ZDRAVSTVENA NEGA PRI PACIENTU Z AKUTNIMI LEDVIČNIMI KOLIKAMI - Bratkovič, Anamarija (A. Bratkovič, 2009)
POVZETEK Sečni kamni ali urolitaza je bolezen, ki po arheoloških dokazih spremlja človeka že tisočletja. Sečni kamni so ena najpogostejših ledvičnih bolezni, saj zaradi njih oboleva 5 % prebivalstva, prav tako pa so eden od najpogostejših vzrokov za prihod pacientov na Splošno nujno medicinsko pomoč Zdravstvenega doma v Ljubljani. Najdemo jih lahko kjerkoli v sečilih, od ledvic do sečnice. Najpogosteje se kamni pojavljajo med 18. in 45. letom starosti, lahko pa jih imajo tudi otroci ali ljudje v pozni starosti. Pogostost nastanka kamnov je 2-4 krat večja pri moških. Pri 6% obolelih je imel kamne že nekdo v družini (Bresjanc, 1999). Ledvična kolika je močna enostranska bolečina, ki nastane zaradi oviranega odtekanja seča po sečevodu zaradi kamnov. Večina kamnov, manjših od 4 mm, se izloči sama. Pri kamnih, ki se ne izločijo sami, je potreben urološki poseg. Bolečina je pogosto prenesena, seva navzdol proti spolovilom. Spremlja jo lahko slabost, bruhanje, najpogosteje je pridruženo neznatno izločanje rdečih krvničk s sečem oz. mikrohematurija. Zagotovo je ravno neznosna bolečina, ki jih sečni kamni povzročajo razlog, da si pacienti ne morejo sami pomagati doma. Vloga medicinske sestre je pri takih primerih ključnega pomena, saj mora takoj ko sprejme takega pacienta v obravnavo oceniti nujnost stanja. Poleg izvajanja medicinsko tehničnih nalog po naročilu zdravnika pacienta tudi vzpodbuja, ocenjuje stanje in jakost bolečine, izvaja zdravstveno vzgojno izobraževanje ter spremlja pacienta na nadaljnje preiskave. Pacienta obravnava po procesu zdravstvene nege. ABSTRACT Urinary calculi, professionally known as urolithiasis is a disease that, archeologically proofed, has been accompanying human beings for thousand years. Renal calculi are one of the most frequent renal diseases as 5 % of population falls ill because of them. Moreover, it is also one of the most frequent reasons why patients need help at Prehospital Emergency Department in Ljubljana. Urinary calculi can be found anywhere in urinary tract, from kidneys up to urethrea. Calculi are most frequent among adults between the ages of 18 and 45. However, the disease could also affect children or elders. Frequency of calculi is 2-4 times greater with men. Furthermore, 6% of persons suffering from calculi have a member of family having the same problem. Renal colic is a precise, one sided pain usually originating from the flank or kidney area, caused by obstruction of urine overflow by urether because of one or more calculi. Most of solitary calculi, smaller than 4 mm, uncomplicated by infection or obstruction do not require specific therapy and pass spontaneously. Calculi impacted in the renal pelvis or urether may obviate the need of surgery or endoscopic removal. Renal colic pain usually originates from the flank and radiates downwards, in the direction of genital region. Pain is accompanied by symptoms like nausea and vomiting. Often also excretion of an insignificant quantity of red corpuscles-hematuria could occur. Undoubtedly the excruciating pain of renal calculi is the main reason why patients can not help themselves at home but they need an immediate and urgent professional help. The role of a nurse in such cases is very important because of valuation of patient’s condition when accepted at the hospital. Beside performing medicotechnical tasks (skills), made by doctor’s order, she or he stimulates the patient, valuates the degree of pain, performs medical service, health care education, and accompanies the patient to eventual other examinations. She or he then treats the patient by performing nurse care (process nursing).