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Oxygen therapy after cardiothoracic surgery from the point of view of nurses and patients
VRCHOTOVÁ, Klára
Cardiac surgeries are very serious surgical procedures with considerable specific features. This bachelor thesis focuses on oxygen therapy from the viewpoints of nurses and patients. Its theoretical part describes physiology of breathing and the oxygen therapy as such. It describes individual sources of oxygen and indications for oxygen administration. It also describes principles to be observed during oxygen administration. Specific aids are used for oxygen administration, particularly oxygen masks or oxygen goggles. Quality pulmonary rehabilitation is also necessary to make oxygen therapy more effective. Pulmonary rehabilitation is particularly important for patients after a cardiac surgery and it should be practiced even before the surgery. This approach is critical because in the post-surgery period the therapy makes it possible for the patient to breathe and to expectorate properly. Pulmonary rehabilitation is practiced with patients by general nurses at the cardio surgery ward, as well as by physiotherapists. There are various techniques available to determine efficiency of oxygen therapy and pulmonary rehabilitation. The techniques may be classified as invasive and non-invasive; the most frequently used non-invasive method is pulse oxymetry and the most frequently used invasive technique is blood collection for ABR. Two objectives were set for the thesis. The first objective was to map knowledge of nurses about how to provide care to patients treated with oxygen therapy. The second objective was to determine how the patients feel after a cardiac surgery. Two hypotheses and two research questions were formulated. The first hypotheses were: Nurses working at the resuscitation care station have more knowledge about oxygen therapy than nurses working at the intermediate care station. The second hypothesis was: Nurses working at the resuscitation care station have more knowledge about pulmonary rehabilitation than nurses working at the intermediate care station. The first research question was: How do the patients feel during oxygen therapy and pulmonary rehabilitation? The second research question was: How are the patients after a cardiac surgery informed about oxygen therapy and pulmonary rehabilitation? In the research part of the bachelor thesis I have used both quantitative and qualitative research methods. Quantitative processing of data was used for questionnaires filled out by nurses working in the hospitals Nemocnice České Budějovice a.s., Nemocnice na Homolce in Prague and in the faculty hospital Královské Vinohrady in Prague. The method was used for evaluation and assessment of knowledge of nurses working at the resuscitation and intermediate care wards. Quantitative methods were used for processing of data obtained through semi-structured interviews with patients after a cardiac surgery. The data were transcribed and coded using a pencil and paper method. The data were categorized based on the identified codes. Two categories were created: oxygen therapy and pulmonary rehabilitation. Each of the categories was further divided into three sub-categories. Two categories were created for the research oxygen therapy and pulmonary therapy. Three sub-categories were subsequently created for the oxygen therapy and the pulmonary therapy. The quantitative research has shown that the knowledge of nurses about oxygen therapy is higher among the nurses working at the resuscitation care ward. However, the situation is different in case of their knowledge about pulmonary rehabilitation. In this case the knowledge of nurses working at the intermediate care ward was higher. The processed data from the qualitative research have shown that patients do have sufficient information about post-surgery oxygen therapy, as well as about pulmonary rehabilitation. For all patients in the post-surgery period after a cardiac surgery the frequency of pulmonary rehabilitation was higher than 1 per day.
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A nursing issue: peripheral venous catheter
TOMÁNKOVÁ NOVÁKOVÁ, Monika
Peripheral venous catheter is used to access the venous system. It is one of the most commonly used invasive procedures in health care facilities. This procedure falls within the competence and daily tasks of nurses. Therefore this type of nursing care is susceptible to risk of proceeding routinely which might result in conscious or unconscious errors. Peripheral venous catheter needs to be introduced into the patient's vein in the following cases: planned parenteral nutrition, infusion or transfusion therapy, application of intravascular medication or contrast media, rehydration, blood sampling (which can be performed immediately after introducing the peripheral venous catheter and before administrating medication) and also during an emergency care for critically ill (such as cardiopulmonary resuscitation). Nurses should be as knowledgeable as possible about this issue so that the peripheral venous catheter can be introduced well and fulfil its purpose. It is important to ensure that nurses obtain all the necessary information about their patients before inserting the catheter and that they are able to properly inform the patients about the procedure and to communicate with them. Next, nurses should be familiar with the correct procedure for inserting catheters, they should be informed about possible contraindications and know how to choose the correct type of catheter as well as where to place it. Furthermore, nurses should care for this vascular access correctly and provide the patient with enough information about taking care of the catheter after the procedure. Finally, nurses should be aware of their own potential errors and also of possible complications. Therefore they should employ aseptic technique so that they can eliminate nosocomial infections. The thesis is divided into a theoretical and an empirical part. The theoretical part focuses on the history of peripheral venous catheters and their types, indications and contraindications, necessary equipment, nursing care, complications, etc. The empirical part consists of a research. The aim of the thesis was to map the use of peripheral venous catheters in hospitals as well as to identify factors that may lead to problems among the patients with peripheral venous catheters. Four research questions were assigned to these aims. 1. What is the procedure prior to inserting a peripheral venous catheter? 2. What are the standards of caring for patients with an inserted peripheral venous catheter? 3. In which steps of caring for peripheral venous catheters do the nurses lack knowledge? What equipment do the nurses prepare in order to insert a peripheral venous catheter? The Bachelor's thesis was conducted using a qualitative research survey. The methods of collecting data included semi-structured interviews and participant observations. The research was carried out only in one hospital ward and it was anonymous. First, the data were collected by means of a semi-structured interview. The nurses were asked 14 questions (see Appendix 8). During this interview, several more subquestions were added. The results of the interviews were then grouped into several categories for the sake of clarity. The second method of collecting data was participant observation. The observed facts were recorded into an observation sheet (see Appendix 9). The same nurses who were interviewed were also observed. This Bachelor's thesis has been written in order to provide a basic overview of the peripheral venous catheters. It could be used as an information source for more experienced as well as novice nurses. The practical output of this Bachelor's thesis is a nursing care standard concerning peripheral venous catheters. This standard was missing in the hospital ward and could help the nurses to take care of these vascular accesses, to proceed correctly and eliminate possible errors (see Appendix10).
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Consumption of fiber in old age
ŠÁLEK, Jan
The theme of this bachelor thesis is the Consumption of fiber in the old age (seniors). Formerly, the dietary fiber was considered unnecessarily burdensome for human organism. Later, it was found that it has a relatively large impact on human health, especially by serving as a prebiotic for symbiotic bacteria inhabiting the gastrointestinal tract. There is still prevailing opinion that roughage divides into a soluble and insoluble, despite that some types of fiber cannot be definitely classified and placed into any of these groups because they have characteristics of both of them. The daily recommended dose is 30 g. The qualitative research was used for elaboration of the practical part. The first goal was to find out how much fiber seniors consume. The second aim was to compare the consumption of fiber among elderly people living alone and the elderly living in retirement homes built for them. The research group, at the first research question, consists of 20 seniors from the Southern Region aged over 65 years. The research group, at the second research question, consists of five retirement homes from the whole Czech Republic. All respondents were given a record sheet for one week, and instructions on how to fill it. Acquired menus were subsequently re-calculated through the program "Nutriservis Professional". The results show higher consumption of fiber than the average in the Czech Republic, but there is still almost a half missing to get the recommended daily dose. There was observed BMI and its impact on the consumption of fiber. No significant effect was found, because overweight had all interviewees except one respondent. The financial limit is visible for evaluated diet of homes for the elderly, therefore, there are no whole grain products, vegetables and almost no fruit. Despite these limitations, the average consumption of fiber is almost equal to elderly people living alone. In conclusion, there is a proposition how to, despite the low funds, increase the intake of roughage, and avoid or, at least, reduce the problems associated with its low consumption. Recommendations for respondents are individual and given under each evaluation.
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Cystic fibrosis and Nutrition
PECHOVÁ, Jana
The name of bachelor's thesis is "Cystic fibrosis and nutrition". Cystic fibrosis is hereditary chronic disease. It is dysfunction ducts of chloride in a human organism. The manifestation of cystic fibrosis is large quantities of a mucus in the respiratory and digestive system of patient with this diagnostic. This disease we put in the group of very rare illnesses. The smaller percentage citizens in the Czech Republic have this disease. For the people with cystic fibrosis is priority follow recommended eating habits. Prognosis of this disease is getting better and patients can live full-value life. This thesis dealing with how observe the recommended eating habits and eating regimens. The thesis contains some objectives. First, there is finding out whether children who suffer from cystic fibrosis can all sorts of foodstuffs whether they have special requests for quality and preparation of foodstuffs. The second most important objective is appraisal of diets some sample of people with cystic fibrosis. For objectivity this thesis was chose four respondents in age bracket from three to eighteen years. On the basis of evaluation their week-long diet, questionnaires with their parents and with them and manoeuver a conversation will be to find out whether children observe all principle of recommended eating regimens. In the theoretic part of the thesis are use opinions of experts who are occupying with cystic fibrosis exhaustively. Their experience show how is important to choose right diet and observe correct eating principles and eating regimens. These opinions are use in the practical part. Conclusions from discussion can be used for practical work nutritive therapists who can meet with children with cystic fibrosis.
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How to prevent the proliferation of Legionella pneumophylis in hot water in the hospital Czech Krumlov
TUREK, Jan
This diploma thesis deals with microbiological quality of hot water in a hospital in Cesky Krumlov as well as hot water piping condition with respect to Legionella. It also deals with arrangements for improving the quality of hot water in this hospital. The subject and target of this thesis are the findings of the mentioned parameters based on own observations, technical documentation and analysis of warm water performed by an accredited laboratory. The hospital in Cesky Krumlov, the construction of which began in 1909, was built in 1911 as the 'Nemocnice Císaře Františka Josefa I.' As the time went by, new buildings were built up. The hospital was renamed to 'Všeobecná veřejná nemocnice' in 1942. In the following years the hospital expanded until the current condition. Water quality and presence of Legionella is a world-wide issue, which we must fight against. The thesis is divided into two parts. First, theoretical part, which includes both general and specific knowledge about Legionella, its health risks, the environment in which it occurs, possibilities of eliminating, suitability of the material for hot water pipes, gained in professional literature and a part of the Czech legislation dealing with public health protection, the law 'No. 258/2004 Coll.' in actual version and quality of drinking water and hot water. In the second, empirical part, I focus on the situation of the hospital in Cesky Krumlov from 2009 till 2015, concerning newly built boiler room and the whole distribution system of hot water regarding Legionella. Particularly I focused on materials used for ecologisation of the gas boiler room and materials used for hot water pipes and actual state of water distribution in individual buildings of this health care facility. I mentioned the analysis of the water samples performed by an accredited laboratory with corresponding technical documentation, which concerns the water distribution system, provided by the medical facility. I used secondary data analysis to evaluate these documents. Regarding the results from 2009 to 2015 the microbiological quality of warm water doesn't meet the limits defined in the Attachment No. 3 of the above mentioned law Order 252/2004 Coll. Limit value for colony forming units of Legionella is set to maximum of 100 CFU. In most of the samples this limit was exceeded by series of units up to hundred thousands of units. The last results in 2015 prove improvement of the unfavorable situation. In that year the analysis was tested three times. First in February, where the CFU units were 'only' in hundreds, with the top value of 550 CFU in the Postacute Care ward. Second analysis was performed in June that same year. Results were acceptable. The highest value was 64 CFU. Last analysis in the hospital was performed in December. Increased concentration of Legionella was again in the Surgery building. There were established of 1400 colony forming units. There were 300 CFU in the Postacute Care ward and the limit value of 100 CFU was in the ward of Internal medicine. The answers to research questions 'How to prevent reproduction of Legionella peumophylis in the water distribution system of the hospital in Cesky Krumlov?' and 'How to ensure a sufficient amount of quality hot water in the medical facility?' are included at the end of the stated recommendations. A risk factor causing the fast reproduction of Legionella is the old water distribution system in most of the buildings and low water temperature of water leaving the boiler, which is 55°C. All mentioned results and evaluations are included in this thesis as well as attached pictures, which show the environment and situation within the Health Care Institutions.
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Iniciace pohybu byčíku, signalizace a regulace pohyblivosti spermií ryb: fyzikální a biochemické řízení
PROKOPCHUK, Galina
The current study attempted to shed light on the regulatory processes and response arrangements of fish spermatozoa during the course of maturation and motility initiation. The first intent of this study was to improve the understanding of the mechanism underlying the acquisition of potential for sperm motility in sturgeon. Up to present work, the physiological process underlying sperm maturation in this species has not been described at all. Our results showed that sperm maturation in sturgeon occurs outside the testes because of dilution of sperm by urine and involves the participation of high molecular weight substances as well as calcium ions present in seminal fluid and/or urine. The second aim of the present study was to investigate the coping mechanisms in fish spermatozoa with osmotic and ionic activating mode, as well as in spermatozoa of euryhaline fishes, to various environmental conditions. We showed that alteration of environmental osmolality might affect the fish sperm in different ways, depending on fish species and modes of spermatozoa motility activation either osmotic or ionic mode. In response to osmotic stress caused by hypotonicity, carp spermatozoa regulated the flow of water across their cell membrane and increased their cytoplasmic volume during their short motility period. In contrast, no indications of sperm volume changes were observed neither in sterlet nor in brook trout spermatozoa, both of which having an ionic mode of motility activation. We also examined the mechanism by which sperm motility triggering in euryhaline fishes can adapt to a broad range of environmental salinity. Our results demonstrated that spermatozoa of euryhaline tilapia, Sarotherodon melanotheron heudelotii, reared in fresh-, sea- or hypersaline water can be activated in hypotonic, isotonic or hypertonic conditions of swimming milieu, provided Ca2+ ions are present at various levels. It was established that the higher the fish rearing salinity or the more hypertonic ambient media at spermatozoa activation, the higher extracellular concentration of Ca2+ ions is required. The results obtained in the present study allow suggesting that osmolality is not the main factor inhibiting sperm motility inside the testis in the S. melanotheron heudelotii. A third aim of this study was investigation of the regulation of motility initiation process and description of flagellar beating initiation in chondrostean spermatozoa. We detected that K+ inhibition of sperm motility in sturgeon can be by-passed due to the pre-exposure of sperm cells to a high osmolality shock prior to its transfer to K+-rich swimming media. Thus, we hypothesized that sturgeon spermatozoa may be activated by use of an unexpected signaling pathway, independent from regular ionic stimulation. The successive activation steps in sturgeon spermatozoa were investigated by high-speed video microscopy, using specific experimental situation, where sperm motility initiation was delayed in time up to several seconds. At motility initiation, the first couple of bends formed at the basal region begins to propagate towards the flagellar tip, but gradually fades when reaching the mid-flagellum. This behavior repeats several times until a stage where the amplitudes of bends gradually reach similar value, what eventually leads to sperm progressive displacement. The total period needed for the flagellum to switch from immobility with rigid shape to full activity with regular propagating bends ranges from 0.4 to 1.2 seconds. In conclusion, the results of the current study bring valuable pieces of information into the general understanding of the processes of maturation of fish spermatozoa, their adaptability to different physical and biochemical circumstances, the extra- and intra-cellular signaling as well as the regulatory mechanisms of motility activation in fish spermatozoa.
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The use of (nano)oxides for metal and metalloid stabilization in contaminated soils
Michálková, Zuzana ; Komárek, Michael (advisor) ; Luke, Luke (referee)
The main objective of the thesis was to evaluate the potential of selected Mn and Fe (nano)oxides for the stabilization of metals and metalloids in contaminated soils. The research was focused basically on three materials - commercial nanomaghemite (Fe III), nanomagnetite (Fe II,III) and a synthetic amorphous Mn oxide (AMO). The main aim of the work was to provide a complex view on the chosen stabilizing amendments regarding not just their direct influence on contaminants mobility and stabilization mechanisms, but also their stability and alterations in soil conditions together with influence on soil microorganisms and higher plants. Firstly, adsorption properties of the tested materials towards Cd, Cu, Pb and As were investigated. In this context, the most effective material showed to be the AMO reaching one to two orders of magnitude higher adsorption capacities than Fe III and Fe II,III under given experimental conditions. Interestingly, the rate of As(V) adsorption onto AMO was increasing with increasing pH as a result of high pHzpc of the AMO (8.1) and significant dissolution of this phase at lower pH values. As a next step, the influence of (nano)oxides on metal(loid)s mobility and other physico-chemical soil characteristics after application to contaminated soil was examined. Again, the AMO proved to be the most efficient in reducing mobile pools of Cd, Cu, Pb, Zn and As. On the other hand, Fe III and Fe II,III addition had generally less significant effects on contaminants mobility. AMO application further resulted in an increase of soil pH connected with AMO dissolution and unwanted decomposition of soil organic matter. When (nano)oxides alterations in soil conditions were observed, MnCO3 coatings were identified on AMO surface while no significant changes were recorded for Fe III and Fe II,III. As the MnCO3 formation was connected with increased AMO stability, AMO particles synthetically covered with MnCO3 coating (denoted as SM AMO) were prepared. Although the SM-AMO had a lower mass loss in soil than pure AMO, the stabilizing efficiency was almost the same for both materials. The differences in surface composition of both materials were decreasing with time as MnCO3 naturally precipitated on the AMO surface in soils while the SM AMO coating was gradually dissolving. When investigating the effect on soil microbiota, AMO efficiently promoted soil microbial activity while no significant changes were observed in the case of Fe III and Fe II,III. The AMO was also able to reduce the uptake of Cd, Pb and Zn by sunflower (Helianthus annuus L.), eliminate Zn phytotoxicity symptoms and increase biomass yield. On the other hand, toxic levels of Mn released from the AMO in an acidic soil were found in sunflower tissues. AMO application is thus recommended for contaminated neutral or slightly alkaline pH with a higher cation exchange capacity in order to avoid unwanted release of Mn. Finally, various types of AMO-biochar composite sorbents were recently prepared and field experiment focused on stabilization of Cd, Pb, Zn and As using studied materials is currently under preparation. The combined results from the thesis highlight the importance of a complex experimental approach dealing with all parts of the contaminated soil environment in order to obtain complete information about the efficiency and usefulness of any newly developed stabilizing amendment.
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Implementation, management and appraisal of process management in a logistic firm
Dujavová, Beáta ; Tichá, Ivana (advisor) ; Lucie, Lucie (referee)
The diploma thesis deals with the topic of process management. The goal of the thesis is to identify the processes in given firm using the graphic process map. Process mapping is performed through several methods -participation in mapping processes, observation and one-to-one interviews.
The practical part of the thesis contains situation analysis. PEST analysis is used to describe the macro environment, defining the political, economical, social and technological environment in the Czech Republic. In terms of analysis of business area, the thesis deals with parcel logistics and e-commerce. In order to analyse the competition, the Porter´s five forces analysis is applied. The analytical part also contains the SWOT analysis.
In the end of the thesis, the business process improvements are suggested by the author based on the conclusions of performed analyses.
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Effect of water deficit on the energy content of individual plant organs in selected species of leafy vegetables
Šimůnková, Petra ; Hnilička, František (advisor) ; Česká, Jana (referee)
This work presents the impact of water deficit on dry mass production and photosynthetic accumulation of energy on every single plant´s organs of selected plant species. As a chosen experimental material were taken plants of Spinacea oleracea "Matador" sort and Tetragonia tetragonioides.
Spinacea oleracea and Tetragonia tetragonioides plants were grown in containers 11x11cm large in mixture of garden substrate A with silicon sand (2:1) in 2 variations placed in FAPPZ greenhouses. One variation was for control and second was exposed to stress reaction. Control variation had been watered for whole time of experiment with 50ml of water 2 times per week. Stressed one had been watered after puncturing and 6. taking until the end of experiment.
During the plant´s ontogenetic evolution had been monitored dry mass´s weight on singular plant´s organs. With usage of burnt calorimetry method had been monitored capacity of photosynteticaly accumulated energy in dry mass. Quantity of netto energy had been found out by dry burning adiabatic calorimeter LAGEST MS 10A.
From the gained results emerge, that plants of Tetragonia tetragonioides have 2 times higher weight growth apart from Spinacea oleracea. Control plants of Tetragonia tetragonioides have higher weight by 25,5% (123 mg) compared to the plants growing in water deficit. Likewise higher weight of roots had been observed on control plants (41 mg) compared to the stressed plants (40 g). Control spinach plants had higher weight of above-ground biomass by 19,5% compared to the stressed ones (43 mg). Roots of control plants had lower weight compared to stressed variant by 2960 mg.
From the results emerge, that plants of Tetragonia tetragonioides have higher weight of roots dry mass and above-ground biomass compared to the Spinacea oleracea plants.
Burning heat without ashes was on above-ground biomass of control plants Tetragonia tetragonioide on 15,96 kJ.g-1 level and on stressed plants 14,93 kJ.g-1 . In case of Spinacea oleracea plants was amount of control plants energy 14,98 kJ.g-1 and on stressed 14,21 kJ.g-1.
Burnt heat without root ashes of Tetragonia tetragonioides control plants was higher by 1.11 kJ.g-1 then on stressed ones (13,19 kJ.g-1). In case of Spinacea oleracea plants was amount of roots energy on control plants 11,90 kJ.g-1 and on stressed 11,72 kJ.g-1 .
Based on measurement were verified differences between species in reaction on water deficit and observed characteristic. From measuring emerged, that Spinacea oleracea plants are more sensitive on effect of water deficit compared to the Tetragonia tetragonioides
plants, which is more tolerant. Next thing observed is, that there are differences in amount of dry mass and rate of burnt heat in relation on effect of water deficit.
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Effect of sex on growth and formation of dorsal muscle of pigs
Fáberová, Gabriela ; Čítek, Jaroslav (advisor) ; Zadinová, Kateřina (referee)
Effect of sex on growth and formation of dorsal muscule of pigs Summary The aim of this thesis is to determine the influence of gender on the growth and formation of the pigs dorsal muscle. Growth is one of the basic phenomenon characterizing living organism. Is a creation of nonliving to living matter. The amount of body mass is not constant through the life, it is changing significantly. In the early postnatal period is skeleton growing faster compared to muscles and fat then leads to faster growth of muscle and in the last period called maturity to the fattening. Evaluating growth has a significant gender effect. In case of pigs, it is common to feed barrows and gilts. Nowadays it begins to think about feeding of boars or the imunocastrates. Due to different hormonal activities we can expect different muscle and fat deposition. The task of this study was to clarify the influence of gender on the formation and growth of pigs dorsal muscle. There were 72 pigs tested in total. Pigs were housed in pairs in cotes and divided by gender for pigs, boars, imunocastrates and sows. This subpopulation of genotype DanBred animals were divided to 1/4 (18ks) uncastrated male pigs (K) 1/4 (18ks) hormonally castrated male pigs (I), 1/4 (18ks) barrows (V) and 1/4 (18ks ) gilts (P). Average live weight of pigs at the start of the trial was 28.5 kg, while the test was conducted to average 107 kg bodyweight. Through all time pigs were fed ad-libitum KKS. During the test it was monitored at weekly intervals individual live weight, back fat thickness at A, B, muscle depth at A, B and the total percentage of muscle for all categories of pigs. The obtained results show that the growth and formation of a long dorsal muscle are influenced by gender. When comparing the weight in a given period, we conclude that during the time the difference between gilts and imunocastrates grow up. Best growth had imunocastrates gilts similarly, only was there an earlier stop of the growth. The highest increase in fat and muscle measured at the A and B, occurred in pigs, in sows we can see increasing gains in fat with respect to the period in which they are fattening. Boars had the lowest backfat thickness, imunocastrates. With imunocastrates we evaluate low fat increase compared to the beginning of the observation. The biggest muscle depth measured at A and B had the barrows with gilts and imunocastrates and especially boars did not reach the values as barrows and gilts, who had the highest muscle depth. Biggest % of muscle was measured in sows. A large proportion of muscle can be seen in male pigs. The proportion of muscle mass of imunocastrates was under the average and worst ratio of muscle had especially at the end of feeding barrows indicating that with increasing age there is a significant fattening, compared to the remaining groups of pigs Keywords: pig, growth rate, muscle fibers
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