Job responsibilities of a nurse in a rehabilitation medicine office. Nurse's rights: main characteristics of the position
I. General provisions
1. The nurse belongs to the category of specialists.
2. For the position nurse a person with secondary education is appointed medical education in the specialty "Nursing" and
qualification category(s).
3. Appointment to the position of a nurse and dismissal from it are made by order of the head of the institution.
4. The nurse should know:
4.1. Laws Russian Federation and other regulatory legal acts on health issues.
4.2. Fundamentals of the diagnostic and treatment process, disease prevention, propaganda healthy image life.
4.3. Organizational structure healthcare institutions.
4.4. Safety rules when working with medical instruments and equipment.
4.5. Labor legislation.
4.6. Internal labor regulations.
4.7. Rules and regulations of occupational health, safety, industrial sanitation and fire protection.
II. Job responsibilities
Nurse:
1. Ensures infectious safety (complies with the rules of sanitary-hygienic and anti-epidemic regime, asepsis, properly stores, processes, sterilizes and uses medical products).
2. Carry out all stages of the nursing process when caring for patients (initial assessment of the patient’s condition, interpretation of the data obtained, planning care together with the patient, final assessment of what has been achieved).
3. Performs preventive, therapeutic and diagnostic procedures prescribed by the doctor in a timely and high-quality manner. Assists when a doctor performs therapeutic and diagnostic procedures and minor operations in outpatient and inpatient settings.
4. Provides emergency first aid at acute diseases, accidents and various types disasters followed by calling a doctor to the patient or referring him to the nearest medical facility.
5. Administers medications, antishock agents (for anaphylactic shock) to patients for health reasons (if it is impossible for a doctor to arrive to the patient in a timely manner) in accordance with the established procedure for this condition.
6. Informs the doctor or manager, and in their absence, the doctor on duty about all detected serious complications and diseases of patients, complications arising as a result of medical procedures or cases of violation of the internal regulations of the institution.
7. Ensures proper storage, accounting and write-off medicines, compliance with the rules for taking medications by patients.
8. Interacts with colleagues and employees of other services in the best interests of the patient.
9. Maintains approved medical records and reporting documentation.
10. Systematically improves his professional qualifications.
11. Conducts sanitary and educational work to promote health and prevent diseases, promote a healthy lifestyle.
III. Rights
The nurse has the right:
1. Use as prescribed by a doctor conservative methods treating patients, carrying out certain medical procedures.
2. Receive the information necessary to accurately perform your professional duties.
3. Make proposals for improving the work of a nurse and the organization of nursing in the institution.
4. Require the head nurse of the department to provide the post (workplace) with equipment, equipment, tools, care items, etc., necessary for the quality performance of their duties. functional responsibilities.
5. Improve your qualifications in the prescribed manner, undergo certification (re-certification) in order to assign qualification categories.
6. Participate in the work of professional nursing associations and others public organizations, not prohibited by the legislation of the Russian Federation.
IV. Responsibility
The nurse is responsible for:
1. For improper execution or failure to fulfill their job responsibilities provided for by this job description - within the limits determined by the current labor legislation of the Russian Federation.
2. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.
3. For causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.
JOB DESCRIPTION OF A NURSE
I. GENERAL PROVISIONS
1.1. Persons who have completed secondary medical education and have worked in this department for at least 3 years are accepted for the position of nurse in the treatment room of a polyclinic.
1.2. The nurse in the treatment room of the clinic is hired and dismissed by the dispensary and in agreement with the dispensary.
1.3. The nurse in the treatment room of the clinic is directly subordinate to.
1.4. He is directly subordinate to the nurse in the treatment room of the clinic.
1.5. The nurse in the treatment room of the clinic works according to a schedule drawn up by the head nurse of the dispensary and approved by.
1.6. The nurse in the treatment room of the clinic in her work is guided by: these instructions, the regulations on the skin and venereal disease clinic, functional responsibilities, the charter of the institution, internal labor regulations, legislative and regulatory acts, official documents in the field of healthcare, orders, instructions and instructions of higher officials and other methodological and instructional documentation regarding the work of nursing and junior medical personnel.
1.7. The replacement of a nurse in the treatment room of a clinic during her absence is carried out by the senior nurse of the dispensary by transferring to this position one of the women who has mastered this work well.
II. RESPONSIBILITIES NURSE
2.1. Perform manipulations only as prescribed by a doctor.
2.2. Begin work only after preparing the room for procedures and thoroughly preparing the instruments.
2.3. Follow the sequence of procedures in accordance with the hourly work schedule.
2.4. Strictly observe the requirements of asepsis and antisepsis when performing procedures.
2.5. During work, maintain the necessary order, appropriate work culture and sanitary condition.
2.6. Strictly follow the technology of procedures and manipulations:
a) intravenous, intramuscular, subcutaneous injections;
b) intradermal tests;
c) taking blood from a vein for diagnostic studies;
d) carrying out (under the supervision of a doctor):
— setting up systems and administering medications using the drip method;
e) preparing material for procedures.
2.7. Immediately notify the doctor about complications associated with performing manipulations in the office, and be familiar with the methods of providing pre-medical care. Prepares the necessary set of tools and materials and assists the doctor during other manipulations in this office.
2.8. Maintain high-quality documentation of the treatment room.
2.9. Make daily notes on the medical prescription sheets about the procedures performed.
2.10. Strictly observe the sanitary and epidemiological regime of the office, wear special clothing that meets the requirements of the treatment room.
2.11. Replenish your account in a timely manner required quantity instruments, medicines, other drugs, equipment, antiseptics necessary for work.
2.12. Be proficient in sampling technology occult blood, washing off disinfectants and detergents.
2.13. Carry out daily monitoring of the availability of the required amount of medications in the first aid kit for emergency care.
2.14. Make timely changes to the instructions on the sanitary and hygienic regime, methods of preparing hands for work, etc.
2.15. Supervise the work of the outpatient nurse.
2.16. Comply with autoclave sterilization requirements and maintain relevant documentation.
2.17. Ensure control over the rational use of office tools and correct accounting. Promptly replace worn-out medical equipment and instruments.
2.18. Ensure proper storage conditions for medications, solutions and serums in the office.
2.19. Comply with internal regulations, safety regulations, fire safety at your workplace, work time do not leave the department without the knowledge of the head nurse of the dispensary, do not leave the treatment room without a key when going home.
2.20. Constantly improve your medical knowledge by reading specialized literature, participating in on-the-job training in the department, hospital-wide nursing conferences, lectures, at least after 5 years, go through cycles of specialization and improvement in advanced training courses, take part in training department nurses to work in treatment room.
3.1.Has the right to receive the information necessary for his work.
3.2. Make proposals for improving the work of the office
3.3. Make comments to the medical staff of the department who do not comply with (violate) the rules of the office.
3.4. Pass certification (re-certification) to obtain qualification category.
3.5. Make proposals for incentives and penalties.
3.6. Get acquainted with the acts of checking the work of the office and, in case of disagreement, add your comments and suggestions to them.
3.7. Take part in production meetings.
3.8. Participate in the work of professional medical associations.
IV. RESPONSIBILITY
4.1. Behind proper organization work of the treatment room of the outpatient department.
4.2. For timely fulfillment of doctor’s orders for procedures.
4.3. For compliance with the sanitary and epidemiological regime at your workplace, the rules of asepsis and antiseptics.
4.4. For providing the office with the necessary number of instruments, medications, solutions, sterile material for performing procedures.
4.5. For compliance with the conditions and rules for storing medicines, equipment, tools, and office equipment.
4.6. For high-quality maintenance of office documentation and making notes on procedures performed.
4.7. For the proper organization of the work of the outpatient nurse
Agreed
(signature)
"___"___________20__g
JOB DESCRIPTION OF A NURSE IN A PHYSEOTHERAPY OFFICE
JOB DESCRIPTION
for a nurse in a physiotherapy room
I. GENERAL PROVISIONS
1.1. Persons who have received a higher medical education in the specialty “Nursing”, a secondary medical education, a diploma in the specialties “Nursing”, “General Medicine”, “Obstetrics” and a specialist certificate in the specialty are allowed to engage in professional activity as a nursing assistant in a physiotherapy room. "Physiotherapy".
1.2. Appointment and dismissal from a position is carried out by the dispensary in accordance with current legislation.
1.3. The physiotherapy specialist reports directly to the FTC doctor.
1.4. In his work he is guided by the regulations on the work of the physiotherapy room, job descriptions, functional responsibilities, the institution's charter, internal labor regulations, an agreement on the team form of labor organization, legislative regulations, official documents in the field of healthcare, orders, instructions and instructions of higher officials.
II. RESPONSIBILITIES
2.1. Possession theoretical knowledge in dermatovenerology to the extent provided for paramedical workers.
2.2. Preparation of physiotherapeutic equipment for work, monitoring of serviceability, correct operation, safety precautions.
2.3. Current control over the safety and serviceability of equipment, its timely repair and decommissioning.
2.4. Preparing patients for physiotherapeutic procedures, monitoring the patient’s condition during the procedure.
2.5. Carry out physiotherapeutic procedures as prescribed by the attending physician, according to the instructions, observe the principles of compatibility and sequence of prescribed physical factors and procedures.
2.6. Compliance with occupational health, safety, occupational health, fire safety requirements when operating premises, equipment and apparatus used for physiotherapeutic procedures.
2.7. Ensuring infection safety of patients and medical personnel, fulfilling infection control requirements in the physiotherapy room.
2.8. Timely and high-quality maintenance of medical records.
2.9. Ensuring proper storage and accounting of use medicines.
2.10. Compliance with moral and legal standards of professional communication, fulfillment of requirements labor discipline.
2.11. Carrying out sanitary and educational work.
2.12. Regular professional development.
2.13. If patients stop a physical procedure without permission, immediately notify the FTC doctor.
2.14. Providing first aid in emergency conditions.
2.15. Must be proficient in the techniques and methods of conducting physiotherapeutic procedures:
electrotherapy;
galvanization;
medicinal electrophoresis;
transcerebral pulsed electrotherapy (electrosleep, transcranial electroanalgesia, mesodiencephalic modulation);
diadymotherapy;
amplipulse therapy;
interference therapy;
fluctuarization, fluctuophoresis;
electrical stimulation;
darsonvalization;
supratonal therapy;
inductothermy;
UHF therapy (UHF electric field, UHF inductothermy);
electromagnetic field of microwave therapy in the decimeter, centimeter and millimeter ranges;
magnetic therapy;
franklinization;
aeroionotherapy;
phototherapy: infrared radiation;
visible radiation;
ultraviolet radiation;
coherent radiation (lasotherapy);
aerosol therapy, halotherapy;
vibration therapy;
barotherapy;
ultrasound therapy, phonophoresis;
hydrotherapy;
balneotherapy;
use of drinking water mineral waters;
mud therapy;
heat and cold treatment;
hypoxic therapy.
III. RIGHTS
3.1. Receive the information necessary for the high-quality performance of functional duties.
3.2. Make proposals to management to improve the quality of medical care to the population and improve the organization of work.
3.3. Give orders to the junior medical staff of the physiotherapy room, control the volume and quality of work performed by them, monitor the work of the technician maintenance and equipment repair.
3.4. Take part in meetings, conferences, sections and medical associations that discuss issues related to professional competence.
3.5. Improve your qualifications, get certified for assignment of a qualification category in the prescribed manner..
IV. RESPONSIBILITY
4.1. For the correct and timely execution of doctors’ orders by subordinate staff of the department.
4.2. For compliance with labor discipline, safety regulations, as well as the medical and protective regime.
4.3. For high-quality maintenance of medical documentation, timely preparation and submission of reporting documents.
4.4. For timely information, manager. emergency department.
4.5. For compliance with the proper sanitary and anti-epidemic regime in the department.
4.6. For failure to comply with the requirements of the job description and one’s functional duties, except for the liability provided for by the Criminal Code of the Russian Federation (for violation of safety regulations).
Agreed
I have read the instructions: ___________________
(signature)
"___"__________ 20__
V. GENERAL KNOWLEDGE
types, forms and methods of rehabilitation, organization and implementation of activities for the rehabilitation of patients with dermatovenerological pathology;
basics of valeology and sanology; methods and means of hygienic education;
basics of medical examination, social significance diseases;
infection control system, infection safety of patients and medical staff of the dispensary;
accounting and reporting activities of a structural unit, main types of medical documentation;
occupational health and safety in the dispensary;
functional duties, rights and responsibilities of junior medical personnel;
fundamentals of disaster medicine.
VI. GENERAL SKILLS
analyze the current situation. And make decisions within the limits of their professional competence and authority;
possess communication skills;
carry out diagnostic, therapeutic, resuscitation, rehabilitation, preventive, health-improving, sanitary-hygienic, sanitary-educational measures in accordance with their professional competence and powers;
implement and document the main stages of the nursing process;
master the basic elements of massage, use psychotherapy techniques;
master the technique of basic nursing manipulations;
assess the condition and identify the leading syndromes and symptoms in patients and victims who are in serious and terminal condition, provide emergency pre-medical care in emergency conditions;
evaluate the effect of drugs in a particular patient;
comply with pharmaceutical procedures for obtaining, storing and using medicines;
comply with occupational safety and health regulations;
maintain approved medical documentation;
comply with the requirements of infection control, infection safety of patients and medical personnel;
carry out measures to protect the population, patients, victims and disaster medicine service personnel, medical service civil defense; provide first aid in emergency situations;
raise professional level knowledge, skills and abilities.
VII. SPECIAL KNOWLEDGE AND SKILLS
issues of organizing physiotherapeutic services and resort business in the Russian Federation;
rules and requirements for the equipment of the physiotherapy department, office;
equipment used in physiotherapy, its technical meaning of physical factors and procedures;
safety precautions in the physiotherapy department and office; regulations on occupational health and safety;
mechanism of action of physical factors, influence of physical factors on the main pathological processes and functions different organs and body systems;
principles of compatibility and sequence of assignment of physical factors and procedures;
principles of using physical factors for the prevention of diseases and rehabilitation of patients, including dispensary groups;
indications and contraindications for the use of physical factors;
possible complications during physiotherapeutic procedures, preventive measures;
principles of emergency care in case of injury from electric current, light radiation, electromagnetic field, etc.;
features and implementation of physical therapy in children;
use technical means protection when performing physical procedures;
master the techniques and methods of conducting physical procedures;
VIII. MANIPULATION
all types of injections;
artificial ventilation lungs;
indirect massage hearts;
stopping bleeding from superficial vessels;
immobilization of limbs for injuries;
gastric lavage;
giving enemas;
change blood pressure;
heart rate measurement;
definition of number breathing movements;
temperature measurement.
I have read the instructions: ___________________
(signature)
"___"___________20__
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Execution conditions: outpatient clinics
1. Carrying out therapeutic and diagnostic appointments in the clinic and at home
2. Carrying out preventive and sanitary education measures
3. Preparation of an outpatient appointment with a local therapist (preparing a workplace, equipment, tools, individual cards outpatient, forms, prescriptions, etc., timely receipt of results and posting them on cards, etc.).
4. Measuring blood pressure in patients as directed by the local physician, performing thermometry and other medical procedures.
5. Under the supervision of a doctor, filling out statistical coupons, emergency notification cards, referral forms for diagnostic and treatment procedures, entering into outpatient cards patients with fluorographic and other examination data, helps fill out application forms for VTEC, health resort cards, extracts from outpatient cards.
6. Issuing coupons to patients for repeat visits to the doctor.
7. Instructing patients on preparation for laboratory and instrumental studies.
8. Under the supervision of a doctor, filling out a dispensary observation card for newly identified patients.
9. Preparation of preliminary materials for drawing up a report on the clinical examination of the population of the site.
10. Equipment necessary tools and medicine bags from a therapist for providing care at home.
11. Performing manipulations and taking material for bacteriological research in accordance with the doctor's prescription.
12. Informing the attending physician about the performance of diagnostic and medical procedures and all cases of violation of the regime by patients left for treatment at home.
13. Conducted under the guidance of a physician preventive vaccinations and their registration.
MEDICAL SERVICE No. 3
Effective Communication Techniques
Functional purpose: diagnostic, therapeutic, preventive
Conditions of implementation: outpatient, inpatient, emergency care at home, sanatorium-resort
Goal: learn effective communication
1. Choose a time for communication that is convenient for the patient and not busy with procedures.
2. Speak slowly, with good pronunciation, giving the patient time to absorb the information
3. Do not abuse terminology, without causing fear in the patient of unknown and incomprehensible information
4. Choose the pace and speed of speech for a specific person, taking into account the characteristics of perception and processing of information in different patients
5. Do not start a conversation with unfavorable information for the purpose of warning negative emotions making communication difficult
7. Ask open-ended questions to get more accurate answers.
8. Use a sense of humor carefully, taking into account the different perception of information and the degree of sense of humor in patients
Techniques for Effective Written Communication
Goal: learn effective written communication
Equipment: pens with refills of different colors, paper, dictionary.
1. Write carefully for better perception and understanding of written information
2. Choose the correct size and color of letters, since patients may have different levels of visual acuity and color perception
3. Include in the note all necessary information to eliminate ambiguities, doubts and questions from the patient
4. Write correctly, as errors distort information and undermine the authority of the nurse
5. Use clear and simple words(complex words and unclear terms make it difficult to understand and cause anxiety and fear in patients)
6. Sign the message in order to enable the patient, if necessary, to receive Additional information
MEDICAL SERVICE No. 4
Individual patient education plan for blood pressure self-monitoring
Goal: to teach the patient and family members to independently control blood pressure
Type of training: individual
Conditions of implementation: outpatient, inpatient, emergency care at home.
Equipment: (tonometer, phonendoscope, pen, temperature sheet, ruler), observation diary.
I. Preparation for the procedure:
1. Warn the patient about upcoming training, determine motivation and ability to learn.
2. Clarify the patient’s understanding of the purpose and course of the training process and obtain his consent to conduct it.
3. Prepare equipment and select the correct cuff size.
II. Performing the procedure:
4. Familiarize the patient with the device of the tonometer and phonendoscope
5. Warn that the measurement is carried out no earlier than 15 minutes after physical activity
6. Demonstrate the cuff application technique:
7. Place the cuff on your left bare shoulder 2-3 cm above the elbow (clothing should not squeeze the shoulder above the cuff); secure the cuff so that only one finger fits through. The center of the cuff is located over the brachial artery (it is advisable for the patient to sit quietly with the cuff applied for 5 minutes).
8. Demonstrate the technique of connecting the cuff and pressure gauge
9. Check the position of the pressure gauge needle relative to the zero scale mark.
10. Demonstrate the technique of palpating the pulse on brachial artery in the elbow area
11. Insert the phonendoscope olives into the ears and place the phonendoscope membrane at the place of pulsation so that the membrane is under the cuff
12. Demonstrate the technique of using the punching bag:
Take the pressure gauge in the hand on which the cuff is placed, and in the other - the “pear” so that with the 1st and 2nd fingers you can open and close the valve.
Close the valve on the bulb by turning it to the right, and with the same hand quickly pump air into the cuff after the disappearance of Korotkoff sounds (or pulsation of the radial artery) by another 30 mm Hg. Art. higher.
Release air from the cuff at a rate of 2-3 mmHg. Art. in 1 s, turning the valve to the left.
At the same time, use a phonendoscope to listen to the sounds on the brachial artery and monitor the indicators of the pressure gauge scale: when the first sounds (Korotkoff sounds) appear, “mark” on the scale and remember the number corresponding to the systolic pressure.
Focus the patient's attention on the fact that the appearance of the first sounds corresponds to the value of systolic pressure, and the transition of loud sounds to dull sounds or their disappearance corresponds to the value of diastolic pressure.
Repeat the procedure after 2-3 minutes.
13. Round the measurement data to 0 or 5, write it as a fraction: in the numerator – systolic pressure; the denominator is diastolic (research data taken according to the smallest dimension).
14. Ensure that the patient is trained in the technique of measuring blood pressure by asking him to demonstrate the procedure. If necessary, provide written instructions.
15. Teach how to keep an observation diary.
III. End of the procedure:
16. After use, wipe the membrane and olives of the phonendoscope with a gauze ball with alcohol.
17. Wash your hands.
Plan nursing care
FULL NAME. patient______ Petrov Ivan Nikolaevich ______________________________
Department________therapeutic_________________________________
Chamber No._________No. 4_____________________________________________
The essence of planning is to determine (together with the patient):
· Goals (expected results) for each problem
· The nature and extent of nursing intervention required to achieve the goals
Duration of nursing intervention
To evaluate the outcome of nursing care, goals must be specified in measurable indicators, i.e. recorded as a change in the patient’s behavior, his verbal reaction, specific changes in the dynamics of the condition, measurement of certain physiological indicators.
The care plan records nursing interventions - a list of nurse actions aimed at solving the problems of a particular patient. It is important to use specific terms and detailed descriptions of actions to describe interventions.
All nursing interventions fourth stage nursing process - implementation, after implementation are recorded in the protocol to the care plan, indicating the time, the action itself and the patient’s reaction to the nursing intervention.
Protocol to the care plan
Department_____therapeutic No. 1_________________________________
Chamber___No. ______________________________________________________________
Patient's full name_____Petrov Ivan Nikolaevich___________________________
Medical diagnosis___Ulcer duodenum __________________
Final rating_________positive______________________________
Signature of sister____Kotova E.V._____________________________________________
Ongoing assessment of the effectiveness and quality of nursing care (fifth stage of the nursing process) made by the sister constantly. Target final assessment– determine the result, i.e. the patient's condition achieved as a result of nursing intervention. To perform the final assessment, the nurse will need the same skills as during the initial assessment of the patient.
If the set goal is achieved, a clear entry is made in the care plan “Goal achieved.” If not achieved or not fully achieved, the patient’s verbal or behavioral reaction should be recorded.
Remember!
· Document all nursing interventions at the earliest short time
· Record vitally important interventions immediately
Always record abnormal patient conditions
· Sign clearly in each box indicated for signature
Document facts, not your own opinions
· Do not use “vague” terms
· Be precise and describe briefly
· Focus on 1-2 problems or important events of the day every day
· Record patient non-compliance with doctor's orders or refusals
· Do not leave empty columns in the documentation
· Record only interventions performed by the nurse
Additional information about the features of the technique
The nurse should constantly monitor appearance and the patient’s condition, and if there are any changes in condition, inform the doctor. Observation of the appearance and condition of the patient is determined by: state of consciousness, position of the patient, general appearance, condition of the external integument.
There are 5 types of states of consciousness:
1. A state of clear consciousness, when the patient specifically and quickly answers questions.
2. A state of darkened consciousness in which the patient answers correctly, but late.
3. Stupor - the patient is in a state of stupor, does not answer questions or answers thoughtlessly.
4. Stupor is a pathological sleep, the patient is unconscious, but his reflexes remain.
5. Coma - complete suppression of consciousness with absence of reflexes.
Short term loss consciousness due to anemia of the brain is called fainting.
There are three positions of the patient: active, passive and forced.
The general appearance of the patient and especially his physique in some cases make it possible to judge his state of health. According to the patient's posture; his demeanor, one can draw conclusions about the severity of the disease, muscle development, and sometimes about professional habits.
Most seriously ill or mentally depressed people are hunched over. At external inspection determine the type of constitution (anatomical and physiological characteristics of the body, inherited from parents and in interaction with external environment). There are three constitutional types: normosthenic, asthenic, hypersthenic.
Facial examination provides significant assistance in diagnosing various diseases. Upon examination, peritonitis (inflammation of the peritoneum) sharpens facial features, sunken eyes, and profuse sweat appears (Hippocrates' face). With kidney disease, the face is swollen and pale.
In feverish patients, the face takes on an expression of excitement: the cheeks are red, the eyes are shiny.
NOSE. Constant redness of the nose with developed small vessels is observed in chronic alcoholism. Nosebleeds can be caused by local reasons And general diseases(hypertension, blood disease).
When examining the EYES, pay attention to the condition of the cornea, conjunctiva, and pupils. Protrusion of the eyes (exophthalmos), trembling eyelids are signs of the disease thyroid gland. Staining of the sclera and conjunctiva in yellow is early symptom jaundice. Constriction of the pupils is observed in case of poisoning with morphine, opium, brain tumors, and dilation is observed in case of atropine poisoning and coma.
Pay attention to color skin and mucous membranes. PALNESS of the skin develops primarily as a result of a decrease in the amount of blood in the vessels of the skin (cooling, blood loss, malignant tumors). In addition, pallor occurs in patients with edema due to kidney disease due to compression of skin vessels.
REDENESS (HYPEREMIA OF THE SKIN) can have different shades, reaching a purple-cherry color, due to an increase in the content of red blood cells and hemoglobin in the blood. Redness of the skin is also caused by dilation of skin vessels (during fever), taking vasodilators(nitroglycerine).
JAUNDICE occurs due to excess accumulation bile pigments (bilirubin) in the blood and their deposits in the skin. Jaundice is distinguished: mechanical, parenchymal and hemolytic. MECHANICAL occurs when there is a violation of the outflow of bile from the gallbladder and liver into the duodenum. Bile is retained in the bile ducts and liver and partially enters the blood, and from it into the skin (cholelithiasis, cholecystitis).
IN case of damage to the parenchyma of liver cells (Botkin's disease, toxic hepatitis). Bile enters not only the bile ducts, but also into blood vessels. This type of jaundice is called parenchymal jaundice.
WITH HEMOLYTIC jaundice, increased breakdown of red blood cells is observed. Jaundice can be true or false. False jaundice occurs when taking carotene, picric acid, tomato and carrot juice. Yellow coloration occurs only on the skin. WITH TRUE jaundice, in addition to the skin, the sclera of the eyes and mucous membranes turn yellow, the bilirubin content in the blood increases, and bile pigments appear in the urine.
CYANOSIS (CYANOSIS) is distinguished between local and general.
GENERAL cyanosis occurs as a result of insufficient oxygen saturation of the blood and excessive accumulation of carbon dioxide in it (lung disease when gas exchange is disrupted). LOCAL acrocyanosis when blood flow in tissues is impaired. In this case, blueness of the tip of the nose, ears, fingers and toes is noted.
RASSHES can be of various types: erythema (large spotted, skin lesions), urticaria (whitish blisters, raised above the surface of the skin), urticaria (whitish blisters, raised above the surface of the skin), roseola (redness of the skin in the form of limited inflammatory dilatation of capillaries). They are of great importance for recognizing infectious and allergic diseases.
EDEMA can be local or general. LOCAL edema develops during a local inflammatory process or due to local obstruction of blood outflow (arthritis, boil, Quincke's edema). GENERAL swelling is observed not only on the legs, arms, face, but also in the serous cavities. Such massive widespread swelling is called anasarca. Accumulation of edematous fluid in pleural cavity is called hydrothorax, in the abdominal cavity - ascites, in the pericardium - hydropericardium. Slight swelling of the face and legs is called pastiness.
MANIPULATION No. 7
Pain intensity assessment
Functional purpose: diagnostic
Conditions of implementation: outpatient, inpatient, transportation in ambulance conditions
I.Preparation for the procedure
1. Make sure the patient is conscious.
1.1. When diagnosing consciousness other than clear, use the Glasgow Coma Scale to determine the level of depression of consciousness.
2. Make sure that verbal contact with the patient is possible, taking into account the severity of the condition, age, level of consciousness, speech impairment, presence or absence of a language barrier.
2.1. If verbal contact with the patient is impossible, diagnose and document verbal signs pain syndrome(pain markers).
II. Execution of the procedure.
3. If there is clear consciousness and the possibility of verbal contact, assess the degree of pain at the diagnostic level.
3.1. Ask the patient about pain.
3.2. If the patient confirms the presence of pain:
3.2.1. Invite the patient to rate the intensity of pain on a 5-point scale.
3.2.2. Find out the location of the pain.
3.2.3. Find out the irradiation of pain.
3.2.4. Find out the duration of pain.
3.2.5. Find out the nature of the pain.
3.2.6. Document the results obtained. Describe pain areas in terms topographic anatomy or mark on a diagram of the human body.
3.3. If the patient denies the presence of pain, document in the medical documentation the fact of the absence of pain at the time of examination.
4. When conducting a repeated study of the pain level (dynamic monitoring of the pain level), assess the pain level at the level of dynamic assessment
4.1. Invite the patient to mark the current level of pain on a 10-point visual analog control scale.
4.2. Ask the patient to mark the level of pain at the time of the previous examination on the same scale.
4.3. Assess the positive/negative dynamics of subjective assessment of pain in absolute and/or relative terms.
4.4. Document the results obtained.
5. When conducting an initial assessment of the level of pain, as well as when the nature of the pain syndrome changes, assess the level of pain at a descriptive level.
5.1. Instruct the patient on the rules for filling out the McGill questionnaire to determine the severity of pain.
5.2. Provide the patient with a questionnaire form and a pen.
5.3. Upon completion of filling, calculate ranking indices for 4 main groups (sensory sensations, emotional sensations, intensity assessment, parameters reflecting General characteristics pain); Based on the obtained indicators, calculate the rank pain index (RIB).
5.4. Fill in the calculated fields of the questionnaire form.
5.5. Based on the data obtained in paragraph 3.2.1., fill in the “real feeling of pain intensity” (NIB) field.
III.End of the procedure
6. Familiarize the patient with the results obtained.
7. Wash (using antiseptic or soap) and dry your hands.
8. Make an appropriate entry about the results of the implementation in the medical documentation.
9. If the patient refuses to undergo an assessment, as well as if there are suspicions about the truth of the data provided (simulation, aggravation, dissimulation), diagnose and document non-verbal signs of pain (pain markers).
Additional information about the features of the technique.
When assessing the level of pain on the McGill scale, it is necessary to ask the patient to mark one word that most accurately reflects his pain level. painful sensation in any (not necessarily all) classes of the rating scale.
In pediatric, geriatric, psychiatric practice, as well as in cases where assessing the level of pain is difficult due to the language barrier, it can be used pictographic scale, schematically depicting a person's facial expression.
To nonverbal signs of pain ( pain markers) relate:
Wet skin
Tachycardia and tachypnea not associated with disease
Tears, wet eyes
Pupil dilation
Forced pose
Characteristic facial expressions – clenched teeth, tension in the facial muscles (frowning forehead, pursed lips)
Pressing the painful area with your hand, stroking and rubbing it
Violation eye contact(shifty eyes).
Changing speech (tempo, coherence, style)
Behavioral reactions (restlessness, finger tapping, restlessness)
Emotional reactions: moodiness, short temper, emotional lability, outbursts of aggression.
Sleep disturbance
Loss of appetite
Longing for loneliness
Moans during sleep or at moments when the patient believes that he is alone
Frequent various complaints not related to pain.
SCALE FOR EVALUATING PATIENT'S DESCRIPTION OF PAIN.
MEDICAL SERVICE No. 9
MEDICAL SERVICE No. 10
I. Preparation for the procedure
1. Unfold the package of gloves (you can put the package on the table)
II. Executing the procedure
2. Take the glove by the lapel with your left hand so that your fingers touch inner surface gloves.
3. Close your fingers right hand and insert them into the glove.
4. Open the fingers of your right hand and pull the glove over your fingers without disturbing its cuff.
5. Place the 2nd, 3rd and 4th fingers of the right hand, already wearing the glove, under the lapel of the left glove so that the 1st finger of the right hand is directed towards the 1st finger on the left hand.
6. Hold the left glove with 2, 3 and 4 fingers of your right hand vertically.
7. Close the fingers of your left hand and insert it into the glove.
III. Completion of the procedure.
8. Straighten the lapel first on the left glove, pulling it over the sleeve, then on the right one using the 2nd and 3rd fingers, bringing them under the folded edge of the glove.
Depending on the situation, it is better to wear gloves over the sleeves of the robe. In cases where a long-sleeved robe is not required, gloves cover the wrist and part of the forearm.
Used gloves are removed as follows:
1. Using the gloved finger of your right hand, make a flap on the left glove, touching it only from the outside.
2. With the finger of your left hand, make a cuff on the right glove, also touching it only from the outside.
3. Remove the glove from your left hand by turning it inside out and holding it by the lapel.
4. Hold the glove removed from your left hand in your right hand.
5. With your left hand, take the glove on your right hand by the lapel from the inside and remove the glove from your right hand, turning it inside out.
6. Place both gloves (the left one is inside the right one) in a container with disinfectant or throw it in a waterproof bag.
MEDICAL SERVICE No. 11
Technology No. 13
Procedure algorithm
I. Cleaning the rooms.
1. During cleaning, open the windows and ventilate the room. In winter, when cleaning, patients should be well covered, their heads tied with a scarf or towel, and a blanket tucked under their feet. Patients on semi-bed rest are asked to leave the room.
2. Cleaning of wards and all other rooms is carried out using a wet method, because contained in dust a large number of microbes that cause various diseases. In the morning, wet cleaning is done after breakfast, so that by 9 o’clock the doctor’s visit will be clean.
3. Repeated wet cleaning is done before quiet time and before bedtime.
4. You need to start wet cleaning from the bedside tables. They wipe off the dust, remove unnecessary items, and control the food in the nightstand (perishable items should be stored in the refrigerator).
5. Then wipe the dust from the window sill and other furniture.
6. The room should be quiet during cleaning.
7. The floor must be washed from the windows and walls to the door. Garbage is collected in the corridor.
8. The issue of ventilation is discussed with patients.
NOTE:
v To wash each room, prepare working solution disinfectant.
v In the infectious diseases hospital, general cleaning of the wards is carried out once a week.
v Buckets and cloths marked as indicated should be used strictly for their intended purpose.
v If there is a patient in the ward who is allergic to the smell of chlorine, then the floor should be washed with a disinfectant of a different composition.
Procedure algorithm
1. Wear protective clothing
2. Inspect the room for cleaning purposes
3. With a clean rag soaked in a disinfectant chemical composition used in a hospital, wipe the surfaces of window sills, furniture, equipment, appliances and then the floor
4. Wipe the floors using the “two buckets” method
Moisten a cleaning rag in the disinfectant solution of container No. 1 and thoroughly wipe the surface to be treated.
Rinse the rags in container No. 2, wring out,
Moisten again with a disinfectant solution and wash the untreated floor surfaces
Change the disinfectant solution taking into account the consumption rate, and change the water as it becomes dirty
After disinfection, disinfect cleaning equipment, rinse, dry and store in a special cabinet or designated place.
5. Turn on bactericidal lamps.
6. Ventilate the premises
CLEANING THE OFFICE ACCORDING TO THE TYPE OF FINAL DISINFECTION.
TARGET: minimizing the number of pathogenic particles after complete cleaning of surgical premises, reducing the risk of cross-contamination.
INDICATIONS: premises of the operating unit, surgical, dressing, treatment and other manipulation rooms.
EQUIPMENT:
Disinfectant (cleaning) solutions approved for use in the Russian Federation in accordance with the established legal procedure;
Sterile rags
Cleaning equipment, either a stationary or portable wet-vacuum cleaning system;
Protective clothing for medical staff: clean gown, moisture-resistant apron, headgear, respirator mask, protective glasses, thick rubber gloves, washing flat-heeled shoes.
Regularity: once every 7 days, according to the general cleaning schedule approved by the head of the department.
Procedure algorithm
1. Wear protective clothing.
2. Inspect the room for cleaning purposes.
3. Conduct preliminary cleaning of the premises using detergent solutions.
4. Wiping the floors using the “two buckets” method.
5. Carry out disinfection: with a clean rag, generously moistened with a disinfectant chemical cleaning composition, wipe the surfaces of window sills, furniture, equipment, appliances and then the floor (irrigation from spray equipment is possible).
6. Exposure to disinfectant extract.
7. Wipe surfaces with a sterile cloth.
8. Turn on bactericidal irradiators with ultraviolet light (direct or reflected)
9. Ventilate the room.
After disinfection, disinfect cleaning equipment, rinse, dry the rags and store in a special cabinet or designated place.
MEDICAL SERVICE No. 14
MEDICAL SERVICE No. 15
Technology algorithm
1. Prepare a working solution of azopyram by mixing equal volumes (1/1) of the initial solution of azopyram and 3% hydrogen peroxide; the working solution is suitable for use only for 1-2 hours.
2. Check the activity of the working control by dropping a few drops onto a glass with a blood smear.
3. Wipe cold products (not higher than 25 0) with a swab moistened with a reagent or apply 3-4 drops of the working solution with a pipette into a syringe and move the reagent several times with a piston. With more high temperature the reagent is destroyed
4. Exposure 0.5-1 minute. Control of suitability and activity of work control.
5. Dispense the solution from the syringe onto a gauze napkin or wipe the smooth product with a gauze napkin. Ensure penetration of the working solution into the joints.
6. Reading the sample:
A brownish color appears in the presence of oxidizing agents, chlorine-containing substances, washing powder, bleaches, and rust. If color changes occur later than one minute, the sample is not counted.
7. Evaluation of the result.
8. Regardless of the test results, rinse the product with water or alcohol to remove toxic substances.
9. If the test is positive, the entire batch of products must be re-cleaned.
10. Record the test result in the log book.
11. Cleaning is carried out until a negative test result appears.
B. PHENOLPHTHALEIN TEST.
TARGET: quality control of pre-sterilization cleaning of instruments to ensure complete removal of detergents from instruments. In the centralized pre-sterilization room (CPS) - daily
Self-monitoring in the department – once a week
The Sanitary and Epidemiological Surveillance Center monitors health facilities once a quarter.
EQUIPMENT: 1% of products of the same name, but not less than 3-5 pieces; 1% alcohol solution of phenolphthalein; gauze napkins; cotton swabs; pipettes or syringe, logbook for recording the results of pre-sterilization cleaning control, alcohol, soap, dispenser with a disposable towel.
Technology algorithm
1. Prepare a 1% alcohol solution of phenolphthalein.
2. Wipe (put inside) the instrument, syringe, needle or cotton swab with alcohol solution 1% phenolphthalein and move the reagent with the piston several times.
3. Exposure – 0.5-1 minute. If the color change is later than one minute, the sample is not counted.
4. Dispense the solution from the syringe onto a gauze napkin or a smooth product, wipe with a gauze napkin.
5. Sample reading:
- “Pink” coloring – in the presence of detergents (test positive);
No staining – (negative test) in the absence of detergents.
6. Regardless of the test results, the products are washed with water or alcohol.
7. If the test is positive, the entire batch of products must be washed again under running water.
8. Record the test result in a journal.
9. Cleaning is carried out until a negative test result appears
B. TEST WITH SUDAN III.
EQUIPMENT: 1% of products of the same name, but not less than 3-5 pieces; Sudan III, ammonia, distilled water, gauze wipes; cotton swabs; pipettes or syringe, logbook for recording the results of pre-sterilization cleaning control, alcohol, soap, dispenser with a disposable towel.
1. Prepare 0.2 grams of Sudan III. ammonia, distilled water, mixing equal volumes (1/1) of the original solution, the working solution is suitable for use only for 14 days.
2. Wipe cold products (not higher than 25 0) with a swab moistened with a reagent or apply 3-4 drops of the working solution with a pipette into a syringe and move the reagent several times with a piston. At higher temperatures the reagent is destroyed
3. Exposure 0.5-1 minute. Control of suitability and activity of work control.
4. Dispense the solution from the syringe onto a gauze napkin or wipe the smooth product with a gauze napkin. Ensure penetration of the working solution into the joints.
5. Sample reading:
Pink-lilac coloring appears when there is hemoglobin on the product;
A brownish color appears in the presence of oxidizing agents, chlorine-containing substances, washing powder, bleaches, and rust. If the color change is later than one minute, the sample is not counted.
6. Evaluation of the result.
7. Regardless of the test results, rinse the product with water or alcohol to remove toxic substances.
8. If the test is positive, the entire batch of products must be re-cleaned.
9. Record the test result in the log book.
10. Cleaning is carried out until a negative test result appears.
MEDICAL SERVICE No. 16
Technique for using sterile bix in the treatment room
Functional purpose - preventive
Conditions of implementation: outpatient, inpatient, sanatorium and resort.
PURPOSE: maintaining the sterility of the dressing material, ensuring asepsis
INDICATIONS:
· invasive procedures
· treatment of skin and mucous membranes
EQUIPMENT: soap or antiseptic solution for hand treatment, sterile gloves, manipulation table, clamp on a stand with sterile material, sterile gripping tools (tweezers, forceps) in a craft bag, 70% alcohol, sterile tray, non-sterile tray (small).
Procedure algorithm
1. Put on a robe, cap, mask.
2. Pay attention to the tightness of the bix and the date of sterilization on the tag of the bix.
3. Open the latch on the bix.
4. Wash your hands in a hygienic manner.
5. Wear sterile gloves.
6. Take sterile tweezers from the craft bag and place them on a sterile tray.
7. Open the bix cover by pressing the stand pedal.
8. Using sterile tweezers, remove the sterilization indicator and check compliance with the sterilization regime.
9. Place the sterilization indicator into a non-sterile tray and keep it until the end of the work shift.
10. Using sterile tweezers, “open” the corners of the sterile diaper in the box and take out the required amount of sterile dressing material
11. Cover the dressing material in the bag with one of the corners of the sterile diaper and leave the rest outside.
12. Close the lid of the box by releasing the pedal.
13. Place sterile tweezers in a sterile tray.
14. The shelf life of sterile material in a hidden container is 2 hours.
MEDICAL SERVICE No. 17
The position of the sister's hands.
The method of restraint used during transfer depends on the patient's painful areas and how much assistance will be provided during transfer.
It is necessary to control the patient's body position and movements as much as possible.
Patient position. Before lifting (moving), you need to help him lie down or put him in a comfortable position, taking into account the biomechanics of the body during subsequent movement.
The position of the sister's back and spine must be straight during movement. The shoulders, as far as possible, should be in the same plane as the pelvis. When lifting the patient with one hand, the other, free, maintains the balance of the torso and, therefore, the position of the back, serving as a support for relieving the load from the spine.
Some patients can help themselves to lift if, with the help of a nurse, they make several rocking movements to create a driving force. In this case real strength The time spent by a nurse to lift a patient in a standing position may be minimal.
When dealing with even a helpless patient, gentle rocking between him and the nurse can encourage movement and make the lifting process easier. These skills can be learned, but require a sense of rhythm, coordination, and patient understanding and cooperation.
Working in a team. The patient's movement can only be successful if the movements are coordinated.
A nurse is a specialist with secondary medical education. This level of specialized knowledge is given in a medical college.
Nurses have three main tasks: assist the doctor, carry out his orders and care for the patient (nursing process). Nurses are considered paramedical staff. The list of their responsibilities depends on the profile of the medical institution, the department where the nurse works and the position held.
Nurses are different
A nurse can hold one of many positions and thus grow professionally.
The top rung in the “hierarchy” of nurses is the chief nurse.
In order to take this position, you must have higher education– successfully complete the Faculty of Higher Nursing Education. The responsibilities of the chief nurse include the rational organization of staff work, organizing the retraining of workers, and monitoring their activities.
The head nurse is an assistant to the head of the department on all administrative and economic issues. Elder sister is the immediate supervisor of ward nurses and junior staff.
The responsibilities of ward nurses include carrying out medical prescriptions, observing and caring for patients, in particular, organizing their meals.
The procedural nurse also carries out the doctor’s orders and helps him with various manipulations.
Operating room nurses help surgeons by preparing instruments, linen, sutures and dressings.
The district nurse assists the district doctor during the appointment of patients,, according to his instructions, performs procedures at the patient’s home, and participates in disease prevention measures.
A separate “type” of nurses are specialists assisting a neurologist, ophthalmologist and other “specialized” doctors.
A dietary nurse, or dietitian, is an assistant to a dietitian. She organizes therapeutic nutrition and controls its quality. Her responsibilities include monitoring the processing and distribution of food, the sanitary condition of the kitchen and dining room.
List of responsibilities common to all nurses
Despite such a wide variety of positions and functional responsibilities, there is a certain list of functions common to all nurses.
This list includes:
- direct implementation of the attending doctor’s prescriptions (mustard plasters, injections, enema, distribution of medications);
- implementation of the nursing process – initial examination patient, removal of vital important indicators, collection biological material for further testing, caring for patients, including organizing their nutrition;
- providing assistance until the doctor arrives;
- transportation of patients;
- admission and discharge of patients;
- monitoring the sanitary condition of hospital departments;
- monitoring patients’ compliance with the hospital’s routine;
- maintaining documents.