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Çocuklarda Sepsis ve Hemşirelik Bakımı

Yıl 2013, Cilt: 17 Sayı: 1, 21 - 28, 01.06.2013

Öz

Sepsis which is early diagnosis and treatment is life saving is cause high mortality and morbidity rates in children with sepsis. Nurses working in emergency and intensive care, has an important role in the evaluation and treatment of patients. If nurses know risk factors and infection prevention of sepsis, andearly notice clinical signs and symptoms of sepsis, they may prevent sepsis. In addition, if they evaluate and take care of the patients in accordance with developed guidelines direction, they may increase the chance of survival. Patients with sepsis; ensuring airway, provide oxygen and fluid needs, recommendantibiotics, implementation of vasopressors, steroids and inotropic drugs and provide nutrition of patient are the most fundamental issues in the provision of nursing care.In our country, the lack of improved guidelines used by nurses for prevention, diagnosis and treatment of sepsis in pediatric patients can be due to this article is intended to contribute to the topic. In this article, in accordance with current guidelines for sepsis developed is aimed to contribute to the nursing literatüre with revised and nursing care of patients with sepsis.

Kaynakça

  • Italian Pediatric Intensive Care Units: a
  • prospective national survey. Intensive Care
  • Med 2008;34(9):1690-7. 6. Goldstein B, Giroir B, Randolph A. International
  • pediatric sepsis consensus conference: Defi
  • nitions for sepsis and organ dysfunction in pe
  • diatrics. Pediatr Crit Care Med 2005;6(1):2-8. 7. Vardar F. Sepsis ve septik şok epidemiyolojisi
  • ve tanımlamalar. ANKEM Derg 2009; 23(Ek 2):254-7. 8. Çıtak A. Çocuklarda septik şok ve tedavisi.
  • Yenidoğan Yoğun Bakım ve Çocuk Yoğun
  • Bakım Hemşireliği Sempozyumu, İstanbul, 2013. 9. Kleinpell RP. The role of the critical care nurse
  • in the assessment and management of the pa
  • tient with severe sepsis. Crit Care Nurs Clin
  • North Am 2003;15(1):27-34. 10. Khilnani P, Deopujari S and Carcillo J. Recent advances in sepsis and septic shock. Indian J
  • Pediatr 2008;75(8):821-30. 11. Çelebi S. Çocuklarda sepsis ve septik şok.
  • Güncel Pediatri 2006;2:13-20. 12. Inwald DP, Tasker RC, Peters MJ, Nadel S
  • Paediatric Intensive Care Society Study Group
  • (PICS-SG). Emergency management of chil
  • dren with severe sepsis in the United King
  • dom: the results of the Paediatric Intensive
  • Care Society sepsis audit. Arch Dis Child
  • 94(5):348-53. 13. Shime N, Kawasaki T, Saito O, Akamine Y
  • Toda Y, Takeuchi M, et al. Incidence and risk
  • factors for mortality in paediatric severe sep
  • sis: results from the national paediatric inten
  • sive care registry in Japan. Intensive Care
  • Med 2012;38(7):1191-7. 14. Yıldızdaş D, Yapıcıoğlu H, Tümgör G, Erbey
  • F. Çocuk yoğun bakım ünitesi'nde sepsis ne
  • deni ile izlenen hastalarda poliklonal intra
  • venöz immünglobülin tedavisi mortaliteyi
  • azaltıyor mu?. Çocuk Sağlığı ve Hastalıkları
  • Dergisi 2005;48:136-41. 15. Leclerc F, Leteurtre S, Duhamel A, Grand
  • bastien B, Proulx F, Martinot A, et al. Cumu
  • lative influence of organ dysfunctions and
  • septic state on mortality of critically ill children.
  • Am J Respir Crit Care Med 2005;171(4):348- 53. 16. Şık V. Çocuk yoğun bakım ünitesinde mekanik
  • ventilatörde izlenen hastaların retrospektif
  • değerlendirilmesi. Samsun: Ondokuz Mayıs
  • Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve
  • Hastalıkları Anabilim Dalı Uzmanık Tezi; 2011. 17. Kleinpell R, Aitken L, Schorr CA. Implications
  • of the New International Sepsis Guidelines for
  • Nursing Care. Am J Crit Care 2013; 22(3):212- 22. 18. Dellinger RP, Levy MM, Rhodes A, Annane D
  • Gerlach H, Opal SM, et al. Surviving Sepsis
  • Campaign: International Guidelines for Man
  • agement of Severe Sepsis and Septic Shock
  • Crit Care Med 2013; 41(2):580-637. 19. Aitken LM, Williams G, Harvey M, Blot S
  • Kleinpell R, Labeau S, et al. Nursing consid
  • erations to complement the Surviving Sepsis
  • Campaign guidelines. Crit Care Med 2011; 39(7):1800-18. 20. Blackwood B, Wilson-Barnett J. The impact of
  • nurse-directed protocolised-weaning from me
  • chanical ventilation on nursing practice: a
  • quasi-experimental study. Int J Nurs Stud
  • 44(2):209-26. 21. İnce E. Çocuklarda Sepsis ve Septik Şok
  • Yönetimi: Antibiyotik Tedavisi. ANKEM Derg
  • 23(Ek 2):258-68. 22. Delgado AF, Falcao MC, Iglesias SB.Nutrition
  • in pediatric/neonatology patients submitted to
  • mechanical ventilation. Current Respiratory
  • Medicine Reviews 2012; 8(1):60-7. 23. Bozkurt G. Yoğun bakımdaki çocuğun beslen
  • mesi. Yoğun Bakım Hemşireliği Dergisi 2010; 14(2):72-8. 24. Rubinsky M, Clark A. Early enteral nutrition in
  • critically ill patients. Dimens Crit Care Nurs
  • 31(5):267-74. 25. Bourgault AM, Ipe L, Weaver J, Swartz S
  • O’Dea PJ. Development of evidence-based
  • guidelines and critical care nurses knowledge of enteral feeding. Crit Care Nurse 2007
  • (4):17-22, 25-9; quiz 30. 26. Ho KM, Dobb GJ, Webb SAR. A comparison
  • of early gastric and post-pyloric feeding in crit
  • ically ill patients: a meta-analysis. Intensive
  • Care Med 2006;32(5):639-49. 27. Sönmez Düzkaya D. Pediatri Yoğun Bakim
  • Ünitesinde Ventilatör İlişkili Pnömoniyi Ön
  • lemede İki Farklı Beslenme Yönteminin Etkin
  • liği. İstanbul:İstanbul Üniversitesi Florence
  • Nightingale Hemşirelik Fakültesi Çocuk
  • Sağlığı ve Hastalıkları Hemşireliği Anabilim
  • Dalı Doktora Tezi; 2013. 28. Marshall A, Elliott R, Rolls K, Schacht S, Boyle
  • M. Eyecare in the critically ill: Clinical practice
  • guideline. Aust Crit Care 2008;21(2):97-109. 29. Samaniengo IA. A sore spot in pediatrics: Risk
  • factors for pressure ulcers. Pediatric Nursing
  • 29 (4): 278-82. 30. Kissoon N, Carcillo JA, Espinosa V, Argent A
  • Devictor D, Madden M, et al. World Federa
  • tion of Pediatric Intensive Care and Critical
  • Care Societies: Global Sepsis Initiative. Pedi
  • atr Crit Care Med 2011; 12(5):494-503. 31. Riley C, Wheeler DS. Prevention of Sepsis in
  • Children: A New Paradigm for Public Policy.
  • Crit Care Res Pract 2012;2012:437139. 32. Pratt RJ, Pellowe CM, Wilson JA, Loveday
  • HP, Harper PJ, Jones SR, et al. EPIC2:Na
  • tional evidence-based guidelines for prevent
  • ing healthcare-associated infections in NHS
  • hospitals in England. J Hosp Infect 2007;65 Suppl 1:S1-64. 33. Bigham MT, Amato R, Bondurrant P, Fridriks
  • son J, Krawczewski CD, Raake K, et al. Ven
  • tilator- associated pneumonia in the pediatric
  • intensive care unit: Characterizing the prob
  • lem and implementing a sustainable solution.
  • J Pediatr 2009;154(4):582-587.e2. 34. Foglia E, Meier MD, Elward A. Neonatal and
  • Pediatric Intensive Care Unit Ventilator-Asso
  • ciated Pneumonia in Patients. Clin Microbiol
  • Rev 2007;20(3):409-25. 35. Standring D, Oddie D. Prevention of ventila
  • tor-associated pneumonia. Br J Cardiac Nurs
  • ing 2011;6(6): 286-90. 36. O'Grady NP, Alexander M, Burns LA
  • Dellinger EP, Garland J, Heard SO, et al.
  • Guidelines for the Prevention of Intravascular
  • Catheter-Related Infections. Clin Infect Dis
  • 52(9):1087-99. 37. Chaiyakunapruk N, Veenstra DL, Lipsky BA
  • Saint S. Chlorhexidine Compared with Povi
  • done-Iodine Solution for Vascular Catheter–
  • Site Care: A Meta-Analysis. Ann Intern Med
  • 136(11):792-801. 38. Humar A, Ostromecki A, Direnfeld J, Marshall
  • JC, Lazar N, Houston PC, et al. Prospective
  • randomized trial of 10% povidone-iodine ver
  • sus 0.5% tincture of chlorhexidine as cuta
  • neous antisepsis for prevention of central
  • venous catheter infection. Clin Infect Dis 2000; 31(4):1001-7. 39. Levy I, Katz J, Solter E, Samra Z, Vidne B
  • Birk E, et al. Chlorhexidine-impregnated
  • dressing for prevention of colonization of cen
  • tral venous catheters in infants and children: a
  • randomized controlled study. Pediatr Infect
  • Dis J 2005;24(8):676-9. 40. Timsit JF, Schwebel C, Bouadma L, Geffroy
  • A, Garrouste-Orgeas M, Pease S, et al.
  • Chlorhexidine-impregnated sponges and less
  • frequent dressing changes for prevention of
  • catheter-related infections in critically ill adults
  • a randomized controlled trial. JAMA
  • 301(12):1231-41. 41. McGee DC, Gould MK. Preventing complica
  • tions of central venous catheterization. N Engl
  • J Med 2003;348(12):1123-33. 42. Pedreira MLG, Kusahara DM, Carvalho WB
  • Nunez SC, Peterlini MAS. Oral care interven
  • tions and oropharyngeal colonization in chil
  • dren receiving mechanical ventilation. Am J
  • Crit Care 2009;18(4):319-28. 43. Speroni KG, Lett MO, Lucas J, Putman M
  • Dugan L, Daniel M., et al. Comparative effec
  • tiveness of standard endotracheal tubes vs.
  • endotracheal tubes with continuous subglottic
  • suctioning on ventilator-associated pneumo
  • nia rates. Nurs Econ 2011;29(1):15-20, 37. 44. Webster J, Hood RH, Burridge CA, Doidge
  • ML, Phillips KM, George N. Water or antisep
  • tic for periurethral cleaning before urinary
  • catheterization: A randomized controlled trial.
  • Am J Infect Control 2001;29(6):389-94. 45. Wong E, Hooton T. Guidelines for the Pre
  • vention of Catheter-Associated Urinary Tract
  • Infections. Guidelines for the Prevention and
  • Control of Nosocomial Infections. Atlanta, GA
  • Centers for Disease Control and Prevention; 2008.
  • www.cdc.gov/ncidod/dhqp/gl_catheter_assoc. html.

Çocuklarda Sepsis ve Hemşirelik Bakımı

Yıl 2013, Cilt: 17 Sayı: 1, 21 - 28, 01.06.2013

Öz

Çocuklarda ciddi oranda mortalite ve morbiditeye neden olan sepsiste erken tanı ve tedavi hayat kurtarıcıdır. Acil servislerde ve yoğun bakımda çalışan hemşirelerin, hastanın değerlendirilmesi ve tedavisindeki rolü önemlidir. Hemşireler sepsis için risk faktörlerini bilir, enfeksiyondan koruma önlemlerini alır ve klinik bulguları erken farkederler ise sepsisi önleyebilirler. Sepsis ile ilgili geliştirilen rehberler doğrultusunda hasta değerlendirilir ve bakımları bu doğrultuda gerçekleştirilirse hastanın hayatta kalma şansı artar. Sepsis gelişen hastanın; hava yolu açıklığının sağlanması, oksijen ve sıvı ihtiyacının karşılanması, önerilen antibiyotik, vazopressör, steroid ve inotrop ilaçların uygulanması ve hastanın beslenmesinin sağlanması hemşirelik bakımında en temel konulardır. Ülkemizde çocuk hastalarda sepsisin önlenmesi, tanı, tedavi ve hemşirelik bakımına yönelik geliştirilmiş rehberler bulunmamaktadır. Bu makalede sepsis için geliştirilen güncel rehberler doğrultusunda, sepsisli hastanın hemşirelik bakımı gözden geçirilerek, hemşirelik literatürüne katkı yapılması amaçlanmıştır.

Kaynakça

  • Italian Pediatric Intensive Care Units: a
  • prospective national survey. Intensive Care
  • Med 2008;34(9):1690-7. 6. Goldstein B, Giroir B, Randolph A. International
  • pediatric sepsis consensus conference: Defi
  • nitions for sepsis and organ dysfunction in pe
  • diatrics. Pediatr Crit Care Med 2005;6(1):2-8. 7. Vardar F. Sepsis ve septik şok epidemiyolojisi
  • ve tanımlamalar. ANKEM Derg 2009; 23(Ek 2):254-7. 8. Çıtak A. Çocuklarda septik şok ve tedavisi.
  • Yenidoğan Yoğun Bakım ve Çocuk Yoğun
  • Bakım Hemşireliği Sempozyumu, İstanbul, 2013. 9. Kleinpell RP. The role of the critical care nurse
  • in the assessment and management of the pa
  • tient with severe sepsis. Crit Care Nurs Clin
  • North Am 2003;15(1):27-34. 10. Khilnani P, Deopujari S and Carcillo J. Recent advances in sepsis and septic shock. Indian J
  • Pediatr 2008;75(8):821-30. 11. Çelebi S. Çocuklarda sepsis ve septik şok.
  • Güncel Pediatri 2006;2:13-20. 12. Inwald DP, Tasker RC, Peters MJ, Nadel S
  • Paediatric Intensive Care Society Study Group
  • (PICS-SG). Emergency management of chil
  • dren with severe sepsis in the United King
  • dom: the results of the Paediatric Intensive
  • Care Society sepsis audit. Arch Dis Child
  • 94(5):348-53. 13. Shime N, Kawasaki T, Saito O, Akamine Y
  • Toda Y, Takeuchi M, et al. Incidence and risk
  • factors for mortality in paediatric severe sep
  • sis: results from the national paediatric inten
  • sive care registry in Japan. Intensive Care
  • Med 2012;38(7):1191-7. 14. Yıldızdaş D, Yapıcıoğlu H, Tümgör G, Erbey
  • F. Çocuk yoğun bakım ünitesi'nde sepsis ne
  • deni ile izlenen hastalarda poliklonal intra
  • venöz immünglobülin tedavisi mortaliteyi
  • azaltıyor mu?. Çocuk Sağlığı ve Hastalıkları
  • Dergisi 2005;48:136-41. 15. Leclerc F, Leteurtre S, Duhamel A, Grand
  • bastien B, Proulx F, Martinot A, et al. Cumu
  • lative influence of organ dysfunctions and
  • septic state on mortality of critically ill children.
  • Am J Respir Crit Care Med 2005;171(4):348- 53. 16. Şık V. Çocuk yoğun bakım ünitesinde mekanik
  • ventilatörde izlenen hastaların retrospektif
  • değerlendirilmesi. Samsun: Ondokuz Mayıs
  • Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve
  • Hastalıkları Anabilim Dalı Uzmanık Tezi; 2011. 17. Kleinpell R, Aitken L, Schorr CA. Implications
  • of the New International Sepsis Guidelines for
  • Nursing Care. Am J Crit Care 2013; 22(3):212- 22. 18. Dellinger RP, Levy MM, Rhodes A, Annane D
  • Gerlach H, Opal SM, et al. Surviving Sepsis
  • Campaign: International Guidelines for Man
  • agement of Severe Sepsis and Septic Shock
  • Crit Care Med 2013; 41(2):580-637. 19. Aitken LM, Williams G, Harvey M, Blot S
  • Kleinpell R, Labeau S, et al. Nursing consid
  • erations to complement the Surviving Sepsis
  • Campaign guidelines. Crit Care Med 2011; 39(7):1800-18. 20. Blackwood B, Wilson-Barnett J. The impact of
  • nurse-directed protocolised-weaning from me
  • chanical ventilation on nursing practice: a
  • quasi-experimental study. Int J Nurs Stud
  • 44(2):209-26. 21. İnce E. Çocuklarda Sepsis ve Septik Şok
  • Yönetimi: Antibiyotik Tedavisi. ANKEM Derg
  • 23(Ek 2):258-68. 22. Delgado AF, Falcao MC, Iglesias SB.Nutrition
  • in pediatric/neonatology patients submitted to
  • mechanical ventilation. Current Respiratory
  • Medicine Reviews 2012; 8(1):60-7. 23. Bozkurt G. Yoğun bakımdaki çocuğun beslen
  • mesi. Yoğun Bakım Hemşireliği Dergisi 2010; 14(2):72-8. 24. Rubinsky M, Clark A. Early enteral nutrition in
  • critically ill patients. Dimens Crit Care Nurs
  • 31(5):267-74. 25. Bourgault AM, Ipe L, Weaver J, Swartz S
  • O’Dea PJ. Development of evidence-based
  • guidelines and critical care nurses knowledge of enteral feeding. Crit Care Nurse 2007
  • (4):17-22, 25-9; quiz 30. 26. Ho KM, Dobb GJ, Webb SAR. A comparison
  • of early gastric and post-pyloric feeding in crit
  • ically ill patients: a meta-analysis. Intensive
  • Care Med 2006;32(5):639-49. 27. Sönmez Düzkaya D. Pediatri Yoğun Bakim
  • Ünitesinde Ventilatör İlişkili Pnömoniyi Ön
  • lemede İki Farklı Beslenme Yönteminin Etkin
  • liği. İstanbul:İstanbul Üniversitesi Florence
  • Nightingale Hemşirelik Fakültesi Çocuk
  • Sağlığı ve Hastalıkları Hemşireliği Anabilim
  • Dalı Doktora Tezi; 2013. 28. Marshall A, Elliott R, Rolls K, Schacht S, Boyle
  • M. Eyecare in the critically ill: Clinical practice
  • guideline. Aust Crit Care 2008;21(2):97-109. 29. Samaniengo IA. A sore spot in pediatrics: Risk
  • factors for pressure ulcers. Pediatric Nursing
  • 29 (4): 278-82. 30. Kissoon N, Carcillo JA, Espinosa V, Argent A
  • Devictor D, Madden M, et al. World Federa
  • tion of Pediatric Intensive Care and Critical
  • Care Societies: Global Sepsis Initiative. Pedi
  • atr Crit Care Med 2011; 12(5):494-503. 31. Riley C, Wheeler DS. Prevention of Sepsis in
  • Children: A New Paradigm for Public Policy.
  • Crit Care Res Pract 2012;2012:437139. 32. Pratt RJ, Pellowe CM, Wilson JA, Loveday
  • HP, Harper PJ, Jones SR, et al. EPIC2:Na
  • tional evidence-based guidelines for prevent
  • ing healthcare-associated infections in NHS
  • hospitals in England. J Hosp Infect 2007;65 Suppl 1:S1-64. 33. Bigham MT, Amato R, Bondurrant P, Fridriks
  • son J, Krawczewski CD, Raake K, et al. Ven
  • tilator- associated pneumonia in the pediatric
  • intensive care unit: Characterizing the prob
  • lem and implementing a sustainable solution.
  • J Pediatr 2009;154(4):582-587.e2. 34. Foglia E, Meier MD, Elward A. Neonatal and
  • Pediatric Intensive Care Unit Ventilator-Asso
  • ciated Pneumonia in Patients. Clin Microbiol
  • Rev 2007;20(3):409-25. 35. Standring D, Oddie D. Prevention of ventila
  • tor-associated pneumonia. Br J Cardiac Nurs
  • ing 2011;6(6): 286-90. 36. O'Grady NP, Alexander M, Burns LA
  • Dellinger EP, Garland J, Heard SO, et al.
  • Guidelines for the Prevention of Intravascular
  • Catheter-Related Infections. Clin Infect Dis
  • 52(9):1087-99. 37. Chaiyakunapruk N, Veenstra DL, Lipsky BA
  • Saint S. Chlorhexidine Compared with Povi
  • done-Iodine Solution for Vascular Catheter–
  • Site Care: A Meta-Analysis. Ann Intern Med
  • 136(11):792-801. 38. Humar A, Ostromecki A, Direnfeld J, Marshall
  • JC, Lazar N, Houston PC, et al. Prospective
  • randomized trial of 10% povidone-iodine ver
  • sus 0.5% tincture of chlorhexidine as cuta
  • neous antisepsis for prevention of central
  • venous catheter infection. Clin Infect Dis 2000; 31(4):1001-7. 39. Levy I, Katz J, Solter E, Samra Z, Vidne B
  • Birk E, et al. Chlorhexidine-impregnated
  • dressing for prevention of colonization of cen
  • tral venous catheters in infants and children: a
  • randomized controlled study. Pediatr Infect
  • Dis J 2005;24(8):676-9. 40. Timsit JF, Schwebel C, Bouadma L, Geffroy
  • A, Garrouste-Orgeas M, Pease S, et al.
  • Chlorhexidine-impregnated sponges and less
  • frequent dressing changes for prevention of
  • catheter-related infections in critically ill adults
  • a randomized controlled trial. JAMA
  • 301(12):1231-41. 41. McGee DC, Gould MK. Preventing complica
  • tions of central venous catheterization. N Engl
  • J Med 2003;348(12):1123-33. 42. Pedreira MLG, Kusahara DM, Carvalho WB
  • Nunez SC, Peterlini MAS. Oral care interven
  • tions and oropharyngeal colonization in chil
  • dren receiving mechanical ventilation. Am J
  • Crit Care 2009;18(4):319-28. 43. Speroni KG, Lett MO, Lucas J, Putman M
  • Dugan L, Daniel M., et al. Comparative effec
  • tiveness of standard endotracheal tubes vs.
  • endotracheal tubes with continuous subglottic
  • suctioning on ventilator-associated pneumo
  • nia rates. Nurs Econ 2011;29(1):15-20, 37. 44. Webster J, Hood RH, Burridge CA, Doidge
  • ML, Phillips KM, George N. Water or antisep
  • tic for periurethral cleaning before urinary
  • catheterization: A randomized controlled trial.
  • Am J Infect Control 2001;29(6):389-94. 45. Wong E, Hooton T. Guidelines for the Pre
  • vention of Catheter-Associated Urinary Tract
  • Infections. Guidelines for the Prevention and
  • Control of Nosocomial Infections. Atlanta, GA
  • Centers for Disease Control and Prevention; 2008.
  • www.cdc.gov/ncidod/dhqp/gl_catheter_assoc. html.
Toplam 139 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Duygu Sönmez Düzkaya Bu kişi benim

Gülçin Bozkurt Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 17 Sayı: 1

Kaynak Göster

Bu derginin içeriği Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı kapsamında lisanslanmıştır.

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