Title Intervencije medicinske sestre kod pacijenta s masnom embolijom nakon traume Title (english) Nurse intervention in patients with fat embolism after trauma Author Zdenka Slivarić Mentor Vesna Sertić (mentor) Committee member Marijana Neuberg (predsjednik povjerenstva)Committee member Vesna Sertić (član povjerenstva) Committee member Melita Sajko (član povjerenstva)Granter University North Defense date and country 2019-03-27, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Embolija je akutna opstrukcija arterije embolusom. U manjem broju slučajeva uzrok je
mast ili dio koštane srži koji prodiru u sustavnu vensku cirkulaciju te u plućne arterije. Takva
embolija je masna embolija, a ona može biti prirodna (endogena), posttraumatska (egzogena) i
jatrogena. Najčešće se masna embolija razvija nakon traume, odnosno prijeloma dugih kostiju i
zdjelice, posebno zatvorenih prijeloma i nakon ortopedskih kirurških zahvata. Simptomi masne
embolije jesu kratak dah, uznemirenost, neurološke abnormalnosti, visoka temperatura, osip itd.
Osnovna klinička obilježja sindroma masne embolije jesu respiratorna insuficijencija, cerebralne
disfunkcije te petehije kože. Sindrom masne embolije ima tri oblika: subklinički, klinički i
fulminantni oblik. Liječenje sindroma masne embolije je simptomatsko i suportivno. Kako
pravog lijeka nema, ključna je prevencija masne embolije i sindroma masne embolije. Prognoza
bolesti te procjena smrtnosti ovisi o drugim bolestima i težini povreda. Smrtnost u bolesnika s
masnom embolijom iznosi od 5 do 15 %. Smrt najčešće nastupa zbog zatajenja srca, i to u
bolesnika s fulminantnim oblikom sindroma masne embolije.
U radu je prikazan slučaj 24-godišnjeg pacijenta s masnom embolijom nakon traume koji
je početkom studenoga 2014. godine hospitaliziran na kirurškom odjelu Opće bolnice „Dr.
Tomislav Bardek“ Koprivnica nakon pada stabla na obje noge, te intervencije medicinske sestre
kod pacijenta s masnom embolijom. Zbog prijeloma obje natkoljenice na pacijentu je hitno
izvedena krvava repozicija i osteosinteza obje bedrene kosti pločicama i vijcima. Postoperativna
zdravstvena njega provodila se u jedinici intenzivnog liječenja do pacijentove stabilizacije, a
nakon toga na otvorenom kirurškom odjelu. Zbog pojave masne embolije pacijent se ponovno
premješta u jedinicu intenzivnog liječenja, a nakon stabilizacije na otvoreni kirurški odjel. Nakon
poboljšanja statusa otpušta se kući, uz edukaciju o svojem zdravstvenom stanju te uz preporuku
da se fizikalna terapija provodi kod kuće i da mu se planira zdravstvena njega kod kuće.
Medicinska sestra mora biti dobro upoznata s kliničkim znakovima masne embolije i o uočenim
znakovima obavijestiti nadležnog liječnika, primijeniti odgovarajuću terapiju te educirati
pacijenta i njegovu obitelj o bolesti.
Abstract (english) Embolism is an acute obstruction of arteries by an embolus. In smaller number of cases
the cause is fat or a part of bone marrow which penetrate the system’s blood circulation and lung
arteries. Such type of embolism is fat embolism and it can be natural (endogenous), post
traumatic (exogenous) and iatrogenic. Most often fat embolism develops after a trauma, long
bone or pelvis fractures, especially closed fractures and after orthopedic surgeries. Symptoms of
fat embolism are shortness of breath, anxiety, neurological abnormalities, high temperature, rash,
etc. Basic clinical characteristic of fat embolism syndrome are respiratory insufficiency, cerebral
dysfunction and skin petechiae. Fat embolism syndrome has three forms: subclinical, clinical and
fulminant form. Treatment of fat embolism syndrome is symptomatic and supportive. Since there
is no real cure, prevention of fat embolism and fat embolism syndrome is key. Prognosis of
illness and estimation of mortality depends on other illnesses and severity of injuries. Mortality
rate in patients with fat embolism is between 5 and 15 %. Death most often occurs due to the
heart failure in patients with the fulminant form of fat embolism syndrome.
In this thesis we presented a case of a 24 year old patient with fat embolism after a
trauma who was hospitalised at the start of November 2014 in the surgical ward of General
hospital “Dr. Tomislav Bardek” in Koprivnica after falling from a tree on both legs. Because of
the fracture of both thighs, on a patient was performed an urgent blood reposition and
osteosynthesis of both thigh bones with plates and screws. Post operative health care was
performed at the ICU until the patient was stable, and after that at the open surgical unit. Because
of the appearance of fat embolism patient is again transferred to the intensive care unit, and after
stabilisation to the open surgical unit. After his condition improved he was released home with
information about his health condition and recommendation to perform physical therapy at home
as well as be assigned home health care.
Keywords
masna embolija
sindrom masne embolije
medicinska sestra
Keywords (english)
fat embolism
fat embolism syndrome
a nurse
Language croatian URN:NBN urn:nbn:hr:122:707526 Study programme Title: Nursing Type of resource Text File origin Born digital Access conditions Open access Terms of use Repository University North Digital Repository Created on 2019-05-17 12:23:10
