INDIVIDUALIZIRANI PRISTUP BOLESNIKU S KRONIČNOM RANOM U OBITELJSKOJ MEDICINI

Autor: T, Sinožić, M, Katić, J, Kovačević
Jazyk: chorvatština
Rok vydání: 2016
Předmět:
Zdroj: Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske
Volume 70
Issue Suplement 1
ISSN: 1848-8897
1330-0164
Popis: Pojava rana, cijeljenje, odgođeno cijeljenje i pojam kronične rane možemo reći, osnovna su značajka svih živih bića. Kod čovjeka se u procesu cijeljenja događaju brojni procesi kojima se, čak i u idealnim prilikama, stvara funkcionalno manje vrijedno ožiljno tkivo uz strukturne i funkcionalne promjene. U području ožiljka na mjestima izloženosti većim silama može doći do stvaranja rana. Takve rane otežano cijele unatoč nepostojanju drugih mogućih razloga otežanog cijeljenja. Prisutnost rane kao i dugotrajnost liječenja utječu na sve sfere života bolesnika te dovode do pada kvalitete života. Prikazom bolesnika s posttraumatskom ranom u području ožiljka u našoj ustanovi opisan je model skrbi prema principu sveobuhvatne individualizirane skrbi uz biopsihosocijalni pristup. Dijagnostičko-terapijski postupci uključivali su procjenu rane, prepoznavanje biofi lma, limfedema, ocjenu psihosocijalnog statusa bolesnika, čimbenika rizika za cijeljenje te ultrazvučnu dijagnostiku, primjenu karboksiterapije kao specijalizirane adjuvantne terapije, korištenje suvremenih pokrivala za rane te primjenu kompresivne terapije. U pozitivnom okruženju tijekom liječenja provođena je suportivna psihoterapija. Partnerskim odnosom s bolesnikom utjecalo se ne samo na cijeljenje rane, što je bio primarni cilj, već i na podizanje ukupne kvalitete bolesnikova života kao i na naše profesionalno zadovoljstvo postignutim rezultatom. U skrbi za bolesnike s kroničnim ranama sudjeluju liječnici obiteljske medicine i dio su multidisciplinarnog tima stručnjaka. Za takvu skrb potrebna su dodatna specifi čna znanja i vještine kako bi se mogla pružiti sveobuhvatna kvalitetna skrb kao nadopuna postojećim znanjima, vještinama i iskustvu rada u obiteljskoj medicini.
It can be said that the occurrence and development of wounds, healing, delayed healing, and the notion of chronic wound are some of the basic characteristics of all living beings. When it comes to people, there are a number of processes that take place during wound healing, and even under ideal circumstances, they create a functionally less valuable skin tissue, along with structural and functional changes. Fibrosis in the form of hypertrophic scars and keloids, contractures and adhesions are examples of excessive healing. Microcirculation is signifi cantly different from healthy skin circulation with consequential formation of local hypoxia and stagnation in lymph fl ow with edema. Poor functionality of the scar tissue, particularly in the areas exposed to stronger forces, can cause forming of wounds. Such wounds are hard to heal despite the inexistence of other possible reasons for delayed healing, precisely because of their poor functionality and placement. The presence of wound requiring long-term treatment affects all areas of patient life and leads to decline in the quality of life. Exemplifi ed by case presentation of a patient with post-traumatic wound in the scar area, in our offi ce we showed a model of care based on the principle of overall personalized care with the biopsychosocial approach. Diagnostic and therapeutic procedures included wound assessment, biofi lm and lymphedema detection, assessment of the patient’s psychosocial status, risk factors for wound healing, vascular ultrasound diagnostics, carboxytherapy as specialized adjuvant therapy, use of modern wound dressings, and compression therapy. Supportive psychotherapy was conducted in positive communication environment during treatment. In this way, in an atmosphere of cooperation with the patient, it was possible not only to infl uence the process of wound healing as the primary objective, but also to improve the quality of the patient’s life, as well as to infl uence our professional satisfaction with the results achieved. Family doctors are involved in the care of chronic wound patients as part of the multidisciplinary team of experts. Additional specifi c knowledge and skills are required for such care in order to ensure overall quality care as a supplement of the existing knowledge, skills and working experience in family medicine.
Databáze: OpenAIRE
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