文档介绍：Instructor:
Participants:
Nursing Round1
Main content
1. General information on patient
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 week
Vascular access for hemodialysis: AVF
Diagnosis:CGN(慢性肾小球肾炎)
History illness
History and
present illness
Present illness
Deep venous catheter surgery(深静脉置管手术史);
Hepatitis B;
Repeated nausea and vomiting,oliguria(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,肌肉痉挛,曾急发左心衰。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 the dialysis,the urine is on the decline,untill October this year the urine is SBP of the patient ranges from 140 to 190mmHg,the DBP of the patient ranges from 70 to edema of the legs is obvious,along with the pruritus(瘙痒).The nausea and vomiting happens frequently,the left heart failure happened twice.
Laboratory tests
Normal value
2010-12
2011-03
BUN before the dialysis
21-28
42
BUN after the dialysis
1/3(21-28)
ALB(g/L)
>35
HCT(l/L)
-
K(mmol/L)
-
Hb(g/L)
>110
40
36
Fe(mmol/L)
-30
PTH(pg/mL)
150-300
1120
P(mmol/L)
-
Cr(mmol/L)
62-115
1179
1101
Blood β2micro blobulin
0-
Nursing problem
营养失调
骨痛,瘙痒
体液过多
Related to excessive intake and dehydration(脱水) shortage.
Below the body‘s requirements.
Related to inadequate intake of Fe 、 protein and EPO , it lead to anemia(贫血).
Related to the high phosphorus and PTH ,it lead to the Renal bone disease.
Fluid overload
malnutrition
Bone pain,pruritus
Psychological care(心理护理)
Nursing problem
High blood
pressure(高血压)
Muscle spasms
(肌肉痉挛)
nausea and vomiting
(恶心呕吐)
High potassium
hematic disease
(高钾血症)
Acute left he