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Specifics of nursing care for patients with spinal muscular atrophy
HRBKOVÁ, Lenka
This thesis is focused on defining the specifics of nursing care for patients with disease spinal muscular atrophy. SMA is classified as an incurable genetic disease that causes progressive muscle atrophy and deformity of the body but sensory perception and intellect remain preserved. The incidence of the disease in the neonatal and childhood prevails, however the outbreak of the disease in adulthood is not any exception. Suitable nursing care is of great importance in maintaining the health of the patients for the longest possible time and delaying the onset of worsening health. The thesis is divided into theoretical and empirical part. The theoretical part deals with SMA disease, incidence, classification, treatment options and nursing care. In connection with the theme of this thesis, we choosed three targets. 1.: Map out the specifics of nursing care of pediatric patients with spinal muscular atrophy from the perspective of nurses. 2.: Map out the specifics of nursing care of adult patients with spinal muscular atrophy from the perspective of nurses. 3.: Comparison of the specifics of nursing care of pediatric and adult patients with spinal muscular atrophy. We used qualitative research method using a semi-structured interview to achieve our goals. To assess quality goals, we used the following research questions: How nurses specify the nursing care provided to a pediatric patient with spinal muscular atrophy? How nurses specify the nursing care provided to an adult patient with spinal muscular atrophy? With which needs of patients suffering with spinal muscular atrophy have the most experienced nurses experience? The research group consisted of six respondents, three of which respondents had experience with care of pediatric patients and the other three with care of adult patiens. As a processing technique we used open coding, through pencil and paper. The information obtained was divided into categories. The research shows that for nurses caring for pediatric patients the age is important at first occurrence of the disease as that influences the possibility of communication. Prevails ensure physiological needs. For nursing care, throughput of the tracheostomy cannula and status check of the oral cavity is important. In terms of nutrition the nurses prefer serving food through the PEG. They also agreed on the need for positioning. Emptying urine is ensured by the PMK or urinating in diapers. The nurses agreed on serving laxatives and manual defecation. The survey of nurses caring for adult patiens explains that the most common barrier is a state of consciousness, mental status and impaired verbal and nonverbal communication. For the needs of the nurses they state the physiological needs, as well as the fulfillment of psychological needs. In the nursing care of respiratory ways nurses report caring for tracheostomy cannula and a suctioning. In the case of nutrition they prefer per os (orally) and after that they use the help of NGS or NJS. The most common way of serving the diet they indicate the PEG. In case of immobility of the patient they all agree on positioning. For emptying urine they use PMK, one also mentioned epicystostomy. For defecation they agree on serving of laxatives, enemas and manual defecation. The results of our survey highlight the differences in nursing care provided to children and adults. The most relevant in the category of barriers in communication, is the age of the children and adults state of consciousness, the willingness and the ability to communicate. Adult patients desire to fulfill even higher requirements,while with children it is about fulfilling the physiological and social needs. In the nursing care, significant differences are not found. The results obtained in the practical part, I would like to use the knowledge to broaden awareness of nurses who have experience in caring for patients with SMA and to better inform the general public about this rare and often fata
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Radiological visualization methods of the cranium by children
BALABÁNOVÁ, Klára
In this bachelor work were examined the imaging methods of the children´s skull. The number of the skull injury move upwards with the rising age. There are different causes of the skull injury falling on the head, car accident, but it could be also an effect of the abuse. It depends on the doctor, which of the examination methods he chooses. All patients and especially children must have the radiation load as small as you can get it. The chosen examination method must bring high-quality result. Special approach to children, professionalism, thoroughness and patience are in the pediatric radiology necessary, because the cooperation with the children is sometimes very difficult. Knowledge of clinic pediatrics and special knowledge by some examinations are required, because children´s disease have another development as by adults. The goal of this work is to acquaint with the radiological visualization methods of skull, as for example X-ray, computational tomography, magnetic resonance and sonography. Particular visualization machines and methods were described in the work. One separate chapter was dedicated to particular X-ray projections. Sonography is more and more used, mainly in the group of small children, for example to post-natal examination of hips. CT is also more and more indicated because of its speed. CT and MR are very difficult for children and their parents, but also for staff. The children could be afraid of the tunnel construction of this machine. Because of the difficult cooperation with the children it is sometimes necessary to give them calming stuff or general anesthesia. There must be an approval for the examination from the parents or legal representative, when these stuffs are given or when different examination machines are used. In the work is also described the anatomy of the skull, there are also described the differences between children´s and adult skull, development of the skull and the sexual differences of the skull. The form of the children´s skull is different from the adult skull. The goal of the second part is to compare the number of examination from the year 2008 to 2013 depending on imaging modalities (RTG, CT, MR), age and sex. The next goal is the gaining of the total number of examination of children´s skull divided into different examination modalities. The goal was to find an answer to a question, whether special X-ray images are still indicated, also when CT is available and whether the number of indications that serve to examination of children by magnetic resonance rises. To answer this research question it was used the statistics from the radiological department of Klinikum Passau and it was made the analysis. The chapter "Results" contains graphs that are made from the available statistics. The graphs are described in this chapter. Some of the results are represented in tables. This chapter is connected with another chapter "Discussion", where the results from Klinikum Passau are compared with the results from two bachelor works and two articles in the journal Injury Prevention, poisoning and violence. The results show the all goals of the work were fulfilled and represented and the answer on both research questions is positive. Yes, the special X-ray images of the skull are still indicated, also when CT is available and the number of indications that serve to examination of children by magnetic resonance still rises. Interesting result was that the most frequent examination in Klinikum Passau in the radiological department was in the last years the examination by magnetic resonance with the contrasting stuff. The statistics was influenced by the fact that it was worked out just in radiological department. Children´s department is separate and has its own X-ray, so there are also X-ray images. This bachelor work can serve as an educational and additional material for students and the workers of this profession.
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The specifics of pediatric radiology
KOLÁŘOVÁ, Veronika
Hardly anything is able to induce stronger emotions in the average man than those induced by matters relating to children. Paediatric patients are not little adults, so not only high-quality modern instrumentation and specific procedures, but also the medical staff?s professional attitude and an adapted environment are desirable when applying radiologic diagnostic imaging techniques. The priority requirement is generally to minimize the radiation burden ? both the overall dose and especially the gonadal dose. In terms of radiation protection, it applies twice to children that the indication for the use of an examination must always be thoroughly considered. A paediatric radiologist must always accurately determine the correct sequence of individual methods (a so-called examination algorithm) that will give the best diagnostic result with the lowest radiation burden and invasiveness. The aim of this bachelor?s thesis was to analyze the difference in a radiology assistant?s approach to a child and to an adult during radiology examinations and to determine whether a child and his/her legal guardian, if any, have sufficient information when the child undergoes radiology examinations. To clear up the aims of the bachelor?s thesis, research using a technique in which two questionnaires were used was used to collect data. The questionnaires were in both the printed form and the electronic form. The surveys took place in selected radiology departments in Strakonice, in Pisek, in Plzeň, and in Ústí nad Labem. The respondents chose from the answer options for some questions and filled in their answers for the others. The respondents? answers are represented using graphs in the ?Results? chapter. The individual graphs are described there and the most interesting answers to questionnaire questions are supplemented by general thoughts and my personal assumptions and opinions in the following ?Discussion? chapter. The practical part of the bachelor?s thesis proves that the aim of the thesis was achieved. The research questions were answered. The surveys found that the answer to the first research question, i.e. whether radiography assistants take a different approach to a child and to an adult when applying radiological imaging methods, was ?yes?. Radiography assistants take a different approach to a child and to an adult. The answer to the second research question, i.e. whether a child and his or her legal guardian, if any, have sufficient information on radiological examinations, is also positive. A child and his or her legal guardian, if any, have sufficient information on radiological examinations. I have summarised the results of my work in the ?Conclusion? chapter. Further, the surveys found that persons accompanying a child perceive the environment of radiology departments as a friendly, safe and comfortable environment. The only lack of accompanying persons? awareness that could be perceived negatively from the results of the questionnaires within this bachelor?s thesis is the finding that the lay public is not clear about the amount of radiation received during certain radiological examinations (CTs and X-ray examinations) and that the possibility of buying the record of a radiological examination on a CD is not generally known. There is room for active radiology workers who are interested in raising public awareness about radiology examinations. This bachelor?s thesis proved that also lay persons accompanying children are interested in being a part of the team, trying to achieve a beneficial result of the examination. The purpose of the bachelor?s thesis was to prepare a comprehensive text on issues of specifics in paediatric radiology that can be used as supplementary material when examining children.
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