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Therapeutic hypothermia from the nursing point of view
SOUKUPOVÁ, Dominika
The objective of the thesis is to find out what are the specifics of care for patients treated using therapeutic hypothermia. On the basis of this objective, two research questions connected with the objective were created. The first research question is: "What is the experience of nurses in care for patients treated using therapeutic hypothermia?" The second research question is: "What are the specifics of care for patients treated by therapeutic hypothermia?" The thesis is divided into two parts. In the first part are defined theoretical basics connected with therapeutic hypothermia, cardiopulmonary resuscitation and nursing care. It is followed by empirical part processed using qualitative research conducted by semi-structured interviews with nurses. The questions were answered by a total of five general nurses working at various hospitals in the South Bohemian Region. The nurses work at emergency department and department of anesthesiology and resuscitation. The interviews were processed by open coding method "Paper and Pencil". The results of the research were divided into categories and for the sake of clarity also to subcategories. These categories show experience and knowledge of the given problematic and the nursing care itself. The results show the method of care for patient treated by therapeutic hypothermia. It is apparent from the research that all nurses have experience with therapeutic hypothermia and are well oriented in the problematic. The experience of nurses is influenced by various factors, for example by the length of practice of the nurse, type of department where they work at or size of hospital. Further, the nurses stated that nursing care for patients treated by therapeutic hypothermia is almost the same as nursing care for any other patient in emergency care. That for example means that care for gastric emptying of the patient or for venous access etcetera is the same as at other patients and the care is provided in the standard way. The care for such patient is always complex.
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Nursing Process for a Patient with Post-resuscitation Therapeutic Hypothermia after Acute Myocardial Infarction
Viktora, Jan ; Vytejčková, Renata (advisor) ; Petrák, Ondřej (referee)
The bachelor's thesis deals with acute cardiology, namely with casuistry of a patient after acute myocardial infarction with successful cardiopulmonary resuscitation in the field, artificial pulmonary ventilation and therapeutic hypothermia. The thesis wants to present the highly specialised and demanding nursing care of resuscitated patients from the nurse's point of view with the use of the most modern procedures and technology. The theoretical part of the thesis is divided to several chapters describing anatomy and physiology of the cardiac muscle, acute myocardial infarction, cardiopulmonary resuscitation and therapeutic hypothermia. The main focus of this part of the thesis is on the diagnosis of the acute coronary syndrom itself. The theoretical part describes in more detail therapeutic hypothermia and nursing care of patients after cardiopulmonary resuscitation. Very important chapter is also introduction of a patient on whom is concentrated the nursing care in the practical part of the thesis, and presentation of his hospitalization. The practical part deals with creating, planning and implementation of the nursing care by means of biomedical model and nursing process. The practical and theoretical part alike is divided to several chapters. The main one is focused on nursing anamnesis with...
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Effect of N-acetylcysteine and therapeutic hypothermia on ischemia-reperfusion injury after experimental cardiac arrest
Pinterová, Nikola ; Škulec, Roman (advisor) ; Kučera, Karel (referee)
Therapeutic hypothermia (TH) is the only clinically used intervention that suppresses nearly all manifestations of ischemia-reperfusion injury after cardiac arrest. Experimental models has proven that exogenous antioxidants have positive impact on ischemia-reperfusion injury and it is able to prevent it as well. Results in this thesis are based on application of high dosages of N-acetylcystein (NAC) on ischemia-reperfusion injury after experimental cardiac arrest in a porcine model. It was used as a form of monoteraphy or in combination with TH. During the experiment animals were randomized into 5 groups: administration of NAC and TH (group A), administration of NAC during cardiac arrest (group B), induction of TH (group C), without any intervention (group D) and administration of NAC after return of spontaneous circulation (group E). We were not able to confirm additive effect of NAC in combination with TH. Administration of NAC during cardiac arrest led to statistically important reduction of oxidative stress but in the same time anafylactic reaction led to higher mortality in group B and changes in hemodynamical parameters in group E. Key words: Therapeutic hypothermia, cardiac arrest, N-acetylcysteine, ischemia-reperfusion injury, cardiopulmonary resuscitation, oxidative stress, oxygen radicals
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Nursing Process for a Patient with Post-resuscitation Therapeutic Hypothermia after Acute Myocardial Infarction
Viktora, Jan ; Vytejčková, Renata (advisor) ; Petrák, Ondřej (referee)
The bachelor's thesis deals with acute cardiology, namely with casuistry of a patient after acute myocardial infarction with successful cardiopulmonary resuscitation in the field, artificial pulmonary ventilation and therapeutic hypothermia. The thesis wants to present the highly specialised and demanding nursing care of resuscitated patients from the nurse's point of view with the use of the most modern procedures and technology. The theoretical part of the thesis is divided to several chapters describing anatomy and physiology of the cardiac muscle, acute myocardial infarction, cardiopulmonary resuscitation and therapeutic hypothermia. The main focus of this part of the thesis is on the diagnosis of the acute coronary syndrom itself. The theoretical part describes in more detail therapeutic hypothermia and nursing care of patients after cardiopulmonary resuscitation. Very important chapter is also introduction of a patient on whom is concentrated the nursing care in the practical part of the thesis, and presentation of his hospitalization. The practical part deals with creating, planning and implementation of the nursing care by means of biomedical model and nursing process. The practical and theoretical part alike is divided to several chapters. The main one is focused on nursing anamnesis with...
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Therapeutic hypotermia after cardiac arrest
JIRCOVÁ, Danuše
The bachelor thesis deals with the influence of a mild therapeutic hypothermia as a hospital post-resuscitation care of patients after cardiopulmonary resuscitation for non-traumatic cardiac arrest. Therapeutic hypothermia is a relatively new method. It is part of the European Guidelines for resuscitation since 2005. It was reported its positive effects on the neurological status of the patients. Using the method reduces the damage to the brain and cardiac muscle. The theoretical part of the thesis deals with the effect of mild hypothermia on the human body. Specifies the indication and contraindication criteria for initiation of therapeutic hypothermia, describes cooling methods of the patient and ways to terminate the therapeutic hypothermia. Describes the monitoring of physiological functions and nursing care of patients. The practical part of bachelor thesis mapped the procedures used in the administration of therapeutic hypothermia in patients treated in two large hospitals. These were Fakultní nemocnice Kralovske Vinohrady in Prague and Nemocnice Ceske Budejovice, a.s. The applied strategy of the research was qualitative. Content analysis of 10 case reports were carried out, 5 case reports from each hospital. Case reports concerning patients after cardiopulmonary resuscitation, who were treated using the therapeutic hypothermia as a part of hospital care. The aim of this thesis was to map the procedures used in the therapeutic hypothermia administration in patients after cardiopulmonary resuscitation. It was made available by hospitals after approval by ethics committees on the basis of applications submitted. The information was subsequently created into case studies that were analysed in the categorization tables. In the discussion, the results were compared with the published knowledge provided in the theoretical part of the thesis, and were commented. Analysed were: the composition of the group of patients by age and gender, provide the basic life support by witnesses prior to arrival of crew of the emergency medical service on scene, initial ECG rhythm after emergency medical service arrival, the time elapsed since the cardiac arrest appeared to restore of spontaneous circulation, initiation of therapeutic hypothermia in pre-hospital care, time elapsed since the therapeutic hypothermia start up to reaching the target body temperature, duration of the therapeutic hypothermia, the methods used for cooling the patients, the methods used for measuring the body temperature and neurological status at the time of discharge or transfer from the hospital. The results of the research surprisingly showed that general public are well-informed. Witnesses were able to recognize cardiac arrest, early called in professional help and were willing to give heart massage. This shows also the success in implementing the method of medical dispatcher-assisted basic life support in practice, because the witnesses were in many cases instructed by the medical dispatchers to resuscitate the patient. The majority of patient's initial ECG rhythm were diagnosed as ventricular fibrillation. Time to restoration of spontaneous circulation in most cases ranged within 29 minutes. To achieve the target body temperature at the recommended time limit has managed to half of patients. Target body temperature was always kept within the recommended timeframe and core body temperature was monitored. Concerns raised by an absence of the method start up in pre-hospital emergency care. The thesis highlighted the seriousness of sudden cardiac arrest and the high incidence of patients dismissed from the department with severe neurological deficit. Therefore, it is necessary to continue in research of this method, improve it and try to incorporate it already to pre-hospital care.
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