| Abstract | Početak 2020. godine obilježila je pandemija SARS-CoV-2 virusom. SARS-CoV-2 je nevidljiv, visoko infektivan i apstraktan virus sa izrazito visokom stopom hospitalizacija. Diljem svijeta zdravstveni sustavi nisu bili spremni na pandemiju unatoč upozorenjima stručnjaka javnog zdravstva. Uvođenjem pandemijskih mjera zaustavljeno je uobičajeno djelovanje ljudi, što je rezultiralo ogromnim strahom od zaraze i smrti, te ekonomskom i gospodarskom krizom u cijelom svijetu. COVID-19 bolest pobuđuje veliki interes za istraživanje brojnih znanstvenika, istraživača i liječnika sa prioritetom na pronalazak cjepiva i lijekova za suzbijanje SARS-CoV-2 virusa. RT-PCR metoda trenutno je zlatni standard za kvalitativno i kvantitativno otkrivanje virusnih nukleinskih kiselina. Glavni uzrok COVID-19 mortaliteta je posljedica akutne virusne upale pluća, koja se dovodi do ARDS-a. ARDS nastaje kada plućni ili izvanplućni inzult, uzrokuje otpuštanje upalnih medijatora, potičući nakupljanje upalnih stanica u alveolama i mikrocirkulaciji pluća. Upalne stanice oštećuju vaskularni endotel i alveolarni epitel, što dovodi do plućnog edema, stvaranja hijalinske membrane, smanjene propustljivosti pluća i smanjene izmjene plinova. Kako bolest napreduje, potrebna je sve veća respiratorna potpora koja najčešće zahtijeva skrb u jedinicama intenzivnog liječenja. Respiratorna potpora uključuje oksigenaciju sa sustavima niskog i visokog protoka kisika, neinvanzivnu ventilaciju, korištenje pomoćne terapije nebuliziranih lijekova i prone položaj tijela, te naposljetku, kod životno ugroženih bolesnika, invanzivnu ventilaciju i ECMO. U liječenju sudjeluje cijeli medicinski tim (liječnici, medicinske sestre, fizioterapeuti i dr.), stoga su potrebni dobri međuljudski odnosi i komunikacija kako bi se postigao optimalan i uspješan oporavak pacijenta. Globalna pandemija zahtijeva snažan angažman medicinskog osoblja u kliničkom upravljanju, podizanju svijesti i razmjeni znanja te javnoj sigurnosti. Medicinske sestre zajedno s ostalim članovima multidisciplinarnog tima čine prvu liniju obrane u liječenje COVID-19 bolesti. Pandemija je pokazala da medicinske sestre posebno zahtijevaju iskustvo, vještine i znanje iz područja pružanja medicinske skrbi kod pacijenata podvrgnutim intenzivnim metodama liječenja, naročito kod respiratornih bolesti. Za uspješno liječenje najtežih COVID-19 respiratornih infekcija ključno je iskusno medicinsko osoblje s dobrom organizacijom rada i jasno definiranim protokolima.
Cilj ovog rada je na jednostavan način opisati djelokrug sestrinskih problema u zbrinjavanju COVID-19 oboljelih, koji su bili podvrgnuti neinvanzivnim i invanzivnim metodama ventilacije, kako bi se olakšao proces prilagodbe, smanjio stres i pružila potpora medicinskim sestrama da što brže svladaju osnove intenzivne medicine. |
| Abstract (english) | The beginning of 2020. was marked by the SARS-CoV-2 virus pandemic. SARS-CoV-2 is an invisible, highly infectious and abstract virus with an extremely high hospitalization rate. Health systems around the world did not prepare for the pandemic properly, despite warnings from public health experts. By introducing pandemic measures, the normal functioning of people was halted and resulted in enormous fear of infection and death, as well as of an impending economic world crisis. The COVID-19 disease motivated a great number of scientists, researchers and doctors to find a vaccine and drugs to combat the SARS-CoV-2 virus. RT-PCR method is currently the gold standard for the qualitative and quantitative detection of viral nucleic acids. The main cause of mortality by COVID-19 is due to acute viral pneumonia that further develops into ARDS. ARDS occurs when pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting the accumulation of inflammatory cells in the alveoli and lung microcirculation. Inflammatory cells damage the vascular endothelium and alveolar epithelium, leading to pulmonary edema, hyaline membrane formation, reduced lung permeability, and reduced gas exchange. As the disease progresses, higher respiratory support is needed and therefore care in intensive care units. The respiratory support includes oxygenation with low and high oxygen flow systems, non-invasive ventilation, the use of adjuvant therapy with nebulized drugs and prone position, and finally, in life-threatening patients, invasive ventilation and ECMO. The entire medical team (doctors, nurses, physiotherapists, etc.) participate in the treatment, so good interpersonal relations and communication are necessary for achieving an optimal and successful patient recovery. A global pandemic requires strong engagement of medical staff in clinical management, raise of awareness, share of knowledge, and public safety. Nurses, together with other members of the multidisciplinary team, form the first line of defense in the treatment of the COVID-19 disease. The pandemic has shown that nurses require experience, skills and knowledge in the field of providing health care in patients treated by intensive methods, especially in treating respiratory disease. Experienced medical staff, with good work organization and clearly defined protocols, are essential for the successful treatment of the most severe COVID-19 respiratory infections.
The aim of this work is to describe, in a simple way, the scope of nursing problems in providing care for COVID-19 patients, who were treated by non-invansive and invasive methods of ventilation, in order to facilitate the adaptation process, reduce stress and provide support for nurses to master the basics of intensive care medicine as quickly as possible. |
