PEDİATRİK YOĞUN BAKIM ÜNİTESİNDE YATAN HASTALARDA DELİRYUMUN TANILANMASI VE HEMŞİRELİK YÖNETİMİ

Year 2020, Volume: 3 Issue: 3, 233 - 243, 30.12.2020

Bircan Kahraman Berberoğlu Hüsniye Çalışır

Abstract

Deliryum, hızlı başlayan, dalgalı seyir gösteren, etiyolojisinde birçok nedenin eşlik ettiği, bilinç, algılama, düşünce, uyku-uyanıklık döngüsünde değişimlerin görüldüğü klinik bir sendromdur. Bu derlemenin amacı, yoğun bakım ünitesinde yatan kritik hasta çocuklarda deliryumun tanılanması, önlenmesi ve pediatri hemşirelerinin rollerine ilişkin güncel bilgileri paylaşmaktır. Bu derlemede Pubmed, Web of Science, Cochrane, Türkiye Atıf Dizini, Google Akademik, EbscoHOST veri tabanları taranarak bu çalışmanın amacına uyan konuyla ilgili araştırmalara ulaşılmıştır. Anahtar kelime olarak “deliryum (delirium), çocuk (child), yoğun bakım (intensive care), hemşirelik bakımı (nursing care) kullanılmıştır. Konuyla ilgili yapılan çalışmalar incelendiğinde kritik hasta çocuklarda deliryum için en temel risk faktörleri, yaş, gelişimsel gecikme, hastalık şiddeti ve mekanik ventilasyon olarak gösterilmiştir. Pediatrik hastalarda deliryumun olumsuz sonuçları arasında mortalite artışı, hastanede kalış süresinde uzama ve maliyet artışı olduğu bildirilmiştir. Ayrıca yapılan araştırmalar incelendiğinde; pediatri hemşirelerinin deliryumun tanılanması, önlenmesi ve bakımı konusunda yeterli bilgiye sahip olmadıkları, doğru yaklaşımları uygulayamadıkları ve hemşirelerin çok azının deliryumu değerlendirmede tanılama araçlarından yararlandıkları bulunmuştur. Deliryum, kritik derecede hasta olan çocuklarda sık görülen bir sorundur. Pediatri hemşireleri hasta sonuçlarını iyileştirmek için kanıta dayalı bilgilerin uygulanmasına öncülük etmelidir. Pediatri hemşireleri, deliryumun oluşmasında rol oynayan çevresel etmenleri kontrol etmeli, uyku bozukluklarını önlemeli, terapötik yaklaşım ile etkin iletişim sağlamalı ve aile merkezli bakım uygulamalıdır.

Keywords

Çocuk, Deliryum, Hemşirelik bakımı, Yoğun Bakım

NURSING MANAGEMENT AND DIAGNOSIS OF DELIRIUM ON PATIENTS IN PEDIATRIC INTENSIVE CARE UNIT

Abstract

Delirium is a clinical syndrome with rapid onset, fluctuating course, accompanied by many causes in the etiology, and changes in consciousness, perception, thought, sleep-wake cycle. The aim of this review is to share current information on the diagnosis, prevention and delirium of pediatric nurses in critically ill children hospitalized in the intensive care unit. In this review, PubMed, Web of Science, Cochrane, Turkey Citation Index, Google Scholar, EBSCOhost databases were scanned matches the achievement of the objectives of this study research on the subject. “Delirium”, “child”, “intensive care”, “nursing care” have been used as keywords. The most important risk factors for delirium in critically ill children are age, developmental delay, disease severity and mechanical ventilation. The adverse outcomes of delirium in pediatric patients have been reported to be increased mortality, prolonged hospital stay, and increased cost. In addition, when the researches are examined; pediatric nurses did not have sufficient information about diagnosis, prevention and care of delirium, could not apply the right approaches and very few of the nurses used diagnostic tools to evaluate delirium. Delirium is a common problem in critically ill children. Pediatric nurses should pioneer the application of evidence-based information to improve patient outcomes. Pediatric nurses should control the environmental factors that play a role in the formation of delirium, prevent sleep disturbances, provide effective communication with therapeutic approach and apply family-centered care.

Keywords

Child, delirium, nursing care, intensive care

References

• Al-Qadheeb NS et al. Perceptions of nurses and physicians of their communication at night about intensive care patients' pain, agitation, and delirium. American Journal of Critical Care; 2013;22(5):49-61.
• American Association of Critical-Care Nurses. AACN practice alert: assessment and management of delirium across the life span. Crit Care Nurse; 2016;36(5):14-9.
• American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing; 2013;5(1):128-9.
• Bilge EU ve ark. Erişkin hastalarda postoperatif yoğun bakım ünitesinde deliryum insidansı. Turkish Journal of Anaesthesiology & Reanimation; 2015;43(4):232-9.
• Brahmbhatt K, Whitgob E. Diagnosis and management of delirium in critically ill infants: case report and review. Pediatrics; 2016,137(3):1-5.
• Colville G, Kerry S, Pierce C. Children’s factual and delusional memories of intensive care. American Journal of Respiratory and Critical Care Medicine; 2008;177(9):976-82.
• Dubois MJ et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Medicine; 2001,27(8):1297-304.
• Durukan İ ve ark. Çocuk ve ergenlerde deliryum ve tedavisi: gözden geçirme. Çocuk ve Gençlik Ruh Sağlığı Dergisi; 2008,15(3):177-86.
• Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: an under-recognized syndrome of organe dysfunction. Seminars in Respiratory and Critical Care Medicine; 2001;22(2):115-26.
• European Delirium Association, American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Medicine. 2014;12(8):141.
• Hamdan-Mansour AM et al. Knowledge and nursing practice of critical care nurses caring for patients with delirium in ıntensive care units in jordan, The Journal of Continuing Education in Nursing; 2010;41(12): 571-76.
• Holly C et al. Original Research Recognizing Delirium in Hospitalized Children A Systematic Review of the Evidence on Risk Factors and Characteristics. AJN The American Journal of Nursing. 2018;118(4):24-36.
• Hosie A, Phillips J. Editorial: Nurses’ role in improving interdisciplinary delirium care in inpatient settings: steps for action. Journal of Clinical Nursing; 2014;23(21-22):2995-7.
• Hughes CG, Patel MB, Pandharipande PP. Pathophysiology of acute brain dysfunction: what’s the cause of all this confusion? Current Opinion in Critical Care; 2012;18(5):518-26.
• Inouye SK et al. The role of adherence on the effectiveness of nonpharmacologic interventions. Archives of Internal Medicine; 2003;163(8):958–64.
• Inouye SK. Delirium in older persons. The New England Journal of Medicine; 2006;354(11):1157-65.
• Kırpınar İ. Dahili ve cerrahi tıpta deliryumun değerlendirilmesi ve yönetimi: Bir gözden geçirme; 2016; 4(3): 113-22.
• Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: a wake-up call for the pediatric critical care community. Critical Care Medicine; 2014;42(7):1592-600.
• Küçük L, Kaya H. Koroner yoğun bakım sürecinde yaşanan psikiyatrik bir durum: deliryum ne kadar tanıyoruz? Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi; 2011;4(1):162-6.
• MacLullich AM et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. Journal of Psychosomatic Research; 2008;65(3):229-38.
• Morandi A, Jackson JC. Delirium in the intensive care unit: A review .Neurologic Clinics; 2011;29(4);749-63.
• Norman S, Taha AA, Turner HN. Delirium in the critically ill child. Clinical Nurse Specialist; 2017;31(5):276-84.
• Ouimet S et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine; 2007;33(1):66-73.
• Özdemir L. Yoğun bakım hastasında deliryumun yönetimi ve hemşirenin sorumlulukları. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi; 2014:1(1):90-8.
• Öztürk C, Ayar D. Pediatri hemşireliğinde aile merkezli bakım. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 2014;7(4):315-20
• Peacock R et al. Care home staff can detect the difference between delirium, dementia and depression. Nursıng Older People; 2012;24(1):26-30.
• Pediatric illness severity measures predict delirium in a pediatric intensive care unit. Crit Care Med. 2008;36(6):1933-36.
• Pereira JM et al. Delirium in critically ill patients: risk factors modifiable by nurses/Delírium no doente crítico: fatores de risco modificáveis pelos enfermeiros/El delirio en pacientes críticos: factores de riesgo modificables por los enfermeros. Revista de Enfermagem Referência; 2016;4(9):29.
• Pisani MA et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Archives of Internal Medicine; 2007;167(15):1629-34.
• Pun BT, Boehm L. Delirium in the intensive care unit assessment and management. AACN Advanced Critical Care; 2011;22(3): 225-37.
• Schieveld JN et al. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Med; 2007;33:1033-40.
• Schieveld JNM, Ista E, Knoester H, Molag ML. Pediatric delirium: a practical approach. In: Rey JM, ed. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva, Switzerland: International Association for Child and Adolescent Psychiatry and Allied Professions. http://iacapap.org/wp-content/ uploads/I.5-Delırıum-2015.pdf, 2015. Erişim Tarihi:24.01.2019.
• Schreier AM. Nursing care, delirium, and pain management for the hospitalized older adult. pain management nursing; 2010;11(3):177-85.
• Silver G et al. Pediatric delirium and associated risk factors: a single-center prospective observational study. Pediatric Critical Care Medicine; 2015;16(4):303-9.
• Silver G et al. Detecting pediatric delirium: development of a rapid observational assessment tool. Intensive Care Medicine; 2012;38(6):1025-31.
• Silver GH et al. Infant delirium in pediatric critical care settings. American Journal of Psychiatry; 2010;167(10): 1172-77.
• Smeets IA et al. Prolonged stay at the paediatric intensive care unit associated with paediatric delirium. European Child & Adolescent Psychiatry; 2010;19(4):389-93.
• Smith HA et al. Pediatric critical care perceptions on analgesia, sedation, and delirium. Seminars in Respiratory and Critical Care Medicine; 2013b;34(2):244-61.
• Smith HA et al. Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Critical care medicine, 2011;39(1), 150.
• Smith HA et al. Pediatric delirium: monitoring and management in the pediatric intensive care unit. Pediatric Clinics of North America; 2013a;60(3):741-60.
• Smith HA et al. The Preschool Confusion Assessment Method for the ICU: Valid and Reliable Delirium Monitoring for Critically Ill Infants and Children. Critical care medicine, 2016;44(3), 592–600.
• Speed G. The Impact of a Delirium educational ıntervention with ıntensive care unit nurses. Clinical Nurse Specialist; 2015;29(2):89-94.
• Spronk PE et al. Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Medicine; 2009;35(7):1276–80.
• Topuz Ş, Doğan N. Bir üniversite hastanesinin yoğun bakım ünitelerinde çalışan hemşirelerin deliryum konusuna ilişkin bilgi düzeyleri. Kırıkkale Üniversitesi Tıp Fak Dergisi; 2012;14(3):21.
• Traube C et al. Cost associated with pediatric delirium in the ICU. Crititical Care Medicine; 2016;44(12):1175-79.
• Traube C et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Critical Care Medicine; 2017a;45(5):891-8.
• Traube C et al. Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU. Critical Care Medicine; 2014;42(3):656-63.
• Traube C et al. Delirium in critically ill children: an international point prevalence study. Critical Care Medicine; 2017b;45(4):584-90.
• Van de Steeg L et al. The effect of an e-learning course on nursing staff's knowledge of delirium: a before- and-after study. BMC Medical Education; 2015;15(1):1-12.
• Van Eijk MM et al. Comparison of delirium assessment tools in a mixed intensive care unit. Critical Care Medicine; 2009;37(6):1881–5.
• Vasilevskis E et al. Delirium and sedation recognition using val idated ınstruments: reliability of bedside ıntensive care unit nursing assessments from 2007 to 2010. Journal of the American Geriatrics Society; 2011;59(2):249-55.
• Wells LG. Why don’t intensive care nurses perform routine delirium assessment? A discussion of the literature. Australian Critical Care; 2012;25(3):157-61.