LUCRARE DE DIPLOMǍ-pielonefrita

8/12/2019 LUCRARE DE DIPLOM-pielonefrita

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LUCRARE DE DIPLOMCOORDONATORI: ABSOLVENT

NGRIJIREA PACIENILOR CU

PIELONEFRIT

PLANUL LUCRRII

Motivatia

Capitolul I

INGRIJIREA BOLNAVILOR CU PIELONEFRIT

Capitolul II

PLANURI DE NGRIJIRE ALE PACIENILORCU PIELONEFRIT

Capitolul III

CONCLUZII

A!"!Bi#lio$%a&ia


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MOTIVAIE

Numai o viat scurt ne este acordat pe planetaPMNT si fiecare trebuie sa-si pun ntrebarea:

"Cum as putea s investesc n puterile mele asanct s aduc cel mai mare folos"

"Cum as putea face mai mult pentru sntatea mea si pentru folosul semenilor mei?"

Pentru c viata, numai atunci are valoare cndeste folosit pentru atingerea acestor scopuri.

CAPITOLUL I

I.1NOIUNI GENERALE DE ANATOMIE sI

FIZIOLOGIE ALE APARATULUI RENAL

M!ta#oli'(ul )!lula% p%o*u)! CO+ 'i au(it! 'u#'tat! &ial!p%ov!it! , 'p!)ial *i )ata#oli'(ul p%ot!i)- apo%tul o"i$! poat! 'i !l%!ali.a )atit/ti !")!'iv! *! au(iti !l!)t%oliti 0apa- NaCl- *i&!%it! '/%u%i(i!%al!1 )a%! t%!#ui! !li(iati2

Pla(3ii !li(ia CO+ 'i alt! 'u#'tat! volatil!- ia% 'u#'tat!l!!volatil! iutili.a#il! 'au , !")!' 'ut !li(iat! ,(p%!ua )u o au(ita)atitat! *! apa- , )!a (ai (a%! pa%t! p%i %ii)4i 'i a))!'o%ii p%i 'u*oa%!'i (at!%ii &!)al!2 P%i !li(ia%!a 'u#'tat!lo% !volatil! %ii)4iul %!p%!.ita

p%i)ipalul o%$a )a%! (!ti! )o'tat volu(ul- )o)!t%atia !l!)t%oliti)/ 'i%!a)tia )4i(i)a a li)4i*!lo% o%$ai'(ului2

Rii)4iul (ai a%! 'i alt! a)tivitati5 p%i '!)%!tia *! %!ia )ot%i#ui! la%!$la%!a t!'iuii a%t!%ial!- p%i !%it%opoi!tia )ot%ol!a.a !%it%opoi!.a- p%i')4i(#a%il! ioi)! )ot%i#ui! la (!ti!%!a !)4ili#%ului a)i*o6#a.i)2

APARATUL 7ECRETOR '! )o(pu! *i5

6 %ii)4i- o%$!! *! !")%!ti!-

6 )ai u%ia%!5


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6 )ali)!6(i)i

6 )ali)!6(a%i

6 p!lvi' %!al

6 u%!t!%!

6 v!.i)a u%ia%a

6 u%!t%a2

I.1.aRINIC8I

7ut o%$a! p!%!)4! 'ituat! %!t%op!%itoal- *! o pa%t! 'i *! alt! a

)oloa!i v!%t!#%al! lo(#a%!2 Rii)4iul a%! &o%(a )a%a)t!%i'ti)a- )i%)a 9::$%a(!- a%! *oua &!t! 0at!%ioa%a 'i po't!%ioa%a1 'i *oua (a%$ii 0lat!%ala)ov!"a 'i (!*iala )o)ava12

I .oa (a%$iii )o)av! '! $a'!') 4ilul 'i p!*i)ulul %!al , )a%! '!va* va'!l! %!al! 0a%t!%a 'i v!a1- u%!t%ul 'i &i#%! !%voa'! v!$!tativ!2

7!l!)tio3* %ii)4iul , lu$ul lii!i (!*ia!- *i pa%t!a )ov!"a'p%! )!a )o)ava '! o#'!%va5

6 papil!l! 'i )ali)!l! %!al!5 &o%(atiui (!(#%oa'! p%i )a%! '! ')u%$!u%ia;

6 pa%!)4i(ul %!al- )u 't%u)tu%a .oala5 )o%ti)ala 'i (!*ula%a2

Zoa )o%ti)ala !'t! &o%(ata , p%i)ipal *i $lo(!%uli- tu#i u%ii&!%i 'iva'!l! *! '3$! )a%! l! apa%ti2 Zoa (!*ula%a )oti! pi%a(i*! %!al!0Malpi$4i1- &o%(at! *i tu#i )ol!)to%i )a%! *%!!a.a (ai (ulti !&%oi2

Pi%a(i*!l! 'ut o%i!tat! )u #a.a 'p%! p!%i&!%i! 'i v3%&ul 'p%! 'iu'ul%!al- *!')4i.3*u6'! , papil!l! %!al!- a)!'t!a '! *!')4i* , )ali)!l! (i)i)a%! )o&lu!a.a &o%(3* )ali)!l! (a%i 0+691 'i apoi p!lvi'ul %!al 0#a.i!t1)otiuat )u u%!t!%ul2

O pi%a(i*a Malpi$4i )u 'u#'tata )o%ti)ala *i ?u%ul 'au &o%(!a.a ulo# )o%ti)al2


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NEFRONUL

E't! uitat!a (o%&o&u)tioala %!ala; ,*!pli!'t! toat! p%o)!'!l!)o(pl!"! )a%! au )a %!.ultat &o%(a%!a u%iii2 N!&%oul !'t! al)atuit *ut%6o)ap'ula 'i u tu# ui&!% lu$2

Cap'ula Bo@(a- !"t%!(itat!a p%oi(ala- ,)4i'a *ilat!%ala a!&%oului- a%! &o%(a u!i )up! )u p!%!ti *u#li- (a%$ii* o )avitat! )!)otiua lu(!ul tu#ului2 I a*3)itu%a )ap'ula%a '! a&la u $4!( *! 6=+

#u)l! )apila%! 0$lo(!%ul1- )a%! %!.ulta p%i *ivi.iu!a a%t!%iol!i a&!%!t! 'i)a%! '! %!u!') la i!'i%!a *i )ap'ula- , a%t!%iola a&!%!ta2 Cap'ula ,(p%!ua)u $lo(!%ulul al)atui!') )ap'ulul %!al Malpi$4i2

7!$(!tul p%oi(al al tu#ului u%ii&!% !'t! )o'tituit *it%6o po%tiu!

)oto%ta- tu#ul )oto%t p%o"i(al 0)a%! '! a&la , )o%ti)a %!ala1 'i !'t! &o%(at*it%6u 't%at *! )!lul! a )a%o% (!(#%aa- 'p%! lu(!- p%!.ita o (a%$i! ,p!%ii- &o%(ata *i (i)%ovili- )a%! (a%!') (ult 'up%a&ata (!(#%a!i2

7!$(!tul it!%(!*ia% 0a'a 8!ul!1- 'u#ti%! !'t! &o%(at *i *oua#%at! 0*!')!*!t 'i a')!*!t1 uit! ,t%! !l! p%it%6o #u)la- a%! !pit!liultu%tit- &a%a (i)%ovi%i2 N!&%oii )a%! au $lo(!%ulii , .oa )o%ti)ala !"t!%aa%! a'a 8!ul! ')u%ta- , ti(p )! !&%oii )u $lo(!%uli , .oa !"t!%a a)o%ti)ol!i 0?uta(!*ula%i1 a%! a'a lu$a- )a%! )o#oa%a p%o&u* , (!*ula%a2

7!$(!tul *i'tal !'t! &o%(at *it%6o po%tiu! *%!apta- a')!*!ta- )a%!a?u$! , )o%ti)ala , v!)iatat!a $lo(!%ulului p%opiu- , i(!*iat )ota)t )ua%t!%iala a&!%!ta2 La a)!'t iv!l !pit!lul tu#ula%- la &!l )a 'i )!lul!l!(u')ulatu%ii !t!*! a a%t!%iol!i a&!%!t!- p%!.it/ (o*i&i)a%i 'i &o%(!a.aapa%atul ?u"ta$lo(!%ula% )a%! '!)%!t/ %!i/2 U%(!a.a o po%tiu! )oto%t/'ituata , ,t%!$i(! , )o%ti)ala2 Mai (ulti tu#i *i'tali '! u!') 'i '! *!')4i*, tu#ul )ol!)to% *i 't%u)tu%a pi%a(i*!lo% Malpi$4i2

VA7CULARIZAIA RENAL

E't! !"t%!( *! #o$ata- p%i(i* +:6+ *i *!#itul )a%*ia) *! %!pao'2 A%t!%a %!ala-%a(u%a a ao%t!i a#*o(ial!- pat%u*! p%i 4il 'i apoi '! ,(pa%t! , %a(u%i it!%lo#a%!0,t%! pi%a(i*!1- *i )a%! '! *!'p%i* a%t!%!l! a%)uat!- )! &o%(!a.a o a'a , ?u%ul #a.!ipi%a(i*!lo%- a%t!%!l! it!%lo#ula%!- *i )a%! $lo(!%ulul2 Dupa )! '! %!$%up!a.a ,a%t!%iol!- '! )apila%i.!a.a *i ou , ?u%ul tu#ului %!'p!)tiv 0, (!*ula%a1 'i '! *!')4i* ,v!!l! it!%lo#ula%!- apoi , v!!l! a%)uat!2


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V!!l!- av3* u t%ai!)t ap%oap! a'!(aato% )u )!l al a%t!%!lo%- '!)ol!)t!a.a , v!a %!ala )a%! '! *!')4i*! , v!a )ava i&!%ioa%a2

INTERVAIA RENAL

P%ovi! *i pl!"ul 'ituat , 4ilul o%$aului &o%(at , (a?o%itat! *i&i#%! 'i(pati)!- *a% 'i *i )3t!va &i#%! pa%a'i(pati)! v!it! p%i !%vul va$2Fi#%!l! !%voa'!- 'ituat! p!%iva')ula%- '! *i't%i#ui! )!lul!lo% (u')ula%! *i

p!%!t!l! a%t!%iola% 'i )o(po!t!lo% tu#ula%!2

I1b. FORMAREA URINEI

M!)ai'(ul *! &o%(a%! a u%i!i )up%i*! t%!i p%o)!'! &u*a(!tal!5

ult%a&ilt%a%!a pla'(!i la iv!l $la(!%ula%;

%!a#'o%#tia;

'!)%!tia au(ito% )o'titu!ti , tu#i2

ULTRAFILTRAREA GLOMERULAR

E't! u p%o)!' *i%i?at *! &o%t! &i.i)! , u%(a )a%uia ap%o"i(ativ +:*i )atitat!a *! pla'(a )a%! i%i$a %ii)4ii t%!)! p%i (!(#%aa &ilt%ata

$lo(!%ula%a- !"t%!( *! 'u#ti%!- , )avitat!a )ap'ula%a2 M!(#%aa &ilt%atau '! )o(po%ta )a o (!(#%aa i!%ta !i- p%i p%op%i!tatil! !i &i.i)o6)4i(i)!-p!%(it! t%!)!%!a '!l!)tiva *oa% a uo% )o'titu!ti 'i #lo)4!a.a t%!)!%!aalto%a2 Ult%a&ilt%atul $lo(!%ula% 0u%ia p%i(a%a1 a%! o )o(po.iti! !l!)t%oliti)ai*!ti)a )u )!a a pla'(!i; *a% !'t! lip'it *! p%ot!i!- *!)i !'t! o pla'(a*!p%ot!ii.ata2 Ult%a&ilt%a%!a $lo(!%ula%a !'t! %!.ultatul p%!'iuii !&!)tiv! *!&ilt%a%!- )a%! '! !"!%)ita la iv!lul )apila%!lo% $lo(!%ula%! 'i %!p%!.ita 'u(aal$!#%i)a a uo% p%!'iui )a%! )ot%ol!a.a ')4i(#u%ilo% li)4i*i!! la iv!lultutu%o% )apilal!lo% *i o%$ai'(2

CONSTITUENT

U.M. FILTRAR E

REABSORIE

SECREIE

EXCREIE

APA0=1 =: =- 6 =-

Na 0(EHl1

+: 6 =:


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0(EHl1

K:: K:: =:: =::

Cl6 0(EHl1

=>::: =>: 6 =:

UREE 0(oli1 >: :: >:: 6 :

La iv!lul tu#ilo% u%ii&!%i au lo) p%o)!'! !"t%!( *! a)tiv!- au(iti)o'titu!ti ai ult%a&ilt%a?ului &ii* %!a#'o%#iti )o(pl!t 0$lu)o.a1 'au *oa%

pa%tial 0Na- Cl6- U%!!1- altii &ii* iitial %!a#'o%#iti 'i apoi '!)%!tati 012

Rabs!"b#$a #%b%&a"a

E't! p%o)!'ul p%i )a%! 'ut %!)up!%at! au(it! 'u#'tat! util!o%$ai'(ului *i ult%a&ilt%atul $lo(!%ula%- (!ti3*u6'! a't&!l 4o(o'ta.ialo% pla'(ati)a2 P%o)!'ul !'t! '!l!)tiv- , '!'ul )a '! %!ali.!a.a (a"i(al

p!t%u &i!)a%! 'u#'tata ,t%6u '!$(!t tu#ula% p%i a)tiu!a uo%(!)ai'(! )!lula%! 'p!)i&i)!- &ii* )o*itioat *! *!#itul 'u#'tat!i%!'p!)tiv! 'i *! !)!'it/til! o%$ai'(ului2 R!a#'o%#tia 0t%a'po%tul1*i&!%itilo% )o'titu!ti *i ult%a&ilt%at p%i p!%!t!l! tu#ului u%ii&!% '! &a)!

p%i (!)ai'(! a)tiv! 'i pa'iv!2 T%a'&!%ul a)tiv '! %!ali.!a.a )ot%a uo%$%a*i!t! *! )o)!t%ati! 'au !l!)t%i)!- !)!'it3* u )o'u( *! !!%$i!

&u%i.ata p%i 4i*%oli.a ATP2 M!)ai'(!l! *! t%a'po%t- a)tiv au )apa)itat!li(itata p! uitat!a *! ti(p 'i it!%vi , %!a#'o%#tia $lu)o.!i- au(ito%a(ioa)i.i- a)i*ului u%i)- uo% vita(i! 0B=+- C1- &o'&atilo% ao%$ai)i-'ul&atilo% 'i a p%i)ipalilo% ioi ai &ilt%atului 0Na- - 8CO912

T%a'po%tul pa'iv '! &a)! 'u# a)tiu!a uo% $%a*i!t! &i.i)o6)4i(i)!u !)!'ita )o'u( !!%$!ti)- u !'t! li(itat *! o )apa)itat! (a"i(a 'i)ot%i#ui! la %!'o%#tia a t%!i )o'titu!ti p%i)ipali ai ult%a&ilt%a?ului5 apau%!!a 'i Cl62

Apa '! %!a#'oa%#! , toat! '!$(!t!l! tu#ului- )u it!'itati *iv!%it!-p! #a.a l!$ilo% *i&u.iuii 'i a o'(o.!i- a't&!l ,)3t *i )!i =+ (l &ilt%ati$lo(!%ula% p! (iut- , v!.i)a a?u$! u(ai =(l(i 0*!)i '! a#'o%#=+(l12 tu#ul )oto%t 'i (ai al!' , )!l )ol!)to% '! %!ali.!a.a %!a#'o%#tia&a)ultativa a ap!i 'i Na'u# )ot%olul AD8 'i al*o't!%oului- a?u't3*u6'!!li(ia%il! , &u)ti! *! 'ta%!a *! 4i*%ata%! a o%$ai'(ului2


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7ECREIA TUBULAR

E't! p%o)!'ul iv!%' )!lui *! %!a#'o%#ti!- t%a'po%t3* au(it!'u#'tat! *i )apila%!l! p!%itu#ula%! , lu(!ul tu#ului2 A%! %olul *! a!li(ia at3t 'u#'tat!l! 't%ai! o%$ai'(ului- )3t 'i 'u#'tat!l! p%!.!t!o#i'uit , '3$! 0- a)i* u%i)1- u!l! u(ai )3* '! a&la , )o)!t%atii(a%i 0)%!atia12 7! %!ali.!a.a a)tiv 'i pa'iv2

7!)%!tia a)tiva- av3* '!*iul la iv!lul tu#ilo% p%oi(al 'i *i'tal- '!&a)! ,(pot%iva uo% $%a*i!t! !l!)t%o)4i(i)! 'i *! a)!!a !)!'ita u )o'u(!!%$!ti) %i*i)at 0'!)%!tia *! 812 P%i !li(ia%!a 8 tu#ii *!ti u %ol&u*a(!tal , (!ti!%!a !)4ili#%ului a)i*o6#a.i) al o%$ai'(ului2

7!)%!tia pa'iva i(pli)a t%a'po%tul uo% )o'titu!ti , '!'ul

$%a*i!t!lo% *! )o)!t%ati! 'i *! a)!!a u !)!'ita )o'u( !!%$!ti) *i%!)t2A)!'t (!)ai'( it!%vi! , '!)%!tia - a #a.!lo% 'i a a)i.ilo% 'la#i2

I1'REGLAREA ACTIVITII RENALE

7! &a)! p! )al! !%voa'a 0a)tivitat!a $lo(!*ula%a1 'i p! )al! u(o%ala0a)tivitat!a tu#ula%a12

REGLAREA NERVOA7

7! %!ali.!a.a p%i &i#%!l! v!$!tativ! )a%! '! *i't%i#ui! a%t!%io%!lo%-$lo(!%ulului 'i tu#ilo%2 7i't!(ul v!$!tativ u )ot%i#ui! *i%!)t la )ot%olul!la#o%a%ii u%i!i- )i *oa% i*i%!)t- p%i i&lu!ta%!a )o*itiilo% *! i%i$ati!%!ala2 D! alt&!l- '! 'ti! )a %ii)4iul *!!%vat 'i )4ia% t%a'platat )otiua 'a&u)tio!.! ap%oap! o%(al2 7ti(ula%!a !%vilo% %!ali 'i a uo% .o!

p%!'oa%! *i #ul#- 4ipotala(u' 'i ')oa%ta )!%!#%ala *!t!%(ia va'o)o't%i)ti!%!ala 'i ')a*!%!a *iu%!.!i p3a la au%i!2 7ti(ula%!a !%vilo% v!$!tativi%!ali p%o*u)! 'i ')a*!%!a !li(ia%ilo% u%ia%! *! Na- p%i )%!'t!%!a%!a#'o%#ti!i tu#ula%! a ioului2

REGLAREA UMORAL

Co'i*!%ata a *!ti! %olul p%i)ipal- '! %!ali.!a.a *! (ai (ulti4o%(oi2 8o%(oul ati*iu%!ti 0A2D2N21- '!)%!tat *! u)l!ii 4ipotala(i)i 'i!li#!%at *i !u%o4ipo&i.a- )ot%ol!a.a !li(ia%il! u%ia%! *! apa- a)tio3*la iv!lul '!$(!tului *i'tal al !&%oului2 7u# a)tiu!a AND )%!'t!


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%!a#'o%#tia *! apa , tu#ii *i'tali 'i )ol!)to%i- )o)o(it!t )u *i(iua%!avolu(ului 'i )%!'t!%!a )o)!t%ati!i u%i!i2

Mi!%alo)o%ti)oi.ii- , 'p!)ial al*o't!%oul- )ot%ol!a.a !li(ia%il!u%ia%! *! Na 'i la iv!lul '!$(!tului *i'tal al !&%oului- 'ti(ul3*%!a#'o%#tia *! Na'i !")%!tia *! 2

Pa%at4o%(oul (o#ili.!a.a 'a%u%il! (i!%al! *i oa'!- 'ti(ul!a.a!li(ia%il! %!al! *! &o'&ati- 'i %!ti! Ca 'i Na2 8o%(oii ti%oi*i!iit!'i&i)a (!ta#oli'(ul )!lula%- , 'p!)ial p! )!l p%oti*i) 'i p%i )%!'t!%!a$!!%a%ii *! p%o*u'i &iali *! (!ta#oli'(- (a%!') *iu%!.a- a)!la'i !&!)tav3* 'i alt!%a%!a l!$a%ii ap!i 'i a 'a%ii , t!'utu%i2

Rii)4iul , )o*itii *! i%i$ati! i'u&i)i!ta 'au )a u%(a%! a uo%

(o*i&i)a%i al! )o(po.iti!i )4i(i)! a u%i!i a?u'a , tu#ii *i'tali- *!')a%)a o!.i(a6%!ia6)a%! a)tio3* a'up%a u!i $lo#uli! pla'(ati)!- p%o*u)!a$iot!'ia I- )a%! '! t%a'&o%(a !.i(ati) , pla'(a 'i t!'utu%i ,a$iot!'ia II- )!l (ai put!%i) va'o)o't%u)to% atu%al 'i 'ti(ulato% al'!)%!ti!i *! al*o't!%o2 La iv!lul %!al- a$iot!'ia II- a)tio3* a'up%a(u')ulatu%ii a%t!%io%!lo% $lo(!*ula%! (o*i&i)a it!' %ata &ilt%a%ii 'i p%ial*o't!%o i&lu!t!a.a !li(ia%il! u%ia%! *! Na'i 2

I1(MICIUNEA

U%ia !la#o%ata *! %ii)4i a?u$! p%i tu#ii )ol!)to%i la iv!lulpapil!lo%- u(pl! )ali)!l! 'i #a.i!tul- apoi p%i )ot%a)tia a)!'to%a- !'t!!li(iata , u%!t!%2 P%i u*! *! )ot%a)ti! u%ia !'t! t%a'po%tata *!6alu$ul u%!t!%ului p3a , v!.i)a u%ia%a2

VEZICA URINAR

E't! u o%$a )avita% (u')ula% , )a%! '! a)u(ul!a.a u%ia ,t%!(i)tiui2 U%ia- *!')a%)ata , ?!tu%i p%i )!l! *oua o%i&i)ii u%!t!%al!- u poat!%!&lua , u%!t!%! *i )au.a )a a)!'t!a au t%ai!)t o#li) , p!%!t!l! v!.i)al 'i

i)i u poat! )u%$! p%i u%!t%a- *!oa%!)! )olul v!.i)al !'t! p%!va.ut )u *oua'&i)t!%!- uul !t!*- ivoluta% )a%! ,)o?oa%a ,)!putul u%!t%!i 'i )!lalalt't%iat- )ot%olat voluta%2

V!.i)a u%ia%a a%! p%op%i!tat!a *! a6'i (a%i )apa)itat!a , ti(pulu(pl!%ii- &a%a (o*i&i)a%i i(po%tat! al! t!'iuii p!%!tilo% 'i al! p%!'iuii


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it%av!.i)al!2 A)!a'ta p%opi!tat!- *!u(ita pla'ti)itat!- !'t! %!.ultatul u!ia*apta%i a tou'ului (u')ulatu%ii v!.i)al! la )%!'t!%!a )otiutului2

%!$i't%a%!a p%!'iuii it%av!.i)al! a a%atat )a- *upa o u'oa%a )%!'t!%!iitiala la p%i(!l! ?!tu%i *! u%ia- p%!'iu!a ,%!$i't%!.a u plato , totti(pul u(pl!%ii v!.i)al! p3a la volu(ul *! 9::6:: (l- )3* a%! lo) o)%!'t!%! #%u')a a p%!'iuii 'i !'t! *!)la'ata (i)tiu!a %!&l!"a )3*,(p%!?u%a%il! p!%(it2

P%i(a '!.ati! *! pl!itu*i! v!.i)ala !'t! p!%)!puta la u volu( *!=::6=:(l- la =:6+::(l !'t! %!'i(tita p%i(a *o%ita *! (i)tioa%!- ia%

p!'t! )apa)itat!a &i.iolo$i)a v!.i)ala 0+:6::(l1 apa% )ot%a)tii put!%i)!al! (u')ulatu%ii p!%!t!lui v!.i)al- )a%! *!t!%(ia '!.atia !)!'itatiii(p!%ioa'! *! a u%ia2

Mi)tiu!a !'t! %!.ultatul uo% %!&l!"! *!)la'at! *! *i't!'ia p!%!tilo%v!.i)ali2 I(pul'u%il! a&!%!t! 'ut t%a'(i'! uui )!t%u lo(#a% 0'i(pati)1-*! u*! '! *!')a%)a i(pul'u%i a&!%!t! )a%!- p%i &i#%!l! 4ipo$a't%i)!- i4i#a)ot%a)tiil!- %!la"!a.a (u')4ii v!.i)ali 'i ,ta%!') tou'ul '&i)t!%ului !t!*al )olului v!.i)al2

Co)o(it!t *i't!'ia v!.i)ala *!)la'!a.a i(pul'u%i )a%! a?u'! la(a*uva p! )al!a !%vilo% %u'io'i 'ut )o*u'! apoi p! )ai a&!%!t!!'p!)i&i)! 'p%! )!t%ii !%vo'i 'up!%io%i- a?u$3* p3a la iv!lul ')oa%t!i

)!%!#%al!- *!t!%(i3* '!.atia *! a u%ia2

Da)a (i)tiu!a u !'t! po'i#ila- i(pul'u%il! po%it! *! la )o%t!"- p%i)!t%ii (!*ula%i- i4i#/ tou'ul (u')4iului v!.i)ul- )o)o(it!t (a%!')tou'ul '&i)t!%ului !"t!%- (a%i* )oti!ta v!.i)ala2 Da)a )o*itiil!

p!%(it- a%! lo) (i)tiu!a2

R!&lu"ul (i)tiuii !'t! *!)la'at *! *i't!'ia v!.i)ala- i(pul'u%il!a?u$ p! &i#%! av!%!t! *i !%vii p!lvi)i la u )!t%u 'a)%at pa%a'i(pati) al(i)tiuii- *! u*! '! *!')a%)a i(pul'u%i )a%! tot p%i &u#%! al !!%vilo%

p!lvi)i p%o*u) )ot%a)tia (u')ulatu%ii v!.i)ii 'i %!la"a%!a '&i)t!%ului it!%al )olului v!.i)al2 Co)o(it!t a%! lo) %!la"a%!a voluta%a a '&i)t!%ului!"t!% 't%iat 'i u%ia ,)!p! 'a '! !va)u!.! *i v!.i)a2

P%o)!'ul !va)ua%ii !'t! a?utat *! )ot%a)tia (u')ulatu%ii a#*o(ial! 'ia *ia&%a$(ului )a%!- )%!')3* p%!'iu!a it%aa#*o(iala- )o(p%i(a v!.i)a2


10/88

R!&l!"ul (!*ula% al (i)tiuii !'t! )ot%olat *! u(!%o'i )!t%ii'up%a(!*ula%i )u %ol &a)ilita% 'au i4i#ito%2

I.). PIELONEFRITA

DEFINIIE5

Pi!lo!&%it!l! 'ut i&la(atii a)ut! 'au )%oi)! )a%! a&!)t!.a t!'utulit!%'titial %!al 0'patiul *it%! !&%oi12 I(po%tata lo% '! *ato%!'t!&%!)v!t!i (a%i 'i , )otiua )%!'t!%! a i&!)tiilo% u%ia%! 0)au.a o#i'uita ai&!)tiilo% it!%'titial!1- $%avitatii lo% 0+:6


11/88

I.*. CLASIFICARE

Pi!lo!&%ita '! $a'!'t! 'u# &o%(a a)uta 'i )%oi)a2

PIELONEFRITA ACUTTa#loul )4i(i) !'t! *! i&!)ti! u%ia%a ia% *!#utul u '! )a%a)t!%i.!a.a

,tot*!ua p%i '!(!l! $!!%al! *! i&!)ti!5 &!#%a )u i'tala%! #%ua 'aup%o$%!'iva- &%i'oa!- t%a'pi%ati!- )!&al!!2

Mai&!'ta%il! u%ia%! )o'tau , *u%!%i lo(#a%!- (ai &%!)v!tuilat!%al!- 'u%*! 'au )u )a%a)t!% *! )oli)a %!ala 0polaiu%i!- a*!'!o%io)tu%a 'i (i)tiu! *u%!%oa'a12

DIAGNO7TICUL57! #a.!a.a p! *oua '!(! )apila%!5

LEUCOCIU!I5 !'t! pu'a , !vi*!ta )u a?uto%ul p%o#!i A**i'68a(#u%$!%1- '! $a'!') (ai (ult *! ::: *! l!u)o)it!2

#CE!IU!I5 '! $a'!') (ai (ult *! =::::: $!%(!i

EVOLUIA5

E't! &avo%a#ila , )o*itiil! uui t%ata(!t )o%!)t2 Boala *u%!%oa'a=6 'apta(3i2 Co(pli)atiil! 'ut %a%!- *a% )%oi)i.a%!a !'t! &%!)v!ta2

PIELONEFRITA CRONIC

DEFINIIE5

Boala )u !voluti! )%oi)a- )a%)t!%i.ata p%i i&la(atia t!'utuluiit!%'titial %!al- )u '!(! )lii)! *! 'u&!%ita p%!)o)! a tu#ilo% %!ali- )ua&!)ta%!a ta%*iva a $lo(!%ulilo% 'i )u !voluti! p%o$%!'iva 'p%! i'u&i)i!ta%!ala2

7! )uo') *oua &o%(! )lii)!5

64!(ato$!a 0%a%a1;

6a')!*!ta 0&%!)v!ta12


12/88

E't! ua *it%! )!l! (ai ,t3lit! a&!)tiui %!al!2

TABLOUL CLINIC5

7! )otu%!.a *upa lui 'au ai *! la !pi'o*ul a)ut *! pi!lo!&%ita2

It!%valul *! lat!ta !'t! ,t%!taiat *! %!)i*iv!- &i!)a%! pu'!u a)ut a*au$3*oi l!.iui %!al!2 Alt!o%i !volutia !'t! lat!ta- *ia$o'ti)ul &ii* 'ta#ilit ,&a.a *! IR- *! ai)i %!.ulta valoa%!a !"plo%a%ilo% #ioli$i)!2 C3* apa% 'i'!(! $!!%al!- a)!'t!a 'ut *! i&!)ti! )%oi)a5 'ta%i 'u#&!#%il! 'au &!#%il!it!%(it!t!- )!&al!!- o#o'!ala- ')a*!%!a ap!titului 'i $%!utatii2

EVOLUIA5

E't! ,*!lu$ata- p%o$o'ti)ul *! o#i)!i !'t! 'u(#%u2

DIAGNO7TICUL5

7! #a.!a.a p! '!(!l! )lii)!- l!u)o)itu%i! 'i #a)t!%iu%i!2Dia$o'ti)ul , 'ta*iu *! IR !'t! 'u$!%at *! poliu%ia )u *!'itat! ')a.uta-

pi!%*!%!a *! !l!)t%oliti 'i a)i*o.a2

I.+. SEMNE, SIMPTOME, MANIFEST-RI DEDEPENDEN-

=2 $U!E!I LO%#!E5 (ai &%!)v!t!- uilat!%al!- 'u%*! 'au )u)a%a)t!% *! )oli)a %!ala2

+2 &E#!'5 *!#ut!a.a viol!t )u &%'o- &!#%a 09K6:oC12U!o%i &!#%a)%!'t! la 96 .il! *upa *!#ut2

92 UL#U!'!I $I(E)I*E I+E+)E5 va%'atu%i- $%!ata- #aloa%!-)o'tipati! alt!%3* )u '!(! *ia%!i)!2

2 POLIU!IE5 *i'u%i!- i)tu%i!2

2 )C'$E!E PEIULUI si (!EU'-II


13/88

>2 CE&LEE

K2 !+)PI!-II

=:2I+(E!E I+E!)I-IULUI !E+L

==2 )!E (E+E!L' LE!', (ai&!'ta%il! u%ia%! &ii* p!pla '!)u*a%2

PROBLEME5

Alt!%a%!a %it(ului )a%*ia) 'i )i%)ulato%;

Ali(!tati! ia*!)vata )atitativ 'i )alitativ;

Eli(ia%! u%ia%a i'u&i)i!ta )alitativ 'i )atitativ;

Di&i)ultat!a *! a '! o*i4i;

D!&i)it *! auto,$%i?i%!;

Alt!%a%!a i(a$iii *! 'i!;

Co(ui)a%! i'u&i)i!ta la iv!l a&!)tiv;

Di&i)ultat!a *! a a)tioa )o&o%( p%op%iilo% )%!*it! 'i valo%i;

N!lii't! &ata *! '!(i&i)atia p%op%i!i !"i't!t!;

Di&i)ultat! , a ,*!plii a)tivitati %!)%!at!;

Lip'a )uo'tiit!lo% &ata *! a&!)tiu!a 'a2

I.. PARTICIPAREA ASISTENTEI MEDICALE

LA INTEVENII AUTONOME, INTERVENII DELEGATE sI TRATAMENTDE SPECIALITATE

I..a.PARTICIPAREA A7I7TENTEI MEDICALE LA


14/88

INVE7TIGAII

Ua *i 'a%)iil! i(po%tat! al! a'i't!t!i (!*i)al! !'t! )ola#o%a%!a 'i !"a(ia%!a)lii)a a #olavului2 Pa%ti)ipa%!a a)!'t!ia !'t! o *ato%i! 'au o o#li$ati! p%o&!'ioala2A?ut3* (!*i)ul 'i #olavul- a'i't!ta )%!a.a u )li(at &avo%a#il p!t%u %!latia (!*i)6

pa)i!t6a'i't!ta2

P!t%u a)!a'ta- a'i't!ta t%!#ui! 'a tia )ot *! u%(atoa%!l! 'a%)ii5

6'a p%!$at!a')a &i.i) 'i p'i4i) pa)i!tul;

6'a p%!$at!a')a (at!%ial!l! 'i i't%u(!t!l! !)!'a%! !"a(ia%ii;

6'a a'i$u%! )o*itiil! *! *!'&a'u%a%! a !"a(ia%ii;

6'a p%!$at!a')a *o)u(!t!l! (!*i)al! 0&i'a *! )o'ultatii- &oaia *!o#'!%vati! )lii)a- %!.ultat!l! !"a(ia%ii1;

6a'i$u%a ilu(iatia !)!'a%a !"a(ia%ii uo% )avitati atu%al! ao%$ai'(ului;

6&!%!'t! pa)i!tul *! t%au(ati'(!- )u%!ti *! a!%;

6a'i$u%a lii't!a !)!'a%a *!'&a'u%a%ii !"a(!ului;

6p%!$at!'t! p%o*u'! #iolo$i)! al! pa)i!tului- p!t%u a l! a%ata (!*i)ului lavi.ita2

E"a(ia%il! *! la#o%ato% !&!)tuat! p%o*u'!lo% #iolo$i)! 'i patolo$i)! l! t%!)! , &i'!l! *!o#'!%vati!2 Co(pl!t!a.a 'i(to(atolo$iil! #olilo% )u !l!(!t! o#i!)tiv!- !"p%i(3*(o*i&i)a%il! apa%ut! , (o%&olo$ia- &i.iolo$ia 'i #io)4i(ia o%$ai'(ului2 A)!'t! !l!(!t!)o&i%(a 'au i&i%(a *ia$o'ti)ul )lii)- %!&l!)ta !volutia #olii 'i !&i)a)itat!at%ata(!tului- )o&i%(a vi*!)a%!a 'au '!(al!a.a apa%itia uo% )o(pli)atii2

Utilitat!a 'i o#i!)tivitat!a !"a(ia%ilo% *! la#o%ato% *!pi* *! (o*ul *! %!)olta%! alp%o*u'!lo% )a%! '! aali.!a.a 'i *! (o*ul )u( '! !&!)tu!a.a !"a(!ul *! la#o%ato%2

R!)olta%!a p%o*u'!lo% !'t! !&!)tuata *! a'i't!ta (!*i)ala )a%! t%!#ui! 'a %!'p!)t!u%(atoa%!l! o%(! $!!%al!5

6o%a%ul %!)olta%ilo%;

6!&!)tu!a.a p%!$ati%!a &i.i)a 'i p'i4i)a a pa)i!tului;


15/88

6p%!$ati%!a i't%u(!ta%ului 'i a (at!%ial!lo% !)!'a%! p!t%u%!)olta%!;

6t!4i)a *! %!)olta%! p%opiu6.i'a;

6)o(pl!ta%!a #ul!tiului *! t%i(it!%! la la#o%oto% 'i !ti)4!ta%!ap%o*u'!lo% %!)oltat!;

6pa't%a%!a 'i t%a'po%tul , )o*itii opti(! a p%o*u'!lo%%!)oltat!2

E&!)tua%!a p%!$ati%ii p'i4i)! a #olavului )o'ta , i't%ui%!a a)!'tuia p%ivi*)o(po%ta(!tul 'au , ti(pul %!)olta%ii- )ola#o%a%!a 'a p!t%u %!u'ita t!4i)ii2 Pa)i!tul!'t! p%!$atit p'i4i) p%it%6u %!$i( ali(!ta%- %!pau' la pat- a'!.3*u6l ,t%6o au(itapo.iti! , &u)ti! *! %!)olta%!a )! '! va !&!)tua2

RECOLTAREA 7NGELUI

P!t%u %!)olta%!a '3$!lui '! &olo'!') (at!%ial! 'i i't%u(!t! , &u)ti! *! ')opul p!t%u)a%! '! &a) a)!'t!a- *a% 'i *! lo)ul u*! '! va %!)olta '3$!l!2

RECOLTAREA 7NGELUI PENTRU V27282

A'i't!ta (!*i)ala p%!$at!'t! (at!%ial!l! !)!'a%!5

6'!%i$a *! +(l *! ui)a &olo'ita;

6a)! 't!%il! *! ui)a &olo'ita;

6'oluti! *! Cit%at *! Na 9->;

6p!%iuta (u'a(a- !p%u#!t!- tavit! %!al!- $a%ou- vata- al)ool :o2

7! p%!$at!'t! pa)i!tul p'i4i)- !"pli)3*u6i )u +4 ,ait! !)!'itat!a !&!)tua%ii!"a(ia%ii2 7! p%!$at!'t! pa)i!tul &i.i)2 7! auta 'a u (a3)! 'i 'a pa't%!.! %!pao'&i.i)2

EFECTUAREA TE8NICII

6a'i't!ta (!*i)ala '! 'pala p! (3ii )u apa 'i 'apu;

6,(#%a)a (3u'il! 't!%il!;


16/88

6a'pi%a , '!%i$a :-(l Cit%at *! Na 9->;

6apli)a $a%oul pa)i!tului p!t%u a pu! , !vi*!ta v!a;

6pu)tio!a./ v!a 'i *!'&a)! $a%oul;

6a'pi%a '3$! p3a la +(l 0=-


17/88

Ep%u#!t! )u *op%O*

7! %!)olt!a./ 8LG FT2

Coti! auto)oa$ulat 0E2D2T2A21

Ep%u#!t! )u *op+E(!U

7! %!)olt!a./ V27282

Coti! )oa$ulat 0)it%at *! Na 9->1

Ep%u#!t! )u *op!OsU

Nu )oti! ati)oa$ulat

7! %!)olt!a./ aali! *! #io6)4i(i! 0!"5 u%!!- )%!atiia- a)i* u%i)1

Ep%u#!t! )u *op#LEU

7! %!)olt!a./ Fi#%io$!!2

Coti! ati)oa$ulat 0)it%at *! Na 9->12

Ep%u#!t! )u *op (!I

7! %!)olt!a./ Gli)!(i!2

Coti! ati)oa$ulat 0&lo%u%a *! Na12

RECOLTAREA URINII

E/a0 s%0a" ( %"$a

7! &a)! '!*i(!t u%ia !"2 Bio)4i(i)

Ma#"$a&:

U%ia%- plo')a- (u'a(a- al!./- (at!%ial! p!t%u i$i!a o%$a!lo%!"t!%!2

7! p%!$/t!'t! pa)i!tul p'i4i)5


18/88

7! i't%u!'t! p%ivi* &olo'i%!a #a.i!tului; '/ u%i!.! &/%/ *!&!)ati!- '/v!%'! i(!*iat u%ia , va'ul )ol!)to%2

7! p%!$/t!'t! pa)i!tul &i.i)5

7! &a)! toal!ta o%$a!lo% $!ital! !"t!%!2

7! a'!a./ plo')a 'u# pa)i!t2

7! %!)olt!a./ p%i(a u%i/ *! *i(i!at/2

Dup/ %!)olta%! u%ia '! !ti)4!t!a./ 'i '! t%i(it! la la#o%ato% 0u!'atio *! =::6=: (l12

P"!ba ADDIS23AMBURGER

Pu! , !vi*!t/ 'tu*iul )atitativ al !l!(!t!lo% &i$u%at! 'i al)ili*%ilo%2

7! ,vat/ pa)i!tul )a la o%a 'ta#ilit/ 091 '/ u%i!.! 'i u%ia '! a%u)/2

Dup/ t%!i o%! , )a%! pa)i!tul u (ai )o'u(/ li)4i*!- u%i!a./ toat/)atitat!a ,t%6u #a.i!t )u%at2

Toat/ u%ia '! )ol!)t!a./ ,t%6u %!)ipi!t 'i '! t%i(it! la la#o%ato%-

*up/ )! , p%!ala#il '6a !ti)4!tat2R'!a"a %"$$$ 4#"% %"!'%%"5

U%o)ultu%a 'ta#il!'t! p%!.!ta #a)t!%iilo% i u%i/2

7! %!)olt!a./ u%ia *! *i(i!at/2

7! p%!$/t!'t! pa)i!tul p'i4i)2

7! i&o%(!a./ pa)i!tul a'up%a t!4i)ii2

A)!'t !"a(! !'t! i*i)at a '! &a)! ,ait!a ,)!p!%ii t%ata(!tului )uati#ioti)!2

P%i(a )atitat! *! u%ia !(i'/ :(l '! !li(i/2 Apoi- &/%/ '/,t%!%up!( ?!tul u%ia% '! %!)olt!a./ ap%o"i(ativ (l *! u%i/ ,t%6o!p%u#!t/ *! ui)/ &olo'it/- *up/ )a%! !ti)4!t/(2


19/88

7! t%a'po%t/ la la#o%ato% u*! '! ,'/(3t!a./ 'i '! pu! lat!%(o'tat2

RADIOGRAFIA RENAL 7IMPL

D6$$#$

E"plo%a%!a %a*iolo$i)/ &/%/ 'u#'tat/ *! )ot%a't- )a%! poat! !vi*!tia)ot%olul 'i po.itia %i)4ilo%- )al)uli %!ali- u%!t!%ali 'au v!.i)ali %a*ioopa)i2

Mat!%ial! !)!'a%!5

6)/%#u!;

6ul!i *! %i)i;

6(at!%ial! !)a'a%! !"plo%/%ii )li'(!i- !va)uatoa%!2

7! p%!$/t!'t! pa)i!tul *i pu)t *! v!*!%! p'i4i)2

7! aut/ 'i '! !"pli)/ !)!'itat!a t!4i)ii2

I '! va !"pli)a t!4i)a 'i %!$(ul ali(!ta% !)!'a% p!t%u %!u'ita a)!'t!ia2

7! &a)! p%!$/ti%!a ali(!ta%/ a pa)i!tului2

Cu +69 .il! ,ait!a !"a(!ului va )o'u(a u %!$i( ali(!ta% &/%/ali(!t! )! )oti )!lulo./ 0a*i)/ &/%/ &%u)t!- l!$u(!- .a%.avatu%i- pa't!&/ioa'!- p3i!1 'i ap! $a.oa'!2

I .iua p%!)!*!t/ !"a(!ului %!$i(ul va &i 4i*%i)5 'up!- li(oa*!-)!ai- ap/2

I '!a%a p%!)!*!t/ !"a(!ului va )o'u(a o )a/ )u )!ai 'i o &!li!*! p3i! p%/?it/2

I *i(i!ata !"a(!ului u (/3)/ 'i u )o'u(/ li)4i*!2

Dup/ !"a(! %!$i(ul ali(!ta% !'t! o#i'uit2

P"75#$"a 0($'a0#!as5 a 4a'$#%&%$


20/88

Cu +69 .il! ,ait!a !"a(!ului '! a*(ii't%!a./ )/%#u! 'i t%i&!%(!t*! 9 o%i p! .i )3t! + ta#l!t!2

I *i(i!ata 'i '!a%a p%!)!*!t! !"a(!ului '! a*(ii't%!a./ + li$u%i*! ul!i *! %i)i 'i '! !&!)tu!a./ )li'(a !va)uatoa%! 'i(pl/2

Iait!a !"a(i/%ii pa)i!tul ,'i $ol!'t! v!.i)a u%ia%/ 'i '!)ot%ol!a./ %a*io')opi) *a)/ u (ai !"i't/ a!% , it!'ti2

Bolavul !'t! )o*u' la '!%vi)iul *! %a*iolo$i!2 E't! a?utat '/ '!*!.#%a)! 'i '/ '! a'!.! , *!)u#it *o%'al p! (a'a %a*iolo$i)/2

Dup/ !&!)tua%!a %a*io')opi!i #olavul !'t! )o*u' , 'alo 'i i'talat)o(o* , pat2

E"a(!ul '! ot!a./ , Foaia *! o#'!%vati!2

UROGRAFIA

D6$$#$

E't! o (!to*/ )u%!t/ *! !"a(ia%! (o%&o&u)tioal/ a %ii)4ilo% 'i a)/ilo% u%ia%!- utili.3* 'u#'tat! io*at! 4i*%o'olu#il!- a*(ii't%at! it%a6v!o'2

Ma#"$a& 'sa"

6toat! (at!%ial! !)!'a%! %a*io$%a&i!i %!al! 'i(pl!;

6'u#'tat! *! )ot%a't5 O*i'to 9:6


21/88

7! !&!)tu!a./ p%!$/ti%!a p'i4i)/- ali(!ta%/ 'i (!*i)a(!toa'/*!')%i'/ la %a*io$%a&ia %!al/ 'i(pl/ 0, plu' '! %!*u)! )atitat!a *! li)4i*!*! la %!$i(ul )uo')ut12

7! &a)! t!'ta%!a '!'i#ilit/tii o%$ai'(ului la 'u#'tata *! )ot%a't2

7! i?!)t!a./ u (l O*i'to it%a6v!o' p%i o(o$!i.a%! )u '3$!2

7! )o(ui)/ pa)i!tului '/ u '! 'p!%i! la u!l! 'i(pto(! )! pot '/apa%/5 a(!t!li- $%!tu%i 'au *u%!%i a#*o(ial! )a%! *i'pa% %!p!*! 'i &/%/)o'!)it!2

Da)/ pa)i!tul p%!.it/ %!a)tii 4ip!%al!%$i)! '! ,t%!%up! a*(ii't%a%!a'i '! aut/ (!*i)ul2

Da)/ tol!%ata !'t! #u/ '! a*(ii't%!a./ it%a6v!o' 'u#'tat! *!)ot%a't5

6p!t%u a*ulti5 6+: (l O*i'to

6+ (l O*i'to


22/88

A'i$u%a%!a u!i ali(!tatii !)4ili#%at!- )o(pl!t! !")lu.3* al)oolul-)o&!ia- )o*i(!t!l!- li)4i*!l! , )atitat! (a%!2

R!$i(ul a)i*i&iat )oti! )a%!- ou/- )!%!al! &/ioa'!2 A)!'tai&lu!t!a./ p86ul , '!' a)i*2

R!$i(ul al)ai.at )oti! &%u)t!- la)tat! )a%! i&lu!t!a./ p86ul ,'!' #a.i)2

R!$i(ul !'t! p%!')%i' *! (!*i) 'i '! ot!a./ , &oaia *! t!(p!%atu%/2

A*(ii't%a%!a t%ata(!ului p%!')%i' *! (!*i) 0ati#ioti)!-aal$!.i)!12

R!)olta%!a p%o*u'!lo% p!t%u )a !"a(!!l! *! la#o%ato% '/ '! &a)/)o%!)t2

I$i!a o%$a!lo% $!ital! 'i a %!$iui2

A'aa%!a o%i)/%o% p%o)!'! i&!)tioa'! *! v!)i/tat! 0vulvo6va$ial1- alitia.!i %!al!2

Di'p!'a%!a *ia#!ti)ilo% )o%!)t/2

Evita%!a *i't!'i!i VU p%i $oli%!a )o(pl!t/2

Do#3*i%!a o#i'uit!lo% )o%!)t! *! !li(ia%!2

E*u)atia pa)i!tului2

I..'PARTICIPAREA A7I7TENTEI MEDICALE LA ACTE

TERAPEUTICE

T%ata(!tul '! a*(ii't%!a./ *! a'i't!ta (!*i)al/ *oa% la i*i)atiil!

(!*i)ilo%2

I $!!%al- t%ata(!tul a%! *%!pt ')op ,*!p/%ta%!a i&!)ti!i u%ia%! 'iapoi t%ata(!tul 'i(pto(ati)2

T%ata(!tul !tiolo$i) atii&!)tio' )o't/ , i*!ti&i)a%!a $!%(!uluip%i t%!i u%o)ultu%i )o'!)utiv! 'i t!'ta%!a '!'i#ilit/tii p%i ati#io$%a(/2


23/88

I &o%(!l! $%av! '! a*(ii't%!a./ ati#ioti)! (a?o%!5

6AMPICILIN 6a)tiv/ , i&!)tii )u E')4!%i)4ia- Colli- P%ot!u';

6ia)tiv/ p!t%u P'!u*o(oa' A!%u$io'a

0Pio))iai)1 l!#'i!lla;

6u !'t! to"i)/5 !&!)t! '!)u*a%! apa% %a% 0$%!at/ v/%6'/tu%i- *ia%!!1;

6%!a)tii *! 4ip!%'!'i#ilitat! 0)a.io&ili!1;

6'! a*(i't%!a./ p!% o' 'au it%a6(u')ula% :: ($ 6 =$*! o%i.i2

6ANAMICIN 6a)tiv/ , i&!)tii )u E2 Colli- l!#'i!lla- P%ot!u';

6ia)tiv/ p!t%u P'!u*o(oa' A!%u$io'a;

6!'t! !&%oto"i)/ 'i ototo"i)/- *o.!l! vo% &i %!*u'! , )a.*! I2R2 'i la #/t%3i;

6'! a*(i't%!a./ it%a6(u')ula% 'au it%a6v!o' :: ($la =+ o%! 0)u%! ')u%t!12

6GENTAMICIN 6a)tiv/ , i&!)tii )u E2 Colli- l!#'i!lla- P%ot!u'-P'!u*o(oa' A!%u$io'a- 7ta&ilo)o);

6!'t! !&%oto"i)/- *o.!l! (a%i a*(ii't%at! la pa)i!tii )uI2R p%o*u) l!.iui v!'ti#ula%! i%!v!%'i#il!;

6'! a*(i't%!a./ it%a6(u')ula% 'au it%a6v!o' =69 ($-%!pa%ti.at! , 9 *o.! la it!%val *! > o%!2

6CEFALEIN 6a)tiv , i&!)tiil! )u E2 Colli- l!#'i!lla- P%ot!u'-P'!u*o(oa'- 7ta&ilo)o);

6 %!a)tii '!)u*a%! 0$%!at/ v/%'/tu%i- *ia%!!1;

6 *a)/ '! *!p/'!'t! *o.a *! $.i '! )ot%ai*i)/ , )a.*! I2R2;


24/88

6u !'t! !&%oto"i)/ , *o.! (i)i;

6'! a*(ii't%!a./ p!% o' :: ($ *! o%i.i;

6, &o%(!l! (ai puti $%av! '! a*(i't%!a./ 'ul&a(i*!2

6NITROFURANTOIN

6a)tiu! #a)t!%i)i*/ p!t%u $!%(!i5 G%a(061 'i G%a( 01

6p%o*u)! '!(! *! itol!%at/ $a't%i)/ 0$%!tu%i- v/%'/tu%i)!&al!!- !%uptii )utaat!1;

6 %!a)tii '!)u*a%! 0$%!at/ v/%'/tu%i- *ia%!!1;

6 )ot%ai*i)at la pa)i!tii )u I2R2;

6'! a*(ii't%!a./ p!% o' 6=: ($$ )o%p.i %!pa%ti.at i p%i.!;

6, t%ata(!tul *! lu$/ *u%!%! '! a*(ii't%!a./ ?u(/tat!*i *o.a o#i'uit/2

6CICLO7ERIN 6a)tiu! #a)t!%i)i*/ p!t%u E2Colli- P%ot!u'-P'!u*o(oa';

6 )ot%ai*i)at la pa)i!tii )u I2R2 )a%! pot p%!.!ta)ovul'ii- 't/%i *!p%!'iv!;

6'! a*(ii't%!a./ i t%ata(!tul *! ata) : ($+ o%i.i= .il!;

6, t%ata(!tul *! ,t%!ti!%! +: ($ .i 'au la + .il!2

6ACID NALIDIIC 'au NEGRAM

6a)tiv i&!)tiil! )u #a)t!%ii G%a(061

6ia)tiv la P'!u*o(oa';

6u !'t! !&%oto"i)- *a% *!.volt/ %api* &o%(! %!.i't!t! *!#a)t!%ii;


25/88

6%!a)tii '!)u*a%! 0$%!at/ v/%'/tu%i- *ia%!!- )!&al!!- !*!(papila%1;

6'! a*(ii't%!a./ p!% o' =$ la < o%!;

T%ata(!tul 'i(pto(ati) )o't/ , a*(ii't%a%!a *!5

6aal$!.i)!5

6ati'pa'ti)!5

6p!t%u ')/*!%!a valo%ilo% t!'ioal!5

6a)i*i&i!%!a u%iii '! &a)! )u )lo%u%/ *! a(oiu 'au METENAMIN-)ot%ai*i)at! la #olavii )u a)i*o./2

7! pot &a)! a'o)i!%i *! ati#ioti)!5

!"5 AMPICILINANAMICIN

AMPICILINGENTAMICIN

Nu '! p%!')%iu ati#ioti)! 'i 'ul&a(i*! la p!%'oa!l! al!%$i)!2

T%ata(!tul *u%!a./ =69 lui- %!'p!)t3*u6'! %!$ulat u%o)ultu%a )u

ati#io$%a(a2

I.8. EVOLUIE, PROGNOSTIC, COMPLICAII

PIELONEFRITA ACUT

EVOLUIA 'i PROGNO7TICUL

7ut &avo%a#il! , )ot!'tul )3* t%ata(!tul !'t! apli)at )o%!)t 'i&a)to%ii &avo%i.ati 'ut ,*!p/%tati2

u%(a apli)/%ii t%ata(!tului- *!'i toat! '!(!l! #olii au *i'p/%ut-u '! poat! vo%#i *! vi*!)a%! *!)3t *up/ )ot%olul %!p!tat al #a)t!%iu%i!i ,u%(/toa%!l! '/pt/(3i 'au lui2

76a o#'!%vat )/ pi!lo!&%ita a)ut/- )4ia% atu)i )3* u !'t! t%atat/ '!a(!lio%!a./- &!#%a 'i piu%ia *i'pa% , )3t!va .il! ,'/ #oala poat! t%!)! ,)%oi)itat!2


26/88

!volutia pi!lo!&%it!i !'t! po'i#il/ apa%itia u%(/toa%!lo% )o(pli)atii)a%! 'ut *! &apt &oa%t! %a%!5 I2R2A2 !)%o./ papila%/- pio!&%o.a- &l!$(oul

p%i!&%iti)- '!pti)opio!(ia2

C!a (ai &%!)v!t/ )o(pli)ati! !'t! ,'/ pi!lo!&%ita )%oi)/2

PIELONEFRITA CRONIC

I ti(pul !voluti!i !'t! po'i#il/ ,'/ i.#u)i%!a u!i i&!)tii $%av!-)a%! poat! !volua %api*- , )3t!va .il! , !"itu'2

T%!#ui! 'u#liiat &aptul )/ apa%itia 82T2A2 %!p%!.it/ u &a)to%i(po%tat )a%! *u)! )/t%! *!.volta%!a %api*/ a I2R22

I $!!%al- !volutia 'i p%o$o'ti)ul *!pi*! *! p%!)o)itat!a*ia$o'ti)ului 'i !&i)a)itat!a t%ata(!tulului (!*i)al2

Co(pli)atiil! pi!lo!&%it!i )%oi)!i apa% o*at/ )u p%o$%!'iu!al!.iuilo% aato(i)!2 8TA *i PNC poat! !volua )/t%! (ali$itat!2

U!o%i !'t! po'i#il/ i'tala%!a uo% l!.iui $%av! *! !)%o./ papila%/2

I.9. EDUCAIE PENTRU SNTATE

I7"$$"$ ( 4";$" 4"$0a"5

Do#3*i%!a o#i'uit!lo% )o%!)t! *! !li(ia%!2 Evita%!a i4i#/%ii %!&l!"ului *! (i)tiu!-*!oa%!)! '! p%o*u)! *i't!.ia v!.i)ii u%ia%! 7TAZA URINAR- )a%! poat! &avo%i.a&o%(a%!a )al)ulilo%2

Evita%!a )o'u(ului *! (!*i)a(!t! )u !&!)t *iu%!ti) 'au !&%oto"i)&/%/ p%!')%ipti! (!*i)al/2

E&!)tua%!a )o%!)t/ a toal!t!i %!$iuii p!%i!al! p!t%u a !vitap/t%u*!%!a (i)%oo%$ai'(!lo% , t%a)tul u%ia%2

Evita%!a apo%tului !")!'iv *! '/%u%i (i!%al!2


27/88

7! vo% !vita &%i$ul- u(i*itat!a- o#o'!ala- t%au(ati'(!l!- a$!tii to"i)i-a&!)tiuil! )a%*iova')ula%!- *!oa%!)! 'ut &a)to%i &avo%i.ati , apa%itia 'ivolutia a&!)tiuilo% %!al!2

7! vo% !&!)tua !"!%)itii &i.i)! p!t%u )%!'t!%!a tou'ului (u')ulatu%iip!%i!al! 'i a#*o(ial!- a)!'t!a &avo%i.3* )ot%a)tiil! v!.i)ii u%ia%! 'i al'&i)t!%ului !"t!% al u%!t%!i2

I7"$$"a ( 4";$" s'%(a"5

D!pi'ta%!a p%!)o)! a i&!)tiuilo% %!al! 'i *i'p!'a%i.a%!a lo% )o%!)t/2

T%ata(!tul )o%!)t al a)!'to% a&!)tiui *up/ *ip/ '&atul (!*i)ului2

Cola#o%a%%!a a'it!t!i 'i !)4ip!i *! i$%i?i%! )u pa)i!tul2

Evita%!a )o(pli)atiilo%2

I7"$$"$ ( 4";$" #"#$a"5

R!it!$%a%!a , 'o)i!tat! a i*ivi*ului )u a&!)tiui )%oi)!2

CAPITOLUL II

II.A PLAN DE INGRIJIRE AL PACIENTEI

R.S. '% PIELONEFRIT

1.CULEGEREA DATELOR

7u%'a *! *at!5 6PACIENTA

6EC8IPA MEDICAL

6FOAIA DE OB7ERVAIE

Dat! %!lativ 'ta#il!5

6Nu(!l! 'i p%!u(!l!5R272

6V3%'ta5 : ai


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67!"5 &!(ii

67ta%! )ivil/5 v/*uv/ *! < ai

6Do(i)iliu5 Ba#a Aa

6O)upati!5 p!'ioa%/ lu)%at )a v3./toa%!

6Natioalitat!5 %o(3/

6R!li$i!5 o%to*o"/

6Co*itii *! viat/5 lo)ui!'t! 'i$u%/ ,t%6o )a'/ )u 9 )a(!%!; ,)o*itii 'alu#%!2

A%! + )opii- )/'/to%iti- )a%! o vi.it!a./ %!$ulat2

6O#i)!iu%i5 ,i pla)! '/ )it!a')/- '/ )%o'!t!.!- '/ '! uit! la t!l!vi.o%2

E&0# 6$


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6!&%!)to(i! 't3$/ 0*i )au.a uui a))i*!t *! (a'i/,t3(plat , u%(/ )u +: ai1

6litia./ %!al/ *%!apt/

M!#$;& $#"5"$$

6C!&al!! o))ipital/

6a(!t!li

6poliat%al$ii

6&ati$a#ilitat!

Is#!"$'%& b!&$$

V!)4! 4ip!%t!'iv/ )u %ii)4i ui) )4i%u%$i)al/2 7! it!%!a./ p!t%u)!&al!! o))ipital/- a(!t!li- poliat%al$ii- &ati$a#ilitat!- 'i(pto(atolo$i! )! '6aa))!tuat , ulti(a v%!(! &/%/ u (otiv )lii) apa%!t2 E't! it!%at/ la7pitalul Ju*!t!a 6 7!)tia N!&%olo$i!2

D$a7!s#$' 0($'a& &a $#"a"

Pi!lo!&%ita )%oi)/ 6 8TA 'ta*iul II

D%"a#a $#"5"$$

=6+2 2+:=9


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).ANALIZA sI INTERPRETAREA DATELOR

NEVOILE FUNAMENTALE

NEVOIA FUN2DAMENTAL

MANIFESTRI SURSA DEDIFICULTATEDE

INDEPENDE

DEPENDETN=2 A %!'pi%a 'i aav!a o #u/)i%)ulati!

6%!'pi%ati! *! tip)o'tal 'up!%io%

6a(#!l!4!(ito%a)!

p%!.it/ a)!l!a'i

(i')/%i *!%i*i)a%! 'i)o#o%3%! ,ti(pul %!'pi%ati!i'i !"pi%ati!i

6%!'pi%ati!lii'tit/ , ti(pul'o(ului

6(u)oa'a%!'pi%ato%i!u(!*/- '!)%!tii%!*u'!t%a'pa%!t!

6.$o(ot!)a%*ia)! #i!

#/tut!

6*i'p!!

6palpitatii la !&o%t

6T2A25 +::=:: ((8$

6p%o)!' i&!)tio'6a&!)tiu!a 8TA't II

+2 A #!a 'i a(3)a 6%!&l!" *!*!$lutiti!-p%!.!t

6(u)oa'a #u)al/%o. 'i u(!*/

6v/%'/tu%iali(!ta%!

6$%!tu%i

6&ati$)i#ilitat!

6alt!%a%!a(u)oa'!i*i$!'tiv!


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6(a'ti)ati!u'oa%/

6*!titi! #u/0)o&o%( v3%'t!i1

6iop!t!t/

6)o'u( %!*u' *!li)4i*!- ali(!t!-'/%u%i (i!%al!

92 A !li(ia 6u%ia )la%/*iluat/ 'au)o)!t%at/

6p8 -6-

6)atitat! =+::6=:: (l+4

6')au o%(al-*! )o'i't!t/

#u/

6&%!)v!t/ ')au=.i

6(i)tiui =:6=+.i

6polaiu%i!

6*i'u%i!

6(i)tu%i!

6*u%!%i lo(#a%!6tul#u%/%i *i$!'tiv!-$%!tu%i- v/%'/tu%i

6t%a'pi%atii

6p%o)!' i&!)tio'

2 A '! (i')a- aav!a o #u/

po'tu%/

6po'tu%/a*!)vat/ ,o%to'tati'(-'!.3* 'i)lio'tati'(

6po.itii atal$i)!6*i&i)ultat! , a '!*!pla'a 0a (!%$!-a'!.a- %i*i)a1

6*u%!%!a

2A *o%(i- a '!o*i4i

6*u%ata 'o(ului6K o%!

6'o( )la% )uvi'! %!$ulat!

6'o( p%o&u*

6a*oa%(! $%!u

6o)4ii ,)!%)/ati

6atipi%i , ti(pul.il!i

6'ta%! *!p%!'iv/

6*u%!%!a6'pitali.a%!a


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t!(p!%atu%a)o%pului ,li(it! o%(al!

(!*iului ,t%!=>6+oC

:oC

6&%i'o

6t%a'pi%atii

6t!$u(!t! pali*!>2 A &i )u%at-,$%i?it

6p%!.it/*!p%i*!%ii$i!i)!

6p%!.it/ 0*up/#ai!1 )/il! a.al!li#!%!- u%!)4i

)u%at!1

6p/%- u$4ii)u%at! #i!,$%i?it!

6pi!l! )u%at/- )utat/ 6v3%'ta

K2 A !vitap!%i)ol!l!

6)uoa't!(/'u%il! *!

p%!v!i%! aa))i*!t!lo%

6%i') *!*!'4i*%ata%!

6%i') *! i&!)tii-!t%ata%!a *u)3*la )o(pli)atii (ai(a%i

6a$itati!- a"i!tat!

6t!a(/- &%i)/

6'ta%! *!p%!'iv/6#oal/

=:2 A )o(ui)a 6*!#it v!%#alo%(al

6o%*i #iolo$i)-&u)tioa%!a*!)vat/ ao%$a!lo% *!'i(t

6o%*i


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p'i4olo$i)5!"p%i(a%! u'oa%/

6o%*i'o)iolo$i)5 %!latiia%(oioa'!

==2A p%a)ti)a%!li$ia

6)%!*i)ioa'/6pa%ti)ip/ la'lu?#! %!li$ioa'!

=+2 A '! %!ali.a 6*!.it!%!' &at/ *!)! !'t! ou

6v3%'ta

=92 A '! %!)%!a 6t%i't!t!

6pli)ti'!al/

6lip'a t%!#u%ilo%.ili)!

6a&!)tiu!a

=2 A ,v/ta 6%!)!ptiv/ la)!!a )! !'t! ou


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PROBLEME ACTUALE PROBLEME POTENIALE6*i')o&o%t *ato%it/ *u%!%ii 'u%*!-lo)ali.at/ lo(#a%

6!li(i/%i ia*!)vat! )atitativ 'i)alitativ

6ali(!tati! ia*!)vat/ , 'u%plu')alitativ 'i )atitativ

6*i&i)ult/ti , a %!'pi%a

6alt!%a%!a t!(p!%atu%ii )o%po%al!

6alt!%a%!a p!%&u.i!i ti'ula%!6*i&i)ult/ti , a '! %!)%!a

6lip'a )uo'tit!lo% *!'p%! #oal/

6*!.!)4ili#%u 4i*%o6!l!)t%oliti)

6%i') *! i&!)tii (a'o)o(ial!

6%i') *! )o(pli)atii

6I2R2A2- I2R2C2

DIAGNO7TIC NUR7ING

=2 Alt!%a%!a t!(p!%atu%ii )o%po%al! *ato%it/ p%o)!'ului i&!)tio'(ai&!'tat p%i 4ip!%t!%(i!- &%i'oa!2

+2 Eli(ia%! u%ia%/ i'u&i)i!t/ )alitativ 'i )atitativ- *ato%it/p%o)!'ului i&!)tio' (ai&!'tat p%i *i'u%i! 'i poliiu%i!2

92 Alt!%a%!a %!'pi%ati!i *ato%it/ *u%!%ii 'i 8TA (ai&!'tat/ p%i*i'p!!2

2 Ali(!tati! ia*!)vat/ )alitativ 'i )atitativ *ato%it/ tul#ul/%ilo%*i$!'tiv!- (ai&!'tat! p%i $%!tu%i- v/%'/tu%i2

2 Di&i)ulltat! , a '! *!pla'a *ato%it/ *u%!%ii (ai&!'tat! p%i po.itiialtal$i)!2


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2 Di&i)ultat! , a '! %!)%!a (ai&!'tat/ p%i *!.it!%!' *ato%it/a&!)tiuii2

GRAD DE DEPENDEN5 II

Pa)i!tul a%! !voi! *! !)4ipa *! ,$%i?i%! p!t%u a6i !"pli)a )! t%!#ui!'/ &a)/2


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6a( a*(ii't%atp!%&u.i! liti)/

6'!% &i.iolo$i) K:: (l

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6p!%&u.i! liti)/6ati#ioti)CIPROFLOACIN + ta#< o%!2

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*,+, PLANIFICAREA, APLICAREA, EVALUAREAINGRIJIRILOR

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8. EXTERNAREA

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a '! (i')a- a av!a o #u/ po'tu%/

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E't! %!)!ptiv la tot )! !'t! ou2

P"!b&0 &a /#"a"

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6Va )otiua t%ata(!t a(#ulato% )u5 Bi'!ptol- o ta#l!t/> o%! ti(p *! .il!- o *at/ la 9 lui2

II C PLAN DE INGRIJIRE AL PACIENTEI

C.A. '% PIELONEFRIT

=2CULEGEREA DATELOR

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71/88

).ANALIZA sI INTERPRETAREA DATELOR

NEVOILE FUNAMENTALE

NEVOIA FUN2DAMENTAL


INDEPENDE


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PROBLEME ACTUALE PROBLEME POTENIALE6!li(ia%! ia*!)vat/ )atitativ 'i)alitativ , 'u%plu'

6alt!%a%!a t!(p!%atu%ii )o%po%al!6vul!%a#ilitat! &at/ *! p!%i)ol!

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92 Vul!%#ilitat! &at/ *! p!%i)ol! *ato%i/ a&!)tiuii (ai&!'tat p%i)uo'tit! i'u&i)i!t! *!'p%! #oal/2

2 Co(ui)a%! i'u&i)i!t/ *ato%it/ 'pitali./%ii- (ai&!'tat p%ii%a')i#ilitat!2

2 Di&i)ultat! , a '! %!)%!a *ato%it/ 'pitali./%ii- (ai&!'tat p%it%i't!t!2


75/88

*,+,. PLANIFICAREA, APLICAREA, EVALUAREAINGRIJIRILOR NURSING

PROBLEME

OBIECTIVE

INTERVENII EVALUAREAUTONOM

EDELEGATE

Tul#u%/%iu%ia%!

6*i'u%i!

6poliiu%ui!

Pa)i!ta '/p%!.it!!li(i/%i&i.iolo$i)!, *!)u%' *! .iil!

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*au *!talii*!'p%!(!(#%iia)!'t!ia2

Di&i)ultat!, a '!%!)%!a

Pa)i!ta '/ai#/a)tivit/ti%!)%!ativ! ,*!)u%' *! .il!

6a( a'i$u%atu )li(at)o&o%ta#il ,'alo

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p!t%ua)tivit/ti%!)%!ativ!

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pa)i!t!i

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60 3II

pa)i!ta a%!a)tivit/ti )a%!o %!)%!a./


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(ultLip'a)uo'tit!lo% *!'p%!a&!)tiu!

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6a( (oito%i.at &u)tiil! vital! 'i v!$!tativ!;

6a( p%!$/tit &i.i) 'i p'i4i) pa)i!ta p!t%u it!%v!tii 'i !"plo%/%i2

E"t!%a%!a

I u%(a iv!'ti$atiilo% 'i a t%ata(!tulului 'i a it!%v!tiilo% autoo(! !&!)tuat!- la!"t!%a%! !'t! %!&/)ut/ )o(pl!t2

Bilatul &u)tiilo% vital! la !"t!%a%!

PQ>: pul'atii p! (iut

TQ9


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P&a ( "'%4"a"

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6Va )otiua t%ata(!tul a(#ulato% )u5 Bi'!ptol- o ta#l!t/=+ o%! ti(p*! .il! p!% o'2

CAPITOLUL III

CONCLUZII

D!&iiti!5 pi!lo!&%ita !'t! i&la(atia a)ut/ 'au )%oi)/ )a%! a&!)t!a./t!'utul it!%'titial %!al6'patiul *it%! !&%oi2

Etiolo$i!5 G!%(!ii )!i (ai &%!)v!ti ,t3liti 'ut5 !')4!%i)4ia Colli-P%ot!u'- l!#'i!lla- Pio)iai)- 7ta&ilo)o)2

O#i'uitii &a)to%i &avo%i.ati 'ut o#'ta)ol!l! *! la iv!lul )/ilo%

!")%!toa%! %!al!- a&!)tiui %!al! )o$!ital!- tu(o%i- litia.a %!al/- )i'tita27!(!5

*u%!%i lo(#a%!- (ai &%!)v!t uilat!%al!- 'u%*! 'au )u )a%a)t!% *! )oli)/%!al/

&!#%/ )u *!l!t viol!t

tul#u%/%i *i$!'tiv!

poloiu%i!- *i'u%i!- i)tu%i!

8TA

6t%a'pi%atii

ati$!%!a it!%'titiului %!al

'ta%! $!!%al/ alt!%at/

Pa%ti)ipa%!a a'i't!t!i (!*i)al! la iv!'ti$atii

Ua *i 'a%)iil! i(po%tat! al! a'i't!t!i (!*i)al! !'t! )ola#o%a%!a 'i!"a(ia%!a )lii)/ a #olavului2


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A?ut3* (!*i)ul 'i pa)i!tul- a'i't!ta (!*i)al/ )%!!a./ u )li(at&avo%a#il p!t%u %!latia5

M!*i) 6 pa)i!t 6 a'i't!t/

P!t%u a)!a'ta a'i't!ta t%!#ui! '/ ti/ )ot *! u%(/toa%!l! 'a%)ii5

'/ p%!$/t!a')/ &i.i) 'i p'i4i) pa)i!tul

'/ p%!$/t!a')/ (at!%ial!l! 'i i't%u(!t!l! !)!'a%! !"a(i/%ii

'/ p%!$/t!a')/ *o)u(!t!l! !)!'a%!5 &i'a *! o#'!%vatii- %!.ultat!l!!"a(i/%ii

a'i$u%/ )o*itii *! (i)%o)li(at , 'alop%!$/t!'t! p%o*u'! #iolo$i)! 'i l! t%i(it! la la#o%ato%

t%a'po%t/ , )o*itii opti(! p%o*u'!l! %!)oltat! la la#o%ato%- *up/ )! ,p%!ala#il l! !ti)4!t!a./

p%!$/t!'t! pa)i!tul &i.i) 'i p'i4i) p!t%u !"a(!! %a*iolo$i)!

a*(ii't%!a./ t%ata(!tul (!*i)a(!to' u(ai la i*i)atia (!*i)ului2

Evoluti!2 P%o$o'ti)

Evolutia 'i p%o$o'ti)ul 'ut &avo%a#il! , )ot!"tul , )a%!t%ata(!tul !'t! apli)at )o%!)t 'i &a)to%ii &avo%i.ati 'ut ,*!p/%tati2

u%(a apli)/%ii t%ata(!tului- *!'i toat! '!(!l! #olii au *i'p/%utu '! poat! vo%#i *! vi*!)a%! *!)3t *up/ )ot%olul %!p!tat al u%o)ultu%ii ,u%(/toa%!l! lui2

76a o#'!%vat )/ pi!lo!&%ita a)ut/- )4ia% atu)i )3* u !'t! t%atat/- '!a(!lio%!a./- &!#%a *i'pa%! , )3t!va .il!- #oala poat! t%!)! , )%oi)itat!2

PNAPNC

E(%'a#$ 4#"% s55#a#

=2 I$%i?i%i *! p%!v!i%! p%i(a%/


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