INGRIJIREA PACIENTILOR LA DOMICILIU IN FAZA TERMINALA

Ingrijirile terminale reprezinta ingrijirile care e ac!r"a #!lna$il!r

in %azele "e %aritale #!lil!r& "inaintea m!rtii'
Ingrijirile terminale (nt imp!rtante pentr( m%& "e!arece maj!ritatea
#!lna$il!r $!r a m!ara acaa&"e aceea maj!ritatea #!lna$il!r aj(ni
in acet ta"i( re%(za internarea a( "aca (nt internati in pital
!licita e)ternarea'
Aig(rarea (n(i %arit "emn& "ei #!ala ete inc(ra#ila i n( e mai
p!ate %ace nimic pentr( a !pri e$!l(tia #!lii& #!lna$(l are "rept(l la (n
%arit "emn "(pa c(m e arata in C!"(l "e "e!nt!l!gie me"icala&
#!lna$(l inc(ra#il tre#(ie tratat c( aceeai grija i atentie ca i ceilalti
#!lna$i'
Iar "(pa c(m e arata in Declaratia pri$in" "rept(rile pacient(l(i&
!rice per!ana are "rept(l la ! ingrijire (mana i "e a m(ri in
"emnitate'
Ec*ipamentele minime neceare pentr( ingrijire (nt+
, -eringa a(t!mat.
, Apirat!r ecre/ii
, Gl(c!metr(
,Tr(. "e mic. c*ir(rgie "e (nic. %!l!in/.
, Tr(a me"ical. a per!nal(l(i& care tre#(ie . c!n/in.+
tet!c!p&teni!metr(&eringi "e (nic. %!l!in/.& per%(z!are&
materiale pentr( rec!ltare& panamente pentr(
ecare& me"icamente+
0 Nal!)!n.& Met!cl!prami"& Trama"!l& Alg!calmin&-c!#(til&
De)ametaz!n.& 11C& 1al!peri"!l& L!razepam&
Mi"az!lam& A"renalin.&Diazepam ir'
Materialel!r anitare neceare (nt+
, Materiale pentr( panamente& pre$enirea 2i 3ngrijirea ecarel!r4
, Materiale pentr( e%ect(area injec/iil!r 2i p(nc/ii
l!r4
, Can(le tra*eale pentr( tra*e!t!me4
, Catetere (rinare4
, Materiale pentr( pr!ce"(ri "e mic. c*ir(rgie4
, Materiale pentr( rec!ltarea pr!"(el!r #i!l!gice4
, P(ngi "e c!l!t!mie& c!lect!are (rinare& p(ngi c!lect!are4
, Dip!ziti$e a(t!mate5mecanice 2i c!n(ma#ile neceare
pentr(a"minitrarea c!ntin(. (#c(tanat a me"ica/iei antalgice a(
antiemetice
-ER6ICII MEDICALE DE INGRIJIRE LA DOMICILIU
0 e$al(area tarii "e anatate a pacient(l(i'
0m!nit!rizarea parametril!r %izi!l!gici temperat(ra& teni(ne arteriala&
p(l&repiratie& "i(reza & ca(n'
0t!aleta pacient(l(i c( pr!#leme me"icale'
0a"minitrarea me"icametel!r pe cale !rala& injectii intram(c(lare i
intra$en!ae&per%(zii'
0ma(rarea glicemiei c( gl(c!metr(l'
0rec!ltarea pr!#el!r pentr( la#!rat!r
0alimentatia arti%iciala'
0ingrijirea plagil!r& ecarel!r& t!mel!r& %it(lel!r& "renajel!r'
0!n"aj $ezical c( !n"a permanenta a( c( c!p e$ac(at!r'
0terapia "(rerii
0e"(catia pacientil!r i a %amiliei'
C!m#aterea impt!mel!r care a%ecteaza calitatea $ietii #!lna$(l(i'
De!arece %aza inc(ra#ila ete "e !#icei int!$araita "e
nite impt!me care a%ecteaza gra$ calitatea $ietii #!lna$(l(i& c*iar
"aca e$!l(tia #!lii "e %!n" n( mai p!ate %i in%l(entata&m% tre#(ie a
%aca t!t ce ete p!i#il pentr( a c!m#ate acete impt!me i a
%ace$iata #!lna$(l(i cat mai (p!rta#ila'
C!m#aterea "(rerii+ D(rerea ete prezenta in %!arte m(lte #!li
ire$eri#ile i apr!ape la t!ti #!lna$ii cancer!i'
0D(rerea p!ate %i "e tip $iceral a( "e tip !matic'
0D(rerea p!ate a$ea intenitati "i%erite'Tratament(l "(rerii e %ace in
trepte in %(nctie "e intenitatea "(rerii i "erap(n(l ei la tratament+
0 Treapta intaia+ D(rerea (!ara a( m!"erata care n( a mai %!t
tratata anteri!r& e$a %ace c( paracetam!l& c( apirina& #r(%en&
"icl!%enac& pira)icam& $i!!)& etc
0 Treapta a "!(a + D(rerea (!ara a( m!"erata& care n( ce"eaza la
me"icamenteleanteri!are& $a p(tea %i tratata c( !pi!i"e (!are& aa
c(m ar %i trama"!l(l a(c!"eina& a( i ami #ine in a!ciere c(
analgezicele
0 Treapta a treia+ D(rerea m!"erata care n( a ce"at la
me"icamentele anteri!ara&prec(m i "(rerea e$era a( c*in(it!are&
e p!ate trata c( !pi!i"e p(ternice& aa c(m ar
%i nea%ina&*i"r!ma%en(l i pentaz!cin(l'
Pe langa me"icamente& intratament(l "(rerii e mai p!ate apela la
%izi!terapie'
Tratament(l "ipneei' Dipneea p!ate %i intalnita la %!arte m(lti
#!lna$i in %azainc(ra#ila' In tratament(l "ipneei e p!t %!l!i
#r!n*!"ilatat!are& aa c(m ar %ial#(tan!l(l& %en!ter!l(l i mi!%ilin(l
i c!rtic!izi& aa c(m ar %i #eclametaz!n(l itriamcin!l!l(l' In caz(l
in care "ipneea n( ce"eaza c( #r!n*!"ilatat!are i c(c!rtic!izi& e
p!ate apela la !pi!i"e& in "!ze mici& aa c(m ar %i m!r%ina
i*i"r!ma%en(l'
Tratament(l gret(ril!r i $arat(ril!r& intalnite in 789 "in #!lna$ii c(
cancer& e p!ta"minitra anti"!paminergice& aa c(m ar %i
*al!peri"!l(l i "r!peri"!l(l&anti*itaminice& aa c(m ar %i
pr!met*azina& antier!t!ninice& aa c(m ar %i"!lateren(l&
pr!:inetice& aa c(m ar %i met!cl!prami"(l& a( antic!linergice
aac(m ar %i c!p!lamina'
Tratament(l c!ntipatiei& care p!ate %i accent(ata "e im!#ilizarea
la pat i "etratament(l c( !pi!i"e& e p!ate %ace c( lact(l!za& c(
la)ati$& erina& p;lla& galc!rini tritic(m& care c!ntin %i#re "in tarata
"e gra('
Intrarea in %aza terminala p!ate %i (gerata "e %apt(l ca #!lna$(l
n( e mai p!atealimenta !ral& "e t(l#(rarile "e repiratie& c(
*!rcait(ri& "e aparitia (n!r ecretii!r!%aringiene a#(n"ente& "e
e)tremitatile reci& "e marm!rarea pielii& "e !lig(rie i "etarea "e
c!n%(zie i "elir& care an(nta %aza ag!nica a #!lii& care p!ate "(ra <0=
zile'
In aceata %aza tre#(ie aig(rata alimentatia i *i"ratarea #!lna$(l(i&
pe !n"anaz!gatrica& a( prin per%(zii' De aemenea tre#(ie
aig(rata repecarea c!n"itiil!r"e igiena per!nala a #!lna$(l(i'
Sustinerea psihologica a bolnavului si a familiei:
-(tinerea pi*!l!gica a #!lna$(l(i+ Maj!ritatea #!lna$il!r "in
%aza ire$eri#ilaprezinta ! tare "e an)ietate i "e "epreie pi*ica'
De aceea #!lna$(l a%lat in %azaire$eri#ila tre#(ie (tin(t pi*!l!gic
"e m%' Dei n( ne p(tem atepta la ! im#(natatire a tarii "e anatate
a #!lna$(l(i& ete neceara ! pi*!terapie "e(tinere& pentr(
c!m#aterea an)ietatii i a "epreiei& care agra$eaza tarea
#!lna$(l(i'
-(tinerea pi*!l!gica a %amiliei+ De!arece im#!lna$irea (n(i
mem#r( al %amiliei reprezinta (n tre %!arte imp!rtant& iar "ece(l
(n(i mem#r( al %amiliei reprezinta(n tre i mai mare& m% tre#(ie a
ac!r"e imp!rtanta c($enita i (tinerii pi*!l!gice a %amiliei' In acet
en& m% tre#(ie a in%!rmeze c!rect %amilia i a !pregateaca& a !
in$ete ce are "e %ac(t'
-(tinerea pirit(ala a #!lna$(l(i+ Dei (tinerea pirit(ala a
#!lna$(l(i eteneceara in t!ate caz(rile& "ar pr!#a#il ca in nici ! alta
it(atie& (tinerea pirit(ala a #!lna$(l(i n( ete mai neceara ca in
%azele terminale ale $ietii' Pentr( ca in nici !alta it(atie a $ietii
#!lna$(l n( ete mai tentat a e intre#e a(pra emni%icatiei $ietii i
a m!rtii'