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Uvod: Kritično bolni v enotah intenzivnega zdravljenja so poleg življenjsko ogrožujočega stanja izpostavljeni nastanku razjede zaradi pritiska. Pri preprečevanju le-teh ima medicinska sestra pomembno vlogo. Medicinske sestre uporabljajo pripomočke in lestvice za presejanje prehranske ogroženosti in oceno tveganja za nastanek razjed zaradi pritiska. Presejanje prehranske ogroženosti omogoča pravočasno in ustrezno prehransko podporo. Namen: Namen diplomskega dela je ugotoviti, kakšen vpliv ima prehrana in stanje prehranjenosti na ogroženost kritično bolnih v enotah intenzivnega zdravljenja za nastanek razjede zaradi pritiska. Cilji diplomskega dela so: raziskati povezanost stanja prehranjenosti in pojavnosti razjed zaradi pritiska predstaviti priporočila za oceno prehranskega stanja in priporočila o prehrani kritično bolnega v smislu preprečevanja razjede zaradi pritiska opisati ocenjevalne lestvice za oceno tveganja za nastanek razjede zaradi pritiska pri kritično bolnih ter raziskati vključenost prehranjevanja in pitja v njihove ocenjevalne parametre. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom znanstvene in strokovne literature. Literaturo smo iskali v podatkovnih bazah CINAHL in Medline, v vzajemni kataloški bazi podatkov COBIB.SI in v Obzorniku zdravstvene nege. Pri iskanju literature je bilo uporabljenih 7 ključnih besed: prehrana/ nutrition, kritično bolni/ critically ill, enota intenzivnega zdravljenja/ intensive care unit, razjeda zaradi pritiska/ pressure ulcers, nedohranjenost/ malnutrition, prehransko presejanje/ nutritional screening, ocenjevalne lestvice/ assessment scale. Uporabljenih je bilo 59 enot literature. Rezultati: Podhranjenost in pojavnost razjed zaradi pritiska sta dokazano povezana. Za oceno prehranjenosti bolnikov je v uporabi več prehranskih presejalnih orodij. Priporočila za prehrano kritično bolnih predlagajo prilagajanje vnosa hranil glede na stanje prehranjenosti kritično bolnega. Če zadosten vnos ni mogoč, se med obroki dodajajo visoko kalorični in visoko beljakovinski dodatki, po potrebi se uvede enteralna oziroma parenteralna podpora. Cubbin-Jackson lestvica in COMHON index lestvica sta z vidika povezanosti prehranjenosti in pojavnosti razjed zaradi pritiska najbolj primerni lestvici za oceno tveganja za nastanek razjed, saj edini vključujeta tudi ocenjevanje prehranjevanja. Razprava in zaključek: Ocena prehranskega stanja bolnika je pomembna pri ugotavljanju prehranskega tveganja in za načrtovanje individualno prilagojene prehranske podpore pri kritično bolnih. Za doseganje boljših izidov zdravljenja je potrebno sodelovanje vseh članov zdravstvenega tima, saj le celostna obravnava bolnika lahko zagotovi ustrezno in kakovostno zdravstveno oskrbo. Introduction: Critically ill patients in intensive care units are in a life-threatening condition where they are also exposed to developing pressure ulcers. Nurses play an important role in pressure ulcer prevention. Nurses use various aids and tools for nutritional and pressure ulcer risk screening. Nutrition risk screening enables timely and appropriate nutritional support. Purpose: The purpose of this diploma work is to determine the impact of diet and nutritional status on the risk of critically ill patients in intensive care units for the development of pressure ulcers. The objectives of the diploma work are: To investigate the relationship between the diet and the incidence of pressure ulcers present nutritional assessment and nutritional recommendations for the critically ill in terms of preventing pressure ulcers describe rating scales to assess the risk of pressure ulcer in critically ill patients and investigate the involvement of eating and drinking in their assessment parameters. Methods: A descriptive method of working with a review of scientific and professional literature was used. The literature was searched in databases: CINAHL, Medline, PubMed, COBIB.SI mutual catalogue database and in the Nursing Review. 7 keywords were used to search the literature: nutrition, critically ill, intensive care unit, pressure ulcers, malnutrition, nutritional screening, assessment scale. 59 units of literature were used. Results: Malnutrition and the incidence of pressure ulcers have been proven to be associated. Several nutritional screening tools are used to assess patient nutrition. Recommendations for the diet of the critically ill suggest adjusting the nutrient intake to the nutritional status of the critically ill. If sufficient intake is not possible, high calorie and high protein supplements are added between meals and enteral or parenteral support is introduced as needed. The Cubbin-Jackson scale and the COMHON index scale are, the most appropriate scales for assessing the risk of ulceration, since they are the only ones that include eating assessment and have the highest correlation between nutrition and the incidence of pressure ulcers. Discussion and conclusion: Assessing a patient's nutritional status is important in determining nutritional risk and in planning individually tailored nutritional support for critically ill patients. Achieving better treatment outcomes requires the involvement of all members of the healthcare team, as only an integrated treatment of the patient can provide adequate and quality health care. |
