Case Presentation: nursery care in long term hospitalizations

Five-months old patient admitted to our institute’s neurosurgery outpatient clinic for swelling and intermittent discharge at the occipital region; and diagnosed as “dermal sinus tract” following the tests. The patient was interned in the Neurosurgery Clinic and occipital dermal sinus repair was performed in 18/12/2008. The patient was discharged without any complications in 22/12/2008. The patient was under outpatient follow-up, while due to unrest and bad medical condition, he was brought back to the neurosurgery outpatient clinic. The CT evaluation of the patient revealed a cystic lesion at the posterior of the 4th ventricule, so the patient was admitted to the hospital again. Abscess drainage was performed at 06/04/2009 and the patient was admitted to the intensive care unit (ICU). The patient’s medical condition was bad, he was unconscious, and had no spontaneous respiration when he was taken to the ICU; thus, individualized nursing care was planned, and implemented, and success was achieved. Individualized nursing care was applied in terms of respiratory activity, infection risk, nutrition and fluid volume deficiency, providing of a safe environment and maintaining it, urinary retansion/incontinence, risk of disturbance of skin integrity and intolerance to activity. The body temperature was around 36-37°C, and the height and weight development remained within favorable range with the normal children. As a result of the individualized care plans performed by the experienced nurses in the ICU, the patient grew in the normal range as the children with the same ages, no pressure sore or infection developed. The patient was still being cared at the ICU when this article was written. This is the longest period of hospitalization of a child in the literature as we found out.

Olgu sunumu: Uzun süreli yatýþlarda hemþirelik bakýmý

5 aylýkken oksipital bölgede þiþlik ve ara ara akýntý þikayeti üzerine kurumumuz beyin cerrahi polikliniðine baþvurduktan sonra, yapýlan tetkiklerin ardýndan ‘’Dermal Sinüs Traktý’’ tesbit edilmesi üzerine opere edilmek üzere Beyin Cerrahi Kliniðine yatýrýlan hastaya 18.12.2008 tarihinde oksipital dermal sinüs onarýlmasý ameliyatý yapýlmýþtýr. Operasyon iþleminin ardýndan herhangi bir komplikasyon geliþmeyen hasta 22/12/2008 tarihinde taburcu edilmiþtir. Poliklinik takipleri yapýlan hasta huzursuzluk ve genel durum bozukluðu ile ailesi tarafýndan Beyin Cerrahi Polikliniðine getirilmiþtir. Hastanýn deðerlendirilmesi sonucunda BT’sinde 4. ventrikül posteriorunda kistik lezyon tespit edilmesi üzerine
2. Yatýþý saðlanmýþtýr. 06.04.2009 tarihinde apse boþaltýmý giriþimi yapýlmýþ ve yoðun bakým ünitesine kabul edilmiþtir. Yoðunbakým ünitesine geldiðinde genel durumu kötü, þuuru kapalý, spontan solunumu olmayan hastaya bireye özgü hemþirelik bakýmý planlanarak uygulanmýþ ve baþarý saðlanmýþtýr. Solunum aktivitesine, enfeksiyon riskine, beslenme ve sývý volüm eksikliðine, güvenli çevrenin saðlanmasý ve sürdürülmesine, idrar tutamama/kaçýrmaya, deri bütünlüðü bozulma riskine ve aktivite intoleransýna yönelik bireysel hemþirelik bakýmý uygulanmýþtýr. Vücut ýsýsý 36-37°C civarýnda, boy ve kilo geliþimi normal çocuklarýn geliþmesine uygun oranda seyretmiþtir. Yoðunbakýmda deneyimli hemþireler tarafýndan yapýlan bireysel bakým planlarý sonucunda hasta normal yaþýtlarý ölçüsünde geliþmeye devam etmiþ, basý yarasý oluþmamýþ, enfeksiyon geliþmemiþtir. Makalenin yazýldýðý tarihte yoðun bakým ünitesinde bakýlmaya devam edilmektedir. Literatürlerde bu kadar uzun süre hastanede yatan çocuk hastaya rastlanmamýþtýr.