Riƙon Ƙarfin Ƙirar Ƙiƙwalwar Ƙirar Ciki da Kulawa da Gaggawa na Ciwon Ciki¶

Cutar fitsari mai tsauri (AUR) na faruwa kwatsam, mai raɗaɗi na rashin iya zubar da mafitsara mai zafi duk da cikar mafitsara mai saurin miƙewa mai ɗauke da 500 zuwa sama da milliliters 1,500 (oce 17 zuwa 50) na fitsarin tarko. Hakanan gaggawa shine ** an toshe shi sosai a cikin urethra (Foley) ko catheter suprapubic , inda ma'adinan ma'adinai, kauri mai kauri, kink na inji, ko gudan jini ya toshe bututun magudanar ruwa na catheter. Lokacin da fitsari ba zai iya tserewa daga mafitsara ba, matsa lamba na ciki yana hawa da sauri, yana haifar da spasms na ƙananan ciki (suprapubic), tsarin juyayi mai cin gashin kansa ( matsananciyar hawan jini ko barazanar rayuwa). autonomic dysreflexia a cikin marasa lafiya na kashin baya *), matsananciyar baya na sama wanda ke rufe kodan biyu ( bayan-renal m koda rauni da hydronephrosis na biyu), da kuma urosepsis.

Ayyukanku na gaggawa lokacin da wani ba zai iya yin fitsari ba ko kuma yana da toshewar catheter na ciki shine ** dakatar da shan duk wani ruwa nan da nan ** (shan ƙarin ruwa lokacin da aka toshe fitar mafitsara yana kara tsanantawa mafitsara da ɓacin rai), allon duban jijiyoyin jiki cauda equina syndrome (ciwon baya tare da lanƙwasa sirdi ko raunin ƙafa) da autonomic dysreflexia (nauyin ciwon kai da hawan jini a cikin majinyacin rauni na kashin baya), yi duban bututun catheter na waje na na biyu na 60 ** (tushen murɗaɗɗen bututun da ba a kwance ba, daɗaɗɗen madaurin ƙafa, da runtse jakar magudanar ruwa a ƙasa matakin mafitsara) idan catheter ya riga ya kasance, ** kar a taɓa turawa, ja, ko wayoyi na jabu, nan da nan don shiga cikin mafitsara. decompression.

Yi wannan yanzu¶

1. Ka daina shan duk ruwa da ruwa nan da nan: Lokacin da aka toshe hanyar mafitsara ko catheter, kowane ruwan da ka sha yana tacewa ta cikin kodan zuwa cikin mafitsarar da ke cikin tarko, yana kara shimfida filayen tsokar da ke lalata da kuma kara zazzafan spasms na suprapubic.
2. Kira ma'aikatan kiwon lafiya na gaggawa nan da nan idan babban haɗarin jijiya, septic, ko rauni ja tutoci suna nan: Kira lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a cikin United Kingdom, 000 a Ostiraliya) ko duba kundin adireshi na lambobin gaggawa idan rashin iya fitsari yana tare da:
3. ** Raunin kashin baya a sama da T6 tare da ciwon kai mai zafi, fuska mai zazzagewa, ko hauhawar jini** (Mai sarrafa kansa Dysreflexia, gaggawa mai haifar da bugun jini).
4. ** Ƙarƙashin ciwon baya, ƙumburi a cikin makwancin gwaiwa / duwawu ("saddle anesthesia"), ko rauni / tingling a kafafu *** (Cauda Equina Syndrome).
5. ** Zazzabi (> = 38.0 digiri Celsius / 100.4 digiri Fahrenheit), girgiza sanyi, rudani, ko dizziness** (Urosepsis).
6. ** karaya na baya-bayan nan, rauni ko jinni da ke digowa daga saman urethra** (karshen urethra; kada a taba yunkurin shigar da catheter har sai an yi retrograde urethrogram).
7. ** Idan mutumin yana da Foley mai ciki ko catheter na suprapubic wanda ya daina zubarwa, gudanar da Duban Tubing na waje na 60 na biyu a yanzu:**
8. ** Unkink: ** Bincika dukkan bututu daga jiki zuwa jakar; daidaita duk wani kaifi mai lanƙwasa, murɗawa, ko madaukai inda majiyyaci ke zaune ko kwance akan bututu.
9. ** Cikewa:** Tabbatar da duk wani matsi na faifan filastik ko bawul ɗin catheter flip-flo ba a bar shi da gangan a kulle ba.
10. Sake madaurin kafa: Cike madaidaicin madaurin jakar ƙafar Velcro wanda maiyuwa yana tsotse lumen silicone mai laushi.
11. Rasa jakar da ke ƙasa da hips: Matsar da jakar magudanar ruwa ƙasa ƙasa da matakin mafitsara (fitsari ba zai iya gudana sama da nauyi ba, jakar da ke kan katifa ta haifar da ** kulle iska ** wanda ke dakatar da malalewa).
12. KADA KA KYAUTA FITAR DA catheter na cikin gida ba tare da lalata balloon riƙewa na ciki ba, kuma KAR KA taɓa wani abu a cikin catheter: Ballon mai cike da ruwa mai *milili 10 yana ɗaure a cikin mafitsara ta hanyar tumatur mai girma kamar tumatir ceri. Fitar da catheter tare da kumburin balloon yana yanke prostate da urethra, yana haifar da zubar jini mai yawa.
13. Kada a danna maƙarƙashiya a ƙananan ƙananan ciki (Credé maneuver yana da haɗari a cikin toshewa): Matsa karfi a kan ƙwanƙwasa ƙwanƙwasa, toshewar mafitsara yana haifar da matsa lamba na intravesical, sojojin da suka kamu da fitsari a baya a cikin kodan (** vesicoureteral reflux**), kuma zai iya rushe bangon mafitsara mai bakin ciki ko mai divertic diver.
14. Jeka sashin gaggawa na asibiti da gaggawa idan fitsari bai wuce awanni 4 zuwa 6 na radadi mai zafi ba (ko sa'o'i 1 zuwa 2 na toshewar catheter): Catheterization na gaggawa na bakararre mafitsara yana kawar da radadin cikin dakika 30 kuma yana kare tsokar mafitsara da koda daga rauni na dindindin.

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    StopDrink --> CheckNeuro{"2. Bincika Mahimman Tutoci na Ja: Rauni na Kashin baya + Ciwon kai/High BP (Autonomic Dysreflexia), Saddle Numbness/Weakness Leg (Cauda Equina), Zazzabi/Ciwon sanyi, ko Ciwon pelvic?"}
    CheckNeuro -->|Yes| CallEMS["Kira Ayyukan Gaggawa (911/112/999) Nan take"]
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    HasCath -->|Yes: Blocked Catheter| CheckTube["Gudu Bikin Bututu na Biyu na 60: Madaidaicin Kinks, Buɗe Maɗaukaki, Sauke madauri, Rataya Jakar ƙasa Hips"]
    HasCath -->|No Catheter| UrgentED["Kai Kai Gaggawa zuwa Sashen Gaggawa don duban mafitsara da lalatawar Catheter"]
    CheckTube --> Draining{"4. Shin Fitsari Ya Fara Ruwa A Cikin Jakar A Cikin Minti 5?"}
    Draining -->|No / Still Blocked or Bypassing| UrgentCath["Nemi Ma'aikacin jinya na Gaggawa / Kulawa na Asibiti don Ruwan Ruwa ko Canji (Kada a Cire Balloon)"]
    Draining -->|Yes| Monitor["Kula da Launin Fitsari, Clots, da Ƙarar a hankali"]

Me yasa mn fitsari mai tsanani ke faruwa: Dalilai na yau da kullun a cikin maza, mata, da yara¶

A al'ada, urinating (micturition) yana buƙatar ayyuka guda biyu masu aiki tare da sacral kashin baya (** S2, S3, da S4 parasympathetic jijiyoyi ) da kuma kwakwalwar kwakwalwa pontine micturition cibiyar: bangon muscular na mafitsara ( detrusor tsoka ) dole ne ** kwangiloli na ciki da kuma wuyansa sphine state ( masu karɓa) dole ne a lokaci guda ** shakatawa da buɗewa ***. Riƙewar fitsari mai tsanani yana faruwa a duk lokacin da aka matse magudanar jiki KO raunin jijiya/ tsoka ya gaza:

Mummuna tare da Riƙewar Urinary Na Zamani: Gane "Rashin Ƙarfafawa" (Me yasa ɗibar fitsari baya nufin mafitsara ba komai bane)¶

Ɗaya daga cikin kuskure mafi haɗari a tsakanin iyalai da masu kulawa shine tunanin cewa saboda mutum yana zubar da ƙananan fitsari a kowane minti 20 ko kuma ya jika abin da ba zai iya jurewa ba, ba za su iya samun riƙewar fitsari ba.

A haƙiƙa, wucewar ƙananan fitsari akai-akai (30 zuwa 50 milliliters a lokaci ɗaya) ko ɗigon ruwa akai-akai ba tare da wani jin daɗi na cikar ciki ba shine babban alamar Rashin ƙazantawa daga matsanancin riƙewar fitsari:

Magance matsalar gaggawa don katafaren gida mai katange (Foley ko Suprapubic)¶

Miliyoyin mutane suna zaune a gida tare da catheter na dogon lokaci ** na zama na urethra (Foley) ko kuma ** catheter na suprapubic ** (catheter yana shiga cikin mafitsara kai tsaye ta hanyar ƙaramin maɓalli na stoma a ƙasan ciki kusa da ƙashin mahaifa). Saboda kwayoyin cuta irin su Proteus mirabilis suna mamaye catheters na dogon lokaci kuma suna samar da enzyme urease, suna juyar da fitsari alkaline kuma suna haɓaka struvite da calcium phosphate crystals ("catheter encrustation") wanda zai iya toshe gashin ido a ƙarshen catheter cikin sa'o'i.

1. Yadda za a gane kateter a katange¶

Yi zargin catheter da aka toshe nan da nan idan:

• Fitsarin sifili ya zube a cikin jakar tarin a cikin awanni 2 zuwa 4 da suka gabata (duk da yawan shan ruwa).
• Mutumin yana tasowa ** sabon cikar ciki na ƙasa (suprapubic), zafi, ko kumburin mafitsara mai raɗaɗi**.
• ** Paradoxical "Catheter Bypassing" (Fitsarin fitsari a kusa da waje na catheter):** Yawancin masu kulawa suna ganin fitsari yana jika zanen gado * a kusa da * waje na catheter tube kuma suna kuskuren tunanin "Catheter yana da kankanta." ciki*, tilasta wa cikakken mafitsara mai raɗaɗi shiga cikin tashin hankali wanda ke fitar da fitsari a waje da bututu.
• ** A cikin majiyyaci tare da Rauni na Spinal Cord a ko sama da matakin thoracic T6:** Kwatsam ** bugun ciwon kai, hawan jini yana karuwa 20 zuwa 40+ mmHg sama da asali, jinkirin ko bugun zuciya, yawan gumi da zubar da jini sama da matakin raunin da ya faru, da guzbumps a ƙasa da matakin rauni **. Wannan shine Mai sarrafa kansa Dysreflexia, kuma toshewar catheter na fitsari shine dalilin #1 (wanda ke da alhakin sama da kashi 75 zuwa 85 na duk hare-haren dysreflexia na autonomic).

2. Mataki-mataki amintaccen bincike na waje don katange catheter (Abin da kowa zai iya yi a cikin daƙiƙa 60)¶

Kafin ka je asibiti ko kiran ma'aikacin jinya na gaggawa na al'umma, yi wannan ** dubawar waje mai aminci mai lamba 5** (wanda ke warware makullin iska da kinks nan da nan):

1. Zauna majiyyaci a tsaye idan yana da raunin Spinal Cord da Ciwon Kai: Zama mutum a tsaye a digiri 90 kuma suna lanƙwasa ƙafafu yana amfani da nauyi don rage haɗarin hawan jini mai haɗari a cikin kwakwalwa yayin da kuke duba catheter.
2. Buɗe tare da bibiyar hanyar catheter gaba ɗaya daga jiki zuwa jaka: Duba ƙarƙashin bargo, tsakanin cinyoyi, da kuma ƙarƙashin kujerun guragu don tabbatar da cewa mara lafiya baya zaune akan bututu kuma babu murɗaɗɗen murɗaɗɗen.
3. Duba madaurin jakar ƙafa da na'urorin amintaccen catheter (StatLock): Sake duk wani madaidaicin madaurin kafa na roba ko ƙugun rigunan rigar da ke matsawa bututu.
4. Rasa jakar magudanar ruwa da kyau a ƙasan matakin mafitsara (kwatangwalo): Tabbatar jakar tana rataye da yardar rai ƙasa da kwatangwalo (kada a taɓa kwanciya akan katifa ko ɗaure sama akan gadon gado). Idan dogon madauki na tubing ya rataye zuwa ƙasa sannan ya haura zuwa jakar, ɗaga madaukin abin dogaro a hankali na tsawon daƙiƙa 5 don haka fitsarin da ya kama cikin jakar ya karya duk wani makullin iska **.
5. Duba filogi masu iya gani a cikin madaidaicin taga filastik: Dubi bayyanannen mahaɗin inda catheter ya hadu da buhun buhunan magudanar ruwa:
6. ** Kauri mai duhu ja jini clots ("Clot Retention"):** Idan bututun yana cike da duhu ja jelly-kamar ɗigon jini (na kowa bayan tiyatar prostate [TURP], tiyatar tumor mafitsara, radiation cystitis, ko catheter catheter tugging), ** daidaitaccen catheter mai fata Foley ba zai iya zubar da jini ba**; dole ne majiyyaci ya je sashin gaggawa nan da nan don sanya wani ƙwararriyar ƙwararriyar 22-zuwa-24 Faransanci mai ci gaba da ba da ruwa mai ɗorewa (CBI) Hematriuria Catheter** da ƙaurawar jini tare da babban sirinji Toomey.
7. ** Yashi fari mai ƙanƙara ko ƙaƙƙarfan ƙwayar rawaya mai kauri:** Yana nuna ma'adinan ma'adinai ko ƙwayar cuta ta biofilm tana toshe tip catheter.

3. Muhimman ƙa'idodin aminci: Abin da ba za a taɓa yi tare da katange ko rushewar catheter ba¶

• KADA KA YI yunƙuri don zubar da ruwa ko ban ruwa da aka toshe sai dai idan likitanka ya horar da kai kuma kana da maganin saline mai bakararre/catheter mai bakararre da sirinji mara kyau: Fitar da ruwan famfo mara kyau ko turawa da sirinji a gaban catheter da aka toshe gaba ɗaya zai iya karshe bangon mafitsara kai tsaye ko kuma a shigar da ƙwayar koda kai tsaye. Idan an horar da shi don yin bakararre mai laushi kuma ruwan ya gamu da tsayin daka, ** tsayawa nan da nan; kada ku tilastawa mai tsiya**.
• KADA KA KYAUTA A JIN KAETTER Foley ko kayi ƙoƙarin yanke bututun catheter don katse balloon da ya makale: Yanke ramin catheter na Foley akai-akai yana haifar da ƙaramin tashar hauhawar farashin kaya a cikin bangon roba don rufewa har abada don haka balloon * ba zai iya bacewa ba. Likita kawai ko ƙwararren ma'aikacin jinya yana amfani da bawul ɗin gefe (tare da sirinji na Luer-slip don cire 10 ml na ruwa mara kyau) yakamata ya cire catheter.
• ** Dokar gaggawa ta sa'a 1 zuwa 2 idan catheter na Suprapubic ya fadi da gangan: ** Ba kamar urethra na halitta (wanda ke buɗewa), wani ** suprapubic catheter tract ** (ramin tiyata ta bangon ciki na cikin mafitsara) ** fara kwangila da rufewa a cikin 30 zuwa 120 mintuna idan bututu ya ja da gangan. Idan catheter na suprapubic ya fado, rufe ƙananan stoma na ciki tare da kushin gauze mai tsabta mai tsabta kuma je zuwa sashin gaggawa mafi kusa ko horar da ma'aikacin urology nan da nan (a cikin sa'a 1) don haka za'a iya zame sabon bututun maye gurbin lafiya ta hanyar da ke akwai kafin a rufe ta.

Gaggawa ta musamman: Riƙewar jini mai ƙarfi (Gross Hematuria tare da ɗigon jini)¶

Lokacin da wani ya zubar da jini a cikin mafitsara (daga prostate ko mafitsara tiyata na baya-bayan nan, ciwon koda, ciwon daji na mafitsara, cystitis radiation, ko magungunan jini), fitsarin ɗan adam yana ɗauke da wani enzyme mai suna urokinase wanda ke ƙoƙarin narkar da ƙananan jini. Duk da haka, lokacin da zubar jini ya yi kururuwa, jini yana taruwa a cikin mafitsara mai dumi zuwa kauri, rubbery, ja mai duhu "kamar hanta" ko gudan jini kamar tsutsa.

Wadannan gudan guda biyu suna nutsewa zuwa gindin mafitsara (trigone) kuma suna aiki kamar madaidaicin baho na roba akan wuyan mafitsara (Cutar Clot Retention).

• Yadda ake tabo daurewar jini: Mara lafiyan ya wuce fitsarin ja mai haske ko duhu burgundy mai dauke da ɗigon jajayen ɗigon gani, sannan ya biyo baya ba zato ba tsammani da ** zafi na ƙanƙanin ciki da rashin iya wucewar fitsari** (ko kuma ya wuce digo na ruwan hoda a kusa da wani babban jini).
• Me yasa Riƙewar Clot shine ainihin gaggawar tiyata na asibiti: Ba ruwan sha ko sanya catheter na Foley na Faransa na yau da kullun 14 ko 16 ba zai yi aiki ba, saboda masu taushin catheters nan da nan sun rushe kuma su toshe tare da gudan jini. A cikin sashen gaggawa, likitoci suna saka stiff ** 22 ko 24 Faransanci Uku-Way Council ko Coude Irrigation Catheter **, da hannu aspirate duk rubbery jini clots daga cikin mafitsara ta amfani da bakararre saline da 60 ml catheter-tip sirinji har sai da dawowar ya bayyana, da kuma haɗa wani ** 3-lita Bladder Congative bags (Ci gaba da bags). yana wanke mafitsara don haka sabon jini ba zai iya samuwa ba.

Abin da ke faruwa a sashen gaggawa: duban mafitsara, raguwa, da Diuresis na baya-baya¶

Fahimtar halayen halayen halayen jiki guda biyu bayan lalatawar da ke faruwa daidai bayan an zubar da mafitsara a cikin asibiti ya bayyana dalilin da yasa likitoci ke kula da marasa lafiya bayan sanya catheter:

1. ** Duban mafitsara na duban dan tayi na gado da sauri da catheterization:**
2. Bayan isowa, ma'aikacin jinya ko likita ya yi 10-na biyu mara zafi ** duban dan tayi na mafitsara ** a kan ƙananan ciki don auna daidai adadin fitsarin da aka kama (yawanci ** 500 zuwa 2,000+ milliliters **) kuma ya sanya catheter mai laushi mai laushi (ta yin amfani da intraurethral na intraurethral) kafin minti 5. Urethra kuma a shakata da sphincter, ko a hankali mai lankwasa Coudé-tip catheter don yawo a hankali akan girman prostate).
3. Lura akan "Clamping the Catheter Every 500 ml": A tarihi, an koyar da ma'aikatan jinya su danne catheter bayan sun zubar da 500 ml saboda tsoron cewa zubar da mafitsara gaba daya zai haifar da zubar jini ("hematuria ex vacuo") ko suma. Ka'idodin urological na zamani da gwaje-gwaje na asibiti bazuwar sun tabbatar da cewa ci gaba da zubar da mafitsara gabaɗaya a lokaci ɗaya yana da aminci kuma mafi girma ga ɗanɗano kaɗan: yayin da hawan jini a zahiri ya ragu kaɗan (cire karu mai raɗaɗi) da ƙananan ƙwayar fitsari na ruwan hoda na iya faruwa daga kumburin mucosal ba tare da la'akari da saurin kamuwa da cuta ba, yana tsawaita rabi.
4. ** Kallon "Diuresis Bayan-Obstructive" (Maɗaukakin Fitar da Fitsarin Fitsarin Bayan Matsala na Tsayawa ko Tsanani mai tsanani):**
5. Lokacin da mutum ya sami ** sama da milliliters 1,000 zuwa 1,500 na fitsari** a tarko a cikin mafitsara (musamman tsawon kwanaki a cikin matsananciyar matsa lamba tare da haɓakar creatinine na jini), kodan na ɗan lokaci suna rasa ikon tattara fitsari bayan an sami sassauci.
6. A cikin sa'o'i 24 na farko bayan sanya catheter, koda na iya zubar da sauri ** fiye da milimita 200 na kodadde, fitsari mai ruwa a kowace awa guda na awa 2 a jere (ko> 3,000 milliliters a cikin awanni 24)**.
7. Yayin da diuresis mai laushi kawai yana fitar da gishiri mai yawa, ruwa, da urea, ** pathologic post-obstructive diuresis ** na iya kawar da majiyyaci da sauri kuma ya cire jikinsu na ** sodium, potassium, magnesium, da phosphate *, yana haifar da hauhawar jini da arrhythmias na zuciya. Duk wani mara lafiya wanda magudanar mafitsara na farko ya wuce ** milliliters 1,000, wanda yawan fitsarinsa ya wuce 200 ml/hour tsawon awanni 2, ko kuma wanda ya sami raunin koda a kan gwaje-gwajen jini ana lura da shi a asibiti tare da bin diddigin fitsari na sa'a da kuma duban electrolyte kafin komawa gida.
8. Fara Alfa-1 Blocker (Tamsulosin ko Alfuzosin) don Nasara "Trial Without Catheter" (TWOC):
9. Ga maza masu fama da cutar hawan jini (BPH) waɗanda ke zuwa gida tare da catheter na ɗan lokaci na Foley catheter da jakar ƙafa, likitocin gaggawa suna ba da shawarar baka kowace rana ** zaɓi alpha-1A blocker (kamar tamsulosin 0.4 mg ko alfuzosin 10 mg). Shan maganin alpha-blocker na aƙalla kwana 3 zuwa 7 kafin likitan urologist ya cire catheter yana sassautawa prostate santsin tsoka da ** ninka damar da namiji zai iya yin fitsari da kanshi idan catheter ya fito.

Matsalolin gaggawa guda biyu na waje waɗanda ke haifar da riƙewar fitsari mai tsauri: Paraphimosis da Retroverted Gravid Uterus¶

Baya ga haɓakar prostate, magunguna, da matsewar kashin baya, ƙayyadaddun abubuwan gaggawa guda biyu na injina a jiki sun rufe urethra kuma suna buƙatar ganewa nan take:

1. Paraphimosis ("The Foreskin Tourniquet" a cikin Maza marasa kaciya, Samari, da marasa lafiya Catheterized)¶

Paraphimosis* shine gaggawar gaggawar urological na lokaci mai mahimmanci wanda ke faruwa akai-akai a asibitoci, gidajen jinya, ko a gida lokacin da kaciyar mara lafiya wanda ba a yi wa kaciya ba ya ja baya a bayan kan azzakari (glans and coronal sulcus*) yayin tsaftacewa, sanya catheter, ko ayyukan jima'i, ba tare da komawa gaba ba.

• Abin da ya faru: Matsattsen zoben da aka ja da baya yana zama kamar yawon shakatawa na roba a kusa da sandar bayan kan azzakari. Magudanar jini da lymfatic magudanar ruwa daga glans da na nesa na kaciyar yana shakewa, yana haifar da balloon zuwa wani nau'in nau'in nau'i mai nau'i mai nau'i mai nau'i mai nau'i mai nau'i mai nau'i mai nau'i mai nau'i, kumburin ruwa mai juyayi ** yayin da kan azzakari ya kumbura, ya juya duhu shuɗi ko bluish-baki, kuma yana damun urethra (** yana haifar da tashin hankali, rashin jin daɗi a cikin fitsari). necrosis/gangrene**).
• Taimakon Farko da Rage Asibiti don Paraphimosis:
• Kowane namiji ko yaro mara kaciya da aka sanya masa catheter na Foley, to dole ne a sa kaciyar sa a hankali ya koma gaba a kan kan azzakari nan da nan bayan an sami catheter.
• Idan paraphimosis ya tasowa, ** je zuwa sashin gaggawa nan da nan *. Likitoci suna amfani da gel na maganin sa barci (ko yin jijiyar azzakari na dorsal), kunsa abin wuyan da ya kumbura tare da gauze ko damfara osmotic, a shafa damtse mai daɗaɗɗen hannu (”matsin hannu”**) na tsawon mintuna 5 zuwa 10 don matse ruwan ƙazamin da ke cikin tarko daga cikin zoben gaban gaba ɗaya, sannan a ja da baya tare da gyaɗa baya. kaciyar gaba a kan kan azzakari.

2. Ciwon mahaifar Gravid Mai Ciki (Makon Ciki 10 zuwa 16)¶

Kusan kashi 15 cikin 100 na mata a zahiri suna da mahaifar mahaifa ** koma baya ("mai karkata baya")**. A al'ada, yayin da ciki ya wuce makonni 10 zuwa 12 **, mahaifa yana tashi a hankali daga ƙashin ƙugu zuwa cikin ciki.

A lokuta da ba kasafai ba tsakanin makonni 10 da 16 na daukar ciki, mahaifar da ta koma baya ta kan samu ** a daure (a daure) a karkashin kashin da ke kan sacral promontory** a bayan ƙashin ƙugu. Yayin da mahaifar da ke makale ta fadada, sai ta tunkuda mahaifar mahaifa da karfi gaba da sama a bayan kashin na miji, mikewa da dunkulewar fitsarin mace a kan kwarjinin mahaifa.

• **Alamomin Gargadi:*Mace mai ciki a sati 10 zuwa 16 tana farkawa da safe ko la'asar tare da **rashin fitsari kwatsam, mai raɗaɗi, ko ciwon ƙanƙara, ko ɗigon ruwa.
• Taimakon Farko na Matsayi na gaggawa yayin tafiya zuwa Sashen Gaggawa:
• Yayin jiran jigilar kaya zuwa OB/GYN da matakan gaggawa na gaggawa, hutawa a ** Matsayin kirji ** ( durƙusa akan gado tare da ƙirji da kafadu suna hutawa ƙasa a kan matashin kai don mintuna 10 zuwa 15) ko ** Matsayin Sims na hagu ** yana amfani da nauyi don taimakawa tip mai nauyi mai nauyi na mahaifa gaba gaba daga sacrum, yayin da likitan gaggawa ya rage ƙwayar mahaifa zuwa gaba daga sacrum. cikin ciki.

Lokacin da catheterization na urethra ya kasance mai ƙin yarda: Ragewar Urethra¶

Yayin sanya foley catheter ta cikin urethra shine daidaitaccen magani na kashi 99 cikin 100 na cututtukan da ke riƙe da fitsari, akwai ** wani labari mai mahimmanci wanda ya hana shigar da catheter na urethra sosai** saboda zamewa da bututu sama da tsagewar urethra yana jujjuya tsagewar tsage zuwa cikakke, tsayin daka na rayuwa ko tura cikin catheter.

Tambayoyin da ake yawan yi¶

An duba tushe¶

• American Urological Association (AUA, United States): Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH) and Acute Urinary Retention Guideline and Catheter-Associated Urinary Tract Care.
• **Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (EAU)
• National Institute for Health and Care Excellence (NICE, United Kingdom): Lower Urinary Tract Symptoms in Men: Management (CG97) and Healthcare-Associated Infections: Long-Term Urinary Catheter Care (CG139).
• Ƙungiyar Magungunan Kaya (Paralyzed Veterans of America, United States): Kima da Gudanar da Ciwon Ciwon Kai da Sauran Rashin Ciwon Kai: Tsananin Kulawa na Toshewar Catheters na Urinary.
• ** Nyman MA, Schwenk NM, Silverstein MD (Mayo Clinic Proceedings):** * Gudanar da riƙewar fitsari: sauri tare da ragewa a hankali da haɗarin rikitarwa* (tabbatar da cikakkiyar magudanar mafitsara cikin sauri yana da aminci kuma ya fi dacewa da matsawa).

Jagora masu alaƙa¶

• Dysreflexia mai sarrafa kansa a cikin raunin kashin baya kulawar gaggawa
• Cauda equina ciwo da m kashin baya matsawa ja tutoci
• Ciwon tsakuwar koda mai tsanani vs. toshewar koda kamuwa da cuta (urosepsis)
• Exertional rhabdomyolysis, m koda rauni, da duhu fitsari
• Karyawar ƙashin ƙashin ƙugu da kula da zubar jini na ciki
• Lambobin gaggawa ta ƙasa