uremia尿毒癥幻燈片

uremia尿毒癥案例

NursingRounduremia[ju?‘ri:mi?]尿毒癥uremia尿毒癥案例Maincontent1.Generalinformationonpatient

2.Historyandpresentillness

3.Laboratorytests

4.Careissuesandmeasures

5.Healtheducation

uremia尿毒癥案例GeneralinformationName:吳**Gender:femaleAge:48yStartdialysis:

2009-8-3Dialysisfrequency:

5times/2weeksVascularaccessforhemodialysis[,hi:m?dai'?lisis,,hem-]:

AVF動靜脈瘺管（arteriovenous[ɑ:,ti?ri?u'vi:n?s]fistula['fistjul?]

,AVF)Diagnosis:CGN(慢性腎小球腎炎Chronicglomerulonephritis[ɡl?,merjul?uni'fraitis]

)uremia尿毒癥案例動靜脈瘺管是為了建造可供血液透析使用的管道，將動脈與鄰近靜脈血管相連接的手術(shù)，通常選擇非慣用手的手臂或手腕血管，術(shù)后三到四周，靜脈血流增多且膨脹就可使用。hemodialysis[,hi:m?dai'?lisis,,hem-]

:AVF動靜脈瘺管動靜脈瘺管日常照護(hù)重點(diǎn)：

1.避免由瘺管處打針、抽血、量血壓，碰撞、用力壓迫、提重物等。

2.隨時注意瘺管處有無博動及可聽見明顯水流聲，若發(fā)現(xiàn)以上現(xiàn)象減弱或消失，可能發(fā)生栓塞，應(yīng)及早治療。

3.若有紅、腫、熱、痛、化膿、麻木感、出血時應(yīng)趕快就醫(yī)

4.血管過度膨脹時，可以彈性護(hù)套保護(hù)，防止血流過強(qiáng)，造成心臟衰竭。

5.可利用遠(yuǎn)紅外線儀器提高瘺管血流并減少血栓形成。

6.熱敷、按摩與握球運(yùn)動可增加血管血流量，但透析后應(yīng)避免，并保持瘺管處干燥清潔。

uremia尿毒癥案例uremia尿毒癥案例HistoryillnessHistoryand

presentillnessPresentillnessDeepvenouscatheter['k?θit?]

surgery（深靜脈置管手術(shù)史）；HepatitisB[,hep?'taitis]

；Repeatednausea'n?:zi?

vomiting，oliguria[,?li'ɡju?ri?]

(少尿).uremia尿毒癥案例Presentillness

患者現(xiàn)呈灰暗面貌，自透析以來，尿量逐漸減少，至今年10月份無尿。患者收縮壓波動在140-190mmg，舒張壓在70-100mmg，雙下肢凹陷性浮腫明顯，伴瘙癢。透析過程中常出現(xiàn)惡心嘔吐，曾急發(fā)左心衰兩次?，F(xiàn)口服降壓藥壓氏達(dá)，抗貧血藥力蜚能，糾酸藥小蘇打，每周一次Epiao。家庭經(jīng)濟(jì)狀況不好。

Thepatienthasagloomyoutlook.Sincethedialysis,theurineisonthedecline,untillOctoberthisyeartheurineiszero.TheSBP收縮壓(Systolic[si'st?lik]

BloodPressure)ofthepatientrangesfrom140to190mmHg,theDBP[,dai?'st?lik]

ofthepatientrangesfrom70to100mmHg.Theedema[i'di:m?]ofthelegsisobvious,alongwiththepruritus[pru'rait?s]

（瘙癢）.Thenauseaandvomitinghappensfrequently,theleftheartfailurehappenedtwice.uremia尿毒癥案例壓陷性水腫uremia尿毒癥案例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尿毒癥案例Nursingproblem營養(yǎng)失調(diào)骨痛，瘙癢體液過多

Relatedtoexcessiveintakeanddehydration(脫水)shortage.Below

thebody‘srequirements.RelatedtoinadequateintakeofFe、protein

andEPO,itleadtoanemia（貧血）RelatedtothehighphosphorusandPTH,itleadtotheRenalbonedisease.

1.Fluidoverload2.malnutrition3.Bonepain,pruritus4.Psychologicalcare（心理護(hù)理）uremia尿毒癥案例NursingproblemHighbloodPressure(高血壓)Musclespasms（肌肉痙攣）nauseaandvomiting(惡心嘔吐)Highpotassiumhematicdisease(高鉀血癥)

Acuteleftheartfailure（急性左心衰）Complications(并發(fā)癥)uremia尿毒癥案例1.

Fluidoverload

嚴(yán)格限制水鈉入量，透析間體重增長小于5%干體重。Strictlylimittheamountofwater，the

growthoftheweightis

lessthan5%ofdryweight.增加透析次數(shù)，可改為每周兩次HD，一次HDF。increasethetimesofdialysis,itmaybe2hemodialysisesand1hemodiafiltrationeveryweek.

uremia尿毒癥案例

血液透析濾過是在血液透析基礎(chǔ)上，利用透析濾過膜來清除中分子毒素，故尿毒癥患者出現(xiàn)中分子毒素蓄積表現(xiàn)如嚴(yán)重心包炎、心包積液、周圍神經(jīng)病變時，均可考慮使該療法。與血液透析相比，血液透析濾過不僅能清除中分子毒性物質(zhì)，還能保證不影響小分子毒素清除效率，因此，特別適于需要血液濾過又不能增加透析次數(shù)患者；血液透析濾過具有心血管狀態(tài)穩(wěn)定特點(diǎn)，故適于普通血液透析時易發(fā)生低血壓不耐受超濾患者。uremia尿毒癥案例TipsUsethecupwhichhasscale;Eatsomethingsourwhenfeelsthirsty.Usethecoldwatertogargle.Guidethepatienttoweighseriouslybeforeandafterthedialysis.uremia尿毒癥案例malnutritionFeALBEPO

2.malnutritionuremia尿毒癥案例Management每日攝入充足熱量的前提下，增加優(yōu)質(zhì)蛋白的攝入（1.1-1.2g/kg）,50%以上的蛋白應(yīng)來自奶類、蛋類、魚類、肉。Besidestheadequateheat,increasetheinputofhigh-qualityprotein,50%oftheproteinshouldbecomefrommilk、eggs、fishandmeat.increasetheinputoffoodwhichnotonlycontainmuchFebutalsohashighabsorptionrate,forexample,meat、liver、blood、kelpandblackfungi.Besides,thefoodwhichhasrichVitCcanhelpFk、coffeeandteashouldbeavioded.UseEPOaccordingtothedoctor'sorder,andsupplytheferralia.

uremia尿毒癥案例3.Bonepain,pruritus

1lowerthetempertureduringthedialysis,andguidethepatienttousethecoldwatertoscrub（擦洗）,nottoscratchtheskin.2limitthefoodwhichcontainmuchP,milk,animalentrails（內(nèi)臟）,ethecalciumduringthemeal.3Perfecttheexaminationoftheparathyroid,resecti-on（切除術(shù)）isneeded.uremia尿毒癥案例4.ComplicationsMuscleSpasms

肌肉痙攣heartfailure心衰Highpotassihematic

diseae高鉀血癥Highbloodpressure

血壓過高提高鈉濃度，肌肉痙攣時，停止血濾，使用高滲液。improvetheconcentrationofsodium,ifmuslespasmshappen,usecalciumgluconate,stopUF.呼吸困難氣促,立即給予病人吸氧,抬高床尾使用強(qiáng)心藥物。Ifthepatienthasshortnessofbreath,wecangiveheroxygen,raisetheendofbed,usethedrugtostrongheart避免食用高鉀食物，花生，核桃，瓜子，水果，豆類，瘦肉Avoideatinghighpotassiumfood,suchas

peanut,walnut,melonseeds,fruit,beans,meat.將鈉濃度調(diào)低，體溫略高，若無緩解予心痛定舌下含服。Lowersodiumconcentration,maketemperaturehigher.ifnotease,usethedrug.uremia尿毒癥案例Na5modeuremia尿毒癥案例

5.Psychologicalcare心理護(hù)理

ForpatientWecanalwaystalkwiththepatientandgetthereasonthatwesuitandtocomfort,tellherthepeoplearoundherdialysisfor20years,stillhealthyandhappy.Setsupherconfidenceofconqueringthedisease.Havingoptimisticattitudetoimprovethequalityoflife.

For

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

uremia尿毒癥案例HealthEducationBasicguideBalanceReasona-bledietPreventinfectionuremia尿毒癥案例1.BasicknowldegeguideExplainthebasicknowledgeofrenalfailuretopatientandfamily.Emphasizetheimportanceofactivetherapy.ProtectAVFcarefullly,d