尿毒症英文护理查房1

Instructor:Participants：

NursingRound1Maincontent1.Generalinformationonpatient

2.Historyand

presentillness

3.Laboratorytests

4.Careissuesandmeasures

5.Healtheducation

GeneralinformationName:吴**Gender:femaleAge:48yStartdialysis:2009-8-3Dialysisfrequency:5times/2

weekVascularaccessforhemodialysis:AVF

Diagnosis:CGN(慢性肾小球肾炎)HistoryillnessHistoryand

presentillnessPresentillnessDeepvenouscathetersurgery（深静脉置管手术史）；HepatitisB；Repeatednauseaandvomiting，oliguria(少尿).Presentillness

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。患者收缩压波动在140-190mmg，舒张压在70-100mmg，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。

Thepatienthasagloomyoutlook.Sincethedialysis,theurineisonthedecline,untillOctoberthisyeartheurineiszero.TheSBPofthepatientrangesfrom140to190mmHg,theDBPofthepatientrangesfrom70to100mmHg.Theedemaofthelegsisobvious,alongwiththepruritus（瘙痒）.Thenauseaandvomitinghappensfrequently,theleftheartfailurehappenedtwice.压陷性水肿Laboratorytests

Normalvalue2010-122011-03BUNbeforethedialysis21-2849.8742BUNafterthedialysis1/3(21-28)15.716.8ALB(g/L)>3535.130.3HCT(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)62-11511791101Bloodβ2microblobulin0-2.244.2238.10Nursingproblem营养失调骨痛，瘙痒体液过多

Relatedtoexcessiveintakeanddehydration(脱水)shortage.Below

thebody‘srequirements.RelatedtoinadequateintakeofFe、protein

andEPO,itleadtoanemia（贫血）.RelatedtothehighphosphorusandPTH,itleadtotheRenalbonedisease.

FluidoverloadmalnutritionBonepain,pruritusPsychologicalcare（心理护理）NursingproblemHighbloodpressure(高血压)Musclespasms（肌肉痉挛）nauseaandvomiting(恶心呕吐)Highpotassiumhematicdisease(高钾血症)

Acuteleftheartfailure（急性左心衰）Complications(并发症)1.

Fluidoverload

严格限制水钠入量，透析间体重增长小于5%干体重。Strictlylimittheamountofwater，the

growthoftheweightis

lessthan5%ofdryweight.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()。increasethetimesofdialysis,itmaybe2hemodialysisesand1hemodiafiltrationeveryweek.

TipsUsethecupwhichhasscale;Eatsomethingsourwhenfeelsthirsty.Usethecoldwatertogargle.Guidethepatienttoweighseriouslybeforeandafterthedialysis.malnutritionFeALBEPO

2.malnutritionManagement每日摄入充足热量的前提下，增加优质蛋白的摄入（1.1-1.2g/kg）,50%以上的蛋白应来自奶类、蛋类、鱼类、肉。Besidestheadequateheat,increasetheinputofhigh-qualityprotein,50%oftheproteinshouldbecomefrommilk、eggs、fishandmeat.increasetheinputoffoodwhichnotonlycontainmuchFebutalsohashighabsorptionrate,forexample,meat、liver、blood、kelpandblackfungi.Besides,thefoodwhichhasrichVitCcanhelpFeabsorb.Milk、coffeeandteashouldbeavioded.UseEPOaccordingtothedoctor'sorder,andsupplytheferralia.

3.Bonepain,pruritus

1lowerthetempertureduringthedialysis,andguidethepatienttousethecoldwatertoscrub（擦洗）,nottoscratchtheskin.2limitthefoodwhichcontainmuchP,milk,animalentrails（内脏）,nuts.Usethecalciumduringthemeal.3Perfecttheexaminationoftheparathyroid,resecti-on（切除术）isneeded.4.ComplicationsMusclespasms

肌肉痉挛heartfailure心衰Highpotassihematic

diseae(高钾血症)Highbloodpressure

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。improvetheconcentrationofsodiumorusethesodium5mode,ifmuslespasmshappen,usecalciumgluconate,stopUF.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。Ifthepatienthasshortnessofbreath,wecangiveheroxygen,raisetheendofbed,usethedrugtostrongheart.

避免食用高钾食物，花生，核桃，瓜子，水果，豆类，瘦