Electrolyte metabolism disorder
In patients with chronic renal failure, due to the decrease of phosphorus excretion, the blood phosphorus level rises repeatedly and the blood ionized calcium level drops, which stimulates PTH secretion and leads to secondary hyperparathyroidism.
Studies have shown that secondary hyperparathyroidism can cause skin itching, and its increase can cause hypercalcemia, skin calcification and stimulate skin mast cells to release histamine, so the increase of PTH is considered as an important pathogenic factor.
At present, the commonly used treatment methods are:
The intake of phosphorus in the diet must be limited (800- 1000 mg/day);
Apply active vitamin D to supplement calcium according to the doctor's advice;
Adjust the dialysate to an appropriate calcium concentration according to the doctor's advice to prevent hypercalcemia;
Take phosphorus binder according to the doctor's advice to reduce the absorption of phosphorus in the intestine;
According to the doctor's advice, choose HP combined with HD or HDF (hemodialysis and filtration) for regular treatment;
Change the way you scratch. Pat with your hands and often cut your nails. Pay special attention to maintain the integrity of the arm skin on the arteriovenous fistula side to avoid internal fistula infection. If there is local infection, puncture should be avoided, and antibiotic ointment such as Baiduobang should be used according to the doctor's advice.
Because the skin of fistula is often coated with alcohol and adhesive tape, long-term use is easy to cause skin allergy and dryness. Xerox can be used for skin care.
Retention of nitrogen metabolites
The retention of nitrogen metabolites will stimulate the skin, make sebaceous glands and sweat glands contract, make the skin dry and desquamate to varying degrees, and cause itching. The patient's skin looks like ichthyosis, and the itching is unbearable. He often scratches or even scratches his skin, which can't be relieved.
The increase of nitrogen metabolites is related to inadequate dialysis. For economic reasons, some patients are dialyzed twice a week and treated with cheap and low-permeability dialyzers. At the same time, some low-flux dialyzers are reused several times. The increase of repeated use can lead to insufficient dialysis, accumulation of nitrogen metabolites and aggravation of skin itching.
Therefore, in order to ensure the adequacy of dialysis and reduce the irritation of nitrogen metabolites to the skin. It is suggested that patients reduce the number of repeated use of low-flux dialyzers and increase the number of dialysis. If conditions permit, you can use a dialyzer with medium flux for dialysis. Instruct patients to wet compress with cold water and ice towel to relieve itching.
Response measures:
1. Reduce the reuse times of low-flux dialyzers and increase the dialysis times (3 times /w). If conditions permit, medium flux dialyzer (ultrafiltration coefficient 15-30) can be selected.
ML/mmHg/m2) for dialysis.
2. In the process of dialysis, closely observe whether the operation of the dialysis machine is normal, and strive for early detection, prevention and treatment.
3, nursing operation should be standardized, pay attention to aseptic operation during treatment, to ensure the safety of dialysis treatment.
4. Instruct patients to wet compress with cold water and ice towel to relieve itching. When the skin is dry, apply skin lubricant and use cheese soap.
anaphylactic reaction
Patients with chronic renal failure are prone to allergic reaction mainly because heparin, plasticizer softening hemodialysis channel, disinfection of dialyzer and ethylene oxide in blood channel can stimulate the proliferation of mast cells in spleen, bone marrow and skin of dialysis patients, leading to the increase of histamine concentration in blood and itchy skin. The itching caused by this allergic reaction is often accompanied by a rash. Patients should be instructed to avoid skin damage caused by scratching hard, and some cool medicinal oil can be applied to relieve symptoms.
Response measures:
1. Antihistamine treatment relieved.
2. Encourage and comfort patients and relieve their nervousness.
3. Choose a dialyzer with good biocompatibility to reduce the allergic reaction caused by ethylene oxide.
4. Before dialysis, you can choose to fully pre-flush the dialyzer and pipeline with normal saline, and do a good job in detecting the residual disinfectant on the computer to ensure the safety of dialysis treatment.
The itching caused by this allergic reaction is often accompanied by a rash. Instruct patients to avoid skin damage caused by scratching. You can apply some cool oil to relieve symptoms.
Nursing o
Because the patient's skin itches and scratches, which leads to the defect of self-image, the patient is very anxious. As the symptoms get worse day by day, it affects the quality of sleep at night. You can take sedatives under the guidance of a doctor to avoid excessive anxiety. Because the cost of hemoperfusion combined with hemodialysis is higher than that of hemodialysis alone, it will bring some psychological pressure to patients, resulting in low compliance of patients receiving hemoperfusion combined with hemodialysis. Therefore, we should do a good job in health guidance, improve patients' treatment compliance and ensure the smooth progress of treatment.
2. Daily care
Instruct patients to wear cotton and loose underwear in daily life. The bath water should not be too hot. It is generally appropriate to take a bath with 40% warm water. Alkaline soap and shower gel should be avoided. In order to avoid itching caused by dry skin, moisturizer can be applied locally, and personal hygiene should be done at the same time. Take a bath and change clothes frequently. Don't drink and eat less irritating food.
3. Others
Instruct patients to take phosphorus binder correctly, draw blood regularly to check all indexes, strengthen nutrition education, improve patients' treatment compliance and delay the occurrence of long-term complications.
Tips:
1. Wear cotton loose underwear in daily life. The bath water should not be too hot. Generally, it is advisable to take a bath with 40 warm water. Avoid using alkaline soap and shower gel.
2. In order to avoid itching caused by dry skin, apply it locally to relieve itching. At the same time, do a good job in personal hygiene, take a bath frequently and change clothes frequently. Don't drink and eat less irritating food.
3, in strict accordance with the requirements of the doctor's advice, blood test indicators on a regular basis. Strengthen the study of nutrition intake and strictly control diet.