血液透析个案护理

人工透析患者的个案护理XX学校XXXXXXAcaseofcarefordialysispatientsHubeiMedicalUniversityFirstly：Patientdata(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,XXyearsold,XXXadmission,XXXdialysis,dialysisfrequency:Xtimes/week.ChiefComplaint:repeatedfatigue,chesttightness,morethanXmonths.OliguriaforXmonth,diarrheaXdays.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。Historyofpresentillness(现病史):Xmorethanamonthago,noobviousincentivetoappearweak,chesttightness,shortnessofbreath,palpitations,chestpain,nofever,nausea,vomiting,dizziness,headache.Diagnosedasuremiaatalocalhospital,ForNiaoduqingmedication.Noimprovementofsymptoms.X,theabovesymptomswithurinegraduallyreduced,lowerextremityedemaandabdominaldistension,urineoutputlessthan100ml/d,theedemagraduallyincreasedwithshortnessofbreath.Diarrhea10daysbeforetheobviousluresolutionyellowwaterystoolsXtimes,withabdominalpain,nonausea,vomiting,nofever,notreatment.Xthisyear,ourhospital.Pastmedicalhistory(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。MorethanXyear-oldsufferingfromacutenephritis,topenicillintreatment,mitigation,andonXthisyearinhospitalemergencyabdominalparacentesisdrainage.Nohypertension,nodiabetes,nohistoryofrheumaticheartdisease,nohistoryofallergies,poisoninghistory.Laboratorytests（实验室检查）：生化：肌酐2245umol/L,Bun88.94mol/L,co2-cp15.4mmol/L,血k7.09mmol/L。血常规：WBC9.19，HGB56g/L尿常规：白蛋白2.0g/L,WBC16.2/LB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：Creatinine2245umol/L,Bun88.94mol/L,co2-cp15.4mmol/L,Potassium7.09mmol/L。Blood:WBC18.5,HGB56g/LUrine:albumin2.0g/L,WBC16.2/LB-Tip:kidneysshrink,sonographicabnormalities(inaccordancewiththeultrasoundimagesofkidneydisease),prostaticcalcification,abdominaleffusion,Idialysisdiuretic,antihypertensivetherapy.Ray:increasedheartshadow.Secondly.Careissuesandmeasures(护理问题及措施)1.FluidoverloadDamageandacuterenalfailureduetoglomerularfiltrationrate.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.TheriskofinfectionRestrictedproteindiet,dialysis,andthebodyloweredimmunity.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.ImpairedskinintegrityVascularchangesandthepuncturesite皮肤完整性受损与穿刺部位血管变化有关4.MalnutritionPatientsappetiteislow,restricteddiet,theprimarydiseaseandotherfactors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.AnxietyRelatedtothepatient‘seconomicsituation焦虑与患者家庭的经济状况有关6.Commoncomplication：Disequilibriumsyndrome、hypotension、hypoxemia,cardiacarrhythmias、cardiactamponade、hemolysis、airembolism、cerebralhemorrhage、subduralhematoma、anemia、Musclespasm、Nauseaandvomiting、Highbloodpressure、Thepuncturesite,vascularpain、Itchyskin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.Nursinginterventions（护理措施）：Fluidoverload（体液过多的护理）:Controlofintake,Demandfordialysistreatment.控制入量，按需透析。Careofinfection(感染的护理)：(1)Thewardventilation,airdisinfection,toavoidtheflu.病室通风，空气消毒，避免上感(2)dialysisoperatingstrictlysteriletoavoidinfection.透析操作严格无菌，避免感染(3)infectionshouldbeprescribedbyadoctorrationaluseofthedrugontherenaltoxicity.感染时应遵医嘱合理使用对肾脏毒性低的药物Skincare（皮肤的护理）：Needleinjection,nearthepuncturesmearointment,anti-infectionandprotecttheskinintegrity.拔针时，在穿刺口附近涂抹软膏，抗感染、保护皮肤完整性。Puncturewoundhealing,donotscratch,topreventskinscratches穿刺口愈合时，勿挠，防止皮肤抓伤.Careofmalnutrition(营养失调的护理)：0.8g/(kg·d)Thehigh-qualityproteinintake,asappropriate,lowsodium,lowpotassium,lowchlorine,high-carbohydrate,high-fatdrink,relievesymptomssuchasnauseaandvomiting,increaseappetite.0.8g/(kg·d)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.Anxietycare（焦虑的护理）：(1)Bepatiencetounderstandtheeconomicsituationofthepatient‘sfamilyagreedwiththepatientsandtheirfamilieswithappropriatecareandtreatmentplan.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)theobservationofthepatient’spsychologicalchangesfortheprogressofinformationabouttheexaminationandtreatmenttorelievethepatient‘sfear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)togivecareandencouragepatientstoestablishtheconfidencetoovercomethedisease给予关怀和鼓励，使病人树立战胜疾病的信心Commoncomplicationcare(常见并发症的护理)Duringdialysis（透析过程中）Lowbloodpressure（低血压）Rapidadoptionofthesupine,Trendelenburgposition,slowbloodflow,slowdownorpausetheUF.Oxygen,ifnecessary,enterthephysiologicalsaline100-200ml.Symptomsandincreasethefluidvolumeuntiltheriseinbloodpressure,symptoms.Alsogivenhypertonicsaline,hypertonicglucose,albumin,andshouldjoinetiology,symptomatictreatment.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上升，症状缓解。还可给予高渗盐水、高渗蒲萄糖、白蛋白等，并应联合病因，对症处理。Highbloodpressure（血压升高）1.Betweendialysissessionstoavoidtoomuchwaterandsaltintake.透析间期避免水盐摄入过多2.Sedation,givetheESTAZOLAMTABLETS10mg.镇静,可予安定10mg。3.GivenantihypertensivedrugNifedipineTablets10to15mgsublingual15mindoesnotalleviatecangivethesamedose.给予降压药心痛定10~15mg舌下含服15min不缓解可以再给予同等剂量。4).Thesymptomsweresignificantlyslower(highrenin)inadditiontowater,reducingbloodflow.症状显著时(高肾素型)减慢除水量,降低血流量。5.Theendofthedialysissystolicbloodpressurethe24kPa180mmHg)above,afterhalfanhourre-measuredbloodpressure,ifstillhighgi