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Nursing care for pacients with heart transplantation.
VINKLEROVÁ, Petra
The bachelor thesis focuses on the issues of nursing care of patients with heart transplantation. The first heart transplantation in the Czech Republic was performed in IKEM, Prague in 1984. There are seven transplantation centres in the Czech Republic, but only those in Prague and Brno perform heart transplantation. The thesis is divided into a theoretical and a practical part, while the theoretical part also deals with the anatomy, history and characteristics of transplantation. Heart transplantation is performed on patients with heart disease at the stage of terminal heart collapse. A recipient has to meet some conditions for the transplantation. He/she has to be added to a register on the waiting list, must have the same blood group as the donor, similar weight and be less than fifty five years old. A suitable donor is necessary. Another condition is that all the conditions of Act No. 285/2002 Col. as amended have to be met. The fact that the donor is not in the national register of persons not agreeing with post mortem organs or tissues donation has to be excluded and his/her identification has to be confirmed. Before a patient is added to the waiting list he/she undergoes detailed examination to determine the urgency of addition to the waiting list. As transplantation is considered an acute surgical intervention the recipient only undergoes an immediate body preparation before the operation when a suitable donor is found. The theoretical part then describes heart removal from the donor, the operation procedure and heart transplantation techniques. There are three heart removal techniques nowadays. The biggest attention is paid to postoperative care. It includes endomyocardial biopsy, which is done in regular intervals, control visits and administration of immunosuppressive drugs. Post transplantation complications that might occur in early or later postoperative period are also dealt with there. Postoperative care also includes education in postoperative regimen. The main goal of the thesis was to map the specifics of nursing care of patients after heart transplantation both before and after operation. A partial goal was to find out in what way patients are given information on postoperative regimen after heart transplantation. The thesis also endeavours to determine the difference between nursing care provided to patients after heart transplantation and after cardiac surgical operation. The empiric part of the thesis involved qualitative research, for which research questions had been set. The research sample consisted of seven nurses. Four nurses were from the Institute for Clinical and Experimental Medicine in Prague and three from cardiac surgery department of the České Budějovice Hospital. The research had the form of non-standardized interview at a nurse daily room and one in domestic environment. The results are based on the interviews and were processed by means of categorized groups. The results show that nursing care of patients after heart transplantation does not differ from that of patients after cardiac surgery operation. There are differences between examinations of patients before heart transplantation. We may see them in the most important preoperative examinations. They include special taking of antibodies as they define the intensity of administered immunosuppressive medication. The difference in postoperative care is in regular medical checkups. There are big differences in social contacts between patients and their environment. Provision of detailed information to the patient is an important part of the nursing care. Information should be provided during both preoperative and postoperative care. The other spheres are identical. The thesis should be beneficial for nurses caring of patients after heart transplantation, but also for those who are deciding whether to undertake heart transplantation or are more closely interested in the problems of heart transplantation.
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