血液透析个案-护理课件

Acaseofcarefordialysispatients°.人工透析患者的个案护理HubeiMedicalUniversityXX学校XXXXXXAcaseofcare1Firstly:Patientdatal患者资料)XXX,XXyearsold,XXXadmission,XXXdialysis,dialysisfrequency.Xtimes/weekX,X岁,XX入院,XXX开始透析,透析频率:X次/周ChiefComplaint:repeatedfatigue,chesttightness,morethanXmonths.OliguriaforXmonth,diarrheaⅩd主诉:反复乏力、胸闷X月有余,尿少X月,腹泻X天。Firstly:Patientdatal患者资料)2Historyofpresent∥ness病史)Xmorethanamonthago,noobviousincentivetoappearweak,chesttightness,shortnessofbreath,palpitations,chestpain,nofever,nausea,vomitingdizziness,headache.Diagnosedasuremia"atalocalhospital,ForNiaoduqingedication.Noimprovementofsymptoms.X,theabovesymptomswithurinegraduallyreduced,lowerextremityedemaandabdominaldistension,urineoutputlessthan100ml/d,theedemagraduallyincreasedwithshortnessobreath.Diarrhea10daysbeforetheobviousluresolutionyellowwaterystoolstimes,withabdominalpain,nonausea,vomiting,nofever,notreatment.Xthisyear,ourX余前无明显诱因出现乏力、胸闷,无气促、心悸、胸痛,无发热恶心呕吐,无头晕、头痛。在当地医院诊断为“尿毒症”,予尿毒清服药治疗,症状无改善。X个月前上述症状加重伴尿量逐渐减少,双下肢水肿及腹胀、尿量小于100md,水肿逐渐加重伴气促。10天前明显诱引下出现腹泻,每日解黄色水样便X次,伴上腹隐痛,无恶心呕吐、无发热、未治疗。今年X来我院就诊。Historyofpresent∥ness病史)3Pastmeaicalhistory(既往MorethanXyear-oldsufferingfromacutenephritis,topenicillintreatment,mitigation,andonXthisyearinhospitalemergencyabdominalparacentesisdrainage.Nohypertension,nodiabetes,nohistoryofrheumaticheartdisease,nohistoryofallergies,poisoninghistoryX余岁患急性肾炎,予青霉素治疗后缓解,今年X日在我院急诊行腹腔穿刺引流术。无高血压、无糖尿病、无风湿性心脏病史、无过敏史、无中毒史。Pastmeaicalhistory(既往4Laboratory-tests(实验室检查)Biochemical:Creatinine2245umol/L,Bun88.94mol/L,CO2-cp15.4mmol/,Potassium7.09mmol/LBlood:WBC18.5,HGB56g/LUrinealbumin2.0g/L,WBC16.2/LB-Tip:kidneysshrink,sonographicabnormalities(inaccordancewiththeultrasoundimagesofkidneydisease),prostaticcalcification,abdominaleffusion,Idialysisdiuretic,antihypertensivetherapyRay:increasedheartshadow生化:肌酐2245umol/LBun88.94mol/L,co2-cp15.4mmol/L,imk7.09mmol/L血常规:WBC9.19,HGB56g/L尿常规%白蛋白2.0g/L,WBC16.2/LB超提示:双肾缩小、声像图异常(符合肾脏疾病声像图改变)前列腺钙化,盆腹腔积液,予透析利尿,降压治疗胸片:心影增大。Laboratory-tests(实验室检查)5Secondly.Careissuesandmeasures(护理间题及措施)1.FluidoverloadDamageandacuterenalfailureduetoglomerularfiltrationrate.体液过多与急性肾衰竭时所致的肾小球率过功能受损有关。2.TheriskofinfectionRestrictedproteindietdialysis,andthebodyloweredimmunity有感染的危险与限制蛋白质饮食、透析、机体的抵抗为降低等有关。Secondly.Careissuesandmeas63.ImpairedskinintegrityVascularchangesandthepuncturesite皮肤完整性受损与穿刺部位血管变化有关4.MalnutritionPatientsappetiteislow,restricteddiet,theprimarydiseaseandotherfactors营养失调与病人食欲低下、限制饮食、原发疾病等因素有关3.ImpairedskinintegrityVas75.AnxietyRelatedtothepatientseconomicsituation焦虑与患者家庭的经济状况有关6mOncomplicationDisequilibriumsyndromehypotension,hypoxemia,cardiacarrhythmias,cardiactamponade、hemolysis、airembolism、cerebralhemorrhagesubduralhematoma、anemla、Musclespasm、Nauseaandvomiting.Highbloodpressure,Thepuncturesite,vascular见并发症:失衡综合征血气黜·蓥、穿刺部位血管痛、皮肤瘙痒5.AnxietyRelatedtothepati8ThirdlyNursinginterventions(护理措施)Fluidoverload(体液过多的护理)Controlofintake,Demandfordialysistreatment控制入量,按需透析Careofinfection(染的护理(1)Thewardventilation,airdisinfection,toavoidtheflu.i通风,空气消毒,避免上感(2)dialysisoperatingstrictlysteriletoavoidinfection透析操作格无菌,避免感染(3)intectionshouldbeprescribedbyadoctorrationaluseofthedrugontherenaltoxicity.感染时应遵医嘱合理使用对肾脏毒性低的ThirdlyNursinginterventions(9Skincare(皮肤的护理)Needleinjection,nearthepuncturesmearointment,antiinfectionandprotecttheskinintegrity拔针时,在穿刺口附近涂抹软膏,抗感染、保护皮肤完整性。Puncturewoundhealing,donotscratch,topreventskirscratches穿刺口愈合时,勿挠,防止皮肤抓伤Careofmalnutrition信养失调的护理0.8g/(kg.d)Thehigh-qualityproteinintake,asappropriate,lowsodium,lowpotassium,lowchlorine,highcarbohydrate,high-fatdrink,relievesymptomssuchasnauseaandvomiting,increaseappetite0.89/kQ)优质蛋白摄入情低钠、低钾、低氯、高碳水化合物状,增进食欲Skincare(皮肤的护理)10血液透析个案_护理课件11血液透析个案_护理课件12血液透析个案_护理课件13血液透析个案_护理课件14血液透析个案_护理课件15血液透析个案_护理课件16血液透析个案_护理课件17血液透析个案_护理课件18血液透析个案_护理课件19血液透析个案_护理课件20血液透析个案_护理课件21血液透析个案_护理课件22血液透析个案_护理课件23血液透析个案_护理课件24血液透析个案_护理课件25血液透析个案_护理课件26血液透析个案_护理课件27血液透析个案_护理课件28血液透析个案_护理课件29血液透析个案_护理课件30血液透析个案_护理课件31血液透析个案_护理课件32血液透析个案_护理课件33血液透析个案_护理课件34Acaseofcarefordialysispatients°.人工透析患者的个案护理HubeiMedicalUniversityXX学校XXXXXXAcaseofcare35Firstly:Patientdatal患者资料)XXX,XXyearsold,XXXadmission,XXXdialysis,dialysisfrequency.Xtimes/weekX,X岁,XX入院,XXX开始透析,透析频率:X次/周ChiefComplaint:repeatedfatigue,chesttightness,morethanXmonths.OliguriaforXmonth,diarrheaⅩd主诉:反复乏力、胸闷X月有余,尿少X月,腹泻X天。Firstly:Patientdatal患者资料)36Historyofpresent∥ness病史)Xmorethanamonthago,noobviousincentivetoappearweak,chesttightness,shortnessofbreath,palpitations,chestpain,nofever,nausea,vomitingdizziness,headache.Diagnosedasuremia"atalocalhospital,ForNiaoduqingedication.Noimprovementofsymptoms.X,theabovesymptomswithurinegraduallyreduced,lowerextremityedemaandabdominaldistension,urineoutputlessthan100ml/d,theedemagraduallyincreasedwithshortnessobreath.Diarrhea10daysbeforetheobviousluresolutionyellowwaterystoolstimes,withabdominalpain,nonausea,vomiting,nofever,notreatment.Xthisyear,ourX余前无明显诱因出现乏力、胸闷,无气促、心悸、胸痛,无发热恶心呕吐,无头晕、头痛。在当地医院诊断为“尿毒症”,予尿毒清服药治疗,症状无改善。X个月前上述症状加重伴尿量逐渐减少,双下肢水肿及腹胀、尿量小于100md,水肿逐渐加重伴气促。10天前明显诱引下出现腹泻,每日解黄色水样便X次,伴上腹隐痛,无恶心呕吐、无发热、未治疗。今年X来我院就诊。Historyofpresent∥ness病史)37Pastmeaicalhistory(既往MorethanXyear-oldsufferingfromacutenephritis,topenicillintreatment,mitigation,andonXthisyearinhospitalemergencyabdominalparacentesisdrainage.Nohypertension,nodiabetes,nohistoryofrheumaticheartdisease,nohistoryofallergies,poisoninghistoryX余岁患急性肾炎,予青霉素治疗后缓解,今年X日在我院急诊行腹腔穿刺引流术。无高血压、无糖尿病、无风湿性心脏病史、无过敏史、无中毒史。Pastmeaicalhistory(既往38Laboratory-tests(实验室检查)Biochemical:Creatinine2245umol/L,Bun88.94mol/L,CO2-cp15.4mmol/,Potassium7.09mmol/LBlood:WBC18.5,HGB56g/LUrinealbumin2.0g/L,WBC16.2/LB-Tip:kidneysshrink,sonographicabnormalities(inaccordancewiththeultrasoundimagesofkidneydisease),prostaticcalcification,abdominaleffusion,Idialysisdiuretic,antihypertensivetherapyRay:increasedheartshadow生化:肌酐2245umol/LBun88.94mol/L,co2-cp15.4mmol/L,imk7.09mmol/L血常规:WBC9.19,HGB56g/L尿常规%白蛋白2.0g/L,WBC16.2/LB超提示:双肾缩小、声像图异常(符合肾脏疾病声像图改变)前列腺钙化,盆腹腔积液,予透析利尿,降压治疗胸片:心影增大。Laboratory-tests(实验室检查)39Secondly.Careissuesandmeasures(护理间题及措施)1.FluidoverloadDamageandacuterenalfailureduetoglomerularfiltrationrate.体液过多与急性肾衰竭时所致的肾小球率过功能受损有关。2.TheriskofinfectionRestrictedproteindietdialysis,andthebodyloweredimmunity有感染的危险与限制蛋白质饮食、透析、机体的抵抗为降低等有关。Secondly.Careissuesandmeas403.ImpairedskinintegrityVascularchangesandthepuncturesite皮肤完整性受损与穿刺部位血管变化有关4.MalnutritionPatientsappetiteislow,restricteddiet,theprimarydiseaseandotherfactors营养失调与病人食欲低下、限制饮食、原发疾病等因素有关3.ImpairedskinintegrityVas415.AnxietyRelatedtothepatientseconomicsituation焦虑与患者家庭的经济状况有关6mOncomplicationDisequilibriumsyndromehypotension,hypoxemia,cardiacarrhythmias,cardiactamponade、hemolysis、airembolism、cerebralhemorrhagesubduralhematoma、anemla、Musclespasm、Nauseaandvomiting.Highbloodpressure,Thepuncturesite,vascular见并发症:失衡综合征血气黜·蓥、穿刺部位血管痛、皮肤瘙痒5.AnxietyRelatedtothepati42ThirdlyNursinginterventions(护理措施)Fluidoverload(体液过多的护理)Controlofintake,Demandfordialysistreatment控制入量,按需透析Careofinfection(染的护理(1)Thewardventilation,airdisinfection,toavoidtheflu.i通风,空气消毒,避免上感(2)dialysisoperatingstrictlysteriletoavoidinfection透析操作格无菌,避免感染(3)intectionshouldbeprescribedbyadoctorrationaluseofthedrugontherenaltoxicity.感染时应遵医嘱合理使用对肾脏毒性低的Third