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INGRI!IREA PACIENTILOR CU CARDIOPATIEISC"EMICA
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CUPRINS
ARGUMENT
CAPITOLUL I- NOTIUNI GENERALE DESPRE CARDIOPATIE ISCHEMICA
CAPITOLUL II- PARTICIPAREA ASISTENTEI MEDICALE LA ACTE DE
INVESTIGATII ŞI INTERVENTII AUTONOME ŞI DELEGATEII.1 PARTICIPAREA ASISTENTEI LA ACTE DE INVESTIGATIIII.2. PARTICIPAREA ASISTENTEI LA INTERVENTII AUTONOME ŞIDELEGATE
CAPITOLUL III- DESCRIEREA TEHNICILOR IMPUSE DE AFECTIUNE
CAPITOLUL IV- PLANUL DE INGRIJIRE AL PACIENTULUI CUCARDIOPATIE ISCHEMICA
BIBLIOGRAFIE
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CAPITOLUL I- NOTIUNI GENERALE DESPRE CARDIOPATIE ISC"EMICA
D,4**(*,
C#r$!)+#t!e !"'e!'# "e $e0!&e"te '# 0!!&$ #0e't!&e# '#r$!#'# 'e #+#re '# r#re # $e(e'!,!br,!
$!&tre &e'e"!t#t!,e $e !r!#re #,e !)'#r$,! "! +)"!b!,!t#t!,e $e !r!#re #,e %#"e,)r ')r)&#r!e&e.
Cardiopatia ischemică "# b)#,# '#r$!#' !"'e!'* ' #! e $e&!t* e"te ) "0er!&t # !&!!!
$eter!&#t $e & #+)rt !&"0!'!e&t $e )/!e& &e'e"#r 5'!,! '#r$!#'* 4&$e)"eb! 4& ')&$!3!! $e
"),!'!t#re 0!(!'.S0er!&3# +)#te 0! ,#te&t "# #&!0e"t ',!&!'* +t6&$ ',!&# ' )#rte# "b!t.
C%$3*4*$+,
C)&0)r O.M.S. "e $e"'r! $)# #r! '#te)r!! $e #0e't!&! @
1. '#r$!)+#t!# !"'e!'# &e$rer)#"# "# #"!+t)#t!'# @
- t,br#r! $e r!t "! $e ')&$'ere $e &#tr# !"'e!'#
- )#rte "b!t# ')r)&#r!#&#
- !&"0!'!e&t# '#r$!#'# $e et!),)!e !"'e!'#
2. '#r$!)+#t!# !"'e!'# $rer)#"#
- #&!&# +e't)r#,# 7AP8
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&e'e"#r, $e 0,/ "#&!& e"te #r!t. De #"ee&e#* 0,/, "#&!& ')r)&#r +)#te 0! ,!!t#t +r!&
tr)b! #rter!#,!* "+#" "!* r#re)r!* eb),! ')r)&#r!* +re' "! +r!& "te&)(#re# )"t!#,# $#t)r#t##)rt!te! ,et!'e. A&)#,!!,e ')&e&!t#,e* ' #r 0! )r!!&e# #&)r#,# # #rtere! ')r)&#re
$e"'e&$e&te #&ter!)#re "t#&! $!& #rter# +,)&#r#* +)t $eter!&# !"'e!e "! !&0#r't
!)'#r$!' ,# "#r* $#r #'e#"t# '#(# e"te 0)#rte r#r# ,# #$,t!.
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"&t #&)r#, 're"'te* #"# ' "e 4&t6+,# 4& !+ertr)0!# %e&tr!',#r# "e%er# !&$"# $e
!+erte&"!&e "# $e "te&)(# #)rt!'#. A'e#"t# $!& r# "e +)#te #&!0e"t# ' #&!&#* '#re &
"e +)#te $!0ere&t!# $e 'e# +r)$"# $e #ter)"',er)(# ')r)&#r!#&#.
O '#(# r#r# $e !"'e!e !)'#r$!'# e"te re+re(e&t#t# $e re$'ere# '#+#'!t#t!! "#&e,! $e #
tr#&"+)rt# )/!e&,* ' #r 0! 4& #&e!# e/tre $e "e%er# "# 4& +re(e&t#
'#rb)/!e),)b!&e!. N r#re)r!* $)# "# #! ,te '#(e $e !"'e!e +)t ')e/!"t#* ' #r
0! ) 're"tere # &e'e"#r,! $e )/!e&* $eter!&#t# $e !+ertr)0!# %e&tr!',#r# "t#&# "! )
re$'ere # #+)rt,! $e )/!e& "e'&$#r #ter)"',er)(e! ')r)&#r!e&e. A$e"e#* #"ee&e#
')b!&#t!e ')&$'e ,# #&!0e"t#r! ',!&!'e $e !"'e!e.
De"! #rtere,e ')r)&#re e+!'#r$!'e #r! "&t '#+#b!,e $e ')&"tr!'t!e "! re,#/#re* ,# +er")#&e,e
"#&#t)#"e e,e "er%e"' 4& #re #"r# $re+t ')&$'te "! "&t '&)"'te '# %#"e $e ')&$'t#&t#*
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P+**'$%,%, 4/+),%, , )$*4,3($+, $%, CI
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9. I&0#r't, !)'#r$!' #'t
. C#r$!)+#t!# !"'e!'# &e$rer)#"#
M$*4,3(:+* %**,
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A&!&# +e't)r#, #re & t#b,) ',!&!' 0)#rte "e"t!%* $rere# t)r#'!' )'+6&$ & ,)' 'e&tr#,.
Drere# e"te +ter&!' ,)'#,!(#t $e )b!'e! 4& re!&e# +!e+t,! "e "!te 4& re!&e#
retr)"ter&#,* 4& +)r !&e# !?,)'!e* "+er!)#r* $#r* &e)r!* ! 4& 'e# !&0er!)#r.M,t #! r#rț ș
"e$!, $rer!! e"te #t!+!' @ ,# ')t* #rt!',# !# +&,! * &! "# b!,#ter#, 4& re!&e# '),)#&e!ț
t)r#'#,e "+er!)#re "# '!#r 4& re!&e# ,)b#r Drere# #re & '#r#'ter ')&"tr!'t!%* 0!!&$
$e"'r!" '# ) "e&(# !e $e "tr6&ere* '# ) !#r '#re "06"6!e +!e+t,. U&e)r! #'e#"t "t#re e"teț
4&") !t $e te#* $e "e&(# !# )r !! !!&e&te* tr#&"+!r# !!* ,!+" $e #er* er't# !!. A,te)r!ț ț ț ț ț
b),&#%, "!te $rere# '# ) #r"r* )r! '# ) #+"#re $rer)#"* #"e&t)#re &e! ret !ț
'#re 44 +re"e#( +!e+t,.
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I& t#r!,e %e"t!'e* "t$!!,e +)"t)rte #,e %!'t!e,)r #''!$e&te,)r "! #,e ')&0,!'te,)r !,!t#re #
#r#t#t '# #ter)"',er)(# ')r)&#r!#&# 4&'e+e #$e"e# "# "e $e(%),te 4&#!&te $e %6r"t# $e 2= #&! "!e"te ,#r r#"+6&$!t# '!#r +r!&tre #$,t!! '#re # 0)"t #"!+t)#t!'! 4& t!+, %!et!!. At&'!
'6&$ "&t ,#te 4& ')&"!$er#re t)#te r+e,e $e %6r"t#* '#r$!)+#t!# !"'e!'# e"te 'e# #!
)b!"&!t# '#(# # $e'e",!* & &#! ,# b#rb#t!* '! "! ,# 0ee! .
L# +er")#&e,e #"!+t)#t!'e* te"te,e $e e0)rt +)t e%!$e&t!# "e&e $e !"'e!e !)'#r$!'#
"!,e&t!)#"#* #$!'# )$!0!'#r! e,e'tr)'#r$!)r#0!'e !&$"e $e e0)rt* &e4&")t!te $e #&!&#K "t$!!,e
$e #&!)r#0!e ')r)&#r!#&# ,# #"ee&e# +er")#&e $e(%#,!e 0re'%e&t b)#,# ')r)&#r!#&#
)b"tr't!%#. Ne'r)+"!!,e +#'!e&t!,)r ' b)#,# ')r)&#r!#&# )b"tr't!%# '#re & # +re(e&t#t 4&
#&te'e$e&te #&!0e"t#r! ',!&!'e $e !"'e!e !)'#r$!'# e%!$e&t!#(# #$e"e# '!'#tr!'e
#'r)"')+!'e "e'&$#re !&0#r't,! !)'#r$!' 4& re!&!,e !r!#te $e #rtere,e ')r)&#re
"0er!&$e. P)tr!%!t "t$!!,)r +)+,#t!)&#,e* #+r)/!#t!% 2:; $!& +#'!e&t!! '#re "+r#%!et!e"'
!&0#r't,! !)'#r$!' #'t +)t "# & #?&# "b "+r#%eere e$!'#,#* #'e"t! +#'!e&t! #%6&$
#'e,#"! +r)&)"t!' &e0#%)r#b!, '# "! 'e! '#re "e +re(!&t# ' "!&$r), ',!&!' ',#"!' . M)#rte#
"b!t# +)#te 0! &e#"te+t#t# "! e"te ) #&!0e"t#re 0re'%e&t# $e $ebt # '#r$!)+#t!e! !"'e!'e.
De #"ee&e#* +#'!e&t!! "e +)t +re(e&t# ' '#r$!)e#,!e "! !&"0!'!e&t# '#r$!#'#* "e'&$#re
$eter!)r#r!! !"'e!'e # !)'#r$,! %e&tr!',#r "t6&* '#re & $eter!&# "!+t)e 4&#!&te $e
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> !&0,##t!#!&0e't!# 'r)&!'#
> &e,e #&)#,!! e&et!'e +&'t!0)re
C/)'%*$ **ț
C)+,!'# !# 'e# #! $e tet 4& '#r$!)+#t!!,e !"'e!'e e"te )#rte# "b!t. Se "+&e 'ț
#&!&# +e't)r#, e"te ) b)#, '#re +)#te $r# $e ,# 9= "e'&$e ,# 9= $e #&!. )',Ș
'#r$!)e& re+re(!&t & $e0!'!t '!r',#t)r 'e&tr#, #, +)+e! '#r$!#'e $#t)r#t #+r)#+e 4&
e/',"!%!t#te &e'r)(e! !)'#r$!'e #'te. C)+,!'# !!,e "e'&$#re "&t ')+,!'# !! tr)b)ț ț
eb),!'e #,e !&0#r't,! !)'#r$!'. Eb),!# +,)&#r* #''!$e&t, %#"',#r 'erebr#,*
tr)b)(# %e&)#"* #r!t!! ' )#rte "b!t* r+tr# '#r$!#'* '),#+".
T+$($),(&% $+*/'$(*,* *3;,)*,
Ob!e't!%e,e 0&$#e&t#,e #,e tr#t#e&t,! '#r$!)+#t!e! !"'e!'e "e +)t re(# #"t0e, @
-+re%e&!re# '#r$!)+#t!e! !"'e!'e ! # ')+,!'# !!,)r "#,eș ț
-tr#t#e&t 'r#t!% e$!'#,
-tr#t#e&t, '!rr!'#,
-re#b!,!t#re# '#r$!)%#"',#r
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-N!0e$!+!&# 7 A$#,#t 8 t#b,ete $e 1=* 4& $)( $e 9 t#b,ete (! )r! t#b,ete ret#r$ $e 2=-9=
-Ver#+#!, 7I")+t!&8 t#b,ete =*= 4& $)( $e 9 t#b,ete +e (!
-D!,t!#(e <=-= (!
-A!)$#r)&# 7 C#r$#r)&e8 ' #' !&e ')r)&#r)$!,#t#t)#re ! #&t!#r!t!'ț ș
T+$($),(&% *5*,/-*,(,(*
-re+#" ,# +#t*)b!,!(#re +r)re"!%#
-$!et# !$r)(##r#t)%eet#r!#&# "! re! !+)'#,)r!'
T+$($),(&% ;*+&+5*$%
- Re#,!(e#re# b +#""-, #)rt)')r)&#r!#& ' %e& "#0e&.
- A&!)+,#"t!# tr#&",b!&#,*')r)&#r* +er't#&t.
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Re"+e't#re# r!r)#" # +r)r#,! $e re#b!,!t#re 0!(!' ! +"!!'-4& '#re tr#t#e&t,ș
'r#t!%* #,!e&t# !# r# !)&#, ! #&tre&#e&t, 0!(!' )'+ & ,)' !+)rt#&t-$'e 0!re"' ,#ț ț ș
re'+er#re# "tr!! $e "&t#te ! ,# re!&ter#re# 4& ")'!et#te # b),&#%,!* tr#&"0)r6&$-,ș
$!&tr-& #&$!'#+#t !&tr-& ) t!, +e&tr "!&e ! +e&tr '),e't!%!t#te.ș
TRATAMENTUL DE INTRETINERE
A. T+$($),(&% , *(+,(*,+, * $5;*$ ',(/+$%$
Tr#tee&t, #&!&e! +e't)r#,e %!(e#(#@
1. St#b!,!re# '#(e,)r "! # 0#'t)r!,)r '#re +re'!+!t# #+#r!t!# "# 0#%)r!(e#(# #''e",
$e #&)r. De)#re'e #?)r!t#te# '#(e,)r "&t* r#re # #ter)"',er)(e! ')r)&#r!e&e*
tr#t#e&t, %# %!(# re!, "! tr#t#e&t, #ter)"',er)(e!.
A,te '#(e@ "te&)(# #)rt!'#* '#r$!)!)+#t!!* HTA.
I& #'e"t '#(* tr#t#e&t, #&!&e! +e't)r#,e "e +re"+&e tr#t#e&t,! #'e"t)r b),!.
D+# '#( "e tr#te#(#@ #&e!#* !+)/e!#* !+ert!r)!$#* !&"0!'!e&t# '#r$!#'#. Treb!e
')b#tt 0#t,* )be(!t#te#* "e$e&t#r!",* !+er'),e"ter),e!#* b!#bet, (##r#t*
"tre",*!+ert!r)!$!",K ' #,te '%!&te* t)t! 0#'t)r!! $e r!"'.
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TRATAMENTUL CRI>EI ANGIOASE
- re+#" #, b),&#%,!* 'ee# 'e !&"e#&# !&trer+ere# )r!'#r! e0)rtK
- #$!&!"tr#re# $e &!tr),!'er!&# "b,!&#, 1 ')+. $e =*===:* "# 2 - 9 +!'#tr!
$e "),t!e. A$!&!"tr#re# #'e"t)r# "e +)#te re'e+t# $e #! ,te )r! +e (!* "e +)#te ,# "!
+r)0!,#'t!e* $e)#re'e & 're#(# )b!"&!&t#* #'t!&e# e"te $e "'rt# $r#t# "! b!&e t),er#t#.
- $#'# $rere# & 'e$e#(# !& 2= - 9= !&. "e ""+e'te#(# & #&)r !&tr!'#t "# &
"$. ')r)&#r!#& "e%er.
Se #$!&!"tre#(# NITRIUL DE AMIL 70!),# !&#,#t#8* #'t!)&e#(# r#+!$ 1= - 1: "e'.
Pre%e&!re# "e 0#'e +r!&@
- e%!t#re# '!r'"t#&te,)r $e',#&"#t)#re 7e0)rt* e)t!!* e"e ')+!)#"e* tt&8
- #$!&!"tr#re# $e e$!'#e&te ' #'t!&e ')r)&#r)$!,#t#t)#re@
- INTENSATINK
- PRESATINK
- AGOOL 7PRENILAMINA8
- &!tr)')+"! ' #'t!&e +re,&!t#@
- PENTALONGK
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"ter&#,# "# +e #&tebr#t.
- DERIVATI NITRICI CU ACTIUNE PRELUNGITA 7ret#r$8@ "e #$!&!"tre#(#
(!,&!'* 2 - 9 (! PENTALONG* NITROPECTOR ')+r!#te $e 2=* 1 - 9 (!.
E0e't, #+#re $+# ) )r# "! ?#t#te "! $re#(# - : )re* re$' ')&", $e
&!tr),!'er!&#.
E0e'te "e'&$#re@ %#")$!,#t#t!# 't#&#t#* 'e0#,ee "# #ete,!.
- $!&tre 'e,e ',#"!'e@ - MIOFILILINUL
- PAPAVERINA
- DIPIRIADOL
- BLOCANTI BETA-ADRENERGICI@ - PROPANOL
- INDERAL
- TRASICOR
Se !&'e+e ' / 1=(! 7')+. $e 1= "# = 8 "! "e #?&e +#&# ,# <= (!.
CI@ t,br#r! $e r!t "! ')&$'ere br#$!'#r$!'e* #"t br)&"!'* IC
- ANTAGONISTII CALCIULUI@ !&!b#&$ +#tr&$ere# '#,'!,! !& 'e,,# !)'#r$!'#* e!
re$' ')&", $e )/!e&* "'#(#&$ &e'e"!t#t!,e "#,e !& O2.
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MORFINA "# HIDROMORF.
- COCTEILUL LITIC 7ROMERGAN : PLEGOMAIN :=
MIALGIN 2: 8 !& +er0(!e "# !..
- ALGOCALMIN
- OXIGENUL +e ")&$# &#(#,# "# #"'#* e"te &e'e"#r &! t)#t# +er!)#$# $rer)#"#
"! !& 0)re,e !&")t!te $e ")' "# EPA.
Re+#", ,# +#t "! $!et#@
- e"te )b,!#t)r!e !& t)#te 0)re,eK
- !& +r!e,e )re "! (!,e re+#", %# 0! #b"),t !&")t!t $e #$!&!"tr#re# $e "e$#t!%e
7BARBITURICA* DIAEPAM8 "! #,!e&t#t!e !$r)(##r#t# 7"'r! $e 0r'te* ')+)tr!*'e#!
",#b* ,#+te $!,#t !& #+#8K
- re+#", %# $r# !& e$!e 9 - "#+t##&! "! %# 0! ')+,et 70!(!' "! +"!!'8* !#r
+)(!t!# %# 0! "e!"e(#&$#K
- !"'#r!,e #'t!%e #,e ebre,)r* "&t +er!"e $+# 2 - )re* !#r "e$ere# +e
#r!&e# +#t,!* #,!e&t#t!e ,# +#t "! t)#,et# $+# - 1 (!,eK
- )b!,!(#re# %# 0! )b,!#t)r! +re'e$#t# $e #"#?e #,e ebre,)r !&0er!)#reK
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- OXIGEN +e ")&$# &#(#,#.
De #"ee&e#* "e #+,!'# tr#t#e&t, IC '@
- LANATOSID 'K
- CHINIDINAK
- PREDNISON.
Tr#t#e&t, $e 0)&$* #$re"#t #ter)"',er)(e! e"te )b,!#t)r!.
I& e&er#, tr#t#e&t, %# 0! $!etet!'@
- < e"e (! ' ) r#t!e '#,)r!'# #$#+t#t# ret#t!! "#,e@
- !& '#( $e )be(!t#te@ - 1=== - 12== '#,)r!!(! K
- !+)'),e"ter),e!#&tK
- !+),!+e!#&tK
- $e")$#t.
D+# '#(* "e %)r #$!&!"tr#@
- #&#,e(!'e@ - )r0!&#* !#,!&* 0)rt#,.
- "e$#t!%e "! tr#&'!,!(#&te@ - $!#(e+#* e+r)b##t* 0e&)b#rb!t#,K
- & "e$#t!% ")rK
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- !# e$!'#e&t#t!# ) +er!)#$# $e t!+* "e "!te b!&e* #+re'!#(# $e ,# "!&e'# "-#
%!&$e'#t* !&trer+e e$!'#e&t#t!# "! & #! re"+e't# &!'! !&$!'#t!!,e $e re!K
- & re&&t# ,# 0#t* #,')), "! re! $e "#reK
- & re%!&e ,# t!+ ,# e$!' !& )e&t, re#+#r!t!e! "!+t)e,)r "! & e&t!)&e#(#
'!&"t!t '# & # re"+e't#t e$!'#t!# "# re!, !!e&)-$!etet!'K
M)$, "! 0e,, $e # e/+,!'# b),&#%,! $e 'e "0er# "! 0#+t, '# treb!e re"+e't#t
tr#t#e&t, "! re!, !!e&)-$!etet!' #re !+)rt#&t#.
E"te &e'e"#r & t)& b,#&$ "! 0er* $#r &!'! e/#er#r! "# e/+re"!!@ Q'#'! $#'# &
0#'! ' !t! "+&* #! #! +t!& "! )r!Q* "# #,te %)rbe '#re !, 0#' +e b),&#% "# +,e'e
!&r)(!t*"tre"#t.
D+# %!(!t#* b),&#%, treb!e "# +,e'e ' !&te,eere# b!&e0#'er!! tr#t#e&t,! "!
&e'e"!t#te# ')&tr),,! $e %er!0!'#re # e$!'#t!e! $+# '#te%# (!,e* +er!)$!'!t#te# +re(e&t#r!! ,#
')&tr),, TA* '#&$ e$!'#t!# %# 0! ')&?#t# !& 0&'t!e $e e%),t!e.
Tr#t#e&t, #0e't!&!,)r '#r$!)%#"',#re !& #b,#t)r !"! #re "+e'!0!', e! "! "e
$e)"ebe"te $e 'e, $!& "+!t#,@
- treb!e "# "e t!&# ')&t@ - $e ')&$!t!!,e +e '#re ,e #re #'#"# 0!e'#re b),&#%K
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- '))+er#re# b),&#%,! ' e$!', e"e 0)#rte $!0er!t#* %#r!!&$ !& 0&'t!e $e +er")&#,!t#te* $e
e$'#t!e* &!%e, $e ',tr#* "t#re# +"!))t)r!'#* $e )b!'e!, $e # 0# "#
')&" $e #,')),K
- & treb!e &e,!?#t e$!, ")'!)-e')&)!' !& '#re tr#!e"te b),&#%,* +e&"!)&#r*
"#,#r! !'* 0#!,!e &er)#"#* "t#r! ')&0,!'t#,e* "t#r! $e "tre" '#@ )#rte# &! #+r)+!#t -")t*
")t!e* +#r!&te* ')+!,* 0r#te* +r!ete&.
L#&$ !& ')&"!$er#t!e 0#'t)r!! $e #! "" &e +te #0,#* '# #"!"te&t# e$!'#,#* !&
0#t# &! b),&#% ' HTA* '#re "# 0!e ) 0)r# ")#r#* e$!e "# r#%#* !&")t!t# 0re'%e&t $e
&# $!&tre ')+,!'#t!!* '#@ !+ertr)0!e %e&tr!',#r# "t#&#* b)#,# ')r#&#r!#&# !"'e!'#*
t,br#r! '# e)$!&#!'# 'erebr#,#.
B),&#%, ' 0)r# r#%# $e #0e't!&e '#r$!)%#"',#r# "# !&")t!t# $e &# $!&
')+,!'#t!!,e e&er#te* #re !&$!'#t!e $e !&ter&#re re&t# !&tr-& #"e(##&t "+!t#,!'e"' '
+r)0!, '#r$!)%#"',#r &$e "e %)r ,# #"r! #$e'%#te.
I& )e&t, '#&$ "-# ,#t )t#r#re# '# b),&#%, "e tr#te#(# !& #b,#t)r* "e !+&
#&!te +r!&'!+!! $e ')&$!t# $e '),#b)r#re e$!'-+#'!e&t* '#re +)t 0! re(#te #"t0e,@
- "t#b!,!re# $!& +#rte# e$!',! # &e! "'ee $e tr#t#e&t '#t #! "!+,#* ')&"t#&$ $!&@
- & !+)te&"!%K
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- +er")#&e,e ' r!"' 're"'t $e # 0#'e HTA* %)r 0! "0#t!te "# #,e## +r)0e"!&! ' "tre"
+r)0e"!)&#, #re. V)r e%!t# $e #"ee&e#* +r)0e"!&!,e '#re +re$!"+& ,# "e$e&t#r!" "!
)be(!t#te.
E$'#t!# +e&tr "#&#t#te "e #$re"e#(#@
- +)+,#t!e! #'t!%e !& e&er#, "! t!&er!,)r !& "+e'!#,K
- 'e,)r ' !&'#r'#re ere$!t#r#K
- #$),e"'e&t!,)r "! t!&er!,)r* '#re $e"! &)r)te&"!%! # !& )$ ')&"t#&t %#,)r! #,e TA !& ,!!t#
"+er!)#r# # &)r#,,!K
- "e$e&t#r!,)rK
- "+r#+)&$er#,!,)rK
- #r!,)r ')&"#t)r! $e "#re $e b'#t#r!e 7+e"te 1= (!,e8.
Te&$!&t# #'t#,# e"te "# "e $e+!"te(e 0#'t)r!! $e r!"' !&tr-) 0#(# '#t #! +re')'e* t!&er!! "!
'!#r ')+!! 0!!&$ !& 'e&tr, #te&t!e!. E"te !+)rt#&t "# "e "r+r!&$# tre'ere# $e ,# "t#re# $e
"#&#t#te ,# "t#re# $e b)#,# "! "# "e !$e&t!0!'e "b!e't!! +re$!"+"! ,# b)#,#.
M!?,)#'e,e "&t "!+,e "! ,# !&$e#&# ttr)r@
- %er!0!'#re# ret#t!! - "#+t##&#,K
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CAPITOLUL II – PARTICIPAREA ASISTENTEI MEDICALE LA ACTE DE
INVESTIGATII AUTONOME SI DELEGATE
II.1 > PARTICIPAREA ASISTENTEI LA ACTE DE INVESTIGATII
I&%e"t!#t!! &e!&%#(!%e
1. E,e'tr)'#r$!)r##
Pr!# te"t#re # !&!!! "e 0#'e +r!& e,e'tr)'#r$!)r## 7EG8. D#'# EG #r#t# )$!0!'#r! #,e
!&!!!* $!#&)"t!', e #! +re'!" "! & "&t &e'e"#re #,te te"te.
D#'# !&"# e,e'tr)'#r$!)r## e"te &)r#,#* $#r "!+t)e,e "&t +re(e&te "e 'er #,te
!&%e"t!#t!! +e&tr $!#&)"t!', $e '#r$!)+#t!e !"'e!'#. P#'!e&t, e"te +" "# e#r# +e &
')%)r r,#&t "# "# +e$#,e(e +e ) b!'!',et# e$!'#,#* EG-, 0!!&$ $e e0)rt.
E,e'tr)'#r$!)r## re+re(!&t# et)$# 'e# #! +ret!)#"# $e !&%e"t!#re # b),&#%,! #&!&)".
Pe e,e'tr)'#r$!)r## "e +)t !$e&t!0!'# #&!te &$e "! "ee&te@ &$# P* ')+,e/, RS*
&$# T* "ee&te,e P "! ST .
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0!(!),)!' !& 0&'t!e $e %#r"t# 7#! "'#(t# ,# t!&er!8 "! 0re'%e&t# '#r$!#'# 7"'#$e !& t#!'#r$!e8
7V#& $er Gr##00 H#& A&#t)8.
C)+,e/, RS re+re(!&t# $e+),#r!(#re# %e&tr!',#r#* '#re !&'e+e ' +)rt!&e# "t#&#
# "e+t,! !&ter%e&tr!',#r "! #+)! "e +r)+## !& %e&tr!',! $e ,# %#r0r! "+re b#(e "! $e ,#
e&$)'#r$ "+re e+!'#r$. Dr#t# "e #")#r# ,# &!%e,, ,!&!e! !()e,e'tr!'e* 0!!&$ &)r#,# "b =.12
"e'. F)r# ')+,e/,! RS e"te !& )$ &)r#, ' %#r0r! #"'t!te* 0!!&$ 0)r#t $!& #!
,te &$e* +)(!t!%e "# &e#t!%e #r'#te +r!& ,!tere,e *R*S 7A&#t) #&$ P"!),) >
te U&!t 0)r #&$ F&'t!)&8.
See&t#, ST re+re(!&t# +r!# 0#(# # re+),#r!(#r!! %e&tr!',#re 7re+),#r!(#re#
,e&t#8. Dr#t# "ee&t,! ST e"te ,!+"!t# $e !+)rt#&t# +r#'t!'#* !#r +)(!t!# "# e"te !& )$
&)r#, !()e,e'tr!'#. P#t),)!# "ee&t,! ST '+r!&$e $e%!#t!!,e #'e"t!# 7"b- "#"+r#$e&!%e,#r!8* e,e 0!!&$ !& e&er#, e/+re"!# &)r t,br#r! "e%ere #,e '!r',#t!e! ')r)&#r!e&e.
Re+re(!&t# 0#(# 0!&#,# # re+),#r!(#r!! %e&tr!',#re 7re+),#r!(#re# r#+!$#8. Dr#t# e"te $e
=.12-=.9= "e' 70#r# !+)rt#&t# +r#'t!'#8. F)r# e"te r)t&?!t# "! #"!etr!'#* #%#&$ +#rte#
$e"'e&$e&t# #! r#+!$#. I& )$ &)r#, &$# T e"te +)(!t!%# !& t)#te
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N#r, $er!%#t!!,)r "! r#$, "b$e&!%e,#r!! "ee&t,! ST ')re"+&$e e/t!&$er!! "!
r#$,! $e "e%er!t#te # !"'e!e! "! ')re,e#(# ' & +r)&)"t!' &e0#"t ,# $!"t#&t#. 7198
Pe&tr # 0! re,e%#&te #'e"te )$!0!'#r! '#r$!)+#t!e! !"'e!'e "e re')#&$# +r)be $e
e0)rt !& "')+ $!#&)"t!'. Se 0),)"e"te 0!e & te"t $e e0)rt ,!!t#t $e "!+t)e* 0!e & te"t $e
e0)rt "b#/!#,* '#re +)#te #$'e r#t)#re,e )$!0!'#r! e,e'tr)'#r$!)r#0!'e@ "+r# "#
"b$e&!%e,#re# "ee&t,! STK )$!0!'#r! #,e &$e! TK #+#r!t!# t,br#r!,)r $e r!t "#
')&$'ere '#r$!#'# 7G. O'e#&#* 2==<8.
Trei tipuri de denivelare a segmentului ST: A) Ascendent, B) Orizontal, C) Descendent.
E/t!&$ere# )&!t)r!(#r!! #b,#t)r!! # e,e'tr)'#r$!)r#e! # $" ,# ,#r!re#
')&"!$er#b!,# # +)"!b!,!t#t!,)r $e $ete't#re # !"'e!e! !)'#r$!'e "!,e&t!)#"e. O e/+re"!e #!
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igura *. Arterele coronare + piese anatomice inectate cu su!stanta de contrast si
radiograiate: a) in vitro- !) la cadavru
#amenul coronaroangiograic permite vizualizarea vaselor coronariene si prezinta inormatii e#clusive
asupra prezentei, localizarii si severitatii leziunilor aterosclerotice. Coronarograia se e#ecuta indeose!i pentru
diagnosticul dierential as cardiopatiei ischemice ata de alte cardiomiopatii. Diagnosticul dierential al cardiopatiei
ischemice se ace cu toate cauzele sindromului miocardic.
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igura (. a), !), c), d) Arterele coronare: coronarograie.
a) !)
igura /. Coronarograie stanga a), dreapta !) stenoze multiple ateromatoase
Angiograia coronariana cu su!stanta de contrast eectuata la intervale de timp va arata gradul de
evolutivitate al o!structiei coronariene si modul de dezvoltare a circulatiei colaterale $Dr. 0. 0. 1ateescu, 233*).
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ventricular dintre care i!rilatia ventriculara este cea mai grava sarsind de regula prin oprirea !atailor inimii care
este de regula atala- trom!oem!olii in care se ormeaza cheaguri in cavitatile inimii, iar ragmente din aceste
cheaguri sunt preluate de circulatia sanguina i#andu7se ulterior in vase din dierite teritorii anatomice cum ar iarterele cere!rale, renale, arterele mem!relor inerioare in cazul trom!ilor ormati in cavitatile stangi ale inimii si in
vasele pulmonare cu producerea trom!oem!olismului pulmonar in cazul trom!ilor ormati in cavitatile drepte $Dr.
0. 0. 1ateescu, 233*).
In sarsit complicatia cea mai de temut este moartea su!ita care se poate instala, dupa 8allavardin,
9dupa 3 de secunde sau dupa 3 de ani din momentul aparitiei primelor simptome;.
2. E')'#r$!)r#0!#
D#'# &!'! EG-, ,# e0)rt +r)re"!% & "t#b!,e"te $!#&)"t!', "e 0#'e ) e')r#0!e # !&!!!.E')'#r$!)r#0!# #r#t# ')&tr#'t!!,e "'!,! !&!!! "! )$!0!'#r!,e* !&$!'#&$ '# !& #'e# ()&#
& #?&e $e"t, )/!e& "# e"te ) !'# '!'#tr!'e.
9. S'!&t!r#0!#
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I& "0#r"!t #"!"te&t# e$!'#,# treb!e "# '&)#"'# "! +r!e,e !&r!?!r! '#re re#(# "# 0!e
#')r$#te !& &e,e re&te '#r$!)%#"',#re.
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!& "t#$! $e')+e&"#t.
S# '&)#"'# +r!e,e !&r!?!r! '#re treb!e"' #')r$#te !&tr-) ,!+)t!!e "# "!&')+#* #"r! $e
re#&!#re &e'e"#re 7re"+!r#t!e Qr# ,# r#Q "# Qr# ,# &#"Q8.
R/%&% $3*3(,(,* * *5+*@*+,$ /%$*%/+ & $+*/'$(*, *3;,)*$7
-"e$#re# $rer!!*
-"+r#%eere# 0&'t!!,)r %!t#,e
-#"!r#re# &e! #,!e&t#t!! ")r $!er#b!,e
-#?t#re# +#'!e&t,! !& "#t!"0#'e#re# &e%)!,)r 0&$#e&t#,e
-+re#t!re# +#'!e&t,! +e&tr e/#!&#r! r#$!),)!'e
-re'),t#re# +r)$"e,)r b!),)!'e +e&tr ,#b)r#t)r
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-e$'#t!# +#'!e&t,! +r!%!&$ +re%e&!re# re'!$!%e,)r
-+r)0!,#/!# !&0e't!!,)r +e&tr 'e! ' ,e(!&! %#,%,#re
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CAPITOLUL III- DESCRIEREA TE"NICILOR IMPUSE DE AFECTIUNE
E,e'tr)'#r$!)r#0!# 7 EG 8 4& '#r$!)+#t!# 'r)&!' !"'e!' +r!& e/#!&#re#
')+,ee&t#r $e b#( 4& $!#&)"t!', 5! e%#,#re# '#r$!)+#t!e!* re+re(!&t ) et)$
!+)rt#&t 4& +)0!$# &e! "e&"!b!,!t3! #! re$"e ')+#r#t!% ' #,te et)$e
7 e')'#r$!)r#0!# * te&!'! &',e#re 8 * EG-, 4& 12 $er!%#3!! 0!!&$ te&!'# $e b#(.
ELECTROCARDIOGRAMA STANDARD
E,e'tr)'#r$!)r## "t#&$#r$ ' 12 $er!%#3!! 4&re!"tr#t 4& re+#" e"te &)r#, ,#
#+r)/!#t!% ?t#te $!& +#'!e&3!! ' #&!& +e't)r#, t!+!' * $#r +)t e/!"t# "e&e #,e &!
!&0#r't !)'#r$!' %e'! . C t)#te ' #&)#,!!,e $e re+),#r!(#re * #$!' )$!0!'r! #,e &$e! T
5! "ee&t,! ST 5! t,brr! #,e ')&$'er!! !&tr#%e&tr!',#re 4& re+#" * "&t "e"t!%e +e&tr
'#r$!)+#t!# !"'e!' * e,e "&t &e"+e'!0!'e * 4&tr'6t +)t 0! 4&t6,&!te 5! 4& b),! #,e +er!'#r$,! *
!)'#r$,! * b),! %#,%,#re "# 4& #&/!et#te * )$!0!'r! $e +)"tr * $r)r! "# b),!
e")0#!e&e. M)$!0!'r!,e t!+!'e #,e "ee&t,! ST
5! &$e! T '#re 4&")3e"' e+!")#$e,e $e #&!& +e't)r#, 5! $!"+#r $+ #'ee# "&t #!
"+e'!0!'e . M)$!0!'r!,e 'e,e #! '#r#'ter!"t!'e !&',$ $e&!%e,#re# "ee&t,! ST * '#re e"te
#"e&t)#re 4& t)#te '#(r!,e 4& t!+, &! te"t $e e0)rt . See&t, ST e"te $e )b!'e!
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0!(!)+#t),)!' #! +3!& "e%er * !#r ,e(!&e# e,e'tr)'#r$!)r#0!' * re+re(e&t#t $e )$!0!'r!
#,e "ee&t,! ST * ) !"'e!e #! "e%er.
Abe,e t!+r! $e )$!0!'r! "&t 0re'%e&t '#r#'ter!(#te 4& +r#'t!' $re+t t,brr! $e
re+),#r!(#re * $e5! 4& +r)$'ere# #be,)r !&ter%!& 5! )$!0!'r! #,e $e+),#r!(r!! !)'#r$!'e.
D#t)r!t 0#+t,! ' #t6t )$!0!'r!,e "ee&t,! ST*'6t 5! #,e &$e! T tr#$' !"'e!#
!)'#r$!' * #be,e "&t 0re'%e&t $e&!te 4& +r#'t!' )$!0!'r! !"'e!'e * 0r 4&" # "e
0#'e !&t)t$e#&# +re'!(#re# +re(e&3e!
M$3&+$+,$ 3* /($+,$ +,3'*+$(*,*
De0!&!3!e@ - +r)'e", +r!& '#re "e re#,!(e#( "'!br!,e #()#"e.
S')+@
St#b!,!re# $!#&)"t!',!.
E%#,#re# "tr!! b),&#%,!.
Ob"er%#re# e%),3!e! b),!!.
Ob"er%#re# e0e'te,)r e$!'#e&te,)r.
I&$!'! 4& #+#r!3!# &)r ')+,!'#3!!.
E,ee&te $e #+re'!#t@
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A+re'!ere# 'e,)r,#,te e,ee&te #,e 0&'3!e! re"+!r#t)r!! "e 0#'e +r!& "!+,# )b"er%#re #
!5'r!,)r re"+!r#t)r!!.
N)t#re#@
1 ,!&!e +e 0)#!# $e te+er#tr 1 %#,)#re.
U&!re# %#,)r!,)r "''e"!%e CURBA RESPIRAWIEI.
& &e,e $)'e&te e$!'#,e &)t#re# "e 0#'e '!0r!' 4&")3!te $e '#r#'ter!"t!'!,e
re"+!r#3!e!.
L# $!"+&ee "e &)te#( )r#r,* !&te&"!t#te#* t!+,* e%),3!# 4& t!+.
I&ter+ret#re@
Re"+!r#3!# &)r#,@ "+,* #+,* re,#t* +r)0&$* "!etr!'.
Re"+!r#3!# +#t),)!'@ $!"+&ee* r!t &ere,#t* "+er0!'!#,* 4&'r'#t* ())t)#".
Fre'%e&3# &)r#, 4& 0&'3!e $e %6r"t.
Fre'%e&3# +#t),)!'@
T#!+&ee 7+),!+&ee8 0re'%e&3 're"'t.
Br#$!+&ee 0re'%e&3 "'(t.
A+&ee #b"e&3# re"+!r#3!e!.
D!"+&ee re"+!r#3!# re)#!e* $!0!'!, 7"ete $e #er8.
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M$3&+$+,$ 3* /($+,$ '&%3&%&*
De0!&!3!e@
Re+re(!&t "e&(#3!# $e 5)' #rter!#, +er'e+t ,# +#,+#re# &e! #rtere "+er0!'!#,e +e &
+,#& $r.
Pre"!&e# e/er'!t#t $e '),)#&# $e "6&e "!&'r)& ' #'t!%!t#te# !&!!! +er'e+t "b
0)r $e 5)' "# +,"#3!e
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$!#&)"t!',!.
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A+,!t$!&e 7!&te&"!t#te8.
Te&"!&e 7%),8.
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P"!!'.
F!(!' re+#" 0!(!' 5! +"!!' 1: !&te.
Te&!'#@
Se "+#, 6!&!,e. Se 0!/e#( %6r0, $eete,e +#,+#t)#re #,e 6!&!! $re+te 7!&$e/*
e$!"* !&e,#r8 +e tr#!e't, #rtere! r#$!#,e 4br3!56&$ #&tebr#3, ' +),!'e,e.
Se e/er'!t ) 5)#r +re"!&e #"+r# +erete,! #rter!#, 5! "e +er'e+ (%6'&!tr!,e +,!&e
#,e +,",! t!+ $e 1 !&t 7"e +)#te "r# 5! &#! 1: "e'&$e +,", re,#t* %#,)#re# "e
4&,3e5te ' 5! "e )b3!&e %#,)#re# &)r#,8.
N)t#re@
C!0r!' 4& '#!et > "e &)te#( !&',"!% )r#* $#' +,", # 0)"t "r#t 4& 0r!")&* 0#'!e",
er# r)5 et'.
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#$!' %#,)r! +tr#t8.
U&!re# +&'te,)r CURBA PULSULUI.
I&ter+ret#re@
N)r#,@ +," re,#t* b!&e btt* r!t!'* "!&'r)&* 'e,er!'.
P#t),)!'@ +," ",#b* !+er'e+t!b!,* #r!t!'* #"!&'r)&
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M$3&+$+,$ 3* /($+,$ (,3*&** $+(,+*$%,
De0!&!3!e@
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S')+@ - E%#,#re# 0&'3!e! '#r$!)%#"',#re* e%),3!e! b),!!* # "tr!! e&er#,e.
L)', "rr!!@ - Arter# er#,.
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)"'!,)etr P#')&.
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5! # ),!%e,)r.
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,!K "e e/+,!' et#+e,e te&!'!!8.
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E%!$e&3!#( #+,!t$!&e# )"'!,#3!!,)r #rter!#,e 'e "e )b"er% +e '#$r#&, r#$#t #,
)"'!,)etr,! P#')&.
Se $e"')+er ebre,e "+er!)#re 5! !&0er!)#re > 4br'!&te# & treb!e " 0!e
"tr6t.
M#&5et# "e 0!/e#( ,# &!%e,r!,e $)r!te +e ebre,e b),&#%,!* $e &$e +,"#3!!,e "e
tr#&"!t ,# #&)etr.
Se +)+e#( #er 4& #&5et +6& ,# $!"+#r!3!# +,",! +er!0er!' > '6&$ +re"!&e#
$e+5e5te te&"!&e# #rter!#, #/!.
Se '!te5te )"'!,#3!!,)r +e '#$r#&, #&)etr,!.
Se "'#$e +re"!&e# $!& #&5et ' 1= H 5! "e '!te5te $!& &) %#,)#re# )"'!,#3!!,)r
#rter!#,e.
Se 0#' "'$er! 5! '!t!r! "''e"!%e +6& "e "e5te %#,)#re# #/! # #+,!t$!&!!* 'ee#
'e "e &e5te !&$!'e )"'!,)etr!'.
Se #+re'!#( %#,)r!,e &)r#,e 4& ,!!te 0)#rte ,#r! > %#r!#b!,e $e ,# !&$!%!$ ,# !&$!%!$.
V#,)r! &)r#,e@
Y 9-< $!%!(!&! ,# ')#+".
Y 2- $!%!(!&! 4& 19 "+er!)#r #b.
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A$,t 12== H + !&t.
F#'t)r!! '#re !&0,e&3e#( te&"!&e# #rter!#,@
F#'t)r! b!),)!'!@
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Y Deb!t, '#r$!#'* 0)r3# $e ')&tr#'3!e # !&!!!* e,#"t!'!t#te# 5! '#,!br, %#"e,)r*
%6"')(!t#te# "6&e,!.
Y S)&, > "'#$e TA #rter!#,. E0)rt, 0!(!' > 're5te TA.
Y A,!e&t#3!# > 4& t!+, $!e"t!e! TA 're5te 5)r.
F#'t)r! +"!),)!'! > e)3!!* "tre"* #&/!et#te.
F#'t)r! ")'!#,! > e$!, #b!#&t* 0r!, "# ',$r# e/'e"!% 70r!, +r)$'e
%#")')&"tr!'3!e 5! 're5te te&"!&e# #rter!#,* !#r ',$r# +r)$'e %#")$!,#t#3!e 5! "'#$e
te&"!&e# #rter!#,8* ',!#.
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M"r#re# "e 0#'e ,# #'e,#5! b),&#% ' #'e,#5! #+#r#t* 4& #'e,e#5! ')&$!3!!. M#&5et# %#
0! b!&e 0!/#t +e br#3, +#'!e&t,!.
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!&ter%#,e re')#&$#te $e e$!'.
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) A5e(#re# b),&#%,! 4& $.$. 5! !&ter(!'ere# )r!'r! e0)rt > !&',"!% %)'#,.
) P"!)ter#+!e.
Pre%e&!re# #,t)r ')+,!'#3!!@
Se$#re# $rer!! > ,# !&$!'#3!# e$!',! ' M)r0!& 1 0 !.. "# ".'.* M!#,!& !.. $#'
"&t $rer! #! !'! "e +)#te 4&'er'# #$!&!"tr#re# $e A,)'#,!&* F)rtr#,* C)$e!& > !.%.
Se rre5te te&"!&e# #rter!#,* +,",* re"+!r#3!#* ',)#re# 5! #"+e't, tee&te,)r.
Se !&"t!t!e $#' e"te +)"!b!, +er0(!e ' "er ,')(#t :;* De/tr#&* M#r!"#&*
He!"''!&#t $e H!$r)')rt!()&.
Se #$!&!"tre#( X!,!& > $e ( '#r$!)e&.
O/!e&)ter#+!e.
S'rt#re# t!+,! +6& ,# !&ter&#re# 4& "+!t#,@
Tr#&"+)rt re&t ' &!t#te )b!, ')r)&#r!#&.
P+*)&% $@&(/+ * $5*$ ',(/+$%$
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A&!&# +e't)r#, e"te ) "0er!&3 !)'#r$!' $eter!&#t $e & $e(e'!,!br 4&tre
&e'e"!t#te# )/!e&r!! !&!!! 5! #+)rt, ')r)&#r!#&.
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Se$#t!%e #,e "!"te,! &er%)".
A"!r#re# ")&,! $e &)#+te > b#rb!tr!'e* br)r!* Re(er+!&* ',)r+r)#(!&.
Cr $e ",b!re +e&tr b),&#%!! )be(! > re$'ere# r"!!,)r $!& #,!e&t#3!e ,# <=-=
+e (!.
V#")$!,#t#t)#re > M!)0!,!&* +#+#%er!&* &!tr),!'er!&.
TE"NICA RESPIRATIEI ARIFICIALE
- "e #"e#(# b),&#%, !& $e'b!t $)r"#,* "#,%#t)r, "e +,#"e#(# &! e&!&'! ,# '#+, %!'t!e!
,# +#rte# ,#ter#,# "t#&# "# $re#+t# "! e/e't# et)$# re"+e't#&$ t!+!! 0)r,e! HELP.
1. H!+erte&"!&e# '#+,! - "e +)#te e/e't# +r!& $)# 728 +r)'e$ee@
- "e tre'e ) #&# "b #t, b),&#%,! "! ! "e r!$!'# 'e#0#* !#r ' # $)# #&#*
#"e(#t# +e 0r&te* "e !+!&e '#+, "+re "+#teK
- "#,%#t)r, #+,!'# ) #&# "b 're"tet* !#r # $)# "b b#rb!# b),&#%,! "! !! !+!&e '#+, "+re
"+#te.
2. E,!ber#re# '#!,)r re"+!r#t)r!! "+er!)#re.
M#&e%re,e +r!& '#e "e +)#te )bt!&e e,!ber#re# '#!,)r re"+!r#t)r!! "e +)t e/e't# +r!&@
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- ' #&# "t#&# - !& #'e"t '#(* #&# "t#&# e,!ber#t#* "#,%#t)r, +)#te #"ter&e +e"te r#
%!'t!e! & #ter!#, $e +r)te't!e* #+)! +e&"e#(# &#",K
- ' +e&"e "+e'!#,e $!& tr"# $e +r! #?t)r e$!'#,.
R,3'*+$(*$ #5&+$ %$ 5&+$#@
- "#,%#t)r, tr#e #er !& +!e+t 7!&"+!r#t!e +r)0&$#8K
- !"! ret!&e re"+!r#t!# !& !&"+!r#t!e +r)0&$# 7#+&ee %),&t#r#8K
- #+,!'# re+e$e r# ,#r $e"'!"#* b(e,e +e"te r# !&tre$e"'!"# # %!'t!e! ' +tere #er,
$!& +,##&!! "#! !& '#!,e re"+!r#t)r!! #,e %!'t!e!K
- "#,%#t)r, "e r!$!'#* 0#'e ) &)# !&"+!r#t!e 7!& #'e"t t!+ ,#"# ,!bere &#", "! r#*#er, !e"!&$
#"t0e, $!& +,##&!! %!'t!e!8* #+)! !&"0,# $!& &) #er !& +,##&!! %!'t!e!*re+et#&$ #'e#"t#
"''e"!&e $e 1 - 1< )r! !&tK
- ,# #$,t! "e !&"0,# ' 0)rt#* ,# ')+!! #! ")r* !#r ,# "#r! 0)#rte ")r +e&tr # & "e +r)$'e
r+tr! #,%e),#reK
- !& t!+, !&"0,#t!e! "e !&$re#+t# +r!%!re# #"+r# t)r#'e,! %!'t!e!* +e&tr # #+re'!# e0!'!e&t#
re"+!r#t!e!.
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- r# %!'t!e! & +)#te 0! $e"'!"#K
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C)&tr#!&$!'#t!!,e #"#?,! '#r$!#'@
- ,e(!&! r#%e #,e +erete,! t)r#'!' ' 0r#'tr! ')"t#,eK
- e)r#!e #"!%# !&tr#+er!'#r$!'# "! t#+)&#$# !&!!!K
- eb),!e #()#"# #"!%#.
A''!$e&te@
- $#'# +)(!t!# '#+,! %!'t!e! & e"te ')re't# 7& #"!r# ,!bert#te# '#!,)r #er!e&e8
#er, !&"0,#t +)#te ,# '#,e# $!e"t!%# +r)%)'#&$ $!,#t#re# "t)#',! "! 're!&$
+er!'), $e %#r"#tr! ' !&&$#re# '#!,)r #er!e&eK
- "e %# #+#"# $!& t!+ !& t!+ +e e+!#"tr !& t!+, e/+!r#t!e! +#"!%e* "e %# ')&tr),#
"! ')re't# +)(!t!# $e !+erte&"!e # '#+,! ,# #$,tK
- '#$ere# ,!b!! "! !&e0!'#'!t#te# !&"0,#t!!,)r.
REGULI DE ADMINISTRARE A MEDICAMENTELOR
1. Re"+e't#re# e$!'#e&t,! +re"'r!" $e e$!'.
2. I$e&t!0!'#re# e$!'#e&t,! +re"'r!" $+# et!'et#* 0)r# $e +re(e&t#re*',)#re* !r)"*
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19. A$!&!"tr#re# !e$!#t# # e$!'#e&te,)r $e"'!"e 70!),e* "+)(!t)#re8.
1. Pre%e&!re# !&0e't!!,)r !&tr#"+!t#,!'e"t! +r!& re"+e't#re# "tr!'t# # $)# re,! $e b#(#@
- "+#,#re# +e #!&! !&#!&te "! $+# #$!&!"tr#re# tr#t#e&te,)rK
- t!,!(#re# "er!&!! !&$!%!$#,e.
IN!ECTIA INTRAMUSCULARA
De0!&!t!e@ Re+re(!&t# !&tr)$'ere# &)r "),t!! !()t)&!'e* ,e!)#"e "# "b"t#&te
'),)!$#,e !& "tr#t, "',#r ' #?t)r, &! #' #t#"#t $e "er!&#.
S')+@ U&!' - ter#+et!'@ !&tr)$'ere# $e e$!'#e&te !& )r#&!".
L)', $e e,e't!e@
- re!&e# "+er)-e/ter&# 0e"!#r#* $e#"+r# tr)#&ter,! #reK
- 0#t# e/ter&# # ')#+"e!* tre!e# !?,)'!eK
- "'!, $e,t)!$.
Te&!'#@
1. Pre#t!re# #ter!#,e,)r "! # !&"tre&t#r,! &e'e"#r.
2. Pre#t!re# +"!!'# "! 0!(!'# # b),&#%,!@
- ! "e e/+,!'# &e'e"!t#te# te&!'!!K
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- "e 'ere b),&#%,! "# !&'!$# "! "# $e"'!$# +&, $e '#te%# )r! "! "# r##&#
' e, !&'!"@
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!&$e/, $re+t "e 0!/e#(# #b), #',! #t#"#tK
[ ' !&$e/, #!&!! "t#&! "e +#,+e#(# !#r#"! ,)', +&'t!e!* !#r '
+),!'e,e "e 0!/e#(# %e&# ,# - : ' "b ,)', #,e" +e&tr +&'t!)&#re*
re#,!(#&$-"e ) ")#r# ')+re"!e "! #+)! tr#'t!&e # te"tr!,)r !& ?)"K
[ "e !&tr)$'e #', !& !?,)', %e&e!* $e-# ,&, tr#!e't,! ,)&!t$!&#,K
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e,#"t!'.
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$e 1 - 1*: '.
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#+#re# "#&eK
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"e retr#e* "e #"+!r# +e&tr # %er!0!'# $#'# # +#tr&" $!& &) !& %e&# "! $#'# &
+r)$'e e/tr#%#(#re $e "#&e* "e ')&t!&# )+er#t!&e#K !#r $#'# "! !& #'e"t '#( #+#re )
'),)r#t!e %!),#'ee* +&'t!# "e !&trer+e.
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!&tr)$'er!! +re# r#+!$e # "err!,)r "# #'t!&!! !r!t#&te # $!0er!te,)r "b"t#&te* ' #r 0!
',)rr# $e N# b!+ert)&# 22;K
- Ne'r)(# te"tr!,)r - #+#re '# r#re # !&tr)$'er!! +#r#%e&)#"e # "),r!,)r
!r!t#&teK
- L!+)t!!# - +!er$ere# $e '&)"t!&t#* $e "'rt# $r#t#* ' !&trer+ere# 0&'t!e! $e
re,#t!e "! +#"tr#re# 'e,)r,#,te 0&'t!! #,e )r#&!",! "!* '#re +)#te "# #+#r# 0!e $#t)r!t#
0r!'!!* 0!e $#t)r!t# &! tere& +"!!' e)t!%* "#* !& '#(r!,e r#%e* '# r#"+&" # )r#&!",! ,#
$!0er!te "b"t#&te.
L!+)t!!# e"te #&&t#t# $e +#,)#re# 0ete! !&$!%!$,!* #ete,!* tr#&"+!r#t!!.
Se !&trer+e +&'t!#* "e #&&t# $e re&t# e$!',.
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∼ U$ ORS 3,5),(&% ST * &$ T re+re(!&t e/+re"!# e,e'tr!'# activit ăţii ventriculare.
O3,+$=** ∼ I&ter+ret#re# tr#"e,! e"te 0't $e e$!' 4& ,!&# $#te,)r',!&!'e.
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CAPITOLUL IV- PLANUL DE INGRI!IRE AL PACIENTULUI CU CARDIOPATIEISC"EMICA
D#te 0!/e@ Ne@ T.Pre&e@ A.
N#3!)&#,!t#te@ r)#&#V4r"t#@ 2 #&!Gret#te@ <
&,3!e@ 1< 'Se/@ MRe,!!e@)rt)$)/#
D#te %#r!#b!,e@D)!'!,!@ ?$. Pr#)%#
D#t# !&ter&r!!@ 1.=.2==<
D#t# e/ter&r!!@ 2.=.2==<
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D!"+&ee ,# e0)rt* 0#t!#b!,!t#te* +#,+!t#3!!* #&/!et#te* r!"' 're"'t 0#3 $e !&0e'3!!* t"e*
!+erte&"!&e #rter!#,* rete&3!e r!&#r.
Pr)b,ee,e +#'!e&t,!@
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- +)te&3!#, $e ')+,!'#3!!*
- t"e '!&!t)#re*
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- #,ter#re# $!re(e!*
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5! 'e$e#( ,# &!tr),!'er!&*
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- +#,+!t#3!!.
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e0!(e#t)"* MV $!!&#t b!,#ter#,* AMP 4& ,!!te &)r#,e +er't)r!'* SA "+#3!, :
!&"0!'!e&3 '#r$!#' "t4& +e LMC ())te '#r$!#'e r!t!'e* +," +er!0er!' +re"e&t +4& 4&
#%#,*#b$)e& $e#"+r# +,#&,! /!0)+b!#&* &e$rer)" ,# +#,+#re "+er0!'!#, 5!
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$!#&)"t!' $e !&r!?!re )b!e't!%e !&ter%e&t!! e%),t!eA,ter#re# 0&'3!!,)r re"+!r#-t)r!! #&!0e"t#t +r!&@$!"+&ee ,#e0)rt*0#t!#b!,!t#te #")'!#te' +#,+!t#3!!.
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P#'!e&t, re"+!r #!5)r.Re"+!r#3!# re%!&e,# &)r#
P)te&3!#, $e ')+,!'#3!!$#t)-r!t "'$er!! $eb!t,!'#r$!#'#&!0e"t#t +r!&@$rere*$!"-')&0)rt*!&t),er#&3 ,#e0)rt*r!"' 're"'t 0#3 $e!&0e'3!!
P#'!e&t, " 0!ee'!,!br#t +"!!'*" +re(!&te re(!"te&3're"'t 0#3 $e!&0e'3!!.
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SUPRAVEGHEREA FUNCTIILOR VITALE
Data
233/T.A 6uls 0esp. T°C Diureza Scaun
&(.3* &(3<&23
4*
42
&'
&/
(,(
(,4&2*3 ml
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&>33 ml =
?A1=@% D %ABO0ATO0
#amen cerut 1od de recoltare 0ezultate 5alori normale
5S 3,> ml citrat de =a ,4,se aspira
sange pana la 2 ml.
5S><&2mm
5S&7&3mm<h
/7&*mm<h%eucocite
emoglo!inaInteparea pulpei degetului.Serecolteaza 2 ml sange pe cristalede DTA.
%&3333mmc
g!&
%>23374333
g!&>7&(g
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Trom!ocite
ematocrit
T2&*33
tc>2
T&*37>33333mmc
tc>37>*
i!rinogen 3,* ml citrat de =a,4 si >,* mlsange
&43mg 2337>33mg
8licemie 2 ml sange pe lorura de =a > mg 8&3mg 8437&23mg
@ree
Creatinina
Acid uric
*7&3 ml sange,punctie venoasa
@43 mg
C2,>mg
A.@&72mg
@237>3mg
C3,(7&,2mg
A.@27(mg
Colesterol *7&3 ml sange,punctie venoasa 2(3mg &437243mg
#amen sumar de urina 0ecipiente sterile,din etulmilociu.
=ormal
nzime *7&3 ml,punctie venoasa
T8O2*@<%
T86&,*@<%
T8O2723@<%
T8627&(@<%
AD1I=IST0A0A 1DICA1=T%O0
Data 1edicamente 1od de administrare
&(.3*Dipiridamol
Diazepam
1ialgin
& t!<oral
&t! seara<oral
2ml iv
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eparina &33 @I<
&/.3*
Aspirina
Betaloc
Trom!ostop
Diazepam
E oral
&33mg
37372 oral
3737& seara oral
&4.3*
Betaloc
Aspirina
Trom!ostop
=iedipin
&33 mg
E oral
37372 oral
2& oral
&'.3*
Captopril
Betaloc
Trom!ostop
Diazepam
&3mg oral
&33mg
37372 oral
3737& seara oral
23.3*
Betaloc
Trom!ostop
Diazepam
&33mg
37372 oral
3737& seara oral
INVESTIGATII PARACLINICE
Data #amene curente 6regatire pt e#amen Ingriiri dupa e#amen
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&(.3* F8
Bolnavul va i asezat in decu!it dorsal,isi varela#a musculatura.
1ontarea electrozilor:
-pe membre:rosu7mana dreapta
gal!en7mana stanga
negru7picior drept,verde7picir stang.
7precordial
5I7sp > intercostal drept
527sp > intercostal stang
57intre 52 si5>
5>7sp * intercostal,pe linia medioclavicularastg
5*7sp * intercostal stg pe linia a#ilaraanterioara
5(7sp * intercostal stg pe linia a#ilaramilocie.
=u necesita ingriiri speciale.
&/.3*
0tg toracic
F8
&4.3* F8
&'.3*
0tg toracic
F8
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RECUPERAREA BOLNAVILOR CARDIACI
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Et#+e,e +r!&'!+#,e &e'e"#re +e&tr re'+er#re# )r!'#r! b),&#% '#r$!#'@
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INE>ITERAPIA
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- re,#re# &)r #'t!%!t#t! "e$e&t#re 7$+# 9 - ,&!8.
GIMNASTICA CURATIVA
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!&'re$ere# !& "!&e "! $)r!&t# $e # &'!!. S&t &e'e"#re & '#$r !!e&!'* & "+#t!')re"+&(#t)r "! ) #+#r#tr# !&!#.
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+"!!'# +)#te "# $e+#"e#"'# +)"!b!,!t#t!,e #'e"t!#. Re#'t!!,e +"!!'e "&t &e)r! &
e,ee&t $e'!"!%* $e "''e" "# $e e"e' !& re#$#+t#re. A&/!et#te# e/'e"!%# # +b,!',! b),&#%!,)r "! e$!'!,)r* !& 'ee# 'e +r!%e"te #'t!%!t#te# &! )r#& #t#t $e %!t#,
'# INIMA* e"te !& #re #"r# re"+)&"#b!,# $e +r$e&t# e/'e"!%# $e '#re $# $)%#$#
!& +re(e&t b),&#%!! "! #?)r!t#te# e$!'!,)r. A'e"t ,'r ')+r)!te re#$#+t#re#
8/13/2019 proiect cardiopatie ischemica
http://slidepdf.com/reader/full/proiect-cardiopatie-ischemica 63/65
,t)r b),&#%!.
- t)#te e/er'!t!!,e "e e/e't# ,e&t* &#r#&$ !& #&$ re+et#r!,eK
- !& t!+, e/e't#r!! "e re"+!r#* & "e b,)'e#(# re"+!r#t!#K
- $+# 0!e'#re e/er'!t! "e 0#'e ) +#(# $e 2= - 9= "e'&$eK- &#r, re+et#r!,)r $+# 0!e'#re e/er'!t! 're"te tre+t#tK
- $#'# e/er'!t!!,e $e '#+ +r)$' #ete,!* e,e "e %)r e/e't# !& +r!e,e "e$!&teK
$!& +)(!t!e "e(#&$ "! "e %# 0#'e '#te ) "!&r# !"'#re $!& 0!e'#reK
- +r)r#, %# $r# ,# !&'e+t 1: !&te* #+)!* +r!& 're"tere# &#r,! $e
re+et#r!* %# #?&e ,# 2= !&te.
8/13/2019 proiect cardiopatie ischemica
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8/13/2019 proiect cardiopatie ischemica
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