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Nurse's role in the nutrition of patients in intensive care
VACKOVÁ, Veronika
This bachelor thesis is divided into two parts theoretical and empirical and the purpose of this thesis is to deal with the topic of the nurse´s role in the nutrition of patients in intensive care. In the theoretical part of the thesis, complex issue of the nutrition ensure of intensive care patients is summarized. We have been dealing not only with the common concept of the nutrition on the intensive care units and the role of the nutrition therapist but also with the characteristics, causes and diagnosis of the malnutrition as the most serious issue in the nutrition field. In the thesis, the types of a nutrition support in the intensive care have been also defined as well as the indication, contraindication, types of serving, complications, types of medicines, monitoring and the related role of the nurses. The practical part provides with the results of the research, which have been found by using a qualitative research method. The main purpose of this bachelor thesis was to emphasize the role of the nurse by the handing enteral and parenteral nutrition and also a description of the cooperation with the nutritional therapist on the associated intern and neurological unit of intensive care at České Budějovice hospital. At the basis of above mentioned, two objectives have been stated. At first, our task is to find out the way how is the right handing of the nutrition to the intensive care patient by the nurse secured. The second task is finding out the way of cooperation of the nurse and the patient while securing the nutrition of the patients in the intensive care unit. For the first task, four research questions have been established, for the second task have been established one research question. For the high-quality data network, the method of hidden monitoring for keeping authenticity has been used. As a consequence of the insufficient amount of data to the reaching of the second task, half-structured interview has been chosen instead. Research dataset consisted of thirteen records of sighting and one interview on the above mentioned intensive care unit. As a basis for analyses, three observation sheets were made, into these sheets were then during the observation information assigned. Each sheet consisted of single points planned in accordance to theoretical part. The nurse follows these points when securing the patient´s nutrition. Remaining information, not included in observation sheet were written into the notes section or were included into the information about the performing of the particular point. The results were analyzed by using an open-coding. There are six categories coming out from the analyses, which are connected with securing the education, information providing, keeping an obstacle-free approach complications preventing, using tools, nurse´s cooperation with the patient and deciding processes during work performance. In the results, there is a conclusion of the analysis with illustrative examples to find. The sequence of the results is presented according to sequence of categories during performing. In each category, the results are evaluated according to research tasks stated. We believe, that the obtained information, which map the activities of the nurses when securing the nutrition at the intensive care unit patients and the acquainting the cooperation with the nutrition therapist helps in the future to the awareness of the potential weaknesses and following correction. The results may become inspiration for more detailed analysis of this topic.
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Nutrition of children and adolescents with cancer
VLKOVÁ, Lucie
Diagnosis and treatment of these diseases are still significantly improving and it turns out that nutrition is a significant part of the outcome. But it can be sometimes difficult or even impossible for the patient to follow dietary guidelines. It's possible that patients can have problems with food intake, their taste can alter altogether, or some food can even raise the need to vomit. Furthermore, food doesn't fulfill just biological needs, but it's a significant for psychological needs, too. It's therefore necessary to look at this issue from broader point of view.The aim of this thesis was to describe the composition and serving methods of nutritious meals in various stages of treatment of children and adolescents with cancer, and to map the experiences as well as view of young patients, their families and their nursing staff on whether and how it is possible to meet the nutritional recommendations while satisfying taste preferences of children. I was looking for answers to two research questions: 1. How has the method of service and the composition of diet been changing throughout the treatment in order to maintain sufficient nutrition? 2. What are the views of young patients, their parents and their attending physicians on the possibilities of maintaining nutritional recommendations? The text is divided into two parts: theory and research. The theoretical part describes the Pediatric Oncology issues and the most common types of cancer in young patients, it also mentions the possibilities of prevention. Then this part deals with side effects of cancer therapy, changes in metabolism, malnutrition, cancer cachexia and anorexia. The biggest part is devoted to nutrition nutritional status assessment, nutritional needs and forms of nutritional support. The last section contains recommendations for situations with food intake complications and the ways of increasing the nutritional contents of diet. Due to complexity of the topic I chose a mixed research strategy, several different methods of collecting and processing of data as well as questioning of various groups of respondents. I was observing 45 oncology patients children and adolescents aged 4 to 18, who are undergoing treatment at the Clinic of Pediatric Oncology in Brno, their parents (7) and their nursing staff (2). The data processing method was qualitative and quantitative analysis of questionnaire responses, interviews content analysis, observation, creation of case study, calculations of menus from the program "Nutriservis Profesional". Results are presented in graphs, tables and plain text. It's divided into three subsections. The composition and method of serving the nutritional meals depends on the needs of patients, their age, diagnosis, treatment and complications, which occur in the course of treatment. It also depends on the cooperation of patients themselves and their families. Different approach is with adolescent patients and with children as well as when they're treated at home or in the hospital. At some stages it is necessary to adjust the nutritional diet to have an adequate nutrition, at other stages the nutritional support is in sipping and when there are complications, which accompany the treatment, the method of service is changed into oral, by probe, or parenterally. Keeping of dietary recommendations represent a significant problem for these patients, which are troubles with food intake during the treatment (95% of patients). Due to children's taste preferences are some forms of nutritional support rejected, even though they are able to maintain the nutritional recommendations. Both young patients as well as their parents have preference for children's taste rather than nutrition. There were some exceptions, however. Opinions of the nursing staff are the same it all depends on the attitude of patients themselves and their families.
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Nutrition of patients on surgical departments
ČERMÁKOVÁ, Michaela
The bachelor work called the Nutrition of Patients at Surgical Wards occupies with nutrition of surgical patiens, their energetic nutrition intake and the intake of the basic nutrients during their stay in hospital, ie proteins, fats and carbohydrates. The aim of the work is to find out how many calories on average the patiens at the surgical ward consumed per day. The theoretical section is divided into two parts. In the first part there are described the basic components of food and their recommended daily intake. The second part deals with the problem of various illnesses typical at surgical wards. This part also deals with diets that are often indicated at the area of surgery. For realization of the practical part there was used the method of mixed research. The facts were gained with the help of observation and semi structured interviews. The research team was created by men and women of various age categories who were healed at the surgical ward in Pribram hospital in August 2014. For three days it was recorded how much food the patiens consumed. Then, they were interviewed. The effort was to find out the reason why the patiens had not eaten the meal or if they had not consumed their own food. On the basis of the collected facts there was made a graph (frequency of the consumed hospital food), there was made each patient´s menu using the programme Nutriservis, comparison of the food energy that the patients were given during these free days and that they really ate. Energetic values of hospital food were compared just roughly with energetic needs of an average woman and an average man. To sum up this research, it was realized that only one patient during this period was rating nutritionally rich food. Other 17 patients were not eating enough. On average, the patiens were eating 60% of recommended energy during this research. One of the reasons was the type of the respondents. The patients at the surgical ward had serious healthy problems, they did not feel well and thatsway they ate less than usually. Some patiens did not have a good appetite or they did not like the hospital meals. The next reason were the planned medical examinations and nutritionally poor food given the patiens by the hospital.
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Nutrition of patients in a geriatric departments
ARNOŠTOVÁ, Zuzana
This bachelor thesis is dedicated to the nutrition of patients in geriatric wards. The theoretical part is divided into five main chapters. The first chapter explains the term "geriatric patient", the second chapter describes the physiological and biochemical changes and use of nutrients in old age. The third chapter deals with prescription drugs in old age, the fourth chapter nutrition of geriatric patients and the fifth chapter is devoted to nutrition disorders in old age. The practical part is divided into two parts. The first part is the quantitative research which was done in three hospitals in aftercare departments via questionnaire. The questionnaire focused on patient satisfaction with meals, the quality and quantity of food and drinking regime. The research group consisted of patients in geriatric wards at the age over 60 years. There were distributed 61 questionnaires and their total return was 100%. The second part evaluates a specific menu which was provided by Hospital in Písek. Standard portions in the menu were evaluated in the "Nutriservis Profesional", they were calculated: energy intake, protein, carbohydrates, fat and fiber. Results of energy intake and nutrient value of the menu were compared with diet recommendations for the people older than 65 years given by the literature "Reference values for nutrient uptake, 2011". There were laid down three objectives. The first objective is to describe the level of catering in geriatric wards in terms of quantity and quality of the food. The second objective is to determine whether patients at geriatric wards adequately comply fluid intake. The third objective is the satisfaction of geriatric patients with catering at geriatric wards. The catering in terms of quantity and quality is optimum. According to the survey and also evaluation of the menu, the portion size of main dishes is excessive, but the meals are served only 3 times a day. According to the survey, more than half of the patients eat only half portions, thereby decreasing energy and nutrients intake, therefore providing snacks would be the appropriate solution. Regarding the quality of food, it would be advisable to diversify the menu and include foods from all quadrants of food pyramid. Drinking regime is optimum. Half of the patients complies drinking regime the other half of patients neglect the drinking regime. A possible solution for these patients is to increase controlling or supplement of drinking regime by own drinks. Half of the patients are satisfied with the catering, the other half would like to change the flavor of food, the problem is mainly seasoning. Patients in geriatric departments would welcome more information on catering and preparation of meals, and also a greater possibility to choose main dishes. This bachelor thesis might be used for making the information material, which could be used for better awareness of geriatric patients catering. The nutrition of geriatric patients is a hot topic and its importance should not be forgotten.
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The importance of nutritional support in the treatment of wounds.
PUCHNAROVÁ, Jana
This bachelor thesis is devoted to the importance of nutrition support for therapy of wounds. Today the importance of nutrition support is generally known in all branches of medicine. Due to malnutrition bad healing of wounds occurs. From this reason each nurse should be aware of the importance of proper and balanced nutrition together with proper care of healed wounds. Proper nutrition protects people against infections, facilitates the process of healing and improves therapeutic results. The theoretical part is engaged in the importance of nutrition support, malnutrition, nutrition team, peroral support, and enteral and parenteral nutrition. It further deals with acute and chronic wounds, phases of healing, factors influencing healing, and nursing care of wounds. Two targets were set within the research. The first target was to monitor the knowledge of the importance of nutrition support for healing of wounds nurses have. The other target was to find out whether nurses have active attitude towards the questions of nutrition support when healing wounds. The empirical part uses the method of quantitative research survey together with the method of data collection using a non-standardised questionnaire. The research group consisted of nurses working on shifts and charge nurses working in internal medicine wards, surgical wards and after-care wards in the Jindřichův Hradec Hospital a.s and the České Budějovice Hospital a.s. The questionnaire consisting of 31 questions was filled in by 126 nurses. Processing of the survey was carried out using Microsoft Office Excel 2007. The questionnaire is stated in Annex No.2. Three hypotheses were assessed on the basis of the targets. H1: Nurses are aware of the importance of nutrition support for healing wounds. H2: Nutrition support is provided to patients on the basis of nutrition screening. H3: Nutrition support records are made by charge nurses.
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The Specifics of the nursing care in catering for long- term dialysis patients
ŠRÁMEK, Kamil
Haemodialysis is a method of removing waste substances such as potassium, urea and excess water from the blood during renal failure. Hemodialysis is one of three renal replacement therapies. Other treatments are a kidney transplant and peritoneal dialysis. Hemodialysis can be performed either in the hemodialysis center, or in a hospital, but home hemodialysis is not too frequent. Eating for dialysis patients differs significantly from the forward dialysis diet period. A well balanced diet is the foundation of everything. The patient may neither be malnourished, nor to have surplus of any components in their diet. A diet for patients in dialysis program must meet two basic requirements; the diet must provide enough energy and substances needed by the body mainly amino acids required for the production of protein, calcium, vitamins, iron, restrict certain substances that accumulate in the body is harmful, for example, fluid restriction, excess protein from which the formation of urea, excess phosphorus, which accelerated calcification of blood vessels, excess potassium, which at high levels in the blood can cause heart rhythm disturbances. Qualitative research was carried out by interview. The interview contained a total of twenty semi-structured questions and was prepared in advance. Each interview was anonymous and each respondent had the opportunity to refuse it. With the consent of the respondent and the ward nurse, the interview was recorded on a tape recorder and later adapted into an electronic form, which became the basis for the research. From the research arose categories. Qualitative research file conducted in hospitals Prachatice, České Budějovice and Třebíč. The research sample consisted of five respondents in the Nemocnice Prachatice a. s. Another research sample consisted of five respondents in Nemocnice Třebíč and two respondents in the Nemocnice České Budějovice a. s. All respondents were patients who regularly attend to hemodialysis centers in these cities. Interviews with respondents were conducted from February to April 2014. In the Nemocnice České Budějovice a. s. the research survey was conducted with the consent of the Deputy for nursing care, Mgr. Kyselová. In Nemocnice Prachatice a. s. the research survey was conducted with the consent of the head nurse in the hospital Janoušková and in the Nemocnice Třebíč the research was conducted with the consent of the Deputy for nursing care Mgr. Andělová. The results of the survey provide mapping meals in the hospital for long-term dialysis patients. The benefits of the research will be to develop an information leaflet on the topic: The importance of catering for dialysis patients.
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Principles of nutrition in chronic hemodialysis patients
MATĚJKOVÁ, Miroslava
Nutrition plays a major role in the treatment and preventing the progression of renal disease. Malnutrition is the determining factor for morbidity and mortality in dialysis patients. Patients with renal disease tend to have reduced food intake, due to loss of appetite, depression, but also as a consequence of chronic inflammation or lack of antioxidant mechanisms. Poor nutritional status of these patients must be recognized early and treated. It is important to ensure adequate intake of energy, protein and calcium, and at the same time to reduce intake of potassium, sodium, phosphate and fluids. A supplementation of vitamins and micronutrients may be appropriate. The nutritional status should be checked regularly. The research part demonstrates the dependence of laboratory values on nutritional status and a positive effect of education on patients' compliance with the recommended diet.
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Specifics of feed nutrition to patients in acute and septic state
HOLOUBKOVÁ, Martina
This bachelor thesis describes specifics of nutrition for patients in acute and septic state. It is aimed at improvement of awareness and information of nurses that care about these patients, on the problems of malnutrition and possibilities of specific nutrition. The theoretical part describes malnutrition - imbalanced diet, as a risk factor that complicates the course of disease, extends the hospitalization time and increases mortality. There is also an outline of cooperation with nutrition specialists, diet recommendations and methods of feeding patients in acute disease stage. Enteral end parenteral feeding is analyzed here. The conclusion of the theoretical part deals with the organism inflammatory response syndrome, sepsis, multiorganic dysfunction, like complications threatening a patient in acute state. There are also diet recommendations for patients in septic state. The practical part of this thesis contains results of quantitative research based on data collection by means of an anonymous questionnaire designed for nurses or healthcare rescuers of anaesthetic-resuscitation departments and intensive care units. A nursing care standard focused on assistance in introduction of central venous catheter and consequent patient care was elaborated as the output of the work upon study of the issues of nutrition for patients in acute and septic state, specific possibilities of its administration and evaluation of the research results. The bachelor thesis may also be used as study material for education of healthcare staff caring about patients in acute or septic state.
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Risk of malnutrition for people with schizophrenia
GIERTLOVÁ, Petra
Schizophrenia is a servus mental illness. The majority of people suffering from this illness require lifelong treatment. The prevalence of risk factors such as development of cardiovascular dinase, diabetes, dyslipidemia, overweight, obesity is higher with regard to the patiens with schizophrenia. A large number of these people have bad rating habits, lack of physical aktivity and nicotine dependence. The use of antipsychotik mediactions also contributes to increased storage of fat and overweight.This Bachelor Thesis consists of teoretici and practical part. The theoretical part, based on the professional literature, describes malnutrition, schizophrenia and its different types, treatment and risks associated with this illness. The practical part focuses on research the main objektive of wich is to find out the incidence of malnutrition among patiens with schizophrenia, the influence of antipsychotik medication and surfy whether the nursing staff at the Nursing home with special care in Libníč is sufficiently informed. The survey is accomplished by means of the qualitative method using non-standardized interview. Research file consists of data submitted by four general nurses from the aforementioned Nursing home. The analysis of health documentation reveals that the majority of schizophrenic patiens suffer from other illness, such as obesity, hypertension, diabetes and hyperlipidemia. The results of this surfy prove that nursing staff are sufficiently informed and aware of possible risk factors associated with the development of cardiovascular dinase with regard to the schizophrenic patiens due to incorrect rating nabits or antipsychotik medication. The interview with the nurses implicates that malnutrition is considered as undernourishment. Accordingly, they identify nutrition care with the work of nutrition therapist and his care of patient nutrition. The nurses are aware of nutrition support. However, they have low level of knowledge regarding the products of modular dietetics.The main objective of this work is to demonstrate that schizophrenic patiens are in Langer of higher mortality and morbidity rate, not only as a results of thein illness, but also due to the antipsychotik medication treatment and inappropriate life style. This is the mason why the nutrition care should not be marginalized, nor neglected during the treatment of mental illnesses.
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Specifical nutritional requirements of oncological patients
KRAUSOVÁ, Lada
Nourishment in oncological patients is a very complicated problem. Up to half of the patients experience a lack of appetite that borders to food aversion which is often followed by an almost immediate sense of fullness after first few bites. Furthermore, some of the treatments themselves may lead to nausea, diarrhea and problems with swallowing. Malnutrition, consequently, will often worsen the prognosis for patient with a malignant tumor; lower his susceptibility to oncological treatment and increase the probability of further complications. A complete clinical picture of malnutrition, called cachexia, is characterized by noticeable gauntness, loss of both musculature and subcutaneous fat. Studies show that 30% to 90% of oncological patients suffer from malnutrition. Also, a continuous weight loss considerably lowers the quality of life, and this must not be overlooked for nutrition should not only lead to a prolonged survival, but also to an appropriate life-quality. The aim of this study was to find out how nutritive registry is kept at oncological wards in selected hospitals in the Czech Republic. Further, to find out if nurses are familiar with the causes of malnutrition in oncology patients and have sufficient knowledge of the specific nutritional principals. The hypotheses set were {--} 1) at the selected oncological wards nutritive registry is used, 2) the nurses there do know about causes of malnutrition while 3) nurses in other wards do not have this knowledge. 4) Nurses know about the necessary nutritional principals in oncology patients. Quantitative approach was used for this research. The questioning method was to collect data by distributing questionnaires. The results show that at oncology wards but at other, non-oncological wards as well, nutritive registry is used, and furthermore, a position of nutritional therapist has been appointed and nutritional staff established. The first hypothesis has been proven to be correct. The second and fourth hypotheses are correct as nurses do know the causes of malnutrition in oncology patients and have the knowledge of the necessary nutritional principals. The third hypothesis presumed that nurses from non-oncological wards lack this knowledge and has consequently been proven wrong. These nurses are indeed knowledgeable of the nutritional problems. In practice, a stressed necessity of nurses{\crq} efficient knowledge of the nutritional problem for patients with malnutrition and cachexia at both oncological and non-oncological wards is recommended, together with the introduction and observance of nursing standards concerning the nutritional problems of oncology patients, proper information given to the patients relating their special diet as a consequence of the illness and its subsequent treatment, and finally, a multidisciplinary approach and collaboration (nutritional staff).
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