Delirium in Pediatrics Intensive Care Unit: Diagnosis and Nursing Management

Year 2021, Volume: 2 Issue: 1, 92 - 104, 07.06.2021

Damla Özçevik Subaşi

Abstract

Delirium is a clinical syndrome with rapid onset and fluctuating course, accompanied by many factors in its etiology, and changes in consciousness, perception, thought, sleep-wake cycle. Although the prevalence of pediatric delirium varies according to the clinical profile of intensive care units, this rate can reach up to 57%. In addition to the most common hypoactive delirium observed in hospitalized children, there are three different types including hyperactive and mixed types. Studies show that the number of children with delirium detected after routine screening in units and units is higher. Diagnosis and management of delirium requires multidimensional nursing assessment. Using pediatric delirium screening tools, nurses should initiate delirium screening of critically ill children from their admission to the intensive care unit and evaluate them regularly 2-3 times a day. It is the key to preventing, managing and mitigating delirium in children by applying major non-pharmacological interventions (cognitive interventions, enabling environmental changes and promoting sleep, ensuring family participation, providing physiological support, providing early mobilization). In this review, nursing interventions for the diagnosis, prevention and management of delirium in children hospitalized in pediatric intensive care units are systematically discussed in the light of the literature.

Keywords

Child, delirium, ıntensive care, nursing process, nursing care

Pediatrik Yoğun Bakım Ünitesinde Deliryum: Tanılama ve Hemşirelik Yönetimi

Abstract

Deliryum hızlı başlangıçlı ve dalgalı seyreden, etiyolojisinde birçok faktörün eşlik ettiği, bilinç, algılama, düşünce, uyku-uyanıklık döngüsünde değişikliklerin görüldüğü klinik bir sendromdur. Pediatrik deliryum prevalansı yoğun bakım ünitelerinin klinik profile göre değişkenlik göstermekle birlikte, bu oran %57’ye kadar çıkabilmektedir. Hastanede yatan çocuklarda en sık hipoaktif deliryum gözlenmesinin yanı sıra hiperaktif ve miks tipler dahil olmak üzere toplam üç farklı çeşidi bulunmaktadır. Çalışmalar, birim ve ünitelerde rutin taramadan sonra deliryum tespit edilen çocuk sayısının rutin tarama öncesi daha fazla olduğunu göstermektedir. Deliryumda tanılama ve yönetim, çok boyutlu hemşirelik değerlendirmesi gerektirir. Pediatrik deliryum tarama araçlarını kullanarak, kritik hasta çocukların yoğun bakım ünitesine yatışından itibaren deliryum taramasını başlatmalı ve düzenli olarak günde 2-3 kez değerlendirmelidir. Hemşireler, başlıca non-farmakolojik girişimleri (bilişsel girişimler, çevresel değişikliklerin sağlanması ve uykunun teşviki, aile katılımının sağlanması, fizyolojik destek sağlanması, erken mobilizasyonun sağlanması) uygulayarak çocuklarda deliryumu önleme, yönetme ve olumsuz sonuçları hafifletebilmenin anahtarıdır. Bu derlemede, çocuk yoğun bakım ünitelerinde yatan çocuklarda deliryumun tanılanması, önlenmesi ve yönetimine yönelik hemşirelik girişimleri sistematik olarak literatür ışığında tartışılmıştır.

Keywords

Çocuk, Deliryum, Yoğun bakım, hemşirelik süreci, hemşirelik bakımı

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