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Mekanik ventilasyon desteği alan hastaların ağrı değerlendirilmesinde iki farklı ölçeğin karşılaştırılması

Olgun, Koray

Master Thesis | 2016 | Bülent Ecevit Üniversitesi, Sağlık Bilimleri Enstitüsü, Hemşirelik Anabilim Dalı Cerrahi Hastalıkları Hemşireliği Programı

Hemşirelik uygulamalarının bireyi rahatlatma üzerine temellenmesi, hemşirelerin hasta ile en fazla birlikte olan ekip üyesi olması ve onları yakından izlemeleri, ağrının belirlenmesinde ve giderilmesinde yoğun bakım hemşirelerine büyük sorumluluk yüklemektedir. Bu araştırma bir üniversite hastanesinin yoğun bakım ünitesinde yatan mekanik ventilasyon desteği alan hastaların ağrılarının değerlendirilmesinde iki farklı ölçek olan “Davranışsal Ağrı Ölçeği” ve “Yoğun Bakım Ağrı Gözlem Formu” den hangisinin daha etkin ağrıyı değerlendirdiğini saplamak amacıyla tanımlayıcı-analitik olarak gerçekleştirildi. Araştırmanın evrenini 15.09.2015- . . .31.12.2015 tarihleri arasında ilgili kurumun yoğun bakım ünitesinde tedavi gören hastalar, örneklemini ise Yoğun Bakım ünitesinde tedavi gören ve araştırmaya kabul edilme koşullarını taşıyan 101 hasta oluşturdu. Veriler, literatür doğrultusunda hazırlanan Veri Toplama Formu, Davranışsal Ağrı Ölçeği (DAÖ) ve Yoğun Bakım Ağrı Gözlem Formu (YAGF) ile toplandı. Araştırmada elde edilen veriler SPSS 19,0istatistiksel paket programı kullanılarak analiz edildi. Elde edilen bulgular % 95 güvenaralığında 0,05 anlamlılık düzeyinde yorumlandı. Araştırma sonucunda; her iki ölçekte de işlem öncesi dinlenme durumunda ve işlem sırasında ağrı puanı ortalamalarının artığı saptandı (p=0,000). İki ölçekte de tanıtıcı değişkenlere göre ağrı puanı ortalaması istatiksel olarak fark bulunmadı. İki ölçek karşılaştırıldı ve YAGF DAÖ’ye göre yoğun bakım ünitesinde mekanik ventilasyon desteği alan hastalarda ağrıyı değerlendirmesindeistatistiksel olarak daha etkili olduğu saptandı (p=0,000). The fact that nursing practices are based on relaxation of the person, and that nurses are together with the patients for long hours and are watching them closely, give great responsibility to intensive care nurses in determining and relieving the pain. This research conducted as a definer in order to define whether “Behavioral Pain Scale” or “Intensive Care Unit Observation Scale” evaluating the pain of the patients who stay in hospital and get mechanical ventilation support, is the best way to evaluate the pain of the patients in the university hospital. Research stages, 15.09.2015 - 31.15.2015, were created with 101 patients who have treatment and have suitable conditions to be in this research. Findings in this study have been gathered with Data Collection Form, Behavioral Pain Scale and Intensive Care Unit Observation Scale which have been designed according to the revelant literature. Data obtained at the research has been analyzed by using SPSS. Findings have been evaluated at the level of % 95 confidence interval and 0,05 meaning level. Research; in the case of both scale and rest before the procedure revealed no longer mean score of pain during the procedure (p = 0,000). The mean pain score in both scale according to introductory variables was statistically no difference. Two scales were compared and CPOT BPS based on mechanical ventilation in the intensive care unit in support of evaluation of pain patients was found to be significantly more effective (p = 0,000) Daha fazlası Daha az

Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia

Tanriverdi H. | Tor M.M. | Kart L. | Altin R. | Atalay F. | Sumbsümbüloglu V.

Article | 2015 | Annals of Thoracic Medicine10 ( 2 ) , pp.137 - 142

INTRODUCTION: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP. METHODS: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors . . ., and the mean PCT and CRP values and their kinetics were assessed. RESULTS: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6. CONCLUSION: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP Daha fazlası Daha az

General characteristics and prognostic factors of pneumonia cases developed during pandemic (H1N1) influenza-a virus infection in Turkey

Özlu T. | Bülbül Y. | Taşbakan S. | Kiliç H. | Kuyucu T. | Yildiz T. | Özdemir T.

Article | 2013 | Balkan Medical Journal30 ( 1 ) , pp.68 - 73

Objective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. Study Design: Multicenter retrospective study. Material and Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5± . . .18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels. Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2. © Trakya University Faculty of Medicine Daha fazlası Daha az

Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units

Temiz E. | Piskin N. | Aydemir H. | Oztoprak N. | Akduman D. | Celebi G. | Kokturk F.

Article | 2012 | Scandinavian Journal of Infectious Diseases44 ( 5 ) , pp.344 - 349

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. Methods: Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. Results: Two hundred and four patients were included and 85 developed a nosocomial in . . .fection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone. Conclusions: Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors. © 2012 Informa Healthcare Daha fazlası Daha az

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