血液透析个案护理课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,A case of care,for,dialysis patients,.人工透析患者的个案护理,Hubei Medical University,XX学校,XXXXXX,A case of care,1,Firstly: Patient datal患者资料),XXX, XX years old, XXX admission, XXX dialysis,dialysis frequency. X times/ week,X,X岁,XX入院,XXX开始透析,透析频率:X次/周,Chief Complaint: repeated fatigue, chest tightness,more than X months. Oliguria for X month, diarrhea,d,主诉:反复乏力、胸闷X月有余,尿少X月,腹泻X天。,Firstly: Patient datal患者资料),2,History ofpresentness病史),X more than a month ago, no obvious incentive to appear,weak, chest tightness, shortness of breath, palpitations,chest pain, no fever, nausea, vomiting dizziness, headache.,Diagnosed as uremia at a local hospital, For Niaoduqing,edication. No improvement of symptoms. X, the above,symptoms with urine gradually reduced, lower extremity,edema and abdominal distension, urine output less than,100ml /d, the edema gradually increased with shortness o,breath. Diarrhea 10 days before the obvious lure solution,yellow watery stools times, with abdominal pain, no,nausea, vomiting, no fever, no treatment. X this year, our,X余前无明显诱因出现乏力、胸闷,无气促、心悸、胸痛,无发热恶,心呕吐,无头晕、头痛。在当地医院诊断为“尿毒症”,予尿毒清服,药治疗,症状无改善。X个月前上述症状加重伴尿量逐渐减少,双下,肢水肿及腹胀、尿量小于100md,水肿逐渐加重伴气促。10天前,明显诱引下出现腹泻,每日解黄色水样便X次,伴上腹隐痛,无恶心,呕吐、无发热、未治疗。今年X来我院就诊。,History ofpresentness病史),3,Past meaical history(既往,More than X year-old suffering from acute nephritis, to,penicillin treatment, mitigation, and on X this year in,hospital emergency abdominal paracentesis drainage. No,hypertension, no diabetes, no history of rheumatic heart,disease, no history of allergies, poisoning history,X余岁患急性肾炎,予青霉素治疗后缓解,今年X日在我院急诊行腹腔穿刺引流术。,无高血压、无糖尿病、无风湿性心脏病史、,无过敏史、无中毒史。,Past meaical history(既往,4,Laboratory-tests(实验室检查),Biochemical: Creatinine 2245umol/L, Bun 88.94mol/L, CO2-cp,15.4mmol/,Potassium 7.09 mmol/L,Blood: WBC 18.5, HGB 56g/L,Urine albumin 2.0g/L, WBC 16.2/L,B-Tip: kidneys shrink, sonographic abnormalities (in accordance,with the ultrasound images of kidney disease), prostatic,calcification, abdominal effusion, I dialysis diuretic,antihypertensive therapy,Ray: increased heart shadow,生化:肌酐2245umol/LBun88.94mol/L,co2-cp,15.4mmol/L,imk 7.09 mmol/L,血常规:WBC9.19,HGB56g/L,尿常规%白蛋白2.0g/L,WBC16.2/L,B超提示:双肾缩小、声像图异常(符合肾脏疾病声像图改变),前列腺钙化,盆腹腔积液,予透析利尿,降压治疗,胸片:心影增大。,Laboratory-tests(实验室检查),5,Secondly. Care issues and measures(护理间题及措施),1.Fluid overload Damage and acute renal failure,due to glomerular filtration rate.,体液过多与急性肾衰竭时所致的肾小球率过功能受损,有关。,2. The risk of infection Restricted protein diet,dialysis, and the body lowered immunity,有感染的危险与限制蛋白质饮食、透析、机体的,抵抗为降低等有关。,Secondly. Care issues and meas,6,3. Impaired skin integrity Vascular changes and the,puncture site,皮肤完整性受损与穿刺部位血管变化有关,4. Malnutrition Patients appetite is low, restricted diet, the,primary disease and other factors,营养失调与病人食欲低下、限制饮食、原发疾病等因素有关,3. Impaired skin integrity Vas,7,5. Anxiety Related to the patient s economic situation,焦虑与患者家庭的经济状况有关,6mOncomplicationDisequilibriumsyndrome,hypotension, hypoxemia, cardiac arrhythmias, cardiac,tamponade、 hemolysis、 air embolism、 cerebral hemorrhage,subdural hematoma、 anemla、 Muscle spasm、 Nausea and,vomiting. High blood pressure, The puncture site, vascular,见并发症:失衡综合征,血气黜蓥、,穿刺部位血管痛、皮肤瘙痒,5. Anxiety Related to the pati,8,Thirdly Nursing interventions(护理措施),Fluid overload(体液过多的护理),Control of intake, Demand for dialysis treatment,控制入量,按需透析,Care of infection(染的护理,(1) The ward ventilation, air disinfection, to avoid the flu.i,通风,空气消毒,避免上感,(2) dialysis operating strictly sterile to avoid infection透析操作,格无菌,避免感染,(3)intection should be prescribed by a doctor rational use,of the drug on the renal toxicity.感染时应遵医嘱合理使用对肾,脏毒性低的,Thirdly Nursing interventions(,9,Skincare(皮肤的护理),Needleinjection, near the puncture smear ointment, anti,infection and protect the skin integrity拔针时,在穿刺口附近涂,抹软膏,抗感染、保护皮肤完整性。,Puncture wound healing, do not scratch, to prevent skir,scratches穿刺口愈合时,勿挠,防止皮肤抓伤,Care of malnutrition信养失调的护理,0.8g/(kg. d) The high-quality protein intake, as,appropriate, low sodium, low potassium, low chlorine, high,carbohydrate, high-fat drink, relieve symptoms such as,nausea and vomiting, increase appetite,0.89/kQ)优质蛋白摄入,情低钠、低钾、低氯、高碳水化合,物,状,增进食欲,Skincare(皮肤的护理),10,血液透析个案护理课件,11,血液透析个案护理课件,12,血液透析个案护理课件,13,血液透析个案护理课件,14,血液透析个案护理课件,15,血液透析个案护理课件,16,血液透析个案护理课件,17,血液透析个案护理课件,18,血液透析个案护理课件,19,血液透析个案护理课件,20,血液透析个案护理课件,21,血液透析个案护理课件,22,血液透析个案护理课件,23,血液透析个案护理课件,24,血液透析个案护理课件,25,血液透析个案护理课件,26,血液透析个案护理课件,27,血液透析个案护理课件,28,血液透析个案护理课件,29,血液透析个案护理课件,30,血液透析个案护理课件,31,血液透析个案护理课件,32,血液透析个案护理课件,33,血液透析个案护理课件,34,