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3ULVYRMHPGHOXPRUDPRXSRãWHYDWLQDþLQVSRSULMHPDQMDEROQLNDLQGUXåLQH]EROH]QLMRWHUSR]QDWLGHMDYQL- NHNLYSOLYDMRQDVRGHORYDQMHSUL]GUDYOMHQMX9SULVSHYNXVHWDNRGRWDNQHPRWXGLSRVHEQRVWLGRåLYOMDQMD EROH]QLYPODGRVWQLãNHPREGREMX
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ABSTRACT
7KLVUHYLHZDUWLFOHGLVFXVVHVLPSRUWDQWDUHDVWREHFRQVLGHUHGE\PHGLFDOVWDIILQSUHSDULQJWKHDGROHVFHQW ZLWKPXOWLSOHVFOHURVLV06WROLYHDWKRPH7KHQXUVHSOD\VDQLPSRUWDQWUROHLQWKHWHDPDQGLVPRVW IUHTXHQWO\LQFRQWDFWZLWKWKHSDWLHQWDQGKLVUHODWLYHV6KHFRXQVHOVWKHSDWLHQWRQWUHDWPHQWGHFLVLRQV WHDFKHVKLPWKHFRUUHFWLQMHFWLRQWHFKQLTXHDQGHQFRXUDJHVWKHDGROHVFHQWDQGKLVIDPLO\LQOLYLQJZLWK06 7RXQGHUVWDQGDQGWRPRWLYDWHWKHDGROHVFHQWLQFRSLQJZLWKWKHGLVHDVHZHQHHGWRNQRZWKHSRVVLEOH
FRQVHTXHQFHVRIWKHGLVHDVHDQGWUHDWPHQWLQERWKWKHSK\VLFDODQGSV\FKRVRFLDODUHDV6\PSWRPVRIPXO- WLSOHVFOHURVLVLQWKHSHUFHSWXDOPRWRURUFRJQLWLYHDUHDVDQGWDNLQJLPPXQRPRGXODWRU\WKHUDS\DIIHFWWKH DGROHVFHQW¶VLQYROYHPHQWLQGDLO\DFWLYLWLHV
:HPXVWFRQVLGHUWKHFKDUDFWHULVWLFVRIWKHSDWLHQWDQGKLVIDPLO\FRSLQJZLWKWKHGLVHDVHDQGXQGHUVWDQG WKHIDFWRUVRIWUHDWPHQWFRPSOLDQFH7KHSDSHUDOVRRXWOLQHVWKHVSHFL¿FVRIH[SHULHQFLQJLOOQHVVLQDGROHV- FHQFH
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0XOWLSODVNOHUR]D06MHNURQLþQDLQQDSUHGXMRþD DYWRLPXQVND PRWQMD FHQWUDOQHJD åLYþQHJD VLVWHPD NL]DKWHYDNRPSOHNVQRPXOWLGLVFLSOLQDUQRWLP- VNRREUDYQDYR
9SULVSHYNXSUHGVWDYOMDPRQDMSRPHPEQHMãDSRGUR- þMD NL MLK PRUD XSRãWHYDWL ]GUDYVWYHQR RVHEMH SUL SULSUDYLPODGRVWQLND]PXOWLSORVNOHUR]RQDåLYOMH- QMHGRPD
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DOMA
0HGLFLQVNDVHVWUDMHSRPHPEHQþODQ]GUDYVWYHQHJD WLPD NL EROQLND VSUHPOMD åH Y REGREMX GLDJQRVWL- FLUDQMDEROH]QLLQ]GUDYOMHQMDYEROQLãQLFL%ROQLND QHQHKQRVSRGEXMDLQPXSRPDJDGDELþLPEROMH UD]XPHOVYRMREROH]HQ=QMLPY]SRVWDYLSDUWQHUVNL odnos ter s tehniko motivacijskega pogovora prido- ELYD QMHJRYR ]DXSDQMH %ROQLND WXGL SULSUDYOMD QD åLYOMHQMHYGRPDþHPRNROMXLQSRPHPEQRVRGHOXMH WXGLNDVQHMHNRVNUEL]DWYRUQRVRGHORYDQMXLQ]D- Y]HWRVWSUL]GUDYOMHQMX
.OMXþQHQDORJHPHGLFLQVNHVHVWUHVR
VYHWRYDQMHJOHGHRGORþLWYHR]GUDYOMHQMX
]DJRWDYOMDQMH L]REUDåHYDQMD RE XYHGEL ]GUD- YOMHQMD
VSUHPOMDQMHLQREYODGRYDQMHPRUHELWQLKQHåH- OHQLKXþLQNRY
RFHQMHYDQMHUH]XOWDWRY]GUDYOMHQMD
spodbujanje bolnika k zavzetosti pri zdravlje- QMX
REYODGRYDQMH EROQLNRYLK SULþDNRYDQM JOHGH zdravljenja ter zagotavljanje potrditve in pod- SRUH
Medtem ko otroke le redko zdravimo z imuno- PRGXODWRUQLPL]GUDYLOLSDMLKSULPODGLKEROQLNLK XSRUDEOMDPR SRJRVWR ,]VOHGNL ãWHYLOQLK UD]LVNDY QDPUHþNDåHMRGDMHQDMEROMXþLQNRYLWRSUDY]JR- GQMH ]GUDYOMHQMH = GROJRWUDMQLP ]GUDYOMHQMHP QDPUHþ ]PDQMãDPR SRJRVWRVW NOLQLþQLK SRQRYLWHY EROH]QL LQ XSRþDVQLPR QDSUHGRYDQMH LQYDOLGQRVWL 0ODGRVWQLNH]GUDYLPR]LQWHUIHURQRPEHWDDLQ- WUDPXVNXODUQRLQVXENXWDQRLQWHUIHURQRPEHWDE VXENXWDQRLQJODWLUDPHUDFHWDWRPVXENXWDQR 3R RGORþLWYL R YUVWL ]GUDYOMHQMD VH PHGLFLQVND VH- stra z bolnikom in njegovimi starši dogovori za NUDWNRWUDMQR ]GUDYOMHQMH Y EROQLãQLFL NL YNOMXþXMH L]REUDåHYDQMHR]GUDYOMHQMXLQVSUHPOMDQMHGDMDQMD ]GUDYLO,]REUDåHYDQMDVHPRUDXGHOHåLWLWXGLHGHQ RGVWDUãHYQDYDGQRPODGRVWQLNRYDPDPD%ROQLNX
LQVWDUãHPåHSUHMSRVUHGXMHLQIRUPDWLYQRJUDGLYRR 06]GUDYOMHQMXLQREYODGRYDQMXQHåHOHQLKXþLQNRY ]GUDYLO
,]REUDåHYDOQHYVHELQHNLMLKREUDYQDYDPRVR VWDQGDUGQHRVQRYQHLQIRUPDFLMHR06 VWDQGDUGQHRVQRYQHLQIRUPDFLMHR]GUDYLOX QHåHOHQLXþLQNL]GUDYOMHQMD
strah pred rednim samostojnim vbrizgava- QMHP]GUDYLOD
QHJDNRåH
predstavitev avtoinjektorja in rokovanje z QMLP
SRPHQ]DY]HWRVWL]D]GUDYOMHQMHXSRãWHYD- QMHQDYRGLOLQVRGHORYDQMH
delavnica uporabe avtoinjektorja in samo- VWRMQHJDGDMDQMD]GUDYLOD
proste teme: razgovor mladostnika in star- ãHY]RVHEMHP
samostojno vbrizgavanje zdravila pod men- WRUVWYRPPHGLFLQVNHVHVWUH
SRQRYQRL]REUDåHYDQMHSRSRWUHEL
6WDQGDUGQH RVQRYQH LQIRUPDFLMH R PXOWLSOL VNOHUR]L
0XOWLSOD VNOHUR]D MH NURQLþQD EROH]HQ NL þORYHND VSUHPOMDYVHåLYOMHQMH=RVQRYQLPLSRGDWNLRER- OH]QLVHPODGRVWQLNVLFHUVH]QDQLåHREUD]JRYRUX ]]GUDYQLNRPYHQGDUSDSRGDWNHSRJRVWRLãþHWXGL QD VYHWRYQHP VSOHWX 7L VR ODKNR Y YHOLNR RSRUR LQSRPRþODKNRSDJD]PHGHMRåHSUHGSULþHWNRP ]GUDYOMHQMD 0HGLFLQVND VHVWUD PX Y UD]XPOMLYHP MH]LNXLQQDSULPHUHQQDþLQREXSRUDELLQIRUPDWLY- nega gradiva pojasni pomen vseh pridobljenih in- IRUPDFLM
6WDQGDUGQHRVQRYQHLQIRUPDFLMHR]GUDYLOX
Bolnik se seznani z naslednjimi vsebinami:
YUVWR]GUDYLODNLPXJDMHSUHGSLVDO]GUDYQLN
VKUDQMHYDQMHP]GUDYLOD
SRWRYDQMHP]]GUDYLORP
QDþLQRPXSRUDEH]GUDYLOD
þDVRPYEUL]JDYDQMD]GUDYLOD
SRVWRSQLP SRYHþHYDQMHP RGPHUND ]GUDYLOD SRSRWUHEL
QHåHOHQLPLXþLQNL]GUDYLOD
,PXQRPRGXODWRUQD]GUDYLOD±JOHGHQDYUVWRSUHGSL- VDQHJD]GUDYLOD±YEUL]JDYDPRSRGNRåRYVDNGDQ QDGYDGQLQDGYDGQLVSUHPRURPPHGYLNHQGLDOL YPLãLFRYVDNWHGHQ
1HåHOHQLXþLQNL]GUDYOMHQMD
1HåHOHQLXþLQNL]GUDYOMHQMDVHUD]OLNXMHMRJOHGHQD YUVWR LPXQRPRGXODWRUQHJD ]GUDYLOD 1DYDGQR JUH]DJULSLSRGREQHVLPSWRPHQSUJODYREROSR- YLãDQDWHOHVQDWHPSHUDWXUDPU]OLFDEROHþLQHYPL- ãLFDKLQVNOHSLKXWUXMHQRVWLQVODERVW
=D XEODåLWHY QHåHOHQLK XþLQNRY ]GUDYLO SULSRURþD- PR GD EROQLN PLQXW SUHG YEUL]JDQMHP ]GUDYL- OD]DXåLMHDQDOJHWLNGDVL]GUDYLORYEUL]JDWLNSUHG VSDQMHP QHåHOHQH XþLQNH SUHVSL LQ GD RGPHUHN SRVWRSQRSRYHþXMHWMWLWULUDGRSROQHJDRGPHUND Bolniki prejmejo pisna navodila uvajanja z datumi LQSULSDGDMRþLPLRGPHUNL
9]JRGQMLID]L]GUDYOMHQMDNRVRQHåHOHQLXþLQNLQD- YDGQRQDMEROML]UD]LWLVWDL]MHPQRSRPHPEQLSRG- SRUDLQSRPRþPHGLFLQVNHVHVWUH0HGLFLQVNDVHVWUD bolnika spodbuja k sodelovanju pri zdravljenju in PXVYHWXMHJOHGHPRUHELWQLKWHåDYUHDNFLMHQDYER- GQHPPHVWXWHåDYHSULYEUL]JDYDQMX]GUDYLODVWUDK SUHG YEUL]JDYDQMHP QHVWYDUQD SULþDNRYDQMD JOHGH XþLQNRYLWRVWL ]GUDYLO QHXJRGQL YSOLYL ]GUDYOMHQMD QDNDNRYRVWåLYOMHQMD
6WUDKSUHGUHGQLPVDPRLQMLFLUDQMHP
0ODGRVWQLNLLPDMRUD]OLþQRUD]YLWHURþQHVSUHWQRVWL NLYSOLYDMRQDXVSHãQRVWSULYEUL]JDYDQMX]GUDYLOD âWHYLOQL EROQLNL VR QD ]DþHWNX ]GUDYOMHQMD ]DVNU- EOMHQLVDMMLKMHVWUDKLQMHNFLMVNLKLJHOLQ]EDGDQMD
Medicinska sestra jim pri premagovanju strahu in ]DVNUEOMHQRVWLSRPDJDWDNRGDMLKSRXþLRYDUQRVWL YEUL]JDYDQMDRVSURVWLWYHQLKWHKQLNDKLQRQDþLQLK ]PDQMãHYDQMDQHåHOHQLKXþLQNRY
1HJDNRåH
Pri nekaterih bolnikih se na vbodnem mestu pojavi EROHþLQD DOL UHDNFLMD9ERGQR PHVWR VH ODKNR WXGL RNXåL2EVHJUHVQRVWLQWUDMDQMHUHDNFLMHVHRGSR- VDPH]QLNDGRSRVDPH]QLNDUD]OLNXMHMR
Morebitne reakcije na vbodnem mestu so:
SRUGHORVWLQRWHNOLQD
VUEHQMH
]DWUGOLQH
QHXJRGMHSHNRþDDOLåJRþDEROHþLQD
SRãNRGED
KLSHUWUR¿MDRWUGHORVWDOLRGHEHOLWHYNRåH
OLSRDWUR¿MDL]JXEDPDãþREQHJDWNLYDQDYER- GQHPPHVWX
3RPHPEQL GHMDYQLNL NL ]PDQMãXMHMR SRMDYQRVW reakcij na vbodnem mestu so: dobra tehnika vbri- ]JDYDQMD XVWUH]QD JORELQD YEUL]JDQMD GDMDQMH QD VREQRWHPSHUDWXURRJUHWHJD]GUDYLODUHGQRXPLYD- QMHURN]PLORPLQVWRSORYRGRSUHGYEUL]JDQMHP UHGQRPHQMDYDQMHYERGQLKPHVWYRGHQMHGQHYQLND ter prepoznavanje in takojšnje ukrepanje ob pojavu UHDNFLMQDYERGQHPPHVWX
3UHGVWDYLWHY DYWRLQMHNWRUMD URNRYDQMH ] DYWRLQMHNWRUMHPXþQDGHODYQLFD
0ODGRVWQLND SRXþLPR R XSRUDEL QHJL LQ VKUDQMH- YDQMX DYWRLQMHNWRUMD 6 SRVWRSNRP YEUL]JDYDQMD EROQLND VH]QDQLPR QD GHODYQLFL NL MH QDPHQMHQD SULGRELYDQMXWHRUHWLþQLKLQSUDNWLþQLK]QDQMY]YH]L s samostojnim dajanjem zdravila ter opogumljanju EROQLNRY ]D VDPRVWRMQR L]YDMDQMH SRVWRSND 3UYR vbrizganje opravi bolnik pod nadzorom izkušene PHGLFLQVNHVHVWUH
0ODGRVWQLN ] PXOWLSOR VNOHUR]R VH VRRþD V ãWH- YLOQLPL VWUDKRYL LQ QHRGJRYRUMHQLPL YSUDãDQML = XþLQNRYLWLP L]REUDåHYDQMHP SRPHPEQR RODMãDPR ]DþHWHN ]GUDYOMHQMD Y]SRVWDYLPR ]DXSHQ RGQRV ] ]GUDYVWYHQLPL GHODYFL WHU ]DJRWRYLPR VSURãþHQR VSRUD]XPHYDQMHRESULKRGQMLKVWLNLK7DNRERERO- QLNODåMHVSUHJRYRULORVYRMLKWHåDYDKVWUDKRYLKLQ PRUHELWQLK QHåHOHQLK XþLQNLK ]GUDYOMHQMD 'REUR VRGHORYDQMHMHQHQD]DGQMHRGORþLOQR]DþLPEROMãL L]LG]GUDYOMHQMD
36,+262&,$/1(=1$ý,/1267,0/$- '2671,.$=08/7,3/26./(52=2
'DELUD]XPHOLNDNRSRWHNDPODGRVWQLNRYRåLYOMH- QMH]06PRUDPRSR]QDWLPRUHELWQHSRVOHGLFHER- lezni tako na telesni ravni kot tudi na psihosocial- QHPSRGURþMX9QDVSURWMX]RGUDVOLPLEROQLNLPODGRVWQLNL]06 VSUYD QDYDGQR GRåLYOMDMR SRJRVWHMãH ]DJRQH EROH- ]QL YHQGDU WHOHVQR SR QMLK KLWUHMH RNUHYDMR 7XGL VODEãDQMHIXQNFLRQDOQHJDVWDQMDMHSULRWURFLKSRþD- VQHMãHNRWSULRGUDVOLK.OMXEWHPXSDVHSULRVHEDK NL VR ]EROHOH Y PODGRVWL WHOHVQH RYLUDQRVWL LQ QH- ]PRåQRVWLSRMDYLMRY]JRGQHMãLKOHWLK
0DF$OOLVWHULQVRGVRYUD]LVNDYRYNOMXþLOLERO- QLNRY]06]]DþHWNRPYRWURãWYXDOLDGROHVFHQFL LQXJRWDYOMDOL]]GUDYMHPSRYH]DQRNDNRYRVWåLYOMH- QMD3RORYLFDEROQLNRYMHSRURþDODRYVDMUDKOLXWUX- GOMLYRVWLWHUSRJRVWHMãLKWHåDYDKQDNRJQLWLYQHPLQ ãROVNHP SRGURþMX WHU PDQMãLK WHOHVQL ]PRJOMLYRVWL LQXGHMVWYRYDQMX%ROQLNLVRWXGLSRJRVWHMHL]RVWD- jali iz šole in so bili telesno bistveno manj dejavni NRWQMLKRYLYUVWQLNL$PDWRLQVRGSRURþDMRGDVH]
XWUXMHQRVWMRVUHþXMHNDURWURN]068WUX- GOMLYRVWMHRVQRYQLY]URNGDRWURFLSRRSUDYOMHQLK ãROVNLKREYH]QRVWLQLPDMRGRYROMHQHUJLMH]DGUXåH- QMH]YUVWQLNLLQSURVWRþDVQHGHMDYQRVWL
.RJQLWLYQHWHåDYHNLODKNRVSUHPOMDMREROH]HQVR še posebej pomembne zaradi uspešnosti na šolskem
SRGURþMX3ULPODGRVWQLNLK]06VRQDMSRJRVWHMãH WHåDYH V SR]RUQRVWMR XþLQNRYLWLP REGHORYDQMHP LQIRUPDFLMSRPQMHQMHPSRLPHQRYDQMHPLQL]YUãLO- QLPLVSRVREQRVWPL
,]VOHGNL UD]LVNDY NL VR MLK RSUDYLOL 0DF$OOLVWHU V VRGHODYFLWHU$PDWDVVRGHODYFLNDåHMRGDLPDSUL- EOLåQRSRORYLFDPODGRVWQLNRY]06EODåMHWHåDYHQD GRORþHQHPSRGURþMXNRJQLWLYQHJDGHORYDQMDPHG- WHPNRMLKSULEOLåQRHQDWUHWMLQDNDåHSRPHPEQHMãH WHåDYHR]LURPDRãNRGRYDQRVWQDYHþSRGURþMLK=D- QLPLYRMHGDVRNRJQLWLYQHWHåDYHRGNULOLWXGLSUL bolnikih z relativno majhno telesno oškodovanostjo
=D SVLKRVRFLDOQL UD]YRM Y REGREMX PODGRVWQLãWYD VR SRPHPEQL SRWUHED SR QHRGYLVQRVWL UD]YLMDQMH LQWLPQLK RGQRVRY LQ LVNDQMH LGHQWLWHWH YNOMXþQR V SRNOLFQLPL FLOML 2GYLVQRVW RG GROJRWUDMQHJD ]GUD- vljenjamorebitne telesne omejitve in nepredvidlji- vost bolezni razlike med bolnimi posamezniki in QMLKRYLPLYUVWQLNLSRPHPEQRSRJODEOMDMR
9UD]OLþQLKUD]LVNDYDKSRURþDMRRSULVRWQRVWLVLPS- tomov depresivnosti ali anksioznosti pri mladostni- NLK]066LPSWRPLVRODKNRSRVOHGLFDSRWHNDER- OH]QLDOLPODGRVWQLNRYGXãHYQLRG]LYQDGLDJQR]R
$PDWRLQVRGHODYFLSRURþDMRGDNDUVWDUãHY SULPODGRVWQLNXXJRWDYOMDQHåHOHQHYHGHQMVNHVSUH- PHPEHYNOMXþQR]DQNVLR]QRVWMRDJUHVLYQRVWMRLQ VRFLDOQRRVDPLWYLMR8SRãWHYDWLPRUDPRGDVWDUãL SRJRVWHMH]D]QDYDMRSULVRWQRVWRPHQMHQLKWHåDYNRW VDPLPODGRVWQLNL,]VOHGNLUD]LVNDYNDåHMRWXGLGD lahko MS zapusti neugodne psihološke posledice ]ODVWLWHGDMNRQL]DJRWRYOMHQRGHORYDQMHXVWUH]QLK SRGSRUQLKVLVWHPRYGUXåLQDãRODGRVWRSQRVW]GUD- YVWYHQHSRGSRUHSULEROH]QL
6SRSULMHPDQMHEROQLNDLQQMHJRYHGUXåLQH ]EROH]QLMR
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