Psihičke reakcije bolesnika u perioperativnom periodu

Psychological reactions of patients in the perioperative period

SAŽETAK

UVOD: Hirurška intervencija uobičajeno dovodi do straha. Operacija je uvijek naglašeni emocionalni ulazak u sferu nepoznatog i nema čovjeka s normalnim psihološkim odbranama koji ne osjeti nelagodu pri odlasku na bilo koju operaciju. Cilj ovog istraživanja je ispitati postojanje psihičkih reakcija pacijenata koji su primljeni na operativni tretman, mogućnost iznalaženja mjera u prevladavanju mogućeg preoperativnog i postoperativnog straha, izrada plana uvođenja promena i strategija u prevladavanju preoperativnog i postoperativnog straha i praćenje njegovog ostvarivanja.

METODE: Istraživanje je sprovedeno u hiruškoj jedinici za anesteziju i reanimaciju Univerzitetske bolnice u Foči u periodu od 01.05.2013. godine do 31.05.2013. godine. U istraživanju je korišten kraći deskriptivni upitnik sa podacima o ispitaniku i upitnik samoprocjene za depresiju.

REZULTATI: Najveći broj pacijenata je par dana pred operaciju imao smanjeno interesovanje za događaje oko sebe, osjećaj praznine, neraspoloženje, probleme sa snom , umor. Najveći broj pacijenata nije imao umanjen apetit, slabost koncentracije, usporenost, suicidalne ideje. Od 20 naših ispitanika 3 pacijenta nisu pokazivala tjelesne simptome, dok njih 17 je navodilo veći broj tjelesnih simptoma iz područja svih organskih sistema. Kod 4 pacijenta pronađen je rezultat koji odgovara za uobičajenu opštu populaciju, blagi oblik depresije je pronađen kod 11 pacijenata, dok je umjereno blagi oblik depresije pronadjen je kod 5 pacijenata.

ZAKLJUČAK: Dobro osmišljena i obavljena psihološka preoperativna priprema predstavlja ne samo važan faktor pozitivnog operativnog ishoda i uspešnog postoperativnog oporavka bolesnika, već i trajniji zalog njegovog racionalnog odnosa prema zdravlju i bolesti.

KLJUČNE REČI: Strah od operacije, ličnost bolesnika, psihološka priprema

SUMMARY

INTRODUCTION: Surgical intervention usually leads to fear. The operation has always been emphasized emotional entry into the sphere of the unknown and there is no man with normal psychological defenses that do not feel any discomfort when visiting any operation.

OBJECTIVE: The aim of this study is to examine the existence of psychological reactions of patients who were admitted to the surgical treatment, the possibility of exploring measures to overcome possible preoperative and postoperative fear, development of a plan to introduce changes and strategies to overcome the preoperative and postoperative fear and monitoring its implementation.

METHODS: The research was conducted in the surgical unit for anesthesia and resuscitation at University Hospital in Foča during the period from 01.05.2013. until 31.05.2013. year. The study used a descriptive short questionnaire with information on the subject and self-assessment questionnaire for depression.

RESULTS: The majority of patients a few days before the operation had diminished interest in the events around them, a feeling of emptiness, indisposition, sleep problems, fatigue. The majority of patients had decreased appetite, weakness of concentration, slow, suicidal ideas. From all examined patients 15% of them showed no physical symptoms, while 85% were showed greater number of physical symptoms in the field of all organ systems. Twenty percent of all examined patients has no signs of depression, a mild form of depression was found in 55% of patients, while the moderately mild form of depression was found in 25% of patients.

CONCLUSION: A well-designed and conducted psychological preoperative preparation is not only an important factor for positive operational outcomes and successful post-operative recovery of patients, but also more durable pledge its rational relationship to health and disease.

KEY WORDS: Fear of surgery, patient personality, psychological preparation

Nastavi čitati Psihičke reakcije bolesnika u perioperativnom periodu

Prehospitalno zbrinjavanje djece sa urgentnim stanjima

Pre-hospital care of children in urgent states

SAŽETAK

UVOD: Hitna stanja u dječijoj dobi odnose se na stanja nastala zbog različitih bolesti ili ozljeda, što ugrožavaju život djeteta ili na stanje djeteta bez vitalnih funkcija.

U dječijoj dobi,kao i kod ostale populacije,hitno stanje nastaje kod dvije važne kategorije ugroženih: jednu čine zdrava djeca kod koje je hitno stanje nastalo kao posljedica akutne bolesti ili ozljede,a drugu kategoriju čine hronično oboljela djeca zbog izostanka povoljnog odgovora na terapiju ili pri potencijalno izlječivim bolestima u toku kojih hitno stanje nastaje zbog sekundarnih komplikacija.

CILJ RADA: Ispitati učestalost hitnih stanja u dječjoj dobi prema spolu, životnoj dobi i godišnjim dobima tokom višegodišnjeg razdoblja; Utvrditi strukturu morbiditeta i mortaliteta hitnih stanja prema životnoj dobi djece;Analizirati socioekonomske faktore koji su povezani s pojavom hitnih stanja kod djece; Analizirati primijenjene medicinske postupke u zbrinjavanju djeteta s hitnim stanjem prije upućivanja u odgovarajuću bolničku ustanovu.

METOD RADA: Zdravstveno stanje djece procijenjeno je na osnovi uvida u službeni protokol Službe hitne medicinske pomoći Doma zdravlja Sapna. Istraživanje je provedeno u periodu od 01.01. 2009.godine do 30. 11. 2014. godine. U istom razdoblju u Službu hitne medicinske pomoći u Sapni javilo se 1.761 dijete od 3.974-ero djece (44,3%).

DISKUSIJA I ZAKLJUČCI: Od ukupnog broja djece koja žive na teritoriju Općine Sapna ispitivanom periodu u Službu hitne medicinske pomoći u Sapni javilo se 68,3% djece u dobi od 0 do14 godina.

Njihova zastupljenost u ukupnom broju pregleda u Službi hitne medicinske pomoći u Sapni bila je 19%. Najveći broj djece s hitnim stanjem definitivno je zbrinut u Klinici za dječije bolesti Univerzitetskog kliničkog centra u Tuzli. Nije bilo smrtnih slučajeva, pa se može zaključiti da su primijenjeni terapijski postupci bili adekvatni.

KLJUČNE RIJEČI: urgentna stanja, djeca, zbrinjavanje

SUMMARY

INTRODUCTION: Urgent states in children age relate to states occured due to different illnesses or injuries that threaten life of children, or relate to state of children without vital functions. In children age, as well as in other populations, utgent state occurs in two important categories of threatened persons: first category are healthy children where urgent state occurs as a consequence of acute disease or injury, and second category chronically ill children due to lack of positive response to therapy or with potentially curable diseases during which urgent state occurs because of secundary implications.

AIM:To examine the frequency of urgent states in children age according to gender, age, seasons over the multi-year period; To determine the structure of morbidity and mortality of urgent states in relation with age of children;

To analyze social and economical factors related to occurence of urgent states in children; To analyze the applied medical procedures in care of children with urgent states prior to sending to the appropriate medical institution.

METHODS: Health condition of children was examined based on inspection of official protocol of Emergency Medical Service of Health Center in Sapna. The survey was conducted in the period from 01.01. 2009 to 30. 11. 2014. During this period, in Emergency Medical Service of Sapna 1761 of 3974 (44.3%) children were reported.

DISCUSSION AND CONCLUSIONS: From the total number of children who live on the Sapna municipality area, in the examined period, in the Emergency Medical Service 68.3% of children ages 0-14 were reported. Their representation in total number of examinations in the Emergency Service in Sapna was 19%. Highest number of children with urgent states was definitely taken care of on Children Disease Clinic of University Clinic Centre in Tuzla. There were no recorded death cases, and it can be concluded that applied therapeutic procedures were adequate.

KEY WORDS: emergency situations, children, medical care

Nastavi čitati Prehospitalno zbrinjavanje djece sa urgentnim stanjima

Učestalost reanimacije novorođenčedi na klinici za pedijatriju kliničkog centra univerziteta u Sarajevu

Reanimation/resuscitation frequency of newborns at the pediatric clinic – university clinical center of Sarajevo

SAŽETAK

UVOD: Reanimacija novorođenčeta podrazumijeva skup mjera i postupaka, kao i primjenu lijekova sa ciljem da se uspostave vitalne funkcije. Najveći procenat beba, njih oko 90%, ulazi u spoljnji (ekstrauterini) život bez poteškoća. One zahtijevaju vrlo malu ili nikakvu pomoć da spontano prodišu i uspostave regularne respiracije. Oko 10% novorođenih beba nalazi se u situaciji da im je potrebna određena pomoć kako bi prodisale odmah po rođenju. Jedan procenat tek rođenih beba traži reanimacione mjere da bi preživjele.

CILJEVI ISTRAŽIVANJA: 1. Utvrditi ukupan broj beba primljenih u jedinicu Neonatalne intenzivne njege Pedijatrijske klinike KCUS u periodu od novembra 2014. do augusta 2015. godine koje su imale letalan ishod poslije prijema; 2. Utvrditi na koliko navedenih pacijenata se radila reanimacija po porodu, a koliko u toku liječenja.

ISPITANICI I METODE ISTRAŽIVANJA: Ispitivanje je retrospektivno. Studija obuhvata period od novembra 2014.godine do augusta 2015. godine isključujući mjesece decembar, januar i februar obzirom da dosjei iz tih mjeseci nisu bili dostupni u arhivi.

REZULTATI ISTRAŽIVANJA: Kao rezultat istraživanja o broju beba primljenih u jedinicu Neonatalne intenzivne njege Pedijatrijske klinike KCUS u periodu od novembra 2014. do augusta 2015. godine koje su imale letalan ishod poslije prijema i koje su bile reanimirane, utvrđeno je da je primljeno 36 navedenih pacijenata, od čega 18 (50%) muškog spola i 18 (50%) ženskog spola. Ispitivanjem i analizom je utvrđeno da je od 36 ukupno primljenih beba u jedinicu Neonatalne intenzivne njege Pedijatrijske klinike KCUS sa letalnim ishodom i koji su bili reanimirani tokom boravka u jedinici navedenog perioda bilo 26 (72%) nedonoščadi i 10 (28%) novorođenčadi.

ZAKLJUČCI: Većina primljenih beba u pomenutom periodu bila su nedonoščad, tačnije njih 26, dok je broj novorođenčadi bio 10. Odnos muške i ženske populacije primljenih beba bio je jedanak. Možemo zaključiti da je najviše beba primljenu u prvom danu života, njih 32, što čini 88%. Istraživanja su pokazala da je na 8 beba vršena reanimacija po porodu, dok su ostale bebe bile reanimirane u toku liječenja.

KLJUČNE RIJEČI: reanimacija, nedonošče, pedijatrijska klinika, intenzivna njega

SUMMARY

INTRODUCTION: Reanimation of the newborn babies implies a set of measures and procedures, as well as the application of drugs in order to establishing vital functions. The highest percentage of newborn babies (around 90%) enters the external life without difficulties. Mainly, they don’t or require very little assistance to breathe spontaneously and establish regular respiration. About 10% of newborn babies need medical assistance to establish normal breath function at birth. One percent of newborn babies require resuscitation measures to survive.

RESEARCH OBJECTIVES: 1) To determine the total number of babies admitted to the neonatal intensive care unit of the Pediatric Clinic-University Clinical Center of Sarajevo, in the period from November 2014 to August 2015 with a lethal outcome after admission; 2) To determine how many of those patients were resuscitated soon after birth and how many of them during treatment.

PATIENTS AND METHODS: The study was retrospective. The study covers the period from November 2014 to August 2015, excluding the months of December, January and February, since records of these months were not available in the archives.

SURVEY RESULTS: Research results showed that 36 babies with a lethal outcome after admission (which were reanimated) were admitted to the neonatal intensive care unit of the Pediatric Clinic-University Clinical Center of Sarajevo in the period from November 2014 to August 2015. From that number, 18 (50%) admitted babies were males and 18 (50%) females. The research and analysis showed that 26 (72%) of those patients were premature infants and 10 (28%) infants.

CONCLUSIONS: Majority of patients during this period were premature babies, precisely 26 of them, while the number of newborns was 10, with equal ratio of male and female babies. Conclusion is that most babies (32 of them or 88%) were admitted at the first day of life. Studies showed that the 8 babies required resuscitation soon after birth, while the other babies were resuscitated during treatment.

KEY WORDS: reanimation/resuscitation, a premature baby, pediatric clinic, intensive care

Nastavi čitati Učestalost reanimacije novorođenčedi na klinici za pedijatriju kliničkog centra univerziteta u Sarajevu

Kinesitherapy in respiratory disorders in children

SAŽETAK

Plućne bolesti su među najčešćim bolestima u djetinjstvu. Nedavno je zabilježen neverovatan porast alergijskih reakcija kod djece i postoji posebna briga svu djecu – pacijenti da budu tretirani i da pruži odgovarajuću dijagnozu, liječenje i praćenje stanja u cilju poboljšanja kvaliteta života.

Poremećaj funkcije respiratornog sistema, povezan je sa patološkim promjenama u mehaniku disanja (poremećaj u pravilnom kombinacijom faza udisaja i izdisaja, površno, frekventno, neefikasno disanje i poremećaj koordinacije respiratornih pokreta). To dovodi do poremećaja plućne ventilacije i razmjenu gasova, kao i pojavljivanje manjka kisika u disanje.

Ovi poremećaji su uzrokovane smanjenjem respiratorne površine, pogoršanjem bronhijalne prohodnosti ili usporenosti u mali krug cirkulacije kao posljedica patoloških procesa različitih profila. Paralelno sa smanjene pokretljivosti dijafragme i grudi i smanjenje kontraktilne sposobnosti mišića da dišu i pokretačka aktivnost pacijenata.

Najčešće respiratorne bolesti kod djece su, hronične opstruktivne bolesti pluća (COPD), bronhitis, bronhijalna astma, upala pluća, plućni apsces, emfizema pluća, restriktivne bolesti pluća.Tokom rehabilitacije i liječenje respiratornih bolesti stavlja poseban akcenat na ulogu kineziterapiju.

KLJUČNE RIJUEČI: respiratorni sistem, plućna ventilacija, bronhitis, bronhijalna astma, pneumonia, kineziterapija

SUMMARY

The pulmonary diseases are among the most common diseases in childhood. Recently was recorded an incredible increase in allergic reactions in pediatric patients and there is special concern all children – patients to be treated and to provide appropriate diagnosis, treatment and monitor the situation in order to improve their quality of life.

The disorder of the function of the respiratory system, is associated with pathological changes in the mechanics of respiration (disruption in proper combination of the phases of inhaling and exhaling, the appearance of the surface, and frequently inefficient breathing, impaired coordination of respiratory movements). This leads to disruption of pulmonary ventilation and gas exchange, as well as the emergence of an oxygen shortage in breathing.

These disorders are caused by the reduction of respiratory area, worsening of bronchial patency or slowdown in the small circle of circulation as a consequence of pathological processes from different backgrounds. Parallel with the reduced mobility of the diaphragm and chest and decrease the contractile ability of muscles to breathe and the driving activity of patients.

The most common respiratory disorders among children are, chronic obstructive pulmonary disease (COPD), bronchitis, bronchial asthma, pneumonia, pulmonary abscess, pulmonary emphysema, restrictive lung disease.

During the rehabilitation and treatment of respiratory diseases puts special emphasis on the role of kinesitherapy.

KEY WORDS: respiratory system, pulmonary ventilation, bronchitis, bronchial asthma, pneumonia, Kynesitherapy

Nastavi čitati Kinesitherapy in respiratory disorders in children