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Nursing care of patients with acute respiratory failure
NĚMCOVÁ, Kateřina
Acute respiratory failure is a state when the respiratory tract suddenly is not able to carry out its functions. The disorder can be both at the inflow of the air into the respiratory tract or at the point of the gas exchange between the alveoli and the blood. The most severe form of acute respiratory failure is the acute respiratory distress syndrome-ARDS. It is necessary to treat acute respiratory failure immediately when it appears because it can cause serious damage to the organism or death. The treatment requires securing the respiratory pathway. A theoretical knowledge of the possible causes of the origin and development of ARDS, and its treatment using artificial pulmonary ventilation helps to correctly understand the problems of this illness. Nursing care is essential while treating severe respiratory failure. The care is highly specialized in this case. The nurses participate in the securing of respiratory pathway, beginning and progress of artificial pulmonary ventilation and the process of weaning of mechanical ventilation. The aim of this bachelor's thesis is to determine the basic terms and issues of acute respiratory failure. This is necessary to properly understand the case and the subsequent treatment of respiratory failure with mechanical ventilation. The study deals with defining and comparing particular guidelines of the complex nursing care of the patients with acute respiratory failure. This project was defined because of the continual development and improvement of the care of critical status patients. This thesis, entitled "Nursing Care of Patients with Acute Respiratory Failure," expounds on its topic only as a theoretical work based on both Czech and international scientific resources. Knowledge of particular parts of the thesis was obtained from various scientific and professional books, magazines and Internet resources of professional associations. The Czech authors most frequently cited are MUDr. Pavel Dostál PhD. MBA, who is focused on the issue of artificial pulmonary ventilation, and MUDr. Bronislav Stibor, who is dedicated chiefly to ARDS and revitalizing methods. Based on the studied literature, basic theoretical terms and issues were expounded concerning acute respiratory failure and acute respiratory distress syndrome. Particularly emphasized was the artificial pulmonary ventilation. The theoretical part gradually joins the part dealing nursing care of those patients suffering from acute respiratory failure. The part contains every guideline concerning the most recent developments and the latest innovations in the field of nursing of the critically ill. After studying the scientific sources, it was concluded that there were some differences regarding each authors´ guidelines. The guidelines differed from each other only slightly. Each guideline is mentioned in the thesis and analyzed at the end of the thesis. There is a comparison of competences of general nurses and specialized nurses for intensive care. According to Czech law, the patients with the failure of a vital function should be treated by specialized nurses. The range of permitted treatment attended by an intensive care nurse is plentiful when compared to general nurses. If the only one student carried out one of the proposed guidelines from my thesis and was able to use them at work, she or he would help to improve the complex treatment at intensive care units and my study would fulfil its propose.
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Ventilation support in prehospital care and during transport of the patient
PETROVIČ, Pavel
The topic of presented bachelor thesis is ventilation support in prehospital care and during transport of the patient. Consciousness, breathing and blood circulation belong among basic life functions. Thanks to ventilation support we are able to provide full or partial pulmonary ventilation. For this we use aids such as resuscitation masks meant for lay public or aids for trained paramedics like laryngeal masks, endotracheal tube and ventilator for artificial pulmonary ventilation. Prehospital care is not only about professional first aid, but about giving first aid by lay public as well. That is why aids for pulmonary ventilation are included in this thesis. This bachelor thesis had two aims; to map and compare knowledge of students attending the last year of high school in kiss of life and map experiences of paramedics with a laryngeal mask Supreme and capnometry. The research was implemented with mixed method research. Knowledge of students were found out by tests which were give in class "Z4" at Střední odborná škola veterinární, mechanizační a zahradnická a Jazyková škola s právem státní jazykové zkoušy and in class "4.B" Gymnázium Jírovcova. At Z4 class research took place on 14th March 2014. There were 25 students in this class, 4 men and 21 women. At class of 4.B students' knowledge was tested on 2nd April 2014 with presence of 26 students, 16 women and 10 men. At the beginning of test the anonymity of respondents was stressed, and then all respondents were acquainted with the character of my research and its aim. At the start of the test there were two statistic questions; if the respondent is either man or woman and whether the respondent has his/her driving license. There were 15 closed questions in the test and students were supposed to choose one right. After handing all the tests, the correct results were told to students. 51 tests altogether were given. Experiences of paramedic with the laryngeal mask and capnometry were found out in a form of five short dialogues in a week from 7th to 11th April 2014. The research group include paramedics of Zdravotnická záchranná služba Jihočeského kraje. Gained data from tests were evaluated, each question separately and then transformed in graphs which show the number of wrong and right answers. The aim of this thesis was to map and compare knowledge of students in the last year of their studies. Evaluated tests show us, that students of Z4 class have more knowledge about kiss of life or with cardiopulmonary resuscitation. In seven questions these students were more successful than their same-age colleagues from Gymnázium, who were better at three questions only. Experiences of paramedic with laryngeal masks Supreme are positive and if ensuring of air passages is needed, when a doctor is not present, they choose LMA Supreme. Paramedics agreed on that following ventilation via LMA Supreme is sufficient as long as we choose the right size. Paramedics ask for capnometer device in all cars EMS. Paramedics of the research group do not daily meet patients who would need or used at controlled ventilation. Students of the last year at high school have basic knowledge about kiss of life or about giving first aid. This knowledge is not 100% and teaching of giving first aid should be as a subject at high schools. Paramedics accept new aids and machines and use them during their practise. Thanks to this, first aid is becoming more beneficial for patients and for paramedics.
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The quality of life of children suffering with spinal muscular atrophy
KOČOVÁ, Helena
The scope of this dissertation focuses on issues related to the quality of life of children suffering with spinal muscular atrophy (SMA) and their carers and the associated social impact on families affected by this progressive and incurable disease. It describes ethical aspects of help to families with SMA and serious decisions in relation to the need to connect to artificial ventilation. Spinal Muscular Atrophy - SMA is a motoneuron disease i.e. disease of neurons, which are responsible for conscious movements of muscles e.g. running, head movement and swallowing. The prevalence is approximately 1 newborn for 6000 live births and approximately 1 person of 40 people is the carrier of the disease. SMA affects all the bone muscles i.e. proximal muscles are often affected the most. Everyone affected is in some point in life, depending on stage and type, reliant on mechanical or electrical wheelchair, in many cases also on artificial ventilation and permanent 24hr care. Families affected by this illness accept the fact of this progressive and incurable illness differently, this dissertation reflects upon such different perceptions on quality of life of the affected children, the carers. It forms a contribution in building a foundation for organising multi-discipline teams of experts with sole purpose of therapeutical interventions, to support the child and his/hers family. The World Health Organization (WHO) defines palliative care as "improving quality of life of patients facing life-threatening illnesses, and their families, through the prevention and relief of suffering by early identification and treatment of pain and other problems, whether physical, psychological, social or spiritual." Palliative care prepares families for these situations and should be provided along with whatever treatment options families choose. This dissertation is a comprehensive information base to support children affected by SMA and their families in early care in Czech Republic and in the process of inclusive educational integration into mainstream society.
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Ethical aspects of Nursing care in mechanical ventilated Patients
KŘIVKOVÁ, Jana
The diploma is focused on Ethical aspects of nursing care from the perspective of staff providing nursing care in the intensive care units and long-term intensive care units. We were also interested in respondent?s knowledge in the field of ethical principles in biomedicine and their legislation. The thesis is divided into two parts - theoretical and empirical. The theoretical part describes nursing care of the mechanically ventilated patients, short history of medical ethics and current status of the ethics in biomedicine. The investigative part was implemented by combination of a quantitative and a qualitative research. For the quantitative part of the investigation we used the method of questioning by a questionnaire. The questionnaire consisted of 20 questions, 10 closed questions, 8 half-opened questions and 2 open questions which offered to show a personal opinion. Questionnaires were anonymous. Respondents that were asked were workers providing nursing care in the intensive care units and long-term intensive care units. The first goal of the diploma was to find out respondents point of view on nursing care in patients on long term mechanical ventilation. The second goal was to find out the most important ethical problems in providing nursing care in this category of patients. The last goal of the diploma was to find out respondents knowledge of codes of ethics and legislation. For the quantitative research we had two hypotheses: 1. There are ethical problems related to providing nursing care in patients on long term mechanical ventilation. This hypothesis was verified, because statistically significant majority of respondents said, that there are ethical problems related to providing nursing care in this category of patients. 2. The nurses´ approach to patients on long term mechanical ventilation is different in the intensive care units and long term intensive care units. This hypothesis was verified, because there were statistically significant differences between answers of respondents providing nursing care in intensive care units and long term intensive care units. For the qualitative research we used the technique of half-structured interview offering open questions. Into the research file was involved 10 nurses, 5 from intensive care units and 5 from long term intensive care units. There were set three investigatory questions. 1. What opinion has respondents about nursing care in patients on long term mechanical ventilation? The investigation showed that nurses have the same attitude to long term ventilated paitents as in the case of patients on acute short term mechanical ventilation. 2. What are the most serious ethical problems related to nursing long term mechanical ventilated patients? The research found out the most serious ethical problems related to long term mechanical ventilation from the point view of a nursing staff. These are preservation of human dignity and prolonging medically futile treatment. 3. What awareness of basic ethical principles and their legislation the respondents have? The investigation showed that nurses have poor knowledge of the issue. The results confirm the current situation of this issue. Based on the results of our research, we prepared educational brochure draft, which could help to facilitate orientation in this field.
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Nosocomial infection occurrence in patients receiving mechanical ventilation
HOMOLKOVÁ, Lenka
The thesis deals with the most frequent nosocomial infection in the intensive care, the ventilator-associated pneumonia. The main purpose of the thesis was to raise nurses? awareness of this hospital-associated infection. It concentrates particularly on possibilities of prevention from this infection. The thesis consists of a theoretical part and a research part. As the ventilator-associated pneumonia occurs in connection with the mechanical ventilation the introduction to the theoretical chapter deals with the basic terms related to mechanical ventilation. It concentrates on the description of reasons for mechanical ventilation and the ways of its application by nurses during the care of patients receiving mechanical ventilation. The subsequent part deals with nosocomial infections, the factors conditioning the occurrence of nosocomial infections, nosocomial infections in the intensive care and the ways of prevention from these infections. The part following the introduction to mechanical ventilation and nosocomial infections deals with the nosocomial infection associated with continuous mechanical ventilation, the ventilator-associated pneumonia. It describes the disease pathogenesis, factors conditioning its occurrence, diagnostics, treatment and particularly the ways of prevention from this disease. The research part of this thesis contains the results of the quantitative research based on the data gathered by means of an anonymous questionnaire targeted at the nurses at the anesthesiology and resuscitation department and by subsequent monitoring of the nurses. The research also included monitoring the nurses at work. In order to complete the thesis five objectives were outlined and six hypotheses were constructed. The aim of the objectives was to investigate how the nurses care of a tracheostomy and the pulmonary toilet of respiratory tract in patients receiving mechanical ventilation, how they maintain the ventilator and its components. The investigation also concerned the nurses? awareness of the aseptic techniques during the treatment of the respiratory tract and the ventilator. The aim of the last objective was to investigate the ways of prevention from the occurrence of nosocomial infections in patients receiving mechanical ventilation at individual workplaces. Concurrently the following hypotheses were constructed: H1 ? nurses perform the tracheostomy under aseptic conditions; H2 ? nurses perform the pulmonary toilet under aseptic conditions; H3 ? nurses observe the aseptic techniques when maintaining the ventilator; H4 ? nurses are informed about the aseptic techniques during the care of tracheostomy; H5 ? nurses are informed about the aseptic techniques during pulmonary toilet; H6 ? nurses are informed about the ventilator maintenance. On the basis of the knowledge of the issue and the results of the research the output of the thesis was realized in the form of a nursing care standard aimed at the suction of the lower respiratory tract. The second output of this thesis is a poster with ways of prevention from the ventilator-associated pneumonia designed simply to motivate nurses to observe the preventive measures.
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The Care of Air Passages of Ventilated Clients at the Department of Anesthesiology and Resuscitation ? Creating Instructional Materials for Starting Nurses
PAŠAVOVÁ, Miroslava
The bachelor thesis is focussed on issues relating to the care of air passages of ventilated clients and on creating instructional materials for starting nurses of the Nemocnice Strakonice a.s. The thesis is divided two parts ? the theory and the research. Chapters in the theoretical part describe besides other things the air passages anatomy, ways, aids, and tools for ?securing? the airway during the artificial ventilation, and the following care of the airway of course. The research part was realised as qualitative research in the form of unstandardised individual interviews. Three targets were set and should be met by sets of questions. Two groups of nurses of the same ward ? of the anaesthesiology and the intensive care ward in the hospital Nemocnice Strakonice a.s. ? were asked these questions. The first group consisted of nurses with years of experience on the anaesthesiology and the intensive care ward, who give the initial training to starting nurses during the adaptation process, and the second group consisted of starting nurses or of nurses with minimal experience on the anaesthesiology and the intensive care ward. The goal was to find out specifics of the nursing care of the airway in case of ventilated clients on the anaesthesiology and the intensive care ward and the optimal form of instructional materials for starting nurses. The last goal was to find out the contribution to and applicability of the created materials of the airway care in practice. The result showed that the basic specifics are the airway suction, humidifying, micronebulization, and the care of the endotracheal tube and tracheostomic cannula. The nurses suggested creating the instructional materials in the form of a printed manual and in the electronic form because the instructional materials relating to the airway care for ventilated clients have to be supplemented continually. New technology and new methods are developed and it is a duty of medical staff members to supplement the information and procedures and provide adequate nursing care. A suitable solution could be the created instructional materials because they are both printed and in the PowerPoint format. It is possible to modify and update it anytime. The created materials were given to the anaesthesiology and the intensive care ward team for two months so that they could test them in practice in Nemocnice Strakonice a.s. where the research was realised. Finally, the materials were presented to the ward sister.
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Possibilities of artificial pulmonary ventilation in urgent care and anesteziological resuscitation department
BINTEROVÁ, Jana
The aim was to explore the possibilities of mechanical ventilation in prehospital emergency care and Anesthesiology and Intensive Care qualitative research method. The first part of the research was focused on finding out how the use, including the most frequently used modes of ventilation, and frequency of artificial ventilation. Research has found that in pre-hospital care are used methods of invasive and noninvasive ventilation and ventilatory modes most widely used in prehospital care are IPPV, CPAP and SIMV. In the second part of the research focuses on the possibility of mechanical ventilation on Anesthesiology-Intensive Care and neužívanějších detection schemes. They are IPPV, BIPAP, SIMV, APRV, PS and CPAP. The last part of the research deals mainly comparing the possibilities of mechanical ventilation at the base emergency medical services of the Liberec Region and South Region. I ran into very different views on the importance of mechanical ventilation in prehospital emergency care, but the result is the possibility of artificial ventilation in different regions does not differ much.
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Health and social issues in patients ventilated at home
FENEŠOVÁ, Lucia
An outstanding progress in pulmonary ventilation was documented recently when artificial pulmonary ventilation was introduced for home care. In-home pulmonary ventilation is meant for patients who suffer from serious progressive diseases. In most cases, such state is irreversible and obstructs patient`s ability to breathe consciously. Those patients benefit a lot from the newly introduced ventilation. It helps them live a regular life in natural background for a few more years. The target of the thesis was to identify the most frequent health and social issues in patients ventilated at home; to determine advantages of home care and possible risks in ventilated patients; and to elaborate a nursing standard to be followed when taking care of ventilated patients at their homes. The qualitative research was carried out by means of two half-structured interviews. One interview was made with 5 pre-selected nurses working for a home-care agency; the other interview was made in the same agency with 5 patients on artificial pulmonary ventilation that are looked after by the same agency. The outcome of the interviews is that the most frequent health problem in ventilated patients reported both by patients and nurses is obstruction of tracheostomic cannula. Another finding was that ventilated patients do not feel socially isolated which is in total contradiction to what the nurses claimed. The interviews taken with the patients showed that in-home care benefits mainly from the fact that the patients are at home, and the risk of receiving home care is that such care is dependant basically on one person and is time consuming. The objectives of the thesis have been met. The outcomes of the research will be made available to the company named Home health-care services Eva Šafránková, which was the venue of the research. The nursing standard can be used as a source of additional information for ventilated patients and to improve care provided to patients ventilated at their homes. It is recommended that nurses should further educate themselves in pulmonary ventilation. Training seems to be an appropriate solution in this case. Nurses would certainly also benefit from a visit to a place providing artificial pulmonary ventilation. Another recommendation is to carry out a follow-up research that would observe advantages of artificial pulmonary ventilation provided at home compared with benefits of artificial pulmonary ventilation provided in health care centres.
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Clearing the airway by an emergency care provider in the prehospital emergency care
NOVOTNÁ, Magdalena
Clearing an obstructed airway to facilitate breathing is a critical element of airway management. It is the emergency care provider who administers first aid and he/she has to master the technique of opening the airway as well as the aspiration prevention. The right airway management may avert the life-threatening condition of an injured person. The thesis is focused on the possibilities of clearing the airway by the emergency care provider in the Central Bohemian region. Techniques of opening and clearing the airway both without or with aids, which are at the emergency care provider´s disposal in prehospital care, are mentioned. The research set was formed by emergency care providers in transit first-aid stations providing emergency care in the Central Bohemian region. The research was conducted by the quantitative method. To collect data, the questionnaire method was used. I handed out 100 questionnaires in transit first-aid stations in the Central Bohemian region. The research was anonymous. The rate of return was 76%, it means I was given back 76 anonymously filled in questionnaires. The objective of the research was to survey possibilities of clearing the airway by the emergency care provider in the Central Bohemian region {--} and the objective was accomplished. The hypothesis I {--} on the part of an emergency care provider the most effective way how to clear the airway is endotracheal intubation {--} was confirmed {--} as well as the hypothesis II - emergency care providers do not use the {\clqq}LMA- Fastrach`` to clear the airways.The conclusions of the thesis may be used in making up standardized methods and techniques of clearing the airway in the prehospital emergency care. They may also be used for further education of university students of nursing and medical care.
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