| 特集名 | 栄養障害に陥った腎不全患者のケア -- 医師・栄養士・看護師の連携 | |
|---|---|---|
| 題名 | ケース・スタディ I. 糖尿病透析患者 | |
| 発刊年月 | 2002年 12月 | |
| 著者 | 武田 一人 | 麻生飯塚病院腎臓内科 |
| 著者 | 田中 理恵子 | 麻生飯塚病院腎臓内科 |
| 著者 | 土井 俊樹 | 麻生飯塚病院腎臓内科 |
| 著者 | 小田 恭子 | 麻生飯塚病院 S2A（腎臓内科）病棟・看護師 |
| 著者 | 樋口 礼子 | 麻生飯塚病院 S2A（腎臓内科）病棟・看護師 |
| 著者 | 岸本 朱里 | 麻生飯塚病院腎臓内科・管理栄養士 |
| 【 要旨 】 | 症例1は，77歳，男性．以前より陳旧性脳梗塞と難治性腹水がみられた高齢の糖尿病性慢性腎不全患者で，透析導入前に，急性硬膜下血腫にて開頭術を余儀なくされたが，腹膜灌流にて透析を導入し，看護師，栄養士の連携により，早期に退院できた症例である． 症例2は，64歳，男性．陳旧性心筋梗塞，陳旧性脳梗塞，冠動脈バイパス術後，C型肝炎による肝硬変がある糖尿病性慢性腎不全患者で，重症の脳心血管系合併症を有し，透析導入時には低栄養状態であったが，栄養士，看護師の連携により，ようやく外来透析可能となった症例である． 糖尿病性腎不全患者には，保存期から十分な自己管理教育を行い，透析導入後も継続的な指導や教育が重要であり，栄養士，看護師，ケースワーカーも含めた医療チームで集団的に実践していくことが必要不可欠である． |
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| Theme | Care of Patients with Chronic Renal Failure under Malnutrition -- The Teamplay of Physicians, Nutritionists, and Nurses | |
|---|---|---|
| Title | Two cases of diabetic hemodialysis patients in states of severe malnutrition | |
| Author | Kazuhito Takeda | Department of Nephrology and Kidney Center, Aso-Iizuka Hospital |
| Author | Rieko Tanaka | Department of Nephrology and Kidney Center, Aso-Iizuka Hospital |
| Author | Toshiki Doi | Department of Nephrology and Kidney Center, Aso-Iizuka Hospital |
| Author | Kyoko Oda | Registered nurses of Nephrology, Aso-Iizuka Hospital |
| Author | Reiko Higuchi | Registered nurses of Nephrology,, Aso-Iizuka Hospital |
| Author | Akari Kishimoto | Renal dietician, Aso-Iizuka Hospital |
| [ Summary ] | Case 1: A 77 year old male diabetic patient with chronic renal failure, intractile ascites, and an old cerebral infarction. Hematectomy was done because of acute subdural hematoma before induction of maintenance hemodialysis. After intracranial surgery, peritoneal dialysis was gradually induced. The patient was in a state of malnutrition and had no appetite. Going on a special diet with unrestricted salt and successive rehabilitation, he recovered immediately by virtue the cooperation of the medical staff, registered nurses and renal dieticians. Case 2: A 64 year old male diabetic patient with chronic renal failure, an old myocardial infarction, having had AC-bypass surgery, an old cerebral infaction, and liver cirrhosis due to C type viral hepatitis, received maintenance hemodialysis. He was still in a severe state of malnutrition, and could not walk by himself for a great deal of time. However, he recovered through intensive rehabilitation and his cooperation with doctors, nurses, and renal dieticians over a two month period. In diabetic hemodialysis patients, sufficient education and guidance before and after the induction of dialysis therapy are very important for successful treatment. Nephrologists, registered nurses and renal dieticians should be well organized into a renal medical team in the nephrology department not only for non-diabetic patients but also for diabetic hemodialysis patients. |
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