臨牀透析 Vol.19 No.2(9)


特集名 透析患者における高血圧と低血圧
題名 血圧不安定患者における透析中の看護の実際
発刊年月 2003年 02月
著者 大坪 みはる 西部腎クリニック・看護師
【 要旨 】 透析患者の血圧不安定要因はさまざまであり,原疾患や合併症に加え,体液量の増減,薬物療法,自己管理などに影響を受ける.そのため透析看護師は,透析中の血圧維持や下降時の対処とともに患者および家族が血圧安定の必要性を理解し,血圧測定,食事管理,服薬管理を適正に実行できるよう短時間に効果的な支援をする必要がある.以上の理由から当院では頻度の高い看護問題をスタンダード化した記録用紙を作成,使用しており,血圧関連の問題として,透析中の血圧下降,血圧コントロール不良,体液過剰の3項目で看護展開している.体外循環療法に不利な患者層が急増している現在,個別のきめこまかな対策が血圧安定には不可欠である.
Theme Hypertension and Hypotension in Patients with Maintenance Dialysis -- Mechanisms and Therapeutic Approach
Title Nursing for hemodialysis patients with unstable blood pressure
Author Miharu Otsubo Department of Nursing, Seibu Jin Clinic
[ Summary ] Many factors are associated with unstable blood pressure in hemodialysis patients, such as primary diagnosis, complications, fluid balance, pharmacological therapy, intensity of self care, etc. Speedy and effective dialysis nursing care is necessary for the achivement of stable blood pressure and control of dialysis induced hypotension by patients and their families in order to educate the importance of daily care, blood pressure monitoring, proper diet and medication by themselves. Therefore, we standardized frequent nursing problems for the handing of those patients, and developed a nursing record form based on those problems. Our nursing attends to three particular parts in blood-pressure-related problems; (1) dialysis induced hypotension, (2) mal-control of blood pressure, and (3) excessive fluid retention. While the number of high risk patients in extra filtration treatment are rapidly increasing, individualized care and quality of primary nursing care are especially desired for maintaining of stable blood pressure in hemodialysis patients.
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