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Use of individual types of positioning on patients after stroke in the acute and subacute phase of rehabilitation from the perspective of occupational therapy
Švecová, Adéla ; Uhlířová, Jaromíra (advisor) ; Kuželková, Anna (referee)
OF MASTER THESIS Tittle of master thesis: Use of individual types of positioning on patients after stroke in the acute and subacute phase of rehabilitation from the perspective of occupational therapy. Stroke is one of the diseases that most affects the human population. It can result in temporary disability, permanent consequences and death. The patient's positioning after a stroke can affect many risks of secondary changes. The aim of this work is to find out how occupational therapists are involved in the positioning of patients in the acute and subacute phase after a stroke in stroke centers in the Czech Republic and how the positioning in stroke centers takes place. The literature and recommended procedures show that the correct positioning after a stroke in the acute and subacute phase prevents the development of immobilization syndrome and secondary changes. Positioning patients after a stroke can affect muscle tone, shoulder pain, prevent subluxation in the joints, maintain passive and active range in the joints, etc. In patients after a stroke, agitation should occur from the affected side to support the return of sensorimotor functions and to involve the affected parties to activities. The occupational therapist is most involved in positioning the affected upper limb, especially to...
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The Nursing Care as an Instrument of Prevention of Complications in a Patient in Stroke Centre
HULÍNSKÁ, Silvie
In the diploma thesis called Nursing Care as a Complication Prevention Tool in the Patient Stroke Center, we dealt with various aspects of nursing care in the stroke center. The development of nursing research in the stroke center lags behind the development of rapidly growing medical knowledge. With the development of medical care, nursing care should respond flexibly. The research intent was to get comprehensive information on preventing complications in patients in the stroke center using nursing care. We have investigated the complications that may arise in patients with acute stroke and how they can be affected by nursing care. We have set three goals: to find out what stroke complications can be influenced in the acute phase by nursing care, to identify nursing activities by nurses in stroke centers to prevent complications and to identify obstacles and limits of preventive nursing care in the stroke center. These objectives correspond to five identified research questions. We were interested in the opinions of the staff on the provided nursing care and we also wanted to know the perception of the care provided by the patients themselves. We have tried to identify key nursing care sites, identify weaknesses and possible shortcomings, and have sought to find the basis for possible improvement in care. The qualitative research strategy was chosen to achieve the objectives of the thesis. The technique of data collection was an individual depth semi-structured interview with ten respondents. The interviews were subjected to qualitative analysis using the ATLAS.ti program. By coding, a total of 104 codes have been identified, grouped into 20 categories. We identified 18 complications that can occur with a stroke patient. For all these complications, we have found interventions to be prevented or alleviated. The results also show that nurses working in the stroke center should have specialized education for intensive care rather than college education. Specialized education in neurological issues, which nurses can acquire through post-graduate stroke seminars and exercises, is also suitable. We have identified systemic barriers to nursing care, including lack of material, lack of time and lack of staff. As obstacles on the part of nursing staff we have identified nursing indifference, poor mood, poor collaboration with the patient, hurried care, physical limitations (back pain, fatigue), lack of awareness, knowledge or skills and inadequate teamwork. As obstacles on the part of the patient we have evaluated speech disorders, perception disorder, unconsciousness, faulty adaptation, lack of cooperation, lack of understanding, distrust, negation, aggression, restlessness, disorientation, apathy, depression, overvaluation of own abilities, conflict with the patient's family. During the research, other interesting facts emerged that do not directly relate to the goals and research questions.
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Prehospital urgent care for patients with acute cerebral infarction indicated for thrombolytic therapy
VOKÁLKOVÁ, Martina
The topic of this bachelor thesis is prehospital emergency care for patients with acute cerebral infarction indicated for thrombolytic therapy. In the theoretical part of the thesis there are data about the actual occurrence of cerebral strokes, and there are defined terms such as medical rescue service, pre-hospital emergency care and stroke center. The following chapters describe the basic anatomy of the brain. Owing to the topic the largest part of the anatomy consists of vascular supply of the brain, which is related to the cause of cerebral vascular events. This thesis also involves the theme of cerebral vascular events, where the causes of the illness, the clinical picture and its basic distribution are described. There are also described diagnostic procedures in the following chapters. Due to the subject of the bachelor thesis, the most space is devoted to pre-hospital emergency care. Further chapters focus on how to place a patient to the appropriate healthcare facility and the follow-up treatment. The last chapters of the theoretical part mention the possible prevention of this disease. The practical part of the bachelor thesis was qualitative research. Structured managed interviews with medical rescuers of the Health Rescue Service of the South Bohemian Region (ZZS JčK) and non-medical staff involved in the admission of patients to a complex cerebrovascular center ("KCC") were used for the research. There were drawn up two different interviews. The first interview was focused on mapping the knowledge of health rescuers about providing pre-hospital emergency care to patients with stroke. This interview also involved questions for the assessment of the cooperation between ZZS JčK and KCC in the Hospital České Budějovice from the point of view of medical rescuers. The second interview was drawn up for the non-medical staff of the KCC at the České Budějovice Hospital and was about the cooperation between ZZS JčK and KCC at the České Budějovice Hospital from the point of view of the KCC staff. The interviews were rewritten in the practical part and the answers were processed in tables. The research showed that ZZS JčK health rescuers have sufficient knowledge of vascular events. Furthermore, it was found, that the cooperation between ZZS JčK and KCC is evaluated by both sides positively. Research also showed that glycemia measurement is an important point of improvement for patient examination. Both variants of the interviews showed, that this value is not always measured and therefore, it can happen that a patient with hypoglycemia is brought to the KCC instead of a cesarean stroke.
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