| Abstract | Bol je najčešći simptom traumatoloških bolesnika. Iako prepoznata i liječena, bol u ovih bolesnika najčešće nije tretirana dovoljnom količinom medikamenata bilo radi nepotpune evaluacije stanja pacijenta, radi potcijenjivanja intenziteta boli (jer bol se vrlo različito doživljava kod različitih bolesnika) ili radi bojazni medicinskih djelatnika od razvoja sedacije, depresije vitalnih funkcija ili narušavanja kliničke slike pacijenta važne u procjeni ozljede. Medicinske sestre najintenzivnije su od svih zdravstvenih djelatnika u kontaktu s pacijentom. One moraju evaluirati pacijenta u pogledu njegovog zdravstvenog stanja, vrste ozljede i intenziteta boli koju trpi, ali i obzirom na ostale zdravstvene poremećaje koje pacijent ima, lijekove koje troši, te obzirom na njegovo psihičko i socijalno stanje. Točna procjena uzroka i intenziteta boli može značajno pridonijeti kvalitetnom terapijskom pristupu, započinjanju preventivne analgezije, balansirane farmakološke ili multimodalne analgezije i provođenju nefarmakoloških analgetskih postupaka. Medicinske sestre procijenu boli izvode često, a osobito nakon svake intervencije kojom se može mijenjati intenzitet boli. Za procjenu boli koriste se nekim od instrumenata kao što su vizualno-analogna skala boli, facies skala boli, numerička skala boli, a postoje i instrumenti koji se koriste kod dementnih osoba i pacijenata koji slabije komuniciraju (Abbey skala, PAIN-AD, Bolton skala, bihevioralna skala). U liječenju boli medicinske sestre dio su multidisciplinarnog tima koji skrbi o liječenju boli a čine ga uz medicinsku sestru i anesteziolog, kirurg te klinički farmakolog. Osnova liječenja boli je medikamentna terapija – opioidni lijekovi čine sukus analgetske terapije, a u sklopu multimodalnog pristupa valja ih kombinirati s nesteroidnim protuupalnim lijekovima, antikonvulzivima, te lokalnim i regionalnim analgetskim postupcima i lijekovima. Sestre brinu o provođenju plana analgezije, a dodatno imaju zadaću provoditi i nemedikamentne postupke u liječenju boli; krioterapija, postupci relaksacije, masaža, promjena položaja i sl. Njihova uloga je i u educiranju pacijenata i njihovih obitelji o važnosti redovite analgezije, načinu primjene lijekova, dozama i eventualnim nuspojavama lijekova. |
| Abstract (english) | Pain is the most common symptom of trauma patients. Although recognized and treated, the pain in these patients was most often underestimated symptom treated with aninsufficient amount of medication. That is either due to an incomplete evaluation of the patient's condition, underestimation of pain intensity (because the pain is very different in different patients) or for fear of patient sedation (vital function depression or distorting clinical picture of a patient important in assessing injury). Nurses are the most intensive of all healthcare professionals in contact with the patient. They must evaluate the patient in terms of his health condition, the type of injury and the intensity of the pain he is suffering, as well as the other health problems the patient has, the medication he is consuming, and the psychological and social condition he or she has. Accurate assessment of the cause of pain intensity can significantly contribute to a quality of therapeutic approach, initiating preventive analgesia, balanced pharmacological or multimodal analgesia, and performing nonpharmacological analgesic procedures. Nurses evaluate pain often, and especially after each intervention that can change the pain intensity. For pain estimation, some instruments such as visual-analogue pain scores, facies pain scales, numeric scales of pain are used. There are instruments used in dementia and poorly communicating patients (Abbey scale, PAIN-AD, Bolton scale , bievioral scale). In the pain treatment protocols, nurses are part of a multidisciplinary team with the anesthesiologist, surgeon and clinical pharmacologist. The basis of proper pain treatment is medication therapy - opioid drugs are core of analgesic therapy, and in the multimodal approach they must be combined with nonsteroidal anti-inflammatory drugs, anticonvulsants, and local and regional analgesic procedures and medications. Nurses are concerned about the implementation of the pain treatment protocol, and additionally they are obligatory to conduct non-medicated procedures for the treatment of pain; cryotherapy, relaxation procedures, massage, change of position, etc. Their role is also in educating patients and their families on the importance of regular analgesia, the way drugs are administered, drug doses and possible side effects of medication therapy. |
