General Nursing Departmental Manual

8/10/2019 General Nursing Departmental Manual

http://slidepdf.com/reader/full/general-nursing-departmental-manual 1/531

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Hospital 48مستش

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Hospital 48مستش

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Hospital 84مستش

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Hospital 48مستش

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Hospital 48مستش

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Hospital 48مستش

نلاجذ

13

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Hospital 48مستش

نلاجذ

14

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Hospital 48مستش

نلاجذ

15

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Hospital 48مستش

نلاجذ

16

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Hospital 48مستش

نلاجذ

17

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Hospital 48مستش

نلاجذ

18

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Hospital 48مستش

نلاجذ

19

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Hospital 48مستش

نلاجذ

20

48 *-)'R+ $-1&/T%,

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Hospital 48مستش

نلاجذ

21

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Hospital 48مستش

نلاجذ

22

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Hospital 48مستش

نلاجذ

23

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

26

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

27

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Hospital 48مستش

نلاجذ

28

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Hospital 48مستش

نلاجذ

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29

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Hospital 48مستش

نلاجذ

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30




Hospital 48مستش

نلاجذ

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Hospital 48مستش

نلاجذ

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32




Hospital 48مستش

نلاجذ

33

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Hospital 48مستش

نلاجذ

34

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

35

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

36

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Hospital 48مستش

نلاجذ

37

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Hospital 48مستش

نلاجذ

38

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Hospital 48مستش

نلاجذ

39

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Hospital 48مستش

نلاجذ

40

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

41

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Hospital 48مستش

نلاجذ

42

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Hospital 48مستش

نلاجذ

44

48 *-)'R+ $-1&/T%,

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Hospital 48مستش

نلاجذ

45

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Hospital 48مستش

نلاجذ

46

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Hospital 48مستش

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47

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Hospital 48مستش

نلاجذ

48

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Hospital 48مستش

نلاجذ

49

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

50

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Hospital 48مستش

نلاجذ

51

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

52

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Hospital 48مستش

نلاجذ

53

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Hospital 48مستش

نلاجذ

54

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

55

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

56

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Hospital 48مستش

نلاجذ

57

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Hospital 48مستش

نلاجذ

58

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

59

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

69

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Hospital 48مستش

نلاجذ

71

45(57 M?en Re"u>nin@ elon@in@# "o "?e &"ien"<

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Hospital 48مستش

نلاجذ

&R-!')0R'1<

72

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

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Hospital 48مستش

نلاجذ

74

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Hospital 48مستش

نلاجذ

75

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76

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77

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Hospital 48مستش

نلاجذ

79

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Hospital 48مستش

نلاجذ

81

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Hospital 48مستش

نلاجذ

82

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نلاجذ

83

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Hospital 48مستش

نلاجذ

84

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Hospital 48مستش

نلاجذ

85

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87

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Hospital 48مستش

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88

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Hospital 48مستش

نلاجذ

89

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Hospital 48مستش

نلاجذ

91




Hospital 48مستش

نلاجذ

92

48 *-)'R+ $-1&/T%,


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7:85




Hospital 48مستش

نلاجذ

93

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

94

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Hospital 48مستش

نلاجذ

95

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

96

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Hospital 48مستش

نلاجذ

97

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

98

nme n= /) numbe>5

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Hospital 48مستش

نلاجذ

99

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Hospital 48مستش

نلاجذ

100

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

101

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Hospital 48مستش

نلاجذ

102

48 *-)'R+ $-1&/T%,


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##e##men"5




Hospital 48مستش

نلاجذ

103

54 0ni" *n@e><4545( ReHieC# p"ien"D# p#Gc?olo@icl nee=# ##e##men" n= "?e fo>mul"e= pln of

>e m=ebG "?e #"J5

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Hospital 48مستش

نلاجذ

104

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

105

458 'n#u>e "?" p"ien"D# enHi>onmen" i# #feU clenU "i=G n=?>= f>ee545B )ocumen" p>ope>lG nG i=en"iEe= p>oblem# n= i"# co>>ec"iHeme#u>e#5

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Hospital 48مستش

نلاجذ

106

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

108

48 *-)'R+ $-1&/T%,


Ti"le< %i>CG *n@emen"


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Hospital 48مستش

نلاجذ

109

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45457




Hospital 48مستش

نلاجذ

110

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

111

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Hospital 48مستش

نلاجذ

112

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

113

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Hospital 48مستش

نلاجذ

114

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Hospital 48مستش

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115

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124

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Hospital 48مستش

نلاجذ

125

A5A5: %##i#" "?e clien" Ci"? C#?in@ n= @e""in@ ou" of "?e "ub5A5A5:5( M#? "?e clien"D# bcQU loCe> le@#U n= fee"U if nece##>G5A5A5:57 %##i#" "?e clien" ou" of "?e "ub5

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Hospital 48مستش

نلاجذ

126

48 *-)'R+ $-1&/T%,


Ti"le< e= *Qin@

pplie# "o< 2ene>l M>= n= 1pecil"G 0ni"#-+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e p>oce=u>e in be= mQin@5)'./+/T/-+<(5( e=mQin@ 6 i# p>oce=u>e of c?n@in@ be= linen# ei"?e><

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Hospital 48مستش

نلاجذ

127

I5(5: %##e## #Qin con=i"ion n= nee= fo> #pecil m"">e##U foo"bo>=U o> ?eel

p>o"ec"o>#5I57 %##emble eKuipmen" n= #upplie#5

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Hospital 48مستش

نلاجذ

128

A5L5I57 &ull "?e >emin=e> of "?e #?ee" E>mlG #o "?" "?e>e >e no C>inQle#5 A5L5I5: !omple"e "?i# #me p>oce## fo> "?e =>C#?ee"S#5 A5L5A %pplG o> comple"e "?e "op #?ee"U blnQe"U n= #p>e=5 A5L5A5( &lce "?e "op #?ee"U ?em6#i=e upU on "?e be= #o "?" i"# cen"e> fol= i# " "?ecen"e> of "?e be= n= "?e "op e=@e i# eHen Ci"? "?e "op e=@e of "?e m"">e##5 A5L5A57 0nfol= "?e #?ee" oHe> "?e be=5 A5L5A5: *oHe "o "?e o"?e> #i=e of "?e be=U n= #ecu>e "?e "op be==in@ in "?e #memnne>5 A5L5L &u" clen pilloCc#e# on "?e pilloC# # >eKui>e=5 A5L5L5( 2>#p "?e clo#e= en= of "?e pilloCc#e " "?e cen"e> Ci"? one ?n=5 A5L5L57 2"?e> up "?e #i=e# of "?e pilloCc#eU n= plce "?em oHe> "?e ?n=@>#pin@ "?e c#e5 T?en @>#p "?e cen"e> of one #?o>" #i=e of "?e pilloC "?>ou@? "?e pilloCc#e5 A5L5L5: Mi"? "?e f>ee ?n=U pull "?e pilloCc#e oHe> "?e pilloC5 A5L5L54 %=Zu#" "?e pilloCc#e #o "?" "?e pilloC E"# in"o "?e co>ne># of "?e c#e n="?e #em# >e #">i@?"5 A5L5L5I &lce "?e pilloC# pp>op>i"elG " "?e ?e= of "?e be=5 A5L58 &>oHi=e fo> clien" comfo>" n= #fe"G5 A5L585( %""c? "?e #i@nl co>= #o "?" "?e clien" cn conHenien"lG u#e i"5 A5L5857 /f "?e be= i# cu>>en"lG bein@ u#e= bG clien"U ei"?e> fol= bcQ "?e "op coHe>#" one #i=e o> fnfol= "?em =oCn "o "?e cen"e> of "?e be=5

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A58575(4 *oHe "o "?e o"?e> #i=e of "?e be= n= loCe> "?e #i=e >il5








Hospital 48مستش

نلاجذ

131

48 *-)'R+ $-1&/T%,


Ti"le< >e#"fee=in@

pplie# "o< 2ene>l M>= n= 1pecil"G 0ni"#-+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e b>e#"fee=in@oce=u>e#5)'./+/T/-+<(5( >e#"fee=in@ 6 i# "?e #fe#"U #imple#"U n= le#" ePpen#iHe me"?o= fo> p>oHi=in@

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Hospital 48مستش

نلاجذ

132

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Hospital 48مستش

نلاجذ

133

I5(AM#? ?n=# f"e>fee=in@5

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Hospital 48مستش

نلاجذ

134

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

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135

A.'!T/-+ !-+TR-, R',%T') &-,/!/'1<

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Hospital 48مستش

نلاجذ

136

L57I.olloC up >e#ul" n= no"ifG "?e p?G#icin onceHilble5

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Hospital 48مستش

نلاجذ

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137

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

140

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Hospital 48مستش

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141

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143

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Hospital 48مستش

نلاجذ

144

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Hospital 48مستش

نلاجذ

145

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146

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Hospital 48مستش

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Hospital 48مستش

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150

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Hospital 48مستش

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153

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Hospital 48مستش

نلاجذ

154

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نلاجذ

155

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Hospital 48مستش

نلاجذ

156

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Hospital 48مستش

نلاجذ

157

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

158

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Hospital 48مستش

نلاجذ

159

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نلاجذ

160

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Hospital 48مستش

نلاجذ

161

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Hospital 48مستش

نلاجذ

162

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Hospital 48مستش

نلاجذ

164

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Hospital 48مستش

نلاجذ

165

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Hospital 48مستش

نلاجذ

166

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Hospital 48مستش

نلاجذ

167

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Hospital 48مستش

نلاجذ

168

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

170

48 *-)'R+ $-1&/T%,


Ti"le< 'nem %=mini#">"ion

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Hospital 48مستش

نلاجذ

171

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Hospital 48مستش

نلاجذ

172

)u>in@ ?i@? enemU ?n@ "?e #olu"ion con"ine> bou" 4I cm S(8 in5

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Hospital 48مستش

نلاجذ

173

48 *-)'R+ $-1&/T%,


Ti"le< 'lec">oc>=io@>p?G

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Hospital 48مستش

نلاجذ

174

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Hospital 48مستش

نلاجذ

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175

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

A5A5( 'Ge &"c?<A5A5(5( 'n#u>e Jec"e= eGe i# clen#e= "?o>ou@?lG5

176






Hospital 48مستش

نلاجذ

178

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

179

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Hospital 48مستش

نلاجذ

180

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

183

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Hospital 48مستش

نلاجذ

184

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Hospital 48مستش

نلاجذ

185

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

186

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Hospital 48مستش

نلاجذ

187

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Hospital 48مستش

نلاجذ

188

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Hospital 48مستش

نلاجذ

189

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

190

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Hospital 48مستش

نلاجذ

191

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

193

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Hospital 48مستش

نلاجذ

194

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

195

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Hospital 48مستش

نلاجذ

196

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Hospital 48مستش

نلاجذ

197

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

198

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Hospital 48مستش

نلاجذ

199

45(457 1"e"?o#cope 45(45: 1Qin m>Qe>Npencil

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Hospital 48مستش

نلاجذ

200

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Hospital 48مستش

نلاجذ

201

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Hospital 48مستش

نلاجذ

202

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Hospital 48مستش

نلاجذ

203

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Hospital 48مستش

نلاجذ

204

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Hospital 48مستش

نلاجذ

206

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Hospital 48مستش

نلاجذ

207

I5:75(5B&lp"e "?e po#"e>io> c?e#" fo> >e#pi>"o>G ePcu>#ion5 I5:75(5(F&lce "?e plm# of bo"? Gou> ?n=# oHe> "?e loCe> "?o>PU Ci"? Gou>"?umb# =Zcen" "o "?e #pine n= Gou> En@e># #">e"c?e= l"e>llG5 I5:75(5((%#Q "?e clien" "o "Qe =eep b>e"? C?ile Gou ob#e>He "?e moHemen" ofGou> ?n=# n= nG l@ in moHemen"5 I5:75(5(7&lp"e "?e c?e#" fo> Hocl S"c"ile f>emi"u#5 I5:75(5(:&lce "?e plm> #u>fce# of Gou> En@e>"ip# o> "?e uln> #pec" of Gou>

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Hospital 48مستش

نلاجذ

208

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Hospital 48مستش

نلاجذ

209

I5:45I54&lp"e ?e>ni#5 I5:45I5I)ocumen" En=in@# in "?e clien" >eco>=5 I5:45A %##e##in@ "?e Rec"um n= %nu# I5:45A5()e"e>mine clien"D# ?i#"o>G of "?e folloCin@< I5:45A57$i#"o>G of b>i@?" bloo= in #"ool#U ">>G blcQ #"ool#U =i>>?eU con#"ip"ionU b=ominl pinU ePce##iHe @#U ?emo>>?oi=#U o> >ec"l pin I5:45A5:.milG ?i#"o>G of colo>ec"l cnce> I5:45A54M?en l#" #"ool #pecimen fo> occul" bloo= C# pe>fo>me=U n= "?e >e#ul"#

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be u#e=5 I5:45((/n#pec" "?e nu# n= #u>>oun=in@ "i##ue fo> colo>U in"e@>i"GU n= #Qin le#ion# I5:45(7T?enU #Q "?e clien" "o be> =oCn # "?ou@? =efec"in@5 I5:45(:)e#c>ibe "?e loc"ion of ll bno>ml En=in@# in "e>m# of clocQU Ci"? "?e(7oDclocQ po#i"ion "oC>= "?e pubic #Gmp?G#i#5 I5:45(4&lp"e "?e >ec"um fo> nl #p?inc"e> "onici"GU no=ule#U m##e#U n="en=e>ne##5 I5:45(I-n Ci"?=>Cin@ "?e En@e> f>om "?e >ec"um n= nu#U ob#e>He i" fo> fece#5 I5:45(A)ocumen" En=in@# in "?e clien" >eco>=5I5:I%##e##in@ "?e *u#culo#Qele"l 1G#"em I5:I5( )e"e>mine clien"D# ?i#"o>G of "?e folloCin@<

I5:I5(5($i#"o>G o> p>e#ence of mu#cle pin< on#e"U loc"ionU c?>c"e>U ##oci"e= p?enomenU n= @@>H"in@ n= lleHi"in@ fc"o># I5:I5(57%nG limi""ion# "o moHemen" o> inbili"G "o pe>fo>m c"iHi"ie# of =ilGliHin@ I5:I5(5:&>eHiou# #po>"# inZu>ie# I5:I5(54%nG lo## of func"ion Ci"?ou" pin I5:I57 *u#cle# I5:I575(/n#pec" "?e mu#cle# fo> #ie5 I5:I5757!omp>e ec? mu#cle on one #i=e of "?e bo=G "o "?e #me mu#cle on "?eo"?e> #i=e5 I5:I575:.o> nG pp>en" =i#c>epncie#U me#u>e "?e mu#cle# Ci"? "pe5 I5:I5754/n#pec" "?e mu#cle# n= "en=on# fo> con">c"u>e#5

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Hospital 48مستش

نلاجذ

210

me#u>e "?e n@le of "?e Zoin" in =e@>ee#5 I5:I5I )ocumen" En=in@# in "?e clien" >eco>=5I5:A%##e##in@ "?e &e>ip?e>l 3#cul> 1G#"em I5:A5( &e>ip?e>l &ul#e# I5:A5(5(&lp"e "?e pe>ip?e>l pul#e# SePcep" "?e c>o"i= pul#e on bo"? #i=e# of"?e clien"D# bo=G in=iHi=ullGU #imul"neou#lGU n= #G#"em"icllG "o =e"e>mine "?e#Gmme">G of pul#e Holume5 I5:A5(57/f Gou ?He =icul"G plp"in@ #ome of "?e pe>ip?e>l pul#e#U u#e )opple>

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Hospital 48مستش

نلاجذ

211

48 *-)'R+ $-1&/T%,


Ti"le< $ep>in %=mini#">"ion

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Hospital 48مستش

نلاجذ

212

I575:I5754

I575II575AI575LI5758I575B

A

&e>fu#o> "ubin@)i#po#ble @loHe#

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Hospital 48مستش

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213

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Hospital 48مستش

نلاجذ

214

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Hospital 48مستش

نلاجذ

215

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Hospital 48مستش

نلاجذ

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Hospital 48مستش

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Hospital 48مستش

نلاجذ

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Hospital 48مستش

نلاجذ

220

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Hospital 48مستش

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221

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Hospital 48مستش

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222

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Hospital 48مستش

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Hospital 48مستش

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Hospital 48مستش

نلاجذ

225

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Hospital 48مستش

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226

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Hospital 48مستش

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227

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Hospital 48مستش

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228

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Hospital 48مستش

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229

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Hospital 48مستش

نلاجذ

230

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

231

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Hospital 48مستش

نلاجذ

233

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A




Hospital 48مستش

نلاجذ

234

/n#">uc" p"ien" "o b>in@ ?>= cn=ie# n= pcQ of #u@> Ci"? ?imN?e> lCG#5 &"ien" n= >el"iHe# mu#" be C>e of "?e #i@n# n= #Gmp"om# of in#ulin>ec"ion n= "?e p>ope> in"e>Hen"ion5A57 Me> i=en"iEc"ion b>cele" o> necQlce5 !>>G mo>e =e"ile= info>m"ion bou"in#ulin in "?e Clle"5A5: &>ep>"ion of in#ulin5 A5:5( %Hoi= inZec"ion of col= in#ulin5 /" cn le= "o lipo=G#">op?GU >e=uce= >"e ofb#o>p"ion n= locl >ec"ion#5 A5:57 'Pmine Hil befo>e p>ep>in@ =o#e5 )o no" u#e #olu"ion# if =i#colo>e= o>p>e#ence of p>ecipi""e# i# no"e=5 A5:5: /n#ulin #?oul= no" be miPe= unle## p>e#c>ibe= bG p?G#icin5 /n @ene>lU >e@ul>in#ulin i# =>Cn up in"o #G>in@e E>#" "o Hoi= con"min"in@ "?e bo""le Ci"? "?e #econ=in#ulin5 A5:54 /n#ulin i# @ene>llG =mini#"e>e= (I6:F minu"e# befo>e mel #o "?" peQc"ion Cill coinci=e Ci"? po#"p>n=il ?Gpe>@lGcemi5 A5:5I %lloC pp>oPim"elG ( inc?5 be"Ceen inZec"ion #i"e# n= Hoi= >eu#e of #i"efo> A68 CeeQ# if po##ible5 *in"in n inZec"ion >eco>= o> c?>" "o ##u>e #G#"em"ic#i"e >o""ion5

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A5(5IA5(5A




Hospital 48مستش

نلاجذ

235

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

236

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Hospital 48مستش

نلاجذ

237

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A

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Hospital 48مستش

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Hospital 48مستش

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243

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Hospital 48مستش

نلاجذ

244

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Hospital 48مستش

نلاجذ

245

A57545I5457 T?e #olu"ion con"ine> i# ne>lG emp"G5 A57545I545: T?e>e i# bloo= in "?e /3 "ubin@5 A57545I5454 )i#comfo>" o> #Cellin@ i# ePpe>ience= " "?e /3 #i"e5 A57545A )ocumen" ll >eleHn" info>m"ion5A5: )i#con"inuin@ n /3 /nfu#ion A5:5( &>ep>e "?e eKuipmen"5 A5:5(5( !lmp "?e infu#ion "ubin@5

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Hospital 48مستش

نلاجذ

246

A545A57 RemoHe "?e p>o"ec"iHe "ubin@ cp n=U min"inin@ #"e>ili"GU in#e>" "?e"ubin@ en= #ecu>elG in"o "?e nee=le ?ub5 A545A5: TCi#" i" "o #ecu>e i"5 A545A54 -pen "?e clmp "o #">" "?e #olu"ion _oCin@5 A545L RemoHe "?e "pe #ecu>in@ "?e nee=le o> c"?e"e>5 A545L5( M?en >emoHin@ "?i# "peU #"bilie "?e nee=le o> c"?e"e> ?ub Ci"? one?n=5 A5458 !len "?e /3 #i"e5 A54585( 1">" Ci"? =?e#iHe >emoHe> "o >emoHe =?e#iHe >e#i=ue5 A545857 T?enU u#in@ c?lo>?ePi=ine #Cb# o> lco?ol n= poHi=one6io=ine #Cb#Uclen "?e #i"eU be@innin@ " "?e c"?e"e> o> nee=le n= clenin@ ou"C>= in 76inc?=ime"e>5 A545B Re"pe "?e nee=le o> c"?e"e>5 A545B5( .o> bu""e>_G nee=leU pplG #">ip# of "pe "o "?e Cin@# of "?e bu""e>_Gu#in@ "?e c>i##c>o## Sc?eH>on me"?o=5 A545B57 .o> c"?e"e>[ pplG "?e "pe u#in@ "?e W0X me"?o=5 A545(F %pplG n"i#ep"ic oin"men" o> #olu"ionU if in=ic"e=U n= pplG "?e =>e##in@5 A545(F5(&lce poHi=one6io=ine oin"men" o> #olu"ion " "?e en">G #i"eU incco>=nce Ci"? @encG p>o"ocol5 A545(F57%pplG #"e>ile @ue o> ">n#p>en" =>e##in@ oHe> "?e #i"e5

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Hospital 48مستش

نلاجذ

247

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Hospital 48مستش

نلاجذ

248

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Hospital 48مستش

نلاجذ

249

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Hospital 48مستش

نلاجذ

250

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Hospital 48مستش

نلاجذ

251

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Hospital 48مستش

نلاجذ

252

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Hospital 48مستش

نلاجذ

253

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Hospital 48مستش

نلاجذ

254

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Hospital 48مستش

نلاجذ

255

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Hospital 48مستش

نلاجذ

257

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Hospital 48مستش

نلاجذ

258

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Hospital 48مستش

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263

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264

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Hospital 48مستش

نلاجذ

265

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Hospital 48مستش

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266

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Hospital 48مستش

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267

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Hospital 48مستش

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Hospital 48مستش

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270

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Hospital 48مستش

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271

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Hospital 48مستش

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272

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Hospital 48مستش

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273

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bG pullin@ bcQ on b>>el of #G>in@e5 I545:575(5758 RemoHe >eminin@ i> on #G>in@e bG "ppin@ b>>el bG ?ol=in@ i" up>i@?"U "p b>>el "o =i#lo=@e i> bubble#5 )>C bcQ #li@?"lG on plun@e>5 &u#? plun@e> upC>= "o eZec" i>5 )o no" eZec" _ui=5 I545:575(575B RemoHe nee=le n= c?n@e5 I545:575(575(F !len Co>Q >e n= =i#po#e u#e #upplie#5 I545:575(5: *iPin@ me=ic"ion# f>om 7 Hil# in"o one #G>in@e5 I545:575(5:5( !?ecQ "?e nee= fo> one me=ic"ion "o be =>Cn befo>e"?e o"?e>5

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I545:5:57 0#in@ "ube>culin #G>in@e Ci"?=>C F5Bcc of =i#"ille= C"e> n=F5(cc of "?e =>u@ "o be "e#"e= Ci"? "?e u#e of #pi>"in@ nee=le5 I545:5:5: RemoHe nee=le n= c?n@e5 I545:5:54 %=mini#">"ionI545:54 1ubcu"neou# I545:545( TQe "?e me=ic"ion ">G con"inin@ "?e #G>in@e Ci"? p>ep>e=me=icineU lco?ol #Cb n= me=ic"ion c>= "o "?e p"ien" be=#i=e5 I545:5457 /=en"ifG "?e p"ien" c>efullG bG< I545:545: %#Qin@ ?i#N?e> full nme I545:5454 !?ecQin@ "?e /) bn=

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Hospital 48مستش

نلاجذ

274

%##i#" p"ien" in comfo>"ble po#i"ion5 !len #i"e Ci"? n"i#ep"ic #Cb5 RemoHe cp f>om nee=le bG pullin@ i" #">i@?" oJ5 $ol= #G>in@e co>>ec"lG be"Ceen "?umb n= fo>eEn@e> of =ominn"?n= # in =>" f#?ion5 I545:545(( .o> He>@e #ie p"ien"U #p>e= #Qin "i@?"lG c>o## inZec"ion# #i"eo> pinc? #Qin Ci"? non6=ominn" ?n=5 .o> obe#e p"ien"U pinc? #Qin " #i"e5 I545:545(7 /nZec" nee=le E>mlG n= KuicQlG " 4I =e@>ee# 6 BF =e@>ee#U "?en>ele#e

#Qin if pinc?5 I545:545(: &ull bcQ "?e plun@e> of "?e #G>in@e "o c?ecQ if "?e nee=le i# no"in "?e Hein Sop"ionl5 /f no bloo= >e"u>nU inZec" "?e me=icine #loClG5 I545:545(4 /f bloo= ppe>#U >emoHe n= p>ep>e neC one5 I545:545(I T?en Ci"?=>C "?e nee=le C?ile pplGin@ lco?ol #Cb @en"lGboHe o> oHe> inZec"ion #i"e5 I545:545(A 2en"lG m##@e "?e #i"e if no" con">in=ic"e=5 I545:545(L %pplG bn=6i=5 I545:545(8 %##i#" p"ien" "o comfo>"ble po#i"ion5 I545:545(B )i#c>= nee=le n= #G>in@e in #?>p con"ine>5

I545:5457F M#? ?n=5 I545:5457( )ocumen" ="eU "imeU #i"e n= #i@n5 I545:54577 'Hlu"e >e#pon#e "o me=ic"ion5I545:5I /n">mu#cul> I545:5I5( &lce "?e p>ep>e= inZec"ble me=icine in "?e ">G "o@e"?e> Ci"?"?e me=ic"ion c>=U lco?ol #CbU bn=6i=U #mll #?>p con"ine># n= =i#po#ble @loHe#5 I545:5I57 /=en"ifG "?e p"ien" c>efullG bG< I545:5I5: G #Qin@ ?i#N?e> nme I545:5I54 !?ecQin@ "?e /) bn=5 I545:5I5I 'Pplin "?e pu>po#e n= c"ion of ec? me=ic"ion n= "?e

common ePpec"e= #i=e eJec"#5 I545:5I5A &>oHi=e p>iHcG n= ##i#" p"ien" in comfo>"ble po#i"ion5 I545:5I5L 1elec" #i"e fo> inZec"ion u#in@ n"omicl ln=m>Q5 I545:5I58 3#"u# ,"e>li# 6 loc"e= in "?e n"e>io> #pec" of "?e "?i@?5 I545:5I5B 3en">o@lu"el *u#cle# 6 loc"e= =eep n= CG f>om mZo> bloo=He##el# n= ne>He#5 I545:5I5(F )o>#ol"e>l *u#cle# 6 mu#cle# in "?e uppe> ou"e> Ku=>n" of"?e bu""ocQ#5 I545:5I5(( )el"oi= *u#cle 6 loc"e= in "?e uppe> >m5

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Hospital 48مستش

نلاجذ

275

I545:5I577 M#? ?n=#5 I545:5I57: )ocumen" "?e p>oce=u>e5 I545:5I574 'Hlu"e >e#pon#e "o p>oce=u>e5 I545:5I57I !?>@e #upplie# u#e= n= p>oce=u>e5I545:5A /n">Henou# I545:5A5( &lce "?e p>ep>e= inZec"ble me=icine in "?e ">G "o@e"?e> Ci"?"?e

me=ic"ion c>=U lco?ol #CbU =i#po#ble @loHe#U lbele= #G>in@eCi"? #line #olu"ionU #mll #?>p con"ine>U "ou>niKue"5 I545:5A57 /=en"ifG "?e p"ien" c>efullG bG< I545:5A5: %#Q p"ien" ?i#N?e> nme5 I545:5A54 !?ecQ /) bn=5 I545:5A5I 'Pplin "?e p>oce=u>eU >e#on =>u@# i# @iHen n= "?e ePpec"e=common #i=e eJec"5 I545:5A5A &>oHi=e p>iHcGU ##i#" p"ien" in comfo>"ble po#i"ion5 I545:5A5L %##e## p"ien" in">Henou# in#e>"ion #i"e fo> #i@n# of inEl">"ionn=

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I545:5A58575( 1elec" inZec"ion po>" clo#e#" "o p"ien"5 I545:5A585757 !len inZec"ion po>" Ci"? n"i#ep"ic #Cb I545:5A58575: -cclu=e "?e in">Henou# line bG pinc?in@ "ubin@ Zu#" boHe inZec"ion po>"5 I545:5A585754 2en"lG #pi>"e fo> bloo= >e"u>nU if "?e>e i# =mini#"e> me=ic"ion oHe> #peciEe= "ime >ecommen=e=5 I545:5A585: u""e>_G nee=le I545:5A585:5( !onnec" "?e #G>in@e Ci"? me=icine "o "?e po>" of "?ebu""e>_G "ubin@ n= pu#? #loClG "?e plun@e> "o Ell "?e "ubin@ Ci"? me=icine n= "o ePpel "?e i>5 I545:5A585:57 1elec" "?e #i"e fo> "?e /3 in#e>"ion5

I545:5A585:5: &lce "?e "ou>niKue" 46A inc?e# boHe "?e #elec"e= #i"eU#Q "?e p"ien" "o open n= clo#e ?i#N?e> E#"5 I545:5A585:54 !len "?e #i"e Ci"? lco?ol #Cb5 I545:5A585:5I /nZec" "?e nee=le " n n@le of 7I64I =e@>ee# ` c?ecQ fo> >e"u>n _oC5 I545:5A585:5A Rele#e "?e "ou>niKue" n= #"bilie "?e nee=le Ci"? one?n=5 I545:5A585:5L M?en >e"u>n _oC i# p>e#en"U #loClG inZec" "?e me=icine5 I545:5A585:58 &inc? "?e "ubin@ f"e> me=icine i# comple"elG inZec"e= n= >eplce "?e #G>in@e Ci"? #line #G>in@e n= _u#? "?e "ubin@5 I545:5A585:5B &lce #"e>ile @ue Ci"? lco?ol #Cb oHe> "?e in#e>"ion

#i"e n= >emoHe "?e nee=le5 I545:5A5854 %pplG bn= i= oHe> "?e #i"e I545:5A585I /n#pec" "?e >e fo> >e=ne##U pinU #Cellin@U e=em5 I545:5A585A -b#e>He clo#elG fo> =He>#e >ec"ion # "?e =>u@ i# =mini#"e>n= fo> #eHe>l minu"e# "?e>e f"e>5 I545:5A585L )i#po#e uncp nee=le n= #G>in@e in #?>p con"ine>5




Hospital 48مستش

نلاجذ

276

I545:5A5858 M#? ?n=# I545:5A585B )ocumen" "?e p>oce=u>e n= no"e =He>#e >ec"ion if nG5 I545:5A585(F!?>@e "?e p>oce=u>e n= #upplie#5 I545:5A5B /n">=e>ml I545:5A5B5( &lce "?e p>ep>e= inZec"ble me=icine in "?e ">G "o@e"?e> Ci"?"?e me=ic"ion c>=U lco?ol #Cb n= #mll #?>p con"ine>5 I545:5A5B57 /=en"ifG "?e p"ien" co>>ec"lG< I545:5A5B5: %#Q ?i#N?e> nme I545:5A5B54 !?ecQ /) bn= I545:5A5B5I 'Pplin "?e p>oce=u>eU >e#on =>u@ i# @iHen5 I545:5A5B5A &>oHi=e p>iHcG n= ##i#" p"ien" in comfo>"ble po#i"ion I545:5A5B5L 1elec" #i"e fo> inZec"ion< I545:5A5B58 'P"en= elboC n= #uppo>" i"U n= fo>e>m in _" #u>fce5 I545:5A5B5B /n#pec" #i"e fo> b>ui#e#U in_mm"ionU le#ion =i#colo>"ionUe=emU m##e# n= "en=e>ne##5 I545:5A5B5(F.o>e>m #i"e #?oul= be :64 En@e> Ci="?# beloC n"e cubi"l#pce n= one ?n= Ci="? boHe "?e C>i#" on inne> #pec" fo>e>m5 I545:5A5B5((0#e n"i#ep"ic #Cb in ci>cul> mo"ion "o cle> #Qin " #i"e5 I545:5A5B5(7M?ile ?ol=in@ "?e #Cb Ci"? non6=ominn" ?n=U pull cp f>omnee=le5 I545:5A5B5(:Mi"? non6=ominn" ?n=U #">e"c? "?e #Qin oHe> #i"e Ci"?

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I545:5A5B5(L)o no" m##@e "?e #i"e5 I545:5A5B5(8%##i#" p"ien" in comfo>"ble po#i"ion5 I545:5A5B5(B)>C ci>cle >oun= "?e pe>ime"e> of inZec"ion #i"e u#in@ blcQinQ5 I545:5L )i#po#e #G>in@e Ci"? nee=le in "?e #?>p con"ine>5 I545:58 M#? ?n=#5 I545:5B )ocumen" on "?e me=ic"ion c>= "?e =ue "ime5 I545:5(FReco>= "?e ="eU "imeU =o#eU >ou"e n= #i"e of inZec"ion on me=ic"ion>eco>= n= nu>#e# no"e#5 I545:5((%f"e> :F minu"e# >e"u>n "o p"ien" Ci"? "?e p?G#icin "o eHlu"e "?e>e#ul" n= >eco>=

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Hospital 48مستش

نلاجذ

277

I545458 /f =iepm of c?lo>=iepoPi=e $!, i# @iHen "?>ou@? /3 pu#?U _u#? Ci"? bc"e>io#""ic C"e> in#"e= of #line "o p>eHen" =>u@ p>ecipi""ion =ue "o incomp"ibili"G5 I54545B %f"e> ?ep>in inZec"ion bG 1! >ou"eU =o no" >ub o> m##@e "?e #i"e "oHoi= minu"e

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Hospital 48مستش

نلاجذ

278

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Hospital 48مستش

نلاجذ

280

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281

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285

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Hospital 48مستش

نلاجذ

286

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Hospital 48مستش

نلاجذ

287

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Hospital 48مستش

نلاجذ

288

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Hospital 48مستش

نلاجذ

289

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Hospital 48مستش

نلاجذ

290

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Hospital 48مستش

نلاجذ

291

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Hospital 48مستش

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292

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293

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Hospital 48مستش

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294

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296

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Hospital 48مستش

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297

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Hospital 48مستش

نلاجذ

-!')0R'1<( 'Pplin "o "?e clien" C?" Gou >e @oin@ "o =oU C?G i" i# nece##>GU n= ?oC #?e cn coope>"e5

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48 *-)'R+ $-1&/T%,


Ti"le< +#o@#">ic Tube RemoHl

%pplie# "o< 2ene>l M>= n= 1pecil"G 0ni"#!-+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? n#o@#">ic "ube >emoHl5( )'./+/T/-+< (5( +#o@#">ic "ube >emoHl 6 Ci"?=>Cin@Npullin@ oJ "?e +2T in plce pe> me=icl=Hi#e# of "?e =oc"o>57 &0R&-1'1< 75( To p>oHi=e comfo>"5 757 To p>eHen" occu>>ence of complic"ion liQe @#">ic ulce>"ionU #inu#i"i#U e#op?@i"i#Upulmon>G n= o>l infec"ionU #Qin e>o#ion " "?e no#">il5 75: M?en mPimum "?e>peu"ic eJec" i# c?ieHe=5: '\0/&*'+T1N10&&,/'1< :5( 1"e"?o#cope :57 1G>in@e c"?e"e> "ip S%#ep"o #G>in@e :5: 'me#i# b#in :54 )i#po#ble @loHe# :5I &enli@?"U "on@ue =ep>e##o>

:5A +o>ml #line :5L *ou"?C#? :58 )i#po#ble @oCn Sop"ionl :5B 0n=e>p=#U "i##ue#4 &-,/!/'1< 45( -b"in p?G#icinD# o>=e> fo> >emoHl of +2 "ube5 457 .olloC infec"ion con">ol me#u>e#5 45: &>im>ilG "?e >e#pon#ibili"G of "?e nu>#e unle## =icul"ie# >e encoun"e>e=5I &R'&%R%T/-+1< I5( %##e##< I5(5( .o> "?e p>e#ence of boCel #oun=# I5(57 .o> "?e b#ence of nu#e o> Homi"in@ C?en "ube i# clmpe=

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Hospital 48مستش

نلاجذ

7 'Pplin "o "?e clien" C?" Gou >e @oin@ "o =oU C?G i" i# nece##>GU n= ?oC #?e cn coope>"e5

299




Hospital 48مستش

نلاجذ

300

5: &>oHi=e fo> clien" p>iHcG554 )e"c? "?e "ube5

A545( )i#connec" "?e n#o@#">ic "ube f>om "?e #uc"ion pp>"u#U if p>e#en"5A5457 0npin "?e "ube f>om "?e clien"D# @oCn5A545: RemoHe "?e =?e#iHe "pe #ecu>in@ "?e "ube "o "?e no#e5

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Hospital 48مستش

نلاجذ

301

48 *-)'R+ $-1&/T%,


Ti"le< +u>#in@ !>e of 'pilep"ic !lien"

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Hospital 48مستش

نلاجذ

302

:'\0/&*'+T1N10&&,/'1< :5( &==e= #i=e>il# :57 1uc"ion mc?ine :5: 1uc"ion c"?e"e> :54 &==e= "on@ue =ep>e##o> :5I -PG@en "nQ Ci"? oPG@en =eHice# :5A &enli@?" :5L ->l i>CG :58 1p?G@momnome"e> n=#"e"?o#cope :5B lue #?ee"# :5(FToCel# :5((2ue :5(7)i#po#ble @loHe# :5(:*#Q :5(4%==i"ionl pilloC#

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Hospital 48مستش

نلاجذ

303

I5:5B 1"G Ci"? "?e p"ien" n= ob#e>He5

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Hospital 48مستش

نلاجذ

304

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Hospital 48مستش

نلاجذ

305

48 *-)'R+ $-1&/T%,


Ti"le< -b"inin@ Moun= )>in@e 1pecimen

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Hospital 48مستش

نلاجذ

306

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Hospital 48مستش

نلاجذ

307

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Hospital 48مستش

نلاجذ

308

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Hospital 48مستش

نلاجذ

309

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Hospital 48مستش

نلاجذ

310

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Hospital 48مستش

نلاجذ

311

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

312

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Hospital 48مستش

نلاجذ

314

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Hospital 48مستش

نلاجذ

315

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Hospital 48مستش

نلاجذ

316

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

317

I5757 1elf6c>e bili"ie#

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Hospital 48مستش

نلاجذ

319

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

320

%##i#"iHe =eHice# #uc? # oHe>?e= ">peeU pull n=No> "u>n #?ee"U n=

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Hospital 48مستش

نلاجذ

321

I5I54 RemoHe ob#"cle# f>om "?e >e u#e= fo> "?e ">n#fe>5I5A T>n#fe>>in@ !lien" e"Ceen e= n= 1">e"c?e> I5A5( efo>e ">n#fe>>in@ clien"U ##e## "?e folloCin@< I5A5(5( T?e clien"D# bo=G #ie I5A5(57 %bili"G "o folloC in#">uc"ion# I5A5(5: %c"iHi"G "ole>nce I5A5(54 ,eHel of comfo>" I5A5(5I T?e #pce in C?ic? "?e ">n#fe> i# "o be mneuHe>e= I5A5(5A T?e numbe> of #"J nee=e= "o ccompli#? "?e ">n#fe> #felG I5A5(5L T?e #Qill n= #">en@"? of "?e nu>#e# I5A57 /f in=ic"e=U implemen" pin >elief me#u>e# #o "?" "?eG >e eJec"iHe C?en"?e ">n#fe> be@in#5 I5A5: %##emble eKuipmen" n= #upplie#< I5A5:5( 1">e"c?e> I5A5:57 -p"ionl< #li=in@ bo>= I5A54 -b"in "?e nece##>G eKuipmen" n= nu>#in@ pe>#onnel "o ##i#" in "?e">n#fe>5I5L %##i#"in@ !lien" "o %mbul"e I5L5( %##e##< I5L5(5( ,en@"? of "ime in be= n= "ime up p>eHiou#lG I5L5(57 #eline Hi"l #i@n# I5L5(5: Rn@e of mo"ion of Zoin"# nee=e= fo> mbul"in@ I5L5(54 *u#cle #">en@"? of loCe> eP">emi"ie#

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Hospital 48مستش

نلاجذ

322

I5L5A57 Ti@?"en Gou> @lu"elU b=ominlU le@U n= >m mu#cle#[ >ocQ bcQC>=U#?if"in@ Gou> Cei@?" f>om "?e fo>C>= "o "?e bcQC>= foo"[ n= >oll "?e clien"on"o "?e #i=e of "?e bo=G "o fce Gou5I5L5A5: &o#i"ion "?e clien" on ?i# #i=e Ci"? >m# n= le@# po#i"ione= n=#uppo>"e= p>ope>lG5I5L5A54 To "u>n clien" "o "?e p>one po#i"ionU folloC "?e p>ece=in@ #"ep#U Ci"?"Co ePcep"ion#< I5L5A545( /n#"e= of b=uc"in@ "?e f> >mU Qeep "?e clien"D# >m lon@#i=e

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I5L5A5A5(5(5(3>i"ion< Tu>nin@ "?e !lien" "o &>one&o#i"ion

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ncoope>"e5

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Hospital 48مستش

نلاجذ

323

I58575( Time n= c?n@e of po#i"ion moHe= f>om n= po#i"ionmoHe= "oI585757 %nG #i@n# of p>e##u>e >e#I58575: 0#e of #uppo>" =eHice#I585754 %bili"G of clien" "o ##i#" in moHin@ n= "u>nin@I58575I Re#pon#e of clien" "o moHin@ n= "u>nin@

I5B T>n#fe>>in@ !lien" e"Ceen e= n= !?i> I5B5( 'Pplin "o "?e clien" C?" Gou >e @oin@ "o =oU C?G i" i# nece##>GU n= ?oC#?e cn

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I5B545I ,ocQ "?e C?eel# of "?e C?eelc?i> n= >i#e "?e foo"pl"e5 I5B5I &>ep>e n= ##e## "?e clien"5 I5B5I5( %##i#" "?e clien" "o #i""in@ po#i"ion on "?e #i=e of "?e be=5 %##e## "?eclien" fo> o>"?o#""ic ?Gpo"en#ion befo>e moHin@ "?e clien" f>om "?e be=5 I5B5I57 %##i#" "?e clien" in pu""in@ on b"?>obe n= non#Qi= #lippe># o> #?oe#5 I5B5I5: &lce ">n#fe> bel" #nu@lG >oun= "?e clien"D# Ci#"5 !?ecQ "o bece>"in "?" "?e bel" i# #ecu>elG f#"ene=5 I5B5A 2iHe ePplici" in#">uc"ion# "o "?e clien"5 %#Q "?e clien" "o< *oHe fo>C>= n= #i"on "?e e=@e of "?e be=5

I5B5A5( ,en fo>C>= #li@?"lG f>om "?e ?ip#5 I5B5A57 &lce "?e foo" of "?e #">on@e> le@ bene"? "?e e=@e of "?e be= n= pu""?e o"?e> foo" fo>C>=5 T?e clien" #?oul= no" @>#p Gou> necQ fo> #uppo>"5 I5B5A5: &lce "?e clien"D# ?n=# on "?e be= #u>fce o> on Gou> #?oul=e>#U #o "?""?e clien" cn pu#? C?ile #"n=in@5 T?e clien" #?oul= no" @>#p Gou> necQ fo> #uppo>" I5B5L &o#i"ion Gou>#elf co>>ec"lG5 1"n= =i>ec"lG in f>on" of "?e clien"5 I5B5L5( ,en "?e ">unQ fo>C>= f>om "?e ?ip#5 .leP "?e ?ip#U Qnee#U n= nQle#5%##ume b>o= #"nceU plcin@ one foo" fo>C>= n= one bcQ5 I5B5L57 *i>>o> "?e plcemen" of "?e clien"D# fee"U if po##ible5

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Hospital 48مستش

نلاجذ

324

I5B5B54 &lce bo"? ?n=# on "?e C?eelc?i> >m# o> on Gou> #?oul=e>#5 I5B5B5I 1"n= =i>ec"lG in f>on" of "?e clien"5 &lce one foo" fo>C>= n= onebcQ5 I5B5B5A Ti@?"en Gou> @>#p on "?e ">n#fe> bel"U n= "i@?"en Gou> @lu"elUb=ominlU le@U n= >m mu#cle#5 I5B5B5L -n "?e coun" of "?>eeU ?He "?e clien" #?if" "?e bo=G Cei@?" bG >ocQin@"o "?e bcQ foo"U n= loCe> "?e bo=G on"o "?e e=@e of "?e C?eelc?i> #e" bG _ePin@"?e Zoin"# of "?e le@# n= >m#5 I5B5B58 &lce #ome bo=G Cei@?" on "?e >m#U C?ile #?if"in@ Gou> bo=G Cei@?"

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Hospital 48مستش

نلاجذ

325

I5(F5: &>oHi=e fo> clien" p>iHcG5

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Hospital 48مستش

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327

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Hospital 48مستش

نلاجذ

328

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

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329

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330

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Hospital 48مستش

نلاجذ

331

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

332

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Hospital 48مستش

نلاجذ

333

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Hospital 48مستش

نلاجذ

334

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

335

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Hospital 48مستش

نلاجذ

336

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

+'R%, +0R1/+2 )'&%RT*'+T%, *%+0%, S7FFL ')/T/-+A

337

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Hospital 48مستش

نلاجذ

338

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

,/!/'1<( )oc"o>D# o>=e> of ">e"men" #?oul= be =ocumen"e=5

339




Hospital 48مستش

نلاجذ

340

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Hospital 48مستش

نلاجذ

341

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Hospital 48مستش

نلاجذ

342

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

,/!/'1<( 'n#u>e #fe"G bG<45(5( /=en"ifGin@ co>>ec" p"ien"5

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Hospital 48مستش

نلاجذ

344

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Hospital 48مستش

نلاجذ

+'R%, +0R1/+2 )'&%RT*'+T%, *%+0%, S7FFL ')/T/-+

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345

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Hospital 48مستش

نلاجذ

346

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

347

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Hospital 48مستش

نلاجذ

348

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

349

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Hospital 48مستش

نلاجذ

350

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

351

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Hospital 48مستش

نلاجذ

352

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

353

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Hospital 48مستش

نلاجذ

355

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Hospital 48مستش

نلاجذ

356

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

357

I5:5: 1olu !o>"ef IFm@

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358

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359




Hospital 48مستش

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360

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361

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Hospital 48مستش

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362

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

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363

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

364

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نلاجذ

,/!/'1<( &>ep>"ion

365

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Hospital 48مستش

نلاجذ

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366




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نلاجذ

367

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نلاجذ

372

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374

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نلاجذ

376

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Hospital 48مستش

نلاجذ

377

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

+TR%/+)/!%T/-+1<( T?e folloCin@ >e con">in=ic"e= C?en u#in@ cen">l Henou# line fo> ?Gpe>limen""ion5

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Hospital 48مستش

نلاجذ

379

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Hospital 48مستش

نلاجذ

380

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Hospital 48مستش

نلاجذ

381

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Hospital 48مستش

نلاجذ

382

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

383

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Hospital 48مستش

نلاجذ

384

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Hospital 48مستش

نلاجذ

385

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Hospital 48مستش

نلاجذ

386

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

387

45A57

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Hospital 48مستش

نلاجذ

388

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Hospital 48مستش

نلاجذ

389

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

390

4575L 0>ine >ecep"cle

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L






Hospital 48مستش

نلاجذ

392

8'!/%, !-+1/)'R%T/-+1<( 0>ine "o be =>ine= #?oul= no" be mo>e "?n LIFcc " one "ime # i" mG cu#epo"en#ionU bl==e>"onG5

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B




Hospital 48مستش

نلاجذ

393

48 *-)'R+ $-1&/T%,


Ti"le< 0>ine 1pecimen !ollec"ion

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Hospital 48مستش

نلاجذ

394

A

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E"5




Hospital 48مستش

نلاجذ

395

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8




Hospital 48مستش

نلاجذ

396




Hospital 48مستش

نلاجذ

397

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

398

48 *-)'R+ $-1&/T%,


Ti"le< 0>in>G !"?e"e> RemoHl

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Hospital 48مستش

نلاجذ

399

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Hospital 48مستش

نلاجذ

400

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

401

A'!/%, !-+1/)'R%T/-+1<

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Hospital 48مستش

نلاجذ

402

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

403

A58 M?en i>>i@"in@ con"ine> i# emp"ie=U clo#e clmp n= >emoHe "?e nole

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Hospital 48مستش

نلاجذ

404

48 *-)'R+ $-1&/T%,



le< 3i"l 1i@n# TQin@)ue fo> ReHieC<&@e ( of (F

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Hospital 48مستش

نلاجذ

405

:545: %n"i#ep"ic Cipe#

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Hospital 48مستش

نلاجذ

407

p>obe po#i"ionin@5

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n= Qeep in plce fo> p>ope> #"o>@e

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Hospital 48مستش

نلاجذ

408

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e> "?epul#e poin"5

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pe> minu"e on Gou> Co>Q#?ee"5 /f "Qin@ clien";# pul#e fo> "?e#"

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>eco>=5

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Hospital 48مستش

نلاجذ

409

=i>ec"ion of "?e e> cnl#U o> #li@?"lG fo>C>=U "o fcili""e?e>in@54575:5:545 Tp Gou> En@e> li@?"lG on "?e =ip?>@m "o be #u>e i" i# "?e

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coun" # one >e#pi>"ion5




Hospital 48مستش

نلاجذ

410

5:5:5 -b#e>He "?e =ep"?U >?G"?mU n= c?>c"e> of >e#pi>"ion#5

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Hospital 48مستش

نلاجذ

411

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Hospital 48مستش

نلاجذ

412

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Hospital 48مستش

نلاجذ

413

48 *-)'R+ $-1&/T%,


Ti"le< Moun= )>e##in@

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# on ?oC "o =oun=

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Hospital 48مستش

نلاجذ

415

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

416

4 &-,/!/'1<

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Hospital 48مستش

نلاجذ

417

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Hospital 48مستش

نلاجذ

418

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

419

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Hospital 48مستش

نلاجذ

420

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

421

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Hospital 48مستش

نلاجذ

422

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

423

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Hospital 48مستش

نلاجذ

424

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

425

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Hospital 48مستش

نلاجذ

426

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

428

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

429

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Hospital 48مستش

نلاجذ

430

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Hospital 48مستش

نلاجذ

431

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Hospital 48مستش

نلاجذ

432

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Hospital 48مستش

نلاجذ

433

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Hospital 48مستش

نلاجذ

434

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Hospital 48مستش

نلاجذ

435

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Hospital 48مستش

نلاجذ

436

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Hospital 48مستش

نلاجذ

437

48 *-)'R+ $-1&/T%,*nul< 2ene>l +u>#in@ )ep>"men"l *nul

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Hospital 48مستش

نلاجذ

438

45(71ilQ :6F45(:&unc"u>e "oCel

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Hospital 48مستش

نلاجذ

439

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Hospital 48مستش

نلاجذ

440

48 *-)'R+ $-1&/T%,


Ti"le< !?e#" Tube RemoHl

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Hospital 48مستش

نلاجذ

441

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Hospital 48مستش

نلاجذ

442

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Hospital 48مستش

نلاجذ

443

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

444

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Hospital 48مستش

نلاجذ

,/!/'1<( -b"in =oc"o>D# o>=e>5

445

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Hospital 48مستش

نلاجذ

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446




Hospital 48مستش

نلاجذ

447

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Hospital 48مستش

نلاجذ

448

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Hospital 48مستش

نلاجذ

449

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A'!/%, !-+1/)'R%T/-+1<( T?e p"ien" mG complin mil= ?e=c?e n=No> =i#comfo>" in "?e @>oin o> o"?e> #i"epen=in@ on>ou"e bG C?ic? con">#" me=ium C# =mini#"e>e=5




Hospital 48مستش

نلاجذ

450

48 *-)'R+ $-1&/T%,


Ti"le< >ium 'nem

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# =u>in@>ium enemoce=u>e5)'./+/T/-+<(5( >ium 'nem 6 p>oce=u>e in C?ic? b>ium miP"u>e i# in">o=uce= in "?e l>@ee#"ine Hi

>ec"l c"?e"e> fo> _uo>o#copic Hi#uli"ion of "?e en"i>e colon Sl>@e in"e#"ine5&0R&-1'1<75( To =emon#">"e "?e p>e#ence of polGp#U "umo>#U n= o"?e> le#ion# of l>@e in"e#"ine5757 To >eHel nG bno>ml n"omG o> mlfunc"ion of "?e boCel#575: To i= in =i@no#i# of colo>ec"l cnce> n= in_mm"o>G =i#e#e5754 To ""emp" "o >e=uce non6#">n@ul"e= ileocolic in"u##u#cep"ion in c?il=>en5!-+TR%/+)/!%T/-+1<:5( Tc?Gc>=i:57 0lce>"iHe coli"i#:5: 1u#pec"e= pe>fo>"ion o> ob#">uc"ion

:54 ToPic me@colon'\0/&*'+T1N10&&,/'1<45( )i#po#ble @loHe#457 lue p=45: .lee" enem454 T?e>mome"e>45I 1p?G@momnome"e> n= 1"e"?o#cope&-,/!/'1<I5( -b"in =oc"o>D# o>=e>5I57 %ppoin"men" mu#" be ob"ine= =G befo>e "?e p>oce=u>e5I5: &"ien" mu#" #i@n con#en" fo>m fo> =i@no#"ic p>oce=u>e5 'n#u>e "?" p"ien" i# Cello>me= of

"?e pu>po#e of "?e p>oce=u>e5I54 &?G#icl n= p#Gc?olo@icl p>ep>"ion i# mu#"5I5I &>oHi=e p>iHcG5

AR-!')0R'1<A5( &>ep>"o>G &?#e<

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">e"c?e> Ci"?#fe"G #">p# =epen=in@ on p"ien"D# con=i"ion f"e> p>ope> =ocumen""ion5




Hospital 48مستش

نلاجذ

451

A5(585( .o> femle p"ien"U Qeep ?i> n= fce fullG coHe>e=5A5(5B 'n=o>#e p"ien" "o V6RG Tec?nicin5A5(5(F ReKue#" V6RG Tec?nicin "o info>m "?e C>= C?en p>oce=u>e i# Eni#?e=5

7 &o#" &>oce=u>e &?#e<A575( ReceiHe p"ien" f>om V6RG )ep>"men" Ci"? comple"e en=o>#emen" inclu=in@

ecilin#">uc"ion# >el"in@ "o p"ien"D# con=i"ion5

A5757 TQe no"e of "?e "ime p"ien" C# >eceiHe= f>om "?e V6>G =ep>"men"U"ien"D#

con=i"ion n= "ole>nce "o "?e p>oce=u>e5A575: T>n#po>" p"ien" bcQ "o "?e >oom5 T>n#fe> "o "?e be=U if ineelc?i>N#">e"c?e>5A5754 %##e## p"ien"D# con=i"ion5 TQe Hi"l #i@n#5A575I /n#">uc" p"ien" "o >e#ume =ie" n= "Qe mo>e _ui=#5A575A %=mini#"e> "?e p>e#c>ibe= c"?>"ic o> clen#in@ enem "o p>omo"e elimin"ionb>iumU

in o>=e> "o p>eHen" impc"ion n= boCel ob#">uc"ion5A575L 'Pplin "o p"ien" "?" "?e b>ium Cill li@?"en colo> of #"ool5A5758 )ocumen"<

A57585( Time >eceiHe=A575857 Tole>nce "o "?e p>oce=u>eA57585: -bZec"iHeN#ubZec"iHe ob#e>H"ion#A575854 3i"l #i@n#

A575B !?>@e "?e p>oce=u>e n= #upplie# u#e=5

L1&'!/%, !-+1/)'R%T/-+1<

L5( /f b>ium i# no" elimin"e= Ci"?in 76: =G# no"ifG "?ep?G#icin5




Hospital 48مستش

نلاجذ

452

48 *-)'R+ $-1&/T%,


Ti"le< >ium *el N >ium 1ClloC

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# in pe>fo>min@>ium

elNb>ium #ClloC5

)'./+/T/-+<(5( >ium *elN>ium 1ClloC i# >=io@>p?ic #"u=G of "?e @#">o6in"e#"inl ">c" n=

##oci"e= o>@n# bG =mini#"e>in@ con">#" me=ium5 T?e p>oce=u>e i# #fe n=n#i#"# of

@iHin@ >=iopKue #ub#"nce clle= b>ium "o =>inQ5 /" _oC# "?>ou@? "?e uppe> 2/=

moni"o>e= bG #e>ie# of P6>G# "Qen " H>Gin@ in"e>Hl#5 /" i# "Qe# (F6:F minu"e#5&0R&-1'1<75( 'Hlu"e# p"ien"D# bili"G "o #ClloC5757 ReHel# nG bno>mli"ie# of "?e p?>GnP o> e#op?@u#575: $elp# "o =i@no#e ?i"l ?e>niU =iHe>"icul n= H>ice#5754 To =e"ec" #">ic"u>e#U ulce>#U "umo>#U polGp#U n= mo"ili"G =i#o>=e># Se#op?@u#U

omc? n==uo=enum5

+)/!%T/-+1<:5( &"ien" #uJe>in@ f>om =G#p?@i5:57 2#">oe#op?@el >e_uP5:5: To >ule ou" "umo> of e#op?@u#U #"omc? o> =uo=enum5!-+TR%/+)/!%T/-+1<45( &>e@nncG457 /n"e#"inl ob#">uc"ion45: &"ien" Ci"? #u#pec"e= @#">oin"e#"inl pe>fo>"ion SC"e> #oluble con">#" me=ioul= be u#e=

#felG

'\0/&*'+T1N10&&,/'1<I5( /3%! "?e>mome"e> Ci"? p>obe coHe>I57 & pp>"u#&-,/!/'1<A5( -b"in =oc"o>D# o>=e>5A57 'n#u>e p"ien" i# Cell info>me= of p>oce=u>e n= i"# pu>po#e5A5: !on#en" fo> )i@no#"ic &>oce=u>e S.o>m *((4( mu#" be #i@ne= bG "?e p"ien" n="ne##e= bG

">e"in@ =oc"o>5A54 %ppoin"men" mu#" be ob"ine= =G befo>e "?e p>oce=u>e5A5I .olloC #fe"G me#u>e# =u>in@ ">n#fe>5

L&R-!')0R'1< L5( &>ep>"o>G &?#e< L5(5( 3e>ifG =oc"o>D# o>=e>5 L5(57 'Pplin "?e p>oce=u>e "o "?e p"ien"5 L5(5: 'n"e> "?e >eKue#" "?>ou@? "?e compu"e> f"e> c?>@in@5 L5(54 2e" ppoin"men" f>om V6RG )ep>"men"5

L5(5I Oeep p"ien" +o"?in@ &e> ->em S+&- f"e> mi=ni@?"5 L5(5A %##e## p"ien"D# con=i"ion5 TQe n= >eco>= Hi"l #i@n#5 L5(5L 3e>ifG n= conE>m f>om V6RG )ep"5 "?e p"ien"D# ppoin"men""ime5




Hospital 48مستش

نلاجذ

453

T>n#po>" p"ien" "o V6RG )ep"5 bG #">e"c?e> o> C?eelc?i> pe> p"ien"D#con=i"ion5 &u"

on #fe"G #">p5L5(5B 'n=o>#e p"ien" "o "?e V6RG Tec?nicin5 ReKue#" V6RG Tec?nicin "o no"ifG "?e

C>=bG "elep?one once "?e p>oce=u>e i# Eni#?e=5

L57 &o#" &>oce=u>e &?#e<

L575( ReceiHe p"ien" Ci"? comple"e en=o>#emen" f>om V6RG Tec?nicinL5757 TQe no"e of "?e "ime n= p"ien"D# con=i"ion5L575: 1en= bcQ "o "?e >oom n= ">n#fe> "o be=5L5754 %##e## p"ien"D# con=i"ion5 !?ecQ Hi"l #i@n#5 +o"ifG "?e p?G#icin of nG

=eHi"ion f>omno>ml5

L575I ,e" p"ien" >e#ume o>l in"Qe C?en p>oce=u>e i# =one5L575A 2iHe c"?>"ic o> clen#in@ enem # o>=e>e= "o p>eHen" fecl impc"ion n= "o

p>omo"eelimin"ion of "?e b>ium5

L575L /nfo>m p"ien" "?" #"ool# Cill ppe> c?lQG fo> 74 "o L7 ?ou># f"e> "e#"5L5758 )ocumen" "?e folloCin@<

L57585( Time >e"u>ne= bcQ "o "?e C>=5L575857 Tole>nce "o p>oce=u>e5L57585: %nG un"oC>= mnife#""ion# ob#e>He= f"e> "?e p>oce=u>e n= no"ifG "?e

p?G#icin5L575854 3i"l# #i@n# "Qen5L57585I 'nem @iHen n= ob#e>H"ion# m=e Sif nG5 8&'!/%, !-+1/)'R%T/-+1<

85( /f p"ien" i# #moQe> Ci"??ol= ci@>e""e# becu#e nico"ine #"imul"e# pe>i#"l#i#n= inc>e#e#

@#">ic #ec>e"ion#U C?ic? C?en =ilu"e= "o con">#" @en" cn >e#ul" "o inccu>"e "e#"e#ul"5857 Mi"??ol= n"ic?oline>@ic n= n>co"ic# fo> 74o ?ou># pe> =oc"o>D# o>=e> becu#e "?eGmG

=ec>e#e pe>i#"l#i# n= impe=e elimin"ion of b>ium f>om "?e 2/ ">c" f"e>>oce=u>e5

L5(58




Hospital 48مستش

نلاجذ

454

48 *-)'R+ $-1&/T%,


Ti"le< >onc?o#copG

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#-+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# =u>in@onc?o#copGoce=u>e5

)'./+/T/-+<(5( >onc?o#copG i# "?e =i>ec" in#pec"ion n= ePmin"ion of "?e l>GnPU ">c?e n=onc?i "?>ou@?

ei"?e> _ePible Ebe>op"ic o> >i@i= b>onc?o#cope5(5(5( )i@no#"ic >onc?o#copG(5(57 T?e>peu"ic >onc?o#copG

&0R&-1'1<75( )i@no#"ic

75(5( To ePmine "i##ue# o> collec" #ec>e"ion#575(57 To =e"e>mine "?e loc"ion n= eP"en" of "?e p"?olo@ic p>oce##575(5: To ob"in "i##ue #mple fo> =i@no#i#575(54 To =e"e>mine if "umo> cn be >e#ec"e= #u>@icllG5

75(5I To loc"e "?e #ou>ce of ?emop"G#i#5757 T?e>peu"ic

7575( To >emoHe fo>ei@n bo=ie# f>om "?e ">c?eob>onc?il ">ee575757 To >emoHe #ec>e"ion# ob#">uc"in@ "?e ">c?eob>onc?il ">ee C?en "?e p"ien"

nno" cle>"?em5

7575: To ">e" &o#"6op "elec"#i#575754 To =e#">oG n= ePci#e le#ion#5

!-+TR%/+)/!%T/-+1<:5( Recen" *Goc>=il /nf>c"ion:57 !e>eb>l $emo>>?@e Sle## "?n A CeeQ#:5: -7 #"u>"ion le## "?n BF Ci"? oPG@en

'\0/&*'+T1N10&&,/'1<45( & pp>"u#457 /3%! mc?ine Ci"? p>obe coHe>45: 1G>in@e# n= nee=le454 %lco?ol p=#45I n=6i=45A 1mll #?>p con"ine>45L &ul#e -Pime"e>&-,/!/'1<I5( -b"in =oc"o>D# o>=e>5I57 1ecu>e C>i""en con#en"5I5: -b#e>He fll p>ecu"ion#5

I54 'n#u>e "?" p"ien" i# +&- fo> A6(7 ?ou># "o p>eHen" #pi>"ion C?en >e_ePe# >eocQe=5

A&R-!')0R'1< A5( &>ep>"o>G p?#e

A5(5( 3e>ifG =oc"o>D# o>=e>5 A5(57 /=en"ifG "?e co>>ec" p"ien"5 A5(5: 'Pplin "?e p>oce=u>e "o "?ep"ien"5




Hospital 48مستش

نلاجذ

455

A5(54 Oeep p"ien" on +&- fo> A6(7 ?ou>#5

7 &e>fo>mnce p?#eA575( !?ecQ fo> "?e folloCin@<A575(5( 1i@ne= con#en"A575(57 '!2A575(5: !?e#" P6>GNlb inHe#"i@"ion# # o>=e>e= bG =oc"o>

A5757 'n#u>e "?" p"ien" i# Qep" +&- fo> A6(7 ?ou>#5A575: RemoHe =en"u>e#U con"c" len#e#U n= o"?e> p>o#"?e#i#5A5754 M#? ?n=#5 !?ecQ Hi"l #i@n# # b#eline5A575I %=mini#"e> p>eme=# Su#ullG ( mpoule %">opine 1ulp?"e i# @iHen

">m#cul>lG o> #p>e#c>ibe= bG "?e =oc"o> "o >e=uce #ec>e"ion# :F minu"e# p>io> "o "?e p>oce=u>e5

A575A T>n#po>" p"ien" pe> #">e"c?e> "o@e"?e> Ci"? "?e comple"e EleU pin c>= n= (

mpoule of )o>micumU pu" on #fe"G #">p#5A575L 'n=o>#e= "o -&) #"J n= >emin= ?e> "o no"ifG "?e C>= once "?e p>oce=u>e i#i#?e=5A5758 &o#" p>oce=u>e p?#e<

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A575(F5(+me n= &/+A575(F57TGpe of #pecimen

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occu>#<A575((5($Gpo"en#ionA575((57$emop"G#i#A575((5:!Gno#i#A575((54)G#pneA575((5I$GpoPiA575((5A)G#>?G"?mi#A575((5LTc?Gc>=i

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A575(: *in"in "?e p"ien" +&- un"il @@N#ClloCin@ >e_eP >e"u>n5A575(4 !?>@e "?e me=icine# n= #upplie# u#e=5

L1&'!/%, !-+1/)'R%T/-+1< L5( T?e folloCin@ >e "?e po##ible complic"ion# f"e>b>onc?o#copG< L5(5( >ec"ion "o "?e locl ne#"?e#i

L5(57 infec"ion L5(5: #pi>"ion L5(54 b>onc?o#p#m L5(5I pneumo"?o>P




Hospital 48مستش

نلاجذ

456

L5(5A blee=in@ n= pe>fo>"ionL57 1e="ion @iHen "o p"ien"# Ci"? >e#pi>"o>G in#uciencG mG p>ecipi""e >e#pi>"o>G>>e#"5L5: %##e## p"ien"# @@ >e_eP befo>e @iHin@ o>l in"Qe5 -nce "?e p"ien" =emon#">"e#"?" ?eN#?e cn cou@?U ice c?ip# n= eHen"ullG _ui=# mGbe @iHen5




Hospital 48مستش

نلاجذ

457

48 *-)'R+ $-1&/T%,


Ti"le< !olono#copG

pplie# "o< 2ene>l M>= n= 1pecil"G 0ni"#-+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# =u>in@olono#copG

>oce=u>e5)'./+/T/-+<(5( !olono#copG ] "?e Hi#uli"ion of "?e en"i>e l>@e in"e#"ineU #i@moi= colonU >ec"um

n= nlcnlU Ci"? "?e u#e of colono#cope5 /" i# mo>e eP"en#iHe p>oce=u>e "?n

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>oce=u>e5&0R&-1'1<75( )i@no#"ic

75(5( To eHlu"e fo> mli@nncGU =iHe>"iculo#i#U in_mm"o>G boCel =i#e#eU polGp#U">ic"u>e

n= blee=in@575(57 0#e= fo> #u>Heillnce in p"ien"# Ci"? ?i#"o>G of c?>onic ulce>"iHe coli"i#U>eHiou# colon

cnce> o> colon polGp#5757 T?e>peu"ic

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/+)/!%T/-+1<:5( ,e#ion in "?e p>oPiml colonU c?>onic con#"ip"ionU blee=in@N >ec"um5:57 To co@ul"e c"iHelG blee=in@ He##el#5!-+TR%/+)/!%T/-+1<45( 0ncoope>"iHe p"ien"

457 %b=ominl #u>@e>G45: %#ci"e#454 &>e@nncG45I *Goc>=il inf>c"ion n= #eHe>e c>=ic =ecompen#"ion45A &>ofu#e >ec"l blee=in@'\0/&*'+T1<I5( 3i=eo !olono#copeI57 iop#G fo>cep#I5: lue p=#I54 2ue p=#I5I &l#"ic p>onI5A )i#po#ble @loHe#I5L /3 #e" Qi"I58 oCel p>ep>"ion

I585( !ololG" o> colop>ep S @iHen ni@?" of "?e p>oce=u>e I5857 .lee" enem

A,/!/'1<( &>oce=u>e #?oul= be ePpline= "o "?e p"ien"D# leHel of un=e>#"n=in@5

7 /nfo>me= con#en" #?oul= be #i@ne= S.o>m *((4(5: %##e## p"ien"D# ?i#"o>G of nG QnoCn lle>@ie# n= cu>>en" me=ic"ion#5 !e>"ine=ic"ion #uc?# n"ico@uln"# mG be ?el= befo>e "?e p>oce=u>e5




Hospital 48مستش

نلاجذ

458

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نلاجذ

459

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460

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نلاجذ

461

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462

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Hospital 48مستش

نلاجذ

463

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نلاجذ

464

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Hospital 48مستش

نلاجذ

466

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Hospital 48مستش

نلاجذ

467

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Hospital 48مستش

نلاجذ

469

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Hospital 48مستش

نلاجذ

470

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

471

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Hospital 48مستش

نلاجذ

472

48 *-)'R+ $-1&/T%,


Ti"le< *Gelo@>m

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Hospital 48مستش

نلاجذ

474

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

475

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Hospital 48مستش

نلاجذ

477

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Hospital 48مستش

نلاجذ

478

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

479

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Hospital 48مستش

نلاجذ

480

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

481

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Hospital 48مستش

نلاجذ

482

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

483

A

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Hospital 48مستش

نلاجذ

484

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Hospital 48مستش

نلاجذ

*%!$/+'1

485




Hospital 48مستش

نلاجذ

486

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

487

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Hospital 48مستش

نلاجذ

488

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

(5A

489

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Hospital 48مستش

نلاجذ

490

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

491




Hospital 48مستش

نلاجذ

492

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Hospital 48مستش

نلاجذ

493

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Hospital 48مستش

نلاجذ

494

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

495

48 *-)'R+ $-1&/T%,


Ti"le< 'lec">oc>=io@>p?G *c?ine

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Hospital 48مستش

نلاجذ

496

I5458 ,ef" n"e>io> Pill>G lineU on l"i"u=e of c4 SCblI545B ,ef" cen">l Pill>G lineU on l"i"u=e of c4 SCH

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Hospital 48مستش

نلاجذ

497

48 *-)'R+ $-1&/T%,


Ti"le< /nfu#ion &ump

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Hospital 48مستش

نلاجذ

499

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

500

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Hospital 48مستش

نلاجذ

501

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Hospital 48مستش

نلاجذ

502

48 *-)'R+ $-1&/T%,


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Hospital 48مستش

نلاجذ

503

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Hospital 48مستش

نلاجذ

L5:5:5I

504




Hospital 48مستش

نلاجذ

505

i#plG5%" AF minu"e# f"e> comple"ion of "?e #"" me#u>emen"#U "?e

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Hospital 48مستش

نلاجذ

506

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Hospital 48مستش

نلاجذ

507

48 *-)'R+ $-1&/T%,


Ti"le< &ul#e -Pime"e>

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Hospital 48مستش

نلاجذ

508

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Hospital 48مستش

نلاجذ

509

48 *-)'R+ $-1&/T%,


Ti"le< 1ep"ic .lui= %#pi>"o> *e=p &LF4F

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Hospital 48مستش

نلاجذ

-!')0R'1<( !?ecQ if "?e #upplG Hol"@e co>>e#pon=# "o "?e info>m"ion on "?e "Gpe of lbel5

510




Hospital 48مستش

نلاجذ

511

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Hospital 48مستش

نلاجذ

512

48 *-)'R+ $-1&/T%,


Ti"le< 1G>in@e &ump#

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# in ope>"in@ >in@emp5)'./+/T/-+<

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Hospital 48مستش

نلاجذ

513

IFmlN?> fo> 7Fml #G>in@e# :FmlN?> fo> (Fml #G>in@e# /f "?e p>o@>mme= >"e ePcee=# "?e boHe Hlue#U "?e pump =i#plG# info>m"ion bou" "?i# fc"5 'n"e> "?e p>ope> Hlue of infu#ion >"e n=p>e## Y'15 /" i# po##ible "o p>o@>m infu#ion "ime in#"e=5 1Ci"c?in@ f>om R%T' "o T/*' Sn= Hice He># i# ob"ine= bG p>e##in@ +- "Cice5 I575(5( Time 6 mPimum "ine i# BB ?ou>#U IB minu"e# n= IB #econ=#5 G p>e##in@+- "?e c"ul Hlue cn be cle>e=U bG Y'1 ccep"e=5 %f"e> +-U ll e>oe# ppe> on"?e =i#plG5 'n"e> numbe># f>om lef" "o >i@?"5 T?e p>o@>mme= =i@i" cn becle>e= Ci"? +-5 % blinQin@ e>o #?oC# C?e>e "?e c"ullG p>o@>mme= =i@i" #?oul= been"e>e=5 %ll #iP =i@i"# mu#" be en"e>e=U ePmple< -ne ?ou> i# p>o@>mme= # F(<FF<FF :F minu"e# i# p>o@>mme= # FF<:F<FF %f"e> R%T' n= T/*' i# p>o@>mme= Sccep"e= bG Y'1 n= in c#e if "?>ee occlu#ion limi"# Ce>e in#"lle= bG p>o@>mme> "?e folloCin@me##@e# ppe>#< -ccl5 VVV Smen# nG occlu#ion limi"< ,-MU */)U $/2$

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Hospital 48مستش

نلاجذ

R1/+2 R'1&-+1//,/T/'1<( T?e p>o@>mme= >"e n= Holume Hlue# >e ccu>"e onlGU C?en "?e pp>op>i"e #G>in@e i#e=UePc"lG "?e one "?" C# p>o@>mme=5

514




Hospital 48مستش

نلاجذ

515

7 .o> clenin@ n= =i#infec"ionU "?e =eHice mu#" be #Ci"c?e= oJ n= =i#connec"e=om "?e min#5T?e uni" i# Cipe= Ci"? =i#infec"n" 6 #oQe= clo"? o> lco?ol 6 b#e= =i#infec"n" cnu#e=l#o5 %f"e> =i#infec"ionU " le#" one minu"e #?oul= elp#e befo>e "?e pump i#

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Kuipmen" i#"u>ne= onU "?e>e Cill be >e= ful" lmp fo> #?o>" "ime n= "?e cou#"icl

l>m Cill#oun=5




Hospital 48مستش

نلاجذ

516

48 *-)'R+ $-1&/T%,


Ti"le< 0l">#onic +ebulie>

plie# "o< 2ene>l M>= n= 1pecil"G 0ni"#+T'+T1< T?i# 2ene>l M>= policG n= p>oce=u>e =el# Ci"? "?e @ui=eline# in ope>"in@ul">#onicbulie>5)'./+/T/-+<(5( 0l">#onic +ebulie> 6 =eHice u#e= in #?o>" "?e>peu"ic #e##ion# "o =eliHe> moi#"u>e

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uni" Cill no" nebulie5




Hospital 48مستش

نلاجذ

517

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Hospital 48مستش

نلاجذ

518

48 *-)'R+ $-1&/T%,



Ti"le< 1uc"ion *c?ine)ue fo> ReHieC<&@e ( of 7

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4




Hospital 48مستش

نلاجذ

519

IR1/+2 R'1&-+1//,/T/'1<( )o f"e> c>e of eKuipmen"57 &ull "?e poCe> plu@ p>io> "o ec? clenin@5: !len p>"# c>efullG n= "?o>ou@?lG Ci"? =i#infec"in@ #olu"ion Ci"? C"e>5 )>G ll>"# He>G Cell5*Qe #u>e "?" no _ui=# pene">"e "?e #pi>"o>5

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Hospital 48مستش

نلاجذ

520

48 *-)'R+ $-1&/T%,



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Hospital 48مستش

نلاجذ

521

575L RemoHe "?e clib>"o> f>om "?e me"e> n= #"o>e i" in "?e me"e>D# c>>Gin@ c#e5: loo= 2luco#e Te#"in@ &>oce=u>e

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Hospital 48مستش

نلاجذ

522

45I575:57 ,-T numbe> fo> "?e boP of @luco#e #">ip# n= !-)' numbe> fo> "?e boP ofQe"one

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Hospital 48مستش

نلاجذ

523

45L5(( *e#u>ble Rn@e# 45L5((5( loo= @luco#e < 7F 6 IFF m@N=, q 7F m@N=,U "?e >e#ul" ppe># W,-X k IFF m@N=,U "?e >e#ul" ppe># # W$/X 45L5((57 loo= 6Qe"one#< F 6 A mmolN, k A mmolN,U "?e >e#ul"# ppe># # W$/X




Hospital 48مستش

نلاجذ

-T$'R )'&%RT*'+T1&-,/!/'1 %+) &R-!')0R'1

%..'!T/+2 +0R1/+2 &R%!T/!'

524




Hospital 48مستش

نلاجذ

licG +o5FF7

525

48 *-)'R+ $-1&/T%,

Manual: R'1&/R%T-RY T$'R%&Y

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le< %>"e>il loo= 2#

+T'+T1< This OM describes the policies, procedures & responsibilities of Respiratory CareUnit personnel with regards to arterial blood gas sampling in S!"

)'./+/T/-+ of T'R*1<(5( %>"e>il punc"u>e# in#ol#e drawing blood from a peripheral artery $radial, brachial, femoral,dorsalis pedis% through a single percutaneous needle puncture" Results obtained fromsampling arterial blood gas are the cornerstone in the diagnosis and management of oygenation and acid'base disturbances"

&0R&-1'1<75( To pro#ide guidelines to assure that all blood gas punctures and samples are performed

properly with patient safety as the foremost consideration"

7 To ensure that arterial blood samples are properly handled from the time that they areobtained until the time that they arri#e at the location where the analysis are performed"

: To establish guidelines for notifying the physicians of blood gas #alues outside the normalimits(range $panic #alues%"

4 To pro#ide guidelines for a safe and effecti#e techni)ue for assessing collateral circulationn the hand prior to arterial puncture $*llen+s Test%"

: /+)/!%T/-+1<

( The need to e#aluate the ade)uacy of #entilation $aCO-%, acid'base status $p!%, andoygenation status $aO-%"

7 The need to determine the patient+s response to therapeutic inter#ention" $e"g" O-

herapy%"

:5: The need to monitor se#erity and progression of a documented disease process"

4 !-+TR%/+)/!%T/-+1

( .egati#e results on *llen+s test are indicati#e of inade)uate blood supply to the hand andsuggest the need to select another etremity or the site for puncture"

7 *rterial puncture should not be performed through a lesion or through or distal to a

urgical shunt"

I $%%R)1 n= &-11/,' !-*&,/!%T/-+1<




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I5( *rteriospasm

I57 *ir or clotted blood emboli

I5: *rterial occlusionI54 !emorrhageI5I ainI5A atient or sampler contamination

A &-,/!/'1 n= 20/)',/+'1<

A5( *rterial blood gas punctures shall be performed onlG if<

A5(5( * written physician+s order is a#ailable in the patient+s file"

(57 /irect #erbal instructions or #ia telephone by the physician to the RespiratoryTherapist"

7 Twenty fi#e $-0% 0(12 needles shall be used on all radial, brachial and dorsalis pedis

arterial punctures" +eHe> u#e nee=le# l>@e> "?" 7:2 fo> nG #i"e5

: * maimum of two $-% puncture attempts per patient per site shall be made by any oneherapist"

4 * maimum of four $3% puncture attempts per patient for two sites shall be made by anywo therapists"

A5I *uthori4ed puncture sites include $in order of preference%:

A5I5( 5or adults and children o#er 6- years:

A5I5(5( 5irst $6st% choice: Radial *rtery

R"ionleNOeG poin"#

A5I5(5(5( Collateral circulation by ulnar artery can be tested and documented

A5I5(5(57 The artery is superficial with no ner#e immediately parallel to it"

A5I5(5(5: 7ase of determination(detection of bleeding( occult bleeding"

I5(5(54 8e#el of needle should be up and artery penetration is atapproimately 9; to 30; angle"

A5I5(57 Second $-nd% choice: 8rachial *rtery

R"ionleNOeG poin"#

I5(5(5( <f neither the right nor the left radial artery may be punctured, then

puncture the brachial artery"

I5(5(57 8e#el of needle should be up and artery penetration is at




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approimately 30; to =; angle"A5I5(5(5: .o test for collateral circulation can be performed"

I5(5(54 Care must be ta>en not to obtain #enous blood, puncture the ner#e or puncture the bicipital aponeurosis"

A5I5(57 Third $9rd% choice: /orsalis edis *rtery

R"ionle5OeG poin"#

I5(5(5( <f unable to obtain sample from brachial arteries $due to bandages,casts, burns, etc"% then puncture the dorsalis pedis artery"

I5(5(57 /orsalis pedis artery is #ery peripheral" Care must be ta>en not toinsert the needle too deep"

I5(5(5: 8e#el of needle should be up and artery penetration is atapproimately 30; to =; angle"

A5I5(5(54 .o test for collateral circulation can be performed"

I5(5(5I The foot is perfused with blood from both the dorsalis pedis as well asthe posterior tibial arteries with good circulation through the plantar arches in the foot"

A5I5(57 5ourth $3th% choice: 5emoral *rtery $7mergency(Code situations only%

I5(575( * physician+s written or #erbal order specifically indicating femoralartery puncture is re)uired"

I5(5757 Only RTs eperienced with femoral puncture is allowed to performfemoral puncture"

I5(575: rocedure is reser#ed only for emergency(code situations or etremehypotension"

I5(5754 * longer needle $6'6 ?2% may be re)uired, but needle must not be

larger than -9

A5I5(575I *ngle of entry is =;"

I5(575A *ssessment of hemostasis is mandatory, as bleeding into the fascialplanes may persist unnoticed"

A5I5(5:/nfn"# and children under 6- years:

A5I5(5:5(

A5I5(5:57

A5I5(5:5:

5irst $6st% choice: Radial *rtery

Second $-nd% choice: /orsalis edis *rtery

Third $9rd% choice: 8rachial *rtery




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A5I5(5:545ourth $3th% choice: 5emoral *rteryR"ionleNOeG poin"#

I5(5:545(.emo>l punctures are ne#er performed under anycircumstances, on any children under the age of eight $1% years topre#ent possibility of lacerating the child+s urinary bladder"

I5(5:5457% physician+s written or #erbal order specifically indicatingfemoral artery puncture is re)uired"

I5(5:545:-nlG RTs eperienced with femoral puncture are allowed to

perform femoral puncture"

I5(5:5454&>oce=u>e is reser#ed only for emergency( code situations or etreme hypotension"

I5(5:545I% longer needle $6'6 ?2% may be re)uired, but needle must notbe larger than -9

A5I5(5:545A%n@le of entry is =;"

I5(5:545L%##e##men" of hemostasis is mandatory, as bleeding into the

fascial planes may persist unnoticed"

L R'1&-+1//,/T/'1<

( *ttending physician shall initiate written or #erbal orders $documented in patient+s file%egarding all arterial blood gas sampling" The physician+s order shall include the following:

L5(5(L5(57L5(5:L5(54

Oygen 5lowOygen de#ice@entilator setting5<O-

L57 riority of sample collection:

L575( ST*T collectionL5757 Routine $ indicate fre)uency%L575: Specific time of collection

: The nurse on duty shall write the re)uest on the official physiotherapy re)uisition formand inform the RT on duty of the said re)uest"

L54 *ll RTs shall be familiar(>nowledgeable with: L545( Criteria for Site and Techni)ue of *rterial unctures

457 <nfection Control, *pplication of Standard recautions & Uni#ersal 8lood &Secretion recaution

L545: Contraindications & Complications




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L5454 roper reporting of *8 $panic #alues% results

45( *ll RTs shall perform procedure in accordance with the procedure established inthis policy and procedure manual"

8 '\0/&*'+T1<

85( Sterile 9cc or 0cc syringe, pre'heparini4ed

857 -9 or -0 needle, short le#el, clear hub with lure loc>"85: .eedle stopper 854 Syringe tip cap85I AB alcohol prep pad or other suitable antiseptic solution

85A - -2 gau4e pad

85L *dhesi#e bandage858 <ce chips( cup filled with ice water ( ice pac>85B lo#es $clean%

B &R-!')0R'<

5( *llen+s TestB5(5( The *llen+s test shall always be performed prior to radial punctures" This test shall

be a standard mandatory procedure" +o 'Pcep"ion#5

B5(57 !a#e the patient clench his hand into a tight fist"

B5(5: Occlude the radial and ulnar arteries"

B5(54 et the patient open his hand $but not to fully etend%"

B5(5I Release the pressure from the ulnar artery"

(5A <f ulnar circulation is ade)uate, the hand should become normal in color after afew seconds"

B5(5L /o not puncture radial artery if circulation is not bac> in fifteen $60% seconds"

B5(58 <f *llen+s Test is negati#e:

B5(585(!?ecQ the other hand"

(5857)ocumen" and communicate to the physician and other RT staff the patient+sname, pinD and results of the test"

(585:/f the right and left radial arteries ha#e both negati#e results for *llen+s Testperform brachial or dorsalis pedis puncture"

B5(5B *rterial uncture

5(5B5(M>i"e the date, time & badgeD on the re)uest form upon recei#ing the form"




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B5(5B57.ill up the laboratory re)uest form with all the necessary information"B5(5B5:!?ecQN #erify for a complete physician+s order in the patient+s file"

B5(5(F Re#iew the patient+s medical file for:

B5(5(F5($i#"o>G of patient+s clinical condition"B5(5(F57Re#pi>"o>G therapy orders $ oygen & #entilator set'ups%B5(5(F5:%n"ico@uln" or thrombolytic therapy

B5(5(F541pecil precautions

B5(5(( Eash hands"

(5(7 <dentify patient by chec>ing </ bracelet then eplain the procedure, e)uipment &

therapeutic obFecti#es to the patient"

(5(: Chec> for proper oygen therapy set'up, 5<O-, oygen concentration and oygende#ice and #entilatory set'up"

B5(5(4 *pply clean glo#es"

(5(I *ssemble e)uipment including ice'water solution" @isually inspect needle tip for patency and imperfections"

(5(A abel slush ice water container with patient+s name & <." <f ice slush is nota#ailable, label the syringe with patient+s name & <."

B5(5(L alpate radial artery to assess the strength of pulse"

B5(5(8 erform *llen+s Test"

(5(B /isinfect the patient+s s>in with alcohol pad, wiping it in a circular motion from thecenter outward"

(57F Using inde and middle fingers of your non'dominant hand, carefully palpateartery again" alpate as long as necessary to ma>e sure there is good pulse andartery is stable"

(57( !old syringe with dominant hand with needle be#el up" Guic>ly puncture site withcorresponding angles for different sites $radial 9'30;, brachial 30'=;, femoral=;%"

(577 *rterial entry is indicated by a flush or pulsating blood in the clear hub of theneedle"

(57: *llow the syringe to fill automatically until at least 6'-ml for adults and childreno#er 6- years old, "0 ml for neonates and children under 6-"

(574 /iscontinue puncture after obtaining sample and apply digital pressure to site for

" le#" 0 minutes or until hemostasis is achie#ed"

(57I Chec> sample for air bubbles and epel immediately if any air is present" .e#er pull plunger of syringe down as this can cause aspiration of ambient air that may




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affect result of analysis"(57A <nsert the needle into needle stopper ma>ing sure that the needle does not

protrude through the rubber"

(57L Remo#e needle and apply luer tip cap on syringe" *gitate syringe to mi sample"

(578 5ully immerse entire syringe with the capped end downwards in slush ice water or >eep between ice pac>s if no ice slush is a#ailable"

(57B Chec> puncture site" <f no e#idence of bleeding is present apply adhesi#ebandage"

B5(5:F lace sample in bioha4ard bag and send sample to laboratory"

General Nursing Departmental Manual

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