DEFINITION
ACUTE RENAL FAILURE
PAGE FROM 4158 TO 4172
EPIDEMIOLOGY ‫ﻋ ﻠ ﻢ ا ﻷو( ﺌ ﺔ‬
The most frequent causes of ARF are Acute tubular ‫ﻲ‬،g‫(ﻮ‬٪‫ﻧﺒ‬21‫اﻟاﻟﻜﻨ=ﺨ>ﺮ)اﻷ‬a‫ﻞ‬u‫ﺒ‬ARF
necrosis (ATN)(45%), prerenal (21%), acute-onset
chronic renal failure (12.7%) and obstructive ARF ‫ﺎﻧﺖ وﻇﺎﺋﻒ اﻟﻜ=> ﻃﺒﻴﻌﻴ ًﺔ ﻋﻨﺪ‬Å .(٪10) ‫اﻻ•ﺴﺪادي‬
‫ﺒﻮا ﻻﺣﻘﺎ‬ä‫ اﻟﺬﻳﻦ أﺻ‬àáÜ‫ ﻣﻦ اﳌﺮ‬٪48 a` ‫اﻟﺪﺧﻮل‬
(10%). Renal function was normal at admission in
48% of patients who later developed ARF.
Acute renal failure (ARF) is a rapid loss of ‫ﻊ‬7‫ﻮ ﻓﻘﺪان ﺳﺮ‬0ARF) ) ‫ﺎد‬,+‫اﻟﻔﺸﻞ اﻟ'ﻠﻮي ا‬
renal function due to damage to the kidneys.
Depending on the duration and severity of ARF,
a wide range of potentially life-threatening
metabolic complications can occur, including
metabolic acidosis as well as fluid and electrolyte
imbalances.
PATHOPHYSIOLOGY
Acute renal failure can be caused by conditions that
reduce blood flow to the kidney and impair kidney
function:
ً
‫ﺷﻴﻮﻋﺎ ﻟـ‬sr‫اﻷﺳﺒﺎب اﻷﻛ‬
‫ ﻣﺎ ﻗ‬، (٪ATN) (45) ‫ﺎد‬,+‫ا‬
(1) hypovolemia.
ARF ‫( و‬٪12.7) ‫ﺎد‬,+‫اﻟﻔﺸﻞ اﻟ'ﻠﻮي اﳌﺰﻣﻦ ا‬ (2) hypotension.
(3) reduced cardiac output and heart failure.
ARF. ‫ﺑﺤﺎﻻت‬ (4) obstruction of the kidney or lower urinary tract by
tumour, blood clot, or kidney stone.
(5) bilateral obstruction of the renal arteries or veins. If
these conditions are treated and corrected before the
kidneys are permanently damaged, the increased BUN and
creatinine levels, oliguria, and other signs may be reversed.
.>=‫ﺐ ﺗﻠﻒ اﻟﻜ‬A‫ﻟﻮﻇﻴﻔﺔ اﻟﻜ=> ?ﺴ‬
‫ﻳﻤﻜﻦ أن‬ARF ، ‫اﻋﺘﻤﺎًدا ﻋ=> ﻣﺪة وﺷﺪة‬
‫ﺗﺤﺪث ﻣﺠﻤﻮﻋﺔ واﺳﻌﺔ ﻣﻦ اﳌﻀﺎﻋﻔﺎت اﻷﻳﻀﻴﺔ‬
‫ﻤﺎض‬,+‫ ذﻟﻚ ا‬a` ‫ ﺑﻤﺎ‬، ‫ﻴﺎة‬,+‫ ﻗﺪ \]ﺪد ا‬ZY‫اﻟ‬
.‫ﺎرل‬m‫ﻲ وﻛﺬﻟﻚ اﺧﺘﻼﻻت اﻟﺴﻮ اﺋﻞ واﻟﻜ‬g‫اﻻﺳﺘﻘﻼ‬
‫ﺐ‬A‫ﺎد ?ﺴ‬,+‫ﻳﻤﻜﻦ أن ﻳﺤﺪث اﻟﻔﺸﻞ اﻟ'ﻠﻮي ا‬
>=‫> اﻟﻜ‬ë‫ ﺗﻘﻠﻞ ﻣﻦ ﺗﺪﻓﻖ اﻟﺪم إ‬ZY‫اﻟﻈﺮوف اﻟ‬
:>=‫وﺗﻀﻌﻒ وﻇﺎﺋﻒ اﻟﻜ‬
.‫ﻢ اﻟﺪم‬ïî ‫( ﻧﻘﺺ‬1)
.‫( اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم‬2)
.‫ وﻓﺸﻞ اﻟﻘﻠﺐ‬Zú‫( اﻧﺨﻔﺎض اﻟﻨﺘﺎج اﻟﻘﻠ‬3)
‫( ا•ﺴﺪاد اﻟﻜ=> أو اﳌﺴﺎﻟﻚ اﻟﺒﻮﻟﻴﺔ اﻟﺴﻔﻠﻴﺔ‬4)
.>=‫ﺔ أو ﺣﺼﻮات اﻟﻜ‬ü‫ﺐ ورم أو ﺟﻠﻄﺔ دﻣﻮ‬A‫?ﺴ‬
‫ اﻟﺸﺮ اﻳ§ن أو اﻷوردة‬a` ‫ﻲ‬£‫( ا•ﺴﺪاد ﺛﻨﺎ‬5)
‫ﺎ‬m‫ﻴﺤ‬,¶‫ﺎﻻت وﺗ‬,+‫ﺬﻩ ا‬0 ‫ إذا ﺗﻢ ﻋﻼج‬.‫ﺔ‬ü‫اﻟ'ﻠﻮ‬
‫ ﻓﻘﺪ ﻳﺘﻢ‬، ‫ﻗﺒﻞ أن ﺗﺘﻀﺮر اﻟﻜ=> ?ﺸ'ﻞ داﺋﻢ‬
‫ﻨ§ن‬ä‫ﺎﺗ‬ü‫واﻟﻜﺮ‬BUN ‫ﺎت‬ü‫ﺎدة ﻣﺴﺘﻮ‬ü‫ﻋﻜﺲ ز‬
.‫وﻗﻠﺔ اﻟﺒﻮل وﻋﻼﻣﺎت أﺧﺮى‬

CATEGORIES OF ACUTE RENAL
FAILURE (ARF)
*The major categories of ARF are:
1. prerenal (hypoperfusion of kidney), Prerenal ARF, which
occurs in 60% to 70% of cases, is the result of impaired blood
flow that leads to hypoperfusion of the kidney and a decrease
in the GFR.
2. intrarenal (actual damage to kidney tissue), Intrarenal ARF
is the result of actual parenchymal damage to the glomeruli
or kidney tubules. Acute tubular necrosis (ATN) is the
most common type of intrinsic ARF.
3. postrenal (obstruction to urine flow), postrenal ARF
usually results from obstruction distal to the kidney. Pressure
rises in the kidney tubules and eventually, the GFR decreases.
SIGNS AND SYMPTOMS
Almost every system of the body is affected with
‫ًﺒﺎ ﺑﻔﺸﻞ‬ü‫ﺴﻢ ﺗﻘﺮ‬ï+‫ﺰة ا‬m‫ﺎزﻣﻦ أﺟ‬m‫ﻞ ﺟ‬Å‫ﻳﺘﺄﺛﺮ‬
failure of the normal renal regulatory mechanisms.
.‫ﺔ اﻟﻄﺒﻴﻌﻴﺔ‬ü‫اﻵﻟﻴﺎت اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟ'ﻠﻮ‬
1. The patient may appear critically ill and lethargic. ‫ﻴﺔ ﺣﺮﺟﺔ‬,ª ‫ ﺣﺎﻟﺔ‬a` ‫ﺾ‬ü‫ ﻗﺪ ﻳﺒﺪو اﳌﺮ‬.1
2. The skin and mucous membranes are dry from ‫ﺎﻃﻴﺔ ﻣﻦ‬æ½‫ﻠﺪ واﻷﻏﺸﻴﺔ ا‬ï+‫ ﺟﻔﺎف ا‬.2
dehydration.
3. drowsiness. ‫ واﻟﻨﻮ¬ﺎت‬، ‫ وار¿ﻌﺎش اﻟﻌﻀﻼت‬، ‫ اﻟﺼﺪاع‬.4
4. headache, muscle twitching, and seizures.
5. low urine output (oliguria).
PHASES OF ACUTE KIDNEY INJURY
:auARF ‫ﺴﻴﺔ ﻟـ‬ä‫* اﻟﻔﺌﺎت اﻟﺮﺋ‬
(>=‫ﻧﻘﺺ ا•ﺴﻴﺎب اﻟﻜ‬prerenal ( .1
٪ 60 a` ‫واﻟﺬي ﻳﺤﺪث‬ARF ، ‫ ﻣﺎ ﻗﺒﻞ‬، There are four phases of AKI: initiation, oliguria, diuresis,
‫ﻴﺠﺔ ﻟﻀﻌﻒ‬-‫ﻮ ﻧ‬0 ، ‫ﺎﻻت‬,+‫ ﻣﻦ ا‬٪ 70 >ë‫إ‬ and recovery. :‫ﺎد‬87‫ﻠﻮي ا‬4‫!ﻨﺎك أر(ﻊ ﻣﺮاﺣﻞ ﻣﻦ اﻟﻘﺼﻮر اﻟ‬
.GF‫ واﻟﺘﻌﺎ‬، ‫ إدراراﻟﺒﻮل‬، ‫ ﻗﻠﺔ اﻟﺒﻮل‬، ‫اﻟﺒﺪء‬
‫> ﻧﻘﺺ ﺗﺪﻓﻖ‬ë‫ﺗﺪﻓﻖ اﻟﺪم اﻟﺬي ﻳﺆدي إ‬
• The initiation period begins with the initial insult and ends ‫ ﻋﻨﺪﻣﺎ‬UT‫ﺘ‬S‫ة اﻟﺒﺪء ﺑﺎﻹ!ﺎﻧﺔ اﻷوﻟﻴﺔ وﺗ‬LK‫ﺗﺒﺪأ ﻓ‬
‫ ﻣﻌﺪل‬a` ‫ اﻟﻜ=> و اﻧﺨﻔﺎض‬a` ‫اﻟﺪم‬
when oliguria develops. .‫ﻳﺘﻄﻮر ﻗﻠﺔ اﻟﺒﻮل‬
.Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫اﻟ‬ ‫ ﺗﺮﻛ^_اﳌﺼﻞ‬GF ‫ﺔ ﺑﺰ\ﺎدة‬Z‫ﻮ‬8Y‫ة ﻗﻠﺔ اﻟﺒﻮل ﻣ‬LK‫ﻓ‬
‫ﺔ‬ﱕ‫ ﻷ‬a=‫ داﺧﻞ اﻟﻜ=> )اﻟﻀﺮر اﻟﻔﻌ‬.2 • The oliguria period is accompanied by an increase in the ، ‫ ﻋﺎدة )اﻟﻴﻮر\ﺎ‬gf‫ ﺗﻔﺮز!ﺎ اﻟﻜ‬Ub‫ﻟﻠﻤﻮاد اﻟ‬
‫ﻴﺠﺔ‬-‫ﻮ ﻧ‬0 >=‫داﺧﻞ اﻟﻜ‬ARF ، (>=‫اﻟﻜ‬ serum concentration of substances usually excreted by the ‫ !ﺬﻩ‬GF .(.......... ‫ ﺣﻤﺾ اﻟﺒﻮﻟﻴﻚ‬، ‫ﻨ^ن‬i‫اﻟﻜﺮ\ﺎﺗ‬
‫ﺐ‬ä‫ﺒﺎت أو اﻷﻧﺎﺑ‬ä‫ ﻟﻠﻜﺒ‬a=‫ اﻟﻔﻌ‬Z²‫ﻟﻠﺘﻠﻒ اﳌﺘ‬ kidneys (urea, creatinine, uric acid..........). In this phase, uremic ً
‫ أوﻻ وﺗﺘﻄﻮر‬Us\‫ﺮأﻋﺮاض اﻟﻴﻮر‬q‫ ﺗﻈ‬، ‫اﳌﺮﺣﻠﺔ‬
‫ﺎد‬,+‫ﻲ ا‬g‫ اﻟﻨﺨﺮاﻷﻧﺒﻮ‬.‫ﺔ‬ü‫اﻟ'ﻠﻮ‬ symptoms first appear and life-threatening conditions such as ‫ﻴﺎة ﻣﺜﻞ ﻓﺮط ﺑﻮﺗﺎﺳﻴﻮم‬87‫ﺪد ا‬xw Ub‫ﺎﻻت اﻟ‬87‫ا‬
‫ﺷﻴﻮًﻋﺎ ﻣﻦ‬sr‫ﻮ اﻟﻨﻮع اﻷﻛ‬0ATN) ) hyperkalemia develop. .‫اﻟﺪم‬
‫ إﺧﺮاج‬GF ‫ة إدراراﻟﺒﻮل ﺑﺰ\ﺎدة ﺗﺪر\ﺠﻴﺔ‬LK‫ﺗﺘﻤ^_ﻓ‬
.a=‫اﻟﺪاﺧ‬ARF • The diuresis period is marked by a gradual increase in urine
‫ ﻗﺪ ﺑﺪأ‬UÖ‫ﺷﻴﺢ اﻟﻜﺒﻴ‬LK‫ أن اﻟ‬gÇ‫إ‬L^‫ﺸ‬Ä ‫ ﻣﻤﺎ‬، ‫اﻟﺒﻮل‬
، (‫ ﻣﺎ ?ﻌﺪ اﻟﻜ=> )ا•ﺴﺪاد ﻟﺘﺪﻓﻖ اﻟﺒﻮل‬.3 output, which signals that glomerular filtration has started to
‫?ﻌﺪ اﻟﻜ=> ﻣﻦ‬ARF ‫ﺘﺞ‬¥‫وﻋﺎدة ﻣﺎ ﻳ‬ recover. .GF‫ اﻟﺘﻌﺎ‬GF
‫ وﻗﺪ‬gf‫ ﺗﺤﺴﻦ وﻇﺎﺋﻒ اﻟﻜ‬gÇ‫ إ‬GF‫ة اﻟﺘﻌﺎ‬LK‫ﻓ‬L^‫ﺸ‬Ü
‫ ﻳﺮﺗﻔﻊ‬.>=‫ﺰء اﻟﺒﻌﻴﺪ ﻣﻦ اﻟﻜ‬ï+‫ ا‬a` ‫ا•ﺴﺪاد‬ • The recovery period signals the improvement of renal ً.‫ﺮا‬q‫ ﺷ‬12 gÇ‫ إ‬3 ‫ﺴﺘﻐﺮق ﻣﻦ‬Ü
‫ اﻟ·]ﺎﻳﺔ‬a`‫ﺔ و‬ü‫ﺐ اﻟ'ﻠﻮ‬ä‫ اﻷﻧﺎﺑ‬a` ‫اﻟﻀﻐﻂ‬ function and may take 3 to 12 months.
Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫ﻳﻨﺨﻔﺾ ﻣﻌﺪل اﻟ‬
GFR).)
DIAGNOSIS
‫ﺗﻘﻴﻴﻢ‬ARF ‫ﺸﻤﻞ ﺗﻘﻴﻴﻢ اﳌﺮ\ﺾ اﳌﺼﺎب ﺑﺎﻟـ‬Ä
Ub‫ﻴﺼﻴﺔ اﻟ‬ñïî‫ واﻻﺧﺘﺒﺎرات اﻟ‬، ‫ اﻟﺒﻮل‬GF ‫ات‬L^‫اﻟﺘﻐ‬
Assessment of the patient with ARF includes ‫ وﻣﺠﻤﻮﻋﺔ ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﻘﻴﻢ‬، gf‫ﺗﻘﻴﻢ ﻣﺤﻴﻂ اﻟﻜ‬
GFR). ، ‫ﻨ^ن‬i‫ﻳﺔ )اﻟﻜﺮ\ﺎﺗ‬Lô‫ﺘ‬ñò‫ا‬
evaluation for changes in the urine, diagnostic tests / ‫ ﻣﺠﻢ‬1.0 ‫ أﻗﻞ ﻣﻦ‬Gö‫ﻨ^ن اﻟﻄﺒﻴ‬i‫( * اﻟﻜﺮ\ﺎﺗ‬
that evaluate the kidney contour, and a variety of .(LK‫ﺴﻴﻠ‬Ä‫د‬
.‫وﺧﺎﻣﻠﺔ‬ GF ‫اﻟﺘﺼﻮ\ﺮﺑﺎﳌﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﻴﺔ !ﻮ ﻋﻨﺼﺮﺣﺎﺳﻢ‬
laboratory values (creatinine, GFR). ُ
‫ﺮﻣﺨﻄﻂ‬q‫ ﻗﺪ ﻳﻈ‬.‫ﻠﻮي‬4‫† اﻟﻔﺸﻞ اﻟ‬üû‫ﺗﻘﻴﻴﻢ ﻣﺮ‬
.‫ﻔﺎف‬ï+‫ا‬
* (normal creatinine is less than 1.0 mg/dL).
Gö‫ﻠﻮ\ﺔ أو اﻟﺘﺼﻮ\ﺮاﳌﻘﻄ‬4‫اﳌﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﻴﺔ اﻟ‬
ً
gf‫ دﻟﻴﻼ ﻋ‬Uü•i‫ﻮﺳﺐ أو اﻟﺘﺼﻮ\ﺮﺑﺎﻟﺮﻧ^ن اﳌﻐﻨﺎﻃ‬8ò‫ا‬
.‫ اﻟﻨﻌﺎس‬.3
Ultrasonography is a critical component of the
.‫ﺸﺮ\ﺤﻴﺔ‬î‫ات اﻟ‬L^‫اﻟﺘﻐ‬
.‫اﳌﺮﺿﻴﺔ‬
.‫ ﻗﻠﺔ اﻟﺒﻮل‬.5 evaluation of patients with renal failure. A renal
sonogram or a CT or MRI scan may show evidence of
anatomic changes.

MEDICAL MANAGEMENT
Treatment is aimed at replacing renal function
temporarily to minimize potentially lethal complications
and reduce potential causes of increased renal injury
with the goal of minimizing long-term loss of renal
function.
Management includes eliminating the underlying cause;
maintaining fluid balance; avoiding fluid excesses; and,
when indicated, providing renal replacement therapy
ARF is a problem seen in hospitalized patients and
those in outpatient settings. A widely accepted criterion
for ARF is a 50% or greater increase in serum creatinine
above baseline. Urine volume may be normal, or
changes may occur. Possible changes include oliguria
(less than 500 mL/day), nonoliguria (greater than 800
mL/day), or anuria (less than 50 mL/day).
NURSING MANAGEMENT
1. Monitoring Fluid and Electrolyte Balance.
2. Reducing Metabolic Rate.
3. Promoting Pulmonary Function.
4. Preventing Infection.
5. Providing Skin Care.
6. Providing Psychosocial Support.
ً
‫ﺒﺪال وﻇﺎﺋﻒ اﻟﻜ=> ﻣﺆﻗﺘﺎ‬-‫> اﺳ‬ë‫]ﺪف اﻟﻌﻼج إ‬Ã
‫ﺘﻤﻠﺔ وﺗﻘﻠﻴﻞ‬,½‫ﻟﺘﻘﻠﻴﻞ اﳌﻀﺎﻋﻔﺎت اﳌﻤﻴﺘﺔ ا‬ MEDICAL MANAGEMENT
‫]ﺪف‬Å ‫ﺔ‬ü‫ﺎدة اﻹﺻﺎﺑﺔ اﻟ'ﻠﻮ‬ü‫ﺘﻤﻠﺔ ﻟﺰ‬,½‫اﻷﺳﺒﺎب ا‬
.‫ﻞ‬ü‫ﺗﻘﻠﻴﻞ ﻓﻘﺪان وﻇﺎﺋﻒ اﻟﻜ=> ﻋ=> اﳌﺪى اﻟﻄﻮ‬
‫ ؛‬ZáÆ‫ﺐ اﻷﺳﺎ‬A‫¿ﺸﻤﻞ اﻹدارة اﻟﻘﻀﺎء ﻋ=> اﻟﺴ‬
1. Adequate renal blood flow in patients with a` a`‫ ﻳﻤﻜﻦ اﺳﺘﻌﺎدة ﺗﺪﻓﻖ اﻟﺪم اﻟ'ﻠﻮي اﻟ'ﺎ‬.1
‫ﻔﺎظ ﻋ=> ﺗﻮازن اﻟﺴﻮ اﺋﻞ ﺗﺠﻨﺐ ﻓﺎﺋﺾ‬,+‫ا‬ ‫ﺴﺎﺳﻴﺔ‬,Õ‫ﻌﺎﻧﻮن ﻣﻦ أﺳﺒﺎب ﺳﺎﺑﻘﺔ ﻟ‬à ‫ اﻟﺬﻳﻦ‬àáÜ‫اﳌﺮ‬
‫اﻟﻌﻼج‬s§‫ ﻳﺘﻢ ﺗﻮﻓ‬، ‫ﺎﺟﺔ‬,+‫ وﻋﻨﺪ ا‬.‫اﻟﺴﻮ اﺋﻞ‬ prerenal causes of ARF may be restored by IV fluids
‫ﺪﻳﺔ أو ﻋﻤﻠﻴﺎت ﻧﻘﻞ‬ü‫ﻖ اﻟﺴﻮ اﺋﻞ اﻟﻮر‬ü‫ﺎدة ﻋﻦ ﻃﺮ‬,+‫ا‬
‫ﺔ‬ü‫ﺑﺎﻟﺒﺪاﺋﻞ اﻟ'ﻠﻮ‬ or transfusions of blood products. .‫ﻣﻨﺘﺠﺎت اﻟﺪم‬
a` àáÜ‫ اﳌﺮ‬a`‫ﺮ‬m‫ ﻣﺸ'ﻠﺔ ﺗﻈ‬auARF .‫ اﻟﻌﻮاﻣﻞ اﻟﺪو اﺋﻴﺔ‬.2
‫ اﳌﻌﻴﺎر‬.‫ﺎرﺟﻴﺔ‬æ+‫ اﻟﻌﻴﺎدات ا‬a` ‫ﺸﻔﻴﺎت وأوﻟﺌﻚ‬-‫اﳌﺴ‬ 2. Pharmacological agents. .>=‫ ﻏﺴﻴﻞ اﻟﻜ‬.3
‫ﺴﺒﺔ‬¥‫ﺎدة ﺑ‬ü‫ﻮ ز‬0ARF ‫اﳌﻘﺒﻮل ﻋ=> ﻧﻄﺎق واﺳﻊ ﻟـ‬ .‫ﻳﺘﻮ•ﻲ‬s ‫ ﻏﺴﻴﻞ اﻟﻜ=> اﻟ‬.4
‫ اﻟﺪم ﻓﻮق ﺧﻂ‬a` ‫ﻨ§ن‬ä‫ﺎﺗ‬ü‫ اﻟﻜﺮ‬a`s ‫ أو أﻛ‬٪50 3. Haemodialysis.
‫ﺒﺪال اﻟ'ﻠﻮي اﳌﺴﺘﻤﺮة‬-‫ ﻋﻼﺟﺎت اﻻﺳ‬.5
‫ أو ﻗﺪ‬، ‫ﻢ اﻟﺒﻮل ﻃﺒﻴﻌًﻴﺎ‬ïî ‫ ﻗﺪ ﻳﻜﻮن‬.‫اﻷﺳﺎس‬
‫ﺘﻤﻠﺔ ﻗﻠﺔ‬,½‫ات ا‬s§‫ ¿ﺸﻤﻞ اﻟﺘﻐﻴ‬.‫ات‬s§‫ﺗﺤﺪث ¿ﻐﻴ‬ 4. peritoneal dialysis. CRRTs).)
‫ أو ﻋﺪم ﻗﻠﺔ اﻟﺒﻮل‬، (‫ ﻳﻮم‬/ ‫ ﻣﻞ‬500 ‫اﻟﺒﻮل )أﻗﻞ ﻣﻦ‬
‫ أو اﻧﻘﻄﺎع اﻟﺒﻮل )أﻗﻞ‬، (‫ ﻳﻮم‬/ ‫ ﻣﻞ‬800 ‫ﻣﻦ‬s ‫)أﻛ‬
5. continuous renal replacement therapies (CRRTs).
.(‫ ﻳﻮم‬/ ‫ ﻣﻞ‬50 ‫ﻣﻦ‬
NURSING DIAGNOSIS
.‫ﺎرل‬m‫ﻣﺮ اﻗﺒﺔ ﺗﻮازن اﻟﺴﻮ اﺋﻞ واﻟﻜ‬ 1. Excess Fluid Volume.
.‫ﺧﻔﺾ ﻣﻌﺪل اﻷﻳﺾ‬
2. Risk for Decreased Cardiac Output.
.‫ﺰوﻇﻴﻔﺔ اﻟﺮﺋﺔ‬ü‫¿ﻌﺰ‬
.‫ﻢ اﻟﺴﻮ اﺋﻞ اﻟﺰ اﺋﺪة‬ïî .1
.‫ﻣﻨﻊ اﻟﻌﺪوى‬ 3. Risk for Imbalanced Nutrition: Less Than Body Requirements.
.‫ﺸﺮة‬A‫اﻟﻌﻨﺎﻳﺔ ﺑﺎﻟ‬s§‫ﺗﻮﻓ‬
4. Risk for Infection.
.‫ اﳌﻨﺨﻔﺾ‬Zú‫ ﺧﻄﺮاﻟﻨﺘﺎج اﻟﻘﻠ‬.2
.aœ‫ واﻻﺟﺘﻤﺎ‬ZáŒ‫ﺗﻘﺪﻳﻢ اﻟﺪﻋﻢ اﻟﻨﻔ‬ .‫ﺴﻢ‬ï+‫ أﻗﻞ ﻣﻦ ﻣﺘﻄﻠﺒﺎت ا‬:‫اﳌﺘﻮازﻧﺔ‬s§‫ ﻣﺨﺎﻃﺮاﻟﺘﻐﺬﻳﺔ ﻏ‬.3
5. Risk for Deficient Fluid Volume. .‫ ﺧﻄﺮاﻟﻌﺪوى‬.4
.‫ﻢ اﻟﺴﻮ اﺋﻞ‬ïî ‫ ﺧﻄﺮﻧﻘﺺ‬.5
6. Deficient Knowledge. .‫ ﻧﻘﺺ اﳌﻌﺮﻓﺔ‬.6
 COMPLICATIONS

1. Excessive fluid volume.

2. chest pain.
CHRONIC RENAL FAILURE
3. Chronic renal failure.
.‫ﻢ اﻟﺴﻮ اﺋﻞ اﳌﻔﺮط‬ïî PAGE FROM 4136 TO 4139
4. Muscle weakness due to electrolytes imbalances. .‫أﻟﻢ ﺻﺪر‬
.‫اﻟﻔﺸﻞ اﻟ'ﻠﻮي اﳌﺰﻣﻦ‬
5. Death. .‫وﻟﻴﺘﺎت‬sØ‫ﺐ اﺧﺘﻼل ﺗﻮازن اﻻﻟﻜ‬A‫ﺿﻌﻒ اﻟﻌﻀﻼت ?ﺴ‬
.‫ﻣﻮت‬

RISK FACTORS INCLUDE

CHRONIC RENAL FAILURE

• Chronic kidney disease is an umbrella term that describes

‫— ﺷﺎﻣﻞ ﻳﺼﻒ ﺗﻠﻒ‬Õ‫ﻮ ﻣﺼﻄ‬0 ‫ﻣﺮض اﻟﻜ=> اﳌﺰﻣﻦ‬
kidney damage or a decrease in the glomerular filtration
GFR) ) Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫اﻟﻜ=> أو اﻧﺨﻔﺎض ﻣﻌﺪل اﻟ‬
rate (GFR) lasting for 3 or more months. .sr‫ﺮأو أﻛ‬m‫ أﺷ‬3 ‫ﺴﺘﻤﺮﳌﺪة‬Ã ‫اﻟﺬي‬
• cardiovascular disease,
>=‫> ﻣﺮض اﻟﻜ‬ë‫“ إ‬+‫اﳌﻌﺎ‬s§‫ﻏ‬CKD ‫ﻳﻤﻜﻦ أن ﻳﺆدي‬ ، ‫ﺔ‬ü‫أﻣﺮاض اﻟﻘﻠﺐ واﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬
• Untreated CKD can result in end stage kidney disease • Diabetes. .‫داء اﻟﺴﻜﺮي‬
‫ة‬s§‫ اﳌﺮﺣﻠﺔ اﻷﺧ‬au‫و‬ESKD) ، ) ‫ اﳌﺮﺣﻠﺔ اﻟ·]ﺎﺋﻴﺔ‬a`
(ESKD), which is the final stage of CKD ESKD results in ‫ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم‬
‫> اﻻﺣﺘﻔﺎظ‬ë‫ﻣﻤﺎ ﻳﺆدي إ‬CKD ESKD ‫ﻣﻦ‬ • hypertension
retention of uremic waste products and the need for renal ‫ﺒﺪال‬-‫> ﻋﻼﺟﺎت اﺳ‬ë‫ﺎﺟﺔ إ‬,+‫ﺑﻤﺨﻠﻔﺎت اﻟﺒﻮل وا‬ .‫ﺑﺪاﻧﺔ‬
replacement therapies, dialysis, or kidney transplantation. .>=‫اﻟﻜ=> أو ﻏﺴﻴﻞ اﻟﻜ=> أو زرع اﻟﻜ‬
ً ‫ﻌﺮف أﻳ‬Ãُ
• obesity.
‫ﻮ‬0‫ و‬، ‫ ‘]ﺎﻳﺔ اﳌﺮﺣﻠﺔ‬a` >=‫ﻀﺎ ﺑﺎﺳﻢ ﻣﺮض اﻟﻜ‬
• Also known as end-stage renal disease, its irreversible loss ÷§‫ﻓﻘﺪان وﻇﺎﺋﻒ اﻟﻜ=> اﻟﺬي ﻻ رﺟﻌﺔ ﻓﻴﮫ واﻟﺬي ﻳﺘﻤ‬
of kidney function characterized by low urine output, ‫ﻢ اﻟﺴﻮ اﺋﻞ واﺧﺘﻼل‬ïî ‫ﺎدة‬ü‫ﺑﻘﻠﺔ إﻧﺘﺎج اﻟﺒﻮل وز‬
excessive fluid volume and electrolytes imbalances affecting ‫ ﺗﺆﺛﺮﻋ=> وﻇﺎﺋﻒ اﻟﻘﻠﺐ واﻟﺘﻤﺜﻴﻞ‬ZY‫ﺎرل اﻟ‬m‫ﺗﻮازن اﻟﻜ‬
heart function and metabolism. .‫ﻲ‬£‫اﻟﻐﺬا‬
 Causes:
cause of ESRD (End stage renal disease )include
systemic diseases, such as :
- diabetes mellitus .
- hypertension.
- chronic glomerulonephritis.
- pyelonephritis .
- obstruction of the urinary tract.
- hereditary lesions, as in polycystic kidney disease.
- vascular disorders.
- infections.
- medications; or toxic agents.(Environmental and
occupational agents that have been implicated in
chronic renal failure.
- congenital disorder
SIGNS AND SYMPTOMS
3. Pulmonary: ( Crackles• Thick, tenacious sputum•
Depressed cough reflex• Pleuritic pain• Shortness of
breath• Tachypnea• Kussmaul-type respirations
Uremic pneumonitis).
4. Gastrointestinal: (• Ammonia odor to breath
(“uremic fetor”) • Metallic taste• Mouth ulcerations
and bleeding• Anorexia, nausea, and vomiting •
Hiccups• Constipation or diarrhea• Bleeding from
gastrointestinal tract )
SIGNS AND SYMPTOMS
:‫اﻷﺳﺒﺎب‬
a` ‫ة )اﻟﺪاء اﻟ'ﻠﻮي‬s§‫ﺐ اﻟﺪاء اﻟ'ﻠﻮي ﺑﻤﺮاﺣﻠﮫ اﻷﺧ‬A‫ﺸﻤﻞ ﺳ‬Ã 1. Neurologic: (Weakness and fatigue • Confusion
:‫ ﻣﺜﻞ‬، ‫ﺔ‬ü‫ﺎز‬mï+‫اﳌﺮﺣﻠﺔ اﻟ·]ﺎﺋﻴﺔ( اﻷﻣﺮاض ا‬
. ‫اﻟﺴﻜﺮى‬ • Inability to concentrate • Disorientation • Tremors•
.‫ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم‬ Seizures• Asterixis
.‫ﺒﺎت اﻟﻜ=> اﳌﺰﻣﻦ‬ä‫]ﺎب ﻛﺒ‬ÿ‫اﻟ‬
.‫ﻀﺔ واﻟ'ﻠﻴﺔ‬ü‫ﻮ‬,+‫]ﺎب ا‬ÿ‫اﻟ‬
• Restlessness of legs• Burning of soles of feet • Behaviour
.‫ا•ﺴﺪاد اﳌﺴﺎﻟﻚ اﻟﺒﻮﻟﻴﺔ‬ changes).
‫ ﻣﺮض اﻟﻜ=> اﳌﺘﻌﺪد‬a` ‫ﺎل‬,+‫ﻮ ا‬0 ‫ ﻛﻤﺎ‬، ‫آﻓﺎت ور اﺛﻴﺔ‬
.‫ﺴﺎت‬ä‫اﻟﻜ‬ 2. Integumentary: (Grey-bronze skin colour • Dry, flaky skin
.‫ﺔ‬ü‫اﺿﻄﺮ اﺑﺎت اﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬ • Pruritus• Ecchymosis • Purpura• Thin, brittle nails•
.‫]ﺎﺑﺎت‬ÿ‫اﻻﻟ‬
‫ﻨﻴﺔ‬m‫ﻴﺔ واﳌ‬⁄‫ أو اﻟﻌﻮاﻣﻞ اﻟﺴﺎﻣﺔ )اﻟﻌﻮاﻣﻞ اﻟﺒﻴ‬.‫ﺔ‬ü‫اﻷدو‬
.‫ اﻟﻔﺸﻞ اﻟ'ﻠﻮي اﳌﺰﻣﻦ‬a` ‫اﳌﺘﻮرﻃﺔ‬
‫ﻋﻴﺐ ﺧﻠﻘﻲ‬ ‫ﺰات • اﻟﻨﻮ¬ﺎت • اﻟﻨﺘﻮءات • ﺗﻤﻠﻤﻞ‬m‫ﻛ§÷• اﻻرﺗﺒﺎك • اﻟ‬sØ‫ )اﻟﻀﻌﻒ واﻟﺘﻌﺐ • اﻻرﺗﺒﺎك • ﻋﺪم اﻟﻘﺪرة ﻋ=> اﻟ‬:‫ﻴﺔ‬A‫اﻟﻌﺼ‬
.(‫ اﻟﺴﻠﻮك‬a` ‫ات‬s§‫اﻟﺴﺎﻗ§ن • ﺣﺮق ﺑﺎﻃﻦ اﻟﻘﺪﻣ§ن • ¿ﻐ‬
• ‫ﺸﺔ‬0‫ﺔ • أﻇﺎﻓﺮرﻗﻴﻘﺔ و‬ü‫ ﺑﺮوﻧﺰي • ﺟﻠﺪ ﺟﺎف ﻣﺘﻘﺸﺮ• ﺣﻜﺔ • ﻛﺪﻣﺎت • ﻓﺮﻓﺮ‬- ‫ﺸﺮة رﻣﺎدي‬A‫ )ﻟﻮن اﻟ‬:a`‫ﻏﻼف ﻏﻼ‬
SIGNS AND SYMPTOMS
5. Hematologic: ( Anemia• Thrombocytopenia). ‫ )ﻓﻘﺮاﻟﺪم • ﻗﻠﺔ اﻟﺼﻔﻴﺤﺎت‬:‫ أﻣﺮاض اﻟﺪم‬.5
• ‫ﺸﺔ • اﻟﺒﻠﻐﻢ اﻟﻜﺜﻴﻒ اﳌﺘﺼﻠﺐ‬æ›æ+‫ )ا‬:‫ اﻟﺮﺋﺔ‬.3 6. Reproductive: (Amenorrhea• Testicular atrophy .(‫ﺔ‬ü‫اﻟﺪﻣﻮ‬
• ‫ﻨﺒﺔ‬ï+‫]ﺎب ا‬ÿ‫ﻲ • أﻟﻢ اﻟ‬g‫ﻣﻨﻌﻜﺲ اﻟﺴﻌﺎل اﻻﻛﺘﺌﺎ‬ • Infertility• Decreased libido). • ‫ﺼﻴﺔ‬æ+‫ )اﻧﻘﻄﺎع اﻟﻄﻤﺚ • ﺿﻤﻮر ا‬:‫ اﻹﻧﺠﺎب‬.6
‫ﺿﻴﻖ اﻟﺘﻨﻔﺲ • ¿ﺴﺮع اﻟﺘﻨﻔﺲ • اﻟﺘﻨﻔﺲ ﻣﻦ ﻧﻮع‬ .(‫ﺴﻴﺔ‬¥ï+‫اﻟﻌﻘﻢ • اﻧﺨﻔﺎض اﻟﺮﻏﺒﺔ ا‬
.(aë‫]ﺎب رﺋﻮي ﺑﻮ‬ÿ‫ﻛﻮﺳﻤﺎول اﻟ‬
7. Musculoskeletal : (Muscle cramps• Loss of • ‫ )ﺗﻘﻠﺼﺎت اﻟﻌﻀﻼت‬:a=‫ﻴﻜ‬m‫ اﻟ‬a=‫ﺎزاﻟﻌﻀ‬mï+‫ ا‬.7
‫ )• راﺋﺤﺔ اﻷﻣﻮﻧﻴﺎ ﻟﻠﺘﻨﻔﺲ‬:Zfi‫ﻀ‬m‫ﺎزاﻟ‬mï+‫ ا‬.4 muscle strength • Renal osteodystrophy, Bone pain, ‫ آﻻم‬، ‫ اﻟ'ﻠﻮي‬Zfi‫ﺜﻞ اﻟﻌﻈ‬,+‫ﻓﻘﺪان اﻟﻘﻮة اﻟﻌﻀﻠﻴﺔ • ا‬
‫"( • اﻟﻄﻌﻢ اﳌﻌﺪ•ﻲ • ﺗﻘﺮﺣﺎت اﻟﻔﻢ‬aë‫)"اﻟﻨﺘﻮء اﻟﺒﻮ‬ Bone fractures ,Foot drop). .(‫ﺒﻮط اﻟﻘﺪم‬0 ، ‫ ﻛﺴﻮر اﻟﻌﻈﺎم‬، ‫اﻟﻌﻈﺎم‬
• ‫ﻴﺔ واﻟﻐﺜﻴﺎن واﻟﻘﻲء‬m‫واﻟ‡÷ﻳﻒ • ﻓﻘﺪان اﻟﺸ‬ 8. Cardiovascular: ( • Hypertension• Pitting
• ‫ )• ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم‬:‫ﺔ‬ü‫ اﻟﻘﻠﺐ واﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬.8
‫ﺰ( • اﻟﻮذﻣﺔ‬ï‚‫اﻟﻮذﻣﺔ اﳌﺆﳌﺔ )اﻟﻘﺪﻣ§ن واﻟﻴﺪﻳﻦ واﻟ‬
‫ﺎز‬mï+‫ﻒ ﻣﻦ ا‬ü‫ﺎل • ﻧﺰ‬m‫اﻟﻔﻮاق • اﻹﻣﺴﺎك أو اﻹﺳ‬ edema (feet, hands, sacrum) • Periorbital edema• ‫ﺎج • اﺣﺘ'ﺎك اﺣﺘ'ﺎك اﻟﺘﺎﻣﻮر • اﺣﺘﻘﺎن‬ï„+‫ﺣﻮل ا‬
(Zfi‫ﻀ‬m‫اﻟ‬
Pericardial friction rub• Engorged neck veins• • ‫]ﺎب اﻟﺘﺎﻣﻮر • اﻻﻧﺼﺒﺎب اﻟﺘﺄﻣﻮري‬ÿ‫أوردة اﻟﺮﻗﺒﺔ • اﻟ‬
Pericarditis• Pericardial effusion• Pericardial ‫اﻟﺴﺪاد اﻟﺘﺎﻣﻮر • ﻓﺮط ﺑﻮﺗﺎﺳﻴﻮم اﻟﺪم • ﻓﺮط‬
tamponade• Hyperkalemia• Hyperlipidemia). .(‫ﻤﻴﺎت اﻟﺪم‬,‰
 STAGES OF CHRONIC KIDNEY DISEASE
STAGES OF CHRONIC KIDNEY DISEASE
• Stages are based on the glomerular filtration
rate (GFR). The normal GFR is 125 mL/min Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫¿ﻌﺘﻤﺪ اﳌﺮاﺣﻞ ﻋ=> ﻣﻌﺪل اﻟ‬
-Stage 1 ‫ﻮ‬0 aÂ‫ اﻟﻄﺒﻴ‬Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫ﻣﻌﺪل اﻟ‬GFR). ) • -Stage4
GFR ≥ 90 mL/min ‫ دﻗﻴﻘﺔ‬/ ‫ ﻣﻞ‬125
Kidney damage with normal or increased GFR >=‫ دﻗﻴﻘﺔ ﺗﻠﻒ اﻟﻜ‬/ ‫ﻣﻞ‬GFR ≥ 90 1 ‫اﳌﺮﺣﻠﺔ‬ GFR = 15–29 mL/min ‫ دﻗﻴﻘﺔ‬/ ‫ﻣﻞ‬GFR = 15-29 4 ‫اﳌﺮﺣﻠﺔ‬ -
Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫ ﻣﻌﺪل اﻟ‬a` ‫اﻧﺨﻔﺎض ﺣﺎد‬
-Stage 2 ‫÷ اﻳﺪ‬Ø‫ أو اﳌ‬aÂ‫ اﻟﻄﺒﻴ‬Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫ﻣﻊ ﻣﻌﺪل اﻟ‬ Severe decrease in GFR ‫ دﻗﻴﻘﺔ‬/ ‫ﻣﻞ‬GFR <15 5 ‫ اﳌﺮﺣﻠﺔ‬- -
‫ دﻗﻴﻘﺔ‬/ ‫ﻣﻞ‬GFR = 60-89 2 ‫اﳌﺮﺣﻠﺔ‬
GFR = 60–89 mL/min GFR a` ‫اﻧﺨﻔﺎض ﻃﻔﻴﻒ‬
-Stage 5 ‫اﻟﻔﺸﻞ اﻟ'ﻠﻮي‬
Mild decrease in GFR ‫ دﻗﻴﻘﺔ‬/ ‫ﻣﻞ‬GFR = 30-59 3 ‫اﳌﺮﺣﻠﺔ‬ GFR <15 mL/min
-Stage 3 Zú‫ﺷﻴﺢ اﻟﻜﺒﻴ‬sØ‫ ﻣﻌﺪل اﻟ‬a` ‫اﻧﺨﻔﺎض ﻣﻌﺘﺪل‬ Kidney failure
GFR = 30–59 mL/min
Moderate decrease in GFR

Diagnoses: MEDICAL MANAGEMENT

-Urine analysis proteinuria may be present. 1. Treatment Options:

- RFT (blood urea ,creatinine,). 1-Monitoring & Predialysis

- Electrolyte (Na ,K, ca)
- CBC.
- Ultrasonography .
- A renal sonogram or a CT
:‫ ﺧﻴﺎرات اﻟﻌﻼج‬.1
• Control symptoms
‫اﳌﺮ اﻗﺒﺔ واﻟﻐﺴﻴﻞ اﳌﺴﺒﻖ‬-1
• Preserve Residual Renal Function ‫أﻋﺮاض اﻟﺴﻴﻄﺮة‬
:‫ﻴﺼﺎت‬æ›-‫اﻟ‬ • Control rising BP (Antihypertensive)
‫ﻔﺎظ ﻋ=> وﻇﻴﻔﺔ اﻟﻜ=> اﳌﺘﺒﻘﻴﺔ‬,+‫ا‬
ً (‫اﻟﺴﻴﻄﺮة ﻋ=> ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم )ﺧﺎﻓﺾ ﻟﻠﻀﻐﻂ‬
.‫ ﻗﺪ ﻳﻜﻮن ﻣﻮﺟﻮدا‬Z²‫وﺗﻴ‬s ‫ ﺗﺤﻠﻴﻞ اﻟﺒﻮل اﻟ‬-
.(، ‫ﻨ§ن‬ä‫ﺎﺗ‬ü‫ اﻟﻜﺮ‬، ‫ﺎ اﻟﺪم‬ü‫ﻳﻮر‬RFT (
• Control Renal Bone Disease (Ca2+,Vit D) (‫ ﻓﻴﺘﺎﻣ§ن د‬، + 2 ‫ﺎ‬Å) ‫ﺔ‬ü‫اﻟﺴﻴﻄﺮة ﻋ=> أﻣﺮاض اﻟﻌﻈﺎم اﻟ'ﻠﻮ‬
• Prevent/Treat Anaemia (Erythropoietin, Blood) (‫ اﻟﺪم‬، ‫ﺘ§ن‬ü‫ ﻋﻼج ﻓﻘﺮاﻟﺪم )إرﺛﺮو¬ﻮ‬/ ‫ﻣﻨﻊ‬
or MRI scan (‫ﺎﻟﻴﻔﻮرﻧﻴﺎ‬Å ، ‫ ك‬، ‫ﺮ¬ﺎء )ﻧﺎ‬m‫اﳌﻨﺤﻞ ﺑﺎﻟﻜ‬
.(‫ﺘ§ن‬ü‫و¬ﻮ‬srü‫اﻟﻌﻮاﻣﻞ اﻟﺪو اﺋﻴﺔ )إر‬
.ZáÆ ‫ﻲ‬g ZáÆ Pharmacological agents (Erythropoietin). >=‫ ﻏﺴﻴﻞ اﻟﻜ‬.2
.‫ﺮﺑﺎﳌﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﻴﺔ‬ü‫اﻟﺘﺼﻮ‬
‫ﺮﺑﺎﻟﺮﻧ§ن‬ü‫ﻮﺳﺐ أو اﻟﺘﺼﻮ‬,½‫ ا‬aÂ‫ﺮاﳌﻘﻄ‬ü‫ﺮﺑﺎﳌﻮﺟﺎت اﻟﺼﻮﺗﻴﺔ ﻟﻠ'ﻠﻴﺔ أو اﻟﺘﺼﻮ‬ü‫ﺗﺼﻮ‬ 2. Dialysis .>=‫ﻏﺴﻴﻞ اﻟﻜ‬
.‫ﻳﺘﻮ•ﻲ‬s ‫ﻏﺴﻴﻞ اﻟﻜ=> اﻟ‬
ZáŒä‫اﳌﻐﻨﺎﻃ‬ • Haemodialysis. .(‫ ﺗﻨﺎول اﻟﺴﻮ اﺋﻞ‬، ‫وﺗ§ن‬s ‫ﻲ )اﻟﺘﻨﻈﻴﻢ اﻟﺪﻗﻴﻖ ﻟﺘﻨﺎول اﻟ‬£‫ اﻟﻌﻼج اﻟﻐﺬا‬.4
• peritoneal dialysis. .>=‫ زراﻋﺔ اﻟﻜ‬.5
4. Nutritional therapy (careful regulation of protein intake, fluid intake).
5. Renal transplant.
Nursing Management: Nursing diagnose:
Teaching Patients Self-Care; 1-Excess fluid volume related to decreased urine output, dietary
The nurse plays an important role in teaching the patient excesses, and retention of sodium and water.

with ESRD. Goal: Maintenance of ideal body weight without excess fluid.

-explanations of nutritional needs and dietary restrictions Interventions :Assess fluid status: :‫ﺾ‬ü‫ﻴﺺ اﻟﺘﻤﺮ‬替
:‫ﺾ‬ü‫إدارة اﻟﺘﻤﺮ‬
• Daily weight ، ‫ واﻟﺘﻐﺬﻳﺔ اﻟﺰ اﺋﺪة‬، ‫ﻢ اﻟﺴﻮ اﺋﻞ اﳌﺮﺗﺒﻂ ﺑﺎﻧﺨﻔﺎض إﻧﺘﺎج اﻟﺒﻮل‬ïî ‫ﺎدة‬ü‫ز‬-1
including fluid, sodium, potassium, and protein restriction. ‫ﺾ اﻟﺮﻋﺎﻳﺔ اﻟﺬاﺗﻴﺔ ؛‬ü‫¿ﻌﻠﻴﻢ اﳌﺮ‬
.‫واﺣﺘﺒﺎس اﻟﺼﻮدﻳﻮم واﳌﺎء‬
- patient and family need to know what problems to report to ‫ﺾ‬ü‫ ¿ﻌﻠﻴﻢ اﳌﺮ‬a` ‫ًﻤﺎ‬m‫ﺗﻠﻌﺐ اﳌﻤﺮﺿﺔ دوًرا ﻣ‬ • Intake and output balance .‫ﺎدة اﻟﺴﻮ اﺋﻞ‬ü‫ دون ز‬aë‫ﺴﻢ اﳌﺜﺎ‬ï+‫ﻔﺎظ ﻋ=> وزن ا‬,+‫ ا‬:‫ﺪف‬m‫اﻟ‬
the health care provider. ( include the following: Worsening .‫ة‬s§‫ﻣﻊ اﻟﺪاء اﻟ'ﻠﻮي ﺑﻤﺮاﺣﻠﮫ اﻷﺧ‬ • Skin turgor and presence of edema :‫ ﺗﻘﻴﻴﻢ ﺣﺎﻟﺔ اﻟﺴﻮ اﺋﻞ‬:‫اﻟﺘﺪﺧﻼت‬
‫ات ﻟﻼﺣﺘﻴﺎﺟﺎت اﻟﻐﺬاﺋﻴﺔ واﻟﻘﻴﻮد اﻟﻐﺬاﺋﻴﺔ‬s§‫ ﺗﻔﺴ‬- ‫اﻟﻮزن اﻟﻴﻮﻣﻲ‬
sign change in usual urine output Signs and symptoms .‫ﻨﺎت‬ä‫وﺗ‬s ‫ ذﻟﻚ اﻟﺴﻮ اﺋﻞ واﻟﺼﻮدﻳﻮم واﻟﺒﻮﺗﺎﺳﻴﻮم واﻟ‬a` ‫ﺑﻤﺎ‬ • Distention of neck veins
‫ﺮج‬æ½‫اﻟﺘﻮازن اﳌﺪﺧﻮل وا‬
of hyperkalemia , Signs and symptoms of access problems . ‫ ﻳﺠﺐ إﺑﻼغ ﻣﻘﺪم اﻟﺮﻋﺎﻳﺔ‬ZY‫> ﻣﻌﺮﻓﺔ اﳌﺸﻜﻼت اﻟ‬ë‫ﺾ وﻋﺎﺋﻠﺘﮫ إ‬ü‫ ﻳﺤﺘﺎج اﳌﺮ‬- • Blood pressure, pulse rate, and rhythm ‫ﻠﺪ ووﺟﻮد وذﻣﺔ‬ï+‫ﺗﻮرم ا‬
‫ ﺗﻔﺎﻗﻢ‬:a=‫ )¿ﺸﻤﻞ ﻣﺎ ﻳ‬.‫]ﺎ‬Å ‫ﻴﺔ‬,¶‫اﻟ‬ ‫اﻧﺘﻔﺎخ أوردة اﻟﻌﻨﻖ‬
-assess the patient's environment, emotional status, and the • Respiratory rate and effort
‫ إﺧﺮاج اﻟﺒﻮل اﳌﻌﺘﺎد اﻟﻌﻼﻣﺎت واﻷﻋﺮاض‬a`s§‫ﻋﻼﻣﺔ اﻟﺘﻐﻴ‬ ‫ﺿﻐﻂ اﻟﺪم وﻣﻌﺪل اﻟﻨﺒﺾ واﻹﻳﻘﺎع‬
coping strategies used by the patient and family to deal .‫ﻞ اﻟﻮﺻﻮل‬Å‫ وﻋﻼﻣﺎت وأﻋﺮاض ﻣﺸﺎ‬، ‫ﻓﺮط ﺑﻮﺗﺎﺳﻴﻮم اﻟﺪم‬ -Explain to patient and family rationale for fluid restriction. ‫ﺪ‬mï+‫ﻣﻌﺪل اﻟﺘﻨﻔﺲ وا‬
with the changes associated with chronic illness. ‫ﺾ وﺣﺎﻟﺘﮫ اﻟﻌﺎﻃﻔﻴﺔ و‬ü‫ﺌﺔ اﳌﺮ‬ä‫ ﺗﻘﻴﻴﻢ ﺑ‬-
-Assist patient to cope with the discomforts resulting from fluid .‫ﺾ واﻷﺳﺮة اﻷﺳﺎس اﳌﻨﻄﻘﻲ ﻟﺘﻘﻴﻴﺪ اﻟﺴﻮ اﺋﻞ‬ü‫ اﺷﺮح ﻟﻠﻤﺮ‬-
‫ﺾ وﻋﺎﺋﻠﺘﮫ ﻟﻠﺘﻌﺎﻣﻞ‬ü‫ﺎ اﳌﺮ‬m‫ﺴﺘﺨﺪﻣ‬Ã ZY‫ﺔ اﻟ‬m‫ اﺗﻴﺠﻴﺎت اﳌﻮاﺟ‬sØ‫اﺳ‬
restriction. .‫ﺾ ﻋ=> اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﳌﻀﺎﻳﻘﺎت اﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺗﻘﻴﻴﺪ اﻟﺴﻮ اﺋﻞ‬ü‫ ﻣﺴﺎﻋﺪة اﳌﺮ‬-
.‫ات اﳌﺼﺎﺣﺒﺔ ﻟﻸﻣﺮاض اﳌﺰﻣﻨﺔ‬s§‫ﻣﻊ اﻟﺘﻐ‬ .‫ﻊ ﻋ=> ﻧﻈﺎﻓﺔ اﻟﻔﻢ ?ﺸ'ﻞ ﻣﺘﻜﺮر‬ï›Ã ‫ ﻳﻮﻓﺮأو‬-
-Provide or encourage frequent oral hygiene.

2-Imbalanced nutrition; less than body requirements related to ‫ﺴﻢ‬ï+‫ أﻗﻞ ﻣﻦ ﻣﺘﻄﻠﺒﺎت ا‬.‫اﳌﺘﻮازﻧﺔ‬s§‫اﻟﺘﻐﺬﻳﺔ ﻏ‬-2
anorexia, nausea, vomiting, dietary restrictions, and altered oral ‫ﻴﺔ واﻟﻐﺜﻴﺎن واﻟﻘﻲء واﻟﻘﻴﻮد‬m‫اﳌﺘﻌﻠﻘﺔ ﺑﻔﻘﺪان اﻟﺸ‬
mucous membranes. .‫ﺎﻃﻴﺔ ﻟﻠﻔﻢ‬æ½‫اﻷﻏﺸﻴﺔ ا‬s§‫اﻟﻐﺬاﺋﻴﺔ و¿ﻐﻴ‬
‫ﺎﻓﻈﺔ ﻋ=> اﻟﺘﻐﺬﻳﺔ اﻟ'ﺎﻓﻴﺔ‬,½‫ ا‬:‫ﺪف‬m‫اﻟ‬
Goal: Maintenance of adequate nutritional
.‫اﳌﺪﺧﻮل‬
Intake. :‫ﺔ‬ü‫ﺎﻟﺔ اﻟﺘﻐﺬو‬,+‫اﻟﺘﺪﺧﻼت ﺗﻘﻴﻴﻢ ا‬
Interventions Assess nutritional status: ‫ات اﻟﻮزن‬s§‫¿ﻐ‬ RENAL REPLACEMENT THERAPIES
BUN ، ، ‫وﻟﻴﺖ اﳌﺼﻞ‬sØ‫اﻟﻘﻴﻢ اﳌﻌﻤﻠﻴﺔ )إﻟﻜ‬
• Weight changes ‫ﺎت‬ü‫ وﻣﺴﺘﻮ‬، ‫ﻳﻦ‬s§‫ ا•ﺴﻔ‬sØ‫ اﻟ‬، ‫وﺗ§ن‬s ‫ اﻟ‬، ‫ﻨ§ن‬ä‫ﺎﺗ‬ü‫اﻟﻜﺮ‬ DIALYSIS
• Laboratory values (serum electrolyte, BUN, creatinine, (‫ﺪﻳﺪ‬,+‫ا‬ PAGE FROM 4186 TO
protein, transferrin, and iron levels) ‫ﺾ‬ü‫ﺗﻘﻴﻴﻢ اﻷﻧﻤﺎط اﻟﻐﺬاﺋﻴﺔ ﻟﻠﻤﺮ‬
‫اﳌﺪﺧﻮل‬s§‫ ¿ﻐ‬a` ‫ﻢ‬0‫ ¿ﺴﺎ‬ZY‫ﺗﻘﻴﻴﻢ اﻟﻌﻮاﻣﻞ اﻟ‬
• Assess patient's nutritional dietary patterns ، ‫ أو اﻟﻘﻲء‬، ‫ اﻟﻐﺜﻴﺎن‬، ‫ﻴﺔ‬m‫ )ﻓﻘﺪان اﻟﺸ‬:‫ﻲ‬£‫اﻟﻐﺬا‬
• Assess for factors contributing to altered nutritional intake: ، ‫ اﻻﻛﺘﺌﺎب‬، ‫ﺾ‬ü‫ﺴﺎغ ﻟﻠﻤﺮ‬-‫اﳌﺴ‬s§‫ﻲ ﻏ‬£‫اﻟﻨﻈﺎم اﻟﻐﺬا‬
(Anorexia, nausea, or vomiting ,Diet unpalatable to patient, (‫]ﺎب اﻟﻔﻢ‬ÿ‫اﻟ‬
Depression, Stomatitis) ‫ﻔﻴﻔﺔ ﻋﺎﻟﻴﺔ اﻟﺴﻌﺮات‬æ+‫ﻊ اﻟﻮﺟﺒﺎت ا‬ï‰
‫وﺗ§ن وﻣﻨﺨﻔﻀﺔ اﻟﺼﻮدﻳﻮم‬s ‫وﻣﻨﺨﻔﻀﺔ اﻟ‬
• Encourage high-calorie, low-protein, low-sodium, and low-
.‫واﻟﺒﻮﺗﺎﺳﻴﻮم ﺑ§ن اﻟﻮﺟﺒﺎت‬
potassium snacks between meals.
 DIALYSIS
TYPES:

Definition:
• Artificial process that partially replaces renal HD)) >=‫ﻏﺴﻴﻞ اﻟﻜ‬
>=‫ﻋﻤﻠﻴﺔ اﺻﻄﻨﺎﻋﻴﺔ ﺗﺤﻞ ﻣﺤﻞ وﻇﺎﺋﻒ اﻟﻜ‬
:‫ﻒ‬ü‫¿ﻌﺮ‬ • Haemodialysis (HD) PD)) ‫ﻳﺘﻮ•ﻲ‬s ‫ﻏﺴﻴﻞ اﻟﻜ=> اﻟ‬
function s ‫ ﺣﺮﻛﺔ اﳌﺬاب أو اﳌﺎء ﻋ‬:‫ﻌﻤﻠﻮن ﻋ=> ﻣﺒﺎدئ ﻣﻤﺎﺛﻠﺔ‬Ã (
‫ﺟﺰﺋًﻴﺎ‬
‫ﺴﺘﺨﺪم ﻏﺴﻴﻞ اﻟﻜ=> ﻹزاﻟﺔ اﻟﺴﻮ اﺋﻞ‬Ãُ
• Peritoneal Dialysis (PD) (‫ﻏﺸﺎء ﻧﺼﻒ ﻧﺎﻓﺬ‬
• Dialysis is used to remove fluid and uremic
>=‫ﺴﻢ ﻋﻨﺪﻣﺎ ﺗﻜﻮن اﻟﻜ‬ï+‫وﻓﻀﻼت اﻟﺒﻮل ﻣﻦ ا‬
waste products from the body when the kidneys .‫ﻗﺎدرة ﻋ=> اﻟﻘﻴﺎم ﺑﺬﻟﻚ‬s§‫ﻏ‬
(They work on similar principles: Movement
are unable to do Removes waste products from ‫ﺷﻴﺢ اﻟﻔﺎﺋﻖ‬sØ‫ﻖ اﻟ‬ü‫ﻞ اﳌﺎء اﻟﺰ اﺋﺪ ﻋﻦ ﻃﺮ‬ü‫ﻳﺰ‬ of solute or water across a semipermeable
blood by diffusion (toxin clearance) (‫ﻔﺎظ ﻋ=> ﺗﻮازن اﻟﺴﻮ اﺋﻞ‬,+‫)ا‬
membrane )
• Removes excess water by ultrafiltration
(maintenance of fluid balance)

SELECTION FOR HD/PD: HAEMODIALYSIS (HD)

‫ﺔ‬ü‫ﺮ‬ü‫ﺎﻟﺔ اﻟﺴﺮ‬,+‫ا‬ • Dialysis process occurs outside the body in a machine

• Clinical condition ‫ﻴﺎة‬,+‫أﺳﻠﻮب ا‬
• The dialysis membrane is an artificial one: Dialyser
(‫ﻣﺨﺎﻃﺮﻋﺎﻟﻴﺔ ﻟﻺﺻﺎﺑﺔ‬PD - ) ‫ اﻟﻨﻈﺎﻓﺔ‬/ ‫ﺾ‬ü‫ﻛﻔﺎءة اﳌﺮ‬
• Lifestyle / ‫ﺗﻮ اﻓﺮاﻟﺘ'ﻠﻔﺔ‬ • The dialyser removes the excess fluid and wastes from the blood and returns ‫ آﻟﺔ‬a` ‫ﺴﻢ‬ï+‫ﺗﺤﺪث ﻋﻤﻠﻴﺔ ﻏﺴﻴﻞ اﻟﻜ=> ﺧﺎرج ا‬
the filtered blood to the body >=‫ﺎزﻏﺴﻴﻞ اﻟﻜ‬m‫ ﺟ‬:aœ‫ﻏﺸﺎء ﻏﺴﻴﻞ اﻟﻜ=> ﻏﺸﺎء اﺻﻄﻨﺎ‬
• Patient competence/hygiene (PD - high risk of • Haemodialysis needs to be performed three times a week ‫ﺎزاﻟﻐﺴﻴﻞ اﻟﺴﻮ اﺋﻞ اﻟﺰ اﺋﺪة واﻟﻔﻀﻼت ﻣﻦ اﻟﺪم‬m‫ﻞ ﺟ‬ü‫ﻳﺰ‬
infection) • Each session lasts 3 to 4 hours per treatment ‫ﺴﻢ‬ï+‫> ا‬ë‫ﻌﻴﺪ اﻟﺪم اﳌﺼﻔﻰ إ‬7‫و‬
* A dialyzer (also referred to as an artificial kidney) ‫ اﻷﺳﺒﻮع‬a` ‫ﻳﺠﺐ إﺟﺮاء ﻏﺴﻴﻞ اﻟﻜ=> ﺛﻼث ﻣﺮات‬
• Affordability / Availability ‫ ﺳﺎﻋﺎت ﻟ'ﻞ ﻋﻼج‬4 >ë‫ إ‬3 ‫ﻞ ﺟﻠﺴﺔ ﻣﻦ‬Å‫¿ﺴﺘﻤﺮ‬
ً ‫ﺸﺎرإﻟﻴﮫ أﻳ‬Ã) >=‫ﺎزﻏﺴﻴﻞ اﻟﻜ‬m‫* ﺟ‬
‫ﻀﺎ ﺑﺎﺳﻢ اﻟ'ﻠﻴﺔ‬
(‫اﻻﺻﻄﻨﺎﻋﻴﺔ‬
 HEMODIALYSIS
:‫ﻧﻮﻋﺎن‬HD: >ë‫اﻟﻮﺻﻮل إ‬
• Indications of Hemodialysis: HD Access :2 types : ‫ﺪي‬ü‫ﺎ•ﻲ ور‬ü‫ ﻃﻌﻢ ﺷﺮ‬:‫ﻧﺎﺳﻮر‬
.‫ﺔ‬ü‫ﻗﺴﻄﺮة وﺻﻮل اﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬
1-Acute renal failure.
:‫ اﻹﺳﺘﻌﻤﺎل‬aœ‫دوا‬
2-Chronic renal failure. .‫ﺎد‬,+‫ اﻟﻔﺸﻞ اﻟ'ﻠﻮي ا‬-1 • A fistula: arterio-venous (AV) 0rGraft
.‫ اﻟﻔﺸﻞ اﻟ'ﻠﻮي اﳌﺰﻣﻦ‬-2
3-Hepatic coma (increased ammonia). .(‫ﺎدة اﻷﻣﻮﻧﻴﺎ‬ü‫ اﻟﻐﻴﺒﻮ¬ﺔ اﻟﻜﺒﺪﻳﺔ )ز‬-3 • Vascular Access Catheter.
4-Pulmonary edema. .‫ﺔ‬ü‫اﻟﻮذﻣﺔ اﻟﺮﺋﻮ‬-4
.. ‫ ¿ﺴﻤﻢ‬-5
5-Poisoning.. ‫ ﺟﺮاﺣﺔ اﻟﺒﻄﻦ واﻟﺼﺪر‬-6 A fistula
>=‫ﻣﻮ ا•ﻊ ﻏﺴﻴﻞ اﻟﻜ‬
6-Abdominal and chest surgery .‫ﺔ‬ü‫ أﻣﺮاض اﻟﻘﻠﺐ واﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬-1 Vascular Access Catheter
• Contraindications of Hemodialysis .(‫ﻒ اﻟﺪم‬ü‫أﻣﺮاض اﻟﺪم )ﻧﺰ‬-2
.‫ﺔ‬ü‫> اﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬ë‫ﻣﻤﻨﻮع اﻟﻮﺻﻮل إ‬-3
1-Cardiovascular disease.
2-Blood disease (bleeding tendency).
3-No vascular access. 34

PERITONEAL DIALYSIS: RENAL TRANSPLANTATION

qin peritoneal dialysis Abdominal lining filters blood
qIndication ‫ ﺗﻘﻮم ﺑﻄﺎﻧﺔ اﻟﺒﻄﻦ‬، ‫ﻳﺘﻮ•ﻲ‬s ‫ ﻏﺴﻴﻞ اﻟﻜ=> اﻟ‬a` Definition:
1-In acute & chronic renal failure.. ‫ﺑﺘﺼﻔﻴﺔ اﻟﺪم‬
‫إﺷﺎرة‬ • Renal transplantation is the organ transplant in a :‫ﻒ‬ü‫¿ﻌﺮ‬
2- Used in patients with vascular access problems.. .. ‫ﺎد واﳌﺰﻣﻦ‬,+‫`> ﺣﺎﻻت اﻟﻔﺸﻞ اﻟ'ﻠﻮى ا‬-1 ‫ﻠﻮي‬Å ‫ﺾ ﻣﺼﺎب ﺑﻤﺮض‬ü‫ﻮ زرع اﻷﻋﻀﺎء ﳌﺮ‬0 >=‫زرع اﻟﻜ‬
a` ‫ﻞ‬Å‫ﻌﺎﻧﻮن ﻣﻦ ﻣﺸﺎ‬à ‫ اﻟﺬﻳﻦ‬àáÜ‫ اﳌﺮ‬a` ‫ﺴﺘﺨﺪم‬à -2
patient with end stage renal disease.
.‫ة‬s§‫ ﻣﺮاﺣﻠﮫ اﻷﺧ‬a`
3-Used in patients of cardiovascular diseases (who
cannot tolerate rapid fluid removal).
.. ‫ﺔ‬ü‫> اﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬ë‫اﻟﻮﺻﻮل إ‬ Source of the donor organ: :‫ع‬s ‫ﻣﺼﺪراﻟﻌﻀﻮ اﳌﺘ‬
‫ﺔ‬ü‫ اﻟﻘﻠﺐ واﻷوﻋﻴﺔ اﻟﺪﻣﻮ‬àáÜ‫ ﻣﺮ‬a` ‫ﺴﺘﺨﺪم‬Ã-3 .(‫ﺜﺚ‬ï+‫ع )ا‬s ‫زراﻋﺔ اﻟﻜ=> اﳌﺘ‬-1
4-In patients with bleeding tendency .(‫)اﻟﺬﻳﻦ ﻻ ﻳﺘﺤﻤﻠﻮن إزاﻟﺔ اﻟﺴﻮ اﺋﻞ ?ﺴﺮﻋﺔ‬ 1-Dead donor (Cadaveric) renal transplants. ‫ﻴﺎة‬,+‫ع ﻋ=> ﻗﻴﺪ ا‬s ‫زراﻋﺔ اﻟﻜ=> ﻣﻦ ﻣﺘ‬-2
‫ﻒ اﻟﺪم‬ü‫ﻌﺎﻧﻮن ﻣﻦ ﻧﺰ‬à ‫ اﻟﺬﻳﻦ‬àáÜ‫ اﳌﺮ‬a`-4 :‫ اﻹﺳﺘﻌﻤﺎل‬aœ‫دوا‬
qContraindication ‫ﻣﻮ ا•ﻊ‬ 2-Living-donor renal transplants ‫ ‘]ﺎﻳﺔ اﳌﺮﺣﻠﺔ‬a` >=‫ﻮ ﻣﺮض اﻟﻜ‬0 >=‫ﻣﺆﺷﺮزرع اﻟﻜ‬
.‫]ﺎب اﻟﺼﻔﺎق‬ÿ‫ اﻟ‬-1
1-Peritonitis. ‫ اﻟﺒﻄﻦ أو اﻟﺼﺪر‬a` ‫ﻋﻤﻠﻴﺎت ﺟﺮاﺣﻴﺔ ﺣﺪﻳﺜﺔ‬-2 Indications:
2-Recent abdominal or chest surgery, trauma, and .‫واﻟﺮﺿﻮض وﻓﺘﻖ اﻟﺒﻄﻦ‬
• The indication for kidney transplantation is end-
.ZáŒ‫اﻟﻘﺼﻮر اﻟﺘﻨﻔ‬-3
abdominal hernia.. stage renal disease
3-Respiratory insufficiency.
36 37
 LRD (LIVING RENAL DONOR )SOURCE:
4.RENAL TRANSPLANT

vParents 53%
Ø MOTHER - 76% FATHER - 24%

vSiblings 25% ٪53 ‫اﻵﺑﺎء‬

Ø SISTER- 66% BROTHER - 34%
vSpouse 22%
Ø WIFE - 84% Husband 16%
٪24 - ‫ أب‬٪76 - ‫أم‬
٪25 ‫اﻷﺷﻘﺎء‬
٪34 - ‫ اﻷخ‬٪66 -‫اﻟﺸﻘﻴﻘﺔ‬
٪22 ‫اﻟﺰوج‬
٪16 ‫ اﻟﺰوج‬٪84 - ‫اﻟﺰوﺟﺔ‬

CONTRAINDICATIONS: POSTOPERATIVE NURSING CARE

The postoperative nursing care of the renal transplant

1-Cardiac and pulmonary insufficiency.
recipient is similar in many ways to the care of any patient ‫ﺮاﺣﻴﺔ‬ï+‫ﻀﻴﺔ ?ﻌﺪ اﻟﻌﻤﻠﻴﺔ ا‬ü‫ﺸﺎﺑﮫ اﻟﺮﻋﺎﻳﺔ اﻟﺘﻤﺮ‬-‫ﺗ‬
2-Hepatic disease. who has undergone a major surgical procedure; the ‫ﺾ‬ü‫ة ﻣﻊ رﻋﺎﻳﺔ أي ﻣﺮ‬s§‫ﳌﺘﻠﻘﻲ زرع اﻟﻜ=> ﻣﻦ ﻧﻮاح ﻛﺜ‬
:>=‫ﻛ§÷ﻋ‬sØ‫ى ؛ ﻳﻨﺼﺐ اﻟ‬s ‫ﺧﻀﻊ ﻟﻌﻤﻠﻴﺔ ﺟﺮاﺣﻴﺔ ﻛ‬
.‫ﻗﺼﻮر اﻟﻘﻠﺐ واﻟﺮﺋﺘ§ن‬-1 emphasis is on:
3-Hematologic abnormalities, such as anemia and .‫أﻣﺮاض اﻟﻜﺒﺪ‬-2
‫ﺔ واﻟﻜﺸﻒ ﻋﻦ‬ü‫ﻴﻮ‬,+‫> اﻟﻌﻼﻣﺎت ا‬ë‫ اﻟﻮﺻﻮل إ‬-1
platelet dysfunction. .‫ﺔ‬ü‫ﺔ ﻣﺜﻞ ﻓﻘﺮاﻟﺪم وﺧﻠﻞ اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮ‬ü‫ﺎت اﻟﺪﻣﻮ‬0‫ﺸﻮ‬-‫ اﻟ‬-3
1.Access vital signs and detect early signs of infection. .‫اﻟﻌﻼﻣﺎت اﳌﺒﻜﺮة ﻟﻠﻌﺪوى‬
I&O).) & ‫دارة اﻷﻟﻢ‬Ó‫ﺮوح و‬ï+‫ﻣﺨﻄﻂ اﻟﻌﻨﺎﻳﺔ ﺑﺎ‬-2
:‫ﻣﺘﻄﻠﺒﺎت‬ 2.Wound care, pain management& (I&O) chart. ُ
• Requirements: .‫اﻟﻌﻤﺮاﳌﻨﺎﺳﺐ‬
3 >ë‫ ﻣ'ﺎ‘]ﺎ ﳌﺪة ﺗﺼﻞ إ‬a` ‫ﺮاﺣﻴﺔ‬ï+‫ﻴﻮط ا‬æ+‫ك ا‬sØ‫ ﺗ‬3-
3.Sutures are left in place for up to 3 weeks to ‫ﺾ ﻋﻨﺪ ﺗﻨﺎول‬ü‫ﻴﻌﺎب اﻟﺘﺌﺎم أﺑﻄﺄ ﻟﺪى اﳌﺮ‬-‫أﺳﺎﺑﻴﻊ ﻻﺳ‬
.(‫ﻠﻮي‬Å ‫ﺔ ﺟﻴﺪة )ﻻ ﻳﻮﺟﺪ ﻣﺮض‬,ª
Suitable age. accommodate for slower healing in the patient on high
.‫ﺪ‬ü‫و‬s§‫ﺟﺮﻋﺎت ﻋﺎﻟﻴﺔ ﻣﻦ اﻟﻜﻮرﺗﻴﻜﻮﺳﺘ‬
ُ
‫ ¿ﻌﻄﻰ ﻣﻠﻴﻨﺎت‬.aÂ‫ اﺳﺘﻌﺎدة ﺧﺮوج اﻷﻣﻌﺎء اﻟﻄﺒﻴ‬.4
Good health (no kidney disease). doses of corticosteroid. ‫ﻘﻦ‬,+‫ وا‬، ‫ة‬s§‫ ¿ﺸ'ﻞ ﻛﻤﻴﺎت ﻛﺒ‬ZY‫ واﳌﻠﻴﻨﺎت اﻟ‬،‫از‬s ‫اﻟ‬
4. Restoration of normal bowel elimination. stool softeners, .‫اﻟﺸﺮﺟﻴﺔ ﻋﻨﺪ اﻟﻀﺮورة‬
bulk-forming laxatives, and enemas are administered as
necessary.
40 41

CONTINUING CARE
1-The patient and family must understand why they
should adhere continuously to the therapeutic
regimen, with special emphasis on the methods of
administration, rationale, and side effects of the
prescribed immunosuppressive agents.
2- The nurse provides written as well as verbal
instructions about how and when to take the
medications. To avoid running out of medication or
skipping a dose
CONTINUING CARE
3- the patient must make sure that an adequate supply
of medication is available immunosuppression to
prevent rejection, corticosteroid to prevent
‫ﺾ ﻣﻦ ﺗﻮﻓﺮﻛﻤﻴﺔ‬ü‫ ﻳﺠﺐ أن ﻳﺘﺄﻛﺪ اﳌﺮ‬-3
‫ﻢ‬m‫÷اﻣ‬Ø‫ﺐ اﻟ‬A‫ﺾ واﻷﺳﺮة ﺳ‬ü‫ﻢ اﳌﺮ‬m‫ﻳﺠﺐ أن ﻳﻔ‬-1
inflammation ‫ﺔ اﳌﺜﺒﻄﺔ ﻟﻠﻤﻨﺎﻋﺔ ﳌﻨﻊ اﻟﺮﻓﺾ‬ü‫ﺎﻓﻴﺔ ﻣﻦ اﻷدو‬Å
‫ﻛ§÷?ﺸ'ﻞ ﺧﺎص‬sØ‫ ﻣﻊ اﻟ‬، að‫اﳌﺴﺘﻤﺮﺑﺎﻟﻨﻈﺎم اﻟﻌﻼ‬ 4- The nurse emphasizes the importance of follow-up ‫]ﺎب‬ÿ‫ﺪ ﳌﻨﻊ اﻻﻟ‬ü‫و‬s§‫واﻟﻜﻮرﺗﻴﻜﻮﺳﺘ‬
‫ واﻵﺛﺎر‬، ‫ واﻷﺳﺒﺎب اﳌﻨﻄﻘﻴﺔ‬، ‫ﻋ=> ﻃﺮق اﻹﻋﻄﺎء‬ ‫ﻤﻴﺔ ﻣﺘﺎ?ﻌﺔ‬0‫ ﺗﺆﻛﺪ اﳌﻤﺮﺿﺔ ﻋ=> أ‬-4
.‫ﻴﺔ ﻟﻠﻌﻮاﻣﻞ اﳌﺜﺒﻄﺔ ﻟﻠﻤﻨﺎﻋﺔ اﳌﻮﺻﻮﻓﺔ‬A‫ﺎﻧ‬ï+‫ا‬
blood tests that assess the function of the liver and
‫ ﺗﻘﻴﻢ وﻇﻴﻔﺔ اﻟﻜﺒﺪ‬ZY‫ﻓﺤﻮﺻﺎت اﻟﺪم اﻟ‬
‫ﻴﺔ ﺣﻮل‬m‫ ﺗﻘﺪم اﳌﻤﺮﺿﺔ ¿ﻌﻠﻴﻤﺎت ﻣﻜﺘﻮ¬ﺔ وﺷﻔ‬-2 kidneys >=‫واﻟﻜ‬
‫ ﻟﺘﺠﻨﺐ ﻧﻔﺎذ‬.‫ﺎ‬m‫ﺔ وﻣﻮﻋﺪ ﺗﻨﺎوﻟ‬ü‫ﻛﻴﻔﻴﺔ ﺗﻨﺎول اﻷدو‬ 5- The importance of routine ophthalmologic ‫ﻤﻴﺔ ﻓﺤﻮﺻﺎت ﻃﺐ اﻟﻌﻴﻮن‬0‫ ﺗﻜﻤﻦ أ‬-5
‫ﺔ أو ﺗﺨﻄﻲ ﺟﺮﻋﺔ‬ü‫اﻷدو‬ ‫ﺎدة ﺣﺪوث إﻋﺘﺎم ﻋﺪﺳﺔ اﻟﻌ§ن‬ü‫ ز‬a` ‫ﻴﺔ‬¥‫اﻟﺮوﺗﻴ‬
examinations is done because of the increased
‫ﻞ اﻷﻣﺪ‬ü‫واﻟﺰرق ﻣﻊ اﻟﻌﻼج ﻃﻮ‬
incidence of cataracts and glaucoma with the long- .‫ﺪ اﳌﺴﺘﺨﺪم ﻣﻊ اﻟﺰرع‬ü‫و‬s§‫ﺑﺎﻟﻜﻮرﺗﻴﻜﻮﺳﺘ‬
term corticosteroid therapy used with
transplantation.
42 43
44