Amasu Okunakekela Ababelethisi Ezimweni Ze-Typhus
I-Pendahuluan
I-Typhus (umkhuhlane we-typhoid) yisifo esithathelwanayo esibangelwa yi-Salmonella typhi futhi ngokuvamile sidluliselwa ngokudla noma iziphuzo ezingcolile. I-Typhus idinga ukunakwa okukhethekile kwabesifazane abakhulelwe, abesifazane abakhulelwe, kanye nomama abancelisayo ngoba ingadala isimo sikamama sibe sibi kakhulu, iphazamise isimo sokudla, yandise ingozi yokuphelelwa amanzi emzimbeni kanye nokuntuleka kwegazi emzimbeni, futhi ithinte ngisho nenhlalakahle yomntwana osanda kuzalwa. Ngokomongo wokunakekelwa kokubelethisa, ababelethisi badlala indima ebalulekile ekutholakaleni kusenesikhathi, ekuhlolweni okuphelele, ekubambisaneni nabasebenzi bezokwelapha, emfundweni, kanye nokuqapha okuqhubekayo. Lesi sihloko sixoxa ngamasu okunakekelwa kwababelethisi ezimweni ze-typhoid, sigcizelela indlela ephephile, egxile esigulini, futhi egxile emndenini.
Imiqondo Eyisisekelo Ye-Typhus Ezinkonzweni Zokubeletha
Umkhuhlane we-typhoid uvame ukubonakala ngomkhuhlane ohlala izinsuku ezingaphezu kwezingu-7, ubuthakathaka, ikhanda elibuhlungu, izinhlungu zemisipha, izinkinga zokugaya ukudla (isicanucanu, ukuhlanza, ukuqunjelwa, noma uhudo), ukuncipha kwesifiso sokudla, futhi ngezinye izikhathi ukubonakala kwamabala abomvu (amabala e-rose). Kwabesifazane abakhulelwe, izimpawu zingaba zimbi kakhulu ngenxa yezinguquko zomzimba zokukhulelwa, okuhlanganisa ukwanda kwezidingo zoketshezi nezakhamzimba kanye nezinguquko ekulweni nokutheleleka. Uma ingelashwa, i-typhoid ingaholela ezinkingeni ezifana nokopha kwamathumbu, ukubhoboka kwamathumbu, i-sepsis, kanye nokuphazamiseka kokuqwashisa. Ngakho-ke, ukunakekelwa kokubeletha kumele kugcizelele ukuqaphela izimpawu zengozi kanye nokudluliselwa ngesikhathi.
Ukuhlolwa Kokubelethisa
Indlela yokuqala yokunakekelwa kwababelethisi ezimweni ze-typhus ukuhlolwa okuphelele nge-anamnesis, ukuhlolwa ngokomzimba, kanye nokuhlolwa okusekelayo ngokuya ngegunya kanye nokubambisana.
1. I-Anamnesis Eqondisiwe
Umbelethisi uzoqoqa umlando wesikhalazo esiyinhloko: ubude bomkhuhlane, iphethini yomkhuhlane (ukwanda kancane kancane noma okuqhubekayo), ukusetshenziswa kwemithi ngaphambilini, kanye nanoma yiziphi izimpawu ezihambisanayo njengesicanucanu, ukuhlanza, ubuhlungu besisu, isifo sohudo/ukuqunjelwa, ukukhwehlela, kanye nobuthakathaka. Umlando wokudla ukudla ngaphandle, imikhuba yokugeza izandla, imithombo yamanzi okuphuza, nokuthi ngabe kukhona yini amalungu omndeni ake aba nezifo ezifanayo nakho kubalulekile.
Kwabesifazane abakhulelwe, ababelethisi kufanele babuze ngeminyaka yokukhulelwa, ukunyakaza kombungu, ukufinyela, ukopha, noma ulwelwesi oluqhekekile. Kwabesifazane abakhulelwe, imibuzo kufanele ibuzwe mayelana ne-lochia, ubuhlungu besisu, izimpawu zokutheleleka kwenxeba, kanye nenqubekela phambili yokuncelisa.
2. Ukuhlolwa Komzimba
Izimpawu ezibalulekile zibalulekile: izinga lokushisa, ukushaya kwenhliziyo, umfutho wegazi, izinga lokuphefumula, kanye nezimpawu zokuphelelwa amanzi emzimbeni (ukukhukhumala kwesikhumba, ulwelwesi lwamafinyila omile, kanye nokukhishwa komchamo). Umbelethisi uphinde ahlole isimo sesiguli esijwayelekile, izinga lokuqwasha, kanye nokuba khona kwe-anemia. Ukuhlolwa kwesisu kungahlola ukuqina, ukuvuleka, noma isibindi noma uqweqwe olukhuphukile, uma lukhona.
Abesifazane abakhulelwe bahlolwa ngokukhulelwa: ukuphakama kwesibeletho, izinga lokushaya kwenhliziyo kwengane (FHR), kanye nokuhlolwa kwempilo yengane ngokuya ngeminyaka yokukhulelwa. Uma kutholakala, ukuqapha i-Doppler noma ukudluliselwa kwe-ultrasound kungacatshangelwa uma kusolwa ukuthi kukhona ukucindezeleka kwengane.
3. Ukuhlolwa Okusekelayo (Okubambisanayo)
Ukuxilongwa kwe-typhus kwenziwa ngabasebenzi bezokwelapha ngokuhlolwa okufana nokuhlolwa kwegazi (ama-leukocyte, ama-platelet), ukuhlolwa kwe-Widal, i-Tubex, noma ukukhiqizwa kwegazi (okunembe kakhulu). Indima yababelethisi ukuqinisekisa ukuthi iziguli ziyafinyelela ezindaweni zokuhlola, ziqaphe imiphumela, futhi zihumushe ulwazi ngokucacile. Ukuhlolwa okwengeziwe, njenge-electrolytes, ukuhlolwa kokusebenza kwesibindi, noma ukuhlolwa komchamo, kungadingeka uma kukhona ukuphelelwa amanzi emzimbeni noma izinkinga.
Ukuxilongwa Kwezinkinga Zokubeletha Nokuhlonza Inkinga
Ekunakekelweni kwababelethisi, ababelethisi bahlonza izinkinga zangempela kanye nezinkinga ezingaba khona, isibonelo:
– I-Hyperthermia ihlotshaniswa nenqubo yokutheleleka.
– Ingozi yokuphelelwa ngamanzi emzimbeni ihlotshaniswa nomkhuhlane ophakeme, ukungatholi uketshezi olwanele, isicanucanu/ukuhlanza/uhudo.
– Izinkinga zokudla okunempilo zincane kunezidingo zomzimba.
– Ingozi yokuphazamiseka kwempilo yombungu (ngesikhathi sokukhulelwa) ngenxa yomkhuhlane ohlala isikhathi eside kanye nesimo sokungondleki kahle.
– Ubuthakathaka/ukwehla kwamandla okwenza imisebenzi yansuku zonke.
– Ukuntuleka kolwazi lomndeni mayelana nokudluliswa kwe-typhoid kanye nokuvimbela.
Ukuhlonza izimpawu zengozi kumele kucace: umkhuhlane oqhubekayo ophakeme kakhulu, ukuhlanza okuqhubekayo, isifo sohudo esibi, ubuhlungu obukhulu besisu, indle emnyama noma enegazi, ukuncipha kokuqaphela, ukuxhuzula, ukuphelelwa umoya, kanti kwabesifazane abakhulelwe, ukwehla kokunyakaza kombungu, ukopha, noma ukufinyela ngaphambi kwesikhathi.
Ukuhlela Ukunakekelwa
Ukuhlela kwenziwa ngokwesimo sesiguli kanye nesimo sokubeletha, okuhlanganisa nezenzo ezizimele, ukubambisana, imfundo, kanye nokudluliselwa uma kudingeka.
1. Isenzo Sokuzimela Sababelethisi
– Ukulawulwa komkhuhlane: ukucindezela okufudumele, izincomo zokuphumula ngokwanele, ukuqapha izinga lokushisa njalo, kanye nemfundo ngokusetshenziswa kwemithi yokubulala umkhuhlane njengoba kunconywe udokotela.
– Ukudla uketshezi: khuthaza ukuphuza kancane njalo, usawoti wokubuyisela amanzi emzimbeni uma kukhona isifo sohudo, qapha umbala kanye nokuvama kokuchama.
– Ukwaneliseka kokudla okunomsoco: ukudla okuthambile okunama-calories amaningi namaprotheni, ukudla okuncane kodwa kaningi, ukugwema ukudla okunongwe/okune-asidi okubangela ukucasuka kwesisu.
– Imfundo yokuhlanzeka: ukugeza izandla ngensipho, ukusebenzisa amanzi ahlanzekile, ukudla okuphekiwe, kanye nokuhlanza izitsha zokudla.
– Ukuvimbela ukutheleleka ekhaya: ungabelani ngezinto zokudla, uhlanze izindlu zangasese, futhi uqinisekise ukuthi amalungu omndeni agcina inhlanzeko.
2. Ukubambisana Kwezokwelapha
Ukwelashwa kwe-typhoid kudinga ama-antibiotic anqunywe udokotela. Ababelethisi baqinisekisa ukunamathela emithini, baqaphe imiphumela emibi (isib. isicanucanu, ukusabela kokungezwani komzimba), futhi bagcizelela ukubaluleka kokuqeda yonke inkambo yama-antibiotic. Uma isiguli sikhulelwe, ukukhetha ama-antibiotic kumele kuphephe ekukhulelweni, okwenza ukubambisana kubaluleke kakhulu. Ngaphezu kwalokho, uma ukuphelelwa amanzi emzimbeni kukhulu, isiguli singadinga ukwelashwa ngoketshezi olufakwa emthanjeni esikhungweni sokudlulisela.
3. Izinkomba
Ukudluliselwa ngokushesha kuyadingeka uma kunezinkinga, izimpawu zengozi, noma uma isimo siqhubeka. Kwabesifazane abakhulelwe, ukudluliselwa kuqala uma kutholwa izinga lokushaya kwenhliziyo lengane engavamile (i-FHR), ukunyakaza kwengane kuncipha, noma kukhona usongo lokubeletha ngaphambi kwesikhathi. Ababelethisi benza ukuzinza kokuqala: ukuqinisekisa ukuthi umoya ucacile, ukuhlola uketshezi, ukuqapha izinga lokushisa, nokulungiselela imibhalo yokudluliselwa.
Ukuqaliswa Kokunakekelwa (Ukuqaliswa)
Ukuqaliswa kuhlanganisa izinyathelo ezihleliwe kusengaphambili. Ababelethisi baqapha izimpawu ezibalulekile okungenani izikhathi ezingu-2-3 ngosuku ezimweni eziphakathi kuya kwezinzima noma ngokwenqubo yokusebenza. Iziguli ziyasizwa ekugcineni ukudla okumanzi, ukudla ukudla okunconywayo, kanye nokulandela imithi. Kwabesifazane abakhulelwe, ukuqapha izinga lokushaya kwenhliziyo kwengane (FHR) nokubafundisa ngokubala ukunyakaza kwengane kubalulekile.
Ababelethisi bafundisa nemindeni indlela yokunakekela iziguli zabo: ukulungiselela ukudla okuhlanzekile, ukugcina umbhede uhlanzekile, nokuqaphela izimpawu zengozi. Uma isiguli sibhekene nobuthakathaka obukhulu, ababelethisi batusa ukwandisa kancane kancane umsebenzi wokukhanya nokuvimbela ukuwa.
Ukuhlola Nokulandelela
Ukuhlolwa kwenziwa ngokuhlola:
– Ukunciphisa umkhuhlane kanye nokuthuthukiswa kwezikhalazo zezokwelapha.
– Ukudla uketshezi okwanele (ukuchama okwanele, akukho zimpawu zokuphelelwa amanzi emzimbeni).
– Ukwanda kwesifiso sokudla kanye nokubekezelela ukudla.
– Ukuthobela imithetho ye-antibiotic kanye nokungabikho kwemiphumela emibi kakhulu.
– Kwabesifazane abakhulelwe: i-DJJ evamile, ukunyakaza okwanele kombungu, akukho zimpawu zokubeletha ngaphambi kwesikhathi.
Uma kungekho ngcono phakathi kwamahora angu-48-72 noma kuvela izimpawu zezinkinga, umbelethisi kufanele akhuthaze ukuhlolwa kabusha nokudluliselwa. Ukulandelela kufanele futhi kufake phakathi imfundo ngokuvimbela ukuphindaphinda kwesifo: ukuhlanzeka, amanzi okuphuza aphephile, kanye nokudla okuhlanzekile.
Indima Yemfundo Yezempilo Nokukhuthaza
Ukuvimbela i-typhus kuncike kakhulu emikhubeni yokuphila ehlanzekile nenempilo. Ababelethisi banganikeza imfundo ngalokhu:
– Umkhuba wokugeza izandla ngaphambi kokudla nangemva kokuya endlini yangasese.
– Pheka ukudla kahle futhi ugweme ukuthenga ukudla okulula okungahleliwe.
– Ukusetshenziswa kwamanzi okuphuza abilisiwe noma aqinisekisiwe.
– Ukuhlanzeka kwemvelo kanye nokuphathwa kwemfucuza.
– Ukubaluleka kokuhlolwa njalo kwabesifazane abakhulelwe ukuze kutholakale izimo ngokushesha.
Isiphetho
Amasu okunakekela ababelethisi bomkhuhlane we-typhoid adinga ukuhlolwa okuphelele, ukuqapha eduze izimpawu ezibalulekile, ukwesekwa okwanele koketshezi nokudla okunempilo, imfundo ngokuvimbela ukutheleleka, kanye nokubambisana kwezokwelapha ukuze kutholakale ukwelashwa ngama-antibiotic afanele. Abesifazane abakhulelwe badinga ukunakwa okwengeziwe ngoba umkhuhlane we-typhoid ungathinta kokubili umama nomntwana osesiswini, okwenza ukudluliselwa ngesikhathi kube yisihluthulelo sokuphepha. Ngendlela yokubelethisa ehlelekile—kusukela ekuhlolweni nasekuxilongweni kuya ekuhleleni nasekusetshenzisweni kuya ekuhlolweni—ababelethisi bangasiza ekusheshiseni ukululama kwesiguli ngenkathi benciphisa ingozi yezinkinga.
Uma ungathanda, ngingalungisa lesi sihloko sibe amagama ayi-1000 ngqo (okwamanje siseduze, kodwa asikabalwa ngokunemba), noma ngishintshe ifomethi ibe yifomethi ephelele ye-SOAP/Varney enezinyathelo ezingu-7 ngezibonelo zamacala.
