| التسجيل |
| التمريض قسم خاص بطلاب كليات التمريض ووسائل التمريض والأسعافات الأولية |
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| مصري مميز
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اقتباس:
الجميلة sweet nurse اهلا بيكي حبيبتي انا هحاول ادورلك على العناصر اللي اقدر عليها وان شاء الله كهرمان لما تدخل كمان تقدر تساعدك اكتر... بس انتي ما حاولتيش ليه على جوجل اكيد هتلاقي كتير...عموما هدورلك على قد ما اقدر وابعتلك اول ما الاقي حاجة.... وتحت امرك في اي حاجة.........
__________________ أبتاهُ بالأمس عدتُ إلى الحسين صليتُ فيه الركعتين بقيت همومي مثلما كانت صارت همومي في المدينةِ لا تذوب بركعتين | | ||||
| مصرى جديد |
شكرا ياعمري بصراحه حاولت على جوجل ابحث عنه لكن تعبت وماحصلت وغير كذا انا لازم اشرحه قدام الاستاذه والطالبات المشكله ان الاستاذه اللي درسنا هنديه صارت صعبه علي لاني شفت صديقاتي اللي حصل معاهن يوم الشرح محتاجه اقدم البحث واشرحه باحسن صوره واقدم افكاره جديده مميزه لو كانت عربيه الاستاذه بتكون اسهل انا عن جد خايفه ولا اعرف يومها وش ممكن يصير فيني عموما شكرا ياقلبي لانك بتساعديني
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بعتذر جدا عن التاخير بس ما كنتش متواجدة والله منورة يا سويت
__________________  إليكم يا من أحببت فى الله .. إلى من فارقنا معذوراً أو مهموماً .. نفتقد حروفكم .. دفء تواجدكم .. همسكم .. ضحكاتكم ... وننتظر عودتكم .. إلى ما شـاء الله | | |||
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Defintion* a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are in renal failure Hemodialysis is one of three renal replacement therapies (the other two being renal transplant; peritoneal dialysis). vascular Access* In hemodialysis, three primary methods are used to gain access to the blood: an intravenous catheter, an arteriovenous (AV) fistula, or a synthetic graft. The type of access is influenced by factors such as the expected time course of a patient's renal failure and the condition of his or her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is maturing and a catheter is still being used. A. subulavian , Internal Jugular and femoral catheters Catheter access, sometimes called a CVC (Central Venous Catheter), consists of a plastic catheter with two lumens (or occasionally two separate catheters) which is inserted into a large vein (usually the vena cava, via the internal jugular vein or the femoral vein) to allow large flows of blood to be withdrawn from one lumen, to enter the dialysis circuit, and to be returned via the other lumen. However, blood flow is almost always less than that of a well functioning fistula or graft. Catheters are usually found in two general varieties, tunnelled and non-tunnelled. Non-tunnelled catheter access is for short-term access (up to about 10 days, but often for one dialysis session only), and the catheter emerges from the skin at the site of entry into the vein. Tunnelled catheter access involves a longer catheter, which is tunnelled under the skin from the point of insertion in the vein to an exit site some distance away. It is usually placed in the internal jugular vein in the neck and the exit site is usually on the chest wall. The tunnel acts as a barrier to invading microbes, and as such, tunnelled catheters are designed for short- to medium-term access (weeks to months only), because infection is still a frequent problem.Image:Tunnelled hemo.jpg Aside from infection, venous stenosis is another serious problem with catheter access. The catheter is a foreign body in the vein and often provokes an inflammatory reaction in the vein wall. This results in scarring and narrowing of the vein, often to the point of occlusion. This can cause problems with severe venous congestion in the area drained by the vein and may also render the vein, and the veins drained by it, useless for creating a fistula or graft at a later date. Patients on long-term hemodialysis can literally 'run out' of access, so this can be a fatal problem. Catheter access is usually used for rapid access for immediate dialysis, for tunnelled access in patients who are deemed likely to recover from acute renal failure, and for patients with end-stage renal failure who are either waiting for alternative access to mature or who are unable to have alternative access. Catheter access is often popular with patients, because attachment to the dialysis machine doesn't require needles. However, the serious risks of catheter access noted above mean that such access should be contemplated only as a long-term solution in the most desperate access situation. B. fistula AV (arteriovenous) fistulas are recognized as the preferred access method. To create a fistula, a vascular surgeon joins an artery and a vein together through anastomosis. Since this bypasses the capillaries, blood flows rapidly through the fistula. One can feel this by placing one's finger over a mature fistula. This is called feeling for "thrill" and produces a distinct 'buzzing' feeling over the fistula. Fistulas are usually created in the nondominant arm and may be situated on the hand (the 'snuffbox' fistula'), the forearm (usually a radiocephalic fistula, or so-called Brescia-Cimino fistula, in which the radial artery is anastomosed to the cephalic vein), or the elbow (usually a brachiocephalic fistula, where the brachial artery is anastomosed to the cephalic vein). A fistula will take a number of weeks to mature, on average perhaps 4-6 weeks. During treatment, two needles are inserted into the fistula, one to draw blood and one to return it. The advantages of the AV fistula use are lower infection rates, because no foreign material is involved in their formation, higher blood flow rates (which translates to more effective dialysis), and a lower incidence of thrombosis. The complications are few, but if a fistula has a very high blood flow and the vasculature that supplies the rest of the limb is poor, a steal syndrome can occur, where blood entering the limb is drawn into the fistula and returned to the general circulation without entering the limb's capillaries. This results in cold extremities of that limb, cramping pains, and, if severe, tissue damage. One long-term complication of an AV fistula can be the development of an aneurysm, a bulging in the wall of the vein where it is weakened by the repeated insertion of needles over time. To a large extent the risk of developing an aneurysm can be reduced by careful needling technique. Aneurysms may necessitate corrective surgery and may shorten the useful life of a fistula. To prevent damage to the fistula and aneurysm or pseudoaneurysm formation, it is recommended that the needle be inserted at different points in a rotating fashion. Another approach is to cannulate the fistula with a blunted needle, in exactly the same place. This is called a 'buttonhole' approach. Often two or three buttonhole places are available on a given fistula. This also can prolong fistula life and help prevent damage to the fistula. C. Graft AV (arteriovenous) grafts are much like fistulas in most respects, except that an artificial vessel is used to join the artery and vein. The graft usually is made of a synthetic material, often PTFE, but sometimes chemically treated, sterilized veins from animals are used. Grafts are inserted when the patient's native vasculature does not permit a fistula. They mature faster than fistulas, and may be ready for use several weeks after formation (some newer grafts may be used even sooner). However, AV grafts are at high risk to develop narrowing, especially in the vein just downstream from where the graft has been sewn to the vein. Narrowing often leads to clotting or thrombosis. As foreign material, they are at greater risk for becoming infected. More options for sites to place a graft are available, because the graft can be made quite long. Thus a graft can be placed in the thigh or even the neck (the 'necklace graft'). complication* Hemodialysis often involves fluid removal (through ultrafiltration), because most patients with renal failure pass little or no urine. Side effects caused by removing too much fluid and/or removing fluid too rapidly include low blood pressure, fatigue, chest pains, leg-cramps, nausea and headaches. These symptoms can occur during the treatment and can persist post treatment; they are sometimes collectively referred to as the dialysis hangover or dialysis washout. The severity of these symptoms are usually proportionate to the amount and speed of fluid removal. However, the impact of a given amount or rate of fluid removal can vary greatly from person to person and day to day. These side effects can be avoided and/or their severity lessened by limiting fluid intake between treatments or increasing the dose of dialysis e.g. dialyzing more often or longer per treatment than the standard three times a week, 3-4 hours per treatment schedule. Since hemodialysis requires access to the circulatory system, patients undergoing hemodialysis may expose their circulatory system to microbes, which can lead to sepsis, an infection affecting the heart valves (endocarditis) or an infection affecting the bones (osteomyelitis). The risk of infection varies depending on the type of access used (see below). Bleeding may also occur, again the risk varies depending on the type of access used. Infections can be minimized by strictly adhering to infection control best practices. Heparin is the most commonly used anticoagulant in hemodialysis, as it is generally well tolerated and can be quickly reversed with protamine sulfate. Heparin allergy can infrequently be a problem and can cause a low platelet count. In such patients, alternative anticoagulants can be used. In patients at high risk of bleeding, dialysis can be done without anticoagulation. First Use Syndrome is a rare but severe anaphylactic reaction to the artificial kidney. Its symptoms include sneezing, wheezing, shortness of breath, back pain, chest pain, or sudden death. It can be caused by residual sterilant in the artificial kidney or the material of the membrane itself. In recent years, the incidence of First Use Syndrome has decreased, due to an increased use of gamma irradiation, steam sterilization, or electron-beam radiation instead of chemical sterilants, and the development of new semipermeable membranes of higher biocompatibility. New methods of processing previously acceptable components of dialysis must always been considered. For example, in 2008, a series of first-use type or reactions, including deaths occurred due to heparin contaminated during the manufacturing process with oversulfated chondroitin sulfate. Longterm complications of hemodialysis include amyloidosis, neuropathy and various forms of heart disease. Increasing the frequency and length of treatments have been shown to improve fluid overload and enlargement of the heart that is commonly seen in such patients. Listed below are specific complications associated with different types of hemodialysis access. pharmacologic therapy* Nutritional and fliud therapy*
__________________ إليكم يا من أحببت فى الله .. إلى من فارقنا معذوراً أو مهموماً .. نفتقد حروفكم .. دفء تواجدكم .. همسكم .. ضحكاتكم ... وننتظر عودتكم .. إلى ما شـاء الله | | |||
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ده كل اللى قدرت الاقيه عن التوبيك يا سويت الاساوب على فكرة سهل وسلس بس محتاج منك تنظيم فى نقط بقى عشان تقدرى تلقيه فى البحث اتمنى انى اكون افدتك
__________________ إليكم يا من أحببت فى الله .. إلى من فارقنا معذوراً أو مهموماً .. نفتقد حروفكم .. دفء تواجدكم .. همسكم .. ضحكاتكم ... وننتظر عودتكم .. إلى ما شـاء الله | | |||
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| مواقع النشر |
| العبارات الدلالية |
| بليز, محتاجه, مساعدتكم |
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