PEDİATRİK YOĞUN BAKIM ÜNİTESİNDE YATAN HASTALARDA DELİRYUMUN TANILANMASI VE HEMŞİRELİK YÖNETİMİ

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

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