NURSING CARE IN PATIENTS WITH BURNS

Prema definiciji svjetske zdravstvene organizacije (SZO) opeklina ili ozljeda toplinom nastaje kada vruća voda, vrući predmet ili plamen uništi dio ili sve slojeve stanica koje čine čovjekovu kožu. Opekline se prema uzroku dijele na toplinske, kemijske, opekline uzrokovane električnom strujom, uzrokovane radijacijom te inhalacijske opekline. Klasificiramo ih prema površini opekline i prema dubini tkivnog oštećenja. Za zbrinjavanje i liječenje opeklinske ozljede treba razumjeti njenu patogenezu. Najteža od svih komplikacija je opeklinski šok. Gubitak plazme, hipovolemija, hemokoncentracija, bubrežna insuficijencija i funkcionalni deficit Na+ uzrokuju njegov razvoj. Ostale komplikacije su infekcija, septikemija, akutna dilatacija želuca, Curlingov ulkus te ožiljne kontrakture. U ovom radu cilj mi je prikazati zdravstvenu njegu bolesnika sa opeklinama kod prijema, kod smještaja na jedinicu njege, kod pripreme za operaciju i previjanje opečenih površina, kroz poslijeoperacijsko razdoblje kroz proces zdravstvene njege bolesnika s opeklinama i opeklinskom bolešću kroz 14 osnovnih ljudskih potreba te u ranoj rehabilitaciji bolesnika, pri otpustu i zdravstvenom odgoju. Pri prijemu medicinska sestra uzima sestrinsku anamnezu. Priprema bolesnički krevet, promatra vanjski izgled (boja kože), mjeri vitalne znakove (disanje, puls, temperatura,RR), pomaže liječniku pri procjeni opečene površine, uvodi intravenski put, uzima krv za osnovne laboratorijske pretrage, krvnu grupu i ukriženu reakciju, uvodi urinarni kateter (kad su opekline opsežnije od 20 %), primjenjuje zaštitu protiv tetanusa, primjenjuje hitnu ordiniranu nadoknadu tekućine te priprema pribor i asistira pri traheotomiji. Nakon toga slijedi previjanje opekline gdje sestra osigurava aseptični protokol i asistira liječniku pri previjanju opekline. Intenzivno liječenje opeklina obuhvaća liječenje bolesnika prvih 36 sati po opeklinskoj ozljedi. U ovom razdoblju je najbitnije nadoknađivati tekućinu i pratiti diurezu budući da je šok glavni problem u ovom razdoblju. Intravenska je nadoknada u pravilu potrebna kad opeklina zahvaća više od 20 % tjelesne površine, a u djece i starih osoba već i kod 10 % tjelesne površine. Rana rehabilitacija je važan proces kod oporavka bolesnika. U toj fazi se otklanjaju ili smanjuju posljedice ozljede ili oboljenja. Sam pristup bolesniku se bazira na tome da ne gledamo što pacijentu nedostaje, nego što je ostalo i kako to maksimalno iskoristili, i učiniti bolesnika funkcionalnim i što samostalnijim u svakodnevnom, profesionalnom i društvenom životu i što manje ovisnim o tuđoj pomoći.According to the definition of the World Health Organization (WHO), burns or heat injuries occur when hot water, hot objects or flame destroys a part of or all of the layers of cells that make up the human skin. Depending on the cause burns are divided into thermal, chemical, burns caused by electric current, burns caused by radiation and inhalation burns. They are classified depending on how deep and severe they penetrate the skin's surface. In order to care for and treat burn injuries one should understand it`s pathogenesis. The most severe of all related complications is the burn shock. It`s development is caused by the loss of plasma, hypovolemia, haemoconcentration, renal failure and functional deficit of Na+. Other complications include infection, septicemia, acute dilatation of the stomach, Curlings ulcer and scar contractures. The aim of this study was to show nursing care of patients with burns on reception, in the care unit, during the preparation for surgery and bandaging of the burned areas, care throughout the postoperative period, through the process of health care of patients with burns and burn disease, while maintaining the 14 basic human needs and in the early rehabilitation of patients, while discharging patients and during their health education. During patient reception nurse takes nursing anamneses. The nurse also prepares the bed, monitors outward appearance (skin color), measures vital signs (respiration, pulse, temperature, RR), helps the doctor in evaluating burned areas, sets up intravenous access, takes blood for basic laboratory tests, blood type and cross reaction, inserts urinary catheter (when there are extensive burns of 20 %), applies protection against tetanus, applies emergency ordained compesation of fluids and prepares equipment and materials and provides assistance with tracheotomy. This is followed by the bandaging of burns where the nurse ensures the aseptic protocol and assists the doctor during burn bandaging. Treatment in intensive care unit involves treatment of patient during the first 36 hours after the occurence of burn injury. During this time it is of the most importance to compensate fluids and monitor diuresis since shock is the main problem during this period. Intravenous compensation is generally required when the burns affects more than 20 % of patient`s body or 10% if the patients are children or elderly. Early rehabilitation is important process in the recovery of patients. It is during this phase that we can remove or reduce the consequences of the injuries or illness. The approach to the patient is based on the fact that we do not look at what the patient is missing, but instead we focus on what the patient has left and how to maximize it's efficiency, and to make patient functional and as independent as possible in their everyday, professional and social life, and less dependent on other people