c# #n po"op #"cat, ca($K- p( "e #"#c& c# #"c&to#(.

#.3 S*>i/,a-(a po?ii(i pa*i(9t!!i i/o,ii?at: a0i9a/i* S*op- a"ig#aea confot#(#i pacient#(#iK- pe)eniea co%p(icaii(o fa)oi5ate $e i%o4i(i5ae e"cae, to%4o5e, >ncetiniea tan5it#(#i.

Mat(-ia( 9(*(+a-(- peneK- "#(#i $in pat#&, $in a(te %ateia(e te?ti(eK- "piinito pent# picioae, "aci $e ni"ip.

P-(gi/,a-(a po?ii(i 0i9 0(*!,it 0o-+a @9 0(*!,it at(-a- pe"oana cae face "c*i%4aea "e a!ea5& $e patea pat#(#i "pe cae "e >ntoace pacient#(K- "e p(ia5& p&t#a "pe patea op#"& pent# a ea(i5a #n "#( $e "piinieK- "e pin$e #%( pacient#(#i, "e i$ic& !i "e "piin& c# p&t#aK


31/251

- "e "piin& apoi toace(e pacient#(#i c# o %na, !i c# %na $in"pe picioae(e ace"t#ia "e otea5&4a5in#( !i %e%4e(e infeioaeK

- %e%4#( infeio $e $ea"#pa "e f(ectea5&, ce( $e $e$e4"#4t &%ne intin"K- "e p#ne o pen& "#4 gen#nc*i#( "#peioK- "e "piin& "pate(e c# p&t#a f&c#t& "#(K- "e ea!ea5& pat#(, "e >ntin$e (eneiaK- "e acope& pacient#(.,1 S*>i/,a-(a po?ii(i 0i9 0(*!,it at(-a @9 0(*!,it 0o-+a- pe"oana cae face "c*i%4aea "e a!ea5& $e patea pat#(#i "pe cae e"te >nto" pacient#(K- "e >n$ep&tea5& pena $e "#4 gen#nc*i !i "#(#( $in p&t#&K

- "e a!ea5& pacient#( c# %i!c&i 4(n$e >n $ec#4it $o"a(K- "e into$#c "#4 egi#nea (o%4a& !i "#4 gen#nc*i penie %ici "a# %ateia(e te?ti(e >%p&t#ite pent#

a e"pecta c#4#a fi5io(ogic& a co(oanei !i pent# a e)ita *ipee?ten"ia %e%4e(oK- "e ea!ea5& pat#(, "e >ntin$e (eneiaK- "e acope& pacient#(.

*1S*>i/,a-(a po?ii(i 0i9 0(*!,it 0o-+a @9 po?ii( ;(?90 D( *


32/251

- ce(e $o#& pe"oane "e a!ea5& $e o pate !i $e a(ta a pat#(#i fa& >n fa&K- 4ae(e $in"pe cap#( pacient#(#i "e >nc#ci!ea5& pe "pate(e ace"t#ia, cea(a(t& %n& "e into$#ce >n a?i(&K

- #na $inte pe"oane co%an$& %i!caeaK- pacient#( e"te ta" "pe cap#( pat#(#i !i "e fi?ea5& po5iia.01 S*>i/,a-(a po?ii(i 0i9 po?ii( ;(?90 @9 0(*!,it 0o-+a

Rea!e5aea pacient#(#i >n $ec#4it $o"a( $in po5iia !e5n$ "e face $e c&te $o#& pe"onae.- ce(e $o#& pe"oane "e a!ea5& $e o pate !i $e a(ta a pat#(#i fa& >n fa&K- #na $inte pe"oane co%an$& %i!caeaK- "e >n$ep&tea5& o4iecte(e $e "piin $e "#4 gen#nc*i !i $in $ept#( t&(pi(oK

- 4ae(e $in"pe cap#( pacient#(#i "e >nc#ci!ea5& pe "pate(e ace"t#ia, cea(a(t& %n& "e into$#ce >n a?i(&K

- c# o %i!cae atent& pacient#( e"te ta" pna a#nge >n $ec#4it $o"a(, c# cap#( "piinit pe pen&K- "e fi?ea5& "#(#i(e $e "piin "#4 egi#nea (o%4a& !i gen#nc*iK- "e ea!ea5& pat#(, "e >ntin$e (eneiaK- "e acope& pacient#(.(1 R(a0!*(-(a pa*i(9io- a!9(*ai 0i9 po?ii( +(/i;(?90 +a! ;(?90- pacient#( e"te #gat "& "e "piine pe t&(piK- "e pin$e $e "#4 a?i(e !i "e tage #!o "pe cap#( pat#(#iK

- $ac& acti)ea5& $o#& pe"oane "e pin$e c# o %n& $e "#4 a?i(&, ia cea(a(t& $e into$#ce "#4 egi#nefe"ie& !i "e acionea5& (a co%an$&K

- "e fi?ea5& po5iia.

#.2. Mo,ii?a-(a pa*i(9t!!i S*op- pe)eniea co%p(icaii(oK- "ti%#(aea ton#"#(#i %#"c#(a, fi5ic !i p"i*ic. Mat(-ia( 9(*(+a-(- ca$# %o4i(K- agitatoK- 4a"tonK- ce.

P-(gati-(a pa*i(9t!!i0e an#n& pacient#( !i "e e?p(ic& i%potan!a %o4i(i5&ii pecoce. 'ent# an#%ii pacienti "e cee aco$#(%e$ic#(#i pi)in$ tip#( !i paa(i5ai, opeai, c# infact %ioca$ic.Mo,ii?a-(a pa+i=nt-#n #ng*i $e +Q !i "#nt (&"ate "& atne #!o (a %aginea pat#(#iK- "e "piin& $ac& pacient#( n# i!i poate %enine po5iia. E?ec#taea $e c&te $o#& pe"oane

- "e into$#ce cte o %n& "#4 o%op(ai, ia cea(a(t& "#4 egi#nea pop(iteeK- "e i$ic& pacient#( >n po5iie !e5n$ !i "e ote!te c# #n #ng*i $e +Q, fiin$ a$#" (a %aginea pat#(#iK- ea!e5aea >n pat "e face e?ec#tn$ %i!c&i(e >n o$ine in)e"&.*1 A;(?a-(a pa*i(9t!!i @9 )otoi!- "e a!ea5& pacient#( (a %aginea pat#(#iK- "e a$#ce foto(i#( c# e5e%&toaea (atea(& (a %aginea pat#(#iK- pe"oana "e a!ea5& >n faa pacient#(#i, into$#ce %ini(e "#4 a?i(&K- pacient#( "e i$ic& #!o >n picioae a#tat $e c&te #na "a# $o#& pe"oaneK- "e >ntoace pacient#( c# "pate(e "pe foto(i# !i "e a!ea5& c# gi&K- "e acope& c# #n p(e$K- ea$#ceea >n pat "e face e?ec#tn$ %i!c&i(e >n "en" in)e".01 Ri0i*a-(a pa*i(9t!!i @9 po?ii( o-to+tati*n pat $aca ae a%ee(iK

- ea!e5aea >n pat "e face e?ec#tn$ %i!c&i(e >n "en" in)e".(1 E)(*t!a-(a p-i/io- pa;i- "e >ntea4& %e$ic#( $ac& pacient#( poate fi %o4i(i5atK- "e i$ic& >nti >n po5iie !e5n$, apoi e"te a$#" (a %aginea pat#(#iK- "e i$ic& >n picioae !i "e o4"e)& co%pota%ent#(K

- "e "piin& $e 4a "a# "e ofe& #n ca$# %o4i( !i "e pac#ge $i"tana eco%an$at& $e %e$icK- "e ce!te $i"tana poge"i)K- pacient#( e"te inc#aat "a "e $ep(a"e5e !i "ing# pe %&"#& ce "taea "a pe%ite.

#.4. Capta-(a (i/i9n #ina "a# "e oientea5& "pe p(o"c&K

- pacient#( "e i5o(ea5& !i "e (a"& cte)a %in#te "ing#K

- "e a#t& pacient#( "a-!i "pe(e %ini(e.,1 Capta-(a /at(-iio- )(*a(- "e "pa(& %ini(e, "e >%4ac& %&n#!i $e #nic& fo(o"in&K- "e poteea5& pat#( c# a(e5& !i %#!a%aK- "e i5o(ea5& pacient#( c# #n paa)anK- "e $e54ac& patea infeioa& a cop#(#iK


34/251

- "e >nc&(5e!te p(o"ca4a5inet#( c# ap& ca($&, "e !tege c# *tie igienic&K- "e into$#ce o %n& "#4 egi#nea "aca(& a pacient#(#i, "e i$ic& #!oK- c# cea(a(t& %n& "e into$#ce p(o"ca "#4 pacientK- "e acope& pacient#( !i "e (a"& "ing#K- "e ofe& $#p& $efeca!ie *tie igienic&, $ac& "taea pacient#(#i >i pe%ite "& o fo(o"ea"c&K- "e >n$ep&tea5& p(o"ca acopeit&K- $aca e"te nece"a "e face toa(eta egi#nii pe #n a(t 4a5inetK- "e ofe& pacient#(#i ap&, "&p#n, po"op pent# a-!i "p&(a %ini(eK- "e ea!ea5& pat#(K

- "e aei"e!te ca%ea. O,+(-=aii

0e o4"e)& $ac& "ca#n#( e"te %o$ificat c#(oae, con"i"ten&, fo%&, cantitate.*1 Capta-(a +p!t(i- #%&e!te pe)eniea &"pn$iii infeciei, o4"e)aea a"pect#(#i "a# o4ineea #no %o"te pent#

e?a%ene $e (a4oatoK- captaea "e face >n c#tii peti "a# pa*ae conice ga$ate c# "o(#ie $e5infectant& c# e?cepia "it#aiei >n

cae "e eco(tea5& pent# (a4oatoK- pacient#( e"te in"t#it c#% "& co(ecte5e "a# "a eco(te5e "p#ta pent# e?a%en#( $e (a4oato, e(i%inn$

n#%ai >n co(ectoae(e ofeiteK- "c#ip&toaea "e "c*i%4& ce( p#in $e $o#& oi pe 5iK- "e a#t& pacient#( "&-!i c(&tea"c& g#a c# ap&K- "e "f&t#ie!te pacient#( "& "tea >nt-o po5iie cae "& fa)oi5e5e e(i%inaeaK- "e go(e"c c#tii(e "a# pa*ae(e fo(o"ite !i "e "tei(i5ea5& coect >n )e$eea efo(o"iiiK- "e notea5& cantitatea, a"pect#(, co%po5iiaK- "e e"pect& c# "tictee peca#ii(e #ni)e"a(e.01 Capta-(a =n $ec#4it, "e ote!te cap#( >nt-o pate !i t&)ia "e a!ea5& (ng& faa ace"t#iaK- "e >n$epatea5& i%e$iat t&)ia c# )o%&, $#p& cae "e o4"e)& conin#t#(K- "e ofe& pacient#(#i #n pa*a c# ap& pent# a-!i c(&ti g#a, !i #n !e)ee(K- pacient#( >n $ec#4it te4#ie atent "#pa)eg*eat "& n# a"pie )o%aK- $ac& pacient#( ae $in no# "en5atia $e )o%&

- e"te "f&t#it "& e"pie a$ncK- "e aei"e!te >nc&peeaK

- pacient#( >n $ec#4it te4#ie atent "#pa)eg*eat "& n# a"pie )o%aK- $ac& pacient#( ae $in no# "en5atia $e )o%&

- e"te "f&t#it "& e"pie a$ncK- "e aei"e!te >nc&peeaK- "e "e)e!te o t&)i& c#ata )e$eea )o%ei poate $ec(an!a ef(e?#( $e )o%&K O,+(-=aii

n ca5#( inge"tiei acci$enta(e $e a(i%ente a(teate "a# to?ice,"a# $e %e$ica%ente, eco(taea "e face $in)&"&t#a pent# e?a%en#( $e (a4oato.

/


35/251

Capito! % ALIMENTAREA PACIENTULUI

A+p(*t( g(9(-a(- "e c#(eg $ate $e"pe egi%, oa#( %e"e(o, epati5aea pe %e"e, po"i4i(it&i(e $e %o4i(i5ae,

capacitatea pacient#(#i $e a-!i fo(o"i %e%4e(e "#peioaeK- "e o4in info%aii $e"pe e"ticii (egate $e efect#aea #no e?a%ene, a$%ini"taea #no

%e$ica%ente >n f#ncie $e oa#( %e"e(oK- "e o4in info%aii $e"pe pefeine(e a(i%entae a(e pacient#(#i.

%.". Ai/(9ta-(a a*ti=n "a(on (a %a"&, >n "a(on (a pat >n po5iie !e5n$, "a# >n $ec#4it(atea(.Dac& e"te ca5#(, "e poteea5& (eneia c# #n po"op.6(i%ente(e "#nt "e)ite >n con$iii igienice pe o ta)&, %a"& pota4i(&, acopeite. 'acient#( e"te a#tat "& >!ipoione5e a(i%ente(e.0e o4"e)& con"#%#( $e a(i%ente $e c&te pacient, e"pingeea #no a(i%ente. n $ec#4it (atea(

- "e i$ic& #!o cap#( pacient#(#i, "e poteea5& pat#(K- a(i%ente(e "e a!ea5& (ng& pacientK- pacient#( e"te a!e5at c# patea "&n&toa"& acce"i4i(&K- "e a"ig#& a$%ini"taea (ic*i$e(o c# pai#( "a# $in c&ni c# cioc.

%.# Ai/(9ta-(a pa+i=n f#ncie $e "taea genea(a, pacient#( e"te a!e5at >n po5iie !e5n$, "a# c# cap#( i$icatK- "e poteea5& (eneia $e pat !i cea $e copK- "e p(a"ea5& ta)a (ng& pacient >n a!a fe( >nct "& )a$& a(i%ente(eK- "e )eific& te%peat#a a(i%ente(oK- "e a$%ini"tea5& cantit&i %ici, )eificn$#-"e $ac& a >ng*iit cantitatea $e a(i%ente $at& anteioK- a(i%ente(e "e taie 4#c&i %ici, n# "e ating c# %naK- e"t#i(e $e a(i%ente "e >n$ep&tea5& $in "a(on. %io"#( "a# )e$eea (o poate $ec(an!a ef(e? $e

)o%&K

O,+(-=aii- $ac& %a"a "e "e)e!te >n "a(on, ace"ta te4#ie aei"it >nainteK- "e >n$ep&tea5& p(o!ti(e #inaeK- n# "e a"ocia5& oa %e"ei c# oa $e tata%entK- pacienii a!i, c# 4o(i $e pie(e, c# a"pect nep(&c#t, "#nt acopeii !i i5o(ai- "e i$entific& %oti)e(e pent# cae pacient#( ef#5& a(i%entaia "a# an#%ite a(i%enteK- "e con"e%nea5a toate ac#5e(e $in ti%p#( %e"eiK- pacient#( inapetent te4#ie "ti%#(at c# tact "& accepte *anaK- pacienii c# t#(4#&i $e $eg(#ie "#nt atent o4"e)ai.

- "e fo(o"e"c a(i%ente "e%i"o(i$e $ac& pacient#( ae t#(4#&i $e $eg(#ie.


36/251

Capito &. MSURAREA I SUPRAVEGEREA FUNCIILOR VITALE I A ALTORPARAMETRI

&." Ma+!-a-(a ;i 9ota-(a t(/p(-at!-ii *o-po-a(9&"#aea te%peat#ii copoa(e "e efect#ea5&, (a oa act#a(&, c# te%o%et#( e(ectonic.6paat#( pe%ite %&"#aea te%peat#ii c#tanate >n a?i(&, ecta(e !i ti%panice. 6cea"t&%&"#ae a te%peat#ii e"te api$& !i fia4i(&.

I90i*aii- "#pa)eg*eea "i"te%atic& >n c#"#( "pita(i5&iiK- "#pa)eg*eea #n#i "in$o% infecio" "a# inf(a%ato.

P-(gn patK

'ent# "#pa)eg*eea "i"te%atic& e"te i%potant $e con"i$eat fapt#( c& te%peat#a e"te %ai %ic&$i%ineaa >nainte ca pacient#( "& "e i$ice $in pat.

E)(*t!a-(a p-o*(0!-ii 0( /n #ec*ea pacient#(#iK- "e ote!te te%o%et#( c# Q >n "pate pent# a fi >n faa ti%pan#(#iK

- apaat#( afi!ea5& te%peat#a >n 1- "ec#n$e. C! t(-/o/(t-! ((*t-o9i* *!ta9at- "e $e"cope& a?i(a pacient#(#iK- "e ta%ponea5& pent# a >n$ep&ta tan"piaiaK- "e into$#ce "on$a captato#( te%o%et#(#i >n %i(oc#( a?i(ei !i "e apopie 4a#( $e toaceK- "e a!teapt& "ec. pn& "e a#$e "e%na(#( "onoK- "e a#"tea5& te%peat#a afi!at& c# ,QC pent# a o4ine te%peat#a copoa(&K

- "e "pa(& %ini(e.6ce(a!i te%o%et# poate fi fo(o"it !i pent# %&"#aea te%peat#ii ecta(e. C!t(-/o/(t-! ((*t-o9i* o-a

- "e into$#ce "on$a captato#( e(ectonic >nt-#n capi!on $in %ateia( p(a"ticK- "e p(a"ea5& >n ca)itatea 4#ca(&, "#4(ing#a(K- "e %enine te%o%et#( pe (oc pn& (a "e%na(#( "onoK

- "e "coate te%o%et#( !i "e cite!te )a(oaeaK- "e a#nc& capi!on#( $in p(a"tic >n ecipient#( pent# $e!e#iK- "e "pa(& %ini(e.

C! t(-/o/(t-! ((*t-o9i* -(*ta- "e a!ea5& pacient#( >n po5iia 0I90K- "e into$#ce "on$a te%o%et#(#i poteat& $e capi!on#( (#4ifiat apo?i%ati) / c%K

3


37/251

- "e %enine te%o%et#( pn& (a "e%na(#( "onoK- "e "coate te%o%et#(, "e cite!te )a(oaeaK- "e a#nc& capi!on#( >n ecipient#( pent# $e!e#iK

- "e "pa(& %ini(e.O,+(-=aii

- %&"#aea te%peat#ii ecta( poate "& antene5e (e5i#ni $ac& e"te pacticat& coti$ianK.- %&"#aea te%peat#ii ecta( poate po)oca "nge&i (a copii, #pt#i a(e )ene(o *e%ooi$a(e,

e"cae "a# ectite nece"itn$ inte)enii c*i#gica(e.

R(p-(?(9ta-(a g-a)i*< a t(/p(-at!-ii- "e "ocote"c pent# fiecae (inie oi5onta(& $in foaia $e te%peat#& cte 2 $i)i5i#ni $e ga$K- "e notea5& gafic )a(oaea >negi"tat&, pint-#n p#nct $e c#(oae a(4a"t& a!e5at $iect pe (inia

oi5onta(& $in #4ica coe"p#n5&toae pent# $i%ineaa D "a# "eaa 0 pent# cife(e c# "o paeKe?e%p(# 3,2K 7,/K 8,3K etc

- "e #ne!te pi%#( p#nct c# #4ica pent# te%peat#& af(at& >n patea $eapt& a "i"te%#(#i $ecoo$onate $in foaia $e te%peat#&K

- "e o4ine c#4a te%ic& pin #niea p#ncte(o cae in$ic& )a(oi(e te%peat#ii %&"#ate 4icoti$ian pepac#"#( 5i(e(o $e "#pa)eg*ee !i >ngiie.

E0!*a-(a pa*i(9t!!i- "e info%ea5& pacient#( c& te%o%et#( e"te #n in"t#%ent in$i"pen"a4i( pent# apecieea "t&ii

genea(e (a $o%ici(i#K- "e e?p(ic& pacient#(#i c#% "& >ntein& !i "& #ti(i5e5e te%o%et#(K- "e ofe& pacient#(#i #n ta4e( c# )a(oi te%ice oientati)e, >n f#ncie $e ca(ea $e %&"#ae fo(o"it&, ca

>n e?e%p(#( $e %ai o".

Ca(ea $e 0ca(a Ce("i#" 0ca(a Fa*en*eit%&"#ae

Oa(& 7QC , - ,3 +8,3QF , - 1,

Recta(& 7,QC , - ,3 ++,3QF , - 1,

6?i(a& 3,QC , - ,3 +7,3QF , - 1,

&.# M


38/251

- "e e?p(ic& pacient#(#i poce$#a pent# a e$#ce e%oii(e, tea%a !i a o4ine co(a4oaeaK- "e a"ig#& #n epa#" p"i*ic $e ce( p#in %in#te >nainte $e %&"#aeK 'eg&tiea fi5ic&

- "e a"ig#& #n epa#" fi5ic $e ce( p#in %in#te >nainte $e %&"#aeK- "e a!ea5& pacient#( >n po5iie confota4i(& >n f#ncie $e "taea genea(&

- >n $ec#4it $o"a( c# %e%4#( "#peio >ntin" pe (ng& cop, atic#(aia %inii ine?ten"ie, %na in "#pinaie pa(%a oientat& >n "#"K

- >n po5iie "e%i!e5n$a >n pat "a# >n foto(i# ante4a#( >n #ng*i $ept "piinit pe"#pafaa pat#(#i, %na >n "#pinaie !i e?ten"ie.

E)(*t!a-(a p-o*(0!-io-- "e "pa(& %ini(eK- "e epeea5& atea a$ia(& (a e?te%itatea $i"ta(& a ante4a#(#i, pe faa anteioa& inten&, >n !an#(

a$ia( af(at >n pe(#ngiea po(ice(#iK- "e p(a"ea5& $egete(e in$e?, %e$i# !i ine(a 2,,/ $ea"#pa ateei a$ia(e epeateK- "e e?ecit& o pe"i#ne #!oa& a"#pa ateei pe o"#( a$i#", a"tfe( >nct "& "e peceap& "#4 $egete

p#("aii(e "nge(#iK- "e fi?ea5& #n p#nct $e epe pe ca$an#( cea"#(#i $e %n&K- "e n#%&& ti%p $e 1 %in#t p#("aii(e pecep#te "#4 $egete, "a# "ec#n$e !i >n%#(ite c# $oi

n#%( pent# a o4ine ata p#("#(#i pe %in#tK- "e apecia5& it%#(, a%p(it#$inea !i e(a"ticitatea peete(#i ateia( >n ti%p ce "e %&"pa& fec)enaK- "e >negi"tea5& fec)ena p#("#(#i >n canet#( pe"ona( notn$ n#%e(e pacient#(#i, "a(on#(, $ata

>negi"t&ii, ataK- "e "pa(& %ini(e.

R(p-(?(9ta-(a g-a)i*< a p!+!!i @9 )oaia 0( t(/p(-at!-n / e?. 3/, 38, 73, 8K

- "e notea5& gafic )a(oaea >negi"tat& pint-#n p#nct $e c#(oae o!ie a!e5at >n %i(oc#( p&tat#(#i$in #4ica coe"p#n5&toae D "a# 0 pent# )a(oi(e cae ce"c $in 2 >n 2 e?. 32, 33, 7K

- "e #ne!te pi%#( p#nct, pint-o (inie c# "&geat&, c# #4ica p#("#(#i af(at& >n patea $eapt& a"i"te%#(#i $e coo$onate $in foaia $e te%peat#&K

- "e o4ine c#4a p#("#(#i pin #niea p#ncte(o cae in$ic& )a(oi(e atei ca$iace %&"#ate 4icoti$ian,pe pac#"#( 5i(e(o $e "#pa)eg*ee !i >ngiie.

E=a!a-(a ()i*a*itn (i%ite(e no%a(e coe"p#n5&toae )"teiK- teg#%ente(e !i %#coa"e(e "#nt no%a( co(oateK

- pacient#( e"te (ini!tit.

R(?!tat( 9(0o-it(- ata p#("#(#i e"te %ai %ae "a# "#4 no%a(#( caactei"tic )"teiK- p#("#( a$ia( n# e"te pecepti4i(K- p#("#( e"te ait%icK- a%p(it#$inea e"te %ic& "a# ce"c#t&K- pacient#( e"te pa(i$, an?io", ac#5& pa(pitaii, e?ta"i"to(eK

8


39/251

- pacient#( ae #na "a# %ai %#(te $inte po4(e%e(e $e $epen$en& #%&toae- into(ean& (a acti)itateK- a(teaea confot#(#iK- $eficit $e )o(#% (ic*i$ianK- e?ce" $e )o(#% (ic*i$ianK

- at(-a-(a p (-)!?i(i ti +!a-(. Mo0i)i*n egi#nea ing*ina(&, (a ni)e(#( ti#ng*i#(#i (#i 0capaK- ape? )f#( ini%ii - p#("#( apica(, >n "pai#( inteco"ta( i.c. pe (inia %e$ioc(a)ic#(a&

"tng&K- (a copiii "#4 2 ani "e e)it& %&"#aea p#("#(#i a$ia( >nt#ct ata ce"c#t& !i aia %ic& $e pa(pae pot

$ete%ina )a(oi ine?acteK- (a copiii pe"te 2 ani ata p#("#(#i a$ia( "e o4ine at#nci cn$ "#nt (ini!tii "a# $o%, >nt#ct e"te

$ifici( "& o4ii co(a4oaea copi(#(#i $e a &%ne c# %na ne%i!cat&K- (a copi(, pent# o ac#atee %a?i%&, ata p#("#(#i "e n#%&& ti%p $e 1 %in#t.

E0!*a-(a pa*i(9t!!i- "e >n)a& pacient#( "&-!i %&"oae "ing# p#("#( peifeic (a atee(e caoti$& "a# te%poa(& >nt#ct

"#nt %ai acce"i4i(e pent# a#topa(paea (a $o%ici(i#K- "e in"t#ie!te pacient#( "& e?ecite o pe"i#ne #!oa& fo(o"in$ $egete pent# pa(paeK- "e info%ea5& pacient#(fa%i(ia cae "#nt )a(oi(e no%a(e a(e p#("#(#i, caactei"tice )"teiK- "e in"t#ie!te pacient#(fa%i(ia "& ia (eg&t#a c# %e$ica( c#ant oi $e cate oi )a(oi(e atei p#("#(#i

"#nt $e)iate $e (a no%a( !i "taea genea(& a pacient#(#i "e %o$ific&.- "e ofe& pacient#(#i #n ta4e( c# )a(oi oientati)e ca >n e?e%p(#( $e %ai o"

;"ta Rata apo?i%ati)& Rata %e$ie

No#-n&"c#t 12 -13 1/

1- 2(#ni"#ga 1-1/ 12

12 (#ni - 2 ani 8-1 11

2 ani- 3 ani 7-12 1

3 ani - 12 ani 7-11 +

6$o(e"cent 3-1 8

6$#(t 3-1 8

&.% M


40/251

- e)a(#aea "t&ii pacient#(#i >n ce pi)e"te )o(#%#( $e "nge, an$a%ent#( ini%ii !i "i"te%#( )a"c#(aK- apecieea &"p#n"#(#i pacient#(#i (a tata%ent#( c# f(#i$e "a#!i %e$ica%ente.

P-(g


41/251

- "e >negi"tea5& %enta( cifa in$icat& $e ac#( %ano%et#(#i >n o"ci(aie >n %o%ent#( >n cae, >n #ec*i,"e a#$e pi%a 4&taie c(a& (#p-$#pK acea"t& cif& epe5int& pe"i#nea ten"i#nea "i"to(ic& "a#%a?i%&K

- "e >negi"tea5& n#%( cae coe"p#n$e 4&t&ii $e fina( >n ti%p ce "e contin#& $eco%pi%aea%an!eteiK ace"ta epe5int& T.6. $ia"to(ic& "a# %ini%&K

- "e >n$ep&tea5& %an!eta, "e c#&& !i "e $e5infectea5& o(i)e(e "teto"cop#(#iK- "e >negi"tea5& )a(oi(e %&"#ate >n canet#( pe"ona(, notn$ n#%e(e pacient#(#i, $ata >negi"t&ii,

)a(oi(e o4in#te T.6. S 17 %%=g "a# T.6.S 17 c%=g.

R(p-(?(9ta-(a g-a)i*< a T.A.- "e "ocote"c pent# fiecae (inie oi5onta(& $in foaia $e te%peat#&, 1 %%=g "a# 1 c% =gK- "e epe5int& gafic )a(oi(e >negi"tate pint-#n $ept#ng*i $e c#(oae a(4a"t&, a!e5at pe )etica(a

ti%p#(#i D "a# 0K (at#a $e "#" a $ept#ng*i#(#i epe5int& T.0. ten"i#nea "i"to(ic& ia (at#a $e o"a $ept#ng*i#(#i epe5int& T.D. ten"i#nea $ia"to(ic&.

E=a!a-(a ()i*a*itn #ec*iK- "e %&"oa& T.6. (a coap"& $aca acce"#( (a atee(e 4a#(#i n# e"te po"i4i(K- "e a(ege o %an!et& (at& !i "e a!ea5& pacient#( pe a4$o%en pent# pa(paea a$ec)at& a ateei pop(iteeK- "e a#"tea5& e)a(#aea pe"i#nii ateia(e >negi"tate, $ac& "e fo(o"e!te coap"a, >nt#ct e?i"t& ten$ina

ca T.6. "& fie %ai %ae (a e?te%itatea $i"ta(& faa $e e?te%itatea po?i%a(& "#peioa&K- "e %&"oa& pe"i#nea ateia(& pin %eto$a pa(patoie, >n (ip"a "teto"cop#(#i a#ic#(aK pin acea"ta

%eto$& >ntot$ea#na "e o4ine e?act n#%ai ten"i#nea "i"to(ic&.

E0!*a-(a pa*i(9t!!i

- "e "f&t#ie!te pacient#( a$#(t "&-!i %&"oae T.6. ce( p#in o$at& pe anK- "e info%ea5& pacient#( $e"pe #ti(itatea a#to%&"#&ii T.6. (a $o%ici(i#, pin ec*ipa%ent $igita(K$e!i e"te co"ti"ito e"te %#(t %ai #!o $e citit )a(oi(eK

- "e in"t#ie!te pacient#( "& "e pe5inte c# po%ptit#$ine (a %e$ic $ac& )a(oi(e T.6. "#nt o"ci(anteK- "e in"t#ie!te pacient#( c# *ipeten"i#ne ateia(& =T6 "&-!i ia %e$ica%ente(e >n %o$ eg#(at, "&

e$#c& con"#%#( $e "ae, "&-!i )eifice ge#tatea !i "& >n)ee te*nici $e %anage%ent a( "te"#(#iK

/1


42/251

- "e info%ea5& pacient#(fa%i(ia cae "#nt )a(oi(e no%a(e >n f#ncie $e )"t&K "e ofe&, e)ent#a(, #nta4e( c# )a(oi oientati)e ca >n e?e%p(#( $e %ai o"

;"ta ;a(oi no%a(e a(e Li%ite "#peioae a(e

T.6. no%a(#(#i1 an +3 %%=g Ne$ete%inate

3-+ ani 13 %%=g 11+7+ %%=g

1-1 ani 113 %%=g 12/8/ %%=g

1/-17 ani 128 %%=g 1/8+ %%=g

18- a$#(t 128 %%=g 1+8+ %%=g

&.& M!i poate %o$ifica it%#( o4i!n#it >n %o%ent#(

>n cae con!tienti5ea5& popia e"piaieK- "e %&"oa& e"piaia conco%itent c# ce(e(a(te "e%ne )ita(e $ac& apa "c*i%4&i >n "taea pacient#(#i,

$ac& pacient#( ae o afeci#ne ca$io-p#(%onaa "a# pi%e!te o?igen oi %e$ica%ente ce afectea5&fi5io(ogia e"piaiei.

E)(*t!a-(a p-o*(0!-ii- "e o4"e)& %i!c&i(e $e i$icae "a# $e co4oe a(e toace(#i c# fiecae in"piaie "a# e?piaieK- "e %enin, >n contin#ae, $egete(e pe (oc#( $e %&"#ae a p#("#(#i >n ti%p ce "e o4"e)& toace(e

pacient#(#iK- "e n#%&& %i!c&i(e $e i$icae a toace(#i in"piaii(e ti%p $e %ini%#% $e "ec#n$e !i "e

>n%#(e!te c# 2 n#%( o4in#t pent# a af(a ata pe %in#tK- "e n#%&& ti%p $e 1 %in#t in"piaii(e $ac& e"piaia e"te neeg#(at&K- "e >negi"tea5& ata e"piatoie >n canet#( pe"ona( notn$ n#%e(e pacient#(#i, $ata >negi"t&ii,

ata e"piatoieK- "e "pa(& %ini(e $ac& "-a atin" pacient#( "a# pat#( ace"t#ia pe $#ata %&"#&ii.

/2


43/251

R(p-(?(9ta-(a g-a)i*< a T.A- "e "ocote!te cte o e"piaie pent# fiecae (inie oi5onta(a $in foaia $e te%peat#&K- "e notea5& gafic )a(oaea >negi"tat& pint-#n p#nct $e c#(oae a(4a"t& a!e5at $iect pe (inia

oi5onta(& $in #4ica coe"p#n5&toae pent# $i%ineaa D "a# "eaa 0K- "e #ne!te pi%#( p#nct, pint-o (inie c# "&geat&, $e #4ica e"piaiei af(at& >n patea $eapt& a

"i"te%#(#i $e coo$onate $in foaia $e te%peat#&K- "e o4ine c#4a e"piaiei pin #niea p#nct#(#i iniia( c# ce(e(a(te )a(oi a(e %&"#&toi(o efect#ate

#(teio.

E=a!a-(a ()i*a*itn ti%p !i "pai#.

R(?!tat( 9(0o-it(- ata e"piatoie e"te %ai %ic& "a# %ai %ae fa& $e )a(oi(e no%a(e caactei"tice )"teiK- pacient#( tece pint-o $ete"& e"piatoie %anife"tat& pin 5go%ote e"piatoii ano%a(e, efot

e"piato, #ti(i5aea %#!c*i(o e"piatoii acce"oii, otopnee, pie(e pa(i$& "a# cianotic&, pie$ee $ec#no!tin&K

- pacient#( poate a)ea #na "a# %ai %#(te $in #%&toae(e po4(e%e $e $epen$en&- into(ean& (a acti)itateK- an?ietateK- a(teaea confot#(#iK- c(eaance ineficient a( c&i(o e"piatoiiK- po"i4i(& in"#ficien& e"piatoieK- a(teaea "c*i%4#i(o ga5oa"e.

Mo0i)i*nainte $e n#%&aea e"piaii(o $ac& a apt o acti)itate ecent&

ce poate a(tea ata e"piatoie a pacient#(#iK- "e $e"cope& toace(e pacient#(#i $ac& e"piaia e"te "#peficia(& pent# a o4ine cea %ai coect& at&

e"piatoieK- "e e)it& %&"#aea e"piaiei (a "#ga "a# copi( >n ti%p#( p(n"#(#iK- "e ap(ic& po$#( pa(%ei pe toace(e copi(#(#i at#nci cn$ $oa%e pent# a n#%&a e?act %i!c&i(e

e"piatoii.

E0!*a-(a pa*i(9t!!i- "e >n)a& poce$#a $e %&"#ae !i >negi"tae a atei e"piatoii $e c&te %e%4ii fa%i(iei ca !i

aco$aea $e >ngiii at#nci cn$ e"te ne)oieK- "e a#t&in"t#ie!te pacient#( pi)in$ %o$#( >n cae te4#ie "& "e >ngiea"c& (a $o%ici(i# in f#ncie $e

caactei"tici(e e"piaiei !i $e "tat#"#( e"piatoK- "e e?p(ic& p&ini(oapain&toi(o c& te4#ie "a "e pe5inte c# copiii (a %e$ic $ac& apa $ific#(t&i >n

e"piaie "a# e"piaie "#peficia(&K- "e "f&t#ie!te pacient#( "& #%i$ifice, "& >nc&(5ea"c& "a# "& &cea"c& ae#( $in "pai#( a%4ienta( pent# ae$#ce inci$ena infecii(o e"piatoiiK

- "e "f&t#ie!tein"t#ie!te pacient#( "& e"pecte in$icaii(e %e$ic#(#i (egate $e a$%ini"taea%e$ica%ente(o, $e $iet& !i e)itaea factoi(o $e i"c >n "cop#( a%e(io&ii "a# $i"paiiei po4(e%e(oe"piatoiiK

/


44/251

- "e info%ea5& pacient#(fa%i(ia $e"pe )a(oi(e no%a(e caactei"tice )"tei e?. in ta4e(#( $e %aio".

;"ta Rata %e$ie%in#t

No#-n&"c#t -8

Copi( %ic 2-/

Copi( %ae 1-2

6$#(t 1/-2

:&4at 1/-18Fe%eie 13-2

&.3 M%pe#n& oa poti)it& >n c#"#( 5i(eiK- "e a"ig#& pacient#(, $ac& e"te ca5#(, c& "e e"pect& inti%itatea. Fi5ic&

- "e a#t& pacient#( "& "e $e54ace $e *a(at K- "e in"t#ie!te pacient#( "& n# %&nnce, "& #ine5e !i "& e(i%ine "ca#n#(.

E)(*t!a-(a p-o*(0!-ii Mn&(i%ii. Mn$ep(inite con$iii(e

- pacient ne%ncatK- )e5ica #ina& go(it&K- "ca#n e(i%inatK

- "e a"ig#& c& poat& ace(ea!i *aine (a fiecae cnt&ieK- "e fo(o"e!te ace(a!i cntaK- "e a$a#g& c#"oae(e pe i(oga%e !i ga%e, "a# c#"o#( apoape $e ge#tatea e"ti%at& a

pacient#(#iK

//


45/251

- "e cee pacient#(#i "& #ce pe cntaK- "e $e"c*i$e 4a#( tia !i "e %i!c& ce(e $o#& c#"oae c#"o#( pn& ac#( "e "ta4i(e!te $in no#

(a 5eoK- "e fi?ea5& "caa c#"o#(#i !i "e cee pacient#(#i "& co4oae.

Fi9ai?a-(a p-o*(0!-ii- "e con$#ce pacient#( (a pat $ac& e"te ne)oieK- "e a#t& "& "e a!e5e >n pat.

Nota-(a p-o*(0!-ii- "e notea5& )a(oi(e >n&(i%ii !i ge#t&iiK

- "e peci5ea5& $ac& $in $i)e"e %oti)e n# pot fi >n$ep(inite toate con$iii(e i%p#"e pent# ea(i5aea$e %&"#&toi e?acte.

E=a!a-(a ()i*a*itn ogani"%K- "e )eific& e"pectaea egi%#(#i a(i%enta.

PARTEA III 6 INTERVENII DELEGATE '()(*t!at( +!, p-(+*-ipi( /(0i*a


46/251

- e?a%ene paa5ito(ogice.

P-(gne(egee, e)itn$ te%eni

%e$ica(iK- "e e?p(ic& nece"itatea e?a%en#(#i- "e o4ine con"i%&%nt#(K

- "e info%ea5& pacient#( c# pi)ie (a oa#( eco(t&i(o >n apot c# ce(e(a(te acti)it&i $in "ecie"e)iea %e"ei, a$%ini"taea %e$ica%ente(o, efect#aea a(to in)e"tigaiiK

- "e in"t#ie!te pacient#( c# pi)ie (a e"ticii(e a(i%entae, peioa$a $e po"t oe, e)ent#a(a>nte#pee a #no %e$ica%ente (a eco%an$aea %e$ic#(#i. 9aoitatea te"te(o "e eco(tea5& >ncon$iii 4a5a(e pe ne%ncate, $i%ineaa $e)e%e, $#p& te5ie !i (a %ini% 8 oe $e (a #(ti%a %a"& >ncon$iii $e epa#" fi5ic !i p"i*icK

- "e i$entific& e)ent#a(e a(egii (a "#4"tane $e5infectante, (ate?K- "e co%4ate an?ietateaK- "e ofe& info%aii c# pi)ie (a ti%p#( nece"a pn& (a o4ineea e5#(tate(o.

E-o-i 0( -(*ota-(- pacient#( n# e"te in"t#it coe"p#n5&to pi)in$ poce$#aK

- pacient#( n# e"te peg&tit coect "a# n# "e e"pect& eco%an$&i(e pi)in$ $ieta, con"#%#( $e%e$ica%ente, po"t#& incoect&K

- %ane)ae, etic*etae incoect&K- ecipient ina$ec)at, cantitate $e po$#" in"#ficient&K- tan"pot !i con"e)ae necoe"p#n5&toaeK- neetan!ei5aea ecipiente(o, conta%inaea po4e(oK- >nt5ieea e?pe$ieii po$#"e(o (a (a4oato, p&"taea >n con$iii necoe"p#n5&toaeK

- nee"pectaea o$inii $e eco(tae $e #%p(ee a f(acoane(oK- neo%ogeni5aea coect& a "nge(#i c# anticoag#(ant#(a$iti)#( $in f(aconK

- %enineea gao#(#i %ai %#(t $e 1 %in#t poate %o$ifica o "eie $e e5#(tate po$#ce*e%oconcentaie, %o$ificaea poteine(o p(a"%atice, acti)aea p(ac*ete(oK

O,+(-=aiiMedicul identific medicamente cunoscute a interaciona cu metodele de testare (anticoagulante,

anticonvulsivante, antihipertensive, antibiotice, antivirale, hipoglicemiante orale, hormoni,

medicamente psihotrope) i hotrte dac trebuie ntrerupte i cu ct timp nainte!

Mat(-ia( 9(*(+a-(9ateia( pent# p#ncie

- "eingi, ace "tei(e a$aptate, ace c# f(#t#a!i 4#ttef(K- )ac##%#i a$ec)ate c# "a# f&& anticoag#(anta$iti)i >n f#ncie $e po4&K

- pan"a%ent a$e5i)K 9ateia( $e $e5infecie

- ta%poane )at&, tifonK- a(coo(, 4eta$in&K- %&n#!i $e #nic& fo(o"in&K- gao#K- %ateia( $e potecie %ateia( i%pe%ea4i(, a(e5&c%pK

- containe pent# %ateia(e fo(o"iteK 6(te %ateia(e

/3


47/251

- etic*ete, co$ $e 4aeK- ta)& pent# %ateia(e.

P-(gn "nge, a ni)e(#(#i "eic a( #no %e$ica%ente "e pefe&ecipiente $in "tic(&K

- "e e"pect& #%&toae(e in"t#ci#ni $e fo(o"ie a )ac##%#i(o c# a$iti)i anticoag#(ani, acti)atoi aicoag#(&ii

- >naintea fo(o"iii "e (o)e!te #!o )ac##%#( "#4 capac pent# a $e"pin$e oice e"t $e a$iti)$e pe peeii ep#4eteiK

- pent# a a"ig#a apot#( a$ec)at "ngea$iti), ep#4eta "e #%p(e co%p(et (&"n$#- "e #n %ic"pai# (i4e (a po(#( "#peio. Dac& acea"t& con$iie n# a fo"t >n$ep(init& n# "e #%p(e c#"einga $eoaece e?i"t& i"c $e *e%o(i5&. 0e >n(oc#ie!te c# a(t )ac##%K

- pent# a e)ita fo%aea %icoc*eag#i(o "e a%e"tec& "nge(e c# anticoag#(ant#(, efect#n$-3 %i!c&i $e otaie a"ig#n$ a"tfe( $i5o()aea co%p(et& a a$iti)#(#iK

- $ac& "e eco(tea5& %ai %#(te po4e, "e a%e"tec& fiecae po4& i%e$iat $#p& eco(taeK- ep#4ete(e "e a!ea5& >n "tati) >n po5iie )etica(.

- >n ca5#( )ac##%#i(o f&& anticoag#(ani- ep#4eta "e #%p(e co%p(etK- >nte %o%ent#( eco(t&ii !i efect#aea po4ei >n (a4oato te4#ie "& teac& -3 %in#teK

- "e e"pect& o$inea $e eco(tae

- f(acoane pent# *e%oc#(t#iK- ep#4ete f&& anticoag#(ant o!iiK- ep#4ete c# anticoag#(ant a(4a"teK- ep#4ete "epaatoae $e "eK- ep#4ete c# *epain& )e5iK

/7


48/251

- ep#4ete c# EDT6 %o)K- ep#4ete c# citat $e $e?to5& ga(4ene.

A(g(-(a o*!!i- pent# p#ncia capi(a& )f#( $egete(o %e$i#" "a# ine(a $e (a %na ne$o%inant&, (o4#( #ec*iiK- pent# p#ncia )enoa"& )ena $e (a p(ica cot#(#i )ena %e$ia(&, c#4ita(&, cefa(ic& !i 4a5i(ic&Ku se abordea braul cu fistula arteriovenoas pentru hemodiali i cel aflat de aceeai parte cu

mastectomia!

"ac pacientul are montat cateter venos cu perfuie i#v# se procedea n unul din urmtoarele moduri$

- se puncionea alt ven# u se recoltea din locuri situate deasupra liniei venoase, e%ist riscde dilataie&

- se oprete perfuia i se ateapt ' minute&- se deinfectea atent capacul cateterului cu betadin i alcool *- folosind mnui sterile se scoate capacul i se detaea perfuorul, se ataea o sering de '+ ml la

conector&

- se as

Documents

Proceduri de Practica Pentru Asistentii Medicali Generalisti_788_1560