A, peritoneal dialysis patients living and living precautions
1. Maintain good personal hygiene habits, take a shower once a day, if bathing, bath water should be shallow and not into the outlet of the catheter. Before bathing, do a good job of protecting the outlet of the catheter and keep the dialysis bag and dialysis tubing dry. After bathing, check the outlet and disinfect it with iodophor once locally to keep it clean and clear.
2. Keep the temperature of the peritoneal dialysis fluid at about 37℃, avoid overcooling or overheating of the peritoneal dialysis fluid. Microwave ovens and thermostats can be used for home peritoneal dialysis. When microwave oven is used for heating, the dialysis fluid can be properly shaken to keep the temperature of the dialysis fluid in the bag even, and avoid the local temperature of the dialysis fluid being too high.
3. The position of dialysis tubing, temperature and flow rate of dialysis fluid can be adjusted appropriately when abdominal pain is present. If the abdominal distension may be due to the reduction of intestinal peristalsis, you can apply heat or gently massage the abdomen.
4.Keep the room of dialysis ventilated and clean, strengthen the concept of asepsis when operating, and do a good job of protective isolation to prevent cross-infection.
5, good monitoring, daily weight and pulse should be measured, accurate recording of 24-hour in and out volume, observation of the color and clarity of the dialysis fluid.
6, appropriate exercise is also important, exercise should follow the three, five, seven principles (that is, 30 minutes each time, five times a week, the intensity of exercise to heart rate does not exceed 170-age is appropriate), should be combined with their own specific circumstances, step by step, and obtain the approval of the doctor. Exercise is not recommended when there is fever, acute infection, serious cardiovascular pathology, deterioration of physical condition, fractures, new diseases that have not been treated, or hypoglycemia in diabetics. Exercise can be done in the morning and evening, but should be avoided in hot or excessively cold temperatures, and not after a full meal. Dialysis patients can choose the form of exercise: flexibility exercise, including neck joints, upper and lower limb joints, iliac joint activities, it can make the joints more flexible, easy to complete walking, bending, squatting and other movements. Exercises to enhance muscle strength, including biceps, such as quadriceps, lumbar muscles, etc., which can make the muscles stronger, so that the weight-bearing and counter-assist ability is enhanced. Cardiovascular function exercise (aerobic exercise), including walking, cycling, jogging, swimming, tai chi, etc., it can make the heart, lungs, and the normal work of the circulatory system is improved, increase the endurance of the cardiovascular system, not easy to feel fatigue. If the exercise aggravates the joint or bone lesions, short tube pulling should stop the exercise.
7, according to the weather changes to add and subtract clothing, to prevent colds; reduce to the crowded public places to prevent infectious diseases.
Second, the peritoneal dialysis patient’s diet considerations
1.Reasonable dietary principles
Foods that can be eaten more: (1) high-quality animal protein; (2) foods rich in B vitamins and vitamin C; (3) foods rich in fiber, such as whole wheat bread, brown rice, thick noodles and high-fiber cereals, which can reduce the occurrence of constipation, which can easily lead to abdominal infections.
Foods that should be eaten sparingly: (1) avoid foods high in phosphorus; (2) limit salt intake to prevent fluid overload; (3) limit the intake of sweets and fats.
2. Intake of appropriate protein
During peritoneal dialysis, about 5-15g of protein is lost every day, so an appropriate amount of protein must be consumed every day to replenish the lost portion. More high-quality animal protein should be consumed, such as fish, lean meat, milk, eggs, etc., and less vegetable protein, such as beans, soy products, etc.
3, control the intake of carbohydrates (calories)
Most of the carbohydrates in our food usually come from sugar and starch in staple foods or sweets, such as rice, bread, noodles, etc. The glucose in the dialysis solution of abdominal dialysis can also bring in calories, and these extra calories can make weight gain. If you are already overweight, try to avoid sugars, sweets, and foods that contain a lot of fat, such as cream, fatty meats, and whole milk.
4, limit the intake of phosphorus and potassium in food
Phosphorus: elevated blood phosphorus can cause itchy skin and osteoporosis, which is very common in uremic patients, so you should eat less food containing high phosphorus, such as dairy products (yogurt, milkshakes, pudding), soy and other beans, animal offal, carp, squid and shrimp, etc.
Potassium: Elevated blood potassium can cause arrhythmia of the heartbeat, so it is necessary to eat less foods high in potassium, such as fresh fruits (bananas, oranges, grapefruit), vegetables (tomatoes, potato chips, mushrooms), fruit juices, beer and red wine. However, patients containing poor condition can be caused by insufficient intake of low blood potassium. If blood tests suggest low blood potassium, potassium intake should be supplemented or treated under the guidance of a doctor.
5.Correct cooking method
In addition to paying attention to the intake of various food components, the correct cooking method can also help to achieve the desired dietary treatment effect.
5.1 Reducing potassium content
(1) Soak green leafy vegetables in plenty of water for more than half an hour, then pour off the water and put them in plenty of boiling water to heat them up.
(2) Root vegetables with high potassium content, such as potatoes, should be peeled first, cut into thin slices and soaked in water before cooking.
(3) Recommended to eat more melon soup, such as winter melon, loofah, etc., they contain less potassium than leafy greens soup, with vegetables cooked into the soup are containing potassium.
(4) Canned fruits and vegetables in the manufacturing and processing process are reduced potassium content, but attention should be paid to the additives in the cans.
5.2 Reduce sodium content
(1) Seasoning should be light, using less high-sodium condiments such as salt, soy sauce, monosodium glutamate, oyster sauce and various ready-made sauces.
(2) Avoid using ingredients with high salt content, such as preserved vegetables, pickled vegetables and squash.
(3) Try to use more of the following low-sodium condiments, which can increase the deliciousness of the dishes. Such as pepper, vinegar, sugar, wine, five spice powder, pepper, star anise, coriander, peel, mustard, onion, ginger, garlic, lemon juice, lime juice, chili, etc.
5.3 Avoid thirst
(1) Avoid using pickled ingredients and high salt seasonings.
(2) Add lemon slices or mint leaves to beverages.
(3) Make some drinks into ice cubes and hold them in your mouth for a better thirst quenching effect.
(4) Avoid drinking strong tea or coffee.
5.4 Cooking methods for diabetic patients
(1) Use a limited amount of sugar or switch to sugar substitutes for flavoring, but sugar substitutes should not be cooked at high temperatures because the sweetness will be reduced by heat.
(2) Avoid eating foods with high sugar content such as soft drinks, candies, sweet pastries and canned fruits (made of sweet water), etc.
(3) Eat starchy foods regularly as the main source of calories.
(4) Avoid foods with high cholesterol and cook with a small amount of vegetable oil.
(5) Increase the amount of foods rich in dietary fiber.
6. Recommended daily meal structure
(1) Grain: 200~250g.
(2) Vegetables and fruits: 300~400g of fruits and vegetables with low phosphorus and low potassium, such as winter melon, buddha melon, golden melon, cucumber, cabbage, mung bean sprouts, pear, apple, etc.
(3) 1 bottle of milk or yogurt (200~300mL)
(4) 1 egg (50g)
(5) Fish or meat: 100~150g.
(6) Soybeans or soy products: 40g of soybeans (equivalent to 100g of tofu), less for those with high blood phosphorus.
(7) Seasoning: 25g of oil, 3g of salt, 25g of sugar.
(8) Daily water intake = 500mL + previous day’s urine volume + previous day’s peritoneal dialysis net water removal (and ultrafiltration volume)
Third, peritoneal dialysis patients taking medication precautions
1.Phosphorus binding agent
Most dialysis patients have elevated blood phosphorus and need to take phosphorus binding agents, which can prevent phosphorus accumulation in the body and prevent bone disease. It should be noted that phosphorus binding agents should be taken at mealtime, if not taken at mealtime, it will be ineffective.
2.Active vitamin D
In kidney failure, the kidneys cannot synthesize active vitamin D. Under normal circumstances, active vitamin D and calcium work together, and vitamin D plays a role in “opening the door” to the bones so that calcium can enter the bones and make them strong. Therefore, patients with kidney failure need to take active vitamin D supplements, but they should be taken under the guidance of a doctor and monitored regularly.
3.Erythropoietin (EPO) and iron supplements
Erythropoietin is produced by the kidneys and is used to stimulate the bone marrow to make red blood cells. Reduced erythropoietin production by the kidneys in renal failure leads to anemia. EPO supplementation can promote bone marrow hematopoiesis and correct anemia, and should be used under medical supervision and monitored regularly. iron supplements should also be taken under medical supervision during EPO treatment.
4.Insulin
Insulin is used to lower blood sugar in diabetic patients. After receiving CAPD treatment, diabetic patients need to continue to control blood sugar by subcutaneous insulin injection.
5. Antihypertensive drugs
Most patients with kidney disease are accompanied by high blood pressure, and need to take antihypertensive drugs to control blood pressure and prevent cardiovascular complications. Patients with kidney disease often need to use antihypertensive drugs in combination to control blood pressure should reach the standard.