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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 historical view of the army nurse profession.
PAVLÍKOVÁ, Andrea
The thesis deals with the profession of a military nurse. We can assert that the official study of military, non-medical health-care related qualifications and its use in practice not only for military purposes dates back to the fifties of the last century. However, women as health care professionals, consequently in uniforms, have always been an actual issue. The development of health care activities always existed, however, we must not neglect influence of scientific and medical findings. The historical timeline of development of medical care in the battle field was recorded and ranges from pre-historical healing. The way of Christian medicine was negatively influenced by the Catholic Church. The dark period of the Middle Ages had actually wrested medical performance from the hands of specialists and the suffering were left to the "tender" mercies of the priests. The following part of the thesis concerns modern medicine where enlightenment reforms were exercised. Some of the original six-month courses for military surgeons were organised in this period of time; they weretransformed into Military Surgical Academy, out of which the famous Josefinum originated. A expression of humanity which supported a form of health care of war veterans was demonstrated by constructing buildings for invalid people. The second half of the nineteenth century is characterized by the phenomenon of the presence of nuns in military hospitals. This study goes further in depth of professionally organized healthcare right in the battle field, which dates back from the era of wars in the Crimea.This stage describes the transformation of caring into nursing which requires the necessity of specialized preparation of persons providing nursing practice. In addition, Henry Dunant engraved himself into the history of the profession of a nurse, as the founder of the Red Cross, who first trained health care professionals for working within armed intentions of the state. The continuation of this action sketches out the process of providing first aid in principal armed conflicts of the twentieth century. It describes the functioning of commander operated military health service of that time. WWI drove Czech medical staff to both sides of the front where they provided medical help to the injured. Nurses of the WWII already performed their duties in uniforms as the rightful members of the army. The thesis also mentions post-war usage of military health care professionals in secret foreign missions and their specialized erudition.Last but not least, it marginally discusses contemporary possibilities of modern health care service of the Army of the Czech Republic. The goal of the endeavours of writing this thesis was to chart out clearly the development of the profession of a military nurse within the historical context, focusing mainly on women coming from Czech regions. In order to make the history background concerning specific female participants of the world war conflicts understandable to the reader, this paper reports, in broader extension, peculiar medical and nursing findings, already from the era of prehistoric civilisations. The history study method were applied for the purpose of the theoretical thesis. The methodology is based on searching, studying, sorting and the consecutive systematic objective describing of the events from the past times with the intention to propose comprehensive report on the subject given. It was necessary to study inexhaustible amount of sources to obtain awareness of historical connections. Factual information was derived by analysing of primary and mainly secondary documents. The thesis sketches out histories of military health care and the profession of a military health care professional stemmed from the exploration of appropriate written sources and conclusion of the basic findings. The intentions of the work are not only to clarify the past but also to contribute to solutions of every-day issues.
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The role of nurses and their impact on the care of patients with total hip arthroplasty.
SLABÁKOVÁ, Květoslava
Total hip replacement is one of the most extensively and highly effective operating methods in orthopaedics. The patients are brought back the self-sufficiency, life without the pain and noticeably motion restriction. Irreplaceable function here is a role of the nurse, who helps the patient to return back to his common life...The aim of this work was to find out, how the patients feel the role of the nurse and its influence to given nursing care before and after the total hip replacement as the less fulfilled. There were following research questions set: How the patients feel the role of the nurse before and after the total hip replacement? How the patients before and after the total hip replacement feel the interpretation of the nurse roles? How the patients before and after the total hip replacement feel the role of the nurse and its influence to given nursing care. Which of the nurse roles are felt by the patient as the unsatisfactory in postoperative care? The patients before and after the total hip replacement feel through the everyday nurse activities the nurse in her role of the caregiver and education giving person, following the nurse vindicator and the nurse bearer of changes. The patients feel the care thanks these roles as a quality, holistic and continual. Nevertheless was the role of the education giving named as the least fulfilled. In connection with these research results was created a manual, a Guide book for the patients before and after the total hip replacement. This Guide book was given to testing purposes. This Guide book was appreciated by the patients very positive despite a large amount of information, which were surprising for many of them. We gained some data, which gave the impulse to complete the information in the Guide.The created Guide book can´t replace the effective communication of the patient with the medical staff, which could be always the most suitable "source" of information.
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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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Gluten-free diet - reality in school facilities
JIRÁČKOVÁ, Marie
The topic of this bachelor thesis is gluten-free diet - reality in schools facilities. The goal of this work was to determine the number of school cafeterias in the Vysocina Region which provide gluten-free meals, to evaluate awareness of the canteen staff about preparation of the gluten-free diet and to describe the cooperation between the school cafeteria and family of the pupil with gluten-free diet. School meals are important to provide optimal intake of nutrition during the time the child spends in school, to establish proper eating habits and to better integrate the child into the group of its peers. Gluten-free diet is a necessary medical precaution especially for those with coeliac disease, in which case gluten can lead to villous atrophy, and for those with gluten allergy for whom gluten intake can cause anaphylactic shock. Adherence to the gluten-free diet is recommended also to those with non-coeliac gluten sensitivity diagnosis, although gluten causes only short-term complications, usually intestinal. The method of quantitative and qualitative research was used to make this thesis. The research sample consisted of 8 school cafeterias from the Vysocina Region which provide gluten-free meal to their pupils. Awareness about gluten-free diet principles of the managers of the cafeterias or of the cooks responsible for preparation of gluten-free meal was determined by means of semi-structured interviews. The calculation of the two-day menu of each cafeteria by means of the Nutriservis Profesional program was also part of this thesis. The results were compared with the recommended daily intake of energy, proteins, fat, and saccharides for pupils of elementary and secondary schools. The results of the quantitative research show that gluten-free diet is provided by only a small percentage of school cafeterias in the Vysocina Region. The qualitative research prove sufficient awareness of the cooks about gluten-free diet, with awareness of those cooks directly responsible for preparation of gluten free meals being at much higher level. It was also determined that the cooperation with parents of pupils with gluten-free diet is a usually one time occasion limited to an arrangement of nonperishable gluten free meal packages.
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Poliomyelitis and contemporary issues of its eradication
PETRÁŇOVÁ, Monika
This diploma thesis deals with the issue of the eradication of infectious polio and its current problems. Polio is a highly infectious disease of viral origin. The most effective form of protection from the disease is vaccination. The main aim of this work was to determine the major issues in polio surveillance in the Pilsen region at present. Intermediate goals were determined in relation to the main aim: to ascertain the awareness of practicing paediatricians about the principles of poliomyelitis surveillance with an emphasis on diagnosing and reporting cases of acute palsy and further to ascertain the quality of the cooperation between the locally competent public health authority and practicing paediatricians in the field of poliomyelitis surveillance. The work is divided into two parts, theoretical and practical. The practical part was elaborated using a qualitative method based on semi-structured interviews with practicing paediatricians and with the locally competent public health authority. The research was participated in by 9 practicing paediatricians and one public health authority worker from the Pilsen region, with an average length of practice of 20 years. The resulting data was then evaluated by a coding method and divided into schemes according to Švaříček and Šeďová (2007). Three research questions were defined based on the set aims: RQ1: What do practising paediatricians see as the prime problems in polio surveillance? RQ2: How many cases of acute palsy do practising paediatricians record and subsequently report to the competent public health authority? RQ3: What is the quality of the cooperation between practising paediatricians and the locally competent public health authority? The research revealed that, according to the practising paediatricians, the problem in poliomyelitis surveillance is refusal of the vaccination and the associated decreasing immunisation coverage of the population. The next most commonly reported problem was population migration. Furthermore, it was found that not one practising paediatrician recorded or reported cases of acute palsy in their surgery. Only one respondent encountered acute palsy 10 years ago. The answer to the last research question is also apparent from the information obtained. More than half of the respondents agreed that so far there is no cooperation on this issue. Although four respondents stated that the cooperation is at a high level and is of very good quality.
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Stress situations and nursing personnel
MAREŠOVÁ, Lucie
This thesis deals with the stressful situations in the profession of the nursing staff. The occupation of the nurse belongs to the most demanding ones. In this occupation, the nurse is permanently affected by many stressors of different types. She faces death, the suffering, dying and incurably ill people very often. She is there in times of pain, agony and suffering. Personal encounters with these difficult situations require highly professional approach but most of all, they present immense work stress for the nurse. The theory section describes mainly the stressful situations that are the most common and most difficult in the work of the nursing staff. The next part of the theory section describes possible consequences of the stressful situations and methods of managing them including the support by the management. This thesis has two objectives. The first objective was to map the manners used by the nursing personnel to cope with the stressful situations brought by their profession. The second objective was to find out the difference in the coping with the stressful situations between the hospital staff and hospice staff. The research section of this thesis contains the quantitative research done using the technique of an anonymous questionnaire with 20 question prepared by ourselves. The questionnaire was distributed to the nursing staff of all categories in the hospital and hospice care. It was completed by 269 respondents in total. The data was statistically processed using systems Microsoft Excel 2010 and Software R, version 3.0.2 (Chi-squared test, Fisher´s exact test, and Wilcoxon test). We determined four hypotheses. H1: Manners of coping with the stressful situations depend on the qualification of the nursing staff reached; not confirmed. H2: Manners of coping with the stressful situations are influenced by the length of practice of the staff; not confirmed. H3: Manners of coping with the stressful situations differ between the hospital staff and hospice staff; confirmed. H4: The nursing staff views their own mental hygiene as more efficient than the support from the management concerning the coping with the stressful situations; confirmed. The research results show that the nursing staff faces the stressful situations very often. They see as the heaviest stress the care of the suffering and aggressive patient, conflicts with the patient´s family, conflicts at work and workload. The manners of coping with the work burden which proved as the best for them are relax, rest and sleep. There were no differences proved in the manners of coping with the stress among respective members of the nursing team. Nevertheless, the coping with the work burden of the nursing staff in the hospital and hospice care is different. A minimum of the respondents notices any support during the stressful situations from the employer. On the other hand, certain support by the management could be viewed in the form of trainings, supervision or contribution to a "recovery" which are granted to the respondents from the employer according to their answers. However, the respondents would prefer, as the support by the management, the increase in pay or more days off. The respondents view as insufficient the preparation of the graduates for the future stressful situations in their profession, as well. They would recommend mainly various trainings dealing with the stress and its management. A good solution to alleviate the work burden of the nursing staff and quality enhancement of the services provided could be investments into better work conditions, both in terms of sufficient human and material resources and the very organization of the work processes.
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Narcolepsy and other seizure disorders
TONDLOVÁ, Andrea
The thesis deals with the issue of seizure disorders from the perspective of special neurology. In terms of content, it is focuses on two major areas. The first part is theoretical in nature and has descriptions of the individual disorders, their clinical manifestations, diagnoses and current treatments. It is focused on the following seizure disorder group with regard to one of the objectives of the work: epilepsy, tetany, Meniere's syndrome, migraine and more specifically narcolepsy. These findings are supplemented with information on current knowledge regarding the treatment and diagnoses of these diseases, which make the lives of thus disables people very difficult and prevent them from leading their lives the way they could if they were in full health. The aim of the work is not just a theoretical description of the currently available knowledge of these diseases from literature, but also a practical confrontation thereof from experiences, which in this case result from the true stories of people suffering from seizure disorders. A specific seizure disorder has been selected for this second part of my thesis, which needs to be talked about more in order to become better known. It is a disorder that is interchangeable with regard to its symptoms, which are similar to other disorders, and it is difficult to diagnose or is only diagnosed after an inconveniently long time - i.e. Narcolepsy . The thesis therefore deals with the issue of narcolepsy in most detail, with regard to the practical focus in the next section, where in addition to aforementioned basic knowledge, the author describes the activities and the importance of sleep laboratories and centres as institutions involved in treatment. In order to penetrate into the issue of this disorder even more deeply, she adds the aforementioned anonymous stories of people affected in this way. This part is also complemented with illustrative images of the sleep laboratory and the stories of these people as a better visual complement of the thesis for the reader. A descriptive analysis (comparison) of each symptom was chosen as a comparative method of the aforementioned thesis objective (to compare the theoretically given symptoms of narcolepsy with the symptoms of individuals suffering from this disease), in which the goal was to choose the common symptoms these people which make their lives difficult and compare these data with information (symptoms of narcolepsy) found in contemporary literature. In conclusion, we visit the most important information from scientific literature, the views of the professional community on the current research and studies on narcolepsy, i.e. the specifically examined causal links of applying the Pandemrix vaccine (against swine flu) and narcolepsy and a summary of the results of other studies investigating the etiology of this disease. The aim of this section is to present the reader with, and identify, the current developments in narcolepsy research. An evaluation of the historical development of interest in sleep disorders and an evaluation of the conclusions drawn by comparing symptoms specified in professional literature on narcolepsy with actual symptoms of people suffering from this disease are also included. The aim is to provide the reader with a bio-psycho-social view of a person with this disease, which is not always emphatically discussed in every piece of professional literature. The result of the entire thesis is a summary of the current state of knowledge of these diseases and a reflection on the research of the current possible causes of narcolepsy. It continues to compare the theoretical background of the narcolepsy disorder with the experience of living with this disease, including stories of selectively chosen individuals suffering from narcolepsy.
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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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Strategie oplozování u ryb s vnějším oplozením
SIDDIQUE, Mohammad Abdul Momin
Morphological properties, species specific differences, development, and function of egg envelopes are of importance for a better understanding of fertilization strategies as well as for captive reproduction. We reviewed morphology and the developmental stages of egg envelopes, mechanism of polyspermy block, and also the role of micropyle and cortical granules in polyspermy block for acipenserid eggs. The structure of the egg envelope is similar among the acipenserids, comprising an external envelope (thecal cells, basal lamina, and follicular epithelium), a five-layered oocyte envelope (adhesive layer, alveolar layer, epilayer, and zona radiata externa and interna) and a layer of oocyte matrix and cortical granules. The development of acipenserid egg envelope within the ovary comprises five stages, with further changes following fertilization. Moreover, we standardized the terminology used to describe the egg membranes which can minimize the confusions and be helpful for future work on acipenserids eggs as well as for other fish species. The sperm to egg ratio (required to fertilize eggs) and effects of pre-incubation of eggs in freshwater before fertilization were studied to standardized fertilization protocols for sterlet Acipenser ruthenus. Pre-incubation time had no effect on fertilization success at 430,000:1 and 43,000:1 sperm to egg ratios, while it was significant at the 4300:1 and 430:1 ratios. The use of adequate experimental suboptimal sperm to egg ratio revealed a positive effect of pre-incubation time, such that at the 430:1 ratio, 0.5 min pre-incubation increased the fertilization rate than 10 min. Transmission electron microscopy showed that pre-incubation of eggs in water for <10 min did not trigger a cortical reaction, suggesting that a low sperm to egg ratio 0.5 to 1 min pre-incubation of eggs in freshwater prior to fertilization can enhance fertilization rate of sterlet (minimally do not change fertilization). The effects of pre-incubation in seawater and the duration of egg receptivity were determined for fresh and over-ripe sea bass eggs. Our results revealed a significant effect of pre-incubation time for both the fresh (P < 0.01) and over-ripe eggs (P < 0.01). The fresh eggs had a higher fertilization success than over-ripe eggs. Fertilization success of eggs significantly declined for both of these treatments after 3 min of pre-incubation clearly indicated that sea bass eggs are able to be fertilized by sperm for up to 3 min after release into seawater. Effects of pre-incubation of eggs and activation medium on the percentage of eyed embryos for Ide Leuciscus idus were examined. At the eyed-egg stage, pre-incubation time was significant for the freshwater activation medium (P < 0.001), such that the percentage of eyed embryos declined across the pre-incubation time gradient. Activating medium had a significant effect on the percentage of eyed embryos for each pre-incubation time (P < 0.05). More precisely, freshwater produced the lowest percentage of eyed embryos at all pre-incubation times, whereas saline water and Woynarovich solution produced the highest percentage of eyed embryos at 0 s and 30 s before incubation. Examination of sperm traits showed no impact of activating medium on computer assisted sperm analysis parameters. Our results suggested that saline water or Woynarovich solution improve fertilization rate in Ide during fertilization. In conclusion, this thesis provides basic knowledge on gamete biology, role of egg receptivity period, effects of pre-incubation of eggs and different activating medium which can be useful to understand the fertilization strategies of different externally fertilizing fishes as well as standardize their fertilization protocol for captive reproduction.
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