a' aoMi\r r

PAR

ur

M ooqbts3r\.,0 .

Crpiiolul
21.1

21-

ineriiiri in rrcciiui chirtrryi.rlc

ingrijiri prc.pcrllorii Anran$Lul ni-qrLjirilor crrc se clccrucazi h lori |aticndi nraime de a

il

surusi inrervenri.i

cofsrri tu lnriiirc. pa.ictrlul'ri cxDliciDd dcrularc!

i cnrorici. .l!pclc opunrorii. .nc(.zid. Asi(cr1dmcdicdlahbriesa-si.ritcdnponihiLihtsdc.risDuidcinrcbirilorpdcimtrLL i.

Praiftea cutanaln
a

onerdului:

Dinrlnmr.r lr m im d n.rci brdmcnc rnnznoni pr.-nrc pc picler viitoruluioltnr ncf1tu cvih i'rfectir in hmpnl irciziel ii cdnhmin.rc. mcdltrlui din bLoctrl operrtor

scatuliinJi'nincrhicn.nri.i.tdci.ntul\afrcdJtrrcusdnuD.fisct{iclrtnb.ixdi'r

iaurloirexidi|a dacl esie aie,gic lr iol): se u insnh h nivetul pLiunln de fl\iune. regiurilor iDal,irdlc. on$rhctrlL'i si plci!rrcLo. rccasti proreduri ede realizatl dcpacienrdutt eccy. intonndr rLrn hhtri!
daci p3cnhtul cn. d.pcndcnl
dupa

isi.nr.orponli v: li cfccrrraic
va imbrica

irti.nilri

cftchrrcr igimci .ortonlc. t..icitLl

pija rl. r!fur.

Do,ltrl

nn..I !: ri:r \r:rirrrrl

LJ

Ntr e$ nroccdu.i sislcrn lci. cl csrc in linrclic dc ri|rL. pmlocoalclc sccrictscr!i!i!Lri. Dcriilarcr cic to lizrrii dc tr!ii.nr, srr dc hlinnicr;i. Dottri rcrodc tor n trriLiz{c:

lor

d. nnc .nri.

d!

/.,rrc dc.olc4,. +,.JJ'r' i rr^.nl,i - {'p.".brl....fc!tr. pieler \i usuci sc $dli - *rpllcirpoicrcDadcpilaroalc { clatc{c-.|[isc trsrci piclcl
Radcrcr nrc.dnici csc inroTi\i fin,dL.i rcie.lscul dc cfraclc cur.nnrirzoncioncd.ri. Sc tucdhdndi iunderca pilozirililorcu rna$hodctons. atoi sc ldce du\ trcicn[]!i.
Se eftctucrzi pNlclari dc singc pcrtn': gan saDgtrir si nLcror P.h- ionognma $nguini. u.se. crcari'rna. lS.TC. Hl.C sirllcci.hcnc nruscnsddo 'ncJic. Pcihr ihrc crliiI nnponant. \crali2cxza !i akc cum.nc: ndiograrii pulnronari ti I:( Ci sc notcrzi .or$mrcb !nab: P. T. TA. dnrczir

'

qrlica rccohrndirll. amncliiuLui: rcrtrim{lor d evcntu.ti rnns]nzic. .mibidennte. Eechi ibito hidro et.crrotnrd
sc

tru tinuc: . a\erlicJ trnJ! plniqdrfrnli !nc, ln{rro '.c\, fi.;,b.".td. t' irf.un, tl,." ,,,t. p1,!.e: sc indcpin$z. prore/elc dcrrorc, och.ta t. bijure,iitc. tcnil.tedc.onraci: - so nobrz.co.{mrlcrilatu podtu a ovc. darc dc rctcrinri. pepfcurrutopcrirjei: - s. irnitisroa/i pruncd icd ria rof toin fesri i rncdi ca lei

sc iDlsrcite pacictr!ul. $ slsrine psihic: icvmtrciia tic cnr:nral, si N bcr_ si

ie

J
21.2

! k.: rf ,lr,f. J - 'cl. l,'dr' 'd

vcilici

do*rutpacicnrutut. sa

ti! conrttcl.r ratbtctc

D] ic

ex

Incn.lor

tecn,.

G tioutd.

nsrnbhrl ingnjniloro.ordxlenrlui|a.iurcarea

injriiiri Doft perdorij

tsiro iDrc orrieohirtrrgioa

La reinlorrccrcr dc ltr htoNt openlor s.inlirmcviipacicnru dcsp rjpulsj mddiut dc dcflrtare a inrencnttci: \e Lcvcde Drcrocolrt dpsrb.ti schcnt inicrvcnrici pr?dic.re:

seinirleaTaFcio. tif partuftn.ttcdcripuldcrne$cre$idcimdwcrli.i sc.hsryi slxrcr pansrmcnnrtui. se cotrrutcrj !i sc iorcazi siycnelc de drcMi: se ocordua2, vrnd! dc as|idic digdnn:l h o run-la cotc.bdr. se a.tmi0in;cr,.i l]2
Dirn lx

rlerirca nirii
de

dc otrrosrinn

l'. T r\.. srrumiia 02. tu

dnftai
u

!prclcnrutuisc vor supr.lcehe did l5 {o.ionzrc priD dr.idri

j!

t5 ninul!:

g'!dul

.uD.rrirla:
I
p

acr.isicilc$ lolLm

i$derilor

cx

nxrerFnsrmcntului.

sutm\.shcrc 5i,ngrui,.i dupJ rreima 0o0rrutui ln !J/ dc i\Pirn'! ih!c{n; . se irlinno.2i plcrcitrL )t ari[mjul siu dcsr.c rc.csna{cr dc
anon dliiicn.ar cne

a Eminc neminca. oriru c.ris: $nda cstc incnrinuE panli tr (tuaLc. ranzjt,rtul idrcdiml (rplriljx grzclor sau , nhldrjitor

i'

lccaLe)nrnni icoit tchi'lquhn: robli. r , r.a " ord,ti,,....rt..,,,,1,

c\l
r,

D.

\t i[. .. ..nr u....ttr.r.r.: i, ',.iD'obli,J,.r,1..r....orJ( f. ,,.,^....,o. !i^ruitor bJlonr,'1,tr if oaz de pcdtr/ie i mvondrs, sc verifict lo!tr1 punc!ioMl. r.iectuI vodos: . se sislcrzl pc uziad.., rprrc o trll,maliei '. dr 1"+d, n,",.d,.. r.rt..prc..,.cr..riJ,

scrinrbi zilni. borcuut. purga sim.ordut: s.noi.iza /ih ! Ln I rrd!, bnn. e vn trmul

'. 1.rt ira!.'..,rr"... .r1!t.,

nc trJt\i," L.r. dnt, ..t . , , ,t.tr J,. ",p ,r ..

fice bilrntrLl iitiLi.ic!iri, coridiani irr.dri: bnrc intarjlc prrcnrenlc: - icsi'i: diLrcT:i-rsnir.iicdigc$iva'(lln!ic. l'ft vcnn.a conrpl iclli,lor {lc dccu b it . sc nobilizea,i gaftb.lr si sc $rnravcghcazi nroleteLci - sc admlnistcudlnricoag anrc suh cuhrr! cortnm lrescri iei: sc ridici,- dacii D tosibil. paolcnrul in t-otoliu. conprimntrd Dlarl! oPcntoic (pa'satncnt .
se

scaplid ine'jiriNnning

nrm prcvcnirt!

e$xrtlor: igi.nt. sLnnnb.rca Po2i!ici.r{e'u

. -

se

rsnirr sccfttiilc sc Ir...rosolisrukinerirerani. rcspidoricdrre n.roie

rcLcc p.Nanentu /ilnic iru l{ 2 /ilc ruNrila indicrlir nredicrl:,: r sc.t firele. ii.!'ptud.u un fir$r doRii pr0mnunrl hbunlor dc dren4 sc !d rcihc. zilnic !ivor li indcl).rhrc atrncicafd dlcr.jrIl vr ri nininr,la indicrlia 'ncdicuhi Srpfr !.qhcra clnri sl raruclinici
sc

- P. T..\.. T' !i tirtlcnb rcspiraloricr ' 11!'pl e'!p(.rlt.d'l'..'(rJ..r1

corsrautcb bnno-gicc lr indicada mdJir

d'cru'.

'uI'

a- 'r'tr. i 1 zi.:
ari. !a

ldcc dup, sl'rrc. t'afzitolL,i inre(inr pentr tuarfii lNrlc. in g.n.irl dupa sondd gJsricli $ dMrp.rT-i dupi o proba dc claryrji rcLurrcr aLiDcnurioi sc tu.c in!-o nrnicli proeNsivi ni nuclic dc iN.r1.trria r$! .jutunn dictdiriaruLBi

!r

dupi o i'nenenlje cbirurgioali Pima nroblli/xre I nnui t.cicnrcsre decisi dc 'nediculchiturg sau duDdo ncioadi Lungi de imohilizarc Obiudiwl p.i opcriror c$c. in a.n.ral. acch dcr asig aomohiliTar.plccoc.pcntru.Drcv.ri dri...dn1plicrlii lrgrro do dccubn. Aindnn.c! cstc i'r tunc!rc dc tipuLdc intcNcrti.. dc sldcr generlS a pacientului ii nu poalc li d.0isi de. dc cclrlfa mcdic.Li.
dupi oricc inreFentie ch,nqic.h: dupa o pcrio i lun!5 de imobilizarc (dc cx. com.).

. .c ro.'c/rp'.r Jrl p'J.\'. "'.0 . r'r' . i\eerpliciidc l.rci pmredurli: - isc $!lict. dc ascmenci. i.roN.Ddtuil. mediolle cnrc insole$prima mobilizarci - sc {conlii limf |cftru a lAculrai

sc,nsrle!z. pa.ienrulin pozilirscmisc/ind,r

mf.loLiu iir apruPisc: unsphiidpd tupi!ioarc pcntrasigmreasccuritaliiplcicnruLui.prjnam!hiLiz0rrv{ri.fectoxlrdedouaNr$rdc: sc mli$rri 1 A Nrcicm'luictrlcari sc inrufli pacictrlulL'i iiftderinr sii1c. r ajura prricitule s sprilinc in cor iisr sc idicc pc maryjien I)anrtuinrpdrrja ascz.r. sc ccrd rli rinr:ini n, rcani to,rlc si si pnldascii dreFr in.inrci su acordi rinrppcnru I erp.imr.cca.c snnE trat$.de rdqrislx vrcm scnn de sia,! dc serjuEp.cicDrLLsinr'sg, niirii la foi!t u ii si s6 iniat./ocoitor.bit: scccrcprrLeotoluisii\crb.!i2vcleDrirncnre.hgrrcdcxccr$aprijninrrhiirdl
sc n.rerzA froccdotu in dosarul de

' -

rc tENnrir ont nrcdiculL lrodut

irEijirr:
de

dcn't.'!. drfiodl14it. s.u comtticarilc apimc

2l-.l l ehdcx gcneraln a piisrm{nrului PntranrdnLJ s.pdc simtlu &msh if pr.rcjarca ptel tnrorrivo drcrruj agcm nociv c\1un. rbsoarid .rudltului din ! hgi ri lirlorizd.a cicanjztur.

' .

si nrncjc^ pl.gdLlcnulitrLext.ml ill diniNr^ amtlirdi|c. nris.iritor

fnr N\!ir d! un cinriornrlanr. cu d!trii cqe dcco rrni,jarc. Pii..,L f ro..,.,:. r ii'. ,".,..n,,n ,t.,1t,11 r !iJc pJn,Jm!nred.urri tuluynL ronl,nJnd

'

t.!ii nrcdi.ili: 2r.ns.rpKochcr:

o

conrprlscsdilel trtrciimr$erit: m llacon cn sipm rrrGrfli.i uD anrisqiric iod!r 1bdldd:i):

nriDUii dc cxuciuc n.iedle: mlrc a dc pmlcclie a p.tulri: o pddch dc nanuli ncrile: bcnziadezivcMu lesi..Dr0las:

saci pcntu

col.!taru dcsclnlor

MONIIORUL OFICIAL AL ROMANIE

previm lxcicnrul \i se prccizcazr utulxinsrjnii: scrmlicii prc\criFia ncdicaLii re iNtalcazri trcic ul conbndbil.rspecrilid pudomc4 in 1itNri. JctocatjzEr ptagiii sc irsrilcrTx rniii'tx pcnh trn\a,nenrc in salonrcsnecdrd rqulit. .rgonomicci
1e

st spalifrtinih(lniuresjrph)i { ddschide sc! / kn-ul ncnrfl pansamcDrc srcric si

s. prcgatc$ rorre nutc.i2trtc

. !i'dn' y'f \'tr a nJr',, ',."i(,cr..qu. 'l pftznri sc.reriile. - \cohsefristarci p s rcinrlu: c..!rar.n. rspcctut_ crtodica nir.rut: '. 1-\,.r p'. ' p . rLr.3-. c'..o.!,!'.: 'r'. sc antru panrrmcnt'l si minurllc ii, pung.coLccrorE: ' sosprli iiniLc(spilarlnnscprici)r - so nnb ci mitrus l.dccauciuc $drlsl . '
21.5

sc curitil icgnDcilcle din .iu.uL pliSii .u $nllic anriscprica pdrtu pictc. r,rir ,nisdin oircular s.u ccntipete: sc badijorerzi plagr cu soturic adlsopriur (hchdinr pcntru pLasi. atcoot rodr0: sc acope$ phgr !u &mprcsc icilc: se Ixcaza .tr bc.z c Mdzivc satr Drin bi drjN fotosind !n procctleu adinhr rcgrtrfu (cncuLrr. ii spicli. tuspinli, dc ): cprncar:iminu$lei

s.i
sc

(iinrlca/i

s. pun,lrneloic, jn{nhcnree foloslr.inlFd solulictenrru

se cur:l1i

t)acicntul:

d(

nnni,,.tr! r

rnl.

nisuir

dc FtrsanrDnrci

sc ndteazi ploccdutu

h doratol

enx uiiorindsurca

Ablnlh lirelor dc suturi slurgmfolor Ablaiir tirclor d. strur, curanari csrcun acr nrcdic.tprcs$ndc

'nedic.

r.ntiai

ta

ii\rtul
I

l).:/aJrin.r.p"L\.,:n'-.' ll1Ji lc o..r.. rr. i't, '1

se

,.'o' .J'tu Ju'dj.to ,.,i L p,.. ,.rJ.,c,r,J .trn! '.pn.

pacinrLldespGproccdur:r peDt!tr 3 oblirc cooperarc. dcestuir: lcrzi confofr'b il sc Aiguri paciennrl cinrocedum csi. iftLdori, podrd sarcsnnd o f.dc usoari pirciniiii { $licira pacienruluisa rcmnal.T.oriccdre'.!panni in rimptrtproccdurtitsinu puDi
sc irlsla

intimrvli

Dl]inilc nc plagr sururati.

d peEchc

dc

nsene.iLcilp Kochc(

MONI'ORUL OFICIAL AL ROMANIE

un

''llslD r c. onlr!.r.Jc .1nL\iscrir

trtr Jlacon

scr\rc sao. rolnace Di..s{crili:

.u sertiziolo:icl

nn nacoi cu \o 0!ic tuJrrr (ip beladini): brdcler. aulorddTive scnle:

o

lrviri rdalineDh cokcrau NdcrUtcL.rrbl.sirc . hl

:r" nl!,,tR , | .n J. '" nreorr: Ic.rv Jdcn4yfienht. irrbnci minuli ncnte dc.a!rnLc: scn,d{ir1.a, pans.Drerhr ti rhifulils uritiTjr.: sesrulidir mu miiinilci
sc

dr drr

.l

',b.-\d .n. tf

,pnr .,Jnrt,.. n.udc,..- t.

$ aveniz.r/i N.dic0l
sc dcschnlc

in caz dc.etrntridic dubiu: mM ctr mrlerhte srcr tc conserylindu sc lcnlnaFi r.cnon seiDhncam{trNi *e lcd.caucir,c:

rnrdntrlL'i\ n, is5 Ltsii. ir oz ae suMi in purcrc spa:rc

!.x,' J.ri. i dlonrr..c.!, I i. bDr" n,.-,.,tu,.

J1 aDrrd!o . 11

p .r.f,.,

{ \ ![ ri.ilrtnll f nl!'ip l n nx,\usL]eor r .r ulc !.ur I'at' tri!L prc..iir,tplJs,. L.p,.

h' r

Ldr \uturJ r " '.LrJre ,b i .- .Jl t.' .l

prtu I rEr Jin

prJ b JnI d...

'nu,ncnr!t

rip$rtuic.rrourpor:
,nLleDxlinr

fiF.r

r.,1..e.

t,1

- i .r,."-",*'y'" p.a:i"L,oJ. rp, (,. ,r. v, r.,.r rpc..run.,,., ll: 1, ' . ". ' b'i. p., ..cc\.,,f,.r,1 cn,dtr in c('r;.,pd', -:llll 'l''''""
ic

r.j

vlinci

apoi

rtrlalt! b trnali.arcaa8tulnto rccoiutrlxr JeDedjc

f .u1 .."t'!i. otJr, i ,^.. r,ep nr ..., tr. 4c/!i(in r3tr' ur \utur r. tl!tu cJ oJ.ilnh,lur . ei',' J.p.! 1u . r*r r.it... '

lnlri (rNrc

de

if..ric,

MON TORIL OF C ALALROMAN E

sc

cdr.i p..icrol

sii

{4flrolhc/c

plag!

:i

gicDx

d$i na..tctx

lr donrcilio:

n1 Dldrr i' .d! o-. r i ' patologica cu aiurdni trtr(i dr.n. unor m.sc crtc sc lrsi De loc \ru r trnor Lrniu in scoprl oblincrii uDci ciradliri flp c l)rcnul o$ un tub supLu iad riliJ. d I cxuciuc. nrrerirL nla$ic. carc sc^cgc h cr&uJ'tr lichidclor prlobgrcc difl.o p!rgi. Lniirelc sun. dir crkiu.. onduLrt. {cnh i $ror pl.sdc in!'o t giurc urdc sc pRdNc o
D'rn.'jul

ru .i

.i

bdndi i|a din Fuil dc bunbrc $re sc inhdnc. intr o phgii sr! nrlr. i!ul.pcrtir a impiedicr iift crci t.i,rFo cicxttarD prc! tpldi Ji I lacilitd rdfcl i.urgc*r

It{elr

c$

drcnrrcapuoltrlui.aunci

iiledii col.c il
a

cpr

fvr.trdtua lichidulLriin pe'iord

ncftcfldmle:
po$ operl rorie

[src n.yoic dc un cirucior n'prartujal. cnmr

Pc cr.jn I supcrior se

rnNi

l)eftut.

*Drefie dontinind: K..hcr: Pense comfrcse$d,lcl

Aer/j rdrrc.$sr$ilsicunr

5i

dcc.nlrnrind

$llli nr:inNi

{nlis{ticc

iodrre rin Bcr.dinal

n.icilc:
rrtr

mrrenrlDm..rorpc

Pll

bcMi.dczive: n hniniL' sruo loxrlccc !fih: n & dE si$rarta $eilin d'do Lrnicl' . Pctc[c dc DriDus]$cnlc

colcdlrex dcscuilor: ur coDtriner tlnrn ac.

saci pcnrru

Du rrctr.rnsllsauctro$aru$adcnnicalblontrti: 'cuoloarlcri{cnli.s.dcsDicicomp.eseein..\..cucondilirs:lfiDntr{.poiinb-o
!cindcpi lMa
sc

pansarncrtul

indcptncvi acrldc siglmnti v.chidiiil: s. |rrinde rctrl.n o Pcnsi rnri]nicii:

MONITORUL

dHdAL AL RAN,A.IIEI, PARTEA

1.

NI. 663

b*;TNTOT3

' -

dzinfe.kun daSa in$prnd c! p!tua cc{ d,j clErti wcuElrinjurnl4r{duiprinni$.nricisddr6s cdaitugoi $,lixezE drcoul, se n@ acul dc rirliaqn plh drenri se hchlde epoi cu

e cudF ii

- e dp4 lehe &chir $i aaul de s'fidF in recipiorul rczcnaq

ss

e nr.z{

cu pene

ko.hc!$ Eroi sc d$tide

o Ftre

anatomicr:

!o

r. tdi.scgde.lu]
dace

i'td.panpod. d rt.@ta.. o4nrM ntuLah .rhhtoir,lr\.. nta .erh.n,J.

, -

' - F clanl.ui.t i drhll.cr o F6si Koclorr s inleaFi dinul rparq 1atc41d. $b penst !i $ rqFda,a slulrd; - se indcDiriaiua $iilga 9l :irDl, sc diriLhltaz! nftn de dreni i :nlrdjr.d om-, cJ iupl .. sb"le dw oc firlo.:
so

denMef,at&swra! t'.ebllie$* jnjccuc u nnlibiolic: - si dcaileolca?d donl:

luj de sisn'znlr:

rpoi lerian dod@sulF dlonulli o rl1. conrRse n{srale; Drin bind.idc s.u c! b.Mi adcrre nipotqci*r sc 6bslnd zihid lqnelul li.]1nlllui..csrirol!!, $i F norcvi in to.ir dd.blciali.r
!e 6*!,i

ed,tr,