2014 kidney wind (Focal Segmental Glomerulosclerosis) nursing program

A common syndrome
(A) the wind v renal syndrome: swelling in the face or limbs, wind onset orrecurrence of wind or wind aggravation or delayed a long time does not heal,joint discomfort, more bubbles in urine, pale and dark, lumbar debility, fatiguefatigue. Pale tongue, and MOSS thin yellow or white.
(B) the damp syndrome: seriously swollen, thoracic and epigastric swellingstuffy, hot, thirsty, scanty and dark urine, or stool, or loose stools-delay ofsorts. Red tongue, yellow greasy Moss.
(Iii) kidney collateral stasis syndrome: kidney protracted course of disease,recurrent, when swollen, until the breastwork and lustreless, bone pain. Darktongue there petechiae or ecchymosis.
A common syndrome
(D) wet of kidney deficiency and blood stasis syndrome: swelling of extremitiesless, face, lips, dark bronze with delay, abdominal veins exposed, hot palms andsoles, lumbar debility, or women with colored dark red and purple, or throughless through close and dark urine. Red tongue or dark purple, yellow and thick.
(E) the deficiency of qi and Yin syndrome: swelling time, face swelling ofextremities less, shortness of breath, fatigue, hot palms and soles, dry throat,leader of dizziness, lumbar debility, often sweating or sweating, urine shortred, mamillata little Moss or pale tongue and side bars. (F) the spleen-kidneyYang deficiency syndrome: body swelling below her waist, according to sag, not easily come back, abdominal distension stuffy, anorexia, loose stools, sallowcomplexion, God is tired and cold extremities, or cold and pain in waist, urineshort. Fat pale tongue, white slip, or white fur and thick.
Second, the common symptom/syndrome nursing
(A) bubbles in urine (proteinuria)
(B) edema
(C) hematuria
(D) the dizziness, high blood pressure
(E) the urine abnormalities (oliguria, anuria; polyuria, nocturia)
(F) lumbar debility
(A) bubbles in urine (proteinuria)
1. urine bubble and dissipation. Doctor collected urine, a 24-hour urine proteinand urine micro protein and so on. Specimens collected should correctly, ontime, avoiding excessive dilution or concentration in urine to prevent samplecontamination or degeneration. 2. observe there is no fever, strenuous exercise,and changing body position on patients with bubbles in urine (proteinuria)effects. 3. a large number of bubbles in urine (proteinuria), dominated by bedrest, proper bedside activities. Should be regularly rolled over bed, dorsal flexion, dorsiflexion motion, after the remission, you can gradually increaseyour activity. 4. good oral, skin, perineum and other care, avoid repeatedillness due to infections, increase in proteinuria. 5. the prescribedmoxibustion, desirable air-sea, guanyuan, zusanli acupoint.
(B) edema
1. to assess the degree of edema, position, monitoring body weight, waistcircumference, volume, etc. Severe edema should be on bed rest, recorded 24-hourintake, focus observe changes in blood pressure, heart rate, respiratory andkidney functions. Height of lower extremity edema patients, need to observeswelling degree of symmetry of both lower limbs, with or without pain, hightemperature conditions, detect the thrombotic event. 2. keep the skin clean anddry, soft loose clothes, regularly turn to prevent skin breakdown and infection.Head pillow should be the palpebral oedema; edema of lower limbs should beraised a foot; scrotal edema of scrotum hold up. Severe hydrothorax and ascites
Timely take half-sitting position. 3. proper control of water quantity, directthe amount of income, keep a balance of intake.
(B) edema
4. When you use captured by agents, or diuretics, should pay attention to themonitoring of blood pressure, urine volume, and the number and volume of stool,preventing effective shock caused by decreased blood volume and electrolytedisorders. 5. physician's herb soaking. 6. the prescribed Chinese herbal medicine external application. 7. the physician's traditional Chinese medicinefumigation.
(C) hematuria
1. distinguish the urine color and character. Regularly check urine, urine Red
Correlation of cell volume changes, repeatedly and daily life, such as anactivity, sleep and fatigue, and there is no infection and other factors. • 2.hematuria syndrome or both kidney collateral stasis syndrome, prescribed forpromoting blood circulation Chinese herbs, care should be observed in the skinwithout bleeding, mouth, gums and other parts of female patients, such as bychanging the menstrual period.
(D) the dizziness, high blood pressure
1. step up inspections, monitoring blood pressure. Vertigo occurs, try to keeppatients on bed rest. If severe headache, vomiting, increased blood pressure,blurred vision, immediately report to physicians, do rescue preparations. • 2.antihypertensive drug, attention to monitoring dynamic change of blood pressureand avoid pressure too fast. And to observe the antihypertensive drugs mayimpact on renal function. Normal blood pressure should be controlled within130/80mmHg, >1g/24 hour for urine protein, blood pressure should be controlledin 125/75mmHg. • 3. physician's Auricular, take the door, God, heart, liver,blood pressure ditch sympathetic points. • 4. physician's acupressure, take thewind pool, Bai Hui, Sun and other points.
(E) the urine abnormalities (oliguria, anuria; polyuria, nocturia)
1. the oliguria and anuria is kidney severe wind, focus on blood pressure, heart rate, breathing, consciousness, such as 24 hour access to change, paying particular attention to presence of high potassium and high blood volume,acidosis and its effects on heart and lung function. Strict control of waterintake and keep intake balanced. 2. observation on patients with polyuria,nocturia, specific gravity of urine, urine osmolality, urine output, such asfrequency of urination. 3. the prescribed moxibustion, take shenshu, guanyuan,zusanli with life gate, sea air, two groups of points sanyinjiao alternate,intermittent applications. 4. the prescribed Chinese herbs colon irrigation.
(F) lumbar debility
1. to observe nature, location and symptoms associated with pain, pay attentionto
Extrarenal factors cause low back pain. 2. acid in patients after Renal puncturelumbar pain condition, generally taboo within the 3rd postoperative physicaltherapy at the waist. 3. the physician's Auricular, harvesting, lumbosacral, and other points. 4. the prescribed moxibustion, take shenshu, sea air, guanyuanpoint. 5. physician's herbal, taking double sided shenshu, Jiao Yu and otherpoints.
Third, the characteristics of traditional Chinese medicine treatment and nursing care
(A) drug therapy
(Ii) characteristics of technology
(A) drug therapy
1. herbal decoction: clothing tonic herbs, should be observed with exogenous,injury-free food, stagnation, signs of dampness, such as in case of drug benefitHIV/AIDS enough of evil. Traditional Chinese medicine activating blood circulation xiaozheng, observing the skin, mucous membranes, mouth and otherparts with or without bleeding, Renal Biopsy should be prescribed before and after deactivation. Dispelling wind and dampness Chinese medicine such as Lei Gong Teng tablet, prescribed patients have no gastrointestinal discomfort aftertaking the medicine, and to observe changes in the menstrual cycle, if menstrualdisorders, amenorrhea and other abnormalities, and
B) techniques
1. the external application of herbal medicine: (1) Glauber: Glauber's saltpounded to a powder or fine granular, into a discharged private bag, evenlyspread out, sticking to the treatment site. Discharged each time 8-10 hours, 1times a day. (2) the hot application of Medicine (TCM reyanbao): medicine in theform reyanbao, 40~50℃, topical in bilateral shenshu, Jiao Yu and other pointsto keep warm during treatment, asking whether there is discomfort, such as atopical skin burning, scalding sensation should stop treatment immediately.Gently wipe the skin with a towel after the end of treatment. 20-30 minutes at atime, 1~2 times a day (see Appendix 2). 2. Herb soaking: Herb soaking time in patients with lower extremity edema, knee following skin should be fullysubmerged in liquid. Water temperature 40~42℃, daily or every other day 1 (seeAppendix 2). 3. traditional Chinese medicine fumigation (see Appendix 2). 4.Chinese medicine total colonic lavage (see Appendix 2). 5. the moxa (seeAppendix 2). 6. Auricular points (see Appendix 2). 7. acupressure (see Appendix2).
Four, health guidance
(A) live
(B) dietary guidance (iii) emotional conditioning
(A) live
1. maintain Ward's quiet fresh, daily life sometimes; comply with the fouro'clock, avoided six evil invasion. 2. keep your mouth, skin and perinealcleanliness to prevent infection. 3. avoid renal injury in aggravating factorssuch as overwork, etc. Caution damage to the kidneys, drugs and food. 4. regularmonitoring of blood pressure, controlling blood pressure in an acceptable range.5. exercise helps increase physical fitness, such as Tai Chi, Ba Duan Jin and so on. 6. guidance for patients with TCM methods of self-care, such as acupressure, etc.
(B) dietary guidelines
5. Qi-Yin deficiency syndrome: Yi Shi Qi nourishing Yin foods, such as Lotus seeds, red dates, yams, black rice, Chinese wolfberry, and so on. 6. Yang deficiency of spleen and kidney: should be fresh and invigorating the spleen andkidney and warming Yang diuresis food such as yams and papaya, Coix seed, Lotus seeds, red dates, such as Loach. 7. edema, hypertension occurs when low-saltdiets, recommended daily salt intake to 2~3G, diet, salt salted vegetables(fennel). Highly swollen when doctor salt-free diet in the short term. Renalinsufficiency (GFR is less than 50ml/min), should limit their protein intake,protein 0.6~0.8g/kg.d, and accounted for more than 50% of high quality protein.Very low protein diet (0.3~0.4g/kg.d), should also be combined with alpha-Ketoacid therapy. If necessary, you can replace part of the staple food of wheatstarch, guarantee full calories.
(B) dietary guidelines
1. wind underlying renal syndrome: Yi Shi qufeng tongluo foods such as wood
Melon, luffa, cherries, etc. • 2. damp permit: advised to eat food of clearing heat and removing damp, Coix seed, gourd, bitter gourd, crucian carp, and so on.• 3. kidney collateral stasis syndrome: Yi Shi Huo Xue Jie, Qi Qi's food, such as Hawthorn, walnuts, mushrooms, seaweed, kumquats, and so on. • 4. dampness and blood stasis syndrome of kidney deficiency: Yi Shi tonifying kidney and activating blood and clearing heat and removing damp food, such as yams,walnuts, cherries, etc.
(C) the emotional conditioning
1. the duration of the disease and illness repeatedly, and depression inpatients with good care, feeling restless, shunqing method can be used, open
Patients with negative emotions, Yu-Chang, cathartic emotion. 2. the use ofsteroids, immunosuppressive patients worried about side effects, mental stress,enlightened method of reasoning can be used, and how to communicate withpatients about mental health, specific interpretation, provide psychologicalsupport. When patients such as yunu, restlessness when liver Yang Kangcheng,increased blood pressure, timely psychological, speech, behavior, avoid adverseenvironmental factors such as stimulus. 3. relax, distract empathy method isused, such as listening to music, relaxation, exercise and so on; Encouragepatients to cultivate interest in life, their chores and social participation,such as gardening, cooking, chess, etc.
Five, nursing difficulties
Poor medication compliance solutions 1. strengthening health education andincrease awareness of her condition to understand drug effects, side effects ofmedication and the considerations and objective understanding of the pros and cons of drug therapy, actively cooperate with the treatment.

2. the development of a follow-up system, regularly, to improve treatmentcompliance.