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Toxic effects of Radiotherapy for Female Patients over 60 Years of Age with Gynecological Tumors
POLODNOVÁ, Šárka
Cervical cancer and cancer within the body of the uterus are the most frequent cancers of the female reproductive organs, the incidence of which is on the rise. Every year, more than 1,000 new cases of cervical cancer are diagnosed in the Czech Republic, as well as 1,500 cases of endometrial cancer. Surgical treatment and external radiotherapy are used during therapy and, in some cases, it is combined with brachytherapy and chemotherapy. I focused on the early toxicity of radiotherapy, which can be a limiting factor for the completion of treatment, especially in older patients. The investigated sample consists of 100 female patients who were divided into 4 groups, according to age and the primary diagnosis of these patients. Each group consists of 25 women. Patients in the first group are represented in a group of those under 60 years of age with cervical cancer; the average age is 48 years. The second group consists of patients with the same diagnosis, but who are over 60 years of age; the average age is 66 years. The third group consists of patients who are under 60 years of age who have uterine cancer; the average age is 54 years. The 4th group consists of patients who are over 60 years of age with uterine cancer; the average age is 71 years. All patients were irradiated at the Oncological Clinic of České Budějovice Hospital. In my thesis, I compared the toxicity of radiotherapy in the group of younger patients with the group of the older patients. Hematological toxicity was more frequently identified in older patients, be it the malignant cervical cancer (76%) or the endometrial cancer (52%). In younger patients, hematological complications occurred less frequently (cervix {--} 52%, body of uterus {--} 24%). Serious grade 4 toxicity was identified in one patient over 60 years of age with separate pelvis radiotherapy for cervical cancer. Grade 3 toxicity was identified in one patient from the younger group and in one patient from the older group with combined treatment for cervical cancer. In regard to non-hematological complications, toxicity was more severe in older patients too. The incidence of diarrhea in the over 60-year-olds was 64% as opposed to 48% in the younger group. The stated hypothesis of higher toxicity of treatment for older patients was confirmed during my research.
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The Role of Nurses in Colorectal Surgeries
ŠULCOVÁ, Jana
Theoretical basis: The problems in rectal and anal diseases have had rising tendency, especially haemorrhoidal diseases, on which we put emphasis in our bachelor thesis. 37% of adult population suffers from this disease so we may line it up to civilization illnesses. Their treatment involves wide range of medical methods, from the conservative therapy to semi invasive ways of treatment. The semi invasive treatment is well withstood by patients and it can help up to 90% of clients. This bachelor thesis is concerned with specifics of nursing duties in a colorectal surgery. It links with topics like taking faecal specimen, basic methods of endoscopy, communication with patients and giving them information about lifestyle. The theoretical basis describes haemorrhoidal disease and gives brief introduction into causes of its developing, most common symptoms and possible treatments. The aim of the thesis: From the practical point of view we set two tasks. The first one is aimed at specifics of nursing job in a colorectal surgery and the second one tries to monitor how nurses in colorectal surgeries inform patients about healthy lifestyle. We asked two research questions regarding these aims. The first research question is: What are the specifics of the nursing job in the colorectal surgery? The second question concerns how nurses in colorectal surgeries provide information to their patients about healthy lifestyle. Methodology: Regarding the bachelor thesis we decided to choose a form of a qualitative research with using semi structural interviews with practical nurses working in colorectal surgeries. The interviews took place from February 28 2014 to March 15 2014 in five colorectal surgeries in following towns: České Budějovice, Písek, Strakonice, Jindřichův Hradec a Třemošná u Plzně. The focus group was created of 6 nurses working in colorectal surgeries. The interviews were performed and recorded with the consent of all practical nurses involved in the research. All extracted data was arranged and categorised into groups that were consequently analysed. The interviewer´s questions were prepared in advance and some extra questions were asked during the interview. The interview was divided into five areas: Identification questions, role of a nurse, examination methods, recommendation and giving information about lifestyle. Results: The results show the specifics of nursing in colorectal surgeries. We found out that nurses working in colorectal surgeries deal mainly with preparing special medical instruments and devices needed for endoscopic examination. Then they assist doctors during a medical examination and with treatment methods of RBL (Barron´s rubber band ligation) and Hemoron, they manipulate with devices in a surgery, check hygiene measures, do administrative work and keep surgery office running. In other conversation areas practical nurses mostly mentioned sampling of biological materials, mainly blood and faecal specimen taking to be given up to histological examination, preparing patients for an endoscopic exam, communication with patients and attending to the intimacy of patients. Consequently we found out that more than half of the practical nurses pay attention to psychological conditioning of the patient before rectoscopy. The research also revealed some weak spots. More than half of the nurses in the focus group do not inform patients about preparations before anoscope exam. Barely one third of the group said that they inform patients about the natural emptying before the exam. Regarding the issue of giving information about lifestyle, we came to the conclusion that practical nurses, even though they do not have enough time, try to inform patients about physical activities, hygiene care and quality of eating and they do it in sufficient rate. But because of the time constrain they put emphasis only on the essential information.
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Nursing care of the operation area before and after the operation
KRATOCHVÍLOVÁ, Michaela
Theoretical outcomes The preparation of the operating field is an important part of all preoperative preparation. Preoperative preparation, before surgical intervention, cannot be neglected. In most cases, the doctor will not perform an operation without proper preoperative preparation. The only exception is urgent surgical intervention for which only the most basic preoperative preparation is provided. Preoperative preparation can be categorized as long-term, short-term, or immediate. A thorough and proper preparation of the operating field reduces any development of postoperative wound complications. The aim of thorough preoperative preparation of the operating field is to reduce any risk of developing postoperative wound complications. Postoperative care prevents postoperative complications. It is aimed at controlling the state of a patient's current health after surgical intervention, but also the surgical wound and its dressing. Both nurses and doctors are obliged to perform these controls. In the early postoperative period, the client stays in the ward or in the postoperative room. In the case of arising complications during surgical intervention, the client is moved to the ICU/ARO. The Aims of the Thesis The aim of the thesis is to map the differences in preoperative preparation of the operating field among surgery departments, and to find the differences between preparation in the operating field before a scheduled and an urgent surgical intervention. Furthermore, the aim is to find out if nurses perform preoperative and postoperative care properly. The following questions were chosen: What are the differences in preoperative preparation of the operating field among surgery departments? How do nurses perform preoperative and postoperative care of the operating field? Implemented methods In order to gain the desired information, a qualitative form of research was chosen, namely an in-depth interview method, a method of questioning, and an observational method. Observation was implemented using the hidden observation method. The respondents in the research were the nurses from the urology and the surgery departments at a hospital in Vysočina. Data collection was conducted from February to March, 2014. The acquired data was then analyzed through an open coding method. Results The subsequently transcribed interviews and observations were carefully analyzed using the 'pencil & paper' method and open coding. Eventually, five categories were created: preoperative preparation before a scheduled surgical intervention, preoperative preparation before an acute or urgent surgical intervention, preparation of the operating field, postoperative wound care, medical documentation. Conclusion The research suggests that nurses are well aware of the complete preoperative and postoperative care. What is, however, surprising is how adherence to the principles of barrier care and the client's intimity vary in the course of providing this care.The conclusions in this thesis should aim at an improvement of preoperative and postoperative care of a client and to eliminate any discovered shortcomings in the provided nursing care. The practical outcome of this thesis will be an article in a professional magazine for nurses.
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