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Nutritional prevention and the treatment of decubitus of seniors
DĚKANOVÁ, Klára
This bachelor thesis called Nutrition prevention and treatment of decubitus on seniors is about condition of client's diet in Máj České Budějovice Seniors' House and following nutrition intervention on critical clients. Decubitus is a disease, which greatly affects not only sick client or care staff, but also the economic aspect of the medical and social facilities. Because there was no knowledge about, how decubitus originate, the prevention nor treatment in the past, it was considered as very serious illness. Doctors were convinced, that decubitus origins spontaneously and it's a sign of inevitable death. Since the end of the 19th century, more attention has been paid to decubitus, and thus industrial production of phenol-impregnated bandages has been developed to improve the healing of decubitus, together with passive patient activation and surgical wound healing. There are currently many companies on the market that produce a wide range of products and tools to reduce the risk of decubitus or their effective treatment. For example, passive and active anti-decubital mattresses are used for keeping the wet environment in the wound and, last but not least, enteral and parenteral nutritional preparations to help wound healing. The goal of this thesis was to find out whether there are clients with a risk of developing decubitus in the Máj Česke Budejovice Seniors' House and then to process the nutritional intervention of these clients. The theoretical part of the work summarizes the previous knowledge in the field of prevention and treatment of decubitus. As first, the term "decubitus" has been characterized, and the distribution of the individual steps and assessment scales used for the risk assessment or the defects already occurred has been described. There are also mentioned factors influencing the occurrence of decubitus, prevention and nutrition prevention and treatment of decubitus. One chapter of the work was devoted to the NutritionDay project, which was used to collect data for the practical part of the research. A combination of quantitative and qualitative research methods was used to develop the practical part. In the first phase of the research, screening was carried out within the NutritionDay project in the Máj České Budějovice Seniors' Home. The screening revealed how many clients are at risk of malnutrition, how many of them are already malnutritive and how many of them are experiencing decubitus. In the second phase, the work has been done only with clients experiencing decubitus. For each of the clients with decubitus, an adequate daily intake of energy and essential nutrients was calculated. Nutritional support was then set and their diet evaluated in the Nutriservis Profesional program to determine whether it meets the recommended nutritional values. The results of this bachelor thesis can be used by other nutritional therapists for the purposes of teaching or further research.
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The use of lymph drainage in patients with lymphedema
DĚKANOVÁ, Klára
For my bachelor thesis I chose the theme ?Utilisation of the lymph drainage at patients with lymphedema?. In the Czech Republic the lymph drainage is a relatively new method which is used in medical facilities only since the year 1992. Efforts to introduce this method in the area of the Czech Republic came already before, since the seventies of the 20th century this problems was dealt by MUDr. Miroslav Bechyně CSc. Thanks to him in 1992 the first course of manual lymph drainage was realised in the Czech Republic. In the same year MUDr. Bechyně contributed to the foundation of the League against swelling and he made a motion to the birth of the Czech society of lymphology. The aim of my thesis was to acquaint patients with the possibilities of the use of the lymph drainage in the health care, to find out to which extent it is possible to influence the lymphedema and above all how this method affects the global state of patients. In the theoretical part of the bachelor thesis I summarized the findings dealing with this problems. I engaged myself in the history of lymph drainage and in the research of the lymph system in the world and in our country. In my thesis I defined the notion of lymphedema and I sorted it according to its origin into primary and secondary. Next in the thesis I present the diagnosis of lymphedema and the possibilities of his conservative and chirurgical treatment. Among possibilities how to treat the lymphedema I chose in particular manual and instrumental lymph drainage. I present also indications and contraindications of the lymph drainages. In the thesis I dealt as well with the use of lymph taping. This method is more and more popular at patients with the chronical lymphedema. The application of the lymph tape has many advantages, for example it does not limit patients in move. In the last chapter of the theoretical part I dealt with possibilities of the spa treatment at patients with lymphedema. The practical part of my thesis was realised by the qualitative research strategy and the results were treated by the form of case interpretations. The research sample was constituted by four probands who had the diagnosis of lymphedema and whose therapy took place in the rehabilitation department of the health centre Poliklinika Jih MEDIPONT s.r.o. in České Budějovice. The sample was chosen from clients with various kinds of lymphedema who were willing to cooperate on my bachelor thesis. The chosen sample was constituted by one client with primary lymphedema and three clients with secondary lymphedema. Clients with the secondary lymphedema had diagnoses venous insufficiency, postoperative and post-traumatic lymphedema. All probands underwent 10 therapies of the manual and instrumental lymph drainage. At the beginning and at the end of the therapy the lower limb circumferences were measured. With the patient´s consent I have used their health documentation, I have elaborated their detailed anamnesis and I have realised a structured dialogue with all probands. The dialogue contained both closed-ended and open-ended questions in order to chart proband´s health state and the contribution of the implemented therapy. After the end of the therapy the probands had possibility to express their subjective opinions on the undergone treatment. All probands found out lymph drainage as a very pleasant procedure. Three of four probands have noticed improvement of their health state and a visible swelling reduction. At the fourth patient, who was treated with the lymphedema caused by the venous insufficiency the improvement did not take place yet. But this patient says that she did not observe regime measures. The doctor proposed to the patient to continue with the treatment. The results of my bachelor thesis may be used by other physiotherapists for the needs of education or for a further research.
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