Title Sestrinska skrb u bolesnika na neinvazivnoj mehaničkoj ventilaciji Title (english) Nursing care for patients on non-invasive mechanical ventilation Author Kristina Pauker Mentor Gordana Pavliša (mentor)Committee member Marija Santini (predsjednik povjerenstva)Committee member Venija Cerovečki Nekić (član povjerenstva)Committee member Gordana Pavliša (član povjerenstva)Granter University of Zagreb Defense date and country 2019-09-24, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Neinvazivna mehanička ventilacija (eng. noninvasive mechanical ventilation NIV) predstavlja
oblik mehaničke ventilacijske potpore u kojem nije potrebna intubacija bolesnika. U
posljednjem je desetljeću značajno povećana upotreba neinvazivne mehaničke ventilacije u
liječenju akutne respiracijske insuficijencije različitih uzroka, no najveća korist od ovog
oblika respiratorne potpore se pokazala u akutnom pogoršanju KOPB-i s posljedičnom
globalnom respiracijskom insuficijencijom. U pogoršanju kronične opstruktivne plućne
bolesti pokazano je da NIV značajno smanjuje parcijalni tlak CO2, povećava pH, smanjuje
frekvenciju disanja i smanjuje težinu zaduhe. Time bitno smanjuje potrebu za endotrahealnom
intubacijom, trajanje boravka u bolnici i bolnički mortalitet. U akutnoj fazi bolesti NIV se
može započeti već u ambulanti hitnog prijema, no pravo mjesto takvom bolesniku je u jedinici
intenzivne skrbi, prvenstveno zbog pojačanog nadzora i mogućnosti brze reakcije
(endotrahealne intubacije) u slučaju naglog pogoršanja. Kada takvi bolesnici postanu vitalno
stabilni terapiju je moguće nastaviti na otvorenom bolničkom odjelu, a onima s kroničnom
globalnom respiracijskom insuficijencijom i u kućnim uvjetima, nakon prethodne edukacije
bolesnika i članova obitelji. O tome gdje je bolesnik smješten i u kojoj je fazi bolesti, ovisi i
vrsta i razina sestrinske skrbi. Razlika u pružanju sestrinske skrbi na bolničkom odjelu i
jedinici intenzivne skrbi odnosi se na razinu pomoći oko samozbrinjavanja, monitoringu
vitalnih funkcija, učestalosti kontrola laboratorijskih nalaza. Dakle govorimo o bolesnicima
koji prema stupnju samozbrinjavanja i nadzora mogu varirati od drugog do četvrtog stupnja.
Posebnu kategoriju čine bolesnici na kućnoj terapiji NIV-om, koje prije otpusta kući moramo
dobro educirati, a način i stupanj edukacije specifično prilagoditi bolesniku i članovima
njegove obitelji, odnosno skrbniku. Timski rad liječnika, sestara i respiratornih fizioterapeuta,
neophodan je za uspješno provedenu terapiju NIV-om. Ovaj oblik pružanja respiracijske
podrške zahtijeva dosta vremena i upravo je najveći naglasak na sestrinskoj skrbi koja je
ključna karika u dobroj koordinaciji intervencija svih članova tima vezanih za ovakvu vrstu
bolesnika.
Abstract (english) Non-invasive mechanical ventilation (NIV) is a form of mechanical ventilation support that
does not require endotracheal intubation. During the last decade, the use of NIV in the
treatment of acute respiratory failure of various causes has significantly increased. NIV has
been shown to decrease the partial pressure of carbon dioxide, increase pH, decrease
respiratory rate, and reduces breathlessness in acute exacerbation of chronic obstructive
pulmonary disease. By such, it significantly reduces the need for endotracheal intubation,
length of hospital stay, and hospital mortality. In the acute phase of the disease, non-invasive
ventilation can be started already in the outpatient clinic at time of patient admission, but the
most appropriate place to care for these patients is intensive care unit, primarily due to
possibility ofbetter surveillance and the possibility of prompt reactions (eg. endotracheal
intubation) in case of sudden deterioration. When such patients become vitally stable, NIV
can be applied at inpatient wards or at home if education of patients and family members is
compleated. Type and level of nursing care depends on patients location and stage of the
disease. The difference in providing nursing care at hospital ward and intensive care unit is
differentiated on a level of assistance with self-care, vital functions monitoring and frequency
of blood tests control. Therefore, we distinguish patients belonging to second to the fourth
degree of the of self-care and surveillance, and also a special category of patients on at home
NIV treatment who must be well educated together with their family and caregivers in
accordance with severity of their condition. Teamwork of physicians, nurses and respiratory
physiotherapists is necessary for successful NIV treatment. This form of respiratory support is
time consuming and nursing care is a key to the good intervention coordination of all team
members associated with such type of patient.
Keywords
neinvazivna mehanička ventilacija
sestrinska skrb
Keywords (english)
noninvasive mechanical ventilation
nursing care
Language croatian URN:NBN urn:nbn:hr:105:065364 Study programme Title: Studies in Nursing Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-03-10 08:34:26
