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Strokes and the protocol of a stroke for Emergency Medical Services of the South Bohemian Region
SCHWARTZ, Kamila
The topic of this thesis are the Stroke and the Protocol of a Stroke for Emergency Medical Services of the South Bohemian Region. The teoretical part of this thesis includes basic anathomy and pathophysiology facts of brain necessary for understanding of a cerebrovascular accident. Afterwards the chapters are focused on the CVA itself. First of all are described the definition and a basic division of Strokes. In the next chapter are described possible high-risk factors leading to an inception of a cerebrovascular accident. The following topic is the Clinical Picture of Ischemic and Hemorrhaging CVA, diagnostic method used in a hospital facility. The important chapter is the therapy of a cerebrovascular accident in a preliminary medical care, there is also described the Protocol of a Stroke and potential patient's aiming to an acute medical treatment. The two last chapters are focused on a hospital medical treatement and after-care. The intention of this thesis is the maping of theoretical knowledge and differences in application of the Protocol of a Stroke aplicated by paramedics and nurses working in the Emergency Medical Service of the South Bohemian Region. We also wanted to evaulate a cooperation with Stroke Centers that can help to get the patient to undergo a medical performance as fast as it is possible which is essential for the patient and improves many times a future quality of life. Practical part tooks place by the method of a qualitative research. There were used semi-structured interviews with paramedics and nurses employed by Emergency Medical Services of the South Boheminan Region. The interviews included twelve questions concerning theoretical knowledge about the Cerebrovascular Accident, knowledge of the Stroke Protocol and filling in of of it, evaulation of co-operation and a telephonic consultation with Stroke Centers in the South Bohemian Region. Furthermore there was led a semi-structured interview with the doctor of the Complex Cerebrovascular Centre in České Budějovice and with the doctor of the Stroke Centre in Písek. The interviews consited of five questions concerning primarily a frequency of occurrence of the Stroke Protocol during the submittig of the patient and the evaulation of the consultation of patient's condition using the Stroke Telephone. Transcribed interviews are the component of practical part. The evaulated answers were catalogued into the charts for a better arrangement and orientation.
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Nurses and physical therapist cooperation for clients after stroke
ŠOULOVÁ, Kateřina
Theoretical base: The brain stroke is one of the most frequented illness which affect our population and which belongs to the second place between reasons of the death. We can divide strokes by origin on ischemics and hemoragics. The biggest part of strokes is composed of ischemics brain strokes, approximately 85%. The rest of strokes are hemoragics brain strokes. When affect patient the brain stroke is necessary fast transport to the hospital, screening and institution of medical treatment. Important part of medical treatment is comprehensive health care which is arranged thanks for the good function multidisciplinary team. It is necessary cooperation of nurses and physiotherapist in the rehabilitation care too. Last not least it is necessary that the patient is the part of the care and the motivation to the cooperation trying to return him to his normal life. My bachelor work is divided into the theoretic part and empiric part. In theoretic part we talk about brain stroke, health care, rehabilitee care and cooperation between nurses and physiotherapist. In empiric part there are results of the research.The objective of the work: The object of empiric part was mapping the cooperation of nurses and physiotherapists with clients after brain stroke in the hospital. For realization of the objective were determinate two questions. In what consist the cooperation between nurses and physiotherapists with clients after the brain stroke? The second question was: What problems complicate the cooperation between nurses and physiotherapists? Methodology: For processing the bachelor work was used qualitative research. For collecting dates we used forms of hidden observation and half structured conversations. The research was realized with 7 nurses and 3 physiotherapists in the hospital in neurologic ward and after care ward. The collection of dates was realized by the approval of the main nurse and head nurses in wards which I named. For keeping the anonymity the agreement is not the part of the bachelor work but it is possible to see it at author of the bachelor work. The research was anonymous, observation and conversations were realized from 23.3.2015 to 17.4.2015. For realization of the research was used the form f hidden participating observation. Discovered dates were written into the diary of observations of sisters (annexe 5) and of physiotherapists (annexe 6) during the observation. Discovered information were rewritten and evaluated. For collecting dates was applicate half structured conversation. I put 35 questions to nurses (annexe 7) and 28 questions to physiotherapists (annexe 8) which were completed thanks for other questions. Conversations were realized with the group of observed nurses and physiotherapists. Answers were written and then rewritten (annexe 9). Obtained dates were analysed, evaluated and sorted into categorical groups. Solutions: Thanks for the research we could see the cooperation between nurses and physiotherapists. The cooperation between them is in the passing on information because awareness is key for giving care. We discovered that they cooperate in rehabilitee care like is setting into position, putting clients to sit down on another place, putting clients to sit down, half help and practise of daily activities. The deficiency was noticed in not cooperation of nurses with physiotherapists next to the bed of the client. From conversations we discovered that nurses are not informed from physiotherapists about correct setting into right position even it is in their competence. From results we can see that the cooperation between nurse and physiotherapist hardly the deficiency of time which we can see in passing information and two-way cooperation. Other factor is changing of physiotherapists in the ward and insufficient consultation in the care of the patient.
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Nursing care of patients with stroke
BALGOVÁ, Veronika
This thesis is divided into a theoretical and an empirical part and it deals with nursing and patient care after a stroke. The theoretical part comprehensively summarized the issues related to stroke. It deals with the definition of the disease given, its causes, symptoms, diagnosis, complications and therapy. Very important part is the area of nursing care that due to the nature of the disease, carries many specifics and includes comprehensive care, which may include stroke centers. There were stated objectives for this bachelor thesis: 1. To identify the problematic areas when providing nursing care to the patient after a stroke. 2. To secure the patient´s satisfaction with nursing care. Based on these objectives there were asked two research questions: 1. What are the problematic areas in nursing care of patients after a stroke? 2. Are patients satisfied with nursing care? The empirical part of this bachelor thesis presents the results of a qualitative research. The form of a semi-structured interview and a hidden observation was used. The interview with five nurses working in the neurology department and with five respondents who have had a stroke was conducted on the basis of questions prepared in advance. When analyzing the results, the method of "paper and pencil" was used. The processed results were categorized and then split into subcategories. The hidden observation was focused on five nurses working in the neurology department. Observation results were recorded into an observation diary and eventually evaluated. All of the research questions asked were answered by realizing and processing the survey. The results of the survey point to a very good quality of nursing care provided in the neurology department. However, based on interviews and observations, some minor flaws occurred. One of them is the lack of respect for privacy and intimacy while providing nursing care and inadequate defecation reflex training. It was further found that nurses presented the rehabilitation as the most important part in providing nursing care, but they unfortunately did not take part in it. Another problem mentioned by nurses is the lack of time to be able to individually work on all interventions that have been chosen. As a great positive we can present big satisfaction of respondents with the approach of nurses in providing nursing care. Based on the result of this research an informative brochure was created. This booklet can serve to the nursing staff as a kind of summary of the principles needed to be held when giving nursing care about patients with the issues mentioned above. It can also be used as a teaching tool for students.
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The issues of patient´s self-sufficient after cerebrovascular accident at ward of subsequent care
MACHKOVÁ, Marcela
Cerebrovascular accident is a serious destructive condition with suddenly formed infliciton of cerebral blood vessel. There might appear obstruction and taper of them or defect on wholeness of vascular wall which result into hemorrhage to brain tissue. Sings of this condition might be termporary with physical and psychical changes or fatal which end up with serious paralysis, unconsciousness or even death of individual. Cerebrovascular accident problematics is currently a big challenge for the entire society, because progressiveness of European society´s aging is likely to bring increase in total amount of this disease´s causes. The first important step in problematics of the disease is to reduce the risk of stroke by consistent prevention; general lifestyle changes; blood pressure controls and treatment; lipid, coagulation factor and heart disease observation and compensation. The second step, when speaking about already formed disease, is to start well-timed and complex therapy which provides the patient with distinctly higher chance of better final clinical status without permanent harm. After overcoming the acute phase in neurology department the patient carries on with another therapy acorrding to seriousness of his/her condition in rehabilitation or aftercare department. Therapeutic, nursing and rehabilitation care should be set to contain all aspects of lost self-sufficiency encouragement and should be oriented mainly on person who has, even after stroke, his/her own needs, motivations, leisure time activities and skills. The bachelor thesis starts with medical part which describes brain anatomy, deals with epidemiology and stroke history. More detailted stroke characteristics and disease itself are defined by etiology, clinical picture, diagnostics and treatment. This part is then ended up with stroke consequences, factors influecing patient´s recovery, patient´s needs and self-sufficiency after stroke. Multidisciplinary team and aftercare deparment create an independent chapter and after this starts a new chapter interested in the role of nurse and needed nursing interventions, evaluation techniques during basic needs saturation of patients after stroke. Therapeutic rehabilitation creates almost the last important part of the bachelor thesis, on which depend gradual recovery and patient´s future life quality after this desease. The recovery part includes physiotherapy, occupational therapy, speech-language pathology, neuropsychology, spa treatment and prosthetic security of patient. Then, the whole thesis is ended up with patient´s preparation on release into home environment. The first set aim is to find out patient´s needs to reach the maximal functional independence and self-sufficiency after stroke according to previously studied sources. The second aim is to find out the nurse´s role in the encouragement of patient´s self-sufficiency and the third aim is to find out nursing interventions in the encouragement of patient´s self-sufficiency after stroke according to previously studied sources. The whole bachelor thesis is mainly taken as theoretical. It tries to insight into problematics of all needs, self-sufficiency encouragement and patient´s maximal functional independence after stroke according to previsously studied sources and information obtained from consultants, physiotherapists and general nurses. Then, the thesis deals with the role of nurse and nursing interventions in patient´s self- sufficiency encouragement on aftercare department to satisfy his/her essential needs of life without someone else´s help after the disease. After a gradual improvement of functional disability, the whole life quality and the independence of patient, it is necessary to follow all nursing, medical and rehabilitation procedures very carefully without their neglect with a sufficient amount of medical staff and specialized doctors.
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Hippotherapy as a supporting therapy in patients with stroke
ČERVENÁ, Kateřina
This bachelor thesis deals with hippotherapy as supportive therapy of patients with stroke. Our starting platform is from the practical experience of therapists hippotherapy's centers Pirouette and available literature. The work is traditionally divided into theoretical and practical. The theoretical part provides an overview of current knowledge and is divided into two chapters, which dealing with the issue of stroke and hippotherapy. There are explained basic concepts necessary for insight into the problems of work. As part of subchapter about of stroke describing its dividing, the causes, consequences, and treatment. In hippotherapy I deal with the principles of hippotherapy effect and its impact to humans, both physically and mentally. In the research part describes the objectives of the work and the research itself. For the purposes of work I chose the design of qualitative research - a case study, which was carried out on three probands after a stroke. The probands were selected from the "Centre of hippotherapy Pirouette" Havlíčkův Brod, where it was from the end of September 2014 to mind January 2015 performed a practical application of hippotherapy under the expert guidance of a certified therapist. Data collection was conducted three complex processing of case studies using the technique of observation (kinesiology analysis of motor skills), secondary data analysis and interview with probands. The aim of this thesis is to map the effect of hippotherapy for patients with stroke and the develop specific hippotherapy's procedures in these patients. The purpose why the work was created, is an effort to improve awareness about hippotherapy as supporting methods for patients after stroke and objectification many years of practical experience hippotherapy's center "Pirouette". The outputs of this work can also be further utilized as educational material for students of physiotherapy and hipoterapeuty alone or as a basis for further research in this area.
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Cooperation between a Home Care Nursing Agency and Family Members in the Care for Patients after Cerebrovascular Accident
SILOVSKÁ, Petra
Cerebrovascular accident means acute vascular brain damage. It may have various causes. This includes either blocking of a vein with a blood clot, vasoconstriction or combination of the aforementioned causes. Frequent symptoms of CVA are paralysis, weakness, loss of sensitivity in face or on one side of a limb. Another symptom may be speech disturbance. Cerebrovascular accident may be identified as brain ischemia and hemorrhagic ictus. The thesis includes characteristics and symptoms of the aforementioned types. Furthermore, the thesis describes examination methods and treatment for CVA. Consequences of CVA may include some forms of paresis or plegia, which brings limitation of self-sufficiency for a client. Thus, it is necessary to start timely rehabilitation which shall engage the affected body parts. If the client suffers from speech disturbance as a consequence of CVA s/he should be treated by a speech specialist. If the client does not stay in hospital facilities the family may use service of a home care agency. If the client's health allows s/he may stay at his/her home and a nurse from the home care agency may come to his/her home regularly and helps the client's family. The nurse performs all the required activities and s/he also makes the family engaged in the care. Communication forms an inseparable part of the care. The thesis called Cooperation of nurses and family members within care for a patient who suffered from cerebrovascular accident used qualitative research. The interviews were taken with nurses from home care agency and with family members who take care for a patient who suffered from cerebrovascular accident. The survey was categorized and charted to make it more illustrative. The aim of the thesis was to identify the extent of cooperation between nurses from home care agency and family members taking care for a patient who suffered from cerebrovascular accident, and then to define in which activities the family members may be engaged, and finally to describe how the nurse from home care agency communicates with the family. The nurses' point of view has shown the same positive results and they were satisfied with family's engagement in care for the patient. The revealed results of the survey may be provided to the home care agency to allow assessment of the effect of nurses' work on the overall condition of the clients.
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Comprehensive system of rehabilitation in younger individuals after stroke
BEČVÁŘOVÁ, Lucie
Title of the bachelor thesis is Comprehensive rehabilitation in younger individuals after stroke. The aim of this thesis was to determine the subjective perception of individuals´ needs after stroke. The theoretic part is divided into two main chapters. The first one contains brief information about the disease, its types, anatomy and physiology background and symptoms. The second chapter deals with the issue of comprehensive rehabilitation and its parts. Particular approaches are defined and described in detail, health professionals working in this area are also mentioned here. The research part was processed by a method of qualitative research strategy. Semi-structured interview technique and observation were used. The research set included 5 respondents - four men and one woman. Past history of stroke and age of individuals between 45 and 55 years were the inclusion criteria for this research. Interview was held according to scenario questions, where I focused on two areas. First section included information about the respondent, his disease and treatment in the way of comprehensive rehabilitation. In the second part, respondents were asked how their life had changed after the experience of stroke. The interview was audio-recorded and then verbatim transcribed. One of the respondents did not wish to be audio-recorded, thus written notes were taken during the interview. Interviewing results are presented in a narrative format. By conducting this research I tried to answer the following question: What are the needs of individuals at various stages of stroke recovery? Need of self-sufficiency was mentioned by all respondents. In early stage, it was mainly coping with basic activities such as food intake, control of excretion, verbal expression and movement. In the later phase of treatment, there are increasing demands on self-care, understanding ability, memory and social interaction. Individuals often went through an intensive therapy. After returning back to their home environment, the need of self-realization, activation and meaningful ways to spend a free time are the most significant issues. This work should provide more information on the given topic.
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Identifikace a kvalifikovaný odhad nákladů na léčbu cévní mozkové příhody v ČR na základě farmakoekonomické analýzy a návrh alternativního řešení
Pokorná, Hana
Background: Stroke is the second most frequent cause of death in developed countries and the most frequent cause of permanent disability. This way this illness creates high costs for society which should be minimized as much as possible. One of the possibilities is to administer cost-saving drugs which are at the same time from the medical point of view of the top quality and their economic effectiveness can be identified by means of pharmacoeconomic analysis. Objective: The objective of the work is to identify and carry out a quantified estimate of costs connected with the stroke treatment in the Czech Republic. Next is the necessary to confront the results with the alternative solution to the treatment (taking drug Xarelto instead of Warfarin) and to carry out comparison of the both the possibilities from the quantitative point of view. Methods: Costs of stroke treatment are evaluated from the social point of view. From their determination COI method with type of bottom-up approach has been picked out which includes all-life cost-of-illness. For comparison of costs both the treatment vari-ants the Cost-Minimization Analysis (CMA) has been chosen, the results of which shows net cost savings. Data are taken from non-public data of the provider (St. Anne 's Uni-versity Hospital Brno), Institute of Health Information and Statistics of the Czech Republic, Czech Statistical Office, foreign studies and consultations with neurologists as well. Results: Total social costs of treatment of stroke were 12 991 273 843,65 CZK. COI method was used to calculate average costs for one patient with Warfarin in the amount of 1 203 423,68 CZK, in case of alternative treatment with Xarelto in the amount of 1 465 963,32 CZK. Relaps creates the biggest item of the costs. CMA method was used to identify savings when Warfarin is administered in the average amount of 262 539,64 CZK per patient. The hypothesis that Xarelto is more effective from the economic point of view has not been confirmed. Conclusion: Because of high cost of Xarelto, this drug has not beaten the economic effectiveness of Warfarin with lower quality. It is possible to search for savings in other items of identified costs as well.
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Activity of the radiographer at the emergency department.
PIŠTĚKOVÁ, Martina
A patient with urgent condition which threatens his life or health requires special approach of a radiology assistant to executed diagnostic performances. In this bachelor thesis, I describe procedures in case of these conditions. Because the given topic is quite extensive, I preferred a detailed description of the most serious conditions. I chose the topic because of its timeliness. The number of patients with urgent condition has an upward character for sure because of accelerated life pace and related traumas as well as diseases of civilization. My work describes three researches. The first one finds out the share of different investigations in the radiodiagnostic department as regards patients with urgent condition per one year in one hospital. The second one is related to the refresher courses of radiology assistants in relation to patients with urgent condition. The third one investigates algorithms of investigations in the radiodiagnostic department in different medical facilities. The bachelor thesis is divided into a theoretical and practical part. The theoretical part explains the term "urgent condition" and basic description of the approach to a patient in the given situation. I mention brief principles of cardiopulmonary resuscitation. I analyse individual modalities used in the radiodiagnostic department. Other subchapters are focused on the description of concrete conditions and sequence of investigations. The practical part begins with the chapter called "Targets, Hypothesis". It is concentrated on the description of the main role of my work which is discovery of radiology assistants´ approach to patients with urgent condition and the situation in education of radiology assistants in the Czech Republic. Some parts compare the condition with the situation in other countries of the European Union. The chapter called "Discussion" is devoted to the general evaluation of researches. It mentions also the important role of radiology assistants when treating patients with urgent condition. The "Conclusion" evaluates meeting of targets of this thesis and outlines possible solutions.
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Physiotherapy for Stroke Patients in Chronic Stage Using the Methods of the Neurophysiological Basis
HANZALOVÁ, Jitka
The topic of the thesis is the physiotherapy based on neurophysiological methods for chronical stage stroke patients. The stroke is a lesion of a part of the brain tissue which develops suddenly from lack of blood perfusion in the area. The clinical manifestation of stroke can differ widely depending mainly on localization, extent, graveness and duration of the reduced blood perfusion or encephalorragia. This results in need of special rehabilitation programme made for each patient individually. The main principle of physiotherapy based on neurophysiological methods is prospering from plasticity of the neural tissue which is preserved in spite of severe injury of the brain. These methods influence control mechanisms in central nervous system by activation of various neural receptors. This therapy affects the patient complexly, it is not aimed at analytic muscle training. The purpose of this thesis was to prove and to evaluate the significance of the neurophysiological methods based physiotherapy for chronical stage stroke patients. The thesis consists of theoretical part and practical part. The theoretical part resumes information on the stroke, its risk factors, complications, consequences etc. The next part briefly describes some of the neurophysiological methods which can be used for the stroke rehabilitation. These particular methods were then utilized in the practical part during physiotherapy sessions with concrete patients. The theoretical part also informs about other means of complex rehabilitation which can be used for treating chronical stage stroke patients. The practical part records physiotherapeutical treatment with the patients. In the practical part of the thesis qualitative research method was used and following methodics: anamnesis, entering examination, special examination by Chedoke for hemiplegia scoring, the records of each therapy session and evaluating the effect of the therapy, which show that physiotherapy for stroke patients is meaningful in chronical stage as well and that the methods and concepts used are suitable. The thesis may serve as a source of information for healthcare professionals and other people taking part in care of the chronic stage stroke patient.
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