Yenidoğanlarda Palyatif Bakım
Özet
Yenidoğan palyatif bakımı; yaşamı tehdit eden kronik veya akut hastalıklara sahip bebekler için fiziksel, psikososyal ve spiritüel süreçleri destekleyen, konfor odaklı multidisipliner bir strateji sunmaktadır. Süreç; ağrı kontrolü, solunum sıkıntısının giderilmesi, beslenme yönetimi, pamukçuk, kusma ve perine hijyeni gibi bütüncül hemşirelik girişimlerini kapsamaktadır. İnceleme kapsamında, 24. gebelik haftasında 480 gram ağırlığında preeklamptik bir anneden sezaryen ile doğan ve respiratuvar distres sendromu tanısıyla izlenen Bebek U’nun 3 günlük klinik takibi sunulmuştur. Olgunun takibinde etkisiz solunum, bozulmuş gaz değişimi ve serebral perfüzyon problemleri gibi birçok hemşirelik tanısı konulmuş, gerekli farmakolojik ve konfor önlemleri uygulanmıştır. Ancak 3. günde ani desatürasyon ve kardiyak arrest gelişen bebek, 30 dakikalık resüsitasyon sonrası kaybedilmiştir. Bu süreçte aileye yönelik şeffaf iletişim, ebeveyn-bebek bağlanması, yas ve kayıp desteği çalışmaları yürütülmüştür. Türkiye'de yenidoğan palyatif bakımına yönelik ulusal rehberlerin ve etik protokollerin geliştirilmesi kritik bir ihtiyaçtır.
Neonatal palliative care offers a comfort-oriented multidisciplinary strategy that supports physical, psychosocial, and spiritual processes for infants with life-threatening chronic or acute conditions. The process encompasses holistic nursing interventions such as pain control, respiratory relief, nutritional management, thrush, vomiting, and perineal hygiene. Within this scope, the 3-day clinical follow-up of Baby U is presented, who was born at 24 weeks of gestation weighing 480 grams to a preeclamptic mother via cesarean section and monitored for respiratory distress syndrome. Multiple nursing diagnoses, including ineffective breathing, impaired gas exchange, and cerebral perfusion issues, were established, and necessary pharmacological and comfort measures were applied. However, on the 3rd day, the infant developed sudden desaturation and cardiac arrest, passing away after 30 minutes of resuscitation. Throughout this period, transparent communication, parent-infant bonding, and grief and bereavement support were provided to the family. Developing national guidelines and ethical protocols for neonatal palliative care remains a critical need in Turkey.
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