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The role of a nurse in the care of a patient´s nutrition
SKŘÍŠOVSKÁ, Martina
This Master's Thesis "The Role of a Nurse in the Care of a Patient's Nutrition" is written in a purely theoretical plane, deals with the basic pillar of the existence of the human organism the correct and sufficient nutrition of a human, and studies the extent of an involvement of the general nurse in satisfying biological, psychological aspects of patient's nutrition in the nursing process. The topic of nutrition plays an important part of the complete spectrum of each medical expertise. The satisfaction of patient's need for nutrition in all of the stages of his life is a part of a nurse's job in a nursing process not only in Intensive Care Units, Resuscitation Care Units and Standard Care Departments, but even in Geriatric Units and Social Care Institutes. The thesis is methodically divided into separate parts, each logically following its preceding one. In the Introduction we define malnutrition as a global medicinal and social problem, introduce principles and theoretical starting points of an organisation of an optimal nutrition care and introduce international activities, which contribute to creating guidelines using the Evidence Based Practice method, and implementation of effective methods in providing complex care of a patient's nutrition in medical facilities and institutes of social care. We follow with the summarisation of basic nutrients, emphasising their importance for the right function of a human body, and negative effects of their insufficiency in the food intake. The thesis presents an algorithm of an evaluation of a patient's nutrition state in a nursing process, comparing available screening standardised questionnaires, which are usable in detecting sings of a malnutrition. We present the possibilities of food fortification, specify targets of nutritional support in medical facilities, focusing on indications, benefits, risks and paths of application of enteral and parenteral nutrition, and provide complete summary of nutritional interventions in the context of nursing care, which is oriented on ensuring the food intake. In the Conclusion, we identify those aspects of the patient's nutrition care, which are hard to fulfil and realise, and those psychological and social-cultural aspects, which the nurse can in the nursing process satisfy only when using holistic and empathetic approach. The altruistic, but controversial and ethical-philosophical topic represents not initiating or ending the interventions of nutritional support, where this decision respects principles of beneficence and non-maleficence of The Hippocratic Oath, the quality of a patient's life and human dignity.
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The role of nurses in the care of chronic wounds by using alternative methods and materials of moist wound healing
SKŘÍŠOVSKÁ, Martina
This bachelor?s thesis deals with the actual classification of wounds and the issue of the chronic wound treatment. In the preface of the theoretical part of the thesis, the term wound is defined and the wounds are subcategorized in the terms of their pathological traumatological origin. In the next chapters, the process of the wound healing is analysed from molecular biological aspect, the terms acute and chronic wound are defined and newly introduces the term non-healing wound for the chronic wound. In the special part, the particular pathological-surgical types of chronic wounds are described from their molecular biological, surgical anatomical and therapeutic point of view. Next, the paper specifies risky factors influencing wound healing process aiming their therapeutic influenceability. These factors are further divided into the system ones and the local ones. The thesis continues with the analysis of the therapeutic and nursing possibilities in the chronic wound treatment describing traditional bandages including sterile pieces of gauze and disinfectant solutions for the materials of the moist wound healing. This is followed by the chapters discussing modern methods of the debridement of the chronic wound such as ultrasonic hydrotherapy, negative-pressure wound therapy or larval therapy. Each chapter describes both the indications and the contraindications for the use of these methods, their advantages and benefits for the patient, aiming the role of the nurse in the chronic wound healing process using these methods. The end of the theoretical part of the thesis is devoted to the nutritional support and the systemic enzymotherapy, which ensures a sufficient energy intake to the organism and both all the macronutrients and micronutrients necessary for building the body tissues. The empirical part of the thesis is in the form of a qualitative research focused on the documentation of the role of the nurse in the care of the patients with a single type of the chronic wound ? more precisely the patient after laparotomy with an extensive resection of the digestive system and a subsequent secondarily healed chronic wound. The method of using case studies was used to accomplish this goal. The record of the chosen group of the patients and the process of the systemic therapy with the support of the cardiovascular, ventilatory and nutritional functions regarding the surgical performance is acquisited and it is completed with the description of the local therapy of the chronic wound, with the description of the role of the nurse in the healing process and with the enclosed photo documentation. Casuistries describe the regression, the stagnation or the progress of the wound healing process; they map the role and the participation rate of the nurse in this process and the use of alternative equipment in this process and the art of improvisation. The summary of the results brings up the conclusion that the scientific and technological progress opens up new possibilities to the patient with the chronic wound and introduces modern technological procedures into the chronic wound therapy though there is a group of patients after laparotomy surgeries with the conducted extensive resection of the digestive system and with the subsequent anastomosis dehiscence, which is contraindicated for the use of these methods. These patients are left to depend on the holistically provided care of a multidisciplinary team with irreplaceable role of the nurse. Biopsychosocial needs of the patient puts great demands on the nurse regarding both the personal and the professional side. The reasoning at the end weighs up and suggests the possibilities of the participation of the nurse in the preoperative preparation of the patient for the planned resection of the digestive system mainly in the form of the education in the support of the nutritive functions and the systemic enzymotherapy.
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