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'