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1、尿 毒 症,Main content,1. General information on patient,2.History and present illness,3. Laboratory tests,4. Care issues and measures,5. Health education,General information,Name: 吴* Gender: female Age: 48y Start dialysis: 2009-8-3 Dialysis frequency: 5 times/2 weeks Vascular access for hemodialysis,hi
2、:mdailisis, ,hem- : AVF 动静脉瘘管（arteriovenous:,tiriuvi:ns fistulafistjul ,AVF) Diagnosis: CGN ( 慢性肾小球肾炎Chronic glomerulonephritis l,merjulunifraitis ),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:mdailisis, ,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
3、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。,Deep venous catheter kit surgery（深静脉置管手术史）； Hepatitis B ,heptaitis ；,Repeated nausea n:zi vomiting，oligu
4、ria ,lijuri (少尿).,Present illness,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。 The patient has a gloomy outlook. Since the dialysis, the urine is on the decline, untill October this year the urine i
5、s zero. The SBP收缩压(Systolicsistlik Blood Pressure) of the patient ranges from 140 to 190mmHg, the DBP ,daistlik of the patient ranges from 70 to 100mmHg. The edemaidi:m of the legs is obvious, along with the prurituspruraits （瘙痒）.The nausea and vomiting happens frequently, the left heart failure hap
6、pened twice.,压陷性水肿,Laboratory tests,blood urea nitrogen 血尿素氮,Nursing problem,营养失调,骨痛，瘙痒,Below the bodys requirements. Related to inadequate intake of Fe 、 protein and EPO , it lead to anemia（贫血）,Related to the high phosphorus and PTH ,it lead to the Renal bone disease.,1. Fluid overload,2.malnutriti
7、on,3. Bone pain,pruritus,4. Psychological care（心理护理）,Nursing problem,High blood Pressure (高血压),Muscle spasms （肌肉痉挛）,nausea and vomiting (恶心呕吐),Acute left heart failure（急性左心衰）,Complications (并发症),1. Fluid overload,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
8、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。,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.,2.malnutrition,Management,
9、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。 Besides the adequate heat,increase the input of high-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
10、、liver、blood、kelp 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. Bone pain, pruritus,4.Complications,Muscle Spasms 肌肉痉挛,heart failure 心衰,High potassi hematic diseae 高钾血症
11、,High blood pressure 血压过高,提高钠浓度，肌肉痉 挛时，停止血滤， 使用高渗液。 improve the concen tration of sodium, if musle spasm s happen,use calci um gluconate,stop UF.,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 patient has shortness of breath,we can give her oxygen, raise the end of bed,use the drug to strong heart,避免食用高钾食物 ，花
12、生，核桃，瓜 子，水果，豆类， 瘦肉 Avoid eating high potassium food, such as peanut, walnut, melon se eds, 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。 Lower sodium concentration, make temperature higher.if not ease, use the drug.,Na 5 mode,5.Psychological care 心理护理,1.Basic knowldege guide,Explain the basic kno
13、wledge 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 body whether has the bleeding in daily life.,2.Reasonable
14、 diet,adequate heat and high-quality protein. limit the input of P、water and Na. supply the VitC and VitB and calcuim.,3.Prevent infection,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 the place where crowded.,4.Maintain the balance,Guide the patient to record the input and output and weigh seriously everyday. Self management about the BP.,Thank You !,