| 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 | |
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| 題名 | ケース・スタディ II. 小児 | |
| 発刊年月 | 2002年 12月 | |
| 著者 | 星井 桜子 | 国立療養所西札幌病院小児科 |
| 【 要旨 】 | 小児慢性腎不全患者の最終目標は正常の成長発達である．そのためには乳幼児期からの適切な栄養管理が必須である．小児の透析は腹膜透析（PD）が主流であるが，PD導入時には食欲喪失や嘔吐などのために十分な食事摂取量の確保が困難な例をしばしば経験する．摂食障害を呈したPD例に小児科医，栄養士，看護師，心理療法士それぞれの連携による栄養管理がどのように展開されたかを述べる． 摂食障害と胃食道逆流を呈した乳児例では夜間の自動腹膜透析中に持続的な鼻腔チューブ栄養を行い，さらに成長ホルモン投与により成長障害は改善した．拒食を呈した学童児例では食事摂取を励ますことが強制にならない配慮と，患児や家族に対する心理面でのサポートが重要であった． |
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| Theme | Care of Patients with Chronic Renal Failure under Malnutrition -- The Teamplay of Physicians, Nutritionists, and Nurses | |
|---|---|---|
| Title | Nutritional management for infants and children with chronic renal failure | |
| Author | Sakurako Hoshii | Department of Pediatrics, Nishi-Sapporo National Hospital |
| [ Summary ] | The ultimate goal for treatment of children with chronic renal failure is the achievement of normal growth and development, for which adequate nutritional management is essential from infancy. Peritoneal dialysis (PD) is the main dialysis modality for children, however, it is difficult to attain adequate nutrition, because of anorexia and vomiting, which are sometimes present in children at the start of PD. This article, describes how the pediatrician, dieticians, nurses and psychologists worked together to support children with these eating problems. Case 1 was an infant on PD who had gastroesophageal reflux. Continuous tube feeding during automated peritoneal dialysis and growth hormone therapy were helpful for the improvement of her nutritional state and growth. Case 2 was an eight-year-old boy who refused to eat. We felt that it was most important, that we do not try to force him to eat. Because chronic renal disease results in severe psychological stress, supportive care for both the patient and his family was needed to manage his eating problem. |
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