{"id":597,"date":"2025-06-20T09:27:20","date_gmt":"2025-06-20T07:27:20","guid":{"rendered":"https:\/\/medica3nec.cz\/zp\/?page_id=597"},"modified":"2025-07-29T10:44:39","modified_gmt":"2025-07-29T08:44:39","slug":"edukace-rodiny-o-domaci-peci","status":"publish","type":"page","link":"https:\/\/medica3nec.cz\/zp\/edukace-rodiny-o-domaci-peci\/","title":{"rendered":"Informace pro l\u00e9ka\u0159e"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"597\" class=\"elementor elementor-597\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cc8bf00 e-ecs-flex e-flex e-con-boxed e-con e-parent\" data-id=\"cc8bf00\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-3027d8b e-con-full e-ecs-flex e-flex e-con e-child\" data-id=\"3027d8b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-596ecb4 elementor-widget elementor-widget-heading\" data-id=\"596ecb4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Informace pro l\u00e9ka\u0159e<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7603343 elementor-widget elementor-widget-text-editor\" data-id=\"7603343\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dom\u00e1c\u00ed p\u00e9\u010de poskytuje pacient\u016fm kvalitn\u00ed p\u00e9\u010di v jeho p\u0159irozen\u00e9m dom\u00e1c\u00edm prost\u0159ed\u00ed po ukon\u010den\u00ed hospitalizace nebo jin\u00e9 \u00fastavn\u00ed p\u00e9\u010de. Umo\u017e\u0148uje zkr\u00e1tit dobu hospitalizace a nep\u0159eru\u0161it pot\u0159ebn\u00fd kontakt mezi pacientem a nemocnic\u00ed. Z pohledu pacienta znamen\u00e1 tato slu\u017eba p\u0159edev\u0161\u00edm jeho brzk\u00e9 navr\u00e1cen\u00ed do dom\u00e1c\u00edho prost\u0159ed\u00ed a mo\u017enost pokra\u010dov\u00e1n\u00ed v pot\u0159ebn\u00e9 odborn\u00e9 o\u0161et\u0159ovatelsk\u00e9 p\u00e9\u010di v jeho dom\u00e1cnosti.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d58928d elementor-widget elementor-widget-gallery\" data-id=\"d58928d\" data-element_type=\"widget\" data-e-type=\"widget\" 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data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MjI5LCJ1cmwiOiJodHRwczpcL1wvbWVkaWNhM25lYy5jelwvenBcL3dwLWNvbnRlbnRcL3VwbG9hZHNcLzIwMjVcLzA2XC80MzU3MzI1OF8xNzU1Njg0MzExMjIwODAwXzg4MjUxNjQ0MzYwNjM5MTE5MzZfby0xLmpwZyIsInNsaWRlc2hvdyI6ImQ1ODkyOGQifQ%3D%3D\">\n\t\t\t\t\t<div class=\"e-gallery-image elementor-gallery-item__image\" data-thumbnail=\"https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/43573258_1755684311220800_8825164436063911936_o-1.jpg\" data-width=\"1599\" data-height=\"788\" aria-label=\"\" role=\"img\" ><\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-gallery-item__overlay\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d9000a elementor-widget elementor-widget-text-editor\" data-id=\"5d9000a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>Komu je dom\u00e1c\u00ed p\u00e9\u010de ur\u010den\u00e1<\/h4><p>Dom\u00e1c\u00ed p\u00e9\u010de je ur\u010dena pacient\u016fm v poopera\u010dn\u00edm a po\u00farazov\u00e9m obdob\u00ed, rovn\u011b\u017e pro klienty s chronick\u00fdm onemocn\u011bn\u00edm, jejich\u017e zdravotn\u00ed stav vy\u017eaduje dlouhodobou a pravidelnou dom\u00e1c\u00ed p\u00e9\u010di kvalifikovan\u00e9ho person\u00e1lu. D\u00e1le klient\u016fm po mozkov\u00fdch p\u0159\u00edhod\u00e1ch, s roztrou\u0161enou skler\u00f3zou, cukrovkou, pacient\u016fm s pln\u00fdm nebo \u010d\u00e1ste\u010dn\u00fdm ochrnut\u00edm, klient\u016fm s du\u0161evn\u00edm onemocn\u011bn\u00edm i chronickou bolest\u00ed. Dom\u00e1c\u00ed p\u00e9\u010de navazuje na l\u00e9\u010debnou p\u00e9\u010di praktick\u00fdch l\u00e9ka\u0159\u016f pro dosp\u011bl\u00e9, d\u011bti a dorost, ambulantn\u00edch specialist\u016f a o\u0161et\u0159uj\u00edc\u00edch l\u00e9ka\u0159\u016f ve zdravotnick\u00fdch za\u0159\u00edzen\u00edch.<\/p><p>Sestry pracuj\u00ed v souladu s diagn\u00f3zou stanovenou l\u00e9ka\u0159em a poskytuj\u00ed z\u00e1kladn\u00ed a specializovanou o\u0161et\u0159ovatelskou p\u00e9\u010di prost\u0159ednictv\u00edm o\u0161et\u0159ovatelsk\u00e9ho procesu. Dbaj\u00ed na ochranu pr\u00e1v ka\u017ed\u00e9ho pacienta, pracuj\u00ed s respektem a zachov\u00e1n\u00edm d\u016fstojnosti pacienta. Zdravotn\u00ed slu\u017eby poskytuj\u00ed jednotlivc\u016fm i rodin\u00e1m v koordinaci se slu\u017ebami jin\u00fdch obor\u016f.<\/p><p>Rozsah a \u010detnost dom\u00e1c\u00ed p\u00e9\u010de ordinuje l\u00e9ka\u0159. P\u00e9\u010de je poskytov\u00e1na bezplatn\u011b, ve\u0161ker\u00e9 v\u00fdkony jsou hrazeny zdravotn\u00ed poji\u0161\u0165ovnou. Dostupnost p\u00e9\u010de je 7 dn\u00ed v t\u00fddnu, v\u010detn\u011b sv\u00e1tk\u016f, 365 dn\u016f v roce.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f86ff64 elementor-widget elementor-widget-toggle\" data-id=\"f86ff64\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2601\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2601\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Spektrum na\u0161\u00edch slu\u017eeb<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2601\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2601\"><ul><li>kontrola zdravotn\u00edho stavu<\/li><li>m\u011b\u0159en\u00ed fyziologick\u00fdch funkc\u00ed: krevn\u00ed tlak, puls, SpO<sub>2<\/sub><\/li><li>odb\u011bry krve<\/li><li>odb\u011bry biologick\u00e9ho materi\u00e1lu<\/li><li>kontroly glykemie<\/li><li>p\u0159\u00edprava a pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f<\/li><li>aplikace injekc\u00ed, infuz\u00ed<\/li><li>aplikace inzul\u00ednu<\/li><li>n\u00e1cvik a zau\u010dov\u00e1n\u00ed aplikace inzul\u00ednu<\/li><li>o\u0161et\u0159ov\u00e1n\u00ed ko\u017en\u00edch defekt\u016f<\/li><li>o\u0161et\u0159ov\u00e1n\u00ed b\u00e9rcov\u00fdch v\u0159ed\u016f<\/li><li>p\u0159evazy ran (akutn\u00edch i chronick\u00fdch)<\/li><li>osobn\u00ed hygiena a o\u0161et\u0159en\u00ed opruzenin<\/li><li>prevence prole\u017eenin a jejich o\u0161et\u0159ov\u00e1n\u00ed<\/li><li>polohov\u00e1n\u00ed, podkl\u00e1d\u00e1n\u00ed<\/li><li>dohled nad dietn\u00edm a pitn\u00fdm re\u017eimem<\/li><li>pod\u00e1v\u00e1n\u00ed kysl\u00edkov\u00e9 terapie<\/li><li>p\u00e9\u010de o stomie<\/li><li>p\u00e9\u010de o pacienty s \u017eiln\u00edmi katetry PICC, intraven\u00f3zn\u00ed port<\/li><li>katetrizace mu\u017e\u016f i \u017een<\/li><li>o\u0161et\u0159en\u00ed permanentn\u00edch mo\u010dov\u00fdch katetru u mu\u017e\u016f i \u017een<\/li><li>aplikace klysmatu<\/li><li>p\u00e9\u010de o pacienty s perkut\u00e1nn\u00ed gastrostomi\u00ed, tracheostomi\u00ed<\/li><li>ods\u00e1v\u00e1n\u00ed hlen\u016f<\/li><li>edukace pacient\u016f, pop\u0159\u00edpad\u011b jin\u00fdch osob v o\u0161et\u0159ovatelsk\u00fdch postupech<\/li><li>o\u0161et\u0159ovatelsk\u00e1 rehabilitace<\/li><li>n\u00e1cvik ch\u016fze v chod\u00edtku<\/li><li>n\u00e1cvik ch\u016fze s berlemi<\/li><li>dechov\u00e1 cvi\u010den\u00ed<\/li><li>u\u017eit\u00ed kompenza\u010dn\u00edch pom\u016fcek<\/li><li>aktivace klienta<\/li><li>promaz\u00e1n\u00ed zad, h\u00fd\u017ed\u00ed, doln\u00edch kon\u010detin<\/li><li>l\u00e9\u010dba bolest\u00ed<\/li><li>n\u00e1cvik sob\u011bsta\u010dnosti<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2602\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2602\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Jak p\u00e9\u010de prob\u00edh\u00e1<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2602\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2602\"><p><strong><em>Podm\u00ednky pro zah\u00e1jen\u00ed a poskytov\u00e1n\u00ed p\u00e9\u010de<\/em><\/strong><\/p><ol><li>prost\u0159ed\u00ed, ve kter\u00e9m se pacient nach\u00e1z\u00ed, mus\u00ed b\u00fdt vhodn\u00e9 pro poskytov\u00e1n\u00ed dom\u00e1c\u00ed p\u00e9\u010de<\/li><li>pacient nesm\u00ed ohro\u017eovat zdrav\u00ed pracovn\u00edk\u016f agentury<\/li><li>po\u017eadovan\u00e1 p\u00e9\u010de mus\u00ed b\u00fdt v mo\u017enostech agentury dom\u00e1c\u00ed p\u00e9\u010de<\/li><\/ol><p><strong><em>Zah\u00e1jen\u00ed dom\u00e1c\u00ed p\u00e9\u010de <\/em><\/strong><\/p><p>Po indikaci dom\u00e1c\u00ed p\u00e9\u010de o\u0161et\u0159uj\u00edc\u00edm l\u00e9ka\u0159em je klient nav\u0161t\u00edven vybran\u00fdm pracovn\u00edkem agentury. Je proveden vstupn\u00ed pohovor, vy\u0161et\u0159en\u00ed klienta i stavu jeho vlastn\u00edho soci\u00e1ln\u00edho prost\u0159ed\u00ed, sezn\u00e1men\u00ed klienta s rozsahem v\u00fdkon\u016f a frekvenc\u00ed n\u00e1v\u0161t\u011bv. \u00a0S klientem, pop\u0159\u00edpad\u011b jeho rodinou \u010di bl\u00edzk\u00fdmi je dohodnut harmonogram odborn\u00e9 i laick\u00e9 p\u00e9\u010de.<\/p><p><strong><em>Pr\u016fb\u011bh p\u00e9\u010de<\/em><\/strong><\/p><p>Vybran\u00fd pracovn\u00edk agentury dom\u00e1c\u00ed p\u00e9\u010de, doch\u00e1z\u00ed za pacientem do jeho vlastn\u00edho soci\u00e1ln\u00edho prost\u0159ed\u00ed dle stanoven\u00e9ho harmonogramu a prov\u00e1d\u00ed po\u017eadovan\u00e9 v\u00fdkony dle ordinace l\u00e9ka\u0159e. S pacientem i jeho rodinou konzultuje ve\u0161ker\u00e9 zm\u011bny v indikaci p\u00e9\u010de, zm\u011bny frekvence n\u00e1v\u0161t\u011bv, zm\u011bny zdravotn\u00edho stavu apod. Ve\u0161ker\u00e9 zm\u011bny a d\u016fle\u017eit\u00e9 informace p\u0159ed\u00e1v\u00e1 praktick\u00e9mu (o\u0161et\u0159uj\u00edc\u00edmu) l\u00e9ka\u0159i pacienta.<\/p><p><strong><em>Zm\u011bna indikace<\/em><\/strong><\/p><p>Pokud dojde ke zm\u011bn\u011b zdravotn\u00edho stavu klienta, indikuje rozsah zm\u011bny v poskytov\u00e1n\u00ed dom\u00e1c\u00ed p\u00e9\u010de praktick\u00fd l\u00e9ka\u0159, \u010d\u00edm\u017e p\u00edsemn\u011b zm\u011bn\u00ed rozsah pop\u0159\u00edpad\u011b \u010detnost p\u016fvodn\u00ed indikace.\u00a0 K tomuto po\u017eadavku je nutno vystavit <strong>nov\u00fd poukaz<\/strong>, kdy jako den zah\u00e1jen\u00ed vyzna\u010d\u00ed den, od kdy zm\u011bnu po\u017eaduje. P\u0159edchoz\u00ed poukaz t\u00edmto nov\u00fdm po\u017eadavkem pozb\u00fdv\u00e1 platnost.<\/p><p><strong><em>Prodlou\u017een\u00ed p\u00e9\u010de<\/em><\/strong><\/p><p>V p\u0159\u00edpad\u011b, \u017ee zdravotn\u00ed stav pacienta vy\u017eaduje dal\u0161\u00ed p\u00e9\u010di i po uplynut\u00ed platnosti poukazu, je nutn\u00e9 vyplnit nov\u00fd poukaz. U pacient\u016f, u kter\u00fdch je p\u0159edpoklad v pokra\u010dov\u00e1n\u00ed p\u00e9\u010de, v\u010das upozorn\u00edme l\u00e9ka\u0159e na prodlou\u017een\u00ed poukazu, tak aby nedo\u0161lo k ne\u010dekan\u00e9mu p\u0159eru\u0161en\u00ed p\u00e9\u010de. Platnost poukazu je omezena u praktick\u00e9ho l\u00e9ka\u0159e na 3 m\u011bs\u00edce, po propu\u0161t\u011bn\u00ed z nemocnice na 14 dn\u00ed.<\/p><p><strong><em>P\u0159eru\u0161en\u00ed\/ukon\u010den\u00ed p\u00e9\u010de<\/em><\/strong><\/p><ol><li style=\"list-style-type: none;\"><ol><li>na \u017e\u00e1dost praktick\u00e9ho l\u00e9ka\u0159e, p\u0159i spln\u011bn\u00ed c\u00edl\u016f p\u00e9\u010de<\/li><li>pacient dom\u00e1c\u00ed p\u00e9\u010di odm\u00edt\u00e1\/v\u016fbec nespolupracuje<\/li><li>pacient nebo prost\u0159ed\u00ed, ve kter\u00e9m se nach\u00e1z\u00ed, ohro\u017euje zdrav\u00ed pracovn\u00edk\u016f agentury<\/li><li>po\u017eadovan\u00e1 p\u00e9\u010de nen\u00ed v mo\u017enostech agentury dom\u00e1c\u00ed p\u00e9\u010de<\/li><li>p\u0159i odm\u00edtnut\u00ed nebo p\u0159eru\u0161en\u00ed p\u00e9\u010de, db\u00e1me na to, aby nedo\u0161lo k ohro\u017een\u00ed pacientova zdrav\u00ed \u010di \u017eivota<\/li><\/ol><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2603\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2603\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">V\u00fdkony v dom\u00e1c\u00ed p\u00e9\u010di<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2603\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2603\"><p>Dom\u00e1c\u00ed p\u00e9\u010de je realizov\u00e1na prost\u0159ednictv\u00edm \u201eo\u0161et\u0159ovatelsk\u00fdch n\u00e1v\u0161t\u011bv\u201c, kter\u00e9 prov\u00e1d\u00ed v\u0161eobecn\u00e1 sestra ve vlastn\u00edm soci\u00e1ln\u00edm prost\u0159ed\u00ed klienta. Poji\u0161\u0165ovna hrad\u00ed sv\u00fdm poji\u0161t\u011bnc\u016fm maxim\u00e1ln\u011b 3 o\u0161et\u0159ovatelsk\u00e9 n\u00e1v\u0161t\u011bvy denn\u011b.<\/p><p><strong><em>V\u00fdkony dom\u00e1c\u00ed p\u00e9\u010de lze vyk\u00e1zat pouze: <\/em>(dle vyhl. 45\/1997 Sb.)<\/strong><\/p><ol><li>p\u0159i indikaci registruj\u00edc\u00edho praktick\u00e9ho l\u00e9ka\u0159e nebo registruj\u00edc\u00edho praktick\u00e9ho l\u00e9ka\u0159e pro d\u011bti a dorost<\/li><li>p\u0159i indikaci o\u0161et\u0159uj\u00edc\u00edho l\u00e9ka\u0159e p\u0159i hospitalizaci, a to po dobu nezbytn\u011b nutnou, nejv\u00fd\u0161e v\u0161ak 14 dn\u016f po ukon\u010den\u00ed hospitalizace.<\/li><\/ol><p>P\u0159epis dom\u00e1c\u00ed p\u00e9\u010de registruj\u00edc\u00edm l\u00e9ka\u0159em nebo registruj\u00edc\u00edm l\u00e9ka\u0159em pro d\u011bti a dorost m\u00e1 platnost nejv\u00fd\u0161e 3 m\u011bs\u00edce.<\/p><p>\u017d\u00e1dost o poskytov\u00e1n\u00ed dom\u00e1c\u00ed p\u00e9\u010de mus\u00ed b\u00fdt vyhotoven\u00e1 p\u00edsemn\u011b. K vy\u017e\u00e1d\u00e1n\u00ed p\u00e9\u010de a p\u0159edpisu dom\u00e1c\u00ed p\u00e9\u010de je nutno pou\u017e\u00edvat tiskopis VZP-06dp\/2009.\u00a0 Tento tiskopis je nutno vyplnit kompletn\u011b, v\u010detn\u011b v\u0161ech po\u017eadovan\u00fdch zdravotn\u00edch \u00fadaj\u016f o klientovi, stupni jeho mobility i dal\u0161\u00edch n\u00e1le\u017eitosti.<\/p><p>V dom\u00e1c\u00ed p\u00e9\u010di existuj\u00ed \u010dty\u0159i typy n\u00e1v\u0161t\u011bv. Jednotliv\u00e9 typy se li\u0161\u00ed pouze \u010dasov\u00fdm rozsahem \u2013 15, 30, 45 a 60 minut. Rozsah poskytovan\u00e9 p\u00e9\u010de stanov\u00ed o\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159.<\/p><p>K vybran\u00e9mu typu n\u00e1v\u0161t\u011bvy je nutno doplnit stru\u010dnou formou konkr\u00e9tn\u00ed po\u017eadovan\u00e9 v\u00fdkony, kter\u00e9 v r\u00e1mci indikovan\u00e9ho typu n\u00e1v\u0161t\u011bvy jsou vy\u017eadov\u00e1ny. Jedn\u00e1-li se o v\u00fdkony nesouc\u00ed s sebou ur\u010dit\u00e9 materi\u00e1lov\u00e9 n\u00e1klady, je nutno z\u00e1rove\u0148 uv\u00e9st \u010d\u00edslo p\u0159\u00edslu\u0161n\u00e9ho k\u00f3du. K\u00f3dy obsahuj\u00ed pr\u016fm\u011brn\u00e9 materi\u00e1lov\u00e9 n\u00e1klady, kter\u00e9 jsou nezbytn\u011b nutn\u00e9 pro proveden\u00ed z\u00e1kladn\u00edho v\u00fdkonu.<\/p><p><strong>K\u00f3dy v\u00fdkon\u016f<\/strong> \u2013 \u010dasov\u00e9 k\u00f3dy<\/p><ul><li>06311\u00a0\u00a0 zaveden\u00ed, ukon\u010den\u00ed dom\u00e1c\u00ed p\u00e9\u010de\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a060 minut<\/li><li>06313\u00a0 o\u0161et\u0159ovac\u00ed n\u00e1v\u0161t\u011bva \u2013 dom\u00e1c\u00ed p\u00e9\u010de typ I.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a030 minut<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>06315\u00a0 o\u0161et\u0159ovac\u00ed n\u00e1v\u0161t\u011bva \u2013 dom\u00e1c\u00ed p\u00e9\u010de typ II.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 45 minut<\/li><li>06317\u00a0 o\u0161et\u0159ovac\u00ed n\u00e1v\u0161t\u011bva \u2013 dom\u00e1c\u00ed p\u00e9\u010de typ III.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a060 minut<\/li><li>06318\u00a0 o\u0161et\u0159ovac\u00ed n\u00e1v\u0161t\u011bva \u2013 dom\u00e1c\u00ed p\u00e9\u010de typ IV.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 15 minut<\/li><li>06319\u00a0 fyzick\u00e1 asistence p\u0159i poskytov\u00e1n\u00ed dom\u00e1c\u00ed p\u00e9\u010de\u00a0\u00a0\u00a0\u00a0 30 minut<\/li><\/ul><\/li><\/ul><p><strong>K\u00f3dy v\u00fdkon\u016f<\/strong> \u2013 materi\u00e1lov\u00e9 k\u00f3dy<\/p><ul><li>06321 vy\u0161et\u0159en\u00ed stavu pacienta ve vlastn\u00edm prost\u0159ed\u00ed\u00a0\u00a0\u00a0\u00a0\u00a0<\/li><li>06323 odb\u011br biologick\u00e9ho materi\u00e1lu\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0<\/li><li>06325 aplikace parenter\u00e1ln\u00ed hydratace, v\u00fd\u017eivy a l\u00e9\u010dby bolesti\u00a0\u00a0\u00a0\u00a0<\/li><li>06327 o\u0161et\u0159en\u00ed stomi\u00ed<\/li><li>06329 lok\u00e1ln\u00ed o\u0161et\u0159en\u00ed<\/li><li>06331 klysma, v\u00fdplach, c\u00e9vkov\u00e1n\u00ed, lav\u00e1\u017ee, o\u0161et\u0159en\u00ed permanentn\u00edch katetr\u016f<\/li><li>06333 aplikace inhala\u010dn\u00ed a l\u00e9\u010debn\u00e9 terapie p.o., s.c., i.m., i.v. a dal\u0161\u00ed aplikace l\u00e9\u010div<\/li><\/ul><div>\u00a0<\/div><p><strong>K\u00f3dy v\u00fdkonu \u2013 <\/strong>prov\u00e1d\u011bn\u00e9 v mimopracovn\u00edch dnech a v no\u010dn\u00edch hodin\u00e1ch<\/p><ul><li style=\"list-style-type: none;\"><ul><li>06135 v\u00fdkon sestry v dob\u011b od 22 do 6 hodin<\/li><li>06137 v\u00fdkon sestry v den pracovn\u00edho klidu nebo volna<\/li><\/ul><\/li><\/ul><p>Zah\u00e1jit dom\u00e1c\u00ed p\u00e9\u010di lze v den, kter\u00fd je uveden na poukaze nebo nejpozd\u011bji den n\u00e1sleduj\u00edc\u00ed po ozn\u00e1men\u00ed po\u017eadavku. U pacient\u016f propu\u0161t\u011bn\u00fdch z l\u016f\u017ekov\u00e9ho za\u0159\u00edzen\u00ed m\u016f\u017ee b\u00fdt hrazen\u00e1 p\u00e9\u010de zah\u00e1jen\u00e1 a\u017e den n\u00e1sleduj\u00edc\u00ed po propu\u0161t\u011bn\u00ed, nebo\u0165 o\u0161et\u0159ovatelsk\u00e1 p\u00e9\u010de je v den propu\u0161t\u011bn\u00ed hrazena l\u016f\u017ekov\u00e9mu odd\u011blen\u00ed a nebude uhrazena agentu\u0159e dom\u00e1c\u00ed p\u00e9\u010de.<\/p><p>Dom\u00e1c\u00ed p\u00e9\u010de je zah\u00e1jen\u00e1 prvn\u00edm dnem, kdy pacienta nav\u0161t\u00edv\u00ed sestra a pokra\u010duje a\u017e do doby ukon\u010den\u00ed p\u00e9\u010de l\u00e9ka\u0159em nebo je ukon\u010dena z jin\u00fdch d\u016fvod\u016f, nap\u0159. hospitalizace, \u00famrt\u00ed pacienta apod.<\/p><p>Dom\u00e1c\u00ed p\u00e9\u010de je mo\u017en\u00e9 indikovat a\u017e do rozsahu 3 hodin denn\u011b (v\u010detn\u011b v\u00edkend\u016f a sv\u00e1tk\u016f). Je ov\u0161em t\u0159eba, aby rozsah p\u00e9\u010de byl stanoven \u00fa\u010deln\u011b.<\/p><p>Spl\u0148uje-li ordinace dom\u00e1c\u00ed p\u00e9\u010de v\u0161echny po\u017eadavky, p\u00e9\u010de je pln\u011b hrazena ze zdravotn\u00edho poji\u0161t\u011bn\u00ed a pacient z\u00e1sadn\u011b nic nedopl\u00e1c\u00ed.<\/p><p><strong><em>Kdy zdravotn\u00ed poji\u0161\u0165ovna p\u00e9\u010di neuhrad\u00ed<\/em>?<\/strong><\/p><p>Pokud dom\u00e1c\u00ed p\u00e9\u010di vy\u017eaduje nap\u0159. ambulantn\u00ed specialista (odb\u011bry krve pro diabetologickou ambulanci), mus\u00ed po\u017e\u00e1dat praktick\u00e9ho l\u00e9ka\u0159e, aby dom\u00e1c\u00ed p\u00e9\u010di schv\u00e1lil. Taky nen\u00ed mo\u017en\u00e9, aby dom\u00e1c\u00ed p\u00e9\u010di po\u017eadoval nemocni\u010dn\u00ed l\u00e9ka\u0159 u pacienta z ambulance. V tomto p\u0159\u00edpad\u011b nelze p\u00e9\u010di vy\u00fa\u010dtovat zdravotn\u00ed poji\u0161\u0165ovn\u011b.<\/p><p>Zdravotn\u00ed poji\u0161\u0165ovna p\u00e9\u010di neuhrad\u00ed, je-li indikov\u00e1na ambulantn\u00edm specialistou (nap\u0159. onkologem, diabetologem, chirurgem, internistou) nebo nemocni\u010dn\u00edm l\u00e9ka\u0159em u pacienta, kter\u00fd nen\u00ed propu\u0161t\u011bn z nemocnice. V takov\u00fdch p\u0159\u00edpadech je nutn\u00e1 indikace praktick\u00fdm l\u00e9ka\u0159em.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2604\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2604\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Odb\u011br biologick\u00e9ho materi\u00e1lu - kultiva\u010dn\u00ed vy\u0161et\u0159en\u00ed<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2604\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2604\"><p>Jedn\u00e1 se o odb\u011bry mo\u010de, sputa, st\u011bru z ran, krku apod. Tyto odb\u011bry p\u0159edstavuj\u00ed kultiva\u010dn\u00ed vy\u0161et\u0159en\u00ed z odebran\u00e9ho vzorku biologick\u00e9ho materi\u00e1lu, pomoc\u00ed kter\u00e9ho lze ur\u010dit p\u0159\u00edtomnost a druh mikroorganismu (bakterii, vir\u016f, hub) zp\u016fsobuj\u00edc\u00ed onemocn\u011bn\u00ed. Krom\u011b ur\u010den\u00ed p\u016fvodce infekce lze tak\u00e9 zjistit citlivost prok\u00e1zan\u00e9ho p\u016fvodce infekce na antibiotika.<\/p><p>\u00a0 K \u010demu jednotliv\u00e1 slou\u017e\u00ed:<\/p><ul><li>\u00a0v\u00fdt\u011br z krku anebo nosu &#8211; jedn\u00e1 se o kultiva\u010dn\u00ed vy\u0161et\u0159en\u00ed, kter\u00e9 zahrnuje pr\u016fkaz nejb\u011b\u017en\u011bj\u0161\u00edch p\u016fvodc\u016f infekc\u00ed horn\u00edch cest d\u00fdchac\u00edch.<\/li><li>odb\u011br sputa neboli hlenu slou\u017e\u00ed k zji\u0161t\u011bn\u00ed a identifikaci p\u0159\u00ed\u010diny bakteri\u00e1ln\u00ed pneumonie a jin\u00fdch infekci doln\u00edch d\u00fdchac\u00edch cest.<\/li><li>v\u00fdt\u011br z rekta neboli kone\u010dn\u00edku &#8211; toto vy\u0161et\u0159en\u00ed je zam\u011b\u0159en\u00e9 na pr\u016fkaz st\u0159evn\u00edch patogen\u016f.<\/li><li>st\u011br z r\u00e1ny se prov\u00e1d\u00ed u sekund\u00e1rn\u011b se hoj\u00edc\u00edch ran a ko\u017en\u00edch ploch. V\u00fdsledek poukazuje na p\u016fvodce infek\u010dn\u00edho procesu.<\/li><li>odb\u011br mo\u010de prokazuje b\u011b\u017en\u00e9 p\u016fvodce infekci mo\u010dov\u00e9ho \u00fastroji jako infekce mo\u010dov\u00fdch cest, z\u00e1n\u011bty mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e, ledvin, prostaty.<\/li><\/ul><p><strong>Obecn\u00e9 z\u00e1sady p\u0159i prov\u00e1d\u011bn\u00ed odb\u011br\u016f, st\u011bru\/v\u00fdt\u011bru:<\/strong><\/p><ul><li>st\u011bry se prov\u00e1d\u00ed za pomoc\u00ed steriln\u00edch souprav. Steriln\u00ed souprava obsahuje vatov\u00fd tamp\u00f3n na ty\u010dince ve steriln\u00ed zkumavce s transportn\u00edm m\u00e9diem. Tamp\u00f3n vyj\u00edm\u00e1 sestra ze zkumavky t\u011bsn\u011b p\u0159ed odb\u011brem a po proveden\u00ed st\u011bru\/v\u00fdt\u011bru ho vrac\u00ed aseptick\u00fd zp\u011bt do steriln\u00ed zkumavky.<\/li><li>mo\u010d se odeb\u00edr\u00e1 do steriln\u00ed zkumavky s uz\u00e1v\u011brem.<\/li><li>sputum se odeb\u00edr\u00e1 do steriln\u00ed zkumavky se \u0161irok\u00fdm hrdlem, tzv sputovky.<\/li><li>biologick\u00fd materi\u00e1l se spr\u00e1vn\u011b ozna\u010d\u00ed identifika\u010dn\u00edmi \u00fadaji pacienta a spole\u010dn\u011b s vypln\u011bnou \u017e\u00e1dankou ode\u0161le do laborato\u0159e.<\/li><li>pou\u017eit\u00ed spr\u00e1vn\u00e9 techniky odb\u011bru je nezbytn\u00e9 pro n\u00e1sledn\u00e9 z\u00edsk\u00e1n\u00ed spolehliv\u00fdch v\u00fdsledk\u016f.<\/li><\/ul><p><strong>Z\u00e1sady, kter\u00e9 by m\u011bl pacient p\u0159ed odb\u011brem dodr\u017eet:<\/strong><\/p><ul><li>\u00a0p\u0159ed v\u00fdt\u011brem z d\u00fdchac\u00edch cest by pacient nem\u011bl kou\u0159it a \u010distit si zuby. V\u00fdt\u011br se prov\u00e1d\u00ed r\u00e1no, nala\u010dno, nebo alespo\u0148 2-3 hodiny po j\u00eddle.<\/li><\/ul><ul><li>u odb\u011bru hlenu se rovn\u011b\u017e prov\u00e1d\u00ed rann\u00ed odb\u011br, a to po vy\u010di\u0161t\u011bn\u00ed zub\u016f a po vypl\u00e1chnut\u00ed dutiny \u00fastn\u00ed vla\u017enou vodou, aby byla co nejv\u00edce eliminov\u00e1na kontaminace vzorku florou \u00fastn\u00ed dutiny.<\/li><li>p\u0159ed st\u011brem z chronick\u00e9 r\u00e1ny, by m\u011bly b\u00fdt z r\u00e1ny odstran\u011bny v\u0161echny ne\u010distoty, jako je nekrotick\u00e1 tk\u00e1\u0148, zaschl\u00fd exsud\u00e1t nebo zbytky kryc\u00edho materi\u00e1lu. R\u00e1na se m\u016f\u017ee o\u010distit vodou nebo steriln\u00edm fyziologick\u00fdm roztokem.<\/li><\/ul><p><strong>Jak samotn\u00fd odb\u011br prob\u00edh\u00e1:<\/strong><\/p><ul><li>sestra p\u0159ed odb\u011brem biologick\u00e9ho materi\u00e1lu zkontroluje toto\u017enost pacienta<\/li><li>ov\u011b\u0159\u00ed si \u00fadaje na pr\u016fkazce zdravotn\u00ed poji\u0161\u0165ovny<\/li><li>nachyst\u00e1 si pot\u0159ebn\u00e9 pom\u016fcky, ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy a sezn\u00e1m\u00ed pacienta s postupem<\/li><li>po hygienick\u00e9 dezinfekci rukou si nasad\u00ed jednor\u00e1zov\u00e9 rukavice<\/li><li>odb\u011bry prov\u00e1d\u00ed dle druhu po\u017eadovan\u00e9ho vy\u0161et\u0159en\u00ed:<\/li><\/ul><ul><li><u>v\u00fdt\u011br z krku<\/u> \u2013 sestra pacienta ulo\u017e\u00ed do polohy vsed\u011b nebo polosed\u011b, stla\u010d\u00ed \u00fastn\u00ed lopatkou ko\u0159en jazyka a vatov\u00fdm tamp\u00f3nem ot\u00e1\u010div\u00fdm pohybem shora dol\u016f set\u0159e povrch mandl\u00ed nebo patrov\u00fdch oblouk\u016f.<\/li><li><u>v\u00fdt\u011br z nosu<\/u> \u2013 steriln\u00edm tamponem provede sestra st\u011br z okraje nosn\u00edho vchodu a n\u00e1sledn\u011b zachyt\u00ed krou\u017eiv\u00fdm pohybem nosn\u00ed sekret.<\/li><li><u>v\u00fdt\u011br z rekta<\/u> (kone\u010dn\u00edk) &#8211; sestra ulo\u017e\u00ed pacienta do polohy vle\u017ee na boku anebo vyzve pacienta k p\u0159edklonu a odb\u011brov\u00fd tamp\u00f3n zavede rota\u010dn\u00edm pohybem do rekta do hloubky asi 3-4cm. N\u00e1sledn\u011b v\u00fdt\u011brovou \u0161t\u011bti\u010dku vlo\u017e\u00ed do n\u00e1dobky s \u017eivnou p\u016fdou a uzav\u0159e.<\/li><li><u>odb\u011br sputa<\/u> \u2013 sestra po\u017e\u00e1d\u00e1 pacienta aby zaka\u0161lal a odebere sekret z doln\u00edch cest d\u00fdchac\u00edch do steriln\u00edho kontejneru. Pacient, kter\u00fd m\u00e1 zavedenou tracheostomii, provede sestra odb\u011br sputa p\u0159i ods\u00e1v\u00e1n\u00ed z d\u00fdchac\u00edch cest steriln\u00ed ods\u00e1vac\u00ed kanylou.<\/li><li><u>odb\u011br mo\u010de<\/u> se prov\u00e1d\u00ed dv\u011bma zp\u016fsoby:<\/li><\/ul><ol><li>po pe\u010dliv\u00e9m umyt\u00ed a osprchov\u00e1n\u00ed genit\u00e1lu, se zachyt\u00ed st\u0159edn\u00ed proud mo\u010de do steriln\u00ed zkumavky. Tzn. \u017ee prvn\u00ed porci mo\u010de vymo\u010d\u00ed pacient do m\u00edsy a zachyt\u00ed st\u0159edn\u00ed proud mo\u010de do steriln\u00ed zkumavky.<\/li><li>c\u00e9vkovan\u00e1 mo\u010d se odebere p\u0159i jednor\u00e1zov\u00e9 katetrizaci mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e nebo z nov\u011b zaveden\u00e9ho permanentn\u00edho kat\u00e9tru p\u0159\u00edmo do steriln\u00ed zkumavky.<\/li><\/ol><ul><li><u>st\u011br z povrchov\u00fdch defekt\u016f k\u016f\u017ee<\/u> se prov\u00e1d\u00ed steriln\u00edm vatov\u00fdm tamp\u00f3nem, kdy sestra ot\u0159e m\u00edsto z\u00e1n\u011btu nebo tk\u00e1\u0148 na spodin\u011b r\u00e1ny.<\/li><li><u>st\u011br z chronick\u00e9 r\u00e1ny<\/u> se prov\u00e1d\u00ed rovn\u011b\u017e steriln\u00edm vatov\u00fdm tamp\u00f3nem. Technika st\u011bru by m\u011bla postihnout co nejv\u011bt\u0161\u00ed rozsah. Sestra tamp\u00f3nem pohybuje na povrchu r\u00e1ny technikou tzv. deset\u00ed bod\u016f a z\u00e1rove\u0148 vyu\u017e\u00edv\u00e1 metodu \u201ecik-cak\u201c a lehk\u00fdm tlakem je\u0161t\u011b tamp\u00f3n roluje a ot\u00e1\u010d\u00ed 360\u00b0.<\/li><\/ul><ul><li>n\u00e1sledn\u011b tamp\u00f3n um\u00edst\u00ed do transportn\u00edho m\u00e9dia a uzav\u0159e.<\/li><li>odebran\u00fd materi\u00e1l ulo\u017e\u00ed do transportn\u00edho obalu a p\u0159eprav\u00ed do laborato\u0159e.<\/li><\/ul><p><strong>Co mus\u00ed obsahovat \u017e\u00e1danky ke kultiva\u010dn\u00edmu vy\u0161et\u0159en\u00ed:<\/strong><\/p><ul><li>\u00a0jm\u00e9no a p\u0159\u00edjmen\u00ed pacienta<\/li><\/ul><ul><li>poji\u0161\u0165ovna, rodn\u00e9 \u010d\u00edslo<\/li><li>datum a \u010das odb\u011bru<\/li><li>raz\u00edtko a podpis sestry, kter\u00e1 odb\u011br prov\u00e1d\u00ed<\/li><li>raz\u00edtko a podpis l\u00e9ka\u0159e<\/li><li>druh ATB, pokud je pacient u\u017e\u00edv\u00e1, m\u00edsto odb\u011bru a lokalizaci r\u00e1ny<\/li><\/ul><p><strong>Shrnut\u00ed:<\/strong><\/p><p>\u00a0Odb\u011bry ke kultiva\u010dn\u00edmu vy\u0161et\u0159en\u00ed v\u017edy indikuje praktick\u00fd nebo jin\u00fd o\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159, kter\u00fd vystav\u00ed \u017e\u00e1danku k po\u017eadovan\u00e9mu vy\u0161et\u0159en\u00ed. Sestra po p\u0159edchoz\u00ed domluv\u011b s pacientem provede odb\u011br dle stanoven\u00fdch pokyn\u016f a zajist\u00ed transport odebran\u00e9ho vzorku do laborato\u0159e. V\u00fdsledky jsou z laborato\u0159e p\u0159ed\u00e1ny l\u00e9ka\u0159i, kter\u00fd v\u00fdkon po\u017eadoval do 2-4dn\u016f.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2605\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2605\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Odb\u011br biologick\u00e9ho materi\u00e1lu<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2605\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2605\"><p><span style=\"font-family: georgia, palatino, serif;\">Jedn\u00edm z nej\u010dast\u011bj\u0161\u00edch zdravotn\u00edch v\u00fdkon\u016f, kter\u00e9 lze prov\u00e9st v dom\u00e1c\u00edm prost\u0159ed\u00ed pacienta jsou odb\u011bry biologick\u00e9ho materi\u00e1lu. Jedn\u00e1 se p\u0159edev\u0161\u00edm o odb\u011bry krve, mo\u010de, sputa, st\u011bru z ran, v\u00fdt\u011bru z krku, stolice apod. Odb\u011bry biologick\u00e9ho materi\u00e1lu se prov\u00e1d\u00ed zejm\u00e9na u pacient\u016f, kte\u0159\u00ed se ze zdravotn\u00edch d\u016fvodu\u00a0 nem\u016f\u017eou dostavit\u00a0 ke sv\u00e9mu o\u0161et\u0159uj\u00edc\u00edmu l\u00e9ka\u0159i. P\u0159\u00ed\u010dina m\u016f\u017ee b\u00fdt r\u016fzn\u00e1, nej\u010dast\u011bji je to imobilita pacienta, \u010d\u00e1ste\u010dn\u00e1 nebo \u00fapln\u00e1, poopera\u010dn\u00ed obdob\u00ed, onemocn\u011bn\u00ed pohybov\u00e9ho apar\u00e1tu a dal\u0161\u00ed.<\/span><\/p><p><span style=\"font-family: georgia, palatino, serif;\">Odb\u011br biologick\u00e9ho materi\u00e1lu se prov\u00e1d\u00ed na z\u00e1klad\u011b po\u017eadavku praktick\u00e9ho l\u00e9ka\u0159e, kter\u00fd rozhodne, o jak\u00fd odb\u011br se bude jednat, pod\u00e1 pokyny k odb\u011bru, pop\u0159\u00edpad\u011b vystav\u00ed \u017e\u00e1danku k odb\u011bru. Odb\u011bry krve nebo jin\u00e9ho biologick\u00e9ho materi\u00e1lu lze prov\u00e9st tak\u00e9 na \u017e\u00e1dost specializovan\u00fdch ambulanci jako nap\u0159. diabetologick\u00e1, nefrologick\u00e1 nebo kardiologick\u00e1 ambulance. Tyto odb\u011bry se prov\u00e1d\u00ed se souhlasem praktick\u00e9ho l\u00e9ka\u0159e. Pokud je pacient propu\u0161t\u011bn z nemocnice a jeho stav vy\u017eaduje b\u011bhem 14 dn\u00ed po propu\u0161t\u011bn\u00ed odb\u011bry, indikuje v\u00fdkon nemocni\u010dn\u00ed o\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159.<\/span><\/p><p><b><span style=\"font-family: georgia, palatino, serif;\">V\u00fdznam slova biologick\u00fd materi\u00e1l:<\/span><\/b><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">v klinick\u00e9 praxi se tak ozna\u010duje materi\u00e1l biologick\u00e9ho p\u016fvodu, tj. poch\u00e1zej\u00edc\u00ed z organismu \u010dlov\u011bka.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">odb\u011br a n\u00e1sledn\u00e9 zpracov\u00e1n\u00ed v laborato\u0159i m\u00e1 z\u00e1sadn\u00ed v\u00fdznam pro ur\u010den\u00ed spr\u00e1vn\u00e9 diagn\u00f3zy i pro v\u010dasn\u00e9 a \u00fa\u010dinn\u00e9 l\u00e9\u010den\u00ed.<\/span><\/li><\/ul><p><b><span style=\"font-family: georgia, palatino, serif;\">Nej\u010dast\u011bji prov\u00e1d\u011bn\u00e9 <strong>odb\u011bry krve<\/strong>:<\/span><\/b><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\"><strong>KO<\/strong> (krevn\u00ed obraz), p\u0159edstavuje z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed krve, kter\u00e9 ur\u010duje po\u010det krevn\u00edch bun\u011bk, jejich velikost a jin\u00e9 vlastnosti. Z vy\u0161et\u0159en\u00ed krevn\u00edho obrazu je mo\u017eno stanovit po\u010det b\u00edl\u00fdch a \u010derven\u00fdch krvinek, hemoglobin, hematokrit a po\u010det krevn\u00edch desti\u010dek.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\"><strong>BP <\/strong>(biochemick\u00fd panel), ur\u010duje obsah organick\u00fdch i anorganick\u00fdch l\u00e1tek v materi\u00e1lu, nap\u0159. b\u00edlkoviny, tuky, gluk\u00f3za, miner\u00e1ly, hormony, enzymy, vitam\u00edny, l\u00e9ky apod.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\"><strong>HbA<sub>1<\/sub>c <\/strong>(glykovan\u00fd hemoglobin) se pou\u017e\u00edv\u00e1 k posouzen\u00ed dlouhodob\u00e9 kompenzace diabetu, vy\u0161et\u0159en\u00ed ukazuje pr\u016fm\u011br glykemie za posledn\u00edch 6-8 t\u00fddn\u016f.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\"><strong>Hemokoagulace <\/strong>je speci\u00e1ln\u00ed vy\u0161et\u0159en\u00ed, p\u0159i kter\u00e9m se vy\u0161et\u0159uj\u00ed syst\u00e9my, kter\u00e9 zaji\u0161\u0165uj\u00ed v organismu z\u00e1stavu krv\u00e1cen\u00ed. Tato vy\u0161et\u0159ovac\u00ed metoda se pou\u017e\u00edv\u00e1 ke zji\u0161t\u011bn\u00ed z\u00e1va\u017en\u00fdch stav\u016f anebo monitorov\u00e1n\u00ed antitrombotick\u00e9 l\u00e9\u010dby.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\"><strong>FW<\/strong> (sedimentace) m\u011b\u0159\u00ed se rychlost samovoln\u00e9 sedimentace erytrocyt\u016f za \u010dasovou jednotku, za 1 hod., pop\u0159\u00edpad\u011b 2 hodiny. Sedimentace se urychluje u chorobn\u00fdch stav\u016f, proto je typick\u00e1 u z\u00e1n\u011btliv\u00fdch stav\u016f.<\/span><\/li><\/ul><p><b><span style=\"font-family: georgia, palatino, serif;\">Proveden\u00ed odb\u011bru krve:<\/span><\/b><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">den p\u0159ed odb\u011brem V\u00e1s kontaktuje sestra a domluv\u00ed \u010das n\u00e1v\u0161t\u011bvy<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">odb\u011bry krve se prov\u00e1d\u011bj\u00ed v rann\u00edch hodin\u00e1ch, mezi 6-9 hodinou<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pokud je pacient imobiln\u00ed, zajist\u00ed rodinn\u00fd p\u0159\u00edslu\u0161n\u00edk p\u0159\u00edstup k pacientovi<\/span><\/li><\/ul><p><b><span style=\"font-family: georgia, palatino, serif;\">Vlastn\u00ed odb\u011br krve:<\/span><\/b><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">sestra p\u0159ed odb\u011brem krve zkontroluje toto\u017enost pacienta, ov\u011b\u0159\u00ed si \u00fadaje na \u017e\u00e1dance<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">zjist\u00ed, zda je pacient k odb\u011bru p\u0159ipraven (dodr\u017een\u00ed doby la\u010dn\u011bn\u00ed apod.)<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">nachyst\u00e1 si pot\u0159ebn\u00e9 pom\u016fcky a ozna\u010d\u00ed p\u0159ipraven\u00e9 zkumavky k odb\u011bru (jm\u00e9no a p\u0159\u00edjmen\u00ed, rodn\u00e9 \u010d\u00edslo)<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy, nejl\u00e9pe vsed\u011b na \u017eidli s op\u011bradlem nebo vle\u017ee na l\u016f\u017eku<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">sezn\u00e1m\u00ed pacienta s postupem odb\u011bru a vyzve ho ke spolupr\u00e1ci<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">po hygienick\u00e9 dezinfekci rukou si nasad\u00ed ochrann\u00e9 rukavice<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">\u0161krtidlem m\u00edrn\u011b sev\u0159e pa\u017ei pacienta, 5-10cm nad m\u00edstem vpichu<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pohmatem identifikuje vhodnou \u017e\u00edlu a dezinfikuje m\u00edsto vpichu<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">po zaschnut\u00ed dezinfekce provede odb\u011br z \u017e\u00edly<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">odb\u011br krve m\u016f\u017ee prov\u00e9st dv\u011bma zp\u016fsoby:<\/span><\/li><\/ul><ol><li><span style=\"font-family: georgia, palatino, serif;\"><u>uzav\u0159en\u00fdm syst\u00e9mem (Sarstedt Monovette)<\/u><\/span><ul><li><span style=\"font-family: georgia, palatino, serif;\">kdy jehlu nasad\u00ed na odb\u011brovou st\u0159\u00edka\u010dku S-Monovette<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">provede vpich a kdy\u017e se v hrdle st\u0159\u00edka\u010dky objev\u00ed krev, uvoln\u00ed \u0161krtidlo, aby byla nabr\u00e1na proud\u00edc\u00ed krev<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">tahem p\u00edst vyt\u00e1hne a po\u010dk\u00e1, a\u017e se hladina krve ve st\u0159\u00edka\u010dce ust\u00e1l\u00ed<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pot\u00e9, bu\u010f pokra\u010duje odb\u011brem do dal\u0161\u00ed zkumavky nebo odb\u011br ukon\u010d\u00ed<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pokud prov\u00e1d\u00ed odb\u011br do zkumavky s p\u0159\u00eddavkem antikoagula\u010dn\u00edho \u010dinidla, zkumavku po odb\u011bru ihned n\u011bkolikr\u00e1t m\u00edrn\u011b prom\u00edch\u00e1 pomal\u00fdm ot\u00e1\u010den\u00edm<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">po odb\u011bru vyzve pacienta, aby ruku uvolnil, jehlu vyt\u00e1hne, na m\u00edsto vpichu p\u0159itla\u010d\u00ed tamp\u00f3n a po chv\u00edli p\u0159elep\u00ed n\u00e1plasti s pol\u0161t\u00e1\u0159kem<\/span><\/li><\/ul><\/li><\/ol><ol start=\"2\"><li><span style=\"font-family: georgia, palatino, serif;\"><u> otev\u0159en\u00fdm zp\u016fsobem (za pou\u017eit\u00ed klasick\u00e9 jehly a st\u0159\u00edka\u010dky)<\/u><\/span><\/li><\/ol><ul><li><span style=\"font-family: georgia, palatino, serif;\">injek\u010dn\u00ed st\u0159\u00edka\u010dku dr\u017e\u00ed shora, sejme kryt s jehly, srovn\u00e1 hrot, vypne k\u016f\u017ei v okol\u00ed m\u00edsta vpichu a jehlu zavede do \u017e\u00edly pod \u00fahlem 30\u00b0 a pak srovn\u00e1 do \u00fahlu 15\u00b0<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">kdy\u017e se objev\u00ed v k\u00f3nusu kapka krve, uvoln\u00ed \u0161krtidlo a \u0161etrn\u00fdm zata\u017een\u00edm za p\u00edst odebere pot\u0159ebn\u00e9 mno\u017estv\u00ed krve<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pomoc\u00ed p\u0159ilo\u017een\u00e9ho tamp\u00f3nu vyjme jehlu s \u017e\u00edly a po chv\u00edli p\u0159elep\u00ed n\u00e1plasti<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">jehlu odstran\u00ed do kontejneru a opatrn\u011b vst\u0159ikuje krev po st\u011bn\u011b zkumavek a zaz\u00e1tkuje<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">po odb\u011bru krve sestra \u0159\u00e1dn\u011b ozna\u010den\u00e9 zkumavky a vypln\u011bn\u00e9 \u017e\u00e1danky doru\u010d\u00ed do laborato\u0159e.<\/span><\/li><\/ul><p><b><span style=\"font-family: georgia, palatino, serif;\">Co mus\u00ed obsahovat \u017e\u00e1danky k odb\u011bru krve:<\/span><\/b><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">jm\u00e9no a p\u0159\u00edjmen\u00ed pacienta<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">zdravotn\u00ed poji\u0161\u0165ovna a rodn\u00e9 \u010d\u00edslo pacienta<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">datum a \u010das odb\u011bru<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">raz\u00edtko a podpis sestry, kter\u00e1 odb\u011br prov\u00e1d\u00ed<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">raz\u00edtko a podpis l\u00e9ka\u0159e indikuj\u00edc\u00ed odb\u011br<\/span><\/li><\/ul><p><span style=\"font-family: georgia, palatino, serif;\">\u00a0<\/span><\/p><p><span style=\"font-family: georgia, palatino, serif;\">P\u0159\u00edprava pacienta p\u0159ed odb\u011brem krve:<\/span><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">odpoledne a ve\u010der p\u0159ed odb\u011brem vynechejte tu\u010dn\u00e1 j\u00eddla.<\/span><\/li><\/ul><ul><li><span style=\"font-family: georgia, palatino, serif;\">pokud V\u00e1\u0161 l\u00e9ka\u0159 nedoporu\u010d\u00ed jinak, prov\u00e1d\u00ed se odb\u011bry z\u00e1sadn\u011b na la\u010dno.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">r\u00e1no p\u0159ed odb\u011brem je nutno vyp\u00edt zhruba 1\/4l neslazen\u00e9ho \u010daje nebo vody.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">pokud jste alergick\u00fd na dezinfek\u010dn\u00ed prost\u0159edek nebo ur\u010dit\u00fd typ n\u00e1plasti, oznamte tuto skute\u010dnost odeb\u00edraj\u00edc\u00ed sest\u0159e<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\"><u>p\u0159ipravte si p\u0159edem pr\u016fkaz zdravotn\u00ed poji\u0161\u0165ovny ke kontrole \u00fadaj\u016f.<\/u><\/span><\/li><\/ul><p><span style=\"font-family: georgia, palatino, serif;\"><strong>\u00a0<\/strong><\/span><\/p><p><span style=\"font-family: georgia, palatino, serif;\"><strong>Odb\u011br mo\u010de<\/strong><\/span><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">biochemick\u00e9 vy\u0161et\u0159en\u00ed mo\u010de pat\u0159\u00ed mezi z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed, kdy se mo\u010d zpracov\u00e1v\u00e1 chemicky a mikroskopicky.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">chemick\u00fdm vy\u0161et\u0159en\u00edm se z\u00edsk\u00e1v\u00e1 informace o pH mo\u010di, p\u0159\u00edtomnosti b\u00edlkoviny, gluk\u00f3zy, acetonu, \u017elu\u010dov\u00fdch barviv a krve.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">mikroskopicky se n\u00e1sledn\u011b v\u00a0mo\u010dov\u00e9m sedimentu hodnot\u00ed v\u00fdskyt erytrocyt\u016f, leukocyt\u016f, v\u00e1lc\u016f, soli a epiteli\u00ed.<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">v\u00fdsledky vy\u0161et\u0159en\u00ed mo\u010di informuj\u00ed zejm\u00e9na o onemocn\u011bn\u00ed vylu\u010dovac\u00edho syst\u00e9mu a rovn\u011b\u017e pod\u00e1vaj\u00ed p\u0159esn\u00e9 informace o stavu vnit\u0159n\u00edho prost\u0159ed\u00ed.<\/span><\/li><\/ul><p><span style=\"font-family: georgia, palatino, serif;\">\u00a0<\/span><\/p><p><span style=\"font-family: georgia, palatino, serif;\">Z\u00e1sady p\u0159i odb\u011bru mo\u010de:<\/span><\/p><ul><li><span style=\"font-family: georgia, palatino, serif;\">odb\u011br mo\u010di se prov\u00e1d\u00ed p\u0159i prvn\u00edm rann\u00edm mo\u010den\u00ed, z\u00a0tzv. st\u0159edn\u00edho proudu mo\u010de<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">t\u011bsn\u011b p\u0159ed odb\u011brem by m\u011bla b\u00fdt provedena o\u010dista zevn\u00edch genit\u00e1li\u00ed<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">p\u0159\u00edjem tekutin b\u011bhem noci by nem\u011bl b\u00fdt nadm\u011brn\u00fd, aby mo\u010d nebyla p\u0159\u00edli\u0161 na\u0159ed\u011bn\u00e1<\/span><\/li><li><span style=\"font-family: georgia, palatino, serif;\">mo\u010d se odeb\u00edr\u00e1 do p\u0159edem ozna\u010den\u00fdch zkumavek opat\u0159en\u00fdch z\u00e1tkou, pro bezpe\u010dn\u00fd transport do laborato\u0159e.<\/span><\/li><\/ul><p><span style=\"font-family: georgia, palatino, serif;\"><strong>Shrnut\u00ed:<\/strong><\/span><\/p><p><span style=\"font-family: georgia, palatino, serif;\">Odb\u011br krve nebo mo\u010de v\u017edy za\u010d\u00edn\u00e1 ordinac\u00ed l\u00e9ka\u0159e, kter\u00fd \u0159\u00e1dn\u011b vypln\u00ed \u017e\u00e1danku k\u00a0vy\u0161et\u0159en\u00ed biologick\u00e9ho materi\u00e1lu. Pacient by m\u011bl dodr\u017eet ve\u0161ker\u00e1 omezen\u00ed p\u0159ed odb\u011brem, aby v\u00fdsledek\u00a0 nebyl negativn\u011b ovlivn\u011bn. Sestra pak nav\u0161t\u00edv\u00ed pacienta v\u00a0domluven\u00e9m \u010dase a provede konkr\u00e9tn\u00ed v\u00fdkon. N\u00e1sledn\u011b zajist\u00ed transport materi\u00e1lu do laborato\u0159e, aby vy\u0161et\u0159en\u00ed mohlo b\u00fdt provedeno co nejrychleji. V\u00fdsledky vy\u0161et\u0159en\u00ed jsou z\u00a0laborato\u0159e p\u0159ed\u00e1ny l\u00e9ka\u0159i, kter\u00fd v\u00fdkon po\u017eadoval. Nej\u010dast\u011bji ji\u017e n\u00e1sleduj\u00edc\u00ed den m\u016f\u017eete b\u00fdt o v\u00fdsledku informov\u00e1ni o\u0161et\u0159uj\u00edc\u00edm l\u00e9ka\u0159em.<\/span><\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2606\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2606\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Aplikace injekc\u00ed<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2606\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2606\"><blockquote><blockquote><p>Pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f je nezbytnou sou\u010d\u00e1st\u00ed procesu l\u00e9\u010dby pacienta. Ve\u0161ker\u00e9 l\u00e9ky je nutn\u00e9 pod\u00e1vat velmi p\u0159esn\u011b, podle ordinace l\u00e9ka\u0159e a tak\u00e9 vhodn\u00fdm zp\u016fsobem. Nejobvyklej\u0161\u00ed a nejpohodln\u011bj\u0161\u00ed zp\u016fsob pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f je \u00fasty. V situac\u00edch, ve kter\u00fdch nelze podat l\u00e9ky \u00fasty, nap\u0159. pot\u0159ebujeme-li dos\u00e1hnout rychlej\u0161\u00edho n\u00e1stupu \u00fa\u010dinku l\u00e9ku, m\u016f\u017eeme podat l\u00e9ky pomoc\u00ed injekc\u00ed \u010dili parenter\u00e1ln\u011b. I v dom\u00e1c\u00edm prost\u0159ed\u00ed lze zajistit aplikaci l\u00e9\u010div\u00fdch l\u00e1tek pomoc\u00ed injekc\u00ed a to na z\u00e1klad\u011b ordinace l\u00e9ka\u0159e, kter\u00fd dle stavu a v\u00fdvoje Va\u0161eho onemocn\u011bn\u00ed ur\u010d\u00ed d\u00e1vku a \u010detnost pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f.<\/p><p>Mezi parenter\u00e1ln\u00ed aplikace pat\u0159\u00ed:<\/p><ul><li>s.c. \u2013 subkut\u00e1nn\u00ed aplikace \u2013 do podko\u017e\u00ed<\/li><li>i.m. \u2013 intramuskul\u00e1rn\u00ed \u2013 do svalu<\/li><li>i.v. \u2013 intraven\u00f3zn\u00ed \u2013 do \u017e\u00edly.<\/li><\/ul><\/blockquote><h4>INTRAMUSKUL\u00c1RN\u00cd INJEKCE je vpraven\u00ed \u00fa\u010dinn\u00e9ho l\u00e9ku do svalu:<\/h4><blockquote><p>\u00b7 do svalu se aplikuj\u00ed l\u00e9ky ve form\u011b roztoku, emulz\u00ed, olejnat\u00e9 l\u00e9ky a suspenze.<\/p><p>\u00b7 mno\u017estv\u00ed podan\u00e9 l\u00e1tky b\u00fdv\u00e1 obvykle 1-20ml.<\/p><p>\u00b7 nej\u010dast\u011bj\u0161\u00edm m\u00edstem aplikace je velk\u00fd a st\u0159edn\u00ed h\u00fd\u017e\u010fov\u00fd sval, d\u00e1le pak sval stehenn\u00ed, ev. deltov\u00fd sval na rameni.<\/p><p>\u00b7 v\u00fdhodou intramuskul\u00e1rn\u00edch injekc\u00ed je rychlej\u0161\u00ed vst\u0159eb\u00e1v\u00e1n\u00ed ne\u017e p\u0159i subkut\u00e1nn\u00ed aplikaci.<\/p><p>\u00b7 intramuskul\u00e1rn\u00ed aplikace se vyu\u017e\u00edv\u00e1 p\u0159edev\u0161\u00edm pro aplikaci:<\/p><ul><li>analgetik \u2013 l\u00e9ky tlum\u00edc\u00ed bolest: Almiral, Dolmina, Tramal.<\/li><li>myorelaxanci\u00ed \u2013 l\u00e9ky uvol\u0148uj\u00edc\u00ed kostern\u00ed svalstvo: Muscoril.<\/li><li>vitam\u00edn\u016f &#8211; Milgamma, B12, Neuromultivit, Calciferol.<\/li><\/ul><h4>Postup p\u0159i aplikaci injekce do svalu:<\/h4><p>\u00b7 sestra p\u0159ed v\u00fdkonem sezn\u00e1m\u00ed pacienta o zp\u016fsobu a \u00fa\u010delu aplikace.<\/p><p>\u00b7 dotazem zjist\u00ed, zda pacient netrp\u00ed alergi\u00ed na dezinfekci nebo l\u00e9k.<\/p><p>\u00b7 nachyst\u00e1 si pom\u016fcky k aplikaci, provede hygienickou dezinfekci rukou a p\u0159iprav\u00ed si injekci.<\/p><p>\u00b7 zkontroluje pom\u016fcky i ampuli s l\u00e9kem: n\u00e1zev, expiraci, mno\u017estv\u00ed, vzhled p\u0159\u00edpravku a to, zda je l\u00e9k ur\u010den k p\u0159edepsan\u00e9 aplikaci.<\/p><p>\u00b7 ur\u010d\u00ed vhodn\u00e9 m\u00edsto aplikace a ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy (poloha vle\u017ee na b\u0159i\u0161e, na boku, poloha na z\u00e1dech pop\u0159. vsed\u011b p\u0159i aplikaci do stehna).<\/p><p>\u00b7 provede dezinfekci, vypne k\u016f\u017ei v m\u00edst\u011b vpichu a rychl\u00fdm pohybem zavede injek\u010dn\u00ed jehlu do svalu, pod \u00fahlem 90\u00b0. U kachektick\u00fdch nemocn\u00fdch vytvo\u0159\u00ed ko\u017en\u00ed \u0159asu a jehlu zavede pod \u00fahlem 60\u00b0.<\/p><p>\u00b7 provede aspiraci a p\u0159i negativn\u00ed aspiraci pomalu aplikuje l\u00e9ky.<\/p><p>\u00b7 po vpraven\u00ed l\u00e9ku do svalu, jehlu vyjme, p\u0159ekryje m\u00edsto vpichu \u010dtvere\u010dkem, velmi lehce promas\u00edruje a p\u0159elep\u00ed n\u00e1plasti.<\/p><p>\u00b7 b\u011bhem v\u00fdkonu a po n\u011bm sleduje stav pacienta, v\u00fdskyt mo\u017en\u00fdch vedlej\u0161\u00edch \u00fa\u010dinku a n\u00e1sledn\u011b p\u0159em\u011b\u0159\u00ed fyziologick\u00e9 funkce (TK a P).<\/p><p>\u00b7 p\u0159i v\u00fdskytu ne\u017e\u00e1douc\u00edch \u00fa\u010dinku kontaktuje l\u00e9ka\u0159e.<\/p><h4>SUBKUT\u00c1NN\u00cd INJEKCE je vpraven\u00ed l\u00e9\u010debn\u00e9ho roztoku do podko\u017e\u00ed:<\/h4><p>\u00b7 vst\u0159eb\u00e1v\u00e1n\u00ed l\u00e9ku je pomal\u00e9, \u00fa\u010dinek se dostavuje za 10-20 minut.<\/p><p>\u00b7 mno\u017estv\u00ed podan\u00e9 l\u00e1tky b\u00fdv\u00e1 obvykle 0,2-2ml.<\/p><p>\u00b7 nej\u010dast\u011bj\u0161\u00edm m\u00edstem aplikace je zevn\u00ed strana pa\u017ee, zevn\u00ed strana stehna , oblast b\u0159icha a h\u00fd\u017ed\u011b.<\/p><p>\u00b7 touto formou se pod\u00e1vaj\u00ed:<\/p><ul><li>antikoagulancia \u2013 l\u00e9ky sni\u017euj\u00edc\u00ed sr\u00e1\u017elivost krve: Fraxiparin, Zibor .<\/li><li>inzulin \u2013 pou\u017e\u00edv\u00e1 se k l\u00e9\u010db\u011b cukrovky.<\/li><\/ul><p>\u00b7 k subkut\u00e1nn\u00ed aplikace se pou\u017e\u00edvaj\u00ed obvykle inzulinov\u00e9 st\u0159\u00edka\u010dky nebo p\u0159edpln\u011bn\u00e9 st\u0159\u00edka\u010dky se zabudovanou jehlou.<\/p><h4><span style=\"color: #808080;\">Postup p\u0159i aplikaci injekce do podko\u017e\u00ed:<\/span><\/h4><p>\u00b7 sestra p\u0159ed pod\u00e1n\u00edm l\u00e9ku provede identifikaci pacienta a zkontroluje ordinaci l\u00e9ka\u0159e.<\/p><p>\u00b7 dotazem zjist\u00ed, zda pacient netrp\u00ed alergi\u00ed na dezinfekci nebo l\u00e9k.<\/p><p>\u00b7 provede hygienickou dezinfekci rukou a p\u0159iprav\u00ed injekci s l\u00e9kem.<\/p><p>\u00b7 ur\u010d\u00ed vhodn\u00e9 m\u00edsto k aplikaci a ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy.<\/p><p>\u00b7 provede dezinfekci m\u00edsta vpichu dle zvyklost\u00ed pacienta.<\/p><p>\u00b7 suspenze p\u0159ed aplikac\u00ed prom\u00edch\u00e1 (roluje mezi dlan\u011bmi nebo p\u0159evr\u00e1t\u00ed, net\u0159epe).<\/p><p>\u00b7 inzulin nat\u00e1hne v mezin\u00e1rodn\u00edch jednotk\u00e1ch dle ordinace l\u00e9ka\u0159e.<\/p><p>\u00b7 po odstran\u011bn\u00ed krytu z jehly provede vpich do ko\u017en\u00ed \u0159asy pod \u00fahlem 45\u00b0nebo 90\u00b0, podle d\u00e9lky jehly a typu k\u016f\u017ee.<\/p><p>\u00b7 p\u0159i aplikaci antikoagulanci\u00ed neodstra\u0148uje vzduchovou bublinu, neaspiruje a po celou dobu aplikace dr\u017e\u00ed ko\u017en\u00ed \u0159asu.<\/p><p>\u00b7 aplikuje l\u00e9k zatla\u010den\u00edm na p\u00edst, u inzulinu stiskem d\u00e1vkovac\u00edho tla\u010d\u00edtka.<\/p><p>\u00b7 po aplikaci l\u00e9ku vy\u010dk\u00e1 p\u0159ibli\u017en\u011b 5-10 vte\u0159in a pot\u00e9 jehlu vyt\u00e1hne.<\/p><p>\u00b7 po aplikaci n\u00edzkomolekul\u00e1rn\u00edho heparinu nemas\u00edruje m\u00edsto vpichu.<\/p><p>\u00b7 m\u00edsta vpichu pravideln\u011b st\u0159\u00edd\u00e1.<\/p><p>\u00b7 pou\u017eit\u00e9 jehly a st\u0159\u00edka\u010dky odlo\u017e\u00ed do n\u00e1doby k tomu ur\u010den\u00e9.<\/p><h4>Shrnut\u00ed:<\/h4><p>I v dom\u00e1c\u00edm prost\u0159ed\u00ed lze zajisti aplikaci l\u00e9\u010div\u00fdch l\u00e1tek pomoc\u00ed injekc\u00ed. T\u00fdk\u00e1 se to pacient\u016f, kte\u0159\u00ed se nemohou z d\u016fvodu akutn\u00edho nebo chronick\u00e9ho onemocn\u011bn\u00ed dostavit k l\u00e9ka\u0159i. Aplikaci injekc\u00ed indikuje l\u00e9ka\u0159, kter\u00fd vystav\u00ed recept a dle stavu onemocn\u011bn\u00ed p\u0159edep\u00ed\u0161e d\u00e1vku a \u010detnost aplikace l\u00e9k\u016f. N\u00e1sledn\u011b sestra, kter\u00e1 je vybavena pot\u0159ebn\u00fdmi pom\u016fckami jako dezinfekce, injek\u010dn\u00ed st\u0159\u00edka\u010dky a jehly, n\u00e1plasti, nav\u0161t\u00edv\u00ed pacienta v jeho dom\u00e1c\u00edm prost\u0159ed\u00ed a dle po\u017eadavku l\u00e9ka\u0159e aplikuje l\u00e9ky podle p\u0159edem stanoven\u00e9ho harmonogramu.<\/p><\/blockquote><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2607\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2607\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Aplikace inzul\u00ednu<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2607\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2607\"><blockquote><p>Diabetes mellitus je komplexn\u00ed metabolick\u00e1 porucha, p\u0159i n\u00ed\u017e organismus nen\u00ed schopen zpracov\u00e1vat gluk\u00f3zu jako za fyziologick\u00fdch podm\u00ednek v\u00a0d\u016fsledku absolutn\u00edho nebo relativn\u00edho nedostatku inzulinu a sou\u010dasn\u00e9 perifern\u00ed inzulinov\u00e9 rezistenci. L\u00e9\u010d\u00ed se obvykle dietou a antidiabetiky v\u00a0tabletov\u00e9 form\u011b, ale v\u00a0n\u011bkter\u00fdch p\u0159\u00edpadech se vol\u00ed l\u00e9\u010dba inzulinem.<\/p><p>Inzulin je hormon produkovan\u00fd beta-bu\u0148kami slinivky b\u0159i\u0161n\u00ed. Jeho nejd\u016fle\u017eit\u011bj\u0161\u00ed funkci je udr\u017een\u00ed norm\u00e1ln\u00ed koncentrace gluk\u00f3zy v\u00a0krvi a zaji\u0161t\u011bn\u00ed jej\u00edho vstupu do bun\u011bk.<\/p><p>Inzulin se pod\u00e1v\u00e1 ve form\u011b podko\u017en\u00ed injekce v\u00a0r\u016fzn\u00fdch sch\u00e9matech, tzv. inzulinov\u00fdch re\u017eimech, podle stadia a typu onemocn\u011bn\u00ed. Aplikuje se do m\u00edst s\u00a0v\u011bt\u0161\u00edm mno\u017estv\u00edm tuku, nej\u010dast\u011bji do oblasti b\u0159icha, horn\u00ed zevn\u00ed poloviny pa\u017ee, p\u0159edn\u00ed strany stehen a horn\u00ed t\u0159etiny h\u00fd\u017ed\u00ed. M\u00edsta aplikace je nutno st\u0159\u00eddat, postupovat systematicky a neaplikovat do m\u00edst zan\u00edcen\u00fdch \u010di bolestiv\u00fdch. Nejpou\u017e\u00edvan\u011bj\u0161\u00ed pom\u016fckou pro podko\u017en\u00ed aplikaci je inzulinov\u00e9 pero, do kter\u00e9ho se vkl\u00e1daj\u00ed cartridge \u2013 n\u00e1boje (sklen\u011bn\u00e9 n\u00e1dobky s\u00a0inzulinem) nebo inzulinov\u00e1 pera jednor\u00e1zov\u00e1 &#8211; p\u0159edpln\u011bn\u00e1.<\/p><p>Inzulin se pod\u00e1v\u00e1 s\u00a0ur\u010dit\u00fdm p\u0159edstihem, v\u00a0p\u0159\u00edpad\u011b lidsk\u00e9ho inzulinu je doporu\u010dov\u00e1no 15-30minut p\u0159ed j\u00eddlem, u inzulinov\u00fdch analog\u016f t\u011bsn\u011b p\u0159ed nebo na za\u010d\u00e1tku j\u00eddla. Ide\u00e1ln\u00ed odstup m\u016f\u017ee b\u00fdt individu\u00e1ln\u00ed, v\u017edy z\u00e1le\u017e\u00ed na ordinaci l\u00e9ka\u0159e &#8211; diabetologa.\u00a0<\/p><p>Postup p\u0159i aplikace inzulinu:<\/p><ul><li>sestra p\u0159ed aplikaci informuje pacienta o nutnosti a zp\u016fsobu aplikace.<\/li><li>ulo\u017e\u00ed pacienta do polohy vsed\u011b, event. vle\u017ee.<\/li><li>pohledem zkontroluje nez\u00e1vadnost inzulinu.<\/li><li>suspenze p\u0159ed aplikaci prom\u00edch\u00e1 (roluje mezi dlan\u011bmi nebo n\u011bkolikr\u00e1t p\u0159evr\u00e1t\u00ed).<\/li><li>nat\u00e1hne inzulin v\u00a0mezin\u00e1rodn\u00edch jednotk\u00e1ch podle ordinace l\u00e9ka\u0159e.<\/li><li>zvol\u00ed a dezinfikuje m\u00edsto vpichu. V\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed p\u0159i dodr\u017eov\u00e1n\u00ed hygienick\u00fdch podm\u00ednek posta\u010duje \u010dist\u00e9 aplika\u010dn\u00ed m\u00edsto.<\/li><li>sund\u00e1 kryt z\u00a0jehly.<\/li><li>vytvo\u0159\u00ed ko\u017en\u00ed \u0159asu v\u00a0m\u00edst\u011b vpichu a \u0161etrn\u011b aplikuje inzulin pod \u00fahlem 90\u00b0nebo 45\u00b0 (volba \u00fahlu z\u00e1vis\u00ed na stavu podko\u017en\u00ed konstituce t\u011bla, d\u00e9lky jehly apod.)<\/li><li>m\u00edsta vpichu d\u016fkladn\u011b st\u0159\u00edd\u00e1, \u010d\u00edm\u017e chr\u00e1n\u00ed tk\u00e1\u0148 p\u0159ed po\u0161kozen\u00edm (lipodystrofie).<\/li><li>stejn\u00e9 m\u00edsto nepou\u017e\u00edv\u00e1 k\u00a0aplikaci v\u00edcekr\u00e1t ne\u017e 1x za m\u011bs\u00edc. Injekce by m\u011bly b\u00fdt rozm\u00edst\u011bny alespo\u0148 2cm od sebe.<\/li><li>pomalu aplikuje d\u00e1vku inzulinu stiskem d\u00e1vkovac\u00edho tla\u010d\u00edtka.<\/li><li>d\u00e1vkova\u010d ponech\u00e1 v\u00a0m\u00edst\u011b vpichu alespo\u0148 5-10 sekund po \u00fapln\u00e9m zatla\u010den\u00ed d\u00e1vky.<\/li><li>pot\u00e9 jehlu opatrn\u011b vyt\u00e1hne.<\/li><li>provede z\u00e1znam do den\u00ed\u010dku pacienta a do zdravotnick\u00e9 dokumentace.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>L\u00e9\u010dba inzulinem vy\u017eaduje pravidelnost, pod\u00e1v\u00e1n\u00ed inzulinu a \u00fapravy d\u00e1vek souvis\u00ed jak s\u00a0j\u00eddlem, tak b\u011b\u017en\u00fdmi denn\u00edmi \u00fakony. \u00dasp\u011b\u0161nost l\u00e9\u010dby z\u00e1vis\u00ed na diabetikovi samotn\u00e9m. Pokud pacient nen\u00ed schopen aplikovat inzulin samostatn\u011b, je zde mo\u017enost zaji\u0161t\u011bn\u00ed dom\u00e1c\u00ed p\u00e9\u010de. V\u00a0takov\u00e9m p\u0159\u00edpad\u011b, sestra doj\u00ed\u017ed\u00ed za pacientem dom\u016f a dle domluvy, v\u00a0pravideln\u00fdch \u010dasech a v\u00a0z\u00e1vislosti na j\u00eddle aplikuje inzulin dle ordinace l\u00e9ka\u0159e.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2608\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-2608\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">N\u00e1cvik a zau\u010dov\u00e1n\u00ed aplikace inzul\u00ednu<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2608\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-2608\"><blockquote><p>Pokud je pacient propu\u0161t\u011bn do dom\u00e1c\u00edho o\u0161et\u0159en\u00ed a je mu zavedena l\u00e9\u010dba inzulinem, lze ze za\u010d\u00e1tku vyu\u017e\u00edt dom\u00e1c\u00ed p\u00e9\u010di k\u00a0n\u00e1cviku aplikace inzulinu. Sest\u0159i\u010dka z\u00a0dom\u00e1c\u00ed p\u00e9\u010de nav\u0161t\u00edv\u00ed pacienta doma a dle doporu\u010den\u00ed l\u00e9ka\u0159e u\u010d\u00ed pacienta aplikovat inzulin, zach\u00e1zet s\u00a0inzulinov\u00fdm perem a glukometrem. Pokud se pacient stane samostatn\u00fdm, je mo\u017eno dom\u00e1c\u00ed p\u00e9\u010di ukon\u010dit.<\/p><p>Postup p\u0159i n\u00e1cviku aplikace inzulinu:<\/p><ul><li>sestra sezn\u00e1m\u00ed pacienta s\u00a0v\u00fdkonem.<\/li><li>edukuje pacienta nebo i rodinn\u00e9 p\u0159\u00edslu\u0161n\u00edky o:<ul><li>nutnosti inzulinoterapie \u2013 dodr\u017eov\u00e1n\u00ed p\u0159edepsan\u00e9 d\u00e1vky, veden\u00ed z\u00e1znamu d\u00e1vek inzulinu.<\/li><li>zp\u016fsobu aplikace inzulinu:<ul><li>m\u00edsto autoaplikace \u2013 podko\u017e\u00ed b\u0159icha, stehna.<\/li><li>dal\u0161\u00ed m\u00edsta vpichu \u2013 horn\u00ed \u010d\u00e1st pa\u017ee, h\u00fd\u017ed\u011b.<\/li><\/ul><\/li><li>nutnosti st\u0159\u00eddat m\u00edsta vpichu.<\/li><li>neaplikovat do otekl\u00e9ho, barevn\u011b zm\u011bn\u011bn\u00e9ho, bolestiv\u00e9ho nebo zatvrdl\u00e9ho m\u00edsta.<\/li><li>dodr\u017eov\u00e1n\u00ed z\u00e1sad osobn\u00ed hygieny p\u0159i aplikaci.<\/li><li>dodr\u017eov\u00e1n\u00ed doby z\u00e1vislosti na j\u00eddle.<\/li><li>pou\u017e\u00edv\u00e1n\u00ed a manipulaci s\u00a0inzulinov\u00fdm perem:<ul><li>z\u00e1soby inzulinu nutno skladovat v\u00a0lednici p\u0159i teplot\u011b 2-8\u00b0C.<\/li><li>pou\u017e\u00edvan\u00fd inzulin skladovat p\u0159i pokojov\u00e9 teplot\u011b.<\/li><li>nepou\u017e\u00edvat inzulin po expiraci.<\/li><li>po ka\u017ed\u00e9 v\u00fdm\u011bn\u011b n\u00e1pln\u011b inzulinu odst\u0159ihnout 1 a\u017e 2 jednotky.<\/li><li>suspenze p\u0159ed aplikac\u00ed prom\u00edchat.<\/li><\/ul><\/li><li>riziku vzniku akutn\u00edch i chronick\u00fdch komplikac\u00ed.<\/li><li>sledov\u00e1n\u00ed a rozpozn\u00e1n\u00ed akutn\u00edch p\u0159\u00edznak\u016f u:<ul><li><em>hypoglykemie<\/em> \u2013 t\u0159es, chv\u011bn\u00ed, pocen\u00ed, nervozita, bledost, ospalost apod. \u2192 nadm\u011brn\u00e1 d\u00e1vka inzulinu, neadekv\u00e1tn\u00ed nebo opo\u017ed\u011bn\u00fd p\u0159\u00edjem potravy, nep\u0159im\u011b\u0159en\u00e1 fyzick\u00e1 aktivita.<\/li><li><em>hyperglykemie <\/em>\u2013 polyurie, polydipsie, slabost, mal\u00e1tnost, letargie apod. \u2192 nedostate\u010dn\u00e1 d\u00e1vka inzulinu, nekontrolovan\u00fd p\u0159\u00edsun stravy, nemoc.<\/li><\/ul><\/li><li>selfmonitoringu \u2013 pou\u017e\u00edv\u00e1n\u00ed glukometru, prov\u00e1d\u011bn\u00ed z\u00e1znamu glykemi\u00ed.<\/li><li>d\u00e1le sestra informuje pacienta o zdrav\u00e9m \u017eivotn\u00edm stylu v\u010detn\u011b stravy a pohybu.<\/li><li>v\u00a0p\u00e9\u010di o nohy a v\u00fdb\u011bru vhodn\u00e9 obuvi.<\/li><\/ul><\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Za\u010d\u00e1tek nov\u00e9 l\u00e9\u010dby p\u0159in\u00e1\u0161\u00ed do \u017eivota pacienta ur\u010ditou nejistotu. Pokud je pacient nebo jeho rodina nejist\u00e1 jak postupovat a zvl\u00e1dat nov\u00e9 situace, je mo\u017eno vyu\u017e\u00edt slu\u017eeb dom\u00e1c\u00ed p\u00e9\u010de. Sest\u0159i\u010dka, kter\u00e1 doch\u00e1z\u00ed za pacientem dom\u016f, edukuje pacienta o nutnosti dodr\u017eovat l\u00e9\u010debn\u00fd re\u017eim. Ten spo\u010d\u00edv\u00e1 v\u00a0pravideln\u00e9 aplikaci inzulinu, pravideln\u00e9m u\u017e\u00edv\u00e1n\u00ed l\u00e9k\u016f, dodr\u017eov\u00e1n\u00ed vyv\u00e1\u017een\u00e9 stravy, no\u0161en\u00ed vhodn\u00e9 obuvi apod. Tato p\u00e9\u010de je rovn\u011b\u017e hrazena ze zdravotn\u00edho poji\u0161t\u011bn\u00ed.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2609\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-2609\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">M\u011b\u0159en\u00ed glykemie<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2609\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-2609\"><blockquote><p>Selfmonitoring neboli samostatn\u00e9, dom\u00e1c\u00ed m\u011b\u0159en\u00ed hladiny gluk\u00f3zy v\u00a0krvi je ned\u00edlnou sou\u010d\u00e1st\u00ed \u017eivota pacient\u016f s\u00a0diabetem. V\u00a0praxi to znamen\u00e1, \u017ee si pacient zm\u011b\u0159\u00ed glykemi\u00ed glukometrem a na z\u00e1klad\u011b nam\u011b\u0159en\u00e9ho v\u00fdsledku si m\u016f\u017ee upravit d\u00e1vku inzulinu nebo p\u0159\u00edjem potravy. Prov\u00e1d\u00ed se pomoc\u00ed osobn\u00edch glukometr\u016f s\u00a0vyu\u017eit\u00edm kompatibiln\u00edch testovac\u00edch prou\u017eku. Pacienti jsou sv\u00fdm l\u00e9ka\u0159em \u2013 diabetologem edukov\u00e1n\u00ed o hodnot\u00e1ch glykemie, stejn\u011b tak maj\u00ed stanoveno kdy se m\u00e1 glykemie m\u011b\u0159it, jak maj\u00ed v\u00e9st z\u00e1znam a jak upravovat podle selfmonitoringu re\u017eim. C\u00edlem selfmonitoringu je tedy udr\u017eet glykemii co nejbl\u00ed\u017ee c\u00edlov\u00fdm hodnot\u00e1m a p\u0159edej\u00edt jak vysok\u00fdm hodnot\u00e1m cukru (hyperglykemii), tak n\u00edzk\u00fdm hodnot\u00e1m cukru (hypoglykemii).<\/p><p>Postup p\u0159i odb\u011bru kapil\u00e1rn\u00ed krve:<\/p><ul><li>sestra informuje pacienta o v\u00fdkonu.<\/li><li>pacient si umyje ruce m\u00fddlem a teplou vodou a n\u00e1sledn\u011b je d\u016fkladn\u011b osu\u0161\u00ed.<\/li><li>sestra odb\u011brov\u00e9 m\u00edsto (prst) nedezinfikuje, pouze opl\u00e1chne vodou nebo umyje m\u00fddlem.<\/li><li>pokud odb\u011brov\u00e9 m\u00edsto dezinfikuje, prvn\u00ed kapku set\u0159e.<\/li><li>zapne glukometr a nasad\u00ed testovac\u00ed prou\u017eek.<\/li><li>provede vpich pomoc\u00ed lancety nebo odb\u011brov\u00e9ho pera (autolancety) z\u00a0bo\u010dn\u00ed strany prstu, zejm\u00e9na 3-5. prstu nedominantn\u00ed ruky.<\/li><li>p\u0159ilo\u017e\u00ed prst k\u00a0prou\u017eku (samonas\u00e1vac\u00ed), pokud nen\u00ed uvedeno v\u00a0n\u00e1vodu na obsluhu jinak.<\/li><li>k\u00a0m\u011b\u0159en\u00ed pou\u017eije dostate\u010dn\u00e9 mno\u017estv\u00ed krve.<\/li><li>po\u010dk\u00e1 na v\u00fdsledek (n\u011bkolik sekund).<\/li><li>zlikviduje prou\u017eek bezpe\u010dn\u00fdm zp\u016fsobem.<\/li><li>provede z\u00e1znam do glykemick\u00e9 karty pacienta a do zdravotnick\u00e9 dokumentace.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Samokontrole cukru v\u00a0krvi se \u0159\u00edk\u00e1 selfmonitoring. Prov\u00e1d\u00ed se jak v\u00a0\u00favodu nemoci tak periodicky a umo\u017e\u0148uje z\u00edskat p\u0159ehled o profilech, kter\u00e9 poukazuj\u00ed na re\u00e1lnou situaci nemocn\u00e9ho. Monitoring glyk\u00e9mie mus\u00ed b\u00fdt prov\u00e1d\u011bn\u00fd pravideln\u011b, systematicky s\u00a0c\u00edlem udr\u017een\u00ed motivace a kompliance diabetika. V\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed se prov\u00e1d\u00ed se 1-3x denn\u011b dle ordinace l\u00e9ka\u0159e. \u00dakolem sestry je rovn\u011b\u017e sledov\u00e1n\u00ed zda pacient techniku selfmonitoringu zvl\u00e1d\u00e1, podpor a motivace<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26010\" class=\"elementor-tab-title\" data-tab=\"10\" role=\"button\" aria-controls=\"elementor-tab-content-26010\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Aplikace infuzn\u00ed terapie<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26010\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"10\" role=\"region\" aria-labelledby=\"elementor-tab-title-26010\"><p>Dal\u0161\u00ed mo\u017enosti jak aplikovat l\u00e9ky mimo tr\u00e1vic\u00ed trakt je zp\u016fsob intraven\u00f3zn\u00ed \u010dili nitro\u017eiln\u00ed. Intraven\u00f3zn\u00ed pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f hraje v p\u00e9\u010di o pacienty v\u00fdznamnou \u00falohu s c\u00edlem uzdravit nebo zlep\u0161it jejich zdravotn\u00ed stav.\u00a0 Infuzn\u00ed terapie p\u0159edstavuje vpraven\u00ed v\u011bt\u0161\u00edho mno\u017estv\u00ed tekutin nebo l\u00e9k\u016f do organismu nitro\u017eiln\u00ed cestou. Infuzi pod\u00e1v\u00e1me do perifern\u00edho nebo centr\u00e1ln\u00edho kat\u00e9tru. M\u016f\u017eeme ji tak\u00e9 aplikovat subkut\u00e1nn\u011b neboli podko\u017en\u011b, tento zp\u016fsob se pak naz\u00fdv\u00e1 hypodermokl\u00fdza, a pou\u017e\u00edv\u00e1 se p\u0159ev\u00e1\u017en\u011b v dom\u00e1c\u00ed hospicov\u00e9 p\u00e9\u010di a rovn\u011b\u017e v paliativn\u00ed p\u00e9\u010di jako preferovan\u00fd zp\u016fsob pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f.<\/p><p><strong>Nej\u010dast\u011bj\u0161\u00ed d\u016fvody aplikace infuzn\u00ed terapie:<\/strong><\/p><ul><li>z\u00e1soben\u00ed organismu tekutinou v situac\u00edch, kdy pacient nen\u00ed schopen p\u0159ij\u00edmat dostate\u010dn\u00e9 mno\u017estv\u00ed tekutiny \u00fasty.<\/li><li>zabezpe\u010den\u00ed dod\u00e1vky v\u00fd\u017eivy v situac\u00edch, kdy pacient nen\u00ed schopen p\u0159ij\u00edmat dostate\u010dn\u00e9 mno\u017estv\u00ed potravy \u00fasty.<\/li><li>vytvo\u0159en\u00ed zp\u016fsobu rychl\u00e9ho pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f.<\/li><\/ul><p><strong>Zp\u016fsoby aplikace infuzn\u00ed terapie:<\/strong><\/p><ol><li><span style=\"color: #993300;\"><em><strong>Pomoc\u00ed perifern\u00edho \u017eiln\u00edho kat\u00e9tru<\/strong>, kdy se zavede kanyla do perifern\u00ed \u017e\u00edly, do kter\u00e9 je pod\u00e1v\u00e1na infuze.<\/em><\/span><\/li><\/ol><p><strong>Postup p\u0159i pod\u00e1v\u00e1n\u00ed infuze:<\/strong><\/p><ul><li>sestra p\u0159ed samotn\u00fdm v\u00fdkonem sezn\u00e1m\u00ed pacienta se zp\u016fsobem zaveden\u00ed kanyly a pod\u00e1n\u00ed infuze.<\/li><li>p\u0159iprav\u00ed si pom\u016fcky a infuzn\u00ed sm\u011bs (do infuzn\u00ed l\u00e1hve za aseptick\u00e9ho postupu aplikuje injek\u010dn\u00ed st\u0159\u00edka\u010dkou ordinovan\u00fd l\u00e9k).<\/li><li>ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy a zajist\u00ed vhodnou polohu kon\u010detiny.<\/li><li>po p\u0159ilo\u017een\u00ed turniketu, p\u0159ibli\u017en\u011b 5cm nad p\u0159edpokl\u00e1dan\u00fdm m\u00edstem vpichu, provede dezinfekci m\u00edsta vpichu ot\u011brem od st\u0159edu.<\/li><li>po zaschnut\u00ed dezinfekce zavede kanylu a uvoln\u00ed za\u0161krcen\u00ed kon\u010detiny.<\/li><li>n\u00e1sledn\u011b povyt\u00e1hne mandr\u00e9n, zasune plastov\u00fd kat\u00e9tr a napoj\u00ed spojovac\u00ed hadi\u010dku s fyziologick\u00fdm roztokem.<\/li><li>provede proplach kat\u00e9tru, zkontroluje m\u00edsto vpichu nad zaveden\u00fdm kat\u00e9trem a sleduje p\u0159itom reakci pacienta.<\/li><li>m\u00edsto vpichu steriln\u011b p\u0159elep\u00ed zvolen\u00fdm kryt\u00edm, ozna\u010d\u00ed datem a \u010dasem zaveden\u00ed.<\/li><li>pot\u00e9 napoj\u00ed infuzn\u00ed soupravu a nastav\u00ed rychlost infuze \u2013 po\u010det ml\/h.<\/li><li>sestra b\u011bhem infuzn\u00ed terapie pravideln\u011b sleduje a hodnot\u00ed m\u00edsto vpichu a jeho okol\u00ed (Klasifikace dle Maddona).<\/li><li>p\u0159i ukon\u010den\u00ed infuze, uzav\u0159e soupravu tla\u010dkou, uvoln\u00ed kryt\u00ed a vyt\u00e1hne kat\u00e9tr, m\u00edsto vpichu p\u0159elep\u00ed n\u00e1plasti.<\/li><li>p\u0159i opakovan\u00e9 infuzn\u00ed terapii, odpoj\u00ed set od spojovac\u00ed hadi\u010dky a provede proplach 10ml FR metodou start-stop, uzav\u0159e z\u00e1tkou a spojovac\u00ed hadi\u010dku fixuje ke kon\u010detin\u011b n\u00e1plasti.<\/li><li>v\u0161e zaznamen\u00e1 do pacientovy zdravotn\u00ed dokumentace.<\/li><\/ul><ol start=\"2\"><li><em><span style=\"color: #993300;\"><strong> Pomoc\u00ed centr\u00e1ln\u00edho \u017eiln\u00edho kat\u00e9tru,<\/strong> nej\u010dast\u011bji do ven\u00f3zn\u00edho portu.<\/span><\/em><\/li><\/ol><ul><li>ven\u00f3zn\u00ed port zaji\u0161\u0165uje dlouhodob\u00fd p\u0159\u00edstup do c\u00e9vn\u00edho \u0159e\u010di\u0161t\u011b.<\/li><li>skl\u00e1d\u00e1 se z kat\u00e9tru, kter\u00fd je zaveden do centr\u00e1ln\u00ed \u017e\u00edly a portu (kom\u016frky), ke kter\u00e9mu je kat\u00e9tr pevn\u011b p\u0159ipojen. T\u011blo kom\u016frky je um\u00edst\u011bno pod k\u016f\u017ei, nej\u010dast\u011bji na hrudn\u00edku.<\/li><\/ul><p>\u00a0Postup p\u0159i pod\u00e1v\u00e1n\u00ed infuze:<\/p><ul><li>sestra informuje pacienta o\u00a0v\u00fdkonu.<\/li><li>provede hygienickou dezinfekci rukou, p\u0159iprav\u00ed si pom\u016fcky k zaveden\u00ed jehly, ulo\u017e\u00ed pacienta do polohy vle\u017ee a vyzve ho ke spolupr\u00e1ci.<\/li><li>ve steriln\u00edch rukavic\u00edch a po proveden\u00ed dezinfekce m\u00edsta vpichu zavede Huberovou jehlu do portov\u00e9 kom\u016frky.<\/li><li>provede aspiraci krve, z d\u016fvodu kontroly spr\u00e1vn\u00e9 lokalizace jehly v kom\u016frce.<\/li><li>n\u00e1sledn\u011b napoj\u00ed 20ml st\u0159\u00edka\u010dku s fyziologick\u00fdm roztokem a provede proplach.<\/li><li>jehlu zajist\u00ed proti pohybu, dle pot\u0159eby podlo\u017e\u00ed steriln\u00edm kryt\u00edm a p\u0159elep\u00ed steriln\u00ed foli\u00ed a ozna\u010d\u00ed datem a \u010dasem zaveden\u00ed.<\/li><li>napoj\u00ed infuzn\u00ed soupravu a nastav\u00ed rychlost infuze (ml\/hod).<\/li><li>pokud pou\u017eije k nastaven\u00ed rychlosti infuzn\u00ed pumpu, zalo\u017e\u00ed set do pumpy, na kom\u016frku p\u0159ipevn\u00ed kapkov\u00fd senzor a po zalo\u017een\u00ed setu uvoln\u00ed tla\u010dku.<\/li><li>pak zad\u00e1 rychlost nebo hodnotu celkov\u00e9ho objemu a doby, po kterou m\u00e1 infuze kapat.<\/li><li>b\u011bhem pod\u00e1v\u00e1n\u00ed infuze hodnot\u00ed pacientovu reakci na infuzn\u00ed terapii, sleduje m\u00edsto vpichu a dodr\u017eov\u00e1n\u00ed p\u0159edepsan\u00e9 terapie.<\/li><li>p\u0159i v\u00fdskytu komplikac\u00ed informuje l\u00e9ka\u0159e.<\/li><\/ul><ol start=\"3\"><li><em><span style=\"color: #993300;\"><strong> Pomoc\u00ed subkut\u00e1nn\u00ed kanyly, <\/strong>kdy je infuze pod\u00e1v\u00e1na do podko\u017e\u00ed = hypodermokl\u00fdza<\/span><\/em><\/li><\/ol><ul><li>k zaveden\u00ed se pou\u017e\u00edv\u00e1 nej\u010dast\u011bji kanyla \u2013 mot\u00fdlek (jehla s k\u0159id\u00e9lkem a spojovac\u00ed hadi\u010dkou).<\/li><li>kanylka se zav\u00e1d\u00ed do podko\u017e\u00ed na p\u0159edn\u00ed stran\u011b hrudn\u00edku, v oblasti b\u0159icha, pa\u017ee a stehna.<\/li><\/ul><p>\u00a0Postup p\u0159i zaveden\u00ed infuze:<\/p><ul><li>sestra informuje pacienta o nutnosti zaveden\u00ed infuzn\u00ed terapie.<\/li><li>provede hygienickou dezinfekci rukou a p\u0159iprav\u00ed infuzi.<\/li><li>po \u0159\u00e1dn\u00e9 dezinfekci nabodne z\u00e1tku infuzn\u00ed l\u00e1hve (vaku) bodcem infuzn\u00ed soupravy, napln\u00ed kom\u016frku soupravy a odstran\u00ed vzduchov\u00e9 bubliny, uzav\u0159e hadi\u010dku tla\u010dkou.<\/li><li>propl\u00e1chne spojovac\u00ed hadi\u010dku kanyly fyziologick\u00fdm roztokem.<\/li><li>ulo\u017e\u00ed pacienta do pohodln\u00e9 polohy, vybere m\u00edsto vpichu, kter\u00e9 dezinfikuje a zavede kanylu.<\/li><li>uchop\u00ed jehlu za k\u0159id\u00e9lka, sund\u00e1 kryt z\u00a0jehly a druhou rukou chyt\u00ed k\u016f\u017ei dv\u011bma prsty a vytvo\u0159\u00ed ko\u017en\u00ed \u0159asu.<\/li><li>\u0161ikm\u00fdm vpichem zavede kanylu do podko\u017e\u00ed v cel\u00e9 jej\u00ed d\u00e9lce.<\/li><li>n\u00e1sledn\u011b jehlu a hadi\u010dku fixuje jako klasick\u00fd perifern\u00ed vstup.<\/li><li>napoj\u00ed infuzn\u00ed soupravu a nastav\u00ed rychlost infuze.<\/li><li>kanylka m\u016f\u017ee b\u00fdt do podko\u017e\u00ed zaveden\u00e1 5-7 dn\u00ed a infuzn\u00ed set je odpojov\u00e1n za proplachu fyziologick\u00fdm roztokem.<\/li><li>m\u00edsto vpichu sestra pravideln\u011b kontroluje a st\u0159\u00edd\u00e1.<\/li><li>pro hydrataci v dom\u00e1c\u00edm prost\u0159ed\u00ed je tolerov\u00e1na d\u00e1vka a\u017e 1500ml\/24h.<\/li><li>aplikace do podko\u017e\u00ed se v\u00a0paliativn\u00ed p\u00e9\u010di rovn\u011b\u017e pou\u017e\u00edv\u00e1 ke kontinu\u00e1ln\u00edmu pod\u00e1v\u00e1n\u00ed l\u00e9k\u016f.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>O pod\u00e1n\u00ed infuzn\u00ed terapie v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed v\u017edy rozhoduje l\u00e9ka\u0159, kter\u00fd vych\u00e1z\u00ed z\u00a0aktu\u00e1ln\u00edho zdravotn\u00edho stavu pacienta. Ten ordinuje infuzn\u00ed roztok a l\u00e9ky, kter\u00e9 do n\u011bj budou p\u0159id\u00e1ny. Sestra na z\u00e1klad\u011b indikace l\u00e9ka\u0159e infuzi p\u0159iprav\u00ed a pod\u00e1v\u00e1, korektn\u011b s\u00a0dodr\u017eov\u00e1n\u00edm v\u0161ech z\u00e1sad asepse. \u00a0Sestra je rovn\u011b\u017e vybavena pot\u0159ebn\u00fdmi pom\u016fckami jako dezinfekce, injek\u010dn\u00ed st\u0159\u00edka\u010dky a jehly, n\u00e1plasti, infuzn\u00ed soupravy, infuzn\u00ed pumpy nebo line\u00e1rn\u00ed d\u00e1vkova\u010de. Pacienta v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed nav\u0161t\u00edv\u00ed po vz\u00e1jemn\u00e9 domluv\u011b a infuzn\u00ed terapie je pod\u00e1v\u00e1na dle p\u0159edem stanoven\u00e9ho \u010dasov\u00e9ho pl\u00e1nu.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26011\" class=\"elementor-tab-title\" data-tab=\"11\" role=\"button\" aria-controls=\"elementor-tab-content-26011\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">O\u0161et\u0159ov\u00e1n\u00ed ran<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26011\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"11\" role=\"region\" aria-labelledby=\"elementor-tab-title-26011\"><p>R\u00e1na je definov\u00e1na jako poru\u0161en\u00ed kontinuity ko\u017en\u00edho povrchu a integrity organismu, poru\u0161en\u00ed anatomick\u00e9 struktury a funkce k\u016f\u017ee zp\u016fsoben\u00e9 r\u016fzn\u00fdmi p\u0159\u00ed\u010dinami zasahuj\u00edc\u00edmi r\u016fzn\u011b hluboko do podko\u017en\u00edch tk\u00e1n\u00ed.<\/p><p>R\u00e1ny klasifikujeme z\u00a0n\u011bkolika hledisek. Podle pr\u016fb\u011bhu a d\u00e9lky hojen\u00ed rozli\u0161ujeme r\u00e1ny akutn\u00ed a chronick\u00e9.<\/p><ul><li>Akutn\u00ed r\u00e1na vznik\u00e1 ve zdrav\u00e9 tk\u00e1ni. P\u0159\u00ed\u010dinou b\u00fdv\u00e1 obvykle operace nebo trauma (pop\u00e1leniny, tr\u017en\u00e9 r\u00e1ny, od\u0159eniny apod). Hoj\u00ed se obvykle bez komplikac\u00ed a v\u00a0pom\u011brn\u011b kr\u00e1tk\u00e9m \u010dase. Pokud jsou okraje akutn\u00ed r\u00e1ny z\u00e1hy p\u0159ilo\u017eeny k\u00a0sob\u011b, nap\u0159 chirurgickou suturou, hoj\u00ed se p\u0159\u00edm\u00fdm pror\u016fst\u00e1n\u00edm okraj\u016f, tzv. hojen\u00edm per primam. Jestli\u017ee je hojen\u00ed komplikovan\u00e9 infekc\u00ed, hroz\u00ed jej\u00ed roztr\u017een\u00ed (dehiscence) a vznikl\u00fd defekt se hoj\u00ed postupn\u00fdm zmno\u017een\u00edm granula\u010dn\u00ed tk\u00e1n\u011b za vzniku v\u011bt\u0161\u00ed jizvy, tzv. hojen\u00ed per secundam.<\/li><li>Chronick\u00e1 r\u00e1na vznik\u00e1 v\u00a0troficky zm\u011bn\u011bn\u00e9 tk\u00e1n\u00ed nebo sekund\u00e1rn\u00ed dehiscenc\u00ed, nem\u00e1 tendenci se zahojit za v\u00edc jak 9-12 t\u00fddn\u016f. Mezi takov\u00e9 r\u00e1ny pat\u0159\u00ed ulcus cruris na arteri\u00e1ln\u00edm nebo ven\u00f3zn\u00edm podkladu, diabetick\u00fd v\u0159ed, dekubity, neuropatick\u00e9 ko\u017en\u00ed v\u0159edy, exulcerovan\u00e9 n\u00e1dory atd.<\/li><\/ul><p><strong>Postup p\u0159i o\u0161et\u0159ov\u00e1n\u00ed r\u00e1ny:<\/strong><\/p><ul><li>sestra sezn\u00e1m\u00ed pacienta s\u00a0postupem o\u0161et\u0159en\u00ed r\u00e1ny, ov\u011b\u0159\u00ed si, zda pacient netrp\u00ed alergii na p\u0159\u00edpravky, n\u00e1plast apod.<\/li><li>p\u0159iprav\u00ed si pom\u016fcky dle druhu p\u0159evazu: p\u0159evazov\u00e9 n\u016f\u017eky, anatomickou nebo chirurgickou pinzetu, chirurgick\u00e9 n\u016f\u017eky, p\u0159evazov\u00fd materi\u00e1l (steriln\u00ed i nesteriln\u00ed), oplachov\u00fd roztok, l\u00e9\u010div\u00e9 p\u0159\u00edpravky (masti, kr\u00e9my apod.), steriln\u00ed i nesteriln\u00ed rukavice, st\u0159\u00edka\u010dky na proplach r\u00e1ny, n\u00e1dobu na odpad.<\/li><li>ulo\u017e\u00ed pacienta na pohodln\u00e9 polohy, p\u0159itom respektuje pr\u00e1vo na soukrom\u00ed a dodr\u017een\u00ed intimity.<\/li><li>provede dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<ul><li>postup p\u0159i p\u0159evazu aseptick\u00e9 r\u00e1ny:<ul><li>odstran\u00ed p\u016fvodn\u00ed kryt\u00ed, o\u010dist\u00ed okol\u00ed r\u00e1ny (zbytky n\u00e1plasti)<\/li><li>zhodnot\u00ed r\u00e1nu (p\u0159\u00edznaky infekce, sekrece apod.)<\/li><li>dezinfikuje r\u00e1nu a okol\u00ed<\/li><li>provede v\u00fdkony dle ordinace l\u00e9ka\u0159e (odstran\u011bn\u00ed steh\u016f, dr\u00e9nu)<\/li><li>o\u0161et\u0159\u00ed r\u00e1nu dle ordinace l\u00e9ka\u0159e, p\u0159ilo\u017e\u00ed steriln\u00ed kryt\u00ed, pop\u0159. sekund\u00e1rn\u00ed kryt\u00ed a provede fixaci.<\/li><\/ul><\/li><li>postup p\u0159i p\u0159evazu nehoj\u00edc\u00ed se r\u00e1ny:<ul><li>dle pot\u0159eby a dle ordinace l\u00e9ka\u0159e pod\u00e1 pacientovi analgetika dle ordinace l\u00e9ka\u0159e s\u00a0dostate\u010dn\u00fdm p\u0159edstihem.<\/li><li>\u0161etrn\u011b odstran\u00ed p\u016fvodn\u00ed kryt\u00ed a obvaz, tak aby nedo\u0161lo k\u00a0poran\u011bn\u00ed spodiny r\u00e1ny a jej\u00edho okol\u00ed. Ulp\u00edvaj\u00edc\u00ed kryt\u00ed m\u016f\u017ee zvlh\u010dit fyziologick\u00fdm roztokem, destilovanou vodou nebo oplachov\u00fdm roztokem s\u00a0antiseptick\u00fdm p\u016fsoben\u00edm.<\/li><li>vym\u011bn\u00ed si rukavice.<\/li><li>zhodnot\u00ed r\u00e1nu: velikost, spodinu r\u00e1ny, sekrec\u00ed, okol\u00ed a okraje r\u00e1ny, bolestivost, sklon ke krv\u00e1cen\u00ed.<\/li><li>o\u0161et\u0159\u00ed okol\u00ed r\u00e1ny: o\u010dist\u00ed a p\u0159\u00edpadn\u011b dezinfikuje k\u016f\u017ei v\u00a0okol\u00ed r\u00e1ny, odstran\u00ed krusty, povlaky, zbytky mast\u00ed a past aplikovan\u00fdch kolem r\u00e1ny.<\/li><li>provede oplach r\u00e1ny a d\u00e9bridement \u2013 steriln\u00edm tamp\u00f3nem, pinzetou, n\u016f\u017ekami odstran\u00ed zbytky nekr\u00f3z a povlak\u016f.<\/li><li>u syndromu diabetick\u00e9 nohy a ko\u017en\u00edch v\u0159ed\u016f na chodidlech v\u011bnuje pozornost odstran\u011bn\u00ed hyperkerat\u00f3z, ztvrdl\u00e9 k\u016f\u017ei a otlak\u016f.<\/li><li>p\u0159ilo\u017e\u00ed vhodn\u00e9 terapeutick\u00e9 kryt\u00ed dle ordinace l\u00e9ka\u0159e.<\/li><li>zhodnot\u00ed stav tk\u00e1n\u00ed v\u00a0okol\u00ed defektu a o\u0161et\u0159\u00ed vhodn\u00fdm materi\u00e1lem s\u00a0ohledem na rannou sekreci a p\u0159\u00edpadnou maceraci.<\/li><li>p\u0159ekryje prim\u00e1rn\u00ed kryt\u00ed kryt\u00edm sekund\u00e1rn\u00edm \u2013 podle velikosti rann\u00e9 sekrece a jej\u00edho charakteru.<\/li><li>kryt\u00ed fixuje obinadly a n\u00e1plasti, fixa\u010dn\u00ed materi\u00e1l mus\u00ed p\u0159ech\u00e1zet a\u017e na zdravou tk\u00e1\u0148.<\/li><li>podle charakteru z\u00e1kladn\u00edho onemocn\u011bn\u00ed (lymfed\u00e9m, chronick\u00e1 \u017eiln\u00ed insuficience) provede band\u00e1\u017e doln\u00edch kon\u010detin p\u0159ilo\u017een\u00edm kr\u00e1tkota\u017en\u00e9ho obinadla.<\/li><\/ul><\/li><li>po skon\u010den\u00ed p\u0159evazu ulo\u017e\u00ed pacienta do p\u016fvodn\u00ed polohy.<\/li><li>provede \u00faklid pom\u016fcek a odstran\u00ed pou\u017eit\u00fd p\u0159evazov\u00fd materi\u00e1l.<\/li><li>provede hygienickou dezinfekci rukou.<\/li><li>informuje pacienta o dal\u0161\u00edm term\u00ednu p\u0159evazu.<\/li><li>provede z\u00e1znam do zdravotnick\u00e9 dokumentace:<ul><li>p\u0159i vstupn\u00edm hodnocen\u00ed zaznamen\u00e1v\u00e1:<ul><li>lokalizaci a rozsah r\u00e1ny (velikost a hloubka), typ a klasifikace r\u00e1ny (spodina, p\u0159\u00ed\u010dina vzniku, m\u00edra sekrece, z\u00e1pach, okol\u00ed a okraje r\u00e1ny, p\u0159\u00edtomnost a nep\u0159\u00edtomnost bolesti).<\/li><\/ul><\/li><li>v\u00a0hodnocen\u00ed pr\u016fb\u011b\u017en\u00e9m:<ul><li>popis vlastn\u00ed r\u00e1ny \u2013 posouzen\u00ed v\u00fdvoje r\u00e1ny<\/li><li>popis lok\u00e1ln\u00ed terapie \u2013 o\u0161et\u0159ovatelsk\u00e1 p\u00e9\u010de o r\u00e1nu<\/li><\/ul><\/li><li>\u00a0<\/li><\/ul><\/li><\/ul><\/li><\/ul><p>Shrnut\u00ed:<\/p><p>\u00a0V\u00a0dom\u00e1c\u00ed p\u00e9\u010di se setk\u00e1v\u00e1me s\u00a0ranami akutn\u00edmi i chronick\u00fdmi. L\u00e9\u010dba chronick\u00fdch ran je dlouhodob\u00e1, vy\u017eaduje \u00fasil\u00ed a trp\u011blivost jak ze strany pacienta tak i zdravotn\u00edka, proto\u017ee fyziologick\u00e9 hojen\u00ed u t\u011bchto ran stagnuje a selh\u00e1v\u00e1. Proces hojen\u00ed m\u016f\u017ee b\u00fdt ovlivn\u011bn rovn\u011b\u017e lok\u00e1ln\u00edmi i syst\u00e9mov\u00fdmi faktory. K\u00a0syst\u00e9mov\u00fdm faktor\u016fm pat\u0159\u00ed vysok\u00fd v\u011bk, pohlav\u00ed, onemocn\u011bn\u00ed jako diabetes mellitus, imunodeficience, selh\u00e1n\u00ed jater, ledvin, z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed srdce a plic. Hojen\u00ed rovn\u011b\u017e ovliv\u0148uje nutri\u010dn\u00ed stav (malnutrice, obezita), psychosoci\u00e1ln\u00ed faktory (stres, strach z\u00a0recidivy onemocn\u011bn\u00ed), farmakoterapie (glukokortikoidy, chemoterapie), imobilita, inkontinence apod. \u00a0L\u00e9\u010dba proto mus\u00ed b\u00fdt komplexn\u00ed aby byla efektivn\u00ed.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26012\" class=\"elementor-tab-title\" data-tab=\"12\" role=\"button\" aria-controls=\"elementor-tab-content-26012\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">C\u00e9vkov\u00e1n\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26012\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"12\" role=\"region\" aria-labelledby=\"elementor-tab-title-26012\"><p>C\u00e9vkov\u00e1n\u00ed neboli katetrizace mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e je zaveden\u00ed kat\u00e9tru (c\u00e9vky) p\u0159es mo\u010dovou trubici do mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e k zaji\u0161t\u011bn\u00ed odtoku mo\u010de. Rozli\u0161ujeme katetrizaci jednor\u00e1zovou, kdy je c\u00e9vka ihned po vypr\u00e1zdn\u011bn\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e odstran\u011bna, nap\u0159. p\u0159i nemo\u017enosti se vymo\u010dit nebo p\u0159i odb\u011bru mo\u010de na bakteriologick\u00e9 vy\u0161et\u0159en\u00ed. V p\u0159\u00edpad\u011b permanentn\u00ed (dlouhodob\u00e9) katetrizaci z\u016fst\u00e1v\u00e1 c\u00e9vka ponech\u00e1na del\u0161\u00ed dobu. Mo\u010d odt\u00e9k\u00e1 z mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e pomoc\u00ed speci\u00e1ln\u00ed c\u00e9vky, kter\u00e1 m\u00e1 na konci bal\u00f3nek napln\u011bn\u00fd steriln\u00ed vodou, kter\u00fd br\u00e1n\u00ed vyklouznut\u00ed z mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a dren\u00e1\u017en\u00edho syst\u00e9mu (sb\u011brn\u00fd s\u00e1\u010dek s v\u00fdpust\u00ed). Permanentn\u00ed katetrizace je indikov\u00e1na u imobiln\u00edch pacient\u016f, v poopera\u010dn\u00edm obdob\u00ed kdy je pacient\u016fv pohyb na l\u016f\u017eku omezen\u00fd.\u00a0 Rovn\u011b\u017e p\u0159i urologick\u00fdch onemocn\u011bn\u00edch jako zbytn\u011bn\u00ed prostaty, p\u0159i rozs\u00e1hl\u00fdch ko\u017en\u00edch defektech v sakr\u00e1ln\u00edch nebo perine\u00e1ln\u00edch oblastech, p\u0159i opruzenin\u00e1ch a p\u0159i inkontinenci mo\u010di.<\/p><p>Obecn\u00e9 z\u00e1sady p\u0159i katetrizaci mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e:<\/p><ul><li>zaveden\u00ed kat\u00e9tru v\u017edy indikuje l\u00e9ka\u0159.<\/li><li>katetrizaci u \u017een prov\u00e1d\u00ed v\u0161eobecn\u00e1 sestra.<\/li><li>katetrizaci u mu\u017e\u016f prov\u00e1d\u00ed l\u00e9ka\u0159 nebo v\u0161eobecn\u00e1 sestra se specializac\u00ed \u201eSestra pro intenzivn\u00ed p\u00e9\u010di\u201c nebo sestra po absolvov\u00e1n\u00ed certifikovan\u00e9ho kurzu se zam\u011b\u0159en\u00edm na katetrizaci mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e u mu\u017e\u016f.<\/li><li>p\u0159i katetrizaci je nezbytn\u00e9 dodr\u017een\u00ed asepse, aby se zabr\u00e1nilo zanesen\u00ed mikroorganismu do mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e.<\/li><\/ul><p>Postup p\u0159i zaveden\u00ed mo\u010dov\u00e9ho kat\u00e9tru:<\/p><ul><li>sestra p\u0159ed samotn\u00fdm v\u00fdkonem pou\u010d\u00ed pacienta o nutnosti zaveden\u00ed c\u00e9vky, zajist\u00ed soukrom\u00ed pacienta.<\/li><li>u imobiln\u00edch pacient\u016f provede hygienu urogenit\u00e1ln\u00ed oblasti.<\/li><li>po proveden\u00ed hygienick\u00e9 dezinfekce rukou si p\u0159iprav\u00ed pom\u016fcky, tak aby je m\u011bla pohodln\u011b dostupn\u00e9.<\/li><li>otev\u0159e balen\u00ed steriln\u00edch tamp\u00f3nu a provlh\u010d\u00ed je antiseptick\u00fdm roztokem, na steriln\u00ed \u010dtverec aplikuje Mesocain gel.<\/li><li>pootev\u0159e balen\u00ed kat\u00e9tru, polo\u017e\u00ed p\u0159es hranu stolku, aby koncov\u00e1 \u010d\u00e1st visela pro snadn\u00e9 uchopen\u00ed.<\/li><li>ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy:<\/li><\/ul><ul><li>u \u017een \u2013 na z\u00e1da s m\u00edrn\u011b pokr\u010den\u00fdmi doln\u00edmi kon\u010detinami, stehna od sebe,<\/li><li>u mu\u017e\u016f \u2013 na z\u00e1da s voln\u011b nata\u017een\u00fdmi doln\u00edmi kon\u010detinami.<\/li><\/ul><ul><li>v p\u0159\u00edpad\u011b zaveden\u00ed permanentn\u00edho kat\u00e9tru si p\u0159iprav\u00ed mo\u010dov\u00fd dren\u00e1\u017en\u00ed syst\u00e9m a zav\u011bs\u00ed jej na l\u016f\u017eko pod \u00farove\u0148 mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e.<\/li><\/ul><ul><li><em>katetrizaci u \u017een provede takto:<\/em><ul><li>nedominantn\u00ed rukou odd\u00e1l\u00ed a vyt\u00e1hne sm\u011brem nahoru stydk\u00e9 pysky a provede dezinfekci \u00fast\u00ed mo\u010dov\u00e9 trubice.<\/li><li>z p\u0159edem otev\u0159en\u00e9ho s\u00e1\u010dku uchop\u00ed c\u00e9vku, konec namo\u010d\u00ed do lubrika\u010dn\u00edho gelu.<\/li><li>pak zav\u00e1d\u00ed kat\u00e9tr do mo\u010dov\u00e9 trubice, tak hluboko dokud neza\u010dne odt\u00e9kat mo\u010d.<\/li><li>v p\u0159\u00edpad\u011b jednor\u00e1zov\u00e9 katetrizace odebere vzorek mo\u010de a zbytek mo\u010de nech\u00e1 vyt\u00e9ct do m\u00edsy nebo pleny. Kat\u00e9tr po odb\u011bru vyt\u00e1hne.<\/li><li>p\u0159i zaveden\u00ed permanentn\u00ed c\u00e9vky aplikuje ur\u010den\u00e9 mno\u017estv\u00ed roztoku do vedlej\u0161\u00edho lumenu k napln\u011bn\u00ed c\u00e9vky.<\/li><li>napoj\u00ed c\u00e9vku na hadici dren\u00e1\u017en\u00edho syst\u00e9mu a zav\u011bs\u00ed jej pod \u00farove\u0148 mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e.<\/li><li>jemn\u00fdm zata\u017een\u00edm za kat\u00e9tr zkontroluje fixaci v mo\u010dov\u00e9m m\u011bch\u00fd\u0159i.<\/li><\/ul><\/li><\/ul><ul><li><em>katetrizaci u mu\u017e\u016f provede takto:<\/em><\/li><\/ul><ul><li>sestra zdvihne penis pomoc\u00ed steriln\u00edho \u010dtverce a p\u0159et\u00e1hne p\u0159edko\u017eku p\u0159es glans penis.<\/li><li>provede dezinfekci \u00fast\u00ed uretry a steriln\u011b aplikuje anestetikum.<\/li><li>zdvihne penis do kolm\u00e9 polohy a pomoc\u00ed pinzety zav\u00e1d\u00ed kat\u00e9tr, pot\u00e9 penis m\u00edrn\u011b sklop\u00ed a zavede c\u00e9vku.<\/li><li>dal\u0161\u00ed postup je stejn\u00fd jak u c\u00e9vkov\u00e1n\u00ed \u017eeny.<\/li><\/ul><p>Doporu\u010den\u00ed p\u0159i zaveden\u00ed permanentn\u00edho kat\u00e9tru:<\/p><ul><li>p\u0159ed ka\u017edou manipulaci s kat\u00e9trem je nutn\u00e9 prov\u00e9st hygienu rukou.<\/li><li>sb\u011brn\u00fd s\u00e1\u010dek mus\u00ed b\u00fdt po celou dobu pou\u017e\u00edv\u00e1n\u00ed pod \u00farovn\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e, aby se ji\u017e jednou vytekl\u00e1 mo\u010d nevracela zp\u011bt do mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e (riziko infekce).<\/li><li>p\u0159i vyprazd\u0148ov\u00e1n\u00ed s\u00e1\u010dku nutno zabr\u00e1nit kontaktu v\u00fdpustn\u00ed dren\u00e1\u017en\u00ed spojky a nesteriln\u00ed n\u00e1doby. S\u00e1\u010dek nepokl\u00e1dat na zem.<\/li><li>hygienu kat\u00e9tru a jeho okol\u00ed prov\u00e1d\u011bt denn\u011b vodou a m\u00fddlem.<\/li><li>zajistit u pacienta dostate\u010dn\u00fd p\u0159\u00edjem tekutin.<\/li><li>sledovat mno\u017estv\u00ed vylou\u010den\u00e9 mo\u010de. Pokud c\u00e9vka p\u0159estane odv\u00e1d\u011bt nutno zkontrolovat jej\u00ed polohu a odstranit p\u0159\u00edpadn\u00e9 zalomen\u00ed c\u00e9vky.<\/li><li>pokud mo\u010d neza\u010dne odt\u00e9kat a dostav\u00ed se tlak v mo\u010dov\u00e9m m\u011bch\u00fd\u0159i a pocit nucen\u00ed na mo\u010den\u00ed kontaktujte sestru dom\u00e1c\u00ed p\u00e9\u010de.<\/li><li>permanentn\u00ed kat\u00e9tr mus\u00ed b\u00fdt pravideln\u011b m\u011bn\u011bn v\u010detn\u011b dren\u00e1\u017en\u00edho syt\u00e9mu a to podle druhu materi\u00e1lu, z kter\u00e9ho je vyroben, nej\u010dast\u011bji co 4 t\u00fddny.<\/li><\/ul><ul><li>pokud m\u00e1 pacient kat\u00e9tr uzav\u0159en\u00fd z\u00e1tkou, je nutn\u00e9 mo\u010dov\u00fd m\u011bch\u00fd\u0159 v pravideln\u00fdch intervalech vypou\u0161t\u011bt (co 2-3hodiny).<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Dal\u0161\u00edm \u010dast\u00fdm v\u00fdkonem, kter\u00fd lze prov\u00e9st v dom\u00e1c\u00edm prost\u0159ed\u00ed pacienta je katetrizaci neboli c\u00e9vkov\u00e1n\u00ed mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e. O zaveden\u00ed i odstran\u011bn\u00ed mo\u010dov\u00e9ho kat\u00e9tru rozhoduje l\u00e9ka\u0159 na z\u00e1klad\u011b zdravotn\u00edho stavu pacienta. Sestra v\u00fdkon prov\u00e1d\u00ed, edukuje pacienta i rodinu jak zach\u00e1zet se zaveden\u00fdm kat\u00e9trem a v p\u0159\u00edpad\u011b komplikaci kontaktuje l\u00e9ka\u0159e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26013\" class=\"elementor-tab-title\" data-tab=\"13\" role=\"button\" aria-controls=\"elementor-tab-content-26013\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Klyzma<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26013\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"13\" role=\"region\" aria-labelledby=\"elementor-tab-title-26013\"><p>Klyzma neboli n\u00e1lev je aplikace ur\u010dit\u00e9ho mno\u017estv\u00ed tekutiny kone\u010dn\u00edkem do tlust\u00e9ho st\u0159eva nej\u010dast\u011bji za \u00fa\u010delem vypr\u00e1zdn\u011bn\u00ed. Prov\u00e1d\u00ed se v\u00a0poloze na lev\u00e9m boku s\u00a0pokr\u010denou pravou doln\u00ed kon\u010detinou, proto\u017ee d\u00edky anatomick\u00fdm pom\u011br\u016fm se tekutina z\u00a0t\u00e9to polohy dostane co nejv\u00fd\u0161e (do colon sigmoideum a colon descendens). U imobiln\u00edch pacient\u016f se prov\u00e1d\u00ed v\u00a0poloze vle\u017ee na z\u00e1dech s\u00a0pokr\u010den\u00fdmi doln\u00edmi kon\u010detinami. K\u00a0proveden\u00ed klyzmatu se pou\u017e\u00edv\u00e1 voda nebo fyziologick\u00fd roztok v\u00a0mno\u017estv\u00ed 1-1,5l \u00a0cca 37\u00b0C. V p\u0159\u00edpad\u011b mikroklyzmatu lze p\u0159idat do n\u00e1levu proj\u00edmavou l\u00e1tku dle ordinace l\u00e9ka\u0159e.<\/p><p>Postup p\u0159i proveden\u00ed klyzmatu:<\/p><ul><li>sestra sezn\u00e1m\u00ed pacienta s\u00a0v\u00fdkonem, poskytne mu informace o zp\u016fsobu a \u00fa\u010delu klyzmatu.<\/li><li>zajist\u00ed soukrom\u00ed pacienta b\u011bhem p\u0159\u00edpravy i vlastn\u00edho v\u00fdkonu.<\/li><li>p\u0159iprav\u00ed si pom\u016fcky (napln\u00ed irig\u00e1tor, propl\u00e1chne hadici, zav\u011bs\u00ed na stojan, pop\u0159. napln\u00ed Janettovou st\u0159\u00edka\u010dku a nasad\u00ed na ni rekt\u00e1ln\u00ed rourku).<\/li><li>provede hygienickou dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<\/li><li>ulo\u017e\u00ed pacient a do vhodn\u00e9 polohy a vypodlo\u017e\u00ed h\u00fd\u017ed\u011b podlo\u017ekou.<\/li><li>konec rekt\u00e1ln\u00ed rourky pot\u0159e lubrikantem.<\/li><li>jednou rukou odd\u00e1l\u00ed h\u00fd\u017ed\u011b pacienta, po\u017e\u00e1d\u00e1 ho, aby zatla\u010dil jako na stolici, a druhou rukou zavede rourku opatrn\u011b krou\u017eiv\u00fdm pohybem do kone\u010dn\u00edku v\u00a0d\u00e9lce 6-10cm.<\/li><li>po odchodu plyn\u016f z\u00a0kone\u010dn\u00edku napoj\u00ed spojkou hadici irig\u00e1toru, uvoln\u00ed tok tekutiny a pomalu aplikuje.<\/li><li>pokud pacient poci\u0165uje siln\u00fd tlak v\u00a0b\u0159i\u0161e, sestra aplikaci zpomal\u00ed nebo p\u0159eru\u0161\u00ed a doporu\u010d\u00ed pacientovi zhluboka d\u00fdchat.<\/li><li>po aplikaci rourku \u0161etrn\u011b vyt\u00e1hne z\u00a0kone\u010dn\u00edku a z\u00e1rove\u0148 druhou rukou ot\u0159e toaletn\u00edm pap\u00edrem a n\u00e1sledn\u011b ob\u011b \u010d\u00e1st\u00ed h\u00fd\u017ed\u011b p\u0159itla\u010d\u00ed k\u00a0sob\u011b.<\/li><li>upozorn\u00ed pacienta, aby je\u0161t\u011b z\u016fstal v\u00a0klidu le\u017eet, aby udr\u017eel tekutinu v\u00a0sob\u011b (15-20minut).<\/li><li>pak doprovod\u00ed pacienta na WC, u imobiln\u00edch pacient\u016f p\u0159ilo\u017e\u00ed plenu.<\/li><li>provede \u00faklid a dekontaminaci pom\u016fcek.<\/li><li>a provede z\u00e1znam do zdravotnick\u00e9 dokumentace v\u010detn\u011b zhodnocen\u00ed \u00fa\u010dinku klyzmatu.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>V\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed lze prov\u00e9st klyzma za \u00fa\u010delem vypr\u00e1zdn\u011bn\u00ed stolice nej\u010dast\u011bji p\u0159i z\u00e1cp\u011b. O\u010distn\u00e9 klyzma vyprazd\u0148uje a vyplachuje st\u0159evo. Proj\u00edmav\u00e9 klyzma zm\u011bk\u010duje stolici a pod\u00e1v\u00e1 se v\u00a0podob\u011b mikroklyzmatu o men\u0161\u00edm obsahu tekutiny. O proveden\u00ed klyzmatu rozhoduje l\u00e9ka\u0159 dle aktu\u00e1ln\u00edho zdravotn\u00edho stavu pacienta. Sestra v\u00fdkon prov\u00e1d\u00ed, edukuje pacienta i jeho rodinu jak p\u0159edch\u00e1zet z\u00e1cp\u011b a v\u00a0p\u0159\u00edpad\u011b komplikac\u00ed kontaktuje praktick\u00e9ho l\u00e9ka\u0159e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26014\" class=\"elementor-tab-title\" data-tab=\"14\" role=\"button\" aria-controls=\"elementor-tab-content-26014\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">P\u00e9\u010de o ven\u00f3zn\u00ed port a PICC kat\u00e9tr<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26014\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"14\" role=\"region\" aria-labelledby=\"elementor-tab-title-26014\"><blockquote><p>Zaveden\u00ed ven\u00f3zn\u00edho portu nebo PICC kat\u00e9tru je sou\u010d\u00e1st\u00ed l\u00e9\u010dby p\u0159ev\u00e1\u017en\u011b onkologick\u00fdch pacient\u016f. P\u0159edch\u00e1z\u00ed se t\u00edm nadm\u011brn\u00e9 a opakovan\u00e9 traumatizaci perifern\u00edch \u017eil, \u010d\u00edm\u017e se pro pacienta nab\u00edz\u00ed v\u011bt\u0161\u00ed komfort b\u011bhem cel\u00e9 l\u00e9\u010dby. Dlouhodob\u00fd \u017eiln\u00ed p\u0159\u00edstup umo\u017e\u0148uje vstup do centr\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b a je vyu\u017e\u00edv\u00e1n pro opakovan\u00e9 cykly chemoterapie, k\u00a0odb\u011br\u016fm krve, pod\u00e1v\u00e1n\u00ed infuz\u00ed, v\u00fd\u017eivy, analgetik apod. Kvalitn\u00ed o\u0161et\u0159ovatelsk\u00e1 p\u00e9\u010de je z\u00e1kladem pro dlouhodob\u00e9 a bezprobl\u00e9mov\u00e9 pou\u017e\u00edv\u00e1n\u00ed t\u011bchto \u017eiln\u00edch vstup\u016f.\u00a0 V\u017edy je dodr\u017eov\u00e1n aseptick\u00fd p\u0159\u00edstup a postupuje se dle platn\u00e9ho standardu.<\/p><p><span style=\"color: #993300;\"><strong>Ven\u00f3zn\u00ed port<\/strong> <\/span>je tvo\u0159en kom\u016frkou se speci\u00e1ln\u00ed silikonovou membr\u00e1nou a vlastn\u00edm kat\u00e9trem, kter\u00fd nased\u00e1 na kom\u016frku a je veden podko\u017en\u00edm tunelem do centr\u00e1ln\u00ed \u017e\u00edly. Port neboli kom\u016frka je um\u00edst\u011bna pod k\u016f\u017e\u00ed nemocn\u00e9ho, obvykle na hrudi. Membr\u00e1nu kom\u016frky je mo\u017eno propichovat pouze speci\u00e1ln\u00edmi jehlami tzv. Huberovy jehly, kter\u00e9 maj\u00ed zkosen\u00fd hrot a nepo\u0161kozuj\u00ed membr\u00e1nu. Port je ur\u010den pro dlouhodob\u00e9 pou\u017eit\u00ed (roky). V\u00a0p\u0159\u00edpad\u011b \u017ee nen\u00ed pou\u017e\u00edv\u00e1n, je nutn\u00e9 ho pravideln\u011b proplachovat a kontrolovat jeho funk\u010dnost. Proplachy se prov\u00e1d\u011bj\u00ed dle zvyklosti pracovi\u0161t\u011b, zpravidla jednou za 6-8 t\u00fddn\u016f.<\/p><p>Postup p\u0159i proplachu portu:<\/p><ul><li>sestra pacienta sezn\u00e1m\u00ed s\u00a0postupem, provede hygienickou dezinfekci rukou a p\u0159iprav\u00ed si pom\u016fcky (Huberovou jehlu, spojovac\u00ed hadi\u010dku, 20ml st\u0159\u00edka\u010dky, fyziologick\u00fd roztok, dezinfekci na k\u016f\u017ei a ruce, steriln\u00ed tamp\u00f3ny, kryt\u00ed Cosmopor, steriln\u00ed rukavice).<\/li><li>yvsvle\u010de pacienta z\u00a0horn\u00edho d\u00edlu oble\u010den\u00ed, ulo\u017e\u00ed do vodorovn\u00e9 polohy na z\u00e1dech a vyhmat\u00e1 port.<\/li><li>op\u011bt provede hygienickou dezinfekci rukou a nasad\u00ed si \u00fastenku a steriln\u00ed rukavice.<\/li><li>provede dezinfekci m\u00edsta vpichu ot\u011brem steriln\u00edmi tamp\u00f3ny od st\u0159edu ven, na prostoru cca 10-15cm.<\/li><li>p\u0159i zav\u00e1d\u011bn\u00ed jehly jednou rukou uchop\u00ed port palcem a ukazov\u00e1kem.<\/li><li>vyzve pacienta k\u00a0hlubok\u00e9mu n\u00e1dechu.<\/li><li>a druhou rukou provede kolm\u00fd vpich do portov\u00e9 kom\u016frky s\u00a0jehlou napojenou na spojovac\u00ed hadi\u010dku s\u00a0fyziologick\u00fdm roztokem, oto\u010denou sm\u011brem ke sternu.<\/li><li>vpich provede tak hluboko, a\u017e se zastav\u00ed o dno kom\u016frky portu a s jehlou ji\u017e neot\u00e1\u010d\u00ed.<\/li><li>provede aspiraci krve, z\u00a0d\u016fvodu kontroly spr\u00e1vn\u00e9 lokalizace jehly v\u00a0kom\u016frce.<\/li><li>napoj\u00ed novou 20ml st\u0159\u00edka\u010dku s\u00a0fyziologick\u00fdm roztokem a provede proplach technikou \u201estart-stop\u201c.<\/li><li>n\u00e1sledn\u011b uchop\u00ed kom\u016frku palcem a ukazov\u00e1kem, p\u0159itla\u010d\u00ed k\u00a0hrudi pacienta.<\/li><li>a druhou rukou jehlu kolmo vyt\u00e1hne, za tzv. pozitivn\u00edho tlaku (za pomoc\u00ed injek\u010dn\u00ed st\u0159\u00edka\u010dky vyvine m\u00edrn\u00fd tlak tlakem na p\u00edst, aby nedo\u0161lo k\u00a0zp\u011btn\u00e9mu nas\u00e1t\u00ed krve).<\/li><li>m\u00edsto vpichu dezinfikuje, komprimuje cca 20 sekund a pot\u00e9 steriln\u011b p\u0159ekryje.<\/li><li>provede z\u00e1pis do portov\u00e9 pr\u016fkazky pacienta.<\/li><li>p\u0159i v\u00fdskytu komplikac\u00ed (nepr\u016fchodnost portu, zm\u011bny v\u00a0m\u00edst\u011b vpichu apod.) kontaktuje l\u00e9ka\u0159e, ambulanci nebo stacion\u00e1\u0159, kde pacient doch\u00e1z\u00ed.<\/li><\/ul><p><strong><span style=\"color: #993300;\">PICC kat\u00e9tr<\/span> <\/strong>(perifern\u00ed implantovan\u00fd centr\u00e1ln\u00ed \u017eiln\u00ed kat\u00e9tr) je kat\u00e9tr zaveden\u00fd do centr\u00e1ln\u00ed \u017e\u00edly cestou povrchov\u00fdch \u017eil na horn\u00ed kon\u010detin\u011b. Zav\u00e1d\u00ed se na st\u0159edn\u011bdobou a dlouhodobou l\u00e9\u010dbu jednoho roku, kdy je l\u00e9\u010dby indikov\u00e1na na t\u00fddny a m\u011bs\u00edce. Proplachy se prov\u00e1d\u011bj\u00ed dle zvyklosti pracovi\u0161t\u011b, zpravidla jednou za 7 dn\u00ed. Sou\u010d\u00e1st\u00ed proplachu je i v\u00fdm\u011bna kryt\u00ed a kontrola m\u00edsta vpichu.<\/p><p>Postup p\u0159i proplachu PICC kat\u00e9tru a v\u00fdm\u011bn\u011b kryt\u00ed:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p><ul><li>sestra pacienta sezn\u00e1m\u00ed s\u00a0postupem, provede hygienickou dezinfekci rukou a p\u0159iprav\u00ed si pom\u016fcky (20ml st\u0159\u00edka\u010dky, fyziologick\u00fd roztok, dezinfekci na k\u016f\u017ei a ruce, steriln\u00ed tamp\u00f3ny, steriln\u00ed kryt\u00ed ur\u010den\u00e9 pro PICC, steriln\u00ed i jednor\u00e1zov\u00e9 rukavice, n\u00e1vlek).<\/li><li>provede hygienickou dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<\/li><li>odstran\u00ed n\u00e1vlek, od\u0161roubuje combi z\u00e1tku nebo pou\u017eije bezjehlov\u00fd vstup a provede dezinfekci koncov\u00fdch \u010d\u00e1st\u00ed.<\/li><li>na kat\u00e9tr nasad\u00ed 20ml st\u0159\u00edka\u010dku s\u00a0fyziologick\u00fdm roztokem, provede aspiraci a proplach metodou \u201estart-stop\u201c.<\/li><li>tla\u010dku na kat\u00e9tru uzav\u0159e za aplikace fyziologick\u00e9ho roztoku a uzav\u0159e kat\u00e9tr steriln\u00ed combi z\u00e1tkou.<\/li><li>n\u00e1sledn\u011b jemn\u011b odstran\u00ed p\u016fvodn\u00ed kryt\u00ed ve sm\u011bru zaveden\u00ed kat\u00e9tru.<\/li><li>sleduje m\u00edsto vpichu, zda nen\u00ed p\u0159\u00edtomen otok, zarudnut\u00ed, bolestivost, sekrece.<\/li><li>nasad\u00ed si steriln\u00ed rukavice a provede dezinfekci m\u00edsta vpichu, krou\u017eiv\u011b kolem m\u00edsta vpichu ot\u011brem steriln\u00edmi tamp\u00f3ny smo\u010den\u00fdmi v\u00a0dezinfek\u010dn\u00edm roztoku.<\/li><li>dezinfekci provede na prostoru cca 15cm, dle velikosti pou\u017e\u00edvan\u00e9ho kryt\u00ed.<\/li><li>po zaschnut\u00ed dezinfekce p\u0159ilo\u017e\u00ed steriln\u00ed kryt\u00ed, kter\u00e9 ozna\u010d\u00ed datem a \u010dasem p\u0159elepen\u00ed.<\/li><li>PICC kat\u00e9tr zafixuje jemn\u00fdm ov\u00e1z\u00e1n\u00edm obinadlem nebo pou\u017eije n\u00e1vlek.<\/li><li>provede z\u00e1znam do pr\u016fkazky nositele PICC kat\u00e9tru a pou\u010d\u00ed pacienta o n\u00e1sledn\u00e9 p\u00e9\u010di:<ul><li>pacient denn\u011b kontroluje, zda se kryt\u00ed neodlepuje, kon\u010detinou ve kter\u00e9 je kat\u00e9tr zaveden nesm\u00ed zvedat t\u011b\u017ek\u00e1 b\u0159emena, p\u0159i sprchov\u00e1n\u00ed nesm\u00ed kryt\u00ed namo\u010dit, kryt\u00ed a lumeny by m\u011bl udr\u017eovat v\u00a0suchu a \u010distot\u011b.<\/li><\/ul><\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Dlouhodob\u00e9 \u017eiln\u00ed vstupy p\u0159i spr\u00e1vn\u00e9m pou\u017e\u00edv\u00e1n\u00ed v\u00fdznamn\u00fdm zp\u016fsobem usnad\u0148uj\u00ed \u017eivot pacient\u016fm v jejich nelehk\u00e9 \u017eivotn\u00ed situaci. Dokonal\u00e9 zvl\u00e1dnut\u00edm o\u0161et\u0159ovatelsk\u00e9 p\u00e9\u010de p\u0159\u00edmo ovliv\u0148uje \u017eivotnost kat\u00e9tru a v\u00fdskyt komplikac\u00ed. D\u016fle\u017eit\u00e1 je n\u00e1sledn\u00e9 p\u00e9\u010de o \u017eiln\u00ed vstup v dom\u00e1c\u00edm prost\u0159ed\u00ed stejn\u011b jak proplachy z d\u016fvodu funk\u010dnosti v pravideln\u00fdch intervalech. P\u0159evazy a proplachy kat\u00e9tru lez v dom\u00e1c\u00edm prost\u0159ed\u00ed prov\u00e1d\u011bt na z\u00e1klad\u011b indikace l\u00e9ka\u0159e, stacion\u00e1\u0159e nebo ambulance kde pacient doch\u00e1z\u00ed.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26015\" class=\"elementor-tab-title\" data-tab=\"15\" role=\"button\" aria-controls=\"elementor-tab-content-26015\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">P\u00e9\u010de o PEG<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26015\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"15\" role=\"region\" aria-labelledby=\"elementor-tab-title-26015\"><blockquote><p>PEG neboli perkut\u00e1nn\u00ed endoskopick\u00e1 gastrostomie p\u0159edstavuje um\u011bl\u00fd vstup do \u017ealudku pro pod\u00e1v\u00e1n\u00ed v\u00fd\u017eivy. Tvo\u0159\u00ed ho tenk\u00e1 sonda, jej\u00ed\u017e jeden otvor \u00fast\u00ed na k\u016f\u017ei b\u0159icha a druh\u00fd v\u00a0\u017ealudku. Sonda umo\u017e\u0148uje p\u0159\u00edm\u00e9 pod\u00e1v\u00e1n\u00ed um\u011bl\u00e9 v\u00fd\u017eivy pacient\u016fm, kte\u0159\u00ed nemohou p\u0159ij\u00edmat potravu \u00fasty a maj\u00ed funk\u010dn\u00ed gastrointestin\u00e1ln\u00ed trakt. Zaveden\u00ed sondy je indikov\u00e1no u nemoc\u00ed, v\u00a0jejich\u017e pr\u016fb\u011bhu nebo z\u00a0d\u016fvodu l\u00e9\u010dby nen\u00ed mo\u017en\u00fd peror\u00e1ln\u00ed p\u0159\u00edjem d\u00e9le ne\u017e 4-6 t\u00fddn\u016f. Jedn\u00e1 se o onemocn\u011bn\u00ed onkologick\u00e1 (chemoterapie, chirurgick\u00fd z\u00e1krok, radioterapie), i neonkologick\u00e1 nap\u0159. c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda, degenerativn\u00ed posti\u017een\u00ed nervov\u00e9 soustavy apod). Z\u00e1kladem p\u00e9\u010de o PEG je udr\u017eov\u00e1n\u00ed m\u00edsta pr\u016fchodu b\u0159i\u0161n\u00ed st\u011bnou v\u00a0\u010dist\u00e9m stavu a suchu. O\u0161et\u0159ov\u00e1n\u00ed sondy se li\u0161\u00ed podle d\u00e9lky zaveden\u00ed a je nutn\u00e9 o ni pe\u010dovat po celou dobu zaveden\u00ed.<\/p><p>Postup p\u0159i o\u0161et\u0159ov\u00e1n\u00ed PEGu v\u00a0prvn\u00edch 10-14 dnech:<\/p><ul><li>v \u00a0prvn\u00edch 24-48 hodin\u00e1ch po zaveden\u00ed sondy z\u016fst\u00e1v\u00e1 p\u00e9\u010de na person\u00e1lu nemocnice.<\/li><li>v\u00a0n\u00e1sleduj\u00edc\u00edch dnech se prov\u00e1d\u00ed denn\u011b steriln\u00ed p\u0159evaz a o\u0161et\u0159uje se m\u00edsto vpichu:<ul><li>sestra uvoln\u00ed zevn\u00ed desti\u010dku a posune ji od b\u0159i\u0161n\u00ed st\u011bny asi o 5 cm.<\/li><li>sondou neot\u00e1\u010d\u00ed ani nezano\u0159uje (m\u00edrn\u00e9 pooto\u010den\u00ed nevad\u00ed).<\/li><li>m\u00edsto kolem vstupu dezinfikuje a o\u010dist\u00ed od zaschl\u00e9ho sekretu.<\/li><li>pak pod zevn\u00ed desti\u010dku vlo\u017e\u00ed steriln\u00ed g\u00e1zov\u00fd \u010dtverec.<\/li><li>b\u011bhem p\u0159evazu sleduje zm\u011bny kolem vstupu \u2013 zarudnut\u00ed, hnis, obt\u00e9k\u00e1n\u00ed v\u00fd\u017eivy apod.<\/li><li>n\u00e1sledn\u011b za stal\u00e9ho m\u00edrn\u00e9ho tahu za sondu posune fixa\u010dn\u00ed desti\u010dku zp\u011bt t\u011bsn\u011b ke k\u016f\u017ei.<\/li><\/ul><\/li><\/ul><p>Postup p\u0159i o\u0161et\u0159ov\u00e1n\u00ed od 10-14 dne po zaveden\u00ed PEGu:<\/p><ul><li>v\u00a0dal\u0161\u00edch dnech se prov\u00e1d\u00ed 1x t\u00fddn\u011b zano\u0159en\u00ed o 2-3 cm a oto\u010den\u00ed sondy o 360\u00b0:<ul><li>sestra uvoln\u00ed zevn\u00ed fixa\u010dn\u00ed desti\u010dku a zasune sondu 2-3cm dovnit\u0159.<\/li><li>provede rotaci kolem dlouh\u00e9 osy o 360\u00b0C.<\/li><li>sondu n\u00e1sledn\u011b znovu povyt\u00e1hne do p\u016fvodn\u00ed polohy.<\/li><li>ov\u011b\u0159\u00ed, zda je mezi zevn\u00ed fixa\u010dn\u00ed desti\u010dkou a k\u016f\u017ei dostatek voln\u00e9ho prostoru (cca 5mm, nesm\u00ed se vtla\u010dovat do k\u016f\u017ee).<\/li><li>zevn\u00ed desti\u010dku nepodkl\u00e1d\u00e1 steriln\u00edm \u010dtvercem.<\/li><\/ul><\/li><li>denn\u011b se kontroluje stav sondy \u2013 zm\u011bna barvy, vlasov\u00e9 trhliny, prosakov\u00e1n\u00ed apod.<\/li><li>nejm\u00e9n\u011b 2x t\u00fddn\u011b se gastrostomie om\u00fdv\u00e1 vodou a m\u00fddlem, osprchuje a \u0159\u00e1dn\u011b osu\u0161\u00ed.<\/li><li>svorku na sond\u011b je nutno lokalizovat co nejd\u00e9le od k\u016f\u017ee, pou\u017e\u00edv\u00e1 se jen jako p\u0159echodn\u00fd uz\u00e1v\u011br b\u011bhem pod\u00e1v\u00e1n\u00ed v\u00fd\u017eivy.<\/li><li>pokud se PEG nepou\u017e\u00edv\u00e1 je ho nutno proplachovat 2x denn\u011b.<\/li><\/ul><p>Postup p\u0159i pod\u00e1v\u00e1n\u00ed stravy a l\u00e9k\u016f do PEGu:<\/p><ul><li>b\u011bhem aplikace v\u00fd\u017eivy a cca 30minut pot\u00e9 by m\u011bl pacient m\u00edt zv\u00fd\u0161enou polohu horn\u00ed \u010d\u00e1st\u00ed t\u011bla o 30-45\u00b0jako prevence reflexu a aspirace.<\/li><li>p\u0159ed a po pod\u00e1n\u00ed v\u00fd\u017eivy (i l\u00e9k\u016f) je nutno sondu propl\u00e1chnout 50ml vody.<\/li><li>rozpis a slo\u017een\u00ed enter\u00e1ln\u00ed v\u00fd\u017eivy by m\u011blo b\u00fdt konzultov\u00e1no s\u00a0l\u00e9ka\u0159em-nutricionistou.<\/li><li>do PEGu nejsou vhodn\u00e9 potraviny jako k\u00e1va, d\u017eusy, pivo apod.<\/li><li>do PEGu je strava aplikov\u00e1na bolusov\u011b s\u00a0no\u010dn\u00ed pauzou.<\/li><li>celkov\u00fd objem v\u00fd\u017eivy b\u00fdv\u00e1 rozd\u011blen do 5-7 porc\u00ed po cca 300-350ml.<\/li><li>krom\u011b v\u00fd\u017eivy je nutn\u00e9 pod\u00e1vat i tekutiny, cca 1,5l denn\u011b mezi j\u00eddly.<\/li><li>l\u00e9ky pod\u00e1van\u00e9 do sondy mus\u00ed b\u00fdt \u0159\u00e1dn\u011b nadrceny.<\/li><\/ul><p>P\u0159\u00edpravky klinick\u00e9 v\u00fd\u017eivy:<\/p><ul><li>do PEGu se aplikuje strava tekut\u00e9 konzistence, aby sondu neucp\u00e1vala .<\/li><li>strava je nutri\u010dn\u011b kompletn\u00ed \u2013 obsahuje v\u0161echny pot\u0159ebn\u00e9 \u017eiviny b\u00edlkoviny, vitam\u00edny, miner\u00e1ln\u00ed l\u00e1tky a stopov\u00e9 prvky a m\u00e1 pot\u0159ebnou energetickou hodnotu.<\/li><li>pacient\u016fm tedy zaji\u0161\u0165uje plnohodnotnou stravu.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Perkut\u00e1nn\u00ed endoskopick\u00e1 gastrostomie je u\u017e\u00edv\u00e1na k\u00a0enter\u00e1ln\u00ed v\u00fd\u017eiv\u011b a je vhodn\u00e1 pro dlouhodobou v\u00fd\u017eivu. Lok\u00e1ln\u00ed p\u00e9\u010de o sondu se li\u0161\u00ed v\u00a0\u010dase. V\u00a0prvn\u00edch dvou t\u00fddnech od zaveden\u00ed doch\u00e1z\u00ed k\u00a0vyzr\u00e1v\u00e1n\u00ed gastrokut\u00e1nn\u00edho kan\u00e1lu, manipulace a o\u0161et\u0159ov\u00e1n\u00ed PEGu by m\u011blo b\u00fdt co nej\u0161etrn\u011bj\u0161\u00ed s\u00a0dodr\u017eov\u00e1n\u00edm z\u00e1sad asepse. Smyslem dlouhodob\u00e9 p\u00e9\u010de je pak prevence komplikac\u00ed. Pokud stav pacienta umo\u017e\u0148uje pobyt mimo nemocnici, tj. v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed, je mo\u017en\u00e9 prov\u00e1d\u011bt toto o\u0161et\u0159en\u00ed p\u0159\u00edmo u pacienta doma.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26016\" class=\"elementor-tab-title\" data-tab=\"16\" role=\"button\" aria-controls=\"elementor-tab-content-26016\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">O\u0161et\u0159ov\u00e1n\u00ed stomie<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26016\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"16\" role=\"region\" aria-labelledby=\"elementor-tab-title-26016\"><blockquote><p>Stomie je um\u011bl\u00e9 vy\u00fast\u011bn\u00ed dut\u00e9ho org\u00e1nu na povrch t\u011bla. Nej\u010dast\u011bji se jedn\u00e1 o tlust\u00e9 st\u0159evo, tenk\u00e9 st\u0159evo nebo mo\u010dov\u00e9 cesty. Doch\u00e1z\u00ed tak k\u00a0neovladateln\u00e9mu vyprazd\u0148ov\u00e1n\u00ed st\u0159evn\u00edho obsahu nebo mo\u010di nep\u0159irozenou cestou s\u00a0nutnost\u00ed pou\u017e\u00edv\u00e1n\u00ed stomick\u00fdch pom\u016fcek. Ve\u0161ker\u00e9 pom\u016fcky hrad\u00ed poji\u0161\u0165ovna a stanoven\u00e9 limity se ur\u010duj\u00ed podle druhu stomie. Indikac\u00ed k\u00a0zalo\u017een\u00ed stomie jsou nej\u010dast\u011bji n\u00e1dorov\u00e1 onemocn\u011bn\u00ed, komplikovan\u00e9 st\u0159evn\u00ed z\u00e1n\u011bty, n\u00e1hle p\u0159\u00edhody b\u0159i\u0161n\u00ed nebo \u00farazy. V\u00a0z\u00e1vislosti na typu stomie rozli\u0161ujeme stomie do\u010dasn\u00e9, kter\u00e9 slou\u017e\u00ed k\u00a0odleh\u010den\u00ed \u010dinnosti st\u0159eva do doby zhojen\u00ed a trval\u00e9, kdy ji\u017e nelze obnovit p\u0159irozenou cestu odchodu stolice \u010di mo\u010di z\u00a0d\u016fvodu onenmocn\u011bn\u00ed.<\/p><p>Druhy stomie:<\/p><ul><li>Kolostomie \u2013 v\u00fdvod tlust\u00e9ho st\u0159eva.<\/li><li>Ileostomie \u2013 v\u00fdvod tenk\u00e9ho st\u0159eva.<\/li><li>Urostomie \u2013 v\u00fdvod mo\u010dovodu.<\/li><\/ul><p>Postup p\u0159i o\u0161et\u0159en\u00ed stomie:<\/p><ul><li>sestra informuje pacienta o v\u00fdm\u011bn\u011b stomick\u00e9ho setu a o\u0161et\u0159en\u00ed stomie.<\/li><li>zajist\u00ed soukrom\u00ed pacienta a vyb\u00eddne ho ke spolupr\u00e1ci.<\/li><li>p\u0159iprav\u00ed si pot\u0159ebn\u00e9 pom\u016fcky: odstra\u0148ova\u010d n\u00e1plasti, jednod\u00edln\u00fd nebo dvoud\u00edln\u00fd set, ochrann\u00e9 rukavice, ochrann\u00fd film, \u010dist\u00edc\u00ed p\u011bnu, ubrousky, n\u016f\u017eky, fixa\u010dn\u00ed p\u00e1sky, t\u011bsn\u00edc\u00ed krou\u017eky atd.<\/li><li>ulo\u017e\u00ed pacienta do pohodln\u00e9 polohy, nej\u010dast\u011bji vle\u017ee.<\/li><li>p\u016fvodn\u00ed stomick\u00fd s\u00e1\u010dek odlep\u00ed tahem shora dol\u016f, v\u00a0p\u0159\u00edpad\u011b pot\u0159eby pou\u017eije odstra\u0148ova\u010d n\u00e1plasti.<\/li><li>zhodnot\u00ed okol\u00ed peristom\u00e1ln\u00ed k\u016f\u017ee, obsah s\u00e1\u010dku, stomii, jej\u00ed velikost a tvar a p\u0159\u00edpadn\u00e9 odchylky.<\/li><li>zbytky stolice ot\u0159e ubrousky a k\u016f\u017ei omyje vla\u017enou vodou nebo \u010dist\u00edc\u00ed p\u011bnou a osu\u0161\u00ed. Dle pot\u0159eby odstran\u00ed ochlupen\u00ed pod lep\u00edc\u00ed plochou.<\/li><li>k\u016f\u017ei o\u0161et\u0159\u00ed podle stavu ochrann\u00fdm filmem, pudrem apod.<\/li><li>zm\u011b\u0159\u00ed velikost stomie pomoc\u00ed \u0161ablony a podle nazna\u010den\u00fdch okraj\u016f vyst\u0159ihne otvor tak, aby byl o 2-3mm v\u011bt\u0161\u00ed, ne\u017e je pr\u016fm\u011br stomie.<\/li><li>u jednod\u00edln\u00e9ho syst\u00e9mu m\u011bn\u00ed podlo\u017eku i s\u00e1\u010dek.<\/li><li>u dvoud\u00edln\u00e9ho syst\u00e9mu podlo\u017eku lep\u00ed samostatn\u011b, n\u00e1sledn\u011b p\u0159ilo\u017e\u00ed s\u00e1\u010dek.<\/li><li>lep\u00edc\u00ed plochu zah\u0159eje (promnut\u00edm v\u00a0ruk\u00e1ch) a odstran\u00ed plastov\u00fd kryt z\u00a0podlo\u017eky.<\/li><li>s\u00e1\u010dek p\u0159elo\u017e\u00ed v\u00a0polovin\u011b a p\u0159ilo\u017e\u00ed ke stomii lep\u00edc\u00ed plochou, nejd\u0159\u00edv na doln\u00ed polovinu a pot\u00e9 sm\u011brem nahoru.<\/li><li>p\u0159itiskne k\u00a0t\u011blu, aby dob\u0159e p\u0159ilnula k\u00a0podlo\u017ece, a nech\u00e1 5-6 minut proh\u0159\u00e1t, p\u0159ilo\u017een\u00edm dlan\u011b na stomick\u00fd set.<\/li><li>u jednod\u00edln\u00e9ho syst\u00e9mu m\u011bn\u00ed podlo\u017eku i s\u00e1\u010dek.<\/li><li>u dvoud\u00edln\u00e9ho syst\u00e9mu podlo\u017eku lep\u00ed samostatn\u011b, n\u00e1sledn\u011b p\u0159ilo\u017e\u00ed s\u00e1\u010dek.<\/li><li>jemn\u00fdm tahem se ujist\u00ed, \u017ee s\u00e1\u010dek na t\u011ble pevn\u011b dr\u017e\u00ed.<\/li><li>provede \u00faklid pom\u016fcek a pou\u017eit\u00e9ho materi\u00e1lu.<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>\u017divot se stomii nen\u00ed pro \u017e\u00e1dn\u00e9ho \u010dlov\u011bka jednoduch\u00fd. Pacient se mus\u00ed vyrovnat jak se stomii, tak se z\u00e1va\u017enou diagn\u00f3zou, kter\u00e9 u n\u011bho vedla k\u00a0vytvo\u0159en\u00ed stomie. V\u00fdznamnou roli p\u0159i vyrovn\u00e1v\u00e1n\u00ed se s\u00a0nov\u011b vzniklou situac\u00ed hraje i p\u00e9\u010de o stomii v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed po propu\u0161t\u011bn\u00ed pacienta z\u00a0nemocnice. V\u0161eobecn\u00e1 sestra, kter\u00e1 doch\u00e1z\u00ed k\u00a0pacientovi dom\u016f, pokra\u010duje v\u00a0edukaci o z\u00e1sad\u00e1ch p\u0159i p\u0159evazov\u00e1n\u00ed, u\u010d\u00ed pacienta starat se o v\u00fdvod, \u0159e\u0161\u00ed p\u0159\u00edpadn\u00e9 komplikace nebo konzultuje stav se stomickou sestrou.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26017\" class=\"elementor-tab-title\" data-tab=\"17\" role=\"button\" aria-controls=\"elementor-tab-content-26017\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Zaveden\u00ed nasogastrick\u00e9 sondy<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26017\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"17\" role=\"region\" aria-labelledby=\"elementor-tab-title-26017\"><blockquote><p>Nasogastrick\u00e1 neboli \u017ealude\u010dni sonda je tenk\u00e1 trubi\u010dka, kter\u00e1 se zav\u00e1d\u00ed nosem nebo \u00fasty do \u017ealudku. Pou\u017e\u00edv\u00e1 se k\u00a0jednor\u00e1zov\u00e9 nebo dlouhodob\u00e9 dekompresi \u017ealudku s\u00a0ods\u00e1v\u00e1n\u00edm plynu a \u017ealude\u010dn\u00edho obsahu. M\u016f\u017ee b\u00fdt tak\u00e9 pou\u017eita jako v\u00fd\u017eivov\u00e1 sonda ke kr\u00e1tkodob\u00e9mu pod\u00e1v\u00e1n\u00ed v\u00fd\u017eivy, p\u0159i neschopnosti p\u0159ij\u00edmat j\u00eddlo a tekutiny \u00fasty, v\u00a0paliativn\u00ed onkologick\u00e9 p\u00e9\u010di m\u016f\u017ee zavedena sonda odstranit \u00fazkost, obavy ze zvracen\u00ed a bolesti b\u0159icha.<\/p><p>Postup p\u0159i zaveden\u00ed nasogastrick\u00e9 (\u017ealude\u010dn\u00ed) sondy:<\/p><ul><li>sestra poskytne pacientovi informace o \u00fa\u010delu a zp\u016fsobu zaveden\u00ed sondy, vyzve ho ke spolupr\u00e1ci.<\/li><li>p\u0159iprav\u00ed si pom\u016fcky a ulo\u017e\u00ed pacient do vhodn\u00e9 polohy vsed\u011b nebo polosed\u011b.<\/li><li>provede hygienickou dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<\/li><li>vyjme sondu z\u00a0obalu a zm\u011b\u0159\u00ed d\u00e9lku zaveden\u00ed (dist\u00e1ln\u00ed konec sondy p\u0159ilo\u017e\u00ed pod me\u010d\u00edk hrudn\u00ed kosti \u2013 nad oblast \u017ealudku, d\u00e1le k\u00a0u\u0161n\u00edmu lal\u016f\u010dku a ke \u0161pi\u010dce nosu) a ozna\u010d\u00ed m\u00edsto fixem nebo n\u00e1plast\u00ed.<\/li><li>konec sondy nat\u0159e lubrika\u010dn\u00edm gelem a opatrn\u011b zav\u00e1d\u00ed voln\u011bj\u0161\u00edm nosn\u00edm pr\u016fchodem.<\/li><li>pokud je pacient schopn\u00fd polykat pod\u00e1v\u00e1 \u010daj nebo vodu po l\u017ei\u010dk\u00e1ch a p\u0159i ka\u017ed\u00e9m polknut\u00ed zavede sondu d\u00e1l.<\/li><li>pokud pacient nem\u016f\u017ee p\u0159ij\u00edmat nic per os, vyzve ho, aby polykal napr\u00e1zdno.<\/li><li>sondu zavede a\u017e k\u00a0ozna\u010den\u00e9mu m\u00edstu na sond\u011b a zkontroluje spr\u00e1vnost zaveden\u00ed:<ul><li>aspirace \u017ealude\u010dn\u00edho obsahu<\/li><li>poslechov\u00e1 kontrola: na oblast \u017ealudku p\u0159ilo\u017e\u00ed fonendoskop a do sondy aplikuje 10-30ml vzduchu, pokud je sly\u0161et za\u0161krouk\u00e1n\u00ed, je sonda um\u00edst\u011bna spr\u00e1vn\u011b.<\/li><\/ul><\/li><li>pot\u00e9 zafixuje sondu n\u00e1plasti na nos, pop\u0159\u00edpad\u011b na tv\u00e1\u0159.<\/li><li>sondu napoj\u00ed na sb\u011brn\u00fd s\u00e1\u010dek nebo uzav\u0159e z\u00e1tkou.<\/li><li>provede \u00faklid pom\u016fcek a z\u00e1pis do zdravotnick\u00e9 dokumentace<\/li><\/ul><p>Shrnut\u00ed:<\/p><p>Zaveden\u00ed i extrakce \u017ealude\u010dn\u00ed sondy spad\u00e1 do kompetence l\u00e9ka\u0159e. Zaveden\u00ed nasogastrick\u00e9 sondy je nep\u0159\u00edjemn\u00fd v\u00fdkon, pacientovi mus\u00ed b\u00fdt z\u0159eteln\u011b objasn\u011bn d\u016fvod zaveden\u00ed. Sestra pot\u00e9 u pacienta pravideln\u011b kontroluje stav sliznic a okoln\u00edch tk\u00e1n\u00ed, p\u0159i dlouhodob\u00e9m zaveden\u00ed sondu v\u00a0nosn\u00edm pr\u016fchodu p\u0159emis\u0165uje, aby nedo\u0161lo k\u00a0vytvo\u0159en\u00ed slizni\u010dn\u00edch dekubit\u016f. Jakmile dojde k\u00a0\u00fastupu pot\u00ed\u017e\u00ed u pacienta, sonda m\u016f\u017ee b\u00fdt odstran\u011bna.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-26018\" class=\"elementor-tab-title\" data-tab=\"18\" role=\"button\" aria-controls=\"elementor-tab-content-26018\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-right\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><svg class=\"e-font-icon-svg e-fas-long-arrow-alt-down\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M168 345.941V44c0-6.627-5.373-12-12-12h-56c-6.627 0-12 5.373-12 12v301.941H41.941c-21.382 0-32.09 25.851-16.971 40.971l86.059 86.059c9.373 9.373 24.569 9.373 33.941 0l86.059-86.059c15.119-15.119 4.411-40.971-16.971-40.971H168z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><svg class=\"elementor-toggle-icon-opened e-font-icon-svg e-fas-long-arrow-alt-up\" viewBox=\"0 0 256 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M88 166.059V468c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12V166.059h46.059c21.382 0 32.09-25.851 16.971-40.971l-86.059-86.059c-9.373-9.373-24.569-9.373-33.941 0l-86.059 86.059c-15.119 15.119-4.411 40.971 16.971 40.971H88z\"><\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Aplikace dom\u00e1c\u00ed parenter\u00e1ln\u00ed v\u00fd\u017eivy<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-26018\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"18\" role=\"region\" aria-labelledby=\"elementor-tab-title-26018\"><blockquote><p>Dom\u00e1c\u00ed parenter\u00e1ln\u00ed v\u00fd\u017eiva (DPV) p\u0159edstavuje pod\u00e1v\u00e1n\u00ed v\u00fd\u017eivy, ve form\u011b tzv. vak\u016f, do c\u00e9vn\u00edho \u0159e\u010di\u0161t\u011b (\u017e\u00edly). Nahrazuje klasick\u00fd zp\u016fsob p\u0159\u00edjmu potravy \u00fasty a tr\u00e1ven\u00ed potravy v za\u017e\u00edvac\u00edm traktu. Parenter\u00e1ln\u00ed v\u00fd\u017eivu d\u011bl\u00edme na \u00faplnou a \u010d\u00e1ste\u010dnou. \u00dapln\u00e1 hrad\u00ed ve\u0161ker\u00e9 energetick\u00e9 a metabolick\u00e9 n\u00e1roky, zat\u00edmco \u010d\u00e1ste\u010dn\u00e1 kryje pouze nepokryt\u00e9 b\u011b\u017enou stravou. Parenter\u00e1ln\u00ed v\u00fd\u017eiva je pod\u00e1v\u00e1na nej\u010dast\u011bji cestou centr\u00e1ln\u00edho \u017eiln\u00edho kat\u00e9tru \u2013 PICC, podko\u017en\u00edho portu nebo kat\u00e9tru Broviacova typu. V\u00fd\u017eiva je pod\u00e1v\u00e1na v tzv. vac\u00edch \u201eall in one\u201c, kter\u00e9 mohou b\u00fdt p\u0159ipraven\u00e9 na m\u00edru v l\u00e9karn\u011b nebo firemn\u011b vyroben\u00e9 se 2 nebo 3 preformovan\u00fdmi komorami, kter\u00e9 se p\u0159ed pou\u017eit\u00edm spoji.<\/p><p>Parenter\u00e1ln\u00ed v\u00fd\u017eivu je mo\u017en\u00e9 pod\u00e1vat i ve vlastn\u00edm soci\u00e1ln\u00edm prost\u0159ed\u00ed pacienta. Nezbytnou podm\u00ednkou jsou pravideln\u00e9 kontroly v nutri\u010dn\u00ed ambulanci, vhodn\u00e1 je i mo\u017enost zaji\u0161t\u011bn\u00ed dom\u00e1c\u00ed zdravotn\u00ed p\u00e9\u010de. Dom\u00e1c\u00ed parenter\u00e1ln\u00ed v\u00fd\u017eiva je zpravidla pod\u00e1v\u00e1na kontinu\u00e1ln\u011b, 24h denn\u011b nebo i v no\u010dn\u00edch hodin\u00e1ch, kdy hlavn\u00edm d\u016fvodem je co mo\u017en\u00e1 nejmen\u0161\u00ed omezov\u00e1n\u00ed nemocn\u00e9ho.<\/p><p>1. P\u0159\u00edprava vaku s v\u00fd\u017eivou:<\/p><p>*sestra se p\u0159ed samotn\u00fdm v\u00fdkonem sezn\u00e1m\u00ed se zdravotn\u00ed dokumentaci pacienta.<\/p><p>*pacienta sezn\u00e1m\u00ed s v\u00fdkonem.<\/p><p>*provede dezinfekci pracovn\u00ed plochy.<\/p><p>*provede hygienickou dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<\/p><p>*p\u0159iprav\u00ed si pom\u016fcky k aplikaci DPV v\u010detn\u011b p\u0159\u00edsad.<\/p><p>*na\u0159ed\u011bn\u00e9 aditiva vst\u0159\u00edkne do \u010dir\u00e9 slo\u017eky vaku a n\u00e1sledn\u011b sm\u00edch\u00e1 obsah v\u0161ech komor<\/p><p>vaku.<\/p><p>*na infuzn\u00ed set p\u0159ipoj\u00ed spojovac\u00ed hadi\u010dku, pokud nepou\u017e\u00edv\u00e1 pumpu i regul\u00e1tor rychlosti<\/p><p>a zav\u0159e tla\u010dku na infuzn\u00edm setu.<\/p><p>*sund\u00e1 kryt na vstupu do vaku pro infuzn\u00ed set, provede dezinfekci s pou\u017eit\u00edm<\/p><p>dezinfek\u010dn\u00edho \u010dtvere\u010dku a opatrn\u011b vp\u00edchne infuzn\u00ed set do vaku a\u017e po zar\u00e1\u017eku.<\/p><p>*pov\u011bs\u00ed vak na stojan, nastav\u00ed hladinku ve vzduchov\u00e9 ba\u0148ce infuzn\u00edho setu.<\/p><p>*tla\u010dku setu opatrn\u011b pootev\u0159e a propl\u00e1chne set i spojovac\u00ed hadi\u010dku v\u00fd\u017eivou a\u017e ke<\/p><p>konci.<\/p><p>2. Napojen\u00ed vaku s v\u00fd\u017eivou:<\/p><p>*sestra ulo\u017e\u00ed pacienta do vhodn\u00e9 polohy dle p\u0159\u00edstupu ke kat\u00e9tru.<\/p><p>*pokud m\u00e1 pacient Port a nem\u00e1 zavedenou Huberovou jehlu, postupuje nejd\u0159\u00edv podle<\/p><p>standardu \u201eP\u00e9\u010de o ven\u00f3zn\u00ed port\u201c \u2013 zaveden\u00ed Huberovy jehly.<\/p><p>*provede mechanickou dezinfekci bezjehlov\u00e9ho vstupu na kat\u00e9tru dezinfek\u010dn\u00edm \u010dtvere\u010dkem a ponech\u00e1 zaschnout.<\/p><p>*provede proplach 10ml FR metodou \u201estart-stop\u201c.<\/p><p>*n\u00e1sledn\u011b napoj\u00ed na bezjehlov\u00fd vstup infuzn\u00ed set a nastav\u00ed rychlost infuze dle ordinace l\u00e9ka\u0159e (ml\/h) na regul\u00e1toru rychlosti.<\/p><p>*v p\u0159\u00edpad\u011b pou\u017eit\u00ed infuzn\u00ed pumpy, zalo\u017e\u00ed napln\u011bn\u00fd infuzn\u00ed set do infuzn\u00ed pumpy<\/p><p>a nastav\u00ed rychlost dle ordinace l\u00e9ka\u0159e (ml\/h).<\/p><p>3. Odpojen\u00ed vaku s v\u00fd\u017eivou:<\/p><p>*sestra informuje pacienta o v\u00fdkonu a ulo\u017e\u00ed ho do vhodn\u00e9 polohy.<\/p><p>*provede hygienickou dezinfekci rukou a nasad\u00ed si jednor\u00e1zov\u00e9 rukavice.<\/p><p>*p\u0159iprav\u00ed si pom\u016fcky k odpojen\u00ed vaku s v\u00fd\u017eivou.<\/p><p>*zav\u0159e tla\u010dku na setu, pokud pou\u017e\u00edv\u00e1 infuzn\u00ed pumpu, tak j\u00ed zastav\u00ed.<\/p><p>*odpoj\u00ed infuzn\u00ed set i s prodlu\u017eovac\u00ed hadi\u010dkou.<\/p><p>*vydezinfukuje membr\u00e1nu bezjehlov\u00e9ho vstupu dezinfek\u010dn\u00edm \u010dtvere\u010dkem a provede<\/p><p>proplach 20ml FR metodou \u201estart-stop\u201c.<\/p><p>*pokud je ordinov\u00e1na aplikace z\u00e1tky, p\u0159iprav\u00ed z\u00e1tku (po\u010det ml dle udan\u00e9ho objemu kanyly ordinuje l\u00e9ka\u0159) a aplikuje do kat\u00e9tru.<\/p><p>*pokud m\u00e1 pacient Port a je nutno odstranit Huberovou jehlu, postupuje d\u00e1le podle<\/p><p>standardu \u201eP\u00e9\u010de o ven\u00f3zn\u00ed port\u201c \u2013 odstran\u011bn\u00ed Huberov\u00fd jehly.<\/p><p>*nakonec provede \u00faklid pom\u016fcek, ostr\u00e9 p\u0159edm\u011bty a jednor\u00e1zov\u00fd pou\u017eit\u00fd materi\u00e1l odlo\u017e\u00ed do n\u00e1doby na nebezpe\u010dn\u00fd odpad.<\/p><p>*provede z\u00e1pis do zdravotnick\u00e9 dokumentace pacienta.<\/p><p>Shrnut\u00ed:<\/p><p>Dom\u00e1c\u00ed parenter\u00e1ln\u00ed v\u00fd\u017eiva p\u0159edstavuje proces, kter\u00fd vyu\u017e\u00edv\u00e1 spojen\u00ed l\u00e9\u010debn\u00e9 v\u00fd\u017eivy a p\u0159irozen\u00e9ho dom\u00e1c\u00edho prost\u0159ed\u00ed ke zkvalitn\u011bn\u00ed poskytovan\u00e9 zdravotnick\u00e9 p\u00e9\u010de. DPV je indikov\u00e1na p\u0159i selh\u00e1n\u00ed v\u00fd\u017eivov\u00e9 funkce st\u0159eva, nej\u010dast\u011bji p\u0159i syndromu kr\u00e1tk\u00e9ho st\u0159eva a st\u0159evn\u00ed obstrukce nebo jako n\u00e1sledek n\u00e1dorov\u00e9ho onemocn\u011bn\u00ed. B\u011bhem l\u00e9\u010dby je nutn\u00e9 dodr\u017eovat a respektovat v\u0161echna poskytnut\u00e1 doporu\u010den\u00ed. Aplikace parenter\u00e1ln\u00ed v\u00fd\u017eivy rovn\u011b\u017e vy\u017eaduje pe\u010dliv\u00fd a d\u016fsledn\u00e9 p\u0159\u00edstup k \u017eiln\u00edmu vstupu, zcela z\u00e1sadn\u00ed roli m\u00e1 n\u00e1sledn\u00e1 o\u0161et\u0159ovatelsk\u00e1 p\u00e9\u010de. Pro prevenci komplikac\u00ed u DPV je nezastupiteln\u00e1 dokonal\u00e1 edukace pacienta i rodinn\u00fdch p\u0159\u00edslu\u0161n\u00edk\u016f.<\/p><\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b8a4db0 e-con-full e-ecs-flex e-flex e-con e-child\" data-id=\"b8a4db0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-c4a349b e-con-full e-ecs-flex e-flex e-con e-child\" data-id=\"c4a349b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2a9ebb8 elementor-widget elementor-widget-image\" data-id=\"2a9ebb8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"534\" src=\"https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800-1024x684.jpg\" class=\"attachment-large size-large wp-image-95\" alt=\"\" srcset=\"https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800-1024x684.jpg 1024w, https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800-300x200.jpg 300w, https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800-768x513.jpg 768w, https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800-1536x1025.jpg 1536w, https:\/\/medica3nec.cz\/zp\/wp-content\/uploads\/2025\/06\/DSC_2800.jpg 1898w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8e67a9d elementor-widget elementor-widget-heading\" data-id=\"8e67a9d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Informace<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ac7437c elementor-widget elementor-widget-text-editor\" data-id=\"ac7437c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">informace o p\u00e9\u010di pro ve\u0159ejnost i l\u00e9ka\u0159e<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6719c24 elementor-tablet-align-start elementor-mobile-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"6719c24\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:+420%20774%20441%20581\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-phone\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M493.4 24.6l-104-24c-11.3-2.6-22.9 3.3-27.5 13.9l-48 112c-4.2 9.8-1.4 21.3 6.9 28l60.6 49.6c-36 76.7-98.9 140.5-177.2 177.2l-49.6-60.6c-6.8-8.3-18.2-11.1-28-6.9l-112 48C3.9 366.5-2 378.1.6 389.4l24 104C27.1 504.2 36.7 512 48 512c256.1 0 464-207.5 464-464 0-11.2-7.7-20.9-18.6-23.4z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">+420 774 735 577<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/medica.pacienti@seznam.cz\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-envelope\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M502.3 190.8c3.9-3.1 9.7-.2 9.7 4.7V400c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V195.6c0-5 5.7-7.8 9.7-4.7 22.4 17.4 52.1 39.5 154.1 113.6 21.1 15.4 56.7 47.8 92.2 47.6 35.7.3 72-32.8 92.3-47.6 102-74.1 131.6-96.3 154-113.7zM256 320c23.2.4 56.6-29.2 73.4-41.4 132.7-96.3 142.8-104.7 173.4-128.7 5.8-4.5 9.2-11.5 9.2-18.9v-19c0-26.5-21.5-48-48-48H48C21.5 64 0 85.5 0 112v19c0 7.4 3.4 14.3 9.2 18.9 30.6 23.9 40.7 32.4 173.4 128.7 16.8 12.2 50.2 41.8 73.4 41.4z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">medica.pacienti@seznam.cz <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ae8d4cd e-con-full e-ecs-flex e-flex e-con e-child\" data-id=\"ae8d4cd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7c1fbe4 elementor-widget elementor-widget-heading\" data-id=\"7c1fbe4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Informace pro pacienty<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f33e4e7 elementor-tablet-align-start elementor-mobile-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"f33e4e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.medica3nec.cz\/wp-content\/uploads\/2022\/01\/Informace-o-zpracovani-osobnich-udaju-1.pdf\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-pdf\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Informace o zpracov\u00e1n\u00ed osobn\u00edch \u00fadaj\u016f<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.medica3nec.cz\/wp-content\/uploads\/2022\/01\/Formular-pro-uplatneni-prav-uzivatele-jako-subjektu-osobnich-udaju-1.pdf\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-pdf\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Formul\u00e1\u0159 pro uplatn\u011bn\u00ed pr\u00e1v u\u017eivatele jako subjektu osobn\u00edch \u00fadaj\u016f <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.medica3nec.cz\/wp-content\/uploads\/2022\/01\/Postup-pri-podavani-stiznosti-1.pdf\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-pdf\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Postup p\u0159i pod\u00e1v\u00e1n\u00ed st\u00ed\u017enost\u00ed<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.medica3nec.cz\/wp-content\/uploads\/2022\/04\/Nakla\u0301da\u0301ni\u0301-s-odpady-ze-zdravotni\u0301-pe\u0301c\u030ce-informace-pro-pacienty.pdf\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-pdf\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Informace o nakl\u00e1d\u00e1n\u00ed s odpady<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ce53ecb e-con-full e-ecs-flex e-flex e-con e-child\" data-id=\"ce53ecb\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;ecs_container_type&quot;:&quot;flex&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7f98644 elementor-widget elementor-widget-heading\" data-id=\"7f98644\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Soubory ke sta\u017een\u00ed<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c32098 elementor-tablet-align-start elementor-mobile-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"1c32098\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.medica3nec.cz\/wp-content\/uploads\/2020\/06\/bazalni-stimulace2.pdf\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-file-pdf\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Co je baz\u00e1ln\u00ed stimulace<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Informace pro l\u00e9ka\u0159e Dom\u00e1c\u00ed p\u00e9\u010de poskytuje pacient\u016fm kvalitn\u00ed p\u00e9\u010di v jeho p\u0159irozen\u00e9m dom\u00e1c\u00edm prost\u0159ed\u00ed po ukon\u010den\u00ed hospitalizace nebo jin\u00e9 \u00fastavn\u00ed p\u00e9\u010de. Umo\u017e\u0148uje zkr\u00e1tit dobu hospitalizace a nep\u0159eru\u0161it pot\u0159ebn\u00fd kontakt mezi [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":580,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-597","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Informace pro l\u00e9ka\u0159e - Medica3nec - Dom\u00e1c\u00ed zdravotn\u00ed p\u00e9\u010de<\/title>\n<meta name=\"description\" content=\"Poskytujeme profesion\u00e1ln\u00ed zdravotn\u00ed p\u00e9\u010di ve Va\u0161\u00ed dom\u00e1cnosti (mobiln\u00ed hospic, dom\u00e1c\u00ed p\u00e9\u010de, p\u016fj\u010dovna zdravotn\u00edch p\u0159\u00edstroj\u016f, soci\u00e1ln\u00ed poradna, vzd\u011bl\u00e1v\u00e1n\u00ed).\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medica3nec.cz\/zp\/edukace-rodiny-o-domaci-peci\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Informace pro l\u00e9ka\u0159e - 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