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Yoğun Bakım Hastasında Deliryumun Yönetimi ve Hemşirenin Sorumlulukları

Year 2014, Volume: 1 Issue: 1, 90 - 98, 27.11.2015

Abstract

Yoğun bakımlarda yüksek prevelansla görülen deliryum, nöro-psikolojik bozukluklara yatkınlığı, mortalite, morbidite, hastanede ve mekanik ventilasyonda kalış sürelerini artırmaktadır. Hemşire bakım verirken deliryumun çeşidine göre uygulamalarını planlamalıdır. Hipoaktif deliryumdaki hastalar uzun süreli mekanik ventilasyon uygulamasına ve aspirasyona ilişkin komplikasyonlar, nozokomiyal pnömoni, basınç ülseri ve venöz tromboemboli açısından risk altındadır. Hiperaktif deliryumda ise düşünce sürecinde bozulma, korku ve yıkıcı davranışlar nedeniyle bakımın kesintiye uğraması ya da reddi gibi sorunlarla karşılaşılmaktadır. Hemşire, hastanın sahip olduğu risk faktörleri ile birlikte deliryum gelişimine katkı sağlayan çevresel faktörleri de ele alınmalıdır. Yoğun bakımlarda gürültü, akıl karıştıran uyaranlar, sosyal izolasyon önlenmeli; hastanın gün ışığından yararlanması sağlanmalıdır. Hastayla net bir iletişim kurulmalı, kişi-yer-zaman oryantasyonu sağlanmalı, uyku için elverişli bir ortam oluşturularak sirkadyen ritmi sürdürülmeli ve ağrı analjeziklerle kontrol altında tutulmalıdır. Ayrıca deliryumun önlenmesinde yoğun bakımlarda gereksiz invaziv girişimlerin kontrol altına alınması da önerilmektedir. Bu makalede yoğun bakım hastalarında görülen deliryumun yönetimi ve deliryumlu hastaya yönelik hemşirelik uygulamaları ele alınmıştır.

Anahtar Kelimeler: Ajitasyon, deliryum, hemşire, yoğun bakım

References

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  • 2. Greve I, Vasilevskis EE, Egerod I, Bekker Mortenson C, Moller AM, Svenningsen H, et al. Interventions for preventing intensive care unit delirium (protocol). Cochrane Database of Systematic Reviews 2012; 4: 1-18.
  • 3. American Psychiatric Association. Diagnostic and statistics manual of mental disorders. Arlington: American Psychiatric Publishing; 2000. p.135-180.
  • 4. Morandi A, Jackson JC. Delirium in the intensive care unit: A review. Neurol Clin 2011; 29: 749-763.
  • 5. McGuire BE, Basten CJ, RyAn CJ, Gallagher J. Intensive care unit syndrome. Archives of Internal Medicine 2000; 160(10): 906-909.
  • 6. Wells LG. Why don’t intensive care nurses perform routine delirium assessment? A discussion of the literature. Australian Critical Care 2012; 25: 157-161.
  • 7. Querques J. Disordered consciousness: Delirium in the intensive care unit. Seminars in Anesthesia, Perioperative Medicine and Pain 2006; 25: 219-224.
  • 8. Guo-hao X, Xiang-ming F. Importance of recognizing and managing delirium in intensive care unit. Chinese Journal of Traumatology 2009; 12(6): 370-374.
  • 9. Truman B, Ely EW. Using the confusion assessment method for the intensive care unit. Critical Care Nurse 2003; 23(2): 25-37.
  • 10. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care unit. Critical Care Medicine 2001; 29(7):1370-1379.
  • 11. Peterson JF, Pun BT, Dittus RS, Thomason JWW, Jackson JC, Shintani AK, et al. Delirium and its motoric subtypes: A study of 614 critically ill patients. Journal of American Geriatrics Society 2006; 54: 479-484.
  • 12. Rompaey BV, Schuurmans MJ, Shortridge-Baggett LM, Truijen S Bossaert L. Risk factors for intensive care delirium: A systematic review. Intensive and Critical Care Nursing 2008; 24: 98-107.
  • 13. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Critical Care Clinics 2013; 29: 51-65.
  • 14. Christensen M. What knowledge do ICU nurses have with regard to the effects of noise exposure in the intensive care unit? Intensive and Critical Care Nursing 2005; 21: 199-207.
  • 15. Christensen M. Noise levels in a general intensive care unit: a descriptive study. Nursing in Critical Care 2007; 12(4): 188-197.
  • 16. Szokol JW, Vender JS. Anxiety, delirium, and pain in the intensive care unit. Critical Care Clinics 2001; 17(4): 1-16.
  • 17. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine 2013; 41(1): 263-306.
  • 18. Inouye SK, Bogardus ST, Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions. Archives of Internal Medicine 2003; 163(28): 958-964.
  • 19. Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR et al. A multicomponent intervention to prevent delirium in hospitalized older patients. The New England Journal of Medicine 1999; 340(4): 669-676.
  • 20. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: A randomized trial. Journal of American Geriatrics Society 2001; 49(5): 516-522.
  • 21. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and accupational therapy in mechanically ventilated, critically ill patients: A randomized controlled trial. Lancet 2009; 373(30): 1874-1882.
  • 22. Dünya Sağlık Örgütü (World Health Organization). Berglund B, Lindvall T, Schwela DH (eds). Guidelines for community noise. Geneva: WHO; 1999. p.1-95.
  • 23. Boot R. Delirium: A review of the nurses role in the intensive care unit. Intensive and Critical Care Nursing 2012; 28: 185-189.
  • 24. Mo Y, Zimmermann. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. The Annals of Pharmacotherapy 2013; 47: 869-876.
  • 25. Forsgren LM, Eriksson M. Delirium-Awareness, observation and interventions in intensive care units: A national survey of Swedish ICU head nurses. Intensive and Critical Care Nursing 2010; 26: 296-303.
  • 26. Bergmann MA, Murphy KM, Kiely DK, Jones RN, Marcantonio ER. A model for management of delirious postacute care patients. Journal of American Geriatrics Society 2005; 53: 1825-2005.
  • 27. Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, Yasuda C, et al. Assessment of delirium in the intensive care unit nursing practices and perceptions. American Journal of Critical Care 2013; 17(6): 555-566.
  • 28. Juctic M. Does ICU psychosis really exist? Critical Care Nurse 2000; 20(3): 28-39.
  • 29. Pattison N. Psychological implications of admission to critical care British Journal of Nursing 2005; 14(13):708-714.
  • 30. Kadiroğlu AK, Ebik B, Kaya Ö, Yıldırım S, Bez Y. Nöroleptik malign sendrom tanılı üç oldu: Ayrıcı tanı ve predispozan nedenler. Yoğun Bakım Dergisi 2011; 3: 67-70.
Year 2014, Volume: 1 Issue: 1, 90 - 98, 27.11.2015

Abstract

References

  • 1. Arend E, Christensen M. Delirium in the intensive care unit: a review. Nursing in Critical Care 2009; 14(3): 145-154.
  • 2. Greve I, Vasilevskis EE, Egerod I, Bekker Mortenson C, Moller AM, Svenningsen H, et al. Interventions for preventing intensive care unit delirium (protocol). Cochrane Database of Systematic Reviews 2012; 4: 1-18.
  • 3. American Psychiatric Association. Diagnostic and statistics manual of mental disorders. Arlington: American Psychiatric Publishing; 2000. p.135-180.
  • 4. Morandi A, Jackson JC. Delirium in the intensive care unit: A review. Neurol Clin 2011; 29: 749-763.
  • 5. McGuire BE, Basten CJ, RyAn CJ, Gallagher J. Intensive care unit syndrome. Archives of Internal Medicine 2000; 160(10): 906-909.
  • 6. Wells LG. Why don’t intensive care nurses perform routine delirium assessment? A discussion of the literature. Australian Critical Care 2012; 25: 157-161.
  • 7. Querques J. Disordered consciousness: Delirium in the intensive care unit. Seminars in Anesthesia, Perioperative Medicine and Pain 2006; 25: 219-224.
  • 8. Guo-hao X, Xiang-ming F. Importance of recognizing and managing delirium in intensive care unit. Chinese Journal of Traumatology 2009; 12(6): 370-374.
  • 9. Truman B, Ely EW. Using the confusion assessment method for the intensive care unit. Critical Care Nurse 2003; 23(2): 25-37.
  • 10. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care unit. Critical Care Medicine 2001; 29(7):1370-1379.
  • 11. Peterson JF, Pun BT, Dittus RS, Thomason JWW, Jackson JC, Shintani AK, et al. Delirium and its motoric subtypes: A study of 614 critically ill patients. Journal of American Geriatrics Society 2006; 54: 479-484.
  • 12. Rompaey BV, Schuurmans MJ, Shortridge-Baggett LM, Truijen S Bossaert L. Risk factors for intensive care delirium: A systematic review. Intensive and Critical Care Nursing 2008; 24: 98-107.
  • 13. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Critical Care Clinics 2013; 29: 51-65.
  • 14. Christensen M. What knowledge do ICU nurses have with regard to the effects of noise exposure in the intensive care unit? Intensive and Critical Care Nursing 2005; 21: 199-207.
  • 15. Christensen M. Noise levels in a general intensive care unit: a descriptive study. Nursing in Critical Care 2007; 12(4): 188-197.
  • 16. Szokol JW, Vender JS. Anxiety, delirium, and pain in the intensive care unit. Critical Care Clinics 2001; 17(4): 1-16.
  • 17. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine 2013; 41(1): 263-306.
  • 18. Inouye SK, Bogardus ST, Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions. Archives of Internal Medicine 2003; 163(28): 958-964.
  • 19. Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR et al. A multicomponent intervention to prevent delirium in hospitalized older patients. The New England Journal of Medicine 1999; 340(4): 669-676.
  • 20. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: A randomized trial. Journal of American Geriatrics Society 2001; 49(5): 516-522.
  • 21. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and accupational therapy in mechanically ventilated, critically ill patients: A randomized controlled trial. Lancet 2009; 373(30): 1874-1882.
  • 22. Dünya Sağlık Örgütü (World Health Organization). Berglund B, Lindvall T, Schwela DH (eds). Guidelines for community noise. Geneva: WHO; 1999. p.1-95.
  • 23. Boot R. Delirium: A review of the nurses role in the intensive care unit. Intensive and Critical Care Nursing 2012; 28: 185-189.
  • 24. Mo Y, Zimmermann. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. The Annals of Pharmacotherapy 2013; 47: 869-876.
  • 25. Forsgren LM, Eriksson M. Delirium-Awareness, observation and interventions in intensive care units: A national survey of Swedish ICU head nurses. Intensive and Critical Care Nursing 2010; 26: 296-303.
  • 26. Bergmann MA, Murphy KM, Kiely DK, Jones RN, Marcantonio ER. A model for management of delirious postacute care patients. Journal of American Geriatrics Society 2005; 53: 1825-2005.
  • 27. Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, Yasuda C, et al. Assessment of delirium in the intensive care unit nursing practices and perceptions. American Journal of Critical Care 2013; 17(6): 555-566.
  • 28. Juctic M. Does ICU psychosis really exist? Critical Care Nurse 2000; 20(3): 28-39.
  • 29. Pattison N. Psychological implications of admission to critical care British Journal of Nursing 2005; 14(13):708-714.
  • 30. Kadiroğlu AK, Ebik B, Kaya Ö, Yıldırım S, Bez Y. Nöroleptik malign sendrom tanılı üç oldu: Ayrıcı tanı ve predispozan nedenler. Yoğun Bakım Dergisi 2011; 3: 67-70.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Leyla Özdemir

Publication Date November 27, 2015
Submission Date November 27, 2015
Published in Issue Year 2014 Volume: 1 Issue: 1

Cite

Vancouver Özdemir L. Yoğun Bakım Hastasında Deliryumun Yönetimi ve Hemşirenin Sorumlulukları. JOHUFON. 2015;1(1):90-8.