ROLA PIELĘGNIARKI W OPIECE NAD PACJENTEM PRZYGOTOWYWANYM DO AMPUTACJI KOŃCZYNY DOLNEJ SPOWODOWANEJ ZESPOŁEM STOPY CUKRZYCOWEJ studium przypadku w oparciu o ICNP®

Wstęp

Cukrzyca jest niewątpliwie jednym z największych problemów współczesnej medycyny. Odsetek chorych wzra¬sta z roku na rok. Współczesny tryb życia – zmniejszona aktywność fizyczna, spożywanie wysokokalorycznych produktów, to główne przyczyny takiego stanu rzeczy. W cukrzycy problem stanowi nie tylko podwyższony poziom glukozy we krwi, ale także zagrożenie licznymi zaburzeniami metabolicznymi, które prowadzą do poważnych powikłań, jak np. amputacja kończyny na skutek zespołu stopy cukrzycowej [Szewczyk, 2013].

Cel pracy

Celem prezentowanej pracy jest określenie, na podstawie studium indywidualnego przypadku, problemów pielęgnacyjnych pacjenta oraz zdefiniowanie zadań pielęgniarki w opiece nad pacjentem przygotowywanym do amputacji kończyny dolnej spowodowanej zespołem stopy cukrzycowej. Podczas tworzenia planu opieki odwoływano się do terminów zaczerpniętych z ICNP®.

Prezentacja przypadku

W prezentowanym przypadku pacjentem jest kobieta w wieku 49 lat z cukrzycą insulino zależną z po¬wikłaniami w zakresie krążenia obwodowego. Pacjentka uskarża się na silny, przeszywający ból chorej kończyny. Chora przygotowywana do zabiegu amputacji kończyny dolnej prawej spowodowanej martwicą palców stopy prawej oraz martwicą przodostopia prawego w przebiegu stopy cukrzycowej. Zabieg prze¬biegł prawidłowo i bez powikłań przy ogólnym znieczuleniu chorej.

Wnioski

Osoba po zabiegu chirurgicznym amputacji kończyny dolnej nie jest zdolna do samoopieki i samopielę¬gnacji. zastosowaniu terminów z katalogu ICNP® proces pielęgnowania jest zrozumiały dla osób o różnych narodowościach.

Introduction

Diabetes is undoubtedly one of the biggest problems of modern medicine. The percentage of patients incre¬ases every year. Modern lifestyle – reduced physical activity, consumption of high-calorie products are the main causes of a given state of affairs. In diabetes, the problem is not so much increased blood glucose, but the threat of numerous metabolic disorders that lead to serious complications such as limb amputation due to diabetic foot syndrome [Szewczyk, 2013].

Aim of the study

The aim of the presented work is to determine the patient’s care problems and to develop the tasks of a nurse in patient care prepared for amputation of the lower limb caused by diabetic foot syndrome based on a case--by-case study. While creating the care plan, reference was made to the dates taken from ICNP®.

Case in the presented case, the patient is a woman aged 49 years with insulin-dependent diabetes with peri-pheral circulation complications. The patient complains of severe, stabbing pain in a sick limb. The patient is being prepared for amputation of the right lower limb caused by necrosis of the right toes of the right foot and right forefoot necrosis in the course of the diabetic foot. The procedure went well and without compli¬cations under general anesthesia.

Discussion

Diabetes is one of the earliest diagnosed diseases of our civilization, but recently it has been learned to treat without destroying the sick organism. However, it is still a serious problem to this day and, despite treat¬ment, leads to numerous complications. Complications affect the whole body of the patient, from vascular changes in the head to the feet. According to the World Health Organization, it is estimated that by 2025 there may already be 300 million diabetics worldwide [Dębosz i Humańska, 2017].

It is estimated that 7-9% of patients with diabetes in Poland. At present, 3 million people suffer from diabe¬tes in Poland, but only 2.2 million are diagnosed with the disease. Every fourth person over 60 years of age suffers from diabetes, and among people over 80 years of age every second. People with pre-diabetes, i.e. when the blood glucose level is higher than it should, but is too low to make a diagnosis of type II diabetes, is 4 times more than those with diabetes [Czupryniak i Strojek, 2016].

The goal of diabetes treatment is to maintain normal blood glucose, cholesterol and blood pressure levels, but also to prevent complications through a diabetic diet, maintain adequate weight, exercise, and quit smo¬king, e.g. The lifestyle of people with diabetes can have a huge impact on the occurrence of complications, and the most common complication is diabetic foot syndrome [Sutkowska, 2012].

Diabetic foot syndrome is a serious health problem for diabetics, it worsens the quality of life and is the most common cause of disability, as well as shortening life. Late diagnosed, poorly controlled and too long dura¬tion of the disease leads to chronic complications that affect the foot ulcer in a diabetic [Szewczyk, 2013].

Self-monitoring is very important in treating the diabetic foot. If a diabetic notices any disturbing changes on the foot, he should immediately visit a diabetologist [Szewczyk, 2013].

Preventive measures should be implemented as early as possible, as proper control and proper foot care can completely prevent the formation of diabetic foot, or at least delay its formation [Szewczyk, 2013].

Amputation is cutting off the limb used to improve health and is always the last surgery most often after an unsuccessful attempt to heal. In patients with diabetes, damage to the blood vessels and nerves leads to serious infections that are very difficult to treat. Minor damage is the cause of infection, which consequently results in amputation. Amputation is done when the efforts to save the foot are ineffective and the infection is a serious threat to life [Wannot, Nierobisz i Biskupek-Wannot, 2017].

The most common risk factors for lower limb loss: peripheral atherosclerosis and neuropathy, deformity of the feet especially in limited joints, past ulceration or amputation due to diabetes, poor glycemic self-con¬trol, vision impairment, obesity, foot injuries due to incorrect footwear, hypertension, dyslipidemia, smo¬king tobacco and alcohol abuse, inability to care for feet due to mobility restrictions or visual impairment as well as old age [Fabian, Koziarska–Rościszewska i Szymczyk, 2008].

Proper preparation of patients for diabetes and intensive perioperative care have a great impact on the outcome of surgical treatment. A patient with diabetes requires special therapeutic treatment in the perio¬perative period. To ensure the best care for a patient with diabetes during surgery, the cooperation of the surgical, anaesthesiological and diabetic team is important [Szewczyk, 2013].

Conclusions

A person who has undergone lower leg amputation is not capable of self-care and self-care. Proper prepara¬tion of patients for diabetes and intensive perioperative care have a great impact on the outcome of surgical treatment. A patient with diabetes requires special therapeutic treatment in the perioperative period. To ensure the best care for a patient with diabetes during surgery, the cooperation of the surgical, anaesthe¬siological and diabetic team is important [Szewczyk, 2013]. By using the terms from the ICNP catalog, the nursing process is understandable for people of different nationalities.