《尿毒症》PPT课件.ppt

尿毒症 Maincontent 1 Generalinformationonpatient 2 Historyandpresentillness 3 Laboratorytests 4 Careissuesandmeasures 5 Healtheducation Generalinformation Name 吴 Gender femaleAge 48yStartdialysis 2009 8 3Dialysisfrequency 5times 2weeksVascularaccessforhemodialysis hi m dai lisis hem AVF动静脉瘘管 arteriovenous ti ri u vi n s fistula fistjul AVF Diagnosis CGN 慢性肾小球肾炎Chronicglomerulonephritis l merjul uni fraitis 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 m dai lisis 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 Deepvenouscatheter k it surgery 深静脉置管手术史 HepatitisB hep taitis Repeatednausea n zi vomiting oliguria li ju ri 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 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 st lik BloodPressure ofthepatientrangesfrom140to190mmHg theDBP dai st lik ofthepatientrangesfrom70to100mmHg Theedema i di m ofthelegsisobvious alongwiththepruritus pru rait s 瘙痒 Thenauseaandvomitinghappensfrequently theleftheartfailurehappenedtwice 压陷性水肿 Laboratorytests bloodureanitrogen血尿素氮 Nursingproblem 营养失调 骨痛 瘙痒 Belowthebody srequirements RelatedtoinadequateintakeofFe proteinandEPO itleadtoanemia 贫血 RelatedtothehighphosphorusandPTH itleadtotheRenalbonedisease 1 Fluidoverload 2 malnutrition 3 Bonepain pruritus 4 Psychologicalcare 心理护理 Nursingproblem HighbloodPressure 高血压 Musclespasms 肌肉痉挛 nauseaandvomiting 恶心呕吐 Acuteleftheartfailure 急性左心衰 Complications 并发症 1 Fluidoverload 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 Tips Usethecupwhichhasscale Eatsomethingsourwhenfeelsthirsty Usethecoldwatertogargle Guidethepatienttoweighseriouslybeforeandafterthedialysis 2 malnutrition 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 thefoodwhichhasrichVitCcanhelpFeabsorb Milk coffeeandteashouldbeavioded UseEPOaccordingtothedoctor sorder andsupplytheferralia 3 Bonepain pruritus 4 Complications MuscleSpasms肌肉痉挛 heartfailure心衰 Highpotassihematicdiseae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 suchaspeanut 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 Na5mode 5 Psychologicalcare心理护理 1 Basicknowldegeguide Explainthebasicknowledgeofrenalfailuretopatientandfamily Emphasizetheimportanceofactivetherapy ProtectAVFcarefullly don tpress don tcarryheavyloads Letthepatientcanspeakofthecommonlyusedmedicineandtakethemontime Observethebodywhetherhasthebleedingindailylife 2 Reasonablediet adequateheatandhigh qualityprotein limittheinputofP waterandNa supplytheVitCandVitBandcalcuim 3 Preventinfection keeptheAVFclean wearingloose Putonmoreorlessclothesaccordingtotheweather