Ukuphathwa Kokunakekelwa Kwababelethisi Ezimweni Zomkhuhlane We-Dengue
I-Pendahuluan
Umkhuhlane Wokopha Kwegazi weDengue (DHF) ukutheleleka ngegciwane le-dengue okudluliselwa ngokulunywa omiyane be-Aedes aegypti kanye ne-Aedes albopictus. Ezindaweni eziningi ezishisayo, i-DHF isalokhu iyinkinga yezempilo yomphakathi evame ukubangela izehlakalo ezingavamile, kufaka phakathi amaqembu asengozini njengabesifazane abakhulelwe, omama abakhulelwe, kanye nezinsana ezisanda kuzalwa. Ngokwezinsizakalo zokubeletha, i-DHF idinga ukunakwa okukhethekile ngoba ingathinta isimo somama kanye nosana, futhi ingabangela izinkinga ezinkulu njengokopha, ukushaqeka, ukuphelelwa amanzi emzimbeni, kanye nokuphazamiseka ngesikhathi sokubeletha.
Ukuphathwa kokunakekelwa kwababelethisi bomkhuhlane we-dengue kudinga ababelethisi ukuba babe nekhono ekutholeni kusenesikhathi, ukuqapha eduze, imfundo, ukubambisana nabanye abasebenzi bezokwelapha, kanye nokudluliselwa ngokushesha nangokufanele. Lesi sihloko sixoxa ngezimiso nezinyathelo zokuphathwa kokunakekelwa kwababelethisi bomkhuhlane we-dengue, ikakhulukazi kwabesifazane abakhulelwe, kuyilapho kusacatshangelwa ukuphepha kukamama nomntwana osanda kuzalwa.
Ukubuka Konke Ngomkhuhlane We-Dengue
Umkhuhlane we-dengue ubonakala ngomkhuhlane omkhulu ngokuzumayo (izinsuku ezingu-2-7) ohambisana nezinye izimpawu ezifana nekhanda elibuhlungu, ubuhlungu bemisipha namalunga, isicanucanu, ukuhlanza, ukuqubuka, kanye nokubonakaliswa kokuphuma kwegazi (isb., ukuphuma kwegazi ekhaleni, ukuphuma kwegazi ezinsinini, i-petechiae). Esigabeni esibucayi (ngokuvamile izinsuku ezingu-3-5), ukuvuza kwe-plasma kungenzeka, okuholela ekugcwaleni kwegazi, ukwehla komfutho wegazi, kanye nokushaqeka (i-Dengue Shock Syndrome). Ukuhlolwa okuvamile kwelabhorethri kufaka phakathi i-thrombocytopenia, ukwanda kwe-hematocrit, kanye nemiphumela ye-serology/dengue antigen (NS1) esekela ukuxilongwa.
Kwabesifazane abakhulelwe, umkhuhlane we-dengue ungandisa ingozi yokukhipha isisu, ukubeletha ngaphambi kwesikhathi, ukopha ngaphambi kokubeletha kanye nokuphuma kwegazi ngemva kokubeletha, kanye nokucindezeleka kombungu ngenxa yokuphazamiseka kokuphuma kwegazi e-placenta. Ngakho-ke, ukunakekelwa kwababelethisi kumele kube okuphelele futhi okuqhubekayo.
Izinhloso Zokuphathwa Kokunakekelwa Kwababelethisi
Ukuphathwa kokunakekelwa kwababelethisi ezimweni ze-DHF kuhlose:
1. Thola izimpawu zokuqala zomkhuhlane we-dengue kwabesifazane abakhulelwe.
2. Vimbela izinkinga ezinkulu, ikakhulukazi ukushaqeka kanye nokopha.
3. Gcina ibhalansi yoketshezi kanye nesimo sikamama se-hemodynamic.
4. Qapha impilo yombungu njalo.
5. Nikeza imfundo nokusekelwa kwengqondo komama nemindeni.
6. Yenza ukubambisana kanye nokudluliselana njengoba kubonisiwe.
Ukuhlolwa Kokubelethisa
Ukuhlolwa kokuqala kuyisinyathelo esibalulekile kumbelethisi ukuze anqume ubucayi kanye nezidingo zokwelashwa. Izici okufanele zihlolwe zifaka:
1. Umlando
– Izikhalazo eziyinhloko: umkhuhlane ophakeme, umkhuhlane ohlala isikhathi eside, ubuhlungu, isicanucanu nokuhlanza, ubuthakathaka.
– Umlando wokopha: ukopha ekhaleni, ukuhlanza igazi, indle emnyama, izinsini eziphuma igazi, amabala esikhumbeni.
– Umlando wokuchayeka: indawo enabantu abanomkhuhlane we-dengue, omiyane abaningi, amanzi amile.
– Umlando wokukhulelwa: iminyaka yokukhulelwa, ukunyakaza kwengane esanda kuzalwa, umlando wezinkinga zokukhulelwa zangaphambilini.
– Umlando wezokwelapha: i-anemia, izinkinga zokujiya kwegazi, izifo ezingamahlalakhona.
2. Ukuhlolwa Komzimba
– Izimpawu ezibalulekile: izinga lokushisa, umfutho wegazi, ukushaya kwenhliziyo, ukuphefumula. Qaphela ukushaya kwenhliziyo okusheshayo kanye nokwehla komfutho wegazi.
– Izimpawu zokuphelelwa ngamanzi emzimbeni: ukukhukhumala kwesikhumba, i-mucosa eyomile.
– Izimpawu zokopha: i-petechiae, i-ecchymosis, ukopha kwe-mucosal.
– Ubuhlungu besisu, ukuvuvukala kwesibindi, noma ukungakhululeki esifundeni se-epigastric (izimpawu zengozi).
– Ukuhlolwa kokubeletha: ukuphakama kwe-fundus yesibeletho, izinga lokushaya kwenhliziyo kwengane (FHR), ukufinyela, isimo somlomo wesibeletho uma kunezimpawu zokubeletha.
3. Ukuhlolwa Okusekelayo (Okubambisanayo)
Ababelethisi badlala indima ekukhuthazeni nasekulandeleleni ukusekela izivivinyo ngokwegunya labo kanye nohlelo lwabo lwenkonzo:
- I-Hematology: ama-platelet, i-hematocrit, i-hemoglobin, ama-leukocyte.
– Udenga lwe-NS1/IgM/IgG ngokwesigaba sesifo.
– Ukusebenza kwesibindi uma kusolwa ukuthi kukhona ukubandakanyeka kwezitho zomzimba.
– Ukuqapha umbungu: USG, NST/CTG uma kutholakala futhi kubonisiwe.
Ukuhlonza Izinkinga Zokubeletha Nokuxilongwa
Ababelethisi bakha ukuxilongwa nezinkinga zokubeletha ngokusekelwe kudatha. Isibonelo:
– Abesifazane abakhulelwe enyangeni yesibili/yesithathu yokukhulelwa okusolwa ukuthi banomkhuhlane we-dengue ohambisana nomkhuhlane ophezulu kanye ne-thrombocytopenia.
– Ingozi yokopha ehlobene nokwehla kwama-platelet egazini.
– Ingozi yokushaqeka kwe-hypovolemic ngenxa yokuvuza/ukuphelelwa amanzi emzimbeni nge-plasma.
– Ingozi yokukhubazeka kwenhlalakahle yombungu ngenxa yokuncipha kokugeleza kwegazi esikhumbeni.
– Ukukhathazeka komama nomndeni mayelana nezimo zesifo kanye nokukhulelwa.
Ukuhlela Nokungenelela Kokunakekelwa Kwababelethisi
Ukuphathwa komkhuhlane we-dengue kuyasekela futhi kudinga ukubhekwa ngokucophelela. Emsebenzini wokubeletha, ukungenelela kuhlanganisa:
1. Ukuqapha ngokucophelela isimo sikamama
– Bheka izimpawu ezibalulekile njalo (kaningi ngezikhathi ezibucayi).
– Qaphela izimpawu zengozi ze-DHF: ubuhlungu obukhulu besisu, ukuhlanza okuqhubekayo, ukopha, ubuthakathaka obukhulu, ukungahlaliseki, ukwehla kokuqwasha, ukwehla kokukhishwa komchamo, ukubanda kwemilenze, ukuphelelwa umoya.
– Lawula uketshezi olungena emzimbeni kanye nokukhishwa kwalo kanye nemvamisa yokuchama. Ukwehla kokukhishwa komchamo kungabonisa ukushaqeka noma ukuphelelwa amanzi emzimbeni.
2. Ukuphathwa Koketshezi Nokuphumula
Ababelethisi bafundisa isiguli ngokubaluleka kokuphumula okwanele nokuphuza uketshezi. Ezimweni ezincane ngaphandle kwezimpawu eziyisixwayiso, kungase kunconywe uketshezi oluphuzwayo (amanzi, isisombululo sokubuyisela amanzi emzimbeni, isobho). Kodwa-ke, uma kukhona ukuhlanza okuphindaphindiwe, izimpawu zokuphelelwa amanzi emzimbeni okukhulu, noma isimo siba sibi kakhulu, ukubambisana kokwelashwa ngoketshezi olufakwa emthanjeni kanye nokulaliswa esibhedlela kuyadingeka.
3. Ukuvimbela Nokuphathwa Kokopha
– Imfundo yokugwema izidakamizwa ezandisa ingozi yokopha njenge-aspirin ne-ibuprofen.
– Bambisana nodokotela uma ama-platelet ephansi kakhulu noma kukhona ukopha okusebenzayo.
– Ukuqapha ukopha kwesitho sangasese sowesifazane kwabesifazane abakhulelwe, ikakhulukazi ngaphambi kokubeletha.
4. Ukuqapha Inhlalakahle Yomntwana Osesiswini
Umkhuhlane we-dengue ungathinta ukugeleza kwegazi esikhumbeni. Izenzo zombelethisi:
– Qapha ukunyakaza kombungu okubikwe ngumama.
– Hlola uDJJ njalo.
– Ukusebenzisana nokuhlolwa kwe-USG/NST uma ukunyakaza kombungu kunciphile noma kunezimpawu zokucindezeleka kombungu.
– Lungiselela ukudluliselwa ngokushesha uma kutholakala izimpawu zokucindezeleka kombungu.
5. Ukunakekelwa Kokubeletha Komama Abanomkhuhlane We-Dengue
Uma umama eba ne-DHF eduze nesikhathi sokubeletha, abaphathi kumele baqaphele kakhulu:
– Ukulungiselela ukubeletha endaweni ekwaziyo ukwenza ukumpontshelwa igazi/umkhiqizo wegazi uma kudingeka.
– Ukulindela ukopha ngemva kokubeletha (i-uterine atony, i-coagulopathy).
– Ukubambisana ekunqumeni indlela yokubeletha: akuzona zonke izimo ezidinga ukuhlinzwa, kodwa isinqumo sincike esimweni sikamama, umbungu, kanye namazinga e-platelet kanye nezimpawu zokopha.
– Ukuphathwa okusebenzayo kwesigaba sesithathu ukuvimbela ukopha ngemva kokubeletha ngokweziqondiso.
6. Imfundo Yezempilo Nokuvimbela
Ababelethisi badlala indima enkulu ekukhuthazeni impilo:
– Ukuvimbela ukulunywa omiyane: amanethi omiyane, izingubo ezinde, izinto ezixosha omiyane eziphephile ngesikhathi sokukhulelwa njengoba kunconywa, ukusetshenziswa kwenethi yomiyane.
– Ukususwa kwezidleke zomiyane (PSN) 3M plus: ukukhipha amanzi, ukumboza, ukuphinda usebenzise/ukulahla izimpahla ezisetshenzisiwe, kanye nokunye ukuvimbela.
– Imfundo yokuthi kufanele uye nini ngokushesha esikhungweni sezempilo, ikakhulukazi uma umkhuhlane ungosuku lwesithathu kuya kolwesihlanu.
– Ukwelulekwa ngokudla okunempilo: ukudla okunempilo okulinganiselayo ukuze kusekelwe ukululama.
Ukuqaliswa, Ukuhlola, kanye Nokubhala Imibhalo
Ngesikhathi sokuqaliswa, umbelethisi usebenzisa uhlelo olumisiwe futhi enze ukuhlolwa njalo. Imingcele yempumelelo ifaka: ukwehla kwezinga lokushisa, izimpawu zokuphila ezizinzile, ukungabi nazimpawu zokushaqeka, ukuphuza uketshezi okwanele, ukungabi nokopha, ukubalwa kwama-platelet kanye ne-hematocrit okuthuthukisiwe, kanye nenhlalakahle yombungu eqashwe kahle. Uma isimo siba sibi kakhulu noma kuvela izimpawu zengozi, umbelethisi kumele aqale ngokushesha ukudluliselwa futhi axhumane kahle nesikhungo sokudluliselwa.
Imibhalo kumele ibe ephelele futhi ehlelekile: idatha yomuntu siqu, engeyona eyenhloso, ehlaziyayo, kanye neyokuhlela (i-SOAP), okuhlanganisa namarekhodi okuqapha ama-platelet/hematocrit, okufakwayo-okukhiphayo, i-DJJ, kanye nemfundo enikeziwe.
Ukubambisana kanye Nokudluliselwa
Umkhuhlane we-dengue kwabesifazane abakhulelwe uvame ukudinga ukwelashwa okuxubile. Ababelethisi kudingeka babambisane nodokotela abajwayelekile, odokotela bezokubelethisa, kanye nodokotela bezifo zamazinyo uma kudingeka. Izinkomba zokudluliselwa ngokushesha zifaka: izimpawu zokushaqeka, ukopha okukhulu, ama-platelet aphansi kakhulu, ukuncipha kokuqaphela, ukuphelelwa umoya, ukuncipha kokunyakaza kombungu, noma ukuba khona kwezinkinga zokubeletha ezifana ne-preeclampsia kanye nokopha kwegazi ngaphambi kokubeletha.
Isiphetho
Ukuphathwa kokunakekelwa kwababelethisi bomkhuhlane we-dengue kudinga ukuhlolwa okucophelelayo, ukuqapha eduze ngesikhathi esibucayi, ukuvimbela izinkinga zokopha kanye nokushaqeka, kanye nokunaka okukhethekile inhlalakahle yombungu. Ababelethisi badlala indima ebalulekile ekutholakaleni kusenesikhathi, emfundweni, ekusekelweni kwengqondo, kanye nokuxhumana kokudluliselwa. Ngokunakekelwa kwababelethisi okusheshayo, okufanele, nokubambisana, ingozi yezinkinga ze-dengue kwabesifazane abakhulelwe ingancishiswa, ngaleyo ndlela kuqinisekiswe ukuphepha komama nomntwana.
Uma ufisa, ngingahlanganisa lesi sihloko ngendlela yezemfundo (ngezingxenye ze-“Pathway”, “SOAP”, noma ngisebenzise izinkomba zejenali kanye neziqondiso zoMnyango Wezempilo/WHO) ngokwezidingo zesabelo.
