Speci

alMedi
cal
-Sur
gicalNur
singI
II

For

Secondy
earNur
singSt
udent
s

SecondSemest
er

By

Teachi
ngSt
affMember
s

Of

Medi
cal
-Sur
gicalDepar
tment

2021-
2022

1
 Topi
cs Pages

Chapt erI:Nur singmanagementofpat i

ent swit
hMusculoskel
etalsyst
em
disorders:
Unit1:Muscul oskel etalTrauma 5
a.Orthopedi ct raumapat ient. 19
b.Fracturemanagement . 30
c.Fracturecompl ications
Unit2:Muscul oskel etalcaremodal i
ti
es:
a.Cast . 39
b.Splints 44
c.TractionandEx ternalfi
xator. 48
d.Orthopedi csur geries. 57
Unit3:Muscul oskel etali
nfect i
on:
a.Met aboli
cbonedi sorders( ost
eoporosis). 62
b.Ost eomal acia 65
c.Acut eosteomy elit
is. 68
d.Rheumat oidar t hri
tis. 73
e.Ost eoar
thr i
tis. 78
Chapt erII
:Nur singmanagementofpat ientswithuri
nar
ysystem disor
der
s:
Unit1:Anat omyandphy siologyoftheur inar
ysystem 83
Unit2:Urinarytracti
nfect
ion
a.Uri
naryt r
actinfect
ions. 96
b.Cystit
is 101
c.Pyelonephrit
is 103
Unit3:Renal calcul
i.
105
Unit4:Renal failure:
a.Acut er enal failur e. 111
b.Chr onicr enal fai lure. 117
c.Dialysis. 121
Chapt erI I
I:Nur singmanagementofpat ient
swi
thneur
ologi
csy
stem di
sor
der
s
Unit1:Cent ral ner v oussystem disor
der
s
a.Alteredl ev elofconsci ous. 133
b.Seiz uredi sorder s. 145
c.Epilepsy . 150
d.Headache 156
e.Meni ngit
is. 163
f.Encephal itis 168
Unit2: Cerebr ov ascul ardisorders.
a.Cer ebrov ascul ardi sorders. 171
b.Increasei ntracr anialpressure. 180

Uni
t3:Br
aint
umor
184
Chapt
erI
V:Nursingmanagementofpati
ent
swi
thbur
ninj
urydi
sor
der
s:
Uni
t1:
Burninj
uri
es 190
Uni
t2:Managementofpat
ientwi
thbur
n 200

2
"It does not matter how slowly you
go as long as you do not stop"

ChapterI
Nur
singManagementofPatientwit
h
Muscul
oskel
etalsyst
em di
sorder
s

‫ﻷﻝ‬
‫ﺍﻭ‬ ‫ﻔﺼﻞ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬
‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﻛﻲ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬

3
 Uni
tI
Muscul
oskel
etalTr
auma
Ort
hopedi
cTraumaPatient

Learningobj ectives:
Attheendoft hisl ect ure,thest udentwillbeablet o:
1-Differenti
aterelat edt ermi nologybetweencont usi
ons,st
rain,
sprain,andJoi ntdi slocat i
on.
2-Descr ibeeti
ologyofor t
hopedi ctrauma.
3-Speci fyhowt odi agnost ictestsusedf ororthopedictr
auma.
4-Dev elopgener al nur singcar eofor t
hopedict r
auma.
5-Classifygroupsofor thopedict r
aumapat ient.
6-Descr ibeassessmentact ivi
tiesdesignedt oidenti
fyassessing
fr
actur esanddi slocat ions.
7-Ident i
fyassessmentofmul ti
pletraumapat ient.

‫ﻟﻰ‬‫ﻭ‬
‫ﺍﻷ‬‫ﺓ‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻜ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻌﻀ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬‫ﻣ‬

:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬
‫ﺓﺳ‬ ‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻔﺼﻞ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻠ‬‫ﺀﻭﺧ‬‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺮﻭ‬
‫ﺗ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﺕﻭ‬‫ﻣ‬‫ﺪ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺔﺑ‬‫ﻠ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺎﺕﺫ‬ ‫ﻠﺤ‬‫ﻤﺼﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻳﻖﺑ‬‫ﺮ‬‫ﻔ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
-1
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺎﺕﺇﺻ‬ ‫ﺒ‬‫ﺒ‬
‫ﻭﺻﻒﻣﺴ‬- 2
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺔﻓﻲﺇﺻ‬‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻴﺼ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬‫ﺀ‬ ‫ﺍ‬
‫ﺮ‬‫ﺔﺇﺟ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬
‫ﺪﻛ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-3
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺎ‬
‫ﺩﺙﺇﺻ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺤ‬‫ﺔ‬‫ﻣ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺗﻄ‬-4
.
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﺎﺕﻣ‬ ‫ﻮﻋ‬‫ﻤ‬
‫ﻴﻒﻣﺠ‬ ‫ﻨ‬‫ﺗﺼ‬-5
.‫ﺎﺕ‬
‫ﺑ‬‫ﺍ‬‫ﺮ‬
‫ﺍﻻﺿﻄ‬‫ﺭﻭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺪﺗ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﺔ‬‫ﻤ‬
‫ﻤ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬‫ﺃ‬‫ﻭﺻﻒ‬- 6
.
‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﺎﺕﻣ‬ ‫ﻣ‬‫ﺪ‬‫ﺎﺏﺑﺼ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﻠﻰﺗ‬‫ﺮﻑﻋ‬ ‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
-7

4
Def initi
onsf ort ermsr el at edt oor thopedi ct raumapat i
ent :
Muscul oskel etalinjuries:
Iti
ncl udeanychanget ot hest ructur alintegr i
tyofsof ttissues[ muscl e, li
gament ,
tendons], joint,orbone.
Cont usions:
Iti
ssof tti
ssuei njurypr oducedbybl untf orceorf all
.
Spr ain:
Iti
sat raumat icinjuryi nwhi chl i
gamentf ibersar et ornt hatcausedbyt wist i
ng
mot ion.
Strain:
Iti
sat raumat icinjuryi nwhi cht endonf i
ber saret ornormuscl epullcausedby
overuseorexcessi vest ress.
JointDi slocat ion:
Iti
sacompl etedi srupt ionofaj oi
nti nwhi cht hear t
icularsur facesar enol onger
i
ncont actwi t
heachot her .
Subl uxat ion:
Iti
sami nordi srupt i
onoft hej ointi nwhi cht hear t
icularcont actstil
l remai n.Itis
oftenassoci atedwi thj ointf ractures.
Fract ure:I ti sast ruct ur al lossi nt hecont inuityofabone.
:
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺔﺑ‬ ‫ﻘ‬
‫ﻠ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻠﺤ‬ ‫ﻤﺼﻄ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎﺕ‬ ‫ﻔ‬
‫ﻳ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
:‫ﻠﻲ‬‫ﻜ‬‫ﻴ‬
‫ﻬ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻲ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬
‫ﻭ‬،
‫[ﺃ‬ ‫ﺭ‬‫ﺎ‬‫ﺗ‬
‫ﻭ‬ ‫ﺃﺍﻷ‬
‫ﻭ‬، ‫ﺔ‬‫ﺑﻄ‬‫ﺭ‬‫ﺃﺍﻷ‬‫ﻭ‬، ‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬]‫ﺓ‬‫ﻮ‬ ‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﻟﻸ‬‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻟﺴ ﻣ‬‫ﺍ‬ ‫ﺮﻓﻲ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺃﻱﺗ‬ ‫ﻤﻞ‬‫ﻭﻫﻲﺗﺸ‬
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬،
‫ﺎﺻﻞﺃ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
:‫ﺎﺕ‬ ‫ﻣ‬
‫ﺪ‬‫ﻛ‬
.‫ﻮﻁ‬ ‫ﻘ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﺓﻏ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬ ‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﻫﻲﺇﺻ‬
:
‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺇ‬
.‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺎﺟﻢﻋﻦﺣ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻁ‬ ‫ﺑ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻬ‬‫ﻴ‬‫ﺰﻕﻓ‬ ‫ﻤ‬‫ﺘ‬‫ﺔﻳ‬‫ﻴ‬‫ﺔﺭﺿﺤ‬ ‫ﺑ‬
‫ﺎ‬‫ﻭﻫﻲﺇﺻ‬
:
‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﺃﺍﻹﺟ‬ ‫ﻡﻭ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﻻﺳ‬ ‫ﺍﻁﻓﻲ‬ ‫ﺮ‬ ‫ﻓ‬‫ﺍﻹ‬ ‫ﺒﺐ‬ ‫ﻌﻀﻼﺕﺑﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻭﺷ‬ ‫ﺃ‬‫ﺭ‬‫ﺎ‬
‫ﺗ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﺎﻑ‬‫ﻴ‬‫ﻟ‬
‫ﺃ‬ ‫ﺰﻕ‬ ‫ﻤ‬
‫ﺎﺗ‬‫ﻬ‬‫ﻴ‬‫ﺘﻢﻓ‬‫ﺔﻳ‬ ‫ﻤ‬‫ﻟ‬‫ﺆ‬‫ﺔﻣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺎﺇﺻ‬‫ﻬ‬‫ﻧ‬‫ﺇ‬
.‫ﺮﻁ‬ ‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
:‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻠ‬‫ﺧ‬
.
‫ﻌﺾ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻬ‬‫ﻌﻀ‬‫ﻊﺑ‬‫ﺎﻝﻣ‬ ‫ﺗﺼ‬ ‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬ ‫ﻴ‬‫ﻠ‬‫ﻔﺼ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻷﺳﻄﺢ‬ ‫ﺪ‬‫ﻌ‬‫ﻟﻢﺗ‬ ‫ﻴﺚ‬‫ﻔﺼﻞﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﻞﻓﻲ‬ ‫ﺎ‬‫ﺍﺏﻛ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻪ‬‫ﻧ‬‫ﺇ‬
:
‫ﺋﻲ‬‫ﺰ‬ ‫ﻊﺟ‬‫ﻠ‬‫ﺧ‬
.‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﺒﻂﺑ‬ ‫ﺗ‬‫ﺮ‬
‫ﺎﻳ‬ ‫ﻏﺎﻣ‬ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬. ‫ﻠﻲ‬‫ﻔﺼ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬‫ﻻﺼ‬‫ﺍﺗ‬ ‫ﻪ‬ ‫ﻴ‬
‫ﺍﻝﻓ‬ ‫ﻻﺰ‬
‫ﺬﻱ ﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻒﻓﻲ‬ ‫ﻔ‬‫ﺍﺏﻃ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻪ‬‫ﻧ‬‫ﺇ‬
.
‫ﻌﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻠ‬‫ﻜ‬‫ﻴ‬
‫ﺓﻫ‬ ‫ﺭ‬‫ﺎ‬‫ﻮﺧﺴ‬ ‫ﻫ‬:‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
Etiologyofor t
hopedi ct raumapat ient:
1.Spr ain&st rainoccuri nr esponset oasudden, for ci
ble, str
et chonamuscl eor
l
igament .
2.Commonsi tesf orspr ainsar ewr i
st ,ankle, el
bow&kneej oint.
3.Commonsi tesf orst rai nsar eheel ,ankl e,thigh, knee&upperar m.
4.Di slocat ionandSubl uxat ionoccuri nresponset ophy sicaltraumai nwhi ch
thej ointi sfor ciblymov edbey ondi tsROM. Commonsi tesar et hehi p, shoul der,
knee, elbow&f ingerjoi nt s(Fi g.1).
:‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺎﺕ‬ ‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬

5
 ‫‪.‬‬
‫ﺔ‬‫ﺑﻄ‬‫ﺭ‬
‫ﺃﺍﻷ‬
‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻠﻰﺇﺣ‬‫ﺮﻱﻋ‬‫ﻗﺴ‬‫ﺎﺟﺊﻭ‬ ‫ﻔ‬‫ﺩﻣ‬‫ﺪ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬
‫ﺩﻧ‬‫ﺎ‬‫ﻬ‬
‫ﺍﻹﺟ‬‫ﺀﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺪﺙ‬ ‫‪.‬ﻳﺤ‬
‫‪1‬‬
‫‪.‬‬‫ﺔ‬
‫ﺒ‬‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﺣﻞﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻎﻭ‬‫ﺮﺳ‬‫ﻟ‬‫ﺍ‬
‫ﻔﺼﻞ‬ ‫ﺀﻫﻲﻣ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﻟﻼ‬‫ﺔ‬‫ﻌ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺸ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬
‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬
‫‪2‬‬
‫‪.‬‬‫ﺍﻉ‬
‫ﺭ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﺃﻋ‬
‫ﺔﻭ‬ ‫ﺒ‬
‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻭ‬‫ﻔﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺣﻞﻭ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﺐﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻫﻲ‬ ‫ﺎ‬
‫ﻬ‬‫ﻟﻺﺟ‬‫ﺔ‬‫ﻌ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺸ‬‫ﺍ‬‫ﻛﻦ‬‫ﺎ‬
‫ﻣ‬‫ﺍﻷ‬‫‪.‬‬
‫‪3‬‬
‫ﺪ‬
‫ﻌ‬‫ﺎﺑ‬
‫ﻟﻰﻣ‬
‫ﺓﺇ‬‫ﻮ‬
‫ﻘ‬‫ﻟ‬‫ﺎ‬
‫ﻔﺼﻞﺑ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻚ‬‫ﺮ‬‫ﺎﺗﺤ‬
‫ﻬ‬‫ﻴ‬‫ﺘﻢﻓ‬‫ﺔﻳ‬‫ﻳ‬
‫ﺪ‬‫ﺔﺟﺴ‬ ‫ﻣ‬ ‫ﺪ‬
‫ﻟﺼ‬ ‫ً‬
‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﺋﻲ‬‫ﺰ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻊﻭ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺪﺙ‬ ‫‪.‬ﻳﺤ‬
‫‪4‬‬
‫‪.‬‬
‫(‬‫ﻜﻞ‪1‬‬‫ﻟﺸ‬
‫ﺍ‬
‫ﻊ)‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻷﺻ‬‫ﻮﻉﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﺒ‬‫ﻛ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻒﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻙﻭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﺔﻫﻲﻣ‬ ‫ﻌ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻊ‬‫ﻗ‬‫ﺍ‬‫ﻮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬
‫‪ROM‬‬

‫‪(Fi‬‬
‫‪g.‬‬‫‪1)Et‬‬
‫‪i‬‬‫‪ol‬‬
‫‪ogyofor‬‬
‫‪t‬‬‫‪hopedi‬‬
‫‪ct‬‬‫‪r‬‬
‫‪auma‬‬

‫‪Howt‬‬ ‫‪odi‬‬ ‫‪agnoseor‬‬ ‫‪t‬‬

‫‪hopedi‬‬ ‫‪ct‬‬‫‪r‬‬‫‪aumapat‬‬‫‪i‬‬‫‪ent‬‬‫‪:‬‬
‫‪I‬‬‫‪-‬‬
‫‪Cl‬‬‫‪i‬‬‫‪ni‬‬‫‪calmani‬‬ ‫‪f‬‬‫‪est‬‬
‫‪at‬‬‫‪i‬‬
‫‪onsf‬‬ ‫‪ort‬‬ ‫‪r‬‬
‫‪aumapat‬‬ ‫‪i‬‬
‫‪ent‬‬‫‪:‬‬
‫‪A-Spr‬‬ ‫‪ai‬‬‫‪n&st‬‬ ‫‪r‬‬
‫‪ai‬‬‫‪n:‬‬
‫‪1.Compl‬‬ ‫‪ai‬‬‫‪nt‬‬‫‪sofanacut‬‬ ‫‪ei‬‬‫‪nj‬‬‫‪ur‬‬
‫‪y‬‬ ‫‪.‬‬
‫‪2.Pai‬‬ ‫‪n.‬‬
‫‪3.I‬‬‫‪nabi‬‬‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪yt‬‬ ‫‪obearwei‬‬‫‪ghtoruset‬‬ ‫‪heaf‬‬
‫‪f‬‬‫‪ect‬‬‫‪edsi‬‬‫‪de.‬‬
‫‪4.Ecchy‬‬ ‫‪mosi‬‬ ‫‪s.‬‬
‫‪5.Poi‬‬ ‫‪ntt‬‬‫‪ender‬‬‫‪ness.‬‬
‫‪6.Swel‬‬ ‫‪l‬‬‫‪i‬‬
‫‪ngoredema.‬‬
‫‪7.Changei‬‬ ‫‪nj‬‬‫‪oi‬‬‫‪ntcont‬‬‫‪our‬‬‫‪.‬‬
‫‪8.Cr‬‬ ‫‪epi‬‬‫‪t‬‬
‫‪us.‬‬
‫‪9.Guar‬‬ ‫‪di‬‬‫‪ngoft‬‬ ‫‪hei‬‬‫‪nj‬‬
‫‪ur‬‬‫‪edsi‬‬ ‫‪t‬‬
‫‪e.‬‬
‫‪:‬‬
‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻮﺽ‬ ‫ﻴ ﺺﺭﺿ‬ ‫ﺔﺗﺸﺨ‬ ‫ﻴ‬‫ﻔ‬
‫ﻴ‬‫ﻛ‬
‫‪:‬‬‫ﺔ‬
‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫‪I-‬‬‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬
‫ﺎ‪:‬‬
‫ﻻﻌﻝ‬‫ﻔ‬
‫ﺍﻧ‬ ‫ﺀﻭ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫‪-‬‬
‫ﺃ‬
‫‪.‬‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻻﺻ‬ ‫ﻭﻯ‬‫ﺎ‬‫ﻜ‬‫‪.‬ﺷ‬ ‫‪1‬‬
‫‪.‬‬‫ﻟﻢ‬‫ﺍﻷ‬‫‪.‬‬‫‪2‬‬
‫‪.‬‬
‫ﺎﺏ‬‫ﻤﺼ‬
‫ﻟ‬‫ﺍ‬‫ﻧﺐ‬
‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬
‫ﺍﺳ‬‫ﻭ‬‫ﺃ‬‫ﺯﻥ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﻠﻰﺗﺤ‬‫ﺓﻋ‬ ‫ﺭ‬
‫ﺪ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫‪.‬ﻋ‬ ‫‪3‬‬
‫‪.‬‬
‫ﺔ‬‫ﻣ‬ ‫ﺪ‬‫‪.‬ﻛ‬‫‪4‬‬
‫‪.‬‬‫ﺔ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘﻄ‬ ‫‪.‬ﻧ‬‫‪5‬‬
‫‪.‬‬‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻭﻭ‬ ‫ﺃ‬
‫ﻡ‬ ‫ﺭ‬‫ﻮ‬‫‪.‬ﺗ‬‫‪6‬‬
‫‪.‬‬‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻑ‬‫ﻔ‬‫ﺮﻓﻲﻛ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬‫‪.‬ﺗ‬‫‪7‬‬

‫‪6‬‬
 .‫ﻮﺱ‬‫ﺘ‬‫ﻴ‬‫ﺒ‬
‫ﻳ‬‫ﺮ‬‫ﻛ‬.
8
.
‫ﺎﺏ‬‫ﻤﺼ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺳ‬
‫ﺮ‬‫ﺣ‬.9
B-Dislocat i
ons&Subl uxat i
on:
1.Historyofdi r
ectfallortrauma.
2.Pain.
3.Swel l
ingi nandaroundt hej oi
nt.
4.Li
mi tationsinthemot ionoft hejoint
.
5.Jointdef ormity
.
6.Tender nesst otouch.
7.Abnor mal posturi
ng.
8.Diminishedorabsentdi stalpulses.
Disl
ocat ions&Subl uxation( Fi
g.2).
:‫ﺋﻲ‬‫ﺰ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﻊ‬
‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻊﻭ‬ ‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬-‫ﺏ‬
.
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻁ‬ ‫ﻘ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺗ‬.1
.‫ﻟﻢ‬
‫ﺍﻷ‬.2
.
‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﻡﻓﻲﻭﺣ‬ ‫ﺭ‬
‫ﻮ‬‫ﺗ‬.3
.
‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺩﺣ‬‫ﻮ‬‫ﻴ‬‫ﻗ‬.4
.‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﻮ‬‫ﺗﺸ‬.5
.
‫ﻤﺲ‬ ‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬.6
.‫ﺔ‬‫ﻴ‬
‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﺮﻃ‬ ‫ﻴ‬‫ﺎﺕﻏ‬ ‫ﻴ‬‫ﻌ‬
‫ﻭﺿ‬. 7
.‫ﺓ‬
‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺒﻀ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻴ‬‫ﻭﻏ‬‫ﺃ‬‫ﻗﺺ‬ ‫ﺎ‬‫ﻨ‬
‫ﺗ‬.8
.(2‫ﻜﻞ‬‫ﻟﺸ‬‫ﺍ‬
)‫ﺋﻲ‬ ‫ﺰ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻠ‬‫ﻟﺨ‬
‫ﺍ‬‫ﻊﻭ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬

(
Fig.2)Di
slocat
ions&Subl
uxat
ion

II
-Di agnost icpar amet ersforOr t
hopedi ctr
aumapat i
ent:
A.Cl assi fi
cat i
onofspr ai
n&st rain:
ar egradedaccor
dingto:
-Thesev eri
tyofsy mpt oms.
-Tissuedamagepr esent.
GradeI :
-Lesst han25%t hef i
bersaret orn.
-Mi l
dpai nort ender ness,swelling.
-Limi tedbr uising.
GradeI I:
-25%: 75%oft hef i
ber saretorn.
-Sli
ghti nstabili
ty.
-Moder atepain.
-Tender ness, swel l
i
ng, &bruising.
GradeI II:
-75%ormor eoft hefibersaret orn.
-Av ulsionf ractureaccompani ed.
-Signif i
canti nstabil
itywithpain.
-Tender ness; swel l
i
ng&ext ensivebr uisi
ng.
:‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺮﺿﻰﺇﺻ‬ ‫ﻤ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻳ‬‫ﺎ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬-I
I
:
‫ﺎﺣﺴﺐ‬‫ﻬ‬‫ﻔ‬‫ﻴ‬
‫ﻨ‬‫ﺘﻢﺗﺼ‬‫ﻳ‬:‫ﺎ‬
‫ﻻﻌﻝ‬
‫ﻔ‬‫ﺍﻧ‬‫ﺀﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﻴﻒ‬‫ﻨ‬‫ﺗﺼ‬.‫ﺃ‬
.
‫ﺍﺽ‬ ‫ﺮ‬
‫ﺍﻷﻋ‬ ‫ﺓ‬
‫ﺪ‬‫ﺷ‬-
.‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﺔﻣ‬ ‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻠﻒ‬‫ﺗ‬-
:
‫ﻟﻰ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬
‫ﻗ‬‫ﺰ‬‫ﻤ‬‫ﺎﻑﻣ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍﻷ‬٪25‫ﻗﻞﻣﻦ‬ ‫ﺃ‬-
.‫ﻡ‬‫ﺭ‬‫ﻮ‬
‫ﺗ‬‫ﺔﻭ‬‫ﻗ‬ ‫ﻭﺭ‬‫ﺃ‬‫ﻴﻒ‬‫ﻔ‬‫ﻟﻢﺧ‬‫ﺃ‬-

7
 .‫ﺓ‬‫ﺩ‬‫ﻭ‬
‫ﺪ‬‫ﺎﺕﻣﺤ‬ ‫ﻣ‬‫ﺪ‬‫ﻛ‬-
:
‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
.
‫ﺔ‬‫ﻗ‬‫ﺰ‬‫ﻤ‬
‫ﺎﻑﻣ‬ ‫ﻴ‬‫ﻟ‬
‫ﻣﺍﻷ‬
‫ ﻦ‬75٪: 25٪-
.
‫ﻴﻒ‬‫ﻔ‬‫ﺭﻃ‬ ‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﺳ‬‫ﻡ‬‫ﺪ‬‫ﻋ‬-
.‫ﺪﻝ‬‫ﺘ‬‫ﻌ‬‫ﻟﻢﻣ‬‫ﺃ‬
-
.
‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺭ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻗ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
-
:
‫ﻟﺚ‬‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺼﻒ‬ ‫ﺍ‬
.
‫ﺔ‬‫ﻗ‬‫ﺰ‬
‫ﻤ‬‫ﺎﻑﻣ‬ ‫ﻴ‬
‫ﻟ‬‫ﻣﺍﻷ‬
‫ﺮﻦ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻭ‬7
‫ ﺃ‬5٪-
.
‫ﻮﺏ‬‫ﻌﻲﻣﺼﺤ‬ ‫ﻠ‬‫ﺮﻗ‬‫ﻛﺴ‬-
.‫ﻟﻢ‬
‫ﻣﺍﻷ‬
‫ﺮﻊ‬ ‫ﻴ‬‫ﺒ‬‫ﺭﻛ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﺳ‬‫ﻡ‬‫ﺪ‬‫ﻋ‬-
.
‫ﺎﻕ‬‫ﻨﻄ‬
‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬
‫ﺍﺳ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﺪ‬‫ﻛ‬‫ﻡﻭ‬‫ﺭ‬‫ﻮ‬‫؛ﺗ‬
‫ﺎﻥ‬‫ﻨ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻗ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
-
B.Ot herdi agnost ictest s:
1.Radi ogr aphs:
-I
tdi agnosesdi slocations, subl ux ati
on&sev erespr ainandst rain.
2.MRI :
-Usedt odet ermi net heext entofl i
gamentdamage.
3.Cl i
nicalpr ocedur es:
-Dur ingphy sical exami nation. Speci f
ictestsar eperfor medt odet ermi net he
str
engt hoft hesof tti
ssueorcompet enceoft hejoint .
Nur singManagementf orOr t hopedi cTr aumapat i
ent :
Probl em ( I):Acut epai nev i
dencedbycompl aintofpai n,facial gri
maci ng,
guar dingoft heaf fectedsi te, bruising&swel l
ing.
Nur singi nt erv ent i
on:
1.Ev aluat et hesev eri
tyofi nj ur y
.
2.Inspectf orsi gnsoft rauma.
3.Pal pat ear easf ortender ness.
4.Assessneur ov ascul arst atusbychecki ngforpul se, sensationnumbnessor
ti
ngl i
ng.
5.Assessr angeofmot ion&gai tdisturbances.
6.Immobi l
izingt hejointorl i
mbwi thspl i
ntorsl i
ng.
7.Admi nisteranal gesi c.
8.Inst ructusenonphar macol ogicinterventi
on.
:
‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺔ‬ ‫ﻴ‬‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬
‫ﺍﻻﺧ‬
:
‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬.1
.‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬‫ﺋﻲﻭ‬‫ﺰ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻊ‬‫ﻠ‬
‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻊﻭ‬ ‫ﻠ‬
‫ﻟﺨ‬ ‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻴ ﺺﺣ‬ ‫ﺗﺸﺨ‬-
:
‫ﻴﺴﻲ‬‫ﺎﻃ‬ ‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻧ‬‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬
‫ﺍ‬.2
.
‫ﺔ‬ ‫ﺑﻄ‬‫ﺭ‬
‫ﺍﻷ‬‫ﻠﻒ‬ ‫ﺪﻯﺗ‬ ‫ﺪﻣ‬ ‫ﻳ‬ ‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﻳﺴ‬-
:‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬.3
‫ﺓ‬‫ﺀ‬ ‫ﺎ‬‫ﻔ‬
‫ﻭﻛ‬ ‫ﺃ‬‫ﺓ‬‫ﻮ‬ ‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺓ‬
‫ﻮ‬ ‫ﺪﻗ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬ ‫ﻟ‬‫ﺓ‬
‫ﺩ‬ ‫ﺪ‬
‫ﺍﺕﻣﺤ‬ ‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬ ‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﺘﻢﺇﺟ‬ ‫ﻴﺚﻳ‬ ‫ﺣ‬، ‫ﻧﻲ‬ ‫ﺪ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻔﺤ ﺺ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬-
.‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
:‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺎ‬‫ﺮﺿﻰﺇﺻ‬ ‫ﻤ‬ ‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﻭ‬، ‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬ ‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺳ‬‫ﺮ‬‫ﻭﺣ‬، ‫ﻪ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﻘﺸ‬ ‫ﺗ‬
‫ﻭ‬،‫ﻟ‬‫ﻣﺍﻷﻢ‬
‫ﻮﻯ ﻦ‬ ‫ﻜ‬‫ﻟﺸ‬‫ﺍ‬‫ﺗﺞﻋﻦ‬ ‫ﺎ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻟﻢ‬ ‫ﺍﻷ‬:
(1)‫ﺔ‬ ‫ﻠ‬
‫ﻜ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬
.‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﺪ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻻﺻ‬ ‫ﺓ‬‫ﺪ‬‫ﻴﻢﺷ‬ ‫ﻴ‬‫ﻘ‬
‫ﺗ‬.1
.‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬ ‫ﺎﻋﻦﻋﻼ‬ ً
‫ﺜ‬
‫ﻓﺤ ﺺﺑﺤ‬ ‫ﺍ‬.2
.‫ﺔ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬‫ﺔﻣ‬‫ﻣﺴ‬ ‫ﻣﻼ‬.3
.
‫ﺰ‬‫ﻭﻭﺧ‬ ‫ﺃ‬ ‫ﺎﺱ‬ ‫ﺍﻹﺣﺴ‬ ‫ﺭ‬‫ﺪ‬‫ﻭﺧ‬، ‫ﺒﺾ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻘﻖﻣﻦ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺣﺔ‬
‫ﻟ‬‫ﻴﻢ ﺎ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬.4
.
‫ﺔ‬‫ﻴ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻛ‬
‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﺔﻣﻦ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﻴﻢﻣﺠ‬ ‫ﻴ‬‫ﻘ‬
‫ﺗ‬.5
.‫ﺎ‬
‫ﺒﻝ‬ ‫ﻭﺣ‬ ‫ﺃ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﺮﻑﺑﺠ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬
‫ﺗ‬.6

8
 .‫ﻜﻦ‬‫ﺓﻣﺴ‬ ‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬.7
.‫ﺪﺧﻞ‬ ‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻭ‬ ‫ﺮﺩ‬ ‫ﻴ‬‫ﻡﻏ‬ ‫ﺍ‬‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬ ‫ﺇ‬.8
Problem ( 2) :impai redphy sicalmobi l
ityrelatedt olimi tati
oni nmot ionorwei ght
bearingandr ef usedt ouset heaf f
ect edj oint.
Nursingi nt erv ent i
on:
1.Per f
ormt heappr opriatedi agnost i
ct est.
2.Teachi somet ricexer cisest ol i
mi tsecondar ymuscl eat rophydur ing
i
mmobi lit
yper iod.
3.Suppor trehabi li
tat iv
eef for t
sbyt eachi ngexer ci
ses.
‫ﻡ‬‫ﺍ‬‫ﺪ‬
‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻓﺾ‬ ‫ﺭ‬
‫ﺯﻥﻭ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﻭﺗﺤ‬ ‫ﺃ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺪﻣﻦ‬ ‫ﻟﺤ‬‫ﺎ‬‫ﺔﺑ‬ ‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺪ‬ ‫ﻟﺠﺴ‬‫ﺍ‬‫ﺔ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻌﻒ‬ ‫ﺿ‬: (2)‫ﺔ‬ ‫ﻠ‬
‫ﻜ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﺎﺏ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.
‫ﺎﺳﺐ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺼﻲ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺈﺟ‬‫ﻗﻢﺑ‬. 1
.‫ﺔ‬‫ﻛ‬ ‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﺘ‬‫ﺀﻓ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻮﻱ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﻮ‬‫ﻤ‬‫ﺪﻣﻦ ﺿ‬ ‫ﻠﺤ‬‫ﻟ‬ ‫ﺎﺱ‬ ‫ﻴ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺎ‬‫ﺘﺴ‬ ‫ﻳﻦﻣ‬ ‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﻴﻢﺗ‬‫ﻠ‬‫ﻌ‬‫ﺗ‬.2
‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺲ‬ ‫ﺭ‬
‫ﺪ‬‫ﻴﻞﻣﻦﺧﻼﻝﺗ‬ ‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬ ‫ﺩﺇ‬‫ﻮ‬‫ﻬ‬‫ﻋﻢﺟ‬ ‫ﺩ‬.3
Problem ( 3) :Sel f
-caredef i
citEv idencedbydecr easedabi l
ityt obat hedr ess,
feed,andt oiletonesel f.
Nursingi nt erv ent on:
i
-Demonst r
at et heabi l
ityt ouseassi stivedev icest of acili
tateal lar easofsel f
care.
‫ﻭ‬، ‫ﻡ‬‫ﺎ‬‫ﻌ‬‫ﺍﻹﻃ‬ ‫ﻭ‬، ‫ﻡ‬‫ﺎ‬‫ﻤ‬‫ﺘﺤ‬‫ﺍﻻﺳ‬ ‫ﻠﻰ‬ ‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺽ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﺘﻀﺢﻣﻦﺧﻼﻝ‬ ‫ﺔﻳ‬ ‫ﻴ‬‫ﺗ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬ ‫ﺎ‬
‫ﻋ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻘﺺ‬ ‫ﻧ‬:(3)‫ﺔ‬ ‫ﻠ‬
‫ﻜ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬
.
‫ﺎﺽ‬ ‫ﺮﺣ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.‫ﺔ‬‫ﻴ‬ ‫ﺗ‬
‫ﺍ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﻣﺎﻻﺕ‬‫ﻊﺠ‬ ‫ﻴ‬‫ﻤ‬‫ﻴﻞﺟ‬ ‫ﻬ‬
‫ﺘﺴ‬ ‫ﻟ‬‫ﺓ‬ ‫ﺪ‬‫ﻋ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺍﻷﺟ‬ ‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻠﻰ‬ ‫ﺓﻋ‬ ‫ﺭ‬
‫ﺪ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺒ‬‫ﺛ‬‫ﺇ‬-
Nursingi nt erv ent i
onf orj ointdi slocat ion:
1.Suppor tthel imbt oav oidt ractiont heneur ov ascularst ruct uresi nt hear eaof
thejoint.
2.Discour ageat t
empt sbyunt rainedper sonnel topr event .
3.Suppor tthepat ientdur ing&af t
err educt ionsofdi slocatedj oint .
4.Admi nist eranal gesi c,muscul arr elaxant s.
5.Moni torv i
tal si
gns.
6.Teacht hepat i
enttomai ntainimmobi li
zat ionoft hej ointaf teropenr educt ion.
7.Hipabduct orbr acef or6- 8weeks.
8.Shoul dersl ingf or3weeks.
9.Fingerspl intf or3- 4weeks.
10.Encour ageact iver angeofmot ionexer cisest oall j
ointdi st al tot he
disl
ocat i
on.
11.Admi nist erpai nr elivesaspr escr ibed.
:‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻠ‬
‫ﻟﺨ‬ ‫ﻳﻀﻲ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻘ‬‫ﻨﻄ‬‫ﺔﻓﻲﻣ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬‫ﻋ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻨﺐﺟ‬ ‫ﺘﺠ‬ ‫ﻟ‬‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻋﻢ‬ ‫ﺩ‬.1
.‫ﺎ‬‫ﻬ‬‫ﻌ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﻴﻦ‬‫ﺑ‬‫ﺭ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺩﻏ‬ ‫ﺍ‬‫ﺮ‬ ‫ﻓ‬‫ﺍﻷ‬ ‫ﻭﻻﺕ‬ ‫ﺎ‬
‫ﻴﻂﻣﺤ‬ ‫ﺒ‬‫ﺜ‬‫ﺗ‬.2
.‫ﻮﻉ‬ ‫ﻠ‬
‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺎﺕﺗﺼ‬ ‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﺪﻋ‬ ‫ﻌ‬ ‫ﺑ‬
‫ﺀﻭ‬ ‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻋﻢ‬ ‫ﺩ‬.3
.‫ﺎﺕ‬ ‫ﻨ‬
‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻴ‬
‫ﺮﺧ‬ ‫ﺓﻣ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬.4
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬. 5
.‫ﻮﺡ‬ ‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻓ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻌ‬‫ﻔﺼﻞﺑ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺒ‬‫ﻠﻰﺛ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬‫ﺗ‬.6
.
‫ﻊ‬ ‫ﻴ‬
‫ﺑ‬‫ﺎ‬‫ﺃﺳ‬ 8-6‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬ ‫ﺭﻙ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻔ‬‫ﺎﻃ‬‫ﺔﺧ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﻋ‬ ‫ﺩ‬.7
.
‫ﻊ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬‫ﺃﺳ‬ 3‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬ ‫ﺘﻒ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﺒ‬‫ﺣ‬. 8
.‫ﻊ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺳ‬ 4- 3‫ﺓ‬ ‫ﺪ‬‫ﻤ‬ ‫ﻟ‬‫ﻊ‬‫ﺒ‬‫ﺍﻹﺻ‬ ‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺟ‬. 9
.‫ﻊ‬‫ﻠ‬‫ﻠﺨ‬‫ﻟ‬‫ﺓ‬‫ﺪ‬ ‫ﻴ‬
‫ﻌ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻤ‬ ‫ﻟﺠ‬ ‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻳﻦ‬ ‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻣﻦﺗ‬ ‫ﺔﻧﺸﻄ‬ ‫ﻮﻋ‬‫ﻤ‬ ‫ﻊﻣﺠ‬ ‫ﻴ‬‫ﺗﺸﺠ‬. 10
.‫ﻪ‬‫ﻴ‬‫ﻠ‬‫ﻮ ﺹﻋ‬ ‫ﻨﺼ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻟﻢﻋ‬ ‫ﺍﻷ‬ ‫ﻳﺢ‬ ‫ﺮ‬‫ﺘ‬‫ﺓﻳﺴ‬ ‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬. 11

9
Di schar gei nstruct ions&homeheal t
hcar eabout :
1.Act ivit
yl imi t
ationsandposi tionr est ri
ctiont opr omot eheal ing.
2.Teachsy mpt omsofcast ,br ace, bandaget ightness:
-Pai n.
-Edema.
-Numbness.
-Ti ngling.
-Changei nski nt emper at ureorcol or.
3.Teacht hepat i
entt heappr opr i
ateappl icationofbr acesori mmobi l
izi
ng
dev ice.
4.Teachassessmentofski ni nt hear eaoft hedev i
ce.
5.I nstructt hepat ientonhowt ocor rectlyposi ti
ont hei njuredpar twhen
per formi ngt heADLs.
6.Demonst ratet heuseoft heal lsuppor ti
v edev ice.
7.Rev iewt headmi nist rationoft hemedi cationr egimen.
8.Encour agemaxi mal mobi l
izat i
ont hroughphy sical therapy&ADLs.
9.Expl aint ot hepat ientt hatt empor aryl eav eorabsencef rom wor k.
10.Encour aget hepat i
entt oav oidr einjurybyper formi ngst retchi ngandwar m
upexer cisesbef or ewor kact iv ity
.
:‫ﻮﻝ‬ ‫ﺔﺣ‬ ‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻋ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺝﻭ‬‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻤ‬‫ﻴ‬‫ﻠ‬‫ﻌ‬‫ﺗ‬
.‫ﺀ‬‫ﺎ‬‫ﻔ‬
‫ﻟﺸ‬ ‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﻗﻒ‬ ‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬ ‫ﻴ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬
‫ﺎﻁﻭ‬‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬ ‫ﻮ‬‫ﻴ‬‫ﻗ‬.1
:‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬ ،‫ﺔ‬‫ﻣ‬‫ﺎ‬‫ﻋ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬،‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻴﻖ‬‫ﺍ ﺽﺿ‬ ‫ﺮ‬‫ﺃﻋ‬ ‫ﻠﻢ‬‫ﻋ‬.2
.‫ﺍ‬
‫ﻟﻢ‬-
.
‫ﺔ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬-
.‫ﺧ‬
‫ﺭ‬
‫ﺪ‬-
.‫ﻴﻞ‬ ‫ﻤ‬‫ﻨ‬‫ﺗ‬-
.‫ﻪ‬‫ﻧ‬‫ﻮ‬‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﺔﺣ‬‫ﺭﺟ‬‫ﺮﻓﻲﺩ‬ ‫ﻴ‬‫ﻐ‬‫ﺗ‬-
.‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻭﺟ‬ ‫ﺃ‬‫ﺎﻥ‬‫ﻨ‬‫ﺍﻷﺳ‬ ‫ﻳﻢ‬‫ﻮ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬ ‫ﺎﺳﺐ‬‫ﻨ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻖ‬ ‫ﺒ‬‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻢ‬‫ﻋ‬.3
.
‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﺓﻓﻲﻣ‬ ‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﻴﻢﺗ‬ ‫ﻠ‬
‫ﻌ‬‫ﺗ‬.4
.
ADLs‫ﺀ‬ ‫ﺍ‬‫ﺮ‬‫ﺪﺇﺟ‬ ‫ﻨ‬‫ﻴﺢﻋ‬ ‫ﻜﻞ ﺻﺤ‬ ‫ﺎﺏﺑﺸ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬ ‫ﺔﻭﺿ‬ ‫ﻴ‬‫ﻔ‬ ‫ﻴ‬‫ﻮﻝﻛ‬ ‫ﻳ ﺾﺣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬ ‫ﺇ‬.5
.‫ﺔ‬‫ﻤ‬‫ﺍﻋ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺰ‬
‫ﻬ‬ ‫ﻛﺍﻷﺟ‬‫ﻡﻞ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻭﺿﺢ‬. 6
.
‫ﺀ‬‫ﺍ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬‫ﺓﻧﻈ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺔﺇ‬‫ﻌ‬‫ﺍﺟ‬ ‫ﺮ‬‫ﻣ‬.7
.ADLs‫ﻌﻲﻭ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻯﻣﻦﺧﻼﻝ‬ ‫ﻘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﺒ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻴ‬‫ﺗﺸﺠ‬. 8
.
‫ﻤﻞ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏﻋﻦ‬ ‫ﻴ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬ ‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺯ‬ ‫ﺎ‬
‫ﺃﺍﻹﺟ‬ ‫ﻳﺾﻥ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺮﺡ‬ ‫ﺍﺷ‬ .
9
.
‫ﻤﻞ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﺒﻞﻧﺸ‬ ‫ﺀﻗ‬ ‫ﺎ‬‫ﻤ‬ ‫ﺍﻹﺣ‬ ‫ﺪﻭ‬ ‫ﻟﺸ‬ ‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬ ‫ﺎ‬
‫ﻤ‬‫ﺀﺗ‬ ‫ﺍ‬‫ﺩ‬
‫ﺃ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬
‫ﺍﻫ‬‫ﺮ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻨﺐ‬ ‫ﻠﻰﺗﺠ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻴ‬
‫ﺗﺸﺠ‬. 10
Or thopedi ct raumapat ient sgr oups:
I.Fr actur edneckoff emur .
II.Supr acondy l
arf ract ureoft hehumor ous.
III.Fract ure–di sl ocat i
onsoft heankl e.
IV.Mul tiplet rauma.
Af tertheassessment , thenur seal locat est hepat i
entt oapr i
or itygroup.
Assessmentusedf oror thopedi ctraumagr oups:
Fi vecol or edpr i
or ityr at ingar eusedt ogr ouppat ient s:
Thenur semayhav et ogi v eanexpl anat ionast owhyt hatpar ticularpatient .
1.Red: islifet hreat eni ng; thepat entmustbeseeni mmedi at ely .
2.Or ange:i sv eryur gent ;t hepat ientmustbeseenwi thin10mi nutes.
3.Yel l
ow: isur gent ;meani ngt hepat i
entwi l
l beseenwi thin1hour .
4.Gr een:i snotur gentwhi chmeanst hati nterventionwi llt
akepl acewi thin2
hour s.
5.Bl ue: i
sal l
ocat edt opat ient swhocoul dbeseeni nt hepr imar ycar eset t
ing.

10
‫‪Thesepat‬‬ ‫‪i‬‬‫‪ent‬‬‫‪scoul‬‬ ‫‪dwai‬‬ ‫‪tasl‬‬ ‫‪ongas4hour‬‬ ‫‪sf‬‬ ‫‪orexami‬‬ ‫‪nat‬‬ ‫‪i‬‬‫‪onbyt‬‬ ‫‪hedoct‬‬ ‫‪or‬‬‫‪.‬‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﺎﺕﻣ‬ ‫ﻮﻋ‬ ‫ﻤ‬‫ﻣﺠ‬
‫‪.‬‬‫ﺬ‬ ‫ﻔﺨ‬‫ﻟ‬‫ﺍ‬‫ﺭﻓﻲﻋﻈﻢ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻨﻖﻣ‬ ‫‪.‬ﻋ‬ ‫‪I‬‬
‫‪.‬‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺪﻋ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭﺡ‬ ‫ﻤﻲﻣﻦﺭ‬ ‫ﻘ‬‫ﻟ‬‫ﻮﻕ‬ ‫ﺮﻓ‬ ‫‪.‬ﻛﺴ‬ ‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺛ‬
‫‪.‬‬‫ﺎﺣﻞ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻊﻓﻲ‬ ‫ﻠ‬
‫ﺮ‪-‬ﺧ‬ ‫ﺎ‪.‬ﻛﺴ‬‫ﺛﺎ‬
‫ﺜ‬‫ﻟ‬
‫‪.‬‬
‫ﺓ‬‫ﺩ‬‫ﺪ‬ ‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫‪.‬‬‫ﺎ‬
‫ﻌ‬‫ﺑ‬‫ﺍ‬
‫ﺭ‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬ ‫ﻟ‬
‫ﻭ‬ ‫ﺃ‬‫ﺍﺕ‬ ‫ﺔﺫ‬ ‫ﻮﻋ‬‫ﻤ‬ ‫ﻤﺠ‬ ‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫‪،‬ﺗﺨﺼ ﺺ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻋ‬‫ﻮ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫‪:‬‬‫ﺮﺿﻰ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻴ‬
‫ﻤ‬‫ﺘﺠ‬ ‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻟ‬‫ﻭ‬‫ﻟﻸ‬ ‫ﺔ‬‫ﻧ‬‫ﻮ‬‫ﻠ‬‫ﺎﺕﻣ‬ ‫ﻔ‬‫ﻴ‬‫ﻨ‬‫ﺔﺗﺼ‬ ‫ﻤﺴ‬ ‫ﻡﺧ‬ ‫ﺪ‬ ‫ﺘﺨ‬‫ﺗﺴ‬‫ُ‬
‫‪.‬‬‫ﻪ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬ ‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍ‬‫ﺬ‬‫ﺍﻫ‬ ‫ﺫ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬‫ﺮ‬‫ﻴ‬‫ﻔﺴ‬ ‫ﻳﻢﺗ‬ ‫ﺪ‬‫ﻘ‬
‫ﻟﻰﺗ‬ ‫ﺔﺇ‬‫ﺮﺿ‬ ‫ﻤ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺪﺗﻀﻄ‬ ‫ﻗ‬
‫‪.‬‬
‫ﺭ‬ ‫ﻮ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺍﻉﻋ‬ ‫ﺮ‬‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﺓ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺔﺑ‬ ‫ﻳ‬
‫ﺅ‬ ‫؛ﻳﺠﺐﺭ‬ ‫ﺓ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺩ‬‫ﺪ‬‫ﻬ‬‫ﺣ‪:‬ﻳ‬
‫ﺮ‬‫ﺍﻷ ﻤ‬ ‫‪.‬‬‫‪1‬‬
‫‪.‬‬‫ﺋﻖ‬‫ﺎ‬‫ﻗ‬‫ﻮﻥ‪10‬ﺩ‬ ‫ﻳ ﺾﻓﻲﻏﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺅ‬‫ﺟ‪.‬ﻳﺠﺐﺭ‬ ‫ﺍ‬‫ﺎﺟﻞ ﺪ‬ ‫‪:‬ﻋ‬‫ﻟﻲ‬ ‫ﺎ‬
‫ﻘ‬‫ﺗ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪2‬‬
‫‪.‬‬
‫ﺓ‬ ‫ﺪ‬
‫ﺍﺣ‬ ‫ﺔﻭ‬‫ﺎﻋ‬‫ﻮﻥﺳ‬ ‫ﺮﻓﻲﻏﻀ‬ ‫ﻬ‬‫ﻴﻈ‬ ‫ﻳ ﺾﺳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺃﻥ‬ ‫ﻨﻲ‬‫ﻌ‬‫ﺎﻳ‬‫ﻤ‬‫‪.‬ﻣ‬‫ﺎﺟﻞ‬ ‫ﺻ‪:‬ﻋ‬
‫ﺮ‬‫ﺍﻷ ﻔ‬ ‫‪.‬‬‫‪3‬‬
‫‪.‬‬
‫ﻴﻦ‬ ‫ﺘ‬‫ﺎﻋ‬‫ﻮﻥﺳ‬ ‫ﺪﺙﻓﻲﻏﻀ‬ ‫ﻴﺤ‬ ‫ﺪﺧﻞﺳ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺃﻥ‬ ‫ﻨﻲ‬‫ﻌ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﺎﺟﻼًﻣ‬ ‫ﻴﺲﻋ‬ ‫ﻟ‬‫‪:‬‬
‫ﺮ‬‫ﺍﻷﺧﻀ‬ ‫‪.‬‬‫‪4‬‬
‫ﺍﻻ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬ ‫ﺆﻻ‬‫ﻬ‬‫ﻟ‬
‫ﻜﻦ‬ ‫ﻤ‬‫‪.‬ﻳ‬ ‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬ ‫ﻜ‬‫ﻬﻢﻓﻲﻣ‬ ‫ﺘ‬‫ﻳ‬‫ﺅ‬‫ﻜﻦﺭ‬ ‫ﻤ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫‪:‬ﻣﺨﺼ ﺺ‬ ‫ﺭﻕ‬ ‫ﺯ‬‫ﺍﻷ‬‫‪.‬‬‫‪5‬‬
‫‪.‬‬‫ﻴﺐ‬ ‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﺒﻞ‬‫ﻬﻢﻣﻦﻗ‬ ‫ﻔﺤﺼ‬ ‫ﻟ‬‫ﺎﺕ‬ ‫ﻋ‬‫ﺎ‬‫ﻟﻰ‪4‬ﺳ‬ ‫ﺓﺗﺼﻞﺇ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬ ‫ﺭ‬‫ﺎ‬
‫ﺘﻈ‬ ‫ﻧ‬
‫‪Or‬‬‫‪t‬‬‫‪hopedi‬‬ ‫‪ct‬‬ ‫‪r‬‬‫‪aumapat‬‬ ‫‪i‬‬
‫‪entgr‬‬ ‫‪oups:‬‬
‫‪I‬‬‫‪.Fr‬‬‫‪act‬‬ ‫‪ur‬‬‫‪edneckoff‬‬ ‫‪emur‬‬ ‫‪:‬‬
‫‪-Thecommonestf‬‬ ‫‪or‬‬ ‫‪m ofi‬‬ ‫‪nj‬‬‫‪ur‬‬‫‪yi‬‬ ‫‪nanel‬‬ ‫‪der‬‬‫‪l‬‬‫‪yper‬‬ ‫‪sons.‬‬
‫‪-Themaj‬‬ ‫‪or‬‬ ‫‪i‬‬‫‪t‬‬
‫‪yofwhi‬‬ ‫‪choccuri‬‬ ‫‪nt‬‬ ‫‪hoseov‬‬ ‫‪er65.‬‬
‫‪-Thecausat‬‬ ‫‪i‬‬
‫‪v‬‬ ‫‪ei‬‬‫‪nj‬‬
‫‪ur‬‬ ‫‪ymechani‬‬ ‫‪sm i‬‬ ‫‪susual‬‬ ‫‪l‬‬
‫‪ymi‬‬ ‫‪ni‬‬‫‪mal‬‬ ‫‪,‬‬‫‪suchasal‬‬ ‫‪ow-‬‬ ‫‪i‬‬
‫‪mpactf‬‬ ‫‪al‬‬‫‪l‬‬
‫‪orst‬‬ ‫‪umbl‬‬ ‫‪e,‬‬‫‪butt‬‬ ‫‪heconsequencesar‬‬ ‫‪ef‬‬ ‫‪arr‬‬ ‫‪eachi‬‬ ‫‪ngf‬‬ ‫‪ort‬‬ ‫‪hei‬‬ ‫‪ndi‬‬‫‪v‬‬‫‪i‬‬‫‪dual‬‬ ‫‪concer‬‬ ‫‪ned.‬‬
‫‪-Ol‬‬‫‪derpeopl‬‬ ‫‪ear‬‬ ‫‪epar‬‬ ‫‪t‬‬‫‪i‬‬‫‪cul‬‬‫‪ar‬‬‫‪l‬‬‫‪ysuscept‬‬ ‫‪i‬‬
‫‪bl‬‬ ‫‪et‬‬‫‪odehy‬‬ ‫‪dr‬‬‫‪at‬‬‫‪i‬‬‫‪onandpr‬‬ ‫‪essur‬‬ ‫‪eul‬‬ ‫‪cer‬‬‫‪s.‬‬
‫‪-Theper‬‬ ‫‪sonwi‬‬ ‫‪t‬‬
‫‪ht‬‬ ‫‪hi‬‬‫‪si‬‬ ‫‪nj‬‬‫‪ur‬‬‫‪yneedsear‬‬ ‫‪l‬‬‫‪yi‬‬‫‪nt‬‬‫‪er‬‬ ‫‪v‬‬‫‪ent‬‬ ‫‪i‬‬‫‪onandr‬‬ ‫‪equi‬‬ ‫‪r‬‬‫‪esear‬‬ ‫‪l‬‬
‫‪y‬‬
‫‪admi‬‬ ‫‪ssi‬‬ ‫‪ont‬‬ ‫‪oahospi‬‬ ‫‪t‬‬‫‪al‬‬‫‪bed.‬‬
‫‪-Thepr‬‬ ‫‪esent‬‬ ‫‪at‬‬‫‪i‬‬
‫‪onofext‬‬ ‫‪er‬‬‫‪nal‬‬ ‫‪r‬‬
‫‪ot‬‬ ‫‪at‬‬‫‪i‬‬
‫‪on,‬‬ ‫‪wi‬‬ ‫‪t‬‬‫‪hl‬‬‫‪egshor‬‬ ‫‪t‬‬‫‪eni‬‬ ‫‪ng.‬‬
‫‪-Anymov‬‬ ‫‪ementoft‬‬ ‫‪hehi‬‬ ‫‪pcausessev‬‬ ‫‪er‬‬ ‫‪epai‬‬ ‫‪n.‬‬
‫‪-Anal‬‬ ‫‪gesi‬‬ ‫‪aadmi‬‬ ‫‪ni‬‬‫‪st‬‬‫‪er‬‬ ‫‪edf‬‬‫‪ort‬‬ ‫‪hepai‬‬ ‫‪n.‬‬
‫‪-AnECGi‬‬ ‫‪sdoneandanX-‬‬ ‫‪r‬‬‫‪ayr‬‬ ‫‪equest‬‬ ‫‪edoft‬‬ ‫‪hei‬‬ ‫‪nj‬‬‫‪ur‬‬‫‪edhi‬‬ ‫‪pandt‬‬ ‫‪hechest‬‬ ‫‪.‬‬
‫‪-Admi‬‬ ‫‪ssi‬‬‫‪ont‬‬ ‫‪ot‬‬‫‪hewar‬‬ ‫‪dshoul‬‬ ‫‪dnott‬‬ ‫‪akel‬‬ ‫‪ongert‬‬ ‫‪han1hour‬‬ ‫‪.‬‬
‫‪-Thepat‬‬ ‫‪i‬‬
‫‪entwhohassuf‬‬ ‫‪f‬‬
‫‪er‬‬ ‫‪edf‬‬ ‫‪r‬‬‫‪om ani‬‬ ‫‪mpact‬‬ ‫‪edabduct‬‬ ‫‪i‬‬‫‪onf‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪ewi‬‬ ‫‪l‬‬‫‪l‬‬‫‪not‬‬
‫‪pr‬‬‫‪esentwi‬‬ ‫‪t‬‬‫‪ht‬‬‫‪heobv‬‬ ‫‪i‬‬‫‪oussi‬‬ ‫‪gnsf‬‬ ‫‪orf‬‬‫‪astt‬‬ ‫‪r‬‬‫‪acki‬‬ ‫‪ng.‬‬
‫‪-Ther‬‬ ‫‪ei‬‬ ‫‪snodet‬‬ ‫‪ect‬‬ ‫‪abl‬‬ ‫‪eshor‬‬ ‫‪t‬‬‫‪eni‬‬‫‪ngorr‬‬ ‫‪ot‬‬‫‪at‬‬‫‪i‬‬‫‪onal‬‬ ‫‪def‬‬ ‫‪or‬‬‫‪mi‬‬ ‫‪t‬‬‫‪y‬‬ ‫‪.‬‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﺎﺕﻣ‬ ‫ﻮﻋ‬ ‫ﻤ‬‫ﻣﺠ‬
‫‪:‬‬
‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬‫ﺍ‬‫ﻨﻖﻋﻈﻢ‬ ‫ﺮﻋ‬‫‪:‬ﻛﺴ‬ ‫ﺃﻻ‬‫ﻭ‬
‫‪.‬‬‫ﻟﺴﻦ‬ ‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺪﻛ‬ ‫ﻨ‬‫ﺎﻋ‬ ‫ً‬
‫ﻋ‬‫ﻮ‬‫ﻴ‬‫ﺔﺷ‬ ‫ﺑ‬‫ﺎ‬‫ﺎﺍﻹﺻ‬ ‫ﻜﻝ‬ ‫ﺃﺷ‬ ‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫‪-‬‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻣ‬ ‫ﺎ‬
‫ﺭﻫﻢﻋﻦ‪65‬ﻋ‬ ‫ﺎ‬
‫ﻤ‬‫ﻋ‬‫ﺃ‬ ‫ﺪ‬‫ﻳ‬‫ﺰ‬‫ﺪﻯﻣﻦﺗ‬ ‫ﻟ‬ ‫ﺎ‬
‫ﻬ‬‫ﻨ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﺙ‬ ‫‪-‬ﺗﺤ‬
‫ﻗﺐ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻟ‬‫‪،‬‬‫ﺮ‬‫ﻴ‬‫ﺛ‬
‫ﺄ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻔﺾ‬ ‫ﻨﺨ‬‫ﺮﻣ‬ ‫ﺜ‬‫ﻌ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻮﻁ‬ ‫ﻘ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺜﻞ‬‫‪،‬ﻣ‬ ‫ﺔ‬‫ﻠ‬‫ﻴ‬‫ﺌ‬‫ﺔﺿ‬ ‫ﺒ‬‫ﺒ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺁ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺎﺗ‬‫ﺓﻣ‬ ‫ﺩ‬
‫ﺎ‬‫‪-‬ﻋ‬
‫‪.‬‬‫ﻨﻲ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺮ‬‫ﻔ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺒ‬‫ﻨﺴ‬‫ﻟ‬‫ﺎ‬
‫ﺪﻯﺑ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺑ‬
‫‪.‬‬‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺮﺡ‬ ‫ﻗ‬‫ﺎﻑﻭ‬ ‫ﻔ‬‫ﻠﺠ‬‫ﻟ‬ ‫ﺎﺹ‬ ‫ﻜﻞﺧ‬ ‫ﻮﻥﺑﺸ‬ ‫ﺮﺿ‬ ‫ﻌ‬‫ﻟﺴﻦﻣ‬ ‫ﺍ‬ ‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫‪-‬ﻛ‬
‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﺪﺧﻞﻣ‬ ‫ﻟﻰﺗ‬ ‫ﺔﺇ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﻩ‬‫ﺬ‬‫ﻬ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬‫ﺎﺝ‬ ‫ﺘ‬‫‪-‬ﻳﺤ‬
‫‪.‬‬‫ﻔﻰ‬ ‫ﺘﺸ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﻰﺳ‬ ‫ﺮﺇ‬‫ﻜ‬‫ﺒ‬‫ﺎﻝﻣ‬ ‫ﺩﺧ‬ ‫ﻟﻰﺇ‬‫ﺎﺝﺇ‬ ‫ﺘ‬‫ﻳﺤ‬‫ﻭ‬
‫‪.‬‬‫ﺎﻕ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻘﺼ‬ ‫ﻊﺗ‬ ‫ﺭﺟﻲﻣ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬ ‫ﺍﻥ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫‪-‬ﻋ‬
‫‪.‬‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺎﺷ‬ ‫ﻤ‬‫ﻟ‬‫ﺃ‬‫ﺒﺐ‬ ‫ﺭﻙﺗﺴ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﻛ‬‫ﺮ‬‫ﺃﻱﺣ‬ ‫‪-‬‬
‫‪.‬‬‫ﻡ‬‫ﺍﻵﻻ‬ ‫ﻴﻦ‬ ‫ﻜ‬‫‪-‬ﺗﺴ‬
‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ ‫ﻠﺐ‬ ‫(ﻭﻃ‬ ‫ﻠﺐ)‪ECG‬‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻤﻞﻣﺨﻄﻂﻛ‬ ‫ﺘﻢﻋ‬ ‫‪-‬ﻳ‬
‫‪.‬‬‫ﺭ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬
‫ﺎﺏﻭ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬ ‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﺎﻋ‬‫ﺮﻣﻦﺳ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬ ‫ﺎﺡ‬‫ﻨ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﻮﻝﺇ‬ ‫ﺪﺧ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻐ‬ ‫ﺘ‬‫ﺃﻻﻳﺴ‬ ‫‪-‬ﻳﺠﺐ‬
‫‪.‬‬‫ﺓ‬‫ﺪ‬‫ﺍﺣ‬‫ﻭ‬
‫ﺎﻑ‬ ‫ﺘﻄ‬ ‫ﺍﻻﺧ‬ ‫ﺮﻓﻲ‬ ‫ﻧﻰﻣﻦﻛﺴ‬ ‫ﺎ‬‫ﺬﻱﻋ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺮﻋ‬ ‫ﻬ‬‫‪-‬ﻦﻳﻈ‬ ‫ﻟ‬

‫‪Fracture neck femur‬‬

‫‪11‬‬
 .‫ﻊ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻊ‬ ‫ﺒ‬
‫ﺘ‬‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺍﺿﺤ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬
.‫ﻪ‬
‫ﻓ‬‫ﺎ‬‫ﺘﺸ‬
‫ﻛ‬‫ﺍ‬ ‫ﻜﻦ‬
‫ﻤ‬‫ﻧﻲﻳ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﻩﺩ‬‫ﻮ‬‫ﻭﺗﺸ‬‫ﺃ‬‫ﺮ‬‫ﺪﻗﺼ‬‫ﻮﺟ‬‫ﻻﻳ‬-
-Fr
act
ureneckf
emur(Fi
g.3).
.(
3‫ﻜﻞ‬ ‫ﻟﺸ‬
‫ﺍ‬)‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻖﻋﻈﻢ‬‫ﺮﻋ‬‫ﻛﺴ‬-

II.Supr acondy larf r act ureoft hehumer us:

-Oneoft hecommonestandi mpor t antf ract ur esi nchi ldren, occur ringmost lyi n
the.3- 11y earagegr oup.
-Av er yur gentpr ior ityduet ot her iskofi njur yt ot hebr achi alarteryandt he
medi anner ve.
-Thehi stor yofaf al lont ot heout st retchedar m, of teni nv olvingf alli
ngf rom a
hei ght .
-Anydi splacementi sr egar dedasdanger ous, thedi st al fragmentnor mal ly
bei ngdi spl acedandt itledbackwar ds.
-Ident ificat i
onandobser vationoft hel imbi scr uci al.
-At tent i
oni spai dt ot heci rculation, col our, sensat ionandt emper atur eoft he
for ear m andhand; theseandt hepr esenceofar adi al pul sear edocument ed
ev ery15mi nutes.
-Thear mi spl acedi nabr oadar m sl i
ngandt hen, fol lowi ngex ami nat i
onbyt he
doct or.
-Thepat i
enti st ransf er redt ot heat ref orfr act ur er educt i
onunderanest het icas
soonaspossi bl e.
-Af t
err educt i
on, thear mi simmobi lizedi npl ast erwi t
ht heel bowf lexed.
-Car ef ul wat chi skeptont heci rcul at i
ont oensur et hatcompl i
cat ionsdonot
occur .
:
‫ﺪ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻕﻋﻈﻢ‬ ‫ﺮﻓ‬ ‫ﻛﺴ‬. ‫ﺎ‬ً
‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﺛ‬
.‫ﺳ‬
‫ﺔ‬‫ ﻨ‬11- 3‫ﺔ‬ ‫ﻳ‬‫ﺮ‬‫ﻤ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬.‫ﻓ‬
‫ﻏﺎ ﻲ‬ً
‫ﺒ‬‫ﻟ‬‫ﺪﺙﺎ‬ ‫ﺗﺤ‬ ‫ﻭ‬،‫ﺎ‬‫ﻷﻔﻝ‬ ‫ﺍﻃ‬ ‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬ ‫ﻴ‬‫ﻤ‬‫ﺃﻫ‬‫ﺎﻭ‬ً
‫ﻋ‬‫ﻮ‬‫ﻴ‬‫ﺭﺷ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬ ‫ﻣﻦ‬-
.‫ﻮﺳﻂ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﺼﺐ‬ ‫ﻟ‬‫ﺍ‬
‫ﺪﻱﻭ‬ ‫ﻌﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬ ‫ﺍ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺓﺇﺻ‬ ‫ﺭ‬‫ﻮ‬ ‫ﺒﺐﺧﻄ‬ ‫ﺔﺑﺴ‬ ‫ﻳ‬‫ﺎ‬‫ﻐ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻠﺤ‬ ‫ﺔﻣ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻟ‬‫ﻭ‬
‫ﺃ‬-
.‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﻮﻁﻣﻦ‬ ‫ﻘ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻤﻦ‬ ‫ﺘﻀ‬ ‫ﺎﻳ‬‫ﺎﻣ‬ ً
‫ﺒ‬‫ﻟ‬‫ﺎ‬
‫ﻭﻏ‬، ‫ﺓ‬‫ﺩ‬‫ﻭ‬‫ﺪ‬ ‫ﻤ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻮﻁﻋ‬ ‫ﻘ‬‫ﻟﺴ‬‫ﺍ‬‫ﻳﺦ‬ ‫ﺭ‬‫ﺎ‬
‫ﺗ‬-
.
‫ﻠﻒ‬ ‫ﻠﺨ‬‫ﻟ‬‫ﻪ‬‫ﻬ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﺗ‬‫ﺪﻭ‬ ‫ﻴ‬ ‫ﻌ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺰ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬ ‫ﺍﺣ‬ ‫ﺯ‬‫ﺘﻢﺇ‬ ‫ﺎﻳ‬‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﻭ‬، ‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺮﺧﻄ‬ ‫ﺒ‬‫ﺘ‬‫ﻌ‬‫ﺔﺗ‬ ‫ﺍﺣ‬‫ﺯ‬‫ﺃﻱﺇ‬-
.
‫ﺔ‬‫ﻴ‬ ‫ﻤ‬‫ﺍﻷﻫ‬ ‫ﺑﻎ‬‫ﻟ‬‫ﺮﺎ‬ ‫ﻣ‬ ‫ﺃ‬‫ﻪ‬ ‫ﺘ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬‫ﺮ‬
‫ﻣ‬‫ﺮﻑﻭ‬ ‫ﻟﻄ‬‫ﺍ‬ ‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
‫ﺎﺕ‬ ‫ﺒﻀ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻩ‬‫ﺬ‬‫ﻴﻖﻫ‬ ‫ﺛ‬‫ﻮ‬‫ﺘﻢﺗ‬ ‫؛ﻳ‬ ‫ﺪ‬ ‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﺎﻋ‬‫ﻟﺴ‬ ‫ﺍ‬
‫ﺓ‬ ‫ﺭ‬‫ﺍ‬
‫ﺮ‬ ‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﺩ‬‫ﺎﺱﻭ‬ ‫ﺍﻹﺣﺴ‬ ‫ﻭ‬، ‫ﻮﻥ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬،‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺎ‬‫ﻡﺑ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻻﻫ‬-
.
‫ﺔ‬ ‫ﻘ‬‫ﻴ‬‫ﻗ‬ ‫ﺩ‬15‫ﺔﻛﻞ‬ ‫ﻳ‬‫ﺮ‬
‫ﺔﻧﺼﻒﻗﻄ‬ ‫ﺒﻀ‬ ‫ﺩﻧ‬‫ﻮ‬ ‫ﻭﺟ‬‫ﻭ‬
.‫ﻴﺐ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﺒﻞ‬‫ﺎﻣﻦﻗ‬ ‫ﻬ‬ ‫ﺘﻢﻓﺤﺼ‬ ‫ﻟﻚﻳ‬ ‫ﺪﺫ‬ ‫ﻌ‬‫ﺑ‬‫ﺔﻭ‬ ‫ﻳﻀ‬ ‫ﺮ‬‫ﺍﻉﻋ‬ ‫ﺭ‬‫ﺔﺫ‬‫ﻟ‬‫ﺎ‬
‫ﻤ‬‫ﺍﻉﻓﻲﺣ‬ ‫ﺭ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻮﺿ‬ ‫ﺗ‬-
.‫ﻜﻦ‬ ‫ﻤ‬
‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬ ‫ﺃﺳ‬ ‫ﺮﻓﻲ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﺛ‬‫ﺄ‬‫ﺮﺗﺤﺖﺗ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬ ‫ﺎﺕ‬ ‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻟﻰﻏ‬ ‫ﻳ ﺾﺇ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻘﻞ‬ ‫ﻨ‬
‫ﻳ‬-
.‫ﻮﻉ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬ ‫ﻊﺛ‬ ‫ﺒﺲﻣ‬ ‫ﻟﺠ‬‫ﺎ‬‫ﺍﻉﺑ‬ ‫ﺭ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘﻢﺗ‬ ‫ﻳ‬، ‫ﺮ‬‫ﻴ‬
‫ﻐ‬ ‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬ ‫ﻌ‬
‫ﺑ‬-
.
‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬ ‫ﻡﺣ‬ ‫ﺪ‬‫ﺎﻥﻋ‬ ‫ﻤ‬ ‫ﻟﻀ‬ ‫ﺭ‬
‫ﺬ‬‫ﺔﺑﺤ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
III.Fr act ure- di
sl ocat ionsoft heankl e:
Injur yt ot heankl ei soneoft hemostcommonpr esent at ions, fr
act ur esoft he
mal eol uswi thorwi thoutdi slocat ioncanoccuri nt hr eedi f
ferentway s:
1.Abduct ionorl ater al rotat i
onf or ce, orthecombi nat ionofbot h.
2.Adduct ionf or ce.
3.Ver t
ical compr essi onf orce.
-Fr act ur edi slocat ionoft heankl ej oi ntwi thneur ov ascul arcompr omi sei s
treat edasanemer gency .
-Iti si dent ifiedbyt hegr ossdef ormi tyoft heankl ej ointandt heexcr uci at i
ng
pai nexper ienced.
-Thepedal pulsei snotpr esent .
-Thef ooti scol dt ot het ouchandbl anchi ngoft het oenai l
spr ovesnegat ive.
-Ifmani pulat i
oni snotunder takenal mosti mmedi at elyt hepat ientmayl ose

12
‫‪t‬‬‫‪hei‬‬
‫‪rf‬‬‫‪oot‬‬‫‪.‬‬
‫‪-Ther‬‬‫‪educt‬‬ ‫‪i‬‬
‫‪oni‬‬‫‪sdonev‬‬ ‫‪er‬‬
‫‪yqui‬‬ ‫‪ckl‬‬‫‪y‬‬‫‪.‬‬
‫‪-Thenur‬‬ ‫‪sepr‬‬‫‪ov‬‬‫‪i‬‬
‫‪dest‬‬‫‪het‬‬ ‫‪r‬‬
‫‪act‬‬‫‪i‬‬‫‪onr‬‬‫‪equi‬‬ ‫‪r‬‬‫‪edwhi‬‬ ‫‪l‬‬‫‪et‬‬‫‪hedoct‬‬ ‫‪orunder‬‬ ‫‪t‬‬‫‪akesar‬‬ ‫‪api‬‬‫‪d‬‬
‫‪mani‬‬‫‪pul‬‬‫‪at‬‬‫‪i‬‬
‫‪onoft‬‬ ‫‪hej‬‬
‫‪oi‬‬‫‪nt‬‬‫‪.‬‬
‫‪:‬‬
‫ﺎﺣﻞ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﻊﻣ‬‫ﻠ‬‫ﺮ‪-‬ﺧ‬ ‫ﺎ‪.‬ﻛﺴ‬
‫ﺛﺎ‬
‫ﺜ‬
‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﻊ‬‫ﺭﻣ‬‫ﻮ‬‫ﻛ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬
‫ﺪﺙﻛﺴ‬ ‫ﺃﻥﺗﺤ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬‫‪،‬ﻭ‬‫ﺎ‬‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬‫ﺔﺷ‬ ‫ﻴ‬‫ﻤ‬‫ﻳ‬‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺽ‬ ‫ﺮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺓﻣﻦ‬ ‫ﺪ‬‫ﺍﺣ‬
‫ﺎﺣﻞﻭ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺪﺇﺻ‬ ‫ﻌ‬
‫ﺗ‬
‫‪:‬‬‫ﺔ‬
‫ﻔ‬ ‫ﻠ‬
‫ﺘ‬‫ﺮﻕﻣﺨ‬ ‫ﺑﻼﺙﻃ‬ ‫ﻊﺜ‬ ‫ﻠ‬‫ﻭﻥﺧ‬‫ﺪ‬‫ﺑ‬
‫ﻣ‪.‬‬
‫ﺎ‬‫ﻴﻦ ﻌ‬‫ﻨ‬‫ﺛ‬‫ﻣﺍﻻ‬
‫ﻳﺞ ﻦ‬ ‫ﺰ‬‫‪،‬ﻭﻣ‬‫ﺒﻲﺃ‬ ‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﻥ‬‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻑ‬‫ﺘﻄ‬ ‫ﺍﻻﺧ‬‫ﺓ‬‫ﻮ‬‫‪.‬ﻗ‬‫‪1‬‬
‫‪.‬‬‫ﻳﺐ‬‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﻮ‬‫‪.‬ﻗ‬‫‪2‬‬
‫‪.‬‬‫ﺩﻱ‬‫ﻮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﻮ‬‫‪.‬ﻗ‬‫‪3‬‬
‫‪.‬‬‫ﺔ‬
‫ﺋ‬‫ﺭ‬‫ﺎ‬
‫ﺔﻃ‬‫ﻟ‬‫ﺎ‬
‫ﺔﻛﺤ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺔ‬
‫ﻳ‬‫ﻮ‬ ‫ﻊﺗﺴ‬‫ﺎﺣﻞﻣ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﺮﻣ‬‫ﺮﻛﺴ‬ ‫ﻊﻛﺴ‬ ‫ﻣﻞﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻢ‬‫‪-‬ﻳ‬
‫ﻣ‪.‬‬
‫ﻪ‬‫ﻧﻲﻨ‬ ‫ﺎ‬
‫ﻌ‬‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻟﻢ‬‫ﺍﻷ‬‫ﺎﺣﻞﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬‫ﻴﻢ‬‫ﻟﺠﺴ‬‫ﺍ‬‫ﻩ‬‫ﻮ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫ﻩﻣﻦﺧﻼﻝ‬ ‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺘﻢﺗﺤ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﺮﻣ‬ ‫ﻴ‬
‫ﺔﻏ‬ ‫ﺍﺳ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺒﺾ‬‫‪-‬ﻧ‬
‫‪.‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻠ‬
‫ﺎﺳ‬ ‫ﻬ‬‫ﻧ‬
‫ﺃ‬ ‫ﻡ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺎ‬‫ﺃﻇ‬ ‫ﺎﺽ‬‫ﻴﻀ‬‫ﺑ‬‫ﺍ‬‫ﺒﺖ‬‫ﺜ‬‫ﻳ‬‫ﺎﻭ‬‫ﻬ‬‫ﻤﺴ‬‫ﻟ‬‫ﺪ‬‫ﻨ‬‫ﺓﻋ‬‫ﺩ‬‫ﺭ‬‫ﺎ‬‫ﻡﺑ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫‪-‬ﺗ‬
‫‪.‬‬
‫ﻪ‬‫ﻣ‬‫ﺪ‬‫ﻳ ﺾﻗ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻘ‬‫ﻔ‬
‫ﺪﻳ‬ ‫ﻘ‬‫‪،‬ﻓ‬‫ﺎ‬‫ً‬
‫ﺒ‬
‫ﻳ‬‫ﺮ‬‫ﻘ‬‫ﺭﺗ‬‫ﻮ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋﺐﻋ‬ ‫ﺘﻼ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺘﻢﺇﺟ‬ ‫ﻟﻢﻳ‬‫ﺍ‬‫ﺫ‬
‫‪-‬ﺇ‬
‫‪.‬‬
‫ﺓ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﺔﻛ‬‫ﺮﻋ‬‫ﻴ ﺾﺑﺴ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻢ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﻔﺼﻞ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬ ‫ﻌ‬‫ﻳ‬
‫ﺮ‬‫ﺔﺳ‬ ‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻴﺐﺑ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬‫ﺎﻳ‬‫ﻤ‬
‫ﻨ‬‫ﻴ‬‫ﻮﺏﺑ‬ ‫ﻠ‬
‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﻮ‬‫‪-‬ﺗ‬

‫‪-AnX-‬‬ ‫‪r‬‬‫‪aycanbet‬‬ ‫‪aken.‬‬

‫‪-Oncet‬‬ ‫‪hel‬‬ ‫‪i‬‬
‫‪mbhasbeeni‬‬ ‫‪mmobi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪z‬‬‫‪edi‬‬‫‪nPl‬‬‫‪ast‬‬ ‫‪erofPar‬‬ ‫‪i‬‬
‫‪s,‬‬ ‫‪anal‬‬‫‪gesi‬‬ ‫‪awi‬‬ ‫‪l‬‬‫‪l‬‬‫‪be‬‬
‫‪admi‬‬ ‫‪ni‬‬‫‪st‬‬‫‪er‬‬‫‪edandanX-‬‬ ‫‪r‬‬‫‪ayr‬‬‫‪equest‬‬ ‫‪edoft‬‬ ‫‪her‬‬ ‫‪educedankl‬‬ ‫‪e.‬‬
‫‪-Thepat‬‬ ‫‪i‬‬‫‪entwi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪r‬‬‫‪emai‬‬ ‫‪nni‬‬‫‪l‬‬‫‪bymout‬‬ ‫‪hunt‬‬ ‫‪i‬‬
‫‪l‬‬‫‪t‬‬‫‪heankl‬‬ ‫‪ecanbest‬‬ ‫‪abi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪zedi‬‬ ‫‪nt‬‬ ‫‪heat‬‬‫‪r‬‬‫‪e.‬‬
‫‪-Anur‬‬ ‫‪semustal‬‬ ‫‪way‬‬ ‫‪sbeawar‬‬ ‫‪et‬‬‫‪hatcompar‬‬ ‫‪t‬‬‫‪mentsy‬‬ ‫‪ndr‬‬‫‪omei‬‬ ‫‪nv‬‬ ‫‪ol‬‬‫‪v‬‬‫‪i‬‬‫‪ngt‬‬ ‫‪he‬‬
‫‪muscl‬‬ ‫‪esi‬‬ ‫‪nt‬‬‫‪hecal‬‬ ‫‪fmaydev‬‬ ‫‪el‬‬‫‪opwi‬‬ ‫‪t‬‬
‫‪hi‬‬‫‪nhour‬‬ ‫‪sasacompl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪onofaf‬‬ ‫‪r‬‬ ‫‪act‬‬ ‫‪ur‬‬‫‪e‬‬
‫‪di‬‬
‫‪sl‬‬‫‪ocat‬‬ ‫‪i‬‬‫‪onoft‬‬ ‫‪heankl‬‬ ‫‪e.‬‬
‫‪-Thepr‬‬ ‫‪esent‬‬ ‫‪i‬‬
‫‪ngsi‬‬ ‫‪gnsandsy‬‬ ‫‪mpt‬‬‫‪omsar‬‬ ‫‪ev‬‬‫‪er‬‬ ‫‪ysev‬‬ ‫‪er‬‬‫‪epai‬‬ ‫‪n,‬‬‫‪neur‬‬ ‫‪ol‬‬‫‪ogi‬‬ ‫‪cal‬‬
‫‪dy‬‬‫‪sf‬‬‫‪unct‬‬ ‫‪i‬‬‫‪on,‬‬‫‪occasi‬‬ ‫‪onal‬‬ ‫‪l‬‬
‫‪yedemaandmuscl‬‬ ‫‪est‬‬ ‫‪hatar‬‬ ‫‪est‬‬‫‪i‬‬‫‪f‬‬‫‪fonpal‬‬ ‫‪pat‬‬ ‫‪i‬‬‫‪on.‬‬
‫‪-Acut‬‬ ‫‪emuscl‬‬ ‫‪enecr‬‬ ‫‪osi‬‬ ‫‪swi‬‬ ‫‪l‬‬
‫‪l‬‬ ‫‪dev‬‬‫‪el‬‬‫‪opi‬‬‫‪ft‬‬‫‪hecondi‬‬ ‫‪t‬‬
‫‪i‬‬‫‪oni‬‬‫‪sl‬‬ ‫‪ef‬‬‫‪tunt‬‬ ‫‪r‬‬‫‪eat‬‬ ‫‪ed.‬‬
‫‪-Thecl‬‬ ‫‪i‬‬‫‪ni‬‬‫‪cal‬‬‫‪si‬‬‫‪gnsandsy‬‬ ‫‪mpt‬‬ ‫‪omsar‬‬ ‫‪esuf‬‬ ‫‪f‬‬
‫‪i‬‬‫‪ci‬‬‫‪entt‬‬ ‫‪owar‬‬ ‫‪r‬‬‫‪antt‬‬ ‫‪hedi‬‬ ‫‪agnosi‬‬ ‫‪s.‬‬
‫‪-Whenacut‬‬ ‫‪ecompar‬‬ ‫‪t‬‬‫‪mentsy‬‬ ‫‪ndr‬‬‫‪omei‬‬ ‫‪ssuspect‬‬ ‫‪edanor‬‬ ‫‪t‬‬‫‪hopedi‬‬ ‫‪csur‬‬ ‫‪geonmust‬‬
‫‪beal‬‬ ‫‪t‬‬
‫‪er‬‬ ‫‪edi‬‬‫‪mmedi‬‬ ‫‪at‬‬ ‫‪el‬‬‫‪yasdecompr‬‬ ‫‪essi‬‬‫‪onsur‬‬ ‫‪ger‬‬ ‫‪ywi‬‬‫‪l‬‬‫‪l‬‬‫‪ber‬‬ ‫‪equi‬‬ ‫‪r‬‬‫‪edt‬‬ ‫‪opr‬‬ ‫‪ev‬‬ ‫‪ent‬‬
‫‪per‬‬‫‪manentl‬‬ ‫‪ossoff‬‬ ‫‪unct‬‬ ‫‪i‬‬‫‪on‬‬
‫‪-Fr‬‬‫‪act‬‬‫‪ur‬‬ ‫‪eoft‬‬ ‫‪heankl‬‬ ‫(‪e‬‬‫‪Fi‬‬‫)‪g.4‬‬ ‫‪.‬‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬ ‫ﻌ‬‫ﺎﻷﺷ‬‫ﺓﺑ‬ ‫ﺭ‬‫ﻮ‬‫ﺬﺻ‬ ‫ﺃﺧ‬‫ﻜﻦ‬ ‫ﻤ‬
‫‪-‬ﻳ‬
‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬‫ﻠﺐ‬ ‫ﻟﻢﻭﻃ‬ ‫ﻟﻸ‬‫ﻜﻦ‬ ‫ﺀﻣﺴ‬‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬‫ﻴ‬‫‪،‬ﺳ‬ ‫ﻳﺲ‬ ‫ﺭ‬‫ﺎ‬‫ﺮﻑﻓﻲﺟ ﺺﺑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘﻢﺗ‬ ‫ﺃﻥﻳ‬ ‫ﺩ‬‫ﺮ‬
‫ﻤﺠ‬ ‫‪-‬ﺑ‬
‫‪.‬‬‫ﺮ‬‫ﻐ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺣﻞ‬‫ﻜ‬ ‫ﻠ‬
‫ﻟ‬
‫‪.‬‬
‫ﺎﺕ‬ ‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻓ‬
‫ﺮ‬‫ﺎﺣﻞﻓﻲﻏ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬
‫ﻜﻦﺗ‬ ‫ﻤ‬‫ﺘﻰﻳ‬ ‫ﻔﻢﺣ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺧﺎﻋﻦﻃ‬ ‫ً‬
‫ﻴ‬‫ﻟ‬‫ﻳﺾ ﺎ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫‪-‬ﻳﻈﻞ‬
‫ﻮﻥ‬ ‫ﺭﻓﻲﻏﻀ‬ ‫ﻮ‬‫ﺘﻄ‬‫ﺪﺗ‬‫ﺎﻕﻗ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬ ‫ﻠ‬
‫ﺑ‬‫ﻤﻞﻋﻀﻼﺕﺭ‬ ‫ﺘﻲﺗﺸ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺃﻥ ﺘ‬ ‫ﺎ‬‫ً‬
‫ﻤ‬‫ﺋ‬
‫ﺍ‬‫ﺔﺩ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭﻙ‬ ‫ﺪ‬‫ﺃﻥﺗ‬ ‫‪-‬ﻳﺠﺐ‬
‫‪.‬‬‫ﺎﺣﻞ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻊﻓﻲ‬ ‫ﻠ‬‫ﺮﺧ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﺎﺕﻛ‬‫ﻋ‬‫ﺎ‬‫ﺳ‬
‫ﺘﻲ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ً‬
‫ﺎ‬
‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﺃﺣ‬‫‪،‬ﻭ‬ ‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻞ‬‫ﻟﺨ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﺓ‬‫ﺪ‬ ‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺍﻵﻻ‬ ‫ﺓﻫﻲ‬ ‫ﺮ‬‫ﺎﻫ‬‫ﻟﻈ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﻟﺠﺲ‬ ‫ﺍ‬ ‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬ ‫ﺒﺴ‬‫ﻴ‬‫ﺘ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺗ‬
‫‪.‬‬‫ﻭﻥﻋﻼﺝ‬ ‫ﺔﺩ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﻛﺖ‬‫ﺮ‬‫ﺍﺗ‬‫ﺫ‬‫ﺩﺇ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺭﻧﺨ‬ ‫ﻮ‬‫ﺘﻄ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﻴﺺ‬‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﺔﻛ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫ﻮﻥ‬‫ﻜ‬ ‫ﺘ‬‫ﻴﺚﺳ‬ ‫ﺭﺣ‬ ‫ﻮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﻡﻋ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺡ‬‫ﺮ‬‫ﺮﺟ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫‪،‬ﻳﺠﺐﺗ‬ ‫ﺓ‬ ‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺩﺘ‬ ‫ﻮ‬‫ﻩﻓﻲﻭﺟ‬ ‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺷ‬ ‫ﺪ‬
‫ﻨ‬‫‪-‬ﻋ‬
‫ﺋﻢ‬ ‫ﺍ‬
‫ﻜﻞﺩ‬ ‫ﺔﺑﺸ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻊﻓ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﺔﺗﺨ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺔ‬ ‫ﺎﺟ‬‫ﺎﻙﺣ‬ ‫ﻨ‬‫ﻫ‬
‫‪.‬‬‫(‬
‫ﻜﻞ‪4‬‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺎﺣﻞ)‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮﻓﻲ‬ ‫‪-‬ﻛﺴ‬

‫‪13‬‬
 (
Fig.4)Fr
act
ureoft
heankl
e.

Assessmentoff r
act uresanddi slocations:
Intheassessmentbyt henur sewi llr
ecordt he:
1.Pulsesdi stal t
ot hei njury.
2.Colourandt emper at ur
eoft hel imb.
3.Capi l
laryr efill
.
-Neur ol
ogi cal st
atusoft hear eaanddi st
al toi
njur
y.
Emer gencymanagement( Firstai d):
1.Remov al ofanyr ingsorbr acel ets.
2.Cont r
ol ofbl eeding.
3.Appl i
cat ionofdr ydr essing.
4.Appl i
cat ionofasl i
ng.
5.Admi ni strationofmi l
danal gesi aifappr opri
ate.
6.Identifi
cat ionoft et anusandal lergi
es.
7.RequestanX- rayoft heinjuredl i
mb.
IV.Multi
pl et raumapat ientassessment :
I-Pri
mar ysur vey:
1.Iti
sar api dassessmentoft hepat i
ent'
si nj
uri
es.
2.Vitalsigns.
3.Bodyf unct ions.
4.Thei nitiationofl ife-savi
ngt reat ment.
:‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﻻﺿﻄ‬ ‫ﺭﻭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬
:‫ﻮﻑﺗﺴﺠﻞ‬‫ﺔﺳ‬ ‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻞ‬‫ﻴﻢﻣﻦﻗ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬
.‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻟﻺﺻ‬ ‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺒﻀ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬
.1
.‫ﻪ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﺩ‬‫ﺮﻑﻭ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻟ‬
.2
.‫ﺮﻱ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﺀ‬‫ﻤﻞ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﺇ‬.3
.
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻋﺍﻹﺻ‬
‫ﺓﻦ‬ ‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺑ‬
‫ﺔﻭ‬ ‫ﻘ‬
‫ﻨﻄ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬-
:
(‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻓ‬‫ﺎ‬‫ﻌ‬
‫ﺍﻹﺳ‬ )‫ﺭﺉ‬‫ﺍ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬ ‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬

14
 .‫ﺭ‬‫ﻭ‬‫ﺎ‬
‫ﺃﺍﻷﺳ‬ ‫ﺗﻢﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺨ‬‫ﺍ‬‫ﺰﻉ‬ ‫ﻧ‬.1
.‫ﻳﻒ‬‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬ ‫ﻟﺴ‬‫ﺍ‬.2
.
‫ﺎﻑ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺗﻄ‬. 3
.‫ﺎ‬
‫ﺒﻝ‬ ‫ﻴﻖﺣ‬ ‫ﺒ‬‫ﺗﻄ‬. 4
.
‫ﺎ‬‫ﺒ‬‫ﺎﺳ‬ ‫ﻨ‬‫ﻟﻚﻣ‬ ‫ﺎﻥﺫ‬ ‫ﺍﻛ‬‫ﺫ‬‫ﺔﺇ‬‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻋﻄ‬ ‫ﺇ‬.5
.‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬‫ﺍ‬‫ﻮﺱﻭ‬ ‫ﻧ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬.6
.
‫ﺎﺏ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻑ‬ ‫ﻠﻄ‬‫ﻟ‬‫ﺔ‬ ‫ﻌ‬
‫ﺎﻷﺷ‬ ‫ﺓﺑ‬‫ﺭ‬‫ﻮ‬ ‫ﻠﺐ ﺻ‬ ‫ﻃ‬. 7
:‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻴﻢﻣ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬: ‫ﺎ‬
‫ﻌ‬‫ﺑ‬‫ﺍ‬
‫ﺭ‬
:‫ﻟﻲ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﻤﺴﺢ‬ ‫ﻟ‬‫ﺍ‬-
I
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﻊﻹﺻ‬ ‫ﻳ‬
‫ﺮ‬ ‫ﻴﻢﺳ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬.1
.‫ﺔ‬‫ﻳ‬
‫ﻮ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬.2
.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺋﻒ‬ ‫ﺎ‬‫ﻭﻇ‬. 3
.‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻠﺤ‬‫ﻟ‬‫ﺬ‬‫ﻘ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﻉﻓﻲ‬ ‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬.4
TheABCDEoft r aumacar ei denti
fiesl i
fe-thr eateni ngcondi t
ions:
A-Ai rwaymai ntenancewi thcer vi
cal spinecont rol.
B-Br eathi ngandv entil
at i
on.
C-Ci rculat i
onwi thhemor rhagecont rol.
D-Di sabi li
ty :neur ological signs.
E-Exposur eandenv ir
onmentcont rol:compl et elyundr esst hepat i
ent ,but
prev enthy pot her mi a.
Duringt hepr imar ysur v ey:
-Life-threat eni ngcondi ti
onsar eident i
fi
edandmanagementi sbegun
simul taneousl y .
-All themember soft het raumat eam wi l
lknowwhatspeci fi
cr olet heywi l
lbe
takingwhi chenabl esmanyoft hel i
fe-savingi nter ventionst obei nv estigatedat
thesamet ime.
:‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺩ‬
‫ﺪ‬‫ﻬ‬ ‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﻑ‬ ‫ﺮ‬‫ﻟﻈ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬ ‫ﺮ‬‫ﻟ‬ABCDE‫ﺩ‬ ‫ﺪ‬‫ﻳﺤ‬
.‫ﻘﻲ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻱ‬ ‫ﻘ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻤ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺀﻣ‬ ‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﻧ‬‫ﺎ‬‫ﻴ‬‫ﺻ‬-‫ﺃ‬
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺲﻭ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬-
‫ﺏ‬
.‫ﺰﻑ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﺔﻣ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬-‫ﺝ‬
.‫ﺔ‬
‫ﻴ‬‫ﺒ‬‫ﺎﺕﻋﺼ‬ ‫ﻣ‬‫ﻋﻼ‬: ‫ﺔ‬‫ﻗ‬‫ﺎ‬‫ﺍﻹﻋ‬-‫ﺩ‬
.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﺎ ﺽﺣ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬ ‫ﻊ‬‫ﻨ‬
‫ﻊﻣ‬ ‫ﺎﻣ‬ً
‫ﻣ‬‫ﺎ‬‫ﻤ‬
‫ﻳ ﺾﺗ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺑﺲ‬ ‫ﻊﻣﻼ‬ ‫ﻠ‬‫ﺧ‬:‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ ﺽﻭ‬ ‫ﻌ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬-‫ـ‬
‫ﻩ‬
:
‫ﻟﻲ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﻤﺴﺢ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺧﻼﻝ‬
.‫ﺪ‬‫ﺍﺣ‬
‫ﻗﺖﻭ‬ ‫ﺓﻓﻲﻭ‬ ‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬ ‫ﺀ‬ ‫ﺪ‬‫ﺑ‬‫ﺓﻭ‬ ‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻬ‬‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﻑ‬ ‫ﺮ‬‫ﻟﻈ‬‫ﺍ‬‫ﺪ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﻢﺗﺤ‬ ‫ﻳ‬-
‫ﻴﻖﻓﻲ‬ ‫ﻘ‬
‫ﺘﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﻜﻦﻣﻦ‬ ّ ‫ﻤ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻪﻭ‬ ‫ﻮﻥﺑ‬ ‫ﻌ‬‫ﻠ‬‫ﻴﻀﻄ‬‫ﺬﻱﺳ‬ ‫ﻟ‬‫ﺍ‬
‫ﺩ‬ ‫ﺪ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺀﻓ‬ ‫ﺎ‬
‫ﺃﻋﻀ‬ ‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﺮﻑﺟ‬ ‫ﻌ‬ ‫ﻴ‬
‫ﺳ‬-
.‫ﻗﺖ‬ ‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻔﺲ‬ ‫ﺓﻓﻲﻧ‬ ‫ﺎ‬
‫ﻴ‬‫ﻠﺤ‬‫ﻟ‬‫ﺓ‬‫ﺬ‬‫ﻘ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
Assessmentoft heaf f
ect edext remi ti
es:
1-Ci rculat oryst at usassessment :
-Inspect ion: col our ,skint emper atureandsy mmet r
y .
-Pal pationofdi st al pulses.
2-Sensor yf unct ionassessment :
-Test ingofgr osssensor yfunct i
on.
-Compar isonwi tht heuni nj
ur edext r
emi ty.
3-Mot orf unct ionassessment :
-Inspect ionf orspont aneousmot orf unctionofi njuredanduni njured
extremi ties.
-Test ingt hepr esenceandsy mmet r
yofmot orst rengt handr angeofmot i
on.
:
‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬
:‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻴﻢ ﺎ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬-1
.‫ﺎﺳﻖ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬ ‫ﺍ‬
‫ﺮ‬‫ﺔﺣ‬ ‫ﺭﺟ‬ ‫ﺩ‬‫ﻮﻥﻭ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬:
‫ﻴﺶ‬ ‫ﺘ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-

15
 .
‫ﺓ‬ ‫ﺪ‬‫ﻴ‬
‫ﻌ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺒﻀ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺟﺲ‬-
:
‫ﺔ‬ ‫ﻴ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-2
.‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻹﻤ‬
‫ﺍﺟ‬ ‫ﺔ‬ ‫ﻴ‬‫ﻟﺤﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬ -
.
‫ﻴﻢ‬ ‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﺔﻣ‬ ‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻣ‬-
:‫ﺔ‬‫ﻴ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-3
.‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬‫ﺔﻭﻏ‬ ‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬
‫ﻟﻸﻃ‬ ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻘ‬ ‫ﻠ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻛ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬ ‫ﻔ‬‫ﻴ‬‫ﻓﺤ ﺺﻭﻇ‬-
.‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺪﻯ‬ ‫ﻣ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻛ‬ ‫ﺮ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺛﻞ‬‫ﺎ‬
‫ﻤ‬‫ﺗ‬‫ﺩﻭ‬ ‫ﻮ‬‫ﺭﻭﺟ‬ ‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬ -
4-Sof tt i
ssuei njuriesr equi reinspect ionf or:
-Lacer ations.
-Abr asionsandcont usions.
-Av ulsions.
-Punct urewounds.
-Impal edobj ect s.
-Ecchy mosi s.
-Edema
-Angul at i
ons.
-Def ormi ty.
-Openwoundsi npr oximi tytoadef ormi ty.
-Pal pationf orcr epitus.
:‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤ‬‫ﻟ‬ ‫ﺎ‬ً‫ﺓﻓﺤ‬
‫ﺼ‬ ‫ﻮ‬‫ﺮﺧ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻠﺐﺇﺻ‬ ‫ﺘﻄ‬‫ﺗ‬-4
.‫ﺎﺕ‬ ‫ﻗ‬‫ﺰ‬‫ﻤ‬‫ﺗ‬-
.
‫ﻮﺽ‬ ‫ﺮﺿ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬ ‫ﻟﺴﺤﺠ‬ ‫ﺍ‬-
.‫ﺎﺕ‬‫ﺒ‬‫ﻠ‬‫ﻘ‬‫ﺗ‬-
.
‫ﻭﺡ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺛ‬‫ﺍ‬-
.‫ﺔ‬‫ﻗ‬‫ﺯ‬‫ﻮ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻴ‬‫ﺍﻷﺷ‬ -
.
‫ﺎﺕ‬ ‫ﻣ‬‫ﺪ‬‫ﻛ‬-
‫ﺔ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬-
.
‫ﻧﻲ‬ ‫ﺎ‬‫ﻬ‬‫ﺗ‬-
.‫ﻩ‬‫ﻮ‬‫ﺗﺸ‬-
.
‫ﻩ‬‫ﻮ‬ ‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮﺏﻣﻦ‬ ‫ﻘ‬‫ﻟ‬‫ﺎ‬
‫ﻭﺡﺑ‬ ‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﺘﺢ‬‫ﻓ‬-
.‫ﻊ‬‫ﻠ‬‫ﻠﺨ‬‫ﻟ‬‫ﻟﺠﺲ‬ ‫ﺍ‬-
II
-Secondar ysur vey:
-Thesecondar ysur v eyi sahead- t
o- t
oeev aluat ionoft hepat ientincludi ngv ital
signs.Eachar eaoft hebodyi scompl et elyexami ned.
-Thesecondar ysur v eydoesnotbegi nunt ilthepr imar ysur v eyi scompl ete.
-Ifresusci tationi sini t
iated, t
hepr imar ysur v eyst at usisr eassessed.An
unst ablepat ientmaynotpr ogressont ot hesecondar y.sur veybef orel eaving
thedepar tmentofemer gencysur geryort ot hei nt ensivecar euni tforv entilation,
i
ft heyar esev erelycar diopulmonar ycompr omi sed.
-Inthi ssur veyt hef ract uredl i
mbsar ei dent i
fiedandst abi l
ised.
-Acompl eteev aluationmayr equirer epeat edexami nationsoft hepat ient.
-Theext remi tiesar ei nspect edf orcont usionordef ormi ty.
-Pal pationoft hebones, exami nat i
onf ort ender ness, crepitat ionorabnor mal
mov emental laidi nt hei dentifi
cationoff ractur es.
-Significantext remi tyinjuriesmayexi stwi thoutf ractures; fori nstance,
l
igamentr uptur espr oducej ointinstabi li
ty .
-Theext remi tiesar eassessedf orcircul ator y,sensor yandmot orf unct i
onspl us
softt i
ssuei njur ies.
-Anyext remi tyi nj
ur yist reatedconser v ativelyunt ilthepat ient 'smor esev ere
i
njurieshav ebeent reat edandt hepat ienti sst abl e.

16
 ‫‪:‬‬
‫ﻮﻱ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺴﺢ‬ ‫ﻟ‬‫ﺍ‬
‫‪-‬‬‫‪I‬‬‫‪I‬‬
‫ﻟﺠﺴﻢﺑ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻘ‬
‫ﻨﻄ‬‫ﺘﻢﻓﺤ ﺺﻛﻞﻣ‬ ‫‪.‬ﻳ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬ ‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﻳ ﺾﻳﺸ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﻣﻞ‬‫ﺎ‬
‫ﻴﻢﺷ‬ ‫ﻴ‬‫ﻘ‬‫ﻮﺗ‬‫ﻮﻱﻫ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﺴﺢ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫‪.‬‬‫ﻟﻲ‬‫ﻭ‬‫ﺍﻷ‬‫ﻤﺴﺢ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﻝ‬ ‫ﻤ‬‫ﺘ‬‫ﻛ‬
‫ﺍ‬‫ﺘﻰ‬‫ﻮﻱﺣ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬‫ﺍ‬‫ﻤﺴﺢ‬ ‫ﻟ‬‫ﺍ‬‫ﺃ‬
‫ﺪ‬ ‫ﺒ‬‫‪-‬ﻻﻳ‬
‫ﻟﻰ‬‫ﺮﺇ‬‫ﻘ‬‫ﺘ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻳ ﺾﻏ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﺘ‬‫ﺪﻻﻳ‬ ‫‪.‬ﻗ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬‫ﻤﺴﺢ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺣﺔ‬
‫ﻟ‬
‫ﻴﻢ ﺎ‬‫ﻴ‬‫ﻘ‬‫ﺓﺗ‬‫ﺩ‬ ‫ﺎ‬
‫ﻋ‬‫ﺘﻢﺇ‬‫‪،‬ﻳ‬‫ﺎﺵ‬ ‫ﻌ‬‫ﻧ‬‫ﺍﻹ‬‫ﺀ‬‫ﺪ‬‫ﺣﺔﺑ‬‫ﻟ‬
‫‪-‬ﻓﻲ ﺎ‬
‫ﺍ‬‫ﺫ‬
‫‪،‬ﺇ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬‫ﺓ‬‫ﺰ‬
‫ﻛ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻟﻰﻭﺣ‬ ‫ﻭﺇ‬‫ﺃ‬‫ﺔ‬‫ﺋ‬
‫ﺭ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬
‫ﺍﺣ‬‫ﺮ‬ ‫ﻟﺠ‬
‫ﺍ‬‫ﺓﻗﺴﻢ‬ ‫ﺭ‬‫ﺩ‬‫ﺎ‬‫ﻐ‬‫ﺒﻞﻣ‬‫ﻤﺴﺢﻗ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻓﻲ‬ ‫ﻳ‬‫ﺪ‬‫ﺭﺷ‬ ‫ﺮ‬‫ﻴﻦﺑﻀ‬ ‫ﺑ‬‫ﺎ‬‫ﺍﻣﺼ‬ ‫ﻮ‬‫ﻧ‬‫ﺎ‬
‫ﻛ‬
‫‪.‬‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻴ‬
‫ﺒ‬‫ﺜ‬‫ﺗ‬
‫ﺓﻭ‬ ‫ﺭ‬
‫ﻮ‬‫ﻜﺴ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬‫ﻤﺴﺢﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫‪-‬ﻓﻲﻫ‬
‫‪.‬‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺓ‬‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﺎﺕﻣ‬ ‫ﻮﺻ‬‫ﺀﻓﺤ‬ ‫ﺍ‬
‫ﺮ‬‫ﻣﻞﺇﺟ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐ‬ ‫ﺘﻄ‬ ‫ﺪﻳ‬‫‪-‬ﻗ‬
‫‪.‬‬‫ﻩ‬‫ﻮ‬‫ﻭﺗﺸ‬ ‫ﺃ‬‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﺎﻋﻦﻛ‬‫ً‬‫ﺜ‬‫ﺍﻑﺑﺤ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺘﻢﻓﺤ ﺺ‬ ‫‪-‬ﻳ‬
‫‪.‬‬‫ﺭ‬
‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬
‫ﺪﻓﻲﺗﺤ‬ ‫ﺎﻋ‬‫ﺎﺗﺴ‬‫ﻬ‬‫ﻠ‬
‫ﺔﻛ‬ ‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺔﻏ‬ ‫ﻛ‬
‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺕ‬‫ﻘ‬‫ﻘ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬ ‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫‪-‬ﺟﺲ‬
‫ﻡ‬‫ﺪ‬‫ﺔﻋ‬‫ﺑﻄ‬‫ﺭ‬‫ﺍﻷ‬‫ﺰﻕ‬‫ﻤ‬‫ﺘﺞﻋﻦﺗ‬‫ﻨ‬‫ﺎ‪،‬ﻳ‬
‫ﺜﻝ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫؛ﻋ‬‫ﺭ‬‫ﻮ‬‫ﻭﻥﻛﺴ‬ ‫ﺍﻑﺩ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺓﻓﻲ‬ ‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﺎﺕﻛ‬ ‫ﺑ‬‫ﺎ‬‫ﺪﺇﺻ‬ ‫ﻮﺟ‬ ‫ﺪﺗ‬‫‪-‬ﻗ‬
‫‪.‬‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻓﻲ‬ ‫ﺍ‬
‫ﺮ‬ ‫ﻘ‬‫ﺘ‬
‫ﺍﺳ‬
‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻰﺇﺻ‬‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬‫ﺎﻹﺿ‬‫ﺔﺑ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻟﺤﺴ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬
‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬
‫ﻮﻇ‬ ‫ﻟ‬‫ﺍﻑ‬‫ﺮ‬ ‫ﺍﻷﻃ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﺓ‬‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﻮ‬‫ﺮﺧﻄ‬ ‫ﺜ‬
‫ﻛ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺘﻢﻋﻼﺝ‬ ‫ﺘﻰﻳ‬‫ﻔﻈﻲﺣ‬ ‫ﻜﻞﺗﺤ‬ ‫ﺍﻑﺑﺸ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺔﻓﻲ‬‫ﺑ‬‫ﺎ‬‫ﺃﻱﺇﺻ‬ ‫ﻊ‬ ‫ﻣﻞﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺘﻢ‬‫‪-‬ﻳ‬
‫‪.‬‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﺳ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬

‫‪Fr‬‬
‫‪act‬‬
‫‪ur‬‬‫‪eManagement‬‬
‫‪Lear‬‬‫‪ni‬‬‫‪ngobj‬‬ ‫‪ect‬‬ ‫‪i‬‬
‫‪v‬‬ ‫‪es:‬‬
‫‪Att‬‬‫‪heendoft‬‬ ‫‪hi‬‬‫‪sl‬‬ ‫‪ect‬‬‫‪ur‬‬‫‪e,‬‬ ‫‪t‬‬
‫‪hest‬‬ ‫‪udentwi‬‬ ‫‪l‬‬‫‪l‬‬‫‪beabl‬‬ ‫‪et‬‬‫‪o:‬‬
‫‪1-Def‬‬ ‫‪i‬‬
‫‪neaf‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪2-Expl‬‬‫‪ai‬‬‫‪nmechani‬‬ ‫‪sm off‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪3-Descr‬‬ ‫‪i‬‬
‫‪besi‬‬ ‫‪t‬‬
‫‪eoff‬‬ ‫‪r‬‬
‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪4-Li‬‬‫‪stcl‬‬‫‪assi‬‬‫‪f‬‬‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪onandt‬‬ ‫‪y‬‬‫‪pesoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪5-I‬‬‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪yt‬‬ ‫‪hecausesoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪6-Expl‬‬‫‪ai‬‬‫‪nst‬‬ ‫‪agesoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪eheal‬‬ ‫‪i‬‬
‫‪ng.‬‬
‫‪7-Descr‬‬ ‫‪i‬‬
‫‪becl‬‬ ‫‪i‬‬
‫‪ni‬‬‫‪cal‬‬ ‫‪mani‬‬ ‫‪f‬‬‫‪est‬‬‫‪at‬‬‫‪i‬‬‫‪onsoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪8-Descr‬‬ ‫‪i‬‬
‫‪behowt‬‬ ‫‪oassessanddi‬‬ ‫‪agnost‬‬ ‫‪i‬‬
‫‪cf‬‬‫‪i‬‬‫‪ndi‬‬‫‪ngoff‬‬ ‫‪r‬‬
‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪9-I‬‬‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪yf‬‬ ‫‪act‬‬‫‪or‬‬ ‫‪st‬‬ ‫‪hatenhanceandi‬‬ ‫‪nhi‬‬‫‪bi‬‬‫‪tf‬‬‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪eheal‬‬‫‪i‬‬
‫‪ng.‬‬
‫‪10-Descr‬‬ ‫‪i‬‬
‫‪benor‬‬ ‫‪mal‬‬ ‫‪f‬‬
‫‪r‬‬‫‪act‬‬‫‪ur‬‬ ‫‪eheal‬‬‫‪i‬‬‫‪ng.‬‬
‫‪11-I‬‬‫‪dent‬‬‫‪i‬‬‫‪f‬‬
‫‪ymedi‬‬ ‫‪cal‬‬ ‫‪managementoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪12-Uset‬‬ ‫‪henur‬‬ ‫‪si‬‬‫‪ngpr‬‬ ‫‪ocessasf‬‬ ‫‪r‬‬‫‪amewor‬‬ ‫‪kf‬‬‫‪orcar‬‬ ‫‪eoft‬‬‫‪hepat‬‬‫‪i‬‬‫‪ent‬‬
‫‪t‬‬‫‪hef‬‬‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪13-Descr‬‬ ‫‪i‬‬
‫‪bet‬‬ ‫‪hedi‬‬ ‫‪schar‬‬ ‫‪geandhomegui‬‬ ‫‪del‬‬‫‪i‬‬‫‪nef‬‬ ‫‪orf‬‬
‫‪r‬‬‫‪act‬‬‫‪ur‬‬
‫‪emanagement‬‬ ‫‪.‬‬
‫‪14-Descr‬‬ ‫‪i‬‬
‫‪bedocument‬‬ ‫‪at‬‬‫‪i‬‬‫‪ongui‬‬ ‫‪del‬‬‫‪i‬‬
‫‪nef‬‬ ‫‪orf‬‬‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪emanagement‬‬ ‫‪.‬‬
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫‪:‬‬
‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
‫ﻣ‪:‬‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﻜﻦ‬ ‫ﻤ‬
‫ﺘ‬‫ﻴ‬‫ﺓﺳ‬ ‫ﺮ‬
‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﺔﻫ‬ ‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
‫‪.‬‬
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫‪-‬ﺗﺤ‬‫‪1‬‬
‫‪.‬‬
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺁ‬‫ﺮﺡ‬‫‪-‬ﺷ‬‫‪2‬‬

‫‪17‬‬
 .
‫ﺮ‬ ‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻭﺻﻒﻣ‬- 3
.‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫ﻴﻒﻭ‬ ‫ﻨ‬
‫ﺔﺗﺼ‬ ‫ﻤ‬‫ﺋ‬
‫ﺎ‬‫ﻗ‬-4
.
‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-5
.‫ﺭ‬‫ﻮ‬
‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﻡ‬ ‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬‫ﺮﺡﻣ‬‫ﺷ‬- 6
.
‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﺻﻒ‬- 7
.
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﻑ‬‫ﺘﺸ‬‫ﻛ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬ ‫ﻴﻢﻭ‬ ‫ﻴ‬
‫ﻘ‬‫ﺔﺗ‬ ‫ﻴ‬‫ﻔ‬
‫ﻴ‬‫ﻭﺻﻒﻛ‬- 8
.
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺎ‬‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬
‫ﺗ‬‫ﺯﻭ‬‫ﺰ‬ ‫ﻌ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-9
.
‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬- 10
.
‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-11
.
‫ﺮ‬‫ﻜﺴ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺭ‬‫ﺎ‬‫ﺈﻃ‬‫ﻳ ﺾﻛ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻡﻋ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬-12
.
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﻟﻲﻹ‬ ‫ﺰ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻟ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻎﻭ‬ ‫ﻳ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬- 13
.‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﻴﻖﻹ‬ ‫ﺛ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻟ‬‫ﻭﺻﻒﺩ‬- 14
Fr
act
ureManagement
Def i
nit
ionoff ract ur e:
Itisacompl eteori ncompl etedi srupt i
oni nt hecont inuityoft hebonest ruct ure
andi sdef inedaccor dingt oitst ypeandext ent.
Mechani sm off ract ure:
Itoccurwhent hebonei ssubj ect edt ostressgr eatert hanitcanabsor b.When
thebonei sbr oken, adj acentst ruct uresar eaf fected,resulti
ngi nsof tti
ssue
edema, hemor rhagei nt omuscl esandj oints, j
ointdislocat i
ons, ruptured
tendons, anddamagedbl oodv essel s.
:
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬ ‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
.
‫ﻩ‬‫ﺍ‬‫ﺪ‬‫ﻣ‬ ‫ﻪﻭ‬ ‫ﻮﻋ‬ ‫ﻨ‬‫ﻟ‬‫ﺎ‬ً
‫ﻘ‬
‫ﻓ‬ ‫ﻩﻭ‬ ‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺘﻢﺗﺤ‬ ‫ﻳ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﻨ‬‫ﺔﺑ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﻣﻞﻓﻲ‬ ‫ﺎ‬
‫ﺮﻛ‬ ‫ﻴ‬‫ﻭﻏ‬ ‫ﺃ‬‫ﻣﻞ‬ ‫ﺎ‬
‫ﺍﺏﻛ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻪ‬‫ﻧ‬‫ﺇ‬
‫ﺮ‬‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﺗ‬،‫ﻌﻈﻢ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻨ‬‫ﺎﻳ‬‫ﻣ‬ ‫ﺪ‬‫ﻨ‬‫ﻋ‬.‫ﻪ‬ ‫ﺎﺻ‬‫ﺘﺼ‬‫ﻣ‬ ‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺘﻄ‬ ‫ﺎﻳﺴ‬‫ﻤ‬‫ﺮﻣ‬‫ﺒ‬‫ﻛ‬ ‫ﺃ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﻌﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﺪﺙﻋ‬ ‫ﺗﺤ‬:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺁ‬
‫ﻊ‬‫ﻠ‬‫ﻭﺧ‬، ‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻒﻓﻲ‬ ‫ﺰ‬‫ﻧ‬‫ﻭ‬، ‫ﺓ‬‫ﻮ‬
‫ﺮﺧ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻟﻰﻭ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬،‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺎ‬
‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻛﻞ‬ ‫ﺎ‬
‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﻠﻒ‬‫ﺗ‬
‫ﻭ‬، ‫ﺭ‬‫ﺎ‬
‫ﺗ‬‫ﻭ‬‫ﺍﻷ‬‫ﺰﻕ‬‫ﻤ‬‫ﺗ‬‫ﻭ‬، ‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
Siteoff ract ure:
Thel ocationoff ract urecanbe:
-Diaphy sis.
-Met aphsi s.
-Epiphy sis
-Intraarticularar ea
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻣ‬
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
.‫ﻠﻞ‬‫ﻟﺸ‬‫ﺍ‬-
.‫ﻭﺱ‬ ‫ﺩ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬-
‫ﺎﺵ‬ ‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬-
‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺧﻞ‬‫ﺔﺩ‬ ‫ﻘ‬‫ﻨﻄ‬‫ﻣ‬-
Classifi
cat ionoff ract ur e:
Ther earesev er al kindsoff r
act uret hatmayoccuri nabone:
Compl et ef ract ure.Acompl etef racturei nvolvesabr eakacr osst heent i
re
cross-sect ionoft heboneandi sf requent lydi splaced.
I
ncompl et ef ract ure.Ani ncompl etef r
act urei nvolvesabr eakt hroughonl y
partoft hecr osssect ionoft hebone.
Commi nut edf ract ure.Acommi nutedfr acturei sonet hatpr oducessev eral
bonef ragment s.
Closedf ract ur e.Acl osedf ractur eisonet hatdoesnotcauseabr eaki nt he
skin.
Openf ract ur e.Anopenf r
act urei sonei nwhi cht heski normucous
membr anewoundext endst ot hef r
acturedbone.

18
 ‫‪:‬‬
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻒ‬‫ﻨ‬‫ﺗﺼ‬
‫‪:‬‬
‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﺙﻓﻲ‬ ‫ﺪﺗﺤ‬ ‫ﺘﻲﻗ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬
‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉﻣﻦ‬ ‫ﻮ‬‫ﻧ‬
‫ﺃ‬‫ﺓ‬‫ﺪ‬‫ﺎﻙﻋ‬
‫ﻨ‬‫ﻫ‬
‫ﻜﻞ‬‫ﻪﺑﺸ‬
‫ﺘ‬‫ﺍﺣ‬‫ﺯ‬
‫ﺘﻢﺇ‬‫ﻳ‬
‫ﻣﻞﻭ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬
‫ﻌﻈﻢﺑ‬ ‫ﻠ‬
‫ﻟ‬‫ﺮﺿﻲ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻠﻰﻛﺴ‬‫ﻣﻞﻋ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬ ‫ﻨﻄ‬
‫‪.‬ﻳ‬‫ﻣﻞ‬‫ﺎ‬‫ﺮﻛ‬‫• ﻛﺴ‬
‫‪.‬‬
‫ﺭ‬‫ﺮ‬‫ﻜ‬
‫ﺘ‬‫ﻣ‬
‫‪.‬‬‫ﻌﻈﻢ‬‫ﻠ‬
‫ﻟ‬‫ﺮﺿﻲ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻂﻣﻦ‬ ‫ﺀﻓ‬‫ﺰ‬‫ﺍﻓﻲﺟ‬ ‫ً‬
‫ﺮ‬‫ﻣﻞﻛﺴ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺮﻏ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﻦ‬‫ﺘﻀ‬‫‪.‬ﻳ‬‫ﻣﻞ‬‫ﺎ‬‫ﺮﻛ‬‫ﻴ‬‫ﺮﻏ‬‫• ﻛﺴ‬
‫‪.‬‬
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﺪﻣﻦﺷﻈ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺘﺞ‬‫ﻨ‬‫ﺬﻱﻳ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮ‬
‫ﺘﺖﻫ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫ﺘﺖ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫•ﺍ‬
‫‪.‬‬
‫ﺪ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺎﻓﻲ‬ ‫ً‬
‫ﻗ‬
‫ﻮ‬‫ﻘ‬‫ﺒﺐﺷ‬ ‫ﺬﻱﻻﻳﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻮ‬ ‫ﻠﻖﻫ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﻠﻖ‬‫ﻐ‬‫ﺮﻣ‬‫• ﻛﺴ‬
‫‪.‬‬‫ﺭ‬
‫ﻮ‬‫ﻜﺴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬
‫ﺎﻃﻲﺇ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬ ‫ﺎ‬
‫ﻐﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺡ‬‫ﻭﺟ‬ ‫ﺃ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻪ‬‫ﻴ‬‫ﺪﻓ‬‫ﺘ‬‫ﻤ‬‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻮﺡﻫ‬ ‫ﺘ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫ﻮﺡ‬ ‫ﺘ‬
‫ﻔ‬‫ﺮﻣ‬‫•ﻛﺴ‬

‫‪19‬‬
 (
Fig.
5)Cl
assi
fi
cat
ionsoff
ract
ure

CausesofFr
act
ure:

20
Factur emaybecausedbyt hef ollowi ng:
1.Di rectbl ows.Bei nghi tdi rect lybyagr eatf or cecoul dcausef ract ur eint he
bones.
2.Cr ushi ngf or ces.For cest hatcomei ntocont actwi tht hebonesandcr ush
them coul dal sor esul tinf ract ur es.
3.Suddent wi st i
ngmot ions.Twi stingt hej oi ntsi nasuddenmot ionl eadst o
fractur es.
4.Ext rememuscl econt ractions.Whent hemuscl eshav er eachedi tsl imitin
contr act i
on, i
tcoul dl eadt oser iousf r
act ur es.
:
‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﺒ‬
‫ﺃﺳ‬
:‫ﻠﻲ‬ ‫ﺎﻳ‬‫ﺎﻋﻦﻣ‬ ً‫ﺗ‬
‫ﺠ‬ ‫ﺎ‬‫ﻣﻞﻧ‬ ‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﻓﻲ‬ ‫ﻭﺙﻛﺴ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺓﺇ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺓﻛ‬ ‫ﻮ‬‫ﻘ‬ ‫ﺮﺑ‬ ‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﺏ‬‫ﻟﻀ‬ ‫ﺍ‬ ‫ﺩﻱ‬ ‫ﺆ‬‫ﺪﻳ‬ ‫ﻗ‬.‫ﺓ‬ ‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬.1
.‫ﺭ‬‫ﻮ‬‫ﻭﺙﻛﺴ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺎﺇ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺎ‬
‫ﺮﻫ‬ ‫ﻜﺴ‬ ‫ﺗ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻣﺲﻣ‬ ‫ﺗﻼ‬‫ﺘﻲﺘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻯ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺩﻱ‬ ‫ﺆ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.‫ﺮ‬‫ﻴ‬‫ﻜﺴ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬ ‫ﻗ‬.2
.‫ﺭ‬‫ﻮ‬‫ﻭﺙﻛﺴ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺔﺇ‬ ‫ﺌ‬‫ﺎﺟ‬‫ﻔ‬‫ﺔﻣ‬ ‫ﻛ‬ ‫ﺮ‬‫ﺎﺻﻞﺑﺤ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩﻱ‬ ‫ﺆ‬‫ﻳ‬. ‫ﺔ‬‫ﺌ‬‫ﺎﺟ‬‫ﻔ‬‫ﺀﻣ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻛ‬‫ﺮ‬‫ﺣ‬. 3
‫ﻟﻚ‬‫ﺩﻱﺫ‬ ‫ﺆ‬ ‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬، ‫ﻠﺺ‬ ‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻗﺼﻰﻣﻦ‬ ‫ﺍﻷ‬ ‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﻟﻰ‬‫ﻌﻀﻼﺕﺇ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺗﺼﻞ‬ ‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬. ‫ﺓ‬‫ﺪ‬ ‫ﻳ‬‫ﺪ‬‫ﺔﺷ‬ ‫ﻴ‬‫ﻠ‬‫ﺎﺕﻋﻀ‬ ‫ﻠﺼ‬‫ﻘ‬‫ﺗ‬.4
.‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺭﺧﻄ‬ ‫ﻮ‬‫ﻟﻰﻛﺴ‬ ‫ﺇ‬
Clini
calMani fest at i
onsoff ract ur e:
Thecl i
ni cal signsandsy mpt omsofaf ract ur emayi ncl udet hef ollowi ngbutnot
allarepr esenti nev eryf r
act ur e:
1-Thepai ni scont inuousandi ncr easesi nsev erityunt ilthebonef ragment sar e
i
mmobi li
zed.
2-Lossoff unct i
on.Af teraf ract ur e, t
heext remi tycannotf unct ionpr oper ly
becausenor mal f unct ionoft hemuscl esdependsont hei ntegr i
tyoft hebones
towhi cht heyar eat tached.
3-Di spl acement ,angul at i
on, orr ot ationoft hef ragment si naf ract ur eoft he
arm orl egcausesadef or mi tyt hati sdet ect abl ewhent hel imbi scompar ed
wi t
ht heuni njuredext r emi ty.
4-Ther ei sact ual shor teningoft heext remi tybecauseoft hecompr essionof
thef ract uredbone.
5-Whent heext remi tyi sgent lypal pat ed, acr umbl ingsensat ion, cal l
edcr epitus,
canbef elt.
Local izededemaandecchy mosi s.Local izededemaandecchy mosi soccur- 6
afteraf ract ureasar esul toft raumaandbl eedi ngi ntot het i
ssues.
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺮ‬‫ﺎﻓﻲﻛﻞﻛﺴ‬ ‫ﻬ‬‫ﻌ‬‫ﻴ‬‫ﻤ‬‫ﺮﺟ‬ ‫ﻬ‬‫ﻜﻦﻻﺗﻈ‬ ‫ﻟ‬‫ﻠﻲﻭ‬ ‫ﺎﻳ‬ ‫ﺮﻣ‬ ‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬ ‫ﻗ‬
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺎ‬‫ﺒﺖﺷﻈ‬ ‫ﺜ‬
‫ﺘﻰﺗ‬ ‫ﻪﺣ‬ ‫ﺗ‬‫ﺪ‬‫ﺩﺷ‬ ‫ﺍ‬‫ﺩ‬‫ﺰ‬‫ﺗ‬‫ﺮﻭ‬ ‫ﻤ‬‫ﺘ‬‫ﻟﻢﻣﺴ‬ ‫ﺍﻷ‬-1
‫ﻌﻀﻼ‬ ‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﺢﻷﻥ‬ ‫ﻜﻞ ﺻﺤ‬ ‫ﻤﻞﺑﺸ‬ ‫ﻌ‬‫ﺃﻥﻳ‬ ‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬ ‫ﻊ‬‫ﻴ‬
‫ﺘﻄ‬ ‫ﻻﻳﺴ‬، ‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬ ‫ﺑ‬.‫ﺔ‬‫ﻔ‬‫ﻴ‬ ‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬-2
.‫ﺑ‬
‫ﺎ‬
‫ﺒﻂﻬ‬ ‫ﺗ‬
‫ﺮ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻼﺔ‬‫ﻠﻰﺳ ﻣ‬ ‫ﺪﻋ‬‫ﻤ‬‫ﺘ‬‫ﻌ‬‫ﺕﺗ‬
‫ﺪ‬‫ﻨ‬‫ﻪﻋ‬ ‫ﻓ‬‫ﺎ‬‫ﺘﺸ‬‫ﻛ‬ ‫ﺍ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﺎﻳ‬ً‫ﻮ‬
‫ﻫ‬ ‫ﺒﺐﺗﺸ‬ ‫ﺎﻕﻳﺴ‬ ‫ﻟﺴ‬ ‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﻓﻲ‬ ‫ﺎﻓﻲﻛﺴ‬ ‫ﻳ‬
‫ﺎ‬‫ﻟﺸﻈ‬ ‫ﺍ‬‫ﺍﻥ‬ ‫ﺭ‬
‫ﻭ‬ ‫ﻭﺩ‬ ‫ﺃ‬‫ﺀ‬ ‫ﺍ‬
‫ﻭ‬‫ﺰ‬ ‫ﻧ‬‫ﺍ‬
‫ﻭ‬ ‫ﺃ‬‫ﺎﺡ‬‫ﻳ‬
‫ﺰ‬‫ﻧ‬‫ﺍ‬-3
.‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺍﻑﻏ‬ ‫ﺮ‬ ‫ﺎﻷﻃ‬ ‫ﺮﻑﺑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻣ‬
.‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻈﻢ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻐ‬‫ﻧﻀ‬‫ﺍ‬ ‫ﺒﺐ‬ ‫ﺍﻑﺑﺴ‬ ‫ﺮ‬‫ﻟﻸﻃ‬ ‫ﻠﻲ‬ ‫ﻌ‬‫ﺮﻓ‬ ‫ﺪﻗﺼ‬ ‫ﻮﺟ‬ ‫ﻳ‬-4
.‫ﺮﻕ‬‫ﻤﻰﺧ‬ ‫ﺘﺖﻳﺴ‬ ‫ﻔ‬‫ﺘ‬‫ﺎﺱﻣ‬ ‫ﺈﺣﺴ‬ ‫ﺭﺑ‬‫ﻮ‬ ‫ﻌ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬، ‫ﻓﻖ‬ ‫ﺮ‬‫ﺮﻑﺑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬ ‫ﻣﺴ‬ ‫ﺘﻢﻣﻼ‬ ‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬- 5
‫ﺍﻷ‬‫ﻳﻒﻓﻲ‬ ‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻣ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺔ‬‫ﻴﺠ‬ ‫ﺘ‬‫ﺮﻧ‬ ‫ﺪﻛﺴ‬ ‫ﻌ‬‫ﺔﺑ‬ ‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬ ‫ﺪ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺗﺤ‬. ‫ﺔ‬‫ﻴ‬ ‫ﻌ‬‫ﻮﺿ‬ ‫ﺎﺕﻣ‬ ‫ﻣ‬‫ﺪ‬‫ﻛ‬‫ﻡﻭ‬ ‫ﺭ‬‫ﻮ‬‫ﺗ‬-6
.
‫ﺔ‬‫ﻧﺴﺠ‬
Assessmentanddi agnost icf indi ngsoff ract ure:
Todet er mi net hepr esenceoff ract ur e,thef ollowi ngdi agnost ict ool sar eused.
1.X- rayexami nat ions:Det ermi nesl ocat ionandex tentoff ractur es/ trauma,
mayr ev eal pr eexi stingandy etundi agnosedf ractur e(s).
2.Bonescans, tomogr ams, comput edt omogr aphy( CT) / magnet icr esonance
i
magi ng( MRI )scans:Vi sual izesf ract ures, bl eeding, andsof t-
tissuedamage;

21
different i
at esbet weenst ress/ tr aumaf ract ur esandboneneopl asms.
3.Ar ter i
ogr ams:Maybedonewhenoccul tv ascul ardamagei ssuspect ed.
4.Compl et ebl oodcount( CBC)Muscl et raumai ncreasesl oadofCr eat i
ninef or
renal clear ance.
5.Coagul ationpr of i
le:Al terat i
onsmayoccurbecauseofbl oodl oss, mul tiple
transf usions, orl i
veri njury .
):Hemat ocr it(Hct )maybei ncr eased
(hemoconcent ration)ordecr eased( signi fyinghemor rhageatt hef ract uresi te
oratdi stantor gansi nmul t i
pl et rauma) .Incr easedwhi tebl oodcel l(WBC)count
i
sanor mal stressr esponseaf tert rauma.
6.Ur inecr eat i
ni ne( Cr)cl ear ance.
:
‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬ ‫ﺗﺸﺨ‬ ‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬‫ﺋﺞﺗ‬ ‫ﺎ‬
‫ﺘ‬‫ﻧ‬
.
‫ﺔ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﻭ‬‫ﺩ‬‫ﺃ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬ ‫ﻳ‬،‫ﺮ‬‫ﺩﻛﺴ‬ ‫ﻮ‬‫ﺪﻭﺟ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬
(‫ﺭ‬‫ﻮ‬ ‫ﻛﺴ‬)‫ﺮ‬ ‫ﻜﺸﻒﻋﻦﻛﺴ‬ ‫ﺪﺗ‬‫ﻗ‬ ‫ﻭ‬، ‫ﻮﺽ‬ ‫ﺮﺿ‬ ‫ﻟ‬‫ﺍ‬/‫ﺭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺪﻯ‬ ‫ﻣ‬‫ﻊﻭ‬ ‫ﻗ‬
‫ﻮ‬ ‫ﺩﻣ‬‫ﺪ‬ ‫ﺗﺤ‬: ‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ ‫ﺎﺕ‬‫ﻮﺻ‬ ‫ﻓﺤ‬. 1
.‫ﺔ‬‫ﺮﻣﺸﺨﺼ‬ ‫ﻴ‬
‫ﻏ‬ ‫ﺎﻭ‬ً
‫ﻘ‬‫ﺒ‬‫ﺓﻣﺴ‬ ‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻣ‬
‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻧ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬‫ﺍ‬/( CT)‫ﻌﻲ‬ ‫ﻘﻄ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬ ،‫ﻌﻲ‬‫ﻘﻄ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬ ،‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻮﺻ‬ ‫ﻓﺤ‬. 2
‫ﻡ‬ ‫ﺍ‬
‫ﺭ‬‫ﻭ‬ ‫ﺃ‬
‫ﺔﻭ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬/‫ﺩ‬ ‫ﺎ‬
‫ﻬ‬‫ﺍﻹﺟ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﻴﻦﻛﺴ‬ ‫ﺮﻕﺑ‬ ‫ﻔ‬‫ﻳ‬.‫ﺓ‬‫ﻮ‬ ‫ﺮﺧ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻠﻒ‬ ‫ﺗ‬‫ﻳﻒﻭ‬ ‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﻮ‬‫ﺗﺼ‬: (MRI )
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﻔﻲ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬ ‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻠﻒ‬ ‫ﻩﻓﻲﺗ‬ ‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺷ‬ ‫ﺪ‬ ‫ﻨ‬
‫ﻩﻋ‬ ‫ﺅ‬‫ﺍ‬
‫ﺮ‬‫ﻜﻦﺇﺟ‬ ‫ﻤ‬‫ﻳ‬:‫ﻴﻦ‬ ‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﻣﺨﻄﻂ‬. 3
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﺘﺼ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﻴﻦ‬‫ﻨ‬‫ﻴ‬‫ﺗ‬‫ﺎ‬‫ﻳ‬
‫ﺮ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﻌﻀﻼﺕﻣﻦﺣ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺪﺻ‬ ‫ﻳ‬‫ﺰ‬‫(ﺗ‬ CBC)‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺗ‬.4
:(.‫ﺪ‬‫ﺒ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺑ‬
‫ﺎ‬‫ﻭﺇﺻ‬، ‫ﺓﺃ‬ ‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻘﻞ‬ ‫ﺎﺕﻧ‬ ‫ﻴ‬ ‫ﻠ‬
‫ﻤ‬‫ﻭﻋ‬،‫ﻡﺃ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬ ‫ﻘ‬
‫ﺒﺐﻓ‬ ‫ﺍﺕﺑﺴ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺪﺙﺗ‬ ‫ﺪﺗﺤ‬ ‫ﻗ‬:‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻒ‬ ‫ﻣ‬. 5
‫ﺀ‬‫ﺎ‬
‫ﺃﻋﻀ‬ ‫ﻭﻓﻲ‬ ‫ﺃ‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻗ‬‫ﻮ‬
‫ﻳﻒﻓﻲﻣ‬ ‫ﺰ‬
‫ﻟﻰﻧ‬ ‫ﺮﺇ‬‫ﻴ‬‫ﻳﺸ‬ )‫ﻘ ﺺ‬ ‫ﻨ‬‫(ﻭﻳ‬
‫ﻡﺃ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺗ‬)‫ﺪ‬‫ﻳ‬ ‫ﺰ‬‫ﺪﻳ‬ ‫(ﻗ‬ Hct )‫ﻳﺖ‬ ‫ﺮ‬‫ﻛ‬‫ﻮ‬ ‫ﺗ‬‫ﺎ‬
‫ﻤ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
‫ﺪ‬ ‫ﻌ‬‫ﺮﺑ‬‫ﺗ‬‫ﻮ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻌ‬ ‫ﻴ‬‫ﺒ‬
‫ﺔﻃ‬ ‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬ ‫ﻮ‬‫(ﻫ‬ WBC)‫ﺀ‬ ‫ﺎ‬‫ﻴﻀ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺩﺧﻼ‬ ‫ﺪ‬‫ﺓﻋ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺯ‬.(‫ﺓ‬ ‫ﺩ‬‫ﺪ‬ ‫ﻌ‬‫ﺘ‬
‫ﺔﻣ‬ ‫ﻣ‬ ‫ﺪ‬‫ﺓﻓﻲ ﺻ‬ ‫ﺪ‬ ‫ﻴ‬
‫ﻌ‬‫ﺑ‬
.
‫ﺔ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
.(Cr)‫ﻴﻦ‬ ‫ﻨ‬
‫ﻴ‬ ‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﺗﺼ‬. 6
St agesoff ract urer epai r:
St age1:I nflammat oryphase:
-Hemat omaf or mat ionbegi nswi tht hef ormat ionofacl ott hatser vesasaf ibrin
net wor k.Bl eedi ngcomesf rom r upt uredv essel swi thint heboneaswel l asf rom
tearsi nt heper i
ost eum andadj acentt issues.
-Thehemat omai snotabsor bedbutdev el opsi nt ogr anul ationt issue.wher e
oset eocy t
eandper iosteal cel ldeat hoccur s.Thi sr esul tinani nf l
ammat or y
responsewi thv asodi l
ationandt hegat her ingofpol ymor phonucl eocy tesand
histiocy tes.
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺣﻞﺇﺻﻼﺡ‬ ‫ﺮ‬‫ﻣ‬
:‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬:‫ﻟﻰ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬ ‫ﺍﻷ‬ ‫ﺰﻕ‬ ‫ﻤ‬‫ﻳﻒﻣﻦﺗ‬ ‫ﺰ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺗﻲ‬‫ﺄ‬‫ﻳ‬. ‫ﻳﻦ‬‫ﺮ‬‫ﺒ‬‫ﻴ‬‫ﻔ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻜ‬‫ﺒ‬‫ﺔﺷ‬ ‫ﺑ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻤﻞﺑ‬ ‫ﻌ‬ ‫ﺔﺗ‬‫ﻠﻄ‬‫ﻳﻦﺟ‬ ‫ﻮ‬‫ﻜ‬‫ﺘ‬‫ﻮﻱﺑ‬ ‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬ ‫ﻮ‬‫ﻜ‬‫ﺃﺗ‬‫ﺪ‬‫ﺒ‬‫ﻳ‬-
.‫ﺓ‬‫ﺭ‬‫ﻭ‬ ‫ﺎ‬
‫ﻤﺠ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺎﻕﻭ‬ ‫ﻤﺤ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﺰﻕﻓﻲ‬ ‫ﻤ‬‫ﻟﻚﻣﻦﺗ‬ ‫ﺬ‬ ‫ﻛ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺧﻞ‬ ‫ﺔﺩ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻗ‬ ‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟﺴ‬ ‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﻟﺨﻼ‬ ‫ﺍ‬ ‫ﻮﺕ‬ ‫ﺪﺙﻣ‬ ‫ﻴﺚﻳﺤ‬ ‫ﺣ‬. ‫ﺒﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻴﺞﺣ‬ ‫ﻟﻰﻧﺴ‬ ‫ﺭﺇ‬‫ﻮ‬‫ﺘﻄ‬ ‫ﻮﻱﺑﻞﻳ‬ ‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺹ‬ ‫ﺘﺼ‬ ‫ﻣ‬‫ﺍ‬ ‫ﺘﻢ‬‫ﻻﻳ‬-
‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﺎﻝﻭ‬ ‫ﻜ‬ ‫ﺍﻷﺷ‬ ‫ﺓ‬‫ﺩ‬ ‫ﺪ‬
‫ﻌ‬ ‫ﺘ‬‫ﺎﻣ‬‫ﻳ‬‫ﻟﺨﻼ‬ ‫ﺍ‬‫ﻊ‬ ‫ﻴ‬‫ﻤ‬‫ﺗﺠ‬ ‫ﺔﻭ‬ ‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻊ‬‫ﻮﺳ‬ ‫ﻊﺗ‬ ‫ﺔﻣ‬ ‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬ ‫ﺍ‬‫ﺬ‬ ‫ﺘﺞﻋﻦﻫ‬ ‫ﻨ‬‫ﻳ‬.‫ﻗﻲ‬ ‫ﺎ‬‫ﻤﺤ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺎﺕ‬ ‫ﻨﺴﺠ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬

St
ageone

22
Stage2:Repar ati
vephase:
-Thisstagecharacterizedbyt heformationofcal l
us.Theboneendsar e
subsequentlysealedbyt hefracturehaemat oma, Granulati
ontissueformsa
softti
ssuecallusthatsur r
oundst hefracturesit
eandser vesasat empor ary
spli
nt.
-Atthisstagethecallusisv i
sibl
eonX- r
ay .
:
‫ﺍﻹﺻﻼﺡ‬ ‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬
‫ﻣ‬:‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﺇﻏ‬ً
‫ﻘ‬
‫ﺘﻢﻻﺣ‬ ‫ﻳ‬.‫ﻟﺲ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬‫ﺘ‬‫ﺔﺑ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺰﻫ‬ ‫ﻴ‬‫ﻤ‬
‫ﺘ‬‫ﺗ‬-
،
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﻣ‬‫ﻡﺩ‬ ‫ﺭ‬
‫ﺔﻭ‬ ‫ﺍﺳﻄ‬‫ﻮ‬‫ﻡﺑ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻼﻕﻧ‬
‫ﻴﻂ‬‫ﺎﻳﺤ‬ ً
‫ﻤ‬‫ﻋ‬
‫ﺎ‬‫ﺍﻧ‬
ً
‫ﺬ‬ ‫ﺒ‬
‫ﺔﺩﺷ‬ ‫ﻴ‬
‫ﺒ‬‫ﻴ‬‫ﺒ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬ ‫ﻜﻞ‬‫ﺗﺸ‬‫ﻭ‬
.
‫ﺔ‬‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﺓﻣ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻤﻞﻛﺠ‬ ‫ﻌ‬‫ﻳ‬
‫ﺮﻭ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬
‫ﻮ‬‫ﻤ‬‫ﺑ‬
‫ﺍﻷ‬‫ﺎﻓﻲ‬ً
‫ﻴ‬‫ﺋ‬
‫ﺮ‬‫ﻡﻣ‬ ‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﻮﻥﻣﺴ‬ ‫ﻜ‬‫ﺔﻳ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬ ‫ﺬ‬‫ﻓﻲﻫ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬
‫ﺷ‬

St
aget
wo
Stage3:Remodel i
ngphase:
-Remodelingiscompletedbyost
eoclasti
cacti
vi
ty,wherebyexcess
boneisgraduall
yreducedandremovedbyabsor pt
ionuntilt
he
ori
ginal
shapeandout li
neofthefr
act
ur edbonearereestabl
ished.
(Fi
g.6)
:
‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﺔﺇ‬
‫ﻠ‬‫ﺮﺣ‬
‫ﻣ‬:3‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻗﻖ‬ ‫ﺮ‬
‫ﺎﻁﺗ‬‫ﺀﻣﻦﺧﻼﻝﻧﺸ‬ ‫ﺎ‬‫ﻨ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﺔﺇﻋ‬
‫ﻴ‬‫ﻠ‬‫ﻤ‬
‫ﻤﻞﻋ‬ ‫ﺘ‬
‫ﻜ‬‫ﺗ‬-
‫ﻪ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺇ‬
‫ﺎﻭ‬ً‫ﻴ‬
‫ﻳﺠ‬‫ﺭ‬‫ﺪ‬‫ﺪﺗ‬‫ﺋ‬
‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺘﻢﺗ‬‫ﻴﺚﻳ‬‫ﺣ‬،‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬
‫ﺍﻷ‬‫ﻜﻞ‬‫ﻟﺸ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬‫ﺘﻢ‬‫ﺘﻰﻳ‬‫ﺎ ﺹﺣ‬ ‫ﺘﺼ‬‫ﻣ‬
‫ﺍﻻ‬‫ﻳﻖ‬‫ﺮ‬‫ﻋﻦﻃ‬
(6‫ﻜﻞ‬ ‫ﻟﺸ‬‫ﺍ‬
).‫ﺭ‬
‫ﻮ‬‫ﻜﺴ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻳﻀ‬‫ﺮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻁ‬‫ﻟﺨﻄ‬‫ﺍ‬
‫ﻠﻲﻭ‬‫ﺻ‬

St
aget
hree
(
Fig.6)St
agesofboneheal
ing

Factor
st hatenhancef ractureheali
ng:
1-I
mmobi l
izati
onoff r
acturefragment s.
2-Suffi
cientbloodsupplies.
3-Propernut r
it
ion.
4-Exerci
ses&wei ghtbear i
ngforlongbones.
5-Hormones, growthhor mone, t
hy r
oid,cal
cit
oni
n,vi
taminD.
:
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺰ‬‫ﻌ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺎ‬
‫ﻴﺖﺷﻈ‬ ‫ﺒ‬
‫ﺜ‬‫ﺗ‬-
1
.
‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻡﻛ‬ ‫ﺍﺕﺩ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻣ‬‫ﺇ‬-
2
.‫ﺔ‬‫ﻤ‬
‫ﻴ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬-
3
.‫ﺔ‬
‫ﻠ‬‫ﻳ‬‫ﻮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻠ‬
‫ﻟ‬‫ﺍﻥ‬‫ﺯ‬
‫ﻭ‬‫ﺃ‬‫ﻤﻞ‬‫ﻳﻦﻭﺣ‬ ‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﺗ‬-
4
.‫ﻴﻦﺩ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﻓ‬‫ﻴﻦﻭ‬ ‫ﻧ‬
‫ﻮ‬‫ﺘ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺎ‬
‫ﻭﻜ‬
‫ﻟ‬‫ﺔﺍ‬‫ﻴ‬
‫ﻗ‬‫ﺭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﻭ‬ ‫ﻤ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻣ‬‫ﺮ‬‫ﺎﺕﻭﻫ‬ ‫ﻧ‬
‫ﻮ‬‫ﻣ‬‫ﺮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬-
5

Factorsthati
nhibi
tfract
ureheal
ing:
1-Extensiv
elocalt
rauma.

23
2-Boneloss.
3-I
nadequat eimmobi l
i
zation.
4-Spacebetweenbonesf ragment
s.
5-I
nfecti
on.
6-Vascularnecrosi
s.
7-Localmalignancy.
8-Age.
9-I
ntraarti
cularfr
acture.
10-Cort
icosteroi
ds.

:
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺎﻕ‬‫ﻨﻄ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬
‫ﺍﺳ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻌ‬‫ﻮﺿ‬ ‫ﺎﺕﻣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬-1
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻓ‬-2
.
‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬ ‫ﺪ‬‫ﻋ‬-3
.‫ﻡ‬
‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺎ‬
‫ﻴﻦﺷﻈ‬ ‫ﺍﻍﺑ‬ ‫ﺮ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬-
4
.‫ﻭﻯ‬‫ﺪ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬-
5
.‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺮ‬‫ﻨﺨ‬‫ﺗ‬-
6
.
‫ﻌﻲ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺚ‬‫ﺒ‬‫ﻟﺨ‬‫ﺍ‬ ‫ﻡ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬-
7
.‫ﺮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬-
8
.
‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺧﻞ‬‫ﺮﺩ‬ ‫ﻛﺴ‬-9
.
‫ﺍﺕ‬‫ﺪ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻮﺳ‬‫ﻜ‬ ‫ﻴ‬
‫ﺗ‬‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬-
10
Medi cal Managementoff ract ure:
Pr i
nci pl
esoff racturemanagement :
1.Reduct ion.ist hepr ocessofr estoringt heboneends( andanyf ractured
fragment s)i ntot heirnor mal anat omi cal posi ti
ons.Thi sisaccompl ishedby
openorcl osedmani pulationoft heaf f
ect edar ea, refer r
edt oasopenr eduction
andcl osedr educt i
on.
-Cl osedr educt ioni saccompl ishedbybr ingi ngt heboneendsi ntoal ignmentby
mani pulat i
onandmanual tr
act ion.X- raysar etakent odet ermi net heposi t
ionof
thebones.Acasti snor mal lyappl i
edt oi mmobi li
zet heex tremi tyandmai ntain
ther educt i
on.
Inopenr educt ion, asur gical openi ngi smade, all
owi ngt hebonest obe-
reducedmanual lyunderdi rectv i
sual i
zat i
on.Fr equent ly,internal fixationdev ices
wi l
lbeusedt omai ntaint hebonef ragment sinr educt ion.
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
:
‫ﺭ‬‫ﻮ‬ ‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺩﺉﺇ‬‫ﺎ‬‫ﺒ‬‫ﻣ‬
‫ﺔ‬‫ﻴ‬‫ﻳﺤ‬ ‫ﺮ‬‫ﺘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻬ‬‫ﻌ‬
‫ﻗ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻟﻰﻣ‬‫(ﺇ‬ ‫ﺓ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﺀﻣ‬ ‫ﺍ‬
‫ﺰ‬‫ﺃﺟ‬ ‫ﺃﻱ‬‫ﻭ‬)‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﺃﻃ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻫﻲﻋ‬. ‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬.1
‫ﺎﺳﻢ‬‫ﺎﺑ‬‫ﻬ‬‫ﻴ‬‫ﻟ‬‫ﺭﺇ‬‫ﺎ‬‫ﻳﺸ‬، ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻠﻖ‬ ‫ﻐ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﻮﺡ‬‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺘﻼﻋﺐ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬ ‫ﺮ‬‫ﻟﻚﻋﻦﻃ‬ ‫ﻴﻖﺫ‬ ‫ﻘ‬‫ﺘﻢﺗﺤ‬ ‫ﻳ‬.‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬
.‫ﻠﻖ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬
‫ﺘﺨ‬ ‫ﻟ‬‫ﺍ‬
‫ﻮﺡﻭ‬ ‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﻭﻱ‬ ‫ﺪ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺘﻼﻋﺐﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺓﻋﻦﻃ‬ ‫ﺍ‬
‫ﺫ‬ ‫ﺎ‬
‫ﻡﻣﺤ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﺎ‬‫ﻬ‬‫ﻌﻞﻧ‬ ‫ﻳﻖﺟ‬ ‫ﺮ‬‫ﻠﻖﻋﻦﻃ‬ ‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺘﻢﺇﺟ‬ ‫ﻳ‬-
‫ﺮﻑﻭ‬ ‫ﻟﻄ‬‫ﺍ‬ ‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺒﺲ‬ ‫ﻟﺐﺟ‬ ‫ﺎ‬
‫ﻡﻗ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﺎﻳ‬‫ﺓﻣ‬ً‫ﺩ‬‫ﺎ‬
‫ﻋ‬. ‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻮﺿ‬ ‫ﺪﻣ‬ ‫ﻳ‬‫ﺪ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺔ‬ ‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬‫ﺬ‬‫ﺃﺧ‬ ‫ﺘﻢ‬‫ﻳ‬
.
‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺭ‬‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺗﺤﺖ‬ ً
‫ﻳ‬
‫ﻭ‬‫ﺪ‬‫ﻡﻳ‬ ‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﻠ‬
‫ﻘ‬ ‫ﺘ‬‫ﻤﺢﺑ‬ ‫ﺎﻳﺴ‬‫ﻤ‬‫ﻣ‬، ‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬ ‫ﺮ‬
‫ﺔﺟ‬ ‫ﺘﺤ‬ ‫ﻤﻞﻓ‬ ‫ﺘﻢﻋ‬ ‫ﻳ‬،‫ﻮﺡ‬ ‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬-
‫ﻡﻓﻲ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬ ‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﻠﻰﺷﻈ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﻠﻲ‬ ‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬ ‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻴ‬‫ﺳ‬، ‫ﺎﻥ‬‫ﻴ‬‫ﻣﺍﻷﺣ‬‫ﺮﻦ‬ ‫ﻴ‬
‫ﺜ‬‫ﻓﻲﻛ‬. ‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬
2.Immobi li
zat i
on.I mmobi lizationi snecessar yt omai ntainf r
act urer educt i
on
unt i
l healingoccur s.I mmobi l
izationmaybeaccompl ishedbyex ternal or
i
nt ernal fixation.
-Met hodsofext ernal fi
xationi ncludecast s,spl i
nt s,andcont inuoust raction.

24
-Int ernal fixat i
ondev i
cesi ncl udepi ns, wi r
es, screws, rods, nai l
s,andpl ates.
Thesedev ices, at tachedt ot hesi desoft heboneori nser tedt hrought hebone,
prov i
dei nt ernal immobi li
zat ionoft hebone.
‫ﻴﺖﻋﻦ‬ ‫ﺒ‬‫ﺜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻖ‬ ‫ﻘ‬‫ﻜﻦﺗﺤ‬ ‫ﻤ‬‫ﻳ‬. ‫ﺀ‬‫ﺎ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﺪﺙ‬ ‫ﺘﻰﻳﺤ‬ ‫ﺮﺣ‬ ‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻟﺤ‬ ‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬ ‫ﺭﻱ‬ ‫ﻭ‬‫ﺮ‬‫ﻴﺖ ﺿ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬.‫ﻠﻞ‬ ‫ﻟﺸ‬ ‫ﺍ‬.2
.‫ﻠﻲ‬ ‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺭﺟﻲ‬ ‫ﺎ‬‫ﻟﺨ‬ ‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬ ‫ﺮ‬ ‫ﻃ‬
.‫ﺮ‬‫ﻤ‬ ‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻟﺴﺤﺐ‬ ‫ﺍ‬‫ﺮﻭ‬ ‫ﺋ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻟﺐﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺭﺟﻲ‬ ‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬ ‫ﻤﻞﻃ‬ ‫ﺗﺸ‬-
‫ﺍﻷ‬ ‫ﻩ‬‫ﺬ‬‫ﺮﻫ‬ ‫ﻓ‬‫ﻮ‬‫ﺗ‬.‫ﺍﺡ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍﻷ‬‫ﺮﻭ‬ ‫ﻴ‬‫ﻣ‬ ‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻥﻭ‬ ‫ﺒ‬‫ﻘﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻏﻲﻭ‬ ‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻷﺳﻼﻙﻭ‬ ‫ﺮﻭ‬ ‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻲ‬ ‫ﺍﺧ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺰ‬ ‫ﻬ‬
‫ﺃﺟ‬ ‫ﻤﻞ‬ ‫ﺗﺸ‬-
.‫ﻌﻈﻢ‬ ‫ﻠ‬‫ﻟ‬‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬، ‫ﻌﻈﻢ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺎﻣﻦﺧﻼﻝ‬ ‫ﻬ‬
‫ﻟ‬‫ﺎ‬‫ﺩﺧ‬ ‫ﺘﻢﺇ‬‫ﺘﻲﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﻧﺐ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﺔﺑﺠ‬ ‫ﻠ‬‫ﺘﺼ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬، ‫ﺓ‬‫ﺰ‬‫ﻬ‬ ‫ﺟ‬
3.Rehabi litat i
on.Rehabi li
tat ioni st her egai ningofst rengt handnor mal funct ion
i
nt heaf fect edar ea.Speci ficr ehabi li
tat i
onf oreachpat ientwi llbebasedupon
thet ypeoff ractureandt hemet hodsofr educt ionandi mmobi l
izationused.The
phy sici anwi llgener allyconsul twi tht hephy sical ther api stt odev el opan
i
ndi v i
dual izedr ehabi li
tat i
onpl anf oreachpat ient .Thi spl ani snor mal l
y
i
mpl ement edandcont rolledbyt hephy sical ther apydepar tment .
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺪﺇﻋ‬ ‫ﻤ‬‫ﺘ‬‫ﻌ‬‫ﺗ‬.‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬ ‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬ ‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬ ‫ﻮ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﻮ‬ ‫ﻴﻞﻫ‬ ‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬
‫ﻋ‬‫ﺇ‬.‫ﻴﻞ‬ ‫ﺄﻫ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬.3
‫ﻊ‬‫ﻡﻣ‬ ‫ﺎ‬
‫ﻜﻞﻋ‬ ‫ﻴﺐﺑﺸ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﺭ‬‫ﻭ‬ ‫ﺎ‬
‫ﺘﺸ‬ ‫ﻴ‬‫ﺳ‬. ‫ﻪ‬ ‫ﺘ‬‫ﻴ‬‫ﺒ‬‫ﺜ‬‫ﺗ‬‫ﻩﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺮﻕﺗﺼ‬ ‫ﺮﻭﻃ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻉ‬ ‫ﻠﻰﻧ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻜﻞﻣ‬ ‫ﻟ‬ ‫ﺔ‬‫ﺎﺻ‬ ‫ﻟﺨ‬‫ﺍ‬ ‫ﻴﻞ‬ ‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻩ‬‫ﺬ‬ ‫ﺬﻫ‬ ‫ﻴ‬‫ﻔ‬‫ﻨ‬
‫ﺘﻢﺗ‬ ‫ﺎﻳ‬ ‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬‫ﻋ‬. ‫ﻳﺾ‬ ‫ﺮ‬‫ﻜﻞﻣ‬ ‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺩ‬‫ﺮ‬‫ﻴﻞﻓ‬ ‫ﺄﻫ‬ ‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﺔﺇ‬ ‫ﻊﺧﻄ‬ ‫ﻮﺿ‬ ‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺋﻲ‬ ‫ﺎ‬
‫ﺃﺧﺼ‬
.‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺒﻞﻗﺴﻢ‬ ‫ﺎﻣﻦﻗ‬ ‫ﻬ‬‫ﻴ‬‫ﻜﻢﻓ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬
Nur si ngManagementoff ract ur e:
Nur si ngmanagementf orcl oseandopenf ract uresshoul dbedi ffer entiated.
Nur si ngAssessment :
Assessmentoft hef ract ur edar eai ncl udest hef ollowi ng:
A.Byper formi nganaccur atenur singassessmentonar egul arbasi s,the
nur singst affcanmanaget hepat ient '
spai nandpr ev entcompl icat i
ons.
B.Whenassessi ngapat ientwi thaf ract ure, checkt he" 5P' s" -
-pain, pul se, pal lor,
par est hesi a, andpar alysis.
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻳ ﺾﻋﻼﺝ‬ ‫ﺮ‬‫ﻤ‬‫ﺗ‬
.‫ﺔ‬‫ﻮﺣ‬ ‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻘ‬‫ﻠ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﻴﻦﺇ‬ ‫ﺰﺑ‬‫ﻴ‬‫ﻴ‬‫ﻤ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺠﺐ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬ ‫ﻴﻢ‬‫ﻴ‬ ‫ﻘ‬
‫ﺗ‬
:
‫ﻠﻲ‬ ‫ﺎﻳ‬‫ﺓﻣ‬ ‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬ ‫ﻤﻞﺗ‬ ‫ﻳﺸ‬
‫ﻡ‬‫ﻣﺁﻻ‬‫ﻣﻞ ﻊ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻗﻢ‬‫ﺎ‬‫ﻟﻄ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬، ‫ﺘﻈﻢ‬ ‫ﻨ‬‫ﺎﺱﻣ‬ ‫ﺃﺳ‬ ‫ﻠﻰ‬ ‫ﻴﻖﻋ‬ ‫ﻗ‬‫ﻳﻀﻲﺩ‬ ‫ﺮ‬‫ﻤ‬‫ﻴﻢﺗ‬ ‫ﻴ‬‫ﻘ‬‫ﺀﺗ‬ ‫ﺍ‬‫ﺮ‬‫ﻣﻦﺧﻼﻝﺇﺟ‬: ‫ﺝ‬
.‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻠﻞ‬‫ﻟﺸ‬‫ﺍ‬‫ﻭ‬، ‫ﻤﻞ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬،‫ﻮﺏ‬ ‫ﻟﺸﺤ‬ ‫ﺍ‬،‫ﺒﺾ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬،‫ﻟ‬‫ﺍﻷﻢ‬ -" P's5"‫ﻓﺤ ﺺ‬ ‫ﺍ‬ ،‫ﺮ‬‫ﻜﺴ‬ ‫ﺎﺏﺑ‬ ‫ﻳ ﺾﻣﺼ‬ ‫ﺮ‬‫ﻴﻢﻣ‬ ‫ﻴ‬‫ﻘ‬‫ﺪﺗ‬ ‫ﻨ‬‫ﻋ‬. ‫ﺏ‬
(1)Pai n.Det er minewher et hepai ni slocat edandi fi tiswor seorbet t
er ?
Wor seni ngpai nmayi ndi cat ei ncr easededema, l
ackofadequat ebl oodsuppl y,
ort issuedamage.
(2)Pul se.Checkt heper ipher al pul ses, especi allyt hosedi st al t
ot hef ract ure
site.Compar eall pul seswi tht hoseont heunaf fect edsi de.Pul sesshoul dbe
strongandequal .
(3)Pal lor.Obser v et hecol orandt emper atureoft heski n, especi allyar oundt he
fract uresi te.Per formt hecapi ll
ar yr efill(blanchi ng)t est .
(4)Par esthesi a.Exami net hei nj uredar eaf ori ncr easeordecr easei nsensat ion.
Cant hepat ientdet ectt act i
lest i
mul at i
on
suchasabl untt ouchorashar ppi npr i
ck?Doest hepat ientcompl ainof
numbnessort ingling?
(5)Par alysis.Checkt hepat ient '
smobi li
ty.Canhewi ggl ehi st oesandf inger s?
Canhemov ehi sext remi ties?
‫ﻘﺺ‬ ‫ﻭﻧ‬ ‫ﺃ‬ ‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬ ‫ﻗﻢﺇ‬ ‫ﺎ‬‫ﻔ‬‫ﺘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻟﻢ‬‫ﺍﻷ‬ ‫ﺮ‬‫ﻴ‬‫ﺪﻳﺸ‬ ‫؟ﻗ‬ ‫ﻓﻀﻞ‬ ‫ﺃ‬ ‫ﻡ‬‫ﺃ‬ ‫ﺃ‬
‫ﻮ‬ ‫ﺃﺳ‬ ‫ﻮ‬‫ﻟﻢﻭﻫﻞﻫ‬ ‫ﺍﻷ‬‫ﺎﻥ‬‫ﻜ‬ ‫ﺪﻣ‬ ‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬. ‫ﻟﻢ‬ ‫ﺍﻷ‬ (1)
.‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻠﻒ‬ ‫ﻭﺗ‬‫ﺃ‬ ‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻣ‬‫ﺇ‬
‫ﻊ‬ ‫ﺎﺕﻣ‬ ‫ﺒﻀ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻴ‬
‫ﻤ‬‫ﺭﻥﺟ‬ ‫ﺎ‬‫ﻗ‬. ‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻗ‬‫ﻮ‬ ‫ﺓﻋﻦﻣ‬ ‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻚ‬‫ﺔﺗ‬ً‫ﺎﺻ‬ ‫ﺧ‬، ‫ﺔ‬ ‫ﻴ‬‫ﻴﻄ‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﺒﻀ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬ ‫ﺍ‬.‫ﺔ‬ ‫ﺒﻀ‬ ‫(ﻧ‬ 2)

25
 .‫ﺔ‬
‫ﻳ‬‫ﻭ‬‫ﺎ‬‫ﺘﺴ‬‫ﻣ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻮﻝﻗ‬‫ﻘ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺃﻥﺗ‬‫ﻳﺠﺐ‬. ‫ﻴﻢ‬‫ﻠ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻧﺐ‬‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻚ‬‫ﺗ‬
‫ﺀ‬
‫ﻤﻞ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﺭﺇﻋ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬
‫ﺍﺧ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺈﺟ‬
‫ﻗﻢﺑ‬.‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻮﻝﻣ‬ ‫ﺔﺣ‬‫ﺎﺻ‬ ‫ﺧ‬، ‫ﻪ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﺩ‬‫ﺪﻭ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻟ‬‫ﻗﺐ‬‫ﺍ‬‫ﺭ‬.
‫ﻮﺏ‬ ‫(ﺷﺤ‬ 3)
.(‫ﻠﻖ‬
‫ﻟﺴ‬‫ﺍ‬)‫ﺮﻱ‬‫ﻌ‬‫ﻟﺸ‬
‫ﺍ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬
‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻑ‬‫ﺘﺸ‬‫ﻛ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻴ‬‫ﺘﻄ‬‫ﻫﻞﻳﺴ‬. ‫ﺎﺱ‬ ‫ﺍﻹﺣﺴ‬‫ﺎﻥ‬‫ﻘﺼ‬‫ﻭﻧ‬‫ﺃ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺰ‬‫ﻟ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻓﺤ ﺺ‬‫ﺍ‬.‫ﻤﻞ‬‫ﻨ‬
‫(ﺗ‬4)
‫ﻤﺴﻲ‬ ‫ﻠ‬
‫ﻟ‬
‫ﺍ‬
‫؟‬
‫ﺰ‬‫ﻭﻭﺧ‬ ‫ﺃ‬‫ﻴﻞ‬‫ﻤ‬‫ﻨ‬
‫ﻳ ﺾﻣﻦﺗ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻜ‬‫ﺣ؟ﻫﻞﻳﺸ‬‫ﺩ‬
‫ﺓﺎ‬ ‫ﺮ‬‫ﺑ‬
‫ﺰﺇ‬‫ﻭﻭﺧ‬‫ﺃ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﺔﺣ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺜﻞ‬‫ﻣ‬
‫؟ﻫﻞ‬ ‫ﻪ‬‫ﻌ‬
‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬‫ﻪﻭ‬‫ﻳ‬
‫ﺪ‬‫ﻊﻳ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﺰ‬‫ﻬ‬‫ﺃﻥﻳ‬‫ﻊ‬‫ﻴ‬
‫ﺘﻄ‬ ‫ﻫﻞﻳﺴ‬.‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬
‫ﻘﻖﻣﻦﻗ‬ ‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬.‫ﻠﻞ‬‫ﻟﺸ‬
‫ﺍ‬(5)
‫؟‬‫ﻪ‬‫ﻓ‬‫ﺍ‬
‫ﺮ‬‫ﺃﻃ‬‫ﻳﻚ‬‫ﺮ‬‫ﻊﺗﺤ‬‫ﻴ‬‫ﺘﻄ‬‫ﻳﺴ‬

Nur singDi agnosi s:

Basedont heassessmentdat agat her ed, thenur singdi agnosesdev eloped
i
ncl ude:
Acut epai nr elatedt of racture, sof ttissuei njury,andmuscl espasm.
I
mpai redphy sicalmobi l
it
yr elat edt of racture.
Riskf orinfect ionr elatedt oopeni ngi nt heski ninanopenf ract ure.
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
:
‫ﻠﻲ‬ ‫ﺎﻳ‬‫ﺓﻣ‬ ‫ﺭ‬‫ﻮ‬‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬، ‫ﺎ‬‫ﻬ‬‫ﻌ‬‫ﻤ‬‫ﺘﻲﺗﻢﺟ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﻠﻰﺑ‬‫ﺀﻋ‬ً‫ﺎ‬
‫ﻨ‬‫ﺑ‬
.
‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻨﺞ‬‫ﺗﺸ‬ ‫ﺓﻭ‬ ‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬ ‫ﺭﻭ‬‫ﻮ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺎ‬
‫ﻠﻖﺑ‬ ‫ﻌ‬‫ﺘ‬‫ﺩﻣ‬‫ﺎ‬‫ﻟﻢﺣ‬ ‫•ﺃ‬
.
‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﺒﻄ‬ ‫ﺗ‬‫ﺮ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺔﺣ‬ ‫ﻗ‬
‫ﺎ‬‫ﻋ‬ ‫•ﺇ‬
.
‫ﻮﺡ‬ ‫ﺘ‬‫ﻔ‬‫ﺮﻣ‬ ‫ﺪﻓﻲﻛﺴ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺘﺢ‬ ‫ﻔ‬
‫ﺔﺑ‬ ‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﻭﻯﻣ‬ ‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫•ﺧﻄ‬
Planni ng&Goal s:
Planni ngandgoal sdev elopedf orapat i
entwi thfract ureare:
Reli
efofpai n.
Achiev eapai n-free,funct i
onal , andst abl ebodypar t
.
Maint ainasepsi s.
Maint ainv i
tal signswi t
hinnor mal range.
Exhibitnoev idenceofcompl i
cat i
ons.
:‫ﺍﻑ‬‫ﺪ‬ ‫ﺍﻷﻫ‬‫ﻴﻂﻭ‬ ‫ﺘﺨﻄ‬‫ﻟ‬‫ﺍ‬
:‫ﻫ‬
‫ﺮ ﻲ‬ ‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻮﻋ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻑ‬‫ﺪ‬ ‫ﺍﻷﻫ‬‫ﻴﻂﻭ‬ ‫ﺘﺨﻄ‬‫ﻟ‬‫ﺍ‬
.‫ﻡ‬‫ﺍﻵﻻ‬ ‫ﻴﻦ‬‫ﻜ‬‫• ﺗﺴ‬
.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬ ‫ﻟﻢﻣﻦ‬‫ﻣﺍﻷ‬
‫ﻝﻦ‬ ٍ‫ﺎ‬‫ﺎﻝﻭﺧ‬ ‫ﻌ‬‫ﻓ‬‫ﺮﻭ‬ ‫ﻘ‬‫ﺘ‬‫ﺀﻣﺴ‬ ‫ﺰ‬‫ﻴﻖﺟ‬ ‫ﻘ‬‫• ﺗﺤ‬
.‫ﻘﻢ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫•ﺍ‬
.‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻦ‬ ‫ﺔﺿ‬ ‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬ ‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫•ﺍ‬
.
‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﻠﻰﺣ‬ ‫ﻴﻞﻋ‬ ‫ﻟ‬‫ﺃﻱﺩ‬ ‫ﺮﺽ‬ ‫ﻌ‬
‫• ﻻﺗ‬
Nur singI ntervent ions:
Nur si
ngcar eofapat i
entwi thf ract ur eincl ude:
Thenur seshoul di nstructthepat ientr egar di
ngpr opermet hodst ocont r
ol
edemaandpai n.
I
tisi mpor tantt ot eachexer cisest omai ntaintheheal thoft heunaf fected
muscl esandt oi ncreaset hest rengt hofmuscl esneededf ort ransf erringand
forusi ngassi st i
v edev ices.
Plansar emadet ohel pt hepat ient smodi f
ythehomeenv i
ronmentt opr omot e
safetysuchasr emov inganyobst ructioni nt hewal ki
ngpat hsar oundt hehouse.
Woundmanagement .Woundi rrigationanddebr i
dementar ei niti
atedassoon
aspossi ble.
Elevateext remi ty.Theaf f
ect edext remi tyiselev atedt omi nimi zeedema.
Signsofi nfect i
on.Thepat ientmustbeassessedf orpr esenceofsi gnsand
sympt omsofi nfection.

26
 ‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﻠﻲ‬‫ﺎﻳ‬‫ﺮﻣ‬‫ﻜﺴ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬
‫‪.‬‬‫ﻟﻢ‬‫ﺍﻷ‬
‫ﺔﻭ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬‫ﻠﺴ‬‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬ ‫ﻟﻄ‬
‫ﺎ‬‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬
‫ﺎﻳ‬‫ﻤ‬‫ﻴ‬‫ﻳ ﺾﻓ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﺭﺷ‬‫ﺔﺇ‬‫ﺮﺿ‬‫ﻤ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫•ﻳﺠﺐﻋ‬
‫ﻘﻞ‬
‫ﻨ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﺍﻼ‬‫ﻌﻀﻼﺕﻟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﺓﻗ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬‫ﻟ‬
‫ﺔﻭ‬ ‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻌﻀﻼﺕﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠﻰ ﺻﺤ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬‫ﻬﻢﺗ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫•ﻣﻦ‬
‫‪.‬‬‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺍﻷﺟ‬ ‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﻭﻻﺳ‬
‫ﺋﻖﻓﻲ‬‫ﺎ‬‫ﺃﻱﻋ‬‫ﺔ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺜﻞﺇ‬‫ﻼﺔﻣ‬
‫ﻟﺴ ﻣ‬‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺰﻝ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺌ‬
‫ﻴ‬‫ﻳﻞﺑ‬‫ﺪ‬‫ﻌ‬‫ﻠﻰﺗ‬‫ﺮﺿﻰﻋ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺪ‬‫ﺎﻋ‬
‫ﻤﺴ‬‫ﻟ‬‫ﻟﺨﻄﻂ‬ ‫ﺍ‬‫ﻊ‬‫•ﻢﻭﺿ‬‫ﺗ‬
‫‪.‬‬‫ﺰﻝ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻤﺸﻲﺣ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﻣﺴ‬
‫‪.‬‬
‫ﻜﻦ‬‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬‫ﺃﺳ‬ ‫ﺎﻓﻲ‬‫ﺮﻫ‬‫ﻴ‬‫ﻨﻀ‬‫ﺗ‬‫ﻭﺡﻭ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺀﻓﻲﺭﻱ‬ ‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫•ﺇ‬
‫‪.‬‬
‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺎﺏ‬ ‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﻓ‬‫ﺘﻢﺭ‬‫‪.‬ﻳ‬‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻊ‬‫ﻓ‬‫ﺭ‬‫•ﺍ‬
‫‪.‬‬
‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺃ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﺩﻋﻼ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫‪.‬ﻳﺠﺐﺗ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺎﺕ‬‫ﻣ‬‫• ﻋﻼ‬

‫‪Ev‬‬ ‫‪al‬‬
‫‪uat‬‬ ‫‪i‬‬
‫‪on‬‬
‫‪Thef‬‬ ‫‪ol‬‬‫‪l‬‬‫‪owi‬‬ ‫‪ngshoul‬‬ ‫‪dbeev‬‬ ‫‪al‬‬‫‪uat‬‬ ‫‪edf‬‬ ‫‪orasuccessf‬‬ ‫‪ul‬‬‫‪i‬‬‫‪mpl‬‬‫‪ement‬‬ ‫‪at‬‬ ‫‪i‬‬
‫‪onoft‬‬ ‫‪hecar‬‬ ‫‪e‬‬
‫‪pl‬‬‫‪an.‬‬
‫‪‬‬‫‪‬‬
‫‪Pai‬‬ ‫‪nwasr‬‬ ‫‪el‬‬
‫‪i‬‬‫‪ev‬‬‫‪ed.‬‬
‫‪‬‬‫‪‬‬
‫‪Achi‬‬ ‫‪ev‬‬ ‫‪edapai‬‬ ‫‪n-‬‬‫‪f‬‬‫‪r‬‬‫‪ee,‬‬‫‪f‬‬
‫‪unct‬‬ ‫‪i‬‬
‫‪onal‬‬ ‫‪,‬‬ ‫‪andst‬‬ ‫‪abl‬‬‫‪ebodypar‬‬ ‫‪t‬‬‫‪.‬‬
‫‪‬‬‫‪‬‬
‫‪Mai‬‬ ‫‪nt‬‬‫‪ai‬‬ ‫‪nedasepsi‬‬ ‫‪s.‬‬
‫‪‬‬‫‪‬‬
‫‪Mai‬‬ ‫‪nt‬‬‫‪ai‬‬ ‫‪nedv‬‬ ‫‪i‬‬‫‪t‬‬
‫‪al‬‬ ‫‪si‬‬‫‪gnswi‬‬ ‫‪t‬‬‫‪hi‬‬‫‪nnor‬‬ ‫‪mal‬‬ ‫‪r‬‬‫‪ange.‬‬
‫‪‬‬‫‪‬‬
‫‪Exhi‬‬ ‫‪bi‬‬‫‪t‬‬‫‪ednoev‬‬ ‫‪i‬‬‫‪denceofcompl‬‬ ‫‪i‬‬‫‪cat‬‬ ‫‪i‬‬‫‪ons.‬‬
‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
‫‪.‬‬‫ﺔ‬ ‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟﺨﻄ‬ ‫ﺎﺟﺢ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺬ‬
‫ﻴ‬‫ﻔ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺃﺟﻞ‬ ‫ﻠﻲﻣﻦ‬ ‫ﺎﻳ‬‫ﻴﻢﻣ‬ ‫ﻴ‬‫ﻘ‬
‫ﻳﺠﺐﺗ‬
‫‪.‬‬
‫ﻟﻢ‬‫ﺍﻷ‬‫ﻴﻒ‬ ‫ﻔ‬‫•ﻢﺗﺨ‬‫ﺗ‬
‫‪.‬‬‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﻣﺴ‬ ‫‪،‬ﻭ‬ ‫ﻔﻲ‬‫ﻴ‬‫ﻟ‪،‬ﻭﻇ‬‫ﻣﺍﻷﻢ‬‫ﻝﻦ‬ ‫ﺎٍ‬‫ﻟﺠﺴﻢﺧ‬ ‫ﺍ‬
‫ﺀﻣﻦ‬ ‫ﺰ‬‫ﻴﻖﺟ‬ ‫ﻘ‬‫• ﺗﺤ‬
‫‪.‬‬‫ﺋﻢ‬‫ﺍ‬
‫ﻴﻢﺩ‬‫ﻘ‬ ‫ﻌ‬‫•ﺗ‬
‫‪.‬‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻦ‬ ‫ﺔﺿ‬ ‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬ ‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﻓﻈﺖﻋ‬ ‫ﺎ‬‫• ﺣ‬
‫‪.‬‬
‫ﺎﺕ‬ ‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﻠﻰﺣ‬ ‫ﻴﻞﻋ‬ ‫ﻟ‬
‫ﺃﻱﺩ‬ ‫ﺮ‬‫ﻬ‬‫•ﻢﺗﻈ‬‫ﻟ‬
‫‪Di‬‬‫‪schar‬‬ ‫‪geandHomeCar‬‬ ‫‪eGui‬‬ ‫‪del‬‬ ‫‪i‬‬‫‪nes‬‬
‫‪Af‬‬‫‪t‬‬‫‪ercompl‬‬ ‫‪et‬‬
‫‪i‬‬‫‪onoft‬‬ ‫‪hehomecar‬‬ ‫‪ei‬‬ ‫‪nst‬‬ ‫‪r‬‬
‫‪uct‬‬ ‫‪i‬‬‫‪ons,‬‬ ‫‪t‬‬‫‪hepat‬‬‫‪i‬‬‫‪entorcar‬‬ ‫‪egi‬‬ ‫‪v‬‬‫‪erwi‬‬‫‪l‬‬‫‪l‬‬‫‪be‬‬
‫‪abl‬‬‫‪et‬‬‫‪o:‬‬
‫‪‬‬‫‪‬‬
‫‪Cont‬‬ ‫‪r‬‬
‫‪olswel‬‬ ‫‪l‬‬‫‪i‬‬
‫‪ngandpai‬‬ ‫‪n.Descr‬‬ ‫‪i‬‬‫‪beappr‬‬ ‫‪oachest‬‬ ‫‪or‬‬‫‪educeswel‬‬ ‫‪l‬‬‫‪i‬‬
‫‪ngandpai‬‬ ‫‪n‬‬
‫‪suchasel‬‬ ‫‪ev‬‬‫‪at‬‬‫‪i‬‬
‫‪ngt‬‬ ‫‪heext‬‬ ‫‪r‬‬
‫‪emi‬‬ ‫‪t‬‬‫‪yandt‬‬ ‫‪aki‬‬ ‫‪nganal‬‬ ‫‪gesi‬‬‫‪csaspr‬‬ ‫‪escr‬‬ ‫‪i‬‬
‫‪bed.‬‬
‫‪‬‬‫‪‬‬
‫‪Car‬‬ ‫‪eoft‬‬ ‫‪heaf‬‬ ‫‪f‬‬‫‪ect‬‬ ‫‪edar‬‬‫‪ea.‬‬
‫‪Consumedi‬‬ ‫‪ett‬‬‫‪opr‬‬ ‫‪omot‬‬ ‫‪eboneheal‬‬ ‫‪i‬‬‫‪ng.‬‬
‫‪‬‬‫‪‬‬
‫‪Mobi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬‫‪yai‬‬ ‫‪ds.Demonst‬‬ ‫‪r‬‬
‫‪at‬‬ ‫‪euseofmobi‬‬ ‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪yai‬‬‫‪dsandassi‬‬ ‫‪st‬‬‫‪i‬‬
‫‪v‬‬ ‫‪edev‬‬ ‫‪i‬‬‫‪cessaf‬‬ ‫‪el‬‬ ‫‪y‬‬‫‪.‬‬
‫‪‬‬‫‪‬‬
‫‪Av‬‬ ‫‪oi‬‬‫‪dexcessi‬‬ ‫‪v‬‬‫‪euseofi‬‬ ‫‪nj‬‬ ‫‪ur‬‬‫‪edext‬‬ ‫‪r‬‬‫‪emi‬‬ ‫‪t‬‬‫‪yandobser‬‬ ‫‪v‬‬‫‪ewei‬‬ ‫‪ght‬‬‫‪-‬‬‫‪bear‬‬ ‫‪i‬‬
‫‪ngl‬‬ ‫‪i‬‬
‫‪mi‬‬ ‫‪t‬‬‫‪s.‬‬
‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﺰ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺝﻭ‬ ‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬‫ﺇ‬
‫ﻣ‪:‬‬
‫ﺔﻦ‬ ‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻭﻣ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬‫‪،‬ﺳ‬ ‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﺰ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻤ‬
‫ﻴ‬‫ﻠ‬‫ﻌ‬‫ﺀﻣﻦﺗ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬ ‫ﺪ‬
‫ﻌ‬‫ﺑ‬
‫ﺎﺕ‬‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺗ‬‫ﺍﻑﻭ‬ ‫ﺮ‬‫ﺍﻷﻃ‬‫ﻊ‬ ‫ﻓ‬
‫ﺜﻞﺭ‬ ‫ﻟﻢﻣ‬ ‫ﺍﻷ‬‫ﻡﻭ‬ ‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺮﻕﺗ‬‫‪.‬ﻭﺻﻒﻃ‬ ‫ﻟﻢ‬
‫ﺍﻷ‬‫ﻡﻭ‬ ‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬‫ﻟﺴ‬ ‫•ﺍ‬
‫‪.‬‬‫ﻮﻑ‬ ‫ﻮﺻ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬
‫‪.‬‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫• ﺭﻋ‬
‫‪.‬‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﻠﻚ‬ ‫ﻬ‬
‫ﺘ‬‫ﺍﺳ‬
‫ﺓ‬‫ﺪ‬
‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺍﻷﺟ‬‫ﺔﻭ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺓﻋ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬ ‫ﺎ‬‫ﻮﺳ‬ ‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺮﺡ‬‫‪.‬ﺷ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫• ﻭﺳ‬
‫‪.‬‬‫ﺎﻥ‬‫ﻣ‬‫ﺄ‬
‫ﺑ‬
‫‪.‬‬
‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺩﺗﺤ‬ ‫ﻭ‬ ‫ﺪ‬‫ﺓﺣ‬ ‫ﺎ‬‫ﺍﻋ‬‫ﺮ‬
‫ﻣ‬ ‫ﺔﻭ‬‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺮ‬‫ﻟﻸﻃ‬‫ﺮﻁ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﻻﺳ‬ ‫ﻨﺐ‬ ‫•ﺗﺠ‬

‫‪Document‬‬
‫‪at‬‬‫‪i‬‬
‫‪onGui‬‬
‫‪del‬‬
‫‪i‬‬‫‪nesf‬‬
‫‪orf‬‬
‫‪r‬‬‫‪act‬‬
‫‪ur‬‬‫‪emanagement‬‬
‫‪:‬‬

‫‪27‬‬
Thef ocusofdocument ati
onshoul dinclude:

Pat i
ent’sdescr i
pti
onofr esponset opainandaccept ablelev elofpai n.

Priormedi cat i
onuse.

Lev eloffunct i
on.

Abilit
yt opar t
ici
pateinspeci f
icordesi redactivit
ies.

Signsandsy mptomsofi nfectiouspr ocess.

Wound/i ncisionsite.

Planofcar e.

Teachi ngpl an.

Responset oi nt
erventi
ons,teachi ng,andact i
onsper formed.

Attainmentorpr ogresstowar ddesi redoutcomes.

Modi fi
cationst oplanofcar e.

Longt erm needs.
:
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﻴﻖﻹ‬ ‫ﺛ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬‫ﺇ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬‫ﻴﻖﻣ‬‫ﺛ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺰﻓﻲ‬ ‫ﻴ‬‫ﻛ‬
‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻞ‬‫ﺃﻥﻳﺸ‬ ‫ﻳﺠﺐ‬
.‫ﻮﻝ‬‫ﺒ‬‫ﻘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻢ‬‫ﺍﻷ‬‫ﻮﻯ‬‫ﺘ‬‫ﻣﺴ‬‫ﻟﻢﻭ‬‫ﻟﻸ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﻟﻼﺳ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫•ﻭﺻﻒ‬
.‫ﺒﻞ‬‫ﺔﻗ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫• ﺍﺳ‬
.
‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬
‫•ﻣﺴ‬
.‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﺮﻏ‬‫ﻭﻣ‬‫ﺃ‬‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﺔﻣﺤ‬ ‫ﻧﺸﻄ‬‫ﺃ‬‫ﺔﻓﻲ‬ ‫ﻛ‬
‫ﺭ‬‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫•ﺍ‬
.
‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫• ﻋﻼ‬
.
‫ﻟﺸﻖ‬ ‫ﺍ‬/‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫•ﻣ‬
.
‫ﺔ‬‫ﻳ‬ ‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫• ﺧﻄ‬
.‫ﻳﺲ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫• ﺧﻄ‬
.
‫ﺎ‬‫ﺬﻫ‬‫ﻴ‬‫ﻔ‬‫ﻨ‬‫ﺘﻢﺗ‬‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬‫ﻭ‬،‫ﻳﺲ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫• ﺍﻻﺳ‬
.‫ﺓ‬‫ﻮ‬‫ﺮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬ ‫ﻡﻧﺤ‬ ‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻞ‬‫ﺘﺤﺼ‬ ‫ﻟ‬‫•ﺍ‬
.
‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠﻰﺧﻄ‬ ‫ﻳﻼﺕﻋ‬ ‫ﺪ‬‫ﻌ‬‫•ﺗ‬
.‫ﺟ‬
‫ﺍﻷ ﻞ‬‫ﺔ‬‫ﻠ‬‫ﻳ‬‫ﻮ‬‫ﺎﺕﻃ‬ ‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬•

28
 Fr
act
urecompl
icat
ions

Learni
ngobj ectives:
Attheendoft hi
sl ect
ure,thestudentwi ll
beabl et
o:
1.Describet ypesoff racturecompl i
cati
ons.
2.I
dent i
fyriskf actorsoff r
acturecompl i
cati
ons.
3.I
dent i
fylocal andsy stemi cli
fethreat
eningfract
urecompli
cat
ions
4.I
dent i
fythesi gnsandsy mpt omsf orlocalandsyst
emicli
fe
thr
eateningf racturecompl icati
ons.
5.Describet henur sesrolepr eventi
onandmanagementoff ract
ure
complicati
ons.
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻜﻦ‬ ‫ﻤ‬
‫ﺘ‬‫ﻴ‬‫ﺓﺳ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬ ‫ﻓﻲﻧ‬
.
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﺍﻉﻣﻀ‬ ‫ﻮ‬
‫ﻧ‬‫ﺃ‬‫ﻭﺻﻒ‬. 1
.
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺮ‬
‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﺪﻋ‬ ‫ﻳ‬‫ﺪ‬
‫ﺗﺤ‬. 2
‫ﻣﻲ‬ ‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬
‫ﻠﻲﻭ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬
‫ﺓﻋ‬ ‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬‫ﻬ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﻠﻰﻣﻀ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬.
3
.
‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬
‫ﻬ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬ ‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﺍ ﺽﻣﻀ‬ ‫ﺮ‬
‫ﻋ‬‫ﺃ‬‫ﺎﺕﻭ‬‫ﻣ‬
‫ﻠﻰﻋﻼ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬.
4
.
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﺓﻣﻀ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫ﺔﻭ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﻭﺻﻒﺩ‬. 5
Fr
act urecompl icati
ons
TypesofFr acturecompl i
cat i
ons:
I
.Ear l
ycompl icati
onsoffr acture:
Acutecompl icati
onsaregener all
ythoseoccur ri
ngasaresultofthe
i
niti
altraumaandi ncludeneur ov ascularandsoftti
ssuedamage,
bl
oodl ossandl ocali
zedcont ami nati
onandi nf
ecti
on.
I
I.Latecompl i
cati
onsoff ractures
Delayedcompl icat
ionsmayoccuraf tert r
eatmentorasaresul
tof
i
niti
altreat
mentandmayi ncludemal union,emboli
ccomplicat
ions,
osteomy el
it
isandl ossoffunct ion.
:
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬
‫ﺎ‬‫ﺍﻉﻣﻀ‬‫ﻮ‬
‫ﻧ‬‫ﺃ‬
:‫ﺮ‬‫ﻜﺴ‬‫ﻠ‬‫ﻟ‬
‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬
‫ﺍﻷ‬‫ﻠﻒ‬
‫ﻤﻞﺗ‬
‫ﺗﺸ‬‫ﺔﻭ‬
‫ﻴ‬‫ﻟ‬‫ﻭ‬
‫ﺍﻷ‬‫ﺔ‬
‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺔ‬‫ﻴﺠ‬
‫ﺘ‬‫ﺪﺙﻧ‬
‫ﺘﻲﺗﺤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻚ‬
‫ﻡﺗ‬‫ﺎ‬
‫ﻜﻞﻋ‬
‫ﺓﻫﻲﺑﺸ‬ ‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬

29
 .‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻌﻲﻭ‬ ‫ﻮﺿ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﺙ‬ ‫ﻠ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬ ‫ﺪ‬‫ﻘ‬‫ﻓ‬‫ﺓﻭ‬ ‫ﻮ‬‫ﺮﺧ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻭ‬
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻠ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﺄﺧ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬ ‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ .
‫ﺎ‬ً
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺛ‬
‫ﻭ‬، ‫ﻡ‬‫ﺎ‬‫ﺌ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﻡ‬‫ﺎ‬‫ﺌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺪﺗﺸ‬ ‫ﻗ‬‫ﻟﻲﻭ‬ ‫ﻭ‬‫ﺍﻷ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴﺠ‬‫ﺘ‬‫ﺝﻭﻧ‬‫ﻌﻼ ﺃ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺓﺑ‬‫ﺮ‬‫ﺄﺧ‬‫ﺘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺪﺙ‬ ‫ﺪﺗﺤ‬ ‫ﻗ‬
.‫ﺔ‬ ‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬‫ﻘﻲﻭ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬
Riskf act orsf orf ract ur ecompl icat ions:
Compl icat i
onscl ear lyv arywi t
hf r act uresi teandnat ureandwi thqual ityof
surger ybutmanyal sov arywi thpat ientat tri
but essuchasage, nut ri
ti
onal status,
smoki ngst at usandal cohol useandwi thpost -fractureact iviti
essuchas
i
mmobi lity.
Identifyt hemai nr i
skf act orsf orheal i
ngcompl i
cat ions( delay eduni on, non-
unionormal uni on) , regar dlessoff r actur esite, as:
1-Di abet es( ty pe1ort ype2) .
2-Useofnon- ster oi dal ant i
-i
nf lammat orydr ugs( NSAI Ds)wi thin12mont hs.
3-Ar ecentmot orv ehicl eacci dent( onemont horl esspr i
ortof r
act ure) .
4-Oest rogen- cont ai ninghor monet her apy( althought hismaybeapr ox yf or
osteopor osi s) .
Classi fi
cat ionofFr act ur ecompl icat ions:
Ear l
ycompl icat ionsoff ractur e:
Life-threat eni ngoff ract ur ecompl icat ions:
1.Pat i
ent swi thmul ti
pl er i
bf ract ur esmaydev eloppneumot hor ax ,fl
ail chest
andr espi rat or ycompr omi se.
2.Hi pf ract ur es, par ti
cul arlyinel der lypat ients, l
eadt ol ossofmobi li
tywhi ch
mayr esul tinpneumoni a, thromboembol i
cdi seaseorr habdomy olysis.
:
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻋ‬
‫ﺎ‬‫ﻬ‬‫ﻨ‬‫ﺪﻣ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬ ‫ﻜﻦ‬ ‫ﻟ‬، ‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﻮ‬‫ﻪﻭﺟ‬ ‫ﺘ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﺮﻭﻃ‬ ‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬ ‫ﻮ‬‫ﺘﻼﻑﻣ‬ ‫ﺎﺧ‬‫ﺍﺿﺢﺑ‬ ‫ﻜﻞﻭ‬ ‫ﺎﺕﺑﺸ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻒ‬‫ﺘ‬ ‫ﺗﺨ‬
‫ﻮﻝ‬ ‫ﻜﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲ‬ ‫ﻌ‬‫ﺗ‬‫ﻴﻦﻭ‬ ‫ﺪﺧ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬‫ﺔﻭﺣ‬ ‫ﻳ‬ ‫ﻭ‬
‫ﺬ‬ ‫ﻐ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﻭ‬‫ﻤ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺜﻞ‬‫ﻳ ﺾﻣ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻤ‬‫ﺘﻼﻑﺳ‬ ‫ﺎﺧ‬‫ﺎﺑ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬ ‫ﻠﻒ‬‫ﺘ‬‫ﻳﺨ‬
.
‫ﺔ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺜﻞﻋ‬ ‫ﺮﻣ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬ ‫ﺔﻣ‬ ‫ﻧﺸﻄ‬ ‫ﺃ‬‫ﻭ‬
‫ﺮ‬
‫ﻨﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻐﺾ‬ ‫ﺑ‬، (‫ﻡ‬‫ﺎ‬‫ﺌ‬‫ﺘ‬‫ﻟ‬‫ﺃﺍﻻ‬‫ﺩﻭ‬ ‫ﺎ‬
‫ﺗﺤ‬ ‫ﺍﻻ‬ ‫ﻡ‬‫ﺪ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﺍﻥ‬‫ﺮ‬ ‫ﺘ‬‫ﻗ‬‫ﺍﻻ‬ ‫ﺮ‬
‫ﺄﺧ‬ ‫ﺗ‬
)‫ﺀ‬ ‫ﺎ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬‫ﻮ‬‫ﺩﻋ‬ ‫ﺪ‬‫ﺣ‬
:
‫ﻟﻲ‬ ‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬، ‫ﺮ‬
‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻋﻦﻣ‬
.(2‫ﻮﻉ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬1
‫ﻮﻉ ﺃ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬)‫ﺮﻱ‬ ‫ﻜ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬- 1
.
‫ﺍ‬ً
‫ﺮ‬‫ﻬ‬‫ﺷ‬12‫(ﺧﻼﻝ‬ NSAI Ds)‫ﺔ‬ ‫ﻳ‬‫ﺪ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺏﻏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫ﻡﻣﻀ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ -2
.
(‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺒﻞ‬‫ﻗﻞﻗ‬ ‫ﺃ‬ ‫ﻭ‬‫ﺃ‬‫ﺮ‬‫ﻬ‬
‫ﻳﺚ)ﺷ‬ ‫ﺪ‬‫ﺓﺣ‬ ‫ﺭ‬‫ﺎ‬‫ﻴ‬‫ﺩﺙﺳ‬ ‫ﺎ‬‫ﺣ‬- 3
‫ﺔ‬‫ﺎﺷ‬‫ﻬﺸ‬ ‫ﻟ‬ ً‫ﻳﻼ‬ ‫ﺪ‬‫ﻮﻥﺑ‬ ‫ﻜ‬‫ﺪﻳ‬ ‫ﺍﻗ‬‫ﺬ‬‫ﺃﻥﻫ‬ ‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬‫ﺎ‬
‫ﺑ‬)‫ﻴﻦ‬ ‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﺍﻷﺳ‬ ‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﻮ‬‫ﻣ‬‫ﺮ‬‫ﻬ‬ ‫ﻟ‬
‫ﺎ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬ -4
.(‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﻴﻒﻣﻀ‬ ‫ﻨ‬‫ﺗﺼ‬
:‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬
:‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬ ‫ﻬ‬‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
‫ﺋﺐ‬ ‫ﺎ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺭ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺭﻭ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬ ‫ﺍﺡ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﺎﺳ‬ ‫ﻮﻥﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺪﻳﺼ‬ ‫ﺍﻷﺿﻼﻉﻗ‬ ‫ﺓﻓﻲ‬ ‫ﺩ‬‫ﺪ‬‫ﻌ‬ ‫ﺘ‬
‫ﺭﻣ‬ ‫ﻮ‬‫ﻮﻥﻣﻦﻛﺴ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ .1
.‫ﻔﺴﻲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﻠﻒﻓﻲ‬ ‫ﺗ‬‫ﻭ‬
‫ﻮﻱ‬ ‫ﺋ‬‫ﺎﺏﺭ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻰ‬‫ﺩﻱﺇ‬ ‫ﺆ‬ ‫ﺪﻳ‬ ‫ﺎﻗ‬ ‫ﻤ‬‫ﺔﻣ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﻥ‬ ‫ﺪ‬‫ﻘ‬ ‫ﻟﻰﻓ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺗ‬،‫ﻴﻦ‬ ‫ﻨ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﺔﻋ‬ ‫ﺎﺻ‬ ‫ﻭﺧ‬، ‫ﺭﻙ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻛﺴ‬. 2
.‫ﺍﺕ‬ ‫ﺪ‬‫ﻴ‬‫ﺑ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻧﺤﻼﻝ‬ ‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻠﻄﻲ‬ ‫ﺘﺠ‬ ‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬ ‫ﺍﻻ‬‫ﺮﺽ‬ ‫ﻭﻣ‬ ‫ﺃ‬
Lifet hreat eni ngl ocaloff ractur ecompl i
cat i
ons:
1.Vascul ari njur y :thesei ncl udev ascul ardamagesuchasdi srupt iont ot he
femor alar teryori tsmaj orbr ancesbyf emor al fracture, damaget ot hepel v i
c
arteriesbypel v i
cf ractur e.
2.Vi scer ali njur ycausi ngdamaget ost ructur essuchast hebr ain, l
ungor
bladder .
3.Damaget osur roundi ngt issue, ner v esorski n.
4.Haemar thr osi s.
5.WoundI nf ect i
on-mor ecommonf oropenf ract ures.

30
6.Compar t
mentsy ndrome(orVolkmann'sischaemi a).
7.Fr
acturebli
ster
s.
:‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬
‫ﺎﻋ‬ ‫ﻤﻀ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻬ‬
‫ﺗ‬
‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻧ‬
‫ﺎ‬‫ﺃﻏﺼ‬‫ﻭ‬‫ﺃ‬‫ﺬﻱ‬
‫ﻔﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺰﻕ‬‫ﻤ‬‫ﺜﻞﺗ‬‫ﺔﻣ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻠﻒ‬ ‫ﻤﻞﺗ‬‫ﺗﺸ‬‫ﻭ‬:‫ﺔ‬ ‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬.1
.
‫ﻮﺽ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺮ‬‫ﺒﺐﻛﺴ‬‫ﻮ ﺽﺑﺴ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻴﻦ‬‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻠﻒﺷ‬ ‫ﺗ‬‫ﻭ‬، ‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬‫ﺍ‬‫ﺮﻋﻈﻢ‬‫ﺒﺐﻛﺴ‬ ‫ﺑﺴ‬
.‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﻛﻞﻣ‬‫ﺎ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻒ‬ ‫ﺒﺐﻓﻲﺗ‬ ‫ﺘﺴ‬ ‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻟﺤﺸ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬.2
.‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺏ‬ ‫ﺃﺍﻷﻋﺼ‬
‫ﺔﻭ‬ ‫ﻴﻄ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻠﻒ‬‫ﺗ‬.3
.‫ﻔﺼﻞ‬‫ﺀﻣ‬ ‫ﺍ‬
‫ﺩ‬.4
.‫ﺔ‬
‫ﻮﺣ‬‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬ً
‫ﺎ‬‫ﻮﻋ‬‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬
-‫ﻭﺡ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻋ‬.5
.
(‫ﺎﻥ‬‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﻮ‬‫ﺔﻓ‬‫ﻳ‬‫ﻭ‬ ‫ﺮ‬
‫ﻘ ﺺﺗ‬ ‫ﻭﻧ‬‫ﺃ‬)‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬
‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺘ‬. 6
.‫ﺮ‬
‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺜ‬
‫ﺑ‬.7

Compar tmentsy ndr ome( orVol kmann' si schaemi a) :isacompl i

cat ioncaused
byi ncreasedpr essur ewi thinaconf inedmy of ascial spacer esultingi n
circulatorycompr omi se,ischemi aandi fnott reated, t
issuenecr osiscanoccur .
Pat hophy siol ogyofcompar tmentsy ndr ome:
Subsequentt issuedamagemayr esul tinper manentneur ol ogici njuryand
necr osisofmuscl e.Increasedi nternal pressur ewi t hinacompar tmentmaybe
causedbyswel li
ng, bleedi ngori ncreasedcapi ll
aryper meabi li
ty.whi leex ternal
compar tmentpr essur eiscausedbyper ipher al compr essi onsuchast ightcast s
ordr essings.
Managi ngofcompar tmentsy ndrome:
1.Ongoi ngpai nmanagementi salsocr uci al andmedi cati
onmaybeneededt o
treatanxi ety, whi chmaycompoundt hev asoconst riction.
2.Sur gical tr
eat mentconsi stsofr el
iev i
ngpr essur e, achiev edt hrough
fasciot omyf ori nternal compr essionori nt hecaseofexcessi veex ter nal
pressur e,bi valvingcast .
‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﻔ‬
‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬ ‫ﻴ‬
‫ﺍﺧﻞﺣ‬ ‫ﻐﻂﺩ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺓ‬
‫ﺩ‬ ‫ﺎ‬‫ﻳ‬‫ﺔﻋﻦﺯ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﺎﺕﻧ‬ ‫ﻔ‬‫ﻋ‬ ‫ﺎ‬‫ﻫﻲﻣﻀ‬: (
‫ﺎﻥ‬ ‫ﻤ‬ ‫ﻜ‬
‫ﻟ‬‫ﻮ‬‫ﺔﻓ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻘ ﺺﺗ‬ ‫ﻭﻧ‬ ‫ﺃ‬)‫ﺰ‬ ‫ﻴ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺘ‬
،‫ﺟ‬
‫ﺎ‬
‫ﺘﻢﻋﻼﻬ‬ ‫ﻟﻢﻳ‬ ‫ﺍ‬
‫ﺫ‬ ‫ﺇ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬ ‫ﻘﺺ‬ ‫ﻧ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰﺣﻞﻭﺳﻂﻓﻲ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﺭﻣ‬ ‫ﻮ‬ ‫ﻤﺤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻲ‬‫ﻌﻀ‬‫ﻟ‬‫ﺍ‬
.
‫ﺔ‬ ‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺮ‬‫ﺪﺙﻧﺨ‬ ‫ﺃﻥﻳﺤ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
:‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬ ‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬‫ﻮ‬‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﻲ‬‫ﺍﺧ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺘﺞ‬ ‫ﻨ‬‫ﺪﻳ‬‫ﻗ‬.‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻧﺨ‬‫ﺔﻭ‬ ‫ﻤ‬‫ﺋ‬‫ﺍ‬‫ﺔﺩ‬ ‫ﻴ‬‫ﺒ‬‫ﺔﻋﺼ‬ ‫ﺑ‬‫ﺎ‬‫ﻟﻰﺇﺻ‬ ‫ﺍﻼﺣﻖﺇ‬ ‫ﺔﻟ‬ ‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻠﻒ‬ ‫ﺩﻱﺗ‬ ‫ﺆ‬‫ﺪﻳ‬
‫ﻗ‬
‫ﻐﻂ‬ ‫ﺪﺙ ﺿ‬ ‫ﺎﻳﺤ‬ ‫ﻤ‬‫ﻨ‬‫ﻴ‬‫ﺑ‬،‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺫ‬‫ﺎ‬‫ﻔ‬‫ﺓﻧ‬ ‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻭﺯ‬ ‫ﺃ‬‫ﻳﻒ‬ ‫ﺰ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬
‫ﻡ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓﻋﻦ‬ ‫ﺮ‬‫ﺍﺧﻞﺣﺠ‬ ‫ﺪﺩ‬‫ﻳ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
.‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﻘ‬
‫ﻴ‬‫ﻟﻀ‬‫ﺍ‬ ‫ﻟﺐ‬‫ﺍ‬‫ﻮ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﻴﻄﻲﻣ‬ ‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬
‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺒﺐ‬ ‫ﺭﺟﻲﺑﺴ‬ ‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻟﺤﺠ‬‫ﺍ‬
:‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬‫ﺓﺘ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫ﺪ‬‫ﺎﻗ‬‫ﻤ‬‫ﻣ‬، ‫ﻠﻖ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻟﻼﺝ‬‫ﺔﻌ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻟﻰ‬‫ﺔﺇ‬ ‫ﺎﺟ‬‫ﺎﻙﺣ‬ ‫ﻨ‬‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫ﻗ‬‫ﺎﻭ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺎ‬
ً
‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬ ‫ﺍﺿ‬ ً
‫ﺮ‬‫ﻣ‬‫ﺃ‬‫ﺓ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻟﻢ‬‫ﺍﻷ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬ ‫ﺮﺇ‬‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﺗ‬.
1
.‫ﺔ‬
‫ﻴ‬ ‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻴﻖ‬‫ﻗﻢﺗﻀ‬ ‫ﺎ‬
‫ﻔ‬‫ﻟﻰﺗ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﻳ‬
‫ﻭ‬ ‫ﺃ‬‫ﻠﻲ‬‫ﺍﺧ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﻠﻀ‬ ‫ﻟ‬‫ﺔ‬‫ﻓ‬ ‫ﺎ‬
‫ﻔ‬ ‫ﻠ‬
‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻪﻣﻦﺧﻼﻝﺑﻀ‬ ‫ﻘ‬‫ﻴ‬
‫ﻘ‬‫ﺘﻢﺗﺤ‬ ‫ﻳ‬‫ﻭ‬، ‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﻴﻒ‬ ‫ﻔ‬‫ﺍﺣﻲﻣﻦﺗﺨ‬ ‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺘ‬‫ﻳ‬.
2
.
‫ﻴﻦ‬ ‫ﺍﻋ‬‫ﺭ‬‫ﻊﺫ‬ ‫ﺘﻢﻭﺿ‬ ‫ﻳ‬، ‫ﺮﻁ‬ ‫ﻔ‬
‫ﻤ‬ ‫ﻟ‬‫ﺍ‬‫ﺭﺟﻲ‬ ‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺣﺔ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬
Nur sesr oleofcompar tmentsy ndrome:
1.Nur sescandet ectcompar tmentsy ndromebyf r equentandr eliable
assessment .
−Pai nbey ondwhati sexpect ed, whichi snotr esponsi vet onar cot ics.
−I ntensifiedbypassi vest retchingandel ev at i
on, maybei ndicat i
v eof
compar tmentsy ndr ome.I nspect i
onoft heski nmaynot eshi ninessr elat edt o
i
ncr easedi nternal pressur e.

31
Ski ncol ormaypr ogr essf rom br ightpi nkdur ingt hei niti
al inf l
ammat oryphase−
toapal eandduskycol orwi thi ncr easedar terial compr ession.
:‫ﺰ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻣ‬ ‫ﺯ‬‫ﻣﻼ‬‫ﺎﺕﻓﻲ ﺘ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬ ‫ﺩ‬
.
‫ﻮﻕ‬ ‫ﺛ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻭ‬ ‫ﺮ‬‫ﻜ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺰﻣﻦﺧﻼﻝ‬ ‫ﻴ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻣ‬ ‫ﺯ‬
‫ﻣﻼ‬‫ﻜﺸﻒﻋﻦ ﺘ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬.1
.‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬‫ﻤﺨ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﻴﺐ‬ ‫ﺘﺠ‬ ‫ﻊﻭﻻﻳﺴ‬ ‫ﻗ‬‫ﻮ‬‫ﺘ‬ ‫ﻮﻣ‬ ‫ﺎﻫ‬ ‫ﺯﻣ‬ ‫ﻭ‬‫ﺎ‬‫ﺘﺠ‬ ‫ﻟﻢﻳ‬‫ﺃ‬-
‫ﺒﻂ‬ ‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥ‬‫ﻌ‬‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻗﻳﻼﺣﻆﻓﺤ ﺺ‬ ‫ﺪ‬. ‫ﺰ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬‫ﻠﻰ ﺘ‬ ‫ﺒﻲﻋ‬ ‫ﻠ‬
‫ﻟﺴ‬ ‫ﺍ‬
‫ﺎﻉ‬‫ﻔ‬ ‫ﺗ‬‫ﺭ‬‫ﺍﻻ‬‫ﺩﻭ‬ ‫ﺪ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬ ‫ﺪ‬‫ﺪﻝﺷ‬ ‫ﺪﺗ‬‫ﻗ‬-
.‫ﻠﻲ‬ ‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬‫ﺑ‬
‫ﻛﻦ‬ ‫ﺍ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺣﺐ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻠ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬ ‫ﺍﻷ‬ ‫ﺔ‬‫ﻴ‬‫ﺑ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺗﺢﺧﻼﻝ‬ ‫ﺎ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬ ‫ﺩﻱ‬‫ﺭ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬ ‫ﺪﻣﻦ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻟ‬‫ﺭ‬‫ﻮ‬‫ﺘﻄ‬ ‫ﺪﻳ‬‫ﻗ‬-
.‫ﻴﻦ‬ ‫ﻳ‬‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺎﻁ‬ ‫ﻐ‬‫ﻧﻀ‬ ‫ﺍ‬‫ﺓ‬‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫ﻊﺯ‬ ‫ﻣ‬
−Theski nbecomescol dt ot ouchandcapi llaryr ef il
l i
susual l
yl esst han3
seconds.
−Par est hesi ar elat edt oner v ecompr essioni mpl iesdecr easedneur ov ascul ar
funct ionandpai nisl ikelyt odecr easewi t
hpr ogr essi veinjury .
−Ser iousi njuryi si mmi nentwhenpul sesar enotpal pabl edueort hepat i
ent
showssi gnsofl i
mbpar aly sis.
2.Nur sescar ryoutpr escr ibedwoundcar e, moni t orandr epor tr edandwhi te
bloodcount saswel l asadmi nisterant ibioticst opr eventi nf ect ion.
3.Teachpat ientandt hei rcar egi ver sthei mpor tanceofmoni t
or ing.
4.Emot ional suppor tmayal soof f setsomeoft heanx ietyanddi scomf ort.
Fract ur ebl ister s.Thesear ear elat i
velyuncommoncompl icat ionoff r actur esin
areaswher eski nadher est ight l
yt obonewi thlittlei nter v
eni ngsof ttissue
cushi oni ng.Exampl esi ncludet heankl e, wrist,el bowandf oot .
.‫ﺍﻥ‬ ‫ﻮ‬‫ﺛ‬3‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬ ‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺮ‬‫ﻴ‬
‫ﻌ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﺒ‬
‫ﻌ‬ ‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬‫ﻮﻥﺇﻋ‬ ‫ﻜ‬‫ﺎﺗ‬ ‫ﺓﻣ‬‫ﺩ‬ ‫ﺎ‬
‫ﻋ‬‫ﻪﻭ‬ ‫ﻤﺴ‬ ‫ﻟ‬ ‫ﺪ‬‫ﻨ‬‫ﺍﻋ‬ ‫ﺩ‬‫ﺭ‬‫ﺎ‬‫ﺪﺑ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺒﺢ‬ ‫ﻳﺼ‬-
‫ﺍ‬‫ﻘﻞ‬‫ﺃﻥﻳ‬ ‫ﺮﺟﺢ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬ ‫ﺔﻭ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬ ‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬ ‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﺎ ﺽﻭﻇ‬ ‫ﻔ‬‫ﻧﺨ‬ ‫ﺍ‬ ‫ﻨﻲ‬‫ﻌ‬‫ﻌﺼﺐﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻐ‬ ‫ﻧﻀ‬ ‫ﺎ‬
‫ﺒﻂﺑ‬ ‫ﺗ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻤﻞ‬‫ﻨ‬‫ﺗ‬-
.‫ﺔ‬‫ﻴ‬‫ﻳﺠ‬ ‫ﺭ‬ ‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﻣﺍﻹﺻ‬ ‫ﻟﻢ ﻊ‬ ‫ﻷ‬
‫ﻠﻞ‬ ‫ﺎﺕﺷ‬ ‫ﻣ‬‫ﻳ ﺾﻋﻼ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻋ‬ ‫ﻬ‬‫ﻭﺗﻈ‬ ‫ﺃ‬ ‫ﺔ‬‫ﻮﺳ‬‫ﺎﺕﻣﺤﺴ‬ ‫ﺒﻀ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬ ‫ﺎﻻﺗ‬ ‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬ ‫ﻜ‬‫ﻴ‬‫ﺓﻭﺷ‬ ‫ﺮ‬‫ﻴ‬ ‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﺔ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﻮﻥ‬ ‫ﻜ‬‫ﺗ‬-
.‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻓﻲ‬
‫ﺎﻹ‬‫ﻴ ﺾﺑ‬ ‫ﺑ‬‫ﺍﻷ‬‫ﺮﻭ‬ ‫ﻤ‬
‫ﺍﻷﺣ‬ ‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬
‫ﺍ‬‫ﺪ‬ ‫ﻌ‬‫ﺎﻥﻋﻦﺗ‬ ‫ﻐ‬
‫ﻠ‬‫ﺒ‬‫ﻳ‬‫ﺎﻥﻭ‬ ‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻳ‬‫ﻭ‬، ‫ﻭﺡ‬ ‫ﺮ‬‫ﻠﺠ‬ ‫ﻟ‬‫ﺔ‬‫ﻓ‬‫ﻮ‬‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬ ‫ﻟ‬
‫ﺎ‬‫ﺎﺕﺑ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﻮ‬ ‫ﻘ‬
‫ﺗ‬.2
.‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬ ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬‫ﻋﻄ‬ ‫ﻟﻰﺇ‬ ‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬‫ﺿ‬
.‫ﺔ‬‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻤ‬‫ﺃﻫ‬ ‫ﻬﻢ‬‫ﺘ‬‫ﻳ‬‫ﺎ‬‫ﻠﻰﺭﻋ‬ ‫ﻴﻦﻋ‬ ‫ﻤ‬‫ﺋ‬‫ﺎ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬ ‫ﻠ‬‫ﻌ‬
‫ﺗ‬.3
.
‫ﺔ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻠﻖﻭﻋ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﺾ‬ ‫ﻔﻲﺑ‬ ‫ﺎﻃ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬‫ﺍ‬ ‫ﻔﻒ‬‫ﺪﻳﺨ‬ ‫ﻗ‬.4
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺎ‬‫ﺓﺑ‬ ‫ﺪ‬‫ﺪﺑﺸ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺎ‬
‫ﻬ‬ ‫ﻴ‬‫ﺘﺼﻖﻓ‬ ‫ﻠ‬‫ﺘﻲﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭﻓﻲ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻠ‬‫ﻟ‬‫ﺎ‬ً
‫ﻴ‬‫ﺒ‬‫ﺔﻧﺴ‬ ‫ﻌ‬‫ﺋ‬
‫ﺎ‬‫ﺮﺷ‬ ‫ﻴ‬‫ﺎﺕﻏ‬ ‫ﻔ‬‫ﻋ‬ ‫ﺎ‬‫ﻩﻣﻀ‬ ‫ﺬ‬ ‫ﻫ‬.‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺜ‬‫ﺑ‬
.‫ﻡ‬‫ﺪ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻉﻭ‬ ‫ﻜ‬ ‫ﻟ‬‫ﺍ‬
‫ﻌﺼﻢﻭ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺣﻞﻭ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺜ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﻤﻞ‬ ‫ﺗﺸ‬. ‫ﺓ‬‫ﻮ‬ ‫ﺮﺧ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺪ‬‫ﻴ‬‫ﻮﺳ‬ ‫ﻴﻞﻣﻦﺗ‬ ‫ﻠ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻣ‬
Riskf act orsofFr act urebl ist ers:
othert hansi te, i
ncl udeanycondi tionwhi chpr edi sposest opoorski nheal ing,
i
ncl udi ngdi abet es, hy per tensi on,smoki ng, excessal cohol andper ipher al
vascul ardi sease.
Lifet hr eat eningsy stemi ccompl icationsf orf ract ur e:
1.Exacer bat ionofunder ly i
ngdi seasessuchasdi abet esorcor onar yar tery
disease( CAD) .
2.Pneumoni a.
3.Shock: hemor r
hagi cmostcommonoccurt of ract uresoft hepel v i
s, long
bones&pol yt r
auma.
Signs&sy mpt omsf orshock:
-Firm, dist endedabdomenorex tremi tysof tti
ssue.
-Ext remeedema, tender ness, &Ecchy mosi sheart hesi t
eoft hei njury .
-Incr easei nhear t&r espir at oryrat eswi thdecr easei nBF.
-Pal lor&col d, clammyski n.
-Anxi ety, agitationorconf usi on.
:‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬ ‫ﺭ‬‫ﻮ‬‫ﺜ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻣﻞﺧﻄ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻋ‬

32
 ‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬ ‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﺮﻱﻭ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻟﻚﻣ‬ ‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫‪،‬ﺑ‬ ‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬ ‫ﺎ‬
‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬ ‫ﻟﻰ ﺿ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺣﺔﺗ‬
‫ﻟ‬‫ﺃﻱ ﺎ‬ ‫ﻤﻞ‬‫‪،‬ﺗﺸ‬ ‫ﻊ‬ ‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺑﺨﻼﻑ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬
‫ﺪﻭ‬ ‫ﺋ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﺪﺧ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫‪:‬‬‫ﺮ‬‫ﻜﺴ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻬ‬‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫(‬‫ﺎﺟﻲ)‪CAD‬‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺸ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻭﻣ‬‫ﺃ‬ ‫ﺮﻱ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﺜﻞﻣ‬ ‫ﺔﻣ‬‫ﻨ‬‫ﻣ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﻗﻢ‬‫ﺎ‬‫ﻔ‬‫‪.‬ﺗ‬‫‪1‬‬
‫‪.‬‬‫ﻮﻱ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫‪.‬‬‫‪2‬‬
‫‪.‬‬‫ﺩ‬‫ﺪ‬
‫ﻌ‬ ‫ﺘ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﺽ‬ ‫ﺮﺿ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻠ‬‫ﻳ‬‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻮ ﺽﻭ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬ ‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﻊ‬‫ﺋ‬‫ﺎ‬
‫ﻜﻞﺷ‬ ‫ﺪﺙﺑﺸ‬ ‫ﺔﺗﺤ‬ ‫ﻴ‬‫ﻓ‬‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫‪:‬‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫‪.‬‬‫‪3‬‬
‫‪:‬‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬ ‫ﻋﻼ‬
‫‪.‬‬‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺓﻓﻲ‬ ‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺃﺍﻷ‬
‫ﺔﻭ‬ ‫ﻔﺨ‬ ‫ﺘ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻜ‬ ‫ﺎﺳ‬‫ﻤ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻄﻦ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺃ‬
‫‪-‬‬
‫‪.‬‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺎﻥ‬‫ﻜ‬ ‫ﻊﻣ‬‫ﻤ‬‫ﺎﺕﺗﺴ‬ ‫ﻣ‬‫ﺪ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥﻭ‬‫ﻨ‬‫ﻟﺤ‬‫ﺍ‬‫ﺓﻭ‬ ‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺔ‬‫ﻣ‬ ‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫‪-‬‬
‫‪.‬‬
‫ﺎ ﺽﻓﻲ‪BF‬‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﻊ‬‫ﻔﺴﻲﻣ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺮ‬‫ﺪﻝ ﺿ‬ ‫ﻌ‬‫ﺓﻓﻲﻣ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫‪-‬ﺯ‬
‫‪.‬‬
‫ﺔ‬ ‫ﺒ‬
‫ﺓﺭﻃ‬ ‫ﺮ‬
‫ﺑﺸ‬ ‫ﺩﻭ‬ ‫ﺭ‬‫ﺎ‬‫ﺑ‬
‫ﻮﺏﻭ‬ ‫‪-‬ﺷﺤ‬
‫‪.‬‬‫ﺎﻙ‬ ‫ﺒ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺎﺝ‬‫ﻴ‬‫ﻭﻫ‬ ‫ﺃ‬ ‫ﻠﻖ‬‫‪-‬ﻗ‬
‫‪4.Fatembol‬‬ ‫‪i‬‬‫‪sm:mostcommonwi‬‬ ‫‪t‬‬‫‪hf‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪eofl‬‬ ‫‪ongbones,‬‬ ‫‪t‬‬‫‪heonsetof‬‬
‫‪sy‬‬‫‪mpt‬‬ ‫‪omsoccurwi‬‬ ‫‪t‬‬‫‪hi‬‬‫‪n24-27hour‬‬ ‫‪.‬‬
‫‪Si‬‬‫‪gns&sy‬‬ ‫‪mpt‬‬ ‫‪omsf‬‬ ‫‪orf‬‬‫‪atembol‬‬ ‫‪i‬‬
‫‪sm:‬‬
‫‪-Anxi‬‬ ‫‪et‬‬‫‪y‬‬‫‪,‬‬‫‪f‬‬‫‪eel‬‬‫‪i‬‬‫‪ngofi‬‬ ‫‪mpendi‬‬ ‫‪ngdoom,‬‬ ‫‪conf‬‬‫‪usi‬‬ ‫‪on.‬‬
‫‪PO2<60mm Hg.‬‬
‫‪-I‬‬‫‪ncr‬‬ ‫‪easedr‬‬ ‫‪espi‬‬ ‫‪r‬‬‫‪at‬‬
‫‪or‬‬ ‫‪yr‬‬‫‪at‬‬‫‪e.‬‬
‫‪-Shor‬‬ ‫‪t‬‬‫‪nessofbr‬‬ ‫‪eat‬‬‫‪h.‬‬
‫‪-Bl‬‬ ‫‪oodt‬‬ ‫‪i‬‬
‫‪ngedsput‬‬ ‫‪um.‬‬
‫‪-Chestpai‬‬ ‫‪n.‬‬
‫‪-Tachy‬‬ ‫‪car‬‬‫‪di‬‬‫‪a.‬‬
‫‪-Pet‬‬ ‫‪echi‬‬ ‫‪aeoft‬‬ ‫‪r‬‬‫‪unk,‬‬ ‫‪abdomen,‬‬ ‫‪scl‬‬‫‪er‬‬‫‪aorconj‬‬ ‫‪unct‬‬ ‫‪i‬‬
‫‪v‬‬‫‪a.‬‬
‫‪-Fev‬‬ ‫‪erofunknowncause.‬‬
‫‪5.Thr‬‬ ‫‪omboembol‬‬ ‫‪i‬‬
‫‪sm‬‬
‫‪Def‬‬ ‫‪i‬‬‫‪ni‬‬‫‪t‬‬‫‪i‬‬‫‪onoft‬‬ ‫‪hr‬‬ ‫‪omboembol‬‬ ‫‪i‬‬‫‪sm i‬‬‫‪sawi‬‬ ‫‪del‬‬‫‪yacknowl‬‬ ‫‪edgedcompl‬‬ ‫‪i‬‬
‫‪cat‬‬ ‫‪i‬‬‫‪onof‬‬
‫‪or‬‬‫‪t‬‬‫‪hopedi‬‬ ‫‪csur‬‬ ‫‪ger‬‬‫‪yandi‬‬ ‫‪ncl‬‬ ‫‪udesbot‬‬ ‫‪hdeepv‬‬ ‫‪ei‬‬‫‪nt‬‬‫‪hr‬‬‫‪ombosi‬‬ ‫‪sandpul‬‬ ‫‪monar‬‬ ‫‪y‬‬
‫‪embol‬‬ ‫‪i‬‬
‫‪sm.‬‬
‫‪.‬‬‫ﺔ‬‫ﺎﻋ‬‫ﻮﻥ‪27-24‬ﺳ‬ ‫ﺍ ﺽﻓﻲﻏﻀ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﺮ‬‫ﻬ‬‫‪،‬ﺗﻈ‬ ‫ﺔ‬‫ﻠ‬
‫ﻳ‬‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻊﻛﺴ‬ ‫ﺎﻣ‬‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬
‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬ ‫‪:‬‬‫ﻨﻲ‬‫ﺪﻫ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬‫ﻤ‬‫ﻧﺼ‬ ‫ﺍﻻ‬‫‪.‬‬‫‪4‬‬
‫‪:‬‬
‫ﻨﻲ‬ ‫ﺪﻫ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻤ‬ ‫ﻧﺼ‬‫ﺍﻻ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬ ‫ﻋﻼ‬
‫‪.‬‬
‫ﺎﻙ‬‫ﺒ‬
‫ﺗ‬‫ﺭ‬‫ﺍﻻ‬‫ﻴﻚﻭ‬ ‫ﻮﺷ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺑﻬﻼﻙ‬‫ﻟ‬
‫ﺭﺎ‬ ‫ﻮ‬‫ﻌ‬ ‫ﻟﺸ‬‫ﺍ‬
‫ﻠﻖﻭ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫‪-‬‬
‫‪.‬‬‫ﺒﻖ‬‫ﺋ‬‫ﻠﻢﺯ‬ ‫‪PO2<60‬ﻣ‬
‫‪.‬‬
‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬‫ﺓﻣ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫‪-‬ﺯ‬
‫‪.‬‬
‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻖﻓﻲ‬ ‫‪-‬ﺿ‬
‫‪.‬‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺎ‬
‫ﻮﺏﺑ‬ ‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻢ‬ ‫ﻠ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫‪-‬‬
‫ﺻ‪.‬‬
‫ﺭ‬
‫ﻟﻢ ﺪ‬ ‫ﺃ‬
‫‪-‬‬
‫‪.‬‬‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺮﻉ‬ ‫‪-‬ﺗﺴ‬
‫‪.‬‬
‫ﺔ‬‫ﻤ‬‫ﺘﺤ‬‫ﻠ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﺒ‬‫ﻠ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺒﻄﻦ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺬﻉ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﻤﺸ‬ ‫‪-‬ﻧ‬
‫‪.‬‬‫ﺒﺐ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻟ‬
‫ﻮ‬ ‫ﻬ‬‫ﻤﻰﻣﺠ‬ ‫‪-‬ﺣ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻠﻄ‬‫ﻟﺠ‬ ‫ﺍ‬‫‪.‬‬‫‪5‬‬
‫ﻤﻞﻛﻞ‬ ‫ﻳﺸ‬ ‫ﻡﻭ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟﺠ‬ ‫ﻊ‬‫ﺍﺳ‬‫ﺎﻕﻭ‬ ‫ﻠﻰﻧﻄ‬ ‫ﺎﻋ‬‫ﻬ‬‫ﺮﻑﺑ‬ ‫ﺘ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬
‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺪﺗ‬ ‫ﻌ‬
‫ﻳ‬
‫‪.‬‬‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬ ‫ﻧﺴ‬‫ﺍﻻ‬‫ﺔﻭ‬‫ﻘ‬ ‫ﻴ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﻠﻂ‬‫ﻣﻦﺗﺠ‬
‫‪Thr‬‬ ‫‪eef‬‬ ‫‪act‬‬‫‪or‬‬‫‪st‬‬ ‫‪hatcont‬‬ ‫‪r‬‬‫‪i‬‬‫‪but‬‬ ‫‪et‬‬‫‪ot‬‬ ‫‪hr‬‬‫‪omboembol‬‬ ‫‪i‬‬
‫‪sm:‬‬
‫‪1.v‬‬ ‫‪enousst‬‬ ‫‪asi‬‬‫‪s,‬‬
‫‪2.bl‬‬ ‫‪oodcoagul‬‬ ‫‪abi‬‬‫‪l‬‬
‫‪i‬‬‫‪t‬‬
‫‪y‬‬ ‫‪,‬‬
‫‪3.v‬‬ ‫‪essel‬‬ ‫‪wal‬‬ ‫‪l‬‬‫‪damage.‬‬
‫‪Ot‬‬‫‪herf‬‬ ‫‪act‬‬ ‫‪or‬‬‫‪scommonl‬‬ ‫‪yseeni‬‬ ‫‪nt‬‬ ‫‪heor‬‬ ‫‪t‬‬‫‪hopedi‬‬ ‫‪cpat‬‬‫‪i‬‬‫‪entpopu-‬‬
‫‪l‬‬
‫‪at‬‬ ‫‪i‬‬‫‪oni‬‬ ‫‪ncl‬‬‫‪ude:‬‬
‫(‬‫‪a)obesi‬‬ ‫‪t‬‬‫‪y‬‬‫‪,‬‬‫(‬‫‪b)l‬‬ ‫‪ackofmobi‬‬ ‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪y‬‬‫‪,‬‬‫(‬‫‪c)smoki‬‬ ‫‪ng,‬‬ ‫(‬‫‪d)chr‬‬‫‪oni‬‬‫‪chear‬‬ ‫‪tdi‬‬ ‫‪sease,‬‬ ‫(‪and‬‬ ‫)‪e‬‬
‫‪hor‬‬ ‫‪moner‬‬ ‫‪epl‬‬‫‪acement.‬‬

‫‪33‬‬
Sympt omsandsi gnsf orv enoust hromboembol i
sm:
Signsandsy mpt omsar edependentont hesi zeoft hecl ot.
1.Sy mpt omsi ncl udeer ythema, pai n, andt ender nessi nthecl ot
l
ocat i
onaswel last hi ghand/ orcal fswel li
ng.
2.Signsandsy mpt omsofpul monar yembol usi ncludedy spneaor
tachypnea, lowerar terial pr essur e, coughwi thhemopt ysis,
anxietyandr estlessness, chestpai n,andt achy cardia
:
‫ﺔ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻭﺙ‬ ‫ﺪ‬‫ﺎﻫﻢﻓﻲﺣ‬ ‫ﻣﻞﺗﺴ‬ ‫ﺍ‬‫ﻮ‬‫ﺔﻋ‬ ‫ﺛ‬‫ﺛﻼ‬
،‫ﺪﻱ‬ ‫ﻳ‬‫ﺭ‬‫ﺩﻭ‬ ‫ﻮ‬‫ﻛ‬‫ﺭ‬.1
،‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﺗﺨ‬. 2
.
‫ﺀ‬‫ﺎ‬‫ﻮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺍ‬‫ﺪ‬‫ﻠﻒﺟ‬ ‫ﺗ‬.3
‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﺮﺿﻰﺟ‬ ‫ﻴﻦﻣ‬ ‫ﻊﺑ‬ ‫ﺋ‬
‫ﺎ‬‫ﻜﻞﺷ‬ ‫ﺮﺑﺸ‬ ‫ﻬ‬‫ﺘﻲﺗﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬ ‫ﺍﻷﺧ‬ ‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
:‫ﻠﻲ‬‫ﺎﻳ‬‫ﺔﻣ‬ ‫ﻤ‬‫ﺋ‬‫ﺎ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻞ‬‫ﺗﺸ‬
.‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﻣ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺎﺿ‬ ‫ﻌ‬
‫ﺘ‬ ‫ﺍﻻﺳ‬ (‫ـ‬
‫ﻩ‬ )،‫ﺔ‬ ‫ﻨ‬‫ﻣ‬‫ﺰ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬ ‫ﺃ‬(‫ﺩ‬)، ‫ﻴﻦ‬‫ﺪﺧ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬(‫)ﺝ‬، ‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬ ‫ﺔ‬‫ﻠ‬
‫(ﻗ‬ ‫)ﺏ‬، ‫ﺔ‬‫ﻨ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬(‫ﺃ‬
)
:‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻠﻄ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﻋﻼ‬ ‫ﺍ ﺽﻭ‬ ‫ﺮ‬
‫ﻋ‬‫ﺃ‬
.‫ﺔ‬‫ﻠﻄ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻠﻰﺣﺠﻢ‬ ‫ﺍ ﺽﻋ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻤ‬‫ﺘ‬
‫ﻌ‬‫ﺗ‬
‫ﺔ‬ ‫ﻠﻄ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﻥﻓﻲ‬ ‫ﻨ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻟﻢﻭ‬ ‫ﺍﻷ‬‫ﻣﻲﻭ‬ ‫ﺎ‬‫ﻤ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬ ‫ﻤﻞ‬‫ﺗﺸ‬. 1
.‫ﺎﻕ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬/‫ﺬﻭ ﺃ‬ ‫ﻔﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺭ‬‫ﻮ‬‫ﻟﻚﺗ‬ ‫ﺬ‬‫ﻛ‬‫ﻊﻭ‬ ‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻭ‬‫ﺃ‬ ‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻖ‬ ‫ﺔﺿ‬ ‫ﻳ‬‫ﻮ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬ ‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻤﻞﻋﻼ‬ ‫ﺗﺸ‬. 2
، ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻔﺚ‬ ‫ﻊﻧ‬ ‫ﺎﻝﻣ‬ ‫ﻌ‬‫ﻟﺴ‬ ‫ﺍ‬،‫ﻴﻦ‬‫ﻳ‬‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎ ﺽﺿ‬ ‫ﻔ‬
‫ﻧﺨ‬ ‫ﺍ‬،‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻉ‬‫ﺗﺴ‬
‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻗ‬‫ﻡﺩ‬‫ﺎ‬‫ﺘﻈ‬‫ﻧ‬‫ﺍ‬‫ﻡ‬ ‫ﺪ‬‫ﻋ‬‫ﺭﻭ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻟﻢ‬‫ﺃ‬‫ﻷﻕﻭ‬‫ﺍﺭ‬ ‫ﻠﻖﻭ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬
Nursesr oleofv enoust hr omboembol ism:
1.Admi nisterpr escr ibedchemi cal andmechani calpr ophy l
axi sandcont inual l
y
evaluateandr epor tt heef fect s.
2.Managementwi t hant i
coagul ant ssuchasl owmol ecul arwei ghthepar i
nand
warfarinaspr escr ibed.
3.Moni torl abor at oryr esul tsf orant i
coagul ant .
4.Teachpat ientsandt hei rcar egi ver saboutt hesedr ugs, whi cht heywi llneedt o
manageoncedi schar ged.
5.Ther apeut i
cdev icessuchasi nt ermi t tentpneumat iccompr essi onst ockings
andv enousf ootpumpsar eusef ul topr ev entv enousst asis.
6.Encour agedpat ient st odor siflexandpl ant arf lexankl esandt oes.
7.Nur sessuppor tear lymobi lizat i
ont opr omot elowerext r
emi t
yv enousr et urn.
:
‫ﺪﻱ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭﻱ‬ ‫ﺎ‬‫ﺜ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻡ‬ ‫ﺎ‬‫ﻤ‬‫ﻧﺼ‬ ‫ﻟﻼ‬ ‫ﺎﺕ‬ ‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﺩ‬
.‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺎﺳ‬ ‫ﺎﺑ‬‫ﻬ‬ ‫ﻨ‬
‫ﺑﻼﻍﻋ‬ ‫ﺍﻹ‬‫ﻵﺭﻭ‬‫ﺎ‬‫ﺍﺛ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻓ‬‫ﻮ‬ ‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻜ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬ ‫ﻴ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬ ‫ﺍ‬
‫ﺩ‬‫ﺇ‬.1
.‫ﻮﻑ‬ ‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻳﻦﻋ‬ ‫ﺭ‬‫ﺎ‬‫ﻓ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬ ‫ﻟ‬‫ﺍ‬‫ﺌﻲﻭ‬ ‫ﻳ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺯﻥ‬ ‫ﻮ‬ ‫ﻟ‬‫ﺍ‬‫ﻔﺾ‬ ‫ﻨﺨ‬ ‫ﻳﻦﻣ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﺮﻣ‬‫ﺜ‬‫ﺘﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﺓﺑ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬.2
.‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬ ‫ﺎ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬.3
‫ﺩ‬‫ﺮ‬‫ﻤﺠ‬ ‫ﺎﺑ‬‫ﻬ‬‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﻟﻰﺇ‬ ‫ﻮﻥﺇ‬ ‫ﺎﺟ‬‫ﺘ‬ ‫ﻴﺤ‬ ‫ﺘﻲﺳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬ ‫ﺍﻷ‬ ‫ﻩ‬‫ﺬ‬‫ﻬﻢﻋﻦﻫ‬ ‫ﺘ‬‫ﻳ‬‫ﺎ‬‫ﻋ‬‫ﻠﻰﺭ‬‫ﻴﻦﻋ‬ ‫ﻤ‬‫ﺋ‬‫ﺎ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰﻭ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻢ‬ ‫ﻋ‬.4
.‫ﻔﻰ‬ ‫ﺘﺸ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻬﻢﻣﻦ‬ ‫ﻭﺟ‬ ‫ﺮ‬
‫ﺧ‬
‫ﺩ‬‫ﻮ‬‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬ ‫ﺓ‬‫ﺪ‬
‫ﻴ‬ ‫ﻔ‬‫ﺔﻣ‬ ‫ﻳ‬
‫ﺪ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣﻀﺨ‬ ‫ﺔﻭ‬ ‫ﻌ‬
‫ﻘﻄ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻮ‬ ‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺭﺏ‬ ‫ﺍ‬‫ﻮ‬‫ﺜﻞﺟ‬ ‫ﺔﻣ‬ ‫ﻴ‬‫ﻌﻼﺟ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺍﻷﺟ‬ .5
.
‫ﺪﻱ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
.‫ﻡ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺑ‬‫ﺎ‬‫ﺃﺻ‬ ‫ﺎﺣﻞﻭ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬ ‫ﻤﺺ‬ ‫ﺃﺧ‬‫ﺮﻱﻭ‬ ‫ﻬ‬‫ﻨﻲﻇ‬ ‫ﻠﻰﺛ‬ ‫ﺮﺿﻰﻋ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺷﺠ‬. 6
.
‫ﻠﻲ‬ ‫ﻔ‬‫ﻟﺴ‬ ‫ﺍ‬ ‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺪ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﻮ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﺒ‬‫ﻌ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﺩﻋﻢ‬ ‫ﺮﺿ‬‫ﻤ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬.7
Latecompl icationsoff ract ur es
Systemi ccompl icat ionsoff r act ure:
1.Gangr ene, tetanus, sept icaemi a.
Localcompl icationsoff ract ur e:
1.Delay eduni on( fract uret akesl ongert imet hannor mal toheal ).
2.Mal uni on( fractur edoesnotheal i
nnor mal al i
gnmentusual lyduet o
i
nsuf f
icientr educt ion) .

34
‫‪3.Non-‬‬ ‫‪uni‬‬ ‫(‪on‬‬ ‫‪f‬‬‫‪r‬‬‫‪act‬‬ ‫‪ur‬‬‫‪edoesnotheal‬‬ ‫‪I‬‬‫‪toccur‬‬‫‪swhent‬‬ ‫‪her‬‬‫‪ear‬‬‫‪enosi‬‬ ‫‪gnsof‬‬
‫‪heal‬‬‫‪i‬‬
‫‪ngaf‬‬ ‫‪t‬‬‫‪er>3-‬‬ ‫‪6mont‬‬ ‫(‪hs‬‬‫‪dependi‬‬ ‫‪ngupont‬‬ ‫‪hesi‬‬‫‪t‬‬‫‪eoff‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫)‪e‬‬‫‪.‬‬
‫‪4.Joi‬‬‫‪ntst‬‬ ‫‪i‬‬‫‪f‬‬‫‪f‬‬‫‪ness.‬‬
‫‪5.Cont‬‬ ‫‪r‬‬‫‪act‬‬ ‫‪ur‬‬‫‪es.‬‬
‫‪6.My‬‬ ‫‪osi‬‬‫‪t‬‬‫‪i‬‬‫‪sossi‬‬ ‫‪f‬‬‫‪i‬‬‫‪cans.‬‬
‫‪7.Av‬‬ ‫‪ascul‬‬ ‫‪arnecr‬‬ ‫‪osi‬‬‫‪s.‬‬
‫‪8.Ost‬‬ ‫‪eomy‬‬ ‫‪el‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪s.‬‬
‫‪9.Gr‬‬‫‪owt‬‬ ‫‪hdi‬‬ ‫‪st‬‬‫‪ur‬‬‫‪banceordef‬‬ ‫‪or‬‬‫‪mi‬‬‫‪t‬‬
‫‪y‬‬ ‫‪.‬‬
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺓ‬
‫ﺮ‬‫ﺄﺧ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫‪:‬‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﻳ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻢ‬‫ﺗﺴ‬‫ﻮﺱﻭ‬ ‫ﻧ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬ ‫ﻨ‬
‫ﻳ‬‫ﺮ‬‫ﺮﻏ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪1‬‬
‫‪:‬‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫(‬
‫ﺀ‬‫ﺎ‬‫ﻔ‬‫ﻠﺸ‬‫ﻟ‬‫ﺩ‬‫ﺎ‬
‫ﺘ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝﻣﻦ‬‫ﺃﻃ‬ ‫ﺎ‬
‫ً‬
‫ﺘ‬‫ﻗ‬‫ﺮﻭ‬ ‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻕ‬‫ﻐ‬‫ﺘ‬‫ﻳﺴ‬‫ﺎﻁ)‬ ‫ﺒ‬‫ﺗ‬
‫ﺭ‬‫ﺍﻻ‬‫ﺮ‬‫ﺄﺧ‬‫‪.‬ﺗ‬‫‪1‬‬
‫‪.‬‬
‫(‬‫ﻓﻲ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻴ ﺾﻏ‬‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﺒﺐ‬‫ﺓﺑﺴ‬ ‫ﺩ‬
‫ﺎ‬‫ﺔﻋ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺌﻢﻓﻲ‬ ‫ﺘ‬‫ﻠ‬
‫ﺮﻻﻳ‬ ‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫‪)Mal‬‬ ‫‪uni‬‬‫‪on.‬‬ ‫‪2‬‬
‫ﺮ)ﺣﺴﺐ‬ ‫ﻬ‬‫ﺃﺷ‬ ‫‪6-‬‬‫ﺪ<‪3‬‬ ‫ﻌ‬‫ﺀﺑ‬‫ﺎ‬
‫ﻔ‬‫ﻠﺸ‬‫ﻟ‬‫ﺎﺕ‬‫ﻣ‬‫ﺎﻙﻋﻼ‬ ‫ﻨ‬
‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺎﻻﺗ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﺪﺙﻋ‬ ‫ﻳﺤ‬ ‫ﺌﻢﻭ‬‫ﺘ‬‫ﻠ‬‫ﺮﻻﻳ‬ ‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻡ)‬ ‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﻡ‬‫ﺪ‬‫‪.‬ﻋ‬‫‪3‬‬
‫‪.‬‬
‫(‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻣ‬
‫‪.‬‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐ‬ ‫‪.‬ﺗﺼ‬‫‪4‬‬
‫‪.‬‬‫ﺎﺕ‬‫ﻠﺼ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪5‬‬
‫‪.‬‬‫ﻤﻲ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪6‬‬
‫‪.‬‬‫ﺋﻲ‬‫ﺎ‬
‫ﻭﻋ‬ ‫ﺍﻼ‬
‫ﺮﻟ‬ ‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪7‬‬
‫‪.‬‬‫ﻘﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪8‬‬
‫‪.‬‬
‫ﻪ‬‫ﻮﻫ‬ ‫ﻭﺗﺸ‬ ‫ﺃ‬‫ﻮ‬‫ﻤ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺍﺏ‬‫ﺮ‬‫ﺍﺿﻄ‬ ‫‪.‬‬
‫‪9‬‬
‫‪Fact‬‬‫‪or‬‬ ‫‪spr‬‬ ‫‪edi‬‬ ‫‪sposi‬‬ ‫‪ngt‬‬ ‫‪odel‬‬‫‪ay‬‬‫‪eduni‬‬ ‫‪onf‬‬ ‫‪r‬‬
‫‪act‬‬‫‪ur‬‬‫‪e:‬‬
‫‪1.Sev‬‬ ‫‪er‬‬‫‪esof‬‬ ‫‪tt‬‬ ‫‪i‬‬
‫‪ssuedamage.‬‬
‫‪2.I‬‬‫‪nadequat‬‬ ‫‪ebl‬‬ ‫‪oodsuppl‬‬ ‫‪y‬‬‫‪.‬‬
‫‪3.I‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬‫‪on.‬‬
‫‪4.I‬‬‫‪nsuf‬‬ ‫‪f‬‬
‫‪i‬‬‫‪ci‬‬‫‪entspl‬‬ ‫‪i‬‬‫‪nt‬‬‫‪age.‬‬
‫‪5.Excessi‬‬ ‫‪v‬‬ ‫‪et‬‬ ‫‪r‬‬‫‪act‬‬ ‫‪i‬‬
‫‪on.‬‬
‫‪6.Ol‬‬‫‪derage.‬‬
‫‪7.Sev‬‬ ‫‪er‬‬‫‪eanaemi‬‬ ‫‪a.‬‬
‫‪8.Di‬‬‫‪abet‬‬ ‫‪es.‬‬
‫‪9.Lowv‬‬ ‫‪i‬‬‫‪t‬‬‫‪ami‬‬ ‫‪nDl‬‬ ‫‪ev‬‬‫‪el‬‬‫‪.‬‬
‫‪10.Hy‬‬ ‫‪pot‬‬ ‫‪hy‬‬ ‫‪r‬‬‫‪oi‬‬‫‪di‬‬‫‪sm.‬‬
‫‪11.Medi‬‬ ‫‪cat‬‬ ‫‪i‬‬
‫‪onsi‬‬ ‫‪ncl‬‬‫‪udi‬‬‫‪ngNSAI‬‬ ‫‪Dsandst‬‬ ‫‪er‬‬‫‪oi‬‬
‫‪ds.‬‬
‫‪12.I‬‬‫‪nf‬‬‫‪ect‬‬ ‫‪i‬‬
‫‪on.‬‬
‫‪13.Compl‬‬ ‫‪i‬‬
‫‪cat‬‬ ‫‪ed/‬‬ ‫‪compoundf‬‬ ‫‪r‬‬
‫‪act‬‬‫‪ur‬‬‫‪e.‬‬
‫‪14.Ost‬‬ ‫‪eopor‬‬ ‫‪osi‬‬‫‪s.‬‬
‫‪:‬‬
‫ﺮ‬‫ﺄﺧ‬ ‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺎ‬‫ﺗﺤ‬ ‫ﺍﻻ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬ ‫ﻠﻒ‬‫‪.‬ﺗ‬‫‪1‬‬
‫‪.‬‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻣ‬‫ﻘ ﺺﺇ‬‫‪.‬ﻧ‬‫‪2‬‬
‫‪.‬‬
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪3‬‬
‫‪.‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﻟﺸﻈ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬ ‫ﺪ‬‫‪.‬ﻋ‬‫‪4‬‬
‫‪.‬‬
‫ﺮﻁ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫‪.‬‬
‫‪5‬‬
‫‪.‬‬‫ﺮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫‪.‬ﺗ‬‫‪6‬‬
‫‪.‬‬
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻘ‬‫‪.‬ﻓ‬‫‪7‬‬
‫‪.‬‬‫ﺮﻱ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺮﺽ‬ ‫‪.‬ﻣ‬‫‪8‬‬
‫‪.‬‬
‫ﻴﻦﺩ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﻮﻯﻓ‬ ‫ﺘ‬‫ﺎ ﺽﻣﺴ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬ ‫‪.‬‬
‫‪9‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻗ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫‪.‬ﻗﺼ‬ ‫‪10‬‬
‫‪.‬‬
‫ﺎﺕ‬‫ﻨﺸﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻴ‬‫ﺋ‬
‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺎﺏﻏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻟﻚﻣﻀ‬ ‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺔﺑ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫‪.‬‬‫‪11‬‬
‫‪.‬‬
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪12‬‬

‫‪35‬‬
 .
‫ﻛﺐ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
/‫ﺪ‬ ‫ﻘ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬.
13
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻫﺸ‬.
14
Pr esent ationofnon- uni onf ractur e:
1.Pai natf racturesi te, per sistingf ormont hsory ear s.
2.Non- useofext r
emi ty.
3.Tender nessandswel ling.
4.Joi ntst iffness( prolonged>3mont hs).
5.Mov ementar oundt hef ract uresi te(pseudar throsi s).
6.Pal pabl egapatf ract uresi te.
7.Absenceofcal l
us( remodel ledbone)
8.Cl osedmedul l
arycav i
tiessuggestnon- union.
9.Radi ol ogical l
y,bonecanl ooki nact ive, suggest ingt hear eai sav ascul ar
(knownasat r
ophi cnon- uni on).
:‫ﺑﻲ‬ ‫ﺎ‬
‫ﻘ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺮﻏ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻋ‬
.‫ﺍﺕ‬‫ﻮ‬‫ﻨ‬‫ﻭﺳ‬ ‫ﺃ‬‫ﺭ‬‫ﻮ‬ ‫ﻬ‬‫ﻟﺸ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻳﺴ‬، ‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻗ‬‫ﻮ‬‫ﻟﻢﻓﻲﻣ‬ ‫ﺃ‬.
1
.‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻡ‬‫ﺪ‬‫ﻋ‬.2
.
‫ﺎﺥ‬ ‫ﻔ‬‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺔﻭ‬ ‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬.
3
.(
‫ﺮ‬‫ﻬ‬ ‫ﺃﺷ‬ 3<‫ﺔ‬ ‫ﻠ‬‫ﻳ‬‫ﻮ‬‫ﺍﺕﻃ‬ ‫ﺮ‬‫ﺘ‬‫ﻔ‬‫ﻟ‬)‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬ ‫ﺗﺼ‬.4
.(
‫ﺫﺏ‬ ‫ﺎ‬
‫ﻔﺼﻞﻛ‬ ‫)ﺀﻣ‬‫ﺍ‬
‫ﺮﺩ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬ ‫ﻮ‬‫ﻮﻝﻣ‬ ‫ﺔﺣ‬ ‫ﻛ‬
‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬.
5
.‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻗ‬‫ﻮ‬‫ﺔﻓﻲﻣ‬ ‫ﻮﺳ‬ ‫ﻤ‬ ‫ﻠ‬
‫ﺓﻣ‬ ‫ﻮ‬ ‫ﻓﺠ‬.6
(‫ﻪ‬‫ﻠ‬‫ﻴ‬
‫ﻜ‬ ‫ﺩﺗﺸ‬ ‫ﺎ‬‫ﻌ‬‫ﻋﻈﻢﻣ‬ )‫ﻟﺲ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻋ‬.7
.‫ﺩ‬‫ﺎ‬
‫ﺗﺤ‬‫ﺍﻻ‬ ‫ﻡ‬‫ﺪ‬‫ﻟﻰﻋ‬ ‫ﺔﺇ‬ ‫ﻘ‬‫ﻠ‬‫ﻐ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﻉ‬‫ﻨﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬ ‫ﻭ‬‫ﺎ‬‫ﺮﺗﺠ‬ ‫ﻴ‬‫ﺗﺸ‬.8
‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬‫ﺮﻭﻋ‬ ‫ﻴ‬‫ﺔﻏ‬ ‫ﻘ‬
‫ﻨﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻥ‬ ‫ﻟﻰ‬‫ﺮﺇ‬ ‫ﻴ‬‫ﺎﻳﺸ‬ ‫ﻤ‬‫ﻣ‬، ‫ﺮﻧﺸﻂ‬ ‫ﻴ‬‫ﻌﻈﻢﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺪ‬‫ﺒ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬، ‫ﺔ‬ ‫ﻴ‬‫ﺎﻋ‬‫ﻌ‬‫ﺍﻹﺷ‬ ‫ﺔ‬ ‫ﻴ‬‫ﺎﺣ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﻦ‬.9
.(‫ﺪ‬‫ﺘﺤ‬ ‫ﺮﻣ‬ ‫ﻴ‬‫ﺭﻏ‬ ‫ﻮ‬‫ﻤ‬‫ﺎﺳﻢ ﺿ‬ ‫ﺮﻑﺑ‬ ‫ﻌ‬
‫ﺗ‬)
Managementofnon- uni onf ract ure: Non- surgical appr oaches:
1.Ear lywei ghtbear ingandcast ingmaybehel pf ul fordel ayeduni onandnon-
uni on.
2.Bonest imul ati
oncansomet imesbeused.Thi sdel iverspul sedul trasoni cor
elect romagnet icwav est ost imul at enewbonef ormat i
on.I tneedst obeused
forupt oanhourev er yday ,andmayt akesev eral weekst obeef fect i
v e.]
3.Medi cal t
reatment ssuchast eripar atidehav eal sobeenusedt opr omot e
fract ureheal ing,par ti
cul ar l
yi npat ientswi thost eopor osi s.
:‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﻴﺐﻏ‬ ‫ﻟ‬‫ﺎ‬
‫ﺍﻷﺳ‬ :‫ﺑﻲ‬‫ﺎ‬‫ﻘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬‫ﺮﻏ‬ ‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
.‫ﺩ‬‫ﺎ‬‫ﺗﺤ‬‫ﺍﻻ‬ ‫ﻡ‬‫ﺪ‬ ‫ﺩﻭﻋ‬ ‫ﺎ‬
‫ﺗﺤ‬‫ﺍﻻ‬ ‫ﺮ‬ ‫ﺄﺧ‬‫ﺣﺔﺗ‬‫ﻟ‬
‫ﺍﻓﻲ ﺎ‬ ً
‫ﺪ‬‫ﻴ‬‫ﻔ‬ ‫ﻟﺼﺐﻣ‬ ‫ﺍ‬
‫ﺮﻭ‬ ‫ﻜ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﻮﻥﺣ‬ ‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬.1
‫ﺎﺕ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﺗ‬
‫ﻮ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻮﻕ‬ ‫ﺎﺕﻓ‬ ‫ﻮﺟ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍ‬‫ﺬ‬‫ﻠﻢﻫ‬ ‫ﻳﺴ‬. ‫ﺎﻥ‬‫ﻴ‬‫ﺍﻷﺣ‬ ‫ﻌﺾ‬ ‫ﻡﻓﻲﺑ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻡﺗﺤ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬.2
‫ﺔﻛﻞ‬ ‫ﺎﻋ‬ ‫ﻟﻰﺳ‬ ‫ﺓﺗﺼﻞﺇ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﻪ‬ ‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻳﺠﺐ‬. ‫ﺓ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬ ‫ﻮ‬‫ﻜ‬‫ﺰﺗ‬ ‫ﻴ‬‫ﻔ‬‫ﺘﺤ‬ ‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺒﻀ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺎﻃ‬ ‫ﻨ‬‫ﻐ‬
‫ﻣ‬ ‫ﻭ‬‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
[.
ً‫ﺎﻻ‬ ‫ﻌ‬‫ﺒﺢﻓ‬ ‫ﺘﻰﻳﺼ‬ ‫ﻊﺣ‬ ‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﺃﺳ‬ ‫ﺓ‬ ‫ﺪ‬‫ﺮﻕﻋ‬ ‫ﻐ‬‫ﺘ‬‫ﺪﻳﺴ‬ ‫ﻗ‬‫ﻭ‬، ‫ﻡ‬‫ﻮ‬‫ﻳ‬
‫ﻳﻦ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺎﺻ‬ ‫ﻭﺧ‬، ‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺪ‬‫ﻴ‬‫ﺗ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻌﻼﺟ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺎﺗﻢ‬‫ﻤ‬‫ﻛ‬.3
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻮﻥﻣﻦﻫﺸ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳ‬
Sur gi calappr oaches:
1.Debr i
dementt oest abl i
shaheal thyi nfect i
on-freev ascul arityatt hef ract ur e
site.
2.Bonegr afti
ngt ost imul at enewcal lusf or mation.Bonemaybet akenf rom t he
pat ientormaybecadav eric.
3.Bonegr aftsubst i
tut es/ ost eobi ologi cs.
4.I nternal fi
xat i
ont or educeandst abi l
iset hefract ur e.( Bonegr af t
ingpr ov ides
nost abi li
ty )
.
5.Dependi ngont het y peofnon- uni on, anycombi nat ionoft heabov e
Iatrogeni ccompl i
cat ionsoff ractur et reatment :
Castappl icationcompl icat ions:

36
‫‪1.Pr‬‬‫‪essur‬‬
‫‪eul‬‬‫‪cer‬‬‫‪s‬‬
‫‪2.Ther‬‬‫‪mal‬‬‫‪bur‬‬‫‪nsdur‬‬‫‪i‬‬
‫‪ngpl‬‬
‫‪ast‬‬
‫‪erhar‬‬
‫‪deni‬‬
‫‪ng‬‬
‫‪3.Thr‬‬‫‪ombophl‬‬‫‪ebi‬‬
‫‪t‬‬‫‪i‬‬
‫‪s‬‬
‫‪:‬‬‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﺐ‬ ‫ﻟ‬
‫ﺎ‬
‫ﺍﻷﺳ‬
‫‪.‬‬‫ﺮ‬
‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻗ‬‫ﻮ‬‫ﻭﻯﻓﻲﻣ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺧ‬ ‫ﻴ‬‫ﺔ ﺻﺤ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻧﺸ‬‫ﺮﻹ‬ ‫ﻴ‬
‫ﻨﻀ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪1‬‬
‫ﺟ‪.‬‬
‫ﺔ‬‫ﻮﻥ ﺜ‬
‫ﻜ‬‫ﺪﺗ‬
‫ﻭﻗ‬‫ﺃ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻣﻦ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺬ‬‫ﺆﺧ‬‫ﺪﺗ‬
‫‪.‬ﻗ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻟﺲ‬ ‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬‫ﺰﺗ‬‫ﻴ‬
‫ﻔ‬‫ﺘﺤ‬‫ﻟ‬‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫‪.‬ﺗ‬
‫‪2‬‬
‫‪.‬‬
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻴ‬‫ﻡ‪/‬ﺑ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻌﻢ‬ ‫ﺋﻞﻃ‬‫ﺍ‬‫ﺪ‬‫‪.‬ﺑ‬
‫‪3‬‬
‫‪.‬‬
‫(‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻘ‬
‫ﺘ‬‫ﺍﺳ‬‫ﺃﻱ‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬
‫ﺮﺗ‬‫ﻓ‬‫ﻮ‬‫‪).‬ﻻﻳ‬‫ﻪ‬
‫ﺘ‬‫ﻴ‬‫ﺒ‬
‫ﺜ‬‫ﺗ‬‫ﺮﻭ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﻠﻲ‬
‫ﺍﺧ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪4‬‬
‫ﺒﻖ‬
‫ﺎﺳ‬ ‫ﻤ‬
‫ﻳﺞﻣ‬ ‫ﺰ‬
‫ﺃﻱﻣ‬ ‫‪،‬‬‫ﺑﻲ‬‫ﺎ‬‫ﻘ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻮﻉﻏ‬ ‫ﻠﻰﻧ‬ ‫ﺍﻋ‬‫ً‬
‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻋ‬‫ﺍ‬‫‪.‬‬
‫‪5‬‬
‫‪:‬‬
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬‫ﻟﻼﺝ‬
‫ﺄﻌ‬ ‫ﻨﺸ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕﻋﻼﺟﻲ‬ ‫ﻔ‬
‫ﺎﻋ‬‫ﻣﻀ‬
‫‪:‬‬‫ﻴﻖ‪Cast‬‬ ‫ﺒ‬‫ﺎﺕﺗﻄ‬ ‫ﻔ‬
‫ﺎﻋ‬‫ﻣﻀ‬
‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺮﺣ‬‫ﻘ‬‫‪.‬ﺗ‬
‫‪1‬‬
‫ﺒﺲ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻠﺐ‬‫ﺀﺗﺼ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫‪.‬‬
‫‪2‬‬
‫ﺭﻱ‬‫ﺎ‬
‫ﺜ‬‫ﻟﺨ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪3‬‬

‫‪Tr‬‬‫‪act‬‬‫‪i‬‬‫‪onappl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪oncompl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪ons:‬‬ ‫‪Muscl‬‬‫‪ewast‬‬ ‫‪i‬‬

‫‪ngandweaknessandot‬‬ ‫‪her‬‬
‫‪compl‬‬ ‫‪i‬‬‫‪cat‬‬ ‫‪i‬‬
‫‪onsoft‬‬ ‫‪r‬‬‫‪act‬‬‫‪i‬‬‫‪oni‬‬ ‫‪ncl‬‬‫‪ude:‬‬
‫‪1.Pr‬‬‫‪essur‬‬ ‫‪eul‬‬‫‪cer‬‬ ‫‪s.‬‬
‫‪2.Pneumoni‬‬ ‫‪a/‬‬ ‫‪ur‬‬‫‪i‬‬
‫‪nar‬‬ ‫‪yt‬‬ ‫‪r‬‬
‫‪acti‬‬ ‫‪nf‬‬‫‪ect‬‬ ‫‪i‬‬
‫‪ons.‬‬
‫‪3.Per‬‬‫‪manentf‬‬ ‫‪oot‬‬‫‪dr‬‬ ‫‪opcont‬‬ ‫‪r‬‬‫‪act‬‬‫‪ur‬‬‫‪es.‬‬
‫‪4.Per‬‬‫‪oneal‬‬ ‫‪ner‬‬ ‫‪v‬‬‫‪epal‬‬ ‫‪sy‬‬‫‪.‬‬
‫‪5.Pi‬‬‫‪nt‬‬ ‫‪r‬‬‫‪acti‬‬‫‪nf‬‬ ‫‪ect‬‬‫‪i‬‬‫‪on.‬‬
‫‪6.Thr‬‬‫‪omboembol‬‬ ‫‪i‬‬‫‪sm.‬‬
‫‪Ext‬‬‫‪er‬‬‫‪nalf‬‬ ‫‪i‬‬‫‪xat‬‬‫‪i‬‬‫‪oncompl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪ons:Pr‬‬ ‫‪obl‬‬‫‪emscausedbyext‬‬ ‫‪er‬‬ ‫‪nalf‬‬‫‪i‬‬
‫‪xat‬‬‫‪i‬‬‫‪oni‬‬ ‫‪ncl‬‬ ‫‪ude:‬‬
‫‪1.Pi‬‬‫‪nt‬‬ ‫‪r‬‬‫‪acti‬‬‫‪nf‬‬ ‫‪ect‬‬‫‪i‬‬‫‪on.‬‬
‫‪2.Pi‬‬‫‪nl‬‬ ‫‪ooseni‬‬ ‫‪ngorbr‬‬ ‫‪eakage.‬‬
‫‪3.I‬‬‫‪nt‬‬
‫‪er‬‬ ‫‪f‬‬‫‪er‬‬‫‪encewi‬‬ ‫‪t‬‬‫‪hmov‬‬ ‫‪ementoft‬‬ ‫‪hej‬‬‫‪oi‬‬‫‪nt‬‬‫‪.‬‬
‫‪4.Neur‬‬ ‫‪ov‬‬ ‫‪ascul‬‬ ‫‪ardamageduet‬‬ ‫‪opi‬‬‫‪npl‬‬‫‪acement‬‬ ‫‪.‬‬
‫‪5.Mi‬‬‫‪sal‬‬ ‫‪i‬‬‫‪gnmentduet‬‬ ‫‪opoorpl‬‬ ‫‪acementoft‬‬ ‫‪hef‬‬‫‪i‬‬
‫‪x‬‬‫‪at‬‬‫‪or‬‬‫‪.‬‬
‫‪6.Psy‬‬ ‫‪chol‬‬ ‫‪ogi‬‬‫‪cal‬‬ ‫‪compl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪ons:‬‬ ‫‪Al‬‬‫‪t‬‬
‫‪er‬‬‫‪edbodyi‬‬ ‫‪mageandasenseofv‬‬ ‫‪i‬‬‫‪si‬‬‫‪bl‬‬‫‪e‬‬
‫‪di‬‬
‫‪sabi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬‫‪y‬‬‫‪,‬‬‫‪ordef‬‬ ‫‪or‬‬‫‪mi‬‬ ‫‪t‬‬‫‪ycanoccur‬‬ ‫‪.‬‬
‫‪:‬‬‫ﻠﻲ‬‫ﺎﻳ‬‫ﺮﻯﻣ‬ ‫ﺍﻷﺧ‬ ‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬
‫ﺎﻋ‬‫ﻣﻀ‬ ‫ﺎﻭ‬‫ﻬ‬
‫ﻔ‬‫ﻌ‬‫ﻌﻀﻼﺕﻭﺿ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﻴ‬‫ﻤﻞ ﺿ‬‫‪:‬ﺗﺸ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺎﺕﺗﻄ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
‫‪.‬‬‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬ ‫ﺎﺕ‬ ‫ﺮﺣ‬ ‫ﻘ‬
‫‪.‬ﺗ‬‫‪1‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻱ‪/‬‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫‪.‬‬
‫‪2‬‬
‫‪.‬‬‫ﺔ‬‫ﻤ‬
‫ﺋ‬‫ﺍ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻠﺼ‬ ‫ﻘ‬
‫‪.‬ﺗ‬‫‪3‬‬
‫‪.‬‬‫ﻮﻱ‬‫ﻟﺸﻈ‬‫ﺍ‬‫ﻌﺼﺐ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻞ‬ ‫‪.‬ﺷ‬‫‪4‬‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻮﺳ‬‫ﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬ ‫ﻭﻯ‬ ‫ﺪ‬‫‪.‬ﻋ‬‫‪5‬‬
‫‪.‬‬
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬ ‫‪.‬‬
‫‪6‬‬
‫‪:‬‬
‫ﻠﻲ‬ ‫ﺎﻳ‬‫ﺭﺟﻲﻣ‬ ‫ﺎ‬
‫ﻟﺨ‬ ‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫‪:‬ﺗﺸ‬‫ﺭﺟﻲ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻮﺳ‬‫ﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬ ‫ﻭﻯ‬ ‫ﺪ‬‫‪.‬ﻋ‬‫‪1‬‬
‫‪.‬‬‫ﻮﺱ‬ ‫ﺑ‬
‫ﺮﺩ‬ ‫ﻭﻛﺴ‬ ‫ﺃ‬‫‪.‬ﻓﻚ‬ ‫‪2‬‬
‫‪.‬‬‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺪﺧﻞﻓﻲﺣ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪3‬‬
‫‪.‬‬
‫ﻮﺱ‬ ‫ﺑ‬‫ﻊﺩ‬‫ﺒﺐﻭﺿ‬ ‫ﺔﺑﺴ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬ ‫ﺍﻷ‬ ‫ﻠﻒ‬‫‪.‬ﺗ‬‫‪4‬‬

‫‪37‬‬
 .‫ﻴﺖ‬
‫ﺒ‬‫ﺜ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻊﺟ‬
‫ﺀﻭﺿ‬‫ﻮ‬‫ﺒﺐﺳ‬‫ﺓﺑﺴ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻼﻝ‬‫ﺍﺧ‬.
5
.
‫ﻩ‬‫ﻮ‬‫ﺘﺸ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻗ‬‫ﺎ‬‫ﺎﻹﻋ‬
‫ﺎﺱﺑ‬
‫ﺇﺣﺴ‬
‫ﻟﺠﺴﻢﻭ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﻮ‬‫ﺮﻓﻲ ﺻ‬‫ﻴ‬‫ﻐ‬
‫ﺪﺙﺗ‬‫ﺃﻥﻳﺤ‬
‫ﻜﻦ‬‫ﻤ‬
‫ﻳ‬:‫ﺔ‬‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬.
6

Uni tI
I
Musculoskel
et alcaremodali
ties
Cast
Learningobjecti
ves:
Attheendoft hislectur
e;thestudentwi l
lbeableto:
1.Definecast
2.Selectfourreasonsfortheuseofcast s.
3.Selectthecorrectnursi
ngmanagementt echniquesusedincar
ing
forapatientwithacast.
4.Identi
fythenursingcaremanagementpr inci
plesforapat
ienti
n
cast.

‫ﺔ‬‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻮﺣ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻠﻲ‬‫ﻜ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻲ‬‫ﻌﻀ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﺋﻖﺭﻋ‬ ‫ﺍ‬
‫ﺮ‬‫ﻃ‬
‫ﺬﻑ‬ ‫ﻘ‬‫ﻳ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬
‫ﺳ‬.‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬‫ﻬ‬‫ﻓﻲﻧ‬
‫ﻮﺏ‬‫ﺒ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬.1
.‫ﻟﺐ‬‫ﺍ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺏﻻﺳ‬ ‫ﺒ‬‫ﺃﺳ‬‫ﺔ‬‫ﻌ‬‫ﺑ‬‫ﺭ‬‫ﺃ‬
‫ﺩ‬‫ﺪ‬‫ﺣ‬. 2
.
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺎ‬
‫ﺎﺏﺑ‬ ‫ﻤﺼ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺔﻓﻲﺭﻋ‬ ‫ﻣ‬
‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴﺤ‬ ‫ﻟﺼﺤ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﻴﺐﺇ‬ ‫ﻟ‬
‫ﺎ‬‫ﺃﺳ‬‫ﺩ‬‫ﺪ‬‫ﺣ‬. 3
.
‫ﻴﻞ‬‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻳ ﺾﻓﻲﻓ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬ ‫ﺔ‬‫ﻴ‬
‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺩﺉﺇ‬‫ﺎ‬‫ﺒ‬
‫ﻠﻰﻣ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
.4
Defi
niti
onofcast:
Castisadeviceusedf ori
mmobi li
zati
on.
Purposesofcast:
1.Toimmobi l
izefract
uresandhol dbonefr
agment si nreducti
on.
2.Topreventmov ementinsoftti
ssueinjur
ies.

38
‫‪3.Tomai‬‬ ‫‪nt‬‬‫‪ai‬‬‫‪npr‬‬ ‫‪operal‬‬‫‪i‬‬‫‪gnmentandcor‬‬ ‫‪r‬‬‫‪ectdef‬‬ ‫‪or‬‬‫‪mi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪es.‬‬
‫‪4.Toper‬‬ ‫‪mi‬‬‫‪tear‬‬ ‫‪l‬‬‫‪ymobi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪zat‬‬‫‪i‬‬
‫‪on.‬‬
‫‪Cast‬‬‫‪i‬‬‫‪ngmat‬‬ ‫‪er‬‬‫‪i‬‬‫‪al‬‬‫‪s:‬‬
‫‪Castmat‬‬ ‫‪er‬‬‫‪i‬‬
‫‪al‬‬‫‪si‬‬ ‫‪ncl‬‬‫‪udepl‬‬ ‫‪ast‬‬
‫‪erofPar‬‬ ‫‪i‬‬
‫‪s,‬‬‫‪f‬‬‫‪i‬‬‫‪ber‬‬‫‪gl‬‬‫‪ass,‬‬ ‫‪andpl‬‬ ‫‪ast‬‬‫‪i‬‬‫‪c.‬‬
‫‪Pl‬‬‫‪ast‬‬‫‪ercast‬‬‫‪s:‬‬
‫‪Ar‬‬‫‪eheav‬‬ ‫‪ycast‬‬‫‪,‬‬ ‫‪mol‬‬ ‫‪dv‬‬‫‪er‬‬‫‪ysmoot‬‬ ‫‪hl‬‬‫‪yt‬‬‫‪ot‬‬‫‪hebody‬‬ ‫’‬
‫‪scont‬‬ ‫‪our‬‬ ‫‪s.Thecasti‬‬ ‫‪ni‬‬‫‪t‬‬‫‪i‬‬
‫‪al‬‬‫‪l‬‬
‫‪y‬‬
‫‪emi‬‬‫‪t‬‬‫‪sheatandt‬‬ ‫‪akesabout15mi‬‬ ‫‪nut‬‬‫‪est‬‬‫‪ocool‬‬ ‫‪and24t‬‬ ‫‪o72hour‬‬ ‫‪st‬‬ ‫‪odr‬‬ ‫‪y‬‬‫‪.I‬‬
‫‪t‬‬
‫‪mustbehandl‬‬ ‫‪edcar‬‬ ‫‪ef‬‬
‫‪ul‬‬‫‪l‬‬‫‪yunt‬‬‫‪i‬‬
‫‪l‬‬‫‪dr‬‬ ‫‪y‬‬‫‪.andl‬‬‫‪osest‬‬ ‫‪r‬‬‫‪engt‬‬‫‪handi‬‬ ‫‪nt‬‬‫‪egr‬‬‫‪i‬‬
‫‪t‬‬‫‪yi‬‬ ‫‪ft‬‬‫‪hey‬‬
‫‪becomewet‬‬ ‫‪.‬‬
‫ﺑ‪:‬‬
‫ﺎ‬‫ﻟﻰﻬ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫‪.‬‬
‫ﺔ‬‫ﻛ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﻟﺸﻞ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺯﻳﺴ‬ ‫ﺎ‬
‫ﻬ‬‫ﻮﺟ‬ ‫ﺮﻫ‬‫ﺰﻫ‬‫ﻟ‬‫ﺍ‬
‫‪:‬‬‫ﻟﺼﺐ‬ ‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻏ‬‫ﺃ‬
‫‪.‬‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﻴﻞﺷﻈ‬ ‫ﻠ‬‫ﻘ‬‫ﺗ‬
‫ﺭﻭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺸﻞﺣ‬ ‫‪.‬‬‫‪1‬‬
‫‪.‬‬
‫ﺓ‬‫ﻮ‬ ‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺔﻓﻲﺇﺻ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬ ‫ﻟ‬
‫‪.‬‬‫‪2‬‬
‫‪.‬‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﺘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺢ‬ ‫ﺗﺼﺤ‬ ‫ﺔﻭ‬ ‫ﻴﺤ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻠﺤ‬ ‫ﻟ‬
‫‪.‬‬‫‪3‬‬
‫‪.‬‬
‫ﺓ‬ ‫ﺮ‬
‫ﻜ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﺒ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺡﺑ‬‫ﻤ‬
‫ﻠﺴ‬ ‫ﻟ‬
‫‪.‬‬‫‪4‬‬
‫‪:‬‬‫ﻟﺼﺐ‬ ‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻣ‬
‫‪.‬‬‫ﻴﻚ‬‫ﺘ‬‫ﺒﻼﺳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﺟ‬‫ﺰﺟ‬‫ﻟ‬‫ﺍ‬‫ﺎﻑ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍﻷ‬‫ﻳﺲﻭ‬ ‫ﺭ‬
‫ﺎ‬‫ﺔﺟ ﺺﺑ‬ ‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬
‫‪:‬‬
‫ﻟﺠ ﺺ‬ ‫ﺍ‬‫ﻘﻲ‬‫ﻠ‬
‫ﻳ‬
‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﺋ‬
‫ﺪ‬‫ﺒ‬‫ﺓﻣ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻌﺚ‬‫ﺒ‬
‫ﻨ‬‫‪.‬ﺗ‬‫ﻟﺠﺴﻢ‬ ‫ﺍ‬
‫ﺎﺕ‬ ‫ﻴ‬‫ﻨ‬‫ﻨﺤ‬‫ﻠﻰﻣ‬ ‫ﺔﻋ‬ ‫ﻳ‬
‫ﺎ‬‫ﻐ‬‫ﻠ‬
‫ﻟ‬ ‫ﻠﺲ‬ ‫ﻜﻞﺳ‬ ‫ﻜﻞﺑﺸ‬ ‫ﺘﺸ‬‫‪،‬ﻳ‬ ‫ﻴﻞ‬‫ﻘ‬
‫ﻟﺐﺛ‬ ‫ﺎ‬
‫ﻗ‬
‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻨ‬‫ﻌ‬
‫ﺎﺑ‬‫ﻬ‬‫ﻌ‬
‫ﻣﻞﻣ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫‪.‬ﻳﺠﺐ‬ ‫ﺘﻰﺗﺠﻒ‬ ‫ﺔﺣ‬ ‫ﺎﻋ‬‫ﻟﻰ‪72‬ﺳ‬ ‫ﻣﻦ‪24‬ﺇ‬ ‫ﺩﻭ‬‫ﺮ‬‫ﺒ‬‫ﺘﻰﺗ‬‫ﺔﺣ‬ ‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﻟﻲ‪15‬ﺩ‬ ‫ﺍ‬
‫ﻮ‬‫ﺮﻕﺣ‬ ‫ﻐ‬‫ﺘ‬‫ﺗﺴ‬‫ﻭ‬
‫‪.‬‬‫ﻠﺖ‬‫ﻠ‬‫ﺒ‬
‫ﺍﺗ‬‫ﺫ‬‫ﺎﺇ‬‫ﻬ‬‫ﺘ‬‫ﻣ‬‫ﺎﻭﺳﻼ‬ ‫ﻬ‬
‫ﺗ‬‫ﻮ‬‫ﺪﻗ‬ ‫ﻘ‬‫ﻔ‬
‫ﺗ‬‫‪.‬ﻭ‬ ‫ﺘﻰﺗﺠﻒ‬ ‫ﺣ‬

‫‪Fi‬‬‫‪ber‬‬‫‪gl‬‬‫‪asscast‬‬ ‫‪s:‬‬
‫‪Ar‬‬‫‪el‬‬‫‪i‬‬‫‪ghti‬‬ ‫‪nwei‬‬ ‫‪ght‬‬‫‪,‬‬‫‪dr‬‬‫‪yi‬‬‫‪n10t‬‬ ‫‪o15mi‬‬ ‫‪nut‬‬‫‪esandcanbearwei‬‬ ‫‪ght30mi‬‬ ‫‪nut‬‬ ‫‪esaf‬‬‫‪t‬‬‫‪er‬‬
‫‪appl‬‬‫‪i‬‬‫‪cat‬‬‫‪i‬‬‫‪on.Andcanbei‬‬ ‫‪mmer‬‬ ‫‪sedi‬‬‫‪nwat‬‬ ‫‪erandr‬‬ ‫‪edr‬‬ ‫‪i‬‬
‫;‪ed‬‬ ‫‪howev‬‬ ‫‪er‬‬‫‪,‬‬‫‪t‬‬‫‪heyar‬‬ ‫‪e‬‬
‫‪expensi‬‬ ‫‪v‬‬‫‪eandmaymacer‬‬ ‫‪at‬‬‫‪eunder‬‬ ‫‪l‬‬
‫‪y‬‬‫‪i‬‬
‫‪ngski‬‬ ‫‪n.‬‬
‫‪Pol‬‬‫‪y‬‬‫‪est‬‬ ‫‪er‬‬‫‪-‬‬‫‪cot‬‬‫‪t‬‬
‫‪onkni‬‬ ‫‪tcast‬‬ ‫‪s:‬‬
‫‪Takeabout7t‬‬ ‫‪o10mi‬‬ ‫‪nut‬‬‫‪est‬‬‫‪odr‬‬ ‫‪yandcanwi‬‬ ‫‪t‬‬
‫‪hst‬‬ ‫‪andwei‬‬ ‫‪ghtbear‬‬ ‫‪i‬‬‫‪ngal‬‬‫‪most‬‬
‫‪i‬‬
‫‪mmedi‬‬ ‫‪at‬‬‫‪el‬‬‫‪y‬‬‫‪.‬‬
‫‪Ty‬‬‫‪pesofcast‬‬ ‫‪s:‬‬
‫‪−Shor‬‬ ‫‪tl‬‬ ‫‪egcast‬‬ ‫‪:‬‬‫‪ext‬‬‫‪endsf‬‬ ‫‪r‬‬‫‪om bel‬‬‫‪owt‬‬ ‫‪hekneet‬‬ ‫‪ot‬‬ ‫‪hebaseoft‬‬ ‫‪het‬‬ ‫‪oes.‬‬
‫‪Longl‬‬ ‫‪egcast‬‬ ‫‪:‬‬‫‪ext‬‬‫‪endsf‬‬ ‫‪r‬‬‫‪om t‬‬‫‪heupperormi‬‬ ‫‪ddl‬‬‫‪et‬‬ ‫‪hi‬‬‫‪ght‬‬‫‪ot‬‬ ‫‪hebaseoft‬‬ ‫‪het‬‬‫‪oes.‬‬‫‪−‬‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﺎﺟ‬ ‫ﺰﺟ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻑ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍﻷ‬‫ﻘﻲ‬‫ﻠ‬
‫ﻳ‬
‫‪.‬‬‫ﻴﻖ‬‫ﺒ‬‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‪30‬ﺩ‬ ‫ﻌ‬‫ﺯﻥﺑ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺘﺤ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬ ‫ﻳ‬
‫ﺔﻭ‬ ‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﻟﻰ‪15‬ﺩ‬ ‫ﻮﻥ‪10‬ﺇ‬ ‫‪،‬ﺗﺠﻒﻓﻲﻏﻀ‬ ‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻔ‬‫ﺧ‬
‫‪.‬‬‫ﺎﺳﻲ‬‫ﺍﻷﺳ‬ ‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻘ‬‫ﻟﻰﻧ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺪﺗ‬‫ﻗ‬‫ﻤﻦﻭ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﻬﻲﻏ‬ ‫‪،‬ﻓ‬ ‫ﻟﻚ‬‫ﻊﺫ‬ ‫ﻣ‬‫؛ﻭ‬ ‫ﺎ‬‫ﻬ‬‫ﻔ‬‫ﻴ‬‫ﻔ‬
‫ﺓﺗﺠ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻋ‬‫ﺇ‬‫ﺀﻭ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻓﻲ‬‫ﺮﻫ‬‫ﻤ‬‫ﻜﻦﻏ‬ ‫ﻤ‬
‫ﻳ‬‫ﻭ‬
‫‪:‬‬
‫ﻘﻄﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻭ‬ ‫ﺘ‬‫ﻴﺴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻮﺟ‬‫ﻨﺴ‬‫ﻟﺐﻣ‬ ‫ﺍ‬
‫ﻮ‬‫ﻗ‬
‫‪.‬‬
‫ﺎ‬‫ً‬
‫ﺒ‬
‫ﻳ‬‫ﺮ‬‫ﻘ‬‫ﺭﺗ‬‫ﻮ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺯﻥﻋ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﻪﺗﺤ‬‫ﻨ‬‫ﻜ‬‫ﻤ‬‫ﻳ‬‫ﺘﻰﻳﺠﻒﻭ‬ ‫ﺋﻖﺣ‬ ‫ﺎ‬‫ﻗ‬‫ﻟﻰ‪10‬ﺩ‬ ‫ﻟﻲ‪7‬ﺇ‬ ‫ﺍ‬‫ﻮ‬
‫ﺮﻕﺣ‬ ‫ﻐ‬
‫ﺘ‬‫ﻳﺴ‬
‫‪:‬‬
‫ﻟﺐ‬ ‫ﺍ‬
‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬
‫‪.‬‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻟﻰﻗ‬ ‫ﺔﺇ‬‫ﺒ‬‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﻞ‬‫ﺃﺳ‬ ‫ﺪﻣﻦ‬ ‫ﺘ‬‫ﻤ‬‫‪:‬ﻳ‬‫ﺎﻕ‬‫ﻠﺴ‬‫ﻟ‬‫ﺮ‬‫ﻴ‬
‫ﻟﺐﻗﺼ‬ ‫ﺎ‬
‫‪-‬ﻗ‬
‫‪.‬‬
‫ﻡ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬
‫ﻟﻰﻗ‬‫ﻭﺳﻂﺇ‬ ‫ﺃﺍﻷ‬‫ﻮﻱﻭ‬ ‫ﻠ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﺬ‬‫ﻔﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﺘ‬‫ﻤ‬‫‪:‬ﻳ‬‫ﺎﻕ‬‫ﻠﺴ‬
‫ﻟ‬ ‫ﻳﻞ‬‫ﻮ‬‫ﻟﺐﻃ‬ ‫ﺎ‬
‫‪-‬ﻗ‬

‫‪39‬‬
 (
Fig.7)Ty
pesofl
egcast

−Shor
tarm cast:extendsfrom bel owt heel bowt ot hepalm.
−ThumbSpi caorgaunt l
etcast:ex tendsf rom belowt heelbowt othepalm and
i
ncl
udesthet humb.
Longarm cast:extendsfr
om axill
at opal m, wit
ht heelbownor mall
y−
i
mmobili
zedatar i
ghtangle.
.‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﻟﻰﺭ‬‫ﻮﻉﺇ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬‫ﺪﻣﻦ‬‫ﺘ‬‫ﻤ‬‫ﻳ‬:
‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬
‫ﻠ‬‫ﻟ‬‫ﺮ‬
‫ﻴ‬‫ﻟﺐﻗﺼ‬ ‫ﺎ‬‫ﻗ‬-
.‫ﻡ‬‫ﺎ‬‫ﻬ‬‫ﺑ‬
‫ﺍﻹ‬‫ﻤﻦ‬‫ﺘﻀ‬ ‫ﻳ‬
‫ﺪﻭ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﻟﻰﺭ‬‫ﻮﻉﺇ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬ ‫ﺪﻣﻦ‬‫ﺘ‬‫ﻤ‬‫ﻳ‬:gauntl
etcast‫ﺃ‬
‫ﻭ‬Spica‫ﻡ‬ ‫ﺎ‬
‫ﻬ‬‫ﺑ‬‫ﺍﻹ‬-
.‫ﺔ‬‫ﻤ‬‫ﺋ‬
‫ﺎ‬‫ﺔﻗ‬‫ﻳ‬‫ﻭ‬‫ﺍ‬
‫ﺰ‬‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻮﻉﻋ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﻊﺗ‬ ‫ﻣ‬،‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺍﺣ‬‫ﻟﻰﺭ‬‫ﻹﻂﺇ‬‫ﻣﺍﺑ‬
‫ﺪﻦ‬ ‫ﺘ‬‫ﻤ‬‫ﻳ‬:‫ﺑ‬
‫ﻣﺍﻹﻂ‬‫ﻳﻞ ﻦ‬‫ﻮ‬‫ﺍﻉﻃ‬ ‫ﺭ‬‫ﺫ‬-

(
Fig.8)Ty
pesofar
m cast

−Walkingcast:ashortorlonglegcastwi
tharubberormetalwalki
ngdevi
ce
at
tachedtothefoot.
Bodycast:encasesthetrunk.−
.‫ﻡ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺎ‬
‫ﺘﺼﻞﺑ‬‫ﻧﻲﻣ‬ ‫ﺪ‬‫ﻌ‬
‫ﻭﻣ‬ ‫ﺃ‬‫ﺎﻃﻲ‬‫ﺯﻣﺸﻲﻣﻄ‬‫ﺎ‬
‫ﻬ‬‫ﻊﺟ‬‫ﺎﻕﻣ‬‫ﻠﺴ‬‫ﻟ‬
‫ﻳﻞ‬‫ﻮ‬‫ﻭﻃ‬‫ﺃ‬‫ﺮ‬‫ﻴ‬
‫ﻟﺐﻗﺼ‬ ‫ﺎ‬
‫ﻗ‬:‫ﻤﺸﻲ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺐ‬
‫ﺎ‬‫ﻗ‬-
.‫ﺬﻉ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻠﻒ‬ ‫ﻐ‬
‫ﻳ‬:‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﻟﺐ‬
‫ﺎ‬‫ﻗ‬-

(
Fig.9)Ty
pesofspi
cacast

−Shoul
derspi
cacast
:abodycastt
hatencasesthet
runk,
shoul
der,
andel
bow.
Hipspi
cacast
:abodycastt
hatencasest
het r
unkandoneorbothl
ower−

40
ext
remi
ti
es.
.‫ﻓﻖ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻒﻭ‬ ‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺬﻉﻭ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﻠﻒ‬ ‫ﻐ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﻟﺐ‬ ‫ﺎ‬‫ﻗ‬: ‫ﺔ‬‫ﻠ‬‫ﺒ‬‫ﻨ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺘﻒ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻟﺐ‬‫ﺎ‬‫ﻗ‬-
.
‫ﻴﻦ‬ ‫ﻴ‬‫ﻠ‬‫ﻔ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻴﻦ‬‫ﻓ‬‫ﺮ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﻭﻛﻼ‬ ‫ﺃ‬‫ﺪ‬‫ﺃﺣ‬‫ﺬﻉﻭ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻠﻒ‬ ‫ﻐ‬
‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬ ‫ﺍ‬ ‫ﻟﺐ‬ ‫ﺎ‬
‫ﻗ‬: ‫ﺭﻙ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻟﺐ‬‫ﺎ‬‫ﻗ‬-
Pur posesofcastcut ting:
Cast smaybecutf ordi ffer entreasonst o:
1.Al lowf orwounddr essi ngs.
2.Exami neapai nful area.
3.Rel ievepr essur e.
Cut ti
ngcasti nt hef ollowi ngf orms:
a.Bi valvingt heCast :
Bivalv i
ngi st her ecommendedmet hodf oremer gencycut ti
ngt or eliev epr essur e.
b.Wi ndowi ngt heCast :
Thispr ocedur eisdoneonspeci ficor deroft hephy sici
an.
:‫ﻟﺼﺐ‬ ‫ﺍ‬‫ﻊ‬‫ﺍ ﺽﻗﻄ‬ ‫ﺮ‬‫ﻏ‬‫ﺃ‬
:‫ﺃﺟﻞ‬ ‫ﺔﻣﻦ‬ ‫ﻔ‬‫ﻠ‬
‫ﺘ‬ ‫ﺎﺏﻣﺨ‬ ‫ﺒ‬‫ﻟﺐﻷﺳ‬ ‫ﺍ‬‫ﻮ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺘﻢﻗﻄ‬ ‫ﺪﻳ‬‫ﻗ‬
.‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﺎﺡﺑﻀ‬ ‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬.1
.
‫ﺔ‬ ‫ﻤ‬‫ﻟ‬‫ﺆ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬ ‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬ ‫ﺍ‬.2
.
‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﺗﺨ‬.3
:‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺎ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻝ‬‫ﻜ‬ ‫ﺍﻷﺷ‬ ‫ﺮﻓﻲ‬ ‫ﺰﻫ‬‫ﻟ‬‫ﺍ‬‫ﻗﺺ‬
:‫ﻮﺏ‬ ‫ﺒ‬
‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬.‫ﺃ‬
.‫ﻐﻂ‬‫ﻟﻀ‬ ‫ﺍ‬ ‫ﻴﻒ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬ ‫ﺭﺉ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﻊ‬‫ﻘﻄ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎ‬‫ﻬ‬‫ﻮﺻﻰﺑ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬ ‫ﻳ‬‫ﺮ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﻴﻦﻫﻲ‬ ‫ﺘ‬
‫ﻓ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬
:‫ﻮﺏ‬ ‫ﺒ‬
‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻟﻒ‬ .‫ﺏ‬
.‫ﻴﺐ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﺩﻣﻦ‬ ‫ﺪ‬ ‫ﻠﺐﻣﺤ‬ ‫ﻠﻰﻃ‬ ‫ﺀﻋ‬ً‫ﺎ‬‫ﻨ‬‫ﺀﺑ‬ ‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺍ‬
‫ﺬ‬‫ﺀﻫ‬ ‫ﺍ‬‫ﺮ‬‫ﺘﻢﺇﺟ‬‫ﻳ‬
Gener alNur si ngmanagementoft hepat ientwi thacast :
a.Checkt heedgesoft hecastandal lskinar easwher et hecastedgesmay
causepr essur e.I fther ear esi gnsofedemaorci rculator yimpai rment ,notifythe
char genur seorphy siciani mmedi ately.
−Sl ipy ourf inger sundert hecastedgest odet ectanypl astercr umbsorot her
foreignmat er i
al.Mov et heski nbackandf or thgent lytost i
mul ateci rculation.
−Leandownandsmel l t
hecastt odet ectodor si ndicatingt i
ssuedamage.A
must yormol dyodoratt hesur faceoft hecastmaybet hef irsti ndi cat i
ont hat
necr osisf rom pr essur ehasdev elopedunder neat h.
−Checkt hei ntegr i
tyoft hecastbyl ooki ngf orcr acks, br eaks, andsof tspot s.
b.Thecast edbodypar tmustbeexami nedandassessedf requent l
yi nor dert o
prev entcompl icat i
ons.
−Assessci rculat i
onbyper formi ngt hebl anchi ngt estandcompar ingt heski n
temper atur eandbl anchi ngr eact ionoft heaf fect edlimbt ot hatoft he
unaf fectedl imb.
Assesst hepr esenceofsensat i
oni nt heaf fect edl i
mbbyt ouchi ngex posed−
areasofski nandi nst ruct i
ngt hepat ientt odescr ibewhathef elt.
:
‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺠ‬ ‫ﺎ‬
‫ﻳ ﺾﺑ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﻡ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺎﻙ‬
‫ﻨ‬‫ﻧﺖﻫ‬ ‫ﺎ‬‫ﺍﻛ‬ ‫ﺫ‬‫ﺇ‬.‫ﺒﺲ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﻮ‬ ‫ﺎﺣ‬ ‫ﻬ‬‫ﻴ‬‫ﺎﻓ‬ ً‫ﻐ‬
‫ﻄ‬ ‫ﺒﺐ ﺿ‬ ‫ﺪﺗﺴ‬ ‫ﺘﻲﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬
‫ﻊﻣ‬ ‫ﻴ‬‫ﻤ‬‫ﺒﺲﻭﺟ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﺍﻑ‬ ‫ﻮ‬ ‫ﻓﺤ ﺺﺣ‬ ‫ﺍ‬.‫ﺃ‬
‫ﻠﻰ‬‫ﻭﻝﻋ‬ ‫ﺆ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﺐ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺇﻼﻍ‬‫ﻳﺠﺐﺑ‬، ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬
‫ﻌﻒﻓﻲ‬ ‫ﻭﺿ‬ ‫ﺃ‬ ‫ﺔ‬‫ﻣ‬ ‫ﺫ‬‫ﺩﻭ‬ ‫ﻮ‬‫ﻠﻰﻭﺟ‬ ‫ﺎﺕﻋ‬ ‫ﻣ‬‫ﻋﻼ‬
.‫ﺭ‬
‫ﻮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﺮﻙ‬‫ﺣ‬. ‫ﺮﻯ‬ ‫ﺃﺧ‬ ‫ﺔ‬‫ﺒ‬‫ﻳ‬‫ﺮ‬‫ﺓﻏ‬ ‫ﺩ‬‫ﺎ‬‫ﺃﻱﻣ‬ ‫ﻭ‬ ‫ﺃ‬‫ﺒﺲ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺎﺕﻣﻦ‬ ‫ﺘ‬‫ﺃﻱﻓ‬ ‫ﺎﻑ‬ ‫ﺘﺸ‬ ‫ﻛ‬‫ﺒﺲﻻ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﻮ‬‫ﻔﻞﺣ‬ ‫ﺃﺳ‬ ‫ﻌﻚ‬ ‫ﺑ‬
‫ﺎ‬‫ﺃﺻ‬ ‫ﺮﻙ‬ ‫ﺣ‬-
.
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬
‫ﻭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻂ‬ ‫ﻨﺸ‬ ‫ﺘ‬‫ﻟ‬‫ﻓﻖ‬ ‫ﺮ‬‫ﺎﺑ‬ً
‫ﺑ‬
‫ﺎ‬‫ﻳ‬‫ﺇ‬‫ﺎﻭ‬ً
‫ﺑ‬‫ﺎ‬
‫ﺫﻫ‬
‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫ﻗ‬. ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻠﻒ‬ ‫ﻟﻰﺗ‬ ‫ﺮﺇ‬ ‫ﻴ‬‫ﺘﻲﺗﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﺋﺢ‬ ‫ﺍ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻑ‬ ‫ﺘﺸ‬ ‫ﻛ‬‫ﺓﻻ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺘﻢﺭ‬ ‫ﺍﺷ‬ ‫ﻔﻞﻭ‬ ‫ﺃﺳ‬ ‫ﻟﻰ‬‫ﻨﻲﺇ‬ ‫ﻧﺤ‬ ‫ﺍ‬
-
.‫ﺎ‬
‫ﻬ‬ ‫ﺘ‬
‫ﻐﻂﺗﺤ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻭﺙﻧﺨ‬ ‫ﺪ‬‫ﻠﻰﺣ‬ ‫ﺮﻋ‬ ‫ﺆﺷ‬ ‫ﻭﻝﻣ‬ ‫ﺃ‬‫ﺓﻫﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻠﻰﺳﻄﺢ‬ ‫ﺔﻋ‬‫ﻨ‬‫ﻔ‬‫ﻌ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﻨ‬‫ﻔ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻨ‬‫ﻴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻘ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﻮﻕﻭ‬ ‫ﻘ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺒﺤﺚﻋﻦ‬ ‫ﻟ‬‫ﺍ‬‫ﺓﻣﻦﺧﻼﻝ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬‫ﻘﻖﻣﻦﺳ ﻣ‬ ‫ﺗﺤ‬-
.
‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﻊﺣ‬ ‫ﻨ‬‫ﺃﺟﻞﻣ‬ ‫ﺭﻣﻦ‬ ‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﻪﺑﺸ‬ ‫ﻤ‬
‫ﻴ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬
‫ﻟﺠﺴﻢﻭ‬ ‫ﺍ‬‫ﻮﺏﻣﻦ‬ ‫ﺒ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺰ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﻳﺠﺐﻓﺤ ﺺ‬. ‫ﺏ‬

41
 ‫ﻠﻖ‬‫ﻟﺴ‬‫ﺍ‬‫ﻌﻞ‬ ‫ﺩﻓ‬ ‫ﺭ‬
‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﺔﺣ‬ ‫ﺭﺟ‬ ‫ﺔﺩ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬‫ﻘ‬
‫ﻣ‬‫ﻠﻖﻭ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﻳﻖﺇﺟ‬ ‫ﺮ‬
‫ﺔﻋﻦﻃ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.‫ﺎﺏ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺮﻑﻏ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﺎﺏﻣ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻠﻄ‬‫ﻟ‬
‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬ ‫ﺇ‬‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻓ‬‫ﻮ‬‫ﻜﺸ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬ ‫ﺎﻃﻖ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻤﺲ‬ ‫ﻟ‬
‫ﻳﻖ‬ ‫ﺮ‬‫ﺎﺏﻋﻦﻃ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺎﺱﻓﻲ‬ ‫ﺍﻹﺣﺴ‬ ‫ﺩ‬
‫ﻮ‬‫ﻴﻢﻭﺟ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻗﻢﺑ‬-
.
‫ﻪ‬‫ﺮﺑ‬ ‫ﻌ‬‫ﺎﺷ‬‫ﻟﻰﻭﺻﻒﻣ‬ ‫ﻳ ﺾﺇ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
−Assesst hemot orabi l
ityoft heaf fect edl i
mbbyhav ingt hepat ientwi ggl ehis
fi
ngersort oes.
c.Patienteducat i
onwi lldomucht opr ev entcompl ications.I nstructthepat ient
todot hef ol l
owi ng.
−Av oidr estingcastonhar dsur facesorshar pedgest hatmaydentt hecast
andcausepr essur ear eas.
−Nev eruseacoathangerorot herf orei gnobj ectto" scratch"i nsidet hecast .
Thismaycauseski ndamageandi nfect i
on.
−Repor tanydangersi gnst ot henur singst af fimmedi ately.Dangersi gns
i
ncludepal e, coldf i
nger sort oes, t
ingling, numbness, increasedpai n, pressur e
spots,odor ,orfeel i
ngt hatt hecasthasbecomet oot i
ght .
−Repor tanydamaget ot hecastsuchascr acks, breaks, orsof tspot s.
Nev erat temptt or emov eoral tert hecast .−
.
‫ﻪ‬ ‫ﻣ‬‫ﺪ‬‫ﻊﻗ‬ ‫ﺑ‬
‫ﺎ‬‫ﺃﺻ‬ ‫ﻭ‬‫ﺃ‬‫ﻪ‬ ‫ﻳ‬
‫ﺪ‬‫ﻊﻳ‬ ‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﺰ‬‫ﻬ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬ ‫ﻳﻖﺟ‬ ‫ﺮ‬‫ﺎﺏﻋﻦﻃ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻠﻄ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤ‬‫ﻡﺑ‬‫ﺎ‬‫ﻴ‬
‫ﻘ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺐﻣﻦ‬ ‫ﺍﻃ‬ .‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺮ‬‫ﻴ‬‫ﺜ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻞ‬ ‫ﻔ‬‫ﻴ‬‫ﻳ ﺾﺳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻒ‬ ‫ﻘ‬‫ﺜ‬
‫ﻥﺗ‬.‫ﺝﺇ‬
‫ﺒﺐ‬‫ﺗﺴ‬ ‫ﺓﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﺙ‬‫ﻌ‬‫ﺒ‬‫ﻧ‬‫ﺍ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺪﺗ‬‫ﺘﻲﻗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺍﻑ‬‫ﻮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺒ‬‫ﻠ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﻷﺳﻄﺢ‬ ‫ﻠﻰ‬‫ﻟﺼﺐﻋ‬ ‫ﺍ‬ ‫ﻊ‬
‫ﻨﺐﻭﺿ‬ ‫ﺗﺠ‬-
.‫ﺎﻃﻖ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬ ‫ﺍ‬
‫ﻟﻚﻓﻲ‬ ‫ﺒﺐﺫ‬ ‫ﺘﺴ‬ ‫ﺪﻳ‬‫ﻗ‬.‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺍﺧﻞ‬ ‫"ﺩ‬‫ﺪﺵ‬ ‫ﻠﺨ‬‫ﻟ‬
"‫ﺮ‬ ‫ﺁﺧ‬ ‫ﻳﺐ‬ ‫ﺮ‬‫ﺃﻱﺟﺴﻢﻏ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺑﺲ‬ ‫ﺔﻣﻼ‬ ‫ﺎﻋ‬‫ﻤ‬‫ﺍﺷ‬ً
‫ﺪ‬‫ﺑ‬‫ﺃ‬‫ﻡ‬‫ﺪ‬ ‫ﺘﺨ‬‫ﻻﺗﺴ‬-
.‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻠﻒ‬‫ﺗ‬
‫ﻳﻦ‬‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﻮﺏ‬ ‫ﺮﺷﺤ‬ ‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻤﻞﻋﻼ‬ ‫ﺗﺸ‬.‫ﺭ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻋ‬ ‫ﺎﺕﺧﻄ‬ ‫ﻣ‬‫ﺃﻱﻋﻼ‬ ‫ﻳ ﺾﻋﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻢ‬‫ﺎ‬‫ﺑﻼﻍﻃ‬ ‫ﺈ‬‫ﻗﻢﺑ‬-
‫ﺄﻥ‬ ‫ﺭﺑ‬‫ﻮ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻊ‬ ‫ﻘ‬
‫ﻭﺑ‬ ‫ﺃ‬‫ﻟﻢ‬‫ﺍﻷ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻭﺯ‬ ‫ﺃ‬‫ﻴﻞ‬‫ﻤ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺰ‬‫ﻮﺧ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎ‬‫ﻤ‬‫ﺓﻫ‬‫ﺩ‬‫ﻭ‬‫ﺮ‬‫ﻭﺑ‬‫ﺃ‬ ‫ﻴﻦ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
.‫ﺟ‬
‫ﺍ‬ً‫ﺔ‬
‫ﺪ‬ ‫ﻘ‬‫ﻴ‬‫ﺒﺤﺖ ﺿ‬ ‫ﺃﺻ‬ ‫ﺓ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬
.
‫ﺔ‬‫ﻨ‬‫ﻴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻘ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺕ‬ ‫ﻘ‬‫ﻘ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﺓﻣ‬ ‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺎ‬‫ﻠﺤﻖﺑ‬ ‫ﺭﻳ‬‫ﺮ‬‫ﺃﻱ ﺿ‬ ‫ﻎﻋﻦ‬ ‫ﻠ‬‫ﺑ‬‫ﺃ‬
-
.
‫ﺎ‬‫ﺮﻫ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﻭﺗ‬‫ﺃ‬‫ﺓ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺍﺇ‬ً
‫ﺪ‬‫ﺑ‬‫ﺃ‬‫ﻭﻝ‬‫ﺎ‬‫ﻻﺗﺤ‬-

Patientcareaf t
ercastr emov al:
a.Af t
eracasthasbeenr emov ed,conti
nuet opr ovi
desupportt ojoint
sand
normal bodycur ves.
Themuscl eswillhavebecomeweakenedf rom disuseand,althoughmov ement
i
sencour aged, supportisnecessar y.
Usef ir
m pill
owst osuppor tt
hepat ientwhi l
ei nbedanduseel ast i
cbandagesor
anar m sli
ng,ifnecessary,whent hepat ientisupandabout .
b.Av oidvi
gorousat tempt st
or emov eski nexudateandcr ust
sofdeadski ncell
s,
whichar epresentwhenacasthasbeeni nplaceforseveralweeks.
Gent l
esoakingandappl i
cati
onsofoi l
tosof tentheskinandl oosencr ust
smay
ber ecommended.
c.Af t
erthecasti sremov ed,
thephy si
cianorphy sicalt
herapi
stmaypr escri
be
exercisestoincreasest r
ength.
Atrophyoft hepar tmaybenot i
ced,butt hisshouldgraduall
ydi sappearwit
ht he
ret
ur nofmuscl efunction.

42
 ‫‪:‬‬‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺪﺇ‬‫ﻌ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺭﻋ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻨ‬‫ﻨﺤ‬‫ﻣ‬‫ﺎﺻﻞﻭ‬ ‫ﻔ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺪﻋﻢ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺮﻓﻲﺗ‬ ‫ﻤ‬‫ﺘ‬
‫ﺍﺳ‬ ‫‪،‬‬‫ﺓ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺪﺇ‬‫ﻌ‬‫‪.‬ﺑ‬‫ﺃ‬
‫‪.‬‬
‫ﺭﻱ‬‫ﻭ‬‫ﺮ‬
‫ﺪﻋﻢ ﺿ‬‫ﻟ‬
‫ﺍ‬‫ﻻﻥ‬
‫‪،‬ﺇﺃ‬ ‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻏﻢﻣﻦﺗﺸﺠ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫‪،‬ﻭﻋ‬ ‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﻻﺳ‬ ‫ﻡ‬‫ﺪ‬‫ﺒﺐﻋ‬ ‫ﻌﻀﻼﺕﺑﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬‫ﺘﻀ‬ ‫ﺳ‬
‫ﺍﻉ‬‫ﺭ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻤ‬‫ﻭﺣ‬‫ﺃ‬‫ﺔ‬‫ﻧ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﻡ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬‫ﺮﻭ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻩﻓﻲ‬‫ﺩ‬‫ﻮ‬‫ﺀﻭﺟ‬ ‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻋﻢ‬‫ﺪ‬ ‫ﻟ‬
‫ﺔ‬ ‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺪﺛ‬‫ﺋ‬‫ﺎ‬
‫ﻡﻭﺳ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬
‫‪.‬‬
‫ﺎ‬‫ﻘً‬
‫ﻈ‬ ‫ﻴ‬‫ﺘ‬‫ﻳ ﺾﻣﺴ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬ ‫ﻨ‬
‫ﻣ‪،‬ﻋ‬‫ﺍﻷﺮ‬ ‫ﻡ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺫ‬‫‪،‬ﺇ‬
‫ﺪ‬
‫ﻨ‬‫ﺓﻋ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻮﻥﻣ‬‫ﻜ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫‪،‬ﻭ‬‫ﺔ‬‫ﺘ‬‫ﻴ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﺭﺧﻼ‬ ‫ﻮ‬‫ﻗﺸ‬‫ﺪﻭ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺯﺔﺇ‬
‫ﻟ‬‫ﺔﻹﺍ‬ ‫ﻳ‬
‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻭﻻﺕ‬ ‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺐ‬‫‪.‬ﺗﺠ‬‫ﺏ‬
‫‪.‬‬‫ﻊ‬‫ﻴ‬
‫ﺑ‬‫ﺎ‬‫ﺃﺳ‬‫ﺓ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﻪ‬‫ﻧ‬
‫ﺎ‬‫ﻜ‬ ‫ﺒﺲﻓﻲﻣ‬ ‫ﻟﺠ‬
‫ﺍ‬‫ﻊ‬‫ﻭﺿ‬
‫‪.‬‬
‫ﺭ‬‫ﻮ‬‫ﻘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻴ‬‫ﻠ‬‫ﺗ‬
‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻴﻢ‬‫ﻌ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﻳﺖ‬ ‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻴﻒﻭ‬ ‫ﻠﻄ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻘ‬‫ﻨ‬
‫ﻟ‬‫ﺎ‬
‫ﻮﺻﻰﺑ‬ ‫ﺪﻳ‬ ‫ﻗ‬
‫‪.‬‬‫ﺓ‬
‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺰ‬‫ﻟ‬ ‫ﻳﻦ‬‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﻌﻲﺗ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻟﺞ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﺐ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺪﻳﺼﻒ‬ ‫‪،‬ﻗ‬‫ﺓ‬ ‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺪﺇ‬‫ﻌ‬‫‪.‬ﺑ‬‫ﺝ‬
‫‪.‬‬‫ﻌﻀﻼﺕ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﺓﻭﻇ‬ ‫ﺩ‬‫ﻮ‬‫ﻊﻋ‬ ‫ﺎﻣ‬
‫ً‬
‫ﻴ‬‫ﻳﺠ‬ ‫ﺭ‬
‫ﺪ‬‫ﻔﻲﺗ‬ ‫ﺘ‬
‫ﺃﻥﻳﺨ‬ ‫ﺍﻳﺠﺐ‬ ‫ﺬ‬‫ﻜﻦﻫ‬ ‫ﻟ‬‫‪،‬‬‫ﺀ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺭﻓﻲ‬ ‫ﻮ‬‫ﻤ‬‫ﻳﻻﺣﻆ ﺿ‬‫ﺪُ‬ ‫ﻗ‬

‫‪Spl‬‬
‫‪i‬‬‫‪nt‬‬
‫‪s‬‬
‫‪Lear‬‬‫‪ni‬‬‫‪ngobj‬‬‫‪ect‬‬‫‪i‬‬
‫‪v‬‬‫‪es:‬‬
‫‪Att‬‬‫‪heendoft‬‬ ‫‪hi‬‬
‫‪sl‬‬‫‪ect‬‬‫‪ur‬‬
‫;‪e‬‬‫‪t‬‬‫‪hest‬‬‫‪udentwi‬‬‫‪l‬‬
‫‪lbeabl‬‬‫‪et‬‬‫‪o:‬‬
‫‪1.Def‬‬‫‪i‬‬‫‪nespl‬‬‫‪i‬‬
‫‪nt‬‬‫‪.‬‬
‫‪2.Sel‬‬‫‪ectf‬‬‫‪ourr‬‬‫‪easonsf‬‬‫‪ort‬‬‫‪heuseofspl‬‬‫‪i‬‬
‫‪nt‬‬‫‪.‬‬
‫‪3.Li‬‬‫‪stt‬‬‫‪hr‬‬
‫‪eet‬‬‫‪y‬‬‫‪pesofspl‬‬ ‫‪i‬‬
‫‪nt‬‬‫‪s.‬‬
‫‪4.I‬‬‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪yt‬‬‫‪henur‬‬‫‪si‬‬‫‪ngcar‬‬‫‪emanagementpr‬‬ ‫‪i‬‬
‫‪nci‬‬‫‪pl‬‬
‫‪esf‬‬‫‪orapat‬‬ ‫‪i‬‬
‫‪enti‬‬‫‪nspl‬‬‫‪i‬‬
‫‪nt‬‬‫‪s.‬‬
‫ﺮ‬
‫ﺋ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬
‫‪:‬‬
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
‫ﻣ‪:‬‬
‫ﻟﺐ ﻦ‬‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬
‫ﻴ‬‫‪.‬ﺳ‬‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
‫‪.‬‬
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫‪.‬ﺗﺤ‬‫‪1‬‬
‫‪.‬‬‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺏﻻﺳ‬‫ﺒ‬‫ﺃﺳ‬‫ﺔ‬‫ﻌ‬‫ﺑ‬‫ﺭ‬
‫ﺃ‬‫ﺩ‬‫ﺪ‬‫‪.‬ﺣ‬‫‪2‬‬
‫‪.‬‬‫ﺮ‬
‫ﺋ‬‫ﺎ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺍﻉﻣﻦ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬‫ﺔ‬‫ﺛ‬‫ﺑﻼ‬
‫ﺔﺜ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻊﻗ‬ ‫‪.‬ﺿ‬‫‪3‬‬
‫‪.‬‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬‫ﻟﺠ‬
‫ﺎ‬
‫ﺎﺏﺑ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺩﺉﺇ‬‫ﺎ‬
‫ﺒ‬‫ﻠﻰﻣ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪4‬‬
‫‪Spl‬‬
‫‪i‬‬‫‪nt‬‬
‫‪s‬‬

‫‪43‬‬
Def i
niti
on:
Isadev i
ceusedf orsupportori mmobi li
zati
onofal i
mbort hespine.
Pur poses:
1.Toi mmobi lizetheaf f
ectedbodypar tbeforetreatmentbegi nsorunt i
l
swel l
ingsubsi des.
2.Toi mmobi lizetheaf f
ectedbodypar timmedi atel
yaf terani nj
ury,atempor ary
splintisnecessar yfortherapeuticpurposes.
3.Tosuppor tthej oi
ntsduringact i
vit
y.
Ty pesofspl i
nt s:
Hal f-
castspl int:
Isaspl intinwhi chafullcastisappl i
ed,thensawedi nhal flengthwise(bivalved).
Thebot tom hal fofthecastmaybeusedal one,orbot hhal vesmayr emainin
place.
Hal f-
cast sarehel dinplacewi thanel asti
croll
erbandage.
:
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
.
‫ﺮﻱ‬ ‫ﻘ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﻮ‬ ‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺍﻑ‬ ‫ﺮ‬
‫ﺍﻷﻃ‬ ‫ﺪ‬‫ﺃﺣ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﻭﺗ‬‫ﺃ‬‫ﺪﻋﻢ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﺯﻳﺴ‬ ‫ﺎ‬
‫ﻬ‬‫ﻮﺟ‬ ‫ﻫ‬
:‫ﺪ‬‫ﺎﺻ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻝ‬‫ﻭ‬‫ﺘﻰﺯ‬ ‫ﺝﻭﺣ‬‫ﻌﻼ ﺃ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺪ‬‫ﺒﻞﺑ‬‫ﻟﺠﺴﻢﻗ‬ ‫ﺍ‬‫ﺎﺏﻣﻦ‬ ‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬
‫ﻟﺸﻞﺣ‬ .1
‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻟﻸﻏ‬‫ﺔ‬ ‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﺓﻣ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻡﺟ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺭﻱ‬‫ﻭ‬‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬‫ﻣﻦ‬،‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪ‬‫ﻌ‬‫ﺓﺑ‬‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﺎﺏﻣ‬ ‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬
‫ﻟﺸﻞﺣ‬ .2
.‫ﺟ‬
‫ﺔ‬‫ﻴ‬
.‫ﺎﻁ‬‫ﻨﺸ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻋﻢ‬‫ﺪ‬‫ﻟ‬.3
:
‫ﺮ‬‫ﺋ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬
:‫ﻮﺏ‬‫ﺒ‬‫ﺓﻧﺼﻒﻣﺼ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺟ‬
.(
‫ﻴﻦ‬‫ﺘ‬‫ﻓ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﻭ‬
‫ﺫ‬)‫ﻮﻝ‬ ‫ﻟﻄ‬‫ﺎ‬
‫ﻴﻦﺑ‬‫ﻔ‬‫ﺮﻧﺼ‬‫ﻨﺸ‬ُ‫ﺛﻢ‬،
‫ﻳ‬ ‫ﻣﻞ‬‫ﺎ‬‫ﻟﺐﻛ‬ ‫ﺎ‬
‫ﻊﻗ‬ ‫ﺎﻭﺿ‬‫ﻬ‬‫ﻴ‬‫ﺘﻢﻓ‬‫ﺓﻳ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻫﻲﺟ‬
.‫ﺎ‬‫ﻤ‬
‫ﻬ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬ ‫ﺎﻥﻓﻲﻣ‬ ‫ﻔ‬
‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺃﻥﻳﻈﻞ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻭﻳ‬،‫ﻩﺃ‬‫ﺩ‬‫ﺮ‬‫ﻔ‬‫ﻤ‬
‫ﻮﺏﺑ‬ ‫ﺒ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻲﻣﻦ‬ ‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﻨﺼﻒ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
.
‫ﺔ‬ ‫ﻧ‬
‫ﺮ‬‫ﺓﻣ‬‫ﺭ‬‫ﺍ‬
‫ﻭ‬‫ﺓﺩ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﺎﺑﻀ‬‫ﻬ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻟﺐﻓﻲﻣ‬ ‫ﺍ‬‫ﻮ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺖﻧﺼﻒ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘﻢﺗ‬‫ﻳ‬

(
Fig.10)Hal
f-
castspl
i
nt
Infl
atablespl i
nt:
Itisaplast i
cbagt hati
sinflat
edinsideasecondplasticbagwithazipperon
onesi de.
Althought heyaremostof tenusedi nemergencyf
irstaid,acut
ecar
ef aci
li
ti
es
alsousei nflat
ablespli
nts.
Thesespl intsareavail
ableindif
ferentsi
zestofi
tvariousbodypart
s, i
ncl
uding

44
‫‪t‬‬‫‪hel‬‬‫‪eg,‬‬‫‪ankl‬‬‫‪e,‬‬‫‪andar‬‬ ‫‪m.‬‬
‫‪Thi‬‬‫‪sspl‬‬ ‫‪i‬‬
‫‪nti‬‬‫‪scomf‬‬ ‫‪or‬‬‫‪t‬‬
‫‪abl‬‬‫‪ebecausei‬‬ ‫‪ti‬‬‫‪sl‬‬‫‪i‬‬
‫‪ght‬‬‫‪wei‬‬‫‪ght‬‬‫‪.‬‬
‫‪I‬‬
‫‪ti‬‬ ‫‪sal‬‬‫‪soconv‬‬ ‫‪eni‬‬‫‪entf‬‬‫‪orheal‬‬‫‪t‬‬‫‪hcar‬‬‫‪eper‬‬‫‪sonnel‬‬ ‫‪t‬‬
‫‪ousebecausei‬‬ ‫‪ti‬‬‫‪st‬‬‫‪r‬‬‫‪anspar‬‬‫‪ent‬‬
‫‪anddoesnotneedt‬‬ ‫‪ober‬‬ ‫‪emov‬‬ ‫‪edwhenx-‬‬ ‫‪r‬‬
‫‪ayf‬‬‫‪i‬‬‫‪l‬‬
‫‪msar‬‬ ‫‪et‬‬‫‪aken.Becar‬‬ ‫‪ef‬‬‫‪ul‬‬‫‪nott‬‬‫‪o‬‬
‫‪punct‬‬‫‪ur‬‬‫‪eani‬‬ ‫‪nf‬‬‫‪l‬‬‫‪at‬‬‫‪abl‬‬‫‪espl‬‬‫‪i‬‬
‫‪nt‬‬‫‪.‬‬
‫‪:‬‬
‫ﻔﺦ‬ ‫ﺓﻧ‬
‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺟ‬
‫‪.‬‬
‫ﺪ‬‫ﺍﺣ‬‫ﻧﺐﻭ‬ ‫ﺎ‬
‫ﺎﺏﻣﻦﺟ‬ ‫ﺎﻥﺑﺴﺤ‬‫ﻜﻲﺛ‬‫ﻴ‬‫ﺘ‬‫ﻴﺲﺑﻼﺳ‬ ‫ﺍﺧﻞﻛ‬‫ﻪﺩ‬ ‫ﻔﺨ‬‫ﺘﻢﻧ‬‫ﻜﻲﻳ‬‫ﻴ‬‫ﺘ‬‫ﻴﺲﺑﻼﺳ‬ ‫ﺓﻋﻦﻛ‬ ‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻭﻫﻲﻋ‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺍ‬‫ﺮ‬‫ﻻﻥﻣ‬‫‪،‬ﺇﺃ‬ ‫ﺭﺉ‬‫ﺍ‬‫ﻮ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺎﻻﺕ‬‫ﺔﻓﻲﺣ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻓ‬
‫ﺎ‬‫ﻌ‬‫ﺍﻹﺳ‬ ‫ﻏﺎﻓﻲ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫ﻡﺎ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﺎﺗﺴ‬‫ﻬ‬‫ﻧ‬‫ﺃ‬‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬
‫‪.‬‬‫ﻔﺦ‬‫ﻨ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬
‫ﻠ‬‫ﺑ‬‫ﺎ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎ‬
‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﺓﺗﺴ‬‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬
‫‪.‬‬‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺣﻞﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻕﻭ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫‪،‬ﺑ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺰ‬‫ﺃﺟ‬ ‫ﻠﻒ‬‫ﺘ‬
‫ﺎﺳﺐﻣﺨ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﻡﻣﺨ‬ ‫ﺎ‬
‫ﺄﺣﺠ‬ ‫ﺮﺑ‬‫ﺋ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻩ‬ ‫ﺬ‬
‫ﺮﻫ‬ ‫ﻓ‬‫ﻮ‬‫ﺘ‬
‫ﺗ‬
‫‪.‬‬
‫ﺯﻥ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻔ‬‫ﻷﺎﺧ‬
‫ﻬ‬‫ﺔﻧ‬ ‫ﻳﺤ‬‫ﺮ‬‫ﺓﻣ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻫ‬
‫ﺎﻁ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻪﻋ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺯ‬‫ﻟﻰﺇ‬ ‫ﺎﺝﺇ‬‫ﺘ‬‫ﺎﻑﻭﻻﻳﺤ‬ ‫ﻔ‬
‫ﻪﺷ‬ ‫ﻧ‬
‫ﻡﻷ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﻟﻼﺳ‬‫ﺔ‬‫ﻴ‬‫ﻟﺼﺤ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﺮﻋ‬
‫ﻟ‬‫ﺍ‬‫ﻔﻲ‬‫ﻮﻇ‬ ‫ﻤ‬
‫ﻟ‬‫ﺎ‬‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫ﺎﺳﺐ‬‫ﻨ‬‫ﻪﻣ‬‫ﻧ‬‫ﺃ‬‫ﺎ‬
‫ﻤ‬‫ﻛ‬
‫‪.‬‬
‫ﻔﺦ‬‫ﻨ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻠ‬‫ﺑ‬
‫ﺎ‬‫ﺓﻗ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻘﺐﺟ‬ ‫ﻡﺛ‬‫ﺪ‬ ‫ﻠﻰﻋ‬‫ﺮ ﺹﻋ‬ ‫ﺍﺣ‬‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬‫ﻡ‬‫ﺃﻼ‬‫ﻓ‬

‫(‬
‫‪Fi‬‬‫‪g.11)I‬‬
‫‪nf‬‬‫‪l‬‬
‫‪at‬‬‫‪abl‬‬
‫‪espl‬‬
‫‪i‬‬‫‪nt‬‬

‫‪Thomasorr‬‬‫‪i‬‬‫‪ngspl‬‬‫‪i‬‬‫‪nt‬‬‫‪s:‬‬
‫‪I‬‬‫‪saspl‬‬‫‪i‬‬
‫‪ntwhi‬‬‫‪chmaybeusedi‬‬ ‫‪ncombi‬‬ ‫‪nat‬‬‫‪i‬‬
‫‪onwi‬‬‫‪t‬‬‫‪ht‬‬‫‪r‬‬‫‪act‬‬
‫‪i‬‬‫‪on,‬‬
‫‪mol‬‬ ‫‪dedal‬‬‫‪umi‬‬‫‪num‬‬
‫‪spl‬‬
‫‪i‬‬‫‪nt‬‬
‫‪s,‬‬‫‪andot‬‬‫‪hermet‬‬ ‫‪al‬‬‫‪spl‬‬
‫‪i‬‬‫‪nt‬‬‫‪s.‬‬
‫‪Nur‬‬‫‪si‬‬
‫‪ngcar‬‬‫‪eofapat‬‬ ‫‪i‬‬
‫‪enti‬‬‫‪naspl‬‬ ‫‪i‬‬‫‪nti‬‬‫‪ssi‬‬‫‪mi‬‬‫‪l‬‬
‫‪art‬‬‫‪ot‬‬‫‪hatofapat‬‬‫‪i‬‬‫‪enti‬‬‫‪nacast‬‬‫‪.‬‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﻘ‬‫ﻠ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺱ‬‫ﻣ‬
‫ﻮ‬‫ﺗ‬
‫‪.‬‬
‫ﺮﻯ‬ ‫ﺍﻷﺧ‬
‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺪ‬
‫ﻌ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺔﻭ‬‫ﺒ‬‫ﻟ‬
‫ﻮ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍﻷ‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬
‫ﺮﻭﺟ‬ ‫ﻟﺠ‬
‫ﺍ‬‫ﻊ‬‫ﺎﻣ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬‫ﻤ‬
‫ﺓﻳ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻫﻲﺟ‬
‫‪.‬‬‫ﺒﺲ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺓﺭﻋ‬
‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻳ ﺾﻓﻲﺟ‬ ‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﺒ‬
‫ﺗﺸ‬

‫‪45‬‬
‫‪(Fig.12)Thomas splints‬‬
 Tr
act
ion
Learningobjecti
ves:
Attheendoft hi
slect
ure;thestudentwi l
lbeableto:
1.Definetr
action.
2.Selectfi
vereasonsfortheuseoft racti
on.
3.I
dent i
fytwobasicmet hodsofapply i
ngtract
ion.
4.Givenadescr i
pti
on,i
dent i
fyt
wot ypesoft r
acti
on.

46
5.Identi
fyt
henur
singcar
emanagementpr
inci
plesf
orapat
ienti
n
tr
action.
‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻌ‬
‫ﺷ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﺘ‬‫ﻴ‬‫ﺳ‬.‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻩ‬ ‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬.1
.‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺏﻻﺳ‬‫ﺒ‬‫ﺃﺳ‬‫ﺔ‬‫ﻤﺴ‬‫ﺩﺧ‬ ‫ﺪ‬‫ﺣ‬. 2
.‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﻴﻖ‬ ‫ﺒ‬
‫ﺘﻄ‬‫ﻟ‬‫ﻴﻦ‬‫ﺘ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺃﺳ‬‫ﻴﻦ‬‫ﺘ‬
‫ﻘ‬‫ﻳ‬‫ﺮ‬‫ﺪﻃ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬. 3
.
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻦﻣﻦ‬‫ﻋ‬‫ﻮ‬‫ﺩﻧ‬‫ﺪ‬‫ﺣ‬،‫ﺀﻭﺻﻒ‬ ‫ﺎ‬
‫ﻋﻄ‬ ‫ﺇ‬.4
.
‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻳ ﺾﻓﻲ ﺎ‬
‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺩﺉﺇ‬
‫ﺎ‬‫ﺒ‬
‫ﻠﻰﻣ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.5
Tr
act
ion
Defini ti
onoft ract ion:
Tract i
oni st heactofexer ti
ngapul l
ingf orcet obet herapeut ic,tractionappl ied
i
nonedi r
ect ionr equi rescount ertraction( exerti
onofpul li
nt heopposi t
e
dir
ect ion) .
Count ertract i
oni ssuppl iedbyt hepat ient '
sbodywei ghtandf r
ictionagai nstt he
bed.
Addit i
onal count er tractionmaybeachi evedbyel evati
ngt heheadorf ootoft he
bedorbyappl icat ionofcount ert ractionappar atus.
Purposesoft ract ion:
−Reduceandi mmobi l
izef ractures.
−Pr ev entf r
act ur edef ormi t
ies.
−Rel iev emuscl espasm.
−Reducepai n.
Hel pr egai nt henor mal lengt handal ignmentofani nj
uredex tremi ty.−
:‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬
‫ﺗ‬
‫ﺎ‬ً
‫ﻴ‬‫ﻜﺴ‬ ‫ﺍﻋ‬ ً
‫ﺪ‬ ‫ﻠﺐﺷ‬ ‫ﺘﻄ‬ ‫ﺪﻳ‬ ‫ﺍﺣ‬‫ﻩﻭ‬ ‫ﺎ‬‫ﺗﺠ‬
‫ﺍ‬ ‫ﺒﻖﻓﻲ‬ ‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻭ‬،‫ﺟ‬‫ﺎ‬
ً‫ﻮﻥﻋﻼ‬
‫ﻴ‬ ‫ﻜ‬‫ﻴ‬‫ﻟ‬‫ﺓﺳﺤﺐ‬ ‫ﻮ‬‫ﺔﻗ‬ ‫ﺭﺳ‬ ‫ﺎ‬‫ﻤ‬‫ﻌﻞﻣ‬ ‫ﻮﻓ‬ ‫ﺮﻫ‬ ‫ﻟﺠ‬‫ﺍ‬
.
(‫ﻛﺲ‬ ‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻩ‬‫ﺎ‬
‫ﺗﺠ‬ ‫ﺍﻻ‬ ‫ﺪﻓﻲ‬ ‫ﻬ‬‫ﺬﻝﺟ‬ ‫ﺑ‬
)
.
‫ﺮ‬ ‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺎ‬‫ﺎﻙﺑ‬‫ﻜ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯﻥﺟﺴﻢ‬ ‫ﺎﺱﻣﻦﺧﻼﻝﻭ‬ ‫ﻜ‬‫ﻌ‬‫ﻧ‬‫ﺍﻻ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺘﻢﺗ‬‫ﻳ‬
‫ﺮ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬ ‫ﻴﻖﺟ‬ ‫ﺒ‬‫ﻳﻖﺗﻄ‬ ‫ﺮ‬‫ﻭﻋﻦﻃ‬ ‫ﺃ‬ ‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻭﻗ‬ ‫ﺃ‬ ‫ﺃﺱ‬ ‫ﻊﺭ‬‫ﻓ‬‫ﻳﻖﺭ‬ ‫ﺮ‬‫ﻓﻲﻋﻦﻃ‬ ‫ﺎ‬‫ﺍﻹﺿ‬ ‫ﺎﺵ‬ ‫ﻤ‬‫ﻜ‬‫ﻧ‬‫ﺍﻻ‬ ‫ﻴﻖ‬‫ﻘ‬‫ﻜﻦﺗﺤ‬ ‫ﻤ‬
‫ﻳ‬
.
‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬
:
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻏ‬‫ﺃ‬
.
‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻴ‬‫ﺒ‬‫ﺜ‬
‫ﺗ‬‫ﺭﻭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﻘ‬
‫ﺗ‬-
.
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻮﻫ‬‫ﻊﺗﺸ‬ ‫ﻨ‬‫ﻣ‬-
.‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﻨﺞ‬ ‫ﻴﻒﺗﺸ‬ ‫ﻔ‬‫ﺗﺨ‬-
.‫ﻡ‬‫ﺍﻵﻻ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﻘ‬
‫ﺗ‬-
.‫ﺎﺏ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﻣﺤ‬ ‫ﻌﻲﻭ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺓﻓﻲ‬ ‫ﺪ‬
‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬
-
Met hodsofappl yingt ract i
on:
Thebasi cmet hodsofappl yingt ractionar ereferredt oasski nt ract i
onand
skelet al t
ract ion.
Skint ract ion:
Adhesi vemat erial isappl i
edt oal i
mborahal teri sfi
ttedtot hepat ient '
sheador
pelvis.Theadhesi v emat eri
al ort hehal teristhenat t
achedt oat r
act ion
appar at usandf orcei sexer tedbymeansofapul leyandwei ght s.
Skelet alt raction:
Forcei sexer teddi rectlyont hebonebyt ongsi nsertedintot heskul lorapi nor
wirei nser tedt hrought heboneatapoi ntdi staltot hefractureofanext r
emi ty.
Thet ong, pin, orwi rei st henat tachedt ot hetractionappar atusandf or cei s
exertedbymeansofpul leysandwei ght s.

47
‫‪Agr‬‬ ‫‪eat‬‬‫‪erpul‬‬ ‫‪l‬‬
‫‪canbeex‬‬ ‫‪er‬‬‫‪t‬‬‫‪edbyskel‬‬ ‫‪et‬‬‫‪al‬‬ ‫‪t‬‬‫‪r‬‬
‫‪act‬‬ ‫‪i‬‬
‫‪ont‬‬ ‫‪hanbyski‬‬ ‫‪nt‬‬‫‪r‬‬‫‪act‬‬ ‫‪i‬‬
‫‪on.‬‬
‫‪:‬‬
‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻴﻖ‬ ‫ﺒ‬‫ﺮﻕﺗﻄ‬ ‫ﻃ‬
‫‪.‬‬‫ﻠﻲ‬‫ﻜ‬‫ﻴ‬
‫ﻬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﺎﺷ‬ ‫ﻬ‬
‫ﻧ‬ ‫ﺃ‬‫ﻠﻰ‬‫ﺮﻋ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺘﻄ‬ ‫ﻟ‬
‫ﺔ‬ ‫ﻴ‬
‫ﺎﺳ‬ ‫ﺍﻷﺳ‬ ‫ﺮﻕ‬‫ﻟﻄ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﺭﺇ‬‫ﺎ‬‫ﻳﺸ‬
‫‪:‬‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻟﻚ‬‫ﺪﺫ‬ ‫ﻌ‬
‫ﺘﻢﺑ‬ ‫‪.‬ﻳ‬‫ﻪ‬ ‫ﻮﺿ‬‫ﻭﺣ‬ ‫ﺃ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺃﺱ‬ ‫ﻠﻰﺭ‬‫ﻴﺖﺭﺳﻦﻋ‬ ‫ﺒ‬‫ﺜ‬
‫ﺘﻢﺗ‬ ‫ﻭﻳ‬‫ﺃ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺪ‬‫ﺃﺣ‬ ‫ﻠﻰ‬‫ﺔﻋ‬ ‫ﻘ‬‫ﺓﻻﺻ‬ ‫ﺩ‬
‫ﺎ‬‫ﻊﻣ‬ ‫ﺘﻢﻭﺿ‬ ‫ﻳ‬
‫‪.‬‬‫ﺍﻥ‬‫ﺯ‬‫ﻭ‬‫ﺃ‬
‫ﺓﻭ‬ ‫ﺮ‬‫ﻜ‬‫ﺔﺑ‬‫ﺍﺳﻄ‬ ‫ﻮ‬‫ﺓﺑ‬ ‫ﻮ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬
‫ﺯﺳﺤﺐﻭ‬ ‫ﺎ‬‫ﻬ‬‫ﺮﺳﻦﺑﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬ ‫ﻘ‬
‫ﺍﻼﺻ‬ ‫ﺓﻟ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﻮﺻ‬ ‫ﺗ‬
‫‪:‬‬
‫ﻠﻲ‬‫ﻜ‬ ‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﺮ‬‫ﺒ‬
‫ﻠﻚﻋ‬ ‫ﻭﺳ‬ ‫ﺃ‬ ‫ﻮﺱ‬ ‫ﺑ‬
‫ﺎﻝﺩ‬ ‫ﺩﺧ‬‫ﻭﺇ‬ ‫ﺃ‬
‫ﺔ‬ ‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻪﻓﻲ‬ ‫ﻟ‬
‫ﺎ‬‫ﺩﺧ‬ ‫ﺘﻢﺇ‬‫ﻘﻂﻳ‬ ‫ﻠ‬‫ﻳﻖﻣ‬ ‫ﺮ‬‫ﻌﻈﻢﻋﻦﻃ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﺓﻣ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺭﺱ‬ ‫ﺎ‬‫ﻤ‬
‫ﺗ‬
‫‪.‬‬‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺪ‬‫ﺃﺣ‬‫ﺮ‬ ‫ﺓﻋﻦﻛﺴ‬ ‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺔﺑ‬‫ﻘﻄ‬ ‫ﺪﻧ‬‫ﻨ‬‫ﻌﻈﻢﻋ‬ ‫ﻟ‬‫ﺍ‬
‫ﺍﻷ‬
‫ﺍﺕﻭ‬ ‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻖ‬ ‫ﺮ‬‫ﺓﻋﻦﻃ‬ ‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘﻢﻣ‬ ‫ﻳ‬‫ﺮﻭ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻠﻚﺑﺠ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻮﺱ‬ ‫ﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻘﻂ‬ ‫ﻠ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻮﺻ‬ ‫ﻟﻚﺗ‬ ‫ﺪﺫ‬ ‫ﻌ‬‫ﺘﻢﺑ‬‫ﻳ‬
‫‪.‬‬‫ﺍﻥ‬‫ﺯ‬‫ﻭ‬
‫‪.‬‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺪ‬
‫ﺮﻣﻦﺷ‬ ‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺪ‬‫ﻟﻰﺷ‬ ‫ﻠﻲﺇ‬ ‫ﻜ‬‫ﻴ‬
‫ﻬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﺩﻱ‬‫ﺆ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬
‫‪Thebasi‬‬ ‫‪cf‬‬ ‫‪or‬‬‫‪msoft‬‬ ‫‪r‬‬‫‪act‬‬ ‫‪i‬‬
‫‪on:‬‬
‫‪a.Bal‬‬‫‪ancedsuspensi‬‬ ‫‪ont‬‬ ‫‪r‬‬
‫‪act‬‬ ‫‪i‬‬
‫‪on.‬‬
‫‪Di‬‬‫‪r‬‬
‫‪ectpul‬‬ ‫‪l‬‬ ‫‪ont‬‬ ‫‪hepar‬‬ ‫‪ti‬‬‫‪sappl‬‬ ‫‪i‬‬
‫‪edwi‬‬ ‫‪t‬‬
‫‪ht‬‬ ‫‪heext‬‬ ‫‪r‬‬‫‪emi‬‬ ‫‪t‬‬‫‪ysuppor‬‬ ‫‪t‬‬‫‪edi‬‬‫‪naspl‬‬ ‫‪i‬‬‫‪ntand‬‬
‫‪hel‬‬
‫‪di‬‬ ‫‪npl‬‬ ‫‪acewi‬‬ ‫‪t‬‬
‫‪hbal‬‬ ‫‪ancedcount‬‬ ‫‪er‬‬‫‪wei‬‬ ‫‪ght‬‬‫(‪s‬‬ ‫‪ex‬‬‫‪ampl‬‬ ‫‪es:‬‬‫‪Thomasspl‬‬ ‫‪i‬‬
‫‪ntwi‬‬ ‫‪t‬‬‫‪h‬‬
‫‪Pear‬‬‫‪sonat‬‬ ‫‪t‬‬‫‪achment‬‬ ‫)‬‫‪.‬‬
‫‪Theex‬‬ ‫‪t‬‬‫‪r‬‬‫‪emi‬‬ ‫‪t‬‬‫"‪y‬‬‫‪f‬‬‫‪l‬‬‫‪oat‬‬‫‪s"ori‬‬ ‫‪ssuspendedi‬‬ ‫‪nt‬‬ ‫‪het‬‬ ‫‪r‬‬‫‪act‬‬‫‪i‬‬‫‪onappar‬‬ ‫‪at‬‬‫‪usbyt‬‬ ‫‪hebal‬‬ ‫‪anced‬‬
‫‪wei‬‬‫‪ght‬‬‫‪s.‬‬
‫‪Thel‬‬ ‫‪i‬‬
‫‪neoft‬‬ ‫‪r‬‬‫‪act‬‬‫‪i‬‬‫‪onont‬‬ ‫‪heext‬‬ ‫‪r‬‬
‫‪emi‬‬ ‫‪t‬‬‫‪yr‬‬ ‫‪emai‬‬ ‫‪nsf‬‬ ‫‪ai‬‬‫‪r‬‬‫‪l‬‬
‫‪yconst‬‬ ‫‪antdespi‬‬ ‫‪t‬‬‫‪eany‬‬
‫‪changesi‬‬ ‫‪nt‬‬ ‫‪heposi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪onoft‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪ent‬‬ ‫‪.‬‬
‫‪Thi‬‬‫‪spr‬‬‫‪i‬‬‫‪nci‬‬‫‪pl‬‬ ‫‪emaybeut‬‬ ‫‪i‬‬
‫‪l‬‬‫‪i‬‬
‫‪zedi‬‬ ‫‪nbot‬‬ ‫‪hski‬‬ ‫‪nandskel‬‬ ‫‪et‬‬‫‪al‬‬‫‪t‬‬‫‪r‬‬‫‪act‬‬ ‫‪i‬‬
‫‪onandmaybe‬‬
‫‪ei‬‬
‫‪t‬‬‫‪heruni‬‬ ‫‪l‬‬‫‪at‬‬‫‪er‬‬‫‪al‬‬‫‪orbi‬‬ ‫‪l‬‬‫‪at‬‬‫‪er‬‬‫‪al‬‬‫‪.‬‬
‫‪:‬‬
‫ﺮ‬ ‫ﻠﺠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺎﺍﻷﺳ‬‫ﻜﻝ‬ ‫ﺍﻷﺷ‬
‫‪.‬‬‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻴﻖﻣ‬ ‫ﻠ‬
‫ﻌ‬‫‪.‬ﺳﺤﺐﺗ‬ ‫ﺃ‬
‫ﺔ‬‫ﻧ‬
‫ﺯ‬‫ﺍ‬‫ﻮ‬‫ﺎﻝﻣ‬‫ﻘ‬ ‫ﺛ‬
‫ﺄ‬‫ﻪﺑ‬ ‫ﻧ‬
‫ﺎ‬‫ﻜ‬‫ﻪﻓﻲﻣ‬ ‫ﺘ‬ ‫ﻴ‬
‫ﺒ‬‫ﺜ‬‫ﺘﻢﺗ‬‫ﻳ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﺮﻑﻓﻲﺟ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊﺩﻋﻢ‬ ‫ﺀﻣ‬ ‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻋ‬‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻟﺴﺤﺐ‬ ‫ﺍ‬ ‫ﻴﻖ‬‫ﺒ‬‫ﺘﻢﺗﻄ‬ ‫ﻳ‬
‫‪.‬‬
‫(‬‫ﻮﻥ‬ ‫ﺮﺳ‬ ‫ﻴ‬
‫ﻠﺤﻖﺑ‬ ‫ﻊﻣ‬ ‫ﺎﺱﻣ‬ ‫ﻣ‬‫ﻮ‬‫ﺓﺗ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬‫‪:‬ﺟ‬ ‫ﺔ‬‫ﻠ‬‫ﺜ‬‫ﻣ‬‫ﺃ‬
‫)‬
‫‪.‬‬‫ﺔ‬‫ﻧ‬‫ﺯ‬
‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺯ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬ ‫ﺍﺳﻄ‬‫ﻮ‬‫ﺮﺑ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻠﻖﻓﻲﺟ‬ ‫ﻌ‬‫"ﻭﻳ‬
‫ﻮﺃ‬ ‫ﻔ‬‫ﻳﻄ‬ ‫ﺮﻑ"‬ ‫ﻟﻄ‬‫ﺍ‬
‫‪.‬‬‫ﻳﺾ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺍﺕﻓﻲﻭﺿ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺃﻱﺗ‬ ‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻋ‬‫ﺪﻣ‬ ‫ﻟﻰﺣ‬ ‫ﺎﺇ‬‫ً‬
‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻑﺛ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻠﻰ‬‫ﻟﺴﺤﺐﻋ‬ ‫ﺍ‬‫ﻳﻈﻞﺧﻂ‬
‫ﻭ‬‫ﺃ‬‫ﻧﺐ‬ ‫ﺎ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺩﻱ‬ ‫ﺎ‬
‫ﺃﺣ‬ ‫ﺎ‬
‫ﻣ‬‫ﻮﻥﺇ‬ ‫ﻜ‬‫ﺪﻳ‬ ‫ﻗ‬
‫ﻤﻲﻭ‬ ‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻜﻞ‬ ‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻱﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺃﻓﻲﻛﻞﻣﻦ‬ ‫ﺪ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻡﻫ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬

‫(‬
‫‪Fi‬‬‫‪g.13)Bal‬‬
‫‪ancedsuspensi‬‬
‫‪ont‬‬
‫‪r‬‬‫‪act‬‬
‫‪i‬‬‫‪on‬‬

‫‪b.Runni‬‬
‫‪ngt‬‬ ‫‪r‬‬
‫‪act‬‬‫‪i‬‬
‫‪on:‬‬
‫‪Di‬‬‫‪r‬‬
‫‪ectpul‬‬‫‪l‬‬
‫‪i‬‬‫‪sappl‬‬
‫‪i‬‬‫‪edwi‬‬‫‪t‬‬‫‪houtsuppor‬‬
‫‪toft‬‬
‫‪hepar‬‬
‫(‪t‬‬‫‪exampl‬‬
‫‪e:‬‬‫'‪Buck‬‬
‫‪st‬‬‫‪r‬‬
‫‪act‬‬
‫‪i‬‬‫)‪on‬‬
‫‪.The‬‬
‫‪pul‬‬
‫‪l‬‬‫‪i‬‬‫‪sex‬‬‫‪er‬‬‫‪t‬‬
‫‪edi‬‬‫‪nonl‬‬‫‪yonepl‬‬‫‪ane.‬‬

‫‪48‬‬
Thispr i
nci plemaybeut il
izedi nbot hskinandskel etal t
ract ion,andmaybe
eit
heruni l
ateral.
Princi pl
esoft r
act i
on:
Whenwor kingwi tht ract i
onappar atus,thefoll
owi ngpoi ntsshoul dbeobser ved
routinelyandanydef ectr eportedt othechar genur se.
a.Wei ght s:
Thewei ght smusthangf ree.Eachwei ghtbagmustbet iedsecur elytoitsr ope.
Avoi dbumpi ngorknocki ngt hewei ghtbags.Theyshoul dnotbeal l
owedt o
swingbackandf orth.
:
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻞ‬‫ﻐ‬‫ﺗﺸ‬.‫ﺏ‬
‫ﺓ‬‫ﺮ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺤﺐﻓﻲﻃ‬ ‫ﺍ‬ ‫ﺘﻢ‬‫ﻳ‬. (‫ﺎﻙ‬‫ﺮﺑ‬‫ﺟ‬:‫ﺎ‬‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬)‫ﺀ‬‫ﺰ‬‫ﻠﺠ‬‫ﻟ‬ ‫ﻭﻥﺩﻋﻢ‬ ‫ﺪ‬‫ﺮﺑ‬‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﺴﺤﺐ‬ ‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺘﻢﺗﻄ‬‫ﻳ‬
.
‫ﻘﻂ‬ ‫ﺓﻓ‬‫ﺪ‬‫ﺍﺣ‬‫ﻭ‬
‫ﻧﺐ‬ ‫ﺎ‬‫ﺎﻣﻦﺟ‬ ‫ﻣ‬‫ﻮﻥﺇ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬‫ﻭ‬،‫ﻤﻲ‬ ‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻞ‬ ‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺠ‬ ‫ﺍ‬ ‫ﺃﻓﻲﻛﻞﻣﻦ‬ ‫ﺪ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍ‬‫ﺬ‬‫ﻡﻫ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬
.
‫ﺪ‬‫ﺍﺣ‬‫ﻭ‬
:‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺩﺉ‬‫ﺎ‬‫ﺒ‬
‫ﻣ‬
‫ﺃﻱ‬ ‫ﺔﻋﻦ‬ ‫ﻟ‬
‫ﻭ‬ ‫ﺆ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺑﻼﻍ‬ ‫ﺇ‬
‫ﻨﻲﻭ‬ ‫ﻴ‬‫ﺗ‬
‫ﻭ‬‫ﻜﻞﺭ‬ ‫ﺔﺑﺸ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬‫ﻘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳﺠﺐﻣﻼﺣﻈ‬، ‫ﺮ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻤﻞﺑﺠ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻨ‬‫ﻋ‬
.‫ﻴﺐ‬‫ﻋ‬
:
‫ﺍﻥ‬‫ﺯ‬‫ﻭ‬‫ﺍﻷ‬.‫ﺃ‬
‫ﻭ‬
‫ﺃ‬ ‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺱ‬ ‫ﻴ‬‫ﻛ‬‫ﺄ‬
‫ﻡﺑ‬ ‫ﺍ‬
‫ﺪ‬‫ﺍﻻﺻﻄ‬ ‫ﻨﺐ‬ ‫ﺗﺠ‬.‫ﻪ‬‫ﻠ‬‫ﺒ‬‫ﻡﺑﺤ‬‫ﺎ‬‫ﻜ‬‫ﺈﺣ‬‫ﺯﻥﺑ‬‫ﻴﺲﻭ‬ ‫ﺑﻂﻛﻞﻛ‬ ‫ﻳﺠﺐﺭ‬. ‫ﺎ‬ً
‫ﻧ‬‫ﺎ‬
‫ﺍﻥﻣﺠ‬ ‫ﺯ‬‫ﻭ‬‫ﺍﻷ‬‫ﻴﻖ‬ ‫ﻠ‬
‫ﻌ‬‫ﻳﺠﺐﺗ‬
.
‫ﺎ‬ً
‫ﺑ‬
‫ﺎ‬‫ﻳ‬
‫ﺇ‬‫ﺎﻭ‬ً
‫ﺑ‬
‫ﺎ‬‫ﺭﺟﺢﺫﻫ‬ ‫ﺄ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻬﻢﺑ‬ ‫ﻟ‬‫ﺎﺡ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫ﻐﻲ‬ ‫ﺒ‬
‫ﻨ‬‫ﻻﻳ‬. ‫ﺎ‬
‫ﻬ‬‫ﻗ‬‫ﺮ‬‫ﻃ‬
Wei ght sshoul dnev erber emov edf r
om apat ientwi thaf ract ureunlessso
order edbyt hephy sici anori nthecaseofanext remeemer gency .Wei ghtand
pulleyt ract i
oni sappl i
edt opr ovideconst antcorrect iveex tensi on.Ifthewei ghts
arer emov ed, thepur poseoft heirusehasbeendef eated.
b.Ropes:
Ther eshoul dbenof ray edspot sorknot sinther unni ngl engt h.Theyshoul dnot
dragont hebedcl othesort hebedf rame.Nor opesshoul dr estagai nstone
anot her.
c.Pul ley s:
Ther opeshoul drestsecur el
yint hepul l
eygrooves.Pul leycl ampsmustbe
secur elyat tachedt ot hebedf rameandmustnotbemov edunl essor deredby
thephy sician.
d.Spr eaderBar s:
Thespr eaderbar sshoul dcausenopr essureonadj acentski nareas.

‫ﺭﺉ‬‫ﺍ‬‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻭﻓﻲ ﺎ‬ ‫ﺃ‬‫ﻴﺐ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻟﻚ‬ ‫ﺬ‬‫ﺮﺑ‬‫ﻣ‬‫ﺄ‬
‫ﻟﻢﻳ‬ ‫ﺎ‬
‫ﺮﻣ‬ ‫ﻜﺴ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥﻋﻦ‬ ‫ﺯ‬‫ﻭ‬
‫ﺍﻷ‬ ‫ﻊ‬ ‫ﻓ‬
‫ﻡﺭ‬ ‫ﺪ‬‫ﻳﺠﺐﻋ‬
‫ﺪﺗﻢ‬ ‫ﻘ‬
‫ﻓ‬، ‫ﺍﻥ‬‫ﺯ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﻤﺖﺇ‬ ‫ﺍﺗ‬
‫ﺫ‬‫ﺇ‬.
‫ﺑﺖ‬ ‫ﺎ‬‫ﻴﺤﻲﺛ‬ ‫ﺪﺗﺼﺤ‬ ‫ﻳ‬‫ﺪ‬‫ﻤ‬
‫ﺮﺗ‬ ‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﻜ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺯﻥﻭ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻖﺳﺤﺐ‬ ‫ﺒ‬‫ﺘﻢﺗﻄ‬ ‫ﻳ‬.‫ﻮﻯ‬ ‫ﻘﺼ‬‫ﻟ‬‫ﺍ‬
.‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺮ ﺽﻣﻦ‬ ‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻤ‬
‫ﻳ‬‫ﺰ‬‫ﻫ‬
:‫ﺎ‬
‫ﺒﻝ‬ ‫ﻟﺤ‬‫ﺍ‬.‫ﺏ‬
‫ﻜﻞ‬‫ﻴ‬‫ﻭﻫ‬ ‫ﺃ‬ ‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬ ‫ﺃﻏﻄ‬‫ﺍ‬‫ﻭ‬
‫ﺮ‬‫ﺃﻥﻳﺠ‬ ‫ﻐﻲ‬ ‫ﺒ‬
‫ﻨ‬‫ﻻﻳ‬.‫ﺮﻱ‬ ‫ﻟﺠ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﺔﻓﻲﻃ‬ ‫ﺋ‬
‫ﺮ‬‫ﺘ‬‫ﻬ‬‫ﺓﻣ‬‫ﺪ‬‫ﻘ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﻊ‬‫ﻘ‬‫ﺎﻙﺑ‬‫ﻨ‬‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺃﻻﻳ‬ ‫ﻳﺠﺐ‬
.‫ﻌﺾ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻬ‬ ‫ﻌﻀ‬‫ﻠﻰﺑ‬‫ﻛﻢﻋ‬ ‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺃﻥﺗ‬ ‫ﺎﻝﻳﺠﺐ‬ ‫ﺒ‬
‫ﻻﺣ‬. ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬
:
‫ﺍﺕ‬ ‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬.‫ﺝ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻜﻞ‬‫ﻴ‬‫ﻡﻓﻲﻫ‬ ‫ﺎ‬‫ﻜ‬
‫ﺈﺣ‬‫ﺓﺑ‬‫ﺮ‬‫ﻜ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺑﻚ‬ ‫ﺎ‬‫ﻴﺖﻣﺸ‬ ‫ﺒ‬‫ﺜ‬‫ﻳﺠﺐﺗ‬. ‫ﺓ‬‫ﺮ‬
‫ﻜ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺩ‬‫ﺎ‬‫ﺃﺧ‬‫ﻡﻓﻲ‬ ‫ﺎ‬
‫ﻜ‬ ‫ﺈﺣ‬‫ﺒﻞﺑ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺒﺖ‬‫ﺜ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬
.‫ﻴﺐ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬
‫ﺮﻣﻦ‬ ‫ﻣ‬‫ﺄ‬‫ﺎﺇﻻﺑ‬‫ﻬ‬‫ﻜ‬‫ﻳ‬‫ﺮ‬‫ﻡﺗﺤ‬ ‫ﺪ‬‫ﻳﺠﺐﻋ‬ ‫ﻭ‬
:
‫ﺔ‬ ‫ﺯﻋ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥ‬
‫ﺒ‬‫ﻗﻀ‬. ‫ﺩ‬
.
‫ﺓ‬‫ﺭ‬‫ﻭ‬ ‫ﺎ‬
‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬
‫ﺎﻃﻖ‬ ‫ﻨ‬
‫ﻠﻰﻣ‬ ‫ﺎﻋ‬ً‫ﻐ‬
‫ﻄ‬ ‫ﺔﺿ‬ ‫ﺯﻋ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﺒ‬‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬‫ﺒﺐ‬ ‫ﺃﻻﺗﺴ‬ ‫ﻳﺠﺐ‬
e.Footpl ate:
Thef ootplateshoul dmai ntainandsuppor tthef ootinaneut ral position,wi thno
pressureonei t
hersi deoft hef oot ,t
heheel ,orthet oes.Itmustnotr estagai nst
thefootoft hebed, asthisint erf
er eswi t
hthet racti
onpul l.

49
f.Tr apeze:
Thet rapezeshoul dbesuspendedf r
om t heov erheadbaroft hebedf rameso
thatt hepat ientcanr eachandgr aspi twi thoutst rainandwi thoutt wist i
ngoutof
pr operal i
gnment .
g.Hammocks, Slings, andHal t
er s:
Theseshoul dbef reeofwr i
nklesandcausenopr essur eonbonypr omi nenceor
j
oi nts.Ifpaddi ngmat erialisused, i
tmustbecl ean, dry,andf reeofwr i
nkl esand
crumbs.
:‫ﻡ‬‫ﺪ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴﺤ‬‫ﻔ‬ ‫ﺻ‬. ‫ﻩ‬
‫ﺃﻱﻣﻦ‬ ‫ﻠﻰ‬‫ﻐﻂﻋ‬ ‫ﺩﺿ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻊﻋ‬ ‫ﻣ‬، ‫ﺪ‬‫ﻳ‬‫ﺎ‬
‫ﻊﻣﺤ‬ ‫ﺎﻓﻲﻭﺿ‬ ‫ﻬ‬‫ﻤ‬‫ﺪﻋ‬ ‫ﺗ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻴﻦﻋ‬ ‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻓﻆﻣﺴ‬ ‫ﺎ‬
‫ﺃﻥﺗﺤ‬ ‫ﻳﺠﺐ‬
‫ﻊﺳﺤﺐ‬ ‫ﺭ ﺽﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﺍﻳ‬‫ﺬ‬‫ﻷﻥﻫ‬، ‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻠﻰﻗ‬‫ﺎﺡﻋ‬ ‫ﺗ‬‫ﺮ‬‫ﺃﻻﻳ‬ ‫ﻳﺠﺐ‬. ‫ﻡ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺑ‬‫ﺎ‬‫ﺃﺻ‬ ‫ﻭ‬‫ﺃ‬‫ﻌﺐ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻡ‬‫ﺪ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻲ‬ ‫ﻧ‬
‫ﺎ‬‫ﺟ‬
.
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
:‫ﺔ‬‫ﻮﺣ‬ ‫ﺭﺟ‬ ‫ﺃ‬.F
‫ﺎ‬
‫ﻬ‬ ‫ﺎﻙﺑ‬‫ﻣﺴ‬ ‫ﺍﻹ‬‫ﺎﻭ‬‫ﻬ‬‫ﻴ‬‫ﻟ‬‫ﻮﻝﺇ‬ ‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻜﻦ‬‫ﻤ‬‫ﻴﺚﻳ‬ ‫ﺮﺑﺤ‬ ‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﻮﻱﻹﻃ‬ ‫ﻠ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻳﻂ‬ ‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻮﺣ‬‫ﺭﺟ‬ ‫ﺍﻷ‬ ‫ﻴﻖ‬‫ﻠ‬‫ﻌ‬‫ﻳﺠﺐﺗ‬
.‫ﺔ‬ ‫ﻴﺤ‬‫ﻟﺼﺤ‬ ‫ﺍ‬ ‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺀﻣﻦ‬ ‫ﺍ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻭﻥ‬‫ﺩ‬ ‫ﺩﻭ‬ ‫ﺎ‬
‫ﻬ‬‫ﻭﻥﺇﺟ‬ ‫ﺩ‬
:‫ﺑﺾ‬ ‫ﺍ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺎﺕ‬‫ﻌ‬‫ﻓ‬‫ﺍ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ،‫ﻴﺢ‬ ‫ﺍﺟ‬‫ﺭ‬‫ﺍﻷ‬.‫ﺯ‬
‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺣﺔ‬
‫ﻟ‬‫ﻓﻲ ﺎ‬. ‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻤﻲ‬ ‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﻭ‬ ‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻋ‬ ً‫ﻐ‬
‫ﻄ‬ ‫ﺒﺐ ﺿ‬ ‫ﺪﻭﻻﺗﺴ‬ ‫ﻴ‬‫ﻋ‬‫ﺎ‬‫ﺘﺠ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻮﻥﺧ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬
.‫ﺎﺕ‬‫ﺘ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﻴ‬‫ﺎﻋ‬‫ﺘﺠ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬‫ﺎ‬‫ﺔﻭﺧ‬ ‫ﻓ‬
‫ﺎ‬‫ﺔﻭﺟ‬ ‫ﻔ‬‫ﻴ‬‫ﻮﻥﻧﻈ‬ ‫ﻜ‬ ‫ﺃﻥﺗ‬‫ﻳﺠﺐ‬، ‫ﻮ‬ ‫ﻟﺤﺸ‬ ‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻣ‬
Buck' sext ensi ont raction
Thi sf orm ofski ntractiont ot hel owerl imbpr ov i
desf orst raightpul lthrougha−
singlepul l
eyat tachedt oacr ossbaratt hef ootoft hebed.Thel imbi nt ract i
on
l
iespar alleltot hebed.
−Thef ootoft hebedi sr outinel
yel evat edt opr ovidecount er
tractionandt okeept hepat i
entf rom bei ngpul leddownt ot he
footoft hebed.I nBuck' sext ensiont raction, thepat ientis
usual lynotal lowedt ot urnandmustr emai nf latonhi sback.
‫ﺎﻙ‬‫ﺪﺑ‬ ‫ﻳ‬‫ﺪ‬‫ﻤ‬‫ﺮﺗ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻴﺐ‬ ‫ﻘﻀ‬‫ﺔﺑ‬ ‫ﻠ‬
‫ﺘﺼ‬ ‫ﺓﻣ‬ ‫ﺪ‬‫ﺍﺣ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﻜ‬‫ﺍﻣﻦﺧﻼﻝﺑ‬ ً
‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﺎﻣ‬‫ﺒ‬
.‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻠﺴ‬ ‫ﻟ‬‫ﺎ‬
ً
‫ﻳ‬‫ﺯ‬
‫ﺍ‬‫ﻮ‬‫ﺮﻣ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﺮﻑﻓﻲ ﺎ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﻘ‬‫ﻳ‬.‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻔﺢ‬ ‫ﺪﺳ‬ ‫ﻨ‬‫ﺮﺿﻲﻋ‬ ‫ﻋ‬
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﻨﻲ‬‫ﻴ‬‫ﺗ‬‫ﻭ‬‫ﻜﻞﺭ‬ ‫ﺮﺑﺸ‬ ‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻔﺢ‬ ‫ﻊﺳ‬ ‫ﻓ‬‫ﺘﻢﺭ‬ ‫ﻳ‬-
‫ﻔﻞ‬ ‫ﺃﺳ‬ ‫ﻟﻰ‬‫ﺍﻑﺇ‬ ‫ﺮ‬‫ﻧﺠ‬‫ﻣﺍﻻ‬
‫ﻳﺾ ﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬ ‫ﺍ‬
‫ﺮﻭ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬ ‫ﻜ‬‫ﻳ‬،‫ﺎﻙ‬‫ﺒ‬‫ﻟ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬. ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻡ‬
‫ﺪ‬ ‫ﻗ‬
.
‫ﻩ‬ ‫ﺮ‬
‫ﻬ‬‫ﻠﻰﻇ‬ ‫ﺎﻋ‬ً‫ﺃﻥﻳﻈﻞﻣﺴﻄ‬
‫ﺤ‬ ‫ﻳﺠﺐ‬ ‫ﺍﻥﻭ‬ ‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺑ‬
‫ﻤﺢﻪ‬ ‫ﺓﻻﻳﺴ‬ ‫ﺩ‬‫ﺎ‬‫ﻋ‬

A.Buck’
str
act
ion .B.Russel
ltr
act
ion

s&Russel
ltr
act
ion’
(Fi
g.14)Buck

50
Russel l tract ion
−Int hisf orm ofski nt ract ion, asy st em ofsuspensi onandt ract ionpul lisused.
Adhesi v est ripsar eappl iedasi nBuck' sext ensi on, andt hekneei ssuspendedi n
asling.Ar opei sat tachedt ot hesl i
ng' sspr eaderbar .
−Thi sr opepassesov erapul leywhi chi sat tachedt oanov er headbarandi s
thendi rect edt oasy stem oft hr eepul leysatt hef ootoft hebed: firsttoapul ley
ont hebed' sf ootbar ,nextt oapul leyat tachedt ot hef ootspr eaderbar ,and
thenbackt oasecondpul leyont hebed' sf ootbar .
−Ther ei sanupwar dpul lfrom t hesl i
ngpul leyandaf or war dpul l fr
om t he
pull
ey satt hef ootoft hebed.I nRussel ltr action, theangl ebet weent het high
andt hebedi sappr oximat ely20andt her ei sal way ssl ightf lex ionofbot ht he
hipandt heknee.
Theadv ant ageofRussel ltr act i
oni st hatsomemov ementi nbedi sper mi ssible.
Thepat ientcant ur nsl ight lyt owar dt hesi de
i
nt ractionf orbackcar e, bedpanpl acement ,orlinenchange
‫ﺍﺳﻞ‬ ‫ﺮﺭ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﺎ‬
‫ﻤ‬‫ﺔﻛ‬ ‫ﻘ‬‫ﺍﻼﺻ‬ ‫ﺔﻟ‬ ‫ﺮﻃ‬ ‫ﺍﻷﺷ‬ ‫ﻊ‬ ‫ﺘﻢﻭﺿ‬ ‫ﻳ‬. ‫ﻟﺴﺤﺐ‬ ‫ﺍ‬
‫ﻴﻖﻭ‬ ‫ﻠ‬
‫ﻌ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬ ‫ﺎ‬
‫ﻡﻧﻈ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬، ‫ﺪ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺪ‬‫ﻜﻞﻣﻦﺷ‬ ‫ﻟﺸ‬ ‫ﺍ‬‫ﺍ‬
‫ﺬ‬ ‫ﻓﻲﻫ‬-
.
‫ﺔ‬ ‫ﻌ‬‫ﻓ‬ ‫ﺍ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺮﺷ‬ ‫ﻴﺐﻓ‬ ‫ﻘﻀ‬ ‫ﺘﺼﻞﺑ‬ ‫ﺒﻞﻣ‬ ‫ﺣ‬.‫ﺎ‬ ‫ﺒﻝ‬ ‫ﺔﻓﻲﺣ‬ ‫ﺒ‬‫ﻛ‬‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻖ‬‫ﻠ‬‫ﻌ‬‫ﺘﻢﺗ‬ ‫ﻳ‬‫ﻭ‬، ‫ﺎﻙ‬‫ﺪﺑ‬ ‫ﻳ‬‫ﺪ‬‫ﻤ‬‫ﺎﻝﻓﻲﺗ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻮ‬ ‫ﻫ‬
‫ﻔﺢ‬ ‫ﺪﺳ‬ ‫ﻨ‬‫ﺍﺕﻋ‬ ‫ﺮ‬‫ﻜ‬‫ﻡﻣﻦﺛﻼﺙﺑ‬ ‫ﺎ‬‫ﻟﻰﻧﻈ‬ ‫ﻪﺇ‬ ‫ﻬ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﺘﻢﺗ‬ ‫ﻮﻱﺛﻢﻳ‬ ‫ﻠ‬
‫ﻴﺐﻋ‬ ‫ﻘﻀ‬ ‫ﺔﺑ‬ ‫ﻠ‬‫ﺘﺼ‬ ‫ﺓﻣ‬ ‫ﺮ‬ ‫ﻜ‬‫ﻮﻕﺑ‬ ‫ﺒﻞﻓ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺍ‬
‫ﺬ‬‫ﺮﻫ‬ ‫ﻤ‬‫ﻳ‬-
‫ﻟﻰ‬‫ﺓﺇ‬ ‫ﺩ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻡﺛﻢ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺯﺭﺵ‬ ‫ﺎ‬‫ﻬ‬‫ﺔﺑﺠ‬ ‫ﻠ‬‫ﺘﺼ‬ ‫ﺓﻣ‬ ‫ﺮ‬‫ﻜ‬ ‫ﺭﺑ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﺑﺠ‬، ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻡ‬ ‫ﺪ‬ ‫ﻴﺐﻗ‬ ‫ﻠﻰﻗﻀ‬ ‫ﺓﻋ‬ ‫ﺮ‬‫ﻜ‬ ‫ﻟﻰﺑ‬‫ﺃﻻًﺇ‬ ‫ﻭ‬: ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻡ‬‫ﺪ‬ ‫ﻴﺐﻗ‬ ‫ﻠﻰﻗﻀ‬ ‫ﺔﻋ‬ ‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺓﺛ‬ ‫ﺮ‬‫ﻜ‬‫ﺑ‬
‫ﻎ‬‫ﻠ‬‫ﺒ‬
‫ﺗ‬، ‫ﺍﺳﻞ‬ ‫ﺮﺭ‬ ‫ﻓﻲﺟ‬. ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻔﺢ‬ ‫ﺪﺳ‬ ‫ﻨ‬‫ﺍﺕﻋ‬ ‫ﺮ‬‫ﻜ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬ ‫ﻡﻣﻦ‬ ‫ﺎ‬‫ﻣ‬ ‫ﻟﻸ‬ ‫ﺔﻭﺳﺤﺐ‬ ‫ﻌ‬‫ﻓ‬‫ﺍ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻜ‬ ‫ﻠﻰﻣﻦﺑ‬ ‫ﻟﻸﻋ‬ ‫ﺪﺳﺤﺐ‬ ‫ﻮﺟ‬ ‫ﻳ‬-
.‫ﺔ‬‫ﺒ‬‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻙﻭ‬ ‫ﻮ‬ ‫ﻟ‬‫ﺍ‬‫ﻜﻞﻣﻦ‬ ‫ﻟ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﺀﻃ‬ ‫ﺎ‬‫ﻨ‬‫ﺜ‬‫ﻧ‬‫ﺍ‬‫ﺎ‬ً
‫ﻤ‬‫ﺋ‬‫ﺍ‬‫ﺎﻙﺩ‬‫ﻨ‬‫ﻭﻫ‬20‫ﻟﻲ‬ ‫ﺍ‬
‫ﻮ‬‫ﺮﺣ‬ ‫ﻳ‬‫ﺮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺬﻭ‬ ‫ﻔﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﺔﺑ‬ ‫ﻳ‬‫ﻭ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬
‫ﻮ‬ ‫ﻴﻼًﻧﺤ‬ ‫ﻠ‬
‫ﺮﻗ‬ ‫ﻳ‬‫ﺪ‬‫ﺘ‬‫ﺃﻥﻳﺴ‬ ‫ﻳﺾ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.‫ﺑ‬‫ﺎ‬‫ﻮﺡﻬ‬ ‫ﻤ‬‫ﺮﻣﺴ‬ ‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﻛ‬‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﻌﺾ‬ ‫ﺃﻥﺑ‬ ‫ﺍﺳﻞﻫﻲ‬ ‫ﺮﺭ‬‫ﺓﺟ‬ ‫ﺰ‬‫ﻴ‬‫ﻣ‬
‫ﻧﺐ‬ ‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺎﻥ‬‫ﺘ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﻭﺗ‬، ‫ﺮﺃ‬ ‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺀ‬ ‫ﺎ‬
‫ﻊﻏﻄ‬ ‫ﻭﻭﺿ‬، ‫ﺮﺃ‬ ‫ﻬ‬ ‫ﻟﻈ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬ ‫ﻠ‬
‫ﻟ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻓﻲ‬
Nursi ngmanagementf orpat ienti nt ract i
on:
−Nur singmanagementbegi nswi t
hassessi ngt hepat i
ent .Whatar ehi sneeds?
Whatar ehi sl imitations?Det er mi newhi chact ivitiest hepat ientcandoby
himsel fandwi thwhi chact i
v i
tiesher equi resassi stance.
−Assesst hepat i
entandt het ract i
onset -upt odet ermi net hebestmet hodf or
changi ngt hebedl inen.Ther ear esev eral accept abl emet hodsf ormaki ngan
occupi edbedand, dependi ngupont het y peoft ract i
oni nuse, y ouwi llwantt o
uset hemet hodt hati seasi est .Forsomepat ient s, ahead- to-t oet echni quemay
workbet tert hansi de- to-si de.Al way sbesur et hatt hel ineni ssmoot handdr y .
Util
izedr awsheet swhenappr opr iat e.Reposi t
ionsuppor tingpi llowsandchange
thepi ll
owcasesasof tenasneededt opr ev entt hepat ientf rom bei ngsuppor ted
bysoi led, damp, wr inkled, orf lat t
enedpi llows.
:
‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻳ ﺾﻓﻲ ﺎ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺘﻲ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬ ‫ﺍﻷ‬ ‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫؟ﺗﺤ‬ ‫ﻩ‬‫ﺩ‬‫ﻭ‬ ‫ﺪ‬‫؟ﺎﻫﻲﺣ‬ ‫ﻪﻣ‬ ‫ﺗ‬‫ﺎ‬‫ﺎﺟ‬ ‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬ ‫ﺎﻫﻲ‬.‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬‫ﻟ‬
‫ﻴﻢ ﺎ‬ ‫ﻴ‬‫ﻘ‬ ‫ﺘ‬
‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺃﺇ‬‫ﺪ‬‫ﺒ‬‫ﺗ‬-
.‫ﺑ‬
‫ﺎ‬‫ﺓﻬ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﺎﺝﺇ‬ ‫ﺘ‬‫ﺘﻲﻳﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬ ‫ﻧﺸﻄ‬ ‫ﺍﻷ‬‫ﻪﻭ‬ ‫ﻔﺴ‬ ‫ﻨ‬
‫ﺎﺑ‬ ‫ﻬ‬‫ﻡﺑ‬ ‫ﺎ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬
‫ﻤﻞ‬‫ﻌ‬‫ﻟ‬‫ﺔ‬ ‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻘ‬‫ﺮﻕﻣ‬ ‫ﺓﻃ‬ ‫ﺪ‬‫ﺎﻙﻋ‬ ‫ﻨ‬‫ﻫ‬. ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻏﻄ‬ ‫ﺃ‬‫ﺮ‬‫ﻴ‬ ‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬ ‫ﻘ‬‫ﻳ‬‫ﺮ‬‫ﻓﻀﻞﻃ‬ ‫ﺃ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬ ‫ﺘﺤ‬ ‫ﻟ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻴﺐ‬ ‫ﻛ‬‫ﺮ‬‫ﺗ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬-
‫ﺔ‬‫ﺒ‬‫ﻨﺴ‬ ‫ﻟ‬
‫ﺎ‬‫ﺑ‬.‫ﻬﻞ‬ ‫ﺍﻷﺳ‬ ‫ﺔ‬‫ﻘ‬‫ﻳ‬‫ﺮ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻟﻰ‬ ‫ﺎﺝﺇ‬ ‫ﺘ‬‫ﺘﺤ‬ ‫ﺳ‬، ‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻮﻉ‬ ‫ﻠﻰﻧ‬ ‫ﺍﻋ‬ ً
‫ﺩ‬‫ﺎ‬‫ﻤ‬ ‫ﺘ‬‫ﻋ‬‫ﺍ‬‫ﻭ‬، ‫ﻮﻝ‬ ‫ﻐ‬‫ﺮﻣﺸ‬ ‫ﻳ‬
‫ﺮ‬‫ﺳ‬
.
"‫ﻧﺐ‬ ‫ﺎ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻟﻰ‬‫ﻧﺐﺇ‬ ‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬"‫ﻮﺏ‬ ‫ﻠ‬‫ﺃﺳ‬ ‫ﻓﻀﻞﻣﻦ‬ ‫ﺃ‬ ‫ﻜﻞ‬ ‫"ﺑﺸ‬ ‫ﻴﻦ‬ ‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﺃﺱﺇ‬ ‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬"‫ﺔ‬ ‫ﻴ‬‫ﻨ‬‫ﻘ‬‫ﻤﻞﺗ‬ ‫ﻌ‬‫ﺪﺗ‬ ‫ﻗ‬، ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﺾ‬ ‫ﺒ‬
‫ﻟ‬
‫ﺪ‬‫ﺋ‬‫ﺎ‬‫ﻮﺳ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺓﻭﺿ‬ ‫ﺩ‬‫ﺎ‬‫ﺈﻋ‬‫ﻗﻢﺑ‬. ‫ﺀ‬‫ﺎ‬‫ﺘﻀ‬ ‫ﻗ‬‫ﺍﻻ‬ ‫ﺪ‬ ‫ﻨ‬‫ﺮﺳﻢﻋ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﻕ‬ ‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻡ‬‫ﺪ‬ ‫ﺘﺨ‬ ‫ﺍﺳ‬ .‫ﺎﻑ‬ ‫ﻋﻢﻭﺟ‬ ‫ﺎ‬‫ﺎﻥﻧ‬ ‫ﺘ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺃﻥ‬ ‫ﺎﻣﻦ‬ ً
‫ﻤ‬‫ﺋ‬‫ﺍ‬
‫ﺪﺩ‬ ‫ﻛ‬ ‫ﺄ‬
‫ﺗ‬
‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﺘﺴﺨ‬ ‫ﺪﻣ‬ ‫ﺋ‬‫ﺎ‬
‫ﻠﻰﻭﺳ‬ ‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬ ‫ﻳ ﺾﻣﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬ ‫ﺔ‬‫ﺎﺟ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﻋﺖ‬ ‫ﺎﺩ‬‫ﻤ‬ ‫ﻠ‬
‫ﺪﻛ‬ ‫ﺋ‬‫ﺎ‬‫ﻮﺳ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬ ‫ﻴ‬‫ﻛ‬‫ﺃ‬‫ﺮ‬‫ﻴ‬ ‫ﻴ‬
‫ﻐ‬ ‫ﺗ‬
‫ﺔﻭ‬ ‫ﻤ‬ ‫ﺍﻋ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻠﻄﺤ‬ ‫ﻔ‬‫ﻭﻣ‬ ‫ﺃ‬ ‫ﺓ‬
‫ﺪ‬ ‫ﻌ‬‫ﻭﻣﺠ‬ ‫ﺃ‬‫ﺔ‬ ‫ﺒ‬
‫ﺭﻃ‬

51
−Whenassi stingwi tht hebedpanorur i
nal ,pr ov ideadequat et imeandpr iv acy
fort hepat ient.Manypat ient sdonotadj usteasi lytot heawkwar dnessofusi ng
abedpanorur i
nal .Thepr esenceofr oommat es, visitor s,orhospi tal per sonnel
j
ustout si det hepr ivacycur t
aini senought omakeany oneuncomf or t
abl e.
Alway spl acet oilettissue, moi stt owel ettes, andcal l bel lwi t
hi neasyr each.
−Checkdai l
yt oseewhet hert hepat ienthashadabowel mov ement .Tr eat ing
const ipat ionwi l
l prev entt hemor eser iouspr obl em off ecal impact ion.
Phy si cianswi l
l r
out inelypr escr ibeast ool sof tenerf ori mmobi li
zedpat ient si n
ordert opr ev entconst i
pat ion.
−Encour aget hepat ientt oeatal loft hepr escr ibeddi et .Ar ecov er i
ngpat ient '
s
dietshoul dbehi ghi ncal cium, protein, i
ron, andv i
tami ns.Pl ent yoff l
uidsand
foodshi ghi nroughagewi llhelppr eventbowel andbl addercompl i
cat ions.
−Assi stt hepat ientt ot akesev eral deepbr eat hseachhour .Coughi nganddeep
breat hi ngwi llhel ppr ev entr espi ratorycompl icat ions.Encour aget hepat ientt o
activ elyexer ciset heunaf f ectedext remi ties.
‫ﺮﻣﻦ‬ ‫ﻴ‬‫ﺜ‬‫ﻛ‬. ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻮﺻ‬ ‫ﻟﺨﺼ‬ ‫ﺍ‬
‫ﻓﻲﻭ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬ ‫ﻓ‬‫ﻮ‬‫ﻳﺠﺐﺗ‬، ‫ﺔ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬ ‫ﺎ‬
‫ﺓﻓﻲﻏﻄ‬ ‫ﺪ‬ ‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻨ‬
‫ﻋ‬-
‫ﻭ‬‫ﺃ‬ ‫ﻜﻦ‬ ‫ﻟﺴ‬ ‫ﺍ‬‫ﺀﻓﻲ‬ ‫ﺎ‬‫ﻘ‬
‫ﻓ‬ ‫ﺩﺭ‬ ‫ﻮ‬‫ﻥﻭﺟ‬. ‫ﺔﺇ‬ ‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻭﻣ‬ ‫ﺃ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﺮﺵﺳ‬ ‫ﻔ‬‫ﻡﻣ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺔ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻌ‬‫ﻊﺻ‬ ‫ﺔﻣ‬ ‫ﻟ‬‫ﻮ‬‫ﻬ‬‫ﻮﻥﺑﺴ‬ ‫ﻤ‬‫ﻠ‬
‫ﻗ‬ ‫ﺄ‬
‫ﺘ‬‫ﺮﺿﻰﻻﻳ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺎ‬ً
‫ﻤ‬‫ﺋ‬‫ﺍ‬‫ﻊﺩ‬ ‫ﺿ‬. ‫ﺎﺡ‬‫ﺗ‬‫ﺮ‬‫ﺮﻣ‬ ‫ﻴ‬‫ﺃﻱﺷﺨ ﺺﻏ‬ ‫ﻌﻞ‬ ‫ﻟﺠ‬‫ﻔﻲ‬ ‫ﻜ‬ ‫ﺔﻳ‬‫ﻴ‬‫ﻮﺻ‬ ‫ﻟﺨﺼ‬ ‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﺭﺝﺳ‬ ‫ﺎ‬‫ﻔﻰﺧ‬ ‫ﺘﺸ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺩﻓﻲ‬ ‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺃ‬ ‫ﻭ‬ ‫ﺃ‬
‫ﺭ‬‫ﺍ‬‫ﻭ‬‫ﺯ‬
.
‫ﺪ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺘ‬ ‫ﺮﺱﻓﻲﻣ‬ ‫ﻟﺠ‬‫ﺎ‬‫ﺗﺼﻞﺑ‬ ‫ﺍ‬‫ﺔﻭ‬ ‫ﻠ‬
‫ﻠ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺷﻒ‬ ‫ﻨ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻤ‬ ‫ﻟﺤ‬ ‫ﺍ‬‫ﻳﻞ‬ ‫ﺩ‬
‫ﺎ‬‫ﻨ‬
‫ﻣ‬
‫ﺮ‬‫ﺜ‬‫ﻛ‬ ‫ﺍﻷ‬ ‫ﺔ‬‫ﻠ‬‫ﻜ‬‫ﻤﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻙ‬‫ﻣﺴ‬ ‫ﺍﻹ‬ ‫ﻊﻋﻼﺝ‬ ‫ﻨ‬
‫ﻤ‬‫ﻳ‬.‫ﺀ‬ ‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻛ‬ ‫ﺮ‬‫ﻧﻲﻣﻦﺣ‬ ‫ﺎ‬‫ﻌ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬‫ﺔﻣ‬ ‫ﻓ‬‫ﺮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬ ‫ﺎ‬
ً
‫ﻴ‬ ‫ﻣ‬‫ﻮ‬ ‫ﻘﻖﻳ‬ ‫ﺗﺤ‬-
‫ﻴﻦﻣﻦ‬ ‫ﻠ‬‫ﻌﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺯ‬ ‫ﺍ‬
‫ﺮ‬‫ﺒ‬‫ﻠ‬
‫ﻟ‬ ‫ﺎ‬ً
‫ﻨ‬‫ﻴ‬
‫ﻠ‬‫ﻨﻲﻣ‬ ‫ﻴ‬‫ﺗ‬‫ﻭ‬‫ﻜﻞﺭ‬ ‫ﺀﺑﺸ‬ ‫ﺎ‬‫ﺒ‬‫ﺍﻷﻃ‬ ‫ﻴﺼﻒ‬ ‫ﺳ‬. ‫ﺯ‬ ‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺎ‬‫ﻧﺤﺸ‬ ‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻠ‬
‫ﺜ‬‫ﻤ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﻮ‬‫ﺧﻄ‬
.‫ﺎﻙ‬‫ﻣﺴ‬ ‫ﺍﻹ‬ ‫ﻊ‬ ‫ﻨ‬‫ﺃﺟﻞﻣ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬ ‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺎ‬
‫ﻨﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬. ‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺎ‬‫ﻮﻑﺑ‬ ‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﻲ‬ ‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻨﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬‫ﻠﻰﺗ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬ ‫ﻴ‬‫ﺗﺸﺠ‬-
‫ﺔ‬‫ﻤ‬‫ﻌ‬‫ﺍﻷﻃ‬ ‫ﺋﻞﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺮﻣﻦ‬ ‫ﻴ‬‫ﺜ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬‫ﺪﺗ‬‫ﺎﻋ‬‫ﻳﺴ‬. ‫ﺎﺕ‬ ‫ﻨ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬ ‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬ ‫ﺎ‬‫ﺑﻜ‬
‫ﻟ‬‫ﺎﺎ‬ً
‫ﻴ‬ ‫ﻨ‬
‫ﻓﻲﻏ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻭ‬ ‫ﺎ‬‫ﻌ‬ ‫ﻣ‬‫ﺍﻷ‬ ‫ﺎﺕﻓﻲ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬ ‫ﻊﺣ‬ ‫ﻨ‬‫ﻠﻰﻣ‬ ‫ﺔﻋ‬ ‫ﻟ‬‫ﺎ‬‫ﻨﺨ‬ ‫ﻟ‬‫ﺎ‬‫ﺔﺑ‬‫ﻴ‬‫ﻨ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬
‫ﻊ‬ ‫ﻨ‬‫ﻠﻰﻣ‬ ‫ﻴﻖﻋ‬ ‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝﻭ‬ ‫ﻌ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬‫ﺎﻋ‬‫ﻳﺴ‬. ‫ﺔ‬‫ﺎﻋ‬ ‫ﺍﺕﻛﻞﺳ‬ ‫ﺮ‬‫ﺓﻣ‬ ‫ﺪ‬‫ﻤﻖﻋ‬ ‫ﻌ‬ ‫ﻔﺲﺑ‬ ‫ﻨ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻣﺴ‬-
.‫ﺎﻁ‬ ‫ﻨﺸ‬‫ﺔﺑ‬ ‫ﻤ‬‫ﻴ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺔ‬‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬‫ﻠﻰﻣ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻊ‬‫ﺷﺠ‬. ‫ﻔﺴﻲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﺣ‬
−El imi nat eanyf act orst hatr educet het ract i
onpul l oral teri tsdi rect i
on.Ropes
andpul ley sshoul dbei nst raightal ignmentandt her opesshoul dbe
unobst ruct ed.
−Thepat ient'sbodyshoul dal way sbei nal ignmentwi tht hef orceoft ract ion.
Checkt hepat i
ent '
sposi t
ioneacht imey ouent ert her oom andhel pt hepat i
ent
sli
deupi nbedi fnecessar y .Encour aget hepat ientt ouset heov er headt rapez e
i
nst eadofel bowst omov ei nbed.
−Checkt heext remi tiesf orcol or(pal lor, cyanosi s),numbness, edema, si gnsof
i
nf ect ion, andpai n.Lookf orar easofski nbr eakdownorpr essur esor esonal l
skinsur faces.
‫ﺍﺕﻓﻲ‬ ‫ﺮ‬ ‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝﻭ‬ ‫ﺒ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬. ‫ﺎ‬
‫ﻬ‬‫ﺎﻫ‬‫ﺗﺠ‬ ‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﻐ‬ ‫ﻭﺗ‬‫ﺃ‬ ‫ﻟﺴﺤﺐ‬ ‫ﺍ‬‫ﺓ‬‫ﻮ‬ ‫ﻠﻞﻣﻦﻗ‬ ‫ﻘ‬‫ﻣﻞﺗ‬ ‫ﺍ‬‫ﻮ‬ ‫ﺃﻱﻋ‬ ‫ﻠﻰ‬ ‫ﺀﻋ‬ ‫ﺎ‬‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬-
.‫ﺋﻖ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﻮﻥﺧ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﺎﻝﻳﺠﺐ‬ ‫ﺒ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻤ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﺓﻣﺴ‬ ‫ﺍ‬‫ﺫ‬‫ﺎ‬
‫ﻣﺤ‬
‫ﺎ‬‫ﻬ‬‫ﻴ‬‫ﺪﺧﻞﻓ‬ ‫ﺓﺗ‬ ‫ﺮ‬‫ﻳ ﺾﻓﻲﻛﻞﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻊ‬‫ﻘﻖﻣﻦﻭﺿ‬ ‫ﺗﺤ‬. ‫ﺮ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺓ‬‫ﻮ‬ ‫ﻊﻗ‬ ‫ﺎﻣ‬ً
‫ﻤ‬ ‫ﺋ‬
‫ﺍ‬‫ﻳ ﺾﺩ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺷﻰﺟﺴﻢ‬ ‫ﻤ‬‫ﺘ‬ ‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬-
‫ﺪ‬‫ﺔﺑ‬ ‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻮﺣ‬ ‫ﺭﺟ‬‫ﺍﻷ‬ ‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺷﺠ‬. ‫ﻷﺮ‬
‫ﺍﻣ‬ ‫ﻡ‬‫ﺰ‬ ‫ﻟ‬‫ﺍ‬
‫ﺫ‬ ‫ﺮﺇ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻧﻻﻕﻓﻲ‬ ‫ﺍﻻﺰ‬ ‫ﻠﻰ‬ ‫ﻩﻋ‬ ‫ﺪ‬ ‫ﻋ‬‫ﺎ‬‫ﺔﻭﺳ‬ ‫ﻓ‬‫ﺮ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬
.‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﻙﻓﻲ‬ ‫ﺘﺤ‬‫ﻠ‬‫ﻟ‬ ‫ﻴﻦ‬‫ﻘ‬ ‫ﻓ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻻًﻣﻦ‬
‫ﺑﺤﺚﻋﻦ‬ ‫ﺍ‬.
‫ﻟﻢ‬‫ﺃ‬‫ﻭ‬، ‫ﻭﻯ‬ ‫ﺪ‬‫ﺎﺕﻋ‬ ‫ﻣ‬ ‫ﻋﻼ‬، ‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻭ‬، ‫ﺭ‬‫ﺪ‬‫ﺧ‬، (‫ﺔ‬‫ﻗ‬ ‫ﺭ‬‫ﺯ‬، ‫ﻮﺏ‬ ‫ﻮﻥ)ﺷﺤ‬ ‫ﻟ‬ ‫ﺎﻋﻦ‬ً‫ﺜ‬‫ﺍﻑﺑﺤ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﻓﺤ ﺺ‬ ‫ﺍ‬-
.‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺃﺳﻄﺢ‬ ‫ﻊ‬ ‫ﻴ‬‫ﻤ‬ ‫ﻠﻰﺟ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﻭﺡ‬ ‫ﺮ‬‫ﻭﻗ‬ ‫ﺃ‬ ‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺮ‬‫ﻜﺴ‬ ‫ﺎﻃﻖﺗ‬ ‫ﻨ‬
‫ﻣ‬

52
 Ext
ernalf
ixat
or

Learningobjectives:
Attheendoft hislecture;thest
udentwil
lbeabl eto:
1.Defineeternal f
ixat
or.
2.Selectfi
ver easonsf ortheuseofexter
nalfixator
.
3.Li
stt hr
eeindi cati
onsf orappl
yi
ngexternalf
ixator
.
4.Discussnur singmanagementf orapati
entwi t
hexter
nal
fix
ator
.
‫ﺭﺟﻲ‬‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬
‫ﺒﺖ‬ ‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬
‫ﻴ‬‫ﺳ‬.‫ﺓ‬‫ﺮ‬
‫ﺎﺿ‬ ‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬ ‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﺪﻱ‬‫ﺑ‬‫ﺍﻷ‬‫ﺒﺖ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬.
1
.
‫ﺭﺟﻲ‬‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺒﺖ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺏﻻﺳ‬ ‫ﺒ‬
‫ﺃﺳ‬ ‫ﺔ‬‫ﻤﺴ‬‫ﺩﺧ‬ ‫ﺪ‬‫ﺣ‬.2
.
‫ﺭﺟﻲ‬
‫ﺎ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺒﺖ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺘﻄ‬
‫ﻟ‬‫ﺍﺕ‬‫ﺮ‬‫ﺆﺷ‬‫ﺑﻼﺙﻣ‬‫ﺔﺜ‬ ‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻊﻗ‬ ‫ﺿ‬.3
.
‫ﺭﺟﻲ‬
‫ﺎ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺒﺖ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺔﺇ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.4
Ext
ernalf
ixat
or

Defi
niti
onofext ernalf ixation:
I
samet al
li
cdev icecomposedofmet al pinsthatar einser tedi nto
theboneandat t
achedt oexternalrodst ost abili
zethef ract ure
whil
eitheals.
Purposesofext ernalf ixation:
1.Tocompr essf ract uref r
agment s
2.Toimmobi l
izeandmai ntainreducedf ragment s.
3.Toallowthepat ienttobemor emobi let hanifconfinedt oa
bedintract
ion.
4.Tomi ni
mi zesomehazar dsofi mmobi l
i
t y.
5.Tofacil
it
at egivingnur si
ngcar e.
:
‫ﺭﺟﻲ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﻪ‬‫ﻴ‬‫ﺎﻓ‬‫ﻬ‬‫ﻟ‬
‫ﺎ‬
‫ﺩﺧ‬ ‫ﺘﻢﺇ‬‫ﺔﻳ‬ ‫ﻴ‬‫ﻧ‬
‫ﺪ‬‫ﻌ‬‫ﻴﺲﻣ‬ ‫ﺑ‬‫ﺎ‬
‫ﺑ‬‫ﻮﻥﻣﻦﺩ‬ ‫ﻜ‬‫ﻧﻲﻣ‬ ‫ﺪ‬‫ﻌ‬‫ﺯﻣ‬‫ﺎ‬‫ﻬ‬
‫ﺓﻋﻦﺟ‬ ‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻋ‬
‫ﺮ‬‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺖ‬‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺭﺟ‬ ‫ﺎ‬
‫ﺎﻥﺧ‬ ‫ﺒ‬‫ﻠﻰﻗﻀ‬ ‫ﻠﻖﻋ‬‫ﻌ‬ ‫ﺗ‬
‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
.‫ﻔﻰ‬‫ﺎﻳﺸ‬ ‫ﻤ‬
‫ﻨ‬‫ﻴ‬‫ﺑ‬
:
‫ﺭﺟﻲ‬ ‫ﺎ‬‫ﻟﺨ‬
‫ﺍ‬ ‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻏ‬‫ﺃ‬
‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻐﻂﺷﻈ‬ ‫ﻟﻀ‬ .
1
.
‫ﺔ‬‫ﻔﻀ‬ ‫ﻨﺨ‬‫ﺎﻣ‬ ‫ﻳ‬‫ﺎ‬
‫ﻠﻰﺷﻈ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻟﺸﻞﻭ‬ .
2
‫ﺃ‬‫ﺍﻓﻲ‬ً
‫ﺭ‬ ‫ﻮ‬
‫ﺎﻥﻣﺤﺼ‬ ‫ﻮﻛ‬ ‫ﻟ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻣ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﺮﻗ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬ ‫ﻮﻥ‬ ‫ﻜ‬‫ﺄﻥﻳ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺎﺡ‬‫ﻤ‬‫ﻠﺴ‬‫ﻟ‬.
3
.‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﺮﻓﻲ‬ ‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬ ‫ﺪ‬‫ﺮﻋ‬ ‫ﺎﻃ‬‫ﻌ ﺾﻣﺨ‬ ‫ﻴﻞﺑ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬.
4
.
‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬‫ﻘ‬‫ﻴﻞﺗ‬‫ﻬ‬‫ﺗﺴ‬.5
Indi
cati
onsofext er nalfixati
on:
1.Whent heuseofacastorot hertracti
oni snotappr opriate
2.Simplefr
act ures, compl exfractureswi thext ensi
vesof ttissue
damage

53
3.Cor r
ectionofbonydef ects(congeni tal),
nonuni onormal union
4.Limbl engthening.
Nur singmanagementofext ernalf i
xation:
1.Ongoi ngassessmentf orpinlooseni ngandi nfecti
oni scriti
cal.
2.Inf ecti
onsi gnal
edbyexudat e,erythema, tender ness,andpai n
may r equireremov alofthedev i
ce.
3.Inst ructthepatientandcar egiveraboutmet iculouspi ncar e.
4.Al thougheachphy sici
anhasapr otocol forpi ncarecl eaning,
hal
f -strengthhy dr
ogenper oxidewi thnor mal sali
nei sof t
en
used.
:‫ﺭﺟﻲ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬ ‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬‫ﻣ‬
‫ﺎﺳﺐ‬ ‫ﻨ‬‫ﺮﻣ‬‫ﻴ‬‫ﺮﻏ‬‫ﻭﺟ‬ ‫ﺃ‬‫ﻟﺐ‬‫ﺎ‬‫ﻡﻗ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬.1
‫ﺔ‬‫ﻌ‬‫ﺍﺳ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﻮ‬
‫ﺮﺧ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺍﺕ‬ ‫ﺓﺫ‬‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴﻄ‬‫ﺒﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬.2
‫ﻠﻒ‬‫ﺗ‬
‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬‫ﺃﺍﻻ‬
‫ﻡﻭ‬ ‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﻡ‬‫ﺪ‬‫(ﻭﻋ‬‫ﺔﺃ‬‫ﻴ‬‫ﻘ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬
)‫ﺔ‬ ‫ﻴ‬
‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬ ‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺢ‬ ‫ﺗﺼﺤ‬. 3
.‫ﺍﻑ‬ ‫ﺮ‬‫ﺍﻷﻃ‬‫ﺔ‬ ‫ﻟ‬
‫ﺎ‬‫ﺇﻃ‬.4
:‫ﺭﺟﻲ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬
.
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﺍﻷﻫ‬ ‫ﺑﻎ‬
‫ﻟ‬
‫ﺮﺎ‬ ‫ﻣ‬‫ﺃ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫ﻮﺱﻭ‬ ‫ﺑ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻔﻚ‬‫ﻟ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.1
‫ﻟﻢ‬‫ﺍﻷ‬‫ﺎﻥﻭ‬ ‫ﻨ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﻣﻲﻭ‬ ‫ﺎ‬‫ﻤ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﺍﺕﻭ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺍﻹ‬‫ﻠﻰ‬ ‫ﺪﻝﻋ‬ ‫ﻭﻯﺗ‬‫ﺪ‬ ‫ﻋ‬.2
.‫ﺯ‬
‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﻠﺐﺇ‬‫ﺘﻄ‬ ‫ﺪﻳ‬‫ﻗ‬
.
‫ﺮ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﻴﺲ‬ ‫ﺑ‬‫ﺎ‬
‫ﺑ‬‫ﺪ‬‫ﺔﺑ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺔﺣ‬ ‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻣ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﺭﺷ‬‫ﺇ‬.3
،‫ﻴﺲ‬ ‫ﺑ‬
‫ﺎ‬‫ﺑ‬
‫ﺪ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬‫ﻮﻝ‬ ‫ﻛ‬‫ﻮ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﻪﺑ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻴﺐ‬‫ﺒ‬‫ﺃﻥﻛﻞﻃ‬ ‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻋ‬.4
‫ﺩﻱ‬‫ﺎ‬‫ﻠﺤﻲﻋ‬‫ﻮﻝﻣ‬ ‫ﻠ‬
‫ﻊﻣﺤ‬ ‫ﺓﻣ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻧﺼﻒ‬ ‫ﻭﺟ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬
‫ﻴ‬‫ﻛﺴ‬‫ﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﻮﻥﺑ‬‫ﻜ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬ً
‫ﺒ‬
‫ﻟ‬‫ﺎ‬
.
‫ﻡ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﺗﺴ‬

A B

A.
Stabi
li
zat
ionofhandinj
ury
.B.Stabi
li
zat
ionofat
ibi
alf
ract
ure.
(Fi
g.15)Ext
ernalf
ixat
ion

54
 Or
thopedi
csur
ger
ies

Learni
ngobjecti
v es:
Attheendofthisl ect
ure;thestudentwi
llbeabl
eto:
1.Defi
neopenr eduction&i nt
ernalfi
xat
ion.
2.Expl
aintheprocessofORI F
3.I
denti
fytheindicati
onsf orORIF.
4.Formulat
enur singprocessformusculoskel
etal
car
emodal
i
ties
‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺍﺣ‬‫ﺮ‬‫ﺟ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬
‫ﺳ‬. ‫ﺓ‬
‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻠﻲ‬‫ﺍﺧ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﺡﻭ‬ ‫ﺘ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬
‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬.1
ORIF‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬
‫ﺮﺡﻋ‬ ‫ﺷ‬.2
.ORIF‫ـ‬‫ﺍﺕﻝ‬ ‫ﺮ‬
‫ﺆﺷ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬.3
‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻼﺕﻭ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺎﻁﺭﻋ‬‫ﻤ‬ ‫ﻧ‬
‫ﺔﻷ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬‫ﺔﺗ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﺔﻋ‬‫ﻏ‬‫ﺎ‬‫ﻴ‬‫ﺻ‬.4
Or
thopedi
csurger
ies

OpenReduct ionandI nt
ernalFixati
on
Orthopedicsurgery,cal
l
edanopenr educti
onandinter
nal f
ixati
on( ORIF)
,is
usuall
ynecessaryifapat i
enthasacompound( open)fr
actureori fmulti
ple
bonefragment sarepresent.
‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺣ‬‫ﺮ‬‫ﺟ‬
‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻴ ﺾﻭ‬‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺘﺢ‬‫ﻓ‬
‫ﺍ‬‫ﺫ‬
‫ﺔﺇ‬‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬
‫ﺿ‬، (ORIF)‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺡﻭ‬ ‫ﺘ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬
‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻰ‬‫ﺘﻲﺗﺴ‬‫ﻟ‬‫ﺍ‬،‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻮﻥﺟ‬‫ﻜ‬‫ﺎﺗ‬
‫ﺓﻣ‬ ‫ﺩ‬
‫ﺎ‬‫ﻋ‬
.
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﺎ‬
‫ﺪﻣﻦﺷﻈ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﺣﺔﻭﺟ‬
‫ﻟ‬‫(ﻭﻓﻲ ﺎ‬
‫ﻮﺡﺃ‬‫ﺘ‬‫ﻔ‬‫ﻣ‬)‫ﻛﺐ‬‫ﺮ‬‫ﺮﻣ‬‫ﻧﻲﻣﻦﻛﺴ‬ ‫ﺎ‬
‫ﻌ‬‫ﻳ ﺾﻳ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻥ‬‫ﻛ‬

(
Fig.16)Openr
educt
ionandi
nter
nalf
ixat
ion

−Wi thanopenr educt

ion,thesurgeonmakesani ncisionsot hatt heinjur
edor
damagedar eacanbeseen.
−Af tert
hewoundi sdebrided(deadanddamagedt i
ssueremov ed)andi rr
igat
ed
withantibi
otics,perox
ide,normalsali
ne,orothersoluti
ons,thesur geonlooksat
thebonef ragment sanddet er
minesex actl
yhowt orejoi
nthem.
−Thef r
acturedendsoft hebonear eplacedinali
gnment( i
.e.,thef ract
ureis
―r educed‖),whichpromot esboneheal i
ng.
Wi thinter
nal f
ixati
on,t
hesur geonplacesapin,wire,scr
ew, plate,nail,
orrod−

55
i
nt ooront ot hebonet okeepi treduced( proper l
yal i
gned) ,immobi l
ized, orbot h.
.‫ﺓ‬‫ﺭ‬
‫ﺮ‬‫ﺘﻀ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺅ‬ ‫ﻜﻦﺭ‬ ‫ﻤ‬‫ﺘﻰﻳ‬ ‫ﻤﻞﺷﻖﺣ‬ ‫ﻌ‬
‫ﺍﺡﺑ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬‫ﻳ‬،‫ﻮﺡ‬‫ﺘ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺾ‬ ‫ﻔ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣ‬-
،‫ﺪ‬ ‫ﻴ‬
‫ﻛﺴ‬ ‫ﻭ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺔﺃ‬ ‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺎ‬
‫ﺎﺑ‬‫ﻬ‬‫ﻳ‬‫ﺭ‬‫(ﻭ‬‫ﺔ‬ ‫ﻔ‬‫ﻟ‬
‫ﺎ‬‫ﻭﺘ‬
‫ﻟ‬
‫ﺔﺍ‬ ‫ﺘ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺇ‬)‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﻧﻀ‬ ‫ﺘﻢﺇ‬ ‫ﺃﻥﻳ‬ ‫ﺪ‬
‫ﻌ‬‫ﺑ‬-
‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﺒﻂﻛ‬‫ﻟﻀ‬ ‫ﺎ‬
‫ﺩﺑ‬ ‫ﺪ‬‫ﻳﺤ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﻟﻰﺷﻈ‬ ‫ﺍﺡﺇ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺮ‬‫ﻨﻈ‬‫ﻳ‬،‫ﺮﻯ‬‫ﺃﺧ‬ ‫ﻴﻞ‬‫ﻟ‬
‫ﺎ‬‫ﺃﻱﻣﺤ‬ ‫ﻭ‬،
‫ﺩﻱﺃ‬ ‫ﺎ‬
‫ﻠﺤﻲﻋ‬ ‫ﻮﻝﻣ‬ ‫ﻠ‬‫ﻭﻣﺤ‬‫ﺃ‬
.
‫ﺮﻯ‬ ‫ﺃﺧ‬ ‫ﺓ‬‫ﺮ‬‫ﺎﻣ‬‫ﻬ‬
‫ﻤ‬‫ﺿ‬
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺰ‬‫ﻌ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ('
'‫ﻔﺾ‬ ‫`ﻣﺨ‬`‫ﺮ‬ ‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺃﻥ‬‫)ﻱ‬‫ﺓﺃ‬ ‫ﺍ‬
‫ﺫ‬‫ﺎ‬‫ﺓﻓﻲﻣﺤ‬ ‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻊﻧ‬ ‫ﺘﻢﻭﺿ‬ ‫ﻳ‬-
‫ﺎﻓﻲ‬ ً
‫ﺒ‬‫ﻴ‬‫ﻭﻗﻀ‬،‫ﺍﺃ‬ً
‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﻭﻣﺴ‬، ‫ﺔﺃ‬ ‫ﻴﺤ‬ ‫ﻔ‬
‫ﻭ ﺻ‬،‫ﺎﺃ‬ ً
‫ﻴ‬‫ﻏ‬‫ﺮ‬‫ﻭﺑ‬،
‫ﺎﺃ‬ ً
‫ﻜ‬
‫ﻠ‬‫ﻭﺳ‬،‫ﺎﺃ‬ ً‫ﻮ‬
‫ﺳ‬ ‫ﺑ‬
‫ﺍﺡﺩ‬ ‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻊ‬‫ﻳﻀ‬،‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣ‬-
.‫ﺎ‬
‫ﻤ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬
‫ﻭﻛ‬،‫ﺎﺃ‬ ً
‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﻭﺛ‬،‫(ﺃ‬ ‫ﻴﺢ‬‫ﻜﻞ ﺻﺤ‬ ‫ﺎﺑﺸ‬ً
‫ﻳ‬‫ﺫ‬‫ﺎ‬
‫ﻣﺤ‬ )‫ﺎ‬ً‫ﻔ‬
‫ﻀ‬ ‫ﻨﺨ‬
‫ﻪﻣ‬ ‫ﺋ‬
‫ﺎ‬‫ﻘ‬
‫ﺑ‬‫ﻪﻹ‬ ‫ﻴ‬‫ﻠ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﻌﻈﻢ‬‫ﻟ‬
‫ﺍ‬
−TheORI Fist het reatmentofchoi cef orcer t
ainf racturesi nwhichcast ingi s
gener all
yimpossi ble( e.g.,hipfract ure)ori fmul ti
plef ragment sarei mpossi bl
e
tor eali
gn.Internal fixati
onel iminat est heneedf ort r
act i
on.Inaddition, t
he
patient’srecov eryisusual l
yqui ckerI nt ernal f
ixati
oncanbeper f
ormedusi ng
variousdev ices.
Itisusedmostf requent l
yf orfract ur
esoft hel eg’slongbones, inwhi chcase−
thespi keiscal ledani ntramedul l
ar ynai l
.Usual lyinternalfixati
onisdonei fthe
patienthasmor et hanonet ransv ersef ractureori fthepat ient’
shistoryi ncludes
fracturesthatdonotal i
gnorheal easilywi t
hcast ing.

،‫ﺎ‬
‫ﺜﻝ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬‫ﻡ)ﻋ‬‫ﺎ‬‫ﻜﻞﻋ‬‫ﺎﺑﺸ‬ً
‫ﻠ‬‫ﻴ‬
‫ﺘﺤ‬‫ﻟﺼﺐﻣﺴ‬ ‫ﺍ‬
‫ﺎ‬‫ﻬ‬‫ﻴ‬
‫ﻮﻥﻓ‬ ‫ﻜ‬‫ﺔﻳ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﺭﻣ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻫ‬ORI F‫ﺇﻥ‬-
‫ﻟﻰ‬‫ﺔﺇ‬‫ﺎﺟ‬‫ﻟﺤ‬‫ﺍ‬‫ﻐﻲ‬‫ﻠ‬
‫ﻠﻲﻳ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﺎﻣ‬‫ﻳ‬‫ﺎ‬
‫ﻴﻢﺷﻈ‬ ‫ﻨﻈ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻴﻞﺇﻋ‬‫ﺘﺤ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥﻣﻦ‬ ‫ﺍﻛ‬‫ﺫ‬
‫(ﻭﺇ‬
‫ﺭﻙﺃ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻛﺴ‬
‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﻠﻲﺑ‬‫ﺍﺧ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﻜﻦﺇﺟ‬‫ﻤ‬‫ﻳ‬
‫ﺮﻉﻭ‬ ‫ﺃﺳ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻔ‬‫ﻮﻥﺷ‬‫ﻜ‬ ‫ﺎﻳ‬
‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬، ‫ﻟﻚ‬‫ﻟﻰﺫ‬‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻹﺿ‬‫ﺑ‬.‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
.
‫ﺔ‬‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﺓﻣﺨ‬ ‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬
‫ﺍﺳﻢ‬‫ﺔ‬‫ﻠ‬‫ﺒ‬
‫ﻨ‬‫ﻟﺴ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻠﻖﻋ‬ ‫ﺔﻳﻄ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﻓﻲﻫ‬ ‫ﻭ‬،‫ﺔ‬‫ﻠ‬‫ﻳ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎﻕ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺭﻋﻈ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺭ‬‫ﺮ‬
‫ﻜ‬‫ﺘ‬ ‫ﻜﻞﻣ‬‫ﻪﺑﺸ‬ ‫ﻣ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬-
‫ﺮ‬‫ﺮﻣﻦﻛﺴ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻧﻲﻣﻦ‬‫ﺎ‬‫ﻌ‬
‫ﻳ ﺾﻳ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬
‫ﺫ‬‫ﻠﻲﺇ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺘﻢﺇﺟ‬‫ﺎﻳ‬
‫ﺓﻣ‬ً‫ﺩ‬‫ﺎ‬‫ﻋ‬.‫ﺎﻉ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺧﻞ‬‫ﺮﺩ‬ ‫ﻔ‬
‫ﻟﻈ‬‫ﺍ‬
.‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻊ‬‫ﺔﻣ‬ ‫ﻟ‬
‫ﻮ‬‫ﻬ‬‫ﺌﻢﺑﺴ‬‫ﺘ‬‫ﻠ‬
‫ﻭﺗ‬‫ﺃ‬‫ﺎﺷﻰ‬‫ﻤ‬‫ﺘ‬
‫ﺍﻻﺗ‬ً
‫ﺭ‬‫ﻮ‬‫ﻤﻦﻛﺴ‬ ‫ﺘﻀ‬‫ﻳ ﺾﻳ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺎﻥﺗ‬‫ﺍﻛ‬ ‫ﺫ‬
‫ﻭﺇ‬‫ﺃ‬‫ﺪ‬‫ﺍﺣ‬‫ﺮﺿﻲﻭ‬ ‫ﻋ‬

−Thesur geonmayappl yamet al platewi t

hscr ewst ot heout sideoft hebone;
suchadev iceof tenmustr emai ni npl aceper manent ly.Thispr ocedur eis
usual l
yper f or medwhenabonei sf ract uredinsev eral places.Scr ewsar e
somet i
mesi nser t
edt ohol dthebonef ragment si npl acewi thoutusi ngapl ate.
Wi resmaybeusedt ohol dfragment sofbonet oget her .
Al thought hepat ientwi thinternal fixationmayhav enov i
sibleform of−
i
mmobi li
zat ion, af ract urestil
l existst hatr equir escar efulhandl ing.Somet i
mes,
i
nt ernal f
ixat ioni scombi nedwi thanot herf orm ofi mmobi l
i
z ati
on, suchas
splinti
ngorcast i
ng.
‫ﺃﻥﻳﻈﻞ‬ ‫ﺎﻳﺠﺐ‬ ‫ﻏﺎﻣ‬ً
‫ﺒ‬
‫ﻟ‬‫؛ﺎ‬ ‫ﻌﻈﻢ‬ ‫ﻟ‬‫ﺍ‬‫ﺭﺟﻲﻣﻦ‬ ‫ﺎ‬
‫ﻟﺨ‬ ‫ﺍ‬‫ﺀ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻠﻰ‬‫ﺮﻋ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻪﻣﺴ‬ ‫ﻧﻲﺑ‬ ‫ﺪ‬‫ﻌ‬‫ﻮﺡﻣ‬ ‫ﻟ‬
‫ﻊ‬‫ﻮﺿ‬ ‫ﺍﺡﺑ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻡ‬ ‫ﻮ‬‫ﻘ‬
‫ﺪﻳ‬ ‫ﻗ‬-
‫ﺘﻢ‬‫ﻳ‬.‫ﻛﻦ‬ ‫ﺎ‬
‫ﻣ‬‫ﺃ‬‫ﺓ‬ ‫ﺪ‬‫ﻌﻈﻢﻓﻲﻋ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﻨ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﺓﻋ‬ً‫ﺩ‬‫ﺎ‬‫ﺀﻋ‬ ‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺍ‬‫ﺬ‬‫ﺬﻫ‬ ‫ﻴ‬‫ﻔ‬‫ﻨ‬‫ﺘﻢﺗ‬ ‫ﻳ‬.‫ﺋﻢ‬‫ﺍ‬
‫ﻜﻞﺩ‬ ‫ﻪﺑﺸ‬ ‫ﻧ‬‫ﺎ‬‫ﻜ‬‫ﺯﻓﻲﻣ‬ ‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﺍ‬
‫ﺬ‬‫ﻫ‬
‫ﺍﻷﺳﻼﻙ‬ ‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬ ‫ﻳ‬.‫ﺔ‬ ‫ﻴﺤ‬‫ﻔ‬‫ﻡﺻ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻭﻥ‬‫ﺎﺩ‬ ‫ﻬ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻡﻓﻲﻣ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻴﺖﺷﻈ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬ً
‫ﻧ‬
‫ﺎ‬‫ﻴ‬‫ﺃﺣ‬‫ﻏﻲ‬ ‫ﺍ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﺩﺧ‬‫ﺇ‬
.‫ﻣ‬
‫ﺎ‬
ً‫ﻡ‬
‫ﻌ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻴﺖﺷﻈ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﻻﻥ‬
‫ﺇﺃ‬، ‫ﻠﻞ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﺋﻲﻣﻦ‬ ‫ﺮ‬‫ﻜﻞﻣ‬ ‫ﻪﺷ‬ ‫ﻳ‬‫ﺪ‬
‫ﻟ‬ ‫ﻮﻥ‬‫ﻜ‬ ‫ﺪﻻﻳ‬ ‫ﻠﻲﻗ‬ ‫ﺍﺧ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺏﺑ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺃﻥ‬‫ﻏﻢﻣﻦ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬-
‫ﻠﻲ‬ ‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻊﺑ‬‫ﻤ‬‫ﻟﺠ‬‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬، ‫ﺎﻥ‬‫ﻴ‬‫ﺍﻷﺣ‬ ‫ﻌﺾ‬ ‫ﻓﻲﺑ‬. ‫ﺔ‬‫ﻘ‬ ‫ﻴ‬
‫ﻗ‬‫ﺔﺩ‬ ‫ﻟﺠ‬‫ﺎ‬
‫ﻌ‬‫ﻠﺐﻣ‬ ‫ﺘﻄ‬ ‫ﺍﻳ‬ً
‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﺍﻝﻣ‬‫ﻻﺰ‬
‫ﺮﻳ‬ ‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬
.‫ﻟﺼﺐ‬ ‫ﺍ‬ ‫ﻭ‬
‫ﺃ‬‫ﺮ‬ ‫ﻴ‬‫ﺒ‬‫ﺘﺠ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬ ‫ﻣ‬، ‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﻜ‬ ‫ﺃﺷ‬‫ﺮﻣﻦ‬ ‫ﺁﺧ‬‫ﻜﻞ‬ ‫ﻭﺷ‬
Nur singcar epl anf ormuscul oskel etalcar emodal it
ies
Nur singdi agnosi s:
Impai redPhy sical Mobi li
tyrelatedt or epai roff ract uredsi teasev idencedby
pat i
ent ’
sst at ementaboutwal kingandpr escribedpost oper ativerest ri
cti
ons.
Planni ng:
Shor t-t
erm Goal s
1.Pat ientpar ti
cipat esi nproperposi t
ioni ngwhi leinbed.
2.Pat ientdemonst r atesappr opr iateexer ciset echni ques.

56
Long- term Goal s
3.Pat i
entdemonst ratesabi li
tyt ot ransf erf rom bedt ochai ri ndependent l
y .
4.Pat i
entpar ticipat esinphy sical therapypr ogr am forpr ogr essi veambul ation.
‫ﻠﻲ‬‫ﻜ‬ ‫ﻴ‬
‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻠﻲ‬ ‫ﻌﻀ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻕﺭﻋ‬ ‫ﻟﻄ‬ ‫ﺔ‬ ‫ﻴ‬
‫ﻳﻀ‬ ‫ﺮ‬ ‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺧﻄ‬
:‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻤﺸﻲﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝ‬ ‫ﻳ ﺾﺣ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻴ‬‫ﺘﻀﺢﻣﻦﺑ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﺭﻛ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻊ‬‫ﻗ‬‫ﻮ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺈﺻﻼﺡ‬ ‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬‫ﻌ‬‫ﺘ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻟﺠﺴ‬ ‫ﺍ‬‫ﺔ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻌﻒ‬ ‫ﺿ‬
.‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺪ‬ ‫ﻌ‬‫ﺎﺑ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬‫ﻮ ﺹﻋ‬ ‫ﻨﺼ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻴ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬
:‫ﻴﻂ‬‫ﺗﺨﻄ‬
‫ﺪﻯ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺍﻑﻗﺼ‬ ‫ﺪ‬ ‫ﺃﻫ‬
.‫ﺮ‬‫ﻳ‬‫ﺮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻩﻓﻲ‬ ‫ﺩ‬‫ﻮ‬ ‫ﺀﻭﺟ‬ ‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬‫ﺎﺳﺐ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬ ‫ﺎ‬
‫ﻳﺸ‬. 1
.‫ﺔ‬ ‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻴ‬‫ﻨ‬‫ﻘ‬‫ﻳ ﺾﺗ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﺿﺢ‬ ‫ﻳ‬.2
‫ﺪﻯ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﺍﻑﺑ‬ ‫ﺪ‬ ‫ﺃﻫ‬
.
‫ﻘﻞ‬ ‫ﺘ‬‫ﻜﻞﻣﺴ‬ ‫ﺮﺳﻲﺑﺸ‬ ‫ﻟﻰﻛ‬ ‫ﺮﺇ‬ ‫ﻳ‬‫ﺮ‬‫ﺎﻝﻣﻦﺳ‬ ‫ﻻﻘ‬
‫ﺘ‬‫ﺍﻧ‬ ‫ﻠﻰ‬ ‫ﻪﻋ‬ ‫ﺗ‬‫ﺭ‬
‫ﺪ‬ ‫ﻳ ﺾﻗ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﺿﺢ‬ ‫ﻳ‬.3
.
‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺸﻲ‬ ‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬ ‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﻳ ﺾﻓﻲﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬ ‫ﺎ‬
‫ﻳﺸ‬. 4
Implement ation:Nur singact i
on
1.Checkt hephy si cian’si nst ruct ionsaboutposi tionandact i
v i
t y.
2.Bef oremov ingt hepat ient ,expl ainwhatwi ll bedoneandhowshecan
3.help.
4.Ensur et hatt hebedi sequi ppedwi t
hat rapezebarf orpat ientuse.
5.Teachexer ci sest hepat ientcandoi nbed, incl udingi somet ric,quadr i
ceps-
setti
ng, andgl ut eal -setti
ngexer cises.
6.Encour ageexer ci sesev ery1t o2hour s.
7.Of f
ersuppor tandencour agementasor der ed.
8.Assi stthepat ientt r
ansf erf rom bedt ochai r, whilemai nt ainingpr oper
positi
oni ngoft hepat i
ent ’
sext remi tyandpr escr i
bedamountofwei ght-bear ing
all
owed
9.Asor der ed, cont actPhy sical Ther apydepar tmentf orpr ogr essi veambul ation
program.Wor kwi thphy sical ther api standpat ientt opr omot eambul ation.
10.Rei nfor cet heambul at i
onski ll
st hepat ienti sl earningi nphy sical ther apy
anduset hem whenassi stingt hepat i
enti nt r
ansf erri
ng, get tingoutofbedt ogo
tothebat hr oom, orf orwal ks.
11.Takepr opersaf etypr ecaut ionswi theachi nt eraction.
12.Pr aiset hepat i
ent ’
spr ogr ess.
Evaluat i
on:
Patientdemonst rat est ransf erf rom bedt ochai rwi t
hnur sewat chi ngat
bedside.Pat i
entr epor tsambul atingwi thwal ker .
‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬:‫ﺬ‬‫ﻴ‬‫ﻔ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﺎﻁ‬ ‫ﻨﺸ‬‫ﻟ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻔ‬ ‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﻴﺐﺣ‬ ‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻤ‬‫ﻴ‬‫ﻠ‬‫ﻌ‬‫ﻘﻖﻣﻦﺗ‬ ‫ﺗﺤ‬. 1
‫ﻟﻚ‬ ‫ﺎﺫ‬ ‫ﻬ‬‫ﻨ‬
‫ﻜ‬ ‫ﻤ‬
‫ﻴﻒﻳ‬ ‫ﻛ‬ ‫ﻪﻭ‬ ‫ﻡﺑ‬ ‫ﺎ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬‫ﻴ‬‫ﺎﺳ‬‫ﺮﺡﻣ‬ ‫ﺍﺷ‬ ، ‫ﺔ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬ ‫ﺒﻞﻧ‬ ‫ﻗ‬.2
.
‫ﺓ‬‫ﺪ‬ ‫ﻋ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ .
3
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺔﻻﺳ‬ ‫ﻮﺣ‬ ‫ﺭﺟ‬ ‫ﺃ‬‫ﻴﺐ‬ ‫ﻘﻀ‬ ‫ﺰﺑ‬ ‫ﻬ‬‫ﺮﻣﺠ‬ ‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺃﻥ‬ ‫ﺪﻣﻦ‬ ‫ﻛ‬‫ﺄ‬‫ﺗ‬.4
،
‫ﺎﺱ‬ ‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺎ‬‫ﺘﺴ‬ ‫ﻳﻦﻣ‬ ‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻚﺗ‬ ‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬، ‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺎﻓﻲ‬ ‫ﻬ‬‫ﻡﺑ‬ ‫ﺎ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬‫ﺗ‬.5
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻟ‬
‫ﺍﻷ‬‫ﺪ‬ ‫ﻳ‬
‫ﺪ‬‫ﻳﻦﺗﺤ‬ ‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﺗ‬‫ﻭ‬، ‫ﻭﺱ‬ ‫ﺅ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬
‫ﺎﻋ‬ ‫ﺑ‬‫ﺭ‬‫ﻭ‬
.‫ﻴﻦ‬‫ﺘ‬‫ﺎﻋ‬ ‫ﻟﻰﺳ‬ ‫ﺔﺇ‬ ‫ﺎﻋ‬
‫ﻳﻦﻛﻞﺳ‬ ‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺭﺳ‬‫ﺎ‬‫ﻤ‬‫ﻠﻰﻣ‬ ‫ﻪﻋ‬ ‫ﻌ‬
‫ﺷﺠ‬. 6
.‫ﺮﺕ‬ ‫ﻣ‬‫ﺃ‬
‫ﺎ‬‫ﻤ‬ ‫ﻊﻛ‬ ‫ﻴ‬
‫ﺘﺸﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﻋﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻳﻢ‬‫ﺪ‬‫ﻘ‬‫ﺗ‬.7
‫ﺍﻑ‬ ‫ﺮ‬‫ﺎﺳﺐﻷﻃ‬ ‫ﻨ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻊ‬‫ﻣ‬، ‫ﺮﺳﻲ‬ ‫ﻟﻰﻛ‬ ‫ﺮﺇ‬ ‫ﻳ‬
‫ﺮ‬‫ﺎﻝﻣﻦﺳ‬ ‫ﻻﻘ‬
‫ﺘ‬ ‫ﺍﻧ‬ ‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻣﺴ‬. 8
‫ﻪ‬ ‫ﻮﺡﺑ‬ ‫ﻤ‬ ‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺩﻣﻦﺣ‬ ‫ﺪ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺋﻲﻭ‬ ‫ﺎ‬‫ﻳ‬
‫ﺰ‬‫ﻴ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻟﺞ‬ ‫ﺎ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻤﻞﻣ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬.‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻤﺸﻲ‬ ‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬ ‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻘﺴﻢ‬ ‫ﺗﺼﻞﺑ‬ ‫ﺍ‬،‫ﻠﺐ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺣﺴﺐ‬. 9
.‫ﻤﺸﻲ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﺪﻣﺴ‬ ‫ﻨ‬‫ﺎﻋ‬ ‫ﻬ‬‫ﻣ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻌﻲﻭ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻬ‬‫ﻤ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻤﺸﻲ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﻬ‬‫ﺰﻣ‬ ‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﺗ‬. 10

57
 ‫‪.‬‬
‫ﻩ‬‫ﺰ‬‫ﻨ‬
‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﻡ‬
‫ﺎ‬‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺎﺏﺇ‬‫ﺬﻫ‬
‫ﻠ‬‫ﻟ‬ ‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻮ ﺽﻣﻦ‬‫ﻬ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻝ‬
‫ﻻﻘ‬
‫ﺘ‬‫ﺍﻧ‬ ‫ﻓﻲ‬
‫‪.‬‬‫ﻋﻞ‬‫ﺎ‬
‫ﻔ‬‫ﻊﻛﻞﺗ‬‫ﺔﻣ‬‫ﺒ‬‫ﺎﺳ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻼﺔ‬
‫ﻟﺴ ﻣ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺎﻃ‬‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬‫ﺬ‬‫ﺗﺨ‬‫ﺍ‬‫‪.‬‬‫‪11‬‬
‫‪.‬‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﺪﺡﺗ‬‫ﻣ‬‫ﺍ‬‫‪.‬‬‫‪12‬‬
‫‪:‬‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬
‫ﻮﻝ‬
‫ﺘﺠ‬‫ﻳ ﺾﻳ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻘ‬‫‪.‬ﺗ‬
‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻧﺐ‬
‫ﺎ‬‫ﻗﺐﺑﺠ‬‫ﺍ‬‫ﺮ‬
‫ﺔﺗ‬‫ﺮﺿ‬‫ﻤ‬‫ﻊﻣ‬‫ﺮﺳﻲﻣ‬‫ﻟﻰﻛ‬ ‫ﺮﺇ‬‫ﻳ‬
‫ﺮ‬‫ﺎﻝﻣﻦﺳ‬ ‫ﻻﻘ‬
‫ﺘ‬‫ﺍﻧ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺿﺢ‬ ‫ﻳ‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣ‬

‫‪Uni‬‬‫‪t3:‬‬
‫‪Muscul‬‬
‫‪oskel‬‬
‫‪et‬‬‫‪aldi‬‬
‫‪sor‬‬
‫‪der‬‬
‫‪s‬‬

‫‪:‬‬
‫ﺓ‪3‬‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻜ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻌﻀ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬

‫‪58‬‬
 Met
aboli
cbonedisor
der
s
Osteopor
osi
s
Def initionofOst eopor osis:
Ost eopor osisi sar educt i
onofbonedensi t
yandachangei nbonest ruct ur e,
whi chi ncr easesuscept i
bili
tyt of ractur e.
-Ther at eofboner esor pti
oni sgr eatert hant her ateofbonef ormat i
on,
resul ti
ngi nar educedt otal bonemass.
Riskf act orsofost eopor osis:
A.I ndi vidualRi skFact ors
-Femal e
-Incr easedage: Bonedensi t
ypeakswhenaper soni si ntheirlate20s.Af tert he
ageofar ound35y ears,bonest artstobecomeweaker .Asage, bonebr eaks
downf ast erthani tbui l
ds.Ift hishappensexcessi vely,osteopor osi sr esul ts.
-Lowwei ghtandbodymassi ndex .Bei ngtallorsl imi ncreasest her isk.
-Est rogendef iciencyormenopause
-Fami lyhi story
-Coexi st i
ngmedi cal condi t
ions( eg, mal absor pti
onsy ndromes, cancer , COPD,
alcohol abuse, renal f
ailure, l
i
v erf ail
ur e,Cushi ng’ssy ndrome, hy per thy roidism,
andhy per parathy roidism)cont ri
but et obonel oss
-Medi cat ions( eg, cor ti
cost eroids, ant isei
zuremedi cat i
ons)
‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺍﻷ‬‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻫﺸ‬
:‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺎﺷ‬‫ﻳﻒﻫﺸ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﺔﺑ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺑ‬‫ﺎ‬‫ﺪﻣﻦﻗ‬ ‫ﻳ‬‫ﺰ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻨ‬
‫ﺮﻓﻲﺑ‬ ‫ﻴ‬‫ﻐ‬
‫ﺗ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻓ‬‫ﺎ‬
‫ﺜ‬‫ﺎ ﺽﻓﻲﻛ‬ ‫ﻔ‬ ‫ﻧﺨ‬‫ﺍ‬‫ﻡﻫﻲ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺎﺷ‬‫ﻫﺸ‬
.‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺎ‬
.
‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺘ‬‫ﺎ ﺽﻛ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬ ‫ﻤ‬‫ﻣ‬، ‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬‫ﺪﻝﺗ‬ ‫ﻌ‬‫ﺮﻣﻦﻣ‬ ‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻑ‬ ‫ﺗﺸ‬‫ﺭ‬‫ﺍ‬ ‫ﺪﻝ‬ ‫ﻌ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﻳ‬-
:
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻬﺸ‬ ‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻣﻞﺧﻄ‬ ‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫ﺔ‬‫ﻳ‬‫ﺩ‬ ‫ﺮ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬‫ﻮ‬‫ﻋ‬.‫ﺃ‬
‫ﺜﻰ‬‫ﻧ‬‫ﺃ‬-
‫ﺪﺳﻦ‬ ‫ﻌ‬ ‫ﺑ‬.‫ﺮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕﻣﻦ‬ ‫ﻨ‬
‫ﻳ‬‫ﺮ‬‫ﻌﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺍﺧ‬‫ﻭ‬‫ﺃ‬ ‫ﻟﺸﺨ ﺺﻓﻲ‬ ‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬ ‫ﺪ‬
‫ﻨ‬‫ﺎﻋ‬‫ﻬ‬‫ﺗ‬‫ﻭ‬‫ﺭ‬‫ﻡﺫ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﺜ‬‫ﻎﻛ‬ ‫ﻠ‬
‫ﺒ‬‫ﺗ‬: ‫ﺮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺯ‬-
‫ﺍ‬
‫ﺬ‬ ‫ﺪﺙﻫ‬ ‫ﺍﺣ‬‫ﺫ‬‫ﺇ‬.‫ﻮﻥ‬ّ
‫ﻜ‬ ‫ﺘ‬‫ﺎﺗ‬‫ﻤ‬‫ﺮﻉﻣ‬ ‫ﺃﺳ‬‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﻬ‬‫ﻨ‬
‫ﺗ‬، ‫ﺮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻊﺗ‬ ‫ﻣ‬.‫ﻌﻒ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻌﻈﻢﻓﻲ‬ ‫ﻟ‬‫ﺍ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬
‫ﻳ‬، ‫ﺎ‬ً
‫ﺒ‬‫ﻳ‬‫ﺮ‬‫ﻘ‬‫ﺎﺗ‬ً
‫ﻣ‬‫ﺎ‬‫ﻋ‬35
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻪﻫﺸ‬ ‫ﻨ‬‫ﺘﺞﻋ‬ ‫ﻨ‬
‫ﻳ‬، ‫ﺮﻁ‬ ‫ﻔ‬‫ﻜﻞﻣ‬ ‫ﺑﺸ‬
.‫ﺮ‬‫ﺎﻃ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺰ‬‫ﺎﻳ‬ً
‫ﻔ‬‫ﻴ‬‫ﻭﻧﺤ‬ ‫ﺃ‬‫ﺔ‬ ‫ﻣ‬‫ﺎ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻞ‬‫ﻮ‬‫ﻧﻚﻃ‬ ‫ﻮ‬‫ﻛ‬.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺘ‬‫ﺮﻛ‬ ‫ﺆﺷ‬ ‫ﻣ‬‫ﺯﻥﻭ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺽ‬ ‫ﻔ‬ ‫ﻧﺨ‬‫ﺍ‬-
‫ﻤﺚ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺎﻉ‬‫ﻘﻄ‬‫ﻧ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﻮﻥ‬ ‫ﻣ‬‫ﺮ‬‫ﻘ ﺺﻫ‬ ‫ﻧ‬-
‫ﺔ‬‫ﻠ‬‫ﺋ‬‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺗ‬-
‫ﺍﻻ‬ ‫ﺮﺽ‬ ‫ﻣ‬‫ﻭ‬، ‫ﺎﻥ‬‫ﺮﻃ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬، ‫ﺎﺹ‬ ‫ﺘﺼ‬ ‫ﻣ‬‫ﺍﻻ‬ ‫ﺀ‬‫ﻮ‬‫ﺎﺕﺳ‬ ‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺘ‬،‫ﺎ‬‫ﺜﻝ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫ﺔ)ﻋ‬‫ﻳﺸ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻟﺤ‬‫ﺍ‬-
‫ﺮﻁ‬ ‫ﻓ‬‫ﻭ‬، ‫ﻎ‬‫ﻨ‬‫ﻴ‬‫ﻮﺷ‬‫ﺔﻛ‬ ‫ﻣ‬‫ﺯ‬‫ﺘﻼ‬ ‫ﻣ‬‫ﻭ‬، ‫ﺪﻱ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬،‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻮﻝ‬‫ﻜﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲ‬‫ﻌ‬‫ﺗ‬‫ﻭ‬، ‫ﻣﻦ‬ ‫ﺰ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻱ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬ ‫ﺩ‬‫ﺍ‬
‫ﺪ‬ ‫ﻧﺴ‬
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬ ‫ﻘ‬‫ﺎﻫﻢﻓﻲﻓ‬ ‫(ﺗﺴ‬ ‫ﺔ‬‫ﻴ‬
‫ﻗ‬‫ﺭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺎﻁﺟ‬ ‫ﺮﻁﻧﺸ‬ ‫ﻓ‬ ‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﻗ‬‫ﺭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺪ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻧﺸ‬
(‫ﺧﻼﺝ‬‫ﺍﻻﺘ‬ ‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﺔﻣﻀ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺃ‬
‫ﺍﺕﻭ‬ ‫ﺪ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻮﺳ‬ ‫ﻜ‬‫ﻴ‬‫ﺗ‬‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬ ‫ﺜﻞ‬‫ﻣ‬)‫ﺔ‬ ‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬-
B.Li fest yleRi skFact or s

59
-Dietslowincalcium andvit
aminD
-Cigarett
esmoki ng
-Useofal cohol
and/ orcaff
eine
-Lackofwei ght
-bearingexerci
se
-Lackofexposur etosunshine
‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﻤﻂ‬ ‫ﻨ‬‫ﺔﺑ‬ ‫ﻘ‬‫ﻠ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫ﻴﻦﺩ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﻓ‬ ‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔﻀ‬ ‫ﻨﺨ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻤ‬‫ﻧﻈ‬‫ﺍﻷ‬-
‫ﺮ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺠ‬ ‫ﺍ‬‫ﻴﻦ‬ ‫ﺪﺧ‬‫ﺗ‬-
‫ﻴﻦ‬ ‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬/
‫ﻮﻝﻭ ﺃ‬ ‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻃﻲ‬ ‫ﻌ‬‫ﺗ‬-
‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺔﺗﺤ‬ ‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬ ‫ﺔﻣ‬ ‫ﻠ‬
‫ﻗ‬-
‫ﻤﺲ‬ ‫ﻟﺸ‬‫ﺍ‬ ‫ﺔ‬‫ﻌ‬‫ﺮ ﺽﻷﺷ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻋ‬-
AssessmentandDi agnost icFindi ngsofOst eopor osi s:
-Assesspat ient '
sf ami lyhi storyandt heirriskf actor s.
-Bonescant omeasur ebonemi ner aldensi ty(BMD)
-Bonedensi tyscanni ngusesat ypeofx- rayt echnol ogyknownasdual -
ener gyX
-rayabsor pt iomet ry(DEXA)andbonedensi tomet r
y .
-DEXAcani ndi cateoff ract uresoccur r
ingduet oost eopor osi sandmoni tor
responset ot r
eat ment .
-Ther esul tsoft het estar egi venasaDEXAT- scor eoraZ- scor e.
-TheT- scor ecompar est hepat i
ent 'sbonemasswi thpeakbonemassofa
youngerper son.
--1. 1orabov ei snor mal
-fr om -1.0t o- 2. 5suggest smi l
dbonel oss
--2. 5orbel owi ndicat esost eopor osi s
-TheZ- scor ecompar est hepat i
ent 'sbonemasswi tht hatofot herpeopl ewi th
simi larbui l
dandage.
:‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﺮ ﺽﻫﺸ‬ ‫ﻤ‬‫ﻟ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﻧ‬
.‫ﻬﻢ‬ ‫ﺔﺑ‬‫ﺎﺻ‬‫ﻟﺨ‬ ‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬‫ﺍ‬ ‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬ ‫ﻋ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﻠﻲ‬‫ﺋ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
(
BMD)‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬ ‫ﻧ‬
‫ﺪ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬
‫ﺜ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺱ‬ ‫ﻴ‬‫ﻘ‬
‫ﻟ‬ ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻣﺴﺢ‬-
‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ ‫ﺎﺹ‬ ‫ﺘﺼ‬ ‫ﻣ‬ ‫ﺍ‬‫ﺎﺱ‬ ‫ﻴ‬‫ﺎﺳﻢﻗ‬ ‫ﺔﺑ‬ ‫ﻓ‬‫ﻭ‬ ‫ﺮ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ ‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻘ‬‫ﺎﻣﻦﺗ‬ ً‫ﻮ‬
‫ﻋ‬ ‫ﻡﻧ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﺜ‬
‫ﻡﻣﺴﺢﻛ‬ ‫ﺪ‬‫ﺘﺨ‬ ‫ﻳﺴ‬-
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﺜ‬‫ﺎﺱﻛ‬ ‫ﻴ‬‫ﻗ‬‫(ﻭ‬ DEXA)‫ﺔ‬ ‫ﻗ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬‫ﺋﻲ‬‫ﺎ‬‫ﻨ‬
‫ﺔﺛ‬ ‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺍ‬
.
‫ﻌﻼﺝ‬ ‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬ ‫ﺍﻻﺳ‬ ‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﺒﺐﻫﺸ‬ ‫ﺪﺙﺑﺴ‬ ‫ﺘﻲﺗﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬ ‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬ ‫ﺇ‬DEXA‫ﺮ‬ ‫ﻴ‬‫ﺃﻥﻳﺸ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬-
.Z‫ﺔ‬ ‫ﺭﺟ‬ ‫ﻭﺩ‬D
‫ ﺃ‬EXAT‫ﺔ‬ ‫ﺭﺟ‬ ‫ﺪ‬‫ﺭﻛ‬ ‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﺀﻧ‬‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬ ‫ﻳ‬-
.‫ﺳ‬
‫ﺎ‬ً‫ﺮ‬
‫ﻨ‬ ‫ﻐ‬‫ﺍﻷﺻ‬ ‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬‫ﻡ‬ ‫ﺎ‬
‫ﺔﻋﻈ‬ ‫ﻠ‬‫ﺘ‬‫ﺓﻛ‬ ‫ﻭ‬‫ﺭ‬‫ﺫ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬
‫ﺔﻋﻈ‬ ‫ﻠ‬
‫ﺘ‬‫ﻴﻦﻛ‬ ‫ﺑ‬T‫ﺔ‬ ‫ﺭﺟ‬ ‫ﺭﻥﺩ‬ ‫ﺎ‬‫ﻘ‬
‫ﺗ‬-
‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﺮﻃ‬ ‫ﻣ‬‫ﺃ‬‫ﻠﻰ‬‫ﻋ‬ ‫ﺃ‬‫ﻭ‬1
‫ﺃ‬. 1--
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻠ‬‫ﻟ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﺍﻥﺧ‬ ‫ﺪ‬‫ﻘ‬‫ﻟﻰﻓ‬ ‫ﺮﺇ‬ ‫ﻴ‬‫ﻳﺸ‬2. 5-‫ﻟﻰ‬‫ﺇ‬1. 0-‫ﻣﻦ‬-
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺎﺷ‬‫ﻟﻰﻫﺸ‬ ‫ﺮﺇ‬‫ﻴ‬‫ﻗﻞﻳﺸ‬ ‫ﺃ‬ ‫ﻭ‬2
‫ﺃ‬. 5-
‫ﺔﻭ‬ ‫ﻴ‬‫ﻨ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺲ‬ ‫ﻬﻢﻧ‬ ‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻳﻦ‬‫ﺬ‬ ‫ﻟ‬‫ﺍ‬
‫ﻳﻦ‬ ‫ﺮ‬‫ﺍﻵﺧ‬ ‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﻡ‬‫ﺎ‬
‫ﺔﻋﻈ‬ ‫ﻠ‬
‫ﺘ‬‫ﻊﻛ‬ ‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺘ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬Z‫ﺔ‬ ‫ﺭﺟ‬ ‫ﺭﻥﺩ‬ ‫ﺎ‬‫ﻘ‬
‫ﺗ‬-
.
‫ﺮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
Signsandsy mpt omsOst eopor osis:
-Ther ear enosy mpt omsandaper sonmaynotknowt heyhav ei tuntilthey
exper i
enceaf ract ureaf terami nori ncident ,suchasaf all
,orev enacoughor
sneeze.
-Wi t
host eopor osis, thebonesbecomepr ogr essiv elypor ous, br i
ttl
e, andf ragile;
Thebonesbecomeweaker ,increasi ngt her iskoff ract ures, especi allyint hehi p,
spi nalv ertebr ae, andwr ist.
-Br eaksi nt hespi necanl eadt ochangesi npost ur e, ast oop, andcur vatureof
thespi ne.
-Thegr adual collapseofav ert
ebr amaybeasy mpt omat i
c;itisobser vedas
pr ogressi veky phosi s.Wi t
ht hedev elopmentofky phosi s,ther ei sanassoci ated

60
‫‪l‬‬
‫‪ossofhei‬‬
‫‪ght‬‬
‫‪.‬‬
‫‪:‬‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﺍ ﺽﻫﺸ‬ ‫ﺮ‬
‫ﺍﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻋﻼ‬
‫ﺘﻰ‬‫ﻪﺣ‬ ‫ﺎﺏﺑ‬‫ﻪﻣﺼ‬ ‫ﻧ‬‫ﺃ‬‫ﻟﺸﺨ ﺺ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻌ‬‫ﺪﻻﻳ‬ ‫ﻗ‬‫ﺍ ﺽﻭ‬‫ﺮ‬‫ﺃﻋ‬ ‫ﺪ‬
‫ﻮﺟ‬ ‫‪-‬ﻻﺗ‬
‫ﺎﻝ‬‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﺘﻰ‬‫ﻭﺣ‬ ‫ﺃ‬‫ﻮﻁ‬ ‫ﻘ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺜﻞ‬‫ﻴﻂﻣ‬ ‫ﺩﺙﺑﺴ‬ ‫ﺎ‬
‫ﺪﺣ‬ ‫ﻌ‬‫ﺮﺑ‬‫ﻜﺴ‬‫ﺎﺏﺑ‬ ‫ﻳﺼ‬
‫‪.‬‬‫ﻌﻄﺲ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺔ‬‫ﺔﻭﻫﺸ‬ ‫ﺔﻭﻫﺸ‬ ‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﻡﻣﺴ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺒﺢ‬‫‪،‬ﺗﺼ‬ ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻊﻫﺸ‬ ‫‪-‬ﻣ‬
‫ﺍﻹ‬‫ﺮ‬‫ﺪﻣﻦﺧﻄ‬ ‫ﻳ‬
‫ﺰ‬‫ﺎﻳ‬‫ﻤ‬‫‪،‬ﻣ‬‫ﻌﻒ‬ ‫ﺃﺿ‬ ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺒﺢ‬ ‫؛ﺗﺼ‬‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬‫ﻜﻞﺗ‬ ‫ﺑﺸ‬
‫‪.‬‬‫ﻎ‬‫ﺮﺳ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻛ‬‫ﻮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﺭﻙﻭ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺎﺻ‬‫‪،‬ﺧ‬ ‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺻ‬
‫‪،‬‬
‫ﻊ‬ ‫ﻮﺿ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻟﻰﺗ‬‫ﺮﻱﺇ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬
‫ﻮ‬ ‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬ ‫ﺩﻱﻛﺴ‬ ‫ﺆ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬ ‫ﻤ‬‫‪-‬ﻳ‬
‫‪.‬‬
‫ﺮﻱ‬‫ﻘ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﻧﺤ‬‫ﺍ‬‫‪،‬ﻭ‬ ‫ﺀ‬
‫ﺎ‬‫ﻨ‬‫ﻧﺤ‬‫ﺍﻻ‬‫ﻭ‬
‫ﻮﺣﻆ‬ ‫ﻟ‬‫؛‬‫ﺍﺽ‬‫ﺮ‬‫ﺃﻋ‬ ‫ﻭﻥ‬‫ﺪ‬‫ﺓﺑ‬‫ﺮ‬
‫ﻘ‬ ‫ﻔ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﻴ‬‫ﻬ‬‫ﻧ‬
‫ﺍﻻ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺪﻳ‬ ‫‪-‬ﻗ‬
‫ﺓ‬‫ﺭ‬
‫ﺎ‬‫ﺎﻙﺧﺴ‬ ‫ﻨ‬
‫‪،‬ﻫ‬ ‫ﺍﺏ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻊﺗﻄ‬ ‫‪.‬ﻣ‬‫ﻳﺠﻲ‬ ‫ﺭ‬
‫ﺪ‬‫ﺍﺏﺗ‬‫ﺪ‬ ‫ﻪﺣ‬ ‫ﻧ‬
‫ﺃ‬‫ﻠﻰ‬ ‫ﻋ‬
‫‪.‬‬‫ﻮﻝ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﻣ‬

‫(‬
‫‪Fi‬‬‫‪g.17)Ost‬‬
‫‪eopor‬‬
‫‪osi‬‬
‫‪s‬‬

‫‪Phar‬‬ ‫‪macol‬‬ ‫‪ogi‬‬‫‪ct‬‬‫‪her‬‬ ‫‪apyofOst‬‬ ‫‪eopor‬‬ ‫‪osi‬‬‫‪s‬‬

‫‪-Atnat‬‬ ‫‪ur‬‬‫‪al‬‬‫‪orsur‬‬‫‪gi‬‬ ‫‪cal‬‬ ‫‪menopause,‬‬ ‫‪hor‬‬‫‪moner‬‬ ‫‪epl‬‬ ‫‪acementt‬‬ ‫‪her‬‬ ‫‪apy‬‬‫(‬‫‪HRT)wi‬‬ ‫‪t‬‬‫‪h‬‬
‫‪est‬‬‫‪r‬‬‫‪ogenandpr‬‬ ‫‪ogest‬‬ ‫‪er‬‬ ‫‪onenecessar‬‬ ‫‪yt‬‬‫‪or‬‬ ‫‪et‬‬‫‪ar‬‬‫‪dbonel‬‬ ‫(‪oss‬‬ ‫‪decr‬‬ ‫‪easesbone‬‬
‫‪r‬‬‫‪esor‬‬ ‫‪pt‬‬‫‪i‬‬
‫‪onandi‬‬ ‫‪ncr‬‬ ‫‪easesbonemass),‬‬ ‫‪andpr‬‬ ‫‪ev‬‬ ‫‪entoccur‬‬ ‫‪r‬‬‫‪enceoff‬‬ ‫‪r‬‬ ‫‪act‬‬‫‪ur‬‬‫‪es.‬‬
‫‪Pr‬‬‫‪ev‬‬ ‫‪ent‬‬ ‫‪i‬‬
‫‪onofost‬‬ ‫‪eopor‬‬ ‫‪osi‬‬‫‪s:‬‬
‫‪Li‬‬‫‪f‬‬‫‪est‬‬‫‪y‬‬ ‫‪l‬‬
‫‪emodi‬‬ ‫‪f‬‬‫‪i‬‬
‫‪cat‬‬ ‫‪i‬‬‫‪onscanr‬‬ ‫‪educet‬‬ ‫‪her‬‬ ‫‪i‬‬‫‪skofost‬‬ ‫‪eopor‬‬‫‪osi‬‬‫‪s:‬‬
‫‪1.Cal‬‬ ‫‪ci‬‬‫‪um andv‬‬ ‫‪i‬‬‫‪t‬‬‫‪ami‬‬ ‫‪nD:‬‬
‫‪-Cal‬‬‫‪ci‬‬ ‫‪um i‬‬‫‪sessent‬‬ ‫‪i‬‬‫‪al‬‬‫‪f‬‬‫‪orbones,‬‬ ‫‪andpr‬‬ ‫‪ev‬‬ ‫‪entost‬‬ ‫‪eopor‬‬‫‪osi‬‬‫‪s.‬‬
‫‪-Cal‬‬‫‪ci‬‬ ‫‪um t‬‬‫‪akenwi‬‬ ‫‪t‬‬‫‪hmeal‬‬ ‫‪sorwi‬‬ ‫‪t‬‬‫‪habev‬‬ ‫‪er‬‬‫‪agehi‬‬ ‫‪ghi‬‬ ‫‪nv‬‬‫‪i‬‬‫‪t‬‬
‫‪ami‬‬ ‫‪nCt‬‬ ‫‪opr‬‬ ‫‪omot‬‬ ‫‪e‬‬
‫‪absor‬‬ ‫‪pt‬‬‫‪i‬‬‫‪on.‬‬
‫‪-I‬‬‫‪faper‬‬ ‫'‪son‬‬‫‪sdi‬‬‫‪et‬‬‫‪ar‬‬ ‫‪yi‬‬‫‪nt‬‬‫‪akei‬‬ ‫‪snotenough,‬‬ ‫‪suppl‬‬ ‫‪ement‬‬ ‫‪sar‬‬ ‫‪eanopt‬‬ ‫‪i‬‬‫‪on.‬‬
‫‪-Vi‬‬‫‪t‬‬‫‪ami‬‬ ‫‪nDpl‬‬ ‫‪ay‬‬‫‪sakeyr‬‬ ‫‪ol‬‬‫‪e,‬‬‫‪asi‬‬‫‪thel‬‬‫‪pst‬‬ ‫‪hebodyabsor‬‬ ‫‪bcal‬‬ ‫‪ci‬‬‫‪um.Di‬‬ ‫‪et‬‬ ‫‪ar‬‬‫‪y‬‬
‫‪sour‬‬ ‫‪cesi‬‬ ‫‪ncl‬‬‫‪udef‬‬‫‪or‬‬ ‫‪t‬‬‫‪i‬‬‫‪f‬‬
‫‪i‬‬‫‪edf‬‬ ‫‪oods,‬‬‫‪sal‬‬‫‪t‬‬‫‪wat‬‬ ‫‪erf‬‬‫‪i‬‬‫‪sh,‬‬ ‫‪andl‬‬ ‫‪i‬‬‫‪v‬‬
‫‪er‬‬‫‪.‬‬
‫‪-Mostv‬‬ ‫‪i‬‬
‫‪t‬‬‫‪ami‬‬ ‫‪nDdoesnotcomef‬‬ ‫‪r‬‬
‫‪om f‬‬ ‫‪oodbutf‬‬ ‫‪r‬‬
‫‪om sunexposur‬‬ ‫‪e,‬‬ ‫‪somoder‬‬ ‫‪at‬‬‫‪e,‬‬
‫‪r‬‬‫‪egul‬‬‫‪arexposur‬‬ ‫‪et‬‬ ‫‪osunl‬‬ ‫‪i‬‬
‫‪ghti‬‬‫‪sr‬‬‫‪ecommended.‬‬
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻬﺸ‬ ‫ﻟ‬‫ﺋﻲ‬‫ﺍ‬
‫ﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻭﻥ‬ ‫ﺮ‬‫ﺘ‬‫ﻭﺟﺴ‬ ‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﺎﻹﺳ‬‫(ﺑ‬ ‫ﺔ)‪HRT‬‬ ‫ﻠ‬
‫ﻳ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﻮ‬ ‫ﻣ‬
‫ﺮ‬ ‫ﻬ‬‫ﻟ‬
‫ﺎ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬‫ﺍ‬‫‪،‬‬‫ﺍﺣﻲ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬ ‫ﺄﺱ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫‪-‬ﻓﻲﺳﻦ‬
‫‪.‬‬
‫ﺭ‬‫ﻮ‬‫ﻜﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﺙ‬ ‫ﺪ‬‫ﻊﺣ‬ ‫ﻨ‬
‫ﻤ‬‫ﻳ‬‫‪،‬ﻭ‬ ‫(‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺘ‬
‫ﺪﻣﻦﻛ‬ ‫ﻳ‬‫ﺰ‬‫ﻳ‬
‫ﻡﻭ‬ ‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﻑ‬‫ﺗﺸ‬ ‫ﺭ‬‫ﺍ‬‫ﻠﻞﻣﻦ‬‫ﻘ‬‫ﻳ‬‫ﻡ)‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﺮﻓ‬ ‫ﻴ‬
‫ﺄﺧ‬‫ﺘ‬‫ﻟ‬‫ﺭﻱ‬‫ﻭ‬‫ﺮ‬‫ﺿ‬
‫‪:‬‬
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬ ‫ﺔﻣﻦﻫﺸ‬ ‫ﻳ‬‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬ ‫ﻬﺸ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺓﻣﻦﺧﻄ‬ ‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﻤﻂ‬ ‫ﻳﻼﺕﻧ‬ ‫ﺪ‬ ‫ﻌ‬
‫ﻠﻞﺗ‬‫ﻘ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
‫‪:‬‬
‫ﻴﻦﺩ‬ ‫ﻣ‬‫ﺎ‬
‫ﺘ‬ ‫ﻴ‬‫ﻓ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪1‬‬
‫‪.‬‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺎﺷ‬‫ﻊﻫﺸ‬ ‫ﻨ‬
‫ﻤ‬‫ﻳ‬‫‪،‬ﻭ‬ ‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻠ‬‫ﻟ‬
‫ﺭﻱ‬ ‫ﻭ‬‫ﺮ‬‫ﻡﺿ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﺎﺹ‬ ‫ﺘﺼ‬‫ﻣ‬ ‫ﺍﻻ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﻴﻦﺳﻲ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﻔ‬‫ﺔﺑ‬‫ﻴ‬‫ﻨ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻭ‬‫ﺮ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻭﻣ‬ ‫ﺃ‬‫ﺎﺕ‬‫ﺒ‬‫ﻮﺟ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻪﻣ‬‫ﻟ‬‫ﻭ‬‫ﺎ‬‫ﻨ‬
‫ﺘﻢﺗ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﺍ‬‫ً‬
‫ﺭ‬‫ﺎ‬‫ﻴ‬
‫ﺪﺧ‬ ‫ﻌ‬‫ﺔﺗ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻤﻼﺕ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺈﻥ‬ ‫‪،‬ﻓ‬ ‫ﺎٍ‬
‫ﻑ‬ ‫ﺮﻛ‬‫ﻴ‬‫ﻠﺸﺨ ﺺﻏ‬ ‫ﻟ‬‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺪﺧ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫‪-‬ﺇ‬

‫‪61‬‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﺬ‬ ‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬.‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺹ‬ ‫ﺘﺼ‬‫ﻣ‬‫ﺍ‬‫ﻠﻰ‬‫ﻟﺠﺴﻢﻋ‬ ‫ﺍ‬‫ﺪ‬ ‫ﻋ‬
‫ﺎ‬‫ﻴﺚﻳﺴ‬ ‫ﺣ‬، ‫ﺎ‬ً
‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬‫ﺍﺭ‬ً
‫ﺭ‬‫ﻭ‬‫ﻴﻦﺩﺩ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻌﺐﻓ‬ ‫ﻠ‬
‫ﻳ‬-
.‫ﺪ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻟﺤ‬
‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺎ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻙ‬ ‫ﻤ‬
‫ﺃﺳ‬ ‫ﺔﻭ‬
‫ﻤ‬ ‫ﻋ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻌ‬
‫ﻷﻃ‬
‫ﺪﻝ‬ ‫ﺘ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻨﺼﺢﺑ‬ ‫ﻟﻚﻳ‬‫ﺬ‬‫ﻟ‬،‫ﻤﺲ‬‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺮ ﺽﻷﺷ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻜﻦﻣﻦ‬ ‫ﻟ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﺗﻲﻣﻦ‬ ‫ﺄ‬‫ﻴﻦﺩﻻﻳ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﺘ‬‫ﻴ‬‫ﻌﻈﻢﻓ‬‫ﻣ‬-
.‫ﻤﺲ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬
‫ﻌ‬ ‫ﺘﻈﻢﻷﺷ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬
2.Notsmoki ng, asthi
scanr educethegr owt hofnewboneanddecr ease
estrogenl evelsi nwomen
3.Av oidingal coholintake,t
oencour ageheal thybonesandpr eventfal l
s
4.Regul arwei ght-
bearingexerci
se:From 20t o30mi nutesofaer obi
cex erci
se
(eg,wal king),3day sormor eaweek, i
srecommended, ast hi
spr omot eshealthy
boneandst rengthenssuppor tfr
om muscl es.Doi ngexer cisest opr omot e
fl
exibili
tyandbal ance,suchasy oga,asthesecanr educet her iskoff all
sand
fractures.

‫ﺍ‬
‫ﻮﻥ‬‫ﻣ‬‫ﺮ‬‫ﺎﺕﻫ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻠﻞﻣﻦﻣﺴ‬‫ﻘ‬‫ﻳ‬
‫ﺓﻭ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻠﻞﻣﻦﻧ‬‫ﻘ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬
‫ﻤ‬‫ﺍﻳ‬
‫ﺬ‬‫ﻷﻥﻫ‬، ‫ﻴﻦ‬‫ﺪﺧ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻉﻋﻦ‬‫ﻨ‬‫ﺘ‬
‫ﻣ‬‫ﺍﻻ‬.
2
‫ﺀ‬‫ﺎ‬‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬‫ﺪﻯ‬‫ﻟ‬‫ﻴﻦ‬‫ﻭﺟ‬‫ﺮ‬‫ﺘ‬
‫ﻻﺳ‬
‫ﻮﻁ‬‫ﻘ‬‫ﻟﺴ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻣ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺰ ﺻﺤ‬‫ﻳ‬
‫ﺰ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺩﻋﻦﺗ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺑ‬
‫ﺍﻻ‬.
3
‫ﻭ‬‫ﺃ‬‫ﻡ‬
‫ﺎ‬‫ﻳ‬‫ﺃ‬
3، (‫ﻤﺸﻲ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬
‫ﻣ‬)‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬30‫ﻟﻰ‬‫ﺇ‬20‫ﻣﻦ‬:‫ﺔ‬‫ﻤ‬‫ﺘﻈ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﻘ‬ ‫ﺛ‬
‫ﺍﻷ‬ ‫ﻤﻞ‬‫ﻳﻦﺣ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺗ‬.
4
‫ﻳﻦ‬
‫ﺭ‬‫ﺎ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬‫ﻣ‬.‫ﻌﻀﻼﺕ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱﺩﻋﻢ‬‫ﻘ‬‫ﻳ‬‫ﻡﻭ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺯ ﺻﺤ‬‫ﺰ‬‫ﻌ‬
‫ﺍﻳ‬‫ﺬ‬
‫ﻷﻥﻫ‬،‫ﺑ‬‫ﺎ‬‫ﻮﺻﻰﻬ‬ ‫ﻳ‬،‫ﻮﻉ‬ ‫ﺒ‬
‫ﺍﻷﺳ‬‫ﺮﻓﻲ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬
.‫ﺭ‬
‫ﻮ‬‫ﻜﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻁﻭ‬‫ﻘ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮ‬‫ﻠﻞﻣﻦﺧﻄ‬ ‫ﻘ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬‫ﻴﺚﻳ‬‫ﺣ‬،‫ﺎ‬‫ﻮﺟ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬،‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻧ‬‫ﻭ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬

Ost
eomal
aci
a

Learningobjecti
ves:
Attheendoft hi
slect
ure;t
hest udentwi llbeabl
eto:
1-Defineosteomalaci
a.
2-Listcausesofosteomalacia.
3-Enumer atesymptomsofost eomal aci
a.
4-I
dent i
fydiagnosi
sofosteomal acia.
5-Listcompl i
cat
ionsofosteomal acia.
6-Describetreat
mentandPr event i
onofost eomal
aci
a

‫ﻡ‬
‫ﺎ‬‫ﻌﻈ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬
‫ﻠ‬‫ﺗ‬

:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬‫ﺳ‬.‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬ ‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-1
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﺎﺏ‬‫ﺒ‬
‫ﺃﺳ‬ ‫ﺔ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬-2
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬‫ﺍ ﺽﺗ‬‫ﺮ‬‫ﺃﻋ‬‫ﺪ‬‫ﻋ‬-3
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻟ‬
‫ﻴﺺ‬ ‫ﻠﻰﺗﺸﺨ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
-4
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻟ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﺔﺑ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬-5
‫ﻡ‬
‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻟ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻌﻼﺝﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭﺻﻒ‬- 6

Ost
eomal
aci
a
Def
ini
ti
onofOsteomal
aci
a:
Ost
eomalaci
aref
erst
oamarkedsof
teni
ngofbones,
causedbysev
erev
itami
n

62
Ddefi
ciency.Osteomalaciainolderadul
tscanleadtof ractures.
-Vi
taminDi simportantforcalci
um absorpt
ioninst
omach.
-Vi
taminDal sohelpsmai ntai
ncalci
um andphosphat elevelsf orproperbone
for
mation.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﻳﻒ‬‫ﺮ‬
‫ﻌ‬‫ﺗ‬:
‫ﺩﻱ‬‫ﺆ‬
‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.
(‫ﺩ‬)‫ﻴﻦ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﺩﻓﻲﻓ‬ ‫ﺎ‬‫ﻘ ﺺﺣ‬‫ﺎﺟﻢﻋﻦﻧ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻅ‬‫ﻠﺤ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻴ‬‫ﻠ‬
‫ﻟﻰﺗ‬‫ﻡﺇ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬
‫ﺮﺗ‬‫ﻴ‬
‫ﻳﺸ‬
‫ﺭ‬‫ﻮ‬‫ﻟﻰﻛﺴ‬ ‫ﻟﺴﻦﺇ‬‫ﺍ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺪﻛ‬ ‫ﻨ‬
‫ﻡﻋ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬
‫ﺗ‬.
-‫ﺓ‬
‫ﺪ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺹ‬‫ﺘﺼ‬ ‫ﻣ‬‫ﻬﻢﻻ‬‫ﻴﻦﺩﻣ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻓ‬.
-‫ﻜﻞ‬ ‫ﻡﺑﺸ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻦ‬
‫ﻮ‬‫ﻜ‬‫ﺘ‬‫ﻟ‬‫ﺎﺕ‬‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﻠﻰﻣﺴ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻓﻲ‬ ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻴﻦﺩ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﺪﻓ‬‫ﺎﻋ‬
‫ﻳﺴ‬
‫ﻴﺢ‬‫ﺻﺤ‬.

CausesofOst eomal aci a:

1.Vi tami nDdef i
ciency .Sunl ightpr oducesv i
taminDi nskin.Peopl ewhol ivein
areaswher esunl ighthour sar eshor toreatadi etlowi nv i
tami nDcandev elop
osteomal acia.
2.Cer tai
nsur ger i
es.sur ger ytor emov epar torallofst omach, .Surgeryto
remov eorby passsmal l i
nt estinealsocanl eadt ov i
tami nDandcal cium
deficiency .
3.Ki dneyorl iv erdi sor der s.Pr oblemswi t
hkidney sorl i
vercani nterf
er ewi th
body 'sabi l
it
yt omakeact ivev i
tami nD.
4.Dr ugs.Somedr ugsusedt ot reatseizures,cancausesev er
ev it
ami nD
deficiencyandost eomal acia.
:‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬‫ﺎﺏﺗ‬ ‫ﺒ‬
‫ﺃﺳ‬
‫ﻮﻥﻓﻲ‬ ‫ﻴﺸ‬‫ﻌ‬ ‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺎﺹ‬ ‫ﻟﻸﺷﺨ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻴﻦﺩﻓﻲ‬ ‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬‫ﻤﺲﻓ‬ ‫ﻟﺸ‬ ‫ﺍ‬
‫ﺀ‬‫ﻮ‬ ‫ﺘﺞ ﺿ‬‫ﻨ‬‫ﻳ‬.
‫ﻴﻦﺩ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻘ ﺺﻓ‬ ‫ﻧ‬.1
‫(ﻥ‬‫ﺩﺃ‬)‫ﻴﻦ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬‫ﻴ‬‫ﻔ‬‫ﺎﺑ‬ً‫ﻔ‬
‫ﻀ‬ ‫ﻨﺨ‬ ‫ﺎﻣ‬ ً
‫ﻴ‬
‫ﺋ‬‫ﺍ‬‫ﺬ‬‫ﺎﻏ‬ً
‫ﻣ‬ ‫ﺎ‬
‫ﻮﻥﻧﻈ‬ ‫ﻌ‬
‫ﺒ‬‫ﺘ‬‫ﻭﻳ‬‫ﺃ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﻤﺲﻗﺼ‬ ‫ﻟﺸ‬ ‫ﺍ‬‫ﺀ‬
‫ﻮ‬ ‫ﺎﺕ ﺿ‬‫ﻋ‬‫ﺎ‬‫ﺎﺳ‬‫ﻬ‬‫ﻴ‬
‫ﻮﻥﻓ‬ ‫ﻜ‬‫ﺎﻃﻖﺗ‬‫ﻨ‬‫ﻣ‬
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬‫ﺘ‬
‫ﺍﺑ‬‫ﻮ‬ ‫ﺑ‬
‫ﺎ‬‫ﻳﺼ‬
‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬ ‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺔﺇ‬‫ﺍﺣ‬ ‫ﺮ‬
‫ﺩﻱﺟ‬ ‫ﺆ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.‫ﺓ‬‫ﺪ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻛﻞ‬ ‫ﺃ‬‫ﺀ‬‫ﺰ‬‫ﺯﺔﺟ‬‫ﻟ‬
‫ﺔﻹﺍ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﺟ‬. ‫ﺔ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﺔﻣ‬‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﺎﺕﺟ‬ ‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻋ‬.2
.
‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻘﺺ‬ ‫ﻧ‬
‫ﻴﻦﺩﻭ‬ ‫ﻣ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬‫ﻘ ﺺﻓ‬‫ﻟﻰﻧ‬‫ﺎﺇ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺎ‬‫ﺯﻫ‬‫ﻭ‬‫ﺎ‬‫ﻭﺗﺠ‬‫ﺃ‬
‫ﺎﺝ‬‫ﺘ‬‫ﻧ‬
‫ﻠﻰﺇ‬‫ﻟﺠﺴﻢﻋ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬ ‫ﻊﻗ‬ ‫ﺪﻣ‬ ‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﺍﺧﻞﻣﺸ‬‫ﺪ‬‫ﺘ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.‫ﺪ‬‫ﺒ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬ .3
.
‫ﻴﻦﺩ‬ ‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻓ‬
‫ﻴﻦﺩ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﺍﻓﻲﻓ‬ ً
‫ﺩ‬‫ﺎ‬‫ﺎﺣ‬ ً‫ﻘ‬
‫ﺼ‬ ‫ﺒﺐﻧ‬ ‫ﺃﻥﺗﺴ‬ ‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲﻋﻼﺝ‬ ‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻌﺾ‬ ‫ﺒ‬‫ﻟ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬.4
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬
‫ﺗ‬‫ﻭ‬

SymptomsofOst eomal acia:

1.Earl
ystagesofost eomal acia,thereisnosy mptoms.
2.Asosteomal aci
apr ogresses, bonepai nandmuscl eweaknessmaydev elop.
3.Thedull,achingpai nassociat edwi t
host eomalaci
amostcommonl yaffects
thel
owerback, pelvi
s,hips,legsandr i
bs.
4.Thepainmi ghtbewor seatni ght,orwhenputpr essureonthebones.
5.Decreasedmuscl etoneandl egweaknesscancauseawaddl i
nggai tand
makewal kingsl owerandmor edi ffi
cult.
:
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬
‫ﺃ‬
.
‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬
‫ﺪ‬‫ﻮﺟ‬‫ﻻﺗ‬، ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬‫ﻟ‬‫ﺓﻣﻦ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.1
.
‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻒ‬ ‫ﻡﻭﺿ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻢ‬
‫ﺃ‬‫ﺭ‬‫ﻮ‬‫ﺘﻄ‬‫ﺪﻳ‬‫ﻗ‬،‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻊﺗ‬‫ﻣ‬.2
‫ﻴﻦﻭ‬ ‫ﻛ‬‫ﺭ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ ﺽﻭ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺮﻭ‬‫ﻬ‬‫ﻟﻈ‬‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬ ‫ﻠﻰ‬‫ﻊﻋ‬ ‫ﺋ‬
‫ﺎ‬‫ﻜﻞﺷ‬ ‫ﺮﺑﺸ‬
‫ﺛ‬‫ﺆ‬‫ﻡﻳ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬
‫ﻠ‬‫ﺘ‬‫ﻟ‬‫ﺎﺣﺐ‬‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻟﻢ‬‫ﺍﻷ‬.3
.‫ﺍﻷﺿﻼﻉ‬ ‫ﻴﻦﻭ‬‫ﻗ‬‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬

63
 .‫ﻡ‬
‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬
‫ﺍ‬ ‫ﺪ‬‫ﻨ‬
‫ﻭﻋ‬،‫ﻴﻞﺃ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺃﻓﻲ‬
‫ﻮ‬‫ﺃﺳ‬ ‫ﻟﻢ‬
‫ﺍﻷ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬.4
‫ﺮ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺄﻭ‬
‫ﺑﻄ‬‫ﺃ‬‫ﻤﺸﻲ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﻳﺠ‬ ‫ﺔﻭ‬ ‫ﻠ‬
‫ﻳ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺔﻣ‬‫ﻴ‬‫ﺒﺐﻣﺸ‬ ‫ﺃﻥﻳﺴ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺎﻕﻳ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻌﻒ‬‫ﻌﻀﻼﺕﻭﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﻗ ﺺﻗ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬.5
.
‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻌ‬‫ﺻ‬
DiagnosisofOst eomal acia:
1.Bloodandur inetests.Thesehel pdet ectlowl evel
sofv i
taminDandpr oblems
withcalcium andphosphor us.
2.X-rays.
3.Bonebi opsytowi t
hdr awasmal l sampl eofbone.Al t
houghabonebi opsyis
accurateindetecti
ngost eomal aci
a,
:
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
‫ﻛﻞ‬ ‫ﺎ‬
‫ﻣﺸ‬‫ﻴﻦﺩﻭ‬ ‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﺔﻣﻦﻓ‬ ‫ﻔﻀ‬ ‫ﻨﺨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻜﺸﻒﻋﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩﻓﻲ‬ ‫ﺬ‬‫ﺪﻫ‬‫ﻋ‬‫ﺎ‬
‫ﺗﺴ‬.‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﺧ‬ .
1
.‫ﺭ‬
‫ﻮ‬‫ﻔ‬‫ﻮﺳ‬ ‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ .
2
‫ﻜﺸﻒﻋﻦ‬ ‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬
‫ﻡﺩ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺰﻋ‬ ‫ﺃﻥﺧ‬‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓﻣﻦ‬‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺔﺻ‬ ‫ﻨ‬
‫ﻴ‬‫ﻟﺴﺤﺐﻋ‬ ‫ﻡ‬
‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻋ‬‫ﺰ‬
‫ﺧ‬. 3
،‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬

Compl icationsofOst eomal acia:

Fractur epar ti
cul arlythosei nribs,spineandlegs.
TreatmentofOst eomal aci
a:
1.Get tingenoughv it
ami nDt hroughor alsupplement sforseveralweekst o
mont hscancur eost eomal acia.
2.Treat ingcondi tionst hataffectvitaminDmet abol
ism, suchaskidneyand
l
iverdi seaseorl owphosphat el ev
els.
3.Liverci rrhosisandki dneyfailur
emustbet reatedtor educeosteomalaci a.
4.Phy si cal,psychol ogical,andphar maceut i
calmeasur esar eusedtoreducet he
pati
ent ’sdi scomf ortandpai n.
5.Thenur sehandl est hepat i
entgent ly
,andpill
owsar eusedt osuppor tthe
body.
6.Someper sistentor thopedicdef ormiti
esmayneedt obet r
eatedwithbr aces
orsur ger y(eg, ost eotomymaybeper formedtocor r
ectl ongbonedefor mity).

:‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻠ‬
‫ﺎﺕﺗ‬ ‫ﻔ‬‫ﺎﻋ‬
‫ﻣﻀ‬
.
‫ﻴﻦ‬‫ﻗ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮﻱﻭ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﻉﻭ‬ ‫ﻠ‬
‫ﻟﻀ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺎﺻ‬ ‫ﺮﺧ‬ ‫ﻛﺴ‬
:‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻠ‬‫ﻋﻼﺝﺗ‬
‫ﻟﻰ‬‫ﻊﺇ‬‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﺃﺳ‬
‫ﺓ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﻔﻢ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬
‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻤﻼﺕ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻴﻦﺩﻋﻦﻃ‬ ‫ﻣ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﻔﻲﻣﻦﻓ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻠﻰﻣ‬‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬.1
.‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻟ‬‫ﻟﺞ‬‫ﺎ‬‫ﻌ‬
‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬ ‫ﺭﻳ‬‫ﻮ‬‫ﻬ‬‫ﺷ‬
‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﺎ ﺽﻣﺴ‬‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺃ‬ ‫ﺜﻞ‬‫ﻣ‬،‫ﻴﻦﺩ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻘﻼﺏﻓ‬ ‫ﺘ‬‫ﺍﺳ‬‫ﻠﻰ‬‫ﺮﻋ‬‫ﺛ‬‫ﺆ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻟﺤ‬
‫ﺍ‬ ‫ﻋﻼﺝ‬. 2
.
‫ﺎﺕ‬ ‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬
‫ﻟ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﺒ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻠ‬
‫ﺔﺗ‬‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬‫ﻳﺠﺐﻣ‬. 3
.
‫ﻪ‬‫ﻤ‬‫ﻟ‬‫ﺃ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺰﻋ‬‫ﻧ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬
‫ﻴ‬‫ﻧ‬‫ﺪﻻ‬‫ﻴ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺪ‬‫ﻟﺠﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬.4
.
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬‫ﺪ‬‫ﺋ‬
‫ﺎ‬‫ﻮﺳ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﺗﺴ‬‫ﻭ‬،‫ﻠﻄﻒ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬
‫ﻣﻞﻣ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺔﺗ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.5
،‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬‫ﺔ)ﻋ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺍﺱ‬ ‫ﻮ‬‫ﻗ‬‫ﺎﻷ‬
‫ﺔﺑ‬ ‫ﻟﺠ‬
‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬‫ﻨ‬‫ﻣ‬‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬
‫ﻮﻫ‬ ‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫ﻌﺾ‬ ‫ﺎﺝﺑ‬‫ﺘ‬‫ﺪﺗﺤ‬ ‫ﻗ‬.6
.(‫ﻳﻞ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﻮ‬‫ﻴﺢﺗﺸ‬‫ﺘﺼﺤ‬ ‫ﻟ‬‫ﻌﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺀﻗﻄ‬ ‫ﺍ‬
‫ﺮ‬‫ﻜﻦﺇﺟ‬ ‫ﻤ‬‫ﻳ‬

Prevent
ionofOst
eomal
acia:
1.Spendsometimeout
doorsinsunl
i
ghtf
orbodyt
omakesuf
fi
cientv
itami
nD

64
withinski
n
2.Eatfoodshighinvit
aminD.Foodsnaturallyri
chinvi
taminDincl
udeoi
l
yfish
(salmon,mackerel
,sardi
nes)andeggyolks.Alsolookf
orfoodsfor
ti
fi
edwit
h
vit
ami nD,suchascereal
,bread,
milkandy ogurt
.
3.Takesupplements,i
fneeded.

Muscul
oskel
etali
nfecti
on
Acut
eosteomyelit
is
Learningobjecti
ves:
Attheendoft hi
sl ecture;thestudentwil
lbeabl eto:
1.Definecuteosteomy elit
is.
2.Identi
fycausesandr iskofcuteosteomy el
iti
s.
3.Describepathophy siologyofcuteosteomy eli
ti
s.
4.Enumer at
ecl i
nicalmani festat
ionsofcuteosteomy el
iti
s.
5.Listdi
agnost i
cfindingsofcut eosteomy el
i
tis.
6.ListManagementandpr event
ionofcuteosteomy el
it
is.

‫ﻠﻲ‬
‫ﻜ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻲ‬‫ﻌﻀ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻋ‬
‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻘﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬‫ﺳ‬.‫ﺓ‬‫ﺮ‬
‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬ ‫ﻳ‬
‫ﺎ‬‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻴﻒ‬ ‫ﻠﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬.1
.
‫ﻴﻒ‬‫ﻠﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻃ‬
‫ﻣﺨ‬ ‫ﺎﺏﻭ‬‫ﺒ‬‫ﺃﺳ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬.2
.
‫ﻴﻒ‬‫ﻠﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺔﻻ‬ ‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﺻﻒ‬. 3
.‫ﻴﻒ‬‫ﻠﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺔﻻ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬
‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻋ‬.4
.
‫ﻴﻒ‬‫ﻠﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺔﻻ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬
‫ﺎ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.5
.
‫ﻴﻒ‬‫ﻟﻄ‬‫ﻘﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺓﻭ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺔﺇ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.6
Acut
eost
eomy
eli
ti
s

Defi
nit
ionofacuteosteomyeli
ti
s:
Acuteosteomyeli
ti
sisapyogenici
nfect
ionoft
hebone,
bonemar
rowand
sur
roundingti
ssue.
Causesofacuteosteomyeli
ti
s:

65
1.Themostcommoncausat iveorganism isstaphylococcusaureus.
2.Otherorganismsare,str
eptococci,pseudomonasandEscher i
chi
acoli
.
3.Dir
ectinoculat
ionatthetimeofsur geryortraumai ncident.
4.Heamat ogenousspreadfrom acor epointofi nf
ectionabscessorchest
i
nfecti
on.
5.Localspreadfrom aninf
ectedwound, especiall
ysof tt
issuetr
auma.

:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺗ‬
.
‫ﺔ‬‫ﻴﻄ‬
‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬
‫ﺍﻷ‬‫ﻡﻭ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬
‫ﻧﺨ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺐ‬
‫ﺔﺗﺼ‬ ‫ﻴ‬
‫ﻴﺤ‬‫ﻭﻯﻗ‬‫ﺪ‬‫ﻮﻋ‬‫ﺩﻫ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﺒ‬
‫ﺃﺳ‬
.‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﺬﻫ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻘ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬
‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻫﻲ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬
‫ﺔﺷ‬ ‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻨ‬‫ﺋ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬
‫ﺃ‬.1
.‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﻮ‬‫ﻟ‬
‫ﻮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻜ‬
‫ﻳ‬‫ﺮ‬‫ﺍﻹﺷ‬‫ﻭ‬،‫ﺔ‬
‫ﻔ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬،‫ﺎﺕ‬‫ﻳ‬
‫ﺪ‬‫ﻘ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬،‫ﺮﻯﻫﻲ‬‫ﺍﻷﺧ‬ ‫ﺔ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﺋ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬.2
.
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺩﺙ‬‫ﺎ‬‫ﻭﺣ‬‫ﺃ‬‫ﺔ‬‫ﺍﺣ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻗﺖ‬‫ﺮﻓﻲﻭ‬ ‫ﺎﺷ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺢ‬‫ﻘ‬‫ﻠ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬.3
.
‫ﺭ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺎﺏﻓﻲ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺍﺝ‬
‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬‫ﻭﻯ‬
‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬
‫ﺍﻷﺳ‬‫ﺔ‬‫ﻘﻄ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱﻣﻦ‬ ‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬
‫ﺍ‬.4
.
‫ﺓ‬‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻮﺽ‬ ‫ﺔﺭﺿ‬‫ﺎﺻ‬‫ﺧ‬،‫ﺎﺏ‬‫ﺮﺡﻣﺼ‬ ‫ﻌﻲﻣﻦﺟ‬ ‫ﻮﺿ‬ ‫ﺭﻣ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬
‫ﺍ‬.5

Highriskpatientforacut eosteomy el
it
is:
1.Poorlynourished,Elderl
y,andobese.
2.Impairedimmunesy st
ems
3.Chronicil
lnesses( eg,di
abetes,r
heumat oi
dart
hri
ti
s),
Cor
ti
cost
eroi
dther
apy.
4.Postoperativesurgicalwoundinfecti
onsoccurwi
thi
n30daysaft
ersur
gery
.

:
‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺓ‬ ‫ﺭ‬
‫ﻮ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻟﻲ‬‫ﺎ‬‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻣ‬
.‫ﺔ‬‫ﻨ‬
‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬،‫ﻟﺴﻦ‬ ‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬‫ﻛ‬
‫ﻭ‬، ‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﻮ‬‫ﺳ‬.1
‫ﺔ‬‫ﻋ‬‫ﺎ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻌﻒﺟ‬ ‫ﺿ‬.2
.‫ﺪ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻮﺳ‬ ‫ﻜ‬‫ﻴ‬‫ﺗ‬
‫ﺭ‬ ‫ﻮ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﻭﻌﻼﺝﺑ‬‫ﻟ‬‫(ﺍ‬ ‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻱﻭ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬)‫ﺔ‬‫ﻨ‬‫ﻣ‬
‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬‫ﻣ‬‫ﺍﻷ‬.
3
.‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟﺠ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﻌ‬
‫ﺎﺑ‬‫ﻣ‬‫ﻮ‬‫ﻳ‬30‫ﻮﻥ‬ ‫ﺪﺙﻓﻲﻏﻀ‬ ‫ﺔﺗﺤ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻭﺡﺑ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
4
Pat hophy siologyofacut eost eomy eliti
s:
1.Oncebact er i
ahav egai nedaccesst ot hebone, t
heypr oli
ferateandt ri
ggeran
i
ni t
iali
nf ectionr esponse.
2.Ifunt reated, thebui ld-upofpr essur eint hebonecausest heinfectedmat eri
al
tomi grat etot hecor t
ex, separ ati
ngtheper iosteum from theunder lyi
ngbonet o
form asubper iost eal abscess.
3.Thei nfectioncant hent r
ackt otheski nv i
aasi nus.
4.Ifthear eainf ect edi snearaj oi
nt,thei nfectionmayt r
acki ntothejointand
causesept i
car t hrit
is.Thi sriskisgreat estatt hehip,knee, shoulder,elbowand
wr i
stjoints.
5.Ifinitialtr
eat menti seitherunsuccessf ul orisnotiniti
ated, t
hesequest rum
becomesi solat ed, theper i
osteum dev elopsnew
bonear oundi tandl eav esar eservoirofi nfectionwithin.
6.Thebonei sweakenedandt hereisani ncreasedr i
skofapat hological
fracture.

:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢﻭ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺔﻻ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺗ‬
‫ﺮﻭ‬ ‫ﺛ‬
‫ﺎ‬‫ﻜ‬‫ﺘ‬
‫ﺗ‬، ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬ ‫ﺎﺇ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺩﻭﺻ‬ ‫ﺮ‬‫ﻤﺠ‬‫ﺑ‬.1
‫ﻓﺼﻞ‬
‫ﻭ‬، ‫ﺓ‬
‫ﺮ‬‫ﻘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬
‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻟﻰﻫﺠ‬‫ﻌﻈﻢﺇ‬‫ﻟ‬‫ﺍ‬
‫ﻐﻂﻓﻲ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻛﻢ‬‫ﺍ‬
‫ﺮ‬‫ﺩﻱﺗ‬ ‫ﺆ‬‫ﻳ‬،‫ﺟ‬
‫ﺎ‬‫ﺘﻢﻋﻼﻬ‬ ‫ﻟﻢﻳ‬‫ﺍ‬‫ﺫ‬
‫ﺇ‬.2
.‫ﺎﻕ‬‫ﻤﺤ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺍﺝﺗﺤﺖ‬ ‫ﺮ‬‫ﻴﻞﺧ‬ ‫ﻜ‬‫ﺘﺸ‬‫ﻟ‬‫ﻩ‬
‫ﺀ‬‫ﺍ‬‫ﺭ‬‫ﻣﻦﻭ‬ ‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻈﻢ‬‫ﻟ‬‫ﺍ‬‫ﺎﻕﻋﻦ‬ ‫ﻤﺤ‬‫ﻟﺴ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﻔ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻮﺏ‬‫ﻴ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﺪﻋ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻰ‬‫ﻭﻯﺇ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻘﻞ‬‫ﺘ‬‫ﻨ‬
‫ﺃﻥﺗ‬ ‫ﻟﻚ‬
‫ﺪﺫ‬ ‫ﻌ‬‫ﻜﻦﺑ‬ ‫ﻤ‬
‫ﻳ‬.3
‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬‫ﺗﺴ‬‫ﻔﺼﻞﻭ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻰ‬‫ﻭﻯﺇ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬‫ﺘ‬‫ﻨ‬
‫ﺪﺗ‬‫ﻘ‬‫ﻓ‬،‫ﻔﺼﻞ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺏﻣﻦ‬ ‫ﻘ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻘ‬
‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻧﺖ‬‫ﺎ‬‫ﺍﻛ‬‫ﺫ‬
‫ﺇ‬.4

66
 .
‫ﻌﺼﻢ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻉﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫ﺘﻒﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﺒ‬‫ﻛ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻙﻭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬
‫ﺮﻓﻲﻣ‬‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺮ‬
‫ﻟﺨﻄ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻮﻥﻫ‬‫ﻜ‬‫ﻳ‬.‫ﻧﻲ‬‫ﺎ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻹ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺪﺙ‬
‫ﻳﺤ‬‫ﻭ‬،
‫ﺔ‬‫ﻟ‬‫ﻭ‬‫ﺰ‬
‫ﻌ‬‫ﺒﺢﻣ‬‫ﺓﺗﺼ‬
‫ﺯ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺈﻥ‬‫ﻓ‬،‫ﻪ‬‫ﻴ‬‫ﺀﻓ‬
‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬
‫ﻟﻢﻳ‬
‫ﻭ‬‫ﺃ‬ ‫ﺎﺟﺢ‬‫ﺮﻧ‬
‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﻟﻲﺇ‬‫ﻭ‬‫ﺍﻷ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬
‫ﺇ‬.5
‫ﺍ‬
ً
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺎﻕﺟ‬ ‫ﻤﺤ‬‫ﻟﺴ‬
‫ﺍ‬
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺍﻥ‬
‫ﺰ‬‫ﻪﺧ‬‫ﻠ‬‫ﺍﺧ‬
‫ﺪ‬‫ﺮﻙﺑ‬‫ﺘ‬‫ﻳ‬‫ﻪﻭ‬‫ﻟ‬‫ﻮ‬‫ﻡﺣ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺮﺿﻲ‬‫ﺮﻣ‬‫ﻭﺙﻛﺴ‬‫ﺪ‬‫ﻟﺤ‬‫ﺪ‬‫ﻳ‬
‫ﺍ‬‫ﺰ‬‫ﺘ‬
‫ﺮﻣ‬‫ﺎﻙﺧﻄ‬‫ﻨ‬‫ﻡﻭﻫ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬‫ﺿ‬. 6

(
Fig.18)Dev
elopmentofOst
eomy
eli
ti
s

Cli
nicalMani f
estat
ionsofacut eosteomy el
iti
s:
1.Theonseti susuall
ysudden( eg,chil
ls,
highfever,r
apidpulse,gener
al
malaise) .
2.Thei nfectedareabecomespai nful,swoll
en,andtender.
3.Paini sconstant,pulsati
ngandincreasewi t
hmov ement .
4.I
nchr onicosteomy eli
ti
sther
eareacont i
nuouslydrai
ningsinus,r
ecurr
ent
peri
odsofpai n,i
nfl
ammat i
on,swell
ing,anddrainage.

Diagnosi
sofacut eost eomy eli
ti
s:
1.Bloodstudiesrevealleukocy tosi
sandanelev
atedESR.
2.Woundandbl oodcultur estudies.
3.Inacut
eost eomy el
iti
s,x- raydemonstr
atesof
tti
ssueswell
i
ng.Aft
er2weeks,
bonenecrosis,peri
osteal elevati
on,andnewboneformat
ionareev
ident
.

:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺔﻻ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬
‫ﺭﻉﻓﻲ‬
‫ﺎ‬‫ﺗﺴ‬،
‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺎﻉﻓﻲﺩ‬‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
،‫ﺓ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻌ‬‫ﻗﺸ‬،‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﺒ‬‫ﻠﻰﺳ‬‫ﺔ)ﻋ‬‫ﺌ‬‫ﺎﺟ‬‫ﻔ‬
‫ﺔﻣ‬ ‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﺗ‬
‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻋ‬.1
.(‫ﻋ‬
‫ﻡ‬‫ﻋﻚﺎ‬ ‫ﻮ‬‫ﺗ‬،‫ﺒﺾ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻤ‬‫ﻟ‬
‫ﺆ‬‫ﻣ‬‫ﺔﻭ‬‫ﻣ‬‫ﺭ‬
‫ﻮ‬‫ﺘ‬‫ﻣ‬‫ﺔﻭ‬‫ﻤ‬‫ﻟ‬
‫ﺆ‬‫ﺔﻣ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺢ‬‫ﺗﺼ‬.2
.‫ﺔ‬
‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﻊ‬
‫ﺩﻣ‬ ‫ﺍ‬
‫ﺩ‬‫ﺰ‬‫ﻳ‬
‫ﺑ ﺾﻭ‬‫ﺎ‬‫ﻧ‬
‫ﺮﻭ‬ ‫ﻤ‬‫ﺘ‬
‫ﻟﻢﻣﺴ‬ ‫ﺍﻷ‬.
3
‫ﻭ‬،‫ﻟ‬
‫ﻣﺍﻷﻢ‬
‫ﺓﻦ‬ ‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬
‫ﺍﺕﻣ‬‫ﺮ‬‫ﺘ‬‫ﻓ‬
‫ﻭ‬،‫ﺔ‬‫ﻴ‬‫ﻔ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻮﺏ‬‫ﻴ‬‫ﻠﺠ‬
‫ﻟ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻴﻒﻣﺴ‬‫ﻔ‬‫ﺎﻙﺗﺠ‬‫ﻨ‬
‫ﻫ‬،‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬.4
.‫ﺮﻑ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬،‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬

:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬
‫ﺗﺸﺨ‬

67
 .ESR‫ﺎﻉ‬
‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﺀﻭ‬‫ﺎ‬
‫ﻴﻀ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬‫ﺓﻋ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻡﻋﻦﺯ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺳ‬
‫ﺭ‬‫ﻜﺸﻒﺩ‬ ‫ﺗ‬.1
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺡﻭ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺔ‬‫ﺍﻋ‬‫ﺭ‬
‫ﺎﺕﺯ‬ ‫ﺍﺳ‬
‫ﺭ‬‫ﺩ‬.2
‫ﺮ‬
‫ﻬ‬‫ﻳﻈ‬،
‫ﻴﻦ‬‫ﻮﻋ‬
‫ﺒ‬‫ﺃﺳ‬
‫ﺪ‬‫ﻌ‬‫ﺑ‬.
‫ﺓ‬‫ﻮ‬‫ﺮﺧ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻡ‬
‫ﺭ‬‫ﻮ‬‫ﺔﺗ‬‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬
‫ﻌ‬‫ﺍﻷﺷ‬‫ﺮ‬‫ﻬ‬
‫ﺗﻈ‬،‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬.3
.
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻴﻞﻋﻈﻢﺟ‬‫ﻜ‬‫ﺗﺸ‬
‫ﺎﻕﻭ‬ ‫ﻤﺤ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺎﻉ‬‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﻡﻭ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻧﺨ‬

4.Withchronicosteomy el
iti
s,l
arge,i
rregul
arcav
iti
es,r
aisedper
iost
eum,
sequest
ra,ordensebonef ormationsareseenonx-ray
.TheESRandt heWBC
countareusuall
ynor mal.
5.Computedt omogr aphy(CT)
6.Magneti
cr esonancei maging(MRI )
.

،
‫ﻊ‬‫ﻔ‬‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻕ‬
‫ﻤﺤ‬‫ﻟﺴ‬
‫ﺍ‬،‫ﺔ‬‫ﻤ‬
‫ﺘﻈ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺓﻏ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬‫ﻭ‬‫ﺎ‬
‫ﺘﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻬ‬
‫ﺗﻈ‬،‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻲ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬.4
WBC‫ﻭ‬ESR‫ﺩ‬ ‫ﺪ‬‫ﻮﻥﻋ‬‫ﻜ‬
‫ﺎﻳ‬‫ﺓﻣ‬
ً‫ﺩ‬‫ﺎ‬
‫ﻋ‬.‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬
‫ﺍﻷﺷ‬‫ﻠﻰ‬‫ﺔﻋ‬
‫ﻔ‬ ‫ﻴ‬
‫ﺜ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻨ‬‫ﻳ‬‫ﻮ‬
‫ﻜ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬،
‫ﺍﺃ‬‫ﺮ‬‫ﺘ‬
‫ﻜﺴ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺎ‬
ً
‫ﻴ‬‫ﻌ‬‫ﻴ‬
‫ﺒ‬‫ﻃ‬
(CT)‫ﻌﻲ‬ ‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬
.5
.(MRI)‫ﻴﺴﻲ‬ ‫ﺎﻃ‬
‫ﻨ‬‫ﻐ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬
‫ﺮ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬
‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬
.6

2-Antibiotict herapy :
Antibioticther apyisst artedoncebl oodorwoundcul tur
es.
-Abr oad- spect rum ant ibioti
cisprescr ibeduntilthesensit
ivi
tyresult
sare
knownandt heideal antibioti
cidentifi
ed.
-Intr
av enousant i
biot i
car egiveninitial
lytoestabl i
shedanef f
ecti
vetherapeut
ic
bloodl evel.
-Regul armeasur ementoft heserum concent rati
onoft heantibi
oticis.
-Regul arant iemet icsar eneededf orsomepat ientsexperi
encingnauseaasa
si
deef fectoft hedr ugs.
-Thel ong- term ant ibioti
ct herapyisgener all
ychangedt oor al
admi nistration,oncet hei nfecti
oniscont r
oll
ed.
-Radiol ogical studies, bonescans, reducedCRPandaf alli
ntheESRl ev
elsar
e
usedt omeasur et her esponset otreatment .

:‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺎ‬‫ﻌﻼﺝﺑ‬-
‫ﻟ‬‫ﺍ‬2
.
‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭﻉ‬‫ﺩﺯ‬‫ﺮ‬‫ﻤﺠ‬‫ﺔﺑ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺎ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬
‫ﻳ‬
‫ﻮﻱ‬
‫ﻴ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬‫ﺍ‬‫ﺋﺞ‬
‫ﺎ‬‫ﺘ‬‫ﺔﻧ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬
‫ﺘﻰﻣ‬ ‫ﻴﻒﺣ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﺍﺳ‬‫ﻮﻱﻭ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻢﻭﺻﻒ‬ ‫ﻳ‬-
.
‫ﻟﻲ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
.‫ﺎ‬
‫ﻌﻝ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻼﺟﻲ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬
‫ﺪﻣﺴ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻦﻓﻲ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬‫ﻳ‬-
.
‫ﻮ‬‫ﻡﻫ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻱﻓﻲ‬ ‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺘﻈﻢ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
-
‫ﻟﻸ‬‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻵﺭ‬
‫ﺎ‬
‫ﺍﺛ‬‫ﺪ‬‫ﺄﺣ‬‫ﺎﻥﻛ‬‫ﻴ‬
‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﺾ‬ ‫ﺒ‬‫ﻟ‬‫ﺔ‬‫ﻤ‬
‫ﺘﻈ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬ ‫ﻘﻲ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺔ‬ ‫ﺎﺟ‬‫ﺎﻙﺣ‬‫ﻨ‬‫ﻫ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬
‫ﻌﻼﺝﻋﻦﻃ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﻳﻞﺇ‬‫ﻮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺪﻯ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺎ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺘﻢﺗ‬‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬-
.‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬ ‫ﻟﺴ‬
‫ﺍ‬ ‫ﺩ‬
‫ﺮ‬‫ﻤﺠ‬‫ﺑ‬
ESR‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﺎ ﺽﻣﺴ‬‫ﻔ‬‫ﻧﺨ‬
‫ﺍ‬‫ﻠﻲﻭ‬‫ﺎﻋ‬
‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﺳﻲ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﻴﻞﺑ‬ ‫ﻠ‬
‫ﻘ‬‫ﺗ‬
‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﺴﺢ‬ ‫ﺔﻭ‬‫ﻴ‬‫ﺎﻋ‬‫ﻌ‬‫ﺍﻹﺷ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﺗﺴ‬-
.
‫ﻌﻼﺝ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﻻﺳ‬‫ﺎﺱ‬ ‫ﻴ‬‫ﻘ‬‫ﻟ‬

2-Surgicalmanagement :
Surgi
cal i
nterventi
onisindi
catedift
heanti
bioti
cther
apyi
sinef
fect
ive.
Surgerycani nv ol
ve:
-Surgi
cal debridementtocontrol
theinf
ecti
on
-Asequest rectomy(remov al
ofthesequestr
um)

68
-Bonet ranspor t
ation.
-Skeletal f
ixati
on,
-Excisionoramput at ionmaybet heonl yr ecour set opr eventt heinf ect i
on
spreadingandr esultingi nsept icemi a.
:‫ﺍﺣﻲ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﺑ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-2
.‫ﺎ‬
‫ﻌﻝ‬ ‫ﺮﻓ‬ ‫ﻴ‬‫ﺔﻏ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺩ‬ ‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺎ‬
‫ﻌﻼﺝﺑ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺍﺣﻲﺇ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺪﺧﻞ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺭﺇ‬ ‫ﺎ‬
‫ﻳﺸ‬
:
‫ﺔ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻤﻞ‬ ‫ﺃﻥﺗﺸ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬‫ﻠﺴ‬‫ﻟ‬‫ﺍﺣﻲ‬ ‫ﺮ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﻨﻀ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
‫ﺮ‬ ‫ﺤﺠ‬َ‫ﻟ‬‫ﺍ‬ ‫ﺎﻝ‬ ‫ﺌﺼ‬‫ﺘ‬‫ﺍﺳ‬-
.
‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬‫ﻧ‬-
،‫ﻤﻲ‬‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬ ‫ﻜﻞ‬ ‫ﻴ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬ ‫ﺒ‬‫ﺜ‬
‫ﺗ‬-
.
‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻤﻢ‬‫ﺗﺴ‬ ‫ﻭﻯﻭ‬ ‫ﺪ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬ ‫ﻧ‬
‫ﺍ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺪ‬‫ﻴ‬‫ﻮﺣ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮ‬‫ﺮﻫ‬ ‫ﺘ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺎﻥ‬‫ﺘ‬‫ﻟﺨ‬ ‫ﺍ‬ ‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬-
Prevent i
onofacut eost eomy eli
tis:
1.Electiveor t
hopedi csur ger yshoul dbepost ponedi fthepat ienthasacur rent
i
nfection( eg,uri
nar yt racti nfect i
on, sor ethr oat).
2.Dur i
ngor thopedicsur gery ,careful at tent i
oni spai dt ot hesur gical
envir
onmentandt ot echni quest odecr easedi rectbonecont ami nat ion.
3.Prophy lacti
cant i
bi oticsadmi nister edatt i
meofsur gery&24hour saf ter .
4.Urinarycat heter
sanddr ai nsar er emov edassoonaspossi blet odecr ease
theincidenceofhemat ogenousspr eadofi nfection.
5.Treat mentoff ocal i
nf ectionsdi mi nisheshemat ogenousspr ead.
6.Asept icpostoper ativ ewoundcar er educest heincidenceofsuper ficial
i
nfections.
7.Promptmanagementofsof tti
ssuei nfect ionsr educesex tensionofi nf ection
tothebone.
:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﻘﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻌﻈﻢﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬)‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬‫ﻭﻯﺣ‬ ‫ﺪ‬‫ﻧﻲﻣﻦﻋ‬ ‫ﺎ‬‫ﻌ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺔﺇ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻴ‬‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻴﻞﺟ‬ ‫ﺄﺟ‬ ‫ﻳﺠﺐﺗ‬. 1
.
(‫ﻠﻖ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
.
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻠ‬‫ﻟ‬‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺙ‬ ‫ﻠ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﻠ‬
‫ﻘ‬‫ﺎﺕﺗ‬ ‫ﻴ‬ ‫ﻨ‬
‫ﻘ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺎﺹ‬ ‫ﻡﺧ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻫ‬‫ﺀ‬‫ﺇﻼ‬‫ﺘﻢﻳ‬ ‫ﻳ‬، ‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺍﺣ‬‫ﺮ‬ ‫ﺀﺟ‬ ‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬.2
.‫ﺔ‬ ‫ﺎﻋ‬‫ﺳ‬24‫ﺪ‬ ‫ﻌ‬‫ﺑ‬‫ﺔﻭ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻗﺖ‬ ‫ﺭﻓﻲﻭ‬ ‫ﺍ‬‫ﺪ‬‫ﺔﺗ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬.3
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﺎﻳ‬‫ﺮﻉﻣ‬ ‫ﺄﺳ‬‫ﺭﻑﺑ‬ ‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺘﻢﺇ‬‫ﻳ‬.4
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺎ‬
‫ﺘﺸ‬‫ﻧ‬‫ﺍ‬‫ﻠﻞﻣﻦ‬ ‫ﻘ‬
‫ﺔﻳ‬ ‫ﻳ‬
‫ﺭ‬‫ﺆ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﻋﻼﺝ‬. 5
.‫ﺔ‬‫ﻴ‬‫ﻟﺴﻄﺤ‬ ‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﻭﺙ‬ ‫ﺪ‬‫ﺔﻣﻦﺣ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬ ‫ﻌ‬
‫ﺔﺑ‬ ‫ﻤ‬‫ﻘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺡ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺎ‬‫ﺔﺑ‬ ‫ﻳ‬‫ﺎ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞ‬‫ﻘ‬‫ﺗ‬.6
.‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻟﻰ‬‫ﻭﻯﺇ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬‫ﺍ‬ ‫ﻠﻞﻣﻦ‬ ‫ﻘ‬‫ﺓﺗ‬‫ﻮ‬‫ﺮﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬ ‫ﻌ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬.7

Joi
ntsinfl
ammator
ydisor
der
s
Rheumat
oidart
hri
ti
s
Learni
ngobjectives:
Attheendoft hislect
ure;t
hestudentwi
llbeabl
eto:
1-Defi
nerheumat oidart
hri
ti
s.
2-Enumeratesignsandsy mptomsofrheumatoi
dart
hri
ti
s.

69
‫‪3-Li‬‬
‫‪stcausesandr‬‬ ‫‪i‬‬
‫‪skf‬‬‫‪act‬‬
‫‪or‬‬‫‪sofr‬‬‫‪heumat‬‬‫‪oi‬‬‫‪dar‬‬‫‪t‬‬
‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s.‬‬
‫‪4-I‬‬
‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪ycompl‬‬ ‫‪i‬‬
‫‪cat‬‬
‫‪i‬‬‫‪onsofr‬‬‫‪heumat‬‬‫‪oi‬‬
‫‪dar‬‬ ‫‪t‬‬
‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s.‬‬
‫‪5-Descr‬‬
‫‪i‬‬‫‪bedi‬‬‫‪agnosi‬‬
‫‪sofr‬‬‫‪heumat‬‬‫‪oi‬‬‫‪dar‬‬‫‪t‬‬
‫‪hr‬‬‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s.‬‬
‫‪6-For‬‬‫‪mul‬‬‫‪at‬‬
‫‪et‬‬‫‪r‬‬‫‪eat‬‬‫‪mentofr‬‬
‫‪heumat‬‬ ‫‪oi‬‬
‫‪dar‬‬‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s.‬‬

‫ﺎﺻﻞ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﺍﺿﻄ‬
‫ﺪﻱ‬
‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺼﻞ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﻠﻢ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
‫ﻣ‪:‬‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬
‫‪.‬ﺳ‬ ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
‫‪.‬‬‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫‪-‬ﺗ‬
‫‪1‬‬
‫‪.‬‬‫ﺪﻱ‬‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬‫ﻣ‬
‫ﻭ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬
‫ﺃﻋ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﺩﻋﻼ‬‫ّ‬
‫ﺪ‬‫‪-‬ﻋ‬‫‪2‬‬
‫‪.‬‬
‫ﺪﻱ‬‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺮﻻ‬ ‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﺎﺏﻭﻋ‬ ‫ﺒ‬
‫ﺄﺳ‬‫ﺔﺑ‬‫ﻤ‬
‫ﺋ‬‫ﺎ‬
‫‪-‬ﻗ‬‫‪3‬‬
‫‪.‬‬
‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬
‫ﺗ‬‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻠﻰﻣﻀ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪4‬‬
‫‪.‬‬‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫‪-‬ﻭﺻﻒﺗﺸﺨ‬ ‫‪5‬‬
‫‪.‬‬‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬ ‫ﻭ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻋﻼﺝ‬ ‫ﻏ‬‫ﺎ‬
‫ﻴ‬‫‪-‬ﺻ‬‫‪6‬‬

‫‪Rheumat‬‬
‫‪oi‬‬‫‪dar‬‬
‫‪t‬‬‫‪hr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬
‫‪Def‬‬‫‪i‬‬
‫‪ni‬‬‫‪t‬‬
‫‪i‬‬‫‪onofRheumat‬‬ ‫‪oi‬‬‫‪dar‬‬‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s:‬‬
‫‪Rheumat‬‬‫‪oi‬‬
‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫(‪s‬‬‫‪RA)i‬‬‫‪sachr‬‬ ‫‪oni‬‬
‫‪ci‬‬‫‪nf‬‬‫‪l‬‬‫‪ammat‬‬ ‫‪or‬‬‫‪ydi‬‬‫‪sor‬‬‫‪dert‬‬‫‪hatcanaf‬‬‫‪f‬‬
‫‪ect‬‬
‫‪mor‬‬‫‪et‬‬‫‪hanj‬‬‫‪oi‬‬‫‪nt‬‬‫‪s.‬‬
‫‪RAi‬‬‫‪st‬‬‫‪hemostcommonf‬‬ ‫‪or‬‬‫‪m ofaut‬‬‫‪oi‬‬‫‪mmunear‬‬ ‫‪t‬‬
‫‪hr‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪s.‬‬
‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﺪﻱ‬‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬‫ﻣ‬‫ﻭ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫‪.‬‬
‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﻴﺐ‬‫ﺃﻥﻳﺼ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﻣﻦﻳ‬ ‫ﺰ‬
‫ﺑﻲﻣ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺏ‬‫ﺮ‬
‫ﺍﺿﻄ‬ ‫ﻮ‬ ‫(ﻫ‬‫ﺪﻱ)‪RA‬‬ ‫ﻳ‬‫ﻮ‬
‫ﺗ‬‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺗﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻋﻲ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺎﻻ‬‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬
‫ﺮﺷ‬‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬‫ﻜﻞ‬ ‫ﻟﺸ‬
‫ﺍ‬‫ﻮ‬‫ﺪﻱﻫ‬ ‫ﻳ‬‫ﻮ‬
‫ﺗ‬‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬

‫‪-Rheumat‬‬‫‪oi‬‬‫‪dar‬‬
‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪scanaf‬‬ ‫‪f‬‬‫‪ectmanynon-‬‬ ‫‪j‬‬‫‪oi‬‬‫‪ntst‬‬‫‪r‬‬
‫‪uct‬‬‫‪ur‬‬
‫‪es,‬‬
‫‪i‬‬‫‪ncl‬‬‫‪udi‬‬‫‪ng:‬‬
‫‪ski‬‬‫‪n,‬‬
‫‪ey‬‬‫‪es,‬‬
‫‪l‬‬
‫‪ungs,‬‬‫‪hear‬‬‫‪t‬‬
‫‪,‬‬‫‪ki‬‬
‫‪dney‬‬‫‪s,‬‬‫‪sal‬‬
‫‪i‬‬
‫‪v‬‬ ‫‪ar‬‬‫‪ygl‬‬‫‪ands,‬‬‫‪ner‬‬‫‪v‬‬
‫‪et‬‬ ‫‪i‬‬‫‪ssue,‬‬‫‪bonemar‬‬‫‪r‬‬
‫‪ow,‬‬ ‫‪bl‬‬
‫‪oodv‬‬‫‪essel‬‬
‫‪s.‬‬
‫‪-Rheumat‬‬‫‪oi‬‬‫‪dar‬‬
‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪saf‬‬‫‪f‬‬‫‪ect‬‬‫‪st‬‬‫‪hel‬‬‫‪i‬‬‫‪ni‬‬
‫‪ngofj‬‬ ‫‪oi‬‬‫‪nt‬‬‫‪s,‬‬
‫‪causi‬‬‫‪ngapai‬‬‫‪nf‬‬‫‪ul‬‬‫‪swel‬‬‫‪l‬‬
‫‪i‬‬
‫‪ngt‬‬‫‪hat‬‬
‫‪r‬‬‫‪esul‬‬
‫‪ti‬‬‫‪nboneer‬‬‫‪osi‬‬
‫‪onandj‬‬ ‫‪oi‬‬‫‪ntdef‬‬‫‪or‬‬
‫‪mi‬‬ ‫‪t‬‬
‫‪y‬‬‫‪.‬‬

‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫‪:‬‬
‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫‪،‬ﺑ‬‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻔﺼ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻛﻞﻏ‬‫ﺎ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬‫ﻳ‬‫ﺪ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺪﻱﻋ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﺛ‬‫ﺆ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻡﻭ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﻧﺨ‬
‫ﺔﻭ‬‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﻌ‬
‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐﻭ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﺘ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬
‫ﻩ‬
‫ﻮ‬‫ﺗﺸ‬‫ﻡﻭ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﻛﻞ‬‫ﺂ‬‫ﻟﻰﺗ‬
‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬
‫ً‬
‫ﻤ‬‫ﻟ‬‫ﺆ‬
‫ﺎﻣ‬‫ً‬
‫ﺎﺧ‬‫ﻔ‬
‫ﺘ‬‫ﻧ‬‫ﺍ‬
‫ً‬
‫ﺎ‬‫ﺒ‬‫ﺒ‬
‫ﺎﺻﻞﻣﺴ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺪﻱﺑﻄ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺐ‬‫‪-‬ﻳﺼ‬
‫‪.‬‬
‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

‫(‬
‫‪Fi‬‬‫‪g.19)Rheumat‬‬
‫‪oi‬‬‫‪dar‬‬
‫‪t‬‬‫‪hr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬

‫‪Si‬‬‫‪gnsandsy‬‬‫‪mpt‬‬
‫‪omsofr‬‬
‫‪heumat‬‬‫‪oi‬‬
‫‪dar‬‬
‫‪t‬‬‫‪hr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s:‬‬
‫‪1.Tender‬‬
‫‪,‬‬‫‪war‬‬‫‪m,‬‬
‫‪swol‬‬
‫‪l‬‬
‫‪enj‬‬‫‪oi‬‬
‫‪nt‬‬‫‪s‬‬

‫‪70‬‬
2.Jointstif
fnessthatisusuall
ywor seinthemor ni
ngsandaf terinact
ivi
ty.In
mostcases, symptomsoccuri nthesamej oint sonbot hsidesofbody .
3.Fat i
gue,feverandwei ghtl
oss
4.Ear l
yrheumat oi
darthrit
isaf
fectsmal l
erjoints( t
hejoint
sthatat t
achfingers
tohandsandt oestofeet )
.Asthediseasepr ogr esses,symptomsspr eadt othe
wr i
sts,knees,ankl
es,elbows,hi
psandshoul ders.
5.Firml umps, cal
l
edrheumat oi
dnodul es,whi chgr owbeneatht heskinin
placessuchast heel
bowandhands

:‫ﺪﻱ‬‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬
‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻋﻼ‬
‫ﺔ‬‫ﻔﺨ‬‫ﺘ‬‫ﻨ‬
‫ﻣ‬،‫ﺔ‬‫ﺌ‬‫ﻓ‬‫ﺍ‬
‫ﺩ‬،‫ﺔ‬ ‫ﻤ‬
‫ﻟ‬‫ﺆ‬‫ﺎﺻﻞﻣ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.1
‫ﺍ ﺽﻓﻲ‬
‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬‫ﺪﺙ‬‫ﺗﺤ‬، ‫ﺎﻻﺕ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻌﻈﻢ‬‫ﻓﻲﻣ‬.‫ﻮﻝ‬‫ﻤ‬‫ﻟﺨ‬‫ﺍ‬
‫ﺪ‬‫ﻌ‬‫ﺑ‬‫ﺎﺡﻭ‬
‫ﺒ‬‫ﻟﺼ‬‫ﺍ‬‫ﺃﻓﻲ‬‫ﻮ‬‫ﺃﺳ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻮﻥﻋ‬ ‫ﻜ‬
‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐ‬ ‫ﺗﺼ‬.2
.
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺒﻲ‬‫ﻧ‬‫ﺎ‬
‫ﻠﻰﺟ‬ ‫ﺎﺻﻞﻋ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺲ‬‫ﻧ‬
‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻓ‬‫ﻤﻰﻭ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻌﺐﻭ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬.3
‫ﻊ‬
‫ﻣ‬.(
‫ﻴﻦ‬‫ﻣ‬
‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻳﻦﻭ‬ ‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺑ‬
‫ﺎ‬‫ﺃﺻ‬‫ﺑﻂ‬‫ﺮ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
)‫ﺮ‬‫ﻐ‬‫ﺍﻷﺻ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻱ‬ ‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﻳﺼ‬. 4
.‫ﻴﻦ‬‫ﻔ‬
‫ﺘ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻛ‬‫ﺭ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻘ‬‫ﻓ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻠ‬‫ﺎﺣ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﺘ‬
‫ﺒ‬‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻐ‬
‫ﺮﺳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺍ ﺽﺇ‬
‫ﺮ‬‫ﺍﻷﻋ‬‫ﺮ‬‫ﺘﺸ‬‫ﻨ‬‫ﺗ‬،‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬
‫ﺗ‬
‫ﻳﻦ‬‫ﺪ‬
‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻉﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬
‫ﻛﻦﻣ‬ ‫ﺎ‬
‫ﻣ‬‫ﺃ‬‫ﺪﻓﻲ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻮﺗﺤﺖ‬ ‫ﻤ‬‫ﻨ‬
‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺔ‬‫ﻴ‬‫ﻣ‬
‫ﺰ‬‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺪ‬‫ﻴ‬
‫ﻘ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻰ‬ ‫ﺗﺴ‬، ‫ﺔ‬
‫ﺒ‬‫ﻠ‬‫ﺘﻞ ﺻ‬‫ﻛ‬.5

CausesofRheumat oidar thri

ti
s:
ThecauseofRAi snotknown.
Pathophysi
ologyofRheumat oidarthri
ti
s
1.Rheumatoidarthr i
tisoccur swheni mmunesy stem att
ackst hesy novium (the
l
ini
ngoft hemembr anest hatsurroundjoint
s) .
2.Theresult
inginflammat i
onthickensthesy nov i
um, anddest royt hecar ti
l
age
andbonewi thi
nthej oi
nt.
3.Thetendonsandl igament sweakenandst ret
ch.Gr aduall
y,thej ointlosesi t
s
shapeandalignment .
:‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬
.‫ﻭﻑ‬ ‫ﺮ‬
‫ﻌ‬ ‫ﺮﻣ‬‫ﻴ‬
‫ﺪﻱﻏ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬
‫ﻭ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺒﺐ‬‫ﺳ‬
‫ﺪﻱ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬ ‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﺘﻲ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﺍﻷﻏﺸ‬‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺑﻄ‬)‫ﻠﻲ‬ ‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻋ‬‫ﺎ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﺎﺟﻢﺟ‬ ‫ﻬ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬
‫ﻨ‬‫ﺪﻱﻋ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬. 1
.(‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺎ‬
‫ﻴﻂﺑ‬ ‫ﺗﺤ‬
.‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻡﺩ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻒﻭ‬ ‫ﺭ‬
‫ﺎ‬‫ﻐﻀ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬‫ﺪ‬‫ﻳ‬‫ﻠﻲﻭ‬‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺜﺨﻦ‬ ‫ﺗﺞﻳ‬ ‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬.2
.‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬‫ﻣﺤ‬‫ﻪﻭ‬ ‫ﻠ‬
‫ﻜ‬‫ﻔﺼﻞﺷ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻘ‬
‫ﻔ‬‫ﻳ‬، ‫ﺎ‬
‫ﻴ‬‫ﻳﺠ‬‫ﺭ‬‫ﺪ‬‫ﺗ‬.
‫ﺩ‬‫ﺪ‬‫ﻤ‬‫ﺘ‬
‫ﺗ‬‫ﺔﻭ‬ ‫ﺑﻄ‬‫ﺭ‬‫ﺍﻷ‬
‫ﺭﻭ‬ ‫ﺎ‬‫ﺗ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﻌﻒ‬‫ﺗﻀ‬. 3

(
Fig.20)Joi
ntchangesi
nrheumat
oidar
thr
it
is

Riskfact
orsofRheumatoidart
hri
ti
s:
1.Sex:Womenar emoreli
kel
ythanment odevel
oprheumatoi
dart
hri
ti
s.
2.Age:Rheumatoi
dart
hrit
iscanoccuratanyage,
butitmostcommonlybegi
ns
betweentheagesof40and60.

71
‫‪3.Fami‬‬ ‫‪l‬‬‫‪yhi‬‬ ‫‪st‬‬‫‪or‬‬ ‫‪y‬‬
‫‪4.Ci‬‬ ‫‪gar‬‬‫‪et‬‬ ‫‪t‬‬‫‪esmoki‬‬ ‫‪ngi‬‬‫‪ncr‬‬ ‫‪easesr‬‬ ‫‪i‬‬‫‪skofdev‬‬ ‫‪el‬‬‫‪opi‬‬‫‪ngr‬‬ ‫‪heumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪s.‬‬
‫‪5.Env‬‬ ‫‪i‬‬‫‪r‬‬
‫‪onment‬‬ ‫‪al‬‬ ‫‪exposur‬‬ ‫‪es:‬‬ ‫‪ex‬‬ ‫‪posur‬‬ ‫‪est‬‬ ‫‪oasbest‬‬ ‫‪osorsi‬‬ ‫‪l‬‬‫‪i‬‬
‫‪caanddustmay‬‬
‫‪i‬‬
‫‪ncr‬‬ ‫‪easet‬‬ ‫‪her‬‬ ‫‪i‬‬
‫‪skf‬‬ ‫‪ordev‬‬ ‫‪el‬‬ ‫‪opi‬‬‫‪ngr‬‬ ‫‪heumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪s.‬‬
‫‪6.Obesi‬‬ ‫‪t‬‬‫‪y‬‬‫‪:‬‬‫‪Peopl‬‬ ‫‪ewhoar‬‬ ‫‪eov‬‬ ‫‪er‬‬‫‪wei‬‬ ‫‪ghtorobeseappeart‬‬ ‫‪obeathi‬‬ ‫‪gherr‬‬ ‫‪i‬‬
‫‪sk.‬‬
‫‪:‬‬
‫ﺪﻱ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻣﻞﺧﻄ‬ ‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫‪.‬‬‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺎﻟﻺﺻ‬‫ﺮﺟﻝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺮﺿ‬ ‫ﺮﻋ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬‫‪:‬‬
‫ﻨﺲ‬ ‫ﻟﺠ‬‫ﺍ‬‫‪.‬‬‫‪1‬‬
‫ﻴﻦﺳﻦ‪40‬‬ ‫ﻊﺑ‬ ‫ﺋ‬
‫ﺎ‬‫ﻜﻞﺷ‬ ‫ﺃﺑﺸ‬‫ﺪ‬‫ﺒ‬‫ﻪﻳ‬ ‫ﻨ‬
‫ﻜ‬ ‫ﻟ‬
‫‪،‬ﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﺃﻱﻋ‬ ‫ﺪﻱﻓﻲ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺃﻥﻳﺤ‬ ‫ﻜﻦ‬‫ﻤ‬‫‪:‬ﻳ‬‫ﺮ‬‫ﻤ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪2‬‬
‫‪.‬‬‫ﻭ‪60‬‬
‫ﺔ‬‫ﻠ‬‫ﺋ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫‪.‬ﺗ‬‫‪3‬‬
‫‪.‬‬
‫ﺪﻱ‬ ‫ﻳ‬‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺮﻣﻦﺧﻄ‬ ‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺠ‬ ‫ﺍ‬‫ﻴﻦ‬ ‫ﺪﺧ‬‫ﺪﺗ‬ ‫ﻳ‬‫ﺰ‬‫‪.‬ﻳ‬‫‪4‬‬
‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺎﻃ‬ ‫ﺓﻣﺨ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬ ‫ﺭﺇ‬‫ﺎ‬‫ﺒ‬
‫ﻐ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬‫ﻜ‬ ‫ﻴ‬‫ﻠ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻮﺱ‬ ‫ﺘ‬‫ﺒﺴ‬‫ﻟﻸﺳ‬ ‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬ ‫ﺪﻳ‬ ‫‪:‬ﻗ‬‫ﺌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪5‬‬
‫‪.‬‬‫ﺪﻱ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﺮ‬‫ﺒ‬
‫ﻛ‬ ‫ﺃ‬‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﻮﻥ‬‫ﺮﺿ‬ ‫ﻌ‬‫ﺔﻣ‬ ‫ﻨ‬‫ﻤ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺯﻥ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻮﻥﻣﻦﺯ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺹ‬ ‫ﺃﺍﻷﺷﺨ‬ ‫ﻭﻥ‬ ‫ﺪ‬‫ﺒ‬‫‪:‬ﻳ‬‫ﺔ‬‫ﻨ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫‪.‬‬‫‪6‬‬
‫‪Compl‬‬ ‫‪i‬‬
‫‪cat‬‬ ‫‪i‬‬
‫‪onsofRheumat‬‬ ‫‪oi‬‬ ‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬ ‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪s:‬‬
‫‪Rheumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬ ‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪si‬‬‫‪ncr‬‬‫‪easesr‬‬ ‫‪i‬‬‫‪skofdev‬‬ ‫‪el‬‬‫‪opi‬‬‫‪ng:‬‬
‫‪1.Ost‬‬ ‫‪eopor‬‬ ‫‪osi‬‬ ‫‪s.‬‬
‫‪2.Rheumat‬‬ ‫‪oi‬‬‫‪dnodul‬‬ ‫‪es.Thesef‬‬ ‫‪i‬‬
‫‪r‬‬‫‪m bumpsoft‬‬ ‫‪i‬‬
‫‪ssuear‬‬ ‫‪oundpr‬‬ ‫‪essur‬‬ ‫‪epoi‬‬ ‫‪nt‬‬‫‪s,‬‬
‫‪suchast‬‬ ‫‪heel‬‬ ‫‪bows.‬‬
‫‪3.Dr‬‬ ‫‪yey‬‬ ‫‪esandmout‬‬ ‫‪h:‬‬ ‫‪r‬‬‫‪heumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬
‫‪hr‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪sr‬‬ ‫‪esul‬‬‫‪ti‬‬‫‪nSj‬‬‫‪ogr‬‬ ‫'‪en‬‬‫‪ssy‬‬ ‫‪ndr‬‬‫‪ome,‬‬ ‫‪a‬‬
‫‪di‬‬‫‪sor‬‬ ‫‪dert‬‬ ‫‪hatdecr‬‬ ‫‪easest‬‬ ‫‪heamountofmoi‬‬ ‫‪st‬‬‫‪ur‬‬‫‪ei‬‬‫‪ney‬‬ ‫‪esandmout‬‬ ‫‪h.‬‬
‫‪4.I‬‬‫‪nf‬‬ ‫‪ect‬‬‫‪i‬‬‫‪ons:‬‬ ‫‪r‬‬
‫‪heumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪si‬‬ ‫‪mpai‬‬ ‫‪rt‬‬ ‫‪hei‬‬ ‫‪mmunesy‬‬ ‫‪st‬‬‫‪em,‬‬ ‫‪l‬‬‫‪eadi‬‬ ‫‪ngt‬‬ ‫‪o‬‬
‫‪i‬‬
‫‪ncr‬‬ ‫‪easedi‬‬ ‫‪nf‬‬ ‫‪ect‬‬ ‫‪i‬‬
‫‪ons‬‬
‫‪:‬‬‫ﺪﻱ‬ ‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬ ‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
‫‪:‬‬‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺪﻱﻣﻦﺧﻄ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬ ‫ﺪ‬‫ﻳ‬
‫ﺰ‬‫ﻳ‬
‫‪.‬‬
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫‪.‬ﻫﺸ‬ ‫‪1‬‬
‫‪.‬‬‫ﻴﻦ‬‫ﻘ‬‫ﻓ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬ ‫‪،‬ﻣ‬ ‫ﻐﻂ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﺎﻁ‬ ‫ﻘ‬‫ﻮﻝﻧ‬ ‫ﺔﺣ‬ ‫ﻧﺴﺠ‬ ‫ﻣﺍﻷ‬
‫ﺔﻦ‬ ‫ﺒ‬
‫ﻠ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﻮ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫‪.‬ﻫ‬ ‫ﺔ‬‫ﻴ‬‫ﻣ‬ ‫ﺰ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺪ‬‫ﻴ‬‫ﻘ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪2‬‬
‫ﻠﻞ‬‫ﻘ‬
‫ﺍﺏﻳ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻮ‬‫‪،‬ﻭﻫ‬ ‫ﺮﻥ‬ ‫ﻮﺟ‬ ‫ﺔﺳﺠ‬ ‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬‫ﻟﻰ ﺘ‬ ‫ﺪﻱﺇ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩﻱ‬‫ﺆ‬‫‪:‬ﻳ‬ ‫ﻔﻢ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻑ‬ ‫ﻔ‬‫‪.‬ﺟ‬ ‫‪3‬‬
‫‪.‬‬
‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﻨ‬‫ﻴ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﺮﻃ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻣﻦﻛ‬
‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﺓ‬‫ﺩ‬ ‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬ ‫ﻤ‬‫‪،‬ﻣ‬ ‫ﺔ‬‫ﺎﻋ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻌﻒﺟ‬ ‫ﺪﻱﻳﻀ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫‪:‬‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫‪.‬‬‫‪4‬‬
‫‪Di‬‬‫‪agnosi‬‬ ‫‪sofRheumat‬‬ ‫‪oi‬‬‫‪dar‬‬ ‫‪t‬‬‫‪hr‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪s:‬‬
‫‪1.Phy‬‬ ‫‪si‬‬‫‪cal‬‬ ‫‪exam:‬‬ ‫‪checkj‬‬ ‫‪oi‬‬‫‪nt‬‬‫‪sf‬‬ ‫‪orswel‬‬ ‫‪l‬‬
‫‪i‬‬‫‪ng,‬‬ ‫‪r‬‬
‫‪ednessandwar‬‬ ‫‪mt‬‬ ‫‪h.‬‬
‫‪2.Bl‬‬ ‫‪oodt‬‬ ‫‪est‬‬‫‪s‬‬
‫‪-Anemi‬‬ ‫(‪a‬‬ ‫‪al‬‬‫‪owr‬‬ ‫‪edbl‬‬ ‫‪oodcel‬‬ ‫‪l‬‬‫‪count‬‬ ‫)‬
‫‪-El‬‬‫‪ev‬‬ ‫‪at‬‬‫‪eder‬‬ ‫‪y‬‬‫‪t‬‬‫‪hr‬‬ ‫‪ocy‬‬ ‫‪t‬‬‫‪esedi‬‬ ‫‪ment‬‬ ‫‪at‬‬ ‫‪i‬‬‫‪onr‬‬ ‫‪at‬‬‫(‪e‬‬ ‫‪ESR)orC-‬‬ ‫‪r‬‬
‫‪eact‬‬ ‫‪i‬‬‫‪v‬‬‫‪epr‬‬ ‫‪ot‬‬ ‫‪ei‬‬
‫(‪n‬‬ ‫)‪CRP‬‬ ‫‪,‬‬
‫‪whi‬‬‫‪chmayi‬‬ ‫‪ndi‬‬ ‫‪cat‬‬ ‫‪et‬‬ ‫‪hepr‬‬ ‫‪esenceofani‬‬ ‫‪nf‬‬ ‫‪l‬‬
‫‪ammat‬‬ ‫‪or‬‬ ‫‪ypr‬‬‫‪ocessi‬‬ ‫‪nt‬‬ ‫‪hebody‬‬ ‫‪.‬‬
‫‪-Ant‬‬ ‫‪i‬‬‫‪-‬‬‫‪cy‬‬‫‪cl‬‬‫‪i‬‬‫‪cci‬‬ ‫‪t‬‬‫‪r‬‬‫‪ul‬‬‫‪l‬‬‫‪i‬‬
‫‪nat‬‬ ‫‪edpept‬‬ ‫‪i‬‬‫(‪de‬‬ ‫‪ant‬‬‫‪i‬‬‫‪-‬‬‫‪CCP)ant‬‬ ‫‪i‬‬
‫‪bodi‬‬ ‫‪es.‬‬
‫‪3.I‬‬‫‪magi‬‬ ‫‪ngt‬‬ ‫‪est‬‬ ‫‪s:‬‬ ‫‪X-‬‬ ‫‪r‬‬
‫‪ay‬‬ ‫‪s,‬‬‫‪MRIandul‬‬ ‫‪t‬‬‫‪r‬‬‫‪asoundt‬‬ ‫‪est‬‬‫‪s‬‬

‫‪Tr‬‬‫‪eat‬‬
‫‪mentofRheumat‬‬‫‪oi‬‬
‫‪dar‬‬‫‪t‬‬
‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s:‬‬
‫‪Ther‬‬‫‪ei‬‬
‫‪snocur‬‬‫‪ef‬‬‫‪orr‬‬
‫‪heumat‬‬
‫‪oi‬‬‫‪dar‬‬‫‪t‬‬
‫‪hr‬‬‫‪i‬‬
‫‪t‬‬‫‪s.‬‬
‫‪i‬‬
‫‪:‬‬
‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
‫‪.‬‬‫ﺀ‬‫ﺪﻑ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﺍﻻﺣ‬‫ﻡﻭ‬‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻋﻦ‬‫ً‬
‫ﺜ‬‫ﺎﺻﻞﺑﺤ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻓﺤ ﺺ‬‫ﺍ‬‫‪:‬‬‫ﻧﻲ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺤ ﺺ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪1‬‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻟ‬
‫ﺎ‬‫‪.‬ﺗﺤ‬‫‪2‬‬
‫(‬
‫ﺀ‬‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺩﺧﻼ‬ ‫ﺪ‬‫ﺎ ﺽﻋ‬‫ﻔ‬‫ﻧﺨ‬
‫ﺍ‬‫ﻡ)‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻘ‬‫‪-‬ﻓ‬
‫ﻟﻰ‬
‫ﺮﺇ‬‫ﻴ‬
‫ﺪﻳﺸ‬
‫ﺎﻗ‬‫ﻤ‬
‫‪،‬ﻣ‬‫(‬‫ﻠﻲ)‪CRP‬‬‫ﺎﻋ‬
‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﺳﻲ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫(ﻭﺑ‬
‫ﺀ)‪ESR‬ﺃ‬ ‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴﺐﻛ‬‫ﺮﺳ‬‫ﺪﻝﺗ‬‫ﻌ‬‫ﺎﻉﻣ‬ ‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫‪-‬‬
‫‪.‬‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬
‫ﺩﻋ‬ ‫ﻮ‬‫ﻭﺟ‬
‫‪.‬‬‫(‬‫ـ‪CCP‬‬‫ﺩﻝ‬ ‫ﺎ‬
‫ﻣﻀ‬ ‫ﻘﻲ)‬‫ﻠ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻨﻲ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬‫ﻴ‬
‫ﺘ‬‫ﺒ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﺃﺿ‬‫‪-‬‬
‫ﺔ‬‫ﻴ‬
‫ﺗ‬‫ﻮ‬‫ﻟﺼ‬
‫ﺍ‬‫ﻮﻕ‬‫ﺎﺕﻓ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺴﻲﻭ‬‫ﺎﻃ‬ ‫ﻨ‬
‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬ ‫‪:‬‬
‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﺻ‬ ‫‪.‬ﻓﺤ‬‫‪3‬‬

‫‪72‬‬
 :
‫ﺪﻱ‬‫ﻳ‬
‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻋﻼﺝ‬
‫ﺪﻱ‬
‫ﻳ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺪﻋﻼﺝﻻ‬‫ﻮﺟ‬‫ﻻﻳ‬
Thet reat menti ncl udet hef ollowi ng:
1.Medi cat i
ont her apy :
-NSAI Ds.Nonst er oidal ant i
-i
nf lammat orydr ugs( NSAI Ds)canr el
iev epai nand
reducei nfl
ammat ion.
-St eroi ds:suchaspr edni sone, reducei nflammat i
onandpai nandsl owj oint
damage.
-Di sease- modi fyingant ir
heumat icdr ugs( DMARDs) .Thesedr ugscansl owt he
pr ogressi onofr heumat oidar t
hr i
tisandsav et hejointsandot hert i
ssuesf rom
per manentdamage.
2.Phy sicaloroccupat ionalt her apy :
-Phy sical oroccupat ional ther apykeepj ointsf l
exible.
-Assi stivedev i
cescanmakei teasi ert oav oidstressingpai nful j
oints.E. g.a
kitchenkni feequi ppedwi thasawhandl ehel pspr otectf i
ngerandwr istjoi nts.
3.Sur gi calintervent ion:
Ifmedi cati
onsf ail,sur geryhel pt orest oreabi l
it
ytousej oint.Itcanal sor educe
pai nandcor rectdef or mities.
:
‫ﻠﻲ‬ ‫ﺝﺎﻳ‬
‫ﻌﻼ ﻣ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻤﻞ‬ ‫ﻳﺸ‬
:
‫ﺋﻲ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬.1
‫ﻟﻢ‬‫ﺍﻷ‬ ‫ﻔﻒ‬ ‫(ﻥﺗﺨ‬‫ﺎﺕﺃ‬ ‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬
)‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﻬ‬ ‫ﺘ‬‫ﻟ‬
‫ﻟﻼ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬ ‫ﻭ‬‫ﺩ‬‫ﻟﻸ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.‫ﺔ‬ ‫ﻳ‬
‫ﺪ‬‫ﻴ‬‫ﺋ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺏﻏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﺍﺕ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻣﻀ‬-
.
‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺗ‬‫ﻭ‬
.
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻒ‬ ‫ﺒﻄﺊﺗ‬ ‫ﺗ‬‫ﻟﻢﻭ‬ ‫ﺍﻷ‬
‫ﺎﺏﻭ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﻠﻞ‬‫ﻘ‬‫ﻭﻥﺗ‬ ‫ﺰ‬‫ﻴ‬‫ﻧ‬
‫ﺪ‬‫ﻳ‬‫ﺮ‬‫ﺜﻞﺑ‬‫ﻣ‬: ‫ﺍﺕ‬ ‫ﺪ‬‫ﻳ‬‫ﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬-
‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺔﺗﻄ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﻩ‬‫ﺬ‬‫ﺒﻄﺊﻫ‬ ‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.(DMARDs)‫ﺮ ﺽ‬ ‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻟ‬‫ﺪ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺰ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬-
.‫ﺋﻢ‬‫ﺍ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻒ‬ ‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻯﻣﻦ‬ ‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬
‫ﺎﺻﻞﻭ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻲ‬‫ﺗﺤ‬ ‫ﺪﻱﻭ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬ ‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
:‫ﻨﻲ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬.2
.
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧ‬
‫ﻭ‬‫ﺮ‬‫ﻠﻰﻣ‬ ‫ﻓﻆﻋ‬ ‫ﺎ‬‫ﻨﻲﻳﺤ‬ ‫ﻬ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬-
‫ﻴﻦ‬ ‫ﻜ‬ ‫ﺪﺳ‬ ‫ﺎﻋ‬‫ﺎﻝﻳﺴ‬ ‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬.‫ﺔ‬ ‫ﻤ‬‫ﻟ‬
‫ﺆ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﻬ‬‫ﻨﺐﺇﺟ‬ ‫ﻬﻞﺗﺠ‬ ‫ﺃﻥﺗﺴ‬ ‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﻟﻸﺟ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬-
.
‫ﻌﺼﻢ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻊﻭ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻷﺻ‬ ‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﺔﻣ‬‫ﻳ‬‫ﺎ‬‫ﻤ‬‫ﻠﻰﺣ‬ ‫ﺭﻋ‬ ‫ﺎ‬
‫ﻨﺸ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺾ‬ ‫ﻘ‬
‫ﻤ‬ ‫ﺰﺑ‬‫ﻬ‬‫ﻤﺠ‬ ‫ﻟ‬‫ﺍ‬‫ﺒﺦ‬ ‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﺍﺣﻲ‬ ‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬.3
‫ﻟﻢ‬‫ﺍﻷ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﻘ‬‫ﺎﺗ‬
ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬
‫ﻪ‬ ‫ﻨ‬
‫ﻜ‬‫ﻤ‬ ‫ﻳ‬.‫ﻔﺼﻞ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﺍﺳ‬ ‫ﺔﻓﻲ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﺗﺴ‬،‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﻠﺖ‬ ‫ﺍﻓﺸ‬ ‫ﺫ‬
‫ﺇ‬
.
‫ﺎﺕ‬‫ﻮﻫ‬ ‫ﺘﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﺢ‬ ‫ﺗﺼﺤ‬ ‫ﻭ‬
Ty pesofsur gerymayi nvolvet hef oll
owi ng:
-Sy nov ectomy :remov ethei nf l
amedsy nov i
um.
-Tendonr epair.
-Joi ntf usi
ont ost abilizeorr ealignaj oint.
-Tot al j
ointr eplacement .
:
‫ﻠﻲ‬‫ﺎﻳ‬‫ﺔﻣ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬ ‫ﻤﻞ‬‫ﺪﺗﺸ‬ ‫ﻗ‬
.‫ﻬﺐ‬ ‫ﺘ‬‫ﻠ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻲ‬‫ﻴ‬
‫ﻟ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬:
‫ﻠﻲﺇ‬ ‫ﻴ‬‫ﻟ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﻝ‬‫ﺌﺼ‬ ‫ﺘ‬‫ﺍﺳ‬ -
.‫ﺭ‬‫ﺎ‬‫ﺗ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﺇﺻﻼﺡ‬-
.
‫ﻪ‬ ‫ﻜ‬‫ﺎﺳ‬‫ﻤ‬
‫ﺓﺗ‬ ‫ﺩ‬‫ﺎ‬
‫ﻭﺇﻋ‬ ‫ﺃ‬‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﻔﺼﻞ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬ ‫ﺩ‬-
.‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻠﻲ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺍﻝ‬ ‫ﺪ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺳ‬ -

4.Li
festyl
emodi fi
cation:
A.BalancingActivi
tywithRest
-RestisimportantwhenRAi sacti
ve.
-Restreduceinfl
ammat ionandfat
igue.
B.Exerci
ser egul
arly:

73
-Gent l
eexer cisecanhel pst r
engthent hemuscl esar oundj oints.
-Av oidexer cisingt ender , inj
uredorsev erelyinfl
amedj oints.
C.Heatorcol dappl icat i
on:
-Heatpadsorwar m bat hs, bestforsoot hingst if
fjointsandt i
redmuscl es.
-Col disbestf oracut epai n.
D.Rel axationt echniques.
-Suchasdeepbr eat hi
ng, guidedimager y,distr
act i
onandmuscl erelax ation
usedt ocont rol pain.
E.Al t
ernat i
v emedi cine
-Fishoi l
:fishoi lsupplement smayr educer heumat oidarthr i
tispainand
sti
ffness.
-Plantoi l
s: cont ainat y peoff at
tyacidt hatmayhel pwi t
hr heumat oidar t
hriti
s
painandmor ningst iff
ness.
-Tai chi.Thist her apyi nv olvesgent l
eexer ci
sesandst r
etchescombi nedwi th
deepbr eat hing.Tai chi mayr educer heumat oidarthrit
ispai n.
:
‫ﺓ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﻤﻂ‬ ‫ﻳﻞﻧ‬ ‫ﺪ‬‫ﻌ‬‫ﺗ‬.4
‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺎﻁﻣ‬ ‫ﻨﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧ‬
‫ﺯ‬ ‫ﺍ‬
‫ﻮ‬‫ﻣ‬.‫ﺃ‬
.‫ﺎ‬
ً‫ﺪﻱﻧﺸ‬
‫ﻄ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬‫ﻣ‬
‫ﻭ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬
‫ﺪ‬ ‫ﻨ‬
‫ﺔﻋ‬ ‫ﻤ‬‫ﻬ‬‫ﺔﻣ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺎﻕ‬ ‫ﺭﻫ‬‫ﺍﻻ‬‫ﺎﺏﻭ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﻠﻞ‬ ‫ﻘ‬
‫ﺔﺗ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬-
:‫ﻡ‬‫ﺎ‬‫ﺘﻈ‬‫ﻧ‬‫ﺎ‬‫ﺮﻥﺑ‬‫ﻤ‬‫ﺗ‬.‫ﺏ‬
.‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻌﻀﻼﺕﺣ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻘ‬‫ﺔﻓﻲﺗ‬ ‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬ ‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻋ‬ ‫ﺎ‬‫ﺃﻥﺗﺴ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬-
.
‫ﺓ‬‫ﺪ‬‫ﺔﺑﺸ‬ ‫ﺒ‬
‫ﻬ‬ ‫ﺘ‬
‫ﻠ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬‫ﻨﺐﻣ‬ ‫ﺗﺠ‬-
:‫ﺓ‬‫ﺩ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻖ‬‫ﺒ‬‫ﺗﻄ‬
.‫ﺔ‬‫ﺒ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﺒﺴ‬ ‫ﻴ‬‫ﺘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺋ‬‫ﺪ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﻓﻀﻞ‬ ‫ﺍﻷ‬‫ﻭﻫﻲ‬، ‫ﺔ‬ ‫ﺌ‬
‫ﻓ‬‫ﺍ‬
‫ﺎﺕﺩ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﻤ‬‫ﻭﺣ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﺍﺕﺣ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻭﺳ‬-
.‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺍﻵﻻ‬‫ﻟﻼﺝ‬‫ﺔﻌ‬ ‫ﻠ‬‫ﻴ‬‫ﻓﻀﻞﻭﺳ‬ ‫ﺃ‬‫ﺓﻫﻲ‬ ‫ﺩ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺀ‬‫ﺎ‬
‫ﺮﺧ‬‫ﺘ‬ ‫ﺍﻻﺳ‬ ‫ﺎﺕ‬ ‫ﻴ‬‫ﻨ‬
‫ﻘ‬‫ﺗ‬-‫ﺩ‬
.‫ﻟﻢ‬‫ﺍﻷ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬ ‫ﻠﺴ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﺮﺧ‬‫ﺘ‬‫ﺍﺳ‬‫ﺀﻭ‬ ‫ﺎ‬‫ﻬ‬‫ﻟ‬
‫ﺍﻹ‬‫ﻭ‬،‫ﻪ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﻴﻖ‬‫ﻤ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﻣ‬-
‫ﻳﻞ‬ ‫ﺪ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻄﺐ‬ ‫ﺍ‬.E
.
‫ﺪﻱ‬ ‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﻣﺁﻻ‬
‫ﻠﻞ ﻦ‬ ‫ﻘ‬‫ﺪﺗ‬‫ﻤﻚﻗ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﻳﺖ‬ ‫ﻤﻼﺕﺯ‬ ‫ﻜ‬‫ﻣ‬: ‫ﻤﻚ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻳﺖ‬ ‫ﺯ‬-
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺁﻻ‬ ‫ﺪﻓﻲﻋﻼﺝ‬ ‫ﺎﻋ‬‫ﺪﺗﺴ‬‫ﺘﻲﻗ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﺪﻫ‬‫ﻟ‬‫ﺍ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﻣﺍﻷﺣ‬
‫ﻮﻉ ﻦ‬ ‫ﻠﻰﻧ‬ ‫ﻮﻱﻋ‬ ‫ﺘ‬‫ﺗﺤ‬:‫ﺔ‬‫ﻴ‬‫ﺗ‬‫ﺎ‬‫ﺒ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺕ‬ ‫ﻳ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺎﺡ‬‫ﺒ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﺲ‬ ‫ﻴ‬‫ﺗ‬‫ﺪﻱﻭ‬ ‫ﻳ‬‫ﻮ‬
‫ﺗ‬‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﻱ‬‫ﻠﻞﺗ‬ ‫ﻘ‬
‫ﺪﻳ‬ ‫ﻗ‬.‫ﻴﻖ‬ ‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻨﺐﻣ‬ ‫ﻟﻰﺟ‬ ‫ﺎﺇ‬
ً
‫ﺒ‬‫ﻨ‬
‫ﺔﺟ‬ ‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﺎﻻﺕﺧ‬ ‫ﺇﻃ‬‫ﻳﻦﻭ‬ ‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﻌﻼﺝﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻤﻦﻫ‬ ‫ﺘﻀ‬ ‫ﻳ‬. ‫ﺎﻱﺗﺸﻲ‬ ‫ﺗ‬-
.
‫ﺪﻱ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﻣﺁﻻ‬
‫ﺗﺸﻲ ﻦ‬

Ost
eoar
thr
it
is
Learningobjectives:
Attheendoft hislecture;
thest udentwi l
lbeabl
eto:
1-Defineosteoar t
hrit
is.
2-I
dent i
fyri
skf actorsofosteoar t
hrit
is.
3-Listsi
gnsandsy mptomsofost eoarthr
iti
s.
4-Enumer at
edi agnosi sofosteoarthrit
is.
5-Describetreatmentofost eoar t
hri
tis.

74
 ‫ﺮﻱ‬
‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬
:‫ﻠﻢ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬‫ﻴ‬
‫ﺳ‬. ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬ ‫ﻳ‬
‫ﺎ‬‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬
‫ﻳﻒﻫﺸ‬ ‫ﺮ‬‫ﻌ‬ ‫ﺗ‬-
1
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺎﺷ‬‫ﻬﺸ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻣﻞﺧﻄ‬‫ﺍ‬‫ﻮ‬‫ﺪﻋ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-2
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬
‫ﺍ ﺽﻫﺸ‬ ‫ﺮ‬‫ﻋ‬
‫ﺃ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﺑﻼ‬
‫ﺔﻌ‬ ‫ﻤ‬‫ﺋ‬
‫ﺎ‬‫ﻊﻗ‬‫ﺿ‬- 3
.
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻴ ﺺﻫﺸ‬‫ﺩﺗﺸﺨ‬ ّ
‫ﺪ‬‫ﻋ‬-4
.
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺎﺷ‬
‫ﻭﺻﻒﻋﻼﺝﻫﺸ‬- 5
Ost
eoar
thr
it
is
Defi
niti
onofOst eoarthri
tis:
-Osteoarthri
ti
s( OA)calleddegener ati
vejointdiseaseordegener ati
vearthri
ti
s
-Iti
sthemostcommonchr onicconditionofthej oints.Itoccurswhent he
cart
il
ageorcushi onbetweenj oint
sbr eaksdownl eadi ngtopai n,sti
ff
nessand
swell
ing.
-OAcanaf f
ectanyj oint
, butitoccur smostof teni nknees, hips, l
owerbackand
neck,smal l
jointsofthef ingersandt hebasesoft het humbandbi gtoe.
:‫ﻡ‬‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻳﻒﻫﺸ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﻜﺴﻲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻜﺴ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻤﻰﻣ‬‫(ﻳﺴ‬ OA)‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬‫ﻮﺳ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﻭﻑ‬ ‫ﺮ‬‫ﻐﻀ‬ ‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻜﺴ‬ ‫ﻨ‬
‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﺪﺙﻋ‬‫ﻳﺤ‬. ‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺎ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬‫ﺔ‬‫ﻨ‬‫ﻣ‬‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻭﻫﻲ‬-
.‫ﻡ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﺐﻭ‬ ‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻟﻢﻭ‬‫ﺍﻷ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬
‫ﺮ‬‫ﻬ‬‫ﻟﻈ‬
‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬‫ﻴﻦﻭ‬‫ﻛ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﺘ‬
‫ﺒ‬‫ﻛ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻏﺎﻓﻲ‬ً
‫ﺒ‬‫ﻟ‬
‫ﺪﺙﺎ‬ ‫ﻪﻳﺤ‬ ‫ﻨ‬‫ﻜ‬‫ﻟ‬
‫ﻭ‬، ‫ﻔﺼﻞ‬‫ﺃﻱﻣ‬ ‫ﻠﻰ‬‫ﺎﺻﻞﻋ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺛ‬‫ﺆ‬
‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬-
.‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺒ‬‫ﺇﺻ‬‫ﻡﻭ‬‫ﺎ‬
‫ﻬ‬ ‫ﺑ‬
‫ﺍﻹ‬‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻗ‬‫ﻊﻭ‬ ‫ﺑ‬‫ﺎ‬
‫ﻟﻸﺻ‬ ‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺻﻞ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﺒ‬
‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬

(
Fig.21)Ost
eoar
thr
it
is

(
Fig.22)Ost
eoar
thr
it
icspi
ne

Riskfactorsofost eoarthr
it
is:
1.Incr
easingage
2.Obesi t
y
3.Previousjointi
njury
4.Inj
uryandov er
use: Repet
it
ivemovement
sorinj
uri
estoj
oint
s(suchasa
fr
acture,surgeryorligamenttear
s)canl
eadtoost
eoart
hri
ti
s

75
5.Weakthi
ghmuscl es
6.Genet
icf
actors.
7.Boneandjoi
ntdisor
der
sli
ker
heumat
oidar
thr
it
is

Signsandsy mptomsofost eoarthr

iti
s
1.Pai nandstif
fness, i
nt hemor ningoraf t
erresti
ng.
2.Swel li
ngofjoint,especiall
yafterextendedact i
vi
ty.
3.Sor eorsti
ffjoint
spar ticul
arl
yt hehips,knees,andlowerbackaf terinactivi
ty
orov eruse.
4.Limi t
edrangeofmot ionorst i
ffnessthatgoesawayaf termov ement
5.Cli
cki ngorcrackingsoundwhenaj ointbends
:
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻬﺸ‬‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬
‫ﻣﻞﺧﻄ‬ ‫ﺍ‬‫ﻮ‬
‫ﻋ‬
‫ﺮ‬‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﺗ‬.
1
‫ﺔ‬
‫ﻨ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬.
2
‫ﺔ‬‫ﻘ‬‫ﺑ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻔﺼﻞ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬.3
‫ﺜﻞ‬ ‫ﻣ‬
)‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻓﻲ‬ ‫ﺭ‬‫ﺮ‬
‫ﻜ‬ ‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﺃﺍﻹﺻ‬
‫ﺎﺕﻭ‬ ‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬:‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﻻﺳ‬‫ﺍﻁﻓﻲ‬ ‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬
‫ﺔﻭ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ .
4
‫ﻡ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺎﺷ‬‫ﻟﻰﻫﺸ‬ ‫(ﺇ‬
‫ﺔ‬ ‫ﺑﻄ‬
‫ﺭ‬‫ﺍﻷ‬‫ﺰﻕ‬‫ﻤ‬‫ﻭﺗ‬‫ﺃ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒﻋﻀﻼﺕ‬ ‫ﺿ‬.5
.
‫ﺔ‬‫ﻴ‬‫ﺛ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬.
6
‫ﺪﻱ‬‫ﻳ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﺎﺻﻞﻣ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬ .
7

‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺎﺷ‬‫ﺍ ﺽﻫﺸ‬‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﻋﻼ‬
.
‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻭﺑ‬‫ﺃ‬‫ﺎﺡ‬‫ﺒ‬‫ﻟﺼ‬‫ﺍ‬‫ﻓﻲ‬، ‫ﺒﺲ‬ ‫ﻴ‬
‫ﺗ‬‫ﻟﻢﻭ‬‫ﺃ‬.1
.‫ﺪ‬‫ﺘ‬‫ﻤ‬
‫ﺎﻁﻣ‬ ‫ﺪﻧﺸ‬ ‫ﻌ‬‫ﺔﺑ‬‫ﺎﺻ‬‫ﻔﺼﻞﺧ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺥ‬‫ﻔ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬.2
‫ﺍﻻ‬‫ﺍﻁﻓﻲ‬ ‫ﺮ‬‫ﻓ‬
‫ﺃﺍﻹ‬‫ﻮﻝﻭ‬ ‫ﻤ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺮﺑ‬
‫ﻬ‬‫ﻟﻈ‬
‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬‫ﻴﻦﻭ‬‫ﺘ‬‫ﺒ‬
‫ﻛ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻛ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺻ‬ ‫ﺎﺻﻞﺧ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬
‫ﻭﺗﺼ‬ ‫ﺃ‬
‫ﻟﻢ‬‫ﺃ‬.3
.‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺳ‬
‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻭﻝﺑ‬‫ﺰ‬‫ﻠﺐﻳ‬‫ﻭﺗﺼ‬ ‫ﺃ‬ ‫ﺔ‬
‫ﻛ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺩﻣﻦ‬ ‫ﻭ‬‫ﺪ‬
‫ﺎﻕﻣﺤ‬ ‫ﻧﻄ‬.4
‫ﻔﺼﻞ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬‫ﺪﺛ‬ ‫ﻨ‬‫ﺮﻋ‬‫ﻴ‬‫ﻜﺴ‬‫ﻭﺗ‬ ‫ﺃ‬
‫ﺔ‬‫ﻘ‬‫ﻘﻄ‬‫ﻮﺕﻃ‬ ‫ﺻ‬. 5
Diagnosi sofost eoarthr
iti
s:
A.Per sonal andfami l
ymedi calhi
stor
y
B.Phy sicalExami nati
on
C.Di agnosticTest s
-Jointaspi r
ation.Thef l
uidwill
beexami nedforev i
denceofcr ystal
sorj oint
deteriorati
on.
-X-rayandMRI .

Osteoar thri
ti
sTr eatment:
Osteoarthriti
sisachr onic(l
ong- t
erm)di sease.Thereisnocure,butt r
eatment s
areavailabletomanagesy mptoms, i
nclude:
A.Phy sicalActivit
y
-Getmov i
ngandsi mpl eacti
vi
tiesli
kewal kingcanreducepai
nandhel p
maintainaheal t
hywei ght.
-Range- of-motionexercisehelpsmai ntainandi mprovejoi
ntfl
exibil
it
yand
reducest if
fness.
:
‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺷ‬‫ﻴ ﺺﻫﺸ‬ ‫ﺗﺸﺨ‬
‫ﻠﻲ‬‫ﺋ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺸﺨﺼﻲﻭ‬ ‫ﺍ‬
‫ﺒﻲ‬ ‫ﻟﻄ‬‫ﺍ‬
‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
‫ﺃ‬
‫ﻧﻲ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺤ ﺺ‬‫ﻟ‬‫ﺍ‬-
‫ﺏ‬
‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬
.‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺭﻓﻲ‬‫ﻮ‬‫ﺪﻫ‬‫ﻭﺗ‬ ‫ﺃ‬
‫ﺍﺕ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﺩﺑ‬‫ﻮ‬‫ﻠﻰﻭﺟ‬ ‫ﻴﻞﻋ‬ ‫ﻟ‬‫ﺎﻋﻦﺩ‬ً
‫ﺜ‬‫ﺋﻞﺑﺤ‬
‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺘﻢﻓﺤ ﺺ‬‫ﻴ‬‫ﺳ‬.‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻂ‬ ‫ﺷ‬-

76
 ‫‪.‬‬‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻴﻦﻣ‬ ‫ﻧ‬‫ﺔﻭﺭ‬ ‫ﻌ‬‫ﺃﺷ‬ ‫‪-‬‬
‫‪:‬‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺎﺷ‬‫ﻋﻼﺝﻫﺸ‬
‫‪،‬‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺎﺕﻹ‬ ‫ﻌﻼﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﻮ‬‫ﺘ‬‫ﻜﻦﺗ‬ ‫ﻟ‬‫‪،‬ﻭ‬‫ﺪﻋﻼﺝ‬ ‫ﻮﺟ‬ ‫‪.‬ﻻﻳ‬‫ﻣ(‬
‫ﺍﻷﺪ‬ ‫ﻳﻞ‬‫ﻮ‬ ‫ﻣﻦ)ﻃ‬ ‫ﺰ‬‫ﺮ ﺽﻣ‬ ‫ﻡﻣ‬ ‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺎﺷ‬ ‫ﻫﺸ‬
‫‪:‬‬‫ﻤﻞ‬ ‫ﺗﺸ‬ ‫ﻭ‬
‫ﻧﻲ‬‫ﺪ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫ﺃ‬
‫‪.‬‬
‫ﺯﻥ ﺻﺤﻲ‬ ‫ﻠﻰﻭ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺪﻓﻲ‬ ‫ﺎﻋ‬‫ﺗﺴ‬‫ﻟﻢﻭ‬‫ﺍﻷ‬ ‫ﻠﻞ‬‫ﻘ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻤﺸﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﺔﻣ‬ ‫ﻴﻄ‬‫ﺒﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧﺸﻄ‬ ‫ﺍﻷ‬‫ﺔﻭ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫‪-‬‬
‫‪.‬‬
‫ﺒﺲ‬ ‫ﻴ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺗ‬‫ﺎﻭ‬‫ﻬ‬‫ﻨ‬‫ﻴ‬
‫ﺗﺤﺴ‬ ‫ﺎﺻﻞﻭ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧ‬‫ﻭ‬‫ﺮ‬‫ﻠﻰﻣ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﻝ‬‫ﻳﻦﻣﺠ‬ ‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﺪﺗ‬ ‫ﺎﻋ‬‫‪-‬ﺗﺴ‬
‫‪B.Wei‬‬ ‫‪ghtManagement‬‬
‫‪-Losi‬‬‫‪ngwei‬‬ ‫‪ghtcanhel‬‬ ‫‪ppeopl‬‬ ‫‪ewi‬‬ ‫‪t‬‬
‫‪hOAr‬‬ ‫‪educepai‬‬ ‫‪nandl‬‬ ‫‪i‬‬
‫‪mi‬‬ ‫‪tf‬‬‫‪ur‬‬ ‫‪t‬‬‫‪herj‬‬‫‪oi‬‬ ‫‪nt‬‬
‫‪damage.‬‬
‫‪C.Pai‬‬ ‫‪nandAnt‬‬ ‫‪i‬‬
‫‪-‬‬‫‪i‬‬‫‪nf‬‬
‫‪l‬‬‫‪ammat‬‬ ‫‪or‬‬ ‫‪yMedi‬‬ ‫‪cat‬‬‫‪i‬‬‫‪ons‬‬
‫‪-Anal‬‬ ‫‪gesi‬‬‫‪cs.‬‬
‫(‪-‬‬‫‪NSAI‬‬ ‫‪Ds)andCor‬‬ ‫‪t‬‬
‫‪i‬‬‫‪cost‬‬‫‪er‬‬‫‪oi‬‬‫‪ds.‬‬
‫‪-Hy‬‬ ‫‪al‬‬‫‪ur‬‬‫‪oni‬‬‫‪caci‬‬ ‫‪d.Hy‬‬ ‫‪al‬‬‫‪ur‬‬‫‪oni‬‬‫‪caci‬‬ ‫‪doccur‬‬ ‫‪snat‬‬ ‫‪ur‬‬‫‪al‬‬‫‪l‬‬‫‪yi‬‬‫‪nj‬‬‫‪oi‬‬‫‪ntf‬‬ ‫‪l‬‬
‫‪ui‬‬‫‪d,‬‬ ‫‪act‬‬ ‫‪i‬‬
‫‪ngas‬‬
‫‪l‬‬
‫‪ubr‬‬ ‫‪i‬‬
‫‪cant‬‬ ‫‪.Howev‬‬ ‫‪er‬‬‫‪,‬‬
‫‪t‬‬‫‪heaci‬‬ ‫‪dappear‬‬ ‫‪st‬‬ ‫‪obr‬‬ ‫‪eakdowni‬‬ ‫‪npeopl‬‬ ‫‪ewi‬‬ ‫‪t‬‬
‫‪host‬‬ ‫‪eoar‬‬ ‫‪t‬‬‫‪hr‬‬ ‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s.‬‬
‫‪Thei‬‬ ‫‪nj‬‬‫‪ect‬‬‫‪i‬‬‫‪onsar‬‬ ‫‪edonei‬‬ ‫‪nadoct‬‬ ‫‪or‬‬‫’‬
‫‪sof‬‬ ‫‪f‬‬
‫‪i‬‬‫‪ce.‬‬
‫‪D.Phy‬‬ ‫‪si‬‬‫‪calandOccupat‬‬ ‫‪i‬‬
‫‪onalTher‬‬ ‫‪apy‬‬
‫‪-Heatandcol‬‬ ‫‪dt‬‬‫‪her‬‬‫‪api‬‬‫‪es‬‬
‫‪-Rangeofmot‬‬ ‫‪i‬‬
‫‪onandf‬‬ ‫‪l‬‬‫‪exi‬‬‫‪bi‬‬
‫‪l‬‬‫‪i‬‬‫‪t‬‬‫‪yexer‬‬ ‫‪ci‬‬‫‪ses‬‬
‫‪-Assi‬‬ ‫‪st‬‬‫‪i‬‬‫‪v‬‬‫‪edev‬‬ ‫‪i‬‬‫‪ces,‬‬‫‪suchasscoot‬‬ ‫‪er‬‬‫‪s,‬‬‫‪canes,‬‬ ‫‪wal‬‬‫‪ker‬‬‫‪s,‬‬‫‪spl‬‬‫‪i‬‬‫‪nt‬‬‫‪s.‬‬
‫‪E.Sur‬‬ ‫‪ger‬‬ ‫‪y‬‬
‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬‫ﺩ‬‫‪.‬ﺇ‬‫ﺏ‬
‫ﺪﻣﻦ‬ ‫ﻟﺤ‬‫ﺍ‬
‫ﻟﻢﻭ‬ ‫ﺍﻷ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺎﺻﻞﻓﻲﺗ‬ ‫ﻔ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬ ‫ﻳﻦﻳ‬ ‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﺪﻓ‬ ‫ﺎﻋ‬‫ﺃﻥﻳﺴ‬ ‫ﻜﻦ‬ ‫ﻤ‬
‫‪-‬ﻳ‬
‫‪.‬‬
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻒ‬ ‫ﺪﻣﻦﺗ‬ ‫ﻳ‬‫ﺰ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﻟﻼ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬‫ﻡﻭ‬ ‫ﺍﻵﻻ‬ ‫‪-‬ﻋﻼﺝ‬ ‫ﺝ‬
‫‪.‬‬
‫ﺎﺕ‬ ‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﺍﺕ‬‫ﺪ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻮﺳ‬ ‫ﻜ‬‫ﻴ‬‫ﺗ‬‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻴ‬‫ﺋ‬
‫ﻭ‬ ‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺏﻏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻣﻀ‬ ‫‪)-‬‬
‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻤﻞﻛ‬ ‫ﻌ‬‫ﻳ‬‫‪،‬ﻭ‬‫ﻔﺼﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻞ‬‫ﺎ‬
‫ﻌﻲﻓﻲﺳ‬ ‫ﻴ‬‫ﺒ‬‫ﻜﻞﻃ‬ ‫ﻴﻚﺑﺸ‬ ‫ﻧ‬‫ﻭ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺎ‬‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﺪﺙﺣ‬ ‫‪.‬ﻳﺤ‬ ‫ﻴﻚ‬ ‫ﻧ‬
‫ﻭ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺎ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫‪-‬ﺣ‬
‫ﻘﻦﻓﻲ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺘﻢ‬‫‪.‬ﻳ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺎﺷ‬ ‫ﻬﺸ‬‫ﻴﻦﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﺪ‬‫ﻨ‬‫ﻠﻞﻋ‬ ‫ﺘﺤ‬‫ﻤ ﺾﻳ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺃﻥ‬ ‫ﻭ‬‫ﺪ‬‫ﺒ‬‫‪،‬ﻳ‬ ‫ﻟﻚ‬‫ﻊﺫ‬ ‫ﻣ‬‫‪.‬ﻭ‬ ‫ﻴﻢ‬ ‫ﺗﺸﺤ‬
‫‪.‬‬‫ﻴﺐ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻴ‬ ‫ﻋ‬
‫ﻨﻲ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻲﻭ‬ ‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬‫ﺩ‬
‫ﺓ‬‫ﺩ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬ ‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬ ‫ﺎ‬
‫ﺎﺕﺑ‬ ‫ﻌﻼﺟ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫ﺔ‬ ‫ﻧ‬
‫ﻭ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻝ‬ ‫ﻳﻦﻣﺠ‬ ‫ﺭ‬‫ﺎ‬‫ﻤ‬‫‪-‬ﺗ‬
‫‪.‬‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﺎﺕ‬ ‫ﻳ‬
‫ﺎ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﻌﺼﻲ‬ ‫ﻟ‬‫ﺍ‬‫‪،‬ﻭ‬ ‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﺎ‬‫ﺒﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺟ‬ ‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺜﻞ‬‫‪،‬ﻣ‬ ‫ﺓ‬ ‫ﺪ‬‫ﻋ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬ ‫ﺍﻷﺟ‬ ‫‪-‬‬
‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫‪.‬‬
‫‪E‬‬

‫‪77‬‬
 ChapterI
I
Nur
singManagementofPat i
entwi
th
Uri
nar
ysy st
em disor
ders

‫ﻧﻲ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫ﻊ‬
‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﻟﻲ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﺍﺿﻄ‬

78
 Uni
t1:Anat
omyandphy
siol
ogyoft
heUr
inar
ySy
stem
Learni
ngobj
ecti
ves:
Attheendofthi
slect
ure,thest
udent
swil
lbeabl
eto:
1.Descri
bet
henormal anatomyandphy
siol
ogyoft
heur
inar
ysy
stem.
2.Li
stmaj
orf
unct
ionsoft
heki
dney
s.
3.Assessanddescr
ibet
hecommoncl
i
nical
mani
fest
ati
onsoft
heur
inar
ytr
act
dysf
uncti
on.
4.Ident
if
yinf
ormati
onandphysi
cal
exami
nat
iondat
aessent
ial
tot
he
assessmentoftheur
inar
ysyst
em.
5.I
denti
fyt
hemostcommonl
abor
ator
yandr
adi
ologi
cst
udi
esusedt
o
di
agnoseuri
nar
ysyst
em.
6.Formulatethenursingr esponsibil
it
iesforpati
entunder goingr adiologicand
otherstudi
esoft heurinarysystem.
‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻭﻇ‬‫ﻳﺢﻭ‬‫ﺮ‬‫ﺗﺸ‬:1‫ﺓ‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﻳﻦﻋ‬‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫ﻟﻄﻼﺏﻗ‬ ‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﻴ‬
‫ﺓﺳ‬ ‫ﺮ‬
‫ﺎﺿ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻟﻲ‬ ‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻠﺠ‬‫ﻟ‬‫ﺀ‬‫ﺎ‬
‫ﺍﻷﻋﻀ‬ ‫ﺋﻒ‬‫ﺎ‬
‫ﻠﻢﻭﻇ‬ ‫ﻋ‬‫ﻌﻲﻭ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﻳﺢ‬‫ﺮ‬
‫ﺘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 1
.
‫ﻠﻰ‬‫ﻜ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬
‫ﺋ‬‫ﺎ‬‫ﻗ‬.
2
.‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬‫ﻟﻀ‬‫ﺔ‬‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬ ‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬‫ﻭﺻﻒ‬ ‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬.
3
.
‫ﻟﻲ‬ ‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﻟﻀ‬
‫ﺍ‬‫ﻧﻲ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺤ ﺺ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺎ‬
‫ﻴ‬ ‫ﺑ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬
‫ﺗﺤ‬.4
.‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
ً
‫ﺎ‬‫ﻮﻋ‬‫ﻴ‬‫ﺔﺷ‬‫ﻴ‬‫ﺎﻋ‬
‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
5
‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬
‫ﺎﻣﻦﺩ‬ ‫ﺮﻫ‬
‫ﻴ‬‫ﺔﻭﻏ‬ ‫ﻴ‬‫ﺎﻋ‬
‫ﻌ‬‫ﺍﻹﺷ‬ ‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬
‫ﺪ‬‫ﻠ‬‫ﻟ‬‫ﻊ‬‫ﺬﻱﻳﺨﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺆ‬‫ﺪﻣﺴ‬ ‫ﻳ‬‫ﺪ‬
‫ﺗﺤ‬.6
.
‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬

Anat
omyandphy
siol
ogyoft
heUr
inar
ySy
stem
Anatomyoft heuri
nar
ysy
stem:
-Pair
edkidneys
-Uret
ers,
-Uri
narybladder
.
-Uret
hra.

Thesestr
uctur
esareessent
ial
l
ythesameinbothsexes.However,
theur ethrais
l
ongerinthemale.
‫ﻟﻲ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻭﻇ‬ ‫ﻳﺢﻭ‬‫ﺮ‬‫ﺗﺸ‬
:
‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﺢ‬‫ﺮ‬‫ﺗﺸ‬
‫ﺔ‬‫ﻭﺟ‬‫ﺩ‬‫ﺰ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬-
، ‫ﻟﺐ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬-
.‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﻧﻲﺑ‬ ‫ﺎ‬
‫ﺜ‬‫ﻣ‬-
.‫ﻴﻞ‬ ‫ﻠ‬
‫ﺍﻹﺣ‬-
.‫ﺭ‬
‫ﻮ‬‫ﻛ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻓﻲ‬‫ﺃﻃ‬‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺮﻯ‬‫ﺈﻥﻣﺠ‬‫ﻓ‬،‫ﻟﻚ‬
‫ﻊﺫ‬‫ﻣ‬‫ﻭ‬.
‫ﻴﻦ‬‫ﻨﺴ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺎﺱﻓﻲﻛﻼ‬ ‫ﺍﻷﺳ‬‫ﺎﻓﻲ‬‫ﻬ‬
‫ﻔﺴ‬‫ﻛﻞﻫﻲﻧ‬ ‫ﺎ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻫ‬

79
 (
fi
g.23)Anat
omyoft
heur
inar
ysy
stem

Kidney s:
-Theki dney sarepai redor gant hatl i
eslateraltothev ert
ebral columnbet ween
thetwel fththoraci
c( T-12)andt het hir
dlumbar( 2-3)v ertebra.
-Anadul tkidneywei ghs120t o170gandi s12cm l ong, 6cm wi de,and2. 5cm
thick
-Themedul lai
sbel owt hecor tex.Thecor tex(outerlayer)oft heki dney
containst henephr onsuni toft heki dney.
-Itcont ainstheglomer ulus, andt ubulethatj oi
ntof ormt hepel visofeach
kidney.
:
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫(ﻭ‬T- 12)‫ﺮ‬‫ﺔﻋﺸ‬ ‫ﻴ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﺮﻱﺑ‬‫ﻘ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻤ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺎ‬
ً
‫ﻴ‬‫ﺒ‬‫ﻧ‬
‫ﺎ‬‫ﻊﺟ‬ ‫ﻘ‬‫ﺮﻥﻳ‬‫ﺘ‬‫ﻘ‬‫ﻮﻣ‬ ‫ﺓﻋﻦﻋﻀ‬ ‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻠﻰﻋ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬-
.(
3-2)‫ﺔ‬ ‫ﺜ‬‫ﻟ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻘﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﺳﻢ‬2.5‫ﺎ‬ ‫ﻬ‬‫ﻜ‬‫ﻤ‬
‫ﺳﻢﻭﺳ‬6‫ﺎ‬ ‫ﻬ‬‫ﺮﺿ‬ ‫ﻋ‬‫ﺳﻢﻭ‬12‫ﺎ‬ ‫ﻬ‬‫ﻟ‬
‫ﻮ‬‫ﺟﻢﻭﻃ‬170‫ﻟﻰ‬ ‫ﺇ‬120‫ﺔ‬ ‫ﻐ‬‫ﻟ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺰﻥ‬‫ﺗ‬-
.
‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻥﻓﻲ‬ ‫ﺮ‬‫ﻔ‬‫ﻴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬
‫ﻠﻰﻭﺣ‬ ‫(ﻋ‬‫ﺔ‬ ‫ﻴ‬‫ﺭﺟ‬‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬
)‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻮﻱﻗﺸ‬ ‫ﺘ‬‫ﺗﺤ‬. ‫ﺓ‬
‫ﺮ‬ ‫ﻘﺸ‬‫ﻟ‬‫ﺍ‬‫ﺎﻉﺗﺤﺖ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻮ ﺽﻛﻞﻛ‬ ‫ﻴﻞﺣ‬ ‫ﻜ‬
‫ﺘﺸ‬ ‫ﻟ‬‫ﻨﻀﻢ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻴ‬‫ﺒ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺎﺕ‬‫ﺒ‬‫ﻴ‬‫ﺒ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻮﻱﻋ‬ ‫ﺘ‬‫ﻳﺤ‬-

(
Fig.24)Ki
dney
s.

TheNephr on:
-I
tisthebasicfuncti
onalunitofthekidney
.
-Whichisconsistsofanenlargedt er
minalendcal
led"
renalcorpuscl
e"and
"t
ubularsyst
em" .
-Approximatel
yonet hi
rdof1,000,000or1,300,
000nephronineachkidney
mustbef uncti
onaltoensuresurvival
.

Ureters:
Arepai r
ed,fi
bromusculartubesthattr
ansporturi
nebyper i
stal
si
sf r
om the
renalpelvi
stothebladder.Theyareapproxi
mat el
y30t o33cm inlengt
h.
:‫ﻭﻥ‬‫ﺮ‬‫ﻔ‬‫ﻴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
.‫ﺔ‬
‫ﻴ‬ ‫ﻠ‬
‫ﻜ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﺔ‬‫ﻴ‬
‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬
‫ﻮﺣ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭﻫﻲ‬-
.
"‫ﺑﻲ‬
‫ﻮ‬‫ﺒ‬‫ﻧ‬
‫ﺍﻷ‬‫ﻡ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬
"‫"ﻭ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬
"‫ﻤﻰ‬‫ﺘﻀﺨﻢﻳﺴ‬ ‫ﻓﻲﻣ‬‫ﺮ‬‫ﺮﻑﻃ‬ ‫ﻮﻥﻣﻦﻃ‬ ‫ﻜ‬
‫ﺘ‬‫ﺬﻱﻳ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬-
‫ﻠﻰ‬‫ﺀﻋ‬‫ﺎ‬‫ﻘ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻥ‬‫ﻤ‬‫ﻟﻀ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻭﻥﻓﻲﻛﻞﻛ‬ ‫ﺮ‬‫ﻔ‬
‫ﻧ‬1،
300،000‫ﻭ‬1‫ﺃ‬،000،000‫ﻠﺚ‬‫ﺮﺏﻣﻦﺛ‬‫ﻘ‬‫ﺎﻳ‬‫ﻤﻞﻣ‬‫ﻌ‬
‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬-
.
‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬
‫ﻴ‬‫ﻗ‬

:
‫ﻟﺐ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬
‫ﻎ‬
‫ﻠ‬‫ﺒ‬‫ﻳ‬.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬
‫ﻮﻱﺇ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺽ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﻌﺞﻣﻦ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬
‫ﺮ‬‫ﻮﻝﻋﻦﻃ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬
‫ﻨ‬‫ﺔﺗ‬
‫ﻧ‬‫ﺮ‬‫ﺘ‬
‫ﻘ‬‫ﺔﻣ‬
‫ﻴ‬‫ﻔ‬‫ﻴ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻴﺐﻋﻀ‬
‫ﺑ‬‫ﺎ‬
‫ﻧ‬‫ﺃ‬‫ﻫﻲ‬

80
 .
‫ﺳﻢ‬33‫ﻟﻰ‬
‫ﺇ‬30‫ﻟﻲ‬
‫ﺍ‬
‫ﻮ‬‫ﺎﺣ‬
‫ﻬ‬‫ﻟ‬
‫ﻮ‬‫ﻃ‬

Bladder :
-Isahal l
ow, muscul aror gant hatser v esasar eservoirforuri
ne.Theadul t
bladdernor mal lyhasacapaci tyof350t o450ml .
-Nor mal adul tur i
neout putisappr oximat ely1500ml /day,whichvarieswi th
foodandf luidi nt ake.
-Ont heav erage, 200t o250ml ofur inei nt hebladdercausesmoder ate
distent i
onandt heur get ourinate.
Urethr a:
Isahal lowmuscul artubet hatconv ey sur inef r
om t hebladdertotheur inary
meat us( openi ng)f orexcr eti
on, inwomen; theurethraisapproximately4cm i n
l
engt h.I nmen, t heur ethraisappr ox i
mat ely15cm l ong.
:‫ﺔ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻣ‬
.‫ﻣ‬
‫ ﻞ‬450‫ﻟﻰ‬ ‫ﺇ‬350‫ﺓ‬ ‫ﺩ‬
‫ﺎ‬‫ﺔﻋ‬ ‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﻎﺳ‬ ‫ﻠ‬
‫ﺒ‬‫ﺗ‬.‫ﻮﻝ‬ ‫ﺒ‬‫ﻠ‬
‫ﻟ‬‫ﺍﻥ‬‫ﺰ‬
‫ﺔﺧ‬ ‫ﺑ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻤﻞﺑ‬‫ﻌ‬‫ﻠﻲﻳ‬‫ﺪﺱﻋﻀ‬ ‫ﻘ‬‫ﻮﻣ‬ ‫ﻮﻋﻀ‬ ‫ﻫ‬-
‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬‫ﺗ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﺘﻼﻑ‬ ‫ﺎﺧ‬‫ﻠﻒﺑ‬ ‫ﺘ‬‫ﺘﻲﺗﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﻡ‬‫ﻮ‬‫ﻳ‬/‫ﻣﻞ‬1500‫ﻟﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﻴﻦﺣ‬ ‫ﻐ‬‫ﻟ‬
‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﻛ‬-
.‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﻮﻝ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﺎﻋ‬ً
‫ﺜ‬ ‫ﺎﻭﺣ‬ً
‫ﻟ‬‫ﺪ‬‫ﺘ‬‫ﻌ‬‫ﺎﻣ‬ً‫ﺎ‬
‫ﺧ‬ ‫ﻔ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﺔﻳﺴ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝﻓﻲ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞﻣﻦ‬250‫ﻟﻰ‬ ‫ﺇ‬200، ‫ﻮﺳﻂ‬ ‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬-
:‫ﻴﻞ‬‫ﻠ‬
‫ﺍﻹﺣ‬
‫ﻎ‬ ‫ﻠ‬
‫ﺒ‬‫؛ﻳ‬ ‫ﺀ‬‫ﺎ‬‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻯ‬ ‫ﻟ‬ ‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﻟﻺ‬ (
‫ﺘﺢ‬ ‫ﻔ‬‫ﻟ‬
‫ﺍ‬
)‫ﺔ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺎﺥ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﻟﻰ‬ ‫ﺔﺇ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝﻣﻦ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬‫ﻨ‬
‫ﺪﺱﻳ‬ ‫ﻘ‬‫ﻠﻲﻣ‬ ‫ﻮﺏﻋﻀ‬ ‫ﺒ‬‫ﻧ‬
‫ﺃ‬‫ﻮ‬‫ﻫ‬
.‫ﺳﻢ‬15‫ﻟﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﺎﻝﺣ‬‫ﺮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻨ‬‫ﻮﻝﻋ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬ ‫ﺮﻯ‬ ‫ﻮﻝﻣﺠ‬‫ﻎﻃ‬ ‫ﻠ‬
‫ﺒ‬‫ﻳ‬.
‫ﺳﻢ‬4‫ﻟﻲ‬ ‫ﺍ‬
‫ﻮ‬‫ﻮﻝﺣ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬ ‫ﻮﻝﻣﺠ‬ ‫ﻃ‬
Maj orf unct ionsoft heki dney s:
1-Homeost asi sofi nternalenv ironment :
-Fluid–v olumecont rol.
-Elect rolytesr egul at
ion.
-Aci dbasebal ance.
-Excr etionofmet abolicwast es, toxinsanddr ugs.

2-Regul ationofbodypr ocesses:

-Regulationofbl oodpressur e.
-Sti
mul ationofredbl oodcel lpr
oductiont hroughproducti
onofer ythropi oten
whichst imulatebonemar rowt oformr edbl oodcell
s.
-Regulationofcal ci
um –phosphat emet aboli
sm thr
oughact i
v ati
onofv itami n
Dwhi chi simportantforcal ci
um absorpt i
on.
:‫ﻠﻰ‬‫ﻜ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﻴ‬
‫ﻴﺴ‬ ‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻒ‬ ‫ﺎ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬ ‫ﺒ‬‫ﺘ‬‫ﺘ‬
‫ﺍﺳ‬ -
1
.‫ﻮﺕ‬‫ﻟﺼ‬‫ﺍ‬
‫ﻮﻯ‬ ‫ﺘ‬
‫ﻜﻢﻓﻲﻣﺴ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬-‫ﺋﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬-
.‫ﺎﺕ‬‫ﺘ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻜ‬‫ﻟ‬‫ﺍﻻ‬ ‫ﻴﻢ‬‫ﻨﻈ‬‫ﺗ‬-
.
‫ﺪﻱ‬ ‫ﺎﻋ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻀﻲ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺩ‬‫ﺍﻷ‬
‫ﻡﻭ‬ ‫ﻮ‬
‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻳﻀ‬ ‫ﺍﻷ‬‫ﻔﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺇ‬-
:‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻴﻢﻋ‬ ‫ﻨﻈ‬‫ﺗ‬-
2
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﻴﻢ ﺿ‬ ‫ﻨﻈ‬‫ﺗ‬-
‫ﻳﻦﺧ‬ ‫ﻮ‬
‫ﻜ‬ ‫ﻠﻰﺗ‬‫ﻡﻋ‬ ‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﺰﻧﺨ‬‫ﻔ‬‫ﺬﻱﻳﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺗ‬‫ﻮ‬
‫ﻴ‬‫ﺑ‬‫ﻭ‬
‫ﺮ‬‫ﺜ‬‫ﻳ‬‫ﺭ‬‫ﺍﻹ‬‫ﺎﺝ‬‫ﺘ‬‫ﻧ‬
‫ﺀﻣﻦﺧﻼﻝﺇ‬ ‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺎﺝﺧﻼ‬ ‫ﺘ‬‫ﻧ‬‫ﺰﺇ‬ ‫ﻴ‬‫ﻔ‬
‫ﺗﺤ‬-
.‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﻼ‬
.‫ﻡ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺹ‬‫ﺘﺼ‬ ‫ﻣ‬
‫ﻬﻢﻻ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﺩ‬ ‫ﻣ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﻴﻂﻓ‬ ‫ﻨﺸ‬‫ﺎﺕﻣﻦﺧﻼﻝﺗ‬ ‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬-‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻼﺏ‬ ‫ﺘ‬‫ﺍﺳ‬ ‫ﻴﻢ‬‫ﻨﻈ‬‫ﺗ‬-

3-Execr
ator
yFuncti
on:
-Excr
eti
onoftheexcessf
lui
dvol
umef
rom t
hebody
.

81
-Excr
eti
onsofthewast
epr
oduct
sresul
tfr
om met
abol
i
sm as"
urea,
creat
ini
ne,
ammonia,et
c.‖

4-SecretaryFuncti
on" Endocr i
nal"
:
-Producti
onandsecr etionof( Renni
nHor mone) ,whichpl aysanimpor tantrol
e
i
nregulationofbloodpr essure.
-Secret
ionofpr ost
aglandinswhi chhav eav asodil
atoreffectandar eimpor t
ant
i
nmai ntaini
ngrenalbloodf l
ow.
:
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺍﻹﺟ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬
‫ﺍ‬-3
.‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓﻣﻦ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺇ‬-
".
‫ﻟﺦ‬‫ﺇ‬،
‫ﺎ‬‫ﻴ‬‫ﻧ‬
‫ﻮ‬‫ﻣ‬‫ﺍﻷ‬،‫ﻴﻦ‬‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
،‫ﺎ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬"‫ﺜﻞ‬‫ﺋﻲﻣ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻋﻦ‬ ‫ﺗﺠ‬‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻠ‬
‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺇ‬-
:"
‫ﺀ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬
"‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻴﻦﻭﻇ‬‫ﻣ‬‫ﺃ‬-4
.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﻴﻢ ﺿ‬‫ﻨﻈ‬‫ﺎﻓﻲﺗ‬ً
‫ﻣ‬‫ﺎ‬
‫ﺍﻫ‬ً‫ﺭ‬
‫ﻭ‬‫ﻌﺐﺩ‬ ‫ﻠ‬
‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬(‫ﻴﻦ‬‫ﻨ‬‫ﻳ‬
‫ﺭ‬)‫ﻮﻥ‬‫ﻣ‬‫ﺮ‬‫ﺯﻫ‬ ‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺇ‬
‫ﺎﺝﻭ‬‫ﺘ‬‫ﻧ‬
‫ﺇ‬-
.‫ﻠﻰ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﻠﻰﺗ‬
‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻤ‬
‫ﻬ‬‫ﺔﻭﻫﻲﻣ‬ ‫ﻴ‬‫ﻭﻋ‬‫ﻟﻸ‬‫ﻊ‬‫ﻮﺳ‬‫ﺮﻣ‬‫ﻴ‬‫ﺛ‬‫ﺄ‬
‫ﺎﺗ‬‫ﻬ‬‫ﻟ‬‫ﺘﻲ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻦ‬‫ﺪ‬‫ﻧ‬‫ﺎﺟﻼ‬‫ﺘ‬‫ﻭﺳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺇ‬-

Assessment :
A.Subj ecti
v edat a:
Pastheal thhi story:
-Askt hepat ientaboutt hehi storyoft hepr esenti l
lnessordi sorder s.
-Askwhati st hepat i
ent '
schi efcompl aint(e.g.incont i
nence; dysur i
a,pai n).
-Determi neweat hert hecol orandconsi stencyoft heur ineiswi thinnor mal
range.
-Askwhet heradi schar gei spr esentwi thur i
nationori spr esentar oundt he
meat us.Askt hepat i
entst odescr ibet hedi schar gebycol orandodor .
-Determi netheusual amountoff luidingest eddai lyandt heappr oximat edof
output .
-Askt hepat ientsaboutpastmedi calpr oblems, medi cationsandpr evious
surgery.
-Askaboutt hef ami l
yhi stor yofi l
l
ness.
-Determi nethepat ient'susual acti
v i
ti
esofdai lylivingandweat hert hepr esent
conditi
oni nterfereswi t
ht henor mal dailyrout i
ne.
-Askt hepat ienttheaboutnumberofpastur i
nar yinf ecti
ons.
-Episodesofbl eedi ngi nt heur ine.
-Episodesofur inar ypai n.
-Carefullydocumentt hei nformat ionobt ai
ned.
:
‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬
:‫ﺔ‬‫ﻴ‬‫ﺗ‬
‫ﺍ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬-‫ﻟﻒ‬‫ﺃ‬
:
‫ﺑﻖ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻟﺼﺤﻲ‬ ‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺃﺍﻻﺿﻄ‬ ‫ﺮ ﺽﻭ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﻳ ﺾﻋﻦﺗ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺄﻝ‬‫ﺍﺳ‬-
.
(‫ﻟ‬
‫ﺍﻷﻢ‬ ‫ﻭ‬، ‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬ ‫ﻭ‬، ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺲ‬ ‫ﺜﻞﺳ‬ ‫ﻣ‬)‫ﻳ ﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻴﺴ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬ ‫ﻜ‬
‫ﻟﺸ‬ ‫ﺍ‬‫ﺎﻫﻲ‬ ‫ﺄﻝﻣ‬‫ﺍﺳ‬-
.‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﻦ‬ ‫ﻪﺿ‬ ‫ﻣ‬‫ﺍ‬‫ﻮ‬‫ﻗ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻟ‬‫ﺣﺔ‬
‫ﻟ‬‫ﺪﺎ‬ ‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-
‫ﺮﺿﻰﻭﺻﻒ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺐﻣﻦ‬ ‫ﺍﻃ‬.‫ﺎﺥ‬‫ﻤ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻮﻝ‬ ‫ﺓﺣ‬ ‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﺎﻣ‬‫ﻬ‬‫ﻧ‬
‫ﺃ‬ ‫ﻡ‬
‫ﺃ‬ ‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﺍﺕﻣ‬ ‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺎﻙﺇ‬‫ﻨ‬‫ﻧﺖﻫ‬ ‫ﺎ‬‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬‫ﻤ‬‫ﺄﻝﻋ‬‫ﺍﺳ‬-
.
‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻭ‬ ‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻎﺣﺴﺐ‬ ‫ﻳ‬
‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺎ‬‫ﻬ‬‫ﻟ‬
‫ﻭ‬‫ﺎ‬‫ﻨ‬
‫ﺘﻢﺗ‬ ‫ﺘﻲﻳ‬ ‫ﻟ‬‫ﺍ‬
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻳﺐﻛ‬ ‫ﺮ‬ ‫ﻘ‬
‫ﺗ‬‫ﺎﻭ‬ً
‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﺎﻳ‬‫ﻬ‬‫ﻟ‬‫ﻭ‬‫ﺎ‬
‫ﻨ‬‫ﺘﻢﺗ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺘ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﺪﻛ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-
.‫ﺔ‬
‫ﻘ‬‫ﺑ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﺔﻭ‬ ‫ﻘ‬‫ﺑ‬
‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰﻋﻦ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻔﺴ‬‫ﺘ‬‫ﺍﺳ‬-
.‫ﺮﺿﻲ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻠ‬‫ﺋ‬‫ﺎ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺄﻝﻋﻦﺗ‬ ‫ﺍﺳ‬-
‫ﻣﻲ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﺭ ﺽﻣ‬ ‫ﺎ‬
‫ﻌ‬ ‫ﺘ‬‫ﻟﻲﻳ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻘﺲ‬ ‫ﻟﻄ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺓﻓﻲ‬ ‫ﺩ‬‫ﺎ‬
‫ﺘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬ ‫ﺃ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬-
.
‫ﺩﻱ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬

82
 ‫‪.‬‬
‫ﺔ‬‫ﻘ‬‫ﺑ‬
‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬
‫ﺩﺣ‬ ‫ﺪ‬
‫ﻳ ﺾﻋﻦﻋ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺄﻝ‬
‫ﺍﺳ‬‫‪-‬‬
‫‪.‬‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒﻓﻲ‬‫ﺰ‬‫ﺎﺕﻧ‬‫ﺑ‬
‫ﻮ‬‫‪-‬ﻧ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺍﻵﻻ‬‫ﺎﺕ‬‫ﺑ‬
‫ﻮ‬‫‪-‬ﻧ‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬
‫ﺎﺑ‬‫ﻬ‬
‫ﻴ‬‫ﻠ‬‫ﻮﻝﻋ‬‫ﻟﺤﺼ‬
‫ﺍ‬‫ﺘﻲﺗﻢ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻖ‬‫ﺛ‬
‫ﻮ‬‫‪-‬ﺗ‬

‫‪Cl‬‬‫‪i‬‬‫‪ni‬‬‫‪calmani‬‬ ‫‪f‬‬‫‪est‬‬ ‫‪at‬‬‫‪i‬‬

‫‪onofur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yt‬‬ ‫‪r‬‬‫‪actdy‬‬‫‪sf‬‬‫‪unct‬‬ ‫‪i‬‬
‫‪onas:‬‬
‫‪1.Changi‬‬ ‫‪nv‬‬‫‪oi‬‬‫‪di‬‬‫‪ng:Voi‬‬ ‫‪di‬‬‫(‪ng‬‬‫‪mi‬‬ ‫‪ct‬‬‫‪ur‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪on)i‬‬ ‫‪snor‬‬ ‫‪mal‬‬‫‪l‬‬
‫‪yapai‬‬ ‫‪nl‬‬
‫‪essf‬‬ ‫‪unct‬‬‫‪i‬‬
‫‪on‬‬
‫‪occur‬‬ ‫‪r‬‬‫‪i‬‬
‫‪ngappr‬‬ ‫‪oxi‬‬‫‪mat‬‬ ‫‪el‬‬‫‪yei‬‬‫‪ghtt‬‬‫‪i‬‬
‫‪mesi‬‬ ‫‪na24-‬‬ ‫‪hourper‬‬‫‪i‬‬‫‪od.Theav‬‬ ‫‪er‬‬‫‪ageper‬‬ ‫‪son‬‬
‫‪v‬‬‫‪oi‬‬‫‪ds1,‬‬ ‫‪200t‬‬ ‫‪o1,‬‬ ‫‪500mLofur‬‬ ‫‪i‬‬‫‪nei‬‬‫‪n24hour‬‬ ‫‪s,‬‬ ‫‪al‬‬
‫‪t‬‬‫‪hought‬‬ ‫‪hi‬‬‫‪samountv‬‬ ‫‪ar‬‬‫‪i‬‬
‫‪es‬‬
‫‪dependi‬‬ ‫‪ngonf‬‬ ‫‪l‬‬‫‪ui‬‬‫‪di‬‬‫‪nt‬‬‫‪ake,‬‬ ‫‪sweat‬‬‫‪i‬‬‫‪ng,‬‬‫‪env‬‬‫‪i‬‬‫‪r‬‬‫‪onment‬‬ ‫‪al‬‬‫‪t‬‬‫‪emper‬‬ ‫‪at‬‬‫‪ur‬‬‫‪ev‬‬‫‪omi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪ng,‬‬ ‫‪or‬‬
‫‪di‬‬‫‪ar‬‬‫‪r‬‬‫‪hea‬‬
‫‪-Fr‬‬‫‪equency‬‬
‫‪-Ur‬‬ ‫‪gency‬‬
‫‪-Dy‬‬ ‫‪sur‬‬‫‪i‬‬‫‪a‬‬
‫‪-Hesi‬‬ ‫‪t‬‬‫‪ancy‬‬
‫‪-Noct‬‬ ‫‪ur‬‬ ‫‪i‬‬
‫‪a‬‬
‫‪-I‬‬‫‪ncont‬‬ ‫‪i‬‬‫‪nence‬‬
‫‪-Enur‬‬ ‫‪esi‬‬ ‫‪s‬‬
‫‪-Pol‬‬ ‫‪y‬‬‫‪ur‬‬‫‪i‬‬‫‪a‬‬
‫‪-Ol‬‬ ‫‪i‬‬
‫‪gur‬‬ ‫‪i‬‬
‫‪a‬‬
‫‪-Anur‬‬ ‫‪i‬‬‫‪a‬‬
‫‪-Hemat‬‬ ‫‪ur‬‬‫‪i‬‬
‫‪a‬‬
‫‪-Pr‬‬ ‫‪ot‬‬‫‪ei‬‬‫‪nur‬‬‫‪i‬‬‫‪a‬‬
‫‪:‬‬‫ﺜﻞ‬‫ﺔﻣ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬‫ﻟﻀ‬ ‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‪24‬‬ ‫ﺮ‬‫ﺘ‬
‫ﺍﺕﻓﻲﻓ‬ ‫ﺮ‬‫ﻧﻲﻣ‬ ‫ﺎ‬‫ﻤ‬
‫ﻟﻲﺛ‬ ‫ﺍ‬
‫ﻮ‬‫ﺪﺙﺣ‬ ‫ﺔﺗﺤ‬ ‫ﻤ‬
‫ﻟ‬‫ﺆ‬‫ﺮﻣ‬‫ﻴ‬‫ﺔﻏ‬ ‫ﻔ‬
‫ﻴ‬‫ﻮﻝﻭﻇ‬ ‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬ ‫ﺎﻳ‬
‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫‪:‬ﻋ‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪1‬‬
‫ﻩ‬‫ﺬ‬‫ﺃﻥﻫ‬ ‫ﺮﻏﻢﻣﻦ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫‪،‬ﻋ‬‫ﺔ‬‫ﺎﻋ‬‫ﻮﻝﺧﻼﻝ‪24‬ﺳ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻰ‪1500‬ﻣﻞﻣﻦ‬ ‫ﺩﻱ‪1200‬ﺇ‬ ‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻟﺸﺨ ﺺ‬‫ﺍ‬ ‫ﺮﻍ‬‫ﻔ‬‫‪.‬ﻳ‬‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬
‫ﺎﻝ‬‫ﻹﻬ‬
‫ﺃﺍ ﺳ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬ ‫ﺭﺟ‬‫ﺒﺐﺩ‬ ‫ﺀﺑﺴ‬‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺮﻕ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺘﻼﻑﺗ‬ ‫ﺎﺧ‬‫ﻠﻒﺑ‬ ‫ﺘ‬‫ﺔﺗﺨ‬‫ﻴ‬‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫‪-‬ﺗ‬
‫ﺎﻝ‬ ‫ﻌﺠ‬‫ﺘ‬‫ﺍﻻﺳ‬‫‪-‬‬
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫‪-‬ﻋﺴ‬
‫ﺩ‬‫ﺩ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫ﻠﻲ‬‫ﻴ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﺲ‬‫‪-‬ﺳ‬
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﺲ‬‫‪-‬ﺳ‬
‫ﺎ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫‪-‬ﺑ‬
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫‪-‬ﻗ‬
‫ﺎ‬
‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬‫‪-‬‬
‫ﻮﻱ‬ ‫ﻣ‬
‫ﻮﻝﺩ‬ ‫‪-‬ﺑ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫‪-‬ﺑ‬

‫‪2.Changi‬‬‫‪ngi‬‬‫‪nur‬‬
‫‪i‬‬‫‪nechar‬‬
‫‪act‬‬
‫‪er‬‬‫‪i‬‬
‫‪st‬‬‫‪i‬‬
‫‪cs:‬‬
‫‪-Hemat‬‬ ‫‪ur‬‬
‫‪i‬‬‫‪a‬‬
‫‪-Badodor‬‬
‫‪-Fr‬‬‫‪ot‬‬
‫‪hi‬‬‫‪ng‬‬

‫‪:‬‬
‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﺺ‬‫ﺎ‬
‫ﺮﺧﺼ‬
‫ﻴ‬‫ﻐ‬‫‪.‬ﺗ‬
‫‪2‬‬

‫‪83‬‬
 ‫ﻮﻱ‬ ‫ﻣ‬
‫ﻮﻝﺩ‬‫ﺑ‬-
‫ﺔ‬
‫ﺌ‬‫ﻴ‬‫ﺔﺳ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺭ‬-
‫ﺪ‬‫ﺑ‬
‫ﺰ‬‫ﻣ‬-

3.Changei nur inev olume:

-Anuria
-Oli
gur ia
-Polyuria
4.Pain: Geni tour i
nar ypai nisusual l
ycausedbydi stentionofsomepor ti
onof
theurinar ytractbecauseofobst r
uctedur ineflowori nflammat i
onandswel l
ing
ofti
ssues.Sev er i
tyofpai nisrelatedtot hesuddenonsetr atherthantheex t
ent
ofdistent i
on, thesev arioust ypesofgeni touri
nar ypai n.
:
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲﺣﺠﻢ‬ ‫ﻴ‬‫ﻐ‬‫ﺗ‬.3
‫ﺎ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬ ‫ﻧ‬
‫ﺃ‬-
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﻗ‬-
‫ﺎ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬ ‫ﻟ‬
‫ﻮ‬‫ﺑ‬-
‫ﻓﻖ‬‫ﺪ‬‫ﺩﺗ‬ ‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬ ‫ﺒﺐ‬ ‫ﺔﺑﺴ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀﻣﻦ‬ ‫ﺰ‬‫ﺎﺥﺟ‬ ‫ﻔ‬
‫ﺘ‬‫ﻧ‬‫ﺍ‬‫ﺒﺐ‬‫ﺓﺑﺴ‬ ‫ﺩ‬‫ﺎ‬‫ﻠﻲﻋ‬ ‫ﺎﺳ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻢ‬
‫ﺍﻷ‬‫ﺪﺙ‬‫ﻳﺤ‬: ‫ﻟﻢ‬
‫ﺍﻷ‬ .4
‫ﺍﻉ‬
‫ﻮ‬ ‫ﻧ‬
‫ﺍﻷ‬ ‫ﻩ‬‫ﺬ‬‫ﻭﻫ‬، ‫ﺩ‬‫ﺪ‬ ‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻯ‬ ‫ﻤ‬‫ﻴﺲﺑ‬ ‫ﻟ‬‫ﺎﺟﺊﻭ‬ ‫ﻔ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬
‫ﻬ‬‫ﻟﻈ‬‫ﺎ‬‫ﻟﺑ‬
‫ﺍﻷﻢ‬ ‫ﺓ‬‫ﺪ‬
‫ﺒﻂﺷ‬ ‫ﺗ‬‫ﺮ‬
‫ﺗ‬.‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬
‫ﺗ‬‫ﺎﺏﻭ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻠﻲ‬ ‫ﺎﺳ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﻣﺁﻻ‬
‫ﺔﻦ‬ ‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬
B.Object ivedat a:
1.Phy sicalexami nation:
Begint heex ami nat i
onwi t
hagener alinspectionoft hepat ient.
1-Not ethef l
uidst atusoft hepat ientby:
-Checkski nt urgar ,l
ooki ngf orsignsofedemaandcompar ingdailyfl
uidintake
andoutput .
-Checkt hemucusmembr aneoft hemout h.
-Lookf ordr y, crackedski nandsunkeney es.
-Checkpat ient sv i
tal signs.
-Obser vet hepat i
ent 'sskincol or,checkf orsi
gnsofj aundice.

2-Checkt hepatient'
sabdomenf orsi
gnsofasciti
es.
3-Wearinggl ov
esi nspectt
heur ethr
ameat us,l
ooki
ngf orredness, deviationor
di
scharge.
4-Pal
pat ethekidney sandbladdertodetectanymassort enderness.
5-Observet heurineforcol
or,consist
encyandamount .
:
‫ﺔ‬ ‫ﻴ‬
‫ﻋ‬‫ﻮ‬‫ﻮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺎ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
-‫ﺀ‬‫ﺎ‬‫ﺑ‬
:
‫ﻧﻲ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺤ ﺺ‬‫ﻟ‬‫ﺍ‬.
1
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻡ‬‫ﺎ‬‫ﻔﺤ ﺺﻋ‬‫ﻔﺤ ﺺﺑ‬ ‫ﻟ‬
‫ﺍ‬‫ﺃ‬
‫ﺪ‬‫ﺑ‬‫ﺍ‬
:
‫ﻳ ﺾﻣﻦﺧﻼﻝ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻻﺣﻆ ﺎ‬- 1
‫ﺔ‬‫ﻣ‬
‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻣ‬‫ﺒﺤﺚﻋﻦﻋﻼ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻭ‬، ‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺭﺟ‬ ‫ﻮ‬‫ﻓﺤ ﺺﺗ‬-
.
ً
‫ﺎ‬‫ﻴ‬
‫ﻣ‬‫ﻮ‬‫ﺎﻳ‬‫ﻬ‬‫ﺍﺟ‬‫ﺮ‬‫ﺇﺧ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺔﺗ‬‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻣ‬
‫ﻭ‬
.‫ﻔﻢ‬‫ﻠ‬‫ﻟ‬
‫ﺎﻃﻲ‬ ‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬-
.‫ﺔ‬‫ﻗ‬‫ﺭ‬
‫ﺎ‬‫ﻮﻥﻏ‬‫ﻴ‬
‫ﺔﻭﻋ‬ ‫ﻘ‬‫ﻘ‬‫ﺘﺸ‬‫ﻣ‬‫ﺔﻭ‬‫ﻓ‬‫ﺎ‬‫ﺓﺟ‬‫ﺮ‬‫ﺜﻲﻋﻦﺑﺸ‬ ‫ﺑﺤ‬‫ﺍ‬-
.
‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬-

84
Palpate the bladder
 .‫ﺎﻥ‬
‫ﻗ‬‫ﺮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻘﻖﻣﻦﻋﻼ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻠ‬‫ﻮﻥﺟ‬ ‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﺍﻍ‬‫ﺮ‬‫ﻔ‬
‫ﺘ‬‫ﺍﺳ‬‫ﺎﺕ‬‫ﻣ‬‫ﺎﻋﻦﻋﻼ‬ ً
‫ﺜ‬
‫ﻳ ﺾﺑﺤ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻓﺤ ﺺﺑﻄﻦ‬- 2
.‫ﺍﺕ‬
‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﻭﺇ‬
‫ﺃ‬‫ﺍﻑ‬
‫ﺮ‬‫ﻧﺤ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻤ‬
‫ﺍﺣ‬ ‫ﺎﻋﻦ‬‫ﺜ‬
‫ﻮﻝﺑﺤ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺮﻯ‬ ‫ﻔﺤ ﺺﻣﺠ‬‫ﻟ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬‫ﻔ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺍ‬‫ﺪ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬
-3
(
Fig.25)Pal
pat
ethe. ‫ﺔ‬‫ﻗ‬‫ﻭﺭ‬‫ﺃ‬‫ﺔ‬‫ﻠ‬
‫ﺘ‬‫ﺃﻱﻛ‬‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺟﺲ‬- 4
bl
adder
.‫ﻪ‬‫ﺘ‬
‫ﻴ‬‫ﻤ‬‫ﻛ‬‫ﻪﻭ‬‫ﻣ‬‫ﺍ‬
‫ﻮ‬‫ﻗ‬‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-5

(
Fig.26)Pal
pat
etheki
dney
s

2.Di agnost icst udi esorpr ocedur e:

Diagnost i
cst udi esar ei mpor tanti nlocati
ngandunder st
andi ngt hepr oblemsof
theur inarysy st em; iti ncludest hef ol
lowing.
-Ur i
nal ysisandur inecul tur e.
-Renal functiont est es.
-Bloodst udies.
-Radi ological st udi es.
-Endoscopi es.
-Ur ody nami cs: e.g.cy stomet rogram.
-Inv asi vepr ocedur e.
:‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬ ‫ﺍ‬
‫ﺮ‬‫ﺃﺍﻹﺟ‬‫ﺎﺕﻭ‬ ‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬.
2
.‫ﻠﻲ‬‫ﺎﻳ‬ ‫ﻤﻦﻣ‬ ‫ﺘﻀ‬ ‫؛ﻳ‬‫ﻟﻲ‬ ‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬
‫ﻬﻢﻣﺸ‬‫ﻓ‬‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﺔﻓﻲﺗﺤ‬ ‫ﻤ‬‫ﻬ‬‫ﺔﻣ‬‫ﻴ‬‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
.
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﻋ‬
‫ﺭ‬‫ﺯ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬
‫ﺗﺤ‬-
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﺍﺕﻭﻇ‬ ‫ﺭ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺧ‬ -
.
‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺩ‬-
.
‫ﺔ‬‫ﻴ‬‫ﺎﻋ‬
‫ﻌ‬ ‫ﺎﺕﺇﺷ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺩ‬-
.‫ﺮ‬‫ﻴ‬‫ﺎﻇ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬-
.
‫ﺮﺣﻢ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝﻣﺨﻄﻂ‬ ‫ﺜ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫ﻋ‬:‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻜ‬
‫ﻴ‬‫ﻣ‬ ‫ﺎ‬
‫ﻨ‬‫ﻳ‬
‫ﺩ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬
‫ﺇﺟ‬-
A.Ur inest udi es
1-Ur ineanal ysi s:ist hesi mpl estandmostf requentl
yper formeddi agnost i
c
procedur eitisanessent i
al componentoft heurologicevaluation.Thebest
urinesampl ef ort hisr outineexami nati
onisami dstream ur i
nesampl e.
Ur i
neexami nat ioni ncl udest hef oll
owing:
Urinecl ari
tyandodor
UrinepHandspeci fi
cgr av i
ty
Test st odet ectpr ot ein,gl ucose, andket onebodiesi ntheur i
ne( proteinuria,
glycosur ia,andket onur ia,respect i
vely)
Micr oscopi cexami nat i
onoft heur i
nesedi mentaftercentri
fugingt odet ect

85
RBCs(hemat uri
a),whi t
ebloodcel ls,casts(cyli
ndruri
a),crystals(crystal
luri
a),
pus(pyur
ia),
andbact eri
a( bacteri
uria)
Uri
necolor
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺩ‬.‫ﺃ‬
‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬ ‫ﻴ‬‫ﻘ‬
‫ﺎﺳﻲﻓﻲﺗ‬ ‫ﺃﺳ‬‫ﻮﻥ‬‫ﻜ‬‫ﻮﻣ‬ ‫ﺎﻭﻫ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺎﺷ‬‫ﺮﻫ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﻴﺼﻲﻭ‬ ‫ﺀﺗﺸﺨ‬ ‫ﺍ‬
‫ﺮ‬‫ﺑﺴﻂﺇﺟ‬ ‫ﺃ‬ ‫ﻮ‬‫ﻫ‬:‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﺗﺤ‬ -
1
.‫ﻳﻖ‬‫ﺮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺘﺼﻒ‬ ‫ﻨ‬
‫ﻮﻝﻓﻲﻣ‬ ‫ﺔﺑ‬‫ﻨ‬‫ﻴ‬‫ﻨﻲﻫﻲﻋ‬ ‫ﻴ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺤ ﺺ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍ‬
‫ﺬ‬ ‫ﻬ‬
‫ﻟ‬ ‫ﻮﻝ‬‫ﺔﺑ‬‫ﻨ‬‫ﻴ‬‫ﻓﻀﻞﻋ‬ ‫ﺃ‬.
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬‫ﻮﻝﻣ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞﻓﺤ ﺺ‬ ‫ﻳﺸ‬
‫ﻪ‬‫ﺘ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺭ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺡ‬‫•ﻭﺿ‬
‫ﺔ‬
‫ﻴ‬‫ﻮﻋ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬
‫ﺫ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻮﺿ‬‫ﻤ‬‫ﺔﺣ‬ ‫ﺭﺟ‬‫•ﺩ‬
،‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻜ‬‫ﺔﺳ‬ ‫ﻠ‬
‫ﻴ‬‫ﺑ‬
‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺔﺑ‬‫ﻠ‬
‫ﻴ‬‫ﺑ‬)‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻓﻲ‬ ‫ﺘ‬‫ﻴ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺯﻭ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺃﺟﺴ‬ ‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬‫ﻟ‬
‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﺧ‬ •
(
‫ﻟﻲ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬،‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﻮ‬‫ﺘ‬
‫ﻴ‬‫ﺔﻛ‬ ‫ﻠ‬
‫ﻴ‬‫ﺑ‬
‫ﻭ‬
(‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
)‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻜﺸﻒﻋﻦﻛ‬ ‫ﻠ‬‫ﻟ‬‫ﺰﻱ‬‫ﻛ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬
‫ﻮﻝﺑ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺳﺐ‬ ‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺮﻱ‬‫ﻬ‬‫ﻤﺠ‬‫ﻟ‬‫ﺍ‬‫ﻔﺤ ﺺ‬‫ﻟ‬‫ﺍ‬•
‫ﺎ‬
‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬‫ﺔ‬‫ﻠ‬
‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬)‫ﻴﺢ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
)‫ﺍﺕ‬ ‫ﺭ‬‫ﻮ‬
‫ﻠ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫(ﻭ‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺍ‬‫ﻮ‬‫ﺍﻷﺳﻄ‬‫ﺔ‬‫ﻠ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬)‫ﻟﺐ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﺀﻭ‬ ‫ﺎ‬
‫ﻴﻀ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﻭﺧﻼ‬
(‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﺛ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬)
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻟ‬•
Changesi
nUr
ineCol
orandPossi
bleCauses
Possi bl
eCauses Changesi
nUrineCol
or
Dil
uteur i
neduet odiuret
ics,al
cohol Col
orl
esstopale
consumpt ion,di
abetesinsipi
dus, yel
l
ow
gl
y cosuri
a,excessfluidi
ntake,r
enal
Disease
Pyuria,i
nfecti
on,vaginalcr
eam Yellowtomilky
whi t
e
Mul t
iplev itami npr epar ations, Brighty
ell
ow
hemogl obi nbr eakdown, r
edbl oodcells, Pinktored
grossbl ood, menses, bladderorpr ostat
e
surgery,beet s, blackber ri
es,medi cati
ons
(pheny t
oin, r
ifampi n)
Dyes, met hy l
enebl ue,Pseudomonas Bl
ue, bl
uegreen
speciesor gani sms, medi cati
ons
Concent rat edur i
neduet odehy drati
on, Or angetoamber
fever,bil
e, excessbi li
rubinorcar otene,
medi cati
ons( thiami ne)
Oldredbl oodcel ls, bi
li
rubi n,
mel anin, Brownt obl
ack
concent ratedur i
neduet odehy drat
ion,
medi cati
ons( Ni t
rof ur
ant oin)

Uri
nechar acteri
sti
cs:
-Amount–1500ml i
n24hour s
-pH–av erage6.0
-Specif
icGr avi
ty–heavierthanwat
er(1.
001-
1.035)
-Color–y ell
ow( amber,
strawcolor
ed,
concentr
ated,
orange,
brown,
red,
sedi
ment ,clearorcl
oudy)
-Dehydrated=deepy ell
ow, dar
k

86
-Ov
erhy
drat
ed=pal
eyel
l
ow,
col
orl
ess
:‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺋﺺ‬‫ﺎ‬‫ﺧﺼ‬
‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬24‫ﻣﻞﻓﻰ‬1500: ‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬-
6.
0‫ﻮﺳﻂ‬ ‫ﺘ‬‫ﻣ‬-‫ﻨﻲ‬‫ﻴ‬
‫ﻭﺟ‬ ‫ﺭ‬
‫ﺪ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻢ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬-
(1.
035-1.
001)‫ﺀ‬‫ﺎ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻞﻣﻦ‬‫ﺛ‬‫ﺃ‬-‫ﻋﻲ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬-
(
‫ﺋﻢ‬‫ﺎ‬
‫ﻭﻏ‬‫ﺃ‬
ٍ‫ﺎ‬
‫ﻑ‬ ‫ﺻ‬،
‫ﺑﻲ‬‫ﻮ‬
‫ﺭﺳ‬،
‫ﺮ‬‫ﻤ‬‫ﺃﺣ‬
،‫ﻨﻲ‬
‫ﺑ‬،‫ﻟﻲ‬
‫ﺎ‬
‫ﻘ‬‫ﺗ‬‫ﺮ‬
‫ﺑ‬،‫ﺰ‬ّ
‫ﻛ‬
‫ﺮ‬‫ﻣ‬،‫ﻘﺶ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻠ‬
‫ﺑ‬، ‫ﻧﻲ‬
‫ﺎ‬‫ﻣ‬‫ﺮ‬
‫ﻬ‬‫ﻛ‬)‫ﺮ‬‫ﻔ‬‫ﺃﺻ‬‫ﻮﻥ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬-
‫ﻛﻦ‬
‫ﺍ‬‫ﺩ‬، ‫ﻣﻖ‬
‫ﺎ‬‫ﺮﻏ‬‫ﻔ‬‫ﺍﺻ‬=‫ﺔ‬ ‫ﻔ‬‫ﻔ‬
‫ﻣﺠ‬-
‫ﻮﻥ‬‫ﻠ‬
‫ﻟ‬
‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬‫ﻋ‬،‫ﺎﺣﺐ‬‫ﺮﺷ‬ ‫ﻔ‬‫ﺃﺻ‬=‫ﺀ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁﻓﻲ‬ ‫ﻔ‬‫ﻣ‬-

Nursingresponsi
bili
ti
esforuri
neanal
ysis:
1.Trytoobtainfi
rsturi
natedmorni
ngspecimen.
2.Ensurethatspecimenisexaminedwi
thinlhourofur
inati
on.
3.Washper i
nealareaifsoil
edwit
hmensesorf ecal
mat er
ial
.

:‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﻠ‬‫ﺘﺤ‬‫ﻟ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺆ‬
‫ﻣﺴ‬
.
‫ﺎﺡ‬‫ﺒ‬
‫ﻟﺼ‬ ‫ﺍ‬
‫ﻟﺖﻓﻲ‬ ‫ﻮ‬
‫ﺒ‬‫ﺔﺗ‬ ‫ﻨ‬
‫ﻴ‬‫ﻭﻝﻋ‬‫ﺃ‬‫ﻠﻰ‬
‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﺣ‬. 1
.
‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬‫ﻋ‬‫ﺎ‬‫ﻮﻥﺳ‬ ‫ﺔﻓﻲﻏﻀ‬ ‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦﻓﺤ ﺺ‬ ‫ﻛ‬‫ﺄ‬
‫ﺗ‬.2
.
‫ﺔ‬‫ﻳ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﺓﺑ‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬
‫ﻭﺑ‬‫ﺃ‬‫ﻴﺾ‬ ‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺘﺴﺨ‬‫ﻧﺖﻣ‬ ‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬
‫ﺎﻥﺇ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻏﺴﻞﻣ‬‫ﺍ‬.3
2-Creat i
nineclearances:
Creatini
nei swastepr oductofpr ot
einbreakdown.Cr
eatini
neclear
ancebythe
ki
dneyappr oximatest heGlumelarFil
trat
ionRate(G.
F.R)normalfi
ndi
ngis85-
135mol /mi n.
Nursingr esponsibil
ity:
-Collect24hour surinespecimen.
-Discardf i
rsturi
nati
onwhent estisstart
ed.
-Saveur inefrom allsubsequenturinat
ionfor24hoursandaddspecimento
coll
ect i
oncont ai
ner.
-Ensur eurinecoll
ectioncontainerisused.

3-Uri
necul ture(clearcatchmi dstream) :
Thisst
udyi sdonet ocompr esssuspect edur inar
ytractinfecti
onandi denti
fy
causat
iveor ganisms.
4-Uri
necy tology:
Thisst
udyi stoident i
fychangesi ncellularstruct
ure,i
ndicat i
veofmal ignancy,
especi
allybladdercancer .Hereobtainur ineandsendi mmedi atelyto
l
aboratory.Thef i
rstmor ningspecimenshoul dnotbeused.
:‫ﻴﻦ‬‫ﻨ‬
‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻔ‬
‫ﺗﺼ‬- 2
‫ﻴﺢ‬‫ﺮﺷ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﻠﻰﻣ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻴﻦﻋﻦﻃ‬ ‫ﻨ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﺭﺏﺗﺼ‬ ‫ﺎ‬
‫ﻘ‬‫ﺗ‬.‫ﻴﻦ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴ‬ ‫ﺎﺕﺗ‬‫ﻳ‬
‫ﺎ‬‫ﻔ‬‫ﺗﺞﻋﻦﻧ‬ ‫ﺎ‬
‫ﻴﻦﻧ‬‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻘ‬
‫ﻴ‬‫ﻗ‬ ‫ﺩ‬/‫ﻮﻝ‬ ‫ﻣ‬135-85‫ﻮ‬ ‫ﻌﻲﻭﻫ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬(Glumelar(GFR
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺆ‬‫ﻣﺴ‬
.‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬ ‫ﻤ‬
‫ﻟ‬‫ﻮﻝ‬‫ﺔﺑ‬ ‫ﻨ‬
‫ﻴ‬‫ﻊﻋ‬‫ﻤ‬‫ﺍﺟ‬-
.‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﺀ‬‫ﺪ‬‫ﺪﺑ‬‫ﻨ‬
‫ﻷﻝﻋ‬‫ﺍﻭ‬ ‫ﻮﻝ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻫﻞ‬‫ﺗﺠ‬-
.‫ﻊ‬
‫ﻴ‬ ‫ﻤ‬
‫ﺘﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻟﻰﻭﻋ‬ ‫ﺔﺇ‬
‫ﻨ‬‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬
‫ﺇﺿ‬ ‫ﺔﻭ‬ ‫ﺎﻋ‬
‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺍﻼﺣﻖ‬‫ﻮﻝﻟ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝﻣﻦﻛﻞ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻆ‬‫ﺣ‬-
.‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﺀﺗﺠ‬‫ﺎ‬‫ﻋ‬‫ﻡﻭ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺪﻣﻦ‬ ‫ﻛ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
-

:
(‫ﺭ‬
‫ﺎ‬‫ﻴ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺘﺼﻒ‬
‫ﻨ‬‫ﺔﻣ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﻮﻝ)ﺻ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻋ‬ ‫ﺭ‬
‫ﺰ‬‫ﻣ‬-
3
.
‫ﺔ‬‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻨ‬‫ﺋ‬
‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻳ‬ ‫ﺪ‬
‫ﺗﺤ‬‫ﺎﻭ‬‫ﻬ‬
‫ﻪﺑ‬‫ﺒ‬‫ﺘ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻐﻂﻋ‬
‫ﻟﻀ‬ ‫ﺔ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻫ‬‫ﺍ‬‫ﺮ‬
‫ﺘﻢﺇﺟ‬‫ﻳ‬
:
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﻴﻞﺧﻼ‬ ‫ﻠ‬
‫ﺗﺤ‬-
4
،
‫ﻴﺚ‬ ‫ﺒ‬
‫ﻡﺧ‬‫ﺭ‬‫ﺩﻭ‬‫ﻮ‬‫ﻠﻰﻭﺟ‬
‫ﺪﻝﻋ‬ ‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬،‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺍﺕﻓﻲ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬
‫ﺮﻑﻋ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺪﻑﻫ‬‫ﻬ‬‫ﺗ‬

87
 ‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬
‫ﺍﺳ‬‫ﻐﻲ‬
‫ﺒ‬‫ﻨ‬
‫ﻻﻳ‬.
‫ﺮ‬‫ﺒ‬
‫ﺘ‬‫ﻤﺨ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬
‫ﺭﺇ‬‫ﻮ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﻪﻋ‬
‫ﻟ‬‫ﺎ‬
‫ﺭﺳ‬‫ﺇ‬
‫ﻮﻝﻭ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬
‫ﻮﻝﻋ‬
‫ﻟﺤﺼ‬
‫ﺍ‬‫ﺎ‬
‫ﻨ‬‫ﻫ‬.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬
‫ﺮﻃ‬‫ﺔﺳ‬‫ﺎﺻ‬‫ﻭﺧ‬
.
‫ﻟﻰ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺡ‬
‫ﺒ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺔ‬‫ﻨ‬
‫ﻴ‬‫ﻋ‬

B.RenalFunct
ionTest
s:

Nor
mal
val
ues Test
s

1.
010–1.
025 RenalConcentr
ati
onTest
s
Speci
fi
cgravit
y

311–911mOsm/ kg/
24h,
50–1,
200 Ur
ineosmol
ali
ty
mOsm/ kg
random sampl
e

Measur
edi
nmL/
minut
e/1.
73m2 24-HourUr
ineTest
Creat
ini
neclear
ance

0.
6–1.
2mg/
dL(
50–110ì
mol
/L) Serum Test
s
Creat
ininel
evel

7–18mg/
dLPat
ient
sov
erage60y
ear
s: Ur
eani
trogen(
blood
8–20mg/
dL ur
eani
tr
ogen(BUN)

About10:
1 BUNt
ocr
eat
ini
ner
ato
i

88
Nursingr esponsibi
li
ti
esforcreati
nineclear ances:
1.Collect24hour suri
nespecimen.
2.Discardf i
rsturi
nati
onwhent esti
sst arted.
3.Saveur inefrom al
lsubsequenturinat
ionf or24hoursandaddspeciment o
col
lectioncont ai
ner.
:‫ﻴﻦ‬‫ﻨ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺢ‬‫ﺭ‬‫ﺎ‬
‫ﺘﺼ‬‫ﻟ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺆ‬‫ﻣﺴ‬
.
‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬‫ﻤ‬
‫ﻟ‬‫ﻮﻝ‬‫ﺔﺑ‬‫ﻨ‬
‫ﻴ‬‫ﻊﻋ‬‫ﻤ‬
‫ﺍﺟ‬ .
1
.
‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬
‫ﺍﻻﺧ‬ ‫ﺀ‬
‫ﺪ‬‫ﺪﺑ‬
‫ﻨ‬‫ﻷﻝﻋ‬
‫ﺍﻭ‬ ‫ﻮﻝ‬‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻫﻞ‬
‫ﺗﺠ‬.2
.
‫ﻊ‬‫ﻤ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻟﻰﻭﻋ‬‫ﺔﺇ‬‫ﻨ‬‫ﻴ‬
‫ﺔﻋ‬ ‫ﻓ‬
‫ﺎ‬‫ﺇﺿ‬‫ﺔﻭ‬ ‫ﻋ‬‫ﺎ‬‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍﻼﺣﻖ‬‫ﻮﻝﻟ‬‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻣﻦﻛﻞ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻆ‬‫ﺣ‬.3

C.Bl oodSt udies:

1-Compl et ebloodcount .
2-Bloodchemi strystudi es.
-Bloodur eanitrogen( 20–40mg/ dl)
,andser um creati
nine(upt o1mg/ dl)
.
-Uricaci d.
-Sodi um, potassium, calcium,Phosphor us,andbicarbonatelev els.
:‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺩ‬-‫ﺝ‬
.‫ﻣﻞ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻌ‬‫ﺗ‬-
1
.
‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻴ‬‫ﻤ‬
‫ﻴ‬‫ﺎﺕﻛ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺩ‬-2
.
(‫ﺮ‬‫ﺘ‬‫ﻠ‬‫ﻴ‬
‫ﻳﺴ‬ ‫ﺩ‬/‫ﻣﺠﻢ‬1‫ﺘﻰ‬ ‫ﻤﺼﻞ)ﺣ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻨ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻛ‬‫(ﻭ‬‫ﺮ‬
‫ﺘ‬‫ﻠ‬‫ﻴ‬‫ﻳﺴ‬‫ﺩ‬/‫ﻣﺠﻢ‬40- 20)‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻓﻲ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬
‫ﺘ‬‫ﻴ‬‫ﻧ‬-
.‫ﻳﻚ‬‫ﺭ‬‫ﻮ‬
‫ﻴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﺣ‬-
.‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﺑ‬
‫ﺮ‬‫ﻜ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬‫ﻮ‬‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﻮ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻭﻜ‬
‫ﻟ‬
‫ﻡﺍ‬ ‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﻮ‬‫ﻳ‬‫ﺩ‬
‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﻣﺴ‬-
C.Radi ologicalst udies:
-kidney ,uret
erandbl adderX, rayfi
lms.
-Ret rogradepy elography .
-Cy stogram .
-Ultrasound.
-CTscan.
-MRI .
-Intravenouspy elography( I
VP):X-rayexami nati
onv i
suali
zesur inarytr
act.

:
‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﺎ‬
‫ﻌ‬‫ﺍﻹﺷ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
-‫ﺝ‬
.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺐﻭ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺃﺷ‬‫ﻡ‬‫ﺃﻼ‬
‫ﻓ‬-
.
‫ﻌﻲ‬‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺗﺼ‬-
.‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﺨﻄﻂ‬-

89
 .‫ﺔ‬
‫ﻴ‬‫ﺗ‬‫ﻮ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻮﻕ‬‫ﺎﺕﻓ‬ ‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺔ‬
‫ﻴ‬‫ﻌ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻻﺷ‬-
.
‫ﻴﺴﻲ‬‫ﺎﻃ‬‫ﻨ‬
‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬
‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺮﺑ‬‫ﻳ‬
‫ﻮ‬ ‫ﺘﺼ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬
‫ﺔﻳﺼ‬
‫ﻴ‬‫ﻨ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻌ‬‫ﺎﻷﺷ‬
‫ﻓﺤ ﺺﺑ‬:
(I
VP)‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬‫ﻳﻀ‬ ‫ﻮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﻮ‬‫ﺗﺼ‬-

PurposesofIVPar e:
-Determi
nati
onofsi zeandlocati
onofki
dney
s.
-Determi
nati
onpr esenceofcystsort
umors.
-Outli
neoffi
l
lingofr enal
pelvi
s.
-Outli
neofureter
sandbl adder.
:‫ﻫ‬
‫ ﻲ‬I VP‫ﺍ ﺽ‬‫ﺮ‬
‫ﻏ‬‫ﺃ‬
.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻣ‬
‫ﺪﺣﺠﻢﻭ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-
.
‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﺎﺱ‬‫ﻴ‬‫ﻛ‬‫ﺃ‬‫ﺩ‬
‫ﻮ‬‫ﺪﻭﺟ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-
.‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺽ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺀ‬‫ﻣﺨﻄﻂﻣﻞ‬-
.‫ﺔ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺐﻭ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻣﺨﻄﻂ‬-
Preparati
onforthisprocedure:
-Eveningbeforeprocedure,gi
vecat harti
corenemat oempt ycolonoff ecesand
gas.
-Keeppat i
entonNPOst atus8hr spr iortopr ocedur
e.
-Beforetheprocedure,assesst hepat ientforanyhistoryofall
ergyt oiodine,
shellf
ishordyestoav oidanaphy lacti
cr eaction.
:
‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺍ‬‫ﺬ‬‫ﻬ‬‫ﻟ‬‫ﺮ‬‫ﻴ‬
‫ﺘﺤﻀ‬ ‫ﻟ‬
‫ﺍ‬
.
‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﺯﻭ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻟ‬‫ﻮ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻎ‬‫ﻳ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻠ‬‫ﻬ‬
‫ﻭﻣﺴ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﺮﺟ‬‫ﺔﺷ‬‫ﻨ‬‫ﻘ‬‫ﺀﺣ‬‫ﺎ‬
‫ﺔﺇﻋﻄ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻞ‬‫ﺀﻗ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬-
.‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺒﻞ‬‫ﺎﺕﻗ‬‫ﺎﻋ‬
‫ﺳ‬NPO8‫ﺣﺔ‬ ‫ﻟ‬
‫ﻠﻰ ﺎ‬ ‫ﻳ ﺾﻋ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻘ‬‫ﺑ‬‫ﺇ‬-
‫ﺎﻍ‬
‫ﺒ‬‫ﺃﺍﻷﺻ‬
‫ﺎﻙﻭ‬ ‫ﻤ‬
‫ﺃﺍﻷﺳ‬
‫ﺩﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺎ‬‫ﺔﺗﺠ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﻳﺦﻣﻦ‬ ‫ﺭ‬
‫ﺎ‬‫ﺃﻱﺗ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻗﻢﺑ‬،‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺒﻞ‬‫ﻗ‬-
.
‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬‫ﺍ‬‫ﻋﻞ‬ ‫ﺎ‬
‫ﻔ‬‫ﻨﺐﺗ‬ ‫ﺘﺠ‬‫ﻟ‬

-Inform pati
entthataf eeli
ngofwar m, f
lushingofthef aceandsal tytastei
nt he
mout hmayoccurast hedy eisi
njected.
-Inform pati
entthatnumer ousXr ayf i
lm ar
et akenduringt heprocedure.This
doesnoti ndicateproblem.
-Dur i
ngthepr ocedurepat i
entshouldbecar efull
ymoni toredforsignsand
sympt omsofar eacti
ont ody ei
ncludingrespirat
orydistress,di
aphoresis,
urti
caria,i
nstabil
it
yofv it
alsignsorunusual sensati
ons.Emer gencyequipment
shouldbeav ailabl
e.
D.Endoscopi es:e.g.cystoscopy:toinspectbladder.
Lithotomyposi ti
onisused.I tmaybedonni ngusinglocal orgeneralanesthesia.

.
‫ﺔ‬‫ﻐ‬‫ﺒ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻘﻦ‬‫ﺀﺣ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺢﻓﻲ‬‫ﺎ‬‫ﻌﻢﻣ‬‫ﻪﻭﻃ‬ ‫ﻮﺟ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻤ‬
‫ﺍﺣ‬‫ﺀﻭ‬ ‫ﺪﻑ‬ ‫ﻟ‬
‫ﺎ‬‫ﺎﺱﺑ‬ ‫ﺪﺙﺇﺣﺴ‬ ‫ﺪﻳﺤ‬‫ﻪﻗ‬‫ﻧ‬‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻎ‬‫ﻠ‬
‫ﺑ‬‫ﺃ‬-
‫ﺩ‬‫ﻮ‬
‫ﻟﻰﻭﺟ‬ ‫ﺮﺇ‬‫ﻴ‬
‫ﺍﻻﻳﺸ‬‫ﺬ‬‫ﻫ‬.‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﻷﺷ‬‫ﻡ‬‫ﺃﻼ‬‫ﺪﻣﻦﻓ‬ ‫ﻳ‬
‫ﺪ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺬ‬‫ﺃﺧ‬ ‫ﺘﻢ‬
‫ﻪﻳ‬‫ﻧ‬‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻎ‬‫ﻠ‬
‫ﺑ‬‫ﺃ‬-
.‫ﺔ‬‫ﻠ‬
‫ﻜ‬‫ﻣﺸ‬
‫ﺎﻓﻲ‬‫ﻤ‬‫ﺔﺑ‬‫ﻐ‬
‫ﺒ‬‫ﻟﺼ‬‫ﺍ‬‫ﻩ‬‫ﺎ‬‫ﻌﻞﺗﺠ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺍ ﺽﺭ‬‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﺎﻋﻦﻋﻼ‬ ً
‫ﺜ‬‫ﺔﺑﺤ‬ ‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬
‫ﺀﻳﺠﺐﻣ‬ ‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬-
.‫ﺔ‬‫ﻳ‬
‫ﺩ‬‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻴﺲﻏ‬ ‫ﺎﺳ‬‫ﺃﺍﻷﺣ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻘ‬
‫ﺘ‬‫ﺍﺳ‬‫ﻡ‬‫ﺪ‬‫ﻋ‬ ‫ﻭ‬، ‫ﺮﻯ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻭ‬، ‫ﺮﻕ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻖ‬‫ﻟﻚ ﺿ‬
‫ﺫ‬
.
‫ﺓ‬‫ﺮ‬ ‫ﻓ‬
‫ﻮ‬‫ﺘ‬‫ﺭﺉﻣ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺍﺕ‬‫ﺪ‬‫ﻌ‬‫ﻮﻥﻣ‬‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬
.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺤ ﺺ‬ ‫ﻟ‬
:‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻨﻈ‬‫ﺗ‬.‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫ﻋ‬:
‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬
‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
‫ﺩ‬
(Fi
g.27)Cy stoscopyexami nati
on
.
‫ﻡ‬‫ﺎ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻌﻲ‬‫ﻮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﺪ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﺎﺑ‬
‫ﺅﻫ‬‫ﺍ‬‫ﺪ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺘﻢ‬‫ﺪﻳ‬ ‫ﻗ‬.‫ﻟﺤﺼﻰ‬ ‫ﺍ‬‫ﻗﻒﺷﻖ‬ ‫ﻮ‬
‫ﻡﻣ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬‫ﺘﻢ‬‫ﻳ‬

I
ndi
cat
ion:

90

(Fig.27)Cystoscopy examination
1.Isusedt odirectlyvisualizet heur ethraandbl adder .
2.Toobt ainaur i
nespeci menf rom eachki dneyt oev aluatei tsfunct ion
3.Calculi mayber emov edf rom theur ethra,bladder ,andur eterusi ng
Nursingr esponsi bili
ti
es:
1.Beforet hepr ocedur ef orcef l
uidorgi veI Vfluidi fgener alanest hesi aist obe
used.
2.Explainpr ocedur etopat i
ent .
3.Givepr e–oper ativemedi cation.
4.Afterpr ocedure, explaint hebur ningonur i
nat ion,pinkt i
ngedur ineand
uri
nationf requencyar eexpect edaf t
ercy stoscopy .
5.Donotl etpatientwal kalonei mmedi atel
yaf tert hepr ocedur eor thost atic
hypotensi onmayoccur .
6.Offerwar m sit
ebat handmi ldanal gesicst or eli
evedi scomf ort.
:‫ﺓ‬‫ﺭ‬‫ﺎ‬
‫ﺇﺷ‬
.‫ﺮ‬
‫ﺎﺷ‬‫ﺒ‬‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬ ‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻯ‬‫ﺭﻣﺠ‬ ‫ﻮ‬ ‫ﺘﺼ‬‫ﻟ‬ ‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻳﺴ‬.1
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻔ‬‫ﻴ‬‫ﻴﻢﻭﻇ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻮﻝﻣﻦﻛﻞﻛ‬ ‫ﺔﺑ‬‫ﻨ‬
‫ﻴ‬‫ﻠﻰﻋ‬ ‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬.2
‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺎﺳ‬‫ﻟﺐﺑ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺍﺕﻣﻦﻣﺠ‬ ‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﻜﻦﺇ‬ ‫ﻤ‬‫ﻳ‬.3
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺆ‬‫ﻣﺴ‬
.
‫ﻡ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻳ‬
‫ﺪ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻴ‬‫ﺎﻥﺳ‬ ‫ﺍﻛ‬‫ﺫ‬‫ﺪﻱﺇ‬ ‫ﻳ‬
‫ﺭ‬‫ﺋﻞﻭ‬‫ﺎ‬‫ﺀﺳ‬ ‫ﺎ‬‫ﻭﺇﻋﻄ‬ ‫ﺃ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻳﺠﺐﺇﺟ‬، ‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺒﻞ‬‫ﻗ‬.1
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺮﺡ‬ ‫ﺷ‬.2
.‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺒﻞ‬‫ﺀﻗ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻋﻄ‬ ‫ﺍ‬.3
‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻜ‬‫ﺗ‬‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺩﻱﻓﻲ‬ ‫ﺭ‬‫ﻮﻥﻭ‬ ‫ﻟ‬‫ﻭﺙ‬ ‫ﺪ‬‫ﻊﺣ‬ ‫ﻗ‬‫ﻮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻦ‬‫ﻭ‬، ‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺗﺞﻋﻦ‬ ‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﻗ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﺡ‬‫ﺍﺷ‬ ، ‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬.4
.
‫ﺔ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻨﻈ‬‫ﺪﺗ‬ ‫ﻌ‬‫ﻮﻝﺑ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﺑﻲ‬‫ﺎ‬‫ﺘﺼ‬‫ﻧ‬‫ﺍﻻ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﺎ ﺽﺿ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬ ‫ﺪﺙ‬ ‫ﺪﻳﺤ‬‫ﺀﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺪ‬‫ﻌ‬‫ﺓﺑ‬‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﻩﻣ‬ ‫ﺩ‬
‫ﺮ‬ ‫ﻔ‬
‫ﻤ‬‫ﻤﺸﻲﺑ‬ ‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪﻉ‬‫ﻻﺗ‬. 5
.
‫ﺎﺝ‬‫ﺰﻋ‬‫ﻧ‬‫ﺍﻻ‬‫ﻴﻒ‬ ‫ﻔ‬
‫ﺘﺨ‬ ‫ﻟ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻔ‬ ‫ﺎﺕﺧ‬ ‫ﻨ‬‫ﻜ‬‫ﻣﺴ‬‫ﻊﻭ‬ ‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻓﻲ‬ ً
‫ﺌ‬‫ﻓ‬‫ﺍ‬
‫ﺎﺩ‬ً
‫ﻣ‬ ‫ﺎ‬
‫ﻤ‬‫ﻡﺣ‬ ‫ﺪ‬‫ﻗ‬.6

E.Urodynami cs:e.g.cy st
omet rogram:
Thisstudyinvolvesi nsert
ionofcatheterforinst
il
lat
ionofsal
inesoluti
onint
o
thebladdertoev aluatebladdertone,sensationoffi
lli
ngandbladderinst
abi
li
ty.
F.Invasi
v epr
ocedur e:
Renalbiopsy:
Purposeofbi opsy :
1-Toobt ainr
enal tissueexami nati
ontodet ermi
net ypeofr
enaldisease.
2-Tof ol
lowpr ogressofr enaldisease.

:
‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬‫ﻴ‬‫ﺎﻝﻣﺨﻄﻂﻗ‬ ‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫ﻋ‬:‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻜ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﻨ‬‫ﻳ‬
‫ﺩ‬
‫ﺍﻹ‬‫ﻭ‬، ‫ﺔ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﻴﻢﺗ‬‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺤﻲﻓﻲ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻠ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬ ‫ﻴ‬
‫ﻘﻄ‬ ‫ﺘ‬
‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﺎﻝﻗﺴﻄ‬ ‫ﺩﺧ‬‫ﺔﺇ‬ ‫ﺍﺳ‬‫ﺭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻤﻦﻫ‬‫ﺘﻀ‬ ‫ﺗ‬
.‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻘ‬
‫ﺘ‬‫ﺍﺳ‬ ‫ﻡ‬‫ﺪ‬ ‫ﻋ‬‫ﺀﻭ‬‫ﻣﻼ‬‫ﺎﻻﺘ‬‫ﺎﺱﺑ‬ ‫ﺣﺴ‬
:
‫ﺯﻱ‬‫ﺎ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬
‫ﺍﻹﺟ‬ .
‫ﻭ‬
:‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻋ‬‫ﺰ‬‫ﺧ‬
:‫ﺔ‬‫ﺰﻋ‬‫ﻟﺨ‬‫ﺍ‬‫ﺮ ﺽﻣﻦ‬ ‫ﻐ‬
‫ﻟ‬‫ﺍ‬
.‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻉ‬‫ﺪﻧ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬ ‫ﺀﻓﺤ ﺺ‬ ‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬-1
.‫ﻠﻰ‬
‫ﻜ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬‫ﺭ‬‫ﻮ‬‫ﺔﺗﻄ‬‫ﻌ‬‫ﺑ‬‫ﺎ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬-
2
Nursi
ngr esponsi bil
it
ies:
Befor
epr ocedure:
-Ascertaincoagulationstatusthroughpati
enthistory,
medi cationhi story,
Compl eteBloodCount( CBC),haemotocri
t,pr
othrombi nti
me, bleedingand
cl
otti
ngt ime.

91
-Beawar et hatIVPorul t
r asoundst udyi sdonebef or ebiopsy .
-Afterpr ocedur e,appl ypr essur edr essi ngt obi opsysi teandcheckf requent l
y
forbleedi ng.
-Bedr estmustbemai ntai nedwi tht hepat i
entf latposi ti
on.
-Coughi ngi sav oidedf orf i
rst4hr saf terbi opsy .
-Bloodpr essureandpul seshoul dbet akenont hef ollowingschedul e.Ev ery15
minut esf or1hour ,ev ery30mi nut ef or1hour ,everyhourf or2hour sunt i
l i
t
becomest able
-Bedr estshoul dmai ntainedf or24hr s.
-Urinei sobser vedf orhaemat uriaforf irst24hr s
-Patientshoul dav oidheav ylif
tingf or10day safterbi opsy .
-Assesspat ientforf l
ankpai nandmoni toringhaemot ocritlevel.
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺆ‬‫ﻣﺴ‬
:‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺒﻞ‬‫ﻗ‬
‫ﻭ‬، (CBC)‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬ ‫ﻌ‬‫ﺗ‬‫ﻭ‬،‫ﺀ‬‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺗ‬‫ﻭ‬، ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺮﻣﻦﺧﻼﻝﺗ‬ ‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺪﻣﻦ ﺎ‬ ‫ﻛ‬‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻭ‬‫ﻳﻒﻭ‬ ‫ﺰ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻴﻦ‬‫ﺒ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﺛ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻭ‬‫ﻭ‬،‫ﻳﺖ‬ ‫ﺮ‬‫ﻛ‬‫ﻮ‬‫ﺗ‬
‫ﻮ‬‫ﻤ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬
‫ﺰﻋ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﺒﻞ‬‫ﺎﻗ‬ ‫ﺅﻫ‬ ‫ﺍ‬‫ﺮ‬
‫ﺘﻢﺇﺟ‬ ‫ﺔﻳ‬ ‫ﻴ‬‫ﺗ‬
‫ﻮ‬ ‫ﻟﺼ‬‫ﺍ‬ ‫ﻮﻕ‬ ‫ﺎﺕﻓ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺍﺳ‬‫ﺭ‬‫ﻭﺩ‬I‫ﺃ‬VP‫ﺄﻥ‬ ‫ﻠﻢﺑ‬‫ﻠﻰﻋ‬ ‫ﻛﻦﻋ‬-
.‫ﻳﻒ‬ ‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﻓﺤ ﺺﺑﺸ‬ ‫ﺍ‬
‫ﺔﻭ‬ ‫ﺰﻋ‬‫ﻟﺨ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻠﻰﻣ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬
‫ﻊﺿ‬ ‫ﺿ‬، ‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺪ‬‫ﻌ‬‫ﺑ‬-
.
‫ﻊﻣﺴﻄﺢ‬ ‫ﻳ ﺾﻓﻲﻭﺿ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻊﻭﺿ‬ ‫ﺍﺵﻣ‬ ‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﻳﺠﺐ‬-
.‫ﺔ‬‫ﻋ‬‫ﺰ‬‫ﻟﺨ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺎﺕﺑ‬ ‫ﺎﻋ‬‫ﺳ‬4‫ﺓ‬ ‫ﺪ‬‫ﻤ‬
‫ﻟ‬‫ﺎﻝ‬‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﻨﺐ‬‫ﺗﺠ‬-
‫ﺓ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬ ‫ﻘ‬
‫ﻴ‬‫ﻗ‬ ‫ﺩ‬30‫ﻛﻞ‬، ‫ﺔ‬ ‫ﺎﻋ‬‫ﺓﺳ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬ ‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬15‫ﻛﻞ‬. ‫ﻟﻲ‬ ‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬ ‫ﻭﻝ‬‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺒ ﺾﻭ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﺎﺱ ﺿ‬ ‫ﻴ‬‫ﻳﺠﺐﻗ‬-
‫ﺮ‬
‫ﻘ‬‫ﺘ‬‫ﺘﻰﺗﺴ‬ ‫ﻴﻦﺣ‬ ‫ﺘ‬‫ﺎﻋ‬‫ﺓﺳ‬‫ﺪ‬ ‫ﻤ‬
‫ﻟ‬‫ﺔ‬‫ﻋ‬‫ﺎ‬‫ﻛﻞﺳ‬، ‫ﺔ‬
‫ﺎﻋ‬‫ﺳ‬
.
‫ﺔ‬ ‫ﺎﻋ‬‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺍﺵ‬ ‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﻳﺠﺐ‬-
‫ﻟﻰ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬24‫ﺍﻝ‬ ‫ﺔﻓﻰ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻠ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬‫ﻟ‬
‫ﻮﻝﻓﻰ ﺎ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘﻢﻣﻼﺣﻈ‬ ‫ﻳ‬-
.‫ﺔ‬‫ﺰﻋ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻡﺑ‬ ‫ﺎ‬
‫ﻳ‬‫ﺃ‬10‫ﺓ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬ ‫ﺔ‬‫ﻠ‬
‫ﻴ‬‫ﻘ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻴ‬
‫ﺍﻷﺷ‬ ‫ﻊ‬‫ﻓ‬‫ﻨﺐﺭ‬ ‫ﻳ ﺾﺗﺠ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻳﺠﺐﻋ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻯ‬‫ﺘ‬‫ﺔﻣﺴ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬‫ﺓﻭ‬‫ﺮ‬‫ﺎﺻ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﻟﻢ‬
‫ﻳ ﺾﻷ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-

Uni
t2:Uri
narytr
acti
nfect
ion
Upperandloweruri
naryt
racti
nfect
ion
Lear
ningobj
ect
ives:
1.I
denti
fyt
hecl
assif
yingur
inar
ytr
acti
nfect
ions.
2.Descr
ibethemechani
caldef
ensemechani
smsassi
sti
nmai
ntai
ningst
eri
l
ity
andprevent
ingur
inar
ytr
actinf
ect
ion
3.Li
str
iskf
act
orsf
orur
inar
ytr
acti
nfect
ion
4.Descr
ibet
hepr
event
ingr
ecur
rentur
inar
ytr
acti
nfect
ions
5.Li
stdef
ini
ti
on&causesofpy
elonephr
it
is

92
‫‪6.Compar‬‬
‫‪ebet‬‬
‫‪weenacut‬‬
‫‪e&chr‬‬
‫‪oni‬‬
‫‪cpy‬‬
‫‪el‬‬‫‪onephr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬
‫‪7.Li‬‬
‫‪stnur‬‬
‫‪si‬‬‫‪ngmeasur‬‬
‫‪esf‬‬
‫‪orpat‬‬
‫‪i‬‬‫‪entwi‬‬
‫‪t‬‬‫‪hpy‬‬
‫‪el‬‬‫‪onephr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬
‫‪8.Def‬‬
‫‪i‬‬‫‪necy‬‬
‫‪st‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s‬‬
‫‪9.I‬‬
‫‪dent‬‬
‫‪i‬‬‫‪f‬‬
‫‪yt‬‬‫‪hecausesandcl‬‬
‫‪i‬‬
‫‪ni‬‬‫‪cal‬‬
‫‪mani‬‬
‫‪f‬‬‫‪est‬‬
‫‪at‬‬‫‪i‬‬
‫‪onsofcy‬‬
‫‪st‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s‬‬
‫‪10.Uset‬‬ ‫‪henur‬‬‫‪si‬‬
‫‪ngpr‬‬‫‪ocessasaf‬‬ ‫‪r‬‬
‫‪amewor‬‬ ‫‪kf‬‬‫‪ort‬‬ ‫‪hecar‬‬ ‫‪eofpat‬‬ ‫‪i‬‬
‫‪entl‬‬‫‪owerur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪y‬‬
‫‪t‬‬‫‪r‬‬
‫‪acti‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫‪on.‬‬
‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫‪:‬‬
‫ﺓ‪2‬‬ ‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻔ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬ ‫ﻋ‬
‫‪:‬‬
‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬‫ﻨ‬‫ﻠﻰﺗﺼ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪1‬‬
‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬
‫ﺔﻣﻦﻋ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
‫ﻘﻢﻭ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺪﻓﻲ‬ ‫ﺎﻋ‬‫ﺘﻲﺗﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬
‫ﻧ‬‫ﺎ‬‫ﻜ‬‫ﻴ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻉ‬
‫ﻓ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬
‫ﺁ‬‫‪.‬ﻭﺻﻒ‬ ‫‪2‬‬
‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬ ‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺮ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﺔﻋ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫‪.‬ﻗ‬‫‪3‬‬
‫ﺓ‬‫ﺭ‬‫ﺮ‬‫ﻜ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫‪.‬ﻭﺻﻒ‬ ‫‪4‬‬
‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳﻀ‬ ‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﺒ‬
‫ﺃﺳ‬‫ﻳﻒﻭ‬ ‫ﺮ‬‫ﻌ‬
‫ﺔﺗ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫‪.‬ﻗ‬‫‪5‬‬
‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻭ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺭﻥﺑ‬‫ﺎ‬
‫‪.‬ﻗ‬‫‪6‬‬
‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫‪.‬ﻗ‬‫‪7‬‬
‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫‪.‬ﺗﺤ‬‫‪8‬‬
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻩ‬‫ﺮ‬‫ﺎﻫ‬‫ﻣﻈ‬‫ﺔﻭ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬
‫ﺃﺳ‬ ‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪9‬‬
‫‪.‬‬‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻔ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺔﺑ‬ ‫ﻳ‬
‫ﺎ‬‫ﻨ‬
‫ﻌ‬ ‫ﻠ‬
‫ﻟ‬‫ﺭ‬‫ﺎ‬‫ﺈﻃ‬‫ﻳ ﺾﻛ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻡﻋ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫‪.‬‬‫‪10‬‬

‫‪I‬‬
‫‪nf‬‬‫‪l‬‬
‫‪ammat‬‬
‫‪or‬‬‫‪ydi‬‬
‫‪sor‬‬‫‪der‬‬
‫‪s‬‬
‫‪Ur‬‬‫‪i‬‬
‫‪nar‬‬
‫‪yt‬‬‫‪r‬‬
‫‪acti‬‬
‫‪nf‬‬‫‪ect‬‬
‫‪i‬‬‫‪on‬‬

‫‪Ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yt‬‬ ‫‪r‬‬‫‪acti‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫(‪ons‬‬ ‫‪UTI‬‬ ‫‪s)ar‬‬‫‪ecausedbypat‬‬ ‫‪hogeni‬‬‫‪cmi‬‬ ‫‪cr‬‬‫‪oor‬‬‫‪gani‬‬‫‪smsi‬‬‫‪nt‬‬‫‪he‬‬
‫‪ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yt‬‬ ‫‪r‬‬‫(‪act‬‬ ‫‪t‬‬‫‪henor‬‬ ‫‪mal‬‬ ‫‪ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yt‬‬‫‪r‬‬‫‪acti‬‬‫‪sst‬‬‫‪er‬‬‫‪i‬‬‫‪l‬‬
‫‪eabov‬‬ ‫‪et‬‬‫‪heur‬‬‫‪et‬‬‫‪hr‬‬‫)‪a‬‬‫‪.UTI‬‬‫‪sar‬‬‫‪e‬‬
‫‪gener‬‬ ‫‪al‬‬‫‪l‬‬‫‪ycl‬‬ ‫‪assi‬‬‫‪f‬‬‫‪i‬‬
‫‪edasi‬‬ ‫‪nf‬‬‫‪ect‬‬‫‪i‬‬‫‪onsi‬‬‫‪nv‬‬‫‪ol‬‬‫‪v‬‬‫‪i‬‬
‫‪ngt‬‬ ‫‪heupperorl‬‬ ‫‪owerur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yt‬‬‫‪r‬‬‫‪act‬‬
‫‪Cl‬‬‫‪assi‬‬‫‪f‬‬ ‫‪y‬‬‫‪i‬‬‫‪ngUr‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yTr‬‬ ‫‪actI‬‬ ‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫‪ons:‬‬
‫‪Ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yt‬‬ ‫‪r‬‬ ‫‪acti‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫(‪ons‬‬ ‫‪UTI‬‬‫‪s)ar‬‬‫‪ecl‬‬ ‫‪assi‬‬
‫‪f‬‬‫‪i‬‬‫‪edbyl‬‬‫‪ocat‬‬‫‪i‬‬‫‪on:‬‬‫‪t‬‬‫‪hel‬‬‫‪owerur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yt‬‬‫‪r‬‬
‫‪act‬‬
‫(‬‫‪whi‬‬‫‪chi‬‬ ‫‪ncl‬‬‫‪udest‬‬ ‫‪hebl‬‬ ‫‪adderandst‬‬ ‫‪r‬‬‫‪uct‬‬‫‪ur‬‬‫‪esbel‬‬‫‪owt‬‬ ‫‪hebl‬‬‫‪adder‬‬‫‪)ort‬‬ ‫‪heupper‬‬
‫‪ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yt‬‬ ‫‪r‬‬‫(‪act‬‬ ‫‪whi‬‬‫‪chi‬‬ ‫‪ncl‬‬‫‪udest‬‬ ‫‪heki‬‬‫‪dney‬‬ ‫‪sandur‬‬ ‫‪et‬‬
‫‪er‬‬‫)‪s‬‬‫‪.Theycanal‬‬ ‫‪sobe‬‬
‫‪cl‬‬‫‪assi‬‬‫‪f‬‬‫‪i‬‬‫‪edasuncompl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪edorcompl‬‬ ‫‪i‬‬
‫‪cat‬‬‫‪edUTI‬‬‫‪.‬‬
‫‪LowerUTI‬‬ ‫‪:‬‬
‫‪Cy‬‬ ‫‪st‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪s,‬‬ ‫‪pr‬‬‫‪ost‬‬‫‪at‬‬‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s,‬‬‫‪ur‬‬‫‪et‬‬‫‪hr‬‬‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪s‬‬

‫‪UpperUTI‬‬ ‫‪:‬‬
‫‪Acut‬‬‫‪epy‬‬ ‫‪el‬‬‫‪onephr‬‬‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s,‬‬‫‪chr‬‬
‫‪oni‬‬‫‪cpy‬‬ ‫‪el‬‬‫‪onephr‬‬ ‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s,‬‬‫‪r‬‬‫‪enal‬‬‫‪abscess,‬‬‫‪i‬‬‫‪nt‬‬‫‪er‬‬‫‪st‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪al‬‬‫‪nephr‬‬ ‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪s,‬‬
‫‪per‬‬
‫‪i‬‬‫‪r‬‬‫‪enal‬‬‫‪abscess.‬‬
‫ﺔ‬‫ﻴ‬
‫ﺑ‬‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬
‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺍ ﺽﻓﻲ‬ ‫ﺮ‬‫ﻣ‬‫ﻟﻸ‬‫ﺔ‬‫ﺒ‬
‫ﺒ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻘ‬ ‫ﻴ‬
‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﺋ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺒﺐ‬‫(ﺑﺴ‬‫‪UTI‬‬‫ﺔ)‪s‬‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺗﺤ‬
‫ﻠﻰ‬‫ﺎﻋ‬ ‫ً‬
‫ﻣ‬
‫ﻮ‬‫ﻤ‬‫ﺔﻋ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻨﻒﻋ‬ ‫‪.‬ﺗﺼ‬ ‫(‬
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻮﻕﻣﺠ‬ ‫ﺔﻓ‬‫ﻤ‬‫ﻘ‬‫ﻌ‬‫ﺔﻣ‬‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ)‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻲﻣﻦ‬ ‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬ ‫ﺰ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻴﺐ‬ ‫ﻭﻯﺗﺼ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻬ‬‫ﻧ‬‫ﺃ‬
‫‪:‬‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻒ‬‫ﻨ‬‫ﺗﺼ‬
‫ﺔﻭ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺬﻱﻳﺸ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻲ)‬‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫‪:‬‬
‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫(ﺣﺴﺐ‬ ‫‪UTI‬‬‫ﺔ)‪s‬‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻒ‬ ‫ﺗﺼ‬
‫ُ‬
‫ﺎ‬
‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫ﻜﻦ‬‫ﻤ‬‫‪.‬ﻳ‬‫(‬
‫ﻟﺐ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺬﻱﻳﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻱ)‬‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫(ﻭ‬
‫ﺔﺃ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬‫ﺓ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺓ‬‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬
‫ﺃ‬‫ﺓ‬ ‫ﺪ‬
‫ﻘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﺔﻏ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﻯ‬‫ﺪ‬‫ﺎﻋ‬‫ﻬ‬‫ﻧ‬
‫ﺃ‬‫ﻠﻰ‬‫ﺎﻋ‬ ‫ﻬ‬‫ﻔ‬
‫ﻴ‬‫ﻨ‬‫ﺗﺼ‬

‫‪93‬‬
 :
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻔ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬
‫ﻴﻞ‬
‫ﻠ‬‫ﺍﻹﺣ‬
‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬
‫ﺗ‬‫ﺎ‬
‫ﺘ‬‫ﻭﺳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬

:
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
،‫ﻼﻲ‬‫ﻟﺨﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬، ‫ﻮﻱ‬‫ﻠ‬‫ﺍﺝﻛ‬ ‫ﺮ‬‫ﺧ‬، ‫ﻣﻦ‬ ‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳﻀ‬ ‫ﻮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬،‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬
‫ﻴﻂﺑ‬ ‫ﺍﺝﻣﺤ‬‫ﺮ‬‫ﺧ‬
Uncompl icatedLowerorUpperUTI :
Communi ty-
acquiredi nfect ion;commoni ny oung
women
Compl i
cat edLowerorUpperUTI :
Oftennosocomi al( acqui r
edi nt hehospi tal
)and
relatedtocat heterizat i
on; occur si npat i
entswi t
h
urologicabnor malities,pr egnancy ,
i
mmunosuppr ession, diabet esmel li
tus,bstructi
ons.
Sev eralphy si
ologicalandmechani caldefence
mechani smsassi sti nmai nt ai
ni ngst eri
li
tyand
prev enti
ngur inaryt racti nf ectionas:
-Nor mal voidingwi thcompl eteempt yingoft he
bladder .
-Nor mal phagocy teabi li
tyoft hebl addermucosaand
urine.
-Ur eter
ov esical j
unct ioncompet ence.
-Per ist
alti
cact iv
ityt hatpr opelsur i
net owardt hebladder.
-Theant i
bact eri
al effectoft hezi ncconcent rati
oninprostat
esflui
d(seef i
g.28)
.

:
‫ﺪ‬‫ﻘ‬‫ﻌ‬ ‫ﺮﻣ‬‫ﻴ‬ ‫ﻮﻱﻏ‬ ‫ﻠ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻠﻲ‬‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﻟﺸ‬ ‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻊﻋ‬ ‫ﺋ‬‫ﺎ‬‫؛ﺷ‬ ‫ﻊ‬‫ﻤ‬‫ﺘ‬‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺒ‬‫ﺘﺴ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
:‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻠﻲ‬‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻘ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬‫ﻔﻰ‬‫ﺘﺸ‬ ‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﺒ‬‫ﺘﺴ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
)‫ﺎﺕ‬ ‫ﻴ‬‫ﻔ‬‫ﺘﺸ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻴ‬ ‫ﻣﺍﻷﺣ‬
‫ﺮﻦ‬ ‫ﻴ‬‫ﺜ‬‫ﻓﻲﻛ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﻮﻥﻣﻦﺗﺸ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬ ‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙﻓﻲ‬ ‫؛ﻳﺤ‬ ‫ﺓ‬
‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬‫ﺎ‬
‫ﺑ‬
.
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍﻻ‬ ، ‫ﺮﻱ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺩ‬، ‫ﺔ‬‫ﻋ‬‫ﺎ‬‫ﻨ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺒﺖ‬‫ﻛ‬، ‫ﻤﻞ‬ ‫ﻟﺤ‬‫ﺍ‬،
‫ﺔ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﻅ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻜ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻜ‬
‫ﻴ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻴ‬‫ﻔﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻉ‬‫ﻓ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻴ‬
‫ﻟ‬‫ﺁ‬ ‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻋ‬‫ﺎ‬‫ﺗﺴ‬
:‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻴ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﺔﻣﻦﻋ‬ ‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻘﻢﻭ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﻋ‬
.
‫ﺔ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﻣﻞ‬ ‫ﺎ‬‫ﺍﻍﻛ‬‫ﺮ‬‫ﻓ‬‫ﻊﺇ‬ ‫ﻌﻲﻣ‬ ‫ﻴ‬‫ﺒ‬
‫ﺍﻍﻃ‬ ‫ﺮ‬‫ﻓ‬‫ﺇ‬-
.
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺎﻃﻲ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻌ‬‫ﻠ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻗ‬-
.
‫ﻠﻲ‬ ‫ﻳﺼ‬‫ﻮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻟﺐ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﺎﻃ‬‫ﻘ‬‫ﺓﺗ‬‫ﺀ‬‫ﺎ‬‫ﻔ‬‫ﻛ‬-
.
‫ﺔ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻮ‬
‫ﻮﻝﻧﺤ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻓ‬‫ﺪ‬ ‫ﻌﺠﻲﻳ‬ ‫ﻤ‬‫ﺎﻁﺗ‬‫ﻧﺸ‬-
‫ﻜﻞ‬‫ﻟﺸ‬‫ﺍ‬‫ﺮ‬‫ﻧﻈ‬‫ﺍ‬
)‫ﺎ‬‫ﺗ‬‫ﺎ‬
‫ﺘ‬‫ﻭﺳ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬‫ﻧﻚﻓﻲﺳ‬ ‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬
‫ﺘ‬‫ﻟ‬ ‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻠ‬‫ﻟ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﺛ‬‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.
(28
(Fig.28)
Asanal terati
oni nanyofthesedef encesi ncr easest her iskofcont r
act i
nga
urinarytractinfecti
on.
Riskfact orsforur i
narytr
actinfection:
1.Inabili
tyorf ai
luretoempt ythebladdercompl etely
2.Obst ructedurinaryfl
ow, f
rom congeni tal anomal ies, urethralstrictures,
contractureoft hebladderneck, bl
addert umor s,
3.calculi(stones)intheuretersorki dneys, compr essi onoft heur eters,and
neurologicabnor mal i
ti
es
4.Decr easednat uralhostdefensesori mmunosuppr essi on

94
‫‪5.I‬‬‫‪nst‬‬‫‪r‬‬
‫‪ument‬‬‫‪at‬‬‫‪i‬‬
‫‪onoft‬‬
‫‪heur‬‬‫‪i‬‬
‫‪nar‬‬
‫‪yt‬‬‫‪r‬‬‫(‪act‬‬
‫‪eg,‬‬‫‪cat‬‬
‫‪het‬‬‫‪er‬‬
‫‪i‬‬‫‪z‬‬‫‪at‬‬
‫‪i‬‬‫‪on,‬‬
‫‪cy‬‬‫‪st‬‬
‫‪oscopi‬‬
‫‪c‬‬
‫‪pr‬‬‫‪ocedur‬‬‫)‪es‬‬
‫‪6.I‬‬‫‪nf‬‬‫‪l‬‬
‫‪ammat‬‬ ‫‪i‬‬
‫‪onorabr‬‬
‫‪asi‬‬
‫‪onoft‬‬‫‪heur‬‬‫‪et‬‬
‫‪hr‬‬‫‪al‬‬‫‪mucosa‬‬

‫‪.‬‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬
‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬
‫ﺪﻣﻦﺧﻄ‬ ‫ﻳ‬‫ﺰ‬
‫ﺎﺕﻳ‬ ‫ﻋ‬
‫ﺎ‬‫ﻓ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻩ‬‫ﺬ‬‫ﺃﻱﻣﻦﻫ‬ ‫ﺮﻓﻲ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺃﻱﺗ‬‫ﺍﻷﻥ‬‫ً‬
‫ﺮ‬‫ﻧﻈ‬
‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬
‫ﻣﻞﺧﻄ‬ ‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫ﻣﻞ‬‫ﺎ‬
‫ﻜﻞﻛ‬‫ﺔﺑﺸ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻍ‬‫ﺮ‬
‫ﻓ‬‫ﻔﺸﻞﻓﻲﺇ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬
‫‪.‬ﻋ‬ ‫‪1‬‬
‫ﺔ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬
‫‪،‬‬‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻖ‬‫ﻠ ﺺﻋ‬‫ﻘ‬
‫‪،‬ﺗ‬‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻴﻖﻣﺠ‬‫‪،‬ﺗﻀ‬‫ﺔ‬‫ﻴ‬‫ﻘ‬
‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫‪،‬ﻣﻦ‬ ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺩﻣﺠ‬ ‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬‫‪.‬‬‫‪2‬‬
‫‪،‬‬
‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﻟﺐ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻐﻂ‬‫‪،‬ﻭﺿ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬ ‫ﻟﺐ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫(ﻓﻲ‬ ‫ﺍﺕ‬‫ﻮ‬‫ﺍﺕ)ﺣﺼ‬ ‫ﻮ‬‫‪.‬ﺣﺼ‬ ‫‪3‬‬
‫ﺔ‬‫ﺎﻋ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﺖ‬‫ﻭﻛ‬‫ﺃ‬‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺎﻋ‬‫ﻓ‬‫ﻗ ﺺﺩ‬‫ﺎ‬
‫ﻨ‬‫‪.‬ﺗ‬‫‪4‬‬
‫(‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻨﻈ‬
‫ﺍﺕﺗ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬‫ﺓﻭ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬‫ﺔ)‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﻭ‬‫ﺩ‬‫ﺃ‬‫‪.‬‬‫‪5‬‬
‫ﻴﻞ‬‫ﻠ‬
‫ﻟﻺﺣ‬ ‫ﺎﻃﻲ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞﻓﻲ‬‫ﺂ‬‫ﻭﺗ‬‫ﺃ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪6‬‬

‫‪7.Cont‬‬ ‫‪r‬‬
‫‪i‬‬‫‪but‬‬‫‪i‬‬‫‪ngcondi‬‬ ‫‪t‬‬‫‪i‬‬‫(‪ons‬‬‫‪cer‬‬ ‫‪t‬‬‫‪ai‬‬
‫‪npopul‬‬ ‫‪at‬‬‫‪i‬‬
‫‪onsofpat‬‬ ‫‪i‬‬‫‪ent‬‬‫‪sar‬‬‫‪emor‬‬ ‫‪epr‬‬ ‫‪onet‬‬‫‪o‬‬
‫‪UTI‬‬‫‪st‬‬‫‪hanot‬‬ ‫‪her‬‬‫)‪s‬‬‫‪,‬‬‫‪i‬‬
‫‪ncl‬‬‫‪udi‬‬‫‪ngt‬‬ ‫‪hosewi‬‬ ‫‪t‬‬‫‪h:‬‬
‫‪-Di‬‬‫‪abet‬‬‫‪esmel‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬‫(‪us‬‬‫‪i‬‬‫‪ncr‬‬‫‪easedur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪ygl‬‬‫‪ucosel‬‬ ‫‪ev‬‬‫‪el‬‬‫‪scr‬‬‫‪eat‬‬‫‪eani‬‬ ‫‪nf‬‬‫‪ect‬‬‫‪i‬‬‫‪on-‬‬‫‪pr‬‬
‫‪one‬‬
‫‪env‬‬‫‪i‬‬‫‪r‬‬
‫‪onmenti‬‬ ‫‪nt‬‬ ‫‪heur‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yt‬‬‫‪r‬‬‫‪act‬‬ ‫)‬‫‪,‬‬
‫‪pr‬‬‫‪egnancy‬‬ ‫‪,‬‬‫‪neur‬‬‫‪ol‬‬
‫‪ogi‬‬‫‪cdi‬‬‫‪sor‬‬‫‪der‬‬‫‪s,‬‬ ‫‪gout‬‬‫‪,‬‬‫‪and‬‬
‫‪ot‬‬‫‪heral‬‬‫‪t‬‬‫‪er‬‬‫‪edst‬‬ ‫‪at‬‬‫‪eschar‬‬ ‫‪act‬‬‫‪er‬‬‫‪i‬‬‫‪z‬‬‫‪edbyi‬‬ ‫‪ncompl‬‬ ‫‪et‬‬‫‪eempt‬‬ ‫‪y‬‬‫‪i‬‬
‫‪ngoft‬‬ ‫‪hebl‬‬ ‫‪adderand‬‬
‫‪ur‬‬‫‪i‬‬
‫‪nar‬‬‫‪yst‬‬ ‫‪asi‬‬‫‪s‬‬
‫‪8.Vesi‬‬‫‪cour‬‬ ‫‪et‬‬‫‪er‬‬‫‪al‬‬ ‫‪r‬‬
‫‪ef‬‬‫‪l‬‬‫‪uxofur‬‬ ‫‪i‬‬‫‪ne.‬‬
‫‪-N.‬‬‫‪B.‬‬‫‪:‬‬‫‪Ther‬‬ ‫‪ear‬‬‫‪e2t‬‬ ‫‪y‬‬
‫‪pesofr‬‬ ‫‪ef‬‬‫‪l‬‬‫‪ux‬‬‫‪:‬‬
‫‪-Ur‬‬‫‪et‬‬‫‪hr‬‬‫‪ov‬‬ ‫‪esi‬‬‫‪cal‬‬‫‪r‬‬‫‪ef‬‬‫‪l‬‬
‫‪ux f‬‬ ‫‪l‬‬
‫‪owi‬‬‫‪ngbackofur‬‬ ‫‪i‬‬‫‪nef‬‬‫‪r‬‬‫‪om ur‬‬‫‪et‬‬‫‪hr‬‬
‫‪ai‬‬‫‪nt‬‬ ‫‪ot‬‬‫‪hebl‬‬ ‫‪adder‬‬‫‪.‬‬
‫‪-Vesi‬‬‫‪cour‬‬ ‫‪et‬‬‫‪er‬‬‫‪al‬‬ ‫‪r‬‬
‫‪ef‬‬‫‪l‬‬
‫‪ux f‬‬ ‫‪l‬‬
‫‪owi‬‬ ‫‪ngbackofur‬‬ ‫‪i‬‬‫‪nei‬‬‫‪nt‬‬‫‪ooneorbot‬‬ ‫‪hur‬‬ ‫‪et‬‬ ‫‪er‬‬‫(‪s‬‬‫‪seef‬‬‫‪i‬‬
‫‪g.‬‬
‫)‪29‬‬‫‪.‬‬
‫‪9.Femal‬‬ ‫(‪egender‬‬ ‫)‪sex‬‬ ‫‪.‬‬
‫‪10.Rar‬‬‫‪ehaemat‬‬ ‫‪ogenoust‬‬ ‫‪r‬‬
‫‪ansmi‬‬ ‫‪ssi‬‬
‫‪onv‬‬ ‫‪i‬‬‫‪at‬‬‫‪hebl‬‬ ‫‪ood.‬‬
‫‪11.Ani‬‬ ‫‪mpor‬‬ ‫‪t‬‬‫‪antsour‬‬ ‫‪cei‬‬ ‫‪sHospi‬‬ ‫‪t‬‬‫‪al‬‬‫‪-‬‬
‫‪acqui‬‬‫‪r‬‬‫‪edornosocomi‬‬ ‫‪al‬‬‫‪i‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬‫‪on.‬‬

‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺔ‬‫ﺮﺿ‬‫ﺮﻋ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻣﻦ‬ ‫ﻨ‬‫ﻴ‬
‫ﻌ‬‫ﺎﺕﻣ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﻣﺠ‬‫ﺔ)‬‫ﻤ‬ ‫ﺎﻫ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﻻﺕ‬ ‫ﻟﺤ‬‫ﺍ‬‫‪.‬‬‫‪7‬‬
‫ﻣ‪:‬‬
‫ﻮﻥ ﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺌﻚ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫‪،‬ﺑ‬‫(‬‫ﺮﻫﻢ‬‫ﻴ‬‫ﻏ‬
‫‪،‬ﻭ‬‫(‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯﻓﻲ‬ ‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺮﺿ‬‫ﻌ‬‫ﺔﻣ‬ ‫ﺌ‬
‫ﻴ‬‫ﻠﻖﺑ‬‫ﻮﻝﻳﺨ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺯﻓﻲ‬ ‫ﻮ‬
‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﺓﻣﺴ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫ﺯ‬‫ﺮﻱ)‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺀ‬
‫ﺍ‬‫‪-‬ﺩ‬
‫ﺍﻍ‬
‫ﺮ‬‫ﻓ‬‫ﺎﻝﺇ‬
‫ﻤ‬‫ﺘ‬‫ﻛ‬‫ﺍ‬‫ﻡ‬
‫ﺪ‬‫ﻌ‬‫ﺰﺑ‬‫ﻴ‬‫ﻤ‬
‫ﺘ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺎﻣﻦ‬‫ﺮﻫ‬‫ﻴ‬
‫‪،‬ﻭﻏ‬ ‫ﺮﺱ‬ ‫ﻘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬‫ﺮ‬‫ﺍﻻﺿﻄ‬ ‫‪،‬ﻭ‬‫ﻤﻞ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻛ‬‫ﺭ‬‫ﺔﻭ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﻮﻝ‬ ‫ﺒ‬
‫ﻠ‬‫ﻟ‬‫‪Vesi‬‬
‫ﻟﺐ‪co‬‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫‪.‬‬‫‪8‬‬
‫‪:‬‬
‫ﺎﻉ‬‫ﺗﺠ‬ ‫ﺭ‬‫ﻣﺍﻻ‬
‫ﺎﻥ ﻦ‬‫ﻮﻋ‬ ‫ﺎﻙﻧ‬‫ﻨ‬‫‪:‬ﻫ‬‫ﺔ‬‫ﻮﻇ‬ ‫ﻠﺤ‬‫‪-‬ﻣ‬
‫‪.‬‬
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﻮﻝﺇ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﻮﻝﻣﻦﻣﺠ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬ ‫ﻮﻝ‪-‬ﺗ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﻠﻲﻣﺠ‬ ‫ﻳﺼ‬‫ﻮ‬‫ﺩﺣ‬ ‫ﺍ‬‫ﺪ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫(‬
‫ﻜﻞ‪29‬‬ ‫ﻟﺸ‬
‫ﺍ‬‫ﺮ‬‫ﻧﻈ‬‫ﺍ‬
‫ﺎ)‬‫ﻤ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬
‫ﻭﻛ‬‫ﺃ‬‫ﻴﻦ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﺃﺣ‬‫ﻟﻰ‬‫ﻮﻝﺇ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻓﻖ‬ ‫ﺪ‬
‫‪-Vesi‬ﺗ‬ ‫ﻟﺐ‪co‬‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬
‫(‬‫ﻨﺲ‬ ‫ﻟﺠ‬
‫ﺍ‬‫ﻮﻱ)‬ ‫ﺜ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻨﺲ‬ ‫ﻟﺠ‬‫ﺍ‬‫‪.‬‬‫‪9‬‬
‫‪.‬‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻡﻋﻦﻃ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬‫ﻘ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺭ‬ ‫ﺩ‬
‫ﺎ‬‫‪.‬ﻧ‬
‫‪10‬‬
‫‪.‬‬
‫ﺎﺕ‬‫ﻴ‬‫ﻔ‬
‫ﺘﺸ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﺎﺕ‬‫ﻴ‬
‫ﻔ‬‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺒ‬‫ﺘﺴ‬‫ﻜ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬ ‫ﻬﻢﻫ‬ ‫ﺭﻣ‬ ‫ﺪ‬‫‪.‬ﻣﺼ‬‫‪11‬‬

‫‪95‬‬
 (
Fig.
29)

Pr eventingRecur r
entUrinaryTractI nfecti
ons:
1.Hy gi
ene:
-Showerr at herthanbatheint ubbecausebact eriainthebathwat ermayent er
theur ethra.
-Af t
ereachbowel movement ,cleant heperineum andur ethr
al meatusfr
om
frontt oback.Thi swi l
lhelpreduceconcent r
at i
onsofpat hogensatt heurethr
al
openi ngand, i
nwomen, t
hev aginalopeni ng.
2.Flui dintake:
-Dr i
nkl i
ber alamount sofflui
dsdai lyt ofl
ushoutbact eri
a.
-Av oidcof fee,tea,col
as,alcohol ,
andot herf l
uidsthatareurinarytr
actir
rit
ants.

:‫ﺓ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬.1
‫ﺪﺧﻞ‬‫ﺪﺗ‬
‫ﻡﻗ‬‫ﺎ‬‫ﻤ‬
‫ﺘﺤ‬‫ﺍﻻﺳ‬ ‫ﺀ‬
‫ﺎ‬‫ﺓﻓﻲﻣ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻷﻥ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬‫ﺎ‬‫ﻤ‬‫ﺘﺤ‬‫ﻣﺍﻻﺳ‬‫ﺑﻻً ﻦ‬‫ﻡﺪ‬ ‫ﺎ‬‫ﻤ‬
‫ﺘﺤ‬ ‫ﺍﻻﺳ‬-
.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬ ‫ﻣﺠ‬
‫ﺍ‬
‫ﺬ‬‫ﺪﻫ‬‫ﺎﻋ‬
‫ﻴﺴ‬‫ﺳ‬.‫ﻠﻒ‬‫ﻟﺨ‬
‫ﺍ‬‫ﻟﻰ‬‫ﻡﺇ‬‫ﺎ‬
‫ﻣ‬‫ﻣﺍﻷ‬
‫ﻴﻞ ﻦ‬‫ﻠ‬
‫ﺍﻹﺣ‬‫ﺎﺥ‬‫ﻤ‬‫ﺎﻥﻭﺻ‬‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﻴﻒﻣ‬ ‫ﻨﻈ‬‫ﺘ‬‫ﻗﻢﺑ‬،‫ﺀ‬‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺃ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺪﻛﻞﺣ‬ ‫ﻌ‬‫ﺑ‬-
.‫ﺀ‬‫ﺎ‬
‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺒﻞﻋ‬‫ﻬ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺘﺤ‬‫ﻓ‬
‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬‫ﺘﺤ‬‫ﺍ ﺽﻓﻲﻓ‬ ‫ﺮ‬
‫ﻣ‬ ‫ﺍﻷ‬‫ﺎﺕ‬‫ﺒ‬‫ﺒ‬
‫ﺍﺕﻣﺴ‬ ‫ﺰ‬
‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻴﻞﺗ‬‫ﻠ‬‫ﻘ‬
‫ﻓﻲﺗ‬
:
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬ ‫ﺍ‬
‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺗ‬.2
.
‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺮ‬‫ﻟﻄ‬‫ﺎ‬ً
‫ﻴ‬
‫ﻣ‬‫ﻮ‬‫ﺋﻞﻳ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓﻣﻦ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﺎﺕﻛ‬‫ﻴ‬‫ﻤ‬‫ﺮﺏﻛ‬ ‫ﺍﺷ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬‫ﻤﺴ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬
‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝﻭ‬‫ﻜﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻻﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻱﻭ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺓﻭ‬‫ﻮ‬‫ﻬ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺐ‬ ‫ﺗﺠ‬-

3.Voidinghabi ts:
-Voidev er
y2t o3hour sduringthedayandcompl etelyempt ythebladder.
-Voidimmedi atelyaftersexual i
ntercour se.
-Takethepr escri
bedsi ngledoseofanor alantimicrobialagentaf t
ersexual
i
ntercourse.
4.Therapy:
-Takemedi cati
onexact l
yaspr escri
bed.
-Forrecurrentinfect i
on,consideraci difi
cationoft heur i
net hr
oughascor bic
aci
d( vi
tami nC) ,1,000mgdai ly,
orcr anber r
yj uice.
-Consulttheheal t
hcar eprov i
derregul arlyforfollow-up,recurrenceof
symptoms, orinfectionsnonr esponsivet otr eatment.
:
‫ﺔ‬‫ﻏ‬‫ﺮ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬.3
.
‫ﻣﻞ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺎ‬‫ﺔﺑ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻎ‬ ‫ﻳ‬
‫ﺮ‬‫ﻔ‬‫ﺗ‬‫ﺭﻭ‬‫ﺎ‬‫ﻬ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﺧﻼﻝ‬ ‫ﻋ‬‫ﺎ‬
‫ﻟﻰﺛﻼﺙﺳ‬ ‫ﻴﻦﺇ‬‫ﺘ‬‫ﻋ‬‫ﺎ‬
‫ﺍﻍﻛﻞﺳ‬ ‫ﺮ‬
‫ﻓ‬‫ﺇ‬-
.‫ﺓ‬‫ﺮ‬
‫ﺎﺷ‬ ‫ﺒ‬
‫ﺎﻉﻣ‬‫ﻤ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬
‫ﻌ‬‫ﺒﻄﻞﺑ‬‫ﻳ‬-
.‫ﺎﻉ‬
‫ﻤ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻔﻢﺑ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬
‫ﺬﻋﻦﻃ‬ ‫ﺆﺧ‬‫ﺎﺕﻳ‬ ‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺩ‬ ‫ﺎ‬
‫ﻣﻞﻣﻀ‬ ‫ﺎ‬‫ﺔﻣﻦﻋ‬ ‫ﻓ‬‫ﻮ‬‫ﻮﺻ‬ ‫ﺓﻣ‬‫ﺪ‬‫ﺍﺣ‬‫ﺔﻭ‬‫ﻋ‬‫ﺮ‬
‫ﻭﻝﺟ‬ ‫ﺎ‬‫ﻨ‬
‫ﺗ‬-
:‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬.4
.
‫ﻮﻑ‬ ‫ﻮﺻ‬‫ﻮﻣ‬ ‫ﺎﻫ‬‫ﻤ‬‫ﺒﻂﻛ‬‫ﻟﻀ‬‫ﺎ‬‫ﺀﺑ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬-

96
 ،
(‫ﺳ‬
‫ﻴﻦ ﻲ‬‫ﻣ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬
‫ﻓ‬)‫ﻴﻚ‬
‫ﺑ‬‫ﺭ‬‫ﻮ‬
‫ﻜ‬‫ﺍﻷﺳ‬‫ﻤﺾ‬‫ﻳﻖﺣ‬‫ﺮ‬
‫ﻮﻝﻋﻦﻃ‬ ‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﺭﻙﺗﺤ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬
‫ﻋ‬‫ﺍ‬‫ﻊﻓﻲ‬‫ﺿ‬، ‫ﺓ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬
‫ﻠ‬‫ﻟ‬-
.‫ﺮﻱ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻭﻋﺼ‬،
‫ﺎﺃ‬ً
‫ﻴ‬‫ﻣ‬
‫ﻮ‬‫ﻣﺠﻢﻳ‬1000
.
‫ﻌﻼﺝ‬
‫ﻠ‬‫ﻟ‬‫ﻴﺐ‬
‫ﺘﺠ‬‫ﺎﺕﻻﺗﺴ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺍﺽ‬‫ﺮ‬
‫ﺍﻷﻋ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻜ‬‫ﻭﺗ‬
‫ﺃ‬‫ﺔ‬‫ﻌ‬‫ﺑ‬
‫ﺎ‬‫ﺘ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﻡ‬‫ﺎ‬‫ﺘﻈ‬‫ﻧ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻴ‬‫ﻟﺼﺤ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬
‫ﻘ‬‫ﺮﻣ‬‫ﺘﺸ‬
‫ﺍﺳ‬ -

Prevent i
onofur i
narytr
actinf
ectionint hecat heterizedpat i
ent
s:
1.Strictasepsi sduri
ngcathet
erinsertion.
2.Nev erraiset hebagabovethebl adderlev el
.
3.Thedr ainagebagmustnev ertoucht hef loor.
4.Thedr ainaget ubemustnotbecont ami nated.
5.Thecat hetermustnotdi sconnectf r
om t het ubing.
6.Irr
igati
onoft hecathet
erisnev ercarri
edoutr outinely
.
7.Thecat hetershoul dnotbeleftinplacel ongert hannecessary.
8.Handwashi ngbeforeandafterhandl i
ngoft hecat heter
.
9.Ifsignsofi nfecti
onoccuraur i
nespeci menmustbeobt ai
nedforcul
tur
e.

:‫ﺓ‬
‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬‫ﺪﻣ‬ ‫ﻨ‬
‫ﺔﻋ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﺔﻣﻦﻋ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
.‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬
‫ﺩﺧ‬‫ﺀﺇ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻡ‬ ‫ﺭ‬
‫ﺎ‬‫ﻘﻢ ﺻ‬‫ﻋ‬.1
.‫ﺍ‬
ً
‫ﺪ‬‫ﺑ‬‫ﺃ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﻮﻕﻣﺴ‬ ‫ﻴﺲﻓ‬ ‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻓ‬‫ﺮ‬‫ﻻﺗ‬.2
.
‫ﺍ‬ً
‫ﺪ‬
‫ﺑ‬‫ﺃ‬‫ﺭﺽ‬ ‫ﺍﻷ‬‫ﺮﻑ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻴﺲ‬ ‫ﻤﺲﻛ‬ ‫ﻠ‬‫ﺃﻻﻳ‬‫ﻳﺠﺐ‬. 3
.‫ﺎ‬
ً
‫ﺛ‬‫ﻮ‬‫ﻠ‬‫ﺮﻑﻣ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬
‫ﺃ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺃﻻﻳ‬‫ﻳﺠﺐ‬. 4
.
‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬‫ﻋﺍﻷ‬
‫ﺓﻦ‬ ‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺼﻞ‬‫ﻨ‬‫ﺃﻻﺗ‬‫ﻳﺠﺐ‬. 5
.‫ﻨﻲ‬‫ﻴ‬‫ﺗ‬‫ﻭ‬
‫ﻜﻞﺭ‬ ‫ﺓﺑﺸ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻢﺭﻱ‬ ‫ﻻﻳ‬.6
.‫ﺍﻼﻡ‬
‫ﻮﻝﻣﻦﻟﺯ‬‫ﺃﻃ‬‫ﺓ‬‫ﺮ‬‫ﺘ‬‫ﻔ‬
‫ﻟ‬‫ﺎ‬‫ﻬ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﺓﻓﻲﻣ‬ ‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻙ‬‫ﻐﻲﺗ‬‫ﺒ‬‫ﻨ‬‫ﻻﻳ‬.7
.
‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣﻞﻣ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬
‫ﺒﻞﻭ‬ ‫ﻳﻦﻗ‬‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻏﺴﻞ‬. 8
.
‫ﺭﻉ‬‫ﺰ‬
‫ﻠ‬‫ﻟ‬‫ﻮﻝ‬
‫ﺔﺑ‬‫ﻨ‬
‫ﻴ‬‫ﻠﻰﻋ‬‫ﻮﻝﻋ‬
‫ﻟﺤﺼ‬ ‫ﺍ‬
‫ﻳﺠﺐ‬، ‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﺭﻋﻼ‬ ‫ﻮ‬‫ﻬ‬‫ﺣﺔﻇ‬‫ﻟ‬
‫ﻓﻲ ﺎ‬. 9

Cy
sti
ti
s
Defi
ni t
ion:
Iti
sani nfl
ammat ionofuri
narybladder,
commonl yoccursi
nf emal
ebecauseof
shorteningofuret hr
a.
Cli
nicalMani f
est ati
on:
1.Frequencypai n
2.burningonur inati
on
3.fr
equency
4.Urgency ,
suprapubi corpel
vicpain,dysur
iaandfoulsmell
i
ngur i
ne.
5.I
nsomeper sonshemat uri
a,andpy ur
iamaybepr esent
.
6.Backpai nmayal sobepresent.

97
Diagnosti
cst udies:
-Urineanalysi
sf orpr
esenceWBC.
-Urineforcultur
eandsensitiv
itywit
hcleancatchur
ine.
-I
VPandcy stoscopyifi
ndicated.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
.‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬ ‫ﺮﻣﺠ‬ ‫ﺒﺐﻗﺼ‬ ‫ﺎﺙﺑﺴ‬ ‫ﻧ‬‫ﺍﻹ‬‫ﺪ‬ ‫ﻨ‬‫ﺓﻋ‬ ‫ﺩ‬‫ﺎ‬
‫ﺪﺙﻋ‬ ‫ﻳﺤ‬ ‫ﻭ‬،‫ﺔ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏﻓﻲ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻭﻫ‬
:‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺩ‬‫ﺩ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺁﻻ‬.1
‫ﻮﻝ‬ ‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻨ‬
‫ﺎﻥﻋ‬ ‫ﻗ‬‫ﺮ‬‫ﺣ‬. 2
‫ﺩ‬‫ﺩ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.3
.
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬ ‫ﻬ‬
‫ﻳ‬‫ﺮ‬‫ﺔﻛ‬ ‫ﺋﺤ‬‫ﺍ‬‫ﺭ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬، ‫ﻮﺽ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻮﻕ‬ ‫ﻟﻢﻓ‬‫ﺃ‬ ،‫ﺎﺡ‬‫ﻟﺤ‬‫ﺇ‬.4
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻠ‬‫ﻴ‬‫ﺑ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻠ‬
‫ﻴ‬ ‫ﺎﻙﺑ‬ ‫ﻨ‬‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺪﻳ‬ ‫ﺎ ﺹﻗ‬ ‫ﺍﻷﺷﺨ‬ ‫ﻌﺾ‬ ‫ﻓﻲﺑ‬. 5
.‫ﺎ‬
‫ﻳﻀ‬ ‫ﺃ‬‫ﺓ‬
‫ﺩ‬ ‫ﻮ‬‫ﻮﺟ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫ﺮﻗ‬‫ﻬ‬ ‫ﻟﻈ‬‫ﺍ‬‫ﻡ‬‫ﺁﻻ‬.6
:‫ﺔ‬ ‫ﻴ‬
‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬
.
WBC‫ﺩ‬ ‫ﻮ‬‫ﻮﺟ‬ ‫ﻟ‬‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﺗﺤ‬-
.‫ﻴﻒ‬ ‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻁ‬ ‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﺔﻣ‬‫ﻴ‬‫ﺎﺳ‬ ‫ﻟﺤﺴ‬ ‫ﺍ‬
‫ﺔﻭ‬ ‫ﻓ‬‫ﺎ‬‫ﻘ‬‫ﺜ‬‫ﻠ‬‫ﻟ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬-
.
‫ﻷﺮ‬‫ﺍﻣ‬ ‫ﻡ‬‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺫ‬‫ﺔﺇ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻨﻈ‬‫ﺗ‬‫ﻭ‬IVP-
Phar macol ogi calmanagement :
1.Manydr ugsar eef fect i
veagai nstor gani smst hatcauseur inaryt racti nfection.
Themostef fectiveandl eastexpensi vedr ugsar et hesul phonami des, including,
"macr odant in".
2.Sy stemi cant ibi oti
cssuchasampi cil
lin,amoxi ci ll
in, cephal ospor ins, and
ami nogl ycosi des" gar amy ci
n, nebci n".
3.Sul famet haxazol eandt rimet hopr im" bact er i
um, sut ri
m"hav epr ov edt obean
effectivedr ugcombi nat ionincy sti
tisespeci al l
yr ecur rentone.
Pot entialcompl icat ions:
-Renal fail
ur eduet oext ensi vedamageofki dney
-Sepsi s
:‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻌ‬‫ﺔﻓ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬.‫ﺔ‬‫ﻴ‬ ‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺒﺐ‬ ‫ﺘﻲﺗﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻨ‬‫ﺋ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﺔﺿ‬ ‫ﻟ‬‫ﺎ‬‫ﻌ‬
‫ﺔﻓ‬ ‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﻣﺍﻷ‬
‫ﺪﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬.1
.
"‫ﻴﻦ‬ ‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺮ‬‫ﻛ‬‫ﺎ‬‫ﻣ‬"‫ﻟﻚ‬ ‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬،‫ﺍﺕ‬ ‫ﺪ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻧ‬
‫ﻮ‬‫ﻔ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺔﻫﻲ‬ ‫ﻔ‬‫ﻠ‬
‫ﻜ‬‫ﺎﺗ‬‫ﻬ‬‫ﻠ‬‫ﻗ‬‫ﺃ‬‫ﻭ‬
‫ﻭ‬، ‫ﺎﺕ‬ ‫ﻨ‬
‫ﻳ‬ ‫ﺭ‬‫ﻮ‬‫ﺒ‬‫ﻮﺳ‬ ‫ﻟ‬
‫ﺎ‬‫ﻔ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬،‫ﻴﻦ‬ ‫ﻠ‬‫ﻴ‬
‫ﻴﺴ‬ ‫ﻛﺴ‬ ‫ﻮ‬‫ﻣ‬‫ﺍﻷ‬، ‫ﻴﻦ‬‫ﻠ‬‫ﻴ‬‫ﻴﺴ‬‫ﺒ‬‫ﻣ‬ ‫ﺍﻷ‬ ‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬.2
."‫ﻴﻦ‬‫ﺒﺴ‬‫ﻴ‬ ‫ﻧ‬،‫ﻴﻦ‬ ‫ﻴﺴ‬‫ﻣ‬ ‫ﺍ‬
‫ﺭ‬‫ﺎ‬‫ﺔ"ﺟ‬ ‫ﻴ‬‫ﻨ‬‫ﻴ‬
‫ﻣ‬ ‫ﺍﻷ‬ ‫ﺍﺕ‬‫ﺪ‬‫ﻳ‬‫ﺯ‬‫ﻮ‬‫ﻜ‬‫ﻴ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺔ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝﻓﻲ‬ ‫ﻌ‬ ‫ﺋﻲﻓ‬ ‫ﺍ‬‫ﻭ‬‫ﻳﺞﺩ‬ ‫ﺰ‬‫ﺎﻣ‬‫ﻤ‬‫ﻬ‬‫ﻧ‬‫ﺃ‬"‫ﻳﻢ‬‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﺳ‬، ‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺑ‬"‫ﻳﻢ‬ ‫ﺮ‬‫ﺑ‬‫ﻮ‬‫ﺜ‬ ‫ﻴ‬
‫ﻤ‬‫ﻳ‬‫ﺮ‬‫ﺗ‬‫ﻭﻝﻭ‬ ‫ﺯ‬‫ﺎ‬‫ﻛﺴ‬‫ﺎ‬‫ﺜ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻔ‬‫ﻠ‬‫ﺒﺖﺳ‬ ‫ﺛ‬‫ﺃ‬.3
.‫ﻣ‬
‫ﻪ‬‫ﺭﻨ‬ ‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺻ‬ ‫ﻭﺧ‬
:‫ﺔ‬‫ﻠ‬
‫ﻤ‬ ‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻜ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻠﻒ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴﺠ‬‫ﺘ‬‫ﻮﻱﻧ‬ ‫ﻠ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬-
‫ﺎﻥ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻹ‬ -
Nur singPr ocesswi thl owerur inaryt racti nfect i
on:
Nur singassessment :
-Obt ainheal thhi st ory ,reviewoft hepat ient '
scur rentst atusandsy mpt oms.
-Askaboutv oidingpat terns.
-Assesst hecol orandodoroft heur i
ne.
-Askt hepat ientt odescr ibeanypai nordi scomf or t.
-Askt hepat ientaboutanydr ugal l
er gies.
-Inspectt hel owerabdomenandt hemeat us.
-Pal patet heur inar ybl adderf ordist entionorpai n.
-Rev iewt hepat ient '
sdai lyhygi eneanddi etar ypr act ice.

98
-Askabouttheabili
tytoempt ythebladderatr egularintervalsorwhet her
voi
dingisaft
erdelayedforseveralhours.
-Assessthepati
ent'
slevelofknowl edgeaboutt hedi sorderandt het r
eat ment
andcareneeded.
:‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻔ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.
‫ﺍﺽ‬ ‫ﺮ‬
‫ﺍﻷﻋ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻌ‬
‫ﺍﺟ‬‫ﺮ‬‫ﻣ‬‫ﻭ‬، ‫ﻟﺼﺤﻲ‬ ‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬-
.‫ﻎ‬‫ﻳ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻁ‬‫ﻤ‬‫ﻧ‬‫ﺃ‬‫ﺄﻝﻋﻦ‬ ‫ﺍﺳ‬-
.‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺭ‬‫ﻮﻥﻭ‬ ‫ﻟ‬‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﺎﺝ‬‫ﺯﻋ‬‫ﻭﺇ‬‫ﺃ‬‫ﻟﻢ‬‫ﺃ‬‫ﺃﻱ‬‫ﺃﻥﻳﺼﻒ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐﻣﻦ‬ ‫ﺍﻃ‬-
.
‫ﺀ‬‫ﺍ‬
‫ﻭ‬‫ﺃﻱﺩ‬ ‫ﻩ‬‫ﺎ‬‫ﺔﺗﺠ‬‫ﻴ‬‫ﺎﺳ‬‫ﺃﻱﺣﺴ‬ ‫ﻳ ﺾﻋﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬‫ﻔﺴ‬ ‫ﺘ‬‫ﺍﺳ‬-
.‫ﺎﺥ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﻄﻦﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬ ‫ﻓﺤ ﺺ‬-
.
‫ﻟﻢ‬‫ﺃﺍﻷ‬‫ﺎﺥﻭ‬‫ﻔ‬‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺃﺟﻞ‬ ‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺟﺲ‬-
.
‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﺗ‬‫ﺎ‬
‫ﺭﺳ‬ ‫ﺎ‬
‫ﻤ‬‫ﻣ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬ ‫ﻣ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﺟ‬‫ﺮ‬‫ﻣ‬-
‫ﺓ‬
‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺮ‬
‫ﻴ‬‫ﺄﺧ‬
‫ﺪﺗ‬‫ﻌ‬‫ﺔﺑ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻍ‬
‫ﺮ‬‫ﻓ‬‫ﺘﻢﺇ‬‫ﻭﻫﻞﻳ‬‫ﺃ‬ ‫ﺔ‬‫ﻤ‬
‫ﺘﻈ‬‫ﻨ‬‫ﺍﺕﻣ‬‫ﺮ‬‫ﺘ‬‫ﻠﻰﻓ‬ ‫ﺔﻋ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻍ‬‫ﺮ‬‫ﻓ‬‫ﻠﻰﺇ‬‫ﺓﻋ‬ ‫ﺭ‬
‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺄﻝﻋﻦ‬ ‫ﺍﺳ‬-
.
‫ﺎﺕ‬ ‫ﺎﻋ‬
‫ﺳ‬
.‫ﺔ‬
‫ﻣ‬‫ﺯ‬‫ﺍﻼ‬
‫ﺔﻟ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻌﻼﺝﻭ‬
‫ﻟ‬‫ﺍﺏﺍ‬ ‫ﺮ‬‫ﺎﻻﺿﻄ‬ ‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬‫ﻮﻯﻣ‬ ‫ﺘ‬
‫ﻴﻢﻣﺴ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-

NursingDi agnosi s:
-Acut epainrelatedtoi nfl
ammat i
onandi nfecti
onoftheurethra,bladder,and
otherur i
narytractstructures
-Def i
cientknowl edgerelatedtofactorspredi
sposingthepatienttoinfecti
on
andr ecurrence,detecti
onandpr event i
onofrecurr
ence,andphar macol ogic
therapy
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻛﻞ‬
‫ﺎ‬‫ﻴ‬‫ﺎﻣﻦﻫ‬‫ﺮﻫ‬‫ﻴ‬‫ﺔﻭﻏ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝﻭ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻭﻯﻣﺠ‬‫ﺪ‬‫ﻋ‬‫ﺎﺏﻭ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬‫ﺎ‬‫ﻨ‬
‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬
‫ﺍﻵﻻ‬-
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻭ‬‫ﺭﻫ‬‫ﺍ‬‫ﺮ‬
‫ﻜ‬‫ﻜﺸﻒﻋﻦﺗ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺎ‬
‫ﺭﻫ‬‫ﺍ‬
‫ﺮ‬‫ﻜ‬‫ﺗ‬
‫ﻭﻯﻭ‬ ‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﻳﺾ‬‫ﺮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬‫ﻌ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬ ‫ﻘ‬
‫ﻠ‬‫ﻌ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻘﺺ‬‫ﻧ‬-
.‫ﺋﻲ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭﻌﻼﺝ‬
‫ﻟ‬‫ﺍ‬،‫ﺎ‬‫ﻬ‬
‫ﻨ‬‫ﻣ‬

Planni
ngandGoal s
Majorgoalsforthepati
entmayincl
udereli
efofpainanddiscomf ort
;increased
knowledgeofpreventi
vemeasuresandtreatmentmodali
ti
es; andabsenceof
complicati
ons.
‫ﺍﻑ‬‫ﺪ‬
‫ﺍﻷﻫ‬‫ﻴﻂﻭ‬ ‫ﺘﺨﻄ‬‫ﻟ‬
‫ﺍ‬
‫ﺮﻕ‬‫ﺔﻭﻃ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬
‫ﻓ‬‫ﺮ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬.‫ﺔ‬
‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺪ‬‫ﻋ‬‫ﻟﻢﻭ‬‫ﺍﻷ‬‫ﻴﻒ‬‫ﻔ‬
‫ﻳ ﺾﺗﺨ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺍﻷﻫ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬‫ﻗ‬
.
‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬
‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻴ‬‫ﻏ‬
‫؛ﻭ‬ ‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬

Nursingintervent i
onf orpain:
1.Admi nisteranalgesicsorant i
spasmodi casor dered.
2.Afterawar m sit
ebat htorel
iveperi
neal orsuprapubi
cdi scomfort.
3.Sitzbathsmaybeper formedt wotothreetimes/day .
4.Encour agethepat i
entt odri
nk2t o3Loff l
uid/day .
5.Urinarytractirri
tants( eg,
coffee,t
ea,
citr
us, spi
ces,colas,al
cohol)areavoi
ded
6.Frequentv oiding(ev ery2to3hour s)isencouragedt oempt ythebladder
compl et
ely.

99
 ‫‪:‬‬‫ﻟﻢ‬‫ﻟﻸ‬‫ﻳﻀﻲ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﻠﺐ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻨﺞﺣﺴﺐ‬ ‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻭﻣﻀ‬ ‫ﺃ‬‫ﺎﺕ‬
‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫‪.‬ﺇ‬‫‪1‬‬
‫‪.‬‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻕ‬‫ﻭﻓ‬ ‫ﺃ‬
‫ﻧﻲ‬‫ﺎ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺰﻋ‬
‫ﻧ‬‫ﺍﻻ‬‫ﻴﻒ‬ ‫ﻔ‬
‫ﺘﺨ‬ ‫ﻟ‬
‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻓﺊﻓﻲ‬‫ﺍ‬‫ﻡﺩ‬ ‫ﺎ‬
‫ﻤ‬‫ﺪﺣ‬ ‫ﻌ‬
‫‪.‬ﺑ‬‫‪2‬‬
‫‪.‬‬‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬‫ﺮ‬‫ﻟﻰﺛﻼﺙﻣ‬ ‫ﻴﻦﺇ‬‫ﺗ‬‫ﺮ‬
‫ﺓﻣ‬ ‫ﺪ‬‫ﻌ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﺎ‬
‫ﻤ‬‫ﺀﺣ‬‫ﺍ‬‫ﺮ‬‫ﻜﻦﺇﺟ‬‫ﻤ‬‫‪.‬ﻳ‬‫‪3‬‬
‫‪.‬‬
‫ﻡ‬‫ﻮ‬‫ﺋﻞ‪/‬ﻳ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺍﺕﻣﻦ‬ ‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﻟﻰ‪3‬‬ ‫ﺮﺏ‪2‬ﺇ‬ ‫ﻠﻰﺷ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫‪.‬ﺷﺠ‬ ‫‪4‬‬
‫(‬
‫ﻮﻝ‬‫ﻜﺤ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﻻﻭ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺑﻞﻭ‬
‫ﺍ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕﻭ‬‫ﻴ‬‫ﻤﻀ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻱﻭ‬‫ﻟﺸ‬‫ﺍ‬
‫ﺓﻭ‬‫ﻮ‬‫ﻬ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬‫ﺔ)‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻴﺠ‬‫ﻬ‬‫ﻨﺐﻣ‬ ‫‪.‬ﺗﺠ‬‫‪5‬‬
‫‪.‬‬
‫ﺎ‬‫ً‬
‫ﻣ‬‫ﺎ‬
‫ﻤ‬‫ﺔﺗ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻎ‬‫ﻳ‬‫ﺮ‬‫ﻔ‬
‫ﺘ‬‫ﻟ‬‫(‬‫ﺎﺕ‬
‫ﺎﻋ‬‫ﻟﻰ‪3‬ﺳ‬ ‫)ﻞ‪2‬ﺇ‬‫ﺭﻛ‬ ‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻍ‬‫ﺮ‬
‫ﻓ‬‫ﺍﻹ‬‫ﻊ‬‫ﻴ‬‫ﺘﻢﺗﺸﺠ‬‫‪.‬ﻳ‬‫‪6‬‬

‫‪Py‬‬
‫‪el‬‬‫‪onephr‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬

‫‪Def‬‬ ‫‪i‬‬‫‪ni‬‬
‫‪t‬‬‫‪i‬‬‫‪on:‬‬
‫‪Py‬‬ ‫‪el‬‬‫‪onephr‬‬ ‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪si‬‬‫‪sani‬‬ ‫‪nf‬‬‫‪l‬‬‫‪ammat‬‬ ‫‪or‬‬‫‪ypr‬‬‫‪ocessoft‬‬ ‫‪her‬‬ ‫‪enal‬‬ ‫‪pel‬‬ ‫‪v‬‬‫‪i‬‬
‫‪sandpar‬‬ ‫‪enchy‬‬ ‫‪ma‬‬
‫‪oft‬‬ ‫‪heki‬‬ ‫‪dney‬‬ ‫‪,‬‬
‫‪t‬‬‫‪hei‬‬ ‫‪nf‬‬ ‫‪l‬‬
‫‪ammat‬‬ ‫‪or‬‬‫‪ypr‬‬ ‫‪ocessi‬‬ ‫‪scausedbyt‬‬ ‫‪henor‬‬ ‫‪mal‬‬ ‫‪i‬‬
‫‪nhabi‬‬ ‫‪t‬‬‫‪ant‬‬ ‫‪sof‬‬
‫‪t‬‬‫‪hei‬‬ ‫‪nt‬‬‫‪est‬‬‫‪i‬‬
‫‪nal‬‬ ‫‪t‬‬‫‪r‬‬‫"‪act‬‬‫‪e.‬‬‫‪g.E.col‬‬ ‫‪i‬‬
‫"‬‫‪.‬‬
‫‪-I‬‬‫‪tmaybedev‬‬ ‫‪el‬‬‫‪opedv‬‬ ‫‪i‬‬‫‪at‬‬ ‫‪heascendi‬‬ ‫‪ngr‬‬ ‫‪out‬‬ ‫‪ef‬‬‫‪ol‬‬‫‪l‬‬‫‪owi‬‬‫‪ngcy‬‬ ‫‪st‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪sort‬‬ ‫‪hr‬‬‫‪oughbl‬‬ ‫‪ood‬‬
‫‪suppl‬‬ ‫‪y‬‬‫‪.‬‬
‫‪-I‬‬‫‪si‬‬ ‫‪sf‬‬‫‪r‬‬‫‪equent‬‬ ‫‪l‬‬‫‪ysecondar‬‬ ‫‪yt‬‬‫‪our‬‬‫‪et‬‬‫‪er‬‬‫‪ov‬‬‫‪esi‬‬‫‪cal‬‬ ‫‪r‬‬
‫‪ef‬‬‫‪l‬‬‫‪ux,‬‬‫‪i‬‬‫‪nwhi‬‬ ‫‪chani‬‬ ‫‪ncompet‬‬ ‫‪ent‬‬
‫‪ur‬‬‫‪et‬‬‫‪er‬‬‫‪ov‬‬ ‫‪esi‬‬‫‪cal‬‬‫‪v‬‬ ‫‪al‬‬‫‪v‬‬‫‪eal‬‬ ‫‪l‬‬
‫‪owst‬‬ ‫‪heur‬‬‫‪i‬‬‫‪net‬‬ ‫(‪obackup‬‬ ‫‪r‬‬‫‪ef‬‬‫‪l‬‬‫‪ux)i‬‬ ‫‪nt‬‬‫‪ot‬‬‫‪heur‬‬ ‫‪et‬‬‫‪er‬‬‫‪s,‬‬‫‪Ur‬‬ ‫‪i‬‬‫‪nar‬‬‫‪y‬‬
‫‪t‬‬‫‪r‬‬‫‪actobst‬‬ ‫‪r‬‬‫‪uct‬‬‫‪i‬‬‫‪on,‬‬ ‫‪bl‬‬‫‪addert‬‬ ‫‪umor‬‬ ‫‪s,‬‬‫‪st‬‬‫‪r‬‬‫‪i‬‬
‫‪ct‬‬‫‪ur‬‬‫‪es,‬‬ ‫‪beni‬‬ ‫‪gnpr‬‬ ‫‪ost‬‬ ‫‪at‬‬‫‪i‬‬
‫‪chy‬‬ ‫‪per‬‬‫‪pl‬‬‫‪asi‬‬‫‪a,‬‬ ‫‪and‬‬
‫‪ur‬‬‫‪i‬‬‫‪nar‬‬‫‪yst‬‬ ‫‪onesar‬‬ ‫‪esomeoft‬‬ ‫‪heot‬‬‫‪hercauses.‬‬
‫‪-I‬‬‫‪tmaybeacut‬‬ ‫‪eorchr‬‬ ‫‪oni‬‬ ‫"‪c‬‬‫‪chr‬‬‫‪oni‬‬‫‪cPy‬‬ ‫‪el‬‬‫‪onephr‬‬ ‫‪i‬‬‫‪t‬‬‫‪i‬‬‫‪si‬‬‫‪sal‬‬ ‫‪socal‬‬ ‫‪l‬‬
‫‪edi‬‬ ‫‪nt‬‬‫‪er‬‬‫‪st‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪al‬‬
‫‪nephr‬‬ ‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫"‪s‬‬‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫‪:‬‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﺍﻻ‬‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺗﺤ‬ ‫‪،‬ﻭ‬‫ﻠﻰ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻤ‬‫ﻮﻱﻭﺣ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻮﺽ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﻴﺐ‬ ‫ﺔﺗﺼ‬ ‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬ ‫ﻠ‬
‫ﻤ‬ ‫ﻮﻋ‬‫ﺔﻫ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫"‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﻮ‬‫ﻟ‬
‫ﻮ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻳ‬
‫ﺮ‬‫ﺍﻹﺷ‬ ‫ﺜﻞ‬‫ﻣ‬ ‫ﺔ"‬‫ﻳ‬‫ﻮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺎ‬‫ﻨ‬‫ﻘ‬‫ﻠ‬
‫ﻟ‬ ‫ﻴﻦ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺎﻥ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺒﺐ‬ ‫ﺔﺑﺴ‬ ‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬
‫‪.‬‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬ ‫ﻣ‬‫ﻭﻣﻦﺧﻼﻝﺇ‬ ‫ﺃ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺪﻱﺑ‬ ‫ﺎﻋ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻩﻋﻦﻃ‬ ‫ﺮ‬‫ﻳ‬
‫ﻮ‬ ‫ﻜﻦﺗﻄ‬ ‫ﻤ‬‫‪-‬ﻳ‬
‫ﻮﻝ‬ ‫ﺒ‬‫ﻠ‬
‫ﻟ‬‫ﺀ‬‫ﻜﻒ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬ ‫ﻠﻲﻏ‬ ‫ﻳ‬‫ﻮ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺒﻲ‬‫ﻟ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﻤﺢ‬‫ﻴﺚﻳﺴ‬ ‫‪،‬ﺣ‬ ‫ﻧﻲ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻲ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺎﻉ‬‫ﺗﺠ‬‫ﺭ‬‫ﻟﻼ‬‫ﺎ‬
‫ً‬
‫ﻳ‬‫ﻮ‬ ‫ﻧ‬
‫ﺎ‬‫ﻮﻥﺛ‬‫ﻜ‬‫ﺎﻳ‬ ‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫‪-‬ﺎ‬
‫ﺗﻀﺨﻢ‬ ‫‪،‬ﻭ‬‫ﺎﺕ‬ ‫ﻘ‬‫ﻴ‬‫ﺘﻀ‬ ‫ﻟ‬
‫ﺍ‬‫‪،‬ﻭ‬ ‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺃ‬‫‪،‬ﻭ‬‫ﺔ‬ ‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬‫‪،‬ﻭ‬ ‫ﻟﺐ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻟﻰ‬‫(ﺇ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬
‫ﺗ‬‫ﺭ‬‫ﺍﻻ‬‫ﻮﻉ)‬ ‫ﺮﺟ‬‫ﻟ‬‫ﺎ‬
‫ﺑ‬
‫ﺮﻯ‪.‬‬‫ﺍﻷﺧ‬‫ﺎﺏ‬ ‫ﺒ‬
‫ﺍﻷﺳ‬ ‫ﻌﺾ‬ ‫ﺔﻫﻲﺑ‬ ‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫‪،‬ﻭﺣﺼﻰ‬ ‫ﺪ‬‫ﻴ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎ‬‫ﺗ‬
‫ﺎ‬‫ﺘ‬‫ﻭﺳ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﻣﻦ‬ ‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬ ‫ﺍ‬
‫ﻟ"‬
‫ﻟﺨﻼﻲ‬ ‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻰ‬ ‫ﻣﻦﻳﺴ‬ ‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥ"‬ ‫ﻜ‬ ‫ﺪﻳ‬‫‪-‬ﻗ‬

‫‪100‬‬
ChronicPy elonephr i
tis AcutePy elonephriti
s I
tems
‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳﻀ‬ ‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻏ‬‫ﺃ‬
Cli
nicalManif
estat
ion
-Historyofr ecur rentacute Fev er,chill
s,fl
ankorl ow Compl i
cat
ions
i
nfectionl eadingt opr ogr
essive backpai n, nauseaand ‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬
destr
uct ionsoff uncti
oning vomi t
ing,headache, malaise, ‫ﺎﺕ‬
‫ﻔ‬‫ﻋ‬ ‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
nephronsr esultinginchronic andpai nful ur
inati
on.
renalinsuf f
iciency . Physical exami nati
onr eveal
s
-Duringact i
vei nfecti
on,uri
ne painandt endernessi nthe
cult
urei sposi ti
v eand areaoft hecost ov
ertebral
l
eukocy tesar ef ound. angles

-Fati
gue, Headache. (CVA)
-Poorappet i
te.-Polyuria. chronicpyelonephriti
s
-Excessi
v ethir
standwei ght ‫ﺓ‬‫ﺮ‬‫ﺎﺻ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻡﻓﻲ‬ ‫ﺁﻻ‬ ،‫ﺓ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻌ‬‫ﻗﺸ‬،‫ﻤﻰ‬‫•ﺣ‬
l
oss. ‫ﺍﻉ‬‫ﺪ‬
‫ﺻ‬، ‫ﺀ‬‫ﻗﻲ‬ ‫ﺎﻥﻭ‬‫ﻴ‬‫ﺜ‬
‫ﻏ‬، ‫ﺮ‬‫ﻬ‬
‫ﻟﻈ‬‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬‫ﻭ‬‫ﺃ‬
-Endstager enal di
sease. ‫ﻜﺸﻒ‬‫ﻳ‬.‫ﻮﻝ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻟﻢﻋ‬‫ﺃ‬‫ﻭ‬،‫ﻋﻚ‬‫ﻮ‬‫ﺗ‬،
-Hy per
tension. ‫ﺎﻥﻓﻲ‬‫ﻨ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻟﻢﻭ‬‫ﻋﺍﻷ‬
‫ﻧﻲ ﻦ‬ ‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻔﺤ ﺺ‬ ‫ﻟ‬
‫ﺍ‬
-Formationofki dneystones. ‫ﺔ‬ ‫ﻴ‬
‫ﻌ‬‫ﻠ‬‫ﻟﻀ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺍ‬
‫ﻭ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻣ‬
‫ﺘﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺮ‬
‫ﻜ‬ ‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺦﻣﻦ‬ ‫ﺭ‬‫ﺎ‬
‫ﺗ‬-
‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻠ‬‫ﻟ‬
‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬‫ﺮﺗ‬‫ﻴ‬
‫ﻣ‬‫ﺪ‬ ‫ﻟﻰﺗ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺗ‬ (CVA)
.
‫ﻣﻦ‬‫ﺰ‬‫ﻮﻱﻣ‬ ‫ﻠ‬
‫ﺭﻛ‬‫ﻮ‬‫ﻟﻰﻗﺼ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬ ‫ﻤ‬‫ﺔﻣ‬‫ﻠ‬‫ﻣ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﻦ‬‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻳﻀ‬ ‫ﻮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻋ‬‫ﺭ‬‫ﺰ‬
‫ﻮﻥﻣ‬ ‫ﻜ‬
‫ﺗ‬، ‫ﺔ‬‫ﻨﺸﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬-
.‫ﻴﺾ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻮﺟ‬‫ﺗ‬‫ﺔﻭ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬‫ﻳﺠ‬‫ﻮﻝﺇ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻌﺐﻭ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺎ‬
‫ﻳ‬‫ﺭ‬
‫ﻮ‬ ‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺑ‬-.
‫ﺔ‬‫ﻴ‬‫ﻬ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻌﻒ‬‫ﺿ‬-
.‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬‫ﺪﻭ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻌﻄﺶ‬ ‫ﻟ‬
‫ﺍ‬-
.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﺔﻣﻦﻣ‬ ‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻬ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬-
.
‫ﻠﻰ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﻮﻥﺣﺼ‬ ‫ﻜ‬‫ﺗ‬-
Medi
cal
Measures
-Ant ibiot ics. -Ant i
bioti
csare ‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬
-Agent st hatsuppr esst he admi nist
ered.
format i
onofnewbact eria. -Follow-upculturetoensur e
-Ur i
nar yant i
sept i
cssuchas thaturineissteril
e.
"sulfonami des"or -Ant i
spasmodi csmaybe
"nit
rof ur ant i
on"maybe prescribedtoallevi
ate
admi ni st ered. bladderspasm.
-Ant ihy per t
ensi vedr ugs. -Anyobst r
ucti
onmustbe
-Sur gical cor r
ect i
onof surgicall
yremov ed.
structur al abnor mal i
ti
es. .
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺪ‬‫ﺗ‬-
-Ifend- st ager enal failure ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻥ‬‫ﺪﻣﻦ‬ ‫ﻛ‬‫ﺄ‬
‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﺭﻉ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺑ‬
‫ﺎ‬‫ﺘ‬‫ﻣ‬-
dev elops, dialysisor .
‫ﻘﻢ‬‫ﻌ‬‫ﻣ‬
transpl ant ati
onwi l
lbe ‫ﻨﺞ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻜﻦﻭﺻﻒﻣﻀ‬ ‫ﻤ‬‫ﻳ‬-
necessar y .
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺞ‬‫ﻴﻒﻣﻦﺗﺸ‬ ‫ﻔ‬‫ﺘﺨ‬‫ﻠ‬
‫ﻟ‬
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﺍﺕﺣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻣﻀ‬- .‫ﺎ‬ً
‫ﻴ‬
‫ﺍﺣ‬‫ﺮ‬‫ﺋﻖﺟ‬‫ﺎ‬‫ﺃﻱﻋ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﻳﺠﺐﺇ‬-
‫ﺎ‬
‫ﻳ‬‫ﺮ‬ ‫ﻴ‬‫ﺘ‬‫ﻜ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬‫ﺒﻂﺗ‬ ‫ﺜ‬‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺓ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺜﻞ‬ ‫ﺔﻣ‬ ‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺮ‬‫ﻬ‬‫ﻤﻄ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬ ‫ﺎ‬
‫ﻋﻄ‬ ‫ﻜﻦﺇ‬‫ﻤ‬‫ﻳ‬-
."
‫ﻮﻥ‬ ‫ﻴ‬‫ﺘ‬‫ﻧ‬‫ﺭ‬‫ﺍ‬‫ﻮ‬ ‫ﻓ‬‫ﻭ‬‫ﺮ‬
‫ﺘ‬‫ﻴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬"‫ﺃ‬
‫"ﻭ‬ ‫ﺍﺕ‬ ‫ﺪ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻧ‬‫ﻮ‬
‫ﻔ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬
"
.‫ﻐﻂ‬ ‫ﻠﻀ‬‫ﻟ‬‫ﺔ‬‫ﻓﻀ‬ ‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬-
.
‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻮﻫ‬‫ﺘﺸ‬‫ﻠ‬‫ﻟ‬‫ﺍﺣﻲ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﺢ‬ ‫ﺘﺼﺤ‬ ‫ﻟ‬
‫ﺍ‬-
‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻬ‬
‫ﻮﻱﻓﻲﻧ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺣﺔﺗﻄ‬‫ﻟ‬‫ﻓﻲ ﺎ‬-
‫ﻴﻞ‬‫ﺭﻱﻏﺴ‬ ‫ﻭ‬‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻜ‬‫ﻴ‬‫ﺳ‬، ‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺭﻉ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬

101
Nur singmeasur es:
-Assi stt
hepat i
entwithsuchbasi ccareneedsasHy gi
ene,nutr
it
ion,el
iminati
on,
restandsl eep.
-Fluidbalanceshouldbemoni t
oredandr ecordeddaily
.
-Ant i
bioti
csshouldbeadmi nist
er edtoensurethatappropri
ate24hour sblood
l
ev elsareachieved.
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬
‫ﺗ‬
‫ﺔﻭ‬ ‫ﺍﺣ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻭ‬‫ﺎ‬‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻓ‬‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﺔﻣ‬‫ﻴ‬‫ﺎﺳ‬
‫ﺍﻷﺳ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬‫ﺔ‬
‫ﻴ‬‫ﺒ‬‫ﻠ‬
‫ﻳ ﺾﻓﻲﺗ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻣﺴ‬-
.‫ﻡ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺎ‬ً
‫ﻴ‬
‫ﻣ‬‫ﻮ‬‫ﻪﻳ‬‫ﻠ‬‫ﻴ‬
‫ﺗﺴﺠ‬‫ﺋﻞﻭ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺯﻥ‬‫ﺍ‬
‫ﻮ‬‫ﺔﺗ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻳﺠﺐﻣ‬-
.
‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬24‫ﺓ‬ ‫ﺪ‬‫ﻤ‬
‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻟﻰﻣﺴ‬‫ﻮﻝﺇ‬‫ﻮﺻ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻋﻄ‬‫ﻳﺠﺐﺇ‬-

Uni
t3:Ur
inar
yst
ones(
urol
it
hiasi
s)ur
inar
ycal
cul
i
LearningObject
ives:
Attheendoft hi
slect ur
e,thest udentswillbeableto:
1-Diff
erenti
atedif
ferenttypesofur inarystones.
2-Describecausesandpr edisposingf actorsforur
inar
ystone.
3-Assessclini
calmani f
estationsofur i
nar yst
ones.
4-Specifydi
agnosticevaluati
onf orur i
narystone.
5-Discussmedical andnur si
ngmanagementf oruri
naryst
one.

‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬
‫ﻮ‬‫(ﺣﺼ‬
‫ﻟﻲ‬‫ﻮ‬‫ﺗﺤ ﺺﺑ‬)‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺣﺼ‬: 3‫ﺓ‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻠﻰ‬‫ﻳﻦﻋ‬‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﻟﻄﻼﺏﻗ‬‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﻴ‬
‫ﺓﺳ‬ ‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺔﻣﻦﺣﺼ‬ ‫ﻔ‬
‫ﻠ‬‫ﺘ‬‫ﺍﻉﻣﺨ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬‫ﻴﻦ‬‫ﻳﻖﺑ‬‫ﺮ‬‫ﻔ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬-
1
.‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺔ‬‫ﺒ‬‫ﺆﻫ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺏﻭ‬ ‫ﺒ‬‫ﺍﻷﺳ‬‫ﻭﺻﻒ‬- 2
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
3
.‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﺤﺼﻰ‬ ‫ﻟ‬
‫ﻴﺼﻲ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-4
.‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺤﺼﻰ‬ ‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬-5

102
Obst
ruct
ivedi
sor
ders
Uri
nar
ystones(
urol
it
hiasi
s)ur
inar
ycal
cul
i
Definit
ion:
Uri
nar ycalcul
i r
efertopresenceandf ormationofst onesi nt heur i
nar ytr
actby
depositofcr ystal
l
inesubstances( cal
cium,phosphor ,ox alate,uri
caci d)which
excretedintheur i
ne.(75%ofst onescont ai
ncalcium) .
Causesandr iskfactors:
Thecausesf orstonef or
mat ionisunknownbutt herear emanyf actorshelpin
developmentofur i
narycalculiincl
uding:
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍﻻ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬
(‫ﻟﻲ‬‫ﻮ‬‫ﺗﺤ ﺺﺑ‬ )‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺣﺼ‬
:
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺳﺐ‬ ‫ﻳﻖﺗ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﻮ‬‫ﻴﻞﺣﺼ‬ ‫ﻜ‬‫ﺗﺸ‬
‫ﺩﻭ‬ ‫ﻮ‬
‫ﻟﻰﻭﺟ‬ ‫ﺔﺇ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺮﺣﺼ‬ ‫ﻴ‬‫ﺗﺸ‬
‫ﺭ‬
‫ﺎ‬‫ﻣﺍﻷﺣﺠ‬‫ﻦ‬٪ 75).‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻓﻲ‬‫ﺮ‬‫ﻔ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬(‫ﻴﻚ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﻛﺎﻻﺕﻭﺣ‬‫ﺍﻷﺴ‬ ‫ﺭﻭ‬ ‫ﻮ‬‫ﻔ‬‫ﻮﺳ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫)ﻜ‬
‫ﻟ‬
‫ﺔﺍ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬
.(
‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻮﻱﻋ‬ ‫ﺘ‬‫ﺗﺤ‬
:‫ﺮ‬
‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫ﺎﺏﻭ‬ ‫ﺒ‬‫ﺍﻷﺳ‬
‫ﺍﺕ‬ ‫ﻮ‬‫ﺮﺣﺼ‬ ‫ﻳ‬‫ﻮ‬‫ﺪﻓﻲﺗﻄ‬ ‫ﺎﻋ‬
‫ﺘﻲﺗﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻣﻦ‬‫ﻳ‬‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻙ‬‫ﻨ‬‫ﻜﻦﻫ‬‫ﻟ‬‫ﺔﻭ‬‫ﻓ‬‫ﻭ‬‫ﺮ‬ ‫ﻌ‬‫ﺮﻣ‬ ‫ﻴ‬‫ﺍﺕﻏ‬‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﺏﺗ‬‫ﺒ‬‫ﺃﺳ‬
:‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬
‫ﺔﺑ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬

Diet
:
1.Highintakeofprot
eins,cal
cium cont
aini
ngf oodl
i
kemilk.
2.Excessiveconsumptionofcitr
usfrui
ts,i
ntakeofvi
tami
nD.
3.Vit
ami nAdefici
ency.

Metabolic:
1.Hypercal
cemiaandhy per
cal
ciuri
a.
2.Hyperuri
cosuri
a incr
easeduricaci
dinur
ine.
3.Metaboli
cacidosi
s.
:
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﺣ‬
.
‫ﻴﺐ‬‫ﻠ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺜﻞ‬‫ﺔﻣ‬
‫ﻳ‬‫ﺬ‬‫ﺃﻏ‬
‫ﻠﻰ‬‫ﻮﻱﻋ‬
‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻭﻜ‬
‫ﻟ‬
‫ﺎﺕﺍ‬ ‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﺎﺕﻛ‬‫ﻴ‬‫ﻤ‬‫ﻭﻝﻛ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬.1
.‫ﻴﻦﺩ‬
‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻭﻝﻓ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬،‫ﺎﺕ‬‫ﻴ‬‫ﻤﻀ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺍﻁﻓﻲﺗ‬ ‫ﺮ‬
‫ﻓ‬‫ﺍﻹ‬.2
.
‫ﺃ‬‫ﻴﻦ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻘ ﺺﻓ‬‫ﻧ‬.3
:
‫ﻳﺾ‬ ‫ﺍﻷ‬
.
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺎ‬
‫ﺮﻁﻛ‬ ‫ﻓ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﻮ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﺮﻁﻛ‬ ‫ﻓ‬.1
.‫ﻮﻝ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻚﻓﻲ‬‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬‫ﺓﺣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻳﻚﺯ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﺮﻁﺣ‬ ‫ﻓ‬.2
.
‫ﻳﻀﻲ‬ ‫ﺍﻷ‬‫ﺎﺽ‬ ‫ﻤ‬
‫ﻟﺤ‬‫ﺍ‬.3
Disease:
1.Gout-hyperur
icosur
ia.
2.Leukemia-
polycyt
hemia-ptr
ecei
vedchemot
her
apy ur
icaci
dinur
ine.

103
3.Dehydr
ati
on:uri
neisconcentratedwhichencouragespr eci
pitati
onofsol ids.
:‫ﺮﺽ‬ ‫ﻣ‬
.
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻚﻓﻲ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﺮﻁﺣ‬ ‫ﻓ‬-‫ﺮﺱ‬ ‫ﻘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬.1
.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻚﻓﻲ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﺋﻲ ﺣ‬ ‫ﺎ‬‫ﻴ‬
‫ﻤ‬‫ﻴ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬ PT‫ﻘﺖ‬ ‫ﻠ‬
‫ﺗ‬-‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﺜ‬‫ﻛ‬-‫ﺎ‬‫ﻴ‬‫ﻤ‬
‫ﻴ‬‫ﻛ‬‫ﻮ‬ ‫ﻠ‬
‫ﻟ‬
‫ﺍ‬.2
‫ﺔ‬ ‫ﺒ‬
‫ﻠ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﺮﺳ‬‫ﻠﻰﺗ‬‫ﻊﻋ‬‫ﺎﻳﺸﺠ‬‫ﻤ‬‫ﻮﻝﻣ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻛ‬
‫ﺮ‬‫ﺘ‬‫ﻳ‬:‫ﺎﻑ‬‫ﻔ‬‫ﻟﺠ‬‫ﺍ‬.
3.
Uri
narytr
acti
nfect
ions:anyfor
eignbodyi nUTser vesassur f
acef or
devel
opmentofurinaryst
ones.
‫ﺍﺕ‬‫ﻮ‬‫ﻮﻥﺣﺼ‬
ّ‫ﻜ‬‫ﺘ‬
‫ﻟ‬‫ﻤﻞﻛﺴﻄﺢ‬ ‫ﻌ‬‫ﺔﻳ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻳﺐﻓﻲ‬‫ﺮ‬‫ﺃﻱﺟﺴﻢﻏ‬ :
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬

Mechanical:
1.Uri
narystasi
s facil
it
ati
ngpr ecipit
ati
onofsal
tsf
rom t
heur
ine.
2.I
mmobi li
zati
on:
Ur i
narystasis.
3.Obstr
ucti
oninurinar
ytract:e.g.tumour.
:‫ﻜﻲ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻜ‬
‫ﻴ‬‫ﻣ‬
.‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻣﻼﺡﻣﻦ‬
‫ﺍﻷ‬‫ﻴﺐ‬‫ﺮﺳ‬‫ﻬﻞﺗ‬‫ﻮﻝ ﻳﺴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬
‫ﻛ‬‫ﺭ‬.1
.‫ﻮﻝ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺩ‬‫ﻮ‬‫ﻛ‬‫ﺭ‬:
‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
.2
‫ﻡ‬
‫ﺭ‬‫ﺎﻝﻭ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬
‫ﻋ‬:‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬ ‫ﻟﻚ‬
‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻓﻲ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬.
3.
Heredit
y:
Familyhi
stor
yofst
onef
ormat
ion,
e.g.cy
sti
nest
ones.
:‫ﺔ‬‫ﺛ‬
‫ﺍ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
.
‫ﻴﻦ‬‫ﺘ‬
‫ﻴﺴ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺍﺕ‬
‫ﻮ‬‫ﺎﻝﺣﺼ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﺒ‬‫ﻠﻰﺳ‬
‫ﻋ‬،‫ﺍﺕ‬
‫ﻮ‬‫ﻟﺤﺼ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﻜ‬‫ﺘﺸ‬
‫ﻟ‬‫ﻠﻲ‬
‫ﺋ‬‫ﺎ‬
‫ﻳﺦﻋ‬‫ﺭ‬‫ﺎ‬‫ﺗ‬
Ty
pesofRenalSt
ones:
Typeofstone % Composi
ti
on

Cal
cium 70 Har
dcry
stal
sofcal
cium oxal
ate,
–80% i
nsol
ubl
ephosphat
esalt
,orboth
‫ﻠﺢ‬
‫ﻭﻣ‬‫ﺃ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬‫ﻛﺴ‬
‫ﺃ‬‫ﺔﻣﻦ‬ ‫ﺒ‬
‫ﻠ‬‫ﺍﺕ ﺻ‬‫ﺭ‬
‫ﻮ‬‫ﻠ‬‫ﺑ‬
‫ﺎ‬
‫ﻤ‬‫ﻬ‬‫ﻴ‬
‫ﻠ‬‫ﻭﻛ‬‫ﺃ‬‫ﺎﻥ‬‫ﺑ‬
‫ﻭ‬‫ﺬ‬‫ﻠ‬
‫ﻟ‬‫ﺑﻞ‬
‫ﺎ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺎﺕﻏ‬ ‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
St
urv
ite Crystalizedmagnesium and
‫ﻴﺖ‬
‫ﻓ‬‫ﻭ‬‫ﺮ‬
‫ﺘ‬‫ﺳ‬ 20% ammonia
Commonaci dicby -
product
softhe
bacterialbreakdownofurea

‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺘﺠ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.‫ﺎ‬
‫ﻴ‬‫ﻧ‬
‫ﻮ‬‫ﻣ‬‫ﺍﻷ‬‫ﻡﻭ‬‫ﻮ‬‫ﻴ‬
‫ﻴﺴ‬‫ﻨ‬‫ﻐ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﺑ‬
‫ﺎ‬
‫ﻳ‬‫ﺭ‬‫ﻮ‬
‫ﻴ‬‫ﻠ‬‫ﻟ‬
‫ﺮﻱ‬‫ﻴ‬‫ﺘ‬‫ﻜ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻞ‬‫ﺘﺤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻌ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤﻀ‬
‫ﻟﺤ‬‫ﺍ‬
Cy
sti
ne Aminoacidfoundinnerves,
‫ﻴﻦ‬‫ﺘ‬
‫ﻴﺴ‬‫ﺳ‬ 1–2% muscl
es,andotherbodyt
issues
‫ﻌﻀﻼﺕ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺏﻭ‬
‫ﺍﻷﻋﺼ‬
‫ﺓﻓﻲ‬
‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﻣ‬
‫ﺍﻷ‬‫ﺎﺽ‬‫ﻤ‬
‫ﺍﻷﺣ‬
‫ﺮﻯ‬
‫ﺍﻷﺧ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬
‫ﻭ‬
Thebodypr
oductsur
icaci
dwheni
t
Ur
icAci
d 5–13% br
eaksdownpr
otei
n
‫ﻳﻚ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬
‫ﺣ‬ ‫ﻴﻦ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬
‫ﺎﻳ‬‫ﻣ‬
‫ﺪ‬‫ﻨ‬‫ﻴﻚﻋ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻤﺾ‬‫ﻟﺠﺴﻢﺣ‬
‫ﺍ‬‫ﺘﺞ‬
‫ﻨ‬‫ﻳ‬
Commonsi
tesofst
onef
ormat
ion(
seeFi
g.26)
:
-Uret
ropelv
icj
uncti
on.
-Uret
ruvesi
calj
uncti
on.
-Lowerpartofur
eter.

104
-Bl
adderneck.
-Ur
ethr
alcanal
.

(
Fig.
30)si
tesofst
onef
ormat
ion

Pathophy si
ology :
1.Pathophy siologicconsequencesofcal culiari
sef r
om t heirpotenti
alto
obstr
uctt heur i
nar ytract.
2.Obstructi
onl eadst opr essureonthener v ecausingpai n.
3.Aslightmov ementofst oneatitssiteleadt oinj
urytobl oodcapill
ari
es
l
eadingt ohaemat uria.
4.Obstructi
onofur i
nar ypassageleadst our inarystasiswhi chincreasesthe
ri
skofur i
nar ytractinf ecti
on.
:
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻋ‬‫ﻬ‬
‫ﺗ‬‫ﺭ‬‫ﺪ‬‫ﺄﻣﻦﻗ‬ ‫ﻨﺸ‬‫ﺎﺕﺗ‬‫ﺑ‬‫ﺎ‬
‫ﻠﺤﺼ‬‫ﻟ‬‫ﺔ‬ ‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬.
1
.
‫ﻟﻢ‬‫ﺍﻷ‬ً
‫ﺎ‬‫ﺒ‬‫ﺒ‬
‫ﻌﺼﺐﻣﺴ‬ ‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺩﻳ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍﻻ‬.
2
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬‫ﻠ‬‫ﻴ‬‫ﻟﻰﺑ‬‫ﺩﻱﺇ‬‫ﺆ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﺔﻣ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻰﺇﺻ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﻪﺗ‬‫ﻌ‬‫ﻗ‬‫ﻮ‬ ‫ﺮﻓﻲﻣ‬ ‫ﻠﺤﺠ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺔﺻ‬‫ﻛ‬‫ﺮ‬‫ﺣ‬.3
.‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬ ‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬ ‫ﻌ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﺪﻣﻦﺧﻄ‬ ‫ﻳ‬‫ﺰ‬‫ﺎﻳ‬‫ﻤ‬‫ﻮﻝﻣ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺩ‬‫ﻮ‬‫ﻛ‬‫ﻟﻰﺭ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﻮﻝﻳ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺩﻣﺠ‬ ‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬.
4

Cli
nicalManifestation:
1.Renalcoli
c:intense, i
ntermitt
entandl ocat i
onofpai ndif
feraccordingt osite
ofstoneswhicht rav elf
rom fl
ankar ea,supr apubicangleandex t
ernal genit
alia.
2.Hemat uri
a:mi croscopic.
3.Dysuri
a&hesi tancy .
4.S&Sofobst ruct i
on:Ur i
naryretenti
on, oli
guria.
5.GITdistur
bances:nausea, vomi ti
ng,distension.
6.S&SofUTI :Fev er,chil
l
s,pyuria,bacteriuri
a,
:‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻘﻞﻣﻦﻣ‬ ‫ﺘ‬‫ﻨ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﻮ‬‫ﻟﺤﺼ‬‫ﺍ‬‫ﻊ‬
‫ﻗ‬‫ﻮ‬‫ﺘﻼﻑﻣ‬ ‫ﺎﺧ‬
‫ﻠﻒﺑ‬ ‫ﺘ‬
‫ﻊﻳﺨ‬ ‫ﻗ‬‫ﻮ‬
‫ﻣ‬‫ﻊﻭ‬‫ﻘﻄ‬‫ﺘ‬‫ﻣ‬‫ﺪﻭ‬‫ﻳ‬‫ﺪ‬‫ﻟﻢﺷ‬‫ﺍﻷ‬:‫ﻮﻱ‬‫ﻠ‬‫ﻐ ﺺﻛ‬‫ﻣ‬. 1
.
‫ﺔ‬‫ﻴ‬‫ﺭﺟ‬‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺎﺳ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﺍﻷﻋﻀ‬‫ﺔﻭ‬‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻕ‬‫ﺔﻓ‬‫ﻳ‬‫ﻭ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬‫ﺮ‬‫ﺎﺻ‬ ‫ﻟﺨ‬
‫ﺍ‬
.‫ﺮﻱ‬‫ﻬ‬
‫ﻣﺠ‬: ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻠ‬
‫ﻴ‬‫ﺑ‬.2
.‫ﺩ‬
‫ﺩ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬. 3

105
 .‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻠ‬‫ﻗ‬،‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺣ‬ :
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﻟﻼ‬S&S.4
.
‫ﺎﺥ‬‫ﻔ‬‫ﺘ‬
‫ﻧ‬‫ﺍ‬،
‫ﺀ‬‫ﻗﻲ‬، ‫ﺎﻥ‬
‫ﻴ‬‫ﺜ‬‫ﻏ‬:‫ﻤﻲ‬
‫ﻬﻀ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﺍﺿﻄ‬
.5
،
‫ﺔ‬‫ﻴ‬‫ﻣ‬
‫ﻮ‬‫ﺛ‬‫ﺮ‬
‫ﺔﺟ‬‫ﻠ‬
‫ﻴ‬‫ﺑ‬،
‫ﺔ‬‫ﻠ‬‫ﻴ‬
‫ﺑ‬،‫ﺓ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻌ‬‫ﻗﺸ‬،‫ﻤﻰ‬‫ﺣ‬: ‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬S&S.6

Complicati
ons:
7.Haemor rhage&bleedi
ngi
nurinar
ytr
act
.
8.Anaemia.
9.U.tr
actinfecti
on.
10.Hydronephrosis,
hydr
our
eter
.
11.Renalfail
ure.
:‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬
‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
.‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻒﻓﻲ‬‫ﺰ‬‫ﻧ‬
‫ﻳﻒﻭ‬ ‫ﺰ‬‫ﻧ‬.
7
.
‫ﻡ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬
‫ﻓ‬.8
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻋ‬.9
‫ﺮ‬
‫ﺗ‬‫ﺭ‬‫ﻭ‬
‫ﺭ‬‫ﺪ‬‫ﻴ‬
‫ﻪﻫ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺗﻀﺨﻢ‬.hydr
ouret
er، .
10
.‫ﻮﻱ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬.
11
Cli
nicalManagement:
1.Medi calmanagement
.

Because90%ofr enal calculiaresmal lerthan5mm i ndi amet er,tr

eat ment
usuallyconsi stsofmeasur est opr omot et heirnat ural passagei ncluding:
Phar macol ogicalMeasur es:
12.Ant imicrobialtherapy :varyingwi tht hecul t uredor gani sm forinfect i
on.
13.Anal gesics: e.
g.meper idinef orpai n&col ic.
14.Di ureti
cs: e.
g.thiazide" sodium cel lulosephosphat eal l
opurinol -these
medi cationsdecr easeexcessi vesal texcr etioni nur inesopr eventf urther
cal
cul usf ormat i
on.
15.Dai lyadmi nist
rationofascor bicaci d-admi nisteredt oacidifyur i
ne.
16.Al l
opur i
nol :
alkali
nizeur inei nur i
caci dst ones.
17.Acet ohy droxamicaci d: isex ampl eofant ibiot i
ct her apywhi chki ll
s
persistentbact eri
aandr etardst ruv i
test onef or mat ion.
:‫ﺮﻱ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻌﻼﺟﻲ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬.1
‫ﺍﺕ‬‫ﺀ‬ ‫ﺍ‬
‫ﺮ‬‫ﺓﻣﻦﺇﺟ‬ً‫ﺩ‬‫ﺎ‬
‫ﻮﻥﻋ‬ ‫ﻜ‬‫ﺘ‬
‫ﻌﻼﺝﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺈﻥ‬‫ﻓ‬، ‫ﺮ‬‫ﻘﻄ‬‫ﻟ‬‫ﺍ‬‫ﻣﻢﻓﻲ‬5‫ﺮﻣﻦ‬ ‫ﻐ‬‫ﺃﺻ‬ ‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻣﻦﺣﺼ‬٪ 90‫ﺍﻷﻥ‬ ً
‫ﺮ‬‫ﻧﻈ‬
:‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﻌﻲﺑ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎ‬‫ﺭﻫ‬‫ﻭ‬‫ﺮ‬‫ﺰﻣ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬
:‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬ ‫ﻠ‬
‫ﻟ‬‫ﻟﺤﻲ‬ ‫ﺍ‬‫ﺋﻦ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺘﻼﻑ‬ ‫ﺎﺧ‬ ‫ﻠﻒﺑ‬ ‫ﺘ‬‫ﻳﺨ‬:‫ﺎﺕ‬ ‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﻜ‬‫ﻴ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻌﻼﺝﺑ‬‫ﻟ‬‫ﺍ‬.
12
.‫ﻐﺺ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺍﻵﻻ‬ ‫ﻟﻼﺝ‬
‫ﻳﻦﻌ‬ ‫ﺪ‬‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﻴ‬‫ﺎﻝﻣ‬‫ﺜ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬:‫ﺎﺕ‬ ‫ﻨ‬
‫ﻜ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬.
13
‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﻩ‬
‫ﺬ‬ ‫ﻠﻞﻫ‬‫ﻘ‬‫ﺗ‬-‫ﻮﻝ‬‫ﻨ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬ ‫ﺑ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻮﺳ‬ ‫ﺯﻓ‬ ‫ﻮ‬
‫ﻠ‬‫ﻴ‬‫ﻠ‬
‫ﻡﺳ‬ ‫ﻮ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﺪ"ﺻ‬ ‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻴ‬‫ﺛ‬.‫ﺎ‬
‫ﺜﻝ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬:‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬
‫ﺭ‬ ‫ﺪ‬
‫ﻣ‬.14
.‫ﻠﺢ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬ ‫ﻊﺗ‬‫ﻨ‬‫ﻤ‬‫ﻟﻲﺗ‬ ‫ﺎ‬‫ﻭﺘ‬
‫ﻟ‬‫ﺎ‬‫ﻮﻝﺑ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁﻓﻲ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﺢ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺇ‬
.
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﺘﺤ‬ ‫ﻟ‬ً
‫ﺎ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴﻚﻳ‬ ‫ﺑ‬
‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﺍﻷﺳ‬ ‫ﻤﺾ‬ ‫ﻭﻝﺣ‬ ‫ﺎ‬
‫ﻨ‬‫ﺗ‬.
15
.‫ﻴﻚ‬ ‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﺾ‬ ‫ﺍﺕﺣ‬ ‫ﻮ‬‫ﻮﻝﻓﻲﺣﺼ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﻮ‬‫ﻠ‬‫ﻠﻰﻗ‬‫ﻤﻞﻋ‬ ‫ﻌ‬‫ﻳ‬:‫ﻮﻝ‬ ‫ﻨ‬
‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﺑ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬.
16
‫ﺔ‬ ‫ﻤ‬‫ﺋ‬
‫ﺍ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻜ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺘﻞ‬
‫ﻘ‬‫ﺬﻱﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺎ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬ ‫ﺎﻝﻋ‬ ‫ﺜ‬:
‫ﻴﻚﻣ‬ ‫ﻣ‬‫ﺎ‬‫ﻛﺴ‬‫ﻭ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻮﻫ‬‫ﺘ‬‫ﻴ‬‫ﺍﻷﺳ‬ ‫ﻤﺾ‬ ‫ﺣ‬.17
.‫ﻴﺖ‬‫ﻓ‬ ‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﻮ‬‫ﻳﻦﺣﺼ‬ ‫ﻮ‬‫ﻜ‬‫ﺮﺗ‬‫ﺆﺧ‬‫ﻳ‬‫ﻭ‬

3.Li
thot
ri
psyt
echni
ques:
18.El
ect
rohy
draul
i
cli
thot
ri
psy
.

106
19.Laserl
i
thot
ri
psy
.
20.Extr
acor
por
eal
shockwav
eli
thot
ri
psy(
ESWL)
,whi
chi
sthemostcommon
techni
que.

:
‫ﻟﺤﺼﻰ‬ ‫ﺍ‬‫ﻴﺖ‬
‫ﺘ‬‫ﻔ‬‫ﺎﺕﺗ‬
‫ﻴ‬‫ﻨ‬
‫ﻘ‬‫ﺗ‬.
3
.‫ﻜﻲ‬
‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺭ‬
‫ﺪ‬‫ﻴ‬‫ﻭﻫ‬
‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺤﺼﻰ‬‫ﺍ‬‫ﻴﺖ‬‫ﺘ‬
‫ﻔ‬‫ﺗ‬.
18
.
‫ﺭ‬‫ﺰ‬‫ﻴ‬
‫ﻠ‬‫ﻟ‬
‫ﺎ‬‫ﺍﺕﺑ‬‫ﻮ‬
‫ﻟﺤﺼ‬‫ﺍ‬‫ﻴﺖ‬‫ﺘ‬
‫ﻔ‬‫ﺗ‬.
19
.
‫ﺎ‬ً‫ﻮ‬
‫ﻋ‬‫ﻴ‬‫ﺮﺷ‬
‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬
‫ﻮﺏ‬‫ﻠ‬
‫ﺍﻷﺳ‬
‫ﻮ‬‫ﻭﻫ‬،
(ESWL)‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺭﺝ‬
‫ﺎ‬‫ﺔﺧ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻮﺟ‬ ‫ﻤ‬
‫ﻟﺤﺼﻰﺑ‬‫ﺍ‬‫ﻴﺖ‬‫ﺘ‬
‫ﻔ‬‫ﺗ‬.
20

ESWL: I
tisnon-i
nvasi
veprocedureusedtobreak-
upstonesi
ntosmal l
fr
agmentslikesandgrai
nwhi chcanbeeasil
ypassedandex t
ractedinurinary
passage.
‫ﺘﻲ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞﻭ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻴ‬
‫ﺒ‬‫ﺜﻞﺣ‬‫ﺓﻣ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺀﺻ‬ ‫ﺍ‬
‫ﺰ‬‫ﺃﺟ‬‫ﻟﻰ‬‫ﺍﺕﺇ‬
‫ﻮ‬‫ﻟﺤﺼ‬‫ﺍ‬‫ﻴﺖ‬‫ﺘ‬‫ﻔ‬
‫ﺘ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬
‫ﺍﺣﻲﻳﺴ‬‫ﺮ‬‫ﺮﺟ‬‫ﻴ‬‫ﺀﻏ‬ ‫ﺍ‬
‫ﺮ‬‫ﻮﺇﺟ‬‫ﻫ‬:ESWL
.
‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬‫ﻟ‬‫ﻮ‬
‫ﻬ‬‫ﺎﺑﺴ‬
‫ﻬ‬‫ﺍﺟ‬‫ﺮ‬
‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﺎﻭ‬
‫ﺮﻫ‬‫ﻳ‬‫ﺮ‬‫ﻤ‬
‫ﻜﻦﺗ‬‫ﻤ‬‫ﻳ‬

4.Sur gicalmanagement :
Indicati
onf orsur gi cal st oner emov al
:
21.St onear et ool ar gef orspont aneouspassagemor ethan5mm i ndi amet er.
22.St onest hatar enotr espondt omedi cal t
reat ment .
23.St onesassoci at edwi thinf ection,e.g." struv i
test ones".
24.St onescausi ngper sist entpai n.
25.St onescausi ng- impai rmenti nr enal function.
26.St onescausi ngpar ti
al orcompl eteobst ruct i
onwi t
houtanypr ogr ess.
27.Pat ientwi t
hsol itaryki dney=oneki dney .
:‫ﺍﺣﻲ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺪ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ .
4
:
‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺍﺕ‬ ‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺍ‬ ‫ﺯﺔ‬
‫ﻟ‬
‫ﺓﻹﺍ‬ ‫ﺭ‬
‫ﺎ‬‫ﺇﺷ‬
.‫ﻣﻢ‬5‫ﻩﻋﻦ‬ ‫ﺮ‬‫ﺪﻗﻄ‬ ‫ﻳ‬‫ﺰ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺋﻲ‬ ‫ﺎ‬
‫ﻘ‬‫ﻠ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﻨﺴ‬ ‫ﻟ‬‫ﺎ‬
‫ﺍﺑ‬ً
‫ﺪ‬‫ﺮﺟ‬ ‫ﻴ‬‫ﺒ‬
‫ﺮﻛ‬ ‫ﻟﺤﺠ‬ ‫ﺍ‬.21
.
‫ﺒﻲ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻠ‬
‫ﻟ‬‫ﻴﺐ‬‫ﺘﺠ‬ ‫ﺘﻲﻻﺗﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺎ‬
‫ﺍﻷﺣﺠ‬ .22
."‫ﻳﺖ‬ ‫ﺎ‬
‫ﻓ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬ ‫ﺭ‬
‫ﺎ‬‫ﻟﺤﺠ‬‫ﺍ‬"‫ﺎﻝ‬ ‫ﺜ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫ﻋ‬،‫ﻭﻯ‬ ‫ﺪ‬
‫ﻌ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺎ‬
‫ﺍﻷﺣﺠ‬ .23
.‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻢ‬‫ﺍﻷ‬ ‫ﺒﺐ‬‫ﺓﺗﺴ‬ ‫ﺭ‬
‫ﺎ‬‫ﻟﺤﺠ‬ ‫ﺍ‬.24
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻌﻒﻓﻲﻭﻇ‬ ‫ﺒﺐ ﺿ‬ ‫ﺓﺗﺴ‬ ‫ﺭ‬
‫ﺎ‬‫ﻟﺤﺠ‬ ‫ﺍ‬.25
.
‫ﻡ‬‫ﺪ‬ ‫ﻘ‬‫ﺃﻱﺗ‬ ‫ﻭﻥ‬ ‫ﻣﻞﺩ‬ ‫ﺎ‬
‫ﻭﻛ‬ ‫ﺃ‬‫ﺋﻲ‬‫ﺰ‬‫ﺩﺟ‬ ‫ﺍ‬
‫ﺪ‬ ‫ﻧﺴ‬‫ﺍ‬ ‫ﺒﺐ‬‫ﺓﺗﺴ‬ ‫ﺭ‬
‫ﺎ‬‫ﻟﺤﺠ‬ ‫ﺍ‬.26
‫ﺓ‬ ‫ﺪ‬‫ﺍﺣ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻠ‬‫ﺓ=ﻛ‬ ‫ﺩ‬‫ﺮ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺏﺑ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬ .
27.
4.Nur si
ngManagement :
Nur si
ngcar efort hecl ientwi thur olit
hiasi sisdi rectedatpr ov idingf orcomf ort
dur i
ngacut er enal col ic, assi stingwi thdi agnost i
cmeasur es, ensur ingadequat e
urinaryout putandt eachi ngt hecl ientinf ormat ionnecessar yt opr ev entf uture
stonef ormat i
on.
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬-
4
،‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻐﺺ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﺔ‬ ‫ﺍﺣ‬‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬ ‫ﺘ‬
‫ﻟ‬‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺘﺤﺼﻲ‬ ‫ﺎﺏﺑ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻤ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻳ‬ ‫ﺎ‬
‫ﻋ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﺘﻢﺗ‬ ‫ﻳ‬
‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺔ‬ ‫ﻣ‬
‫ﺯ‬‫ﺍﻼ‬‫ﻴﻞﻟ‬ ‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬
‫ﻮ‬ ‫ﻠ‬‫ﻌ‬‫ﻴﻢﻣ‬ ‫ﻠ‬‫ﻌ‬‫ﺗ‬‫ﻓﻲﻭ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺎﻥﺇﺧ‬ ‫ﻤ‬‫ﻭﺿ‬، ‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬ ‫ﺓﻓﻲﺗ‬ ‫ﺪ‬‫ﻋ‬ ‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬
.
‫ﺒﻞ‬‫ﻘ‬‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕﻓﻲ‬ ‫ﻮ‬‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬ ‫ﻜ‬‫ﺗ‬

107
 Uni
t4:Renalf
ail
ure
Lear ni
ngobj ect
ives:
Attheendoft hislecture,thest udent swi llbeabl eto:
1-Def iner enal f
ailure.
2-Listt ypesandcausesofr enal failure.
3-Descr i
bet hecli
nical mani festat ionsandl abor atoryabnormal iti
esofr enal
fai
lure.
4-Compar eandcont r
astnur singassessmentandmanagementofpat i
ent '
s
under goinghaemodi alysisandper i
toneal dialysis.
5-Compar eandcont r
astt hemedi cal andnur singmanagementofpat i
ent
duringt heol i
guri
aanddi ureticphasesofacut er enal f
ail
ure.
6-For mul atenur singdi agnosi sandexpect edoutcomef orpat ientwithchr oni c
renal f
ailure.
7-Dev elopt henur si
ngi ntervent ionandt heirrationalforpatientwi t
hchr onic
renal f
ailure.
8-Ident i
fyt reatmentgoal sforpat ientwi thchr onicrenalfail
ure.
9-Expl aint hephy siologicpr i
nci plesofdi alysis.
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬:4‫ﺓ‬‫ﺪ‬ ‫ﻮﺣ‬ ‫ﻟ‬
‫ﺍ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻠﻰ‬ ‫ﻳﻦﻋ‬‫ﺭ‬‫ﺩ‬ ‫ﺎ‬
‫ﻟﻄﻼﺏﻗ‬ ‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﻴ‬‫ﺓﺳ‬ ‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬ ‫ﺔﻫ‬ ‫ﻳ‬
‫ﺎ‬‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬ ‫ﺗ‬-1
.
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﺒ‬
‫ﺃﺳ‬‫ﺍﻉﻭ‬ ‫ﻮ‬‫ﻧ‬‫ﺄ‬‫ﺔﺑ‬‫ﻤ‬‫ﺋ‬
‫ﺎ‬‫ﻗ‬- 2
.‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻭﺻﻒ‬- 3
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻪ‬‫ﻟ‬‫ﻊ‬
‫ﺬﻱﻳﺨﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﻠﻰﻭﻏﺴ‬ ‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺓﻏﺴ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻣ‬- 4
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻠ‬‫ﻟ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬‫ﺪ‬‫ﻣ‬
‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺘﻲﻗ‬ ‫ﻠ‬‫ﺮﺣ‬‫ﺀﻣ‬ ‫ﺎ‬‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬ ‫ﻴﻦ‬‫ﺭﻥﺑ‬‫ﺎ‬‫ﻗ‬- 5
.
‫ﺩ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
.‫ﻣﻦ‬ ‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭﺝ‬‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻳﻀﻲﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻏ‬‫ﺎ‬
‫ﻴ‬‫ﺻ‬- 6
.‫ﻣﻦ‬ ‫ﺰ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﻘﻼ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻀﻲﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﻮ‬‫ﺗﻄ‬- 7
.‫ﻣﻦ‬ ‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬ ‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬- 8
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻐﺴ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻴ‬‫ﻔﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺩﺉ‬ ‫ﺎ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺡ‬‫ﺷ‬- 9
Renalf
ail
ure
Defi
niti
ons:
Renalfai
lureissevereimpair
mentandt ot
all
ackofkidneyf
unct
ion,i
nwhi
ch
ther
eisani nabil
it
yt oexcr
etemetabol
icwasteproduct
sandwater.
Typesofr enalfail
ure:
1-Acuterenalfail
ure
2-Chronicrenalfail
ure
1-AcuteRenalFai
lure
AcuteRenal Fail
ure:

108
‫‪i‬‬
‫‪st‬‬‫‪her‬‬‫‪api‬‬
‫‪dl‬‬‫‪ossofr‬‬
‫‪enal‬‬‫‪f‬‬‫‪unct‬‬‫‪i‬‬
‫‪onov‬‬ ‫‪eraper‬‬‫‪i‬‬
‫‪odofday‬‬
‫‪sorweekswi‬‬
‫‪t‬‬‫‪h‬‬
‫‪pr‬‬
‫‪ogr‬‬‫‪essi‬‬
‫‪v‬‬‫‪eazot‬‬
‫‪emi‬‬‫‪a.‬‬
‫(‬‫‪r‬‬
‫‪ev‬‬ ‫‪er‬‬
‫‪si‬‬‫‪bl‬‬
‫)‪e‬‬‫‪.‬‬
‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﻔ‬‫ﻳ‬ ‫ﺮ‬‫ﻌ‬
‫ﺗ‬‫‪:‬‬
‫ﻔﻀ‬‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬ ‫ﻠﻰﺇﺧ‬ ‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺪﻋ‬‫ﻮﺟ‬ ‫ﻴﺚﻳ‬‫‪،‬ﺣ‬ ‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬
‫ﺎ‬‫ﻡﻓﻲﻭﻇ‬ ‫ﺎ‬‫ﻘ ﺺﺗ‬
‫ﻧ‬‫ﺪﻭ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌﻒﺷ‬ ‫ﻮﺿ‬ ‫ﻮﻱﻫ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻩ‬‫ﺎ‬‫ﻴ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻳﻀ‬ ‫ﺍﻷ‬ ‫‪.‬ﻼﺕ‬
‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬ ‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫‪:‬‬
‫ﺩ‪1-‬‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻣﻦ‪2-‬‬‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺩ‪1-‬‬ ‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺩ‬‫ﺎ‬
‫ﻮﻱﺣ‬ ‫ﻠ‬‫ﻓﺸﻞﻛ‬ ‫‪:‬‬
‫ﻜﺲ‬ ‫ﻌ‬‫ﻠ‬‫ﻟ‬‫ﺑﻞ‬‫ﺎ‬‫ﻗ‬‫‪).‬‬‫ﻳﺠﻲ‬ ‫ﺭ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻴ‬ ‫ﻤ‬
‫ﻴ‬‫ﺗ‬‫ﻭ‬‫ﺯ‬‫ﺍ‬
‫ﻊ‬ ‫ﻊﻣ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬‫ﺃﺳ‬‫ﻭ‬‫ﺃ‬‫ﻡ‬‫ﺎ‬
‫ﻳ‬‫ﺃ‬‫ﺪﻯ‬‫ﻠﻰﻣ‬‫ﻠﻰﻋ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬‫ﻊ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻥ‬ ‫ﺪ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫)ﻮ‬
‫‪.‬ﻫ‬
‫‪1-Et‬‬‫‪i‬‬
‫‪ol‬‬ ‫‪ogy‬‬ ‫‪:‬‬
‫‪A.Pr‬‬‫‪er‬‬ ‫‪enal‬‬ ‫‪:‬‬
‫‪1.I‬‬‫‪mpai‬‬ ‫‪r‬‬‫‪edr‬‬ ‫‪enalper‬‬ ‫‪f‬‬‫‪usi‬‬
‫‪on.‬‬
‫‪a.Haemor‬‬ ‫‪r‬‬‫‪hage.‬‬
‫‪b.Bur‬‬‫‪ns.‬‬
‫‪c.Hy‬‬‫‪pov‬‬ ‫‪ol‬‬‫‪emi‬‬ ‫‪a.‬‬
‫‪d.GI‬‬‫‪Tl‬‬ ‫(‪osses‬‬ ‫‪v‬‬‫‪omi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪ng,‬‬‫‪di‬‬
‫‪ar‬‬‫‪r‬‬‫)‪hea‬‬‫‪.‬‬
‫‪e.Renal‬‬ ‫‪l‬‬‫(‪osses‬‬ ‫‪di‬‬‫‪ur‬‬‫‪et‬‬‫‪i‬‬
‫)‪cs‬‬
‫‪2.I‬‬‫‪mpai‬‬ ‫‪r‬‬‫‪edcar‬‬ ‫‪di‬‬
‫‪acef‬‬ ‫‪f‬‬‫‪i‬‬
‫‪ci‬‬‫‪encyr‬‬ ‫‪esul‬‬‫‪t‬‬‫‪i‬‬
‫‪ngf‬‬ ‫‪r‬‬
‫‪om:‬‬
‫‪a.My‬‬ ‫‪ocar‬‬ ‫‪di‬‬
‫‪al‬‬ ‫‪i‬‬‫‪nf‬‬‫‪ar‬‬‫‪ct‬‬‫‪i‬‬
‫‪on‬‬
‫‪b.Hear‬‬ ‫‪tf‬‬ ‫‪ai‬‬‫‪l‬‬
‫‪ur‬‬ ‫‪e‬‬
‫‪c.Dy‬‬‫‪sr‬‬ ‫‪hy‬‬ ‫‪t‬‬‫‪hmi‬‬ ‫‪as‬‬
‫‪d.Car‬‬‫‪di‬‬ ‫‪ogeni‬‬ ‫‪cshock‬‬
‫‪3.Vasodi‬‬ ‫‪l‬‬‫‪at‬‬‫‪i‬‬
‫‪onr‬‬ ‫‪esul‬‬‫‪t‬‬‫‪i‬‬
‫‪ngf‬‬ ‫‪r‬‬
‫‪om:‬‬
‫‪a.Sepsi‬‬ ‫‪s‬‬
‫‪b.Anaphy‬‬ ‫‪l‬‬
‫‪axi‬‬‫‪s‬‬
‫‪c.Ant‬‬‫‪i‬‬‫‪hy‬‬ ‫‪per‬‬ ‫‪t‬‬
‫‪ensi‬‬ ‫‪v‬‬‫‪emedi‬‬ ‫‪cat‬‬‫‪i‬‬‫‪onsorot‬‬ ‫‪hermedi‬‬‫‪cat‬‬‫‪i‬‬
‫‪onst‬‬ ‫‪hatcause‬‬
‫‪d.v‬‬‫‪asodi‬‬ ‫‪l‬‬
‫‪at‬‬‫‪i‬‬‫‪on‬‬
‫‪:‬‬‫ﺎﺕ‬‫ﺒ‬‫ﺒ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪1‬‬
‫‪:‬‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺃ‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬ ‫‪.‬ﺿ‬ ‫‪1‬‬
‫‪.‬‬‫ﻳﻒ‬ ‫ﺰ‬‫‪.‬ﻧ‬‫ﺃ‬
‫‪.‬‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫‪.‬‬‫ﺏ‬
‫‪.‬‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻘ ﺺﺣﺠﻢ‬ ‫‪.‬ﻧ‬‫ﺝ‬
‫‪.‬‬
‫ﺎ(‬
‫ﻹﻬﻝ‬
‫ﺍﺳ‬ ‫‪،‬‬ ‫ﺀ‬
‫ﻘﻲ‬‫ﻟ‬‫ﺍ‬
‫ﻤﻲ)‬ ‫ﻬﻀ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬ ‫‪.‬ﻓ‬‫ﺩ‬
‫(‬‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬‫ﻣ‬‫ﺔ)‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﺮﻛ‬‫ﺋ‬‫ﺎ‬‫‪.‬ﺧﺴ‬ ‫ﻩ‬
‫ﻋ‪:‬‬
‫ﺗﺞ ﻦ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺀ‬‫ﺎ‬‫ﻔ‬‫ﻌﻒﻛ‬ ‫‪.‬ﺿ‬ ‫‪2‬‬
‫ﻠﺐ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻠ‬‫ﺀﻋﻀ‬ ‫ﺎ‬‫ﺘﺸ‬ ‫ﺍﺣ‬‫‪.‬‬‫ﺃ‬
‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫‪.‬ﻓﺸﻞ‬ ‫ﺏ‬
‫ﻨﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻞ‬‫‪.‬ﺧ‬ ‫ﺝ‬
‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻠ‬‫ﺔﻗ‬ ‫ﻣ‬‫ﺪ‬‫‪.‬ﺻ‬ ‫ﺩ‬
‫ﻋ‪:‬‬
‫ﺗﺞ ﻦ‬ ‫ﺎ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻋ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﻊ‬‫ﻮﺳ‬ ‫‪-3‬ﺗ‬
‫ﺎﻥ‬‫ﺘ‬‫ﻧ‬‫ﺍﻹ‬‫‪.‬‬‫ﺃ‬
‫ﺔ‬‫ﺮﻃ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬ ‫ﺎﺳ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫‪.‬‬‫ﺏ‬
‫ﻟﻚ‬‫ﺒﺐﺫ‬ ‫ﺘﻲﺗﺴ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺍﻷﺧ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺃﺍﻷ‬
‫ﻐﻂﻭ‬ ‫ﻠﻀ‬ ‫ﻟ‬‫ﺔ‬‫ﻓﻀ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬ ‫ﺔ‬
‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬ ‫‪.‬‬
‫ﺝ‬
‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬ ‫ﺍﻷ‬‫ﻊ‬ ‫ﻮﺳ‬ ‫‪.‬ﺗ‬‫ﺩ‬
‫‪I‬‬‫‪nt‬‬
‫‪r‬‬‫‪ar‬‬ ‫‪enal‬‬ ‫‪:Pr‬‬ ‫‪ol‬‬‫‪ongedr‬‬ ‫‪enali‬‬‫‪schemi‬‬ ‫‪ar‬‬‫‪esul‬‬‫‪t‬‬
‫‪i‬‬‫‪ngf‬‬‫‪r‬‬‫‪om:‬‬

‫‪109‬‬
a.Myoglobinur i
a( t
rauma, crushi nj
uries,burns)
b.Hemoglobi nuria(transfusionreaction, hemoly
t i
canemia)
c.Nephrotoxicagent ssuchas:
28.Aminogly cosideant ibi
otics(gentami cin,
tobramy ci
n)
29.Radi
opaquecont rastagent s
30.Heavymet als(lead,mer cury)
31.Nonsteroidal anti
-infl
ammat or ydrugs( NSAIDs)
32.Angi
otensi n-conv ert
ingenzy mei nhibitor
s(ACEi nhi
bit
ors)
d.I
nfecti
ouspr ocessessuchas:
33.Acutepy elonephr it
is
34.Acuteglomer ul
onephr it
is

:‫ﻋ‬
‫ﺗﺞ ﻦ‬‫ﺎ‬
‫ﻷﺪﻧ‬
‫ﺍﻣ‬ ‫ﻳﻞ‬‫ﻮ‬‫ﻮﻱﻃ‬ ‫ﻠ‬‫ﺭﻛ‬‫ﺎ‬‫ﻔ‬‫ﻗ‬‫ﺇ‬:‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﺩ‬
(‫ﻭﻕ‬‫ﺮ‬‫ﺣ‬، ‫ﺎﺕﺳﺤﻖ‬ ‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬، ‫ﺭﺿﺢ‬ )‫ﺔ‬ ‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﺑ‬‫ﻮ‬‫ﻠ‬
‫ﻮﻏ‬‫ﻴ‬‫ﺔﻣ‬‫ﻠ‬‫ﻴ‬‫ﺑ‬.‫ﺃ‬
(‫ﻟ‬
‫ﻻﺤﻼﻲ‬‫ﺍﻧ‬ ‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬‫ﻓ‬،‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻞ‬‫ﺎﻋﻞﻧ‬‫ﻔ‬‫ﺗ‬)‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﺑ‬
‫ﻮ‬‫ﻠ‬‫ﻮﻏ‬‫ﻤ‬‫ﻴ‬‫ﺔﻫ‬‫ﻠ‬‫ﻴ‬‫ﺑ‬.‫ﺏ‬
:‫ﺜﻞ‬‫ﻠﻰﻣ‬‫ﻜ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬.‫ﺝ‬
(
‫ﻴﻦ‬‫ﻴﺴ‬‫ﻣ‬‫ﺍ‬
‫ﺮ‬‫ﺑ‬
‫ﻮ‬‫ﺗ‬،‫ﻴﻦ‬‫ﻴﺴ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻨ‬‫ﺪ)ﺟ‬‫ﻳ‬
‫ﺯ‬‫ﻮ‬‫ﻜ‬‫ﻴ‬‫ﻠ‬‫ﻮﻏ‬‫ﻨ‬
‫ﻴ‬‫ﻣ‬‫ﺃ‬ ‫ﺔ‬
‫ﻳ‬‫ﻮ‬ ‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬.28
‫ﺔ‬‫ﻌ‬‫ﻟﻸﺷ‬ ‫ﺔ‬‫ﻌ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻋ‬. 29
(
‫ﺒﻖ‬‫ﺋ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺎ ﺹﻭ‬‫ﺮﺻ‬ ‫ﻟ‬
‫ﺍ‬)‫ﺔ‬‫ﻠ‬‫ﻴ‬‫ﻘ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻥ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬-30
(NSAI Ds)‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻳ‬
‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺏﻏ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻣﻀ‬- 31
(
‫ﻴﻦ‬‫ﻨﺴ‬
‫ﺗ‬‫ﻮ‬‫ﻴ‬
‫ﻧﺠ‬‫ﻟﻸ‬
‫ﻮﻝ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻢ‬‫ﺰ‬‫ﻧ‬
‫ﺍﻹ‬‫ﺎﺕ‬‫ﺒﻄ‬‫ﺜ‬‫ﻣ‬)‫ﻴﻦ‬‫ﻨﺴ‬
‫ﺗ‬‫ﻮ‬‫ﻴ‬‫ﻧﺠ‬‫ﻟﻸ‬‫ﻮﻝ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻳﻢ‬‫ﺰ‬
‫ﻧ‬‫ﺍﻹ‬ ‫ﺎﺕ‬‫ﺒﻄ‬‫ﺜ‬
‫ﻣ‬. 32
:‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬.
‫ﺩ‬
‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.33
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻴ‬‫ﺒ‬
‫ﺎﺏﻛ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.34

Postr
enalFai lur
e:Uri
naryt
ractobst
ruct
ion,
incl
udi
ng:
35.Calculi
( st
ones)
36.Tumor s
37.Benignpr ost
atichyper
plasi
a
38.Str
ictures
39.Bl
oodcl ot
s
‫ﻟﻚ‬
‫ﺎﻓﻲﺫ‬
‫ﻤ‬‫ﺑ‬،
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬:
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬‫ﻓﺸﻞﻣ‬ :
35.
‫ﺔ‬‫ﻤ‬‫ﻳ‬
‫ﺮ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﺍﻷﺣﺠ‬ .
36.‫ﻡ‬ ‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬
37.‫ﺪ‬‫ﻴ‬‫ﻤ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎ‬
‫ﺗ‬‫ﺎ‬
‫ﺘ‬‫ﻭﺳ‬ ‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺗﻀﺨﻢ‬
38-‫ﺩ‬ ‫ﻮ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
39.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻠﻄ‬‫ﺟ‬
Pathophysiol
ogy:
40.Causingtubularnecrosisproducessev erevasoconst rict
ionofrenalbl
ood
vessel
s,causingischemiaofki dneyt i
ssue.
41.Excreti
onisimpaired,accumul ateinbodyf l
uids.
42.Homeost ati
c,endocrine,metabolicfuncti
onsdi srupted.
43.Acuterenalfail
ureproceedst hrough4phases:
:
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﻘﺺ‬ ‫ﺒﺐﻧ‬‫ﺎﻳﺴ‬‫ﻤ‬‫ﻣ‬،‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﺪﻓﻲ‬‫ﻳ‬‫ﺪ‬‫ﻴﻖﺷ‬ ‫ﻪﺗﻀ‬ ‫ﻨ‬
‫ﺘﺞﻋ‬ ‫ﻨ‬‫ﺑﻲﻳ‬‫ﻮ‬‫ﺒ‬
‫ﻧ‬‫ﺃ‬‫ﺮ‬
‫ﺒﺐﻓﻲﻧﺨ‬ ‫ﺘﺴ‬‫ﻟ‬
‫ﺍ‬.
40
.‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺮ‬‫ﺗ‬
.‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻛﻢﻓﻲﺳ‬ ‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﻳ‬،‫ﻴﻒ‬‫ﻌ‬‫ﺯﺿ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺇ‬.
41

110
 .
‫ﻠﺖ‬‫ﻌﻄ‬
‫ﺋﻲﺗ‬
‫ﺍ‬‫ﺬ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬ ‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺀﻭ‬‫ﺎ‬
‫ﻤ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﻘﻼﺏﻭ‬‫ﺘ‬‫ﺍﻻﺳ‬
‫ﺋﻒ‬‫ﺎ‬
‫ﻭﻇ‬.
42
:
‫ﺍﺣﻞ‬‫ﺮ‬‫ﻣ‬4‫ﺩﻣﻦﺧﻼﻝ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬
‫ﻳﺤ‬.
43

a-Ini
ti
ati
onThei
nit
iat
ionper
iodbegi
nswi
tht
hei
nit
ial
insul
tandendswhen
ol
iguri
adevel
ops

b-Ol i
guri
a-anuri
a: Uri
nev ol
ume400ml per24hour s.Serum concentrat
ions
i
ncrease.(urea,creati
nine,ur
icacid,organicaci
ds,andt heintr
acell
ularcati
ons
[potassi
um andmagnesi um])Renalfunct i
onmaydecr ease.TheGFR
decreases.Inthi
sphaseur emic
sympt omsf i
rstappearandl if
e-t
hreateningcondit
ionssuchashy perkal
emia
develop.Durati
on8t o15day s(t
helongert heduration,thel
esschanceof
recoveryorsurviv
al )
.

c-Diur
esis:thepati
entexperiencesgraduallyi
ncreasingurineoutput,whi
ch
signal
sthatglomerularfi
lt
rat
ionhasst artedtorecover.Laboratoryv
aluesst
op
ri
singandev ent
uall
ydecrease.Thepat ientmustbeobser v
edcl osel
yfor
dehydrat
ionduringthisphase;ifdehy
dr ati
onoccurs,theuremi csymptomsare
l
ikelyt
oincrease.

d-Recovery
:thei
mprovementofr
enalf
unct
ionandmayt
ake3t
o12mont
hs.
Laborat
oryval
uesret
urnt
othepati
ent
’snor
mallev
el.

‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺭﻗ‬‫ﻮ‬‫ﺘﻄ‬ ‫ﺎﺗ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻬﻲﻋ‬ ‫ﺘ‬

‫ﻨ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺎﻹﻫ‬‫ﺀﺑ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﺘ‬‫ﺃﻓ‬‫ﺪ‬‫ﺒ‬‫ﺗ‬-‫ﺀ‬ ‫ﺪ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬-
‫ﺃ‬
،‫ﺎ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬
).‫ﻤﺼﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺰ‬‫ﻴ‬
‫ﻛ‬ ‫ﺮ‬
‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬. ‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬24‫ﻜﻞ‬ ‫ﻟ‬‫ﻣﻞ‬400‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺣﺠﻢ‬: ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬ ‫ﻘﻄ‬‫ﻧ‬
‫ﺍ‬-‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻗ‬-‫ﺏ‬
([
‫ﻡ‬ ‫ﻮ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬
]‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬ ‫ﺍﺧﻞ‬‫ﺎﺕﺩ‬ ‫ﻧ‬‫ﻮ‬‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬،‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻌﻀ‬‫ﻟ‬‫ﺍ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﺍﻷﺣ‬، ‫ﻴﻚ‬‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻟ‬
‫ﺍ‬ ‫ﻤﺾ‬ ‫ﺣ‬، ‫ﻴﻦ‬ ‫ﻨ‬
‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫ﻤﻲ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻓﻲﻫ‬. (GFR)‫ﺒﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺢ‬ ‫ﺮﺷ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬‫ﻔ ﺾﻣ‬‫ﻨﺨ‬ ‫ﻳ‬.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬
‫ﻔ‬‫ﻴ‬‫ﻔ ﺾﻭﻇ‬ ‫ﻨﺨ‬‫ﺪﺗ‬‫ﻗ‬
15‫ﻟﻰ‬ ‫ﺇ‬8‫ﺓﻣﻦ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ .
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬ ‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺮﻁﺑ‬ ‫ﺜﻞﻓ‬ ‫ﺓﻣ‬ ‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺩ‬
‫ﺪ‬ ‫ﻬ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬ ‫ﺘﻄ‬‫ﺗ‬
‫ﺃﻻًﻭ‬ ‫ﺍ ﺽﻭ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﺮ‬‫ﻬ‬‫ﺗﻈ‬
.(‫ﺓ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺪ‬‫ﻴ‬
‫ﻠﻰﻗ‬ ‫ﺀﻋ‬‫ﺎ‬‫ﻘ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻔ‬
‫ﻟﺸ‬‫ﺍ‬ ‫ﺔ‬‫ﺮﺻ‬‫ﻠﺖﻓ‬ ‫ﻗ‬، ‫ﺓ‬
‫ﺪ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺖ‬ ‫ﺎ‬
‫ﺎﻃ‬ ‫ﻤ‬‫ﻠ‬
‫ﻛ‬)‫ﺎ‬ً
‫ﻣ‬‫ﻮ‬‫ﻳ‬
‫ﺒﻲ‬‫ﻴ‬‫ﺒ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﺢ‬‫ﺮﺷ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻥ‬ ‫ﻟﻰ‬‫ﺮﺇ‬‫ﻴ‬‫ﺎﻳﺸ‬‫ﻤ‬‫ﻣ‬، ‫ﻮﻝ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺔﻓﻲﺇﺧ‬ ‫ﻴ‬‫ﻳﺠ‬‫ﺭ‬‫ﺪ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻳ ﺾﻣﻦﺯ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻧﻲ‬ ‫ﺎ‬
‫ﻌ‬‫ﻳ‬:‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﺍ‬
‫ﺭ‬‫ﺩ‬‫ﺇ‬-‫ﺝ‬
‫ﻳ ﺾﻋﻦ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻳﺠﺐﻣ‬. ‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻬ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻔ ﺾﻓﻲ‬ ‫ﻨﺨ‬‫ﺗ‬‫ﺎﻉﻭ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﻋﺍﻻ‬
‫ﺮﻦ‬ ‫ﺒ‬‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻗﻒﻗ‬ ‫ﻮ‬‫ﺘ‬‫ﺗ‬.‫ﻓﻲ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺃﻓﻲ‬ ‫ﺪ‬‫ﺪﺑ‬‫ﻗ‬
.‫ﻤﻲ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺩ‬‫ﺍ‬‫ﺩ‬‫ﺰ‬
‫ﺃﻥﺗ‬ ‫ﺮﺟﺢ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻤﻦ‬‫ﻓ‬، ‫ﺎﻑ‬ ‫ﻔ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪﺙ‬‫ﺍﺣ‬ ‫ﺫ‬‫؛ﺇ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺎﻑﺧﻼﻝﻫ‬ ‫ﻔ‬‫ﻠﺠ‬‫ﻟ‬‫ﺜﺐ‬ ‫ﻛ‬
‫ﻮﻯ‬ ‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬ ‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻌ‬
‫ﺗ‬. ‫ﺍ‬
ً
‫ﺮ‬‫ﻬ‬‫ﺷ‬12‫ﻟﻰ‬ ‫ﺇ‬3‫ﺮﻕﻣﻦ‬ ‫ﻐ‬‫ﺘ‬‫ﺪﻳﺴ‬ ‫ﻗ‬‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻒ‬‫ﺎ‬‫ﻴﻦﻭﻇ‬ ‫ﺗﺤﺴ‬: ‫ﻓﻲ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ -
‫ﺩ‬
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬
Cli
ni calmani f
est ationandl abor atoryabnor mal i
ti
esofacut erenal fail
ure:
1.Thepat ientappear scl i
nicallyill
.
2.Let har gy .
3.Per sistentnausea, v omiting, anddi arrhea.
4.Dr yski nandmucousmembr ane.
5.Thebr eat hhav eur ineodor .
6.Cent ral nervoussy stem mani festations( drowsi ness,headache, muscl e
twi
t chi ngandsei zures.
7.Changesi nur i
neout put.
8.Incr easebl oodur eani t
rogenandcr eatini
nel evel.
9.Hy per kalemia.
10.Met abol i
caci dosis.
11.Anemi a.
12.Decr easeCal ci
um andi ncr easephosphor us

111
13.Hemat
uri
amaybepr
esent
,andt
heur
inehasal
owspeci
fi
cgr
avi
ty(
1.010or
l
ess)

:
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬‫ﺘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬
.‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﺎﺳ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﺒ‬‫ﻳ‬.1
.
‫ﻮﻝ‬ ‫ﻤ‬‫ﻟﺨ‬‫ﺍ‬ .
2
.‫ﺎ‬
‫ﻹﻬﻝ‬
‫ﺍﺳ‬ ‫ﺀﻭ‬‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺍﺳ‬ .
3
.
‫ﺎﻃﻲ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﻑ‬ ‫ﻔ‬‫ﺟ‬. 4
.‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺎﺭ‬‫ﻬ‬‫ﻟ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬‫ﺭ‬.5
.
‫ﺮﻉ‬‫ﺎﺕ ﺻ‬
‫ﺑ‬‫ﻮ‬‫ﻧ‬
‫ﻠﻲﻭ‬‫ﺎﺵﻋﻀ‬‫ﻌ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬،‫ﺍﻉ‬
‫ﺪ‬‫ﺻ‬، ‫ﺎﺱ‬‫ﻌ‬‫ﻧ‬
)‫ﺰﻱ‬‫ﻛ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺒﻲ‬ ‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻣﻈ‬. 6
.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺍﺕﻓﻲﺇﺧ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬.7
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻓﻲ‬‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻭ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻭﺟ‬‫ﺮ‬‫ﺘ‬‫ﻴ‬‫ﻮﻯﻧ‬‫ﺘ‬‫ﺓﻣﺴ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺯ‬.8
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬ ‫ﺮﻁﺑ‬ ‫ﻓ‬.9
.
‫ﻳﻀﻲ‬ ‫ﺍﻷ‬ ‫ﺎﺽ‬ ‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬.10
.‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺮ‬
‫ﻘ‬‫ﻓ‬. 11
‫ﺭ‬‫ﻮ‬‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺗ‬.12
(‫ﻗﻞ‬
‫ﺃ‬‫ﻭ‬1
‫ﺃ‬.010)‫ﻔ ﺾ‬
‫ﻨﺨ‬‫ﻮﻋﻲﻣ‬‫ﻘﻞﻧ‬‫ﻭﺛ‬‫ﻮﻝﺫ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻠ‬
‫ﻴ‬‫ﺪﺑ‬‫ﻮﺟ‬ ‫ﺪﺗ‬‫ﻗ‬. 13

Diagnosi sofacut er enalf ailure:

Medi cal diagnosi sisbasedonsy mpt omsandf i
ndi ngsf rom bl oodchemi st r
ies.
Thesei ncl udet hef ollowi ng:
1.Decr easedorabsentur i
nar youtput .
2.Increasedl ev el ofBUN, ser um cr eat i
nine,sodi um, potassium, andchl oride.
Decreasedser um cal cium, car bondi oxide(bicar bonat e),hemogl obinand
haemot ocr i
tlev els.
Compl icat ions:
1.Infection
2.Arrhy thmi asduet ohy per kalemi a
3.Electroly te( sodium, potassi um, uricacid,calci um, phosphor us)abnor mal i
ties
4.Gast roint estinal bleedi ngduet ost ressulcer s
5.Mul ti
pl eor gansy stemsf ailure.
:
‫ﺩ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬‫ﻩﻣ‬ ‫ﺬ‬‫ﻤﻞﻫ‬ ‫ﺗﺸ‬ ‫ﻭ‬.‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﺋﺞﻣﻦﻛ‬ ‫ﺎ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺍ ﺽﻭ‬ ‫ﺮ‬‫ﻋ‬
‫ﺍﻷ‬ ‫ﻠﻰ‬‫ﺒﻲﻋ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻴﺺ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻤ‬‫ﺘ‬‫ﻌ‬
‫ﻳ‬
.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺝ‬‫ﺮ‬‫ﺎﺏﺇﺧ‬‫ﻴ‬‫ﻭﻏ‬ ‫ﺃ‬ ‫ﻘﺺ‬ ‫ﻧ‬.1
.‫ﺪ‬
‫ﻳ‬‫ﺭ‬‫ﻮ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬ ‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻡ‬ ‫ﻮ‬‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬، ‫ﻴﻦ‬ ‫ﻨ‬
‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺼﻞ‬ ‫ﻭ‬، BUN‫ﻮﻯ‬ ‫ﺘ‬‫ﺓﻣﺴ‬ ‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺯ‬.2
‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬ ‫ﻴﻦﻭ‬ ‫ﺑ‬‫ﻮ‬‫ﻠ‬‫ﻮﺟ‬‫ﻤ‬ ‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬ ‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﺑ‬‫ﺮ‬‫ﻜ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬)‫ﻮﻥ‬ ‫ﺑ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻴ‬‫ﻛﺴ‬‫ﺃ‬ ‫ﻧﻲ‬‫ﺎ‬‫ﺛ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﻮ‬ ‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﺎ ﺽﻣﺴ‬ ‫ﻔ‬‫ﻧﺨ‬ ‫ﺍ‬
.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
:‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ .
1
‫ﻡ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬ ‫ﺗ‬
‫ﻮ‬ ‫ﺮﻁﺑ‬ ‫ﺒﺐﻓ‬ ‫ﻠﺐﺑﺴ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺮ‬‫ﻡﺿ‬ ‫ﺎ‬‫ﺘﻈ‬‫ﻧ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻋ‬. 2
(‫ﺭ‬
‫ﻮ‬ ‫ﻔ‬‫ﻮﺳ‬ ‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬ ‫ﺎ‬
‫ﻭﻜ‬
‫ﻟ‬‫ﻴﻚﺍ‬ ‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﻡﻭﺣ‬ ‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬ ‫ﺍ‬
)‫ﺭﻝ‬‫ﺎ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺫ‬‫ﻭ‬‫ﺬ‬‫ﺷ‬. 3
‫ﺩ‬‫ﺎ‬‫ﻬ‬‫ﺍﻹﺟ‬ ‫ﺎﺕ‬‫ﺮﺣ‬‫ﻘ‬‫ﺒﺐﺗ‬ ‫ﻤﻲﺑﺴ‬ ‫ﻬﻀ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒ‬ ‫ﺰ‬‫ﻧ‬.4
.‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﺓﻣ‬‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬ ‫ﻓﺸﻞ‬. 5
Management :Prev ent ivemeasur es:
1.Identifypat ientswi thpr eexi sti
ngr enaldisease.
2.Ini
tiateadequat ehy drationbef ore, duri
ng, andaf teroper ativepr ocedur es.
3.Av oidchr oni canal gesi cabuse—causesi nterst it
ialnephr i
tisandpapi ll
ar y
necrosis.
4.Prev entandt reatshockwi thbl oodandf l
ui dr eplacement .Pr eventprolonged

112
per
iodsofhy potensi
on.
5.Monitoruri
naryoutputandcent r
alvenouspr essurehour l
yincrit
ical
lyil
l
pat
ientstodetectonsetofrenalfail
ureattheear l
iestmoment .
:
‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬:‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬
.
‫ﺎ‬ً
‫ﻘ‬
‫ﺒ‬‫ﺓﻣﺴ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺃ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬.1
.‫ﺔ‬
‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬
‫ﺀﻭ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬
‫ﺒﻞﻭ‬‫ﻓﻲﻗ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺐ‬ ‫ﺮﻃ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺪ‬‫ﺑ‬.2
.
‫ﻤﻲ‬‫ﻴ‬‫ﻠ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺮ‬‫ﻨﺨ‬
‫ﻟ‬‫ﺍ‬
‫ﻼﻲﻭ‬‫ﻟﺨﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﻳﺴ‬-‫ﺔ‬‫ﻨ‬‫ﻣ‬
‫ﺰ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺀ‬
‫ﻮ‬‫ﻨﺐﺳ‬ ‫ﺗﺠ‬.3
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﺎ ﺽﺿ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻠ‬
‫ﻳ‬‫ﻮ‬‫ﺍﺕﻃ‬‫ﺮ‬‫ﺘ‬‫ﻊﻓ‬‫ﻨ‬‫ﻣ‬.‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻳﺾ‬ ‫ﻮ‬‫ﻌ‬
‫ﺗ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻊﻭﻋﻼﺝ‬‫ﻨ‬‫ﻣ‬.4
‫ﺔ‬
‫ﺮﺟ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺎﻻﺕ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭﻱ‬‫ﺮﺿﻰﺫ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﺎﻋ‬‫ﺰﻱﻛﻞﺳ‬ ‫ﻛ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻱ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬
‫ﻟﻲﻭ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬
‫ﺍﻹﺧ‬ ‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬.5
.
‫ﻜﻦ‬‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﺏﻭ‬ ‫ﻗ‬‫ﺃ‬‫ﻮﻱﻓﻲ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫ﻜﺸﻒﻋﻦﺑ‬ ‫ﻠ‬
‫ﻟ‬

6.Payspeci alattentiont odr ai

ningwounds, burns,etc,whi
chcanl eadt o
dehydrati
onandsepsi sandpr ogressiverenaldamage.
7.Givemet iculouscar et opat i
entswi t
hi ndwell
ingcat het
ersandI Vl i
nes.
8.Takeev erypr ecautiont oensur ethatther i
ghtper sonreceivesther ight
blood—toav oidsev eret ransfusionreactions,whi chcanprecipit
ater enal
compl i
cati
ons.
9.Treathypot ensionpr ompt l
y.
10.Preventandt reatinfectionsprompt ly.Inf
ectionscanpr oducepr ogr essive
renaldamage.
11.Topr eventt oxicdrugef f
ects,closelymoni t
ordosage, durati
onofuse, and
bloodlevel
sofal lmedi cationsmet abolizedorexcr etedbytheki dney s.

‫ﺎﻥﻭ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻹ‬
‫ﺎﻑﻭ‬‫ﻔ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻰ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬
‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﻟﻚ‬‫ﻟﻰﺫ‬‫ﺎﺇ‬‫ﻣ‬
‫ﻭﻕﻭ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻭﺡﻭ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﺘﺼ‬ ‫ﻟ‬‫ﺍ‬
ً
‫ﺪ‬‫ﻴ‬‫ﻪﺟ‬‫ﺒ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬ .
6
.
‫ﻳﺠﻲ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻒ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
.‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻁ‬‫ﺔﻭﺧﻄ‬ ‫ﻨ‬
‫ﻛ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺔﺩ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺀﺭ‬ ‫ﺎ‬
‫ﻋﻄ‬‫ﺇ‬.7
‫ﻘﻞ‬‫ﺎﻋﻼﺕﻧ‬‫ﻔ‬
‫ﻨﺐﺗ‬ ‫ﺘﺠ‬‫ﻟ‬-‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﺳﺐﻋ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺸﺨ ﺺ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺎﻥﺣﺼ‬ ‫ﻤ‬‫ﻟﻀ‬‫ﺎﺕ‬‫ﺎﻃ‬‫ﻴ‬‫ﺘ‬‫ﻛﺍﻻﺣ‬
‫ﺬﻞ‬ ‫ﺗﺨ‬‫ﺍ‬ .
8
.‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﺎﺕﻛ‬‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬،‫ﺓ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
.
‫ﺭ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﻡﻋ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﺎ ﺽﺿ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬‫ﻋﻼﺝ‬. 9
.
‫ﻳﺠﻲ‬‫ﺭ‬‫ﺪ‬‫ﻮﻱﺗ‬‫ﻠ‬‫ﻠﻒﻛ‬‫ﻟﻰﺗ‬‫ﻭﻯﺇ‬‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬
‫ﻳ‬.‫ﺔ‬‫ﺮﻋ‬‫ﻟﺴ‬‫ﺍ‬‫ﻪ‬‫ﻠﻰﻭﺟ‬‫ﺎﺕﻋ‬ ‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬‫ﻊﻭﻋﻼﺝ‬ ‫ﻨ‬‫ﻣ‬.10
‫ﺍﻷ‬‫ﻊ‬‫ﻴ‬
‫ﻤ‬‫ﻟﺠ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬‫ﻡﻭ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﻻﺳ‬‫ﺓ‬
‫ﺪ‬ ‫ﻣ‬‫ﺔﻭ‬‫ﺮﻋ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻳﺠﺐﻣ‬، ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﻟﻸ‬ ‫ﺔ‬
‫ﻣ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺮ‬‫ﻴ‬‫ﺛ‬
‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬.11
.
‫ﺜﺐ‬ ‫ﻠﻰﻋﻦﻛ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺎﻋﻦﻃ‬ ‫ﺯﻫ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﻭﺇ‬‫ﺃ‬‫ﻼﺎ‬
‫ﻬ‬‫ﻘﺑ‬‫ﺘ‬ ‫ﺍﺳ‬‫ﺘﻢ‬‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﻭ‬‫ﺩ‬

Corrective/suppor ti
vemeasur es:
1.Correctanyr ev ersi
bl ecauseofacut erenalfai
lure(eg,i
mpr overenal
perf
usion; maximi zecar di
acout put;surgicalr
eli
efofobstruction).
2.Beal ertforandcor r ectunder lyi
ngf l
uidexcessesordef i
cit
s.
3.Correctandcont rol biochemi calimbalances—t r
eatmentofhy perkal
emia.
4.Restor e/maintainbloodpr essure.
5.Maint ainnutri
tion.
Ini
ti
atehemodi al
y sis,per i
toneal di
alysi
s,orcontinuousrenalreplacement
ther
apyf orpati
ent swi thpr ogr
essiveazot emiaandot herli
fe-
threateni
ng
compl i
cat i
ons.

:
‫ﺔ‬‫ﻤ‬‫ﺍﻋ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
/‫ﺔ‬ ‫ﻴ‬‫ﻴﺤ‬
‫ﺘﺼﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬
،
‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬
‫ﺗﺤﺴ‬،‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﺒ‬‫ﻠﻰﺳ‬‫ﻋ‬)‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻠ‬
‫ﻟ‬‫ﻜﺲ‬ ‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺑﻞ‬‫ﺎ‬‫ﺒﺐﻗ‬‫ﺃﻱﺳ‬‫ﻴﺢ‬‫ﺗﺼﺤ‬.1
.
(‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﻟﻼ‬‫ﺍﺣﻲ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺒﻲ‬‫ﻠ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺯ‬‫ﻭ‬
.‫ﺔ‬‫ﻨ‬
‫ﻣ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻘﺺ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺓ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻴﺢ‬‫ﺗﺼﺤ‬‫ﺄﻫﺐﻭ‬ ‫ﺣﺔﺗ‬
‫ﻟ‬
‫ﻛﻦﻓﻲ ﺎ‬.2

113
 .‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬ ‫ﺗ‬
‫ﻮ‬‫ﺮﻁﺑ‬‫ﻋﻼﺝﻓ‬-‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻛ‬‫ﻮ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺧﻼﻻﺕ‬‫ﺍﻻﺘ‬ ‫ﺒﻂ‬‫ﻴﺢﻭﺿ‬ ‫ﺗﺼﺤ‬.3
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﻠﻰ ﺿ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬‫ﺍ‬/‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬
.4
.‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬
‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
.5
‫ﻮﻥﻣﻦ‬‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،
‫ﻧﻲﺃ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻏﺴ‬، ‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﺀﻏﺴ‬ ‫ﺪ‬‫ﺑ‬
.
‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬
‫ﻬ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺍﻷﺧ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫ﻳﺠﻲﻭ‬ ‫ﺭ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺕ‬‫ﺯ‬‫ﺁ‬
Managementofacut er enalfai
lure:
1.Medicali
nt er
venti
ondur ingoliguri
aphasearedesignedtopr event:
Hy perkalemia.
Sev eracidosis.
Sev erfluidoverl
oad.
Infecti
on.
Conv ulsionsandper i
cardi
ti
s
Electrolytei
mbal ancear ecorrectedassoonaspossi bl
e.
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬‫ﻋﻼﺝ‬:
1.‫ﻊ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﻤﻢ‬‫ﻮﻝﻣﺼ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻠ‬‫ﺔﻗ‬
‫ﻠ‬‫ﺮﺣ‬‫ﺒﻲﺧﻼﻝﻣ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
:
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻴ‬ ‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺮﻁﺑ‬‫ﻓ‬.
‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﺎﺽ‬ ‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬
.
Sever‫ﺪ‬‫ﺋ‬‫ﺍ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺭ‬
‫ﻮ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬ ‫ﻨﺠ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬
‫ﻜﻦ‬
‫ﻤ‬‫ﻗﺖﻣ‬
‫ﺮﻉﻭ‬‫ﺃﺳ‬‫ﺀﻓﻲ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬
‫ﻨﺤﻞﺑ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺯﻥ‬‫ﺍ‬
‫ﻮ‬‫ﻡﺗ‬‫ﺪ‬‫ﻴﺢﻋ‬ ‫ﺘﻢﺗﺼﺤ‬ ‫ﻳ‬
.
2.Dr
ugsusedt ot r
eatrenalf
ail
urei
ncludes:
-
Car diotoni
c,asdigoxinandanti
hypert
ensi
ve.
St oolsoft
ness.
3.Di
etarysupplementssuchasironsupplementati
on.
4.Fl
uidrepl
acement .
-:‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻓﻲﻋﻼﺝ‬ ‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺩ‬‫ﺍﻷ‬‫ﻤﻞ‬‫ﺗﺸ‬.2
.‫ﻐﻂ‬‫ﻠﻀ‬
‫ﻟ‬‫ﻓﺾ‬ ‫ﺎ‬
‫ﻴﻦﻭﺧ‬‫ﻛﺴ‬‫ﻮ‬
‫ﻳﺠ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬،‫ﻠﺐ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺸﻂ‬‫ﻣ‬
.
‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﻮ‬‫ﻌ‬‫ﻧ‬
.
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﻤﻼﺕ‬
‫ﻜ‬‫ﺜﻞﻣ‬‫ﺔﻣ‬‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻼﺕ‬ ‫ﻜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
.3
.
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺍﻝ‬
‫ﺪ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺳ‬.4

5.Nur si
ngal ert:
Apat ientwit hahi ghandr i
singlev elofser um pot assi
um of tenr equi
res
i
mmedi atedi alysis.
I ntr
avenousgl ucoseandi nsulinorcal cium gluconat emaybeusedas
emer gencyandt empor arymeasur est otreathy perkalemia.Gl ucoseandi nsulin
drivepotassium i nt othecel l
s,therebyl ower i
ngser um pot assium levels
tempor ari
ly.Pot assi um wi l
lmov eoutoft hecel l
sandr i
seagai ntoadanger ous
l
ev elunlessr emov edbydi al
ysi
s.Theadmi nistrat
ionofcal cium gluconat ehelps
protectthehear tfrom t heeffectsoft hehi ghpot assium levels.
Sodi um bi carbonat emaybeadmi nister edt oelevatethepl asmapH.
Sodium bi carbonat eincreasesthepH, whi chcausespot assium t omov einto
thecel l
,andt her esul tisloweri
ngoft heser um pot assium level.Thisisshort-
termt herapyandi susedwi t
hot herlong-ter m measur es,suchasdi etary
restri
cti
onanddi alysis.

Al
lext
ernal
sour
cesofpot
assi
um (
foods,
sal
tsubst
it
utes,
medi
cat
ions)ar
e

114
‫‪el‬‬
‫‪i‬‬
‫‪mi‬‬‫‪nat‬‬
‫‪edorr‬‬
‫‪educed.‬‬
‫‪:‬‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻴ‬‫ﺒ‬
‫ﻨ‬‫‪.‬ﺗ‬‫‪5‬‬
‫ﻮﻱ‬‫ﻠ‬‫ﻴﻞﻛ‬‫ﻟﻰﻏﺴ‬ ‫ﻡﺇ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺍ‬‫ﺰ‬‫ﺘ‬
‫ﻣ‬‫ﻊﻭ‬ ‫ﻔ‬
‫ﺗ‬‫ﺮ‬‫ﻮﻯﻣ‬ ‫ﺘ‬‫ﻪﻣﺴ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﺬﻱ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬‫ﺎﻳﺤ‬‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫‪.‬‬‫ﺭﻱ‬‫ﻮ‬‫ﻓ‬
‫ﻌ‬
‫ﻟ‬‫ﺔ‬‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﻣ‬
‫ﺔﻭ‬ ‫ﺋ‬‫ﺭ‬‫ﺎ‬
‫ﺍﺕﻃ‬ ‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺈﺟ‬‫ﻡﻛ‬‫ﻮ‬ ‫ﻴ‬
‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬
‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻭﻏ‬ ‫ﺃ‬‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦﻓﻲ‬ ‫ﻟ‬
‫ﻮ‬‫ﻧﺴ‬‫ﺍﻷ‬‫ﺯﻭ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
‫ﺎﻥ‬‫ﻔﻀ‬‫ﻟﻲﻳﺨ‬ ‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫‪،‬ﺑ‬
‫ﺎﻭ‬ ‫ﻳ‬
‫ﻟﺨﻼ‬‫ﺍ‬‫ﻟﻰ‬‫ﻡﺇ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻓ‬
‫ﺪ‬ ‫ﻴﻦﺑ‬‫ﻟ‬
‫ﻮ‬‫ﻧﺴ‬‫ﺍﻷ‬‫ﺯﻭ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬ ‫ﻮ‬
‫ﻘ‬‫‪.‬ﻳ‬ ‫ﻡ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﺮﻁﺑ‬ ‫ﻼﺝﻓ‬
‫ﻟﻰ‬
‫ﺮﻯﺇ‬ ‫ﺃﺧ‬‫ﺓ‬‫ﺮ‬‫ﻊﻣ‬‫ﻔ‬‫ﺗ‬‫ﺮ‬
‫ﻳ‬‫ﺎﻭ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﻡﻣﻦ‬ ‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻘﻞ‬‫ﺘ‬‫ﻨ‬‫ﻴ‬
‫‪.‬ﺳ‬ ‫ﻗﺖ‬ ‫ﺆ‬‫ﻜﻞﻣ‬‫ﻡﺑﺸ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡﻓﻲ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﻣﺴ‬
‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﻠﻰﺣ‬ ‫ﻡﻋ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻭﻝﻏ‬‫ﺎ‬‫ﻨ‬
‫ﺪﺗ‬‫ﺎﻋ‬‫‪.‬ﻳﺴ‬‫ﻠﻰ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻳﻖﻏﺴ‬ ‫ﺮ‬‫ﻪﻋﻦﻃ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺘﻢﺇ‬‫ﻟﻢﻳ‬‫ﺎ‬‫ﺮﻣ‬‫ﻴ‬‫ﻮﻯﺧﻄ‬ ‫ﺘ‬
‫ﻣﺴ‬
‫‪.‬‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﺛ‬
‫ﺄ‬‫ﻠﺐﻣﻦﺗ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻡﻣﻦ‬ ‫ﻮ‬‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﺑ‬‫ﺮ‬
‫ﻜ‬‫ﻴ‬‫ﺪﺑ‬‫ﻳ‬
‫ﺰ‬ ‫ﺯ‪.‬ﻳ‬
‫ﻼﺎ‬
‫ﺒ ﻣ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻮﺿ‬ ‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﻊﺩ‬ ‫ﻓ‬‫ﺮ‬‫ﻟ‬‫ﻡ‬‫ﻮ‬‫ﻳ‬‫ﺩ‬
‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﻮ‬ ‫ﺑ‬
‫ﺮ‬‫ﻜ‬‫ﻴ‬
‫ﺀﺑ‬ ‫ﺎ‬
‫ﻜﻦﺇﻋﻄ‬ ‫ﻤ‬‫ﻳ‬
‫ﻮﻯ‬‫ﺘ‬‫ﻔ ﺾﻣﺴ‬ ‫ﺔﻫﻲﺧ‬ ‫ﻴﺠ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻟﺨ‬
‫ﺍ‬ ‫ﻟﻰ‬‫ﻡﺇ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻝ‬
‫ﻘ‬‫ﺘ‬‫ﻧ‬‫ﺍ‬
‫ﻟﻰ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫‪،‬ﻣ‬‫ﻨﻲ‬‫ﻴ‬‫ﻭﺟ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻢ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬
‫ﺪ‬‫ﻴ‬
‫ﻴ‬ ‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺜﻞ‬‫ﻣ‪،‬ﻣ‬‫ﺍﻷﺪ‬ ‫ﺔ‬‫ﻠ‬
‫ﻳ‬‫ﻮ‬‫ﺮﻯﻃ‬ ‫ﺃﺧ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬
‫ﻊﺗ‬ ‫ﻡﻣ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﻳﺴ‬‫ﻷﺪﻭ‬‫ﺍﻣ‬ ‫ﺮ‬‫ﻴ‬
‫ﺍﻋﻼﺝﻗﺼ‬ ‫ﺬ‬
‫‪.‬ﻫ‬ ‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻏﺴ‬ ‫ﺋﻲﻭ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬

‫‪.‬‬
‫ﺎ‬‫ﻬ‬
‫ﻠ‬‫ﻴ‬
‫ﻠ‬‫ﻘ‬
‫(ﻭﺗ‬
‫ﺔﺃ‬
‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﺍﻷ‬‫‪،‬‬
‫ﻠﺢ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺍ‬‫ﺪ‬
‫‪،‬ﺑ‬‫ﺔ‬
‫ﻤ‬‫ﻌ‬‫ﺍﻷﻃ‬
‫ﻡ)‬‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﺭﺟ‬
‫ﺎ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﻤﺼ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻴ‬‫ﻤ‬‫ﻠ ﺺﻣﻦﺟ‬
‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬
‫ﻳ‬

‫‪Nur‬‬‫‪si‬‬‫‪ngpr‬‬ ‫‪ocessf‬‬ ‫‪oracut‬‬ ‫‪er‬‬ ‫‪enal‬‬‫‪f‬‬‫‪ai‬‬‫‪l‬‬

‫‪ur‬‬ ‫‪e:‬‬
‫‪Nur‬‬‫‪si‬‬‫‪ngassessment‬‬ ‫‪:‬‬
‫‪-Voi‬‬‫‪di‬‬‫‪ngpat‬‬ ‫‪t‬‬‫‪er‬‬‫‪n,‬‬ ‫‪i‬‬
‫‪ncl‬‬‫‪udi‬‬‫‪nganyr‬‬ ‫‪ecentchanges.‬‬
‫‪-Wei‬‬‫‪ghtgai‬‬ ‫(‪n‬‬ ‫‪f‬‬‫‪l‬‬‫‪ui‬‬‫‪dr‬‬‫‪et‬‬‫‪ent‬‬‫‪i‬‬‫)‪on‬‬‫‪.‬‬
‫‪-Nauseaandv‬‬ ‫‪omi‬‬ ‫‪t‬‬
‫‪i‬‬‫‪ng.‬‬
‫‪-Pat‬‬‫‪i‬‬‫‪entandf‬‬ ‫‪ami‬‬ ‫‪l‬‬
‫‪yhi‬‬‫‪st‬‬‫‪or‬‬ ‫‪yofr‬‬‫‪enal‬‬ ‫‪di‬‬‫‪sease.‬‬
‫‪-Medi‬‬ ‫‪cat‬‬‫‪i‬‬
‫‪onused.‬‬
‫‪-Recentsur‬‬ ‫‪ger‬‬ ‫‪y‬‬‫‪,‬‬‫‪anet‬‬‫‪hesi‬‬ ‫‪aort‬‬ ‫‪r‬‬
‫‪auma.‬‬
‫‪-Muscl‬‬ ‫‪esweakness.‬‬
‫‪-Ment‬‬ ‫‪al‬‬‫‪st‬‬‫‪at‬‬‫‪uschanges.‬‬
‫‪-Amountofur‬‬ ‫‪i‬‬‫‪neexcr‬‬ ‫‪et‬‬‫‪edi‬‬ ‫‪n24hr‬‬ ‫‪s.‬‬
‫‪-Bl‬‬
‫‪oodpr‬‬ ‫‪essur‬‬ ‫‪e,‬‬‫‪par‬‬ ‫‪t‬‬
‫‪i‬‬‫‪cul‬‬‫‪ar‬‬‫‪l‬‬
‫‪ypost‬‬ ‫‪ur‬‬‫‪al‬‬‫‪changes.‬‬
‫‪-Fl‬‬
‫‪ui‬‬‫‪dst‬‬ ‫‪at‬‬‫‪us:‬‬ ‫‪pr‬‬‫‪esenceofper‬‬ ‫‪i‬‬‫‪pher‬‬‫‪al‬‬‫‪,‬‬‫‪per‬‬‫‪i‬‬
‫‪or‬‬‫‪bi‬‬‫‪t‬‬
‫‪al‬‬‫‪orsacr‬‬‫‪al‬‬‫‪edema,‬‬ ‫‪l‬‬‫‪ungsounds,‬‬
‫‪ski‬‬
‫‪nt‬‬ ‫‪ur‬‬‫‪gor‬‬‫‪,‬‬‫‪dai‬‬ ‫‪l‬‬
‫‪ywei‬‬ ‫‪ght‬‬
‫‪-Changei‬‬ ‫‪nment‬‬ ‫‪al‬‬‫‪st‬‬‫‪at‬‬‫‪us.‬‬
‫‪-Pul‬‬‫‪ser‬‬ ‫‪at‬‬
‫‪eandr‬‬ ‫‪hy‬‬‫‪t‬‬‫‪hm.‬‬
‫‪:‬‬‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻠ‬
‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻋ‬
‫‪:‬‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬
‫‪.‬‬‫ﺔ‬
‫ﺜ‬‫ﻳ‬‫ﺪ‬‫ﺍﺕﺣ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺃﻱﺗ‬ ‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫‪،‬ﺑ‬ ‫ﻎ‬
‫ﻳ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻂ‬ ‫‪-‬ﻧ‬
‫‪.‬‬‫(‬‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬‫ﺍﺣ‬‫ﺯﻥ)‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫‪-‬ﺯ‬
‫‪.‬‬
‫ﺎﻥ‬ ‫ﻴ‬
‫ﺜ‬‫ﺍﻍﻭﻏ‬ ‫ﺮ‬
‫ﻔ‬‫ﺘ‬‫ﺍﺳ‬ ‫‪-‬‬
‫‪.‬‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺄ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺔ‬‫ﻠ‬
‫ﺋ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫‪-‬ﺗ‬
‫‪.‬‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬ ‫ﺍﻷ‬‫‪-‬‬
‫‪.‬‬
‫ﻮﺽ‬ ‫ﺮﺿ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﺮ‬
‫ﻳ‬‫ﺪ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬ ‫ﺜ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬‫‪-‬ﺿ‬
‫‪.‬‬‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻘ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫‪-‬ﺗ‬
‫‪.‬‬‫ﺔ‬‫ﺎﻋ‬‫ﺯﺧﻼﻝ‪24‬ﺳ‬ ‫ﺮ‬‫ﻔ‬
‫ﻮﻝﺗ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬ ‫‪-‬ﻛ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺻ‬ ‫ﻡﻭﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫‪-‬ﺿ‬
‫ﻣﻲ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺯﻥ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫‪،‬‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﻡ‬ ‫ﺭ‬
‫ﻮ‬‫‪،‬ﺗ‬ ‫ﺔ‬‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺃﺻ‬‫‪،‬‬ ‫ﺰﻱ‬‫ﻭﻋﺠ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﻴﻄ‬‫ﻭﻣﺤ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻴﻄ‬‫ﺔﻣﺤ‬ ‫ﻣ‬‫ﺫ‬‫ﺩﻭ‬‫ﻮ‬‫‪:‬ﻭﺟ‬ ‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫‪-‬ﺣﺔ‬
‫ﻟ‬
‫ﺎ‬

‫‪115‬‬
 .
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻘ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺮﻓﻲ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬-
.‫ﺎﻉ‬
‫ﻘ‬‫ﻳ‬‫ﺍﻹ‬
‫ﺒ ﺾﻭ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺪﻝ‬‫ﻌ‬‫ﻣ‬-
Nursingdiagnosi s:
1.Fl
uidv olumedef i
citorexcess.
2.Nutri
tion,alteredl essthanbodyrequi
rement
s.
3.Activ
ityintolerance.
4.Highriskf orinjury.
5.Copingi neffective
6.Knowl edgedef ici
t
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
.‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺰﺣﺠﻢ‬ ‫ﻋﺠ‬.1
.
‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﺒ‬‫ﻠ‬
‫ﺘﻄ‬‫ﻗﻞﻣﻦﻣ‬ ‫ﺃ‬‫ﺮﺕ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬،‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
2
.‫ﻌﺼﺐ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻁ‬‫ﻧﺸ‬.3
.
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺎ‬‫ﺮﻋ‬‫ﺎﻃ‬‫ﻣﺨ‬.4
‫ﺎﻝ‬‫ﻌ‬‫ﺮﻓ‬‫ﻴ‬‫ﻠﻢﻏ‬‫ﻗ‬‫ﺄ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
5
‫ﺔ‬
‫ﻓ‬‫ﺮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﺺ‬ ‫ﻧ‬.
6

Nursi
ngi nter v
ent i
ons:
1.Maintainingf l
uidandel ectroly tebal ance:
-Maintai
nf luidr estri
ctions.
-Monitorintrav enousf luidscar ef ully.
-Keepaccur at er ecordsofi ntakeandoutput .
-Weightpat ientdai ly.
-Monitorvital signs.
-Administerphosphat ebi ndi
ngmedi cati
onsaspr escribed.
-Monitorser um el ectrolyte.
-Duri
ngdi ureticphase:
Assessf orchangei nment alst atusi ndicati
veofl owser um lev el.
Assessf orpr esenceofapi cal pul seindicativeofhy pokal emia.
:‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:‫ﺭ‬
‫ﺎﻝ‬ ‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬‫ﻠﻰﺗ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬.1
.‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻴ‬‫ﻠﻰﻗ‬‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﺣ‬-
.‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﺔﺑ‬ ‫ﻳ‬
‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﺍﺝ‬‫ﺮ‬
‫ﺍﻹﺧ‬‫ﻬﻼﻙﻭ‬ ‫ﺘ‬ ‫ﻟﻼﺳ‬ ‫ﺔ‬‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﺎﻅﺑﺴﺠﻼﺕﺩ‬ ‫ﻔ‬‫ﺘ‬‫ﺍﻻﺣ‬-
.‫ﺎ‬‫ﻴ‬
‫ﻣ‬‫ﻮ‬ ‫ﻳ ﺾﻳ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯﻥ‬‫ﻭ‬-
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.
‫ﻮﻑ‬ ‫ﻮﺻ‬ ‫ﻮﻣ‬‫ﺎﻫ‬‫ﻤ‬‫ﺎﺕﻛ‬ ‫ﻔ‬‫ﻮﺳ‬ ‫ﻔ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﺑﻄ‬‫ﺍ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻓﻲ‬ ‫ﺎ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﻨﺤﻞﺑ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
:‫ﻮﻝ‬‫ﺒ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬ ‫ﺭ‬‫ﺪ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺧﻼﻝ‬-
.
‫ﻤﺼﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬‫ﺎ ﺽﻣﺴ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬‫ﻠﻰ‬‫ﺪﻝﻋ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻠ‬
‫ﻘ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬
‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫•ﺗ‬
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﻘ ﺺﺑ‬‫ﻠﻰﻧ‬ ‫ﺪﻝﻋ‬ ‫ﻤﻲﻳ‬ ‫ﺒ ﺾﻗ‬ ‫ﺩﻧ‬‫ﻮ‬‫ﻴﻢﻭﺟ‬ ‫ﻴ‬
‫ﻘ‬‫•ﺗ‬
2.Maintainingnut rit
ion:
-Provi
def l
ui dinsmal lamountdur i
ngol i
guriaphase.
-Provi
deadi et:
Restri
ctedi npr otei
naspr escribed
Highincar bohy dratesandf atdur ingproteinrestri
ction.

116

Lowi npot
assi
um dur
inghyper
kal
emiaandhighinpot
assi
um duri
ng
hypokal
emia.
Takemeasurestorel
i
evenausea(ant
iemet
ics-
comfor
tmeasures)
.

:‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬.2
.
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺔﻗ‬‫ﻠ‬‫ﺮﺣ‬‫ﺔﺧﻼﻝﻣ‬ ‫ﻠ‬‫ﻴ‬
‫ﻠ‬‫ﺎﺕﻗ‬‫ﻴ‬‫ﻤ‬‫ﻜ‬‫ﺋﻞﺑ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﺗ‬-
:‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬‫ﻡﻏ‬‫ﺎ‬‫ﺮﻧﻈ‬‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﺗ‬-
‫ﻮﻑ‬‫ﻮﺻ‬ ‫ﻮﻣ‬‫ﺎﻫ‬‫ﻤ‬‫ﻴﻦﻛ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫ﺪﺑ‬‫ﻴ‬‫ﻘ‬‫•ﻣ‬
.
‫ﻴﻦ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻴ‬‫ﻴ‬
‫ﻘ‬‫ﺀﺗ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬‫ﻮﻥ‬‫ﺪﻫ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻭ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻮﻫ‬‫ﺑ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺔﻋ‬‫ﺒ‬‫•ﻧﺴ‬
‫ﻡ‬
‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﻘ ﺺﺑ‬
‫ﺀﻧ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻣﻦ‬
‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺔﻋ‬‫ﺒ‬‫ﻧﺴ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬ ‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬
‫ﺮﻁﺑ‬ ‫ﺀﻓ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎ ﺽﻓﻲ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬•
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
.
(‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺗ‬-‫ﺀ‬‫ﻘﻲ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻣﻀ‬ )‫ﺎﻥ‬
‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺘﺨ‬ ‫ﻟ‬‫ﺮ‬
‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺫﺗ‬‫ﺎ‬
‫ﺗﺨ‬‫ﺍ‬•

3.Maintai
ningrestandactiv
itybal
ance:
-Maintai
nbedr esti
ntheacutephase.
-Assesspatientwit
hADLt oconserveenergy.
-Promoteear l
yambulati
onwhenr enalst
atusper
mit
s.
-Provi
deforplannedrestperi
ods.

:
‫ﺎﻁ‬‫ﻨﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺯﻥﺑ‬‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬.3
.
‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺵﻓﻲ‬ ‫ﺮ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬-
.‫ﺔ‬‫ﻗ‬
‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻠﺤ‬‫ﻟ‬ADL‫ﻊ‬ ‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻤﺢ‬‫ﺎﺗﺴ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﺮﻋ‬‫ﻜ‬‫ﺒ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻤﺸﻲ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬
‫ﻌ‬‫ﺗ‬-
.‫ﻟ‬
‫ﺎ‬‫ﻤﺨﻄﻂﻬ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﺘ‬
‫ﺮﻓ‬ ‫ﻴ‬‫ﻓ‬
‫ﻮ‬‫ﺗ‬-

4.Prev entingi njury:

-Assessor ientation,orientconf usedpat ient .
-Duri
ngbedr est ,keepsi derailsraised.
-Assessf orsi gnsofbl eeding.
-Protectpat i
entf rom bleeding,instructpat ientt ousesof ttoothbr ash.
5.Prev entingi nfection:
-Avoidpat ientcont actbyanyonewi thoni nfection.
-Assessf orsi gnsandsy mpt omsofi nfection.
-Maintainasepsi sforindwel l
inglinesorcat heter .
-Facil
itatepul monar yhy gi
enewhi l
epat ientonbedr est.
-Turnweakori mmobi l
epat i
ent sfrequent l
y .
-Providemet iculousski ncar e.
-Admi nisterpr escr i
bedant i
biotic.
:
‫ﺔ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻻﺻ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬.4
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﺋ‬‫ﺎ‬
‫ﻪﺣ‬ ‫ﻴ‬‫ﻮﺟ‬‫ﺗ‬‫ﻪﻭ‬ ‫ﻮﺟ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.‫ﺔ‬‫ﻌ‬‫ﻔ‬‫ﺗ‬‫ﺮ‬
‫ﺔﻣ‬ ‫ﻴ‬‫ﺒ‬
‫ﻧ‬‫ﺎ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﻥ‬‫ﺒ‬‫ﻘﻀ‬ ‫ﻟ‬
‫ﺍ‬ِ‫ﺑ‬
‫ﻖ‬ ‫ﺃ‬،‫ﺍﺵ‬‫ﺮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬-
.
‫ﻳﻒ‬ ‫ﺰ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻟﻼ‬
‫ﻓﺤ ﺺﻌ‬-
.
‫ﺔ‬‫ﻤ‬‫ﺎﻋ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﻨ‬
‫ﺍﻷﺳ‬ ‫ﺓ‬‫ﻮ‬
‫ﻡﺣﺸ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﻳ ﺾﻻﺳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﺭﺷ‬‫ﺇ‬‫ﻭ‬،‫ﻳﻒ‬‫ﺰ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻣﻦ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬-
:‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬.5
.‫ﻭﻯ‬‫ﺪ‬ ‫ﻌ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺏﺑ‬ ‫ﺃﻱﺷﺨ ﺺﻣﺼ‬ ‫ﺔ‬
‫ﻣﺴ‬ ‫ﻨﺐﻣﻼ‬ ‫ﺗﺠ‬-
.‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﻴﻢﻋﻼ‬ ‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.
‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬
‫ﺔ‬ ‫ﻨ‬‫ﻛ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﻮﻁ‬‫ﻠﺨﻄ‬‫ﻟ‬‫ﻴﻢ‬‫ﻘ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬
‫ﺍ‬-
.
‫ﺍﺵ‬ ‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺍﺣ‬‫ﺀﺭ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻬ‬‫ﺗﺴ‬-

117
 .
‫ﺭ‬‫ﺮ‬‫ﻜ‬
‫ﺘ‬‫ﻜﻞﻣ‬
‫ﻴﻦﺑﺸ‬
‫ﻛ‬‫ﺮ‬‫ﺘﺤ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻭﻏ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬
‫ﻔ‬‫ﻌ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺘﺤ‬‫ﻳ‬-
.‫ﺓ‬
‫ﺮ‬‫ﺒﺸ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﺗ‬-
.
‫ﺔ‬‫ﻓ‬‫ﻮ‬‫ﻮﺻ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺗ‬-
6.Faci lit
at ecopi ng:
-Encour agedev elopmentofnur se–pat ientr elati
onshi ptoassi stpatientto
expressf eel i
ngasdesi red
-Eval uation:
-Compar et hepat ientst atuswi t
ht heexpect edout comesi ftheoutcomesar e
notmet ,
r eassesst hepat ientandr eviset hepl an.
7.Pr ev ent i
onofacut erenalf ailure:
-Prov ideadequat ehy drationt opat i
ent satr i
skofdehy drati
on.
-Prev entandt reatshockpr ompt lywi thbl oodandf luidreplacement .
-Moni torcr it
icallyillpatient sf orcent ralvenousandar terialpressure.
-Cont inual l
yassessr enal funct i
on( urineout put,laboratoryv al
ues)
-Takepr ecaut i
onst oensur et hatt heappr opr i
atebl oodisadmi nist
eredt othe
correctpat ientt oav oi
dt ransf usionr eact i
ons.
-Prev entandt reati nfectionspr ompt ly.
-Payspeci alat tentiont obur ns, wounds, andot hercausesofsepsi s.
-Givespeci alcar et opat ient swi thindwel lingcat heterstopr eventascendi ng
uri
nar yt ractinf ections.
-Closel ymoni t
oral lmedi cat ionsmet abol i
zedandexcr etedbyt heki dneysfor
dosage, dur ationandbl oodl ev els.

:
‫ﻠﻢ‬‫ﻗ‬‫ﺄ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻬ‬‫ﺗﺴ‬.6
‫ﺮﻏﺐ‬‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﺎﻋ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻋﻦ‬‫ﻴ‬‫ﺒ‬‫ﻌ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻋ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ ﺽﻭ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻼﺔﺑ‬‫ﻌﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﻊﺗﻄ‬‫ﻴ‬ ‫ﺗﺸﺠ‬-
‫ﺎ‬‫ﻬ‬‫ﻴ‬‫ﻓ‬
:‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.‫ﺔ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻊ‬‫ﺍﺟ‬‫ﺭ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺪﺗ‬‫ﺃﻋ‬
‫ﻭ‬، ‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻘﻖ‬ ‫ﺘﺤ‬‫ﻟﻢﺗ‬‫ﺍ‬‫ﺫ‬‫ﺔﺇ‬ ‫ﻌ‬
‫ﻗ‬‫ﻮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺎ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺣﺔ‬
‫ﻟ‬‫ﺭﻥ ﺎ‬ ‫ﺎ‬
‫ﻗ‬-
:‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬.
7
.
‫ﺎﻑ‬ ‫ﻔ‬
‫ﻟﺠ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﻴﻦ‬‫ﺮﺿ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻓﻲ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﺮﻃ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬-
.
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﻝ‬‫ﺪ‬‫ﺒ‬‫ﺘ‬‫ﺎﺳ‬‫ﺭﺑ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻋ‬ ‫ﻬ‬‫ﻋﻼﺟ‬‫ﺔﻭ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﻊ‬‫ﻨ‬
‫ﻣ‬-
.
‫ﻧﻲ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬
‫ﺰﻱﻭ‬ ‫ﻛ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻱ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬‫ﻟ‬
‫ﺔ‬ ‫ﺮﺟ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﺔﻣ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬
‫ﻣ‬-
(‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﺒ‬‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬،‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺝ‬‫ﺮ‬‫ﺇﺧ‬)‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺎﺳ‬‫ﻠﻰﺑ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻴﻢﻭﻇ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬‫ﺎﻋﻼﺕﻧ‬‫ﻔ‬‫ﻨﺐﺗ‬‫ﺘﺠ‬‫ﻟ‬‫ﻴﺢ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﺎﻥﺇﻋﻄ‬ ‫ﻤ‬‫ﻟﻀ‬ ‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﺍﻼ‬‫ﺎﺕﻟ‬ ‫ﺎﻃ‬‫ﻴ‬‫ﺘ‬
‫ﺍﻻﺣ‬ ‫ﺫ‬‫ﺎ‬‫ﺗﺨ‬‫ﺍ‬-
.‫ﺔ‬‫ﻋ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻪ‬‫ﻠﻰﻭﺟ‬ ‫ﺎﺕﻋ‬ ‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬‫ﻋﻼﺝ‬ ‫ﻊﻭ‬ ‫ﻨ‬
‫ﻣ‬-
.
‫ﺮﻯ‬ ‫ﺍﻷﺧ‬‫ﺎﻥ‬‫ﺘ‬‫ﻧ‬
‫ﺍﻹ‬ ‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬‫ﻭﺡﻭ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻭﻕﻭ‬‫ﺮ‬‫ﻠﺤ‬ ‫ﻟ‬‫ﺎﺹ‬ ‫ﻜﻞﺧ‬ ‫ﻪﺑﺸ‬ ‫ﺒ‬
‫ﺘ‬‫ﻧ‬‫ﺍ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﺎﻋ‬‫ﻊﺗﺼ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻨ‬‫ﻛ‬
‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬ ‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﺎﺻ‬‫ﺔﺧ‬ ‫ﻳ‬
‫ﺎ‬‫ﺀﺭﻋ‬ ‫ﺎ‬
‫ﺇﻋﻄ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬‫ﺓﻭ‬‫ﺪ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﺮﻋ‬‫ﻠﺠ‬‫ﻟ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﺯﻫ‬‫ﺮ‬
‫ﻔ‬‫ﺗ‬‫ﻼﺎﻭ‬
‫ﻬ‬‫ﻘﺑ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻊ‬ ‫ﻴ‬‫ﻤ‬‫ﺜﺐﺟ‬ ‫ﻗﺐﻋﻦﻛ‬ ‫ﺍ‬‫ﺮ‬‫ﺗ‬-

Chr
oni
cRenalFai
lur
e
Defi
niti
on:
Chronicrenal f
ail
ureinvol
vesprogressi
ve,i
rrev
ersi
bledi
str
uct
ionoft
he
nephronsi nbothkidneys.
Causesofchr onicrenalf
ail
ure:
1.Glomer ulonephri
ti
sandchr oni
cpy el
onephri
ti
s.

118
2.Diabeti
cnephr opathy.
3.Hy pert
ensivenephrosclerosi
s.
4.Si
ckl ecell
anemi a.
5.Systemiclupuser yt
hemat osus.
6.HIV-associatednephr opathy.
7.Prostati
candbl addertumor s.
8.Ureterobstructi
on.
9.Calculi
.
10.Polycy st
ickidneydisease.
11.Renal i
nfarcti
on.

‫ﻣﻦ‬
‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬
‫ﻟ‬‫ﺍ‬
:
‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
.‫ﻴﻦ‬‫ﺘ‬‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﺘ‬‫ﻠ‬
‫ﻭﻥﻓﻲﻛ‬ ‫ﺮ‬‫ﻔ‬‫ﻴ‬
‫ﻨ‬‫ﻠ‬‫ﻟ‬‫ﻪ‬‫ﻴ‬
‫ﺔﻓ‬ ‫ﻌ‬‫ﻳﺠﻲﻻﺭﺟ‬ ‫ﺭ‬‫ﺪ‬‫ﺍﺏﺗ‬‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻠﻰ‬ ‫ﻣﻦﻋ‬ ‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﻨﻄ‬ ‫ﻳ‬
:‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﺒ‬
‫ﺃﺳ‬
.
‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺒ‬‫ﻴ‬‫ﺒ‬‫ﺎﺏﻛ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ .
1
.
‫ﺮﻱ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻼﻝ‬ ‫ﻋ‬‫ﺍ‬ .
2
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺗﺞﻋﻦ‬ ‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺐ‬ ‫ﺗﺼ‬.3
.‫ﻠﻲ‬‫ﻨﺠ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬‫ﻓ‬.4
.‫ﺔ‬‫ﻳ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﻤ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﺋ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬ .
5
.
‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻋ‬‫ﺎ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﺺ‬ ‫ﻭﺱﻧ‬ ‫ﺮ‬
‫ﻴ‬‫ﻔ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻼﻝ‬ ‫ﻋ‬‫ﺍ‬ .
6
.‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬‫ﺗ‬‫ﺎ‬‫ﺘ‬‫ﻭﺳ‬ ‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺃ‬ .
7
.‫ﻟﺐ‬ ‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬ .
8
.‫ﺎﺏ‬ ‫ﺣﺴ‬. 9
.‫ﻟﻲ‬ ‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺴﻲ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬.10
.‫ﻮﻱ‬ ‫ﻠ‬
‫ﺀﻛ‬ ‫ﺎ‬‫ﺘﺸ‬ ‫ﺍﺣ‬.11
Pathophy siology
Asr enalfunctiondecl i
nes, t
heendpr oduct sofpr oteinmet abolism ( whi char e
normal l
yexcr etedinur i
ne)accumul ateint heblood.Ur emi adev elopsand
adverselyaf f
ectsev erysy stem inthebody .Thegr eatert hebui l
dupofwast e
products,themor esev erethesy mpt oms.Ther earet hreewel l-
recogni zed
stagesofchr oni crenaldisease: reducedr enal r
eserv e,
r enal i
nsuf ficiency ,and
ESRD
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
‫ﺓ‬ ‫ﺩ‬
‫ﺎ‬‫ﺯﻋ‬‫ﺮ‬‫ﻔ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬
)‫ﻴﻦ‬ ‫ﺗ‬‫ﻭ‬
‫ﺮ‬‫ﺒ‬‫ﻠ‬
‫ﻟ‬‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬ ‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻬ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺘﺠ‬‫ﻨ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻛﻢ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﺗ‬،‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬ ‫ﺎ‬‫ﺎ ﺽﻭﻇ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﻊ‬‫ﻣ‬
‫ﺩﺕ‬ ‫ﺍ‬
‫ﺯ‬، ‫ﻔﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬‫ﻛﻢ‬‫ﺍ‬‫ﺮ‬
‫ﺩﺗ‬‫ﺍ‬‫ﺎﺯ‬
‫ﻤ‬‫ﻠ‬‫ﻛ‬.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺯﻓﻲ‬‫ﺎ‬‫ﻬ‬‫ﻠﻰﻛﻞﺟ‬ ‫ﺎﻋ‬ً
‫ﺒ‬
‫ﻠ‬‫ﺮﺳ‬ ‫ﺛ‬
‫ﺆ‬‫ﺗ‬‫ﺎﻭ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬ ‫ﺘﻄ‬‫ﺗ‬.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫(ﻓﻲ‬ ‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬
‫ﻭ‬، ‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲ‬ ‫ﻴ‬‫ﺘ‬
‫ﺍﺣ‬ ‫ﺎﺽ‬ ‫ﻔ‬
‫ﻧﺨ‬ ‫ﺍ‬
:‫ﻣﻦ‬‫ﺰ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬ً
‫ﺪ‬‫ﻴ‬‫ﺎﺟ‬‫ﻬ‬‫ﺮﻑﺑ‬ ‫ﺘ‬
‫ﻌ‬‫ﺍﺣﻞﻣ‬ ‫ﺮ‬‫ﺎﻙﺛﻼﺙﻣ‬ ‫ﻨ‬‫ﻫ‬. ‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬ ‫ﺓ‬‫ﺪ‬‫ﺣ‬
‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺍﻷﺧ‬‫ﻪ‬‫ﻠ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻤ‬ ‫ﻮﻱﺑ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬‫ﻮ‬‫ﻘﺼ‬‫ﻟ‬‫ﺍ‬

Stagesofchr onicrenaldisease:
Stage1:
Reducedr enalreserve,charact
eri
zedbya40%t o75%lossofnephr onfuncti
on.
Thepat i
entusuallydoesnothav esympt omsbecausetheremainingnephrons
areabletocar r
youtt henormal f
uncti
onsofthekidney.
Stage2:
Renalinsuffi
ciencyoccur swhen75%t o90%ofnephr onfuncti
onislost.Atthi
s
point,t
heserum cr eat
ini
neandbl oodureanit
rogenise,
thekidneylosesits
abil
itytoconcentrateuri
neandanemi adev el
ops.Thepati
entmayr eport
polyuri
aandnoct uria.

119
 :‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﺍﺣﻞﻣ‬ ‫ﺮ‬
‫ﻣ‬
:
1‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻧﻲ‬‫ﺎ‬
‫ﻌ‬‫ﺓﻻﻳ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬.‫ﻭﻥ‬‫ﺮ‬
‫ﻔ‬‫ﻴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
٪75‫ﻟﻰ‬‫ﺇ‬٪40‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻔ‬
‫ﺰﺑ‬‫ﻴ‬‫ﻤ‬
‫ﺘ‬‫ﻳ‬،‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲ‬‫ﻴ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﺎ ﺽﻓﻲ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
.
‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺋﻒ‬ ‫ﺎ‬
‫ﻮﻇ‬‫ﻡﺑ‬‫ﺎ‬
‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺭﻋ‬‫ﺩ‬‫ﺎ‬
‫ﻘﻲﻗ‬‫ﺒ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭﻥ‬‫ﺮ‬‫ﻔ‬‫ﻴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺍ ﺽﻷﻥ‬‫ﺮ‬‫ﻋ‬‫ﺃ‬‫ﻣﻦ‬
:‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬‫ﻨ‬
‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺈﻥ‬‫ﻓ‬،‫ﺔ‬‫ﻘﻄ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬
‫ﺪﻫ‬ ‫ﻨ‬
‫ﻋ‬.‫ﻭﻥ‬ ‫ﺮ‬
‫ﻔ‬‫ﻴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻣﻦﻭﻇ‬٪ 90‫ﻟﻰ‬‫ﺇ‬٪
75‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﺪﻓ‬‫ﻨ‬‫ﻮﻱﻋ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻘﺼ‬‫ﻟ‬‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬
‫ﻎ‬‫ﻠ‬
‫ﺒ‬‫ﺪﻳ‬‫ﻗ‬.‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻘ‬‫ﺭﻓ‬
‫ﻮ‬‫ﺘﻄ‬‫ﻳ‬
‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬
‫ﻛ‬‫ﺮ‬‫ﻠﻰﺗ‬‫ﺎﻋ‬‫ﻬ‬
‫ﺗ‬‫ﺭ‬‫ﺪ‬‫ﺔﻗ‬
‫ﻴ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻘ‬
‫ﻔ‬‫ﺗ‬،‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻓﻲ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻭﺟ‬‫ﺮ‬‫ﺘ‬‫ﻴ‬‫ﻧ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬
.‫ﻠﻲ‬
‫ﻴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﺜ‬‫ﻳ ﺾﻋﻦﻛ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬

Stage3:
End- stager enaldi sease( ESRD) ,
thef i
nal stageofchr oni crenal fai
lure,occurs
whent her ei slesst han10%nephr onf unct i
onr emai ning.Al loft henor mal
regulator y,excr etory,andhor monal funct i
onsoft hekidney
aresev erelyi mpai r
ed.ESRDi sevidencedbyel ev atedcr eatinineandbl oodur ea
nit
rogenl ev elsaswel lasel ectrol
ytei mbal ances.Oncet hepat ientreachest his
point,di alysisisusual lyindicated.Manyoft hesy mptomsofur emiaar e
reversibl ewi thdialysis.
:
3‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺮ‬
‫ﻴ‬‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬، (
‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺍﻷﺧ‬‫ﻪ‬‫ﻠ‬‫ﺍﺣ‬‫ﺮ‬‫ﻤ‬‫ﻮﻱﺑ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬)‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻬ‬‫ﻠﻰﻓﻲﻧ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﺽ‬ ‫ﺪﺙﻣ‬ ‫ﻳﺤ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬ ‫ﺎ‬‫ﻊﻭﻇ‬ ‫ﻴ‬‫ﻤ‬‫ﺟ‬.‫ﺔ‬‫ﻴ‬‫ﻘ‬‫ﺒ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭﻥ‬ ‫ﺮ‬
‫ﻔ‬‫ﻴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻒ‬ ‫ﺎ‬
‫ﻣﻦﻭﻇ‬٪ 10‫ﻗﻞﻣﻦ‬ ‫ﺃ‬ ‫ﺎﻙ‬‫ﻨ‬‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬، ‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﻮ‬
‫ﻣ‬ ‫ﺮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﺔﻭ‬‫ﻴ‬‫ﻤ‬
‫ﻴ‬‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﻴ‬‫ﺎﺕﻧ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺘ‬
‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬ ‫ﺓﻣﻦﺧﻼﻝ‬ ‫ﺮ‬‫ﻴ‬‫ﺍﻷﺧ‬‫ﻪ‬ ‫ﻠ‬‫ﺍﺣ‬‫ﺮ‬‫ﻤ‬‫ﻮﻱﺑ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺘﻀﺢ‬ ‫ﻳ‬.‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻌﻒﺷ‬ ‫ﻮﻥﻣﻦ ﺿ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳ‬
‫ﻩ‬‫ﺬ‬‫ﻟﻰﻫ‬ ‫ﻳ ﺾﺇ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺩﻭﺻ‬ ‫ﺮ‬ ‫ﻤﺠ‬‫ﺑ‬.‫ﺭ‬
‫ﺎﻝ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯﻥ‬‫ﺍ‬
‫ﻮ‬ ‫ﺘﻼﻝﺗ‬ ‫ﺍﺧ‬ ‫ﻟﻰ‬‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻹﺿ‬ ‫ﻡﺑ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻓﻲ‬ ‫ﻨ‬
‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬
‫ﻴ‬‫ﻟ‬‫ﺍ‬
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﻐﺴ‬‫ﻡﺑ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻓﻲ‬ ‫ﺒ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻜﺲ‬ ‫ﻜﻦﻋ‬ ‫ﻤ‬‫ﻳ‬. ‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬ ‫ﻴﻞ‬‫ﻟﻰﻏﺴ‬ ‫ﺭﺇ‬‫ﺎ‬‫ﺎﻳﺸ‬‫ﺓﻣ‬ ‫ﺩ‬
‫ﺎ‬‫ﻋ‬،‫ﺔ‬‫ﻘﻄ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬

Signsandsy mpt omsofchr onicr enalfai l

ure:
1-Neur ologic:
Weaknessandf at i
gue;conf usion; i
nabilitytoconcent rate;di sorientation;
tr
emor s;sei zures; asteri
xi
s; restlessnessofl egs; burningofsol esoff eet ;
behav iorchanges
2-Integument ary :
Gray -
br onzeski ncol or;
dry ,f
lakyski n;prur i
tus;ecchy mosi s;pur pura; thin,bri
tt
le
nails;coar se,thinni nghair
3-Car diov ascul ar:
Hy pertension; pittingedema( f
eet ,hands, sacrum) ;periorbital edema;
pericardial f
r i
ctionr ub;engor gedneckv eins;ericarditi
s; pericar dialeffusion;
pericardial t
amponade; hyperkalemi a;hy perli
pidemi a
4-Pul monar y:
Crackles; thick,t enacioussput um; depressedcoughr eflex;pl euriti
c
pain;shor tnessofbr eath;tachy pnea;Kussmaul -t
y perespi rations; uremi c
pneumoni t
is;―ur emi cl
ung‖
:‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﻋﻼ‬
:
‫ﺒﻲ‬ ‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬-1
‫ﻴﻦ‬‫ﻗ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻤﻞ‬‫ﻠ‬‫ﻤ‬‫ﺗ‬.‫ﻜﺲ‬ ‫ﻳ‬‫ﺮ‬‫ﺘ‬
‫ﺃﺳ‬‫؛‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫؛‬‫ﺎﺵ‬ ‫ﻌ‬‫ﺗ‬
‫ﺭ‬‫ﺍﻻ‬.‫ﺎﻙ‬‫ﺒ‬‫ﺗ‬‫ﺭ‬
‫ﺍﻻ‬‫؛‬‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫؛ﻋ‬‫ﺎﻙ‬‫ﺒ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬.‫ﻌﺐ‬ ‫ﺗ‬
‫ﻌﻒﻭ‬ ‫ﺿ‬
‫ﻮﻙ‬ ‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻳ‬.‫ﻴﻦ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻃﻦ‬‫ﺮﻕﺑ‬‫ﺣ‬
:‫ﻓ‬
‫ﻏﻼ ﻲ‬- 2

120
 ‫ﺮ‬‫ﻌ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺔ‬‫ﺔﻭﻫﺸ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺮﺭ‬‫ﻓ‬‫ﺎ‬
‫ﺃﻇ‬.
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻓ‬‫ﺮ‬‫ﻓ‬.‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻛ‬.‫ﺔ‬‫ﻜ‬‫ﺮﺣ‬‫ﻘﺸ‬‫ﺘ‬
‫ﺎﻑﻣ‬ ‫ﺪﺟ‬ ‫ﻠ‬
‫ﺟ‬.‫ﺰﻱ‬‫ﻧ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻱ‬‫ﺎ‬‫ﻣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻟ‬
‫ﻴﻖ‬‫ﻗ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻟﺨﺸﻦ‬‫ﺍ‬
:
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬
‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬-3
‫ﺭ‬
‫ﻮ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﻙ‬‫ﻜ‬
‫ﺘ‬‫ﺍﻻﺣ‬‫ﺮﻙ‬‫ﺎﺝﻓ‬‫ﻟﺤﺠ‬‫ﺍ‬‫ﻮﻝ‬‫ﺔﺣ‬‫ﻣ‬‫ﺫ‬
‫؛ﻭ‬ (
‫ﺰ‬ ‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦﻭ‬‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬)‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﻟ‬
‫ﺄ‬‫ﺗ‬.
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬
‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬ ‫ﺗ‬
‫ﻮ‬‫ﺮﻁﺑ‬‫ﺭﻱﻓ‬‫ﻮ‬‫ﻣ‬
‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻙ‬‫ﻛ‬ِ
‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬
‫ﻧﺼ‬‫ﺍ‬.‫ﺎﻥ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻨ‬‫ﻘ‬‫ﺘ‬
‫ﻨﻖﻣﺤ‬ ‫ﻭﻕﻋ‬ ‫ﺮ‬‫ﻋ‬
‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﺷﺤ‬
:
‫ﺔ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬-4
‫ﺒﻲ‬‫ﻨ‬‫ﻟﺠ‬‫ﺍ‬‫ﺑﻲ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬
‫ﻛ‬‫ﺎﺍﻻ‬
‫ﻌﻝ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻜﺲ‬ ‫ﻌ‬‫ﻨ‬
‫ﺪﻣ‬‫ﻴ‬‫ﻨ‬‫ﻴﻒﻋ‬‫ﺜ‬‫ﻐﻢﻛ‬‫ﻠ‬‫ﺑ‬.
‫ﺔ‬‫ﻟﺨﺸﺨﺸ‬ ‫ﺍ‬
‫ﺔ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ .
‫ﻤﻲ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬‫ﺋ‬‫ﺎﺏﺭ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
‫ﻭﻝ‬‫ﺎ‬
‫ﻤ‬‫ﻮﺳ‬‫ﻮﻉﻛ‬ ‫ﻔﺲﻣﻦﻧ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬.
‫ﻔﺲ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻉ‬‫؛ﺗﺴ‬‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻖﻓﻲ‬ ‫ﺍ؛ ﺿ‬
‫ﻟﻢ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬

5-Gast roint est i

nal:
Ammoni aodort obreath( ―ur emicfetor‖);met al
li
ct aste; mouthul cerationsand
bleeding; anor exia,nausea, andv omiti
ng; hi
ccups; const ipati
onordi arrhea;
bleedingf rom gast rointesti
nal t
ract
6-Hemat ologi c:
Anemi a; thrombocy t
openi a
7-Repr oduct ive:
Amenor rhea; testi
cularat r
ophy ;i
nferti
li
ty;decreasedl i
bido.
8-Muscul oskel etal:
Muscl ecr amps; l
ossofmuscl est r
ength;renal osteody strophy;bone, pain;bone
fr
actur es; f
ootdr op.
:‫ﻤﻲ‬ ‫ﻬﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬-5
‫ﺎﻥﻭ‬‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻬ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻓ‬. ‫ﻳﻒ‬‫ﺰ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻢﻭ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺮﺣ‬‫ﻘ‬‫؛ﺗ‬
‫ﻧﻲ‬ ‫ﺪ‬
‫ﻌ‬ ‫ﻌﻢﻣ‬‫؛ﻃ‬ ("‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﺘ‬
‫ﻴ‬‫ﻓ‬"
)‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬‫ﺎ‬‫ﻴ‬‫ﻧ‬
‫ﻮ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﺋﺤ‬‫ﺍ‬
‫ﺭ‬
‫ﻤﻲ‬‫ﻬﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒﻣﻦ‬ ‫ﺰ‬ ‫ﻧ‬.‫ﺎ‬
‫ﻹﻬﻝ‬
‫ﺃﺍ ﺳ‬‫ﺎﻙﻭ‬‫ﻣﺴ‬ ‫ﺍﻹ‬-. ‫ﺍﻕ‬‫ﻮ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬.‫ﺀ‬‫ﻘﻲ‬‫ﻟ‬
‫ﺍ‬
:‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬-6
‫ﺎﺕ‬‫ﻴﺤ‬ ‫ﻔ‬
‫ﻟﺼ‬ ‫ﺍ‬‫ﺔ‬‫ﻠ‬‫؛ﻗ‬‫ﻡ‬‫ﺮﺩ‬‫ﻘ‬‫ﻓ‬
:‫ﺔ‬‫ﻴ‬‫ﺑ‬
‫ﺎ‬‫ﻧﺠ‬‫ﺍﻹ‬-7
.‫ﺔ‬
‫ﻴ‬‫ﻨﺴ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﺮﻏ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻀﺖ‬ ‫ﻧﺨ‬
‫ﺍ‬ .‫ﻘﻢ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫؛‬‫ﺔ‬‫ﻴ‬‫ﻟﺨﺼ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻤ‬‫؛ﺿ‬ ‫ﻤﺚ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺎﻉ‬‫ﻘﻄ‬‫ﻧ‬
‫ﺍ‬
:
‫ﻠﻲ‬‫ﻜ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻲ‬ ‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬-8
.‫ﻡ‬
‫ﺪ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻁ‬ ‫ﺒ‬‫؛ﻫ‬‫ﻡ‬ ‫ﺎ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫؛ﻛﺴ‬‫ﻡ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺁﻻ‬.
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻤﻲ‬ ‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﻟﺤ‬‫ﺍ‬.
‫ﻌﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﺍﻥﻗ‬‫ﺪ‬‫ﻘ‬‫؛ﻓ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻨﺠ‬‫ﺗﺸ‬

Compl ications:
Potent ialcompl i
cationsofchr oni crenalfailure
1.Hy per kal emi aduet odecr easedexcr et i
on, met aboli
cacidosis,cataboli
sm,
andexcessi v eintake( diet,medi cati
ons, fl
uids)
2.Per icardi tis,peri
cardial effusion,andper icardial t
amponadeduet or et
ention
ofur emi cwast eproduct sandi nadequat edialysis
3.Hy per tensi onduet osodi um andwat erretentionandmal functi
onoft he
renin–angi otensi n–aldost er
onesy stem
4.Anemi aduet odecr easeder y thr
opoietinpr oduct i
on,decreasedRBCl i
fespan,
bleedingi nt heGIt ractf rom irr
itati
ngoxi ns,andbl oodlossdur i
nghemodi alysi
s
5.Bonedi seaseandmet astaticcalcif
icationsduet or
etentionofphosphor us,
l
owser um cal ci
um l evels,abnor mal vi
tami nDmet abol
ism,andel evated
alumi num l ev els.

:
‫ﺎﺕ‬‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬
‫ﻟ‬‫ﺍ‬
‫ﻣﻦ‬
‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻔﺸﻞ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻠ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬
‫ﻟ‬‫ﺍ‬
‫ﺍﻁﻓﻲ‬
‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬
‫ﻭ‬،‫ﻳﺾ‬
‫ﻮ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﻼﻲ‬
‫ﻘﺑ‬‫ﺘ‬
‫ﺍﻻﺳ‬
‫ﺎﺽ‬‫ﻤ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﻭ‬،‫ﺍﺝ‬
‫ﺮ‬‫ﺍﻹﺧ‬‫ﺎﺽ‬‫ﻔ‬‫ﻧﺨ‬
‫ﺍ‬‫ﺒﺐ‬‫ﻡﺑﺴ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬ ‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺮﻁﺑ‬‫ﻓ‬.
1

121
 (‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻭ‬، ‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺩ‬‫ﺍﻷ‬‫ﻭ‬،‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬
)‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺗ‬
‫ﺔ‬
‫ﻳ‬ ‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬‫ﺪ‬
‫ﻤﻲﻭﻋ‬ ‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﺎﺱﻧ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺣ‬ ‫ﺒﺐ‬‫ﺭﺑﺴ‬‫ﻮ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﻙ‬‫ﻜ‬
‫ﻭﺳ‬، ‫ﺭ‬‫ﻮ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬
‫ﻧﺼ‬ ‫ﺍ‬
‫ﻭ‬،‫ﺭ‬‫ﻮ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
2
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻏﺴ‬
‫ﺍﻷ‬-‫ﻴﻦ‬
‫ﻨﺴ‬‫ﺗ‬‫ﻮ‬‫ﻴ‬
‫ﻧﺠ‬‫ﺃ‬-‫ﻴﻦ‬‫ﻨ‬
‫ﻳ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻠﻞﻓﻲﻧﻈ‬ ‫ﺀﻭﺧ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﻮ‬
‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬‫ﺍﺣ‬‫ﺒﺐ‬ ‫ﻡﺑﺴ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬.
3
‫ﻭﻥ‬ ‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻭﺳ‬‫ﺪ‬‫ﻟ‬
‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻳﻒﻓﻲ‬‫ﺰ‬‫ﻧ‬‫ﻭ‬،‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﺮﻛ‬‫ﻤ‬‫ﺎ ﺽﻋ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
‫ﻭ‬، ‫ﻴﻦ‬‫ﺘ‬
‫ﻳ‬‫ﻮ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬
‫ﺛ‬‫ﺭ‬‫ﺎﺝﺇ‬‫ﺘ‬‫ﻧ‬
‫ﺎ ﺽﺇ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﺒﺐ‬‫ﻡﺑﺴ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬
‫ﻓ‬.4
‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺀﻏﺴ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻓ‬‫ﻭ‬، ‫ﺔ‬‫ﻴﺠ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺮ‬
‫ﻴ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻲﻣﻦ‬ ‫ﻬﻀ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻓﻲ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﺎ ﺽﻣﺴ‬‫ﻔ‬‫ﻧﺨ‬
‫ﺍ‬‫ﻭ‬،‫ﺭ‬‫ﻮ‬‫ﻔ‬‫ﻮﺳ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺱ‬ ‫ﺒ‬
‫ﺘ‬‫ﺍﺣ‬ ‫ﺒﺐ‬‫ﺔﺑﺴ‬‫ﻴ‬‫ﻠ‬‫ﻴ‬
‫ﻘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻠﺴ‬‫ﻜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺎ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬‫ﺮ‬‫ﻣ‬‫ﺃ‬.
5
.
‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﻨ‬‫ﻣ‬‫ﻮ‬‫ﻟ‬
‫ﺍﻷ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬
‫ﻭ‬، ‫ﻴﻦﺩ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺋﻲﻏ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬

Medicalmanagementofpat ientswit
hchroni
crenalfail
ure:
Goalsofmedi calmanagement :
-St
abil
izat
ionofi nternalenvi
ronment.
-Contr
oloffl
ui dandel ectrol
yteimbal
ance.
-Absenceofinf ecti
on.
-Absenceofbl eeding.
-Contr
olofbloodpr essure.
-Contr
olofcur rentil
lness.
-Absenceoftoxi ci
tyofmedi cati
onsthatar
einadequatel
yexcret
ed.
-Contr
olofanor exiaornausea.
-Contr
olofit
chi ng.

:
‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬‫ﺒﻲ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺟﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺑ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
.‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﺍﺧ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬
‫ﺍﺳ‬ -
.‫ﺭ‬
‫ﺎﻝ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺘﻼﻝ‬‫ﺍﺧ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬
‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬-
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﺩﻋ‬‫ﻮ‬‫ﻡﻭﺟ‬‫ﺪ‬‫ﻋ‬-
.‫ﻳﻒ‬‫ﺰ‬‫ﺩﻧ‬‫ﻮ‬‫ﻡﻭﺟ‬‫ﺪ‬‫ﻋ‬-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺒﻂ ﺿ‬‫ﺿ‬-
.
‫ﻟﻲ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬
‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬-
.
ٍ‫ﺎ‬
‫ﻑ‬ ‫ﻜﻞﻛ‬‫ﺎﺑﺸ‬
‫ﻬ‬‫ﺍﺟ‬‫ﺮ‬
‫ﺘﻢﺇﺧ‬‫ﺘﻲﻻﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﻟﻸ‬‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﺩﺳ‬ ‫ﻮ‬‫ﻡﻭﺟ‬‫ﺪ‬‫ﻋ‬-
.‫ﺎﻥ‬
‫ﻴ‬‫ﺜ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﻴ‬‫ﻬ‬‫ﻟﺸ‬
‫ﺍ‬ ‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﻠﻰﻓ‬‫ﺓﻋ‬ ‫ﺮ‬
‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬-
.‫ﺔ‬‫ﻜ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬
‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬-

Medical management :
1-Pharmacol ogicalTher apy:
-Antacids.Hy per phosphatemiaandhy pocalcemiaar etreatedwi t
hal uminum-
basedant aci ds
-Anti
hy pertensi veandCar di
ovascularAgents
-Anti
seizur eAgent s
-Eryt
hropoi etin( Epogen)
2-Nut r
iti
onalt her apy:
-Protei
ni srest rictedbecauseur ea,uri
cacid,andor ganicacids
-Theal l
owedpr ot einmustbeofhi ghbiol
ogicv al
ue( dair
ypr oducts,eggs,
meats).Hi gh- biologic-
valueprot
einsarethoset hatarecompl et
epr oteinsand
supplytheessent ialaminoacidsnecessaryf orgrowthandcel l
repai r
.
-Thef l
uidal lowancei s500t o600mLmor et hant hepreviousday ’
s24- hour
uri
neout put .Cal or i
esaresuppli
edbycar bohy dr
atesandf att opreventwast i
ng.

122
‫‪Vi‬‬‫‪t‬‬
‫‪ami‬‬‫‪nsuppl‬‬‫‪ement‬‬‫‪at‬‬
‫‪i‬‬‫‪oni‬‬
‫‪snecessar‬‬
‫‪y‬‬‫‪.‬‬
‫‪3-Di‬‬‫‪al‬‬
‫‪y‬‬‫‪si‬‬
‫‪s.‬‬
‫‪4-Renalt‬‬
‫‪r‬‬‫‪anspl‬‬
‫‪ant‬‬‫‪at‬‬‫‪i‬‬
‫‪on.‬‬
‫‪:‬‬
‫ﺔ‬‫ﻴ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
‫‪:‬‬‫ﺋﻲ‬ ‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬‫‪1‬‬
‫ﺔ‬‫ﻮﻋ‬‫ﻨ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻡﺑ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻘ ﺺﻛ‬ ‫ﻧ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻔ‬‫ﻮﺳ‬ ‫ﺮﻁﻓ‬ ‫ﺘﻢﻋﻼﺝﻓ‬ ‫‪.‬ﻳ‬‫ﺔ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬‫‪-‬ﻣﻀ‬
‫ﻡ‬ ‫ﻮ‬‫ﻴ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﻣﺍﻷ‬‫ﻦ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﻠﺐﻭ‬ ‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻐﻂﻭ‬ ‫ﻠﻀ‬‫ﻟ‬‫ﺔ‬ ‫ﻓﻀ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫‪-‬‬
‫‪Ant‬‬ ‫‪i‬‬
‫‪sei‬‬‫‪z‬‬ ‫‪ur‬‬‫ﺀ‪e‬‬ ‫ﻭﻼ‬‫‪-‬ﻛ‬
‫(‬‫ﻴﻦ‬‫ﻮﺟ‬‫ﺒ‬‫ﻳ‬‫ﺇ‬‫ﻴﻦ)‬ ‫ﺘ‬
‫ﻳ‬‫ﻮ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﺛ‬‫ﺭ‬‫‪-‬ﺇ‬
‫‪:‬‬‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫‪-‬‬‫‪2‬‬
‫ﺔ‬‫ﻳ‬ ‫ﻮ‬‫ﻌﻀ‬‫ﻟ‬‫ﺍ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﺍﻷﺣ‬‫ﻴﻚﻭ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﺎﻭﺣ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﺪﺑﺴ‬ ‫ﻴ‬‫ﻘ‬‫ﻴﻦﻣ‬ ‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫(‬
‫ﻡ‬‫ﻮ‬ ‫ﻟﺤ‬ ‫‪،‬‬‫ﻴﺾ‬ ‫‪،‬ﺑ‬‫ﺎﻥ‬‫ﺒ‬‫ﻟ‬
‫ﺃ‬ ‫ﺎﺕ‬‫ﻘ‬‫ﺘ‬‫ﻣﺸ‬ ‫ﺔ)‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺔﻋ‬ ‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬‫ﻮ‬‫ﻴ‬‫ﺔﺑ‬ ‫ﻤ‬‫ﻴ‬‫ﺍﻗ‬ ‫ﻪﺫ‬ ‫ﻮﺡﺑ‬ ‫ﻤ‬ ‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫‪-‬ﻳﺠﺐ‬
‫ﺍﻼ‬
‫ﺔﻟ‬ ‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬ ‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻣ‬‫ﺍﻷ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﺍﻷﺣ‬ ‫ﺮ‬
‫ﻓ‬‫ﻮ‬ ‫ﺗ‬‫ﺔﻭ‬‫ﻠ‬‫ﻣ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻨ‬‫ﻴ‬‫ﺗ‬
‫ﻭ‬ ‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﻚ‬ ‫ﺔﻫﻲﺗ‬ ‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬‫ﻮ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻤ‬‫ﻴ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺕﻋ‬ ‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﻭ‬ ‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬ ‫ﺍ‬‫ﺇﺻﻼﺡ‬ ‫ﻮﻭ‬ ‫ﻤ‬‫ﻨ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﺔ‪24‬‬ ‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺑﻖ‬ ‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻡ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝﻓﻲ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻤ‬
‫ﻟﻰ‪600‬ﻣﻞﻋﻦﻛ‬ ‫ﺪﻣﻦ‪500‬ﺇ‬ ‫ﻳ‬‫ﺰ‬ ‫ﺎﺗ‬‫ﻬ‬
‫ﻮﺡﺑ‬ ‫ﻤ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻤ‬‫‪-‬ﻛ‬
‫ﺎﺕ‬ ‫ﻨ‬
‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻼﺕ‬ ‫ﻜ‬‫ﺍ‪.‬ﻣ‬‫ﺰﻝ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻨ‬‫ﻤ‬
‫ﻟ‬‫ﻮﻥ‬ ‫ﺪﻫ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻭ‬ ‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻮﻫ‬‫ﺑ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬ ‫ﺮ‬
‫ﺔﻋﻦﻃ‬ ‫ﻳ‬‫ﺭ‬ ‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬
‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬‫ﻓ‬
‫ﻮ‬‫ﺘﻢﺗ‬ ‫‪.‬ﻳ‬‫ﺔ‬ ‫ﻋ‬‫ﺎ‬
‫ﺳ‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﺿ‬
‫‪.‬‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫‪-‬ﻏﺴ‬ ‫‪3‬‬
‫‪.‬‬
‫ﻠﻰ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺍﻋ‬‫ﺭ‬ ‫‪-‬ﺯ‬‫‪4‬‬
‫‪Nur‬‬ ‫‪si‬‬‫‪ngManagement‬‬ ‫‪:‬‬
‫‪Nur‬‬ ‫‪si‬‬‫‪ngpr‬‬ ‫‪ocessf‬‬ ‫‪orpat‬‬ ‫‪i‬‬
‫‪entwi‬‬ ‫‪t‬‬‫‪hchr‬‬ ‫‪oni‬‬ ‫‪cr‬‬‫‪enalf‬‬ ‫‪ai‬‬‫‪l‬‬‫‪ur‬‬ ‫‪e:‬‬
‫‪pot‬‬ ‫‪ent‬‬‫‪i‬‬‫‪alnur‬‬ ‫‪si‬‬‫‪ngdi‬‬ ‫‪agnosesf‬‬ ‫‪ort‬‬‫‪hesepat‬‬ ‫‪i‬‬‫‪ent‬‬ ‫‪si‬‬ ‫‪ncl‬‬ ‫‪udet‬‬ ‫‪hef‬‬ ‫‪ol‬‬‫‪l‬‬‫‪owi‬‬ ‫‪ng:‬‬
‫‪-Excessf‬‬ ‫‪l‬‬‫‪ui‬‬‫‪dv‬‬ ‫‪ol‬‬‫‪umer‬‬ ‫‪el‬‬‫‪at‬‬‫‪edt‬‬ ‫‪odecr‬‬ ‫‪easedur‬‬ ‫‪i‬‬‫‪neout‬‬ ‫‪put‬‬ ‫‪,‬‬ ‫‪di‬‬‫‪et‬‬‫‪ar‬‬‫‪yexcesses,‬‬ ‫‪and‬‬
‫‪r‬‬‫‪et‬‬‫‪ent‬‬‫‪i‬‬‫‪onofsodi‬‬ ‫‪um andwat‬‬ ‫‪er‬‬
‫‪-I‬‬‫‪mbal‬‬ ‫‪ancednut‬‬ ‫‪r‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪on:‬‬ ‫‪l‬‬‫‪esst‬‬ ‫‪hanbodyr‬‬ ‫‪equi‬‬ ‫‪r‬‬‫‪ement‬‬ ‫‪sr‬‬ ‫‪el‬‬ ‫‪at‬‬ ‫‪edt‬‬ ‫‪oanor‬‬ ‫‪exi‬‬‫‪a,‬‬ ‫‪nausea‬‬
‫‪andv‬‬ ‫‪omi‬‬ ‫‪t‬‬
‫‪i‬‬‫‪ng,‬‬ ‫‪di‬‬ ‫‪et‬‬‫‪ar‬‬‫‪yr‬‬‫‪est‬‬ ‫‪r‬‬‫‪i‬‬
‫‪ct‬‬‫‪i‬‬‫‪ons,‬‬ ‫‪andal‬‬ ‫‪t‬‬‫‪er‬‬‫‪edor‬‬ ‫‪al‬‬‫‪mucousmembr‬‬ ‫‪anes‬‬
‫‪-Def‬‬ ‫‪i‬‬
‫‪ci‬‬‫‪entknowl‬‬ ‫‪edger‬‬ ‫‪egar‬‬ ‫‪di‬‬‫‪ngcondi‬‬ ‫‪t‬‬‫‪i‬‬‫‪onandt‬‬ ‫‪r‬‬‫‪eat‬‬ ‫‪mentr‬‬ ‫‪egi‬‬‫‪men‬‬
‫‪-Act‬‬ ‫‪i‬‬
‫‪v‬‬ ‫‪i‬‬
‫‪t‬‬‫‪yi‬‬‫‪nt‬‬ ‫‪ol‬‬‫‪er‬‬‫‪ancer‬‬ ‫‪el‬‬‫‪at‬‬‫‪edt‬‬ ‫‪of‬‬ ‫‪at‬‬‫‪i‬‬
‫‪gue,‬‬ ‫‪anemi‬‬ ‫‪a,‬‬ ‫‪r‬‬‫‪et‬‬‫‪ent‬‬ ‫‪i‬‬‫‪onofwast‬‬ ‫‪epr‬‬ ‫‪oduct‬‬ ‫‪s,‬‬ ‫‪and‬‬
‫‪di‬‬‫‪al‬‬‫‪y‬‬‫‪si‬‬‫‪spr‬‬ ‫‪ocedur‬‬ ‫‪e‬‬
‫‪-Lowsel‬‬ ‫‪f‬‬‫‪-‬‬‫‪est‬‬ ‫‪eem r‬‬ ‫‪el‬‬‫‪at‬‬‫‪edt‬‬ ‫‪odependency‬‬ ‫‪,‬‬‫‪r‬‬
‫‪ol‬‬ ‫‪echanges,‬‬ ‫‪changesi‬‬ ‫‪nbodyi‬‬ ‫‪mage,‬‬
‫‪andsexual‬‬ ‫‪dy‬‬ ‫‪sf‬‬ ‫‪unct‬‬‫‪i‬‬‫‪on‬‬
‫‪:‬‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫‪:‬‬‫ﻣﻦ‬ ‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﺔﺗ‬‫ﻴ‬ ‫ﻠ‬
‫ﻤ‬‫ﻋ‬
‫‪:‬‬
‫ﻠﻲ‬‫ﺎﻳ‬‫ﺮﺿﻰﻣ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺆﻻ‬ ‫ﻬ‬ ‫ﻟ‬‫ﺔ‬‫ﻠ‬‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬ ‫ﻴ‬
‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻴﺼ‬‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺗﺸ‬
‫ﺎﺱ‬ ‫ﺒ‬‫ﺘ‬‫ﺍﺣ‬ ‫‪،‬ﻭ‬ ‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﺍﻁﻓﻲ‬ ‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫‪،‬ﻭ‬ ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺝ‬‫ﺘ‬‫ﻧ‬‫ﺎ ﺽﺇ‬ ‫ﻔ‬ ‫ﻧﺨ‬ ‫ﺎ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺓﺣﺠﻢ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫‪-‬ﺯ‬
‫ﺀ‬‫ﺎ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡﻭ‬ ‫ﻮ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺩ‬‫ﻮ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻭ‬ ‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬ ‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻬ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻔ‬‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺎﺕ‬ ‫ﺒ‬‫ﻠ‬
‫ﺘﻄ‬ ‫ﻗﻞﻣﻦﻣ‬ ‫ﺃ‬‫‪:‬‬‫ﺔ‬‫ﻧ‬‫ﺯ‬
‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺔﻏ‬‫ﻳ‬ ‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫ﻔﻢ‬ ‫ﻠ‬‫ﻟ‬‫ﺔ‬ ‫ﻴ‬‫ﺎﻃ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺍﻷﻏﺸ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺎ‬
‫ﻧﻈ‬ ‫ﺔﻭ‬ ‫ﻟ‬‫ﺎ‬‫ﻟﺤ‬ ‫ﺎ‬
‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬‫ﺎﻳ‬‫ﻤ‬‫ﻴ‬‫ﺔﻓ‬‫ﻓ‬‫ﺮ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﺺ‬ ‫‪-‬ﻧ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬ ‫ﻴﻞ‬‫ﺀﻏﺴ‬ ‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬‫‪،‬ﻭ‬ ‫ﺎﺕ‬ ‫ﻳ‬
‫ﺎ‬‫ﻔ‬‫ﻨ‬‫ﻟ‬‫ﺎ‬
‫ﺎﻅﺑ‬ ‫ﻔ‬‫ﺘ‬‫ﺍﻻﺣ‬‫‪،‬ﻭ‬ ‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬ ‫ﻘ‬
‫ﻓ‬ ‫‪،‬ﻭ‬ ‫ﺎﻕ‬ ‫ﺭﻫ‬ ‫ﺎﻹ‬‫ﺒﻂﺑ‬ ‫ﺗ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻨﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬ ‫ﻡﺗﺤ‬ ‫ﺪ‬ ‫‪-‬ﻋ‬
‫ﻨﺴﻲ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﻌﻒ‬ ‫ﻟﻀ‬ ‫ﺍ‬
‫ﺪﻭ‬ ‫ﻟﺠﺴ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻮ‬ ‫ﺍﺕﻓﻲ ﺻ‬ ‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬ ‫ﺍ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺍﺕ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻴ‬ ‫ﻌ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﺍﺣ‬‫ﻧﻲ‬ ‫ﺪ‬‫‪-‬ﺗ‬

‫‪123‬‬
 Di
aly
sis

Learni
ngObj ect i
ves:
Attheendoft hislect
ure, t
hest udent swi ll
beablet o:
1-Defi
nehaemodi al
ysisandper i
toneal dialysi
s.
2-I
dentifygoalsofdi alysi
st her
apy .
3-Outl
inethepr i
ncipl
esofdi alysi
s.
4-I
dentifyindi
cat i
onsandcont raindicationsofeacht ypeofdi al
ysi
s.
5-Compar eandcont rasthaemodi alysi
sandper i
tonealdi
alysisi
nt er
msof
underl
yingpr i
nciples,procedures, compl icati
ons,andnursingconsiderat
ions.
6-Describenur si
ngmanagementoft hehospi tal
i
zeddialysispati
ent.

‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﻏﺴ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻠﻰ‬‫ﻳﻦﻋ‬‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫ﻟﻄﻼﺏﻗ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﻴ‬
‫ﺓﺳ‬ ‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻩ‬‫ﺬ‬ ‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬
‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻐﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬‫ﻳﻒﻏﺴ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬-
1
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺍﻑﻋﻼﺝﻏﺴ‬ ‫ﺪ‬‫ﺃﻫ‬ ‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-2
.‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺩﺉﻏﺴ‬ ‫ﺎ‬
‫ﺒ‬‫ﺪﻣ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-3
.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺍﻉﻏﺴ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫ﻮﻉﻣﻦ‬ ‫ﻊﻛﻞﻧ‬ ‫ﻧ‬
‫ﺍ‬‫ﻮ‬‫ﻣ‬‫ﺪﺩﻻﻻﺕﻭ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬-4
‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬
‫ﺍﺕﻭ‬
‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬
‫ﺍﻷﺳﺲﻭ‬
‫ﻴﺚ‬ ‫ﻧﻲﻣﻦﺣ‬ ‫ﻮ‬‫ﺘ‬
‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬ ‫ﻠﻰﻭﻏﺴ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻴﻦﻏﺴ‬ ‫ﺭﻥﺑ‬‫ﺎ‬
‫ﻗ‬-5
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﻋ‬‫ﺍ‬‫ﻭ‬
.
‫ﻔﻰ‬‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻓﻲ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻳ ﺾﻏﺴ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬‫ﻭﺻﻒ‬- 6

Di
aly
sis
Defi
nit
ion:
Dial
ysi
soccur swiththemovementoffluidandpart
icl
esacr
ossa
semipermeablemembr ane.
Goalsofdialysi
stherapy:
44.Remov alofmetaboli
cwasteproducts.
45.Maintenanceofsafeconcent
rati
onofelectr
oly
tes.
46.Correct
ionofacidbaseimbal
ance.
47.Remov alofexcessfl
uid.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻏﺴ‬
:
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
.
‫ﺬ‬‫ﻓ‬‫ﺎ‬
‫ﺀﻧﺼﻒﻧ‬
‫ﺎ‬‫ﺮﻏﺸ‬
‫ﺒ‬‫ﺎﺕﻋ‬
‫ﺌ‬‫ﻳ‬
‫ﺰ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻊﺣ‬ ‫ﻠﻰﻣ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺪﺙﻏﺴ‬ ‫ﻳﺤ‬
:
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺍﻑﻋﻼﺝﻏﺴ‬ ‫ﺪ‬‫ﺃﻫ‬
.
‫ﺋﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬
‫ﺎ‬‫ﻔ‬
‫ﺔﻧ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺯ‬.
‫ﺇ‬44
.
‫ﺩ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻠﺸ‬
‫ﻟ‬‫ﻵﻦ‬
‫ﺍﻣ‬ ‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬.
45
.‫ﺪﻱ‬
‫ﺎﻋ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻀﻲ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻠﻞ‬‫ﻟﺨ‬
‫ﺍ‬‫ﻴﺢ‬‫ﺗﺼﺤ‬.46
.
‫ﺓ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻠ ﺺﻣﻦ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬.
47

Phy siologicprincipl
esofdi al
ysis:
Dialysisisbasedont hr eepr i
nciples:
1-Di ffusion:
Involvet hemov ementsofpar ti
clesfrom areaofgr eat
ertoanar eaofless
concent ration.Diff
usioni sinvolvedint heclearanceofsol
utefrom thepati
ent'
s
bodyi nbot hhaemodi alysisandper i
tonealdial
y si
s.Di
ff
usionresul
tsinthe
mov ement sofur ea,creatini
neandur icacidfrom thepati
ent'
sbloodintothe
dial
y satesol uti
on.

124
 ‫‪:‬‬‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﻐﺴ‬ ‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻴ‬‫ﻔﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺩﺉ‬ ‫ﺎ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﺩﺉ‬‫ﺎ‬
‫ﺒ‬‫ﻼﺔﻣ‬
‫ﻠﻰﺛﺛ‬ ‫ﻠﻰﻋ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺰﻏﺴ‬ ‫ﻜ‬‫ﺗ‬
‫ﺮ‬‫ﻳ‬
‫‪:‬‬‫ﺭ‬
‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬‫ﺍﻻ‬‫‪-‬‬‫‪1‬‬
‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺭﻓﻲﺇ‬
‫ﺎ‬‫ﺘﺸ‬
‫ﻧ‬‫ﺍﻻ‬‫ﺭﻙ‬
‫ﺎ‬‫‪.‬ﻳﺸ‬‫ﻗﻞ‬‫ﺃ‬‫ﺰ‬
‫ﻴ‬‫ﻛ‬‫ﺮ‬
‫ﺔﺗ‬‫ﻘ‬‫ﻨﻄ‬
‫ﻟﻰﻣ‬‫ﺮﺇ‬‫ﺒ‬
‫ﻛ‬‫ﺃ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﺎﺕﻣﻦﻣ‬ ‫ﻤ‬
‫ﻴ‬‫ﻟﺠﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﻛ‬‫ﺮ‬
‫ﺍﻙﺣ‬ ‫ﺮ‬‫ﺈﺷ‬‫ﻗﻢﺑ‬
‫ﺎﺕ‬
‫ﻛ‬‫ﺮ‬‫ﺭﺣ‬‫ﺎ‬
‫ﺘﺸ‬‫ﻧ‬‫ﻋﺍﻻ‬
‫ﺘﺞ ﻦ‬‫ﻨ‬‫‪.‬ﻳ‬
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬
‫ﻳ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬‫ﻏﺴ‬‫ﻠﻰﻭ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻳ ﺾﻓﻲﻛﻞﻣﻦﻏﺴ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦﺟﺴﻢ‬ ‫ﺑ‬‫ﺍ‬
‫ﺬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺎ‪.‬‬
‫ﺔ‬‫ﻟ‬‫ﻳ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻠ‬
‫ﻟﻰﻣﺤ‬‫ﻳ ﺾﺇ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻴﻚﻣﻦﺩ‬ ‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻤﺾ‬ ‫ﻴﻦﻭﺣ‬‫ﻨ‬
‫ﻴ‬‫ﺗ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻭ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬

‫‪2-‬‬‫‪Osmosi‬‬ ‫‪s:‬‬
‫‪I‬‬‫‪nv‬‬‫‪ol‬‬
‫‪v‬‬‫‪emov‬‬ ‫‪ementofwat‬‬ ‫‪erexcessacr‬‬‫‪ossasemi‬‬ ‫‪per‬‬‫‪mabl‬‬‫‪emembr‬‬ ‫‪anef‬‬‫‪r‬‬‫‪om an‬‬
‫‪ar‬‬‫‪eaofl‬‬‫‪essert‬‬ ‫‪oanar‬‬ ‫‪eaofgr‬‬ ‫‪eat‬‬
‫‪erconcent‬‬‫‪r‬‬‫‪at‬‬‫‪i‬‬
‫(‪on‬‬ ‫‪osmol‬‬‫‪al‬‬‫‪i‬‬
‫‪t‬‬‫‪y‬‬‫‪)ofpar‬‬‫‪t‬‬‫‪i‬‬
‫‪cl‬‬‫‪es.‬‬
‫‪3-‬‬‫‪Ul‬‬‫‪t‬‬
‫‪r‬‬‫‪af‬‬‫‪i‬‬‫‪l‬‬‫‪t‬‬‫‪r‬‬
‫‪at‬‬ ‫‪i‬‬
‫‪on:‬‬
‫‪I‬‬‫‪nv‬‬‫‪ol‬‬
‫‪v‬‬‫‪et‬‬ ‫‪hemov‬‬ ‫‪ementoff‬‬ ‫‪l‬‬
‫‪ui‬‬‫‪daccessofsemi‬‬ ‫‪per‬‬‫‪mabl‬‬ ‫‪emembr‬‬ ‫‪aneasar‬‬ ‫‪esul‬‬ ‫‪tof‬‬
‫‪anar‬‬‫‪t‬‬‫‪i‬‬‫‪f‬‬
‫‪i‬‬‫‪ci‬‬‫‪al‬‬
‫‪l‬‬‫‪ycr‬‬ ‫‪eat‬‬‫‪edpr‬‬‫‪essur‬‬‫‪egr‬‬‫‪adi‬‬‫‪ent‬‬‫‪.‬‬
‫‪Ty‬‬‫‪pesofdi‬‬ ‫‪al‬‬‫‪y‬‬‫‪si‬‬‫‪s:‬‬
‫‪1-Per‬‬‫‪i‬‬‫‪t‬‬
‫‪oneal‬‬ ‫‪di‬‬‫‪al‬‬‫‪y‬‬‫‪si‬‬
‫‪s.‬‬
‫‪2-Haemodi‬‬ ‫‪al‬‬‫‪y‬‬‫‪si‬‬‫‪s.‬‬
‫‪:‬‬‫ﺎﺿﺢ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫‪-‬‬‫‪2‬‬
‫(‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﻤ‬‫ﺍﻷﺳ‬‫ﺮ)‬‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺍﺕﺗ‬‫ﺔﺫ‬‫ﻘ‬‫ﻨﻄ‬‫ﻟﻰﻣ‬‫ﻗﻞﺇ‬‫ﺃ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﺬﻣﻦﻣ‬‫ﻓ‬ ‫ﺎ‬
‫ﻪﻧ‬‫ﺒ‬‫ﺀﺷ‬ ‫ﺎ‬
‫ﺮﻏﺸ‬ ‫ﺒ‬
‫ﺪﻋ‬ ‫ﺋ‬
‫ﺍ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺍﻙﺣ‬ ‫ﺮ‬‫ﺈﺷ‬‫ﻗﻢﺑ‬
‫‪.‬‬
‫ﺎﺕ‬‫ﻤ‬‫ﻴ‬‫ﻟﺠﺴ‬ ‫ﺍ‬‫ﻣﻦ‬
‫‪:‬‬‫ﺋﻖ‬‫ﺎ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺢ‬ ‫ﺮﺷ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫‪-‬‬‫‪3‬‬
‫ﻜﻞ‬ ‫ﻩﺑﺸ‬‫ﺅ‬ ‫ﺎ‬
‫ﻧﺸ‬‫ﻐﻂﺗﻢﺇ‬ ‫ﺭﺝ ﺿ‬‫ﺪ‬‫ﺘ‬
‫ﻟ‬ ‫ﺔ‬‫ﻴﺠ‬
‫ﺘ‬‫ﻨ‬‫ﺫﻛ‬‫ﺎ‬
‫ﻔ‬‫ﻨ‬
‫ﻠ‬‫ﻟ‬‫ﺑﻞ‬
‫ﺎ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻪ‬‫ﺒ‬
‫ﺀﺷ‬ ‫ﺎ‬
‫ﻐﺸ‬‫ﻠ‬
‫ﻟ‬ ‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝ‬‫ﺔﻭﺻ‬ ‫ﻛ‬‫ﺮ‬‫ﺍﻙﺣ‬ ‫ﺮ‬‫ﺈﺷ‬‫ﻗﻢﺑ‬
‫‪.‬‬
‫ﻊ‬‫ﻨ‬‫ﻣﺼﻄ‬
‫‪:‬‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﺍﻉﻏﺴ‬ ‫ﻮ‬‫ﻧ‬
‫ﺃ‬
‫‪.‬‬
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫‪-‬ﻏﺴ‬ ‫‪1‬‬
‫‪.‬‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫‪-‬ﻏﺴ‬ ‫‪2‬‬

‫‪1-Per‬‬
‫‪i‬‬‫‪t‬‬
‫‪onealDi‬‬
‫‪al‬‬‫‪y‬‬
‫‪si‬‬‫‪s‬‬
‫‪Def‬‬ ‫‪i‬‬
‫‪ni‬‬‫‪t‬‬‫‪i‬‬
‫‪on:‬‬
‫‪Thepr‬‬ ‫‪ocessofr‬‬ ‫‪emov‬‬ ‫‪i‬‬‫‪ngmet‬‬‫‪abol‬‬‫‪i‬‬‫‪cwast‬‬‫‪esandwat‬‬‫‪erf‬‬‫‪r‬‬
‫‪om bl‬‬‫‪oodbyuseoft‬‬ ‫‪he‬‬
‫‪l‬‬
‫‪i‬‬‫‪v‬‬‫‪i‬‬‫‪ngsemi‬‬ ‫‪per‬‬‫‪meabl‬‬‫‪emembr‬‬ ‫(‪ane‬‬ ‫‪t‬‬‫‪heper‬‬‫‪i‬‬
‫‪t‬‬‫()‪oneum‬‬
‫‪SeeFi‬‬‫)‪g.31‬‬‫‪.‬‬
‫‪I‬‬‫‪ndi‬‬‫‪cat‬‬‫‪i‬‬
‫‪onf‬‬ ‫‪orper‬‬‫‪i‬‬
‫‪t‬‬‫‪onealdi‬‬‫‪al‬‬
‫‪y‬‬‫‪si‬‬‫‪s:‬‬
‫‪1.Fl‬‬‫‪ui‬‬‫‪dov‬‬‫‪erl‬‬‫‪oad.‬‬
‫‪2.El‬‬‫‪ect‬‬‫‪r‬‬‫‪ol‬‬
‫‪y‬‬‫‪t‬‬‫‪ei‬‬‫‪mbal‬‬‫‪ance.‬‬
‫‪3.Sev‬‬ ‫‪eraci‬‬‫‪dosi‬‬
‫‪s.‬‬
‫‪4.Ur‬‬ ‫‪emi‬‬‫‪amani‬‬ ‫‪f‬‬
‫‪est‬‬‫‪at‬‬‫‪i‬‬‫‪ons.‬‬
‫‪5.Unav‬‬ ‫‪ai‬‬‫‪l‬‬
‫‪abl‬‬‫‪ev‬‬‫‪ascul‬‬‫‪araccess.‬‬
‫‪6.Sev‬‬ ‫‪erhomody‬‬ ‫‪nami‬‬ ‫‪ccompr‬‬‫‪omi‬‬ ‫‪se.‬‬
‫‪7.Sev‬‬ ‫‪eracut‬‬‫‪ebl‬‬‫‪eedi‬‬‫‪ng.‬‬
‫‪8.Lackofaccessi‬‬ ‫‪bl‬‬‫‪ehaemodi‬‬ ‫‪al‬‬‫‪y‬‬
‫‪si‬‬‫‪scent‬‬‫‪er‬‬‫‪.‬‬
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫‪-‬ﻏﺴ‬ ‫‪1‬‬
‫‪:‬‬
‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﻜﻞ‬ ‫ﻟﺸ‬‫ﺍ‬
‫ﺮ‬‫ﻧﻈ‬‫ﺍ‬
‫()‬‫ﺎﻕ‬‫ﻔ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺬ)‬ ‫ﻔ‬‫ﻨ‬
‫ﻪﻣ‬‫ﺒ‬
‫ﺀﺣﻲﺷ‬ ‫ﺎ‬‫ﻡﻏﺸ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﻡﺑ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻩﻣﻦ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻳﻀ‬ ‫ﺍﻷ‬‫ﻔﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺔﺇ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬
‫‪.‬‬
‫(‬‫‪31‬‬
‫‪:‬‬‫ﻧﻲ‬‫ﻮ‬
‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻐﺴ‬‫ﻟ‬‫ﺓ‬‫ﺭ‬‫ﺎ‬
‫ﺇﺷ‬
‫‪.‬‬
‫ﻤﻞ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻕ‬‫ﺋﻞﻓ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫‪.‬‬
‫‪1‬‬
‫‪.‬‬‫ﺀ‬
‫ﺎ‬‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﻨﺤﻞﺑ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫‪.‬ﻋ‬‫‪2‬‬
‫‪.‬‬‫ﺎﺽ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫‪.‬ﺷ‬‫‪3‬‬
‫‪.‬‬
‫ﺎ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫‪.‬ﻣﻈ‬‫‪4‬‬

‫‪125‬‬
 .
‫ﺮ‬‫ﻓ‬‫ﻮ‬
‫ﺘ‬‫ﺮﻣ‬‫ﻴ‬‫ﺔﻏ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﻮﻝ‬‫ﻭﺻ‬.5
.‫ﻊ‬‫ﺎﻃ‬
‫ﻧﺲﻗ‬ ‫ﺎ‬
‫ﺘﺠ‬‫ﺣﻞﻭﺳﻂﻣ‬. 6
.‫ﺣ‬
‫ﺩ‬‫ﺩﺎ‬ ‫ﺎ‬
‫ﻳﻒﺣ‬ ‫ﺰ‬‫ﻧ‬.
7
.
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺰﻏﺴ‬‫ﻛ‬‫ﺮ‬‫ﺮﻣ‬‫ﻓ‬‫ﻮ‬‫ﻡﺗ‬
‫ﺪ‬‫ﻋ‬.8
Contrai
ndicati
onsofper i
tonealdi
aly
sis:
1.Perit
oniti
s.
2.Recentabdomi nalsurgery.
3.Abdomi naladhesions.
4.Colostomy ,
il
eostomy .
5.Respirat
oryinsuff
iciency.
6.Diaphragmatictear.
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﻊﻏﺴ‬ ‫ﻧ‬‫ﺍ‬
‫ﻮ‬‫ﻣ‬:
1.‫ﺎﻕ‬‫ﻔ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
.
2.‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺍﻷﺧ‬‫ﺒﻄﻦ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﺟ‬.
3.‫ﺒﻄﻦ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﻗ‬
‫ﺎ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬
.
4.‫ﻔﻲ‬ ‫ﺋ‬
‫ﺎ‬‫ﻔ‬
‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻐ‬‫ﻓ‬،‫ﻮﻥ‬‫ﻟ‬‫ﻮ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻐ‬‫ﻓ‬.
5.‫ﻔﺴﻲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻗﺼ‬.
6.‫ﺰ‬
‫ﺎﺟ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻟﺤﺠ‬‫ﺍ‬‫ﻮﻉ‬‫ﻣ‬‫ﺪ‬‫ﻠ‬
‫ﻟ‬‫ﻴﻞ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
.
Advantageofper i
tonealdial
y sis:
1.Safe,Si
mple,l
essexpensi ve.
2.Noneedf orvascularaccess.
3.Noneedf ordial
ysistechnician.
4.Canbeusedf ort emporaryorper manentdi
aly
sis.
5.Nosophisti
catedequi pmentneeded.
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺓﻏﺴ‬‫ﺰ‬‫ﻴ‬
‫ﻣ‬:
1.‫ﺔ‬‫ﻔ‬‫ﻠ‬
‫ﻜ‬‫ﻗﻞﺗ‬‫ﺃ‬
‫ﺔﻭ‬ ‫ﻴﻄ‬
‫ﺑﺴ‬‫ﺔﻭ‬‫ﻨ‬‫ﻣ‬‫ﺁ‬
.
2.‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬
‫ﻮﻝ‬ ‫ﻮﺻ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺎﺟ‬‫ﻻﺣ‬.
3.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻨﻲﻏﺴ‬ ‫ﻔ‬
‫ﻟ‬‫ﺔ‬‫ﺎﺟ‬‫ﻻﺣ‬.
4.‫ﺋﻢ‬
‫ﺍ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﻗﺖ‬‫ﺆ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﻐﺴ‬ ‫ﻟ‬‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬‫ﻤ‬
‫ﻳ‬.
5.‫ﺓ‬‫ﺭ‬
‫ﻮ‬‫ﺘﻄ‬‫ﺍﺕﻣ‬ ‫ﺪ‬
‫ﻌ‬‫ﻟﻰﻣ‬‫ﺔﺇ‬‫ﺎﺟ‬‫ﻻﺣ‬.
Disadvant ageofper itoneal
dial
ysis:
1.Riskofper it
oniti
s.
2.Slowpr ocess( 36–48hr s).
3.Slowacl earanceoft oxins.
4.Alterthepat i
ent'
sl ifest yle.
5.Requi reabdomi nal cathet er
care.
:
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﻭﺉﻏﺴ‬ ‫ﺎ‬‫ﻣﺴ‬
.
‫ﺎﻕ‬ ‫ﻔ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺧﻄ‬. 1
.(‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬48-36)‫ﺔ‬ ‫ﺌ‬‫ﻴ‬‫ﺔﺑﻄ‬ ‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻋ‬.2
.
‫ﻡ‬ ‫ﻮ‬‫ﻤ‬
‫ﻟﺴ‬ ‫ﺍ‬ ‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺀﺇ‬ ‫ﺎ‬
‫ﺑﻄ‬‫ﺇ‬.3
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺎ‬‫ﻴ‬‫ﻤﻂﺣ‬ ‫ﺮﻧ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺗ‬.4
.‫ﺒﻄﻦ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺮ‬‫ﺔﻗﺴﻄ‬ ‫ﻳ‬‫ﺎ‬‫ﻠﺐﺭﻋ‬ ‫ﺘﻄ‬‫ﺗ‬.5
Compl icationsofper itoneal
dial
ysis:
1.Per i
toniti
s( mostcommon) .
2.Electrolyteimbal ance.

126
3.Dy srrhy thmi es.
4.Cat het erdi spl acement .
5.Bladderper forat iononcat heteri
nsertion.
6.Bowel per for ationoncat heteri
nserti
on.
7.Lossofpr ot ein.
8.Pai n.
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞ‬ ‫ﺎﺕﻏﺴ‬ ‫ﻔ‬
‫ﻋ‬‫ﺎ‬‫ﻣﻀ‬:
1.‫ﺎ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬ ‫ﻛ‬‫ﺍﻷ‬)‫ﺎﻕ‬ ‫ﻔ‬‫ﻟﺼ‬ ‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
).
2.‫ﺀ‬‫ﺎ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬ ‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﻨﺤﻞﺑ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺯﻥ‬ ‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻋ‬.
3.‫ﻨﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻞ‬ ‫ﺧ‬.
4.‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﺍﺣ‬‫ﺯ‬‫ﺇ‬.
5.‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺎﻝ‬‫ﺩﺧ‬ ‫ﺪﺇ‬ ‫ﻨ‬‫ﺔﻋ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬‫ﻘ‬‫ﺜ‬‫ﻧ‬
‫ﺍ‬.
6.‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺎﻝ‬‫ﺩﺧ‬ ‫ﺪﺇ‬ ‫ﻨ‬‫ﺀﻋ‬ ‫ﺎ‬‫ﻌ‬‫ﻣ‬
‫ﺍﻷ‬ ‫ﺎﺏ‬‫ﻘ‬
‫ﺜ‬‫ﻧ‬‫ﺍ‬
.
7.‫ﻴﻦ‬‫ﺗ‬‫ﻭ‬ ‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬ ‫ﺪ‬‫ﻘ‬‫ﻓ‬.
8.‫ﻟ‬
‫ﺍﻷﻢ‬ .
(Fig.31)Per i
toneal di
alysi
s
Procedur e:
Patientpr epar at ion:
1.Thenur seexpl ainst heproceduretot hepat i
ent
2.Obt ainssi gnedconsent .
3.Basel inev ital signs, weight,andserum electrol
y t
elevelsarer ecorded.
4.Thepat ienti sencour agedtoempt ythebl adderandbowel tor educet herisk
ofpunct ur i
ngi nt er nalorgans.
5.Thenur seal soassessest hepatient’
sanxi et
yaboutt hepr ocedur eand
providessuppor tandi nstr
ucti
on.
6.Broad- spect rum ant i
bioti
cagentsmaybeadmi ni
steredtopr eventinfecti
on

:‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺗﺤﻀ‬
‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺡ‬‫ﺗﺸ‬.1
.‫ﺔ‬‫ﻌ‬
‫ﻗ‬‫ﻮ‬‫ﺔﻣ‬‫ﻘ‬‫ﻓ‬‫ﺍ‬
‫ﻮ‬‫ﻠﻰﻣ‬ ‫ﻳﺤﺼﻞﻋ‬. 2
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻝﻓﻲ‬‫ﺎ‬‫ﻬ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﻣﺴ‬ ‫ﺯﻥﻭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺘﻢﺗﺴﺠ‬‫ﻳ‬.3
.
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺍﺧ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﺍﻷﻋﻀ‬ ‫ﻘﺐ‬
‫ﺮﺛ‬‫ﺎﻃ‬‫ﻴﻞﻣﺨ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺀ‬‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﺔﻭ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻍ‬
‫ﺮ‬‫ﻓ‬‫ﻠﻰﺇ‬‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺘﻢﺗﺸﺠ‬‫ﻳ‬.4
.
‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻋﻢﻭ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻢ‬
‫ﺪ‬‫ﻘ‬‫ﺗ‬
‫ﺀﻭ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﺄﻥ‬‫ﻳ ﺾﺑﺸ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻖ‬
‫ﻴﻢﻗ‬ ‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﺎﺑ‬
ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﻮ‬‫ﻘ‬‫ﺗ‬.5
‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬
‫ﻠ‬‫ﻟ‬‫ﻴﻒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﺳ‬
‫ﺔﻭ‬ ‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﺍﺕﺣ‬‫ﺩ‬‫ﺎ‬‫ﺀﻣﻀ‬ ‫ﺎ‬
‫ﻋﻄ‬‫ﻜﻦﺇ‬‫ﻤ‬‫ﻳ‬.6

Performingt heexchange:
Perit
oneal dialysi
sinvol
vesaser iesofex changesorcy cles.Anex changei
s
defi
nedast heinfusion,dwell
,anddr ainageoft hedial
y sate.Thi
scy cl
eis
repeatedthroughoutt hecourseoft hedialysi
s.
-Thedi al
ysat eisinf
usedbygr av i
tyi
ntot heperi
tonealcav it
y.Aper i
odofabout
5to10mi nut esisusuall
yrequiredtoinfuse2Loff l
uid.
-Thepr escribeddwel l
,orequil
ibrati
on,ti
meal l
owsdi ffusionandosmosi sto

127
occur .Diffusionofsmal l mol ecules, suchasur eaandcr eatinine,peaksi nt he
fi
rst5t o10mi nut esoft hedwel lti
me.
-Thedr ainagepor tionoft heex changebegi ns.Thet ubei suncl ampedandt he
solution
-Drainsf rom t heper it
oneal cavit
ybygr avi
tythr oughacl osedsy stem.Dr ainage
i
susual lycompl etedi n10t o30mi nutes.Thedr ainagef l
uidi snor mal l
y
colorlessorst raw- color edandshoul dnotbecl oudy .
-Nur singpr ocessofper itoneal dialysis:
:‫ﺮﻑ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬
، ‫ﺎﻥ‬‫ﻜ‬‫ﺇﺳ‬‫ﻭ‬، ‫ﻪ ﺿﺦ‬ ‫ﻧ‬‫ﺃ‬‫ﻠﻰ‬ ‫ﺩﻝﻋ‬ ‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ّ
َ‫ﻌ‬
ُ.
‫ﻳ‬ ‫ﺍﺕ‬ ‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺕﻭ‬
‫ﺩﻻ ﺃ‬ ‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻠ‬
‫ﻠﺴ‬‫ﻧﻲﺳ‬ ‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﻤﻞﻏﺴ‬ ‫ﻳﺸ‬
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺓﻏﺴ‬ ‫ﺮ‬‫ﺘ‬‫ﺍﻝﻓ‬ ‫ﻮ‬‫ﺓﻃ‬ ‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻩ‬
‫ﺬ‬ ‫ﺭﻫ‬ ‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﺗ‬.‫ﺎ‬
‫ﺔ‬‫ﻟ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻒ‬‫ﺮ‬‫ﺗﺼ‬‫ﻭ‬
10‫ﻟﻰ‬ ‫ﺇ‬5‫ﺓﻣﻦ‬ ‫ﺮ‬‫ﺘ‬‫ﻷﺮﻓ‬‫ﺍﻣ‬ ‫ﻠﺐ‬ ‫ﺘﻄ‬ ‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬.‫ﻧﻲ‬ ‫ﻮ‬‫ﺘ‬
‫ﻳ‬‫ﺮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻳﻒ‬ ‫ﻮ‬‫ﺘﺠ‬ ‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﻴ‬ ‫ﺑ‬
‫ﺫ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺍﺳﻄ‬ ‫ﻮ‬‫ﺋﻞﺑ‬‫ﺎ‬
‫ﻟﺴ‬ ‫ﺍ‬
‫ﺘﻢ ﺿﺦ‬ ‫ﻳ‬-
.‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﺘ‬
‫ﻟ‬2‫ﺒﺚ‬ ‫ﻟ‬‫ﺋﻖ‬‫ﺎ‬
‫ﻗ‬‫ﺩ‬
‫ﺜﻞ‬ ‫ﻣ‬،‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺎﺕ‬ ‫ﺌ‬
‫ﻳ‬‫ﺰ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬‫ﺍ‬‫ﻎ‬‫ﻠ‬
‫ﺒ‬‫ﻳ‬.‫ﺎﺿﺢ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬‫ﺎ‬‫ﺘﺸ‬‫ﻧ‬‫ﺎﻻ‬‫ﺑ‬، ‫ﺔ‬‫ﻧ‬
‫ﺯ‬‫ﺍ‬
‫ﻮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬،
‫ﻮﻑﺃ‬ ‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﺢ‬‫ﻳﺴ‬-
.‫ﻮﻥ‬ ‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﺋﻖﻣﻦﻭ‬ ‫ﺎ‬
‫ﻗ‬‫ﺩ‬10‫ﻟﻰ‬ ‫ﺇ‬5‫ﻭﻝ‬ ‫ﺃ‬
‫ﻪﻓﻲ‬ ‫ﺗ‬‫ﻭ‬‫ﺭ‬‫ﺫ‬،‫ﻴﻦ‬ ‫ﻨ‬
‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻭ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺤﻞ‬‫ﺍ‬‫ﻠﻖﻭ‬‫ﻐ‬‫ﺮﻣ‬ ‫ﻴ‬‫ﻮﺏﻏ‬ ‫ﺒ‬‫ﻧ‬‫ﺍﻷ‬.‫ﺮﻑ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺮﻑﻣﻦ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺀ‬‫ﺰ‬ ‫ﺃﺟ‬‫ﺪ‬‫ﺒ‬
‫ﻳ‬-
‫ﺮﻑﻓﻲ‬ ‫ﻟﺼ‬ ‫ﺍ‬‫ﻤﻞ‬‫ﺘ‬‫ﻜ‬‫ﺎﻳ‬ ‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬. ‫ﻠﻖ‬‫ﻐ‬‫ﻡﻣ‬ ‫ﺎ‬‫ﺔﻣﻦﺧﻼﻝﻧﻈ‬ ‫ﻴ‬‫ﺑ‬
‫ﺫ‬‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻳﻖ‬ ‫ﺮ‬‫ﻧﻲﻋﻦﻃ‬ ‫ﻮ‬ ‫ﺘ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﻮ‬ ‫ﺘﺠ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒﻣﻦ‬ ‫ﺮ‬‫ﺗﺼ‬-
‫ﻮﻥ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻐﻲ‬‫ﺒ‬‫ﻨ‬‫ﻘﺶﻭﻻﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻠ‬‫ﻭﺑ‬‫ﺃ‬ ‫ﻮﻥ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻢ‬ ‫ﺪ‬
‫ﺮﻑﻋ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬‫ﻮﻥﺳ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬.‫ﺔ‬ ‫ﻘ‬
‫ﻴ‬ ‫ﻗ‬
‫ﺩ‬30‫ﻟﻰ‬ ‫ﺇ‬10‫ﻮﻥ‬ ‫ﻏﻀ‬
.‫ﺍ‬
ً
‫ﺮ‬‫ﻜ‬‫ﻋ‬
:
‫ﻧﻲ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻳ ﺾﻏﺴ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺔﺗ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬-
Nur singassessment :
-Assessf luidandel ectrol ytecont inuall
y .
-Assessv i
talsignsbef or e,during, andatcompl et i
onofdi al
y sis.
-Assessf orsi gnsofr espi ratorydist r
ess, painanddi scomf ort.
-Assessf orpat encyoft hecat het er.
-Assessf oranysi gnsofi nfecti
on.

:‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.
‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﺎﺳ‬
‫ﺭﻝﺑ‬‫ﺎ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﻠﻰ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﺀﻣﻦﻏﺴ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﺀﻭﻋ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬
‫ﺒﻞﻭ‬‫ﺔﻗ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬
‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬
‫ﻋ‬‫ﻟﻢﻭ‬‫ﺍﻷ‬
‫ﻔﺲﻭ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻖ‬‫ﺎﺕ ﺿ‬
‫ﻣ‬‫ﻴﻢﻋﻼ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﺓ‬‫ﺮ‬
‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﻴﻢﺳ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﻭﻯ‬‫ﺪ‬
‫ﻌ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎﺕ‬‫ﻣ‬
‫ﺃﻱﻋﻼ‬ ‫ﺩ‬‫ﻮ‬‫ﻘﻖﻣﻦﻭﺟ‬ ‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬-

Nursingdiagnosi s( 1):Riskf orinfect

ionr elat
edt oper i
tonealcatheterand
di
alysisprocedur e.
Nursingint erv
entionandev aluati
on:
-Observeandr eportsi gnsandsy mpt om ofper i
tonit
is.
-Maintainst eri
letechni quewhenchangi ngdialysatebag, connecti
ng&
di
sconnect ingthecat het erandper f
ormingcat hetercare.
-Maintainst eri
li
tyofdi alysate.
-Assesst hecat hetersi teforredness, drainage, t
endernessorf oulodor.
-Observef orleakageatt hesi te.
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺀﻏﺴ‬ ‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻧ‬‫ﻮ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬‫ﻌ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺧﻄ‬:(1)‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
:
‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻀﻲﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
.
‫ﺎ‬‫ﻬ‬
‫ﻨ‬‫ﺑﻼﻍﻋ‬ ‫ﺍﻹ‬‫ﺎﻕﻭ‬ ‫ﻔ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻋ‬‫ﺃ‬‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﺔﻋﻼ‬ ‫ﻣﻼﺣﻈ‬-
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺎ‬‫ﻡﺑ‬‫ﺎ‬‫ﻴ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻭ‬‫ﻬ‬‫ﻠ‬
‫ﻓﺼ‬ ‫ﺓﻭ‬ ‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬
‫ﻮﺻ‬ ‫ﺗ‬
‫ﺋﻞﻭ‬ ‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻴﺲ‬ ‫ﺮﻛ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺪﺗ‬‫ﻨ‬‫ﻴﻢﻋ‬‫ﻘ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻨ‬‫ﻘ‬‫ﻠﻰﺗ‬‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
-
.‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬‫ﺎ‬
.‫ﺎ‬
‫ﺔ‬‫ﻟ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻢ‬‫ﻠﻰﻋ‬‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﻳﺤ‬-

128
 .
‫ﺔ‬ ‫ﻬ‬
‫ﻳ‬‫ﺮ‬‫ﺔﻛ‬‫ﺋﺤ‬‫ﺍ‬
‫ﻡﻭﺭ‬‫ﺇﻼﺃ‬
‫ﻭﻳ‬‫ﺃ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻭﺗﺼ‬‫ﺃ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺍﺣ‬‫ﺎﻋﻦ‬ً
‫ﺜ‬
‫ﺓﺑﺤ‬ ‫ﺮ‬
‫ﻘﺴﻄ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻮﺿ‬‫ﻓﺤ ﺺﻣ‬‫ﺍ‬-
.
‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻤ‬
‫ﻟ‬‫ﺎ‬
‫ﺮﺏﺑ‬‫ﺘﺴ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
Nursi
ngdi agnosis(2)forr i
skforf
lui
dv olumeexcessordef i
cit
:
-Observeforandr eportsignsandsympt omsoff lui
dov er
load.
-Recordaccuratelythemeasur ementsofinfl
owandout fl
ow.
-Observeforandr eportsignsofoutf
lowpr oblem.
-Maintai
nintakeandout put.
-Weightthepatientdaily.
-Assessforsignsandsy mpt omsoffl
uiddeficit
.

Nur
singdiagnosi
s(3)
:Al
ter
ednut
ri
ti
onl
esst
hanbodyr
equi
rement
s.
-Mai
ntai
nintakeandout
put
.
-Wei
ghtpat
ientdai
l
y.
-Pr
ovi
deadequat
edi
etar
ypr
otei
n.
-I
nst
ructt
hepat
ienti
npr
operdi
et.
-Pr
ovi
deal
i
stofr
est
ri
ctedandencour
agedf
ood.
-Assi
stt
hepat
ienti
ndev
elopi
ngapl
anf
ormeal
sbef
oredi
schar
ge.

Eval
uat
ion:
Comparethepati
ent
s’st
atuswit
htheexpectedout comes.I ftheout comesar e
notmeet,
reassesst
hepati
entandreusetheplan.
:
‫ﺰ‬‫ﻌﺠ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺓﺣﺠﻢ‬ ‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺮﺯ‬‫ﻟﺨﻄ‬(2)‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬
‫ﺍ‬
.‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺍ ﺽﺯ‬‫ﺮ‬‫ﻋ‬‫ﺃ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﺑﻼﻍﻋﻦﻋﻼ‬ ‫ﺍﻹ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.
‫ﺭﺟﻲ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻠﻲﻭ‬ ‫ﺍﺧ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺎﺳ‬‫ﻴ‬‫ﺔﻗ‬‫ﻗ‬‫ﺪ‬‫ﺳﺠﻞﺑ‬-
.
‫ﻓﻖ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻜ‬‫ﺎﺕﻣﺸ‬ ‫ﻣ‬‫ﺑﻼﻍﻋﻦﻋﻼ‬ ‫ﺍﻹ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﺎﺕ‬‫ﺮﺟ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺪﺧﻼﺕﻭ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺎ‬‫ﻴ‬‫ﻣ‬
‫ﻮ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬‫ﻭ‬-
.‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻘﺺ‬ ‫ﺍ ﺽﻧ‬‫ﺮ‬‫ﺃﻋ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻴﻢﻋﻼ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-

.
‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﺒ‬‫ﻠ‬
‫ﺘﻄ‬‫ﻗﻞﻣﻦﻣ‬‫ﺃ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬:(
3)‫ﻴ ﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
.
‫ﺎﺕ‬‫ﺮﺟ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻼﺕﻭ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻓﻈ‬ ‫ﺎ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬-
.
‫ﺎ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻳ ﺾﻳ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬‫ﻭ‬-
.‫ﻓﻲ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬
‫ﺗ‬-
.‫ﻴﻢ‬
‫ﻠ‬‫ﺋﻲﺳ‬‫ﺍ‬‫ﺬ‬‫ﻡﻏ‬‫ﺎ‬‫ﺎﻉﻧﻈ‬‫ﺒ‬
‫ﺗ‬‫ﺍ‬‫ﻟﻰ‬‫ﻳ ﺾﺇ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﺭﺷ‬
‫ﺇ‬-
.
‫ﺔ‬ ‫ﻌ‬
‫ﻤﺸﺠ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺓﻭ‬ ‫ﺭ‬
‫ﻮ‬‫ﻤﺤﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﺎﻷﻏ‬‫ﺔﺑ‬‫ﻤ‬‫ﺋ‬
‫ﺎ‬‫ﻳﻢﻗ‬‫ﺪ‬‫ﻘ‬
‫ﺗ‬-
.‫ﻭﺝ‬‫ﺮ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺒﻞ‬
‫ﺎﺕﻗ‬ ‫ﺒ‬
‫ﻮﺟ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻊﺧﻄ‬ ‫ﻳ ﺾﻓﻲﻭﺿ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬ ‫ﺪ‬
‫ﺎﻋ‬‫ﻣﺴ‬-

:
‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.
‫ﺔ‬‫ﻟﺨﻄ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬
‫ﺍﺳ‬‫ﺪ‬
‫ﺃﻋ‬‫ﻳ ﺾﻭ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬
‫ﻴ‬‫ﻘ‬‫ﺪﺗ‬
‫ﺃﻋ‬،
‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻘﻖ‬‫ﺘﺤ‬
‫ﻟﻢﺗ‬
‫ﺍ‬‫ﺫ‬‫ﺇ‬.
‫ﺔ‬‫ﻌ‬‫ﻗ‬
‫ﻮ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬
‫ﺎ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺿﻰﺑ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺣﺔ‬
‫ﻟ‬‫ﺭﻥ ﺎ‬
‫ﺎ‬‫ﻗ‬

129
 2-Haemodi
aly
sis
Defi
nit
ion:
Theprocessofremovi
ngmet abol
icwasteandwaterfr
om bloodbyuseofa
semipermeablemembraneofonar t
if
ici
alki
dney(
seefi
g.32).
‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻏﺴ‬-2
:‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺗ‬
‫ﺮ‬‫ﻧﻈ‬
‫ﺍ‬)‫ﺔ‬‫ﻴ‬‫ﺎﻋ‬
‫ﻨ‬‫ﺍﻻﺻﻄ‬‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬
‫ﺬﻋ‬ ‫ﻓ‬
‫ﺎ‬‫ﻪﻧ‬
‫ﺒ‬‫ﺀﺷ‬ ‫ﺎ‬
‫ﻡﻏﺸ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬
‫ﻡﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻩﻣﻦ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻳﻀ‬‫ﺍﻷ‬‫ﻔﻀﻼﺕ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺔﺇ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬
.(
32‫ﻜﻞ‬ ‫ﻟﺸ‬
‫ﺍ‬

(
Fig.32)Haemodi
aly
sis

VascularAccess
Accesst othepatient’
svascularsyst
em mustbeest
ablishedtoall
owbloodto
beremov ed,cleansed,andreturnedtot
hepati
ent
’svascularsy
stem atr
ates
between200and800mL/ minute.
Severaltypesofaccessar eav ail
abl
e.
1.Subclavian
2.I
nternalJugular
3.Femor alCatheter
s

Immedi ateaccesst othepatient’

scircul
ati
onf oracut
eheamodi aly
sisis
achievedbyi nsert
ingadoubl e-l
umenormul t
il
umencat het
erintot he
subclavian,i
nternalj
ugular,
orf emoralvei
n.Althoughthismethodofv ascular
accessi nvol
vessomer i
sk(eg, hematoma, pneumothorax,
infection,thrombosis
ofthesubcl avi
anv ei
n,andinadequat efow)
l
‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻻ‬‫ﻟﻰ‬‫ﺍ‬‫ﻮﻝ‬‫ﻮﺻ‬‫ﻟ‬
‫ﺍ‬
‫ﺍ‬‫ﻡ‬
‫ﺎ‬‫ﻟﻰﻧﻈ‬‫ﻪﺇ‬ ‫ﺗ‬
‫ﺩ‬‫ﺎ‬
‫ﺇﻋ‬‫ﻪﻭ‬‫ﻔ‬‫ﻴ‬‫ﻨﻈ‬
‫ﺗ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺈ‬‫ﺎﺡﺑ‬‫ﻤ‬
‫ﻠﺴ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬
‫ﻭ‬‫ﺍﻷ‬‫ﻡ‬‫ﺎ‬
‫ﻟﻰﻧﻈ‬ ‫ﻮﻝﺇ‬‫ﻮﺻ‬ ‫ﻟ‬‫ﺍ‬
‫ﺀ‬ ‫ﺎ‬
‫ﻧﺸ‬‫ﻳﺠﺐﺇ‬

130
 ‫‪.‬‬‫ﺔ‬‫ﻘ‬‫ﻴ‬ ‫ﻗ‬‫ﻴﻦ‪200‬ﻭ‪800‬ﻣﻞ‪/‬ﺩ‬ ‫ﻭﺡﺑ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﺪﻻﺕﺗ‬ ‫ﻌ‬‫ﻤ‬‫ﻳ ﺾﺑ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﻷ‬
‫‪.‬‬
‫ﻮﻝ‬‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉﻣﻦ‬‫ﻮ‬ ‫ﻧ‬
‫ﺃ‬ ‫ﺓ‬‫ﺪ‬‫ﺮﻋ‬ ‫ﻓ‬‫ﻮ‬‫ﺘ‬
‫ﺗ‬
‫ﺓ‬‫ﻮ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬ﺗﺤﺖ‬ ‫‪1‬‬
‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺟﻲ‬ ‫ﺩ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪2‬‬
‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻔﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪3‬‬
‫ﻳﻖ‬ ‫ﺮ‬‫ﺩﻋﻦﻃ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻴﻞ‬ ‫ﺃﺟﻞﻏﺴ‬ ‫ﻳ ﺾﻣﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺭﻱﺇ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬
‫ﺪ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺟﻲ‬‫ﺩ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺓ‬‫ﻮ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﺗﺤﺖ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥﻓﻲ‬ ‫ﻌ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻭﻣ‬‫ﺃ‬ ‫ﺔ‬‫ﻭﺟ‬‫ﺩ‬‫ﺰ‬‫ﺓﻣ‬‫ﺮ‬‫ﺎﻝﻗﺴﻄ‬ ‫ﺩﺧ‬‫ﺇ‬
‫ﻠﻰ‬‫ﺮ)ﻋ‬ ‫ﺎﻃ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﺾ‬ ‫ﻠﻰﺑ‬‫ﻮﻱﻋ‬ ‫ﻨﻄ‬ ‫ﻩﺗ‬ ‫ﺬ‬‫ﺔﻫ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﻟﻰ‬ ‫ﻮﻝﺇ‬‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﺃﻥﻃ‬ ‫ﻏﻢﻣﻦ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫‪.‬ﻋ‬‫ﺬﻱ‬ ‫ﻔﺨ‬‫ﻟ‬
‫ﺍ‬
‫(‬‫ﻓﻖ‬ ‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬‫ﺪ‬‫‪،‬ﻭﻋ‬ ‫ﺓ‬‫ﻮ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺗﺤﺖ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺜ‬‫‪،‬ﺗﺨ‬‫ﻭﻯ‬ ‫ﺪ‬‫‪،‬ﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﺡ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﺍﺳ‬‫‪،‬‬ ‫ﻮﻱ‬‫ﻣ‬‫ﻡﺩ‬‫ﺭ‬‫ﺎ‪،‬ﻭ‬‫ﺜﻝ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﺳ‬
‫‪Fi‬‬‫‪st‬‬‫‪ul‬‬‫‪a:‬‬
‫‪Amor‬‬ ‫‪eper‬‬ ‫‪manentaccess,‬‬ ‫‪knownasaf‬‬ ‫‪i‬‬
‫‪st‬‬‫‪ul‬‬‫‪a,‬‬ ‫‪i‬‬
‫‪scr‬‬‫‪eat‬‬ ‫‪edsur‬‬ ‫‪gi‬‬‫‪cal‬‬‫‪l‬‬
‫(‪y‬‬‫‪usual‬‬ ‫‪l‬‬‫‪yi‬‬‫‪n‬‬
‫‪t‬‬‫‪hef‬‬ ‫‪or‬‬ ‫‪ear‬‬‫‪m)byj‬‬ ‫‪oi‬‬‫‪ni‬‬‫(‪ng‬‬‫‪anast‬‬ ‫‪omosi‬‬ ‫‪ng)anar‬‬ ‫‪t‬‬‫‪er‬‬‫‪yt‬‬‫‪oav‬‬ ‫‪ei‬‬‫‪n,‬‬‫‪ei‬‬‫‪t‬‬‫‪hersi‬‬‫‪det‬‬ ‫‪osi‬‬ ‫‪deor‬‬
‫‪endt‬‬ ‫‪osi‬‬ ‫(‪de‬‬‫‪Fi‬‬‫)‪g.33‬‬‫‪.Thef‬‬ ‫‪i‬‬‫‪st‬‬‫‪ul‬‬‫‪at‬‬ ‫‪akes4t‬‬ ‫‪o6weekst‬‬ ‫‪omat‬‬ ‫‪ur‬‬‫‪ebef‬‬ ‫‪or‬‬‫‪ei‬‬‫‪ti‬‬‫‪sr‬‬ ‫‪eady‬‬
‫‪f‬‬‫‪oruse.Thi‬‬ ‫‪sgi‬‬ ‫‪v‬‬
‫‪est‬‬ ‫‪i‬‬‫‪mef‬‬ ‫‪orheal‬‬ ‫‪i‬‬‫‪ng.Thepat‬‬ ‫‪i‬‬
‫‪enti‬‬ ‫‪sencour‬‬ ‫‪agedt‬‬ ‫‪oper‬‬ ‫‪f‬‬
‫‪or‬‬ ‫‪m‬‬
‫‪exer‬‬‫‪ci‬‬ ‫‪sest‬‬ ‫‪oi‬‬‫‪ncr‬‬‫‪easet‬‬ ‫‪hesi‬‬ ‫‪zeoft‬‬ ‫‪hesev‬‬ ‫‪essel‬‬ ‫(‪s‬‬ ‫‪i‬‬
‫‪e,‬‬‫‪squeezi‬‬ ‫‪ngar‬‬ ‫‪ubberbal‬‬ ‫‪l‬‬‫‪f‬‬‫‪or‬‬
‫‪f‬‬‫‪or‬‬‫‪ear‬‬ ‫‪mf‬‬ ‫‪i‬‬
‫‪st‬‬‫‪ul‬‬
‫)‪as‬‬
‫‪:‬‬
‫ﺭ‬‫ﻮ‬‫ﺎﺳ‬‫ﻧ‬
‫(‬‫ﺓ‬‫ﺮ‬‫ﺎﻏ‬‫ﻔ‬‫ﻣ‬‫ﻳﻖ ﺿﻢ)‬ ‫ﺮ‬
‫(ﻋﻦﻃ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺓﻓﻲ‬‫ً‬ ‫ﺩ‬‫ﺎ‬‫ﻋ‬
‫ﺎ)‬ ‫ً‬
‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬
‫‪،‬ﺟ‬ ‫ﺭ‬‫ﻮ‬ ‫ﺎﺳ‬‫ﻨ‬
‫ﻟ‬‫ﺎ‬
‫ﺮﻑﺑ‬ ‫ﻌ‬‫‪ُ،‬‬
‫ﻳ‬ ‫ﺔ‬ ‫ﻣ‬‫ﻮ‬‫ﻤ‬‫ﻳ‬‫ﺮﺩ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬
‫ﺪﺧﻞ‬ ‫ﺀﻣ‬ ‫ﺎ‬‫ﻧﺸ‬‫ﺘﻢﺇ‬‫ﻳ‬
‫ﺭﻣﻦ‬ ‫ﻮ‬‫ﺎﺳ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻕ‬‫ﻐ‬‫ﺘ‬
‫‪.‬ﻳﺴ‬‫(‬‫ﻜﻞ‪33‬‬ ‫ﻟﺸ‬‫ﺍ‬‫ﻧﺐ)‬ ‫ﺎ‬‫ﻟﻰﺟ‬ ‫ﺮﻑﺇ‬ ‫ﻭﻣﻦﻃ‬ ‫ﺃ‬‫ﻧﺐ‬ ‫ﺎ‬
‫ﻟﻰﺟ‬ ‫ﻧﺐﺇ‬ ‫ﺎ‬‫ﺎﻣﻦﺟ‬ ‫ﻣ‬‫‪،‬ﺇ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬ ‫ﺎﻥﺇ‬‫ﻳ‬‫ﺮ‬‫ﺷ‬
‫ﻊ‬‫ﻴ‬‫ﺘﻢﺗﺸﺠ‬ ‫‪.‬ﻳ‬‫ﺀ‬‫ﺎ‬
‫ﻔ‬‫ﻠﺸ‬‫ﻟ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻄﻲ‬ ‫ﺍﻳ‬ ‫ﺬ‬
‫‪.‬ﻫ‬ ‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﻟﻼﺳ‬‫ﺍ‬‫ً‬
‫ﺰ‬‫ﺎﻫ‬‫ﺒﺢﺟ‬ ‫ﺃﻥﻳﺼ‬ ‫ﺒﻞ‬‫ﻨﻀﺞﻗ‬ ‫ﺘﻰﻳ‬ ‫ﻊﺣ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬‫ﺃﺳ‬ ‫ﻟﻰ‪6‬‬ ‫‪4‬ﺇ‬
‫(‬‫ﺪ‬ ‫ﺎﻋ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺍﺳ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺎﻃ‬‫ﺓﻣﻄ‬ ‫ﺮ‬‫ﻠﻰﻛ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬‫ﺔ)‬‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻩ‬‫ﺬ‬‫ﺓﺣﺠﻢﻫ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫ﺰ‬
‫ﻟ‬ ‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺀﺗ‬‫ﺍ‬‫ﺩ‬
‫ﺃ‬ ‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

‫(‬
‫‪Fi‬‬‫‪g.33)Fi‬‬
‫‪st‬‬‫‪ul‬‬
‫‪a‬‬

‫‪Gr‬‬ ‫‪af‬‬
‫‪t‬‬‫‪:‬‬
‫‪Anar‬‬ ‫‪t‬‬‫‪er‬‬‫‪i‬‬
‫‪ov‬‬‫‪enousgr‬‬ ‫‪af‬‬‫‪t‬‬‫‪.Usual‬‬ ‫‪l‬‬
‫‪y‬‬‫‪,‬‬‫‪agr‬‬‫‪af‬‬‫‪ti‬‬‫‪scr‬‬‫‪eat‬‬ ‫‪edwhent‬‬ ‫‪hepat‬‬‫‪i‬‬‫‪ent‬‬ ‫’‬
‫‪sv‬‬ ‫‪essel‬‬‫‪sar‬‬ ‫‪e‬‬
‫‪notsui‬‬ ‫‪t‬‬
‫‪abl‬‬‫‪ef‬‬‫‪oraf‬‬‫‪i‬‬‫‪st‬‬‫‪ul‬‬‫‪a.Pat‬‬ ‫‪i‬‬
‫‪ent‬‬‫‪swi‬‬‫‪t‬‬‫‪hcompr‬‬ ‫‪omi‬‬ ‫‪sedv‬‬ ‫‪ascul‬‬‫‪arsy‬‬ ‫‪st‬‬‫(‪ems‬‬ ‫‪eg,‬‬
‫‪f‬‬‫‪r‬‬‫‪om di‬‬‫‪abet‬‬‫‪es)of‬‬‫‪t‬‬
‫‪enneedt‬‬ ‫‪ohav‬‬ ‫‪eagr‬‬ ‫‪af‬‬‫‪tt‬‬‫‪ounder‬‬ ‫‪gohemodi‬‬ ‫‪al‬‬
‫‪y‬‬ ‫‪si‬‬‫‪s.Gr‬‬‫‪af‬‬‫‪t‬‬ ‫‪sar‬‬‫‪e‬‬
‫‪usual‬‬‫‪l‬‬‫‪ypl‬‬‫‪acedi‬‬‫‪nt‬‬‫‪hef‬‬ ‫‪or‬‬ ‫‪ear‬‬‫‪m,‬‬‫‪upperar‬‬‫‪m,‬‬ ‫‪oruppert‬‬ ‫‪hi‬‬‫‪gh.I‬‬‫‪nf‬‬
‫‪ect‬‬‫‪i‬‬‫‪onand‬‬
‫‪t‬‬‫‪hr‬‬‫‪ombosi‬‬ ‫‪sar‬‬‫‪et‬‬‫‪hemostcommoncompl‬‬ ‫‪i‬‬
‫‪cat‬‬‫‪i‬‬‫‪onsofar‬‬ ‫‪t‬‬‫‪er‬‬‫‪i‬‬
‫‪ov‬‬‫‪enousgr‬‬ ‫‪af‬‬‫‪t‬‬‫‪s.‬‬
‫‪:‬‬
‫ﻭﻉ‬ ‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻋ‬‫ﻭ‬‫ﺃ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﺗ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻌﻢﻋ‬ ‫ﺀﻃ‬‫ﺎ‬‫ﻧﺸ‬‫ﺘﻢﺇ‬‫‪،‬ﻳ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫‪.‬ﻋ‬ ‫ﺪﻱ‬‫ﻳ‬‫ﺭ‬‫ﻧﻲﻭ‬ ‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻌﻢﺷ‬ ‫ﻃ‬
‫ﺮﺿﻰ‬ ‫ﺜﻞﻣ‬‫ﻣ‬‫ﺔ)‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻠﻞﻓﻲ‬ ‫ﻮﻥﻣﻦﺧ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺝ‬
‫ﺘ‬‫ﺎﻳﺤ‬‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫‪.‬ﺎ‬ ‫ﺭ‬‫ﻮ‬‫ﺎﺳ‬‫ﻨ‬‫ﻠ‬‫ﻟ‬
‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﺮﻣ‬‫ﻴ‬‫ﻏ‬
‫ﻭ‬
‫ﺃ‬‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺃﻋ‬‫ﻭ‬‫ﺃ‬‫ﺪ‬‫ﺎﻋ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﻡﻓﻲ‬ ‫ﻮ‬‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻊ‬‫ﺘﻢﻭﺿ‬ ‫ﺎﻳ‬‫ﺓﻣ‬ ‫ﺩ‬
‫ﺎ‬‫‪.‬ﻋ‬ ‫ﻠﻰ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻐﺴ‬‫ﻟ‬‫ﻮﻉ‬‫ﻠﺨﻀ‬ ‫ﻟ‬‫ﻴﻢ‬‫ﻌ‬‫ﻟﻰﺗﻄ‬ ‫(ﺇ‬‫ﺮﻱ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
‫‪.‬‬‫ﺎ‬
‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬‫ﺔﺷ‬ ‫ﻳ‬ ‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬ ‫ﺎﻋ‬
‫ﺮﻣﻀ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺮ‬‫ﺜ‬
‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻯﻭ‬ ‫ﺪ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫‪.‬ﺗ‬‫ﺬ‬‫ﻔﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬‫ﺃ‬

‫‪131‬‬
Indicati
ons:
-Maybeusedi nthetreatmentofbot hacuteandchr onicrenalfai
lure.
-Thepr ocedureisusual lycarriedoutthreet
ime/week
-Uncont roll
edhyperkalemi a.
-Fluidoverload.
-Per i
toni
tis.
-Sev eracidosi
s.
Cont rai
ndicati
ons:
-Sev erhomody nami cinstabili
ty.
-Acut eandsev erbl
eedi ng.
-Intoler
ancet osystemi chy parini
zat
ion
:‫ﺎ‬
‫ﻤﻝ‬‫ﻌ‬‫ﺘ‬‫ﺍﻹﺳ‬ ‫ﻋﻲ‬‫ﺍ‬‫ﻭ‬‫ﺩ‬
.
‫ﻣﻦ‬‫ﺰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺩﻭ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺸﻞ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲﻋﻼﺝ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﺪﻳﺴ‬ ‫ﻗ‬-
‫ﻮﻉ‬‫ﺒ‬‫ﺍﻷﺳ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬
‫ﺓﺛﻼﺙﻣ‬ ‫ﺩ‬‫ﺎ‬‫ﺀﻋ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺬ‬‫ﻴ‬
‫ﻔ‬‫ﻨ‬‫ﺘﻢﺗ‬‫ﻳ‬-
.
‫ﺒﻂ‬‫ﻨﻀ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻡﻏ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺮﻁﺑ‬ ‫ﻓ‬-
.
‫ﺪ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬-
.‫ﺎﻕ‬‫ﻔ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺪ‬ ‫ﻳ‬‫ﺪ‬
‫ﻟﺸ‬‫ﺍ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬-
:‫ﻊ‬‫ﻧ‬
‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.‫ﺣ‬
‫ﺩ‬‫ﻜﻲ ﺎ‬ ‫ﻴ‬
‫ﻣ‬‫ﺎ‬‫ﻨ‬
‫ﻳ‬‫ﺛﻞﺩ‬‫ﺎ‬‫ﻤ‬‫ﺘ‬‫ﺭﻣ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﻡ‬
‫ﺪ‬‫ﻋ‬-
.‫ﺣ‬
‫ﺩ‬‫ﺩﻭ ﺎ‬ ‫ﺎ‬‫ﻳﻒﺣ‬ ‫ﺰ‬‫ﻧ‬-
‫ﺯﻱ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻳﻢ‬‫ﻮ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻁ‬‫ﻤﻞﻓ‬ ‫ﻡﺗﺤ‬‫ﺪ‬‫ﻋ‬-

Advantages:
-Mor eeffi
cient,fasterprocess.
-Canbeusedf ortempor aryorpermanentdial
ysi
s.
-Shorterti
mef ortreatmentneeded( 3–4h, 3-4ti
meperweek)
.
Disadvantages:
-Requiredtrainedper sonnel andsophi
sti
catedequipment
.
-Requireshepar i
nization.
-Requiremai ntenanceofv ascul
araccess.
-Expensivet omai ntai
n.
:
‫ﺎ‬‫ﻳ‬
‫ﺍ‬‫ﺰ‬‫ﻣ‬
.‫ﺓ‬‫ﺀ‬
‫ﺎ‬‫ﻔ‬‫ﺮﻛ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺮﻉﻭ‬‫ﺃﺳ‬ ‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻤ‬
‫ﻋ‬-
.‫ﺋﻢ‬
‫ﺍ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻗﺖ‬‫ﺆ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻐﺴ‬‫ﻟ‬‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬-
.
(‫ﻮﻉ‬
‫ﺒ‬‫ﺍﻷﺳ‬
‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻣ‬4-
3، ‫ﺎﺕ‬‫ﺎﻋ‬
‫ﺳ‬4- 3)‫ﻌﻼﺝ‬‫ﻠ‬‫ﻟ‬‫ﺮ‬‫ﻗﺼ‬‫ﺃ‬‫ﻗﺖ‬‫ﻭ‬-
:
‫ﺎﺕ‬‫ﻴ‬‫ﺒ‬‫ﻠ‬
‫ﺳ‬
.
‫ﺓ‬‫ﺭ‬‫ﻮ‬
‫ﺘﻄ‬‫ﺍﺕﻣ‬‫ﺪ‬‫ﻌ‬‫ﻣ‬‫ﻴﻦﻭ‬‫ﺑ‬‫ﺭ‬‫ﺪ‬‫ﻴﻦﻣ‬‫ﻔ‬‫ﻮﻇ‬‫ﻮﺏﻣ‬ ‫ﻠ‬
‫ﻣﻄ‬-
.
‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬‫ﺘﻄ‬‫ﻳ‬-
.‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﻮﻝ‬‫ﺔﻭﺻ‬ ‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﻠﺐ ﺻ‬‫ﺘﻄ‬‫ﺗ‬-
.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﻠﺼ‬‫ﻟ‬‫ﻤﻦ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﻏ‬-

Compl icationsofhaemodi alysi

s:
Hy potensionmayoccurdur i
ngt het r
eatmentasf l
uidi
sremoved.Nauseaand
vomi t
ing,diaphoresis,
tachycardia,anddizzinessar
ecommonsi gnsof
hypotension.
Painfulmuscl ecrampingmayoccur ,usuall
ylatei
ndial
ysi
sasflui
dand
electr
olytesr api
dlyl
eav et
heext racell
ularspace.

132
Exsangui nat i
onmayoccuri fbl oodl inessepar ateordi aly sisneedl es
acci dent allybecomedi slodged.
Dy srhy thmi asmayr esul tfrom el ect roly teandpHchangesorf rom r emov alof
ant i
ar r
hy thmi cmedi cat ionsdur ingdi aly sis.
Airembol ism i sr ar ebutcanoccuri fai rent erst hev ascul arsy stem.
Chestpai nmayoccuri npat ient swi thanemi aorar ter i
oscl erot i
chear tdi sease.
Dialy sisdi sequi li
br ium r esul tsf rom cer ebral fl
uidshi ft
s.Si gnsandsy mpt oms
i
ncl udeheadache, nauseaandv omi ting, restlessness, decr easedl ev elof
consci ousness, and
seizur es.I tismor el i
kel yt ooccuri nacut er enal failureorwhenbl oodur ea
nitrogenl ev el
sar ev er yhi gh( exceedi ng150mg/ dL) .Nur singpr ocessf or
haemodi alysis:
:‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺎﺕﻏﺴ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬
‫ﻡ‬‫ﺪ‬‫ﻋ‬‫ﺮﻕﻭ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻭ‬ ‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬ ‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬.‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﺔ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺘﻢﺇ‬ ‫ﻴﺚﺗ‬ ‫ﻌﻼﺝﺣ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎ ﺽﺿ‬ ‫ﻔ‬‫ﻧﺨ‬ ‫ﺍ‬‫ﺪﺙ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬
.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎ ﺽﺿ‬ ‫ﻔ‬ ‫ﻧﺨ‬‫ﺔﻻ‬ ‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﺎﺕﺷ‬ ‫ﻣ‬ ‫ﺔﻫﻲﻋﻼ‬ ‫ﻭﺧ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻗ‬‫ﻡﺩ‬ ‫ﺎ‬
‫ﺘﻈ‬ ‫ﻧ‬
‫ﺍ‬
‫ﺍﻹ‬‫ﺋﻞﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺮﻙ‬ ‫ﺘ‬ ‫ﻴﺚﺗ‬ ‫ﻠﻰﺣ‬ ‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﺮﻣﻦﻏﺴ‬ ‫ﺄﺧ‬‫ﺘ‬‫ﻗﺖﻣ‬ ‫ﺓﻓﻲﻭ‬ ‫ﺩ‬
‫ﺎ‬‫ﻋ‬، ‫ﻟﻢ‬‫ﺆ‬‫ﻠﻲﻣ‬ ‫ﻨﺞﻋﻀ‬ ‫ﺪﺙﺗﺸ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬
.‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬‫ﺭﺝ‬ ‫ﺎ‬
‫ﺀﺧ‬ ‫ﺎ‬‫ﻔﻀ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻋ‬ ‫ﺮ‬‫ﺎﺕﺑﺴ‬ ‫ﺘ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻜ‬‫ﻟ‬
.
‫ﺄ‬‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﻳﻖ‬ ‫ﺮ‬‫ﻠﻰﻋﻦﻃ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﺮﻏﺴ‬ ‫ﺑ‬‫ﺔﺇ‬ ‫ﺍﺣ‬‫ﺯ‬‫ﻭﺗﻢﺇ‬ ‫ﺃ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻁ‬‫ﻠﺖﺧﻄ‬ ‫ﻔﺼ‬ ‫ﻧ‬‫ﺍ‬‫ﺍ‬‫ﺫ‬‫ﻡﺇ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺰ‬‫ﻨ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺪﺙ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬
‫ﺓﻻ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺔ‬ ‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﻭﻋﻦﺇ‬ ‫ﺃ‬ ‫ﺔ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﺭﺟ‬ ‫ﺩ‬‫ﻴﺖﻭ‬ ‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻜ‬‫ﻟ‬‫ﺍﻹ‬ ‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻨﻈﻢﻋﻦﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻞ‬‫ﺘﺞﺧ‬ ‫ﻨ‬
‫ﺪﻳ‬ ‫ﻗ‬
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﺀﻏﺴ‬ ‫ﺎ‬‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻨﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺏ‬ ‫ﺮ‬
‫ﺿﻄ‬
.
‫ﺔ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬ ‫ﻡ‬ ‫ﺎ‬
‫ﻟﻰﻧﻈ‬ ‫ﺀﺇ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺍﺩﺧﻞ‬ ‫ﺫ‬ ‫ﺪﺙﺇ‬ ‫ﺃﻥﻳﺤ‬ ‫ﻜﻦ‬‫ﻤ‬ ‫ﻜﻦﻳ‬ ‫ﻟ‬
‫ﻭﺙﻭ‬ ‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬‫ﺋﻲﻧ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍﻻ‬
.
‫ﺒﻲ‬ ‫ﻠ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬ ‫ﻳ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻠﺐ‬ ‫ﺮ ﺽﺗﺼ‬ ‫ﻭﻣ‬ ‫ﺃ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻘ‬‫ﺮﺿﻰﻓ‬ ‫ﺪﻣ‬ ‫ﻨ‬‫ﺭﻋ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻟﻢﻓﻲ‬ ‫ﺃ‬‫ﺪﺙ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬
‫ﺎﻥ‬‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻉﻭ‬ ‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬ ‫ﺍﻷﻋ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺗﺸ‬. ‫ﻏﻲ‬ ‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻻﺕ‬ ‫ﻠﻰﻣﻦﺗﺤ‬ ‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﺯﻥﻏﺴ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻡﺗ‬‫ﺪ‬‫ﺘﺞﻋ‬ ‫ﻨ‬‫ﻳ‬
‫ﻋﻲﻭ‬ ‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬‫ﺎ ﺽﻣﺴ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﻷﻕﻭ‬‫ﺍﺭ‬ ‫ﺀﻭ‬‫ﻘﻲ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﻴ‬‫ﺎﺕﻧ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻮﻥﻣﺴ‬ ‫ﻜ‬ ‫ﺎﺗ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻭﻋ‬ ‫ﺃ‬ ‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﻮﻱ‬ ‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﺪﺙﻓﻲﺣ‬ ‫ﺃﻥﺗﺤ‬ ‫ﺮﺟﺢ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬. ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
:‫ﻠﻰ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﻐﺴ‬ ‫ﻟ‬ ‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬ ‫ﺔ‬
‫ﻴ‬ ‫ﻠ‬
‫ﻤ‬ ‫ﻋ‬.(‫ﺮ‬‫ﺘ‬ ‫ﻠ‬
‫ﻴ‬ ‫ﻳﺴ‬‫ﺩ‬/‫ﻣﺠﻢ‬150‫ﺯ‬ ‫ﻭ‬‫ﺎ‬‫ﺘﺠ‬ ‫ﺗ‬
)‫ﺍ‬ ً
‫ﺪ‬‫ﺔﺟ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻡﻋ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﻓﻲ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬
Nur singassessment :
-Assesspost ural changesofbl oodpr essur eespeci all
yatt hecompl etionof
dialysis.
-Checkal l vit
al si gns.
-Assesshear tandl ungsounds.
-Assessf l
uidst at usbef oreandaf tert hepr ocess.
-Moni tori ntakeandoutput .
-Wei ghtt hepat i
entbef or eandaf terdi al ysis.
-Assessment al st atus.
-Moni torel ect roly tev alue.
-Checkf orpat encyofv ascul araccess.
-Obser veandr epor tanynumbness, pai norswel l
ingi nt heex tremi tydi stalto
theaccess.
-Assesst hepat ient 'sandf ami ly'sknowl edgeconcer ni
ngdi alysis, vascul ar
accessanddi et aryandmedi cal regi men.
-Assesssuppor tsy st em andt hepat ient '
scopi ngmechani sm.
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬
.‫ﻠﻰ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬ ‫ﻴﻞ‬‫ﺀﻣﻦﻏﺴ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬ ‫ﺪ‬‫ﻨ‬
‫ﺔﻋ‬ ‫ﺎﺻ‬‫ﻡﻭﺧ‬ ‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺔﺿ‬ ‫ﻴ‬‫ﻌ‬‫ﺍﺕﻓﻲﻭﺿ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.‫ﺔ‬‫ﻳ‬ ‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻓﺤ ﺺﻛﻞ‬-
.‫ﺔ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﻮ‬‫ﺃﺻ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬ ‫ﻴ‬‫ﻠ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬ ‫ﺑ‬
‫ﺒﻞﻭ‬ ‫ﺋﻞﻗ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﺣﺔ‬
‫ﻟ‬‫ﻴﻢ ﺎ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.‫ﻭﺝ‬‫ﺮ‬‫ﻟﺨ‬ ‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﺪﺧ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﺪﻏﺴ‬ ‫ﻌ‬‫ﺑ‬
‫ﺒﻞﻭ‬ ‫ﻳ ﺾﻗ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬‫ﻭ‬-
.‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻘ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-

133
 .
‫ﺀ‬ ‫ﺎ‬‫ﺑ‬
‫ﺮ‬ ‫ﻬ‬‫ﻜ‬
‫ﻟ‬‫ﺎ‬
‫ﻨﺤﻞﺑ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻴ‬‫ﺔﻗ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬ ‫ﻮﻝ‬‫ﺔﻭﺻ‬ ‫ﻴ‬‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﻘﻖﻣﻦﺳ‬ ‫ﺗﺤ‬-
.‫ﺪﺧﻞ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻣﻦ‬ ‫ﻴ‬‫ﻌ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﻄ‬
‫ﺍ‬ ‫ﻡﻓﻲ‬ ‫ﺭ‬‫ﻮ‬‫ﻭﺗ‬‫ﺃ‬‫ﻟﻢ‬‫ﺃ‬‫ﻭ‬ ‫ﺃ‬‫ﺭ‬‫ﺪ‬ ‫ﺃﻱﺧ‬ ‫ﺑﻼﻍﻋﻦ‬ ‫ﺍﻹ‬‫ﻻﺣﻆﻭ‬-
‫ﻡ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻟﻰ‬‫ﻮﻝﺇ‬ ‫ﻮﺻ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﻐﺴ‬‫ﻠﻖﺑ‬ ‫ﻌ‬
‫ﺘ‬‫ﺎﻳ‬‫ﻤ‬‫ﻴ‬‫ﻪﻓ‬ ‫ﺘ‬‫ﻠ‬‫ﺋ‬
‫ﺎ‬‫ﻳ ﺾﻭﻋ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬‫ﻴﻢﻣ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﺒﻲ‬‫ﻟﻄ‬‫ﺍ‬‫ﺋﻲﻭ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬ ‫ﻟ‬‫ﻴﻒ‬ ‫ﻜ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺁ‬‫ﻋﻢﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻴﻢﻧﻈ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
Nursingdi agnosi s:
Nursingdi agnosi s( 1)
:Ri skf orf lui
dexcessordef i
citrelat edt orenal f
ailureor
fl
uidov erl oad.
Nursingdi agnosi s( 2)
:Ri skf ori nfectionrelatedt ov ascul araccess.
Nursingi nt ervention:
Protectingt hev ascularaccess:
1.Thenur seassessest hev ascul araccessf orpot ency
2.takespr ecaut i
onst oensur et hatt heext remi tywitht hev ascularaccessi snot
usedf ormeasur ingbloodpr essur eorf orobt ainingbloodspeci mens;
3.ti
ghtdr essings, restraints,orj ewel r
yov ert hev ascularaccessar et obe
avoidedaswel l
.
4.Thebr uitov erthev enousaccesssi temustbeev aluat edatl eastev ery8
hours.Absenceofapal pablet hrilloraudiblebr uitmayi ndi cateblockageor
cl
ottingi nt heaccessdev i
ce.
:‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
.
‫ﺓ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻮﻱ‬‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻔﺸﻞ‬‫ﻟ‬‫ﺎ‬‫ﺒﻂﺑ‬ ‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺮﺯ‬ ‫ﺧﻄ‬: (
1)‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻟﻰ‬
‫ﻮﻝﺇ‬ ‫ﻮﺻ‬ ‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺒﻄ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺧﻄ‬: (
2)‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
:‫ﺔ‬‫ﻳ‬‫ﻮ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﻮﻝ‬ ‫ﺔﻭﺻ‬ ‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺎﻋ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺃﺟﻞ‬ ‫ﺔﻣﻦ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻮﻝ‬‫ﺔﻭﺻ‬ ‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻘ‬‫ﺗ‬.1
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﻟﻸ‬ ‫ﺬ‬‫ﻔ‬
‫ﻨ‬‫ﻠﻰﻣ‬ ‫ﻮﻱﻋ‬ ‫ﺘ‬‫ﺬﻱﻳﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻡ‬‫ﺪ‬‫ﺎﻥﻋ‬‫ﻤ‬‫ﻟﻀ‬ ‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﺍﻼ‬
‫ﺎﺕﻟ‬ ‫ﺎﻃ‬‫ﻴ‬‫ﺘ‬
‫ﺍﻻﺣ‬ ‫ﺬ‬ ‫ﺘﺨ‬‫ﻳ‬.2
‫؛‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻨ‬‫ﻴ‬
‫ﻠﻰﻋ‬ ‫ﻮﻝﻋ‬ ‫ﻠﺤﺼ‬‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﺱ ﺿ‬ ‫ﻴ‬‫ﻘ‬
‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﺪﺧﻞ‬ ‫ﻮﻕﻣ‬ ‫ﺓﻓ‬ ‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺮ‬‫ﻮﻫ‬‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺩ‬‫ﻮ‬ ‫ﻴ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻟﻀ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﻨﺐ‬‫ﺎﺗﺠ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬ ‫ﻳﺠﺐ‬. 3
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺎ‬‫ﺛ‬
‫ﺩﺇ‬‫ﻮ‬ ‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﺮﻋ‬‫ﻴ‬‫ﺪﻳﺸ‬ ‫ﻗ‬.‫ﻗ‬
‫ﺍﻷﻞ‬ ‫ﻠﻰ‬‫ﺎﺕﻋ‬ ‫ﺎﻋ‬‫ﺳ‬8‫ﺪﻱﻛﻞ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﻮﺻ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬ ‫ﻮ‬‫ﻮﻕﻣ‬ ‫ﻐﻂﻓ‬ ‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﻳﺠﺐﺗ‬. 4
.‫ﻮﻝ‬ ‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﺮﻓﻲﺟ‬ ‫ﺜ‬
‫ﻭﺗﺨ‬ ‫ﺃ‬‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬ ‫ﻟﻰ‬‫ﻮﻉﺇ‬ ‫ﻤ‬
‫ﻐﻂﻣﺴ‬ ‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻮﺳ‬ ‫ﻣﺤﺴ‬

5.Thenur seobser vesthepat i

entforsi
gnsandsy mpt omsofi nf
ecti
on,suchas
redness, swelli
ng, dr
ainagef r
om thesit
e, andfever
.
6.Patientswi threnal di
seasear emorepr onetoinfection;theref
ore,i
nfecti
on
controlmeasur esmustbeusedf oral
lprocedures.
7.Prov i
deadequat esitecare.
8.Useasept i
ct echniqueswhenchangi ngdr essi
ng.
9.Moni torv i
talsi
gns.
10.Obser veforsignsofr ednessswelli
ng, warmth,exudat es,andtendernessof
thesite.
11.Teachpat ientandf amilytorecogni
zeS&Sofi nfection.

‫ﻳﻒﻣﻦ‬‫ﺰ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬‫ﺭ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺍﻻﺣ‬
‫ﺜﻞ‬‫ﻣ‬،‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬
‫ﺮ‬‫ﺃﻋ‬
‫ﺎﺕﻭ‬‫ﻣ‬‫ﺎﻋﻦﻋﻼ‬ً
‫ﺜ‬
‫ﻳ ﺾﺑﺤ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺐ‬‫ﺍ‬‫ﺮ‬‫ﺗ‬.5
.‫ﻤﻰ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻊﻭ‬ ‫ﻗ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬
‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﻡﺗ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻳﺠﺐ‬،‫ﻟﻚ‬‫ﺬ‬‫ﻟ‬
.‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻟﻺﺻ‬
‫ﺔ‬‫ﺮﺿ‬‫ﺮﻋ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﻠﻰﻫﻢ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺃ‬‫ﻮﻥﻣﻦ‬‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬.
6
.
‫ﺍﺕ‬‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﻊ‬‫ﻴ‬
‫ﻤ‬‫ﻭﻯﻓﻲﺟ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻓﺤ‬ ‫ﺎ‬
‫ﻜ‬‫ﻣ‬
.
‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬
‫ﺔﻣ‬ ‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮﺭ‬‫ﻴ‬
‫ﻓ‬ ‫ﻮ‬
‫ﺗ‬.7

134
 .‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬
‫ﻟﻀ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻴ‬‫ﻐ‬
‫ﺪﺗ‬‫ﻨ‬‫ﻴﻢﻋ‬‫ﻘ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻴ‬‫ﻨ‬‫ﻘ‬‫ﻡﺗ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ .
8
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﺆﺷ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬
‫ﺍ‬‫ﺮ‬‫ﻣ‬.9
.
‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻥ‬‫ﻨ‬
‫ﻭﺣ‬،‫ﺍﺕ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺇ‬‫ﻭ‬،‫ﺀ‬‫ﺩﻑ‬‫ﻭ‬،‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﺗ‬‫ﻭ‬،‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﺍﻻﺣ‬‫ﺎﺕ‬‫ﻣ‬‫ﻻﺣﻆﻋﻼ‬. 10
.
‫ﻭﻯ‬‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﻣﻦ‬S&S‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻢ‬
‫ﻋ‬. 11

Nur si
ngdi agnosis(3):I
neffecti
vecopi ngr elat
edt oeff
ectoflongterm
haemodi al
ysi
s.
Nur si
ngi nter
vention:
-Instructthepatientandfami l
yinal l
ar easoft hetreat
ment .
-Allowf orquesti
onsandv erbal
izati
onoff earsandconcer ns.
-Prov i
desuppor tfordeci
sionmadebyt hepatientandfami l
y.
-Encour ageactiveparti
ci
pat i
oni nthepat i
ent '
scarebyt hepati
entandthe
fami l
y.
Evaluation:Compar ethepat i
ents’statuswi ththeexpect edout
comes.Ift
he
outcomesar enotmeet ,r
eassesst hepat i
entandr euset hepl
an.

.‫ﻳﻞ‬
‫ﻮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻠﻰﻋ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬
‫ﺮﻏﺴ‬ ‫ﻴ‬
‫ﺛ‬‫ﺄ‬‫ﺘ‬
‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬
‫ﻌ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻠﻢﻏ‬ ‫ﻗ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
:(3)‫ﻳﻀﻲ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
:‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.
‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﻣﺎﻻﺕ‬
‫ﻊﺠ‬ ‫ﻴ‬‫ﻤ‬‫ﺓﻓﻲﺟ‬ ‫ﺮ‬‫ﺍﻷﺳ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬‫ﺇ‬-
.
‫ﻭﻑ‬‫ﺎ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻑﻭ‬ ‫ﺎ‬
‫ﻤﺨ‬ ‫ﻟ‬
‫ﺎ‬
‫ﻔﻆﺑ‬ ‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻠ‬‫ﺌ‬
‫ﺍﻷﺳ‬‫ﺮﺡ‬‫ﻟﻄ‬‫ﺎﺡ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
-
.‫ﻪ‬‫ﺘ‬
‫ﻠ‬‫ﺋ‬
‫ﺎ‬‫ﻳ ﺾﻭﻋ‬‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺘﺨ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﻠ‬
‫ﻟ‬‫ﻋﻢ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬‫ﻘ‬
‫ﺗ‬-
.‫ﺳ‬
‫ﺓ‬
‫ﺍﻷ ﺮ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻞ‬
‫ﻳ ﺾﻣﻦﻗ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺔﻓﻲﺭ‬ ‫ﻟ‬‫ﺎ‬
‫ﻌ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺭ‬
‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺗﺸﺠ‬-
‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬
‫ﺍﺳ‬‫ﺪ‬
‫ﺃﻋ‬‫ﻳ ﺾﻭ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺪﺗ‬‫ﺃﻋ‬،
‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻖ‬‫ﺘﺤ‬‫ﻟﻢﺗ‬‫ﺍ‬
‫ﺫ‬‫ﺇ‬.‫ﺔ‬‫ﻌ‬
‫ﻗ‬‫ﻮ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺎ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺭﻥ ﺎ‬‫ﺎ‬
‫ﻗ‬:‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
.‫ﺔ‬‫ﻟﺨﻄ‬‫ﺍ‬

Terminol ogyofur ol
ogysy stem:
Frequency :.Itr eferstoanexcessi v enumberofur i
nati
on.
Urgency :Urinar yur gencyi sasuddenandv eryst r
ongdesiret
o
urinatet hati sdi ffi
cultt
osuppr ess.
Dy suria:Ispai nfulordifficul turinat i
on.
Noct uria: I
sni ghttimeur inar yf requency .
Noct urnal enur esis:Isthei nv olunt aryreleaseofur ineduri
ngsleep.
Hesi tancy :Isadel ayint hest ateofur i
nat i
on.
Incont i
nence:i tistheinv olunt aryl ossofur ine.
Anur ia:Ref erst ourineout puti s100ml orlessi n24hoursperiod.
Oligur i
a: Urineout putisbet ween100-400ml i
n24hour sper
iod.
Pol yuri
a: Ist heexcessi v esecr et i
onofur i
ne, whichisgeneral
l
ymor e
than2500ml (in24hour s)
Cy stit
is:Ist hei nflammat ionoft heur i
narybl adder.
Py el
onephr itis: i
sabact er ial i
nf ectionofr enal pel
vis,t
ubul
es,and
i
nt ersti
tialtissueofoneorbot hki dney s.
:‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﺎﺕﺟ‬‫ﻠﺤ‬
‫ﻣﺼﻄ‬
.‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺮ‬‫ﺜ‬‫ﻟﻰﻛ‬‫ﺮﺇ‬
‫ﻴ‬‫ﻳﺸ‬.
:‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺗ‬
.
‫ﺎ‬‫ﻬ‬
‫ﻌ‬‫ﻤ‬‫ﻌﺐﻗ‬
‫ﻮﻝﻳﺼ‬
‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬
‫ﻳ‬‫ﺎ‬‫ﻐ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻗ‬
‫ﺔﻭ‬‫ﺌ‬
‫ﺎﺟ‬‫ﻔ‬
‫ﺔﻣ‬‫ﺒ‬
‫ﻮﺭﻏ‬‫ﻟﻲﻫ‬ ‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺡ‬‫ﻟﺤ‬
‫ﺍﻹ‬:‫ﺎ‬
‫ﻌﺠﻝ‬‫ﺘ‬‫ﺍﻻﺳ‬

135
 ‫‪.‬‬
‫ﻌﺐ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻟﻢ‬
‫ﺆ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫‪:‬ﻫ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬
‫‪.‬‬
‫ﻠﻲ‬‫ﻴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬ ‫ﻜ‬‫ﻮﺗ‬‫‪:‬ﻫ‬‫ﻠﻲ‬‫ﻴ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﻡ‬‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬
‫ﺩﻱ‬‫ﺍ‬‫ﺭ‬‫ﺇ‬
‫ﺍﻼ‬‫ﻮﻝﻟ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺝ‬ ‫ﺮ‬
‫ﻮﺧ‬ ‫‪:‬ﻫ‬ ‫ﻠﻲ‬ ‫ﻴ‬
‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬ ‫ﺳ‬
‫‪.‬‬‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺮﻓﻲ ﺎ‬ ‫ﻴ‬
‫ﺄﺧ‬‫ﻮﺗ‬‫‪:‬ﻫ‬‫ﺩ‬‫ﺩ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﺩﻱ‬‫ﺍ‬‫ﺭ‬
‫ﺇ‬‫ﺍﻼ‬
‫ﻮﻝﻟ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬ ‫ﻮﻓ‬‫‪:‬ﻫ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬ ‫ﺳ‬
‫‪.‬‬
‫ﺔ‬‫ﺎﻋ‬‫ﺓ‪24‬ﺳ‬ ‫ﺮ‬‫ﺘ‬
‫ﻗﻞﻓﻲﻓ‬ ‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﻎ‪100‬ﻣﻞ‬ ‫ﻠ‬
‫ﺒ‬‫ﻮﻝﻳ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺃﻥﺇﺧ‬‫ﻟﻰ‬ ‫ﺮﺇ‬‫ﻴ‬‫‪:‬ﻳﺸ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻉ‬‫ﻘﻄ‬‫ﻧ‬‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﺎﻋ‬
‫ﺓ‪24‬ﺳ‬ ‫ﺮ‬‫ﺘ‬‫ﻴﻦ‪400-100‬ﻣﻞﻓﻲﻓ‬ ‫ﻮﻝﺑ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬ ‫ﻧ‬
‫ﻭﺡﺇ‬ ‫ﺍ‬‫ﺮ‬
‫ﺘ‬‫‪:‬ﻳ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻗ‬
‫(‬‫ﺔ‬‫ﺎﻋ‬
‫ﻓﻲ‪24‬ﺳ‬ ‫ﻡﻋﻦ‪2500‬ﻣﻞ)‬ ‫ﺎ‬‫ﻜﻞﻋ‬‫ﺪﺑﺸ‬‫ﻳ‬‫ﺰ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻠ‬
‫ﻟ‬‫ﺮﻁ‬ ‫ﻔ‬‫ﺯﻣ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﻮﺇ‬‫ﺍ‪:‬ﻫ‬
‫ﻮﻝ‬ ‫ﺑ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ‬ ‫‪:‬ﻫ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻼﺔﻹ‬
‫ﻴ‬‫ﻟﺨﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬
‫ﺍﻷ‬‫ﺎﺕﻭ‬‫ﺒ‬
‫ﻴ‬‫ﺒ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱﻭ‬ ‫ﻠ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺽ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻴﺐ‬‫ﺔﺗﺼ‬‫ﻳ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻜ‬‫ﻭﻯﺑ‬‫ﺪ‬‫ﻮﻋ‬ ‫‪:‬ﻫ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳﻀ‬‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﺎ‬‫ﻤ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬
‫ﻭﻛ‬ ‫ﺃ‬
‫ﻴﻦ‬‫ﺘ‬‫ﻴ‬‫ﻠ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻯ‬‫ﺣ‬

‫‪Chapt‬‬
‫‪erI‬‬‫‪I‬‬
‫‪I‬‬
‫‪Nur‬‬
‫‪si‬‬‫‪ngManagementofPat‬‬‫‪i‬‬‫‪entwi‬‬
‫‪t‬‬‫‪h‬‬
‫‪Neur‬‬
‫‪ol‬‬‫‪ogi‬‬
‫‪csy‬‬‫‪st‬‬‫‪em di‬‬
‫‪sor‬‬
‫‪der‬‬‫‪s‬‬

‫ﻟﺚ‬‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺼﻞ‬
‫ﻟ‬‫ﺍ‬
‫ﻊ‬
‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺒﻲ‬‫ﻌﺼ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬

‫‪136‬‬
 Uni
t1:Cent
ral
ner
voussy
stem di
sor
der
s

Al
ter
edl
evelofconsci
ousness
Learningobjectives:
Uponcompl et
ionoft hislecture,eachst udentshoul dbeabl eto:
1.Def i
nelevelofconsci ousnessal terati
on
2.Di
f fer
enti
atebet weenl evelofconsci ousnessal terat
ions
3.I
dent i
fythepat hophy si
ologyofal teredlevelofconsci ousness
4.I
dent i
fytheclinicalmanifestationsandcompl icati
onsofpat ientwi
thalt
ered
l
evel ofconsci
ousness
5.Descr i
bethemul ti
pleneedsoft hepat i
entwithal t
eredlevelofconsci
ousness
6.Uset henursingpr ocessasaf ramewor kforcareoft hepat i
entwit
halt
ered
l
evel ofconsci
ousness
‫ﺰﻱ‬‫ﻛ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬ :
1‫ﺓ‬ ‫ﺪ‬‫ﻮﺣ‬ ‫ﻟ‬
‫ﺍ‬

‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻋﻲ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬
‫ﺘ‬‫ﻣﺴ‬
:‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬
:‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺐﻗ‬ ‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬ ‫ﻜ‬‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬
‫ﻮﻋﻲ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﻮﻯﺗ‬ ‫ﺘ‬
‫ﺪﻣﺴ‬ ‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬.1
‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻓﻲ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻯ‬ ‫ﺘ‬‫ﻴﻦﻣﺴ‬ ‫ﻳﻖﺑ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
2
‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
3
‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬
‫ﺮﻣﺴ‬‫ﻴ‬‫ﻐ‬‫ﻊﺗ‬‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻭ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
4
‫ﻋﻲ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻮﻯﻣ‬ ‫ﺘ‬
‫ﻤﺴ‬ ‫ﻳ ﺾﺑ‬
‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬
‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﻭﺻﻒ‬. 5
‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻣﻦ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻮﻯﻣ‬‫ﺘ‬‫ﻤﺴ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬‫ﺭ‬
‫ﺎ‬‫ﺈﻃ‬‫ﻳ ﺾﻛ‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻡﻋ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬.
6

Introduct i
on:
Anal teredl ev elofconsci ousness( LOC)isapparentinthepati
entwhoi snot
orient ed, doesnotf oll
owcommands, orneedspersistentst
imulit
oachi evea
stateofal ertness.Thel ev elofresponsiv
enessandconsci ousnessist hemost
i
mpor tanti ndicatorofthepat ient
'scondit
ion.
Lev elsofconsci ousness
Def inition:
Statesofar ousal andawar eness,rangi
ngf r
om f
ullyawakeandor ientedt o
one' senv ironmentt ocomat ose.
Alter edl ev elofconsci ousness
Def inition:
Condi ti
onofbei nglessr esponsi v
et oandlessawar eofenvir
onment al sti
muli
:‫ﺔ‬
‫ﻣ‬‫ﺪ‬‫ﻘ‬
‫ﻣ‬

137
 ‫ﻟﻰ‬‫ﺎﺝﺇ‬
‫ﺘ‬‫‪،‬ﻭﻳﺤ‬
‫ﺮﺃ‬ ‫ﻣ‬‫ﺍ‬‫ﻭ‬
‫ﺍﻷ‬‫ﻊ‬‫ﺒ‬‫ﺘ‬
‫‪،‬ﻭﻻﻳ‬‫ﻪﺃ‬ ‫ﻮﺟ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻳ ﺾﻏ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻟ‬‫(‬‫ﻋﻲ)‪LOC‬‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻣﻦ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻮﻯﻣ‬ ‫ﺘ‬‫ﺮﻣﺴ‬ ‫ﻬ‬
‫ﻳﻈ‬
‫ﺣﺔ‬
‫ﻟ‬
‫ﻠﻰ ﺎ‬‫ﺮﻋ‬
‫ﺆﺷ‬ ‫ﺃﻫﻢﻣ‬‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬‫ﻮﻯ‬‫ﺘ‬‫ﺮﻣﺴ‬‫ﺒ‬‫ﺘ‬
‫ﻌ‬‫‪.‬ﻳ‬‫ﺔ‬‫ﻘﻈ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔﻣﻦ‬
‫ﻟ‬‫ﻴﻖ ﺎ‬‫ﻘ‬
‫ﺘﺤ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﺍﺕﻣﺴ‬ ‫ﺰ‬‫ﻔ‬‫ﻣﺤ‬
‫‪.‬‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬
‫‪:‬‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫‪.‬‬‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻴ‬
‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺀﺇ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﻮﺑ‬‫ﺔﻧﺤ‬‫ﻬ‬
‫ﻮﺟ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻠ‬‫ﻣ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻘﻈ‬ ‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻣﻦ‬‫ً‬
‫ﺀ‬
‫ﺪ‬‫‪،‬ﺑ‬‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻘﻈ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺎﻻﺕ‬‫ﺣ‬
‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻋﻲ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﻣﺴ‬
‫‪:‬‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﺔ‬‫ﻴ‬
‫ﺌ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﺰ‬‫ﻔ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺑ‬
‫ً‬
‫ﻴ‬‫ﻗﻞﻭﻋ‬ ‫ﺃ‬
‫ﺔﻭ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬‫ﻗﻞ‬‫ﺃ‬‫ﻮﻥ‬‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﺮﻁ‬‫ﺷ‬

‫‪Al‬‬‫‪er‬‬‫‪t‬‬‫‪:‬‬
‫‪Thepat‬‬ ‫‪i‬‬‫‪entper‬‬ ‫‪cei‬‬ ‫‪v‬‬
‫‪est‬‬ ‫‪heenv‬‬ ‫‪i‬‬‫‪r‬‬‫‪onmentcl‬‬ ‫‪ear‬‬‫‪l‬‬‫‪yandr‬‬ ‫‪espondsqui‬‬ ‫‪ckl‬‬‫‪yand‬‬
‫‪appr‬‬‫‪opr‬‬ ‫‪i‬‬
‫‪at‬‬ ‫‪el‬‬‫‪yt‬‬ ‫‪ov‬‬ ‫‪i‬‬‫‪sual‬‬ ‫‪,‬‬‫‪audi‬‬‫‪t‬‬‫‪or‬‬‫‪y‬‬‫‪,‬‬ ‫‪andot‬‬ ‫‪hersensor‬‬ ‫‪yst‬‬ ‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬
‫‪.‬‬
‫‪Dr‬‬‫‪owsi‬‬ ‫‪ness:‬‬
‫‪Thepat‬‬ ‫‪i‬‬‫‪entdoesnotper‬‬ ‫‪cei‬‬‫‪v‬‬‫‪et‬‬ ‫‪heenv‬‬ ‫‪i‬‬
‫‪r‬‬‫‪onmentf‬‬ ‫‪ul‬‬‫‪l‬‬
‫‪yandr‬‬ ‫‪espondst‬‬ ‫‪ost‬‬ ‫‪i‬‬‫‪mul‬‬‫‪i‬‬
‫‪appr‬‬‫‪opr‬‬ ‫‪i‬‬
‫‪at‬‬ ‫‪el‬‬‫‪ybutsl‬‬ ‫‪owl‬‬‫‪yorwi‬‬ ‫‪t‬‬‫‪hdel‬‬ ‫‪ay‬‬‫‪.Mayber‬‬ ‫‪ousedbyv‬‬ ‫‪er‬‬‫‪bal‬‬ ‫‪st‬‬‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬ ‫‪butmay‬‬
‫‪i‬‬
‫‪gnor‬‬ ‫‪esomeoft‬‬ ‫‪hem.‬‬
‫‪Conf‬‬ ‫‪usi‬‬ ‫‪on:‬‬
‫‪Dr‬‬‫‪owsi‬‬ ‫‪nessi‬‬ ‫‪sof‬‬ ‫‪t‬‬ ‫‪enpr‬‬ ‫‪omi‬‬ ‫‪nentandaccompani‬‬ ‫‪edbydi‬‬ ‫‪sor‬‬‫‪i‬‬‫‪ent‬‬‫‪at‬‬‫‪i‬‬‫‪onpr‬‬ ‫‪i‬‬‫‪mar‬‬ ‫‪i‬‬‫‪l‬‬
‫‪yf‬‬ ‫‪or‬‬
‫‪t‬‬‫‪i‬‬
‫‪me,‬‬ ‫‪l‬‬
‫‪essof‬‬ ‫‪t‬‬‫‪enf‬‬ ‫‪orpl‬‬ ‫‪ace,‬‬‫‪andr‬‬ ‫‪ar‬‬‫‪el‬‬‫‪yf‬‬‫‪orsel‬‬ ‫‪f‬‬‫‪.‬‬
‫‪:‬‬‫ﺭ‬‫ﺍ‬‫ﺬ‬‫ﻧ‬
‫ﺇ‬
‫ﺎﻣﻦ‬ ‫ﺮﻫ‬‫ﻴ‬‫ﺔﻭﻏ‬ ‫ﻴ‬‫ﻌ‬‫ﻤ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻬ‬‫ﺒ‬
‫ﻨ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻜﻞﻣ‬ ‫ﺑﺸ‬‫ﺔﻭ‬ ‫ﺮﻋ‬‫ﻴﺐﺑﺴ‬ ‫ﺘﺠ‬‫ﻳﺴ‬‫ﻮﺡﻭ‬ ‫ﻮﺿ‬ ‫ﺔﺑ‬ ‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬‫ﺪ‬‫ﻳ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺰ‬‫ﻔ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬
‫‪:‬‬
‫ﺎﺱ‬ ‫ﻌ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﺭ‬
‫ﺎ‬‫ﺜ‬‫ﺪﺗ‬ ‫‪.‬ﻗ‬‫ﺮ‬‫ﻴ‬‫ﺄﺧ‬ ‫ﺘ‬‫ﻭﺑ‬ ‫ﺃ‬‫ﺀ‬‫ﺒﻂ‬ ‫ﻜﻦﺑ‬ ‫ﻟ‬
‫ﺎﺳﺐﻭ‬ ‫ﻨ‬‫ﻜﻞﻣ‬ ‫ﺍﺕﺑﺸ‬ ‫ﺮ‬‫ﻴ‬‫ﺜ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻴﺐ‬ ‫ﺘﺠ‬ ‫ﻳﺴ‬‫ﻣﻞﻭ‬‫ﺎ‬‫ﻜﻞﻛ‬ ‫ﺔﺑﺸ‬ ‫ﺌ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬‫ﺪ‬‫ﻻﻳ‬
‫‪.‬‬
‫ﺎ‬‫ﻬ‬‫ﻌﻀ‬ ‫ﺎﻫﻞﺑ‬ ‫ﺘﺠ‬‫ﺪﺗ‬‫ﻜﻦﻗ‬ ‫ﻟ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻔﻈ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻬ‬‫ﺒ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻋﻦﻃ‬
‫‪:‬‬
‫ﺎﻙ‬‫ﺒ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬
‫ﺎ‬‫ﺍﻣ‬‫ً‬
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻧ‬‫‪،‬ﻭ‬ ‫ﺎﻥ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻗﻞﻓﻲ‬ ‫ﺃ‬
‫‪،‬ﻭ‬ ‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺒﺐ‬ ‫ﻷﻝﺑﺴ‬‫ﺍﻭ‬ ‫ﻡ‬‫ﺎ‬‫ﻘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻙﻓﻲ‬ ‫ﺒ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﻪ‬‫ﺒ‬
‫ﺎﺣ‬‫ﻳﺼ‬‫ﺍﻭ‬ ‫ً‬
‫ﺯ‬‫ﺭ‬‫ﺎ‬
‫ﺎﺱﺑ‬ ‫ﻌ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫‪.‬‬‫ﺍﺕ‬ ‫ﺬ‬‫ﻠ‬
‫ﻟ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﻳ‬
‫‪St‬‬‫‪upor‬‬ ‫‪:‬‬
‫‪Thepat‬‬ ‫‪i‬‬‫‪enti‬‬ ‫‪sar‬‬ ‫‪ousedbyi‬‬ ‫‪nt‬‬‫‪ensest‬‬ ‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬‫‪onl‬‬ ‫‪y‬‬‫‪.Mot‬‬ ‫‪orr‬‬‫‪esponseandr‬‬ ‫‪ef‬‬‫‪l‬‬‫‪ex‬‬
‫‪r‬‬‫‪eact‬‬‫‪i‬‬‫‪onsar‬‬ ‫‪eusual‬‬ ‫‪l‬‬‫‪ypr‬‬ ‫‪eser‬‬‫‪v‬‬‫‪edunl‬‬ ‫‪esst‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪enti‬‬ ‫‪spar‬‬‫‪al‬‬‫‪y‬‬‫‪z‬‬‫‪ed.‬‬
‫‪Coma:‬‬
‫‪I‬‬‫‪sacl‬‬ ‫‪i‬‬‫‪ni‬‬‫‪cal‬‬ ‫‪st‬‬ ‫‪at‬‬‫‪eofunar‬‬ ‫‪ousabl‬‬ ‫‪eunr‬‬ ‫‪esponsi‬‬ ‫‪v‬‬‫‪enessi‬‬ ‫‪nwhi‬‬ ‫‪cht‬‬ ‫‪her‬‬‫‪ear‬‬ ‫‪eno‬‬
‫‪pur‬‬‫‪posef‬‬ ‫‪ul‬‬ ‫‪r‬‬‫‪esponsest‬‬ ‫‪oi‬‬‫‪nt‬‬‫‪er‬‬‫‪nal‬‬ ‫‪orext‬‬‫‪er‬‬‫‪nal‬‬ ‫‪st‬‬‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬
‫‪.‬‬
‫‪Aki‬‬‫‪net‬‬ ‫‪i‬‬‫‪cmut‬‬ ‫‪i‬‬
‫‪sm:‬‬
‫‪I‬‬‫‪sast‬‬ ‫‪at‬‬ ‫‪eofunr‬‬ ‫‪esponsi‬‬ ‫‪v‬‬‫‪enesst‬‬ ‫‪ot‬‬ ‫‪heenv‬‬ ‫‪i‬‬‫‪r‬‬‫‪onmenti‬‬ ‫‪nwhi‬‬ ‫‪cht‬‬ ‫‪hepat‬‬ ‫‪i‬‬‫‪entmakes‬‬
‫‪nomov‬‬ ‫‪ementorsoundbutsomet‬‬ ‫‪i‬‬
‫‪mesopenst‬‬ ‫‪heey‬‬ ‫‪es.‬‬
‫‪:‬‬
‫ﻮﻝ‬ ‫ﺫﻫ‬
‫ﺔ‬‫ﻴ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬ ‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺘﻢ‬ ‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬
‫‪.‬ﻋ‬ ‫ﻘﻂ‬ ‫ﺓﻓ‬ ‫ﺪ‬
‫ﻳ‬ ‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﺎﺕ‬‫ﻬ‬‫ﺒ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻣﻦﺧﻼﻝ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺭ‬
‫ﺎ‬‫ﺛ‬‫ﺘﻢﺇ‬‫ﻳ‬
‫‪.‬‬‫ﻠﻞ‬‫ﻟﺸ‬‫ﺎ‬‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻟﻢﻳﺼ‬ ‫ﺎ‬‫ﺔﻣ‬‫ﻴ‬‫ﺎﺳ‬‫ﻜ‬‫ﻌ‬ ‫ﻧ‬
‫ﺍﻻ‬ ‫ﻌﻞ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺩ‬‫ﺭ‬‫ﻭ‬
‫‪:‬‬
‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻴ‬‫ﻏ‬
‫ﺎﺕ‬ ‫ﻬ‬‫ﺒ‬
‫ﻨ‬‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻓ‬‫ﺩ‬‫ﺎ‬‫ﺎﺕﻫ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﺪ‬‫ﻮﺟ‬ ‫ﻴﺚﻻﺗ‬ ‫ﺭﺣ‬‫ﺍ‬‫ﺬ‬‫ﻧ‬‫ﻟﻺ‬‫ﺔ‬ ‫ﻠ‬
‫ﺑ‬‫ﺎ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺔﻏ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻡ‬‫ﺪ‬‫ﺔﻣﻦﻋ‬ ‫ﻳ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬ ‫ﺣﺔﺳ‬‫ﻟ‬
‫ﻫﻲ ﺎ‬
‫‪.‬‬‫ﺔ‬ ‫ﻴ‬
‫ﺭﺟ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫ﻛﻲ‬‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺮﺱ‬ ‫ﻟﺨ‬‫ﺍ‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﺃﺣ‬ ‫ﻪ‬ ‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﺘﺢﻋ‬ ‫ﻔ‬ ‫ﻮﺕﺑﻞﻳ‬ ‫ﻭﺻ‬ ‫ﺃ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺄﻱﺣ‬ ‫ﻳ ﺾﺑ‬‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬ ‫ﻘ‬
‫ﻴﺚﻻﻳ‬ ‫ﺔﺣ‬ ‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻭﺏﻣ‬ ‫ﺎ‬
‫ﺘﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﺣﺔﻣﻦﻋ‬ ‫ﻟ‬
‫ﻫﻲ ﺎ‬
‫‪Pat‬‬‫‪hophy‬‬ ‫‪si‬‬‫‪ol‬‬‫‪ogy‬‬ ‫‪:‬‬
‫‪-Al‬‬‫‪t‬‬‫‪er‬‬‫‪edLOCi‬‬ ‫‪sar‬‬ ‫‪esul‬‬‫‪tofmul‬‬ ‫‪t‬‬
‫‪i‬‬‫‪pl‬‬‫‪epat‬‬‫‪hophy‬‬ ‫‪si‬‬
‫‪ol‬‬‫‪ogi‬‬‫‪cphenomena.Thecause‬‬

‫‪138‬‬
maybeneur ologi c( headi njury ,stroke) ,toxi cologi c(dr ugov er dose, alcohol
i
nt oxicat ion),ormet abol ic( hepat icorr enal fail
ur e,diabet icket oaci dosi s) .
-Theunder l
yingcauseofneur ologi cdy sf unct ioni sdi srupt i
oni nt hecel lsoft he
ner voussy stem, neur ot ransmi tter s,orbr ainanat omy .
-Adi srupt i
oni nt hebasi cf unct ional uni ts( neur ons)orneur ot ransmi t
t ers
resul tsinf aultyi mpul set ransmi ssi on, impedi ngcommuni cationwi thint hebr ain
orf rom t hebr ai nt oot herpar t soft hebody .
‫ﺔ‬ ‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬:
-‫ﺘﺞ‬ ‫ﻨ‬‫ﻳ‬LOC‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬ )‫ﺎ‬ً
‫ﻴ‬‫ﺒ‬‫ﺒﺐﻋﺼ‬ ‫ﻟﺴ‬ ‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬ ‫ﺪﻳ‬‫ﻗ‬. ‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﺔﻣ‬ ‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﺮﻓ‬ ‫ﺍﻫ‬‫ﻮ‬ ‫ﺓﻇ‬ ‫ﺪ‬‫ﺮﻋﻦﻋ‬ ‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬،
‫ﻭ‬‫ﺃ‬‫ﺪﻱ‬ ‫ﺒ‬‫ﻓﺸﻞﻛ‬ )‫ﻼﻲ‬ ‫ﻘﺑ‬ ‫ﺘ‬‫ﺍﺳ‬ ‫ﻭ‬،‫(ﺃ‬ ‫ﻮﻝ‬ ‫ﻜﺤ‬ ‫ﻟ‬‫ﺎ‬‫ﻤﻢﺑ‬ ‫ﺗﺴ‬، ‫ﺍﺕ‬‫ﺭ‬ ‫ﺪ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺪ‬ ‫ﺋ‬‫ﺍ‬
‫ﺔﺯ‬ ‫ﻋ‬‫ﺮ‬‫ﻡ)ﺟ‬ ‫ﻮ‬‫ﻤ‬‫ﺳ‬، (‫ﺔ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﺘ‬‫ﻜ‬‫ﺳ‬
‫ﺮﻱ‬‫ﻜ‬‫ﻧﻲﺳ‬ ‫ﻮ‬‫ﺘ‬‫ﻴ‬‫ﺎ ﺽﻛ‬ ‫ﻤ‬‫ﺣ‬، ‫ﻮﻱ‬‫ﻠ‬‫ﻛ‬).
-‫ﻗﻼﺕ‬ ‫ﺎ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺒﻲ‬ ‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺯ‬ ‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺍﺏﻓﻲﺧﻼ‬ ‫ﺮ‬ ‫ﺍﺿﻄ‬ ‫ﻮ‬ ‫ﺒﻲﻫ‬ ‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﻲ‬ ‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻞ‬‫ﻟﺨ‬ ‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺭ‬
‫ﻣﻦﻭ‬ ‫ﺎ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﻟﺴ‬‫ﺍ‬
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺢ‬‫ﺮ‬‫ﻭﺗﺸ‬ ‫ﺃ‬‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬.
-‫ﻠﻞ‬ ‫ﻟﻰﺧ‬ ‫ﺔﺇ‬ ‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻗﻼﺕ‬ ‫ﺎ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫(ﻭ‬‫ﺔﺃ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬ ‫ﺍ‬)‫ﺔ‬ ‫ﻴ‬‫ﺎﺳ‬ ‫ﺍﻷﺳ‬ ‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺪ‬‫ﻮﺣ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻞﻓﻲ‬ ‫ﻭﺙﺧ‬ ‫ﺪ‬‫ﺩﻱﺣ‬ ‫ﺆ‬ ‫ﻳ‬
‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺮﻯﻣﻦ‬ ‫ﺃﺧ‬ ‫ﺀ‬‫ﺍ‬‫ﺰ‬‫ﺃﺟ‬ ‫ﻟﻰ‬ ‫ﺎﻍﺇ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭﻣﻦ‬ ‫ﺃ‬ ‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﺎﻝﺩ‬‫ﻻﺼ‬ ‫ﺍﺗ‬ ‫ﻴﻖ‬‫ﻌ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ‫ﺎﺕ‬‫ﺒﻀ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬ ‫ﻘﻞ‬‫ﻓﻲﻧ‬ .
-Thesedi srupt ionsar ecausedbycel l
ul aredemaorot hermechani sms, suchas
disrupt ionofchemi cal transmi ssionatr ecept orsi tesbyant i
bodi es.
-Intactanat omi cst ruct uresoft hebr ainar eneededf ornor mal funct i
on.
-Thet wohemi spher esoft hecer ebr um mustcommuni cate, viaani ntact
cor puscal l
osum, andt hel obesoft hebr ain( front al
,par ietal,tempor al, and
occi pital)mustcommuni cat eandcoor dinat et hei rspeci fi
cf unct i
ons.
-Addi t
ional anat omi cst ruct ur esofi mpor tancear ethecer ebel l
um andt hebr ain
stem.Thecer ebel lum i sl argel yr esponsi blef orcoor dinat i
onofmov ement .The
brainst em cont ainsar east hatcont r
ol thehear t
, respiration, andbl oodpr essur e.
-Di srupt i
onsi nt heanat omi cst r
uct ur esar ecausedbyt rauma, edema, pr essur e
from t umor s,orot hermechani sms, suchasani ncreaseordecr easei nt he
circulat i
onofbl oodorcer ebrospi nal fluid( CSF) .

‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻴ‬
‫ﻤ‬‫ﻴ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﻘ‬‫ﺘ‬‫ﻧ‬‫ﺍ‬‫ﻴﻞ‬‫ﻌﻄ‬ ‫ﺜﻞﺗ‬‫ﻣ‬، ‫ﺮﻯ‬‫ﺃﺧ‬ ‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬‫ﺁ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﺎﺕﺑﺴ‬‫ﺑ‬‫ﺍ‬‫ﺮ‬
‫ﺍﻻﺿﻄ‬ ‫ﻩ‬
‫ﺬ‬‫ﺪﺙﻫ‬ ‫ﺗﺤ‬-
.‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺍﻷﺟﺴ‬ ‫ﺔ‬‫ﺍﺳﻄ‬‫ﻮ‬‫ﺒﻼﺕﺑ‬ ‫ﻘ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬‫ﻮ‬
‫ﻓﻲﻣ‬
.‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬ ‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﺎﻍ ﺿ‬‫ﻣ‬‫ﺪ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻤ‬‫ﻴ‬‫ﻠ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻳﺤ‬‫ﺮ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬‫ﺍ‬
-
‫ﺎﻍ‬
‫ﻣ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻮﺹ‬ ‫ﺍﺻﻞﻓﺼ‬ ‫ﻮ‬‫ﺘ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬ ‫ﻭ‬،‫ﻴﻢ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﻨﻲ‬‫ﻔ‬‫ﺜ‬‫ﻟ‬‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺮ‬‫ﺒ‬‫ﺔﻋ‬‫ﻴ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﻲ‬‫ﺍﺻﻞﻧﺼ‬ ‫ﻮ‬‫ﺘ‬
‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬-
.‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻬﻢ‬‫ﻔ‬‫ﺋ‬‫ﺎ‬
‫ﻴﻖﻭﻇ‬ ‫ﻨﺴ‬ ‫ﺗ‬
‫(ﻭ‬‫ﻟﻲ‬‫ﺍ‬‫ﺬ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻨﻲﻭ‬ ‫ﻣ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻱﻭ‬ ‫ﺍ‬
‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻬﻲﻭ‬ ‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬
)
‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﺪﻛ‬ ‫ﻟﻰﺣ‬ ‫ﻭﻝﺇ‬‫ﺆ‬‫ﻴﺦﻣﺴ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬ ‫ﻴﺦﻭﺟ‬ ‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻫﻲ‬ ‫ﻴ‬‫ﻤ‬
‫ﺍﻷﻫ‬ ‫ﺍﺕ‬‫ﺔﺫ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﺍﻹﺿ‬ ‫ﺔ‬‫ﻴ‬‫ﻳﺤ‬‫ﺮ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬‫ﺍ‬
-
.‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﻔﺲﻭﺿ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬‫ﺎﻃﻖﺗ‬ ‫ﻨ‬
‫ﻠﻰﻣ‬‫ﺎﻍﻋ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﻮﻱﺟ‬ ‫ﺘ‬
‫ﻳﺤ‬. ‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻴﻖ‬‫ﻨﺴ‬‫ﻋﻦﺗ‬
‫ﻭ‬،
‫ﻡﺃ‬ ‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﻣﺍﻷ‬
‫ﻐﻂ ﻦ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﻭ‬،
‫ﺔﺃ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬،
‫ﺔﺃ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺒﺐ‬ ‫ﺔﺑﺴ‬‫ﻴ‬‫ﻳﺤ‬‫ﺮ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬ ‫ﺪﺙ‬‫ﺗﺤ‬-
.
(CSF)‫ﺎﻋﻲ‬ ‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻘﺼ‬‫ﻭﻧ‬‫ﺃ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺜﻞﺯ‬‫ﻣ‬،‫ﺮﻯ‬‫ﺃﺧ‬‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬‫ﺁ‬
Cli
nicalMani festations:
1.Thepat ient'
sst ateofal ert
nessandconsci ousnessdecr eases
2.Changesi npupi l
laryresponse.
3.Changesi neyeopeni ngr esponse.
4.Changesi nverbal r
esponse
5.Changesi nmot orr esponse.
6.Ini
ti
al alt
erati
onsi nLOCmayber eflectedby :
a.Subtlebehav ioral changes, suchasr estlessnessori ncreasedanxi ety.
7.Pupilresponset ol i
ghti sslow.
8.Ast hepat i
entbecomescomat ose, t
hepupi l
sbecomef i
xed( nor esponseto
l
ight).

139
9.Thepat ientinacomadoesnotopent heey es, r
espondv erbal l
y ,ormov et he
ext r
emit i
esi nresponset oar equestt odoso.
:‫ﺔ‬‫ﻣ‬ ‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬ ‫ﺍﻻ‬
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪﻯ‬‫ﻟ‬‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻘﻈ‬ ‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻘﻞ ﺎ‬ ‫ﺗ‬.1
.‫ﺔ‬‫ﻗ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬ ‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.2
.‫ﻴﻦ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺘﺢ‬‫ﺔﻓ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬ ‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.3
‫ﺔ‬ ‫ﻴ‬‫ﻔﻈ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﻻﺳ‬ ‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.4
.‫ﺮﻙ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.5
:
‫ﻣﻦﺧﻼﻝ‬LOC‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﻳﻼﺕ‬ ‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻜﺲ‬ ‫ﻌ‬‫ﻨ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.6
.‫ﺪ‬‫ﻳ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻖ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻷﻕ‬‫ﺍﺭ‬ ‫ﺜﻞ‬‫ﻣ‬،‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﺔﻃ‬ ‫ﻴ‬‫ﻛ‬‫ﻮ‬ ‫ﻠ‬
‫ﺍﺕﺳ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬.‫ﺃ‬
.‫ﺔ‬ ‫ﺌ‬
‫ﻴ‬‫ﺀﺑﻄ‬‫ﻮ‬‫ﻠﻀ‬ ‫ﻟ‬‫ﺬ‬ ‫ﻴ‬‫ﻤ‬‫ﻠ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬.7
.(
‫ﺀ‬ ‫ﻮ‬‫ﻠﻀ‬‫ﻟ‬‫ﻮﻥ‬‫ﺒ‬‫ﻴ‬‫ﺘﺠ‬‫ﻮﻥ)ﻻﻳﺴ‬ ‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺬﺛ‬ ‫ﻴ‬‫ﻣ‬‫ﺘﻼ‬‫ﻟ‬‫ﺍ‬‫ﺒﺢ‬‫ﻳﺼ‬، ‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻴ‬‫ﻳ ﺾﻓﻲﻏ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﺎﻳﺼ‬‫ﻣ‬ ‫ﺪ‬‫ﻨ‬‫ﻋ‬.8
.‫ﻟﻚ‬‫ﺬ‬‫ﻪﺑ‬ ‫ﺒ‬‫ﻠ‬‫ﻟﻄ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬‫ﺍﻑ‬ ‫ﺮ‬
‫ﺍﻷﻃ‬ ‫ﺮﻙ‬ ‫ﺎﻭﻻﻳﺤ‬ ‫ﻴ‬‫ﻔﻈ‬‫ﻟ‬ ‫ﻴﺐ‬‫ﺘﺠ‬ ‫ﻪﻭﻻﻳﺴ‬ ‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﺔﻋ‬ ‫ﺑ‬‫ﻮ‬‫ﺒ‬
‫ﻴ‬‫ﻳ ﺾﻓﻲﻏ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺘﺢ‬‫ﻔ‬‫ﻻﻳ‬. 9
AssessmentandDi agnost icFindings:
Acompl eteassessmenti sper formed, wi thpar t
icularat tenti
ont ot heneur ologic
sy st
em.
1.Lev elofconsci ousness, asensi tiveindi catorofneur ologicfunct ion, i
s
assessedbasedont hecr i
teri
ai nt heGl asgowComaScal e:eyeopeni ng, verbal
response, andmot orresponse.Thepat i
ent '
sr esponsesar eratedonascal e
from 3t o15.Ascor eof3i ndicatessev ereimpai rmentofneur ologi cf unction,
orbr ai
ndeat h.Ascor eof15i ndicatest hatt hepat i
enti sfull
yor ient ed.
2.Ment al status
3.Cr anial nervef unction
4.Cer ebel larfunct i
on( balanceandcoor dinati
on)
5.Ref l
exes
6.Mot orf unction.
7.Sensor yf unction.
:
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻧ‬
.‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻠﺠ‬‫ﻟ‬‫ﺎﺹ‬ ‫ﻡﺧ‬ ‫ﺎ‬‫ﻤ‬‫ﺘ‬‫ﺍﻫ‬‫ﺀ‬ ‫ﺇﻼ‬
‫ﻊﻳ‬ ‫ﻣ‬، ‫ﻣﻞ‬‫ﺎ‬‫ﻴﻢﻛ‬ ‫ﻴ‬
‫ﻘ‬‫ﺀﺗ‬‫ﺍ‬‫ﺮ‬‫ﺘﻢﺇﺟ‬ ‫ﻳ‬
‫ﺎﺱﻏﻼ‬ ‫ﻴ‬‫ﻘ‬ ‫ﺮﻓﻲﻣ‬ ‫ﻴ‬
‫ﻳ‬‫ﺎ‬
‫ﻌ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺀﻋ‬ً‫ﺎ‬
‫ﻨ‬‫ﺑ‬، ‫ﺔ‬
‫ﻴ‬ ‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻮﻇ‬ ‫ﻠ‬‫ﻟ‬‫ﺎﺱ‬ ‫ﺮﺣﺴ‬ ‫ﺆﺷ‬ ‫ﻮﻣ‬ ‫ﻭﻫ‬، ‫ﻮﻋﻲ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬ ‫ﻴﻢﻣﺴ‬ ‫ﻴ‬‫ﻘ‬
‫ﺘﻢﺗ‬ ‫ﻳ‬.1
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﻴﻒ‬ ‫ﻨ‬‫ﺘﻢﺗﺼ‬ ‫ﻳ‬.‫ﺔ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﻻﺳ‬‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﻔﻈ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﻻﺳ‬ ‫ﻭ‬،‫ﻴﻦ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺘﺢ‬ ‫ﻓ‬:‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﺒ‬‫ﻴ‬‫ﻐ‬‫ﻠ‬‫ﻟ‬‫ﻮ‬‫ﻜ‬‫ﺳ‬
.‫ﺎﻏﻲ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﺕ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬،
‫ﺔﺃ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪﻓﻲ‬ ‫ﻳ‬‫ﺪ‬‫ﻌﻒﺷ‬ ‫ﻟﻰ ﺿ‬ ‫ﺇ‬3‫ﺔ‬‫ﺭﺟ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺗﺸ‬.15‫ﻟﻰ‬ ‫ﺇ‬3‫ﺎﺱﻣﻦ‬ ‫ﻴ‬‫ﻘ‬‫ﻠﻰﻣ‬ ‫ﻋ‬
.‫ﻣﻞ‬‫ﺎ‬‫ﻜﻞﻛ‬‫ﻪﺑﺸ‬ ‫ﺘﺠ‬ ‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺃﻥ‬ ‫ﻟﻰ‬‫ﺇ‬15‫ﺔ‬ ‫ﺭﺟ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺗﺸ‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻘ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬.2
‫ﻔﻲ‬ ‫ﻘﺤ‬‫ﻟ‬‫ﺍ‬ ‫ﻌﺼﺐ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻭﻇ‬. 3
(‫ﻴﻖ‬ ‫ﻨﺴ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺯﻥﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬)‫ﻴﺦ‬ ‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻭﻇ‬. 4
‫ﻌﻞ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺩ‬‫ﺭ‬.5
.‫ﺮﻙ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻭﻇ‬. 6
.‫ﺔ‬‫ﻴ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬.7

Commondi agnost i
cpr oceduresusedtoi
dent
if
ythecauseof
unconsciousnessi nclude:
1.Comput edt omography( CT)scanni
ng
2.Magnet i
cr esonancei maging(MRI)
3.El
ectroencephalogr aphy.
Laborat
or ytestsinclude:
1.Analy
sisofbl oodgl ucose
2.El
ectrolyt
es
3.Serum ammoni a

140
4.Liverf unct iont est s
5.Bloodur eani trogenl ev els
6.Serum osmol ali
ty
7.Calcium l ev el
8.Prothr ombi nt ime.
9.Serum ket ones, alcohol anddr ugconcent rations.
10.Ar t
er i
al bl oodgases.
:‫ﻠﻲ‬‫ﺎﻳ‬ ‫ﻋﻲﻣ‬ ‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﺒﺐﻓ‬ ‫ﺪﺳ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺸ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺀ‬‫ﺍ‬
‫ﺮ‬ ‫ﻤﻞﺇﺟ‬‫ﺗﺸ‬
(CT)‫ﻮﺳﺐ‬ ‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﻌﻲ‬ ‫ﻘﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬ ‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬.
1
(MRI )‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺮﺑ‬‫ﻳ‬ ‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬.
2
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻴﻂﻛ‬ ‫ﺗﺨﻄ‬.3
:
‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬ ‫ﻤﻞ‬‫ﺗﺸ‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻴﻞﺟ‬ ‫ﻠ‬
‫ﺗﺤ‬.1
‫ﺀ‬‫ﺎ‬‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﻨﺤﻼﺕﺑ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬.
2
‫ﺎ‬‫ﻴ‬
‫ﻧ‬‫ﻮ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﻣﺼﻞ‬. 3
‫ﺪ‬ ‫ﺒ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺋﻒ‬ ‫ﺎ‬
‫ﺍﺕﻭﻇ‬ ‫ﺭ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺧ‬ .
4
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﻓﻲ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬‫ﻴ‬‫ﺎﺕﻧ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬.5
‫ﻤﺼﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻮ‬‫ﻤ‬‫ﺍﻷﺳ‬ .
6
‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬‫ﻣﺴ‬.7
.‫ﻴﻦ‬‫ﺒ‬‫ﻣ‬‫ﻭ‬‫ﺮ‬‫ﺛ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬‫ﺯ‬.8
.‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬‫ﻤﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺰ‬
‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺗ‬‫ﻮﻝﻭ‬ ‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﺼﻞﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬‫ﻮ‬‫ﺘ‬‫ﻴ‬
‫ﻛ‬.9
.‫ﻧﻲ‬ ‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺯ‬
‫ﺎ‬‫ﻏ‬.10
Compl icat ions:
Potential compl i
cat ionsf ort hepat i
entwi thal teredLOCi nclude:
1.Respi rat oryf ailur e
Itmaydev elopshor tlyaf tert hepat i
entbecomesunconsci ous.I ft hepat ient
cannotmai ntai nef fect i
ver espirati
ons, insertionofanai rwayormechani cal
venti
lationi si nitiatedt opr ov ideadequat event il
at i
onandpr otectt heai rway .
2.Pneumoni a
Iti
scommoni npat ientsr ecei vi
ngmechani cal vent i
l
ationori nt hosewho
cannotmai ntai nandcl eart heai rway .
3.Compl icat ionsassoci atedwi thimmobi li
ty
Thepat ientwi thalt eredLOCi ssubjectt oall thecompl icati
onsassoci atedwi th
i
mmobi litysuchas: pressur eulcers,v enousst asis,muscul oskel etal
deteri
orat ion, anddi sturbedgast r
ointest i
nalfunct ioning.Pressur eul cersmay
becomei nfect edandser v easasour ceofsepsi s.
4.Aspir ation
Aspirati
onofgast riccont ent sorf eedingsmayoccur ,precipitatingt he
developmentofaspi rationpneumoni aorai rwayoccl usion.

:‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬
:‫ﻠﻲ‬‫ﺎﻳ‬L
‫ ﻣ‬OC‫ﺮﻓﻲ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﻧﻲﻣﻦﺗ‬‫ﺎ‬‫ﻌ‬
‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻠ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬
‫ﻔﺴﻲ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻓﺸﻞ‬. 1
‫ﻔﺲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬
‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻳ ﺾﻣﻦ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬
‫ﻟﻢﻳ‬‫ﺍ‬‫ﺫ‬
‫ﺇ‬.‫ﻮﻋﻲ‬‫ﻠ‬‫ﻟ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺓﻣﻦﻓ‬‫ﺰ‬‫ﻴ‬
‫ﺓﻭﺟ‬ ‫ﺮ‬
‫ﺘ‬‫ﺪﻓ‬ ‫ﻌ‬‫ﺭﺑ‬‫ﻮ‬
‫ﺘﻄ‬ ‫ﺪﻳ‬‫ﻗ‬
.
‫ﺀ‬ ‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺔﻭﺣ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﺔﻛ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺮﺗ‬
‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻜ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻴ‬‫ﺔﻣ‬‫ﻳ‬‫ﻮ‬
‫ﻬ‬‫ﻭﺗ‬‫ﺃ‬‫ﺋﻲ‬
‫ﺍ‬‫ﻮ‬‫ﺮﻯﻫ‬‫ﺎﻝﻣﺠ‬‫ﺩﺧ‬‫ﺀﺇ‬‫ﺪ‬‫ﺘﻢﺑ‬‫ﻳ‬،‫ﺎ‬
‫ﻌﻝ‬ ‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﻮﻱ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬.2
‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﻥ‬‫ﻌ‬
‫ﻴ‬‫ﺘﻄ‬‫ﻳﻦﻻﻳﺴ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺌﻚ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﻭﻓﻲ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻴ‬‫ﺔﻣ‬‫ﻳ‬
‫ﻮ‬‫ﻬ‬‫ﻮﻥﺗ‬‫ﻘ‬‫ﻠ‬
‫ﺘ‬‫ﻳﻦﻳ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊﻓﻲ‬ ‫ﺋ‬
‫ﺎ‬‫ﻪﺷ‬ ‫ﻧ‬
‫ﺇ‬
.
‫ﻪ‬‫ﻔ‬‫ﻴ‬
‫ﻨﻈ‬‫ﺗ‬‫ﺀﻭ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬ ‫ﻣﺠ‬
‫ﺩ‬‫ﻮ‬
‫ﻤ‬‫ﻟﺠ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺒﻄ‬‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬
‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬.3

141
 ‫ﺎﺕ‬ ‫ﺮﺣ‬ ‫ﻘ‬ ‫ﺗ‬:‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﺒﻄ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻴ‬‫ﻤ‬‫ﻟﺠ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ LOC‫ﺎـ‬ ‫ﺎﺏﺑﻝ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻳﺨﻀ‬
‫ﺎﺏ‬ ‫ﺪﺗﺼ‬ ‫ﻗ‬. ‫ﻤﻲ‬ ‫ﻬﻀ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﺋﻒ‬ ‫ﺎ‬
‫ﺍﺏﻭﻇ‬ ‫ﺮ‬ ‫ﺍﺿﻄ‬ ‫ﻭ‬، ‫ﻠﻲ‬‫ﻜ‬ ‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻲ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺪﻫ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺪﻱ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬ ‫ﻛ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬
.‫ﺎﻥ‬‫ﺘ‬‫ﻧ‬‫ﻟﻺ‬ ‫ﺭ‬‫ﺪ‬‫ﺔﻣﺼ‬ ‫ﺑ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻮﻥﺑ‬ ‫ﻜ‬ ‫ﺗ‬‫ﻭﻯﻭ‬ ‫ﺪ‬‫ﻌ‬ ‫ﻟ‬‫ﺎ‬
‫ﻐﻂﺑ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺮﺡ‬‫ﻗ‬
‫ﻮﺡ‬ ‫ﻤ‬ ‫ﻟﻄ‬‫ﺍ‬.4
‫ﻭ‬‫ﺃ‬ ‫ﻔﺴﻲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻱ‬ ‫ﺋ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬‫ﺭ‬‫ﻮ‬‫ﻟﻰﺗﻄ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ‫ﺔ‬ ‫ﺎﻋ‬‫ﺮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺓ‬
‫ﺪ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻔﻂﻣﻦﻣﺤ‬ ‫ﺪﺙﺷ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬
.
‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺩﻣﺠ‬ ‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬
Medi cal Management :
Prior i
t i
esoft r
eat mentf orpat ientwi thal ter edLOC:
1.Obt ai nandmai nt ainapat entai rway .Thepat i
entmaybeor al l
yornasal ly
i
ntubat ed, orat racheost omymaybeper for med.Unt il t
heabi lityoft hepat ient
tobr eat heonhi sorherowni sdet ermi ned, amechani cal vent ilatori susedt o
mai nt ainadequat eoxy genat ionandv ent i
lat i
on.
2.Theci rcul atoryst atus( bloodpr essur e, hear tr ate)i smoni tor edt oensur e
adequat eper fusiont ot hebodyandbr ain.
3.Ani ntrav enous( IV)cat heteri si nser tedt opr ov ideaccessf orI Vf luidsand
medi cat ions.
4.Neur ologi ccar ef ocusesont hespeci f
icneur ologicpat hology ,ifknown.
5.Nut ritional suppor t,viaaf eedi ngt ubeoragast rost omyt ube, isini ti
atedas
soonaspossi ble.
6.Measur esdesi gnedt odet er mi neandt reatt heunder l
yingcausesofal ter ed
LOC.
7.Ot hermedi cal int ervent i
onsar eai medatphar macol ogicmanagementand
prev ent ionofcompl ications.
:
‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
:LOC‫ﺮ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﻊﺗ‬ ‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻳ‬‫ﻮ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬
‫ﻭ‬،‫ﻷﻒﺃ‬ ‫ﺃﺍﻧ‬ ‫ﻔﻢﻭ‬ ‫ﻟ‬‫ﺍ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﻳ ﺾﻋﻦﻃ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬ ‫ﺒ‬‫ﻨ‬‫ﺘﻢﺗ‬ ‫ﺪﻳ‬ ‫ﻗ‬. ‫ﻪ‬‫ﻴ‬‫ﻠ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﺋﻲﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﻠﻚﻫ‬ ‫ﻠﻰﻣﺴ‬ ‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬.1
‫ﺘﻢ‬ ‫ﻳ‬، ‫ﻪ‬‫ﻔﺴ‬ ‫ﺀﻧ‬ ‫ﺎ‬‫ﻘ‬‫ﻠ‬
‫ﻔﺲﻣﻦﺗ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺪ‬ ‫ﺪﻗ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﻢﺗﺤ‬ ‫ﺘﻰﻳ‬ ‫ﺣ‬. ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻮ‬ ‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺒ‬‫ﻘﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻐ‬‫ﺀﻓ‬‫ﺍ‬‫ﺮ‬‫ﻜﻦﺇﺟ‬ ‫ﻤ‬‫ﻳ‬
.‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﻛﺴﺠ‬ ‫ﻭ‬ ‫ﺍﻷ‬‫ﻠﻰ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻠﺤ‬ ‫ﻟ‬‫ﻋﻲ‬ ‫ﺎ‬‫ﻨ‬
‫ﻟﺼ‬ ‫ﺍ‬ ‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻡﺟ‬ ‫ﺍ‬‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬
‫ﻠﺠﺴﻢﻭ‬ ‫ﻟ‬ ‫ﺔ‬‫ﻴ‬‫ﻓ‬ ‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻤ‬‫ﻟﻀ‬ (‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﺑ‬‫ﺮ‬‫ﺪﻝ ﺿ‬ ‫ﻌ‬‫ﻣ‬، ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﺔ)ﺿ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺔﺎ‬ ‫ﺒ‬
‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺘﻢﻣ‬ ‫ﻳ‬.2
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﻟﻰ‬‫ﻮﻝﺇ‬ ‫ﻮﺻ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺎﺣ‬ ‫ﺗ‬
‫(ﻹ‬ IV)‫ﺔ‬ ‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﺎﻝﻗﺴﻄ‬ ‫ﺩﺧ‬ ‫ﺘﻢﺇ‬ ‫ﻳ‬.3
.‫ﺎ‬
ً
‫ﻓ‬‫ﻭ‬ ‫ﺮ‬
‫ﻌ‬‫ﺎﻥﻣ‬ ‫ﺍﻛ‬ ‫ﺫ‬‫ﺇ‬، ‫ﺩ‬‫ﺪ‬‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬ ‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﻠﻢ‬‫ﻠﻰﻋ‬ ‫ﺔﻋ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬ ‫ﺰ‬‫ﻛ‬‫ﺮ‬‫ﺗ‬.4
.‫ﻜﻦ‬ ‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬ ‫ﺃﺳ‬ ‫ﺃﻓﻲ‬ ‫ﺪ‬‫ﺒ‬‫ﻳ‬، ‫ﺓ‬‫ﺪ‬‫ﻌ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﺏ‬ ‫ﺒ‬‫ﻧ‬‫ﺃ‬‫ﻭ‬‫ﺃ‬ ‫ﺔ‬
‫ﻳ‬ ‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬ ‫ﺒ‬
‫ﻧ‬‫ﺃ‬ ‫ﺮ‬‫ﺒ‬‫ﻋ‬، ‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬
‫ﺍ‬.5
.LOC‫ﺮ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬ ‫ﺀﺗ‬‫ﺍ‬‫ﺭ‬‫ﺔﻭ‬ ‫ﻨ‬
‫ﻣ‬‫ﺎ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﺒ‬‫ﺍﻷﺳ‬ ‫ﺔ‬
‫ﻟﺠ‬ ‫ﺎ‬
‫ﻌ‬‫ﻣ‬ ‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬ ‫ﻟ‬‫ﺔ‬ ‫ﻤ‬
‫ﻤ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬‫ﺍ‬‫ﺪ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬.6
.
‫ﺎﺕ‬ ‫ﻔ‬
‫ﺎﻋ‬ ‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬ ‫ﻟﻰ‬‫ﺮﻯﺇ‬‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻑ‬ ‫ﻬ‬‫ﺗ‬.7
Nur si ngPr ocess:
ThePat i
entwi thanAl teredLev el ofConsci ousness
Assessment :
1.Det er mi ningt hepat i
ent '
sor ient ationt ot ime, per son, andpl ace.
2.Assessv er bal r esponse.( Ver bal responsecannotbeev aluat edi ft hepat ient
i
si nt ubat edorhasat racheost omy ,
andt hisshoul dbecl ear l
ydocument ed. )
3.Al er tnessi smeasur edbyt hepat i
ent '
sabi li
tyt oopent heey esspont aneousl y
orinr esponset oav ocal ornox iousst i
mul us( pr essur eorpai n) .Pat ientswi th
sev er eneur ologi cdy sfunct i
oncannotdot hi s.Assessef orper iorbital edema
(swel l
ingar oundt heey es)ort rauma, whi chmaypr ev entt hepat i
entf r
om
openi ngt heey es, anddocument sanysuchcondi tiont hati nter fereswi they e
openi ng.
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻋ‬
‫ﻋﻲ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻮﻯﻣ‬ ‫ﺘ‬‫ﻤﺴ‬‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

142
 ‫‪:‬‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
‫‪.‬‬
‫ﺎﻥ‬ ‫ﻜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﺸﺨ ﺺﻭ‬ ‫ﺍ‬‫ﺎﻥﻭ‬‫ﻣ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻳ ﺾﻧﺤ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻮﺟ‬‫ﺪﺗ‬‫ﻳ‬‫ﺪ‬‫‪.‬ﺗﺤ‬
‫‪1‬‬
‫ﺎﻥ‬‫ﻭﻛ‬‫ﺃ‬‫ﻮﺏ‬ ‫ﺒ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻳ ﺾﺗﺤﺖ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬
‫ﺫ‬‫ﺔﺇ‬‫ﻴ‬‫ﻔﻈ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﻜﻦﺗ‬‫ﻤ‬‫‪).‬ﻻﻳ‬‫ﺔ‬‫ﻴ‬‫ﻔﻈ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬‫ﻴﻢ‬
‫ﻴ‬‫ﻘ‬‫‪.‬ﺗ‬
‫‪2‬‬
‫‪.‬‬‫(‬
‫ﻮﺡ‬‫ﻮﺿ‬ ‫ﻟﻚﺑ‬‫ﻴﻖﺫ‬ ‫ﺛ‬
‫ﻮ‬‫ﻳﺠﺐﺗ‬ ‫‪،‬ﻭ‬ ‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﻮ‬ ‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻘﺐﻓﻲ‬‫ﻪﺛ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟ‬
‫‪.‬‬‫ﺃ(‬
‫ﻭﻟﻢ‬ ‫ﺃ‬
‫ﻐﻂ‬ ‫ﺫ)ﺿ‬‫ٍ‬
‫ﺆ‬ ‫ﻭﻣ‬‫ﺃ‬‫ﺗﻲ‬
‫ﻮ‬‫ﺮﺻ‬ ‫ﻴ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﻭ‬‫ﺃ‬‫ﺎ‬‫ً‬
‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻘ‬
‫ﻠ‬‫ﻪﺗ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﺘﺢﻋ‬ ‫ﻠﻰﻓ‬‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﺔﺑ‬‫ﻘﻈ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬‫ﻘ‬‫‪ُ.‬‬
‫ﻳ‬‫‪3‬‬
‫ﺔ‬
‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫‪.‬ﻗﻢﺑ‬‫ﻟﻚ‬‫ﺬ‬‫ﻡﺑ‬‫ﺎ‬
‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻬﻢ‬
‫ﻨ‬‫ﻜ‬‫ﻤ‬‫ﺒﻲﻻﻳ‬ ‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺪﻓﻲ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌﻒﺷ‬ ‫ﻮﻥﻣﻦ ﺿ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺣﺔ‬
‫ﻟ‬
‫ﺃﻱ ﺎ‬‫ﻴﻖ‬‫ﺛ‬‫ﻮ‬‫ﺗ‬
‫‪،‬ﻭ‬ ‫ﻴﻦ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺘﺢ‬‫ﻳ ﺾﻣﻦﻓ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬
‫ﺪﺗ‬ ‫ﺘﻲﻗ‬‫ﻟ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫(ﻭ‬
‫ﻴﻦﺃ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬ ‫ﻡﺣ‬‫ﺭ‬‫ﻮ‬‫ﺗ‬‫ﺎﺝ)‬
‫ﻟﺤﺠ‬‫ﺍ‬‫ﻮﻝ‬‫ﺣ‬
‫‪.‬‬
‫ﻴﻦ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺘﺢ‬‫ﻊﻓ‬ ‫ﺭ ﺽﻣ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﻴﻞﺗ‬‫ﺒ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻣﻦﻫ‬

‫‪4.Mot‬‬ ‫‪orr‬‬‫‪esponsei‬‬ ‫‪ncl‬‬‫‪udesspont‬‬ ‫‪aneous,‬‬ ‫‪pur‬‬‫‪posef‬‬ ‫‪ul‬‬‫‪mov‬‬ ‫(‪ement‬‬ ‫‪eg,‬‬ ‫‪t‬‬

‫‪heawake‬‬
‫‪pat‬‬‫‪i‬‬‫‪entcanmov‬‬ ‫‪eal‬‬ ‫‪l‬‬‫‪f‬‬‫‪ourext‬‬ ‫‪r‬‬‫‪emi‬‬‫‪t‬‬‫‪i‬‬‫‪eswi‬‬ ‫‪t‬‬‫‪hequal‬‬ ‫‪st‬‬‫‪r‬‬
‫‪engt‬‬ ‫)‪honcommand‬‬ ‫‪,‬‬
‫‪mov‬‬ ‫‪ementonl‬‬ ‫‪yi‬‬ ‫‪nr‬‬ ‫‪esponset‬‬ ‫‪opai‬‬ ‫‪nf‬‬‫‪ul‬‬‫‪st‬‬‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬‫‪,‬‬‫‪orabnor‬‬ ‫‪mal‬‬ ‫‪post‬‬‫‪ur‬‬‫‪i‬‬
‫‪ng.I‬‬ ‫‪ft‬‬‫‪he‬‬
‫‪pat‬‬‫‪i‬‬‫‪enti‬‬ ‫‪snotr‬‬ ‫‪espondi‬‬ ‫‪ngt‬‬ ‫‪ocommands,‬‬ ‫‪t‬‬‫‪hemot‬‬ ‫‪orr‬‬ ‫‪esponsei‬‬‫‪st‬‬‫‪est‬‬‫‪edby‬‬
‫‪appl‬‬‫‪y‬‬‫‪i‬‬‫‪ngapai‬‬ ‫‪nf‬‬‫‪ul‬‬ ‫‪st‬‬ ‫‪i‬‬
‫‪mul‬‬ ‫(‪us‬‬ ‫‪f‬‬
‫‪i‬‬‫‪r‬‬‫‪m butgent‬‬ ‫‪l‬‬
‫‪epr‬‬ ‫‪essur‬‬ ‫‪e)t‬‬‫‪ot‬‬‫‪henai‬‬ ‫‪l‬‬
‫‪bedorby‬‬
‫‪squeezi‬‬ ‫‪ngamuscl‬‬ ‫‪e.I‬‬‫‪ft‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entat‬‬ ‫‪t‬‬‫‪empt‬‬ ‫‪st‬‬‫‪opushawayorwi‬‬ ‫‪t‬‬‫‪hdr‬‬‫‪aw,‬‬ ‫‪t‬‬
‫‪he‬‬
‫‪r‬‬‫‪esponsei‬‬ ‫‪sr‬‬‫‪ecor‬‬ ‫‪dedaspur‬‬ ‫‪posef‬‬ ‫‪ul‬‬ ‫‪orappr‬‬ ‫‪opr‬‬‫‪i‬‬‫‪at‬‬‫(‪e‬‬‫‪―pat‬‬ ‫‪i‬‬
‫‪entwi‬‬ ‫‪t‬‬
‫‪hdr‬‬‫‪awst‬‬ ‫‪o‬‬
‫‪pai‬‬‫‪nf‬‬‫‪ul‬‬ ‫‪st‬‬‫‪i‬‬
‫‪mul‬‬ ‫‪i‬‬
‫‖‬ ‫)‬
‫‪.Thi‬‬ ‫‪sr‬‬‫‪esponsei‬‬ ‫‪sconsi‬‬ ‫‪der‬‬ ‫‪edpur‬‬ ‫‪posef‬‬ ‫‪ul‬‬
‫‪i‬‬‫‪ft‬‬‫‪hepat‬‬‫‪i‬‬‫‪entcancr‬‬ ‫‪oss‬‬
‫‪t‬‬‫‪hemi‬‬ ‫‪dl‬‬ ‫‪i‬‬
‫‪nef‬‬ ‫‪r‬‬
‫‪om onesi‬‬ ‫‪deoft‬‬ ‫‪hebodyt‬‬ ‫‪ot‬‬ ‫‪heot‬‬ ‫‪heri‬‬‫‪nr‬‬ ‫‪esponset‬‬ ‫‪opai‬‬ ‫‪nf‬‬‫‪ul‬‬‫‪st‬‬
‫‪i‬‬‫‪mul‬‬‫‪i‬‬
‫‪.‬‬
‫‪Ani‬‬ ‫‪nappr‬‬ ‫‪opr‬‬‫‪i‬‬
‫‪at‬‬ ‫‪eornon-‬‬ ‫‪pur‬‬‫‪posef‬‬ ‫‪ul‬‬‫‪r‬‬‫‪esponsei‬‬ ‫‪sr‬‬‫‪andom andai‬‬ ‫‪ml‬‬‫‪ess.Post‬‬ ‫‪ur‬‬‫‪i‬‬
‫‪ng‬‬
‫‪maybedecor‬‬ ‫‪t‬‬
‫‪i‬‬‫‪cat‬‬ ‫‪eordecer‬‬ ‫‪ebr‬‬ ‫‪at‬‬‫‪e.‬‬
‫‪5.I‬‬‫‪naddi‬‬ ‫‪t‬‬
‫‪i‬‬‫‪ont‬‬‫‪oLOC,‬‬ ‫‪t‬‬
‫‪henur‬‬ ‫‪semoni‬‬ ‫‪t‬‬‫‪or‬‬‫‪spar‬‬ ‫‪amet‬‬ ‫‪er‬‬‫‪ssuchasr‬‬ ‫‪espi‬‬‫‪r‬‬‫‪at‬‬‫‪or‬‬‫‪yst‬‬‫‪at‬‬
‫‪us,‬‬
‫‪ey‬‬‫‪esi‬‬ ‫‪gns,‬‬ ‫‪andr‬‬ ‫‪ef‬‬‫‪l‬‬‫‪exesonanongoi‬‬ ‫‪ngbasi‬‬ ‫‪s.‬‬

‫ﺍﻷ‬‫ﺮﻙ‬‫ﺃﻥﻳﺤ‬‫ﻘﻆ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻜﻦ‬‫ﻤ‬‫ﺎ‪،‬ﻳ‬
‫ﺜﻝ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﺔ)ﻋ‬ ‫ﻓ‬‫ﺩ‬‫ﺎ‬
‫ﺔﻫ‬ ‫ﻳ‬
‫ﻮ‬‫ﻔ‬‫ﺔﻋ‬ ‫ﻛ‬‫ﺮ‬
‫ﺔﺣ‬ ‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻤﻞ‬‫‪.‬ﺗﺸ‬‫‪4‬‬
‫ﺮ‬
‫ﻴ‬‫ﺎﺕﻏ‬ ‫ﻴ‬
‫ﻌ‬‫‪،‬ﻭﻭﺿ‬‫ﺔﺃ‬ ‫ﻤ‬
‫ﻟ‬‫ﺆ‬‫ﺍﺕﻣ‬‫ﺰ‬‫ﻔ‬‫ﻤﺤ‬‫ﻟ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﻘﻂ‬ ‫ﺔﻓ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫‪،‬ﻭ‬‫(‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻴ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬‫ﻳ‬‫ﻭ‬‫ﺎ‬‫ﺘﺴ‬‫ﺓﻣ‬ ‫ﻮ‬‫ﻘ‬‫ﺔﺑ‬‫ﻌ‬‫ﺑ‬
‫ﺭ‬‫ﺍﻷ‬ ‫ﺍﻑ‬‫ﺮ‬‫ﻃ‬
‫ﻪ‬‫ﺒ‬
‫ﻨ‬‫ﻴﻖﻣ‬‫ﺒ‬
‫ﻳﻖﺗﻄ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬‫ﺘﻢ‬ ‫‪،‬ﻳ‬‫ﺮ‬‫ﻣ‬‫ﺍ‬
‫ﻭ‬‫ﻟﻸ‬‫ﻴﺐ‬ ‫ﺘﺠ‬‫ﻳ ﺾﻻﻳﺴ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫‪.‬ﺇ‬‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﻃ‬
‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﺍﺣ‬‫ﺫ‬‫‪.‬ﺇ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻭﻋﻦﻃ‬ ‫ﺃ‬
‫ﺮ‬ ‫ﻔ‬‫ﻟﻈ‬‫ﺍ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻠﻰﺳ‬ ‫(ﻋ‬‫ﻴﻒ‬‫ﻟﻄ‬ ‫ﻜﻦ‬‫ﻟ‬‫ﺑﺖﻭ‬ ‫ﺎ‬‫ﻐﻂﺛ‬ ‫ﻟﻢ)ﺿ‬‫ﺆ‬‫ﻣ‬
‫ﻟﻰ‬
‫ﻳ ﺾﺇ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻨﺴﺤﺐ‬ ‫ﻳ‬
‫"‬‫ﺔ)‬‫ﺒ‬‫ﺎﺳ‬
‫ﻨ‬‫ﻭﻣ‬‫ﺃ‬ ‫ﺔ‬‫ﻓ‬
‫ﺩ‬‫ﺎ‬‫ﺎﻫ‬‫ﻬ‬‫ﻧ‬
‫ﺃ‬‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻴﻞ‬‫ﺘﻢﺗﺴﺠ‬ ‫‪،‬ﻳ‬‫ﺎﺏ‬ ‫ﻧﺴﺤ‬ ‫ﺃﺍﻻ‬
‫ﺩﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﺑ‬
‫ﺍﻻ‬
‫ﻧﺐ‬‫ﺎ‬‫ﻮﺳﻂﻣﻦﺟ‬ ‫ﻟ‬‫ﺍ‬‫ﺭﺧﻂ‬ ‫ﻮ‬‫ﺒ‬
‫ﻊﻋ‬ ‫ﻴ‬‫ﺘﻄ‬
‫ﻳ ﺾﻳﺴ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺔﺇ‬‫ﻓ‬‫ﺩ‬‫ﺎ‬
‫ﺔﻫ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻩ‬
‫ﺬ‬‫ﺮﻫ‬ ‫ﺒ‬‫ﺘ‬
‫ﻌ‬ ‫‪.‬ﺗ‬
‫(‬‫"‬‫ﺔ‬‫ﻤ‬‫ﻟ‬‫ﺆ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻬ‬‫ﺒ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻮﻥﻋﺸ‬‫ﻜ‬‫ﺩﻑﻳ‬ ‫ﺎ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻭﻏ‬‫ﺃ‬‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺩﻏ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫ﺔ‬‫ﻤ‬‫ﻟ‬‫ﺆ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻬ‬
‫ﺒ‬‫ﻨ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﻵﺮ‬
‫ﺍﺧ‬ ‫ﻟﻰ‬‫ﻟﺠﺴﻢﺇ‬ ‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﺍﺣ‬‫ﻭ‬
‫ﻧ‪.‬‬
‫ﻋﻼﻲ‬ ‫ﺮﻘ‬ ‫ﻴ‬‫ﻭﻏ‬ ‫ﺃ‬‫ﺓ‬‫ﺮ‬
‫ﻘﺸ‬‫ﻟ‬‫ﺍ‬‫ﻭﻉ‬‫ﺰ‬‫ﻨ‬‫ﺮﻣ‬‫ﺎﻫ‬
‫ﺘﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺪﻳ‬ ‫‪.‬ﻗ‬‫ﺪﻑ‬ ‫ﻭﻼﻫ‬
‫ﺑ‬
‫ﺩ‬‫ﻭ‬‫ﺩ‬‫ﺭ‬
‫ﻴﻦﻭ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫‪،‬ﻭﻋﻼ‬ ‫ﻔﺴﻲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺜﻞ ﺎ‬ ‫ﺎﺕﻣ‬ ‫ﻤ‬‫ﻠ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻗﺐ‬‫ﺍ‬‫ﺮ‬‫‪،‬ﺗ‬‫ﻟﻰ‪LOC‬‬ ‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬‫ﺎﻹﺿ‬‫‪.‬ﺑ‬‫‪5‬‬
‫‪.‬‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺎﺱﻣﺴ‬ ‫ﺃﺳ‬‫ﻠﻰ‬ ‫ﻌﻞﻋ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬

‫(‬
‫‪Fi‬‬‫‪g.34)Abnor‬‬
‫‪malpost‬‬
‫‪ur‬‬‫‪er‬‬
‫‪esponset‬‬
‫‪ost‬‬
‫‪i‬‬ ‫‪.‬‬
‫‪mul‬‬
‫‪i‬‬

‫‪a.Decor‬‬
‫‪t‬‬‫‪i‬‬
‫‪cat‬‬
‫‪epost‬‬
‫‪ur‬‬‫‪i‬‬
‫‪ng,‬‬
‫‪i‬‬‫‪nv‬‬
‫‪ol‬‬‫‪v‬‬
‫‪i‬‬‫‪ngadduct‬‬
‫‪i‬‬‫‪onandf‬‬
‫‪l‬‬‫‪ex‬‬
‫‪i‬‬‫‪onoft‬‬
‫‪heupper‬‬

‫‪143‬‬
extremi ties, i
nt ernal rotationoft hel owerext remi ti
es, andpl antarf l
exionoft he
feet.
b.Decer ebr atepost ur i
ng, inv olvingext ensi onandout wardrot ati
onofupper
extremi tiesandpl ant arflexi onoft hef eet.
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻔ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﻟﻸﻃ‬ ‫ﻠﻲ‬‫ﺍﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺍﻥ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬، ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﻑ‬ ‫ﺮ‬‫ﻟﻸﻃ‬ ‫ﺀ‬ ‫ﺎ‬
‫ﻨ‬‫ﺜ‬‫ﻧ‬‫ﺍﻻ‬‫ﻳﺐﻭ‬ ‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬
‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬،‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻘﺸ‬ ‫ﺗ‬.‫ﺃ‬
.
‫ﻡ‬‫ﺪ‬ ‫ﻘ‬‫ﻠ‬
‫ﻟ‬‫ﻤﺼﻲ‬ ‫ﺍﻷﺧ‬ ‫ﺀ‬
‫ﺎ‬‫ﻨ‬‫ﺜ‬‫ﻧ‬
‫ﺍﻻ‬‫ﻭ‬،
‫ﻤﺼﻲ‬ ‫ﺃﺧ‬ ‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺜ‬‫ﻧ‬‫ﺍ‬
‫ﺭﺝﻭ‬ ‫ﺎ‬
‫ﻠﺨ‬‫ﻟ‬‫ﺔ‬ ‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻑ‬ ‫ﺮ‬ ‫ﺍﻷﻃ‬ ‫ﺍﻥ‬‫ﺭ‬
‫ﻭ‬ ‫ﺩ‬‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬ ‫ﻤ‬‫ﻠﻰﺗ‬‫ﻮﻱﻋ‬ ‫ﻨﻄ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬،‫ﺔ‬‫ﺫﻋ‬‫ﺍﻼ‬
‫ﺔﻟ‬ ‫ﻴ‬
‫ﻌ‬‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬.
‫ﺏ‬
.‫ﻴﻦ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻠ‬‫ﻟ‬
Nur singDi agnoses:
Basedont heassessmentdat a, themaj ornur si ngdi agnosesmayi ncludethe
foll
owi ng:
1.Inef fectiveai rwaycl earancer el atedt oalteredLOC
2.Ri skofi njuryr elat edt odecr easedLOC
3.Def icientf luidv ol umer el atedt oi nabi li
tytot akef l
uidsbymout h
:
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴﺼ‬ ‫ﺗﺸﺨ‬
:‫ﻠﻲ‬‫ﺎﻳ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬‫ﻗ‬، ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺎ‬‫ﻴ‬
‫ﻠﻰﺑ‬ ‫ﺀﻋ‬ً
‫ﺎ‬‫ﻨ‬
‫ﺑ‬
LOC‫ﺮ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻠﻖﺑ‬ ‫ﻌ‬‫ﺘ‬‫ﺎﻳ‬ ‫ﻤ‬‫ﻴ‬
‫ﺎﻝﻓ‬ ‫ﻌ‬‫ﺮﻓ‬
‫ﻴ‬ ‫ﺀﻏ‬ ‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻴ ﺺﻣﺠ‬ ‫ﻠ‬‫ﺗﺨ‬.1
LOC‫ﺎ ﺽ‬ ‫ﻔ‬‫ﻧﺨ‬
‫ﺎ‬‫ﺔﺑ‬ ‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺧﻄ‬. 2
‫ﻔﻢ‬ ‫ﻟ‬‫ﺍ‬
‫ﻳﻖ‬ ‫ﺮ‬‫ﺋﻞﻋﻦﻃ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬
‫ﻠﻰﺗ‬ ‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻌ‬‫ﺒﻂﺑ‬‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻘ ﺺﺣﺠﻢ‬ ‫ﻧ‬.3
4.Impai redor almucousmembr aner elatedt omout h-breathing,absenceof
phar yngeal reflex,andal ter edf luidi nt ake
5.Ri skf ori mpai redski nint egr it
yr elat edt oi mmobi l
ity
6.Impai redt issuei nt egrit
yofcor near elatedt odi minishedorabsentcor neal
refl
ex
7.Inef fectivet her mor egul at i
onr elat edt odamaget ohy pot
hal ami ccenter
8.Impai redur i
nar yel i
mi nat ion( incont inenceorr etention)relatedt oimpai r
ment
i
nneur ologi csensi ngandcont rol
9.Bowel incont inencer elat edt oi mpai rmenti nneur ologicsensi ngandcont rol
andal sor elatedt ochangesi nnut ritional del i
v er ymet hods
10.Di stur bedsensor yper cept ionr elat edt oneur ologi cimpai rment
11.I nterrupt edf ami lypr ocessesr elat edt oheal thcr isis

‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺗ‬
‫ﻭ‬، ‫ﻣﻲ‬ ‫ﻮ‬
‫ﻌ‬ ‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺱ‬‫ﻜ‬ ‫ﻌ‬‫ﻧ‬
‫ﺍﻻ‬‫ﺎﺏ‬‫ﻴ‬‫ﻭﻏ‬،‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻔﺲﻋﻦﻃ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻢ‬‫ﻠ‬
‫ﻟ‬‫ﺎﻃﻲ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻒ‬ ‫ﺿ‬.4
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺗ‬
‫ﺎﺕ‬‫ﺒ‬‫ﺜ‬
‫ﻟ‬‫ﺎ‬‫ﺔﺑ‬‫ﺒﻄ‬‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬ ‫ﺮﻋ‬ ‫ﺧﻄ‬.5
‫ﺔ‬‫ﻴ‬
‫ﻧ‬‫ﺮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻜﺲ‬ ‫ﻌ‬‫ﻨ‬
‫ﺎﺏﻣ‬ ‫ﻴ‬‫ﻭﻏ‬ ‫ﺃ‬
‫ﺅﻝ‬ ‫ﺎ‬
‫ﺘﻀ‬‫ﺒﻂﺑ‬ ‫ﺗ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺮ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺞ‬‫ﻼﺔﻧﺴ‬‫ﻌﻒﺳ ﻣ‬ ‫ﺿ‬.6
‫ﺀ‬‫ﺎ‬
‫ﻮﻃ‬ ‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻛ‬‫ﺮ‬‫ﻴﺐﻣ‬ ‫ﺬﻱﻳﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺮ‬‫ﻟﻀ‬‫ﺎ‬
‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﻌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺭﻱﻏ‬ ‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
7
‫ﺒﻲ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻜﻢ‬ ‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻭ‬‫ﺎ‬‫ﻌ‬‫ﺘﺸ‬
‫ﺍﻻﺳ‬ ‫ﻌﻒﻓﻲ‬ ‫ﺒﻂﺑﻀ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ (
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺣ‬‫ﻭ‬ ‫ﺃ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬‫ﻮﻝ)ﺳ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﻌﻒﺇﺧ‬ ‫ﺿ‬.8
‫ﺍﺕﻓﻲ‬ ‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬‫ﺎﻣ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺒﻲﻭ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘﺸ‬‫ﺍﻻﺳ‬ ‫ﻌﻒﻓﻲ‬ ‫ﺒﻂﺑﻀ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬ ‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﻠﺲ‬ ‫ﺳ‬.9
‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬‫ﻘ‬‫ﺮﻕﺗ‬‫ﻃ‬
‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻌﻒ‬‫ﺒﻂﺑﻀ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺤﺴﻲ‬ ‫ﺍ‬‫ﺍﻙ‬‫ﺭ‬
‫ﺩ‬‫ﺍﻹ‬ ‫ﺍﺏ‬‫ﺮ‬‫ﺍﺿﻄ‬ .
10
‫ﺔ‬
‫ﻴ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻣ‬
‫ﺯ‬‫ﺎﻷ‬‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺋ‬‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻠ‬‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻗﻒ‬ ‫ﻮ‬‫ﺗ‬.
11
Coll
abor ati
vePr oblems/Pot enti
alCompl icati
ons:
Basedont heassessmentdat a,potenti
alcompl i
cationsmayi nclude:
1.Respiratorydistr
essorf ail
ure
2.Pneumoni a
3.Aspirati
on
4.Pressureul cer

144
5.Deepvei
nthrombosi
s(DVT)
6.Cont
ract
ures
:‫ﺔ‬
‫ﻠ‬‫ﻤ‬‫ﺘ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬
‫ﻋ‬ ‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬/‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﻭ‬
‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻛﻞ‬ ‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬
‫ﺔﻣ‬‫ﻠ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬‫ﻗ‬،‫ﻴﻢ‬
‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬
‫ﺎ‬‫ﻴ‬
‫ﻠﻰﺑ‬ ‫ﺀﻋ‬ً‫ﺎ‬
‫ﻨ‬‫ﺑ‬
‫ﻔﺸﻞ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻖ‬‫ﺿ‬. 1
‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍﻻ‬.
2
‫ﻮﺡ‬‫ﻤ‬ ‫ﻟﻄ‬‫ﺍ‬.
3
‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬ ‫ﺮﺣ‬ ‫ﻗ‬.
4
(DVT)‫ﺔ‬‫ﻘ‬‫ﻴ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺭ‬
‫ﻭ‬‫ﺍﻷ‬‫ﻠﻂ‬ ‫ﺗﺠ‬.5
‫ﺎﺕ‬‫ﻠﺼ‬‫ﻘ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬.
6
PlanningandGoal s:
Thegoal sofcar efort hepat ientwi t
halteredLOCincl
ude:
1.Mai ntenanceofacl earai r
way
2.Protect i
onfrom injury
3.Attainmentoff l
ui dv ol
umebal ance
4.Achi evementofi ntactor almucousmembr anes
5.Mai ntenanceofnor mal skinintegrit
y
6.Absenceofcor neal irr
it
at i
on
7.Attainmentofef fectivet hermor egul
ation
8.Effectiveuri
naryel i
mi nation
9.Bowel cont
inence
10.Accur atepercept i
onofenv ir
onment alst
imul
i
11.Mai ntenanceofi ntactf amilyorsuppor tsyst
em
12.Absenceofcompl i
cations

Note:Becauset heunconsci ouspatient '

spr otectiv
er efl
ex esar eimpai r
ed, t
he
nursemustassumer esponsibil
i
tyfort hepat ientuntilthebasi cref lexes
(coughing,bl
inking,andswal l
owing)ret urnandt hepat i
entbecomesconsci ous
andor i
ented.Ther efore,themajornur singgoal istocompensat ef orthe
absenceoft hesepr ot ecti
verefl
exes.
:‫ﺍﻑ‬ ‫ﺪ‬‫ﺍﻷﻫ‬‫ﻴﻂﻭ‬ ‫ﺘﺨﻄ‬‫ﻟ‬‫ﺍ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬L
‫ ﻣ‬OC‫ﺮ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬
‫ﻊﺗ‬ ‫ﻳ ﺾﻣ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺍﻑﺭ‬ ‫ﺪ‬‫ﺃﻫ‬‫ﻤﻞ‬‫ﺗﺸ‬
‫ﻘﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬ ‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﻧ‬‫ﺎ‬‫ﻴ‬
‫ﺻ‬. 1
‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻣﺍﻻﺻ‬ ‫ﺔﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬ .
2
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯﻥﺣﺠﻢ‬ ‫ﺍ‬‫ﻮ‬‫ﻴﻖﺗ‬‫ﻘ‬‫ﺗﺤ‬.3
‫ﻔﻢ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺎﻃ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻏﺸ‬ ‫ﻣﺍﻷ‬
‫ﻴﻖﺳﻼﺔ‬ ‫ﻘ‬‫ﺗﺤ‬.4
‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬
‫ﺍ‬ .
5
‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺮ‬
‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺞ‬ ‫ﻬ‬‫ﺩﺗ‬‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻋ‬.6
‫ﺎﻝ‬‫ﻌ‬
‫ﻔ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭﻱ‬‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻖ‬‫ﻘ‬‫ﺗﺤ‬.7
‫ﺎﻝ‬‫ﻌ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻘﻀ‬‫ﻟ‬
‫ﺍ‬ .
8
‫ﺀ‬‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﻠﺲ‬ ‫ﺳ‬.9
‫ﺔ‬‫ﻴ‬‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺰ‬ ‫ﻔ‬
‫ﻤﺤ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﻴﻖ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﻙ‬‫ﺭ‬
‫ﺩ‬‫ﺍﻹ‬.10
‫ﺪﻋﻢ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻭﻧﻈ‬ ‫ﺃ‬‫ﺓ‬
‫ﺮ‬ ‫ﻣﺍﻷﺳ‬
‫ﻠﻰﺳﻼﺔ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬‫ﺍ‬.11
‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﺩﻣﻀ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻋ‬.12
‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺆ‬
‫ﺔﻣﺴ‬ ‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺘﺤ‬ ‫ﺃﻥﺗ‬‫ﻳﺠﺐ‬، ‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬
‫ﻗ‬ ‫ﺎ‬‫ﻳ ﺾﻓ‬‫ﺮ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺩ‬‫ﻌﻒﺭ‬ ‫ﻟﻀ‬ ‫ﺍ‬
ً
‫ﺮ‬‫ﻧﻈ‬:‫ﺔ‬‫ﻮﻇ‬‫ﻠﺤ‬‫ﻣ‬
.‫ﺎ‬
ً
‫ﻬ‬‫ﻮﺟ‬‫ﻣ‬‫ﺎﻭ‬ً
‫ﻴ‬‫ﻋ‬‫ﺍ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺒﺢ‬‫ﻳﺼ‬‫(ﻭ‬‫ﻊ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴ ﺾﻭ‬‫ﻣ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻝﻭ‬‫ﻌ‬ ‫ﻟﺴ‬
‫ﺍ‬)‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﻌﻞ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺩ‬‫ﺩﺭ‬ ‫ﻮ‬‫ﻌ‬‫ﺘﻰﺗ‬ ‫ﻳ ﺾﺣ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
.‫ﻩ‬‫ﺬ‬‫ﺔﻫ‬ ‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﻭ‬‫ﺩ‬‫ﺎﺏﺭ‬‫ﻴ‬‫ﻳ ﺾﻋﻦﻏ‬ ‫ﻮ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻴﺴﻲﻫ‬ ‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪﻑ‬ ‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺈﻥ‬
‫ﻓ‬، ‫ﻟﻚ‬‫ﺬ‬‫ﻟ‬
NursingInterventions:
MaintainingPatentAi rway

145
1.Secr etionsmustber emov edt oel i
mi nat et hedangerofaspi ration.
2.Elev atingt heheadoft hebedt o30degr eeshel pspr eventaspi ration.
Posi t
ioningt hepat ienti nal ater al orsemi pr oneposi ti
on, becausei tper mi tsthe
j
awandt onguet of allfor ward, thuspr omot ingdr ainageofsecr etions.
3.Suct ioningandor alhy gienemayber equired.Bef oreandaf tersuct ioning,the
patienti shy peroxy genat edandadequat elyv ent i
latedt opr ev enthy poxi a.
4.Chestphy siot herapyandpost uraldr ainagemaybei ni t
iatedt opr omot e
pulmonar yhy giene, unlesscont raindicat edbyt hepat ient'sunder l
y i
ngcondi ti
on.
5.Thechestshoul dbeauscul tatedatl eastev ery8hour st odet ectadv entiti
ous
breathsoundsorabsenceofbr eathsounds.
6.Despi t
et hesemeasur es,orbecauseoft hesev erit
yofi mpai rment ,thepat i
ent
withal teredLOCof tenr equiresi ntubat ionandmechani calv ent il
at i
on.Nur sing
actionsf ort hemechani callyv ent i
latedpat ienti ncludemai ntai ningt hepat ency
oftheendot racheal tubeort racheost omy ,pr ovidingf requentor alcar e, and
moni toringar t eri
albl oodgasmeasur ement s.
:‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻼﺕ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﻮ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬ ‫ﻠﻰﻣﺠ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﻮﺡ‬ ‫ﻤ‬‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬‫ﻠﻰﺧﻄ‬ ‫ﺀﻋ‬ ‫ﺎ‬‫ﻘﻀ‬ ‫ﻠ‬‫ﻟ‬‫ﺍﺕ‬ ‫ﺯ‬‫ﺍ‬
‫ﺮ‬ ‫ﻓ‬
‫ﺍﻹ‬ ‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﻳﺠﺐﺇ‬. 1
‫ﻪ‬‫ﺒ‬‫ﻭﺷ‬ ‫ﺃ‬ ‫ﺒﻲ‬‫ﻧ‬‫ﺎ‬
‫ﻊﺟ‬ ‫ﻳ ﺾﻓﻲﻭﺿ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻭﺿ‬. ‫ﻮﺡ‬ ‫ﻤ‬‫ﻟﻄ‬ ‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻠﻰﻣ‬ ‫ﺪﻋ‬ ‫ﺎﻋ‬‫ﺔﻳﺴ‬ ‫ﺭﺟ‬ ‫ﺩ‬30‫ﻟﻰ‬ ‫ﺮﺇ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺃﺱ‬ ‫ﻊﺭ‬‫ﻓ‬‫ﺭ‬.2
.
‫ﺍﺕ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺍﻹ‬ ‫ﻳﻒ‬ ‫ﺮ‬‫ﺰﺗﺼ‬ ‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﻟﻲﺗ‬ ‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﺑ‬،
‫ﻡﻭ‬ ‫ﺎ‬
‫ﻣ‬‫ﺍﻷ‬ ‫ﻟﻰ‬‫ﻮﻁﺇ‬ ‫ﻘ‬‫ﻟﺴ‬‫ﺎ‬
‫ﺎﻥﺑ‬ ‫ﻠﺴ‬‫ﻟ‬‫ﺍ‬‫ﻔﻚﻭ‬ ‫ﻠ‬‫ﻟ‬‫ﻤﺢ‬‫ﻪﻳﺴ‬ ‫ﻧ‬‫ﻷ‬،‫ﻤﻲ‬ ‫ﻋﻈ‬
‫ﻴﻦ‬‫ﻛﺴﺠ‬ ‫ﻭ‬‫ﺍﻷ‬ ‫ﺮﻁ‬‫ﻳ ﺾﻣﻦﻓ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻧﻲ‬ ‫ﺎ‬
‫ﻌ‬‫ﻳ‬، ‫ﻔﻂ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬‫ﺒﻞﻭ‬ ‫ﻗ‬. ‫ﻔﻢ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﻧﻈ‬‫ﻔﻂﻭ‬ ‫ﻟﻰﺷ‬ ‫ﺔﺇ‬ ‫ﺎﺟ‬‫ﺎﻙﺣ‬ ‫ﻨ‬
‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﺪﺗ‬‫ﻗ‬.3
.‫ﺔ‬‫ﻛﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻘﺺ‬ ‫ﻊﻧ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬ ‫ﻓ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬
‫ﻪ‬‫ﻌ‬‫ﻨ‬‫ﻤ‬‫ﻟﻢﺗ‬ ‫ﺎ‬،
‫ﺔﻣ‬ ‫ﻳ‬‫ﻮ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓ‬ ‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﻌﻲ‬ ‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﺘﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺭﻭ‬ ‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬ ‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬
‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﻉﻓﻲ‬ ‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.4
.
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬ ‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬
​
‫ﺩ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬ ‫ﻮ‬
‫ﺃﺻ‬ ‫ﺎﻑ‬ ‫ﺘﺸ‬‫ﻛ‬‫ﻷﻞﻻ‬ ‫ﺍﻗ‬ ‫ﻠﻰ‬ ‫ﺎﺕﻋ‬ ‫ﻋ‬ ‫ﺎ‬
‫ﺳ‬8‫ﺭﻛﻞ‬ ‫ﺪ‬
‫ﻟﺼ‬ ‫ﺍ‬ ‫ﺎﻉ‬‫ﻤ‬‫ﻳﺠﺐﺳ‬. 5
.‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺃﺻ‬
LOC‫ﺮ‬ ‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺝ‬‫ﺘ‬‫ﺎﻳﺤ‬ ‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬‫ﺎ‬، ‫ﻌﻒ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺒﺐﺷ‬ ‫ﻭﺑﺴ‬، ‫ﺮﺃ‬ ‫ﻴ‬‫ﺑ‬‫ﺍ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻏﻢﻣﻦﻫ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬.6
‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬ ‫ﻴ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻬ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﻊ‬‫ﺎﺿ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﻤﻞﺇﺟ‬ ‫ﺗﺸ‬. ‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬ ‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐﻭ‬ ‫ﺒ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺇ‬
‫ﺔ‬‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻣ‬‫ﻭ‬، ‫ﻔﻢ‬ ‫ﻟ‬
‫ﺎ‬
‫ﺓﺑ‬ ‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﺒ‬
‫ﻘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻐ‬‫ﻭﻓ‬ ‫ﺃ‬‫ﻣﻲ‬ ‫ﺎ‬‫ﺮﻏ‬‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬ ‫ﺒ‬‫ﻧ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﻠﻰﺳ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﻧﻲ‬ ‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬‫ﺎﺕﻏ‬ ‫ﺎﺳ‬‫ﻴ‬
‫ﻗ‬

Protectingt hePat i
ent
1.Sider ai
lsar epadded.Twor ailsar ekepti nt her aisedposi t
ion.
2.Careshoul dbet akentopr eventi njuryfrom i nvasiv elinesandequi pment
3.Otherpot entialsourcesofi nj
ur yshoul dbei dent i
fied,suchasr estraints,ti
ght
dressi
ngs, environment alir
ri
tant s,dampbeddi ngordr essings,andt ubesand
drai
ns.
4.Simpl emeasur essuchaspr ov i
dingpr ivacyandspeaki ngtot hepat ient
duri
ngnur singcar eact i
vit
iespr eservet hepat ient'sdi gnity.Notspeaki ng
negativelyaboutt hepat i
ent'
scondi ti
onorpr ognosi si sal soimpor tant,because
pati
entsi nal ightcomamaybeabl et ohear .
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬
.‫ﻊ‬‫ﻔ‬
‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻮﺿ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻥﻓﻲ‬ ‫ﺒ‬‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻣﻦ‬ ‫ﻨ‬‫ﺛ‬‫ﺍ‬‫ﻊ‬‫ﺘﻢﻭﺿ‬ ‫ﻳ‬.‫ﺔ‬‫ﻨ‬
‫ﺒﻄ‬‫ﺔﻣ‬ ‫ﻴ‬
‫ﺒ‬‫ﻧ‬‫ﺎ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﻥ‬‫ﺒ‬‫ﻘﻀ‬‫ﻟ‬
‫ﺍ‬.1
‫ﺔ‬‫ﻳ‬
‫ﺯ‬ ‫ﺎ‬
‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺪ‬ ‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻁﻭ‬ ‫ﻟﺨﻄ‬ ‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺭ‬
‫ﺬ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﺧﻲ‬ ‫ﻳﺠﺐﺗ‬. 2
‫ﺔ‬‫ﻴ‬‫ﺌ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻴﺠ‬ ‫ﻬ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻭ‬‫ﻘ‬‫ﻴ‬‫ﻟﻀ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﺩﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﻣ‬،‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻠ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻳﺠﺐﺗﺤ‬. 3
.‫ﺭﻑ‬‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﻴﺐﻭ‬ ‫ﺑ‬‫ﺎ‬
‫ﻧ‬‫ﺍﻷ‬‫ﺔﻭ‬‫ﺒ‬‫ﺮﻃ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺍﺵ‬‫ﺮ‬ِ
‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬
‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬ ‫ﺪﺙﺇ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻮﺻ‬‫ﻟﺨﺼ‬ ‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬
‫ﺜﻞﺗ‬ ‫ﺔﻣ‬‫ﻴﻄ‬‫ﺍﺕﺑﺴ‬ ‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬.4
‫ﻴﺺ‬ ‫ﻭﺗﺸﺨ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﺒﻲﻋﻦ ﺎ‬ ‫ﻠ‬
‫ﻜﻞﺳ‬ ‫ﺪﺙﺑﺸ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺎﻋ‬ ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻬﻢ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻦ‬. ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺍ‬‫ﺮ‬‫ﻠﻰﻛ‬ ‫ﻓﻆﻋ‬‫ﺎ‬‫ﺗﺤ‬
.‫ﺎﻉ‬
‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫ﻠﻰ‬‫ﻳﻦﻋ‬ ‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻮﻥﻗ‬ ‫ﻧ‬
‫ﻮ‬‫ﻜ‬‫ﺪﻳ‬ ‫ﺔﻗ‬ ‫ﻔ‬‫ﻴ‬
‫ﻔ‬‫ﺔﺧ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻴ‬‫ﺮﺿﻰﻓﻲﻏ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻷﻥ‬، ‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺳ‬

146
Mai ntainingFl ui dBalanceandManagi ngNut ri
ti
onal Needs
1.Hy drationst atusisassessedbyex ami ningt i
ssuet urgorandmucous
membr anes
2.Assessi ngi ntakeandout put
3.Anal yzingl abor atorydat a
4.Fluidneedsar emeti ni
tial
lybyadmi nisteringther equiredIVf luids.
5.IVsol utions( andbl oodcomponentt herapy )forpat i
entswi thint r
acr anial
condi t
ionsmustbeadmi nisteredsl owly .I
ft heyar eadmi nisteredt oor api dly,
theycani ncr easeI CP.Thequant i
t yoff lui
ds
admi nisteredmayber est ri
ctedt omi ni
mi zet hepossi bil
ityofcer ebr aledema.
6.Ifthepat ientdoesnotr ecov erqui cklyandsuf fici
entlyenought ot ake
adequat ef luidsandcal ori
esbymout h,af eedingorgast rostomyt ubewi llbe
i
nser tedf ort headmi nistrati
onoff l
ui dsandent eral f
eedings.
‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﻻﺣ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬‫ﺋﻞﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯﻥ‬ ‫ﺍ‬‫ﻮ‬‫ﻠﻰﺗ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﺎﻃ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺍﻷﻏﺸ‬‫ﺔﻭ‬ ‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻳﻖﻓﺤ ﺺﺗ‬ ‫ﺮ‬
‫ﻴﺐﻋﻦﻃ‬ ‫ﺮﻃ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻴﻢ ﺎ‬‫ﻴ‬ ‫ﻘ‬‫ﺘﻢﺗ‬‫ﻳ‬.1
‫ﺎﺕ‬‫ﺮﺟ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﺪﺧ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬.2
‫ﺔ‬‫ﻳ‬
‫ﺮ‬ ‫ﺒ‬
‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬‫ﻠ‬‫ﺗﺤ‬.3
.‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻠ‬‫ﻤﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﺪ‬ ‫ﻳ‬
‫ﺭ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬ ‫ﺎ‬
‫ﻳﻖﺇﻋﻄ‬ ‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻳ‬‫ﺍ‬
‫ﺪ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﻞﻓﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﺎﺟ‬ ‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬ ‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻠ‬‫ﺘﻢﺗ‬‫ﻳ‬.4
‫ﺍﺧﻞ‬ ‫ﺍ ﺽﺩ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬‫ﻟ‬(‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﻜ‬‫)ﻋﻼﺝﻣ‬ ‫ﺔﻭ‬ ‫ﻳ‬‫ﺪ‬
‫ﻳ‬ ‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻟ‬‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻋﻄ‬ ‫ﻳﺠﺐﺇ‬. 5
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻛ‬. ‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬‫ﻘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬
‫ﺓﺑ‬ ‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺎﺯ‬‫ﻬ‬‫ﻨ‬‫ﻜ‬‫ﻤ‬‫ﻴ‬‫ﻓ‬، ‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺔﻛ‬‫ﺮﻋ‬‫ﺎﺑﺴ‬‫ﺅﻫ‬ ‫ﺎ‬
‫ﺍﺗﻢﺇﻋﻄ‬ ‫ﺫ‬‫ﺇ‬.‫ﺀ‬‫ﺒﻂ‬‫ﺔﺑ‬ ‫ﻤ‬
‫ﻤﺠ‬ ‫ﻟﺠ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻣ‬‫ﺫ‬‫ﻭﺙﻭ‬ ‫ﺪ‬‫ﺔﺣ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﺣ‬‫ﻴﻞ‬ ‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﺪ‬ ‫ﻴ‬
‫ﻴ‬‫ﻘ‬ ‫ﺘﻢﺗ‬‫ﺪﻳ‬‫ﻗ‬
،‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﺔﻛ‬ ‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺕﺣ‬ ‫ﺮ‬‫ﻌ‬‫ﺋﻞﻭﺳ‬ ‫ﺍ‬
‫ﻮ‬‫ﺬﺳ‬ ‫ﻑﻷﺧ‬ ٍ‫ﺎ‬‫ﻜﻞﻛ‬ ‫ﺑﺸ‬‫ﺔﻭ‬ ‫ﻋ‬‫ﺮ‬‫ﻳ ﺾﺑﺴ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻰ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻟﻢﻳ‬ ‫ﺍ‬
‫ﺫ‬‫ﺇ‬.6
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻭ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﺪﻱﻹﻋﻄ‬ ‫ﻌ‬‫ﺮﻣ‬‫ﻐ‬‫ﻭﻓ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﻮﺏﺗ‬ ‫ﺒ‬‫ﻧ‬‫ﺃ‬‫ﺎﻝ‬‫ﺩﺧ‬ ‫ﺘﻢﺇ‬‫ﻴ‬‫ﻓﺴ‬

Prov idingMout hCar e

1.Themout hi sinspect edfordr yness, inf l
ammat i
on, andcr usti
ng.
2.Theunconsci ouspat i
entrequi r
esor al care,becauset her eisar iskof
par otiti
si fthemout hisnotkeptcl ean.
3.Themout hi scleansedandr insedcar efull
ytor emov esecr etionsandcr ust s
andt okeept hemucousmembr anesmoi st.
4.At hincoat i
ngofpet rol
atum ont hel ipspr eventsdr ying, cracking,and
encr ustat i
ons.
5.Ift hepat i
enthasanendot racheal tube, thetubeshoul dbemov edt ot he
opposi t
esi deoft hemout hdailytopr ev entulcerati
onoft hemout handl ips.
‫ﻔﻢ‬ ‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﻳ‬
‫ﺎ‬‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
.‫ﺭ‬‫ﻮ‬‫ﻘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏﻭ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺎﻑﻭ‬ ‫ﻔ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﻋﻦ‬ ً
‫ﺜ‬
‫ﻔﻢﺑﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺘﻢﻓﺤ ﺺ‬ ‫ﻳ‬.1
‫ﻟﻢ‬ ‫ﺍ‬
‫ﺫ‬‫ﺔﺇ‬ ‫ﻴ‬
‫ﻔ‬ ‫ﻜ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﺎﻙﺧﻄ‬ ‫ﻨ‬‫ﻷﻥﻫ‬، ‫ﻔﻢ‬‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﻮﻋﻲﺇ‬ ‫ﻠ‬
‫ﻟ‬‫ﺪ‬‫ﻗ‬‫ﺎ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺝ‬‫ﺘ‬‫ﻳﺤ‬.2
.‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬ ‫ﺎ‬
‫ﻠﻰﻧﻈ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬
.
‫ﺔ‬‫ﺒ‬‫ﺔﺭﻃ‬ ‫ﻴ‬‫ﺎﻃ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﺍﻷﻏﺸ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺭﻭ‬‫ﻮ‬ ‫ﻘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕﻭ‬ ‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺍﻹ‬ ‫ﺯﺔ‬
‫ﻟ‬
‫ﺔﻹﺍ‬ ‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻪﺑ‬‫ﻔ‬‫ﻔﻢﻭﺷﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻨﻈ‬ ‫ﺘﻢﺗ‬‫ﻳ‬.3
.
‫ﺭ‬‫ﻮ‬‫ﻘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﻘﻖﻭ‬ ‫ﺘﺸ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﻑﻭ‬ ‫ﻔ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﻩﺗ‬‫ﺎ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﻠﻰ‬ ‫ﻴﻦﻋ‬ ‫ﻟ‬
‫ﺯ‬‫ﺎ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺔﺭ‬ ‫ﻘ‬‫ﺒ‬‫ﻃ‬.4
‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺎ‬ً
‫ﻴ‬
‫ﻣ‬ ‫ﻮ‬‫ﻔﻢﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻵﺮﻣﻦ‬‫ﺍﺧ‬ ‫ﻧﺐ‬ ‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻟﻰ‬‫ﻮﺏﺇ‬ ‫ﺒ‬‫ﻧ‬‫ﺍﻷ‬ ‫ﻳﻚ‬ ‫ﺮ‬
‫ﻴﺠﺐﺗﺤ‬ ‫ﻓ‬،‫ﻣﻲ‬ ‫ﺎ‬‫ﻮﺏﺭﻏ‬ ‫ﺒ‬
‫ﻧ‬‫ﺃ‬‫ﻪ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬ ‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬.
5
.
‫ﻴﻦ‬‫ﺘ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﻔﻢﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺮﺡ‬‫ﻘ‬‫ﺗ‬
Mai nt ai
ni ngSki nandJoi ntIntegr i
ty
Prev entingski nbr eakdownr equi r
escont i
nuingnur singassessmentand
i
nt ervent i
on.Speci alattenti
oni sgiv ent ounconsci ouspat ients,becauset hey
cannotr espondt oext ernalsti
mul i
.
1.Regul arschedul eoft urni
ngt oav oi dpr essure,whi chcancausebr eakdown
andnecr osisoft heski n.
2.Dr aggi ngorpul li
ngt hepatientupi nbedmustbeav oided, becauset his

147
createsashear ingf orceandf ri
ctionont heski nsur f
ace.
3.Mai ntaini
ngcor rectbodyposi ti
oni si mpor tant; equallyimpor tantispassi ve
exerciseoft heext r
emi ti
est opr eventcont ract ures.
4.Theuseofspl intsorf oam boot sai dsi nt hepr ev enti
onoff ootdr opand
el
imi natesthepr essureofbeddi ngont het oes.
5.Theuseoft rochant erroll
st osuppor tthehi pj ointskeepst hel egsinpr oper
al
ignment .Thear msar ei nabduct ion, thef ingersl ightl
yf lexed,andt hehandsi n
sl
ightsupi nation.
6.Theheel soft hef eetar eassessedf orpr essur ear eas.Speci altybeds, maybe
usedt odecr easepr essureonbonypr omi nences.
‫ﺎﺻﻞ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺪ‬ ‫ﻗ‬‫ﺎ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺎﺹ‬ ‫ﻡﺧ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻫ‬‫ﺀ‬‫ﺇﻼ‬‫ﺘﻢﻳ‬‫ﻳ‬. ‫ﻳﻦ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺎﻣﺴ‬ ً
‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺎﺗ‬ً
‫ﻠ‬
‫ﺪﺧ‬ ‫ﺗ‬
‫ﺎﻭ‬ ً
‫ﻤ‬‫ﻴ‬‫ﻴ‬
‫ﻘ‬‫ﺪﺗ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻜﺴ‬ ‫ﻊﺗ‬‫ﻨ‬‫ﻠﺐﻣ‬‫ﺘﻄ‬‫ﻳ‬
.‫ﺔ‬‫ﻴ‬‫ﺭﺟ‬ ‫ﺎ‬
‫ﻟﺨ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻬ‬‫ﺒ‬‫ﻨ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻮﻥ‬‫ﻌ‬‫ﻴ‬‫ﺘﻄ‬‫ﻬﻢﻻﻳﺴ‬ ‫ﻧ‬
‫ﻷ‬، ‫ﻋﻲ‬‫ﻮ‬‫ﻠ‬‫ﻟ‬
.‫ﻩ‬‫ﺮ‬‫ﻧﺨ‬‫ﺪﻭ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﺒﺐﺗ‬ ‫ﺃﻥﻳﺴ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﺬﻱﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻨﺐ‬ ‫ﺘﺠ‬‫ﻟ‬‫ﺎﻑ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬‫ﻟﻼ‬‫ﺘﻈﻢ‬‫ﻨ‬‫ﻭﻝﻣ‬ ‫ﺪ‬‫ﺟ‬.1
‫ﻠﻰﺳﻄﺢ‬ ‫ﺎﻙﻋ‬‫ﻜ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﻘ ﺺﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﻮ‬‫ﻠﻖﻗ‬ ‫ﺍﻳﺨ‬‫ﺬ‬‫ﻷﻥﻫ‬، ‫ﺮ‬
‫ﻳ‬‫ﺮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺳﺤﺐ‬ ‫ﺃ‬‫ﻨﺐﺳﺤﺐ‬ ‫ﻳﺠﺐﺗﺠ‬. 2
.‫ﺪ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺍﻑ‬‫ﺮ‬‫ﻟﻸﻃ‬ ‫ﺒﻲ‬‫ﻠ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﻳﻦ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﺔﻫ‬ ‫ﻴ‬‫ﻤ‬‫ﻣﺍﻷﻫ‬
‫ﺭﻦ‬ ‫ﺪ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺲ‬ ‫؛ﻧ‬‫ﻬﻢ‬ ‫ﺮﻣ‬‫ﻣ‬ ‫ﺃ‬‫ﻴﺢ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬ ‫ﻊ‬‫ﻠﻰﻭﺿ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬.
3
.‫ﺎﺕ‬‫ﻠﺼ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﻠﻰ‬ ‫ﺍﺵﻋ‬ ‫ﺮ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻳﻞ ﺿ‬ ‫ﺰ‬‫ﻳ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻁ‬ ‫ﻘ‬‫ﻊﺳ‬ ‫ﻨ‬
‫ﺪﻓﻲﻣ‬ ‫ﺎﻋ‬‫ﺔﻳﺴ‬ ‫ﻴ‬‫ﻨﺠ‬‫ﻔ‬‫ﺍﻹﺳ‬ ‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﺃﺍﻷﺣ‬
‫ﺮﻭ‬ ‫ﺋ‬
‫ﺎ‬‫ﺒ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ .
4
.‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬
‫ﻴﻦ‬‫ﺍﻋ‬‫ﺭ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬.‫ﻴﺢ‬‫ﻜﻞ ﺻﺤ‬ ‫ﻴﻦﺑﺸ‬‫ﻗ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺎ‬‫ﻘ‬
‫ﺘ‬‫ﺍﺳ‬ ‫ﻠﻰ‬‫ﻓﻆﻋ‬ ‫ﺎ‬‫ﺭﻙﻳﺤ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬ ‫ﺎﺻﻞ‬‫ﻔ‬‫ﻋﻢﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻒ‬‫ﺎ‬
‫ﻔ‬‫ﻟ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ .
5
.‫ﻴﻒ‬‫ﻔ‬‫ﺀﺧ‬ ‫ﺎ‬‫ﻘ‬
‫ﻠ‬‫ﺘ‬‫ﺍﺳ‬‫ﺣﺔ‬‫ﻟ‬
‫ﻳﻦﻓﻲ ﺎ‬ ‫ﺪ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ً‫ﻴﻼ‬ ‫ﻠ‬
‫ﻨﻲﻗ‬ ‫ﺜ‬‫ﻨ‬‫ﻊﺗ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻷﺻ‬‫ﻭ‬، ‫ﺎﻑ‬‫ﺘﻄ‬ ‫ﺍﺧ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬
‫ﻠﻰ‬ ‫ﻐﻂﻋ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬،‫ﺔ‬ ‫ﺘﺨﺼﺼ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬ .‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻌﺐ‬‫ﻴﻢﻛ‬ ‫ﻴ‬
‫ﻘ‬‫ﺘﻢﺗ‬‫ﻳ‬.6
.‫ﺔ‬
‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﻮ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬

Preser vingCor nealInt egrity

1.Theey esmaybecl eansedwi thcottonbal lsmoi stenedwi thst eri
lenormal
salinet or emov edebr i
sanddi schar ge.
2.Ifart i
ficialtearsar epr escr ibed, theymaybei nstil
l
edev ery2hour s.Peri
orbital
edema( swel l
ingar oundt heey es)of t
enoccur saft
ercr anialsurger y.Cold
compr essesmaybepr escr ibed, andcar emustbeexer tedtoav oidcontactwi t
h
thecor nea.
3.Ey epat chesshoul dbeusedcaut i
ouslybecauseoft hepot entialforcorneal
abrasionf rom cont actwi tht hepat ch.
‫ﺔ‬ ‫ﻴ‬‫ﻧ‬
‫ﺮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
.
‫ﺍﺕ‬ ‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬
‫ﺎﺥﻭ‬ ‫ﻭﺳ‬ ‫ﺍﻷ‬ ‫ﺯﺔ‬
‫ﻟ‬‫ﻘﻢﻹﺍ‬ ‫ﻌ‬‫ﻠﺤﻲﻣ‬ ‫ﻮﻝﻣ‬ ‫ﻠ‬
‫ﻤﺤ‬ ‫ﺔﺑ‬‫ﻠ‬
‫ﻠ‬‫ﺒ‬
‫ﺔﻣ‬ ‫ﻴ‬‫ﻨ‬‫ﺍﺕﻗﻄ‬ ‫ﺮ‬
‫ﻜ‬ ‫ﻴﻦﺑ‬‫ﻨ‬‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬‫ﻨﻈ‬‫ﻜﻦﺗ‬ ‫ﻤ‬
‫ﻳ‬.1
‫ﺎﺝ‬ ‫ﻟﺤﺠ‬‫ﺍ‬ ‫ﻮﻝ‬ ‫ﺔﺣ‬‫ﻣ‬ ‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺎﺗﺤ‬ ‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬‫ﺎ‬. ‫ﻴﻦ‬ ‫ﺘ‬‫ﻋ‬‫ﺎ‬
‫ﺎﻛﻞﺳ‬ ‫ﻬ‬
‫ﻴﻄ‬ ‫ﻘ‬
‫ﻨ‬‫ﻜﻦﺗ‬‫ﻤ‬‫ﻴ‬‫ﻓ‬،‫ﺔ‬ ‫ﻴ‬‫ﺎﻋ‬‫ﻨ‬‫ﺍﻻﺻﻄ‬ ‫ﻮﻉ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺗﻢﻭﺻﻒ‬ ‫ﺫ‬
‫ﺇ‬.2
‫ﻨﺐ‬‫ﺘﺠ‬‫ﻟ‬ ‫ﺭ‬‫ﺬ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﺧﻲ‬ ‫ﻳﺠﺐﺗ‬ ‫ﻭ‬، ‫ﺓ‬‫ﺩ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻦﻭﺻﻒ‬ ‫ﻤ‬‫ﻳ‬.
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬ ‫ﺍﺣ‬‫ﺮ‬
‫ﺪﺟ‬ ‫ﻌ‬
‫(ﺑ‬ ‫ﻴﻦ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻡﺣ‬ ‫ﺭ‬‫ﻮ‬‫ﺗ‬)
.‫ﺔ‬‫ﻴ‬
‫ﻧ‬‫ﺮ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣﺴ‬‫ﻣﻼ‬
.
‫ﺔ‬‫ﻌ‬‫ﻗ‬‫ﺮ‬‫ﻠ‬
‫ﻟ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻣﺴ‬‫ﺔﻣﻦﻣﻼ‬ ‫ﻴ‬‫ﻧ‬‫ﺮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﻛﻞ‬ ‫ﺂ‬
‫ﺔﺗ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬‫ﺍﺣ‬‫ﺒﺐ‬‫ﺭﺑﺴ‬ ‫ﺬ‬‫ﻴﻦﺑﺤ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻘ‬
‫ﻟﺼ‬ ‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻳﺠﺐ‬. 3
Mai ntainingBodyTemper atur e
1.Ifbodyt emper aturei sel ev ated, ami ni
mum amountofbeddi ng—asheet ,
smal ldr ape, ortowel —isused.
2.Ther oom maybecool edt o18. 3°C(65°F) .Howev er, ifthepat ientiselderl
y
anddoesnothav eanel ev atedt emper ature,awar merenv ir
onmenti sneeded.

St
rat
egi
esf
orr
educi
ngf
everi
ncl
ude:

148
 Remov i
ngal lbeddingoverthepat i
ent(wit
ht hepossibl
eex cept
ionofa
l
ightsheetorsmal ldrape)
Admi ni
steri
ngacet aminophenaspr escri
bed
Givi
ngcool spongebat hsandal l
owinganel ectri
cfantoblowov erthe
patienttoincreasesur f
acecooling
Usingahy pot hermi abl
anket
Frequenttemper aturemonitori
ngisindi
catedt oassessthepatient'
s
responset othet her apyandtopr eventanexcessivedecreaseint emperat
ure
andshi veri
ng.

‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﺔﺣ‬‫ﺭﺟ‬‫ﻠﻰﺩ‬‫ﺔﻋ‬‫ﻓﻈ‬‫ﺎ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬
‫ﺎ‬‫ﺘ‬
‫ﻭﺳ‬ ‫ﺃ‬‫ﻼﺓ‬
‫ﻣ ﺀ‬-‫ﺍﺵ‬‫ﺮ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻧﻰﻣﻦ‬‫ﺩ‬‫ﺍﻷ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺘﻢ‬‫ﻳ‬،‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺔﺣ‬‫ﺭﺟ‬‫ﺎﻉﺩ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬.1
.
-‫ﺔ‬‫ﻔ‬‫ﻨﺸ‬‫ﻭﻣ‬‫ﺃ‬‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺻ‬
‫ﺍ‬
ً
‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻳ ﺾﻛ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬،
‫ﻟﻚ‬‫ﻊﺫ‬‫ﻣ‬‫ﻭ‬.
(‫ﻳﺖ‬‫ﺎ‬‫ﻬ‬
‫ﻧ‬‫ﺮ‬‫ﻬ‬
‫ﺔﻓ‬ ‫ﺭﺟ‬‫ﺩ‬65)‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﺌ‬
‫ﺔﻣ‬‫ﺭﺟ‬‫ﺩ‬18.3‫ﻟﻰ‬‫ﺔﺇ‬‫ﻓ‬
‫ﺮ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﻜﻦﺗ‬‫ﻤ‬
‫ﻳ‬.2
.
‫ﺎ‬ً
‫ﺌ‬
‫ﻓ‬‫ﺮﺩ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺔ‬
‫ﺌ‬‫ﻴ‬‫ﺮﺑ‬‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﻴﺠﺐﺗ‬ ‫ﻓ‬،‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺎﻉﻓﻲﺩ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﻧﻲﻣﻦ‬‫ﺎ‬‫ﻌ‬
‫ﻟﺴﻦﻭﻻﻳ‬‫ﺍ‬‫ﻓﻲ‬

:‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤﻰﻣ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻔﺾ‬ ‫ﺎﺕﺧ‬ ‫ﻴ‬‫ﻴﺠ‬‫ﺗ‬‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺍﺳ‬‫ﻤﻞ‬
‫ﺗﺸ‬
(
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﻟﺼ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺎ‬‫ﺘ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬‫ﻼﺓ‬
‫ﻤﺀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺜ‬‫ﺘ‬
‫ﺎﺳ‬‫ﺑ‬)‫ﻳ ﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻕ‬‫ﺓﻓ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺵ‬ ‫ﺮ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺃﻏﻄ‬‫ﺔﻛﻞ‬ ‫ﻟ‬
‫ﺍ‬‫•ﺯ‬
‫ﺇ‬
‫ﻪ‬
‫ﻴ‬‫ﻠ‬‫ﻮ ﺹﻋ‬‫ﻨﺼ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻴﻦﻋ‬ ‫ﻓ‬‫ﻮ‬‫ﻨ‬
‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬‫ﺍﻻﺳ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﺓﻋ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫•ﺇ‬
‫ﺪ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬
‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻕ‬‫ﻔﺦﻓ‬‫ﻨ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬
‫ﺔﻛ‬‫ﻭﺣ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺎﺡ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺓﻭ‬ ‫ﺩ‬
‫ﺭ‬‫ﺎ‬‫ﺔﺑ‬‫ﻴ‬‫ﻨﺠ‬‫ﻔ‬
‫ﺎﺕﺇﺳ‬ ‫ﻣ‬‫ﺎ‬
‫ﻤ‬‫ﺀﺣ‬ ‫ﺎ‬
‫ﻋﻄ‬‫•ﺇ‬
‫ﻟﺴﻄﺢ‬‫ﺍ‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺎ ﺽﺣ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻡﺑﻄ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ •
‫ﺎﺽ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍﻻ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﻌﻼﺝﻭ‬ ‫ﻠ‬‫ﻟ‬
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﻴﻢ‬
‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬‫ﺭﺟ‬ ‫ﺪ‬‫ﻟ‬‫ﺓ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺭﺇ‬‫ﺎ‬
‫•ﻳﺸ‬
.‫ﺔ‬‫ﻋﺸ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺮﻁﻓﻲﺩ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬

Prev entingUr inaryRet ent i

on
1.Thebl adderi spal pat edorscannedati ntervalstodet ermi newhet herurinar y
retentioni spr esent ,becauseaf ull bladdermaybeanov erl
ookedcauseof
overflowi ncont i
nence.
2.Ifthepat i
enti snotv oiding, ani ndwel l
i
ngur i
narycathet erisi nser
tedand
connect edt oacl oseddr ainagesy st em.Becausecat heter sar eamaj orfact orin
causi ngur i
nar ytracti nfection, t
hepat i
enti sobser v
edf orf ev erandcloudyur i
ne.
Thear eaar oundt heur ethralor i
ficei sinspect edf ordrainage.
3.Ani ntermi ttentcat het eri
zationpr ogr am maybei niti
atedt oensurecompl ete
empt yi
ngoft hebl adderati nterval s, ifindicated.
4.Anext ernal catheter( condom cat het er)forthemal epat ientandabsor bent
padsf ort hef emal epat i
entcanbeusedf orunconsci ouspat ientswhocan
uri
nat espont aneousl yal thoughi nv ol untaril
y.
5.Assoonasconsci ousnessi sr egai ned, abladder-tr
ainingpr ogram i
sinitiated.
6.Thei ncont inentpat ientismoni t
or edf requentlyforski nirri
t at
ionandskin
breakdown.Appr opr iateski ncar ei si mpl ement edtopr ev entt hese
compl i
cat ions.

‫ﻮﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺣ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬
‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻷﻥ‬،‫ﺍ‬
ً
‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻮﻝﻣ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺱ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺣ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬
‫ﺪﻣ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬
‫ﻟ‬‫ﺍﺕ‬‫ﺮ‬‫ﺘ‬‫ﻠﻰﻓ‬‫ﺎﻋ‬‫ﻬ‬‫ﻭﻣﺴﺤ‬‫ﺃ‬‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢﺗﺤﺴﺲ‬ ‫ﻳ‬.1
.‫ﺋﺾ‬‫ﺎ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﺲ‬ ‫ﻟﺴ‬‫ﺎ‬
ً
‫ﻠ‬
‫ﻤ‬‫ﻬ‬‫ﺎﻣ‬ً
‫ﺒ‬
‫ﺒ‬‫ﻮﻥﺳ‬ ‫ﻜ‬‫ﺪﺗ‬
‫ﺔﻗ‬ ‫ﺌ‬
‫ﻠ‬‫ﺘ‬
‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻷﻥ‬.‫ﻠﻖ‬‫ﻐ‬‫ﺮﻑﻣ‬‫ﻡﺻ‬ ‫ﺎ‬
‫ﻨﻈ‬‫ﺎﺑ‬
‫ﻬ‬‫ﻠ‬
‫ﻴ‬‫ﻮﺻ‬‫ﺗ‬‫ﺔﻭ‬‫ﺘ‬
‫ﺑ‬‫ﺎ‬‫ﺔﺛ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺓﺑ‬
‫ﺮ‬‫ﺎﻝﻗﺴﻄ‬‫ﺩﺧ‬ ‫ﺘﻢﺇ‬‫ﻳ‬،
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻍ‬
‫ﺮ‬‫ﻓ‬‫ﻡﺇ‬‫ﺪ‬‫ﺣﺔﻋ‬
‫ﻟ‬
‫ﻓﻲ ﺎ‬. 2
‫ﻤﻰﻭ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻳ ﺾﻣﻦ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘﻢﻣﻼﺣﻈ‬‫ﻳ‬،‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺒﺐﻓﻲ‬ ‫ﺘﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺴﻲﻓﻲ‬ ‫ﺋ‬
‫ﻣﻞﺭ‬‫ﺎ‬‫ﺓﻫﻲﻋ‬ ‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬
‫ﺍ‬

149
 ‫‪.‬‬
‫ﺮﻑ‬ ‫ﻟﺼ‬‫ﺍ‬ ‫ﺃﺟﻞ‬ ‫ﻮﻝﻣﻦ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬ ‫ﺔﻣﺠ‬ ‫ﺘﺤ‬ ‫ﻔ‬ ‫ﺔﺑ‬ ‫ﻴﻄ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺘﻢﻓﺤ ﺺ‬ ‫‪.‬ﻳ‬‫ﺮ‬‫ﻜ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬
‫ﻷﺮ‬
‫ﺍﻣ‬ ‫ﻡ‬ ‫ﺰ‬‫ﻟ‬‫ﺍ‬
‫ﺫ‬‫‪،‬ﺇ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺘ‬‫ﻠﻰﻓ‬‫ﻣﻞﻋ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬ ‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻍ‬ ‫ﺮ‬‫ﻓ‬‫ﺎﻥﺇ‬‫ﻤ‬‫ﻟﻀ‬ ‫ﻊ‬‫ﻘﻄ‬ ‫ﺘ‬‫ﺓﻣ‬ ‫ﺮ‬‫ﻣﺞﻗﺴﻄ‬ ‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﻭﻉﻓﻲﺑ‬ ‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﺘﻢ‬‫ﺪﻳ‬ ‫‪.‬ﻗ‬‫‪3‬‬
‫ﺮﺿﻰ‬ ‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎ‬‫ﻬ‬
‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﺔﻳ‬‫ﻳﻀ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﺎﺻ‬ ‫ﺍﺕﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﺮﻭﺳ‬ ‫ﻛ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫(‬‫ﻗﻲ‬‫ﺍ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﻗﺴﻄ‬ ‫ﺔ)‬ ‫ﻴ‬‫ﺭﺟ‬ ‫ﺎ‬
‫ﺓﺧ‬ ‫ﺮ‬
‫‪.‬ﻗﺴﻄ‬ ‫‪4‬‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻳ‬‫ﺩ‬‫ﺍ‬‫ﺭ‬‫ﺎﻥﻻﺇ‬ ‫ﺇﻥﻛ‬‫ﻮﻱﻭ‬ ‫ﻔ‬‫ﻜﻞﻋ‬ ‫ﻮﻝﺑﺸ‬ ‫ﺒ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻬﻢ‬ ‫ﻨ‬‫ﻜ‬‫ﻤ‬‫ﻳﻦﻳ‬ ‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﻋﻲ‬ ‫ﻮ‬
‫ﻠ‬‫ﻟ‬‫ﺪ‬‫ﻗ‬ ‫ﺎ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺔ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻳﺐ‬ ‫ﺭ‬‫ﺪ‬‫ﻣﺞﺗ‬ ‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﺀﻓﻲﺑ‬ ‫ﺪ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺘﻢ‬ ‫‪،‬ﻳ‬ ‫ﻋﻲ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬ ‫ﺓ‬
‫ﺩ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺩ‬‫ﺮ‬‫ﻤﺠ‬ ‫‪.‬ﺑ‬‫‪5‬‬
‫ﺬ‬ ‫ﻴ‬
‫ﻔ‬‫ﻨ‬‫ﺘﻢﺗ‬ ‫‪.‬ﻳ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬‫ﺗ‬‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﻴﺞ‬ ‫ﻬ‬
‫ﺎﻋﻦﺗ‬ ‫ً‬
‫ﺜ‬‫ﺭﺑﺤ‬ ‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﻮﻝﺑﺸ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻠﺲ‬ ‫ﺎﺏﺑﺴ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺘﻢﻣ‬ ‫‪.‬ﻳ‬‫‪6‬‬
‫‪.‬‬
‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻊﻫ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﺒﺸ‬ ‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺒ‬‫ﺎﺳ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫‪Pr‬‬‫‪omot‬‬ ‫‪i‬‬
‫‪ngBowelFunct‬‬ ‫‪i‬‬‫‪on‬‬
‫‪1.Theabdomeni‬‬ ‫‪sassessedf‬‬ ‫‪ordi‬‬ ‫‪st‬‬ ‫‪ent‬‬ ‫‪i‬‬
‫‪onbyl‬‬ ‫‪i‬‬‫‪st‬‬ ‫‪eni‬‬‫‪ngf‬‬ ‫‪orbowel‬‬ ‫‪soundsand‬‬
‫‪measur‬‬ ‫‪i‬‬
‫‪ngt‬‬ ‫‪hegi‬‬ ‫‪r‬‬‫‪t‬‬‫‪hoft‬‬ ‫‪heabdomenwi‬‬ ‫‪t‬‬‫‪hat‬‬ ‫‪apemeasur‬‬ ‫‪e.‬‬
‫‪2.Commer‬‬ ‫‪ci‬‬‫‪al‬‬ ‫‪f‬‬
‫‪ecal‬‬ ‫‪col‬‬‫‪l‬‬‫‪ect‬‬ ‫‪i‬‬
‫‪onbagsar‬‬ ‫‪eav‬‬ ‫‪ai‬‬‫‪l‬‬‫‪abl‬‬ ‫‪ef‬‬ ‫‪orpat‬‬ ‫‪i‬‬
‫‪ent‬‬ ‫‪swi‬‬ ‫‪t‬‬‫‪hf‬‬ ‫‪ecal‬‬
‫‪i‬‬
‫‪ncont‬‬ ‫‪i‬‬‫‪nence.‬‬
‫‪3.Thenur‬‬ ‫‪semoni‬‬ ‫‪t‬‬‫‪or‬‬‫‪st‬‬ ‫‪henumberandconsi‬‬ ‫‪st‬‬ ‫‪encyofbowel‬‬ ‫‪mov‬‬ ‫‪ement‬‬ ‫‪sand‬‬
‫‪per‬‬‫‪f‬‬‫‪or‬‬ ‫‪msar‬‬ ‫‪ect‬‬ ‫‪al‬‬‫‪exami‬‬ ‫‪nat‬‬ ‫‪i‬‬‫‪onf‬‬ ‫‪orsi‬‬ ‫‪gnsoff‬‬ ‫‪ecal‬‬ ‫‪i‬‬‫‪mpact‬‬ ‫‪i‬‬
‫‪on.‬‬
‫‪4.St‬‬ ‫‪ool‬‬ ‫‪sof‬‬‫‪t‬‬‫‪ener‬‬ ‫‪smaybepr‬‬ ‫‪escr‬‬ ‫‪i‬‬‫‪bedandcanbeadmi‬‬ ‫‪ni‬‬‫‪st‬‬ ‫‪er‬‬‫‪edwi‬‬ ‫‪t‬‬‫‪ht‬‬ ‫‪ube‬‬
‫‪f‬‬‫‪eedi‬‬‫‪ngs.‬‬
‫‪5.Tof‬‬ ‫‪aci‬‬‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪at‬‬‫‪ebowel‬‬ ‫‪empt‬‬ ‫‪y‬‬‫‪i‬‬‫‪ng,‬‬ ‫‪agl‬‬ ‫‪y‬‬‫‪cer‬‬ ‫‪i‬‬
‫‪nsupposi‬‬ ‫‪t‬‬‫‪or‬‬‫‪ymaybei‬‬ ‫‪ndi‬‬ ‫‪cat‬‬ ‫‪ed.The‬‬
‫‪pat‬‬‫‪i‬‬‫‪entmayr‬‬ ‫‪equi‬‬ ‫‪r‬‬‫‪eanenemaev‬‬ ‫‪er‬‬ ‫‪yot‬‬ ‫‪herdayt‬‬ ‫‪oempt‬‬ ‫‪yt‬‬ ‫‪hel‬‬ ‫‪owercol‬‬ ‫‪on.‬‬
‫ﺀ‬‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﺰﻭﻇ‬ ‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﺗ‬
‫‪.‬‬‫ﺎﺱ‬ ‫ﻴ‬‫ﻳﻂﻗ‬ ‫ﺮ‬
‫ﺒﻄﻦﺑﺸ‬ ‫ﻟ‬‫ﺍ‬
‫ﻴﻂ‬ ‫ﺎﺱﻣﺤ‬ ‫ﻴ‬‫ﻗ‬‫ﺀﻭ‬ ‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﺍﺕ‬ ‫ﻮ‬‫ﺃﺻ‬ ‫ﻟﻰ‬ ‫ﺎﻉﺇ‬ ‫ﻤ‬‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﺒﻄﻦﻣﻦﺧﻼﻝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺥ‬ ‫ﻔ‬‫ﺘ‬‫ﻧ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬ ‫‪.‬ﻳ‬‫‪1‬‬
‫‪.‬‬‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺲ‬‫ﺮﺿﻰﺳ‬ ‫ﻤ‬‫ﻟ‬ ‫ﺓ‬‫ﺮ‬‫ﻓ‬‫ﻮ‬‫ﺘ‬‫ﺔﻣ‬ ‫ﻳ‬‫ﺭ‬‫ﺎ‬‫ﺘﺠ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬ ‫ﻤ‬‫ﺎﺱﺟ‬ ‫ﻴ‬‫ﻛ‬‫ﺃ‬‫‪.‬‬‫‪2‬‬
‫ﺭ‬‫ﺎ‬‫ﻧﺤﺸ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬ ‫ﺎﻋﻦﻋﻼ‬ ‫ً‬
‫ﺜ‬ ‫ﻴﻢﺑﺤ‬ ‫ﻘ‬‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻔﺤ ﺺ‬ ‫ﻡﺑ‬ ‫ﻮ‬‫ﻘ‬
‫ﺗ‬‫ﺀﻭ‬ ‫ﺎ‬
‫ﻌ‬ ‫ﻣ‬‫ﺍﻷ‬ ‫ﺎﺕ‬ ‫ﻛ‬‫ﺮ‬‫ﺎﻕﺣ‬ ‫ﺗﺴ‬ ‫ﺍ‬‫ﺩﻭ‬‫ﺪ‬ ‫ﺔﻋ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻗﺐ‬ ‫ﺍ‬‫ﺮ‬‫‪.‬ﺗ‬‫‪3‬‬
‫‪.‬‬‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻧ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﺎﻣ‬ ‫ﺅﻫ‬ ‫ﺎ‬‫ﻋﻄ‬ ‫ﻜﻦﺇ‬ ‫ﻤ‬‫ﻳ‬‫ﺯﻭ‬ ‫ﺍ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻨ‬‫ﻴ‬‫ﻠ‬
‫ﻜﻦﻭﺻﻒﻣ‬ ‫ﻤ‬‫‪.‬ﻳ‬‫‪4‬‬
‫ﺔﻛﻞ‬ ‫ﻴ‬‫ﺮﺟ‬‫ﺔﺷ‬ ‫ﻨ‬‫ﻘ‬‫ﻟﻰﺣ‬ ‫ﻳ ﺾﺇ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺝ‬‫ﺘ‬‫ﺪﻳﺤ‬ ‫‪.‬ﻗ‬‫ﻳﻦ‬ ‫ﺮ‬‫ﻠﺴ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﻴ‬‫ﻤ‬‫ﻡﺗﺤ‬ ‫ﺍ‬‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫‪،‬ﻳ‬ ‫ﺀ‬‫ﺎ‬
‫ﻌ‬‫ﻣ‬ ‫ﺍﻷ‬‫ﺍﻍ‬ ‫ﺮ‬‫ﻓ‬‫ﻴﻞﺇ‬‫ﻬ‬‫ﺘﺴ‬ ‫ﻟ‬‫‪.‬‬‫‪5‬‬
‫‪.‬‬‫ﻠﻲ‬ ‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻟ‬‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻎ‬‫ﻳ‬‫ﺮ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬‫ﻡ‬‫ﻮ‬‫ﻳ‬
‫‪Pr‬‬‫‪ov‬‬ ‫‪i‬‬‫‪di‬‬‫‪ngSensor‬‬ ‫‪ySt‬‬‫‪i‬‬‫‪mul‬‬ ‫‪at‬‬ ‫‪i‬‬‫‪on‬‬
‫‪1.Thenur‬‬ ‫‪set‬‬ ‫‪ouchesandt‬‬ ‫‪al‬‬‫‪kst‬‬ ‫‪ot‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entandencour‬‬ ‫‪agesf‬‬ ‫‪ami‬‬ ‫‪l‬‬
‫‪ymember‬‬ ‫‪s‬‬
‫‪andf‬‬ ‫‪r‬‬ ‫‪i‬‬
‫‪endst‬‬ ‫‪odoso.‬‬
‫‪2.Communi‬‬ ‫‪cat‬‬ ‫‪i‬‬
‫‪oni‬‬ ‫‪sext‬‬ ‫‪r‬‬‫‪emel‬‬ ‫‪yi‬‬ ‫‪mpor‬‬ ‫‪t‬‬‫‪antandi‬‬ ‫‪ncl‬‬ ‫‪udest‬‬ ‫‪ouchi‬‬ ‫‪ngt‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entand‬‬
‫‪spendi‬‬ ‫‪ngenought‬‬ ‫‪i‬‬‫‪mewi‬‬ ‫‪t‬‬‫‪ht‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entt‬‬ ‫‪obecomesensi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪v‬‬ ‫‪et‬‬ ‫‪ohi‬‬ ‫‪sorherneeds.‬‬
‫‪3.I‬‬‫‪ti‬‬‫‪sal‬‬ ‫‪soi‬‬ ‫‪mpor‬‬ ‫‪t‬‬
‫‪antt‬‬ ‫‪oav‬‬ ‫‪oi‬‬‫‪dmaki‬‬ ‫‪nganynegat‬‬ ‫‪i‬‬‫‪v‬‬ ‫‪ecomment‬‬ ‫‪saboutt‬‬ ‫‪he‬‬
‫‪pat‬‬‫‪i‬‬‫‪ent‬‬ ‫'‬
‫‪sst‬‬ ‫‪at‬‬‫‪usorpr‬‬ ‫‪ognosi‬‬ ‫‪si‬‬ ‫‪nt‬‬ ‫‪hepat‬‬ ‫‪i‬‬‫‪ent‬‬‫'‬‫‪spr‬‬ ‫‪esence.‬‬
‫‪4.Thenur‬‬ ‫‪seor‬‬ ‫‪i‬‬‫‪ent‬‬‫‪st‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entt‬‬ ‫‪ot‬‬ ‫‪i‬‬‫‪meandpl‬‬ ‫‪aceatl‬‬ ‫‪eastonceev‬‬ ‫‪er‬‬‫‪y8hour‬‬ ‫‪s.‬‬
‫‪5.Soundsf‬‬ ‫‪r‬‬‫‪om t‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪ent‬‬ ‫'‬
‫‪susual‬‬ ‫‪env‬‬ ‫‪i‬‬‫‪r‬‬‫‪onmentmaybei‬‬ ‫‪nt‬‬ ‫‪r‬‬‫‪oducedusi‬‬ ‫‪ngat‬‬ ‫‪ape‬‬
‫‪r‬‬‫‪ecor‬‬ ‫‪der‬‬‫‪.‬‬
‫‪6.Fami‬‬ ‫‪l‬‬
‫‪ymember‬‬ ‫‪scanr‬‬ ‫‪eadt‬‬ ‫‪ot‬‬ ‫‪hepat‬‬ ‫‪i‬‬‫‪entf‬‬ ‫‪r‬‬‫‪om af‬‬ ‫‪av‬‬‫‪or‬‬‫‪i‬‬‫‪t‬‬‫‪ebookandmay‬‬
‫‪suggestr‬‬ ‫‪adi‬‬‫‪oandt‬‬ ‫‪el‬‬
‫‪ev‬‬ ‫‪i‬‬
‫‪si‬‬ ‫‪onpr‬‬ ‫‪ogr‬‬ ‫‪amst‬‬ ‫‪hatt‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entpr‬‬ ‫‪ev‬‬ ‫‪i‬‬‫‪ousl‬‬ ‫‪yenj‬‬ ‫‪oy‬‬ ‫‪edasa‬‬
‫‪meansofenr‬‬ ‫‪i‬‬‫‪chi‬‬‫‪ngt‬‬ ‫‪heenv‬‬ ‫‪i‬‬‫‪r‬‬‫‪onmentandpr‬‬ ‫‪ov‬‬ ‫‪i‬‬‫‪di‬‬ ‫‪ngf‬‬ ‫‪ami‬‬ ‫‪l‬‬
‫‪i‬‬‫‪ari‬‬ ‫‪nput‬‬ ‫‪.‬‬
‫ﻟﺤﺴﻲ‬ ‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬ ‫ﻮ‬
‫ﺗ‬
‫‪.‬‬
‫ﻟﻚ‬‫ﺬ‬‫ﻡﺑ‬ ‫ﺎ‬‫ﻴ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺀﻋ‬ ‫ﺎ‬‫ﻗ‬‫ﺪ‬‫ﺍﻷﺻ‬ ‫ﺓﻭ‬‫ﺮ‬ ‫ﺍﻷﺳ‬ ‫ﺩ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺃ‬‫ﻊ‬‫ﺗﺸﺠ‬ ‫ﻪﻭ‬ ‫ﻌ‬‫ﺪﺙﻣ‬ ‫ﺘﺤ‬ ‫ﺗ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﺲ‬ ‫‪.‬ﺗﻼ‬ ‫‪1‬‬
‫‪.‬‬‫ﻪ‬‫ﺗ‬‫ﺎ‬
‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺎﻻﺣ‬ ‫ﺎً‬
‫ﺳ‬ ‫ﺒﺢﺣﺴ‬ ‫ﻴﺼ‬ ‫ﻟ‬‫ﻪ‬ ‫ﻌ‬‫ﻑﻣ‬‫ﺎٍ‬ ‫ﻗﺖﻛ‬ ‫ﺀﻭ‬ ‫ﺎ‬‫ﻗﻀ‬ ‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬‫ﺍ‬‫ﻤﺲ‬ ‫ﻟ‬‫ﻤﻦ‬ ‫ﺘﻀ‬ ‫ﻳ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﺎ‬‫ﻐ‬‫ﻠ‬
‫ﻟ‬ ‫ﻬﻢ‬‫ﺎﻝﻣ‬ ‫ﻻﺼ‬‫ﺍﺗ‬ ‫‪.‬‬‫‪2‬‬
‫ﺮ ﺽﻓﻲ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬ ‫ﺎﺕﺳ‬ ‫ﻌ‬‫ﻗ‬‫ﻮ‬‫ﻭﺗ‬‫ﺃ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺣﺔ‬
‫ﻟ‬‫ﻮﻝ ﺎ‬ ‫ﺔﺣ‬ ‫ﻴ‬‫ﺒ‬‫ﻠ‬‫ﺎﺕﺳ‬ ‫ﻘ‬‫ﻴ‬‫ﻠ‬‫ﻌ‬‫ﺄﻱﺗ‬‫ﺀﺑ‬ ‫ﺩﻻ‬ ‫ﺍﻹ‬ ‫ﻨﺐ‬‫ﺎﺗﺠ‬ ‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫ﻬﻢ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫‪.‬ﻣﻦ‬ ‫‪3‬‬
‫‪.‬‬‫ﻳﺾ‬ ‫ﺮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬ ‫ﻭﺟ‬
‫‪.‬‬
‫ﺎﺕ‬ ‫ﺎﻋ‬‫ﻷﻞﻛﻞ‪8‬ﺳ‬ ‫ﺍﻗ‬ ‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺪ‬‫ﺍﺣ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﺎﻥﻣ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖﻭ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬ ‫ﻟﻰ‬‫ﻳ ﺾﺇ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﺘ‬‫ﺔﺑ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﻮ‬‫ﻘ‬‫‪.‬ﺗ‬‫‪4‬‬
‫‪.‬‬‫ﻴﻞ‬‫ﺯﺗﺴﺠ‬ ‫ﺎ‬‫ﻬ‬‫ﻡﺟ‬ ‫ﺍ‬‫ﺪ‬ ‫ﺘﺨ‬‫ﺎﺳ‬ ‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺌ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬ ‫ﺍﺕﻣﻦ‬ ‫ﻮ‬‫ﺃﺻ‬ ‫ﺎﻝ‬‫ﺩﺧ‬ ‫ﻜﻦﺇ‬ ‫ﻤ‬‫‪.‬ﻳ‬‫‪5‬‬
‫ﺎﻥ‬‫ﺔﻛ‬ ‫ﻴ‬‫ﻧ‬‫ﻮ‬‫ﻳ‬
‫ﺰ‬‫ﻔ‬‫ﻠ‬‫ﺗ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﺍﻋ‬‫ﺫ‬‫ﻣﺞﺇ‬ ‫ﺍ‬‫ﺮ‬
‫ﻮﻥﺑ‬ ‫ﺮﺣ‬ ‫ﺘ‬‫ﻘ‬
‫ﺪﻳ‬ ‫ﻗ‬‫‪،‬ﻭ‬ ‫ﻔﻀﻞ‬ ‫ﺎﺏﻣ‬ ‫ﺘ‬‫ﻳ ﺾﻣﻦﻛ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺓ‬‫ﺀ‬ ‫ﺍ‬‫ﺮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺩ‬ ‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﻜﻦﻷ‬ ‫ﻤ‬‫‪.‬ﻳ‬‫‪6‬‬
‫‪.‬‬‫ﺔ‬‫ﻓ‬‫ﻮ‬‫ﻟ‬‫ﺄ‬‫ﺪﺧﻼﺕﻣ‬ ‫ﻳﻢﻣ‬‫ﺪ‬‫ﻘ‬ ‫ﺗ‬‫ﺔﻭ‬ ‫ﺌ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬ ‫ﺍ‬
‫ﺮ‬‫ﺛ‬‫ﺔﻹ‬ ‫ﻠ‬
‫ﻴ‬ ‫ﻮﺳ‬ ‫ﺎﻛ‬ ‫ً‬
‫ﻘ‬‫ﺑ‬
‫ﺎ‬‫ﺎﺳ‬ ‫ﻬ‬‫ﻊﺑ‬ ‫ﺘ‬‫ﻤ‬‫ﺘ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬

‫‪150‬‬
7.Whenar ousi ngf rom coma, manypat i
ent sexper i
enceaper iodofagi tati
on,
i
ndi cat i
ngt hatt heyar ebecomi ngmor eawar eoft heirsurroundi ngsbutst i
ll
cannotr eactorcommuni cateinanappr opri
atefashi on.Althought hisis
disturbingf ormanyf ami l
ymember s,i
tisact uall
yaposi ti
veclinical sign.Atthis
ti
me, itisnecessar yt o:
Minimi zest imul ati
onbyl imitingbackgr oundnoi ses
Hav ingonl yoneper sonspeakt othepat i
entatat i
me
Givingt hepat iental ongerper i
odoft i
met orespond
Allowingf orf requentr estorqui ettimes.
8.Af terthepat i
enthasr egainedconsci ousness, videotapedf ami lyorsoci al
ev entsmayassi stthepat ientinr ecognizingfami lyandf ri
endsandal lowhi m or
hert oexper i
encemi ssedev ents.
‫ﻬﻢ‬‫ﻧ‬‫ﺃ‬‫ﻟﻰ‬‫ﺮﺇ‬‫ﻴ‬‫ﺎﻳﺸ‬‫ﻤ‬‫ﻣ‬، ‫ﻧﺎﻻﺕ‬‫ﻻﻌ‬
‫ﻣﺍ ﻔ‬‫ﺓﻦ‬ ‫ﺮ‬‫ﺘ‬‫ﺮﺿﻰﻣﻦﻓ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻧﻲ‬‫ﺎ‬‫ﻌ‬
‫ﻳ‬،‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﺒ‬‫ﻴ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﻅﻣﻦ‬ ‫ﻘ‬‫ﻴ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﺪ‬‫ﻨ‬
‫ﻋ‬. 7
.
‫ﺔ‬ ‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬‫ﺔﻣ‬ ‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﺍﺻﻞﺑﻄ‬ ‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻋﻞ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﻳﻦﻋ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬‫ﺮﻗ‬‫ﻴ‬‫ﻮﻥﻏ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻻﺰ‬
‫ﻬﻢ ﻳ‬ ‫ﻨ‬‫ﻜ‬‫ﻟ‬
‫ﻬﻢﻭ‬ ‫ﻴﻄ‬‫ﻤﺤ‬ ‫ﺎﺑ‬
ً‫ﻴ‬‫ﺮﻭﻋ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺍ‬‫ﻮ‬
‫ﺒﺤ‬ ‫ﺃﺻ‬
‫ﻓﻲ‬. ‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﻳﺠ‬‫ﺔﺇ‬ ‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻼﺔﺳ‬ ‫ﻊﻋ ﻣ‬ ‫ﻗ‬‫ﺍ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻪﻓﻲ‬ ‫ﻧ‬
‫ﺃ‬‫ﺇﻻ‬،‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺩ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺃ‬‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﻋﺞ‬ ‫ﺰ‬‫ﺮﻣ‬‫ﻣ‬‫ﺃ‬‫ﺍ‬‫ﺬ‬‫ﺃﻥﻫ‬ ‫ﻏﻢﻣﻦ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬
:
‫ﺭﻱ‬ ‫ﻭ‬
‫ﺮ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻣﻦ‬، ‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺍ‬‫ﺬ‬‫ﻫ‬
‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻮﺿ‬ ‫ﺪﻣﻦ ﺿ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺰﻋﻦﻃ‬ ‫ﻴ‬‫ﻔ‬‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞﻣﻦ‬‫ﻗ‬
‫ﺓ‬‫ﺮ‬‫ﻳ ﺾﻓﻲﻛﻞﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﻰ‬‫ﺪﺙﺇ‬‫ﺘﺤ‬ ‫ﻘﻂﻳ‬‫ﺪﻓ‬ ‫ﺍﺣ‬‫ﺩﺷﺨ ﺺﻭ‬ ‫ﻮ‬‫ﻭﺟ‬
‫ﺩ‬‫ﺮ‬
‫ﻠ‬‫ﻟ‬‫ﻮﻝ‬‫ﺃﻃ‬ ‫ﺓ‬‫ﺮ‬‫ﺘ‬‫ﻳ ﺾﻓ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﺇﻋﻄ‬
.‫ﺀ‬‫ﻭ‬‫ﺪ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻗ‬‫ﻭ‬
‫ﺃ‬‫ﻭ‬ ‫ﺃ‬‫ﺓ‬
‫ﺭ‬‫ﺮ‬ ‫ﻜ‬
‫ﺘ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺡﺑ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻳ‬‫ﺪ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻠ‬‫ﻤﺴﺠ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﻋ‬‫ﻤ‬‫ﺘ‬
‫ﺃﺍﻻﺟ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻠ‬‫ﺋ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺙ‬ ‫ﺪ‬‫ﺍﻷﺣ‬‫ﺪ‬‫ﺎﻋ‬‫ﺪﺗﺴ‬ ‫ﻗ‬،‫ﻪ‬‫ﻴ‬‫ﻋ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻴ‬
‫ﻌ‬‫ﺘ‬‫ﺃﻥﻳﺴ‬ ‫ﺪ‬‫ﻌ‬‫ﺑ‬.8
.‫ﺔ‬‫ﺘ‬‫ﺋ‬
‫ﺎ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺙ‬ ‫ﺪ‬‫ﺍﻷﺣ‬ ‫ﺔ‬‫ﺑ‬
‫ﺮ‬‫ﺘﺠ‬‫ﺎﺑ‬‫ﻬ‬‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻟ‬‫ﺎﺡ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺀﻭ‬ ‫ﺎ‬
‫ﻗ‬‫ﺪ‬‫ﺍﻷﺻ‬‫ﺔﻭ‬ ‫ﻠ‬‫ﺋ‬‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬

Meet ingt heFami l

y'sNeeds
1.Tohel pf ami lymember smobi l
izer esourcesandcopi ngski l
l
s, t
he
nurser einf orcesandcl ari
fi
esi nfor mat i
onaboutt hepat ient'
s
condition.
2.Per mi t
st hef amilytobei nvolv edi ncar e.
3.Listenst oandencour agesv ent il
ationoff eel
ingsandconcer ns
whi l
esuppor ti
ngdeci sionmaki ngaboutposthospi tal
ization
managementandpl acement .
4.Fami liesmaybenef i
tf r
om par ti
cipationinsuppor tgroupsof fer
ed
throught hehospi t
al,rehabil
itationf acili
ty,orcommuni ty
organi zat ions.
5.Insomeci rcumst ances, t
hef ami lymayneedt ofacet hedeathof
theirl
ov edone.Whendi scussingapat ientwhoi sbraindeadwi th
fami l
ymember s,i
tisimpor tantt opr ovideaccurate,ti
mel y,
under st andabl e,andconsi stenti nformat ion.
‫ﺓ‬
‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬ ‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻠ‬‫ﺗ‬
‫ﺎﺕ‬
‫ﻣ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺢ‬‫ﻮﺿ‬‫ﺗ‬‫ﺰﻭ‬‫ﻳ‬
‫ﺰ‬‫ﻌ‬‫ﺘ‬
‫ﺔﺑ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬
‫ﺗ‬،‫ﻠﻢ‬‫ﻗ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬
‫ﻬ‬‫ﻣ‬‫ﺩﻭ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻠﻰﺣﺸ‬ ‫ﺓﻋ‬‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺩ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺃ‬‫ﺓ‬‫ﺪ‬
‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻟ‬
.1
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻮﻝ ﺎ‬ ‫ﺣ‬
.‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻛ‬‫ﺭ‬
‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺎ‬‫ﺓﺑ‬‫ﺮ‬‫ﻟﻸﺳ‬‫ﻤﺢ‬ ‫ﻳﺴ‬.2
‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬‫ﺓﻣ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺄﻥﺇ‬
‫ﺭﺑﺸ‬‫ﺍ‬‫ﺮ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺫ‬‫ﺎ‬
‫ﺗﺨ‬‫ﺍ‬‫ﻊﺩﻋﻢ‬‫ﻭﻑﻣ‬ ‫ﺎ‬
‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺮﻭ‬‫ﺎﻋ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺲﻋﻦ‬ ‫ﻔ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻊﻋ‬‫ﻳﺸﺠ‬‫ﻟﻰﻭ‬ ‫ﻊﺇ‬‫ﻤ‬‫ﺘ‬‫ﻳﺴ‬.3
.
‫ﻪ‬‫ﺍﻋ‬‫ﺪ‬‫ﻳ‬
‫ﺇ‬‫ﻔﻰﻭ‬ ‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻓﻖﺇﻋ‬‫ﺮ‬‫ﻭﻣ‬‫ﺃ‬‫ﻔﻰ‬‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦﺧﻼﻝ‬ ‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻋﻢ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﻋ‬‫ﻤ‬‫ﺔﻓﻲﻣﺠ‬‫ﻛ‬‫ﺭ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﻼﺕﻣﻦ‬ ‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻴ‬‫ﻔ‬‫ﺘ‬
‫ﺪﺗﺴ‬ ‫ﻗ‬.4
.‫ﺔ‬‫ﻴ‬
‫ﻌ‬‫ﻤ‬‫ﺘ‬‫ﻤﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻤ‬
‫ﻨﻈ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻞ‬‫ﺄﻫ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬

151
 ‫ﻊ‬
‫ﺎﻣ‬ً
‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﻴﺖﺩ‬
‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﺔﻣ‬
‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﺪﻣ‬ ‫ﻨ‬
‫ﻋ‬.‫ﺓﻣﻦﺗﺤﺐ‬
‫ﺎ‬‫ﻓ‬‫ﺔﻭ‬
‫ﻬ‬‫ﺍﺟ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬
‫ﺍﻷﺳ‬‫ﺎﺝ‬‫ﺘ‬‫ﺪﺗﺤ‬
‫ﻗ‬، ‫ﻭﻑ‬‫ﺮ‬‫ﻟﻈ‬
‫ﺍ‬‫ﻌﺾ‬‫ﻓﻲﺑ‬.5
.
‫ﺔ‬‫ﻘ‬‫ﺘﺴ‬
‫ﻣ‬‫ﺔﻭ‬‫ﻣ‬‫ﻮ‬
‫ﻬ‬‫ﻔ‬‫ﻣ‬‫ﺎﺳﺐﻭ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬‫ﺔﻭ‬
‫ﻘ‬‫ﻴ‬‫ﻗ‬
‫ﺎﺕﺩ‬ ‫ﻣ‬
‫ﻮ‬‫ﻠ‬‫ﻌ‬
‫ﻳﻢﻣ‬‫ﺪ‬‫ﻘ‬‫ﻬﻢﺗ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻣﻦ‬،‫ﻪ‬‫ﺗ‬
‫ﺮ‬‫ﺃﺳ‬‫ﺩ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺃ‬

Monit oringandManagi ngPot ent ialCompl icati

ons
Thelongert heper i
odofunconsci ousness, thegr eaterther i
skfor
compl icat i
ons.
1.Vit
al signsandr espi ratoryf unct ionar emoni t
or edcloselytodetectanysi gns
ofrespi ratoryf ail
ur eordi stress.
2.Total bloodcountandar t
erialbl oodgasmeasur ementsar eassessedt o
determi newhet hert herear eadequat eredbl oodcel l
stocar ryoxygenand
whetherv ent i
lationi sef fective.
3.Chestphy siother apyandsuct ioni ngarei niti
atedt opreventrespiratory
compl icat i
onssuchaspneumoni a.
4.I
fpneumoni adev el ops, culturesar eobt ai
nedt oi dentif
yt heorganism sot hat
appropr iateant ibioticscanbeadmi nistered.
5.Thepat i
entwi thal teredLOCi smoni t
oredcl osel yforevidenceofi mpaired
ski
ni ntegr it
y ,
andst rategiest opr ev entskinbr eakdownandpr essureulcersar e
conti
nuedt hroughal l phasesofcar e, i
ncludinghospi t
ali
zation,r
ehabi l
it
ati
on,
andhomecar e.

‫ﺔ‬‫ﻠ‬‫ﻤ‬‫ﺘ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺔﻭ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬
.‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﺮﺣ‬ ‫ﺩﺧﻄ‬ ‫ﺍ‬
‫ﺯ‬،‫ﻋﻲ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﺓﻓ‬‫ﺮ‬‫ﺘ‬‫ﻟﺖﻓ‬ ‫ﺎ‬
‫ﺎﻃ‬ ‫ﻤ‬‫ﻠ‬
‫ﻛ‬
‫ﻭ‬‫ﺃ‬‫ﻔﺸﻞ‬‫ﻟ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﺃﻱﻋﻼ‬ ‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬‫ﻟ‬‫ﺜﺐ‬‫ﻔﺴﻲﻋﻦﻛ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻭﻇ‬ ‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﺘﻢﻣ‬ ‫ﻳ‬.1
.‫ﻔﺴﻲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻖﻓﻲ‬ ‫ﺿ‬
‫ﺀ‬
‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﻡﺣ‬ ‫ﺎﺩ‬
‫ﻳ‬‫ﺎﻙﺧﻼ‬ ‫ﻨ‬‫ﻧﺖﻫ‬‫ﺎ‬‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬
‫ﺪﻣ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﻧﻲ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬
‫ﻟﺸ‬ ‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬
‫ﺎﺕﻏ‬ ‫ﺎﺳ‬‫ﻴ‬
‫ﻗ‬‫ﻠﻲﻭ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻌ‬‫ﻴﻢﺗ‬‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬‫ﻳ‬.2
.‫ﺎ‬
‫ﺔ‬‫ﻟ‬‫ﻌ‬‫ﺔﻓ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬ ‫ﻧﺖ‬‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬‫ﻣ‬‫ﻴﻦﻭ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻤﻞ‬‫ﻟﺤ‬ ‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻛ‬
.‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺜﻞ‬‫ﻔﺴﻲﻣ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬‫ﺔﻣﻦﻣﻀ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﻔﻂ‬ ‫ﻟﺸ‬‫ﺍ‬
‫ﺭﻭ‬‫ﺪ‬ ‫ﻠﺼ‬‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬
‫ﺃ‬‫ﺪ‬‫ﺑ‬.3
‫ﻜﻦ‬‫ﻤ‬‫ﻴﺚﻳ‬ ‫ﻟﺤﻲﺑﺤ‬‫ﺍ‬‫ﺋﻦ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬
‫ﺘ‬‫ﻠ‬‫ﻟ‬
‫ﺭﻉ‬‫ﺍ‬‫ﺰ‬‫ﻠﻰﻣ‬‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬‫ﺍ‬ ‫ﺘﻢ‬‫ﻳ‬،‫ﻮﻱ‬‫ﺋ‬‫ﺎﺏﺭ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﺙ‬‫ﺪ‬‫ﺣﺔﺣ‬‫ﻟ‬‫ﻓﻲ ﺎ‬. 4
.‫ﺔ‬‫ﺒ‬
‫ﺎﺳ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻋﻄ‬‫ﺇ‬
،‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻌﻒﺳ ﻣ‬ ‫ﻠﻰ ﺿ‬‫ﻴﻞﻋ‬‫ﻟ‬
‫ﺎﻋﻦﺩ‬ً
‫ﺜ‬‫ﺜﺐﺑﺤ‬ ‫ﺮﻋﻦﻛ‬ ‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
LOC‫ﺎـ‬ ‫ﺎﺏﺑﻝ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬‫ﺮ‬
‫ﺘﻢﻣ‬ ‫ﺗ‬.5
‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬،‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬
‫ﻊﻣ‬ ‫ﻴ‬
‫ﻤ‬‫ﻐﻂﺧﻼﻝﺟ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺮﺡ‬‫ﻗ‬‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺮ‬‫ﻜﺴ‬ ‫ﻊﺗ‬‫ﻨ‬‫ﺎﺕﻣ‬ ‫ﻴ‬‫ﻴﺠ‬‫ﺗ‬‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺍﺳ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺗﺴ‬‫ﻭ‬
.‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺰ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞﻭ‬ ‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﺇ‬‫ﻔﻰﻭ‬‫ﺘﺸ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻓﻲ‬

6.Factorst hatcontri
but etoimpai redski nintegr
ity(eg,incontinence,
i
nadequat edi et
aryintake,pressur eonbonypr ominences, edema)ar e
addressed.
7.Ifpressur eul
cersdev elop,strategiestopr omot eheal ingareunder t
aken.
8.Careist akentopr eventbact erialcontami nati
onofpr essureulcers,which
mayl eadtosepsi sandsept i
cshock.
9.Thepat i
entshoul dal sobemoni t
oredf orsignsandsy mpt omsofdeepv ein
thrombosis( DVT).
10.Pat i
entswhodev elopDVTar eatr i
skf orpulmonar yembol ism.Pr ophylaxi
s
suchassubcut aneoushepar inshoul dbepr escribedifnotcont r
aindi
cated.
11.Thigh-highelasti
ccompr essionst ockingsshouldal sobepr escri
bedto
reducether iskforclotformat i
on.

‫ﻮﻝ‬
‫ﺪﺧ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﻔ‬
‫ﻡﻛ‬‫ﺪ‬
‫ﻭﻋ‬،
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬‫ﺜﻞﺳ‬ ‫ﻣ‬
)‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﺔﺳ ﻣ‬‫ﻗ‬
‫ﺎ‬‫ﻋ‬‫ﻬﻢﻓﻲﺇ‬
‫ﺘﻲﺗﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺘﻢﺗ‬
‫ﻳ‬.6
.
(‫ﺔ‬‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬
‫ﻮ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻐﻂﻋ‬‫ﻟﻀ‬‫ﺍ‬
‫ﻭ‬، ‫ﺋﻲ‬
‫ﺍ‬‫ﺬ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬
.
‫ﺀ‬‫ﺎ‬‫ﻔ‬
‫ﻟﺸ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺎﺕ‬‫ﻴ‬
‫ﻴﺠ‬‫ﺗ‬‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺍﺳ‬‫ﺫ‬‫ﺎ‬
‫ﺗﺨ‬‫ﺍ‬
‫ﺘﻢ‬‫ﻳ‬،‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺮﺣ‬‫ﻘ‬‫ﺭﺗ‬‫ﻮ‬
‫ﻬ‬‫ﺣﺔﻇ‬
‫ﻟ‬‫ﻓﻲ ﺎ‬.7

152
 ‫ﺍﻹ‬
‫ﺔ‬‫ﻣ‬‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻦ‬‫ﻌ‬‫ﻟﻰﺗ‬
‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺪﺗ‬‫ﺘﻲﻗ‬‫ﻟ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬
‫ﺮﺣ‬‫ﻣﻲﻣﻦﻗ‬ ‫ﻮ‬
‫ﺛ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻮﺙ‬‫ﻠ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺭ‬‫ﺬ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻮﺧﻲ‬‫‪.‬ﺗ‬‫‪8‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺘ‬
‫ﻧ‬
‫‪.‬‬
‫(‬‫ﺔ)‪DVT‬‬ ‫ﻘ‬‫ﻴ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺩ‬ ‫ﺭ‬
‫ﻭ‬‫ﺍﻷ‬‫ﻠﻂ‬‫ﺍ ﺽﺗﺠ‬‫ﺮ‬‫ﺃﻋ‬
‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﺎﻋﻦﻋﻼ‬ ‫ً‬
‫ﺜ‬‫ﻳ ﺾﺑﺤ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻣ‬‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫‪.‬ﻳﺠﺐ‬‫‪9‬‬
‫‪.‬ﻳﺠﺐ‬‫ﻮﻱ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺎﻻ‬‫ﺔﺑ‬
‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬
‫ﻟﺨﻄ‬ ‫ﻮﻥ‬‫ﺮﺿ‬‫ﻌ‬‫ﺔﻣ‬‫ﻘ‬‫ﻴ‬‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻠﻄ‬
‫ﻮﻥﺑﺠ‬‫ﺑ‬‫ﺎ‬
‫ﻳﻦﻳﺼ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪10‬‬
‫ﻧ‪.‬‬
‫ﻼﺎ‬
‫ﺘﻢﺑﻄ ﻬ‬‫ﻟﻢﻳ‬‫ﺍ‬‫ﺫ‬
‫ﺪﺇ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻳﻦﺗﺤﺖ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﺔﻣ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬
‫‪.‬‬
‫ﺔ‬‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺮﺗ‬
‫ﺎﻃ‬‫ﻴﻞﻣﺨ‬ ‫ﻠ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﻳﻦ‬‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬‫ﻧ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺎﻏﻄ‬‫ﻟﻀ‬‫ﺍ‬‫ﺭﺏ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺎﻭﺻﻒ‬ ‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫‪.‬ﻳﺠﺐ‬‫‪11‬‬
‫‪Ev‬‬‫‪al‬‬
‫‪uat‬‬ ‫‪i‬‬
‫‪on:‬‬
‫‪Expect‬‬‫‪edPat‬‬ ‫‪i‬‬
‫‪entOut‬‬‫‪comes:‬‬
‫‪Expect‬‬‫‪edpat‬‬‫‪i‬‬‫‪entout‬‬
‫‪comesmayi‬‬ ‫‪ncl‬‬
‫‪udet‬‬‫‪hef‬‬‫‪ol‬‬
‫‪l‬‬‫‪owi‬‬‫‪ng:‬‬
‫‪1.Mai‬‬‫‪nt‬‬‫‪ai‬‬‫‪nscl‬‬‫‪earai‬‬
‫‪r‬‬‫‪wayanddemonst‬‬‫‪r‬‬
‫‪at‬‬‫‪esappr‬‬‫‪opr‬‬‫‪i‬‬
‫‪at‬‬‫‪ebr‬‬
‫‪eat‬‬
‫‪h‬‬
‫‪sounds‬‬
‫‪2.Ex‬‬‫‪per‬‬‫‪i‬‬
‫‪encesnoi‬‬ ‫‪nj‬‬
‫‪ur‬‬‫‪i‬‬
‫‪es‬‬
‫‪3.At‬‬
‫‪t‬‬‫‪ai‬‬
‫‪nsormai‬‬
‫‪nt‬‬‫‪ai‬‬
‫‪nsadequat‬‬
‫‪ef‬‬‫‪l‬‬
‫‪ui‬‬‫‪dbal‬‬
‫‪ance‬‬
‫‪‬‬
‫‪‬‬‫‪Hasnocl‬‬
‫‪i‬‬‫‪ni‬‬
‫‪cal‬‬‫‪si‬‬
‫‪gnsorsy‬‬‫‪mpt‬‬‫‪omsofdehy‬‬‫‪dr‬‬‫‪at‬‬
‫‪i‬‬‫‪on‬‬
‫‪Demonst‬‬
‫‪r‬‬‫‪at‬‬
‫‪esnor‬‬‫‪mal‬‬‫‪r‬‬‫‪angeofser‬‬
‫‪um el‬‬
‫‪ect‬‬
‫‪r‬‬‫‪ol‬‬‫‪y‬‬
‫‪t‬‬‫‪es‬‬
‫‪Hasnocl‬‬
‫‪i‬‬‫‪ni‬‬
‫‪cal‬‬
‫‪si‬‬‫‪gnsorsy‬‬‫‪mpt‬‬‫‪omsofov‬‬‫‪erhy‬‬‫‪dr‬‬‫‪at‬‬
‫‪i‬‬‫‪on‬‬
‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬‫‪:‬‬
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻌ‬
‫ﻗ‬‫ﻮ‬ ‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫‪:‬‬
‫ﻠﻲ‬‫ﺎﻳ‬‫ﺮﺿﻰﻣ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﻌ‬‫ﻗ‬ ‫ﻮ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫‪:‬ﺪﺗﺸ‬
‫ﻗ‬
‫ﺔ‪1.‬‬
‫ﺒ‬‫ﺎﺳ‬
‫ﻨ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺲ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﻮ‬‫ﺃﺻ‬ ‫ﺮ‬
‫ﻬ‬‫ﻳﻈ‬‫ﺎﻭ‬
‫ً‬
‫ﻔ‬‫ﻴ‬‫ﺀﻧﻈ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﻠﻰﻣﺠ‬ ‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﻳﺤ‬
‫ﺎﺕ‪2.‬‬‫ﺑ‬‫ﺎ‬‫ﺭﺏﻻﺇﺻ‬ ‫ﺎ‬
‫ﺗﺠ‬
‫ﻓﻲ‪3.‬‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯﻥ‬
‫ﺍ‬‫ﻮ‬‫ﻠﻰﺗ‬‫ﻓﻆﻋ‬ ‫ﺎ‬‫ﻭﻳﺤ‬‫ﺃ‬‫ﻘﻖ‬‫ﻳﺤ‬
‫ﺎﻑ •‬‫ﻔ‬‫ﻠﺠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻜ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻠ‬
‫ﻛ‬‫ﺍ ﺽﺇ‬‫ﺮ‬‫ﺃﻋ‬‫ﻭ‬‫ﺃ‬‫ﺎﺕ‬‫ﻣ‬‫ﻪﻋﻼ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟ‬‫ﻴﺲ‬ ‫ﻟ‬
‫ﻡ•‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻝﻓﻲ‬‫ﺎ‬‫ﻬ‬‫ﻜ‬‫ﻠ‬
‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺎﻕ‬‫ﻨﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺿﺢ‬ ‫ﻳ‬
‫ﻴﺐ•‬‫ﺮﻃ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺰ‬‫ﻟ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﺃﻋ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﺎﺕﺳ‬ ‫ﻣ‬‫ﻪﻋﻼ‬ ‫ﻴ‬‫ﻠ‬
‫ﺮﻋ‬‫ﻬ‬‫ﻻﺗﻈ‬
‫‪4.Achi‬‬‫‪ev‬‬‫‪esheal‬‬‫‪t‬‬‫‪hyor‬‬ ‫‪al‬‬‫‪mucousmembr‬‬ ‫‪anes‬‬
‫‪5.Mai‬‬‫‪nt‬‬‫‪ai‬‬‫‪nsnor‬‬‫‪mal‬‬ ‫‪ski‬‬‫‪ni‬‬‫‪nt‬‬
‫‪egr‬‬‫‪i‬‬
‫‪t‬‬‫‪y‬‬
‫‪6.Hasnocor‬‬ ‫‪neal‬‬‫‪i‬‬‫‪r‬‬‫‪r‬‬
‫‪i‬‬‫‪t‬‬
‫‪at‬‬‫‪i‬‬
‫‪on‬‬
‫‪7.At‬‬‫‪t‬‬
‫‪ai‬‬‫‪nsormai‬‬ ‫‪nt‬‬‫‪ai‬‬
‫‪nst‬‬‫‪her‬‬‫‪mor‬‬‫‪egul‬‬‫‪at‬‬‫‪i‬‬
‫‪on‬‬
‫‪8.Hasnour‬‬ ‫‪i‬‬
‫‪nar‬‬‫‪yr‬‬‫‪et‬‬‫‪ent‬‬‫‪i‬‬
‫‪on‬‬
‫‪9.Hasnodi‬‬ ‫‪ar‬‬‫‪r‬‬‫‪heaorf‬‬ ‫‪ecal‬‬‫‪i‬‬
‫‪mpact‬‬‫‪i‬‬‫‪on‬‬
‫‪10.Recei‬‬‫‪v‬‬‫‪esappr‬‬ ‫‪opr‬‬‫‪i‬‬
‫‪at‬‬‫‪esensor‬‬‫‪yst‬‬‫‪i‬‬‫‪mul‬‬‫‪at‬‬‫‪i‬‬
‫‪on‬‬

‫ﻔﻢ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﺎﻃ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺍﻷﻏﺸ‬‫ﺔ‬‫ﻘﻖ ﺻﺤ‬‫‪.‬ﻳﺤ‬‫‪4‬‬
‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬‫ﻓﻆﻋ‬ ‫ﺎ‬
‫‪.‬ﻳﺤ‬‫‪5‬‬
‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺞ‬‫ﻬ‬‫ﻪﺗ‬‫ﻳ‬
‫ﺪ‬‫ﻟ‬‫ﺪ‬‫ﻮﺟ‬‫‪.‬ﻻﻳ‬‫‪6‬‬
‫ﺭﻱ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﻭﻳﺤ‬‫ﺃ‬‫ﻘﻖ‬‫‪.‬ﻳﺤ‬‫‪7‬‬
‫ﻟﻲ‬‫ﻮ‬‫ﺎﺱﺑ‬‫ﺒ‬‫ﺘ‬‫ﺍﺣ‬‫ﻪ‬‫ﻳ‬
‫ﺪ‬‫ﻟ‬‫ﻴﺲ‬ ‫ﻟ‬‫‪.‬‬
‫‪8‬‬
‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﻧﺤﺸ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻝ‬‫ﻹﻬ‬
‫ﻣﺍ ﺳ‬‫ﻧﻲ ﻦ‬‫ﺎ‬
‫ﻌ‬‫‪.‬ﻻﻳ‬‫‪9‬‬
‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﺤﺴﻲ‬ ‫ﺍ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻰ‬‫ﻠ‬‫ﺘ‬
‫‪.‬ﻳ‬‫‪10‬‬

‫‪11.Fami‬‬
‫‪l‬‬
‫‪ymember‬‬
‫‪scopewi‬‬
‫‪t‬‬‫‪hcr‬‬
‫‪i‬‬‫‪si‬‬
‫‪s‬‬

‫‪153‬‬
 Verbalizef earsandconcer ns
Parti
cipatei npat i
ent'
scareandpr ovi
desensor ysti
mul ationbyt alki
ngand
touching
12.Pat ientisf r
eeofcompl icati
ons
Hasar terialbloodgasv al
uesorO2sat ur
ationlevel
swi thinnor mal r
ange
Displaysnosi gnsorsympt omsofpneumoni a
Exhibitsintactskinoverpressureareas
Doesnotdev elopDVTorpul monar yembolism (PE)
‫ﺔ‬
‫ﻣ‬‫ﺯ‬‫ﻣﺍﻷ‬‫ﻣﻞ ﻊ‬ ‫ﺎ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺩ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺃ‬
.11
‫ﻭﻑ‬ ‫ﺎ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻑﻭ‬ ‫ﺎ‬
‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺮﻋﻦ‬‫ﻴ‬‫ﺒ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬•
‫ﻤﺲ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬
‫ﺪﺙﻭ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻖ‬‫ﺮ‬‫ﻟﺤﺴﻲﻋﻦﻃ‬ ‫ﺍ‬
‫ﺰ‬ ‫ﻴ‬
‫ﻔ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬
‫ﺗ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺔﻓﻲﺭ‬ ‫ﻛ‬‫ﺭ‬‫ﺎ‬
‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬•
‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬ ‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻟﻲﻣﻦ‬‫ﺎ‬‫ﻳ ﺾﺧ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
.12
‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻦ‬‫ﻴﻦ ﺿ‬‫ﻛﺴﺠ‬‫ﺍﻷ‬‫ﻊ‬‫ﺒ‬
‫ﺎﺕﺗﺸ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﻭﻣﺴ‬ ‫ﺃ‬‫ﻧﻲ‬‫ﺎ‬‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬
‫ﻴﻢﻏ‬ ‫ﻪﻗ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬•
‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬ ‫ﻭ‬
‫ﺃ‬ ‫ﺎﺕ‬‫ﻣ‬‫ﻪﻋﻼ‬‫ﻴ‬‫ﻠ‬‫ﺮﻋ‬‫ﻬ‬‫•ﻻﺗﻈ‬
‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬
‫ﻮﻕﻣ‬ ‫ﻴﻢﻓ‬‫ﻠ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻌ‬
‫•ﻳ‬
(
PE)‫ﻮﻱ‬ ‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺃﺍﻻ‬
‫ﺔﻭ‬ ‫ﻘ‬
‫ﻴ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻠﻄ‬‫ﺎﺏﺑﺠ‬‫•ﻻﻳﺼ‬

Sei
zur
eDi
sor
der
s
Lear
ningobjectives:
Uponcompletionoft hi
slectur
e,eachstudentshoul
dbeabl et
o:
1.Defi
neseizures
2.Descri
betheint er
nat
ionalcl
assif
icat
ionofseizur
es.
3.I
denti
fycausesandcl ini
calmanifest
ati
onsofpatientwit
hseiz
uresdi
sor
der
s
4.Descri
benursingmanagementdur i
ngandaf t
erseizur
es

‫ﺮﻉ‬
‫ﺎﺕ ﺻ‬
‫ﺑ‬‫ﻮ‬‫ﻧ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺐﻗ‬
‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬‫ﻜ‬‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬.1
.‫ﺎﺕ‬‫ﻮﻃ‬‫ﺒ‬‫ﻤﻀ‬‫ﻠ‬
‫ﻟ‬‫ﻟﻲ‬‫ﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬‫ﻨ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 2
‫ﺎﺕ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﺎﺿﻄ‬
‫ﺎﺏﺑ‬‫ﻤﺼ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺏﻭ‬‫ﺒ‬‫ﺍﻷﺳ‬‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
3
‫ﺎ‬
‫ﺪﻫ‬‫ﻌ‬
‫ﺑ‬‫ﺎﺕﻭ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﻭﺻﻒﺇ‬. 4

Sei
zur
eDi
sor
der
s
Def
ini
ti
onofSei
zur
es:

154
Sei zuresar eepi sodesofabnor mal mot or ,sensor y,aut onomi c,orpsy chi c
act i
vi
ty( oracombi nat ionoft hese)t hatr esul tfrom suddenexcessi vedi schar ge
from cer ebr al neur ons.
Ty pes:
Thei nternat i
onal cl
assi ficationofsei zur esdi f f
erent iatesbet weent womai n
ty pes:
I.Par ti
al sei zur es: begi ni nonepar toft hebr ain.
II.Gener al izedsei zur es: i
nv olveel ectrical dischar gesi nt hewhol ebr ain.
I.Par tialSei zur es( sei zur esbegi nni ngl ocal l
y)
1.Si mplepar ti
alsei zures( withel ement ar ysy mpt oms, gener all
ywi thout
i
mpai r
mentofconsci ousness)
:‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﻳﺞﻣﻦ‬ ‫ﺰ‬‫ﻭﻣ‬ ‫ﺃ‬)‫ﻔﺴﻲ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﺩﻱ‬ ‫ﺍ‬‫ﺭ‬
‫ﺇ‬‫ﺍﻼ‬
‫ﻭﻟ‬ ‫ﺃ‬‫ﻟﺤﺴﻲ‬ ‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻛﻲ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﺮﻃ‬ ‫ﻴ‬‫ﺎﺕﻏ‬‫ﺑ‬‫ﻮ‬‫ﺎﺕﻫﻲﻧ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬ ‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬ ‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﺌ‬‫ﺎﺟ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺮﻃ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﻋﺍﻹ‬
‫ﺘﺞ ﻦ‬ ‫ﻨ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬(‫ﻩ‬‫ﺬ‬‫ﻫ‬
:‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺍﻷ‬
:‫ﻴﻦ‬ ‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬‫ﻴﻦﺭ‬ ‫ﻮﻋ‬‫ﻴﻦﻧ‬ ‫ﺎﺕﺑ‬ ‫ﻮﻃ‬ ‫ﺒ‬‫ﻤﻀ‬ ‫ﻠ‬‫ﻟ‬‫ﻟﻲ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻨ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻴ‬‫ﻤ‬‫ﻳ‬
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﺍﺣ‬‫ﺀﻭ‬ ‫ﺰ‬‫ﺃﻓﻲﺟ‬ ‫ﺪ‬‫ﺒ‬‫ﺗ‬:‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ .
1
.‫ﻛ‬
‫ﻪ‬‫ﺎﻍﻠ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﺍﺕﻛ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﻠﻰﺇ‬ ‫ﻮﻱﻋ‬ ‫ﻨﻄ‬‫ﺗ‬:‫ﺔ‬‫ﻤ‬‫ﻤ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬.‫ﺎ‬
ً
‫ﻴ‬ ‫ﻧ‬
‫ﺎ‬‫ﺛ‬
(‫ﺎ‬‫ﻴ‬‫ﻠ‬
‫ﺔﻣﺤ‬ ‫ﻴ‬‫ﺮﻋ‬‫ﺎﺕ ﺻ‬ ‫ﺑ‬‫ﻮ‬‫ﺃﻧ‬‫ﺪ‬‫ﺒ‬‫ﺗ‬
)‫ﺔ‬ ‫ﻴ‬‫ﺋ‬
‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬-‫ﺃﻻ‬‫ﻭ‬
(‫ﺎ‬ً
‫ﻣ‬‫ﻮ‬‫ﻤ‬‫ﻮﻋﻲﻋ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻑ‬ ‫ﻌ‬‫ﻭﻥﺇﺿ‬ ‫ﺩ‬، ‫ﺔ‬‫ﻴ‬ ‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺄ‬‫ﺔﺑ‬‫ﺑ‬‫ﻮ‬‫ﻣﺼﺤ‬ )‫ﺔ‬ ‫ﻴﻄ‬‫ﺔﺑﺴ‬ ‫ﻴ‬‫ﺋ‬
‫ﺰ‬ ‫ﺎﺕﺟ‬ ‫ﺑ‬‫ﻮ‬‫ﻧ‬.1
Si gnsandsy mpt oms:
1.Onl yaf i
ngerorhandmayshake
2.Themout hmayj erkuncont rollably
3.Theper sonmayt alkuni ntell
igibly
4.Maybedi zzy
5.Mayexper i
enceunusual orunpl easantsi ghts, sounds, odor s,ortast es
6.Nol ossofconsci ousness
2.Compl expar tialsei zur es( withcompl exsy mpt oms, gener allywith
i
mpai r
mentofconsci ousness)
Si gnsandsy mpt oms:
1.Theper sonei therr emai nsmot ionlessormov esaut omat icallybut
i
nappr opr iat elyf ort imeandpl ace.
2.Excessi v eemot i
onsoff ear,anger , elat i
on, orirritabilit
y .
3.Doesnotr emembert heepi sode.
:
‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻘﻂ‬ ‫ﺪﻓ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻊ‬‫ﺒ‬‫ﺍﻹﺻ‬ ‫ﺰ‬‫ﺘ‬‫ﻬ‬
‫ﺪﻳ‬ ‫ﻗ‬.1
‫ﻴﺐ‬ ‫ﻗ‬‫ﻴﺐﻭﻻﺭ‬ ‫ﻭﻥﺣﺴ‬ ‫ﻔﻢﺩ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺰ‬‫ﺘ‬‫ﻬ‬
‫ﺪﻳ‬ ‫ﻗ‬.2
‫ﻡ‬ ‫ﻮ‬‫ﻬ‬‫ﻔ‬‫ﺮﻣ‬ ‫ﻴ‬‫ﻜﻞﻏ‬ ‫ﻟﺸﺨ ﺺﺑﺸ‬ ‫ﺍ‬‫ﺪﺙ‬ ‫ﺘﺤ‬‫ﺪﻳ‬ ‫ﻗ‬.3
‫ﺭ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺏﺑ‬ ‫ﺪﻳﺼ‬ ‫ﻗ‬.4
‫ﺓ‬‫ﺭ‬‫ﺎ‬‫ﺮﺳ‬ ‫ﻴ‬‫ﻭﻏ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺩ‬‫ﺎ‬‫ﺮﻋ‬ ‫ﻴ‬‫ﺍﻕﻏ‬ ‫ﻭ‬‫ﺫ‬‫ﺃ‬‫ﻭ‬ ‫ﺃ‬‫ﺋﺢ‬ ‫ﺍ‬
‫ﻭ‬‫ﻭﺭ‬ ‫ﺃ‬‫ﺍﺕ‬ ‫ﻮ‬‫ﺃﺻ‬ ‫ﻭ‬‫ﺃ‬‫ﺪ‬‫ﺎﻫ‬
‫ﻪﻣﺸ‬ ‫ﺍﺟ‬‫ﻮ‬‫ﺪﺗ‬ ‫ﻗ‬.5
‫ﻋﻲ‬ ‫ﻮ‬‫ﻠ‬
‫ﻟ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻻﻓ‬. 6
(‫ﻋ‬
‫ﻡ‬‫ﻜﻞﺎ‬ ‫ﻮﻋﻲﺑﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﻌﻒﻓﻲ‬ ‫ﻊﺿ‬ ‫ﻣ‬، ‫ﺓ‬‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﺍ ﺽﻣ‬ ‫ﺮ‬‫ﺃﻋ‬ ‫)ﻊ‬
‫ﺓﻣ‬ ‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ .
2
:
‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬ ‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬
.
‫ﺎﻥ‬‫ﻜ‬‫ﻤ‬ ‫ﻟ‬‫ﺍ‬
‫ﺎﻥﻭ‬ ‫ﻣ‬‫ﺰ‬‫ﻠ‬‫ﻟ‬‫ﻻﻖ‬
‫ﺮﺋ‬ ‫ﻴ‬‫ﻜﻞﻏ‬ ‫ﻜﻦﺑﺸ‬ ‫ﻟ‬‫ﺎﻭ‬ً
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻘ‬‫ﻠ‬‫ﺮﻙﺗ‬ ‫ﺘﺤ‬‫ﻭﻳ‬ ‫ﺃ‬‫ﺎ‬
ً
‫ﺘ‬‫ﺑ‬‫ﺎ‬‫ﻟﺸﺨ ﺺﺛ‬ ‫ﺍ‬‫ﺃﻥﻳﻈﻞ‬ ‫ﺎ‬
‫ﻣ‬‫ﺇ‬.1
.‫ﻴﺞ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺎﺝ‬‫ﻬ‬‫ﺘ‬‫ﺑ‬‫ﺃﺍﻻ‬
‫ﻐﻀﺐﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻮﻑ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺮﻃ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﺮ‬‫ﻋ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬ .
2
.
‫ﺔ‬‫ﻘ‬‫ﻠ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺮ‬‫ﻛ‬‫ﺬ‬‫ﺘ‬‫ﻻﻳ‬. 3

I
I.Gener
ali
zedSei
zur
es(
conv
ulsi
veornonconv
ulsi
ve,
bil
ater
all
ysy
mmet
ri
c,

155
wi t
houtl ocal onset )
a.Toni c-clonicsei zures
b.Toni csei zures
c.Cl onicsei zures
d.Absence( petitmal )seizures
e.At onicsei zures
f.My ocloni cseizur es
Toni c-clonicsei zures:
Intenser igidit
yoft heentirebodymayoccur ,foll
owedbyalter
nat
ingmuscl
e
relaxationandcont racti
on( gener
ali
zedtonic–cloni
ccontr
acti
on)
.
Armsandl egswi ll
fir
ststiff
en(t
hetonicstage).
Limbsandheadwi llt
henbegi njer
king(t
hecl oni
cphase).

(‫ﻌﻲ‬
‫ﻮﺿ‬‫ﺭﻣ‬‫ﻮ‬‫ﻬ‬
‫ﻭﻥﻇ‬‫ﺪ‬‫ﺑ‬،‫ﺍﻑ‬
‫ﺮ‬‫ﺍﻷﻃ‬‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻨ‬‫ﺓﺛ‬‫ﺮ‬‫ﺎﻇ‬
‫ﻨ‬‫ﺘ‬
‫ﻣ‬، ‫ﺔ‬‫ﻨﺠ‬‫ﺘﺸ‬‫ﺮﻣ‬‫ﻴ‬
‫ﻭﻏ‬ ‫ﺃ‬‫ﺔ‬
‫ﻨﺠ‬‫ﺘﺸ‬‫ﻣ‬)‫ﺔ‬‫ﻤ‬‫ﻤ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬
‫ﺍ‬ .
‫ﺎ‬ً
‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺛ‬
‫ﺔ‬‫ﻴ‬‫ﺎﺟ‬‫ﺗﺠ‬‫ﺭ‬‫ﺍﻻ‬ ‫ﺎﺕ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬.‫ﺃ‬
‫ﻨﺸﻂ‬‫ﺎﺕﻣ‬ ‫ﺑ‬‫ﻮ‬‫ﻧ‬.‫ﺏ‬
‫ﺔ‬
‫ﻴ‬‫ﺎﺟ‬‫ﺗﺠ‬‫ﺭ‬‫ﺍﻻ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ .
‫ﺝ‬
(
‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬)‫ﺎﺏ‬‫ﻴ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻧ‬.
‫ﺩ‬
‫ﻴﻚ‬‫ﻧ‬‫ﻮ‬‫ﺗ‬‫ﺁ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻧ‬.
‫ﻩ‬
‫ﻠﻲ‬‫ﻊﻋﻀ‬ ‫ﻣ‬‫ﺎﺕﺭ‬ ‫ﺑ‬‫ﻮ‬
‫ﻧ‬.F
:‫ﺔ‬‫ﻴ‬‫ﺎﺟ‬
‫ﺗﺠ‬ ‫ﺭ‬‫ﺍﻻ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻡ‬
‫ﺎ‬‫ﻨﺸﻂﻋ‬
‫ﻠ ﺺﻣ‬
‫ﻘ‬‫ﺗ‬
)‫ﺎ‬‫ﻬ‬‫ﺎﺿ‬
‫ﺒ‬‫ﻘ‬
‫ﻧ‬‫ﺍ‬
‫ﻌﻀﻼﺕﻭ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﺗﺨ‬‫ﺭ‬
‫ﺍ‬‫ﻭﺏ‬‫ﺎ‬‫ﻨ‬
‫ﻪﺗ‬‫ﻌ‬‫ﺒ‬‫ﺘ‬‫ﻳ‬،‫ﻣﻞ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺠﺴﻢﺑ‬‫ﺍ‬‫ﺪﻓﻲ‬‫ﻳ‬‫ﺪ‬‫ﺒﺲﺷ‬ ‫ﻴ‬‫ﺪﺙﺗ‬ ‫ﺪﻳﺤ‬‫ﻗ‬
.
(‫ﺎﺟﻲ‬ ‫ﺗﺠ‬‫ﺭ‬‫ﺍ‬-
.(
‫ﺮ‬‫ﺗ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻣ‬)ً‫ﺃﻻ‬‫ﻴﻦﻭ‬ ‫ﻗ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﺍﻋ‬
‫ﺭ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬‫ﺘﺼ‬ ‫•ﺳ‬
.(
‫ﺔ‬‫ﻴ‬‫ﺎﺟ‬
‫ﺗﺠ‬‫ﺭ‬‫ﺍﻻ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬)‫ﻴﺞ‬‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻚﻓﻲ‬ ‫ﺪﺫ‬‫ﻌ‬‫ﺃﺱﺑ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑﻭ‬ ‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺃ‬
‫ﺪ‬‫ﺒ‬‫ﺘ‬‫•ﺳ‬


Duringsei zure,
thepersonmaybi t
etongueort heinsi
deofmout h.
Incontinence
Decreaseorceasebr eathing(int
hiscase,breathi
ngshoul
dreturntonormal
duri
ngt hetonic(jer
king)por t
ionofthesei
zure).
Afterward, t
hepersonwi ll
likel
ybeconfused.
Notr ememberwhathappened.
Needt osl eepforawhi l
e.
Mayhav eaheadache.
Dependi ngont heperson,itcantakefrom minutestohourst
of ull
yrecov
er.

.
‫ﺍﺧﻞ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻢﻣﻦ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻥ‬
‫ﻠﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻟﺸﺨ ﺺ‬‫ﺍ‬‫ﺪﻍ‬‫ﻠ‬‫ﺪﻳ‬‫ﻗ‬،‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬ ‫ﺳ‬
‫ﻨﺸﻂ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺰ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬‫ﻪ‬
‫ﺘ‬‫ﻌ‬‫ﻴ‬
‫ﺒ‬‫ﻟﻰﻃ‬‫ﻔﺲﺇ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻮ‬
‫ﻌ‬‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬، ‫ﺔ‬‫ﻟ‬
‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻓﻲﻫ‬)‫ﻔﺲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻒ‬ ‫ﻮ‬‫ﻭﺗ‬‫ﺃ‬‫ﺎﺽ‬ ‫ﻔ‬
‫ﻧﺨ‬ ‫ﺍ‬
.
(‫ﺔ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫(ﻣﻦ‬‫ﻴﺞ‬ ‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬
)
.
‫ﺎﻙ‬‫ﺒ‬
‫ﺗ‬‫ﺭ‬
‫ﺎﻻ‬‫ﻟﺸﺨ ﺺﺑ‬‫ﺍ‬‫ﺮ‬
‫ﻌ‬‫ﺃﻥﻳﺸ‬‫ﻤﻞ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬،‫ﻟﻚ‬‫ﺪﺫ‬ ‫ﻌ‬‫ﺑ‬
.‫ﺪﺙ‬ ‫ﺎﺣ‬‫ﺮﻣ‬‫ﻛ‬‫ﺬ‬‫ﺘ‬‫ﻻﺗ‬
.‫ﺓ‬‫ﺮ‬‫ﺘ‬
‫ﻔ‬‫ﻟ‬‫ﻡ‬‫ﻮ‬‫ﻨ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺎﺟ‬‫ﺑﺤ‬
.
‫ﺍﻉ‬‫ﺪ‬‫ﻪﺻ‬ ‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻮﻥ‬‫ﻜ‬‫ﺪﻳ‬ ‫ﻗ‬
.
‫ﺎﺕ‬‫ﺎﻋ‬
‫ﻟﻰﺳ‬‫ﺋﻖﺇ‬
‫ﺎ‬‫ﻗ‬‫ﻡﻣﻦﺩ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻕ‬‫ﻐ‬
‫ﺘ‬‫ﺪﻳﺴ‬‫ﻗ‬،‫ﻟﺸﺨ ﺺ‬‫ﺍ‬ ‫ﻠﻰ‬
‫ﺍﻋ‬ً
‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﺘ‬‫ﺍﻋ‬

Absence(
pet
itmal
)sei
zur
es:

156
 Thesesei zur esusual l
yl astfrom 2t o15secondsandmayoccurj ustaf ew
ti
mesaday , ormor ethan100t i
mesi nasi ngleday .
Theyusual lypr esentasbl andst ari
ng, whichonemi ghtmi stakef or
day dreami ng, physicalaut omat i
smssuchasl i
psmacki ng,ort witchingoff acial
orbodymuscl es.
Afterward, t heper sonwi llli
kelyhav enomemor yofwhathappenedwhi lehad
thesei zure.
Theyoccurmost lyamongchi l
dren,starti
ngbet weent heageof4and12.They
rarelybeginaf terage20.
At onicseizur es:
Apar t
,oral l,ofaper son’sbodysuddenl ygolimp.Thi smeanst hattheper son’ s
headmaysuddenl ydrop, orcoul dslumpdownorev entotallycollapse, droppi ng
tot hefloor( thust henamedr opat t
ack) .
:
(‫ﺮ‬‫ﻴ‬
‫ﻐ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺮﻉ‬‫ﻟﺼ‬ ‫ﺍ‬
)‫ﺎﺏ‬ ‫ﻴ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻧ‬
‫ﺓ‬ ‫ﺮ‬‫ﻣ‬100‫ﺮﻣﻦ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬
‫ﻭ‬‫ﺃ‬ ‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻊﻣ‬ ‫ﺪﺙﺑﻀ‬ ‫ﺪﺗﺤ‬ ‫ﻗ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺛ‬15‫ﻟﻰ‬ ‫ﺇ‬2‫ﺓﻣﻦ‬ ‫ﺩ‬
‫ﺎ‬‫ﺎﺕﻋ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺮﻫ‬ ‫ﻤ‬‫ﺘ‬‫•ﺗﺴ‬
.‫ﺪ‬‫ﺍﺣ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬
‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﺎﺕﺟﺴ‬ ‫ﻴ‬‫ﻟ‬‫ﺁ‬ ‫ﻭ‬،
‫ﺔﺃ‬ ‫ﻘﻈ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺃﺣﻼ‬ ‫ﻪ‬‫ﻧ‬‫ﺃ‬‫ﺀﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻳﺨﻄﺊ‬ ‫ﺬﻱﻗ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻴﻒ‬‫ﻟﻄ‬‫ﻳﻖ‬ ‫ﺪ‬‫ﺎﺗﺤ‬‫ﻬ‬‫ﻧ‬‫ﺃ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺩ‬
‫ﺎ‬‫ﺮﻋ‬ ‫ﻬ‬‫•ﺗﻈ‬
.‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺵﻋﻀﻼﺕ‬ ‫ﻌ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬ ‫ﻭ‬،
‫ﻩﺃ‬ ‫ﺎ‬
‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﻊ‬ ‫ﻔ‬‫ﺜﻞ ﺻ‬ ‫ﻣ‬
.‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﺪﺙ‬‫ﺎﺣ‬ ‫ﻟﺸﺨ ﺺﻣ‬ ‫ﺍ‬‫ﺮ‬‫ﻛ‬‫ﺬ‬
‫ﺘ‬‫ﺃﻻﻳ‬ ‫ﻤﻞ‬‫ﺘ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻦ‬، ‫ﻟﻚ‬ ‫ﺪﺫ‬‫ﻌ‬ ‫•ﺑ‬
.‫ﻳﻦ‬ ‫ﺮ‬‫ﻌﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﺳﻦ‬‫ﻌ‬ ‫ﺃﺑ‬
‫ﺪ‬ ‫ﺒ‬
‫ﺎﺗ‬‫ﺍﻣ‬ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻧ‬‫ﻭ‬.‫ﺎ‬
ً
‫ﻣ‬‫ﺎ‬‫ﻋ‬12‫ﻟﻰ‬ ‫ﺇ‬4‫ﺍﻣﻦﺳﻦ‬ ً
‫ﺀ‬‫ﺪ‬‫ﺑ‬،‫ﺎ‬
‫ﻷﻔﻝ‬‫ﺍﻃ‬ ‫ﻴﻦ‬‫ﻏﺎﺑ‬
ً
‫ﺒ‬‫ﻟ‬
‫ﺪﺙﺎ‬ ‫•ﺗﺤ‬
:‫ﺔ‬‫ﻴ‬
‫ﻧ‬‫ﻮ‬‫ﺗ‬‫ﺍﻵ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﻭ‬،
‫ﺓﺃ‬ ‫ﺄ‬
‫ﻘﻂﻓﺠ‬ ‫ﺪﻳﺴ‬ ‫ﻟﺸﺨ ﺺﻗ‬ ‫ﺍ‬‫ﺃﺱ‬ ‫ﺃﻥﺭ‬‫ﻨﻲ‬‫ﻌ‬‫ﺍﻳ‬‫ﺬ‬‫ﻫ‬.‫ﺮﺝ‬‫ﻌ‬‫ﻪﻳ‬‫ﻠ‬‫ﻭﻛ‬‫ﺃ‬‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬
‫ﺀﻣﻦﺟﺴﻢ‬ ‫ﺰ‬‫ﺒﺢﺟ‬ ‫ﺓﻳﺼ‬ ‫ﺄ‬‫ﻓﺠ‬
.(‫ﺭﺽ‬ ‫ﺍﻷ‬‫ﻠﻰ‬‫ﺰﻝﻋ‬ ‫ﻨ‬
‫ﺍﻻﺳﻢﻳ‬ ‫ﺈﻥ‬ ‫ﻣﻦﺛﻢﻓ‬‫ﻭ‬ )‫ﺭ ﺽ‬‫ﺍﻷ‬‫ﻠﻰ‬‫ﻘﻂﻋ‬ ‫ﻳﺴ‬‫ﻭ‬،‫ﺎ‬ً
‫ﻴ‬‫ﻠ‬
‫ﺭﻛ‬ ‫ﺎ‬
‫ﻬ‬‫ﻨ‬‫ﻭﻳ‬‫ﺃ‬‫ﻔﺾ‬ ‫ﻨﺨ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬

My oclonicseizures:
Partsofaper son’sbodyj erk—f orinstance,arm orlegmaysuddenl ytwitch.
Causes:
Thespeci f
iccausesofsei zur esar ev ari
edandcanbecat egor i
zedasi di
opat hic
(genetic,development aldef ect s)andacqui red.
Causesofacqui r
edsei zuresi nclude:
1.Cer ebrovasculardisease
2.Hy pox emiaofanycause, incl udingvascularinsuff
ici
ency
:‫ﻠﻲ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻧ‬
.
‫ﺓ‬‫ﺄ‬‫ﺎﻕﻓﺠ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺍﻉ‬ ‫ﺭ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻌﺶ‬ ‫ﺗ‬‫ﺮ‬‫ﺪﺗ‬‫ﻗ‬،‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬-‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬‫ﺀﻣﻦﺟﺴﻢ‬ ‫ﺍ‬‫ﺰ‬‫ﺃﺟ‬‫ﺔ‬‫ﺭﻋﺸ‬
:‫ﺎﺏ‬‫ﺒ‬
‫ﺍﻷﺳ‬
(‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻤ‬
‫ﻧ‬‫ﺔﻭ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬
‫ﻮﺏﺟ‬ ‫ﻴ‬‫ﺒﺐ)ﻋ‬ ‫ﻟﺴ‬‫ﺍ‬ ‫ﻮﻝ‬ ‫ﻬ‬
‫ﺎﻣﺠ‬ ‫ﻬ‬‫ﻧ‬
‫ﺃ‬‫ﻠﻰ‬‫ﺎﻋ‬
‫ﻬ‬ ‫ﻔ‬‫ﻴ‬
‫ﻨ‬‫ﻜﻦﺗﺼ‬‫ﻤ‬‫ﻳ‬‫ﺎﺕﻭ‬‫ﺑ‬‫ﻮ‬
‫ﻨ‬ ‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺪ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬
‫ﺍﻷﺳ‬ ‫ﻮﻉ‬ ‫ﻨ‬
‫ﺘ‬‫ﺗ‬
.‫ﺔ‬‫ﺒ‬
‫ﺘﺴ‬ ‫ﻜ‬‫ﻣ‬‫ﻭ‬
:‫ﻠﻲ‬‫ﺎﻳ‬
‫ﺔﻣ‬ ‫ﺒ‬
‫ﺘﺴ‬ ‫ﻜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬‫ﻤﻞ‬ ‫ﺗﺸ‬
‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬.1
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﺭ‬‫ﻮ‬‫ﻟﻚﻗﺼ‬ ‫ﺎﻓﻲﺫ‬‫ﻤ‬‫ﺒﺐﺑ‬‫ﻡﻷﻱﺳ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻘﺺ‬ ‫ﻧ‬.2
3.Fev er(chil
dhood)
4.Headi nj
ury
5.Hy pertensi
on
6.Cent ralnervoussy stem inf ect i
ons
7.Met abolicandt oxiccondi tions( eg, r
enalfail
ure,hyponatremia, hypocalcemi a,
hypogl ycemia,pesti
cides)
8.Braint umor
9.Drugandal cohol withdrawal

157
10.Al
l
ergi
es
(‫ﺔ‬‫ﻟ‬
‫ﻮ‬‫ﻔ‬‫ﻟﻄ‬ ‫ﺍ‬
)‫ﻤﻰ‬‫ﻟﺤ‬‫ﺍ‬.
3
‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬.4
‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.
5
‫ﺰﻱ‬‫ﻛ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺒﻲ‬ ‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
6
‫ﻘﺺ‬
‫ﻧ‬‫ﻡﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺴ‬‫ﺎ‬
‫ﻘ ﺺﻛ‬
‫ﻧ‬‫ﻡﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻘ ﺺﺻ‬
‫ﻧ‬‫ﻮﻱﻭ‬
‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺸﻞ‬
‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬
‫ﻣ‬)‫ﺔ‬‫ﻣ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺍﻷ‬‫ﺎﻻﺕ‬‫ﻟﺤ‬‫ﺍ‬.
7
(
‫ﺎﺕ‬‫ﻓ‬‫ﺍﻵ‬‫ﺍﺕ‬‫ﺪ‬‫ﻴ‬‫ﺒ‬
‫ﻣ‬‫ﻡﻭ‬ ‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺭ‬
‫ﻭ‬.8
‫ﻮﻝ‬‫ﻜﺤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕﻭ‬ ‫ﺭ‬
‫ﺪ‬‫ﻤﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻧﺴﺤ‬‫ﺍ‬.
9
‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬‫ﺍ‬.
10

NursingManagement
DuringaSei zure
1.Prov i
depr i
vacyandpr otectt hepat i
entf rom cur i
ousonl ooker s.(Thepat ient
whohasanaur a[war ningofani mpendi ngsei zure]mayhav et i
met oseeka
safe,privateplace) .
2.Easet hepat i
entt othef loor, ifpossi ble.
3.Protectt heheadwi t
hapadt opr ev enti njury(from st r
ikingahar dsur face).
4.Loosenconst r
ictiveclothing.
5.Pushasi deanyf urni
turet hatmayi nj uret hepat ientdur i
ngt hesei zure.
6.Ifthepat ientisinbed, r
emov epi l
lowsandr aisesi derails.
7.Ifanaur apr ecedest hesei zur e, i
nser tanor alairwayt or educet hepossi bil
ity
ofthepat ient'sbiti
ngt het ongueorcheek.
8.Donotat temptt opryopenj awst hatar eclenchedi naspasm ort oi nsert
anything.Br okent eethandi njur ytot hel ipsandt onguemayr esultf rom suchan
acti
on.
9.Noat t
emptshoul dbemadet or est raint hepat ientdur i
ngt hesei zure,
becausemuscul arcont ractionsar est rongandr est rai
ntcanpr oducei njury.
‫ﻳﺾ‬ ‫ﺮ‬ ‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬
‫ﺮﻣﻦ‬ ‫ﻳ‬‫ﺬ‬‫ﺗﺤ‬]‫ﻫﺔ‬‫ﻟ‬
‫ﻪﺎ‬ ‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﺬﻱ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
). ‫ﻴﻦ‬ ‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﻔﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﺮﺟ‬ ‫ﻔ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻳ ﺾﻣﻦ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻤ‬
‫ﺔﻭﺣ‬ ‫ﻴ‬‫ﻮﺻ‬ ‫ﻟﺨﺼ‬ ‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬.
1
.(‫ﺎﺹ‬ ‫ﻣﻦﻭﺧ‬ ‫ﺁ‬‫ﺎﻥ‬‫ﻜ‬ ‫ﺒﺤﺚﻋﻦﻣ‬ ‫ﻠ‬
‫ﻟ‬‫ﻗﺖ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻪ‬ ‫ﻳ‬
‫ﺪ‬ ‫ﻟ‬‫ﻮﻥ‬‫ﻜ‬‫ﺪﻳ‬ ‫[ﻗ‬‫ﺔ‬‫ﻜ‬ ‫ﻴ‬
‫ﺔﻭﺷ‬ ‫ﺑ‬
‫ﻮ‬‫ﻧ‬
.‫ﻜﻦ‬ ‫ﻣ‬‫ﺃ‬‫ﻥ‬،
‫ﺭ ﺽﺇ‬ ‫ﺍﻷ‬‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻔﻒ‬ ‫ﺧ‬.2
.
(‫ﻠﺐ‬ ‫ﻡﺑﺴﻄﺢ ﺻ‬ ‫ﺍ‬
‫ﺪ‬‫ﻣﺍﻻﺻﻄ‬ ‫ﺔ)ﻦ‬ ‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﺃﺱﺑﻀ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬.3
.‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻟﻀ‬‫ﺍ‬‫ﺑﺲ‬ ‫ﻤﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﻚ‬ ‫ﻗﻢﺑ‬.4
.‫ﺎ‬ً
‫ﺒ‬
‫ﻧ‬‫ﺎ‬‫ﺔﺟ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬ ‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬ ‫ﺪﻳﺼ‬ ‫ﺎﺙﻗ‬ ‫ﺛ‬‫ﺃ‬‫ﺃﻱ‬ ‫ﻊ‬‫ﻓ‬‫ﺩ‬‫ﺍ‬.
5
.‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻧ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﻥ‬ ‫ﺒ‬‫ﻘﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻓ‬‫ﺭ‬ ‫ﺪﻭ‬‫ﺋ‬‫ﺎ‬‫ﻮﺳ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺈ‬‫ﻘﻢﺑ‬‫ﻓ‬،‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬.
6
.
‫ﻩ‬‫ﺪ‬‫ﻭﺧ‬ ‫ﺃ‬‫ﻪ‬ ‫ﻧ‬
‫ﺎ‬‫ﻟﺴ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻋ ﺾ‬ ‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﺣ‬ ‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬ ‫ﻮﻱ‬ ‫ﻤ‬‫ﺋﻲﻓ‬‫ﺍ‬‫ﻮ‬‫ﺮﻯﻫ‬ ‫ﺩﺧﻞﻣﺠ‬ ‫ﺃ‬،‫ﺔ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻘﺖ‬ ‫ﺒ‬
‫ﺍﺳ‬ ‫ﺫ‬‫ﺇ‬.
7
‫ﺭ‬‫ﻮ‬‫ﺀﻛﺴ‬ ‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺍ‬‫ﺬ‬‫ﺜﻞﻫ‬‫ﺘﺞﻋﻦﻣ‬ ‫ﻨ‬
‫ﺪﻳ‬‫ﻗ‬ ‫ﻭ‬.‫ﺀ‬‫ﺃﻱﺷﻲ‬ ‫ﺎﻝ‬ ‫ﺩﺧ‬‫ﻭﺇ‬ ‫ﺃ‬‫ﻨﺞ‬‫ﻴﻦﻓﻲﺗﺸ‬ ‫ﻛ‬‫ﻮ‬‫ﺒ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻜ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺘﺢ‬ ‫ﻭﻝﻓ‬ ‫ﺎ‬
‫ﻻﺗﺤ‬. 8
.‫ﺎﻥ‬‫ﻠﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﺘ‬
‫ﻔ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺑ‬‫ﺎ‬‫ﺇﺻ‬‫ﺎﻥﻭ‬ ‫ﻨ‬
‫ﺍﻷﺳ‬ ‫ﻓﻲ‬
‫ﺩﻱ‬ ‫ﺆ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻌﻀﻼﺕﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻠﺼ‬ ‫ﻘ‬‫ﻷﻥﺗ‬، ‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺡ‬‫ﻤ‬‫ﺒﺢﺟ‬ ‫ﺔﻛ‬ ‫ﻟ‬
‫ﻭ‬‫ﺎ‬‫ﻡﻣﺤ‬ ‫ﺪ‬‫ﻳﺠﺐﻋ‬. 9
.‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﻟﻰ‬‫ﻔﺲﺇ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺒﻂ‬‫ﺿ‬

10.Ifpossi ble,placet hepatientononesi dewithheadf l

exedforward,which
all
owst het onguet of al
lforwardandf acil
i
tatesdr
ainageofsalivaandmucus.I f
suctioni sav ai
lable,usei ti
fnecessarytoclearsecret
ions.
11.Amaj orresponsi bil
i
tyoft henurseistoobserveandr ecor
dt hesequenceof
signs.Thenat ureoft heseizur eusual
lyindicat
esthetypeoftreatmentthatis
required.

158
12.Beforeandduringasei zure,thepati
entisassessedandt hefol
lowing
i
temsar edocument ed:
Thecir
cumstancesbeforet heseizur
e( vi
sual,
auditory
,orolf
act
orysti
muli,
tacti
lest
imuli
,emotionalorpsy chol
ogicaldi
sturbances,sl
eep)
Theoccur
renceofanaur a( apremoni t
oryorwar ni
ngsensati
onthatcanbe
visual
,audi
tor
y,orolfact
ory)

‫ﻡ‬‫ﺎ‬‫ﻣ‬
‫ﻟﻸ‬‫ﻮﻁ‬ ‫ﺒ‬
‫ﻬ‬‫ﻟ‬
‫ﺎ‬‫ﺎﻥﺑ‬‫ﻠﺴ‬‫ﻟ‬‫ﻤﺢ‬
‫ﺎﻳﺴ‬‫ﻤ‬‫ﻣ‬،‫ﻡ‬‫ﺎ‬
‫ﻣ‬‫ﻟﻸ‬‫ﺃﺱ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬‫ﻊﺛ‬‫ﺪﻣ‬
‫ﺍﺣ‬‫ﻧﺐﻭ‬‫ﺎ‬
‫ﻠﻰﺟ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺿ‬،‫ﻜﻦ‬‫ﻣ‬‫ﺃ‬‫ﺍ‬‫ﺫ‬
‫ﺇ‬.10
.
‫ﺍﺕ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﻴﻒ‬‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬‫ﻷﺮ‬
‫ﺍﻣ‬ ‫ﻡ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺫ‬‫ﻪﺇ‬
‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬
‫ﻓ‬،‫ﺎ‬ً‫ﺎ‬
‫ﺣ‬‫ﺘ‬‫ﻔﻂﻣ‬‫ﻟﺸ‬‫ﺍ‬
‫ﺎﻥ‬‫ﺍﻛ‬
‫ﺫ‬‫ﺇ‬.
‫ﺎﻁ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏﻭ‬‫ﻌ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻬﻞﺗﺼ‬‫ﻳﺴ‬‫ﻭ‬
‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﺮﻃ‬‫ﻴ‬‫ﺎﺗﺸ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬.‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺴﻞ‬
‫ﻴﻞﺗﺴ‬‫ﺗﺴﺠ‬‫ﺔﻭ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﺔﻣ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻴﺴ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺆ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬.11
.
‫ﻮﺏ‬ ‫ﻠ‬
‫ﻤﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻉ‬ ‫ﻟﻰﻧ‬
‫ﺇ‬

:
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﺎﺻ‬ ‫ﻨ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻖ‬
‫ﺛ‬‫ﻮ‬‫ﺗ‬‫ﻳ ﺾﻭ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻴﻢ ﺎ‬‫ﻴ‬‫ﻘ‬
‫ﺘﻢﺗ‬‫ﻳ‬،‫ﺎ‬
‫ﺀﻫ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬‫ﺃ‬
‫ﺔﻭ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻞ‬‫ﻗ‬.12
‫ﻭ‬
‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﻔ‬‫ﺎﻃ‬
‫ﺎﺕﻋ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬‫ﻭ‬‫ﺃ‬
‫ﺔ‬‫ﻴ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍﺕ‬‫ﺰ‬‫ﻔ‬‫ﻭﻣﺤ‬‫ﺃ‬‫ﺔ‬
‫ﻴ‬‫ﻤ‬‫ﻭﺷ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻤ‬‫ﻭﺳ‬‫ﺃ‬‫ﺔ‬ ‫ﻳ‬
‫ﺮ‬‫ﺎﺕﺑﺼ‬‫ﻬ‬‫ﺒ‬
‫ﻨ‬‫ﻣ‬)‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻞ‬‫ﻭﻑﻗ‬ ‫ﺮ‬‫ﻟﻈ‬‫ﺍ‬
•
(‫ﻡ‬
‫ﻮ‬ ‫ﻭﻧ‬
‫ﺃ‬‫ﺔ‬ ‫ﻴ‬‫ﻔﺴ‬‫ﻧ‬
(‫ﻟﺸﻢ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺳ‬
‫ﻭﺣ‬ ‫ﺃ‬‫ﺎ‬
ً
‫ﻴ‬‫ﻌ‬‫ﻤ‬
‫ﻭﺳ‬ ‫ﺃ‬‫ﺎ‬
ً
‫ﻳ‬‫ﺮ‬‫ﻮﻥﺑﺼ‬‫ﻜ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬
‫ﺮﻱﻳ‬‫ﻳ‬‫ﺬ‬‫ﻭﺗﺤ‬‫ﺃ‬‫ﺑﻖ‬
‫ﺎ‬‫ﺎﺱﺳ‬ ‫ﺇﺣﺴ‬)‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺙ‬ ‫ﺪ‬‫•ﺣ‬


Thef i
rstthi
ngthepatientdoesi nthesei zure—wher ethemov ementsorthe
sti
ff
nessbegi ns,
conj
ugat egazeposi t
ion, andtheposi ti
onoftheheadatt he
beginni
ngoft hesei
zure.Thisi nformat iongi vescluestothelocati
onofthe
sei
zureor i
ginint
hebrain.(Inrecor ding, iti
si mportanttost
atewhet hert
he
beginni
ngoft hesei
zurewasobser ved.)
Thet ypeofmov ementsint hepar toft hebodyi nvolved
Thear easofthebodyi nvol
v ed
Thesi zeofbothpupi
lsandwhet hert heey esareopen

Whet hertheeyesorheadt ur nedt oonesi de

،‫ﺔ‬‫ﻧ‬‫ﺮ‬
‫ﺘ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻭﺿ‬‫ﻭ‬،
‫ﺒﺲ‬‫ﻴ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺕ‬‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬
‫ﻴﺚﺗ‬ ‫ﺣ‬-‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﻓﻲ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻠ‬
‫ﻌ‬ ‫ﻔ‬
‫ﺀﻳ‬‫ﻭﻝﺷﻲ‬ ‫ﺃ‬•
‫ﻓﻲ‬
).‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺃﺻﻞ‬
‫ﺎﻥ‬‫ﻜ‬
‫ﻠﻰﻣ‬‫ﺔﻋ‬ ‫ﻟ‬
‫ﺩ‬‫ﺃ‬‫ﺎﺕ‬‫ﻣ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻩ‬‫ﺬ‬‫ﻌﻄﻲﻫ‬‫ﺗ‬.‫ﺔ‬‫ﺑ‬‫ﻮ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫ﺃﺱﻓﻲﺑ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬
‫ﻮﺿ‬ ‫ﻣ‬‫ﻭ‬
(.‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫ﻮﺣﻆﺑ‬ ‫ﻟ‬‫ﺪ‬‫ﺎﻥﻗ‬
‫ﺍﻛ‬‫ﺫ‬
‫ﺎﺇ‬‫ﺪﻣ‬ ‫ﻳ‬
‫ﺪ‬‫ﻬﻢﺗﺤ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬، ‫ﻴﻞ‬‫ﺘﺴﺠ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺎﺏﻣﻦ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻉ‬‫•ﻧ‬
‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺎﻃﻖ‬‫ﻨ‬‫•ﻣ‬
‫ﺎﻥ‬‫ﺘ‬‫ﻮﺣ‬‫ﺘ‬
‫ﻔ‬ ‫ﺎﻥﻣ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻧﺖ‬‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺎﺇ‬
‫ﻣ‬‫ﻴﻦﻭ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺆ‬‫ﺑ‬‫ﺆ‬
‫•ﺣﺠﻢﻛﻞﻣﻦﺑ‬
‫ﺪ‬‫ﺍﺣ‬‫ﻧﺐﻭ‬ ‫ﺎ‬
‫ﻟﻰﺟ‬‫ﺃﺱﺇ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻥ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻬﺖ‬ ‫ﺗﺠ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫• ﺳ‬

Thepresenceorabsenceofaut omat i
sms( i
nvol
untarymotoractivi
ty,suchas
l
i
psmacki ngorr epeatedswal l
owi ng)
I
ncontinenceofurineorst ool
Durat
ionofeachphaseoft hesei z
ure
Unconsciousness,ifpresent,anditsdur at
ion
(
‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻠ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻩ‬‫ﺎ‬
‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﻊ‬‫ﻔ‬‫ﺜﻞ ﺻ‬‫ﻣ‬،‫ﺩﻱ‬‫ﺍ‬
‫ﺭ‬ ‫ﻛﻲﻻﺇ‬‫ﺮ‬‫ﺎﻁﺣ‬ ‫ﻧﺸ‬)‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﺁ‬‫ﺎﺕ‬
‫ﻴ‬‫ﻟ‬
‫ﺁ‬‫ﺩ‬‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻭﻋ‬‫ﺃ‬ ‫ﺩ‬
‫ﻮ‬‫•ﻭﺟ‬
‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬ ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﺲ‬ ‫•ﺳ‬
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬
‫ﺔﻣﻦﻣ‬ ‫ﻠ‬‫ﺮﺣ‬‫ﺓﻛﻞﻣ‬ ‫ﺪ‬‫•ﻣ‬
‫ﻪ‬
‫ﺗ‬‫ﺪ‬‫ﻣ‬
‫ﺪﻭ‬ ‫ﻋﻲﺇﻥﻭﺟ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬
‫ﻘ‬‫•ﻓ‬
‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻴﻦﺑ‬‫ﻗ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﻴﻦ‬ ‫ﻋ‬
‫ﺍ‬‫ﺭ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺿﺢﻓﻲ‬ ‫ﻌﻒﻭ‬‫ﻭﺿ‬ ‫ﺃ‬‫ﻠﻞ‬‫ﺃﻱﺷ‬•

Anyobv
iouspar
aly
sisorweaknessofar
msorl
egsaf
tert
hesei
zur
e

159
 I
nabil
it
ytospeakaf t
ertheseizur
e
Movementsattheendoft hesei
zur
e
Whetherornotthepatientsl
eepsaft
erward
Cogni
tiv
estatus(confusedornotconfused)af
tert
heseizure
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻡﺑ‬‫ﻜﻼ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫•ﻋ‬
‫ﺔ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﺎﺕﻓﻲﻧ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬•
‫ﻡﻻ‬‫ﺃ‬‫ﻟﻚ‬
‫ﺪﺫ‬‫ﻌ‬‫ﻡﺑ‬ ‫ﺎ‬
‫ﻨ‬‫ﻳ ﺾﻳ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬
‫•ﺎﺇ‬
‫ﻣ‬
‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬
‫(ﺑ‬‫ﺔ‬
‫ﻮﺷ‬‫ﺮﻣﺸ‬‫ﻴ‬‫ﻭﻏ‬‫ﺃ‬‫ﺔ‬‫ﻮﺷ‬ ‫ﻣﺸ‬)‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺮ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬•

13.Nur si
ngcar eisdi rectedatpr eventinginjuryandsuppor ti
ngt hepatient
,
physicall
yandpsy chologically .
AfteraSei zure
1.Topr eventcompl ications, thepat ientisplacedint heside-l
yingpositi
onto
facil
i
tatedr ai
nageofor al secr etions.
2.Suctioningt omaint ainapat entairway&pr eventaspirati
on.
3.Thebedi splacedi nal owposi ti
onwi thtwot othreesiderailsupandpadded,
i
fnecessar y ,
toprev entinjuryt ot hepat i
ent.
4.Thepat ient,onawakeni ng, shoul dber eori
entedtot heenv i
ronment .
5.Afterapat ienthasasei zur e, t
henur se'
sroleistodocumentt heevents
l
eadingt oandoccur ri
ngdur ingandaf tertheseizure.

.‫ﺎ‬
ً
‫ﻴ‬‫ﻔﺴ‬‫ﻧ‬‫ﺎﻭ‬ً
‫ﻳ‬
‫ﺪ‬‫ﻳ ﺾﺟﺴ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺩﻋﻢ‬‫ﺔﻭ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﻊ‬‫ﻨ‬‫ﻟﻰﻣ‬‫ﺔﺇ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻑ‬ ‫ﻬ‬‫ﺗ‬.
13
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﺪﻧ‬‫ﻌ‬‫ﺑ‬
‫ﺍﺕ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺍﻹ‬‫ﻳﻒ‬‫ﺮ‬
‫ﻴﻞﺗﺼ‬‫ﻬ‬‫ﺘﺴ‬‫ﻟ‬‫ﺒﻲ‬‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻘ‬
‫ﻠ‬‫ﺘ‬
‫ﺍﻻﺳ‬‫ﻊ‬‫ﻳ ﺾﻓﻲﻭﺿ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺘﻢﻭﺿ‬ ‫ﻳ‬،‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻭﺙﻣﻀ‬ ‫ﺪ‬‫ﻊﺣ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬.
1
.‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻤ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
.‫ﻮﺡ‬
‫ﻤ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬‫ﺀﻭ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻠﻰﻣﺠ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﻔﻂ‬‫ﻟﺸ‬‫ﺍ‬.
2
‫ﺍﻷ‬
‫ﻡ‬‫ﺰ‬‫ﻟ‬‫ﺍ‬
‫ﺫ‬‫ﺇ‬،‫ﺒﻄﻦ‬
‫ﻣ‬‫ﺔﻭ‬‫ﻴ‬
‫ﺒ‬‫ﻧ‬
‫ﺎ‬‫ﺎﻥﺟ‬‫ﺒ‬‫ﻼﺔﻗﻀ‬‫ﻟﻰﺛﺛ‬‫ﻴﻦﺇ‬‫ﺒ‬
‫ﻴ‬‫ﺩﻗﻀ‬‫ﻮ‬‫ﻊﻭﺟ‬‫ﻔ ﺾﻣ‬ ‫ﻨﺨ‬
‫ﻊﻣ‬ ‫ﺮﻓﻲﻭﺿ‬ ‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻊ‬‫ﺘﻢﻭﺿ‬ ‫ﻳ‬.
3
.‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻊﺇﺻ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬،‫ﻣ‬
‫ﺮ‬
.
‫ﺔ‬‫ﺌ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺇ‬،
‫ﺎﻅ‬‫ﻘ‬‫ﻴ‬
‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﺪ‬
‫ﻨ‬‫ﻋ‬،‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬ ‫ﻳﺠﺐﺇ‬.4
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺙ‬‫ﺪ‬‫ﻟﻰﺣ‬
‫ﺩﺕﺇ‬‫ﺃ‬‫ﺘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺙ‬‫ﺪ‬‫ﺍﻷﺣ‬‫ﻴﻖ‬‫ﺛ‬
‫ﻮ‬‫ﻮﺗ‬‫ﺔﻫ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﻮﻥﺩ‬‫ﻜ‬‫ﻳ‬،‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺪﺇﺻ‬ ‫ﻌ‬‫ﺑ‬.
5
.
‫ﺎ‬‫ﺪﻫ‬‫ﻌ‬‫ﺑ‬
‫ﺎﻭ‬‫ﺀﻫ‬‫ﺎ‬‫ﻨ‬
‫ﺛ‬ ‫ﺃ‬
‫ﺪﺙ‬ ‫ﺗﺤ‬
‫ﻭ‬

160
 (
Fig.35)Sei
zur
epr
ecaut
ions

Epi
lepsy
Learningobject i
v es:
Uponcompl etionoft hisl
ecture,eachstudentshoul
dbeabl eto:
1.Defineepilepsy
2.Definestatusepi l
ept i
cus
3.Identi
fythepat hophy si
ologyofepi l
epsy
4.Listty
pesandcausesofepi lepsy
5.Identi
fythecl i
ni cal manif
estationsandcompl i
cat
ionsofpatientwi
thepi
l
epsy
6.Describedi agnost icstudiesneededf orpati
entwit
hepilepsy
7.Describemedi cal andsur gi
cal managementofepilepsy
8.Identi
fyfact or
spr ecipi
tat
est atusepil
epti
cus
9.Describemedi cal andnur si
ngmanagementofst atusepil
epti
cus

‫ﺮﻉ‬
‫ﻟﺼ‬‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺐﻗ‬‫ﺎ‬‫ﻮﻥﻛﻞﻃ‬‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬.
1
‫ﺮﻉ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺪﺎ‬ ‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬.2
‫ﺮﻉ‬‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
3
‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬‫ﺍﻉﻭ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬ ‫ﺔ‬
‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.4
‫ﺮﻉ‬‫ﻟﺼ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻭ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
5
‫ﺮﻉ‬‫ﻟﺼ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﺍﻼ‬‫ﺔﻟ‬‫ﻴ‬‫ﻴﺼ‬ ‫ﺘﺸﺨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 6
‫ﺮﻉ‬‫ﻠﺼ‬‫ﻟ‬‫ﺍﺣﻲ‬ ‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺒﻲﻭ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 7
‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻌﺠﻞ ﺎ‬ ‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬.8
‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬‫ﻭﺻﻒ‬. 9

161
 Epi
l
epsy
Defi
niti
on:
Epi
lepsyisagr
oupofsy
ndr
omeschar
act
eri
zedbyunpr
ovoked,
recur
ri
ng
sei
zures.
:
‫ﻳﻒ‬‫ﺮ‬
‫ﻌ‬‫ﺗ‬
‫ﺓ‬
‫ﺭ‬‫ﺮ‬‫ﺒ‬
‫ﺮﻣ‬‫ﻴ‬
‫ﺓﻏ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬
‫ﺮﻉﻣ‬
‫ﺎﺕ ﺻ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﺰﺑ‬‫ﻴ‬
‫ﻤ‬‫ﺘ‬‫ﺘﻲﺗ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻣ‬‫ﺯ‬‫ﺘﻼ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬
‫ﻮﻋ‬‫ﻤ‬
‫ﻮﻣﺠ‬
‫ﺮﻉﻫ‬‫ﻟﺼ‬‫ﺍ‬
.
Pathophysiol
ogy
1.Messagesf rom thebodyar ecar ri
edbyt heneur ons( nervecells)ofthebr ain
bymeansofdi schargesofelectrochemi cal energythatsweepal ongt hem.
2.Theseimpul sesoccuri nburstswhenev eraner vecel lhasat askt operform.
3.Sometimes, thesecellsorgroupsofcel lscont inuef i
ringafterat askis
fi
nished.
‫ﺔ‬
‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﻎ‬‫ﻳ‬
‫ﺮ‬ ‫ﻔ‬
‫ﻳﻖﺗ‬‫ﺮ‬
‫ﺎﻍﻋﻦﻃ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫(ﻓﻲ‬ ‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬)‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﺔ‬‫ﺍﺳﻄ‬ ‫ﻮ‬
‫ﻟﺠﺴﻢﺑ‬ ‫ﺍ‬‫ﺋﻞﻣﻦ‬ ‫ﺎ‬
‫ﺮﺳ‬‫ﻟ‬‫ﺍ‬‫ﻘﻞ‬‫ﺘﻢﻧ‬‫ﻳ‬.1
.
‫ﺎ‬‫ﻬ‬‫ﺘﺴﺤ‬ ‫ﻜ‬
‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻛ‬‫ﻭ‬‫ﺮ‬‫ﻬ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗ‬‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬
.‫ﺎ‬
‫ﻬ‬‫ﻳ‬‫ﺩ‬‫ﺆ‬‫ﺔﺗ‬‫ﻤ‬‫ﻬ‬
‫ﺔﻣ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬‫ﻠﻰ‬‫ﻮﻥﻋ‬‫ﻜ‬‫ﺎﻳ‬ ‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﺎﺕﻋ‬ ‫ﻌ‬‫ﻓ‬‫ﻜﻞﺩ‬ ‫ﻠﻰﺷ‬‫ﺎﺕﻋ‬ ‫ﺒﻀ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﺪﺙﻫ‬ ‫ﺗﺤ‬.2
.
‫ﺔ‬‫ﻤ‬‫ﻬ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬
‫ﻧ‬‫ﺍ‬ ‫ﺪ‬‫ﻌ‬
‫ﺭﺑ‬‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻓﻲﺇﻃﻼﻕ‬ ‫ﻳ‬
‫ﻟﺨﻼ‬ ‫ﺍ‬‫ﺎﺕ‬
‫ﻮﻋ‬ ‫ﻤ‬‫ﻭﻣﺠ‬ ‫ﺃ‬‫ﺎ‬‫ﻳ‬
‫ﻟﺨﻼ‬‫ﺍ‬ ‫ﻩ‬
‫ﺬ‬ ‫ﺮﻫ‬‫ﻤ‬‫ﺘ‬
‫ﺗﺴ‬، ‫ﺎﻥ‬‫ﻴ‬‫ﺍﻷﺣ‬‫ﻌﺾ‬ ‫ﻓﻲﺑ‬. 3

4.Duri
ngtheperi
odofunwant eddischarges,par
tsofthebodycontr
olledbythe
err
antcell
smayper f
orm err
ati
cal
ly.
5.Resul
tantdysf
uncti
onrangesfr
om mi l
dtoincapacit
ati
ngandoft
encauses
l
ossofconsciousness.
6.I
ftheseuncontr
oll
ed,abnormaldischargesoccurrepeat
edl
y,apersonissaid
tohaveanepil
epti
csy ndr
ome.

Epi
lepsyisnotassoci atedwithintell
ectual l
evel.Peoplewhohav eepi l
epsy
wit
houtotherbr ai
norner voussy stem disabili
ti
esf al
lwit
hinthesame
i
ntell
i
gencer angesast heov eral
l populat
ion.
‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﻀ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﺎ‬
‫ﻬ‬‫ﻴ‬‫ﻜﻢﻓ‬‫ﺘﺤ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬ ‫ﺀ‬
‫ﺍ‬‫ﺰ‬‫ﺃﺟ‬‫ﻤﻞ‬‫ﻌ‬‫ﺪﺗ‬‫ﻗ‬،‫ﺎ‬‫ﻬ‬‫ﻴ‬‫ﻮﺏﻓ‬‫ﺮﻏ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﺍﺕﻏ‬ ‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﺓ‬‫ﺮ‬
‫ﺘ‬‫ﺧﻼﻝﻓ‬. 4
.
‫ﻊ‬‫ﻘﻄ‬‫ﺘ‬‫ﻜﻞﻣ‬‫ﺑﺸ‬
.
‫ﻮﻋﻲ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬ ‫ﻘ‬
‫ﺒﺐﻓ‬ ‫ﺎﻳﺴ‬‫ﺎﻣ‬
ً‫ﺒ‬‫ﻟ‬
‫ﺎ‬‫ﻏ‬‫ﺰﻭ‬‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻰ‬ ‫ﻴﻒﺇ‬‫ﻔ‬ ‫ﻟﺨ‬
‫ﺍ‬‫ﺗﺞﻣﻦ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻲ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞ‬‫ﻟﺨ‬
‫ﺍ‬‫ﻭﺡ‬‫ﺍ‬‫ﺮ‬
‫ﺘ‬‫ﻳ‬.5
‫ﺘﻼ‬‫ﻤ‬‫ﺎﺏﺑ‬‫ﻟﺸﺨ ﺺﻣﺼ‬ ‫ﺍ‬‫ﺎﻝﺇﻥ‬‫ﻘ‬،
ُ‫ﺭ‬
‫ﻳ‬ ‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺔﻭﻏ‬ ‫ﺒﻄ‬‫ﻨﻀ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺍﺕﻏ‬ ‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﻩ‬‫ﺬ‬‫ﺭﺕﻫ‬ ‫ﺮ‬
‫ﻜ‬‫ﺍﺗ‬
‫ﺫ‬‫ﺇ‬.6
.‫ﺮﻉ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬

‫ﺮﻯﻓﻲ‬ ‫ﺃﺧ‬ ‫ﺎﺕ‬‫ﻗ‬‫ﺎ‬‫ﻭﻥﺇﻋ‬‫ﺮﻉﺩ‬ ‫ﻟﺼ‬

‫ﺍ‬‫ﻮﻥﻣﻦ‬‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬‫ﻊ‬‫ﻘ‬‫ﻳ‬.
‫ﺮﻱ‬‫ﻜ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺎ‬
‫ﺮﻉﺑ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﻂ‬‫ﺗ‬
‫ﺮ‬‫ﻻﻳ‬
.
‫ﺎﻥ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻤ‬
‫ﺜﻞﻋ‬‫ﺀﻣ‬‫ﺎ‬
‫ﻛ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﻗ‬‫ﺎ‬
‫ﻔﺲﻧﻄ‬ ‫ﻤﻦﻧ‬‫ﺒﻲ ﺿ‬
‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
Types:
1.Primary( idiopathic)
2.Secondar y( whent hecauseisknownandt heepi
lepsyisasymptom of
anotherunder ly
ingcondi ti
on,suchasabraintumor)
.
Causes:
1.Unknown( i
diopat hic)
2.Cerebrov ascul ardisorders
3.Headi njuries
4.Braintumor s
5.Meni ngi
tis
6.Encephal iti
s
7.bi
rtht r
auma

162
8.Toxicit
y(carbonmonoxideandl
eadpoi
soni
ng)
9.Fever
10.Met abol
icandnutri
ti
onaldi
sor
der
s
11.Drugoral cohol
int
oxicat
ion
:‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺍﻷ‬
(
‫ﺒﺐ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﻬ‬‫ﻣﺠ‬ )‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬‫ﺪ‬
‫ﺘ‬‫ﺑ‬‫ﺍﻻ‬ .
1
‫ﻡﻓﻲ‬ ‫ﺭ‬
‫ﺜﻞﻭ‬‫ﻣ‬، ‫ﺮﻯ‬‫ﺃﺧ‬‫ﺔ‬‫ﻨ‬‫ﻣ‬
‫ﺎ‬‫ﺣﺔﻛ‬
‫ﻟ‬
‫ﺍﺽ ﺎ‬ ‫ﺮ‬‫ﺃﻋ‬‫ﺪ‬‫ﺃﺣ‬‫ﺮﻉ‬‫ﻟﺼ‬‫ﺍ‬‫ﻮﻥ‬
‫ﻜ‬ ‫ﻳ‬
‫ﺎﻭ‬ً
‫ﻓ‬‫ﻭ‬‫ﺮ‬‫ﻌ‬‫ﺒﺐﻣ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬ ‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬ )‫ﻮﻱ‬ ‫ﻧ‬
‫ﺎ‬‫ﺛ‬.2
.(‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬
:
‫ﺎﺏ‬‫ﺒ‬‫ﺍﻷﺳ‬
(‫ﺒﺐ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﻬ‬‫ﻣﺠ‬)‫ﻭﻑ‬ ‫ﺮ‬‫ﻌ‬‫ﺮﻣ‬ ‫ﻴ‬
‫ﻏ‬. 1
‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻋ‬‫ﻭ‬ ‫ﺍﻷ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬ .
2
‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬. 3
‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬ .
4
‫ﺎ‬‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ .
5
‫ﺎﻍ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ .
6
‫ﻻﺓ‬‫ﻮﺩ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺻ‬. 7
(‫ﺎﺹ‬ ‫ﺮﺻ‬‫ﻟ‬
‫ﺎ‬‫ﻤﻢﺑ‬‫ﺘﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻭ‬‫ﺑ‬‫ﺮ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻴ‬‫ﻛﺴ‬‫ﺃ‬ ‫ﻭﻝ‬‫ﺃ‬)‫ﺔ‬ ‫ﻴ‬
‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬ .
8
‫ﻤﻰ‬‫ﻟﺤ‬‫ﺍ‬ .
9
‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺋﻲﻭ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬ .10
‫ﻮﻝ‬
‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﻤﻢ‬‫ﺗﺴ‬. 11
Cli
nicalMani festati
ons:
Dependi ngont helocati
onoft hedischargi
ngneur ons,sei
zuresmayr angef r
om
asimpl estari
ngepi sode(absenceseizure)toprolongedconv ul si
vemov ement s
wit
hl ossofconsci ousness.
1.I
nv ol
unt ar
yepi sodesoflossofconsciousness

:
‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﺘﻼ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬
‫ﻋ‬‫ﺍﻻ‬
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﺔﻣﺼﺤ‬ ‫ﺑ‬‫ﻮ‬
‫ﻧ‬)‫ﺔ‬‫ﻴﻄ‬
‫ﻳﻖﺑﺴ‬‫ﺪ‬‫ﺔﺗﺤ‬‫ﺑ‬
‫ﻮ‬‫ﺎﺕﻣﻦﻧ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻭﺡ‬ ‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺪﺗ‬
‫ﻗ‬، ‫ﺔ‬‫ﺮﻏ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬
‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻠﻰﻣ‬‫ﺍﻋ‬ً
‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﻋ‬‫ﺍ‬
.‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻊﻓ‬‫ﺔﻣ‬ ‫ﻟ‬
‫ﻮ‬‫ﺔﻣﻄ‬ ‫ﻴ‬‫ﻨﺠ‬
‫ﺎﺕﺗﺸ‬‫ﻛ‬‫ﺮ‬
‫ﻟﻰﺣ‬ ‫(ﺇ‬
‫ﺔ‬‫ﺒ‬‫ﻴ‬
‫ﻐ‬‫ﺑ‬
‫ﻮﻋﻲ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺔﻣﻦﻓ‬‫ﻳ‬‫ﺩ‬
‫ﺍ‬‫ﺭ‬‫ﺎﺕﻻﺇ‬‫ﺑ‬
‫ﻮ‬‫ﻧ‬.1
2.Excessi
vemuscularmovementorlossofmuscl etone
3.Changesinbehav
ior,mood,sensat
ion,and/orperception

‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻌﻀ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﻮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻥ‬‫ﺪ‬
‫ﻘ‬‫ﻭﻓ‬
‫ﺃ‬‫ﺔ‬‫ﺮﻃ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻌﻀ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬.
2
‫ﺍﻙ‬
‫ﺭ‬‫ﺩ‬‫ﺃﺍﻹ‬
‫ﻭ‬/‫ﺎﺱﻭ‬ ‫ﺍﻹﺣﺴ‬
‫ﺍﺝﻭ‬
‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻮﻙﻭ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
3

AssessmentandDi agnost i
cFi ndings
Thediagnost i
cassessmenti sai medatdet ermini
ng:
Thet ypeofsei zures
Frequencyandsev erityofseiz ures
Factorst hatprecipitateseizur es
1.Adev elopment alhist oryi
st aken, includingeventsofpregnancyand
chi
ldbir
th, t
oseekev idenceofpr eexi
stinginjury
.
2.Thepat ientisalsoquest i
onedabouti ll
nessesorheadi nj
uri
esthatmayhave
aff
ectedt hebr ai
n.
3.Physical andneur ologicev aluations.
4.Diagnost i
cexami nat ionsinclude:
a.Theel ectroencephal ogram (EEG)i sadi agnosti
cevidenceforpati
ent
swit
h

163
epi
lepsyandassi stsinclassifyi
ngt het ypeofsei zure.
b.Biochemi cal,
hemat ologic,andser ologi
cst udies.
c.MRIi susedt odet ectstructural l
esionssuchasf ocal abnor mal it
ies,
cerebrovascularabnor mali
t i
es,andcer ebraldegener ati
vechanges.
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻧ‬
:
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﻰﺗﺤ‬ ‫ﻴﺼﻲﺇ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻑ‬ ‫ﻬ‬‫ﻳ‬
‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻮﻉ‬‫ﻧ‬
‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺮﻭﺷ‬ ‫ﺗ‬‫ﺍ‬
‫ﻮ‬‫ﺗ‬
‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺙ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬ ‫ﺑ‬
‫ﺎ‬‫ﺩﺇﺻ‬‫ﻮ‬‫ﻠﻰﻭﺟ‬ ‫ﻴﻞﻋ‬ ‫ﻟ‬
‫ﺒﺤﺚﻋﻦﺩ‬ ‫ﻠ‬‫ﻟ‬،‫ﺩ‬
‫ﻭﻮﻻﺓ‬‫ﻟ‬‫ﻤﻞﺍ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺍﺙ‬‫ﺪ‬‫ﺃﺣ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬، ‫ﺋﻲ‬‫ﺎ‬
‫ﻤ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺬ‬‫ﺃﺧ‬ ‫ﺘﻢ‬‫ﻳ‬.1
.
‫ﺔ‬ ‫ﻘ‬
‫ﺑ‬‫ﺎ‬
‫ﺳ‬
.‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺑﺖ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﻮﻥ‬‫ﻜ‬ ‫ﺪﺗ‬‫ﺃﺱﻗ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﺑ‬
‫ﺎ‬‫ﻭﺇﺻ‬ ‫ﺃ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬‫ﺎﻋﻦ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺄﻝ‬‫ﻳﺴ‬. 2
.‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻟﺠﺴ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﻤ‬‫ﻴ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬.3
:‫ﻠﻲ‬‫ﺎﻳ‬‫ﺔﻣ‬‫ﻴ‬‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻮﺻ‬ ‫ﻔﺤ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬ ‫ﺗﺸ‬.4
.‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻉ‬‫ﻴﻒﻧ‬ ‫ﻨ‬
‫ﺪﻓﻲﺗﺼ‬ ‫ﺎﻋ‬
‫ﻳﺴ‬‫ﺮﻉﻭ‬ ‫ﻟﺼ‬‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﻴﺼﻲ‬ ‫ﻴﻞﺗﺸﺨ‬ ‫ﻟ‬
‫ﻮﺩ‬ ‫(ﻫ‬EEG)‫ﺎﻍ‬ ‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻣﺨﻄﻂﻛ‬. ‫ﺃ‬
.‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻛ‬‫ﻮ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬.
‫ﺏ‬
‫ﻭ‬، ‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﺆ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬ ‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻴ‬
‫ﻠ‬‫ﻜ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻓ‬‫ﻋﺍﻵ‬
‫ﻜﺸﻒ ﻦ‬ ‫ﻠ‬
‫ﻟ‬‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻧ‬
‫ﺮ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻳﺴ‬.‫ﺝ‬
.
‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻜﺴ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻮﻋ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻮﻫ‬ ‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬

Medi cal Management

Themanagementofepi lepsyi si ndiv idual i
zedt omeett heneedsofeachpat i
ent
andnotj ustt omanageandpr ev entsei zures.
Phar macol ogi cTher apy
Manymedi cat ionsar eav ail
ablet ocont rolsei zuressuchaspheny t
oin( Di l
ant in),
phenobar bital,carbamazepi ne( Tegr et ol),valproicaci d(Depakene) ,di valproex
(Depakot e) ,areof tenused.
Medi cationt her apycont r olsrat hert hancur essei zur es.Medi cationscont rol
seizuresi n70%t o80%ofpat ient swi thsei zures.
Treatmentusual l
yst art
swi thasi nglemedi cati
on.Thest arti
ngdoseandt he
rateatwhi cht hedosagei sincr easeddependont heoccur renceofsi deef fect s.
Themedi cationl evelsint hebl oodar emoni tored, becauset her ateofdr ug
absor pti
onv ariesamongpat i
ent s.Changi ngt oanot hermedi cationmaybe
necessar yi fsei zurecont r olisnotachi ev edori ftoxicitymakesi ti mpossi blet o
i
ncr easet hedosage.
‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
.
‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬‫ﺓﻭ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﻘﻂﻹ‬ ‫ﻴﺲﻓ‬ ‫ﻟ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﺎﺕﻛﻞﻣ‬ ‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬ ‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻠ‬
‫ﺘ‬‫ﻟ‬ ‫ﺩﻱ‬‫ﺮ‬‫ﻜﻞﻓ‬ ‫ﺮﻉﺑﺸ‬ ‫ﻟﺼ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺘﻢﺇ‬‫ﺗ‬
‫ﺋﻲ‬ ‫ﺍ‬
‫ﻭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬
،‫ﺎ‬
‫ﺘﻝ‬ ‫ﻴ‬‫ﺑ‬‫ﺭ‬‫ﺎ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬،(‫ﻴﻦ‬ ‫ﺘ‬‫ﻧ‬
‫ﺩﻼ‬‫ﻳﻦ)ﻳ‬ ‫ﻮ‬‫ﺘ‬‫ﻴ‬‫ﻨ‬ ‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬ ‫ﺎﺕﻣ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬ ‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬‫ﻠﺴ‬‫ﻟ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﻣﺍﻷ‬
‫ﺪﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﻮ‬ ‫ﺘ‬
‫ﺗ‬
‫ﻳﻚ‬ ‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻤﺾ‬ ‫ﺣ‬، (‫ﻮﻝ‬‫ﺘ‬‫ﻳ‬‫ﺮ‬‫ﻴﺠ‬ ‫ﺗ‬
)‫ﻴﻦ‬ ‫ﺒ‬
‫ﻳ‬‫ﺯ‬‫ﺎ‬‫ﻣ‬‫ﺎ‬‫ﺑ‬‫ﺭ‬‫ﺎ‬
‫ﻛ‬
.
(divalproex( Depakot e‫(ﻭ‬ Depakene)‫ﻡ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬ً
‫ﺒ‬‫ﻟ‬‫ﺎ‬
‫ﻣﻦ‬٪ 80‫ﻟﻰ‬ ‫ﺇ‬٪ 70‫ﺎﺕﻓﻲ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻓﻲ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻜﻢ‬ ‫ﺘﺤ‬ ‫ﺗ‬.‫ﺟ‬
‫ﺎ‬‫ﺑﻻًﻣﻦﻋﻼﻬ‬ ‫ﺎﺕﺪ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻲﻓﻲ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻜﻢ‬ ‫ﺘﺤ‬‫ﻳ‬
.‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻢ‬‫ﺗ‬.‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﻵﺭ‬
‫ﺎ‬‫ﺍﺛ‬ ‫ﻭﺙ‬ ‫ﺪ‬‫ﻠﻰﺣ‬ ‫ﺔﻋ‬ ‫ﺮﻋ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺪﻝﺯ‬ ‫ﻌ‬‫ﻣ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﺍ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻋ‬‫ﺮ‬ ‫ﺪﺟ‬ ‫ﻤ‬‫ﺘ‬‫ﻌ‬‫ﺗ‬.‫ﺪ‬‫ﺍﺣ‬ ‫ﺀﻭ‬‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﺓﺑ‬ ‫ﺩ‬‫ﺎ‬
‫ﻌﻼﺝﻋ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺃ‬
‫ﺪ‬ ‫ﺒ‬
‫ﻳ‬
‫ﺮ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬ ‫ﺪﻳ‬‫ﻗ‬. ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻠﻒﺑ‬ ‫ﺘ‬‫ﺀﻳﺨ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺹ‬ ‫ﺘﺼ‬ ‫ﻣ‬‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬‫ﻷﻥﻣ‬، ‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺀﻓﻲ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬ ‫ﺘ‬‫ﺔﻣﺴ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬
‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﻴﻞﺯ‬ ‫ﺘﺤ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞﻣﻦ‬ ‫ﺔﺗﺠ‬ ‫ﻴ‬ ‫ﻤ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﻧﺖ‬ ‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬ ‫ﻭﺇ‬‫ﺃ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻜﻢﻓﻲ‬ ‫ﺘﺤ‬‫ﻟ‬‫ﺍ‬‫ﺘﻢ‬‫ﻟﻢﻳ‬ ‫ﺍ‬‫ﺫ‬‫ﺎﺇ‬ً
‫ﻳ‬
‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﺮﺿ‬ ‫ﺁﺧ‬ ‫ﺀ‬‫ﺍ‬‫ﻭ‬‫ﻟﻰﺩ‬ ‫ﺇ‬
.
‫ﺔ‬ ‫ﺮﻋ‬‫ﻟﺠ‬ ‫ﺍ‬

Themedicat
ionmayneedtobeadj ust
edbecauseofconcurr
entil
l
ness,wei
ght
changes,
ori
ncreasesi
nst
ress.Suddenwithdr
awalofthesemedicati
onscan
causesei
zur
estooccurwi
thgreaterfr
equencyorcanpreci
pit
atethe

164
dev
elopmentofst
atusepi
l
ept
icus.

Themanifest
ationsofdrugt
oxici
tyarevar
iable,
andanyorgansyst
em maybe
i
nvolv
ed:Gingi
val hy
perpl
asi
a(swoll
enandt endergums)canbeassoci
ated
wit
hlong-
term useofphenyt
oin(Dil
anti
n).

Peri
odicphysi
calanddent
al examinati
onsandlaborat
oryt
estsareper
formed
forpati
ent
srecei
vingmedicati
onst hatar
eknownt ohavehematopoi
eti
c,
genit
ouri
nary,
orhepat
iceffects.

‫ﺍﻻ‬
‫ﺩﻱ‬‫ﺆ‬
‫ﺃﻥﻳ‬ ‫ﻜﻦ‬
‫ﻤ‬‫ﻳ‬.
‫ﺮ‬‫ﺗ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﻭﺯ‬
‫ﺃ‬‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬
‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﻭﺗ‬‫ﺃ‬‫ﻣﻦ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮﺽ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺒﺐ‬‫ﻳﻞﺑﺴ‬‫ﺪ‬‫ﻌ‬
‫ﻟﻰﺗ‬‫ﺀﺇ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫ﺪﻳﺤ‬ ‫ﻗ‬
‫ﺔ‬‫ﻟ‬
‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬‫ﻌﺠﻞﻣﻦﺗﻄ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬
‫ﻤ‬‫ﻭﻳ‬‫ﺃ‬‫ﺮ‬
‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﺗ‬
‫ﻮ‬‫ﺎﺕﺑ‬‫ﺑ‬
‫ﻮ‬‫ﻭﺙﻧ‬
‫ﺪ‬‫ﻟﻰﺣ‬‫ﺔﺇ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻩ‬‫ﺬ‬
‫ﻬ‬‫ﻟ‬‫ﺎﺟﺊ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬ ‫ﻧﺴﺤ‬
.‫ﺔ‬‫ﻴ‬‫ﺮﻋ‬‫ﻟﺼ‬
‫ﺍ‬

‫ﺔ‬
‫ﺜ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﺗ‬)‫ﺔ‬
‫ﺜ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖﺗﻀﺨﻢ‬
‫ﺍ‬‫ﺮ‬‫ﺘ‬
‫ﺃﻥﻳ‬
‫ﻜﻦ‬‫ﻤ‬
‫ﻳ‬:‫ﻮ‬
‫ﺯﻋﻀ‬ ‫ﺎ‬
‫ﻬ‬‫ﺃﻱﺟ‬‫ﺮ‬
‫ﺛ‬‫ﺄ‬‫ﺘ‬
‫ﺪﻳ‬‫ﻗ‬‫ﻭ‬،‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﺔﻣ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﺮﺳ‬
‫ﺎﻫ‬‫ﺇﻥﻣﻈ‬
.
(‫ﻴﻦ‬
‫ﺘ‬‫ﻧ‬‫ﺩﻼ‬
‫ﻳﻦ)ﻳ‬
‫ﻮ‬‫ﺘ‬‫ﻴ‬
‫ﻨ‬‫ﻴ‬‫ﻔ‬
‫ﻠ‬‫ﻟ‬‫ﻷﺪ‬
‫ﺍﻣ‬‫ﻳﻞ‬
‫ﻮ‬‫ﻡﻃ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬
‫ﻣﺍﻻﺳ‬
‫(ﻊ‬‫ﺎ‬‫ﻬ‬
‫ﻤ‬‫ﻟ‬‫ﺃ‬
‫ﻭ‬

‫ﺎ‬‫ﻬ‬
‫ﺗ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﺔﺑ‬ ‫ﻓ‬
‫ﻭ‬‫ﺮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﺍﻷ‬ ‫ﻮﻥ‬‫ﻘ‬‫ﻠ‬
‫ﺘ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻳ‬
‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻧ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺮ‬
‫ﺒ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻮﺻ‬ ‫ﻔﺤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬ ‫ﺘﻢﺇﺟ‬‫ﻳ‬
.‫ﺪ‬‫ﺒ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬
‫ﻠﻲ‬ ‫ﺎﺳ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻲ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻡ‬ ‫ﺪ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻧ‬‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
SurgicalManagement
Surgeryisi ndicatedf orpat i
entswhoseepi lepsyr esul t
sf r
om intracranial
tumor s,abscesses, cysts,orvascularanomal ies.Somepat i
entshav esei zure
disordersthatdonotr espondt omedi cati
on.Ift hesei zuresorigi
nat ei na
reasonablywel l
-cir
cumscr i
bedar eaoft hebr aint hatcanbeexci sedwi thout
producingsi gnifi
cantneur ol
ogicdef icit
s,theremov aloftheareagener atingt he
seizuresmaypr oducel ong-ter
m cont r
olandi mpr ov ement .
‫ﺔ‬ ‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
‫ﻭ‬ ‫ﺃ‬
‫ﺎﺕ‬‫ﻴﺴ‬ ‫ﻜ‬‫ﻭﺗ‬‫ﺃ‬‫ﺎﺕ‬ ‫ﺍﺟ‬
‫ﺮ‬‫ﻭﺧ‬ ‫ﺃ‬‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻡﺩ‬ ‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻬﻢﻋﻦ‬ ‫ﺮﻋ‬‫ﺘﺞ ﺻ‬ ‫ﻨ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﺍﺣ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻰ‬‫ﺭﺇ‬‫ﺎ‬‫ﻳﺸ‬
‫ﺍ‬
‫ﺫ‬‫ﺇ‬.
‫ﺔ‬ ‫ﻳ‬
‫ﻭ‬‫ﺩ‬ ‫ﻟﻸ‬‫ﻴﺐ‬ ‫ﺘﺠ‬‫ﺎﺕﻻﺗﺴ‬ ‫ﺑ‬
‫ﻮ‬‫ﺎﺕﻧ‬‫ﺑ‬‫ﺍ‬‫ﺮ‬
‫ﺍﺿﻄ‬ ‫ﺮﺿﻰﻣﻦ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻌﺾ‬ ‫ﻧﻲﺑ‬‫ﺎ‬‫ﻌ‬‫ﻳ‬.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺎﺕﻓﻲ‬ ‫ﻮﻫ‬‫ﺗﺸ‬
‫ﺈﻥ‬‫ﻓ‬،‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﺒﻲﻛ‬ ‫ﺰﻋﺼ‬ ‫ﺍﺙﻋﺠ‬ ‫ﺪ‬‫ﻭﻥﺇﺣ‬‫ﺎﺩ‬‫ﻬ‬‫ﻟ‬
‫ﺎ‬‫ﺌﺼ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺎﻍﻳ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﻣﻦ‬ ً
‫ﺪ‬‫ﻴ‬‫ﺓﺟ‬ ‫ﺪ‬
‫ﻴ‬‫ﻘ‬‫ﺔﻣ‬‫ﻘ‬‫ﻨﻄ‬‫ﺎﺕﻓﻲﻣ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺄﺕ‬‫ﻧﺸ‬
.‫ﻷﺪ‬
‫ﺍﻣ‬ ‫ﻳﻞ‬‫ﻮ‬‫ﺗﺤﺴﻦﻃ‬ ‫ﻜﻢﻭ‬ ‫ﺎﺗﺤ‬‫ﻬ‬‫ﻨ‬
‫ﺘﺞﻋ‬ ‫ﻨ‬‫ﺪﻳ‬‫ﺎﺕﻗ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻟ‬
‫ﻮ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺇ‬

St
atusEpi
lept
icus

Definiti
on:
Isacut eprol ongedsei zureact i
vit
y ,i
tisaser iesofgener alizedseizuresthat
occurwi t
houtf ullrecov eryofconsci ousnessbet weenat tacks.
Iti
ncludescont i
nuouscl i
nical orelect r
icalseizures(onEEG)l asti
ngatleast30
minutes, ev enwi thouti mpai rmentofconsci ousness.I ti
sconsi deredamedi cal
emer gency .
Vigorousmuscul arcont r
act i
onscani nterf
erewi threspirations.Some
respir
at oryar r
estatt hehei ghtofeachsei zurepr oducesv enouscongest ionand
hypoxiaoft hebr ain.Repeat edepisodesofcer ebralanoxiaandedemamayl ead
toirr
ev ersibleandf atalbraindamage.
Factor sthatpr ecipitatest atusepi l
ept icusinclude:
1.Wi t
hdr awal ofant i
seizuremedi cation.
2.Fev er.
3.Concur r
enti nfection.
‫ﺔ‬
‫ﻴ‬ ‫ﺮﻋ‬‫ﺣﺔ ﺻ‬
‫ﻟ‬
‫ﺎ‬

165
 :
‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬
‫ﺗ‬
‫ﻡ‬
‫ﺎ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻔ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﻭﻥ‬‫ﺪﺙﺩ‬ ‫ﺘﻲﺗﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻤ‬ ‫ﻤ‬
‫ﻌ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻠ‬‫ﻠﺴ‬‫ﺓﻋﻦﺳ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﻭﻫﻲﻋ‬،‫ﻣ‬ ‫ﺍﻷﺪ‬ ‫ﺔ‬‫ﻠ‬‫ﻳ‬‫ﻮ‬‫ﺓﻃ‬ ‫ﺩ‬‫ﺎ‬
‫ﺔﺣ‬ ‫ﺑ‬
‫ﻮ‬‫ﻫﻲﻧ‬
.‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻋﻲﺑ‬ ‫ﻮ‬‫ﻠ‬
‫ﻟ‬
‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬30‫ﺓ‬ ‫ﺪ‬‫ﻤ‬
‫ﻟ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬ ‫(ﺗﺴ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻠﻰﻣﺨﻄﻂﻛ‬ ‫ﻋ‬ )‫ﺓ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺔﻣﺴ‬ ‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻭﻛ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﺎﺕﺳ‬ ‫ﺑ‬‫ﻮ‬‫ﻤﻦﻧ‬ ‫ﺘﻀ‬‫ﻭﻫﻲﺗ‬
.‫ﺔ‬
‫ﺋ‬‫ﺭ‬‫ﺎ‬
‫ﺔﻃ‬ ‫ﻴ‬‫ﺒ‬‫ﺣﺔﻃ‬
‫ﻟ‬‫ﺮﺎ‬ ‫ﺒ‬‫ﺘ‬‫ﻌ‬
‫ﺗ‬.‫ﻮﻋﻲ‬ ‫ﻟ‬‫ﺍ‬‫ﻌﻒﻓﻲ‬ ‫ﻭﻥ ﺿ‬‫ﺪ‬ ‫ﺘﻰﺑ‬‫ﺣ‬،‫ﻗ‬ ‫ﺍﻷﻞ‬ ‫ﻠﻰ‬‫ﻋ‬
‫ﺓﻛﻞ‬ ‫ﻭ‬‫ﺭ‬‫ﻔﺲﻓﻲﺫ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻒ‬ ‫ﻮ‬‫ﻌ ﺾﺗ‬ ‫ﺘﺞﻋﻦﺑ‬ ‫ﻨ‬
‫ﻳ‬.‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺔﻣ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺎﺿ‬‫ﺒ‬‫ﻘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺍﺧﻞ‬‫ﺪ‬ ‫ﺘ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬
‫ﺔ‬‫ﻣ‬
‫ﺫ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻘﺺ‬ ‫ﺓﻣﻦﻧ‬ ‫ﺭ‬
‫ﺮ‬ ‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫ﺪﺗ‬ ‫ﻗ‬.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻛﺴﺠ‬ ‫ﺃ‬‫ﻘﺺ‬ ‫ﻧ‬‫ﺪﻱﻭ‬ ‫ﻳ‬‫ﺭ‬‫ﺎﻥﻭ‬ ‫ﻘ‬‫ﺘ‬
‫ﺍﺣ‬ ‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻧ‬
.
‫ﻴﺖ‬ ‫ﻤ‬‫ﻣ‬‫ﻪﻭ‬‫ﻴ‬‫ﺔﻓ‬ ‫ﻌ‬‫ﻏﻲﻻﺭﺟ‬ ‫ﺎ‬‫ﻣ‬‫ﻠﻒﺩ‬ ‫ﻟﻰﺗ‬‫ﺔﺇ‬ ‫ﻴ‬
‫ﻏ‬ ‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻠﻲ‬‫ﺎﻳ‬‫ﺮﻉﻣ‬ ‫ﻟﺼ‬ ‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﺒﺐ ﺎ‬‫ﺘﻲﺗﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬
.‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺳﺤﺐ‬. 1
.
‫ﻤﻰ‬‫ﺣ‬. 2
.
‫ﺔ‬ ‫ﻨ‬‫ﻣ‬
‫ﺍ‬‫ﺰ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬.3
Medi cal Management :
Thegoal soft reatmentar e:
Stopt heseizur esasqui cklyaspossi bl
e.
Ensur eadequat ecer ebraloxy genati
on.
Mai ntaint hepat ientinasei zure-f
reestat e.
1.Establ ishopenai rwayandadequat eoxy genat i
on.
2.Ifthepat i
entr emai nsunconsci ousandunr esponsi ve, endotracheal tubei s
i
nsert ed.
3.Intravenousdi azepam ( Vali
um)i sadmi nisteredslowl yinanat temptt ohal t
sei
zur esi mmedi ately.
:‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬
:‫ﻫ‬
‫ﻌﻼﺝ ﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
.‫ﻜﻦ‬ ‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬ ‫ﺃﺳ‬ ‫ﺎﺕﻓﻲ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻒ‬ ‫•ﻭ‬
.‫ﻓﻲ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬ ‫ﻛﺴﺠ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﺎﻥ‬‫ﻤ‬‫•ﺿ‬
.
‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺣﺔﺧ‬ ‫ﻟ‬
‫ﻳ ﺾﻓﻲ ﺎ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬•
.‫ﻓﻲ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬
‫ﻮﺡﻭ‬ ‫ﺘ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺀﻣﺠ‬ ‫ﺎ‬
‫ﻧﺸ‬‫ﺇ‬.1
.‫ﻣﻲ‬‫ﺎ‬‫ﺮﻏ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬‫ﺎﺍﻷ‬
‫ﺩﺧﻝ‬ ‫ﺘﻢﺇ‬‫ﻳ‬،‫ﻴﺐ‬ ‫ﺘﺠ‬ ‫ﺮﻣﺴ‬‫ﻴ‬‫ﻮﻋﻲﻭﻏ‬ ‫ﻠ‬‫ﻟ‬‫ﺍ‬
ً
‫ﺪ‬‫ﻗ‬‫ﺎ‬‫ﻳ ﺾﻓ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻇﻞ‬ ‫ﺫ‬‫ﺇ‬.2
.
‫ﺭ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﺎﺕﻋ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻗﻒ‬ ‫ﻮ‬
‫ﻟ‬ ‫ﺔ‬‫ﻟ‬‫ﻭ‬‫ﺎ‬
‫ﺀﻓﻲﻣﺤ‬ ‫ﺒﻂ‬‫ﺪﺑ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫(ﻋﻦﻃ‬ ‫ﻡ‬ ‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫)ﻔ‬
‫ﻟ‬‫ﻡﺍ‬‫ﺎ‬‫ﺒ‬‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬ ‫ﻳ‬.3

4.Ot hermedi cati

ons( pheny t
oin,phenobar bital
)areadmi nisteredlat
erto
mai ntainasei zur
e-fr
eest ate.
5.AnI Vlinei sest abli
shed, andbl oodsampl esareobt ainedt omoni t
orser um
electrolytes, glucose,andpheny toinlevels.
6.EEGmoni tor i
ngmaybeusef ulindet ermi ningthenat ureoft hesei
zure
activi
ty.
7.Vi t
al signsandneur ologi csignsar emoni toredonacont i
nui ngbasis.
8.AnI Vinfusi onofdext r osei sadmi nisteredi ftheseiz ureiscausedby
hypogl ycemi a.
9.Ifiniti
al treat mentisunsuccessf ul
, gener alanesthesiawi thashor t-
acti
ng
barbituratemaybeused.
10.Theser um concent r
at ionoft heant iseizuremedi cat i
oni smeasur ed,
becauseal owl evelsuggest sthatthepat i
entwasnott akingt hemedicationor
thatthedosagewast ool ow.
.
‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻴ‬
‫ﻟ‬‫ﺎ‬
‫ﺣﺔﺧ‬‫ﻟ‬
‫ﻠﻰ ﺎ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻠﺤ‬ ‫ﻟ‬‫ﺎ‬
ً
‫ﻘ‬‫ﺭﻻﺣ‬ ‫ﺍ‬
‫ﺪ‬‫ﺎ(ﺗ‬‫ﺘﻝ‬ ‫ﻴ‬
‫ﺑ‬‫ﺭ‬‫ﺎ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ،‫ﻳﻦ‬‫ﻮ‬‫ﺘ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬
)‫ﺮﻯ‬
‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﺍﻷ‬.
4
،‫ﺯ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻭ‬، ‫ﻤﺼﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬ ‫ﻜ‬‫ﻟ‬
‫ﺔﺇ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﻴ‬
‫ﻠﻰﻋ‬ ‫ﻮﻝﻋ‬‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬‫ﻭ‬،‫ﺪﻱ‬ ‫ﻳ‬
‫ﺭ‬‫ﺀﺧﻂﻭ‬ ‫ﺎ‬
‫ﻧﺸ‬‫ﺘﻢﺇ‬‫ﻳ‬.
5

166
 .‫ﻳﻦ‬‫ﻮ‬‫ﺘ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻣﺴ‬‫ﻭ‬
.
‫ﺀ‬ ‫ﻴﻼ‬‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﺎﻁ‬ ‫ﺔﻧﺸ‬ ‫ﻌ‬‫ﻴ‬‫ﺒ‬‫ﺪﻃ‬ ‫ﻳ‬‫ﺪ‬‫ﺓﻓﻲﺗﺤ‬ ‫ﺪ‬ ‫ﻴ‬
‫ﻔ‬‫ﻣ‬EEG‫ﺔ‬ ‫ﺒ‬
‫ﻗ‬ ‫ﺍ‬
‫ﺮ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫ﻗ‬.6
.‫ﺮ‬‫ﻤ‬‫ﺘ‬ ‫ﺎﺱﻣﺴ‬ ‫ﺃﺳ‬ ‫ﻠﻰ‬ ‫ﺔﻋ‬‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬ ‫ﻭﻌﻼ‬‫ﻟ‬
‫ﺔﺍ‬ ‫ﻳ‬‫ﻮ‬
‫ﻴ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﺘﻢﺭﺻ‬ ‫ﻳ‬.7
.‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻘﺺ‬ ‫ﺔﻋﻦﻧ‬ ‫ﺗﺠ‬‫ﺎ‬‫ﺔﻧ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻧﺖ‬ ‫ﺎ‬
‫ﺍﻛ‬ ‫ﺫ‬‫ﺯﺇ‬‫ﻭ‬ ‫ﺮ‬‫ﺘ‬‫ﻛﺴ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﺔﻭ‬ ‫ﻨ‬‫ﻘ‬‫ﺀﺣ‬ ‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬ ‫ﻳ‬.8
‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺍﺕﻗﺼ‬ ‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻴ‬
‫ﺑ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻡﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺎﺳ‬‫ﻡﺑ‬ ‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻴ‬‫ﻓ‬، ‫ﻟﻲ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﻨﺠﺢ‬ ‫ﻟﻢﻳ‬ ‫ﺍ‬
‫ﺫ‬‫ﺇ‬.9
.‫ﻮﻝ‬ ‫ﻌ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻢ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺄﻥ‬‫ﻮﺣﻲﺑ‬ ‫ﻔ ﺾﻳ‬ ‫ﻨﺨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻯ‬ ‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻷﻥ‬، ‫ﻤﺼﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻠ‬‫ﻟ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺍ‬‫ﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺰ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺎﺱﺗ‬ ‫ﻴ‬‫ﺘﻢﻗ‬ ‫ﻳ‬.10
.‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻐ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻔﻀ‬ ‫ﻨﺨ‬‫ﻧﺖﻣ‬ ‫ﺎ‬
‫ﺔﻛ‬ ‫ﺮﻋ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺃﻥ‬ ‫ﻭ‬‫ﺃ‬‫ﺀ‬‫ﺍ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬‫ﺘ‬‫ﻜﻦﻳ‬‫ﻳ‬
Nur si
ngManagement :
1.Thenur sei nit
iatesongoi ngassessmentandmoni toringofr espi r
at or yand
cardiacf unct i
onbecauseoft her iskf ordel ay eddepr essi onofr espi rationand
bloodpr essur esecondar yt oadmi nistrationofant i
sei zur emedi cat i
onsand
sedat i
vest ohal tthesei zures.
2.Nur singassessmental soi ncl udesmoni tor inganddocument ingt hesei z ure
activi
tyandt hepat i
ent'
sr esponsi v eness.
3.Thepat ientist urnedtoasi de- l
y ingposi tion, ifpossi ble, t
oassi sti ndr aining
phar y
ngeal secretions.
4.Suct i
onequi pmentmustbeav ailabl ebecauseoft her iskf oraspi ration.
5.TheI Vl inei scloselymoni t ored, becausei tmaybecomedi slodgeddur i
ng
seizures.
6.Dur i
ngsei zures, t
hepat ienti spr ot ectedf rom i njur ywi tht heuseofsei zur e
precautionsandi smoni toredcl osel y.
7.Noef fortshoul dbemadet or est rainmov ement s.
8.Thepat ienthav ingseizur escani njur enear bypeopl e, sonur sesshoul d
protectt hemsel ves.
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﻭﺙ‬ ‫ﺪ‬ ‫ﺮﺣ‬ ‫ﺒﺐﺧﻄ‬ ‫ﻠﺐﺑﺴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺴﻲﻭ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬‫ﺮ‬‫ﻤ‬ ‫ﺘ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬ ‫ﺮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺃ‬
‫ﺪ‬ ‫ﺒ‬
‫ﺗ‬.1
.‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻒ‬ ‫ﻮ‬ ‫ﻟ‬‫ﺎﺕ‬‫ﺋ‬‫ﺪ‬‫ﻬ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬‫ﺑ‬‫ﻮ‬
‫ﻨ‬‫ﻠ‬‫ﻟ‬‫ﺓ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬‫ﺀ‬ ‫ﺎ‬
‫ﻋﻄ‬ ‫ﺔﺇ‬ ‫ﻴﺠ‬‫ﺘ‬ ‫ﻡﻧ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﻔﺲﻭﺿ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﺄﺧ‬ ‫ﺘ‬‫ﺎﺏﻣ‬ ‫ﺌ‬‫ﺘ‬‫ﻛ‬‫ﺍ‬
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﺔﻭ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻴﻖﻧﺸ‬ ‫ﺛ‬‫ﻮ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺎﻣ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬ ‫ﻤﻞﺗ‬ ‫ﻳﺸ‬.2
.‫ﻡ‬‫ﻮ‬‫ﻌ‬
‫ﻠ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﻳﻒﺇ‬ ‫ﺮ‬‫ﺓﻓﻲﺗﺼ‬ ‫ﺪ‬ ‫ﺎﻋ‬‫ﻤﺴ‬ ‫ﻠ‬
‫ﻟ‬ ،‫ﻜﻦ‬ ‫ﻣ‬‫ﺃ‬ ‫ﺍ‬
‫ﺫ‬‫ﺇ‬، ‫ﺒﻲ‬‫ﻧ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻘ‬ ‫ﻠ‬
‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﻊ‬‫ﻟﻰﻭﺿ‬ ‫ﻳ ﺾﺇ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬ ‫ﻳ‬
‫ﺪ‬ ‫ﺘ‬‫ﻳﺴ‬.3
.
‫ﻔﻂ‬ ‫ﻟﺸ‬‫ﺍ‬ ‫ﺮ‬‫ﺎﻃ‬‫ﺒﺐﻣﺨ‬ ‫ﺓﺑﺴ‬ ‫ﺮ‬‫ﻓ‬‫ﻮ‬ ‫ﺘ‬‫ﻔﻂﻣ‬ ‫ﻟﺸ‬
‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺪ‬‫ﻌ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬. 4
.‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻪ‬ ‫ﺘ‬‫ﺍﺣ‬‫ﺯ‬‫ﺘﻢﺇ‬‫ﺪﻳ‬ ‫ﻪﻗ‬‫ﻧ‬‫ﻷ‬، ‫ﺜﺐ‬ ‫ﻊﻋﻦﻛ‬ ‫ﺑ‬‫ﺍ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺨﻂ‬ ‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺘﻢﻣ‬ ‫ﻳ‬.5
.‫ﺜﺐ‬ ‫ﻪﻋﻦﻛ‬ ‫ﺘ‬
‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺘﻢﻣ‬‫ﻳ‬‫ﺎﺕﻭ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺎﻃ‬ ‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬ ‫ﻡ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺎﺳ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﻣﺍﻹﺻ‬ ‫ﻳﺾ ﻦ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻤ‬‫ﺘﻢﺣ‬ ‫ﻳ‬، ‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬ .
6
.‫ﺎﺕ‬‫ﻛ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺒﺢ‬‫ﻜ‬‫ﻟ‬ ‫ﺪ‬‫ﻬ‬‫ﺃﻱﺟ‬ ‫ﺬﻝ‬ ‫ﻐﻲﺑ‬ ‫ﺒ‬‫ﻨ‬
‫ﻻﻳ‬. 7
‫ﺎﺕ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻟﻚﻳﺠﺐﻋ‬ ‫ﺬ‬‫ﻟ‬،‫ﻴﻦ‬ ‫ﺒ‬‫ﻳ‬‫ﺮ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﻴﺐ‬ ‫ﺃﻥﻳﺼ‬ ‫ﺎﺕ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻧﻲﻣﻦ‬ ‫ﺎ‬‫ﻌ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻠ‬‫ﻟ‬
‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.8
.‫ﻬﻢ‬ ‫ﻔﺴ‬‫ﻧ‬‫ﺃ‬‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬
Headache

Lear
ningobj ecti
v es:
Uponcompl etionoft hislect
ure,
eachstudentshoul
dbeabl et
o:
1.Defi
neheadache.
2.Li
stclassifi
cationsofheadache.
3.Di
scusspat hophy siologyofheadache.
4.Li
stcli
nicalmani festati
onsofheadache.
5.Descri
beassessmentanddi agnosti
cfi
ndingsofheadache.
6.Descri
bepr event i
onofheadache.
7.Di
scussmedi cal managementofheadache.
8.Descri
benur singmanagementofheadache.

167
 ‫ﺍﺱ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﺻ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺐﻗ‬
‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬
‫ﻜ‬‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻩ‬
‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
.
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺗ‬.1
.
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻴ‬‫ﻨ‬‫ﺔﺗﺼ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.2
.
‫ﺍﻉ‬‫ﺪ‬
‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.3
.
‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.4
.‫ﺍﻉ‬
‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﻴﺺ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻭﺻﻒﻧ‬. 5
.
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻭﺻﻒ‬. 6
.‫ﺍﻉ‬‫ﺪ‬
‫ﻠﺼ‬ ‫ﻟ‬‫ﺒﻲ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.7
.
‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﻳﻀﻲ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﻭﺻﻒ‬. 8

Headache
Introduct ion:
Headache, orcephal gia,i
soneoft hemostcommonofal l humanphy sical
compl aints.Headachei sasy mpt om rathert hanadi seaseent ity
; i
tmayi ndicate
organi cdi sease( neurologicorot herdi sease) ,ast r
essr esponse, vasodi l
ation
(migr aine),skel etalmuscl etension(tensi onheadache) ,oracombi nati
onof
factor s.
Def initi
on:
Thecondi ti
onofpai ni nthehead, causedbyst imulationofpai n-sensiti
v e
struct ureinthecr anium, head, orneck.
Classi fi
cat i
onofheadaches:
1.Apr i
mar yheadache: i
sonef orwhichnoor ganiccausecanbei denti
f i
ed.
Theset ypesofheadachei ncludemi graine, tension-t
y pe,andcl usterheadaches.
:‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻣ‬
‫ﺮﺽ‬ ‫ﻮﻋ‬ ‫ﺍﻉﻫ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬ .
‫ﺎ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺎﻥﺷ‬ ‫ﻧﺴ‬‫ﺍﻹ‬‫ﻴﺐ‬ ‫ﺘﻲﺗﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺪ‬ ‫ﻟﺠﺴ‬‫ﺍ‬ ‫ﻭﻯ‬‫ﺎ‬
‫ﻜ‬‫ﻟﺸ‬‫ﺍ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺪ‬‫ﺃﺣ‬‫ﻮ‬‫ﻫ‬، ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬،
‫ﺍﻉﺃ‬ ‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺍﻷ‬ ‫ﻊ‬‫ﻮﺳ‬ ‫ﻭﺗ‬،‫ﺮﺃ‬ ‫ﺗ‬
‫ﻮ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﻭ‬،
‫(ﺃ‬ ‫ﺮ‬‫ﺁﺧ‬‫ﺮﺽ‬ ‫ﻭﻣ‬‫ﺃ‬ ‫ﺒﻲ‬‫ﻮﻱ)ﻋﺼ‬ ‫ﺮ ﺽﻋﻀ‬ ‫ﻟﻰﻣ‬‫ﺮﺇ‬ ‫ﻴ‬
‫ﺪﻳﺸ‬ ‫؛ﻗ‬‫ﺎﻥ‬‫ﻴ‬‫ﺮ ﺽﻛ‬ ‫ﻴﺲﻣ‬ ‫ﻟ‬‫ﻭ‬
.
‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻮﻋ‬‫ﻤ‬ ‫ﻭﻣﺠ‬،‫(ﺃ‬ ‫ﺮ‬‫ﺗ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻤﻲ)ﺻ‬ ‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﻜﻞ‬ ‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﻭﺗ‬،
‫(ﺃ‬ ‫ﻔﻲ‬‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬)‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬
:‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
.
‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻢﻓﻲ‬ ‫ﻟﻸ‬‫ﺔ‬ ‫ﺎﺳ‬‫ﺔﺣﺴ‬ ‫ﻴ‬‫ﻨ‬
‫ﺰﺑ‬ ‫ﻴ‬‫ﻔ‬
‫ﺔﻋﻦﺗﺤ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﺃﺱﻧ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻢﻓﻲ‬ ‫ﺃ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﺎ‬
:
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻨ‬‫ﺗﺼ‬
‫ﺍﻉ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺍﻉﻣﻦ‬ ‫ﻮ‬‫ﻧ‬‫ﺍﻷ‬ ‫ﻩ‬‫ﺬ‬‫ﻤﻞﻫ‬ ‫ﺗﺸ‬.‫ﻪ‬‫ﻟ‬‫ﻮﻱ‬‫ﺒﺐﻋﻀ‬ ‫ﺪﺳ‬ ‫ﻳ‬‫ﺪ‬‫ﻜﻦﺗﺤ‬ ‫ﻤ‬‫ﺬﻱﻻﻳ‬ ‫ﻟ‬‫ﺍ‬
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻮ‬‫ﻫ‬:‫ﺎﺳﻲ‬‫ﺍﻷﺳ‬ ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬.1
.‫ﺩﻱ‬‫ﻮ‬ ‫ﻘ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺮﻱﻭ‬ ‫ﺗ‬
‫ﻮ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﻔﻲﻭ‬ ‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬

a.Mi gr aine:
I
sacompl exofsymptomschar act
eri
zedbyper iodicandrecurr
entat
tacksof
severeheadachel ast
ingfr
om 4to72hour sinadult
s.
Thecauseofmi grai
nehasnotbeencl earlydemonst r
ated,buti
tispr
imari
lya
vascul ardi stur
bancethatoccur
smor ecommonl yinwomenandhasast rong
familial tendency.
Thet y picalti
meofonsetisatpuberty
, andtheincidenceis18%inwomenand
6%i nmen.

b.Tensi
on-
typeheadaches:
Tendtobechroni
candl esssev
ere.
Themostcommont y
peofheadache.

168
‫‪c.Cl‬‬
‫‪ust‬‬‫‪erheadaches:‬‬
‫‪Sev‬‬‫‪er‬‬
‫‪ef‬‬ ‫‪or‬‬
‫‪msofv‬‬ ‫‪ascul‬‬
‫‪arheadache.‬‬
‫‪Theyar‬‬‫‪eseenf‬‬‫‪i‬‬‫‪v‬‬‫‪et‬‬‫‪i‬‬
‫‪mesmor‬‬ ‫‪ef‬‬‫‪r‬‬‫‪equent‬‬
‫‪l‬‬‫‪yi‬‬
‫‪nment‬‬
‫‪hani‬‬
‫‪nwomen.‬‬
‫‪:‬‬‫ﻔﻲ‬‫ﺍﻉﻧﺼ‬ ‫ﺪ‬‫‪.‬ﺻ‬‫ﺃ‬
‫ﻟﻰ‪72‬‬‫ﺮﻣﻦ‪4‬ﺇ‬‫ﻤ‬‫ﺘ‬
‫ﺪﺗﺴ‬‫ﻳ‬
‫ﺪ‬‫ﺍﻉﺷ‬‫ﺪ‬‫ﺓﻣﻦ ﺻ‬‫ﺭ‬‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﻣ‬‫ﺔﻭ‬‫ﻳ‬‫ﺭ‬
‫ﻭ‬‫ﺎﺕﺩ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﺰﺑ‬‫ﻴ‬‫ﻤ‬‫ﺘ‬
‫ﺍ ﺽﺗ‬‫ﺮ‬‫ﻣﺍﻷﻋ‬
‫ﺔﻦ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﺓﻋﻦﻣﺠ‬ ‫ﺭ‬
‫ﺎ‬‫ﺒ‬‫•ﻋ‬
‫‪.‬‬‫ﻴﻦ‬‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬‫ﺎﻋ‬‫ﺳ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬
‫ﺍﻷ‬‫ﺍﺏﻓﻲ‬‫ﺮ‬
‫ﺍﺿﻄ‬ ‫ﺎﺱ‬‫ﺍﻷﺳ‬‫ﻪﻓﻲ‬‫ﻨ‬‫ﻜ‬‫ﻟ‬
‫‪،‬ﻭ‬‫ﺍﺿﺢ‬ ‫ﻜﻞﻭ‬ ‫ﻔﻲﺑﺸ‬‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﺐ‬ ‫ﺎﺕﺳ‬ ‫ﺒ‬
‫ﺛ‬‫ﺘﻢﺇ‬‫•ﻢﻳ‬
‫ﻟ‬
‫‪.‬‬
‫ﻮﻱ‬‫ﻠﻲﻗ‬‫ﺋ‬‫ﺎ‬
‫ﻴﻞﻋ‬ ‫ﻪﻣ‬ ‫ﻟ‬
‫ﺀﻭ‬‫ﺎ‬‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺎﻋ‬‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬
‫ﻜﻞ‬ ‫ﺪﺙﺑﺸ‬ ‫ﻳﺤ‬
‫ﺎ‪.‬‬
‫ﺮﺟﻝ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻨ‬‫‪٪‬ﻋ‬
‫ﺀﻭ‪6‬‬ ‫ﺎ‬
‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫‪٪‬ﻋ‬
‫ﺔ‪18‬‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺔ‬‫ﺒ‬‫ﻎﻧﺴ‬‫ﻠ‬‫ﺒ‬
‫ﺗ‬‫‪،‬ﻭ‬ ‫ﻮﻍ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺳﻦ‬ ‫ﺭﻫ‬ ‫ﻮ‬‫ﻬ‬‫ﻠﻈ‬‫ﻟ‬‫ﺩ‬‫ﺎ‬
‫ﺘ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫•‬
‫‪:‬‬‫ﺮ‬
‫ﺗ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺗﺞﻋﻦ‬ ‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫‪.‬‬
‫ﺏ‬
‫‪.‬‬‫ﺓ‬‫ﺪ‬
‫ﻗﻞﺣ‬ ‫ﺃ‬‫ﺔﻭ‬‫ﻨ‬‫ﻣ‬‫ﺰ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺃﻥﺗ‬‫ﻟﻰ‬‫ﻴﻞﺇ‬‫ﻤ‬‫•ﺗ‬
‫‪.‬‬‫ً‬
‫ﺎ‬
‫ﻮﻋ‬ ‫ﻴ‬
‫ﺍﻉﺷ‬ ‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬‫ﺮ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫•‬
‫‪:‬‬‫ﺩﻱ‬‫ﻮ‬‫ﻘ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫‪.‬‬‫ﺝ‬
‫‪.‬‬‫ﺋﻲ‬‫ﺎ‬
‫ﻋ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺩ‬‫ﺎ‬
‫ﺎﻝﺣ‬ ‫ﻜ‬‫ﺃﺷ‬‫•‬
‫‪.‬‬
‫ﺀ‬‫ﺎ‬
‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻣﻦ‬ ‫ﺮ‬‫ﻤﺲﻣ‬ ‫ﺮﺑﺨ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺎﻝ‬‫ﺮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﺮﻋ‬‫ﻬ‬‫•ﺗﻈ‬

‫‪2.Asecondar‬‬ ‫‪yheadachei‬‬‫‪sasy‬‬ ‫‪mpt‬‬‫‪om associ‬‬‫‪at‬‬‫‪edwi‬‬ ‫‪t‬‬

‫‪hanor‬‬ ‫‪gani‬‬‫‪ccause,‬‬‫‪such‬‬
‫‪asabr‬‬ ‫‪ai‬‬
‫‪nt‬‬‫‪umororananeur‬‬ ‫‪y‬‬‫‪sm.‬‬
‫‪Al‬‬‫‪t‬‬‫‪houghmostheadachesdonoti‬‬ ‫‪ndi‬‬‫‪cat‬‬
‫‪eser‬‬‫‪i‬‬‫‪ousdi‬‬‫‪sease,‬‬‫‪per‬‬‫‪si‬‬
‫‪st‬‬‫‪ent‬‬
‫‪headachesr‬‬‫‪equi‬‬‫‪r‬‬
‫‪ef‬‬‫‪ur‬‬‫‪t‬‬‫‪heri‬‬‫‪nv‬‬‫‪est‬‬‫‪i‬‬
‫‪gat‬‬‫‪i‬‬‫‪on.‬‬
‫‪‬‬‫‪‬‬
‫‪Ser‬‬‫‪i‬‬‫‪ousdi‬‬
‫‪sor‬‬‫‪der‬‬‫‪sr‬‬‫‪el‬‬
‫‪at‬‬‫‪edt‬‬ ‫‪oheadachei‬‬ ‫‪ncl‬‬‫‪udebr‬‬‫‪ai‬‬‫‪nt‬‬‫‪umor‬‬‫‪s,‬‬‫‪subar‬‬‫‪achnoi‬‬
‫‪d‬‬
‫‪hemor‬‬ ‫‪r‬‬
‫‪hage,‬‬‫‪st‬‬‫‪r‬‬
‫‪oke,‬‬‫‪sev‬‬‫‪er‬‬‫‪ehy‬‬ ‫‪per‬‬
‫‪t‬‬‫‪ensi‬‬‫‪on,‬‬‫‪meni‬‬‫‪ngi‬‬‫‪t‬‬
‫‪i‬‬‫‪s,‬‬‫‪andheadi‬‬‫‪nj‬‬‫‪ur‬‬‫‪i‬‬
‫‪es.‬‬

‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺩ‬‫ﺪ‬‫ﻤ‬‫ﻭﺗ‬ ‫ﺃ‬‫ﻤﺦ‬‫ﻟ‬

‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺭ‬
‫ﺜﻞﻭ‬ ‫‪،‬ﻣ‬ ‫ﻮﻱ‬ ‫ﺒﺐﻋﻀ‬ ‫ﻟﺴ‬ ‫ﺔ‬‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﺪ‬‫ﺃﺣ‬ ‫ﻮ‬‫ﻮﻱﻫ‬ ‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬
‫‪.‬‬‫‪2‬‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻠﺐ‬‫ﺘﻄ‬ ‫ﺮﻳ‬‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﻻﻥ‬‫‪،‬ﺇﺃ‬ ‫ﺮ‬‫ﻴ‬
‫ﺮ ﺽﺧﻄ‬ ‫ﻟﻰﻣ‬‫ﺮﺇ‬‫ﻴ‬‫ﺍﻉﻻﺗﺸ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬
‫ﺎﻻﺕ‬ ‫ﻌﻈﻢﺣ‬ ‫ﺃﻥﻣ‬ ‫ﺮﻏﻢﻣﻦ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫•ﻋ‬
‫‪.‬‬‫ﻘﺼﻲ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻣﻦ‬ ‫ً‬
‫ﺪ‬‫ﻳ‬
‫ﺰ‬‫ﻣ‬
‫ﺔ‬‫ﺘ‬‫ﻜ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺗ‬‫ﻮ‬‫ﺒ‬‫ﻜ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻒﺗﺤﺖ‬ ‫ﺰ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻍﻭ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺎ‬‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﻟﺨﻄ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﻻﺿﻄ‬ ‫ﻤﻞ‬‫• ﺗﺸ‬
‫‪.‬‬
‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬‫ﺇﺻ‬ ‫ﺎﻭ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺪﻭ‬ ‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫‪Pat‬‬ ‫‪hophy‬‬ ‫‪si‬‬‫‪ol‬‬‫‪ogy‬‬ ‫‪:‬‬
‫‪Thecer‬‬ ‫‪ebr‬‬ ‫‪al‬‬‫‪si‬‬‫‪gnsandsy‬‬ ‫‪mpt‬‬ ‫‪omsofmi‬‬ ‫‪gr‬‬‫‪ai‬‬‫‪ner‬‬ ‫‪esul‬‬‫‪tf‬‬‫‪r‬‬‫‪om dy‬‬ ‫‪sf‬‬‫‪unct‬‬‫‪i‬‬
‫‪onoft‬‬ ‫‪he‬‬
‫‪br‬‬‫‪ai‬‬‫‪nst‬‬ ‫‪em pat‬‬ ‫‪hway‬‬ ‫‪st‬‬‫‪hatnor‬‬ ‫‪mal‬‬ ‫‪l‬‬‫‪ymodul‬‬ ‫‪at‬‬‫‪esensor‬‬ ‫‪yi‬‬‫‪nput‬‬ ‫‪.‬‬
‫‪Abnor‬‬ ‫‪mal‬‬ ‫‪met‬‬ ‫‪abol‬‬‫‪i‬‬
‫‪sm ofser‬‬ ‫‪ot‬‬‫‪oni‬‬ ‫‪n,‬‬ ‫‪av‬‬‫‪asoact‬‬ ‫‪i‬‬‫‪v‬‬‫‪eneur‬‬ ‫‪ot‬‬‫‪r‬‬‫‪ansmi‬‬ ‫‪t‬‬‫‪t‬‬
‫‪erf‬‬‫‪oundi‬‬ ‫‪n‬‬
‫‪pl‬‬‫‪at‬‬‫‪el‬‬‫‪et‬‬‫‪sandcel‬‬ ‫‪l‬‬‫‪soft‬‬‫‪hebr‬‬ ‫‪ai‬‬‫‪n,‬‬‫‪pl‬‬‫‪ay‬‬ ‫‪samaj‬‬ ‫‪orr‬‬ ‫‪ol‬‬‫‪e.‬‬
‫‪Theheadachei‬‬ ‫‪spr‬‬‫‪ecededbyar‬‬ ‫‪i‬‬‫‪sei‬‬ ‫‪npl‬‬‫‪asmaser‬‬ ‫‪ot‬‬‫‪oni‬‬‫‪n,‬‬‫‪whi‬‬‫‪chdi‬‬ ‫‪l‬‬
‫‪at‬‬‫‪est‬‬ ‫‪he‬‬
‫‪cer‬‬‫‪ebr‬‬ ‫‪al‬‬ ‫‪v‬‬‫‪essel‬‬ ‫‪s.‬‬
‫‪Butmi‬‬ ‫‪gr‬‬‫‪ai‬‬‫‪nesar‬‬ ‫‪emor‬‬ ‫‪et‬‬‫‪hanj‬‬ ‫‪ustv‬‬ ‫‪ascul‬‬‫‪arheadaches.Theexactmechani‬‬ ‫‪sm‬‬
‫‪ofpai‬‬ ‫‪ni‬‬ ‫‪nmi‬‬ ‫‪gr‬‬‫‪ai‬‬‫‪nei‬‬‫‪spoor‬‬ ‫‪l‬‬
‫‪yunder‬‬ ‫‪st‬‬‫‪ood.‬‬
‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻜﻞ‬ ‫ﺪﻝﺑﺸ‬ ‫ﻌ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﺍﺕﺟ‬ ‫ﺭ‬
‫ﺎ‬‫ﻠﻞﻓﻲﻣﺴ‬ ‫ﻔﻲﻋﻦﺧ‬ ‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬‫ﺎﺕﻭ‬‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻨﺠﻢ‬ ‫ﺗ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬
‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺪﺧﻼﺕ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻃ‬
‫ﺪ‬‫ﻮﺟ‬ ‫ﺔﻳ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﺎﻝﻓﻲ‬ ‫ﻌ‬
‫ﺒﻲﻓ‬ ‫ﻗﻞﻋﺼ‬ ‫ﺎ‬‫ﻮﻧ‬‫‪،‬ﻭﻫ‬‫ﻴﻦ‬ ‫ﻧ‬
‫ﻮ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﻠﺴ‬‫ﻟ‬‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﺋﻲﻏ‬ ‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻌﺐ‬ ‫ﻠ‬
‫ﻳ‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬‫ﺍﺭ‬‫ً‬
‫ﺭ‬‫ﻭ‬‫‪،‬ﺩ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﺔﻭﺧﻼ‬ ‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺋﺢ‬‫ﺎ‬‫ﻔ‬
‫ﻟﺼ‬ ‫ﺍ‬‫ﻓﻲ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻊ‬ ‫ﻮﺳ‬‫ﺬﻱﻳ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻲ‬ ‫ﺯ‬
‫ﺒﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻧ‬
‫ﻮ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺎﻉﻓﻲﻣﺴ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﻖ‬ ‫ﻳﺴ‬
‫ﺮ‬‫ﻴ‬‫ﻔﻲﻏ‬ ‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻟﻢﻓﻲ‬‫ﻟﻸ‬‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻵﺔ‬‫ﻴ‬
‫ﺍﻟ‬ ‫‪.‬‬‫ﺋﻲ‬‫ﺎ‬
‫ﺍﻉﻭﻋ‬ ‫ﺪ‬‫ﺩﺻ‬ ‫ﺮ‬‫ﺮﻣﻦﻣﺠ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻮ‬‫ﻔﻲﻫ‬ ‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻜﻦ‬‫ﻟ‬
‫‪.‬‬‫ﺍ‬‫ً‬
‫ﺪ‬
‫ﻴ‬‫ﺔﺟ‬ ‫ﻣ‬ ‫ﻮ‬‫ﻬ‬
‫ﻔ‬‫ﻣ‬

‫‪‬‬
‫‪‬‬‫‪Mi‬‬
‫‪gr‬‬‫‪ai‬‬
‫‪nescanbet‬‬
‫‪r‬‬‫‪i‬‬
‫‪gger‬‬
‫‪edby‬‬
‫‪:‬‬

‫‪169‬‬
-Menst rualcy cl
es
-Brightli
ghts
-Stress
-Depr ession
-Sleepdepr ivation
-Fatigue
-Ov eruseofcer tainmedi cati
ons
-Cer t
ainfoodscont ai
ningt yr
ami ne,nit
ri
tes,ormil
kpr oducts.Foodtri
ggersal
so
i
ncludeagedcheeseandmanypr ocessedfoods.
-Useofor alcont raceptivesmaybeassoci atedwithincreasedf r
equencyand
severityofattacksi nsomewomen.
Emot i
onalorphy si
calstressmaycausecont r
act
ionoft hemuscl esinthe
neckandscal p, result
ingi ntensionheadache.
Thepat hophy siologyofcl usterheadacheisnotfull
yunder st
ood.Onetheoryi
s
thatitiscausedbydi l
ationofor bitalandnearbyextr
acr anialart
eri
es.

:‫ﻔﻲﻣﻦﺧﻼﻝ‬ ‫ﻨﺼ‬ ‫ﻟ‬

‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺃﻥﻳﺤ‬ ‫ﻜﻦ‬‫ﻤ‬‫•ﻳ‬
‫ﻴﺾ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬
‫ﻭ‬ ‫ﺩ‬-
‫ﺔ‬ ‫ﻌ‬‫ﺎﻃ‬‫ﺀﺳ‬ ‫ﺍ‬
‫ﻮ‬‫ﺃﺿ‬ -
‫ﺩ‬‫ﺎ‬‫ﻬ‬
‫ﺇﺟ‬-
‫ﺔ‬‫ﺑ‬‫ﺂ‬‫ﻛ‬-
‫ﻡ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻣﻦ‬ ‫ﻣ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬-
‫ﺀ‬‫ﺎ‬
‫ﻴ‬‫ﺇﻋ‬-
‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻌﺾ‬ ‫ﻡﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﺍﻁﻓﻲ‬ ‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬-
‫ﺎ‬
ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺀ‬ ‫ﺍ‬
‫ﺬ‬ ‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﺒ‬
‫ﻤﻞﻣﺴ‬ ‫ﺗﺸ‬.‫ﺎﻥ‬
‫ﺒ‬‫ﻟ‬
‫ﺍﻷ‬ ‫ﺎﺕ‬‫ﺘﺠ‬‫ﻨ‬‫ﻭﻣ‬‫ﺃ‬‫ﻳﺖ‬‫ﺮ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬‫ﻣ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻮﻱﻋ‬ ‫ﺘ‬
‫ﺘﻲﺗﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻌ‬‫ﺍﻷﻃ‬ ‫ﻌﺾ‬ ‫ﺑ‬-
.
‫ﺔ‬‫ﻌ‬‫ﻨ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻌ‬
‫ﻣﺍﻷﻃ‬
‫ﺪﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻖﻭ‬ ‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻦ‬‫ﻟﺠ‬‫ﺍ‬
.‫ﺀ‬‫ﺎ‬
‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻌﺾ‬ ‫ﺪﻯﺑ‬ ‫ﻟ‬
‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺓﻭﺷ‬ ‫ﺮ‬‫ﻴ‬‫ﺗ‬
‫ﺓﻭ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻊﺯ‬‫ﺔﻣ‬ ‫ﻳ‬‫ﻮ‬‫ﻤ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﻧ‬
‫ﺍ‬‫ﻮ‬‫ﻡﻣ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻓﻖ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬
‫ﺪﻳ‬ ‫ﻗ‬-
‫ﺍﻉ‬‫ﺪ‬‫ﻟﻰ ﺻ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬،‫ﺃﺱ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﻭ‬‫ﺮ‬‫ﻓ‬
‫ﻨﻖﻭ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠ ﺺﻋﻀﻼﺕ‬ ‫ﻘ‬‫ﻟﻰﺗ‬‫ﺪﻱﺇ‬‫ﻟﺠﺴ‬ ‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﻔﻲ‬‫ﺎﻃ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﺍﻹﺟ‬ ‫ﺩﻱ‬‫ﺆ‬‫ﺪﻳ‬ ‫•ﻗ‬
.
‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺗﺞﻋﻦ‬‫ﺎ‬‫ﻪﻧ‬ ‫ﻧ‬‫ﺃ‬
‫ﺎﺕ‬‫ﻳ‬‫ﺮ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻮﻝﺇﺣ‬ ‫ﻘ‬‫ﺗ‬.
‫ﺎ‬ً
‫ﻣ‬‫ﺎ‬‫ﻤ‬
‫ﺔﺗ‬‫ﻣ‬ ‫ﻮ‬‫ﻬ‬
‫ﻔ‬‫ﺮﻣ‬‫ﻴ‬‫ﺩﻱﻏ‬‫ﻮ‬ ‫ﻘ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﻴ‬
‫ﻔﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻝ‬‫ﻻﺰ‬
‫•ﺗ‬
.‫ﺔ‬‫ﺒ‬‫ﻳ‬
‫ﺮ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﻘﺤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻤ‬‫ﺗ‬
Cli
nicalMani f
estati
ons
1.Migr aine:Themi grai
newi thaur acanbedi v i
dedintof ourphases: prodrome,
aura,theheadache, andr ecov ery(headacheter minati
onandpost drome) .
a.Prodr omePhase:
-Thepr odr omephasei sexper i
encedby60%ofpat ients,wit
hsy mpt omst hat
occurhour stodaysbef oreami gr
aineheadache.

‫ﺔ‬
‫ﻣ‬‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬‫ﻋ‬‫ﺍﻻ‬
،
‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬
‫ﻭ‬،‫ﺓ‬‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
:‫ﺍﺣﻞ‬
‫ﺮ‬‫ﻊﻣ‬
‫ﺑ‬‫ﺭ‬‫ﺃ‬‫ﻟﻰ‬
‫ﺓﺇ‬‫ﺭ‬
‫ﻭ‬‫ﺎﻷ‬
‫ﻮﺏﺑ‬ ‫ﻤﺼﺤ‬
‫ﻟ‬‫ﺍ‬‫ﻔﻲ‬‫ﻨﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻴﻢ‬‫ﻘﺴ‬‫ﻜﻦﺗ‬‫ﻤ‬‫ﻳ‬:
‫ﻔﻲ‬‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬.
1
.
(‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬
‫ﺎﺑ‬‫ﻣ‬‫ﺍﻉﻭ‬‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﻬ‬‫ﻧ‬
‫ﺇ‬)‫ﻓﻲ‬‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬
:
‫ﺓ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻣ‬.‫ﺃ‬
.‫ﻡ‬
‫ﺎ‬‫ﻳ‬‫ﺃ‬‫ﻟﻰ‬
‫ﺎﺕﺇ‬‫ﺎﻋ‬
‫ﻔﻲﺑﺴ‬‫ﻨﺼ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺒﻞ‬‫ﺮﻗ‬‫ﻬ‬
‫ﺍ ﺽﺗﻈ‬
‫ﺮ‬‫ﻋ‬‫ﺃ‬‫ﺭ‬‫ﻮ‬‫ﻬ‬
‫ﻊﻇ‬ ‫ﺓﻣ‬‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﺮﺿﻰﺑ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬٪60‫ﺮ‬‫ﻤ‬
‫ﻳ‬-

-Symptomsmayi ncl
udedepr ession,i
rr
it
abil
ity,
feeli
ngcold,anorexia,
and
changeinacti
vit
ylevel,
increasedur i
nati
on,diar
rhea,orconsti
pation.
-Pati
entsusuall
yexperiencethesamepr odromewi theachmi gr
aineheadache.
b.AuraPhase:
-Auraoccursinami norit
yofpatientswhoexper iencemigrai
nes.Theaura

170
usuall
ylastsl
essthan1hourandmaypr ovi
deenought imeforthepati
entto
taketheprescr
ibedmedicati
ontoav ertanattack.
-Thisperi
odischaracter
izedbyfocalneurologicsymptoms.Visual
dist
urbances(i
e,li
ghtfl
ashesandbr i
ghtspot s)
.Othersymptomsmayi nclude
numbnessandt ingl
ingoftheli
ps,face,orhands,mildconf
usion,sl
ight
weaknessofanext remit
y,anddizzi
ness.

،‫ﺎﻁ‬‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺮﻓﻲﻣﺴ‬ ‫ﻴ‬‫ﻐ‬‫ﺗ‬
‫ﻭ‬، ‫ﺔ‬‫ﻴ‬‫ﻬ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻓ‬‫ﻭ‬، ‫ﺩ‬
‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫ﺭﺑ‬‫ﻮ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﻭ‬،‫ﻴﺞ‬‫ﻬ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺎﺏ‬‫ﺌ‬
‫ﺘ‬‫ﻛ‬‫ﺍﻻ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﻤﻞ‬ ‫ﺪﺗﺸ‬‫ﻗ‬-
.
‫ﺎﻙ‬‫ﻣﺴ‬ ‫ﺃﺍﻹ‬
‫ﻭ‬،‫ﺎ‬‫ﻹﻬﻝ‬
‫ﺍﺳ‬ ‫ﻭ‬، ‫ﻮﻝ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬‫ﻭ‬
.
‫ﻔﻲ‬‫ﺍﻉﻧﺼ‬‫ﺪ‬‫ﻊﻛﻞ ﺻ‬ ‫ﺓﻣ‬ ‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﺲ‬‫ﺓﻣﻦﻧ‬ ‫ﺩ‬‫ﺎ‬
‫ﺮﺿﻰﻋ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻧﻲ‬‫ﺎ‬‫ﻌ‬
‫ﻳ‬-
:‫ﺎ‬
‫ﺔ‬‫ﻟ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻠ‬‫ﺮﺣ‬ ‫ﻣ‬.‫ﺏ‬
‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﺎﺗﺴ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬. ‫ﻔﻲ‬‫ﻨﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻮﻥﻣﻦ‬‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬
‫ﻠ‬‫ﻗ‬‫ﺃ‬‫ﺔﻓﻲ‬ ‫ﻟ‬
‫ﺎ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺙ‬ ‫ﺗﺤ‬-
.
‫ﻡ‬‫ﻮ‬‫ﻭﺙﻫﺠ‬ ‫ﺪ‬‫ﻨﺐﺣ‬ ‫ﺘﺠ‬‫ﻟ‬‫ﻮﻑ‬‫ﻮﺻ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﺎ‬
ً
‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻛ‬ً
‫ﺘ‬‫ﻗ‬‫ﺮﻭ‬ ‫ﻓ‬
‫ﻮ‬‫ﺪﺗ‬‫ﻗ‬ ‫ﺔﻭ‬‫ﺎﻋ‬‫ﺳ‬
‫ﺎﻁ‬‫ﻘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻭ‬‫ﻮ‬‫ﻟﻀ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣﻀ‬‫ﺜﻞﻭ‬ ‫ﻣ‬)‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﺒﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬ .‫ﺔ‬
‫ﻳ‬‫ﺭ‬‫ﺆ‬‫ﺔﺑ‬ ‫ﻴ‬
‫ﺒ‬‫ﺍ ﺽﻋﺼ‬ ‫ﺮ‬‫ﻋ‬‫ﺄ‬
‫ﺓﺑ‬‫ﺮ‬‫ﺘ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺰﻫ‬ ‫ﻴ‬‫ﻤ‬‫ﺘ‬
‫ﺗ‬-
‫ﺎﻙ‬
‫ﺒ‬‫ﺗ‬
‫ﺭ‬‫ﺍﻻ‬
‫ﻭ‬، ‫ﻳﻦ‬‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬‫ﺘ‬
‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﺰﻓﻲ‬‫ﻮﺧ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻞﻭ‬ ‫ﻤ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺍﺽ‬‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬‫ﻤﻞ‬ ‫ﺪﺗﺸ‬‫ﻗ‬.(‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
.
‫ﺔ‬‫ﻭﺧ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺍﻑ‬‫ﺮ‬ ‫ﺍﻷﻃ‬ ‫ﻴﻒﻓﻲ‬ ‫ﻔ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻌﻒ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻭ‬،‫ﻴﻒ‬ ‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬
c.HeadachePhase:
-Throbbingheadache( unilat
erali
n60%ofpat ients)intensifi
esov ersev eral
hours.
-Thisheadachei ssev ereandi softenassociatedwi thphot ophobia, nausea,
andv omiti
ng.
-It
sdur ati
onv ari
es,rangingf r
om 4t o72hour s.

d.Recov er
yPhase:
-Intherecoveryphase(terminati
onandpost drome),
thepai ngraduall
y
subsides.
-Muscl econtr
acti
onint heneckandscal piscommon, wit
hassociatedmuscl e
acheandl ocal
izedtenderness,exhausti
on,andmoodchanges.
-Anyphy si
calexert
ionexacerbatestheheadachepain.
-Duringthi
spostheadachephase, pati
entsmaysleepf orextendedperiods.
:
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻣ‬.‫ﺝ‬
.‫ﺎﺕ‬‫ﺎﻋ‬
‫ﺓﺳ‬ ‫ﺪ‬‫ﺪﻯﻋ‬‫ﻠﻰﻣ‬‫ﺪﻋ‬ ‫ﺘ‬
‫(ﻳﺸ‬ ‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻦ‬٪60‫ﺪﻯ‬‫ﻟ‬‫ﻧﺐ‬ ‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺩﻱ‬‫ﺎ‬‫ﺃﺣ‬
)‫ﺎﻥ‬‫ﻘ‬‫ﻔ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬-
.‫ﺀ‬
‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬
‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻭ‬‫ﻮ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺮﻫ‬‫ﺒﻂﺑ‬‫ﺗ‬
‫ﺮ‬‫ﺎﻳ‬
‫ﺎﻣ‬ ً
‫ﺒ‬
‫ﻟ‬‫ﺎ‬
‫ﻏ‬‫ﺍﻭ‬ً
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺍﻉﺷ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻮﻥﻫ‬ ‫ﻜ‬
‫ﻳ‬-
.‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬72‫ﻟﻰ‬ ‫ﺇ‬4‫ﻪﻣﻦ‬ ‫ﺗ‬
‫ﺪ‬‫ﻠﻒﻣ‬ ‫ﺘ‬
‫ﺗﺨ‬-

:
‫ﻓﻲ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬.‫ﺩ‬
.
ً
‫ﺎ‬‫ﻴ‬‫ﻳﺠ‬
‫ﺭ‬‫ﺪ‬‫ﻟﻢﺗ‬
‫ﺍﻷ‬‫ﺮ‬‫ﻨﺤﺴ‬‫ﻳ‬،(
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬
‫ﻣ‬‫ﺀﻭ‬‫ﺎ‬‫ﻬ‬‫ﻧ‬
‫ﺍﻹ‬)‫ﺀ‬‫ﺎ‬
‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻓﻲﻣ‬-
،
‫ﺎﻕ‬‫ﺭﻫ‬
‫ﺇ‬‫ﻭ‬،
‫ﻌﻲ‬‫ﻮﺿ‬
‫ﻟﻢﻣ‬
‫ﺄ‬
‫ﺒﻂﺑ‬
‫ﺗ‬‫ﺮ‬
‫ﻠﻲﻣ‬‫ﻟﻢﻋﻀ‬‫ﺄ‬‫ﺎﺑ‬ً
‫ﺑ‬
‫ﻮ‬‫ﻣﺼﺤ‬، ‫ﻊ‬‫ﺋ‬
‫ﺎ‬‫ﺮﺷ‬‫ﻣ‬‫ﺃ‬
‫ﺃﺱ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﻭ‬
‫ﺮ‬‫ﻓ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻠ ﺺﻋﻀﻼﺕ‬ ‫ﻘ‬‫ﺇﻥﺗ‬-
.‫ﺍﺝ‬‫ﺰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬‫ﻭ‬
.‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬ ‫ﻡ‬‫ﺁﻻ‬‫ﻗﻢ‬‫ﺎ‬
‫ﻔ‬‫ﻟﻰﺗ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﻧﻲﻳ‬‫ﺪ‬‫ﺩﺑ‬‫ﻮ‬‫ﻬ‬‫ﺃﻱﻣﺠ‬ -
.‫ﺔ‬
‫ﻠ‬‫ﻳ‬‫ﻮ‬
‫ﺍﺕﻃ‬ ‫ﺮ‬‫ﺘ‬
‫ﻔ‬‫ﻟ‬‫ﻡ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬،‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺧﻼﻝﻫ‬-

2.Thet ension-t
ypeheadache:ischaracter
izedbyasteady,const
antfeel
ingof
pressurethatusuallybeginsi
ntheforehead,templ
e,orbackoftheneck.
Iti
sof t
enbandl i
keormaybedescr ibedas―awei ghtontopofmyhead. ‖
3.Clusterheadaches:ar euni
lat
eralandcomei ncl
uster
sofonet oeightdai
ly,
withexcruciati
ngpainlocali
zedtotheeyeandor bi
tandradi
atingtothefaci
al
andt emporal r
egions.
-Thepai nisaccompani edbywateringoftheeyeandnasalcongesti
on.

171
-Eachat t
acklasts15mi nut
esto3hoursandmayhavea
crescendo–decrescendopatter
n.Theheadachei
sof
tendescr
ibedas
penetrat
ing.

‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﻬ‬‫ﺒ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺓﻓﻲ‬ ‫ﺩ‬‫ﺎ‬‫ﺃﻋ‬ ‫ﺪ‬‫ﺒ‬
‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺎ‬‫ﺮﺑ‬ ‫ﻤ‬‫ﺘ‬‫ﻣﺴ‬ ‫ﺑﺖﻭ‬ ‫ﺎ‬
‫ﺎﺱﺛ‬ ‫ﺈﺣﺴ‬ ‫ﺰﺑ‬‫ﻴ‬‫ﻤ‬‫ﺘ‬‫ﻳ‬: ‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺗﺞﻋﻦ‬ ‫ﺎ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬.2
.‫ﻨﻖ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬ ‫ﺮ‬‫ﺆﺧ‬ ‫ﻭﻣ‬ ‫ﺃ‬‫ﺪﻍ‬ ‫ﻟﺼ‬‫ﺍ‬
."‫ﺃﺳﻲ‬ ‫ﻮﻕﺭ‬ ‫ﺯﻥﻓ‬ ‫ﻭ‬ "‫ﻪ‬‫ﻧ‬‫ﺄ‬‫ﻪﺑ‬‫ﻔ‬‫ﻜﻦﻭﺻ‬ ‫ﻤ‬‫ﻭﻳ‬ ‫ﺃ‬ ‫ﻳﻂ‬‫ﺮ‬ ‫ﻟﺸ‬‫ﺍ‬ ‫ﻪ‬‫ﺒ‬
‫ﺎﻳﺸ‬ ‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫ﻴﺐ‬ ‫ﻟﻢﺭﻫ‬ ‫ﺃ‬‫ﻊ‬‫ﻣ‬، ‫ﺎ‬ً
‫ﻴ‬‫ﻣ‬‫ﻮ‬ ‫ﺔﻳ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻰﺛ‬ ‫ﺪﺇ‬ ‫ﺍﺣ‬‫ﺎﺕﻣﻦﻭ‬ ‫ﻮﻋ‬ ‫ﻤ‬ ‫ﺗﻲﻓﻲﻣﺠ‬ ‫ﺄ‬‫ﻳ‬
‫ﻧﺐﻭ‬ ‫ﺎ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺩﻱ‬ ‫ﺎ‬‫ﺃﺣ‬ :‫ﺩﻱ‬‫ﻮ‬ ‫ﻘ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬.3
.
‫ﺎﻥ‬ ‫ﻣ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻪﻭ‬ ‫ﻮﺟ‬ ‫ﻟ‬‫ﺍ‬ ‫ﺎﻃﻖ‬ ‫ﻨ‬‫ﻟﻰﻣ‬ ‫ﺮﺇ‬‫ﺘﺸ‬‫ﻨ‬‫ﻳ‬‫ﻴﻦﻭ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬ ‫ﺮ‬‫ﻣﺤﺠ‬ ‫ﻴﻦﻭ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻌﻲﻓﻲ‬ ‫ﻮﺿ‬ ‫ﻣ‬
.‫ﻧ‬
‫ﺎﻷﻒ‬ ‫ﺎﻥﺑ‬‫ﻘ‬‫ﺘ‬‫ﺍﺣ‬‫ﻴﻦﻭ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻴﻼﻥ‬ ‫ﻮﺏﺑﺴ‬ ‫ﻟﻢﻣﺼﺤ‬ ‫ﺍﻷ‬-
‫ﻮﺻﻒ‬ ‫ﺎﻳ‬‫ﻏﺎﻣ‬‫ﺒ‬
‫ﻟ‬‫ﺎ‬. ‫ﻟﻲ‬ ‫ﺯ‬‫ﺎ‬‫ﻨ‬‫ﺗ‬-‫ﺪﻱ‬ ‫ﺎﻋ‬‫ﻤﻂﺗﺼ‬ ‫ﻪﻧ‬ ‫ﻟ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﻳ‬ ‫ﻗ‬ ‫ﺎﺕﻭ‬ ‫ﻋ‬ ‫ﺎ‬‫ﺳ‬3‫ﻟﻰ‬ ‫ﺔﺇ‬ ‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬15‫ﺮﻣﻦ‬ ‫ﻤ‬ ‫ﺘ‬‫ﻡﻳﺴ‬ ‫ﻮ‬ ‫ﻛﻞﻫﺠ‬-
.‫ﺫ‬‫ﺎ‬‫ﻔ‬‫ﻪﻧ‬ ‫ﻧ‬
‫ﺄ‬‫ﺍﻉﺑ‬ ‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
AssessmentandDi agnost icFi ndi ngs:
1.Adet ai
ledhi stor yt aki ngandphy sicalassessment :
-Theheal t
hhi st or yf ocusesonassessi ngt heheadachei tsel f,wi themphasi son
thef actor sthatpr ecipitat eorpr ov okei t.
-Thepat i
enti saskedt odescr ibet heheadachei nhi sorherownwor ds.
Becauseheadachei sof tent hepr esent ingsy mpt om ofv ar iousphy si ologi cand
psy chol ogical dist urbances, agener al heal thhi storyi sanessent ial component
oft hepat ientdat abase.
-Headachemaybeasy mpt om ofendocr ine, hemat ologi c, gast roint est i
nal ,
i
nf ectious, renal ,car diov ascul ar ,orpsy chiat ricdi sease.Ther efore, quest ions
addr essedi ntheheal thhi storyshoul dcov ermaj ormedi cal andsur gical ill
ness.
-Themedi cat ionhi stor ycanpr ov i
dei nsi ghti nt ot hepat i
ent ’sov eral lheal th
statusandi ndicat emedi cationst hatmaybepr ov okingheadaches.
Ant i
hy pertensi veagent s, diuret icmedi cat ions, andant i
-inflammat or yagent sar e
af ewoft hecat egor iesofmedi cat ionst hatcanpr ov okeheadaches.
-Emot ional fact orscanpl ayar olei npr eci pitatingheadaches.St ressi st hought
tobeamaj ori nitiat i
ngf act ori nmi gr aineheadaches.
:‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﻧ‬
:‫ﺩﻱ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞﻭ‬ ‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻳﺦ‬ ‫ﺭ‬
‫ﺎ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺬ‬‫ﺃﺧ‬ .1
.
‫ﻩ‬ ‫ﺮ‬
‫ﻴ‬‫ﺜ‬‫ﻭﺗ‬ ‫ﺃ‬‫ﻪ‬‫ﺒ‬‫ﺒ‬‫ﺘﻲﺗﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺰﻋ‬ ‫ﻴ‬‫ﻛ‬ ‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻣ‬، ‫ﻪ‬‫ﻔﺴ‬ ‫ﺍﻉﻧ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬ ‫ﻠﻰﺗ‬ ‫ﻟﺼﺤﻲﻋ‬ ‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻛ‬‫ﺮ‬‫ﻳ‬-
‫ﺍﻻ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﺎﻷﻋ‬ ً‫ﺮ‬
‫ﺿ‬ ‫ﻮﻥﻋ‬ ‫ﻜ‬‫ﺎﻳ‬ ‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬
‫ﺍﻉﺎ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺍﻷﻥ‬ ً
‫ﺮ‬‫ﻧﻈ‬. ‫ﻪ‬‫ﺑ‬‫ﻮ‬‫ﻠ‬‫ﺄﺳ‬‫ﺍﻉﺑ‬ ‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﺃﻥﻳﺼﻒ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐﻣﻦ‬ ‫ﻳﻄ‬-
‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﺎﻓﻲﻗ‬ ً
‫ﻴ‬‫ﺎﺳ‬‫ﺃﺳ‬ ‫ﺍ‬ً
‫ﺮ‬‫ﻨﺼ‬ ‫ﺪﻋ‬ ‫ﻌ‬‫ﻡﻳ‬ ‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﺼﺤﻲ‬ ‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬ ‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬ ‫ﺈﻥ‬‫ﻓ‬، ‫ﺔ‬ ‫ﻔ‬
‫ﻠ‬‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻔﺴ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﻴ‬‫ﻔﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺍ‬‫ﺮ‬‫ﺿﻄ‬
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻧ‬
‫ﺎ‬‫ﻴ‬
‫ﺑ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﺪ‬ ‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻤﻲ‬ ‫ﻬﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺀ‬‫ﺎ‬‫ﻤ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺩ‬‫ﺪ‬ ‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬ ‫ﺃ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺃﻋ‬ ‫ﺍﻉﻣﻦ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﻳ‬ ‫ﻗ‬-
‫ﺘﻢ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻠ‬
‫ﺌ‬‫ﺍﻷﺳ‬ ‫ﻐﻄﻲ‬ ‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬، ‫ﻟﻚ‬ ‫ﺬ‬ ‫ﻟ‬.
‫ﺔ‬ ‫ﻴ‬‫ﻔﺴ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃﺍﻷ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬ ‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺃ‬
.‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺍﻷ‬ ‫ﻟﺼﺤﻲ‬ ‫ﺍ‬ ‫ﻟﺴﺠﻞ‬ ‫ﺍ‬‫ﺎﻓﻲ‬ ‫ﻬ‬ ‫ﻟ‬
‫ﻭ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬
‫ﺪ‬‫ﺘﻲﻗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬ ‫ﻟﻰ‬‫ﺮﺇ‬ ‫ﻴ‬‫ﻳﺸ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬‫ﻠﺤ‬ ‫ﻟ‬
‫ﺔ‬ ‫ﺒ‬
‫ﻗ‬‫ﺎ‬‫ﺓﺛ‬‫ﺮ‬‫ﺀﻧﻈ‬ ‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬ ‫ﺭ‬‫ﺎ‬‫ﺮﺗ‬‫ﻓ‬ ‫ﻮ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬-
‫ﺩ‬
‫ﺪ‬ ‫ﺎﺕﻫﻲﻋ‬ ‫ﺑ‬‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﻟﻼ‬ ‫ﺓ‬ ‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻠ‬‫ﻟ‬‫ﺓ‬‫ﺭ‬‫ﺪ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻐﻂﻭ‬ ‫ﻠﻀ‬‫ﻟ‬‫ﺔ‬ ‫ﻓﻀ‬ ‫ﺎ‬‫ﻟﺨ‬ ‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬ .‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺒﺐ‬ ‫ﺗﺴ‬
.‫ﺍﻉ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺒﺐ‬ ‫ﺃﻥﺗﺴ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺎﺕ‬ ‫ﺌ‬‫ﻴﻞﻣﻦﻓ‬ ‫ﻠ‬
‫ﻗ‬
‫ﻴﺴﻲﻓﻲ‬ ‫ﺋ‬‫ﻣﻞﺭ‬ ‫ﺎ‬
‫ﺩﻋ‬ ‫ﺎ‬‫ﻬ‬‫ﺃﺍﻹﺟ‬‫ﺪﻥ‬ ‫ﻘ‬‫ﺘ‬‫ﻌ‬ُ.
‫ﻳ‬ ‫ﺍﻉ‬ ‫ﺪ‬‫ﻟﺼ‬ ‫ﺎ‬‫ﻴﻞﺑ‬ ‫ﻌﺠ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻓﻲ‬ ً
‫ﺭ‬‫ﻭ‬‫ﺔﺩ‬ ‫ﻴ‬‫ﻔ‬‫ﺎﻃ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﺐ‬ ‫ﻠ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬-
.‫ﻔﻲ‬ ‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬

-Apositi
vefamilyhi
stor
ymayhelpinmakingadiagnosi
s.
-Adirectr
elat
ionshi
pmayexistbet
weenexposuretotoxi
csubst
ancesand
headache.Caref
ulquest
ioni
ngmayuncoverchemical
stowhichaworkerhas
beenexposed.

172
-Theoccupat ional historyalsoi ncludesassessmentoft hewor kpl aceasa
possiblesour ceofst ressandf orapossi blebasi sofmuscl est rainand
headache.
-Acompl etedescr i
ptionoft heheadachei tselfiscrucial.Thenur ser eviewst he
ageatonsetofheadache, t
heheadache’ sfr equency,locat ion,anddur ation,the
ty
peofpai n,factor sthatr eli
eveandpr ecipitatetheev ent ,andassoci ated
sympt oms.
-Thedat aobt ainedshoul di ncl
udet hepat i
ent ’
sownwor dsaboutt heheadache
i
nr esponset ot hef ollowingquest i
ons:
.‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺍ‬‫ﺮ‬
‫ﺑﻲﻓﻲﺇﺟ‬ ‫ﺎ‬
‫ﻳﺠ‬ ‫ﺍﻹ‬ ‫ﻠﻲ‬
‫ﺋ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻋ‬‫ﺎ‬‫ﺪﻳﺴ‬ ‫ﻗ‬-
‫ﺩ‬‫ﺍ‬‫ﻮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻖﻋﻦ‬ ‫ﻗ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺏ‬‫ﻮ‬ ‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻜﺸﻒ‬ ‫ﺪﻳ‬‫ﻗ‬. ‫ﺍﻉ‬
‫ﺪ‬ ‫ﻟﺼ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻣ‬‫ﺎ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬ ‫ﺓﺑ‬‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬‫ﻼﺔﻣ‬‫ﺪﻋﻗ‬ ‫ﻮﺟ‬‫ﺪﺗ‬ ‫ﻗ‬-
.
‫ﻣﻞ‬ ‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻬ‬‫ﻟ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬ ‫ﻟﺸ‬‫ﻤﻞ‬ ‫ﺘ‬
‫ﺎﺱﻣﺤ‬ ‫ﺮﻭﻷﺳ‬ ‫ﺗ‬‫ﻮ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬‫ﻤﻞ‬‫ﺘ‬‫ﺭﻣﺤ‬ ‫ﺪ‬‫ﻤﺼ‬‫ﻤﻞﻛ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬
‫ﻜ‬‫ﻴﻢﻣ‬ ‫ﻴ‬‫ﻘ‬‫ﺎﺗ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻨﻲ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻤﻦ‬‫ﺘﻀ‬ ‫ﻳ‬-
.‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺔ‬‫ﻳ‬‫ﺍ‬‫ﺪ‬‫ﺪﺑ‬ ‫ﻨ‬
‫ﺮﻋ‬ ‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺍﺟ‬‫ﺮ‬‫ﻤ‬‫ﺔﺑ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬‫ﺗ‬.‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﺍﻷﻫ‬‫ﺑﻎ‬
‫ﻟ‬
‫ﺮﺎ‬ ‫ﻣ‬‫ﺃ‬‫ﻪ‬‫ﻔﺴ‬ ‫ﺍﻉﻧ‬‫ﺪ‬ ‫ﻠﺼ‬‫ﻟ‬‫ﻣﻞ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﺻﻒ‬ ‫ﻟ‬
‫ﺍ‬-
‫ﺪﺙ‬‫ﻟﺤ‬‫ﺍ‬‫ﻔﻒﻣﻦ‬ ‫ﺘﻲﺗﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﻟ‬‫ﺍﻷﻢ‬ ‫ﻮﻉ‬‫ﻧ‬
‫ﻭ‬، ‫ﻪ‬‫ﺗ‬‫ﺪ‬‫ﻣ‬‫ﻭ‬، ‫ﻪ‬‫ﻌ‬
‫ﻗ‬‫ﻮ‬‫ﻣ‬‫ﻭ‬، ‫ﺍﻉ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻭﺙ‬ ‫ﺪ‬‫ﺭﺣ‬ ‫ﺍ‬
‫ﺮ‬‫ﻜ‬‫ﺗ‬‫ﻭ‬، ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺎ‬
.
‫ﻪ‬‫ﻟ‬ ‫ﺔ‬‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﺍﻷﻋ‬‫ﻭ‬، ‫ﻪ‬‫ﻠ‬‫ﻌﺠ‬‫ﺗ‬‫ﻭ‬
‫ﺔ‬‫ﻠ‬
‫ﺌ‬‫ﺍﻷﺳ‬ ‫ﻠﻰ‬‫ﺍﻋ‬ً
‫ﺩ‬‫ﺍﻉﺭ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺎﺻ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻤ‬‫ﻠ‬‫ﺎﻛ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬‫ﻮﻝﻋ‬‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﺘﻲﺗﻢ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻤﻦ‬‫ﺘﻀ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬-
:
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬

Whatisthelocati
on?Isitunil
ateralorbil
ateral?Doesi tradiat
e?
Whatisthequali
ty—dull
,aching,steady,burning,int
ermittent,cont
inuous?
Howmanyheadachesoccurdur i
ngagi venper iodoft i
me?
Whataretheprecipi
tat
ingfactors,ifany—env i
ronment al(eg,sunli
ght,
weat
herchange),f
oods,exerti
on,other?
Whatmakest heheadachewor se(eg,coughing, str
aini
ng)?

‫؟‬‫ﻊ‬‫؟ﻫﻞﻳﺸ‬ ‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻨ‬‫ﻡﺛ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬
‫ﺩ‬‫ﺎ‬‫ﺃﺣ‬‫؟ﻫﻞﻫﻲ‬ ‫ﻊ‬
‫ﻗ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﺎﻫ‬‫ﻣ‬
‫؟‬‫ﺓ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻣﺴ‬، ‫ﺔ‬‫ﻌ‬
‫ﻘﻄ‬‫ﺘ‬‫ﻣ‬، ‫ﺔ‬
‫ﻠ‬‫ﻌ‬‫ﺘ‬
‫ﻣﺸ‬، ‫ﺔ‬
‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺛ‬،‫ﺔ‬‫ﻤ‬‫ﻟ‬
‫ﺆ‬‫ﻣ‬،‫ﺔ‬‫ﻠ‬
‫ﻤ‬‫ﻣ‬-‫ﺔ‬‫ﻔ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﻫﻲ‬‫ﻣ‬
‫؟‬‫ﺔ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﺔﻣ‬‫ﻴ‬
‫ﻨ‬‫ﻣ‬‫ﺓﺯ‬‫ﺮ‬‫ﺘ‬‫ﺪﺙﺧﻼﻝﻓ‬ ‫ﺘﻲﺗﺤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺎﻻﺕ‬‫ﺩﺣ‬ ‫ﺪ‬‫ﻛﻢﻋ‬
‫ﺪ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬،‫ﺔ‬
‫ﻤ‬‫ﻌ‬‫ﺍﻷﻃ‬
،(‫ﻘﺲ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺗ‬،‫ﻤﺲ‬ ‫ﻟﺸ‬
‫ﺍ‬‫ﺀ‬‫ﻮ‬‫ﺜﻞ ﺿ‬‫ﻣ‬)‫ﺔ‬‫ﻴ‬‫ﺌ‬
‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
-‫ﺪﺕ‬ ‫ﻥﻭﺟ‬،
‫ﺔﺇ‬ ‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻫﻲ‬‫ﻣ‬
‫؟‬‫ﺮﻯ‬‫ﺃﺧ‬،‫ﻭﻝ‬‫ﺬ‬‫ﺒ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫؟‬(‫ﺩ‬
‫ﺎ‬‫ﻬ‬‫ﺍﻹﺟ‬،‫ﺎ‬
‫ﻌﻝ‬‫ﻟﺴ‬‫ﺍ‬‫ﺜﻞ‬
‫ﻣ‬)‫ﺃ‬‫ﻮ‬‫ﺃﺳ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻌﻞ‬‫ﺬﻱﻳﺠ‬‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻣ‬

Whatt ime( dayornight )doesitoccur ?

Howl ongdoesat ypical headachelast?
Ar ethereanyassoci at edsy mptoms, suchasf acial pain,l
acri
mat ion
(excessivetearing)
,orblindspot sinthef i
eldofv i
sion?
Whatusual lyreli
evest heheadache( aspirin,
nonst eroidalanti
-i
nf l
ammat or
y
drugs,rest,neckmassage) ?
Doesnausea, vomiti
ng, weakness, ornumbnessi nt heext r
emities
accompanyt heheadache?
‫؟‬‫ﺪﺙ‬ ‫(ﻳﺤ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬
‫ﻬ‬‫ﻟﻼﻭﻧ‬
‫ﻗﺖ)ﻴ ﺃ‬ ‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﺎﻫ‬‫ﻣ‬
‫؟‬‫ﺫﺟﻲ‬ ‫ﻮ‬
‫ﻤ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺎﻫﻲﻣ‬ ‫ﻣ‬
‫ﺀﻓﻲ‬ ‫ﺎ‬‫ﻴ‬
‫ﻤ‬‫ﺎﻁﻋ‬ ‫ﻘ‬‫ﻭﻧ‬،
‫(ﺃ‬‫ﺮﻁ‬ ‫ﻔ‬
‫ﺰﻕﻣ‬ ‫ﻤ‬‫ﺗ‬
)‫ﺰﻕ‬‫ﻤ‬‫ﻭﺗ‬،
‫ﻪﺃ‬ ‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬‫ﻟﻢﻓﻲ‬‫ﺃ‬‫ﺜﻞ‬‫ﻣ‬، ‫ﺔ‬‫ﺒ‬‫ﺎﺣ‬‫ﺍ ﺽﻣﺼ‬‫ﺮ‬‫ﺃﻋ‬‫ﺃﻱ‬ ‫ﺎﻙ‬
‫ﻨ‬‫ﻫﻞﻫ‬
‫؟‬‫ﺔ‬‫ﻳ‬‫ﺅ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬
‫ﻣﺠ‬
،‫ﺔ‬‫ﺍﺣ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬،‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﻟﻼ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﺪ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺮﻏ‬‫ﻴ‬‫ﻗ‬‫ﺎ‬
‫ﻘ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬،
‫ﻳﻦ‬‫ﺮ‬‫ﺒ‬‫ﺍﻷﺳ‬)‫ﺓ‬ ‫ﺩ‬‫ﺎ‬
‫ﺍﻉﻋ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻔﻒ‬ ‫ﺬﻱﻳﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻣ‬
‫؟‬ (
‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻚ‬‫ﻟ‬
‫ﺪ‬‫ﺗ‬

173
 ‫؟‬
‫ﺍﻑ‬‫ﺮ‬
‫ﺍﻷﻃ‬
‫ﻴﻞﻓﻲ‬
‫ﻤ‬‫ﻨ‬‫ﻭﺗ‬
‫ﺃ‬‫ﻌﻒ‬
‫ﻭﺿ‬‫ﺃ‬
‫ﺀ‬‫ﻭﻗﻲ‬
‫ﺃ‬‫ﺎﻥ‬
‫ﻴ‬‫ﺜ‬
‫ﺍﻉﻏ‬
‫ﺪ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺎﺣﺐ‬
‫ﻫﻞﻳﺼ‬

Doest heheadachei nterferewi t

hdailyact ivi
ties?
Doy ouhav eanyal lergies?
Doy ouhav ei nsomni a, poorappet it
e,lossofener gy?
I sther eaf ami lyhistoryofheadache?
Whati st her elationshipoft heheadachet oy ourlif
est yleorphy sicalor
emot ional stress?
Whatmedi cationsar ey out aking?
‫؟‬ ‫ﺔ‬‫ﻴ‬
‫ﻣ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧﺸﻄ‬ ‫ﻣﺍﻷ‬
‫ﺭﺽ ﻊ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺍﻉﻳ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻫﻞ‬
‫؟‬‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺃﻱﺣﺴ‬ ‫ﻳﻚ‬ ‫ﺪ‬‫ﻟ‬‫ﻫﻞ‬
‫؟‬‫ﺔ‬‫ﻗ‬‫ﺎ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﻬ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻌﻒ‬ ‫ﻷﻕﻭﺿ‬ ‫ﻣﺍﺭ‬‫ﻧﻲ ﻦ‬ ‫ﺎ‬‫ﻌ‬‫ﻫﻞﺗ‬
‫؟‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺎ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﻟﻺﺻ‬ ‫ﻠﻲ‬‫ﺋ‬‫ﺎ‬‫ﻳﺦﻋ‬ ‫ﺭ‬
‫ﺎ‬‫ﺎﻙﺗ‬ ‫ﻨ‬
‫ﻫﻞﻫ‬
‫؟‬‫ﻔﻲ‬‫ﺎﻃ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻧﻲ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﺃﺍﻹﺟ‬
‫ﺗﻚﻭ‬ ‫ﺎ‬‫ﻴ‬‫ﻤﻂﺣ‬ ‫ﻨ‬‫ﺍﻉﺑ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻼﺔ‬‫ﻣﻋ ﻗ‬‫ﺎ‬
‫؟‬ ‫ﺎ‬
‫ﻬ‬‫ﻟ‬‫ﻭ‬‫ﺎ‬‫ﻨ‬
‫ﺘ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬ ‫ﺎﻫﻲ‬ ‫ﻣ‬
2.Diagnost ict esting:
-CTscan.
-Cerebr alangi ogr aphy .
-MRImaybeusedt odet ectunder l
yi
ngcauses, suchast umororaneur ysm.
-Electromy ogr aphy( EMG)mayr evealasust ainedcont r actionoft heneck, scalp,
orfacial muscl es.
-Labor atoryt est smayi ncludecompl etebl oodcount ,er ythrocy tesedi ment ation
rat
e, electrolytes, glucose, creati
nine,andt hy r
oidhor monel evels.
:‫ﻴﺼﻲ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺧ‬ .2
.‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻌ‬‫ﺍﻻﺷ‬ -
.‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺮ‬‫ﻳ‬‫ﻮ‬‫ﺗﺼ‬-
‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﺩ‬‫ﺪ‬‫ﻤ‬‫ﻭﺗ‬ ‫ﺃ‬‫ﻡ‬‫ﺭ‬ ‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬ ‫ﻣ‬،‫ﺔ‬‫ﻨ‬‫ﻣ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﻋﺍﻷﺳ‬‫ﻜﺸﻒ ﻦ‬ ‫ﻠ‬‫ﻟ‬
‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﻧ‬
‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺮﺑ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬ ‫ﻳ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻭ‬‫ﺃ‬ ‫ﺃﺱ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬ ‫ﻭ‬‫ﺮ‬
‫ﻭﻓ‬ ‫ﺃ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲﻋﻀﻼﺕ‬ ‫ﻤ‬
‫ﺘ‬‫ﻠ ﺺﻣﺴ‬‫ﻘ‬ ‫(ﻋﻦﺗ‬ EMG)‫ﻌﻀﻞ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﻴﻂﻛ‬ ‫ﻜﺸﻒﺗﺨﻄ‬ ‫ﺪﻳ‬‫ﻗ‬-
.‫ﻪ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻭ‬، ‫ﺩ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻭ‬، ‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴﺐﻛ‬ ‫ﺮﺳ‬‫ﺪﻝﺗ‬‫ﻌ‬‫ﻣ‬‫ﻭ‬، ‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺗ‬‫ﻴ‬ ‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬‫ﻤﻞ‬ ‫ﺪﺗﺸ‬ ‫ﻗ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻗ‬‫ﺭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬ ‫ﺪ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻣ‬‫ﺮ‬‫ﺎﺕﻫ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺘ‬‫ﻣﺴ‬ ‫ﻭ‬،‫ﻴﻦ‬ ‫ﻨ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﺯ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬

Preventi
on:
1.Preventi
onbeginsbyhav ingthepat ientav oidspeci fi
ctriggerst hatareknown
toini
ti
atetheheadachesy ndrome.
2.Preventi
vemedi calmanagementofmi grainei nvolvesthedai lyuseofoneor
mor eagentsthatarethoughtt obl ockt hephy siologicevent sleadingt oan
att
ack.
3.Alcohol,
nitr
it
es,vasodil
at or
s, andhist ami nesmaypr ecipitatecluster
headaches.Eli
minat i
onoft hesef actorshel pspr eventtheheadaches.
:
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻭ‬
‫ﺔ‬‫ﻣ‬
‫ﺯ‬‫ﻣﻼ‬
‫ﺒﺐ ﺘ‬‫ﺎﺗﺴ‬‫ﻬ‬‫ﻧ‬‫ﺃ‬‫ﺎ‬
‫ﻬ‬‫ﻨ‬
‫ﻭﻑﻋ‬ ‫ﺮ‬‫ﻌ‬‫ﺔﻣ‬‫ﻨ‬‫ﻴ‬‫ﻌ‬‫ﺍﺕﻣ‬‫ﺰ‬ ‫ﻔ‬
‫ﻨﺐﻣﺤ‬ ‫ﺘﺠ‬‫ﻳ ﺾﻳ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﺔﻣﻦﺧﻼﻝﺟ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬
‫ﺗ‬.1
.‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺘﻲ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬‫ﺜ‬‫ﻛ‬
‫ﺃ‬‫ﻭ‬ ‫ﺃ‬
‫ﺪ‬‫ﺍﺣ‬‫ﻮ‬‫ﻟ‬‫ﻣﻲ‬ ‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﻻﺳ‬ ‫ﻔﻲ‬‫ﻨﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻤﻦ‬‫ﺘﻀ‬‫ﺗ‬.2
.‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬ ‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻴ‬‫ﻔﺴ‬‫ﻟ‬‫ﺍ‬‫ﺍﺙ‬‫ﺪ‬‫ﺍﻷﺣ‬ ‫ﻊ‬
‫ﻨ‬‫ﻤ‬‫ﺎﺗ‬‫ﻬ‬
‫ﻧ‬‫ﺃ‬‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻌ‬ُ
‫ﻳ‬
‫ﻠﻰ‬‫ﺀﻋ‬ ‫ﺎ‬
‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬.
‫ﺩﻱ‬‫ﻮ‬‫ﻘ‬‫ﻨ‬
‫ﺍﻉﻋ‬ ‫ﺪ‬
‫ﻭﺙ ﺻ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﻴﻦﺇ‬‫ﻣ‬‫ﺎ‬‫ﺘ‬‫ﻴﺴ‬
‫ﻬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺎﺕ‬‫ﻌ‬‫ﻮﺳ‬‫ﻣ‬‫ﻳﺖﻭ‬ ‫ﺮ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﻜﺤ‬‫ﻟ‬‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫ﺪﻳ‬‫ﻗ‬.3
.‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻠﻰﻣ‬‫ﺪﻋ‬ ‫ﺎﻋ‬‫ﻣﻞﻳﺴ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻫ‬

174
Medi cal Management :
-Ther apyf ormi graineheadachei sdi videdintoabor ti
ve( sy
mpt omat i
c)and
prevent i
veappr oaches.
-Theabor tiveappr oach,bestusedi nthosepat ientswhohav elessfrequent
attacks, i
sai medatr el
ievi
ngorl i
mi ti
ngaheadacheatt heonset .
-Thepr eventiveappr oachi susedi npat i
entswhoex per i
encemor ef r
equent
attacksatr egularorpr edictableintervalsandmayhav eamedi calcondit
ion
thatpr ecl
udest heuseofabor ti
vet herapies.
:‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺍﻹ‬
.‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬‫ﻭ‬‫(ﻭ‬ ‫ﺔ‬
‫ﻴ‬ ‫ﺮﺿ‬‫ﺔ)ﻋ‬‫ﻠ‬‫ﺎﺷ‬‫ﺮﻕﻓ‬‫ﻟﻰﻃ‬ ‫ﻔﻲﺇ‬‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻘﺴﻢﻋﻼﺝ‬ ‫ﻨ‬
‫ﻳ‬-
‫ﻟﻰ‬‫ﺪﻑﺇ‬ ‫ﻬ‬‫ﻳ‬،‫ﺍ‬
ً
‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻜ‬‫ﻗﻞﺗ‬‫ﺃ‬‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻮﻥﻣﻦﻧ‬‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻓﻲ‬ ً
‫ﻣ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻓﻀﻞ‬ ‫ﺍﻷ‬،‫ﺎﺷﻞ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺏ‬ ‫ﻠ‬
‫ﺍﻷﺳ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺍ‬
‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻉﻓﻲ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻒ‬‫ﻔ‬‫ﺗﺨ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻤ‬‫ﺘﻈ‬ ‫ﻨ‬
‫ﺍﺕﻣ‬ ‫ﺮ‬‫ﺘ‬‫ﻠﻰﻓ‬‫ﺓﻋ‬‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﺎﺕﻣ‬‫ﺑ‬‫ﻮ‬‫ﻮﻥﻣﻦﻧ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻲﻓﻲ‬ ‫ﺎ‬
‫ﻗ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﺏ‬‫ﻠ‬‫ﺍﻷﺳ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﻳﺴ‬-
.
‫ﺔ‬ ‫ﻬﻀ‬‫ﻤﺠ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻌﻼﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﺔﺗ‬‫ﻴ‬‫ﺒ‬‫ﺣﺔﻃ‬
‫ﻟ‬‫ﻮﻥﻣﻦ ﺎ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﺪﻳ‬‫ﻗ‬
‫ﺔﻭ‬ ‫ﻌ‬
‫ﻗ‬‫ﻮ‬‫ﺘ‬‫ﻣ‬

-Thetri
ptans,serotoninrecept oragonists,ar
ethemostspeci fi
cant i
migr
aine
agentsavail
able.Theseagent scausev asoconstr
icti
on,reduceinf
lammat i
on,
andmayr educepai nt r
ansmi ssion.
-Manyoft hetriptanmedi cati
onsar eav ail
abl
einav ari
etyofformulati
ons,such
asnasalsprays, i
nhalers,suppositor
ies,orinj
ecti
ons.Thenasal spraysare
usefulf
orpatientsexper i
encingnauseaandv omi
ting.

.
‫ﺍ‬ً
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺔﺗﺤ‬ ‫ﺎﺣ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻔﻲ‬‫ﻨﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﺮﻣﻀ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬ ‫ﻫﻲ‬، ‫ﻴﻦ‬‫ﻧ‬‫ﻮ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﻴ‬
‫ﻟﺴ‬ ‫ﺍ‬
‫ﺒﻼﺕ‬ ‫ﻘ‬
‫ﺘ‬ ‫ﺎﺕﻣﺴ‬ ‫ﺎﻫﻀ‬ ‫ﻧ‬،‫ﺎﻥ‬‫ﺘ‬‫ﺒ‬‫ﻳ‬‫ﺮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬-
.‫ﻟﻢ‬‫ﺎﺍﻷ‬‫ﻘﻝ‬ ‫ﺘ‬‫ﻧ‬
‫ﺍ‬ ‫ﻠﻞﻣﻦ‬‫ﻘ‬‫ﺪﺗ‬ ‫ﻗ‬‫ﺎﺏﻭ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺗ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﻴﻖ‬ ‫ﻣﻞﺗﻀ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬ ‫ﺒﺐﻫ‬ ‫ﺗﺴ‬
‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬
‫ﺃﺟ‬ ‫ﻭ‬ ‫ﺃ‬‫ﻷﻒ‬‫ﺍﻧ‬ ‫ﺎﺕ‬‫ﺎﺧ‬‫ﺜﻞﺑﺨ‬ ‫ﻣ‬، ‫ﺎﺕ‬ ‫ﺒ‬
‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻮﻋ‬‫ﻨ‬‫ﺘ‬‫ﺔﻣ‬‫ﻮﻋ‬ ‫ﻤ‬
‫ﺎﻥﻓﻲﻣﺠ‬ ‫ﺘ‬
‫ﺒ‬‫ﻳ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺃ‬‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﻓ‬‫ﻮ‬‫ﺘ‬‫ﺗ‬-
.
‫ﺀ‬ ‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬‫ﻴ‬‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻔ‬‫ﻧﻒﻣ‬ ‫ﺍﻷ‬‫ﺎﺕ‬ ‫ﺎﺧ‬‫ﺑﺨ‬.‫ﻘﻦ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻞ‬ ‫ﻣ‬‫ﺎ‬
‫ﺘﺤ‬ ‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺎﻕ‬ ‫ﻨﺸ‬‫ﺘ‬‫ﻻﺳ‬
NursingManagement :
Thegoal istot reatt heacut eev entoft heheadacheandt opr eventr ecurrent
epi
sodes.Pr eventioni nv olvespat i
enteducat ionr egardingpr ecipitatingfact ors,
possiblel i
festy l
eorhabi tchangest hatmaybehel pful,andphar macol ogic
measur es.
1.Reliev i
ngPai n:
-Ami gr aineoracl ust erheadachei nt heear l
yphaser equiresabor tive
medicat iont herapyassoonaspossi ble.
-Someheadachescanbepr ev entedi ftheappr opr i
atemedi cationsar etaken
beforet heonsetofpai n.
-Nursingcar edur inganat tacki ncludescomf ortmeasur essuchasaqui et ,dark
envir
onment .
-El
ev ationoft heheadoft hebedt o30degr ees.
-Sympt omat ictreat ment( ie,admi nistrationofant iemet i
cmedi cation).
-Sympt omat icpai nr eli
eff ort ensionheadachemaybeobt ainedbyappl i
cat i
on
oflocal heatormassage.
-Additional strategiesmayi ncludeadmi nist
rationofanal gesi cagent s,
anti
depr essantmedi cat i
ons, andmuscl er el
ax ants.
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺎ‬‫ﻤ‬‫ﻴ‬‫ﻳ ﺾﻓ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻒ‬‫ﻘ‬‫ﺜ‬‫ﺔﺗ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻤﻦ‬‫ﺘﻀ‬ ‫ﺗ‬.‫ﺓ‬
‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﻨ‬
‫ﻣ‬ ‫ﺍﻉﻭ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﺩ‬ ‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺪﺙ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻮﻋﻼﺝ‬ ‫ﺪﻑﻫ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬
‫ﻭ‬، ‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻔ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫ﺘﻲﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﻤﻂ‬ ‫ﺔﻓﻲﻧ‬ ‫ﻠ‬‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺔ‬‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺎ‬‫ﻠﻖﺑ‬‫ﻌ‬‫ﺘ‬‫ﻳ‬
.‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬
‫ﺑ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:‫ﻡ‬‫ﺍﻵﻻ‬‫ﻴﻒ‬ ‫ﻔ‬‫ﺗﺨ‬.1

175
‫ﻗﺖ‬‫ﺮﻉﻭ‬‫ﺃﺳ‬‫ﺎﺷﻞﻓﻲ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻲ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬‫ﺘﻄ‬‫ﺓﻳ‬‫ﺮ‬‫ﻜ‬
‫ﺒ‬‫ﺔﻣ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﺩﻱﻓﻲﻣ‬ ‫ﻮ‬‫ﻘ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻉ‬ ‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻔﻲ‬
‫ﻨﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﻜﻦ‬‫ﻤ‬‫ﻣ‬
‫‪.‬‬‫ﻟﻢ‬
‫ﺍﻷ‬‫ﺭ‬‫ﻮ‬‫ﻬ‬
‫ﺒﻞﻇ‬‫ﺔﻗ‬‫ﺒ‬‫ﺎﺳ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺍﺗﻢﺗ‬‫ﺫ‬‫ﺍﻉﺇ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬‫ﻌﺾ‬ ‫ﺔﻣﻦﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻦ‬‫ﻤ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﺔ‬‫ﻤ‬
‫ﻠ‬‫ﻣﻈ‬‫ﺔﻭ‬‫ﺋ‬
‫ﺩ‬‫ﺎ‬‫ﺔﻫ‬‫ﺌ‬‫ﻴ‬
‫ﺜﻞﺑ‬‫ﺔﻣ‬ ‫ﺍﺣ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﻤﻞﺗ‬‫ﻡﺗﺸ‬‫ﻮ‬‫ﻬﺠ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺮﻋ‬
‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬
‫ﺔ‬‫ﺭﺟ‬‫ﻟﻰ‪30‬ﺩ‬ ‫ﺮﺇ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺃﺱ‬‫ﺎﻉﺭ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫‪-‬ﺇ‬
‫‪.‬‬‫(‬
‫ﺀ‬ ‫ﻘﻰ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺩ‬‫ﺍﻷ‬‫ﺀ‬‫ﺎ‬‫ﻋﻄ‬‫ﺜﻞﺇ‬‫ﻣ‬‫ﺍ ﺽ)‬‫ﺮ‬‫ﻋ‬
‫ﺍﻷ‬‫‪-‬ﻋﻼﺝ‬
‫‪.‬‬‫ﻴﻚ‬‫ﻟ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻌ‬‫ﻮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻳﻖ‬‫ﺮ‬‫ﺮﻋﻦﻃ‬ ‫ﺗ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬
‫ﺪ‬‫ﻟﺼ‬ ‫ﺔ‬
‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍﻵﻻ‬‫ﻴﻒ‬‫ﻔ‬‫ﻜﻦﺗﺨ‬‫ﻤ‬‫‪-‬ﻳ‬
‫ﻌﻀﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬
‫ﺮﺧ‬‫ﻣ‬‫ﺎﺏﻭ‬‫ﺌ‬‫ﺘ‬‫ﻛ‬
‫ﻟﻼ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬
‫ﺎﺕﻭ‬ ‫ﻨ‬
‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺔ‬
‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﺍﻹﺿ‬ ‫ﺎﺕ‬‫ﻴ‬‫ﻴﺠ‬‫ﺗ‬‫ﺍ‬‫ﺮ‬
‫ﺘ‬‫ﺍﻹﺳ‬‫ﻤﻦ‬‫ﺘﻀ‬‫ﺪﺗ‬
‫‪-‬ﻗ‬
‫‪.‬‬‫ﺕ‬

‫‪2.Teachi‬‬ ‫‪ngPat‬‬ ‫‪i‬‬‫‪ent‬‬ ‫‪sSel‬‬ ‫‪f‬‬‫‪-‬‬‫‪Car‬‬‫‪e:‬‬

‫‪-Headaches,‬‬ ‫‪especi‬‬ ‫‪al‬‬‫‪l‬‬‫‪ymi‬‬ ‫‪gr‬‬‫‪ai‬‬‫‪nes,‬‬‫‪ar‬‬‫‪emor‬‬ ‫‪el‬‬ ‫‪i‬‬
‫‪kel‬‬
‫‪yt‬‬ ‫‪ooccurwhent‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪enti‬‬‫‪s‬‬
‫‪i‬‬
‫‪l‬‬‫‪l‬‬
‫‪,‬‬ ‫‪ov‬‬‫‪er‬‬‫‪l‬‬‫‪yt‬‬‫‪i‬‬
‫‪r‬‬‫‪ed,‬‬ ‫‪orst‬‬ ‫‪r‬‬‫‪essed.Nonphar‬‬ ‫‪macol‬‬‫‪ogi‬‬‫‪ct‬‬‫‪her‬‬‫‪api‬‬‫‪esar‬‬ ‫‪ei‬‬‫‪mpor‬‬ ‫‪t‬‬
‫‪antand‬‬
‫‪i‬‬
‫‪ncl‬‬ ‫‪udepat‬‬ ‫‪i‬‬‫‪enteducat‬‬ ‫‪i‬‬‫‪onaboutt‬‬ ‫‪het‬‬ ‫‪y‬‬‫‪peofheadache,‬‬ ‫‪i‬‬
‫‪t‬‬‫‪smechani‬‬ ‫( ‪sm‬‬ ‫‪i‬‬
‫)‪fknown‬‬ ‫‪,‬‬
‫‪andappr‬‬ ‫‪opr‬‬‫‪i‬‬‫‪at‬‬‫‪echangesi‬‬ ‫‪nl‬‬‫‪i‬‬
‫‪f‬‬‫‪est‬‬‫‪y‬‬ ‫‪l‬‬
‫‪et‬‬‫‪oav‬‬ ‫‪oi‬‬
‫‪dt‬‬ ‫‪r‬‬‫‪i‬‬
‫‪gger‬‬‫‪s.‬‬
‫‪-Regul‬‬ ‫‪arsl‬‬‫‪eep,‬‬ ‫‪meal‬‬ ‫‪s,‬‬‫‪exer‬‬ ‫‪ci‬‬
‫‪se,‬‬ ‫‪r‬‬‫‪el‬‬
‫‪axat‬‬‫‪i‬‬
‫‪on,‬‬ ‫‪andav‬‬ ‫‪oi‬‬
‫‪danceofdi‬‬ ‫‪et‬‬‫‪ar‬‬‫‪yt‬‬‫‪r‬‬‫‪i‬‬‫‪gger‬‬‫‪s‬‬
‫‪maybehel‬‬ ‫‪pf‬‬‫‪ul‬‬‫‪i‬‬‫‪nav‬‬ ‫‪oi‬‬‫‪di‬‬‫‪ngheadaches.‬‬
‫‪-Thepat‬‬ ‫‪i‬‬
‫‪entwi‬‬ ‫‪t‬‬
‫‪ht‬‬ ‫‪ensi‬‬ ‫‪onheadachesneedst‬‬ ‫‪eachi‬‬‫‪ngandr‬‬ ‫‪eassur‬‬‫‪ancet‬‬ ‫‪hatt‬‬‫‪he‬‬
‫‪headachei‬‬ ‫‪snott‬‬ ‫‪her‬‬ ‫‪esul‬‬ ‫‪tofabr‬‬ ‫‪ai‬‬‫‪nt‬‬‫‪umor‬‬ ‫;‬‫‪t‬‬‫‪hi‬‬
‫‪si‬‬‫‪sacommonunspokenf‬‬ ‫‪ear‬‬‫‪.‬‬
‫‪-St‬‬ ‫‪r‬‬
‫‪essr‬‬ ‫‪educt‬‬ ‫‪i‬‬
‫‪ont‬‬ ‫‪echni‬‬ ‫‪ques,‬‬ ‫‪suchasbi‬‬ ‫‪of‬‬‫‪eedback,‬‬ ‫‪exer‬‬‫‪ci‬‬
‫‪sepr‬‬ ‫‪ogr‬‬ ‫‪ams,‬‬ ‫‪and‬‬
‫‪medi‬‬ ‫‪t‬‬‫‪at‬‬‫‪i‬‬
‫‪on,‬‬ ‫‪ar‬‬‫‪eexampl‬‬ ‫‪esofnonphar‬‬ ‫‪macol‬‬ ‫‪ogi‬‬‫‪ct‬‬‫‪her‬‬‫‪api‬‬‫‪est‬‬ ‫‪hatmaypr‬‬ ‫‪ov‬‬ ‫‪e‬‬
‫‪hel‬‬‫‪pf‬‬‫‪ul‬‬‫‪.‬‬
‫‪-Thepat‬‬ ‫‪i‬‬
‫‪entandf‬‬ ‫‪ami‬‬ ‫‪l‬‬‫‪yneedt‬‬ ‫‪ober‬‬ ‫‪emi‬‬‫‪ndedoft‬‬ ‫‪hei‬‬‫‪mpor‬‬ ‫‪t‬‬
‫‪anceoff‬‬ ‫‪ol‬‬
‫‪l‬‬‫‪owi‬‬‫‪ngt‬‬ ‫‪he‬‬
‫‪pr‬‬‫‪escr‬‬ ‫‪i‬‬
‫‪bedt‬‬ ‫‪r‬‬‫‪eat‬‬‫‪mentr‬‬ ‫‪egi‬‬‫‪menf‬‬ ‫‪orheadacheandkeepi‬‬ ‫‪ngf‬‬ ‫‪ol‬‬‫‪l‬‬‫‪ow-‬‬‫‪up‬‬
‫‪appoi‬‬ ‫‪nt‬‬‫‪ment‬‬ ‫‪s.‬‬

‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﺗ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬
‫ﻌ‬‫‪.‬ﺗ‬‫‪2‬‬
‫ﻌﺐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﻭﺷ‬ ‫ﺃ‬‫ﺎ‬
‫ﻳً‬
‫ﻀ‬ ‫ﺮ‬
‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬
‫ﺪ‬‫ﻨ‬‫‪،‬ﻋ‬‫ﻔﻲ‬ ‫ﻨﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﺔ‬‫ﺎﺻ‬‫‪،‬ﻭﺧ‬ ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺪﺙ‬‫ﺃﻥﻳﺤ‬ ‫ﺮﺟﺢ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫‪-‬ﻣﻦ‬
‫ﻧﺖ‬‫ﺎ‬‫)ﺍﻛ‬
‫ﺫ‬
‫ﻪﺇ‬ ‫ﺘ‬‫ﻴ‬‫ﻟ‬
‫ﺁ‬
‫ﺍﻉﻭ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻮﻉ‬‫ﻮﻝﻧ‬‫ﻳ ﺾﺣ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻒ‬‫ﻘ‬‫ﺜ‬‫ﻤﻞﺗ‬‫ﺗﺸ‬‫ﺔﻭ‬ ‫ﻤ‬‫ﻬ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺎﺕﻏ‬ ‫ﻌﻼﺟ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﺃﺍﻹﺟ‬‫ﻭ‬
‫‪.‬‬
‫ﺍﺕ‬‫ﺰ‬‫ﻔ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻨﺐ‬‫ﺘﺠ‬‫ﻟ‬‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﻤﻂ‬‫ﺔﻓﻲﻧ‬ ‫ﺒ‬‫ﺎﺳ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫(ﻭ‬ ‫ﺔ‬
‫ﻓ‬‫ﻭ‬ ‫ﺮ‬
‫ﻌ‬‫ﻣ‬
‫ﺪﻓﻲ‬‫ﻋ‬‫ﺎ‬‫ﺪﻳﺴ‬‫ﺔﻗ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺰ‬‫ﻔ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻨﺐ‬‫ﺗﺠ‬‫ﺀﻭ‬‫ﺎ‬‫ﺮﺧ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺎﺿ‬ ‫ﻳ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬‫ﺒ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﺘﻈﻢﻭ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫‪-‬‬
‫‪.‬‬
‫ﺍﻉ‬‫ﺪ‬
‫ﻟﺼ‬ ‫ﺍ‬‫ﻨﺐ‬‫ﺗﺠ‬
‫ﺍ‬
‫ﺬ‬‫‪.‬ﻫ‬‫ﻤﺦ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺭ‬‫ﺔﻭ‬‫ﻴﺠ‬‫ﺘ‬‫ﻴﺲﻧ‬ ‫ﻟ‬‫ﺍﻉ‬‫ﺪ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺄﻥ‬‫ﻪﺑ‬‫ﺘ‬‫ﻧ‬
‫ﺄ‬‫ﻤ‬‫ﻪﻭﻃ‬‫ﻤ‬ ‫ﻴ‬
‫ﻠ‬‫ﻌ‬‫ﻟﻰﺗ‬‫ﺮﺇ‬‫ﺗ‬‫ﻮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬ ‫ﺍﻉ‬‫ﺪ‬
‫ﺎﺏﺑﺼ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬‫‪-‬ﻳﺤ‬
‫‪.‬‬
‫ﻠﻦ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺮﻙﻏ‬‫ﺘ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻑ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﻮ‬‫ﻫ‬
‫ﻌﻼ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻠ‬‫ﺜ‬
‫ﻣ‬‫ﺃ‬‫‪،‬ﻫﻲ‬ ‫ﻣﻞ‬‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪،‬ﻭ‬ ‫ﻳﻦ‬‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺍ‬
‫ﺮ‬‫ﺑ‬‫‪،‬ﻭ‬‫ﻮﺟﻲ‬ ‫ﻟ‬‫ﻮ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻉ‬‫ﺗﺠ‬‫ﺭ‬‫ﺍﻻ‬ ‫ﺜﻞ‬‫‪،‬ﻣ‬‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﻣﺍﻹﺟ‬‫ﺪﻦ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻨ‬‫ﻘ‬
‫‪-‬ﺗ‬
‫‪.‬‬
‫ﺓ‬‫ﺪ‬‫ﻴ‬‫ﻔ‬‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺪﺗ‬‫ﺘﻲﻗ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺕﻏ‬ ‫ﺟ‬
‫ﺪ‬
‫ﻴ‬‫ﺍﻋ‬‫ﻮ‬‫ﻠﻰﻣ‬‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﻉﻭ‬‫ﺪ‬‫ﻠﺼ‬‫ﻟ‬‫ﻮﻑ‬‫ﻮﺻ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺎﻉﻧﻈ‬‫ﺒ‬‫ﺗ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻴ‬‫ﻤ‬ ‫ﺄﻫ‬‫ﻪﺑ‬‫ﺘ‬‫ﻠ‬
‫ﺋ‬‫ﺎ‬
‫ﻳ ﺾﻭﻋ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻛ‬‫ﺬ‬‫‪-‬ﻳﺠﺐﺗ‬
‫‪.‬‬
‫ﺔ‬‫ﻌ‬‫ﺑ‬‫ﺎ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬

‫‪176‬‬
 Meni
ngi
ti
s
Learningobjecti
v es:
Uponcompl etionoft hislect
ure,
eachstudentshoul
dbeabl
eto:
1.Definemeningi ti
s.
2.Discusspathophy siologyofmeningi
tis.
3.Listsi
gnsandsy mpt omsofmeni ngit
is.
4.Describeassessmentanddi agnosti
cf i
ndi
ngsofmeni
ngi
ti
s.
5.Identi
fyPrevent i
onofmeni ngi
ti
s.
6.Discussmedi cal managementofmeni ngi
ti
s.
7.Describenursingmanagementofmeni ngi
ti
s

‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬
‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺐﻗ‬
‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬ ‫ﻜ‬‫ﺃﻥﻳ‬‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬
‫ﺎﺿ‬‫ﻤﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
.‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬.
1
.
‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.2
.
‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﺑﻼ‬
‫ﺔﻌ‬ ‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻊﻗ‬ ‫ﺿ‬.3
.‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﻴ ﺺﻻ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻭﺻﻒﻧ‬. 4
.
‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
5
.
‫ﺎ‬‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺒﻲﻻ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.6
‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﻳﻀﻲﻻ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 7

Meni
ngi
ti
s
Definit
ion:
Meni ngit
isi
sani nflammat ionoftheli
ningaroundthebrai
nandspinal cor
d
causedbybact eri
aorv ir
uses.
Pathophy si
ology
Causat i
veor ganism (bacteri
almeningit
is)
:
1.Meni ngococcus.
2.Streptococcuspneumoni a.
3.My cobacterium.
-Mostcasesofmeni ngiti
sarecausedbyani nfecti
on(pneumonia,earinf
ect
ion,
si
nusi nfecti
onorheadi nj
ury).
-Oncet hecausat iv
eor ganism ent
ersthebloodstr
eam,itcrossest
he

177
‫‪bl‬‬‫‪ood–br‬‬ ‫‪ai‬‬
‫‪nbar‬‬ ‫‪r‬‬‫‪i‬‬
‫‪erandpr‬‬ ‫‪ol‬‬‫‪i‬‬
‫‪f‬‬‫‪er‬‬‫‪at‬‬‫‪esi‬‬‫‪nt‬‬ ‫‪hecer‬‬ ‫‪ebr‬‬‫‪ospi‬‬‫‪nal‬‬‫‪f‬‬‫‪l‬‬
‫‪ui‬‬‫(‪d‬‬ ‫)‪CSF‬‬‫‪.Faci‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬
‫‪at‬‬‫‪i‬‬‫‪ng‬‬
‫‪i‬‬
‫‪nf‬‬ ‫‪l‬‬
‫‪ammat‬‬ ‫‪i‬‬
‫‪onoft‬‬ ‫‪hesubar‬‬ ‫‪achnoi‬‬‫‪dandpi‬‬ ‫‪amat‬‬ ‫‪er‬‬‫‪.Becauset‬‬ ‫‪hecr‬‬ ‫‪ani‬‬‫‪al‬‬‫‪v‬‬‫‪aul‬‬‫‪t‬‬
‫‪cont‬‬‫‪ai‬‬‫‪nsl‬‬‫‪i‬‬‫‪t‬‬
‫‪t‬‬‫‪l‬‬
‫‪er‬‬ ‫‪oom f‬‬‫‪orexpansi‬‬‫‪on,‬‬ ‫‪t‬‬‫‪hei‬‬‫‪nf‬‬‫‪l‬‬‫‪ammat‬‬ ‫‪i‬‬‫‪onmaycausei‬‬ ‫‪ncr‬‬‫‪eased‬‬
‫‪i‬‬
‫‪nt‬‬ ‫‪r‬‬
‫‪acr‬‬‫‪ani‬‬‫‪al‬‬‫‪pr‬‬‫‪essur‬‬‫(‪e‬‬‫‪I‬‬
‫)‪CP‬‬ ‫‪.‬‬
‫‪:‬‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻌ‬
‫ﺗ‬
‫‪.‬‬‫ﺎﺕ‬‫ﻭﺳ‬‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬‫ﻛﻲﺑﺴ‬ ‫ﻮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺒﻞ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻤﺦﻭ‬ ‫ﻟ‬
‫ﺎ‬
‫ﻴﻂﺑ‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺐ‬ ‫ﺎﺏﻳﺼ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﺎﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬ ‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬
‫ﻳ‬‫ﺰ‬ ‫ﻴ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫‪:‬‬‫(‬
‫ﻣﻲ‬ ‫ﻮ‬‫ﺛ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ)‬ ‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻦ‬ ‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺤ‬ ‫ﺍ‬
‫ﺍﺕ‬ ‫ﺭ‬‫ﻮ‬‫ﻜ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪1‬‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻘ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻱ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍﻻ‬‫‪.‬‬‫‪2‬‬
‫‪.‬‬‫ﺓ‬‫ﺮ‬‫ﻔﻄ‬‫ﺘ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪3‬‬
‫ﻭ‬ ‫ﺃ‬‫ﺔ‬
‫ﻴ‬ ‫ﻔ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻮﺏ‬‫ﻴ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺫ‪،‬‬
‫ﺍﻷﻥ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫‪،‬‬‫ﻮﻱ‬ ‫ﺋ‬
‫ﺎﺏﺭ‬ ‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻯ)‬‫ﺪ‬ ‫ﺔﻋﻦﻋ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﺎﻧ‬‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬ ‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻻﺕ‬ ‫ﻌﻈﻢﺣ‬ ‫‪-‬ﻣ‬
‫‪.‬‬‫(‬
‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬‫ﺑ‬‫ﺎ‬‫ﺇﺻ‬
‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺮﻓﻲ‬ ‫ﺘﺸ‬‫ﻨ‬‫ﻳ‬
‫ﺎﻏﻲﻭ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﺎﺟ‬ ‫ﻟﺤ‬‫ﺍ‬
‫ﺮ‬‫ﺒ‬‫ﻌ‬‫ﻪﻳ‬‫ﻧ‬‫ﺈ‬
‫‪،‬ﻓ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻟﻰﻣﺠ‬‫ﺒﺐﺇ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺋﻦ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻝ‬‫ﺩﺩﺧ‬ ‫ﺮ‬‫ﻤﺠ‬‫‪-‬ﺑ‬
‫ﻮﻱ‬‫ﺘ‬‫ﺔﺗﺤ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﺍﻷﻥﻗ‬‫ً‬
‫ﺮ‬‫‪.‬ﻧﻈ‬‫ﻮﻥ‬‫ﻨ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺍﻷ‬‫ﺔﻭ‬‫ﻴ‬‫ﺗ‬
‫ﻮ‬ ‫ﺒ‬
‫ﻜ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏﺗﺤﺖ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻬ‬‫‪.‬ﺗﺴ‬‫(‬‫ﻋﻲ)‪CSF‬‬ ‫ﺎ‬
‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫(‬‫‪I‬‬
‫ﺔ)‪CP‬‬ ‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺎﺏﻓﻲﺯ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬ ‫ﺒﺐ‬‫ﺘﺴ‬‫ﺪﻳ‬‫ﻘ‬‫‪،‬ﻓ‬‫ﻊ‬‫ﻮﺳ‬ ‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺔﺻ‬ ‫ﺎﺣ‬‫ﻠﻰﻣﺴ‬ ‫ﻋ‬

‫‪-CSFci‬‬‫‪r‬‬‫‪cul‬‬
‫‪at‬‬‫‪est‬‬ ‫‪hr‬‬‫‪ought‬‬ ‫‪hesubar‬‬ ‫‪achnoi‬‬‫‪dspace,‬‬‫‪wher‬‬‫‪ei‬‬‫‪nf‬‬
‫‪l‬‬‫‪ammat‬‬ ‫‪or‬‬‫‪ycel‬‬‫‪l‬‬
‫‪ul‬‬‫‪ar‬‬
‫‪mat‬‬‫‪er‬‬‫‪i‬‬
‫‪al‬‬‫‪sf‬‬‫‪r‬‬
‫‪om t‬‬ ‫‪heaf‬‬ ‫‪f‬‬‫‪ect‬‬‫‪edmeni‬‬ ‫‪ngeal‬‬ ‫‪t‬‬
‫‪i‬‬‫‪ssueent‬‬
‫‪erandaccumul‬‬ ‫‪at‬‬‫‪e.‬‬
‫‪-Thepr‬‬‫‪ognosi‬‬‫‪sf‬‬ ‫‪orbact‬‬ ‫‪er‬‬‫‪i‬‬
‫‪al‬‬‫‪meni‬‬ ‫‪ngi‬‬‫‪t‬‬
‫‪i‬‬‫‪sdependsont‬‬ ‫‪hecausat‬‬‫‪i‬‬‫‪v‬‬‫‪eor‬‬‫‪gani‬‬‫‪sm,‬‬ ‫‪t‬‬
‫‪he‬‬
‫‪sev‬‬‫‪er‬‬
‫‪i‬‬‫‪t‬‬
‫‪yoft‬‬ ‫‪hei‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬‫‪onandi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪ness,‬‬ ‫‪andt‬‬‫‪het‬‬‫‪i‬‬‫‪mel‬‬
‫‪i‬‬‫‪nessoft‬‬‫‪r‬‬‫‪eat‬‬‫‪ment‬‬ ‫‪.‬‬
‫(‬‫‪Compl‬‬‫‪i‬‬
‫‪cat‬‬‫‪i‬‬‫‪ons:‬‬‫‪v‬‬ ‫‪i‬‬
‫‪sual‬‬ ‫‪i‬‬
‫‪mpai‬‬ ‫‪r‬‬
‫‪ment‬‬ ‫‪,‬‬
‫‪deaf‬‬‫‪ness,‬‬‫‪sei‬‬
‫‪zur‬‬‫‪es,‬‬‫‪par‬‬
‫‪al‬‬‫‪y‬‬‫‪si‬‬‫‪s,‬‬‫‪hy‬‬‫‪dr‬‬‫‪ocephal‬‬
‫‪us,‬‬
‫‪andsept‬‬‫‪i‬‬‫)‪cshock‬‬ ‫‪.‬‬

‫ﺔﻣﻦ‬‫ﻴ‬
‫ﺑ‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬‫ﻴﺚﺗ‬‫‪،‬ﺣ‬‫ﺔ‬‫ﻴ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻜ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺀﺗﺤﺖ‬‫ﺎ‬
‫ﻔﻀ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﺎﻋﻲﻋ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﻛﻢ‬‫ﺍ‬
‫ﺮ‬‫ﺘ‬‫ﺗ‬
‫ﺎﺏﻭ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﻲ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﻴﺞ‬‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬
‫ﻗﺖ‬‫ﻭ‬
‫‪،‬ﻭ‬ ‫ﺮﺽ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯﻭ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬
‫‪،‬ﻭﺷ‬ ‫ﺒﺐ‬‫ﻤﺴ‬
‫ﻟ‬‫ﺍ‬‫ﻟﺤﻲ‬
‫ﺍ‬‫ﺋﻦ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻣﻲﻋ‬‫ﻮ‬‫ﺛ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬‫ﺪﺗﺸﺨ‬ ‫ﻤ‬‫ﺘ‬
‫ﻌ‬‫‪-‬ﻳ‬
‫ﺍﻹ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﺃﺱ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻘ‬
‫ﺘﺴ‬‫ﺍﺳ‬
‫‪،‬ﻭ‬‫ﻠﻞ‬‫ﻟﺸ‬
‫ﺍ‬‫‪،‬ﻭ‬‫ﺎﺕ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫‪،‬ﻭ‬‫ﻤﻢ‬‫ﻟﺼ‬
‫ﺍ‬‫‪،‬ﻭ‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻒ‬‫‪:‬ﺿ‬ ‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫‪).‬‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫(‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺘ‬
‫ﻧ‬

‫‪Cl‬‬‫‪i‬‬
‫‪ni‬‬‫‪calMani‬‬‫‪f‬‬‫‪est‬‬‫‪at‬‬‫‪i‬‬
‫‪ons‬‬
‫‪1.Headacheandf‬‬ ‫‪ev‬‬‫‪erar‬‬‫‪ef‬‬‫‪r‬‬
‫‪equent‬‬ ‫‪l‬‬‫‪yt‬‬‫‪hei‬‬‫‪ni‬‬
‫‪t‬‬‫‪i‬‬‫‪al‬‬‫‪sy‬‬‫‪mpt‬‬ ‫‪oms.‬‬
‫‪2.Neckmobi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬‫‪y‬‬‫‪:‬‬ ‫‪Ast‬‬‫‪i‬‬
‫‪f‬‬‫‪fandpai‬‬‫‪nf‬‬‫‪ul‬‬‫(‪neck‬‬ ‫‪nuchal‬‬‫‪r‬‬‫‪i‬‬‫‪gi‬‬‫‪di‬‬
‫‪t‬‬‫‪y‬‬‫‪)canbeanear‬‬ ‫‪l‬‬
‫‪ysi‬‬‫‪gn‬‬
‫‪andanyat‬‬ ‫‪t‬‬
‫‪empt‬‬ ‫‪satf‬‬‫‪l‬‬
‫‪exi‬‬‫‪onoft‬‬‫‪heheadar‬‬ ‫‪edi‬‬‫‪f‬‬‫‪f‬‬‫‪i‬‬
‫‪cul‬‬‫‪tbecauseofspasmsi‬‬ ‫‪nt‬‬‫‪he‬‬
‫‪muscl‬‬‫‪esoft‬‬‫‪heneck.‬‬
‫‪3.Posi‬‬‫‪t‬‬‫‪i‬‬
‫‪v‬‬‫‪eKer‬‬‫‪ni‬‬‫’‪g‬‬‫‪ssi‬‬‫‪gn:‬‬‫‪Whent‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪enti‬‬‫‪sl‬‬‫‪y‬‬‫‪i‬‬‫‪ngwi‬‬ ‫‪t‬‬‫‪ht‬‬‫‪het‬‬‫‪hi‬‬‫‪ghf‬‬ ‫‪l‬‬
‫‪exedont‬‬ ‫‪he‬‬
‫‪abdomen,‬‬ ‫‪t‬‬
‫‪hel‬‬ ‫‪egcannotbecompl‬‬ ‫‪et‬‬‫‪el‬‬‫‪yext‬‬‫‪ended.‬‬
‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻻ‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﻣﺍﻷ‬
‫ﻤﻰ ﻦ‬ ‫ﻟﺤ‬‫ﺍ‬
‫ﺍﻉﻭ‬‫ﺪ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
‫ﺒ‬‫ﻟ‬‫‪.‬ﺎ‬‫‪1‬‬
‫ﻭ‬‫ﺎ‬‫ﺃﻱﻣﺤ‬‫ﺓﻭ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻼﺔﻣ‬‫(ﻋ ﻣ‬‫ﻨﻖ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺮ‬‫ﺆﺧ‬‫ﻠﺐﻣ‬ ‫ﺗﺼ‬‫ﺔ)‬‫ﻤ‬‫ﻟ‬‫ﺆ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﺒﺴ‬‫ﻴ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬‫‪:‬ﻳ‬‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬‫‪.‬ﺣ‬‫‪2‬‬
‫‪.‬‬‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕﻓﻲﻋﻀﻼﺕ‬ ‫ﻨﺠ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﺒﺐ‬‫ﺔﺑﺴ‬‫ﺒ‬‫ﻌ‬
‫ﻮﻥ ﺻ‬ ‫ﻜ‬‫ﺃﺱﺗ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬‫ﺜ‬‫ﻟ‬‫ﻻﺕ‬
‫ﺪ‬
‫ﻳ‬‫ﺪ‬‫ﻤ‬‫ﻜﻦﺗ‬‫ﻤ‬
‫‪،‬ﻻﻳ‬ ‫ﺒﻄﻦ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺬﻋ‬‫ﻔﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬‫ﻊﺛ‬ ‫ﺎﻣ‬
‫ً‬‫ﻴ‬‫ﻘ‬
‫ﻠ‬‫ﺘ‬‫ﻳ ﺾﻣﺴ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻣ‬
‫ﺪ‬ ‫ﻨ‬
‫‪:‬ﻋ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﻳﺠ‬‫ﺍﻹ‬‫ﻴﺞ‬‫ﻧ‬‫ﺮ‬‫ﻴ‬‫ﻼﺔﻛ‬
‫‪.‬ﻋ ﻣ‬‫‪3‬‬
‫‪.‬‬‫ﻣﻞ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫ﺎﻕﺑ‬‫ﻟﺴ‬‫ﺍ‬

‫‪178‬‬
 (
Fig.36)Posi
ti
veKer
nig’
ssi
gn

4.Posit
iveBrudzi
nski’
ssign:Whent hepati
ent’
sneckisf
lexed(afterrul
ingout
cerv
icalt
raumaori nj
ury)
,fl
exionofthekneesandhipsisproduced; whenthe
l
owerext r
emityofonesideispassivelyf
lexed,
asimil
armov ementi sseenin
theopposit
eextremity
.Brudzi
nski’
ssignisamor esensi
ti
veindicatorof
meningealir
ri
tati
onthanKernig’
ssign.

،
(‫ﺮﺣﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻖ‬
‫ﺔﻋ‬ ‫ﺑ‬
‫ﺎ‬‫ﻭﺇﺻ‬‫ﺃ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺩﺇﺻ‬‫ﺎ‬
‫ﻌ‬‫ﺒ‬
‫ﺘ‬‫ﺍﺳ‬‫ﺪ‬‫ﻌ‬‫ﺑ‬)‫ﻳ ﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﻨﻲﺭ‬‫ﺪﺛ‬
‫ﻨ‬‫ﻋ‬:‫ﺔ‬‫ﻴ‬
‫ﺑ‬‫ﺎ‬
‫ﻳﺠ‬‫ﺍﻹ‬‫ﻜﻲ‬‫ﻨﺴ‬‫ﻳ‬
‫ﺯ‬‫ﺩ‬‫ﻭ‬‫ﺮ‬
‫ﻼﺔﺑ‬
‫ﻋ ﻣ‬.4
‫ﺮ‬
‫ﻬ‬‫ﺗﻈ‬،‫ﺒﻲ‬
‫ﻠ‬‫ﻜﻞﺳ‬‫ﻴﻦﺑﺸ‬‫ﺒ‬‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺪ‬‫ﻠﻲﻷﺣ‬‫ﻔ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﻑ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻨﻲ‬‫ﺘﻢﺛ‬
‫ﺎﻳ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫؛ﻋ‬‫ﻴﻦ‬‫ﻛ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﺘ‬‫ﺒ‬
‫ﻛ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺜ‬‫ﻧ‬
‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬
‫ﺋﻲﻣﻦﻋﻼ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﻴﺞ‬‫ﻬ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﻴ‬‫ﺎﺳ‬
‫ﺮﺣﺴ‬ ‫ﺜ‬‫ﻛ‬
‫ﺃ‬‫ﺍ‬ً
‫ﺮ‬
‫ﺆﺷ‬ ‫ﻜﻲﻣ‬‫ﻨﺴ‬‫ﻳ‬‫ﺯ‬
‫ﺩ‬‫ﻭ‬‫ﺮ‬
‫ﻼﺔﺑ‬
‫ﺪﻋ ﻣ‬‫ﻌ‬‫ﺗ‬.
‫ﺑﻞ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻑ‬‫ﻟﻄ‬‫ﺍ‬
‫ﺔﻓﻲ‬ ‫ﻠ‬
‫ﺛ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻣ‬ ‫ﻛ‬
‫ﺮ‬‫ﺣ‬
.
‫ﻴﺞ‬‫ﻧ‬‫ﺮ‬‫ﻴ‬
‫ﺔﻛ‬‫ﻣ‬

(
Fig.37)Posi
ti
veBr
udzi
nski
’
ssi
gn

5.Phot ophobi a(ext

remesensi ti
vit
yt oli
ght)
: Thisfindi
ngi scommon, alt
hough
thecausei sunclear.
6.Skinr ash( ski
nlesionsdevelop,rangingfrom apet echialrashwit
hpur pur
ic
l
esionst ol argeareasofecchy mosi s)
.
7.Disorientation
8.Memor yimpairment.
9.Llet
har gy ,
unresponsiveness,andcomamaydev elop.
10.Seizur es.
11.Anacut ef ul
minantinfect
ion,producingsignsofov er
whel mingsepti
cemia:
anabr uptonsetofhi ghfever
,extensivepurpuriclesions(overthefaceand
extr
emi ties),shock,andsignsofdi sseminatedintravascularcoagulat
ion(DI
C)..

.
‫ﺍﺿﺢ‬
‫ﺮﻭ‬‫ﻴ‬
‫ﺒﺐﻏ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﺃﻥ‬‫ﺮﻏﻢﻣﻦ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻋ‬،‫ﺔ‬
‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﺔﺷ‬‫ﻴﺠ‬
‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬
‫ﻫ‬:(
‫ﺀ‬‫ﻮ‬‫ﻠﻀ‬
‫ﻟ‬‫ﺔ‬‫ﺮﻃ‬
‫ﻔ‬‫ﺔﻣ‬
‫ﻴ‬‫ﺎﺳ‬
‫ﺀ)ﺣﺴ‬
‫ﻮ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺎﺏ‬
‫ﺭﻫ‬.
5

179
‫ﺎﻃﻖ‬‫ﻨ‬
‫ﻟﻰﻣ‬
‫ﺔﺇ‬‫ﻳ‬
‫ﺮ‬‫ﻓ‬‫ﺮ‬
‫ﺎﺕﺑ‬‫ﻓ‬‫ﺁ‬
‫ﻊ‬‫ﻘﻄﻲﻣ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺪﻱ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﻔﺢ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻭﺡﻣﻦ‬ ‫ﺍ‬‫ﺮ‬
‫ﺘ‬‫ﺗ‬،‫ﺔ‬
‫ﻳ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻓ‬‫ﺍﻵ‬‫ﺭ‬‫ﻮ‬‫ﺘﻄ‬‫ﺗ‬
)‫ﺪﻱ‬ ‫ﻠ‬
‫ﻔﺢﺟ‬ ‫ﻃ‬.6
.
(‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻌ‬‫ﺍﺳ‬‫ﻭ‬
‫ﺎﻙ‬‫ﺒ‬‫ﺗ‬‫ﺭ‬
‫ﺍﻻ‬ .
7
.
‫ﺓ‬‫ﺮ‬‫ﻛ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻒ‬‫ﺿ‬. 8
.
‫ﺔ‬‫ﺑ‬‫ﻮ‬
‫ﺒ‬‫ﻴ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﻻﺳ‬‫ﻡ‬‫ﺪ‬‫ﺔﻭﻋ‬‫ﺑ‬‫ﻮ‬
‫ﺒ‬‫ﻴ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺘﻄ‬‫ﺪﺗ‬‫ﻗ‬.9
.
‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬.10
‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻓ‬
‫ﺮ‬‫ﺎﺕﺑ‬
‫ﻓ‬‫ﺁ‬،
‫ﺓ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬
‫ﺍ‬‫ﻤﻰ‬‫ﻠﺤ‬‫ﻟ‬‫ﺎﺟﺊ‬‫ﻔ‬
‫ﺭﻣ‬‫ﻮ‬
‫ﻬ‬‫ﻇ‬:‫ﺮ‬‫ﻣ‬
‫ﺎ‬‫ﻮﻱﻏ‬‫ﻣ‬‫ﺎﻥﺩ‬‫ﺘ‬‫ﻧ‬
‫ﺎﺕﺇ‬‫ﻣ‬‫ﺘﺞﻋﻼ‬ ‫ﻨ‬
‫ﺗ‬،‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﺔﺣ‬ ‫ﻔ‬‫ﺎﻃ‬
‫ﻭﻯﺧ‬ ‫ﺪ‬‫ﻋ‬.11
..
(DI
C)‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬
‫ﺍﻷ‬‫ﺍﺧﻞ‬‫ﺮﺩ‬
‫ﺘﺸ‬‫ﻨ‬
‫ﺮﻣ‬‫ﺜ‬‫ﺎﺕﺗﺨ‬‫ﻣ‬‫ﻭﻋﻼ‬،‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺻ‬، (‫ﺍﻑ‬‫ﺮ‬
‫ﺍﻷﻃ‬‫ﻪﻭ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔ)ﻋ‬‫ﻌ‬‫ﺍﺳ‬‫ﻭ‬

AssessmentandDi agnost icFindi ngs:

-Ifthecl i
nicalpresent ati
onsuggest smeni ngiti
s,diagnost i
ct esti
ngi s
conduct edt oidentif
yt hecausat iveor ganism.
-Acomput edt omogr aphy( CT)scanormagnet icr esonancei maging( MRI)
scani susedt odetectashi ftinbr aincont ents( whi chmayl eadtoher niati
on)
priortoal umbarpunct ure.
-Bact eri
al cul
tureandGr am stainingofCSFandbl oodar ekeydi agnost i
ct ests.
CSFst udi
esdemonst ratelowgl ucose, highpr oteinl evels,andhi ghwhi tebl ood
cellcount .Gram stainingal lowsf orrapidident i
ficationoft hecausat iv
ebact eria
andi niti
ationofappr opr i
at eant i
biotictherapy .
:‫ﻴﺺ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬ ‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻧ‬
‫ﻟﺤﻲ‬‫ﺍ‬‫ﺋﻦ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﻴﺼﻲ‬ ‫ﺭﺗﺸﺨ‬ ‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬ ‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺘﻢﺇﺟ‬ ‫ﻳ‬،‫ﺎ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﺮﺇ‬‫ﻴ‬‫ﺮﻱﻳﺸ‬ ‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬-
.‫ﺒﺐ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬‫ﻟ‬(MRI)‫ﻴﺴﻲ‬ ‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬‫ﺮ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫(ﻭ‬
‫ﺃ‬CT)‫ﻮﺳﺐ‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻲ‬ ‫ﻘﻄ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬-
.
‫ﻨﻲ‬‫ﻘﻄ‬ ‫ﻟ‬‫ﺍ‬‫ﺰﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻞ‬‫(ﻗ‬ ‫ﺎﻕ‬‫ﺘ‬‫ﻔ‬
‫ﻧ‬‫ﺍﻻ‬‫ﻟﻰ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﺪﻳ‬ ‫ﺬﻱﻗ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬)‫ﺎﻍ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﻮﻝﻓﻲﻣﺤ‬ ‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﻣﺍﻻﺧ‬
‫ﻡﻦ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻋﻲﻭ‬ ‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﺎﻏﻲ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺍ‬
‫ﺮ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﻴﺦ‬ ‫ﻠﻄ‬‫ﺗ‬‫ﺔﻭ‬ ‫ﻳ‬
‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻜ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻋ‬ ‫ﺍ‬
‫ﺭ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﺗ‬-
‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﺗ‬
‫ﻭ‬ ‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻳ‬
‫ﻮ‬‫ﺘ‬‫ﺎﻉﻣﺴ‬ ‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﺯﻭ‬ ‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺎ ﺽﻣﺴ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬ ‫ﺎﻋﻲ‬‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺮﺩ‬‫ﻬ‬‫ﺗﻈ‬
ُ.‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬
‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺪ‬‫ﺑ‬
‫ﺔﻭ‬‫ﺒ‬‫ﺒ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻊﻋ‬ ‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﻡﺑ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻠ‬‫ﻤﺢﺗ‬ ‫ﻳﺴ‬.‫ﺀ‬‫ﺎ‬‫ﻴﻀ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺩﺧﻼ‬ ‫ﺪ‬‫ﻋ‬
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺎ‬‫ﺎﺳﺐﺑ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

Pr ev enti
on:
1.Meni ngococcal conjugat edv acci negi vent oadol escent sent eri
nghi ghschool
andt ocol l
egef reshmenl i
vi
ngi ndor mi tories.Fr eshmenl ivingi ndor mi tories
hav eat hreet imesgr eaterriskofdev elopi ng
meni ngococcal meni ngiti
sascompar edwi ththegener al popul ationand
student sli
vingof fcampus.
2.Mostst atesmandat eeducat ionaddr essi ngmeni ngococcal meni ngitisand
theav ail
abilityofv accinat i
onsot hatf ami liescanmakei nfor meddeci sions.
Peopl einclosecont actwi thpat ient swi thmeni ngococcal meni ngi t
isshoul dbe
treat edwi thant imicrobi alchemopr ophy laxi susingr if
ampi n( Rifadin)or
cipr ofl
oxaci nhy drochl oride( Ci
pr o) .Ther apyshoul dbest artedwi thin24hour s
afterexposur ebecauseadel ayint hei ni ti
at i
onoft her apyl i
mi tst he
effect iv
enessoft hepr ophy laxi
s.
3.Vacci nationshoul dal sobeconsi der edasanadj unctt oant ibiotic
chemopr ophy laxisforany onelivingwi thaper sonwhodev elopsmeni ngococcal
i
nf ect i
on.
:
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻭ‬
‫ﺩ‬‫ﺪ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﻌ‬‫ﻣ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔﻭﻃﻼﺏ‬ ‫ﻳ‬‫ﻮ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺭﺳ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺎ‬‫ﻴﻦﺑ‬ ‫ﻘ‬‫ﺘﺤ‬ ‫ﻠ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻦ‬‫ﻘ‬‫ﺍﻫ‬‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻓﻖ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺴﺤ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﻮ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺡ‬‫ﻘ‬
‫ﻟ‬.1
‫ﺑﻼﺙ‬‫ﺮﺜ‬ ‫ﺒ‬
‫ﻛ‬ ‫ﺃ‬
‫ﺮ‬ ‫ﺎﻃ‬‫ﻬﻢﻣﺨ‬ ‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻊ‬ ‫ﺎﺟ‬‫ﻬ‬
‫ﻮﻥﻓﻲﻣ‬ ‫ﻴﺸ‬ ‫ﻌ‬
‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻄﻼﺏ‬ ‫ﺍ‬.‫ﺔ‬‫ﺒ‬‫ﻠ‬
‫ﻟﻄ‬‫ﺍ‬ ‫ﻛﻦ‬‫ﺎ‬‫ﻮﻥﻓﻲﻣﺴ‬ ‫ﻴﺸ‬ ‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬
‫ﺭ‬‫ﻮ‬
‫ﺘﻄ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺕﻣﻦ‬ ‫ﺮ‬‫ﻣ‬
‫ﻡ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺭﺝ‬‫ﺎ‬‫ﻮﻥﺧ‬ ‫ﻴﺸ‬ ‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻭﻄﻼﺏ‬ ‫ﻟ‬‫ﺎﻥﺍ‬ ‫ﻜ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﺔﺑ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺴﺤ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬ ‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺑ‬
‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬ ‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬

180
 .‫ﻌﻲ‬‫ﻣ‬‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻌ‬
‫ﺘﻄ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻓ‬ ‫ﺍ‬
‫ﻮ‬‫ﺗ‬‫ﺔﻭ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟﺠ‬‫ﺎ‬
‫ﻌ‬‫ﺄﻥﻣ‬ ‫ﻴﻒﺑﺸ‬ ‫ﻘ‬‫ﺜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻳ‬‫ﻮﻻ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻈﻢ‬ ‫ﺮ ﺽﻣ‬ ‫ﻔ‬‫ﺗ‬.2
‫ﻊ‬‫ﻴﻖﻣ‬ ‫ﺛ‬
‫ﺎﻝﻭ‬ ‫ﺗﺼ‬ ‫ﺍ‬‫ﻠﻰ‬‫ﻳﻦﻫﻢﻋ‬ ‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﻳﺠﺐﻋﻼﺝ‬. ‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﻨ‬‫ﺘ‬‫ﺍﺕﻣﺴ‬ ‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﺫﻗ‬ ‫ﺎ‬‫ﺗﺨ‬
‫ﺍ‬ ‫ﺋﻼﺕﻣﻦ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﺘ‬
‫ﺘﻰﺗ‬ ‫ﺣ‬
‫ﻴﻦ‬‫ﺒ‬‫ﻣ‬‫ﺎ‬
‫ﻔ‬‫ﻳ‬‫ﻡﺭ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺎﺳ‬‫ﺎﺕﺑ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﻜ‬
‫ﻴ‬‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺑ‬‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻣ‬
‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﻋ‬‫ﺎ‬‫ﺳ‬24‫ﻮﻥ‬ ‫ﻌﻼﺝﻓﻲﻏﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺃ‬‫ﺪ‬‫ﺒ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬. (‫ﻭ‬
‫ﺮ‬‫ﺒ‬‫ﻴ‬‫ﻴﻦ)ﺳ‬ ‫ﺎﺳ‬‫ﻛﺴ‬‫ﻮ‬‫ﻠ‬‫ﻓ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻴ‬‫ﺪﺳ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬‫ﻛ‬‫ﻭ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫(ﻭﻫ‬
‫ﻳﻦﺃ‬ ‫ﺩ‬
‫ﺎ‬‫ﻔ‬‫ﻳ‬‫ﺭ‬
)
.
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﻌ‬‫ﺪﻣﻦﻓ‬ ‫ﻌﻼﺝﻳﺤ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺪ‬‫ﺮﻓﻲﺑ‬ ‫ﻴ‬
‫ﺄﺧ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺮ ﺽﻷﻥ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻴﺶ‬ ‫ﻌ‬‫ﺔﻷﻱﺷﺨ ﺺﻳ‬ ‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﺪ‬‫ﻋ‬‫ﺎ‬‫ﻣﻞﻣﺴ‬ ‫ﺎ‬‫ﻌ‬
‫ﻴﻢﻛ‬ ‫ﻌ‬‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻋ‬‫ﺎ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻳﺠﺐ‬. 3
.‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬
‫ﻮ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﺎﺏﺑ‬‫ﻊﺷﺨ ﺺﻣﺼ‬ ‫ﻣ‬
Medi calManagement :
-Successf ul outcomesdependont heear lyadmi ni
strati
onofanant i
bioticthat
crossest hebl ood–br ainbar rierintothesubar achnoi dspacei nsuf f
icient
concent rationtohal tthemul ti
plicati
onofbact eria.
-Vancomy cinhy dr
ochl ori
dei ncombi nati
onwi thoneoft hecephal ospor insis
admi nist
er edintravenousl y(IV).
:‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬
‫ﺀﺗﺤﺖ‬ ‫ﺎ‬‫ﻔﻀ‬‫ﻟ‬‫ﺍ‬ ‫ﻟﻰ‬
‫ﺎﻏﻲﺇ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﺎﺟ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﻌ‬‫ﻮﻱﻳ‬‫ﻴ‬‫ﺩﺣ‬ ‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺮ‬ ‫ﻜ‬‫ﺒ‬
‫ﺀﻣ‬ ‫ﺎ‬
‫ﻋﻄ‬ ‫ﻠﻰﺇ‬‫ﺔﻋ‬ ‫ﺎﺟﺤ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻤ‬‫ﺘ‬
‫ﻌ‬‫ﺗ‬-
.‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺛ‬‫ﺎ‬
‫ﻜ‬‫ﻗﻒﺗ‬ ‫ﻮ‬‫ﻟ‬ٍ‫ﺎ‬
‫ﻑ‬ ‫ﺰﻛ‬‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺘ‬‫ﺔﺑ‬ ‫ﻴ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻜ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
.(I
V)‫ﺪ‬ ‫ﻳ‬
‫ﺭ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺎﺕﻋﻦﻃ‬ ‫ﻨ‬
‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﺒ‬
‫ﻮﺳ‬ ‫ﻟ‬‫ﺎ‬‫ﻔ‬
‫ﻴ‬‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬‫ﺃﺣ‬ ‫ﻊ‬
‫ﺍﻙﻣ‬ ‫ﺮ‬
‫ﺘ‬‫ﺎﻻﺷ‬ ‫ﺪﺑ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﻛ‬‫ﻭ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻴﻦﻫ‬ ‫ﻳﺴ‬ ‫ﺎ‬
‫ﻣ‬‫ﻮ‬‫ﻜ‬‫ﻧ‬‫ﺎ‬
‫ﺀﻓ‬ ‫ﺎ‬‫ﺘﻢﺇﻋﻄ‬‫ﻳ‬-

-Dexamet hasone( Decadron)hasbeenshownt obebenef icialasadjunct

therapyint het r
eatmentofacut ebacteri
almeni ngit
isandi npneumococcal
meni ngit
isifitisadmi ni
stered15t o20mi nutesbeforet hefirstdoseof
antibi
oticandev ery6hour sforthenext4day s.Studiesindicatethat
dexamet hasonei mprovest heoutcomeinadul t
s.
-Dehy drati
onandshockar etreatedwit
hfluidvolumeexpander s.
-Seizures, whichmayoccurear lyint
hecour seofthedi sease, arecontr
oll
ed
withpheny toin(Dilanti
n).
-IncreasedI CPi streat
edasnecessar y.

‫ﺩﻭ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻣﻲ‬‫ﻮ‬‫ﺛ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻓﻲﻋﻼﺝ‬ ‫ﺎﻋ‬‫ﻛﻼﺝﻣﺴ‬‫ﺪﻌ‬ ‫ﻴ‬‫ﻔ‬‫(ﻣ‬‫ﻭﻥ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻜ‬‫ﻳ‬‫ﺩ‬)‫ﻭﻥ‬‫ﺯ‬‫ﺎ‬
‫ﺜ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻜﺴ‬‫ﻳ‬‫ﺃﻥﺩ‬‫ﺒﺖ‬‫ﺛ‬-
20‫ﻟﻰ‬‫ﺇ‬15‫ـ‬‫ﻮﻱﺏ‬ ‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻰﻣﻦ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﺮﻋ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺒﻞ‬‫ﻪﻗ‬‫ﻟ‬‫ﻭ‬
‫ﺎ‬‫ﻨ‬‫ﺍﺗﻢﺗ‬‫ﺫ‬‫ﺔﺇ‬
‫ﻳ‬‫ﻮ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬
‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬‫ﺎ‬‫ﺎﺑ‬‫ﻳ‬
‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
.
‫ﻴﻦ‬‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﺔﻋ‬ ‫ﻴﺠ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻥﻳﺤﺴﻦ‬ ‫ﺯ‬
‫ﺎ‬‫ﺜ‬‫ﻴ‬‫ﻣ‬
‫ﺎ‬‫ﻜﺴ‬‫ﻳ‬
‫ﺃﻥﺩ‬ ‫ﻟﻰ‬‫ﺎﺕﺇ‬‫ﺍﺳ‬‫ﺭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺗﺸ‬.‫ﻡ‬‫ﺎ‬
‫ﻳ‬‫ﺃ‬4‫ﺓ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﺎﺕ‬‫ﺎﻋ‬‫ﺳ‬6‫ﻛﻞ‬ ‫ﺔﻭ‬ ‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﺩ‬
.‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕﺣﺠﻢ‬ ‫ﻌ‬‫ﻮﺳ‬‫ﻤ‬‫ﺔﺑ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺎﻑﻭ‬ ‫ﻔ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻟﺞ‬‫ﺎ‬‫ﻌ‬-
‫ﻳ‬
‫ﺩﻼ‬
‫ﻳﻦ)ﻳ‬‫ﻮ‬
‫ﺘ‬‫ﻴ‬‫ﻨ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﺎﺑ‬
‫ﻬ‬‫ﻴ‬‫ﻜﻢﻓ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬،‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻜ‬‫ﺒ‬‫ﻗﺖﻣ‬ ‫ﺪﺙﻓﻲﻭ‬ ‫ﺪﺗﺤ‬ ‫ﺘﻲﻗ‬ ‫ﻟ‬
‫ﺍ‬،‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
-
.
(‫ﻴﻦ‬‫ﺘ‬
‫ﻧ‬
.
‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬
‫ﻟﻀ‬ ‫ﺍ‬
‫ﺔﺣﺴﺐ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﺓﺑ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻊﺯ‬ ‫ﻣﻞﻣ‬‫ﺎ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺘﻢ‬
‫ﻳ‬-

Nur si
ngManagement :
1.Thepat ientwithmeni ngi t
isi scrit
icallyil
l;ther
ef ore,manyofthenur si
ng
i
nter vent i
onsar ecol l
abor ativewi t
ht hephy sici
an,r espi
rator
ytherapist,and
othermember soft heheal thcar eteam.Thepat ient ’
ssafetyandwel l-
being
dependonsoundnur singj udgment .
2.Neur ologicstatusi scont inuouslyassessed.
3.Vi t
al signsar econt inuousl yassessed.
4.Pul seoxi metryandar t
erial bl
oodgasv aluesar eusedt oquicklyidentif
yt he
needf orr espir
atorysuppor tifincreasingI CPcompr omisesthebrainst em.
5.Inser tionofendot r
acheal tube(ort racheot omy )andmechani cal ventil
ation
maybenecessar ytomai ntai nadequat eti
ssueoxy genati
on.
6.Intrav enousf luidrepl acementmaybepr escri
bed, butcareistakent opr event

181
‫‪f‬‬
‫‪l‬‬‫‪ui‬‬
‫‪dov‬‬
‫‪er‬‬‫‪l‬‬
‫‪oad.‬‬
‫‪:‬‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬
‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻼﺕ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺈﻥ‬‫‪،‬ﻓ‬‫ﻟﻚ‬‫ﺬ‬‫ﻟ‬
‫‪.‬‬‫ﺔ‬‫ﺮﺟ‬‫ﺣﺔﺣ‬‫ﻟ‬
‫ﺎﻓﻲ ﺎ‬‫ﻳ‬‫ﺎ‬‫ﻟﺴﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺎ‬
‫ﺎﺏﺑ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪1‬‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻼﺔ‬
‫ﺪﺳ ﻣ‬ ‫ﻤ‬‫ﺘ‬
‫ﻌ‬‫‪.‬ﺗ‬‫ﺔ‬‫ﻴ‬
‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻳﻦﻓﻲﻓ‬‫ﺮ‬‫ﺁﺧ‬‫ﺀ‬‫ﺎ‬‫ﺃﻋﻀ‬‫ﻔﺴﻲﻭ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻟﺞ‬‫ﺎ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﺐﻭ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻊ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻧ‬
‫ﻭ‬‫ﺎ‬‫ﻌ‬
‫ﺗ‬
‫‪.‬‬
‫ﻴﻢ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﻳﻀﻲ‬‫ﺮ‬ ‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻢ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﻪﻋ‬ ‫ﺎﻫ‬
‫ﻓ‬‫ﺭ‬‫ﻭ‬
‫‪.‬‬‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻜﻞﻣﺴ‬ ‫ﺔﺑﺸ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬‫‪.‬ﻳ‬‫‪2‬‬
‫‪.‬‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻜﻞﻣﺴ‬ ‫ﺔﺑﺸ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬‫‪.‬ﻳ‬‫‪3‬‬
‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻟﻰﺩﻋﻢ‬‫ﺔﺇ‬‫ﺎﺟ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﻧﻲ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬‫ﻴﻢﻏ‬‫ﻗ‬‫ﺒﻀﻲﻭ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻛﺴﺞ‬ ‫ﺄ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺱ‬‫ﻴ‬‫ﻡﻗ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫‪.‬ﻳ‬‫‪4‬‬
‫‪.‬‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﺩﺟ‬ ‫ﺪ‬
‫ﻬ‬‫ﺔﺗ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﺓﺑ‬
‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫ﻧﺖﺯ‬ ‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺔﺇ‬‫ﻋ‬‫ﺮ‬‫ﻔﺴﻲﺑﺴ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﻅ‬
‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﻴﻦ‬‫ﻳ‬‫ﺭ‬‫ﻭ‬
‫ﺮ‬‫ﺔﺿ‬ ‫ﻴ‬‫ﻜ‬
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫(ﻭ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﻮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻘﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻭﺑﻀ‬‫ﺃ‬‫ﻣﻲ)‬ ‫ﺎ‬
‫ﺮﻏ‬‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬
‫ﺎﺍﻷ‬
‫ﺩﺧﻝ‬ ‫ﻮﻥﺇ‬‫ﻜ‬ ‫ﺪﻳ‬‫‪.‬ﻗ‬‫‪5‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﻛﺴﺠ‬ ‫ﺃ‬‫ﻠﻰ‬‫ﻋ‬
‫‪.‬‬
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻠﺴ‬‫ﻟ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﻊ‬
‫ﻨ‬‫ﻠﻰﻣ‬ ‫ﺮ ﺹﻋ‬‫ﻟﺤ‬‫ﺍ‬‫ﻜﻦﻳﺠﺐ‬‫ﻟ‬‫‪،‬ﻭ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺋﻞﻋﻦﻃ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻝ‬‫ﺪ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺳ‬‫ﻜﻦﻭﺻﻒ‬ ‫ﻤ‬‫‪.‬ﻳ‬‫‪6‬‬

‫‪7.Measur‬‬ ‫‪esar‬‬ ‫‪et‬‬‫‪akent‬‬ ‫‪or‬‬‫‪educebodyt‬‬ ‫‪emper‬‬ ‫‪at‬‬‫‪ur‬‬‫‪easqui‬‬‫‪ckl‬‬

‫‪yaspossi‬‬ ‫‪bl‬‬‫‪e.‬‬
‫‪8.Pr‬‬‫‪ot‬‬‫‪ect‬‬‫‪i‬‬
‫‪ngt‬‬ ‫‪hepat‬‬‫‪i‬‬‫‪entf‬‬‫‪r‬‬‫‪om i‬‬‫‪nj‬‬‫‪ur‬‬
‫‪ysecondar‬‬ ‫‪yt‬‬‫‪osei‬‬‫‪z‬‬‫‪ur‬‬‫‪eact‬‬‫‪i‬‬‫‪v‬‬
‫‪i‬‬‫‪t‬‬‫‪yoral‬‬‫‪t‬‬
‫‪er‬‬‫‪edl‬‬‫‪ev‬‬‫‪el‬‬
‫‪ofconsci‬‬‫‪ousness.‬‬
‫‪9.Moni‬‬ ‫‪t‬‬
‫‪or‬‬‫‪i‬‬‫‪ngdai‬‬‫‪l‬‬‫‪ybodywei‬‬ ‫‪ghtandser‬‬‫‪um el‬‬‫‪ect‬‬‫‪r‬‬‫‪ol‬‬‫‪y‬‬
‫‪t‬‬‫‪es.‬‬
‫‪10.Pr‬‬‫‪ev‬‬‫‪ent‬‬‫‪i‬‬‫‪ngcompl‬‬ ‫‪i‬‬‫‪cat‬‬‫‪i‬‬
‫‪onsassoci‬‬ ‫‪at‬‬
‫‪edwi‬‬ ‫‪t‬‬
‫‪hi‬‬ ‫‪mmobi‬‬ ‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪y‬‬‫‪,‬‬
‫‪suchaspr‬‬ ‫‪essur‬‬‫‪e‬‬
‫‪ul‬‬
‫‪cer‬‬‫‪sandpneumoni‬‬ ‫‪a.‬‬
‫‪.‬‬
‫ﻜﻦ‬ ‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬‫ﺃﺳ‬‫ﻟﺠﺴﻢﻓﻲ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺔﺣ‬‫ﺭﺟ‬‫ﻔ ﺾﺩ‬ ‫ﻟﺨ‬‫ﺮ‬‫ﻴ‬
‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺫﺗ‬‫ﺎ‬
‫ﺗﺨ‬‫ﺍ‬‫ﺘﻢ‬‫‪.‬ﻳ‬‫‪7‬‬
‫‪.‬‬
‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻮﻯ‬‫ﺘ‬‫ﺮﻣﺴ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﻭﺗ‬‫ﺃ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻁ‬ ‫ﻨﺸ‬‫ﻟ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻣﺍﻹﺻ‬‫ﻳﺾ ﻦ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﻤ‬‫‪.‬ﺣ‬‫‪8‬‬
‫‪.‬‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺭﻝﻓﻲ‬ ‫ﺎ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
‫ﻣﻲﻭ‬ ‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺯﻥ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫‪.‬ﻣ‬‫‪9‬‬
‫‪.‬‬
‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﻐﻂﻭ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺮﺣ‬‫ﻘ‬‫ﺜﻞﺗ‬‫ﺔﻣ‬ ‫ﻛ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺔ‬‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫‪.‬ﻣ‬‫‪10‬‬

‫‪11.I‬‬‫‪nst‬‬‫‪i‬‬‫‪t‬‬
‫‪ut‬‬‫‪i‬‬‫‪ngi‬‬‫‪nf‬‬
‫‪ect‬‬‫‪i‬‬‫‪oncont‬‬‫‪r‬‬‫‪ol‬‬‫‪pr‬‬
‫‪ecaut‬‬‫‪i‬‬‫‪onsunt‬‬‫‪i‬‬‫‪l‬‬‫‪24hour‬‬‫‪saf‬‬‫‪t‬‬
‫‪eri‬‬‫‪ni‬‬‫‪t‬‬
‫‪i‬‬‫‪at‬‬‫‪i‬‬
‫‪onof‬‬
‫‪ant‬‬‫‪i‬‬
‫‪bi‬‬‫‪ot‬‬‫‪i‬‬‫‪ct‬‬‫‪her‬‬‫(‪apy‬‬‫‪or‬‬‫‪al‬‬‫‪andnasal‬‬‫‪di‬‬‫‪schar‬‬‫‪gei‬‬‫‪sconsi‬‬‫‪der‬‬‫‪edi‬‬
‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫)‪ous‬‬ ‫‪.‬‬
‫‪12.Per‬‬ ‫‪i‬‬
‫‪odi‬‬‫‪cf‬‬‫‪ami‬‬‫‪l‬‬‫‪yv‬‬‫‪i‬‬‫‪si‬‬
‫‪t‬‬‫‪sar‬‬‫‪eessent‬‬‫‪i‬‬‫‪al‬‬‫‪t‬‬
‫‪of‬‬ ‫‪aci‬‬
‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪at‬‬‫‪ecopi‬‬
‫‪ngoft‬‬ ‫‪hepat‬‬‫‪i‬‬‫‪entand‬‬
‫‪f‬‬‫‪ami‬‬‫‪l‬‬‫‪y‬‬‫‪.Ani‬‬‫‪mpor‬‬ ‫‪t‬‬‫‪antaspectoft‬‬‫‪henur‬‬‫’‪se‬‬‫‪sr‬‬‫‪ol‬‬
‫‪ei‬‬ ‫‪st‬‬‫‪osuppor‬‬‫‪tt‬‬
‫‪hef‬‬ ‫‪ami‬‬ ‫‪l‬‬
‫‪yand‬‬
‫‪assi‬‬
‫‪stt‬‬ ‫‪hem i‬‬‫‪ni‬‬‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪y‬‬‫‪i‬‬
‫‪ngot‬‬ ‫‪her‬‬
‫‪swhocanbesuppor‬‬ ‫‪t‬‬‫‪i‬‬
‫‪v‬‬‫‪et‬‬‫‪ot‬‬‫‪hem dur‬‬‫‪i‬‬‫‪ngt‬‬‫‪he‬‬
‫‪cr‬‬‫‪i‬‬
‫‪si‬‬‫‪s.‬‬

‫ﺮ‬‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﻳ‬‫ﺔ)‬
‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﺍﺕ‬
‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺎ‬
‫ﻌﻼﺝﺑ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬‫ﺪ‬‫ﺪﺑ‬‫ﻌ‬‫ﺔﺑ‬‫ﺎﻋ‬
‫ﺘﻰ‪24‬ﺳ‬ ‫ﻭﻯﺣ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓﺤ‬‫ﺎ‬
‫ﻜ‬‫ﺎﺕﻣ‬ ‫ﺎﻃ‬‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬
‫ﻊ‬‫‪.‬ﻭﺿ‬ ‫‪11‬‬
‫‪.‬‬
‫(‬‫ﺔ‬‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﻧﻒﻣ‬ ‫ﺍﻷ‬
‫ﻔﻢﻭ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺇ‬
‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺔ‬
‫ﻤ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻧﺐ‬‫ﺍ‬‫ﻮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺪ‬‫ﺃﺣ‬‫ﺜﻞ‬‫ﻤ‬‫ﺘ‬‫‪.‬ﻳ‬
‫ﻪ‬‫ﺘ‬‫ﻠ‬
‫ﺋ‬‫ﺎ‬
‫ﻳ ﺾﻭﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬‫ﻜ‬‫ﻴﻞﺗ‬‫ﻬ‬‫ﺘﺴ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﺔﺿ‬‫ﻳ‬‫ﺭ‬‫ﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﺋ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬
‫ﺭ‬‫ﺎ‬‫ﻳ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪12‬‬
‫ﺔ‬‫ﻣ‬
‫ﺯ‬‫ﺍﻷ‬‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻬﻢ‬‫ﻟ‬‫ﻴﻦ‬‫ﻤ‬
‫ﺍﻋ‬‫ﺍﺩ‬‫ﻮ‬
‫ﻧ‬‫ﻮ‬‫ﻜ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬‫ﻳﻦﻳ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﺮ‬
‫ﺍﻵﺧ‬ ‫ﺪ‬
‫ﻳ‬‫ﺪ‬‫ﺎﻓﻲﺗﺤ‬
‫ﻬ‬‫ﺗ‬‫ﺪ‬
‫ﻋ‬‫ﺎ‬‫ﻣﺴ‬‫ﺓﻭ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﻋﻢ‬‫ﺔﻓﻲﺩ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

‫‪Encephal‬‬
‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪s‬‬

‫‪Lear‬‬
‫‪ni‬‬‫‪ngobj‬‬‫‪ect‬‬‫‪i‬‬
‫‪v‬‬‫‪es:‬‬
‫‪Uponcompl‬‬‫‪et‬‬‫‪i‬‬‫‪onoft‬‬‫‪hi‬‬
‫‪sl‬‬‫‪ect‬‬
‫‪ur‬‬‫‪e,‬‬
‫‪eachst‬‬
‫‪udentshoul‬‬
‫‪dbeabl‬‬
‫‪et‬‬‫‪o:‬‬
‫‪1.Def‬‬
‫‪i‬‬‫‪neencephal‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬
‫‪s.‬‬

‫‪182‬‬
2.Li
sttypesofencephal it
is.
3.Discusspathophysiologyofherpessimpl exv i
rusencephal
it
is.
4.Li
stclini
calmani f
estati
onsofher pessimpl exvir
usencephalit
is.
5.Describeassessmentanddi agnost i
cfindingsofherpessimplexv ir
us
encephalit
is.
6.Discussmedi calmanagementofher pessi mplexvi
rusencephali
tis.
7.Describenursingmanagementofher pessi mplexvir
usencephalit
is.

‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬ً
‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫ﻟﺐﻗ‬‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬ ‫ﻜ‬
‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬، ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬
‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺗ‬.1
.‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬‫ﺔ‬
‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.2
.‫ﻴﻂ‬
‫ﺒﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺑﺲ‬ ‫ﺮ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬‫ﺎﺟﻢﻋﻦﻓ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬ ‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.3
.‫ﻴﻂ‬‫ﺒﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺑﺲ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺳﻲ‬‫ﺮ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺔﻻ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.4
.
‫ﻴﻂ‬‫ﺒﺴ‬
‫ﻟ‬‫ﺍ‬‫ﺑﺲ‬‫ﺮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬
‫ﻴ‬‫ﺎﺟﻢﻋﻦﻓ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﻴ ﺺﻻ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬ ‫ﺎ‬
‫ﺘ‬‫ﻭﺻﻒﻧ‬. 5
.‫ﻴﻂ‬
‫ﺒﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺑﺲ‬ ‫ﺮ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺱ‬‫ﺮ‬‫ﻴ‬‫ﺎﺟﻢﻋﻦﻓ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.6
.‫ﻴﻂ‬‫ﺒﺴ‬
‫ﻟ‬‫ﺍ‬‫ﺑﺲ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬
‫ﻴ‬‫ﺎﺟﻢﻋﻦﻓ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺔﻻ‬ ‫ﻴ‬
‫ﻳﻀ‬‫ﺮ‬ ‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺍﻹ‬‫ﻭﺻﻒ‬. 7

Encephal
it
is

Definiti
on:Encephal i
ti
sisani nfl
ammat ionofthebrain.
Typesofencephal it
is:
Therear etwomai ntypesofencephal i
ti
s:pri
mar yandsecondary.
-Primar yencephalit
isoccurswhenav ir
usdirectl
yinfectst
hebrai
nandspinal
cord.
-Secondar yencephal i
ti
soccur swhenani nfecti
onstartsel
sewherei
nthebody
andt hent r
avelstothebr ai
n.
HerpesSi mpl exVirusEncephal i
ti
s:
Herpessi mplexv ir
us(HSV)i sthemostcommoncauseofacut eencephali
ti
sin
theUni tedStates.Therearetwoher pessimplexv i
ruses:HSV-
1andHSV- 2.HSV
-1typicall
yaffectschil
drenandadul ts.HSV-2mostcommonl yaff
ect
s
neonat es.

.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﺎﺏﻳﺼ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﺎﻍﻫ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬:‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:‫ﺎﻍ‬
‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬
‫ﻮ‬‫ﻧ‬
‫ﺃ‬
.‫ﻮﻱ‬
‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﻲﻭ‬‫ﺍ‬‫ﺪ‬‫ﺘ‬‫ﺑ‬
‫ﺍﻻ‬:
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬
‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥﻣﻦ‬‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬
‫ﺎﻥﺭ‬‫ﻋ‬‫ﻮ‬‫ﺎﻙﻧ‬
‫ﻨ‬‫ﻫ‬
.‫ﺓ‬
‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬
‫ﻛﻲﻣ‬ ‫ﻮ‬
‫ﻟﺸ‬‫ﺍ‬
‫ﺒﻞ‬‫ﻟﺤ‬
‫ﺍ‬
‫ﺎﻍﻭ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻴﺐ‬ ‫ﺎﻳﺼ‬‫ﻣ‬‫ﺪ‬
‫ﻨ‬‫ﻟﻲﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﻍ‬
‫ﻣ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬-
.
‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻰ‬‫ﻘﻞﺇ‬‫ﺘ‬
‫ﻨ‬‫ﻟﺠﺴﻢﺛﻢﺗ‬
‫ﺍ‬‫ﺮﻣﻦ‬‫ﺁﺧ‬
‫ﺎﻥ‬‫ﻜ‬‫ﻭﻯﻓﻲﻣ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺃ‬
‫ﺪ‬‫ﺒ‬‫ﺎﺗ‬
‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﻮﻱﻋ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻍ‬
‫ﻣ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬-
:
‫ﻴﻂ‬ ‫ﺒﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺑﺲ‬ ‫ﺮ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺱ‬‫ﺮ‬‫ﻴ‬‫ﺎﺟﻢﻋﻦﻓ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬

183
 .
‫ﺓ‬‫ﺪ‬‫ﺘﺤ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬ ‫ﻮﻻ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺩﻓﻲ‬ ‫ﺎ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺎﻻ‬ ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬ ‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬
‫ﺍﻷ‬‫ﺒﺐ‬ ‫ﻟﺴ‬‫ﺍ‬(HSV)‫ﻴﻂ‬ ‫ﺒﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺑﺲ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬ ‫ﻴ‬‫ﺪﻓ‬‫ﻌ‬‫ﻳ‬
‫ﺎﻝﻭ‬ ‫ﻷﻔ‬
‫ﺍﻃ‬ HSV- 1‫ﻴﺐ‬ ‫ﺎﻳﺼ‬ ‫ﺓﻣ‬ً‫ﺩ‬‫ﺎ‬‫ﻋ‬.HSV- 2‫ﻭ‬HSV- 1:‫ﻴﻂ‬ ‫ﺒﺴ‬‫ﻟ‬‫ﺍ‬‫ﺑﺲ‬ ‫ﺮ‬
‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻭﺳ‬‫ﺮ‬‫ﻴ‬‫ﺎﻥﻣﻦﻓ‬ ‫ﻋ‬ ‫ﻮ‬‫ﺪﻧ‬ ‫ﻮﺟ‬‫ﻳ‬
.
‫ﺍﻥ‬‫ﺪ‬‫ﻟ‬
‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﻊﻋ‬ ‫ﺋ‬‫ﺎ‬
‫ﻜﻞﺷ‬ ‫ﺑﺸ‬HSV- 2‫ﺮ‬ ‫ﺛ‬
‫ﺆ‬‫ﻳ‬. ‫ﻴﻦ‬‫ﻐ‬‫ﻟ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬
Pathophy siol ogy :
Herpessi mpl exv ir
usi niti
allygai nsaccesst ohostt i
ssuest hroughmucous
membr anesordamagedski n.Af t
erpr imar yinfectionoft hemucosal orski n
epit
hel i
um, thev ir
usi nfect ssensor yneur ons.
Themechani smsbywhi chHSVgai nsaccesst othecent ralnervoussy st em ar e
unclear .Themostl i
kel yrout est hrought heol f
actor yort r
igeminal nerves.
Cli
nicalMani fest ati
ons:
1.Fev er
2.Headache
3.Conf usi on
4.Behav ioral changes
5.Focal seizur es
6.Dy sphasi a
7.Hemi par esi s
8.Alteredl ev el ofconsci ousness
:
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﺍﻷﻏﺸ‬ ‫ﺔﻣﻦﺧﻼﻝ‬ ‫ﻔ‬‫ﻴ‬‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻟﻰ‬‫ﻮﻝﺇ‬ ‫ﻮﺻ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺍ‬‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻂﻓﻲ‬ ‫ﺒﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺑﺲ‬ ‫ﺮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬
‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬‫ﺘﺴﺐﻓ‬ ‫ﻜ‬‫ﻳ‬
‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬ ‫ﻳﺼ‬، ‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺎ‬‫ﻬ‬
‫ﻭﻇ‬ ‫ﺃ‬‫ﺎﻃﻲ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪ‬‫ﻌ‬‫ﺑ‬.‫ﻟﻒ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬
‫ﻭ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﺎﻃ‬ ‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻴ‬
‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﺰﻱﻏ‬ ‫ﻛ‬‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺒﻲ‬ ‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﻮﻝﺇ‬‫ﻮﺻ‬ ‫ﻟ‬‫ﺍ‬‫ﻴﻂﻣﻦ‬ ‫ﺒﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺑﺲ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬‫ﻜﻦﻓ‬ ‫ﻤ‬‫ﺘ‬
‫ﻼﺎﻳ‬
‫ﻬ‬‫ﺘﻲﻣﻦﺧﻟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍﻵ‬
.‫ﺋﻢ‬‫ﺍ‬‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻼﻲ‬‫ﻭﻋﺼﺐﺛﺛ‬ ‫ﺃ‬‫ﺔ‬ ‫ﻴ‬
‫ﻤ‬‫ﻟﺸ‬‫ﺍ‬‫ﺎﺏ‬‫ﺍﻷﻋﺼ‬ ‫ﺮ‬‫ﺒ‬‫ﺎﻻﻋ‬‫ﻤ‬‫ﺘ‬‫ﺍﺣ‬‫ﺮ‬‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬‫ﺮﻕ‬‫ﻟﻄ‬ ‫ﺍ‬.
‫ﺔ‬ ‫ﺍﺿﺤ‬ ‫ﻭ‬
:‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬‫ﺍﻻ‬
‫ﻤﻰ‬ ‫ﻟﺤ‬‫ﺍ‬.
1
‫ﺍﻉ‬‫ﺪ‬ ‫ﺻ‬.2
‫ﺎﻙ‬‫ﺒ‬‫ﺗ‬‫ﺭ‬‫ﺍﻻ‬.
3
‫ﺔ‬ ‫ﻴ‬
‫ﻛ‬‫ﻮ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬
‫ﻴ‬‫ﻐ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬.
4
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺆ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬.
5
‫ﻡ‬‫ﻜﻼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺮ‬ ‫ﻋﺴ‬.6
‫ﻔﻲ‬‫ﻠﻞﻧﺼ‬ ‫ﺷ‬.7
‫ﻋﻲ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺮﻣﺴ‬ ‫ﻴ‬‫ﻐ‬‫ﺗ‬.
8
AssessmentandDi agnost icFi ndings:
1.Elect roencephal ogr am ( EEG) .Focal changesi nt het empor allobei nabout
80%ofpat ient s.
2.CSFexami nat i
on.Lumbarpunct ureof tenrevealsahi ghopeni ngpr essur e
andl owgl ucoseandhi ghpr oteinlevelsi nCSFsampl es.
3.MRI( edemai nt het empor al l
obe) .
4.Viral cultur esar ealmostal way snegat ive.Thepol y
mer asechai nr eaction
(PCR)i st hest andar dt estf orear l
ydi agnosi sofHSV- 1encephal it
is.Poly mer ase
chainr eact ioni dentifi
est heDNAbandsofHSV- 1int heCSF.Thev alidi
tyofPCR
i
sv eryhi ghbet weent he3r dand10t hday saf t
ersy mpt omsonset .

:
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﻧ‬
.‫ﺮﺿﻰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻣﻦ‬٪80‫ﻟﻲ‬‫ﺍ‬
‫ﻮ‬‫ﺪﻏﻲﻓﻲﺣ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻔﺺ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﻳ‬
‫ﺭ‬‫ﺆ‬‫ﺍﺕﺑ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺗ‬.(EEG)‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻣﺨﻄﻂﻛ‬. 1
‫ﺎﺽ‬‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬
‫ﺘﺢﻭ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬
‫ﺎﻉ ﺿ‬‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﻨﻲﻋﻦ‬‫ﻘﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺰﻝ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻜﺸﻒ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬. ‫ﻋﻲ‬ ‫ﺎ‬
‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻏﻲ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻓﺤ ﺺ‬.2
.‫ﻛﻲ‬‫ﻮ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺎﺕ‬‫ﻨ‬
‫ﻴ‬‫ﺔﻓﻲﻋ‬ ‫ﻌ‬‫ﻔ‬
‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬
‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﺘ‬
‫ﻣﺴ‬ ‫ﺯﻭ‬‫ﻮ‬‫ﻛ‬
‫ﻮ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬
.
(‫ﺪﻏﻲ‬‫ﻟﺼ‬‫ﺍ‬‫ﻔﺺ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻓﻲ‬ ‫ﻣ‬‫ﺫ‬
‫ﻭ‬ )‫ﻴﺴﻲ‬‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬‫ﻧ‬‫ﺮ‬‫ﻟ‬
‫ﺎ‬
‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬
‫ﺍ‬.3

184
 ‫ﺎﺳﻲ‬‫ﻴ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﻫﺍﻻﺧ‬
‫(ﻮ‬PCR)‫ﻠﺴﻞ‬‫ﺘﺴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻤ‬
‫ﻠ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻋﻞ‬‫ﺎ‬
‫ﻔ‬‫ﺗ‬.
‫ﺎ‬ً
‫ﻤ‬‫ﺋ‬
‫ﺍ‬‫ﺔﺩ‬‫ﻴ‬‫ﺒ‬
‫ﻠ‬‫ﺔﺳ‬‫ﻴ‬‫ﻭﺳ‬‫ﺮ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻓ‬‫ﺎ‬‫ﻘ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺗ‬.
4
‫ﻓﻲ‬HSV-1‫ـ‬
‫ﻝ‬DNA‫ﺎﺕ‬ ‫ﻗ‬‫ﺎ‬
‫ﻠﺴﻞﻧﻄ‬‫ﺘﺴ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻋﻞ‬‫ﻔ‬‫ﺩﺗ‬‫ﺪ‬
‫ﻳﺤ‬.HSV-1‫ﺎﻍ‬ ‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬
‫ﺘ‬‫ﻟ‬
‫ﺮﻻ‬ ‫ﻜ‬
‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬‫ﺘﺸﺨ‬‫ﻠ‬‫ﻟ‬
‫ﺍﻷ‬
‫ﺭ‬‫ﻮ‬‫ﻬ‬
‫ﺪﻇ‬ ‫ﻌ‬
‫ﺮﺑ‬‫ﺎﺷ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺚﻭ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻣ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺍﺑ‬
ً
‫ﺪ‬‫ﺔﺟ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﻠﺴﻞﻋ‬ ‫ﺘﺴ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻤ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻋﻞ‬‫ﻔ‬
‫ﺔﺗ‬‫ﻴ‬‫ﻮﻥ ﺻﻼﺣ‬‫ﻜ‬
‫ﺗ‬.CSF
.
‫ﺍﺽ‬ ‫ﺮ‬
‫ﻋ‬

Medi cal Management :

Antivi
ral agent s,aret hemedi cationsofchoi ceint het r
eatmentofHSV.Ear l
y
admi nistrati
onofant i
vir
al agent simpr ov esthepr ognosi sassoci atedwi thHSV-
1encephal i
ti
s.Topr eventr elapse, t
reatmentshoul dcont i
nuef orupt o3weeks.
NursingManagement :
1.Assessmentofneur ologicf unctioni skeyt omoni tori
ngt hepr ogr essionof
di
sease.
2.Comf or tmeasur est or educeheadachei ncludequi teli
ght s,limi t
ingnoi seand
vi
sitors, andadmi nisteri
nganal gesicagent s.Opi oidanal gesi cmedi cationsmay
maskneur ologicsy mpt oms, therefore,theyar eusedcaut iously .
3.Vital signsar econt inuousl ymeasur ed.
4.Measur esaret akent or educebodyt emper atur easqui cklyaspossi ble.
5.Seizur esandal teredlev elofconsci ousnessr equi recaredi rect edati njur y
prevent i
onandsaf ety.
:‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺍﻹ‬
‫ﺍﻻ‬ ‫ﺩﻱ‬ ‫ﺆ‬‫ﻳ‬.
‫ﻴﻂ‬ ‫ﺒﺴ‬‫ﻟ‬‫ﺍ‬‫ﺑﺲ‬ ‫ﺮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﺱ‬ ‫ﺮ‬‫ﻴ‬‫ﺓﻓﻲﻋﻼﺝﻓ‬ ‫ﺭ‬‫ﺎ‬
‫ﺘ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺩ‬‫ﺍﻷ‬‫ﻫﻲ‬، ‫ﺎﺕ‬ ‫ﻭﺳ‬ ‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
.HSV- 1‫ﺎﻍ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺎ‬‫ﺒﻂﺑ‬‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬‫ﺍ‬
‫ﻴﻦ‬ ‫ﻟﻰﺗﺤﺴ‬ ‫ﺎﺕﺇ‬ ‫ﻭﺳ‬ ‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻌ‬‫ﻠ‬
‫ﻟ‬ ‫ﺮ‬
‫ﻜ‬‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬ ‫ﺳ‬
.
‫ﻊ‬‫ﻴ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺳ‬ 3‫ﻟﻰ‬ ‫ﺓﺗﺼﻞﺇ‬ ‫ﺪ‬ ‫ﻤ‬‫ﻟ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﺃﻥﻳﺴ‬ ‫ﻳﺠﺐ‬، ‫ﺎﺱ‬ ‫ﻜ‬‫ﺘ‬ ‫ﻧ‬
‫ﺍﻻ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬
‫ﻟ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬
.
‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﻮ‬‫ﺪﺗﻄ‬ ‫ﺮﺻ‬ ‫ﻟ‬ ‫ﺎﺡ‬‫ﺘ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮ‬ ‫ﺔﻫ‬ ‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬ ‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬.1
‫ﺀ‬ ‫ﺎ‬‫ﺇﻋﻄ‬‫ﻭ‬،‫ﻳﻦ‬‫ﺮ‬‫ﺋ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻭ‬‫ﺎ‬‫ﻮﺿ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬، ‫ﺔ‬‫ﺋ‬
‫ﺩ‬ ‫ﺎ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﺍﻷﺿ‬ ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬‫ﻤﻞﺗ‬ ‫ﺗﺸ‬.2
.‫ﺭ‬‫ﺬ‬
‫ﺎﺑﺤ‬ ‫ﻬ‬‫ﻣ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻟﻚﻳ‬‫ﺬ‬ ‫ﻟ‬،‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬‫ﺮ‬‫ﺍﻷﻋ‬ ‫ﺔ‬‫ﻴ‬ ‫ﻧ‬
‫ﻮ‬‫ﻴ‬‫ﻓ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﻔﻲ‬ ‫ﺪﺗﺨ‬ ‫ﻗ‬.‫ﺎﺕ‬ ‫ﻨ‬‫ﻜ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬
.‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻜﻞﻣﺴ‬ ‫ﺔﺑﺸ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬ ‫ﻌﻼ‬‫ﻟ‬‫ﺍ‬‫ﺎﺱ‬ ‫ﻴ‬‫ﺘﻢﻗ‬ ‫ﻳ‬.3
.‫ﻜﻦ‬‫ﻤ‬‫ﻗﺖﻣ‬ ‫ﺮﻉﻭ‬ ‫ﺃﺳ‬‫ﻟﺠﺴﻢﻓﻲ‬ ‫ﺍ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﻔ ﺾﺩ‬ ‫ﻟﺨ‬ ‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬‫ﺫﺗ‬‫ﺎ‬‫ﺗﺨ‬‫ﺍ‬ ‫ﺘﻢ‬‫ﻳ‬.4
.‫ﻼﺔ‬
‫ﻟﺴ ﻣ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻬ‬‫ﻮﺟ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﻮﻋﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺮﻣﺴ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬‫ﺎﺕﻭ‬ ‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺐ‬‫ﺘﻄ‬ ‫ﺗ‬.5

6.Instit
ut i
nginfectioncont rolprecaut ionsunt i
l24hour safteriniti
ationof
treat
ment( oralandnasal dischar geisconsi deredi nfect i
ous).
7.Pulseoxi metryandar t
erialbloodgasv aluesar eusedt oqui cklyidentif
yt he
needf orr espir
atorysuppor tifincr easingI CPcompr omi sest hebr ainst em.
8.Insertionofendot r
acheal t
ube( ortracheot omy )andmechani cal ventil
ation
maybenecessar ytomai ntainadequat etissueoxy genat i
on.
9.Intr
av enousf luidreplacementmaybepr escribed, butcarei st akent opr ev ent
fl
uidov erload.
10.Nur singcar eaddr essingpat ientandf ami lyanxi etiesisongoi ngt hr
oughout
theil
lness.
11.Moni tori
ngofbl oodchemi stryt estr esultsandur inaryout put,thisalertt he
nurset ot hepresenceofr enal compl icat i
onsr elatedt oant i
v i
ral t
her apy.
12.Moni tori
ngdai l
ybodywei ght .
13.Pr eventingcompl i
cationsassoci atedwi t
hi mmobi lit
y,suchaspr essure
ulcersandpneumoni a.

185
‫‪.‬‬
‫(‬‫ﺔ‬‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﻷﻒﻣ‬‫ﺍﻧ‬‫ﻔﻢﻭ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺮﺇ‬‫ﺒ‬‫ﺘ‬‫ﻌ‬‫ﻳ‬
‫ﻌﻼﺝ)‬ ‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺪ‬‫ﺪﺑ‬‫ﻌ‬‫ﺔﺑ‬‫ﺎﻋ‬
‫ﺘﻰ‪24‬ﺳ‬ ‫ﻭﻯﺣ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓﺤ‬ ‫ﺎ‬
‫ﻜ‬‫ﺎﺕﻣ‬ ‫ﺎﻃ‬‫ﻴ‬‫ﺘ‬
‫ﺍﺣ‬ ‫ﻊ‬
‫‪.‬ﻭﺿ‬ ‫‪6‬‬
‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻟﻰﺩﻋﻢ‬‫ﺔﺇ‬‫ﺎﺟ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﻧﻲ‬‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬
‫ﻴﻢﻏ‬‫ﻗ‬ ‫ﺒﻀﻲﻭ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻛﺴﺞ‬ ‫ﺄ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺱ‬ ‫ﻴ‬‫ﻡﻗ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫‪.‬ﻳ‬‫‪7‬‬
‫‪.‬‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﺩﺟ‬ ‫ﺪ‬‫ﻬ‬‫ﺔﺗ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬
‫ﺮ‬‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻧﺖﺯ‬ ‫ﺎ‬‫ﺍﻛ‬‫ﺫ‬‫ﺔﺇ‬‫ﻋ‬‫ﺮ‬‫ﻔﺴﻲﺑﺴ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺎﻅ‬
‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﻴﻦ‬‫ﻳ‬‫ﺭ‬
‫ﻭ‬‫ﺮ‬‫ﺔﺿ‬ ‫ﻴ‬‫ﻜ‬
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫(ﻭ‬‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻘﺼ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻭﺑﻀ‬ ‫ﺃ‬‫ﻣﻲ)‬‫ﺎ‬
‫ﺮﻏ‬‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬‫ﺎﺍﻷ‬‫ﺩﺧﻝ‬ ‫ﻮﻥﺇ‬‫ﻜ‬‫ﺪﻳ‬‫‪.‬ﻗ‬ ‫‪8‬‬
‫‪.‬‬‫ﺔ‬‫ﻴ‬
‫ﻓ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﻛﺴﺠ‬ ‫ﺃ‬
‫ﻠﻰ‬ ‫ﻋ‬
‫‪.‬‬
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻠﺴ‬
‫ﻟ‬‫ﺪ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻠﻰﻣ‬ ‫ﺮ ﺹﻋ‬ ‫ﻟﺤ‬
‫ﺍ‬ ‫ﻜﻦﻳﺠﺐ‬‫ﻟ‬‫‪،‬ﻭ‬‫ﺪ‬ ‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻓﻲ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻝ‬‫ﺪ‬‫ﺒ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﻜﻦﻭﺻﻒ‬ ‫ﻤ‬‫‪.‬ﻳ‬‫‪9‬‬
‫‪.‬‬
‫ﺮﺽ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﺘ‬
‫ﺍﻝﻓ‬‫ﻮ‬‫ﺓﻃ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﺓﻣﺴ‬ ‫ﺮ‬‫ﺍﻷﺳ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻑ‬ ‫ﺎ‬
‫ﻟﺞﻣﺨ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪10‬‬
‫ﺔ‬‫ﻳ‬
‫ﻮ‬ ‫ﻠ‬
‫ﺎﺕﻛ‬ ‫ﻔ‬
‫ﺎﻋ‬‫ﺩﻣﻀ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺔ‬ ‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻪ‬‫ﺒ‬‫ﻨ‬
‫ﺍﻳ‬‫ﺬ‬‫‪،‬ﻭﻫ‬‫ﻟﻲ‬‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺗﺞ‬‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﺭﻛ‬ ‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺧ‬ ‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬
‫ﺔﻧ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫‪.‬ﻣ‬‫‪11‬‬
‫‪.‬‬
‫ﺎﺕ‬‫ﻭﺳ‬ ‫ﺮ‬
‫ﻴ‬‫ﻔ‬‫ﻠ‬‫ﻟ‬
‫ﺩ‬ ‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺑﻌﻼﺝ‬‫ﻟ‬
‫ﺔﺎ‬ ‫ﻘ‬
‫ﻠ‬‫ﻌ‬‫ﺘ‬‫ﻣ‬
‫‪.‬‬‫ﻣﻲ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬ ‫ﺍ‬ ‫ﺯﻥ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫‪.‬ﻣ‬‫‪12‬‬
‫‪.‬‬
‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﻐﻂﻭ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺎﺕ‬‫ﺮﺣ‬‫ﻘ‬‫ﺜﻞﺗ‬‫ﺰﻣ‬‫ﻌﺠ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬
‫ﺒ‬‫ﺎﺣ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬‫‪.‬ﻣ‬‫‪13‬‬

‫‪Uni‬‬‫‪t2:‬‬‫‪Cer‬‬‫‪ebr‬‬
‫‪ov‬‬‫‪ascul‬‬
‫‪ardi‬‬
‫‪sor‬‬‫‪der‬‬‫‪s‬‬
‫‪ManagementofPat‬‬‫‪i‬‬
‫‪ent‬‬‫‪swi‬‬‫‪t‬‬‫‪hCer‬‬
‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪arDi‬‬
‫‪sor‬‬
‫‪der‬‬
‫‪s‬‬
‫‪Lear‬‬‫‪ni‬‬‫‪ngobj‬‬ ‫‪ect‬‬‫‪i‬‬‫‪v‬‬‫‪es:‬‬
‫‪Oncompl‬‬ ‫‪et‬‬‫‪i‬‬‫‪onoft‬‬ ‫‪hi‬‬‫‪suni‬‬
‫‪t‬‬‫‪,‬‬‫‪t‬‬‫‪hest‬‬‫‪udentwi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪beabl‬‬‫‪et‬‬‫‪o:‬‬
‫‪1.I‬‬‫‪nt‬‬‫‪r‬‬
‫‪oduct‬‬ ‫‪i‬‬
‫‪on‬‬
‫‪2.I‬‬‫‪dent‬‬‫‪i‬‬
‫‪f‬‬‫‪yt‬‬‫‪her‬‬ ‫‪i‬‬‫‪skf‬‬‫‪act‬‬‫‪or‬‬‫‪sf‬‬‫‪orcer‬‬‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬‫‪ardi‬‬
‫‪sor‬‬‫‪der‬‬
‫‪sandr‬‬ ‫‪el‬‬‫‪at‬‬
‫‪edmeasur‬‬ ‫‪es‬‬
‫‪f‬‬‫‪orpr‬‬‫‪ev‬‬‫‪ent‬‬‫‪i‬‬‫‪on.‬‬
‫‪3.Descr‬‬‫‪i‬‬‫‪bet‬‬ ‫‪hepat‬‬ ‫‪hophy‬‬‫‪si‬‬‫‪ol‬‬‫‪ogyofcer‬‬‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪aracci‬‬‫(‪dent‬‬‫)‪CVA‬‬ ‫‪.‬‬
‫‪4.Compar‬‬ ‫‪et‬‬ ‫‪hev‬‬ ‫‪ar‬‬
‫‪i‬‬‫‪oust‬‬‫‪y‬‬‫‪pesofcer‬‬ ‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪ardi‬‬
‫‪sor‬‬‫‪der‬‬‫‪s:‬‬‫‪t‬‬‫‪hei‬‬‫‪rcauses,‬‬‫‪cl‬‬
‫‪i‬‬‫‪ni‬‬
‫‪cal‬‬
‫‪mani‬‬ ‫‪f‬‬
‫‪est‬‬‫‪at‬‬‫‪i‬‬‫‪ons,‬‬ ‫‪andmedi‬‬ ‫‪cal‬‬‫‪management‬‬ ‫‪.‬‬
‫‪5.Expl‬‬‫‪ai‬‬‫‪nt‬‬‫‪hedi‬‬ ‫‪agnost‬‬‫‪i‬‬‫‪ct‬‬‫‪est‬‬‫‪sf‬‬‫‪orcer‬‬‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪aracci‬‬
‫(‪dent‬‬ ‫)‪CVA‬‬ ‫‪.‬‬
‫‪6.Descr‬‬‫‪i‬‬‫‪bePat‬‬ ‫‪i‬‬
‫‪entandf‬‬ ‫‪ami‬‬ ‫‪l‬‬
‫‪yt‬‬‫‪eachi‬‬‫‪ngf‬‬‫‪ort‬‬‫‪hepat‬‬‫‪i‬‬
‫‪entwi‬‬‫‪t‬‬‫‪hcer‬‬ ‫‪ebr‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪ar‬‬
‫‪acci‬‬‫‪dent‬‬‫‪.‬‬

‫ﺔ‬
‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬
‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬‫‪:‬‬
‫ﺓ‪2‬‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬
‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬‫ﻮﻥﻣﻦ‬‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬
‫‪:‬‬
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬ ‫ﺃﻫ‬
‫‪:‬‬
‫ﻠﻰ‬‫ﺍﻋ‬‫ً‬
‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫ﻟﺐﻗ‬‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬
‫ﻴ‬‫‪،‬ﺳ‬ ‫ﺓ‬
‫ﺪ‬ ‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻧ‬
‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬
‫ﺔ‬‫ﻣ‬‫ﺪ‬
‫ﻘ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫‪1‬‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻠ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮﺫ‬‫ﻴ‬‫ﺑ‬
‫ﺍ‬‫ﺪ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻋ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﻟﻼﺿﻄ‬ ‫ﺮ‬
‫ﻟﺨﻄ‬ ‫ﺍ‬
‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﺪﻋ‬‫ﻳ‬‫ﺪ‬‫‪.‬ﺗﺤ‬‫‪2‬‬
‫‪.‬‬‫(‬‫ﺔ)‪CVA‬‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﺩﺙ‬ ‫ﺎ‬
‫ﻟﺤ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻳ‬ ‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫‪.‬ﻭﺻﻒ‬ ‫‪3‬‬
‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺍﻹ‬‫‪،‬ﻭ‬
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬ ‫ﻟ‬
‫ﺍ‬‫‪،‬‬‫ﺎ‬
‫ﻬ‬‫ﺑ‬‫ﺎ‬
‫ﺒ‬‫ﺃﺳ‬‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﻣﺍﻻﺿﻄ‬‫ﺔﻦ‬ ‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬‫ﻧ‬
‫ﺍﻷ‬‫ﺭﻥ‬‫ﺎ‬‫‪.‬ﻗ‬‫‪4‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬
‫‪.‬‬‫(‬
‫ﺔ)‪CVA‬‬ ‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﺩﺙ‬‫ﺎ‬‫ﻟﺤ‬‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺧ‬‫ﺮﺡ‬‫‪.‬ﺷ‬ ‫‪5‬‬
‫‪.‬‬‫ﺋﻲ‬‫ﺎ‬
‫ﺎﻏﻲﻭﻋ‬‫ﻣ‬‫ﺩﺙﺩ‬ ‫ﺎ‬
‫ﺎﺏﺑﺤ‬ ‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻟ‬‫ﺎ‬
‫ﻌ‬‫‪.‬ﻭﺻﻒﺗ‬ ‫‪6‬‬

‫‪Cer‬‬
‫‪ebr‬‬
‫‪ov‬‬‫‪ascul‬‬
‫‪ardi‬‬
‫‪sor‬‬
‫‪der‬‬
‫‪s‬‬
‫‪I‬‬
‫‪nt‬‬‫‪r‬‬‫‪oduct‬‬‫‪i‬‬
‫‪on:‬‬
‫‪I‬‬
‫‪sat‬‬ ‫‪er‬‬‫‪mt‬‬‫‪hatr‬‬ ‫‪ef‬‬
‫‪er‬‬‫‪st‬‬‫‪oanyf‬‬‫‪unct‬‬
‫‪i‬‬‫‪onal‬‬‫‪abnor‬‬
‫‪mal‬‬
‫‪i‬‬‫‪t‬‬
‫‪yoft‬‬ ‫‪hecent‬‬
‫‪r‬‬‫‪al‬‬‫‪ner‬‬
‫‪v‬‬‫‪oussy‬‬ ‫‪st‬‬‫‪em‬‬
‫(‬‫‪CNS)t‬‬‫‪hatoccur‬‬‫‪swhent‬‬ ‫‪henor‬‬‫‪mal‬‬‫‪bl‬‬
‫‪oodsuppl‬‬
‫‪yt‬‬‫‪ot‬‬ ‫‪hebr‬‬‫‪ai‬‬
‫‪ni‬‬‫‪sdi‬‬‫‪sr‬‬
‫‪upt‬‬‫‪ed.‬‬
‫‪St‬‬‫‪r‬‬
‫‪okei‬‬‫‪sst‬‬‫‪i‬‬‫‪l‬‬‫‪l‬‬
‫‪t‬‬‫‪het‬‬‫‪hi‬‬‫‪r‬‬
‫‪dl‬‬‫‪eadi‬‬
‫‪ngcauseofdeat‬‬‫‪hbehi‬‬
‫‪ndhear‬‬ ‫‪tdi‬‬
‫‪seaseandcancer‬‬ ‫‪.‬‬
‫‪Appr‬‬‫‪oxi‬‬
‫‪mat‬‬ ‫‪el‬‬
‫‪y500,‬‬‫‪000peopl‬‬‫‪eex‬‬‫‪per‬‬‫‪i‬‬
‫‪enceanewst‬‬‫‪r‬‬‫‪oke,‬‬‫‪100,‬‬
‫‪000ex‬‬‫‪per‬‬‫‪i‬‬‫‪encesa‬‬

‫‪186‬‬
recurrentstrokeandappr oximatel y160,000di eofast rokeeachy ear .
Strokescanbedi vi
dedi ntotwomaj orcat egories:
-
Ischemi c( 85%) ,t
hereisv ascularoccl usionandsi gnifi
canthypoper fusion.
-
Hemor rhagi c(15%),thereisex travasationofbl oodintot hebrain.
:
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻣ‬
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻣ‬‫ﻊﺇ‬‫ﻘﻄ‬‫ﻨ‬‫ﺎﻳ‬
‫ﻣ‬ ‫ﺪ‬‫ﻨ‬‫ﺪﺙﻋ‬‫(ﻳﺤ‬ CNS)‫ﺰﻱ‬ ‫ﻛ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺒﻲﺍ‬ ‫ﻌﺼ‬‫ﻟ‬
‫ﺯﺍ‬ ‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﻔﻲﻓﻲﺍ‬ ‫ﻴ‬
‫ﻠﻞﻭﻇ‬ ‫ﻟﻰﺃﻱﺧ‬ ‫ﺮﺇ‬‫ﻴ‬‫ﻠﺢﻳﺸ‬‫ﻮﻣﺼﻄ‬ ‫ﻫ‬
‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ ﺽﺍ‬‫ﺮ‬
‫ﻣ‬ ‫ﺪﺃ‬‫ﻌ‬‫ﺓﺑ‬‫ﺎ‬
‫ﻓ‬‫ﻮ‬‫ﻠ‬
‫ﻟ‬‫ﻟﺚ‬ ‫ﺎ‬
‫ﺜ‬‫ﻟ‬‫ﻴﺴﻲﺍ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺒﺐﺍ‬ ‫ﻟﺴ‬‫ﺔﻫﻲﺍ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍﻝﺍ‬‫ﻻﺰ‬
‫ﺗ‬. ‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺪﻡ‬‫ﻟ‬‫ﺎ‬
‫ﺎﻍﺑ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳ‬100000‫ﻭ‬، ‫ﺓ‬
‫ﺪ‬ ‫ﻳ‬
‫ﺪ‬‫ﺔﺟ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬ ‫ﺔﺩ‬ ‫ﺘ‬
‫ﻜ‬ ‫ﻮﻥﻣﻦﺳ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﺷﺨ ﺺﻳ‬500000‫ﺮﺏﻣﻦ‬ ‫ﻘ‬‫ﺎﻳ‬.
‫ﺎﻥﻣ‬‫ﺮﻃ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﻋ‬
‫ﺔﻛﻞﺎﻡ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺔﺍ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﻮﻥﻣﻦﺍ‬ ‫ﺗ‬‫ﻮ‬ ‫ﻤ‬‫ﻳ‬160،000‫ﻟﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﺓﻭﺣ‬‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺔﺍ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
:
‫ﻴﻦ‬‫ﺘ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬
‫ﻴﻦﺭ‬ ‫ﺘ‬‫ﺌ‬
‫ﻟﻰﻓ‬‫ﺔﺇ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻴﻢ‬‫ﻘﺴ‬‫ﻜﻦﺗ‬‫ﻤ‬‫ﻳ‬
.‫ﻮﻅ‬ ‫ﻠﺤ‬
‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬‫ﻳ‬‫ﻭ‬ ‫ﺮ‬
‫ﺘ‬‫ﻟ‬
‫ﻘ ﺺﺍ‬ ‫ﻧ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺔﺍ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺩﻓﻲ‬‫ﺍ‬
‫ﺪ‬ ‫ﻧﺴ‬‫ﺪﺍ‬‫ﻮﺟ‬‫ﻳ‬،(٪ 85)‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻘ ﺺﺗ‬‫ﻧ‬-
.
‫ﻤﺦ‬ ‫ﻟ‬
‫ﻟﻰﺍ‬‫ﻡﺇ‬‫ﺪ‬‫ﻠ‬‫ﻟ‬‫ﺮﺏ‬‫ﺪﺙﺗﺴ‬ ‫ﻳﺤ‬، (٪
15)‫ﻳﻒ‬ ‫ﺰ‬‫ﻧ‬-

Maj
orTy
pesofSt
rokeandThei
rCauses

Causes Types
I
schemicst
roke
1.Largear terythrombosis
2.Small penet r
atingart
erythrombosis
3.Cardiogeni cembol i
4.Cryptogeni c(unknowncause)
5.Other( fr
om causessuchascocai ne
use,coagul opathies,
mi gr
aine,and
spontaneousdi ssect
ionofthecaroti
dor
vert
ebral arter
ies)

Hemor
rhagi
cst
roke
1.Intr
acerebralhemorrhage(Ablood
vesselburstsinthebrain)
2.Subarachnoidhemor rhage(Ablood
vesselburstinthespacebet weenthe
brainandthedur a)
3.Cerebralaneurysm
4.Arteri
ovenousmal f
or mati
on

IschemicSt r
oke,brainattackorcerebrovascularacci
dent(CVA):
Isasuddenl ossoff unct
ionresult
ingfrom disr
uptionoft
hebloodsuppl
ytoa
partofthebrain.
Causes:Abl ockage
-Cerebralthr
ombosi s:abloodclotinanar t
erytothebrai
n
-Cerebralembolism: abl
oodcl otorairbubblecarri
edtothebrai
nandcausi
nga
blockage.

187
 :
(CVA)‫ﺔ‬
‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻋ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺩﺙ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺔ‬ ‫ﻳ‬
‫ﺭ‬‫ﺎ‬‫ﻔ‬
‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻣﻦ‬‫ﺰ‬‫ﻟﺠ‬‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﻣ‬‫ﺎﻉﺇ‬‫ﻘﻄ‬‫ﻧ‬
‫ﺍ‬‫ﺗﺞﻋﻦ‬‫ﺎ‬
‫ﺔﻧ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻠ‬
‫ﻟ‬‫ﺎﺟﺊ‬‫ﻔ‬‫ﺍﻥﻣ‬‫ﺪ‬
‫ﻘ‬‫ﻮﻓ‬‫ﻫ‬
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬:
‫ﺎﺏ‬‫ﺒ‬‫ﺍﻷﺳ‬
‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻳ‬
‫ﺍ‬‫ﺮ‬‫ﺪﺷ‬‫ﺃﺣ‬‫ﺔﻓﻲ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬‫ﻠﻄ‬‫ﺟ‬:‫ﺎﻏﻲ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺎ‬‫ﺜ‬
‫ﻟﺨ‬‫ﺍ‬-
.
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬
‫ﺍ‬‫ﻭﺙ‬
‫ﺪ‬‫ﺒﺐﻓﻲﺣ‬ ‫ﺘﺴ‬‫ﺗ‬
‫ﻤﺦﻭ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬
‫ﻘﻞﺇ‬‫ﺘ‬
‫ﻨ‬‫ﺔﺗ‬‫ﻴ‬
‫ﺋ‬‫ﺍ‬‫ﻮ‬
‫ﺔﻫ‬ ‫ﺎﻋ‬‫ﻘ‬
‫ﻭﻓ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺔﺩ‬‫ﻠﻄ‬‫ﺟ‬:‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻤ‬‫ﻧﺼ‬‫ﺍﻻ‬-

Ischemi
cst
rokesar
esubdi
vi
dedi
ntof
ivedi
ff
erentt
ypesaccor
dingt
othei
r
cause:

Lar
gear t
erythr
ombosi
s(20%),
smallpenetr
ati
ngart
erythr
ombosis(
25%)
,
car
diogenicembol
icst
roke(
20%),
cryptogeni
c(30%)andother(
5%)

Lar gear terythrombot icst rokesar eduet oatheroscler

oticplaquesi nthel arge
bloodv esselsoft hebr ain.Thr ombusf or mationandoccl usionatt hesiteoft he
ather osclerosisresultini schemiaandi nfarcti
on.
:‫ﺎ‬
‫ﻬ‬‫ﺒ‬‫ﺒ‬‫ﺔﺣﺴﺐﺳ‬ ‫ﻔ‬‫ﻠ‬‫ﺘ‬‫ﺍﻉﻣﺨ‬ ‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫ﺔ‬‫ﻤﺴ‬‫ﻟﻰﺧ‬ ‫ﺔﺇ‬‫ﻳ‬‫ﺭ‬
‫ﺎ‬‫ﻔ‬‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻘﺴﻢ‬ ‫ﻨ‬
‫ﺗ‬
‫ﺔ‬ ‫ﻔ‬
‫ﻔ‬ ‫ﻣﺠ‬، (
٪20)‫ﺔ‬ ‫ﻴ‬‫ﺒ‬‫ﻠ‬
‫ﺔﻗ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﺘ‬‫ﻜ‬‫ﺳ‬،(٪25)‫ﺮ‬‫ﻴ‬‫ﻐ‬ ‫ﺫﻱ ﺻ‬‫ﺎ‬
‫ﻔ‬‫ﻧﻲﻧ‬‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﺮﺷ‬ ‫ﺜ‬
‫ﺗﺨ‬، (٪
20)‫ﺮ‬ ‫ﻴ‬‫ﺒ‬
‫ﻧﻲﻛ‬ ‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻠﻂﺷ‬ ‫ﺗﺠ‬
(٪5)‫ﺎ‬‫ﺮﻫ‬‫ﻴ‬‫ﻏ‬‫(ﻭ‬ 30٪)
‫ﺔ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻴﻦﻓﻲ‬ ‫ﻳ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺸ‬ ‫ﺍ‬‫ﻠﺐ‬ ‫ﺘﺼ‬‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬‫ﻴﻦﻧ‬‫ﻳ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺸ‬‫ﺍ‬‫ﺓﻓﻲ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﺜ‬‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﺪﺙ‬ ‫ﺗﺤ‬
.‫ﺀ‬‫ﺎ‬‫ﺘﺸ‬‫ﺍﺣ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻘﺺ‬ ‫ﻟﻰﻧ‬‫ﻴﻦﺇ‬ ‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻠﺐ‬‫ﻊﺗﺼ‬ ‫ﻗ‬‫ﻮ‬
‫ﺎﻓﻲﻣ‬ ‫ﺩﻫ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬‫ﺔﻭ‬‫ﻠﻄ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﻳﻦ‬‫ﻮ‬
‫ﻜ‬‫ﺩﻱﺗ‬ ‫ﺆ‬‫ﻳ‬.‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬ ‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺮ‬ ‫ﻴ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬
Smal lpenet r
atingar t
er ythr omboticstrokesaf fectoneormor ev esselsandar e
themostcommont ypeofi schemicst r
oke.Smal lart
erythrombot icstrokesar e
alsocal ledlacunarst rokesbecauseoft hecav i
tythatiscreatedoncet he
i
nf arctedbr aintissuedi sintegrat
es.

Cardiogenicembolicstr
okesareassociatedwithcardi
acdy srhy
thmias,usuall
y
atr
ialfi
bri
ll
ati
on.Emboliori
ginat
ef r
om theheartandcirculatetothecerebral
vasculat
ure,mostcommonl ytheleftmiddl
ecerebralarter
y ,r
esult
inginastroke.
Embol i
cstrokesmaybepr event
edbyt heuseofant i
coagul ati
ontherapyin
pati
entswithatri
alfi
bri
ll
ati
on.
Cryptogenicstr
okes(haveunknowncause) .
Other(fr
om causessuchascocai neuse,coagulopat
hies,mi grai
ne,and
spontaneousdissecti
onofthecarotidorver
tebralar
teri
es) .

‫ﺎﻣﻦ‬ً‫ﻮ‬
‫ﻋ‬‫ﻴ‬‫ﺮﺷ‬‫ﺜ‬‫ﻛ‬
‫ﺍﻷ‬ ‫ﻮﻉ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻭﻫﻲ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬
‫ﻭ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻠﻰﻭﻋ‬‫ﺔﻋ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬
‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﺜ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮ‬‫ﺛ‬‫ﺆ‬
‫ﺗ‬
‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺎ‬
‫ﺎﺑ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺓ‬
‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺭ‬‫ﺎ‬‫ﺜ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻤﻰ‬‫ﺗﺴ‬
ُ.
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
.‫ﺓ‬
‫ﺰ‬‫ﺘﺠ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬‫ﻜﻚ‬‫ﻔ‬‫ﺩﺗ‬‫ﺮ‬
‫ﻤﺠ‬ ‫ﻩﺑ‬
‫ﺅ‬‫ﺎ‬‫ﻧﺸ‬
‫ﺘﻢﺇ‬‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻒ‬ ‫ﻮ‬‫ﺘﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬‫ﺔﺑﺴ‬‫ﻴ‬
‫ﺑ‬‫ﻮ‬‫ﻟﺠ‬‫ﺍ‬

‫ﺄ‬
‫ﻨﺸ‬‫ﺗ‬.
‫ﻨﻲ‬‫ﻳ‬
‫ﺫ‬‫ﺍﻷ‬‫ﺎﻥ‬
‫ﻔ‬‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥ‬‫ﻜ‬‫ﺎﻳ‬‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻭﻋ‬،‫ﺒﻲ‬‫ﻠ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻈﻢ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞﻓﻲ‬ ‫ﺔﺑﺨ‬‫ﻴ‬‫ﺒ‬
‫ﻠ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬
‫ﻟﺼ‬ ‫ﺍ‬‫ﺔ‬
‫ﻴ‬ ‫ﻏ‬
‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺒﻂ‬‫ﺗ‬
‫ﺮ‬‫ﺗ‬
‫ﺍﻷ‬‫ﻭﺳﻂ‬‫ﺍﻷ‬‫ﺎﻏﻲ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺎﺗ‬
‫ﺎﻣ‬ً
‫ﺒ‬
‫ﻟ‬‫ﺎ‬
‫ﻭﻏ‬، ‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﻟﻰ‬‫ﻘﻞﺇ‬‫ﺘ‬‫ﻨ‬‫ﺗ‬‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬
.‫ﺔ‬‫ﻴ‬‫ﻏ‬
‫ﺎ‬‫ﻣ‬‫ﺔﺩ‬‫ﺘ‬‫ﻜ‬‫ﻭﺙﺳ‬ ‫ﺪ‬‫ﻟﻰﺣ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬،‫ﺮ‬‫ﻳﺴ‬
‫ﻳﻦ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬
‫ﺮﺿﻰ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻓﻲ‬‫ﺜ‬‫ﺘﺨ‬‫ﻠ‬‫ﻟ‬
‫ﺩ‬ ‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬
‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﻊ‬
‫ﻨ‬‫ﻜﻦﻣ‬‫ﻤ‬‫ﻳ‬
.‫ﻨﻲ‬‫ﻳ‬
‫ﺫ‬‫ﺍﻷ‬ ‫ﺎﻥ‬‫ﻔ‬‫ﺮﺟ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥﻣﻦ‬‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳ‬
.(
‫ﻭﻑ‬ ‫ﺮ‬‫ﻌ‬‫ﺮﻣ‬‫ﻴ‬‫ﺒﺐﻏ‬ ‫ﺎﺳ‬‫ﻬ‬‫ﻟ‬‫ﻴﺲ‬‫ﻟ‬)‫ﺓ‬‫ﺮ‬‫ﻔ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﺋﻲ‬
‫ﺎ‬‫ﻘ‬
‫ﻠ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺢ‬
‫ﺮ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﻔﻲ‬ ‫ﻨﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﻭ‬،‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻼﻝ‬ ‫ﺍﻋ‬
‫ﻭ‬، ‫ﻴﻦ‬‫ﻳ‬
‫ﺎ‬‫ﻛ‬‫ﻮ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲ‬‫ﻌ‬‫ﺜﻞﺗ‬‫ﺎﺏﻣ‬ ‫ﺒ‬
‫ﺃﺳ‬ ‫)ﻦ‬
‫ﺮﻯ ﻣ‬‫ﺃﺧ‬
.(
‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻘ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻳ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺗﻲ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﻥ‬
‫ﻳ‬‫ﺮ‬
‫ﻠﺸ‬‫ﻟ‬

Pathophy
siology
1.Str
okeresultf
rom i
mpairedbl
oodcir
cul
ationint
hebrai
n,whichcanbe
causedbyatheroscl
erosi
sandart
eri
oscl
erosis,
car
diacdi
sease,ordi
abet
es.

188
2.Ci rculati
oni simpai redbyat heroscl er osis( buil
d-upoff att
ypl aque)i ncer ebral
bloodv esselsandt hef ormat i
onoft hrombi andmi cr oembol i.
3.Thei nelast i
car t
er i
al system af fect edbyar teri
oscl erosisrestrictst hev ol ume
ofbl oodci rculatingt hroughbl oodv essel s.Thebl oodsuppl yiscutof ftot he
brain.St opsoxy genandnut rientsr eachi ngt hebr ain.Damagesorki l
lsbr ain
cellsandst opspar tsoft hebr ainwor kingpr operly.
3.Hy per tension, whichi sassoci atedwi thsomeoft hepr eviouslyment i
oned
aetiologies, reducest hebl oodt ravelingt ot hebr ainandi ncreasest hepot ential
forrupt uredcer ebr al vesselsf rom theel ev atedpr essur e.
‫ﺔ‬ ‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬ ‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻋﻦ‬ ‫ﻤ‬‫ﺎﺟ‬‫ﻮﻥﻧ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻒ‬ ‫ﺔﻋﻦ ﺿ‬ ‫ﺗﺠ‬‫ﺎ‬‫ﺔﻧ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬.1
.
‫ﺮﻱ‬‫ﻜ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻭﻣ‬ ‫ﺃ‬‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬
‫ﺃ‬ ‫ﻭ‬ ‫ﺃ‬‫ﻴﻦ‬‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻠﺐ‬‫ﺗﺼ‬ ‫ﻴﻦﻭ‬ ‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﻠﺐ‬ ‫ﺗﺼ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫(ﻓﻲ‬ ‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﺪﻫ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺒ‬‫ﺮﺳ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻛﻢ‬ ‫ﺍ‬
‫ﺮ‬‫ﺗ‬)‫ﻴﻦ‬ ‫ﻳ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺸ‬‫ﺍ‬‫ﻠﺐ‬ ‫ﺒﺐﺗﺼ‬ ‫ﺔﺑﺴ‬‫ﻳ‬‫ﻮ‬ ‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻒ‬ ‫ﺿ‬. 2
.
‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻤ‬
‫ﻟﺼ‬ ‫ﺍ‬
‫ﺎﺕﻭ‬ ‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻞ‬‫ﻜ‬ ‫ﺗﺸ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬ ‫ﺍﻷ‬‫ﺮﻓﻲ‬ ‫ﺘﺸ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺪﺣﺠﻢ‬ ‫ﻴ‬‫ﻘ‬‫ﻴﻦﻳ‬ ‫ﻳ‬‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻠﺐ‬‫ﺘﺼ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻥ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻧﻲﻏ‬ ‫ﺎ‬‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬.3
‫ﺎ‬‫ﻳ‬‫ﺘﻞﺧﻼ‬ ‫ﻘ‬‫ﻭﻳ‬‫ﺃ‬‫ﺮ‬ ‫ﻳﻀ‬.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬ ‫ﻳ‬
‫ﺬ‬‫ﻐ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬ ‫ﻮﻝ‬‫ﻗﻒﻭﺻ‬ ‫ﻮ‬‫ﺗ‬.‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻋﻦ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬ ‫ﻊﺗ‬‫ﻘﻄ‬ ‫ﻨ‬
‫ﻳ‬
.‫ﻴﺢ‬‫ﻜﻞ ﺻﺤ‬ ‫ﻤﻞﺑﺸ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬ ‫ﺎﻍﻋﻦ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻣﻦ‬ ‫ﺍ‬‫ﺰ‬‫ﺃﺟ‬ ‫ﻗﻒ‬ ‫ﻮ‬‫ﻳ‬‫ﺎﻍﻭ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﻰ‬ ‫ﻡﺇ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬‫ﻘ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﻠﻞﻣﻦ‬ ‫ﻘ‬‫ﻳ‬،‫ﺎ‬ً
‫ﻘ‬
‫ﺑ‬‫ﺎ‬‫ﺓﺳ‬ ‫ﺭ‬‫ﻮ‬‫ﻛ‬‫ﺬ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺒ‬‫ﺒ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﺾ‬ ‫ﺒ‬
‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬، ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.3
.
‫ﻊ‬‫ﻔ‬‫ﺗ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺒﺐ‬ ‫ﺔﺑﺴ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬ ‫ﺍﻷ‬‫ﺰﻕ‬‫ﻤ‬‫ﺔﺗ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﺣ‬ ‫ﺪﻣﻦ‬ ‫ﻳ‬‫ﺰ‬‫ﻳ‬‫ﺎﻍﻭ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬

Modi fiableRi skFact orsf orIschemi candHaemor rhagicStroke

1.Hy per tensi on( cont r
olli
nghy pertension,themajorr i
skfactor,i
sthekeyt
o
prevent ingst roke)
2.Car diov ascul ardisease( cerebr alembol imayoriginateintheheart
)
3.Atrial fi
br i
llat i
on
4.Cor onar yar terydi sease
5.Hear tfailure
6.Leftv ent r
icul arhy pert r
ophy
7.My ocar dial infarct i
on( especi all
yant er
ior)
8.Rheumat i
chear tdisease
9.Highchol est erol levels
10.Obesi ty
11.Elev at edhemat ocrit(increasest her i
skofcerebr ali
nfarcti
on)
12.Di abet esmel lit
us
13.Or al cont racept i
v euse( i
ncr easesrisk,especi
allywithcoexisti
ng
hypertensi on, smoki ng, andhi ghest rogenlevels)
14.Smoki ng
15.Dr ugabuse( especi all
ycocai ne)
16.Excessi veal cohol consumpt i
on

‫ﺔ‬
‫ﻴ‬‫ﻓ‬‫ﺰ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻳ‬
‫ﺭ‬‫ﺎ‬‫ﻔ‬‫ﻗ‬
‫ﺍﻹ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬‫ﻠﺴ‬‫ﻟ‬‫ﻳﻞ‬‫ﺪ‬‫ﻌ‬
‫ﺘ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬ ‫ﻠ‬
‫ﺑ‬‫ﺎ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻋ‬
‫ﺔﻣﻦ‬
‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺡ‬‫ﺘ‬
‫ﻔ‬‫ﻮﻣ‬
‫ﻫ‬،‫ﻴﺴﻲ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬
‫ﺎ‬‫ﻋ‬،‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﺎﻉ ﺿ‬
‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬
)‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.1
(‫ﺔ‬
‫ﻴ‬‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬
(
‫ﻠﺐ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺄﻓﻲ‬‫ﻨﺸ‬
‫ﺪﺗ‬‫ﺔﻗ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻤ‬
‫ﻟﺼ‬‫ﺍ‬)‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻠﺐﻭ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻣ‬‫ﺃ‬.2
‫ﻨﻲ‬‫ﻳ‬
‫ﺫ‬‫ﺍﻷ‬‫ﺎﻥ‬‫ﻔ‬‫ﺮﺟ‬‫ﻟ‬
‫ﺍ‬.3
‫ﺎﺟﻲ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬.4
‫ﻠﺐ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻓﺸﻞ‬. 5
‫ﺮ‬‫ﻳﺴ‬‫ﺍﻷ‬‫ﻴﻦ‬‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺗﻀﺨﻢ‬. 6

189
 ‫(‬
‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻣ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﺎﺻ‬ ‫ﻠﺐ)ﺧ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻠ‬
‫ﺀﻋﻀ‬ ‫ﺎ‬
‫ﺘﺸ‬ ‫ﺍﺣ‬ ‫‪.‬‬
‫‪7‬‬
‫ﺔ‬ ‫ﻴ‬‫ﻣ‬‫ﺰ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻣ‬‫ﻭ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬ ‫‪.‬‬
‫‪8‬‬
‫ﻭﻝ‬‫ﺮ‬‫ﺘ‬‫ﻴﺴ‬‫ﻟ‬‫ﻮ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬ ‫ﻳ‬‫ﻮ‬‫ﺘ‬‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬ ‫‪.‬‬
‫‪9‬‬
‫ﺔ‬‫ﻨ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫‪.‬‬‫‪10‬‬
‫(‬‫ﻏﻲ‬ ‫ﺎ‬
‫ﻣ‬‫ﺀﺩ‬ ‫ﺎ‬
‫ﺘﺸ‬‫ﺎﺣ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺪﻣﻦﺧﻄ‬ ‫ﻳ‬‫ﺰ‬‫ﻳ‬‫ﻳﺖ)‬ ‫ﺮ‬‫ﻛ‬‫ﻮ‬ ‫ﺗ‬
‫ﺎ‬‫ﻤ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬‫ﺍ‬‫‪.‬‬‫‪11‬‬
‫ﺮﻱ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫‪.‬ﺩ‬‫‪12‬‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﻊ‬‫ﺎﻣ‬‫ﻤ‬‫ﻴ‬
‫‪،‬ﻻﺳ‬ ‫ﺮ‬‫ﺎﻃ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬
‫ﺰ‬‫ﻳ‬‫ﻔﻢ)‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﻤﻞﻋﻦﻃ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﺋﻞﻣ‬ ‫ﺎ‬‫ﻡﻭﺳ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫‪.‬‬‫‪13‬‬
‫(‬‫ﻴﻦ‬‫ﻭﺟ‬‫ﺮ‬‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﻮﻥ‬ ‫ﻣ‬‫ﺮ‬‫ﺎﺕﻫ‬ ‫ﻳ‬‫ﻮ‬ ‫ﺘ‬
‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﺪﺧ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻴﻦ‬‫ﺪﺧ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫‪14‬‬
‫(‬‫ﻴﻦ‬‫ﻳ‬‫ﺎ‬
‫ﻛ‬ ‫ﻮ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺻ‬ ‫ﻭﺧ‬ ‫ﺍﺕ)‬ ‫ﺭ‬‫ﺪ‬ ‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻃﻲ‬ ‫ﻌ‬‫‪-‬ﺗ‬‫‪15‬‬
‫ﻮﻝ‬‫ﻜﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻬﻼﻙ‬ ‫ﺘ‬ ‫ﺍﺳ‬ ‫ﺍﻁﻓﻲ‬ ‫ﺮ‬
‫ﻓ‬ ‫ﺍﻹ‬‫‪.‬‬‫‪16‬‬
‫‪Uncont‬‬ ‫‪r‬‬‫‪ol‬‬‫‪l‬‬
‫‪abl‬‬‫(‪e‬‬ ‫‪Nonmodi‬‬ ‫‪f‬‬‫‪i‬‬
‫‪abl‬‬‫)‪e‬‬
‫‪1.Age:‬‬ ‫‪r‬‬
‫‪i‬‬‫‪skofCVAi‬‬ ‫‪ncr‬‬‫‪easeswi‬‬ ‫‪t‬‬‫‪heachdecadebey‬‬ ‫‪ondage55y‬‬ ‫‪r‬‬‫‪s.‬‬
‫‪2.Sex:‬‬ ‫‪Menhav‬‬ ‫‪easl‬‬ ‫‪i‬‬
‫‪ght‬‬ ‫‪l‬‬
‫‪yhi‬‬‫‪gherr‬‬ ‫‪i‬‬
‫‪skt‬‬ ‫‪hanwomen.‬‬
‫‪3.Race:‬‬ ‫‪Af‬‬ ‫‪r‬‬
‫‪i‬‬‫‪canAmer‬‬ ‫‪i‬‬
‫‪cansexper‬‬ ‫‪i‬‬‫‪encemor‬‬ ‫‪eCVAst‬‬ ‫‪hanot‬‬ ‫‪hergr‬‬ ‫‪oups.‬‬
‫‪4.Genet‬‬ ‫‪i‬‬‫‪cs:‬‬‫‪Thosewhosebl‬‬ ‫‪oodr‬‬ ‫‪el‬‬
‫‪at‬‬‫‪i‬‬‫‪v‬‬‫‪eshav‬‬ ‫‪ehadaCVAar‬‬ ‫‪eati‬‬ ‫‪ncr‬‬ ‫‪easedr‬‬ ‫‪i‬‬
‫‪sk.‬‬
‫‪Cl‬‬‫‪i‬‬
‫‪ni‬‬ ‫‪calMani‬‬ ‫‪f‬‬‫‪est‬‬‫‪at‬‬‫‪i‬‬‫‪ons‬‬
‫‪Ani‬‬ ‫‪schemi‬‬ ‫‪cst‬‬ ‫‪r‬‬‫‪okecancauseawi‬‬ ‫‪dev‬‬ ‫‪ar‬‬‫‪i‬‬
‫‪et‬‬‫‪yofneur‬‬ ‫‪ol‬‬ ‫‪ogi‬‬‫‪cdef‬‬ ‫‪i‬‬‫‪ci‬‬
‫‪t‬‬ ‫‪s,‬‬ ‫‪dependi‬‬ ‫‪ng‬‬
‫‪ont‬‬ ‫‪hel‬‬‫‪ocat‬‬ ‫‪i‬‬
‫‪onoft‬‬ ‫‪hel‬‬‫‪esi‬‬‫(‪on‬‬ ‫‪whi‬‬‫‪chv‬‬ ‫‪essel‬‬‫‪sar‬‬‫‪eobst‬‬ ‫‪r‬‬‫‪uct‬‬‫)‪ed‬‬ ‫‪,‬‬‫‪t‬‬‫‪hesi‬‬ ‫‪zeoft‬‬ ‫‪hear‬‬ ‫‪ea‬‬
‫‪ofi‬‬‫‪nadequat‬‬ ‫‪eper‬‬ ‫‪f‬‬
‫‪usi‬‬‫‪on,‬‬ ‫‪andt‬‬‫‪heamountofcol‬‬ ‫‪l‬‬‫‪at‬‬‫‪er‬‬‫‪al‬‬ ‫‪bl‬‬‫‪oodf‬‬ ‫‪l‬‬
‫‪ow.‬‬
‫(‬‫ﻳﻞ‬ ‫ﺪ‬
‫ﻌ‬ ‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﺑﻞ‬‫ﺎ‬
‫ﺮﻗ‬ ‫ﻴ‬‫ﺎ)ﻏ‬ ‫ﻬ‬
‫ﻴ‬ ‫ﻠ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻻﻳ‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻣ‬ ‫ﺎ‬
‫ﺪﺳﻦ‪55‬ﻋ‬ ‫ﻌ‬‫ﺪﺑ‬‫ﻘ‬‫ﻊﻛﻞﻋ‬ ‫ﺪﻣ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻥ‬ ‫ﺮﻃ‬ ‫ﺔﺑﺴ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﺩﺧﻄ‬ ‫ﺍ‬
‫ﺩ‬‫ﺰ‬‫‪:‬ﻳ‬‫ﺮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪1‬‬
‫‪.‬‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺀﺑ‬‫ﺎ‬
‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻣﻦ‬ ‫ﺑ‬
‫ﺎ‬‫ﻟﻺﺻ‬ ‫ﺔ‬‫ﺮﺿ‬ ‫ﺮﻋ‬ ‫ﺜ‬
‫ﻛ‬ ‫ﺃ‬‫ﺎﻝ‬ ‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬‫‪:‬‬
‫ﻨﺲ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫‪.‬‬
‫‪2‬‬
‫‪.‬‬‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺎﺕ‬‫ﻮﻋ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟ‬‫ﺍ‬‫ﺮﻣﻦ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺎﻻﺕ‪CVAs‬‬ ‫ﻘﻲﻣﻦﺣ‬ ‫ﻳ‬‫ﺮ‬‫ﻓ‬‫ﺃ‬‫ﺃﺻﻞ‬ ‫ﻮﻥﻣﻦ‬ ‫ﻴ‬‫ﻜ‬‫ﻳ‬‫ﺮ‬‫ﻣ‬ ‫ﺍﻷ‬ ‫ﻧﻲ‬‫ﺎ‬‫ﻌ‬
‫‪:‬ﻳ‬‫ﺮﻕ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫‪.‬‬
‫‪3‬‬
‫‪.‬‬‫ﺪ‬‫ﻳ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬‫ﺮﻣ‬‫ﻟﺨﻄ‬ ‫ﻮﻥ‬‫ﺮﺿ‬ ‫ﻌ‬
‫ﻬﻢ‪CVA‬ﻣ‬ ‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺎ‬
‫ﻬﻢﺑ‬‫ﺑ‬‫ﺭ‬‫ﺎ‬
‫ﻗ‬ ‫ﺃ‬‫ﻴﺐ‬ ‫ﺃﺻ‬ ‫ﻳﻦ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺌﻚ‬ ‫ﻟ‬‫ﻭ‬‫ﺃ‬‫‪:‬‬‫ﺔ‬‫ﺛ‬‫ﺍ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻢ‬‫‪.‬ﻋ‬‫‪4‬‬
‫ﺔ‬‫ﻣ‬ ‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬
‫ﻋ‬ ‫ﺍﻻ‬
‫ﺍ‬‫ً‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﺍﻋ‬ ‫‪،‬‬
‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺰ‬‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﺎﻻﺕ‬‫ﺔﻣﻦﺣ‬ ‫ﻋ‬‫ﻮ‬‫ﻨ‬‫ﺘ‬
‫ﺔﻣ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﺔﻓﻲﻣﺠ‬ ‫ﻳ‬‫ﺭ‬‫ﺎ‬‫ﻔ‬
‫ﻗ‬ ‫ﺍﻹ‬ ‫ﺔ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺒﺐ‬ ‫ﺘﺴ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬
‫ﺔﺗ‬ ‫ﻴ‬‫ﻤ‬‫ﻛ‬‫‪،‬ﻭ‬‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺔﻏ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻘ‬
‫ﻨﻄ‬‫‪،‬ﻭﺣﺠﻢﻣ‬ ‫(‬‫ﺓ‬
‫ﺩ‬ ‫ﻭ‬‫ﺪ‬ ‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻓ)ﻱ‬
‫ﺍﻵﺔﺃ‬ ‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻠﻰﻣ‬ ‫ﻋ‬
‫‪.‬‬‫ﺒﻲ‬ ‫ﻧ‬
‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬

‫‪Thepat‬‬ ‫‪i‬‬‫‪entmaypr‬‬ ‫‪esentwi‬‬ ‫‪t‬‬

‫‪hanyoft‬‬ ‫‪hef‬‬‫‪ol‬‬‫‪l‬‬
‫‪owi‬‬‫‪ngsi‬‬ ‫‪gnsorsy‬‬‫‪mpt‬‬‫‪oms:‬‬
‫‪1.Numbnessorweaknessoft‬‬ ‫‪hef‬‬ ‫‪ace,‬‬‫‪ar‬‬‫‪m,‬‬‫‪orl‬‬
‫‪eg,‬‬ ‫‪especi‬‬
‫‪al‬‬‫‪l‬‬
‫‪yon‬‬
‫‪onesi‬‬‫‪deoft‬‬ ‫‪hebody‬‬
‫‪2.Conf‬‬ ‫‪usi‬‬‫‪onorchangei‬‬ ‫‪nment‬‬ ‫‪al‬‬‫‪st‬‬‫‪at‬‬‫‪us‬‬
‫‪3.Tr‬‬‫‪oubl‬‬‫‪espeaki‬‬ ‫‪ngorunder‬‬ ‫‪st‬‬‫‪andi‬‬‫‪ngspeech‬‬
‫‪4.Vi‬‬‫‪sual‬‬ ‫‪di‬‬‫‪st‬‬
‫‪ur‬‬‫‪bances‬‬
‫‪5.Di‬‬‫‪f‬‬‫‪f‬‬
‫‪i‬‬‫‪cul‬‬‫‪t‬‬‫‪ywal‬‬‫‪ki‬‬‫‪ng,‬‬‫‪di‬‬‫‪zzi‬‬
‫‪ness,‬‬ ‫‪orl‬‬‫‪ossofbal‬‬‫‪anceorcoor‬‬ ‫‪di‬‬
‫‪nat‬‬‫‪i‬‬
‫‪on‬‬
‫‪6.Suddensev‬‬ ‫‪er‬‬‫‪eheadache‬‬
‫‪7.Mot‬‬ ‫‪or‬‬‫‪,‬‬‫‪sensor‬‬‫‪y‬‬‫‪,‬‬‫‪cr‬‬‫‪ani‬‬‫‪al‬‬‫‪ner‬‬‫‪v‬‬‫‪e,‬‬‫‪cogni‬‬‫‪t‬‬‫‪i‬‬
‫‪v‬‬‫‪e,‬‬‫‪andot‬‬‫‪herf‬‬‫‪unct‬‬‫‪i‬‬
‫‪onsmaybedi‬‬‫‪sr‬‬
‫‪upt‬‬
‫‪ed.‬‬

‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬‫ﺃﺍﻷﻋ‬
‫ﺎﺕﻭ‬‫ﻣ‬ ‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻱﻣﻦ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺮﻋ‬‫ﻬ‬‫‪:‬ﺪﻳﻈ‬‫ﻗ‬
‫ﻪ‪1.‬‬
‫ﻮﺟ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﺔﻓﻲﻣ‬ ‫ﺎﺻ‬‫‪،‬ﺧ‬ ‫ﺎﻕ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺍﻉ‬‫ﺭ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻌﻒﻓﻲ‬ ‫ﻭﺿ‬ ‫ﺃ‬‫ﺭ‬‫ﺪ‬‫ﺧ‬
‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺪﻣﻦ‬‫ﺍﺣ‬‫ﻧﺐﻭ‬ ‫ﺎ‬‫ﺟ‬
‫ﺔ‪2.‬‬‫ﻴ‬
‫ﻠ‬‫ﻘ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﻓﻲ‬‫ﻴ‬‫ﻐ‬‫ﻭﺗ‬‫ﺃ‬‫ﺎﻙ‬‫ﺒ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﻡ‪3.‬‬‫ﻜﻼ‬‫ﻟ‬‫ﺍ‬
‫ﻬﻢ‬ ‫ﻭﻓ‬‫ﺃ‬‫ﺪﺙ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻌ‬
‫ﺻ‬
‫ﺔ‪4.‬‬ ‫ﻳ‬
‫ﺮ‬‫ﺎﺕﺑﺼ‬ ‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬
‫ﻴﻖ‪5.‬‬‫ﻨﺴ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺯﻥ‬
‫ﺍ‬‫ﻮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻭﻓ‬ ‫ﺃ‬
‫ﺭ‬‫ﺍ‬‫ﻭ‬‫ﻭﺩ‬‫ﺃ‬‫ﻤﺸﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺑ‬‫ﻮ‬‫ﻌ‬
‫ﺻ‬
‫ﺎﺟﺊ‪6.‬‬ ‫ﻔ‬‫ﺪﻣ‬‫ﻳ‬‫ﺪ‬‫ﺍﻉﺷ‬ ‫ﺪ‬
‫ﺻ‬

‫‪190‬‬
 7.‫ﺎ‬
‫ﺮﻫ‬‫ﻴ‬
‫ﺔﻭﻏ‬
‫ﻴ‬‫ﻛ‬‫ﺍ‬
‫ﺭ‬‫ﺩ‬‫ﺍﻹ‬
‫ﺔﻭ‬‫ﻴ‬
‫ﻔ‬‫ﻘﺤ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬
‫ﻟﺤﺴ‬
‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬
‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺋﻒ‬
‫ﺎ‬‫ﻮﻇ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻄﻞ‬
‫ﺘ‬‫ﺪﺗ‬.
‫ﻗ‬
Motorloss
Themostcommonmot ordysfuncti
oni s:
1.Hemi pl
egi a: paral
ysi
sofonesi deoft hebodyduet oal esi
onoft heopposi te
si
deoft hebr ain.
2.Hemi paresis: weaknessofonesi deoft hebody .
3.Ataxi
a: Stagger i
ng,unsteadygait
, unabletokeepf eettogether
;needsabr oad
basetost and.
4.Dysphagi a:Diffi
cult
yinswal l
owing.
‫ﺮﻙ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬
:
‫ﻮ‬‫ﺎﻫ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬‫ﺜ‬‫ﻛ‬
‫ﺍﻷ‬ ‫ﻔﻲ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞ‬
‫ﻟﺨ‬‫ﺍ‬
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻵﺮﻣﻦ‬
‫ﺍﺧ‬ ‫ﻧﺐ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﺑ‬
‫ﺎ‬‫ﺒﺐﺇﺻ‬ ‫ﻟﺠﺴﻢﺑﺴ‬ ‫ﺍ‬
‫ﺪﻣﻦ‬ ‫ﺍﺣ‬‫ﻧﺐﻭ‬ ‫ﺎ‬
‫ﻠﻞﻓﻲﺟ‬ ‫ﺷ‬:‫ﻔﻲ‬ ‫ﻠﻞﻧﺼ‬‫ﺷ‬.1
.‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺪﻣﻦ‬‫ﺍﺣ‬‫ﻧﺐﻭ‬ ‫ﺎ‬
‫ﻌﻒﻓﻲﺟ‬ ‫ﺿ‬:‫ﻔﻲ‬ ‫ﻨﺼ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻞ‬‫ﻟﺸ‬‫ﺍ‬.
2
‫ﺓ‬‫ﺪ‬
‫ﺎﻋ‬‫ﻟﻰﻗ‬ ‫ﺎﺝﺇ‬‫ﺘ‬‫ﻳﺤ‬.‫ﻣ‬
‫ﺎ‬
‫ﻴﻦ ﻌ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﺮﻗ‬‫ﻴ‬‫ﻭﻏ‬، ‫ﺔ‬
‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺮﺛ‬‫ﻴ‬‫ﺔﻭﻏ‬‫ﻠ‬
‫ﺬﻫ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻣﺸ‬:‫ﻧﺢ‬‫ﺮ‬‫ﺗ‬.
3
.‫ﻮﻑ‬ ‫ﻗ‬‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬
‫ﻳﻀ‬ ‫ﺮ‬
‫ﻋ‬
.‫ﻊ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬‫ﺑ‬‫ﻮ‬‫ﻌ‬‫ﺻ‬: ‫ﻊ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬.4

Communi cat i
onl oss
Otherbr ainf unctionsaf f
ectedbyst r
okear elanguageandcommuni cation.
Strokei st hemostcommoncauseofaphasi a.
Thef ollowi ngar edy sfunctionsofl anguageandcommuni cation:
-Dy sarthria( diffi
cul t
yi nformi ngwor ds) ,causedbypar al
y sisoft hemuscl es
responsi blef orpr oduci ngspeech.
-Dy sphasi aoraphasi a(defect i
vespeechorl ossofspeech) ,whichcanbe
expressi veaphasi a, recepti
v eaphasi a, orglobal (mixed)aphasi a.
-Expr essiv eaphasi a:Unabl et of orm wor dst hatareunder st andabl e;maybe
ablet ospeaki nsi ngle-wordr esponses
-Recept iveaphasi a:Unabl etocompr ehendt hespokenwor d;canspeakbut
maynotmakesense
-Global( mi xed)aphasi a:Combi nationofbot hreceptiveandexpr essiv e
aphasi a
-Apr axia( inabili
tyt oper form apr eviouslylear nedact i
on), asmaybeseenwhen
apat ientanat t
empt st ocombhi shai rwi t
h
‫ﺎﻝ‬‫ﻻﺼ‬‫ﺍﺗ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬
‫ﺍﻷ‬‫ﺒﺐ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺔﻫﻲ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬ ‫ﺔ‬
‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬.‫ﺍﺻﻞ‬‫ﻮ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻐ‬
‫ﻠ‬‫ﻟ‬‫ﺍ‬‫ﺔﻫﻲ‬ ‫ﻴ‬‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺎ‬‫ﺮﺑ‬‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﻭﻇ‬
.
‫ﺔ‬‫ﺒﺴ‬ ‫ﻠﺤ‬‫ﻟ‬‫ﺎ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬
:
‫ﺍﺻﻞ‬ ‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻐ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻞﻓﻲ‬ ‫ﻟﺨ‬‫ﺍ‬‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤ‬‫ﻴ‬‫ﻓ‬
.
‫ﻨﻄﻖ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﻟ‬‫ﻭ‬‫ﺆ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻀﻼﺕ‬ ‫ﻟ‬‫ﺍ‬
‫ﻠﻞ‬ ‫ﺎﺟﻢﻋﻦﺷ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬(
‫ﺎﺕ‬‫ﻤ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬ ‫ﺔﻓﻲﺗ‬ ‫ﺑ‬‫ﻮ‬‫ﻌ‬‫ﻡ)ﺻ‬ ‫ﻜﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻋﺴ‬-
‫ﻜﻦ‬‫ﻤ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، (‫ﻡ‬‫ﻜﻼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻡﻭﻓ‬‫ﻜﻼﺃ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻴﺐﻓﻲ‬ ‫ﻡ)ﻋ‬ ‫ﻜﻼ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬
‫ﻘ‬‫ﻡﻭﻓ‬‫ﻜﻼﺃ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬-
.
(‫ﺔ‬‫ﻠﻄ‬‫ﺘ‬‫ﻣﺨ‬ )‫ﺔ‬‫ﻠ‬‫ﻣ‬‫ﺎ‬
‫ﺔﺷ‬ ‫ﺒﺴ‬‫ﻭﺣ‬،‫ﺔﺃ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﺒ‬‫ﻘ‬‫ﺘ‬
‫ﺍﺳ‬ ‫ﺔ‬‫ﺒﺴ‬‫ﻭﺣ‬، ‫ﺔﺃ‬ ‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻌ‬‫ﺔﺗ‬ ‫ﺒﺴ‬‫ﻮﻥﺣ‬ ‫ﻜ‬‫ﺃﻥﺗ‬
‫ﺩﻣﻦ‬ ‫ﻭ‬ ‫ﺩ‬‫ﺪﺙﻓﻲﺭ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﻮﻥﻗ‬ ‫ﻜ‬
‫ﺪﺗ‬ ‫ﻗ‬.‫ﺔ‬‫ﻣ‬ ‫ﻮ‬‫ﻬ‬‫ﻔ‬
‫ﺎﺕﻣ‬ ‫ﻤ‬
‫ﻠ‬‫ﻳﻦﻛ‬‫ﻮ‬‫ﻜ‬‫ﻠﻰﺗ‬‫ﺭﻋ‬ ‫ﺩ‬‫ﺎ‬‫ﺮﻗ‬‫ﻴ‬‫ﻏ‬:‫ﺔ‬ ‫ﻳ‬
‫ﺮ‬ ‫ﻴ‬
‫ﺒ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒﺴ‬‫ﻟﺤ‬‫ﺍ‬-
‫ﺓ‬‫ﺪ‬ ‫ﺍﺣ‬‫ﺔﻭ‬ ‫ﻤ‬
‫ﻠ‬‫ﻛ‬
‫ﻨﻰ‬‫ﻌ‬‫ﻪﻣ‬ ‫ﻟ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﻻﻳ‬ ‫ﻜﻦﻗ‬ ‫ﻟ‬‫ﻡﻭ‬‫ﻜﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺘﻄ‬ ‫ﻳﺴ‬.‫ﺔ‬‫ﻗ‬‫ﻮ‬ ‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻬﻢ‬‫ﻠﻰﻓ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬ ‫ﺪ‬
‫ﻋ‬: ‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬‫ﻘ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﺔ‬‫ﺒﺴ‬‫ﻟﺤ‬‫ﺍ‬-
‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬‫ﻘ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﺔ‬‫ﺒﺴ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻳﺞﻣﻦ‬ ‫ﺰ‬
‫ﻣ‬:(‫ﺔ‬ ‫ﻠﻄ‬‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬
)‫ﺔ‬ ‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒﺴ‬‫ﻟﺤ‬‫ﺍ‬-

191
 ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬
‫ﺎﻳﺤ‬ ‫ﻣ‬‫ﺪ‬‫ﻨ‬
‫ﻪﻋ‬ ‫ﺘ‬‫ﻜﻦﻣﻼﺣﻈ‬ ‫ﻤ‬‫ﺎﻳ‬
‫ﻤ‬‫ﻛ‬، (
‫ﺎ‬ً
‫ﻘ‬
‫ﺑ‬‫ﺎ‬‫ﺘﺴﺐﺳ‬ ‫ﻜ‬‫ﻤﻞﻣ‬ ‫ﺀﻋ‬ ‫ﺍ‬‫ﺩ‬‫ﺃ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺪ‬
‫ﺎ)ﻋ‬ ‫ﻴ‬
‫ﻛﺴ‬ ‫ﺍ‬
‫ﺮ‬‫ﺑ‬
‫ﺃ‬-
‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﻩﺑ‬‫ﺮ‬‫ﻌ‬‫ﻴﻂﺷ‬ ‫ﻤﺸ‬‫ﺗ‬
Percept ualdistur bances:
-Visual-percept ualdy sfunct i
ons:Visual-
perceptual dysfunct i
onsar eduet o
di
st ur
bancesoft hepr imar ysensorypathway sbet weent heey eandv i
sual
cortex.
-Homony moushemi anopi a( l
ossofhalfoft hev i
sualfield)mayoccurf rom
str
okeandmaybet empor aryorpermanent .Theaf f
ect edsi deofv i
sion
correspondst ot hepar alyzedsideoft hebodyar ef r
equent l
yseeni npat ients
wit
hr ighthemi spher icdamage.
-Unawar eofper sonsorobj ectsonsideofv i
sualloss
:‫ﺔ‬
‫ﻴ‬‫ﻟﺤﺴ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬
‫ﻴﻦ‬‫ﺔﺑ‬ ‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﻴ‬‫ﻟﺤﺴ‬‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺭ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕﻓﻲ‬ ‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬‫ﺗﺞﻋﻦ‬ ‫ﺎ‬
‫ﻛﻲﻧ‬ ‫ﺍ‬‫ﺭ‬
‫ﺩ‬‫ﺍﻹ‬‫ﺮﻱ‬‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬ ‫ﻠﻞ‬‫ﻟﺨ‬
‫ﺍ‬ :
‫ﻛﻲ‬‫ﺍ‬‫ﺭ‬‫ﺩ‬
‫ﺍﻹ‬ ‫ﺮﻱ‬‫ﺒﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻞ‬‫ﻟﺨ‬
‫ﺍ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺮ‬‫ﻘﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫ﺪ‬‫ﻗ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺒﺐ‬ ‫ﺪﺙﺑﺴ‬ ‫ﺪﻳﺤ‬‫(ﻗ‬‫ﺮﻱ‬‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬
‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻥﻧﺼﻒ‬ ‫ﺪ‬ ‫ﻘ‬‫ﻓ‬)‫ﻔﻆ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬‫ﺛﻞ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻘﻲﻣ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﻤﻰ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬-
‫ﻳﻻ‬
ُ‫ﺎ‬‫ﺍﻣ‬ً
‫ﺮ‬‫ﻴ‬‫ﺜ‬
‫ﻟﺠﺴﻢﻛ‬ ‫ﺍ‬‫ﻮﻝﻣﻦ‬ ‫ﻠ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻧﺐ‬‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻊ‬‫ﻓﻖﻣ‬ ‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﺔﻳ‬ ‫ﻳ‬
‫ﺅ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏﻣﻦ‬ ‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻧﺐ‬ ‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬.
‫ﺎ‬ً
‫ﻤ‬‫ﺋ‬
‫ﺍ‬‫ﻭﺩ‬‫ﺃ‬‫ﺎ‬ً
‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﻮﻥﻣ‬‫ﻜ‬‫ﻳ‬
.
‫ﻤﻦ‬‫ﻳ‬‫ﺍﻷ‬‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻒﻧﺼﻒ‬ ‫ﻮﻥﻣﻦﺗ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺣﻆﻓﻲ‬
‫ﺮ‬
‫ﺒﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬
‫ﻧﺐﻓ‬ ‫ﺎ‬‫ﺓﺑﺠ‬‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻴ‬‫ﺃﺍﻷﺷ‬
‫ﺎ ﺹﻭ‬ ‫ﺍﻷﺷﺨ‬ ‫ﻬﻞ‬‫ﺟ‬-
-Negl ectofonesi deoft hebody
-Diffi
cultyjudgi ngdi stances
-Lossofper ipher alv ision:

‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺪﻣﻦ‬ ‫ﺍﺣ‬‫ﻧﺐﻭ‬‫ﺎ‬‫ﺎﻝﺟ‬‫ﻤ‬‫ﺇﻫ‬-
‫ﺎﺕ‬
‫ﻓ‬‫ﺎ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻜﻢﻋ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻌ‬‫ﺻ‬-
‫ﺔ‬‫ﻴ‬‫ﻴﻄ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺅ‬ ‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﻓ‬-:
-Di
ffi
cul
tyseei
ngatnight
-Unawareofobj
ect
sort hebor
der
sofobj
ect
s
Dipl
opia:Doubl
evisi
on-
‫ﻴﻞ‬‫ﻠ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺅ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻌ‬‫ﺻ‬-
‫ﺀ‬
‫ﺎ‬‫ﻴ‬‫ﺍﻷﺷ‬
‫ﺩ‬‫ﻭ‬‫ﺪ‬
‫ﻭﺣ‬ ‫ﺃ‬
‫ﺀ‬‫ﺎ‬‫ﻴ‬
‫ﻟﻸﺷ‬ ‫ﺭﻙ‬‫ﺪ‬‫ﺮﻣ‬‫ﻴ‬‫ﻏ‬-
‫ﺔ‬‫ﻳ‬‫ﺅ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬
‫ﻭ‬ ‫ﺩ‬
‫ﺯ‬‫ﺍ‬:‫ﻊ‬
‫ﻔ‬‫ﺷ‬-
Sensor yloss
-Thesensor ylossesf rom strokemayt akethef orm ofsli
ghtimpair
mentof
touchormaybemor esev ere.
-Paresthesia( occursont hesideoppositethelesion):Numbnessandt i
ngl i
ng
ofextremi t
y .
-Proprioception( abil
i
tyt operceivethepositi
onandmot ionofbodyparts)as
wellasdi ff
icultyininterpret
ingv i
sual,
tacti
l
e,andaudi toryst
imuli
.
‫ﺍﻥﺣﺴﻲ‬ ‫ﺪ‬‫ﻘ‬‫ﻓ‬
.
‫ﺓ‬‫ﺪ‬‫ﺮﺣ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻮﻥ‬‫ﻜ‬‫ﺪﺗ‬ ‫ﻭﻗ‬‫ﺃ‬‫ﻤﺲ‬ ‫ﻠ‬
‫ﻟ‬
‫ﺍ‬‫ﻴﻒﻓﻲ‬ ‫ﻔ‬‫ﻌﻒﻃ‬ ‫ﻜﻞ ﺿ‬‫ﺔﺷ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻣﻦ‬ ‫ﻴ‬
‫ﻟﺤﺴ‬‫ﺍ‬‫ﺮ‬‫ﺋ‬
‫ﺎ‬‫ﻟﺨﺴ‬
‫ﺍ‬ ‫ﺬ‬‫ﺄﺧ‬‫ﺪﺗ‬‫ﻗ‬-
.‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬‫ﺰﻓﻲ‬‫ﻭﺧ‬‫ﻴﻞﻭ‬‫ﻤ‬‫ﻨ‬‫ﺗ‬:(‫ﻓ‬
‫ﻟﻶﺔ‬ ‫ﺑﻞ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻧﺐ‬‫ﺎ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺪﺙﻓﻲ‬‫ﻳﺤ‬ )‫ﻤﻞ‬ ‫ﻨ‬
‫ﺗ‬-
‫ﺎﺕ‬‫ﻬ‬
‫ﺒ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻔﺴ‬‫ﺔﺗ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻌ‬
‫ﻟﻰ ﺻ‬ ‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻹﺿ‬‫(ﺑ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺰ‬‫ﺃﺟ‬‫ﺔ‬‫ﻛ‬‫ﺮ‬
‫ﻊﻭﺣ‬ ‫ﻮﺿ‬ ‫ﺍﻙﻣ‬‫ﺭ‬
‫ﺩ‬‫ﻠﻰﺇ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬
)‫ﻴﻖ‬‫ﻤ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺤﺲ‬ ‫ﺍ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻤﺴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬
‫ﺍ‬

Cognit
ivei
mpairmentandpsychologicalef
fects
-I
fdamagehasoccur r
edtothefrontall
obe,lear
ningcapacit
y,memory,orother
hi
ghercort
ical
intel
l
ect
ualf
unctionsmaybei mpai red.
-Suchdysf
unctionmayberefl
ectedinalimitedattent
ionspan,f
orget
ful
ness,

192
andal ackofmot i
vat
ion,whichcausethesepat i
entst
obecomef r
ustr
atedin
thei
rrehabil
it
ati
onprogram.
-Depressioniscommonot herpsy chol
ogicalpr
oblemsiscommonandi s
manifestedbyemot i
onalli
abil
it
y,hosti
l
ity
, f
rust
rati
on,
andlackofcooperat
ion.
-Withdrawal.

TheStr
okeConti
nuum:TimeCour
seClassi
fi
cat
ion:
Str
okesarecommonlycl
assi
fi
edusi
ngtheti
mecoursei
nthef
oll
owi
ng
manner:

‫ﺔ‬
‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻵﺭ‬
‫ﺎ‬
‫ﺍﺛ‬ ‫ﻛﻲﻭ‬‫ﺍ‬‫ﺭ‬
‫ﺩ‬‫ﺍﻹ‬‫ﻌﻒ‬ ‫ﻟﻀ‬‫ﺍ‬
‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻜ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﺋﻒ‬‫ﺎ‬‫ﻮﻇ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺓ‬‫ﺮ‬‫ﻛ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﺮﻗ‬
‫ﺛ‬‫ﺄ‬‫ﺘ‬
‫ﺪﺗ‬‫ﻘ‬‫ﻓ‬،‫ﻣﻲ‬‫ﺎ‬
‫ﻣ‬‫ﺍﻷ‬‫ﻔﺺ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻒﻓﻲ‬ ‫ﻭﺙﺗ‬ ‫ﺪ‬
‫ﺣﺔﺣ‬‫ﻟ‬
‫ﻓﻲ ﺎ‬-
.‫ﺎ‬
‫ﻴ‬‫ﻠ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺮﻯ‬‫ﺍﻷﺧ‬‫ﺔ‬ ‫ﻳ‬
‫ﺮ‬‫ﻘﺸ‬‫ﻟ‬‫ﺍ‬
‫ﺒﺐﻓﻲ‬‫ﺘﺴ‬
‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬،
‫ﺰ‬‫ﻓ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻗ‬‫ﻭ‬،‫ﺎﻥ‬‫ﻴ‬
‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺩ‬‫ﻭ‬‫ﺪ‬‫ﻤﺤ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺎ‬‫ﺒ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻻ‬
‫ﺪﻯ‬‫ﻔﻲﻓﻲﻣ‬ ‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻞ‬‫ﻟﺨ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﻜﺲﻫ‬ ‫ﻌ‬‫ﻨ‬‫ﺪﻳ‬‫ﻗ‬-
.
‫ﻴﻞ‬‫ﺄﻫ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬‫ﻣﺞﺇ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﺮﺿﻰﻓﻲﺑ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﻫﻻ‬
‫ﺎﻁ ﺆ‬ ‫ﺒ‬
‫ﺇﺣ‬
‫ﻡ‬‫ﺪ‬
‫ﺎﻁﻭﻋ‬‫ﺒ‬
‫ﺍﻹﺣ‬‫ﺀﻭ‬‫ﺍ‬
‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬
‫ﻔ‬‫ﺎﻃ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺆ‬
‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻓﻲ‬‫ﺘﺠ‬‫ﺗ‬
‫ﺔﻭ‬‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﺮﻯﺷ‬ ‫ﺃﺧ‬‫ﺔ‬‫ﻴ‬
‫ﻔﺴ‬‫ﻛﻞﻧ‬‫ﺎ‬‫ﻊﻣﺸ‬ ‫ﺋ‬
‫ﺎ‬‫ﺎﺏﺷ‬‫ﺌ‬‫ﺘ‬‫ﻛ‬
‫ﺍﻻ‬ -
.‫ﻭﻥ‬‫ﺎ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺎﺏ‬‫ﻧﺴﺤ‬ ‫ﺍ‬-

:
‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻣ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻒ‬‫ﻨ‬‫ﺗﺼ‬:
‫ﺔ‬‫ﻴ‬‫ﻏ‬
‫ﺎ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻠﺴﻞ‬‫ﺗﺴ‬
:
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻟﻄ‬
‫ﺎ‬
‫ﺔﺑ‬‫ﻴ‬
‫ﻨ‬‫ﻣ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬
‫ﻡﺑ‬‫ﺎ‬‫ﻜﻞﻋ‬‫ﺔﺑﺸ‬
‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻴﻒ‬
‫ﻨ‬‫ﺘﻢﺗﺼ‬‫ﻳ‬

(1)Tr ansi enti schemi cattack( TIA)

-Tr ansienti schemi catt
ackt empor ar yepi sodeofneur ologi
cdy sfunction
mani fest edbyasuddenl ossofmot or,sensor y, orvisual f
unct i
on.
-Itmayl astaf ewsecondsormi nut esbutnotl ongert han24hour s.
-Compl et er ecov eryusual lyoccur sbet weenat tacks.
-Thesy mpt omsr esultfr
om t empor aryimpai r
mentofbl oodf l
owt oaspeci fic
regionoft hebr ainduet oat heroscl erosis, obstructionofcer ebral
mi croci
r culat i
onbyasmal l embol us, adecr easei ncer ebralperfusionpr essure
(CPP) ,orcar diacdy srhyt
hmi as.
-ATI Amayser veasawar ningofi mpendi ngst roke, whi chhasi tsgreatest
i
nci dencei nt hef irstmont haf t
erthef ir
stat tack.
-Lackofev aluationandt reat mentofapat ientwhohasexper i
encedpr ev i
ous
TIAsmayr esul tinast rokeandi r
rev ersibl
edef i
ci t
s.
(1)‫ﺓ‬ ‫ﺮ‬
‫ﺑ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬(
TIA)
-‫ﻭ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻛ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎﺟﺊ‬‫ﻔ‬‫ﺍﻥﻣ‬ ‫ﺪ‬‫ﻘ‬‫ﻔ‬‫ﻠﻰﺑ‬‫ﺘﺠ‬ ‫ﺒﻲﺗ‬ ‫ﻔﻲﻋﺼ‬ ‫ﻴ‬‫ﻠﻞﻭﻇ‬ ‫ﺔﻣﻦﺧ‬ ‫ﺘ‬‫ﻗ‬‫ﺆ‬‫ﺔﻣ‬‫ﺑ‬‫ﻮ‬‫ﺓﻧ‬‫ﺮ‬‫ﺑ‬
‫ﺎ‬‫ﺔﻋ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬‫ﺔﺇ‬‫ﺑ‬
‫ﻮ‬‫ﻧ‬
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﺒﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻟﺤﺴ‬‫ﺍ‬
.
-‫ﺔ‬ ‫ﺎﻋ‬‫ﺳ‬24‫ﺪﻋﻦ‬ ‫ﻳ‬‫ﺰ‬‫ﻜﻦﻻﺗ‬ ‫ﻟ‬‫ﺋﻖﻭ‬‫ﺎ‬‫ﻗ‬‫ﻭﺩ‬‫ﺃ‬ٍ‫ﺍ‬
‫ﻥ‬ ‫ﻮ‬‫ﻊﺛ‬‫ﺮﺑﻀ‬ ‫ﻤ‬‫ﺘ‬
‫ﺪﺗﺴ‬.‫ﻗ‬
-‫ﺎﺕ‬‫ﻤ‬‫ﻬﺠ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻡﻋ‬ ‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﺪﺙ‬‫ﻳﺤ‬.
-‫ﻴﻦ‬ ‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻠﺐ‬ ‫ﺒﺐﺗﺼ‬ ‫ﺎﻍﺑﺴ‬ ‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻨ‬‫ﻴ‬
‫ﻌ‬‫ﺔﻣ‬ ‫ﻘ‬‫ﻨﻄ‬ ‫ﻟﻰﻣ‬‫ﻡﺇ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﻗﺖﻓﻲﺗ‬ ‫ﺆ‬‫ﻌﻒﻣ‬ ‫ﺍ ﺽﻋﻦ ﺿ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﻨﺠﻢ‬‫ﺗ‬،
‫ﺎﻏﻲ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎ ﺽﺿ‬‫ﻔ‬ ‫ﻧﺨ‬‫ﺍ‬‫ﻭ‬،
‫ﺓﺃ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬

193
 (CPP)‫ﺒﻲ‬ ‫ﻠ‬
‫ﻘ‬ ‫ﻟ‬‫ﺍ‬
‫ﻨﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺏ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﻭ‬،
‫ﺃ‬.
-‫ﺪﻝ‬ ‫ﻌ‬ ‫ﻮﻥﻣ‬ ‫ﻜ‬‫ﺘﻲﻳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺔ‬‫ﻜ‬‫ﻴ‬‫ﻮﺷ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻳ‬
‫ﺬ‬‫ﺔﺗﺤ‬ ‫ﺑ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬ ‫ﺓﺑ‬ ‫ﺮ‬‫ﺑ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬‫ﺍﻹ‬ ‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﺗ‬‫ﻗ‬
‫ﻟﻰ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻌ‬ ‫ﻷﻝﺑ‬‫ﺍﻭ‬ ‫ﺮ‬‫ﻬ‬‫ﻟﺸ‬‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺎ‬‫ﻬ‬‫ﺛ‬‫ﻭ‬‫ﺪ‬‫ﺣ‬.
-‫ﻭﺙ‬ ‫ﺪ‬ ‫ﻟﻰﺣ‬ ‫ﺔﺇ‬ ‫ﻘ‬‫ﺑ‬‫ﺎ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺓ‬ ‫ﺮ‬
‫ﺑ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬ ‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻘﺺ‬ ‫ﺎﺕﻧ‬‫ﺑ‬‫ﻮ‬‫ﻧﻰﻣﻦﻧ‬ ‫ﺎ‬
‫ﺬﻱﻋ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢﻭﻋﻼﺝ‬ ‫ﻴ‬
‫ﻘ‬‫ﻡﺗ‬ ‫ﺪ‬‫ﺩﻱﻋ‬ ‫ﺆ‬
‫ﺪﻳ‬ ‫ﻗ‬
‫ﻪ‬‫ﻴ‬ ‫ﺔﻓ‬ ‫ﻌ‬‫ﺰﻻﺭﺟ‬ ‫ﻋﺠ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﺘ‬‫ﻜ‬‫ﺳ‬.
(2)Rev er siblei schemi cneur ologicdef i
cit
-Rev ersi blei schemi cneur ol ogicdef icitssignsandsy mpt omsar econsi stent
withbutmor epr onouncedt hanaTI Aandl astmor ethan24hour s.
-Sympt omsr esol v einday swi thnoper manentneur ologi cdef icit.
(3)St rokei nev ol ution
-Strokei nev olut ionwor seni ngofneur ologicsignsandsy mpt omsov ersev eral
minut esorhour s.Thi si sapr ogr essingst roke.
(4)Compl etedst roke
-Compl etedst rokest abili
zat i
onoft heneur ologicsignsandsy mpt oms.
-Thisi ndi cat esnof urtherpr ogr essionoft hehy poxicinsul ttot hebr ainf r
om
thi
spar ticul arischemi cev ent .
‫ﻜﺴﻲ‬ ‫ﺭﻱﻋ‬ ‫ﺎ‬
‫ﻔ‬ ‫ﻗ‬
‫ﺒﻲﺇ‬ ‫ﺰﻋﺼ‬ ‫(ﻋﺠ‬ 2)
‫ﺓ‬‫ﺮ‬
‫ﺑ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬ ‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬ ‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬‫ﺘﺴﻖﻣ‬ ‫ﻜﺲﺗ‬ ‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻠ‬
‫ﺑ‬‫ﺎ‬
‫ﺔﻗ‬ ‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬‫ﺍﻹ‬ ‫ﺔ‬
‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻘﺺ‬ ‫ﺍ ﺽﻧ‬‫ﺮ‬‫ﺃﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﺇﻥﻋﻼ‬-
.
‫ﺔ‬‫ﺎﻋ‬‫ﺳ‬24‫ﺮﻣﻦ‬ ‫ﺜ‬‫ﻛ‬‫ﺮﻷ‬‫ﻤ‬‫ﺘ‬‫ﺗﺴ‬‫ﺓﻭ‬ ‫ﺮ‬‫ﺑ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﻔ‬‫ﻗ‬ ‫ﺍﻹ‬ ‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻣﻦ‬ ‫ﻮﺣ‬‫ﺮﻭﺿ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﺎ‬‫ﻬ‬‫ﻨ‬‫ﻜ‬
‫ﻟ‬‫ﻭ‬
.‫ﺋﻢ‬‫ﺍ‬
‫ﺒﻲﺩ‬ ‫ﺰﻋﺼ‬ ‫ﻭﻥﻋﺠ‬ ‫ﺪ‬‫ﻡﺑ‬ ‫ﺎ‬
‫ﻳ‬ ‫ﺃ‬‫ﺍ ﺽﺧﻼﻝ‬ ‫ﺮ‬‫ﺍﻷﻋ‬ ‫ﻔﻲ‬ ‫ﺘ‬
‫ﺗﺨ‬-
‫ﺭ‬‫ﻮ‬ ‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺘ‬
‫ﻜ‬ ‫ﻟﺴ‬‫ﺍ‬(3)
‫ﺍ‬‫ﺬ‬
‫ﻫ‬. ‫ﺎﺕ‬ ‫ﺎﻋ‬‫ﻭﺳ‬ ‫ﺃ‬‫ﺋﻖ‬ ‫ﺎ‬
‫ﻗ‬ ‫ﺓﺩ‬ ‫ﺪ‬‫ﺪﻯﻋ‬ ‫ﻠﻰﻣ‬ ‫ﺔﻋ‬ ‫ﻴ‬‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻗﻢ‬‫ﺎ‬‫ﻔ‬ ‫ﺎﺗ‬‫ﺭﻫ‬‫ﻮ‬ ‫ﺔﻓﻲﺗﻄ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬-
.‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻘ‬
‫ﻮﺗ‬ ‫ﻫ‬
‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻠﺖ‬ ‫ﻤ‬‫ﺘ‬‫ﻛ‬‫ﺍ‬(4)
.‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﺎﺕﻭ‬ ‫ﻣ‬
‫ﻌﻼ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻘ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺎﻝ‬ ‫ﻤ‬
‫ﺘ‬‫ﻛ‬‫ﺍ‬-
‫ﺭﻱ‬‫ﺎ‬‫ﻔ‬ ‫ﻗ‬‫ﺍﻹ‬ ‫ﺪﺙ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺍ‬‫ﺬ‬‫ﺎﻍﻣﻦﻫ‬ ‫ﻣ‬‫ﺪ‬ ‫ﻠ‬
‫ﻟ‬ ‫ﻴﻦ‬‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻘﺺ‬ ‫ﺔﻧ‬‫ﻧ‬‫ﺎ‬‫ﻡﻹﻫ‬ ‫ﺪ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬ ‫ﺰ‬‫ﺩﻣ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻟﻰﻋ‬‫ﺍﺇ‬ ‫ﺬ‬
‫ﺮﻫ‬ ‫ﻴ‬
‫ﻳﺸ‬-
.‫ﺩ‬‫ﺪ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬

AssessmentandDi agnosticFi ndi

ngs
-Ini
ti
alassessmentf ocuseson:
Airwaypat ency ,whichmaybecompr omisedbyl ossofgagorcoughr eflexes
andalteredr espir
ator ypattern.

Cardiovascul arstatus( i
ncludingbloodpr essure,
cardiacrhythm andr ate,
caroti
dbr ui
t);andgr ossneur ol
ogicdefici
ts.
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻧ‬
:‫ﻠﻰ‬‫ﻟﻲﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻛ‬‫ﺮ‬‫ﻳ‬-
.
‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻂ‬‫ﺮﻧ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬‫ﺎﻝﻭ‬‫ﻌ‬
‫ﻟﺴ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻊ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻞ‬‫ﺩﻓ‬‫ﻭ‬‫ﺩ‬‫ﺍﻥﺭ‬‫ﺪ‬‫ﻘ‬
‫ﻔ‬‫ﺮﺑ‬‫ﺛ‬
‫ﺄ‬‫ﺘ‬‫ﺪﺗ‬‫ﺘﻲﻗ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬، ‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﻴ‬‫ﻜ‬‫ﻟ‬‫ﺎ‬
‫•ﺳ‬
‫ﺎﻥ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺸ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬،‫ﺪﻝ‬ ‫ﻌ‬‫ﻣ‬
‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﻧﻈﻢ‬، ‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﻟﻚ ﺿ‬‫)ﺎﻓﻲﺫ‬‫ﻤ‬
‫ﺔﺑ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬
‫ﻠﺐﻭ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺣﺔ‬
‫ﻟ‬
‫• ﺎ‬
.‫ﻴﻢ‬
‫ﻟﺠﺴ‬‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬.(‫ﺗﻲ‬‫ﺎ‬‫ﺒ‬
‫ﻟﺴ‬‫ﺍ‬

-Thei niti
aldiagnostictestforast rokeisacomput edt omogr aphy(CT)scan
performedemer gentl
ytodet er
mi nei ft
heev enti
sischemi corhemor r
hagi c(t
he
categor yofst r
okedet erminestreatment )
.
-Furtherdiagnost icwor kupforischemi cstr
okeinvolvesattempt i
ngt oidentif
y
thesour ceoft het hr
ombi orembol i
.
-A12- leadel ect
rocardiogram (ECG)andacar oti
dultr
asoundar estandar dtests.
-Otherst udiesmayi ncludecer ebralangiography
,tr
ans-cranialDopplerflow

194
‫‪st‬‬‫‪udi‬‬
‫‪es,‬‬‫‪t‬‬‫‪r‬‬
‫‪anst‬‬‫‪hor‬‬‫‪aci‬‬
‫‪cort‬‬‫‪r‬‬
‫‪ans-‬‬
‫‪esophageal‬‬‫‪echocar‬‬‫‪di‬‬
‫‪ogr‬‬
‫‪aphy‬‬
‫‪,‬‬‫‪magnet‬‬
‫‪i‬‬‫‪c‬‬
‫‪r‬‬‫‪esonancei‬‬‫‪magi‬‬‫(‪ng‬‬‫‪MRI‬‬‫‪)oft‬‬
‫‪hebr‬‬‫‪ai‬‬
‫‪n,‬‬‫‪neck,‬‬‫‪orbot‬‬‫‪h.‬‬

‫ﺘﻢ‬
‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬‫(‬‫ﻮﺳﺐ)‪CT‬‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻲ‬‫ﻘﻄ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﻮﻓﺤ ﺺ‬ ‫ﺔﻫ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬‫ﻠﺴ‬‫ﻟ‬‫ﻟﻲ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﻴﺼﻲ‬‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺧ‬‫‪-‬‬
‫‪.‬‬‫(‬
‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﺔﺗﺤ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬
‫ﺌ‬‫ﻓ‬‫ﺎ)‬‫ً‬
‫ﻔ‬
‫ﻳ‬‫ﺰ‬‫ﻡﻧ‬‫ﺃ‬
‫ﺎ‬‫ً‬
‫ﻳ‬‫ﺭ‬
‫ﺎ‬‫ﻔ‬‫ﻗ‬‫ﺪﺙﺇ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬
‫ﺎﺇ‬‫ﺪﻣ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬‫ﺭﺉ‬‫ﺎ‬
‫ﻜﻞﻃ‬ ‫ﻩﺑﺸ‬‫ﺅ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬
‫‪.‬‬‫ﺎﺕ‬‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﺪ‬‫ﺪﻣﺼ‬‫ﻳ‬‫ﺪ‬‫ﺔﺗﺤ‬‫ﻟ‬‫ﻭ‬
‫ﺎ‬‫ﻤﻦﻣﺤ‬‫ﺘﻀ‬ ‫ﺔﻳ‬‫ﻴ‬‫ﻏ‬
‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﺘ‬
‫ﻜ‬‫ﻠﺴ‬‫ﻟ‬‫ﻴﺼﻲ‬‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬‫ﻳ‬‫ﺰ‬‫‪-‬ﻣ‬
‫ﺎﻥ‬
‫ﻳ‬‫ﺮ‬‫ﻠﺸ‬‫ﻟ‬‫ﺔ‬
‫ﻴ‬‫ﺗ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﻮﻕ‬‫ﺎﺕﻓ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫(ﻭ‬‫ﺎ)‪ECG‬‬‫ﺎً‬
‫ﺻ‬ ‫ﻮﻥﻣﻦ‪12‬ﺭﺻ‬ ‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻲ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻠﺐ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻂ‬‫ﺪﺗﺨﻄ‬‫ﻌ‬‫‪-‬ﻳ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﻴ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬
‫ﻣﺍﻻﺧ‬
‫ﺗﻲ ﻦ‬ ‫ﺎ‬
‫ﺒ‬‫ﻟﺴ‬
‫ﺍ‬
‫ﻴﻂ‬
‫ﻭﺗﺨﻄ‬ ‫ﺃ‬‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﺮﻋ‬‫ﻠ‬‫ﺑ‬
‫ﻭ‬‫ﻓﻖﺩ‬‫ﺪ‬‫ﺎﺕﺗ‬‫ﺍﺳ‬‫ﺭ‬‫ﻭﺩ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﻏ‬ ‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺮﻯﺗﺼ‬ ‫ﺍﻷﺧ‬ ‫ﺎﺕ‬
‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬‫‪-‬ﻗ‬
‫ﻭ‬
‫ﺃ‬ ‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻠ‬
‫ﻟ‬‫(‬‫‪MRI‬‬‫ﻴﺴﻲ)‬‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬
‫ﻧ‬‫ﺮ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬
‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺀ‬‫ﺮﻱ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺒ‬
‫ﻭﻋ‬ ‫ﺃ‬‫ﺭ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺮ‬
‫ﺒ‬‫ﻠﺐﻋ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﺻ‬
‫‪.‬‬‫ﺎ‬
‫ﻤ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬
‫ﻛ‬

‫‪-Pr‬‬ ‫‪ev‬‬‫‪ent‬‬ ‫‪i‬‬

‫‪on‬‬
‫‪Pr‬‬‫‪i‬‬‫‪mar‬‬ ‫‪ypr‬‬ ‫‪ev‬‬ ‫‪ent‬‬‫‪i‬‬
‫‪onofi‬‬ ‫‪schemi‬‬ ‫‪cst‬‬ ‫‪r‬‬
‫‪oker‬‬ ‫‪emai‬‬ ‫‪nst‬‬ ‫‪hebestappr‬‬ ‫‪oach.‬‬
‫‪-St‬‬‫‪r‬‬ ‫‪oker‬‬ ‫‪i‬‬
‫‪skscr‬‬ ‫‪eeni‬‬‫‪ngsar‬‬ ‫‪eani‬‬ ‫‪deal‬‬ ‫‪oppor‬‬ ‫‪t‬‬‫‪uni‬‬‫‪t‬‬‫‪yt‬‬ ‫‪ol‬‬‫‪owerst‬‬‫‪r‬‬‫‪oker‬‬ ‫‪i‬‬‫‪skby‬‬
‫‪i‬‬
‫‪dent‬‬ ‫‪i‬‬
‫‪f‬‬‫‪y‬‬‫‪i‬‬‫‪ngpeopl‬‬ ‫‪eorgr‬‬ ‫‪oupsofpeopl‬‬ ‫‪ewhoar‬‬ ‫‪eathi‬‬ ‫‪ghr‬‬‫‪i‬‬‫‪skf‬‬‫‪orst‬‬ ‫‪r‬‬‫‪okeandby‬‬
‫‪educat‬‬ ‫‪i‬‬
‫‪ngpat‬‬ ‫‪i‬‬
‫‪ent‬‬‫‪sandt‬‬ ‫‪hecommuni‬‬ ‫‪t‬‬‫‪yaboutr‬‬ ‫‪ecogni‬‬‫‪t‬‬‫‪i‬‬
‫‪onandpr‬‬ ‫‪ev‬‬ ‫‪ent‬‬ ‫‪i‬‬
‫‪onof‬‬
‫‪st‬‬‫‪r‬‬‫‪oke.‬‬
‫‪-Al‬‬‫‪t‬‬‫‪erorcont‬‬ ‫‪r‬‬
‫‪ol‬‬‫‪l‬‬
‫‪i‬‬‫‪ngmodi‬‬ ‫‪f‬‬‫‪i‬‬
‫‪abl‬‬‫‪er‬‬‫‪i‬‬‫‪skf‬‬‫‪act‬‬‫‪or‬‬ ‫‪sf‬‬‫‪ori‬‬ ‫‪schemi‬‬ ‫‪cst‬‬‫‪r‬‬‫‪okei‬‬ ‫‪ncl‬‬‫‪ude‬‬
‫‪hy‬‬‫‪per‬‬ ‫‪t‬‬‫‪ensi‬‬‫‪on,‬‬ ‫‪car‬‬‫‪di‬‬
‫‪ov‬‬ ‫‪ascul‬‬‫‪ardi‬‬‫‪sease,‬‬ ‫‪hi‬‬‫‪ghchol‬‬ ‫‪est‬‬‫‪er‬‬‫‪ol‬‬
‫‪,‬‬‫‪obesi‬‬‫‪t‬‬‫‪y‬‬‫‪,‬‬‫‪smoki‬‬ ‫‪ng,‬‬‫‪and‬‬
‫‪di‬‬‫‪abet‬‬ ‫(‪es‬‬ ‫‪Forpeopl‬‬ ‫‪eathi‬‬ ‫‪ghr‬‬ ‫‪i‬‬
‫‪sk,‬‬‫‪t‬‬‫‪r‬‬
‫‪eat‬‬ ‫‪i‬‬
‫‪nghy‬‬ ‫‪per‬‬ ‫‪t‬‬‫‪ensi‬‬
‫‪onandhy‬‬ ‫‪per‬‬ ‫‪gl‬‬‫‪y‬‬‫‪cemi‬‬ ‫‪aand‬‬
‫‪st‬‬‫‪oppi‬‬ ‫‪ngsmoki‬‬ ‫‪ng,‬‬ ‫‪wi‬‬‫‪l‬‬
‫‪l‬‬‫‪r‬‬‫‪educest‬‬ ‫‪r‬‬‫‪oker‬‬ ‫‪i‬‬
‫)‪sk‬‬ ‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫‪-‬ﻭ‬
‫‪.‬‬‫ﻬﺞ‬‫ﻓﻀﻞﻧ‬ ‫ﺃ‬‫ﺔﻫﻲ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬ ‫ﺍﻷ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺗﻈﻞ‬
‫ﻳﻖ‬‫ﺮ‬‫ﺔﻋﻦﻃ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻃ‬‫ﻴﻞﻣﺨ‬ ‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺜ‬‫ﺔﻣ‬ ‫ﺮﺻ‬ ‫ﺔﻓ‬ ‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺮ‬‫ﺎﻃ‬‫ﺎﺕﻣﺨ‬ ‫ﻮﺻ‬‫ﺪﻓﺤ‬ ‫ﻌ‬
‫‪-‬ﺗ‬
‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻘ‬‫ﺜ‬‫ﺗ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﻟﺨﻄ‬ ‫ﻴﻦ‬ ‫ﺮﺿ‬‫ﻌ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬ ‫ﺎﺹ‬‫ﺍﻷﺷﺨ‬ ‫ﺎﺕ‬‫ﻮﻋ‬‫ﻤ‬‫ﻭﻣﺠ‬ ‫ﺃ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﺪ‬‫ﻳ‬
‫ﺪ‬‫ﺗﺤ‬
‫‪.‬‬
‫ﺎ‬‫ﻬ‬
‫ﻨ‬‫ﺔﻣ‬ ‫ﻳ‬‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝ‬‫ﻊﺣ‬ ‫ﻤ‬
‫ﺘ‬‫ﻤﺠ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬
‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﺃ‬‫ﻡﻭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﻤﻞ‬‫ﺔﺗﺸ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬
‫ﻜ‬ ‫ﻠﺴ‬‫ﻟ‬‫ﻳﻞ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻠ‬‫ﺑ‬‫ﺎ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺨﻄ‬‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻜﻢﻓﻲﻋ‬ ‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻳﻞ‬‫ﺪ‬‫ﻌ‬
‫‪-‬ﺗ‬
‫ﺎﺹ‬ ‫ﻟﻸﺷﺨ‬ ‫ﺔ‬
‫ﺒ‬‫ﻨﺴ‬‫ﻟ‬‫ﺎ‬
‫ﺑ‬‫ﺮﻱ)‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬‫ﻴﻦﻭ‬ ‫ﺪﺧ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻨ‬
‫ﻤ‬ ‫ﻟﺴ‬‫ﺍ‬
‫ﻭﻝﻭ‬ ‫ﺮ‬‫ﺘ‬‫ﻴﺴ‬‫ﻟ‬
‫ﻮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬
‫ﺍﻷ‬‫ﻠﺐﻭ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻠﻞ‬‫ﻘ‬‫ﻴﻦﻳ‬ ‫ﺪﺧ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻗﻒﻋﻦ‬ ‫ﻮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺈﻥﻋﻼﺝ‬ ‫‪،‬ﻓ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﺮﻛ‬ ‫ﻟﺨﻄ‬‫ﻴﻦ‬‫ﺮﺿ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫(‬‫ﺔ‬
‫ﻴ‬‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﻣﻦﺧﻄ‬

‫‪-Manyheal‬‬ ‫‪t‬‬‫‪hpr‬‬‫‪omot‬‬‫‪i‬‬‫‪onef‬‬‫‪f‬‬‫‪or‬‬‫‪t‬‬‫‪si‬‬‫‪nv‬‬ ‫‪ol‬‬‫‪v‬‬‫‪eencour‬‬‫‪agi‬‬

‫‪ngaheal‬‬ ‫‪t‬‬‫‪hyl‬‬‫‪i‬‬
‫‪f‬‬‫‪est‬‬‫‪y‬‬‫‪l‬‬
‫‪e,‬‬
‫‪i‬‬
‫‪ncl‬‬‫‪udi‬‬‫‪ngeat‬‬ ‫‪i‬‬‫‪ngal‬‬‫‪ow-‬‬‫‪f‬‬‫‪at‬‬‫‪,‬‬‫‪l‬‬
‫‪ow-‬‬ ‫‪chol‬‬‫‪est‬‬‫‪er‬‬‫‪ol‬‬‫‪di‬‬
‫‪etandi‬‬‫‪ncr‬‬‫‪easi‬‬‫‪ngexer‬‬‫‪ci‬‬‫‪se.‬‬
‫‪-Recentev‬‬ ‫‪i‬‬‫‪dencesuggest‬‬ ‫‪st‬‬‫‪hateat‬‬ ‫‪i‬‬‫‪ngf‬‬ ‫‪i‬‬
‫‪sht‬‬‫‪woormor‬‬ ‫‪et‬‬ ‫‪i‬‬
‫‪mesperweek‬‬
‫‪r‬‬‫‪educest‬‬ ‫‪her‬‬ ‫‪i‬‬
‫‪skoft‬‬‫‪hr‬‬‫‪ombot‬‬ ‫‪i‬‬
‫‪cst‬‬ ‫‪r‬‬‫‪okef‬‬ ‫‪orwomen.‬‬
‫‪-Sev‬‬‫‪er‬‬‫‪al‬‬‫‪met‬‬ ‫‪hodsofpr‬‬ ‫‪ev‬‬‫‪ent‬‬‫‪i‬‬
‫‪ngr‬‬ ‫‪ecur‬‬ ‫‪r‬‬‫‪entst‬‬
‫‪r‬‬‫‪okehav‬‬‫‪ebeeni‬‬ ‫‪dent‬‬‫‪i‬‬‫‪f‬‬
‫‪i‬‬‫‪edf‬‬‫‪or‬‬
‫‪pat‬‬‫‪i‬‬
‫‪ent‬‬‫‪swi‬‬ ‫‪t‬‬‫‪hTI‬‬ ‫‪Asormi‬‬ ‫‪l‬‬
‫‪di‬‬‫‪schemi‬‬ ‫‪cst‬‬ ‫‪r‬‬‫‪oke.‬‬
‫‪-I‬‬‫‪npat‬‬‫‪i‬‬‫‪ent‬‬‫‪swi‬‬ ‫‪t‬‬
‫‪hat‬‬‫‪r‬‬‫‪i‬‬
‫‪al‬‬ ‫‪f‬‬
‫‪i‬‬‫‪br‬‬‫‪i‬‬
‫‪l‬‬‫‪l‬‬
‫‪at‬‬‫‪i‬‬
‫‪on,‬‬ ‫‪whi‬‬ ‫‪chi‬‬‫‪ncr‬‬
‫‪easest‬‬‫‪her‬‬ ‫‪i‬‬
‫‪skofembol‬‬ ‫‪i‬‬
‫‪,‬‬
‫‪admi‬‬‫‪ni‬‬‫‪st‬‬‫‪r‬‬‫‪at‬‬‫‪i‬‬
‫‪onofwar‬‬ ‫‪f‬‬‫‪ar‬‬‫‪i‬‬‫(‪n‬‬‫‪Coumadi‬‬ ‫)‪n‬‬‫‪,‬‬‫‪anant‬‬‫‪i‬‬
‫‪coagul‬‬‫‪antt‬‬‫‪hati‬‬‫‪nhi‬‬
‫‪bi‬‬‫‪t‬‬‫‪scl‬‬
‫‪ot‬‬
‫‪f‬‬‫‪or‬‬‫‪mat‬‬‫‪i‬‬‫‪on,‬‬‫‪maypr‬‬ ‫‪ev‬‬‫‪entbot‬‬‫‪ht‬‬ ‫‪hr‬‬‫‪ombot‬‬ ‫‪i‬‬
‫‪candembol‬‬ ‫‪i‬‬‫‪cst‬‬‫‪r‬‬‫‪okes.‬‬

‫ﻡ‬‫ﺎ‬‫ﺎﻉﻧﻈ‬‫ﺒ‬‫ﺗ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫‪،‬ﺑ‬‫ﺓ ﺻﺤﻲ‬‫ﺎ‬‫ﻴ‬‫ﻤﻂﺣ‬ ‫ﺎﻉﻧ‬
‫ﺒ‬‫ﺗ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻊﻋ‬ ‫ﻴ‬
‫ﺘﺸﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟﺼﺤ‬‫ﺍ‬‫ﺰ‬‫ﻳ‬
‫ﺰ‬‫ﻌ‬‫ﺩﺗ‬‫ﻮ‬‫ﻬ‬
‫ﺪﻣﻦﺟ‬ ‫ﻳ‬‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻤﻦ‬‫ﺘﻀ‬ ‫‪-‬ﺗ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﺎﺿ‬‫ﻳ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬‫ﻭﻝﻭ‬ ‫ﺮ‬
‫ﺘ‬‫ﻴﺴ‬‫ﻟ‬
‫ﻮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥﻭ‬ ‫ﺪﻫ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺾ‬ ‫ﻨﺨ‬‫ﺋﻲﻣ‬ ‫ﺍ‬
‫ﺬ‬ ‫ﻏ‬
‫ﺔ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﻠﻞﻣﻦﺧﻄ‬ ‫ﻘ‬‫ﻮﻉﻳ‬‫ﺒ‬‫ﺍﻷﺳ‬‫ﺮﻓﻲ‬‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬
‫ﺗ‬‫ﺮ‬‫ﻤﻚﻣ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺃﻥﺗ‬‫ﻟﻰ‬‫ﺔﺇ‬‫ﺜ‬‫ﻳ‬‫ﺪ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻻﻞ‬
‫ﺪﺋ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬
‫‪-‬ﺗﺸ‬
‫‪.‬‬‫ﺀ‬
‫ﺎ‬‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬ ‫ﻟ‬
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﺜ‬‫ﻟﺨ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺔ‬
‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬‫ﺍ‬‫‪T‬ﻭ‬
‫‪I‬ﺃ‬ ‫ﻮﻥﻣﻦ‪As‬‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬ ‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺓ‬‫ﺭ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔﻣﻦ‬‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﺮﻕ‬‫ﺓﻃ‬ ‫ﺪ‬
‫ﺪﻋ‬ ‫ﻳ‬
‫ﺪ‬ ‫‪-‬ﻢﺗﺤ‬‫ﺗ‬
‫‪.‬‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﺈﻥﺇﻋﻄ‬‫‪،‬ﻓ‬‫ﺎﺕ‬‫ﻤ‬
‫ﻟﺼ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺮ‬‫ﺪﻣﻦﺧﻄ‬ ‫ﻳ‬
‫ﺰ‬‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬‫‪،‬‬
‫ﻨﻲ‬‫ﻳ‬‫ﺫ‬‫ﺍﻷ‬‫ﺎﻥ‬
‫ﻔ‬‫ﺮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫‪-‬ﻓﻲ‬

‫‪195‬‬
‫ﺔ‬
‫ﻳ‬‫ﺭ‬‫ﺎ‬
‫ﺜ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺘ‬
‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻊ‬‫ﻨ‬
‫ﻤ‬‫ﺪﻳ‬
‫ﻗ‬،‫ﺎﺕ‬
‫ﻠﻄ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻳﻦ‬
‫ﻮ‬‫ﻜ‬‫ﻊﺗ‬
‫ﻨ‬‫ﻤ‬‫ﻠﻂﻳ‬
‫ﺘﺠ‬‫ﻠ‬
‫ﻟ‬‫ﺩ‬‫ﺎ‬
‫ﻮﻣﻀ‬
‫ﻭﻫ‬،
(‫ﻳﻦ‬
‫ﺩ‬‫ﺎ‬‫ﻣ‬
‫ﻮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
)‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻓ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻴ‬‫ﻣ‬
‫ﺎ‬‫ﻧﺴ‬
‫ﺍﻻ‬‫ﻭ‬

Medi calmanagement :
-ACVAi samedi calemer gency.Treatmentv ari
esandisdirect edt owar
d
rel
i
ev ingthecause, i
fknown.
-Tissueplasmi nogenact i
v at
or(TPA) .
-At hrombolyti
cagenthasbeenf oundt olimi tneurol
ogicdefi
ci tswhengi v
en
wit
hi n3hour saftertheonsetofani schemi cCVA.I tiscontr
aindi catedi
n
hemor rhagi
cCVAs, asi santi
coagulantt herapy.
-Patientswhohav eexper i
encedaTI Aorst rokeshouldhavemedi cal
managementf orsecondar ypreventi
on.Thosewi thatri
alf
ibri
llation(orcardio
embol icstr
okes)ar etreatedwi t
hdose- adjustedwar f
ari
nsodi um ( Coumadi n)
unl
esscont raindicated.

:‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
.‫ﺎ‬ً
‫ﻓ‬
‫ﻭ‬‫ﺮ‬‫ﻌ‬‫ﺎﻥﻣ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬،‫ﺒﺐ‬‫ﻟﺴ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬
‫ﺪﻑﺗﺨ‬ ‫ﻬ‬‫ﺘ‬
‫ﻳﺴ‬‫ﻌﻼﺝﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻉ‬‫ﻨ‬‫ﺘ‬
‫ﻳ‬.‫ﺔ‬‫ﺋ‬‫ﺭ‬
‫ﺎ‬‫ﺔﻃ‬ ‫ﻴ‬
‫ﺒ‬‫ﺣﺔﻃ‬‫ﻟ‬
‫ﻫﻲ ﺎ‬CVA-
.
(TPA)‫ﻴﻦ‬ ‫ﻮﺟ‬‫ﻨ‬‫ﻴ‬‫ﻣ‬‫ﺯ‬
‫ﺒﻼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻨﺸﻂ‬‫ﻣ‬-
‫ﺍﻹ‬
‫ﺔ‬‫ﻳ‬‫ﺍ‬
‫ﺪ‬‫ﺪﺑ‬‫ﻌ‬‫ﺎﺕﺑ‬‫ﺎﻋ‬‫ﺳ‬3‫ﻮﻥ‬ ‫ﻪﻓﻲﻏﻀ‬ ‫ﺋ‬‫ﺎ‬
‫ﺪﺇﻋﻄ‬‫ﻨ‬‫ﺒﻲﻋ‬‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺰ‬
‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻠﺤ‬‫ﻟ‬
‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺎ‬‫ﻠﻰﻋ‬‫ﺭﻋ‬ ‫ﻮ‬‫ﺜ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻢ‬-
‫ﺗ‬
.
‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬‫ﻠ‬
‫ﻟ‬‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺬ‬‫ﻛ‬‫ﻭ‬،‫ﺔ‬‫ﻴ‬
‫ﻓ‬‫ﺰ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬CVAs‫ﻮﺑﻄﻼﻥﻓﻲ‬ ‫ﻫ‬.‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﺎ‬‫ﻔ‬
‫ﻗ‬‫ﺔﺇ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺔﺩ‬ ‫ﺘ‬‫ﻜ‬
‫ﺔﺑﺴ‬ ‫ﺑ‬
‫ﺎ‬‫ﺻ‬
‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﺓﻃ‬ ‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺔﻹ‬‫ﻴ‬‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺘ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺓ‬‫ﺮ‬‫ﺑ‬
‫ﺎ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﺎ‬‫ﻔ‬
‫ﻗ‬‫ﺍﻹ‬‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻣﻦ‬‫ﻮ‬ ‫ﻧ‬
‫ﺎ‬‫ﻳﻦﻋ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺃﻥﻳﺨﻀ‬ ‫ﻳﺠﺐ‬-
(‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻠ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻤ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺘ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
)‫ﻨﻲ‬‫ﻳ‬‫ﺫ‬‫ﺍﻷ‬
‫ﺎﻥ‬‫ﻔ‬‫ﺮﺟ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺌﻚ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬.‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻠ‬
‫ﻟ‬
.
‫ﻟﻚ‬‫ﺘﻢﺑﻄﻼﻥﺫ‬‫ﻟﻢﻳ‬‫(ﺎ‬
‫ﻳﻦ ﻣ‬‫ﺩ‬
‫ﺎ‬‫ﻣ‬‫ﻮ‬‫ﻛ‬)‫ﻡ‬‫ﻮ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬
‫ﻳﻦ ﺻ‬‫ﺭ‬‫ﺎ‬‫ﻓ‬
‫ﺭ‬‫ﺍ‬‫ﺔﻭ‬‫ﺮﻋ‬‫ﻮﻥﺑﺠ‬ ‫ﻟﺠ‬
‫ﺎ‬‫ﻌ‬‫ﻳ‬

Drugst opr eventort reatcerebrovasculardisorders:

1.Antiplatelet:
Aspiri
n:Decr easescl otproduct i
on
2.Thrombol yti
c:
Altepl
ase( Act i
vase);recombi nanttissueplasminogenactivator( r
-TPA).Re-
establ
ishesbl oodf lowt oischemi careasbydissolvingt
hrombi ,contr
aindicat
ed
i
npat i
ent swi t
hhi stor
yofcer ebrov ascul
araccidentorbleedingt endencies.
Sideeffect s:Cardiacdy sr
hy t
hmi as,hypotensi
on,bleedi
ngatv enousorar teri
al
accesssi t
es, nausea, vomiti
ng

:‫ﺟ‬
‫ﺎ‬‫ﻭﻋﻼﻬ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﻣﺍﻻﺿﻄ‬‫ﺔﻦ‬ ‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﺃ‬
:
‫ﺎﺕ‬‫ﻴﺤ‬‫ﻔ‬‫ﻠﺼ‬‫ﻟ‬‫ﺩ‬‫ﺎ‬‫ﻣﻀ‬.1
‫ﺔ‬‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫ﻧ‬‫ﻠﻞﻣﻦﺇ‬‫ﻘ‬‫ﻳ‬:‫ﻳﻦ‬‫ﺮ‬‫ﺒ‬
‫ﺍﻷﺳ‬
:
‫ﺓ‬‫ﺮ‬‫ﺜ‬‫ﻠﺨ‬‫ﻟ‬
‫ﺔ‬ ‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬.2
‫ﻟﻰ‬‫ﻡﺇ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﻴﺲﺗ‬‫ﺄﺳ‬
‫ﺪﺗ‬‫ﻴ‬‫ﻌ‬
‫ﻳ‬.(r
-TPA)‫ﻠﻒ‬ ‫ﺗ‬
‫ﺆ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻴﻦ‬‫ﻮﺟ‬‫ﻨ‬
‫ﻴ‬‫ﻣ‬‫ﺯ‬‫ﺒﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺸﻂ‬ ‫؛ﻣ‬(‫ﺯ‬
‫ﺎ‬‫ﻔ‬‫ﻴ‬‫ﺘ‬
‫ﻛ‬‫ﺃ‬)‫ﺯ‬‫ﺒﻼ‬‫ﻴ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻬﻢ‬
‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻳﻦ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻮﺑﻄﻼﻥﻓﻲ‬‫ﻭﻫ‬،‫ﺔ‬‫ﻠﻄ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬
‫ﺑ‬‫ﺍ‬
‫ﺫ‬‫ﻳﻖﺇ‬‫ﺮ‬‫ﻡﻋﻦﻃ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺮ‬‫ﻘ ﺺﺗ‬ ‫ﻧﻲﻣﻦﻧ‬‫ﺎ‬‫ﻌ‬
‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺎﻃﻖ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻳﻒ‬ ‫ﺰ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻴ‬‫ﻭﻣ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﻏ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬‫ﻋ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺩﺙ‬‫ﺍ‬
‫ﻮ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻳﺦﻣﻦ‬ ‫ﺭ‬‫ﺎ‬
‫ﺗ‬
‫ﻭ‬
‫ﺃ‬ ‫ﻴﻦ‬
‫ﻳ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻟﻰ‬‫ﻮﻝﺇ‬‫ﻮﺻ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬
‫ﻮ‬‫ﻳﻒﻓﻲﻣ‬ ‫ﺰ‬‫ﻧ‬،‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﺎ ﺽﺿ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬،‫ﺒﻲ‬‫ﻠ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻨﻈﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻞ‬‫ﺧ‬:‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻧ‬‫ﺎ‬‫ﻟﺠ‬‫ﺍ‬‫ﻵﺭ‬
‫ﺎ‬‫ﺍﺛ‬
‫ﺀ‬
‫ﻗﻲ‬، ‫ﺎﻥ‬‫ﻴ‬
‫ﺜ‬‫ﻏ‬، ‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬

Nursi
ngi nter
venti
on:
-Usecaut i
onwhenadmi ni
ster
ingwithhepar
inbecauseofi
ncr
easedr
iskf
or
hemorrhage( Monit
orPTandPTT).
-Appl
ypr essuretocont
rol
superfi
cialbl
eedi
ng.
3.Ant
icoagulants:

196
Hepari
nsodium:Inhi
bit
sthrombusandcl
otf
ormat
ion
Warfar
insodium (
Coumadin)
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.
(PTT‫ﻭ‬Moni
torPT)‫ﺰﻑ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻃ‬
‫ﺓﻣﺨ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺒﺐﺯ‬‫ﻳﻦﺑﺴ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺪﺗ‬‫ﻨ‬
‫ﺭﻋ‬ ‫ﺬ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻮﺧﻰ‬‫ﺗ‬-
.‫ﻟﺴﻄﺤﻲ‬‫ﺍ‬‫ﻳﻒ‬
‫ﺰ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬‫ﻠﺴ‬‫ﻟ‬‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬‫ﺭﺳ‬‫ﺎ‬
‫ﻤ‬‫ﻣ‬-
:‫ﺮ‬
‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻣﻀ‬.3
‫ﺓ‬‫ﺮ‬
‫ﺜ‬‫ﻟﺨ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻠﻄ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﻊﺗ‬‫ﻨ‬‫ﻤ‬
‫ﻳ‬:‫ﻡ‬‫ﻮ‬‫ﻳ‬‫ﺩ‬
‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬
(‫ﻳﻦ‬‫ﺩ‬‫ﺎ‬
‫ﻣ‬‫ﻮ‬‫ﻛ‬)‫ﻡ‬‫ﻮ‬‫ﻳ‬‫ﺩ‬‫ﻮ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻓ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻟ‬
‫ﺍ‬

Pati
entandf ami lyteachingf ort
hepat ientwi thcerebrovascularacci
dent:
Homecar efort hepat i
entwi thcerebrovascularaccident.Thenur seaddresses
thefol
lowingkeyar easandpoi ntswhent eachingthepat i
entandf amil
y.
A.Skincare:
-Knowhowt oinspectandcar ef
ort heskin.Apr essureulcerthatisbeginni
ng
todevelopmaynotcausedi scomf ort.
-Changeposi t
ionatl eastev ery2hour stor el
ievepressureonbony
prominences.
-Contactaheal thcareproviderimmedi atelyiftheskinisreddened, war
m, or
disr
upted.

:‫ﺋﻲ‬‫ﺎ‬
‫ﻏﻲﻭﻋ‬ ‫ﺎ‬
‫ﻣ‬‫ﺩﺙﺩ‬‫ﺎ‬‫ﺎﺏﺑﺤ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬
‫ﺗ‬
‫ﺔ‬‫ﻴ‬
‫ﻴﺴ‬‫ﺋ‬
‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻁ‬‫ﻘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻻﺕﻭ‬‫ﻤﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺘ‬
‫ﺗ‬.‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺋﻲﺩ‬‫ﺎ‬
‫ﻋ‬‫ﺩﺙﻭ‬ ‫ﺎ‬
‫ﺎﺏﺑﺤ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻨ‬‫ﺔﻣ‬‫ﻳ‬‫ﺎ‬
‫ﺭﻋ‬
.‫ﺳ‬
‫ﺓ‬‫ﺍﻷ ﺮ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬
‫ﺪﺗ‬ ‫ﻨ‬
‫ﺔﻋ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
:
‫ﺓ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬.‫ﺃ‬
‫ﺃﻱ‬
‫ﺭ‬‫ﻮ‬‫ﻬ‬
‫ﻟﻈ‬‫ﺍ‬‫ﺃﺕﻓﻲ‬‫ﺪ‬‫ﺘﻲﺑ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬‫ﺮﺣ‬‫ﺒﺐﻗ‬‫ﺪﻻﺗﺴ‬ ‫ﻗ‬.‫ﺑ‬
‫ﺎ‬
‫ﺔﻬ‬ ‫ﻳ‬
‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﺤ ﺺ‬ ‫ﻴ‬‫ﻔ‬
‫ﻴ‬‫ﻠﻰﻛ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬
‫ﺗ‬-
.
‫ﺎﺝ‬‫ﻋ‬‫ﺯ‬‫ﺇ‬
.‫ﺔ‬‫ﻴ‬
‫ﻤ‬ ‫ﻌﻈ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬
‫ﻮ‬‫ﺘ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻐﻂﻋ‬‫ﻟﻀ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬‫ﻷﻞ‬
‫ﺍﻗ‬‫ﻠﻰ‬‫ﻴﻦﻋ‬ ‫ﺘ‬
‫ﺎﻋ‬‫ﻊﻛﻞﺳ‬ ‫ﻮﺿ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻗﻢﺑ‬-
.
‫ﺎ‬ً
‫ﻘ‬‫ﻘ‬‫ﺘﺸ‬
‫ﻭﻣ‬ ‫ﺃ‬‫ﺎ‬
ً
‫ﺌ‬‫ﻓ‬
‫ﺍ‬‫ﻭﺩ‬‫ﺃ‬‫ﺍ‬
ً
‫ﺮ‬‫ﻤ‬‫ﺪﻣﺤ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬
‫ﺭﺇ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻴ‬‫ﻟﺼﺤ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻤ‬‫ﺗﺼﻞﺑ‬ ‫ﺍ‬
-

B.Bodyal i
gnment:
-Understandthatgoodbodyalignmenti simportant.
-Beablet odemonstratehowtoputj oint
sthroughaf ullROM.
-Perf
orm ROM exercisesseveralti
mesperdayorasor deredbythephysi
cian
orphysicalt
herapi
st.
-Knowhowt ousev ari
ousdevices,suchasr ol
l
edbl anket sorpill
ows,
to
supportorali
gnareasoft hebody,suchast heback, hips,andlegs.Beabl
et o
expl
aintheuseofaf oot
boardorotherdev i
cetopr eventf ootdrop.

:
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬‫ﻣﺤ‬.‫ﺏ‬
.‫ﺔ‬
‫ﻤ‬‫ﻬ‬‫ﺓﻣ‬‫ﺪ‬ ‫ﻴ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺍ‬
‫ﺫ‬‫ﺎ‬
‫ﺃﻥﻣﺤ‬ ‫ﻬﻢ‬
‫ﻓ‬‫ﺍ‬-
.
‫ﺔ‬‫ﻠ‬‫ﻣ‬
‫ﺎ‬‫ﻘﻂﻛ‬‫ﺓﻓ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬
‫ﺓﻗ‬‫ﺮ‬‫ﻛ‬‫ﺍ‬
‫ﻮﺻﻼﺕﻣﻦﺧﻼﻝﺫ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻊ‬
‫ﺔﻭﺿ‬ ‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﻴﺢﻛ‬‫ﻮﺿ‬ ‫ﻠﻰﺗ‬
‫ﺍﻋ‬ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻮﻥﻗ‬ ‫ﻜ‬‫ﻥﺗ‬-
‫ﺃ‬
.‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻟﺞ‬
‫ﺎ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﻴﺐ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻤ‬
‫ﻴ‬‫ﻠ‬‫ﻌ‬
‫ﻭﺣﺴﺐﺗ‬ ‫ﺃ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﺓﻣ‬‫ﺪ‬‫ﻋ‬ROM ‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬‫ﻤ‬‫ﺀﺗ‬‫ﺍ‬
‫ﺩ‬‫ﺃ‬-
‫ﺓ‬
‫ﺍ‬‫ﺫ‬‫ﺎ‬
‫ﻭﻣﺤ‬ ‫ﺃ‬
‫ﺪﻋﻢ‬ ‫ﻟ‬
،‫ﺔ‬‫ﻓ‬‫ﻮ‬‫ﻔ‬‫ﻠ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﺋ‬‫ﺎ‬
‫ﻮﺳ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺎﺕ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬،
‫ﺔ‬‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺰ‬‫ﻬ‬‫ﺍﻷﺟ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺔ‬‫ﻴ‬
‫ﻔ‬‫ﻴ‬‫ﻠﻰﻛ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺗ‬-
‫ﺃﻱ‬‫ﻭ‬‫ﺃ‬
‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬ ‫ﻨ‬
‫ﻡﻣﺴ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺮﺡ‬‫ﻠﻰﺷ‬ ‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻛﻦﻗ‬.‫ﻴﻦ‬‫ﻗ‬
‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻛ‬‫ﺭ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬
‫ﺮﻭ‬ ‫ﻬ‬‫ﻟﻈ‬‫ﺍ‬
‫ﺜﻞ‬‫ﻣ‬،‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺎﻃﻖﻣﻦ‬ ‫ﻨ‬‫ﻣ‬
.
‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻁ‬‫ﻘ‬‫ﻊﺳ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺮ‬‫ﺁﺧ‬ ‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﺟ‬

C.Nutr
iti
onandf
lui
ds:
-Besuretot
akef
lui
dsfrequent
ly.Ahi
ghf
lui
dint
akei
simpor
tantt
opr
event

197
urinar ytractcompl icati
ons.
-Consumeabal anceddi et,thisisimpor tanti nmaintai
ningopt imal healt
h.
-Itmaybeeasi ert otoleratesmal lmeal sandbet ween-
meal snackst hanthree
l
ar gemeal s.
-Taket i
met ochewf oodanddr inkf l
uids.
:‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬
‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-‫ﺝ‬
‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﺔﻣﻦﻣﻀ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬ ‫ﻠ‬
‫ﻟ‬‫ﻬﻢ‬ ‫ﺋﻞﻣ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﺎﺕﻛ‬ ‫ﻴ‬
‫ﻤ‬‫ﻭﻝﻛ‬ ‫ﺎ‬‫ﻨ‬‫ﺗ‬.
‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬
‫ﻜﻞﻣ‬‫ﺋﻞﺑﺸ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﻠﻰﺗ‬‫ﺮﺻﻲﻋ‬ ‫ﺍﺣ‬-
.‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻚ‬
‫ﺎ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬
.‫ﻠﻰ‬‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟﺼﺤ‬ ‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﻬﻢﻓﻲ‬‫ﺍﻣ‬‫ﺬ‬‫ﻭﻫ‬، ‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬
‫ﺘ‬‫ﺋﻲﻣ‬ ‫ﺍ‬‫ﺬ‬
‫ﻡﻏ‬ ‫ﺎ‬
‫ﺎﻉﻧﻈ‬‫ﺒ‬‫ﺗ‬
‫ﺍ‬-
.‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﺎﺕﻛ‬ ‫ﺒ‬‫ﺔﻣﻦﺛﻼﺙﻭﺟ‬ ‫ﻔ‬
‫ﻴ‬‫ﻔ‬‫ﻟﺨ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺒ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺑ‬‫ﺓﻭ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺎﺕ ﺻ‬
‫ﺒ‬‫ﻤﻞﻭﺟ‬ ‫ﻬﻞﺗﺤ‬ ‫ﻣﺍﻷﺳ‬
‫ﻮﻥ ﻦ‬ ‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬-
.
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮﺏ‬‫ﻡﻭﺷ‬ ‫ﺎ‬‫ﻌ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻎ‬ ‫ﺘﻚﻓﻲﻣﻀ‬ ‫ﻗ‬‫ﺬﻭ‬ ‫ﺧ‬-
D.Bowelandbl adder :
Cont inueabowelandbl addert rainingpr ogr am.
-Incl udeadequat edi etaryfibert of acil
itateregularbowel Elimination
-Useacl eant echni quef orirri
gat i
ng, changi ng,orinser
tingcat hetersathome
(asdemonst ratedbyt henur se).
-Inspectt heur i
nef orcloudiness( whi chmayi ndicat
eaur inary
tracti nfecti
on) .
-Cont actaphy sicianifchi l
lsandf everoccurori ftheurineisbl oody ,
cloudy,or
hasanof fensiveodor .
-Knowhowt oper form ski ncar eoft hegeni tali
aandper i
neum, i
ncludingthe
speci al carethatmustbegi vent ot heanal areaandt hegeni tal
iaaf t
er
def ecat i
on.

:‫ﺔ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻭ‬ ‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬-‫ﺩ‬
.
‫ﺔ‬‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺀﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﻳﺐ‬‫ﺭ‬‫ﺪ‬‫ﻣﺞﺗ‬‫ﺎ‬‫ﻧ‬
‫ﺮ‬‫ﺮﻓﻲﺑ‬ ‫ﻤ‬‫ﺘ‬‫ﺍﺳ‬
‫ﺘﻈﻢ‬‫ﻨ‬‫ﻜﻞﻣ‬‫ﺀﺑﺸ‬‫ﺎ‬‫ﻌ‬
‫ﻣ‬ ‫ﺍﻷ‬‫ﺍﺝ‬
‫ﺮ‬‫ﻴﻞﺇﺧ‬‫ﻬ‬‫ﺘﺴ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻑ‬‫ﻴ‬‫ﻟ‬
‫ﻣﺍﻷ‬
‫ﺔﻦ‬ ‫ﻴ‬‫ﻓ‬
‫ﺎ‬‫ﺔﻛ‬‫ﻴ‬‫ﻤ‬‫ﻴﻦﻛ‬‫ﻤ‬ ‫ﺘﻀ‬‫ﻗﻢﺑ‬-
.
(‫ﺔ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺿﺤﺖ‬ ‫ﺃ‬‫)ﺎ‬
‫ﻤ‬
‫ﺰﻝﻛ‬ ‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻓﻲ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﺩﺧ‬‫ﻭﺇ‬‫ﺃ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﻭﺗ‬‫ﺃ‬‫ﺮﻱ‬‫ﻟ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﺔﻧﻈ‬ ‫ﻴ‬
‫ﻨ‬‫ﻘ‬‫ﻡﺗ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬-
‫ﻮﻝ‬‫ﺩﺑ‬
‫ﻮ‬ ‫ﻟﻰﻭﺟ‬‫ﺮﺇ‬‫ﻴ‬‫ﺪﻳﺸ‬‫ﺎﻗ‬‫ﻤ‬‫ﻣ‬)‫ﺮ‬‫ﻜ‬‫ﺩﻋ‬‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﺪﻣﻦﻋ‬ ‫ﻛ‬
‫ﺄ‬‫ﺘ‬‫ﻠ‬
‫ﻟ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬ ‫ﺍ‬-
.
(‫ﻟﻚ‬‫ﺎ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻋ‬
‫ﺔ‬
‫ﺋﺤ‬ ‫ﺍ‬
‫ﺍﺭ‬‫ﻭﺫ‬‫ﺃ‬
‫ﺍ‬ً
‫ﺮ‬‫ﻜ‬
‫ﻭﻋ‬ ‫ﺃ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺎ‬
‫ﺎﺑ‬ً
‫ﺑ‬‫ﻮ‬
‫ﻮﻝﻣﺼﺤ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬
‫ﺍﻛ‬‫ﺫ‬‫ﻭﺇ‬‫ﺃ‬‫ﻤﻰ‬‫ﺓﻭﺣ‬ ‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻌ‬‫ﻭﺙﻗﺸ‬ ‫ﺪ‬‫ﺣﺔﺣ‬‫ﻟ‬
‫ﻴﺐﻓﻲ ﺎ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺎ‬‫ﺗﺼﻞﺑ‬ ‫ﺍ‬-
.
‫ﺔ‬‫ﻬ‬‫ﻳ‬‫ﺮ‬‫ﻛ‬
‫ﺘﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺻ‬‫ﻟﺨ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫ﺑ‬،‫ﺎﻥ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻠ‬
‫ﺎﺳ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻋﻀ‬ ‫ﺎﻷ‬
‫ﺓﺑ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺔﺇﺟ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﺔﻛ‬ ‫ﻓ‬
‫ﺮ‬ ‫ﻌ‬‫ﻣ‬-
.
‫ﻮﻁ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﻴ‬‫ﻠ‬
‫ﺎﺳ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﺍﻷﻋﻀ‬‫ﺮﺝﻭ‬ ‫ﻟﺸ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﻌﻄﻰ‬ ‫ﺃﻥﺗ‬‫ﻳﺠﺐ‬

D.Act ivi
ty
-Makeuseofsoci alcontacts,hobbies,andchangesinthedailyrouti
neto
reli
ev eboredom.
-Av oidfati
gueandexposur etoinfection.
-Takedeepbr eathsev er
y1or2hour swhileawakeandt ocought oraise
secret i
ons.
-Inspectallpressurepointsdai l
y;keepskincleananddryatall t
imes.
Assessmentenabl esidentifi
cati
onofpr oblems.Clean,
dr yski
nreduces
bact eri
aandt hemoi stur
et hatpromot esthei
rrepr
oduction.
-Massagebonypr ominencest hatblanchwhenpr essureisrel
ieved.Massage

198
‫‪i‬‬
‫‪ncr‬‬‫‪easesci‬‬ ‫‪r‬‬‫‪cul‬‬‫‪at‬‬‫‪i‬‬‫‪ont‬‬ ‫‪ot‬‬‫‪het‬‬ ‫‪i‬‬‫‪ssues,‬‬ ‫‪br‬‬‫‪i‬‬‫‪ngi‬‬‫‪ngoxy‬‬ ‫‪genandr‬‬ ‫‪emov‬‬ ‫‪i‬‬
‫‪ngcar‬‬ ‫‪bon‬‬
‫‪di‬‬
‫‪oxi‬‬‫‪deandcel‬‬ ‫‪l‬‬‫‪ul‬‬‫‪arwast‬‬ ‫‪es.‬‬
‫‪-Massagei‬‬ ‫‪scont‬‬ ‫‪r‬‬‫‪ai‬‬‫‪ndi‬‬‫‪cat‬‬‫‪edi‬‬ ‫‪ft‬‬‫‪heski‬‬ ‫‪ni‬‬ ‫‪sal‬‬ ‫‪r‬‬‫‪eadyi‬‬ ‫‪mpai‬‬ ‫‪r‬‬‫‪ed,‬‬ ‫‪asev‬‬ ‫‪i‬‬‫‪dencedby‬‬
‫‪ar‬‬‫‪east‬‬‫‪hatr‬‬ ‫‪emai‬‬ ‫‪nr‬‬ ‫‪eddenedwi‬‬ ‫‪t‬‬
‫‪hr‬‬ ‫‪el‬‬‫‪i‬‬
‫‪efofpr‬‬ ‫‪essur‬‬ ‫‪e.‬‬
‫‪-Encour‬‬ ‫‪ageadequat‬‬ ‫‪enut‬‬ ‫‪r‬‬
‫‪i‬‬‫‪t‬‬‫‪i‬‬
‫‪onandpr‬‬ ‫‪ov‬‬‫‪i‬‬‫‪desuppl‬‬ ‫‪ement‬‬ ‫‪sasor‬‬ ‫‪der‬‬ ‫‪ed.Pr‬‬ ‫‪ot‬‬‫‪ei‬‬
‫‪n,‬‬
‫‪v‬‬‫‪i‬‬
‫‪t‬‬‫‪ami‬‬‫‪nC,‬‬ ‫‪andzi‬‬ ‫‪ncar‬‬ ‫‪ei‬‬ ‫‪mpor‬‬ ‫‪t‬‬‫‪antf‬‬‫‪orheal‬‬ ‫‪i‬‬‫‪ng/‬‬ ‫‪mai‬‬ ‫‪nt‬‬‫‪ai‬‬
‫‪ni‬‬ ‫‪ngski‬‬ ‫‪ni‬‬ ‫‪nt‬‬‫‪egr‬‬‫‪i‬‬‫‪t‬‬‫‪y‬‬‫‪.‬‬
‫‪Suppl‬‬‫‪ement‬‬ ‫‪smaybenecessar‬‬ ‫‪yt‬‬‫‪omeeti‬‬ ‫‪ncr‬‬‫‪easedneedf‬‬ ‫‪orv‬‬ ‫‪i‬‬‫‪t‬‬‫‪ami‬‬ ‫‪nCandz‬‬ ‫‪i‬‬‫‪nc.‬‬
‫‪-Changepat‬‬ ‫‪i‬‬
‫‪ent‬‬ ‫’‬
‫‪sposi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪onev‬‬ ‫‪er‬‬ ‫‪y2hour‬‬ ‫‪s.‬‬
‫ﺎﻁ‬‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬‫ﺩ‬
‫‪.‬‬‫ﻠﻞ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬ ‫ﺘﺨ‬‫ﻟ‬‫ﻣﻲ‬ ‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬ ‫ﻳ‬
‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻋ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬ ‫ﺗﺎﻻﺕ‬
‫ﻣﺍﻻﺼ‬ ‫ﺓﻦ‬ ‫ﺩ‬‫ﺎ‬‫ﻔ‬
‫ﺘ‬‫ﺍﻻﺳ‬ ‫‪-‬‬
‫‪.‬‬‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬ ‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻌﺐﻭ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻨﺐ‬ ‫‪-‬ﺗﺠ‬
‫‪.‬‬‫ﺍﺕ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﺓ‬‫ﺭ‬‫ﺎ‬‫ﺛ‬‫ﻌﻞﻹ‬ ‫ﺍﺳ‬‫ﺎﻅﻭ‬ ‫ﻘ‬‫ﻴ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﻴﻦ‬‫ﺘ‬‫ﺎﻋ‬‫ﻭﺳ‬ ‫ﺃ‬‫ﺔ‬‫ﺎﻋ‬‫ﺎﻛﻞﺳ‬ ‫ً‬
‫ﻘ‬‫ﻴ‬‫ﻤ‬‫ﺎﻋ‬ ‫ﻔً‬
‫ﺴ‬ ‫ﺬﻧ‬‫‪-‬ﺧ‬
‫ﻴﺢ‬‫ﺘ‬
‫ﻴﻢﻳ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫ﺎﺕ‬ ‫ﻗ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﻊ‬‫ﻴ‬‫ﻤ‬
‫ﺔﻓﻲﺟ‬ ‫ﻓ‬ ‫ﺎ‬
‫ﺔﻭﺟ‬ ‫ﻔ‬‫ﻴ‬‫ﺓﻧﻈ‬ ‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻓﻆﻋ‬ ‫ﺎ‬
‫‪.‬ﺣ‬ ‫ﺎ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻐﻂﻳ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺎﻁ‬ ‫ﻘ‬
‫ﻊﻧ‬ ‫ﻴ‬
‫ﻤ‬ ‫‪-‬ﻓﺤ ﺺﺟ‬
‫‪.‬‬
‫ﺎ‬‫ﺮﻫ‬‫ﺛ‬‫ﺎ‬‫ﻜ‬‫ﺯﺗ‬‫ﺰ‬‫ﻌ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﻮ‬‫ﺮﻃ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻭ‬‫ﻳ‬‫ﺮ‬‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻞﻣﻦ‬ ‫ﻘ‬
‫ﺎﻑﻳ‬ ‫ﻟﺠ‬ ‫ﺍ‬
‫ﻴﻒﻭ‬ ‫ﻨﻈ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫‪.‬‬‫ﻛﻞ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬‫ﺍ‬
‫ﺪ‬ ‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬
‫‪،‬‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﻟﻸ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻴﻚ‬‫ﻟ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻳ‬
‫ﺰ‬‫‪.‬ﻳ‬‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺍﻝ‬‫ﻭ‬‫ﺪﺯ‬‫ﻨ‬‫ﺘﺢﻋ‬ ‫ﻔ‬‫ﺘ‬‫ﺘﻲﺗ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺀ‬‫ﻮ‬‫ﺘ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻚ‬ ‫ﻟ‬
‫ﺪ‬‫‪-‬ﺗ‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻔﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻮﻥﻭ‬ ‫ﺑ‬‫ﺮ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻴ‬‫ﻛﺴ‬ ‫ﺃ‬‫ﻧﻲ‬ ‫ﺎ‬
‫ﻳﻞﺛ‬ ‫ﺰ‬‫ﻳ‬‫ﻴﻦﻭ‬‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻠﺐ‬ ‫ﻳﺠ‬‫ﻭ‬
‫ﻌﻞ‬ ‫ﻔ‬
‫ﻟ‬‫ﺎ‬‫ﺭﺑ‬‫ﺮ‬‫ﺘﻀ‬ ‫ﺪﻣ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺎﻥ‬ ‫ﺍﻛ‬‫ﺫ‬‫ﺎﺝﺇ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻊ‬ ‫ﻨ‬
‫ﻤ‬‫‪-‬ﻳ‬
‫‪.‬‬
‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻔ‬ ‫ﻊﺗﺨ‬‫ﺓﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﺍﻝﻣﺤ‬ ‫ﻻﺰ‬
‫ﺘﻲ ﺗ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻃﻖ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺘﻀﺢﻣﻦ‬ ‫ﻳ‬
‫ﻧﻚ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﺝﻭ‬ ‫ﻣ‬
‫ﺎ‬‫ﺘ‬‫ﻴ‬‫ﻓ‬‫ﻴﻦﻭ‬ ‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﺒ‬‫ﺘ‬
‫ﻌ‬‫‪.‬ﻳ‬‫ﻠﺐ‬ ‫ﻟﻄ‬‫ﺍ‬‫ﺔﺣﺴﺐ‬ ‫ﻴ‬
‫ﺋ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﻤﻼﺕ‬ ‫ﻜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬ ‫ﺮ‬‫ﻴ‬
‫ﻓ‬ ‫ﻮ‬‫ﺗ‬
‫ﺔﻭ‬ ‫ﻴ‬ ‫ﻓ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫‪-‬ﺗﺸﺠ‬
‫ﺓ‬‫ﺪ‬ ‫ﻳ‬
‫ﺍ‬‫ﺰ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺎﺟ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻠ‬‫ﺘ‬
‫ﻟ‬ ‫ﺔ‬
‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﻤﻼﺕ ﺿ‬ ‫ﻜ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻜ‬‫ﺪﺗ‬ ‫‪.‬ﻗ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻠﻰﺳ ﻣ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬ ‫ﺍ‬
‫ﺀ‪/‬‬ ‫ﺎ‬
‫ﻔ‬ ‫ﻠﺸ‬‫ﻟ‬‫ﻴﻦ‬‫ﻤ‬‫ﻬ‬‫ﻣ‬
‫‪.‬‬‫ﻧﻚ‬‫ﺰ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﺝﻭ‬ ‫ﻣ‬ ‫ﺎ‬
‫ﺘ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬
‫‪.‬‬‫ﻴﻦ‬ ‫ﺘ‬‫ﺎﻋ‬‫ﻳ ﺾﻛﻞﺳ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺮﻭﺿ‬ ‫ﻴ‬ ‫ﻴ‬
‫ﻐ‬‫‪-‬ﺗ‬

‫‪I‬‬
‫‪ncr‬‬
‫‪easeI‬‬
‫‪nt‬‬‫‪r‬‬
‫‪acr‬‬
‫‪ani‬‬
‫‪alPr‬‬
‫‪essur‬‬
‫‪e‬‬
‫‪Lear‬‬‫‪ni‬‬
‫‪ngobj‬‬‫‪ect‬‬ ‫‪i‬‬
‫‪v‬‬‫‪es:‬‬
‫‪Uponcompl‬‬ ‫‪et‬‬‫‪i‬‬‫‪onoft‬‬‫‪hi‬‬‫‪sl‬‬‫‪ect‬‬‫‪ur‬‬‫‪e,‬‬
‫‪eachst‬‬‫‪udentshoul‬‬‫‪dbeabl‬‬ ‫‪et‬‬‫‪o:‬‬
‫‪1.Def‬‬‫‪i‬‬
‫‪nei‬‬‫‪nt‬‬‫‪r‬‬‫‪acr‬‬‫‪ani‬‬‫‪al‬‬‫‪pr‬‬
‫‪essur‬‬ ‫‪e‬‬
‫‪2.Def‬‬‫‪i‬‬
‫‪nei‬‬‫‪ncr‬‬‫‪easei‬‬ ‫‪nt‬‬
‫‪r‬‬‫‪acr‬‬‫‪ani‬‬‫‪al‬‬‫‪pr‬‬
‫‪essur‬‬‫‪e‬‬
‫‪3.I‬‬
‫‪dent‬‬‫‪i‬‬‫‪f‬‬
‫‪yt‬‬‫‪hepat‬‬ ‫‪hophy‬‬ ‫‪si‬‬
‫‪ol‬‬‫‪ogyofi‬‬‫‪ncr‬‬
‫‪easei‬‬‫‪nt‬‬‫‪r‬‬
‫‪acr‬‬‫‪ani‬‬‫‪al‬‬‫‪pr‬‬‫‪essur‬‬‫‪e‬‬
‫‪4.I‬‬
‫‪dent‬‬‫‪i‬‬‫‪f‬‬
‫‪yt‬‬‫‪hecl‬‬ ‫‪i‬‬
‫‪ni‬‬‫‪cal‬‬‫‪mani‬‬‫‪f‬‬‫‪est‬‬‫‪at‬‬‫‪i‬‬
‫‪onsandcompl‬‬ ‫‪i‬‬
‫‪cat‬‬‫‪i‬‬‫‪onsofpat‬‬ ‫‪i‬‬
‫‪entwi‬‬‫‪t‬‬
‫‪hi‬‬‫‪ncr‬‬
‫‪ease‬‬
‫‪i‬‬
‫‪nt‬‬‫‪r‬‬‫‪acr‬‬
‫‪ani‬‬‫‪al‬‬
‫‪pr‬‬ ‫‪essur‬‬‫‪e‬‬
‫‪5.Descr‬‬‫‪i‬‬
‫‪bet‬‬‫‪hemul‬‬ ‫‪t‬‬‫‪i‬‬
‫‪pl‬‬‫‪eneedsoft‬‬ ‫‪hepat‬‬‫‪i‬‬
‫‪entwi‬‬‫‪t‬‬
‫‪hi‬‬ ‫‪ncr‬‬‫‪easei‬‬‫‪nt‬‬‫‪r‬‬
‫‪acr‬‬‫‪ani‬‬
‫‪al‬‬‫‪pr‬‬
‫‪essur‬‬
‫‪e‬‬

‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬

‫ﺎ‬‫ﻳ‬‫ﺯ‬
‫‪:‬‬
‫ﻠﻢ‬‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
‫‪:‬‬‫ﻠﻰ‬‫ﺍﻋ‬‫ً‬
‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫ﻟﺐﻗ‬‫ﺎ‬
‫ﻮﻥﻛﻞﻃ‬ ‫ﻜ‬‫ﺃﻥﻳ‬‫‪،‬ﻳﺠﺐ‬ ‫ﺓ‬‫ﺮ‬‫ﺎﺿ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬
‫ﻋ‬
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬
‫ﺪ‬ ‫ﻳ‬
‫ﺪ‬‫‪.‬ﺗﺤ‬‫‪1‬‬
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺪﺯ‬ ‫ﻳ‬
‫ﺪ‬‫‪.‬ﺗﺤ‬‫‪2‬‬
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬
‫ﻐﻂﺩ‬ ‫ﻟﻀ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬ ‫ﻳ‬
‫ﺰ‬‫ﻴ‬ ‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪3‬‬
‫ﺔ‬
‫ﻤ‬‫ﻤﺠ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺍﺧﻞ‬
‫ﻐﻂﺩ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻊﺯ‬ ‫ﻳ ﺾﻣ‬
‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬
‫ﺎﻋ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻭ‬‫ﺎﻫ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪4‬‬
‫ﺔ‬‫ﻤ‬
‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻊﺯ‬‫ﻳ ﺾﻣ‬‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺓ‬ ‫ﺩ‬‫ﺪ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﻻﺣ‬‫‪.‬ﻭﺻﻒ‬ ‫‪5‬‬

‫‪I‬‬
‫‪ncr‬‬
‫‪easeI‬‬
‫‪nt‬‬‫‪r‬‬
‫‪acr‬‬
‫‪ani‬‬
‫‪alPr‬‬
‫‪essur‬‬
‫‪e‬‬

‫‪199‬‬
Int r
oduct ion:
Ther i
gidcr ani alv aultcont ainsbr aintissue( 1400g) ,blood( 75mL) ,and
cer ebrospi nal fl
uid( CSF)( 75mL) .Thev ol
umeandpr essur eoft heset hree
component sar eusual l
yinast ateofequi li
brium andpr oducet heintracranial
pr essure( ICP) .
Def init
ionofi ntracr anialpr essur e:
Ist hepr essur ei nsidet heskul landt husi nthebr ai
nt i
ssueandcer ebrospi nal
fluid.Nor mal pressur ebeing10t o15mm Hg.
Def init
ionofi ncr easei ntracr anialpressur e:
Isel evationoft hepr essurei nthecr ani um.ICPv al
uesof20t o30mm Hg
repr esentmi l
di ncr easei ntracrani alpressure.
:
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻣ‬
75)‫ﺎﻋﻲ‬ ‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻣ(ﻭ‬‫ ﻞ‬75)‫ﻡ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺟ(ﻭ‬‫ ﻢ‬1400)‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬‫ﻠﻰ‬ ‫ﻠﺐﻋ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻔﻲ‬ ‫ﻘﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬ ‫ﺒ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻮﻱ‬‫ﺘ‬‫ﻳﺤ‬
‫ﺔ‬ ‫ﻤ‬
‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺘﺞ‬ ‫ﻨ‬
‫ﻳ‬‫ﺯﻥﻭ‬ ‫ﺍ‬‫ﻮ‬‫ﺣﺔﺗ‬
‫ﻟ‬‫ﺔﻓﻲ ﺎ‬ ‫ﺛ‬‫ﺜﻼ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻐﻂﻫ‬ ‫ﻮﻥﺣﺠﻢﻭﺿ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬ ‫ﺎ‬
‫ﻋ‬.(‫ﻣ‬
‫ﻞ‬
.
(ICP)
:‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟﺠ‬
‫ﺍ‬ ‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬ ‫ﺍ‬
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
15‫ﻟﻰ‬ ‫ﺇ‬10‫ﻌﻲﻣﻦ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬
‫ﺍ‬ .
‫ﺎﻋﻲ‬ ‫ﻨﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻤﺦﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧﺴﺠ‬‫ﺃ‬‫ﻟﻲﻓﻲ‬ ‫ﺎ‬‫ﺘ‬
‫ﻟ‬‫ﺎ‬‫ﺑ‬
‫ﺔﻭ‬ ‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻮ‬‫ﻫ‬
.‫ﺒﻖ‬‫ﺋ‬
‫ﻠﻢﺯ‬‫ﻣ‬
:
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻳﻒﺯ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺒﻖﺯ‬ ‫ﺋ‬‫ﻠﻢﺯ‬‫ﻣ‬30‫ﻟﻰ‬ ‫ﺇ‬20‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻣﺞ‬ ‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﻴﻢﺑ‬‫ﺜﻞﻗ‬‫ﻤ‬‫ﺗ‬.‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻐﻂﻓﻲ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﺎﻉ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﻮ‬‫ﻫ‬
.
‫ﺔ‬‫ﻤ‬ ‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﻃ‬

Pat hophysiology:
-IncreasedI CPaf fectsmanypat ientswithacut eneur ologiccondi ti
ons.Thi sis
becausepat hologiccondi t
ionsalterther elati
onshipbet weeni ntr
acr anial
volumeandI CP.
-Althoughel evatedI CPismostcommonl yassociatedwi t
hheadi njury,italso
maybeseenasasecondar yeffectinot hercondi t
ions, suchasbr aint umor s,
subar achnoidhemor rhage,andt oxicandv i
ralencephal opat hi
es.
:
‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺔﺣ‬‫ﻴ‬‫ﺒ‬‫ﺎﻻﺕﻋﺼ‬ ‫ﻮﻥﻣﻦﺣ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬
‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬ ‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬‫ﻘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬
‫ﺓﺑ‬ ‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺮﺯ‬ ‫ﺛ‬
‫ﺆ‬‫ﺗ‬-
.I
CP‫ﺔﻭ‬ ‫ﻤ‬
‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻟﺤﺠﻢﺩ‬ ‫ﺍ‬‫ﻴﻦ‬‫ﻼﺔﺑ‬
‫ﻌﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺔﺗ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻻﺕ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻟﻚﻷﻥ‬ ‫ﺫ‬‫ﻭ‬
‫ﺮ‬‫ﻨﻈ‬ُ‫ﺪ‬
‫ﻳ‬ ‫ﻪﻗ‬‫ﻧ‬‫ﺃ‬‫ﺇﻻ‬،‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺈﺻ‬‫ﻊﺑ‬‫ﺋ‬
‫ﺎ‬‫ﻜﻞﺷ‬ ‫ﺒﻂﺑﺸ‬ ‫ﺗ‬
‫ﺮ‬‫ﺔﻳ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬
‫ﺮ‬ ‫ﺎﻉﺑ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬‫ﺃﻥ‬ ‫ﻏﻢﻣﻦ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬-
‫ﻋﻼﻝ‬‫ﺍﻻﺘ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺗ‬‫ﻮ‬‫ﺒ‬‫ﻜ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒﺗﺤﺖ‬ ‫ﺰ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻍﻭ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﺜﻞ‬‫ﻣ‬، ‫ﺮﻯ‬‫ﺃﺧ‬‫ﺎﻻﺕ‬‫ﻮﻱﻓﻲﺣ‬ ‫ﻧ‬
‫ﺎ‬‫ﺮﺛ‬‫ﻴ‬‫ﺛ‬
‫ﺄ‬‫ﻪﺗ‬‫ﻧ‬‫ﺃ‬‫ﻠﻰ‬‫ﺎﻋ‬ ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻪ‬‫ﻴ‬‫ﻟ‬
‫ﺇ‬
.‫ﻭﺳﻲ‬‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬

-Incr
easedICPfrom anycausedecreasescerebralper
fusi
on,st
imulat
esfurt
her
swell
ing(edema)
, andmayshiftbr
aintissuethroughopeni
ngsintheri
giddura,
resul
ti
nginherni
ation,
adireandfr
equent l
yfatalevent
.

‫ﺪﻣﻦ‬‫ﻳ‬
‫ﺰ‬‫ﺰﻣ‬‫ﻴ‬
‫ﻔ‬‫ﺗﺤ‬‫ﻭ‬،‫ﺔ‬
‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﻠ‬‫ﻘ‬
‫ﻟﻰﺗ‬‫ﺒﺐﺇ‬‫ﺃﻱﺳ‬‫ﺔﻣﻦ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬
‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺩﻱﺯ‬
‫ﺆ‬‫ﺗ‬-
‫ﻭﺙ‬‫ﺪ‬
‫ﻟﻰﺣ‬‫ﺩﻱﺇ‬‫ﺆ‬
‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬،‫ﺔ‬‫ﺒ‬
‫ﻠ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕﻓﻲ‬‫ﺘﺤ‬‫ﻤﺦﻣﻦﺧﻼﻝﻓ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬
‫ﻘﻞ‬ ‫ﻨ‬
‫ﺪﺗ‬‫ﻗ‬‫ﻭ‬،
(‫ﺔ‬‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
)‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺎﻥ‬‫ﻴ‬
‫ﻣﺍﻷﺣ‬
‫ﺮﻦ‬‫ﻴ‬‫ﺜ‬
‫ﻴﺖﻓﻲﻛ‬ ‫ﻤ‬‫ﻣ‬‫ﺮﻭ‬‫ﻴ‬‫ﺪﺙﺧﻄ‬‫ﻮﺣ‬‫ﻭﻫ‬،‫ﺘﻖ‬‫ﻓ‬

-Herniati
onrefer
stot heshift
ingofbr aintissuefrom anareaofhi ghpressure
toanar eaoflowerpressure.Theherni atedt i
ssueexertspressureonthebr ai
n
areaintowhichithasshift
ed,whichi nterfereswiththebloodsuppl yi
nthatarea.
Cessationofcerebralbl
oodf l
owr esultsincer ebr
alischemia,inf
arcti
on,and
brai
ndeat h.

200
 .‫ﻔﺾ‬‫ﻨﺨ‬‫ﻐﻂﻣ‬‫ﺍﺕ ﺿ‬‫ﺔﺫ‬
‫ﻘ‬‫ﻨﻄ‬‫ﻟﻰﻣ‬
‫ﻊﺇ‬‫ﻔ‬‫ﺗ‬
‫ﺮ‬‫ﻐﻂﻣ‬‫ﺍﺕ ﺿ‬‫ﺔﺫ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤﺦﻣﻦﻣ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻧﺴﺠ‬ ‫ﺃ‬
‫ﻮﻝ‬ ‫ﻟﻰﺗﺤ‬
‫ﺘﻖﺇ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻳﺸ‬-
‫ﻡﻓﻲ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﻣ‬
‫ﻊﺇ‬‫ﺍﺧﻞﻣ‬‫ﺪ‬‫ﺘ‬
‫ﺎﻳ‬‫ﻤ‬
‫ﻣ‬،‫ﺎ‬‫ﻬ‬
‫ﻴ‬‫ﻟ‬
‫ﻘﻞﺇ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺘﻲ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﻠﻰﻣ‬‫ﺎﻋ‬ً‫ﻐ‬
‫ﻄ‬ ‫ﻓﻲ ﺿ‬‫ﻭ‬‫ﺮ‬‫ﻐﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺞ‬‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺭﺱ‬‫ﺎ‬‫ﻤ‬
‫ﻳ‬
.
‫ﺎﻏﻲ‬‫ﻣ‬
‫ﻮﺕﺩ‬ ‫ﻣ‬
‫ﺀﻭ‬‫ﺎ‬‫ﺘﺸ‬
‫ﺍﺣ‬‫ﻤﺦﻭ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺮ‬‫ﻘ ﺺﺗ‬‫ﻟﻰﻧ‬
‫ﻤﺦﺇ‬‫ﻟ‬‫ﺍ‬‫ﻡﻓﻲ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﻗﻒﺗ‬ ‫ﻮ‬
‫ﺩﻱﺗ‬‫ﺆ‬‫ﻳ‬.
‫ﺔ‬ ‫ﻘ‬
‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻚ‬
‫ﺗ‬

Decr easedCer ebralBloodFlow

-Usual ly,t
hisi saccompani edbyasl owboundi ngpul seandr espir
atory
i
rregular i
ti
es.Thesechangesi nbloodpr essur e,pulse,andr espirat
ionar e
i
mpor tantclinicall
ybecauset heysuggesti ncreasedI CP.
-Theconcent rati
onofcar bondi oxi
dei nthebl oodandi nthebr aintissuealso
playsar ol
eint heregulat
ionofcer ebralbloodf low.Ani ncreasei ncar bon
dioxidepar ti
al pressure(PaCO2)causescer ebral vasodil
ation,leadingto
i
ncr easedcer ebralbloodflowandi ncreasedI CP.
-Adecr easei nPaCO2hasav asoconstri
ctiveef fect,l
imiti
ngbl oodf lowtothe
brain.Decr easedv enousoutfl
owmayal soi ncreasecer ebralbloodv ol
ume, t
hus
raisi
ngI CP.

‫ﺎﻏﻲ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﺎ ﺽﺗ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬ ‫ﺬ‬‫ﻫ‬.‫ﻔﺴﻲ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬ ‫ﺍ‬ ‫ﺎﺕﻓﻲ‬ ‫ﺑ‬‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﺔﻭ‬ ‫ﺎﻃ‬‫ﺍﻹﺣ‬ ‫ﺀ‬‫ﺒ ﺾﺑﻄﻲ‬ ‫ﻨ‬‫ﺎﺑ‬ً
‫ﺑ‬‫ﻮ‬‫ﻮﻥﻣﺼﺤ‬ ‫ﻜ‬ ‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬-
.‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬ ‫ﺎ‬
‫ﻧ‬‫ﺮ‬ ‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬ ‫ﺮﺇ‬‫ﻴ‬‫ﻷﺎﺗﺸ‬
‫ﻬ‬‫ﺎﻧ‬ ً
‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﺔﺳ‬ ‫ﻤ‬‫ﻬ‬‫ﻔﺲﻣ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺒ ﺾﻭ‬ ‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﺿ‬
.
‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬ ‫ﻡﻓﻲ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﻴﻢﺗ‬ ‫ﻨﻈ‬‫ﺍﻓﻲﺗ‬ ً
‫ﺭ‬
‫ﻭ‬ ‫ﺎﺩ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧﺴﺠ‬ ‫ﺃ‬‫ﻓﻲ‬ ‫ﻡﻭ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻓﻲ‬ ‫ﺑ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻴ‬‫ﻛﺴ‬ ‫ﺃ‬‫ﻧﻲ‬ ‫ﺎ‬
‫ﺰﺛ‬ ‫ﻴ‬ ‫ﻛ‬‫ﺮ‬
‫ﻌﺐﺗ‬ ‫ﻠ‬
‫ﻳ‬-
‫ﺩﻱ‬ ‫ﺆ‬‫ﺎﻳ‬ ‫ﻤ‬‫ﻣ‬، ‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻊ‬ ‫ﻮﺳ‬ ‫ﻟﻰﺗ‬ ‫(ﺇ‬PaCO2)‫ﻮﻥ‬ ‫ﺑ‬‫ﺮ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬
‫ﻴ‬‫ﻛﺴ‬‫ﺃ‬ ‫ﻧﻲ‬‫ﺎ‬‫ﺜ‬‫ﻟ‬‫ﺋﻲ‬ ‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺩﻱﺯ‬ ‫ﺆ‬‫ﺗ‬
.‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﻡﺩ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺓﺿ‬ ‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺯ‬‫ﻤﺦﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡﻓﻲ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻓﻖ‬ ‫ﺪ‬‫ﺓﺗ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻟﻰﺯ‬ ‫ﺇ‬
‫ﺩﻱ‬ ‫ﺆ‬‫ﺪﻳ‬ ‫ﻗ‬.‫ﺎﻍ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﻡﺇ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬ ‫ﺪﻣﻦﺗ‬ ‫ﺎﻳﺤ‬ ‫ﻤ‬‫ﻣ‬، ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﻟﻸ‬ ‫ﻴﻖ‬‫ﺮﻣﻀ‬ ‫ﻴ‬‫ﺛ‬‫ﺄ‬‫ﻪﺗ‬P
‫ ﻟ‬aCO2‫ﺎ ﺽﻓﻲ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍﻻ‬ -
.
‫ﺔ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﻊﺑ‬‫ﻓ‬ ‫ﻟﻲﺭ‬ ‫ﺎ‬‫ﻭﺘ‬
‫ﻟ‬
‫ﺎ‬‫ﺑ‬، ‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓﺣﺠﻢ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬ ‫ﺪﻱﺇ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺽ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
Cerebr alEdema
-Cer ebr al edemaorswel l
ingi sdef i
nedasanabnor mal accumul ationofwat er
orfluidi nt hei ntracellularspace, ext racellularspace, orbot h, associ at edwi than
i
ncreasei nt hev olumeofbr aint i
ssue.
-Asbr aint issueswel lswi t
hint her i
gidskul l,sev eralmechani smsat temptt o
compensat ef ort hei ncreasi ngI CP.Thesecompensat orymechani smsi ncl ude
autor egul ationanddecr easedpr oduct ionandf l
owofCSF.
-Aut oregul ati
onr efer stot hebr ain'sabi l
itytochanget hedi amet erofi tsbl ood
vessel saut omat i
callytomai nt ainaconst antcer ebr albloodf lowdur ing
alt
erat ionsi nsy stemi cbl oodpr essur e.
-Thismechani sm canbei mpai r
edi npat i
ent swhoar eex per ienci nga
pathol ogi candsust ainedi ncr easei nI CP.
‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺔﺩ‬ ‫ﻣ‬‫ﺫ‬ ‫ﻭ‬
‫ﻭ‬‫ﺃ‬‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬ ‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﺍﻍﺩ‬ ‫ﺮ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞﻓﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬ ‫ﺀ‬‫ﺎ‬
‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﻌﻲ‬ ‫ﻴ‬‫ﺒ‬‫ﺮﻃ‬ ‫ﻴ‬‫ﻛﻢﻏ‬ ‫ﺍ‬‫ﺮ‬
‫ﻪﺗ‬ ‫ﻧ‬
‫ﺄ‬‫ﺎﻏﻲﺑ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺥ‬‫ﻔ‬‫ﺘ‬‫ﻧ‬‫ﺃﺍﻻ‬‫ﺔﻭ‬ ‫ﻣ‬‫ﺫ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻑ‬ّ
َ‫ﻌ‬ُ-
‫ﺗ‬
.‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬ ‫ﻧﺴﺠ‬ ‫ﺃ‬ ‫ﺓﻓﻲﺣﺠﻢ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻊﺯ‬‫ﻓﻖﻣ‬ ‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﻳ‬
‫ﻭ‬، ‫ﺎ‬
‫ﻤ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬‫ﻭﻛ‬ ‫ﺃ‬‫ﺔ‬ ‫ﻴ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬ ‫ﺭﺝ‬ ‫ﺎ‬‫ﺀﺧ‬ ‫ﺎ‬‫ﻔﻀ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻣﺞ‬ ‫ﺎ‬‫ﻧ‬
‫ﺮ‬ ‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﻳ ﺾﺯ‬ ‫ﻮ‬‫ﻌ‬‫ﺎﺕﺗ‬ ‫ﻴ‬‫ﻟ‬‫ﺁ‬‫ﺓ‬‫ﺪ‬ ‫ﻭﻝﻋ‬ ‫ﺎ‬
‫ﺗﺤ‬، ‫ﺓ‬
‫ﺪ‬‫ﻣ‬ ‫ﺎ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﻤﺦﺩ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻧﺴﺠ‬ ‫ﺃ‬‫ﺘﻀﺨﻢ‬ ‫ﺎﺗ‬‫ﻣ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬-
.
‫ﺎﻋﻲ‬ ‫ﻨﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻓﻖ‬‫ﺪ‬ ‫ﺗ‬
‫ﺎﺝﻭ‬ ‫ﺘ‬‫ﻧ‬‫ﻴﻞﺇ‬‫ﻠ‬‫ﻘ‬‫ﺗ‬‫ﺗﻲﻭ‬ ‫ﺍ‬
‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬ ‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬‫ﻳﻀ‬‫ﻮ‬‫ﻌ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻟ‬
‫ﺍﻵ‬ ‫ﻩ‬‫ﺬ‬‫ﻤﻞﻫ‬ ‫ﺗﺸ‬. ‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻡ‬‫ﻓﻖﺩ‬ ‫ﺪ‬‫ﻠﻰﺗ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻠﺤ‬‫ﻟ‬‫ﺎ‬ً
‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻘ‬‫ﻠ‬
‫ﺔﺗ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﻪ‬‫ﺘ‬‫ﻴ‬‫ﻭﻋ‬‫ﺃ‬ ‫ﺮ‬‫ﺮﻗﻄ‬ ‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﻠﻰﺗ‬‫ﺎﻍﻋ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻟﻰﻗ‬ ‫ﺗﻲﺇ‬ ‫ﺍ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻨﻈ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻳﺸ‬-
.‫ﻣﻲ‬‫ﺎ‬‫ﻨﻈ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺍﺕﻓﻲ ﺿ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬ ‫ﺑﺖ‬ ‫ﺎ‬
‫ﻏﻲﺛ‬ ‫ﺎ‬
‫ﻣ‬ ‫ﺩ‬
‫ﻣﺞ‬ ‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﺓﻓﻲﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻣﺴ‬ ‫ﺔﻭ‬ ‫ﻴ‬‫ﺮﺿ‬ ‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻮﻥﻣﻦﺯ‬ ‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻵﺔﻓﻲ‬ ‫ﻴ‬‫ﺍﻟ‬ ‫ﻩ‬‫ﺬ‬ ‫ﻌﻄﻞﻫ‬ ‫ﺘ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬-
.‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬
‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬
Cli
nicalMani fest ations:
1.Changei nl ev elofconsci ousness
2.Headache-i ncreasei nsev er i
tywi t
hcoughi ng, sneez i
ng, orst r
ai ningandear ly

201
i
nt hemor ning
3.Vomi t
ing
4.Visual disturbance
5.Elevationofbl oodpr essur e
6.Decr easedpul ser ate
7.Abnor mal respiratoryresponse
8.Rest l
essness
9.Asneur ologicf unct i
ondet eri
oratesfurt
her ,
thepat i
entbecomescomat ose
andexhi bitsabnor mal mot orresponsesi nthef orm ofdecorti
cation( abnor mal
fl
exionoft heupperext r
emi ti
esandext ensionoft helowerex tr
emi ties),
decerebr ati
on( ext r
emeext ensionoft heupperandl owerextremi t
ies) ,or
fl
accidity
:
‫ﺔ‬‫ﻣ‬ ‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺽ‬ ‫ﺮ‬‫ﻋ‬ ‫ﺍﻻ‬
‫ﻮﻋﻲ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺮﻓﻲﻣﺴ‬ ‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬.1
‫ﺮ‬
‫ﻛ‬‫ﺎ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺡ‬‫ﺒ‬
‫ﻟﺼ‬‫ﺍ‬‫ﻓﻲ‬ ‫ﺩﻭ‬‫ﺎ‬
‫ﻬ‬‫ﺃﺍﻹﺟ‬
‫ﻌﻄﺲﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻝ‬‫ﻌ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻊ‬‫ﻪﻣ‬ ‫ﺗ‬
‫ﺪ‬‫ﺩﺷ‬ ‫ﺍ‬
‫ﺩ‬‫ﺰ‬‫ﺗ‬-‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬.2
‫ﺀ‬‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬.3
‫ﺮﻱ‬ ‫ﺍﺏﺑﺼ‬ ‫ﺮ‬‫ﺍﺿﻄ‬ .4
‫ﻡ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﻐﻂ‬ ‫ﺎﻉ ﺿ‬‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.5
‫ﺒﺾ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬‫ﺎ ﺽﻣ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬.6
‫ﺔ‬
‫ﻴ‬‫ﻌ‬‫ﻴ‬‫ﺒ‬
‫ﺮﻃ‬ ‫ﻴ‬‫ﺔﻏ‬ ‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﺔﺗ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬.7
‫ﻠﻖ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬.8
‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬
‫ﺒ‬‫ﺮﻃ‬ ‫ﻴ‬‫ﺔﻏ‬ ‫ﻴ‬‫ﻛ‬‫ﺮ‬‫ﺎﺕﺣ‬ ‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬‫ﺮ‬‫ﻬ‬‫ﻳﻈ‬‫ﺔﻭ‬‫ﺑ‬‫ﻮ‬‫ﺒ‬
‫ﻴ‬‫ﻐ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻳﺼ‬، ‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺪﻫ‬ ‫ﺭﺗ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﺍﺳ‬ ‫ﻊ‬‫ﻣ‬.9
‫ﺩ‬
‫ﺪ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
)‫ﺎﻍ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺰﻉ‬‫ﻭﻧ‬،
‫(ﺃ‬ ‫ﺔ‬‫ﻴ‬‫ﻠ‬‫ﻔ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬ ‫ﺑﺴﻂ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺮ‬‫ﻟﻸﻃ‬‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﺮﻃ‬ ‫ﻴ‬
‫ﻨﻲﻏ‬ ‫ﺛ‬)‫ﺮ‬ ‫ﻘﺸ‬‫ﻜﻞﺗ‬ ‫ﻓﻲﺷ‬
‫ﺮﻫﻞ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،
‫(ﺃ‬ ‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻔ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬ ‫ﺮ‬‫ﻟﻸﻃ‬ ‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬
AssessmentandDi agnost icFindings:
Thedi agnost icst udi
esusedt odeterminetheunder lyi
ngcauseofi ncr easedI CP
are:
1.CTscanni ng
2.MRI
3.Cerebr alangi ography
4.Transcr anial Doppl erstudiesprov i
deinformat i
onaboutcer ebral bloodf low.
5.Intr
av entricularcat hetermoni t
or i
ngofICP.

LumbarpunctureisavoidedinpatientswithincreasedICP,becauset hesudden
rel
easeofpressureinthelumbarar eacancauset hebrai
ntoher niate.
:‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻧ‬
:‫ﻫ‬
‫ﺔ ﻲ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬
‫ﺎ‬‫ﻘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﺓﺑ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺀﺯ‬
‫ﺍ‬‫ﺭ‬‫ﻣﻦﻭ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺘﺨ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻴﺼ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﺳ‬‫ﺭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬
‫ﻌ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻌ‬‫ﺎﻷﺷ‬ ‫ﻔﺤ ﺺﺑ‬‫ﻟ‬‫ﺍ‬.
1
‫ﻴﺴﻲ‬‫ﺎﻃ‬‫ﻨ‬‫ﻐ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬‫ﺮ‬‫ﻟ‬‫ﺎ‬
‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬.
2
‫ﺔ‬‫ﻴ‬
‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﺮ‬‫ﻳ‬
‫ﻮ‬‫ﺗﺼ‬.3
.
‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﻮﻝﺗ‬‫ﺎﺕﺣ‬ ‫ﻣ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﺔﻣ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺮ‬‫ﺒ‬‫ﺮﻋ‬‫ﻠ‬‫ﺑ‬
‫ﻭ‬‫ﺎﺕﺩ‬ ‫ﺍﺳ‬‫ﺭ‬‫ﺮﺩ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬.
4
.‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬
‫ﺭ‬‫ﺎ‬‫ﻘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬‫ﻨﻲ‬‫ﻴ‬
‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺧﻞ‬ ‫ﺓﺩ‬‫ﺮ‬‫ﻘﺴﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﺭﺻ‬.5

‫ﺭ‬
‫ﺮ‬‫ﺘﺤ‬
‫ﻟ‬‫ﺍ‬‫ﻷﻥ‬،
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬
‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻮﻥﻣﻦﺯ‬‫ﻧ‬
‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻨﻲﻓﻲ‬‫ﻘﻄ‬
‫ﻟ‬‫ﺍ‬‫ﺰﻝ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺐ‬‫ﺘﻢﺗﺠ‬‫ﻳ‬
.
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻕ‬
‫ﺘ‬‫ﻔ‬‫ﻧ‬
‫ﺍ‬‫ﺒﺐﻓﻲ‬‫ﺘﺴ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬‫ﺮﻳ‬‫ﻬ‬
‫ﻟﻈ‬‫ﺍ‬
‫ﻔﻞ‬‫ﺃﺳ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬
‫ﻐﻂﻓﻲﻣ‬ ‫ﻠﻀ‬
‫ﻟ‬‫ﺎﺟﺊ‬‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬

202
 (
Fig.38)Measur
ingi
ntr
acr
ani
alpr
essur
e

Intr
acrani
alpressuremonitori
ng:Afiber
opti
c,tr
ansducer
-ti
ppeddevi
ceplaced
i
n( A)theventr
icl
eor( B)t
hesubarachnoidspace.Thesedevi
cesconnecttoa
pressuret
ransducerandadi spl
aysystem.
Compl i
cati
ons:
1.Brainst
em herniati
on:

Brainstem herniati
onr esultsf
rom anexcessiveincreaseinICPinwhichthe
pressurebuil
dsi nt hecranialvaul
tandthebraintissuepressesdownont he
brai
nstem.Thi si ncreasingpressureonthebrainstem result
sincessat
ionof
bl
oodf lowtot hebr ain,l
eadingtoirr
ever
sibl
ebr ai
nanox iaandbrai
ndeath.
2.Diabetesinsipidus:

Diabet
esinsi
pidusi st
heresultofdecreasedsecret
ionofant
idi
uret
ichor
mone
(ADH).Thepatienthasexcessiveuri
neout put.
3.Syndromeofi nappr
opri
ateantidi
ureti
chor mone(SI
ADH):

SIADHi stheresul
tofincr
easedsecreti
onofADH.Thepatientbecomesv
olume
-over
loaded,uri
neoutputdimi
nishes,andser
um sodi
um concentr
ati
on
becomesdi l
ute.

(
‫ﺃ)ﺏ‬
‫ﻴﻦﻭ‬
‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬(‫ﺃ‬
)‫ﻊﻓﻲ‬
‫ﻮﺿ‬‫ﻮﻝﻳ‬
‫ﺮﻑﻣﺤ‬ ‫ﻭﻃ‬
‫ﺔﺫ‬ ‫ﻴ‬‫ﺋ‬
‫ﻮ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺎﻑ‬‫ﻴ‬
‫ﻟ‬‫ﻣﺍﻷ‬
‫ﺯﻦ‬ ‫ﺎ‬
‫ﻬ‬‫ﺟ‬:
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬
.
‫ﺮﺽ‬‫ﻡﻋ‬‫ﺎ‬
‫ﻧﻈ‬‫ﻐﻂﻭ‬‫ﻮﻝ ﺿ‬‫ﻤﺤ‬
‫ﺓﺑ‬‫ﺰ‬
‫ﻬ‬‫ﺍﻷﺟ‬‫ﻩ‬
‫ﺬ‬‫ﺘﺼﻞﻫ‬
‫ﺗ‬.‫ﺔ‬‫ﻴ‬
‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻜ‬‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺀﺗﺤﺖ‬‫ﺎ‬‫ﻔﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬
:
‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬
‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﺘﻖﺟ‬‫ﻓ‬.1

‫ﻐﻂﻓﻲ‬‫ﻟﻀ‬‫ﺍ‬
‫ﻛﻢ‬‫ﺍ‬‫ﺮ‬‫ﺘ‬
‫ﻴﺚﻳ‬‫ﺔﺣ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬
‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬
‫ﺔﻓﻲﺑ‬ ‫ﺮﻃ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻍﻋﻦ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﺎﻕﺟ‬ ‫ﺘ‬
‫ﻔ‬‫ﻧ‬‫ﺍ‬‫ﺘﺞ‬‫ﻨ‬
‫ﻳ‬
‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺬﻉ‬‫ﻠﻰﺟ‬‫ﺪﻋ‬‫ﻳ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﺘﺞﻋﻦﻫ‬‫ﻨ‬‫ﻳ‬.
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺬﻉ‬‫ﻠﻰﺟ‬‫ﻤﺦﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺃ‬‫ﻐﻂ‬‫ﺗﻀ‬ ‫ﺔﻭ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮ‬
‫ﺒ‬‫ﻗ‬
‫ﻮﺕ‬‫ﻣ‬
‫ﻪﻭ‬‫ﻴ‬‫ﺔﻓ‬‫ﻌ‬‫ﻜﻞﻻﺭﺟ‬‫ﺎﻍﺑﺸ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻓﻲ‬‫ﻛﺴﺠ‬‫ﺍﻷ‬‫ﻘﺺ‬ ‫ﻟﻰﻧ‬
‫ﺩﻱﺇ‬‫ﺆ‬‫ﺎﻳ‬
‫ﻤ‬‫ﻣ‬،‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬‫ﻡﺇ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﻗﻒﺗ‬‫ﻮ‬‫ﺗ‬
.‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
:
‫ﺫﺏ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮﻱ‬‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬.2

‫ﻳﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻧﻲ‬
‫ﺎ‬‫ﻌ‬
‫ﻳ‬.(
ADH)‫ﻮﻝ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺭ‬‫ﺩ‬‫ﺩﻹ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻣ‬
‫ﺮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺎ ﺽﺇ‬
‫ﻔ‬‫ﻧﺨ‬
‫ﺔﻻ‬ ‫ﻴﺠ‬‫ﺘ‬
‫ﻮﻧ‬‫ﺫﺏﻫ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻱ‬‫ﻜ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮﺽ‬ ‫ﻣ‬
.‫ﺮﻁ‬‫ﻔ‬
‫ﻮﻝﻣ‬‫ﺯﺑ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﻣﻦﺇ‬
:
(SIADH)‫ﺎﺳﺐ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬
‫ﻮﻝﻏ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺭ‬‫ﺩ‬‫ﺩﻹ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬
‫ﻣ‬‫ﺮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬
‫ﻣﻼ‬
‫ﺘ‬. 3

203
‫ﺰ‬‫ﻴ‬‫ﻛ‬
‫ﺮ‬‫ﺒﺢﺗ‬ ‫ﻳﺼ‬‫ﻭ‬، ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬ ‫ﺘ‬‫ﻧ‬
‫ﻘﻞﺇ‬‫ﻳ‬‫ﻭ‬، ‫ﻟﺤﺠﻢ‬ ‫ﺎ‬‫ﺎﺑ‬ً
‫ﻠ‬
‫ﻘ‬‫ﺜ‬‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺒﺢ‬‫ﻳﺼ‬. ADH‫ﺯ‬ ‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺓﺇ‬ ‫ﺩ‬‫ﺎ‬‫ﻳ‬‫ﺰ‬‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬ ‫ﻮﻧ‬ ‫ﻫ‬SI ADH
.‫ﺎ‬
ً
‫ﻔ‬‫ﻔ‬‫ﻡﻣﺨ‬ ‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻓﻲ‬ ‫ﻮ‬ ‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬
Medical andNur singManagement :
1.Admi nist eri
ngosmot i
cdi ureticssuchasmanni tol.
2.Rest r
ictingf l
uids.
3.DrainingCSFwi thav entriculostomydr aincandr amat i
callyr educeI CP.
Cautionshoul dbeusedi ndr ainingCSF, howev er,becauseex cessi vedr ainage
mayr esulti ncol l
apseoft hev entri
cles.
4.Cont r
ollingf ever.
5.Mai ntainingsy stemi cbloodpr essureandoxy genat ion.
6.Reduci ngcel lularmet abol icdemandst hrought headmi nistrat i
onofhi gh
dosesofbar bit
urat esifthepat i
enti sunr esponsi vet oconv ent ional treat ment .
7.Hyper vent i
lati
onmaybeusedaccor dingt opat i
ent`scondi tion.
8.El
ev ateheadoft hebed30degr ee.
:‫ﻳﺾ‬ ‫ﺮ‬ ‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻟﻄﺐﻭ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺇ‬
.‫ﻮﻝ‬ ‫ﺘ‬
‫ﻴ‬‫ﻧ‬‫ﺎ‬‫ﺜﻞﻣ‬ ‫ﺔﻣ‬‫ﻴ‬‫ﺎﺿﺤ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬ ‫ﺭ‬‫ﺪ‬‫ﺓﻣ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬.1
.
‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬ ‫ﻴ‬
‫ﻴ‬‫ﻘ‬‫ﺗ‬.2
‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬‫ﺮﻣﻦﺑ‬ ‫ﻴ‬ ‫ﺒ‬
‫ﻜﻞﻛ‬ ‫ﻠﻞﺑﺸ‬ ‫ﻘ‬
‫ﺃﻥﻳ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻴﻦﻳ‬ ‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻐ‬‫ﺍﻑﻓ‬ ‫ﺰ‬‫ﻨ‬‫ﺘ‬‫ﺍﺳ‬‫ﻊ‬ ‫ﻋﻲﻣ‬ ‫ﺎ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻏﻲ‬‫ﺎ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﻥﺗﺼ‬.‫ﺇ‬3
‫ﺪ‬‫ﺮﻁﻗ‬ ‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻷﻥ‬، ‫ﺎﻋﻲ‬‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﺎﻏﻲ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﻳﻒ‬ ‫ﺮ‬‫ﺭﻓﻲﺗﺼ‬ ‫ﺬ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﺧﻲ‬ ‫ﻳﺠﺐﺗ‬. ‫ﺔ‬ ‫ﻴ‬
‫ﻟ‬‫ﻭ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.‫ﻴﻦ‬ ‫ﻨ‬‫ﻴ‬‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﺎ‬‫ﻴ‬‫ﻬ‬‫ﻧ‬‫ﺍ‬ ‫ﻟﻰ‬‫ﺩﻱﺇ‬‫ﺆ‬‫ﻳ‬
.‫ﻤﻰ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺮ‬‫ﻴﻄ‬‫ﻟﺴ‬‫ﺍ‬.4
.‫ﻴﻦ‬‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﺯﻱﻭ‬ ‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﻠﻰ ﺿ‬‫ﺔﻋ‬ ‫ﻓﻈ‬ ‫ﺎ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬.5
‫ﺎﻥ‬‫ﺍﻛ‬‫ﺫ‬‫ﺍﺕﺇ‬ ‫ﺭ‬‫ﻮ‬‫ﺘ‬‫ﻴ‬
‫ﺑ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺎﺕﻋ‬ ‫ﺮﻋ‬‫ﺀﺟ‬ ‫ﺎ‬‫ﻮﻱﻣﻦﺧﻼﻝﺇﻋﻄ‬ ‫ﻠ‬‫ﻟﺨ‬‫ﺍ‬‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﺜ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﺒ‬‫ﻠ‬‫ﺘﻄ‬ ‫ﻴﻞﻣ‬ ‫ﻠ‬
‫ﻘ‬‫ﺗ‬.6
.‫ﺪﻱ‬‫ﻴ‬‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻠ‬‫ﻟ‬‫ﻴﺐ‬ ‫ﺘﺠ‬‫ﻳ ﺾﻻﻳﺴ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻔﺲﺣﺴﺐ ﺎ‬ ‫ﻨ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﻁ‬ ‫ﻡﻓ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬.7
‫ﺔ‬‫ﺭﺟ‬‫ﺩ‬30‫ﺮ‬ ‫ﻳ‬
‫ﺮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺃﺱ‬ ‫ﻊﺭ‬‫ﻓ‬ ‫ﺭ‬
‫ﺍ‬.8

204
 Uni
t3:Braint
umor
Brai
nt umor
Learningobject i
v es:
Attheendoft hisl ecturet hest
udentwi l
lbeableto:
1.Definebraint umor .
2.Listcl
assifi
cat ionsofbr aint
umor.
3.Discusspat hophy siologyandeti
ologyofbr ai
ntumor.
4.Listcl
ini
cal mani festati
onsofbrai
nt umor .
5.Describeassessmentanddi agnosticfindi
ngsofbrai
ntumor
.
6.Discussmedi cal managementofbr aint umor
.
7.Identi
fysurgical managementofbr aintumor.
8.Describenur singmanagementofbr aintumor.

‫ﻤﺦ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺭ‬‫ﻭ‬:3‫ﺓ‬
‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬
‫ﻤﺦ‬
‫ﻟ‬‫ﺍ‬‫ﻡﻓﻲ‬
‫ﺭ‬‫ﻭ‬
:‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:‫ﻣ‬
‫ﻟﺐ ﻦ‬ ‫ﺎ‬‫ﻟﻄ‬
‫ﺍ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘ‬
‫ﻴ‬‫ﺓﺳ‬ ‫ﺮ‬
‫ﺎﺿ‬ ‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬ ‫ﺔﻫ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬
.
‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻳﻒﻭ‬ ‫ﺮ‬‫ﻌ‬‫ﺗ‬.
1
.
‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﺎﺕﻭ‬‫ﻔ‬‫ﻴ‬‫ﻨ‬‫ﺔﺗﺼ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.2
.
‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺭ‬‫ﺎﺕﻭ‬‫ﺒ‬‫ﺒ‬‫ﻣﺴ‬‫ﺔﻭ‬ ‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.3
.‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬
‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬.4
.
‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺭ‬‫ﻮ‬ ‫ﻟ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬‫ﺘ‬‫ﻭﺻﻒﻧ‬. 5
.‫ﻤﺦ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺒﻲ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻗﺸ‬‫ﺎ‬‫ﻨ‬
‫ﻣ‬.6
.
‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﺍﺣﻲﻷ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺑ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬.
7
.‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﻳﻀﻲﻷ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺪ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬. 8

Br
aint
umor
I
ntr oduct i
on:
Braint umor soccuri nallagegr oups.Somet y pesar emor ecommoni npeople
youngert han20y ear
sofage; othersmor efrequent lyaffectolderpeople.
Def init
ion:Abr aintumori salocal i
zedi nt
racraniallesionthatoccupi esspace
withi ntheskul l
.
At umorusual lygrowsasaspher i
cal mass, butitalsocangr owdi f
fuselyand
i
nfiltratetissue.Theef fect
sofneopl asmsar ecausedbyt hecompr essionand
i
nfiltrati
onoft issue.
:‫ﺔ‬‫ﻣ‬‫ﺪ‬
‫ﻘ‬‫ﻣ‬
‫ﻘﻞ‬‫ﻳﻦﺗ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺹ‬ ‫ﺍﻷﺷﺨ‬ ‫ﺪ‬‫ﻨ‬
‫ﺎﻋ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺍﻉ‬ ‫ﻮ‬
‫ﻧ‬‫ﺍﻷ‬‫ﻌﺾ‬ ‫ﺑ‬.‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺌ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﻤﺦﻓﻲﺟ‬ ‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﺪﺙ‬‫ﺗﺤ‬
.
‫ﻟﺴﻦ‬ ‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﻠﻰﻛ‬ ‫ﺭﻋ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﻭﻥﺑﺸ‬ ‫ﺮ‬‫ﺍﻵﺧ‬‫ﺮ‬‫ﺛ‬‫ﺆ‬‫؛ﻳ‬‫ﺎ‬
ً
‫ﻣ‬‫ﺎ‬
‫ﻋ‬20‫ﺭﻫﻢﻋﻦ‬ ‫ﺎ‬‫ﻤ‬‫ﻋ‬‫ﺃ‬
.‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﺔﺩ‬‫ﺎﺣ‬‫ﺘﻞﻣﺴ‬ ‫ﺔﺗﺤ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﺔﺩ‬‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﺔﻣ‬‫ﻓ‬‫ﺁ‬‫ﻮ‬‫ﻤﺦﻫ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻭ‬:‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺍﻷ‬‫ﺭ‬ ‫ﺎ‬‫ﺛ‬
‫ﺁ‬.‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻟﻰ‬‫ﻠﻞﺇ‬‫ﺘﺴ‬‫ﻳ‬‫ﺮﻭ‬‫ﺘﺸ‬‫ﻨ‬‫ﻜﻞﻣ‬‫ﻮﺑﺸ‬ ‫ﻤ‬‫ﻨ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬‫ﺎﻳ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬
‫ﻪ‬‫ﻨ‬‫ﻜ‬‫ﻟ‬‫ﻭ‬،‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺔﻛ‬‫ﻠ‬‫ﺘ‬
‫ﻜ‬‫ﻡﻛ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬
‫ﻤ‬‫ﻨ‬‫ﺎﻳ‬‫ﺓﻣ‬
ً‫ﺩ‬‫ﺎ‬
‫ﻋ‬
.‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻠﻞ‬‫ﺗﺴ‬‫ﻐﻂﻭ‬ ‫ﺔﻋﻦ ﺿ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﻡﻧ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬

Classif
icati
onofBrainTumors:
I.I
ntracerebr
alTumor s:
A.Gliomas: i
nfi
l
trat
eanypor
ti
onoft
hebr
ain;
mostcommont
ypeofbr
aint
umor
1.Astrocytomas
2.Gli
oblastomamul ti
for
m

205
3.Oli
godendrocyt
oma
4.Ependymoma
5.Medull
oblastoma
:‫ﻤﺦ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬ ‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻴﻒ‬‫ﻨ‬‫ﺗﺼ‬
:‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬:
‫ﺃﻻ‬
‫ﻭ‬
‫ﺎ‬
ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬
‫ﻤﺦﺷ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺍ‬‫ﺭ‬‫ﻭ‬
‫ﺃ‬‫ﺍﻉ‬
‫ﻮ‬‫ﻧ‬
‫ﺃ‬‫ﺮ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬.
‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺀﻣﻦ‬
‫ﺰ‬‫ﺃﻱﺟ‬‫ﻟﻰ‬
‫ﻠﻞﺇ‬
‫ﺗﺴ‬:‫ﺔ‬‫ﻴ‬‫ﻘ‬‫ﺑ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬.A
‫ﺔ‬‫ﻴ‬‫ﻤ‬
‫ﻨﺠ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬.1
‫ﺎﻝ‬‫ﻜ‬
‫ﺍﻷﺷ‬‫ﺩ‬
‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﻘﻲﻣ‬ ‫ﺑ‬
‫ﻣﻲﺩ‬ ‫ﻭ‬‫ﺭ‬‫ﺃ‬‫ﻡ‬‫ﺭ‬‫ﻭ‬.2
‫ﻐﺼﻦ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻠ‬‫ﻴ‬‫ﻠ‬
‫ﻘﻲﻗ‬ ‫ﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻭ‬.3
‫ﺒﻲ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻧﻲ‬‫ﺎ‬‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬.4
‫ﺎﻋﻲ‬
‫ﻨﺨ‬‫ﻟ‬‫ﺍ‬‫ﻣﻲ‬‫ﻭ‬‫ﺭ‬‫ﺍﻷ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬.5

I
I.Tumor sAr i
singFrom Support
ingStructur
es
A.Meni ngi omas
B.Neur omas( acousti
cneuroma,schwannoma)
C.Pituitaryadenomas
I
II.Devel opment alTumors
A.Angi omas
B.Der moi d,epider
moid,ser
oma, cr
aniophary
ngi
oma
‫ﺔ‬‫ﻤ‬‫ﻋ‬
‫ﺍ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺄﻣﻦ‬‫ﻨﺸ‬
‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬‫ﻭ‬
‫ﺍﻷ‬.‫ﺎ‬
ً
‫ﻴ‬‫ﻧ‬‫ﺎ‬
‫ﺛ‬
‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺴﺤ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬.A
(
‫ﻧﻲ‬‫ﺎ‬
‫ﻔ‬‫ﻡﺷ‬‫ﺭ‬‫ﻭ‬،‫ﻌﻲ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫ﻌﺼﺐ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬
‫ﻭ‬)‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺍﻷ‬
‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬.C
‫ﻮ‬‫ﻤ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺍ‬‫ﺭ‬‫ﻭ‬‫ﺃ‬.‫ﺎ‬
‫ﺛﺎ‬
‫ﺜ‬
‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻋ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬.A
‫ﻣﻲ‬‫ﻮ‬‫ﻌ‬
‫ﻠ‬‫ﻔﻲﺑ‬
‫ﻡﻗﺤ‬ ‫ﺭ‬
‫ﻭ‬، ‫ﻠﻲ‬
‫ﻡﻣﺼ‬ ‫ﺭ‬
‫ﻭ‬،‫ﺮﻱ‬‫ﺑﺸ‬،‫ﻧﻲ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﺟ‬.‫ﺏ‬
IV.Met astaticLesions
Pat hophysiologyandet iology:
Thecauseofmostbr aintumor s,whichoccurinv ar i
ousareasofthebrai
n,
remai nsunknown.Smal lpercentagesarecongenit al,
suchas
hemangi oblastomas.Genet icfactorsareassoci
at edwi t
htwotypesofbrain
tumor s,astrocyt
oma, agl iomat umori nthefr
ontal lobe,
andneurofi
bromatosi
s.
Ot hercausat i
vefactorsincludev ir
alinf
ecti
on,ex
posur etoradi
ati
on,head
trauma, andi mmunosuppr ession.

Phy siologicchanges: causinganyoral lofthefoll

owi ngpathophysiol
ogic
events:
1.Incr easedi ntracr
anialpressure( ICP)andcer ebraledema.
2.Seizur eact iv
ityandf ocal neurologicsigns.
3.Hy dr ocephalus.
4.Al t
er edpituitaryfuncton.
i
‫ﺓ‬‫ﺮ‬‫ﺘﺸ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻓ‬
‫ﺍﻵ‬.‫ﺎ‬
‫ﻌ‬‫ﺑ‬‫ﺍ‬
‫ﺭ‬
:
‫ﺎﺕ‬‫ﺒ‬
‫ﺒ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﻨﺴﺐ‬ ‫ﻟ‬
‫ﺍ‬.‫ﻭﻑ‬ ‫ﺮ‬‫ﻌ‬‫ﺮﻣ‬‫ﻴ‬‫ﺎﻍﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻣﻦ‬ ‫ﻔ‬
‫ﻠ‬‫ﺘ‬‫ﺎﻃﻖﻣﺨ‬ ‫ﻨ‬‫ﺪﺙﻓﻲﻣ‬ ‫ﺘﻲﺗﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻍ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻌﻈﻢ‬‫ﺒﺐﻣ‬ ‫ﺍﻝﺳ‬‫ﻻﺰ‬
‫ﻳ‬
‫ﺎ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬ ‫ﻡ‬‫ﺭ‬‫ﻭ‬،‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺃ‬‫ﻴﻦﻣﻦ‬ ‫ﻮﻋ‬‫ﻨ‬‫ﺔﺑ‬‫ﻴ‬‫ﺛ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻂ‬‫ﺗ‬
‫ﺮ‬‫ﺗ‬.‫ﺋﻲ‬‫ﺎ‬
‫ﻣﻲﻭﻋ‬ ‫ﻭ‬‫ﺭ‬‫ﺃ‬‫ﻡ‬‫ﺭ‬
‫ﺜﻞﻭ‬ ‫ﻣ‬،‫ﻘﻲ‬‫ﻠ‬‫ﺓﺧ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﻟﺼ‬‫ﺍ‬
‫ﺮﻯ‬‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﺒ‬
‫ﺒ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬ ‫ﻣﻞ‬‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬‫ﺗﺸ‬.‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻔﻲ‬ ‫ﻴ‬‫ﻠ‬
‫ﻟ‬‫ﺍ‬
‫ﻡ‬ ‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬، ‫ﻬﻲ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﻔﺺ‬ ‫ﻟ‬‫ﺍ‬
‫ﻘﻲﻓﻲ‬ ‫ﺑ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬
‫ﻭ‬‫ﻭ‬، ‫ﺔ‬‫ﻴ‬
‫ﻤ‬‫ﻨﺠ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﺎﻋ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻂ‬ ‫ﺒ‬‫ﺜ‬‫ﺗ‬
‫ﺃﺱﻭ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬‫ﺎﻉﻭﺻ‬ ‫ﻌ‬‫ﻟﻺﺷ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻭﺳ‬‫ﺮ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬

206
 ‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺙ‬ ‫ﺪ‬‫ﻛﺍﻷﺣ‬
‫ﻭﻞ‬ ‫ﺃ‬‫ﺃﻱﻣﻦ‬ ‫ﺒﺐﻓﻲ‬ ‫‪:‬ﺗﺴ‬‫ﺔ‬‫ﻴ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﻮ‬‫ﻴ‬‫ﻔﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬ ‫ﺎﻏ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫(ﻭ‬‫‪I‬‬‫ﺔ)‪CP‬‬ ‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬ ‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫‪.‬ﺯ‬‫‪1‬‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺆ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬‫ﺒ‬
‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻭﻌﻼ‬
‫ﻟ‬‫ﺎﻁﺍ‬ ‫ﻨﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺑ‬‫ﻮ‬‫‪.‬ﻧ‬‫‪2‬‬
‫‪.‬‬
‫ﺃﺱ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻘ‬
‫ﺘﺴ‬ ‫ﺍﺳ‬‫‪.‬‬‫‪3‬‬
‫‪.‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﻣ‬‫ﺎ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬ ‫ﻴ‬
‫ﺮﻭﻇ‬ ‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫‪.‬ﺗ‬‫‪4‬‬
‫‪Cl‬‬‫‪i‬‬‫‪ni‬‬
‫‪calMani‬‬ ‫‪f‬‬‫‪est‬‬‫‪at‬‬‫‪i‬‬‫‪ons:‬‬
‫‪I‬‬‫‪.Gener‬‬ ‫‪al‬‬‫‪i‬‬‫‪zedsy‬‬ ‫‪mpt‬‬ ‫‪omsr‬‬ ‫‪ef‬‬‫‪l‬‬‫‪ecti‬‬‫‪ncr‬‬ ‫‪easedI‬‬ ‫‪CP:‬‬
‫‪1.I‬‬‫‪ncr‬‬‫‪easedI‬‬ ‫‪nt‬‬‫‪r‬‬‫‪acr‬‬‫‪ani‬‬‫‪alPr‬‬ ‫‪essur‬‬ ‫‪e:Sy‬‬ ‫‪mpt‬‬ ‫‪omsofi‬‬ ‫‪ncr‬‬‫‪easedI‬‬ ‫‪CPr‬‬‫‪esul‬‬ ‫‪tf‬‬‫‪r‬‬‫‪om a‬‬
‫‪gr‬‬‫‪adual‬‬ ‫‪compr‬‬ ‫‪essi‬‬‫‪onoft‬‬ ‫‪hebr‬‬ ‫‪ai‬‬‫‪nbyt‬‬ ‫‪heenl‬‬ ‫‪ar‬‬‫‪gi‬‬‫‪ngt‬‬ ‫‪umor‬‬ ‫‪.‬‬
‫‪2.Headache:I‬‬ ‫‪smostcommoni‬‬ ‫‪nt‬‬‫‪heear‬‬ ‫‪l‬‬
‫‪ymor‬‬ ‫‪ni‬‬‫‪ngandi‬‬ ‫‪swor‬‬ ‫‪sebycoughi‬‬ ‫‪ng,‬‬
‫‪st‬‬‫‪r‬‬‫‪ai‬‬
‫‪ni‬‬‫‪ng,‬‬ ‫‪orsuddenmov‬‬ ‫‪ement‬‬ ‫‪.I‬‬
‫‪ti‬‬‫‪st‬‬ ‫‪houghtt‬‬ ‫‪obecausedbyt‬‬ ‫‪het‬‬‫‪umor‬‬ ‫’‬
‫‪s‬‬
‫‪i‬‬
‫‪nv‬‬ ‫‪adi‬‬‫‪ng,‬‬ ‫‪compr‬‬ ‫‪essi‬‬‫‪ng,‬‬ ‫‪orbyedema.‬‬
‫‪3.Vomi‬‬ ‫‪t‬‬‫‪i‬‬‫‪ng:I‬‬‫‪ssel‬‬‫‪dom r‬‬ ‫‪el‬‬‫‪at‬‬‫‪edt‬‬ ‫‪of‬‬ ‫‪oodi‬‬ ‫‪nt‬‬‫‪ake,‬‬‫‪i‬‬‫‪susual‬‬ ‫‪l‬‬‫‪yt‬‬‫‪her‬‬‫‪esul‬‬‫‪tofi‬‬‫‪r‬‬‫‪r‬‬‫‪i‬‬
‫‪t‬‬‫‪at‬‬ ‫‪i‬‬
‫‪onof‬‬
‫‪t‬‬‫‪hev‬‬ ‫‪agal‬‬ ‫‪cent‬‬‫‪er‬‬‫‪si‬‬‫‪nt‬‬ ‫‪hemedul‬‬ ‫‪l‬‬
‫‪a.For‬‬ ‫‪cef‬‬‫‪ul‬‬ ‫‪v‬‬‫‪omi‬‬‫‪t‬‬‫‪i‬‬‫‪ngi‬‬‫‪sdescr‬‬ ‫‪i‬‬‫‪bedaspr‬‬ ‫‪oj‬‬‫‪ect‬‬ ‫‪i‬‬‫‪l‬‬
‫‪e‬‬
‫‪v‬‬‫‪omi‬‬ ‫‪t‬‬‫‪i‬‬
‫‪ng.‬‬
‫‪4.Vi‬‬‫‪sualDi‬‬ ‫‪st‬‬
‫‪ur‬‬ ‫‪bances:Papi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪edemai‬‬ ‫‪spr‬‬‫‪esenti‬‬ ‫‪n70%t‬‬ ‫‪o75%ofpat‬‬ ‫‪i‬‬‫‪ent‬‬‫‪sandi‬‬ ‫‪s‬‬
‫‪associ‬‬ ‫‪at‬‬‫‪edwi‬‬ ‫‪t‬‬‫‪hv‬‬ ‫‪i‬‬
‫‪sual‬‬ ‫‪di‬‬‫‪st‬‬‫‪ur‬‬‫‪bancessuchasdecr‬‬ ‫‪easedv‬‬ ‫‪i‬‬‫‪sual‬‬‫‪acui‬‬‫‪t‬‬‫‪y‬‬
‫‪,‬‬ ‫‪di‬‬‫‪pl‬‬‫‪opi‬‬‫‪a‬‬
‫(‬‫‪doubl‬‬‫‪ev‬‬ ‫‪i‬‬
‫‪si‬‬‫)‪on‬‬‫‪,‬‬‫‪andv‬‬ ‫‪i‬‬‫‪sual‬‬ ‫‪f‬‬‫‪i‬‬
‫‪el‬‬‫‪ddef‬‬ ‫‪i‬‬‫‪ci‬‬‫‪t‬‬‫‪s.‬‬

‫‪:‬‬‫ﺔ‬‫ﻣ‬
‫ﺯ‬‫ﺘﻼ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺽ‬‫ﺮ‬‫ﻋ‬‫ﺍﻻ‬
‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬‫ﻧ‬‫ﺮ‬
‫ﺓﺑ‬ ‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺔﺯ‬‫ﻤ‬
‫ﻤ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬‫ﺮ‬‫ﻋ‬‫ﺍﻷ‬‫ﻜﺲ‬ ‫ﻌ‬‫ﺃﻻً‪-‬ﺗ‬‫ﻭ‬
‫ﻳﺠﻲ‬‫ﺭ‬‫ﺪ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﻤ‬
‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺍ ﺽﺯ‬‫ﺮ‬
‫ﻋ‬‫ﺃ‬ ‫ﻨﺠﻢ‬‫‪:‬ﺗ‬
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺧﻞ‬‫ﻐﻂﺩ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫‪.‬ﺯ‬
‫‪1‬‬
‫‪.‬‬
‫ﺘﻀﺨﻢ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺒﺐ‬ ‫ﺎﻍﺑﺴ‬‫ﻣ‬‫ﺪ‬‫ﻠ‬
‫ﻟ‬
‫ﺔ‬‫ﻛ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫ﺩ‬‫ﺎ‬‫ﻬ‬
‫ﺃﺍﻹﺟ‬
‫ﺎﻝﻭ‬ ‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬‫ﺍﻋﻦﻃ‬ ‫ً‬
‫ﺀ‬ ‫ﻮ‬
‫ﺩﺳ‬ ‫ﺍ‬‫ﺩ‬
‫ﺰ‬‫ﻳ‬‫ﺮﻭ‬‫ﻛ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺡ‬ ‫ﺒ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺎﻓﻲ‬‫ﻮً‬
‫ﻋ‬ ‫ﻴ‬‫ﺮﺷ‬ ‫ﺜ‬
‫ﻛ‬‫ﻫﺍﻷ‬
‫‪:‬ﻮ‬ ‫ﺍﻉ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫‪.‬‬
‫‪2‬‬
‫‪.‬‬
‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻐﻄ‬‫ﻭﺿ‬ ‫ﺃ‬‫ﻡ‬ ‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺰ‬
‫ﺗﺞﻋﻦﻏ‬ ‫ﺎ‬
‫ﻪﻧ‬‫ﻧ‬‫ﺃ‬‫ﺪ‬
‫ﻘ‬‫ﺘ‬‫ﻌ‬‫‪ُ.‬‬
‫ﻳ‬ ‫ﺔ‬‫ﺌ‬
‫ﺎﺟ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺮﻓﻲ‬‫ﺋ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻌﺼﺐ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬‫ﺆ‬
‫ﻴﺞﺑ‬ ‫ﻬ‬
‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬ ‫ﺘ‬
‫ﻮﻥﻧ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬
‫‪،‬ﻭﻋ‬ ‫ﻡ‬‫ﺎ‬
‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬
‫ﻨ‬‫ﺘ‬‫ﺎﺑ‬
‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﻮﻥﻣ‬‫ﻜ‬‫ﺎﻳ‬‫ﺍﻣ‬‫ﺭ‬‫ﺩ‬
‫ﺎ‬‫‪:‬ﻧ‬‫ﺀ‬
‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫‪.‬‬
‫‪3‬‬
‫‪.‬‬
‫ﻭﻑ‬ ‫ﺬ‬‫ﻘ‬‫ﺀﻣ‬‫ﻪﻗﻲ‬ ‫ﻧ‬
‫ﺄ‬‫ﻮﻱﺑ‬ ‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﺻﻒ‬ ‫‪.‬ﻳ‬‫ﺎﻉ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬
‫ﻊ‬‫ﻓﻖﻣ‬
‫ﺍ‬‫ﺮ‬‫ﺘ‬
‫ﺗ‬‫ﺮﺿﻰﻭ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫‪٪‬ﻣﻦ‬ ‫ﻟﻰ‪75‬‬ ‫‪٪‬ﺇ‬‫ﺮﻱﻓﻲ‪70‬‬ ‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬‫ﻌﺼﺐ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻴ‬‫ﻠ‬
‫ﺔﺣ‬ ‫ﻣ‬‫ﺫ‬‫ﺪﻭ‬‫ﻮﺟ‬‫‪:‬ﺗ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﺒﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬ ‫‪.‬‬
‫‪4‬‬
‫‪.‬‬
‫ﺮﻱ‬‫ﺒﺼ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬
‫ﻤﺠ‬‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫‪،‬ﻭﻋﺠ‬ ‫(‬‫ﺔ‬‫ﻭﺟ‬‫ﺩ‬‫ﺰ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺅ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ)‬‫ﻳ‬‫ﺅ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﻭ‬‫ﺩ‬‫ﺯ‬
‫ﺍ‬‫‪،‬‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺎ ﺽﺣ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﺜﻞ‬‫ﺔﻣ‬‫ﻳ‬‫ﺮ‬‫ﺎﺕﺑﺼ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬

‫‪I‬‬‫‪I‬‬
‫‪.Local‬‬‫‪i‬‬‫‪zedSy‬‬ ‫‪mpt‬‬‫‪oms:‬‬
‫‪1.Hemi‬‬ ‫‪par‬‬ ‫‪esi‬‬
‫‪s‬‬
‫‪2.Sei‬‬‫‪zur‬‬‫‪es‬‬
‫‪3.Ment‬‬ ‫‪al‬‬ ‫‪st‬‬‫‪at‬‬
‫‪uschanges‬‬
‫‪4.Sensor‬‬ ‫‪yandmot‬‬ ‫‪orabnor‬‬
‫‪mal‬‬‫‪i‬‬‫‪t‬‬
‫‪i‬‬‫‪es‬‬
‫‪5.Vi‬‬‫‪sual‬‬ ‫‪al‬‬‫‪t‬‬‫‪er‬‬
‫‪at‬‬‫‪i‬‬
‫‪ons‬‬
‫‪6.Al‬‬‫‪t‬‬‫‪er‬‬
‫‪at‬‬‫‪i‬‬‫‪onsi‬‬ ‫‪ncogni‬‬‫‪t‬‬
‫‪i‬‬‫‪on‬‬
‫‪7.Languagedi‬‬ ‫‪st‬‬‫‪ur‬‬
‫(‪bances‬‬‫‪eg,‬‬
‫‪aphasi‬‬‫)‪a‬‬
‫‪.‬‬

‫‪:‬‬
‫ﺔ‬‫ﻴ‬‫ﻌ‬
‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺽ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺛ‬
‫ﻔﻲ‬‫ﻠﻞﻧﺼ‬‫‪.‬ﺷ‬‫‪1‬‬
‫ﺎﺕ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪2‬‬
‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻘ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫‪.‬ﺗ‬
‫‪3‬‬
‫ﺔ‬‫ﻴ‬
‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻟﺤﺴ‬‫ﺍ‬ ‫ﺎﺕ‬
‫ﻮﻫ‬‫ﺘﺸ‬‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪4‬‬
‫ﺔ‬‫ﻳ‬‫ﺮ‬‫ﺒﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻼﺕ‬‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪5‬‬
‫ﺍﻙ‬‫ﺭ‬‫ﺩ‬
‫ﺍﻹ‬ ‫ﻳﻼﺕﻓﻲ‬ ‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪.‬‬
‫‪6‬‬
‫‪.‬‬
‫(‬‫ﻡ‬‫ﻜﻼ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﺓﻋ‬‫ﺭ‬
‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺜﻞﻓ‬‫ﻣ‬‫ﺔ)‬‫ﻐ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﺿﻄ‬ ‫‪.‬‬
‫‪7‬‬

‫‪207‬‬
 (
Fig.39)Commonsi
tesofbr
aint
umor

AssessmentandDi agnost i
cFi ndings:
1.Thehi st oryoft heillnessandt hemannerandt imef ramei nwhi chthe
sy mptomsev olvedar ekeycomponent si nthedi agnosisofbr aintumor s.
2.Aneur ologicexami nationi ndicatest hear easoft heCNSt hatareinv ol
ved.To
assistint hepr ecisel ocali
zationoft hel esi
on.
3.Comput edt omogr aphy( CT)scans, enhancedbyacont rastagent ,cangive
specifi
ci nfor mationconcer ningt henumber ,si
ze,anddensi tyoft helesionsand
theextentofsecondar ycer ebral edema.CTscanscanpr ovi
dei nformat i
on
aboutt hev entri
cularsy stem.
:
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺋﺞ‬ ‫ﺎ‬
‫ﺘ‬‫ﻧ‬
‫ﺔﻓﻲ‬‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﻧ‬
‫ﻮ‬‫ﻜ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍ ﺽﻣﻦ‬ ‫ﺮ‬‫ﺍﻷﻋ‬‫ﻪ‬‫ﻴ‬‫ﺭﺕﻓ‬ ‫ﻮ‬‫ﺬﻱﺗﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻨﻲ‬ ‫ﻣ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺍﻹﻃ‬‫ﺔﻭ‬‫ﻘ‬‫ﻳ‬‫ﺮ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺮ ﺽﻭ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻳﺦ‬‫ﺭ‬‫ﺎ‬
‫ﺮﺗ‬‫ﺒ‬‫ﺘ‬‫ﻌ‬‫ﻳ‬.
1
.‫ﻤﺦ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.‫ﺔ‬‫ﻗ‬‫ﺪ‬‫ﻵﺔﺑ‬
‫ﺍﻓ‬ ‫ﻴﻦ‬‫ﻮﻃ‬ ‫ﺓﻓﻲﺗ‬ ‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬‫ﻠ‬
‫ﻟ‬ .‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺰﻱ‬ ‫ﻛ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﻃﻖ‬‫ﻨ‬‫ﻟﻰﻣ‬‫ﺒﻲﺇ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﻔﺤ ﺺ‬ ‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻳﺸ‬.2
‫ﻠﻖ‬‫ﻌ‬‫ﺘ‬
‫ﺓﺗ‬ ‫ﺩ‬‫ﺪ‬‫ﺎﺕﻣﺤ‬ ‫ﻣ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻌﻄﻲﻣ‬ ‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬، ‫ﻳﻦ‬‫ﺎ‬
‫ﺒ‬‫ﻣﻞﺗ‬ ‫ﺎ‬
‫ﻌ‬‫ﺯﺑ‬‫ﺰ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬،(CT)‫ﻮﺳﺐ‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻲ‬ ‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬‫ﺍ‬.
3
‫ﺎﺕ‬‫ﻣ‬‫ﻮ‬‫ﻠ‬‫ﻌ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻌ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻌ‬
‫ﺍﻷﺷ‬ ‫ﺮ‬
‫ﻓ‬‫ﻮ‬‫ﺃﻥﺗ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬.‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻧ‬‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻣ‬‫ﺎﺕﻭ‬ ‫ﻓ‬‫ﺍﻵ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﺜ‬
‫ﻛ‬‫ﺩﻭﺣﺠﻢﻭ‬ ‫ﺪ‬‫ﻌ‬‫ﺑ‬
.‫ﻨﻲ‬‫ﻴ‬
‫ﺒﻄ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮﻝ‬‫ﺣ‬

4.Amagnet i
cresonancei magi ng( MRI )scani sthemosthel pfuldi
agnost
ictool
fordetectingbraintumor s,particularl
ysmal lerlesi
ons,andt umorsinthebrai
n
stem andpi tui
taryregions.
5.Comput er-
assist
edst ereotact i
c( t
hreedimensi onal)biopsyisusedto
diagnosedeep- seatedbr ai
ntumor sandt opr ovi
deabasi sfortreat
mentand
prognosis.
6.Cerebral angiogr
aphypr ovidesv i
sualizat
ionofcer ebralbloodvessel
sand
canlocalizemostcer ebralt
umor s.

4.‫ﻴﺴﻲ‬‫ﺎﻃ‬
‫ﻨ‬‫ﻐ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻧ‬
‫ﺮ‬‫ﻟ‬
‫ﺎ‬‫ﺮﺑ‬‫ﻳ‬‫ﻮ‬‫ﺘﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫(ﻳ‬MRI)‫ﻤﺦ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬‫ﻟ‬
‫ﺓ‬‫ﺪ‬‫ﺋ‬‫ﺎ‬
‫ﺮﻓ‬‫ﺜ‬‫ﻛ‬‫ﺍﻷ‬‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺍ‬‫ﺩ‬‫ﺃ‬
،
‫ﺔ‬ ‫ﻴ‬
‫ﻣ‬‫ﺎ‬‫ﻨﺨ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﻍﻭ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺬﻉ‬‫ﺎﻃﻖﺟ‬ ‫ﻨ‬
‫ﻡﻓﻲﻣ‬ ‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺍﻷ‬
‫ﻭ‬، ‫ﺮ‬
‫ﻐ‬‫ﺍﻷﺻ‬ ‫ﺎﺕ‬‫ﻓ‬‫ﺍﻵ‬‫ﺔ‬‫ﺎﺻ‬‫ﻭﺧ‬.
5.‫ﺎﻍ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬‫ﻟ‬‫ﺮ‬‫ﺗ‬‫ﻮ‬‫ﻴ‬‫ﺒ‬
‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬‫(ﺑ‬‫ﺩ‬
‫ﺎ‬‫ﻌ‬‫ﺑ‬
‫ﺍﻷ‬‫ﺔ‬‫ﻴ‬‫ﺛ‬
‫ﺛﻼ‬)‫ﻤﻲ‬ ‫ﻴ‬
‫ﺘﺠﺴ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻮﺿ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻋ‬‫ﺰ‬
‫ﻡﺧ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺘﻢ‬‫ﻳ‬
‫ﻴﺺ‬ ‫ﺘﺸﺨ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻌﻼﺝﻭ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎﺱ‬ ‫ﺃﺳ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬
‫ﻮ‬ ‫ﺘ‬
‫ﻟ‬‫ﺔﻭ‬‫ﻘ‬‫ﻴ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬.
6.‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺃ‬‫ﻌﻈﻢ‬‫ﻊﻣ‬‫ﻗ‬‫ﻮ‬‫ﺪﻣ‬‫ﻳ‬
‫ﺪ‬ ‫ﻪﺗﺤ‬‫ﻨ‬‫ﻜ‬
‫ﻤ‬‫ﻳ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﻏ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﻟﻸ‬‫ﺍ‬
ً
‫ﺭ‬‫ﻮ‬‫ﺔﺗﺼ‬‫ﻴ‬‫ﻏ‬‫ﺎ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺮ‬‫ﻳ‬‫ﻮ‬‫ﺮﺗﺼ‬‫ﻓ‬‫ﻮ‬‫ﻳ‬
‫ﻤﺦ‬‫ﻟ‬
‫ﺍ‬.

208
7.Anelectr
oencephalogram (
EEG)candetectanabnormal br
ainwav ein
regi
onsoccupiedbytumor ;i
tisusedtoevaluat
etemporall
obesei zur
esandto
assi
stinruli
ngoutotherdisor
ders.
8.Cytol
ogicstudi
esoft heCSFmaybeper formedtodetectmalignantcel
ls
becauseCNSt umorscanshedcel lsi
ntot
heCSF.

‫ﺘﻲ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻃﻖ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻍﻓﻲ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻌ‬
‫ﻴ‬‫ﺒ‬‫ﺮﻃ‬‫ﻴ‬‫ﺔﻏ‬‫ﻮﺟ‬‫ﻜﺸﻒﻋﻦﻣ‬ ‫ﻟ‬
‫ﺍ‬(EEG)‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻤﺨﻄﻂﻛ‬ ‫ﻟ‬‫ﻜﻦ‬‫ﻤ‬
‫ﻳ‬.7
.
‫ﺮﻯ‬‫ﺍﻷﺧ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺍ‬‫ﺮ‬
‫ﺍﻻﺿﻄ‬ ‫ﺩ‬‫ﺎ‬
‫ﻌ‬‫ﺒ‬
‫ﺘ‬‫ﺍﺳ‬‫ﺓﻓﻲ‬ ‫ﺪ‬
‫ﺎﻋ‬‫ﻤﺴ‬‫ﻠ‬
‫ﻟ‬
‫ﺪﻏﻲﻭ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻔﺺ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﻮ‬ ‫ﻴﻢﻧ‬‫ﻴ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﻪ‬‫ﻣ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬.
‫ﻡ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻬ‬‫ﻠ‬
‫ﻐ‬‫ﻳﺸ‬
‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬‫ﺔﻷﻥ‬‫ﺜ‬‫ﻴ‬‫ﺒ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺎ‬
‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬
‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬
‫ﻟ‬‫ﺎﻋﻲ‬‫ﻨﺨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻏﻲ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺎ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔﻋﻦ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﺎﺕﺧ‬ ‫ﺍﺳ‬‫ﺭ‬‫ﺀﺩ‬‫ﺍ‬
‫ﺮ‬‫ﻜﻦﺇﺟ‬‫ﻤ‬
‫ﻳ‬.8
.‫ﺎﻋﻲ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻏﻲ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺎﻓﻲ‬
‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﺯ‬‫ﺮ‬‫ﻔ‬
‫ﺃﻥﺗ‬‫ﻜﻦ‬‫ﻤ‬‫ﺰﻱﻳ‬‫ﻛ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬

Medi cal Management :

Av arietyofmedi cal tr
eatmentmodal i
ti
es,includingchemot herapyandext er
nal
-
beam r adiati
onther apy,areusedal oneorincombi nati
onwi thsurgical
resect i
on.
Surgi calManagement :
1.Theobj ect
iveofsur gicalmanagementi st oremov eordest r
oytheent i
re
tumorwi t
houtincr easingtheneurologicdef i
cit(par al
ysis,bl
indness)ort o
rel
iev esy mpt omsbypar ti
alremov al(decompr ession).
2.Sur ger yforbraint umorinvolvesacr ani
ot omy( incisionthroughtheskul l)or
craniect omy( excisionofpar toftheskull)
.Asect ionofbone( bonef lap)i
s
remov edt oreacht hebr ai
n.Afterthetumori sremov ed,theduraisr e-
appr oximat ed(thecutedgesar elinedupandsewnt ogether)
,thebonef l
ap
replaced, andt heski nsutured.

:
‫ﺔ‬ ‫ﻴ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
‫ﺎﻋﻲﺑ‬‫ﻌ‬‫ﺍﻹﺷ‬‫ﻭﻌﻼﺝ‬‫ﻟ‬
‫ﺋﻲﺍ‬ ‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫ﺑ‬،‫ﺒﻲ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬ ‫ﺔﻣﻦﻃ‬ ‫ﻮﻋ‬‫ﻨ‬‫ﺘ‬‫ﺔﻣ‬‫ﻋ‬‫ﻮ‬‫ﻤ‬‫ﻡﻣﺠ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﺗﺴ‬
ُ
.‫ﺍﺣﻲ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﻝ‬‫ﺌﺼ‬‫ﺘ‬‫ﻣﺍﻻﺳ‬
‫ﺍﻙ ﻊ‬‫ﺮ‬‫ﺘ‬‫ﺎﻻﺷ‬‫ﺃﺑ‬
‫ﺎﻭ‬‫ﺩﻫ‬‫ﺮ‬‫ﻔ‬‫ﻤ‬‫ﺑ‬،‫ﺔ‬‫ﻴ‬
‫ﺭﺟ‬ ‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺰ‬
‫ﻟﺤ‬‫ﺎ‬
:
‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺍﻹ‬
(‫ﻤﻰ‬‫ﻋ‬،‫ﻠﻞ‬‫ﺒﻲ)ﺷ‬‫ﻌﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺰ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﻭﻥﺯ‬‫ﻣﻞﺩ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺎ‬
‫ﻡﺑ‬ ‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻣ‬‫ﺪ‬‫ﻭﺗ‬‫ﺃ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﻮﺇ‬‫ﺍﺣﻲﻫ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺑ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻑﻣﻦ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬.1
.(
‫ﻐﻂ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺗﺨ‬)‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺰ‬‫ﻟﺠ‬‫ﺍ‬‫ﺯﺔ‬
‫ﻟ‬
‫ﺍﻹﺍ‬ ‫ﻳﻖ‬
‫ﺮ‬‫ﺍ ﺽﻋﻦﻃ‬ ‫ﺮ‬
‫ﻋ‬ ‫ﺍﻷ‬ ‫ﻴﻒ‬‫ﻔ‬‫ﻭﺗﺨ‬‫ﺃ‬
‫ﺎﻝ‬
‫ﺌﺼ‬‫ﺘ‬‫ﺍﺳ‬)‫ﻘﺤﻒ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﺌﺼ‬‫ﺘ‬
‫ﺍﺳ‬‫(ﻭ‬‫ﺔﺃ‬‫ﻤ‬‫ﻤﺠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻘﺤﻒ)ﺷﻖﻓﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀﺣﺞ‬ ‫ﺍ‬‫ﺮ‬‫ﺎﻍﺇﺟ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺭ‬‫ﺔﻭ‬‫ﺍﺣ‬‫ﺮ‬‫ﻤﻦﺟ‬ ‫ﺘﻀ‬ ‫ﺗ‬.2
‫ﺘﻢ‬‫ﻳ‬،‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺪﺇ‬‫ﻌ‬‫ﺑ‬.
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﻮﻝﺇ‬‫ﻮﺻ‬‫ﻠ‬‫ﻟ‬(
‫ﻤﻲ‬‫ﺮﻑﻋﻈ‬ ‫ﻓ‬‫ﺭ‬
)‫ﻌﻈﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﺀﻣﻦ‬ ‫ﺰ‬‫ﺔﺟ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺘﻢﺇ‬‫ﺗ‬.(
‫ﺔ‬‫ﻤ‬‫ﻤﺠ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺀﻣﻦ‬ ‫ﺰ‬
‫ﺟ‬
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻠ‬‫ﻳ‬‫ﺪ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺍﻝ‬‫ﺪ‬
‫ﺒ‬‫ﺘ‬‫ﺍﺳ‬
‫ﻭ‬، (‫ﻣ‬
‫ﺎ‬
ً‫ﺎ‬
‫ﻌ‬ ‫ﻬ‬‫ﺘ‬‫ﺎﻃ‬‫ﻴ‬
‫ﺔﻭﺧ‬ ‫ﻋ‬‫ﻮ‬‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﻮ‬‫ﻟﺤ‬ ‫ﺍ‬
‫ﻴﻦ‬‫ﺒﻄ‬‫ﺘﻢﺗ‬‫ﻳ‬)‫ﺔ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻳﺐ‬ ‫ﺮ‬‫ﻘ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬‫ﺇ‬
.‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﺎﻃ‬‫ﻴ‬
‫ﻭﺧ‬

209
 (
Fig.40)Cr
ani
otomy

3.Anothermethodofremov ingbrai
nt umorsusesalaserbeam di
rect
edatthe
tumorsite.Thi
ssurgi
cal
t echniqueenablesthephy
sici
antoreachtumorsthat
prev
iouslywereconsi
deredinoperable.

‫ﺔ‬
‫ﻴ‬‫ﻨ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻜﻦﻫ‬‫ﻤ‬‫ﺗ‬.
‫ﻡ‬‫ﺭ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻟﻰﻣ‬‫ﻪﺇ‬‫ﻮﺟ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺭ‬‫ﺰ‬‫ﻴ‬‫ﻠ‬
‫ﻟ‬
‫ﺍ‬‫ﺎﻉ‬‫ﻌ‬
‫ﻡﺷ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﻤﺦﺗﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺭ‬‫ﻭ‬‫ﺃ‬
‫ﺯﺔ‬
‫ﻟ‬‫ﺮﻯﻹﺍ‬
‫ﺃﺧ‬‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻃ‬.3
.‫ﺔ‬
‫ﺍﺣ‬‫ﺮ‬‫ﻠﺠ‬
‫ﻟ‬‫ﺔ‬‫ﻟﺤ‬
‫ﺎ‬‫ﺮﺻ‬ ‫ﻴ‬
‫ﺑﻖﻏ‬‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺮﻓﻲ‬‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﻧﺖﺗ‬‫ﺎ‬
‫ﺘﻲﻛ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﺍ‬‫ﺭ‬
‫ﻭ‬‫ﺍﻷ‬‫ﻟﻰ‬‫ﻮﻝﺇ‬
‫ﻮﺻ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺐﻣﻦ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬
‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬

NursingManagement :
1.Thepat i
entwi thabr aint umormaybeati ncr easedr iskf oraspi rati
onasa
resultofcranialner vedysf unct i
on.Pr eoperati
v ely,thegagr eflexandabi l
ityto
swallowar eev al
uat ed.Inpat i
ent swithdiminishedgagr esponse, careincl udes
teachingthepat i
entt odi rectf oodandf l
uidst owar dt heunaf f
ect edsi de, having
thepat i
entsitupr i
ghtt oeat ,of f
er i
ngasemi sof tdiet, andhav i
ngsuct i
onr eadi l
y
avail
able.
2.Thenur seper for msneur ologicchecksandmai nt ainsaneur ologicf l
owchar t.
3.Moni tor
sv i
talsi gns.
4.Spacesnur singi ntervent i
onst opreventar api di ncreasei nICP.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﺇ‬
:
1.‫ﻔﻲ‬ ‫ﻘﺤ‬‫ﻟ‬‫ﺍ‬‫ﻌﺼﺐ‬‫ﻟ‬‫ﺍ‬‫ﻠﻞﻓﻲ‬ ‫ﻟﺨ‬ ‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬‫ﻔﻂﻧ‬ ‫ﻟﺸ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﻟﻺﺻ‬ ‫ﺔ‬‫ﺮﺿ‬‫ﺮﻋ‬ ‫ﺜ‬‫ﻛ‬ ‫ﺃ‬‫ﺎﻏﻲ‬‫ﻣ‬ ‫ﻡﺩ‬ ‫ﺭ‬‫ﻮ‬‫ﺎﺏﺑ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬ ‫ﻜ‬
‫ﺪﻳ‬.‫ﻗ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬ ‫ﺍﺳ‬‫ﻌﻒ‬‫ﻮﻥﻣﻦ ﺿ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻓﻲ‬.‫ﻊ‬‫ﻠ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﺓﻋ‬ ‫ﺭ‬‫ﺪ‬‫ﻘ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻊﻭ‬ ‫ﻠ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﻜﺲ‬ ‫ﻌ‬ ‫ﻨ‬
‫ﻴﻢﻣ‬ ‫ﻴ‬‫ﻘ‬‫ﺘﻢﺗ‬‫ﻳ‬، ‫ﺔ‬
‫ﺍﺣ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺒﻞ‬‫ﻗ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻞ‬‫ﻭﺟ‬، ‫ﺎﺏ‬‫ﻤﺼ‬ ‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻧﺐﻏ‬ ‫ﺎ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﻮ‬
‫ﺋﻞﻧﺤ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺎ‬‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬ ‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬ ‫ﻳ ﺾﺗ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻌ‬‫ﺔﺗ‬‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻞ‬ ‫ﺗﺸ‬،‫ﻊ‬ ‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻟ‬
‫ﻮ‬‫ﻬ‬ ‫ﺎﺡﺑﺴ‬‫ﺘ‬‫ﻔﻂﻣ‬ ‫ﻭﺷ‬، ‫ﻴﻦ‬‫ﻟ‬‫ﻪ‬‫ﺒ‬
‫ﺋﻲﺷ‬ ‫ﺍ‬‫ﺬ‬‫ﻡﻏ‬ ‫ﺎ‬‫ﻳﻢﻧﻈ‬ ‫ﺪ‬‫ﻘ‬‫ﺗ‬‫ﻭ‬، ‫ﻡ‬‫ﺎ‬‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻭﻝ‬ ‫ﺎ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬ً
‫ﺎ‬‫ﻤ‬
‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻠﺲﻣﺴ‬ ‫ﻳﺠ‬.
2.‫ﺒﻲ‬ ‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰﻣﺨﻄﻂ‬ ‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﺗﺤ‬ ‫ﺔﻭ‬ ‫ﻴ‬‫ﺒ‬‫ﺎﺕﻋﺼ‬ ‫ﻮﺻ‬ ‫ﺀﻓﺤ‬ ‫ﺍ‬‫ﺮ‬‫ﺈﺟ‬‫ﺔﺑ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬‫ﺗ‬
.
3.‫ﺔ‬‫ﻳ‬‫ﻮ‬ ‫ﻴ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻗﺐ‬ ‫ﺍ‬‫ﺮ‬
‫ﻳ‬.
4.‫ﺔ‬‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻧ‬‫ﺭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻣﺞ‬‫ﺎ‬
‫ﻧ‬‫ﺮ‬‫ﺔﻓﻲﺑ‬ ‫ﻌ‬‫ﻳ‬
‫ﺮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬ ‫ﺎ‬
‫ﻳ‬‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺪﺧﻼﺕ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺎﺕﺗ‬ ‫ﻓ‬‫ﺎ‬‫ﻣﺴ‬.

5.Reor ientsthepat i
entwhennecessar yt oper son, t
ime,andpl ace.Pati
ents
withchangesi ncogni tioncausedbyt heirlesionr equir
ef r
equentr eori
entat
ion
andt heuseofor i
ent ingdev ices(eg,phot ographs, aclock),supervisi
onofand
assistancewi thsel f-car e.
6.Ongoi ngmoni toringandi ntervent
ionf orprev enti
onofi njury
.
7.Pat i
ent swithsei zur esar ecar eful
lymoni t
oredandpr otectedfrom inj
ury.
8.Mot orf uncti
oni scheckedati ntervals,becausespeci f
icmot ordefici
tsmay
occur, dependingont het umor ’
slocation.
9.Sensor ydi
sturbancesar eassessed.
10.Speechi sev aluat ed.
11.Checkey emov ementandpupi ll
arysiz eandr eaction.
12.Psy chosocialsuppor tforpatientandf amilymember sisofgr eat
i
mpor t
ance.

‫ﻮﻥﻣﻦ‬
‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬
‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺝ‬
‫ﺘ‬‫ﻳﺤ‬.‫ﺎﻥ‬
‫ﻜ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬‫ﻣ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﺸﺨ ﺺﻭ‬ ‫ﺍ‬‫ﻟﻰ‬‫ﺓﺇ‬
‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻳ ﺾﻋ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬‫ﺪﺗ‬‫ﻴ‬‫ﻌ‬‫ﻳ‬.
5
‫ﺭ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬
)‫ﻪ‬‫ﻴ‬‫ﻮﺟ‬
‫ﺓﺗ‬‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬
‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﺓﻭ‬‫ﺭ‬‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﻪﻣ‬‫ﻴ‬‫ﻮﺟ‬‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻟﻰﺇﻋ‬‫ﻬﻢﺇ‬‫ﺗ‬
‫ﺎ‬‫ﻓ‬
‫ﺁ‬‫ﺒﺐ‬‫ﺍﻙﺑﺴ‬ ‫ﺭ‬
‫ﺩ‬‫ﺍﻹ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬
.‫ﺔ‬
‫ﻴ‬‫ﺗ‬‫ﺍ‬
‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﺓﻓﻲ‬‫ﺪ‬‫ﺎﻋ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑﻭ‬‫ﺮ‬‫ﺍﻹﺷ‬‫(ﻭ‬‫ﺔ‬
‫ﻋ‬ ‫ﺎ‬
‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻓ‬‫ﺍ‬‫ﺮ‬‫ﻏ‬
‫ﻮ‬‫ﺗ‬‫ﻮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻣﺍﻹﺻ‬
‫ﺔﻦ‬ ‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻠ‬
‫ﻟ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.
6
.
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻣﺍﻹﺻ‬
‫ﻬﻢ ﻦ‬‫ﺘ‬‫ﻳ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻭﺣ‬ ‫ﻳ‬
‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﺎﺕﺑ‬‫ﺑ‬‫ﻮ‬‫ﻨ‬
‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻣﻦ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬
‫ﺍ‬‫ﺮ‬‫ﺘﻢﻣ‬‫ﻳ‬.
7

210
‫‪.‬‬
‫ﻡ‬‫ﺭ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﺎﻥ‬
‫ﻜ‬‫ﻠﻰﻣ‬
‫ﺍﻋ‬‫ً‬
‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﺘ‬
‫ﺍﻋ‬‫‪،‬‬
‫ﺩ‬‫ﺪ‬‫ﻛﻲﻣﺤ‬‫ﺮ‬
‫ﺰﺣ‬‫ﺪﺙﻋﺠ‬ ‫ﺪﻳﺤ‬‫ﻪﻗ‬‫ﻧ‬‫‪،‬ﻷ‬‫ﺍﺕ‬‫ﺮ‬
‫ﺘ‬‫ﻠﻰﻓ‬‫ﺮﻙﻋ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﺘﻢﻓﺤ ﺺﻭﻇ‬ ‫‪.‬ﻳ‬
‫‪8‬‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻟﺤﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻻﺿﻄ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺘﻢﺗ‬‫‪.‬ﻳ‬
‫‪9‬‬
‫‪.‬‬‫ﻡ‬‫ﻜﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺘﻢﺗ‬‫‪.‬ﻳ‬
‫‪10‬‬
‫‪.‬‬
‫ﺎ‬‫ﻬ‬
‫ﻠ‬‫ﻌ‬‫ﺩﻓ‬‫ﺭ‬
‫ﺔﻭ‬‫ﻗ‬‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻦﻭﺣﺠﻢ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻛ‬‫ﺮ‬‫‪.‬ﻓﺤ ﺺﺣ‬‫‪11‬‬
‫‪.‬‬
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﺔﻛ‬
‫ﻴ‬‫ﻤ‬‫ﺃﻫ‬
‫ﻪ‬‫ﻟ‬‫ﺓ‬‫ﺮ‬
‫ﺍﻷﺳ‬ ‫ﺩ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺃ‬‫ﻳ ﺾﻭ‬‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﻋﻲ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬‫ﻔﺴﻲﻭ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻋﻢ‬‫ﻟ‬
‫ﺍ‬‫‪.‬‬
‫‪12‬‬

‫‪Chapt‬‬ ‫‪erI‬‬
‫‪V‬‬
‫‪Nur‬‬
‫‪si‬‬‫‪ngManagementofPat‬‬ ‫‪i‬‬
‫‪entwi‬‬
‫‪t‬‬‫‪h‬‬
‫‪Bur‬‬‫‪ni‬‬‫‪nj‬‬‫‪ur‬‬‫‪y‬‬
‫ﻊ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻔﺼﻞ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬
‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺮﻕ‬‫ﺣ‬

‫‪Uni‬‬
‫‪tI‬‬‫‪:Bur‬‬
‫‪ni‬‬‫‪nj‬‬
‫‪ur‬‬‫‪i‬‬
‫‪es‬‬

‫‪Lear‬‬
‫‪ni‬‬‫‪ngObj‬‬‫‪ect‬‬
‫‪i‬‬‫‪v‬‬‫‪es:‬‬
‫‪Oncompl‬‬‫‪et‬‬‫‪i‬‬
‫‪onoft‬‬ ‫‪hi‬‬
‫‪schapt‬‬
‫‪er‬‬‫‪,‬‬
‫‪t‬‬‫‪hel‬‬
‫‪ear‬‬
‫‪nerwi‬‬
‫‪l‬‬‫‪l‬‬‫‪beabl‬‬
‫‪et‬‬‫‪o:‬‬
‫‪1-I‬‬
‫‪nt‬‬‫‪r‬‬
‫‪oduct‬‬‫‪i‬‬
‫‪on‬‬
‫‪2-Def‬‬
‫‪i‬‬‫‪neofbur‬‬‫‪n‬‬

‫‪211‬‬
3-Li
stcausesofburn.
4-Descr
ibethePathophysi
ologyofburni
njur
y.
5-Cl
assif
icat
ionofburninj
uryaccor
dingtosever
it
y.
6-Descr
ibethelocalandsystemi
ceffect
sofamaj orbur
ninj
ury
.

‫ﻭﻕ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺎ‬
‫ﺇﺻ‬:
‫ﻟﻰ‬‫ﻭ‬
‫ﺍﻷ‬‫ﺓ‬
‫ﺪ‬‫ﻮﺣ‬
‫ﻟ‬‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻠﻢﻗ‬‫ﻌ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬
‫ﻴ‬‫ﺳ‬، ‫ﻔﺼﻞ‬‫ﻟ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻻ‬‫ﺪ‬
‫ﻨ‬‫ﻋ‬
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬1
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬
‫ﺗ‬-2
.
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺏ‬‫ﺒ‬‫ﺄﺳ‬
‫ﺔﺑ‬‫ﻤ‬‫ﺋ‬‫ﺎ‬
‫ﻗ‬-3
.
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺔﻹﺻ‬ ‫ﻴ‬
‫ﺮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬ ‫ﻳ‬
‫ﺰ‬‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬- 4
.
‫ﺎ‬‫ﻬ‬
‫ﺗ‬‫ﺪ‬‫ﻭﻕﺣﺴﺐﺷ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻴﻒﺇﺻ‬ ‫ﻨ‬‫ﺗﺼ‬-5
.
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺔﻹﺻ‬‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻌ‬
‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﺛ‬
‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺻﻒ‬- 6

Intr
oduct ion:
-Abur ni njurycanaf fectpeopleofallagegr oups,inallsocioeconomi cgroups.
-Anest i
mat ed500,000peopl earetr
eatedf ormi norburninjuryannual l
y.The
numberofpat ient
swhoar ehospital
izedeachy earwithburni njuri
esismor e
than40, 000.Thi sincludesapproximately25,000peopl ewhor equire
hospitali
zat ioninspeci al
i
zedburncent ersacr ossthecountr y
.
-Mal eshav egreaterthant wi
cethechanceofbur ninj
urythanwomen, andthe
mostf requentagegr oupforcontactburnsi sbetween20t o40y earsofage.
-Burni njuriesandf i
rescont i
nuetobeal eadingcauseofacci dentaldeathinthe
Arabr epubl icofEgy pt.

Defi
nit
ionofBur
n:
Aburnisatypeofinj
urytoski
n,orot
herti
ssues,
causedbyheat
,col
d,
el
ectr
ici
ty,
chemical
s,fr
ict
ion,
orradi
ati
on.
:
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻣ‬
‫ﺍﻻ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﺎﻋ‬‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬‫ﺎﺕ‬‫ﺌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬
‫ﻓﻲﺟ‬، ‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻤ‬‫ﺎ ﺹﻣﻦﺟ‬ ‫ﺍﻷﺷﺨ‬‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻴﺐﺇﺻ‬‫ﺃﻥﺗﺼ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻳ‬-
.‫ﺔ‬‫ﻳ‬
‫ﺩ‬‫ﺎ‬‫ﺘﺼ‬‫ﻗ‬
‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬‫ﻎﻋ‬ ‫ﻠ‬
‫ﺒ‬‫ﻳ‬.‫ﺎ‬
ً
‫ﻳ‬‫ﻮ‬‫ﻨ‬
‫ﺔﺳ‬ ‫ﻔ‬‫ﻴ‬‫ﻔ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺷﺨ ﺺﻣﻦﺇﺻ‬500000‫ﻮ‬ ‫ﻨﺤ‬‫ﺭﺑ‬‫ﺪ‬‫ﻘ‬
‫ﺝﺎﻳ‬
‫ﺘﻢﻋﻼ ﻣ‬ ‫ﻳ‬-
‫ﺮﺏﻣﻦ‬ ‫ﻘ‬‫ﺎﻳ‬‫ﻤﻞﻣ‬‫ﺍﻳﺸ‬‫ﺬ‬‫ﻭﻫ‬.40.000‫ﺮﻣﻦ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺒﺐﺇﺻ‬‫ﻡﺑﺴ‬‫ﺎ‬‫ﻔﻰﻛﻞﻋ‬ ‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻠ‬‫ﺪﺧ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬
.‫ﺩ‬
‫ﺒﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻧﺤ‬‫ﺃ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﺔﻓﻲﺟ‬ ‫ﺘﺨﺼﺼ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺰ‬‫ﻛ‬
‫ﺍ‬‫ﺮ‬‫ﻔﻰﻓﻲﻣ‬ ‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻟﻰﺩﺧ‬‫ﻮﻥﺇ‬‫ﺎﺟ‬‫ﺘ‬‫ﺷﺨ ﺺﻳﺤ‬25000
‫ﻭﻕ‬‫ﺮ‬‫ﻠﺤ‬‫ﻟ‬‫ﺎ‬
ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬
‫ﺮﺷ‬ ‫ﺜ‬‫ﻛ‬
‫ﺍﻷ‬ ‫ﺔ‬
‫ﻳ‬‫ﺮ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﺀ‬‫ﺎ‬‫ﻨﺴ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻕﻣﻦ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬‫ﺔ‬‫ﺮﺻ‬‫ﻌﻒﻓ‬ ‫ﺮﻣﻦ ﺿ‬‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﻬﻢ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺭ‬‫ﻮ‬‫ﻛ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺎ‬ً
‫ﻣ‬‫ﺎ‬
‫ﻋ‬40‫ﻟﻰ‬ ‫ﺇ‬20‫ﻴﻦ‬‫ﺔﻫﻲﺑ‬ ‫ﻴ‬‫ﻣﺴ‬‫ﺘﻼ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻴ‬‫ﺑ‬
‫ﺮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﺔﻣﺼ‬ ‫ﻳ‬‫ﺭ‬
‫ﻮ‬‫ﻬ‬‫ﻤ‬‫ﺔﻓﻲﺟ‬ ‫ﻴ‬‫ﺮﺿ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺎ‬‫ﻓ‬
‫ﻮ‬‫ﻠ‬‫ﻟ‬‫ﺎ‬
ً
‫ﻴ‬‫ﻴﺴ‬‫ﺋ‬
‫ﺎﺭ‬ً
‫ﺒ‬‫ﺒ‬
‫ﺋﻖﺳ‬‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻭﻕﻭ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻝﺇﺻ‬‫ﻻﺰ‬
‫ﺗ‬-

212
 :
‫ﺮﻕ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﺀ‬
‫ﺎ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﺓ‬‫ﺩ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺒﺐ‬‫ﺮﻯﺑﺴ‬
‫ﺍﻷﺧ‬
‫ﺔ‬‫ﻧﺴﺠ‬
‫ﺃﺍﻷ‬
‫ﺪﻭ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻴﺐ‬ ‫ﺘﻲﺗﺼ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻣﺍﻹﺻ‬
‫ﻮﻉ ﻦ‬ ‫ﻮﻧ‬‫ﺮﻕﻫ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﺎﻉ‬‫ﻌ‬
‫ﺃﺍﻹﺷ‬
‫ﺎﻙﻭ‬‫ﻜ‬‫ﺘ‬‫ﺃﺍﻻﺣ‬
‫ﺔﻭ‬‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬

Causesofbur ns:
1.Thermalbur n:Arecausedbyexposur etoorcontactwit
hflame, hotli
quidsor
steam.
2.Chemi calburn:Arecausedbytissuecontactwit
hst r
ongacids,alkali
esor
organiccompound.
3.Electr
icalburn:I
tcausedbyintenseheatgeneratedbyelectr
icalenergyasit
passesthr oughthebody.
4.Radiationburn:Radiati
onburnsaretheleastcommont ypeofbur ninjur
ies
andar ecausedbyexposur etoaradioacti
veagent.
5.Coldbur n:Frostbi
te(i
cecry
stal
spunct ur
ethecellsanddestroytissue)

:
‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺎﺏ‬‫ﺒ‬‫ﺃﺳ‬
.
‫ﻪ‬‫ﻟ‬‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻣﺴ‬‫ﻭﻣﻼ‬ ‫ﺃ‬‫ﺭ‬
‫ﺎ‬‫ﺒﺨ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﻨ‬‫ﺎﺧ‬‫ﻟﺴ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻬﺐ‬‫ﻠ‬
‫ﻟ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺒﺐ‬‫ﺪﺙﺑﺴ‬‫ﻳﺤ‬:‫ﺭﻱ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺮﻕ‬‫ﻟﺤ‬
‫ﺍ‬.1
.‫ﻮﻱ‬‫ﻌﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻛﺐ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﺕ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺽ‬‫ﻤ‬‫ﻟﻸﺣ‬ ‫ﺔ‬‫ﻧﺴﺠ‬
‫ﺍﻷ‬ ‫ﺔ‬‫ﻣﺴ‬ ‫ﺗﺞﻋﻦﻣﻼ‬‫ﺎ‬‫ﻧ‬:
‫ﺋﻲ‬‫ﺎ‬‫ﻴ‬
‫ﻤ‬‫ﻴ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻟﺤ‬
‫ﺍ‬.2
‫ﺎﻓﻲ‬‫ﺭﻫ‬‫ﻭ‬‫ﺮ‬‫ﺀﻣ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻗ‬‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺓﻋﻦ‬‫ﺪ‬ ‫ﻟ‬
‫ﻮ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺪ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺗﺞﻋﻦ‬‫ﺎ‬‫ﻮﻧ‬
‫ﻭﻫ‬:‫ﺋﻲ‬‫ﺎ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻟﺤ‬
‫ﺍ‬.3
.
‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬‫ﺪﺙﻧ‬‫ﺗﺤ‬‫ﺎﻭ‬ً‫ﻮ‬
‫ﻋ‬ ‫ﻴ‬‫ﻭﻕﺷ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻉﺇﺻ‬‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫ﻗﻞ‬ ‫ﺃ‬‫ﺔﻫﻲ‬‫ﻴ‬‫ﺎﻋ‬‫ﻌ‬‫ﺍﻹﺷ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬:
‫ﺔ‬‫ﻴ‬‫ﻋ‬
‫ﺎ‬‫ﻌ‬‫ﺍﻹﺷ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬.4
.‫ﻋﻲ‬‫ﺎ‬‫ﻌ‬
‫ﻣﻞﺇﺷ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺮﺽ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
(‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺮ‬‫ﻣ‬
‫ﺪ‬ ‫ﺗ‬
‫ﺎﻭ‬‫ﻳ‬‫ﻟﺨﻼ‬‫ﺍ‬‫ﺪ‬‫ﻴ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺍﺕ‬
‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﻘﺐﺑ‬ ‫ﺜ‬
‫ﺗ‬)‫ﻊ‬‫ﻴ‬‫ﻘ‬
‫ﻟﺼ‬‫ﺍ‬‫ﺔ‬‫ﻤ‬‫ﻗﻀ‬:‫ﺩ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻟﺤ‬
‫ﺍ‬.5

Pathophy si
ologyoft hebur n:
-Bur ninjuryisar esultofheatt r
ansf erfrom onesi tetoanot her.Tissue
destructionr esultsf rom coagul ation, proteindenat urati
on, orionizationof
cell
ularcont ent s.
-Theski nandt hemucosaoft heupperai r
way sar esitesoft i
ssuedest ructi
on.
Deept i
ssues, includingt hev iscera, canbedamagedbyel ect r
icalburnsorby
prolongedcont actwi thaheatsour ce.
-Disrupt i
onoft heski ncanl eadt oi ncr easedf l
uidl oss,i
nfect i
on, hypothermi a,
scarring,compr omi sedi mmuni ty
, andchangesi nf uncti
on, appear ance,and
bodyi mage.
-Thedept hoft heinjurydependsont hetemper atur eofthebur ni
ngagentand
thedur ationofcont actwi tht heagent .Forexampl e,inthecaseofscal dbur ns
i
nadul t
s, 1secondofcont actwi t
hhott apwat erat68. 9oC( 156oF)mayr esult
i
nabur nt hatdest r
oy sbot ht heepi der misandt he
dermi s,causingaf ul l
-t
hickness( thir d-degree)inj
ur y.Fi
fteensecondsof
exposur et ohotwat erat56. 1oC( 133oF)r esul
tsi nasi milarfull-
thicknessinjury.
Temper aturesl esst han44oC( 111oF)canbet oleratedforl ongper i
odswi thout
i
njury.

:‫ﺮﻕ‬‫ﻠﺤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
‫ﻤﺴﺦ‬
‫ﻭﺗ‬‫ﺃ‬
‫ﺮ‬‫ﺜ‬‫ﺘﺨ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻋﻦ‬
‫ﻧﺴﺠ‬
‫ﺍﻷ‬‫ﺮ‬
‫ﻴ‬‫ﻣ‬‫ﺪ‬
‫ﺘﺞﺗ‬
‫ﻨ‬‫ﻳ‬.
‫ﺮ‬‫ﺁﺧ‬
‫ﻟﻰ‬‫ﻊﺇ‬
‫ﻗ‬‫ﻮ‬‫ﺓﻣﻦﻣ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﻝ‬‫ﻘ‬‫ﺘ‬
‫ﻧ‬‫ﺍ‬‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬
‫ﻭﻕﻧ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬-
.‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻠ‬‫ﻟﺨ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻳ‬
‫ﻮ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬
‫ﺄ‬‫ﻭﺗ‬‫ﺃ‬
‫ﻴﻦ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬

213
‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﻠﻒ‬‫ﺘ‬‫ﺃﻥﺗ‬‫ﻜﻦ‬ ‫ﻤ‬‫‪.‬ﻳ‬
‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺮ‬‫ﻴ‬
‫ﻣ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬
‫ﻮ‬‫ﺔﻫﻲﻣ‬ ‫ﻳ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬
‫ﻤ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺎﻃﻲ‬ ‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻐﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺭ‬‫ﺪ‬‫ﻤﺼ‬‫ﻮﻝﺑ‬ ‫ﻤﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻝ‬‫ﻻﺼ‬
‫ﺃﺍﺗ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺒﺐ‬‫‪،‬ﺑﺴ‬ ‫ﺀ‬
‫ﺎ‬‫ﺍﻷﺣﺸ‬ ‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫‪،‬ﺑ‬‫ﺔ‬ ‫ﻘ‬
‫ﻴ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬
‫‪،‬‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﺎ ﺽﺩ‬‫ﻔ‬‫ﻧﺨ‬ ‫ﺍ‬
‫‪،‬ﻭ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬ ‫ﻘ‬‫ﺓﻓ‬ ‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﻟﻰﺯ‬‫ﺪﺇ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺍﺏ‬‫ﺮ‬‫ﺍﺿﻄ‬ ‫ﺩﻱ‬‫ﺆ‬ ‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫‪-‬ﻳ‬
‫‪.‬‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﻮ‬‫ﺮﻭﺻ‬ ‫ﻬ‬‫ﻤﻈ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕﻓﻲ‬ ‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺗ‬
‫‪،‬ﻭ‬‫ﺔ‬‫ﻋ‬ ‫ﺎ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻒ‬ ‫‪،‬ﻭﺿ‬ ‫ﺪﺏ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬
‫ﺎ‪،‬‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬ ‫‪.‬ﻋ‬‫ﻣﻞ‬‫ﺎ‬
‫ﻌ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻣﺲﻣ‬ ‫ﺘﻼ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻣ‬
‫ﺮﻕﻭ‬ ‫ﺘ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﻠﻰﺩ‬‫ﺔﻋ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﻤﻖ‬ ‫ﺪﻋ‬‫ﻤ‬‫ﺘ‬‫ﻌ‬‫‪-‬ﻳ‬
‫ﺀ‬
‫ﺎ‬‫ﻊﻣ‬‫ﺓﻣ‬‫ﺪ‬‫ﺍﺣ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺓﺛ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﻣﺲ‬ ‫ﺘﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫ﺪﻳ‬‫‪،‬ﻗ‬ ‫ﻴﻦ‬‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻯ‬‫ﻟ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻓﻲ ﺎ‬
‫‪.‬‬
‫ﺓ‬‫ﺮ‬‫ﺒﺸ‬
‫ﻟ‬‫ﺍ‬
‫ﺓﻭ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻛﻞﻣﻦ‬ ‫ﻣ‬‫ﺪ‬‫ﺮﻕﻳ‬‫ﻟﻰﺣ‬ ‫(ﺇ‬‫ﻳﺖ‬‫ﺎ‬
‫ﻬ‬‫ﻧ‬‫ﺮ‬‫ﻬ‬
‫ﺔﻓ‬ ‫ﺭﺟ‬‫ﺔ)‪156‬ﺩ‬ ‫ﻳ‬‫ﻮ‬‫ﺌ‬
‫ﺔﻣ‬ ‫ﺭﺟ‬‫‪68.‬ﺩ‬‫ﺪ‪9‬‬ ‫ﻨ‬
‫ﺎﺧﻦﻋ‬ ‫ﻟﺴ‬ ‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺒ‬
‫ﻨ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺀ‬
‫ﺎ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺮﺛ‬‫ﺔﻋﺸ‬ ‫ﻤﺴ‬‫‪.‬ﺧ‬‫(‬‫ﺔ‬‫ﺜ‬‫ﻟ‬
‫ﺎ‬
‫ﺜ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫)ﻦ‬
‫ﻣﻞ ﻣ‬ ‫ﺎ‬‫ﻤﻚﻛ‬ ‫ﺔﺑﺴ‬‫ﺑ‬
‫ﺎ‬‫ﺒﺐﻓﻲﺇﺻ‬ ‫ﺎﺗﺴ‬ ‫ﻤ‬‫‪،‬ﻣ‬‫ﺔ‬‫ﻣ‬‫ﺩ‬‫ﺍﻷ‬
‫ﻜﻦ‬‫ﻤ‬‫‪.‬ﻳ‬‫ﺔ‬‫ﻠ‬
‫ﺛ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻣ‬ ‫ﻛ‬
‫ﺎ‬‫ﻤ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﻣ‬‫ﺎ‬‫ﺔﻛ‬‫ﺑ‬‫ﺎ‬
‫ﻪﺇﺻ‬ ‫ﻨ‬
‫ﺘﺞﻋ‬ ‫ﻨ‬
‫(ﻳ‬‫ﻳﺖ‬ ‫ﺎ‬‫ﻬ‬
‫ﻧ‬‫ﺮ‬‫ﻬ‬‫ﺔﻓ‬ ‫ﺭﺟ‬‫ﺔ)‪133‬ﺩ‬ ‫ﻳ‬‫ﻮ‬‫ﺌ‬
‫ﺔﻣ‬ ‫ﺭﺟ‬‫‪56.‬ﺩ‬‫ﺪ‪1‬‬ ‫ﻨ‬
‫ﺎﺧﻦﻋ‬ ‫ﻟﺴ‬‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻭﻥﺇﺻ‬ ‫ﺔﺩ‬‫ﻠ‬‫ﻳ‬
‫ﻮ‬ ‫ﺍﺕﻃ‬ ‫ﺮ‬
‫ﺘ‬ ‫ﻔ‬
‫ﻟ‬‫(‬‫ﻳﺖ‬‫ﺎ‬‫ﻬ‬
‫ﻧ‬‫ﺮ‬‫ﻬ‬
‫ﺔﻓ‬ ‫ﺭﺟ‬‫ﺔ)‪111‬ﺩ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺌ‬
‫ﺔﻣ‬ ‫ﺭﺟ‬‫ﻗﻞﻣﻦ‪44‬ﺩ‬ ‫ﺃ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺎﺕﺣ‬ ‫ﺭﺟ‬‫ﻤﻞﺩ‬ ‫ﺗﺤ‬

‫‪Localandsy‬‬ ‫‪st‬‬‫‪emi‬‬‫‪cr‬‬‫‪esponset‬‬ ‫‪obur‬‬ ‫‪n‬‬

‫‪-Bur‬‬‫‪nst‬‬‫‪hatdonotexceed25%TBSApr‬‬ ‫‪oduceapr‬‬ ‫‪i‬‬‫‪mar‬‬
‫‪i‬‬‫‪l‬‬
‫‪yl‬‬ ‫‪ocal‬‬
‫‪r‬‬‫‪esponse.Bur‬‬‫‪ns‬‬
‫‪t‬‬‫‪hatexceed25%TBSAmaypr‬‬ ‫‪oducebot‬‬ ‫‪hal‬‬ ‫‪ocal‬‬‫‪andasy‬‬ ‫‪st‬‬‫‪emi‬‬‫‪cr‬‬‫‪esponseand‬‬
‫‪ar‬‬‫‪econsi‬‬‫‪der‬‬‫‪edmaj‬‬ ‫‪orbur‬‬‫‪ni‬‬‫‪nj‬‬
‫‪ur‬‬‫‪i‬‬‫‪es.‬‬
‫‪-Thesy‬‬ ‫‪st‬‬
‫‪emi‬‬ ‫‪cr‬‬‫‪esponsei‬‬‫‪scausedbyt‬‬ ‫‪her‬‬‫‪el‬‬‫‪easeofcy‬‬‫‪t‬‬‫‪oki‬‬‫‪nesandot‬‬ ‫‪her‬‬
‫‪medi‬‬‫‪at‬‬‫‪or‬‬‫‪si‬‬‫‪nt‬‬‫‪ot‬‬‫‪hesy‬‬ ‫‪st‬‬
‫‪emi‬‬‫‪cci‬‬‫‪r‬‬‫‪cul‬‬‫‪at‬‬
‫‪i‬‬‫‪on.Ther‬‬ ‫‪el‬‬
‫‪easeofl‬‬‫‪ocal‬‬ ‫‪medi‬‬‫‪at‬‬‫‪or‬‬‫‪sand‬‬
‫‪changesi‬‬‫‪nbl‬‬ ‫‪oodf‬‬‫‪l‬‬‫‪ow,‬‬‫‪t‬‬‫‪i‬‬
‫‪ssueedema,‬‬ ‫‪andi‬‬‫‪nf‬‬‫‪ect‬‬‫‪i‬‬
‫‪oncancausepr‬‬ ‫‪ogr‬‬‫‪essi‬‬
‫‪onof‬‬
‫‪t‬‬‫‪hebur‬‬‫‪ni‬‬‫‪nj‬‬‫‪ur‬‬‫‪y‬‬‫‪.‬‬

‫ﺮﻕ‬‫ﻠﺤ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬
‫ﻭﻕ‪-‬‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫‪.‬‬
‫ﻟﻰ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻴ‬‫ﻠ‬‫ﺔﻣﺤ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬‫ﺘﺞ‬‫ﻨ‬‫ﻟﺠﺴﻢﺗ‬
‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫‪٪‬ﻣﻦﻣﺴ‬ ‫ﺪﻋﻦ‪25‬‬ ‫ﻳ‬
‫ﺰ‬‫ﺘﻲﻻﺗ‬‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻭﻕ‬‫ﺮ‬
‫ﺎﺕﺣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺮﺇﺻ‬‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﺗ‬‫ﺔﻭ‬‫ﻳ‬
‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﺔﻭﺟ‬ ‫ﻴ‬‫ﻌ‬
‫ﻮﺿ‬ ‫ﺔﻣ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬‫ﺘﺞ‬‫ﻨ‬
‫ﺪﺗ‬‫ﻟﺠﺴﻢﻗ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫‪٪‬ﻣﻦﻣﺴ‬ ‫ﺪﻋﻦ‪25‬‬ ‫ﻳ‬
‫ﺰ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻛ‬
‫‪.‬‬
‫ﺯﻱ‪-‬‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺍﻥ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻳﻦﻓﻲ‬‫ﺮ‬‫ﺍﻵﺧ‬‫ﺀ‬‫ﺎ‬
‫ﻮﺳﻄ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺎﺕﻭ‬ ‫ﻨ‬‫ﻴ‬
‫ﻛ‬‫ﻮ‬‫ﺘ‬
‫ﻴ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻳﻖﺇﻃﻼﻕ‬ ‫ﺮ‬
‫ﺔﻋﻦﻃ‬ ‫ﻳ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬
‫ﺍﻻﺳ‬ ‫ﺪﺙ‬‫ﺗﺤ‬‫‪.‬‬
‫ﻟﻰ‬‫ﻭﻯﺇ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻭ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬‫ﺍﺕﻓﻲﺗ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬
‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻮﺳﻄ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺩﻱﺇﻃﻼﻕ‬‫ﺆ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻗﻢﺇﺻ‬‫ﺎ‬‫ﻔ‬
‫ﺗ‬

‫‪.‬‬
‫‪-Pat‬‬‫‪hophy‬‬‫‪si‬‬
‫‪ol‬‬‫‪ogi‬‬‫‪cchangesr‬‬ ‫‪esul‬‬‫‪t‬‬
‫‪i‬‬‫‪ngf‬‬ ‫‪r‬‬
‫‪om maj‬‬ ‫‪orbur‬‬‫‪nsdur‬‬ ‫‪i‬‬
‫‪ngt‬‬‫‪hei‬‬‫‪ni‬‬‫‪t‬‬
‫‪i‬‬‫‪al‬‬‫‪bur‬‬
‫‪n-‬‬
‫‪shockper‬‬‫‪i‬‬‫‪odi‬‬‫‪ncl‬‬‫‪udet‬‬ ‫‪i‬‬
‫‪ssuehy‬‬‫‪poper‬‬ ‫‪f‬‬‫‪usi‬‬
‫‪onandor‬‬ ‫‪ganhy‬‬ ‫‪pof‬‬‫‪unct‬‬‫‪i‬‬
‫‪onsecondar‬‬‫‪y‬‬
‫‪t‬‬‫‪odecr‬‬‫‪easedcar‬‬‫‪di‬‬ ‫‪acout‬‬‫‪put‬‬
‫‪,‬‬‫‪f‬‬‫‪ol‬‬
‫‪l‬‬‫‪owedbyhy‬‬ ‫‪perdy‬‬ ‫‪nami‬‬‫‪candhy‬‬ ‫‪permet‬‬ ‫‪abol‬‬
‫‪i‬‬
‫‪c‬‬
‫‪phases.Thei‬‬‫‪nci‬‬‫‪dence,‬‬ ‫‪magni‬‬‫‪t‬‬
‫‪ude,‬‬ ‫‪anddur‬‬‫‪at‬‬‫‪i‬‬‫‪onofpat‬‬ ‫‪hophy‬‬‫‪si‬‬
‫‪ol‬‬‫‪ogi‬‬
‫‪cchangesi‬‬‫‪n‬‬
‫‪bur‬‬‫‪nsar‬‬‫‪epr‬‬‫‪opor‬‬‫‪t‬‬‫‪i‬‬‫‪onal‬‬‫‪t‬‬‫‪ot‬‬‫‪heext‬‬‫‪entofbur‬‬‫‪ni‬‬ ‫‪nj‬‬‫‪ur‬‬
‫‪y‬‬‫‪,‬‬‫‪wi‬‬‫‪t‬‬‫‪hamax‬‬ ‫‪i‬‬
‫‪mal‬‬ ‫‪r‬‬
‫‪esponse‬‬
‫‪seeni‬‬‫‪nbur‬‬‫‪nscov‬‬ ‫‪er‬‬ ‫‪i‬‬
‫‪ng60%ormor‬‬ ‫‪eTBSA.‬‬

‫ﻤﻞ‬‫ﺔﺗﺸ‬ ‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬ ‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺮﻕﻭ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﺘ‬‫ﺓﺧﻼﻝﻓ‬ ‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬ ‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬
‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬‫ﻮ‬
‫ﻳ‬ ‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫‪-‬‬
‫ﺔ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﻨ‬‫ﻳ‬‫ﺍﺣﻞﺩ‬ ‫ﺮ‬‫ﺎﻣ‬‫ﻬ‬‫ﻴ‬‫ﻠ‬
‫‪،‬ﺗ‬‫ﺒﻲ‬ ‫ﻠ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺽ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﻮﻱﻻ‬ ‫ﻧ‬
‫ﺎ‬‫ﻮﻱﺛ‬‫ﻘ ﺺﻋﻀ‬ ‫ﺔﻧ‬‫ﻔ‬‫ﻴ‬‫ﻭﻇ‬‫ﺔﻭ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﻘ ﺺﻧﻀﺢ‬ ‫ﻧ‬
‫ﺎﺳﺐ‬‫ﻨ‬‫ﺘ‬ ‫ﻭﻕﺗ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﺮﺿ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻮﺟ‬‫ﻟ‬
‫ﻮ‬‫ﻳ‬‫ﺰ‬
‫ﻴ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻣ‬‫ﻭﺙﻭﺣﺠﻢﻭ‬ ‫ﺪ‬ ‫‪.‬ﻥﺣ‬
‫ﺮﻁﺇ‬ ‫ﻔ‬
‫ﻘﻼﺏﻣ‬ ‫ﺘ‬‫ﺍﺳ‬‫ﺔﻭ‬‫ﺮﻃ‬
‫ﻔ‬‫ﻣ‬
‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﺮﻣﻦﻣﺴ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫‪٪‬ﻭ‬
‫ﻐﻄﻲ‪60‬ﺃ‬ ‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﻯﻓﻲ‬ ‫ﺔﻗﺼ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬ ‫ﻊ‬
‫‪،‬ﻣ‬ ‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺪﻯﺇﺻ‬‫ﻊﻣ‬‫ﻣ‬
‫‪.‬‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫‪Sy‬‬‫‪st‬‬‫‪emi‬‬ ‫‪cr‬‬ ‫‪esponse:‬‬
‫‪Thei‬‬‫‪ni‬‬ ‫‪t‬‬
‫‪i‬‬‫‪al‬‬‫‪Sy‬‬ ‫‪st‬‬‫‪emi‬‬ ‫‪cr‬‬‫‪esponsef‬‬ ‫‪ol‬‬‫‪l‬‬
‫‪owi‬‬‫‪ngamaj‬‬ ‫‪orbur‬‬‫‪ni‬‬‫‪nj‬‬‫‪ur‬‬‫‪yi‬‬
‫‪s:‬‬ ‫‪Homody‬‬ ‫‪nami‬‬‫‪c‬‬
‫‪i‬‬
‫‪nst‬‬‫‪abi‬‬ ‫‪l‬‬
‫‪i‬‬‫‪t‬‬
‫‪yr‬‬ ‫‪esul‬‬‫‪t‬‬‫‪i‬‬‫‪ngf‬‬‫‪r‬‬‫‪om:‬‬
‫‪-Lossofcapi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪ar‬‬‫‪yi‬‬‫‪nt‬‬‫‪egr‬‬‫‪i‬‬
‫‪t‬‬ ‫‪y‬‬‫‪.‬‬
‫‪-Subsequentshi‬‬ ‫‪f‬‬‫‪toff‬‬‫‪l‬‬‫‪ui‬‬‫‪d,‬‬‫‪sodi‬‬
‫‪um,‬‬ ‫‪andpr‬‬ ‫‪ot‬‬‫‪ei‬‬
‫‪nf‬‬ ‫‪r‬‬
‫‪om t‬‬‫‪hei‬‬‫‪nt‬‬‫‪r‬‬‫‪av‬‬‫‪ascul‬‬‫‪arspace‬‬
‫‪i‬‬
‫‪nt‬‬‫‪ot‬‬ ‫‪hei‬‬ ‫‪nt‬‬‫‪er‬‬‫‪st‬‬‫‪i‬‬
‫‪t‬‬‫‪i‬‬‫‪al‬‬‫‪spaces.‬‬
‫‪Hemody‬‬ ‫‪nami‬‬ ‫‪ci‬‬‫‪nst‬‬‫‪abi‬‬‫‪l‬‬
‫‪i‬‬‫‪t‬‬‫‪yi‬‬‫‪nv‬‬‫‪ol‬‬‫‪v‬‬
‫‪escar‬‬ ‫‪di‬‬
‫‪ov‬‬ ‫‪ascul‬‬‫‪ar‬‬
‫‪,‬‬‫‪f‬‬‫‪l‬‬
‫‪ui‬‬‫‪dandel‬‬ ‫‪ect‬‬‫‪r‬‬
‫‪ol‬‬‫‪y‬‬‫‪t‬‬‫‪e,‬‬‫‪bl‬‬‫‪ood‬‬

‫‪214‬‬
‫‪v‬‬
‫‪ol‬‬‫‪ume,‬‬
‫‪pul‬‬
‫‪monar‬‬
‫‪y‬‬‫‪,‬‬‫‪andot‬‬
‫‪hermechani‬‬
‫‪sms.‬‬
‫‪:‬‬
‫ﺔ‬ ‫ﻴ‬
‫ﻬﺠ‬ ‫ﻨ‬
‫ﺔﻣ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬
‫ﺗﺞ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺛﻞ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻜﻲ‬‫ﻴ‬
‫ﻣ‬‫ﺎ‬‫ﻨ‬
‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﻡ‬‫ﺪ‬‫ﻫ‪:‬ﻋ‬
‫ﺓ ﻲ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺪﺇﺻ‬‫ﻌ‬‫ﺔﺑ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﻳ‬
‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬
‫ﻋ‪:‬‬
‫ﻦ‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬
‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻴ‬
‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﻼﺔ‬
‫ﺍﻥﺳ ﻣ‬‫ﺪ‬‫ﻘ‬‫‪-‬ﻓ‬
‫ﻟﺨﻼ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺍﻏ‬
‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺔﺇ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬‫ﺍﺧﻞ‬‫ﺀﺩ‬‫ﺎ‬
‫ﻔﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻣﻦ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫ﻡﻭ‬ ‫ﻮ‬‫ﻳ‬‫ﺩ‬
‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻠﺴ‬‫ﻟ‬‫ﺍﻼﺣﻖ‬‫ﻮﻝﻟ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫ﻟ‪.‬‬
‫ﺔ‬‫ﻴ‬
‫ﺭﻝﻭﺣﺠﻢ‬‫ﺎ‬‫ﻬ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﻮ‬
‫ﻣ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻭﻋ‬‫ﺍﻷ‬
‫ﻠﺐﻭ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬
‫ﻟ‬‫ﺁ‬‫ﻮﻱ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻲ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬‫ﻨ‬
‫ﻳ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﻡ‬‫ﺪ‬‫ﻤﻦﻋ‬‫ﺘﻀ‬‫ﻳ‬
‫‪.‬‬‫ﺮﻯ‬
‫ﺃﺧ‬‫ﺎﺕ‬ ‫ﻴ‬
‫ﻟ‬‫ﺁ‬‫ﺔﻭ‬‫ﺋ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬

‫‪Car‬‬‫‪di‬‬‫‪ov‬‬‫‪ascul‬‬
‫‪arr‬‬ ‫‪esponse:‬‬
‫‪1.Theonsetofbur‬‬ ‫‪nshock(hy‬‬ ‫‪pov‬‬
‫‪ol‬‬‫‪emi‬‬‫)‪cshock‬‬‫‪:‬‬
‫‪-Car‬‬‫‪di‬‬‫‪acout‬‬‫‪putdecr‬‬ ‫‪ease.‬‬
‫‪-Vascul‬‬‫‪arv‬‬‫‪ol‬‬‫‪umedecr‬‬ ‫‪ease.‬‬
‫‪-Decr‬‬‫‪easeofbl‬‬ ‫‪oodpr‬‬ ‫‪essur‬‬‫‪e.‬‬
‫‪2.Thesy‬‬ ‫‪mpat‬‬ ‫‪het‬‬‫‪i‬‬
‫‪cner‬‬ ‫‪v‬‬‫‪oussy‬‬‫‪st‬‬‫‪em r‬‬‫‪el‬‬
‫‪easescat‬‬
‫‪echol‬‬‫‪ami‬‬‫‪ne,‬‬
‫‪whi‬‬‫‪chr‬‬‫‪esul‬‬
‫‪t‬‬‫‪si‬‬
‫‪n:‬‬
‫‪i‬‬
‫‪ncr‬‬‫‪easei‬‬‫‪nper‬‬ ‫‪i‬‬‫‪pher‬‬‫‪al‬‬‫‪r‬‬‫‪esi‬‬
‫‪st‬‬‫(‪ance‬‬‫‪v‬‬‫‪asoconst‬‬
‫‪r‬‬‫‪i‬‬
‫‪ct‬‬‫‪i‬‬
‫)‪on‬‬
‫‪,‬‬‫‪i‬‬‫‪ncr‬‬
‫‪easei‬‬‫‪npul‬‬‫‪ser‬‬‫‪at‬‬
‫‪e.‬‬

‫‪:‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﻠﺐﻭ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬
‫‪:‬‬
‫(‬‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻘ ﺺﺣﺠﻢ‬‫ﺔﻧ‬‫ﻣ‬‫ﺪ‬
‫ﻭﻕ)ﺻ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬
‫ﻣ‬‫ﺪ‬ ‫ﺔﺻ‬ ‫ﻳ‬
‫ﺍ‬‫ﺪ‬‫‪.‬ﺑ‬‫‪1‬‬
‫‪.‬‬
‫ﺒﻲ‬‫ﻠ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺽ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎ ﺽﺣﺠﻢ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫‪-‬‬
‫‪.‬‬‫ﻡ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﺎ ﺽﺿ‬ ‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫‪-‬‬
‫ﺍﻷ‬
‫ﻴﻖ‬‫ﺗﻀ‬
‫ﺔ)‬‫ﻴ‬
‫ﻴﻄ‬‫ﻤﺤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻣ‬‫ﻭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫‪:‬ﺯ‬
‫ﻟﻰ‬‫ﺩﻱﺇ‬
‫ﺆ‬‫ﺎﻳ‬
‫ﻤ‬‫‪،‬ﻣ‬‫ﻴﻦ‬‫ﻣ‬‫ﻮﻻ‬
‫ﻜ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻱ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﻠﻖ‬
‫‪.‬ﻳﻄ‬ ‫‪2‬‬
‫‪.‬‬
‫ﺒﺾ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬
‫ﻳ‬‫ﺯ‬‫‪،‬ﻭ‬‫(‬‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬

‫‪Ef‬‬‫‪f‬‬
‫‪ect‬‬‫‪sonf‬‬ ‫‪l‬‬‫‪ui‬‬
‫‪ds,‬‬ ‫‪el‬‬
‫‪ect‬‬‫‪r‬‬‫‪ol‬‬‫‪y‬‬
‫‪t‬‬‫‪es,‬‬‫‪andbl‬‬ ‫‪oodv‬‬‫‪ol‬‬
‫‪ume:‬‬
‫‪1.Ci‬‬‫‪r‬‬
‫‪cul‬‬‫‪at‬‬‫‪i‬‬
‫‪ngbl‬‬ ‫‪oodv‬‬ ‫‪ol‬‬
‫‪umedecr‬‬ ‫‪easesdr‬‬ ‫‪amat‬‬‫‪i‬‬
‫‪cal‬‬
‫‪l‬‬‫‪ydur‬‬
‫‪i‬‬‫‪ngbur‬‬‫‪nshock.I‬‬
‫‪n‬‬
‫‪addi‬‬
‫‪t‬‬‫‪i‬‬‫‪on,‬‬‫‪ev‬‬‫‪apor‬‬‫‪at‬‬‫‪i‬‬‫‪v‬‬
‫‪ef‬‬ ‫‪l‬‬
‫‪ui‬‬‫‪dl‬‬‫‪osst‬‬‫‪hr‬‬‫‪ought‬‬‫‪hebur‬‬‫‪nwoundmayr‬‬ ‫‪each3t‬‬‫‪o5Lor‬‬
‫‪mor‬‬‫‪eov‬‬ ‫‪era24-‬‬ ‫‪hourper‬‬‫‪i‬‬‫‪odunt‬‬‫‪i‬‬‫‪l‬‬‫‪t‬‬
‫‪hebur‬‬ ‫‪nsur‬‬
‫‪f‬‬‫‪acesar‬‬‫‪ecov‬‬‫‪er‬‬
‫‪ed.Massi‬‬‫‪v‬‬‫‪ecel‬‬
‫‪l‬‬
‫‪dest‬‬
‫‪r‬‬‫‪uct‬‬‫‪i‬‬‫‪onl‬‬‫‪eadst‬‬ ‫‪ohy‬‬‫‪per‬‬‫‪kal‬‬‫‪emi‬‬‫‪a.‬‬

‫‪2.I‬‬
‫‪mmedi‬‬ ‫‪at‬‬‫‪el‬‬‫‪yaf‬‬‫‪t‬‬‫‪erbur‬‬‫‪ni‬‬‫‪nj‬‬‫‪ur‬‬
‫‪y‬‬ ‫‪,‬‬
‫‪hy‬‬ ‫‪per‬‬
‫‪kal‬‬‫‪emi‬‬‫(‪a‬‬‫‪excessi‬‬
‫‪v‬‬‫‪epot‬‬‫‪assi‬‬
‫‪um)r‬‬‫‪esul‬‬‫‪t‬‬
‫‪s‬‬
‫‪f‬‬‫‪r‬‬
‫‪om massi‬‬‫‪v‬‬ ‫‪ecel‬‬‫‪l‬‬‫‪dest‬‬‫‪r‬‬
‫‪uct‬‬‫‪i‬‬‫‪on.‬‬‫‪Fl‬‬‫‪ui‬‬‫‪dshi‬‬‫‪f‬‬‫‪t‬‬
‫‪sandi‬‬‫‪nadequat‬‬‫‪epot‬‬‫‪assi‬‬
‫‪um i‬‬
‫‪nt‬‬‫‪ake‬‬
‫‪l‬‬
‫‪eadt‬‬ ‫‪oHy‬‬‫‪pokal‬‬‫‪emi‬‬ ‫‪a.Hy‬‬‫‪pokal‬‬‫‪emi‬‬ ‫(‪a‬‬‫‪pot‬‬‫‪assi‬‬
‫‪um depl‬‬‫‪et‬‬‫‪i‬‬
‫‪on)mayoccurl‬‬
‫‪at‬‬‫‪erwi‬‬‫‪t‬‬‫‪h‬‬
‫‪f‬‬‫‪l‬‬
‫‪ui‬‬‫‪dshi‬‬
‫‪f‬‬‫‪t‬‬
‫‪sandi‬‬ ‫‪nadequat‬‬‫‪epot‬‬ ‫‪assi‬‬‫‪um r‬‬‫‪epl‬‬
‫‪acement‬‬‫‪.‬‬
‫‪3.Hy‬‬‫‪ponat‬‬‫‪r‬‬
‫‪emi‬‬ ‫‪acommondur‬‬ ‫‪i‬‬‫‪ngt‬‬‫‪hef‬‬ ‫‪i‬‬
‫‪r‬‬‫‪stweekoft‬‬ ‫‪heacut‬‬
‫‪ephase.‬‬

‫‪:‬‬‫ﻡ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺩﻭﺣﺠﻢ‬ ‫ﺭ‬
‫ﺍ‬‫ﻮ‬‫ﻟﺸ‬
‫ﺍ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺍﺕﻋ‬‫ﺮ‬‫ﻴ‬
‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﺪ‬
‫ﻘ‬‫ﺪﻳﺼﻞﻓ‬‫‪،‬ﻗ‬‫ﻟﻚ‬
‫ﻟﻰﺫ‬
‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻹﺿ‬‫‪.‬ﺑ‬
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺮﺧﻼﻝ ﺻ‬‫ﻴ‬‫ﺒ‬‫ﻜﻞﻛ‬‫ﺔﺑﺸ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻔ ﺾﺣﺠﻢ‬‫ﻨﺨ‬‫‪.‬ﻳ‬‫‪1‬‬
‫ﺘﻢ‬
‫ﺘﻰﻳ‬‫ﺔﺣ‬‫ﺎﻋ‬
‫ﺓ‪24‬ﺳ‬‫ﺮ‬‫ﺘ‬
‫ﺮﺧﻼﻝﻓ‬ ‫ﺜ‬‫ﻛ‬
‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﺍﺕ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﻟﻰ‪5‬‬‫ﻟﻰ‪3‬ﺇ‬ ‫ﺮﻕﺇ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺮﺡ‬‫ﺮﻱﻣﻦﺧﻼﻝﺟ‬ ‫ﻴ‬‫ﺒﺨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬
‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬
‫‪.‬‬
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬ ‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﺮﻁﺑ‬‫ﻟﻰﻓ‬‫ﺎﺇ‬
‫ﻳ‬‫ﻠﺨﻼ‬‫ﻟ‬‫ﺋﻞ‬‫ﺎ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻣ‬‫ﺪ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺩﻱ‬‫ﺆ‬‫‪.‬ﻳ‬
‫ﺮﻕ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺃﺳﻄﺢ‬ ‫ﺔ‬‫ﻴ‬
‫ﻐﻄ‬‫ﺗ‬

‫ﻠﺨﻼ‬‫ﻟ‬
‫ﺋﻞ‬‫ﺎ‬‫ﺮﻫ‬‫ﻴ‬
‫ﻣ‬‫ﺪ‬‫ﺘﺞﻋﻦﺗ‬‫ﻨ‬‫(ﻳ‬‫ﺮﻁ‬‫ﻔ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﻡ)‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺮﻁﺑ‬ ‫‪،‬ﻓ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪ‬‫ﻌ‬‫ﺓﺑ‬‫ﺮ‬‫ﺎﺷ‬
‫ﺒ‬‫‪.‬ﻣ‬‫‪2‬‬
‫ﻘﺺ‬ ‫ﺪﺙﻧ‬‫ﺪﻳﺤ‬‫‪.‬ﻗ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬
‫ﺗ‬‫ﻮ‬‫ﻘ ﺺﺑ‬‫ﻟﻰﻧ‬‫ﻡﺇ‬‫ﻮ‬‫ﻴ‬
‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬‫ﺒ‬
‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬‫ﺔﺗ‬‫ﻳ‬
‫ﺎ‬‫ﻔ‬‫ﻡﻛ‬‫ﺪ‬
‫ﻋ‬ ‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬
‫ﺩﻱﺗ‬ ‫ﺆ‬‫ﻳ‬‫‪،‬ﻭ‬‫ﺎ‬‫ﻳ‬
‫‪.‬‬‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻝ‬
‫ﺪ‬‫ﺒ‬‫ﺘ‬
‫ﺍﺳ‬ ‫ﺔ‬
‫ﻳ‬ ‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬‫ﺪ‬‫ﺋﻞﻭﻋ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻻﺕ‬‫ﻊﺗﺤ‬‫ﺎﻣ‬‫ً‬
‫ﻘ‬‫(ﻻﺣ‬ ‫ﻡ‬‫ﻮ‬
‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺎ‬‫ﻔ‬‫ﻨ‬
‫ﺘ‬‫ﺍﺳ‬‫ﻡ)‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬ ‫ﻴ‬
‫ﺎﺳ‬ ‫ﺗ‬
‫ﻮ‬‫ﺑ‬
‫‪.‬‬
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻷﻝﻣﻦ‬
‫ﺍﻭ‬ ‫ﻮﻉ‬‫ﺒ‬‫ﺍﻷﺳ‬‫ﻊﺧﻼﻝ‬ ‫ﺋ‬‫ﺎ‬
‫ﻡﺷ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﻮ‬ ‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻘ ﺺﺻ‬ ‫‪.‬ﻧ‬
‫‪3‬‬
‫‪Bur‬‬‫‪nEdema‬‬
‫‪-Edemai‬‬ ‫‪sdef‬‬‫‪i‬‬
‫‪nedast‬‬ ‫‪hepr‬‬‫‪esenceofex‬‬ ‫‪cessi‬‬
‫‪v‬‬‫‪ef‬‬‫‪l‬‬‫‪ui‬‬‫‪di‬‬‫‪nt‬‬‫‪het‬‬‫‪i‬‬‫‪ssuespacesdue‬‬

‫‪215‬‬
tolossofcapi l
lar yintegri
tyandshi f
toff luidar elocal izedt ot hebur nitself
,
result
inginbl i
st erfor mationandedemaonl yint hear eaofi njury.
-Edemai susual lymaxi mal af t
er24hour s.Itbegi nst or esolv e1t o2day spost -
burnandusual lyi scompl etelyresol v
edi n7t o10day spost -i
njury.
-Edemai nbur nwoundscanber educedbyav oidingex cessiv efluiddur i
ngt he
earl
ypost -burnper i
od.Unnecessar yover -r
esusci tati
onwi l
lincreaseedema
formationinbot hbur nti
ssueandnon- bur ntissue.
‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﺮﻕﻭ‬ ‫ﺣ‬
-‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬ ‫ﻴ‬
‫ﻌ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﻼﺔ‬
‫ﺍﻥﺳ ﻣ‬ ‫ﺪ‬ ‫ﻘ‬‫ﻔ‬‫ﻟ‬‫ﺔ‬‫ﻴﺠ‬‫ﺘ‬‫ﺔﻧ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬ ‫ﺎﺕ‬‫ﺍﻏ‬‫ﺮ‬
‫ﺓﻓﻲﻓ‬ ‫ﺪ‬ ‫ﺋ‬‫ﺍ‬
‫ﺋﻞﺯ‬ ‫ﺍ‬
‫ﻮ‬‫ﺩﺳ‬ ‫ﻮ‬‫ﺎﻭﺟ‬‫ﻬ‬‫ﻧ‬‫ﺄ‬
‫ﺔﺑ‬ ‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺮﻑ‬ّ
َ
‫ﻌ‬ُ
‫ﺗ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻘﻂﻓﻲﻣ‬ ‫ﺔﻓ‬‫ﻣ‬‫ﺫ‬‫ﻭ‬‫ﺔﻭ‬ ‫ﻔﻄ‬‫ﻮﻥﻧ‬ ‫ﻜ‬‫ﻟﻰﺗ‬‫ﺩﻱﺇ‬ ‫ﺆ‬‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ‫ﻪ‬‫ﻔﺴ‬ ‫ﺮﻕﻧ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺎﻥ‬‫ﻜ‬‫ﺋﻞﻓﻲﻣ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺗﺤ‬
‫ﻭ‬.
-‫ﺘﻢ‬ ‫ﺎﻳ‬
‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﺮﻕﻭﻋ‬ ‫ﻟﺤ‬‫ﺍ‬ ‫ﺪ‬
‫ﻌ‬ ‫ﻴﻦﺑ‬‫ﻣ‬‫ﻮ‬‫ﻟﻰﻳ‬ ‫ﻡﺇ‬‫ﻮ‬‫ﺀﻣﻦﻳ‬ ‫ﺎ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﺃﻓﻲ‬ ‫ﺪ‬‫ﺒ‬‫ﻳ‬.‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬24‫ﺪ‬ ‫ﻌ‬
‫ﻮﻯﺑ‬ ‫ﺓﻗﺼ‬ ‫ﺩ‬‫ﺎ‬
‫ﺔﻋ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﺗ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺪ‬‫ﻌ‬‫ﻡﺑ‬‫ﺎ‬‫ﻳ‬‫ﺃ‬10‫ﻟﻰ‬ ‫ﺇ‬7‫ﻮﻥ‬ ‫ﺎﻓﻲﻏﻀ‬ ً
‫ﻣ‬‫ﺎ‬‫ﻤ‬
‫ﻪﺗ‬ ‫ﻠ‬
‫ﺣ‬.
-‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬‫ﺓﻣ‬ ‫ﺮ‬‫ﺘ‬‫ﺓﺧﻼﻝﻓ‬ ‫ﺪ‬‫ﺋ‬‫ﺍ‬‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻨﺐ‬‫ﻳﻖﺗﺠ‬ ‫ﺮ‬‫ﻭﻕﻋﻦﻃ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭﺡ‬ ‫ﺮ‬‫ﺔﻓﻲﺟ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﻜﻦﺗ‬‫ﻤ‬‫ﻳ‬
‫ﺮ‬‫ﻴ‬‫ﺔﻏ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔﻭ‬ ‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫ﺔﻓﻲ‬ ‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬ ‫ﻮ‬‫ﻜ‬
‫ﺭﻱﻣﻦﺗ‬ ‫ﻭ‬
‫ﺮ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺪﻏ‬ ‫ﺋ‬‫ﺍ‬
‫ﺰ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺵ‬ ‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬ ‫ﺪ‬
‫ﻳ‬‫ﺰ‬‫ﻳ‬.‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬
.
-Asedemai ncreasesi nci r
cumf erenti
al burns, pressur eonsmal lbloodv essels
andner vesint hedi stalextremi t
iescausesanobst ruct i
onofbl oodf l
owand
consequenti schemi a.
-Thiscompl icat ioni sknownascompar tmentsy ndr ome.Thephy sicianmay
needt oper f
or m aneschar otomy ,asurgi calincisioni ntot heeschar( dev i
tal
ized
ti
ssuer esult
ingf rom abur n),tor el
ievet heconst ri
ctingef f
ectoft hebur ned
ti
ssue.

‫ﺍ‬
‫ﺎﺏﻓﻲ‬ ‫ﺍﻷﻋﺼ‬
‫ﺓﻭ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﻠﻰ‬‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬
‫ﺩﻱ‬ ‫ﺆ‬
‫ﻳ‬،‫ﺔ‬‫ﻴ‬‫ﻴﻄ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﻊﺯ‬‫ﻣ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻘﺺ‬ ‫ﻟﻚﻣﻦﻧ‬‫ﻠﻰﺫ‬‫ﺗﺐﻋ‬ ‫ﺮ‬
‫ﺘ‬‫ﺎﻳ‬‫ﻣ‬
‫ﻡﻭ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻖ‬‫ﺪ‬
‫ﺔﺗ‬ ‫ﻗ‬
‫ﺎ‬‫ﻟﻰﺇﻋ‬
‫ﺓﺇ‬‫ﺪ‬‫ﻴ‬‫ﻌ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺮ‬‫ﻷﻃ‬
‫ﻮﺷﻖ‬‫ﻭﻫ‬،‫ﺭﺝ‬
‫ﺎ‬‫ﻠﺨ‬
‫ﻟ‬‫ﺀﺷﻖ‬ ‫ﺍ‬
‫ﺮ‬‫ﻟﻰﺇﺟ‬‫ﻴﺐﺇ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﺎﺝ‬‫ﺘ‬‫ﺪﻳﺤ‬‫ﻗ‬.‫ﺰ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬
‫ﺯ‬‫ﻣﻼ‬
‫ﺎﺳﻢ ﺘ‬‫ﺎﺕﺑ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺮﻑﻫ‬ ‫ﻌ‬ُ-
‫ﺗ‬
.
‫ﺔ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬
‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬
‫ﻟﻸ‬‫ﻴﻖ‬‫ﻴ‬
‫ﺘﻀ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺘﺨ‬‫ﻟ‬،(
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺗﺞﻋﻦ‬‫ﺎ‬
‫ﻴﺖﻧ‬ ‫ﻤ‬
‫ﻴﺞﻣ‬‫ﻧﺴ‬)‫ﺎﺵ‬ ‫ﻟﺨﺸﺨ‬‫ﺍ‬‫ﺍﺣﻲﻓﻲ‬‫ﺮ‬‫ﺟ‬

Pulmonar yresponse:
1.Hyperventilat
ionandi ncr
easedoxygenconsumption.
2.Themaj orityofdeat hsfr
om fi
reareduetosmokei nhal
at i
on.
3.Theeffectsofbur nshockoncellmembranepotentialmaycausepul
monary
edema.
4.Restr
icti
v edef ectduetoburnofneck.
5.I
nit
ialrespiratoryalkal
osisr
esult
ingfr
om hyper
ventil
ati
on.
6.Respi
rat oryacidosisassoci
atedwithpul
monaryinsuffi
ciencyasar
esul
tof
majorburn.

:
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﺋ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬
.‫ﻴﻦ‬‫ﻛﺴﺠ‬‫ﺍﻷ‬‫ﻬﻼﻙ‬‫ﺘ‬
‫ﺍﺳ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻳ‬
‫ﺯ‬‫ﻔﺲﻭ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁ‬‫ﻓ‬.
1
.
‫ﺎﻥ‬‫ﺪﺧ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻕ‬‫ﻨﺸ‬
‫ﺘ‬‫ﺍﺳ‬‫ﻟﻰ‬
‫ﺋﻖﺇ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔﻋﻦ‬‫ﻤ‬‫ﺎﺟ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻟ‬
‫ﺎ‬
‫ﺩﻏ‬ ‫ﻮ‬
‫ﻌ‬‫ﺗ‬.
2
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﺋ‬‫ﺔﺭ‬‫ﻣ‬‫ﺫ‬‫ﺔﻭ‬‫ﻴ‬‫ﻠ‬
‫ﻟﺨ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﺎﺕﻏﺸ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻣ‬‫ﻠﻰﺇ‬
‫ﻭﻕﻋ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺭﺻ‬ ‫ﺎ‬
‫ﺛ‬‫ﺁ‬‫ﺒﺐ‬‫ﺪﺗﺴ‬‫ﻗ‬.
3

216
 .‫ﻨﻖ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﺒﺐﺣ‬‫ﺪﺑﺴ‬‫ﻴ‬
‫ﻘ‬‫ﻴﺐﻣ‬ ‫ﻋ‬.
4
.
‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁ‬‫ﺗﺞﻋﻦﻓ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻲ‬
‫ﻭ‬‫ﺍﻷ‬
‫ﻔﺴﻲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﻘﻼ‬.
‫ﻟ‬
‫ﺍ‬5
.
‫ﺓ‬‫ﺮ‬‫ﻴ‬
‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻴﺠ‬
‫ﺘ‬‫ﺔﻧ‬‫ﺋ‬
‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﻘﺼ‬
‫ﻟ‬‫ﺎﺣﺐ‬‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺴﻲ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺽ‬ ‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬.
6

Pulmonaryinjuri
esar ecategor
izedas( 1)upperai rwayi njur
yor( 2)inhal
ati
on
i
njurybel
owt hegl ott
is.
Upperairwayi nj
uryresult
sf r
om i nhal
ationofdi rectheatgr eaterthen150oC
(302oF)totheepi theli
um.Thisdamager esult
sinsev ereupperai rwayedema,
whichcancauseobst ruct
ionoft heupperai rway, i
ncludingt hephar ynxand
l
arynx,i
ntheear lyhourspostbur n.Becauseoft hecool i
ngef f
ectofr api
d
vapori
zati
onint hepul monarytract,di
rectheat
i
njurydoesnotnor mal l
yoccurbel owthel eveloft hebr onchus.Upperai rway
i
njuryi
streatedbyear l
ynasotrachealorendot racheal intubati
on.

‫ﺎﻕ‬‫ﻨﺸ‬ ‫ﺘ‬
‫ﺍﺳ‬ ‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫(ﺇﺻ‬2)‫ﺃ‬
‫ﻮﻱﻭ‬ ‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻓﻲﻣﺠ‬ ‫ﺑ‬
‫ﺎ‬‫(ﺇﺻ‬1)‫ﺎ‬‫ﻬ‬
‫ﻧ‬‫ﺃ‬‫ﻠﻰ‬‫ﺔﻋ‬ ‫ﻳ‬
‫ﻮ‬‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﻴﻒ‬‫ﻨ‬‫ﺘﻢﺗﺼ‬‫ﻳ‬
.‫ﺭ‬‫ﺎ‬
‫ﻣ‬‫ﺰ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻔﻞ‬‫ﺃﺳ‬
‫ﺔ‬
‫ﺭﺟ‬ ‫ﺩ‬302)‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﺌ‬
‫ﺔﻣ‬‫ﺭﺟ‬‫ﺩ‬150‫ﺮﻣﻦ‬ ‫ﺒ‬
‫ﻛ‬‫ﺃ‬‫ﺓ‬‫ﺮ‬
‫ﺎﺷ‬‫ﺒ‬
‫ﺓﻣ‬ ‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻕﺣ‬‫ﻨﺸ‬‫ﺘ‬‫ﺍﺳ‬‫ﻮﻱﻋﻦ‬ ‫ﻠ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺞﺇﺻ‬ ‫ﻨ‬
‫ﺗ‬
‫ﺒﺐ‬‫ﺃﻥﺗﺴ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﺓ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻮﻱ‬ ‫ﻠ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬‫ﻣ‬‫ﺫ‬‫ﺭﻭ‬‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬‫ﺍ‬
‫ﺬ‬ ‫ﺘﺞﻋﻦﻫ‬ ‫ﻨ‬
‫ﻳ‬.‫ﺓ‬‫ﺭ‬‫ﺎ‬
‫ﻬ‬‫ﻟﻈ‬‫ﺍ‬‫ﻟﻰ‬
‫(ﺇ‬‫ﻳﺖ‬ ‫ﺎ‬
‫ﻬ‬‫ﻧ‬
‫ﺮ‬‫ﻬ‬‫ﻓ‬
.
‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬
‫ﻟﻰﺑ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﺎﻋ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻓﻲ‬، ‫ﺓ‬‫ﺮ‬
‫ﻨﺠ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻡﻭ‬‫ﻮ‬‫ﻌ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬ ‫ﻤ‬‫ﺑ‬،‫ﻮﻱ‬‫ﻠ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺍﻓﻲﻣﺠ‬ ً
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬
‫ﺓ‬‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬،‫ﻮﻱ‬‫ﺋ‬‫ﺮ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻟﺴ‬‫ﺍ‬‫ﻊﻓﻲ‬ ‫ﻳ‬‫ﺮ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺒﺨ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬‫ﺪ‬‫ﻳ‬
‫ﺮ‬‫ﺒ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﺛ‬‫ﺄ‬
‫ﺒﺐﺗ‬ ‫ﺑﺴ‬
‫ﻳﻖ‬‫ﺮ‬‫ﻮﻱﻋﻦﻃ‬ ‫ﻠ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬
‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﻢﻋﻼﺝﺇﺻ‬‫ﻳ‬.‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺒ‬‫ﻘﺼ‬‫ﻟ‬‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﺓﺗﺤﺖﻣﺴ‬ ‫ﺩ‬‫ﺎ‬‫ﺔﻋ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪﺙ‬‫ﻻﺗﺤ‬
.
‫ﻣﻲ‬ ‫ﺎ‬
‫ﻏ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﺒ‬
‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻣﻲ‬ ‫ﺎ‬
‫ﻏ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻴﺐ‬‫ﺒ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬

Inhal ationi nj urybel owt hegl ottisresul tsfrom inhal i

ngt hepr oduct sof-
i
ncompl et ecombust ionornoxi ousgases.I nhalat i
onofnoxi ousgasesi sof ten
thesour ceofdeat hatt hesceneofaf ir
e.Thesepr oduct sincl udecar bon
monoxi de, cy anide, ammoni a,aldehy des, acrolein,sul furdiox ide, and
i
socy anat es.Ti ssuehy poxi aist her esul tofcarbonmonox idei nhal ation.I t
combi neswi thhemogl obi ntof orm car boxyhemogl obi n.Theaf f
inityof
hemogl obi nf orcar bonmonoxi dei s250t imesgr eat erthant hatf oroxy gen.Thi s
i
njur yr esul tsdi rectlyf r
om chemi cal ir
ritati
onoft hepul monar ytissuesatt he
alveol arl evel .I
nhal at i
oni njuri
esbel owt heglotti
scausel ossofci liaryact ion,
hyper secr etion, sev eremucosal edema, andpossi blybr onchospasm.Tr eatment
usual lyconsi st
sofear lyintubat i
onandmechani cal v enti
lationwi th100%
oxy gen, whi chr educest hehal f-
lif
eofcar boxyhemogl obinf rom 4hour st o45
mi nut es.Howev er,somepat i
entsr equi reonlyox ygent herapy ,dependi ngont he
extentofpul monar yi njuryandedema.
Indicat or sofpossi bleupperai rwayi njuryinclude( 1)i njuryoccur ringi nan
encl osedspace; (
2)bur nsoft hef aceorneck; (
3)si ngednasal hai r;(4)
hoar seness, high- pitchedv oi
cechange, drycough, st ri
dor;(5)soot yorbl oody
sput um; (6)l abor edbr eathingort achy pnea( rapidbr eathing)andot hersi gnsof
reducedoxy genl evel s(hy poxemi a); and( 7)er yt
hemaandbl isteringoft heor al
orphar y ngeal mucosa.

(
2)‫؛‬ ‫ﻠﻖ‬
‫ﻐ‬‫ﺎﻥﻣ‬
‫ﻜ‬‫ﺪﺙﻓﻲﻣ‬ ‫ﺘﻲﺗﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬(1)‫ﻮﻱ‬‫ﻠ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﻤﺠ‬‫ﻟ‬‫ﺔ‬
‫ﻠ‬‫ﻤ‬‫ﺘ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬‫ﺍﺕ‬‫ﺮ‬‫ﺆﺷ‬‫ﻤﻞﻣ‬‫ﺗﺸ‬
‫ﺎﻑ‬‫ﺎﻝﺟ‬‫ﻌ‬‫ﺳ‬،‫ﻟﻲ‬‫ﺎ‬
‫ﻮﺕﻋ‬ ‫ﺮﺻ‬ ‫ﻴ‬‫ﻐ‬
‫ﺗ‬،‫ﻮﺕ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔﻓﻲ‬‫(ﺑﺤ‬4).‫ﺭ‬‫ﻮ‬‫ﻔ‬
‫ﻔﻲﻣﺤ‬ ‫ﻧ‬‫ﺃ‬‫ﺮ‬
‫ﻌ‬‫(ﺷ‬3).‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻪ‬‫ﻮﺟ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕﻓﻲ‬ ‫ﺮ‬
‫ﺣ‬
‫ﺎﺕ‬‫ﻣ‬‫(ﻭﻋﻼ‬‫ﻔﺲ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﺮﻋ‬ ‫ﻔﺲ)ﺳ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻉ‬‫ﻭﺗﺴ‬‫ﺃ‬‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﺑ‬
‫ﻮ‬‫ﻌ‬‫(ﺻ‬6).‫ﻮﻱ‬‫ﻣ‬‫ﻭﺩ‬‫ﺃ‬‫ﺎﻁ‬‫ﻐﻢﻣﺨ‬‫ﻠ‬‫(ﺑ‬
5)‫؛‬‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﺻ‬،
‫ﺀ‬‫ﺎ‬
‫ﻐﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻓﻲ‬ ‫ﺮﺣ‬‫ﻘ‬‫ﺗ‬
‫ﻣﻲﻭ‬‫ﺎ‬‫ﻤ‬
‫(ﺣ‬ 7)‫؛ﻭ‬(‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻛﺴﺞ‬‫ﺄ‬‫ﻘ ﺺﺗ‬‫ﻧ‬
)‫ﻴﻦ‬‫ﻛﺴﺠ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻳ‬
‫ﻮ‬ ‫ﺘ‬
‫ﺎ ﺽﻣﺴ‬‫ﻔ‬‫ﻧﺨ‬‫ﺮﻯﻻ‬‫ﺃﺧ‬
.‫ﻡ‬‫ﻮ‬‫ﻌ‬‫ﻠ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻔﻢ‬‫ﻠ‬
‫ﻟ‬‫ﺎﻃﻲ‬‫ﻤﺨ‬‫ﻟ‬
‫ﺍ‬

217
Renalf unct ionr esponse:
Renal f unctionmaybeal teredasar esultof :
1.Decr easedbl oodv olume.
2.Dest ructionofr edbl oodcel l
satt heinjur ysiter esultsinfreehemogl obinin
theur ine.
3.Bl oodur eani trogenandcr eatininel evel elevat ed
4.Ifmuscl edamageoccur s(eg, from elect rical burns),my oglobini sreleased
from themuscl ecel lsandexcr etedbyt heki dney s.Adequat efluidvolume
replacementr est oresr enal bloodf low, i
ncr easi ngt hegl omer ularfil
tr
ationrate
andur i
nev olume.I fther ei sinadequat ebl oodf lowt hrought heki dneys, t
he
hemogl obi nandmy oglobi noccl udet her enal tubul es,resulti
ngi nacut etubular
necr osisandr enal fail
ur e.
:‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻒ‬‫ﺎ‬‫ﺔﻭﻇ‬ ‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬
:‫ﻠﻲ‬‫ﺎﻳ‬‫ﻤ‬‫ﻟ‬
‫ﺔ‬‫ﻴﺠ‬ ‫ﺘ‬‫ﻠﻰﻧ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﺮﻭﻇ‬ ‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﺪﺗ‬‫ﻗ‬
.‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎ ﺽﺣﺠﻢ‬ ‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬.1
.
‫ﻮﻝ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻧﻲﻓﻲ‬ ‫ﺎ‬
‫ﻴﻦﻣﺠ‬ ‫ﺑ‬
‫ﻮ‬ ‫ﻠ‬
‫ﻮﺟ‬ ‫ﻤ‬‫ﻴ‬‫ﻪﻫ‬ ‫ﻨ‬
‫ﺘﺞﻋ‬ ‫ﻨ‬‫ﺔﻳ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺎﻥ‬‫ﻜ‬‫ﺀﻓﻲﻣ‬ ‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﺮﺧﻼ‬ ‫ﻴ‬
‫ﻣ‬‫ﺪ‬‫ﺗ‬.2
‫ﻴﻦ‬ ‫ﻨ‬
‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﻳ‬‫ﺮ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺪ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﻓﻲ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻭﺟ‬ ‫ﺮ‬‫ﺘ‬
‫ﻴ‬‫ﻮﻯﻧ‬ ‫ﺘ‬
‫ﺎﻉﻣﺴ‬ ‫ﻔ‬‫ﺗ‬
‫ﺭ‬‫ﺍ‬.3
‫ﺮ‬
‫ﻳ‬‫ﺮ‬ ‫ﺘﻢﺗﺤ‬ ‫ﻳ‬،(‫ﺔ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬ ‫ﻬ‬
‫ﻭﻕﻛ‬ ‫ﺮ‬‫ﻣﻦﺣ‬،‫ﺎ‬ ‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻌﻀﻼﺕ)ﻋ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻒﻓﻲ‬ ‫ﻭﺙﺗ‬ ‫ﺪ‬‫ﺣﺔﺣ‬‫ﻟ‬
‫ﻓﻲ ﺎ‬. 4
‫ﻓﻖ‬ ‫ﺪ‬‫ﺋﻞﺗ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻟﺤﺠﻢ‬ ‫ﻓﻲ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻝ‬ ‫ﺪ‬‫ﺒ‬‫ﺘ‬‫ﺍﻻﺳ‬ ‫ﺪ‬‫ﻴ‬‫ﻌ‬‫ﻳ‬.‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻳﻖ‬ ‫ﺮ‬‫ﻩﻋﻦﻃ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺇ‬‫ﻌﻀﻼﺕﻭ‬ ‫ﻟ‬‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﻴﻦﻣﻦﺧﻼ‬ ‫ﺑ‬‫ﻮ‬‫ﻠ‬
‫ﻮﺟ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺮ‬ ‫ﺒ‬
‫ﻡﻋ‬ ‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻓﻖ‬ ‫ﺪ‬‫ﻘ ﺺﻓﻲﺗ‬ ‫ﺎﻙﻧ‬ ‫ﻨ‬
‫ﺎﻥﻫ‬ ‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺒﻲﻭﺣﺠﻢ‬ ‫ﻴ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻴﺢ‬ ‫ﺮﺷ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻝ‬ ‫ﻌ‬
‫ﺪﻣﻦﻣ‬ ‫ﻳ‬‫ﺰ‬‫ﺎﻳ‬‫ﻤ‬
‫ﻣ‬، ‫ﻮﻱ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
‫ﻓﺸﻞ‬ ‫ﺩﻭ‬ ‫ﺎ‬‫ﺑﻲﺣ‬ ‫ﻮ‬‫ﺒ‬‫ﻧ‬
‫ﺃ‬ ‫ﺮ‬
‫ﻟﻰﻧﺨ‬ ‫ﺩﻱﺇ‬‫ﺆ‬ ‫ﺎﻳ‬‫ﻤ‬‫ﻣ‬، ‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻠ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺐ‬‫ﺑ‬
‫ﺎ‬‫ﻧ‬‫ﺍﻷ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻴﻦﻳﺴ‬ ‫ﺑ‬
‫ﻮ‬‫ﻠ‬
‫ﻮﺟ‬ ‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬ ‫ﺑ‬
‫ﻮ‬‫ﻠ‬‫ﻮﺟ‬‫ﻤ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺈﻥ‬‫ﻓ‬،‫ﻠﻰ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻮﻱ‬‫ﻠ‬‫ﻛ‬
Hemat ol ogicalr esponse:
1.Redbl oodcel lsdest roy edl eadt oanemi a.
2.Hemat ocr it
ev aluemaybeel ev atedduet oplasmal oss.
3.Abnor mal i
ti
esi ncoagul ationi ncludingdecr easei nplatelets
(thrombocy topeni a).

:‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﻟﻰﻓ‬
‫ﺩﻱﺇ‬‫ﺆ‬‫ﺀﻳ‬
‫ﺍ‬‫ﺮ‬‫ﻤ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﺮﺧﻼ‬‫ﻴ‬‫ﻣ‬‫ﺪ‬‫ﺗ‬.
1
.‫ﺯ‬
‫ﻼﺎ‬
‫ﺒ ﻣ‬
‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺒﺐﻓ‬‫ﻳﺖﺑﺴ‬‫ﺮ‬
‫ﻛ‬‫ﻮ‬‫ﺗ‬‫ﺎ‬
‫ﻤ‬‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻤ‬‫ﻴ‬‫ﻊﻗ‬‫ﻔ‬
‫ﺗ‬‫ﺮ‬‫ﺪﺗ‬‫ﻗ‬.
2
.
(‫ﺎﺕ‬
‫ﻴﺤ‬‫ﻔ‬
‫ﻟﺼ‬‫ﺍ‬
‫ﺔ‬‫ﻠ‬‫ﻗ‬
)‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺋﺢ‬‫ﺎ‬
‫ﻔ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺎ ﺽﻓﻲ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
‫ﻟﻚ‬‫ﺎﻓﻲﺫ‬‫ﻤ‬‫ﺮﺑ‬
‫ﺜ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
‫ﺫﻓﻲ‬‫ﻭ‬ ‫ﺬ‬
‫ﺷ‬.3

Neuroendocrinesy st
em response:
1.Dir
ectnervei nj
urymayoccuraf terelectri
cali
njur
y .
2.Encephalopathy
3.Catechol
ami ne(epinephri
neandnorepi nephri
ne)arereleased
4.Epi
nephrinepr omoteshypergl
ycemi a.
5.Norepinephrinecausesani ni
ti
al vasoconstri
cti
onaf t
erthebur ni
njury
.
6.Theadrenal cort
exisstimulat
edt of or
m corti
solstimulatealdost
erone
secr
etioninresponset othedecreasei nintr
avascularsodium andhypovolemi
a.

:‫ﻭﻱ‬‫ﺎ‬
‫ﻤ‬‫ﻟﺼ‬‫ﺍ‬‫ﺒﻲ‬‫ﻌﺼ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬
.‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺪ‬‫ﻌ‬‫ﺎﺏﺑ‬‫ﻋﺼ‬‫ﻟﻸ‬ ‫ﺓ‬
‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬
‫ﺔﻣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺪﺙﺇﺻ‬ ‫ﺪﺗﺤ‬ ‫ﻗ‬.1
‫ﺎﻍ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺘﻼﻝ‬‫ﻋ‬‫ﺍ‬.2
(‫ﻴﻦ‬
‫ﻟ‬‫ﺎ‬
‫ﻨ‬‫ﻳ‬
‫ﺭ‬‫ﺩ‬‫ﺍ‬‫ﻴﻦﻭﻻ‬‫ﻟ‬‫ﺎ‬
‫ﻨ‬‫ﻳ‬
‫ﺭ‬‫ﺩ‬‫ﺍ‬
)‫ﻴﻦ‬‫ﻣ‬‫ﻮﻻ‬‫ﻜ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬
‫ﺘﻢﺗﺤ‬ ‫ﻳ‬.3
.
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻓﻲ‬ ‫ﻜ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺎﻉ‬‫ﻔ‬
‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﺯ‬
‫ﺰ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺮ‬‫ﻔ‬‫ﻨ‬‫ﻴ‬
‫ﺑ‬‫ﺍﻹ‬.4
.‫ﺮﻕ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺪﺇﺻ‬‫ﻌ‬‫ﺔﺑ‬‫ﻴ‬
‫ﻋ‬‫ﻭ‬‫ﻟﻸ‬‫ﺎ‬ً
‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺃ‬‫ﺎ‬
ً
‫ﻘ‬‫ﻴ‬‫ﻳﻦﺗﻀ‬‫ﺮ‬‫ﻔ‬
‫ﻨ‬‫ﻴ‬‫ﺑ‬
‫ﺍﻹ‬‫ﺒﺐ‬ ‫ﻭﻻﻳﺴ‬. 5
‫ﺔﻻ‬
‫ﺑ‬‫ﺎ‬‫ﺘﺠ‬
‫ﺍﺳ‬‫ﻭﻥ‬
‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻭﺳ‬‫ﺪ‬
‫ﻟ‬‫ﺍﻷ‬
‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺰﺇ‬
‫ﻔ‬‫ﺬﻱﻳﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺰ‬‫ﻴ‬
‫ﺗ‬‫ﺭ‬‫ﻮ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬
‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻜﻈ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺮ‬‫ﺰﻗﺸ‬ ‫ﻴ‬‫ﻔ‬
‫ﺘﻢﺗﺤ‬ ‫ﻳ‬.6

218
 .
‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻘ ﺺﺣﺠﻢ‬
‫ﻧ‬‫ﺔﻭ‬
‫ﻳ‬‫ﻮ‬‫ﻣ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻭﻋ‬
‫ﺍﻷ‬‫ﺍﺧﻞ‬
‫ﻡﺩ‬‫ﻮ‬
‫ﻳ‬‫ﺩ‬‫ﻮ‬
‫ﻟﺼ‬‫ﺍ‬
‫ﺎﺽ‬‫ﻔ‬
‫ﻧﺨ‬‫ﺍ‬

Immunesy stem r esponse:pat i

entli
abletoinf
ecti
onduet o:
1.Lossoft heski nbar ri
erandpr esenceofeschar.
2.Hy pox i
a,aci dosis,andthrombosi sofvessel
sinwoundar ea.
Gastrointest i
nalr esponse:
1.Per i
stalsi
sdecr eases.
2.Gast ri
cdi stenti
on.
3.Nauseaandv omi t
ing.
4.Par al
yticileus.
5.Ischemi aoft hegast r
icmucosal eadt ori
skforduodenalulcerandgast
ri
c
ulcermani festedbyoccul tbleedingandinsomecasesl if
e-threateni
ng
hemor r
hage.

:
‫ﺒﺐ‬‫ﻭﻯﺑﺴ‬ ‫ﺪ‬‫ﻌ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ :
‫ﺎﻋﻲ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬
.‫ﺎﺵ‬ ‫ﻟﺨﺸﺨ‬‫ﺍ‬ ‫ﺩ‬
‫ﻮ‬‫ﻭﺟ‬ ‫ﺪﻭ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺰ‬‫ﺎﺟ‬‫ﺍﻥﺣ‬ ‫ﺪ‬‫ﻘ‬‫ﻓ‬.1
.‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﺔﻓﻲﻣ‬ ‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬ ‫ﻠﻂ‬‫ﺗﺠ‬‫ﺎ ﺽﻭ‬ ‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻛﺴﺠ‬ ‫ﺍﻷ‬‫ﻘﺺ‬ ‫ﻧ‬.2
:
‫ﻤﻲ‬‫ﻬﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﺳ‬
.
‫ﻌﺠﻲ‬ ‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻥ‬‫ﻘﺼ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬.1
.‫ﺓ‬‫ﺪ‬
‫ﻌ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺥﻓﻲ‬ ‫ﻔ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬.2
.
‫ﺀ‬‫ﻘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥﻭ‬ ‫ﻴ‬
‫ﺜ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬.3
.
‫ﻠﻲ‬‫ﻠ‬‫ﻟﺸ‬‫ﺍ‬‫ﻮﺹ‬ ‫ﻠ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬.4
‫ﺓ‬‫ﺪ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺮﺣ‬ ‫ﻗ‬‫ﺮﻭ‬‫ﻨﻲﻋﺸ‬ ‫ﺛ‬‫ﺍﻻ‬‫ﺔ‬‫ﺮﺣ‬‫ﻘ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺮ‬‫ﻟﻰﺧﻄ‬ ‫ﺩﻱﺇ‬‫ﺆ‬‫ﺓﻳ‬‫ﺪ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻃﻲﻓﻲ‬ ‫ﻤﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻐﺸ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺮ‬‫ﻘ ﺺﺗ‬‫ﻧ‬.5
.‫ﺓ‬
‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺩ‬
‫ﺪ‬‫ﻬ‬‫ﻳﻒﻳ‬ ‫ﺰ‬‫ﺎﻻﺕﻧ‬‫ﻟﺤ‬‫ﺍ‬‫ﻌﺾ‬ ‫ﻓﻲﺑ‬‫ﻣ ﺾﻭ‬ ‫ﺎ‬
‫ﻳﻒﻏ‬ ‫ﺰ‬‫ﻠﻰﻓﻲﻧ‬ ‫ﺘﺠ‬‫ﺘﻲﺗ‬‫ﻟ‬
‫ﺍ‬
Thermoregul atoryr esponse:
Lossofski nalsor esul
tsinani nabili
tytor egulatebodyt emper ature.Pat i
ents
withburninjuriesmayt hereforeexhi bi
tlowbodyt emper at
ur esintheear ly
hoursafterinjury.Then, ashy permet aboli
sm reset scor etemper ature,the
pati
entbecomeshy pothermicf ormuchoft hepostbur nper iod,eveni nt he
absenceofi nfection.
Othersystemi cr esponses:
1.Hypermet abolism.
2.Coronialabr asionsmayr esultafterfacialburns.
3.Chroniccompl icati
onsofel ectri
cal burnsmayi nvolvecat aractsorgl aucoma.

:‫ﺭﻱ‬‫ﺍ‬
‫ﺮ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬
‫ﻳﻦ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻧﻲ‬‫ﺎ‬
‫ﻌ‬‫ﺪﻳ‬‫ﻟﻚﻗ‬‫ﺬ‬‫ﻟ‬
.‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﺔﺣ‬ ‫ﺭﺟ‬‫ﻴﻢﺩ‬‫ﻨﻈ‬‫ﻠﻰﺗ‬‫ﺓﻋ‬‫ﺭ‬‫ﺪ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﺪ‬ ‫ﻟﻰﻋ‬‫ﺎﺇ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬ ‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺩﻱﻓ‬‫ﺆ‬‫ﻳ‬
‫ﺪ‬‫ﻌ‬‫ﺑ‬.‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬‫ﺪ‬
‫ﻌ‬‫ﻟﻰﺑ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬
‫ﻋ‬‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻟﺠﺴﻢﻓﻲ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺎﺕﺣ‬ ‫ﺭﺟ‬‫ﺎ ﺽﺩ‬
‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬‫ﻭﻕﻣﻦ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻮﻥﻣﻦﺇﺻ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳ‬
‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻠﺤ‬‫ﻟ‬
‫ﺎ‬ً‫ﻔ‬
‫ﻀ‬ ‫ﻨﺨ‬‫ﻳ ﺾﻣ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﺢ‬
‫ﻳﺼ‬، ‫ﺔ‬
‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺒﻂﺩ‬‫ﺋﻲ ﺿ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁ‬ ‫ﺪﻓ‬‫ﻴ‬‫ﻌ‬‫ﺎﻳ‬‫ﻣ‬
‫ﺪ‬‫ﻨ‬‫ﻋ‬،‫ﻟﻚ‬‫ﺫ‬
.
‫ﻭﻯ‬‫ﺪ‬‫ﺩﻋ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﺣﺔﻋ‬
‫ﻟ‬
‫ﺘﻰﻓﻲ ﺎ‬ ‫ﺣ‬، ‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺪ‬‫ﻌ‬‫ﺎﺑ‬
‫ﺓﻣ‬ ‫ﺮ‬‫ﺘ‬
‫ﻌﻈﻢﻓ‬‫ﻤ‬‫ﻟ‬
:‫ﺮﻯ‬‫ﺃﺧ‬ ‫ﺔ‬‫ﻴ‬‫ﻬﺠ‬‫ﻨ‬‫ﺎﺕﻣ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬
.
‫ﺋﻲ‬‫ﺍ‬‫ﺬ‬ ‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻁ‬‫ﻓ‬.1
.‫ﻪ‬
‫ﻮﺟ‬ ‫ﻟ‬
‫ﺎ‬
‫ﻭﻕﺑ‬‫ﺮ‬‫ﺪﺣ‬ ‫ﻌ‬‫ﺔﺑ‬‫ﻴ‬‫ﺎﺟ‬
‫ﺎﺕﺗ‬ ‫ﺘﺞﺳﺤﺠ‬ ‫ﻨ‬
‫ﺪﺗ‬‫ﻗ‬.2
.‫ﺎ‬
‫ﻣ‬‫ﻮ‬‫ﻛ‬‫ﻮ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬‫ﻴﻦ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺪﺳ‬‫ﻡﻋ‬‫ﺎ‬‫ﺘ‬‫ﺔﺇﻋ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻠﺤ‬
‫ﻟ‬‫ﺔ‬‫ﻨ‬‫ﻣ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬ ‫ﺎﻋ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻤﻞ‬‫ﺪﺗﺸ‬‫ﻗ‬.3

219
Classif
icationofExt entofBur n
Inj
ury
Burninjuri
esar ecl assified
accordingt o:
1.Depthoft hebur n.
2.Amountofsur facear eaoft he
bodythati sburned.
3.Thepr esenceofi nhal ationi nj
ury.
4.Presenceofot heri njuries.
5.Locat i
onoft hei njuryi nspeci al
careareassuchast hef ace, the
peri
neum, hands, orf eet.
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﺪﻯ‬‫ﻴﻒﻣ‬ ‫ﻨ‬‫ﺗﺼ‬
:‫ﻭﻕﺣﺴﺐ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬‫ﺎ‬
‫ﻨﻒﺇﺻ‬ ‫ﺗﺼ‬
.‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻤﻖ‬ ‫ﻋ‬.1
.
‫ﺔ‬‫ﻗ‬‫ﻭ‬‫ﺮ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﺴ‬. 2
.‫ﺎﻕ‬‫ﻨﺸ‬ ‫ﺘ‬‫ﺍﺳ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﺩﺇﺻ‬ ‫ﻮ‬‫ﻭﺟ‬. 3
.‫ﺮﻯ‬‫ﺃﺧ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬‫ﺩﺇﺻ‬ ‫ﻮ‬‫ﻭﺟ‬. 4
‫ﺔ‬‫ﺎﺻ‬‫ﺔﺧ‬ ‫ﻳ‬‫ﺎ‬‫ﺎﻃﻖﺭﻋ‬‫ﻨ‬‫ﺔﻓﻲﻣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬ ‫ﻊ‬ ‫ﻗ‬‫ﻮ‬‫ﻣ‬.5
.
‫ﻴﻦ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻳﻦ‬‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﺎﻥ‬‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﻪ‬‫ﻮﺟ‬ ‫ﻟ‬
‫ﺍ‬‫ﺜﻞ‬‫ﻣ‬
Burndepth:(SeeFig.41).
1.Fi
rst-
degreeburns
2.Second-degreeburns (
Fig.41)Dept
hofbur
n
3.Thir
d-degreeburns

Char
act
eri
sti
csofbur
nsaccor
dingt
odept
h
Recuperat
ive Wound Sy
mpt
oms Ski
n Dept
hofBurn
Course Appear
ance I
nvolv
ement andCauses

1.Super fi
cialPart i
al-Thickness( SimilartoFirstDegree)
-Compl ete -Reddened; -Tingli
ng Epidermi
s; -
Sunburn
recovery blancheswi t
h - possibl
ya -
Low-int
ensi
ty
withi
naweek; pr essur e; dry Hy peresthesia porti
onof f
lash
noscar ri
ng -Mi nimal orno ( super dermis
edema sensi t
ivi
ty)-
-Possi ble Paint hatis
bli
st ers soothedby
cooling
2.DeepPar ti
al-
Thi ckness( Simi
lartoSecondDegr ee)
-Recoveryin2 - Blistered, -Pain Epidermi
s, -
Scalds
to4weeks mot tl
edr ed - upperdermis, -
Flashfl
ame-
Somescar ri
ng base; broken Hy peresthesia porti
onof Contact
and epider mi s; -Sensiti
vet o deeperdermis
depigment atio weepi ng coldai r
ncont ract
ur es sur face
-I
nfectionmay - Edema
convertitto
fullt
hickness

220
 3.
Ful
l
-Thi
ckness(
Simi
lart
oThi
rdDegr
ee)

-Eschar -Dr y;pal

e -Painf ree Epidermi s, -Fl
ame
sloughs- whi t
e, -Shock entir
eder mis, -Prolonged
Grafti
ng l
eat hery,
or -Hemat uria and exposur eto
necessar y char r
ed (bl
oodi nthe somet imes hotliquids-
-Scarri
ngand -Brokenskin uri
ne)and subcut aneous Electric
l
ossof withf at possibly ti
ssue; may current
contourand exposed hemol ysis i
nvolve -Chemi cal
functi
on; -Edema (bl
oodcel l connect i
v e -Cont act
contractures destruction) ti
ssue,
-Lossofdi gi
ts -Possible muscl e,and
orextremity entranceand bone
possible exitwounds
(el
ectrical
burn)

Amountofsur f
acear eaoft hebodyt hati sbur ned
1.Mi norBur nI nj
ur y
-Second- degreebur nof<15%t otalbodysur facearea( TBSA)i nadultsor<10%
TBSAi nchi l
dr en
-Third-degreebur nof<2%TBSAnoti nv ol
vingspeci alcarear eas(eyes,ears,
face,hands, feet,per i
neum, joints)
-Excludesal lpat i
entswi thel ectr
ical i
njury,inhalat
ioninjury
, orconcur r
ent
traumaandal l poor-ri
skpat ients( eg,ext r
emesofage, i
ntercurrentdisease)
2.Moder at
e, Uncompl i
catedBur nI njury
-Second- degreebur nsof15–25%TBSAi nadul tsor10–20%i nchil
dren
-Third-degreebur nsof<10%TBSAnoti nvolvi
ngspeci alcarear eas
-Excludesel ect r
icalinjury
, i
nhalationi njury,orconcurrenttraumaandal lpoor-
ri
skpat ient
s( eg, extremesofage, i
ntercurrentdisease)

‫ﺔ‬‫ﻗ‬‫ﻭ‬‫ﺮ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﺭﻣﺴ‬ ‫ﺍ‬
‫ﺪ‬‫ﻘ‬‫ﻣ‬
‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻔ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬.1
‫ﻗﻞ‬‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬‫ﻐ‬‫ﻟ‬
‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫(ﻓﻲ‬ TBSA)‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻟﻲﻣﺴ‬‫ﺎ‬
‫ﻤ‬‫ﻣﻦﺇﺟ‬٪15‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻕﻣﻦ‬ ‫ﺣ‬-
‫ﺎﻝ‬‫ﻷﻔ‬
‫ﺍﻃ‬ ‫ﺪ‬‫ﻨ‬
‫ﻟﺠﺴﻢﻋ‬ ‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﻦﻣﺴ‬٪ 10‫ﻣﻦ‬
‫ﺍﻷ‬‫ﻴﻦﻭ‬‫ﻨ‬
‫ﻴ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬)‫ﺔ‬‫ﺎﺻ‬‫ﺔﺧ‬ ‫ﻳ‬‫ﺎ‬
‫ﺎﻃﻖﺭﻋ‬‫ﻨ‬‫ﻤﻞﻣ‬‫ﻟﺠﺴﻢﻻﺗﺸ‬ ‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﺴ‬٪2‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﺔ‬‫ﺜ‬
‫ﻟ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕﻣﻦ‬ ‫ﺮ‬‫ﺣ‬-
(‫ﺎﺻﻞ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻥﻭ‬
‫ﻌﺠ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻭ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦﻭ‬‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﻪﻭ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﻧ‬
‫ﺫ‬
‫ﺔ‬‫ﻨ‬
‫ﻣ‬‫ﺍ‬
‫ﺰ‬ ‫ﺘ‬
‫ﺔﻣ‬ ‫ﻣ‬
‫ﺪ‬‫ﻭﺻ‬ ‫ﺃ‬
‫ﺎﻕ‬‫ﻨﺸ‬‫ﺘ‬
‫ﺍﺳ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻭﺇﺻ‬ ‫ﺃ‬
‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﺎﺕﻛ‬‫ﺑ‬
‫ﺎ‬‫ﻮﻥﻣﻦﺇﺻ‬ ‫ﻧ‬‫ﺎ‬‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﻨﻲﺟ‬‫ﺜ‬‫ﺘ‬‫ﻳﺴ‬-
(
‫ﺔ‬‫ﻠ‬‫ﺍﺧ‬‫ﺪ‬‫ﺘ‬
‫ﺮ ﺽﻣ‬‫ﻣ‬، ‫ﺮ‬‫ﻤ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺮﻑ‬ ‫ﺘﻄ‬‫ﻣ‬،‫ﺎ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬‫ﻠﻰﺳ‬‫ﺮ)ﻋ‬ ‫ﻠﺨﻄ‬‫ﻟ‬‫ﻴﻦ‬‫ﺮﺿ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﻭﺟ‬
‫ﺓ‬
‫ﺪ‬‫ﻘ‬‫ﻌ‬ ‫ﺮﻣ‬‫ﻴ‬‫ﻏ‬‫ﺔﻭ‬‫ﻮﺳﻄ‬‫ﺘ‬‫ﻭﻕﻣ‬ ‫ﺮ‬‫ﺔﺣ‬ ‫ﺑ‬
‫ﺎ‬‫ﺇﺻ‬.2
‫ﺎﻝ‬
‫ﻷﻔ‬
‫ﺍﻃ‬ ‫ﺪ‬‫ﻨ‬
‫ﻋ‬٪20-10‫ﻭ‬ ‫ﺃ‬
‫ﻴﻦ‬‫ﻐ‬ ‫ﻟ‬
‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢﻓﻲ‬ ‫ﺍ‬‫ﺔﺳﻄﺢ‬‫ﺎﺣ‬ ‫ﻣﻦﻣﺴ‬٪ 25-15‫ﺔ‬ ‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕﻣﻦ‬ ‫ﺮ‬‫ﺣ‬-
‫ﺔ‬‫ﺎﺻ‬‫ﺔﺧ‬ ‫ﻳ‬
‫ﺎ‬‫ﺎﻃﻖﺭﻋ‬‫ﻨ‬‫ﻤﻞﻣ‬‫ﻟﺠﺴﻢﻻﺗﺸ‬‫ﺍ‬ ‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﺴ‬٪ 10>‫ﺔ‬‫ﺜ‬‫ﻟ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻕ‬ ‫ﺮ‬‫ﺣ‬-

221
 ‫ﺮﺿﻰ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻴ‬‫ﻤ‬
‫ﺔﻭﺟ‬
‫ﻨ‬‫ﻣ‬‫ﺍ‬
‫ﺰ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﺽ‬
‫ﺮﺿ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺎﻕ‬
‫ﻨﺸ‬‫ﺘ‬
‫ﺍﻻﺳ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﻭﺇﺻ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﻟﻚ‬
‫ﻨﻰﻣﻦﺫ‬‫ﺜ‬
‫ﺘ‬‫‪-‬ﻳﺴ‬
‫(‬‫ﺍﺧﻞ‬‫ﺪ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺽ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫‪،‬‬
‫ﻟﺴﻦ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﺎ‪،‬ﻛ‬
‫ﺜﻝ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺒ‬
‫ﻠﻰﺳ‬ ‫ﻋ‬
‫ﺮ)‬‫ﻠﺨﻄ‬
‫ﻟ‬‫ﻴﻦ‬
‫ﺮﺿ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

‫‪3.Maj‬‬‫‪orBur‬‬‫‪nI‬‬ ‫‪nj‬‬‫‪ur‬‬‫‪y‬‬
‫‪-Second-‬‬‫‪degr‬‬‫‪eebur‬‬ ‫‪ns>25%TBSAi‬‬ ‫‪nadul‬‬‫‪t‬‬‫‪sor>20%i‬‬ ‫‪nchi‬‬
‫‪l‬‬‫‪dr‬‬‫‪en‬‬
‫‪-Al‬‬‫‪l‬‬
‫‪t‬‬‫‪hi‬‬‫‪r‬‬
‫‪d-‬‬‫‪degr‬‬‫‪eebur‬‬ ‫‪ns>10%TBSA‬‬
‫‪-Al‬‬‫‪l‬‬
‫‪bur‬‬‫‪nsi‬‬‫‪nv‬‬‫‪ol‬‬‫‪v‬‬ ‫‪i‬‬
‫‪ngey‬‬ ‫‪es,‬‬‫‪ear‬‬‫‪s,‬‬
‫‪f‬‬‫‪ace,‬‬‫‪hands,‬‬‫‪f‬‬
‫‪eet‬‬‫‪,‬‬‫‪per‬‬
‫‪i‬‬‫‪neum,‬‬‫‪j‬‬‫‪oi‬‬‫‪nt‬‬
‫‪s‬‬
‫‪Al‬‬‫‪l‬‬‫‪i‬‬
‫‪nhal‬‬‫‪at‬‬‫‪i‬‬
‫‪oni‬‬ ‫‪nj‬‬‫‪ur‬‬
‫‪y‬‬‫‪,‬‬‫‪el‬‬‫‪ect‬‬‫‪r‬‬
‫‪i‬‬‫‪cal‬‬‫‪i‬‬
‫‪nj‬‬‫‪ur‬‬
‫‪y‬‬‫‪,‬‬‫‪orconcur‬‬
‫‪r‬‬‫‪entt‬‬‫‪r‬‬‫‪auma,‬‬‫‪andal‬‬‫‪l‬‬
‫‪poor‬‬
‫‪-‬‬‫‪r‬‬
‫‪i‬‬‫‪sk‬‬
‫‪pat‬‬‫‪i‬‬
‫‪ent‬‬‫‪s‬‬

‫ﺮﻯ‬‫ﺒ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫‪.‬ﺇﺻ‬‫‪3‬‬
‫ﺎﻝ‬
‫ﻷﻔ‬
‫ﺍﻃ‬ ‫ﺪ‬‫ﻨ‬‫‪٪‬ﻋ‬‫ﺃ<‪20‬‬‫ﻴﻦﻭ‬‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻟﺠﺴﻢﻋ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫‪٪‬ﻣﻦﻣﺴ‬ ‫ﺔ<‪25‬‬ ‫ﻴ‬
‫ﻧ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫‪-‬ﺣ‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬
‫‪٪‬ﻣﺴ‬ ‫ﺔ<‪10‬‬ ‫ﺜ‬
‫ﻟ‬‫ﺎ‬
‫ﺜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻊﺣ‬‫ﻴ‬‫ﻤ‬‫‪-‬ﺟ‬
‫ﺎﺻﻞ‬‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﻥﻭ‬‫ﻌﺠ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦﻭ‬‫ﺪ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬
‫ﻪﻭ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻧ‬‫ﺫ‬
‫ﺍﻷ‬‫ﻴﻦﻭ‬‫ﻨ‬‫ﻴ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻞ‬‫ﺘﻲﺗﺸ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫‪-‬ﺟ‬
‫ﻴﻦ‬
‫ﺮﺿ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻤ‬ ‫ﺔﻭﺟ‬‫ﻨ‬‫ﻣ‬
‫ﺍ‬‫ﺰ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻣ‬
‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬
‫ﺃ‬ ‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﺑ‬‫ﺮ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺍﻹﺻ‬
‫ﺎﻕﻭ‬ ‫ﻨﺸ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﻊﺇﺻ‬‫ﻴ‬‫ﻤ‬‫ﺟ‬
‫ﺮ‬‫ﻠﺨﻄ‬‫ﻟ‬

‫‪Var‬‬‫‪i‬‬‫‪ousmet‬‬ ‫‪hodsar‬‬‫‪eusedt‬‬‫‪oest‬‬‫‪i‬‬‫‪mat‬‬‫‪et‬‬‫‪heTBSAaf‬‬ ‫‪f‬‬‫‪ect‬‬

‫‪edbybur‬‬ ‫;‪ns‬‬‫‪among‬‬
‫‪t‬‬‫‪hem ar‬‬‫‪e:‬‬
‫‪1-‬‬‫‪Rul‬‬‫‪eofni‬‬‫‪ne:‬‬
‫‪Acommonmet‬‬ ‫‪hodf‬‬‫‪ordet‬‬‫‪er‬‬‫‪mi‬‬
‫‪ni‬‬‫‪ngt‬‬‫‪heex‬‬‫‪t‬‬‫‪entoft‬‬‫‪hei‬‬‫‪nj‬‬
‫‪ur‬‬‫‪yi‬‬
‫‪st‬‬‫‪her‬‬‫‪ul‬‬‫‪eofni‬‬
‫‪ne‬‬
‫‪met‬‬‫‪hods.Thi‬‬ ‫‪smet‬‬‫‪hoddi‬‬‫‪v‬‬‫‪i‬‬
‫‪dest‬‬‫‪hebodyi‬‬‫‪nt‬‬‫‪osegment‬‬ ‫‪swhosear‬‬‫‪easar‬‬‫‪e9%of‬‬
‫‪TBSA,‬‬ ‫‪wi‬‬‫‪t‬‬
‫‪hper‬‬ ‫‪i‬‬
‫‪neum count‬‬
‫(‪edas1%‬‬ ‫‪Seef‬‬
‫‪i‬‬‫‪g.‬‬‫)‪42‬‬

‫‪:‬‬
‫ﺀ‬‫ﻫﻻ‬
‫ﻴﻦ ﺆ‬
‫؛ﻣﻦﺑ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬
‫ﺓﺑ‬‫ﺮ‬‫ﺛ‬‫ﺄ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬
‫ﺮﻣﺴ‬ ‫ﻳ‬
‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺔ‬‫ﻔ‬‫ﻠ‬
‫ﺘ‬‫ﺮﻕﻣﺨ‬‫ﻡﻃ‬ ‫ﺪ‬
‫ﺘﺨ‬‫ﺗﺴ‬
‫‪:‬‬
‫ﺔ‬‫ﻌ‬‫ﻜﻢﺗﺴ‬‫‪-‬ﺣ‬‫‪1‬‬
‫ﻜﻞ‬
‫ﺀﺗﺸ‬
‫ﺍ‬‫ﺰ‬‫ﺃﺟ‬
‫ﻟﻰ‬‫ﻟﺠﺴﻢﺇ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬
‫ﻘﺴﻢﻫ‬ ‫‪.‬ﺗ‬‫ﺮﻕ‬‫ﺔﻃ‬ ‫ﻌ‬
‫ﺓﺗﺴ‬‫ﺪ‬‫ﺎﻋ‬
‫ﺔﻫﻲﻗ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪﻯ‬
‫ﺪﻣ‬ ‫ﻳ‬
‫ﺪ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺔ‬‫ﻌ‬‫ﺋ‬‫ﺎ‬
‫ﺔﺷ‬ ‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻃ‬
‫(‬
‫ﻜﻞ‪42‬‬‫ﻟﺸ‬‫ﺍ‬‫ﺮ‬
‫ﻧﻈ‬‫ﺍ‬
‫‪)٪‬‬‫ﺔ‪1‬‬‫ﺒ‬‫ﻨﺴ‬‫ﺎﻥﺑ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺏ‬‫ﺘﺴ‬
‫ﺍﺣ‬ ‫ﻊ‬
‫‪،‬ﻣ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬
‫‪٪‬ﻣﻦﻣﺴ‬ ‫ﺎ‪9‬‬‫ﻬ‬
‫ﻘ‬‫ﺎﻃ‬‫ﻨ‬
‫ﻣ‬

‫‪222‬‬
 (
Fig.42)Rul
eofni
ne

2-LundandBr owderMethod:
LundandBr owdermethods,i
trequi
restabl
eswitharel
ati
veanatomicscal
eor
di
agram thatesti
matestot
alburnedareabyagesandbysmalleranat
omic
areasofthebody.

:
‫ﺭ‬‫ﺩ‬‫ﻭ‬‫ﺍ‬
‫ﺮ‬‫ﺑ‬
‫ﺪﻭ‬‫ﻧ‬‫ﻮ‬‫ﻟ‬‫ﺔ‬‫ﻘ‬
‫ﻳ‬‫ﺮ‬‫ﻃ‬-2
‫ﺔ‬
‫ﻗ‬‫ﺮ‬‫ﺘ‬
‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺎﺣ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻳ‬
‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﻧﻲ‬
‫ﺎ‬‫ﻴ‬
‫ﻭﻣﺨﻄﻂﺑ‬‫ﺃ‬‫ﺒﻲ‬
‫ﻳﺤﻲﻧﺴ‬‫ﺮ‬
‫ﺎﺱﺗﺸ‬‫ﻴ‬
‫ﻘ‬‫ﻤ‬‫ﻭﻝﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺭﺟ‬‫ﺩ‬‫ﻭ‬‫ﺍ‬
‫ﺮ‬‫ﺑ‬
‫ﺪﻭ‬ ‫ﻧ‬
‫ﻮ‬‫ﻟ‬‫ﺎ‬
‫ﺘ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻠﺐﻃ‬ ‫ﺘﻄ‬
‫ﺗ‬
.‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺮﻣﻦ‬
‫ﻐ‬‫ﺍﻷﺻ‬‫ﺔ‬
‫ﻴ‬‫ﻳﺤ‬
‫ﺮ‬‫ﺘﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻃﻖ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺭﻭ‬‫ﺎ‬
‫ﻤ‬‫ﺍﻷﻋ‬‫ﺔﺣﺴﺐ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﻹﻤ‬
‫ﺍﺟ‬

223
3º 2º Adul
t 15 10-
14y
rs 5-9 1-4 1sty
r Ar
ea
yr
s yr
s yr
s
7 9 11 13 17 19 Head
2 2 2 2 2 2 Neck
13 13 13 13 13 13 Ant.t runk
13 13 13 13 13 13 Post .Tr unk
2.
5 2.
5 2.
5 2.
5 2.
5 2.
5 Rt.but tock
2.
5 2.
5 2.
5 2.
5 2.
5 2.
5 Lt
.but tock
1 1 1 1 1 1 Genit all
ia
4 4 4 4 4 4 Rt.U.ar m
4 4 4 4 4 4 Lt
.U.ar m
3 3 3 3 3 3 Rt.L.ar m
3 3 3 3 3 3 Lt
.L.ar m
2.
5 2.
5 2.
5 2.
5 2.
5 2.
5 Rt.hand
2.
5 2.
5 2.
5 2.
5 2.
5 2.
5 Lt
.hand
9.
5 9 6.
5 8 6.
5 5.
5 Rt.thigh
9.
5 9 6.
5 8 6.
5 5.
5 Lt
.thi gh
7 6.
5 6 5.
5 5 5 Rt.l
eg
7 6.
5 6 5.
5 5 5 Lt
.leg
3.
5 3.
5 3.
5 3.
5 3.
5 3.
5 Rt.foot
3.
5 3.
5 3.
5 3.
5 3.
5 3.
5 Lt
.f oot
Tot
al

LundandBr
owderMet
hod

3-Pal
m Met hod.
Thepati
ent'
shandr epresents1%oft hepat
ient
'sTBSAandmaybeusedt o
est
imateir
regular
lyshapedorwi del
ydist
ri
butedburnwounds.
.
‫ﻴﻞ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫ﻃ‬-3
‫ﺮ‬‫ﻴ‬
‫ﻭﻕﻏ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻭﺡ‬‫ﺮ‬‫ﺮﺟ‬‫ﻳ‬‫ﺪ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺎ‬‫ﻬ‬‫ﻣ‬
‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬
‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬‫ﻳ ﺾﻭ‬
‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﻦﻣﺴ‬٪
1‫ﻳ ﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﺜﻞﻳ‬
‫ﻤ‬‫ﺗ‬
.‫ﻊ‬‫ﺍﺳ‬
‫ﺎﻕﻭ‬‫ﻠﻰﻧﻄ‬
‫ﺓﻋ‬‫ﺮ‬
‫ﺘﺸ‬‫ﻨ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬
‫ﻤ‬‫ﺘﻈ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬

Burncat egor iesandbur nunitr eferr

alcri
teri
a
-Minor-treatasoutpat i
ent
-Moder ate- hospit
alizat
ionr equired
-Part
ialthi cknessgr eaterthan10%BSA.
-Burnoft heey es,face,head, feet,hands,andper
ineum ar
erarel
yconsi
der
edt
o
bemi norormoder atebur ns,regar dl
essoftheest
imatedpercent
age.

224
‫‪-Bur‬‬
‫‪nsoft‬‬‫‪hehead,‬‬‫‪neck,‬‬‫‪andchestf‬‬‫‪r‬‬
‫‪equent‬‬
‫‪l‬‬‫‪yhav‬‬‫‪eassoci‬‬‫‪at‬‬
‫‪edpul‬‬‫‪monar‬‬
‫‪y‬‬
‫‪compl‬‬‫‪i‬‬
‫‪cat‬‬‫‪i‬‬
‫‪on.‬‬
‫‪-Anypat‬‬‫‪i‬‬
‫‪entwi‬‬‫‪t‬‬
‫‪hbur‬‬‫‪nandt‬‬ ‫‪r‬‬
‫‪auma.‬‬
‫‪-Bur‬‬
‫‪nsr‬‬‫‪equi‬‬‫‪r‬‬
‫‪i‬‬‫‪ngsoci‬‬
‫‪al‬‬‫‪,‬‬
‫‪emot‬‬ ‫‪i‬‬
‫‪onal‬‬‫‪orex‬‬‫‪t‬‬
‫‪ensi‬‬
‫‪v‬‬‫‪er‬‬‫‪ehabi‬‬
‫‪l‬‬‫‪i‬‬
‫‪t‬‬‫‪at‬‬
‫‪i‬‬‫‪oni‬‬‫‪nt‬‬
‫‪er‬‬‫‪v‬‬
‫‪ent‬‬‫‪i‬‬
‫‪on‬‬

‫ﺓ‬‫ﺪ‬‫ﻮﺣ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻟ‬‫ﺎ‬
‫ﺮﺇﺣ‬ ‫ﻴ‬
‫ﻳ‬‫ﺎ‬‫ﻌ‬‫ﺮﻕﻣ‬ ‫ﺎﺕﻭﺣ‬ ‫ﺌ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﺣ‬
‫ﺭﺟﻲ‬‫ﺎ‬‫ﻳ ﺾﺧ‬ ‫ﺮ‬‫ﻤ‬
‫ﻴﻂﻛ‬ ‫‪-‬ﻋﻼﺝﺑﺴ‬
‫ﺔ‬‫ﺑ‬
‫ﻮ‬‫ﻠ‬‫ﻤﻄ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻰ‬ ‫ﺘﺸ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻓﻲ‬ ‫ﻟ‬‫ﺪ‬‫ﺘ‬
‫ﻌ‬‫‪-‬ﻣ‬
‫‪.‬‬
‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫‪٪‬ﻣﻦﻣﺴ‬ ‫ﺮﻣﻦ‪10‬‬ ‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬
‫ﺋ‬‫ﺰ‬‫ﺔﺟ‬ ‫ﻛ‬‫ﺎ‬
‫ﻤ‬‫‪-‬ﺳ‬
‫‪،‬‬
‫ﺔ‬‫ﻮﺳﻄ‬
‫ﺘ‬‫ﻭﻣ‬
‫ﺃ‬‫ﺔ‬‫ﻔ‬
‫ﻴ‬‫ﻔ‬‫ﺎﻃ‬
‫ً‬
‫ﻗ‬‫ﻭ‬‫ﺮ‬
‫ﺎﻥﺣ‬ ‫ﻌﺠ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦﻭ‬‫ﺪ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬‫ﻣ‬‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬
‫ﺃﺱﻭ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻪﻭ‬‫ﻮﺟ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻦﻭ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﺮﺣ‬ ‫ﺒ‬
‫ﺘ‬‫ﻌ‬‫ﺎﺗ‬‫ﺍﻣ‬‫ً‬
‫ﺭ‬
‫ﺩ‬‫ﺎ‬‫‪-‬ﻧ‬
‫‪.‬‬‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬‫ﺮﻋﻦ‬‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬‫ﻐﺾ‬ ‫ﺑ‬
‫‪.‬‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬
‫ﺋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﺭﻣ‬
‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬‫ﻓﻖﺑﺸ‬ ‫ﺍ‬
‫ﺮ‬‫ﺘ‬
‫ﺭﺗ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔﻭ‬ ‫ﺒ‬
‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬
‫ﺃﺱﻭ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫‪-‬ﺣ‬
‫‪.‬‬‫ﺔ‬
‫ﻣ‬‫ﺪ‬‫ﻭﻕﻭﺻ‬ ‫ﺮ‬‫ﺎﺏﺑﺤ‬ ‫ﻳ ﺾﻣﺼ‬ ‫ﺮ‬‫ﺃﻱﻣ‬ ‫‪-‬‬
‫ﺜﻒ‬‫ﻜ‬‫ﻴﻞﻣ‬‫ﺄﻫ‬
‫ﺓﺗ‬‫ﺩ‬‫ﺎ‬
‫ﻭﺇﻋ‬‫ﺃ‬‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﻔ‬‫ﺎﻃ‬
‫ﻭﻋ‬ ‫ﺃ‬‫ﺎ‬
‫ً‬
‫ﻴ‬‫ﻋ‬‫ﺎ‬‫ﻤ‬
‫ﺘ‬‫ﺍﺟ‬‫ﺎ‬‫ً‬
‫ﻠ‬
‫ﺪﺧ‬ ‫ﻠﺐﺗ‬ ‫ﺘﻄ‬‫ﺘﻲﺗ‬‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫‪-‬‬

‫‪Associ‬‬‫‪at‬‬‫‪edI‬‬‫‪nj‬‬‫‪ur‬‬‫‪i‬‬‫‪es:‬‬
‫‪-Smokei‬‬ ‫‪nhal‬‬‫‪at‬‬‫‪i‬‬
‫‪on.‬‬
‫‪-Hoar‬‬‫‪seness,‬‬ ‫‪cough,‬‬‫‪si‬‬‫‪ngednasal‬‬
‫‪hai‬‬
‫‪r‬‬‫‪s,‬‬
‫‪or‬‬‫‪al‬‬
‫‪bur‬‬
‫‪ns,‬‬
‫‪wheezi‬‬
‫‪ng.‬‬
‫‪-Car‬‬‫‪bonmonoxi‬‬ ‫‪depoi‬‬‫‪soni‬‬‫‪ng.‬‬
‫‪-Fr‬‬
‫‪act‬‬‫‪ur‬‬‫‪esandTr‬‬ ‫‪auma‬‬

‫‪:‬‬‫ﺔ‬‫ﺒ‬
‫ﺎﺣ‬‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬
‫‪.‬‬
‫ﺎﻥ‬‫ﺪﺧ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻕ‬‫ﻨﺸ‬
‫ﺘ‬‫ﺍﺳ‬‫‪-‬‬
‫‪.‬‬
‫ﻔﺲ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﺮﻋ‬‫ﻴ‬
‫ﻔ‬‫‪،‬ﺻ‬
‫ﻔﻢ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻕﻓﻲ‬
‫ﺮ‬‫‪،‬ﺣ‬
‫ﻧﻒ‬‫ﺍﻷ‬
‫ﺮ‬‫ﻌ‬‫ﺯﻓﻲﺷ‬
‫ﺮ‬‫ﺎ‪،‬ﻏ‬
‫ﻌﻝ‬‫‪،‬ﺳ‬ ‫ﻮﺕ‬‫ﻟﺼ‬‫ﺍ‬‫ﺔﻓﻲ‬‫‪-‬ﺑﺤ‬
‫‪.‬‬‫ﻮﻥ‬
‫ﺑ‬‫ﺮ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻴ‬‫ﻛﺴ‬‫ﺃ‬‫ﻭﻝ‬‫ﺄ‬
‫ﻤﻢﺑ‬‫ﺘﺴ‬‫ﻟ‬
‫ﺍ‬‫‪-‬‬
‫ﺎﺕ‬‫ﻣ‬‫ﺪ‬
‫ﺭﻭﺻ‬ ‫ﻮ‬‫‪-‬ﻛﺴ‬

‫‪225‬‬
 Uni
t2:
Managementofpat
ientwi
thbur
n
LearningObj ect i
ves:
Oncompl etionoft hi
schapt er
,thel ear
nerwi l
lbeableto:
1.Descr i
bet het hreephasesofbur ncareandt hepri
orit
iesofcar ef oreach
phase.
2.Compar eandcont rastthepotent i
alfl
uidandelectr
olytealt
erati
onsoft he
emer gent/resuscitati
veandacut ephasesofbur nmanagement ..
3.Per f
ormf i
rstaidofbur ns.
4.Descr i
bet hemanagementoft hepatientswithaburnI nj
uryduring:
-Emer gencyphase.
-Acut ephase.
-Rehabi l
i
tationphase.
5.Uset henur singpr ocessasaf ramewor kforcar
eoft hepatientdur i
ngt he
emer gent,orr esuscit
ativephase, theacutephase,andt herehabil
itati
onphase
ofbur ncare.

‫ﻭﻕ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺎ‬
‫ﺎﺏﺑ‬
‫ﻤﺼ‬‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬:
2‫ﺓ‬‫ﺪ‬
‫ﻮﺣ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻠﻢ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬ ‫ﺃﻫ‬
:
‫ﻠﻰ‬‫ﺍﻋ‬
ً
‫ﺭ‬‫ﺩ‬‫ﺎ‬
‫ﻠﻢﻗ‬‫ﻌ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﻴ‬‫ﺳ‬، ‫ﻔﺼﻞ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍ‬‫ﺬ‬‫ﺀﻣﻦﻫ‬ ‫ﺎ‬‫ﻬ‬‫ﺘ‬‫ﻧ‬
‫ﺍﻻ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬
.
‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻜﻞﻣ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﻳ‬‫ﻮ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﻭﻕﻭ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺜﻼﺙ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻭﺻﻒ‬. 1
‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺩ‬
‫ﺓﻹ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﺎﺷ‬
‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬/‫ﺔ‬‫ﺌ‬
‫ﺎﺷ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺣﻞ‬‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺭﻝ‬‫ﺎ‬‫ﻬ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔﻓﻲ‬‫ﻠ‬‫ﻤ‬
‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﺭﻥﺑ‬‫ﺎ‬
‫ﻗ‬ ‫ﺭﻥﻭ‬‫ﺎ‬‫ﻗ‬.2
.
.‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﻭﻕ‬‫ﺮ‬‫ﻠﺤ‬
‫ﻟ‬ ‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬ ‫ﻓ‬‫ﺎ‬
‫ﻌ‬‫ﺍﻹﺳ‬ ‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬.3
:
‫ﻭﻕﺧﻼﻝ‬ ‫ﺮ‬‫ﻴﻦﺑﺤ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺻﻒﺇ‬ِ. 4
.‫ﺭﺉ‬‫ﺍ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬-
.‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﺔﺣ‬ ‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬-
.
‫ﻴﻞ‬‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬-
،‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﻭ‬،‫ﺎﺵ‬‫ﻌ‬‫ﻧ‬
‫ﺃﺍﻹ‬
‫ﺭﺉﻭ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬‫ﻟﻄ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻨ‬‫ﺛ‬
‫ﺃ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺭ‬
‫ﺎ‬‫ﺈﻃ‬‫ﺔﻛ‬‫ﻴ‬
‫ﻳﻀ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬
‫ﺪ‬ ‫ﺘﺨ‬‫ﺍﺳ‬.5
.
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬ ‫ﻴﻞ‬‫ﺄﻫ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﺔﺇﻋ‬‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬ ‫ﻭ‬

Managementofpat ientwi t
hbur n
Burncar eistypi
callycat egorizedi ntothreephasesofcar e:
emer gent/r
esuscitati
v ephase, acute/i
nt ermediatephase, andr ehabil
itati
on
phase.Al t
houghpr iori
tiesexi stforeachoft hephases, thephasesov erl
ap,
assessment ,andmanagementofspeci ficproblemsandcompl icati
onsar enot
l
imitedtot hesephasesbutt akepl acet hroughoutbur ncar e.
‫ﻭﻕ‬‫ﺮ‬ ‫ﻟﺤ‬‫ﺎ‬
‫ﺎﺏﺑ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻭ‬،‫ﺔ‬‫ﻴ‬‫ﺎﺷ‬‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬ /‫ﺔ‬ ‫ﺋ‬
‫ﺭ‬‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬
‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬:
‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﺍﺣﻞﻣﻦ‬‫ﺮ‬‫ﻟﻰﺛﻼﺙﻣ‬ ‫ﺓﺇ‬
ً ‫ﺩ‬‫ﺎ‬
‫ﻭﻕﻋ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻒ‬‫ﺗﺼ‬ُ
‫ﺇﻻ‬،
‫ﺍﺣﻞ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬‫ﻠ‬‫ﺮﺣ‬‫ﻜﻞﻣ‬ ‫ﻟ‬‫ﺎﺕ‬ ‫ﻳ‬
‫ﻮ‬ ‫ﻟ‬
‫ﻭ‬‫ﺃ‬‫ﺩ‬‫ﻮ‬‫ﺮﻏﻢﻣﻦﻭﺟ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻋ‬.‫ﻴﻞ‬‫ﺄﻫ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻋ‬
‫ﺔﺇ‬ ‫ﻠ‬‫ﺮﺣ‬‫ﻣ‬‫ﻭ‬،‫ﺔ‬‫ﻮﺳﻄ‬ ‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬/‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬
‫ﺎ‬‫ﻬ‬‫ﻨ‬
‫ﻜ‬‫ﻟ‬
‫ﺍﺣﻞﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻠﻰﻫ‬ ‫ﺮﻋ‬ ‫ﺘﺼ‬‫ﻘ‬‫ﺓﻻﺗ‬ ‫ﺩ‬‫ﺪ‬‫ﺎﺕﻣﺤ‬ ‫ﻔ‬‫ﺎﻋ‬‫ﻣﻀ‬‫ﻛﻞﻭ‬ ‫ﺎ‬‫ﺓﻣﺸ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫ﻴﻢﻭ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬‫ﻭ‬،‫ﺍﺧﻞ‬‫ﺪ‬‫ﺘ‬‫ﺍﺣﻞﺗ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺃﻥ‬
.‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬
‫ﺎ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺮ‬
‫ﺘ‬‫ﺍﻝﻓ‬‫ﻮ‬‫ﺪﺙﻃ‬ ‫ﺗﺤ‬

226
PHASESOFBURNCARE:
Pr i
or itiesofcar e Dur ati
on Phase
•Firstai d From onsetofi nj
ury Emergent
•Pr ev ent i
onof tocompl eti
onof /r
esusci
tat
ive
shock fl
uidr esuscit
at i
on
•Pr ev ent i
onof
respi rat orydistress
•Det ect i
onand
treat mentof
concomi tant
i
nj ur i
es
•Wound
assessmentand
i
ni tial car
•Woundcar eand From begi nningof Acut
e/
closur e diuresistonear i
nter
medi
ate
•Pr ev ent i
onor compl etionof
treat mentof woundcl osure
compl ications,
i
ncl udi ngi nf
ect i
on
•Nut ritionalsuppor t
•Pr ev ent i
onofscar s Fr om maj orwound Rehabi
l
itat
ion
andcont ractures closuretor eturnto
•Phy sical , i
ndi vi
dual ’
sopt i
mal
occupat ional,and l
ev elofphy sicaland
vocat ional psy chosocial
rehabi lit
ation adjustment
•Funct ional and
cosmet i
c
reconst ructi
on
•Psy chosoci al
counsel ing

227
 A.EMERGENT/
RESUSCI
TATI
VEPHASE

Istheti
mer equir
edtor esolv
et hei
mmediate,l
if
e-t
hreateni
ngprobl
ems
resul
ti
ngf r
om theburni nj
ury.Thi
sphaseusuall
ylastsupto72hoursfrom t
he
ti
met heburnoccurred.Thepr imar
yconcernsaretheonsetofhypovol
emic
shockandedemaf ormat i
on.Theemergentphaseendswhenf lui
dmobi l
i
zat
ion
anddiuresi
sbegin.

Fi
rstaidofbur n:
1.Fir
stAi dforMi norBurns:Iftheskinisnotbr oken(
Fir
st-
Degree)
:
-Runcool waterov ert
hebur nedar eaorsoaki ti
nacoolwaterbath(notice
water).
-Keept hear eainthebathforf iv
emi nutes.
-I
fthebur noccur redinacol denv i
ronment ,donotappl
ywater.Aclean,col
d,
wettowel willalsohelpreducepai n.
-Reassur ethepat i
entandkeept hem calm.
-Covert heburnwi thasteri
lenon- adhesivebandage
-Protectthebur nfrom fr
ict
ionandpr essure.

‫ﺔ‬‫ﻴ‬‫ﺎﺷ‬‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬/‫ﺔ‬ ‫ﺋ‬‫ﺭ‬‫ﺎ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬.
‫ﺃ‬
‫ﻩ‬‫ﺬ‬‫ﺮﻫ‬‫ﻤ‬‫ﺘ‬
‫ﺗﺴ‬.‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺎ‬‫ﺔﺑ‬‫ﺑ‬
‫ﺎ‬‫ﻋﺍﻹﺻ‬
‫ﺔﻦ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻠﺤ‬‫ﻟ‬‫ﺓ‬
‫ﺩ‬‫ﺪ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻳ‬‫ﺭ‬‫ﻮ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﻟﺤﻞ‬‫ﻮﺏ‬ ‫ﻠ‬‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻮ‬‫ﻫ‬
‫ﻘ ﺺﺣﺠﻢ‬‫ﺔﻧ‬‫ﻣ‬‫ﺪ‬‫ﺭﺻ‬ ‫ﻮ‬‫ﻬ‬‫ﺔﻫﻲﻇ‬ ‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﻭﻑ‬ ‫ﺎ‬
‫ﻤﺨ‬‫ﻟ‬‫ﺍ‬.
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭﺙ‬‫ﺪ‬‫ﻗﺖﺣ‬ ‫ﺔﻣﻦﻭ‬ ‫ﺎﻋ‬‫ﺳ‬72‫ﺘﻰ‬ ‫ﺓﺣ‬ ‫ﺩ‬‫ﺎ‬
‫ﺔﻋ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺭ‬‫ﺩ‬‫ﺇ‬
‫ﺋﻞﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬
‫ﺌ‬‫ﺒ‬‫ﻌ‬
‫ﺃﺗ‬‫ﺪ‬‫ﺒ‬
‫ﺎﺗ‬‫ﻣ‬‫ﺪ‬
‫ﻨ‬‫ﺔﻋ‬‫ﺌ‬‫ﺎﺷ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻬﻲ‬‫ﺘ‬‫ﻨ‬‫ﺗ‬.
‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻳﻦ‬‫ﻮ‬‫ﻜ‬‫ﺗ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬
:‫ﺮﻕ‬‫ﻠﺤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻭ‬ ‫ﺍﻷ‬‫ﺎﺕ‬‫ﻓ‬‫ﺎ‬
‫ﻌ‬‫ﺍﻹﺳ‬
:
(‫ﻟﻰ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺭﺟ‬‫ﺩ‬
)‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻘﻖ‬‫ﺘﺸ‬‫ﻟﻢﻳ‬‫ﺍ‬‫ﺫ‬‫ﺇ‬:‫ﺔ‬
‫ﻔ‬‫ﻴ‬‫ﻔ‬‫ﻟﻄ‬‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﻠﺤ‬‫ﻟ‬‫ﺔ‬
‫ﻴ‬‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬ ‫ﺎﺕ‬‫ﻓ‬‫ﺎ‬
‫ﻌ‬‫ﺍﻹﺳ‬.1
.
(‫ﻠﺞ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺲ‬‫ﻟ‬
‫ﻭ‬)‫ﺩ‬‫ﺭ‬‫ﺎ‬‫ﺋﻲﺑ‬‫ﺎ‬
‫ﻡﻣ‬‫ﺎ‬‫ﻤ‬‫ﺎﻓﻲﺣ‬‫ﻬ‬‫ﻌ‬‫ﻘ‬‫ﻧ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻗ‬‫ﻭ‬‫ﺮ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﺩﻋ‬ ‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ ﺻﺐ‬-
.‫ﺋﻖ‬‫ﺎ‬
‫ﻗ‬‫ﻤﺲﺩ‬ ‫ﺓﺧ‬ ‫ﺪ‬‫ﻤ‬‫ﻟ‬‫ﻡ‬‫ﺎ‬‫ﻤ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺮﻙ‬‫ﺗ‬
‫ﺍ‬-
‫ﺎ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺔ‬
‫ﻠ‬‫ﻠ‬
‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻭ‬‫ﺩ‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻭ‬‫ﻔ‬‫ﻴ‬
‫ﻨﻈ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻔ‬‫ﻨﺸ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬‫ﺎﻋ‬‫ﺘﺴ‬‫ﺳ‬.‫ﺀ‬‫ﺎ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﻓﻼﺗﺴ‬، ‫ﺓ‬‫ﺩ‬‫ﺭ‬‫ﺎ‬
‫ﺔﺑ‬ ‫ﺌ‬
‫ﻴ‬‫ﺮﻕﻓﻲﺑ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺪﺙ‬‫ﺍﺣ‬ ‫ﺫ‬
‫ﺇ‬-
.‫ﻟﻢ‬‫ﺍﻷ‬ ‫ﻴﻒ‬‫ﻔ‬‫ﻠﻰﺗﺨ‬‫ﻋ‬
.‫ﻪ‬‫ﺋ‬
‫ﻭ‬ ‫ﺪ‬‫ﻠﻰﻫ‬ ‫ﻓﻆﻋ‬ ‫ﺎ‬
‫ﻳ ﺾﻭﺣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺄﻥ‬‫ﻤ‬‫ﻃ‬-
‫ﺔ‬
‫ﻘ‬ ‫ﺮﻻﺻ‬ ‫ﻴ‬‫ﺔﻏ‬‫ﻤ‬‫ﻘ‬‫ﻌ‬‫ﺓﻣ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﺮﻕﺑﻀ‬ ‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻐﻄ‬‫ﺗ‬-
.‫ﻐﻂ‬‫ﻟﻀ‬ ‫ﺍ‬
‫ﺎﻙﻭ‬ ‫ﻜ‬‫ﺘ‬‫ﻣﺍﻻﺣ‬
‫ﺮﻕ ﻦ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﺣ‬-

2-FirstAidforSevereBur ns:(
Second&Thi rd-Degree):
-Donotr emoveburnclothing(unlessitcomesof feasi
ly)
,butdoensurethat
thepat i
entisnotincontactwithbur ni
ngorsmol deri
ngmat eri
als.
-Makesur ethepati
entairwayopen.
-Cov ertheburnwithacool moistster
il
ebandageorcl eancloth.Donotusea
blanketortowel;asheetisbestf orlar
gebur ns.
-Donotappl yanyointment sandav oidbreakingbli
ster
s.

228
 ‫‪:‬‬‫(‬
‫ﺔ‬ ‫ﺜ‬
‫ﻟ‬‫ﺎ‬
‫ﻭﺜ‬
‫ﻟ‬‫ﺔﺍ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﺜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺭﺟ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬
‫ﺓ)‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬ ‫ﻭﻕ‬ ‫ﺮ‬‫ﻠﺤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺎﺕ‬‫ﻓ‬‫ﺎ‬
‫ﻌ‬‫ﺍﻹﺳ‬‫‪-‬‬‫‪2‬‬
‫ﺩ‬‫ﺍ‬
‫ﻮ‬ ‫ﻤ‬
‫ﻠ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻣﺴ‬‫ﻡﻣﻼ‬ ‫ﺪ‬
‫ﺪﻣﻦﻋ‬ ‫ﻛ‬‫ﺄ‬‫ﻜﻦﺗ‬‫ﻟ‬‫‪،‬ﻭ‬ ‫(‬
‫ﺔ‬‫ﻟ‬‫ﻮ‬‫ﻬ‬‫ﺎﺑﺴ‬ ‫ﻬ‬‫ﻌ‬‫ﻠ‬
‫ﺍﺗﻢﺧ‬ ‫ﺫ‬‫ﺇﻻﺇ‬‫ﺔ)‬‫ﻗ‬ ‫ﺮ‬
‫ﺘ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺑﺲ‬‫ﻤﻼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺈ‬‫ﻘﻢﺑ‬‫‪-‬ﻻﺗ‬
‫‪.‬‬
‫ﺔ‬‫ﻠ‬‫ﻌ‬
‫ﺘ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻗ‬
‫ﺮ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬‫ﺘﺢﻣﺠ‬ ‫ﺪﻣﻦﻓ‬ ‫ﻛ‬‫ﺄ‬
‫‪-‬ﺗ‬
‫ﺔ‬‫ﻔ‬‫ﻨﺸ‬‫ﻭﻣ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻡﺑﻄ‬‫ﺪ‬‫ﺘﺨ‬‫‪.‬ﻻﺗﺴ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬‫ﺎﺵﻧﻈ‬ ‫ﻤ‬‫ﺔﻗ‬ ‫ﻌ‬‫ﻘﻄ‬‫ﻭﺑ‬ ‫ﺃ‬‫ﺔ‬‫ﺒ‬‫ﻭﺭﻃ‬ ‫ﺃ‬‫ﺓ‬‫ﺩ‬
‫ﺭ‬ ‫ﺎ‬
‫ﺔﺑ‬‫ﻤ‬‫ﻘ‬‫ﻌ‬‫ﺓﻣ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﺮﻕﺑﻀ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻐﻄ‬‫ﺘ‬‫‪-‬ﻗﻢﺑ‬
‫‪.‬‬‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﻠﺤ‬‫ﻟ‬‫ﻓﻀﻞ‬ ‫ﺍﻷ‬‫ﺔﻫﻲ‬ ‫ﻗ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫؛‬
‫‪.‬‬‫ﺭ‬‫ﻮ‬‫ﺜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴ‬ ‫ﻨﺐﺗ‬ ‫ﺗﺠ‬‫ﺍﻫﻢﻭ‬‫ﺮ‬‫ﺃﻱﻣ‬‫ﻊ‬‫‪-‬ﻻﺗﻀ‬
‫‪.‬‬‫ﺔ‬‫ﻘ‬‫ﺮﻻﺻ‬ ‫ﻴ‬
‫ﺔﻭﻏ‬ ‫ﻤ‬‫ﻘ‬‫ﻌ‬
‫ﻣ‬‫ﺔﻭ‬ ‫ﻓ‬‫ﺎ‬‫ﺍﺕﺟ‬ ‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﺎﺑﻀ‬‫ﻬ‬‫ﻨ‬‫ﻴ‬‫ﻓﺼﻞﺑ‬ ‫ﺎ‬‫‪،‬ﻓ‬‫ﻴﻦ‬‫ﻣ‬ ‫ﺪ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻳﻦ‬‫ﺪ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﺑ‬‫ﺎ‬
‫ﺃﺻ‬ ‫ﺮﻕ‬‫ﺍﺗﻢﺣ‬ ‫ﺫ‬
‫‪-‬ﺇ‬
‫‪-I‬‬‫‪ff‬‬‫‪i‬‬
‫‪nger‬‬‫‪sort‬‬ ‫‪oeshav‬‬ ‫‪ebeenbur‬‬ ‫‪ned,‬‬‫‪separ‬‬ ‫‪at‬‬‫‪et‬‬‫‪hem wi‬‬ ‫‪t‬‬‫‪hdr‬‬ ‫‪yst‬‬‫‪er‬‬‫‪i‬‬‫‪l‬‬
‫‪e,‬‬‫‪non-‬‬
‫‪adhesi‬‬‫‪v‬‬‫‪edr‬‬ ‫‪essi‬‬
‫‪ngs.‬‬
‫‪-El‬‬‫‪ev‬‬‫‪at‬‬‫‪et‬‬‫‪hebur‬‬ ‫‪nedar‬‬‫‪eaandpr‬‬ ‫‪ot‬‬‫‪ecti‬‬‫‪tf‬‬ ‫‪r‬‬
‫‪om pr‬‬ ‫‪essur‬‬ ‫‪eorf‬‬ ‫‪r‬‬
‫‪i‬‬‫‪ct‬‬‫‪i‬‬‫‪on.‬‬
‫‪-Takest‬‬ ‫‪epst‬‬ ‫‪opr‬‬‫‪ev‬‬‫‪entshock.Layt‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪ent‬‬‫‪sf‬‬ ‫‪l‬‬
‫‪atel‬‬ ‫‪ev‬‬‫‪at‬‬‫‪et‬‬ ‫‪hef‬‬ ‫‪eetabout12‬‬
‫‪i‬‬
‫‪nches,‬‬ ‫‪andcov‬‬ ‫‪ert‬‬‫‪hepat‬‬ ‫‪i‬‬‫‪entwi‬‬ ‫‪t‬‬
‫‪hacoatorbl‬‬ ‫‪anket‬‬‫‪.Donotpl‬‬ ‫‪acet‬‬‫‪hepat‬‬ ‫‪i‬‬
‫‪enti‬‬‫‪n‬‬
‫‪t‬‬‫‪heshockposi‬‬ ‫‪t‬‬
‫‪i‬‬‫‪oni‬‬‫‪fahead,‬‬ ‫‪neck,‬‬ ‫‪back,‬‬ ‫‪orl‬‬ ‫‪egi‬‬‫‪nj‬‬‫‪ur‬‬
‫‪yi‬‬ ‫‪ssuspect‬‬ ‫‪edori‬‬ ‫‪fi‬‬‫‪tmakes‬‬
‫‪t‬‬‫‪hepat‬‬‫‪i‬‬‫‪entuncomf‬‬ ‫‪or‬‬‫‪t‬‬‫‪abl‬‬‫‪e.‬‬
‫‪-Cont‬‬ ‫‪i‬‬
‫‪nuet‬‬ ‫‪omoni‬‬ ‫‪t‬‬
‫‪ort‬‬ ‫‪hepat‬‬ ‫‪i‬‬‫‪ent‬‬‫'‬
‫‪sv‬‬ ‫‪i‬‬‫‪t‬‬
‫‪al‬‬ ‫‪si‬‬‫(‪gns‬‬ ‫‪br‬‬‫‪eat‬‬‫‪hi‬‬‫‪ng,‬‬ ‫‪pul‬‬‫‪se,‬‬ ‫‪bl‬‬
‫‪oodpr‬‬ ‫‪essur‬‬‫)‪e‬‬‫‪.‬‬

‫‪.‬‬
‫ﺎﻙ‬‫ﻜ‬‫ﺘ‬‫ﺃﺍﻻﺣ‬‫ﻐﻂﻭ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﺎﻣﻦ‬ ‫ﻬ‬
‫ﺘ‬‫ﻳ‬‫ﺎ‬‫ﻤ‬‫ﺔﻭﺣ‬ ‫ﻗ‬‫ﻭ‬‫ﺮ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻓ‬‫‪-‬ﺭ‬
‫ﻗﻢ‬‫‪،‬ﻭ‬ ‫ﺔ‬‫ﻮﺻ‬ ‫ﻟﻲ‪12‬ﺑ‬ ‫ﺍ‬
‫ﻮ‬‫ﻴﻦﺣ‬ ‫ﻣ‬ ‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻓ‬‫ﺭ‬‫ﺍ‬‫ﻜﻞﻣﺴﻄﺢﻭ‬ ‫ﻳ ﺾﺑﺸ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫‪.‬ﺿ‬ ‫ﺔ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺍﺕ‬‫ﻮ‬‫ﺬﺧﻄ‬ ‫ﺗﺨ‬ ‫ﺍ‬
‫‪-‬‬
‫ﺃﺱ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔﻓﻲ‬ ‫ﺑ‬
‫ﺎ‬‫ﻪﻓﻲﺇﺻ‬ ‫ﺒ‬
‫ﺘ‬‫ﺍﺷ‬‫ﺍ‬‫ﺫ‬‫ﺔﺇ‬ ‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻊ‬ ‫ﻳ ﺾﻓﻲﻭﺿ‬ ‫ﺮ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫‪.‬ﻻﺗﻀ‬ ‫ﺔ‬ ‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻭﺑﻄ‬ ‫ﺃ‬‫ﻌﻄﻒ‬ ‫ﻤ‬‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻐﻄ‬ ‫ﺘ‬
‫ﺑ‬
‫‪.‬‬‫ﺎﺡ‬‫ﺗ‬
‫ﺮ‬‫ﺮﻣ‬‫ﻴ‬ ‫ﻳ ﺾﻏ‬‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻌﻞ‬‫ﻟﻚﻳﺠ‬ ‫ﺎﻥﺫ‬‫ﺍﻛ‬‫ﺫ‬‫ﻭﺇ‬‫ﺃ‬ ‫ﺎﻕ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺮ‬‫ﻬ‬‫ﻟﻈ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬
‫‪.‬‬
‫(‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫‪،‬ﺿ‬ ‫ﺒﺾ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫‪،‬‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻳ ﺾ)‬‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺍﺕ‬‫ﺮ‬‫ﺆﺷ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﺭﻓﻲﻣ‬ ‫ﺍ‬
‫ﺮ‬‫ﻤ‬ ‫ﺘ‬‫ﺍﻻﺳ‬‫‪-‬‬
‫‪Donot‬‬ ‫‪:‬‬
‫‪-Donotappl‬‬ ‫‪yoi‬‬‫‪nt‬‬‫‪ment‬‬ ‫‪,‬‬‫‪but‬‬ ‫‪t‬‬‫‪er‬‬‫‪,‬‬‫‪i‬‬
‫‪ce,‬‬ ‫‪medi‬‬ ‫‪cat‬‬‫‪i‬‬‫‪ons,‬‬ ‫‪f‬‬‫‪l‬‬
‫‪uf‬‬‫‪f‬‬‫‪ycot‬‬ ‫‪t‬‬‫‪ondr‬‬ ‫‪essi‬‬‫‪ng,‬‬‫‪adhesi‬‬ ‫‪v‬‬‫‪e‬‬
‫‪bandages,‬‬ ‫‪cr‬‬‫‪eam,‬‬ ‫‪oi‬‬‫‪l‬‬‫‪spr‬‬‫‪ay‬‬ ‫‪,‬‬‫‪oranyhousehol‬‬ ‫‪dt‬‬ ‫‪oabur‬‬ ‫‪n.Thi‬‬ ‫‪scani‬‬ ‫‪nt‬‬‫‪er‬‬ ‫‪f‬‬
‫‪er‬‬‫‪ewi‬‬ ‫‪t‬‬‫‪h‬‬
‫‪pr‬‬‫‪operheal‬‬‫‪i‬‬‫‪ng.‬‬
‫‪-Donotal‬‬ ‫‪l‬‬‫‪owt‬‬ ‫‪hebur‬‬ ‫‪nt‬‬‫‪obecomecont‬‬ ‫‪ami‬‬ ‫‪nat‬‬ ‫‪ed.Av‬‬ ‫‪oi‬‬‫‪dbr‬‬ ‫‪eat‬‬‫‪hi‬‬‫‪ngorcoughi‬‬ ‫‪ng‬‬
‫‪ont‬‬‫‪hebur‬‬ ‫‪nedar‬‬ ‫‪ea.‬‬
‫‪-Donotdi‬‬ ‫‪st‬‬‫‪ur‬‬‫‪bbl‬‬ ‫‪i‬‬
‫‪st‬‬‫‪er‬‬‫‪sordeadski‬‬ ‫‪n.‬‬
‫‪-Donotappl‬‬ ‫‪ycol‬‬‫‪dcompr‬‬ ‫‪essesanddonoti‬‬ ‫‪mmer‬‬ ‫‪seasev‬‬ ‫‪er‬‬ ‫‪ebur‬‬‫‪ni‬‬ ‫‪ncol‬‬ ‫‪dwat‬‬ ‫‪er‬‬‫‪.‬‬
‫‪Thi‬‬‫‪scancauseshock.‬‬
‫‪-Donotpl‬‬ ‫‪aceapi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪owundert‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪ent‬‬‫'‬‫‪sheadi‬‬ ‫‪ft‬‬‫‪her‬‬‫‪ei‬‬‫‪sanai‬‬ ‫‪r‬‬‫‪waybur‬‬ ‫‪nand‬‬
‫‪t‬‬‫‪heyar‬‬‫‪el‬‬ ‫‪y‬‬
‫‪i‬‬‫‪ngdown.Thi‬‬ ‫‪scancl‬‬ ‫‪oset‬‬ ‫‪heai‬‬ ‫‪r‬‬‫‪way‬‬ ‫‪.‬‬
‫‪:‬‬
‫ﻻ‬
‫ﺎﺥ‬
‫ﻭﺑﺨ‬ ‫ﺃ‬‫ﻳﻢ‬‫ﺮ‬
‫ﻭﻛ‬ ‫ﺃ‬‫ﺔ‬‫ﻘ‬‫ﺍﺕﻻﺻ‬ ‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻭﺿ‬ ‫ﺃ‬‫ﺔ‬‫ﻤ‬‫ﺎﻋ‬‫ﺔﻧ‬‫ﻴ‬‫ﻨ‬‫ﺍﺕﻗﻄ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤ‬ ‫ﻭﺿ‬ ‫ﺃ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺃ‬‫ﻭ‬‫ﺃ‬‫ﺎ‬‫ﻠً‬
‫ﺠ‬ ‫ﻭﺛ‬ ‫ﺃ‬‫ﺓ‬‫ﺪ‬‫ﺑ‬
‫ﻭﺯ‬ ‫ﺃ‬‫ﺎ‬‫ً‬
‫ﻤ‬
‫ﺮﻫ‬‫ﻊﻣ‬ ‫‪-‬ﻻﺗﻀ‬
‫‪.‬‬‫ﻴﻢ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﻔ‬‫ﻟﺸ‬‫ﺍ‬‫ﻊ‬‫ﺭ ﺽﻣ‬ ‫ﺎ‬‫ﻌ‬‫ﺘ‬‫ﺃﻥﻳ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﺍﻳ‬‫ﺬ‬‫‪.‬ﻫ‬‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺰﻝﻋ‬ ‫ﻨ‬‫ﺃﻱﻣ‬ ‫ﻭ‬‫ﺃ‬ ‫ﻳﺖ‬‫ﺯ‬
‫‪.‬‬
‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺎ‬‫ﺔﺑ‬ ‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻝﻓﻲ‬ ‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻨﺐ‬ ‫‪.‬ﺗﺠ‬ ‫ﻮﺙ‬‫ﻠ‬‫ﺘ‬‫ﺮﻕﻳ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺪﻉ‬ ‫‪-‬ﻻﺗ‬
‫‪.‬‬‫ﻴﺖ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺭ‬‫ﻮ‬
‫ﺜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺰﻋﺞ‬ ‫‪-‬ﻻﺗ‬
‫‪.‬‬‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﺒﺐ ﺻ‬‫ﺃﻥﻳﺴ‬ ‫ﻜﻦ‬ ‫ﻤ‬‫ﺍﻳ‬‫ﺬ‬ ‫‪.‬ﻫ‬‫ﺩ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻤ‬‫ﻟ‬‫ﺎ‬
‫ﺪﺑ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟﺸ‬‫ﺍ‬‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﻐ‬‫ﺓﻭﻻﺗ‬ ‫ﺩ‬‫ﺭ‬‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬ ‫‪-‬ﻻﺗﺴ‬
‫ﺃﻥ‬‫ﻜﻦ‬‫ﻤ‬‫ﺍﻳ‬‫ﺬ‬‫‪.‬ﻫ‬‫ﻮﻥ‬‫ﻘ‬‫ﻠ‬‫ﺘ‬
‫ﺀﻭﻫﻢﻣﺴ‬ ‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﻭﻕﻓﻲﻣﺠ‬ ‫ﺮ‬‫ﺎﻙﺣ‬ ‫ﻨ‬‫ﺎﻥﻫ‬ ‫ﺍﻛ‬‫ﺫ‬
‫ﻳ ﺾﺇ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺃﺱ‬ ‫ﺓﺗﺤﺖﺭ‬ ‫ﺩ‬
‫ﺎ‬‫ﻊﻭﺳ‬ ‫‪-‬ﻻﺗﻀ‬
‫‪.‬‬
‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻯ‬ ‫ﻠﻖﻣﺠ‬ ‫ﻐ‬
‫ﻳ‬

‫‪Fl‬‬
‫‪ui‬‬‫‪dandEl‬‬
‫‪ect‬‬
‫‪r‬‬‫‪ol‬‬
‫‪y‬‬‫‪t‬‬‫‪eChangesi‬‬
‫‪nt‬‬‫‪heEmer‬‬
‫‪gent‬‬
‫‪/‬‬‫‪Resusci‬‬
‫‪t‬‬‫‪at‬‬
‫‪i‬‬‫‪v‬‬‫‪e‬‬
‫‪Phase:‬‬

‫‪229‬‬
Fluidaccumul at ionphase( shockphase)
Plasma→ i nt er stiti
alfluid( edemaatbur nsi t
e)
Expl anat ion Observati
on
Plasmal eakst hr oughdamaged Generali
zeddehy drati
on
capi llari
es.
Secondar yt opl asmal oss, fal
l of Reduct i
onofbl oodv olume
bloodpr essur e, anddi mi nished
car diacout put
Secondar yt o: Fl uidlossDecr eased Decr easedurinaryout put
renal bloodf l
owSodi um andwat er
retent ioncausedbyi ncr eased
adr enocor ti
cal act ivi
tyHemol y sis
ofr edbl oodcel ls,causi ng
hemogl obinur iaandmy onecr osi s
ormy oglobi nur ia
Massi vecel l
ul art r
aumacauses Potassi
um (K+)excess
releaseofK+i nt oext racel lularf l
uid
(ordi narily
, mostK+i sint racellular)
.
Lar geamountofNa+i slosti n Sodium (Na+)defi
cit
trappededemaf luidandexudat e
andbyshi ftintocel lsasK+i s
releasedf rom cel l
s(ordi narilymost
Na+i sex tracel lular )
.
Lossofbi car bonat eions Metaboli
caci dosi
s( base-
accompani essodi um l oss. bi
carbonatedef i
cit
)
Liqui dbl oodcomponenti sl ostinto Hemoconcent r
ati
on( elev
ated
extr av ascularspace. hematocrit
)

230
Nur singmanagement :
-Giv epat ienthumi dif
iedoxy gen100%.
-Inser tendot racheal Tubeandi nit
iatemanual v enti
lationwhenpr esentsev er
respiratorydi stressorai rwayedema.
-Assessedqui ckl ycirculatorysy stem: Apicalpul se,Bloodpr essur ei s
moni toredf r
equent l
y.
-Assessneur ol ogi calstatusi nthepat i
entswithex tensivebur ns.
-Not hingpermout h.
-Encour agepat ientt ocought oremov esecretion.
-Remov edal lthingandj ewel r
yofbur npat i
ents.
-TheNur semustal soat tendt othepat i
entsfami l
y’
spsy chol ogical needs
(i
ndi vi
dual izedpsy chosoci alsuppor t).
-Prov ider eassur anceandsuppor t,explanati
onsofpr ocedur esandadequat e
painmedi cati
ont ot hebur npat i
ents.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬:
.٪
100‫ﺮﻃﺐ‬ ‫ﻴﻦﻣ‬ ‫ﻛﺴﺠ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﺇﻋﻄ‬-
.
‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬‫ﺮﻯ‬‫ﺔﻣﺠ‬ ‫ﻣ‬‫ﺫ‬‫ﻭﻭ‬ ‫ﺃ‬‫ﺓ‬‫ﺪ‬‫ﻳ‬
‫ﺪ‬ ‫ﺔﺷ‬ ‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﺔﺗ‬‫ﻘ‬‫ﺋ‬‫ﺎ‬
‫ﺩﺿ‬ ‫ﻮ‬ ‫ﺪﻭﺟ‬‫ﻨ‬‫ﺔﻋ‬‫ﻳ‬‫ﻭ‬‫ﺪ‬ ‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻬ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺃ‬
‫ﺪ‬‫ﺑ‬‫ﺍ‬‫ﻣﻲﻭ‬ ‫ﺎ‬‫ﺮﻏ‬‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬
‫ﺍﻷ‬‫ﺩﺧﻞ‬ ‫ﺃ‬-
.‫ﺭ‬‫ﺮ‬‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﻩﺑﺸ‬‫ﺪ‬‫ﺘﻢﺭﺻ‬ ‫ﻡﻳ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬ ‫ﺿ‬، ‫ﻤﻲ‬‫ﺒ ﺾﻗ‬ ‫ﻧ‬: ‫ﺔ‬‫ﻳ‬
‫ﻮ‬‫ﻣ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺮﻋ‬‫ﺳ‬-
.‫ﺓ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻭﻕﺷ‬ ‫ﺮ‬‫ﻴﻦﺑﺤ‬ ‫ﺑ‬
‫ﺎ‬‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻯ‬ ‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﺒ‬‫ﻌﺼ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﻜﻞﻓﻢ‬ ‫ﻟ‬‫ﺀ‬‫ﻻﺷﻲ‬-
.
‫ﺍﺕ‬ ‫ﺯ‬‫ﺍ‬‫ﺮ‬
‫ﻓ‬‫ﺍﻹ‬ ‫ﺯﺔ‬
‫ﻟ‬
‫ﺎﻝﻹﺍ‬ ‫ﻌ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻠﻰ‬‫ﻳ ﺾﻋ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺗﺸﺠ‬-
.‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬ ‫ﺮﺿﻰ‬ ‫ﺍﺕﻣ‬ ‫ﺮ‬‫ﻮﻫ‬‫ﻣﺠ‬ ‫ﺀﻭ‬‫ﺔﻛﻞﺷﻲ‬ ‫ﻟ‬‫ﺍ‬
‫ﺯ‬-
‫ﺇ‬
‫ﺎﻋﻲ‬ ‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬‫ﻔﺴﻲﻭ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻋﻢ‬‫ﻟ‬‫ﺍ‬)‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺮ‬
‫ﺔﻷﺳ‬ ‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻠ‬‫ﺎﺗ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﺔ‬‫ﺮﺿ‬ ‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﻳﺠﺐﻋ‬-
.(‫ﺩﻱ‬‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬
.‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﻴ‬
‫ﻓ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺍﻵﻻ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬
‫ﺃ‬‫ﺍﺕﻭ‬ ‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺮﺡ‬‫ﺪﻋﻢﻭﺷ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻨ‬‫ﻴ‬‫ﻧ‬
‫ﺄ‬‫ﻤ‬
‫ﻟﻄ‬‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬‫ﻘ‬‫ﺗ‬-

Emer gencymedi calmanagement :

-Suctioni nginser versi t
uationorgi vebr onchodil
atorsandmonolit
hicagent
s.
-Endot racheal i
ntubat ionswhenpr esentedema.
-Remov edi mmedi atelyi fchemi calshav econt r
actedtheeyes.
-Assessf orcer v
ical spinal i
njuri
esorheadi njur
yifthepati
entwasinvolv
ed
el
ectrical inj
ury.
-Ahist oryofpr eexistingdi sease,al l
ergi
esandmedi cati
onsandtheuseof
drugs,al cohol,andt obacco.
-I
nser tedI .Vcatheteri nanon- burnedar ea.
-Givepat i
entlargeamountofi ntr
av enousf l
uidsquickl
yandcentr
al v
enous

231
pressurecanbemoni tored.
-Whenpat ientnauseat ed, anasogast rictubeshoul dbei nser tedandconnect ed
tosuct i
ont opr eventpar alyticill
us.
-Ani ndwel l
ingur i
narycat heterisi nser tedt oaccur atemoni toringofur i
ne
outputandr enal f
unct i
on.
-Basichei ght ,weight, arterialbloodgases, hematocr ite,electrolyte,Ur ine
analysisandchestXRay sar eobt ained.
-Givepat i
ent st etanuspr ophy laxis.
:‫ﺔ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺭﺉ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺓ‬ ‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
.‫ﺔ‬‫ﻧﺴ‬‫ﺎ‬‫ﺘﺠ‬‫ﻣﻞﻣ‬ ‫ﺍ‬‫ﻮ‬‫ﺔﻭﻋ‬ ‫ﻴ‬‫ﺒ‬
‫ﺎﺕﻗﺼ‬ ‫ﻌ‬‫ﻮﺳ‬ ‫ﺀﻣ‬ ‫ﺎ‬‫ﻋﻄ‬‫ﻭﺇ‬ ‫ﺃ‬‫ﻡ‬‫ﺩ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻔﻂﻓﻲ ﺎ‬ ‫ﻟﺸ‬‫ﺍ‬-
.‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﺩﻭ‬ ‫ﻮ‬‫ﺪﻭﺟ‬ ‫ﻨ‬‫ﻣﻲﻋ‬ ‫ﺎ‬
‫ﻏ‬ ‫ﺮ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﺐ‬‫ﺒ‬‫ﻨ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬-
.
‫ﻴﻦ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﺼﺖ‬ ‫ﻘ‬‫ﺪﺗ‬ ‫ﺔﻗ‬ ‫ﻴ‬
‫ﺋ‬‫ﺎ‬
‫ﻴ‬‫ﻤ‬‫ﻴ‬
‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻧﺖ‬‫ﺎ‬‫ﺍﻛ‬‫ﺫ‬‫ﺭﺇ‬‫ﻮ‬ ‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬ ‫ﻪﻋ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﺘﻢﺇ‬‫ﻳ‬-
.
‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﺑ‬‫ﺮ‬‫ﻬ‬‫ﺔﻛ‬ ‫ﺑ‬‫ﺎ‬
‫ﺈﺻ‬‫ﺎﺑ‬ً
‫ﺑ‬‫ﺎ‬
‫ﻳ ﺾﻣﺼ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬‫ﺍﻛ‬ ‫ﺫ‬‫ﺃﺱﺇ‬ ‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﻭﺇﺻ‬‫ﺃ‬ ‫ﻘﻲ‬‫ﻨ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺮﻱ‬‫ﻘ‬‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻴﻢﺇﺻ‬ ‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.‫ﻎ‬‫ﺒ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﻜﺤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕﻭ‬‫ﺭ‬‫ﺪ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺔﻭ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬ ‫ﺍﻷ‬‫ﺔﻭ‬‫ﻴ‬‫ﺎﺳ‬‫ﻟﺤﺴ‬‫ﺍ‬‫ﺎﻭ‬ً
‫ﻘ‬‫ﺒ‬‫ﺓﻣﺴ‬ ‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺍﺽ‬ ‫ﺮ‬‫ﻣ‬‫ﻣﺍﻷ‬‫ﻳﺦ ﻦ‬ ‫ﺭ‬‫ﺎ‬
‫ﺗ‬-
.
‫ﺔ‬ ‫ﻗ‬
‫ﺮ‬‫ﺘ‬‫ﺮﻣﺤ‬‫ﻴ‬ ‫ﺔﻏ‬ ‫ﻘ‬‫ﻨﻄ‬‫ﺔﻓﻲﻣ‬ ‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﺓﻭ‬‫ﺮ‬ ‫ﺎﻝﻗﺴﻄ‬ ‫ﺩﺧ‬‫ﺇ‬-
.
‫ﺰﻱ‬‫ﻛ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻱ‬‫ﻳ‬‫ﺭ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﺔ‬ ‫ﺒ‬‫ﻗ‬
‫ﺍ‬‫ﺮ‬‫ﻜﻦﻣ‬ ‫ﻤ‬‫ﻳ‬‫ﺔﻭ‬ ‫ﺮﻋ‬ ‫ﺔﺑﺴ‬‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺔﻛ‬ ‫ﻴ‬‫ﻤ‬‫ﻳ ﺾﻛ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﺎ‬‫ﺇﻋﻄ‬-
.‫ﻮﻝ‬ ‫ﻠ‬
‫ﻤﺸ‬ ‫ﻟ‬‫ﺍ‬‫ﻮﻫﻢ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﻔﻂ‬ ‫ﻟﺸ‬‫ﺎ‬‫ﻪﺑ‬‫ﺑﻄ‬‫ﺭ‬‫ﺪﻱﻭ‬ ‫ﻌ‬‫ﻔﻲﻣ‬ ‫ﻧ‬
‫ﺃ‬‫ﻮﺏ‬ ‫ﺒ‬‫ﻧ‬‫ﺃ‬‫ﺎﻝ‬‫ﺩﺧ‬‫ﺎﻥﻳﺠﺐﺇ‬ ‫ﻴ‬‫ﺜ‬‫ﻐ‬
‫ﻟ‬‫ﺎ‬‫ﺭﺑ‬‫ﻮ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬‫ﻋ‬-
.‫ﻠﻰ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻭﻇ‬ ‫ﻮﻝﻭ‬ ‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬ ‫ﺮ‬‫ﺔﻹﺧ‬ ‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﺔﺩ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺔ‬‫ﺘ‬‫ﺑ‬‫ﺎ‬
‫ﺔﺛ‬ ‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺓﺑ‬ ‫ﺮ‬‫ﺎﻝﻗﺴﻄ‬ ‫ﺩﺧ‬‫ﺘﻢﺇ‬‫ﻳ‬-
‫ﻴﻞ‬‫ﻠ‬‫ﺗﺤ‬‫ﺭﻝﻭ‬ ‫ﺎ‬
‫ﻬ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻳﺖﻭ‬ ‫ﺮ‬‫ﻛ‬
‫ﻮ‬ ‫ﺗ‬‫ﺎ‬
‫ﻤ‬‫ﻴ‬‫ﻬ‬‫ﻟ‬‫ﺍ‬
‫ﻧﻲﻭ‬ ‫ﺎ‬‫ﻳ‬‫ﺮ‬‫ﻟﺸ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬
‫ﺎﺳﻲﻭﻏ‬ ‫ﺍﻷﺳ‬ ‫ﺯﻥ‬ ‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝﻭ‬ ‫ﻟﻄ‬‫ﺍ‬ ‫ﻠﻰ‬‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬-
.‫ﺔ‬‫ﻴ‬‫ﻨ‬‫ﻴ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﺔ‬‫ﻌ‬‫ﺎﻷﺷ‬‫ﺭﺑ‬ ‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﺗﺤ‬‫ﻮﻝﻭ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺍ‬
‫ﺰ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﺮﺿﻰ‬ ‫ﺀﻣ‬‫ﺎ‬‫ﺇﻋﻄ‬-
Fluidandel ectrolytedi sturbancesi nemer gencyphase:
1-Homody nami cinstabili
ty, r
esul ti
ngf rom:
-Lossofcapi l
laryintegr i
ty.
-Subsequentshi ftoff l
uidf rom t hei ntrav ascularspacei ntot hei nterstiti
al
spaces.
2-Circulati
ngbl oodv ol umedecr ease.
‫ﺭﺉ‬
‫ﺍ‬‫ﻮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﺭﻝﻓﻲﻣ‬ ‫ﺎ‬‫ﻬ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺋﻞﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬
‫ﺍﺿﻄ‬:
١-‫ﺗﺞﻋﻦ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻜﻲ‬‫ﻴ‬‫ﻣ‬
‫ﺎ‬‫ﻨ‬‫ﻳ‬
‫ﺩ‬‫ﻮ‬‫ﻣ‬‫ﻮ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻘ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﻡ‬‫ﺪ‬
‫ﻋ‬:
-‫ﺔ‬ ‫ﻳ‬‫ﻮ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﻴ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬‫ﻼﺔ‬
‫ﺍﻥﺳ ﻣ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬
.
-‫ﻼﺔ‬
‫ﻴ‬‫ﻟﺨﻟ‬
‫ﺍ‬‫ﺎﺕ‬
‫ﻏ‬‫ﺍ‬
‫ﺮ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬
‫ﺔﺇ‬‫ﻴ‬
‫ﻭﻋ‬‫ﺍﻷ‬‫ﺍﺧﻞ‬
‫ﺀﺩ‬ ‫ﺎ‬
‫ﻔﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻣﻦ‬‫ﺎ‬‫ﻠﺴ‬‫ﻟ‬‫ﺍﻼﺣﻖ‬
‫ﻮﻝﻟ‬ ‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬
.
2-‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻭ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺎ ﺽﺣﺠﻢ‬‫ﻔ‬‫ﻧﺨ‬‫ﺍ‬
.
Goalsoffluidrepl
acementt herapy:
-Maintai
nnor malbloodpressureanduri
neout
put.
-Systol
icbloodpressureexceeding100mm Hg.
-PulseRatelessthan110/mi nute.
-Uri
neout putof30t o50ml/ hours.
:‫ﺋﻞ‬
‫ﺍ‬‫ﻮ‬
‫ﻟﺴ‬ ‫ﺍ‬‫ﺋﻞ‬
‫ﺍ‬‫ﺪ‬‫ﺒ‬
‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
.
‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬
‫ﺇﺧ‬ ‫ﻌﻲﻭ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﻡ‬‫ﺪ‬ ‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬‫ﻠﻰ ﺿ‬‫ﺎﻅﻋ‬ ‫ﻔ‬
‫ﻟﺤ‬‫ﺍ‬-
.‫ﺒﻖ‬
‫ﺋ‬‫ﻠﻢﺯ‬‫ﻣ‬100‫ﺎﺿﻲ‬ ‫ﺒ‬‫ﻘ‬‫ﻧ‬‫ﺍﻻ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺯﺿ‬‫ﻭ‬‫ﺎ‬‫ﺗﺠ‬-
.
‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬/110‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﺒﺾ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻝ‬‫ﻌ‬‫ﻣ‬-
.‫ﺔ‬‫ﻋ‬
‫ﺎ‬‫ﺳ‬/‫ﻣﻞ‬50‫ﻟﻰ‬ ‫ﺇ‬30‫ﻮﻝﻣﻦ‬ ‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺇﺧ‬-
Managementoff l
uidlossandshock( r
eplacement ).
-Theflui
dr equirementfort hefirst24hoursiscalculatedbyt hephy si
cian
basedont heext entofthebur ninjury.
-Somecombi nat i
onoffluidcategor i
esmaybeused.
-Coll
oids(whol eblood,plasmaandpl asmaexpander s).
-Cryst
all
oid,electrol
yte(phy si
ologicsodium chl
orideorl act
atedr i
ngers

232
sol
uti
on)
.

-Anexample:-pati
entweighta70-
kgwit
h50%Bodysurfacearea(BSA)bur
n.
-Consensusfor
mul a:
2t o4ml /
kg%BSA.
2×70×50=7000ml /24hours.
-Pl
antoadmi ni
ster=fir
st8hours=3500mlor437ml
/hoursnext16hours=
3500ml,or219ml /hr
.

.
(‫ﺍ‬
‫ﺪﻝ‬‫ﺒ‬
‫ﺘ‬‫ﺍﻻﺳ‬
)‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺋﻞﻭ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺪ‬‫ﻘ‬‫ﺓﻓ‬ ‫ﺭ‬
‫ﺍ‬‫ﺩ‬‫ﺇ‬
‫ﺔ‬
‫ﺑ‬‫ﺎ‬‫ﺪﻯﺇﺻ‬‫ﻠﻰﻣ‬‫ﺀﻋ‬
ً‫ﺎ‬
‫ﻨ‬‫ﻴﺐﺑ‬‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬
‫ﺒﻞ‬‫ﻟﻰﻣﻦﻗ‬
‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬24‫ﺍـ‬‫ﺋﻞﺧﻼﻝﻝ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺎﺝ‬‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬‫ﺎﺏ‬‫ﺘﺴ‬‫ﺍﺣ‬ ‫ﺘﻢ‬‫ﻳ‬-
.‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬
.
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺌ‬
‫ﺔﻣﻦﻓ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﻡﻣﺠ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬ ‫ﻤ‬‫ﻳ‬-
.(‫ﺯ‬
‫ﻼﺎ‬
‫ﺒ ﻣ‬‫ﻟ‬
‫ﺍ‬
‫ﻼﺎﻭ‬
‫ﻣ‬‫ﺒﺯ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻌ‬‫ﻮﺳ‬‫ﻣ‬)‫ﺎﺕ‬ ‫ﻳ‬
‫ﻭ‬ ‫ﺮ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬-
.
(‫ﺔ‬‫ﻴ‬
‫ﺗ‬‫ﺎ‬
‫ﺘ‬‫ﻛ‬‫ﺍﻼ‬
‫ﺎﺕﻟ‬
‫ﻘ‬‫ﻠ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻮﻝ‬‫ﻠ‬
‫ﻭﻣﺤ‬‫ﺃ‬‫ﻮﺟﻲ‬
‫ﻟ‬‫ﻮ‬‫ﻴ‬
‫ﻔﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻠ‬
‫ﻮﻝﻛ‬‫ﻠ‬‫ﻣﺤ‬)‫ﻴﺖ‬ ‫ﻟ‬
‫ﻭ‬‫ﺮ‬‫ﺘ‬‫ﻜ‬‫ﻟ‬
‫ﺇ‬،‫ﺭﻱ‬‫ﻮ‬‫ﻠ‬‫ﺑ‬-

.
(BSA)‫ﻟﺠﺴﻢ‬‫ﺍ‬
‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﻦﻣﺴ‬٪50‫ﺮﻕ‬‫ﻊﺣ‬ ‫ﻛﺠﻢﻣ‬70‫ﻳ ﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺯﻥ‬
‫ﻭ‬-:‫ﺎ‬
‫ﺜﻝ‬-
‫ﻣ‬
.‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﻣﻦﻣﺴ‬٪‫ﻛ‬
‫ ﻎ‬/‫ﻣﻞ‬4‫ﻟﻰ‬
‫ﺇ‬2:‫ﺔ‬‫ﻴ‬
‫ﺎﻋ‬‫ﻤ‬
‫ﺔﺇﺟ‬‫ﻐ‬‫ﻴ‬‫ﺻ‬-
.
‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬24/‫ﻣﻞ‬7000=50×70×2
219‫ﻭ‬
‫ﺃ‬‫ﻣﻞ‬3500=‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬16‫ﺪ‬ ‫ﻌ‬
‫ﺔﺑ‬‫ﺎﻋ‬‫ﺳ‬/‫ﻣﻞ‬437‫ﻭ‬ ‫ﺃ‬‫ﻣﻞ‬3500=‫ﺎﺕ‬ ‫ﻋ‬
‫ﺎ‬‫ﺳ‬8‫ﻭﻝ‬‫ﺃ‬=‫ﺀ‬‫ﺎ‬
‫ﺍﻹﻋﻄ‬‫ﺔ‬‫ﺧﻄ‬-
.
‫ﺔ‬‫ﻋ‬‫ﺎ‬
‫ﺳ‬/‫ﻣﻞ‬

Rateof Sol
uti
on For
mul
a
adminstr
ati
on
1/2giv
eninfir
st8 -3/
4cryst
all
oid1/
4 -2ml /kgper% Brooke
hr col
loi
dD5W as BSAbur n+2000.
1/2giv
eninnext maint
enance. -Ml/24hr
16hr (maintenance
fl
uid).
-1/
2gi veni
nf i
rst -
Cry stal
loidonly -4ml /kgper% Parkl
and
8hr. (l
actatedRi nger'
s). BSAbur nfor24- (Baxt
er)
-1/
2gi veni
nnex t - hrperiod. Monafo
16hr . Crystall
oid(hypert
oni
-Adjustto csal i
ne:sodium=250
maintainuri
nary mEq/ L
outputof30
ml/hr.
-1/
2gi veni
nf i
rst -
Cryst
all
oidonly -
4ml /
kgper% Modifi
ed
8hr. (
lact
atedRinger
's)
. BSAburn+15 par
kland
-1/
2gi veni
nnex t ml/
m2ofBSA.
16hr .
-1/
2gi veni
nf i
rst -
Cryst
all
oidonly -
2ml /
kgper%
8hr. (
lact
atedRinger
's)
. BSAbur n+
-1/
2gi veni
nnex t mai nt
enance
16hr . fl
uid.

233
NURSI NGALERT: For mulasar eonlyaguide.Thepat ient’
sresponse,
evi
dencedbyhear trate,bloodpr essure,andurineoutput,isthepri
mary
det
er mi nantofact ualfl
uidtherapyandmustbeassessedatl easthourl
y.
Pati
entout comesar ei mprovedbyopt imalfl
uidresuscit
ation.
Nursingpr ocessdur i
ngt heEmer gent(Resuscitat
ive)phase:
Assessment :
-Vi
tal signsar echeckedf requent l
y.
-Moni tor edrespi
ratorystatus.
-Apical, caroti
dandf emor alpulsesareev al
uatedtodet ectanyheartdisease.

‫ﻠﺐ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﺑ‬‫ﺮ‬
‫ﺪﻝ ﺿ‬ ‫ﻌ‬
‫ﺘﻀﺢﻣﻦﺧﻼﻝﻣ‬ ‫ﺘﻲﻳ‬‫ﻟ‬
‫ﺍ‬ ،
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﺳ‬.‫ﻴﻞ‬‫ﻟ‬
‫ﻮﻯﺩ‬ ‫ﻴﺴﺖﺳ‬ ‫ﻟ‬‫ﻎ‬‫ﻴ‬
‫ﻟﺼ‬‫ﺍ‬:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻪﺗ‬‫ﻴ‬‫ﺒ‬‫ﻨ‬
‫ﺗ‬
‫ﺔ‬‫ﺎﻋ‬
‫ﺎﻛﻞﺳ‬‫ﻬ‬‫ﻤ‬‫ﻴ‬
‫ﻴ‬‫ﻘ‬‫ﻳﺠﺐﺗ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬
‫ﺎ‬‫ﻠﻲﺑ‬‫ﻌ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻠ‬
‫ﻟ‬‫ﺎﺳﻲ‬‫ﺍﻷﺳ‬‫ﺩ‬
‫ﺪ‬‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻫﻲ‬، ‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺮﺟ‬‫ﻣﺨ‬‫ﻡﻭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﻐﻂ‬‫ﻭﺿ‬
.
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺎ‬
‫ﺜﻞﺑ‬‫ﻣ‬‫ﺍﻷ‬‫ﺎﺵ‬‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬‫ﻳﻖ‬‫ﺮ‬‫ﺮﺿﻰﻋﻦﻃ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺋﺞ‬‫ﺎ‬
‫ﺘ‬‫ﻴﻦﻧ‬‫ﺘﻢﺗﺤﺴ‬‫ﻳ‬.‫ﻗ‬
‫ﺍﻷﻞ‬ ‫ﻠﻰ‬‫ﻋ‬
:
(‫ﺎﺵ‬‫ﻌ‬‫ﻧ‬
‫ﺍﻹ‬)‫ﺔ‬‫ﺋ‬‫ﺭ‬
‫ﺎ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﺧﻼﻝ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻋ‬
:‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.
‫ﺭ‬‫ﺮ‬‫ﻜ‬
‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺘﻢﻓﺤ ﺺ‬ ‫ﻳ‬-
.‫ﻔﺴﻲ‬‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﺔﺎ‬ ‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.
‫ﻠﺐ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﺮ ﺽﻓﻲ‬‫ﺃﻱﻣ‬ ‫ﻜﺸﻒﻋﻦ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺬ‬‫ﻔﺨ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﺗ‬
‫ﺎ‬‫ﺒ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻤ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺒﻀ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺘﻢﺗ‬‫ﻳ‬-

Note:whenal lextr
emi t
iesareburned,deter
miningbloodpressuremaybe
di
ffi
cultast eri
ledressi ngappliedunderthebloodpressurecuf ft
oprotect
woundf rom cont ami nation.
-Assessv einsi t
etousedar teri
alcathet
er.
-I
nsertindwel l
ingur i
nar ycatheter.
-Monitoringf luidintakeandout put.
-Assessur inecont ainthepr esenceofmy ogl
obinresult
ingfrom muscle
damage.
-Measur eBodyt emper atureandbodywei ght
-Assessingt heext entoft heburnwoundoft hepatientslev
el ofconsci
ousness,
psychologi calstatus, painandanxiety.

‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻤ‬
‫ﻡﺿ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬
‫ﺎﺳ‬‫ﻡﺑ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬
‫ﺪﺿ‬ ‫ﻳ‬
‫ﺪ‬‫ﻌﺐﺗﺤ‬ ‫ﻟﺼ‬‫ﺍ‬‫ﻮﻥﻣﻦ‬‫ﻜ‬‫ﺪﻳ‬‫ﻗ‬، ‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﺮﻕﺟ‬‫ﺘﻢﺣ‬ ‫ﺎﻳ‬
‫ﻣ‬ ‫ﺪ‬
‫ﻨ‬‫ﻋ‬:‫ﺔ‬‫ﻮﻇ‬‫ﻠﺤ‬ ‫ﻣ‬
.‫ﻮﺙ‬ ‫ﻠ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﺡﻣﻦ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻤ‬‫ﻟﺤ‬ ‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂ‬ ‫ﺔﺿ‬ ‫ﻌ‬
‫ﻔ‬‫ﻊﺗﺤﺖ ﺻ‬ ‫ﻮﺿ‬ ‫ﺔﺗ‬‫ﻤ‬‫ﻘ‬
‫ﻌ‬ ‫ﻣ‬
.
‫ﻴﻦ‬ ‫ﻳ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺸ‬
‫ﺍ‬ ‫ﺓ‬‫ﺮ‬
‫ﻡﻗﺴﻄ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺪﻻﺳ‬‫ﻳ‬‫ﺭ‬
‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻮﺿ‬ ‫ﻴﻢﻣ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬‫ﻨ‬‫ﻛ‬
‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻘﺴﻄ‬‫ﻟ‬‫ﺍ‬‫ﺎﻝ‬
‫ﺩﺧ‬ ‫ﺇ‬-
.
‫ﺎ‬‫ﻬ‬‫ﺗ‬
‫ﺎ‬‫ﺮﺟ‬‫ﻣﺨ‬‫ﺋﻞﻭ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺔﺗ‬ ‫ﺒ‬
‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.
‫ﻌﻀﻼﺕ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻠﻒ‬‫ﺗﺞﻋﻦﺗ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬ ‫ﺑ‬
‫ﻮ‬‫ﻠ‬‫ﻮﺟ‬‫ﻴ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﻮ‬‫ﻠﻰﻭﺟ‬‫ﻮﻝﻋ‬‫ﺒ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬
‫ﻮ‬‫ﺘ‬‫ﺍﺣ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺯﻥ‬‫ﻭ‬‫ﻟﺠﺴﻢﻭ‬‫ﺍ‬‫ﺓ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬‫ﺔﺣ‬‫ﺭﺟ‬ ‫ﺎﺱﺩ‬ ‫ﻴ‬
‫ﻗ‬-
.
‫ﻠﻖ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﻢﻭ‬‫ﺍﻷ‬
‫ﺔﻭ‬‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻮﻋﻲﻭ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻯ‬ ‫ﺘ‬‫ﻣﺴ‬‫ﺮﺿﻰﻭ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻯ‬‫ﻟ‬‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺮﺡ‬ ‫ﺪﻯﺟ‬ ‫ﻴﻢﻣ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-

NURSI
NGDI
AGNOSI
S

234
NURSI NGDI AGNOSI S:Impai
redgasex changer elatedtocar bonmonoxi de
poisoning, smokei nhalati
on,andupperai rwayobst r
uction
GOAL: Mai ntenanceofadequat et i
ssueoxy genat i
on
Expect edOut comes Rational e Nur singI nter vent ions
•Absenceofdy spnea 1.Humi difiedoxy gen 1.Pr ov idehumi di fi
edoxy gen.
•Respi ratoryrate prov idesmoi stur eto
between12and20 i
njur edt issues;
breaths/ min suppl ement aloxy gen
•Lungscl earon i
ncr easesal veol ar
auscultat i
on oxygenat ion
•Arteri
al oxygen
saturationgr eaterthan
96%bypul seoxi metry
•Arteri
al bloodgasl evels
withinnor mal li
mi t
s
2.Thesef act ors 2.Assessbr eat hsounds, and
prov idebasel inedat a respi ratoryr ate, rhy thm,
forfur therassessment dept h, andsy mmet ry.
andev idenceof Moni torpat i
entf orsi gnsof
i
ncr easi ngr espirator y hy poxi a.
compr omi se.
3.Thesesi gnsi ndicat e 3.Obser vef ort hef ollowing:
possi bl ei nhal ation a.Er y themaorbl isteringof
i
njur yandr iskof l
ipsorbuccal mucosa
respi rat orydy sfunct i
on. b.Si ngednost ri
ls
c.Bur nsoff ace, neck, or
chest
d.I ncr easi nghoar seness
e.Sooti nsput um ort racheal
ti
ssuei nrespi rat ory
secr etions
4.Incr easi ngPaCO2 4.Moni torar terial bloodgas
anddecr easi ngPaO2 values, pulseoxi met ry
andO2sat urati
onmay r eadi ngs, and
i
ndicat eneedf or car boxy hemogl obi nl ev el
s.
mechani cal
ventilat ion .
5.Immedi ate 5.Repor tlabor ed
i
nter v ent ioni sindi cated r espi rations, decr eased
forrespi r
at ory dept hofr espi rations, or
diff
icul ty. signsofhy poxi at ophy si
cian
i
mmedi ately.
6.Int ubat ional lows 6.Pr epar et oassi stwi th
mechani cal vent il
ation. int ubat ionand
Eschar otomyenabl es eschar otomi es.
chestexcur si
oni n
cir
cumf erent i
al chest
burns

235
 7.Moni t
oringall
ows 7.Monitormechani
cal
ly
earl
ydet ecti
onof vent
il
atedpati
entcl
osel
y.
decreasingrespi
rat
ory
stat
usorcompl i
cat
ions
ofmechani cal
venti
lat
ion.

NURSINGDI AGNOSI S:I neff

ect i
veai rwayclearancerelatedtoedemaandef fect
sof
smokei nhalation
GOAL: Maintai npatentai rwayandadequat eairwayclearance
ExpectedOut comes Rational e NursingI nt er
v entions
•Patentairway 1.Apat entairwayis 1.Mai ntainpat entai rway
•Respirat
orysecr etions crucialtorespirati
on. t hr
oughpr operpat ient
areminimal, color
less, and positi
oni ng, r
emov alof
thi
n secretions, andar tifi
cial
•Respirat
oryr ate,pattern, air
wayi fneeded.
andbreathsoundsnor mal
2.Humi dit
yliquefi
es 2.Prov idehumi difi
ed
secret i
onsand oxygen.
faci
litates
expect orati
on.
3.Theseact i
v i
ti
es 3.Encour agepat i
entt otur
n,
promot emobi l
izat
ion cough, anddeepbr eathe.
andr emov alof Encour agepat ienttouse
secret i
ons. i
ncent i
v espi romet ry.
Suctionasneeded.

NURSI NGDI AGNOSI S:Fluidvolumedef i

citr elat
edtoincreasedcapill
ar y
permeabi li
tyandev aporati
velossesf rom t hebur nwound
GOAL: Restorati
onofopt imalfluidandel ect roly
tebal
anceandper f
usionofv it
al
organs
Expect edOut comes Rationale Nur si
ngInterventions
•Serum el ectr
olytes 1.Hy povolemiai sa 1.Obser vevit
al si
gns
withinnormal l
i
mi ts maj orri
skimmedi atel
y ( i
ncludingcentralv enous
•Urineout putbet ween aft
ert heburni nj ury
. pressureorpul monar yartery
0.5and1. 0mL/ kg/h Over r
esuscitation pressure,i
findicated)and
•Bloodpr essurehi gher mightcausef l
ui d urineoutput,andbeal er
tfor
than90/ 60mm Hg overload. signsofhy povolemi aorf l
uid
•Hear tratelesst han120 ov erl
oad.
beats/mi n
•Exhibitsclearsensor ium
•Voidscl earyellowur i
ne
withspeci fi
cgrav it
y
withinnormal l
i
mi ts

236
 2.Out putandwei ght 2.Monitoruri
neout
putat
prov i
deinfor mat i
on l
easthourlyandwei
gh
aboutr enal perfusion, pat
ientdail
y.
adequacyoff l
uid
replacement ,
andf lui
d
requirementandf luid
status
3.Adequat efluidsar e 3.Mai ntai
nIVli
nesand
necessar ytomai nt ai
n regulatefl
uidsatappr
opr
iat
e
fl
uidandel ectrolyte rates,asprescr
ibed
balanceandper fusion
ofv i
talorgans.
4.Rapi dshi f
tsinf luid4.Obser vef orsy mpt omsof
andel ectrolyt
est at usdef i
ciencyorexcessof
arepossi bleint he serum sodi um, potassi um,
post burnper i
od. calcium, phosphor us, and
bicarbonat e.
5.Elev
ationpromot es 5.El ev ateheadofpat i
ent’
s
venousreturn. bedandel evatebur ned
extremi ti
es.
6.Becauseoft her api
d 6.Not ifyphy sician
fl
uidshif
tsinbur n i
mmedi atelyofdecr eased
shock,fl
uiddeficit urineout put ,bloodpr essure,
mustbedet ectedear ly cent r
al venous, pul
monar y
sothatdistr
ibutiv
e artery,orpul monar yar t
ery
shockdoesnotoccur wedgepr essures, or
i
ncr easedpul ser ate.

NURSI NGDIAGNOSI S:Hypother mi arelatedtolossofski

nmi crocirculati
onand
openwounds
GOAL: Maintenanceofadequat ebodyt emper ature
ExpectedOut comes Rat ional e NursingIntervent i
ons
Bodytemper atur
e 1.Ast abl
eenv ironment 1.Provideawar m
remains36.1oCt o38.
3oC mi nimi zesev aporativ
e env i
ronmentt hroughuseof
(97oFt o101oF) heatl oss heatshield,spacebl anket
,
•Absenceofchi l
lsor heatli
ghts,orbl ankets
shiv
erin
2.Mi nimal exposure 2.Wor kquicklywhen
mi nimi zesheatl oss woundsmustbeexposed.
from wound
3.Fr equent 3.Assesscor ebody
temper at
ure temperaturef requentl
y.
assessment shel p
det ectdev eloping
hy pot hermia.

237
NURSI NGDI AGNOSI S:Painr elatedt ot issueandner v einjuryandemot ional i
mpact
ofinj
ury
GOAL:Cont rolofpain
ExpectedOut comes Rat ional e Nursi ngI ntervent ions
•St
atespainlevelis 1.Pai nlev elpr ovides 1.Usepai nintensi tyscaleto
decreased basel inef orev aluating assesspai nlev el (
ie,1to10) .
•Absenceof effect ivenessofpai n Diff
er entiater est l
essnessdue
nonverbalcuesofpai n reli
efmeasur es.Hy poxia topai nf rom rest l
essnessdue
cancausesi mi larsigns t ohy poxi a.
andmustber uledout
bef oreanal gesi c
medi cat i
oni s
admi nistered.
2.Int ravenous 2.Admi nisteri ntravenous
admi nistrationi s opioidanal gesi csas
necessar ybecauseof prescr i
bed.Obser vefor
alteredt i
ssueper fusion r espirator ydepr essioninthe
from bur ni njury patientwhoi snotmechani cal
ly
ventilat
ed.Assessr esponseto
analgesi c.
3.Emot ional suppor tis 3.Pr ovideemot i
onal support
essent i
al tor educef ear andr eassur ance.
andanxi etyr esulting
from bur ni njury.Fear
andanxi etyincr easet he
per cept ionofpai n.

NURSI NGDI AGNOSIS:Anxiet

yr elat edtof earandt heemotional i
mpactofbur n
i
njury
GOAL: Minimizat
ionofpati
ent’sandf ami l
y’
sanxi ety
ExpectedOut comes Rat i
onal e Nur si
ng
Int
er ventions
•Patientandfamily 1.Pr ev i
oussuccessf ul 1.Assesspat ient’
sand
verbali
ze copingst rategiescanbe fami l
y’sunder standingof
understandi
ngof foster edf orusei nt he burninjury ,
copingski l
ls,
emer gentburncare presentcr isi
s.Assessment andf ami l
ydy nami cs.
•Ablet oanswer all
owspl anni ngof
simplequestions individual izedi nterventi
ons.
2.React ionst obur ninjury 2.I ndividuali
zer esponses
areext remel yv ariable. tothepat ient’
sandf amil
y’s
Intervent ionsmustbe copingl evel
appropr iatet ot hepat i
ent’
s
andf ami ly’spr esentlev el
of
coping.

238
 3.Increasedunder st
anding 3.Explainall
procedur
esto
all
eviatesfearofthe thepatientandthefamil
yin
unknown.Hi ghlevel
sof clear
,simpleterms
anxietymayi nt
erf
erewith
understandi ngofcomplex
explanations.
4.Paini ncreasesanxiet
y. 4.Mai ntainadequat epain
rel
ief.
5.Anxietylevelsdur i
ngthe 5.Consi deradmi nist
ering
emer gentphasemay prescr i
bedant i
anx i
ety
exceedt hepat ient’
scoping medi cationsifthepatient
abil
it
ies.Medi cat i
on remai nsextremel yanxious
decreasesphy siol
ogicand despi t enonphar macologic
psychologicalanxi et
y i
nterv enti
ons.
responses.

COLLABORATI VEPROBLEMS: Acut erespi ratoryf ai

lure,distribut iveshock, acut e
renal f
ailure,compar tmentsy ndrome, par alyti
cileus, Curli
ng’ sul cer
GOAL: Absenceofcompl icat
ions
Expect edOut comes Rational e Nur singI nter vent ions
Acut eRespi ratoryFai l
ure
•Arterialbloodgasv alues 1.Suchsi gnsr efl
ect 1.Assessf ori ncr easi ng
withinaccept abl eli
mi t
s: deteriorati
ng dyspnea, st ri
dor ,changesi n
PaO2gr eatert han80mm r espiratoryst atus. respi r
at or ypat ter ns.
Hg, PaCO2l esst han50
mm Hg
•Breat hesspont aneously
withadequat et i
dal v
olume
2.Suchsi gnsr efl
ect Moni t
orpul seoxi met ry ,
decreasedoxy genat ion ar terial bloodgasv aluesf or
status. decr easi ngPaO2and
•Absenceofcer ebralsi
gns oxy gensat ur ation, and
ofhy poxia i
ncr easi ngPaCO2.
•Chestx -rayfindings
normal
3.X-raymaydi sclose 3.Moni torchestx- r
ayr esul
ts
pulmonar yi njury.
4.Suchmani festations 4.Assessf orr est lessness,
mayi ndicatecer ebral conf usion, di ff
icul ty
hypoxia. attendi ngt oquest ions, or
decr easi ngl evel of
consci ousness.
5.Acut erespi ratory 5.Repor tdet erior ating
fai
lureisl i
fe-threatening, r espirat oryst at us
andi mmedi ate i
mmedi at elyt ophy sician.
int
ervent i
oni sr equired.

239
 6.Int
ubationall
ows 6.Preparetoassistwi
th
mechanicalventi
lat
ion. i
ntubationorescharot
omies
Escharotomiesall
ow asindicat
ed.
i
mpr ovedchest
excursi
onwi t
h
respi
rati
ons.

Dist
ributi
veShock
•Urineout putbetween 1.Suchsignsand 1.Assessf ordecreasi ng
0.5and1. 0mL/ kg/h sympt omsmay uri
neout putandbl ood
•Bloodpr essurewi thin i
ndicatedistri
but
ive pressur
easwel las
pati
ent’
snor mal range shockandi nadequate i
ncreasingpulser ate.(If
(usual
lygr eaterthan i
ntravascularvol
ume. hemody namicmoni toringis
90/60mm Hg) used,assessf ordecr easing
•Heartratewi t
hin pulmonar yart
eryand
pati
ent’
snor mal range pulmonar yart
erywedge
(usual
lyless pressur
esandcar diac
than110/mi n) output.
)
•Pressuresandcar di
ac
outputremai nwi thin
normal l
imi t
s
2.Asf luidshiftsinto 2.Assessf
orprogr
essi
ve
theintersti
tialspacesin edemaasflui
dshif
tsoccur
.
burnshock, edema
occursandmay
compr omi set i
ssue
perfusion.
3.Opt i
mal f
luid 3.Adj
ustfl
uidresusci
tati
on
resuscitati
onpr events i
ncollabor
ati
onwi t
hthe
dist
ributiveshockand physi
ciani
nresponset o
i
mpr ov espat i
ent physi
ologi
cfi
ndings.
outcomes
Acut eRenalFai l
ur e
•Adequateuri
ne 1.Thesev aluesreflectrenal 1.Moni
torur
ineoutputand
output funct
ion. bl
oodureani
trogen(BUN)
•BUNandser um andser
um cr
eatini
nelevel
s.
creat
ini
neval
ues
remainnormal
2.Thesel
abor
ator
yval
ues 2.Reportdecreasedur
ine
i
ndicat
epossi
bler
enal
fai
l
ure. outputori
ncreasedBUNand
creat
ini
nev al
uesto
physici
an.

240
 3.Hemoglobi normy oglobinin 3.Assessuri
nef
or
theuri
nepoi ntstoan hemoglobi
normyogl
obi
n.
i
ncreasedriskofr enalfai
lure.
4.Flui
dshelpt ofl
ush 4.Admini
steri
ncr
eased
hemoglobinandmy oglobin fl
uidsaspr
escri
bed.
from r
enaltubules,decreasing
thepotent
ial f
orrenalfail
ure.

Compar tmentSy ndr ome

Absenceof 1.Assessmentwi th 1.Assessper ipheral
paresthesiasor Doppl erdev ice pulseshour lywi t
h
sympt omsofi schemia subst itut esf or Doppl erul trasound
ofnerv esandmuscl es auscul tationand dev i
ce.
•Peripheralpulses indicat es
det
ect ablebyDoppl er char act er i
st i
csof
ar t
er i
al bloodf l
ow.
2.Theseassessment s 2.Assesswar mt h,
indicat echar act eristi
cs capi l
lar yref i
ll,
ofper i
pher al perfusion sensat ion, and
mov ementofex t
remity
hour ly.Compar e
affect edwi th
unaf fect edext remity.
3.Cuf fmayactasa 3.Remov ebl ood
tour ni
quetas pressur ecuf faf t
er
ext remi ti
esswel l. eachr eadi ng.
4.El ev ationr educes 4.El ev atebur ned
edemaf ormat ion extremi ti
es.
5.Thesesi gnsand 5.Repor tlossofpul se
sy mpt omsmay orsensat i
onor
indicat ei nadequat e presenceofpai nto
tissueper fusion phy siciani mmedi atel
y.
6.Eschar ot omi es 6.Pr epar et oassi st
relievet heconst ricti
on wi theschar otomi es.
causedbyswel li
ng
underci r
cumf erential
bur nsandi mpr ove
tissueper fusion.

241
 Paral
y t
icI
leus
•Absenceof 1.Thismeasur erel
ieves 1.Mai ntai
nnasogast r
ic
abdominal
dist
enti
on gastr
icandabdomi nal tubeonl ow
•Normalbowelsounds dist
ent i
on,al
soprevents i
nt ermi t
tentsuct i
on
wit
hin48hours vomiting. unt i
lbowel sounds
resume.
2.Asbowel sounds 2.Auscul t
ateforbowel
resume, feedi ngmaybe sounds, abdomi nal
slowlyini
tiated. distent i
on.
Abdomi nal dist ention
refl
ectsinadequat e
decompr essi on.
Curli
ng’ sUl cer
•Absenceof 1.AcidicpHi ndi cat es 1.Assessgast r
ic
abdominaldistenti
on needf orant acidsor aspi r
at eforpHand
•Normal bowel sounds hist
ami nebl ocker s. blood.
withi
n48hour s Bloodindicat espossi ble
•Gastri
caspirateand gast ri
cbleedi ng.
stool
sdonotcont ai
n
bl
ood
2.Bloodinst ool smay 2.Assessst oolsf or
i
ndicategast ricor occul tblood
duodenal ulcer .
3.Suchmedi cat i
ons 3.Admi nist
er
reducegast ricaci dity histami neblocker sand
andr i
skoful cer ation. ant acidsaspr escribed.

B.Acut ephaseofbur n:
Beginni ngofdur ess’stonearcompl eti
onofwoundcl osurebegi ns48t o72
hoursaf t
ert hebur ninjury.
Priori
tiesi ncar e:
1-Assessmentandmai ntenanceofr espiratoryandci r
culatoryst ate.
2-Fluidandel ectrolytebal ance.
3-Gast rointestinalfunct i
on.
4-Burnwoundcar e( i
e, woundcl eaning,topicalant i
bacterialther apy,wound
dressing, dressingchanges, wounddébr idement ,andwoundgr afti
ng) .
5-Painmanagement .
6-Prev entionort r
eatmentofcompl i
cat i
on( i
nfection).
7-Nut ri
t i
onal suppor t
.
:
‫ﺮﻕ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺓﻣﻦ‬ ‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬
‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.
‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺔﻣﻦﺇﺻ‬ ‫ﺎﻋ‬
‫ﺳ‬72‫ﻟﻰ‬ ‫ﺇ‬48‫ﺪ‬ ‫ﻌ‬‫ﺃﺑ‬
‫ﺪ‬ ‫ﺒ‬
‫ﺮﺡﻳ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻏﻼﻕ‬ ‫ﺀﻣﻦﺇ‬ ‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻧ‬‫ﺍﻻ‬‫ﺮﺏ‬ ‫ﻟﻰﻗ‬‫ﻩﺇ‬‫ﺍ‬‫ﺮ‬
‫ﻛ‬‫ﺍﻹ‬‫ﺔ‬‫ﻳ‬‫ﺍ‬
‫ﺪ‬‫ﺑ‬
:
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﻮ‬‫ﻟ‬
‫ﻭ‬‫ﺃ‬
.‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬
‫ﻭ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬
‫ﻔﺴﻲﻭ‬ ‫ﻨ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬ ‫ﺍ‬
‫ﺣﺔ‬‫ﻟ‬
‫ﺔﺎ‬ ‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﻴﻢﻭﺻ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
1
.‫ﺭ‬
‫ﺎﻝ‬ ‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞﻭ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯﻥ‬‫ﺍ‬
‫ﻮ‬‫ﺗ‬-
2
.
‫ﻤﻲ‬ ‫ﻬﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻔ‬‫ﻴ‬
‫ﻭﻇ‬-3
،
‫ﺮﺡ‬ ‫ﻟﺠ‬
‫ﺍ‬ ‫ﺪ‬ ‫ﻴ‬
‫ﻤ‬‫ﺗﻀ‬، ‫ﻴﻢ‬‫ﺛ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻌﻲﺑ‬‫ﻮﺿ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻼﺝ‬‫ﻟ‬‫ﺍ‬،‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﻴﻒ‬‫ﻨﻈ‬‫ﺜﻞﺗ‬‫ﻣ‬)‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﻭﺡ‬‫ﺮ‬‫ﺔﺑﺠ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬-
4
.(
‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻴﻢ‬‫ﻌ‬
‫ﺗﻄ‬ ‫ﻭ‬،‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺗ‬،‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬
.
‫ﻡ‬‫ﺍﻵﻻ‬‫ﻋﻼﺝ‬-5
.
(‫ﻭﻯ‬ ‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
)‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭﻋﻼﺝ‬ ‫ﺃ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬-
6

242
 .
‫ﺋﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻋﻢ‬
‫ﺪ‬‫ﻟ‬‫ﺍ‬
-7
:
Flui
dandel
ect
rol
ytechangei
ntheacut
ephase
Expl anation Obser vat
ion
Bloodcel l concentrat i
oni sdilut
edasf luident ers Hemdi lut
ion
thei ntrav
ascul arcompar t
ment ,l
ossofr edbl ood (decreased
cellsdest royedatbur nsi t
e. hemat ocri
t)
Fluidshi f
ti ntoint
rav ascularcompar tment I
ncreasedur i
nar
y
i
ncr easesr enalbl
oodf lowandcausesi ncreased output
urinef ormat ion.
Wi thdiuretics,sodium i slostwi t
hwat er;existing Sodi
um (
Na+)def
ici
t
serum sodi um isdil
ut edbywat erinf
lux.
Begi nningont hefour thorf if
thpostbur nday, K+ Pot
assium (
K+)
shiftfrom ext racell
ul arflui
di nt
ocells def
ici
t
Lossofsodi um depl etesf i
xedbase; r
elative Metaboli
caci
dosi
s
carbondi oxi decont enti ncrease.

Wounddr essing:
Defi
niti
onofwounddr essing:
It
'sacleanofbur nedar eaandpr escribedt opi
calagentisappliedandwound
coverwithseverallayersofdr essi
ng.
Purposeofwounddr essi ng:
1-Topr ot
ectthewoundf r
om anyi nfecti
on.
2-Toimmobi li
zedt hewound.
3-Todepr i
dethewoundf rom anydeadt issues.
4-Toinhabitorkillmicroorganism byusi ngdressingwithantisepticpr opert
ies.
5-Topr ovi
depatientwi thphy si
calcomf ortabl
e.
:‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻴ‬‫ﻤ‬‫ﺗﻀ‬
:
‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﺪ‬ ‫ﻴ‬‫ﻤ‬
‫ﻳﻒﺗﻀ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
‫ﺎﺕﻣﻦ‬‫ﻘ‬‫ﺒ‬
‫ﺓﻃ‬ ‫ﺪ‬‫ﻌ‬‫ﺮﺡﺑ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻐﻄ‬‫ﺗ‬
‫ﻮﻑﻭ‬ ‫ﻮﺻ‬ ‫ﻌﻲﻣ‬ ‫ﻮﺿ‬‫ﻣﻞﻣ‬‫ﺎ‬‫ﻊﻋ‬‫ﺘﻢﻭﺿ‬ ‫ﻳ‬‫ﺔﻭ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﺔﻣﺤ‬ ‫ﻔ‬‫ﻴ‬
‫ﺔﻧﻈ‬ ‫ﻘ‬‫ﻨﻄ‬‫ﺎﻣ‬‫ﻬ‬‫ﻧ‬
‫ﺇ‬
.
‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬
:‫ﺮﺡ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺪ‬‫ﻴ‬
‫ﻤ‬‫ﺮ ﺽﻣﻦﺗﻀ‬ ‫ﻐ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻭﻯ‬‫ﺪ‬‫ﺃﻱﻋ‬ ‫ﺮﺡﻣﻦ‬‫ﻟﺠ‬ ‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻤ‬‫ﻟﺤ‬-1
.‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﺖ‬‫ﺒ‬‫ﺜ‬‫ﺗ‬-2
.
‫ﺔ‬‫ﺘ‬‫ﻴ‬‫ﺔﻣ‬‫ﻧﺴﺠ‬‫ﺃ‬‫ﺃﻱ‬ ‫ﺮﺡﻣﻦ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺮ‬
‫ﺗﺠ‬- 3
.
‫ﺓ‬‫ﺮ‬‫ﻬ‬
‫ﻤﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﺋﺺ‬ ‫ﺎ‬‫ﻟﺨﺼ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺍﺕﺫ‬
‫ﺩ‬ ‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬
‫ﺔﺑ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﺋ‬‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﺘﻞ‬‫ﻭﻗ‬ ‫ﺃ‬‫ﻴﻦ‬‫ﻜ‬
‫ﺗﺴ‬- 4
.‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻳ‬ ‫ﺪ‬‫ﻟﺠﺴ‬‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬-5

Typesofwounddressi
ng:
1-Exposuremet
hod
2-Occlusi
vemet
hod
:
‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺪ‬ ‫ﻴ‬
‫ﻤ‬‫ﺍﻉﺗﻀ‬‫ﻮ‬
‫ﻧ‬‫ﺃ‬
‫ﺮﺽ‬ ‫ﻌ‬
‫ﺘ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻳ‬‫ﺮ‬‫ﻃ‬-
1
‫ﺩ‬
‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍﻻ‬‫ﺔ‬‫ﻘ‬
‫ﻳ‬‫ﺮ‬‫ﻃ‬-
2
Exposuremethod:
Defini
ti
on:
Thewoundi st
reat
edbyexposingi
ttoai
r,butnodr
essi
ngappl
i
ed.
Precauti
onofexposedmethod:

243
-Keepingtheimmedi at
eenv i
ronmentf reefrom mi croorganisms.
-Everythi
ngcomi ngincontactwi t
ht hePat ientmustbest eri
le(l
i
nen) .
-I
nst r
uctvisi
torstowearoper ativegownandnott oucht hebedorhandt he
pati
entoranyt hings.
-Thepat i
ent’
sroom mustbecomf ort
abl ywar m with40%t o50%humi dityto
preventexcessiveevaporat
ive.
:‫ﺮﺽ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻳ‬‫ﺮ‬
‫ﻃ‬
:
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
.‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻭﻥ ﺿ‬‫ﺪ‬‫ﻜﻦﺑ‬‫ﻟ‬‫ﻭ‬،‫ﺀ‬‫ﺍ‬‫ﻮ‬‫ﻬ‬‫ﻠ‬‫ﻟ‬
‫ﻪ‬‫ﻳﻀ‬‫ﺮ‬‫ﻌ‬‫ﺘ‬‫ﺮﺡﺑ‬‫ﻟﺠ‬‫ﺍ‬‫ﺘﻢﻋﻼﺝ‬ ‫ﻳ‬
:
‫ﺔ‬ ‫ﻓ‬‫ﻮ‬‫ﻜﺸ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻳ‬‫ﺮ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺮﻣﻦ‬ ‫ﻳ‬‫ﺬ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺍ‬
.‫ﺔ‬‫ﻘ‬‫ﻴ‬
‫ﻗ‬ ‫ﺪ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﺋ‬
‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺓﺧ‬ ‫ﺮ‬‫ﺎﺷ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﻴ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬-
.
(‫ﺎﻥ‬‫ﺘ‬‫ﻛ‬)‫ﻘﻢ‬‫ﻌ‬‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﺲ‬ ‫ﺀﻳﻼ‬‫ﻮﻥﻛﻞﺷﻲ‬ ‫ﻜ‬‫ﺃﻥﻳ‬ ‫ﻳﺠﺐ‬-
.
‫ﺀ‬‫ﺃﻱﺷﻲ‬ ‫ﻭ‬‫ﺃ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻠ‬‫ﻭﺗﺴ‬‫ﺃ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻤﺲ‬ ‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺎﺕﻭﻋ‬ ‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺍ‬
‫ﺩ‬‫ﺀﺭ‬‫ﺍ‬
‫ﺪ‬‫ﺗ‬‫ﺭ‬‫ﻳﻦﻻ‬‫ﺮ‬‫ﺋ‬‫ﺍ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺎ‬‫ﺭﺷ‬‫ﺇ‬-
.
‫ﺮﻁ‬ ‫ﻔ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﺒﺨ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬
‫ﻨ‬‫ﻤ‬‫ﻟ‬٪
50‫ﻟﻰ‬ ‫ﺇ‬٪40‫ﺔ‬ ‫ﺑ‬‫ﻮ‬
‫ﻊﺭﻃ‬ ‫ﻳﺢﻣ‬‫ﺮ‬‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬‫ﺌ‬‫ﻓ‬‫ﺍ‬
‫ﻳ ﺾﺩ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬
‫ﻮﻥﻏ‬ ‫ﻜ‬‫ﺃﻥﺗ‬ ‫ﻳﺠﺐ‬-

Occl usi vedr essi ng:

Anoccl usi vedr essi ngi sthingauzet hati sei therimpr egnat edwi thtopi cal
antimi cr obial agentort hatappl i
edaf tertopi cal antimi crobial application.
Techni queofwounddr essingchanges:
1-Thedr essi ngchangedi nthepat i
ent '
suni t,hy drother apyr oom ort reat ment
areaappr oximat ely20mi nutesaf teranal gesi cagenti sadmi nistered.
2-Amask, haircov er,di sposablepl ast i
capr onorcov ergownandgl ovesar e
wor nbyheal thcar eper sonnel whenr emov ingt hedr essi ng.
3-Theout erdr essi ngar eremov edanddi sposed.
4-Dr essi ngt hatadher et othewoundcanber emov edmor ecomf ortablyi fthey
aremoi stenedwi tht apwat erorift hepat ienti sal lowedt osoakf oraf ew
momenti nt het ub.
:
‫ﺩ‬‫ﺍ‬‫ﺪ‬‫ﻧﺴ‬‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﺿ‬
‫ﻴﻖ‬ ‫ﺒ‬‫ﺪﺗﻄ‬ ‫ﻌ‬
‫ﻊﺑ‬ ‫ﻮﺿ‬ ‫ﻭﻳ‬ ‫ﺃ‬‫ﺎﺕ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﻜ‬ ‫ﻴ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﺩ‬
‫ﺎ‬‫ﻌﻲﻣﻀ‬ ‫ﻮﺿ‬ ‫ﻣﻞﻣ‬ ‫ﺎ‬‫ﻌ‬‫ﺮﺏﺑ‬ ‫ﺎﻣﺸ‬ ‫ﻣ‬‫ﻴﻖﺇ‬ ‫ﻗ‬‫ﺎﺵﺭ‬ ‫ﺓﻫﻲﺷ‬ ‫ﺩ‬‫ﻭ‬‫ﺪ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬
.
‫ﺔ‬ ‫ﻴ‬
‫ﻌ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﻭ‬‫ﺮ‬‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬‫ﺎ‬
‫ﻣﻀ‬
:‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬ ‫ﺪ‬‫ﻴ‬
‫ﻤ‬‫ﺔﺗﻀ‬ ‫ﻴ‬‫ﻨ‬‫ﻘ‬‫ﺮﺗ‬‫ﻴ‬‫ﻴ‬
‫ﻐ‬‫ﺗ‬
‫ﺔ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺩ‬20‫ﻟﻲ‬ ‫ﺍ‬‫ﻮ‬‫ﺪﺣ‬ ‫ﻌ‬‫ﻌﻼﺝﺑ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﻭﻣ‬ ‫ﺃ‬‫ﺋﻲ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬ ‫ﺮ‬‫ﻭﻏ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬‫ﺪ‬‫ﺓﻓﻲﻭﺣ‬ ‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﻢﺗ‬-‫ﺗ‬1
.‫ﻜﻦ‬ ‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻣﻞ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻣﻦﺇﻋﻄ‬
‫ﺰﻉ‬‫ﺪﻧ‬ ‫ﻨ‬‫ﺍﺕﻋ‬ ‫ﺯ‬‫ﺎ‬‫ﻔ‬‫ﻗ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻗ‬‫ﺍ‬‫ﺓﻭ‬ ‫ﺀ‬‫ﺎ‬
‫ﺒ‬‫ﻭﻋ‬ ‫ﺃ‬‫ﺎ‬ً
‫ﻴ‬
‫ﻜ‬‫ﻴ‬‫ﺘ‬‫ﺍﺑﻼﺳ‬ ً
‫ﺭ‬‫ﺰ‬‫ﺌ‬
‫ﻣ‬ ‫ﺮﻭ‬‫ﻌ‬‫ﺀﺷ‬ ‫ﺎ‬‫ﺎﻭﻏﻄ‬ ً
‫ﻋ‬‫ﺎ‬‫ﻨ‬‫ﺔﻗ‬ ‫ﻴ‬‫ﻟﺼﺤ‬ ‫ﺍ‬ ‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺮ‬‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻔ‬‫ﻮﻇ‬ ‫ﺪﻱﻣ‬ ‫ﺗ‬‫ﺮ‬‫ﻳ‬-
2
.‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬
.‫ﺎ‬
‫ﻬ‬‫ﻨ‬‫ﻠ ﺺﻣ‬ ‫ﺘﺨ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻴ‬‫ﺭﺟ‬‫ﺎ‬‫ﻟﺨ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬ ‫ﺰﻉ‬‫ﻧ‬-
3
‫ﻤﺢ‬ ‫ﺍﺳ‬ ‫ﺫ‬
‫ﻭﺇ‬ ‫ﺃ‬‫ﺭ‬‫ﻮ‬‫ﺒ‬‫ﻨ‬‫ﻟﺼ‬ ‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻤ‬‫ﻪﺑ‬ ‫ﺒ‬
‫ﻴ‬‫ﺮﻃ‬‫ﺍﺗﻢﺗ‬‫ﺫ‬‫ﺔﺇ‬‫ﺍﺣ‬‫ﺮﺭ‬ ‫ﺜ‬‫ﻛ‬‫ﺃ‬‫ﻜﻞ‬ ‫ﺮﺡﺑﺸ‬ ‫ﻟﺠ‬ ‫ﺎ‬‫ﺘﺼﻖﺑ‬ ‫ﻠ‬‫ﺬﻱﻳ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬ ‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﻜﻦﺇ‬ ‫ﻤ‬‫ﻳ‬-
4
.‫ﻮﺽ‬ ‫ﻟﺤ‬ ‫ﺍ‬‫ﺋﻖﻓﻲ‬ ‫ﺎ‬‫ﻗ‬‫ﻊﺩ‬ ‫ﺒﻀ‬‫ﻟ‬‫ﻊ‬‫ﻘ‬‫ﻨ‬‫ﻟ‬‫ﺎ‬
‫ﻳ ﺾﺑ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬
5-Thedr essi ngi scar efullyandgent lyremov ed.
6-Thewoundst hencl eanedanddebr idedt or emov edebr i
s, anyr emai ning
topical agent ,exudat es, anddeadski n.
7-Dur ingt hispr ocedur ethewoundandsur r
oundi ngski nar ecar efull
yi nspect ed
8-Inspectt hecol or, odorsi ze,exudat es, signsofr e- epi thelizat ion,andeschar .
9-Topi cal agenti sappl iedandwoundcov erwi thsev er al l
ay er sofdr essi ng.
10-Tr ansf erthepat ientt ohisbed.
.‫ﻓﻖ‬ ‫ﺭ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﺎ‬‫ﻨ‬‫ﻌ‬‫ﺓﺑ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺘﻢﺇ‬ ‫ﻳ‬-
5
‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬
‫ﺍﺕﻭ‬ ‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬‫ﺍﻹ‬‫ﺔﻭ‬ ‫ﻴ‬ ‫ﻌ‬
‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺎﻣﻦ‬‫ﻳ‬‫ﺎ‬‫ﻘ‬‫ﺃﻱﺑ‬‫ﺎﺕﻭ‬ ‫ﻔ‬‫ﻠ‬‫ﻤﺨ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺯﺔ‬
‫ﻟ‬
‫ﺎﻹﺍ‬ ‫ﻬ‬ ‫ﺘ‬
‫ﻴ‬‫ﻘ‬‫ﻨ‬‫ﺗ‬‫ﻭﺡﻭ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻨﻈ‬‫ﺘﻢﺗ‬ ‫ﺛﻢﻳ‬-6
.‫ﻴﺖ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
‫ﺔ‬ ‫ﻳ‬
‫ﺎ‬‫ﻨ‬
‫ﻌ‬ ‫ﻪﺑ‬‫ﻴﻂﺑ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺮﺡﻭ‬ ‫ﻟﺠ‬ ‫ﺍ‬‫ﺘﻢﻓﺤ ﺺ‬ ‫ﺀﻳ‬ ‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬ ‫ﺍ‬‫ﺬ‬‫ﺧﻼﻝﻫ‬- 7

244
 .
‫ﺭ‬‫ﺎ‬
‫ﻜﺴ‬‫ﻟ‬
‫ﺍ‬
‫ﺭﻱﻭ‬
‫ﺎ‬‫ﻬ‬‫ﻟﻈ‬
‫ﺍ‬‫ﻮﻥ‬
ّ
ُ
‫ﻜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﺎﺕﺇﻋ‬
‫ﻣ‬‫ﺍﺕﻭﻋﻼ‬‫ﺯ‬
‫ﺍ‬‫ﺮ‬‫ﻓ‬
‫ﺍﻹ‬‫ﺔﻭ‬‫ﺋﺤ‬
‫ﺍ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥﻭﺣﺠﻢ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍ‬
‫ﻓﺤ ﺺ‬-8
.‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺎﺕﻣﻦ‬‫ﻘ‬‫ﺒ‬
‫ﺓﻃ‬‫ﺪ‬‫ﻌ‬‫ﺮﺡﺑ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺔ‬‫ﻴ‬‫ﻐﻄ‬‫ﺗ‬‫ﻌﻲﻭ‬‫ﻮﺿ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻣﻞ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﺘﻢﻭﺿ‬‫ﻳ‬-9
.‫ﻪ‬
‫ﺍﺷ‬‫ﺮ‬‫ﻟﻰﻓ‬‫ﻳ ﺾﺇ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻘﻞ‬
‫ﻧ‬-10

3-Hy dr otherapy:
Isthebat hi
ngoft heburnpatienti
nat ubofwat erorwi thawatershowerto
facil
itatecleansinganddepr i
dementoft heburnedar ea.
Adv ant ages:
1-Topi cal medicati
ons,adherentdressi
ng,andescharar emoreeasi
lyremoved.
2-Pr ovidesanoppor tunit
yforthepat i
entt
opr acti
cer angeofmotionexerci
ses.
3-Tot al assessmentofthebur nareaisfaci
li
tated;totalbodycl
eansingcanbe
achiev ed.

Disadv antages:
1-Lossofbodyheat ;andl ossofsodi um.
2-Uncomf ort
ableandatt imespai nfulforpatient.
3-Mai ntenanceofI Vl i
nesandv ent i
latorcaremaybedi fficultduringt ubing.
4-Thepat i
ent'
sanxi etylevel ofteni ncreases.
:
‫ﺋﻲ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬-3
‫ﺯ‬‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺇ‬‫ﻴﻒﻭ‬‫ﻨﻈ‬‫ﻴﻞﺗ‬‫ﻬ‬‫ﺘﺴ‬‫ﻟ‬‫ﺋﻲ‬‫ﺎ‬‫ﺪﺵﻣ‬ ‫ﻭﺑ‬‫ﺃ‬‫ﺀ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮ ﺽﻣﻦ‬ ‫ﺮﻕﻓﻲﺣ‬ ‫ﻟﺤ‬‫ﺎ‬‫ﺎﺏﺑ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬‫ﻡ‬‫ﺎ‬‫ﻤ‬‫ﺘﺤ‬‫ﺍﻻﺳ‬‫ﺘﻢ‬‫ﻳ‬
.‫ﺔ‬‫ﻗ‬‫ﻭ‬‫ﺮ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻘ‬
‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
:‫ﺎ‬
‫ﻳ‬‫ﺍ‬
‫ﺰ‬‫ﻣ‬
.
‫ﺮ‬‫ﺒ‬‫ﻛ‬‫ﺃ‬‫ﺔ‬‫ﻟ‬
‫ﻮ‬ ‫ﻬ‬
‫ﺎﺑﺴ‬ ‫ﻬ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬‫ﻜﻦﺇ‬ ‫ﻤ‬
‫ﺔﻳ‬ ‫ﻳ‬‫ﺭ‬
‫ﺎ‬‫ﻟﺨﺸ‬‫ﺍ‬‫ﺔﻭ‬‫ﻘ‬‫ﺍﻼﺻ‬‫ﺍﺕﻟ‬ ‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬-1
.‫ﺔ‬
‫ﻛ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺔﻣﻦﺗ‬ ‫ﻋ‬‫ﻮ‬‫ﻤ‬‫ﺔﻣﺠ‬ ‫ﺭﺳ‬‫ﺎ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﺮﺻ‬ ‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺢ‬‫ﺘ‬‫ﻳ‬-2
.
‫ﻠﺠﺴﻢ‬ ‫ﻟ‬‫ﻣﻞ‬ ‫ﺎ‬
‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﻬ‬‫ﺘﻄ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻖ‬‫ﻘ‬‫ﻜﻦﺗﺤ‬ ‫ﻤ‬‫؛ﻳ‬‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﻣﻞ‬ ‫ﺎ‬‫ﻟﺸ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻬ‬‫ﺗﺴ‬-3
:‫ﺎﺕ‬‫ﻴ‬‫ﺒ‬
‫ﻠ‬‫ﺳ‬
.‫ﻡ‬‫ﻮ‬
‫ﻳ‬‫ﺩ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬ ‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬‫ﻭ‬.‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻥﺣ‬ ‫ﺪ‬‫ﻘ‬‫ﻓ‬-1
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬‫ﻟﻢ‬‫ﺆ‬‫ﺎﻣ‬
ً‫ﻧ‬
‫ﺎ‬‫ﻴ‬‫ﺃﺣ‬‫ﻋﺞﻭ‬ ‫ﺰ‬‫ﻣ‬-2
.
‫ﻴﺐ‬ ‫ﺑ‬
‫ﺎ‬‫ﻧ‬
‫ﺍﻷ‬‫ﺀ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬
‫ﺔ‬ ‫ﺒ‬
‫ﻌ‬‫ﻋﻲ ﺻ‬ ‫ﺎ‬‫ﻨ‬
‫ﻟﺼ‬ ‫ﺍ‬‫ﻔﺲ‬ ‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺯ‬‫ﺎ‬
‫ﻬ‬‫ﺔﺑﺠ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺪﻭ‬ ‫ﻳ‬‫ﺭ‬
‫ﻮ‬ ‫ﻟ‬‫ﺍ‬
‫ﻮﻁ‬ ‫ﺔﺧﻄ‬ ‫ﻧ‬‫ﺎ‬
‫ﻴ‬‫ﻮﻥ ﺻ‬ ‫ﻜ‬‫ﺪﺗ‬‫ﻗ‬-3
.‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪﻯ‬ ‫ﻟ‬
‫ﻠﻖ‬ ‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬ ‫ﺘ‬‫ﺩﻣﺴ‬ ‫ﺍ‬
‫ﺩ‬‫ﺰ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
‫ﺒ‬‫ﻟ‬
‫ﺎ‬- 4
Wounddepr i
dement :
Definit
ion:
Isar emov alofforeignmat erialthatsur roundingheal thtissue.
Goal sofdepr i
dement :
-Tor emov etissuecont ami nat edbybact eriaandf oreignbodi est hereby
protectingthepatientf r
om i nv asionofbact eri
a.
-Tor emov edev i
tali
zedt issueorbur neschari npr eparationf orgr aft
ingand
woundheal i
ng.

Typesofdepridement(
SeeFi
g.42):
1-Nat
ural.
2-Mechanical
.
3-Sur
gical
.
:
‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻒ‬‫ﻔ‬‫ﺗﺠ‬
:
‫ﻳﻒ‬ ‫ﺮ‬
‫ﻌ‬‫ﺗ‬
.‫ﺔ‬‫ﻴ‬
‫ﻟﺼﺤ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺎﻷ‬
‫ﻴﻂﺑ‬
‫ﺘﻲﺗﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻳ‬‫ﺮ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬
‫ﺍ‬‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺍ‬‫ﺯ‬
‫ﻫﻲﺇ‬
:
‫ﺍﻑ‬‫ﺰ‬‫ﻨ‬‫ﺘ‬
‫ﺍﻻﺳ‬‫ﺍﻑ‬‫ﺪ‬‫ﺃﻫ‬
.
‫ﺎ‬‫ﻳ‬
‫ﺮ‬‫ﻴ‬‫ﺘ‬
‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺰ‬
‫ﻳ ﺾﻣﻦﻏ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻲﺣ‬‫ﺎ‬
‫ﻭﺘ‬
‫ﻟ‬
‫ﺎ‬‫ﺔﺑ‬‫ﺒ‬‫ﻳ‬
‫ﺮ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺍﻷﺟﺴ‬‫ﺎﻭ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺎ‬
‫ﺔﺑ‬‫ﺛ‬
‫ﻮ‬‫ﻠ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺔ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬-
‫ﺇ‬
.
‫ﻭﺡ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬
‫ﺎ‬‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬‫ﻌ‬
‫ﺘﻄ‬‫ﻠ‬‫ﻟ‬
‫ﺍ‬ً
‫ﺩ‬‫ﺍ‬
‫ﺪ‬‫ﻌ‬‫ﺘ‬
‫ﺍﺳ‬‫ﺎﺵ‬‫ﻟﺨﺸﺨ‬‫ﺍ‬‫ﺮﻕ‬‫ﻭﺣ‬‫ﺃ‬‫ﺔ‬‫ﺘ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺯﺔ‬
‫ﻟ‬
‫ﻹﺍ‬-

245
 :
(42‫ﻜﻞ‬
‫ﻟﺸ‬‫ﺍ‬
‫ﺮ‬‫ﻧﻈ‬
‫ﺍ‬)‫ﺮﻑ‬‫ﻟﺼ‬‫ﺍ‬‫ﺍﻉ‬‫ﻮ‬
‫ﻧ‬‫ﺃ‬
.
‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻃ‬-
1
.
‫ﻜﻲ‬‫ﻴ‬‫ﻧ‬
‫ﺎ‬‫ﻜ‬
‫ﻴ‬‫ﻣ‬-2
.‫ﺍﺣﻲ‬‫ﺮ‬‫ﺟ‬-
3
Naturaldepr idement:
Thedeadt i
ssuesepar at
edfrom t
heunderly
ingvi
abletissuespontaneousl
y.
Mechani caldebr i
dement:
-Usingsur gicalsci
ssorsandfor
cepstoseparat
eandr emov etheeschar.
-Thistechni quecanbeper f
ormedbyskil
ledphysi
cians,nursesordonewith
dai
lydressi ngchangesandwoundcl eani
ngprocedures.

Surgi
caldebri
dement :
Isoperat
ivepr
ocedur einvol
vi
ngeitherpri
mar
yexci
sion(surgi
cal
removalof
ti
ssue)ofthefullt
hicknessoftheskindowntot
hefasciaor
shavi
ngthebur nedskinlayer
sgraduall
ydowntofr
eelybleedi
ngvi
abl
etissue.

:
‫ﻌﻲ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﺍﻑ‬‫ﺰ‬‫ﻨ‬
‫ﺘ‬‫ﺍﻻﺳ‬
.‫ﺓ‬
‫ﺎ‬‫ﻴ‬‫ﻠﺤ‬
‫ﻟ‬‫ﺔ‬‫ﻠ‬
‫ﺑ‬‫ﺎ‬
‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﻋﺍﻷ‬
‫ﺎﻦ‬ً
‫ﻴ‬‫ﺋ‬
‫ﺎ‬‫ﻘ‬‫ﻠ‬
‫ﻴﺖﺗ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﺞ‬ ‫ﻨﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻔﺼﻞ‬‫ﻨ‬‫ﻳ‬
:
‫ﻜﻲ‬ ‫ﻴ‬
‫ﻧ‬‫ﺎ‬‫ﻜ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻨﻀ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﺮ‬
‫ﻟﺼﺨ‬ ‫ﺍ‬
‫ﺔ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺯ‬‫ﺇ‬‫ﻔﺼﻞﻭ‬‫ﻟ‬‫ﺍﺣﻲ‬‫ﺮ‬
‫ﻘﻂﺟ‬ ‫ﻠ‬‫ﻣ‬
‫ﻘ ﺺﻭ‬ ‫ﻡﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬-
‫ﺔ‬
‫ﻴ‬‫ﻣ‬‫ﻮ‬
‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﺍﺕ‬‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻡﺑ‬‫ﺎ‬
‫ﻴ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺓ‬
‫ﺮ‬‫ﻬ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺮﺿ‬‫ﻤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀﻭ‬‫ﺎ‬
‫ﺒ‬‫ﺍﻷﻃ‬‫ﺒﻞ‬
‫ﺔﻣﻦﻗ‬ ‫ﻴ‬
‫ﻨ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﺬﻫ‬ ‫ﻴ‬‫ﻔ‬
‫ﻨ‬‫ﻜﻦﺗ‬‫ﻤ‬‫ﻳ‬-
.
‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻴﻒ‬ ‫ﻨﻈ‬‫ﺍﺕﺗ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺇﺟ‬‫ﻭ‬

:
‫ﺍﺣﻲ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻨﻀ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﻰ‬
‫ﻮﻻًﺇ‬
‫ﺪﻭﺻ‬
‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻤﻚ‬‫ﻣﻞﺳ‬‫ﺎ‬
‫ﻜ‬‫ﻟ‬(
‫ﻴﺞ‬‫ﻨﺴ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﺍﺣ‬
‫ﺮ‬‫ﺔﺟ‬
‫ﻟ‬‫ﺍ‬
‫ﺯ‬‫ﺇ‬
)‫ﻟﻲ‬
‫ﻭ‬‫ﺃ‬‫ﺎﻝ‬‫ﺌﺼ‬
‫ﺘ‬‫ﺍﺳ‬‫ﺎ‬
‫ﻣ‬‫ﻤﻞﺇ‬‫ﺍﺣﻲﻳﺸ‬‫ﺮ‬‫ﺀﺟ‬‫ﺍ‬
‫ﺮ‬‫ﻮﺇﺟ‬‫ﻫ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻓ‬
‫ﺎ‬‫ﻔ‬‫ﻠ‬
‫ﻟ‬
‫ﺍ‬
.
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﺰﻑﺑﺤ‬‫ﻨ‬
‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻠ‬‫ﺑ‬
‫ﺎ‬‫ﺔﻗ‬‫ﻧﺴﺠ‬
‫ﺃ‬‫ﻟﻰ‬
‫ﻮﻻًﺇ‬‫ﺎﻭﺻ‬ً
‫ﻴ‬‫ﻳﺠ‬
‫ﺭ‬‫ﺪ‬‫ﺔﺗ‬
‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﺎﺕ‬‫ﻘ‬‫ﺒ‬
‫ﻠﻖﻃ‬ ‫ﺣ‬

(
Fig.42)Debr
idement

Disordersofwoundheal ing:
1.Scaring: hy
pertrophyscarsandwoundcontr
actures
2.Keloids: Alar
ge, heaped-upmawofscarti
ssue,kel
oidmaydev
elopand
extendt hewound
3.Fail
uret ohealrelatedtomanyfact
orsi
ncl
uding
-I
nfecti
on.
-I
nadequat ematurat i
on.

246
-Ser
um Al
buminlev
elofl
esst
han29/
dl.
4.Cont
ract
ors.
:
‫ﻭﺡ‬ ‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬
‫ﺍ‬‫ﺮ‬‫ﺍﺿﻄ‬
‫ﺮﺡ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻠﺼ‬‫ﻘ‬‫ﺗ‬
‫ﺎﺕﺗﻀﺨﻢﻭ‬ ‫ﺑ‬
‫ﺪ‬ ‫ﻧ‬:
‫ﻳﻒ‬ ‫ﻮ‬‫ﺘﺨ‬‫ﻟ‬‫ﺍ‬
.1
‫ﺮﺡ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻤ‬
‫ﺗ‬‫ﺓﻭ‬‫ﺭ‬‫ﺪ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺭ‬‫ﻮ‬‫ﺘﻄ‬‫ﺪﺗ‬‫ﻗ‬:‫ﺓ‬‫ﺭ‬‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬
.2
‫ﺎ‬
‫ﻬ‬‫ﻨ‬‫ﻣﻞﻣ‬‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻣﻦ‬‫ﻳ‬‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺎ‬
‫ﻭﺡﺑ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻡ‬‫ﺎ‬‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﺒﻂﻋ‬ ‫ﺗ‬‫ﺮ‬
‫ﻳ‬.3
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﻋ‬-
.‫ﻓﻲ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬
‫ﻨﻀﺞﻏ‬ ‫ﻟ‬‫ﺍ‬-
.
‫ﺮ‬‫ﺘ‬‫ﻠ‬
‫ﻴ‬‫ﻳﺴ‬
‫ﺩ‬/29‫ﻗﻞﻣﻦ‬ ‫ﺃ‬‫ﻤﺼﻞ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻓﻲ‬‫ﻣ‬ ‫ﻮ‬‫ﺒ‬
‫ﻟ‬‫ﺍﻷ‬‫ﻮﻯ‬‫ﺘ‬‫ﻣﺴ‬-
.
‫ﻴﻦ‬ ‫ﻟ‬
‫ﻭ‬‫ﺎ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
.4
Infectioncont rolinbur nedpat ient:
1.Moni toringforcl inicalmani festati
onofi mpendi nginfecti
on,andsepsi s.
2.Mai nt enanceofcl eanenv i
ronmentt oreducet her eservoi
rofmi cr
oor gani
sms,
through:
-Decr easenumberofv i
sitors.
-Av oi
dpl antinpat i
entr oom.
3.Useofasept ictechni quef orallinvasi
vepr oceduresandwoundcar e.
4.Timel yadmi ni str
at i
onofpr escri
bedant imicrobi
al agentssystemicand
topical.Uni versal precaut ionsshoul dbef ol
lowedwhencar i
ngallcli
entswi t
h
burni njuries.
Thebasi cpr inciplesf ori nfecti
oncont rolshouldbef ol
lowedinbur nsuni t
:-
Useant imi cr
obi alagent satt hebur nwound.
-Cap, gown, mask, andgl ovesar ewor nwhi l
ecar i
ngf orthepati
entwi thopen
burnwounds.
-Usecl eant echni quewhencar ingdirectl
yf orburnwounds.

:
‫ﺮﻕ‬ ‫ﺘ‬
‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻭﻯﻓﻲ‬ ‫ﺪ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻓﺤ‬‫ﺎ‬‫ﻜ‬‫ﻣ‬
.
‫ﺎﻥ‬‫ﺘ‬‫ﻧ‬‫ﺍﻹ‬‫ﻭ‬، ‫ﺔ‬‫ﻜ‬
‫ﻴ‬‫ﻮﺷ‬ ‫ﻟ‬‫ﺍ‬‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺮ‬‫ﺎﻫ‬
‫ﻤﻈ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬‫ﺮ‬
‫ﻣ‬. 1
:‫ﻟﻚﻣﻦﺧﻼﻝ‬ ‫ﺫ‬‫ﺔﻭ‬‫ﻘ‬‫ﻴ‬‫ﻗ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻨ‬
‫ﺋ‬‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻥ‬ ‫ﺰ‬‫ﻴﻞﻣﺨ‬ ‫ﻠ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺔ‬‫ﺌ‬‫ﻴ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺎ‬‫ﻠﻰﻧﻈ‬‫ﺔﻋ‬ ‫ﻓﻈ‬‫ﺎ‬‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬.2
.‫ﺭ‬‫ﺍ‬‫ﻭ‬
‫ﺰ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻴﻞﻋ‬ ‫ﻠ‬
‫ﻘ‬‫ﺗ‬-
.‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻓ‬‫ﺮ‬‫ﺎﺕﻓﻲﻏ‬ ‫ﺒ‬‫ﻨ‬
‫ﻟ‬
‫ﺍ‬ ‫ﻨﺐ‬ ‫ﺗﺠ‬-
.‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻳ‬‫ﺯ‬‫ﺎ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬‫ﺮ‬‫ﺍﻹﺟ‬‫ﻊ‬‫ﻴ‬‫ﻤ‬‫ﻟﺠ‬‫ﻴﻢ‬‫ﻘ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻨ‬
‫ﻘ‬‫ﻡﺗ‬ ‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ .3
‫ﻳﺠﺐ‬. ‫ﺎﺳﺐ‬‫ﻨ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻌﻲﻓﻲ‬ ‫ﻮﺿ‬ ‫ﻣ‬‫ﻬﺠﻲﻭ‬ ‫ﻨ‬
‫ﻜﻞﻣ‬ ‫ﺔﺑﺸ‬ ‫ﻓ‬
‫ﻮ‬ ‫ﻮﺻ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﻜ‬
‫ﻴ‬‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻤﻀ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺩ‬‫ﺍﻷ‬‫ﺀ‬‫ﺎ‬‫ﻋﻄ‬ ‫ﺇ‬.4
.‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺑ‬
‫ﺎ‬‫ﻮﻥﻣﻦﺇﺻ‬ ‫ﻧ‬‫ﺎ‬
‫ﻌ‬‫ﻳﻦﻳ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﻤﻼ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻴ‬
‫ﻤ‬‫ﺔﺟ‬ ‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺪﺭ‬‫ﻨ‬‫ﺔﻋ‬ ‫ﻣ‬‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﺎﻃ‬‫ﻴ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﺎﻉ‬‫ﺒ‬‫ﺗ‬
‫ﺍ‬
:
‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻭﻯﻓﻲﻭﺣ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻓﺤ‬‫ﺎ‬‫ﻜ‬‫ﻤ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺍﻷﺳ‬‫ﺩﺉ‬ ‫ﺎ‬
‫ﺒ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﻉ‬‫ﺒ‬‫ﺗ‬
‫ﺍ‬ ‫ﻳﺠﺐ‬
.
‫ﺮﻕ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺮﺡ‬‫ﻠﻰﺟ‬ ‫ﺎﺕﻋ‬ ‫ﺑ‬
‫ﻭ‬‫ﺮ‬‫ﻜ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺩ‬
‫ﺎ‬‫ﻡﻣﻀ‬ ‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬-
.‫ﺔ‬‫ﻮﺣ‬‫ﺘ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻭﺡ‬ ‫ﺮ‬‫ﺎﺏﺑﺠ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﺀﺭﻋ‬ ‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﺍﺕ‬‫ﺯ‬‫ﺎ‬‫ﻔ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﻉﻭ‬ ‫ﻨ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﺓﻭ‬‫ﺀ‬‫ﺎ‬‫ﺒ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬ ‫ﻌ‬‫ﺒ‬
‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﺍ‬‫ﺪ‬‫ﺗ‬‫ﺭ‬‫ﺍ‬‫ﺘﻢ‬‫ﻳ‬-
.‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻭﺡ‬ ‫ﺮ‬‫ﺓﺑﺠ‬‫ﺮ‬‫ﺎﺷ‬ ‫ﺒ‬
‫ﺔﻣ‬ ‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﻴﻒﻋ‬ ‫ﻨﻈ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬
‫ﻨ‬‫ﻘ‬‫ﻡﺗ‬ ‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬-
Nutri
ti
onalsuppor tforbur npat i
ent:
Note:Nutri
ti
onal suppor tconsistsofthreecl osel ylinkedcomponent s:-
-Assessmentofnut ri
ti
onal requir
ement s.
-Pl
anningandi mpl ement ati
onofdi etaryr egimens.
-Monitori
ngtheadequacyoft henut ri
entspr ov i
ded.
Note:Maintenanceofadequat enutri
ti
ondur ingt heacut ephasei sinpr omot ing
woundheal i
ngandpr event i
nginfecti
on.
:
‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺋﻲ‬ ‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻋﻢ‬ ‫ﺪ‬‫ﻟ‬
‫ﺍ‬
-:‫ﺎ‬
ً
‫ﻘ‬‫ﻴ‬‫ﺛ‬‫ﺎﻭ‬ً‫ﺎ‬
‫ﻃ‬‫ﺒ‬‫ﺗ‬‫ﺭ‬
‫ﺍ‬‫ﺔ‬‫ﺒﻄ‬‫ﺗ‬‫ﺮ‬‫ﺎﺕﻣ‬ ‫ﻧ‬‫ﻮ‬‫ﻜ‬‫ﻼﺔﻣ‬‫ﺋﻲﻣﻦﺛﺛ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬ ‫ﺘ‬‫ﻳ‬:‫ﺔ‬‫ﻮﻇ‬ ‫ﻠﺤ‬‫ﻣ‬
.‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻠ‬‫ﺘﻄ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻨﻈﻢ‬‫ﻟ‬‫ﺍ‬‫ﺬ‬‫ﻴ‬‫ﻔ‬‫ﻨ‬
‫ﺗ‬‫ﻴﻂﻭ‬ ‫ﺗﺨﻄ‬-

247
 .
‫ﺔ‬‫ﻣ‬‫ﺪ‬
‫ﻘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬
‫ﻐ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﺎﺻ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﺔﻛ‬‫ﺒ‬‫ﻗ‬
‫ﺍ‬‫ﺮ‬‫ﻣ‬-
‫ﺔﻣﻦ‬
‫ﻳ‬‫ﺎ‬‫ﻗ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻭﺡﻭ‬
‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬
‫ﻮﻓﻲﺗ‬
‫ﺓﻫ‬‫ﺩ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﺧﻼﻝ‬‫ﻴ‬
‫ﻓ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬
‫ﺍ‬:‫ﺔ‬
‫ﻮﻇ‬ ‫ﻠﺤ‬‫ﻣ‬
.‫ﻭﻯ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬

MethodsofNut riti
onalsupportincl
ude:
-Oraldi etr
est
rictedinini
tial
stage,ti
llbowelsoundsreturntonormal.
-Enteral t
ubefeeding,parenter
alnutri
tion.
-I
niti
allykeepthepat i
entonnot hingpermout h(NPO)unt i
lbowelsoundsreturn.
-Whenbowel soundsr eturnadmi ni
steroralf
lui
dsandadv ancedietastol
erated.
-Offermor esolidfoodafter2t o3day spostburnastolerancetofood
i
mpr ov es.
-Provideadequat enutri
ti
onandcal oriestodecreasecataboli
sm.

:‫ﻠﻲ‬
‫ﺎﻳ‬‫ﺋﻲﻣ‬‫ﺍ‬‫ﺬ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻋﻢ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻤﻞﻃ‬ ‫ﺗﺸ‬
.‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻌ‬‫ﻴ‬
‫ﺒ‬‫ﻟﻰﻃ‬‫ﺀﺇ‬‫ﺎ‬
‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﺍﺕ‬
‫ﻮ‬‫ﺃﺻ‬‫ﺩ‬‫ﻮ‬‫ﻌ‬
‫ﺘﻰﺗ‬‫ﺔﺣ‬ ‫ﻴ‬
‫ﻟ‬‫ﻭ‬‫ﺍﻷ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻓﻲ‬‫ﻴ‬‫ﻘ‬
‫ﻮﻱﻣ‬ ‫ﻤ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻨﻈ‬‫ﻟ‬‫ﺍ‬-
.
‫ﻘﻦ‬‫ﻟﺤ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬،
‫ﻮﻱ‬ ‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬
‫ﺎﻷ‬‫ﺔﺑ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬-
.‫ﺀ‬
‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﺍﺕ‬‫ﻮ‬‫ﺃﺻ‬‫ﺩ‬‫ﻮ‬‫ﻌ‬
‫ﺘﻰﺗ‬‫(ﺣ‬NPO)‫ﺎﻋﻦﻛﻞﻓﻢ‬ ً
‫ﺌ‬‫ﻴ‬
‫ﻭﻝﺷ‬ ‫ﺎ‬‫ﻨ‬‫ﺘ‬
‫ﻳ ﺾﻻﻳ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﺍﺟ‬،‫ﺔ‬
‫ﻳ‬‫ﺍ‬‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬-
‫ﺬﻱ‬
‫ﻟ‬‫ﺍ‬‫ﻜﻞ‬
‫ﻟﺸ‬‫ﺎ‬‫ﻡﺑ‬‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﺋﻲﻣ‬‫ﺍ‬‫ﺬ‬‫ﻡﻏ‬‫ﺎ‬
‫ﺎﻉﻧﻈ‬
‫ﺒ‬‫ﺗ‬
‫ﺍ‬‫ﻔﻢﻭ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬
‫ﺋﻞﻋﻦﻃ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺗ‬،‫ﺀ‬
‫ﺎ‬‫ﻌ‬‫ﻣ‬‫ﺍﻷ‬‫ﺍﺕ‬‫ﻮ‬‫ﺃﺻ‬‫ﺓ‬‫ﺩ‬‫ﻮ‬‫ﺪﻋ‬‫ﻨ‬‫ﻋ‬-
.‫ﻪ‬‫ﻠ‬
‫ﻤ‬‫ﻜﻦﺗﺤ‬ ‫ﻤ‬
‫ﻳ‬
.‫ﻡ‬‫ﺎ‬
‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﻤﻞ‬‫ﺘﺤﺴﻦﺗﺤ‬‫ﻴﺚﻳ‬‫ﺮﻕﺣ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻡﺑ‬‫ﺎ‬
‫ﻳ‬‫ﺃ‬3‫ﻟﻰ‬‫ﺇ‬2‫ﺪ‬ ‫ﻌ‬‫ﻠﺐﺑ‬‫ﻟﺼ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﺪﻣﻦ‬‫ﻳ‬‫ﺰ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻣﻲ‬‫ﺪ‬‫ﻗ‬-
.
‫ﻡ‬‫ﺪ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬
‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻌ‬‫ﻟﺴ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻴ‬‫ﻓ‬‫ﺎ‬‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬
‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬
‫ﺗ‬-

-Nutri
tional suppor
twithopti
mizedpr oteinint
ake.
-Provi
de3gpr otei
n/kgbodyweight:20%ofneededcal ori
esinfor
m off ats;
remainderi ncarbohydrat
es.
-Thepat ientalsoneedsadequatevit
ami nsandmi neral
s.Provi
depotassium
andvitami nsandmi neral
ssupplement s( z
inc,
iron,vi
taminc).
-Diet
aryconsul t
ati
onsareusefuli
nhel pingpati
entsmeett hei
rnut
rit
ionalneeds.
-Dail
ycal ori
ccount saidi
nassessingt headequacyofnut ri
ti
onali
ntake.

.‫ﺜﻞ‬‫ﻣ‬‫ﺍﻷ‬‫ﻴﻦ‬‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﻊﺗ‬‫ﺋﻲﻣ‬ ‫ﺍ‬
‫ﺬ‬‫ﻋﻢﻏ‬‫ﺩ‬-
.‫ﻮﻥ‬‫ﻜﻞﺩﻫ‬
‫ﻠﻰﺷ‬ ‫ﺔﻋ‬‫ﻣ‬‫ﺯ‬‫ﺍﻼ‬
‫ﺔﻟ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬
‫ﺮ‬‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﻣﻦ‬٪20:‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺯﻥ‬‫ﻛﺠﻢﻣﻦﻭ‬/‫ﻴﻦ‬ ‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﻡﺑ‬‫ﺍ‬‫ﺮ‬‫ﺟ‬3‫ﺮ‬ ‫ﻓ‬‫ﻮ‬
‫ﺗ‬-
.
‫ﺍﺕ‬‫ﺭ‬‫ﺪ‬‫ﻴ‬‫ﻮﻫ‬‫ﺑ‬
‫ﺮ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬
‫ﻗﻲﻓﻲ‬ ‫ﺎ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺩﻥ‬
‫ﺎ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕﻭ‬‫ﻨ‬
‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬
‫ﻡﻭ‬‫ﻮ‬‫ﻴ‬‫ﺎﺳ‬‫ﺗ‬‫ﻮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻤﻼﺕ‬‫ﻜ‬‫ﺮﻣ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬.
‫ﺔ‬‫ﻴ‬‫ﻓ‬
‫ﺎ‬‫ﺩﻥﻛ‬‫ﺎ‬‫ﻌ‬
‫ﻣ‬‫ﺎﺕﻭ‬ ‫ﻨ‬‫ﻴ‬
‫ﻣ‬‫ﺎ‬‫ﺘ‬
‫ﻴ‬‫ﻟﻰﻓ‬‫ﺎﺇ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺝ‬
‫ﺘ‬‫ﻳﺤ‬-
.
(‫ﻴﻦﺝ‬ ‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﻓ‬‫ﺪﻭ‬ ‫ﻳ‬
‫ﺪ‬‫ﻟﺤ‬‫ﺍ‬‫ﻧﻚﻭ‬‫ﺰ‬
‫ﻟ‬‫ﺍ‬
)
.
‫ﺔ‬‫ﻴ‬‫ﺋ‬
‫ﺍ‬‫ﺬ‬‫ﻐ‬
‫ﻟ‬‫ﺍ‬‫ﻬﻢ‬‫ﺗ‬
‫ﺎ‬‫ﺎﺟ‬‫ﻴ‬
‫ﺘ‬‫ﺍﺣ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬
‫ﻠ‬‫ﻠﻰﺗ‬‫ﺮﺿﻰﻋ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻋ‬‫ﺎ‬
‫ﺓﻓﻲﻣﺴ‬ ‫ﺪ‬
‫ﻴ‬‫ﻔ‬‫ﺔﻣ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬
‫ﺘﺸ‬‫ﺍﻻﺳ‬ -
.‫ﺋﻲ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻝ‬‫ﺪﺧ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻔ‬‫ﺪﻯﻛ‬‫ﻴﻢﻣ‬‫ﻴ‬‫ﻘ‬‫ﺔﻓﻲﺗ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﺎﺏ‬‫ﺪﺣﺴ‬ ‫ﻋ‬‫ﺎ‬
‫ﻳﺴ‬-

Indicationsforparenteralnutri
tioninclude:
Wei ghtlossgreaterthan10%ofnor mal bodyweight.
Inadequat eint
akeofent eralnutrit
ionduet ocl
inical
stat
us,prol
ongedwound
exposur e,andmal nutri
ti
onordebi l
it
atedcondit
ionbefor
einjury
.
Moni toringofnutrit
ionalsuppor t:
-Dai l
ywei ghtmeasur ements.
-Measur ementsofpl asmapr oteins.
-Ant hropometri
cmeasur ements.
Calculat i
onofnutriti
onalrequirement sforadult:

248
‫‪Kcal‬‬
‫‪:‬‬‫(‬‫(‪25xkg)+‬‬‫‪40x%bur‬‬‫)‪n‬‬
‫‪.‬‬
‫‪Pr‬‬‫‪ot‬‬
‫‪ei‬‬‫(‪n‬‬
‫)‪g‬‬‫‪:‬‬
‫(‬‫(‪kg)+‬‬‫‪3x%bur‬‬
‫)‪n‬‬‫‪.‬‬

‫‪:‬‬‫ﻠﻲ‬‫ﺎﻳ‬
‫ﺔﻣ‬ ‫ﻳ‬‫ﺪ‬‫ﻳ‬
‫ﺭ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬ ‫ﻤﻞﻣ‬‫ﺗﺸ‬
‫‪.‬‬‫ﻌﻲ‬‫ﻴ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬ ‫ﻟﺠﺴﻢ‬ ‫ﺍ‬‫ﺯﻥ‬‫‪٪‬ﻣﻦﻭ‬ ‫ﺪﻋﻦ‪10‬‬ ‫ﻳ‬‫ﺰ‬‫ﺔﺗ‬‫ﺒ‬‫ﻨﺴ‬‫ﺯﻥﺑ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺍﻥ‬‫ﺪ‬‫ﻘ‬‫ﻓ‬
‫ﺔ‬‫ﻳ‬‫ﺬ‬‫ﻐ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺀ‬‫ﻮ‬‫ﻭﺡﻭﺳ‬ ‫ﺮ‬
‫ﻠﺠ‬ ‫ﻟ‬‫ﺔ‬‫ﻠ‬‫ﻳ‬
‫ﻮ‬‫ﺓﻃ‬ ‫ﺮ‬‫ﺘ‬
‫ﻔ‬‫ﻟ‬‫ﺮﺽ‬ ‫ﻌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻳ‬‫ﺮ‬‫ﻳ‬‫ﺮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﺒﺐ‬‫ﺔﺑﺴ‬‫ﻳ‬‫ﻮ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻳ‬
‫ﺬ‬‫ﻐ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻭﻝ‬ ‫ﺎ‬
‫ﻨ‬‫ﺔﺗ‬ ‫ﻳ‬‫ﺎ‬
‫ﻔ‬‫ﻡﻛ‬‫ﺪ‬ ‫ﻋ‬
‫‪.‬‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺒﻞ‬‫ﻮﻫﻦﻗ‬ ‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬‫ﻭﺎ‬ ‫ﺃ‬
‫‪:‬‬
‫ﺋﻲ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬
‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﻣ‬
‫‪.‬‬
‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯﻥ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﺎﺳ‬‫ﻴ‬
‫‪-‬ﻗ‬
‫ﺯ‪.‬‬
‫ﻼﺎ‬
‫ﺒ ﻣ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﻨ‬‫ﻴ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬‫ﺎﺕﺑ‬ ‫ﺎﺳ‬‫ﻴ‬
‫‪-‬ﻗ‬
‫‪.‬‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬ ‫ﺘ‬
‫ﻣ‬‫ﻮ‬‫ﺑ‬‫ﻭ‬‫ﺮ‬‫ﺜ‬‫ﻧ‬‫ﺃ‬‫ﺎﺕ‬ ‫ﺎﺳ‬‫ﻴ‬
‫‪-‬ﻗ‬
‫‪:‬‬‫ﺭ‬
‫ﺎ‬‫ﺒ‬‫ﻜ‬‫ﻠ‬
‫ﻟ‬‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻠ‬‫ﺘﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺘﺴ‬ ‫ﺍﺣ‬
‫‪.‬‬
‫(‬‫ﺮﻕ‬‫‪٪‬ﺣ‬ ‫(‪×40)+‬‬ ‫‪×25):‬ﻛﺠﻢ‬ ‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬‫ﺮ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬
‫‪.‬‬‫(‬
‫ﺮﻕ‬ ‫‪٪‬ﺣ‬‫ﻛ(‪×3)+‬‬ ‫ﻎ‬‫‪):‬ﻠ‬ ‫(‬‫ﻴﻦ)ﻍ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
‫‪Ski‬‬‫‪ngr‬‬ ‫‪af‬‬
‫‪t‬‬‫‪:‬‬
‫‪Def‬‬ ‫‪i‬‬‫‪ni‬‬‫‪t‬‬
‫‪i‬‬‫‪onofski‬‬ ‫‪ngr‬‬ ‫‪af‬‬‫‪t‬‬
‫‪:‬‬
‫‪Ski‬‬‫‪ngr‬‬ ‫‪af‬‬‫‪ti‬‬‫‪sasur‬‬ ‫‪gi‬‬‫‪cal‬‬‫‪pr‬‬ ‫‪ocedur‬‬‫‪ei‬‬‫‪nwhi‬‬ ‫‪chapi‬‬ ‫‪eceofski‬‬ ‫‪ni‬‬ ‫‪st‬‬‫‪r‬‬‫‪anspl‬‬‫‪ant‬‬ ‫‪edf‬‬ ‫‪r‬‬‫‪om‬‬
‫‪onear‬‬ ‫‪eat‬‬ ‫‪oanot‬‬‫‪her‬‬‫‪.Of‬‬ ‫‪t‬‬‫‪enski‬‬‫‪nwi‬‬ ‫‪l‬‬
‫‪l‬‬‫‪bet‬‬ ‫‪akenf‬‬ ‫‪r‬‬‫‪om unaf‬‬ ‫‪f‬‬‫‪ect‬‬‫‪edar‬‬ ‫‪easont‬‬ ‫‪he‬‬
‫‪i‬‬
‫‪nj‬‬‫‪ur‬‬ ‫‪edper‬‬ ‫‪sonandusedt‬‬ ‫‪ocov‬‬‫‪eradef‬‬ ‫‪ect‬‬‫‪,‬‬‫‪of‬‬‫‪t‬‬‫‪enabur‬‬ ‫‪n.‬‬
‫‪Aski‬‬ ‫‪ngr‬‬‫‪af‬‬‫‪tmeansaheal‬‬ ‫‪t‬‬
‫‪hyl‬‬‫‪ay‬‬‫‪erofr‬‬‫‪epl‬‬‫‪acementski‬‬ ‫‪ni‬‬‫‪st‬‬ ‫‪r‬‬
‫‪anspl‬‬ ‫‪ant‬‬‫‪edi‬‬ ‫‪nt‬‬ ‫‪oa‬‬
‫‪ski‬‬‫‪nwoundsi‬‬ ‫‪t‬‬
‫(‪e‬‬ ‫‪SeeFi‬‬ ‫)‪g.43‬‬ ‫‪.‬‬
‫‪I‬‬‫‪ndi‬‬‫‪cat‬‬ ‫‪i‬‬
‫‪onofski‬‬ ‫‪ngr‬‬ ‫‪af‬‬‫‪t‬‬‫‪:‬‬
‫‪.‬‬
‫‪Ski‬‬‫‪ngr‬‬ ‫‪af‬‬‫‪t‬‬‫‪sar‬‬‫‪eusedt‬‬ ‫‪ot‬‬ ‫‪r‬‬‫‪eatski‬‬‫‪nul‬‬‫‪cer‬‬
‫‪at‬‬ ‫‪i‬‬
‫‪on‬‬
‫‪Bur‬‬ ‫‪ns‬‬
‫‪Chr‬‬ ‫‪oni‬‬‫‪cski‬‬ ‫‪nwounds‬‬
‫‪:‬‬‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻠ‬‫ﺔﺟ‬ ‫ﻌ‬‫ﻗ‬‫ﺭ‬
‫‪:‬‬
‫ﺪﻱ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻳﻒ‬‫ﺮ‬‫ﻌ‬‫ﺗ‬
‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺬ‬‫ﺆﺧ‬ ‫ﺎﻳ‬‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫‪.‬ﺎ‬ ‫ﺮﻯ‬‫ﺃﺧ‬ ‫ﻟﻰ‬‫ﺔﺇ‬ ‫ﻘ‬
‫ﻨﻄ‬‫ﺪﻣﻦﻣ‬ ‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻌ‬
‫ﺭﻉﻗﻄ‬ ‫ﻪﺯ‬‫ﻴ‬‫ﺘﻢﻓ‬‫ﺍﺣﻲﻳ‬ ‫ﺮ‬‫ﺀﺟ‬ ‫ﺍ‬‫ﺮ‬
‫ﻮﺇﺟ‬ ‫ﺪﻫ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺗ‬
‫‪.‬‬‫ﺎ‬
‫ً‬
‫ﻗ‬‫ﺮ‬‫ﻮﻥﺣ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
‫ً‬
‫ﺒ‬‫ﻟ‬
‫‪،‬ﺎ‬ ‫ﻴﺐ‬‫ﺔﻋ‬‫ﻴ‬‫ﻐﻄ‬‫ﺘ‬‫ﻟ‬
‫ﻡ‬ ‫ﺪ‬‫ﺘﺨ‬‫ﻳﺴ‬‫ﺎﺏﻭ‬ ‫ﻤﺼ‬‫ﻟ‬‫ﺍ‬‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺑ‬
‫ﺎ‬‫ﺮﻣﺼ‬ ‫ﻴ‬‫ﺎﻃﻖﻏ‬ ‫ﻨ‬‫ﻣﻦﻣ‬
‫ﻜﻞ‬‫ﻟﺸ‬ ‫ﺍ‬‫ﺮ‬‫ﻧﻈ‬‫ﺍ‬
‫ﺪﻱ)‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺮﺡ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬ ‫ﻗ‬‫ﻮ‬‫ﻳﻞﻓﻲﻣ‬ ‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﺔ ﺻﺤ‬ ‫ﻘ‬
‫ﺒ‬‫ﺭﻉﻃ‬ ‫ﺘﻢﺯ‬‫ﺃﻥﻳ‬ ‫ﺪﻱ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻢ‬ ‫ﻌ‬‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﻨﻲ‬‫ﻌ‬‫ﻳ‬
‫‪.‬‬
‫(‬‫‪43‬‬
‫‪.‬‬
‫‪:‬‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬ ‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﻠﻰﺗ‬‫ﺔﻋ‬ ‫ﻟ‬
‫ﺩﻻ‬
‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬
‫ﺍ‬‫ﺮﺡ‬ ‫ﻘ‬
‫ﻟﻼﺝﺗ‬ ‫ﺪﻌ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬ ‫ﻴ‬‫ﻗ‬
‫ﺮ‬ ‫ﻡﺗ‬‫ﺪ‬‫ﺘﺨ‬‫ﺗﺴ‬
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
‫ﺔ‬‫ﻨ‬‫ﻣ‬‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬

‫(‬
‫‪Fi‬‬‫‪g.43)Pr‬‬
‫‪ocedur‬‬
‫‪ef‬‬‫‪orski‬‬
‫‪ngr‬‬
‫‪af‬‬‫‪t‬‬

‫‪249‬‬
Purposesofski ngr af
ti
ng:
Reducet hecour seoftreat
mentneedeandt i
mei nthehospital.
Improvet hef uncti
onandappear anceofthear eaofthebodywhi chr
eceivesthe
ski
ngr aft .
Typesofski ngr af
t:
Autograf t: Patchesofhealthyski
ntakenfrom anotherlocationonapat i
ent'
s
body
All
ograf t( homogr aft)
:Skintakenfr
om otherhumansour ces.
Xenogr aft( heterograf
t)Graftsmadefrom theskinofotherani malspeci
es.

:
‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺍ ﺽﺗ‬
‫ﺮ‬‫ﻏ‬‫ﺃ‬
.
‫ﻔﻰ‬‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻪﻓﻲ‬
‫ﻴ‬‫ﻘﻀ‬‫ﺬﻱﻳ‬‫ﻟ‬‫ﺍ‬
‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻌﻼﺝﻭ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺭ‬
‫ﺎ‬‫ﻴ ﺺﻣﺴ‬ ‫ﻠ‬
‫ﻘ‬‫ﺗ‬
.
‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻗ‬‫ﺮ‬‫ﻘﻰﺗ‬‫ﻠ‬‫ﺘ‬
‫ﺘﻲﺗ‬
‫ﻟ‬‫ﺍ‬‫ﻟﺠﺴﻢ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﺮﻣ‬‫ﻬ‬‫ﻣﻈ‬‫ﺔﻭ‬ ‫ﻔ‬‫ﻴ‬‫ﻴﻦﻭﻇ‬‫ﺗﺤﺴ‬
:‫ﺪﻱ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻴﻢ‬ ‫ﻌ‬‫ﺘﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺍﻉ‬
‫ﻮ‬‫ﻧ‬‫ﺃ‬
‫ﻳﺾ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰﺟﺴﻢ‬ ‫ﺮﻋ‬‫ﺁﺧ‬‫ﺎﻥ‬‫ﻜ‬‫ﺓﻣﻦﻣ‬‫ﺫ‬
‫ﻮ‬‫ﺄﺧ‬‫ﻴﻢﻣ‬‫ﻠ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊﻣﻦ‬ ‫ﻘ‬‫ﺑ‬:‫ﺗﻲ‬‫ﺍ‬
‫ﻌﻢﺫ‬‫ﻃ‬
.
‫ﺮﻯ‬‫ﺃﺧ‬‫ﺔ‬‫ﻳ‬
‫ﺮ‬‫ﺭﺑﺸ‬‫ﺩ‬‫ﺎ‬
‫ﺫﻣﻦﻣﺼ‬ ‫ﻮ‬‫ﺄﺧ‬
‫ﺪﻣ‬‫ﻠ‬‫ﺟ‬:(Al
lograft(homogr aft
.
‫ﺮﻯ‬‫ﺃﺧ‬‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﺍ‬‫ﻮ‬
‫ﻴ‬‫ﺍﻉﺣ‬‫ﻮ‬‫ﻧ‬
‫ﺃ‬ ‫ﺪ‬
‫ﻠ‬‫ﻮﻉﻣﻦﺟ‬‫ﻨ‬‫ﻊﻣﺼ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫(ﺗ‬‫ﺮ‬
‫ﻳ‬‫ﺎ‬
‫ﻐ‬‫ﻌﻢﻣ‬ ‫)ﻃ‬Xenogr aft
1-Graftappl icati
on:
-Thephy sicianf i
rstcoll
ectsagr aftfrom adonorsite,usual
lywi than
i
nstr
umentcal l
edader mat ome
-Whichshav esv erythi
nslicesofski n.
-Note:Ifthear eaoft heskindef ectisespeci
allyl
arge,thehar vestedskinmay
bemeshedt ostretchitint
oal argerpatch.
:
Graft‫ﻴﻖ‬‫ﺒ‬‫ﺗﻄ‬-1
‫ﺔ‬‫ﻳ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫ﻘﺸ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﻋﻰ‬ُ‫ﺓ‬
‫ﺗ‬ ‫ﺍ‬
‫ﺩ‬‫ﺃ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬
‫ﺘﺨ‬ ‫ﺎﺳ‬‫ﺓﺑ‬
ً‫ﺩ‬
‫ﺎ‬‫ﻋ‬،‫ﺔ‬‫ﻧﺤ‬‫ﺎ‬
‫ﺔﻣ‬‫ﻘ‬‫ﻨﻄ‬‫ﻌﻢﻣﻦﻣ‬ ُ‫ﻟ‬
‫ﻄ‬ ‫ﺍ‬‫ﻊ‬
‫ﻤ‬‫ﺃﻻًﺑﺠ‬ ‫ﻴﺐﻭ‬ ‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬
‫ﻡ‬‫ﻮ‬‫ﻘ‬‫ﻳ‬-
.‫ﺟ‬
‫ﺍ‬‫ﺔﺪ‬ ‫ﻘ‬‫ﻴ‬
‫ﻗ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺋﺢ‬‫ﺍ‬‫ﺮ‬
‫ﻠﻖﺷ‬ ‫ﺬﻱﻳﺤ‬ ‫ﻟ‬
‫ﺍ‬-
‫ﺔ‬‫ﻜ‬‫ﺒ‬
‫ﻮﻉﺑﺸ‬ ‫ﻘﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺑﻂ‬‫ﺘﻢﺭ‬‫ﺪﻳ‬‫ﻘ‬‫ﻓ‬،‫ﺎﺹ‬ ‫ﻜﻞﺧ‬ ‫ﺓﺑﺸ‬‫ﺮ‬
‫ﻴ‬‫ﺒ‬‫ﺪﻱﻛ‬‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬
‫ﻴﺐ‬ ‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻧﺖﻣ‬ ‫ﺎ‬
‫ﺍﻛ‬‫ﺫ‬‫ﺇ‬:‫ﺔ‬‫ﻮﻇ‬‫ﻠﺤ‬‫ﻣ‬-
.‫ﺮ‬‫ﺒ‬‫ﻛ‬
‫ﺃ‬ ‫ﺔ‬
‫ﻌ‬‫ﻗ‬‫ﻟﻰﺭ‬ ‫ﻩﺇ‬
‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬

-Toensur ethat,theskingr aftwi l

ladheretot hewound, t
hephy sici
andebr i
des
thewoundsi te,thoroughlycleani ngitofbacteria,
debr i
s,anddeadski ncell
sso
thattheskingraf twil
ladher etot hewound.
-Thephy si
ciant henplacest hegr aftonther eci
pientsite.Thegr aftist hen
securedinplacewi thsut ur
esar oundtheedgeoft hegraft.
-Ointmentandmeshgauzet hatadherest othehealthyski nsurroundi ngthe
graftsi
teandpl acespr essureont hegraftit
selfmayal sobepl acedont hegraft
sit
e.
-Othersuppor t
,suchasbandages, maybeusedt ohel pkeept hegr aftinplace.
-Thegr af
tbeginst ogr owandadher ewithi
n48hour s.Attheendoff ourtofive
days,thegraftshouldbeadher ent.

‫ﺍﻣﻦ‬
ً
‫ﺪ‬‫ﻴ‬‫ﻪﺟ‬‫ﻔ‬‫ﻴ‬‫ﻨﻈ‬
‫ﺗ‬‫ﺮﺡﻭ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻊ‬ ‫ﻗ‬
‫ﻮ‬‫ﻴﻒﻣ‬ ‫ﻨﻈ‬
‫ﺘ‬‫ﻴﺐﺑ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬
‫ﻳ‬، ‫ﺮﺡ‬‫ﻟﺠ‬‫ﺎ‬‫ﺘﺼﻖﺑ‬‫ﻠ‬‫ﺪﻱﻳ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻴﻢ‬
‫ﻌ‬‫ﺘﻄ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻥ‬ ‫ﺪﻣﻦ‬‫ﻛ‬‫ﺄ‬‫ﺘ‬
‫ﻠ‬‫ﻟ‬-
.
‫ﺮﺡ‬‫ﻟﺠ‬‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬‫ﺪ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬
‫ﻮ‬ ‫ﻌ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺘﺼﻖ‬ ‫ﻠ‬‫ﺘﻰﺗ‬‫ﺔﺣ‬ ‫ﺘ‬‫ﻴ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎ‬‫ﻳ‬
‫ﻡﻭﺧﻼ‬ ‫ﺎ‬
‫ﻟﺤﻄ‬‫ﺍ‬‫ﺎﻭ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻦ‬‫ﻣ‬
‫ﺄ‬‫ﺘﻢﺗ‬‫ﺛﻢﻳ‬.‫ﻠﻢ‬‫ﺘ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻭﻉﻓﻲﻣ‬ ‫ﺮ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻮﺿ‬ ‫ﻟﻚﺑ‬‫ﺪﺫ‬‫ﻌ‬‫ﻴﺐﺑ‬‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻘ‬
‫ﻳ‬-
.‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻓ‬
‫ﺎ‬‫ﻮﻝﺣ‬ ‫ﻮﻁﺣ‬ ‫ﻴ‬‫ﻪﺑﺨ‬‫ﻧ‬‫ﺎ‬
‫ﻜ‬‫ﻭﻉﻓﻲﻣ‬ ‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬
‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬
‫ﻤ‬‫ﻴﻂﺑ‬ ‫ﻤﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻠ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺎ‬
‫ﺘﺼﻖﺑ‬ ‫ﻠ‬
‫ﻜﻲﻳ‬ ‫ﺒ‬
‫ﺎﺵﺷ‬ ‫ﺮﻫﻢﻭﺷ‬‫ﻊﻣ‬ ‫ﺎﻭﺿ‬ً‫ﻳ‬
‫ﻀ‬ ‫ﺃ‬
‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬-
.
‫ﻭﻉ‬ ‫ﺮ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬
‫ﻮ‬‫ﻠﻰﻣ‬ ‫ﻪﻋ‬ ‫ﻔﺴ‬‫ﻭﻉﻧ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻋ‬ً‫ﻐ‬
‫ﻄ‬ ‫ﻊﺿ‬ ‫ﻳﻀ‬‫ﻭ‬
‫ﻭﻉ‬‫ﺮ‬
‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬‫ﺓﻓﻲ‬ ‫ﺪ‬‫ﺎﻋ‬
‫ﻤﺴ‬‫ﻠ‬‫ﻟ‬،‫ﺍﺕ‬‫ﺩ‬
‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬
‫ﺜﻞ‬ ‫ﻣ‬،‫ﺮﻯ‬‫ﺃﺧ‬‫ﻋﻢ‬ ‫ﺋﻞﺩ‬‫ﺎ‬
‫ﻡﻭﺳ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬‫ﻜﻦ‬ ‫ﻤ‬
‫ﻳ‬-
.‫ﻪ‬‫ﻧ‬
‫ﺎ‬‫ﻜ‬‫ﻓﻲﻣ‬

250
‫ﺃﻥ‬
‫ﻳﺠﺐ‬،
‫ﻡ‬‫ﺎ‬‫ﻳ‬
‫ﺃ‬‫ﺔ‬‫ﻤﺴ‬
‫ﻟﻰﺧ‬
‫ﺔﺇ‬‫ﻌ‬
‫ﺑ‬‫ﺭ‬‫ﺃ‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻬ‬‫ﻓﻲﻧ‬.
‫ﺔ‬‫ﺎﻋ‬
‫ﺳ‬48‫ﺎﻕﺧﻼﻝ‬
‫ﺘﺼ‬‫ﻟ‬
‫ﺍﻻ‬
‫ﻮﻭ‬ ‫ﻤ‬
‫ﻨ‬‫ﻟ‬
‫ﺎ‬‫ﻭﻉﺑ‬
‫ﺮ‬‫ﻤﺸ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬
‫ﻟ‬‫ﺍ‬‫ﺃ‬
‫ﺪ‬‫ﺒ‬‫ﻳ‬-
.‫ﺎ‬
ً
‫ﻘ‬‫ﺘﺼ‬‫ﻠ‬
‫ﻭﻉﻣ‬‫ﺮ‬‫ﻤﺸ‬
‫ﻟ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻜﺴﺐﻏ‬
‫ﻟ‬‫ﺍ‬‫ﻮﻥ‬‫ﻜ‬‫ﻳ‬

-Newski nwi l
lnat
urall
ygrowtocov erthewoundmadeatt hedonorsite.
-Thedonorsi tewil
lheali
nappr oxi
mat el
ytwoweeks.Thegraft
edareaand
donorsi t
emayf orm scar
s.
-Iftheskingrafti
snotsuccessfulort herei
smoredeadt i
ssuetobedebr i
ded,
thepatientwill
ret
urntotheoper at
ingr oom f
orf
urtherski
ngraft
inguntil
all
woundsar ecover
ed.
-Theov erall
numberofsur ger
iesisdet ermi
nedbytheextentofthei
njury(See
Fig.44).

.‫ﺔ‬‫ﻧﺤ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﻨﻄ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺗﺞﻓﻲ‬‫ﺎ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺮﺡ‬ ‫ﻟﺠ‬‫ﺍ‬
‫ﺔ‬ ‫ﻴ‬
‫ﻐﻄ‬‫ﺘ‬‫ﻟ‬‫ﻌﻲ‬‫ﻴ‬
‫ﺒ‬‫ﻜﻞﻃ‬ ‫ﺪﺑﺸ‬‫ﻳ‬
‫ﺪ‬‫ﻟﺠ‬‫ﺍ‬ ‫ﺪ‬
‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻮ‬‫ﻤ‬
‫ﻨ‬‫ﻳ‬-
‫ﻧﺢ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻤ‬‫ﻌ‬‫ﻤﻄ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻜﻞ‬‫ﺪﺗﺸ‬‫ﻗ‬.‫ﺎ‬
ً
‫ﺒ‬‫ﻳ‬‫ﺮ‬
‫ﻘ‬‫ﻴﻦﺗ‬‫ﻮﻋ‬‫ﺒ‬‫ﺃﺳ‬‫ﻮﻥ‬‫ﺔﻓﻲﻏﻀ‬ ‫ﻧﺤ‬‫ﺎ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬
‫ﻨﻄ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺌﻢ‬
‫ﺘ‬‫ﻠ‬‫ﻮﻑﺗ‬‫ﺳ‬-
.‫ﺎﺕ‬‫ﺑ‬
‫ﺪ‬‫ﻧ‬
‫ﺩ‬
‫ﻮ‬‫ﻌ‬‫ﻴ‬
‫ﻓﺴ‬، ‫ﺎ‬‫ﻬ‬
‫ﻔ‬‫ﻴ‬‫ﻨﻈ‬‫ﺩﺗ‬‫ﺍ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺘ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻧﺴﺠ‬‫ﻣﺍﻷ‬
‫ﺪﻦ‬ ‫ﻳ‬
‫ﺰ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻙ‬‫ﻨ‬‫ﺎﻥﻫ‬‫ﻭﻛ‬‫ﺃ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬
‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺔﺗ‬‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﻨﺠﺢﻋ‬ ‫ﻟﻢﺗ‬‫ﺍ‬
‫ﺫ‬‫ﺇ‬-
.‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻊ‬ ‫ﻴ‬‫ﻤ‬
‫ﺔﺟ‬ ‫ﻴ‬‫ﻐﻄ‬‫ﺘﻢﺗ‬
‫ﺘﻰﺗ‬‫ﺪﺣ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬
‫ﻗ‬‫ﺮ‬‫ﺪﻣﻦﺗ‬‫ﻳ‬‫ﺰ‬‫ﻤ‬
‫ﻟ‬‫ﺎﺕ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﻟﻰﻏ‬‫ﻳ ﺾﺇ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬
.
(44‫ﻜﻞ‬ ‫ﻟﺸ‬‫ﺍ‬‫ﺮ‬‫ﻧﻈ‬‫ﺍ‬
)‫ﺔ‬ ‫ﺑ‬
‫ﺎ‬‫ﺍﻹﺻ‬‫ﺪﻯ‬‫ﺔﺣﺴﺐﻣ‬ ‫ﻴ‬‫ﺍﺣ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺎﺕ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻠ‬
‫ﻟ‬‫ﻟﻲ‬
‫ﺎ‬‫ﻹﻤ‬
‫ﺍﺟ‬ ‫ﺩ‬‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺘﻢﺗﺤ‬‫ﻳ‬-
Theski ngraftmayber ejectedduet o:
-Mov ement
-Bleeding
-I
nf ect
ion
-Poornut r
it
ion.

:
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺎ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺏ‬‫ﺒ‬
‫ﻟﻸﺳ‬
‫ﺪﻱ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬
‫ﻊ‬‫ﻴ‬‫ﻗ‬
‫ﺮ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻓﺾ‬ ‫ﺘﻢﺭ‬‫ﺪﻳ‬‫ﻗ‬
‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺣ‬-
‫ﻳﻒ‬‫ﺰ‬‫ﻧ‬-
‫ﻭﻯ‬‫ﺪ‬‫ﻋ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺬ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺀ‬
‫ﻮ‬‫ﺳ‬-
(
Fig.44)Woundaf
terski
ngr
aft

Careoft hepat i
entwi thgraf t:
1-Occlusivedr essingsar ecommonl yusedi ni
tial
lyaf
t ergraf ti
ngt oimmobi li
ze
thegraft.
2-Thef i
rstdr essingchangei susual lyperformed3t o5day saf t
ersur gery.
3-Ifthegraf tisdisl
odged, steri
lesalinecompr esseswi ll
hel ppr eventdr yingof
thegraft.
4-Thepat ientisposi ti
onedandt urnedcar efull
ytoav oiddi sturbingt hegraftor
putti
ngpr essur eont hegr aftsite.
5-Ifanext remi t
yhasbeengr afted,itiselevatedt ominimi zeedema.
6-Assessf oredema, hemat omaf ormat i
on, fl
uidcoll
ect i
on, infecti
on.
:‫ﻌﻢ‬ُ‫ﻟ‬
‫ﻄ‬ ‫ﺎ‬
‫ﻳ ﺾﺑ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺭﻋ‬
.
‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻂ‬ ‫ﺒ‬
‫ﺜ‬‫ﺘ‬‫ﻟ‬‫ﻴﻢ‬‫ﻌ‬‫ﺘﻄ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﻳ‬‫ﺍ‬
‫ﺪ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﻊﻓﻲ‬ ‫ﺋ‬‫ﺎ‬‫ﻜﻞﺷ‬‫ﺔﺑﺸ‬ ‫ﻴ‬‫ﻗ‬‫ﺎ‬‫ﺒ‬‫ﺍﻹﻃ‬ ‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬
‫ﻤ‬‫ﻟﻀ‬ ‫ﺍ‬‫ﻡ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺗﺴ‬-1
.
‫ﺔ‬ ‫ﺍﺣ‬
‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﻡﺑ‬‫ﺎ‬‫ﻳ‬
‫ﺃ‬ 5‫ﻟﻰ‬‫ﺇ‬3‫ﻟﻰﻣﻦ‬ ‫ﻭ‬‫ﺍﻷ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻟﻀ‬‫ﺍ‬ ‫ﺮ‬
‫ﻴ‬‫ﻴ‬‫ﻐ‬‫ﺘﻢﺗ‬‫ﺎﻳ‬‫ﺓﻣ‬‫ﺩ‬‫ﺎ‬‫ﻋ‬-2
‫ﻜﺴﺐ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﻑ‬‫ﻔ‬‫ﻊﺟ‬ ‫ﻨ‬
‫ﻠﻰﻣ‬ ‫ﺪﻋ‬‫ﺎﻋ‬‫ﺘﺴ‬‫ﺔﺳ‬ ‫ﻤ‬
‫ﻘ‬ ‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠﺤ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻤ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺈﻥ‬‫ﻓ‬،‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬ ‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﺍﺝ‬‫ﺮ‬‫ﺍﺗﻢﺇﺧ‬‫ﺫ‬‫ﺇ‬-3
.‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻏ‬
‫ﻜﺴﺐ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﻠﻰﻣ‬ ‫ﻐﻂﻋ‬ ‫ﻟﻀ‬‫ﺍ‬ ‫ﻭ‬‫ﺃ‬
‫ﻭﻉ‬ ‫ﺮ‬‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﺎﺝ‬‫ﺯﻋ‬‫ﻨﺐﺇ‬‫ﺘﺠ‬‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻪﺑ‬ ‫ﺗ‬‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺘﻢﻭﺿ‬ ‫ﻳ‬-4
.‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻏ‬

251
 .
‫ﺔ‬‫ﻣ‬‫ﺫ‬‫ﻮ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﻠ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﻪ‬‫ﻌ‬
‫ﻓ‬‫ﺘﻢﺭ‬
‫ﻴ‬‫ﻓ‬،
‫ﺍﻑ‬‫ﺮ‬‫ﺍﻷﻃ‬‫ﺪ‬
‫ﺃﺣ‬‫ﻴﻢ‬‫ﻌ‬
‫ﺍﺗﻢﺗﻄ‬
‫ﺫ‬‫ﺇ‬-
5
.
‫ﻭﻯ‬‫ﺪ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
،‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻊ‬
‫ﻤ‬‫ﺗﺠ‬،‫ﻮﻱ‬
‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺭ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻥ‬‫ﻜ‬‫ﺗ‬،
‫ﺔ‬‫ﻣ‬‫ﺫ‬
‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
6
Car eofdonorsi te:
Donorsi temustr emai ncl ean, dr
y,andf reef rom pressure.
Inspectt hesi t
edai lyandassessf orbl eeding, painandinf ection.
Possi bl
ecompl ications:
-Rej ect
ionoft heski ngr aft.
-Infecti
onsatdonororr ecipi entsites.
-Bleeding.
-Fluidweepi ngf rom gr aftsi tes.
-Scar ri
ng.
:‫ﺮﻉ‬‫ﺒ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﻗ‬
‫ﻮ‬ ‫ﺔﻣ‬‫ﻳ‬‫ﺎ‬‫ﺭﻋ‬
.
‫ﻐﻂ‬ ‫ﻟﻀ‬
‫ﺍ‬‫ﺎﻣﻦ‬ ً
‫ﻴ‬‫ﻟ‬
‫ﺎ‬‫ﺎﻭﺧ‬ ً
‫ﻓ‬
‫ﺎ‬‫ﺎﻭﺟ‬ً
‫ﻔ‬‫ﻴ‬‫ﺮﻉﻧﻈ‬ ‫ﺒ‬‫ﺘ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﻮ‬‫ﺃﻥﻳﻈﻞﻣ‬ ‫ﻳﺠﺐ‬
.
‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻢﻭ‬‫ﺍﻷ‬
‫ﻳﻒﻭ‬ ‫ﺰ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬
ّ‫ﻗ‬‫ﺎﻭ‬ً
‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻊﻳ‬‫ﻗ‬‫ﻮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻓﺤ ﺺ‬ ‫ﺍ‬
:
‫ﺔ‬‫ﻠ‬‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬ ‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﻓ ﺾﺗ‬‫ﺭ‬-
.‫ﻴﻦ‬‫ﻘ‬
‫ﻠ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻴﻦ‬‫ﺮﻋ‬‫ﺒ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬‫ﻮ‬‫ﻭﻯﻓﻲﻣ‬ ‫ﺪ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬-
.
‫ﻳﻒ‬ ‫ﺰ‬‫ﻧ‬-
.‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬‫ﻮ‬‫ﺋﻞﻣﻦﻣ‬ ‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﻜ‬‫ﺑ‬-
.
‫ﺪﺏ‬ ‫ﻨ‬‫ﺗ‬-
Nur singpr ocessdur i
ngt heacut ephase:
Assessment :
-Assesspai n,woundheal ingandpsy chosoci alresponsesandear lydet ection
ofcompl ications.
-Assessmentofr espirat oryandf l
ui dstatus.
-Det ecti
onofpot ent i
al compl i
cati
ons.
-Assessv i
tal signs.
-Assessr esi dual gast r i
cv ol umesi nt hepat i
entwi t
hnasogast ri
ct ubegi ve
patientant aci dwhenr equi red.
-Assessmentoft hebur nwoundr equi r
esanexper i
encedey e,handandsense
ofsmel l.
-Assesspai nandpsy chosoci alr
esponses, dailybodywei ght s,caloricintake.
-Assessgener al hydr ationandser um electrol yt
e,hemogl obi nandhemat ocr i
te
l
ev el.
-Assessmentf orexcessi v
ebl eedingf r
om bl oodv essels.

:‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬ ‫ﺔ‬
‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻳ ﺾﺧﻼﻝ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬
:
‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬
.‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻋﻦ‬ ‫ﻜ‬
‫ﺒ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻜﺸﻒ‬ ‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻋ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻭﺡﻭ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬‫ﺍﻵﻻ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﻔﺴﻲﻭ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺯ‬
‫ﺎ‬‫ﻬ‬‫ﻟﺠ‬‫ﺍ‬‫ﺣﺔ‬
‫ﻟ‬
‫ﻴﻢ ﺎ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬ ‫ﻠ‬
‫ﻤ‬‫ﺘ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬‫ﺍ‬‫ﻜﺸﻒﻋﻦ‬ ‫ﻟ‬‫ﺍ‬
-
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
‫ﺍ‬
ً
‫ﺩ‬‫ﺎ‬
‫ﻳ ﺾﻣﻀ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺀ‬‫ﺎ‬‫ﺇﻋﻄ‬‫ﻭ‬،‫ﺪﻱ‬‫ﻌ‬‫ﻔﻲﻣ‬‫ﻧ‬‫ﺃ‬‫ﻮﺏ‬‫ﺒ‬‫ﻧ‬
‫ﺃ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬
‫ﻳ ﺾﺑ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻴ‬‫ﻘ‬‫ﺒ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﻌ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﺃﺣﺠ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﺔ‬‫ﺎﺟ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺪ‬
‫ﻨ‬‫ﺔﻋ‬ ‫ﻮﺿ‬‫ﻤ‬‫ﻠﺤ‬‫ﻟ‬
.
‫ﻟﺸﻢ‬‫ﺍ‬‫ﺔ‬‫ﺎﺳ‬‫ﺪﻭﺣ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﻌ‬‫ﻟ‬
‫ﺎ‬
‫ﺓﺑ‬ ‫ﺮ‬‫ﺒ‬
‫ﺮﻕﺧ‬ ‫ﻟﺤ‬‫ﺍ‬‫ﺮﺡ‬‫ﻴﻢﺟ‬ ‫ﻴ‬‫ﻘ‬
‫ﻠﺐﺗ‬‫ﺘﻄ‬‫ﻳ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬،
‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺍﻥ‬
‫ﺯ‬‫ﻭ‬‫ﺃ‬،‫ﺔ‬‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬‫ﻟﻢﻭ‬‫ﺍﻷ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﻳﺖ‬‫ﺮ‬‫ﻛ‬‫ﻮ‬‫ﺗ‬
‫ﺎ‬‫ﻤ‬‫ﻴ‬
‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻦﻭ‬‫ﺑ‬‫ﻮ‬
‫ﻠ‬‫ﻮﺟ‬‫ﻤ‬‫ﻴ‬‫ﻬ‬
‫ﻟ‬‫ﺍ‬
‫ﻤﺼﻞﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﺖ‬‫ﻟ‬‫ﻭ‬‫ﺮ‬
‫ﺘ‬‫ﻜ‬‫ﻟ‬‫ﻮﻯﺇ‬‫ﺘ‬‫ﻣﺴ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺐ‬ ‫ﺮﻃ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻋ‬‫ﻭ‬‫ﻣﺍﻷ‬
‫ﻳﻒ ﻦ‬ ‫ﺰ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬-

252
Nursingdiagnosi s( 1)
:
Fl
uidv ol
umeexcessr elatedtoresumpt i
onofcapi l
l
aryintegri
tyandfl
uidshi
ft
fr
om intersti
ti
altoi ntr
av ascul
ar
Goal:maintenanceofopt i
mal f
lui
dbal ance.
Nursingintervention:
-Moni t
orv i
talsi
gns.
-Moni t
orintakeandoutput .
-Assesswei ght,edema, andjugularveindist
enti
ont odetectfl
uidst
atus.
-MaintainIVfluidsonpumpst opreventaccidentalfl
uidbolus.
-Givepatientdiureticsordopami neaspr escri
bed.

Nursingdiagnosi
s(2):
Ri
skf ori
nfecti
onrel
atedtolossofski
nbarri
erandi
mpai
redi
mmuner
esponse.
Goal:Absenceoflocal
izedorsyst
emicinf
ecti
on.

:(1)‫ﻳ ﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
‫ﻟﻰ‬‫ﻼﻲﺇ‬‫ﻟﺨﻟ‬ ‫ﺍ‬‫ﺋﻞﻣﻦ‬ ‫ﺍ‬
‫ﻮ‬ ‫ﻟﺴ‬‫ﺍ‬‫ﻮﻝ‬ ‫ﺗﺤ‬‫ﺔﻭ‬‫ﻳ‬‫ﻮ‬ ‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﻴ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻼﺔ‬
‫ﺎﻑﺳ ﻣ‬ ‫ﻨ‬‫ﺌ‬
‫ﺘ‬‫ﺎﺳ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺋ ﺾﺣﺠﻢ‬ ‫ﺎ‬
‫ﻓ‬
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻣ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻋ‬‫ﻭ‬‫ﺍﻷ‬‫ﺍﺧﻞ‬‫ﺩ‬
.‫ﺜﻞ‬ ‫ﻣ‬‫ﺍﻷ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬‫ﺯﻥ‬‫ﺍ‬‫ﻮ‬‫ﻠﻰﺗ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬:‫ﺪﻑ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.
‫ﺔ‬ ‫ﻳ‬
‫ﻮ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬ ‫ﺮ‬‫ﺆﺷ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.
‫ﻭﺝ‬ ‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬
‫ﻮﻝﻭ‬ ‫ﺪﺧ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬-
.‫ﺋﻞ‬‫ﺍ‬‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬
‫ﺣﺔ‬‫ﻟ‬‫ﻜﺸﻒﻋﻦ ﺎ‬ ‫ﻠ‬
‫ﻟ‬‫ﺍﺟﻲ‬ ‫ﺩ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺥ‬‫ﻔ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺔﻭ‬ ‫ﻣ‬‫ﺫ‬‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺯﻥﻭ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬
‫ﺗ‬-
.‫ﺮﺿﻲ‬ ‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺋﻞ‬‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬ ‫ﺍ‬‫ﺮﺏ‬ ‫ﻊﺗﺴ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬‫ﺎﺕ‬‫ﻤﻀﺨ‬ ‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﺔﻋ‬‫ﻳ‬‫ﺪ‬‫ﻳ‬‫ﺭ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬‫ﺋﻞ‬ ‫ﺍ‬
‫ﻮ‬‫ﻟﺴ‬‫ﺍ‬ ‫ﻠﻰ‬‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬
‫ﺍ‬-
.‫ﻮﻑ‬ ‫ﻮﺻ‬ ‫ﻮﻣ‬ ‫ﺎﻫ‬‫ﻤ‬‫ﻴﻦﻛ‬ ‫ﻣ‬‫ﺎ‬
‫ﺑ‬‫ﻭ‬‫ﺪ‬‫ﻟ‬‫ﺍ‬‫ﻭ‬‫ﺍ‬‫ﻮﻝ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬ ‫ﺭ‬‫ﺪ‬‫ﻳ ﺾﻣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﺍﻋﻄ‬-
:(2)‫ﻳ ﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.‫ﺔ‬‫ﻴ‬
‫ﺎﻋ‬‫ﻨ‬
‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﺑ‬
‫ﺎ‬‫ﺘﺠ‬‫ﺍﻻﺳ‬ ‫ﻌﻒ‬ ‫ﺪﻭﺿ‬ ‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺰ‬
‫ﺎﺟ‬‫ﺍﻥﺣ‬ ‫ﺪ‬‫ﻘ‬‫ﻔ‬‫ﻭﻯﺑ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬ ‫ﺮ‬‫ﺎﻃ‬‫ﺒﻂﻣﺨ‬ ‫ﺗ‬‫ﺮ‬
‫ﺗ‬
.
‫ﺔ‬‫ﻳ‬‫ﺯ‬‫ﺎ‬‫ﻬ‬‫ﻭﺟ‬ ‫ﺃ‬‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﻭﻯﻣ‬ ‫ﺪ‬‫ﺩﻋ‬ ‫ﻮ‬‫ﻡﻭﺟ‬ ‫ﺪ‬‫ﻋ‬: ‫ﺪﻑ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
Nursingi ntervention:
-Useasepsi sinal laspect sofpat i
entcar et omi ni mizer i
skofcr oss–
contami nation.
-Decreasenumberofv i
sitors.
-Excludepl ant sandf l
ower sinwat erfrom pat ientr oom becausewat ersour ce
ofbact eri
al growth.
-i
nspectwoundf orsi gnsofi nfection.
-Moni torwhi t
ebl oodcel l
ofcounti ndi catesinfect i
on.
-Givespat ientsant ibioticst oreducebact eri
a.
:
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬ ‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.‫ﻮﺙ‬ ‫ﻠ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﻝ‬‫ﻘ‬‫ﺘ‬‫ﻧ‬
‫ﺍ‬‫ﺮ‬‫ﺎﻃ‬‫ﻴﻞﻣﺨ‬ ‫ﻠ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬‫ﻧﺐﺭﻋ‬ ‫ﺍ‬
‫ﻮ‬‫ﻊﺟ‬ ‫ﻴ‬
‫ﻤ‬‫ﻴﻢﻓﻲﺟ‬ ‫ﻘ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬-
.‫ﺭ‬‫ﺍ‬
‫ﻭ‬ ‫ﺰ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺪ‬‫ﻴﻞﻋ‬ ‫ﻠ‬‫ﻘ‬
‫ﺗ‬-
.
‫ﺎ‬‫ﻳ‬‫ﺮ‬
‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮ‬‫ﻤ‬
‫ﻨ‬‫ﻟ‬‫ﺭ‬‫ﺪ‬‫ﺀﻣﺼ‬ ‫ﺎ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻳ ﺾﻷﻥ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬‫ﻓ‬‫ﺮ‬‫ﺀﻣﻦﻏ‬ ‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓﻓﻲ‬ ‫ﺩ‬‫ﻮ‬‫ﻮﺟ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﻮ‬‫ﺰﻫ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬ ‫ﺗ‬‫ﺎ‬
‫ﺒ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﺒ‬
‫ﺘ‬‫ﺍﺳ‬-
.‫ﻭﻯ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻣ‬‫ﺎﻋﻦﻋﻼ‬ ً
‫ﺜ‬‫ﺮﺡﺑﺤ‬ ‫ﻟﺠ‬
‫ﺍ‬ ‫ﻓﺤ ﺺ‬‫ﺍ‬-
.‫ﻭﻯ‬ ‫ﺪ‬
‫ﺩﻋ‬ ‫ﻮ‬‫ﻠﻰﻭﺟ‬ ‫ﺀﻋ‬ ‫ﺎ‬
‫ﻴﻀ‬ ‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻟ‬
‫ﺍ‬‫ﺎ‬‫ﻳ‬‫ﺩﺧﻼ‬ ‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺗ‬ ‫ﺒ‬
‫ﻗ‬‫ﺍ‬‫ﺮ‬‫ﺪﻝﻣ‬‫ﺗ‬-
.‫ﺎ‬
‫ﻳ‬‫ﺮ‬‫ﻴ‬
‫ﺘ‬‫ﻜ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﻴﻞ‬ ‫ﻠ‬
‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﻴ‬‫ﺍﺕﺣ‬ ‫ﺩ‬‫ﺎ‬‫ﺮﺿﻰﻣﻀ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻌﻄﻲ‬‫ﻳ‬-
Nursingdi agnosi s( 3):
Alt
erednut r i
ti
onl esst hanbodyr equirement sr elatedt ohy permet abol i
sm and
woundheal ing.
Goal:Mai ntainofopt imal nutri
tional status.

253
Nursi
ngi nter
vention:
-Provi
dehi ghcalori
c,hi
ghprotei
ndiettopromotewoundheal i
ng.
-Administersupplementalvi
taminsandmi ner
alsasprescr
ibed.
-Reportabdomi naldi
stent
ion,l
argegastr
icresi
dualvol
umesordi ar
rheat
o
physi
cian.

:(
3)‫ﻳ ﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.
‫ﻭﺡ‬‫ﺮ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬
‫ﺎ‬‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
‫ﺋﻲﻭ‬‫ﺍ‬
‫ﺬ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻁ‬‫ﻔ‬‫ﺔﺑ‬‫ﻘ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬‫ﺎﺕ‬‫ﺒ‬‫ﻠ‬
‫ﺘﻄ‬‫ﻗﻞﻣﻦﻣ‬ ‫ﺃ‬
‫ﺓ‬‫ﺮ‬‫ﻴ‬‫ﻐ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﻳ‬
‫ﺬ‬ ‫ﻐ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.‫ﻠﻰ‬‫ﺜ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﻭ‬‫ﺬ‬‫ﻐ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬‫ﺍ‬‫ﻠﻰ‬‫ﺎﻅﻋ‬‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬:
‫ﺪﻑ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﺪﺧﻞ‬‫ﺗ‬
.‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺎﺕ‬
‫ﻨ‬‫ﻴ‬‫ﺗ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻭ‬‫ﻳ‬‫ﺭ‬‫ﺍ‬
‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺍﺕ‬‫ﺮ‬
‫ﻌ‬‫ﻟﺴ‬‫ﺍ‬‫ﻟﻲ‬‫ﺎ‬
‫ﺋﻲﻋ‬ ‫ﺍ‬
‫ﺬ‬‫ﻡﻏ‬ ‫ﺎ‬
‫ﺮﻧﻈ‬ ‫ﻴ‬
‫ﻓ‬‫ﻮ‬‫ﺗ‬-
.‫ﻪ‬‫ﻴ‬
‫ﻠ‬‫ﻮ ﺹﻋ‬‫ﻨﺼ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻮ‬‫ﻨﺤ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬‫ﺔﻋ‬ ‫ﻴ‬
‫ﻠ‬‫ﻴ‬‫ﻤ‬‫ﻜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺩﻥ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻭ‬‫ﻨ‬‫ﻴ‬‫ﻣ‬‫ﺎ‬
‫ﺘ‬‫ﻴ‬
‫ﻔ‬‫ﻟ‬‫ﺍ‬‫ﻭﻝ‬‫ﺎ‬‫ﻨ‬
‫ﺗ‬-
.‫ﺎ‬
‫ﻹﻬﻝ‬
‫ﺃﺍ ﺳ‬
‫ﺓﻭ‬‫ﺪ‬‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎ‬‫ﻳ‬‫ﺎ‬
‫ﻘ‬‫ﺓﻣﻦﺑ‬
‫ﺮ‬‫ﻴ‬‫ﺒ‬‫ﺎﺕﻛ‬‫ﻴ‬‫ﻤ‬‫ﺩﻛ‬‫ﻮ‬‫ﻭﻭﺟ‬ ‫ﺃ‬
‫ﻨﻲ‬‫ﺒﻄ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺥ‬
‫ﻔ‬‫ﺘ‬‫ﻧ‬‫ﺎﻻ‬
‫ﻴﺐﺑ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬‫ﺇﻼﻍ‬‫ﺑ‬-

Nursingdiagnosi s(4):
Impairedskinintegrit
yr elatedtoopenbur nwound.
Goal:Demonst rat i
onofi mpr ovedskinintegri
ty.
Nursinginterv
ent ion:
-Cleanwounds, bodyandhai rdail
yt oreducebacterialcoloniz ati
on.
-Providewoundcar easpr escri
bedt opromot ewoundheal i
ng.
-Preventpressur e,i
nfect i
onandmobi l
izati
onofaut ogr afts.
-Providedonorsi tecare.
-Assesswoundandgr aftsiteswhenpr esentsignsofpoorheal ing,poorgraft
ortrauma, r
eportphy sician.
:(4)‫ﻳ ﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.
‫ﻮﺡ‬ ‫ﺘ‬
‫ﻔ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺮﺡ‬ ‫ﺒﻂﺑﺠ‬ ‫ﺗ‬
‫ﺮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﻌﻒﺳ ﻣ‬ ‫ﺿ‬
.
‫ﺔ‬ ‫ﻨ‬
‫ﻤﺤﺴ‬ ‫ﻟ‬‫ﺍ‬‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﻼﺔ‬
‫ﺭﺳ ﻣ‬ ‫ﺎ‬
‫ﻬ‬‫ﺇﻇ‬:‫ﺪﻑ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.
‫ﺮﻱ‬‫ﻴ‬‫ﺘ‬‫ﻜ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬‫ﺭ‬
‫ﺎ‬‫ﻤ‬‫ﻌ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﻴﻞ‬
‫ﻠ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺎ‬‫ﻴ‬
‫ﻣ‬ ‫ﻮ‬
‫ﺮﻳ‬ ‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬
‫ﻟﺠﺴﻢﻭ‬ ‫ﺍ‬
‫ﻭﺡﻭ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻧﻈﻒ‬-
.‫ﻭﺡ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﻡ‬‫ﺎ‬
‫ﺌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺰ‬
‫ﻳ‬‫ﺰ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﻪ‬‫ﻴ‬‫ﻠ‬‫ﻮ ﺹﻋ‬‫ﻨﺼ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮ‬
‫ﻨﺤ‬ ‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻭﺡﻋ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺎ‬
‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬
‫ﻨ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻓ‬
‫ﻮ‬‫ﺗ‬-
.‫ﺔ‬‫ﻴ‬
‫ﺗ‬‫ﺍ‬
‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬
‫ﻮ‬ ‫ﻌ‬‫ﻟﻄ‬‫ﺍ‬‫ﺔ‬‫ﺌ‬‫ﺒ‬
‫ﻌ‬‫ﺗ‬‫ﻭﻯﻭ‬ ‫ﺪ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻐﻂﻭ‬ ‫ﻟﻀ‬‫ﺍ‬‫ﻊ‬
‫ﻨ‬‫ﻣ‬-
.
‫ﺮﻉ‬‫ﺒ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬
‫ﻮ‬‫ﺔﻣ‬ ‫ﻳ‬
‫ﺎ‬‫ﺮﺭﻋ‬‫ﻴ‬‫ﻓ‬
‫ﻮ‬‫ﺗ‬-
‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬
‫ﻌﻒ‬ ‫ﻭﺿ‬ ‫ﺃ‬‫ﻡ‬ ‫ﺎ‬
‫ﺌ‬‫ﺘ‬‫ﻟ‬
‫ﺍﻻ‬‫ﻌﻒ‬ ‫ﺎﺕ ﺿ‬‫ﻣ‬‫ﺭﻋﻼ‬ ‫ﻮ‬
‫ﻬ‬‫ﺪﻇ‬ ‫ﻨ‬‫ﻭﻉﻋ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬‫ﺍ‬
‫ﺮﺡﻭ‬ ‫ﻟﺠ‬‫ﺍ‬‫ﻊ‬‫ﻗ‬‫ﺍ‬‫ﻮ‬‫ﻴﻢﻣ‬‫ﻴ‬‫ﻘ‬
‫ﺘ‬‫ﻗﻢﺑ‬-
.‫ﻴﺐ‬ ‫ﺒ‬
‫ﻟﻄ‬‫ﺍ‬ ‫ﺮ‬
‫ﻳ‬‫ﺮ‬‫ﻘ‬‫ﺗ‬،‫ﺔ‬‫ﻣ‬‫ﺪ‬‫ﻟﺼ‬‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻭﻉ‬‫ﺮ‬‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬

Nursingdiagnosis( 5)
:
Pai
nr elat
edt oexposedner ves,woundheal ingandt r
eatments.
Goal:Reductionorcont r
olofpai n.
Nursinginterventi
on:
-Assesspai nlevelusi
ngpai nscal e.
-I
nst r
uctandassi stpati
entinrelax at
ionimagerydistr
acti
ontechni
que.
-Giveantianxietyandantipruri
ti
cagent sasi ndi
cat
edt opati
entcomf or
t
-Offeranalgesiabeforepainfulprocedures.
:
(5)‫ﻳ ﺾ‬
‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬‫ﺗﺸﺨ‬
.‫ﺎﺕ‬‫ﻭﻌﻼﺟ‬
‫ﻟ‬
‫ﻭﺡﺍ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬
‫ﻡ‬‫ﺎ‬‫ﺌ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻓ‬‫ﻮ‬‫ﻜﺸ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺏ‬‫ﺎﻷﻋﺼ‬
‫ﺒﻂﺑ‬‫ﺗ‬‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻟﻢ‬‫ﺍﻷ‬

254
 .
‫ﻪ‬‫ﻴ‬‫ﻠ‬
‫ﺓﻋ‬‫ﺮ‬‫ﻴﻄ‬‫ﻟﺴ‬
‫ﺍ‬ ‫ﻭ‬‫ﺃ‬‫ﻟﻢ‬
‫ﺍﻷ‬‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺗ‬:‫ﺪﻑ‬‫ﻬ‬‫ﻟ‬
‫ﺍ‬
:‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬‫ﺗ‬
.‫ﻟﻢ‬
‫ﺍﻷ‬‫ﺎﺱ‬‫ﻴ‬‫ﻘ‬‫ﻡﻣ‬‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬‫ﺎﺳ‬‫ﻟﻢﺑ‬‫ﺍﻷ‬‫ﻮﻯ‬‫ﺘ‬
‫ﻴﻢﻣﺴ‬ ‫ﻴ‬
‫ﻘ‬‫ﺗ‬-
.‫ﺀ‬
‫ﺎ‬‫ﺮﺧ‬‫ﺘ‬
‫ﺍﻻﺳ‬‫ﺭ‬‫ﻮ‬‫ﺔﺻ‬ ‫ﻴ‬‫ﻨ‬
‫ﻘ‬‫ﻳ ﺾﻓﻲﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺪ‬‫ﻋ‬‫ﺎ‬
‫ﻣﺴ‬‫ﺩﻭ‬ ‫ﺎ‬
‫ﺭﺷ‬‫ﺇ‬-
‫ﻳﺾ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬
‫ﺮ‬‫ﻟ‬‫ﻴﻦ‬‫ﺒ‬
‫ﻮﻣ‬‫ﺎﻫ‬‫ﻤ‬‫ﺔﻛ‬‫ﻜ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻠﻖﻭ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬
‫ﺎ‬‫ﻌﻄﻰﻣﻀ‬ ‫ﻳ‬-
.‫ﺔ‬‫ﻤ‬
‫ﻟ‬‫ﺆ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺀ‬‫ﺍ‬
‫ﺮ‬‫ﺍﻹﺟ‬‫ﺒﻞ‬‫ﺎﺕﻗ‬‫ﻨ‬‫ﻜ‬
‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻳﻢ‬‫ﺪ‬
‫ﻘ‬‫ﺗ‬-
Collaborati
veproblem:
-Congest i
veheartfail
ure.
-Pulmonar yedema
-Sepsis.
-Respirator
yfail
ure.
-Adultrespir
atorydist
resssy
ndr
ome.
-Visceraldamage.
:
‫ﺔ‬‫ﻴ‬‫ﻧ‬
‫ﻭ‬‫ﺎ‬‫ﻌ‬‫ﺔﺗ‬‫ﻠ‬
‫ﻜ‬‫ﻣﺸ‬
.
‫ﻧﻲ‬‫ﺎ‬
‫ﻘ‬‫ﺘ‬‫ﺍﻻﺣ‬ ‫ﻠﺐ‬‫ﻘ‬
‫ﻟ‬‫ﺍ‬‫ﻓﺸﻞ‬-
‫ﺔ‬‫ﻳ‬‫ﻮ‬‫ﺋ‬
‫ﺔﺭ‬ ‫ﻣ‬‫ﺫ‬‫ﻭ‬-
.‫ﺎﻥ‬‫ﺘ‬
‫ﻧ‬‫ﺍﻹ‬-
.‫ﻔﺲ‬ ‫ﻨ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻗﻒ‬‫ﻮ‬‫ﺗ‬-
.
‫ﻴﻦ‬‫ﻐ‬
‫ﻟ‬‫ﺎ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻨ‬
‫ﺔﻋ‬‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﺋ‬
‫ﺎ‬‫ﻟﻀ‬‫ﺍ‬‫ﺔ‬‫ﻣ‬‫ﺯ‬‫ﻣﻼ‬
‫ﺘ‬-
.‫ﻮﻱ‬‫ﻟﺤﺸ‬‫ﺍ‬ ‫ﺭ‬
‫ﺮ‬‫ﻟﻀ‬‫ﺍ‬-
C-Rehabi li
tationphaseofbur n
Thef ormal rehabil
it
ati
onphasebegi nswhent hepat i
ent’swoundshav eheal ed
andheorshei sengagingi nsomel evelofself-
care.Thismayhappenasear ly
as2weeksorasl ongas7t o8mont hsaf t
erthebur ninjury.Goalsfort he
pat i
entnowar eto(1)wor ktowar dresumi ngaf uncti
onal roleinsocietyand( 2)
rehabili
tatefrom anyfunctionalandcosmet i
cpostbur nr econstr
uctivesur ger y
thatmaybenecessar y
Rehabili
tati
onbegi nsi
mmedi atelyafterthebur nhasoccur r
edandof t
en
extendsf ory ear
saf t
erinj
ury.
‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻞ‬‫ﺄﻫ‬‫ﺔﺗ‬‫ﻠ‬‫ﺮﺣ‬ ‫ﻣ‬-‫ﺝ‬
‫ﻮﻯ‬ ‫ﺘ‬‫ﺎﻓﻲﻣﺴ‬ ً‫ﺮ‬
‫ﻃ‬ ‫ﻨﺨ‬‫ﻭﻫﻲﻣ‬ ‫ﺃ‬‫ﻮ‬‫ﻮﻥﻫ‬ ‫ﻜ‬‫ﻳ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺡ‬ ‫ﺮ‬
‫ﺌﻢﺟ‬ ‫ﺘ‬
‫ﻠ‬‫ﺎﺗ‬‫ﻣ‬
‫ﺪ‬‫ﻨ‬‫ﺔﻋ‬‫ﻴ‬‫ﻤ‬‫ﺮﺳ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺄﻫ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻋ‬‫ﺔﺇ‬‫ﻠ‬‫ﺮﺣ‬ ‫ﺃﻣ‬‫ﺪ‬‫ﺒ‬
‫ﺗ‬
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺪﺇﺻ‬ ‫ﻌ‬‫ﺮﺑ‬‫ﻬ‬‫ﺃﺷ‬8‫ﻟﻰ‬‫ﺇ‬7‫ﺘﻰ‬ ‫ﻭﺣ‬ ‫ﺃ‬‫ﻴﻦ‬‫ﻮﻋ‬‫ﺒ‬
‫ﺃﺳ‬ ‫ﺮﻣﻦ‬ ‫ﻜ‬‫ﺒ‬
‫ﻗﺖﻣ‬ ‫ﺍﻓﻲﻭ‬ ‫ﺬ‬‫ﺪﺙﻫ‬ ‫ﺪﻳﺤ‬ ‫ﻗ‬.‫ﺔ‬‫ﻴ‬
‫ﺗ‬‫ﺍ‬
‫ﺬ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦﻣﻦ‬ ‫ﻌ‬‫ﻣ‬
‫ﻴﻞ‬ ‫ﺄﻫ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫(ﺇﻋ‬2)‫ﻊﻭ‬‫ﻤ‬‫ﺘ‬‫ﻤﺠ‬‫ﻟ‬
‫ﺍ‬‫ﻔﻲﻓﻲ‬ ‫ﻴ‬
‫ﺭﻭﻇ‬ ‫ﻭ‬‫ﺎﻑﺩ‬ ‫ﻨ‬
‫ﺌ‬‫ﺘ‬‫ﺍﺳ‬‫ﻠﻰ‬‫ﻤﻞﻋ‬ ‫ﻌ‬
‫ﻟ‬‫ﺍ‬(
1)‫ﺍﻵﻥﻫﻲ‬ ‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬.‫ﺮﻕ‬ ‫ﻟﺤ‬
‫ﺍ‬
‫ﺔ‬‫ﻳ‬‫ﺭ‬‫ﻭ‬‫ﺮ‬‫ﻮﻥ ﺿ‬‫ﻜ‬‫ﺪﺗ‬‫ﻭﻕﻗ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻣ‬‫ﺮ‬‫ﺗ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻠ‬‫ﻴ‬‫ﻤ‬
‫ﺔﺗﺠ‬ ‫ﺍﺣ‬‫ﺮ‬‫ﺃﻱﺟ‬ ‫ﻣﻦ‬
.‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﺪ‬‫ﻌ‬‫ﺍﺕﺑ‬ ‫ﻮ‬‫ﻨ‬
‫ﻟﺴ‬‫ﺪ‬‫ﺘ‬‫ﻤ‬‫ﺎﺗ‬
‫ﺎﻣ‬ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬‫ﻏ‬‫ﺮﻕﻭ‬‫ﻟﺤ‬‫ﺍ‬ ‫ﻭﺙ‬‫ﺪ‬‫ﺭﺣ‬ ‫ﻮ‬‫ﻴﻞﻓ‬‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺃﺇﻋ‬‫ﺪ‬‫ﺒ‬
‫ﺗ‬

Theemphasi sonear l
yr ehabili
tat
ioncannotbeov eresti
mated.I nt
hisfi
nal
phaseofcar e,t
hef ocusbecomesr ehabil
itat
ion,reconst r
ucti
on, and
reint
egrati
onoft heburnsur vi
v or.I
naddi t
ion,thebur nteam focusesonl ate
compl i
cations.
Burnrehabili
tationi
st i
me- consumi ngandchal lengingandi sv eryspeci
fi
cto
thesever i
tyandl ocati
onofi njuryaswel lasthepat ient’sneedsandgoal s.
Thesegoal sv arybasedonphaseofcar eandneedt obeaddr essedfrequent
ly
toensur econst antprogress.

‫ﺒﺢ‬‫ﻳﺼ‬،‫ﺔ‬
‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬
‫ﻟ‬‫ﺍ‬‫ﺓﻣﻦ‬‫ﺮ‬
‫ﻴ‬‫ﺍﻷﺧ‬‫ﺔ‬
‫ﻠ‬‫ﺮﺣ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻩ‬
‫ﺬ‬‫ﻓﻲﻫ‬. ‫ﺮ‬
‫ﻜ‬‫ﺒ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬
‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻋ‬‫ﻠﻰﺇ‬‫ﺪﻋ‬‫ﻴ‬‫ﻛ‬‫ﺄ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻐ‬‫ﻟ‬
‫ﺎ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻜﻦ‬‫ﻤ‬‫ﻻﻳ‬
‫ﺰ‬‫ﻛ‬
‫ﺮ‬‫ﻳ‬،‫ﻟﻚ‬
‫ﻟﻰﺫ‬‫ﺔﺇ‬‫ﻓ‬‫ﺎ‬
‫ﺎﻹﺿ‬‫ﺑ‬.
‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻴﻦﻣﻦ‬‫ﺎﺟ‬‫ﻨ‬
‫ﻠ‬‫ﻟ‬
‫ﺎﺝ‬‫ﻣ‬‫ﺩ‬‫ﺍﻹ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﺇﻋ‬
‫ﺀﻭ‬‫ﺎ‬‫ﻨ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﺇﻋ‬
‫ﻴﻞﻭ‬‫ﺄﻫ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻠﻰﺇﻋ‬‫ﺰﻋ‬‫ﻴ‬
‫ﻛ‬‫ﺮ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬
.
‫ﺓ‬‫ﺮ‬‫ﺄﺧ‬
‫ﺘ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬
‫ﻔ‬‫ﺎﻋ‬‫ﻤﻀ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬
‫ﻭﻕﻋ‬ ‫ﺮ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻳﻖ‬‫ﺮ‬
‫ﻓ‬
‫ﺍﻹ‬‫ﺓ‬‫ﺪ‬
‫ﺍﺑﺸ‬
ً
‫ﺪ‬‫ﺔﺟ‬ ‫ﺎﺻ‬‫ﺪﻱﻭﻫﻲﺧ‬‫ﺘﺤ‬‫ﻟ‬
‫ﺎ‬‫ﺘﺴﻢﺑ‬‫ﺗ‬
‫ﻳﻼًﻭ‬ ‫ﻮ‬‫ﺎﻃ‬ً
‫ﺘ‬‫ﻗ‬‫ﻭﻕﻭ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻴﻞﻣﻦ‬‫ﺄﻫ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﺔﺇﻋ‬‫ﻴ‬
‫ﻠ‬‫ﻤ‬‫ﺮﻕﻋ‬‫ﻐ‬
‫ﺘ‬‫ﺗﺴ‬

255
 ‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬ ‫ﻠﻰﻣ‬ ‫ﺀﻋ‬
ً ‫ﺎ‬
‫ﻨ‬‫ﺍﻑﺑ‬ ‫ﺪ‬
‫ﺍﻷﻫ‬ ‫ﻩ‬‫ﺬ‬‫ﻠﻒﻫ‬ ‫ﺘ‬
‫ﺗﺨ‬.‫ﻪ‬‫ﻓ‬‫ﺍ‬‫ﺪ‬‫ﺃﻫ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬‫ﺍﺣ‬ ‫ﻟﻰ‬
‫ﺔﺇ‬‫ﻓ‬ ‫ﺎ‬
‫ﺎﻹﺿ‬ ‫ﺎﺑ‬‫ﻬ‬‫ﻌ‬
‫ﻗ‬ ‫ﻮ‬‫ﻣ‬‫ﺔﻭ‬ ‫ﺑ‬‫ﺎ‬‫ﺇﺻ‬
.‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﺪ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻥ‬ ‫ﻤ‬‫ﻟﻀ‬ ‫ﺭ‬‫ﺮ‬
‫ﻜ‬‫ﺘ‬‫ﻜﻞﻣ‬ ‫ﺎﺑﺸ‬‫ﻬ‬‫ﺘ‬
‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬‫ﻟﻰﻣ‬ ‫ﺎﺝﺇ‬‫ﺘ‬
‫ﺗﺤ‬ ‫ﺔﻭ‬ ‫ﻳ‬‫ﺎ‬‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬

Duringhospi t
alizat i
ont hegoal sinclude:
Mai ntainingr angeofmot i
on( ROM) ,
Pr ev entingofscar sandcont racturest hroughspl int i
ngtechni ques,
Decr easingedema, andt hepr event i
ngski nbr eakdownt hroughpr oper
posit
ioni ng.
Ast heacut ephasecomest oacl ose, patientsbecomemor eawar eoft heir
i
njuri
esandt hechal lengest heyf ace.Thegoal saref unct i
onal andai medat
acti
vit
iesofdai lyl ivi
ngsuchasambul ationandpar ti
ci pati
oni nsel fcareaswel l
asscarmanagementandr eturningt owor korschool
Occupat ional andphy sicaltherapistsar eessent ial tooptimizingpat i
ent
goalsandout comes.
:
‫ﻠﻲ‬ ‫ﺎﻳ‬‫ﻔﻰﻣ‬ ‫ﺘﺸ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﻌﻼﺝﻓﻲ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺀ‬‫ﺎ‬
‫ﻨ‬‫ﺛ‬‫ﺃ‬‫ﺍﻑ‬ ‫ﺪ‬‫ﺍﻷﻫ‬ ‫ﻤﻞ‬‫•ﺗﺸ‬
،(ROM)‫ﺔ‬ ‫ﻛ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﻕ‬ ‫ﻠﻰﻧﻄ‬ ‫ﺎﻅﻋ‬ ‫ﻔ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﺮ‬‫ﻴ‬‫ﺒ‬
‫ﺘﺠ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕ‬ ‫ﻴ‬‫ﻨ‬‫ﻘ‬
‫ﺘ‬‫ﺎﺕﺑ‬‫ﻠﺼ‬ ‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺎﺕﻭ‬‫ﺑ‬‫ﺪ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻊ‬‫ﻨ‬‫ﻣ‬
.‫ﺔ‬‫ﻴﺤ‬‫ﻟﺼﺤ‬‫ﺍ‬ ‫ﺔ‬‫ﻴ‬‫ﻌ‬‫ﻮﺿ‬ ‫ﻟ‬
‫ﺍ‬ ‫ﺪﻣﻦﺧﻼﻝ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬
‫ﻴ‬‫ﻜﺴ‬‫ﻊﺗ‬ ‫ﻨ‬
‫ﻣ‬ ‫ﺔﻭ‬ ‫ﻣ‬
‫ﺫ‬‫ﻮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬ ‫ﻠ‬‫ﻘ‬
‫ﺗ‬
‫ﺘﻲ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﻬﻢﻭ‬ ‫ﺗ‬‫ﺎ‬
‫ﺑ‬‫ﺎ‬
‫ﺈﺻ‬ ‫ﺎﺑ‬
ً‫ﻴ‬‫ﺮﻭﻋ‬ ‫ﺜ‬
‫ﻛ‬‫ﺃ‬‫ﺮﺿﻰ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺒﺢ‬ ‫ﻳﺼ‬، ‫ﺎ‬‫ﻬ‬‫ﺘ‬
‫ﻳ‬‫ﺎ‬
‫ﻬ‬ ‫ﺓﻣﻦﻧ‬ ‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬ ‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺏ‬ ‫ﺮ‬
‫ﺘ‬‫ﻗ‬‫ﺍ‬ ‫ﻊ‬‫ﻣ‬
‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬ ‫ﻟ‬‫ﺍ‬‫ﺔﻓﻲ‬ ‫ﻛ‬‫ﺭ‬‫ﺎ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﺸﻲﻭ‬ ‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫ﺔﻣ‬ ‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬ ‫ﺃ‬‫ﻟﻰ‬‫ﺪﻑﺇ‬ ‫ﻬ‬‫ﺗ‬
‫ﺔﻭ‬ ‫ﻴ‬
‫ﻔ‬‫ﻴ‬‫ﺍﻑﻭﻇ‬ ‫ﺪ‬‫ﺍﻷﻫ‬ .
‫ﺎ‬‫ﻬ‬‫ﻧ‬
‫ﻮ‬ ‫ﻬ‬‫ﺍﺟ‬‫ﻮ‬‫ﻳ‬
‫ﺔ‬‫ﺭﺳ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬ ‫ﺃ‬‫ﻤﻞ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻟﻰ‬ ‫ﺓﺇ‬‫ﺩ‬‫ﻮ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬
‫ﺎﺕﻭ‬ ‫ﺑ‬‫ﺪ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺭ‬‫ﺍ‬‫ﺩ‬‫ﻟﻰﺇ‬‫ﺔﺇ‬ ‫ﻓ‬
‫ﺎ‬‫ﺎﻹﺿ‬ ‫ﺔﺑ‬ ‫ﻴ‬
‫ﺗ‬‫ﺍ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬
.‫ﻬﻢ‬ ‫ﺋﺠ‬‫ﺎ‬‫ﺘ‬
‫ﻧ‬‫ﺮﺿﻰﻭ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺍﻑ‬ ‫ﺪ‬‫ﺃﻫ‬‫ﻴﻦ‬‫ﺘﺤﺴ‬ ‫ﻟ‬‫ﻮﻥ‬ ‫ﻳ‬‫ﺭ‬
‫ﻭ‬‫ﺮ‬‫ﻮﻥ ﺿ‬ ‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻳ‬‫ﺰ‬‫ﻴ‬‫ﻔ‬
‫ﻟ‬‫ﺍ‬
‫ﻮﻥﻭ‬ ‫ﻴ‬‫ﻨ‬‫ﻬ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻥ‬ ‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬

1.Psy chologi calsuppor t

:
Apat i
ent’sout look,mot i
vati
on,andsuppor tsystem arei mpor tanttohisorher
overallwel l
-beingandabi l
it
ytopr ogresst hrought herehabi li
tationphase.
Ther ear ethr eebasicphasesofpsy chologicalrecov eryfrom abur ninjury:
1.Criti
cal phase.
2.Acut ephase.
3.fi
nal stage.
Dur i
ngt hecr i
ticalphase,pati
entsof tenar econf usedf rom medi cati
ont hey
aretaking, butt heyhav eanunder ly
ingsenseoff ear,anx i
ety,andpai n.
:‫ﻔﺴﻲ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻋﻢ‬ ‫ﻟ‬
‫ﺍ‬.1
‫ﺓ‬‫ﺩ‬‫ﺎ‬‫ﺔﺇﻋ‬ ‫ﻠ‬
‫ﺮﺣ‬‫ﻡﺧﻼﻝﻣ‬ ‫ﺪ‬‫ﻘ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻪﻋ‬‫ﺗ‬‫ﺭ‬
‫ﺪ‬‫ﻗ‬‫ﻡﻭ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻪ‬‫ﺎﻫ‬‫ﻓ‬‫ﺮ‬
‫ﻟ‬ ‫ﺎﻥ‬
‫ﻤ‬‫ﻬ‬‫ﺪﻋﻢﻣ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﺎ‬‫ﻧﻈ‬‫ﺰﻭ‬ ‫ﻴ‬
‫ﻔ‬‫ﺘﺤ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻳ ﺾﻭ‬ ‫ﺮ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺮ‬‫•ﻧﻈ‬
.
‫ﻴﻞ‬‫ﺄﻫ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
:‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻔﺴﻲﻣﻦﺇﺻ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻠ‬‫ﻟ‬
‫ﺔ‬‫ﻴ‬‫ﺎﺳ‬‫ﺃﺳ‬ ‫ﺍﺣﻞ‬‫ﺮ‬
‫ﺎﻙﺛﻼﺙﻣ‬ ‫ﻨ‬‫•ﻫ‬
.
‫ﺔ‬‫ﺮﺟ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬.1
.
‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬.2
.‫ﺔ‬
‫ﻴ‬‫ﺋ‬‫ﺎ‬
‫ﻬ‬‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬.3
‫ﻬﻢ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬‫ﻜﻦ‬ ‫ﻟ‬
، ‫ﺎ‬‫ﻬ‬
‫ﻧ‬‫ﻮ‬‫ﻟ‬‫ﻭ‬
‫ﺎ‬‫ﻨ‬‫ﺘ‬
‫ﺘﻲﻳ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﻭ‬
‫ﺩ‬‫ﻣﺍﻷ‬
‫ﺮﺿﻰ ﻦ‬ ‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻴﻦ‬‫ﻠﻂﺑ‬‫ﻟﺨ‬‫ﺍ‬‫ﺘﻢ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬، ‫ﺔ‬‫ﺮﺟ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫•ﺧﻼﻝ‬
.
‫ﻟﻢ‬‫ﺍﻷ‬‫ﻠﻖﻭ‬‫ﻘ‬‫ﻟ‬‫ﺍ‬
‫ﻮﻑﻭ‬ ‫ﻟﺨ‬
‫ﺎ‬‫ﺎﺑ‬ً
‫ﻨ‬
‫ﻣ‬‫ﺎ‬‫ﺍﻛ‬ً
‫ﺭ‬
‫ﻮ‬ ‫ﻌ‬‫ﺷ‬


Int heacutephase,pati
entsrecognizethatsurvi
vali
sex pect
ed.Theyhave
periodsofdepressi
onduet otheirawar enessofthefuncti
onalandbodyimage
challengesaheadandcanr ecognizealltheyhavelost.
Thef i
nalst
ageofpsy chol
ogicalrecoveryoccurswit
hin1t o2yearsfol
lowi
ng
discharge.Thi
sisanemot i
onalti
meast hepati
entandf amil
ybegintoli
vewit
h
newphy si
call
imit
ati
onsandchal lengesinrelat
ionshi
ps.
Psy chologi
calt
reat
mentpl ansshoul dincl
udeaf ul
lassessmentofthese

256
‫‪i‬‬
‫‪ssuesandat‬‬‫‪ar‬‬‫‪get‬‬‫‪edpl‬‬
‫‪anwi‬‬ ‫‪t‬‬
‫‪ht‬‬ ‫‪heappr‬‬
‫‪opr‬‬‫‪i‬‬
‫‪at‬‬‫‪er‬‬
‫‪esour‬‬‫‪cest‬‬
‫‪opr‬‬‫‪omot‬‬‫‪et‬‬‫‪he‬‬
‫‪pat‬‬
‫‪i‬‬‫‪ent‬‬
‫’‬‫‪ssoci‬‬
‫‪al‬‬‫‪andv‬‬‫‪ocat‬‬
‫‪i‬‬‫‪onal‬‬‫‪r‬‬‫‪ei‬‬‫‪nt‬‬
‫‪egr‬‬
‫‪at‬‬‫‪i‬‬
‫‪onandi‬‬‫‪mpr‬‬‫‪ov‬‬‫‪edqual‬‬
‫‪i‬‬
‫‪t‬‬‫‪yofl‬‬
‫‪i‬‬‫‪f‬‬
‫‪e.‬‬

‫ﺎﺏ‬‫ﺌ‬
‫ﺘ‬‫ﻛ‬‫ﻣﺍﻻ‬
‫ﺍﺕ ﻦ‬‫ﺮ‬‫ﺘ‬‫ﻬﻢﻓ‬‫ﻳ‬‫ﺪ‬‫ﻟ‬‫‪.‬‬‫ﻊ‬
‫ﻗ‬‫ﻮ‬‫ﺘ‬ ‫ﺮﻣ‬‫ﻣ‬‫ﺃ‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺪ‬‫ﻴ‬
‫ﻠﻰﻗ‬‫ﺀﻋ‬‫ﺎ‬
‫ﻘ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺃﻥ‬‫ﺮﺿﻰ‬ ‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺭﻙ‬‫ﺪ‬‫‪،‬ﻳ‬‫ﺓ‬‫ﺩ‬‫ﺎ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﻓﻲ‬
‫‪.‬‬
‫ﻩ‬‫ﻭ‬‫ﺪ‬‫ﻘ‬
‫ﺎﻓ‬‫ﻠﻰﻛﻞﻣ‬ ‫ﺮﻑﻋ‬ ‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻬﻢ‬‫ﻨ‬‫ﻜ‬‫ﻤ‬
‫ﻳ‬‫‪،‬ﻭ‬‫ﺔ‬
‫ﻳ‬‫ﺪ‬‫ﻟﺠﺴ‬
‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻮ‬‫ﻟﺼ‬‫ﺍ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬
‫ﻮﻇ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﻳ‬‫ﺪ‬‫ﺘﺤ‬‫ﻠ‬‫ﻟ‬
‫ﻬﻢ‬‫ﻛ‬‫ﺍ‬‫ﺭ‬
‫ﺩ‬‫ﺒﺐﺇ‬ ‫ﺑﺴ‬
‫‪.‬‬
‫ﻔﻰ‬‫ﺘﺸ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻭﺝﻣﻦ‬ ‫ﺮ‬‫ﻟﺨ‬‫ﺍ‬‫ﺪ‬
‫ﻌ‬‫ﻴﻦﺑ‬ ‫ﺘ‬‫ﻨ‬
‫ﻟﻰﺳ‬ ‫ﺔﺇ‬‫ﻨ‬‫ﻮﻥﺳ‬‫ﺪﺙﻓﻲﻏﻀ‬ ‫ﻔﺴﻲﺗﺤ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻓﻲ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﺓﻣﻦ‬ ‫ﺮ‬‫ﻴ‬
‫ﺍﻷﺧ‬ ‫ﺔ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕﻓﻲ‬‫ﻳ‬‫ﺪ‬‫ﺗﺤ‬‫ﺓﻭ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﺔﺟ‬ ‫ﻳ‬‫ﺪ‬‫ﺩﺟﺴ‬ ‫ﻮ‬‫ﻴ‬‫ﻊﻗ‬‫ﻴﺶﻣ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﺓﻓﻲ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺃ‬
‫ﺪ‬‫ﺒ‬‫ﻴﺚﻳ‬ ‫ﻔﻲﺣ‬ ‫ﺎﻃ‬‫ﻗﺖﻋ‬‫ﺍﻭ‬ ‫ﺬ‬‫ﻫ‬
‫‪.‬‬‫ﺎﺕ‬‫ﻗ‬
‫ﺩ‬‫ﺭ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺔﻣ‬‫ﻓ‬‫ﺪ‬‫ﻬ‬‫ﺘ‬‫ﺔﻣﺴ‬ ‫ﺎﻭﺧﻄ‬ ‫ﻳ‬‫ﺎ‬
‫ﻘﻀ‬‫ﻟ‬‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﻬ‬
‫ﻟ‬‫ﻣﻼً‬‫ﺎ‬‫ﺎﻛ‬
‫ً‬
‫ﻤ‬‫ﻴ‬‫ﻴ‬
‫ﻘ‬‫ﻔﺴﻲﺗ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻤﻦﺧﻄﻂ‬ ‫ﺘﻀ‬‫ﺃﻥﺗ‬‫ﻳﺠﺐ‬
‫‪.‬‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬ ‫ﻴ‬
‫ﻮﻋ‬ ‫ﻴﻦﻧ‬‫ﺗﺤﺴ‬‫ﻳ ﺾﻭ‬‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﻨﻲ‬‫ﻬ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻋﻲﻭ‬ ‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﺍﻻﺟ‬‫ﺎﺝ‬‫ﻣ‬‫ﺩ‬‫ﺍﻹ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻋ‬‫ﺰﺇ‬‫ﻳ‬‫ﺰ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬
‫ﺒ‬‫ﺎﺳ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬

‫‪‬‬‫‪‬‬‫‪Bur‬‬ ‫‪ni‬‬‫‪nj‬‬‫‪ur‬‬
‫‪i‬‬‫‪escanhav‬‬ ‫‪eamaj‬‬ ‫‪ori‬‬‫‪mpactonqual‬‬ ‫‪i‬‬
‫‪t‬‬‫‪yofl‬‬‫‪i‬‬‫‪f‬‬
‫‪e.Changesi‬‬ ‫‪nphy‬‬ ‫‪si‬‬‫‪cal‬‬
‫‪act‬‬ ‫‪i‬‬
‫‪v‬‬‫‪i‬‬‫‪t‬‬‫‪yaswel‬‬ ‫‪l‬‬‫‪associ‬‬‫‪al‬‬‫‪andpsy‬‬ ‫‪chol‬‬‫‪ogi‬‬‫‪cal‬‬‫‪adj‬‬‫‪ust‬‬‫‪ment‬‬‫‪s,‬‬‫‪suchasr‬‬ ‫‪et‬‬‫‪ur‬‬‫‪ni‬‬‫‪ngt‬‬‫‪o‬‬
‫‪school‬‬ ‫‪andempl‬‬ ‫‪oy‬‬‫‪mentst‬‬ ‫‪at‬‬‫‪us,‬‬‫‪maybechal‬‬ ‫‪l‬‬
‫‪engi‬‬‫‪ng.I‬‬‫‪ti‬‬
‫‪si‬‬‫‪mpor‬‬ ‫‪t‬‬‫‪antt‬‬ ‫‪hr‬‬‫‪oughout‬‬
‫‪t‬‬‫‪hi‬‬‫‪spr‬‬ ‫‪ocesst‬‬ ‫‪oassessandaddr‬‬ ‫‪esst‬‬‫‪hef‬‬ ‫‪ami‬‬‫‪l‬‬
‫‪yneeds.‬‬
‫‪Whenonememberofaf‬‬ ‫‪ami‬‬‫‪l‬‬‫‪ysust‬‬‫‪ai‬‬‫‪nsamaj‬‬ ‫‪orbur‬‬ ‫‪ni‬‬‫‪nj‬‬
‫‪ur‬‬‫‪y‬‬‫‪,‬‬‫‪t‬‬
‫‪heent‬‬ ‫‪i‬‬‫‪r‬‬
‫‪ef‬‬ ‫‪ami‬‬‫‪l‬‬‫‪yi‬‬
‫‪s‬‬
‫‪af‬‬‫‪f‬‬‫‪ect‬‬‫‪ed.Separ‬‬ ‫‪at‬‬‫‪i‬‬
‫‪on,‬‬‫‪f‬‬‫‪eel‬‬
‫‪i‬‬‫‪ngsofhel‬‬ ‫‪pl‬‬‫‪essness,‬‬‫‪l‬‬‫‪oss,‬‬‫‪andpsy‬‬‫‪chol‬‬ ‫‪ogi‬‬‫‪cal‬‬
‫‪dy‬‬ ‫‪sf‬‬‫‪unct‬‬‫‪i‬‬‫‪onmaybeexper‬‬ ‫‪i‬‬‫‪encedi‬‬‫‪nv‬‬ ‫‪ar‬‬‫‪y‬‬‫‪i‬‬
‫‪ngdegr‬‬ ‫‪ees.Fami‬‬‫‪l‬‬‫‪yandf‬‬ ‫‪r‬‬‫‪i‬‬
‫‪endsneed‬‬
‫‪suppor‬‬ ‫‪t‬‬
‫‪,‬‬‫‪educat‬‬‫‪i‬‬‫‪on,‬‬‫‪andgui‬‬ ‫‪dancei‬‬‫‪nassi‬‬‫‪st‬‬‫‪i‬‬
‫‪ngt‬‬ ‫‪hepat‬‬ ‫‪i‬‬
‫‪entt‬‬‫‪or‬‬‫‪et‬‬‫‪ur‬‬‫‪nt‬‬ ‫‪ot‬‬‫‪hei‬‬ ‫‪r‬‬
‫‪opt‬‬ ‫‪i‬‬
‫‪mal‬‬ ‫‪heal‬‬‫‪t‬‬
‫‪h.‬‬

‫ﺎﻁ‬‫ﻨﺸ‬
‫ﻟ‬‫ﺍ‬‫ﺍﺕﻓﻲ‬‫ﺮ‬‫ﻴ‬‫ﻴ‬‫ﻐ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻥ‬‫ﻜ‬
‫ﺪﺗ‬‫‪.‬ﻗ‬‫ﺓ‬‫ﺎ‬‫ﻴ‬
‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﻴ‬
‫ﻮﻋ‬‫ﻠﻰﻧ‬‫ﺮﻋ‬ ‫ﻴ‬‫ﺒ‬
‫ﺮﻛ‬‫ﻴ‬‫ﺛ‬‫ﺄ‬
‫ﻭﻕﺗ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬‫ﻮﻥﻹﺻ‬ ‫ﻜ‬‫ﺃﻥﻳ‬‫ﻜﻦ‬‫ﻤ‬‫•ﻳ‬
‫ﻬﻢ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫‪.‬ﻣﻦ‬ ‫ﺔ‬
‫ﺒ‬‫ﻌ‬‫‪،‬ﺻ‬ ‫ﻤﻞ‬‫ﻌ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﺔﻭﺣ‬‫ﺭﺳ‬‫ﺪ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺓﺇ‬‫ﺩ‬‫ﻮ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﺜﻞ‬‫‪،‬ﻣ‬‫ﺔ‬‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬
‫ﺔﻭ‬ ‫ﻴ‬‫ﺎﻋ‬
‫ﻤ‬ ‫ﺘ‬
‫ﺍﻻﺟ‬ ‫ﻳﻼﺕ‬ ‫ﺪ‬‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻟﻚ‬‫ﺬ‬‫ﻛ‬
‫ﻧﻲﻭ‬ ‫ﺪ‬‫ﺒ‬
‫ﻟ‬‫ﺍ‬
‫‪.‬‬‫ﺎ‬
‫ﻬ‬‫ﺘ‬‫ﻟﺠ‬‫ﺎ‬‫ﻌ‬
‫ﻣ‬‫ﺓﻭ‬‫ﺮ‬‫ﺍﻷﺳ‬ ‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬
‫ﺍﺣ‬ ‫ﻴﻢ‬‫ﻴ‬‫ﻘ‬‫ﺔﺗ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﻩ‬‫ﺬ‬‫ﺍﻝﻫ‬‫ﻮ‬‫ﻃ‬
‫‪،‬ﻭ‬‫ﺰ‬‫ﻌﺠ‬‫ﻟ‬
‫ﺎ‬‫ﺭﺑ‬
‫ﻮ‬‫ﻌ‬‫ﻟﺸ‬‫ﺍ‬
‫ﺎ‪،‬ﻭ‬‫ﻔﺼﻝ‬ ‫ﻧ‬
‫ﺍﻻ‬‫‪.‬‬‫ﺎ‬
‫ﻬ‬‫ﻠ‬
‫ﻤ‬‫ﻛ‬‫ﺄ‬
‫ﺓﺑ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﺮ‬‫ﺛ‬
‫ﺄ‬‫ﺘ‬‫‪،‬ﺗ‬‫ﺓ‬‫ﺪ‬‫ﻳ‬‫ﺪ‬‫ﻭﻕﺷ‬ ‫ﺮ‬‫ﺓﺑﺤ‬‫ﺮ‬‫ﺍﻷﺳ‬‫ﺩ‬ ‫ﺍ‬
‫ﺮ‬‫ﻓ‬‫ﺃ‬‫ﺪ‬‫ﺃﺣ‬‫ﺎﺏ‬‫ﺎﻳﺼ‬ ‫ﻣ‬
‫ﺪ‬ ‫ﻨ‬
‫•ﻋ‬
‫ﺪﻋﻢﻭ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﻰ‬‫ﺀﺇ‬‫ﺎ‬
‫ﻗ‬‫ﺪ‬‫ﺍﻷﺻ‬‫ﺔﻭ‬‫ﻠ‬‫ﺋ‬
‫ﺎ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺝ‬‫ﺘ‬
‫‪.‬ﺗﺤ‬‫ﺔ‬‫ﺗ‬
‫ﻭ‬‫ﺎ‬‫ﻔ‬‫ﺘ‬
‫ﺎﺕﻣ‬ ‫ﺭﺟ‬‫ﺪ‬‫ﺪﺙﺑ‬ ‫ﺃﻥﺗﺤ‬ ‫ﻜﻦ‬‫ﻤ‬‫ﻔﺴﻲﻳ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬
‫ﻠﻞ‬‫ﻟﺨ‬‫ﺍ‬
‫‪،‬ﻭ‬‫ﺓ‬‫ﺭ‬‫ﺎ‬‫ﻟﺨﺴ‬‫ﺍ‬
‫‪.‬‬
‫ﻠﻰ‬‫ﺜ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﻪ‬
‫ﺘ‬‫ﻟﻰ ﺻﺤ‬ ‫ﺓﺇ‬‫ﺩ‬‫ﻮ‬
‫ﻌ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺪ‬ ‫ﺎﻋ‬‫ﻤﺴ‬‫ﻟ‬‫ﻪ‬‫ﻴ‬
‫ﻮﺟ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻴﻢﻭ‬‫ﻠ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬

‫‪257‬‬
Compl
icat
ionsi
nrehabi
li
tat
ionphaseofbur
ncar
e:

I
nter
vent
ions Cont
ri
but
ingFact
ors Compl
icat
ions

-
Per
form gent
ler
ange-
of- Pr
olongedi
mmobi
l
ity Het erotopic
mot
ionexerci
ses ossi fi
cation( abnor mal
for mat i
onofbonei n
responset osof ttissue
trauma)
-Keepski npl i
ableandsof t
. Parti
al-t
hicknessandf ull Hy per t
rophi cscarring
-Applypr essuregar ment s -t
hicknessbur ns
aspr escribed.Massage.
-Maintainposi ti
onofj oi
nts Parti
al-t
hicknessandf ull Cont ractures
i
nal ignment . -t
hicknessbur ns
-Perform gent l
er angeof
mot ionexer ci
ses.
-Consul tOTandPTf or
exercisesandposi tioning
-Teachpat i
entabout Shearing,pressur e, Woundbr eakdown
i
mpor tanceofgood i
nadequat enut ri
tion
nutriti
on.
-Protectwoundf rom
pressur eandshear ing
forces.
-Provideadequat epai n Pain,burnwound, donor Gai tdev i
ations
management . si
te,scarringofj oints,
-Consul tOTandPT. el
ectricalinj
uryoft he
-Promot eambul ati
onand brain
mobi li
tytraini
ng.
-Provideadequat epai n Traumaandbur ns Compl exr egional pai
n
management . sy ndrome( previous
-Consul tOTandPTf or reflexsy mpat het i
c
exercises.-Promot egentle dy strophy[ RSD])
mot ionofaf fected
extremi ti
es.
Burnwound, burnscar Joi ntinstabili
ty
andcont ractures

258
Nur si
ngpr ocessduringtherehabili
tat
ionphase:
Assessment :
AssessI nformationabout:
-Thepat ient’
seducational
level.
-Occupat ion.
-Cul t
ur albackground.
-Rel i
gion.
-Fami lyint er
acti
ons.
:
‫ﻴﻞ‬‫ﺄﻫ‬
‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﺔﺇﻋ‬‫ﻠ‬
‫ﺮﺣ‬‫ﻳ ﺾﺧﻼﻝﻣ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﻤ‬‫ﻋ‬
:
‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
:‫ﻮﻝ‬‫ﺎﺕﺣ‬‫ﻣ‬‫ﻮ‬‫ﻠ‬
‫ﻌ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﻠ‬‫ﻟ‬
‫ﻤﻲ‬‫ﻴ‬‫ﻠ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻯ‬‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬-
.
‫ﺘﻼﻝ‬‫ﺍﺣ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻓ‬
‫ﺎ‬‫ﻘ‬‫ﺔﺛ‬‫ﻴ‬
‫ﻔ‬‫ﻠ‬
‫ﺧ‬-
.
‫ﻳﻦ‬‫ﺩ‬-
.
‫ﺔ‬‫ﻳ‬‫ﺮ‬
‫ﺍﻷﺳ‬‫ﺎﻋﻼﺕ‬‫ﻔ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
Assesst hepat i
ent’
sabout:
-Self-concept .
-Ment alstatus.
-Emot ional r
esponsetotheinjuryandhospit
ali
zati
on.
-Responset opainandpainreliefmeasures.
-Sleeppat tern.

AssessmentR/ Trehabi li
tati
ongoal sinclude:
-Rangeofmot ionofaf fectedjoints.
-Functional abili
ti
esandact i
v i
ti
esofdai lyli
vi
ng.
Assessear l
ysi gnsofski nbreakdownf rom splintsorposi ti
oningdev i
ces.
:
‫ﻮﻝ‬‫ﻳ ﺾﺣ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
.‫ﺍﺕ‬‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻬ‬‫ﻔ‬‫ﻣ‬-
.
‫ﺔ‬ ‫ﻴ‬
‫ﻠ‬‫ﻘ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬
‫ﺎ‬‫ﻟﺤ‬
‫ﺍ‬-
.
‫ﺀ‬‫ﺎ‬‫ﻔ‬‫ﺘﺸ‬‫ﺍﻻﺳ‬‫ﺔﻭ‬ ‫ﺑ‬
‫ﺎ‬‫ﻟﻺﺻ‬‫ﺔ‬‫ﻴ‬‫ﻔ‬‫ﺎﻃ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬-
.
‫ﻟﻢ‬‫ﺍﻷ‬
‫ﻡﻭ‬ ‫ﺍﻵﻻ‬‫ﻴﻒ‬ ‫ﻔ‬
‫ﺮﺗﺨ‬‫ﻴ‬‫ﺑ‬‫ﺍ‬
‫ﺪ‬‫ﺘ‬‫ﻟ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺘﺠ‬‫ﺍﻻﺳ‬-
.
‫ﻡ‬‫ﻮ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻤﻂ‬‫ﻧ‬-
:
R/T‫ﻴﻞ‬ ‫ﺄﻫ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺓ‬
‫ﺩ‬‫ﺎ‬‫ﻋ‬‫ﺍﻑﺇ‬‫ﺪ‬‫ﺃﻫ‬‫ﻤﻞ‬‫ﺗﺸ‬
.
‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺻﻞ‬‫ﻔ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺔ‬‫ﻛ‬‫ﺮ‬‫ﺪﻯﺣ‬ ‫ﻣ‬-
.‫ﺔ‬‫ﻴ‬‫ﻣ‬‫ﻮ‬‫ﻴ‬‫ﻟ‬‫ﺍ‬
‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬ ‫ﺃ‬
‫ﺔﻭ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﻮﻇ‬‫ﻟ‬‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬
‫ﺪ‬‫ﻘ‬‫ﻟ‬
‫ﺍ‬-
.‫ﻊ‬‫ﻗ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺪ‬‫ﻳ‬‫ﺪ‬ ‫ﺓﺗﺤ‬‫ﺰ‬‫ﻬ‬‫ﺃﺟ‬ ‫ﻭ‬
‫ﺃ‬‫ﺮ‬‫ﺋ‬‫ﺎ‬
‫ﺒ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪﻣﻦ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬
‫ﺮ‬‫ﻜﺴ‬ ‫ﺘ‬
‫ﻟ‬‫ﺓ‬‫ﺮ‬‫ﻜ‬‫ﺒ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﺎﺕ‬ ‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻢ‬‫ﻴ‬
‫ﻘ‬‫ﺗ‬
Nursingdi agnosi s(1):
Acti
vityintolerancer elatedt opai n.
Goals: -
Increasepar t
icipationinact ivi
ti
esofdai lyli
v i
ng.
Nursingi ntervention:
-Providegoodt i
mef orpat i
entrest .
-Givesedat i
vet oreducepai n.
-Givepat ientshy pnoticaspr escribed.
-Reassur et hepat i
entt or educeni ghtmor es.
-Reducingmet aboli
cst ressbyr eliv
ingpai n,prevent i
ngchi l
li
ngorf ever.
-I
ncor poratesphy si
cal therapyexer ci
sesi nthepat ientcaret opreventmuscl e
atr
ophy .

259
 :
(1)‫ﻳ ﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.‫ﻟﻢ‬‫ﺎﻷ‬‫ﺒﻂﺑ‬ ‫ﺗ‬
‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﺼﺐ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺎﻁ‬ ‫ﻧﺸ‬
.
‫ﺔ‬‫ﻴ‬‫ﻣ‬
‫ﻮ‬‫ﻴ‬‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺎ‬
‫ﻴ‬‫ﻟﺤ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺸﻄ‬‫ﺃ‬‫ﺔﻓﻲ‬ ‫ﻛ‬‫ﺭ‬
‫ﺎ‬‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﺓ‬‫ﺩ‬
‫ﺎ‬‫ﻳ‬‫ﺯ‬-:‫ﺍﻑ‬‫ﺪ‬‫ﺍﻻﻫ‬
:
‫ﻳﺾ‬ ‫ﺮ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺍﺣ‬ ‫ﺮ‬‫ﻟ‬‫ﺎﺳﺐ‬ ‫ﻨ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻗﺖ‬ ‫ﻮ‬‫ﻟ‬‫ﺍ‬
‫ﺮ‬‫ﻴ‬‫ﻓ‬‫ﻮ‬‫ﺗ‬-
.
‫ﻡ‬ ‫ﺍﻵﻻ‬ ‫ﻴﻞ‬‫ﻠ‬
‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺪﺉ‬ ‫ﻬ‬‫ﻌﻄﻰﻣ‬ ‫ﻳ‬-
.
‫ﻮﻑ‬ ‫ﻮﺻ‬‫ﻮﻣ‬ ‫ﺎﻫ‬‫ﻤ‬‫ﻡﻛ‬ ‫ﻮ‬‫ﻨ‬‫ﻳ ﺾﻣ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺀ‬‫ﺎ‬‫ﺍﻋﻄ‬-
.‫ﺔ‬
‫ﻴ‬‫ﻠ‬‫ﻴ‬‫ﻠ‬
‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺩ‬‫ﺎ‬‫ﻌ‬‫ﻟ‬‫ﺍ‬‫ﻴﻞ‬‫ﻠ‬‫ﻘ‬
‫ﺘ‬‫ﻟ‬‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧ‬‫ﺄ‬
‫ﻤ‬‫ﻃ‬-
.
‫ﻤﻰ‬‫ﻟﺤ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺓ‬
‫ﺩ‬‫ﻭ‬‫ﺮ‬
‫ﺒ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻣﻦ‬‫ﻳ‬
‫ﺎ‬‫ﻗ‬‫ﻮ‬‫ﻟ‬
‫ﺍ‬
‫ﻟﻢﻭ‬‫ﺍﻷ‬‫ﻴﻒ‬‫ﻔ‬
‫ﻳﻖﺗﺨ‬‫ﺮ‬‫ﺋﻲﻋﻦﻃ‬ ‫ﺍ‬
‫ﺬ‬‫ﻐ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻞ‬‫ﺜ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﻬ‬‫ﻴﻞﺇﺟ‬ ‫ﻠ‬
‫ﻘ‬‫ﺗ‬-
.‫ﻌﻀﻼﺕ‬‫ﻟ‬
‫ﺍ‬‫ﺭ‬‫ﻮ‬
‫ﻤ‬‫ﺔﻣﻦ ﺿ‬‫ﻳ‬‫ﺎ‬
‫ﻗ‬‫ﻮ‬‫ﻠ‬
‫ﻟ‬‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻌﻲﻓﻲﺭﻋ‬ ‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﻣﺞﺗ‬ ‫ﺩ‬-

Nursingdi agnosi s( 2):

Bodyi magedi st urbancer elat
edt oal teredphy si
cal appearanceandsel f-
concept .
Goals: adapt ationandadj ustmentt oalterationsi nbodyi mage, self
-concept
andlife-style.
Nursingi nterv ention:
-Taket imet olistenandt oprov i
der ealisticsuppor t
.
-Referpat ientt osuppor tgroupsuchasr egional burncent ers.
-Encour agepat ientt omeetot her swi thsi milarexper i
encesandl earnto
developcopi ngst rategiest ohelpt hem deal witht hei
rlosses.
-Assesst hepat i
ent ’
spsy chological reactions.
:
(2)‫ﻳ ﺾ‬ ‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.‫ﺍﺕ‬‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻡ‬‫ﻮ‬‫ﻬ‬‫ﻔ‬‫ﻣ‬‫ﺮﻭ‬ ‫ﻴ‬‫ﻐ‬‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺪﻱ‬ ‫ﻟﺠﺴ‬‫ﺍ‬‫ﺮ‬‫ﻬ‬‫ﻤﻈ‬‫ﻟ‬‫ﺎ‬
‫ﺒﻂﺑ‬‫ﺗ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺪ‬
‫ﻟﺠﺴ‬ ‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻮ‬
‫ﺍﺏ ﺻ‬‫ﺮ‬ ‫ﺍﺿﻄ‬
.‫ﺓ‬‫ﺎ‬‫ﻴ‬‫ﻟﺤ‬‫ﺍ‬‫ﻮﺏ‬ ‫ﻠ‬‫ﺃﺳ‬
‫ﺍﺕﻭ‬ ‫ﺬ‬‫ﻟ‬‫ﺍ‬‫ﻡ‬‫ﻮ‬
‫ﻬ‬‫ﻔ‬‫ﻣ‬‫ﺪﻭ‬ ‫ﻟﺠﺴ‬‫ﺍ‬‫ﺓ‬‫ﺭ‬‫ﻮ‬‫ﺍﺕﻓﻲ ﺻ‬ ‫ﺮ‬‫ﻴ‬
‫ﻐ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻊ‬‫ﻴﻒﻣ‬ ‫ﻜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒﻭ‬ ‫ﻜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬
:‫ﺍﻑ‬‫ﺪ‬ ‫ﺍﻷﻫ‬
:
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.‫ﻌﻲ‬‫ﻗ‬‫ﺍ‬‫ﻳﻢﺩﻋﻢﻭ‬ ‫ﺪ‬‫ﻘ‬‫ﺗ‬‫ﺎﻉﻭ‬‫ﻤ‬‫ﺘ‬‫ﺍﻻﺳ‬‫ﺘﻚﻓﻲ‬ ‫ﻗ‬‫ﺬﻭ‬ ‫ﺧ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻠ‬‫ﻗ‬‫ﺍﻹ‬‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺰ‬‫ﻛ‬‫ﺍ‬
‫ﺮ‬‫ﺜﻞﻣ‬ ‫ﺔﺩﻋﻢﻣ‬ ‫ﻮﻋ‬‫ﻤ‬‫ﻟﻰﻣﺠ‬ ‫ﻳ ﺾﺇ‬‫ﺮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺎ‬
‫ﺇﺣ‬-
‫ﺎﺕ‬ ‫ﻴ‬‫ﻴﺠ‬ ‫ﺗ‬
‫ﺍ‬‫ﺮ‬‫ﺘ‬‫ﺍﺳ‬ ‫ﺮ‬‫ﻳ‬
‫ﻮ‬ ‫ﺔﺗﻄ‬‫ﻴ‬‫ﻔ‬‫ﻴ‬‫ﻠﻢﻛ‬‫ﻌ‬
‫ﺗ‬‫ﺔﻭ‬‫ﻠ‬‫ﺛ‬‫ﺎ‬
‫ﻤ‬ ‫ﺭﺏﻣ‬ ‫ﺎ‬‫ﻬﻢﺗﺠ‬‫ﻳ‬ ‫ﺪ‬‫ﻟ‬
‫ﻳﻦ‬ ‫ﺬ‬‫ﻟ‬
‫ﺍ‬‫ﻳﻦ‬‫ﺮ‬‫ﺍﻵﺧ‬ ‫ﺔ‬‫ﻠ‬
‫ﺑ‬‫ﺎ‬
‫ﻘ‬‫ﻠﻰﻣ‬ ‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺷﺠ‬-
.
‫ﺮﻫﻢ‬‫ﺋ‬‫ﺎ‬‫ﻊﺧﺴ‬ ‫ﻣﻞﻣ‬ ‫ﺎ‬
‫ﻌ‬‫ﺘ‬‫ﻟ‬‫ﺍ‬
‫ﻠﻰ‬ ‫ﻬﻢﻋ‬‫ﺗ‬‫ﺪ‬‫ﻋ‬‫ﺎ‬
‫ﻤﺴ‬‫ﻟ‬‫ﻠﻢ‬‫ﻗ‬‫ﺄ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﻠ‬
‫ﻟ‬ ‫ﺔ‬‫ﻴ‬
‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬‫ﺍ‬‫ﻌﻞ‬‫ﻔ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﻭ‬‫ﺩ‬
‫ﻴﻢﺭ‬ ‫ﻴ‬‫ﻘ‬‫ﺗ‬-

Nursingdi agnosi s(3):

Knowl edgedef i
citaboutpostdi schar gehomecar eandf ol
low-upneeds.
Goals: Patients’educationandhomecar econsiderat
ions.
Nursingi ntervention:
-Encour agepat ienttoparticipatetheircareiftheyareawar eoft he
consequencesoft heinjury,t
hegoal ofplannedt r
eatment ,
andt heirrol
ei n
ongoingcar e.
-I
ncludef amili
esi nplanningandcar ryi
ng.
-I
nstructpat i
entandf amilyinwoundcar e,exerci
sesandf oll
ow-upcar e.
-Encour agepat ienttorecogni zeabnor mal si
gnst oreportthephy sici
anand
avai
labler esourcest ohelpt hem meett hei
rfutureneeds.
:(
3)‫ﻳ ﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻴﺺ‬ ‫ﺗﺸﺨ‬
.‫ﻳﺢ‬‫ﺮ‬‫ﺘﺴ‬‫ﻟ‬
‫ﺍ‬‫ﺪ‬‫ﻌ‬‫ﺔﺑ‬ ‫ﻌ‬
‫ﺑ‬‫ﺎ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬‫ﺎﺟ‬‫ﻴ‬‫ﺘ‬
‫ﺍﺣ‬‫ﺔﻭ‬‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬ ‫ﻮﻝ‬‫ﺔﺣ‬ ‫ﻓ‬
‫ﺮ‬ ‫ﻌ‬
‫ﻤ‬‫ﻟ‬‫ﺍ‬
‫ﻘﺺ‬ ‫ﻧ‬
.
‫ﺔ‬‫ﻴ‬‫ﻟ‬
‫ﺰ‬‫ﻨ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﺮﻋ‬‫ﻟ‬
‫ﺍ‬‫ﺍﺕ‬‫ﺭ‬‫ﺎ‬
‫ﺒ‬‫ﺘ‬‫ﻋ‬
‫ﺍ‬‫ﺮﺿﻰﻭ‬ ‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬‫ﻘ‬‫ﺜ‬‫ﺗ‬:
‫ﺍﻑ‬ ‫ﺪ‬‫ﺍﻻﻫ‬
:‫ﻳﺾ‬‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
‫ﻌﻼﺝ‬ ‫ﻟ‬‫ﺍ‬‫ﺪﻑﻣﻦ‬ ‫ﻬ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬،‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﺍﻹﺻ‬ ‫ﻗﺐ‬ ‫ﺍ‬
‫ﻮ‬‫ﻌ‬‫ﺔﺑ‬‫ﻳ‬‫ﺍ‬
‫ﺭ‬‫ﻠﻰﺩ‬ ‫ﺎﻥﻋ‬‫ﺍﻛ‬‫ﺫ‬
‫ﻪﺇ‬‫ﺘ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺔﻓﻲﺭ‬ ‫ﻛ‬‫ﺭ‬‫ﺎ‬
‫ﻤﺸ‬‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﺷﺠ‬-

260
 .
‫ﺓ‬‫ﺮ‬‫ﻤ‬
‫ﺘ‬‫ﻤﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬‫ﺎ‬
‫ﻋ‬‫ﺮ‬‫ﻟ‬
‫ﺍ‬‫ﻩﻓﻲ‬‫ﺭ‬‫ﻭ‬‫ﺩ‬
‫ﻭ‬،‫ﻟ‬
‫ﻤﺨﻄﻂﻪ‬ ‫ﻟ‬
‫ﺍ‬
.‫ﻤﻞ‬‫ﻟﺤ‬‫ﺍ‬
‫ﻴﻂﻭ‬‫ﺘﺨﻄ‬‫ﻟ‬‫ﺍ‬‫ﻻﺮﻓﻲ‬
‫ﺍﺳ‬ ‫ﺍﻙ‬
‫ﺮ‬‫ﺍﺷ‬-
.
‫ﺔ‬‫ﻌ‬‫ﺑ‬
‫ﺎ‬‫ﺘ‬
‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻳ‬
‫ﺎ‬‫ﻋ‬‫ﺭ‬
‫ﻳﻦﻭ‬‫ﺭ‬‫ﺎ‬
‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫ﻭﺡﻭ‬‫ﺮ‬‫ﻟﺠ‬
‫ﺎ‬‫ﺔﺑ‬‫ﻳ‬‫ﺎ‬‫ﻨ‬
‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺓﻓﻲ‬‫ﺮ‬‫ﺍﻷﺳ‬
‫ﻳ ﺾﻭ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺎ‬
‫ﺭﺷ‬‫ﺇ‬-
‫ﻬﻢ‬
‫ﺗ‬‫ﺪ‬‫ﺎﻋ‬
‫ﻤﺴ‬‫ﻟ‬
‫ﺔ‬‫ﺎﺣ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺩ‬‫ﺭ‬
‫ﺍ‬‫ﻮ‬‫ﻤ‬
‫ﻟ‬‫ﺍ‬
‫ﻴﺐﻭ‬‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺑﻼﻍ‬
‫ﺔﻹ‬‫ﻴ‬‫ﻌ‬‫ﻴ‬
‫ﺒ‬‫ﻟﻄ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﺎﺕﻏ‬
‫ﻣ‬‫ﻌﻼ‬‫ﻟ‬
‫ﺍ‬ ‫ﻠﻰ‬‫ﺮﻑﻋ‬‫ﻌ‬‫ﺘ‬
‫ﻟ‬‫ﺍ‬‫ﻠﻰ‬
‫ﻳ ﺾﻋ‬‫ﺮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬‫ﻴ‬‫ﺗﺸﺠ‬-
.
‫ﺔ‬‫ﻴ‬‫ﻠ‬
‫ﺒ‬‫ﻘ‬
‫ﺘ‬‫ﻤﺴ‬‫ﻟ‬
‫ﺍ‬‫ﻬﻢ‬‫ﺗ‬
‫ﺎ‬‫ﺎﺟ‬
‫ﻴ‬‫ﺘ‬
‫ﺍﺣ‬‫ﺔ‬‫ﻴ‬‫ﺒ‬‫ﻠ‬
‫ﻠﻰﺗ‬‫ﻋ‬

Potent ialcompl icat i

on:
-Cont ractur es
-Inadequat epsy chol ogicaladapt ationt obur ni njur y.
Goals: Moni tor i
ngandmanagi ngpot ent i
alcompl i
cat i
on.
Nursingi nt er vent ion:
-Cont ractur e: -sur gicalintervent i
on.
-Impai redpsy chol ogicaladapt ati
ont obur ninj ury: Psy chological counsel i
ngor
psychiat ri
cr eferral shouldbeobt ainedassoonasev i
denceofmaj orcopi ng
problemsappear s.
:‫ﺔ‬‫ﻠ‬‫ﻤ‬‫ﺘ‬
‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﻋ‬‫ﺎ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺎﺕ‬ ‫ﻠﺼ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
.‫ﻭﻕ‬ ‫ﺮ‬‫ﻟﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬‫ﻓﻲﻹﺻ‬ ‫ﺎ‬‫ﻜ‬‫ﻟ‬‫ﺍ‬‫ﻔﺴﻲ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﻴﻒ‬ ‫ﻜ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻓﻲ‬-
.
‫ﺔ‬ ‫ﻠ‬‫ﻤ‬
‫ﺘ‬ ‫ﻤﺤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺎﺕ‬ ‫ﻔ‬‫ﺎﻋ‬
‫ﻤﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬ ‫ﺭ‬‫ﺍ‬
‫ﺩ‬‫ﺇ‬‫ﺔﻭ‬‫ﺒ‬‫ﻗ‬‫ﺍ‬
‫ﺮ‬‫ﻣ‬: ‫ﺍﻑ‬‫ﺪ‬‫ﺍﻻﻫ‬
:‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺗ‬
.
‫ﺍﺣﻲ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺪﺧﻞ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬-:‫ﻊ‬‫ﻔ‬‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬-
‫ﺔ‬‫ﻴ‬‫ﻔﺴ‬ ‫ﻨ‬
‫ﻟ‬‫ﺍ‬‫ﺣﺔ‬‫ﻟ‬
‫ﺃﺍﻹﺎ‬ ‫ﺔﻭ‬ ‫ﻴ‬‫ﻔﺴ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺓ‬
‫ﺭ‬‫ﺎ‬‫ﺘﺸ‬ ‫ﺍﻻﺳ‬‫ﻠﻰ‬ ‫ﻮﻝﻋ‬ ‫ﻟﺤﺼ‬ ‫ﺍ‬‫ﻳﺠﺐ‬: ‫ﻭﻕ‬ ‫ﺮ‬
‫ﻟﺤ‬ ‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺎ‬
‫ﻔﺴﻲﻹﺻ‬ ‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻜ‬
‫ﺘ‬‫ﻟ‬‫ﺍ‬‫ﻌﻒ‬ ‫ﺿ‬-
.‫ﺔ‬‫ﻴ‬‫ﻴﺴ‬ ‫ﺋ‬
‫ﺮ‬ ‫ﻟ‬
‫ﺍ‬‫ﻴﻒ‬ ‫ﻜ‬ ‫ﺘ‬‫ﻟ‬
‫ﺍ‬‫ﻛﻞ‬‫ﺎ‬‫ﻠﻰﻣﺸ‬ ‫ﻴﻞﻋ‬ ‫ﻟ‬‫ﺭﺩ‬‫ﻮ‬‫ﻬ‬‫ﺩﻇ‬ ‫ﺮ‬‫ﻤﺠ‬‫ﺑ‬
Termi nology :
Burn:Bur nsar eaf orm oft raumat icinjurycausedbyt her mal,electri
cal,
chemi cal, orr adioact i
veagent s.
Skingr aft:I sasur gicalprocedur einwhi chapi eceofski nist r
anspl antedf rom
onear eat oanot her .Of t
enski nwi llbet akenf rom unaf fectedar easont he
i
njuredper sonandusedt ocov eradef ect,oftenabur n.
Autogr aft:agr af tder i
vedf rom onepar tofapat ient’sbodyandusedon
anotherpar toft hesamepat ient '
sbody .
Coll
agen:apr ot einpr esenti nski n,tendon, bone, car t
il
age, andconnect i
ve
ti
ssue.
Contract ur e:shr inkageofbur nscart hroughcol lagenmat uration.
:‫ﻠﺢ‬‫ﻤﺼﻄ‬ ‫ﻟ‬
‫ﺍ‬
‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻴ‬ ‫ﺋ‬
‫ﺎ‬‫ﻴ‬‫ﻤ‬‫ﻴ‬‫ﻜ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬ ‫ﺔ‬‫ﻴ‬‫ﺋ‬‫ﺎ‬‫ﺑ‬
‫ﺮ‬‫ﻬ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﺔ‬‫ﻳ‬ ‫ﺭ‬
‫ﺍ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﻣﻞ‬ ‫ﺍ‬‫ﻮ‬‫ﻌ‬‫ﻟ‬
‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﻤ‬‫ﺎﺟ‬‫ﻨ‬‫ﻟ‬
‫ﺍ‬ ‫ﺎﺕ‬‫ﺑ‬‫ﺎ‬
‫ﺎﺍﻹﺻ‬ ‫ﻜﻝ‬ ‫ﺃﺷ‬ ‫ﻜﻞﻣﻦ‬ ‫ﻫﻲﺷ‬: ‫ﻭﻕ‬‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬
.‫ﺔ‬‫ﻌ‬
‫ﻤﺸ‬ ‫ﻟ‬
‫ﺍ‬
‫ﺪ‬‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺬ‬‫ﺆﺧ‬ ‫ﺎﻳ‬‫ﻏﺎﻣ‬ً
‫ﺒ‬‫ﻟ‬
‫ﺎ‬. ‫ﺮﻯ‬ ‫ﺃﺧ‬‫ﻟﻰ‬‫ﺔﺇ‬‫ﻘ‬‫ﻨﻄ‬ ‫ﺪﻣﻦﻣ‬ ‫ﻠ‬
‫ﻟﺠ‬ ‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻌ‬
‫ﺭﻉﻗﻄ‬ ‫ﻪﺯ‬ ‫ﻴ‬‫ﺘﻢﻓ‬ ‫ﺍﺣﻲﻳ‬‫ﺮ‬‫ﺀﺟ‬ ‫ﺍ‬
‫ﺮ‬‫ﻮﺇﺟ‬‫ﻫ‬: ‫ﺪ‬‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬ ‫ﻊ‬
‫ﻴ‬‫ﻗ‬‫ﺮ‬‫ﺗ‬
.‫ﺎ‬ً
‫ﻗ‬‫ﺮ‬‫ﻮﻥﺣ‬ ‫ﻜ‬‫ﺎﻳ‬‫ﻏﺎﻣ‬
ً
‫ﺒ‬
‫ﻟ‬‫ﺎ‬، ‫ﻴﺐ‬ ‫ﺔﻋ‬ ‫ﻴ‬‫ﻐﻄ‬ ‫ﺘ‬‫ﻟ‬‫ﻡ‬‫ﺪ‬‫ﺘﺨ‬‫ﻳﺴ‬ ‫ﺎﺏﻭ‬ ‫ﻤﺼ‬ ‫ﻟ‬
‫ﺍ‬‫ﻟﺸﺨ ﺺ‬ ‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﺑ‬‫ﺎ‬
‫ﺮﻣﺼ‬ ‫ﻴ‬‫ﺎﻃﻖﻏ‬ ‫ﻨ‬‫ﻣﻦﻣ‬
‫ﻳﺾ‬ ‫ﺮ‬‫ﻤ‬ ‫ﻟ‬
‫ﺍ‬‫ﺮﻣﻦﺟﺴﻢ‬ ‫ﺁﺧ‬ ‫ﺀ‬‫ﺰ‬
‫ﻪﻓﻲﺟ‬ ‫ﻣ‬‫ﺍ‬‫ﺪ‬‫ﺘﺨ‬‫ﺍﺳ‬ ‫ﺘﻢ‬‫ﻳ‬‫ﻳ ﺾﻭ‬ ‫ﺮ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺀﻣﻦﺟﺴﻢ‬ ‫ﺰ‬‫ﺫﻣﻦﺟ‬ ‫ﻮ‬‫ﺄﺧ‬‫ﻌﻢﻣ‬ ‫ﻃ‬:‫ﺗﻲ‬‫ﺍ‬‫ﻌﻢﺫ‬‫ﻃ‬
.‫ﻪ‬‫ﻔﺴ‬‫ﻧ‬
.‫ﻡ‬‫ﺎ‬‫ﻟﻀ‬‫ﺍ‬‫ﻴﺞ‬‫ﻨﺴ‬‫ﻟ‬‫ﺍ‬
‫ﻳﻒﻭ‬ ‫ﺭ‬‫ﺎ‬
‫ﻐﻀ‬ ‫ﻟ‬
‫ﺍ‬‫ﻡﻭ‬ ‫ﺎ‬
‫ﻌﻈ‬‫ﻟ‬‫ﺍ‬‫ﺭﻭ‬‫ﺎ‬‫ﺗ‬‫ﻭ‬‫ﺍﻷ‬‫ﺪﻭ‬ ‫ﻠ‬‫ﻟﺠ‬‫ﺍ‬‫ﺩﻓﻲ‬ ‫ﻮ‬‫ﻮﺟ‬ ‫ﻴﻦﻣ‬ ‫ﺗ‬
‫ﻭ‬‫ﺮ‬‫ﺑ‬:‫ﻴﻦ‬‫ﻮﻻﺟ‬ ‫ﻜ‬‫ﻟ‬
‫ﺍ‬
.
‫ﻴﻦ‬ ‫ﻮﻻﺟ‬ ‫ﻜ‬
‫ﻟ‬‫ﺍ‬‫ﻮﺝ‬ ‫ﻭﻕﻣﻦﺧﻼﻝﻧﻀ‬ ‫ﺮ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔ‬‫ﺑ‬‫ﺪ‬‫ﺎﺵﻧ‬ ‫ﻤ‬‫ﻜ‬‫ﻧ‬
‫ﺍ‬ :
‫ﻠﺺ‬ ‫ﻘ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬

Debr i
dement:r
emov alofforeignmater i
alanddevit
ali
zedti
ssueunti
l
surroundi
nghealt
hytissueisex posed.
Epidermis:t
heoutermostl ayerofskin.
Eschar:devi
tal
i
zedtissueresul t
ingfr
om abur n.
Escharotomy:ali
nearexcisionmadet hrougheschartor
eleaseconst
ri
cti
onof

261
‫‪under‬‬ ‫‪l‬‬‫‪y‬‬‫‪i‬‬
‫‪ngt‬‬ ‫‪i‬‬
‫‪ssue.‬‬
‫‪Exci‬‬ ‫‪si‬‬
‫‪on:sur‬‬ ‫‪gi‬‬‫‪cal‬‬‫‪r‬‬‫‪emov‬‬ ‫‪al‬‬‫‪oft‬‬‫‪i‬‬‫‪ssue.‬‬
‫‪Het‬‬ ‫‪er‬‬‫‪ogr‬‬‫‪af‬‬‫‪t‬‬‫‪:gr‬‬‫‪af‬‬‫‪tobt‬‬ ‫‪ai‬‬
‫‪nedf‬‬‫‪r‬‬‫‪om anani‬‬ ‫‪mal‬‬‫‪ofaspeci‬‬‫‪esot‬‬‫‪hert‬‬‫‪hant‬‬‫‪hatoft‬‬
‫‪he‬‬
‫‪r‬‬‫‪eci‬‬‫‪pi‬‬‫‪ent‬‬‫;‬‫‪al‬‬
‫‪socal‬‬ ‫‪l‬‬
‫‪edaxenogr‬‬ ‫‪af‬‬‫‪t‬‬
‫‪.‬‬
‫‪Homogr‬‬ ‫‪af‬‬ ‫‪t‬‬
‫‪:agr‬‬ ‫‪af‬‬‫‪tt‬‬‫‪r‬‬‫‪ansf‬‬‫‪er‬‬
‫‪r‬‬‫‪edf‬‬ ‫‪r‬‬‫‪om onehumant‬‬ ‫‪oanot‬‬‫;‪herhuman‬‬ ‫‪al‬‬
‫‪socal‬‬
‫‪l‬‬‫‪ed‬‬
‫‪al‬‬‫‪l‬‬
‫‪ogr‬‬ ‫‪af‬‬‫‪t‬‬
‫‪.‬‬
‫‪Hy‬‬ ‫‪dr‬‬‫‪ot‬‬‫‪her‬‬‫‪apy‬‬ ‫‪:cl‬‬‫‪eansi‬‬‫‪ngofwoundst‬‬ ‫‪hr‬‬‫‪oughuseofbat‬‬‫‪h,‬‬‫‪shower‬‬‫‪,‬‬‫‪showercar‬‬‫‪t‬‬
‫‪t‬‬‫‪abl‬‬‫‪e,‬‬‫‪ori‬‬‫‪mmer‬‬ ‫‪si‬‬‫‪on.‬‬
‫‪Rul‬‬‫‪eofni‬‬ ‫‪nes:met‬‬ ‫‪hodf‬‬ ‫‪orcal‬‬‫‪cul‬‬‫‪at‬‬‫‪i‬‬
‫‪ngbodysur‬‬‫‪f‬‬‫‪acear‬‬‫‪eabur‬‬‫‪nedbydi‬‬ ‫‪v‬‬
‫‪i‬‬‫‪di‬‬
‫‪ngt‬‬‫‪he‬‬
‫‪bodyi‬‬ ‫‪nt‬‬‫‪omul‬‬ ‫‪t‬‬‫‪i‬‬
‫‪pl‬‬‫‪esofni‬‬ ‫‪ne.‬‬

‫‪.‬‬
‫ﺔ‬‫ﻴﻄ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬ ‫ﺔ‬
‫ﻤ‬‫ﻴ‬‫ﻠ‬
‫ﻟﺴ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺘﻢﻛﺸﻒ‬‫ﺘﻰﻳ‬‫ﺔﺣ‬ ‫ﺘ‬‫ﻴ‬‫ﻤ‬‫ﻟ‬‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺔﻭ‬‫ﺒ‬‫ﻳ‬
‫ﺮ‬‫ﻐ‬‫ﻟ‬‫ﺍ‬‫ﺩ‬‫ﺍ‬
‫ﻮ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻟ‬‫ﺍ‬‫‪:‬ﺯ‬
‫ﺮﺇ‬ ‫ﻴ‬‫ﻨﻀ‬‫ﺘ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺪ‬ ‫ﻠ‬
‫ﻟﺠ‬‫ﺍ‬‫ﺔﻣﻦ‬ ‫ﻴ‬‫ﺭﺟ‬‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﺔ‬‫ﻘ‬‫ﺒ‬
‫ﻟﻄ‬ ‫ﺍ‬
‫‪:‬‬‫ﺓ‬‫ﺮ‬‫ﺒﺸ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬‫ﺮﻕ‬‫ﻟﺤ‬‫ﺍ‬‫ﺔﻋﻦ‬ ‫ﺗﺠ‬‫ﺎ‬
‫ﻨ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬ ‫ﺘ‬
‫ﻴ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬ ‫ﺍﻷ‬‫‪:‬‬
‫ﺭ‬‫ﺎ‬‫ﻜ‬‫ﺇﺳ‬
‫‪.‬‬
‫ﺔ‬‫ﻨ‬‫ﻣ‬
‫ﺎ‬‫ﻜ‬‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﺍﻷ‬‫ﺎﺽ‬ ‫ﺒ‬
‫ﻘ‬‫ﻧ‬‫ﺍ‬
‫ﺭﻹﻃﻼﻕ‬ ‫ﺎ‬
‫ﻟﺨ‬‫ﺍ‬‫ﻩﻣﻦﺧﻼﻝ‬ ‫ﺅ‬
‫ﺍ‬‫ﺮ‬‫ﺘﻢﺇﺟ‬‫ﺎﻝﺧﻄﻲﻳ‬ ‫ﺌﺼ‬‫ﺘ‬‫ﺍﺳ‬‫‪:‬‬‫ﺎﻉ‬‫ﻨﺨ‬‫ﻟ‬
‫ﺍ‬‫ﻊ‬ ‫ﺑﻀ‬
‫‪.‬‬‫ﺔ‬‫ﻧﺴﺠ‬‫ﻟﻸ‬ ‫ﺍﺣﻲ‬‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺎﻝ‬‫ﺌﺼ‬‫ﺘ‬
‫ﺍﻻﺳ‬ ‫ﺎ‪:‬‬
‫ﺌﺼﻝ‬ ‫ﺘ‬‫ﺍﻻﺳ‬
‫ـ‬
‫ﺎﺏ‬‫ﻳً‬
‫ﻀ‬ ‫ﺃ‬‫ﻤﻰ‬ ‫ﺗﺴ‬
‫؛ﻭ‬ ‫ﻘﻲ‬‫ﻠ‬
‫ﺘ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻮﻉ‬‫ﺮﻧ‬‫ﻴ‬‫ﻮﻉﻏ‬‫ﺍﻥﻣﻦﻧ‬‫ﻮ‬
‫ﻴ‬‫ﺫﻣﻦﺣ‬ ‫ﻮ‬‫ﺄﺧ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻭﻉ‬‫ﺮ‬ ‫ﻤﺸ‬‫ﻟ‬
‫ﺍ‬‫ﺮ‬‫ﻴ‬‫ﻜﺴﺐﻏ‬ ‫ﻟ‬
‫ﺍ‬‫‪:‬‬
‫‪Het‬‬ ‫‪er‬‬‫‪ogr‬‬‫‪af‬‬‫‪t‬‬
‫‪.‬‬‫‪x‬‬‫‪enogr‬‬ ‫‪af‬‬‫‪t‬‬
‫‪.‬‬
‫‪al‬‬‫‪l‬‬
‫‪ogr‬‬‫‪af‬‬
‫ﺎ‪t‬‬‫ﻳﻀ‬‫ﺃ‬‫ﻤﻰ‬‫؛ﻳﺴ‬‫ﺮ‬‫ﺁﺧ‬‫ﺎﻥ‬‫ﻧﺴ‬‫ﻟﻰﺇ‬‫ﺎﻥﺇ‬‫ﻧﺴ‬‫ﻘﻞﻣﻦﺇ‬ ‫ﺘ‬‫ﻨ‬‫ﻌﻢﻳ‬‫‪:‬ﻃ‬‫‪Homogr‬‬ ‫‪af‬‬‫‪t‬‬
‫ﻭ‬‫ﺃ‬‫ﺪﺵ‬ ‫ﻟ‬
‫ﺍ‬‫ﺔ‬‫ﺑ‬
‫ﺮ‬‫ﺔﻋ‬ ‫ﻟ‬
‫ﻭ‬‫ﺎ‬
‫ﻭﻃ‬ ‫ﺃ‬‫ﺪﺵ‬ ‫ﻟ‬
‫ﺍ‬‫ﻭ‬‫ﺃ‬‫ﻡ‬‫ﺎ‬
‫ﻤ‬‫ﺘﺤ‬‫ﺍﻻﺳ‬‫ﻮﺽ‬ ‫ﻡﺣ‬ ‫ﺍ‬
‫ﺪ‬‫ﺘﺨ‬ ‫ﺍﺳ‬‫ﻭﺡﻣﻦﺧﻼﻝ‬ ‫ﺮ‬‫ﻟﺠ‬‫ﺍ‬‫ﺮ‬‫ﻴ‬
‫ﻬ‬‫‪:‬ﺗﻄ‬‫ﺋﻲ‬‫ﺎ‬‫ﻤ‬‫ﻟ‬
‫ﺍ‬‫ﻌﻼﺝ‬ ‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺮ‬‫ﻤ‬‫ﻐ‬‫ﻟ‬
‫ﺍ‬
‫‪.‬‬
‫ﺔ‬‫ﻌ‬‫ﺎﺕﺗﺴ‬‫ﻔ‬‫ﺎﻋ‬
‫ﻟﻰﻣﻀ‬ ‫ﻟﺠﺴﻢﺇ‬‫ﺍ‬‫ﻴﻢ‬‫ﻘﺴ‬‫ﺘ‬
‫ﺔﺑ‬‫ﻗ‬‫ﻭ‬
‫ﺮ‬‫ﻤﺤ‬‫ﻟ‬
‫ﺍ‬‫ﻟﺠﺴﻢ‬‫ﺍ‬ ‫ﺔﺳﻄﺢ‬ ‫ﺎﺣ‬‫ﺎﺏﻣﺴ‬ ‫ﻟﺤﺴ‬ ‫ﺔ‬‫ﻘ‬‫ﻳ‬
‫ﺮ‬‫‪:‬ﻃ‬‫ﺔ‬‫ﻌ‬‫ﺘﺴ‬ ‫ﻟ‬
‫ﺍ‬‫ﺓ‬‫ﺪ‬‫ﺎﻋ‬‫ﻗ‬

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