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The nutrition of patients undergoing dialysis
MARTÍNKOVÁ, Barbora
The bachelor thesis "The nutrition of patients undergoing dialysis"(whose count is around 6000 in the Czech Republic), deals with the nutrition of patients who regularly undergo treatment by dialysis. The theoretical part focuses on the anatomy and physiology of kidneys. Moreover, the stages of kidney failure and the possibilities of compensation of the kidney function are discussed. Furthermore, the theoretical part of the thesis focuses on dietary measures by patients undergoing dialysis, suitable and unsuitable groceries and their technological adjustment. The aim of the thesis is to map out the awareness of the patients and their families about the diet of a patient undergoing dialysis and to evaluate the menus of the patients, mainly the presence of basic nutrients potassium, phosphor and calcium in their diets. The practical part of the thesis was carried out by qualitative research. Six respondents who are regularly treated by dialysis participated in the research. On the basis of the evaluation of weekly menu of each respondent and counting guideline daily amounts the result was very negative. All respondents have received less amount of energy then what was counted for them. The same applied for basic nutrients. A positive finding was, that all of the respondents have been successful in reducing potassium and most of them have been able to reduce phosphor. Only one respondent fitted in the recommended amount of calcium for patients undergoing dialysis. From the results is obvious, that only one respondent abides by dietary recommendations. Most of the patients couldn't say which groceries are suitable for them and which are not. Unfortunately, the cause of this is, that not one of the respondents listed a nutrition therapist as a source of dietary measures.
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The Needs of Patients Undergoing Dialysis Treatment.
HORNOVÁ, Klára
This thesis intents on patients with chronic kidney diseases. In the theoretical part I sum up basic informations about kidney failure which is a state when kidneys stop to secrete waste ingredients from the body. Then I describe common treatment methods which are hemodialysis, peritoneal dialysis and transplantation. Nevertheless, the most important is to diagnostic the disease at the early stage and start the therapy as soon as possible. This part of thesis also describes physiological, psychical and social needs of the patient. The nursing staff has to know about all these needs which are connected, therefore neglecting one part may influence the others in a negative way. On the other hand, when all needs are satisfied the patient feels comfortable and the therapy can be successfull. When we get understand the specific needs of every single patient the quality of nursing care enhance radically. The practical part of the thesis explores all the needs through half-structured interviews with nine patients under hemodialysis treatment. We may sum up the outcome briefly as follows: the most important for the patient is the painless state, enough sleep and rest and sufficient fluid intake security. The psychical support is important no less. Unsatisfying these needs may lead to frustruation and deprivation of the patient. On the contrary, satisfaction makes him contented and peaceful and motivates him for getting cured. This thesis may help people with recent diagnosis of chronic kidney disfunction and also people who are already set in dialysis therapy to get more informations. The research may be a source of informations also for students and nurses in practice as well. Hopefully may lead to understanding the needs and limitations of the patients under dialysis treatment and thus to provision them a better care.
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The effect of dialysis on activities of daily live
Kolaříková, Jaroslava ; Nikodemová, Hana (advisor) ; Jirkovský, Daniel (referee)
The aim of this bachelor's thesis entitled "The effect of dialysis on activities of daily life" is to provide a brief overview of relevant basic knowledge of hemodialysis and peritoneal dialysis using existing and already published litarature and try to determine the influence of the dialysis on activities of daily life. The thesis is devided into theoretical and empirical part. The theoretical part is focused on kidney disease, hemodialysis and peritoneal dialysis, principles of dialysis therapy, their differences, complications, dietary measures and approaches to dialysis. Further attention is paid to the comparison of the advantages and disadvantages of both methods of dialysis among themselves. Part of the work deals with human needs and activities of daily life. The empirical part consists of an exploratory survey, which was given to patients in dialysis centers Fresenius Medical Care Prague 5 - Motol, Prague 10 - Vinohrady, Prague 4 - Krc, Prague 9 - Vysočany, Slaný, Louny, Chomutov, Most and dialysis center department of Internal Medicine Strahov Všeobecná fakultní nemocnice in Prague. The obtained data are presented in tabular and in graphic reports. Keywords hemodialysis, peritoneal dialysis, renal failure, activities of daily life, disease impact
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Infectious complications in chronic renal failure
Kielberger, Lukáš ; Eiselt, Jaromír (advisor) ; Dusilová Sulková, Sylvie (referee) ; Matoušovic, Karel (referee)
INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...
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Role of the FTO gene in the genetic determination of common multifactorial diseases
Dlouhá, Dana
Obesity is a risk factor for development of cardiovascular disease, diabetes type 2 and some cancers. Newly detected genetic risk factor for body weight is the FTO gene ("fat mass and obesity associated"). The aim of this thesis was determine 1) whether the presence of risk alleles correlate with BMI in Czech population and to determine 2) whether there is an association between variants in the FTO gene and risk of myocardial infarction/ acute coronary syndrome (MI/ ACS), 3) renal failure (ESRD), or 4) incidence of colorectal cancer (CRC). We analyzed polymorphisms rs17817449 (first intron) and rs17818902 (3rd intron) using by PCR-RFLP and then also RT PCR. We found an association of the first intron variant (but not the 3rd one) and BMI in Czech control population. We have detected an association of 1st intron SNP and BMI changes during the intervention study in obese children, but not in obese females. We found a correlation between the risk allele and increased risk of ACS (OR 1.49) in patients with MI. In patients with ESRD was detected association between the risk allele and the risk of disease (OR 1.37). We didn't confirmed the association between rs17817449 and the development of CRC. Representative selected groups of the Czech populations "MONICA" and "HAPPIE" were used as controls. One...
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Role of the FTO gene in the genetic determination of common multifactorial diseases
Dlouhá, Dana ; Hubáček, Jaroslav (advisor) ; Černá, Marie (referee) ; Rossmeislová, Lenka (referee)
Obesity is a risk factor for development of cardiovascular disease, diabetes type 2 and some cancers. Newly detected genetic risk factor for body weight is the FTO gene ("fat mass and obesity associated"). The aim of this thesis was determine 1) whether the presence of risk alleles correlate with BMI in Czech population and to determine 2) whether there is an association between variants in the FTO gene and risk of myocardial infarction/ acute coronary syndrome (MI/ ACS), 3) renal failure (ESRD), or 4) incidence of colorectal cancer (CRC). We analyzed polymorphisms rs17817449 (first intron) and rs17818902 (3rd intron) using by PCR-RFLP and then also RT PCR. We found an association of the first intron variant (but not the 3rd one) and BMI in Czech control population. We have detected an association of 1st intron SNP and BMI changes during the intervention study in obese children, but not in obese females. We found a correlation between the risk allele and increased risk of ACS (OR 1.49) in patients with MI. In patients with ESRD was detected association between the risk allele and the risk of disease (OR 1.37). We didn't confirmed the association between rs17817449 and the development of CRC. Representative selected groups of the Czech populations "MONICA" and "HAPPIE" were used as controls. One...
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Early postoperative care of the patient with the left ventricular assist device HeartMate II
Malá, Irena ; Hocková, Jana (advisor) ; Slabý, Josef (referee)
Author's name: Bc. Irena Malá School: Charles university, Prague 1st Faculty of Medicine Institut of Theory and Practice of Nursing Vídeňská 800, 140 59 Prague 4 - Krč Program: Health Care Administration Title: Early postoperative care of the patient with the left ventricular assist device HeartMate II Diploma thesis supervisor: PhDr. Hocková Jana, PhD. Number of pages: 170 Number of attachments: 41 Year: 2013 Key words: early postoperative care, hypotermia, blood transfusion, fluid resuscitation, perioperative cardiovascular dysfunction, pharmacologic support, ventricular assist device HeartMateII, monitoration, device, cardiac arrhythmias, ventilation management, postoperative anticoagulation, glycemic kontrol, renal insufficiency, nutrition, nursing, complications, physiotherapy, psychological aspects The occurrence of the heart failure is similar to an epidemic with high mortality. This fact, together with stagnate or even decreasing number of suitable donors, led to a need of replacing the heart pump activity with an artificial one. Mechanical cardiac support systems are sophisticated devices that are able to support a certain period of time or completely replace the function of the heart as a pump. The indications implantation of mechanical cardiac support is significant symptomatic heart...
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Specifics of the nursing care of patients with arteriovenous fistulas in a standard departement
NIEDERMEIEROVÁ, Michaela
Theoretical basis: My bachelor thesis briefly explains the reason for establishing this vascular access, describes the types of dialysis and discusses different types of vascular accesses. It analyses the process of haemodialysis including the role of the nurse during this procedure. Finally, it provides an outline of the life of a patient, who needs to attend dialysis regularly as well as to manage to take care of the fistula at home. This shunt is the only patient's connection to the dialysis during the renal failure and therefore it requires a specific nursing care. In order to preserve the function of the fistula the longest time possible, the patient himself also needs to follow the principles of a good care. The aim of the thesis: One aimsare set in the empirical part. Aim 1 should check whether nurses know the specifics of care of patients with arteriovenous fistula. In order to acquire these aims one research question were set: what nurses know the specifics of care of patients with arteriovenous fistula. Methodology: In the empirical part of the thesis, the qualitative research method with the help of semi-structured interview was used for the research. Respondents consisted of general nurses from surgical and medical ward of selected hospital in the South Bohemian Region. The data collection took place after consultation with the senior nurse and ward sisters during March this year. Before starting the empirical investigation, the reason and intention of interviews, which took place on a voluntary basis and were electronically recorded, was explained to the respondents. The questions in the interview were prepared in advance. Obtained data were processed into categorization groups, which were further analysed. The interview was divided into 5 areas: identifying issues, preoperative preparation, postoperative care, nursing care for fistula, patients' awareness. The research part of the thesis was also consulted with the ward sister of the hemodialysis center of the selected hospital of the South Bohemian Region. Results: The results of the empirical survey shows what specifics of nursing care of patients with arteriovenous fistulas nurses know. After analysing the research, we found that nurses know the basic nursing care of the vascular access. Nurses know that this vascular access is used only for purposes of hemodialysis. They do not measure the pressure on a limb with fistula, draw blood from it or insert a permanent venous catheter into it. They know that the skin around the fistula should be observed carefully and each day. They monitor the limb with fistula mainly for signs of infection and ischemia. In case of necessity of the provision of information for the patient about the care of an arteriovenous fistula, nurses are able to complete the missing information or arrange for a consultation with a specialist. However, the research also revealed weaknesses. Nurses are not sure how long fistula matures, do not really prepare patients for hemodialysis and don't know exactly when to remove the bandage from a patient after dialysis. In case of bleeding from the fistula, they do not know whether to use a pressure bandage.
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Nursing process in patients with hemodialysis
STACHOVÁ, Klára
Chronic kidney disease is often symptomless and painless. It is often late for some patients when they realize that there is something wrong with their bodies, namely the kidney function. Kidney failure causes a complex metabolic failure and water and electrolyte imbalance. Unfortunately this phenomenon is irreversible and a lot of the patients have to undergo hemodialytic therapy, which only substitutes the function of the kidneys but does not treat the kidneys. However dialytic technology is nearly at the perfection level at present. Nevertheless dialysis brings the risk of numerous complications for the patient. The dialysis principle is based on blood cleaning by means of a dialytic apparatus. Life rescue is the patient's priority so he/she has to visit a hemodialysis centre several times a week. The hemodialytic therapy is particularly physically and psychically demanding for the patient and his/her close relatives. This therapy significantly affects the patient's life. It has a substantial influence on patient's lifestyle and values. The therapy is accompanied by various treatment and nursing recommendations adherence to a diet with significant limitation of liquids, regular intake of medicines, stress regulation etc. from physicians and the healthcare staff. The aim of the bachelor thesis called "Nursing Process in Patients with Hemodialysis" was to map the problems of the nursing process in a hemodialysed patient on the base of specialized literature. The topic is elaborated theoretically by the review and synthesis method. The information was obtained from Czech and foreign specialized literature as well as from journals specialized in this issue. Hemodialysis is one of the most demanding elimination treatment methods of long-term character. Nursing care plays a very important role on hemodialysis. It must be effective, of high quality and particularly continuous as the patient only visits the hemodialysis centre on some days of a week. The nursing care has an irreplaceable role in healthcare. The patient before, during and after hemodialysis depends on quality nursing care provided by a nurse. Nursing process based on knowing the patient and active identification of his/her needs is a characteristic feature of modern nursing care. It stresses elaborate continuity, complexity and individuality of the patient, the sequence of the care and satisfaction of needs in partial steps of the nursing process. The nursing process requires continuous interaction between the nurse and the patient. Flexibility, currency, modification and repeated evaluation of the process are advantageous not only for nurses but also for the patients and often leads to timely solution of problems and satisfaction of patient's needs. The theoretical work reveals that hemodialysis is very closely related to the nursing process and contributes to patient's substantial satisfaction. It points out the importance of planning and preparation of nursing diagnoses. A feedback, not only for a nurse, but also for the patient for possible changes or preparation of a new care plan is also an important aspect of preparation of the nursing care plan. The obtained information on the nursing process in a hemodialysed patient are dealt with by the individual chapters of this bachelor thesis. This bachelor thesis is a guide in planning the nursing process and focusing on the most important problems during hemodialytic therapy not only for experienced nurses but also for tertiary school students. It also contributes to recognition of the necessity to create and apply the nursing process in the care of hemodialysed patients. A comprehensive view of the issue in question is the result. This study material for tertiary school students is the result of careful and thorough study of specialized literature.
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Crush syndrom in prehospital care
JENDŘEJASOVÁ, Tereza
The issue of the Crush syndrome in pre-hospital care is not a topic into which new findings are often brought by science workers. All the currently known and available knowledge about the Crush syndrome has not changed for decades. In part this is caused by the difficulty in pre-hospital emergency care to determine whether the condition signifies the Crush syndrome or also a hypovolemic shock resulting in kidney damage. In the Czech Republic there are neither big earthquakes, fortunately nor major landslides, and yet from time to time such an event occurs. That is why today it is more and more desirable that paramedics should be theoretically well prepared for such interventions. The purpose of this study was to survey and compare theoretical knowledge of paramedics working at the Emergency Medical Service of the South Bohemian and the Central Bohemian regions, including the ability to utilize this knowledge in practice. In the study quantitative and qualitative research was used. The quantitative part of the research mapped, using anonymous structured questionnaires, the theoretical knowledge of paramedics working at the Emergency Medical Service of the South Bohemian and the Central Bohemian regions in terms of the Crush syndrome issue. The results of the quantitative research have proved very good knowledge of the Crush syndrome issue in both regions and thus the hypothesis has been verified. The qualitative part of the research identified, through structured interviews with three respondents from the Central Bohemian region and three respondents from the South Bohemian region, the practical connection of theoretical knowledge directly in the field in a client with developing Crush syndrome. The knowledge was assessed as sufficient to provide quality pre-hospital emergency care. The results of this study have shown that paramedics in the South Bohemian as well as the Central Bohemian regions are well familiar with the theory for providing high-quality pre-hospital care for clients with developing Crush syndrome.
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