课件：uremia尿毒症案例.ppt

* * * * L o g o Nursing Round uremia [ju?‘ri:mi?] 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:m?dai?lisis, ,hem-] : AVF 动静脉瘘管（arteriovenous[ɑ:,ti?ri?uvi:n?s] fistula[fistjul?] ,AVF) Diagnosis: CGN ( 慢性肾小球肾炎Chronic glomerulonephritis [ɡl?,merjul?unifraitis] ) 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。 History illness History and present illness Present illness Deep venous catheter [k?θit?] surgery（深静脉置管手术史）； Hepatitis B [,hep?taitis] ； Repeated nausea n?:zi? vomiting，oliguria [,?liɡju?ri?] (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 is zero. The SBP收缩压(Systolic[sist?lik] Blood Pressure) of the patient ranges from 140 to 190mmHg, the DBP [,dai?st?lik] of the patient ranges from 70 to 100mmHg. The edema[idi:m?] of the legs is obvious, along with the pruritus[prurait?s] （瘙痒）.The nausea and vomiting happens frequently, the left heart failure happened twice. 压陷性水肿 Laboratory tests Normal value 2010-12 2011-03 BUN before the dialysis 21-28 49.87 42 BUN after the dialysis 1/3(21-28) 15.7 16.8 ALB(g/L) 35 35.1 30.3 HCT(l/L) 0.37-0.48 0.13 0