1. Clinical manifestations:
(1) Oliguria or anuria: At the most dangerous stage, the urine volume suddenly decreases, generally less than 400ml per day, that is, oliguria begins. This period is usually 7 ~ 10 days, and the urine specific gravity is low and fixed, generally at10 ~10/4. There are protein, cast and red blood cells in urine. Water poisoning, hyperkalemia, acidosis.
(2) polyuria: when the urine volume gradually increases to 400ml per day, it means that the patient has entered polyuria, and then the urine volume continues to increase, reaching more than 3000ml per day. This cycle is usually about 2 weeks. The urine output in the early stage of polyuria is still small, so the manifestations of polyuria such as water poisoning, hyperkalemia and acidosis still exist in the medical and health talent network, and there is still the danger of accidents. When the condition is further improved, the renal function is improved, the water in the body is too much for a long time, and a large number of potassium and acidic substances are discharged and lost, which can cause the other extreme. The water and electrolyte disorders such as dehydration and hypokalemia cannot be ignored.
(3) Recovery period: Generally, patients enter recovery period 4-5 weeks after onset, and their renal function gradually recovers, and their clinical symptoms disappear, but the recovery of renal concentration function and clearance function is slow, which takes about 1-2 years.
2. Nursing measures:
(1) Nursing during oliguria or anuria:
1) Restrict water inflow: put an end to water poisoning and strictly limit the number of water users. Live within your means? Less is better than more, and the daily infusion volume = dominant water loss+non-dominant water loss-endogenous water. Daily weight measurement can reduce body weight by 0.5 kg, blood sodium is higher than 1.30 mmol/L, and central venous pressure is within the normal range.
2) Dietary nutrition: protein was fasted in the early stage of oliguria, and tissue catabolism slowed down after three days, and a small amount of protein was ingested. Give patients a diet low in protein, high in sugar and high in vitamins. Strictly control foods containing potassium.
3) Correct electrolyte and acidosis: To correct hyperkalemia, potassium can be forbidden, resisted, transferred and discharged to correct acidosis and supplement alkaline solution. The key to correct hyponatremia is to control water intake.
4) Prevention of infection: Infection is one of the death causes of acute renal failure, which usually occurs in the lung and urinary system. Attention should be paid to disinfection and isolation, strict aseptic operation and application of antibiotics, but especially drugs that are toxic to the kidney should be avoided.
5) Nursing care of dialysis treatment: In patients with acute renal failure, hematuria nitrogen is higher than 25mmol/L, serum creatinine is higher than 442mmol/L or serum potassium is higher than 6.5 mmol/L, and water poisoning has not improved after general treatment, and acidosis is difficult to correct, so dialysis treatment is needed. Hemodialysis has a good effect, but it is often limited by conditions and requires certain equipment. Peritoneal dialysis is safe, simple and effective, so it is widely used.
(2) Nursing during polyuria:
1) control fluid volume: the urine volume increases gradually during polyuria, and the early rehydration is l/2 or 1/3 of the water output, according to? Measure people? Principle, and in the later period of close observation and monitoring, to prevent dehydration.
2) Treatment of electrolyte disorder and acidosis. Electrolyte disorder and acidosis still exist in the early stage of polyuria and oliguria, and attention should be paid to correcting them. To prevent electrolyte loss, such as hypokalemia.
3) Prevention of infection: At this stage, patients are extremely weak, have low immunity and are prone to infection. Attention should still be paid to aseptic operation and the use of antibiotics.
4) Nutritional support: strengthen nutrition, supplement protein, and improve patients' immunity.
(3) Rehabilitation nursing:
The recovery period is long, about L ~ 2 years. Pay attention to nutritional supplements and give a diet rich in calories and vitamins and protein. Avoid using drugs harmful to the kidneys to prevent trauma, fatigue, infection, pregnancy, etc. Promote early recovery and prevent the formation of chronic renal failure.
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