Ciroza Hepatica licenta
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Transcript of Ciroza Hepatica licenta
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Cuprins
PARTEA TEORETICA..................................................................................................... 2INTRODUCERE..........................................................................................................2
ANATOMIA FICATULUI..............................................................................................5
FIZIOLOGIA FICATULUI.............................................................................................6
CIROZA HEPATICA.....................................................................................................9
ETIOLOGIE............................................................................................................ 9
PATOGENEZA.......................................................................................................10
SIMPTOMATOLOGIE............................................................................................. 10
EXAMEN OBIECTIV GENERAL...............................................................................15
EXPLORAREA FUNCTIONALA A FICATULUI............................................................15
DIAGNOTIC POZITIV............................................................................................ 19
DIAGNOSTIC DIFERENŢIAL..................................................................................20
COMPLICAŢIILE CIROZEI HEPATICE......................................................................21
TRATAMENTUL IN CIROZA HEPATICA....................................................................22
PARTEA PRACTICA.....................................................................................................25
ROLUL ASISTENTEI MEDICALE IN INGRIJIREA BOLNAVILOR CU CIROZĂ HEPATICĂ....26
STUDII DE CAZ........................................................................................................ 28
CAZUL I...............................................................................................................28
CAZUL II..............................................................................................................36
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PARTEA
TEORETICA
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Ingrijireapacientului cu ciroza hepatica
INTRODUCERE
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Ingrijireapacientului cu ciroza hepatica
ANATOMIA FICATULUI
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Ingrijireapacientului cu ciroza hepatica
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FIZIOLOGIA FICATULUI
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Hematopoetică
Biligeră
ntito!ică
"ermogenetică
#egenerare
$egate %e meta&oli'mul interme%iar
(epozit
Homeo'tazie circulator
(eto!i)ere
*oagulare
Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
CIROZA HEPATICA
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Ingrijireapacientului cu ciroza hepatica
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SIMPTOMATOLOGIE
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
PARTEA
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Ingrijireapacientului cu ciroza hepatica
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%(drea&,a )&re u( re.%/ adec5a, de 5%a,a0 ara a*u+ur% de a-c''- )% /ed%ca/e(,e )&re ,ra,area c'rec,a a
,u,ur'r aec,%u(%-'r 1e&a,%ce )% .e(era-e a-e 'r.a(%)/u-u%2
STUDII DE CAZ
CAZUL I
CULEGEREA DATELOR
NUME SI PRENUME : I'(e)cu Ge'r.e,a
25
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Ingrijireapacientului cu ciroza hepatica
V]RSTA: K a(%
SEX: e/%(%(
DOMICILIUL: Ga-a,%
STAREA CIVILĂ: ca)a,'r%,"
OCUPAŢIA: &e()%'(ar"
NAŢIONALITATEA: r'/a("
RELIGIA: 'r,'d'9a
ANTECEDENTE PERSONALE: c%r'+" 1e&a,%c" cu a)c%," d%a.('),%ca," cu @ a(% %( ur/"2
ANTECEDENTE HEREDOCOLATERALE: -%&)%,e de %/&'r,a(!"2
GRUPA DE S]NGE: BIII (e.a,%52
DIAGNOSTIC MEDICAL LA INTERNARE:
• C%r'+a 1e&a,%ca dec'/&e()a,a 5a)cu-ar2
• E(cea-'&a,%e
• Her(%e '/*%-%ca-a
MOTIVELE INTERNARII:
• D%)&(ee /arca,a de e'r, )% re&a')0 a),e(%e e9,er(a
• Cre),erea %( 5'-u/ a a*d'/e(u-u%
• Ede/e a-e /e/*re-'r %(er%'are
• S,are de d%)c'('r, a*d'/%(a-2
ISTORICUL BOLII: =&ac%e(,a %( 5ar),a de K a(%0 a '), %(,er(a," da,'r%," d%)&(ee% /arca(,e0
cre),er%% %( 5'-u/ a a*d'/e(u-u%0 e(de/e a-e /e/*re-'r %(er%'are )% 1er(%e '/*%-%ca-a2 S=a
),a*%-%, d%a.('),%cu- de c%r'+" 1e&a,%c" dec'/&e()a," 5a)cu-ar )% &are(c1%/a,')2 Se adre)ea+a
c-%(%c%% &e(,ru ,ra,a/e(, de )&ec%a-%,a,e2
PROBLEMELE PACIENTEI
=d%)&(ee
=cre),erea %( 5'-u/ a a*d'/e(u-u% da,'r%,a a)c%,e%
=ede/e -a /e/*re-e %(er%'are
NEVOI:
>2 Ne5'%a de a re)&%ra )% a a5ea ' *u(a c%rcu-a,%e
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Ingrijireapacientului cu ciroza hepatica
@2 Ne5'%a de a )e a-%/e(,a )% 1%dra,a
42 Ne5'%a de a e-%/%(a
?2 Ne5'%a de a e5%,a &er%c'-e-e
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INDEPENDENTA
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
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Ingrijireapacientului cu ciroza hepatica
de a %(5a,a
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Ingrijirea pacientului cu ciroza hepatica
Ta*e- @2 P-a(d de %(.r%6%re &ac%e(, I
D%a#)!&%' ,e
I)#(%7%(e
O0%e'%e I)e(e)%% Ea$+a(e
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cu ' rec5e(,a %( -%/%,e
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+%-e2
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re)&%ra,%a0 a)e+a(d %( )&a,e-e
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A/ aer%)%, )a-'(u-2
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re)&%re c'rec, 7)a %()&%re
&r'u(d &e (a) )% )a e9&%re &e
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'9%.e( &e /a)ca K-1 cu
%(,er/%,e(,a > /%( de d'ua
'r% &e 'ra2 A/ )u&ra5e.1ea,
cu /are a,e(,%e /'du- de
ad/%(%),rare a O@ de*%,u- -u%
)% rec5e(,a ad/%(%),rar%%
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re&%ra,%e% %%(d de @/%(=-a >@ 're de -a
%(,er5e(,%% ),area &ac%e(,e% )=a /a%
%/*u(a,a,%,0 rec5e(,a re)&%ra,%e% %%(d
de >/%( &u-)u- e),e de /%( %ar
TAW>?K//H.
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Ingrijirea pacientului cu ciroza hepatica
&arace(,e+a
@2 ALIMENTATIE
INADECVATA PRIN
DEFICIT
Pac%e(,a )a %e ec1%-%*ra,a
(u,r%,%'(a- )% 1%dr'e-ec,'-%,%c
%( 4 +%-e
A/ &re+e(,a, &ac%e(,e%
(ece)%,a,ea u(e% d%e,e
1%&')'da,e2
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a-%/e(,e-e &er/%)e )%
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're re.u-a,e2
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a-%/e(,a, )% 1%dra,a, &er= %()u%c%e(,
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1%dra=,e+e cu >/- -%c1%de2
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Ingrijirea pacientului cu ciroza hepatica
)ca+u, de'arece &ac%e(,a
&re+e(,a e(cea-'&a,%e2
A-%/e(,a,%a era *'.a,a %(
.-uc%de )% -%c1%de 7)uc
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cea%%(du-c%, cu/%ere8
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Ingrijirea pacientului cu ciroza hepatica
42 ELIMINARE
INADECVATA
CANTITATIV
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ur%(are
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>/%(
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Ingrijirea pacientului cu ciroza hepatica
%%(d )c1%/*a,a -a @ de 're2
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eec,ua,e )=a dece-a, &re+e(,a
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a&-%ca(d u( &a()a/e(,
c'/&re)%5 du&a ,er/%(area
&u(c,%e%2
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Ingrijirea pacientului cu ciroza hepatica
?2 INCAPACITATEA DE
A=SI REALIZA
SINGURA INGRIJIRI
MEDICALE
Pac%e(,a )a=)% &'a,a
eec,ua )%(.ura %(.r%6%r%-e
&er)'(a-e %( decur) de
+%-e Sa=)% e9&r%/e
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%(.r%6%r% de %.%e(a %(
,er/e( de > +%-e2
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/'*%-%+e+e2
La )'-%c%,ar%-e &ac%e(,e% a/
ra)&u() cu &r'/,%,ud%(e2
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eec,ue+e ,'a-e,a )%(.ura2
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Ingrijireapacientului cu ciroza hepatica
CAZUL II
CULEGEREA DATELOR
NUME SI PRENUME : R"d'% I'a(a
V]RSTA: K@ a(%
SEX: e/%(%(
DOMICILIUL: Ga-a,%
STAREA CIVILA: c")",'r%,"
OCUPAŢIA: &e()%'(ar" NAŢIONALITATEA: r'/3("
RELIGIA: 'r,'d'9"
ANTECEDENTE PERSONALE: = cu(')cu," de c%rca 4 a(% cu d%a.('),%cu- de c%r'+" 1e&a,%c"
dec'/&e()a," 5a)cu-ar0 cu re&e,a,e %(,er("r%0 cu a/e-%'rarea ),"r%% .e(era-e2
= c'()u/a,'are cr'(%ca de e,a('-
= (u re)&ec,a re.%/u- a-%/e(,ar 7%(.ur.%,ea+a +%-(%c @ - -%c1%d8
= (eu/a,'areANTECEDENTE HEREDOCOLATERALE:
= /a/a= d%a*e, +a1ara,
= ,a,a= (e)e/(%%ca,%5
GRUPA DE SANGE DIAGNOSTIC MEDICAL LA INTERNARE:
• C%r'+a 1e&a,%ca e,a('-%ca dec'/&e()a,a 5a)cu-ar
MOTIVELE INTERNARII:
: AII &'+%,%52
• a),e(%e %+%c" /arca(,"0
• ,u)e cu e9&ec,'ra!%%
• #(a&e,e(!"0
• .re!ur%0
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Ingrijireapacientului cu ciroza hepatica
• 5"r)",ur%
ISTORICUL BOLII: =&ac%e(,a %( 5ar),a de K@ a(% %( e5%de(,a cu c%r'+a 1e&a,%ca dec'/&e()a,a
5a)cu-ar de 4 a(% 0 a '), %(,er(a,a &e(,ru a),e(%e %+%ca /arca(,a0 %(a&e,e(,a0 .re,ur%0 5ar)a,ur%0
a)c%,a 5'-u/%'a)a0 ede/e /arca,e a-e /e/*re-'r %(er%'are2 La d'/%c%-%u (u a re)&ec,a,
%(d%ca,%%-e de ,ra,a/e(, a-e /ed%cu-u% )% (u a re)&ec,a, %(d%ca,%%-e de a re(u(,a -a a-c''-2 Se
adre)ea+a c-%(%c%% &e(,ru ,ra,a/e(, de )&ec%a-%,a,e2
PROBLEMELE PACIENTEI
= a-%/e(,a,%a care(,%a-a da,'r%,a %(a&e,e(,e%0 a-c''-%)/u-u%
= a(9%e,a,e /'dera,a
= d%)&(ee
= cre),erea %( 5'-u/ a a*d'/e(u-u% da,'r%,a a)c%,e%
=ede/e -a /e/*re-e %(er%'are
= d%%cu-,a,ea de a )e 'd%1(%
= r%)cu- u('r c'/&-%ca,%% %(ec,%'a)e
NEVOI:
>2 Ne5'%a de a )e a-%/e(,a )% 1%dra,a
@2 Ne5'%a de a re)&%ra
42 Ne5'%a de a e-%/%(a?2 Ne5'%a de a d'r/% )% )e 'd%1(%
2 Ne5'%a de a=)% /e(,%(e ,e.u/e(,e-e cura,e )% %(,e.re
K2 Ne5'%a de a e5%,a &er%c'-e-e
Ta*e- 42 P-a( de (e5'% &ac%e(, II
NEVOIA MANIFESTARILE PROBLEME SURSE DE
DIFICULTAT
E
OBIECTIV
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INDEPENDENT
A
DE
DEPENDEN
TA>2Ne5'%a
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=a)c%,a =e5acuarea
a)c%,e%
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Ingrijireapacientului cu ciroza hepatica
*u(a
c%rcu-a,%e
c'()u/
a-c''-
ea
e9&a()%'(ar%%
d%ara./a,%c
e
=d%%cu-,a,e %(
a re)&%ra@2 Ne5'%a
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a5ea '
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Ingrijireapacientului cu ciroza hepatica
de a
d'r/% )% a
)e 'd%1(%
=dura,a )'/(u-u%
adec5a,a 5ar),e%
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Ingrijireapacientului cu ciroza hepatica
a
c'/u(%ca
=re-a,%% a(e5'%'a)e
cu a/%-%a
&ac%e(,a )a=)%
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de a
ac,%'(a
c'('r/
&r'&r%%-'r
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)% 5a-'r%0
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re-%.%a
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a %
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a )e recrea
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41
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Ingrijireapacientului cu ciroza hepatica
D%a#)!&%' ,e %)#(%7%(e O0%e'%e I)e(e)%%
>2DISPNEE Pac%e(,a 5a a5ea '
re)&%ra,%e cu '
rec5e(,a %( -%/%,e
%+%'-'.%ce %( decur)
de ?= +%-e2
A/ a)e+a, &ac%e(,a %( &'+%,%e 'r,'&(e%ca
&e(,ru a a5'r%+a re)&%ra,%a 0a)e+a(d %(
)&a,e-e &ac%e(,e% d'ua &er(e2A/ aer%)%,
)a-'(u-2A/ %(5a,a, &ac%e(,a )a re)&%re
c'rec, 7)a %()&%re &r'u(d &e (a) )% )a
e9&%re &e .ura82 Pac%e(,e% % )=a ad/%(%),ra,
'9%.e( &e /a)ca K-1 cu %(,er/%,e(,a >
/%( de d'ua 'r% &e 'ra2 A/ )u&ra5e.1ea,
cu /are a,e(,%e /'du- de ad/%(%),rare a
O@ de*%,u- -u% )% rec5e(,a ad/%(%),rar%%
'9%.e(u-u%2S=a eec,ua, &arace(,e+a &e(,ru
a u)ura re)&%ra,%a
Du&a
),area
rec5e
-a >@
&ac%e(
rec5e
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TAW>
@2 ALIMENTATIE
CARENTIALA
DATORITA
INAPETENTEI
Pac%e(,a )a %e
ec1%-%*ra,a (u,r%=
,%'(a- )% 1%dr'e-ec=
,'-%,%c %( 4 +%-e2
A/ &re+e(,a, &ac%e(,e% (ece)%,a,ea u(e%
d%e,e 1%&')'da,e2A/ %(,'c/%, ' -%),a cu
a-%/e(,e-e &er/%)e )% %(,er)%)e0 educa(d
a/%-%a )% a/ ceru, de -a *uca,ar%a
)&%,a-u-u% re)&ec,area re.%/u-u%2 Au '),
e9&-'ra,e .u),ur%-e &ac%e(,e%2A-%/e(,e-e
au '), )er5%,e -a 're re.u-a,e2A&'r,u- de
&r',e%(e )=a )ca+u, de'arece &ac%e(,a
&re+e(,a e(cea-'&a,%e2
A-%/e(,a,%a era *'.a,a %( .-uc%de )%
-%c1%de 7)uc (a,ura-0 a&a &-a,a0 cea%%(du-c%,
cu/%ere82Pe &arcur)u- re+'-5ar%%
e(cea-'&a,%e% )e 5'r )u&-%/e(,a care(,e-e%( &r',e%(e2La %(d%ca,%%-e /ed%cu-u%
&ac%e(,e% % )=a ad/%(%),ra, P'-%5%,a/%(e
49>+%2Pe(,ru reacerea &are(c1%/u-u%
1e&a=,%c % )=a ad/%(%),ra, A)&a,''r, @9>
I( &r
a-%/
ur/a
)a /
1%dra
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Ingrijireapacientului cu ciroza hepatica
%( /- .-uc'+a +% Du&a re+'-5area
e(cea-'&a,%e% % )=a ad/%(%),ra, 1%dr'-%=
+a(,e de &r',e%(e 7A/(%'&-a/a- 8
/-+%
42 ELIMINARE
INADECVATA
CANTITATIV
Pac%e(,a )a %e
ec1%-%*ra,a 1%dr'=
e-ec,r'-%,%c )% )a (u
&re+%(,e r%)c a-
%(ec,%%-'r ur%(are
Z%-(%c )=a eec,ua, *%-a(,u- 1%dr'ec,r'-%,%c2
I(.e),%a =.-uc'+a > /-9S _>U2I2
%()u-%( =de9,ra( ?=/- =)uc
>/- =a-%/e(,e @. =&-a)/a >/-
E9cre,%a= d%ure+a >?/-=)cau( 4/-
=-%c1%d a)c%,%c ?/-
&ac%e(,e% % )=a %(d%ca, )a (u c'()u/e /a%
/u-, de > - de -%c1%de +% /a% a-e) d%( ce-e *'.a,e %( Na2 A/ rec'-,a, ur%(a &e(,ru
e9a/e(u- ru/ar de ur%(a )% *ac,er%'-'.%c
La a&-%carea )'(de% 5e+%ca-e a/ re)&ec,a,
re.u-%-e de a)e&)%e0 )'(da %%(d )c1%/*a,a
-a @ de 're2 A/ &ar,%c%&a, -a eec,uarea
&arace(,e+e% &r%( &re.a,%rea /a,er%a-e-'r )%
%(),ru/e(,e-'r (ece)are )er5%(d /ed%cu- )%
a&-%ca(d u( &a()a/e(, c'/&re)%5 du&a
,er/%(area &u(c,%e%2
Pac%e
e-ec,
/%c)
)u&-e
ad/%
&re+%
I( ur
au e-I( ac
u)'r
de >
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Ingrijireapacientului cu ciroza hepatica
?2 DIFICULTATEA DE
A SE ODIHNI
2 RISC AL
COMPLICATIILOR
INFECTIOASE
Pac%e(,u- )a
*e(e%c%e+e de
)'/( ca(,%,a%5 )%
ca-%,a,%5
)a,%)aca,'r
Pac%e(,a )a (u
&re+%(,e r%)cu-
c'/&-%ca,%%-'r
Pac%e(,e% % )e ad/%(%),rea+a -%c1%de ca-de
7-a&,e0 cea% de /u)e,e-0 de ,e% 8 %(a%(,e de
cu-care2 Se %(,'c/e),e u( &r'.ra/ de
'd%1(a %( c'/u( de ac'rd cu &ac%e(,u-
Se rea-%+ea+a u( c-%/a, de -%(%),e )% c'('r,
care )a (u )u&ra)'-%c%,e a(a-%+a,'r%% aud%,%5%
)% 5%+ua-%2Nu )e &', ad/%(%),ra /ed%ca=
/e(,e cu eec, )eda,%52 I( ace), )c'& )e
ad/%(%),rea+a /ed%ca/e(,e cu eec, u)'r
)eda,%5 de ,%&u-: C%&r'1e&,ad%(a >,* -a
cu-care )au Fe(%ra/%(a >,* )eara -a cu-care
&e(,ru a e5%,a eec,u- ,'9%c 1e&a,%c a- *ar*%,ur%c%-'r2 A/ e9&-%ca, &ac%e(,e%
(ece)%,a,ea re)&ec,ar%% re&a')u-u% %+%c )% a-
,ra,a/e(,u-u%2 Pe(,ru a (u=% &er%c-%,a
re)&%ra,%a )% u(c,%a card%'5a)cu-are
&ac%e(,u-u% % )=a eec,ua, &arace(,e+a
e-%/%(a(d ?- -%c1%d a)c%,%c2
Du&a eec,uarea ,e1(%c%% a/ de+%(ec,a,-'cu- &u(,%% )% a/ a&-%ca, ' c'/&re)%e
),er%-a &e(,u &re5e(%rea %(ec,%e%2
A/ )a,u%, &ac%e(,u- )a (u )e /%),e &rea
/u-, %( &a, )% )a (u )e r%d%ce du&a
eec,uarea &u(,%%2
A/ a)%.ura, ca &ac%e(,a )a %e ec1%-%*ra,
(u,r%,%'(a- ad/%(%),ra(du=% ' d%e,a *'.a,a
%( .-uc%de0 %,a/%(e )% &r',e%(e2
Se a)%.ura cura,e(%a -e(6er%e% de &a, )% de
c'r& a- &ac%e(,u-u% &e(,ru a &re5e(%%
a-,erarea %(,e.r%,a,%% ,e.u/e(,are2
A/ )u&ra5e.1ea, ca,e,ere-e 5e('a)e
I( ur
d'ar
d%/%
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re)&%
Re)&TAW
Pu-)W
Pac%e
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c'r&u
I( ur
&ac%e
,e.u/
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Ingrijireapacientului cu ciroza hepatica
a&-%ca,e &e(,ru rea-%+area &eru+%%-'r )% /=
a/ a)%.ura, )a %e )c1%/*a,a -a @ de 're2
Ta*e- ?. P-a( de %(.r%6%r% &ace%(, II
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Ingrijireapacientului cu ciroza hepatica
C!)'$+3%%
A/ a-e) acea),a -ucrare &e(,ru a e5%de(,%a .ra5%,a,ea e('/e(e-'r ce a&ar %( c%r'+a 1e&a,%ca
)% &e(,ur a ,ra.e u( )e/(a- de a-ar/a a)u&ra eec,e-'r ('c%5e a-e c'()u/u-u% de ac''-2
F%ca,u- are r'- de de,'9%%ere a 'r.a(%)/u-u%0 %%(d 'ar,e %/&'r,a(, %( ,'a,e &r'ce)e-e
/e,a*'-%ce2 U( e('/e( %(-a/a,'r0 ,u/'ra-0 5%ra-0 e,c care &er,ur*a 1'/e'),a+%a ace),u%a are
re&ercur)%u(% a)u&ra %(,re.u-u% 'r.a(%)/2 De&%),area &rec'ce a u('r *'-%0 &recu/ )% a u('r
,a*%e,ur% a-%/e(,are .re)%,e &'a,e de,er/%(a %(ce,%(%rea &r'ce)e-'r de de.radare2 O da,a a6u()
&ac%e(,u- %( )&%,a-0 a)%),e(,a /ed%ca-a are r'- %/&',a(, %(ca de -a %(,rarea ace),u%a &e &'ar,a
)&%,a-u-u%0 'cu&a(du=)e de %(,e.rarea0 5%(decarea )% reacerea &ac%e(,u-u%2
A/ %(cerca, &r%( acea),a -ucrare )a re5%+u%e)c ,e1(%c%-e de (ur)%(. (ece)are %(.r%6%r%% u(u%
a),e- de &ac%e(,0 %()a ,e/a,%ca ra/a(a(d %(ca de)c1%)a2
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Ingrijireapacientului cu ciroza hepatica
B%0$%!#(a%e
1.Tra,a, de .a),r'e(,er'-'.%e )% 1e&a,'-'.%e0 M2 A(dre%ca0 Ed%,ura Med%ca-a0 @
@2 Tra,a, de /ed%c%(a %(,er(a0 Oc,a5%a( F'd'r0 ed%,ura Med%ca-a0 >
42 C1%ra O-%/&%a ; B'-%-e cr'(%ce a-e %ca,u-u% ;0 Ed%,ura Med%ca-a 0>@ 0 Bucure),%
?2 Ga-ea G1e'r.1e ;C%r'+a He&a,%ca ; 0 Ed%,ura Med%ca-a 0>4 0 Bucure),%
F%. >: 1,,&:2/ed%c%(e(e,2c'/)cr%&,/a%(ar,2a)&ar,%c-eeW@K4K
F%. @: 1,,&:2r'/ed%c2r'c%r'+a=1e&a,%ca
F%. 4: 1,,&:2*e(d'2r'a)c%,a=d%(=c%r'+a=1e&a,%ca
F%. ?: 1,,&:2.a),r'/ed2r'C%r'+a=1e&a,%ca21,/-
F%. : 1,,&):2.''.-e2r')earc1`W1e&a,%cb*%W>@b*%1WKb)'urceW-(/)b,*/W%)c1
b)aWXb5edWa1UE6.u,XNA1MDR'HZ1CAUIB%.B,*/W%)c1b`
Wc%r'+ab%/.rcWG/A-&GG`R.M4A