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Premedical care for patients with methanol intoxication
KŘENEK, Jan
Intoxication through methanol is a relatively less frequent type of poisoning, which can lead even to a serious damage to the human body; can cause loss of vision as well as permanent infliction of the central nervous system. And also the death of the afflicted person is possible with late treated conditions. The methanol metabolites are quilted for the damage of the human body - mainly formic acid that is why the therapy of this health and life-threatening condition is mostly focused on the metabolism of methanol. The theoretical part deals with pre-medical that is pre-hospital emergency care of patients with a methanol intoxication. The first chapter deals with the pre-hospital emergency care, a medical rescuer and his competencies, and the ambulance crew is listed here as well. Furthermore, the theoretical part of the thesis deals with the acid-base balance, metabolic acidosis, but also involves the Toxicological Information Centre. The next chapter explore methanol and its characteristics and the history of methanol in the course of the human civilisation. It explains the metabolism of methanol and highlights the symptoms of acute and chronic methanol intoxications. The last chapter is directly focused on first aid in this state provided by a layman; and on the treat methanol intoxication in terms of pre-hospital emergency. Last but not least, it is also concerned with the effects of the methanol intoxication. The practical part of the thesis is focused on mapping the activities of a paramedic in a pre-medical care of a patient with a methanol intoxication and on determination the level of awareness of laity as well as the clients of the sobering-up station for this type of poisoning. As well as a laity with help of anonymous questionnaires. The research survey was conducted through the quantitative method among the paramedics. The amount of the data was collected during the March 2015. The research group were the randomly choired laymen and clients of the sobering-up station and the paramedics working in the Emergency Medical Services of South Bohemia Region at the regional centres of Strakonice, Písek, Prachatice, Český Krumlov and Jindřichův Hradec. The anonymous questionnaire was distributed to the above stated regional centres in the number of 100 pieces, for the laity in the same number and 10 pieces for the sobering-up station in České Budějovice. The questionnaire for the paramedics contained a total of 18 questions. The first four questions were the ones of stratification, the questions no 5 to 18 were closed and directly addressed the issues concerning the provision of pre-hospital emergency care in methanol intoxication, whereas the hypothesis no. 1 was confirmed. The questionnaire for the laity in itself contained a total of 14 questions. The first three questions were of socio demographic character. The fourth question was closed and crucial to the continued questionnaire. The question no. 5 was semi-open and remaining questions no. 6 to 14 related to determine the level of awareness among the laity methanol intoxication. The results are processed into clear graphs and the related hypothesis no. 2 was also confirmed. The first goal was to map the activity of a paramedic in a pre-medical care of a patient with a methanol intoxication. The second objective was to determine the level of awareness of the laity of this intoxication. Both the objectives have been met. The statistical method of processing a research survey showed that paramedics are knowledgeable in the procedures of pre-medical care for patients with a methanol intoxication and that lay people are informed of this intoxication, but would welcome more active involvement of experts in informing society about this issue. Based on the results of the work an information leaflet was produced for the lay and paramedics in the field of alcohol intoxication.
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Comparison of nursing care about patients with peritoneal dialysis and hemodialysis
JANOUŠKOVÁ, Jaroslava
The number of patients with kidney disease is increasing worldwide. Such diseases include chronic kidney failure that needs dialysis treatment. Problems associated with providing nursing care to patients in a dialysis program are extensive and specific. Starting the treatment with a peritoneal dialysis or a haemodialysis causes a great psychological burden to patients. It noticeably affects not only patients' lives but also lives of their family and friends. Patients in the regular dialysis program are facing many health and social problems. Mutual trust between a nurse and a patient on dialysis to a certain extent influences the course of the treatment. Balanced and satisfied patient can live a better and more valuable life. The goals of the thesis: 1) To determine whether a comparably high quality nursing care is provided to patients with haemodialysis and peritoneal dialysis 2) To determine whether the approach to the provision of nursing care to the patients with haemodialysis and peritoneal dialysis is comparable. 3) To determine whether comparable forms of education and communication are used in providing nursing care for the patients with haemodialysis and peritoneal dialysis. Research questions: 1) Is the nursing care provided to the patients with haemodialysis and peritoneal dialysis of comparable quality? 2) A the approach to the provision of nursing care for patients with haemodialysis and peritoneal dialysis comparable? 3) Are comparable forms of education and communication used in providing nursing care for the patients with haemodialysis and peritoneal dialysis? Methods used: In the empirical part of the thesis a qualitative research was used to process data. The research was conducted through a non-standardized interview. Three sets of questions were created for the three groups of respondents, i.e. the respondents with peritoneal dialysis, respondents with haemodialysis and nurses who take care of patients with haemodialysis and peritoneal dialysis. The criterion for the selection of respondents was their willingness to cooperate. The nature and purpose of the research was explained to the addressed respondents. From the interviews with patients it was determined how they perceive the provided nursing care, the nurses' approach, and the way of interaction during haemodialysis and peritoneal dialysis. Interviews with nurses were focused on comparability and demands of nursing care for patients with haemodialysis and peritoneal dialysis, as well as on the used forms of communication and the way how to approach these patients. Results: The results of the research show that the care provided to patients with peritoneal dialysis as well as with haemodialysis is perceived by the responding patients with peritoneal dialysis, with haemodialysis and nurses as of the same quality. Peritoneal dialysis and haemodialysis each have their specificities and a different way of execution. Both are provided in differing environments. Peritoneal dialysis is done by the patient himself in their own social environment. During haemodialysis, nursing care is provided to the patient by nurses in a haemodialysis centre. As comparable is perceived by all respondents the nurses' approach to the patients, i.e. to each patient individually. In conclusion, the results imply that nurses during the contact with the patients with peritoneal dialysis and with haemodialysis use comparable forms of communication and education. Conclusion: At the present time there is an attempt to perform dialysis treatment to benefit the patient as much as possible. Peritoneal dialysis and haemodialysis are considered as equivalent substitute for renal function. They differ only in the principle and the method of executing. Nursing care provided to patients with peritoneal dialysis and with haemodialysis is perceived by the respondents as of comparable quality. The results of this thesis can be the basis for further research.
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The Specifics of the nursing care in catering for long- term dialysis patients
ŠRÁMEK, Kamil
Haemodialysis is a method of removing waste substances such as potassium, urea and excess water from the blood during renal failure. Hemodialysis is one of three renal replacement therapies. Other treatments are a kidney transplant and peritoneal dialysis. Hemodialysis can be performed either in the hemodialysis center, or in a hospital, but home hemodialysis is not too frequent. Eating for dialysis patients differs significantly from the forward dialysis diet period. A well balanced diet is the foundation of everything. The patient may neither be malnourished, nor to have surplus of any components in their diet. A diet for patients in dialysis program must meet two basic requirements; the diet must provide enough energy and substances needed by the body mainly amino acids required for the production of protein, calcium, vitamins, iron, restrict certain substances that accumulate in the body is harmful, for example, fluid restriction, excess protein from which the formation of urea, excess phosphorus, which accelerated calcification of blood vessels, excess potassium, which at high levels in the blood can cause heart rhythm disturbances. Qualitative research was carried out by interview. The interview contained a total of twenty semi-structured questions and was prepared in advance. Each interview was anonymous and each respondent had the opportunity to refuse it. With the consent of the respondent and the ward nurse, the interview was recorded on a tape recorder and later adapted into an electronic form, which became the basis for the research. From the research arose categories. Qualitative research file conducted in hospitals Prachatice, České Budějovice and Třebíč. The research sample consisted of five respondents in the Nemocnice Prachatice a. s. Another research sample consisted of five respondents in Nemocnice Třebíč and two respondents in the Nemocnice České Budějovice a. s. All respondents were patients who regularly attend to hemodialysis centers in these cities. Interviews with respondents were conducted from February to April 2014. In the Nemocnice České Budějovice a. s. the research survey was conducted with the consent of the Deputy for nursing care, Mgr. Kyselová. In Nemocnice Prachatice a. s. the research survey was conducted with the consent of the head nurse in the hospital Janoušková and in the Nemocnice Třebíč the research was conducted with the consent of the Deputy for nursing care Mgr. Andělová. The results of the survey provide mapping meals in the hospital for long-term dialysis patients. The benefits of the research will be to develop an information leaflet on the topic: The importance of catering for dialysis patients.
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Physiotherapy of dialyzed patients
MUŽÁTKOVÁ, Alena
The bachelor thesis focuses on physiotherapy of dialyzed patients. Hemodialysis is one of the options for patients with a chronic renal insufficiency. It is a therapeutic method that replaces basic functions of kidneys to remove metabolic products from blood. Patients with renal failure are the most frequent group of patients treated for a vital organ failure. Physical activity may positively influence their physical and mental health. The most important benefit of physical activity for dialyzed patients is the overall improvement of physical fitness. Further, it also helps to keep or to improve muscular strength and joint mobility and to relax and to stretch overstrained muscles. Regular exercising may improve self-sufficiency of the patients and support their independence of assistance of other persons. Self-sufficiency is particularly important for old patients so that they can continue living in their familiar environment. The objective of the thesis is to map psychomotoric condition of dialyzed patients and to propose an exercising unit for them. The theoretical part of the thesis deals with chronic renal failure in general and physical activities conducted during the disease. The practical part contains qualitative research of case reports of patients included in a regular dialysis program. The respondents were interviewed with a semi-standardized interview about their case histories. Further, they underwent dynamic tests of spine, anthropometric measurements, goniometric examination, examination of shortened and weakened muscular groups, Barthel test of basic everyday activities and 2-minute Step Test. The respondents were involved in a program with regular exercising for 10 weeks, including exercising at home based on previous instructions and exercising on a rehabilitation treadmill during hemodialysis. The main preconditions of successful physiotherapy of dialyzed patients are personal involvement and proactive approach to regular physical activity. A suitable form of physical activity may contribute to improvement of their physical fitness and mental condition. The patients, however, need to be consistent and exercise regularly on a truly long-term basis.
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The Satisfaction of Patients with Peritoneal Dialysis in the Provision of Nursing Process
JANSOVÁ, Miroslava
Peritoneal dialysis is a method of treatment of chronic renal failure. The principle of this method is the exchange of substances between blood and dialysis solution soaked into the abdominal cavity. The absolute indication for the dialysis is the impossibility to establish vascular access for hemodialysis. It is primarily indicated for patients as a treatment for cardiovascular diseases which may cause hemodynamic instability during extracorporeal circulation. Individual preferences of the patient also play an important role. The contraindications are extensive adhesions in the abdominal cavity and inflammatory bowel diseases. This method has recently become common practice at most dialysis centers. It provides patients with more freedom as well as more independence from a medical center and its staff. The qualitative data collection technique was used for the research survey. The qualitative research took the form of non-standardized interview. The research group consisted of six patients from dialysis centers and hospitals in Tábor and České Budějovice. Objective 1 was to find out whether peritoneal nurses provide patients with sufficient information. The research has shown that the patients had been informed about the method before as well as during the treatment. Objective 2 was to find out how nurses support the patients´ self-care. The research has shown that the nurse had supported patients´ self-care by providing them with information regularly, checking during the exchange of dialysis solution and by reeducating them. Objective 3 was to find out whether a nurse helps to reduce social isolation of patients with peritoneal dialysis by providing a health visiting service. The research has shown that patients had highly praised this service, feeling encouraged to become more active thanks to the health visiting service. The work of nurses caring for these patients is rather independent and individualized. The success of treatment largely depends on high quality work of a nurse, on her educational and communication skills. We hope that the results obtained will be an example for other health professionals caring for these patients. The brochure could help patients with renal failure to decide when selecting a method of treatment.
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Specifics of Nursing Care for Dialysis Patients
ŠŮSOVÁ, Andrea
Abstrakt Nursing is a unique component in patient care. Consistent nursing care depends not only from the theoretical knowledge but also from communicativeness, physical skills, empathy, ability to work in a team and organize work. The aim was to determine the difference in the education of the client with hemodialysis and peritoneal dialysis, and also clarify how nurses educate clients about the dialysis regime measures. We also focused on the awareness of patients when these treatments were first introduced and patient awareness now. We wondered whether patients are properly educated and whether they are satisfied with the amount of information that is provided. Research questions were formed within these specific targets directed specifically to educate clients on hemodialysis and peritoneal dialysis clients, their daily routine and the difference in the complexity of education between the two types of treatment. In these areas we have focused on nurses working at the hemodialysis centre and patients who are treated with dialysis. According to the two groups interviewed and evaluated, we concluded that the majority of nurses educate clients at the start of treatment. The nurses consider the following attributes to be key for the patient:,a positive attitude, positive health habits, good diet and fluid intake, protecting the limb in hemodialysis, where the coupling is introduced. Nurses consider informing patients with peritoneal dialysis to be more difficult than those with hemodialysis because they must comply with more rules and are not under constant observation. Patients are treated in their home environment and need to adapt their premises for the exchange of solutions and must learn the aseptic technique during the procedure for such exchanges and constant monitoring of the catheter, which are introduced in the peritoneum. The education of patients at the research department is usually done by the ward nurse.
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Lifestyle and Quality of Life of Long-Term Dialysis Patients
MÉSZÁROSOVÁ, Eva
The aim of my thesis was to examine the lifestyle and life quality of chronically dialysed patients. I described this wide topic from the point of view of patients, with whom I conducted interviews according to prepared questions, i.e. qualitative research. For healthcare staff providing immediate professional care in dialysis centres I used quantitative research by means of questionnaires. I processed 71 questionnaires and spoke to 12 patients in total. I found the sources in seven healthcare facilities in South and central Bohemian regions. The aim of the thesis was met. The decisive and related aspects linked to the lifestyle and life quality of chronically dialysed patients were described. During preparation of the thesis I met new aspects like the extraordinary demandingness of the work of the healthcare staff, the important influence of science on medical procedures and psychical demandingness and patience of treated patients. The research questions were answered and in the instance of ambiguousness they were deduced and statistically substantiated. Two hypotheses, namely H 1: Nurses in dialysis centres educate dialysed patients about the limitations linked to lifestyle quality and H 2: Nurses in dialysis centres adhere to the principles of specific (structured) communication have been confirmed. My work involved a proposal of an informative brochure for chronically dialysed patients, which sets the goal to inform dialysed patients optimistically, with certain hyperbole, however realistically on the endless possibilities how to use free time in the form of topics, on self-confidence strengthening and effective communication with healthcare staff.
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Treatment of vascular input for patients on hemodialysis department as a nursing problem
ŠTRBOVÁ, Kateřina
The bachelor?s thesis focuses on current problems of dialyzed patients with a dialysis catheter. A properly functioning catheter and minimum complications during its use form essential preconditions of the dialysis treatment. Emphasis is put on observance of aseptic approach when handling the dialysis catheter. The aim of the thesis is to find out whether nurses observe the treatment standard when treating the blood vessel entries and if the nurses of a standard ward find the handling of the catheter for hemodialysis problematic. The objective is also to map the most problematic area of blood vessel entries from the nurses? view. The following research queries result from the objectives set above. 1. Do the nurses observe the treatment standard when treating the blood vessel entries? 2. Do the nurses of a standard ward find the handling of the hemodialysis catheter problematic? 3. What is the most problematic area of blood vessel entries treatment from the view of the nurses? The qualitative research was carried out by means of hidden observation. Participants of the research included 5 nurses from the dialysis centre of Fresenius Medical Care in Benešov and 5 nurses from the internal medicine ward of Nemocnice Rudolfa a Stefanie a.s. (Hospital of Rudolf and Stefanie) in Benešov. The observation was supplemented by an anonymous survey carried out also at the dialysis centre and at a standard internal medicine ward. Hypotheses can be set based on the obtained results. The medical treatment standard for treatment of blood vessel entries is not observed by all nurses, the standard ward nurses find handling the hemodialysis catheter difficult and the most problematic area of the treatment of blood vessel entries is the failure to observe the aseptic procedures during the treatment as well as the fact that patients do not get extra bandage material for home use. The research results shall serve for preparation of a draft for the medical treatment standard ??Medical treatment for dialysis catheter??. The draft can be presented to medical management of the given wards to achieve higher quality of treatment of patients with dialysis catheter.
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The role of the nurse providing therapeutic care for the patient embarking on a hemodialysis program, being on the kidney transplant waiting list.
ROUBALOVÁ, Gabriela
Abstract In the bachelor thesis we are dealing with the question ,,A role of the nurse in care of the hemodialysed patient waiting for kidney transplantation.`` In the theoretical part we have been dealing especially with the role of the nurse, nursing care of the hemodialysed patient waiting for kidney transplantation and also with the educational activities of the nurses. The goal of the research was to determine the role of the nurse from the patient{\crq}s viewpoint, the next goal was to determine how well are the patients informed about the hemodialysis program and the regime measures resulting from it and furthermore what roles result for the nurse from the nursing care of patients within the hemodialysis program. A method of a quantitative research with the use of anonymous questionnaires has been used for determination of the set goals and for verification of the preset hypotheses. The research set was formed of nurses working in the medical department and the hemodialysis department of the Hospital in České Budějovice, a.s., as well as of patients from the department where the research was conducted. A total of 50 questionnaires were distributed to nurses and 50 questionnaires to patients. The return rate was 62% for nurses and 70% for patients. Three hypotheses were preset within the research. In the first hypothesis we have assumed that the patients percieve the role of the nurse as an indispensable part of the nursing care. The first hypothesis has been confirmed. In the second hypothesis we have assumed that the patients in the hemodialysis program have enough information regarding the regime measures resulting from the problems of hemodialysis and kidney transplantation. The second hypothesis has been confirmed. In the third hypothesis we have assumed that the nurses within the nursing process by patients in the hemodialysis program represent a role of an educator for the most part. The third hypothesis has been confirmed as well. The results of the conducted research may lead to an improved awareness of the patients about the hemodialysis program and the regime measures resulting from it and also could be utilized as a feeback for nurses working with the hemodialysis patients. The nurses should be more and more actively interested in patient`s feelings. Furthermore they should have better supervision of patients` observance of the regime measures, although especially the patients should be responsible for their own health, because the regime measures play an indispensable role in the therapy process during the malfunction of kidneys. Furthermore it is important that the nurses actively offer help to patients who need it and try to ensure a quality nursing care, while the greatest reward for the nurse should be the patient{\crq}s satisfaction. It would be convenient to inform the head as well as stationary nurses about the results of the conducted research who would subsequently hand over this information to other nurses who work with the hemodialysed patients. Moreover this work may serve as a material for students who will be interested in these problems. Furthermore this work could lead to extension of educational activities of students regarding the problems of hemodialysed patients.
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Optimization of Providing Dialysis Care to Patients in a chosen Heath Care Facility
Michalík, Jiří ; Mlčák, Jan (advisor) ; Doubravová, Alena (referee)
This thesis deals with the profitability of sales of the dialysis care provider. The main aim of the work was to optimise the dialysis care in Jindrichuv Hradec hospital. Mentioned proposed solution concerns personnel and technical aspects and particular elimination methods. Another aim of the work was to clarify the reimbursement system of the particular dialysis methods, to compare economic results with the profitability of the dialysis care in the years 2006 and 2007. The author endeavoured to create possible ways of the development based on the knowledge of the number of patients and the insurance company reimbursement system. Necessary data and information were acquired from Jindrichuv Hradec hospital reports. This work is thought to contribute to enrich the practical usage and its results can be used by the hospital management or anybody interested in the dialysis care and its economic aspects.
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