小兒腎病綜合癥的護(hù)理

匯報(bào)人：xxx小兒腎病綜合癥的護(hù)理內(nèi)容概要010203病史回顧相關(guān)知識(shí)介紹護(hù)理診斷及護(hù)理措施PART01病史回顧病史回顧姓名：魏XX住院號(hào)：13XXXX年齡：8歲

性別：女床號(hào)：+22床

科別：普兒科入院日期：20XX年X月XX日?？魄闆r：患兒系“眼瞼浮腫2天”入院。神情，精神一般，顏面部及雙眼瞼浮腫，雙下肢無(wú)明顯浮腫，活動(dòng)自如。腎區(qū)無(wú)叩擊痛。腎病綜合征5年病史。病史回顧PE:T38.6℃P85次/分R19次/分BP100/60mmHg（

20XX.XX.XXX鎮(zhèn)醫(yī)院）尿常規(guī)：蛋白質(zhì)2+，隱血1+，RBC(+),肝腎功能：AST15.8U/L,ALT23.3U/L,白蛋白31.4g/L，總蛋白52.3g/L，BUN2.8mmol/L,Ccr42.5umol/L(20XX.XX.)我院門診尿常規(guī)：蛋白質(zhì)1+，白細(xì)胞偶見(jiàn)，潛血（-）。病史回顧入院診斷：腎病綜合征病情動(dòng)態(tài)

XX.1010:30XX.0910:00XX.08患兒神清，精神一般，T37℃，Bp100/60mmHg，顏面部及雙眼浮腫?；純合怠把鄄€浮腫2天”入院，查體：T38.6℃，Bp100/60mmHg。顏面部及雙眼瞼浮腫。輔檢：胸片：心肺膈未見(jiàn)明顯異常；心電圖：竇性心律不齊；生化常規(guī)：肝腎功能正常，TP52.60g/L,ALB27.60g/L,電解質(zhì)正常，CRP3.35mg/L,腹部B超：肝膽胰脾，雙腎，膀胱未見(jiàn)明顯異常，凝血四項(xiàng)正常，大便常規(guī)正常，24小時(shí)尿蛋白0.80g/24h.查體：顏面部及眼瞼浮腫有所好轉(zhuǎn)。病情動(dòng)態(tài)XX.1508:45XX.1408:40XX.1210:30今日甲強(qiáng)龍沖擊治療結(jié)束，改為潑尼松60mg口服，隔日頓服。患兒神清，精神尚可，顏面部及眼瞼浮腫有所好轉(zhuǎn)。T37℃,Bp100/60mmHg,PPD試驗(yàn)陰性，予甲強(qiáng)龍沖擊治療?；純荷袂?，精神尚可，顏面部及眼瞼浮腫有所好轉(zhuǎn)。查體正常?；純耗壳安∏樯蟹€(wěn)定，今日繼續(xù)激素沖擊治療。病情動(dòng)態(tài)

XX.1909:00XX.1709:00輔檢：尿常規(guī)：正常，尿蛋白消失，病情明顯好轉(zhuǎn)，繼續(xù)鞏固治療。XX.1816:00復(fù)查尿常規(guī)正常?；純撼鲈篜ART02相關(guān)知識(shí)介紹相關(guān)知識(shí)介紹腎病綜合癥（nephroticsyndrome，NS）簡(jiǎn)稱腎病，是一組多種原因所致腎小球基底膜通透性增高，導(dǎo)致大量血漿蛋白自尿丟失引起的一種臨床癥候群。定義相關(guān)知識(shí)介紹分類NS按病因可分三種類型原發(fā)性NS占90%以上,分為單純性腎病和腎炎性腎病繼發(fā)性NS多見(jiàn)于過(guò)敏性紫癜、系統(tǒng)性紅斑狼瘡、乙肝病毒相關(guān)腎炎等疾病先天性NS新生兒或生后1年內(nèi)起病,較少見(jiàn)相關(guān)知識(shí)介紹病理生理致病因素（免疫或其他因素）腎小球基底膜通透性↑大量蛋白尿腎內(nèi)蛋白質(zhì)分解代謝↑低蛋白血癥血漿膠體滲透壓↓血容量↓腎小球?yàn)V過(guò)率↓抗利尿激素(ADH)↑醛固酮↑利鈉因子↓水腫水鈉潴留水分轉(zhuǎn)入間質(zhì)高脂血癥脂代謝紊亂相關(guān)知識(shí)介紹大量蛋白尿低蛋白血癥高膽固醇血癥不同程度的水腫臨床特征相關(guān)知識(shí)介紹蛋白尿尿液檢查尿蛋白檢測(cè)結(jié)果-：尿液外觀無(wú)變化?！溃涸诤谏尘跋驴梢?jiàn)極輕度渾濁；<300ng/L。+：白色輕度渾濁，但無(wú)顆粒出現(xiàn)；300-90mng/L。++：明顯白色渾濁，有顆粒出現(xiàn)，但無(wú)絮狀沉淀；1000-2990mg/L。+++：更明顯的渾濁，有片狀的絮狀沉淀，無(wú)凝固塊；3000-9990mg/L。++++：有絮狀渾濁，凝固成塊下沉；>10000g/L。相關(guān)知識(shí)介紹下行性凹陷性嚴(yán)重者可有體腔積液水腫特點(diǎn)相關(guān)知識(shí)介紹高膽固醇血癥血漿白蛋白↓↓脂質(zhì)在肝臟代償合成增加脂蛋白的分解代謝障礙高膽固醇血癥增加心血管疾病的發(fā)病率導(dǎo)致腎小球硬化對(duì)血小板聚集的影響主要危害相關(guān)知識(shí)介紹單純性腎病多發(fā)于2到7歲，發(fā)病男性>女性。開(kāi)始于眼瞼、面部，漸至四肢全身，男孩常有陰囊水腫；嚴(yán)重時(shí)出現(xiàn)腹水、胸水、心包積液，水腫呈凹陷性；病初患兒一般情況良好，繼之出現(xiàn)面色蒼白、疲倦、厭食，水腫嚴(yán)重著可有少尿，一般無(wú)高血壓及血尿。相關(guān)知識(shí)介紹腎炎性腎病發(fā)病年齡多在學(xué)齡期，水腫一般不嚴(yán)重。臨床特點(diǎn)：除了低蛋白血癥、大量蛋白尿、高膽固醇血癥，水腫特征外，尚有明顯的高血壓、血尿、血清補(bǔ)體降低和不同程度的氮質(zhì)血癥。相關(guān)知識(shí)介紹實(shí)驗(yàn)室檢查尿液檢查：蛋白定性（+++~++++），24h尿蛋白定量＞0.05~0.1g/kg，可見(jiàn)透明管型和顆粒管型。血液檢查：血漿總蛋白及白蛋白↓↓，白、球比例（A/G）倒置，膽固醇↑，血沉加快，不同程度的氮質(zhì)血癥，腎炎性腎病者可有血清補(bǔ)體（CH50、C3）↓相關(guān)知識(shí)介紹并發(fā)癥1.感染：本病最常見(jiàn)的合并癥，常見(jiàn)的有上呼吸道感染、皮膚感染、腹膜炎等。2.電解質(zhì)紊亂：常見(jiàn)的有低鈉、低鉀、低鈣血癥。3.高凝狀態(tài)和血栓形成：原因有：肝臟合成凝血因子增加，呈高纖維蛋白原血癥。尿中丟失抗凝血酶III，血漿抗凝物質(zhì)減少。高脂血癥時(shí)，血液粘滯度增高，血流緩慢，血小板聚集增加。4.急性腎功能衰竭5.生長(zhǎng)延遲相關(guān)知識(shí)介紹治療要點(diǎn)一般治療利尿激素治療免疫抑制劑的治療抗凝治療相關(guān)知識(shí)介紹（1）休息無(wú)需嚴(yán)格限制，嚴(yán)重水腫、高血壓、低血容量的患兒需臥床休息，但應(yīng)經(jīng)常變換體位。（2）飲食水腫者限制鹽的攝入（<2g/d），嚴(yán)重水腫、高血壓者要無(wú)鹽飲食，適量?jī)?yōu)質(zhì)蛋白質(zhì)2g/(kg﹒d)。（3）防治感染避免到公共場(chǎng)所，抗生素不作為預(yù)防用藥。（4）補(bǔ)充維生素及礦物質(zhì)口服維生素D500~1000IU，同時(shí)加服鈣劑。一般治療相關(guān)知識(shí)介紹一般無(wú)需給予利尿劑，當(dāng)水腫較重，尤其有胸、腹水時(shí)可給予利尿劑。常用藥物有：氫氯噻嗪、呋塞米、低分子右旋糖苷。利尿相關(guān)知識(shí)介紹（1）潑尼松中長(zhǎng)程療法（2）短程療法（3）療效判斷激素治療腎上腺皮質(zhì)激素為首選藥物相關(guān)知識(shí)介紹適用于激素部分敏感、耐藥、依賴及復(fù)發(fā)的病例。常用藥物為環(huán)磷酰胺（CTX）方案有：口服法和沖擊法免疫抑制劑

PART03護(hù)理診斷及護(hù)理措施護(hù)理診斷

P1體溫過(guò)高：體溫高于正常范圍營(yíng)養(yǎng)失調(diào):低于機(jī)體需要量與大量蛋白尿中丟失有關(guān)有感染的危險(xiǎn)與免疫力低下有關(guān)體液過(guò)多與低蛋白血癥導(dǎo)致的水鈉潴留有關(guān)P2P3P4護(hù)理診斷

潛在并發(fā)癥藥物副作用焦慮與病情反復(fù)及病程長(zhǎng)有關(guān)知識(shí)缺乏與患兒及家長(zhǎng)知識(shí)受限有關(guān)P5P6P7護(hù)理措施加強(qiáng)病情觀察。Ia遵醫(yī)囑給予經(jīng)靜脈補(bǔ)充液體，并囑其多飲水。P1XX.X10:50體溫過(guò)高：體溫高于正常范圍XX.XX

(12:50)O：患兒體溫正常遵醫(yī)囑予藥物降溫。予物理降溫IbIcId護(hù)理措施體液過(guò)多與低蛋白血癥導(dǎo)致的水鈉潴留有關(guān)XX.XXO：患兒顏面部及眼瞼浮腫有所好轉(zhuǎn)。嚴(yán)密觀察水腫情況，定期測(cè)量體重，記錄24h尿量。遵醫(yī)囑予低鹽、低脂、低優(yōu)質(zhì)蛋白飲食。注意觀察患兒血壓IaIbIcP2XX.XX10:50護(hù)理措施優(yōu)質(zhì)蛋白飲食，如魚(yú)，蛋，大豆等熱量供給要滿足，不少于126-147KJ/(kg.d）增加餐次，注意食物的色、香、味，增加食欲。XX.XXO：患兒營(yíng)養(yǎng)狀況良好IaIbIcP3XX.XX10:50營(yíng)養(yǎng)失調(diào):低于機(jī)體需要量與大量蛋白尿中丟失有關(guān)護(hù)理措施做好保護(hù)性隔離，病房每日進(jìn)行空氣消毒，減少探視。堅(jiān)持醫(yī)囑用藥，勿自行減量或停用激素，觀察有無(wú)藥物副作用Ia避免到人多的公共場(chǎng)所去，注意保暖。XX.XXO：無(wú)感染發(fā)生保持皮膚清潔、干燥，避免皮膚受摩擦或擦傷IaP4XX.XIbIcId有感染的危險(xiǎn)與免疫力低下有關(guān)護(hù)理措施配合醫(yī)生，堅(jiān)持醫(yī)囑用藥。嚴(yán)密觀察病情，每日定時(shí)測(cè)量尿量、血壓，體重。注意觀察激素的副作用，如高血壓，消化道潰瘍，骨質(zhì)疏松等。如有異常匯報(bào)醫(yī)生。心理護(hù)理XX.XXO：患兒未出現(xiàn)藥物副作用IaIbIcP5XX.XX潛在并發(fā)癥藥物副作用護(hù)理措施進(jìn)行各項(xiàng)操作前，向患兒及家長(zhǎng)解釋。操作時(shí)動(dòng)作輕柔。關(guān)心，愛(ài)護(hù)患兒，多與患兒及家長(zhǎng)交談。指導(dǎo)家長(zhǎng)多給患兒心理支持。向患兒及家長(zhǎng)介紹病區(qū)的環(huán)境及主治醫(yī)師，責(zé)任護(hù)士，消除陌生感。IaIbIcP6XX.XX焦慮與病情反復(fù)及病程長(zhǎng)有關(guān)XX.XXO：患兒精神尚可，情緒穩(wěn)定護(hù)理措施囑其適當(dāng)休息，臥床時(shí)經(jīng)常變換體位，活動(dòng)時(shí)不要過(guò)度勞累。使患兒及家長(zhǎng)了解感染時(shí)本病做常見(jiàn)的合并癥及復(fù)發(fā)的誘因，因此預(yù)防感染至關(guān)重要。向患兒及家長(zhǎng)介紹疾病的原因，發(fā)展及藥物副作用。講解激素治療對(duì)本病的重要性，堅(jiān)持按計(jì)劃用藥。XX.XXO：患兒及家長(zhǎng)對(duì)本病有所了解，配合治療。IaP7XX.XIbIcId知識(shí)缺乏與患兒家長(zhǎng)知識(shí)受限有關(guān)匯報(bào)人：xxx謝謝觀看醫(yī)療護(hù)理PPT模板Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.適用于工作匯報(bào)/會(huì)議報(bào)告/個(gè)人競(jìng)聘/述職報(bào)告/比賽匯報(bào)人：xxx添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.目錄CONTENTS此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

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添加標(biāo)題添加標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.醫(yī)療健康此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

02Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞添加副標(biāo)題Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.85%KEYWORDS此處添加相關(guān)標(biāo)題010203Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題此處添加相關(guān)標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞添加副標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題01020304關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

03此處添加相關(guān)標(biāo)題關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題2020202220242026專業(yè)團(tuán)隊(duì)專屬定制Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.此處添加相關(guān)標(biāo)題添加標(biāo)題添加標(biāo)題關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

04此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwi