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The issues of patient´s self-sufficient after cerebrovascular accident at ward of subsequent care
MACHKOVÁ, Marcela
Cerebrovascular accident is a serious destructive condition with suddenly formed infliciton of cerebral blood vessel. There might appear obstruction and taper of them or defect on wholeness of vascular wall which result into hemorrhage to brain tissue. Sings of this condition might be termporary with physical and psychical changes or fatal which end up with serious paralysis, unconsciousness or even death of individual. Cerebrovascular accident problematics is currently a big challenge for the entire society, because progressiveness of European society´s aging is likely to bring increase in total amount of this disease´s causes. The first important step in problematics of the disease is to reduce the risk of stroke by consistent prevention; general lifestyle changes; blood pressure controls and treatment; lipid, coagulation factor and heart disease observation and compensation. The second step, when speaking about already formed disease, is to start well-timed and complex therapy which provides the patient with distinctly higher chance of better final clinical status without permanent harm. After overcoming the acute phase in neurology department the patient carries on with another therapy acorrding to seriousness of his/her condition in rehabilitation or aftercare department. Therapeutic, nursing and rehabilitation care should be set to contain all aspects of lost self-sufficiency encouragement and should be oriented mainly on person who has, even after stroke, his/her own needs, motivations, leisure time activities and skills. The bachelor thesis starts with medical part which describes brain anatomy, deals with epidemiology and stroke history. More detailted stroke characteristics and disease itself are defined by etiology, clinical picture, diagnostics and treatment. This part is then ended up with stroke consequences, factors influecing patient´s recovery, patient´s needs and self-sufficiency after stroke. Multidisciplinary team and aftercare deparment create an independent chapter and after this starts a new chapter interested in the role of nurse and needed nursing interventions, evaluation techniques during basic needs saturation of patients after stroke. Therapeutic rehabilitation creates almost the last important part of the bachelor thesis, on which depend gradual recovery and patient´s future life quality after this desease. The recovery part includes physiotherapy, occupational therapy, speech-language pathology, neuropsychology, spa treatment and prosthetic security of patient. Then, the whole thesis is ended up with patient´s preparation on release into home environment. The first set aim is to find out patient´s needs to reach the maximal functional independence and self-sufficiency after stroke according to previously studied sources. The second aim is to find out the nurse´s role in the encouragement of patient´s self-sufficiency and the third aim is to find out nursing interventions in the encouragement of patient´s self-sufficiency after stroke according to previously studied sources. The whole bachelor thesis is mainly taken as theoretical. It tries to insight into problematics of all needs, self-sufficiency encouragement and patient´s maximal functional independence after stroke according to previsously studied sources and information obtained from consultants, physiotherapists and general nurses. Then, the thesis deals with the role of nurse and nursing interventions in patient´s self- sufficiency encouragement on aftercare department to satisfy his/her essential needs of life without someone else´s help after the disease. After a gradual improvement of functional disability, the whole life quality and the independence of patient, it is necessary to follow all nursing, medical and rehabilitation procedures very carefully without their neglect with a sufficient amount of medical staff and specialized doctors.
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The use of self-care deficit theory client CMP
PAULÍKOVÁ, Martina
Theory Stroke, a cerebrovascular disease, causes severe disability and failure of self-sufficiency for nearly of half of the patients. Nursing focuses on respecting the individuality of each patient, supports the return and consolidation of a good health, promotes self-sufficiency and searches for the needs of the patient. Conceptual model of D. E. Orem assumes the ability of each human to take care of self. Although partially, or not capable of self-care at all, it is necessary to fill up the deficit by nursing care. Objectives The first objective was to state the options to how to fill up the deficit of self-care by patienst after stroke. The second objective was to determine, whether the patient´s living environment has an impact the development of self-care. Research questions Q1: Does the home environment stimulate the acceleration of the return of self-care ability by patients after a stroke? Q2 : Does the respondent perceive the issue of own disability equaly as the surrounding? Q3 : Is it more beneficial for the patient to perform self-care with deficiency, or to receive perfect execution of it by others? Q4 : Does the patient perceive the subsequent therapy (physiotherapy, occupational therapy) as a faster way to return to sufficient self-care? The research part of the thesis was carried out by a qualitative survey, conducted as a individual semi-structured thematic interviews with respondents devided into two groups. One group consisted of patients after a stroke and a second group of caregivers. Total of 8 patients, 4 males and 4 females, were interviewed. The research was completed in three sessions, each at intervals of four to six weeks. The information received were processed by open coding method, analytical induction development of technology showdown and narrative analysis. Results Using data received from interviews with respondents it was possible to answer all the research questions. The first research question examined was, whether the home environment stimulates the acceleration of the return of self-care ability by patients after a stroke. According to interviews and objective evaluation, the domestic environment has improved overall condition and faster return to individual self-care. Although, aftercare provided enough nursing and rehabilitative care, patient very much appreciated mental stimulation given by the home environment. The second research question focused on whether the respondent perceives own disability equaly as the surrounding. The interviews showed most of the patients perceive their health and subsequent disabilities better than its surroundings. The third research question examined whether it is more beneficial for the patient to perform self-care with deficiency, or to receive perfect execution of it by others. The results indicated more benefits by performing own self-care, even with mistakes that encourage practising, thereby repeating and consolidating manners. Most of the respondents refused any help. The fourth research question focused on patient´s perception of the subsequent therapy (physiotherapy, occupational therapy) as a faster way to return to sufficient self-care. The interviews showed that the respondents did not realize the importance of aftercare, considered it to be routine and as a part of the treatment. Yet, increased physiotherapy activities results into a quicker adjustment of self-sufficiency. Conclusion The temporal evolution of self-sufficiency of patients after a stroke and the attitudes of caregivers are described in this thesis. The results are presented in a form of mental map. This might be used by the patients after stroke, nursing staff or official home caregivers and informal caregivers, as well.
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Hippotherapy as a supporting therapy in patients with stroke
ČERVENÁ, Kateřina
This bachelor thesis deals with hippotherapy as supportive therapy of patients with stroke. Our starting platform is from the practical experience of therapists hippotherapy's centers Pirouette and available literature. The work is traditionally divided into theoretical and practical. The theoretical part provides an overview of current knowledge and is divided into two chapters, which dealing with the issue of stroke and hippotherapy. There are explained basic concepts necessary for insight into the problems of work. As part of subchapter about of stroke describing its dividing, the causes, consequences, and treatment. In hippotherapy I deal with the principles of hippotherapy effect and its impact to humans, both physically and mentally. In the research part describes the objectives of the work and the research itself. For the purposes of work I chose the design of qualitative research - a case study, which was carried out on three probands after a stroke. The probands were selected from the "Centre of hippotherapy Pirouette" Havlíčkův Brod, where it was from the end of September 2014 to mind January 2015 performed a practical application of hippotherapy under the expert guidance of a certified therapist. Data collection was conducted three complex processing of case studies using the technique of observation (kinesiology analysis of motor skills), secondary data analysis and interview with probands. The aim of this thesis is to map the effect of hippotherapy for patients with stroke and the develop specific hippotherapy's procedures in these patients. The purpose why the work was created, is an effort to improve awareness about hippotherapy as supporting methods for patients after stroke and objectification many years of practical experience hippotherapy's center "Pirouette". The outputs of this work can also be further utilized as educational material for students of physiotherapy and hipoterapeuty alone or as a basis for further research in this area.
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Activity of the radiographer at the emergency department.
PIŠTĚKOVÁ, Martina
A patient with urgent condition which threatens his life or health requires special approach of a radiology assistant to executed diagnostic performances. In this bachelor thesis, I describe procedures in case of these conditions. Because the given topic is quite extensive, I preferred a detailed description of the most serious conditions. I chose the topic because of its timeliness. The number of patients with urgent condition has an upward character for sure because of accelerated life pace and related traumas as well as diseases of civilization. My work describes three researches. The first one finds out the share of different investigations in the radiodiagnostic department as regards patients with urgent condition per one year in one hospital. The second one is related to the refresher courses of radiology assistants in relation to patients with urgent condition. The third one investigates algorithms of investigations in the radiodiagnostic department in different medical facilities. The bachelor thesis is divided into a theoretical and practical part. The theoretical part explains the term "urgent condition" and basic description of the approach to a patient in the given situation. I mention brief principles of cardiopulmonary resuscitation. I analyse individual modalities used in the radiodiagnostic department. Other subchapters are focused on the description of concrete conditions and sequence of investigations. The practical part begins with the chapter called "Targets, Hypothesis". It is concentrated on the description of the main role of my work which is discovery of radiology assistants´ approach to patients with urgent condition and the situation in education of radiology assistants in the Czech Republic. Some parts compare the condition with the situation in other countries of the European Union. The chapter called "Discussion" is devoted to the general evaluation of researches. It mentions also the important role of radiology assistants when treating patients with urgent condition. The "Conclusion" evaluates meeting of targets of this thesis and outlines possible solutions.
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Physiotherapy for Stroke Patients in Chronic Stage Using the Methods of the Neurophysiological Basis
HANZALOVÁ, Jitka
The topic of the thesis is the physiotherapy based on neurophysiological methods for chronical stage stroke patients. The stroke is a lesion of a part of the brain tissue which develops suddenly from lack of blood perfusion in the area. The clinical manifestation of stroke can differ widely depending mainly on localization, extent, graveness and duration of the reduced blood perfusion or encephalorragia. This results in need of special rehabilitation programme made for each patient individually. The main principle of physiotherapy based on neurophysiological methods is prospering from plasticity of the neural tissue which is preserved in spite of severe injury of the brain. These methods influence control mechanisms in central nervous system by activation of various neural receptors. This therapy affects the patient complexly, it is not aimed at analytic muscle training. The purpose of this thesis was to prove and to evaluate the significance of the neurophysiological methods based physiotherapy for chronical stage stroke patients. The thesis consists of theoretical part and practical part. The theoretical part resumes information on the stroke, its risk factors, complications, consequences etc. The next part briefly describes some of the neurophysiological methods which can be used for the stroke rehabilitation. These particular methods were then utilized in the practical part during physiotherapy sessions with concrete patients. The theoretical part also informs about other means of complex rehabilitation which can be used for treating chronical stage stroke patients. The practical part records physiotherapeutical treatment with the patients. In the practical part of the thesis qualitative research method was used and following methodics: anamnesis, entering examination, special examination by Chedoke for hemiplegia scoring, the records of each therapy session and evaluating the effect of the therapy, which show that physiotherapy for stroke patients is meaningful in chronical stage as well and that the methods and concepts used are suitable. The thesis may serve as a source of information for healthcare professionals and other people taking part in care of the chronic stage stroke patient.
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Comparison of level total cholesterol in serum for residents from Pilsen and Czech Budweis provided similar eating habits
FRAITOVÁ, Lucie
Measuring cholesterol is considered as a screening test used primarily to determine cardiovascular risk and monitoring lipid-lowering therapy. Since this is a screening examination, there is a need for further laboratory tests - the lipid profile (HDL cholesterol, LDL cholesterol, triglycerides). Patients who get examined as a part of lipid-lowering therapy should follow a diet. These patiens need to be examined more frequently. Population of Czech Republic is considered at risk of early occurrence of atherosclerosis and its complications. Every year in the Czech Republic nearly 60 000 people die from cardiac and vascular disease. Cardiovascular disease increasingly affects younger age group. They are also a cause of disability of people of working age. One of the main indicators is high level of cholesterol. Accurate and precise measurement of blood cholesterol plays a role in the reduction of morbidity and mortality of people with cardio vascular disease. The aim of this thesis is to: 1) Measure the total cholesterol sample population of Plzeň and České Budějovice 2) Compare and find differences in serum total cholesterol in both locations In the theoretical part of the thesis I was interested in what foods increase cholesterol and what foods can reduce high cholesterol. Furthermore, the theoretical part describes diseases that may occur during hypercholesterolemia. The basic ones include atherosclerosis and its complications, which include heart disease or stroke. Preanalytical factor that may significantly affect laboratory tests are described in this part too. The practical part describes everything from an intake of biological material in the laboratory through the preparation (centrifugation, creating aliquots) to insertion of a secondary sample into the analytical device. Research for the thesis was conducted in the biochemical laboratory of synlab czech s.r.o. in České Budějovice. In this part I investigate ? under supervision ? a total of 100 samples of venous blood from people of Plzeň and České Budějovice. I determined the total cholesterol in serum. Cobas Integra 800 automatic biochemical analyzer was used for the examination of the biological material. In routine practice enzymatic methods are used to determine levels of cholesterol. Cholesterol esters are converted by cholesterol esterase into free cholesterol and fatty acids. Free cholesterol is oxidized by cholesterol oxidase to form cholestenone and hydrogen peroxide. The resultant hydrogen peroxide reacts with 4-aminoantipyrine and phenol to form a red color and water. The color intensity is directly proportional to the concentration of cholesterol and is measured by absorption spectrophotometry at 512 nm.Measured laboratory results were statistically processed and neatly sorted into tables and graphs using the computer program. Data from Plzeň and České Budějovice were sorted according to gender and evaluated using graphs. The data sets were then compared to each other and the difference in cholesterol levels was registered. All the results are in the table and graphs. Hypercholesterolemia was detected in 29 samples from Plzeň and 27 from České Budějovice.
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Communication problems of nurses in pacients after stroke
PECKOVÁ, Jana
The bachelor thesis "Problems in nurses´ communication with patients after cerebral vascular accident? deals with the knowledge of nurses in communication with patients with aphasia after an ictus. Right communication belongs to key points of the subsequent treatment of this disease. A cerebral vascular accident ? a stroke - can negatively affect the life of a person affected by the disease. Other negatives symptoms are provoked by acquired disorders of cognitive function. Phatic failure is of a concern in the nurse-patient communication. Patients are not usually able to express themselves properly or understand others. During their hospitalization the role of a nurse is therefore very important. Nurses should be sufficiently educated in communication and to know the specifics of this disease. Compensation aids to facilitate and improve communication with patients after a stroke should also be available and used by nurses. The objective of this thesis was to determine whether nurses follow the correct procedures in communication with patients after a stroke, and to map the most frequent communication problems between nurses and patients after a stroke. The empirical part of this study consisted of quantitative research, using an anonymous questionnaire that was designed for nurses in neurological and internal wards of the hospitals in Příbram, Písek and České Budějovice. The questionnaire contained a total of 24 questions. 107 questionnaires were distributed and the research was processed with 90 questionnaires, i.e. 84% of the original number. Three hypotheses were stated. The first hypothesis assumed that nurses know principles of good communication with patients after a stroke. This hypothesis has been confirmed. The second hypothesis assumed that nurses use aids to improve communication with patients after a stroke. This hypothesis has been confirmed. The third hypothesis assumed that nurses are interested in further upgrading skills in communicating with patients after a stroke. This hypothesis has also been confirmed. The objectives have been met on the basis of confirmed hypotheses. This bachelor thesis can serve as educational material for nurses working with patients with aphasia after a stroke.
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The Work of the Nurse at the Stroke Unit
BROŽÁKOVÁ, Žaneta
The theme of the Bachelor degree work ?The Work of the Nurse at the Stroke Unit? was chosen as it deals with the interesting issue of the development of neurology medical branch which is closely connected with building ictus stroke units. These new units provide for modern treatment and nursing care in particular to patients suffering from the acute vascular cerebral accident ? stroke (ictus). The development of these units also supposes higher requirements for nurses both in the sphere of the theoretical knowledge and the practical skills. The theoretical part of the work deals with the general issue of ictus in the form of symptoms, diagnostics and treatment. Further, it informs us about the organization of the cerebral-vascular care in the Czech Republic and nurses´ competences in the selected nursing performances. Next, there is described the intervention of the nurse at the acute reception of the patient suffering from ictus and particularly the complex nursing care at the ictus/stroke unit accompanied with nursing diagnoses which occur at the patient suffering from ictus. The aim of the work was to find out specific features of the nurse´s work at the ictus unit from the nurse´s point of view and to map out nurse´s knowledge at the ictus unit from the nurse´s point of view. To accomplish both aims there were answered research questions. VO1: What nursing procedure is specific for the work of the nurse at the ictus unit? VO2: What nursing diagnoses are specific for patients at the ictus unit? VO3: What knowledge is required form the nurses working at the ictus unit? VO4: How does the nurse gain necessary knowledge for the work at the ictus unit? The practical part of the work provides a lot of information on the work of the nurse at the ictus unit from the nurse´s point of view. This detailed information was found out by means of the research investigation, the qualitative method in the form of interviews with nurses at the selected ictus units. The results of the research work are used for the compilation of the nursing standard of the care for the patient suffering from ictus during thrombolytic therapy. This standard provides nurses complex information and helps the patient to get high-quality and safe nursing care.
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The role of the nurse in the prevention of immobilization syndrome after stroke at the department of neurology.
HOLUBCOVÁ, Eliška
Bachelor?s thesis The Role of a nurse in prevention of immobilization syndrom after stroke at the Deprartment of Neurology dwells on the problem of nursing care and prevention of immobilization syndrom of the patients after stroke. The theoretical part of the thesis is aimed at prevention, treatment and examination, which the patient has to go through after stroke and the role of the nurse during these performances. The immobilization syndrom is also described in detail at the thesis. At the conclusion of the theoretical part the author concentrates on the treatment which ought to be performed as a prevention of the immobilization syndrom of the patient after stroke. One of the chapters deals with health care, nutrition, defecation, skin care, mental state and communication with the patient after stroke. The practical part of the bachelor?s thesis focuses especially on qualitative research performed just at the Department of Neurology. The aim of the above mentioned research was to evaluate the role of the nurse in the care of the patient after stroke at the Department of Neurology. In the research the author stated the following question: What is the role of the nurse in the prevention of immobilization syndrom of the patient after stroke? This part also includes interviews with nurses conducted just at the Department of Neurology and the same nurses were also observed during nursing care. The results of the research show that the nurse plays crucial role in the care of the patient after stroke, either as a provider of nursing care or as a communicator, and to a smaller extent as an educator. The thesis also contains a map of nursing care, which describes the correct process during the care of cavity. The nurse can influence the course of disease by correctly performed nursing performances, such as dehydration, malnutrition and dekubital ulcer.
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Rehabilitation Treatment of Patient with Stroke
BŘEZOVSKÁ, Lucie
This bachelor thesis is on the topic of rehabilitative nursing of stroke patients. It is analysing how the issue is dealt with in the rehabilitation department and Department of Neurology. The bachelor thesis is divided into two separate chapters, theoretical and practical. The theoretical part focuses on the causes, symptoms, diagnosis and Treatment of patients after a stroke and the current state of rehabilitative care. One of the parts of rehabilitative care is the collaboration of the nurse and the multidisciplinary team. Furthermore, the thesis describes the possible complications that may occur from the stroke. These complications include mainly pressure sores and immobilization syndrome. Rehabilitative treatment of patients with strokes include positioning, communication, passive movements, active movements, verticalization, breathing exercises. Other methods used in rehabilition nursing, application of heat and cold and basal stimulation. The thesis also includes chapters dealing with nursing management, medical documentation and evaluating the scale of a patient after a stroke. For the practical part there was a set goal, determine the working conditions for nurses who provide the patients rehabilitative treatment after a stroke. There were four main hypotheses defined, which were the subject of an anonymus questionnaire: Hypothesis - H1: There are only positioning aids available for nurses to provide rehabilitative treatment. Hypothesis - H2: Nurses are documenting the rehabilitative treatment regularly used in the nursing process. Hypothesis - H3: Nurses state that the problem of providing rehabilitative care is the lack of time. Hypothesis-H4: Results of rehabilitative nursing care are monitored by the nursing management. As additional research investigation case reports have been formulated with the Barthel index in four patients. Results of the research shows that nurses are using not only positioning aids, but other available tools as well. Rehabilitative care nurses regularly document treatments, especially in nursing documentation. Nurses stated that there is lack of time for providing rehabilitative nursing and nurses state that the treatment is monitored by nursing management.
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