Vpliv 3. stopnje raztrganine perineja na pojav inkontinence blata pri mnogorodkah in vloga medicinske sestre : diplomsko delo

Marašević, Sanja (author), Mihelič Zajec, Andreja (mentor)

Uvod: Najpogostejše spontane poškodbe, ki jih utrpijo porodnice, so raztrganine perineja. Perinej se običajno poškoduje na mestu, kjer je tkivo najtanjše, kar pomeni, da je velika večina poškodb usmerjena k analnemu sfinktru. Poškodbe perineja in poškodbe mišice zapiralke anusa so glavni dejavnik za povzročitev inkontinence blata. Inkontinenca blata je neprijetno stanje, o katerem se premalo poroča. Poznavanje dejavnikov tveganja lahko zmanjša razvoj poškodb mišice zapiralke. Namen: Želimo predstaviti pojavnost raztrganine perineja, izpostaviti dejavnike tveganja za nastanek le-te, predstaviti vpliv raztrganine perineja na inkontinenco blata in predstaviti vlogo medicinske sestre. Metode dela: Uporabljena je desriptivna metoda dela s sistematičnim pregledom domače in tuje strokovne literature. Pri iskanju smo uporabili časovni okvir objav od leta 2006 do 2018. Literatura je izbrana iz podatkovnih baz COBIB.SI, Medline/PubMed, CINAHL, Cochrane Library in Google učenjak. V analizo smo vključili 18 člankov. Rezultati: Na pojavnost inkontinence blata vplivajo številni dejavniki tveganja, kot so teža ploda več kot 4 kg, sprožen porod, medialna epiziotomija, okcipitoposteriorni položaj ploda. S preprečevanjem dejavnikov tveganja v času nosečnosti bi lahko zmanjšali poporodno inkontinenco blata. Medicinska sestra je tista, ki je ob pacientki 24 ur na dan, kontinuirano spremlja celjenje epiziotomije in raztrganin po porodu, spremlja vitalne funkcije, pomaga pri lajšanju bolečin, opravlja zdravstveno nego perineja. Razprava in zaključek: Poškodba perineja se lahko pojavi spontano med vaginalnim porodom, zato imajo ženske, ki so predhodno utrpele raztrganino perineja, večjo možnost za nastanek inkontinence blata. Kljub številnim dejavnikom tveganja za nastanek inkontinence blata lahko veliko naredimo sami s pomočjo ustrezne prehrane, treningi mišic medeničnega dna in masiranjem perineja v času nosečnosti. Medicinska sestra mora poznati poškodbe tkiv, mora znati oceniti stopnjo rane, vrste ran, prav tako mora lajšati bolečine, vse z namenom, da bi s tem omogočila boljšo zdravstveno nego porodnice s poškodbo perineja.

• Language: Slovenian
• Keywords: raztrganina perineja, inkontinenca blata, medicinska sestra, porod
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-106570
• COBISS.SI-ID: 5592683
• Publication date in RUL: 06.03.2019

Secondary language

• Language: English
• Title: Impact of the 3rd degree perineal laceration and occurrence of faecal incontinence in multiparous and the role of nurse : diploma work

Abstract

Introduction: The most common spontaneus injuries sustained by women are perineal lacerations. The perineum is usually damaged in a place where the tissue is the thinnest, which means that the large majority of injuries are directed to the anal sphincter. Damage to the perineum and anal sphincter is a major factor in causing fecal incontinence. Fecal incontinence is an inconvenient state that is not reported too much. Knowing the risk factors can reduce the development of damage to the anal muscle. Purpose: We want to present the incidence of perineal laceration, to highlight risk factors for the formation of this, to present the impact of perineal laceration on the fecal incontinence and to present the role of the nurse. Methods: A descriptive method of work was used with a systematic review of domestic and foreign literature. The search was narrowed down to a specific time frame of publication from 2006 to 2018. Data was gathered from the following databases: COBIB.SI, Medline/PubMed, CINAHL, Cochrane Library and Google Scholar. 18 articles were included in the analysis. Results: The incidence of fecal incontinence is influenced by many risk factors such as a fetus larger than 4 kg, induced labor, medial episiotomy, occipito-posterior presentation. Prevention of risk factors during pregnancy could reduce postpartum fecal incontinence. The nurse is the one who spends 24 hours a day with a patient, continuously monitoring the healing of episiotomy and lacerations after birth, monitoring vital functions, helps to relieve pain, performs health care of the perineum. Discussion and conclusion: Perineal injury may occur spontaneously during vaginal delivery, so women who have previously suffered from perineal tears have bigger chance of developing fecal incontinence. Despite numerous risk factors for incidence of fecal incontinence, we can do a lot with our diet, pelvic floor muscle training and massage of the perineum during pregnancy. The nurse must be acquanted with tissue damage, be able to assess the degree of wound, the type of wounds, and to relieve pain in order to provide better health care for wome with perineal injury.

• Keywords: perineal laceration, fecal incontinence, nurse, labor