Preprečevanje razjed zaradi pritiska pri pacientih v enoti intenzivnega zdravljenja : diplomsko delo

Tomšič, Žiga (author), Djekić, Bernarda (mentor), Beguš, Goranka (co-mentor)

Uvod: Razjeda zaradi pritiska je lokalizirana poškodba kože in/ali spodaj ležečih tkiv, povzročena zaradi pritiska ali kombinacije pritiska, strižnih sil in trenja. Kritično bolni pacienti so zaradi zdravstvenega stanja in načinov zdravljenja bolj ogroženi za njen nastanek. Namen: Namen diplomskega dela je predstaviti preprečevanje razjed zaradi pritiska pri pacientih v enoti intenzivnega zdravljenja. Cilj diplomskega dela je na podlagi pregleda literature opredeliti specifične dejavnike tveganja za nastanek razjed zaradi pritiska pri pacientih v enotah intenzivnega zdravljenja, opredeliti vlogo medicinske sestre pri preprečevanju le-teh ter izdelati shematski prikaz algoritma za preprečevanje razjed zaradi pritiska pri tej skupini pacientov. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom strokovne in znanstvene literature v podatkovnih bazah CINAHL, Medline, ERIC, ScienceDirect, Cochrane library ter preko vzajemne kataloške baze podatkov COBIB.SI. Ključne besede s smiselno uporabo Boolovih operaterjev AND in OR so bile: pressure ulcer, bedsore, pressure sore, decubitus ulcer, intensive care, intensive care unit, critical care, care bundle, ICU, scale, prevention, tool, risk factor, nursing. Pregledana je bila literatura iz časovnega obdobja od januarja 2010 do oktobra 2017. Uporabljenih je bilo 48 enot literature, od tega jih je bilo za izdelavo algoritma uporabljenih 11. Rezultati: Najpogosteje omenjeni specifični dejavniki tveganja, ki se pojavljalo pri pacientih v enoti intenzivnega zdravljenja so: zdravila, opornice, katetri, sonde, žilni pristopi, mehanska ventilacija in slab prehranski status. Oblikovan je primer shematskega algoritma za preprečevanje razjed zaradi pritiska, ki izpostavi s specifičnimi dejavniki tveganja povezane preventivne aktivnosti medicinske sestre. Razprava in sklep: Vpliv specifičnih dejavnikov tveganja na pojav razjede zaradi pritiska je premalo raziskan. Še posebej je to vidno na področju vazopresivnih zdravil, katerih vpliv še vedno ni dokončno razjasnjen. Spodbuja se tudi uporaba profilaktičnih 5-slojnih silikonskih oblog, za katere v slovenskem prostoru ne obstajajo enotni standardi za njihovo uporabo. Lestvice, namenjene kritično bolnim pacientom, v obstoječi literaturi še niso dovolj raziskane. Spodbuditi je potrebno raziskave na področju dejavnikov tveganja za nastanek razjede zaradi pritiska pri pacientih v enotah intenzivnega zdravljenja, raziskati učinkovitost in uporabnost ocenjevalnih lestvic kot so Cubbin-Jackson in COMHON ter oblikovati nove in z dokazi podprte standarde, katerih cilj bo pacient brez razjede zaradi pritiska tekom hospitalizacije.

• Language: Slovenian
• Keywords: zdravstvena nega, ocenjevalne lestvice, algoritem preprečevanja, dejavniki tveganja
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-99330
• COBISS.SI-ID: 5389419
• Publication date in RUL: 13.01.2018

Secondary language

• Language: English
• Title: Preventing pressure ulcers in patients in an intensive care unit : diploma work

Abstract

Introduction: A pressure ulcer is a localized damage of the skin or/and underlying tissues, caused by pressure, or a combination of pressure, shear and friction. The severity of patient illness is greater in the intensive care unit, than on other departments, so they are more prone to the development of a pressure ulcer. Purpose: The purpose of the diploma work is to define specific risk factors for the development of a pressure ulcer in patients in an intensive care unit, to define the role of the nurse and develop a schematic representation of the pressure ulcer prevention algorithm in intensive care unit, based on a sistematic literature review. Methods: A descriptive method with an overview of professional and scientific literature in databases CINAHL, Medline, ERIC, ScienceDirect, Cochrane library and through the catalog database COBIB.SI was used. The keywords with the use of Bool's operators AND and OR were: pressure ulcer, bedsore, pressure sore, decubitus ulcer, intensive care, intensive care unit, critical care, care bundle, ICU, scale, prevention, tool, risk factor, nursing. The literature from the period from January 2010 to October 2017 was reviewed. There were 48 units of literature used, of which 11 for the development of the protocol, Results: Most commonly mentioned specific risk factors in patients in intensive care units are: drugs, braces, catheters, vein accesses, mechanical ventilation and poor nutritional status. An example of the schematic algorithm for the prevention of pressure ulcers in intensive care units that emphasizes specific risk factors with preventive nursing interventions was designed. Discussion and conclusion: The effect of specific risk factors is underresearched. This is particularly seen on the field of vazopressors, whose influence on pressure ulcer development is still not definitively clarified. The effectiveness of prophylactic silicone 5-layer foam dressings has also been proven, but there are no uniform standards for their use in Slovenia. Also the incompatibility of non-specific assessment scales for use in intensive care units has been demonstrated. It is necessary to promote quality research in the field of risk factors for the development of pressure ulcers in patients in intensive care units, to investigate the effectiveness and usefulness of assessment scales such as Cubbin-Jackson and COMHON, and to develope new, evidence-based standards that will ensure a patient without pressure ulcers during hospitalization.

• Keywords: nursing, assessment scales, prevention algoritm, risk factors