diplomsko delo
Anže Jerina (Author), Darja Ovijač (Reviewer), Bernarda Djekić (Mentor), Drago Satošek (Co-mentor)

Abstract

Uvod: Elektrolitsko ravnovesje je pomemben dejavnik homeostaze v človeškem telesu. Odstopanja različnih parametrov, med katere sodi tudi hiperkaliemija, privedejo do resnih stanj, ki so lahko tudi življenje ogrožujoča. O hiperkaliemiji govorimo, kadar je koncentracija kalija v serumu nad 5,5 mmol/l. Ob tem se pojavijo različni simptomi in znaki, ki se kažejo v spremenjenem počutju pacienta, predvsem pa s spremembami v elektrokardiografskem zapisu. Namen: Namen diplomskega dela je prikazati zdravstveno obravnavo pacienta s hiperkaliemijo in izpostaviti pomembno vlogo medicinske sestre, s poudarkom na pravilnem odvzemu krvi. Metode dela: Uporabljena je bila deskriptivna metoda dela s kritičnim pregledom literature. Iskanje literature; v obdobju med leti 2009 do 2019, je potekalo prek spletnega portala digitalne knjižnice Univerze v Ljubljani, v mednarodnih spletnih bazah CINAHL, Medline (Pubmed) in Cochrane library ter prek COBIB.SI. Uporabljene so bile ključne besede in besedne zveze: hiperkaliemija, prepoznava, posledice, elektrokardiogram, zdravstvena nega, napake, hemoliza in odvzem krvi. Rezultati: Hiperkaliemija se kaže s pojavom mišične oslabelosti, parestezijami, ohromelostjo spodnjih udov ter s spremembami v elektrokardiogramu, ki so odvisne od koncentracije kalija. Pojavijo se lahko: razširjeni QRS kompleksi, koničasti T valovi, manjši oz. nevidni P valovi, spremembe v ST spojnici, bradikardija in asistolija. Usposobljena medicinska sestra bo znala hitro prepoznati nevarne spremembe in skladno z navodili zdravnika preprečiti poslabšanje zdravstvenega stanja pacienta. Medicinska sestra je vključena tudi v odvzem krvi za določanje vrednosti serumskega kalija, aplikacijo zdravil za nižanje serumskega kalija po zdravnikovem naročilu in učenje pacienta. V pregledani literaturi je prepoznanih več vzrokov za pojav napačnih rezultatov po odvzemu krvi: predolgo zažeta žilna preveza, stiskanje pesti, udarjanje po veni, nepravilen izbor epruvete, nepopolno polnjenje epruvete in sunkovito obračanje epruvete. Razprava in zaključek: Usposobljena medicinska sestra mora biti pozorna in opazovati pacienta, ta pa ji mora zaupati ter poročati o odstopanjih, ki jih občuti, ker so lahko pomemben pokazatelj odstopanj v elektrolitskem ravnovesju v telesu. Poznati mora pravilen postopek odvzema krvi, da zaradi napak pri odvzemu ne pride do lažnih rezultatov. Prepoznati mora spremembe v elektrokardiografskem zapisu, ki so ključnega pomena za pacienta, saj lahko vodijo v smrt. Za vse našteto medicinska sestra potrebuje visoko raven znanja in sposobnost kritičnega razmišljanja.

Keywords

diplomska dela;zdravstvena nega;hemoliza;simptomi in znaki;elektrokardiogram;odvzem krvi;napake;

Data

Language: Slovenian
Year of publishing:
Typology: 2.11 - Undergraduate Thesis
Organization: UL ZF - University College of Health Studies
Publisher: [A. Jerina]
UDC: 616-083
COBISS: 5676139 Link will open in a new window
Views: 1844
Downloads: 272
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Other data

Secondary language: English
Secondary title: Medical treatment of the patient with hyperkalemia
Secondary abstract: Introduction: Electrolyte balance is an important factor in homeostasis in the human body. Derogations of various parameters, including hyperkalaemia, lead to serious conditions that can also be life-threatening. Hyperkalaemia is discussed when serum potassium is above 5.5 mmol/l. Different symptoms and signs appear, shown in changed feeling of the patient and in particular with changes in the electrocardiographic record. Purpose: The purpose of the diploma work is to present the medical treatment of a patient with hyperkalaemia and to highlight the important role of a nurse, with an emphasis on proper blood collection. Methods: A descriptive method of work with a critical literature review was used. The literature search; the period from 2009 to 2019 was conducted through the web portal of the digital library of the University of Ljubljana in the international online databases CINAHL, Medline (Pubmed), Cochrane library and via COBIB.SI. Key words and phrases were used: hyperkalaemia, recognition, consequences, ECG, nursing, mistakes, hemolysis, and blood withdrawal. Results: Hyperkalaemia is indicated by the occurrence of muscular weakness, paraesthesia and paralysis of the lower limbs and with changes in the electrocardiogram. Changes in electrocardiogram depend on the potassium concentration. The following may occur: extended QRS complexes, tapered T waves, smaller or invisible P waves, changes in ST segment, bradycardia and asystolia. A trained nurse will be able to quickly identify dangerous changes and compliant with the instructions of a doctor prevent the deterioration of the patient's health. The nurse is also involved in blood sampling for the determination of potassium in serum, the application of medicines to lower serum potassium according to the doctor's order and to teach a patient. Several causes for false results after blood collection has been identified in examined literature: tourniquet tighten too long, fist pressing, throbbing a vein, incorrect selection of the tube, incomplete filling of the tube and a sudden rotation of the tube, thrombocytosis, leukocytosis and hysterical crying associated with hyperventilation. Discussion and conclusion: Qualified nurse has to be well aware of and observe a patient, who has to trust her and report deviations that he feels, because they can be an important indicator of the deviations in electrolyte balance in the body. Nurse must know the correct procedure for taking blood so no false results are obtained, while taking blood sample. Nurse must recognize changes in the electrocardiographic record, which are crucial for the patient, as they can lead to death. For all of this, nurse needs a high level of knowledge and the ability to think critically.
Secondary keywords: diploma theses;nursing care;haemolysis;symptoms and signs;electrocardiogram;blood collection;mistakes;
Type (COBISS): Bachelor thesis/paper
Study programme: 0
Thesis comment: Univ. v Ljubljani, Zdravstvena fak., Oddelek za zdravstveno nego
Pages: 31 str.
ID: 11217209