Nursing Countermeasures of Continuous Renal Replacement Treatment in End-Stage Renal Disease with Refractory Hypotension in the Context of Smart Health

Table 1

Specific contents of individualized nursing.

Measures	Specific contents
Condition nursing	Nursing staff should pay close attention to the changes in the patient’s condition. For dialysis patients, it was necessary to regularly observe the changes of vital signs, ask more about the patient’s feeling, and detect abnormal changes in the patient’s condition in time. It should monitor vital signs once per hour for general patients, and once every 15-30 minutes for critically ill patients to detect the aura symptoms and typical symptoms of hypotension in time, such as yawning, palpitation, nausea, vomiting, and cold sweats. In addition, it should timely inform the dialysis doctor of various changes in the dialysis process and give corresponding treatment.
Dietary guidance	Dialysis patients should strengthen nutrition, improve anemia, and eat high-quality high-protein, low-sodium, and vitamin-rich foods to prevent hypoproteinemia. It should inform the patients and their families to strictly limit the intake of sodium salt and water during dialysis, increase body weight by no more than 3%-5% of body weight, and avoid rapid ultrafiltration, and ultrafiltration of water per hour does not exceed 1% of the body weight. It was not advisable to eat during dialysis. If the condition requires, it should inform the patient that eating during hemodialysis was best within 1-2 hours of the start of dialysis. At this time, the solute and water removed by dialysis only account for 20%-40% of the expected target, which had little effect on peripheral effective circulating blood volume and would not cause blood pressure to drop.
Exercise program	Firstly, postural adaptation exercise should be taken: it should keep the patient in a concave lying position, raise the upper body by 30°, place a soft pillow under the feet, raise it by 15°, and train twice a day, and each training time is 20-30 minutes. Secondly, it should turn over regularly: an alarm clock was placed on the bedside of the hemodialysis treatment, and the alarm clock would ring once every 2 hours. After hearing the alarm, the patient used the healthy limb to grasp the bed rail and perform the ipsilateral turning movement. Nursing staff need to monitor during exercise to ensure that the turning movement does not affect the patency of the pipeline and monitor it effectively. Thirdly, according to the actual situation of the patient, acupuncture was mainly based on aerobic exercise, such as walking and playing Taijiquan. The specific exercise time and amount depended on the patient’s tolerance. In addition, it should avoid large movements during exercise.
Psychological nursing	Compared with other treatments, hemodialysis is more likely to cause anxiety, fear, and other adverse emotions in patients, which not only increases the psychological burden but also is not conducive to the treatment of the disease, increasing the probability of hypotension. It can provide targeted psychological care according to the actual situation of the patient, explain the knowledge of the disease to the patient, eliminate the patient’s fear of the disease, assist the patient to vent their negative emotions, and maintain a good psychological state. Nursing staff increased the number and time of visits, communicated with patients as much as possible, encouraged, and comforted patients more, and kept patients in the best condition.