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FEDERAL STATE AUTONOMOUS EDUCATIONAL INSTITUTION OF HIGHER
EDUCATION
”BELGOROD STATE UNIVERSITY”
(
National Research University “B e l S U ” )
MEDICAL INSTITUTE
DEPARTMENT OF FACULTY THERAPY
PRACTICAL TRAINING
А DIARY
about passing the educational introductory practice of a 1st year
student of the group [academic group number]
[Surname, first name, other name]
place of practice (practice base): Department of Faculty Therapy of the Medical Institute of
the National Research University "BelSU"
Terms of practice:
10.01.2022 - 05.02.2022
The headteacher of practice:
Assistant of Faculty therapy:
Litvin N.I.
Belgorod 2022
Exemplary individual work plan for introductory practice
№
of the
subitem
1
2
3
4
5
6
7
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Duration
of work
Types of work
Introductory conference, instruction on labor
protection
Familiarization with the history, structure and
internal regulations of the University and
medical institute
Familiarization with the regulations on the
organization of practical training of students
during practice at the Medical Institute of the
National Research University "BelSU".
Forms of documents
Medical ethics and deontology.
Familiarization with moral and legal norms,
ethical and deontological principles in
professional activity
Familiarity with the structure of the health
care facility. Acquaintance with the structure
and organization of the therapeutic profile
department, emergency room, treatment
room
Subject of general patient care
Primary and secondary disease prevention.
Sanitary and educational work
Test
Signature of the headteacher of practice ______________________
signature
2
1 day
3 days
1 day
1 day
3 days
12 days
2 days
1 day
The order of organization and conduct of the practice for students
The training practice is conducted after the end of the autumn examination session.
Students work in the therapeutic departments and the simulation center 6 days a week, 6
hours a day.
The headteacher of practice from among the staff of the department monitors the
passage of practice, provides methodological assistance to students, checks the diary,
instructs students on occupational safety at the workplace, introduces the rules of internal
labor regulations, monitors compliance with the terms of practice and its content.
The student must arrive at the place of practice on time and report to work by 8 am.
The student must have a report, a diary, a change of shoes and a lab coat, personal protective
equipment (cap, mask, gloves). During the period of academic practice, students perform
tasks provided for by the work program of the practice, comply with the rules of internal
labor regulations, labor protection and fire safety requirements. The practice ends with a test,
which controls the degree of mastery of skills.
Instruction on labor protection at the workplace.
Based on the Decree of the Ministry of Labor and Social Protection No. 1/29 of
13.01.2003 and the order of the Rector of the National Research University "BelSU" No.
1239-00 of 16.11.2020, an initial briefing was conducted at the workplace.
Date
Surname,
First
Name, Signature of the Surname, First Name, Signature of the
Patronymic of the person person
being Patronymic of the instructing instructing person
person
being instructed
instructed
10.01.2022
Litvin Natalia Igorevna
Based on the decree of the Government of the Russian Federation No. 1479 of
16.09.20, an initial fire-prevention briefing was conducted.
Date
Surname,
First
Name, Signature of the Surname, First Name, Signature of the
Patronymic of the person person
being Patronymic of the instructing instructing person
person
being instructed
instructed
10.01.2022
Litvin Natalia Igorevna
Obligation of non-disclosure of personal information of patients
I,_______________________________________________________________________
Surname, First Name, Patronymic of the student
I am familiar with the Regulation on the protection of personal data of patients in the
institution. I undertake not to disclose personal data of patients that have become known to
me in connection with the performance of my duties.
I have been warned about the responsibility for the disclosure of personal data of patients.
___________________________________________________________________
(signature, Surname, First Name, Patronymic of the student)
«_____»__________________20__ year.
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Approximate plan, write by hand
Work performed
Date
10.01.2022 Introductory conference, instruction on labor protection
11.01.2022 Familiarization with the history of the National Research University "BelSU".
The visit to the museum.
12.01.2022 Familiarization with the history of the Medical Institute of the National
Research University "BelSU".
Demonstration of the film. Excursion to the named auditorium of V.F.
Kulikovsky.
13.01.2022 The excursion to the simulation training center of the National Research
University "BelSU".
Acquaintance with the work of medical volunteers.
14.01.2022 Organization of practice at the Medical Institute of the National Research
University "BelSU".
Familiarization with the regulations on the organization of practice. Forms of
documents.
15.01.2022 Familiarization with moral and legal norms, ethical and deontological
principles in professional activity.
Modern medicine is a unique form of synthesizing the achievements of
fundamental and applied branches of natural science. But what distinguishes
medicine from "pure" natural science is that it does not work with "matter",
"field" or "information", but with a person whose knowledge is not limited to
natural science, but assumes a socio-humanitarian dimension.
In the new Criminal
Code of the Russian Federation, which entered into force on 01.01.97, the list
of the main professional
crimes are saved. The article on "disclosure of information constituting a
medical
secret" is absorbed by the more general wording of article 137 "Violation
of privacy". Two new articles are introduced in the section "Crimes against
life and health"
: "coercion to remove human organs or tissues for
transplantation" (Article 120) and "HIV infection" (Article 122). However,
changes
are taking place not only in the Criminal Code. In 1993, the General Legal
Classifier of Branches of Legislation was approved, which includes the
following an independent industry, such as Legislation on the protection of
citizens' health, which in
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Date
Work performed
in turn, it is represented by a number of laws — "On transplantation of
organs and (or)
human tissues", "On psychiatric care", etc. These laws regulate in detail
the relationship between citizens-patients, on the one hand, and medical
workers and
institutions, on the other, when providing medical care.
17.01.2022 Familiarity with the structure of medical facilities.
Familiarity with the structure and organization of the department of
therapeutic profile
Structure of the therapeutic department
Patients with a therapeutic profile are subject to hospitalization in the
therapeutic department of the hospital. Medical departments can be of two
types – general therapeutic: pulmonological, cardiological,
gastroenterological, neurological, hematological, etc.
The work of the therapeutic department is provided by the following medical
staff: The head of the department. Ward doctors.
Senior nurse. Nurses of the department (ward nurses). The sister is the
hostess. Procedural nurse. Junior nurses. Barmaid nurses. Cleaning nurses.
The device and equipment of the therapeutic department.
The device of the therapeutic department provides the following premises the Office of the head of the department. The resident's room (doctors' office).
The office of the senior nurse. Wards for patients. Treatment rooms.
Manipulation rooms (enema room). Bathroom. Toilet rooms. A buffet for
distributing food and a dining room for the sick. The office of the hostess
sister. A room for washing and sterilizing ships. Storage room for cleaning
items. A place to store equipment for transporting patients.
The arrangement of wards in the medical department also provides for a
mandatory list of equipment - Functional beds. Bedside tables. A common
table and chairs for patients. Refrigerator for storing food. Portable screens.
Individual electric lamps. Individual alarm system for emergency call of
medical personnel.
Internal schedule of the therapeutic department:
Stationary mode
* Strict compliance with the rules of the internal daily routine.
* Ensuring a regime of rational physical activity.
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Date
Work performed
18.01.2022 Familiarity with the structure and organization of the emergency room.
The structure of the reception department
The emergency room is an important medical and diagnostic department
designed for registration, admission, initial examination, anthropometry,
sanitary and hygienic treatment of incoming patients and the provision of
qualified (emergency) medical care.
The main functions of the reception department:
* Reception and registration of patients.
* Medical examination of patients.
* Provision of emergency medical care.
* Determination of the hospital department for hospitalization of patients.
* Sanitary and hygienic treatment of patients.
* Preparation of appropriate medical documentation.
* Transportation of patients.
The device of the hospital's reception department
The work of the reception department proceeds in a strict sequence
The device of the reception department includes the following offices.
* Registry: registration of incoming patients and registration of necessary
documentation is carried out in this room.
* Waiting room: there are patients who do not need bed rest, and
accompanying patients.
* Examination room (one or several): designed for medical examination of
patients with a preliminary diagnosis and determination of the type of
sanitary and hygienic treatment, anthropometry, thermometry and, if
necessary, other studies (for example, electrocardiography (ECG).
* Sanitary pass with shower (bath), dressing room.
* Diagnostic room - for patients with an unspecified diagnosis.
* Isolation ward - for patients suspected of having an infectious disease.
* Treatment room - for emergency assistance.
* Operating room (dressing room) - for emergency care.
* X-ray room
* Laboratory
* Office of the doctor on duty
* Office of the head of the reception department
* Toilet room
* A room for storing clothes of admitted patients.
Patients are delivered to the emergency department:
- by ambulance;
-in the direction of the district doctor of the polyclinic;
-transfer from other medical and preventive institutions by agreement with the
hospital administration;
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-without any direction of a medical and preventive institution, i.e. "by
gravity".
Date
Work performed
19.01.2022 Familiarity with the structure and organization of the treatment room
Structure of the treatment room
Treatment room - a specially organized room for carrying out various
therapeutic and preventive procedures (intravenous and intramuscular
interventions, subcutaneous injections, etc.)
The treatment room should be equipped with:
- hand towel;
- sink;
The workplace of the nurse is equipped with:
1) a sterile table; 2) a working table for the preparation of injections;
3) one or two manipulation tables; 4) one or two couches; 5) a set of venous
tourniquets; 6) a set of oilcloth pillows; 7) a cabinet with injection solutions; 8)
first aid kits for emergency care (anaphylactic shock, etc.); 9) bixes with dressing
material; 10) containers with disinfectant solutions for syringes, needles,
dressing material, gloves, rags.
Duties of a nurse in the treatment room
- performing all types of injections,,
- carrying out infusion therapy, including blood transfusion,
- preparation and participation in punctures (sternal, pleural, abdominal,
lumbar, etc.).
Job responsibilities of a nurse in the treatment room:
- perform manipulations only as prescribed by a doctor;
- keep a log of the performed manipulations;
- to carry out the administration of medicinal substances (i / v, p / k, i / m);
- to take blood;
- to help the doctor during technical manipulations;
- determination of blood type and Rh factor;
- strict compliance with the rules of asepsis and antiseptics in the office during
the procedures; - provision of the treatment room with instruments, dressings,
medicinal substances, etc.;
- introduction of accounting documentation;
- compliance with the principles of deontology;
Date
Work performed
20.01.2022 The concept of general patient care. Measurement of body temperature.
Patient care is a set of hygiene measures aimed at alleviating the patient's
condition and contributing to his recovery.
Types of care:
-General care is the measures necessary for the patient himself, regardless of
the nature of the disease or injury. For example, general care includes feeding
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the patient, changing underwear and bed linen.
-Special care – activities carried out in relation to patients of specialized
departments. Care includes helping the patient to meet the physiological needs
of his body in food, water, physical activity, physiological functions, and to
improve well-being in pathological conditions.
Patient care plays an important preventive role in the development of
some diseases and their complications.
Equally important is the observance of moral, ethical and aesthetic norms of
the relationship with a sick person.
In each action of a medical worker when performing
care activities, in communicating with a patient, there should be
tact, courtesy, sincere desire to help the patient.
Measurement of the patient's body temperature (thermometry)
I. I. Preparation for the procedure:
Prepare a dry clean thermometer: check its integrity, if necessary, wipe it dry
with a clean cloth.
Introduce yourself to the patient, explain the course of the upcoming
procedure.
Treat your hands in a hygienic way, drain.
Shake the mercury thermometer from top to bottom so that the mercury drops
down the column into the tank.
II. Performing the procedure:
To examine the armpit, if necessary, wipe dry with a napkin or ask the patient
to do this
, position the thermometer in the armpit area so that the mercury reservoir is in
close contact with the patient's body from all sides
(press the shoulder to the chest)
Leave the thermometer on for 5 minutes
III. The end of the procedure:
Remove the thermometer from the armpit, read the thermometer readings,
holding it horizontally at eye level
Inform the patient of the measurement results
Shake the thermometer from top to bottom, so that the mercury drops down the
column into the tank, put it in a container with
a disinfectant solution
Wash and dry your hands (using soap or antiseptic)
Make an appropriate record of the results of the performance in the medical
documentation (temperature sheet,
inpatient medical card, intensive care sheet)
Report feverish patients to the doctor on duty.
21.01.2022 Measures to ensure personal hygiene of the patient.
After the diagnosis of the disease is established, the patient
is sent for sanitary and hygienic treatment by the decision of the doctor on
duty.
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If the patient is in a serious condition, he is taken to the intensive
care unit or intensive care unit without sanitary and hygienic treatment.
Sanitary and hygienic treatment is carried out in the sanitary
inspection of the reception department. There are one- and two-stage methods
of sanitary and hygienic treatment of patients.
The sanitary inspection of the reception department usually consists of an
examination room,
a locker room, a bath and shower room and a room where patients get dressed.
In the examination room, the patient is undressed, examined for the detection
of pediculosis and prepared for sanitary and hygienic treatment. There is a
couch, a table, chairs, a thermometer on the wall (the air temperature in the
examination room should be at least 25 ° C). If the linen is clean, it is put in a
bag, and the outerwear is hung on hangers and handed over to the storage
room. The list of things (reception receipt) is made in two copies: one is
handed over
things in the storage room, the other is glued to the medical history and when
discharged from it they receive things for the patient. The available valuables
and money are handed over to the senior nurse on receipt to store them in a
safe.
*If the patient has an infectious disease, the laundry
is put in a tank with bleach or chloramine B for 2 hours and sent to a special
laundry.
Stages of sanitary and hygienic treatment of patients.
1. Examination of the skin and hair of the patient.
2. Cutting hair, nails, shaving (if necessary).
3. Washing under the shower or hygienic bath.
Washing the patient
The bath is washed with a washcloth and a brush with soap and disinfectant
solution, rinsed with hot water and filled with water immediately before the
patient enters the bathroom (the water temperature is measured). Next to the
bathroom should
there may be wooden decking (or rubber mats). Clean linen and a washcloth
should be put in bags.
After washing the patient, the bath is washed with soap and rinsed with a 1%
solution of chloramine B. An oilcloth pillow and an oilcloth on the couch
are wiped with a cloth moistened with a 2% solution of chloramine B or 0.5%
with a solution of bleach, and then washed with soap. The sheets on the couch
are changed after each patient. Wet cleaning of the premises is carried out
several times a day. Inventory should be labeled. Washcloths in the bathroom
should be in different dishes marked "Used Washcloths", "Clean Washcloths".
Depending on the nature of the disease and the patient
's condition, the hygienic treatment of the patient can be complete (bath,
shower) or
partial (wiping, washing).
* Hygienic bath is contraindicated in cardiovascular diseases, tuberculosis in
the active phase, skin diseases, bleeding, exhaustion. And also it is impossible
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to take a bath for women in labor and patients with diseases requiring
emergency surgical intervention.
If there are contraindications for taking a hygienic bath
, the patient should be wiped first with a napkin soaked in warm water with
soap or warm water with cologne (alcohol), then with a napkin soaked in clean
water and wiped dry.
22.01.2022 Medical and diagnostic procedures and preparation for them.
The most modern laboratory equipment is not enough for the most accurate
diagnosis of diseases. The accuracy of the results depends not only on the
reagents and equipment used, but also on the time and correctness of the
collection of the studied material. If the basic rules of preparation for analyses
are not followed, their results can be significantly distorted.
Preparation for the blood donation procedure
In the morning on an empty stomach, they take biochemical (glucose,
cholesterol, bilirubin, etc.) and serological tests (syphilis, hepatitis B),
hormones (TSH, parathyroid hormone), etc.
A general blood test, the last meal should be no later than 1 hour before blood
donation. 1-2 days before the examination, exclude fatty, fried and alcohol
from the diet. An hour before taking blood, refrain from smoking
Preparation for the urine donation procedure
Urine collection for general analysis is carried out in a container.
On the eve of the test, it is recommended not to eat vegetables and fruits that
can change the color of urine (beets, carrots, etc.), do not take diuretics.
Before collecting urine, it is necessary to make a thorough hygienic toilet of the
genitals. Women are not recommended to take a urine test during
menstruation.
Collect approximately 50 ml of morning urine in a container. To properly
conduct the study, at the first morning urination, release a small amount of
urine (the first 1-2 seconds) into the toilet, and then, without interrupting
urination, substitute a urine collection container into which to collect
approximately 50 ml of urine. Close the container tightly.
24.01.2022 Rules for preparing the patient for ultrasound examinations
Preparation for ultrasound examination (ultrasound) of the abdominal cavity
and kidneys implies the exclusion of certain products. It is worth limiting the
consumption of foods that provoke gas formation, because they can distort the
image on ultrasound. On the day of the study, it is better to come on an empty
stomach.
*Preparation for ultrasound of the abdominal cavity and kidneys in pregnant
women does not differ from the preparation of the rest of the category of
patients.
Preparation for pelvic ultrasound in women
Ultrasound of the pelvis in women is performed transabdominally and
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transvaginally.
*With transabdominal ultrasound, the bladder should be filled. To do this, it is
recommended to drink at least 1.5 liters of still water before the procedure and
not urinate for 3-4 hours before the study.
*With transvaginal ultrasound, special training is not required, this study is
used, among other things, to determine pregnancy in the early stages. The
study is carried out with an emptied bladder and intestines.
Preparation for ultrasound of the prostate gland (prostate)
Ultrasound of the prostate gland can be performed in two ways:
through the skin of the anterior wall of the abdomen and transrectally (the
sensor is inserted through the anus).
*Ultrasound of the prostate through the abdominal wall: the patient needs to
drink about 1.5 liters of plain still water an hour before the study, and then not
urinate.
*Preparation for ultrasound of the prostate, which is planned to be performed
in a transrectal way (TRUS):
During preparation, 2 conditions must be met:
-A few hours before the study, you need to clean the intestines. To do this, the
best option is to conduct a cleansing enema.
- Fill the bladder. It is necessary to come to the study in advance, at least half
an hour in advance, taking with you a liter container with water without gas,
juice or tea. When you come, start drinking this liquid. As soon as you feel the
urge to urinate, you need to tell the doctor conducting the study about it so that
he will call you to the office.
Preparation for ultrasound of the bladder
It resembles preparation for prostate surgery, but you need to start it a day
before the study. To do this, in the morning of the day before the study, you
need to drink about 2 tablespoons of castor oil.
*It is not recommended to eat: meat and offal, legumes, carbonated drinks and
sweets.
You need to make an enema, or microclysm for bowel emptying. Then it is
necessary to start drinking liquid for 30-40 minutes before the study, and when
you feel the need to urinate, stop drinking water.
Preparation for breast ultrasound
Before the appointment of ultrasound of the breast, no special training is
required. Every woman can drink, eat, take medications (by notifying a
specialist in advance). In order to properly prepare, you need to know some
points: the procedure is prescribed in the first phase of the menstrual cycle (5 14 days of the cycle from the beginning of menstruation).
25.01.2022 Rules for preparing the patient for endoscopic examinations
Preparation for fibrogastroduodenoscopy (FGDS)
FGDS is performed on an empty stomach: in the morning on the day of the
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study, it is forbidden to have breakfast and take any food, even if the study
takes place in the afternoon.
In the morning on the day of the study before FGDS it is forbidden to: smoke;
take medications orally.
It is allowed to: brush your teeth; do ultrasound of the abdominal cavity and
other organs; drink water, weak tea with sugar for 2-4 hours; give injections.
The night before: easily digestible (without salads!) dinner until 18.00 hours.
*Before the examination, you need to remove removable dentures, glasses, tie.
Preparation for colonoscopy
A light lunch is recommended one day before the study.
You can not: fruits and berries with stones, red meat, vegetables, cereals,
lettuce, mushrooms, nuts, grain bread, sweets. Dinner - tea.
In the evening, make two cleansing enemas with an interval of 1 hour.
In the morning on the day of the study, do two cleansing enemas again with an
interval of 1 hour. No breakfast.
Preparation for X-ray examinations (irrigoscopy, intravenous urography)
The day before the study, you can not eat vegetables, fruits, mineral water,
dairy products. On the eve of the study, the last meal is allowed no later than
18:00 hours. At 12:00 on the eve of the study, drink 50 ml of castor oil. At
15:00 hours on the eve of the study, take 2 bags of Fortrans.
On the day of the study in the morning: - irrigoscopy is performed on an empty
stomach!
-intravenous urography needs breakfast!
26.01.2022 Methods of application of medicines
Drug therapy is an essential part of the treatment process. There are the
following methods of drug administration..
1. External method: on the skin; in the ears; on the conjunctiva of the eyes, the
mucous membrane of the nasal cavity and vagina.
2. Enteral method: inside through the mouth (per os); under the tongue (sub
lingualis); behind the cheek (trans buccalis); through the rectum (per rectum).
3. Inhalation method - through the respiratory tract.
4. Parenteral method: intradermally; subcutaneously; intramuscularly;
intravenously; intraarterially; in the cavity; intraosseous; in the subarachnoid
space.
General rules for the use of medicines
A nurse does not have the right to prescribe or replace one medication with
another. If the drug is given to the patient by mistake or its dose is exceeded,
the nurse is obliged to immediately inform the doctor about it.
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Before giving the patient the medicine, it is necessary to wash your hands
thoroughly, carefully read the label, check the expiration date, the prescribed
dose, then monitor the patient's intake of the drug (he must take the medicine in
the presence of a nurse). When the patient takes the medicine, the date and
time, the name of the medicine, its dose and method of administration should
be noted in the medical history (list of prescriptions).
If the drug is prescribed for administration several times a day, in order to
maintain a constant concentration of it in the blood, the correct time intervals
should be observed.
Medications prescribed for taking on an empty stomach should be distributed
in the morning 30-60 minutes before breakfast. If the doctor recommended
taking the medicine before meals, the patient should receive it 15 minutes
before meals. The medicine prescribed during meals is taken by the patient
with food. The remedy prescribed after eating, the patient should drink 15-20
minutes after eating. Sleeping pills are given to patients 30 minutes before
bedtime. A number of drugs (for example, nitroglycerin tablets) should be
constantly in the patient's hands.
• • When performing the injection, it is necessary to thoroughly wash and treat
your hands with a disinfectant solution, follow the rules of asepsis (wear sterile
gloves and a mask), check the label, check the expiration date, put the opening
date on the sterile vial. After administration of the drug, the date and time, the
name of the drug, its dose and method of administration should be noted in the
medical history (list of prescriptions).
Medicines should be stored only in a package released from a pharmacy. It is
impossible to pour solutions into other dishes, transfer tablets, powders to
other packages, make your own inscriptions on the packaging of medicines; it
is necessary to store medicines on separate shelves.
27.01.2022 Observation and care of patients with respiratory pathology
Stokes breathing is observed. It is characterized by the fact that patients after a
certain number of respiratory movements have a prolonged apnea (from 1/4 to
1 min), and then a rare shallow breathing appears, which gradually becomes
more frequent and deepens until it reaches the maximum depth. Further,
breathing becomes more and more rare and shallow until complete cessation
and the onset of a new pause. During apnea, the patient may lose
consciousness. At this time, his pulse slows down and his pupils narrow.
28.01.2022 Monitoring and care of patients with cardiovascular diseases (CVD)
Monitoring and care of patients with CCC diseases should be carried out in
two directions. General measures - monitoring and care measures that patients
with diseases of various organs and systems need: monitoring the general
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condition of the patient, thermometry, monitoring pulse and blood pressure,
filling out a temperature sheet,
ensuring personal hygiene of the patient, feeding the vessel, etc.
Special events - monitoring and care
activities aimed at helping patients with symptoms characteristic of
CCC diseases: pain in the heart and chest,
acute and chronic heart failure, edema, cardiac arrhythmia, etc.
It should be remembered that edema in the early stages of the disease may be
hidden. In these cases, fluid retention in the body can
manifested by a fairly rapid increase in body weight and a decrease in diuresis.
That is why daily monitoring of the water balance in such patients is very
important, i.e. comparing the amount of fluid drunk and administered
parenterally with the amount of urine excreted per day (daily diuresis).
The daily diuresis should be 1.5-2 liters (70-80% of the volume of all liquid
consumed per day). The state of the water balance can also be controlled by
weighing the patient: a rapid increase in body weight indicates fluid retention.
29.01.2022 Observation and care of patients with diseases of the digestive system.
Observation and care of patients with diseases
of the digestive system should be carried out in two directions.
1. General activities - monitoring and care activities, in particular
which patients with diseases of various organs and systems need: monitoring
the general condition of the patient, thermometry, monitoring the pulse and
blood pressure, filling out a temperature sheet, ensuring personal hygiene of
the patient, if necessary, feeding the vessel, etc. 2. Special events - monitoring
and care activities aimed at helping patients with symptoms that manifest
diseases of the digestive system: abdominal pain, nausea, vomiting, belching,
etc.
Carrying out gastric lavage.
Necessary equipment: 1. thick gastric tube; 2. liquid vaseline oil; 3. mouth
expander, tongue holder, metal fingertip; 4. rubber gloves, oilcloth aprons; 5.
a bucket of clean water at room temperature, a liter mug, a funnel with a
capacity of 1 liter, a basin for washing water.
Procedure execution procedure:
1. Insert a thick gastric tube to a certain mark
2. Connect the funnel to the probe and lower it, slightly tilted, to the level of the
patient's knees so that the contents of the stomach pour out. 3. Pour 1 liter of
water into the funnel, then slowly raise it until the level
the water in the funnel will not reach its mouth (but no more!).
4. Lower the funnel below the level of the patient's knees, draining
the stomach contents that have appeared into the pelvis 5. Repeat the gastric
lavage procedure several times until the rinsing waters become clean.
6. Disconnect the funnel from the probe, carefully remove the probe from
the patient's stomach. 7. Allow the patient to rinse the mouth with water,
provide him with rest. 8. Place the probe with a funnel for 1 hour
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in a container with a disinfectant solution (3% chloramine B solution).
9. If necessary, send the first portion of washing water to
laboratory (bacteriological, toxicological, etc.).
31.01.2022 Monitoring and care of patients with kidney and
urinary tract diseases
Monitoring and care of patients with kidney and
urinary tract diseases should be carried out in two directions.
1. General measures - monitoring and care
measures that patients with diseases of various organs and systems need:
monitoring the general condition of the patient, thermometry, monitoring the
pulse and blood pressure, filling out a temperature sheet, ensuring personal
hygiene of the patient, feeding the vessel, etc.
2. Special measures - monitoring and care
measures aimed at helping patients with symptoms characteristic of
diseases of the urinary tract - pain in the lumbar region, edema, urination
disorder, hypertension, etc. A patient with kidney and urinary tract damage
requires
careful observation and careful care. When (or
the patient has edema, urination disorders, changes in urine color, increased
blood pressure, dyspeptic disorders, deterioration of the general condition of
the patient, the nurse should urgently inform the doctor about this.
*Urinary incontinence occurs with damage or
disorders of the tone of the bladder sphincter, malformations of the bladder
and urethra, diseases of the nervous system. The care of patients with urinary
incontinence is reduced to the use of urinals, including soft polyethylene ones
for permanent wear, careful care of the skin, especially the perineum, regular
change of underwear and bed linen.
Before giving the patient a urinal, the latter needs be rinsed with warm water.
After urination, having poured out its contents, the urinal is rinsed again with
warm water, disinfected by immersing in a 1% solution of chloramine for 30
minutes, washed again with running water, dried. The vessels are stored in the
sanitary room on a special rack or under the patient's bed.
01.02.2022 Care of elderly and senile patients
When caring for elderly and senile patients, their psychological characteristics
should be taken into account.
When caring for such patients, it is necessary to be especially
tactful and attentive, patiently answer questions asked by patients not for the
first time, constantly remind them about the time of taking medications,
carrying out a particular procedure.
Elderly and senile patients are most often long-term ill people with chronic,
sometimes incurable diseases. Elderly and senile patients often
sleep disorders are noted. Such patients can often sleep or doze during the day,
and stay awake at night, read, walk, eat, etc., thereby causing others to doubt
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the adequacy of their behavior. Such patients are forced to urinate several
times during the night, and urination in these cases occurs slowly, with a
sluggish stream.
Elderly patients may have other causes contributing to sleep disorders. It
should be borne in mind that older people generally have less need for sleep
than young people. If patients still additionally sleep during the day, then a
violation of night sleep often becomes almost inevitable. A poorly chosen bed
with a sagging mesh can also contribute to insomnia. Common causes of sleep
disorders can
also be poor ventilation of the room, snoring of neighbors in the ward, noise in
the corridor, etc.
An important place in the organization of care for elderly and senile patients is
occupied by the prevention of injuries and accidents, which are often found in
such patients. Age-related vision and hearing loss, shaky gait with poor
coordination of movements and slight loss of balance lead to patients falling
while in the ward, corridor, toilet, bathroom. The changes in bone tissue
present in the elderly (osteoporosis)
contribute to the occurrence of severe fractures, often hip necks, when falling.
Falls and injuries can be facilitated by soft, easily displaced paths, wet and
slippery floors, cluttering of wards and corridors with furniture, the absence of
special barriers at the walls and devices for supporting the toilet in the
corridors, poor lighting.
Accidents with elderly patients often occur while bathing in the bath. There
may also be burns that the patient receives while in the bath, if he mistakenly
opens only the tap with hot water. While taking a hygienic bath or shower, the
elderly may develop angina attacks or even a violation of cerebral circulation.
The most reliable preventive measure
is the presence of medical workers who provide the necessary assistance to
patients when bathing elderly patients.
02.02.2022 Care for the seriously ill. Basics of resuscitation care.
Caring for a serious patient involves providing a comfortable position in bed
("bed comfort"), timely change of bed and underwear, prevention of bedsores,
treatment of bedsores if they are present, care for the mucous membranes of the
nose, oral cavity, treatment of the eyes and auditory passages, etc.
The agonizing patient must be fenced off from other patients with a screen, and
an individual nursing post should be organized around him.
THE GENERAL RULES OF CARE
Of great importance in the care of seriously ill patients are the preparation of the
bed and the monitoring of the condition of bed linen. Mattresses of severe
patients suffering from fecal and urinary incontinence are sheathed with medical
oilcloth. The sheet should be carefully straightened, and its edges should be
tucked under the mattress. Folds on the sheet cause discomfort to the patient and
can cause the development of bedsores.
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With the appearance of bedsores, it is possible to attach a secondary purulent or
putrefactive infection. Prevention of bedsores is reduced to constant monitoring
of the condition of the bed, bed linen and underwear of a serious patient - timely
elimination of irregularities, smoothing of folds. For the prevention of bedsores,
special lining rubber circles are used, which are placed under areas of the body
that are subjected to prolonged compression (for example, under the sacrum).
The circle should not be inflated very tightly so that it can change its shape when
the patient moves. It is necessary to systematically change the position of the
patient, turning him in bed 8-10 times a day.
The change of bed and underwear should be carried out at least once every 10
days, and if necessary much more often. If the patient suffers from urinary
incontinence, it is necessary to change the underwear after each urination (and
soaking of the underwear). If patients perform physiological exercises lying
down, they need to submit a lining vessel, a "duck". After the vessel or "duck" is
released, they must be thoroughly washed with hot water and disinfected with 12% bleach solution or 3% chloramine B solution.
At least 1 time a week, the patient's nails should be cut short, removing the dirt
accumulated under them. Eye care is carried out in the presence of secretions
that glue eyelashes and eyelids. Using a cotton swab moistened with a 2%
solution of boric acid, you should first soften and then remove the formed crusts.
After that, the conjunctiva of the eyes is washed with boiled water or isotonic
sodium chloride solution. The oral cavity of seriously ill patients is washed with
a Janet syringe or a rubber canister (pear) with 0.5% sodium bicarbonate
solution, isotonic sodium chloride solution or a weak potassium permanganate
solution. To prevent the liquid from entering the respiratory tract, during this
procedure, the patient is given a semi-sitting position with his head tilted forward
or, if the patient is lying, turn his head sideways. For a better outflow of fluid, a
spatula is pulled slightly to the side of the corner of the mouth.
Resuscitation measures are carried out in case of sudden cessation of cardiac
activity, acute respiratory arrest, poisoning with various poisons, severe injuries,
massive blood loss, acute renal and hepatic insufficiency, etc.
Resuscitation techniques should be owned by every person. Naturally,
resuscitation measures are most effective when they are carried out in
specialized departments of hospitals. However, even at the same time, only 520% of such patients are discharged home, the rest die. It should also be
imagined that many surviving patients need constant care due to severe disorders
of consciousness that have occurred. It is not possible to reliably predict the
outcome of resuscitation in advance, even in hospital conditions.
03.02.2022 The concept of primary and secondary
Prevention
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Prevention is a set of measures aimed at preserving and
strengthening health and including the formation of a healthy
lifestyle, prevention of the occurrence and (or) spread of diseases,
their early detection, identification of the causes and conditions of
their occurrence and development, as well as aimed at eliminating
the harmful effects of environmental factors on human health (FZ 323 of 21.11.2011, edition of 31.07.2020 "On the basics of health
protection
citizens in the Russian Federation).
Medical prevention is a type of activity of the health service,
mainly of the primary level, aimed at early detection and reduction
of the risk of developing diseases, as well as reducing the negative
impact on the health
of internal and external environmental factors.
Primary prevention is a system of measures to prevent the
occurrence and impact of risk factors for the development of
diseases (vaccination, rational
work and rest, rational quality nutrition, physical activity,
environmental health, etc.).
Primary prevention includes the following components:
1) Measures to reduce the impact of harmful factors on the human
body, conducting sanitary and hygienic and environmental screening;
2) Formation of a healthy lifestyle: creation of a permanent
information and propaganda system aimed at increasing the level of
knowledge of the population about the impact of negative factors on
health and
reducing their impact; sanitary-hygienic education; the decline in
Smoking prevalence, consumption of drugs; the attraction of the
population to engage in physical culture, tourism, sport, improve their
accessibility; 3) prevention of physical and mental diseases and
injuries, accidents,
of disability and mortality from external causes, road traffic injuries,
etc; 4) Conduct immunization (vaccination) of different population
groups;
5) Identification of factors harmful to health, including behavioral
ones, during preventive medical examinations, taking measures to
eliminate them; 6) Rehabilitation of individuals and groups of the
population who are under the influence of factors unfavorable to
health with the use of
medical and non-medical measures.
Secondary prevention is a set of measures to eliminate pronounced
risk factors that, under certain conditions, can lead to the occurrence,
exacerbation or relapse of the disease (decreased immune response
status, overstrain, adaptive breakdown, etc.).
Secondary prevention includes the following components: 1)
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Conducting dispensary medical examinations in order to identify
diseases and factors affecting their course; 2) Targeted sanitary and
hygienic education, training of patients and their family members in
knowledge and skills related to a specific disease or group of diseases;
3) Carrying out health-improving and therapeutic measures to
eliminate negative factors for health, the implementation of dynamic
monitoring; 4) Measures for the medical and social adaptation of the
patient to changes in health status and the formation of the right
attitude to the changed capabilities and needs of the body;;
5) Measures aimed at reducing the level of influence of risk factors,
preserving residual working capacity and opportunities for social
adaptation, creating conditions for optimal life support for patients
and the disabled. The most effective method of secondary prevention is
medical examination - as a comprehensive method of early detection of
diseases, dynamic observation, targeted treatment and rational
sequential recovery.
04.02.2022 Sanitary and educational work
Sanitary education is a set of educational, educational, agitation and
propaganda activities aimed at forming a healthy lifestyle, preventing
diseases, preserving and strengthening health, increasing people's ability
to work, prolonging their active life.
In order to ensure a high level of health, the goal of every medical worker
in his work is to rely on a preventive orientation. The level of prevention in
the country reflects the nature of socio-economic, scientific, technical and
political living conditions..
The tasks of health education include:
- dissemination of medical and hygienic knowledge;
- education of sanitary and hygienic skills in order to preserve and
strengthen health;
- improvement of sanitary and hygienic culture.
In the organization of his sanitary and educational work, the
paramedic, along with traditional methods of teaching the
population on health issues, such as:
- interview; - group discussions; - lectures;
-thematic evenings; - evenings of questions and answers; - round
table discussions; - oral journals; - health schools;
- publications in the press; - conferences, widely uses methods of
visual agitation (wall newspapers; sanbulleteni; exhibitions and
health corners; book exhibitions).
To make this propaganda attractive, useful and informative, we
give an approximate description of some forms of sanitary and
educational information that can be used in their work.
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05.02.2022 The test
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Work performed
Signature of headteacher of practice______________________
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