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Nursing care for patients with gastric and duodenal ulcer disease after surgery
JANKŮ, Jana
This bachelor thesis deals with nursing care for patients with gastroduodenal ulcer disease (GDUD). The goal of the thesis is to map specifics of nursing care for patients with GDUD in the pre-operational and post-operational period and to find out how satisfied patients were with the care given to them. The research included ten interviews with nurses working in the department of surgery and gastroenterology and ten interviews with patients who have undergone surgery with GDUD. The interviews were carried out using the in-depth interview method and later processed with a coding method. Based on interviews, it can be concluded that the first step done by nurses before the operation is monitoring basic physiological functions, followed by giving the patient informed consent for signature, and taking the patient's blood for testing and deposition. Meanwhile, patients get Controloc continually. Afterwards, patients get a nasogastric tube, and the nurses start preparing the operation field. Meanwhile, nurses apply bandages of inferior extremities, and they apply pre-medication. In terms of post-operational care, nurses monitor basic vital functions, draining from the nasogastric tube, and other drains. They also monitor bleeding, the level of the patient's pain, and the results of blood tests. Besides that, nurses must write down all interventions done by doctors and the patient's statistics to the documentation. This research shows that nurses are acquainted with knowledge of all the specifics and differences in the nursing care of patients with an acute and a chronic form of this disease. Nurses from the research are properly educated in the nursing care of patients with other associated diseases, such as DM, ischemic disease of the lower extremities, chronic obstructive pulmonary disease or cordial diseases. Nurses also have enough information about the most common complications associated with GDUD - perforation and bleeding. The research also shows that nurses know how to communicate with patients about necessary examinations, how to educate them, and explain possible complications as well as later home care. On the other hand, several patients stated that the communication from the doctors and the nurses was not always adequate. Patients usually explain this fact by the lack of nurses' time. Due to insufficient communication the patients are also forced to look up information by themselves. On the other hand, most patients state that the provided nursing care was sufficient. The nursing care that the patients described also agrees with the standards and recommendations. Based on the interviews, we can conclude that the patients who participated in the research are well informed about pre-operational and post-operational care. They are well educated about home care, regime measures, and ways that can decrease the risk of emergence of new peptic ulcers.
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Diagnosis and therapy of Helicobacter pylori infection
POSPÍŠILOVÁ, Michaela
H pylori is a Gram-negative, microaerophilic rod-shaped moving bacterium, notorious for its urease production. It colonizes gastric mucosa and always leads to chronic gastritis, which may result in the development of other serious diseases, such as gastroduodenal ulcer disease and gastric adenocarcinoma. In 1994, H pylori was classified as a category 1 carcinogen. H pylori infection can be tested for invasively and noninvasively. The invasive methods include cultivation, histological examination and a rapid urease test. Noninvasive options are the carbon urea breath test, a stool antigen (HpSA) test and a blood antibody test. H pylori is sensitive to betalactam antibiotics. These should therefore be the essential part of the treatment; the instances of resistance are rare. Should the patient be allergic to betalactam antibiotics, nitroimidazoles can be used instead. H pylori is also sensitive to macrolides. The objective of my bachelor thesis was to acquire practical knowledge necessary for the correct processing of stool and serum samples in laboratory practice. I also intended to describe current trends in diagnosis and treatment of H pylori infection, together with the infection rates depending on age, sex and the season of the year. The findings were discussed in the context of relevant academic literature. Finally, I monitored the ways in which gastroduodenal ulcer disease caused by H pylori infection is diagnosed and treated by gastroenterologists in České Budějovice. The collection of the data for quantitative research was carried out between 1 January 2012 and 31 December 2012 in the microbiological laboratory Synlab czech s.r.o. in České Budějovice, which covers the whole of the South Bohemian Region. The samples were supplied mostly, but not exclusively, by GPs, and two methods of medical examination (euroSCREEN HP and EIA Helicobacter MONO IgG) were used. EuroSCREEN HP is based on the stool antigen (HpSA) detection, EIA Helicobacter MONO IgG is an immunoenzymatic method detecting IgG antibodies against H pylori in human serum or plasma. The data for qualitative research were collected in gastroenterologic ambulances in České Budějovice. Guided semi-structured interviews were carried out with one doctor in each ambulance. The acquired data were then processed as case studies and used to obtain categorization tables. The quantitative research confirmed all three hypotheses subject to evaluation. Higher age groups were found to have higher infections rates. However, no effect of either sex or the season of the year on the infection rates was registered. The qualitative research showed that gastroduodenal ulcer disease is most frequently diagnosed by České Budějovice gastroenterologists by the means of a biopsy check during gastroscopy. The samples are then sent to a microbiological laboratory for cultivation, histological examination and a rapid urease test. H pylori infection is usually treated by the standard triple therapy: amoxicillin, clarithromycin and a proton pump inhibitor. In case of hypersensitivity to betalactam antibiotics clarithromycin, a proton pump inhibitor and metronidazole are used instead. Occassional resistance to metronidazole and clarithromycin was reported. In these situations, cultivation is carried out in order to determine the sensitivity to antibiotics. The effects of the eradication treatment are evaluated by the means of a biopsy check during gastroscopy 6-8 weeks after its application. The samples are analysed in a microbiological laboratory. Some gastroenterologists also use a stool antigen (HpSA) test.
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