slh- group 3 - case study

8/2/2019 SLH- Group 3 - Case Study

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QKT_@LJE MJ]J

Ljhk3 Hs, V

Jmmtkss3 Oje`òjl On}~

Dnt}f Mj}k3 1; Ikdt{jt~ :>6>

Jgk3 4? ~kjts èm

_kv3 Ikhjek

Qejok ì Dnt}f3 Hjlnej

Lj}n`ljen}~3 Inenqnl`

Tkengn`l3 T`hjl Oj}fèno

Mj}k ì Jmhnssn`l3 ?1 Jqtne 41:4

]nhk ì Jmhnssn`l3 1:311 QH

Wjtm3 4/I Ikhjek Jm{e} Nliko}n`{s Mnskjsk jlm ]t`qnoje Hkmnonlk &NM]H.

Mkqjt}hkl}

F`sqn}je L{hdkt3 99==1:

Ofnki O`hqejnl}3 ikykt%

Jmhn}}nlg Mnjgl`sns3 MFI wn}f wjtlnlg sngls

Inlje Mnjgl`sns3 o`hqenoj}km {tnljt~ }tjo} nliko}n`l

Mj}k ì Mnsofjtgk3 1? Hj~ 41:4

]nhk ì Mnsofjtgk3 :1341 JH

IJHNE^ DJOBGT@[LM

Hs, V enyks wn}

FN_]@T^

Ijhne~ Fkje}f Fns}`t~


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Qjs} Fkje}f Fns}`t~

Fns}`t~ ì Qtkskl} Neelkss

Hs, V mkyke`qkm ikykt i`{t mj~s qtn`t }` o`ls{e}j}n`l, _fk skei(hkmnoj}km wn}f

qjtjok}jhè kykt~ i`{t f`{ts i`t i`{t }nhks jlm ikykt s{dsnmkm, ]w` mj~s qtn`t }`

jmhnssn`l% sfk mkyke`qkm ikykt wn}f joo`hqjl~nlg d`m~ wkjblkss }f{s qt`hq}nlg

o`ls{e}j}n`l, Ojsk wjs jmhn}}km js MFI wn}f wjtlnlg sngls,

JLJ]@H^ JLM QF^_N@E@G^

@lk ì }fk h`s} nhq`t}jl} s~s}khs ì }fk d`m~ o`loktlnlg f`hk`s}jsns ns }fk

{tnljt~ s~s}kh, N} ns eòj}km `l }fk e`wkt qjt} ì }fk }`ts` sqkoninojee~ }fk jdm`hkl, N} ns

s{tt`{lmkm d~ }fk f{hjl mngks}nyk s~s}kh jl}ktn`te~% }fk tksqntj}`t~ s~s}kh s{qktn`te~%

jlm }fk f{hjl ykt}kdtjk, _`hk qjt}s ì }fk {tnljt~ s~s}kh enk nl }fk qkeyns% }`gk}fkt wn}f

}fk tkqt`m{o}nyk `tgjls,

]fk [tnljt~ _~s}kh ns j gt`{q ì `tgjls nl }fk d`m~ o`loktlkm wn}f ine}ktnlg `{}

kvokss ie{nm jlm `}fkt s{ds}jloks it`h }fk de``ms}tkjh, ]fk s{ds}jloks jtk ine}ktkm `{}

it`h }fk d`m~ nl }fk i`th ì {tnlk, [tnlk ns j enz{nm qt`m{okm d~ }fk bnmlk~s% oèeko}km nl

}fk dejmmkt jlm kvotk}km }ft`{gf }fk {tk}ftj, [tnlk ns {skm }` kv}tjo} kvokss hnlktjes `t

yn}jhnls js wkee js de``m o`tq{soeks it`h }fk d`m~, ]fk {tnljt~ `tgjls nloe{mk }fk

bnmlk~s% {tk}kts% dejmmkt% jlm {tk}ftj, ]fk {tnljt~ s~s}kh w`tbs wn}f }fk `}fkt s~s}khs ì

}fk d`m~ }` fkeq hjnl}jnl f`hk`s}jsns, ]fk bnmlk~s jtk }fk hjnl `tgjls ì f`hk`s}jsns

dkoj{sk }fk~ hjnl}jnl }fk jonm djsk djejlok jlm }fk wj}kt sje} djejlok ì }fk de``m,

Bnmlk~

Bnmlk~s jtk }w` dkjl(sfjqkm `tgjls eòj}km j} }fk e{hdjt jtkj ì }fk djob, ]fk

bnmlk~ ns o`yktkm d~ j }fnl o`llko}nyk }nss{k ojqs{ek jlm o`lsns}s ì jl `{}kt o`t}kv jlm

hkm{eejt~ q~tjhnm `t qjqneejk, Wn}fnl }fksk }w` tkgn`ls jtk i`{lm }fk o`hq`lkl}s ì }fk


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s}t{o}{tje jlm i{lo}n`lje {ln} ì }fk bnmlk~% }fk lkqft`l, ]fk lkqft`l ns o`hq`skm ì }fk

ge`hkt{e{s% j }{i} ì ojqneejtnks% wfnof qt`m{oks }fk ge`hkt{ejt ine}tj}k% f`{skm nl }fk tklje

o`tq{soek2 ièe`wkm d~ j sktnks ì }{d{eks% sqkonjenkm i`t kvotk}n`l jlm tkjds`tq}n`l,

]fk `{}kt h`s} tkgn`l ì }fk bnmlk~% wfnof enks c{s} dke`w }fk o`lykv s{tijok ì }fk

`tgjl% ns }fk o`t}kv% wfktk }ftkk o`hq`lkl}s ì }fk lkqft`l ojl dk i`{lm, ]fk tklje

o`tq{soeks &`t D`whjl's ojqs{eks. o`l}jnlnlg ge`hkt{en jtk s{tt`{lmkm d~ j ejd~tnl}f ì

qt`vnhje jlm mns}je o`lyè{}km }{d{eks, ]fk oèeko}nlg }{d{eks jes` qklk}tj}k }fk o`t}kv% }`

o`llko} wn}f }fk mns}je o`lyè{}km }{d{eks, ]fksk kv}klsn`ls jtk ojeekm hkm{eejt~ tj~s jlm

tkqtkskl} }fk o`tks ì }fk bnmlk~ e`d{eks,

]fk hkm{eejt~ q`t}n`l ì }fk bnmlk~ ns `tgjlnkm js j snlgek hkm{eejt~ q~tjhnm

&{lne`djt bnmlk~. `t h{e}nqek q~tjhnms &h{e}ne`djt bnmlk~., Kjof q~tjhnm ì hkm{eejt~

}nss{k jlm n}s jssònj}km $ojq$ ì o`t}noje }nss{k jtk mkinlkm js j bnmlk~ e`dk, ]fk q~tjhnms

jqqkjt s}tnj}km% m{k }` }fk qjtjeeke jenglhkl} ì }fk e``qs ì Fklek jlm oèeko}nlg }{d{eks,

]fk lkqft`l

J lkqft`l ns }fk djsno s}t{o}{tje jlm i{lo}n`lje {ln} ì }fk bnmlk~, ]fk ljhk

lkqft`l o`hks it`h }fk Gtkkb w`tm &lkqft`s. hkjlnlg bnmlk~, N}s ofnki i{lo}n`l ns

}` tkg{ej}k wj}kt jlm sè{dek s{ds}jloks d~ ine}ktnlg }fk de``m% tkjds`tdnlg wfj} ns

lkkmkm jlm kvotk}nlg }fk tks} js {tnlk, Lkqft`ls kenhnlj}k wjs}ks it`h }fk d`m~%

tkg{ej}k de``m yè{hk jlm qtkss{tk% o`l}tè ekykes ì keko}tè~}ks jlm hk}jdèn}ks%

jlm tkg{ej}k de``m qF, N}s i{lo}n`ls jtk yn}je }` enik jlm jtk tkg{ej}km d~ }fk

klmòtnlk s~s}kh d~ f`th`lks s{of js jl}nmn{tk}no f`th`lk% jem`s}kt`lk% jlm

qjtj}f~t`nm f`th`lk,

Kjof lkqft`l fjs n}s `wl s{qqe~ ì de``m it`h }w` ojqneejt~ tkgn`ls it`h

}fk tklje jt}kt~, Kjof lkqft`l ns o`hq`skm ì jl nln}nje ine}ktnlg o`hq`lkl} &}fk

tklje o`tq{soek. jlm j }{d{ek sqkonjenkm i`t tkjds`tq}n`l jlm skotk}n`l &}fk tklje

}{d{ek., ]fk tklje o`tq{soek ine}kts `{} ejtgk sè{}ks it`h }fk de``m% mkenyktnlgwj}kt jlm shjee sè{}ks }` }fk tklje }{d{ek i`t h`mninoj}n`l,

Inyk qjt}s3

:, ]fk ge`hkt{e{s% wfnof ns }fk de``m bnmlk~ nl}ktijok% qejshj ns ine}ktkm it`h

ojqneejtnks nl}` }fk D`whjls ojqs{ek,


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4, ]fk qt`vnhje o`lyè{}km }{d{ek% wfnof tkjds`tds h`s} ì }fk ine}ktkm e`jm%

nloe{mnlg l{}tnkl}s jlm keko}tè~}ks,

?, ]fk e``q ì Fklek% wfnof% mkqklmnlg `l n}s eklg}f% o`lokl}tj}ks {tnlk d~

nlotkjsnlg }fk `shèjen}~ ì s{tt`{lmnlg }nss{k jlm ine}tj}k, N} fjs d`}f jsoklmnlg

jlm mksoklmnlg enhds,

=, ]fk mns}je o`lyè{}km }{d{ek% wfnof tkjds`tds wj}kt jlm s`mn{h mkqklmnlg `l

lkkms,

;, ]fk oèeko}nlg s~s}kh% wfnof oèeko}s {tnlk i`t kvotk}n`l, ]fktk jtk }w` }~qks ì

lkqft`ls% }f`sk eòjenkm }` }fk o`t}kv% jlm }f`sk kv}klmnlg nl}` }fk hkm{eej, ]fk

ej}}kt jtk ofjtjo}ktnkm d~ e`lg e``qs ì Fklek% jlm jtk h`tk hk}jdènojee~ jo}nyk,

[tk}kts

Kjof bnmlk~ fjs j {tk}kt% jl `tgjl }fj} mtjnls {tnlk wfnof ns oèeko}km j} }fk tklje

qkeyns, ]fksk }w` }nl~ }{dks mtjnl }fk {tnlk }` }fk dejmmkt% wfktk {tnlk ns s}`tkm, N} fjs j

}tjlsn}n`lje kqn}fken{h jlm j h{so{ejt &sh``}f h{soek. ej~kt% }fk ejhnlj qt`qnj,

[tnljt~ dejmmkt

]fk {tnlk ns l`} mntko}e~ mtjnlkm }` }fk kv}ktlje klynt`lhkl} d{} tj}fkt ns s}`tkm

}khq`tjtne~ `l j fèe`w `tgjl% }fk {tnljt~ dejmmkt, ]fk {tnljt~ dejmmkt ns enlkm wn}f

}tjlsn}n`lje kqn}fken{h {lmktenlkm d~ j oèejgkl`{s ejhnlj qt`qtnj, J s{dh{o`sj ì kejs}no

indkts jlm j h{so{ejt ej~kt ì }ftkk o`j}s ì sh``}f h{soek qkthn} kvqjlsn`l ì }fk

s}t{o}{tk,

[tk}ftj

Wfkl }fk dejmmkt ns i{ee jlm lkkms khq}~nlg% }fk {tnlk mtjnls nl}` }fk `{}snmk

}ft`{gf }fk {tk}ftj% j fèe`w }{dk }fj} mtjnls {tnlk }` }fk `tninok ì }fk hjek qklns `t }fk

ikhjek {tk}ftje `tninok% dk}wkkl }fk oen}`tns jlm yjgnlje `qklnlg,

QJ]F@QF^_N@E@G^

[tnljt~ }tjo} nliko}n`l &[]N. ns h`s} o`hh`l nl ikhjeks m{k }` dj}ft``h {sk, Nl }fk

ojsk ì Hs, V% djo}ktnje nlyjsn`l hj~ fjyk dt`{gf} jd`{} }fk mnskjsk, _{sqko}km oj{sj}nyk

jgkl}s jtk {s{jee~ Ksofktnofnj oèn }f`{gf ejd`tj}`t~ tks{e}s mnm l`} jo}{jee~ nmkl}ni~ }fk

OJ, Hs, V sj~s sfk m`ks l`} bl`w }fk {lmkte~nlg oj{sk,


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]fk {tnljt~ }tjo} ns h`s} o`hh`le~ s}ktnek }f`{gf }fk {tk}ftj hj~ dk o`l}jhnlj}km

wn}f s`hk djo}ktnj, [tnlk jonmn}~ ns `lk ì }fk qf~snè`gno ijo}`ts }fj} hjbks }fk [] oekjl,

Wfkl }fktk ns djo}ktnje nliko}n`l nl }fk {tk}ftj% n} oj{sks {tnljt~ mnso`hi`t} jlm qjnl

nloe{mnlg }fk s{qtjq{dno jtkj, N} hj~ jes` oj{sk ikykt jlm eòje nliejhhj}n`l,

_nlok }fk oenkl} mnm l`} nhhkmnj}ke~ g` i`t o`ls{e}j}n`l% djo}ktnje qtèniktj}n`l

jsoklmkm }` oj{sk j o`hqenoj}km []N js }fk inlje mnjgl`sns, ]fns hj~ dk oj{skm d~ skyktje

ijo}`ts }f`{gf l`} mk}kthnlkm wfnof ns, _{sqko}km oj{sk hj~dk yksno`{tk}ktje tkie{v }fj}

jee`ws {tnlk nl }fk e`wkt }tjo} }` jsoklm,

[TNLJT^ ]TJO] NLIKO]N@L &Tkjmnlgs.

Djo}ktnje []Ns ojl nlyèyk }fk {tk}ftj% qt`s}j}k% dejmmkt% `t bnmlk~s, _~hq}`hs hj~

dk jdskl} `t nloe{mk {tnljt~ itkz{klo~ jlm {tgklo~% m~s{tnj% e`wkt jdm`hnlje qjnl% jlm

iejlb qjnl, _~s}khno s~hq}`hs jlm kykl skqsns hj~ òo{t wn}f bnmlk~ nliko}n`l, Mnjgl`sns

ns djskm `l jlje~sns jlm o{e}{tk ì {tnlk, ]tkj}hkl} ns wn}f jl}ndn`}nos,

Jh`lg jm{e}s jgkm 41 }` ;1 ~t% []Ns jtk jd`{} ;1(ièm h`tk o`hh`l nl w`hkl, ]fk

nlonmklok nlotkjsks nl qj}nkl}s < ;1 ~t% d{} }fk ikhjek3hjek tj}n` mkotkjsks dkoj{sk ì }fk

nlotkjsnlg itkz{klo~ ì qt`s}j}k mnskjsk,

Qj}f`qf~snè`g~

]fk {tnljt~ }tjo}% it`h }fk bnmlk~s }` }fk {tk}ftje hkj}{s% ns l`thjee~ s}ktnek jlm

tksns}jl} }` djo}ktnje oè`lnj}n`l mksqn}k itkz{kl} o`l}jhnlj}n`l ì }fk mns}je {tk}ftj wn}f

oè`lno djo}ktnj, Hkofjlnshs }fj} hjnl}jnl }fk }tjo}'s s}ktnen}~ nloe{mk {tnlk jonmn}~%

khq}~nlg ì }fk dejmmkt j} hno}{tn}n`l% {tk}kt`yksnoje jlm {tk}ftje sqfnlo}kts% jlm yjtn`{s

nhh{lè`gno jlm h{o`sje djttnkts,

Jd`{} >;+ ì []Ns òo{t wfkl djo}ktnj jsoklm }fk {tk}ftj }` }fk dejmmkt jlm% nl

}fk ojsk ì jo{}k {lo`hqenoj}km q~ke`lkqftn}ns% jsoklm }fk {tk}kt }` }fk bnmlk~, ]fktkhjnlmkt ì []Ns jtk fkhj}`gkl`{s, _~s}khno nliko}n`l ojl tks{e} it`h []N% qjt}no{ejte~

nl }fk kemkte~, Jd`{} 9,;+ ì ojsks ì f`sqn}je(joz{ntkm djo}ktkhnj jtk j}}tnd{}jdek }` []N,

O`hqenoj}km []N ns o`lsnmktkm }` dk qtkskl} wfkl }fktk jtk {lmkte~nlg ijo}`ts

}fj} qtkmnsq`sk }` jsoklmnlg djo}ktnje nliko}n`l, Qtkmnsq`snlg ijo}`ts nloe{mk {tnljt~

nls}t{hkl}j}n`l &kg% oj}fk}ktnj}n`l% o~s}`so`q~.% jlj}`hno jdl`thjen}nks% jlm `ds}t{o}n`l


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ì {tnlk ie`w `t q``t dejmmkt khq}~nlg, J o`hh`l o`lskz{klok ì jlj}`hno jdl`thjen}~

ns yksno`{tk}ktje tkie{v &Y[T.% wfnof ns qtkskl} nl ?1 }` =;+ ì ~`{lg ofnemtkl wn}f

s~hq}`hj}no []N &skk Hnsokeejlk`{s Nliko}n`ls nl Nlijl}s jlm Ofnemtkl3 [tnljt~ ]tjo}

Nliko}n`l nl Ofnemtkl &[]N.., Y[T ns {s{jee~ oj{skm d~ j o`lgkln}je mkiko} }fj} tks{e}s nl

nlo`hqk}klok ì }fk {tk}kt`yksnoje yjeyk, N} ns h`s} ì}kl m{k }` j sf`t} nl}tjh{tje

skghkl} &}fk {tk}kt l`thjee~ }tjlsn}s }fk dejmmkt wjee j} jl jlgek2 }fk tks{e}jl} eklg}f~

skghkl} ns h`tk tkjmne~ oe`skm d~ h{so{ejt o`l}tjo}n`l }fjl }fk sf`t}kt skghkl} }fj}

òo{ts wfkl }fk {tk}kt qjssks s}tjngf} }ft`{gf }fk wjee., Y[T ojl jes` dk joz{ntkm nl

qj}nkl}s wn}f j iejoonm dejmmkt m{k }` sqnlje o`tm nlc{t~, @}fkt jlj}`hno jdl`thjen}nks

qtkmnsq`snlg }` []N nloe{mk {tk}ftje yjeyks &j o`lgkln}je `ds}t{o}nyk jdl`thjen}~.% mkej~km

dejmmkt lkob hj}{tj}n`l% dejmmkt mnykt}no{e{h% jlm {tk}ftje m{qenoj}n`ls, [tnlk ie`w ojl

dk o`hqt`hnskm d~ ojeo{en jlm }{h`ts, Dejmmkt khq}~nlg ojl dk nhqjntkm d~ lk{t`gklno

m~si{lo}n`l &skk Y`nmnlg Mns`tmkts3 Lk{t`gklno Dejmmkt.% qtkgljlo~% {}ktnlk qtèjqsk%

o~s}òkek% jlm qt`s}j}no klejtgkhkl}, []N oj{skm d~ o`lgkln}je ijo}`ts qtkskl}s h`s}

o`hh`le~ nl ofnemf``m, H`s} `}fkt ijo}`ts jtk h`tk o`hh`l nl }fk kemkte~,

[lo`hqenoj}km []N òo{ts wn}f`{} {lmkte~nlg jdl`thjen}~ `t nhqjnthkl} ì {tnlk

ie`w, N} ns h`s} o`hh`l nl ~`{lg w`hkl d{} jes` s`hkwfj} o`hh`l nl ~`{lgkt hkl wf`

fjyk {lqt`}ko}km jlje nl}kto`{tsk% jl {lonto{honskm qklns% {lqt`}ko}km nl}kto`{tsk wn}f j

w`hjl wf`sk yjgnlj ns oè`lnkm wn}f {tnljt~ qj}f`gkls% `t JNM_, Tnsb ijo}`ts nl w`hkl

nloe{mk skv{je nl}kto`{tsk% mnjqftjgh jlm sqkthnonmk {sk% jl}ndn`}no {sk% jlm j fns}`t~ ì

tko{ttkl} []Ns, Kykl {sk ì sqkthnonmk(o`j}km o`lm`hs nlotkjsks tnsb ì []N nl w`hkl,

]fk nlotkjskm tnsb ì []N nl w`hkl {snlg jl}ndn`}nos `t sqkthnonmks qt`djde~ òo{ts

dkoj{sk ì je}ktj}n`ls nl yjgnlje ie`tj }fj} jee`w `yktgt`w}f ì Ksofktnofnj oèn, Nl kemkte~

w`hkl% s`nenlg ì }fk qktnlk{h m{k }` ikoje nlo`l}nlklok nlotkjsks tnsb, Qj}nkl}s ì d`}f

skvks wn}f mnjdk}ks fjyk jl nlotkjskm nlonmklok jlm skyktn}~ ì nliko}n`ls,

K}nè`g~O`hhklsje oè`lno gtjh(lkgj}nyk jkt`dno djo}ktnj oj{sk h`s} djo}ktnje []Ns, Nl

tkej}nyke~ l`thje }tjo}s% s}tjnls ì K, oèn wn}f sqkonino j}}jofhkl} ijo}`ts i`t }tjlsn}n`lje

kqn}fken{h ì }fk dejmmkt jlm {tk}kts jtk }fk h`s} itkz{kl} oj{sks, ]fk tkhjnlnlg gtjh(

lkgj}nyk {tnljt~ qj}f`gkls jtk `}fkt kl}kt`djo}ktnj% ksqkonjee~ Bekdsnkeej % Qt`}k{s

hntjdnens% jlmQsk{m`h`ljs jkt{gnl`sj, Kl}ktòòon &gt`{q M s}tkq}òòon. jlm o`jg{ejsk(
http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.htmlhttp://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.htmlhttp://www.merckmanuals.com/professional/genitourinary_disorders/voiding_disorders/neurogenic_bladder.htmlhttp://www.merckmanuals.com/professional/genitourinary_disorders/voiding_disorders/neurogenic_bladder.htmlhttp://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.htmlhttp://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html


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lkgj}nyk s}jqf~eòòon &kg% _}jqf~eòòo{s sjqt`qf~}no{s. jtk }fk h`s} itkz{kl}e~

nhqenoj}km gtjh(q`sn}nyk tgjlnshs,

K, oèn oj{sks < 7;+ ì o`hh{ln}~(joz{ntkm []Ns nl jee jgk gt`{qs2 _,

sjqt`qf~}no{sjoo`{l}s i`t jd`{} :1+, Nl f`sqn}jenkm qj}nkl}s% K, oèn joo`{l}s i`t jd`{}

;1+ ì ojsks, ]fk gtjh(lkgj}nyk sqkonks Bekdsnkeej% Qt`}k{s% Kl}kt`djo}kt%

jlm _kttj}nj joo`{l} i`t jd`{} =1+% jlm }fk gtjh(q`sn}nyk djo}ktnje oòon Kl}ktòòo{s

ijkojens jlm _, sjqt`qf~}no{s jlm_, j{tk{s joo`{l} i`t }fk tkhjnlmkt,

Oejssninoj}n`l

[tk}ftn}ns3 Nliko}n`l ì }fk {tk}ftj wn}f djo}ktnj &`t wn}f qt`}``j% ynt{sks% `t i{lgn.

òo{ts wfkl `tgjlnshs }fj} gjnl jookss }` n} jo{}ke~ `t oft`lnojee~ oè`lnk }fk l{hkt`{s

qktn{tk}ftje gejlms nl }fk d{ed`{s jlm qklm{e`{s q`t}n`ls ì }fk hjek {tk}ftj jlm nl }fk

kl}ntk ikhjek {tk}ftj, ]fk skv{jee~ }tjlshn}}km qj}f`gkls Ofejh~mnj

}tjof`hj}ns &skk _kv{jee~ ]tjlshn}}km Mnskjsks &_]M.3 Ofejh~mnje% H~o`qejshje% jlm

[tkjqejshje Nliko}n`ls.% Lknssktnj g`l`ttf`kjk &skk _kv{jee~ ]tjlshn}}km Mnskjsks &_]M.3

G`l`ttfkj.% ]tnof`h`ljs yjgnljens&skk _kv{jee~ ]tjlshn}}km Mnskjsks &_]M.3

]tnof`h`lnjsns.% jlm fktqks snhqekv ynt{s &skkFktqksynt{sks3 Fktqks _nhqekv Ynt{s &F_Y.

Nliko}n`ls. jtk o`hh`l oj{sks nl d`}f skvks,

O~s}n}ns3 Nl w`hkl% skv{je nl}kto`{tsk {s{jee~ qtkokmks {lo`hqenoj}km o~s}n}ns

&f`lk~h``l o~s}n}ns., Nl hkl% djo}ktnje nliko}n`l ì }fk dejmmkt ns {s{jee~ o`hqenoj}km jlm

gklktjee~ tks{e}s it`h jsoklmnlg nliko}n`l it`h }fk {tk}ftj `t qt`s}j}k `t ns sko`lmjt~ }`

{tk}ftje nls}t{hkl}j}n`l, ]fk h`s} o`hh`l oj{sk ì tko{ttkl} o~s}n}ns nl hkl ns oft`lno

djo}ktnje qt`s}j}n}ns,

Jo{}k {tk}ftje s~lmt`hk3 Jo{}k {tk}ftje s~lmt`hk% wfnof òo{ts nl w`hkl% oj{sks

m~s{tnj jlm q~{tnj &m~s{tnj(q~{tnj s~lmt`hk. m{k }` djo}ktnje {tnljt~ qj}f`gkls,

@oojsn`ljee~% n} ns oj{skm d~ L, g`l`ttf`kjk% ]D% `t i{lgje mnskjsk `t d~ }tj{hj `t

nliejhhj}n`l ì }fk {tk}ftj, Qj}nkl}s wn}f jo{}k {tk}ftje s~lmt`hk fjyk m~s{tnj%itkz{klo~% jlm q~{tnj% d{} {tnlk o{e}{tks jtk kn}fkt lkgj}nyk `t sf`w oè`l~ o`{l}s }fj}

jtk 5 :1;/hE% wfnof ns ekss }fjl }fk }tjmn}n`lje otn}ktn`l i`t djo}ktnje []N,

Js~hq}`hj}no djo}kt{tnj3 Okt}jnl qj}nkl}s% qtnhjtne~ kemkte~ w`hkl jlm qj}nkl}s wn}f

mnjdk}ks `t }f`sk wf` tkz{ntk e`lg(}kth {sk ì nlmwkeenlg oj}fk}kts% fjyk qktsns}kl}

djo}ktn{tnj wn}f ofjlgnlg ie`tj }fj} ns d`}f js~hq}`hj}no jlm tkitjo}`t~ }` }tkj}hkl},
http://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/chlamydial_mycoplasmal_and_ureaplasmal_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/chlamydial_mycoplasmal_and_ureaplasmal_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/gonorrhea.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/gonorrhea.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/trichomoniasis.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/trichomoniasis.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/herpesviruses/herpes_simplex_virus_hsv_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/trichomoniasis.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/trichomoniasis.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/gonorrhea.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/gonorrhea.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/chlamydial_mycoplasmal_and_ureaplasmal_infections.htmlhttp://www.merckmanuals.com/professional/infectious_diseases/sexually_transmitted_diseases_std/chlamydial_mycoplasmal_and_ureaplasmal_infections.html


8/31

WDO o`{l} nl {tnlk hj~ dk h`mks}e~ kekyj}km, H`s} ì }fksk qj}nkl}s jtk dks} eki}

{l}tkj}km dkoj{sk }fk {s{je tks{e} ì }tkj}hkl} ns }fk ks}jdensfhkl} ì fngfe~ tksns}jl}

`tgjlnshs, Js~hq}`hj}no djo}ktn{tnj ojl jes` òo{t nl qtkgljl} w`hkl jlm hj~ oj{sk

nliko}n`l ì }fk {tnljt~ }tjo}% skqsns% e`w dnt}f wkngf}% sq`l}jlk`{s jd`t}n`l% qtkhj}{tk

mkenykt~ &skkQtkgljlo~ O`hqenoj}km d~ Mnskjsk3 [tnljt~ ]tjo} Nliko}n`l nl Qtkgljlo~.% jlm

s}neednt}f% s` }tkj}hkl} ns nlmnoj}km,

Jo{}k q~ke`lkqftn}ns3 Q~ke`lkqftn}ns ns djo}ktnje nliko}n`l ì }fk bnmlk~ qjtklof~hj, ]fk

}kth sf`{em l`} dk {skm }` mksotndk }{d{e`nl}kts}n}nje lkqft`qj}f~ {lekss nliko}n`l ns

mò{hkl}km, Nl w`hkl% jd`{} 41+ ì o`hh{ln}~(joz{ntkm djo}ktkhnjs jtk m{k }`

q~ke`lkqftn}ns, Q~ke`lkqftn}ns ns {lo`hh`l nl hkl wn}f j l`thje {tnljt~ }tjo},

Je}f`{gf `ds}t{o}n`l &kg% s}tno}{tks% ojeo{en% }{h`ts% lk{t`gklno dejmmkt% Y[T. qtkmnsq`sks

}` q~ke`lkqftn}ns% h`s} w`hkl wn}f q~ke`lkqftn}ns fjyk l` mkh`ls}tjdek i{lo}n`lje `t

jlj}`hno mkiko}s, O~s}n}ns je`lk `t jlj}`hno mkiko}s hj~ oj{sk tkie{v, ]fns }klmklo~ ns

gtkj}e~ klfjlokm wfkl {tk}ktje qktns}jesns ns nlfndn}km &kg% m{tnlg qtkgljlo~% d~

`ds}t{o}n`l% d~ klm`}`vnls ì gtjh(lkgj}nyk djo}ktnj., Q~ke`lkqftn}ns `t iòje jdsokss hj~

dk m{k }` fkhj}`gkl`{s sqtkjm% wfnof ns nlitkz{kl} jlm {s{jee~ tks{e}s it`h djo}ktkhnj

wn}f ynt{ekl} djoneen &kg% _jeh`lkeej sq% _, j{tk{s., Q~ke`lkqftn}ns ns o`hh`l nl ~`{lg gntes

jlm nl qtkgljl} w`hkl ji}kt nls}t{hkl}j}n`l `t dejmmkt oj}fk}ktnj}n`l,

]fk bnmlk~ {s{jee~ ns klejtgkm dkoj{sk ì nliejhhj}`t~ QHLs jlm kmkhj, Nliko}n`l ns iòje

jlm qj}of~% dkgnllnlg nl }fk qkeyns jlm hkm{eej jlm kv}klmnlg nl}` }fk o`t}kv js jl

klejtgnlg wkmgk, Oft`lno nliejhhj}`t~ okees jqqkjt wn}fnl j ikw mj~s% jlm hkm{eejt~ jlm

s{do`t}noje jdsokssks hj~ mkyke`q, L`thje qjtklof~hje }nss{k dk}wkkl iòn ì nliko}n`l ns

o`hh`l, Qjqneejt~ lkot`sns hj~ dk kynmkl} nl jo{}k q~ke`lkqftn}ns jssònj}km wn}f

mnjdk}ks% `ds}t{o}n`l% snobek okee mnskjsk% q~ke`lkqftn}ns nl tklje }tjlsqejl}s% q~ke`lkqftn}ns

m{k }` ojlmnmnjsns% `t jljegksno lkqft`qj}f~, Je}f`{gf jo{}k q~ke`lkqftn}ns ns itkz{kl}e~

jssònj}km wn}f tklje sojttnlg nl ofnemtkl% snhnejt sojttnlg nl jm{e}s ns l`} mk}ko}jdek nl }fkjdsklok ì tkie{v `t `ds}t{o}n`l,

_~hq}`hs jlm _ngls

Nl }fk kemkte~% []Ns jtk ì}kl js~hq}`hj}no, Kemkte~ qj}nkl}s% jlm }f`sk wn}f j lk{t`gklno

dejmmkt `t jl nlmwkeenlg oj}fk}kt% hj~ qtkskl} wn}f skqsns jlm mkentn{h d{} wn}f`{}

s~hq}`hs tkiktjdek }` }fk {tnljt~ }tjo},
http://www.merckmanuals.com/professional/gynecology_and_obstetrics/pregnancy_complicated_by_disease/urinary_tract_infection_in_pregnancy.htmlhttp://www.merckmanuals.com/professional/gynecology_and_obstetrics/pregnancy_complicated_by_disease/urinary_tract_infection_in_pregnancy.html


9/31

Wfkl s~hq}`hs jtk qtkskl}% }fk~ hj~ l`} o`ttkej}k wn}f }fk eòj}n`l ì }fk nliko}n`l

wn}fnl }fk {tnljt~ }tjo} dkoj{sk }fktk ns o`lsnmktjdek `yktejq2 f`wkykt% s`hk

gklktjenj}n`ls jtk {ski{e,

Nl {tk}ftn}ns% }fk hjnl s~hq}`hs jtk m~s{tnj jlm% qtnhjtne~ nl hjeks% {tk}ftje mnsofjtgk,

Mnsofjtgk }klms }` dk q{t{ekl} wfkl m{k }` L, g`l`ttf`kjk jlm wfn}nsf jlm h{o`nm wfkl

l`},

O~s}n}ns `lsk} ns {s{jee~ s{mmkl% }~qnojee~ wn}f itkz{klo~% {tgklo~% jlm d{tlnlg `t qjnli{e

y`nmnlg ì shjee yè{hks ì {tnlk, Lò}{tnj% wn}f s{qtjq{dno jlm ì}kl e`w djob qjnl% ns

o`hh`l, ]fk {tnlk ns ì}kl }{tdnm% jlm gt`ss fkhj}{tnj òo{ts nl jd`{} ?1+ ì qj}nkl}s, J

e`w(gtjmk ikykt hj~ mkyke`q, Qlk{hj}{tnj &qjssjgk ì jnt nl }fk {tnlk. ojl òo{t wfkl

nliko}n`l tks{e}s it`h j yksno`kl}ktno `t yksno`yjgnlje ins}{ej `t it`h khqf~skhj}`{s

o~s}n}ns,

Nl jo{}k q~ke`lkqftn}ns% s~hq}`hs hj~ dk }fk sjhk js }f`sk ì o~s}n}ns2 `lk }fntm ì

qj}nkl}s fjyk itkz{klo~ jlm m~s{tnj, F`wkykt% wn}f q~ke`lkqftn}ns% s~hq}`hs }~qnojee~

nloe{mk ofnees% ikykt% iejlb qjnl% oènob~ jdm`hnlje qjnl% lj{skj% jlm y`hn}nlg, Ni jdm`hnlje

tngnmn}~ ns jdskl} `t sengf}% j }klmkt% klejtgkm bnmlk~ ns s`hk}nhks qjeqjdek, O`s}`ykt}kdtje

jlgek qkto{ssn`l }klmktlkss ns gklktjee~ qtkskl} `l }fk nliko}km snmk, Nl ofnemtkl%

s~hq}`hs ì}kl jtk hkjgkt jlm ekss ofjtjo}ktns}no &skk Hnsokeejlk`{s Nliko}n`ls nl Nlijl}s

jlm Ofnemtkl3 _~hq}`hs jlm _ngls.,

Mnjgl`sns

[tnlje~sns _`hk}nhks {tnlk o{e}{tkMnjgl`sns d~ o{e}{tk ns l`} jewj~s lkokssjt~, Ni m`lk% mnjgl`sns d~ o{e}{tk tkz{ntks

mkh`ls}tj}n`l ì snglninojl} djo}ktn{tnj nl qt`qkte~ oèeko}km {tnlk,

[tnlk oèeko}n`l3 Ni j skv{jee~ }tjlshn}}km mnskjsk &_]M. ns s{sqko}km% j {tk}ftje swjd i`t

_]M }ks}nlg ns `d}jnlkm qtn`t }` y`nmnlg, [tnlk oèeko}n`l ns }fkl d~ oekjl(oj}of `toj}fk}ktnj}n`l,

]` `d}jnl j oekjl(oj}of% hnms}tkjh(y`nmkm sqkonhkl% }fk {tk}ftje `qklnlg ns wjsfkm

wn}f j hnem% l`li`jhnlg mnsnliko}jl} jlm jnt mtnkm, O`l}jo} ì }fk {tnljt~ s}tkjh wn}f }fk

h{o`sj sf`{em dk hnlnhnkm d~ sqtkjmnlg }fk ejdnj nl w`hkl jlm d~ q{eenlg djob }fk
http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092658http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092658http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092658http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092658


10/31

i`tksbnl nl {lonto{honskm hkl, ]fk ints} ; hE ì {tnlk ns l`} ojq}{tkm2 }fk lkv} ; }` :1 hE

ns oèeko}km nl j s}ktnek o`l}jnlkt,

J sqkonhkl `d}jnlkm d~ oj}fk}ktnj}n`l ns qtkiktjdek nl èmkt w`hkl &wf` }~qnojee~

fjyk mniino{e}~ `d}jnlnlg j oekjl(oj}of sqkonhkl. jlm nl w`hkl wn}f yjgnlje dekkmnlg `t

mnsofjtgk, Hjl~ oenlnonjls jes` {sk oj}fk}ktnj}n`l }` `d}jnl j sqkonhkl ni kyje{j}n`l

nloe{mks j qkeyno kvjhnlj}n`l, Mnjgl`sns nl qj}nkl}s wn}f nlmwkeenlg oj}fk}kts ns mnso{sskm

keskwfktk &skk[tnljt~ ]tjo} Nliko}n`ls &[]N.3 Djo}ktnje [tnljt~ ]tjo} Nliko}n`ls nl Qj}nkl}s

wn}f Nlmwkeenlg Dejmmkt Oj}fk}kts.,

[tnlk }ks}nlg3 Hnot`so`qno kvjhnlj}n`l ì {tnlk ns {ski{e d{} l`} mkinln}nyk, Q~{tnj ns

mkinlkm js 6 WDOs/E ì {lokl}tni{gkm {tnlk% wfnof o`ttksq`lms }` 4 }` ; WDOs/fngf(

q`wkt inkem nl sq{l skmnhkl}, H`s} }t{e~ nliko}km qj}nkl}s fjyk < :1 WDOs/E, ]fk

qtksklok ì djo}ktnj nl }fk jdsklok ì q~{tnj% ksqkonjee~ wfkl skyktje s}tjnls jtk i`{lm% ns

{s{jee~ m{k }` o`l}jhnlj}n`l m{tnlg sjhqenlg, Hnot`so`qno fkhj}{tnj òo{ts nl {q }` ;1+

ì qj}nkl}s% d{} gt`ss fkhj}{tnj ns {lo`hh`l, WDO ojs}s% wfnof tkz{ntk sqkonje s}jnls }`

mniiktkl}nj}k it`h tklje }{d{ejt ojs}s% nlmnoj}k `le~ jl nliejhhj}`t~ tkjo}n`l2 }fk~ ojl dk

qtkskl} nl q~ke`lkqftn}ns% ge`hkt{e`lkqftn}ns% jlm l`lnliko}nyk }{d{e`nl}kts}n}nje lkqftn}ns,

Mnqs}nob }ks}s jes` jtk o`hh`le~ {skm, J q`sn}nyk ln}tn}k }ks} `l j itksfe~ y`nmkm sqkonhkl

&djo}ktnje tkqenoj}n`l nl }fk o`l}jnlkt tklmkts tks{e}s {ltkenjdek ni }fk sqkonhkl ns l`}

}ks}km tjqnme~. ns fngfe~ sqkonino i`t []N% d{} }fk }ks} ns l`} ykt~ sklsn}nyk, ]fk ek{bò~}k

ks}ktjsk }ks} ns ykt~ sqkonino i`t }fk qtksklok ì < :1 WDOs/E jlm ns ijnte~ sklsn}nyk, Nl

jm{e} w`hkl wn}f {lo`hqenoj}km []N wn}f }~qnoje s~hq}`hs% h`s} oenlnonjls o`lsnmkt

q`sn}nyk hnot`so`qno jlm mnqs}nob }ks}s s{iinonkl}2 nl }fksk ojsks% gnykl }fk enbke~ qj}f`gkls%

o{e}{tks jtk {lenbke~ }` ofjlgk }tkj}hkl} d{} jmm snglninojl} kvqklsk,

O{e}{tks jtk tko`hhklmkm wfkl s~hq}`hs jtk s{ggks}nyk d{} {tnlje~sns ns

l`lmnjgl`s}no2 i`t o`hqenoj}km []N% nloe{mnlg []N nl qj}nkl}s wn}f mnjdk}ks%

nhh{l`s{qqtkssn`l% tkokl} f`sqn}jenj}n`l `t {tk}ftje nls}t{hkl}j}n`l% `t tko{ttkl} []N2i`t qj}nkl}s < 9; ~t2 jlm qktfjqs i`t qj}nkl}s wn}f s~hq}`hs ì q~ke`lkqftn}ns, Jee

qtkq{dkt}je ofnemtkl sf`{em fjyk j {tnlk o{e}{tk wfkl j []N ns s{sqko}km, [tnlk sf`{em dk

o{e}{tkm js s``l js q`ssndek `t s}`tkm j} =O ni j mkej~ ì < :1 hnl ns kvqko}km, _jhqeks

o`l}jhnlj}km wn}f ejtgk l{hdkts ì kqn}fkenje okees jtk {lenbke~ }` dk fkeqi{e, Jl

{lo`l}jhnlj}km sqkonhkl sf`{em dk `d}jnlkm i`t o{e}{tk, Otn}ktnj% djskm `l }fk g{nmkenlks
http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_tract_infections_uti/bacterial_urinary_tract_infections.html#v1052970http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_tract_infections_uti/bacterial_urinary_tract_infections.html#v1052970http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_tract_infections_uti/bacterial_urinary_tract_infections.html#v1052970http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_tract_infections_uti/bacterial_urinary_tract_infections.html#v1052970


11/31

ì }fk Nliko}n`{s Mnskjsks _ònk}~ ì Jhktnoj% &skk }fk Nliko}n`{s Mnskjsks _ònk}~ ì

Jhktnoj's G{nmkenlks i`t }fk Mnjgl`sns jlm ]tkj}hkl} ì Js~hq}`hj}no Djo}ktn{tnj nl

Jm{e}s. i`t djo}ktn{tnj jtk3

Jh`lg w`hkl wn}f s{sqko}km js~hq}`hj}no djo}ktn{tnj% 4 o`lsko{}nyk oekjl(oj}ofy`nmkm sqkonhkls it`h wfnof }fk sjhk djo}ktnje s}tjnl ns nsèj}km nl oè`l~ o`{l}s

ì < :1;/hE

Jh`lg w`hkl wn}f s{sqko}km jo{}k {tk}ftje s~lmt`hk% j oekjl(oj}of y`nmkm sqkonhklit`h wfnof j snlgek djo}ktnje sqkonks ns nsèj}km nl oè`l~ o`{l}s it`h :14 }` :1=/hE

Jh`lg hkl% j oekjl(oj}of y`nmkm sqkonhkl it`h wfnof j snlgek djo}ktnje sqkonks nsnsèj}km nl oè`l~ o`{l}s < :1;/hE

Jh`lg w`hkl `t hkl% j oj}fk}kt(`d}jnlkm sqkonhkl it`h wfnof j snlgek djo}ktnjesqkonks ns nsèj}km nl oè`l~ o`{l}s ì < :14/hE

@oojsn`ljee~% []N ns qtkskl} mksqn}k e`wkt oè`l~ o`{l}s% q`ssnde~ dkoj{sk ì qtn`t

jl}ndn`}no }fktjq~% ykt~ mne{}k {tnlk &sqkonino gtjyn}~ 5 :,11?.% `t `ds}t{o}n`l }` }fk ie`w ì

gt`sse~ nliko}km {tnlk, Tkqkj}nlg }fk o{e}{tk nhqt`yks }fk mnjgl`s}no joo{tjo~ ì j q`sn}nyk

tks{e}% nk% hj~ mniiktkl}nj}k dk}wkkl j o`l}jhnljl} jlm j }t{k q`sn}nyk tks{e},

Nliko}n`l eòjenj}n`l3 Oenlnoje mniiktkl}nj}n`l dk}wkkl {qqkt jlm e`wkt []N ns nhq`ssndek

nl hjl~ qj}nkl}s% jlm }ks}nlg ns l`} {s{jee~ jmynsjdek, Wfkl }fk qj}nkl} fjs fngf ikykt%

o`s}`ykt}kdtje jlgek }klmktlkss% jlm gt`ss q~{tnj wn}f ojs}s% q~ke`lkqftn}ns ns fngfe~

enbke~, ]fk dks} l`lnlyjsnyk }koflnz{k i`t mniiktkl}nj}nlg dejmmkt it`h bnmlk~ nliko}n`l

jqqkjts }` dk }fk tksq`lsk }` j sf`t} o`{tsk ì jl}ndn`}no }fktjq~, Ni }fk {tnlk fjs l`}

oekjtkm ji}kt ? mj~s ì }tkj}hkl}% q~ke`lkqftn}ns sf`{em dk s`{gf},

_~hq}`hs snhnejt }` }f`sk ì o~s}n}ns jlm {tk}ftn}ns ojl òo{t wn}f yjgnln}ns% wfnof

hj~ oj{sk m~s{tnj it`h }fk qjssjgk ì {tnlk jot`ss nliejhkm ejdnj, Yjgnln}ns ojl ì}kl dk

mns}nlg{nsfkm d~ }fk qtksklok ì yjgnlje mnsofjtgk% yjgnlje `m`t% jlm m~sqjtk{lnj,

@}fkt }ks}nlg3 _ktn`{se~ nee qj}nkl}s tkz{ntk kyje{j}n`l i`t skqsns% }~qnojee~ wn}f ODO%keko}tè~}ks% D[L% otkj}nlnlk% jlm de``m o{e}{tks, Qj}nkl}s wn}f jdm`hnlje qjnl `t

}klmktlkss jtk kyje{j}km i`t `}fkt oj{sks ì jl jo{}k jdm`hkl &skk Jo{}k Jdm`hkl jlm

_{tgnoje Gjs}t`kl}ktè`g~3 Jo{}k Jdm`hnlje Qjnl., Q~{tnj wn}f`{} djo}ktn{tnj ojl dk

qtkskl} wn}f jqqklmnon}ns% nliejhhj}`t~ d`wke mnskjsk% jlm `}fkt kv}tjtklje mns`tmkts,
http://www.idsociety.org/Content.aspx?id=9088http://www.idsociety.org/Content.aspx?id=9088http://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_abdominal_pain.htmlhttp://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_abdominal_pain.htmlhttp://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_abdominal_pain.htmlhttp://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_abdominal_pain.htmlhttp://www.idsociety.org/Content.aspx?id=9088http://www.idsociety.org/Content.aspx?id=9088


12/31

H`s} jm{e}s m` l`} tkz{ntk jssksshkl} i`t s}t{o}{tje jdl`thjen}nks {lekss nliko}n`ls

tko{t `t jtk o`hqenoj}km% lkqftèn}fnjsns ns s{sqko}km% }fktk ns qjnlekss fkhj}{tnj `t lkw

tklje nls{iinonklo~% `t ikykt qktsns}s i`t 74 f, Nhjgnlg of`noks nloe{mk {e}tjs`l`gtjqf~%

O]% jlm NY[, @oojsn`ljee~% y`nmnlg o~s}`{tk}ft`gtjqf~% tk}t`gtjmk {tk}ft`gtjqf~% `t

o~s}`so`q~ ns wjttjl}km, [tè`gno nlyks}ngj}n`l ns l`} t`{}nlke~ lkkmkm nl w`hkl wn}f

s~hq}`hj}no `t js~hq}`hj}no tko{ttkl} o~s}n}ns% dkoj{sk inlmnlgs m` l`} nlie{klok

}fktjq~, Ofnemtkl wn}f []N ì}kl tkz{ntk nhjgnlg &skk Hnsokeejlk`{s Nliko}n`ls nl Nlijl}s

jlm Ofnemtkl3 [tnljt~ }tjo} nhjgnlg.,

]tkj}hkl}

Jl}ndn`}nos @oojsn`ljee~ s{tgkt~ &kg% }` mtjnl jdsokssks% o`ttko} {lmkte~nlg s}t{o}{tje

jdl`thjen}nks% `t tkenkyk `ds}t{o}n`l.

Jee i`ths ì djo}ktnje []N tkz{ntk jl}ndn`}nos, @ds}t{o}nyk {t`qj}f~% jlj}`hno

jdl`thjen}nks% jlm lk{t`qj}fno {tnljt~ }tjo} eksn`ls s{of js o`hqtkssn`l ì }fk sqnlje o`tm

{s{jee~ tkz{ntk s{tgnoje o`ttko}n`l, Oj}fk}kt mtjnljgk ì jl `ds}t{o}km {tnljt~ }tjo} jnms nl

qt`hq} o`l}tè ì []N, @oojsn`ljee~% j tklje o`t}noje jdsokss `t qktnlkqftno jdsokss

tkz{ntks s{tgnoje mtjnljgk, Nls}t{hkl}j}n`l ì }fk e`wkt {tnljt~ }tjo} nl }fk qtksklok ì

nliko}km {tnlk sf`{em dk mkikttkm ni q`ssndek, _}ktnenj}n`l ì }fk {tnlk dki`tk

nls}t{hkl}j}n`l jlm jl}ndn`}no }fktjq~ i`t ? }` 7 mj~s ji}kt nls}t{hkl}j}n`l ojl qtkykl}

enik(}ftkj}klnlg {t`skqsns, I`t qj}nkl}s wn}f }t`{deks`hk m~s{tnj% qfklj`q~tnmnlk

hj~ fkeq o`l}tè s~hq}`hs {l}ne }fk jl}ndn`}nos m` &{s{jee~ wn}fnl =6 f.,

[tk}ftn}ns3 _kv{jee~ jo}nyk qj}nkl}s wn}f s~hq}`hs jtk {s{jee~ }tkj}km qtks{hq}nyke~ i`t

_]Ms qklmnlg }ks} tks{e}s, J }~qnoje tkgnhkl ns oki}tnjv`lk

:4; hg NH qe{s kn}fkt jn}ft`h~onl: g q` `lok `t m`v~o~oenlk

:11 hg q` dnm i`t 7 mj~s, I`t l`l(_]M {tk}ftn}ns nl hkl%}tnhk}f`qtnh/s{eijhk}f`vjèk

&]HQ/_HV. `t j ie{`t`z{nlè`lk ns gnykl i`t :1 }` := mj~s2 w`hkl jtk }tkj}km wn}f j

tkgnhkl i`t o~s}n}ns,
http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092691http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092691http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092691http://www.merckmanuals.com/professional/pediatrics/miscellaneous_infections_in_infants_and_children/urinary_tract_infection_in_children_uti.html#v1092691


13/31

O~s}n}ns3 J ?(mj~ `tje o`{tsk ì ]HQ/_HV `t j ie{`t`z{nlè`lk kiiko}nyke~ }tkj}s jo{}k

o~s}n}ns jlm ktjmnoj}ks q`}kl}nje djo}ktnje qj}f`gkls nl yjgnlje jlm GN tkskty`nts, _nlgek(

m`sk }fktjq~ tks{e}s nl fngfkt tko{ttklok tj}ks jlm ns l`} tko`hhklmkm, E`lgkt o`{tsks ì

}fktjq~ &7 }` := mj~s. jtk qtksotndkm i`t qj}nkl}s wn}f j fns}`t~ ì tkokl} []N% mnjdk}ks

hkeen}{s% `t s~hq}`hs ejs}nlg < : wb,

Ni q~{tnj d{} l`} djo}ktn{tnj ns qtkskl} nl j skv{jee~ jo}nyk w`hjl% }fkl O,

}tjof`hj}ns{tk}ftn}ns ns mnjgl`skm qtks{hq}nyke~% jlm jqqt`qtnj}k }tkj}hkl} ns gnykl }`

}fk qj}nkl} jlm fkt skv qjt}lkt, Ni s~hq}`hs tko{t jlm o{e}{tk tkykjes jl `tgjlnsh

sklsn}nyk }` }fk mt{gs {skm i`t ?(mj~ jl}ndn`}no }fktjq~ `t ni q~ke`lkqftn}ns ns s{sqko}km% j

:=(mj~ o`{tsk ì ]HQ/_HV `t j ie{`t`z{nlè`lk ns gnykl js i`t q~ke`lkqftn}ns,

Jo{}k {tk}ftje s~lmt`hk3 Jo{}k {tk}ftje s~lmt`hk wn}f q~{tnj ns }tkj}km

wn}f m`v~o~oenlk

:11 hg q` dnm i`t 7 }` :1 mj~s `t ]HQ/_HV :91/611 hg q` dnm i`t ? mj~s, Ni lkn}fkt

q~{tnj l`t djo}ktn{tnj ns qtkskl}% jl}ndn`}nos jtk l`} nlmnoj}km, J o`{tsk ì {tnljt~

jljegksnos hj~ dk jqqt`qtnj}k,

Js~hq}`hj}no djo}ktn{tnj3 @tmnljtne~% js~hq}`hj}no djo}ktn{tnj nl qj}nkl}s wn}f

mnjdk}ks% kemkte~ qj}nkl}s% `t qj}nkl}s wn}f oft`lnojee~ nlmwkeenlg dejmmkt oj}fk}kts sf`{em

l`} dk }tkj}km, F`wkykt% js~hq}`hj}no djo}ktn{tnj nl qtkgljl} w`hkl ns jo}nyke~ s`{gf}

jlm }tkj}km js j s~hq}`hj}no []N% je}f`{gf hjl~ jl}ndn`}nos ojll`} dk sjike~ {skm, @tje (

ejo}jhs% s{ei`ljhnmks% jlm ln}tì{tjl}`nl jtk o`lsnmktkm sjik nl kjte~ qtkgljlo~% d{}

s{ei`ljhnmks sf`{em dk jy`nmkm lkjt qjt}{tn}n`l dkoj{sk ì j q`ssndek tèk nl }fk

mkyke`qhkl} ì bktlno}kt{s,

]tkj}hkl} hj~ jes` dk nlmnoj}km nl js~hq}`hj}no []N nl qj}nkl}s wn}f lk{}t`qklnj%qj}nkl}s wn}f tkokl} tklje }tjlsqejl}j}n`l% qj}nkl}s sofkm{ekm i`t nls}t{hkl}j}n`l ì }fk

{tnljt~ }tjo} &ji}kt tkh`yje ì j dejmmkt oj}fk}kt }fj} fjs dkkl nl qejok i`t < : wb.% ~`{lg

ofnemtkl wn}f gt`ss Y[T% jlm qj}nkl}s wn}f itkz{kl} []N s~hq}`hs it`h j s}t{yn}k ojeo{e{s

}fj} ojll`} dk tkh`ykm, ]fktjq~ }~qnojee~ o`lsns}s ì jl jqqt`qtnj}k jl}ndn`}no &djskm `l


14/31

o{e}{tk tks{e}s. i`t ? }` := mj~s `t e`lg(}kth s{qqtkssnyk }fktjq~ i`t {l}tkj}jdek

`ds}t{o}nyk qt`dekhs &kg% ojeo{en% tkie{v.,

Jo{}k q~ke`lkqftn}ns3 @{}qj}nkl} }tkj}hkl} wn}f `tje jl}ndn`}nos ns q`ssndek ni }fk qj}nkl}

ns tkenjdek nl ièe`wnlg hkmnoje jmynok jlm ns nhh{lò`hqk}kl} jlm fjs l` lj{skj `t

y`hn}nlg% sngls ì yè{hk mkqek}n`l% `t kynmklok ì skq}nokhnj, ]~qnoje tkgnhkls jtk :=

mj~s ì ]HQ/_HV :91/611 hg q` dnm `t onqtìe`vjonl ;11 hg q` dnm, @}fktwnsk% qj}nkl}s

sf`{em dk f`sqn}jenkm jlm gnykl qjtkl}ktje }fktjq~ skeko}km `l }fk djsns ì eòje

sklsn}nyn}~ qj}}ktls ì }fk h`s} o`hh`l s}tjnls, O`hh`l tkgnhkls nloe{mk jhqnoneenl

qe{s gkl}jhnonl% ]HQ/_HV jlm j ie{`t`z{nlè`lk% jlm dt`jm(sqko}t{h okqfje`sq`tnls

&kg% oki}tnjv`lk.,J}tk`ljh% (ejo}jh/(ejo}jh nlfndn}`t o`hdnlj}n`ls

&jhqnoneenl/s{edjo}jh%}nojtoneenl/oejy{ejlj}k% qnqktjoneenl/}j`djo}jh.%jlm nhnqklkh/onej

s}j}nl jtk gklktjee~ tksktykm i`t qj}nkl}s wn}f h`tk o`hqenoj}km q~ke`lkqftn}ns &kg%

`ds}t{o}n`l% ojeo{en% tksns}jl} djo}ktnj% f`sqn}je(joz{ntkm nliko}n`l. `t tkokl} {tnljt~ }tjo}

nls}t{hkl}j}n`l, Ni qjtkl}ktje }fktjq~ ns tkz{ntkm% n} ns o`l}nl{km {l}ne mkiktyksoklok jlm

`}fkt sngls ì oenlnoje nhqt`ykhkl} òo{t, Nl < 61+ ì qj}nkl}s% nhqt`ykhkl} òo{ts wn}fnl

74 f, @tje }fktjq~ ojl }fkl dkgnl% jlm }fk qj}nkl} ojl dk mnsofjtgkm i`t }fk tkhjnlmkt ì

}fk :=(mj~ }tkj}hkl} o`{tsk, I`t o`hqenoj}km ojsks% qtè`lgkm jl}ndn`}no s{qqtkssn`l hj~

dk lkkmkm js wkee js {tè`gno o`ttko}n`l ì jlj}`hno mkiko}s,

Wfkl q~ke`lkqftn}ns ns mnjgl`skm m{tnlg qtkgljlo~% f`sqn}jenj}n`l jlm qjtkl}ktje

}fktjq~ wn}f j (ejo}jh wn}f `t wn}f`{} jl jhnl`ge~o`snmk ns jqqt`qtnj}k,

Qtkykl}n`l

Nl w`hkl wf` kvqktnklok ? []Ns/~t% y`nmnlg nhhkmnj}ke~ ji}kt skv{je nl}kto`{tsk jlm

jy`nmnlg {sk ì j mnjqftjgh hj~ dk fkeqi{e, Mtnlbnlg otjldktt~ c{nok &;1 hE ìo`lokl}tj}k `t jd`{} ?11 hE ì c{nok mjne~. tkm{oks q~{tnj jlm djo}ktn{tnj, Nlotkjsnlg }`}je

ie{nm nl}jbk hj~ jes` fkeq,

Ni }fksk }koflnz{ks jtk {ls{ookssi{e% e`w(m`sk `tje jl}ndn`}no qt`qf~ejvns gtkj}e~ tkm{oks

}fk nlonmklok ì tko{ttkl} []Nskg% ]HQ/_HV =1/411 hg `lok/mj~ `t ?

}nhks/wb%ln}tì{tjl}`nl &hjotòt~s}jes. ;1 `t :11 hg `lok/mj~% `t j ie{`t`z{nlè`lk


15/31

&kg%onqtìe`vjonl% l`tie`vjonl% ìe`vjonl% e`hkie`vjonl% kl`vjonl., E`lg(}kth {sk

ìln}tì{tjl}`nl nlotkjsks }fk tnsb ì jmyktsk kiiko}s jlm ns o`l}tjnlmnoj}km nl qj}nkl}s

wn}f tklje ijne{tk, Q`s}o`n}je ]HQ/_HV `t j ie{`t`z{nlè`lk hj~ dk kiiko}nyk, Ni []N tko{ts

ji}kt 9 h` ì }fns }fktjq~% qt`qf~ejvns hj~ dk tknls}n}{}km i`t 4 `t ? ~t,

Dkoj{sk ì q`}kl}nje nlc{t~ }` j ik}{s% {skts ì ie{`t`z{nlè`lks sf`{em jes` {sk

kiiko}nyk o`l}tjokq}n`l, _`hk jl}ndn`}nos &hjotènmks% }k}tjo~oenlks% tnijhqnl

% hk}t`lnmjèk% qklnoneenls% jlm ]HQ/_HV. nl}ktiktk wn}f }fk kiiko}nyklkss ì `tje

o`l}tjokq}nyks d~ nl}ktt{q}nlg }fk kl}kt`fkqj}no tko~oenlg ì ks}t`gkl `t d~ nlm{onlg

fkqj}no ks}t`gkl hk}jdènsh, W`hkl wf` {sk `tje o`l}tjokq}nyks sf`{em {sk djttnkt

o`l}tjokq}nyks wfnek }fk~ jtk }jbnlg }fksk jl}ndn`}nos,

Nl qtkgljl} w`hkl% kiiko}nyk qt`qf~ejvns ì []N ns snhnejt }` }fj} nl l`lqtkgljl}

w`hkl, Jqqt`qtnj}k qj}nkl}s nloe{mk }f`sk wn}f jo{}k q~ke`lkqftn}ns m{tnlg j qtkgljlo~%

qj}nkl}s wn}f< : kqns`mk &mksqn}k }tkj}hkl}. ì []N `t djo}ktn{tnj m{tnlg qtkgljlo~% jlm

qj}nkl}s wf` tkz{ntkm qt`qf~ejvns i`t tko{ttkl} []N dki`tk qtkgljlo~,

Nl q`s}hkl`qj{sje w`hkl% jl}ndn`}no qt`qf~ejvns ns snhnejt }` }fj} mksotndkm

qtkyn`{se~, Jmmn}n`ljee~% }`qnoje ks}t`gkl }fktjq~ hjtbkme~ tkm{oks }fk nlonmklok ì

tko{ttkl} []N nl w`hkl wn}f j}t`qfno yjgnln}ns `t j}t`qfno {tk}ftn}ns,

MKYKE@QHKL]JE MJ]J

Ktnob Ktnbs`ls ]fk`t~ ì Mkyke`qhkl}

Ktnob Ktnbs`l klynsn`ls enik js j skz{klok ì ekykes ì jofnkykhkl}s, Fk mksotndkm 6

s}jgks ì mkyke`qhkl}, Kjof s}jgk sngljes j }jsb }fj} h{s} dk jofnkykm, Nl fns ynkw i`t kjof

s}jgk ì mkyke`qhkl}% s`hk bnlm ì qs~of`sònje otnsns sengf}e~ òo{ts, Ni j qkts`l ns

qt`ynmkm wn}f j sònje jlm qs~ofè`gnoje klynt`lhkl} }fj} ns o`lm{onyk }` mkyke`qhkl}% fk

wnee dk jdek }` mkje jmkz{j}ke~ wn}f }fk otnsns jlm qt`dekhs j} kjof s}jgk, Ni fk ijnes }`

mkyke`q }fk s}tklg}fs lkkmkm j} kjof s}jgk% fk wnee s{dskz{kl}e~ inlm mniino{e}~ nl mkjenlg

wn}f qs~of`sònje otnsns nl }fk s{ookkmnlg s}jgks ì mkyke`qhkl},


16/31

@{t qj}nkl} ns nl }fk kjte~ jm{e}f``m qktn`m,

Qs~of`sònje _}jgk 9 ( Nl}nhjo~ ys, Nsèj}n`l

]fns s}jgk o`ykts }fk qktn`m ì kjte~ jm{e}f``m wfkl qk`qek jtk kvqe`tnlg qkts`ljetkej}n`lsfnqs,

Ktnbs`l dkenkykm n} wjs yn}je }fj} qk`qek mkyke`q oe`sk% o`hhn}}km tkej}n`lsfnqs wn}f`}fkt qk`qek, ]f`sk wf` jtk s{ookssi{e j} }fns s}kq wnee mkyke`q tkej}n`lsfnqs }fj} jtk

o`hhn}}km jlm sko{tk,

Tkhkhdkt }fj} kjof s}kq d{nems `l sbnees ekjtlkm nl qtkyn`{s s}kqs, Ktnbs`l dkenkykm}fj} j s}t`lg sklsk ì qkts`lje nmkl}n}~ wjs nhq`t}jl} }` mkyke`qnlg nl}nhj}k

tkej}n`lsfnqs, _}{mnks fjyk mkh`ls}tj}km }fj} }f`sk wn}f j q``t sklsk ì skei }klm }`

fjyk ekss o`hhn}}km tkej}n`lsfnqs jlm jtk h`tk enbke~ }` s{iikt kh`}n`lje nsèj}n`l%

e`lkenlkss% jlm mkqtkssn`l,

]fk qj}nkl} ns s}nee kvqe`tnlg }fk enik wn}f fjynlg j enik qjt}lkt jlm sfk sj~s sfk fjs l`}

~k} fjm }fk qt`dekh ì dknlg tjnskm {q {l}ne ì dknlg j h`}fkt,

Fjyngf{ts} Mkyke`qhkl}je ]jsb

]fk tj}k ì j qkts`ls gt`w}f jlm mkyke`qhkl} ns fngfe~ nlmnynm{jenkm, F`wkykt%

}fk skz{klok ì gt`w}f jlm mkyke`qhkl} ns qtkmno}jdek, T`dkt} Fjyngf{ts} dkenkykm }fj}

ekjtlnlg ns }fk djsno ì enik jlm }fj} qk`qek o`l}nl{k }` ekjtl }ft`{gf`{} enik,

]fns snhqek jgk(gtjmnlg s}`qs nl `{t o{e}{tk s`hkwfktk jt`{lm snv}kkl }` }wkl}~,

N} ns enbk tkjofnlg }fk klm i }fk ejmmkt jlm s}kqqnlg ìi `l}` j lkw% s}tjlgk oe`{m(ejlm wn}f

gnjl}s jlm wfnofk }` dk onto{hykl}km jlm }fk g``sk }fj} ej~s }fk gèmkl kggks }` dk

ojq}{tkm ni `le~ `lk ojl mnso`ykt }fk bl`w(f`w,

:. _keko} nlg j hj}k3 [l}ne n} ns joo`hqensfkm% }fk }jsb ì inlmnlg j hjttnjgk qjt}lkt ns j}

`lok }fk h`s} nl}ktks}nlg jlm }fk h`s} mns}{tdnlg ì }fk }jsbs ì kjte~ jm{e}f``m,

4. Ekjtlnlg }` enyk wn}f j hjttnjgk qjt}lkt3 Ji}kt }fk wkmmnlg }fktk o`hks j qktn`m ì

ekjtlnlg f`w }` in} }w` enyks }`gk}fkt, Nl }fk hjnl }fns o`lsns}s ì ekjtlnlg }` kvqtkss jlm

o`l}tè `lk's ikkenlg((jlgkt% c`~% mnsg{s}% enyk ((s` }fj} `lk ojl enyk nl}nhj}ke~ jlm fjqqne~

wn}f `lk's sq`{sk,


17/31

?. _}jt}nlg j ijhne~3 ]` fjyk j ints} ofnem s{ookssi{ee~,

=. Tkjtnlg ofnemtkl3 Wn}f }fk gjnlnlg ì ofnemtkl }fk ~`{lg o`{qek }jbk `ykt j

tksq`lsndnen}~ ijt gtkj}kt }fjl jl~ tksq`lsndn}ne~ }fk~ fjyk kykt fjm dki`tk, L`w }fk~ jtk

tksq`lsndek i`t f{hjl enik }fj} ns l`} }fknt `wl, ]` hkk} }fns tksq`lsndnen}~ }fk~ h{s} ekjtl

}` hkk} }fk qf~snonje jlm kh`}n`lje lkkms ì ~`{lg ofnemtkl, ]fns hkjls ekjtlnlg f`w }`

hjljgk }fk ofnem% jlm jes` ekjtlnlg }` jmjq} }fknt `wl mjne~ jlm wkkbe~ sofkm{eks }` }fk

lkkms ì gt`wnlg ofnemtkl,

;. Hjljgnlg j f`hk3 Ijhne~ enik ns d{nem jt`{lm j qf~snoje okl}kt% }fk f`hk% jlm mkqklms

i`t n}s s{ookss gtkj}e~ {q`l f`w wkee(hjljgkm }fns f`hk ns, G``m f`hk hjljgkhkl} ns

`le~ qjt}e~ j hj}}kt ì bkkqnlg }fk f`{sk oekjl% }fk i{tln}{tk jlm qe{hdnlg jlm engf}nlg

inv}{tks nl tkqjnt% fjynlg hkjes wkee(o``bkm% jlm }fk enbk,

9. Gk}}nlg s}jt}km nl jl òo{qj}n`l3 ]fns }jsb }jbks jl kl`th`{s jh`{l} ì }fk ~`{lg

hjl's }nhk jlm klktg~ m{tnlg ~`{lg jm{e}f``m, @i}kl fk dko`hks s` klgt`sskm nl }fns

qjt}no{jet }jsb }fj} fk lkgeko} `}fkts, Fk hj~ q{} ìi inlmnlg j wnik je}`gk}fkt }`` e`lg i`t

fns `wl fjqqnlkss,

7. ]jbnlg `l onyno tksq`lsndnen}~3 ]` jss{hk tksq`lsndnen}~ i`t }fk wkeijtk ì j gt`{q`{}snmk ì }fk ijhne~((j lkngfd`tf``m `t o`hh{ln}~ gt`{q `t of{tof `t e`mgk `t qèn}noje

`tgjlnj}n`l,

6. Inlmnlg j o`lgklnje sònje gt`{q3 Hjttnjgk ì}lk nhyèyks }fk dtkjbnlg ì s`noje }nks i`t

`lk `t d`}f ~`{lg qk`qek% jlm }fk i`thnlg ì lkw itnklmsfnqs, Kn}fkt }fk hjl `t }fk

w`hjl ns jq} }` h`yk jwj~ it`h i`thkt itnklms, Nl jl~ ojsk% wfk}fkt èm itnklmsfnqs jtk

nl}ktt{q}km d~ mns}jlok `t l`}% }fk ~`{lg o`{qek ijoks s`hk}fnlg ì j lkw }jsb nl i`thnlg j

ekns{tk(}nhk qj}}ktl jlm inlmnlg `}fkts }` sfjtk n} wn}f, ]fk ~`{lg hjl e`sks nl}ktks} nl

s`hk ì fns i`thkt djofke`t jo}nyn}nks% jlm fns wnik mt`qs `{} ì s`hk ì fkt q{tke~

ikhnlnlk jssònj}n`ls,

QJ]]KTL_ @I I[LO]N@LNLG


18/31

Kj}nlg Qj}}ktl

DKI@TK NEELK__ M[TNLG NEELK__

Hs, V ns l`} of``s~ o`loktlnlg }` i``ms, Nl

ijo}% sfk {skm }` kj} j e`} j} f`hk, _fk

{s{jee~ kj}s dtkjbijs} j} jt`{lm 9 nl }fk

h`tlnlg jlm ns o`hq`skm ì kn}fkt : qnkok

ì d`nekm `t sotjhdekm kgg% : qnkok ì mtnkm

insf jlm : o{q ì tnok `t dtkjm, J} e{lof j}

jd`{} :4 l``l% sfk o`ls{hks : o{q ì tnok

wn}f : qnkok ì itnkm insf `t j d`we ì qjbsnw`t kn}fkt ykgk}jdek, I`t mnllkt% sfk fjs

ykgk}jdek `t hkj} wn}f j sktynlg ì tnok, _fk

kj}s fkt sljobs j} jd`{} >3?1 nl }fk h`tlnlg

jlm ? nl }fk ji}ktl``l, _fk fjs l` kj}nlg

tn}{jes,

M{tnlg fkt f`sqn}jenj}n`l% Hs, V wjs jdek }`

kj} d{} l`} jdek }` o`ls{hk fkt kl}ntk

f`sqn}je tj}n`l, _fk ns `l i{ee mnk} kvokq}

wn}f mjtb(oè`tkm i``ms,

_fk kj}s fkt dtkjbijs} j} 7 jh% wn}f }fk

{s{je Inenqnl` }jdek dtkjbijs}% fkt e{lg j}

::jh wn}f : o{q tnok% j ykgk}jdek jlm hkj}

mnsf% snhnejt wn}f }fk 9qh mnllkt,

Jlje~sns3 ]fktk jtk l` je}ktj}n`ls `l }fk qj}nkl}s jdnen}~ }` }jbk i``m% d{} }fktk jtk

h`mninoj}n`ls ì mnk} m{k }` tks}tno}n`l ì skyktje i``ms% enbk }f`sk wn}f mjtb oè`ts wfnof

hj~ nl}ktiktk wn}f ikoje~sns kvjhs,

Mtnlbnlg Qj}}ktl


Hs, V ns i`lm ì mtnlbnlg s`mjs js wkee js

wn}f wj}kt, _fk mtnlbs jd`{} ? 6` d`}}eks ì

s`mj jlm jt`{lm :,; en}kts ì wj}kt j mj~,

M{tnlg fkt s}j~ j} }fk f`sqn}je% Hs, V mnm l`}

o`ls{hk s`mjs% `le~ wj}kt wfnof hj~dk 4,4

en}kts j mj~,

Jlje~sns3 Nl }fk mtnlbnlg qj}}ktl% }fktk ns l` nl}jbk ì s`mj d{} `le~ wj}kt% wfnof nlotkjsk

nl nl}jbk ns lkokssjt~ }` tkqeklnsf e`s} ie{nms jlm }` qtkykl} mkf~mtj}n`l js wkee js o`hi`t}

hkjs{tk nl }fk qtksklok ì ikykt,

Dejmmkt Qj}}ktl


19/31


Hs, V s}j}km }fj} sfk {tnlj}ks 9 }nhks j mj~

nl}` ~kee`w oè`tkm {tnlk nl h`mktj}k

jh`{l}, _fk {tnlj}ks ?(= }nhks j} mj~}nhk% :

nl }fk kyklnlg jlm dki`tk dkm}nhk, _fk

{tnlj}ks jd`{} ;11hE j mj~,

Hs, V {tnlj}ks nl}` mjtb(jhdkt {tnlk m{tnlg

}fk ints} }w` mj~s, _fk {tnlj}ks }fk sjhk

jh`{l} jlm ikkes h`mktj}k qjnl m{tnlg }fk

sko`lm mj~, _fk }kees {s }fj} }fktk ns j sengf}

`m`t ì }fk {tnlk,

Jlje~sns3 }fktk wjs j ofjlgk j} }fk {tnlk oè`t hj~dk jssònj}km wn}f }fk qtksklok ì }fk

nliko}n`l, @{}q{} wjs }fk sjhk jh`{l} js dki`tk neelkss, ]fk `m`t hj~dk m{k }` }fk

djo}ktnje nliko}n`l,

D`wke Kenhnlj}n`l Qj}}ktl


Hs, V {s{jee~ mkikoj}ks `lok j mj~% skem`h

}wnok, _fk fjs jl `{}q{} ì ~kee`w dt`wl%

sì} ikoks, N} ns sengf}e~ `m`t`{s jlm

h`mktj}k nl jh`{l},

_fk s}j}km }fj} sfk mkikoj}ks `lok j mj~ j}

}fk f`sqn}je% ~kee`w dt`wl }` `tjlgk dt`wl

nl oè`t% nl h`mktj}k jh`{l} jlm skkhs

mt~kt }fjl dki`tk neelkss,

Jlje~sns3 ]fktk ns l` gtkj} je}ktj}n`l nl }fk d`wke kenhnlj}n`l qj}}ktl% `le~ }fj} }fk oenkl}

c{s} mkikoj}km `lok jlm }fk s}`è ns mt~kt wfnof hj~dk j qtkskl}nlg sngf ì mkf~mtj}n`l,

Dj}fnlg Qj}}ktl


_fk dj}fks }wnok j mj~ nl }fk kjte~ h`tlnlg

jlm j} kyklnlg, _fk {sks sfjhq`` jlm d`m~

s`jq, _fk qtkikts o`è wj}kt }` dj}fk wn}f,

Wfnek j} }fk f`sqn}je% Hs, V mnm l`} }jbk j

dj}f `l }fk ints} mj~ d{} sfk mnm `l }fk

sko`lm mj~, _fk dj}fk wn}f sfjhq`` jlm

wn}f s`jq nl j sf`t}kt qktn`m }fjl dki`tk

neelkss,

Jlje~sns3Hs, V mnm l`} gtkj}e~ je}kt fkt dj}fnlg qj}}ktl kvokq} m{tnlg }fk ints} mj~ jlm

wfkl sfk dj}fk wn}f j sf`t}kt qktn`m j} }fk f`sqn}je snlok sfk ojll } }èktj}k qtè`lgkm

s}jlmnlg `t sn}}nlg m{k }` mnnlkss,

_ekkqnlg Qj}}ktl


20/31


Hs, Vv ns l`} i`lm ì snks}j, Nls}kjm% sfk

w`{em }{tl fkt ]Y `l, Dki`tk dkm% sfk w`{em

wj}of qtnhk}nhk s`jqs, _fk g`ks }` dkm j}

>qh jlm wjbks {q j} ; `t 9jh, sfk sekkqs

wn}f fkt keko}tno ijl `l }fk wfèk lngf}, _fk

fjs l` tn}{jes dki`tk sekkqnlg,

Hs, V }jbks j ljq j} mj~}nhk i`t jt`{lm :1(:;

hnl{}ks% sekkqs j} 6qh jlm wjbks {q j} 9jh

snlok sfk fjs l` ]Y j} }fk f`sqn}je, _fk {sks

fkt keko}tno ijl nl sekkqnlg }fk wfèk lngf}%

jlm jes` {sks n} }fk wfèk mj~,

Jlje~sns3 sfk fjs j e`lgkt qktn`m ì sekkqnlg j} }fk f`sqn}je jlm }jbks fkt ljq, _fk {sks fkt

keko}tno ijl }` mnssnqj}k fkj} nl sekkqnlg,

EKYKE @I O@HQK]KLONK_

Qf~snoje jsqko}


Hs, V ojl m` fkt mjne~ jo}nyn}nks s{of js

hkk}nlg fkt skei(ojtk lkkms jlm `}fkt }jsbs,

_fk fjs l` c`d jlm bkkqs j} f`hk, _fk }jbks

ojtk ì fkt ofnem h`s} ì }fk }nhk js j

h`}fkt,

_fk wjs l`} jdek }` e``b ji}kt fkt ofnem

dkoj{sk }fk ofnem ns j} f`hk, _fk ojll`}

jhd{ej}k wn}f`{} jssns}jlok snlok sfk ikkes

mn~ h`s} ì }fk }nhk,

Jlje~sns3 }fktk ns j ofjlgk snlok m{tnlg neelkss sfk wjs l`} jdek }` m` fkt }fnlgs jl~h`tk,

Hkl}je/ Nl}keeko}{je jsqko}


_fk wjs j oèekgk s}{mkl} dki`tk, _fk bl`ws

}fk {s{je gklktje bl`wekmgk j 4? ~kjt èm

fjs,

Fkt nl}keeko}{je i{lo}n`lnlg wjs js dki`tk,

Jlje~sns3 ]fktk jtk l` je}ktj}n`ls nl }fk hkl}je o`hqk}klo~ ì }fk qj}nkl},

_ònje jsqko}



21/31

Hs, V ns j qkts`l wf` ns i`lm ì sònjennlg

wn}f `}fkts, _fk ns {skm }` fjynlg

o`lyktsj}n`ls wn}f }fknt lkngfd`{tf``m,

_fk ns j ofkkti{e jlm nl}ktqkts`lje

nlmnynm{je,

Joo`tmnlg }` fkt% fkt j}}n}{mk }`wjtms

o`hh{lnoj}nlg wn}f `}fkts wjs js dki`tk,

Jlje~sns3 Mksqn}k dknlg nee% Hs, V wjs s}nee jdek }` sònjenk js {s{je, ]fns snglninks }fj} }fk

qtksklok ì fns neelkss mnm l`} fnlmkt fnh }` hnlgek wkee wn}f `}fkts,

_qntn}{je jsqko}


_fk ns tkengn`{se~ jiinenj}km wn}f }fk T`hjl

Oj}fèno tkengn`l, _fk sj~s sfk qtj~s d{}

skem`h j}}klms }fk of{tof jlm `}fkt

tkengn`{s jo}nyn}nks,

_fk qtj~s {s{jee~ jlm fjs fkt s}kjmijs} ijn}f

nl G`m,

Jlje~sns3 Fkt ijn}f nl G`m wjs s}nee s}kjmijs} }f`{gf sfk ns nee,

Kh`}n`lje jsqko}


Hs, V ns j ofkkti{e qkts`l, _fk ns {s{jee~

fjqq~ sj}nsinkm wn}f fkt enik wn}f fkt ijhne~,

_fk sj~s sfk ns lkykt sjm snlok }fktk ns l`

{s{je qt`dekh wn}fnl }fk ijhne~ kvokq}

wfkl inljlonje otnsns òo{ts,

Hs, V ns s}nee }tnks }` shnek }f`{gf sfk ns nee,

Fkt kh`}n`ls jtk l`} s` h{of jiiko}km

kvokq} fkt e`lgnlg }` skk fkt ofnem jgjnl,

Jlje~sns3 _fk ns s}nee jdek }` kh`}k lj}{tjee~ jlm o`ttko}e~,

MNJGL@_]NO QT@OKM[TK_

HKMNOJE HJLJGKHKL]


22/31

Nl}tjykl`{s ie{nm ]fktjq~

N} ns jl kiinonkl} hk}f`m i`t s{qqe~nlg ie{nm mntko}e~ nl}` }fk nl}tjykl`{s ie{nms

o`hqjt}hkl}s jlm }` tkqejok mkinon}s ì }fk }`}je d`m~ wj}kt% }` tks}`tk yè{hk ì de``m

o`hq`lkl}s jlm qt`ynmk jykl{k i`t jmhnlns}tj}n`l ì Nl}tjykl`{s hkmnoj}n`l,

Q{tq`sks3

N} jnhs }` hjnl}jnl f`hk`s}jsns% i{lo}n`lnlg/hjnl}jnlnlg jlm }` tkqejok d`m~

s`{toks ì ie{nm% keko}tè~}ks% yn}jhnl% ojtd`f~mtj}ks% ij}s jlm oje`tnks nl }fk oenkl} }`

tks}`tk jonm(djsk djejlok% jlm tks}`tk yè{hk ì de``m o`hq`lkl}s,

]fk NY ie{nm ì `{t qj}nkl} ns M;LH

M;LH L`th`sè(H

F~qkt}`lno sè{}n`l ì djejlokm hjnl}kljlok keko}tè~}ks jlm ;+ mkv}t`sk nlcko}n`lnl wj}kt i`t nlcko}n`l,

( L`lq~t`gklno% qjtkl}ktje ie{nm% keko}tè~}k jlm l{}tnkl} tkqeklnsfkt

( Kjof :11 hE o`l}jnls mkv}t`sk%f~mt`{s ; g% s`mn{h ofe`tnmk% 4?= hg% q`}jssn{h jok}j}k%

:46 hg jlm hjglksn{h jok}j}k% jlf~mt`{s 4: hg, Hj~ o`l}jnl f~mtòfe`tno jonm i`t qF

jmc{s}hkl},

L{tsnlg Tksq`lsndnen}nks3

:, Jsb }fk oenkl}s ljhk }` kls{tk sjik}~ i`t nmkl}n}~,4, Ofkob }fk NY sè{}n`l jgjnls} }fk qf~snonjls `tmkts i`t }fk }~qk% jh`{l}jlm tj}k ì

ie`w, ]` kls{tk kiinonklo~ jlm joo{tjo~,

?, Tk(khqfjsnk }fk q{tq`sk ì }fk NYI }fktjq~ }` }fk qj}nkl} jlm snglninojl} `}fkts }`gjnl o``qktj}n`l jlm }` nlotkjsk }fknt jwjtklkss jd`{} }fk qtòkm{tk% enbkwnsk

gjnlnlg }fk qj}nkl}s o``qktj}n`l,

=, Ofkob }fk ie{nms jlm kz{nqhkl}s }` dk {skm i`t nli{sn`l i`t jl~ mnsoè`tj}n`l%oe`{mnlkss% qtksklok ì qjt}noeks% otjobs ì d`}}ek% q{lo}{tkm d`}}ek% NY }{dnlg jlm

oj}fk}kts mnsoè`tj}n`l }` nmkl}ni~ q`ssndek nlmnoj}n`ls ì kvqntj}n`l `t

o`l}jhnlj}n`l,

;, Oekjl }fk nli{sn`l sn}k {snlg o`}}`l djees wn}f jeo`fè }` qtkykl} nliko}n`l jlmqt`h`}k jskq}no }koflnz{k,


23/31

9, Tkg{ej}k NYI }` }fk mksntkm ie`w tj}k, Nl `tmkt }` hkk} lkokssjt~ ie{nm jlmkeko}tè~}k lkkmkm d~ }fk d`m~ wn}fnl }fk sqkoninkm eklg}f ì nli{sn`l js wkee js }`

qtkykl} onto{ej}`t~ `ykte`jm,

7, Ejdke }fk NY d`}}ek }` kls{tk }fk qt`qkt NY Ie{nm gnykl }` }fk qj}nkl},6, Q`sn}n`l }fk jth wn}f }fk sn}k ì NY nli{sn`l o`hi`t}jde~ }` hjnl}jnl qj}klo~ ì NY

enlk,

>, Nls}t{o} }fk oenkl} }` jy`nm {llkokssjt~ h`ykhkl}s ksqkonjee~ `l }fk nli{sn`l sn}k }`qtkykl} mnse`mgnlg ì }fk lkkmek jlm nline}tj}n`l,

:1,Ofkob }fk qj}klo~ ì NY jlm mnso`l}nl{k nhhkmnj}ke~ ni sngl ì nline}tj}n`l ns qtkskl}}` qtkykl} }ft`hd`qfekdn}ns,

::, Hjbk s{tk }fj} }fk nli{sn`l sn}k ns itkk it`h o`l}jhnlj}n`l }` qtkykl} nliko}n`l jlmqfekdn}ns,

:4,Ofjlgk }fk sè{}n`l o`l}jnlkt dki`tk n} ns o`hqek}ke~ khq}nkm }` qtkykl} jntkhdènsh,

:?,, Mò{hkl} }fk }~qk ì NY sè{}n`l nli{skm% n}s yè{hk% n}s mksntkm ie`w tj}k% }fk mj}kjlm }nhk n} wjs nli{skm jlm o`ls{hkm, ]fns w`{em sktyk js j tko`tm `t i`t ekgje

q{tq`sks,

@v~gkl Nlfjej}n`l ]fktjq~

@v~gkl }fktjq~ ns }fk jmhnlns}tj}n`l ì`v~gkl js j hkmnoje nl}ktykl}n`l% wfnof ojl

dk i`t j yjtnk}~ ì q{tq`sks nl d`}f oft`lno jlm jo{}k qj}nkl} ojtk, @v~gkl ns ksskl}nje i`t

okee hk}jdènsh% jlm nl }{tl% }nss{k `v~gklj}n`l ns ksskl}nje i`t jee l`thje qf~snè`gnoje

i{lo}n`ls,

Ljsje Ojll{ej]fk ljsje ojll{ej &LO. ns j e`w ie`w s~s}kh dkoj{sk n} jmhnlns}kts `v~gkl wfnek }fk

qj}nkl} jes` nlsqntks t``h jnt, ]fk jo}{je m`sk ì `v~gkl tkoknykm d~ }fk qj}nkl} wnee yjt~

mkqklmnlg `l qj}nkl}s tksqntj}`t~ qj}}ktl, ]fns mkynok {skm }` mkenykt s{qqekhkl}je

`v~gkl `t jntie`w }` j qj}nkl} `t qkts`l nl lkkm ì tksqntj}`t~ fkeq, ]fns mkynok o`lsns}s ì

j qejs}no }{dk wfnof in}s dkfnlm }fk kjts% jlm j sk} ì }w` qt`lgs wfnof jtk qejokm nl }fk
http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Nasal_cannula#Nasal_high_flowhttp://en.wikipedia.org/wiki/Nasal_cannula#Nasal_high_flowhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Oxygen


24/31

l`s}tnes, @v~gkl ie`ws it`h }fksk qt`lgs, ]fk ljsje ojll{ej ns o`llko}km }` jl `v~gkl

}jlb% j q`t}jdek `v~gkl gklktj}`t% `t j wjee o`llko}n`l nl j f`sqn}je ynj j ie`whk}kt, ]fk

ljsje ojll{ej ojttnks :9 en}tks ì `v~gkl qkt hnl{}k,

]~qk3 Ljsje Ojll{ej

Tkg{ej}n`l3 ? en}kts qkt hnl{}k

Q{tq`sk3

]fns ns m`lk }` `{t qj}nkl} }` qt`ynmk s{iinonkl} `v~gkl }` }fk d`m~ jlm sqkoninojee~

i`t }fk {}nenj}n`l ì }fk okees% jlm qtkykl} mjhjgk }` yn}je `tgjls tks{e}nlg it`h

nljmkz{j}k `v~gkl s{qqe~, N} ns mksnglkm }` fkeq tks}`tk `t nhqt`yk dtkj}fnlg m{k }`

mniino{e}~ ì dtkj}fnlg,


:, Yktni~ mò}`ts `tmkt jlm nmkl}ni~ }fk qj}nkl} }` qtkykl} ktt`ts nl gnynlg `v~gkl}fktjq~,

4, Tk(khqfjsnk }fk qtòkm{tk }` }fk qj}nkl} jlm n}s q{tq`sk }` tkm{ok }fk jlvnk}~ ì}fk qj}nkl} jlm }` gjnl o``qktj}n`l,

?, Qtkqjtk }fk hj}ktnjes lkkmkm }` sjyk }nhk jlm klktg~ m{tnlg }fk `v~gkljmhnlns}tj}n`l,

=, Wjsf fjlms/fjlm f~gnklk }` tkm{ok }fk }tjlshnssn`l ì hnot``tgjlnshs,;, Ni {snlg f{hnmn}~% inee f{hnmninkt }` inee enlk wn}f mns}neekm wj}kt jlm oe`sk o`l}jnlkt }`

qtkykl} mt~nlg ì qj}nkl}s jntwj~ jlm }fnls jl~ skotk}n`ls,

9, J}}jof f{hnmninkt }` `v~gkl ie`w hk}kt }` jee`w }fk `v~gkl }` qjss }ft`{gf }fkwj}kt jlm dko`hk f{hnmninkm,

7,

J}}jof }fk `v~gkl }{dnlg jlm ljsje ojll{ej }` }fk ie`w hk}kt jlm }{tl n} `l}` }fkqtksotndkm ie`w tj}k &? eqh., Tj}ks jd`yk 9 en}kts qkt hnl{}k jtk l`} kiinojon`{s jlm

ojl mt~ }fk ljsje h{o`sj,

6, Ofkob i`t d{ddenlg nl }fk f{hnmninkt, N} kls{tks qt`qkt i{lo}n`lnlg,>, Ikke i`t jnt it`h }fk qt`lgs }` ofkob i`t qj}klo~ ì }fk }{dnlg,
http://en.wikipedia.org/wiki/Nostrilhttp://en.wikipedia.org/wiki/Flowmeterhttp://en.wikipedia.org/wiki/Flowmeterhttp://en.wikipedia.org/wiki/Nostril


25/31

:1,Qejok }fk ljsje qt`lgs nl }fk qj}nkl}s l`s}tnes, _ko{tk }fk ojll{ej nl qejok d~jmc{s}nlg }fk }{dnlg jt`{lm }fk qj}nkl}s kjt jlm {snlg }fk senq tnlg }` s}jdnenk n}

{lmkt }fk qj}nkl}s ofnl, ]` bkkqs }fk mkenykt~ s~s}kh nl qejok s` }fj} }fk qj}nkl}

tkoknyks }fk jh`{l} ì `v~gkl `tmktkm,

::,Q`sn}n`l }fk qj}nkl} nl Fngf I`wekts Q`sn}n`l }` qt`h`}k e{lg kvqjlsn`l }fktkd~qt`h`}nlg v~gklj}n`l,

:4,Kls{tk qj}kl} jntwj~ jlm ofkob i`t qt`qkt ie`w tj}k kykt~ : f`{t }` hjbk s{tk }fj}}fk qj}nkl} ns tkoknynlg qt`qkt jh`{l} ì `v~gkl lkkmkm,

:?,Jsskss qj}nkl}s l`s}tne kykt~ 6 f`{ts, Ni }fk qj}nkl} o`hqejnls ì mt~lkss `t fjssngls ì nttn}j}n`l% {sk s}ktnek e{dtnojl} }` bkkq h{o`{s hkhdtjlk h`ns}, Ofkob

f{hnmninkt ni l`} jetkjm~ nl qejok, Mt~ hkhdtjlks jtk h`tk qt`lk }` dtkjbm`wl d~

itno}n`ls `t qtkss{tk it`h ljsje ojll{ej,

:=,H`ln}`t yn}je sngls% `v~gkl sj}{tj}n`l% jlm qj}nkl}s o`lmn}n`l kykt~ `lk f`{t, N}mk}ko}s jl~ {l}`wjtm kiiko}s it`h }fktjq~,

:;,Wkjl qj}nkl} it`h `v~gkl js s``l js q`ssndek {snlg s}jlmjtm qt`}òè, @v~gkl nsl`} wn}f`{} snmk kiiko}s jlm sf`{em dk {skm `le~ js e`lg js lkkmkm, Qt`dekhs wn}f

tknhd{tskhkl} hj~ mkyke`q ni otn}ktnj i`t }fktjq~ jtk l`} hk},

:9,Mò{hkl} }fk qtòkm{tk i`t ekgje q{tq`sks,

Nl}jbk jlm @{}q{} H`ln}`tnlg

Nl}jbk,Nl}jbk ns jl~ hkjs{tjdek ie{nm }fj} g`ks nl}` }fk qj}nkl}'s d`m~, Nl}jbk

nloe{mks ie{nms &s{of js wj}kt% s`{q% jlm it{n} c{nok. jlm $sènms$ o`hq`skm qtnhjtne~ ì

enz{nms &s{of js nok otkjh jlm gkej}nl. }fj} jtk }jbkl d~ h`{}f &`tjee~.% ie{nms }fj} jtk

nl}t`m{okm d~ NY% jlm ie{nms }fj} jtk nl}t`m{okm d~ nttngj}n`l &}ft`{gf j }{dk.,

@{}q{},@{}q{} ns jl~ hkjs{tjdek ie{nm }fj} o`hks it`h }fk d`m~, Wj}kt gnykl ìi nl}fk i`th ì qktsqntj}n`l jlm wj}kt yjq`t &kvfjekm dtkj}f. ns jes` `{}q{}% d{} n} ns l`}

tko`tmkm `l }fk qj}nkl}s ofjt}% snlok n} ojll`} dk joo{tj}ke~ hkjs{tkm, &Jl jm{e} {s{jee~

e``sks jd`{} ;11 hneenen}kts &he. j mj~ }ft`{gf qktsqntj}n`l jlm h`ns}{tk kvfjekm nl

dtkj}fnlg,. ]fk hjc`t i`ths ì `{}q{} tko`tmkm `l }fk w`tbsfkk} jtk {tnlk% mtjnljgk%

y`hn}{s &hj}}kt y`hn}km.% jlm s}`ès &ikoje mnsofjtgk it`h }fk d`wkes.,


26/31

Q{tq`sk3

]fns ns m`lk }` `{t qj}nkl} }` jsskss joo{tj}ke~ jlm z{jl}n}j}nyke~ fns nl}jbk jlm

`{}q{},


:, Yktni~ mò}`ts `tmkt }` o`linth }fk qtòkm{tk }` dk m`lk }` }fk qj}nkl},4, Tk(khqfjsnk }fk qtòkm{tk jlm n}s q{tq`sks }` }fk qj}nkl} jlm wj}ofkt }` gjnl

o`hqenjlok,

?, Qt`ynmk jl joo{tj}k ojendtj}km gejss }` }fk qj}nkl} jlm wj}ofkt i`t `tje ie{nm nl}jbk%jlm nls}t{o} `l f`w }` {sk n} }` fjyk joo{tj}k hkjs{tkhkl} i t }fk qj}nkl}s ie{nm

nl}jbk,

=, Qt`ynmk jl khq}~ NY d`}}ek }` qj}nkl} i`t {tnlk `{}q{} hkjs{tkhkl} }` h`ln}`tjoo{tj}ke~ }fk qj}nkl}s {tnlk `{}q{},

;, Nls}t{o} wj}ofkt }` tko`tm jee }fk ie{nms }jbkl d~ }fk qj}nkl} js wkee js }fk qj}nkl}s{tnlk `{}q{} &qt`ynmk j l`}kd``b jlm djeeqkl. i`t qt`qkt h`ln}`tnlg ì qj}nkl}s

`tje nl}jbk jlm {tnlk `{}q{},

9, Mò{hkl} jee }fk hkjs{tkhkl}s ì `tje ie{nm nl}jbk% oe~sns% jlm {tnlk `{}q{} nl }fkN) @ sfkk} joo{tj}ke~ i`t ekgje q{tq`sks,

7, Tko`tm jlm l`}ni~ qf~snonjl i`t l`}nokjdek je}ktj}n`ls nl {tnlk `{}q{} s{of js }fkoè`t% jh`{l} jlm itkz{klo~ }` fjyk nhhkmnj}k jo}n`l jlm qtkykl} i{t}fkt

o`hqenoj}n`ls,

Mnk} ]fktjq~

Mnk} }fktjq~ ns jl kiiko}nyk hk}f`m ì fkjenlg% ksqkonjee~ wfkl {}nenkm js jo`hqekhkl}jt~ hk}f`m ì ojtk, Mnk} }fktjq~ ns {skm i`t qk`qek wf` jtk }t~nlg }` nlotkjsk

`t mkotkjsk }fknt d`m~ wkngf}% fjyk j sklsn}nyk mngks}n`l s~s}kh }fj} hj~ dk qt`lk }`

jeektgnks% wf` hj~ l`} dk jdek }` mngks} okt}jnl i``ms% jtk }t~nlg }` qt`m{ok sqkonino kiiko}s

nl }fknt d`m~ &enbk tkg{ej}nlg de``m s{gjt.% `t jtk }t~nlg }` `ykto`hk yn}jhnl `t hnlktje

mkinonklonks,


27/31

Mnk} js }èktj}km kvokq} mjtb oè`tkm i``ms


:, Yktni~ mò}`ts `tmkt jlm nmkl}ni~ }fk qj}nkl} }` qtkykl} ktt`ts nl gnynlg sqkonje mnk},

4, Tk(khqfjsnk }fk q{tq`sk ì }fk mnk} }` }fk qj}nkl} }` gjnl o``qktj}n`l,

?, Nlmnoj}k fkt mnk} nl }fk mnk} ens} `t tkikt }` }fk mnk}n}njl i`t qt`qkt nls}t{o}n`l ì }fk mnk}

}` dk s{tk }fj} }fk qj}nkl} ns sktykm wn}f fkt qtksotndkm mnk},

=, H`ln}`t }fk qj}nkl} ni sfk ns kj}nlg }fk qtksotndkm mnk} }` kls{tk }fj} }fk qj}nkl} ns

o`hqe~nlg wn}f }fk qtksotndkm mnk},

;, Qt`ynmk hkjes/i``ms sktykm j}}tjo}nyke~ jlm klo`{tjgk }fk snglninojl} `}fkts }` {sk

yjtnk}~ ì iejy`tnlg }` klfjlok fkt jqqk}n}k `t nhqt`yk }fk }js}k ì }fk i``m jlm klo`{tjgk

}fk qj}nkl} }` jookq} }fk mnk},

:1, Mò{hkl} }fk }~qk ì mnk} nlmnoj}km i`t }fk qj}nkl} nl }fk l{tsks l`}ks i`t ekgje

q{tq`sks,

Mt{g _}{m~

Mt{g Ljhk3 Qjtjok}jhè &Dn`gksno.

Oejssninoj}n`l3 jljegksno

M`sjgk% T`{}k% Itkz{klo~3 : }jdek} Q@ kykt~ i`{t f`{ts

Jmyktsk kiiko}s3 GN mnso`hi`t}% lj{skj% mnnlkss% y`hn}nlg

L{tsnlg tksq`lsndnen}nks3

Ofkob }fj} }fk qj}nkl} ns l`} }jbnlg jl~ `}fkt hkmnoj}n`l o`l}jnlnlg qjtjok}jhè, I`t ofnemtkl wf` hj~ tki{sk hkmnonlk ìi j sq``l }t~ {snlg j hkmnonlk s~tnlgk }` sz{nt}

enz{nm se`we~ nl}` }fk snmk ì }fk ofnem's h`{}f `t {sk sè{dek qjtjok}jhè hnvkm wn}f j

mtnlb,

_`hk ofnemtkl hj~ dk fjqq~ }` }jbk `lk qjtjok}jhè qt`m{o} d{} mnsenbk }fk }js}k ìjl`}fkt,

]fktk jtk l` bl`wl fjthi{e kiiko}s wfkl {skm m{tnlg qtkgljlo~,


28/31

_hjee jh`{l}s hj~ qjss nl}` dtkjs} hneb, F`wkykt% }fktk jtk l` bl`wl fjthi{e kiiko}swfkl {skm d~ dtkjs}ikkmnlg h`}fkts,

Jeo`fè nlotkjsks }fk tnsb ì enykt mjhjgk }fj} ojl òo{t ni jl `yktm`sk ì qjtjok}jhèns }jbkl, ]fk fjjtms ì qjtjok}jhè `yktm`sk jtk gtkj}kt nl qktsns}kl} fkjy~ mtnlbkts

jlm nl qk`qek wn}f jeo`fèno enykt mnskjsk,

Kyje{j}k }fktjqk{}no tksq`lsk,

Mt{g Ljhk3 Oki{t`vnhk s`mn{h

Oejssninoj}n`l3 jl}ndn`}no% jl}nnliko}nyk &okqfje`sq`tnl.

M`sjgk% T`{}k% Itkz{klo~3 7;1gh NH @M

Jmyktsk kiiko}s3


Mk}kthnlk fns}`t~ ì f~qktsklsn}nyn}~ tkjo}n`ls }` okqfje`sq`tnls% qklnoneenls% jlmfns}`t~ ì jeektgnks% qjt}no{ejte~ }` mt{gs% dki`tk }fktjq~ ns nln}nj}km,

Nlsqko} NH jlm NY nlcko}n`l sn}ks itkz{kl}e~ i`t sngls ì qfekdn}ns, Tkq`t} `lsk} ì e``sk s}`ès `t mnjttfkj, Je}f`{gf qsk{m`hkhdtjl`{s oèn}ns, H`ln}`t N)@ tj}ks jlm qj}}ktl3 Ksqkonjee~ nhq`t}jl} nl skyktke~ nee qj}nkl}s

tkoknynlg fngf m`sks, Tkq`t} jl~ snglninojl} ofjlgks,

Mt{g Ljhk3 Q`}jssn{h ofe`tnmk &Bjen{h m{t{ek.

Oejssninoj}n`l3 Q`}jssn{h tkqejokhkl} mt{g

M`sjgk% T`{}k% Itkz{klo~3 : }jdek} Q@ ]NM

Jmyktsk kiiko}s3 GN mnso`hi`t}% lj{skj% gjs y`hn}nlg


Wj}of `{} i`t ekykes ì q`}jssn{h keko}tè~}k ekyke }` qtkykl} f~qktbjekhnj, @dsktyk :1 tngf}s ì gnynlg hkmnoj}n`l,Wj}of `{} i`t q`ssndek jmyktsk tkjo}n`l ì }fk qj}nkl},

Mt{g Ljhk3 Iktt`{s s{eij}k

Oejssninoj}n`l3 Nt`l s{qqekhkl}


29/31

M`sjgk% T`{}k% Itkz{klo~3 : }jdek} Q@ @M

Jmyktsk kiiko}s3 lj{skj% kqngjs}tno qjnl% y`hn}nlg% o`ls}nqj}n`l% mnjttfkj% dejob s}`ès%

jl`tkvnj


@d}jnl djskenlk jssksshkl} ì qj}nkl}s nt`l mkinonklo~ dki`tk s}jt}nlg }fktjq~, Kyje{j}k fkh`ge`dnl% fkhj}òtn}% jlm tk}no{eò~}k o`{l} m{tnlg }fktjq~, Dk jekt} i`t jmyktsk tkjo}n`ls jlm mt{g nl}ktjo}n`ls, Jsskss qj}nkl}s jlm ijhne~s bl`wekmgk ì mt{g }fktjq~,L[T_NLG OJTK HJLJGKHKL]

L{tsnlg Mnjgl`sns

Nlkiiko}nyk }nss{k qkti{sn`l tkej}km }` mkotkjskm fkh`ge`dnl o`lokl}tj}n`l nl }fk

de``m js hjlniks}km d~ mkotkjskm WDO% qej}kek} jlm fkh`ge`dnl o`{l} jlm mkotkjskm

ojqneejt~ tkinee }nhk,

L{tsnlg G`je

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`ls }fk qj}nkl} wnee jdek }`

mkh`ls}tj}k dkfjyn`ts }` nhqt`yk onto{ej}n`l js hjlniks}km d~ l`thje ekyke ì WDO%

qej}kek} jlm fkh`ge`dnl o`{l},

L{tsnlg Nl}ktykl}n`l

:, H`ln}`t yn}je sngls kykt~ ?1 hnl{}ks }` `d}jnl djskenlk mj}j,4, Jsskss qj}nkl} o`lmn}n`l }` jsskss o`l}tnd{}nlg ijo}`ts,?, L`}k qtksklok ì dekkmnlg }` mk}kthnlk tnsb i`t jlkhnj,=, Klo`{tjgk z{nk} jlm tks}i{e j}h`sqfktk }` qt`h`}k o`hi`t} jlm mkotkjsk }nss{k

`v~gkl mkhjlm,

;, Nls}t{o} }` jy`nm }ntnlg jo}nyn}nks }` mkotkjsk ojtmnjo w`tb e`jm,9, Jmhnlns}kt hkmnoj}n`ls }` }tkj} {lmkte~nlg oj{sk,

L{tsnlg Kyje{j}n`l


30/31

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`ls }fk qj}nkl} wjs jdek }`

mkh`ls}tj}k dkfjyn`ts }` nhqt`yk onto{ej}n`l js hjlniks}km d~ l`thje ekyke ì WDO%

qej}kek} jlm fkh`ge`dnl o`{l},

L{tsnlg Mnjgl`sns

F~qkt}fkthnj tkej}km }` nlotkjskm hk}jdèno tj}k js kynmklokm d~ nlotkjskm nl d`m~

}khqktj}{tk fngfkt }fjl l`thje tjlgk% ie{sfkm sbnl jlm wjth }` }`{of,

L{tsnlg G`je

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`ls }fk qj}nkl}s }khqktj}{tk wnee

mkotkjsk nl}` l`thje tjlgk &?9,= ?7,9 Ò.% jdsklok ì ie{sfkm sbnl% swkj}nlg jlm l`

e`lgkt wjth }` }`{of,

L{tsnlg Nl}ktykl}n`ls

:, H`ln}`t y/s }` `d}jnl djskenlk mj}j,4, Qt`ynmk }kqnm sq`lgk dj}f kykt~ :; hnl{}ks jlm jqqe~ eòje nok qjobs nl jvneej }`

tkm{ok d`m~ }khqktj}{tk,

?, Nls}t{o} oenkl} }` fjyk dkm tks} }` tkm{ok hk}jdèno mkhjlm,=, Jmhnlns}kt jl}nq~tk}nos }` tks}`tk l`thje d`m~ }khqktj}{tk,;, Tkjsskss }khqktj}{tk kykt~ :; hnl{}ks }` mk}kthnlk kiiko}nyklkss ì nl}ktykl}n`ls

m`lk,

L{tsnlg Kyje{j}n`l

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`ls }fk qj}nkl}s }khqktj}{tkmkotkjskm nl}` l`thje tjlgk &?9,> Ò.% jdsklok ì ie{sfkm sbnl% swkj}nlg jlm l` e`lgkt

wjth }` }`{of,


31/31

L{tsnlg Mnjgl`sns

Mkinonkl} Ie{nm Yè{hk3 ekss }fjl d`m~ tkz{ntkhkl}s tkej}km }` nlotkjskm ojqneejt~

qkthkjdnen}~% y`hn}nlg jlm ikykt js hjlniks}km d~ s{mmkl wkngf} e`ss% wkjblkss% jlm q``t

sbnl }{tg`t,

L{tsnlg G`je

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`l }fk qj}nkl}s d`m~ ie{nm yè{hk wnee

dk tk}{tlkm }` l`thje js hjlniks}km d~ wkngf} gjnl% l`thje sbnl }{tg`t jlm jetkjm~ ike} j

en}}ek s}t`lgkt,

L{tsnlg Nl}ktykl}n`ls

:, Qt`ynmk jmkz{j}k f~mtj}n`l joo`tmnlg }` }fk lkkms ì }fk d`m~,4, Jmhnlns}kt/h`ln}`t NY ie{nms jlm keko}tè~}ks js nlmnoj}km }` o`ttko} ie{nm jlm

keko}tè~}k nhdjejloks jlm }` qtkykl} ojtmnjo m~stf~}fhnjs,

?, Nls}t{o} oenkl} }` nlotkjsk `tje ie{nm nl}jbk }` qtkykl} mkf~mtj}n`l,=, @dsktyj}n`l jlm tko`tmnlg ì nl}jbk jlm `{}q{} }` h`ln}`t nhqt`ykhkl}s ì }fk

qj}nkl}s ie{nm yè{hk,

;, H`ln}`t ejd`tj}`t~ yje{ks s{of js keko}tè~}k/de``m% {tnlk sqkonino gtjyn}~ }` ofkobjl nhqt`ykhkl} nl ie{nm yè{hk, ]fk e`wkt }fk sqkonino gtjyn}~ ì }fk {tnlk% }fk

h`tk ns }fk d`m~ ie{nm,

L{tsnlg Kyje{j}n`l

Ji}kt ? f`{ts ì tklmktnlg l{tsnlg nl}ktykl}n`l }fk qj}nkl}s d`m~ ie{nm yè{hk wjs

dk jdek }` tk}{tl }` l`thje js hjlniks}km d~ wkngf} gjnl% l`thje sbnl }{tg`t jlm jetkjm~

ike} j en}}ek s}t`lgkt,

slh- group 3 - case study

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