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The role of nurses in the care of patients with acute pain in intensive care departments.
LINHARTOVÁ, Lucie
Diploma thesis entitled focuses on acute pain in general, as well as on post-operation pain, which is one of the types of acute pain. The first part of the thesis deals with acute pain as such and its characteristics. The second part deals with intensive care units (ICU). The third part contains description of post-surgery pain, treatment thereof, and the nurse?s role in taking care of clients suffering post-surgery pain. Three goals have been outlined. Goal 1: Identification of the techniques that nurses use at ICUs to sooth clients? pain. Goal 2: Map the monitoring the pain of clients hospitalized at ICUs. Goal 3: Find out whether the techniques for reducing pain of clients hospitalized at ICUs are effective. A quality-oriented research was applied for evaluation of the results, using a method of non-standardized interview with nurses and clients.The results can be used as a comparative overview of the most common pain-reducing techniques and proof of their effectiveness for clients.
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Physiotherapy of functional disorders resulting from the prolonged sitting at a computer- focusing on neck pain
RYBECKÁ, Pavla
The topic of this Bachelor thesis looks at the issue of ?Physiotherapy of functional movement disorder originating from sitting in front of a computer for long periods ? aimed at pain in the cervical spine?. Many people with long-term sitting jobs often complain about pain in the cervical spine. The theoretical part focuses especially on ergonomics while sitting and the proper poise or postures of sitting. The second part of the aforesaid theoretical part describes the cervical spine anatomy, as well as causes of the origin of pain in the cervical spine and its symptoms. Finally, the theoretical part introduces various possibilities for therapy dealing with functional movement disorder of the cervical spine. The aim of the thesis is to specify the functional disorder of the limbs movement system, appoint and implement an individual plan and assess the resulting effect of therapy. Qualitative research focused on data collection was used as the main method by using different practices, such as direct anamnesis, input and output medical examination, nursing observation, document analysis, project and execution of a physiotherapeutic schedule. The survey was carried out on 2 men and 1 woman who have jobs which require long-term sitting. Their working tasks require sitting in front of a computer for at least an 8-hour period a day. All three people submitting the given survey suffered from pain in the cervical spine. The kinesiological examination described faulty body poises and related findings on soft tissues of the given testing group. The main problem was also caused by a faulty poise while sitting in front of a computer. The objective of the aforesaid therapy concentrated on releasing the overload of stressed muscle groups and on their integration according to the optimal kinetic formula. Functional movement disorders of the spine are prevented by implementing ergonomics of sitting in front of a computer. The results of the given survey demonstrate that the cervical spine subsided. Furthermore, the practical part of the thesis reveals that the positive effect of the targeted physiotherapy dealing with functional disorder and changes of the stereotype of our postures and poises was considerable. The main problem causing pain was incorrect poise while sitting at the desk. The essential point of therapy was to release the overload of muscle groups and their integration into a new poise. The results of the given survey demonstrate that pain in the cervical spine has been alleviated. Based on the results introduced in the practical part, it may be stated that functional movement disorder can be positively influenced by targeted physiotherapy and changes made in the routine of body movements. The results specified in the submitted thesis shall be used in practice for the needs of other surveys to follow, during lessons or by companies furnishing their offices.
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Toxicity of freely available analgesics in relation to human health
VODVÁŘKA, Stanislav
Analgesics represent a large group of medicines which is used for suppresing subjectively perceived pain. Analgesics can be divided into two large groups, opioids and non-opioids. Some of the non-opioids can be used as anti-inflammatory and/or antipyretics as well. All non-opioids influence metabolism of prostaglandins. Diverse group of non-opioid analgesics is available in Czech pharmacies as prescription medicines or for sale over the counter. The aim of this work is mainly to assess the toxicity of over-the-counter analgesics and to find out the frequency of fatal intoxications caused by these analgesics in the Czech Republic and abroad. A list of peroral over-the-counter analgesics was created. A partial analysis of data from medical judicial departments of regional hospitals in the Czech Republic was performed in order to obtain total number of deaths caused by overdosing with these drugs. Using ÚZIS the number of deaths was extracted from information system Deceased. These logged deaths were caused only by acute intoxication with analgesics and were chosen on basis of precisely defined combinations of diagnostic codes (MKN10). Results were then expanded by similar enumeration from the National register of hospitalized, by which we specified the amount of intoxications where patients survived. Overall case report was evaluated from processed information. The number of deaths caused by analgesics and commonly misused addictive substances were compared by which the second hypothesis was clarified. The data was obtained from Annual reports about substance misuse and 6 years were compared in total. Identified risk of analgesic in Czech Republic was compared with registered cases of overdosing in world. Data used for comparing were gained from analysis of world literature. During the years 2006 ? 2011, 53 deaths and 2024 hospitalizations in the Czech Republic were caused by acute intoxication as a result of overdosing with mentioned medication. Our first hypotesis can be confirmed on the basis of these numbers, and therefor it can be said that over-the-counter medicines used for suppressing pain can cause death. On the basis of analysis of world literature a certain risk is seen in fact that these analgesics ? mainly paracetamol ? are often linked with suicides. For instance in United Kingdom thousands of cases of self-harm are caused by overdosing with paracetamol. In USA 16 500 deaths are thought to be caused by NSAIDS and 1600 acute liver failure incidents are caused by overdosing with paracetamol annualy. Illegal drugs caused 253 intoxications during the years 2006 -2011 compared to 53 cases of deaths caused by overdosing by analgesics. Annual reports about substance misuse report that deaths caused by illegal drugs are more common than deaths caused by over-the-counter analgesics in the Czech Republic. There remains a question: What percentage of analgesics intoxications, where patient survived or not, is caused only by over-the-counter analgesics without any other cause.
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Stress incontinence and the possibilities of targeted rehabilitation
VYHLÍDALOVÁ, Denisa
The topic of my bachelor thesis is stress incontinence and options of targeted physiotherapy. The first section contains theoretical background concerning mentioned problems. The theoretical section summarizes anatomical and physiological facts about urinary system and pelvic floor, and the theory of incontinence. There are described types of urinary incontinence and their causes. As next, there are mentioned the options of diagnostics and treatment especially of stress incontinence. Incontinence, i.e. involuntary leakage of urine, is one of the most widespread female inconveniences of recent years. It brings many problems, not only physical ones but also mental, and so that it has negative impact on quality of the life. This involuntary leakage of urine is not an illness to all intents and purposes but symptom with various causes. The most common cause are weakened muscles of pelvic floor, which belong to the deep stability system. They significantly support the whole stability system of the trunk. These muscles and fasciae of pelvic floor provide proper stabilization of urinary bladder, urethral closure, and urethra in proper position and by this they assure continence, especially when intra abdominal pressure increases. The muscles of pelvic floor and diaphragm participate together in breathing. The frequency of incidence of urinary incontinence increases depending upon the age. One of the incontinence types is stress incontinence. Urine leakage is always related to physical activity. Urine leakage happens when intra abdominal pressure increases and happens without contraction of detrusor. Unlike against other disorders, it is possible to fight successfully against incontinence not using only drugs and operative surgery. The treatment of incontinence is in recent years relatively successful and with the help of proper and regular exercise it is possible to prevent it. According to some recommendations, when treating stress incontinence, physiotherapy should be chosen as a primary treatment. The goal of physiotherapy is the effort to help patient to be able to activate muscles of pelvic floor in situations when the leakage of urine is expected. There was used the method of qualitative research in practical section of the thesis, using case studies of 2 patients suffering from stress incontinence. The thesis contains entry and final kinesiologic analysis completed with the query CONTILIFE, the plan with adequate exercises and measures, and the final success rate of the treatment. The goal of the thesis was to point out significant role of physiotherapy in the treatment of patient with stress incontinence, then outline the available rehabilitation methods and propose complex of appropriate exercises and measures. There was created a booklet with the list of exercises for each patient. Patients have exercised using these single exercises being previously instructed about them for eight weeks, and they were simultaneously controlled on regular basis. Patients were observed in a complex manner so that the individual therapy was made for each of them according to individual problems, revealed in entry kinesiologic analysis. Final results of this study showed that the chosen therapy was successful and patients mention not only subjective feeling of improvement of their incontinence problems during the day, but also an improvement of their physical condition and relief from the pain of the cervical and lumbar spine due to a complex approach and individual therapy.
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Physiotherapy in patients after injuries of the spine and spinal cord
HAJNÁ, Petra
In connection with our lifestyle every year in our country but also abroad there is a growing number of people with spinal cord injuries. The spinal cord injury usually occurs while a spinal injury, where the spinal canal is compressed by luxated vertebra or bone fragments. Affected are more often young people, especially men. The most common causes are falls from height, accidents and sports injuries. A person with this condition not only has limitations in terms of loss of movement or sensitivity but is often threatened by various health complications. Therefore a complex care and intensive rehabilitation is very important, which is in the Czech Republic secured by the spinal program lasting 6-9 months. Rehabilitation is needed not only in the acute period after injury, but has a unique place in the chronic stage of spinal cord injury as well. The aim of this thesis was to explore issues of trauma and spinal cord injury from the perspective of physiotherapy. Based on the defined targets following research questions have been determined. What kinds of physiotherapy procedures may be used onpatients in the subacute stage and what procedures in the chronic stage of spinal cord lesion. A qualitative research in the form of case reports has been executed. Data was obtained from interviews, observation, document analysis and kinesiological analysis. Standard tests related to the spinal lesion were performed, only the most relevant tests and the results that were found during therapy in case reports were entered. The sample included four patients. Two patients in the subacute and two patients in the chronic stage of spinal cord injury lesion etiology. The research was conducted at the Spinal Unit Department of Traumatic Surgery, University Hospital Brno and at the Rehabilitation and restoration center Borovany. Physiotherapy in subacute phase of spinal cord injury is directed at the prevention of pressure sores, contractures, pain, maintaining optimal mobility of joints, focusing on respiratory rehabilitation, maintenance and strengthening of preserved motor potential, activation of the motor transient spinal cord lesion with efforts to activate the motor skills in the most distally way, improving the overall physical condition. The aim is to use and support functional ability of the patient to the fullest extent and quality with the subsequent effort to develop alternative mechanisms.Of the special methods the ones on the neurophysiological basis are the most commonly used treatment methods. An important part is the gradual verticalization of the patient, training equilibrium reactions such as training seat, support for upper limb, keeping in certain positions and functional training, thus the mobility on the bed, self-care, transfers, training wheel chair control, practicing functional replacement grip. Patients return to life with a big handicap, are often dependent on the assistance of others, learn to use a wheelchair and other aids. They have years of life ahead in which they have to cope with the conditions subsequent their injury. In the chronic period, it is important to maintain physical fitness, preventpossible complications, especially pressure sores and joint contractures. Physiotherapist addresses the consequences of overloading the exposed muscles, monitors the vertebral problems, joint pain or muscle imbalance. During this period, patients can attend ambulant physiotherapy or use maintenance stays in rehabilitation centers. The purpose of the study was to mention the basic and the most important areas in the care of spinal patients and to highlight the importance of physiotherapy comprehensive care not only within the spinal program, but also from the perspective of the long-term care of these patients as the rehabilitation should accompany the patient's whole life.
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Nursing Care of Klients with Fractured Distal Femur
VOPÁLKOVÁ, Milena
The name of this Bachelors thesis is "Nursery Care of Patients with Fractured Distal Femur". With view to the lengthening of the populations age, increasing popularity of adrenalin sports and development of traffic we can expect an increasing number of this serious type of injury, and therefore it is time to address the issues of nursery care of the clients with this type of fracture. Fracture of the distal part of femur often happens suddenly and unexpectedly and the client has to deal with a health problem, which brings about a lot of changes as regards his/her health, psychic and social situation. The purpose of this thesis is to map the nursing specifics and nursing problems experienced by clients with a fractured distal femur from the nurses point of view. Through an analysis of a research survey we will summarize the thesis outcomes and determine the specifics of possible complications under the nursery care of such clients. Hence, the thesis contains two fundamental parts: theoretical and empirical. The theoretical part deals with the historical development of nursing and care provided as regards these fractures, the anatomy of lower limbs and causes of such fractures. It also addresses the basic classification of such fractures, principles of an osteosynthesis therapy, education, nursing and rehabilitation care. The empirical part includes a research survey with two predetermined goals mapping the specifics and complications within the nursing care of clients with a distal femur fracture. With view to the fact that various specifics and complications within the nursing care in the period before and after surgery were ascertained, they were categorized as pre-surgery and post-surgery specifics and complications. The research survey found out that one specific is differing pre-surgery nursing care of the clients with a fractured distal femur, mainly provided that stabilisation of the fractured part is executed by means of a skeletal traction or a patch traction or through a knee brace. The ascertained nursing complications are related to such immobilization interventions. According to the interviewed nurses the nursing procedure is even more diverse, mainly as regards the injured clients mobility and the nursing care. Other specifics of the nursing care are monitoring of locomotion and sensitivity of the traumatized lower limb, antidecubitus care, aself-care deficit and a possible risk of the lever action impact on the distal femur when moving on the bed. Specifics of the post-surgery nursing care regarding clients with a knee brace are: monitoring of locomotion and sensitiveness of the lower limb, correct manipulation with the knee brace, care of the locomotion, a risk of the lever action impact on the osteosynthesis area mainly when the client is sitting on the bed with lowered limbs or doing exercise on the motor splint. Nursing complications ascertained during the post-surgery period are mainly an oedema and a haematoma of the surgical wound place, urine and faeces emptying disorders, inadequate relief of acute pain, decubites under the knee brace or on the heels, long-term deficit of the clients self-care due to the traumatic consequences and other possible complications as described in this thesis. Outcomes of this thesis are two simple mind maps, which are a part of this thesis. The first mind map shows the nursing care specifics as regards a client with a fractured distal femur and the second describes the most frequent complications and interventions of a nurse within the nursing care as regards a client with a fractured distal femur. The outcomes of this thesis can serve as an information material for traumatology unit nurses and also for nurses working in other complements.
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Pectoris angina as a symptom of acute myocardial infarction in urgent care
ŠVORC, Jaroslav
This dissertation deals with the topic of stenocardia as the symptom of an acute myocardial infarction in prehospital emergency care. The goal of my work is to map the time lag from the first symptoms of an acute myocardial infarction to giving an urgent non-hospital first aid. The introductory part summarizes basic terms of anatomy and physiology of the considered system. The theoretical part of my work includes an ischemic disease and the most frequent risk factors which patients bear. The theoretical part is mainly dedicated to an acute myocardial infarction, i.e. its origin, symptoms, diagnostics, and treatment. The final part deals with issues concerning education of a patient from a medical rescuer's point of view. My work also involves a research part including the file of patients with diagnosed acute myocardial infarction. I nave got the data using retrospective analysis of the outgoing cards of the patients of the Medical Rescue Service Team of Ústí Region, with diagnoses of an acute myocardial infarction. The data has been processed into a table from which other graphs and tables in research part result. It observes the time lag from the first symptoms of an acute myocardial infarction to calling for help and giving an urgent non-hospital first aid. I also follow the main symptoms of an acute myocardial infarction (pain, propagation of pain). The research part results into conclusion, that the majority of patients calls for Medical Rescue Service Team within 3 hours after appearing the first symptoms of stenocardia. The patients mainly call for help within 1 hour after the first problems appear in this 3 hours interval.
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Treatment of a pain from the perspective of nurse.
RŮŽIČKOVÁ NEUŽILOVÁ, Michaela
The theoretical section of a bachelor thesis deals with pain treatment, specifically of urgent post operational pain management treatment from the nurse's point of view. It is divided into several sections. First section is focused at pain in general, briefly characterizes the pain itself as well as its formation and division. This part also contains brief description of pain score and mostly used methods pain measurement. Then follows the part, where the urgent post operational pain as well as its specifics and cure possibilities are described. A post operational analgesia appearing by geriatric patients and kids is marginally mentioned here. In the conclusion of theoretical section there is mentioned the issue of urgent post operational treatment quality management. Thesis aim The main purpose of the bachelor thesis is to chart an evaluation of the level post-operative pain by general nurse in the post-operative unit. There are ways and technics, which are in general used on one side, on the other side opinion including practical experience. The second target is general information how to treat pain and to find shortage in management of quality treatment of postoperative pain. The third target is about to map the general nurse's practical skills in the care of patients with epidural catheter. Research methods A qualitative research was chosen for the empirical section of this bachelor thesis. A form of a half structured interview was used for data mining. The interviews with respondents were recorded in written way into in advance prepared form, consequently the qualitative data were analysed and organized according to their importance into categorization group with the coding technic pencil & paper. Results The research resulted, that nurses use VAS technic to chart the urgent post operational pain, which is also standardized pain record of particular medical institution. This technic is absolutely suitable for interviewed nurses, no other technics of pain score are used in daily routine. The nurses report clarity and intelligibility of the record of progression and pain treatment to be the main advantages in scoring pain according to VAS, which simplifies the communication with the other nursing team members participating on pain treatment of particular patient. Next result: Nurses working on post-operative units are not active enough to find symptoms of acute post-operative pain. Nurses wait for patients themselves to verbalize the pain. Nurses give a main cause of post operational pain postoperative wound, they don't accept other reasons. The next problem was discovered in organization of management of post operational acute pain. The main reason is bad accessibility or inaccessibility of attended physician. Also bad multiprofesional communication is guilty. Cooperation reaches on dead lock on bad communication, on confused records from preoperational and post operational period. Nurses have plenty of experience of treatment of urgent pain. Nobody from nurses has special education in algesiology. Care of patient with epidural catheter taken is provided in accordance with standard approach. Is an epidural analgesiology contributing for patients? Nurses answer positive. The main contribution is better cooperation in line patient staff and more effective care process. Conclusion The bachelor thesis is concerned on problematic and specify of care of patients with acute post-operative pain. Acute post-operative pain is good managed symptom, it is impossible to pass it. It could be negatively influenced postoperative recovering, it could be a reason of prolonged hospitalization, increasing costs of treatment. Untreated postoperative pain could lead to chronical problems with health in general.
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The issue of prevention and early detection for patients with vertebrogenic syndrome in the cervical spine
HORKÁ, Michaela
This bachelor thesis deals with preventive measures and early detection of the vertebrogenic algic syndrome in the cervical spine. Vertebrogenic algic syndrome is a pain in different parts of the spine, which is one of the most common reasons for doctor visits. An alarming fact is that up to 80% of adults face these difficulties up and age of patients is constantly decreasing. Most common cause is poor posture, cervical spine injuries, mental health, degenerative changes, tumors and more. Part of this work is devoted to the prevention of vertebral problems. In these modern times, when the use of computers, laptops, tablets, became the ordinary matter, it is necessary to raise awareness of the basic ergonomic principles when using these devices, modifying work and home environment. The theoretical part is supposed to inform about the causes, mechanisms and physiotherapy practice in the treatment of vertebrogenic algic syndrome. It includes basic knowledge of anatomy, biomechanics of the cervical spine and preventive measures concerning the ergonomics of the working environment, sleeping position and appropriate sports activities. For the practical part of the thesis has been used qualitative research method. Qualitative research was done in the form of case studies of three persons. Each was subjected to an input and output kinesiology examination and history-taking in the form of a structured interview. The probands were interviewed regarding home and work ergonomics. The therapy lasted five weeks at the Health centre Medipont in České Budějovice. The task of the practical part was to use physiotherapy techniques to alleviate pain in a particular segments of the cervical spine and report about basic preventive measures. The result is the production of an educational booklet that contains exercises to stretch and release the cervical spine, basic ergonomic positions accompanied by photographs. This brochure will be available at the front desk at the Health centre Medipont in České Budějovice, in waiting rooms of general practitioners in Jemnice as a practical and synoptical helper in the fight against the problems in the cervical spine. This bachelor thesis could increase an awareness among general public about preventive measures and how to prevent pain in the cervical spine. Furthermore, it can be used by clinical practice physiotherapists in the treatment of vertebrogenic algic syndrome.
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Acute myocardial infarction in pre-hospitalization urgent care - direct cooperation with a cardiology center
JONÁŠ, Jindřich
Acute myocardial infarction in pre-hospitalization urgent care {--} direct cooperation with a cardiology center The evaluation of urgency of the condition of a patient with cardiac disease symptoms, identified as chest pain or acute coronary syndrome, used to be in the pre-hospitalization urgent care always in the domain of the emergency service physician. However, with the progress of diagnostic techniques the working diagnosis can be also made by a trained paramedic, as long as he/she is unable to get a physician to the place of the intervention. A great advantage in this respect is the possibility of telemetric transmission of electrocardiographic records to the cardiology center where the curve is evaluated by a cardiologist and then the optimized method can be agreed with the specialist by phone so that the concerned patient can be transported into a hospital and given specialized treatment. The objective of the thesis was to analyze the working procedure of a paramedic with a patient who suffered an acute myocardial infarction and to evaluate specific features of communication and cooperation with the cardiology center by means of data transmission. The bachelor thesis is divided into two parts. The first part is theoretical and it describes the issues of pre-hospitalization urgent care of a patient with an acute myocardial infarction and the provision of the care. The second, practical part of the thesis, consists of a qualitative research. The employed technique for data collection was a structured interview. Based on an analysis of the acquired data we set the following hypotheses: Hypothesis 1: Paramedics are familiar with the procedure for pre-hospitalization urgent care of a patient with an acute myocardial infarction. Hypothesis 2: Teams sent to interventions with chest pain indication are primarily emergency medical service teams.
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