Scientific nursing care of children with nephropathy should be based on the particularity of children with nephropathy. On the basis of improving the professional level, we should pay attention to the psychological care of children at different ages and communication with their families so that children can recover better. This paper mainly discusses the scientific nursing of children's nephropathy from the aspects of psychological nursing, peritoneal dialysis nursing, health education and nurse-patient communication.
[Keywords:] children; Department of Nephrology; nurse
[China Library Classification Number] R473.32 [Document Identification Number] C [Document Number]1673-7210 (2007) 08 (c)-059-02
Nursing care of children with nephropathy has its particularity in internal medicine nursing. Children are in the process of growth and development. Nephropathy patients not only bring them physical pain, but also make them have psychological doubts and fears in the unfamiliar environment of the hospital. In addition, babies are young and have poor language skills, which brings certain difficulties to diagnosis and nursing. This paper mainly discusses how to do a good job in nursing children with nephropathy from the following aspects.
1 Pay attention to the psychological care of children patients.
With the transformation of medical model from biomedical model to physiological-psychological-social model, nursing has also changed from functional nursing centered on diseases and based on functional tasks to systematic holistic nursing centered on people and based on nursing procedures. Therefore, nursing should not only pay attention to patients' physiological needs, but also pay attention to patients' psychological needs. Psychological nursing has become an important part of modern nursing, especially for children [1].
The children came to a strange hospital from a warm family, and the changes in the environment made them suspicious and uneasy. Seeing other children receiving injections, infusions, dialysis and other treatments with their own eyes makes them even more afraid. Nursing workers can take targeted inspiration and guidance for children of different ages according to their personality characteristics, eliminate their fear and distrust of hospitals and medical staff, and make them happily undergo examination and treatment and recover as soon as possible.
1. 1 baby
Babies are very sensitive to the surrounding environment, afraid of strangers, easily frightened, and even have a strong sense of tension about medical staff wearing white coats. Babies' perception of external things is still in a hazy stage, so it is difficult to cooperate with medical staff in language and action. At this time, the nurse can give the child proper physical contact, such as cuddling and touching, so that the child can feel the care of the nurse's mother, which is conducive to the smooth development of nursing work.
1.2 children
Infantile children, in addition to the fear of the unfamiliar environment in the hospital, will also have distrust and disobedience to the medical staff. They often ignore the questions of medical staff, refuse examination and treatment, and even resist and run away. Nurses can familiarize them with the hospital environment as soon as possible with a cordial and active attitude, and they can also tell stories to bring their favorite toys to the hospital and even play with them, so that they can feel the trust in the medical staff. They can also serve as role models for other children and dispel their fear of treatment.
For infant patients with different personalities, nursing staff can guide them according to the situation. For example, some children are timid, some children are competitive and some children like to be praised. Nursing workers can adopt different ways of encouragement and comfort according to their own characteristics and habits.
1.3 school-age children
School-age children have entered school, have the experience of collective life, and have some independent thinking. During the treatment, they are not only afraid of the hospital, but also worried about the serious consequences of their illness, such as affecting their studies and being separated from their teachers and classmates. Besides, you may be too shy to cooperate with the physical examination and answer questions about personal hygiene. In view of these situations, nursing workers can communicate with them patiently and eliminate their ideological concerns with facts and reasons. In the treatment, you can explain the purpose and operation process to your child, so that your child can have good psychological preparation. In physical examination and other operations, we should pay attention to respecting children's privacy and maintaining children's self-esteem. Obtaining the trust and cooperation of children will make the treatment and nursing work more smooth and effective.
2 Nursing care of peritoneal dialysis
Dialysis is one of the effective methods to treat acute and chronic renal failure in clinic, and the nursing work of dialysis is also an important content in the nursing work of nephrology. Children's blood vessels are small in diameter, and hemodialysis operation is difficult. However, the peritoneal area per unit weight of children is larger than that of adults, so most children with renal failure are treated with peritoneal dialysis (PD).
2. 1 get ready.
Before operation, check whether the dialysate has turbidity, floc, leakage and the effective date of the dialysate, put it in a thermostat and heat it to about 37.5℃, and add medicine to the dialysate according to the doctor's advice [2]. Properly fix the catheter, check whether the catheter is cracked and unobstructed, and pay attention to strict disinfection and aseptic operation.
2.2 Nursing care of dialysis process
In the process of dialysis, it is necessary to keep the speed of dialysate in and out uniform. For ordinary children, it should be controlled at about 30 minutes. Too fast dialysis speed often makes children feel severe abdominal stimulation. The dialysate volume is usually 25~30 ml/kg, and each time it does not exceed 65438±0000ml. The child's omentum is long, so don't drain the liquid too fast. The omentum must be prevented from flowing downstream of the dialysis tube. If the catheter is seriously wrapped by the greater omentum, necessary surgery should be considered to remove part of the greater omentum. The peritoneum of children is crisp and tender, so the operation should be gentle. Try to avoid pulling the catheter during dialysis to prevent trauma at the catheter outlet.
2.3 Observe carefully and record strictly.
The multifunctional monitor can be used to continuously monitor children's vital signs and blood oxygen saturation. The dialysis times, the inflow and outflow of dialysate, the ultrafiltration volume and the residence time in vivo were strictly recorded. Children's intravenous intake, drinking water and urine volume should also be carefully observed and recorded. During peritoneal dialysis treatment, 1 blood potassium, urea nitrogen, creatinine and blood gas were analyzed every 2~3 days, routine examination of exudate was done every day, and bacterial culture of exudate was done every week.
2.4 Prevention of complications
Abdominal cavity in children is the most susceptible part of peritoneal dialysis, and aseptic operation should be strictly carried out during dialysis. Antibiotics can be added to peritoneal dialysate to prevent infection, but it should be noted that drugs harmful to the kidneys cannot be used. The catheter outlet should be cleaned in the specified way every day. In addition, the air in the dialysis room should be disinfected twice a day, and careful observation of whether the exudate is clear and transparent is helpful for early detection of complications of abdominal infection.
In addition, pay attention to observe whether the children have complications such as hypokalemia, hyperglycemia, hypoproteinemia, edema, calcium and phosphorus metabolism disorder.
3. Carry out necessary health education.
Necessary health education for children and their families can help them to establish healthy behaviors, mobilize their enthusiasm for treatment, and achieve the effect of helping children recover and reducing the incidence of diseases.
Nursing workers can take various forms of individual education according to the specific situation of children themselves and their families. It can be divided into disease knowledge education, medication and treatment guidance, diet guidance, activity guidance, follow-up guidance and so on. For example, in terms of medication, it is necessary to introduce the types, dosage, methods, precautions and therapeutic purposes of medication to children and their families in detail, guide them to observe the efficacy and adverse reactions of drugs, and report to doctors in time, and do not add or subtract drugs at will. Severe children are advised to stay in bed, and those who are light can do quantitative activities every day; For children receiving continuous ambulatory peritoneal dialysis, children and their parents can be taught how to do dialysis, so that children can move freely and even go to school, and dialysis can be done at home when necessary.
It is also very important to do a good job of psychological counseling for children and their families, which is conducive to reducing their pressure and better cooperating with treatment. Children's discharge guidance should be given in writing, and they should be told to check regularly as needed to prevent colds and keep contact information with each other.
4. Communicate with children and their families.
When communicating with children, nursing workers should smile more, pay more attention to the use of language skills, and eliminate children's strangeness and fear with words of encouragement and guarantee in order to obtain their cooperation.
Because the child's physical and mental development is incomplete, his language ability is poor and he can't take care of himself, the communication between medical staff and children is largely reflected in the communication with his family. Nursing workers should understand the anxiety of children's families, listen carefully to their descriptions of children's illness, and patiently explain their illness, treatment measures and necessity. When family members raise objections to certain treatment methods, medication and charging standards, nurses should give patient, sincere and reasonable explanations. Some families of children often turn their nervousness and anxiety into dissatisfaction with the work of medical staff or the hospital environment. Faced with this situation, medical staff should have good quality and self-cultivation, make appropriate explanations as flexibly and sincerely as possible, and don't rush to refute and criticize.
[References]
[1] kong, Xia Liyan, et al. Psychology and nursing of pediatric children [J]. China Journal of General Medicine, 2005,6 (1): 75.
[2] Gao Jinhua. 1 Nursing care of children with chronic renal failure undergoing peritoneal dialysis [J]. Journal of Anhui Health Vocational and Technical College, 2006,5 (6): 43.
With the continuous progress of society, the development of science and technology and medicine puts forward new requirements for the comprehensive quality standard of medical students. Clinical nursing is an important course to cultivate students' comprehensive quality and improve their practical ability. The purpose of clinical nursing teaching of kidney disease is to make students master the basic knowledge of clinical nursing theory of kidney disease, so as to improve their clinical nursing ability and achieve the goal of comprehensive improvement. This paper discusses how to cultivate students' ability to analyze and solve problems, as well as the cultivation of clinical thinking and skills in clinical nursing teaching of nephrology, in order to provide reference for clinical nursing teaching of nephrology in the future.
Key words: kidney disease; Clinical nursing; Teaching; Comprehensive quality; medical ethics
China Library Classification. R7 1 1 ID number C1672-3783 (2012) 03-0494-01.
Clinical nursing in nephrology department is a highly operational work, which needs rich experience and various technologies as support. Practical operation reflects practical ability, and rich experience and technology are gradually accumulated in long-term work. Clinical nursing teaching is an important process for students to transform from basic theoretical study to clinical practical work, and it is a method to improve students' practical ability and enrich their experience and technology. To explore the clinical nursing teaching of nephrology, and make contributions to better improve students' comprehensive quality.
1 Cultivation of students' noble medical ethics in clinical nursing teaching of nephrology
No matter at work or in life, ideological and moral quality is always an important weather vane to guide people forward. Only people with high moral character and excellent sentiment can embody perfect dedication in their work and life and achieve the best service effect. Is clinical nursing of kidney disease for patients? Dedicated? The work needs the dedication and enthusiasm of clinical medical staff. As an important means to improve students' comprehensive quality, clinical nursing teaching in nephrology should first cultivate students' ideological and moral quality. Under the condition of market economy, we should have a high sense of responsibility for clinical nursing teaching, keep learning in teaching, improve comprehensive business skills, master the frontier knowledge of the subject at any time, and integrate into teaching. Increase the amount of information and update the knowledge structure in teaching, so that the teaching quality can be strengthened and improved. In the process of students' practice, clinical probation and clinical teaching, students are not only taught how to care for patients, but also cultivated their ideological and moral quality and medical ethics. Let students be full of service consciousness in their minds, and always realize that patients are not only the objects of service, but also ours. God? , can also be said to be ours? Teacher? . In actual clinical work, we should be anxious about patients' urgent needs, think about patients' thoughts, adhere to patient-centered, win patients' recognition with serious attitude, rigorous style and enthusiastic service, and harmonize the relationship between superiors and subordinates. So as to achieve the goal of cultivating students' comprehensive quality and make students truly become excellent clinical nursing medical workers with high ideological and moral quality and good medical ethics in the new era.
2 Clinical nursing teaching in nephrology should integrate theory with practice to improve students' ability to deal with problems.
Clinical nursing of kidney disease is a specialized course. Compared with most students, this subject needs relatively strong professional knowledge as support. At the same time, as a clinical course, students' practical ability should be cultivated more in teaching. Professionalism and practical ability are two difficulties in teaching. Therefore, in the clinical nursing teaching of kidney disease, it is necessary to integrate theory with practice and present the knowledge of kidney disease with a wide range and complicated content to students in an easy-to-understand way. At the same time, fully realize the cultivation of problem-solving ability in teaching, and pay attention to cultivating students' practical ability under the support of basic theoretical knowledge. With the increasingly comprehensive and highly differentiated medicine, it is more required that clinical nursing teaching in nephrology should not only teach students basic theoretical knowledge, but also cultivate students' ability to apply knowledge, innovate knowledge, think comprehensively and deal with problems.
3. Innovating teaching methods in clinical nursing teaching of nephrology to improve teaching quality.
The clinical nursing knowledge of nephrology department is relatively boring only from the knowledge level. If you don't pay attention to methods in teaching, blindly? Script? Or teaching for the sake of teaching will definitely make students' learning more passive. In the clinical nursing teaching of nephrology, we should fully absorb the essence of traditional teaching, and at the same time boldly innovate and change our thinking. Especially the rapid development of modern information technology, we should make full use of it in teaching. For example, the combination of multimedia teaching means and teaching can not only display the teaching content vividly, but also visualize the boring professional knowledge, thus improving students' interest in learning and enhancing learning efficiency. In teaching, we should fully understand the frontier development of nursing discipline, master basic theoretical knowledge, improve teaching quality, strengthen the training of students' basic skills, and lay a solid foundation for entering practical clinical work. On the one hand, we should guide students from basic theoretical knowledge to clinical practice, on the other hand, we should also pay attention to cultivating students' thinking of returning to basic theory in clinical practice, so that students can integrate theory with practice, guide practical work with theory, and further deepen and consolidate theoretical knowledge in practical work. In the process of practice, we should strengthen the training of students' clinical nursing skills and let them do it boldly, but at the same time, we should always pay attention to students' movements, find problems in time and give guidance in time. By innovating teaching methods, the teaching quality is continuously improved, and nursing mistakes are avoided while cultivating students' comprehensive quality.
4 discussion
In clinical nursing teaching of nephrology, we should fully absorb the essence of traditional teaching, take theory as guidance, and pay attention to cultivating students' practical ability, problem analysis and problem solving ability. In teaching, we should pay attention to cultivating students' ideological and moral quality, take good medical ethics as the training goal, and ensure that students become clinical nursing talents with good comprehensive quality in line with the requirements of the new era. In the actual teaching process, we should continue to study hard, constantly improve our professional skills, update our cutting-edge knowledge at any time, and keep up with the development of the times. Of course, it is necessary to continue to explore and think in teaching, so as to provide reference for clinical nursing teaching in nephrology department in the future.
refer to
Zhang Shuhua, Jiang Xiaoying, Qiu Xiaoxue. Application of clinical pathway in clinical nursing teaching of nephrology [J]. ordinary care, 2009 (17):1583-1584.
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