尿毒症英文护理查房1ppt课件

L o g o Instructor: Participants： Nursing Round1 Main content 1. 1. General information on patientGeneral information on patient 2.2.History andHistory and present illnesspresent illness 3 3 . . Laboratory tests Laboratory tests 4 4 . . Care issues and measuresCare issues and measures 5. 5. Health Health e educationducation General informationGeneral information vName:吴* Gender:female vAge:48y vStart dialysis:2009-8-3 vDialysis frequency:5 times/2 week vVascular access for hemodialysis: AVF vDiagnosis:CGN(慢性肾小球肾炎) History History illnessillness History andHistory and present illnesspresent illness Present illnessPresent illness Deep venous Deep venous catheter catheter surgerysurgery（深（深 静脉置管手术静脉置管手术 史）；史）； Hepatitis BHepatitis B； Repeated Repeated nausea and nausea and vomitingvomiting， o oligurialiguria( (少尿少尿) ). . Laboratory testsLaboratory tests Normal value 2010-122011-03 BUN before the dialysis21-2849.8742 BUN after the dialysis1/3(21-28)15.716.8 ALB(g/L)3535.130.3 HCT(l/L)0.37-0.480.130.11 K(mmol/L)3.5-5.54.775.46 Hb(g/L)1104036 Fe(mmol/L)9.0-3048.53.81 PTH(pg/mL)150-300632.61120 P(mmol/L)0.96-1.782.412.10 Cr(mmol/L)62-11511791101 Blood 2micro blobulin 0-2.244.2238.10 Nursing problem 营养失调营养失调 骨痛，瘙痒骨痛，瘙痒 体液过多体液过多 Related to excessive intake and dehydration( 脱水) shortage. 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. Fluid overloadFluid overload malnutritionmalnutrition Bone pain,pruritusBone pain,pruritus Psychological Psychological carecare（心理护理（心理护理 ） Nursing problem High blood pressure(高血压) Muscle spasms （肌肉痉挛） nausea and vomitingnausea and vomiting ( (恶心呕吐恶心呕吐) ) High potassium hematic disease (高钾血症) Acute left heart failure（急性左心衰） Complications (并发症) ) 1. Fluid overloadFluid overload 严格限制水钠入量，透析间体重增长 小于5%干体重。 Strictly limit the amount of water Strictly limit the amount of water ，the the growth of the weight isgrowth of the weight is less less than than 5% of dry weight.5% of dry weight. 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()。 increase the times of dialysis,it may increase the times of dialysis,it may be 2 hemodialysises and 1 be 2 hemodialysises and 1 hemodiafiltration every week.hemodiafiltration every week. Tips vUse the cup which has scale; vEat something sour when feels thirsty. vUse the cold water to gargle. vGuide the patient to weigh seriously before and after the dialysis. malnutritionmalnutrition FeFe ALBALB EPOEPO 2.2.malnutritionmalnutrition Management v 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. v increase the input of food which not only contain much Fe but also has high absorption rate,for example,meat、liver、blood、kelp and black fungi.Besides,the food which has rich VitC can help Fe absorb.Milk、coffee and tea should be avioded. v Use EPO according to the doctors order,and supply the ferralia. 3.Bone pain,pruritusBone pain,pruritus 1 lower the ower the temperture during temperture during the dialysis,and the dialysis,and guide the patient to guide the patient to use the cold water use the cold water to scrubto scrub（擦洗）（擦洗）,not ,not to scratch the skin.to scratch the skin. 2 limit the food which contain much P,milk,animal entrails（内脏） ,nuts.Use the calcium during the meal. 3 Perfect the examination of the parathyroid,resecti -on （切除术）is needed. 4.Complications Muscle spasms 肌肉痉挛 heart failure 心衰 High potassi hematic diseae (高钾血症 ) High blood pressure 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 concen tration of sodium or use the sodium 5 m ode,if musle spasm s happen,use calci um gluconate,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,ra ise 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 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 modeNa 5 mode 5.Psychological care 5.Psychological care 心理护理心理护理 For patientFor patient 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 optimistic attitude to improve the quality of life. For For familiesfamilies 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 economic support. Health Education Basic guideBasic guide BalanceBalance Reasona-Reasona- ble dietble diet Prevent Prevent infection infection 1.Basic knowldege guide1.Basic knowldege guide v Explain the basic knowledge of renal failure to patient and family . v Emphasize the importance of active therapy. Protect AVF carefullly, dont press ,dont carry heavy loads. v Let the patient can speak of the commonly used medicine and take them on time. v Observe the body whether has the bleeding in daily life. 2.Reasonable diet2.Reasonable diet vadequate heat and high- quality protein. vlimit the input of P、water and Na. vsupply the VitC and VitB and calcuim. 3.Prevent infection3.Prevent infection vkeep the AVF clean,wearing loose; vPut on more or