Care and treatment of patients with cerebrovascular diseases in the period from 2010 – 2014 in the municipality of Veles
Summary
Aim: To establish the influence and the specifics of the workplace – nurse on the patients with cerebral vascular diseases and their influence to their health condition.
Material and methods: This specialist work is done on the basis of the data which is available at the General Hospital in Veles, at the Neuropsychiatry Department . This research included most of the employees from the Neuropsychiatry Department. Questionnaire is also used – Barthel’s index.
Results: Most of the patients with cerebrovascular diseases are from 2012, with a larger number of male patients and patients who live in the city. Also, most of the patients with CVD are patients who live in the city and have no physical activities, i.e. retired citizens, unemployed and office workers.
Conclusion: From this research we can conclude that most of the patients with CVD are patients from the older age group and patients who were not physically active, i.e. retired citizens, unemployed and office workers. Age and physical activity are some of the main factors for the occurrence of cerebral vascular diseases.
Key words: CVD, physically active, trombosis, bleeding, hemiplegia, paresis
Sažetak
Cilj rada: Uspostaviti utjecaj i specifičnosti na radnom mjestu medicinske sestre koja radi sa pacijentima s cerebralnom vaskularnih bolesti i utjecaj takvih pacijenata na zdravstveno stanje medicinske sestre.
Materijali i metode rada: Ovakav specijalistički rad vrši se na osnovu podataka koji je dostupni u Opštoj bolnici u Velesu, na Odjelu Neuropsihijatrije. U ovo istraživanje je uključena većina zaposlenih iz Odjela Neuropsihijatrije, uz korištenje Upitnika – indeks Barthel je.
Rezultati: Većina pacijenata sa cerebrovaskularnim bolestima su od 2012. godine, a većina pacijenata su muškaraci i oni koji žive u gradu. Isto tako, većina bolesnika sa celebralno-vaskularnim bolestima su pacijenti koji žive u gradu i nemaju fizičke aktivnosti, jer su u penziji, nezaposleni ili se nalaze na evidenciji Biroa za zapošljavanje..
Zaključak: Iz ovog istraživanja se može zaključiti da su većina bolesnika sa celebralno-vaskularnim bolestima stariji pacijenti i pacijenti koji nisu bili fizički aktivni, odnosno penzioneri, nezaposleni i oni koji su evidentirani na Birou za zapošljavanje. Starost (godine života) i fizička aktivnost predstavljaju glavne faktore za nastanak cerebralno-vaskularnih bolesti.
Ključne riječi: Cerebralnovasklularne bolesti, fizički aktivni, tromboza, krvarenja, hemiplegija, pareza
INTRODUCTION
There is a tendency in the modern world for the increase of the number of circulatory system diseases at the humans and they take a significant place in the morbidity and the mortality of the population which is a serious medical, epidemiological and social problem. It seems that in today’s conditions one stressful situation can speed up the development of the hardening of the brain blood vessels and the increase of the blood pressure. Cerebrovascular diseases are a term that includes all the disorders in the cerebral circulation with any cause possible. This term includes the disorders caused by mechanical, physical and other damages, disorders in the general circulation, diseases in the other organs and systems which manifest with the decreasing of the circulation in the central nervous system. The main types of cerebrovascular diseases in clinical realm encompass the following conditions: cerebral thrombosis, cerebral embolia, cerebral hemorrhagy and subarachnoidal hemorrhagy. The researches show that the brain metabolism needs 8% of the total consumption of the oxygen in the body1. The circulation in the brain can be influenced by the following factors: the blood pressure level, cerebrovascular resistence etc.
AIM
The main aim of my research will be the patients with cerebrovascular diseases and the presentation of the care for these patients, i.e. the application of the health care, as well as the results of this care.
MATERIAL AND METHODS
In this specialist work, we used data from the Neuropsychiatry Department of the General Hospital in Veles. We used data from the Neurological Diseases Ward and we also consulted part of the employees and the doctors who take part in the treatment and rehabilitation of the patients. To process the data we used descriptive, epidemiological and social – medicine method of work with statistical processing of the data and the relevant professional literature which describes this matter. The results of the research are displayed in a graphic, numeric and table manner.
RESULTS AND DISCUSSION
From the research conducted (Table 1) we can notice that in the General Hospital in Veles, on the Neuropsychiatry Department, the number of patients who were received for a hospital therapy with cerebrovascular diseases was the highest in 2012 with a total number of 306 patients, while the lowest number was in 2010 with 238 patients.
Table 1.
| 2010 | 2011 | 2012 | 2013 | 2014 | |
| January | 13 (5%) | 18 (7%) | 26 (8%) | 29 (11%) | 19 (8%) |
| February | 18 (8%) | 20 (7%) | 25 (8%) | 19 (7%) | 17 (7%) |
| March | 15 (6%) | 25 (9%) | 23 (8%) | 17 (6%) | 29 (11%) |
| April | 21 (9%) | 28 (10%) | 18 (6%) | 28 (11%) | 22 (8%) |
| May | 23 (10%) | 19 (7%) | 35 (11%) | 25 (9%) | 24 (9%) |
| June | 23 (10%) | 23 (9%) | 21 (7%) | 23 (8%) | 27 (10%) |
| July | 27 (11%) | 21(8%) | 28 (9%) | 26 (10%) | 20 (8%) |
| August | 8 (3%) | 12 (5%) | 21 (7%) | 20 (7%) | 16 (6%) |
| September | 19 (8%) | 23 (9%) | 24 (8%) | 23 (8%) | 17 (7%) |
| October | 16 (7%) | 28 (10%) | 31 (10%) | 25 (10%) | 31 (12%) |
| November | 32 (13%) | 23 (9%) | 24 (8%) | 21 (7%) | 16 (6%) |
| December | 23 (10%) | 27 (10%) | 30 (10%) | 16 (6%) | 22 (8%) |
| TOTAL | 238 | 267 | 306 | 272 | 263 |
From Table 2, we can draw a conclusion that the largest number of the cerebrovascular patients are male and it is in every year of the conducted research.
Table 2.
| М | F | Total | |
| 2010 | 138 (76%) | 100 (24%) | 238 |
| 2011 | 153 (53%) | 114 (43%) | 267 |
| 2012 | 161 (53%) | 145 (47%) | 306 |
| 2013 | 161 (59%) | 111 (41%) | 272 |
| 2014 | 151 (57%) | 112 (43%) | 263 |
From Table 3 we can conclude that the largest number of cardiovascular patients are patients who live in a town.
Table 3.
| Town | Village | Total | |
| 2010 | 187 (79%) | 51 (21%) | 238 |
| 2011 | 198 (74%) | 69 (26%) | 267 |
| 2012 | 226 (74%) | 80 (26%) | 306 |
| 2013 | 185 (68%) | 87 (32%) | 272 |
| 2014 | 191 (73%) | 72 (27%) | 263 |
From Table 4 we draw a conclusion that most of the patients with cardiovascular diseases are aged from 71-80 years old.
Table 4.
| age | 40-50 y.o. | 51-60 y.o. | 61-70 y.o. | 71-80 y.o. | Above 80 y.o. | Total |
| 2010 | 9 | 39 | 68 | 99 | 23 | 238 |
| 2011 | 14 | 42 | 81 | 98 | 32 | 267 |
| 2012 | 16 | 41 | 87 | 123 | 39 | 306 |
| 2013 | 9 | 51 | 67 | 103 | 42 | 272 |
| 2014 | 8 | 42 | 70 | 104 | 39 | 263 |
From Table 5 we can conclude that most of the patients who had a CVD in the period from 2010 – 2014 were patients without physical activity, unemployed people and office workers.
Table 5.
| Occupation | Retired/unemployed | Office workers | Farmers | Physical workers | Total |
| 2010 | 190 | 29 | 7 | 12 | 238 |
| 2011 | 220 | 27 | 10 | 15 | 272 |
| 2012 | 249 | 32 | 9 | 16 | 306 |
| 2013 | 211 | 28 | 9 | 19 | 267 |
| 2014 | 217 | 24 | 8 | 14 | 263 |
CONCLUSION
When we talk about neurological diseases of the adult population, apoplexy is on the top of the list according to the frequency of its occurrence and on the third place according to its death rate. Invalidity of the survivors is in more of 50% of the cases, and the incapability to live without help of another person is in the 30% of the cases3.
Most often the symptoms are not heralded, but can be felt a few weeks or months before the first stroke. The patients do not recognize the symptoms, or sometimes ignore or substitute them for everyday stress and fatigue, and even ignore them. These symptoms usually are: speech and concentration problems which last for only very short moments, short term paralysis, a feeling of weakness, breathlessness. These symptoms can disappear in a few minutes or an hour, but they can also cause damage to the brain. In most cases it can lead to paralysis of not just arms and legs, but also of the face. One of the symptoms is speech problems, and other symptoms can be headache and losing consciousness. Apoplexy is an urgent medical condition and it takes immediate transportation and hospitalization in a suitably equipped health institution3.
Today it is possible to apply a specific therapy for the ischemic apoplexy: we have medicines which can melt the coagulum that blocked the blood vessel. In this way, we can enable the re-establishing of the blood circulation and stop the dying out of the neurons. This therapy can be applied in the first three hours after the occurrence of the ischemic apoplexy and after the diagnostic processing in the suitably equipped medical centers. Having in mind the goals of the rehabilitation treatment, the health care team, on the basis of the estimate of the individual needs of the patient, decides on the care program. This care program includes independent and interdependent nurse interventions. The independent interventions refer to the basic or general care measures which are to allow psychophysical comfort of the patient, increase the adaptive reaction and create suitable environment for interdependent interventions4.
Prevention has the key place in the treatment of the cerebrovascular diseases and we can rightly say that this disease is not any more a matter of bad luck but a reflection of our healthy (or unhealthy) habits. The primary prevention is a fight against the risk factors (age, gender, smoking, obesity and physical inactivity, increased blood pressure, using contraceptives, disruptions of the heart rhythm, murmur above the carotid arteries in the neck, previous apoplexy, increased hematocrit, social problems)5. This primary prevention has the aim to stop the development of the disease at individuals with some or more of the risk factors listed. Secondary prevention includes the treatment of apoplexy, good rehabilitation (involving team work of neurologists, physiatrists, speech therapists, psychologists, psychiatrists, cardiologists), fight against the risk factors, etc. The large epidemiological studies of the general population indicate that the number of people endangered by this cerebrovascular disease is very high and that it increases with the age. Apoplexy is a very rare cause of death in the first and second decade of the life, but it becomes more often cause of death in the third and the following decades. Beside the high mortality and invalidity together with the losing of independence in life, this disease is also a large socio-economical problem. Advices are given every day and they are taken and applied depending on the character and capability of the patient to think about his health, keep it and live longer6.
REFERENCES
- Vladimir E. Trajkovski, “Medical basics for disabled people”, Skopje, 2005
- Prof. Gordana Panova, PhD, “Patient care” (authorized lectures).
- Prof. Snezana Vlashki-Jekic, PhD, Prof. Liljana Ilievska, PhD, Prof. Radoslav Naumovski, PhD, Prof. Ante Popovski, PhD, Prof. Vera Daskalovska, PhD, Prof. Risto Ljapchev, PhD, Prof. Vera Petrova, PhD, Prof. Ilija Dzonov, PhD, “Basic principles of modern neurology”, Prosvetno delo, Skopje, 2002.
- Prof. Jovica Ugrinovski, PhD, Prof. Spase Jovkovski, PhD, Prof. Ilija Prangovski, PhD, Prof. Kiril Lozanche, phD, Doc. Vlado Stolevski, phD, “Neurohirurgy”, Kultura, Skopje, 2003.
- Ackovska, R., “Rehabilitation basics”, Bitola, 2006.
- Popova Ramova, E., Poposka, A.: “Physical therapy with medical rehabilitation”, Bitola, 2008.
- Stevanovich, M., “Medical rehabilitation of bodily invalid persons”, Belgrade, 1990.