尿毒症英文相关护理查房1.ppt

L o g o Instructor: Participants： Nursing Round1 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 week Vascular access for hemodialysis: AVF Diagnosis:CGN(慢性肾小球肾炎) History illness History and present illness Present illness Deep venous catheter surgery（深静脉置管手术史）； Hepatitis B； Repeated nausea and vomiting，oliguria(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，肌肉痉挛，曾急发左心衰。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 is zero.The SBP of the patient ranges from 140 to 190mmHg,the DBP of the patient ranges from 70 to 100mmHg.The edema of the legs is obvious,along with the pruritus（瘙痒）.The nausea and vomiting happens frequently,the left heart failure happened twice. 压陷性水肿 Nursing problem High blood pressure(高血压) Muscle spasms （肌肉痉挛） nausea and vomiting (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 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 ，the growth of the weight is less than 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 be 2 hemodialysises and 1 hemodiafiltration every week. 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. malnutrition Fe ALB EPO 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。 Besides the adequate heat,increase the