好多地方没看懂？

NONCOMPLIANT PATIENT

Among the significant complications or sequelae of dialysis, whether psychiatric or otherwise, are nonadherence to the medical regimen and difficulties with rehabilitation. There is a small but significant segment of patients who do not show up for dialysis runs, act out against the staff, and/or do not adhere to their medical regimen. The dialysis population is not cross-sectional of the general population. It is skewed in the direction of the noncompliant diabetic, the noncompliant hypertensive, and the substance abuser. Diabetic and/or overweight people will attest to the fact that following a diet is a hardship. Ninety-five percent of overweight people who diet do not maintain their weight loss. A significant group of them weigh more 1 and 2 years later than they did when they initiated their diet. Why should the patient with ESRD be any different, especially with a diet that requires more deprivation than merely the lowering of calories? As to other aspects of nonadherence to their regimen, anger may explain much of the acting out both inside and outside the dialysis center. Renal patients are often angry with their lot in life. Why have they been chosen to have this problem and this treatment, whereas staff and others are healthy , employed, and able to assume normal lives? Patients tend to see professional staff as representing authority and often displace their accumulated animosity on them. Part of the problem in handling the noncompliant and/or acting out patient comes from setting unrealistic expectations. Professional staff members, by and large, are high achievers in life, both educationally and professionally . They often have a tendency to identify with the patients and project their values about dialysis on the patients in regard to what they would do if they had renal failure and were required to have dialysis. This is a very common fallacy and needs to be kept in mind in setting realistic goals for these people. Patients have the right to trade the luxury of excessive fluid intake for longevity , even if we, the staff, would not do that, as long as they have the capacity to understand what they are doing. Dialysis staff should maintain a zero tolerance of patients who endanger the life or well-being of others or themselves. In general, staff is often too lenient in forgiving unacceptable behavior. At times, the police need to be called to protect life and safety , even if this means that the dangerous patient receives dialysis in the criminal justice system. Every center should be prepared to have unremitting, acting out patients told that they can no longer be dialyzed in that unit and be prepared to provide an alternate place for them to receive treatment.

依从性差的病人

无论是精神方面的还是其他方面的，透析的重大并发症或后遗症包括不遵守医疗方案和康复困难。有一小部分但重要的患者不愿进行透析治疗、对工作人员行为不当、和/或不遵守他们的医疗方案。透析人群不是一般人群中的普通部分，它更多的是依从性差的糖尿病、高血压和物质滥用患者。糖尿病和/或超重的人会证明这样一个事实，即节食是一件困难的事情。在节食的超重者中，95%的人没有保持他们的减肥效果。他们中相当一部分人1到2年后的体重比他们开始节食还重了。为什么ESRD病患者会有这些不同，尤其是为什么饮食需要更多的剥夺而不仅仅是降低热量？至于其他治疗方面依从性也差，愤怒可以解释透析中心内外的许多发泄行为。肾病患者经常对他们的命运感到愤怒。为什么他们会得病和需要这种治疗，而工作人员和其他人是健康的、有工作的、能够过上正常的生活？患者倾向于将专业工作人员视为权威，并经常将其积累的不满转移到他们身上。在与依从性差和/或行为不当的患者交流时发现：部分问题来自于设定了不切实际的期望。总的来说，专业工作人员在教育和职业上都是生活中的高成就者。他们往往倾向于认同患者，并将他们关于透析的价值观灌输给患者，即如果自己肾功能衰竭而被要求进行透析时会怎么做。这其实是一个非常普遍的谬论，在为患者设定现实目标时需要牢记这一点。患者有权用过量摄入液体来换取长寿，即使我们这些工作人员不会这样做，只要他们有能力理解自己在做什么就可以这么做。透析工作人员应对危及他人或自己生命或幸福的患者保持零容忍。总体而言，工作人员在原谅不可接受的行为方面往往过于宽大。即使这意味着危险的患者需要在刑事司法系统中接受透析，有时还是需要叫警察来保护生命和安全。每个中心都应该准备好，让那些屡教不改的、行为不当的患者知晓：他们不能再在那个病房接受透析，已准备为他们提供另一个接受治疗的地方。

好多地方没看懂？不知道理解的对吗？

还有，1.为啥当中会讲到节食？讲到为什么饮食需要更多的剥夺而不仅仅是降低热量？

2.患者有权用过量摄入液体来换取长寿，这句话什么意思？指透析时多滤去液体还是指多摄取了水？为什么这么做可以长寿而我们不会这么做？