KirurškaNjega

7/23/2019 KirurškaNjega

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ŠKOLA ZA MEDICINSKE SESTRE MLINARSKAZAGREB, MLINARSKA 34

ZDRAVSTVENA NJEGAKIRURŠKIH BOLESNIKA

- nastavnica: Sanda Sa!"#$an%c, &acc'!%d't%c(n'



ZDRA)ST)ENA N*EGA KIR+RŠKOG BOLESNIKA - OA

Previjanje kirurške raneRana .% /%0id 0"1% i2i s2nic% iavan ta!"! i2i 0i#0i! a(vat"!'

!ije"jenje rane ER RIMAM 5 /i!an" ci.%2.%n.% an% 6&% in7%0ci.%8 ER SEC+NDAM 5 s%0ndan" ci.%2.%n.% an% 6s in7%0ci."!8

ER RIMAM INTENCIONEM 6''89 /i!an" ci.%2.%n.% i2i s.%din.%n.% /" /v". int%nci.i 6na!.%i8 a "dn"si s% na ci.%2.%n.%n%in7ician% an% /i!a0nt% 0i#0i! #av"vi!a' Ta0" !"1% ci.%2iti i 0i#0a i ta!ats0a ana'Te#e u $ri %a&e

prva faza 9 INLAMATORNA 9 AZA ;IŠ;EN*A RANE ta.% <4 5 4= sati' T" .% %a0ci.at0iva na ta!' + /va dva sata s% stvaa 0vni >#a0 i is/n.ava /"st" an%, a na /"v#ini0"1% >#a0 tv"i 0ast 0".a /"0iva an i #titi .% "d "#t%$%n.a i in7%0ci.%'Z&"> /"/st2.iv"sti sti.%n0% 0a/i2aa d"2ai d" i2a1%n.a t0ivn% t%0$in% 6sad1i %it"cit%,&.%2an?%vin%, 2i!7, 2%0"cit%8 0".a s% s2i.%va %n /0"tin' +2">a 2%0"cita .% da %2i!inia.

#t%tn% tvai 6"&a!&%ni !%(ania!8'druga faza 9 KOLAGENA AZA 9 AZA SL*EL*I)AN*A &"va an% ta.% @ - dana'T" .% 7aa stvaan.a v%ivn"> t0iva t.' 0"2a>%na' "st" an% s% is/n.ava >an2aci.s0i! t0iv"!i /"?in.% /%!"#tavan.% an% 0"2a>%ni! v2a0ni!a' Za stvaan.% 0"2a>%na /"t%&n% s&.%2an?%vin%, 0isi0 i c vita!in '

treća faza 9 AZA ST)ARAN*A CICATRIA 9 OIL*KA ta.% "d n%0"2i0" t.%dana d"n%0"2i0" !.%s%ci /a i >"din dana'

O1i2.a0 !"1% &itin%%2i 9 cv%n, tvd i inad ain% 0"1% 6ta0" "sta.% n%0"2i0" t.%dana, !.%s%ci8%2i 9 &i.%2, !%0an i aini 0"1% 6na0"n n%0"2i0" !.%s%ci, >"din dana 8

Svr'a (revijanja rane ' Osi>ati "/ti!a2n% v.%t% a n.%in" ci.%2.%n.%<' Za#tititi "d 0"nta!inaci.% /at">%ni! !i0"">ani!i!ai "0"2in%3' S/i.%?iti /i.%n"s !i0"">ania!a i in7ician% an% na d>% &"2%sni0%

v" /%vi.an.% an% /"v"di s% <' i2i 3' /"st "/%ativni dan' Rani.% s% /"v"di sa!" a0" .%/"t%&n" 60va%n.%, ana ni.% s(a, da s/i.%?i!" a!n"1avan.% !i0"">ania!a 5 0v .%d"&a /"d2">a8' In7%0ci.a

Za)a*e +e+$re (ri (revijanju rane ' Pri(re,a (ri-.ra: 0"2ica a /%vi.an.% "/ati i d%in7iciati' S2"1iti /i&"' Na >"n.". /"2ici

sv% st%i2n": "t"/in% a /%vi.an.%, s%t"vi a /%vi.an.%, 0avic%' Na s%dn.". /"2ici sv% ?ist":av".i, 2%0"/2ast, )C 0avic%' Na d"n.". /"2ici n%?ist": /"sda a "d2a>an.%/"ti.%&2.%ni( inst!%nata, /"ti.%&2.%n% &&%1ast% d.%2ic%'

)%$a a "d2a>an.% s0int"> av".n"> !at%i.a2a' i.% /%vi.an.a /%0"nt"2iati/"t%&an /i&"F KOLICA ZA RE)I*AN*E MORA*+ +)I*EK BITI SREMNA SAS)IM OTREBNIM RIBOROM'

<' Pri(re,a (r.+$.ra: %vi.an.% s% v#i /"s%&n". /"st"i.i 5 /%vi.a2i#t i2i &"2%sni?0".s"&i' "st" 0".%! s% v#i /%vi.an.% !"a s% "?istiti sat /i.% /%vi.an.a 60"2i0" s%/%vi.an.% v#i &"2%sni?0". s"&i, "n" s% iv"di sat na0"n .tan.% n.%>% i ?i#$%n.a8'Zatv"iti /""% i vata, "si>ati d"&" "sv.%t2.%n.% i /ivatn"st &"2%sni0a - /aavan'

3' Pri(re,a .+.-"ja: !%dicins0a s%sta i 2i.%?ni0 : /"v%ati 0"s , staviti 0a/ i !as0,a#titn /%>a?, "/ati 0% FFF , "&$i 0avic% n%/"s%dn" /i.% /%vi.an.a'

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4' Pri(re,a -."e+nika: /titi &"2%sni0a va1n"st /%vi.an.a, 0at0" "&.asniti /"st/a0'+/""iti >a da a vi.%!% /%vi.an.a ni#ta n% dia 0a!a i n% /i?a, t% da "0%n% >2av s/"tn stan ' S!.%stiti >a "d>"vaa.$i /"2"1a.'

@' P.+$u(ak: na0"n /i/%!% /"st"a, /i&"a, &"2%sni0a, "/ati 0%' Ot0iti /"d?.%/%vi.an.a' Os2"&"diti an av".a' i s0idan. av".a 672ast%a8 /aiti da n% "#t%ti!" 0"1'Ga s an% s0inti 0"! )C 0avici d" /"s2.%dn.% >a% 6"n% di%0tn" na ani8' Od2"1itiav".ni !at%i.a2 n%?ist"' Otv"iti st%i2an s%t a /%vi.an.%, "&$i 0avic%' inc%t"! i2i(vata2.0"! i!a!" >a' S%sta 0".a asistia /"2i.% t/7% d%in7%0ci.s0i! s%dstv"! NEDODIR+*+I GA BOCOM 6"0" c! inad t/7%a8' D"v"2.n" .% t"2i0" d%in7ici.%nsa da it/7%a 0a/n% n%0"2i0" 0a/i' D%in7%0ci.a an% v#i s% d1ni! /"0%t"! di%0tn" /"sa!"! % 6/v" !%di.a2n", a 2at%a2n" 0asni.%8 "d v(a an% /%!a d"2.% 0"d v%$i( ana6.%dan /"t% i &aca s% t/7%8, a 0"d !an.i( 01n" "d s%din% /%!a van' A0" &"2%sni0 i!avi#% ana 6%, d%n, vi#% incii.a8, sva0a s% ana d%in7icia /"s%&n", 0"ist%$i s% vi.%0n"vi! t/7%"!' +vi.%0 d%in7iciati "d %a 0a /%i7%i.iF "0iti an st%i2ni! t/7%"! 6i2i"staviti "tv"%n"8' N% staviti vi#% "d <-3 s2".a >a% 0a0" &i !">2i /atiti 0va%n.% i s%0%ci.an%, a2i i "!">$i2i d"t"0 0isi0a'Li.%/2.%n.% 2%0"/2asta:N%/"s%dn" na0"n "/%aci.% 2%0"/2ast s% 2i.%/i sa sv% ?%tii stan%>a% a s%dina .% &% 72ast%a &"> 0isi0a 0".i .% ani /"t%&an a ci.%2.%n.% 6stvaan.%0"2a>%na i aa#tan.%8' Na0"n /v"> /%vi.an.a 72ast% s% 2i.%/i sa!" s >"n.% i d"n.% stan% i/" /"t%&i /" s%dini' D"&" at%>nti i %dn" a2i.%/iti 2%0"/2ast"! .%dna0% v%2i?in%'

Re).+"ije) (revijanja ' ?ist% an%<' s%/ti?n% i 0"nta!inian% an%

Kit%i. a %d"s2i.%d /%vi.an.a !"1% &iti i stan.% (itn"sti 5 0va%n.%, "t/st i &"2nic%'

Ki#0i s%t sast".i s% "d : 3-4 0"c0asta t/7%a, 3-4 0"c0asta a%ana t/7%a, 3-4 "0>2a t/7%a, <-3 #ta/i$a na!"tana vat"! #0a%, anat"!s0a /inc%ta, (vata2ica /" /%an

Va/enje šav.va: "&i?a.%n" s% #avi vad%:

H - = /"st"/%ativni dan 60%, t&(, >dni 0"#84 - @ /"st"/%ativni dan 62ic%, vat, !%0i ">2ava08 5 < /"st"/%ativni dan 62%a, d"n.i %0st%!it%ti 0"d stai.i( "s"&a8

"t%&n" .% an d%in7iciati' Anat"!s0"! /inc%t"! s% (vati J&0 J inad ?v"a, 2a>an"di>n% i /%%1% 0"nac is/"d ?v"a ti0 0"1' Di" #ava 0".i .% &i" vani 6i 0"1%8 n%/"v2a?i!" 0" 0"1' Šavi s% vad% i 0"1% a n% 0" 0"1'Re)0 šv0 Zna?i %dciati #av% 5 sva0i d>i i2i t%$i "visi 0a0" "dinia "/%at%'Šv0 E10 Zna?i da s% vad% svi #avi'

I>2% a #ivan.%: na.?%#$% s !.%s%?ast"> "&2i0a, i.%t0" s% 0"ist% avn%' Ra2i?it% s d1in% id%&2.in%' Za 0"1 s% 0"ist% t"&id%' I>2% !"> &iti i ata!ats0% a0" s a.%dn" s 0"nc%!6tv"ni?0i /"iv%d%n%8 /a n% ta!atiia. t0iv" .% n% i2a% dva ta0a 0"nca i a .%dn"0atn

s /"t%&' I>2% &% 0"nca "&i?na i>2a 5 0"nac s% nav"di n%/"s%dn" /i.% /"t%&%' K"nacs21i a s/a.an.% &"va a%an"> t0iva ist% st0t%' K"nac !"1% &iti %s"&ia.$i 6%s"&iat.' as/adn% s%8 i n%%s"&ia.$i 6n% %s"&ia s% v%$ a#ta t0iv"8'"st".i i STERISTRI 5 t" .% ta0a a 2i.%/2.%n.% !an.i( %ni( ana' R&"vi an% s% /i2.&%/"!"$ 72ast%a'M%(ani?0i #av STALES

OTOPINE ZA PREVIJANJE KIRURŠKIH RANA

ALKOHOL %ti2ni H n% na an

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D%natia &.%2an?%vin% &a0t%i.a, n% d.%2.% na s/"%' D.%2.% na "?ni0% t&%02"% i vis(%/atitisa B' + 0"!&inaci.i s d>i! d%in7ici.%nsi!a d.%2.% na vis PI)-a' B" (2a/i,d.%2"van.% nast/a @-< s%0ndi na0"n nan"#%n.a' Kat0" d.%2.% i n% #titi d%in7ician/"v#in "d da2.n.% 0"nta!inaci.%' 62ivas%/t tin0ta8 6"/i2-a20"("2 ."# .% a0tivni.i "d %ti25a20"("2a8'BENZIN n% na anZa s0idan.% !asn"$% i n%?ist"$% s 0"1% i s0idan.% 2%0"/2asta'PLIVASEPT GLUKONAT 602"(%0sidin8 ,@Za d%in7%0ci. 0"1% i s2nica' B"> .% /"d1%n"> &a0t%icidn"> d.%2"van.a, >2.ivic% candidaPI), n% d.%2.% na "?ni0a t&%02"% ni na vis (%/atitisa B' Ba0t%icidni ?ina0 nast/a a@ s%0, a anti!i0"&ni 7i2! 0".i s% stvaa na 0"1i #titi sati "d da2.% !i0"&n% 0"nta!inaci.%'D.%2.% /istn"sti 0vi, >n".a, s%!a, 7%c%sa i d>i( ">ans0i( tvai' ;va s% na s"&n".t%!/%ati, n% s!i.% s% ?vati &"ca!a s /2t%ni! ?%/"! .% /2t" !"1% !an.iti d.%2"van.%02"(%0sidina na n%0% >a! n%>ativn% &a0t%i.%, st">a s% /%/"?.% /2asti?ni, sta02%ni i2i>!%ni ?%/'VODIKOV PEROKSID 3 6"0sidativn" s%dstv"8i ?i#$%n. n%?isti( 5 >n".ni( ana' + d"di s ">ans0"! tvai /.%n#an.% s% "s2"&aa 0isi0i d.%2.% n%/"s%dn" "0sidativn" na /"t"/2a! &a0t%i.a' .%n#an.% !.%(i$a a&i.a i di1%na /"v#in "d!2" t0iv", >n". i sv n%?ist"$ #t" "2a0#ava n.i("v" "t02an.an.% i ana' N%0"a>2ia 0v' N%d"stata0 .% #t" d.%2.% sa!" d"0 ta.% /.%n#an.%, iitia t0iv" 6"#t%$.%>an2aci.%8' Sta&i2an .% a0" s% /"/isn" ?va ta!n". &"ci'BETADIN 6/"vid"n! i"dinat! 8Ot"/ina .% s!%% &".%, s21i a d%in7%0ci. 0"1%, 0i#0i( in7iciani( ana' Ba0t%icidn"> .%,vicidn">, 7n>icidn"> i /"2"n>ian"> d.%2"van.a' +/"t%&2.ava s% 0i#0". /"7i2a0si6/%v%nci.a !i0"&i"2"#0% 0"nta!inaci.%8'2ER!URI!HRO2 <B2a>i antis%/ti0, /"s/.%#.% %/it%2iaci. - a /2i$%, /"v#ins0% an%'NATRI*-!HLORID 345 6'i(er$.ni#na .$.(ina 7I+ušuje an% 0".% v2a1% .% na s%&% nav2a?i v"d , /"s/.%#.% stvaan.% >an2aci.a 'NATRII !HLORIDI IN8UNDIBILE ,Q 67ii"2"#0a8+/"t%&a a is/ian.% ana i t.%2%sni( #/2.ina'

!ije"jenje kirurške raneRana !"1% ci.%2itiER RIMAM - /i!an", &% in7%0ci.% 6sti.%n0% an% s /i2.&2.%n%, ana n% &"2i, t.%2%snat%!/%ata ni.% /"vi#%na, n%!a isc.%t0a, ana aci.%2i i!% H- dana8ER SEC+NDAM 5 s%0ndan", s in7%0ci."! 6sti.%n0% an% s a!a0nt%, i an% s% ci.%di>n".ni isc.%da0, ana .% &"2na, t.%2%sna t%!/%ata .% /"vi#%na8

Na.?%#$i "0 /"%!%$a.a ci.%2.%n.a an% .% in7%0ci.a'

IZVORI IN8EK!IJE RANE

E>">%ni - "/%aci.s0a dv"ana - a0, /"0iva?i, "s"&2.% 6n"s, 0% 57n028- "d.%2 5 in7ician% an%, 0"nta!iniani av".i, inst!%nti, a0, /"d, /"0iva?i,

"s"&2.% 6n"s,0%, in7%0tivna 1ai#ta8 &"2%sni0 6n"s, 0%, in7%0tivna 1ai#ta8End">%ni 5 na.!an.% "t/"n" t0iv" .% ta!atiian" t0iv" /a .% d"&a /"d2">a aa!n"1avan.% MO' D>"ta.na "/%aci.a, J/2.ava "/%aci.a6MO i /"a 0"1% i2a% na/"v#in, a ati! i an a0" "/%aci.a ta.% d1% "d ,@ sat8' St%i2na 7"2i.a s% 2i.%/i nad%in7ician" "/%ativn" /"2.% /i.% "/%aci.%, /%0" n.% s% v#i % i ta0" s!an..% !">$n"stnastan0a in7%0ci.%'

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Rana s% /vi /ta /%vi.a <' d" 3' /"st "/%ativni dan' %vi.an.% an% s% "&avi i ani.% a0" s%/".av% n%0% "d 0"!/2i0aci.a i2i /"t%#0"$a 60va%n.%, &"28%vi.an.% an% 0".a ci.%2i /% s%cnda!: s0inti 0avica!a av".% s an%' Ivaditi #av%,astv"iti an i %ti &is 6na a%"&n% i ana%"&% anti&i">a!8' Rana s% t%0 tada ?isti t.'d%in7icia i t" (id">%n"!' Na0"n t">a s% is/i% 7ii"2"#0"! "t"/in"! &"> iitaci.%' + an s%stav2.a >aa nat"/2.%na B%tadin"!' Ka0" .% t" ana 0".a ci i !"a s% sva0"dn%vn" /%vi.ati6?i! >aa /"!"?i8, stav2.a s% vi#% s2".%va >a% i2i vatiana da /i.% sad1a.' Kada /%stan%i2aiti >n".an sad1a., a ana ."# v2a1i, stav2.a s% >aa nat"/2.%na NaC2 ' Ta0" s% &avastvaan.% >an2aci.a a ti!% i !">$n"st stav2.an.a s%0ndani( #av"va' i.% stav2.an.a #av"vat%&a %ti &is an% >d.% s% "?%0.% 7ii"2"#0a 72"a' S%c%niati - na?i da ana v2a1i 6!"1% &iti>n".an i2i s%"an sad1a.8' In7%0ci.a s% 2i.%?i "0" 4 dana' S%0%ci.a s% /"st%/%n" s!an..%6na.vi#% /va 4 dana8' Rana s% /"v%!%n" 0"nt"2ia !i0"&i"2"#0i' Kada /%stan% s%0%ci.a a!i0"&i"2"#0i na2a .% ad"v"2.ava.$i, stav2.a. s% s%0ndani #av"vi' S%0ndani #av"vi s%stav2.a. na "d.%2 2"0a2n". an%st%i.i' +0"2i0" an t%&a "&aditi 5 !"di7iciati, adi s% "&adaan% "/$". an%st%i.i sa2i' Ovi #av"vi "sta. d1% /a s% n% vad% /i.% ' 5 4' dan "d/"stav2.an.a'

K.,("ika9ije .(era$ivne rane' Kva%n.%<' In7%0ci.a3' P%!at"!4' S%"!@' D%(isc%nci.a 5 /"t/na i n%/"t/na

Krvarenje: na.?%#$% s%0ndan"' "st/a0 "visi " a2"> 0va%n.a'

In%ek9ija: Kaa0t%isti0% in7ician% an%a8 &"2 5 n"!a2n" &"2i <4-4= sati na0"n "/%aci.%, a a0" &"2i i da2.% 5 t" .% /vi i >2avni na0in7%0ci.%&8 cv%ni2" 5 na0 /a2%c8 %d%! 5 sva0a "/%ativna ana .% %d%!at"na /a t" ni.% si>an na0

d8 t"/2ina 5 n% !"1%!" &a# /i/ati an, a2i "0"2in da

He,a$.,: &"2%sni0 "s.%$a &"2, i!a 2a>an" /"vi#%n t%!/%at, "visn" " v%2i?ini /"d2i.%va,ana 2a>an" i&"?%na 6/2av"8, an t%&a "tv"iti i istisnti sad1a. 6>#a08

Ser.,: ana 2a>an" i&"?%na, "s.%$a &"2 i t%!/%ata .% 2a>an" /"vi#%na i na0"n 4= sati' A0"s% ana "tv"i, i2ai s%"na t%0$ina'

De'i+9en9ija: T" .% a!ican.% &"va sa#iv%n% an%'n%/"t/na 5 astvaan.% d" !i#i$a i2i 7asci.%' "/sti2i s i2i sa!" van.s0i i2i sa!" ntan.i#av"vi' i!.% .% 0ada ci.%v" i2ai d" 0"1% 5 "1i2.na (%ni.a,/"t/na - 0ada /"/st% i van.s0i i ntan.i #av"vi 9 dis/ci.a'

D%(isc%nci.a sa %visc%aci."! 5 svi #av"vi s /"/sti2i i ntan.i ">ani is/ada. van6ci.%va8' "!"$ .% st%i2n" aviti i v2a1iti 7ii"2"#0"! "t"/in"! da n% nast/i >an>%na' NE)RAATI ORGANEF B"2%sni0a t%&a (itn" /%v%sti sa2'+"ci d%(isc%nci.% 5 (i/"/"t%in%!i.a, /"%!%$a. 0"a>2aci.%, 0acin"!i, %"/%aci.a,di.a&%t%s, 0"ni?ni a20"("2i?ai, d>"ta.n% "/%aci.%, in7%0ci.%, /%ti2"st

A0" s% /%dvia !">$n"st nast/an.a d%(isc%nci.% stav2.a s% v%nt"7i2 5 si>n"sni #av' Ta.#av s% s0ida i t.%dan dana na0"n /i!an"> #ava '

DRENA:A .% /"st/a0 0".i! s% "!">$.% i2a1%n.% t%0$%> sad1a.a i ana, >n".n">1ai#ta, t.%2%sni( #/2.ina'

5



/"!"$ d%na, s"nd% i2i 0at%t%a "!">$.% s% "dstan.ivan.% 0vi, s%0%ta i as/adnti(/"d0ata i 0i#0% an% i t.%2%sni( #/2.ina' t%0$i sad1a. .% 0v, s0vica, >n"., ci.%vni sad1a., 1%2?ani sad1a., in, 1?, d%n s% /"stav2.a na na.ni1%! di.%2 an% 0".a s% d%nia' indi0aci.% a d%na1: A/sc%s, 72%>!"na, in7ician% an%, in7ician% t.%2%sn% #/2.in%, /i!an""&a%n% 0i#0% an% sa stvaan.%! v%$% 0"2i?in% s%!a, "2.%d% /sn"> 0"#a, d%na1at&#n% #/2.in% a2i0.%!" a0tivn i /asivn d%na1; Ak$ivna )rena<a REDON DREN 7n0ci"nia na na?%2 n%>ativn"> t2a0a, /i!.%n..% s% 0"d"/%aci.% d".0%, #titn.a?% 0"#tani( "/%aci.a, (%ni.% D%na1a s% v#i /"!"$ &"c% s nis0i!n%>ativni! t2a0"!' Osi! #t" "dstan..% s%0%t i an%, /id"n"si s2.%/2.ivan. &"va an% ici.%2.%n.' O?%0.% s% -<!2 s0vic% ti.%0"! <-3 dana'

ZAT)ORENA ASIRACI*SKA DRENAA s /"!"$ a/aata sas&at!"s7%s0i! t2a0"! 0".i sisava a0 i2i t%0$in i /si#ta'

Zada$% s%st% 0"d a0tivn% d%na1%: "!atati &"2%sni0a' K"nt"2a &".% i 0"2i?in% sad1a.a, i!a2i n%>ativn"> t2a0a &"ci, .% 2i d%n /"("dan,

; Pa+ivna )rena<a NAZOGASTRI;NA SONDA+RINARNI KATETER

ABDOMINALNI DREN LAŠ)ICA GAZANa">asti?na s"nda 5 d%nia s% 1%2dac' S"nda na 0i>i.i na?i ni#ta na sta' Sad1a. .%1t% &".%, a a0" ni.% %d !"1% &iti %t%nci.a, 0v, 7%0a2i.%''

+inani 0at%t% 5 d%na1a !.%(a' M.%iti di%, >2%dati &"., i!ati "0% a ana2i''

A&d"!ina2ni d%n 5 i!a vi#% "tv"a, 7i0sian .% 0"1ni! #av"!' N"!a2n" s% s0/2.a s0vavsad1a. 6t0ivna t%0$ina8 inan v%$ic d" <@ !2 ti.%0"! ci.%2% d%na1%' )adi s% <'-3'/"st"/%ativni dan, "visn" " 0"2i?ini id%nian"> sad1a.a' at"2"#0i sad1a. .% 0v, >n"., ci.%vni

sad1a. +0"2i0" na a&d"!ina2ni d%n id% /at"2"#0i sad1a., d%n s% n% vadi v%$ "sta.% d"0 s%stan.% n% /"/avi, a /"n%0ad s% d%n s0a$.% /a >a tada t%&a "si>ati i>2"! si>n"snic"!'

La#vica 5 .% >!%na ta0ica -< c! #iin% i d" < c! d1in%' K"isti s% 0"d >n".ni( ana 0".%i!a. dn"' "stav2.a s% s ci2.%! da s% ana n% s2i.%/i t% da s% /" n.". >n". s2i.%va i an% asad1a. s% s0/2.a >a'

D%n"vi s "d%%n"! na!.%"! : T 5 d%n, BU2a

Zada$% s%st% 0"d /asivn% d%na1%: /"!atan.% &"2%sni0a, 0"nt"2a &".% i 0"2i?in% sad1a.a,/atiti i!a 2i d%na1a /i"dan /ad, %d"vita /"!.%na v%$ic% a s0/2.an.% sad1a.a i &i2.%1%n.%i!.%%n"> na t%!/%atn 2ist'

6



KIRURŠKA OBRADA RANE

OZLJEDE s "#t%$%n.a ">ani!a, 0".a a(va$a. sv% n.%>"v% di.%2"v% "d 0"1% i s2nica d"svi( ntan.i( ">ana'S "&i"! na "#t%$%n"st 0"1% i s2nica di.%2i!" i( na atv"%n% "tv"%n%

ZATVORENE OZLJEDEN%!a "#t%$%n.a 0"1% i s2nica, &ivan.a s% "dvi.a. nta ">ani!a' O2.%d% !"> &iti t%#0%6ntan.a 0va%n.a, "2.%d% ntan.i( ">ana8'G2avni si!/t"!i 5 &"2"vi, na0"vi ntan.%> 0va%n.a, "2.%d% ">ana, /i.%2"!i

OTVORENE OZLJEDENasta.% "#t%$%n.% 0"1% i2i s2nica9RANA .% /"v%da 0".a a/"?in.% /%0id"! 0"ntinit%ta 0"1%

i2i s2nic%, a da2.a d%st0ci.a 6aaan.%8 t0iva "visi " si2i i !%(ani!/"v%ivan.a'

KARAKTERISTIKE RANE: Otvaan.% 0"1n"> "!"ta?a, d%st0ci.a t0iva, "tvaan.% /ta in7%0ci.i

LIJE=ENJE RANE

va !%dicins0a /"!"$, A0" 0vai S0idan.% "d.%vni( /%d!%ta ;i#$%n.% an%ZavitiI!"&i2iiati Ana2>%i.a Tans/"t

OSNOVNA NA=ELA KIRURŠKOG ZAHVATA

A+e($i#ki (.+$u(akOs"&2.% 0".% sd.%2.% 0"d a(vata !"a "&aviti 0i#0" /an.% i d%in7%0ci. 0, "&$i st%i2ni">ta?, nav$i st%i2n% 0avic%, na >2av staviti 0a/, a /%0" n"sa i sta !as0' i/%!a&"2%sni0"v% 0"1%' O/%aci.s0a dv"ana !"a &iti ?ista "d 0"nta!inaci.%!i0"">ania!a'Ti.%0"! a(vata 0"isti s% is02.?iv" st%i2an /i&" i !at%i.a2'

KIRURŠKE TEHNIKEIncii.a 9 0i#0i % 6Radi s% /avi2 d1 n"!a2ni( 0"1ni( 2ini.a - i&.%>ava s% n%0"a 0".a

/">"d.% in7%0ci.i i2i s/"%n"! ci.%2.%n. 8Dis%0ci.a 9 /%/aian.%' Iv"di s% anat"!s0i! s2".%vi!a t0iva'E0scii.a 9 d%&id!an &"va an% s2i.%d "2.%da' Na.va1ni.i .% /"st/a0 /i "&adi

0"nta!inian% an%, "dstan..% s% "#t%$%n" t0iv" i stana ti.%2a 6a#tita"d in7%0ci.%8'

P%!"staa 9 astav2.an.% 0va%n.a' S/.%?ava s% nastana0 (%!at"!a i s%"!a, va1n" .% da/"d?.% 0".%! s% adi &d% ?ist" &"> /%cin"> ada' Radi s%%2%0t"0"a>2aci."! i2i /"v%ivan.%! 0vn% 1i2%'

PRI2ARNA OBRADA RANE 6/" i%dic(8 .% 0i#0i a(vat 0".i s% ?ini 0"d sv.%1% an%/vi( = d" < sati "d nastan0a "2i.%d% 'RIMARNA OBRADA RANE .% %0scii.a &"va /"vi.%%n"> t0iva, "dstan.%n.% >#a0a,stani( ti.%2a i "#t%$%ni( di.%2"va' Radi s% t%!%2.ita (%!"staa' Zatvaa s% ana /i!ani!#av"! 0a0" &i s% s/i.%?i2a na0nadna 0"nta!inaci.a' Ran t%&a st%i2n" aviti, /"vi.%%ni%0st%!it%t i!"&i2iiati'

RIMARNI ŠA) *E ZABRAN*EN a0" .% ana stai.a "d =-< sati 6na!n"1i2% s s% &a0t%i.%8,a0" ni.% &i2" !">$% /"t/n" "dstaniti stana ti.%2a, an% s d1%/"vi!a i v%2i0i! st/n.%!na>n.%?%n.a, in7ician% an%, /"7%si"na2n% "2.%d% 60i>, /at"2">, v%t%ina8, >in% an%

7



6"/asn"st "d !i.%#an.a in7%0ci.% i >n.%?%n.a t0iva8, atn% i sti.%2n% an% 6"/s%1n" "#t%$%n.% i .a0" a>a%n.%, t% a0a#n.%2a "&ada8'+vi.%0 s% /"v"di a#tita /"tiv t%tansa'

PRI2ARNO ODGO>ENI ? ODLO:ENI ŠAVNa0"n "&ad% an% /" i%dic( 5 an s "d2"1%ni! #avi!a st%i2n" aviti' "s2i.% <4 5 4= satian t%&a /%viti 5 /%0"nt"2iati .% 2i s% avi2a in7%0ci.a' A0" s% avi2a in7%0ci.a t"0 ti( 4=sati #av"vi s% n% st%1, v%$ s% vad% i /"st/a s% 0a" sa in7ician"! an"!' A0" .% ana i!%3' i @' dana s(a i &% >n".n% s%0%ci.%, !"1% .% s% atv"iti /%t("dn" /i/%!2.%ni! /i!an""d2"1%ni! #avi!a'

SEKUNDARNI ŠAV"st/a0 atvaan.a an% na0"n i2i.%?%n% in7%0ci.%' %stana0 s%0%ci.% i sv.%1% cv%ni i>2%d>an2aci.a, na0 s da .% in7%0ci.a sav2adana 6&is >an2aci.s0% /"v#in%8'S%0ndani #av"vi s% stav2.a. i!% ' i <' t.%dna na0"n sanian.a in7%0ci.%'

ORGANIZA!IJA RADA NA KIRURŠKO2 ODJELU

INDIKACI*E ZA OERACI*+ A/s"2tna indi0aci.a 9 PITNA OERACI*A R%2ativna indi0aci.a 9 PLADNA OERACI*A

OERACI*A *E MEPANI;KI RAD NA TKI)IMA i ORGANIMA 0".i "!">$.%: i2.%?%n.%,"2a0#an.% t%>"&a, /"stav2.an.% di.a>n"%'RADIKALNA OERACI*A 9 IZL*E;EN*E "t02an.an.% "0a, 1ai#ta, "&"2.%2"> ">anaALI*ATI)NA OERACI*A "!">$.%: "t02an.an.% t%#0"> stan.a 6ans /a%t%8EKSLORATI)NA OERACI*A s21i a /"stav2.an.% di.a>n"% 62a/a"t"!i.a8

RI*EM BOLESNIKA 9 PITAN i REDO)AN

KARAKTERISTIKE RANE "tvaan.% 0"1n"> "!"ta?a 6s2nic%8, d%st0ci.a t0iva, "tvaan.%/ta in7%0ci.i

OZLJEDA IZAZIVAOE ROM*ENE 5 %a0ci.a ">ani!a na ta! "visi " v%2i?ini i "/s%> "2.%d%' Š"0 .%%a0ci.a ">ani!a na t%#0 ta!,LOKALNE ROM*ENE 5 ana, &"2, 0va%n.%, in7%0ci.aKIR+RŠKA 9 OERATI)NA RANA 9 /2aniani .% "/%ativni a(vat' Iv"di >a st?n" 2ic% 90i>, "/%aci.s0". sa2i 9 as%/ti?0i v.%ti' Iv"di s% s na!.%"! - 02"niti ">an-% i2i "2a0#ati&"2, is/aviti /i"%n% i2i st%?%n% !an% i n%d"stat0%'TRA+MATSKA RANA *E IZNENADNA O)REDA KO*A NASTA*E &i2" >d.%, &i2" 0ada, &i2"?i!%, &i2" t0" . na/avi'PRIJEOPERA!IJSKA PRIPRE2A: OA, SECI*ALNADULJINA i VRSTA PRIPREME OVISI O:

KONDI!IJI DOBRA 0a$a LOŠA d2.aDOBI MLAVA 0a$%, d"&" "/$% stan.% STARI*A d2.%, 0"ni?n%&"2%sti, >%"nt"2"#0% /"!.%n%DIJAGNOZIVRSTI OPERATIVNOG ZAHVATA

RIZI=NI =I2BENI!I ZA KIRURŠKI ZAHVATSTARI*A DOB 5 s/"" aastan.% ana, 0"!/2i0aci.% d>"ta.n"> 2%1an.aDEPIDRACI*A 5 s/"%na ci02aci.a 6t"!&"a8+ŠEN*E 5 /a2a /2$a, at%2%0taa, s/"%na ci02aci.a t"!&"%!&"2i.a

8



RETILOST 5 t%1% 0%tan.%, disan.%, /n%!"ni.a, t"!&"a, s/"" aastan.% anaSTRAP 5 %!"ci"na2ni st%s, !i#i$na na/%t"st, (i/%t%ni.a, ta(i0adi.aLI*EKO)I 5 anti0"a>2ansi, /si("7a!aci, 0"ti0"st%"idiO)ISNOST 5 a20"("2 , d">a

OP@A PRIJEOPERA!IJSKA PRIPRE2A BOLESNIKA

Sv(a /i/%!% &"2%sni0a a "/%aci. .% "si>ati ! na.&"2. !">$ 7ii?0, /si("2"#0,s"ci.a2n i d("vn s/%!n"st a 0i#0i a(vat' B"2%sni0a t%&a /i/%!ati /si(i?0i i 7ii?0i'

O/$a /i.%"/%aci.s0a /i/%!a sast".i s% "d "s"&n% (i>i.%n%, /%(an% &">at% &.%2an?%vina!a6,@-<>0> TT &.%2an?%vina8, s/.%?avan.a in7%0ci.% i /%v%ntivni( v.%1&i sv( s/.%?avan.a/"s2i.%"/%aci.s0i( 0"!/2i0aci.a: v.%1&% disan.a, v.%1&% is0a#2.avan.a, v.%1&% %0st%!it%ta'

PSIHOLOŠKA PRIPRE2A BOLESNIKA ZA KIRURŠKI ZAHVATsi("2"#0a /i/%!a &"2%sni0a /"v"di s% "d t%nt0a 0ada sana.% a /"t%& 2i.%?%n.a0i#0i! /t%! sv% d" "d2as0a sa2' M"1% s% a02.?iti da /si("2"#0 /i/%! a/"?in.%0i> 0".i .% /"stavi" indi0aci. a 0i#0" 2i.%?%n.%' On $% &"2%sni0 i n.%>"v". "&it%2.i naa!2.iv na?in "&.asniti /"t%&, va1n"st i 0"isn"st 0i#0"> a(vata' D"2as0"! &"2nicsa!a s/"stava /"itivni( "dn"sa i!% &"2%sni0a i !%dicins0"> "s"&2.a s!an.it $% t.%s0"&i /"ti#t%n"st 0"d &"2%sni0a i /"&"2.#at $% !%s"&n sadn.' "!"$ ?2an"va "&it%2.i i2i d>i(&2is0i( "s"&a v2" .% va1na /a i n.i( t%&a 02.?iti ad s &"2%sni0"!'

"t%&a a 0i#0i! a(vat"! !"1% iavati 0"d &"2%sni0a n%0"2i0" %!"ci"na2ni( %a0ci.a0a0" n"!a2ni(, ta0" i a&n"!a2ni(' Ra2"i a&int"sti &"2%sni0a na0"n /i.%!a &"2nic sa2i?iti'''istan .% "s.%$a. &%s/"!"$n"sti i i>&2.%n"sti, sta( "d s!ti, sta( "d &"2i, sta( "d"/%ativn"> a(vata i i2i an%st%i.%, sta( "d !">$% di.a>n"% !a2i>n"> "&"2.%n.a' istan .% ista( "d v2astit"> i>2%da na0"n "/' a(vata, sta( 0a0" $% "&it%2. /"dni.%ti i&ivan.% i d"!a"s"&it" a0" s0&i " !a2". d.%ci i2i n%!"$n". stai.". "s"&i' M">$ .% i sta( "d >&it0aa/"s2%n.a, /"d#0% "&it%2.i i s2' "&2%!i s% !"> .aviti i st">a #t" &"2%snici n% !"> ad"v"2.itin%0% "d sv".i( 2.ds0i( /"t%&a i Mas2"v2.%v% /ia!id% n/' : /"t%&% a si>n"#$, a7i2i.ativn%/"t%&%, /"t%&% a sa!"/"#t"van.%! i d>%'

ist/i 2i !%dicins0a s%sta &"2%sni0 0"d /i.%!a "s!.%("! i t"/2"! i.%?i, !"1% v%$ tadaad"&iti n.%>"v" /"v.%%n.%' T%&a ! /"0aati &"2%sni?0 s"& i /"st"i.% 0".% &i ! !">2%at%&ati' M"a "dv".iti vi.%!% a a>"v" s &"2%sni0"!, t%tiati >a s /ni! /"#t"van.%!,va1avati 0a" "s"& i na isti na?in t%tiati "&it%2.' "t%&n" .% 02.?iti &"2%sni0a /2anian.% i/"v"%n.% davstv%n% n.%>%, /titi va1n"st i sv( "d%%n"> /"st/0a, /1iti in7"!aci.%" /%dst".%$%! a(vat a2i sa!" "n"2i0" 0"2i0" s!" "v2a#t%ni, t% /1iti %!"ci"na2n /"d#0'Bi2" &i d"&" "&.asniti na?in 0"!ni0aci.% s &"2ni?0i! "s"&2.%! sa2i, /"st"i.i a &%n.% i2i

.%dinici int%nivn"> 2i.%?%n.a'D"0aan" .% da d"&a /si(i?0a /i/%!a /id"n"si &"2.%! /"dn"#%n. "/%aci.s0"> a(vata,&1%! "/"av2.an., da t%&a !an.% ana2>%ti0a, a &"ava0 &"2nici s0a$.% s% a -< dana'

9



8IZI=KA PRIPRE2A BOLESNIKA ZA KIRURŠKI ZAHVAT

ii?0a /i/%!a "&(va$a tins0% /%ta>%, t.' "n% /%ta>% 0".% s% ad% sva0"! &% "&iana di.a>n" a /"/isan% s na sva0"! /".%din"! "d.%2 !a2% 0"%0ci.%' T /i/ada. "n%/%ta>% 0".% "!">$. /"c.%n "/$%> davstv%n"> stan.a n%"/("dn"> a an%st%i. i0i#0i a(vat'T" s: KKS .% 0"!/2%tna 0vna s2i0a >d.% s% 0"nt"2ia.: E 5 %it"citi, L 5 2%0"citi idi7%%nci.a2na 0vna s2i0a, SE 5 s%di!%ntaci.a, G+K 6#"0 i &%n.% vi.%0 /"vis% G+K8, "&i?niin, s%di!%nt ina, %a, 0%atinin' Za 7n0ci. .%t% t%&a na/aviti .%t%n% /"&% 5 AST, ALT,&i2i&in 0/ni i di%0tni' E2%0t"2iti s n%"/("dni a t" s Na 6">ania! >a ?va /vi( /a sati8K 6.a0" s% >&i na0"n "/%aci.% in"! i d%na1"! a va1an .% a !i#i$n 7n0ci.8, Ca, C2' A0"&"2%sni0 d%(idia s&.%0tivn" .% /istna 1% a "&.%0tivn" .% /istna s("$a .%i0a, s!an.%nt>" 0"1%, /a2% "?i, "2i>i.a' A0" nast/i !an.a0 nati.a, "s.%$a s2a&"st, a/ati?n"st >?%n.%!i#i$a, an"%0si.' +0"2i0" i!a !an.a0 0a2i.a &it $% /istna !i#i$na s2a&"st, a/ati.a, nadt"st,ast". st"2ic% i v.%t"va, /a /aa2iti?0i i2%s ?%st" nasta.% 0a" /"s2.%dica !an.0a 0a2i.a' A2&!inis &itni &"> aastan.a an%' Ma2i 0"a>2">a! 6vi.%!% >#avan.a i vi.%!% 0va%n.a t%/"t"!&ins0" vi.%!%8 .% .a0" &itna /%ta>a' Ma0%i (%/atitisa i AIDS-a s% vad% "&av%n"'B"2%snici s /"%!%$%n"! /2$n"! 7n0ci."! i!a. (i/"0si., s02"ni s at%2%0tai, nastan0/n%!"ni%' Zat" stai.i "d >"dina, /#a?i, >".ani, "&av%n" !"a. /"v.%iti /2$n7n0ci.'Nit0" n% s!i.% i$i na "/%aci. &% Kvn% >/% i R( 7a0t"a, EKG-a, RTG-a /2$a i sca 6sa!"ini!n" 6!2adi8 as02taci.a ada sca i /2$a8, /"t/isan"> /istan0a a an%st%i. i "/%aci. t%an%st%i"2"#0"> /%>2%da &% "&ia na (itan i2i %d"van /i.%!'+ 7ii?0% /i/%!% s/ada. i s/%ci.a2n% /%ta>%, a "n% s /"s%&n% a sva0 /".%din di.a>n"t.' s2?a.' Ta0" n/' n%$%!" aditi CT !">a a0" i!a 7a0t nad2a0tic%'

%(ana &"2%sni0a /i.% "/%aci.% v.%t"vana .% stan.%! &"2%sni0a i indi0aci."!, vst"! i!.%st"! 0i#0"> a(vata, stan.%! (an.%n"sti' Pi/"a2&!in%!i.a .% v%2i0i /"&2%! 0"dn%(an.%ni( "s"&a .% ana t%#0" aasta' D%(idaci.a s% sva0a0" !"a i&.%$i'D"0 &"2%sni0 ."# ni.% "/%ian t%&a >a na?iti v.%1&% disan.a i is0a#2.avan.a, t% v.%1&% n"> ist"/a2a 0a" /%v%nci. 0"!/2i0aci.a d>"ta.n"> 2%1an.a' Kada &d% i!a" &"2"v% na0"n"/%ativn"> a(vata n%$% (t.%ti aditi ni#ta #t" >a &"2i i n%$% s2#ati na#a "&.a#n.%n.a a#t" .% t"/"t%&n"'

OP@A PREOPERATIVNA PRIPRE2A BOLESNIKA DAN PRIJE OPERA!IJE

"?in.% /"v.%"! vita2ni( 7n0ci.a, /"!atan.%! "/$%> stan.a, a>"v""! 6/1an.%/si("2"#0% /"t/"%8' Sva0a0" t%&a /"v.%iti i!a 2i sv% 2a&"at"i.s0% /%ta>%' T%&a na?iti0v a0" .% /"t%&n" i /"v.%iti sv &"2%sni0"v d"0!%ntaci.'

)a1na .% /i/%!a /"&avn"> ta0ta /a < sati /i.% "/%aci.% n% s!i.% .%sti a sati /i.%"/%aci.% n% s!i.% /iti' Zadn.i "&"0 .% ?a0 i t" .(a' M"1% /iti n%>aiana /i$a 0a" v"d , ?a.s"0 i s2'd" <<-<4 sata

i/%!a /"&avn"> ta0ta s% sast".i i "d ?i#$%n.% ci.%va: 02i!a 6= sati8 i2i c"2"c2%ns 64sati8 i2i !anit < 4 sati 6<@!2 /% "s8, dana#n.% vi.%!% s/"it"i. = sati i2i D2c"2aWt&2 "0" < sati 'B"2%sni0a t%&a /"d?iti v.%1&a!a disan.a i is0a#2.avan.a i v.%1&a!a /%v%nci.% t"!&"%'T%&a>a /"nati da /i.% "/%aci.% !"a s0inti sv% #t" &i !">2" "!%tati "/%aci. i2i an%st%i. 0a"#t" s na0it, #!in0a, &na /"t%a, 2%$%, d"n.% &2.%' )a1na .% i "s"&na (i>i.%na i /i!.%na/"/isan% t%a/i.%'

10



;%st" s% da.% A/ain a !in n"$ 6@!>8 i anti0"a>2antna t%a/i.a 0a" sastavni di"/%!%di0aci.%'

OP@A PREOPERATIVNA PRIPRE2A BOLESNIKA NA DAN OPERA!IJE

sast".i s% "d /"v"%n.a "s"&n% (i>i.%n%, /i/%!% "/%ativn"> /"2.a, /"v.%% &"2%sni0"v%d"0!%ntaci.%, /i/%!% &"2%sni?0"> 0%v%ta, 0"nt"2% vita2ni( 7n0ci.a, /"!atan.a &"2%sni0a,"&av2.an.a 2a&"at"i.s0i( /%ta>a 0".% ."# n%d"sta. i davan.a /%!%di0aci.%'

Os"&na (i>i.%na s% /"v"di 0"nt"2 /"0%tn"> &"2%sni0a, /1an.a /"!"$i /"2/"0%tn"!&"2%sni0 i2i n.%> n%/"0%tn"> &"2%sni0a' T#ian.% 6/an.%8 &"2%sni0a .% vi.%0 &"2.% "d0/an.a' "s%&n" t%&a d%in7ici.%ns"! "/ati /"d?.% "/%ativn"> /"2.a i di.%2"v% ti.%2a >d.% s%a!n"1ava vi#% MO 6/a(, >2t%a2na %>i.a8' )a1na .% (i>i.%na sn% #/2.in% .% .% &">vaan.a t&sa !">$% iavati in7%0ci. d"n.i( di#ni( /t"va'Bi2" &i d"&" "&$i &%n0icX a "/%aci.' "t%&n" .% /"s0idati sv% d"dat0% 62%$%, /%i0,!.%tn" &a2", na0it, #!in0 8' "v.% t%&a is0"istiti a a>"v" s /aci.%nt"! 0a" di"/si(i?0% /i/%!%'+0"2i0" .% /"t%&n" v"di s% 0at%t%, s"nda, C)K i2i &i2" #t" /" na2"> 0i>a i2i an%st%i"2">a'i/%!a "/%ativn"> /"2.a s% sast".i i "d &i.an.a 6n">%, t&(8' I&.%>ava s% &i.an.% na"d.%2' A0" s% dan /i.% "/%aci.% &i.% &"> !">$i( !i0"/"v%da avi. s% MO, /a s%>2avn"! &i.% sa2i' Bi.% s% .%dn"0atni! /i&""!' N% s!i.% s% d%/i2iati .% &i !">2a nastati%a0ci.a 6cv%ni2", a2%>i.a''8Na vi.%!% t%&a /"v.%iti i!a 2i sv /"t%&n d"0!%ntaci.' M"a i!ati sv% &% ?%>a nit0" n%!"1% na "/%aci. i na2a% tins0i(, a2i i s/%ci.a2ni( /%ta>a a0" .% t" /"t%&n"'B"2%sni0"v 0%v%t !"a &iti /%sv?%n i /i/%!2.%n 0a" a in0"ntin%ntn"> &"2%sni0a' + 0%v%t!"a. &iti /i/%!2.%na sva /"!a>a2a 0".a &i !">2a at%&ati' I&" /"!a>a2a "visi " vsti"/%ativn"> a(vata' T" !"> &iti &&%1asta d.%2ica, stani?%vina, t2a0"!.%, sta2a0 a in7i.,72ast%, d1a?i a v%$ic%, v%$ica s /.%s0"! i "sta2"'N"$na s!.%na !"a /"?%ti 0"nt"2 vita2ni( 7n0ci.a' K"nt"2a t2a0a, disan.a, /2sa it%!/%at% .% va1na i 0"2i0" n%0a "d 7n0ci.a ni.% %d "d!a( t%&a "&avi.%stiti "/%at%a ian%st%i"2">a'"!atan.% &"2%sni0a .% v2" va1n" .% t%&a /i!i.%titi /"!.%n as/"2"1%n.a 6n%!i%n"st8 i" t"!% "&avi.%stiti 2i.%?ni0a 0".i $% dati &"2%sni0 n%#t" a s!i%n.%' T%&a "t0iti %s/iat"niin7%0t a0" s% avi.% /a $% s% "d>"diti "/%aci.a, !%nstaci.a dana#n.% vi.%!% >2avn"! ni.%a2"> a "d>"d'T%&a /"v.%iti .% 2i nata#t%' Št" a0" ni.% K"nt"2a /#%n.a Na/%!%di0aci.s0"! 2isti$ st".i na/"!%ni a0" t%&a ."# n%#t" d"datn" ivaditi "d /%ta>a6G+K, E, L8 +0"2i0" t%&a n%0a RTG /%ta>a i2i 0"ni2i.ani /%>2%d !"a s% "&aviti /i.%"d2as0a sa2' N%0i &"2%snici d"&i. anti0"a>2ans 0a" /%v%nci. t"!&"%, n%t0" !"a d"&itianti&i"ti0

PRE2EDIKA!IJA

.% !%di0a!%nt"na /i/%!a &"2%sni0a a an%st%i. i "/%aci.' Odinia .% an%st%i"2"> a%d"vn% /aci.%nt% na0"n an%st%i"2"#0"> /%>2%da'

Sv(% davan.a /%!%di0aci.% s da "si>ava &"2%sni0 "d%%ni st/an. s%daci.%, s!an..%&%n"st, s!an..% sta( /i.% "/%aci.%, s!an..% s%0%ci. s2in% i n".a, s!an..% &"2 i/"t%& a v%$i! 0"2i?ina!a an%st%ti0a ti.%0"! "/%aci.%, s!an..% %72%0s% 0"2in%>i?0i(1ivaca' + /"stan%st%ti?0"! i n%/"s%dn"! /"st"/%aci.s0"! t"0, ad1ava ta.an.% ana2>%i.%'

11



Na?ini /i!.%n% /%!%di0aci.% s a2i?iti a !a0si!! d.%2"van.a "visi " na?in davan.a K"ds'c' /i!.%n% !a0si!! d.%2"van.a .% a H@ !in' K"d i'!' i /% "s /i!.%n% !a0si!!d.%2"van.a .% a 3-4@ !in, a 0"d i'v' /i!.%n% a @ !in'

i.% /i!.%n% /%!%di0aci.% t%&a /"v.%iti .% 2i nata#t%' A0" ni.% t%&a "&avi.%stiti an%st%i"2">ai2i v%sti s"nd'T%&a vid.%ti .% 2i s0in" sv% d"dat0% i a0" ni.% t%&a ! d"datn" "&.asnitiva1n"st s0idan.a isti( i "/asn"sti a0" "stan' T%&a sanati .% 2i s% /"!"0i" .% na0"n/%!%di0aci.% !"1% i!ati vt">2avic, (i/"t%ni., sa2i n%!a YC-a' i.% davan.a/%!%di0aci.% t%&a /"v.%iti: KOME, ŠTO, KAKO i KOLIKO t%&a dati' B"2%sni0a s% v"i sa2na 2%1%$i! 0"2ici!a' N% "stav2.a s% &"2%sni0a sa!">, v%$ s% /%da.% "s"&i i sa2% s /"t%&ni!d"0!%nti!a'

ANESTEZIJA

.% >&ita0 sa!" "s.%ta BOLI i2i >&ita0 S)I*ESTI' Svi.%st i &"2 s 7n0ci.i CNS-a aan%st%ti0 d%/i!ia "&".%' An%st%i.a !"1% &iti "/$a i2i 2"0a2na'

O(*a ane+$e&ija .% %v%i&i2na d%/%si.a CNS-a 0".a /v" "0.% >&ita0 svi.%sti /a na0"nt">a ana2>%i., a ati! a!n%i. /a !i#i$n %2a0saci.' + "/$ an%st%i. s% !"1% v%sti/aci.%nta intav%n"n", in(a2aci."! i i.%t0" %0ta2n"' Li.%0"vi s% 0"d v"%n.a /i!.%n../".%dina?n" i2i !%s"&ni! 0"!&inian.%!' K"ntaindi0aci.% a "/$ an%st%i. s/%"s.%t2.iv"st, "#t%$%n 0adi"vas02ani sist%!, n%/"("dni di#ni /t"vi, n%!">$n"st!.%tn"> disan.a'

L.ka"na ane+$e&ija .% >&ita0 "s.%ta i /iv%!%ni n%stana0 &"2i' Svi.%st .% "?vana' Na?iniv"%n.a: /"v#ins0a an%st%i.a, in7i2taci.s0a an%st%i.a, /"v"dna an%st%i.a'Površinska anestezija .% /i!.%na an%st%ti0a sa!" na s2nic% ">ana' Iaiva &2"0ad "s.%tni(av#%ta0a 1iv?ani( v2a0ana s2nica!a' i!.%n..% s% /%!aivan.%!, as/#ivan.%!' M"a2i /aci.%nt &iti nata#t%

Infiltracijska anestezija s2i?i /"v#ins0"., a2i 0a0" an%st%ti0 n% !"1% d.%2"vati 0" n%"#t%$%n0"1, an%st%ti0 s% in.%0tia /"d 0"1 i2i t0iv" "0"2in !.%sta "/%ativn"> a(vata' An%st%ti0 n%d.%2.% 0is%2"! !%di. 6/a2a8, !i.%n.a anat"!s0i i>2%d t0iva 0".% s% #tca 5 #ii >a /a s%da.% "0"2in !.%sta "&ad%'

Provodna anestezija .% /i!.%na an%st%ti0a /%di" 1ivca i2i sn"/a 1ivaca 0".i in%via. .%dnci.%2 %>i.' + %>i"na2n% 6/"v"dn% 8 an%st%i.% /i/ada. s/ina2na i /aav%t%&a2na' )st%s/ina2n% an%st%i.% s: s&da2na i %/ida2na a /"st".i i /aav%t%&a2na tv' /2%0ssan%st%i.a'

K"ntaindi0aci.% a 2"0a2n an%st%i. s /si(i?0" stan.% &"2%sni0a, /%"s.%t2.iv"st na 2"0a2ni

an%st%ti0 i /a2a t0iva'

Na0"n "/$% a2i i 2"0a2n% an%st%i.% .% "&av%na 0"nt"2a vita2ni( 7n0ci.a 6disan.%, /2s, t2a08 , .% .% sva0i an%st%ti0 va"di2atat"' Na0"n "/%aci.% sva0i &"2%sni0 id% s"& a &%n.%, a a0" .%/"t%&an int%nivan nad" d2.% vi.%!% 6t%1a0 i2i d>"ta.an "/%ativni a(vat8 , "nda id% *IL'

12



ABDO2INALNE OPERA!IJE

30 Hernija -ru' ki"aS "&i"! na vid2.iv"st, /"st".%+N+TARN*E:(i.ats (%ni.a i dis0s (%ni.a i

)AN*SKE: !&i2i0a2na, in>vina2na, 7%!"a2na, s0"ta2na'

P%ni.a 5 van.s0a 9 A&d"!ina2na (%ni.a .% i&"?%n.% /"t&#nic% 6/%it"n%! 8 0"0"n>%nita2ni i2i st%?%ni "tv" 0".% ta.n" i2i /"2an" sad1ava di.%2"v% t&#ni( ">ana)%nta2na (%ni.a 9 "st"/%ativna (%ni.a 9 (%ni.a v%nta2is /"st"/%ativa 6%cidivans8 Nasta.%na !.%st "/%ativn"> "1i2.0a 6n%/"t/na d%(isc%nci.a8P%ni.a s% sast".i "d: Ki2n"> /st%na: Otv" na t&#n". st.%nci >d.% 0i2a i2ai i t&#n% #/2.in%Ki2n% v%$%: I&"?%n.% /%it"n%!aKi2ni"> sad1a.a: ci.%v", "!%nt!+"ci nastan0a s: s2a&"st t&#n% sti.%n0%, na/%an.% 60a#a2., "/sti/aci.a8, d%&2.ina 5!#av2.%n.%, t%#0i 7ii?0i ad'

R%/"ni&i2na 0i2a .% %2ativna indi0aci.a a "/%aci.' T" .% i&"?%n.% vid2.iv" /i na/in.an.'itis0"! 0% !"1% s% /"tisnti nta' B"2%sni0 s% 1a2i na "s.%$a. /itis0a ii2i &"2 /"d?.(%ni.%'I%/"ni&i2na 0i2a s% /%/"na.% /" t"!% #t" .% 0i2ni sad1a. ad1an 0i2n". v%$ici' N% !"1% s%vatiti t&#n #/2.in'M">$a 0"!/2i0aci.a 5 INKARCERACI*A 9 02.%#t%n.% a0tni a&d"!%ni.%"/%aci.s0a /i/%!a a "&i?n (%ni. s tins0% /%ta>%, an%st%i"2"#0i /%>2%d, "/$a/si("2"#0a i 7ii?0a /i/%!a Ovisn" " d"&i i 0"ndici.i "/%aci.a !"1% &iti iv%d%na 02asi?n" i2i2a/a"s0"/s0i, a !"1% s% na/aviti (%ni"/2asti0a'

An%st%i.a !"1% &iti "/$a i2i s/ina2na 60"nt"2a &"2%sni0a <4 sata /" "/%aci.i, /a1n.a &">!an.0a "s.%ta8'

"s2i.%"/%aci.s0a n.%>a /"?in.% s"&i a &%n.% i ati! 0ad &"2%sni0 /"stan% 0"nta0ti&i2anid% na "d.%240 )anK"nt"2a vita2ni( na0"va, ni#ta na sta, davan.% /"/isan% t%a/i.%-in7i.aK"nt"2a "/%ativn% an% 6%a0tivn" 0va%n.% 5 v%$ica s /.%s0"!8K"nt"2a d%na1% 6%d"n d%n8, /%v%ntivn% v.%1&% disan.a i ci02aci.%, /%v%nci.a /"st"/%ativni( /"t%#0"$a /a i 0"!/2i0aci.a'K"d !#0aaca /i "/%aci.i in>vina2n% i2i s0"ta2n% (%ni.% 5 ss/%n"i. t.' 0>2a "d vat% is/"ds0"t!a a %2%vaci., a ti!% /%v%nci. %d%!a i &"2"va'30 )an+sta.% /"!"$ 6/i!iti an 0a" /%v%nci. %cidiva8, "s"&na (i>i.%na /"!"$, t%0$a di.%ta,v.%1&% /%v%nci.%, 0"nt"2a "/%ativn% an%'

0 P.+$ .(era$ivni )an"s/.%#ivan.% /%ista2ti0%, t%0$% 0a#asta di.%ta' D%n %vi.an.% an%La/a"s0"/s0i "/%iani id 0$i'C0 )an šavi e1+/t% a 0$iLa0" /"&av2.iva (ana 0".a n% nadi!a' I&.%>avati na/%an.% 60a#a2., /%(2ada, 0"nsti/aci.a,"/sti/aci.a, t%#0i 7ii?0i ad !.%s%ci8' M#0i n"!a2n% >a$%, n% &"0s%ic%'

13



Inkar9erirana 'ernija +i,($.,iCv%n", tvd", &"2n"' Ki2ni sad1a. .% ad1an 0i2n". v%$i, /%sta.% /"2an"st 0" ci.%v"'S2i0a !%(ani?0"> i2%sa' T" .% a/s"2tna indi0aci.a a "/%aci. a0" s% n% iv%d% taWis'Si!/t"!i in0ac%aci.% s &"2 /"d?. (%ni.% i ?itav"! t&(, !?nina, /"va$an.%' N%!ast"2ic% ni v.%t"va'TaWis .% /"st/a0 va$an.a 0i2n"> sad1a.a t&#n #/2.in' M"a s% na/aviti nta < sata "din0ac%aci.%' "&ati 02i! i /%!%di0aci. 6A/ain8' Za "/%ativni a(vat t%&a na/aviti2a&"at"i.s0% /%ta>%: &i"0%!i.s0%, KG i R( 7a0t", EKG, Rt> /2$a i sca' S"nda /" "d%d&i2i.%?ni0a, in7i.a /" "d%d&i 2i.%?ni0a' "t/isan /istana0 a "/%aci. i an%st%i.'"s2i.%"/%aci.s0a n.%>a ista 0a" i na0"n "/%aci.% "sta2i( (%ni.a'+0"2i0" .% &i2a %s%0ci.a ci.%va 5 n.%>a 0a" na0"n "/%aci.% ci.%va i CA)E KLIZMAF

0 A((en)i9i$i+ a9u$a A0tni a&d"!%nStan.% a0tni( &ivan.a a&d"!%n 6/a2a8Zna0"vi: B"2, %0ta2na t%!/%ata vi#a "d .%dn"> st/n.a "d "n% !.%%n% i!% dva na&"a0"1%'

A//%ndicitis acta s% .av2.a sva0". 1iv"tn". d"&i, v%$in"! i!% ' i 3' >"din% 1iv"ta, .%%/i.% <' >"din% 1iv"ta' +"0 .% "/st0ci.a 2!%na cv2.0a'Si!/t"!i s &"2 %/i>asti. i2i "0" //0a, !?nina i /"va$an.%' "s2i.% 3-4 sata 2"0a2iaci.a&"2i d"n.i d%sni di" t&(a 6i2%"c%0a2n" /"d?.%8'

A0" cv2.a0 ni.% anat"!s0"! /"2"1a., .av2.a. s% "/sti/aci.a i2i /"2.%v, .a0i &"2"vi ?itav"!t&(, ?%st" !"0%n.%'Hi$na a,-u"an$aB"2na /a2/aci.a Mc Bn%%v". i 2an"v". t"?0i' R"[sin>"v na0 6/i /itis0 d2ana na 2i.%vi2i.a?n .a!&"2 i2%"c%0a2n". %>i.i8, B2!&%>"v na0 6/i /"/#tan. /itis0a i2"c%0a2n"!di.%2 .av2.a s% .a?a &"2 na t"! !.%st8'

A/s"2tna .% indi0aci.a a "/%ativni a(vat' )adi s% KKS, L, s%di!%nt ina, !.%i s%t%!/%ata: a0si2an" i %0ta2n"'S2i.%di (itn" /i!i$%, vadi s% KG i R( 7a0t", sni!a EKG i Rt> /2$a i sca' T%&a /"t/isati/istana0 a "/%aci. i an%st%i. an%st%i"2"#0i /%>2%d' O&avi s% "s"&na (i>i.%na, na0it,#!in0a, d"daci, &i.an.%

Kr.ni#ni a(en)i9i$+-%2ativna .% indi0aci.a a "/%aci.' *%dna0i s si!/t"!i, a2i 2a&"at"i.s0i na2ai n%: L 5n"!a2ni( vi.%dn"sti, in 5 s%di!%nt 5BO, >in%0"2"#0i 5 BO ' *%dini d"0a 5 ii>">a7i.a s dva0"ntasta' M"1% s% a0tiviati 6/a2iti8 &i2" 0ada i &i2" >d.%'

Z)rav+$vena njeFa nak.n .(era9ijeS"&a a &%n.%, isti dan /%!.%#ta. na "d.%2-40 )anK"nt"2a "/$%> stan.a, "/%ativn% an%, !"0%n.a, d%na1% 6/%it"nitis-a&d"!ina2ni d%n, s"nda,

in7i.a anti&i"tici8' Ni#ta na sta - ?a. <4 sata na0"n "/%aci.%'30 (.+$.(era$ivni )an+sta.% "visn" " "/$%! stan. i d"&i 60"2a/s8' D1ati s% a an /"!"$ 0"d "s"&n% (i>i.%n%'K"nt"2a an%, ?a.'0 (.+$.(era$ivni )an+sta.%, "&av2.a "s"&n (i>i.%n' K"nt"2a "/' an% d%na1a 6%W8' K"nt"2a /%ista2ti0%s/"it"i., 02i!a'T%0$% 0a#asta di.%ta'0 (.+$.(era$ivni )an%vi.an.% an% 6ci.%2.%n.%8' La0" /"&av2.iva /%(ana'C00 (.+$.(era$ivni )an

14



Šavi %W'K"!/2i0aci.%Rana ci.%2i /%' s%c' %it"nitisanti&i"tici, a&d"!ina2ni d%nD>2as"v a/sc%s 6-H /"st "/' dan8+/t% a 0$iLa0" /"&av2.iva /%(ana 6!.%s%c dana8' N% diati ni#ta t%#0" niti s% na/%ati'

0 O(era9ija <e"u9aIndi0aci.% a "/%ativn" 2i.%?%n.% 1%2ca: 0va%$i 20s, /%7"aci.%, a0tna 0"!/2i0aci.a 20sn%&"2%sti, st%n"%, /%n%tia.$i 20s, a0 1%2ca'%ta>%: tins0% /%ta>% s/%ci.a2n% /%ta>%: %nd"s0"/s0%,RTG,PD,/%ta>% 0vi

Pre.(era$ivna njeFa (ri(re,aO/$a - /si(i?0a, 7ii?0a S/%ci.a2na

Specijalna priprema - La0" /"&av2.iva /%(ana, d"datn% /%ta>%' Nad"0nada in7i."! "ni(sast".a0a 0".i n%d"sta. 6%2%0t"2iti, %it"citi, 1%2.%"8 i/%!a /"&avn"> ta0ta, v"%n.%s"nd%, is/ian.% 1%2ca 6-< dana8'

Dan /i.% "/%aci.% - 02i!a, ?a0: .(a, t%0$ina d" <<-<4 sata, /"d0a: v.%1&% /%v%nci.%%s/iat"ni( i ci02at"ni( 0"!/2i0aci.a, /"v.%a d"0!%ntaci.%'Na dan "/%aci.% - 0"nt"2a "/$%> stan.a, d"0!%ntaci.%, s0idan.% d"data0a, /%!%di0aci.a6/"v.%i na/"!%n8'

P.+"ije.(era9ij+ka njeFa - S"&a a &%n.%, *IL, "d.%240 )an - K"nt"2a vita2ni( na0"va, "/%ativn% an%,d%na1%, i>2%d' In7i.a 6<- <,@ 2it%8'"vi#%ni /"2"1a.' "t%#0"$% - 0"!/2i0aci.% s !">$%' K"nt"2a d%na1%'30 (.+$ .( )an - sta.an.%, /"!"$ /i "s"&n". (i>i.%ni 6(i>i.%na sn% #/2.in%8 s"nda -sad1a.,is/ian.%, c/2.%n.%, v.%1&% /%v%nci.%, in7i.a , t%a/i.a'0 (.+$ .(0 )an - sta.an.% - /"!"$ /i "s"&n". (i>i.%ni, s"nda, /%ista2ti0a 5 /"s/.%#ivan.%,in7i.a, t%a/i.a, /%vi.an.% "/' an%'

0 (.+$ .(0 )an - sta.an.%, s"nda %W 6"visn" " sad1a., /%ista2tici8, a&d"!ina2ni d%n %W,0"nt"2a "/%ativn% an%, ?a. -< #a2ic% <4 sata0 (.+$ .(0 )an - t%0$a di.%ta-?a., 0(an"0 (.+$ .(0 )an - T%0$a "/$a di.%ta, v"d 1%2?an di.%t-"&"ci !a2i a2i ?%stiC00 (.+$ .(0 )an - Šavi %W+/t% a 0$i 5 davstv%ni "d>"., 1%2?ana di.%ta, n% diati t%#0% t%%t%' A20"("2 i ci>a%t%La>an% #%tn.% %0"nva2%sc%nci.a'

"st"/%ativn% 0"!/2i0aci.%Ran% - D%(isc%nci.a #av"va na &ata2.0, %t%nci.a 1%2?an"> sad1a.aKasn% - Sind"! !a2"> 1%2ca, d!/in> sind"!, an%!i.a, st%at"%.a, >ast"st"!aRane k.,("ika9ijeD%(isc%nci.a -@' /"st"/%ativni dan, .a0i &"2"vi >"n.%! a&d"!%n, d%7ansDi.a>n"a 5 t> 1%2ca 6&ai.%v s27at8"!"$ -Ni#ta na sta, s"nda, anti&i"tici, in7i.aR%t%nci.a 1%2?an"> sad1a.a &"> "t%1an"> /"2aa 0" anast"!"Si!/t"!i - Nadt"st, /"di>ivan.%, #tcavica, /"va$an.% %2%n"> sad1a.a 6%t%nci.a8"!"$ - S"nda 6c/2.%n.% 1%2?an"> sad1a.a8, ni#ta na sta, in7i.a'Ka+ne k.,("ika9ije Sind"! !a2"> 1%2ca 6B 228 - "s.%$a. /n"$% i na0"n !a2"> "&"0a, /"s2.%dica .% !#av2.%n.%"!"$ - ?%sti i !a2i "&"ciD!/in> sind"!

15



Rani - nasta.% 3-4 !in na0"n "&"0a &"> /"2aa (an% .%.n!' Os.%$a. s2a&"sti,v$ina, ta(i0adi.a' "!"$ - 2%1%$i /"2"1a., ?%sti i !a2i "&"ci &% t%0$in%' M2i.%0" t%&ai&aciti'Ka+ni - nasta.% < sata na0"n .%2a i ta.% 3-4 !in t%!", n%sv.%stic, /"va$an.% 6na>2i /adG+K-a8' "!"$ - #%$% i 0(

An%!i.a - Man.a0 1%2.%a i vita!ina B<St%at"%.a - Masna st"2ica' N%!a d"v"2.n" /an0%ati?n"> s"0a'Gast"st"!a a /%(an - N.%>a "0" st"!%' )"diti a?na da 0at%t% n% &d% !an.i "d st"!%6(ana i2ai /"%d i !ac%ia 0"18%(ana: #tca2.0a 6n% 2.%va08, t%0$% 0a#asta (ana, ?%sti "&"ci 6d" @ !28' Na0"n "&"0a0at%t% is/ati i atv"iti'

0 O(era9ija <u#n.F ,je'ura ii"i <u#ni' v.).va

Si!/t"!i - 1?n%-&i2i.an% 0"2i0%Na/av% s% tins0% /%ta>% i s/%ci.a2n% /%ta>% 62tav0 &i2i.an"> ta0ta, /%"a2na0"2%cist">a7i.a, intav%ns0a &i2i>a7i.a, CT a&d"!%na, n02%an" !%dicins0% /%ta>%, ERC6%nd"s0"/s0a %t">adna 0"2an>i"/an0%at">a7i.a8'

i.%"/%aci.s0a /i/%!a .% .(*a (rije.(era9ij+ka (ri(re,a /si(i?0a i 7ii?0a'

C("2%2it(iasis 9 1?n% 0"2i0%C("2%d"c("2it(iasis 9 1?n% 0"2i0%, i0t%s, a("2i?na st"2ica, ta!an in

P.+"ije.(era9ij+ka njeFaS"&a a &%n.%, int%nivna, "d.%2' K"nt"2a vita2ni( na0"va' Ad%0vatan /"2"1a.' "v"%n.%,/%v%nci.a /"t%#0"$a i 0"!/2i0aci.a' Da.% s% t%a/i.a 0a0" "dinia "/%at%' "v"di s% 0"nt"2ad%na1% 6A&d"!ina2ni d%n, s"nda, 0at%t%' T)ren0"d c("2%d"c("2it(iasis i c("2%d"c("t"!i.%840 )an -Ni#ta na sta, in7i.a30 )an 5In7i.a, s"nda?a.' "!"$ /i "s"&n". (i>i.%ni i (i>i.%ni sn% #/2.in%, /"v"%n.%v.%1&i, 0"nt"2a an% i d%na1%'

0 )an -"!"$ /i "s"&n". (i>i.%ni, in7i.a /" /"t%&i, t%0$% 0a#asta di.%ta' O&av%n"/"s/.%#ivan.% /%ista2ti0% 602i!a,s/"it"i.80 )an - ti?0a di.%ta, a&d"!ina2ni d%n %W, 0"nt"2a "/%ativn% an%C00 dan - Šavi %W' B"2%sni0 !"1% 0$iUpute za kući ti?0a di.%ta, /"st/n" d"davati na!inic% 0".% nis di.%ti, n% t%#0" diati &"> %cidiva'

!'."e).9'."i$'ia+i+T-d%n 0"d c("2%d"c("t("!i%' Sad1a. .% 1?.%ta 2?i H@-!2' S!.%#t%n .% c("2%d"c(s, i2ai i a&d"!%na /"0a. "/%ativn% an% i s/".%n .% na v%$ic' vi( danana0"n "/%aci.% /"t"0 .% s!an.%n &"> %d%!a /a/i2%, /a sad1a. id% v%$ic a n%

d"d%n!'30 )an 9 @-!200)an 0"2i?ina s% s!an..%0)an 9 <-@!2Osta2% dan% sad1a. id% d"d%n!, a n% v%$ici!ana &i2i>a7i.a s% adi a vi.%!% "/%aci.%' S%0ndana &i2i>a7i.a s% adi H'-='/"st'"/'dan,a /%t("di .". /"st/n" atvaan.%02%!an.% T-d%na

16



K"e,anje T)rena /"?in.% 4'-@' /"st'"/'dan i2i H'-='/"st'"/' dan' O&av%n" .% a t" vi.%!%/"!atati &"2%sni0a i /i!i.%titi a0" s% /".av% si!/t"!i 0"!/2i0aci.a 6!?nina, /"va$an.%,/"vi#%na t%!/%ata, &"2"vi, na/%t"st8vi dan 02%!an.a - <\< sata 6d"?a0-v%?%a8D>i dan 02%!an.a - 3\< sata 6d"?a0, ?a0, v%?%a8 <\4T%$i dan 02%!an.a - <4 sata;%tvti dan s% adi s%0ndana &i2i>a7i.ad%n .% atv"%nVa/enje T)rena - a0" .% na2a s%0ndan% &i2i>a7i.% %d T-d%n s% vadi i2i s0a$.%'Os2"&"di s% 0"1ni #av, &"2%sni0 d&"0" da(n% i d%n s% ivadi'

O(+$ruk$ivni ik$eru+Ra2"> .% !%(ani?0a a/%0a "tican. 1?i' +"0 !"1% &iti - 0a!%nci 1?ni! v"d"vi!a,&"2n% 1?n% 0"2i0%'T!"-0acin"!: i0t%s &% &"2"va'Si!/t"!i: i0t%s, a("2i?na st"2ica, ta!ni inDi.a>n"a: .%t%n% /"&%, ERC, CT &i2i.an"> ta0tai.%"/%aci.s0a /i/%!a: v%2i0i 0"a>2">a!, K vita!in0"na0i"n .% s s02"ni 0va%n.'"s2i.%"/%aci.s0a n.%>a - In7i.avita!ini, K-vita!in, d%na1a

- T-d%n61$"v"d8- A&d"!ina2ni d%n- S"nda- Kat%t%

La(ar.+k.(+ka 9'."e9i+$ek$.,ija rani9e40 )an: In7i.a, nav%?% ?a., sta.%' D%na1a a0" .% /"t%&na, a&d"!ina2ni d%n'30 )an: T%0$a di.%ta, a&d"!ina2ni d%n %W0 )an: ti?0a di.%ta, id% 0$i6H'-='dan #avi %W i 0"nt"2a na "d.%2 i2i a!&2anti8

0 Z)rav+$vena njeFa -."e+nika + .(era9ij., 9rijeva

Rani na0"vi 0acin"!a d%&%2"> ci.%va: s!%tn.% d%7%0aci.i, !", &2.%d"$a, >&ita0 a/%tita,/"st/ni >&ita0 na t%1ini, n%"d%%ni &"2"vi t&(, st"2ica /"!i.%#ana sa sv.%1"! 0vi'%/"0a .% SISTEMATSKI REGLED'DVA F"avna na0a 0acin"!a s i!.%na "/sti/aci.a i /"2.%va i sv.%1a 0v st"2ici'Di.a>n"sti0aDi>it"%0ta2ni /%>2%d, st"2ica na &%n%din, %nd"s0"/s0% /%ta>% PD,ii>">a7i.a, !a0%i na0acin"! 5 CEA, CT i2i +Z a&d"!%na, >in%0"2"#0i, "2"#0i /%>2%di/%!a &"2%sni0a a "/%aci.- Rtins0% /%ta>%, an%st%i"2"#0i /%>2%d,s/%ci.a2n% /%ta>%- O/$a /i.%"/%aci.s0a /i/%!a- O/$a s/%ci.a2na /i/%!a- L"0a2na /i/%!aO/$a /i.%"/%aci.s0a /i/%!a sast".i s% "d /si(i?0% i 7ii?0% , t% /%v%nci.a 0"!/2i0aci.aO/$a s/%ci.a2na /i/%!a sast".i s% "d 0"%0ci.% /"%!%$%ni( 7n0ci.a, /"&"2.#an.a "/$%>stan.a, d.%2"van.a na an%!i., (i/"/"t%in%!i.' T" s% /"sti1% in7i."! vita!ini!a,tans7i."!' Radi s% 0"%0ci.a /"%!%$%ni( 7n0ci.a i /"&"2.#an.% "/$%> stan.a d.%2"van.%! naan%!i., (i/"/"t%in%!i.L"0a2na /i/%!a;i#$%n.% d%&%2"> ci.%va "d 7%0a2ni( !asa 0".% ta.% < dana' Da. s% anti&i"tici' Dan /i.%"/%aci.% /" "d%d&i 2i.%?ni0a na?.% s% 0v, /2a!a a "/%aci.'

17



vi dan ?i#$%n.a ci.%va da.% s% t%0$a di.%ta, anti&i"ti0 ,in7i.a 60"%0ci.a8' ;i#$%n.% d%&%2">ci.%va /"!"$ 02i!% , s/"it"i.a' Oa2n" s%dstv" a ?i#$%n.% 6isan8D>i dan ?i#$%n.a ci.%va, t%0$ina, in7i.a, anti&i"ti0' ;i#$%n.% d%&%2"> ci.%va 02i!a i2is/"it"i. "a2n" s%dstv" a ?i#$%n.%'O/$a /%"/%ativna /i/%!a na dan "/%aci.%'T"!&"/"7i2a0sa Na/"!%n% 6G+K, RR, '8

"s2i.%"/%aci.s0a n.%>a*IL, na "d.%2 id% <' d" 3' /"st "/%ativni dan"[2%"v /"2"1a. 6&"2.a v%nti2aci.a /2$a8' K"nt"2a vita2ni( na0"va, "/$%> stan.a, davan.%/"/isan% t%a/i.%' %v%nci.a /"t%#0"$a i /"st "/%ativni( 0"!/2i0aci.a, 0"nt"2a "/%ativn%an% -a&d"!%n ,%0t!, 0"2"st"!aK"nt"2a d%na1%

A&d"!ina2ni d%n, %0ta2ni d%n, s"nda ,inani 0at%t% ' "st "/%ativni dan*"# vi.%0 *IL' K"nt"2a vita2ni( 7n0ci.a, "/$%> stan.a, "s"&na (i>i.%na /"!"$' N.%>a sn%#/2.in% .a0" va1na' +sta.an.% "visn" " "/$%! stan.' "/isana t%a/i.a, 0"nt"2a "/%ativn%an%, d%na1%, /"v"%n.% v.%1&i /%v%nci.% 6d&"0" disan.%, is0a#2.avan.%, v.%1&% n">8<' "st "/%ativni dan - &"2%sni0 id% na "d.%2K"nt"2a "/$%> stan.a, vita2ni( na0"va, d%na1% 6va%n.% S"nda8, an% 6/%vi.an.%8' Os"&na(i>i.%na i sta.an.% /"!"$, /"/isana t%a/i.a, /"v"%n.% v.%1&i /%v%nci.%, 0"nt"2a/%ista2ti0% CA)E KLIZMA3' "st "/%ativni danOs"&na (i>i.%na /"!"$, sta.an.%, va%n.% d%n"va v.%1&% /%v%nci.%, /"/isana t%a/i.a,/%ista2ti0a 6/"sti>!in8, ?a.4-=' "st "/%ativni danT%0$% 0a#asta di.%ta, 0"nt"2a st"2ic%, /i2a>"avan.% /%(an% ">ani!S$.,a .% s/". #/2.%> ">ana s "0"2in"!"1%2.n" .% s 0i>"! na/i.%d "d%diti !.%st" st"!% a0" $% &iti ta.na 0"2"st"!a"d.%2a /%!a !.%st st"!%: I2%"st"!a, c%0"st"!a, tans7%"st"!a, si>!"id"st"!a"d.%2a /%!a &". "tv"a

5 Je)n.9jevna 9 ni/"2ana

5 Dv.9jevna 9 &i/"2ana*%dan .% "tv" a0tivan,d>i .% "tv" /asivan

ii"2">i.a d%&%2"> ci.%va .% a/s"/ci.a t%0$in%, stvaan.% 7"!ian% st"2ic%Di.a%.a 9 &a /%ista2ti0aO/sti/aci.a 9 s/"%na /%ista2ti0aI2%"st"!a- c%0"st"!a -,@ 2itaa t%0$% st"2ic% dn%vn",st"2ica .% /na %ni!a /a na>ia 0"1Tans7%"st"!a - St"2ica n%0"2i0" /ta dn%vn", 0a#asta 0"nist%nci.aSi>!"id"st"!a-< st"2ic% dn%vn"' St"2ica .% 7"!ianaNjeFa +$.,ean.% n%ta2ni! s%dstvi!a, d%in7ici.%nsi s #t%tni .% ni#tava. "&a!&%ni s2". 0"1%, &%nin/"ti.%&iti sa!" 0ad .% n%"/("dn"' "1%2.n" .% t#ian.%, n% 0/an.%' Na 0a. t%&a d"&"

"s#iti 0"1 /i.% 2i.%/2.%n.a /"!a>a2a 0a0" &i !a0si!a2n" d1a2" 6@- dana8"!a>a2a a st"!*%dn"d.%2na i dv"d.%2na"!a>a2a 2i.%/iti na ?ist i d"&" "?i#$%n 0"1, /i.% stav2.an.a d"&" s0".iti' T&( /i2i0"!stav2.an.a /"!a>a2a t%&a na/%ti' K"istiti st"!a(%iv /ast% i2i d>" S!.% /"stav2.an.av%$ic% "visi " /"0%tn"sti &"2%sni0a' Li.%/i s% "d"d" /%!a >"%'"?avan.% &"2%sni0a' !%dicins0a s%sta-t%(ni?a sa! adi, a /aci.%nt >2%da<' &"2%sni0 adi - !%dicins0" "s"&2.% >2%da i is/av2.a a0" n%#t" adi 0iv"3' &"2%sni0 na/avi sa! i d"% /"0aati !%d' s%sti-t%(ni?a /"stav2.%n" /"!a>a2"'

18



S0idan.% /"!a>a2aSa!" "dv".iti v%$ic "d /"d2">% ta0" da s% v%$ica "dva.a "d >"% /a /%!a d"2.% 0a0"sad1a. n% &i isci"' "d2"> t%&a "staviti 6"d @ d" dana8 i ci.%v" "?istiti, t% staviti n"vv%$ic' *%dn"d.%2n" /"!a>a2" "d2.%/2..%!" "d >"% /%!a d"2.%' K"1 "?isti!", "s#i!" ina2i.%/i!" n"v" /"!a>a2"' "!a>a2" na is/st n% "dva.a!", v%$ sa!" is/sti!" sad1a. 0ana2iaci.';van.% "0"2i#a - /"st".% /"!a>a2a 5 v%$ic% "d !"s0i( a2>i 0".% !"1%!" &acati 0ana2iaci. .% s &i"a>adiv%'O/sti/aci.a 2.di sa st"!"!" d">"v" s 2i.%?ni0"! !"1% s% dati 02i!a s /"s%&n" dia.niani! ii>at""! i 0at%t%"!'St"!a n%!a s7in0t% iv"t sa st"!"!%(ana - Na!inic% v"diti /"st%/%n", vid.%ti 0a0" %a>ia na "d%%n% na!inic%, /itid"v"2.n" t%0$in%' Zadn.i "&"0 "0" = sati &"> n"$ni( 6n%0"nt"2iani(8 /a1n.%n.aO&2a?%n.% - K"!"tn", da n% st%1%ii?0a a0tivn"st - /"1%2.na, n%!a ">ani?%n.a "si! dian.a t%#0i( t%%taI2asci - N%!a ">ani?%n.a, vi.%0 /"ni.%ti %%vna /"!a>a2a s2?a. /"t%&%t"van.a -N"siti sa s"&"! d"v"2.n" sv%>a a "d%%ni &". dana .% vani !"1da n%$% &iti &a#va#%> &".a i2i vst% /"!a>a2a' T%&a s% "si>ati "d n%>"dn"sti'"sa" - Sv% /"s2"v% !"1% n"!a2n" "&av2.ati a2i n% t%#0% 7ii?0% /"s2"v% i n% ad /%(a!&%n". indsti.i i2i 0(in.a!a'M"%, /2ivan.% - ni.% n%!">$% n%0a /"!a>a2a i /%t("dn 02i!+ n%0i! s2?a.%vi!a 6di.a>n"a i2%sa8 /"st".i !">$n"st atvaan.a st"!% na0"n /a !.%s%ci 0ada s% ci.%v" "/"avi'K2&"vi s !.%sta na 0".i!a s% sasta. 2.di s isti! /"&2%!i!a i a!.%n.. is0stva, sanan.a" /avi!a' La0#% i! .% 0ada vid% da i( d>i a!i.')a1na .% /"d#0a "&it%2.i '

OP@A POSTOPERATIVNA NJEGA

Na0"n "/%ativn"> a(vata &"2%sni0 id% s"& a &%n.%'T .% /"d int%nivni! nad""! d"0n% /"stan% 0"nta0ti&i2an i d"0 vita2n% 7n0ci.% n% /"stan sta&i2n%' + .%dinic int%nivn">2i.%?%n.a id "ni /aci.%nti 0".i s i!a2i d>"ta.ni.i i t%1i "/%ativni a(vat - &"ava0 -3 dana'" av#%t0 "/%ativn"> a(vata 0"nt"2a vita2ni( 7n0ci.a sva0i( @@3 !inta "visn" "stan. "/%ian">, 0"nt"2a stan.a svi.%sti, an%0va%n.a i d%na1%' N%"/("dna .% nad"0nadat%0$in% i davan.% t%a/i.% 0a0" "dinia 2i.%?ni0 '

POSTOPERATIVNE POTEŠKO@EM">$% i( .% &2a1iti n%0i! /"st/ci!a'

- D(tavica, &"2, >2"&"2.a, !?nina i /"va$an.%, 1%' R%s"/tivna t%!/%ata, #tcavica 5sin>2ts, /"t%#0"$% s !"0%n.%!, st"2ic"!, nadt"st- !%t%"ia!, ast". st"2ic%'

DRPTA)ICANasta.% &"> /"t(2aivan.a &"2%sni0a' "!"$ s% sast".i "d /"0ivan.a &"2%sni0a, t"/2.avan.a'N% a>i.avati &"2%sni0a i2i >a staviti iv" t"/2in%'

BOLN"!a2n" s% "?%0.% &"2 0a" /"t%#0"$a /vi( 4= sati "d "/%aci.%' vi ana2>%ti0 s% !"1% dati sati na0"n "/%aci.%, a2i /a12.iv"' +"ci - %stana0 d.%2"van.a an%st%i.%, st%>nt

19



av"., d2a>a, %d%!, (%!at"! "/' ani, d%n, n%d"&an /"2"1a.S%sta t%&a nati2"0a2iaci. &"2i, 0aa0t% &"2i: t/a, "#ta, na>2a, /2ia.$a, vi.%!% ta.an.a &"2i' Za sv% &"2i0".% ta. d1% t%&a /"v.%iti "0 .% !"1% &iti i in7%0ci.a' B"2 !"1% s!an.iti d"&a /si(i?0a/i/%!a, d"&a /"2"1a., /"2"1a. d%na' T%&a /"/stiti av"., d2a>, dati ana2>%ti0 6a0" ni.%0"ntaindician8'

GRLOBOL*AO"/(ain>%a2ni t&s a vi.%!% "/%ativn"> a(vata' B"2%sni0 s% 1a2i da >a &"2i >2"'T%&a !"&.asniti a#t" &"2i i 0ada $% &"2 /"$i'

M+;NINA I O)RAAN*E"s2.%dica s d.%2"van.a an%st%ti0a, na0/2.%n"> 1%2?an"> sad1a.a' N%0i 2.di t%1% /"dn"s%"/$ an%st%i.' K"d d%&2.i( 2.di s% d1% %s"&ia an%st%ti0' +"0.% >&ita0 t%0$in% i%2%0t"2ita, n%>"dan "s.%$a. sti!a i &"2, na/%an.% t&#ni( !i#i$a, d%(isc%nci.a"!"$:+/titi da d&"0" di#%, sav.%t"vati da i&.%>ava /"0%t%'T%0$ina na sta sa!" !a2i!0"2i?ina!a a0" .% d"v"2.%n" &"> a(vata' O&avi.%stiti 2i.%?ni0a' A0" ta.% d1% "d <4sata t%&av%sti na">asti?n s"nd' EV- sv.%sna 1%2.a a /i.%n.%! v"d%' +"0 !"1% &iti d%(idaci.a, /%!%di0aci.a, >&ita0 t%0$in% avi.%!% "/%aci.% i a&ana /i.%n.a t%0$in% na0"n "/%aci.%' "!"$: )2a1iti snic% !"0"!>a"!, n.%>a sn% #/2.in%, /i!.%na /"/isani( in7i.s0i( "t"/ina'T%0$ina /% "s /" "d%d&i2i.%?ni0a'

RESORTI)NA TEMERAT+RA+!.%%n" /"vi#%na ' i <' /"st "/' dan "d 3H,@-3=]C' T" .% %a0ci.a ">ani!a na %s"/ci.&.%2an?%vina i "/%ativn% an%' A0" ta.% d2.% 5 INEKCI*A 6/2$a, !"0a$ni !.%(,"/%ativna ana, t"!&"72%&itis d&"0i( v%na8'

ŠT+CA)ICA

.% 02"ni?0i >? di.a7a>!% "0"van nada1a.%! n%vsa 7%ni0sa 6/"nav2.an" n%v"2.n"st%an.% "#ita /a$%n" na>2i! atvaan.%! %/i>2"tisa 0aa0t%isti?an v08' +"ci #tcavic%!"> &iti !%t%"ia!, a0tna di2ataci.a 1%2ca, /%it"nitis' S"nda .% "vi! s2?a.%vi!aindiciana' K"d n%/"nat"> "0a #tcavic% @ !in disati i idisati /a/inat v%$ic iad1ati da(' Oni 0".i s!i. /iti t%&a. ad1ati da( d"0 ! v%2i0i >t2.a. v"d%'M%di0a!%nt"na t%a/i.a'

OTEŠKOE S MOKREN*EMO>ania! #"0 ?va nati.' v" !"0%n.% !"a &iti "0 = sati "d "/%aci.%, a /istna .%"2i>i.a' K"2i?ina /i!2.%n% i i2?%n% t%0$in% s% i%>2ia ti.%0"! 4= sati' +"ci /"t%#0"$a s!"0%n.%! !"> &iti: a&d"!ina2n% "/%aci.%, s/ina2na an%st%i.a 6n%d"stata0 /"da1a.a8,s!an.%n" stvaan.% ina 6d%(idaci.a8, /si(i?0% i 7ii?0% /"t%#0"$%' "!"$ 0"d /"t%#0"$a s

!"0%n.%! .% iavati !"0%n.% ani! /"st/ci!a 6t"/2a n"$na /"sda, 0% "niti t"/2v"d, #! v"d%, s.%d%$i /"2"1a., /aavan8' T%&a /"ticati na !"0%n.% /i %t%nci.i ina 6&">

.a0" /"#i%n"> !.%(a nasta.% at"ni.a !i#i$a, /a !"0i !a2% 0"2i?in% - 3-!2 sva0i( <-3!in8' S2i.%di 0at%t%iaci.a 62i.%?ni0 "dinia8 /"2a>an" /a1n.%n.% !.%(a'

20



OTEŠKOE SA STOLICOM+ "0 4= sati "d "/%aci.% !"a s% s/"staviti /%ista2ti0a sa!"sta2n" /"!"$ n%0i( "dna?ina s/"stav2.an.a /%ista2ti0% 6!i0"02i!a, s/"it"i., 02i!a,/"sti>!in8Poteškoće sa stolicom - nadutost - meteorizamNasta.% &"> na0/2.an.a /2in"va i t%0$in% ci.%vi!a, a ci.%vna s% /%ista2ti0a s/""s/"stav2.a i2i .% n%!a i n%!a i2as0a /2in"va 6v.%t"vi-72ats8' istna .% a&d"!ina2nadist%ni.a, a "0 !%t%"i!a .% n%a0tivn"st >ast"int%stina2n"> sstava' D.%2"van.% an%st%i.%!"1% s/"iti /%ista2ti0 0".a s% n"!a2n" s/"stav2.a 0a.%! /v"> i2i /"?%t0"! d>">/"st"/%ativn"> dana' Si!/t"!i !%t%"i!a s da n%!a v.%t"va /a .% !%t%"isti?an a&d"!%n6a&d"!ina2na dist%ni.a8, /istna .% &"2 i n%>"dan "s.%$a., "t%1an" disan.%/itisa0 1%2ca ici.%va na "#it, #tcavica' "!"$ 0"d !%t%"i!a - v%sti %0ta2ni 0at%t% DARMROR' i&" s%sast".i "d st%i2n"> da!"a, va%2ina, #/at2%, 0avica, v%$ic%, stani?%vin%, a#tit% a 0%v%t i&&%1ast% d.%2ic%'"2"1a. &"2%sni0a: 2i.%vi &"0 sa savi.%ni! n">a!a i2i na 2%i!a, v%sti da!" H- c! d&"0" is/".iti s v%$ic"!' Da!" "sta.% %0t! <-3!in, a !"1% s% /"n"viti a <-3 sata' " /ti2i.%?ni0a da.% s% /"sti>!in .% /"ti?% /%ista2ti0, a na0"n 3 !in dati 02i!'Poteškoće sa stolicom - zastoj stoliceNasta.% &"> s!an.%n"> n"sa t%0$in%, n%a0tivn"sti' K"d "ni( 0".i ina?% i!a. "/sti/aci.n"!a2n" .% da /vi dan na0"n "/%aci.% n%!a st"2ic%' %ista2ti0a s% n"!a2n" s/"stavi a<4-4=sati' K"d ast".a st"2ic% /%!a "d%d&i 2i.%?ni0a <' /"st"/%ativni dan da.% s% s/"it"i. i2i02i!a a /"tican.% /%ista2ti0%' aiF CA)E KLIZMA' "t%&n" .% nati %2tat' S/"ntan"st"2ica d"% 4-@' /"st"/%ativni dan !"1% i /i.%' A0" s% d" tada n% s/"stavi /%ista2ti0a-/aa2iti?0i i2%s'

ŠOK

.% stan.% t%#0" /"%!%$%n% ci02aci.%, a "?it.% s% 5 s!an.%n"! /"0v2.%n"sti t0iva -n%d"stat0"! 0isi0a - acid""!'G2avni /at"7ii"2"#0i !%(ani!i 5 'i(.v."e,ija 6s!an.%n v"2!%n ci02ia.$% 0vi8 -

in+u%i9ijen9ija +r9a 6ata.%n.% /!/%8 - (r.,jena $.nu+a krvni' <i"a 6va"0"nsti0ci.a i2iva"di2ataci.a8'Vrste šoka:Hi(.v."e,ij+ki:E>">%ni >&ita0: /n% 0vi-0va%n.%, /2a!%-"/%02in%, t%0$in% i %2%0t"2ita-/"va$an.%,/"2.%vEnd">%ni >&ita0: %0sdativni-/%it"nitis, ta!ats0i-(%!at"!Kar)ija"ni: - "#t%$%n.% !i"0ada 6a0tni in7act sca, /"%!%$a. it!a8

- "/st0ci.a 0v"t"0a i sca /2$na %!&"2i.aVa&.,.$.rni i"i )i+$ri-u$ivni: s!an.%n.% va"!"t"n"> t"nsa 6n%">%ni #"0 0"d "2.%da0a2.%1ni?n% !"1din%, "2.%da, sta(a, .a0i( &"2"va8

-ad1avan.% ">"!n% 0"2i?in% 0vi !i0"ci02aci.is%/ti?0i #"0' Ana7i2a0ti?0i#"0 6i!n"2"#0"! %a0ci."! s% "s2"&aa. va"a0tivn% tvai(ista!ini #t" "0.% di2ataci. I/"v%$an /"/sn"st 0vni( 1i2a8Si!/t"!i #"0a: s&.%0tivni "s.%$a. "/$% s2a&"sti 6vt">2avica, !?nina, 1%, "s.%$a. (2adn"$%,st%/n.%, &2is0% s!ti8- 0"1a i s2nica: &2i.%da, v2a1na , (2adna, #0% i vid2.iv% s2nic% 2a>an" ci.an"ti?n%- /"na#an.%: /2a#%n, n%!ian, /"n%0ad avn"d#an, 0asni.% a/ati.a- svi.%st: /i svi.%sti, s"!n"2%nci.a, s"/", d" >&it0a svi.%sti)ita2ni na0"vi: disan.% &an" i /"v#n", /2s 7i2i7"!an, t2a0 nia0 i2i n%!.%2.ivZ.%nic% /"#i%n%, "dstan /">2%dDi%a: s!an.%na!an.% "d <!2sat"%!%$%n s%n"i.

21



OST+AK 5 .%dinica int%nivn% s0&i)"d"avni /"2"1a. na 2%i!a!"1% s 2a>an" /"di>nti! n">a!a - n% T%nd%2%n&>"v &">/itis0a t&#ni( ">ana na "#itM"nit"ian.% : vita2ni na0"vi, EKG, sataci.a 0isi0a)%ns0i /t: C)T, &ani2a, /%ta>% 0vi, in7i.a 0ista2"idni! "t"/ina!a 6,Q NaC2, in>%, @>20"a8 0"2"idni! "t"/ina!a 6S"2d%W48, tans7i.a 0vii!.%na /"/isan% t%a/i.%+v"%n.% inan"> 0at%t%a satna di%a 6!an.a "d <!29stan.% t%#0"> #"0a .% .% !an.% "d@!20>sat #t" !"1% "0"vati a0tn %na2n ins7ici.%nci.8End"ta(%a2na int&aci.a R%s/iaci.aD%7i&i2aci.ai!.%na 0isi0a!as0a, n"sni 0at%t%N.%>a "?i. - v2a1%n.% 7ii"2"#0"! "t"/in"! &"> s#%n.a "1nic%N.%>a 0"1% - "s"&na (i>i.%na, /"!.%na /"2"1a.a, !asa1aN.%>a sn% #/2.in% - /%&isavan.% 7ii"2"#0"! "t"/in"!%(ana - /a%nt%a2na, s"ndaEvid%ntian.% - /"s%&n% 2ist%O/$i i>2%d: ad"v"2.ava.$%9!ian, d"&" sa.%, 0"1a 1i?asta, t"/2a i s(a, /itis0"! nan"0at &".a s% &" va$a)ita2ni na0"vi 9 disan.% !in", s/"i.% "d <=!in, /2s d"&" /n.%n =-!in, t2a0 sist"2i?0ivi#i "d - !!P>K"d "/%ian"> &"2%sni0a 0"nt"2a an% i d%na1%'"c.%na &"2%sni0"v"> stan.a svi.%sti /%!a G2as>"[ 0"!a s0a2i, na.ni1i !">$i &". &"d"va .%9t%#0" stan.%"#t%$%n.a, na.v%$i &". &"d"van"!a2n% 7n0ci.%

POSLIJEOPERA!IJSKE KO2PLIKA!IJE

O/asn% s a sv% "/%ian% &"2%sni0% .% /"d1. &"ava0 &"2nici - %s/iat"n%0"!/2i0aci.%, 0"!/2i0aci.% na sc i 0vni! 1i2a!a, 0"!/2i0aci.% na /"&avn"! ta0t

RESIRATORNE KOMLIKACI*ENasta. 0a" /"s2.%dica s!an.%n% v%nti2aci.% /2$a, ast".a s%0%ta i in7%0ci.%' ;%#$% s% .av2.a.0"d stai.i( "s"&a .% v%$ i!a. /"!.%n% na /2$i!a' O/%aci.a na t"a0s i "/%aci.a naa&d"!%n s /%dis/"ici.%' K"!/2i0aci.a!a /">"d. &"2, s!an.%na /"0%t2.iv"st, s%dativi,!%t%"ia! i /#%n.%' *av2.an.% si!/t"!a /"?in.% <4 sata na0"n "/%aci.%' T" s &"n(itis,at%2%0taa, /n%!"ni.a ,%!&"2i.a, /"st"/%aci.s0i /a"titis'B"n(itis: "t"0 s2nic%, v2a1an 0a#a2., t%!/%ata

At%2%0taa: 0"2a/s a2v%"2a, t%!/%ata, ta(i/n%a, dis/n%a, ci.an"an%!"ni.a: +/a2a 0".a s% "dvi.a a2v%"2a!a' +"?nici !"> &iti &a0t%i.%, visi' Ka#a2.,dis/n%a2$na %!&"2i.a: Mi0"%!&"2i.a ,!asna %!&"2i.aMi0"%!&"2i."! &d a(va$%n% !an.% /2$n% at%i.%' *av2.a s% H'-<' /"st'"/' dan .a0%&"2"v%, (%!"/ti, t%!/%at'Masna %!&"2i.a s% .av2.a 0"d "/%aci.a na 0"sti!a i 0"d /i.%2"!a - 7%!, ti&i.a' Si!/t"!i%!&"2i.%:in%nadna s2a&"st, &2i.%da i "n".%na 0"1a, ta(i0adi.a, ta(i/n"a, dis/n"a, &"2 /si!a, (%!"/tia, n%!i'%v%nci.a %s/iat"ni( 0"!/2i0aci.a: "[2%"v /"2"1a., /"!.%na /"2"1a.a, /"!atan.%&"2%sni0a, /"v"%n.% v.%1&i disan.a i is0a#2.avan.a, !i0"02i!ats0i v.%ti, "d1avan.% "s"&n%(i>i.%n%' T%&a sta.ati na /%stan0 /#%n.a, /"v"diti !.%% /%v%nci.% 0a/2.i?ni( in7%0ci.a'T%&a #t" /i.% stati i 0%v%ta, /i!i.%niti /"/isan t%a/i.' "v%sti d"& /%"/%ativn/i/%!' O&av%an .% 7ii"t%a/%t a stai.% i s2a&" /"0%tn%, as/iaci.a s%0%ta,"d>"vaa.$a ana2>%i.a, n% /%0"!.%na s%daci.a' i!.%na 0isi0a-ABS'

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a"titis .% /a2a 12i.%d% s2in"vnic%->2and2% /a"tis' ">"d.% .". /%!%di0aci.a i at"/in' *av2.as% 0"d t%1i( &"2%sni0a, d%(idiani(, stai.i( "s"&a, a0" "s"&a di#% na sta, 0"d /"vi#%n%t%!/%at%, 0"d 2"#% (i>i.%n% sn% #/2.in%' +"0 nastan0a /a"titisa .% stvaan.% nas2a>a,a!n"1avan.% &a0t%i.a, "/st0ci.a iv"dn"> 0ana2a /a"tidn% 12i.%d% vis0"ni! s%0%t"!'".av2.ivan.% si!/t"!a /a"titisa nasta.% n%0"2i0" dana na0"n "/%aci.% i2i 0asni.% si!/t"!%:&"2, "t%02ina, cv%ni2" /"d?. /a"tidn% 12i.%d%' M"1% &iti .%dn"stan" i2i "&"stan"'%v%nci.a /a"titisa: R%d"vita n.%>a sn% #/2.in%, /an.% &i, is/ian.% 7ii"2"#0"! "t"/in"!'% "s t%0$ina ii2i (ana #t" /i.%'"!"$ a0" s% 7"!ia a/sc%s iv%d% s% incii.a i d%na1a anti&i"ti0%'

KOMLIKACI*E NA SRC+ I KR)NIM ILAMA^ K"2a/s^ In7a0t^ S?ani a%st^ i&i2aci.a

K"2a/s .% 0at0"ta.ni >&ita0 svi.%sti &"> d%"0si>%naci.% !">a' Nasta.% st".%$%! i2is.%d%$%! /"2"1a.' +"0 0"2a/sa .% na>2" sta.an.%, "t"stats0a (i/"t%ni.a, >&ita0 t"nsa0vni( 1i2a' M"1% &iti vidni, n.#ni i %!"ci"na2ni /"da1a.'%0"2a/sna 7aa ta.% n%0"2i0" s%0ndi d" n%0"2i0" !inta' O&i2.%1ava . "/$a s2a&"st, &"2 1%2c, !?nina, sa2ivaci.a' Cni s% /%d "?i!a, v.%dic%, dv"s2i0%, !tna s2i0a' Os"&a .%n%si>na /i sta.an. vt">2avic, (2adan n"., &2i.%d 0"1, ta(i/n", 7i2i7"!an /2sG&ita0 svi.%sti: K"2a/sna 7aa ta.% n%0"2i0" s%0ndi d" n%0"2i0" !inta' Zna0"vi s .a?%ia1%ni: /"#i%n% .%nic%, /ad t2a0a' "!"$ 0"d 0"2a/sa: At"tans7i.s0i /"2"1a., "s2"&"ditisv% #t" st%1%, >2ava na stan, 0"nt"2a "/$%> stan.a' %v%nci.a 0"2a/sa: /"st/n" sta.an.% -/v" s.%di, d&"0" di#% i !i?% n">a!a' A0" n%!a na0"va 0"2a/sa sta.%'T"!&"a - "v#ins0i t"!&"72%&itis T" .% /a2a v%n% sa stvaan.%! t"!&a 0".a a(va$a/"v#ins0% v%n% 0 &"> davan.a in7i.%, &ani2%' "v#ins0% v%n% n">: a(va$%n% s/"t0"2.%nic% 6v%na sa7%na i n.%ni ">anci8' +?%sta2i.a .% 0"d 1%na, a /"d2i.%1 "ni 0".i s /i.%&"2"va2i "d t"!&"% i2i stai.% "s"&%, >".ani, "ni 0".i &"2. "d 0acin"!a' K"d "/%aci.a naa&d"!%n i >in%0"2"#0i( "/%aci.a "&av%na .% t"!&"/"7i2a0sa' Li.%?%n.% t"!&"% id%2"0a2n" s anti0"a>2aci.s0i! 0%!a!a "&av%n" !i"van.% s /"di>nti! %0st%!it%t"!'

Da.% s% (%/ain sva0"dn%vn 0"nt"2 0"a>2aci.%' K"!/%sivni av". s% stav2.a /i.%sta.an.a'D&"0a v%ns0a t"!&"a Mani7%stia s% "d 4'-4' /"st"/%ativn"> dana'T%#0" s%di.a>n"sticia' O&i?n" /"?in.% d&"0i! v%na!a 2ista /"t0"2.%nic%' M"1% s% /"#iiti /"/2it%a2n v%n, 7%!"a2n v%n, v%n% !a2% d.%2ic%' Si!/t"!i: N">a 2a>an" "0%nta /%!avan i savi.%na 0"2.%n'T%1ina i &"2 2ist 0"d st%an.a !i#i$a' T.%2%sna t%!/%ata !"1% &iti/"vi#%na' Li.%?%n.% d&"0% v%ns0% t"!&"%: !i"van.% 0%v%t,a&ana !asian.a i a0tivni(/"0%ta' "di>nti /"dn"1.% 0%v%ta - *AST+K NE' "v"di s% !.%%n.% "&.!a dav% i&"2%sn% n">%, da.% s% anti0"a>2antna t%a/i.a 0"nt"2 0"a>2aci.%' ).%1&% i sta.an.% /""d%d&i 2i.%?ni0a %2asti?ni av".'

KOMLIKACI*E NA ROBA)NOM TRAKT+

A0tna di2ataci.a 1%2ca 5 "va$an.% 5 R%>>itaci.a - "st"/%ativna /aa2ia ci.%va A0tna di2ataci.a 1%2ca .% na>2" /"#i%n.% 1%2ca 0".i .% i>&i" t"ns 6sv". !i#i$n na/%t"st8'*av2.a s% 0"d "/%aci.% na a&d"!%n, i!"&i2iaci.% !a2% d.%2ic%, a !"1% i 0"d d>i("/%aci.a'T" .% t%#0a 0"!/2i0aci.a 0".a s% .av2.a s% <'-3' /"st"/%ativni dan na0/2.an.%!n%0"2i0" 2itaa t%0$%> sad1a.a ta!n" s!%% &".%' Si!/t"!i a0tn% di2ataci.% 1%2ca: #tcan.%i s!ad i sta, 2"#% "s.%$an.%, ta(i0adi.a, %>>itaci.a, d%(idaci.a, "2i>i.a, ast". v.%t"va na0"v% #"0a' P2adni ci.an"ti?ni %0st%!it%ti, #i2.%n n"s, /a2% "?i' "!"$ i 2i.%?%n.%:Na">asti?na s"nda - ni#ta na sta' C/2.%n.% sad1a.a sva0i( -< sata sa #tca2.0"! "d <-@!2' "t%&an /i&" .% i &&%1asta d.%2ica i stani?%vina' )a1n" .% &i2.%1%n.% 0"2i?in%'Is/ian.% 1%2ca sa ,Q NaC2' In7i.a KC2 H,4@, 0"nt"2a "/$%> stan.a, vita2ni( na0"va'

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"va$an.% .% a0tivan /"c%s va$an.a 1%2?an"> sad1a.a, d"&" .% vid2.iv i 2a0#% s/.%?iv'"st".i "/asn"st "d as/iaci.% 0t"> i2i t%0$%> sad1a.a'R%>>itaci.a .% /asivan a0t i2i.%van.a 1%2?an"> sad1a.a 'Ti( .% i n%vid2.iv, /a .% at" "/asan'MENDELSONO) SINDROM - as/iaci.a 0is%2"> 1%2?an"> sad1a.a' Iaiva "#t%$%n.%s2nic% di#n"> ta0ta%d%! d#ni0a i s2nic% /2$a /a &d% /"%!%$%n tans/"t CO< i O<'i!.%ti s% t%0 na0"n _ sata /a .% at" n%!in"vna t%#0a 02ini?0a s2i0a'aa2iti?0i i2%s T" .% stan.% ci.%vn% at"ni.%, t.' 7n0ci"na2na /aa2ia ci.%va' Z&"> t">a nasta.%ast". ci.%vn"> sad1a.a 2!%n ci.%va' Nasta.% &"> /"da1a.a /%it"n%!a ti.%0"!"/%aci.% i "/%ativn% !ani/2aci.% s ci.%vi!a' M">$ .% av". /%it"nitisa'Si!/t"!i /aa2iti?0"> i2%sa: dist%ndian a&d"!%n, n% ?.% s% /%ista2ti0a, a/s"2tni ast".v.%t"va i st"2ic%0 Ne,a a-).,ina"ni' -.".va' "va$an.%, d%(idaci.a i "/$% 2"#% stan.%' Za/"stav2.an.% di.a>n"% RTG nativna sni!0a a&d"!%na st".%$%! /"2"1a. i2i na &"0')id% s%/"#i%n% vi.>% ci.%va i t%0$i sad1a. 6niv" t%0$in% /a inad a08'"!"$ i 2i.%?%n.% - na">asti?na s"nda, in7i.a, da!", anti&i"tici' Na">asti?na s"nda -c/2.%n.% i is/ian.% 1%2ca' Odstan.ivan.% t%0$%> sad1a.a i /">tan"> a0a 0".i stvaa .a0dist%ni.' In7i.a %2%0t"2iti-0a2i.' Da!" /" "d%d&i 2i.%?ni0a' L%1i na d%sn"! &"0 ta0" daans /%dstav2.a na.vi# t"?0 ti.%2a' D"&i.% "sti>!in, a na0"n 3 !in 02i!' Za /"tican.%/%ista2ti0% !asa1a a&d"!%na' Anti&i"tici 0a" /%v%nci.a in7%0ci.%' A0" n%!a /%ista2ti0%, n%!av.%t"va ni st"2ic%' Ravi.a s% /aa2iti?0i i2%s, /a .% indician "/%ativni a(vat' Radi s%d%0"!/%si.a ci.%va /t%! c%0"st"!% i2i i2%"st"!%'

OPERA!IJA DOJKE

D".0a .% /aan 12.%dani ">an s!.%#t%n na /sn"! 0"# i!% d>"> i s%d!"> %&a ii!% /sn% 0"sti i s%dn.% /a#n% 2ini.%' "1%ta .% !%1"! 2i!7ni( 1i2a'B"2%sti d".0%: Mastitis, !ast"/ati.a, t!"i, CA d".0%%dis/"ici.%: Nas2.%dna, n%"t0in.% i2i /vi /""d na0"n 3' >"din%, 0"ntac%/ci.s0a s%dstva6a sada ni.% d"0aan"8' R.%% 0"d 1%na sa t".% i vi#% "%n% d.%c%'Si!/t"!i CA d".0%: Bezbolni vor , /"n%0ad &"2an na d"di i2i s/"ntan" &"2an isc.%da0 i !a!i2%0vav, .%% s%"an i2i a!$%n' Ods0"a v?%na &adavica, %0c%! i 0st% na &adavici'Pa!etova boles t - ">ani?%na v?%n"st 0"1% inad t!"a, %ta0ci.a 0"1%, 2c%aci.% 0"1%inad t!"a' K"1a d".0% s2i?na 0"i naan?%, cv%ni2", t"/2ina, &"2na "s.%t2.iv"st i %d%! 0"1%'Upalni oblik karcinoma - /"v%$ani 2i!7ni ?v""vi a0si2i, &"2"vi 2%i!a i2i /at"2"#0% 7a0t%Zna0 !%tastaa n%0i( 1%na /vi na0 0acin"!a'Di.a>n"sti0a - Sa!"/%>2%d d".0%, ana!n%sti?0i /"datci, 7ii0a2ni /%>2%d, ins/%0ci.a, /a2/aci.a,RTG, !a!">a7i.a, >a2a0t">a7i.a, CT, MR, +Z) d".0i, !a0%i 0acin"!a d".0%, cit"2"#0a/n0ci.a d".0% - ?v"a, "/%aci.s0a &i"/si.a PDPreoperativna priprema: Rtins0% i s/%ci.a2n% /%ta>%"pća prijeoperacijska priprema - si("2"#0a /i/%!a .% .a0" va1an di" 2i.%?%n.a' N%"/("dn" .%

02.?ivan.% "&it%2.i i /atn%a' Bitna .% /"t/"a t%#0"! /si(i?0"! stan.ii?0a /i/%!a - #an prije operativno! za$vata 2a0" /"&av2.iv ?a0' T%0$ina d" <<-<4 sata,s/"it"i., 02i!a' T%&a /"d?iti #t" s0inti, "&$i, v.%1&% /%v%nci.%, %s/iat"n%, ci02at"n%Priprema na dan operacije - Os"&na (i>i.%na, &i.an.% /a(a i2i "/%aci"n". sa2i,/%!%di0aci.a'%irurško lijeenje - Odstan.%n.% t!"a i ss/%0tn"> /"d?.a d" dav" t0iv",0vadant%0t"!i.a, s%>!%nt%0t"!i.a, /aci.a2na %s%0ci.a d".0%, adi0a2na !ast%0t"!i.a' +0i#0" 2i.%?%n.% 0%!"t%a/i.a, a?%n.%' -4 dana na0"n "/%aci.% 6adi"d%!atitis8,("!"ns0a t%a/i.a'Poslijeoperacijska nje!a

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40 )an - "vi#%ni /"2"1a. a &"2. v%nti2aci. /2$a i is0a#2.avan.%' K"nt"2a vita2ni( 7n0ci.a, a/"s%&n" disan.% &"> av".a' R0 na "/%ian". stani staviti na .ast0, a 2a0at /"d /avi!0t"! a /%v%nci. %d%!a: &"2.% "t.%can.% 0vi i 2i!7%' D%na1a .%%d"n d%n - &"?ni /"2"1a. nastani d%na a &"2.% "tican.% sad1a.a' K"nt"2a "/%ativn% an% - 0va%n.%, a &"> %2asti?n">av".a "0" >dn"> 0"#a - disan.%' K"d 0va%n.a 0v s% s2i.%va "d"sta>a - na 2%a' M"> s%

.aviti /"st"/%ativn% /"t%#0"$% i 0"!/2i0aci.%' Bitn" .% /"v"%n.% v.%1&i /%v%nci.% %s/iat"ni(i ci02at"ni( 0"!/2i0aci.a' Nav%?% !"1% stati i /iti ?a.'30 (.+$.(era$ivni )an - +sta.%, /"!"$ "0" "s"&n% (i>i.%n%, 0"nt"2a vita2ni( na0"va, 0"nt"2aan% i d%na1%, /"v"%n.% v.%1&i /%v%nci.%' v" ?%#2.an.%,/a ("dan.% 0"! /" id, /astaviti 0 na >2av' %(ana 2a0"/"&av2.iva s d"sta vita!ina i &.%2an?%vina "si! a0" i!a"d%%n di.%t '0 (.+"ije.(era$ivni )an sta.an.%, 0"nt"2a disan.a, d%na1%, an%' K"nt"2a /%ista2ti0%s/"tit"i.' I da2.% /"v"%n.% v.%1&i a>i&avan.a 0%, a!%n"> >2"&a &"> /%v%nci.%0"nta0t%, %d%!a i 2i!7ad%!a0 (.+$.(era$ivni )an - Ed0aci.a &"2%snic%, v.%1&% 0% na "/%ian". stani'si("2"#0a /"!"$ i /"d#0a a /i(va$an.% i /i2a>"d& na /"!.%n% nasta2% "/%ativni!a(vat"!02.?ivan.% n"!a2an 1iv"tX' "st".i d>a 1%na "/%iani( na d".ci' Za 2a0#/i2a>"d& n"v". sitaci.i i i>2%d /sn% /"t%%, >dn.aci, %0"nst0tivni a(vati' Zdavstv%ni"d>". - /i.% "d2as0a i &"2nic% /aci.%ntici i n.%in". "&it%2.i t%&a /"!"$i /si("2"#0"., s/"2n". is"ci.a2n". a(a&i2itaci.i' T%&a .% /titi !%(ani!% /i2a>"d&% '%v%nci.a - Sa!"/%>2%d d".0i /"v"diti .%dn"! !.%s%?n", n%/"s%dn" na0"n !.%s%?nic% 0ads d".0% na.!%0#% i nis "s.%t2.iv%' O&av2.a s% /"!atan.%! - ins/%0ci."!, "/i/avan.%!-/a2/aci."!' I!a 2i /"!.%na v%2i?ini .%dn% "d d".0i, i!a 2i /"!.%na &adavica!a i2id&2.%n.a i2i s!%1an"sti na d".0a!a i2i &adavica!a' *%s 2i v%n% na d".0a!a is//?%ni.%n%>" "&i?n"'

OPERA!IJA NA PRSNO2 KOŠU

"stav2.an.% di.a>n"% - Is/2.va0 na &a0t%i"2"#0 i cit"2"#0 ana2i' RTG /2$a, t"!">a7i.a,CT /2$a'Ot0ivan.% /i!ani( t!"a, !%tastaa, scinti>a7i.a /2$a, %!&"2i.a, 0acin"! &"n(a,&"n("s0"/i.a, &"n(">a7i.aPD' 2%a2na /n0ci.a'Ki#0" 2i.%?%n.%O2.%d% /sn"> 0"#a 5 n%!"t"a0s, %!/i%! /2%%, /2$ni a/sc%s, t!" /2$a i /2%%,%(in"0"0 /2$a)st% 0i#0i( a(vata: T"a0"t"!i.a9"tvaan.% /sn"> 0"#a, R%s%0ci.a /2$a90i#0""dstan.%n.% .%dn"> di.%2a /2$a, 2!%0t"!i.a9"dstan.%n.% /2$n"> 0i2a,L"&%0t"!i.a9"dstan.%n.% /2$n"> %1n.a, S%>!%nt%0t"!i.a9"dstan.%n.% .%dn"> di.%2a %1n.ai.%"/%aci.s0a /i/%!a : si("2"#0a , 7ii?0aii?0a /i/%!a : Os"&na (i>i.%na - (i>i.%na sn% #/2.in%,

i/%!a %s/iat"n"> sstava - Ci2. .% s!an.%n.% s%0%ta di#ni! /t"vi!a' ).%1&% is0a#2.avan.a, v.%1&% disan.a, /"2"1a.na d%na1a - B"n(i%0tai.%,

/2$ni a/sc%s - "visn" " s%>!%nt 0".i t%&a d%niati' Pidaci.a -3 2t%0$in%<4sata - ta0" s% av"dn.ava s%0%t i /"s/.%#.% is0a#2.avan.%,!i0"02i!a

i!.%na /"/isan% t%a/i.% 5 Anti&i"tici, 0%!"t%a/%tici#an prije operativno! za$vata - O/$a /i.%"/%aci.s0a /i/%!a&a dan operacije - i/%!a "/%ativn"> /"2.a, /%!%di0aci.aPoslijeoperacijska zdravstvena nje!a - G2avni adaci s "d1avati /"("dn"st di#ni( /t"va,/"sti$i #t" &"2.% /"#i%n.% /%"sta2"> di.%2a /2$a, /%/"nati si!/t"!% 0"!/2i0aci.a, "si>atit%!%2.it %(a&i2itaci.

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Int%nivna <4-4=-H< sata /"vi#%n"! /"2"1a. a &"2. v%nti2aci. i is0a#2.avan.%' K"nt"2avita2ni( na0"va, %s/iaci.%' R%s/iat"n% %%v% s s!an.%n% &"> %s%0ci.% /2$a, >&it0a0vi i sni1%n"> 0vn"> t2a0a' K"nt"2ia s% 0isi0-ABS at%i.s0% 0vi' Dis/n%.a-ci.an"a .% na0n%d"v"2.n% "0si>%naci.%' O&av%na .% 0"nt"2a 0va%n.a' D%na1a .% /"stav2.%na a"dstan.%n.% a0a i s0vic% i /si#ta' T" .% B`LA+ atv"%na d%na1a 6/asivna8B`LA+ sisna i2i as/iaci.s0a d%na1ad%na1ni sist%! s/".%n s a/aat"! na n%>ativni t2a0 i2i nac%nta2ni %a. a n%>ativni t2a0' Bitna .% &i>a " /"("dn"sti ci.%vi-n% savi.ati i(, a "&av%n"&i2.%1iti 0"2i?in <4 sata' K"d /"!.%n% &"c% t%&a . 02%!ati s dva /%ana' D%n "sta.% /si#t d"0 0"2i?ina<4sata n% &d% !2 ' )a%n.% d%na: <-3/ta &"2%sni0 d&"0" da(n% iad1i da(, 01ni #av "0" d%na st%>nti /i va%n. d%na' Gaa2%0"/2ast 6ci.%/8"s2i.%"/%aci.s0a n.%>a - i!.%na /"/isan% t%a/i.%, in7i.a, tans7i.a, anti&i"tici' Sana2>%tici!a "/%n" da s% i&.%>n% n%1%2.%n" d.%2"van.% na c%nta a disan.% i %72%0s 0a#2.a, ati!% i 0"!/2i0aci.a - at%2a0taa'T%&a /aiti na /2$ni %d%! - /istna .% i dis/n%.a, ci.an"a, /.%n#avi is/2.va0, /"da1a.ni0a#a2.'T%&a /"v"diti v.%1&% disan.a i is0a#2.avan.a 7ii"t%a/%ta, /2asti?ni %s/iat", ad%0vatn!i0"02i!, a%"s"2 t%a/i.' A0" .% /n" s%0%ta: %nd"ta(%a2na as/iaci.a,&"n("s0"/i.aas/iaci.a'%(ana - 40 )an /a%nt%a2na, 30 (.+$.(era$ivni )an t%0$% 0a#asta - n%!a ">ani?%n.a"si! &"> d>% &"2%sti, &">ata &.%2an?%vina!a, vita!ini!a, !in%a2i!aP.+$.(era$ivne k.,("ika9ije - "%!%$a.i /2$n% 7n0ci.% .% .% /2$ni v"2!%n s!an.%n <@-3 /va 4 dana' S!an.%na .% v%nti2aci.a, s!an.%na i!.%na /2in"va, s!an.%n /2$ni"&a!&%ni !%(ania!'

At%2%0taa ti.%0"! n"$i <'/"st'"/'dan &"> ana2>%ti0a .% s!an.%na v%nti2aci.a i is0a#2.avan.%,na0/2.an.% s%0%ta, a?%/2.%n.% &"n(a i &"n(i"2aB"n("/n%!"ni.an%!"ni.a

ZDRAVSTVENA NJEGA BOLESNIKA KOD OPERA!IJE PROSTATE

Indi0aci.% a "/%aci. -Pi/%t"7i.a /"stat% -ad%n"! i 0acin"! /"stat%Si!/t"!i - Ot%1an" !"0%n.%, na/in.an.% /i.% /"?%t0a !"0%n.a, "s2a&2.%n !2a, /"2a0isi.a,?%st" !"0%n.% "s.%$a. &"2i i n%d"v"2.n"> /a1n.%n.a' Ni0ti.a , (%!ati.a , &"2 s2a&ina!a iav#n"! di.%2 d%&%2"> ci.%va'%ta>%: di>it"%0ta2ni /%>2%d-)%2i?ina,0"nist%nci.a

+Z) !"0a$ni( /t"vaR%ida2ni in - /aci.%nt d"2ai na +Z) /%>2%d s /ni! !.%("! da s% "d%di

7n0ci"na2ni 0a/acit%t i 0"2i?ina ina 0".i a"sta.% na0"n !"0%n.a !2Tans%0ta2ni 2tav0 /"stat% -a is/itivan.% st0t% /"stat%Mi0ci"!%ti.a9"72"[ - is/it.% s% &ina i sna>a !2aa /i !"0%n.+%t"cist"s0"/i.aIv'">a7i.a

Bi"/si.a /"stat%PDSA -"stata s/%ci7i?ni anti>%n - !2 v%ns0% 0vi' "vi#%n% vi.%dn"sti vid% s%i 0"d /a2%, a n% sa!" 0"d 0acin"!a /"stat% - t%&a /"nav2.ati na2a'

Prijeoperacijska priprema - tins0% /%ta>%, an%st%i"2"#0i /%>2%d, s/%ci7i?n% /%ta>%si("2"#0a /i/%!aii?0a /i/%!a

Dan /i.% "/%aci.% - .(a a ?a0, t%0$ina d" <4 sata, ?i#$%n.% /"&avn"> ta0ta' "d0a/%v%ntivni( v.%1&i, /titi #t" t%&a /"s0idati'Na dan "/%aci.% - "s"&na (i>i.%na, &i.an.% %!%di0aci.at"!&"/"7i2a0sa, vid.%ti na/"!%nna /%!%di0aci.s0"! 2isti$

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)st% "/%aci.%:- K2asi?na "/%aci.a - adi0a2na /"stat%0t"!i.a % na t&#n". sti.%nci i !.%(- End"s0"/s0i a(vat - "/%aci.a /%0" cist"s0"/a,2as% -T+R tans%ta2na %s%0ci.a /"stat%

"s2i.%/"%aci.s0a davstv%na n.%>a - S"&a a &%n.%40 )an - K"nt"2a vita2ni( na0"va sva0i( @-3 !in' + "0 -3 sata /"sta. sta&i2ni' "[2%"v/"2"1a. a &"2. v%nti2aci. /2$a i is0a#2.avan.%' Ni#ta na sta' Nav%?% !"1% ?a.' "/isanat%a/i.a s% da.% /a%nt%a2n"in7i.s0% "t"/in%' K"nt"2a "/%ativn% an%K"d 02asi?n% "/%aci.% 5 d%na1a, is/ian.% !"0a$n"> !.%(a !">$ /".av /"t%#0"$a i0"!/2i0aci.a' T%&a /"v"diti v.%1&% /%v%nci.% 0"!/2i0aci.a d>"ta.n"> 2%1an.a'30 )an -Os"&na (i>i.%na /"!"$' +sta.% a0" n%!a is/ian.% !"0a$n"> !.%(a' "v"div.%1&% /%v%nci.% i d"&iva /"/isan t%a/i. in7i.%' T%0$%-0a#asta di.%ta, 2a0"/"&av2.iva/%(ana' iti d"sta t%0$in% - "2"#0i ?a.' K"nt"2a "/$%> stan.a, vita2ni( na0"va, "/%ativn%an%' K"nt"2a inan"> 0at%t%a i v%$ica, t% is/ian.% i in0 )an - Os"&na (i>i.%na, sta.an.%, t%0$ina2a0"/"&av2.iva /%(ana' A0" n%!a t%&a /"?%ti/"s/.%#ivan.% /%ista2ti0%' K"nt"2a 0at%t%a i da2.% /"/isan t%a/i.'0C0 )an - "st/ci isti' Kat%t% "sta.% d" s%d!"> dana'K"d 02asi?n% "/%aci.% #avi "sta. H'-='danaU(u$e &a ku*i - .%sti (an 0".a n% na/(ava, /aiti na %d"vit"st st"2ic% %d"vn% 2a>an%#%tn.%' O&av%n% s %d"vit% 0"nt"2% 0"d 2i.%?ni0a' M">$a .% /".ava /"t%#0"$a s !"0%n.%!'Sv(a is/ian.a !"0a$n"> !.%(a .% 02an.an.% 0vi i 0vni( >#a0a i !"0a$n"> !.%(a,s!an.%n.% &a0t%i.s0% 72"%' Is/ian.% s% v#i /t%! t"c.%vn"> 0at%t%a' Ba2"n s% na/ni sa -= !2'

End"s0"/s0a "/%aci.a - Dv"c.%vn"> 0at%t%a i cist"st"!% , &a2"n -= !2K2asi?na "/%aci.aIs/ian.% - T%0$ina .% 7ii"2"#0a "t"/ina /a0iana v%$% "d < !2 s"&n% t%!/%at%' Da.%s% -@ 2itaa <4 sata' "t"0, t.' &ina c%n.a "visi " i>2%d sad1a.a' B" 0a/an.% 0adai!a >#a0a'Ta.an.% is/ian.a - Na dan "/%aci.% i ' /"st'"/' dan "visn" " i>2%d is/an"> sad1a.a'

Kat%t% .% s/".%n s ins0"! v%$ic"! na is/st na atv"%n sist%!' )a1n" .% ?%st" /a1n.%n.%v%$ic% /%0" is/sta' T%&a s% /id1avati as%/ti?0i( v.%ta ada i &i2.%1iti 0"2i?in n%#%n% ii2?%n% t%0$in%'a1n.a - /aiti da s% 0at%t% n% a?%/i >#ci!a' A0" s% t" i d">"di, t%&a #tca2.0"! i7ii"2"#0"! "t"/in"! nast".ati "d?%/iti' O&av%n" t%&a 0"istiti 0avic%'

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