Καταγραφή και αξιολόγηση των ελκών πίεσης σε νευρολογικούς και νευροχειρουργικούς ασθενείς.
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Ημερομηνία
2018-11-13
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Τ.Ε.Ι. Κρήτης, Επαγγελμάτων Υγείας και Πρόνοιας (Σ.Ε.Υ.Π), Τμήμα Νοσηλευτικής
T.E.I. of Crete, School of Health and Welfare Services (SEYP), Nursing Department
T.E.I. of Crete, School of Health and Welfare Services (SEYP), Nursing Department
Επιβλέπων
Περίληψη
Στην παρούσα πτυχιακή εργασία πραγματοποιήθηκε καταγραφή και αξιολόγηση των ελκών πίεσης σε νευρολογικούς και νευροχειρουργικούς ασθενείς.
Η έρευνα διεξήχθη στο Πανεπιστημιακό Γενικό Νοσοκομείο Ηρακλείου και συμμετείχαν 102 ασθενείς από τους οποίους το 61,8% ήταν άνδρες και το 38,2% ήταν γυναίκες, τα περισσότερα περιστατικά ήταν ασθενείς ηλικίας από 51-74 ετών (47,1%), οι περισσότεροι ασθενείς χαρακτηρίζονται ως υπέρβαροι με δείκτη μάζας σώματος 25,0-29,9 (43,1%), το 4,9% είχε ως έκβαση τον θάνατο και η πλειοψηφία του δειγματός των ασθενών νοσηλεύτηκε στην νευρολογική κλινική (63,7%). Επίσης τα περισσότερα περιστατικά διαγνώστηκαν κατά την εισαγωγή τους με ΑΕΕ (38,2%) και και το 53,9% έπασχε από 1-2 νοσήματα.
Όσον αφορά τους 15 ασθενείς με παρουσία ελκών πίεσης ως προς τα χαρακτηριστικά των 102 ασθενών της μελέτης, το 20,5% ήταν γυναίκες και το 11,1% ήταν άνδρες, τα περισσότερα περιστατικά ήταν ηλικίας 75-94 ετών (19,4%), τα περισσότερα περιστατικά με έλκη πίεσης νοσηλεύτηκαν στην νευροχειρουργική κλινική (18,9%) και το 66,7% εισήχθε από την ΜΕΘ (p<0,001). Ακόμα, υπήρξε αυξημένη θνησιμότητα σε ποσοστό 66,7% (p<0,001). Όσον αφορά τα εργαλεία εκτίμησης του κινδύνου ανάπτυξης ελκών πίεσης, με χαμηλές βαθμολογίες κλιμάκων (αυξημένο κίνδυνο) σχετίζονται οι μεγαλύτερες ηλικίες και η αύξηση των ημερών νοσηλείας. Στην αξιολόγηση που πραγματοποιήθηκε μέσω της Modified Braden δεν βρέθηκε κανένας ασθενής σε υψηλό κίνδυνο ενώ οι περισσότεροι ασθενείς (94,3%) βρέθηκαν χωρίς κίνδυνο για την εμφάνιση ελκών πίεσης. Η αξιολόγηση που πραγματοποιήθηκε μέσω της Norton ανέδειξε το 39,1% σε πολύ υψηλό κίνδυνο, το 32,2% σε υψηλό κίνδυνο, το 16,1% σε μέτριο κίνδυνο και το 12,6% σε χαμηλό κίνδυνο.
Κατά την διεξαγωγή της παρούσας έρευνας εμφανίστηκαν έλκη πίεσης σε ασθενείς που η Norton τους είχε αναδείξει σε κίνδυνο ενώ η Modified Braden τους είχε κατατάξει χωρίς κίνδυνο. Στην Νευρολογική κλινική φωτοτεκμηριώθηκαν 7 ασθενείς με έλκη πίεσης ενώ στην Νευροχειρουργική φωτοτεκμηριώθηκαν 8. Το δήγμα των ασθενών της νευρολογικής που φωτοτεκμηριώθηκε είχε κατά μέσω όρο 2,85 έλκη πίεσης ο καθένας ενώ της νευροχειρουργικής με σημαντική διαφορά, 8 έλκη πίεσης κατά μέσο όρο.
Αναλυτικότερα στην νευρολογική κλινική το 42,8% είχε 1 έλκος πίεσης, το 14,3 είχε 3 έλκη πίεσης, το 28,6 είχε 4 έλκη πίεσης και το 14,3% είχε 6 έλκη πίεσης. Στην νευροχειρουργική κλινική το 25% είχε 1 έλκος πίεσης, το 37,5% 3 έλκη πίεσης, το 12,5% 9 έλκη πίεσης και το 25% είχε 10 έλκη πίεσης.
In this dissertation, the subject of the evaluation of the pressure ulcers in neurological and neurosurgical patients was investigated. The survey was conducted at the University General Hospital of Heraklion and 102 patients participated, 38.2% of whom were women, 61.8% were men, their age ranged from 51-74 ετϊν (47.1%), most patients in the study appear to be overweight as their body mass index is 25.0-29.9 (43.1%), 4.9% resulted in death and the majority of the patient sample was hospitalized in the neurological clinic (63.7%). The type of analgesia administered to patients in the sample was continuous intravenous in 54 patients (49.1%) and continuous epidural analgesia in 56 patients (50.9%). Also most of the cases were diagnosed with stroke (38.2%) and 53.9% suffered from 1-2 diseases. With regard to the 15 patients with the presence of pressure ulcers in the characteristics of the 102 patients in the study, 20.5% were women and 11.1% were males, most cases were 75-94 years old (19.4%), most cases with pressure ulcers were hospitalized in the neurosurgery clinic (18.9%) and the 66.7% was imported from the ICU (p <0.001). In addition, there was an increased mortality rate of 66.7% (p <0.001). With regard to risk assessment tools for the development of pressure ulcers, low stair scores (increased risk) are associated with older age and increased days of hospitalization. No patient at high risk was found in the assessment performed through Modified Braden while most patients (94.3%) found no risk of pressure ulcers. The Norton evaluation showed 39.1% at a very high risk, 32.2% high risk, 16.1% moderate risk and 12.6% low risk. In the course of this study, pressure ulcers occurred in patients who Norton had shown them at risk while Modified Braden had classified them without risk. At the Neurological Clinic 7 patients were photographed with pressure ulcers, while in Neurosurgery they were photographed 8. In neurological clinic a bite of patients was photo-documented to have an average of 2.85 pressure ulcers, while neurosurgery with a significant difference, 8 pressure ulcers on average. More specifically in the neurological clinic, 42.8% had 1 pressure ulcer, 14.3 had 3 pressure ulcers, 28.6 had 4 pressure ulcers and 14.3% had 6 pressure ulcers. In the neurosurgery clinic, 25% had 1 pressure ulcer, 37.5% 3 pressure ulcers, 12.5% 9 pressure ulcers, and 25% had 10 pressure ulcers.
In this dissertation, the subject of the evaluation of the pressure ulcers in neurological and neurosurgical patients was investigated. The survey was conducted at the University General Hospital of Heraklion and 102 patients participated, 38.2% of whom were women, 61.8% were men, their age ranged from 51-74 ετϊν (47.1%), most patients in the study appear to be overweight as their body mass index is 25.0-29.9 (43.1%), 4.9% resulted in death and the majority of the patient sample was hospitalized in the neurological clinic (63.7%). The type of analgesia administered to patients in the sample was continuous intravenous in 54 patients (49.1%) and continuous epidural analgesia in 56 patients (50.9%). Also most of the cases were diagnosed with stroke (38.2%) and 53.9% suffered from 1-2 diseases. With regard to the 15 patients with the presence of pressure ulcers in the characteristics of the 102 patients in the study, 20.5% were women and 11.1% were males, most cases were 75-94 years old (19.4%), most cases with pressure ulcers were hospitalized in the neurosurgery clinic (18.9%) and the 66.7% was imported from the ICU (p <0.001). In addition, there was an increased mortality rate of 66.7% (p <0.001). With regard to risk assessment tools for the development of pressure ulcers, low stair scores (increased risk) are associated with older age and increased days of hospitalization. No patient at high risk was found in the assessment performed through Modified Braden while most patients (94.3%) found no risk of pressure ulcers. The Norton evaluation showed 39.1% at a very high risk, 32.2% high risk, 16.1% moderate risk and 12.6% low risk. In the course of this study, pressure ulcers occurred in patients who Norton had shown them at risk while Modified Braden had classified them without risk. At the Neurological Clinic 7 patients were photographed with pressure ulcers, while in Neurosurgery they were photographed 8. In neurological clinic a bite of patients was photo-documented to have an average of 2.85 pressure ulcers, while neurosurgery with a significant difference, 8 pressure ulcers on average. More specifically in the neurological clinic, 42.8% had 1 pressure ulcer, 14.3 had 3 pressure ulcers, 28.6 had 4 pressure ulcers and 14.3% had 6 pressure ulcers. In the neurosurgery clinic, 25% had 1 pressure ulcer, 37.5% 3 pressure ulcers, 12.5% 9 pressure ulcers, and 25% had 10 pressure ulcers.