Patient's question:
Patient Gender:Patient Age:
Description of Symptoms:
Doctor's answer:
(1) Complete bed rest can reduce the production of metabolic byproducts and alleviate renal load. Adequate calories and a certain amount of essential amino acids should be supplied. In the early stage, only carbohydrates should be given, with 3-5 g/kg of glucose administered intravenously per day to reduce protein catabolism and ketone production. Once the condition improves and oral intake is possible, food should be provided as soon as possible to meet the caloric needs for basal metabolism. The diet may consist of low-protein, low-sodium, low-potassium, and low-phosphorus meals. Protein intake should be limited to 0.5-1 g/kg per day, with high-quality protein being preferred. To enhance appetite, oral hygiene should be maintained before meals. Patients with anorexia should be fed small, frequent meals, while those with vomiting should receive antiemetic medication before meals and be provided with a pleasant dining environment. To promote protein synthesis, nandrolone phenylpropionate can be administered via intramuscular injection once or twice a week. Patients unable to take oral nutrition may receive parenteral nutrition.(2) Strict adherence to "output equals input" is essential. The daily fluid requirement is calculated as: previous day's urine output + insensible fluid loss + abnormal losses - internal water produced from food metabolism and tissue breakdown. Insensible fluid loss is estimated at 400 mL/m2 per day, increasing by 75 mL/m2 for each 1°C rise in body temperature. Internal water production is calculated at 100 mL/m2 per day, while abnormal losses include vomiting, diarrhea, and gastrointestinal drainage.
1) Accurate recording of fluid intake and output is crucial. Fluids entering and exiting through various routes should be recorded item by item, including urine output, vomit, gastrointestinal drainage, and water content in feces. For infants, urine should be collected in a bag, and diapers should be weighed.
2) Weigh the child at the same time each day using the same scale to ensure accuracy and monitor changes in edema.
3) If the child is severely thirsty, small ice chips can be provided to alleviate the thirst. Fluid intake should be restricted as per medical advice.
(3) Skin care
1) Assess and record skin condition at each shift. Keep the bed clean, dry, and free of debris.
2) Maintain skin cleanliness and dryness. Assist the child in cleaning and drying the perineal area after defecation.
3) Avoid using alkaline soaps for bathing.
4) Encourage the child not to scratch itchy skin and apply anti-pruritic or lubricating agents to itchy areas. For severe itching, antihistamines or sedatives may be administered as per medical advice.
(4) Infection control
1) Maintain a clean environment and implement protective isolation measures. Strict aseptic techniques must be followed for children undergoing dialysis treatment.
2) Keep the mouth and skin clean. Encourage bedridden children to take deep breaths and cough.
3) Encourage food intake to improve the child's nutritional status.
4) Minimize catheterization. If necessary, perform strict aseptic procedures and provide proper care.
5) Promptly identify signs of infection and take appropriate measures to control it.
6) Send blood, urine, and sputum cultures for sensitivity testing to select antibiotics that are effective and non-harmful to the kidneys.
(5) Monitor the condition and avoid factors that may worsen the condition. Provide sufficient calories, reduce protein catabolism, avoid foods and medications high in potassium, and avoid transfusing stored blood. Observe for signs of bleeding; monitor coagulation times and platelet counts. Apply pressure until bleeding stops after any puncture, using small needles to minimize injury. For patients with central nervous system involvement, implement protective measures to prevent accidents.