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MINISTERUL EDUCAIEI NAIONALE

Colegiul Mihai Eminescu Bacu

Nivel pos!liceal

Speciali"a#e$ asisen me%ical gene#alis

LUCRARE DE DI&LOM'

Coo#%onao#$ Can%i%a$

M( Ins#( C#ciun Ionela )#*ncu An%#ei! Ioan

+,-.

1

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/N0RI1IREA &ACIENTULUI

cu

ASTM BRON2IC

2

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Sntatea nu este preuit pn cnd

3

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CU&RINS

MOTIVAIE.................................................................................................................. 6

CAPITOLUL I ................................................................................................................

NOIUNI DE ANATOMIE !I FIZIOLOGIE A APARATULUI RESPIRATOR...............................

NASUL.....................................................................................................................

LARINGELE..............................................................................................................

TRAHEEA................................................................................................................. "

PL MNII ................................................................................................................. #

I.1 FUNCIILE PLMNULUI....................................................................................... 13

I.1.1 Funcia antit!ic"................................................................................................. 13

CAPITOLUL II ............................................................................................................. 1$

ASTMUL #RON$IC ...................................................................................................... 1$

%%.1DEFINI%IA #OLII................................................................................................ 1$

%%.2 ISTORICUL #OLII............................................................................................... 1&

%%.3.ETIOLOGIE....................................................................................................... 16

%%.3.1............................................................FACTORII ALERGICI & 1'& (') *in a*u+i.16

%%.3.2 FACTORII INFECIO!I................................................................................. 1

%%.3.3 FACTORII IRITANI...................................................................................... 1

%%.3.$ FACTORII PSIHICI ........................................................................................ 1"

%%.3.& FACTORUL GENETIC.................................................................................... 1"

%%.3.6 FACTOR ENDOCRIN..................................................................................... 1"

%%.3. FACTORII MEDICAMENTO!I......................................................................... 1"

%%.$SIMPTOMATOLOGIE........................................................................................... 1#

%%.&TA#LOU CLINIC................................................................................................. 1#

%%.6DIAGNOSTIC POZITIV......................................................................................... 22

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%%.DIAGNOSTIC DIF EREN%IAL................................................................................ 2$

%%."FORME CLINICE................................................................................................. 2&

%%.#EVOLU%IE......................................................................................................... 2&

%%.1'TRATAMENT .................................................................................................... 2

CAPITOLUL III ............................................................................................................ 31

NOIUNI DE NURSING ................................................................................................ 31

N,-i+, un*a/,nta+ , a+, iin,i u/an,............................................................................ 31

Eta0,+, 0c,2u+ui *, 3n4i5i,........................................................................................ 32

CAPITOLUL IV ............................................................................................................ 33

CAZUL NR. I............................................................................................................... 33INTERVIU............................................................................................................... 33

PLAN DE 6NGRI7IRE ................................................................................................. 3$

EVALUARE LA E8TERNARE..................................................................................... $6

CAZUL NR. II.............................................................................................................. $

INTERVIU............................................................................................................... $

PLAN DE 6NGRI7IRE ................................................................................................. $"

EVALUARE LA E8TERNARE..................................................................................... &"

CAZUL NR. III .............................................................................................................

INTERVIU...............................................................................................................

PLAN DE 6NGRI7IRE ................................................................................................. 6'

EVALUARE LA E8TERNARE..................................................................................... 6

#I#LIOGRAFIE........................................................................................................... 6"

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MOTI3AIE

6n u+ti/u+ ti/09 au* *in c, 3n c, /ai *,2 -:in*u&2, *,20, a2t/u+ :n(ic.

P, int,n,t9 +a t,+,-i; (i c 2>n>ta2> actu+ *, a ,20ia nu

i/0un, un ,t9 *a 0,ntu c,+ :+na- *, a2t/ :n(ic *,-in, un

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CA&ITOLUL I

NOIUNI DE ANATOMIE I )I4IOLO0IE AA&ARATULUI RES&IRATOR

A0aatu+ ,20iat ,2t, /at *in tta+itat,a 4an,+ ca, 2,-,2c +a

,,ctua,a ,20iai,i 0u+/na,= ,+i/ina,a *i!i*u+ui *, ca:n *in 2?n4,9

,20,cti- 0,+ua,a !i4,nu+ui *in a,u+ a/:iant. Ac,2ta ,2t, /at *in *u"

cat,4ii *, 4an,=

Cile respiratorii ca, 2unt ,0,;,ntat, *, ca-itat,a na;a+" @na2u+9 +ain4,9 ta

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& 0i/a ,2t, ,0,;,ntat" *, 0t,cia cilor respiratorii inferioare& a *ua ,2t, ,0,;,ntat" *, respiraie;& a t,ia ,2t, ,0,;,ntat" *,funcia de fonaie.

TRA5EEA ,2t, un 4an tu:u+a a+at 3n cntinua,a +ain4,+ui *, +a ni-,+u+-,t,:,i C 0?n" +a T9 un*, 2, 3/0at, 3n c,+, *u" :n

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&L'M7NII

P+"/?nu+ 2, *,;-+t" t,0tat 3n ti/0u+ -i,ii inta&ut,in,. 6n 0i/a +un" *,

2acin" a0a *i /u4ui :n

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1

*i/,n2iuni /ai ,*u2, *,c?t +a 0+"/?nu+ 2t?n4 (i i/0,2iuni+, -,n,i ca-,

2u0,ia" (i -,n,i ca-, in,ia,. Tt +a ac,2t ni-,+ 2, *,2ci, i/0,2iun,a /aii

-,n, a;42. #a;a 0u+/na" a, a20,ct cnca- (i -in, 3n cntact cu *iaa4/a.

Pin int,/,*iu+ ac,2t,ia9 0+"/?nii au a0t cu iactu+ 3n *,a0ta (i un*u+4a2tic (i 20+ina 3n 2t?n4a.

V?u+ 0u+/na *,0"(,(t, 3n 2u2 0i/a ca2t"9 -,nin* 3n a0t cu 4an,+,

*, +a ni-,+u+ :a;,i 4?tu+ui.Ma4in,a ant,ia" a 0+"/?ni+ ,2t, a2cuit" (i ,2t,

+ca+i;at" 02t,i *, 2t,n9 iin* ac0,it" *, ,c,2u+ c2t&/,*ia2tina+. Ma4in,a

02t,ia" ,2t, tun5it" (i -in, 3n a0t cu c+ana -,t,:a+" (i ,!t,/itat,a

02t,ia" a ca2t,+.P+"/?nii 2unt a+c"tuii *in a:, :n(ic9 +:u+i9 a/iicaii+, -a2,+

0u+/na, (i :n(ic,9 n,-i (i +i/atic,9 tat, iin* cu0in2, 3n ,2ut

cn5uncti-. Va2cu+ai;aia 0+"/?ni+ ,2t, *u:+" J nutiti-" Bi uncina+". C,a

nutiti-" ,2t, a2i4uat" *, at,,+, :nBic,9 ia c,a uncina+" *, at,a

0u+/na" @/ica cicu+ai,.

Unitat,a uncina+" a 0+"/?nu+ui ,2t, acinul pulmona# @2au 2acu+ a+-,+a/at *in a+-,+, 0u+/na,. Ac,2t,a cnin *u" ti0ui *, c,+u+, J 0n,u/cit,

*, ti0 I Bi 0n,u/cit, *, ti0 II @c,+, *, ti0 *i 2,c,t" 2uactant. P, +?n4" ac,2t,

c,+u+, 2, /ai 0t 4"2i Bi /aca4,. 6n tta+9 c,i *i 0+"/?ni cnin a0!i/ati-

'' *, /i+ian, *, a+-,+, 0u+/na, c, a2i4u" 2c

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1

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Ca unci, -ita+" a 4ani2/,+ -ii9 ,20iaia ,0,;int" an2a/:+u+

,n/,n+ i;ic,9c

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I.1 )UNCIILE &L'M7NULUI

I.1.1 )unc8ia anio9icPin in20i 2unt in

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CA&ITOLUL II

ASTMUL

BRON2ICII.1 DE)INI:IA BOLII

A2t/u+ ,2t, :a+a :2tucti-" a :n

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II.( ISTORICUL BOLII

T,/,nu+ *, a2t/ a a0"ut *,-,/,9 3n +it,atu" ,,in*u&2, +a *i20n,, 3n4,n,a+ ,+ *,i-" *, +a un cu-?nt 4,c,2c a2/aticu2 ca, 3n2,a/n" 4,utat,,20iati,.

In*i,nii -,c

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6n R/?nia c,+, /ai i/0tant, c,c,t"i a2u0a a2t/u+ui +,&a "cut0,2u+ Dani,+0+u9 +uc"i+, +ui a2u0a 0i+a!i,i (i a ,!i2t,n,i *;,+/ici (i /ai *, /,*iati c

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actu+ /,t,+4ic a, un 0c,nt *, c,(t,, a ,c-,n,i acc,2,+ *, a2t/0in 0,;,na ntui+ *, a, ,c,.

II.. )ACTORII &SI5ICI

Patici0" ,c-,nt +a *,c+an(a,a acc,2,+ *, a2t/9 i, 2u: in+u,na un,/ii 0ut,nic, 2au 0in 2i/0+a cn*iina, (i +a 3nt,in,,a +. Etu+ +anu/,(i a2/atici9 3n 0aticu+a c0ii (i tin,i9 un ,!,ciiu i;ic *, int,n2itat,-aia:i+"9 0at, *,t,/ina un :n

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tata/,nt,+ cu a,2+i 0, ca+, *i4,2ti-"9 2i0ui9 c/0i/at,9 0u+:,i 0, ca+,/uca2"9 in2ti+aii na;a+, 2au cu+a,9 c+i2/".

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Nu t,:ui, uitat c" un,+, anti:itic, 2, 4"2,2c 3n -accinui. Nu/,a2,/,*ica/,nt, 0t 0*uc, a+,4i;a, *a c,+ /ai ,c-,nt 2unt inci/inat,anti:itic,+, ia *int, ,+, 99:,ta&+acta/in,+, @0,nici+in,+, (i a/i+ia +9 a/0ici+ina9!aci+ina9 c,a+20in,+,9 c+a2a 2u+a/i*,+.

II. SIM&TOMATOLO0IELa 3nc,0ut9 ci;,+, 2unt ti0ic,9 cu 3nc,0ut (i 2?(it :u2c9 cu int,-a+,

+i:,, /ai t?;iu9 3n int,-a+,+, *int, ci;,9 a0a 2,/n,+, :n(it,i cnic, (i a+,,/i;,/u+ui9 cu *i20n,, /ai /u+t 2au /ai 0uin ,-i*,nt". Ci;a a0a, 3n a *ua

5u/"tat, a n0ii9 *, :ic,i :uta+9 cu *i20n,, (i n,+ini(t,9 0uit (i

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2

#+na-u+ ,2t, an!i29 20,iat9 n,+ini(tit *in cau;a 2,n;ai,i *, 2uca,.Ca ,n/,n, 0*/a+, ca, 0,c,* un,i ci;a *, a2t/ 2, *,2ciu ci;, *,2t"nut cu in,, (i +"ci/a,.

Un,i ci;a 2u-in, -, ,4u+" (i -, cau;" c+a" cu 0,*i+,ci, 3nti/0u+ n0ii. O c,+a, a 2i/0t/,+ cu +cu+ un*, a0a in*ic" caua ,!4,n"a a2t/u+ui. Si/0t/,+, *iun, cu a0aiia *, :ic,i 3n ca/,a *, */it nut,:ui, 0u2, n,a0"at :+i4atiu 3n +,4"tu" cu a+,4,nii *in 3nc"0,,a ,20,cti-"9*,a,c, (i +a a2/aticii n,a+,4ici 0t a0",a 2i/0t/, @*i20n,,9 tu2, 3n 0i/,+,, a+, *i/in,ii.

6n ti/0u+ ci;,i 2au +a 2?(itu+ ,i a0a, tu2,a9 ,a 0at, i un,i 2in4ua/ani,2ta, c+inic" a a2t/u+ui 2au 0at, 0-ca ,a 3n2"(i acc,2. Tu2,a 0at, iu2cat" 2au u/,*" cu 20u/" /uca2"9 +i0icia2" cu ,+i/ina, *iici+"9

,!0,ctaia cu ti/0u+ *,-in, 0,+at". 6n 0,;,na un,i in,cii ta

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2

,20iaia *,-in, 2u0,icia+"9 :+na-u+ 2, cian;,a;" int,n29 *,-in, :nu:i+at(i 0at, inta 3n c/".

Factii *, i2c9 *,c+an(ati ai 2t"ii *, "u a2/atic=

In,cii+, int,cu,nt, cu -iu(i (i H,/0

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II. DIA0NOSTIC &O4ITI3

6n a2t/u+ a+,4ic *ia4n2ticu+ 0;iti- (i ,ti+4ic 2, ,a+i;,a;" 0inana/n,;"9 t,2t, cutanat, (i t,2tu+ *, 0-ca, :n(ic"9 uti+, *a *, u; cu,nt2unt RAST (i ,+i:,a,a *,

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P,ntu natua a+,4,nic" a a2t/u+ui 0+,*,a;" ant,c,*,nt,+, a+,4ic, a/i+ia+,(i 0,2na+,9 a0aiia acc,2,+ 3n cn*iii 2i/i+a, *, ti/0 @a2t/ 0+,nic 3n

0,ia*a *, 0+,ni;a,9 *,+c9 a2t/ 0,2ina+ (i cntact cu ac,+,a(i :i,ct, *,3/:"c"/int,9 ta+,ta *, a(t,nut.

Anc

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6n a2t/u+ :n(ic 2ca*, VEMS& u+9 in*ic,+, *, 0,/,a:i+itat, :n(ic".Ca0acitat,a -ita+" (i c,(t, VR (i CFR9 ,+,/,nt, c, 0+,*,a;" 0,ntuin2uici,na 0u+/na" :2tucti-" @ IPO .

Dat iin* un,i ana/n,;, /inuia2, 2, +2,2c un,+, 2,-icii 3n ac,2t 2c0c

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Ra,i

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t,2t, cutanat, n,4ati-, Bi -in*,ca, *u0" 1 ani *, ,-+ui, +a 1) *in c0ii cuun a2t/ intin2,c ia ) au "/a2 a/,+iai. A2t/u+ ca, *,:ut,a;" 3na*+,2c,n" 2au +a -?2t, a*u+t, ,4,2,a;" /ai 0uin uB ca a2t/u+ c0i+u+ui.

A2t/u+ ta*i-9 cu a0aii, 3n 5u *, ' *, an Bi ca, a ,0,;,nta (') *in

tat, ca;ui+, *, a2t/9 ,2t, a *, natu" a+,4ic"9 ,-+u,a;" 3n ,0i2a*, :nBitic,9,0,tat, Bi cu 0,ia*" -aia:i+" *, ti/0 2" *,-in" a2t/ cu *i20n,, cntinua.

A2t/u+ 3n ti/0u+ 4a-i*it"ii ,2t, 3nt?+nit cu ,c-,n" *, 1)9 u/",aa2u0a ,-+ui,i 2acinii ,2t, -aia:i+".

A4a-a,a a2t/u+ui 2, ,a+i;,a;" i, 0in ,0,tiia ,c-,n" a acc,2,+9 cu,/i2iuni inc/0+,t, a *i20n,,i 3nt, 0,ia*,+, 0a!i2tic,9 i, 0in 2u0a0un,,aun ,0i2a*, ,0,tat, *, in,ci, :nBic"9 ca,&i *au un a20,ct c+inic *, :nBitacnic" :2tucti-" Bi cu ti/0u+ *uc, +a cn2titui,a unui c* 0u+/na acut.

E-+uia 04,2i-" 0at, cn*uc, +a 2ta, *, in-a+i*itat, a :+na-u+ui9caact,i;at" 0in u/"ta,+, cit,ii=

o C+inic,= *i20n,, ;i+nic"9 ,acta" +a tata/,nt,+, ;i+nic, :iBnuit,9inca0acitat,a *, /unc" *, /ai /u+t, +uni 0, an9 20ita+i;"i ,0,tat,92ta,a *, "u a2/atic9 ctict,a0i, *, +un4" *uat" cu *;, *,/,nin,, *, 0,2t, 1' /4K;i9 n,c,2itat,a *, in5,ci,9 ,c-,n"9

0,*/inanta acti+ *,c+anBati a c" ,+i/ina, nu ,2t, 02i:i+"9a/,+ia,a ,2t, ,*u2" *u0" un tata/,nt int,n2i- Bi ,ci*i-a a0i*"*u0" ,!t,na,a *in 20ita+ Bi ,inta,a 3n /,*iu+ */,2tic 2au a/i+ia+9in,!i2t,nta unu +c *, /unc" a*,c-at9 c/0+icaii 2,-,,= c*

0u+/na9 *,c/0,n2"i ca*iac,9 n,-;" 4a-".o Funcina+,= :2tuci, :nBic" 0nunat" 0,/an,nt9 c-a2ii,-,2i:i+"

*u0" :n

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in,ci2 2au intin2,c /at,a 2, 0*uc, 0in a2i!i, cn2,cuti-a :2tu"ii:n

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0,ntu ,c,0tii :( au ,,ct, 2,cun*a, at, ,*u2,. Sunt in*icai 3n 20,cia++a 0aci,nii ca, n,c,2it" a*/ini2ta, ;i+nic" *, #ADSA9 3n a2t/u+ cu/ani,2t"i nctun, (i 3n c,+ in*u2 *, ,t.

Antic+in,4ic,+, au un ,,ct :n

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ia/0icina9 a+c+u+9 /ai5uana 2au ica, a+t, *4ui ca0a:i+, 2" in*uc",n;i/,+,

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3

cti;nic"9 2t,0;a Bi actui+, @3n 20,cia+ +a ,/,i 02t&/,n0au;"9:,;itat,a9

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3

CA&ITOLUL III

NOIUNI DE

NURSIN0

Vi4inia H,n*,2n *,in,Bt, nu2in4u+ a2t,+=9

S a@u8i in%ivi%ul ie acesa 6olnav sau snos s!i ale calea sp#e

snae sau #ecupe#a#e s a@u8i in%ivi%ul ie 6olnav sau snos s!i

oloseasc ieca#e ac8iune pen#u a p#omova snaea sau #ecupe#a#ea cu

con%i8ia ca acesa s ai6 #ia voin8a sau cunoae#ea necesa# pen#u a o

ace i s ac8ione"e *n aa el *nc acesa s!i poa#e %e g#i@ singu# c mai

cu#n% posi6il(

Nevoile un%amenale ale iin8ei umane sun$

1. N,-ia *, a ,20ia Bi a a-,a :un" cicu+ai,9

(. N,-ia *, a :,a Bi a /?nca9

. N,-ia *, a ,+i/ina9

. N,-ia *, a 2, /iBca Bi a a-,a :un" 02tu"9

. N,-ia *, a */i Bi a 2, *i

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3

11. N,-ia *, a acina cn/ 00ii+ cn-in4,i Bi -a+i9 *, a 0actica,+i4ia9

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1(. N,-ia *, a i 0,cu0at 3n -,*,,a ,a+i;"ii9

1. N,-ia *, a 2, ,c,a9

1. N,-ia *, a 3n-"a cu/ 2"&i 0"2t,;i 2"n"tat,a

Eapele p#ocesului %e *ng#i@i#e

1. Culege#ea %e %ae & n, 0,/it, 2" ac,/ in-,ntai,, a tutu a20,ct,+ 0i-in*

0aci,ntu+ 3n 4+:a+itat,a 2". S, 0at, 20un, c" ,+, n, in/,a;" a2u0a a c,,a c,

,2t, 0aci,ntu+9 a2u0a 2u,in,i9 a2u0a :ic,iui+ *, -ia" Bi a20" 2t"ii *,

2ati2ac,, a n,-i+ un*a/,nta+,.(. Anali"a i ine#p#ea#ea %aelo#9 n, 0,/it, 2" 0un,/ 3n +u/in" 0:+,/,+,

20,ciic, *, *,0,n*,n" Bi 2u2a *, *iicu+tat, ca, +,&a 4,n,at9 a*ic" ,+a:a,a9

*ia4n2ticu+ui *, 3n4i5i,.

. &laniica#ea *ng#i@i#ilo# ne pe#mie=

A *,t,/ina,a 2c0ui+ ca, t,:ui, u/"it, /ai 0,ci2 *,t,/ina,a

:i,cti-,+ *, atin2 @,;u+tatu+ aBt,0tat9

# 2ta:i+i,a /i5+ac,+ 0,ntu ,;+-a,a :i,cti-,+ @0,ntu atin4,,a

,;u+tat,+.

. E9ecua#ea aplica#ea ine#ven8iilo#

Uti+i;a,a 0+anu+ui *, int,-,nii ,+a:at.

. Evalua#ea & cn2t" 3n ana+i;a ,;u+tatu+ui :inut @*ac" int,-,nii+, au 2t

a*,c-at,9 *ac" 2&a :inut ,;u+tatu+ *it 2au nu Bi *ac" au a0"ut ni *at, 3n

,-+uia 2t"ii 0aci,ntu+ui Bi9 ,-,ntua+9 *ac" ,2t, n,c,2a" ,a5uta,a int,-,nii+

Bi :i,cti-,+.

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CA&ITOLUL I3

CAZUL NR. I

INTERVIU

Paci,nta C.R 3n -?2t" *, ' *, ani 2, 0,;int" 0, S,cia M,*icin" Int,n" 3n*ata *, .1'.('1 acu;?n*= ci;" *, *i20n,, *, ti0 ,!0iat9 tu2, cu ,!0,ctai,/uc0uu+,nt"9 *u,i tacic,9 0a+0itaii9 ,:"9 c,a+,, cu -,ti59 an!i,tat,9in2/ni,.S, int,n,a;" 0,ntu in-,2ti4aii (i tata/,nt *, 20,cia+itat,.

Paci,nta 0,ci;,a;" c" ,2t, cun2cut" cu a2t/ :n(ic *, /ai /u+i ani. 6nu/a c,+ /,ninat, a 2t *ia4n2ticat" custm !ronic "n criz i suspiciuneaunei pneumonii.

Paci,nta M.A9 cu */ici+iu+ 3n #u

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3

&LAN DE /N0RI1IRE

Daa Diagnosic %e *ng#i@i#e O6iecive Ine#veniile asisenei Evalua#e

1. A+t,a,a unci,i ,20iatii*atit" :2tuci,i c"i+,20iatii /ani,2tat" 0in

acc,2, *, *i20n,, 0a!i2tic".

Paci,nta 2"0,;int, ,20iai,

:un" (i c"i,20iatii0,/,a:i+,.

6n-" 0aci,nta 2" tu(,a2c" 2",!0,ct,;, (i 2" c+,ct,;, 20uta3n ,ci0i,nt9 a*/ini2t,; O( +a

n,-i,. A,i2,2c 2a+nu+9 a2i4u 0;iia2,/i(,;?n*" @t0n,, ca,a-i;,a;" ,20iai, /ai:un".

Fac ,*ucai, 2anita" 0,ntu0,-,ni,a in,ci,i:n(ic,.

La in*icaia /,*icu+ui a*/ini2t,;= #iofilin 1' /+9 (!1+K;i9 i.-. $entolin Spra%9 ( 0u+-,i;"i9 !K;i

0, 2. &romhe'im /49 !1c0K;i9 0, 2. ((C 1'' /49 (!1+K;i9 i.-.

Paci,nta "20un*, :in,+a tata/,ntu+ a2t/atic(i 2, +ini(t,(t,

R X 1 K/inut

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(. P2i:i+" /*iica, acn2tant,+ :i+4ic, *incau;a a,ciunii /ani,2tat"0in /*iica,a -a+i+ac,2ta.

Paci,nta 2"0,;int,cn2tant,:i+4ic, 3n+i/it,n/a+,.

La in*icaia /,*icu+ui ,c+t,;2?n4, 0,ntu *,t,/ina,a= VSH9TGO9 TGP9 H:9 Ht9 C+,2t,+9G+ic,/ia9 U,,a9 C,atinina.

3&

R,;u+tat,+, ana+i;,+ *,+a:at= U#ee=

V.N= (' & ' /4)V.O= /4)

C#eaininV.N= '91 & 19( /4)

V.O= '9 /4)

Colese#ol=V. N= 19' & (9' 4V.O= (9 4) 3S5=

V.N= & 11 //K