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Enteral nutrition in oncology patients
Šulcová, Jana ; Křížová, Jarmila (advisor) ; Mráz, Miloš (referee)
This bachelor thesis considers possibilities of enteral nutrition and its influence on life quality of oncological patients. The thesis consists of a theoretical and an experimental part. The theoretical part compiles the issue of malnutrition and nutritional support with emphasis on enteral nutrition. It deals with malnutrition in oncology and its solution. In the experimental part, a study of influence of enteral nutrition on life quality of oncological patients was conducted. A question was, how health condition, life quality and energy intake of patients are changed after one month of enteral nutrition use. The survey includes a physical examination, measuring patients with a machine Bodystat Quadscan 4000, filling up a questionnaire, evaluation of laboratory tests, and analysis of the patient's diet. The results of the study prove positive influence of enteral nutrition on health condition of patients with respect to laboratory tests. According to the questionnaire, the life quality of patients increased and the diet report shows increased energy intake. The physical examination results and Bodystat measurements did not prove positive influence of enteral nutrition.
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Evaluation of nutritional status and cardiac risk in patients with anorexia nervosa.
Pálová, Sabina ; Charvát, Jiří (advisor) ; Ošťádal, Petr (referee) ; Zamrazil, Václav (referee)
Anorexia nervosa (MA) is serious psychiatric disease associated with significant mortality. One of the main causes of mortality in these patients is cardiac complications. In 2003 - 2010 we examined 30 patients with established diagnosis of MA. Routinely used nutritional parameters are normal even in severe malnutrition in MA patients and we can ́t use them to diagnose or monitor nutritional status. Therefore we evaluated plasma aminoacids levels to detect minor changes of protein metabolism. According to our results we found mild hyperaminoacidemia and significant elevation of Gly/Val and Phe/Tyr ratio. In the second part of our research we performed non invasive examination s in risky patients with AN to consider possible cardiac complications. Results of ECG and echocardiography confirm results of the previous published studies. Original finding is significant decrease in flow mediated dilatation of brachial artery and its normalization after realimentation. We found also in ambulatory blood pressure monitoring significant decrease in blood pressure during the active period which was the consequence of changes in the heart rate variability. Decrease of the blood pressure in patients with AN in standing position was associated with increase of HF power in supine position and particularly with the lack of...
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Nutrition of oncology patients in palliative care
TICHÁ, Miroslava
Nutrition of oncological patients in palliative care is a serious global problem, and therefore, I decided to make a reseach and learn more about this problematics. Although treatment of cancer in this time has moved forward, cancer spread throughout the world in relatively high values. This work is divided into two parts, while in the theoretical part is described the way the disease spreads, what is the percent incdence, prevalence and mortality in the Czech Republic. Next, what symptoms are associated with this disease malnutrition, cachexia, nausea, and other. The most important part of this thesis is description of the nutritional recommendation, witch is specified for each patient individually associated in regards with enteral and parenteral nutrition, as proper nutrition can affect not only the physical needs, but also psychological and also improve the overall condition of the patient. The described care and its division is the last point in the theoretical part. The current way of eating of oncological patients in palliative care was the aim of the practical part of the thesis. My research questions are: 1. How does the disease affect the appetite of the patient in palliative care? and 2. Which component of the patients diet is deficient? The topic was processed in a way of qualitative reseach of 6 oncology patients at palliative department, I used interviews and questionnaires with patients and medical staff. I reviewed the menus in the program Nutriservis and the general condition of patients using a scale of most common symptoms. According to the results, the majority of patients ranged under the limits of standards, with protein energy malnutrition, which was caused by a lack of food rich in protein and also opioids medication which can affect appetite or symptoms associated with this disease.
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The role of a nurse in the care of a patient´s nutrition
SKŘÍŠOVSKÁ, Martina
This Master's Thesis "The Role of a Nurse in the Care of a Patient's Nutrition" is written in a purely theoretical plane, deals with the basic pillar of the existence of the human organism the correct and sufficient nutrition of a human, and studies the extent of an involvement of the general nurse in satisfying biological, psychological aspects of patient's nutrition in the nursing process. The topic of nutrition plays an important part of the complete spectrum of each medical expertise. The satisfaction of patient's need for nutrition in all of the stages of his life is a part of a nurse's job in a nursing process not only in Intensive Care Units, Resuscitation Care Units and Standard Care Departments, but even in Geriatric Units and Social Care Institutes. The thesis is methodically divided into separate parts, each logically following its preceding one. In the Introduction we define malnutrition as a global medicinal and social problem, introduce principles and theoretical starting points of an organisation of an optimal nutrition care and introduce international activities, which contribute to creating guidelines using the Evidence Based Practice method, and implementation of effective methods in providing complex care of a patient's nutrition in medical facilities and institutes of social care. We follow with the summarisation of basic nutrients, emphasising their importance for the right function of a human body, and negative effects of their insufficiency in the food intake. The thesis presents an algorithm of an evaluation of a patient's nutrition state in a nursing process, comparing available screening standardised questionnaires, which are usable in detecting sings of a malnutrition. We present the possibilities of food fortification, specify targets of nutritional support in medical facilities, focusing on indications, benefits, risks and paths of application of enteral and parenteral nutrition, and provide complete summary of nutritional interventions in the context of nursing care, which is oriented on ensuring the food intake. In the Conclusion, we identify those aspects of the patient's nutrition care, which are hard to fulfil and realise, and those psychological and social-cultural aspects, which the nurse can in the nursing process satisfy only when using holistic and empathetic approach. The altruistic, but controversial and ethical-philosophical topic represents not initiating or ending the interventions of nutritional support, where this decision respects principles of beneficence and non-maleficence of The Hippocratic Oath, the quality of a patient's life and human dignity.
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Patients' education by enteral nutrition
Argaláčová, Tereza ; Novotný, Aleš (advisor) ; Meisnerová, Eva (referee)
Enteral nutrition is a form of a nutritional support which should be considered for malnourished patients or those at risk of a malnutrition who have a functioning gastrointestinal tract but are unable or unwilling to maintain adequate oral intake. This bachelor thesis discusses issues of the enteral nutrition - it's indications, contraindications, methods of delivering and possible complications. A big part of the thesis is dedicated to a percutaneous endoscopic gastrostomy which became the technique of choice to provide long-term enteral nutrition support and is nowadays one of the most popular approaches to the gastrointestinal tract for long term home enteral nutrition. The last part of the thesis shows the importance of the education of patients on a long- term enteral nutrition and provides a short guideline on how to properly educate them. Keywords: malnutrition, enteral nutrition, percutaneous endoscopic gastrostomy, education
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Nurse's role in the nutrition of patients in intensive care
VACKOVÁ, Veronika
This bachelor thesis is divided into two parts theoretical and empirical and the purpose of this thesis is to deal with the topic of the nurse´s role in the nutrition of patients in intensive care. In the theoretical part of the thesis, complex issue of the nutrition ensure of intensive care patients is summarized. We have been dealing not only with the common concept of the nutrition on the intensive care units and the role of the nutrition therapist but also with the characteristics, causes and diagnosis of the malnutrition as the most serious issue in the nutrition field. In the thesis, the types of a nutrition support in the intensive care have been also defined as well as the indication, contraindication, types of serving, complications, types of medicines, monitoring and the related role of the nurses. The practical part provides with the results of the research, which have been found by using a qualitative research method. The main purpose of this bachelor thesis was to emphasize the role of the nurse by the handing enteral and parenteral nutrition and also a description of the cooperation with the nutritional therapist on the associated intern and neurological unit of intensive care at České Budějovice hospital. At the basis of above mentioned, two objectives have been stated. At first, our task is to find out the way how is the right handing of the nutrition to the intensive care patient by the nurse secured. The second task is finding out the way of cooperation of the nurse and the patient while securing the nutrition of the patients in the intensive care unit. For the first task, four research questions have been established, for the second task have been established one research question. For the high-quality data network, the method of hidden monitoring for keeping authenticity has been used. As a consequence of the insufficient amount of data to the reaching of the second task, half-structured interview has been chosen instead. Research dataset consisted of thirteen records of sighting and one interview on the above mentioned intensive care unit. As a basis for analyses, three observation sheets were made, into these sheets were then during the observation information assigned. Each sheet consisted of single points planned in accordance to theoretical part. The nurse follows these points when securing the patient´s nutrition. Remaining information, not included in observation sheet were written into the notes section or were included into the information about the performing of the particular point. The results were analyzed by using an open-coding. There are six categories coming out from the analyses, which are connected with securing the education, information providing, keeping an obstacle-free approach complications preventing, using tools, nurse´s cooperation with the patient and deciding processes during work performance. In the results, there is a conclusion of the analysis with illustrative examples to find. The sequence of the results is presented according to sequence of categories during performing. In each category, the results are evaluated according to research tasks stated. We believe, that the obtained information, which map the activities of the nurses when securing the nutrition at the intensive care unit patients and the acquainting the cooperation with the nutrition therapist helps in the future to the awareness of the potential weaknesses and following correction. The results may become inspiration for more detailed analysis of this topic.
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Nutrition of children and adolescents with cancer
VLKOVÁ, Lucie
Diagnosis and treatment of these diseases are still significantly improving and it turns out that nutrition is a significant part of the outcome. But it can be sometimes difficult or even impossible for the patient to follow dietary guidelines. It's possible that patients can have problems with food intake, their taste can alter altogether, or some food can even raise the need to vomit. Furthermore, food doesn't fulfill just biological needs, but it's a significant for psychological needs, too. It's therefore necessary to look at this issue from broader point of view.The aim of this thesis was to describe the composition and serving methods of nutritious meals in various stages of treatment of children and adolescents with cancer, and to map the experiences as well as view of young patients, their families and their nursing staff on whether and how it is possible to meet the nutritional recommendations while satisfying taste preferences of children. I was looking for answers to two research questions: 1. How has the method of service and the composition of diet been changing throughout the treatment in order to maintain sufficient nutrition? 2. What are the views of young patients, their parents and their attending physicians on the possibilities of maintaining nutritional recommendations? The text is divided into two parts: theory and research. The theoretical part describes the Pediatric Oncology issues and the most common types of cancer in young patients, it also mentions the possibilities of prevention. Then this part deals with side effects of cancer therapy, changes in metabolism, malnutrition, cancer cachexia and anorexia. The biggest part is devoted to nutrition nutritional status assessment, nutritional needs and forms of nutritional support. The last section contains recommendations for situations with food intake complications and the ways of increasing the nutritional contents of diet. Due to complexity of the topic I chose a mixed research strategy, several different methods of collecting and processing of data as well as questioning of various groups of respondents. I was observing 45 oncology patients children and adolescents aged 4 to 18, who are undergoing treatment at the Clinic of Pediatric Oncology in Brno, their parents (7) and their nursing staff (2). The data processing method was qualitative and quantitative analysis of questionnaire responses, interviews content analysis, observation, creation of case study, calculations of menus from the program "Nutriservis Profesional". Results are presented in graphs, tables and plain text. It's divided into three subsections. The composition and method of serving the nutritional meals depends on the needs of patients, their age, diagnosis, treatment and complications, which occur in the course of treatment. It also depends on the cooperation of patients themselves and their families. Different approach is with adolescent patients and with children as well as when they're treated at home or in the hospital. At some stages it is necessary to adjust the nutritional diet to have an adequate nutrition, at other stages the nutritional support is in sipping and when there are complications, which accompany the treatment, the method of service is changed into oral, by probe, or parenterally. Keeping of dietary recommendations represent a significant problem for these patients, which are troubles with food intake during the treatment (95% of patients). Due to children's taste preferences are some forms of nutritional support rejected, even though they are able to maintain the nutritional recommendations. Both young patients as well as their parents have preference for children's taste rather than nutrition. There were some exceptions, however. Opinions of the nursing staff are the same it all depends on the attitude of patients themselves and their families.
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Nutrition of patients on surgical departments
ČERMÁKOVÁ, Michaela
The bachelor work called the Nutrition of Patients at Surgical Wards occupies with nutrition of surgical patiens, their energetic nutrition intake and the intake of the basic nutrients during their stay in hospital, ie proteins, fats and carbohydrates. The aim of the work is to find out how many calories on average the patiens at the surgical ward consumed per day. The theoretical section is divided into two parts. In the first part there are described the basic components of food and their recommended daily intake. The second part deals with the problem of various illnesses typical at surgical wards. This part also deals with diets that are often indicated at the area of surgery. For realization of the practical part there was used the method of mixed research. The facts were gained with the help of observation and semi structured interviews. The research team was created by men and women of various age categories who were healed at the surgical ward in Pribram hospital in August 2014. For three days it was recorded how much food the patiens consumed. Then, they were interviewed. The effort was to find out the reason why the patiens had not eaten the meal or if they had not consumed their own food. On the basis of the collected facts there was made a graph (frequency of the consumed hospital food), there was made each patient´s menu using the programme Nutriservis, comparison of the food energy that the patients were given during these free days and that they really ate. Energetic values of hospital food were compared just roughly with energetic needs of an average woman and an average man. To sum up this research, it was realized that only one patient during this period was rating nutritionally rich food. Other 17 patients were not eating enough. On average, the patiens were eating 60% of recommended energy during this research. One of the reasons was the type of the respondents. The patients at the surgical ward had serious healthy problems, they did not feel well and thatsway they ate less than usually. Some patiens did not have a good appetite or they did not like the hospital meals. The next reason were the planned medical examinations and nutritionally poor food given the patiens by the hospital.
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