|
|
The role of the nurse in the system of early search for critical ill patients
BOUŠOVÁ, Adéla
The diploma thesis is focused on the role of nurses in the system of early search for critically ill patients in intensive care units. The Czech healthcare system still does not place the emphasis on the system of early search for the critically ill as it should. Knowledge of the issue can improve the quality of health care and reduce the mortality of critically ill patients who suddenly enter a life-threatening condition, but with knowledge of the issue, a life-threatening condition could have been prevented. The theoretical part of the diploma thesis consists of five chapters and several subchapters. The first chapter focuses on the critically ill, the second chapter on the monitoring of the critically ill, the third chapter on technical equipment in intensive care, the fourth chapter on the role of nurses in intensive care and the last chapter deals with the system of early search for critically ill patients. Three goals were set for the diploma thesis, namely to map the roles of nurses, how nurses are involved and whether they are educated in the issue of early search for critically ill patients. The practical part was processed by a qualitative survey in the form of semi-structured interviews, which were analyzed in the form of "paper pencil" by the method of open coding. The practical part was divided into four categories and then into subcategories. For clarity and clarity, the categories and subcategories have been visualized in diagrams. Based on the set goals of the diploma thesis, three research questions were set. The first research question dealt with the roles represented by nurses in the system of early search for critically ill patients. The second research question was how nurses are involved in the system of early search for critically ill patients. The third research question deals with the way of lifelong education of nurses in the system of early search for critically ill patients. The set goals of the diploma thesis were met.
|
|
|
Palliative care in intensive and resuscitation care units
ZIMOVÁ, Eva
The diploma thesis deals with the topic of palliative care in Intensive and Resuscitation Care units. Intensive care aims to save lives, while palliative care accompanies the patients and improves their last moments. Although it would appear that these two fields has not much in common, this is not the case. Both touch the death and work with people who balance between life and death. The theoretical part describes the various fields, including their history. The chapter is further dedicated to the connection of these two areas. The following chapters cover the ethical aspects of palliative care provided in Intensive and Resuscitation Care units. Following chapters deal with dying and death. The last chaptersof the theoretical part are focused on the relatives of dying and deceased patients. The aim of the thesis was to map the awareness of medical staff working in Intensive and Resuscitation Care, discover the approach of medical staff working in Intensive and Resuscitation Care to the provision of palliative care in Intensive Care units, to identify problems and shortcomings on the part of medical staff in providing palliative care to Intensive and Resuscitation Careunitsand to identify the factors which influence the medical staff in the provision of palliative care in Intensive and Resuscitation Care units. The research was carried out at the Department of Anaesthesiology and Intensive Care of one of the South Bohemian hospitals. Results are showing that the medical staff working at the Department of Anaesthesiology and Intensive Care staff have excellent theoretical knowledge in the field of palliative care. They try to provide the best possible care to patients and do their best for them. Despite all this, problems related to insufficient and inappropriate communication were found, which is underlined by the environment in which it takes place. Due to the great specificity of the ward, it is often very difficult to ensure the best possible conditions for the dying patient and his beloved ones. Another shortcoming was the absence of psychological support and care for medical professionals, who are constantly exposed to stress. There was also a complete absence of support and care for the bereaved which is part of and a prerequisite for providing quality palliative care. Based on the interviews, we can say that at Department of Anaesthesiology and Intensive Care is highly educated stuffandthey do their work with passion and want to provide it with the best possible quality. However, in this case, it would be appropriate to offer healthcare professionals sufficient training opportunities in palliative care and communication. The results of this work could help to minimize the problems identified and could serve as a basis for lectures and seminars for Department of Anaesthesiology and Intensive Care staff.
|
|
|
Glycemic level check performed by a nurse in critically sick people in intensive care
Vaňková, Daniela ; Heczková, Jana (advisor) ; Lišková, Iveta (referee)
This thesis deals with the control of blood glucose levels of critically ill patients in intensive care, focusing on hyperglycemia of the critically ill and possible therapy within the competences of nursing and medical staff. The theoretical part of the thesis deals with the issue of hyperglycemia of critically ill patients from the medical and nursing perspective as well as the issues concerning instrumentation. The first chapter describes briefly the history of insulin, relating to its discovery and introduction into practice. The following chapter describes the concepts of critically ill, intensive medicine, intensive care as well as specific nursing care. Short information about etiology, diagnosis, treatment and complications of diabetes mellitus is described in the third chapter. The following are the chapters, which are more specifically devoted to the issue of hyperglycemia of the critically ill, including chapters on glucose homeostasis of the critically ill, the evolution of blood glucose levels, instrument technique, insulin protocols, insulin therapy, details of insulin therapy in intensive care and on the principles of correct blood collection for the determination of blood glucose levels in the conditions of intensive care. The empirical part of this work contains research on the...
|
|
|
Hemodynamics in the early stages of the critical illness and in the perioperative setting
Beneš, Jan ; Kasal, Eduard (advisor) ; Málek, Jiří (referee) ; Kroužecký, Aleš (referee) ; Adamus, Milan (referee)
Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...
|
|
|
Gastrointestinal tract dysfunction in critical ill patients
Balihar, Karel ; Matějovič, Martin (advisor) ; Kula, Roman (referee) ; Martínek, Jan (referee)
Multiorgan dysfunction syndrom is the major driving pathophysiological mechanism of morbidity and mortality in critically ill patients. Gastrointestinal dysfunction usually develops as a result critical illness and it is believed to play a key role in the development and progression of multiple organ dysfunction. Moreover, any primary disorder of the gastrointestinal tract, if severe enough, can lead to a critical state and secondary multiorgan dyfunction. Despite intensive experimental and clinical research, reliable tools for monitoring and evaluation of the severity of gastrointestinal dysfunction remain unknown. In the same line, therapy of this complex pathology remains largely supportive. The aim of this thesis was first to explain the severity of the most common and most serious nosocomial infection of the digestive tract, second to elucidate the safety and effectiveness of the endoscopic dual enteral probe insertion in ventilated critically ill patients, and, third to evaluate new diagnostic tools of the gastrointestinal dysfunction. Finally, we present an ongoing project aimed at investigating esophageal dysfunction in mechanically ventilated critically ill patients.
|
|
|
New trends in perioperative monitoring and glycaemic control.
Lipš, Michal ; Kunstýř, Jan (advisor) ; Bešík, Josef (referee) ; Beneš, Jan (referee)
Glycaemic control in critically ill patients has been a topic of considerable attention for the past 20 years. In literature and at scientific meetings, there have been ongoing debates regarding the efficacy of glycaemic control in these patients with frequently entirely opposite opinions. These range from a strict invasive approach with target glycaemia 4-6 mmol/l to a liberal approach tolerating even values higher than 12 mmol/l. In the preview of this PhD thesis we have analysed so far published literature and describe the reasons for this inconsistency. According to the results of recent studies, the most significant efficacy of tight glycaemic control has been observed in cardiac surgical patients. If we consider the concept of tight glycaemic control as efficient strategy, there are three important questions remaining unanswered as follow. Does the specific algorithm-protocol play a key part in the concept of tight glycaemic control alongside the knowledge and skills of nursing staff in safe and efficient blood glucose control? What is the ideal timing of starting the strategy of tight glycaemic control (TGC) in cardiac surgical patient? And is there any benefit in outcome respect to mortality or morbidity? Do we have any more safe and efficient option or add-on to standard perioperative...
|
|
|
Effect of parenteral and enteral nutrition on nutritional status of severely ill patients
Krištofová, Hana ; Otáhal, Michal (advisor) ; Kotrlíková, Eva (referee)
The system of nutritional support in the form of enteral and parenteral nutrition is an inherent part of therapeutic procedures in severely ill patients. The intake of sufficient energy and nutrients affects the course of treatment and subsequent convalescence. The aim of this bachelor thesis is to find out whether the intake of nutrients in these patients corresponds with the relevant recommendations and also to evaluate the difference between the nutrition indicators in blood for the different types of nutrition. The theoretical part of this bachelor thesis defines the concepts of enteral and parenteral nutrition, their indications, contraindications, composition and delivery systems. The pathophysiological processes that occur in the organism of severely ill patients as well as the needs of individual nutrients that differ from the stabilized patients are described here. The practical part deals with a sample of 36 patients who were hospitalized at the Intensive care unit of Department of Anesthesiology and Intensive Care, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague . It describes energy and protein intake from the different types of nutritional support. It also evaluates whether the real income corresponds to the planned intake and whether...
|
|
|
Glycemic level check performed by a nurse in critically sick people in intensive care
Vaňková, Daniela ; Heczková, Jana (advisor) ; Lišková, Iveta (referee)
This thesis deals with the control of blood glucose levels of critically ill patients in intensive care, focusing on hyperglycemia of the critically ill and possible therapy within the competences of nursing and medical staff. The theoretical part of the thesis deals with the issue of hyperglycemia of critically ill patients from the medical and nursing perspective as well as the issues concerning instrumentation. The first chapter describes briefly the history of insulin, relating to its discovery and introduction into practice. The following chapter describes the concepts of critically ill, intensive medicine, intensive care as well as specific nursing care. Short information about etiology, diagnosis, treatment and complications of diabetes mellitus is described in the third chapter. The following are the chapters, which are more specifically devoted to the issue of hyperglycemia of the critically ill, including chapters on glucose homeostasis of the critically ill, the evolution of blood glucose levels, instrument technique, insulin protocols, insulin therapy, details of insulin therapy in intensive care and on the principles of correct blood collection for the determination of blood glucose levels in the conditions of intensive care. The empirical part of this work contains research on the...
|
|
|
Gastrointestinal tract dysfunction in critical ill patients
Balihar, Karel ; Matějovič, Martin (advisor) ; Kula, Roman (referee) ; Martínek, Jan (referee)
Multiorgan dysfunction syndrom is the major driving pathophysiological mechanism of morbidity and mortality in critically ill patients. Gastrointestinal dysfunction usually develops as a result critical illness and it is believed to play a key role in the development and progression of multiple organ dysfunction. Moreover, any primary disorder of the gastrointestinal tract, if severe enough, can lead to a critical state and secondary multiorgan dyfunction. Despite intensive experimental and clinical research, reliable tools for monitoring and evaluation of the severity of gastrointestinal dysfunction remain unknown. In the same line, therapy of this complex pathology remains largely supportive. The aim of this thesis was first to explain the severity of the most common and most serious nosocomial infection of the digestive tract, second to elucidate the safety and effectiveness of the endoscopic dual enteral probe insertion in ventilated critically ill patients, and, third to evaluate new diagnostic tools of the gastrointestinal dysfunction. Finally, we present an ongoing project aimed at investigating esophageal dysfunction in mechanically ventilated critically ill patients.
|
|
|
Hemodynamics in the early stages of the critical illness and in the perioperative setting
Beneš, Jan ; Kasal, Eduard (advisor) ; Málek, Jiří (referee) ; Kroužecký, Aleš (referee) ; Adamus, Milan (referee)
Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...
|
guest ::
