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,*,人工透析患者的个案护理,XX学校,XXX XXX,A case of care for dialysis patients,Hubei Medical University,Firstly：Patient data(患者资料）,XXX,，,XX,岁，,XXX,入院，,XXX,开始透析，透析频率：,X,次/周,。,主诉：反复乏力、胸闷,X,月有余，尿少,X,月，腹泻,X,天。,XXX,XX,years old,XXX,admission,XXX,dialysis,dialysis frequency:,X,times/week.,Chief Complaint:repeated fatigue,chest tightness,more than,X,months.Oliguria for,X,month,diarrhea,X,days.,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100ml/d，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 of present illness(现病史),:,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 medication.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 of breath.Diarrhea 10 days before the obvious lure solution yellow watery stools,X,times,with abdominal pain,no nausea,vomiting,no fever,no treatment.,X,this year,our hospital.,Past medical history(既往史)：,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。,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.,Laboratory tests（,实验室检查,）,：,生化：肌酐 2245umol/L,Bun 88.94mol/L,co2-cp 15.4mmol/L,血k 7.09 mmol/L。,血常规：WBC 9.19，HGB 56g/L,尿常规：白蛋白2.0g/L,WBC 16.2/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。,Biochemical：Creatinine 2245umol/L,Bun 88.94mol/L,co,2,-cp 15.4mmol/L,Potassium 7.09 mmol/L。,Blood:WBC 18.5,HGB 56g/LUrine: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.,Secondly.Care issues and measures(护理问题及措施),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、机体的抵抗力降低等有关。,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,5.Anxiety Related to the patients economic situation,焦虑 与患者家庭的经济状况有关,6.Common complication：Disequilibrium syndrome、hypotension、hypoxemia,cardiac arrhythmias、cardiac tamponade、hemolysis、air embolism、cerebral hemorrhage、subdural hematoma、anemia、Muscle spasm、Nausea and vomiting、High blood pressure、The puncture site,vascular pain、Itchy skin,常见并发症：失衡综合征、低血压、低氧血症、心律失常、心包填塞、溶血、空气栓塞、脑出血、硬膜下血肿、贫血、肌肉痉挛,、,恶心呕吐、血压升高、穿刺部位血管痛,、皮肤瘙痒,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(感染的护理,),：,The ward ventilation,air disinfection,to avoid the flu.,病室通风，空气消毒，避免上感,(2)dialysis operating strictly sterile to avoid infection.,透析操作严格无菌，避免感染,(3)infection 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药物,Skin care（皮肤的护理）,：Needle injection,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 skin scratches,穿刺口愈合时，勿挠，防止皮肤抓伤.,Care of malnutrition(营养失调的护理),：,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.,0.8g/(kgd)优质蛋白摄入，酌情低钠、低钾、低氯、高碳水化合物、高脂饮、缓解恶心呕吐等症状，增进食欲.,Anxiety care（焦虑的护理）,：(1)Be patience to understand the economic situation of the patients family agreed with the patients and their families with appropriate care and treatment plan.,耐心沟通，了解病人家庭经济状况，与病人及其家属议定合适的护理治疗计划,(2)the observation of the patients psychological changes for the progress of information about the examination and treatment to relieve the patients fear观察病人的心理变化，为其讲述各项检查及 治疗的进展信息，解除病人的恐惧(3)to give care and encourage patients to establish the confidence to overcome the disease,给予关怀和鼓励，使病人树立战胜疾病的信心,Common complication care(常见并发症的护理),During dialysis（透析过程中,）,Low blood pressure（低血压）,Rapid adoption of the supine,Trendelenburg position,slow blood flow,slow down or pause the UF.Oxygen,if necessary,enter the physiological saline 100-200ml.Symptoms and increase the fluid volume until the rise in blood pressure,symptoms.Also given hypertonic saline,hypertonic glucose,albumin,and should join etiology,symptomatic treatment.迅速,采取平卧，头低脚高位，变慢血流量，变慢或暂停超滤。吸氧，必要时输入生理盐水100-200ml。症状重者加大补液量直至血压