How to observe and care for patients in the period of acute renal failure and oliguria

In acute renal failure, oliguria is dispensable when renal function continues to decline rapidly (days to weeks) (azotemia). For the care of the oliguric phase of acute renal failure, the following aspects should be noted.

1.Acid correction: mild metabolic acidosis is not necessary**, and alkali replacement is given unless the serum bicarbonate concentration is < 10 mmolL.

Sodium bicarbonate, sodium lactate, or trimethylolaminomethane** are used as appropriate. After the acidosis is corrected, the concentration of calcium ions in the blood can be reduced, and tetany of the hands and feet occurs, so it should be combined with 10% calcium gluconate 10 20ml intravenous injection.

2.Diet and nutrition: Sufficient caloric energy should be supplied to ensure the body's metabolic needs.

Consume at least 100 g of carbohydrates per day, which can be fed or supplemented intravenously to reduce gluconeogenesis and starvation acidosis. To reduce nitrogen, potassium, phosphorus, and sulfur**, protein intake should be appropriately restricted. Give daily protein kg body weight, and choose high-quality animal protein with high biological value, such as eggs, fish, milk and lean meat.

3.Strict control of water and sodium intake: This is the main part of this period.

The daily infusion volume is about 400ml of urine output from the previous day plus overt and non-dominant water loss (**, 700ml of respiratory evaporative water minus 300ml of endogenous water). Overt dehydration is the sum of the observable amount of fluid such as stool, vomitus, exudate, and drainage.

4.Correction of heart failure: Acute heart failure in acute renal failure is mostly caused by excessive water and sodium, increased cardiac workload, or arrhythmia and metabolic acidosis caused by electrolyte imbalance are also related to heart failure.

The clinical manifestations are broadly the same as those of acute heart failure, and the management measures are basically similar.

Observe urine output, and daily water intake, including porridge, fruits, and all other foods that contain water! Eat a light diet and eat less vegetable proteins, such as soy products such as tofu!

1. Closely observe the changes in the condition Pay attention to changes in body temperature, breathing, pulse, heart rate, heart rhythm, blood pressure, etc. Heart failure, heart rhythm disorders, infection, and convulsions are often the main causes of death in acute renal failure, and early manifestations should be detected in time and doctors should be contacted at any time.

2. Ensure that the patient is on bed rest The rest period depends on the condition, generally bed rest should be taken in both oliguric and polyuria periods, and appropriate activities should be gradually increased during the recovery period.

3. Nutritional care During the oliguric period, the amount of water, salt, potassium, phosphorus and protein should be limited, and the daily water intake should be 500ml of the previous day's water output to provide enough calories to reduce the decomposition of tissue protein. Those who cannot eat are supplemented with glucose, amino acids, fat emulsion, etc. from the vein. During dialysis**, children lose a large amount of protein, so there is no need to limit the amount of protein, and plasma, hydrolyzed protein, amino acids, etc. can be transfused during long-term dialysis.

4. Accurately record the amount of fluid in and out of oral and intravenous fluid to be recorded one by one, urine output and abnormal loss such as vomit, gastrointestinal drainage, and fecal water during diarrhea need to be accurately measured, and the weight should be measured regularly every day to check whether edema is aggravated.

5.Strict implementation of the intravenous infusion plan During the infusion process, closely observe whether there are symptoms of pulmonary edema caused by too much infusion or too fast, and observe other factors.

6. Prevent infection: Strictly implement aseptic operation, strengthen first-class care and oral care, turn over regularly, and pat your back. Daily ultraviolet disinfection of patient rooms.

7. Do a good job in the patient's ideological work, stabilize the mood, explain the condition and the best plan, so as to obtain cooperation.

Answer]: B This question examines the nursing measures in the oliguric phase of acute renal failure. In the period of acute renal failure and oliguria, the amount of liquid should be controlled to 500ml plus the amount of the previous day; Guaranteed heat; Prevention and treatment of hyperkalemia, including avoiding the use of foods and drugs high in potassium, and prohibiting blood stocks.

Therefore, B should be selected for this question.

Answer]: When the urine output of patients with acute renal failure exceeds 400ml, the patient will enter the polyuria phase from the oliguric phase.

Answer]: B Analysis: In acute renal failure, due to the decrease in renal urinary function, oliguria or no urine deficiency can occur, resulting in water intoxication, hyperkalemia, metabolic acidosis and azotemia, of which hyperkalemia is the most serious complication of oliguria, because hyperkalemia can poison the myocardium, cause heart rhythm disorders, and even cardiac arrest and death.

Master the knowledge of "acute renal insufficiency".

Answer]: Bright jujube a

In the oliguric phase of acute renal failure**, control the amount of body fluids is done in order to"What you do is what you do"As a principle, attention should be paid to the monitoring and treatment of this equivalence of toxicity and hyperkalemia in metabolic acids.

Answer]: ePatients with acute renal failure may experience oliguric or anuria periods, which can eliminate all of the above electrolyte imbalances. The most serious consequences of potassium exposure are high, which can cause ventricular fibrillation and cardiac arrest and require urgent treatment.

Answer]: B patients with acute renal failure can have problems such as water poisoning, hyperkalemia, azotemia, and infection, and should pay attention to preventing infection, supplementing alkaline drugs, limiting potassium intake, limiting protein intake, and strictly limiting the amount of fluid.