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Opioids in caesarean section
Nosková, Pavlína ; Bláha, Jan (advisor) ; Málek, Jiří (referee) ; Vymazal, Tomáš (referee)
The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...
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Opioids in caesarean section
Nosková, Pavlína ; Bláha, Jan (advisor) ; Málek, Jiří (referee) ; Vymazal, Tomáš (referee)
The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...
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Pain assessment in intensive care nurses view
Haklová, Andrea ; Koutná, Markéta (advisor) ; Nosková, Pavlína (referee)
Pain has a strong impact on quality of life. Even nowadays, in Czech Republic pain is underestimated both by sanitarians and patients. In consequence of this depreciation, only marginal pain treatment applies and the means are not always appropriate. Progress in medicine goes forward all the time. We are finding new solutions for formerly insolvable problems. Despite of that, quality of life in 21.century is significantly influenced by pain and even these days people are dying in pain, which we are unable to abolish completely. In health care we witness pain more often then anywhere else. That is the reason for this work to focus on matters of pain and its treatment. The aim of this thesis is to investigate handling pain at the Intensive Care Units. I focused on departments of anesthesiology and intensive care, where most often are unconscious people who cannot express the pain verbally. I tried to observe if nurses are familiar with signs of pain, whether they are able to assess the pain and which is the most common way of this assessment. Likewise I was interested in how the documentation aimed on pain is administered. First part of the thesis clarifies the theory of pain, which is briefly described here. In the second part of the work there are results of the questionnaire. The questionnaire was targeted...
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Influence of compression therapy on wound healing
NOSKOVÁ, Pavlína
Theory background Compression therapy (CT) is an efficient, easily accessible and simple nursing treatment most frequently used in patient with chronic venous insufficiency and the consequently occurring venous leg ulcers. These occur often in still mobile elderly. In CT an elastic garment is applied around the leg causing increased blood circulation which helps to decrease swelling, improve venous return, narrow enlarged blood-vessels, contradict insufficient function of venous valves and promotes wound healing. Every nurse should possess the skill of correctly applying the bandage and suitably explaining the significance of the treatment to the patient. All depends on the mutual collaboration between doctor, nurse and patient. It is necessary for the nurse to be manually skilful and have sufficient knowledge on the topic of CT. Unfortunately this treatment is often underestimated by health care practitioners, especially in connection to chronic wound healing. Aim of thesis The first research aim consists of mapping the effectivity of compressional therapy for treatment of chronic wounds, where we focus on the degree to which CT helps the process. The second aim is to find out about the influence on correctly conducted technical approach to CT regarding wound healing, where the question is how correct technique of CT influences wound healing. Used methods Qualitative research was used for this thesis in the form of in-depth interviews. The majority of the interviews were recorded and subsequently transcribed; the rest was transcribed directly by hand and paraphrased. First research group consisted of respondents with chronic wounds undergoing compression therapy. Second research group was comprised of nurses who treat wounds and use compression therapy as a part of treatment. Results Answers obtained during the interviews were analysed by the pen and paper method by open coding. Nine categories resulted from this analysis. The important finding are: education, its content and the way it is conducted as well as the instruction the nurse gives on applying the bandage are most significant together with positive reaction from the patient regarding protecting the wound and releasing pain. Materials for wound treatment are selected according to necessary criteria from a wide offer of products. The technique is conducted according to individual given steps based on the condition of the wound and with suitably chosen materials. The procedure steps must be correctly followed from beginning to end. The positive influence on wound healing is manifested by increased blood supply to the limb, better blood circulation, decrease of swelling and faster wound healing. The results show that nurses agree CT is an irreplaceable supporting treatment of venous insufficiency and leg ulcers. The patient learns about the effect of CT seeing the improvement in wound healing, feeling swelling decrease and by having the wound treated and bandaged by the nurse. The influence of CT on quality of life is connected to bio-psycho-social side with both positive and negative effects on the patient. . Conclusion Due to the time demanding treatment of wound healing, compression therapy method is very beneficial for the patient. It is beneficial also for the nurse as if conducted correctly and consistently, it gives very good results over which both the patient and the nurse can feel satisfaction.
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