谵妄和循证护理实践:Covid-19大流行最新情况

Gülşah Kayserilioğlu, Nedret Tekin Kaya
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引用次数: 0

摘要

谵妄是一种复杂的神经精神综合征,其特点是急性发作的认知、注意力、定向障碍和意识水平的改变。谵妄是一种严重的健康问题,在从急诊室到手术室的许多地方,在所有年龄和医疗条件下都很常见。谵妄症状可在数小时或数天内出现,持续时间超过一个月。护士在诊断谵妄和管理过程中有重要的作用与循证实践的病人护理。用于谵妄风险分类和诊断的谵妄筛查和诊断测量工具应由日夜护理患者的护士使用。谵妄桌上的高死亡率,在重症监护病房或医院的长时间停留导致高昂的维护费用。新冠肺炎患者谵妄患病率有所上升。在Covid-19大流行中导致谵妄的触发因素可能是社会距离和社会隔离、深度镇静做法、高热、机械通气时间延长、因气溶胶传播焦虑而延迟拔管、疼痛评估不充分、心理感知(大规模死亡)、多器官功能障碍。众所周知,ABCDEF(疼痛评估、自发觉醒和呼吸试验、药物选择、谵妄监测/管理、早期运动/活动和家庭授权)护理包的应用对谵妄的管理是有效的。建议使用ABCDEF护理包对Covid-19患者进行谵妄管理。本文综述了影响全球的新型冠状病毒(SARS-CoV-2)大流行中谵妄预防和护理的循证实践。(JNNN 2022; 11(2): 74 - 82)。
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Delirium and Evidence-Based Nursing Practices: Covid-19 Pandemic Updates
Delirium is a complex neuropsychiatric syndrome characterized by an acute onset of cognitive, attention, disorientation and change in the level of consciousness. Delirium is a serious health problem that is common at all ages and medical conditions in many places from the emergency department to the operating room. Delirium symptoms can develop within hours or days and last longer than a month. Nurses have important roles in diagnosing delirium and managing the process with evidence-based practices in patient care. Delirium screening and diagnostic measurement tools used for delirium risk classification and diagnosis should be used by nurses who care for the patient day and night. High mortality in the delirium table, a long stay in the intensive care unit or in the hospital lead to high maintenance costs. The prevalence rates of delirium in patients with Covid-19 have increased. The triggering factors that cause delirium in the Covid-19 pandemic may be social distance and social isolation, deep sedation practices, high fever, prolonged mechanical ventilation, delayed extubation due to aerosol propagation anxiety, inadequate pain assessment, psychological perceptions (mass death), multiple organ dysfunctions. It is known that the application of the ABCDEF (Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium monitoring/management, Early exercise/mobility, and Family Empowerment) care package is effective in the management of delirium. It is recommended to use the ABCDEF care package for delirium management in Covid-19 patients. In this review, evidence-based practices are included in the prevention of delirium and nursing care in the coronavirus (SARS-CoV-2) pandemic affecting the whole world. (JNNN 2022;11(2):74–82).
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