‫ﻓﺎﺭﻣﺎﻛﻮﻟﻮﮊﻱ‬

‫ﺁﺷﻨﺎﻳﻲ ﺑﺎ ﺩﺍﺭﻭﻫﺎ ﻭ ﻃﺮﻳﻘﻪ ﻣﺼﺮﻑ ﺁﻧﻬﺎ‪ ،‬ﻋﻮﺍﺭﺽ ﺩﺍﺭﻭﻳﻲ‪ ،‬ﻣﺪﺍﺧﻼﺕ ﺧﺎﺹ ﭘﺮﺳﺘﺎﺭﻱ ﺳﺒﺐ ﺗﺴﻬﻴﻞ ﺩﺭ ﺍﻧﺠـﺎﻡ ﻛـﺎﺭ ﭘﺮﺳـﺘﺎﺭﻱ‪،‬‬
‫ﺑﻬﺒﻮﺩ ﺳﺮﻳﻌﺘﺮ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺍﻓﺰﺍﻳﺶ ﻛﻴﻔﻴﺖ ﻛﺎﺭﻫﺎﻱ ﺩﺭﻣﺎﻧﻲ ﻣﻲ ﮔﺮﺩﺩ‪.‬‬
‫ﻭﻇﻴﻔﻪ ﭘﺮﺳﺘﺎﺭ ﻧﻪ ﻓﻘﻂ ﻗﺮﺍﺭ ﺩﺍﺩﻥ ﺩﺍﺭﻭ ﺩﺭ ﺍﺧﺘﻴﺎﺭ ﺑﻴﻤﺎﺭ ﺑﻠﻜﻪ ﻣﻄﻤﺌﻦ ﺷﺪﻥ ﺍﺯ ﻣﺼﺮﻑ ﺑﻪ ﻣﻮﻗﻊ ﻭ ﺩﺭﺳﺖ ﺩﺍﺭﻭﻫﺎﺳﺖ‪.‬‬

‫ﻗﺎﻧﻮﻥ ‪ 5 R‬ﺳﺮﻓﺼﻞ ﻣﺒﺎﺣﺚ ﺩﺍﺭﻭﻳﻲ ﭘﺮﺳﺘﺎﺭﻱ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬

‫ﺑﻴﻤﺎﺭ ﺩﺭﺳﺖ‬ ‫‪-۱‬‬
‫ﺩﺍﺭﻭﻱ ﺩﺭﺳﺖ‬ ‫‪-۲‬‬
‫ﺭﻭﺵ ﺩﺭﺳﺖ‬ ‫‪-۳‬‬
‫ﺯﻣﺎﻥ ﺩﺭﺳﺖ‬ ‫‪-۴‬‬
‫ﺩﻭﺯ ﺩﺭﺳﺖ‬ ‫‪-۵‬‬

‫ﺩﺭ ﺍﻳﻦ ﻣﺒﺤﺚ ﺗﻌﺪﺍﺩ ﻣﺤﺪﻭﺩﻱ ﺍﺯ ﺩﺍﺭﻭﻫﺎﻱ ﻗﻠﺒﻲ ﺑﺤﺚ ﺷﺪﻩ ﻛﻪ ﺟﻬﺖ ﺁﺷﻨﺎﻳﻲ ﺑﻴﺸﺘﺮ ﺑﻬﺘﺮ ﺍﺳﺖ ﺑﻪ ﺗﻔﺼﻴﻞ ﺩﺭ ﻣﻮﺭﺩ ﺍﻳﻦ ﺩﺍﺭﻭﻫـﺎ‬
‫ﻭ ﺩﺍﺭﻭﻫﺎﻱ ﺩﻳﮕﺮ ﻛﻪ ﺑﻴﺸﺘﺮ ﺩﺭ ﻭﺍﺣﺪﻫﺎﻱ ﻭﻳﮋﻩ ﻣﺼﺮﻑ ﻣﻲ ﺷﻮﻧﺪ ﺍﻃﻼﻋﺎﺕ ﻛﺴﺐ ﻛﻨﻴﺪ‪.‬‬

‫ﺁﺗﺮﻭﭘﻴﻦ‪:‬‬ ‫•‬
‫ﻣﻜﺎﻧﻴﺴﻢ‪ :‬ﺁﻧﺘﻲ ﻛﻮﻟﻲ ﻧﺮﮊﻳﻚ‪ ،‬ﻣﻬﺎﺭ ﻛﻨﻨﺪﻩ ﻋﺼﺐ ﻭﺍﮒ‬ ‫‪-‬‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺑﺮﺍﺩﻱ ﻛﺎﺭﺩﻱ ﻋﻼﻣﺘﻲ‪ ،‬ﺑﺮﺍﺩﻱ ﺁﺭﻳﺘﻤﻲ‪ ،‬ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﺗﺮﺷﺤﺎﺕ ﻗﺒﻞ ﺍﺯ ﺟﺮﺍﺣـﻲ‪ ،‬ﭘـﺎﺩﺯﻫﺮ ﻣﺴـﻤﻮﻣﻴﺖ ﺑـﺎ‬ ‫‪-‬‬
‫ﺣﺸﺮﻩ ﻛﺶ ﻫﺎ ﻭ ﻣﺴﻤﻮﻡ ﻛﻨﻨﺪﻩ ﻫﺎ‬
‫ﻣﻘﺎﺩﻳﺮ ﻣﺼﺮﻑ‪ 1 - 0/5 mg/ml :‬ﺗﺰﺭﻳﻖ ﻭﺭﻳﺪﻱ ﺑﻌﺪ ﺍﺯ ﻫﺮ ‪ ۳‬ﺗﺎ ‪ ۵‬ﺩﻗﻴﻘﻪ ﺗﺎ ﺣﺪﺍﻛﺜﺮ ‪ 0/03 mg/kg‬ﻣﺼﺮﻑ ﻣﻲ ﺷﻮﺩ‪.‬‬ ‫‪-‬‬
‫ﺩﺭ ﻛﻮﺩﻛﺎﻥ ﻣﻘﺪﺍﺭ ‪ 0/02 mg/kg‬ﺗﺎ ﺣﺪﺍﻛﺜﺮ ‪ ۱‬ﻣﻴﻠﻲ ﮔﺮﻡ ﻣﺼﺮﻑ ﻣﻲ ﺷﻮﺩ‪ .‬ﺗﻜﺮﺍﺭ ﻫﺮ ‪ ۵‬ﺩﻗﻴﻘﻪ ﺍﺳﺖ‪.‬‬ ‫‪-‬‬
‫‪-‬‬
‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬ ‫‪-‬‬
‫ﻣﻘﺎﺩﻳﺮ ﻛﻤﺘﺮ ﺍﺯ ‪ 0/5 mg‬ﻭ ﮔﺎﻫﺎﹰ ﻣﻘﺎﺩﻳﺮ ﺯﻳﺎﺩﺗﺮ ﺳﺒﺐ ﻭﺍﻛﻨﺶ ﻣﺘﻨﺎﻗﺾ ﺁﻫﺴﺘﻪ ﺷﺪﻥ ﺿﺮﺑﺎﻥ ﻗﻠـﺐ ﺑـﻪ ﻋﻠـﺖ ﺍﺛـﺮ ﺭﻭﻱ ﺳﻴﺴـﺘﻢ‬
‫ﻫﻴﺲ ﭘﻮﺭﻛﻴﻨﮋ ﻣﻲ ﺷﻮﺩ‪.‬‬

‫ﺩﺳﺘﻪ ﺩﺍﺭﻭﻫﺎﻱ ﺿﺪ ﺁﻧﮋﻳﻦ ﺻﺪﺭﻱ‪:‬‬

‫ﺍﻳﻦ ﺩﺳﺘﻪ ﺩﺍﺭﻭﻳﻲ ﺷﺎﻣﻞ ﻧﻴﺘﺮﺍﺗﻬﺎ ﻣﺜﻞ ﺍﻳﺰﻭﺭﺩﻳﻞ ‪ ... ، TNG.‬ﻭ ﺑﺘﺎﺑﻠﻮﻛﺮﻫﺎ ﺷﺎﻣﻞ ﺁﺗﻨﻮﻟـﻮﻝ‪ ،‬ﺍﻳﻨـﺪﺭﺍﻝ‪ ،‬ﻣﺘﻮﭘﺮﻭﻟـﻮﻝ‪ ...‬ﻭ ﻛﻠﺴـﻴﻢ‬
‫ﺑﻠﻮﻛﺮﻫﺎ ﺷﺎﻣﻞ ﺁﻣﻠﻮﺩﻳﭙﻴﻦ‪ ،‬ﺩﻳﻠﺘﻴﺎﺯﻡ‪ ،‬ﻭﺭﺍﭘﺎﻣﻴﻞ ﻭ ‪ ...‬ﺍﺳﺖ‪.‬‬
‫ﻛﻪ ﺑﻪ ﺗﻔﺼﻴﻞ ﺗﻮﺿﻴﺢ ﺧﻮﺍﻫﺪ ﺷﺪ‪.‬‬
 ‫ﻧﻴﺘﺮﺍﺗﻬﺎ‬ ‫•‬
‫ﻧﻴﺘﺮﺍﺗﻬﺎ ﺷﺎﻣﻞ ‪ TNG‬ﺑﻪ ﺻﻮﺭﺕ ﭘﺮﻝ‪ ،‬ﺁﻣﭙﻮﻝ‪ ،‬ﮊﻝ‪ ،‬ﺍﺳﭙﺮﻱ‪ ،‬ﻗﺮﺻﻬﺎﻱ ﺍﻳﺰﻭﺭﺩﻳﻞ ﻭ ﻧﻴﺘﺮﻭﻛﺎﻧﺘﻴﻦ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬
‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪ :‬ﻧﻴﺘﺮﺍﺗﻬﺎ ﺳﺒﺐ ﮔﺸﺎﺩ ﺷﺪﻥ ﺷﺮﻳﺎﻥ ﻛﺮﻭﻧﺮ ﻭ ﻛﺎﻫﺶ ﭘﺮﻩ ﻟـﻮﺩ ﻭ ﻫﻤﭽﻨـﻴﻦ ﮔﺸـﺎﺩ ﺷـﺪﻥ ﺷـﺮﻳﺎﻧﻬﺎﻱ ﺳﻴﺴـﺘﻤﻴﻚ ﻭ‬
‫ﻛﺎﻫﺶ ﺍﻓﺘﺮﻟﻮﺩ ﻣﻲ ﺷﻮﻧﺪ ﻛﻪ ﺍﻳﻦ ﺩﻭ ﺳﺒﺐ ﻛﺎﻫﺶ ﺩﺭﺩ ﺳﻴﻨﻪ ﺩﺭ ﺑﻴﻤﺎﺭ ﻣﻲ ﺷﻮﺩ‪.‬‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺩﺭ ﺍﻧﻮﺍﻉ ﺁﻧﮋﻳﻨﻬﺎ )ﭘﺎﻳﺪﺍﺭ ﻭ ﻧﺎﭘﺎﻳﺪﺍﺭ(‪ CAD ،‬ﻭ ‪ MI‬ﻣﺼﺮﻑ ﻣﻲ ﺷﻮﻧﺪ‪.‬‬
‫ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ‪ :‬ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻭﺿﻌﻴﺘﻲ‪ ،‬ﺳﺮﺩﺭﺩ‪ ،‬ﻓﻼﺷﻴﻨﮓ‪ ،‬ﮔﻴﺠﻲ‪ ،‬ﺗﻬﻮﻉ‪ ... ،‬ﺍﺳﺖ‪.‬‬
‫ﻣﻮﺍﺭﺩ ﻣﻨﻊ ﻣﺼﺮﻑ‪ :‬ﺣﺴﺎﺳﻴﺖ ﻣﻔﺮﻁ ﺑﻪ ﺩﺍﺭﻭ‪ ،‬ﺍﻓﺰﺍﻳﺶ ﻓﺸﺎﺭ ﻣﻐﺰﻱ‪ ،‬ﺧﻮﻧﺮﻳﺰﻱ ﻣﻐﺰﻱ‬
‫ﻣﻮﺍﺭﺩ ﺍﺣﺘﻴﺎﻁ‪ :‬ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻭﺿﻌﻴﺘﻲ‪ ،‬ﺑﺎﺭﺩﺍﺭﻱ‪ ،‬ﺷﻴﺮﺩﻫﻲ‪ ،‬ﻛﻮﺩﻛﺎﻥ‪ ،‬ﺑﻴﻤﺎﺭﺍﻥ ﻛﻠﻴﻮﻱ ﻭ ﻛﺒﺪﻱ‬
‫ﻛﻼﭘﺲ ﻗﻠﺒﻲ‪ ،‬ﻋﺮﻭﻗﻲ‪ ،‬ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ‬ ‫ﺗﺪﺍﺧﻼﺕ ﻣﻬﻢ‪ :‬ﻧﻴﺘﺮﺍﺗﻬﺎ ‪ +‬ﺍﻟﻜﻞ‬

‫ﻧﻴﺘﺮﺍﺗﻬﺎ‪ +‬ﺁﺳﭙﺮﻳﻦ‬
‫ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ‬ ‫ﻧﻴﺘﺮﺍﺗﻬﺎ‪ +‬ﺑﺘﺎﺑﻠﻮﻛﺮﻫﺎ‬
‫ﻧﻴﺘﺮﺍﺗﻬﺎ ‪ +‬ﻧﺎﺭﻛﻮﺗﻴﻚ ﻫﺎ‬

‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬
‫ﺗﻮﺿﻴﺢ ﻭ ﺁﻣﻮﺯﺵ ﺑﻪ ﺑﻴﻤﺎﺭ ﺩﺭ ﻣﻮﺭﺩ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻭﺿﻌﻴﺘﻲ‬ ‫‪-۱‬‬
‫ﺁﻣﻮﺯﺵ ﺩﺭ ﻣﻮﺭﺩ ﺳﺮ ﺩﺭﺩ ﻭ ﺑﻬﺒﻮﺩﻱ ﺍﺣﺘﻤﺎﻟﻲ ﺁﻥ‬ ‫‪-۲‬‬
‫ﻛﻨﺘﺮﻝ‪ HR‬ﻭ‪ BP‬ﺧﺼﻮﺻﺎﹰ ﺩﺭ ﻣﻮﺭﺩ ﻧﻴﺘﺮﺍﺗﻬﺎﻱ ‪IV‬‬ ‫‪-۳‬‬

‫ﺑﺘﺎ ﺑﻠﻮﻛﺮﻫﺎ‬ ‫•‬

‫ﺑﺘﺎﺑﻠﻮﻛﺮﻫﺎ ﺷﺎﻣﻞ ﺁﺗﻨﻮﻟﻮﻝ‪ ،‬ﻣﺘﻮﭘﺮﻭﻟﻮﻝ‪ ،‬ﻛﺎﺭﻭﺩﻳﻠﻮﻝ‪ ،‬ﺍﻳﻨﺪﺭﺍﻝ ﻭ ‪...‬‬
‫ﻛﺎﻫﺶ ﻣﻴﺰﺍﻥ ﻣﺼﺮﻑ ﺍﻛﺴﻴﮋﻥ ﻣﻴﻮﻛﺎﺭﺩ‬ ‫ﻛﺎﻫﺶ ﺳﺮﻋﺖ ﺿﺮﺑﺎﻥ ﻗﻠﺐ‬ ‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪ :‬ﺑﺘﺎﺑﻠﻮﻛﺮ‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺩﺭﻣﺎﻥ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ‪ ،‬ﺍﺧﺘﻼﻝ ﺭﻳﺘﻢ ﺑﻄﻨﻲ ﻭ ﭘﺮﻭﻓﻴﻼﻛﺴﻲ ﺁﻧﮋﻳﻦ ﺻﺪﺭﻱ‬

‫ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ‪:‬‬
‫ﺷﺎﻳﻌﺘﺮﻳﻦ ﻋﻮﺍﺭﺽ ﻋﺒﺎﺭﺗﻨﺪ ﺍﺯ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﺍﺭﺗﻮﺳﺘﺎﺗﻴﻚ‪ ،‬ﺑﺮﺍﺩﻱ ﻛﺎﺭﺩﻱ‪ ،‬ﺑﺮﻭﻧﻜﻮﺍﺳﭙﺎﺳﻢ ﺧﺼﻮﺻﺎﹰ ﺩﺭ ﻣﻮﺭﺩ ﺍﻳﻨﺪﺭﺍﻝ(‬
‫ﻣﻮﺍﺭﺩ ﻣﻨﻊ ﻣﺼﺮﻑ‪ :‬ﺁﻟﺮﮊﻱ ﺑﻪ ﺩﺍﺭﻭﻫﺎ‪ ،‬ﺑﻠﻮﻛﻬﺎ‪ ،‬ﺷﻮﻙ ﻛﺎﺭﺩﻳﻮﮊﻧﻴﻚ‪ ،‬ﻣﺸﻜﻼﺕ ‪COPD‬‬
‫ﻣﻮﺍﺭﺩ ﺍﺣﺘﻴﺎﻁ‪ :‬ﺳﺎﻟﻤﻨﺪﺍﻥ‪ ،‬ﺑﻴﻤﺎﺭﺍﻥ ﻛﻠﻴﻮﻱ ﻭ ﺗﻴﺮﻭﺋﻴﺪﻱ‪ ، CAD ، COPD ،‬ﺩﻳﺎﺑﺖ‪ ،‬ﺑﺎﺭﺩﺍﺭﻱ‪ ،‬ﺁﺳﻢ‬

‫ﺍﻓﺰﺍﻳﺶ ﺍﺛﺮ‬ ‫ﺗﺪﺍﺧﻼﺕ‪ :‬ﺑﺘﺎﺑﻠﻮﻛﺮﻫﺎ ‪ +‬ﻭﺭﺍﭘﺎﻣﻴﻞ‬

‫ﻛﺎﻫﺶ ﺍﺛﺮ‬ ‫ﺑﺘﺎﺑﻠﻮﻛﺮﻫﺎ ‪ +‬ﺍﻳﺒﻮﺑﺮﻭﻓﻦ ﻭ ﺍﻳﻨﺪﻭﺳﻴﺪ ﻭ ﺑﺎﺭﺑﻴﺘﻮﺭﺍﺗﻬﺎ‬

‫‪ -۱‬ﺑﺮﺭﺳﻲ ﺁﺯﻣﻮﻧﻬﺎﻱ ﻛﻠﻴﻪ‬ ‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬

‫‪ -۲‬ﻛﻨﺘﺮﻝ ‪ BP ، HR‬ﻭ ﺭﻳﺘﻢ ﺑﻴﻤﺎﺭ‬
‫‪ -۳‬ﻛﻨﺘﺮﻝ ‪I&O‬‬
‫‪ -۴‬ﺩﻗﺖ ﻫﻨﮕﺎﻡ ﺗﺰﺭﻳﻖ ‪ IV‬ﺑﺎﻳﺴﺘﻲ ﺭﻗﻴﻖ ﻭ ﺁﻫﺴﺘﻪ ﺑﺎﺷﺪ‬
 ‫ﻛﻠﺴﻴﻢ ﺑﻠﻮﻛﺮﻫﺎ ‪CCBs‬‬ ‫•‬
‫ﻛﻠﺴﻴﻢ ﺑﻠﻮﻛﺮﻫﺎ ﺷﺎﻣﻞ ﺩﻳﻠﺘﻴﺎﺯﻡ‪ ،‬ﻭﺭﺍﭘﺎﻣﻴﻞ‪ ،‬ﺁﺩﺍﻻﺕ‪ ،‬ﺁﻣﻠﻮﺩﻳﭙﻴﻦ ‪( Norvac‬‬
‫ﺑﻠﻮﻙ ﺟﺮﻳﺎﻥ ﻳﻮﻥ ﻛﻠﺴﻴﻢ ﺑﻪ ﺩﺍﺧﻞ ﻋﻀﻠﻪ ﺻﺎﻑ ﻗﻠﺒﻲ – ﻋﺮﻭﻗﻲ ﺷﺪﻩ ﻛﻪ ﺍﻳﻦ ﺍﻣﺮ‬ ‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪ :‬ﺑﻠﻮﻙ ﻛﻨﻨﺪﻩ ﻛﺎﻧﺎﻝ ﻛﻠﺴﻴﻢ‬
‫ﻣﻨﺠﺮ ﺑﻪ ﺷﻞ ﺷﺪﻥ ﻋﻀﻠﻪ ﺻﺎﻑ ﻋﺮﻭﻕ ﻛﺮﻭﻧﺮ ﻭ ﮔﺸﺎﺩ ﺷﺪﻥ ﻋﺮﻭﻕ ﻛﺮﻭﻧﺮ ﻭ ﻛﻨـﺪ ﺷـﺪﻥ ﻫـﺪﺍﻳﺖ ﺩﺭ ﮔـﺮﻩ ‪ SA‬ﻭ ‪ AV‬ﻭ ﮔﺸـﺎﺩ‬
‫ﺷﺪﻥ ﺷﺮﺍﻳﻴﻦ ﻣﺤﻴﻄﻲ ﻣﻲ ﺷﻮﺩ‪.‬‬

‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺁﻧﮋﻳﻦ ﺻﺪﺭﻱ ﭘﺎﻳﺪﺍﺭ ﻭ ﻏﻴﺮﭘﺎﻳﺪﺍﺭ‪ ،‬ﺁﻧﮋﻳﻦ ﻭﺍﺯﻭ ﺍﺳﭙﺎﺗﻴﻚ ﻳﺎ ﭘﺮﻳﻨﺰﻣﻨﺘﺎﻝ‪ ،‬ﺩﻳﺲ ﺭﻳﺘﻤﻲ ﻗﻠﺒﻲ‬
‫ﻋﻮﺍﺭﺽ‪ :‬ﺑﺎﻋﺚ ﺩﻳﺲ ﺭﻳﺘﻤﻲ‪ ،‬ﺍﺩﻡ‪ ،‬ﺳﺮﺩﺭﺩ‪ ،‬ﺧﺴﺘﮕﻲ‪ ،‬ﺧﻮﺍﺏ ﺁﻟﻮﺩﮔﻲ‪ ،‬ﻓﻼﺷﻴﻨﮓ ﻣﻲ ﺷﻮﺩ‪.‬‬
‫ﻣﻨﻊ ﻣﺼﺮﻑ‪ :‬ﺑﻠﻮﻙ ﻗﻠﺒﻲ ﺩﺭﺟﻪ ‪ ۲‬ﻭ ‪ ،۳‬ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ‪ ،‬ﺳﻨﺪﺭﻡ ‪ ،WPW‬ﺷﻮﻙ ﻗﻠﺒﻲ‬
‫ﺍﺣﺘﻴﺎﻁ‪ :‬ﺩﺭ ‪ CHF‬ﺑﻪ ﻋﻠﺖ ﺍﻓﺰﺍﻳﺶ ﺍﺩﻡ ﻭﺿﻌﻴﺖ ﺑﻴﻤﺎﺭ ﺑﺪﺗﺮ ﻣﻲ ﺷﻮﺩ‪ .‬ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻛﺒﺪﻱ ﻭ ﻛﻠﻴﻮﻱ‬
‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪ -۱ :‬ﻛﻨﺘﺮﻝ ‪ ، HR ، BP‬ﺭﻳﺘﻢ‬
‫‪ -۲‬ﻛﻨﺘﺮﻝ ﺍﺩﻡ‬

‫ﮔﻠﻴﻜﻮﺯﻳﺪﻫﺎﻱ ﻗﻠﺒﻲ‬ ‫•‬

‫‪ Digoxin‬ﺑﻬﺘﺮﻳﻦ ﻋﻀﻮ ﺍﻳﻦ ﺧﺎﻧﻮﺍﺩﻩ ﺍﺳﺖ‬
‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪ :‬ﻣﻬﺎﺭ ‪ Na-K ATPase‬ﺩﺭ ﻧﺘﻴﺠﻪ ﻛﻠﺴﻴﻢ ﺑﻴﺸﺘﺮ ﺩﺭ ﺍﺧﺘﻴﺎﺭ ﭘﺮﻭﺗﺌﻴﻦ ﺍﻧﻘﺒﺎﺿﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺳﭙﺲ ﺍﻓﺰﺍﻳﺶ ﻗﺪﺭﺕ‬
‫ﺍﻧﻘﺒﺎﺽ ﻗﻠﺐ ﻭ ﺍﻓﺰﺍﻳﺶ ﺑﺮﻭﻥ ﺩﻩ ﺭﺥ ﻣﻲ ﺩﻫﺪ‪.‬‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ ، CHF :‬ﻓﻴﺒﺮﻳﻼﺳﻴﻮﻥ ﺩﻫﻠﻴﺰﻱ‪ ،‬ﻓﻠﻮﺗﺮ ﺩﻫﻠﻴﺰﻱ‪ ،‬ﺗﺎﻛﻴﻜﺎﺭﺩﻱ ﺩﻫﻠﻴﺰﻱ‬
‫ﻋﻮﺍﺭﺽ‪ :‬ﺳﺮﺩﺭﺩ‪ ،‬ﻋﻼﺋﻢ ‪) GI‬ﮔﻮﺍﺭﺷﻲ(‬
‫ﻣﻨﻊ ﻣﺼﺮﻑ‪:‬‬
‫‪ -‬ﺣﺴﺎﺳﻴﺖ ﺑﻪ ﺩﺍﺭﻭ‬
‫‪ -‬ﺗﺎﻛﻲ ﻛﺎﺭﺩﻱ ﺑﻄﻨﻲ ﻭ ﻓﻴﺒﺮﻳﻼﺳﻴﻮﻥ ﺑﻄﻨﻲ‬
‫ﺳﻨﺪﺭﻡ ﺳﻴﻨﻮﺱ ﻛﺎﺭﻭﺗﻴﺪ )ﺳﻨﻜﻮﭖ ﻫﻨﮕﺎﻡ ﻓﺸﺎﺭ ﺭﻭﻱ ﺳﻴﻨﻮﺱ ﺑﺼﻮﺭﺕ ﻳﻚ ﻳﺎ ﺩﻭ ﻃﺮﻓﻪ(‬
‫‪ MI -‬ﺣﺎﺩ‪ ،‬ﻋﺪﻡ ﺗﻌﺎﺩﻝ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻲ‬
‫‪ -‬ﺑﻠﻮﻙ ‪AV‬‬
‫‪ -‬ﺑﻴﻤﺎﺭﻱ ﻛﺒﺪ ﻭ ﻛﻠﻴﻪ‬

‫ﻣﺪﺍﺧﻼﺕ ﭘﺮﺳﺘﺎﺭﻱ‬
‫ﻛﻨﺘﺮﻝ ‪I&O‬‬ ‫‪-۱‬‬
‫ﻛﻨﺘﺮﻝ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻬﺎ ﻭ ‪ BUN‬ﻭ ‪Cr‬‬ ‫‪-۲‬‬
‫ﻛﻨﺘﺮﻝ ﻧﺒﺾ‬ ‫‪-۳‬‬
‫ﻛﻨﺘﺮﻝ ﻣﺸﻜﻼﺕ ﮔﻮﺍﺭﺷﻲ‬ ‫‪-۴‬‬

‫ﺩﻳﻮﺭﺗﻴﻜﻬﺎ‬ ‫•‬
‫ﺩﻳﻮﺭﺗﻴﻜﻬﺎ ﺧﺎﻧﻮﺍﺩﻩ ﺑﺰﺭﮔﻲ ﻫﺴﺘﻨﺪ ﻛﻪ ﺷﺎﻣﻞ ﺗﻴﺎﺯﻳﺪﻫﺎ‪ ،‬ﻻﺯﻳﻜﺲ‪ ،‬ﺁﻟﺪﺍﻛﺘﻮﻥ‪ ،‬ﻣﺎﻧﻴﺘﻮﻝ ﻭ ‪ ...‬ﻫﺴﺘﻨﺪ‬

‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪:‬‬
 ‫ﺍﺯ ﺩﺳﺖ ﺩﺍﺩﻥ ﺁﺏ ﻭ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻬﺎ ﺑﺎ ﻣﻜﺎﻧﻴﺴﻢ ﻫﺎﻱ ﻣﺘﻔﺎﻭﺕ‪.‬‬
‫ﺩﺭ ﮔﻠﻮﻛﻮﻡ‬ ‫‪1‬‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﻛﺎﻫﺶ ‪ BP‬ﺩﺭ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ‪ ،‬ﻛﺎﻫﺶ ﺍﺩﻡ ﺩﺭ ‪ ،CHF‬ﻛﺎﻫﺶ ‪IOP‬‬
‫ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ‪ :‬ﻫﻴﭙﻮﻛﺎﻟﻤﻲ‪ ،‬ﻫﻴﭙﺮﮔﻠﻴﺴﻤﻲ ﺩﻳﻮﺭﺗﻴﻚ ﺗﻴﺎﺯﻳﺪﻱ(‬
‫‪1- Intraocular Pressure‬‬

‫‪ -۱‬ﺍﺧﺘﻼﻝ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻲ ‪ ( Cl ، K ، Na‬ﺷﺪﻳﺪ‬ ‫ﻣﻮﺍﺭﺩ ﻣﻨﻊ ﻣﺼﺮﻑ‪:‬‬

‫‪ -۲‬ﺁﻧﻮﺭﻱ‬

‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬
‫‪ -۱‬ﻛﻨﺘﺮﻝ ﺍﺧﺘﻼﻻﺕ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻲ ﺧﺼﻮﺻﺎﹰ ﺩﺭ ﺳﺎﻟﻤﻨﺪﺍﻥ‬
‫‪ -۲‬ﻛﻨﺘﺮﻝ ‪I&O‬‬
‫‪ -۳‬ﻛﻨﺘﺮﻝ ‪Cr ، BUN‬‬
‫‪ -۴‬ﺍﺷﺎﺭﻩ ﺑﻪ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻭﺿﻌﻴﺘﻲ ﺑﻪ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺁﻣﻮﺯﺵ ﺑﻪ ﺁﻧﻬﺎ‬
‫‪ -۵‬ﻣﺼﺮﻑ ﺩﺍﺭﻭ ﺩﺭ ﺻﺒﺢ‬

‫ﺩﺍﺭﻭﻫﺎﻱ ﺿﺪ ﻫﻴﭙﺮﻟﭙﻴﺪﻣﻲ‬ ‫•‬

‫ﺍﻳﻦ ﺩﺳﺘﻪ ﺷﺎﻣﻞ ﺁﺗﻮﺭﻭﺍﺳﺘﺎﺗﻴﻦ‪ ،‬ﻓﻠﻮﺳﺘﺎﺗﻴﻦ )ﺑﻪ ﻋﺒﺎﺭﺗﻲ ﺍﺳﺘﺎﺗﻴﻦ ﻫﺎ(‪ ،‬ﺟﻢ ﻓﻴﺒﺮﻭﺯﻳﻞ‪ ،‬ﻛﻠﺴﺘﺮ ﺁﻣﻴﻦ ﻭ ‪ ...‬ﺍﺳﺖ‪.‬‬
‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪ :‬ﻣﻬﺎﺭ ﻛﻨﻨﺪﻩ ﺁﻧﺰﻳﻢ ﻭ ﻛﻤﻚ ﺑﻪ ﻛﺎﻫﺶ ﻛﻠﺴﺘﺮﻭﻝ‪ VLDL ،‬ﻭ ‪) TG‬ﺗﺮﻱ ﮔﻠﻴﺴﻴﺮﻳﺪ( ﺍﺳﺖ‪.‬‬
‫ﻣﻨﻊ ﻣﺼﺮﻑ‪ :‬ﺑﻴﻤﺎﺭﻱ ﻓﻌﺎﻝ ﻛﺒﺪﻱ‪ ،‬ﺑﺎﺭﺩﺍﺭﻱ‪ ،‬ﺷﻴﺮﺩﻫﻲ‬
‫ﺍﺣﺘﻴﺎﻁ‪ :‬ﻣﺼﺮﻑ ﺍﻟﻜﻞ ﺯﻳﺎﺩ‪ ،‬ﺑﻴﻤﺎﺭﻱ ﻛﺒﺪﻱ‪ ،‬ﺍﻓﺮﺍﺩ ﺯﻳﺮ ‪ ۱۸‬ﺳﺎﻝ‬
‫ﻋﻮﺍﺭﺽ‪ :‬ﺍﺳﻬﺎﻝ‪ ،‬ﻛﺮﺍﻣﭗ ﻋﻀﻼﻧﻲ‪ ،‬ﻧﻔﺦ‪ ،‬ﺳﻮﺀ ﻫﺎﺿﻤﻪ‪ ،‬ﻛﺮﺍﻣﭗ ﺷﻜﻤﻲ‪ ،‬ﻣﻴﻮﭘﺎﺗﻲ‪ ،‬ﺍﺿﻄﺮﺍﺏ ‪...‬‬

‫‪ -۱‬ﺁﻣﻮﺯﺵ ﺩﺭ ﻣﻮﺭﺩ ﺭﮊﻳﻢ ﻏﺬﺍﻳﻲ‬ ‫ﻣﻼﺣﻈﺎﺕ ‪:‬‬

‫‪ -۲‬ﻛﻨﺘﺮﻝ ﺁﻧﺰﻳﻢ ﻛﺒﺪﻱ ﻭ ﭼﺮﺑﻲ ﻫﺎ‬
‫‪ -۳‬ﻣﺼﺮﻑ ﺑﻪ ﻣﻮﻗﻊ ﺩﺍﺭﻭ‬

‫ﺩﺍﺭﻭﻫﺎﻱ ﺿﺪ ﺩﻳﺲ ﺭﻳﺘﻤﻲ‬ ‫•‬

‫ﺷﺎﻣﻞ ﻛﻼﺱ ‪ I‬ﻣﺜﻞ‪ :‬ﺁﻣﻴﻮﺩﺍﺭﻭﻥ‪ ،‬ﺩﻳﺴﻮﭘﺮﺍﻣﻴﺪ‪ ،‬ﭘﺮﻭﻧﺴﺘﻴﻞ‪ ،‬ﻛﻨﻴﺪﻳﻦ‪ ،‬ﻟﻴﺪﻭﻛﺎﺋﻴﻦ ‪ ،memilitine ،‬ﻓﻨﺎﺗﻮﺋﻨﻴﺪ‪ ،‬ﻓﻠﻜﺎﺋﻨﻴﺪ‪.‬‬
‫ﻣﻜﺎﻧﻴﺴﻢ‪ :‬ﺍﻓﺰﺍﻳﺶ ﻣﺪﺕ ﭘﺘﺎﻧﺴﻴﻞ ﻋﻤﻞ ‪ AP‬ﻭ ﺩﻭﺭﻩ ﺗﺤﺮﻳﻚ ﭘﺬﻳﺮﻱ ﻣﻮﺛﺮ‬
‫ﻛﻼﺱ‪ II‬ﻣﺜﻞ‪ :‬ﺍﺳﻤﻮﻟ ﻮﻝ‪ ،‬ﺍﻳﻨﺪﺭﺍﻝ‬
‫ﻣﻜﺎﻧﻴﺴﻢ‪ :‬ﻛﺎﻫﺶ ﺳﺮﻋﺖ ﻭ ﺷﺎﺭﮊ ﺷﺪﻥ ‪ ، SA‬ﺁﻫﺴﺘﻪ ﻛﺮﺩﻥ ﻫﺪﺍﻳﺖ ﮔﺮﻩ ‪ ، AV‬ﻛـﺎﻫﺶ ﺳـﺮﻋﺖ ﺿـﺮﺑﺎﻥ ﻗﻠـﺐ‪ ،‬ﻛـﺎﻫﺶ ﻣﺼـﺮﻑ‬
‫ﺍﻛﺴﻴﮋﻥ‬
‫ﻛﻼﺱ ‪ III‬ﻣﺜﻞ‪ :‬ﺁﻣﻴﻮﺩﺍﺭﻭﻥ‪ -‬ﺑﺮﺗﻠﻴﻮﻡ – ‪Sotalol‬‬
‫ﻣﻜﺎﻧﻴﺴﻢ‪ :‬ﺍﻓﺰﺍﻳﺶ ﻣﺪﺕ ‪ERP ، AP‬‬
‫ﻛﻼﺱ ‪ IV‬ﻣﺜﻞ‪ :‬ﻭﺭﺍﭘﺎﻣﻴﻞ‬
‫ﻣﻜﺎﻧﻴﺴﻢ‪ :‬ﻣﻬﺎﺭ ﺟﺮﻳﺎﻥ ﻳﻮﻥ ﻛﻠﺴﻴﻢ ﺑﻪ ﺩﺍﺧﻞ ﻏﺸﺎﺀ ﺳﻮﻟﻲ ﺩﺭ ﻃﻲ ﺩﭘﻼﺭﻳﺰﺍﺳﻴﻮﻥ ﻗﻠﺒﻲ‬
‫ﺩﺍﺭﻭﻫﺎﻱ ﻣﺘﻔﺮﻗﻪ‪ :‬ﺁﺩﻧﻮﺯﻳﻦ‪ ،‬ﺁﺗﺮﻭﭘﻴﻦ‪ ،Digoxin ،‬ﻣﻨﻴﺰﻳﻢ‪ ،‬ﭘﺘﺎﺳﻴﻢ‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺍﺧﺘﻼﻻﺕ ﺭﻳﺘﻢ ﻗﻠـﺐ‪ ، PVC ،‬ﺗﺎﻛﻴﻜـﺎﺭﺩﻱ‪ ،‬ﻫﻴﭙﺮﺗﺎﻧﺴـﻴﻮﻥ‪ ،‬ﻓﻴﺒﺮﻳﻼﺳـﻴﻮﻥ ﺩﻫﻠﻴـﺰﻱ ﻭ ﺩﺭﺩ ﺁﻧـﮋﻳﻦ‬
‫ﺻﺪﺭﻱ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻲ ﺷﻮﻧﺪ‪.‬‬

‫ﻋﻮﺍﺭﺽ‪ :‬ﺑﺴﺘﻪ ﺑﻪ ﺩﺳﺘﻪ ﺩﺍﺭﻭﻳﻲ ﻣﺘﻔﺎﻭﺕ ﺍﺳﺖ‪.‬‬

‫ﺍﺣﺘﻴﺎﻁ‪:‬‬
‫ﺑﺮﺗﻠﻴﻮﻡ‪ :‬ﺩﺭ ﺑﺎﺭﺩﺍﺭﻱ‪ ،‬ﺑﻴﻤﺎﺭﺍﻥ ﻛﻠﻴﻮﻱ‬
‫ﺁﻣﻴﻮﺩﺍﺭﻭﻥ‪ :‬ﺩﺭ ﮔﻮﺍﺗﺮ‪ ،‬ﺍﺧﺘﻼﻝ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻲ‪ ،CHF ،‬ﺑﻴﻤﺎﺭﻱ ﻛﺒﺪﻱ‬
‫ﺁﺩﻧﻮﺯﻳﻦ‪ :‬ﺩﺭ ﺑﺎﺭﺩﺍﺭﻱ‪ ،‬ﺁﺳﻢ‪ ،‬ﺳﺎﻟﻤﻨﺪﺍﻥ‬
‫ﺁﺗﺮﻭﭘﻴﻦ‪ :‬ﺩﺭ ﺑﺎﺭﺩﺍﺭﻱ ﻫﺎ‪ ،‬ﺑﻴﻤﺎﺭﻱ ﻛﻠﻴﻪ ‪CHF ،‬‬
‫ﺩﻳﮕﻮﻛﺴﻴﻦ‪ :‬ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻛﻠﻴﻮﻱ‪ ،‬ﺍﺳﻬﺎﻝ‪ ،‬ﻫﻴﭙ ﻮﻛﺎﻟﻤﻲ‪ ،‬ﺑﻴﻤﺎﺭﻱ ﮔﺮﻩ ﺳﻴﻨ ﻮﺳﻲ‬

‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬
‫‪ -۱‬ﻛﻨﺘﺮﻝ ‪ - HR – BP‬ﺭﻳﺘﻢ‬
‫‪ -۲‬ﻛﻨﺘﺮﻝ ‪I&O‬‬
‫‪ -۳‬ﻛﻨﺘﺮﻝ ﺍﻟﻜﺘﺮﻭﻟﻴﺘﻬﺎ ﻣﺨﺼﻮﺻﺎﹰ ‪K‬‬
‫‪ -۴‬ﺑﺮﺭﺳﻲ ﺍﺩﻡ ﺩﺭ ﭘﺎﻫﺎ‬
‫‪ -۵‬ﺩﺭ ﺻﻮﺭﺕ ﺗﺰﺭﻳﻖ ﺑﺎ ﺩﻗﺖ ﻭ ﺑﻄﻮﺭ ﺻﺤﻴﺢ ﻭ ﻋﻠﻤﻲ ﻣﺼﺮﻑ ﺷﻮﺩ‪.‬‬

‫ﺩﺍﺭﻭﻫﺎﻱ ﺿﺪ ﺍﻧﻌﻘﺎﺩ‬ ‫•‬

‫ﺍﻳﻦ ﺩﺍﺭﻭﻫﺎ ﺷﺎﻣﻞ ﻫﭙﺎﺭﻳﻦ‪ ،‬ﺍﻧﺎﮔﺰﺍﭘﺎﺭﻳﻦ )ﻛﻠﮕﺰﺍﻥ(‪ ،‬ﻭﺍﺭﻓﺎﺭﻳﻦ ﻭ ‪...‬‬
‫ﺩﺭ ﻣﻜﺎﻧﻴﺴﻢ ﻟﺨﺘﻪ ﺷﺪﻥ ﺧﻮﻥ ﻣﺪﺍﺧﻠﻪ ﻛﺮﺩﻩ ﻭ ﺟﻠﻮﻱ ﺗﺸﻜﻴﻞ ﻟﺨﺘﻪ ﮔﺮﻓﺘﻪ ﻣﻲ ﺷﻮﺩ‪.‬‬
‫ﻣﻮﺍﺭﺩ ﻣﺼﺮﻑ‪ :‬ﺗﺮﻭﻣﺒﻮﺯ ﻋﺮﻭﻕ ﻭﺭﻳﺪﻱ‪ ،‬ﺁﻣﺒﻮﻟﻲ ﺭﻳﻪ‪ ،‬ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﺑﺎﺯ‪ ،‬ﻓﻴﺒﺮﻳﻼﺳﻴﻮﻥ ﺩﻫﻠﻴﺰﻱ‪ ، MI ، CAD ،‬ﭘﺮﻭﻓﻴﻼﻛﺴـﻲ ﺍﺯ‬
‫ﺍﻳﺠﺎﺩ ﻟﺨﺘﻪ ﻫﻨﮕﺎﻡ ﺑﺴﺘﺮﻱ ﻃﻮﻻﻧﻲ ﻣﺪﺕ‬

‫ﻋﻮﺍﺭﺽ‪ :‬ﺁﮔﺮﺍﻧﻮﻟﻮﺳﻴﺘﻮﺯ‪ ،‬ﻟﻜﻮﭘﻨﻲ‪ ،‬ﺗﺮﻭﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ‪ ،‬ﺍﺳﻬﺎﻝ‪ ،‬ﺭﺍﺵ‬

‫ﻣﻨﻊ ﻣﺼﺮﻑ‪:‬‬
‫ﻫﻤﻮﻓﻴﻠﻲ‪ ،‬ﻟﻮﺳﻤﻲ‪ ،‬ﺁﻧﺪﻭﻛﺎﺭﺩﻳﺖ ﺑﺎﻛﺘﺮﻳﺎﻝ‬

‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬
‫‪ -۱‬ﺁﺯﻣﻮﻥ ﺧﻮﻧﻲ ‪ - Hb – Hct‬ﭘﻼﻛﺖ‬
‫‪ PTT -۲‬ﻛﻪ ﺑﺎﻳﺪ ‪ ۲-۱/۵‬ﺑﺮﺍﺑﺮ ﺣﺪ ﻧﺮﻣﺎﻝ ﺑﺎﺷﺪ‪.‬‬
‫‪ -۳‬ﻛﻨﺘﺮﻝ ﻓﺸﺎﺭ ﺧﻮﻥ ﺑﻴﻤﺎﺭ ﺟﻬﺖ ﻛﻨﺘﺮﻝ ﻫﭙﻴﺮﺗﺎﻧﺴﻴﻮﻥ‬
‫‪ -۴‬ﺧﻮﻧﺮﻳﺰﻱ ﻟﺜﻪ‪ ،‬ﻣﺪﻓﻮﻉ ﺳﻴﺎﻩ‪ ،‬ﻫﻤﺎﭼﻮﺭﻱ‪ ،‬ﺗﺐ ﻭ ﺭﺍﺵ ﮔﺰﺍﺭﺵ ﺷﻮﺩ‪.‬‬
‫‪ -۵‬ﭘﺮﻫﻴﺰ ﺍﺯ ﻣﺎﺳﺎﮊ ﺩﺍﺩﻥ ﻧﺎﺣﻴﻪ ﻳﺎ ﺁﺳﭙﻴﺮﻩ ﻛﺮﺩﻥ ﻫﻨﮕﺎﻡ ﺗﺰﺭﻳﻖ ‪ SC‬ﺩﺭ ﺷﻜﻢ‪ ،‬ﺍﻋﻤﺎﻝ ﻓﺸﺎﺭ ﺑﺮﺍﻱ ‪ ۱‬ﺩﻗﻴﻘﻪ‪ ،‬ﻋﺪﻡ ﺗﺰﺭﻳﻖ ‪IM‬‬
‫‪-۶‬ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﺴﻮﺍﻙ ﻧﺮﻡ ﺟﻬﺖ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﺧﻮﻧﺮﻳﺰﻱ ﻟﺜﻪ‪ ،‬ﭘﺮﻫﻴﺰ ﺍﺯ ﻭﺭﺯﺵ ﻫﺎﻱ ﭘﺮ ﺑﺮﺧﻮﺭﺩ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻳـﺶ ﺗـﺮﺍﺵ ﻫـﺎﻱ‬
‫ﺑﺮﻗﻲ ﺑﻪ ﺟﺎﻱ ﺗﻴﻎ ﺭﻳﺶ ﺗﺮﺍﺵ‬
 ‫ﺍﭘﻲ ﻧﻔﺮﻳﻦ‬ ‫•‬
‫ﻃﺒﻘﻪ ﺑﻨﺪﻱ ‪ :‬ﺁﺩﺭﻧﺮﮊﻳﻚ‬
‫ﺳﺒﺐ ﮔﺸﺎﺩ ﺷﺪﻥ ﻧﺎﻳﮋﻩ‪ ،‬ﺗﻨﮓ ﻛﻨﻨﺪﻩ ﻋﺮﻭﻕ ﻭ ﻣﺤﺮﻙ ﻗﻠﺒﻲ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬

‫ﻣﻘﺪﺍﺭ ﻣﺼﺮﻑ‪:‬‬
‫ﺍﺑﺘﺪﺍ ‪ ۰/۵-۱‬ﻣﻴﻠﻲ ﮔﺮﻡ ﺍﺯ ‪ ۰/۱-۱‬ﻣﻴﻠﻲ ﮔﺮﻡ ﻳﻌﻨﻲ ‪ ۱-۱۰‬ﻣﻴﻠﻲ ﻟﻴﺘﺮ ﺍﺯ ﻣﺤﻠﻮﻝ ‪ ۱‬ﺩﺭ ‪ ۱۰۰۰۰‬ﺑﻪ ﺻﻮﺭﺕ ﺳﺮﺷـﺎﺭ( ﺗﺰﺭﻳـﻖ ﻭﺭﻳـﺪﻱ‬
‫ﻣﻲ ﺷﻮﺩ‪ .‬ﺩﺭ ﺻﻮﺭﺕ ﻧﻴﺎﺯ ﻫﺮ ‪ ۳-۵‬ﺩﻗﻴﻘﻪ ﺗﻜﺮﺍﺭ ﻣﻲ ﺷﻮﺩ‪ .‬ﺩﺭ ﺻﻮﺭﺕ ﻧﺪﺍﺷﺘﻦ ‪ ۱۰ ،IV Line‬ﺳﻲ ﺳﻲ ﺍﺯ ﻣﺤﻠﻮﻝ ‪ ۱‬ﺩﺭ ‪ ۱۰۰۰۰‬ﺭﺍ‬
‫ﺩﺍﺧﻞ ﺗﺮﺍﺷﻪ ﺭﻳﺨﺘﻪ ﺳﭙﺲ ﭼﻨﺪ ﺑﺎﺭ ﺁﻣﺒﻮﺑﮓ ﺭﺍ ﻓﺸﺎﺭ ﻣﻲ ﺩﻫﻴﻢ ﺗﺎ ﻗﻄﺮﺍﺕ ﺭﻳﺰ ﺷﺪﻩ ﻭ ﺗﺎﺛﻴﺮ ﻛﻨﻨﺪ‪.‬‬

‫ﻣﻜﺎﻧﻴﺴﻢ ﺍﺛﺮ‪:‬‬
‫ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺑﻪ ﻃﻮﺭ ﻣﺴﺘﻘﻴﻢ ﺑﺮ ﺭﻭﻱ ﮔﻴﺮﻧﺪﻩ ﻫﺎﻱ ﺁﻟﻔﺎ ﻭ ﺑﺘﺎ ﺁﺩﺭﻧﺮﮊﻳﻚ ﺩﺭ ﺳﻴﺴﺘﻢ ﺍﻋﺼﺎﺏ ﺳﻤﭙﺎﺗﻴﻚ ﺍﺛﺮ ﻣﻲ ﻛﻨﺪ‪ .‬ﺍﺛﺮ ﻋﻤﺪﻩ ﺍﻳـﻦ‬
‫ﺩﺍﺭﻭ ﻋﺒﺎﺭﺕ ﺍﺳﺖ ﺍﺯ ﺷﻞ ﻛﺮﺩﻥ ﻋﻀﻼﺕ ﺻﺎﻑ ﻧﺎﻳﮋﻩ ﺍﻱ ﻭ ﺗﺤﺮﻳﻚ ﻗﻠﺐ ﻭ ﮔﺸﺎﺩ ﻛﺮﺩﻥ ﻋﺮﻭﻕ ﻋﻀﻼﺕ ﺍﺳﻜﻠﺘﻲ‪.‬‬
‫ﺟﺬﺏ ﺩﺍﺭﻭ ﺳﺮﻳﻊ ﻭ ﻃﻮﻝ ﻣﺪﺕ ﺍﺛﺮ ﺁﻥ ﻛﻮﺗﺎﻩ ﺍﺳﺖ‪.‬‬
‫ﻣﻮﺍﺭﺩ ﻣﻨﻊ ﻣﺼﺮﻑ ﻭ ﺍﺣﺘﻴﺎﻁ‪:‬‬
‫‪ -۱‬ﺣﺴﺎﺳﻴﺖ ﺑﻪ ﺩﺍﺭﻭ‪ ،‬ﺁﺭﻳﺘﻤﻲ ﻫﺎﻱ ﻗﻠﺒﻲ‬
‫‪ -۲‬ﺩﺭ ﺁﻧﮋﻳﻦ‪ ،‬ﺗﺎﻛﻴﻜﺎﺭﺩﻱ‪ ،‬ﺳﻜﺘﻪ ﻗﻠﺒﻲ‪ ،‬ﺑﻴﻤﺎﺭﻱ ﻋﺮﻭﻕ ﻣﻐﺰﻱ‪ ،‬ﺩﻳﺎﺑﺖ ﻭ ‪...‬‬

‫ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ‪:‬‬
‫ﺗﺮﺱ‪ ،‬ﺍﺿﻄﺮﺍﺏ‪ ،‬ﺑﻲ ﻗﺮﺍﺭﻱ‪ ،‬ﺳﺮ ﺩﺭﺩ‪ ،‬ﺳﺮﮔﻴﺠﻪ‪ ،‬ﺧﻮﻧﺮﻳﺰﻱ ﻭ ﺳﻜﺘﻪ ﻣﻐﺰﻱ‪ ،‬ﺍﺧﺘﻼﻝ ﺩﺭ ﺭﻳﺘﻢ ﻭ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﻭ ﺁﺭﻳﺘﻤﻲ‪.‬‬

‫ﻣﻼﺣﻈﺎﺕ ﭘﺮﺳﺘﺎﺭﻱ‪:‬‬
‫‪ -‬ﻣﺤﻠﻮﻝ ﺭﻗﻴﻖ ﺷﺪﻩ ﺗﺎ ‪ ۲۴‬ﺳﺎﻋﺖ ﺩﺭ ﻳﺨﭽﺎﻝ ﻧﮕﻬﺪﺍﺭﻱ ﺷﻮﺩ‪.‬‬
‫‪ -‬ﻣﺤﻠﻮﻝ ﺗﻐﻴﺮ ﺭﻧﮓ ﻳﺎﻓﺘﻪ ﺩﻭﺭ ﺭﻳﺨﺘﻪ ﺷﻮﺩ‪.‬‬
‫‪ -‬ﺑﺮﺭﺳﻲ ﺭﻳﺘﻢ‪ ،‬ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﻭ ﻣﺎﻧﻴﺘﻮﺭﻳﻨﮓ ﻓﺸﺎﺭ‪.‬‬
‫‪ -‬ﻣﺼﺮﻑ ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺳﺒﺐ ﺑﺎﻻ ﺭﻓﺘﻦ ﻗﻨﺪ ﺧﻮﻥ ﻣﻲ ﺷﻮﺩ‪ ،‬ﭘﺲ ﻛﻨﺘﺮﻝ ﻗﻨﺪ ﺧﻮﻥ ﺍﻟﺰﺍﻣﻲ ﺍﺳﺖ‪.‬‬
‫‪ -‬ﺩﺭ ﺻﻮﺭﺕ ﻧﺸﺖ ﺩﺍﺭﻭ ﺍﺯ ﺭﮒ ﺑﻪ ﺑﺎﻓﺘﻬﺎﻱ ﺍﻃﺮﺍﻑ‪ ،‬ﻣﻲ ﺗﻮﺍﻧﺪ ﻣﻮﺟﺐ ﻧﻜﺮﻭﺯ ﻣﻮﺿﻌﻲ ﻭ ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﻣﺤﻠﻮﻝ ﺗﺰﺭﻳﻖ ﺷﻮﺩ‪.‬‬
‫‪ -‬ﺗﺰﺭﻳﻖ ﺳﺮﻳﻊ ﺩﺍﺭﻭ ﺑﻪ ﺻﻮﺭﺕ ﻭﺭﻳﺪﻱ‪ ،‬ﺳﺒﺐ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺑﻪ ﻋﻠﺖ ﺧﻮﻧﺮﻳﺰﻱ ﻫﺎﻱ ﻣﻐﺰﻱ ﻳﺎ ﺁﺭﻳﺘﻤﻲ ﻣﻲ ﺷﻮﺩ‪.‬‬