uremia尿毒症幻灯片

uremia尿毒症案例

NursingRounduremia[juə‘ri:miə]尿毒症uremia尿毒症案例Maincontent1.Generalinformationonpatient

2.Historyandpresentillness

3.Laboratorytests

4.Careissuesandmeasures

5.Healtheducation

uremia尿毒症案例GeneralinformationName:吴**Gender:femaleAge:48yStartdialysis:

2009-8-3Dialysisfrequency:

5times/2weeksVascularaccessforhemodialysis[,hi:mədai'ælisis,,hem-]:

AVF动静脉瘘管（arteriovenous[ɑ:,tiəriəu'vi:nəs]fistula['fistjulə]

,AVF)Diagnosis:CGN(慢性肾小球肾炎Chronicglomerulonephritis[ɡlɔ,merjuləuni'fraitis]

)uremia尿毒症案例动静脉瘘管是为了建造可供血液透析使用的管道，将动脉与邻近静脉血管相连接的手术，通常选择非惯用手的手臂或手腕血管，术后三到四周，静脉血流增多且膨胀就可使用。hemodialysis[,hi:mədai'ælisis,,hem-]

:AVF动静脉瘘管动静脉瘘管日常照护重点：

1.避免由瘘管处打针、抽血、量血压，碰撞、用力压迫、提重物等。

2.随时注意瘘管处有无博动及可听见明显水流声，若发现以上现象减弱或消失，可能发生栓塞，应及早治疗。

3.若有红、肿、热、痛、化脓、麻木感、出血时应赶快就医

4.血管过度膨胀时，可以弹性护套保护，防止血流过强，造成心脏衰竭。

5.可利用远红外线仪器提高瘘管血流并减少血栓形成。

6.热敷、按摩与握球运动可增加血管血流量，但透析后应避免，并保持瘘管处干燥清洁。

uremia尿毒症案例uremia尿毒症案例HistoryillnessHistoryand

presentillnessPresentillnessDeepvenouscatheter['kæθitə]

surgery（深静脉置管手术史）；HepatitisB[,hepə'taitis]

；Repeatednausea'nɔ:ziə

vomiting，oliguria[,ɔli'ɡjuəriə]

(少尿).uremia尿毒症案例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，曾急发左心衰两次。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.TheSBP收缩压(Systolic[si'stɔlik]

BloodPressure)ofthepatientrangesfrom140to190mmHg,theDBP[,daiə'stɔlik]

ofthepatientrangesfrom70to100mmHg.Theedema[i'di:mə]ofthelegsisobvious,alongwiththepruritus[pru'raitəs]

（瘙痒）.Thenauseaandvomitinghappensfrequently,theleftheartfailurehappenedtwice.uremia尿毒症案例压陷性水肿uremia尿毒症案例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)62-11511791101Bloodβ2microblobulin0-2.244.2238.10bloodureanitrogen血尿素氮uremia尿毒症案例Nursingproblem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.

1.Fluidoverload2.malnutrition3.Bonepain,pruritus4.Psychologicalcare（心理护理）uremia尿毒症案例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)uremia尿毒症案例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。increasethetimesofdialysis,itmaybe2hemodialysisesand1hemodiafiltrationeveryweek.

uremia尿毒症案例

血液透析滤过是在血液透析基础上，利用透析滤过膜来清除中分子毒素，故尿毒症患者出现中分子毒素蓄积表现如严重心包炎、心包积液、周围神经病变时，均可考虑使该疗法。与血液透析相比，血液透析滤过不仅能清除中分子毒性物质，还能保证不影响小分子毒素清除效率，因此，特别适于需要血液滤过又不能增加透析次数患者；血液透析滤过具有心血管状态稳定特点，故适于普通血液透析时易发生低血压不耐受超滤患者。uremia尿毒症案例TipsUsethecupwhichhasscale;Eatsomethingsourwhenfeelsthirsty.Usethecoldwatertogargle.Guidethepatienttoweighseriouslybeforeandafterthedialysis.uremia尿毒症案例malnutritionFeALBEPO

2.malnutritionuremia尿毒症案例Management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,thefoodwhichhasrichVitCcanhelpFk、coffeeandteashouldbeavioded.UseEPOaccordingtothedoctor'sorder,andsupplytheferralia.

uremia尿毒症案例3.Bonepain,pruritus

1lowerthetempertureduringthedialysis,andguidethepatienttousethecoldwatertoscrub（擦洗）,nottoscratchtheskin.2limitthefoodwhichcontainmuchP,milk,animalentrails（内脏）,ethecalciumduringthemeal.3Perfecttheexaminationoftheparathyroid,resecti-on（切除术）isneeded.uremia尿毒症案例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，肌肉痉挛时，停止血滤，使用高渗液。improvetheconcentrationofsodium,ifmuslespasmshappen,usecalciumgluconate,stopUF.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，瘦肉Avoideatinghighpotassiumfood,suchas

peanut,walnut,melonseeds,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。Lowersodiumconcentration,maketemperaturehigher.ifnotease,usethedrug.uremia尿毒症案例Na5modeuremia尿毒症案例

5.Psychologicalcare心理护理

ForpatientWecanalwaystalkwiththepatientandgetthereasonthatwesuitandtocomfort,tellherthepeoplearoundherdialysisfor20years,stillhealthyandhappy.Setsupherconfidenceofconqueringthedisease.Havingoptimisticattitudetoimprovethequalityoflife.

For

familiesFamiliesthatdon'tcooperatewithpatientcare,economicconditionispoor,donotpayenoughattentiontothepatient.Weshouldtellthepatient'sconditiontofamilymembers,toldtheconsequencesofnotinsistingonhemodialysis,soastoobtaintheeconomicsupport.

uremia尿毒症案例HealthEducationBasicguideBalanceReasona-bledietPreventinfectionuremia尿毒症案例1.BasicknowldegeguideExplainthebasicknowledgeofrenalfailuretopatientandfamily.Emphasizetheimportanceofactivetherapy.ProtectAVFcarefullly,d