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Life before and after heart transplantation
Get PDFTeoretična izhodišča:Opisali smo transplantacijo srca, potek operacije in predvsem spremembe v življenju pacienta. Zanimal nas je predvsem vpliv transplantacije srca kakovost življenja pacienta. Namen zaključnega dela je opisati življenje pred in po transplantaciji srca.
Metodologija:Deskriptivno metodo smo uporabili za teoretični del,v raziskovalnem delu je bila uporabljena kvalitativna metodologija. Vprašalnik za intervju smo sestavili s pomočjo 11 funkcionalnih vzorcev po Marjory Gordon inglede na ugotovljene potrebe po zdravstveni negi smo izpostavili negovalne diagnoze. Obravnavali smo enega pacienta s presajenim srcem.
Rezultati:Ugotovitve v študiji primera so pokazale, da se je kakovost življenja po presaditvi srca znatno izboljšala na vseh ravneh. Izpostavilismo 6 negovalnih diagnoz. Pacient je po transplantacijiokreval brez težav ali posebnosti in je sedaj, v času obravnavev zelo dobrem psiho-fizičnem stanju.
Sklep:Po transplantaciji srca se je življenje pacienta občutno spremenilo na bolje. Vloga medicinske sestre v času po operaciji je zelo pomembna, saj zajema poučevanje pacientov in njihovih svojcev, spremljanje pacienta pri okrevanju in spodbujanje k gibanju ter zdravemu načinu življenja.Theoretical starting points: We have described a heart transplant, a course of surgery and, in particular, changes in the patient’s life. We have been particularly interested in the impact of the operation on the quality of life. The purpose of the diploma is to describe the patient’s life before and after a heart transplant.
Methodology: We have applied the descriptive method for the theoretical part and the qualitative method for the research part. The interview questionnaire was compiled with the help of 11 functional samples of Marjory Gordon based on which we developed nursing diagnoses. We treated one patient with a heart transplant.
Results: The findings in the case study have shown that after the heart transplantation the quality of life at all levels has improved significantly. We have also developed some nursing diagnoses. After the operation, the patient recovered with no problems or peculiarities and is now in very good psychological and physical condition.
Conclusion: After the heart transplantation, the patient’s life has changed considerably for the better. The role of a nurse during the post-surgery process is very important, as it involves teaching patients and their relatives, monitoring the patient in recovery, and encouraging an active and healthy lifestyle
The significance of using Compression therapy in chronic venous insufficiency
Get PDFUvod: Kronična venska insuficienca je klinično opredeljena kot skupek znakov in simptomov, ki so vzrok in posledica dlje časa trajajočega povečanega krvnega tlaka v venah spodnjih udov. Ključno je pravočasno ukrepanje z redno uporabo kompresijske terapije. Namen zaključnega dela je bil na podlagi pregledane literature raziskati pomen uporabe kompresijske terapije pri kroničnem venskem popuščanju.
Metode: Pregledali smo strokovno in znanstveno literaturo s področja pomena uporabe kompresijske terapije pri kroničnem venskem popuščanju. Literaturo smo iskali v podatkovnih bazah PubMed, CINAHL Ultimate (EBSCOhost) in Sage Journal. S pomočjo PRISMA diagrama smo prikazali potek iskanja, uporabili smo deskriptivno metodo dela.
Rezultati: V končno analizo smo vključili 10 raziskav. Ugotovili smo, da so pozitivni učinki kompresijske terapije možni le, če se ta izvaja dosledno. Pripomore k zmanjšanju simptomov in izboljšuje kakovost življenja. Izziv pri doseganju optimalnih rezultatov pri dosledni rabi terapije predstavlja predvsem doslednost pri upoštevanju navodil in pravilna uporaba predpisane kompresijske terapije.
Razprava in Zaključek: Kronična venska bolezen predstavlja vse večjo skrb zaradi naraščajočih trendov dolge življenjske dobe, zato je pravočasno ukrepanje ključnega pomena. Kompresijska terapija je učinkovita pri zdravljenju KVI, vendar je informiranost okrnjena, kar nakazuje na potrebo po večjem izobraževanju. Za izboljšanje doslednosti pacientov pri upoštevanju navodil in za boljše razumevanje so nujne dodatne raziskave koristi uporabe kompresijske terapije.Introduction: Chronic venous insufficiency (CVI) is clinically defined as a collection of signs and symptoms that are both causes and consequences of prolonged increased venous pressure in the lower extremities. Timely intervention through regular use of compression therapy is crucial. The aim of this study was to explore the significance of compression therapy in the management of chronic venous insufficiency based on the reviewed literature.
Methods: We conducted a review of professional and scientific literature regarding the significance of compression therapy in chronic venous insufficiency. The literature was searched in databases such as PubMed, CINAHL Ultimate (EBSCOhost) and Sage Journal. A PRISMA flow diagram was utilized to illustrate the search process and we employed a descriptive method of analysis.
Results: Ten studies were included in the final analysis. We found out that the positive effects of compression therapy are only achievable with consistent application. Compression therapy contributes to the reduction of symptoms and improves quality of life. Achieving optimal results with consistent therapy presents a challenge primarily due to adherence to instructions and proper application of the prescribed compression therapy.
Discussion and Conclusion: Chronic venous disease is an increasing concern due to rising life expectancy trends, making timely intervention essential. Compression therapy is effective in treating CVIhowever, awareness is limited, indicating a need for greater education. Additional research is necessary to improve patient adherence to instructions and to enhance understanding of the benefits of compression therapy
Diabetic foot-complication of diabetes
Get PDFIzhodišča. Sladkorna bolezen je kronična bolezen, ki se pojavi, ko trebušna slinavka ne proizvaja dovolj inzulina ali kadar telo ne more učinkovito izrabiti oz. proizvajati inzulina. Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pripeljejo do destrukcije tkiva, kar ima za končno posledico zbolevnost, lahko pa tudi amputacijo. Namen magistrskega dela je bil predstaviti in raziskati problem diabetičnega stopala kot zapleta sladkorne bolezni z vidika medicinskih sester v diabetološki ambulanti in z vidika pacientov s sladkorno boleznijo.
Raziskovalna metodologija. Za teoretični del je bila uporabljena deskriptivna metoda in analiza domače in tuje literature, za raziskavo pa smo uporabili kvalitativna in kvantitativna metodologija. Tehnika zbiranja podatkov je anketni vprašalnik za paciente s sladkorno boleznijo in delno strukturiran intervju za medicinske sestre, ki delajo v diabetološki ambulanti. Pridobljene empirične podatke smo analizirali in obdelali s pomočjo statističnega računalniškega programa IBM SPSS Statistics 20 in računalniškega programa Microsoft Office Excel 2010.
Rezultati. Najpomembnejše o zdravstveni vzgoji pri diabetičnem stopalu za paciente je, da so ti pisno in ustno poučeni o zdravstveni vzgoji sladkornih pacientov, da jim je predstavljeno diabetičnego stopalo, pravilen način uporabe antibiotikov in da so seznanjeni s primerno obutvijo, ki preprečujejo težave pri gibanju. Za medicinske sestre je za pravilno oskrbo diabetičnega stopala najpomembnejše, da prepoznajo, kaj se s stopalom dogaja in kaj se bo, da oskrbi diabetičnega stopala posveti veliko pozornosti, da izvaja preveze in uporablja ustrezne materiale za celjenje ran. Medicinske sestre morajo glede na ugotovitve stanja diabetičnega stopala vedeti, kam napotiti pacienta na nadaljne obravnave, čeprav o tem odloča zdravnik. Ugotovili smo, da amputacija noge ni pogost zaplet diabetičnega stopala in da so pacienti zelo dobro poučeni glede nege stopal in pravilne obutve. Največ anketirancev je potrebne informacije dobilo pri medicinskih sestrah v diabetološki ambulanti. Z višjo starostjo pacienta s sladkorno boleznijo se večajo težave z vidom, ne povečujejo pa se težave oziroma spremembe tipljivosti stopalnih pulzov, spremembe nohtov, ne povečuje se prisotnost razjed, nevrološke okvare, arterijska hipertenzija in povečana vrednost maščob v krvi. Diabetično stopalo se enako pogosto pojavlja tako pri moških kot tudi pri ženskah.
Sklep. Pojavnost sladkorne bolezni vsako leto narašča in s tem tudi diabetično stopalo. Zdravstvena vzgoja je na tem na področju tako napredovala, da imajo diabetološke ambulante svojo šolo za diabetike in s tem tudi medicinske sestre edukatorke, ki poučujejo paciente o zdravstveni vzgoji pri sladkorni bolezni. Da bi preprečili najhujši zaplet diabetičnega stopala, je zelo pomembno, da medicinske sestre poučijo paciente, kaj je diabetična noga, kaj storiti, da ne pride do zapletov pa tudi glede urejenosti krvnega sladkorja, redne telesne dejavnosti, redne in pravilne nege nog, samopregledovanja nog, pravilne izbire obutve in nogavic ter kam in kdaj naj se obrnejo po pomoč.Background. Diabetes occurs due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. Presence of several characteristics, such as neuropathy, ischaemia and infection is called diabetic foot syndrome, which causes destrucion of tissue and may lead to morbidity or even amputation. The purpose of the master thesis was to present and explore the problem of diabetic foot as a complication of diabetes from the perspective of nurses and patients with diabetes.
Research Methodology. Descriptive method analysis of domestic and foreign literature were used for the theoretical part of the study. Qualitative and quantitative methodology were used for the research. The data were collected using a questionnaire for patients with diabetes and a semi-structured interview for nurses working at the clinic. The empirical data obtained were analyzed and processed using a statistical computer program IBM SPSS Statistics 20 and a computer program Microsoft Office Excel 2010..
Results. It is important for patients to be educated about the health education of diabetes patients. They should be presented a diabetic foot, be educated about the correct way to use the antibiotics and be familiarized with the appropriate footwear to prevent problems with movement. In treating a diabetic foot it is important for nurses to recognize what is and what is going to be happening with the foot, to pay more attention to the diabetic foot care, to change bandages and to use the appropriate materials for wound healing. According to the state of diabetic foot, the nurses should know where to refer a patient to for further treatment, despite the fact the doctor makes the final call. Leg amputation is not a common complication of diabetic foot. Patients are well educated about foot care and proper footwear. Most respodents learned from nurses in clinics. Eyesight problems occur with increased age of the patients with diabetes. But problems, such as pedal pulse sensation changes, toenail changes, the presence of ulcers, neurological disorders, arterial hypertension, and an increased level of blood fat are not effected by increased age. Diabetic foot is equally common in men and women.
Conclusion. The number of patients with diabetes and diabetic foot is increasing every year. Health education for diabetes has progressed to a degree where clinics have their own schools. Thus patients with diabetes and also nurses are taught about diabetes health education. In order to prevent a serious complication of diabetic foot, it is important for nurses to educate their patients about diabetic foot, blood sugar control, regural physical activity, regural and proper foot care, self foot examination, proper footwear, where and when to get help, and how to avoid complications
Multilayer Polysaccharide Nanofilms for Controlled Delivery of Pentoxifyllin and Possible Treatment of Chronic Venous Ulcer
Get PDFKronične rane predstavljajo velik socialno-ekonomski problem v zahodnem svetu. Eno najpomembnejših vrst kroničnih ran predstavlja kronična venozna razjeda, ki je odgovorna za okoli 80% vseh kroničnih razjed. Nova histo-patološka spoznanja so pokazala, de je lokalno, kronično vnetje v veliki meri odgovorno za patološke procese, ki vodijo do nastanka razjede kot tudi do upočasnjenega procesa celjenja. V tej študiji je predstavljen nov možen pristop k terapiji kronične venozne razjede, ki temelji na lokalnem dajanju potentne protivnetne zdravilne učinkovine, pentoksifilin (PTX). V ta namen so bile razvite ne-toksične polisaharidne večslojne medicinske obloge iz hitozana in alginata, ki zraven nadzorovanega sproščanja zdravilne učinkovine, že same pozitivno vplivajo na potek celjenja kroničnih ran. V okviru razvoja in optimizacije postopkov priprave omenjenih medicinskih oblog so bili pripravljeni in okarakterizirani najprej 2D modelni večslojni nosilni materiali, ter nato še obložena 3D alginatna koprena. S pomočjo različnih analiznih metod, smo dokazali uspešno pripravo večslojnih medicinskih oblog z dodanim PTX. Z analizo in vitro sproščanja je bilo pokazano, da tako pripravljene medicinske obloge omogočajo nadzorovano, dvo-stopenjsko sproščanje vodotopnega PTX. S pomočjo študij na humanih kožnih celicah smo pokazali biokompatibilnost večslojnih matric z dodatkom PTX. Za konec smo na osnovi eksperimenta na humanih monocitih potrdili tudi, da so pripravljene večslojne medicinske obloge preko delovanja PTX, uspešno zavrle sproščanje TNF-alfa, ki je ključen vnetni mediator pri kroničnih venoznih razjedah.Chronic wounds represent a huge socio-economical problem in the western sociality. One of the most common types of chronic wounds, is the chronic venous ulceration, which accounts for 80% of all chronic wounds. New histo-pathological insights have revealed that chronic local inflammation, which is believed to be preferentially caused by by chronic venous insufficiency, is one of the major causes for the development and poor healing of chronic wounds. In this study we represent a new approach for the treatment of chronic venous ulcers, which is based on the local application of a potent anti-inflammatory drug, pentoxifyllin (PTX). TO achieve controlled release of PTX, and hence provide an efficient and safe local treatment, a non-toxic, multi-layered polysaccharide matrix based on alginate and chitosan was developed. Besides the controlled drug release, such composition has a well-known positive effect on wound healing on its own. As part of their development, 2D model multilayer matrices, as well as functionalized 3D alginate fleece was prepared and characterized. With the help of different analytical methods, it was possible to demonstrate the successful preparation of multilayer matrices with the added PTX. By analysing the in vitro release, it has been shown that the prepared matrices allow a controlled release of the incorporated substance. Further analysis of the drug release profiles has shown, that a two-step release mechanism of the substance was achieved. The biocompatibility of multilayer matrixces with the added PTX was demonstrated through cellular studies on human skin derived fibroblasts. Additional cellular testing using human monocytes confirmed our hypothesis, that the controlled release of PTX is able to inhibit the secretion of TNF-alpha
No fault compensation for medical injuries
Get PDFFor decades in both Europe and the United states , the issue of compensation for victims f medical injuries has led to lively debates. Many scholars have analyzed the adverse effects of the "tort system" (based on negligence standards and court proceedings) on the increasing costs of insurance premiums, on the patient-doctor relationship and the quality of care. These debates have led to changes in compensation in some countries. Compensation would be based not on negligence, but rather on a broader avoidable medical injury standard. Some nations have long operated administrative schemes based on no fault principle. No fault compensation model for victims of medical injuries might be characterized by the choices it makes regarding some key issues: (a) the definition of compensation criteria in particular the status given to fault(b) the organization of the decision -making process. What type of body adjudicates medical claims? (c) Who finances the mechanism. What injuries are likely to be compensated for, to what extent and by whom? This article reviews the origins and operations of the no fault systems, the evolution of their compensation criteria, and how these criteria are actually applied
No Fault Compensation for Medical Injuries
No full textFor decades in both Europe and the United states , the issue of compensation for victims f medical injuries has led to lively debates. Many scholars have analyzed the adverse effects of the „tort system” (based on negligence standards and court proceedings) on the increasing costs of insurance premiums, on the patient-doctor relationship and the quality of care. These debates have led to changes in compensation in some countries. Compensation would be based not on negligence, but rather on a broader avoidable medical injury standard. Some nations have long operated administrative schemes based on no fault principle. No fault compensaton model for victims of medical injuries might be characterized by the choices it makes regarding some key issues: (a) the definiton of compensation criteria in particular the status given to fault; (b) the organization of the decision -making process. What type of body adjudicates medical claims? (c) Who finances the mechanism. What injuries are likely to be compensated for, to what extent and by whom? This article reviews the origins and operations of the no fault systems, the evolution of their compensation criteria, and how these criteria are actually applied
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Peripheral arterial embolization and limb ischemia complicating septic internal jugular vein thrombosis: a case report of Lemierre’s syndrome: Lemierrov sindrom: primer bolnice s septičnim tromboflebitisom notranje jugularne vene in septično embolizacijo perifernih arterij z ishemičnimi zapleti
No full textPurpose: Septic thrombophlebitis of the internal jugular vein is a life-threatening complication of venous thrombosis. While heparin is frequently added to antimicrobial therapy, its usefulness in patients with Lemierre’s syndrome is controversial. In this case report, we demonstrate that delayed use of intravenous heparin may be associated with septic embolization of peripheral arteries. Limb ischemia has rarely been reported in patients with Lemierre’s syndrome.
Case presentation: Lemierre’s syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein and accompanied by sepsis. We present an unusual case of a young female with Lemierre’s syndrome who developed peripheral arterial embolization and Streptococcus pyogenes sepsis, complicating septic internal jugular vein thrombosis. The patient was initially treated with antibiotics without therapeutic heparin. The patient developed digital gangrene in all four extremities, septic meningitis, and a severe fungal infection; she died 6 weeks after admission secondary to multisystem organ failure. We discuss the importance of rapid diagnosis of disease extent in directing heparin treatment in patients with Lemierre’s syndrome.
Conclusion: It may be advisable to treat Lemierre’s syndrome with anticoagulation in the acute setting.Namen: Septični tromboflebitis, v tem primeru notranje jugularne vene (Lemierrov sindrom), je bolezenska slika, ki ogroža bolnikovo življenje. Pogosto se pri zdravljenju poleg antibiotikov uporabljaheparin. Zdravljenje s heparinom pri bolnikih z Lemierrovim sindromom je protislovno. Vendar zamujanje s pričetkom dajanja heparina lahko povzroči periferne embolizacije z gangreno udov. Namen prikaza primera bolnice z Lemierrovim sindromom je prikazati, kako obsežne so lahko posledice opustitve zgodnjega dajanja heparina pri bolniku z Lemierrovim sindromom. Doslej ni bilo poročila o akutni ishemiji udov kot posledici septičnih embolizacij pri bolniku z Lemierrovim sindromom.
Poročilo o primeru: Prikazan je neobičajen primer 23 letne bolnice z Lemierrovim sindromom, kjer se je zaradi septičnih embolizacij hitro pojavila gangrena prstov vseh okončin, kar je neobičajno tudi pri streptokokni sepsi. Pacientka je imela najprej bolečine v desnem ušesu s temperaturo. Zdravljena je bila ambulantno. Po dveh dnevih so jo z visoko temperaturo pripeljali v bolnišnico, kjer so ugotovili septični šok in jo premestili v našo ustanovo. Že ob sprejemu je bila vidna huda ishemija prstov vseh okončin, ki je kasneje prešla v gangreno obeh dlani in obeh goleni. CTA preiskava je pokazala trombozo notranje vene jugularis, v hemokulturah pa je bil izoliran Streptococcus pyogenes. Kasneje je dobila gnojni meningitis, pojavila pa se je tudi gljivična sepsa. Šest tednov po sprejemu je umrla zaradi večorganske odpovedi. Pacientka je od začetka dobivala antibiotike, terapevtskih odmerkov heparina pa ne. Pacientka je umrla šest tednov po sprejemu zaradi mnogo organske odpovedi.
Zaključek: Avtorja ob primeru razpravljata o prednostih in morebitnih slabih straneh takojšnje uporabe heparina v terapevtskih odmerkih pri odraslih bolnikih z Lemierrovim sindromom in sodita, da je pri takih bolnikih smiselno takoj pričeti z dajanjem terapevtskih odmerkov heparina
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