Nursing Approach to Pediatric Intensive Care Patients in Delirium

Year 2020, Volume: 8 Issue: 3, 964 - 972, 30.11.2020

Abdullah Sarman , Emine Sarman

https://doi.org/10.33715/inonusaglik.726409

Cited By: 1

Abstract

Delirium is defined as non-specific organic brain syndrome in which disturbances of consciousness is accompanied by attention, perception, thought, memory, psychomotor-activation, mood, and sleep-wake cycle disturbances. Pediatric delirium is a common condition that causes various neurological and cognitive problems. Pediatric delirium has a prevalence rate of 25% in pediatric intensive care units (PICUs). Patients with delirium who require critical care may more frequently experience longer hospital stay, long-term mechanical ventilation, and post-traumatic stress disorder symptoms. Routine screening for delirium provides early recognition. Pediatric delirium screenings are often not regularly performed in the PICU. There are some obstacles for the application of delirium screenings. One of these is the lack of information among nurses who provide critical care. Nurses have a key role in defining and identifying delirium risks, and providing care by using a valid and reliable tool in pediatric intensive care units. Increasing delirium knowledge of pediatric intensive care nurses, developing an appropriate attitude towards delirium is the first step in alleviating the negative consequences of delirium for children with critical illness. Multi-faceted training increases delirium knowledge, self-esteem and attitude towards delirium for pediatric intensive care nurses. Employees must constantly follow up to recognize delirium. The sustainability of delirium screening and inclusion of application changes require continuous measurement of delirium results and multidisciplinary team communication. In order to better understand the importance of this issue, longitudinal studies are needed in pediatric intensive care units. 

Keywords

Pediatric intensive care, delirium, nursing, care, child

DELİRYUMDAKİ PEDİATRİK YOĞUN BAKIM HASTALARINA HEMŞİRELİK YAKLAŞIMI

Abstract

Deliryum; bilinç değişikliğine dikkat, algı, düşünce, bellek, devinim, duygu-durum ve uyku-uyanıklık döngüsü bozukluklarının eşlik ettiği, özgül olmayan organik beyin sendromu olarak tanımlanır. Pediatrik deliryum, yaygın olarak görülen, çeşitli nörolojik ve bilişsel problemlere neden olan durumdur. Pediatrik deliryum, pediatrik yoğun bakım ünitelerinde (PYBÜ) %25 prevalans oranına sahiptir. Kritik bakıma gereksinim duyan deliryumdaki hastalar daha uzun hastanede kalma, uzun süreli mekanik ventilasyon ve hastane sonrası dönemde travma sonrası stres bozukluğu belirtilerini daha sık yaşayabilmektedirler. Deliryum için rutin yapılan taramalar erken dönemde tanınmasını sağlar. Pediatrik deliryum taramaları çoğu zaman PYBÜ'de düzenli bir şekilde yapılmamaktadır. Deliryum taramalarının uygulanmasının önünde bazı engeller bulunmaktadır. Bunlardan biri kritik bakımı sağlayan hemşireler arasındaki bilgi eksikliğidir. Hemşireler, pediatrik yoğun bakım ünitelerinde geçerli ve güvenilir bir araç kullanarak deliryum risklerinin tanımlanması ve belirlenmesi, ve bakım sağlanmasında kilit role sahiptir. Pediatrik yoğun bakım hemşirelerinin deliryum bilgisini arttırması, deliryuma karşı uygun bir tutum geliştirmesi, kritik hastalığı olan çocuklar için deliryumun olumsuz sonuçlarını hafifletmenin ilk adımıdır. Çok yönlü eğitim, pediatrik yoğun bakım hemşireleri için deliryum bilgisini, özgüveni ve deliryuma karşı olumlu tutumu arttırmaktadır. Çalışanların deliryumu tanıması için sürekli izlem yapması gereklidir. Deliryum taramasının sürdürülebilirliği ve uygulama değişikliklerinin dâhil edilmesi, deliryum sonuçlarının sürekli olarak ölçülmesini ve multidisipliner ekip iletişimini gerektirir. Bu konunun önemini daha iyi anlamak için pediatrik yoğun bakım ünitelerinde boylamsal çalışmalara ihtiyaç vardır.

Keywords

Pediyatrik yoğun bakım, deliryum, hemşirelik, bakım, çocuk

References

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (2013) 5 th edition. American Psychiatric Association, Washington, DC.
• Armstrong, S. C., Cozza, K. L., Watanabe, K. S. (1997). The misdiagnosis of delirium. Psychosomatics, 38(5), 433-439.
• Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., … Jaeschke, R. (2013). American college of critical care medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit, Critical Care Medicine, 41(1), 263-306.
• Boot, R. (2012). Delirium: a review of the nurses role in the intensive care unit. Intensive and Critical Care Nursing, 28(3), 185-189.
• Bosisio, M, Caraceni, A, Grassi, L. (2006). Phenomenology of delirium in cancer patients, as described by The Memorial Delirium Assessment Scale (MDAS) and The Delirium Rating Scale (DRS), Psychosomatics, 47(6), 471-478.
• Brummel, N. E, Girard, T. D. (2013). Preventing delirium in the intensive care unit, Critical Care Clinics, 29(1), 51-65.
• Caraceni, A., Simonetti, F. (2009). Palliating delirium in patients with cancer. The Lancet Oncology, 10(2), 164-172.
• Combs, D., Rice, S. A, Kopp, L. M. (2014). Incidence of delirium in children with cancer. Pediatric Blood ve Cancer, 61(11), 2094-2095.
• Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M, Harrell, F. E Jr, … Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 291(14), 1753-1762.
• Flagg, B., Cox, L., McDowell, S., Mwose, J. M., Buelow, J. M. (2010). Nursing identification of delirium. Clinical Nurse Specialist, 24(5), 260-266.
• Grandahl, M. G., Nielsen, S. E., Koerner, E. A., Schultz, H. H., Arnfred, S. M. (2016). Prevalence of delirium among patients at a cancer ward: clinical risk factors and prediction by bedside cognitive tests. Nordic Journal of Psychiatry, 70(6), 413-417.
• Greve, I., Vasilevskis, E. E., Egerod, I., Mortensen, C. B., Møller, A. M., Svenningsen, H., Thomsen, T. (2012). Interventions for preventing intensive care delirium. Cochrane Database for Systematic Reviews, 4, 1-21.
• Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354(11), 1157-1165.
• Kain, Z. N., Caldwell-Andrews, A. A., Maranets, I., McClain, B., Gaal, D., Mayes, L. C., … Zhang, H. (2004). Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia and Analgesia, 99(6), 1648-1654.
• Kang, J. H., Shin, S. H., Bruera, E. (2013). Comprehensive approaches to managing delirium in patients with advanced cancer. Cancer Treatment Reviews, 39(1), 105-112.
• Ljubisavljevic, V., Kelly, B. (2003). Risk factors for development of delirium among oncology patients. General Hospital Psychiatry, 25(5), 345-352.
• Marcantonio, E. R., Flacker, J. M., Wright, R. J., Resnick, N. M. (2001). Reducing delirium after hip fracture: a randomized trial. Journal of the American Geriatrics Society, 49(5), 516-522.
• McGuire, B. E., Basten, C. J., Ryan, C. J., Gallagher, J. (2000). Intensive care unit syndrome: a dangerous misnomer. JAMA Internal Medicine, 160(7), 906-909.
• Pandharipande, P. P., Girard, T. D., Jackson, J. C., Morandi, A., Thompson, J. L., Pun, B. T, … Ely, E. W. (2013). BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. The New England Journal of Medicine, 369(14), 1306-1316.
• Rivosecchi, R. M., Smithburger, P. L., Svec, S., Campbell, S., Kane-Gill, S. L. (2015). Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Critical Care Nurse, 35(1), 39-49.
• Silver, G., Traube, C., Gerber, L. M., Sun, X., Kearney, J., Patel, A., Greenwald, B. (2015). Pediatric delirium and associated risk factors: a single-center prospective observational study. World Federation of Pediatric Intensive and Critical Care Societies, 16(4), 303-309.
• Smith, C. D., Grami, P. (2016). Feasibility and effectiveness of a delirium prevention bundle in critically ill patients. American Journal of Critical Care, 26(1), 19-27.
• Smith, H. A. B., Brink, E., Fuchs, D. C., Ely, E. W., Pandharipande, P. P. (2013). Pediatric delirium: monitoring and management in the pediatric intensive care unit. Pediatric Clinics, 60(3), 741-760.
• Sullinger, D., Gilmer, A., Jurado, L., Zimmerman, L. H., Steelman, J., Gallagher, A., … Acquista, E. (2017). Development, implementation, and outcomes of a delirium protocol in the surgical trauma intensive care unit. Annals of Pharmacotherapy, 51(1), 5-12.
• Şenel, G., Uysal, N., Oguz, G., Kaya, M., Kadioullari, N., Koçak, N.,… Karaca, S. (2015). Delirium frequency and risk factors among patients with cancer in palliative care unit. American Journal of Hospice and Palliative Medicine, 34(3), 282-286.
• Tabet, N., Hudson, S., Sweeney, V., Sauer, J., Bryant, C., Macdonald, A.,… Howard, R. (2005). An educational intervention can prevent delirium on acute medical wards. Age and Ageing, 34(2), 152-156.
• Traube, C., Ariagno, S., Thau, F., Rosenberg, L., Mauer, E. A., Gerber, L. M., … Silver, G. (2017). Delirium in hospitalized children with cancer: incidence and associated risk factors. The Journal of Pediatrics, 191, 212-217.
• Traube, C., Augenstein, J., Greenwald, B., LaQuaglia, M., Silver, G. (2014). Neuroblastoma and pediatric delirium: a case series. Pediatric Blood ve Cancer, 61(6), 1121-1123.
• Traube, C., Silver, G., Gerber, L. M., Kaur, M., Mauer, E. A., Kerson, A., … Greenwald, B. M. (2017). Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Critical Care Medicine, 45(5), 891-898.
• Trompeo, A. C., Vidi, Y., Locane, M. D., Braghiroli, A., Mascia, L., Bosma, K.,… Ranieri, V. M. (2011). Sleep disturbances in the critically ill patients: role of delirium and sedative agents. Minerva Anestesiologica, 77(6), 604-612.
• Truman, B., Ely, E. W. (2003). Monitoring delirium in critically ill patients. Using the confusion assessment method for the intensive care unit. Critical Care Nurse, 23(2), 25-28.
• Turkel, S. B., Tavare, C. J. (2003). Delirium in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences, 15(4), 431-435.
• van den Boogaard, M., Pickkers, P., Slooter, A. J., Kuiper, M. A., Spronk, P. E., van der Voort, P. H, … Schoonhoven, L. (2012). Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ, 344, e420
• van den Boogaard, M., Pickkers, P., van der Hoeven, H., Roodbol, G., van Achterberg, T., Schoonhoven, L. (2009). Implementation of a delirium assessment tool in the ıcu can influence haloperidol use. Critical Care, 13(4), R131.
• Van Tuijl, S. G. L., Van Cauteren, Y. J. M, Pikhard, T., Engel, M., Schieveld, J. N. M. (2015). Management of pediatric delirium in critical illness: a practical update. Minerva Anestesiologica, 81(3), 333-341.
• Wada, T., Wada, M., Wada, M., Onishi, H. (2010). Characteristics, interventions, and outcomes of misdiagnosed delirium in cancer patients. Palliative and Supportive Care, 8(2), 125-131.