Varella L, Utermohlen V
Crit Care Nurs Clin North Am. 1993 Mar;5(1):79-96.
Renal failure presents patients and caregivers alike with numerous dilemmas in nutritional management. Too much protein, phosphate, or electrolytes, and the patient's renal failure becomes more symptomatic; too little of these nutrients and the patient is at great risk of developing fluid and electrolyte imbalances and of becoming protein-calorie malnourished. Dietary manipulation and often vigorous nutritional intervention (i.e., parenteral nutrition) are a must for these patients' survival. The nurse needs to understand the rationales behind nutritional care choices made by the physician and dietitian, and to be able to convey these rationales to the patient. The nurse also needs to be aware that the patient will use food, eating, and diet as a focus for acting out anxiety, fear, hopelessness, and anger. The nurse should also realize that these emotions are due, in part, to the metabolic derangements induced by the renal disease itself.
肾衰竭给患者及其护理人员在营养管理方面带来了诸多难题。蛋白质、磷酸盐或电解质摄入过多，患者的肾衰竭症状会更明显；而这些营养素摄入过少，患者则极易出现液体和电解质失衡，并有发展为蛋白质 - 热量营养不良的风险。饮食调整以及通常较为积极的营养干预（即肠外营养）对于这些患者的生存至关重要。护士需要理解医生和营养师做出营养护理选择背后的基本原理，并能够将这些原理传达给患者。护士还需要意识到，患者会将食物、饮食和节食作为排解焦虑、恐惧、绝望和愤怒情绪的焦点。护士也应认识到，这些情绪部分是由肾病本身引发的代谢紊乱所致。
