The role of nurse in the extracorporeal shock wave lithotripsy

Uvod: Ledvični kamni nastanejo zaradi kristalizacije mineralov in soli v urinu. 20 % vseh uroloških bolezni predstavljajo kamni v sečilih. V Sloveniji zaradi njih zboli 4 % prebivalcev medtem ko se v svetu delež giblje med 2-5 %. Velika večina nastalih kamnov se izloči sama. Neizločene kamne je zaradi težav, ki jih povzročajo, priporočljivo odstraniti kirurško ali po neinvazivni metodi z drobljenjem. Trenutno je metoda z drobljenjem prva izbira. Medicinska sestra ima pomembno vlogo pri osveščanju ljudi o preventivi glede nastanka ledvičnih/sečnih kamnov, kot tudi o posegu samem, ko je to potrebno. Namen: Namen diplomskega dela je s pomočjo pregleda literature predstaviti neinvazivno zdravljenje ledvičnih kamnov s poudarkom na metodi zunajtelesnega drobljenja in opredelitvi vloge medicinske sestre. Metode dela: V diplomskem delu smo uporabili deskriptivno metodo dela s sistematičnim pregledom literature. Iskali smo v časovnem okvirju od leta 2006 do 2016. Iskali smo z angleškimi ključnimi besedami in sicer: ESWL, extracorporeal shock wave lithotripsy, kidney calculi, urolithiasis. Za iskanje literature smo uporabili naslednje podatkovne baze: Medline, PubMed in CINAHL. Pri nekaterih smo poleg samostojnih ključnih besed uporabili tudi Boolov operater IN (v ang. AND) v različnih kombinacijah. Rezultati: Prvi znak kamnov v sečilih je krvav urin, kateremu v večini primerov sledi ledvična kolika (krčevita bolečina v ledvenem in trebušnem predelu, ki jo povzroča krčenje gladkega mišičja), ki jo spremljata slabost in bruhanje. Urologi glede na laboratorijske in slikovne izvide preiskav določijo vrsto zdravljenja. Trenutno je najbolj priporočljiva metoda zunajtelesnega drobljenja, ki ima lahko le blage zaplete in malo kontraindikacij. Vloga medicinske sestre je predvsem sodelovanje med posegom in zdravstvena vzgoja pacienta po odpustu. Razprava in sklep: Kamni v sečilih se pojavijo kadarkoli ne glede na starost in spol. Zdravljenje se začne na primarni ravni, kamor prihajajo pacienti z akutno fazo ledvične kolike in ostalimi spremljajočimi simptomi. Nato pacienta napotijo k urologu, ki potrdi kamen v sečilih in se odloči za vrsto zdravljenja. Simptomi in zdravljenje so za pacienta lahko težavni. Z metodo drobljenja dosežemo, da večje kamne zdrobimo na manjše, kar omogoča lažje izplavljanje zdrobljenih konkrementov. Medicinska sestra je pomemben del urološkega tima, ki načrtuje obravnavo pacientov, sodeluje pri posegu ter izvaja zdravstveno vzgojno delo. Pomembno bi bilo spodbujati uporabo in širjenje znanja o kamnih tudi v praksi, saj bi tako zagotovili kakovostno zdravstveno nego.Introduction: Kidney calculus are caused by crystallization of minerals and salts in urine. 20% of all urological diseases are represented by the kidney calculus in the urinary tract. 4% of Slovenian population have problems caused by kidney calculus, while the world share is between 2 and 5%. The vast majority of the calculus is eliminated itself. Non-excluded calculus cause problems therefore it is advisable to remove them surgically or by non-invasive method of crushing. For the time being, the method by crushing is the first choice. A nurse plays an important role in educating people about the prevention of the creation of kidney / urinary calculus, as well as the surgery itself, when it is needed.Purpose: The aim of this thesis is to present a non-invasive treatment of kidney calculus through literature review with an emphasis on the ESWL method and define the role of a nurse. Methods: In this thesis, a descriptive method with a systematic review of the literature was used. We searched in the period from 2006 to 2016, and it was searched with the English keywords as follows: ESWL, extracorporeal shock wave lithotripsy, kidney calculus, and urolithiasis. For searching the literature, we used the following database: Medline, PubMed and CINAHL. In different combinations, we used for some of them, besides the keywords, the Bool’s operator AND as well. Results: The first sign of kidney calculus in the urinary tract is blood in the urine which is followed by renal colic in most cases (spasmodic pain in the lumbar and abdominal tract caused by the contraction of muscles), which is accompanied by nausea and vomiting. Urologists determine the type of treatment which is based on laboratory and imaging diagnosis. For the time being, the method of crushing outside the body is most advisable, because it might have only mild complications and just a few contraindications. The nurse has a very important role, especially during and after procedure. Results… Discussion and conclusion: Kidney calculus can break out whenever, irrespective of age and sex. Health begins at the primary level, when patients come with acute phase of renal colic and by other accompanying symptoms. The patient is directed to an urologist, who confirms the calculus in the urinary tract and decides which type of treatment would be the most appropriate. Symptoms and treatment can be difficult for the patient. The kidney calculus are broken into small pieces by crushing and concretions can move out easily. The nurse is an important part of the urology team, who plans the treatment of patients, takes part in the operation and has the main role with the healthcare. With the expansion of knowledge about kidney calculus in practice, the quality of healthcare could be assured