Pediatri Yoğun Bakımlarda Deliryum Yönetiminde Hemşirenin Sorumlulukları ve Rolleri

Yıl 2021, , 67 - 78, 24.04.2021

İlçim Ercan , Evrim Kızıler

https://doi.org/10.51536/tusbad.832764

Öz

Deliryum, bilinç durumunda dalgalanmaya neden olan akut başlangıçlı mental bir durumdur. Yoğun bakım ünitelerinde tedavi gören çocuk hastalarda, ortamın gürültülü ve sürekli aydınlık olması, tıbbi cihazların varlığı, sağlık ekibinin tekrarlayan müdahaleleri ve mekanik ventilasyon ihtiyacı gibi nedenlerle görülme sıklığı %80’e kadar çıkmaktadır. Çocuk hastalarda deliryum yüksek mortalite oranlarıyla ilişkili, sık görülen bir sağlık sorunu olmasına rağmen çocuk gelişim düzeylerindeki farklılıklar, bilgi eksikliği, yapılan çalışmaların azlığı ve rutin değerlendirmede aksamalar nedeniyle pediatrik deliryum vakaları sağlık ekibi üyeleri tarafından ya erken dönemde fark edilememekte ya da depresyon gibi farklı bir tanı ile karıştırılabilmektedir. Bu durumda tablo daha da ilerlemekte, çocukların oryantasyonu, düşünce süreçleri, uyku düzenleri bozulmakta, hastanede kalış süresi uzamakta ve hatta hasta kaybedilebilmektedir. Yoğun bakımda tedavi gören çocuk hastalarla tedavi ve bakım gereği sürekli temas ve iletişim halinde olan hemşireler, hastada oluşabilecek ufak bir değişikliğin bile fark edilmesi, pediatrik deliryumun erken dönemde tanılanması ve tedavisinin sağlanmasında kritik rol oynamaktadır. Bu derlemede hemşirelerin pediatri yoğun bakımlarda deliryum yönetimindeki sorumluluk ve rollerinin vurgulanması amaçlanmıştır.

Anahtar Kelimeler

Delliryum, Hemşirelik, Pediatrik Yoğun Bakım Ünitesi

Nursing Responsibilities and Roles in Delirium Management in Pediatric Intensive Care Unit

Öz

Delirium which causes fluctations in consciousness is an acute mental state. Pediatric patients who treated in intensive care units, the incidence increases up to %80 because of noisy environment, permanent bright environment, presence of medical devices, repetitive intervetions of healthcare team and need for mechanical ventilation. Although delirium is a common health problem associated with high mortality rates in pediatric patients, not be noticed by healthcare team in early period or is mixed up with a different diagnosis such as deppresion due to differences in developmental levels, lack of information, minority of studies and hitch of routine evaluation. In this case, the status progresses further, orientation, thouht processes and sleep cycle decay, the duration of hospital stay is prolonged and even the patient may be died. Nurses, who are in constant contact and communication with pediatric patients who are treated in intensive care accordingly treatment and care, play a critical role in recognizing even a small alteration that occur in patient, early diagnosis of pediatric delirium and providing treatment. In this review, it is aimed to emphasize the responsibilities and roles of nurses in delirium management in pediatric intensive care units.

Anahtar Kelimeler

Delirium, Nursing, Pediatric Intensive Care Unit

Kaynakça

• 1. Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric icu: evaluation of picu staff knowledge. J Pediatr Nurs. 2016; 31(1): 81-4.
• 2. Traube C, Silver G, Reeder RW, Doyle H, Hegel E, Wolfe HA, et al. Delirium in critically ill children: an international point prevalence study. Crit Care Med. 2017; 45(4): 584-90.
• 3. Turkel S, Hanft A, Epstein D, Jacobson J. Review of Delirium in the pediatric intensive care unit. J of Pediatr Intensive Care. 2013; 2(4): 169-76.
• 4. Bettencourt A, Mullen JE. Delirium in children: identification, prevention, and management. Crit Care Nurse. 2019; 37(3): 9-18.
• 5. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of icu delirium. Intensive Care Med. 2007; 33: 66-73.
• 6. Norman S, Taha AA, Turner HN. Delirium in the critically ill child. Clin Nurse Spec. 2017; 31(5): 276-84.
• 7. Bryant K. Pediatric delirium in the cardiac intensive care unit identification and intervention. Crit Care Nurse. 2018; 38(4): 1-7.
• 8. Colville G, Kerry S, Pierce C. Children’s factual and delusional memories of ıntensive care. Am J Resp Crit Care Med. 2008; 177(9): 976-82.
• 9. Holly C, Porter S, Echevarria M, Dreker M, Ruzehaji S. Recognizing delirium in hospitalized children a systematic review of the evidence on risk factors and characteristics. Am J Nurse. 2018; 118 (4): 24-36.
• 10. Çınar MA, Balıkçı A, Sertoğlu E, Ak M, Serdar MA, Özmenler KN. Deliryum patofizyolojisinde CRP, TNF-α ve IGF-1’in rolü. Nöropsikiyatri Arşivi. 2014; 51: 376-82.
• 11. Kaya E, Sönmez S, Barlas F. Deliryum. Okmeydanı Tıp Dergisi. 2013; 29 (Ek sayı 2):70-4.
• 12. Hipp DM. Pharmacological and non-pharmacological management of delirium in critically ill Patients. Neurotherapeutics. 2012; 9 (1): 158-75.
• 13. Hatherill S, Flisher AJ. Delirium in children and adolescents a systematic review of the literatüre. J Psychosom Res. 2010; 68(4): 337–44.
• 14. Franken A, Sebbens D, Mensik J. Pediatric delirium: early identification of barriers to optimize success of screening and prevention. J Pediatr Health Care. 2019; 33(3): 228-233.
• 15. Özdemir L. Yoğun bakım hastasında deliryumun yönetimi ve hemşirenin sorumlulukları. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2014; 1(1): 90–8.
• 16. Ista E, Beest H, Rosmalen J, Hoog M, Tibboel D, Beusekom B, et al. Sophia observation withdrawal symptoms- pediatric delirium scale: a tool for early screening of delirium in the picu. Aust Crit Care. 2018; 31(5): 266-73.
• 17. Patel AK, Biagas KV, Clarke EC, Gerber LM, Mauer E, Silver G, et al. Delirium in children after cardiac bypass surgery. Pediatr Crit Care Med. 2017; 18(2): 165-71.
• 18. 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. Crit Care Med. 2014; 42(7): 1592-600.
• 19. Staveski SL, Pickler RH, Lin L, Shaw RJ, Meinzen-Derr J, Redington A, et al. Management of pediatric delirium in pediatric cardiac intensive care patients: an international survey of current practices. Pediatr Crit Care Med. 2018; 19(6): 538-43.
• 20. Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, et al. Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the picu, Crit Care Med. 2014; 42(3): 656–63.
• 21. Traube C, Augenstein J, Greenwald B, LaQuaglia M, Silver G. Brief report neuroblastoma and pediatric delirium: a case series. Pediatr Blood Cancer. 2014; 61(6): 1121–3.
• 22. Thom RP. Pediatric Delirium. Am J Psychiatry. 2017; 12(2): 6-8.
• 23. Johnston C, Krebs VLJ, Carvalho WB, Sampaio MC. Early mobilization in pıcu: are we on time?. Pediatrics in South America. 2019; 5: 397–405.
• 24. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, et al. Picu up!: impact of a quality improvement intervention to promote early mobilization in critically ill Children. Pediatr Crit Care Med. 2016; 17(12): 559–66.
• 25. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678): 1874–82.
• 26. Simone S, Edwards S, Lardieri A, Walker LK, Graciano AL, Kishk OA, et al. Implementation of an icu bundle: an interprofessional quality improvement project to enhance delirium management and monitor delirium prevalence in a single picu. Pediatr Criti Care Med. 2017; 18(6): 531-40.
• 27. Arend E, Christensen M. Delirium in the intensive care unit: a review. Nurs Crit Care. 2009; 14(3): 145-54.
• 28. Sarı N. Sağlık çalışanlarının yoğun bakımlarda deliryum yönetimlerinin incelenmesi, Yüksek Lisans Tezi, İzmir, Ege Üniversitesi Sağlık Bilimleri Enstitüsü, 2015.
• 29. Weatherhead J, Niedner M, Kahoud R, Kawai Y. Noise pollution in a pediatric intensive care unit. Crit Care Med. 2016; 44 (12): 350.
• 30. Kawai Y, Weatherhead JR, Traube C, Owens TA, Shaw BE, Fraser EJ, et al. Quality improvement initiative to reduce pediatric intensive care unit noise pollution with the use of a pediatric delirium bundle. J Intensive Care Med. 2019; 34(5): 383-90.
• 31. Rompaey BV, Elseviers MM, Drom WV, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care Med. 2012; 16(3): 1-10.
• 32. Guen ML, Robin AN, Lebard C, Arnulf I, Langeron O. Earplugs and eye masks vs routine care prevent sleep impairment in post-anaesthesia care unit: a randomized study. Br J of Anaesth. 2014; 112 (1): 89–95.
• 33. Yazdannik AR, Zareie A, Hasanpour M, Kashef J. The effect of earplugs and eye mask on patients’ perceived sleep quality in intensive care unit. Iranian J Nursing Midwifery Res. 2014; 19 (6): 673-8.
• 34. Kim HJ, Kim DH. Factors associated with Pediatric Delirium in the Pediatric Intensive Care Unit. Child Health Nurs Res. 2019; 25 (2): 103-11.
• 35. Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care Patients. Anaesth. 2014; 69: 540–9.
• 36. Atalan N, Sevim ME. Postoperative delirium associated with prolonged decline in cognitive function and sleep disturbances after cardiac surgery. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2013; 21 (2): 358-63.
• 37. Tosun A, Tüfekci G. Çocuk kliniklerinde aile merkezli bakım uygulamalarının incelenmesi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2015; 18 (2): 131-9.
• 38. Boztepe H. Pediatri hemşireliğinde aile merkezli bakım. Türkiye Klinikleri J Nurs Sci. 2009; 1(2): 88-93.
• 39. Bauer PR, Rabinstein AA, Wilson ME. Family Visitation Policies in the ICU and Delirium. JAMA. 2019; 322 (19): 1923-5.
• 40. Rosa RG, Kochhann R, Barbosa MG, Cavalcanti AB, Pellegrini JAS, Ayres LO, et al. Effect of flexible family visitation on delirium among patients in the intensive care unit the icu visits randomized clinical trial. JAMA. 2019; 322 (3): 216-28.
• 41. Simonsen BY, Lisby M, Traube C, Skovby P. The cornell assessment of pediatric delirium: translation and inter‐rater reliability in a danish pediatric intensive care unit. Acta Anaesthesiol Scand. 2019; 63 (7): 900–4.
• 42. Schieveld JNM, Janssen JNF. Delirium in the pediatric patient on the growing awareness of ıts clinical interdisciplinary importance. JAMA Pediatr. 2014; 168(7): 595-6.
• 43. Smith HAB, Gangopadhyay M, Goben CM, Jacobowski NL, Chestnut MH, Savage S, et al. The preschool confusion assessment method for the icu (pscam-icu): valid and reliable delirium monitoring for critically ill infants and children. Crit Care Med. 2016; 44(3): 592–600.
• 44. Şahin H. Bir üniversite hastanesinde çalışan hemşirelerin deliryum hakkındaki bilgi ve tutumlarının araştırılması, Yüksek Lisans Tezi, Avrasya Üniversitesi Sağlık Bilimleri Üniversitesi, Trabzon, 2019.