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Nursing care for patients with biliary tract malignancy.
ROUBALOVÁ, Jana
This thesis deals with nursing care for patients with biliary tract cancer. The theoretical part focuses on the issue of biliary tract cancer, the needs of patients in the preterminal stage of the disease with introduced percutaneous transhepatic drainage and the role of nurses during their meeting. Biliary tract tumours cause gradual blockage of the biliary tract, thus preventing the flow of bile; there is also the progression of icterus and pain. The patient develops sepsis. In many cases the disease proceeds rapidly and death is inevitable. One of the possible methods of bile removal from the blocked biliary tract in patients with inoperable tumours is percutaneous transhepatic drainage. The operation will not prolong the patient?s life, but it will improve the quality of life, i.e. it has only a palliative effect. One objective a three research questions were set for this thesis; the questions were focused on specific aspects of nursing care for patients with biliary tract cancer. Objective: 1. To find out specifics aspects of nursing care for patients with biliary tract cancer. Research questions: 1. What are the specific needs of patients with biliary tract cancer? 2. To what extent are patients with percutaneous transhepatic drainage informed about the care for the drainage? 3. Are the patients informed about their disease? To achieve the objective, qualitative research was used in the form of semi-structured interviews with patients with biliary tract cancer having percutaneous transhepatic drainage, hospitalized at the University Hospital in Pilsen, the Department of Internal Medicine specializing in gastrointestinal diseases. The first research question of the thesis was to find out what the specific needs of patients with biliary tract cancer were. The identified specific needs can help nurses to understand better the problems of this disease and to improve the quality of nursing care provision. The results revealed a number of needs that patients in nursing care miss or that are neglected by the nursing staff The second research question was to find out to what extent patients with percutaneous transhepatic drainage are informed about the care for the drainage. As regards the informedness about the care of the drainage, it was found out that, despite the efforts of the nurses to educate their patients properly, the patients were not interested in such education. That was due, in particular, to the high age of the patients. Most of them cannot cope with the care alone and they rely on assistance from the nursing staff or family members. The third research question was to find out to what extent the patients are informed about their disease. The responses from the interviews concerning this question showed at what level the awareness of the patients about their disease is. The research indicated that the patients have information about their disease obtained from the nursing staff, but they do not understand it in most cases. The patient requests information from the nurses but such information does not fall within their competences but within the competence of the doctor. Based on the findings, a booklet was compiled for patients with biliary tract cancer.
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X-RAY controlled implantation stents to stenoses in gastrointestinal system.
CERKUNÍKOVÁ, Anna
X-ray controlled stent implantation into gastrointestinal tract stenoses is a modern mini-invasive method. Many medicine branches have gone through considerable development in the second half of 20th century. In many cases it has been based on new discoveries in disease pathogenesis, new approaches in therapy and most importantly on new technical possibilities. This thesis describes treatment of stenotic tumors in gastrointestinal tract that used to belong to frequent surgery indication, regardless of possible radicality. Intervention radiology is a dynamic and quickly developing specialisation. New material and procedures development extends the possibilities of mini-invasive therapy in gastrointestinal tract illness. Instead of surgery, stent implantation is indicated in many cases. This method has many advantages when comparing with surgery, e.g. lower invasivity without general anesthesia usage and short recuperation. Indications of stent implantation into gastrointestinal tract stenoses can be divided according to more aspects, e.g. stenosis localisation, stenosis etiology, inborn or acquired stenoses and last but not least benign and malign stenoses that are the main topic of this thesis. The aim of this thesis is success and effectively assessment in stent implantation into gastrointestinal tract stenoses. The procedures are divided according to stenosis localisation in a certain period. The results are compared with other centers in the Czech Republic. In every procedure, we assess the etiology, stenosis localisation, patient age and sex, procedure type and its success rate, early and late complications (to 30 days from the procedure). As in the majority of cases we analysed patients with inoperable malign tumors, the mortality was not assessed. This thesis confirms the only chosen hypothesis ? the stent implantation in gastrointestinal tract stenosis is a quick and effective method with a low number of complications. Our department wants to use the data acquired in practise to compare the success rate and complication number with other centers and according to the results to confront the procedure method.
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