uremia尿毒症案例.ppt

Main content 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。 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 Nursing problem Nursing problem 1. Fluid overload 　血液透析滤过是在血液透析基础上，利用透析滤过膜来清除中分子毒素，故尿毒症患者出现中分子毒素蓄积表现如严重心包炎、心包积液、周围神经病变时，均可考虑使该疗法。与血液透析相比，血液透析滤过不仅能清除中分子毒性物质，还能保证不影响小分子毒素清除效率，因此，特别适于需要血液滤过又不能增加透析次数患者；血液透析滤过具有心血管状态稳定特点，故适于普通血液透析时易发生低血压不耐受超滤患者。 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. 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 input of high-quality protein,50% of the protein should be come from milk、eggs、fish and mea