Title Sestrinska skrb za pacijenta s teškim oblikom akutne upale gušterače
Title (english) Nursing care for a patient with severe acute pancreatitis
Author Luka Smokrović
Mentor Tatjana Šimurina (mentor)
Committee member Boris Dželalija (predsjednik povjerenstva)
Committee member Tatjana Šimurina (član povjerenstva)
Committee member Nina Sulen (član povjerenstva)
Granter University of Zadar (Department of Health Studies) Zadar
Defense date and country 2021-07-13, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Nursing
Abstract Teški oblik akutne upale gušterače treći je i ujedno najteži stupanj akutne upale gušterače. Najčešći uzrok akutne upale gušterače jest kolelitijaza i alkoholizam. Do razvoja teške upale može doći i do nekoliko sati po prijemu pacijenta, a razlog tomu je razvoj jakog sistemnog upalnog odgovora. Zbog progresije bolesti i razvoja multiorganskog zatajenja oko 50% pacijenata završi smrtnim ishodom unutar dva tjedna. Pacijenti su lošeg općeg stanja s prisutnim teškim lokalnim i/ili sistemskim komplikacijama. Prisutna je hipotenzija, metabolički poremećaji, sepsa i septički šok te multiorgansko zatajenje. Od lokalnih komplikacija najteže su nekroza i infektivna nekroza gušterače. Akutni respiratorni distres sindrom najčešće dovodi do potrebe za mehaničkom ventilacijom. Tešku upalu gušterače obilježava prisustvo nekroze tkiva, a kasnije moguća infektivna nekroza koja dodatno otežava liječenje i povećava smrtnost. Kako se radi o kompleksnoj bolesti, važan je multidisciplinarni pristup tijekom dijagnostike i liječenja. U dijagnostici se najčešće koriste serumske vrijednosti amilaze i lipaze, CRP i prokalcitonin te CT snimka abdomena kao zlatni standard za potvrđivanje dijagnoze i lokalnih komplikacija. Vrlo je važno na samom početku liječenja procijeniti težinu bolesti. Najčešće se primjenjuju Ransonov kriterij, APACHE II bodovni sustav, Balthazar bodovni sustav na temelju CT snimke te BISAP indeks i SOFA bodovni sustav. Cilj potporne terapije usmjeren je prema ograničavanju i prevenciji daljnjih lokalnih i sustavnih komplikacija dok kirurško liječenje nije uvijek indicirano. Ono se provodi laparatomijom uz nekrektomiju. Kao dio multidisciplinarnog tima medicinski tehničar dužan je kontinuirano procjenjivati hemodinamski status pacijenta, primjenjivati ordiniranu terapiju te pravovremeno izvješćivati liječnika o pogoršanju kliničke slike pacijenta.
Abstract (english) Severe form of acute pancreatitis is the third and most severe stage of acute pancreatitis. The most common causes of acute pancreatitis are cholelithiasis and alcoholism. The development of severe inflammation can occur up to several hours after the patient's admission, and the reason for this is the development of a strong systemic inflammatory response. Due to disease progression causing multiorgan failure, about 50% of patients die within two weeks. Patients are of poor health with severe local and/or systemic complications present. Hypotension, metabolic disorders, sepsis and septic shock, and multiorgan failure are present as well. As for the local complications, the most severe are necrosis and infectious necrosis of the pancreas. Acute respiratory distress syndrome usually requires mechanical ventilation. Severe inflammation of the pancreas is characterized by the presence of tissue necrosis, and possible infectious necrosis which further complicates treatment and increases mortality. As it is a complex disease, a multidisciplinary approach during diagnosis and treatment is crucial. Serum amylase and lipase values, CRP and procalcitonin, as well as CT abdominal imaging are most commonly used in diagnosis as the gold standard for confirming the diagnosis and local complications. It is very important at the very beginning of treatment to assess the severity of the disease. The most commonly used are the Ranson criterion, the APACHE II scoring system, the Balthazar scoring system based on the CT image, and the BISAP index as well as the SOFA scoring system. The goal of supportive therapy is aimed at limiting and preventing further local and systemic complications, while surgical treatment is not always indicated. It is performed by laparotomy with necrectomy. As part of a multidisciplinary team, the medical technician is obliged to continuously assess the hemodynamic status of the patient, apply the prescribed therapy and timely inform the doctor about the deterioration of the patient's clinical features.
Keywords
upala gušterače
intezivno liječenje
kompliakcije
sestrinska skrb
Keywords (english)
severe acute pancreatitis
intensive care
complications
nursing care
Language croatian
URN:NBN urn:nbn:hr:162:194917
Study programme Title: Nursing Study programme type: professional Study level: undergraduate Academic / professional title: stručni/a prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva (stručni/a prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2021-07-22 10:42:41