尿毒症英文护理查房

1、L o g oInstructor: Participants： Nursing RoundMain content Name:吴吴* Gender:female Age:48y Start dialysis:2009-8-3 Dialysis frequency:5 times/2 week Vascular access for hemodialysis: AVF Diagnosis:CGN(慢性肾小球肾炎慢性肾小球肾炎) 患者现呈灰暗面貌，自透析以来，尿量逐渐减少，至今年患者现呈灰暗面貌，自透析以来，尿量逐渐减少，至今年10月份无尿。患者收月份无尿。患者收缩压波动在缩压波动在140-19

2、0mmg，舒张压在，舒张压在70-100mmg，双下肢凹陷性浮肿明显，伴瘙，双下肢凹陷性浮肿明显，伴瘙痒。透析过程中常出现恶心呕吐，肌肉痉挛，曾急发左心衰。现口服降压药压氏达，抗痒。透析过程中常出现恶心呕吐，肌肉痉挛，曾急发左心衰。现口服降压药压氏达，抗贫血药力蜚能，纠酸药小苏打，每周一次贫血药力蜚能，纠酸药小苏打，每周一次Epiao。家庭经济状况不好。家庭经济状况不好。 The patient has a gloomy outlook.Since the dialysis,the urine is on the decline,untill October this year the uri

3、ne is zero.The SBP of the patient ranges from 140 to 190mmHg,the DBP of the patient ranges from 70 to 100mmHg.The edema of the legs is obvious,along with the pruritus（瘙痒）（瘙痒）.The 压陷性水肿压陷性水肿 Normal value2010-122011-03BUN before the dialysis21-2849.8742BUN after the dialysis1/3(21-28)15.716.8ALB(g/L)3

4、535.130.3HCT(l/L)0.37-0.480.130.11K(mmol/L)3.5-5.54.775.46Hb(g/L)1104036Fe(mmol/L)9.0-3048.53.81PTH(pg/mL)150-300632.61120P(mmol/L)0.96-1.782.412.10Cr(mmol/L)62-11511791101Blood 2micro blobulin0-2.244.2238.10Nursing problem Related to excessive intake and dehydration(脱水脱水) shortage.Below the bodys r

5、equirements.Related to inadequate intake of Fe 、 protein and EPO , it lead to anemia（贫血（贫血）.Related to the high phosphorus and PTH ,it lead to the Renal bone disease.Nursing problemHigh bloodpressure(高血压高血压)Muscle spasms（肌肉痉挛）（肌肉痉挛）High potassium hematic disease(高钾血症高钾血症) Acute left heartfailure（急性左

6、心衰）（急性左心衰）Complications(并发症并发症1. 严格限制水钠入量，透析间体重增长小于5%干体重。增加透析次数，可改为每周两次HD，一次HDF，每次脱水量为透前体重减去干体重加300ml()。 Tips Use the cup which has scale; Eat something sour when feels thirsty. Use the cold water to gargle. Guide the patient to weigh seriously before and after the dialysis.Management 每日摄入充足热量的前提下，增

7、加优质蛋白的摄入（1.1-1.2g/kg）,50%以上的蛋白应来自奶类、蛋类、鱼类、肉。 Besides the adequate heat,increase the input ofhigh-quality protein,50% of the protein should be come from milk、eggs、fish and meat. increase the input of food which not only contain much Fe but also has high absorption rate,for example,meat、liver、blood、ke

8、lp and black fungi.Besides,the food which has rich VitC can help Fe absorb.Milk、coffee and tea should be avioded. Use EPO according to the doctors order,and supply the ferralia. 3.1l2limit the food which contain much P,milk,animal entrails（内脏）,nuts.Use the calcium during the meal.3Perfect the examin

9、ation of the parathyroid,resecti-on （切除术）is needed.4.ComplicationsMuscle spasms 肌肉痉挛肌肉痉挛heart failure 心衰心衰 Highpotassihematic diseae(高钾血症高钾血症)High blood pressure 血压过高血压过高提高钠浓度，或者使用钠5模式。肌肉痉挛时，停止血滤，使用高渗液。improve the concentration of sodium or use the sodium 5 mode,if musle spasms happen,use calcium gl

10、uconate,stop UF.如果病人呼吸困难气促 ,立即给予病人吸氧 ,抬高床尾使用强心药物。If the patienthas shortness of breath,we can giveheroxygen,raise the end of bed,use the drug to strong heart. 避免食用高钾食物，花生，核桃，瓜子，水果，豆类，瘦肉Avoid eating high potassium food,such as peanut, walnut, melon seeds, fruit, beans, meat.将钠浓度调低，体温略高，若无缓解予心痛定舌下含服。L

11、ower sodium concentration,make temperaturehigher.if not ease, use the drug.We can always talk with the patient and get the reason that we suit and to comfort, tell her the people around her dialysis for 20 years, still healthy and happy. Sets up her confidence of conquering the disease.Having optimi

12、stic attitude to improve the quality of life.Families that dont cooperate with patient care, economic condition is poor, do not pay enough attention to the patient. We should tell the patients condition to family members, told the consequences of not insisting on hemodialysis, so as to obtain the ec

13、onomic support. Health Education Explain the basic knowledge of renal failure to patient and family . Emphasize the importance of active therapy. Protect AVF carefullly, dont press ,dont carry heavy loads. Let the patient can speak of the commonly used medicine and take them on time. Observe the bod

14、y whether has the bleeding in daily life.adequate heat and high-quality protein.limit the input of P、water and Na.supply the VitC and VitB and calcuim.keep the AVF clean,wearing loose;Put on more or less clothes according to the weather.Proper exercise to build up the resistance to disease。Not to th

15、e place where crowded. Guide the patient to record the input and output and weigh seriously everyday. Self management about the BP.L o g oNursing problem Related to excessive intake and dehydration(脱水脱水) shortage.Below the bodys requirements.Related to inadequate intake of Fe 、 protein and EPO , it lead to anemia（贫血（贫血）.Related to the high phosphorus and PTH ,it lead to the Renal bone disease.1. 严格限制水钠入量，透析间体重增长小于5%干体重。增加透析次数，可改为每周两次HD，一次HDF，每次脱水量为透前体重减去干体重加300ml()。 keep the AVF clean,wearing loose;Put on