Title Sestrinsko liječnički pristup pacijentu s fibrilacijom i undulacijom atrija Title (english) Atrial fibrillation and undulation through the nursing and doctor aspect Author Ena Klarić Mentor Vedran Velagić (mentor) Committee member Martina Lovrić Benčić (predsjednik povjerenstva)Committee member Boško Skorić (član povjerenstva)Committee member Vedran Velagić (član povjerenstva) Granter University of Zagreb Defense date and country 2023-09-22, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Aritmije su poremećaji srčanog ritma, a normalni srčani ritam naziva se sinusni ritam. U
provodnom sustavu srca nastaje električna aktivnost i širi se kao električni podražaj u radno
mišićje srca te ga pobuđuje na mehaničku aktivnost. Postoji čitav spektar aritmija, od bezazlenih
pa sve do životno ugrožavajućih. Aritmije se najčešće dijele prema frekvenciji srca, na taj način
razlikujemo bradiaritmije i tahiaritmije. Fibrilacija atrija je najčešća postojana aritmija u općoj
populaciji, ona može ugroziti bolesnike te im sniziti kvalitetu života. Mehanizam njezinog
nastanka nije u potpunosti razjašnjen, ali se smatra da je njezin način razvoja i održavanja
multifaktorijalan. Liječenje se može provesti farmakološki – antiaritmicima te operacijskim
metodama kao što je kateterska ablacija. Kateterska ablacija je invazivni zahvat kojim se
kateterima ulazi do srca kako bi se ablirale određene strukture, a najčešće primjenjivana
metoda je ablacija radiofrekventnom energijom (RF). Ablacija se može raditi fokalno, na
dokazanim fokusima izbijanja impulsa, zatim izolacijom plućnih vena, ablacijom koronarnog
sinusa i drugih aritmogenih struktura unutar srca. Novija metoda koja se sve više koristi za
izolaciju plućnih vena je krioablacija u kojoj se pomoću katetera s balonom zaleđuju izlazišta
plućnih vena (PV). Za uspješnu ablaciju ključnu ulogu imaju sustavi navigacije i vizualizacije srca,
oni uključuju elektroanatomsko mapiranje (EAM), intrakardijalni ultrazvuk (ICE), fluoroskopiju i
kompjutersku tomografiju (CT). Prije, tijekom i nakon kateterske ablacije svakako je vrlo bitno
provesti primjerenu antikoagulcijsku terapiju kako bi se smanjio rizik od nastanak
tromboembolijskih incidenata. Komplikacije zahvata su relativno rijetke te se nastoji pravilnim
monitoriranjem bolesnika i sve boljim operacijskim tehnologijama još više suzbiti njihova
pojavnost. Osim kateterske ablacije postoje i metode kirurške ablacije, one se u novije vrijeme
kombiniraju s metodama kateterske ablacije u takozvanim hibridnim operacijama. Srčane
bolesnike s fibrilacijom i undulacijom atrija smatramo visokorizičnima jer imaju visoki rizik od
tromboembolizama te je kod njih prvenstveno potrebno prevenirati moguće komplikacije
bolesti, a najčešća od njih je moždani udar. Uloga sestre ovdje je jako bitna jer je potrebno
provesti kvalitetnu edukaciju o važnosti terapije, pridržavanju dobivenih uputa o nuspojavama
lijekova te znakovima i simptomima tromboembolije i krvarenja. Sestrinska se važnost također
odnosi i na intervencije koje je potrebno provesti pri zbrinjavanju bolesnika, što je opisano u
nadolazećem tekstu rada.
Abstract (english) Arrhythmias are heart rhythm disorders. A normal heart rhythm is called a sinus rhythm. An
electrical activity is generated in the conduction system and spreads as an electrical impluse to
the working muscles of the heart and excites it to mechanical activity. There is a whole spectrum
of arrhythmias, from harmless to life-threatening. The most common division of arrhythmias is
according to the heart rate: bradyarrhythmias and tachyarrhythmias. Atrial fibrillation is the
most common arrhythmia in the general population. It is a very common supraventricular
arrhythmia that can endanger patients and reduce their quality of life. The mechanism of atrial
fibrillation itself has not been fully elucidated. It is considered that the causes of development
and maintenance of arrhythmia is multifactorial. Treatment can be carried out
pharmacologically with antiarrhythmic drugs and by invasive methods such as catheter
ablation and surgery. Catheter ablation is an invasive procedure in which catheters are inserted
into the heart to ablate certain structures. The most common method of catheter ablation is
ablation with RF energy. Ablation can be done focally, on proven foci of impulse outbreaks,
followed by isolation of the pulmonary veins, the ablation of the coronary sinus and other
ablation of arrhythmogenic structures inside the heart. A newer method that is increasingly
used to isolate the pulmonary veins is cryoablation, in which the PV ostia are frozen with a
balloon catheter. Heart navigation and visualization systems play a key role in successful
ablation. These systems include EAM, ICE, fluoroscopy, and CT and MR rotational angiography.
Before, during and after catheter ablation, it is certainly very important to carry out an
appropriate anticoagulant therapy to reduce the risk of thromboembolic incidents.
Complications of the procedure are relatively rare, and efforts are beeing made to lower their
occurrence through proper patient monitoring and ever-improving operating technologies. In
addition to catheter ablation, there are also methods of surgical ablation. Surgical ablation
methods are recently combined with catheter ablation methods in the so-called hybrid
operations. We consider heart patients, in this case, patients suffering from atrial fibrillation
and undulation, as high-risk patients, and in such patietns it is primarily necessary to prevent
possible complications, the most common of which is a stroke. The nurse's role is very
important here because it is necessary to carry out quality education about the importance of
therapy, adherence to the instructions given about the side effects of drugs and the signs and
symptoms of thromboembolism and bleeding. The nursing role also refers to the interventions
that need to be carried out during patient care, which is described in the upcoming text of the
paper.
Keywords
aritmija
medicinska sestra
pacijent
ablacija
Keywords (english)
arrhythmia
nurse
patient
ablation
Language croatian URN:NBN urn:nbn:hr:105:950170 Study programme Title: Studies in Nursing Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-04-18 09:19:00
