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General nursing care. Turkina N.V., Filenko A.B.

General nursing care. Textbook. Turkina N.V., Filenko A.B. In accordance with the program approved by the Ministry of Health of the Russian Federation, the textbook discusses the main issues of general patient care, raising the necessary issues of asepsis and antisepsis, desmurgy, emergency conditions, including bleeding and methods for stopping it. The basic principles of caring for patients in surgical and therapeutic clinics are described. The issues of performing various manipulations are described in detail: all types of injections, catheterization, measuring blood pressure using all modern devices and their detailed characteristics, thermometry using all modern thermometers, an algorithm for placing cups, mustard plasters and much more. Algorithms of actions for performing various manipulations are given, as well as the necessary set of tools and material for their implementation.
The textbook is illustrated with photos, diagrams, tables. When presenting the material, the authors focused on the results of modern scientific developments and new technologies.
The textbook was created according to the ROXY project. Designed for students of medical institutes and medical faculties of universities.

a common part

1. Types of medical and preventive institutions
2. Hospital structure
2.1. Reception department
2.1.1. Responsibilities of the duty nurse of the admission department
2.1.2. Pediculosis and anti-pediculosis treatment technology
2.2. Structure of the medical department
2.2.1. Equipping a nurse's station
2.2.2. Therapeutic and protective regime of the department
2.2.3. Ward (guard) nurse
2.3. Operating block structure
2.3.1. General requirements for the design of a modern operating unit
3. Requirements for sanitary processing of instruments and equipment in medical institutions
3.1. Basic sterilization methods
3.1.1. Examples of high-level disinfectants and sterlet
3.2. Requirements for sanitary treatment of surfaces
3.3. Requirements for sanitizing the hands of medical personnel
3.3.1. Surgical hand antisepsis
3.3.2. Surgical hand antisepsis technique
3.3.3. The effects of antiseptics on the skin
4. Medical waste
4.1. Waste classification
4.2. General procedure for disinfection of waste and reusable equipment
4.3. Methods of waste disposal
5. Method of general examination of the patient
5.1. Examination of the patient
5.1.1. Assessment of the patient’s motor activity (position)
5.1.2. Body assessment
5.1.3. Methodology for performing the medical service “growth measurement”
5.1.4. Skin
5.1.5. Assessment of consciousness
5.1.6. Study and assessment of vital functions
5.1.7. Arterial pressure
5.1.8. Breath
5.1.9. Determining the severity of the patient
6. Fever
6.1. Thermoregulation
6.2. Rules for measuring temperature
6.2.1. Measuring temperature with an electric thermometer
6.2.2. Methods for measuring body temperature with a liquid crystal thermometer
6.3. Types of fevers
6.3.1. Character of the temperature curve
6.3.2. The impact of fever on the human body
6.4. Stages of fever
6.5. Some variants of fevers encountered in practice
6.6. Treatment of febrile conditions. Antipyretic drugs
7. Creating a state of comfort for the patient while maintaining bed rest
7.1. Change of bed linen
7.1.1. Changing linen for a bedridden patient who is allowed to turn over in bed
7.1.2. Changing linen for a bedridden patient who is prohibited from turning over in bed
7.2. Change of underwear
7.3. Defecation aid for seriously ill patients
8. Basic hygiene procedures
8.1. Skin care
8.1.1. Carrying out a hygienic shower
8.1.2. Carrying out a hygienic bath
8.1.3. Skin care for seriously ill patients
8.1.4. Washing feet in bed
8.1.5. Washing the patient
8.2. Oral care
8.2.1. Oral treatment
8.2.2. Oral irrigation
8.3. Ear care
8.3.1. Removing dirt and wax plugs
8.3.2. Putting ointment in the ear
8.3.3. Putting drops in the ears
8.4. Nose care
8.4.1. Treatment of the nasal passages
8.4.2. Putting drops into the nose
8.4.3. Help with nosebleeds
8.5. Eye care
8.5.1. Rubbing the eyes
8.5.2. Eye wash
8.5.3. Other manipulations in eye care
8.5.4. Chemical burns to the eyes
8.5.5. Thermal burns of the eyes
9. Transportation and repositioning of the patient
9.1. Transportation on a gurney
9.2. Transporting the patient to the department on a wheelchair
9.3. Transportation on a stretcher
9.4. Shifting the patient
10. Organization of feeding of patients
10.1. Therapeutic diets
10.2. Fasting diets
10.3. Organization of meals for patients in the department
10.4. Artificial nutrition
10.4.1. Artificial nutrition through a gastric tube
10.4.2. Artificial nutrition through a gastrostomy tube
10.4.3. Parenteral nutrition
11. The simplest physiotherapeutic procedures in organizing patient care
11.1. Segmental reflex therapy
11.2. Mustard plasters
11.2.1. Mechanism of action of mustard
11.2.2. Application of mustard plasters
11.2.3. Mustard baths and wraps
11.3. Medical banks
11.4. Medical heating pads
11.4.1. Types of medical heating pads
11.4.2. Using medical heating pads
11.5. Using an ice pack
11.6. Compresses
11.7. Hirudotherapy
11.7.1. Anatomical structure of medicinal leeches
11.7.2. The mechanism of the therapeutic action of leeches

Basic manipulations

12. Injections
12.1. Syringe
12.1.1. General information about medical syringes
12.1.2. Diagram of the structure of a disposable syringe
12.2. Medical needles
12.2.1. injection needles
12.2.2. Puncture force
12.2.3. Packaging of needles
12.3. Safe manipulation (injection)
12.4. Injections
12.4.1. Preparing for the injection
12.4.2. Intradermal injections
12.4.3. Subcutaneous injections
12.4.4. Intramuscular injections
12.4.5. Intravenous injections
12.4.6. Catheter care
13. Giving enemas
13.1. Cleansing enema
13.2. Siphon enemas
13.3. Hypertonic enemas
13.4. Oil enemas
13.5. Emulsion enemas
13.6. Medicinal enemas
13.7. Starch enemas
13.8. Chloral hydrate enemas
13.9. Drip enemas
13.10. Nutrient enemas
14. Gastric lavage
14.1. Gastric lavage using the tube method
14.1.1. Probe length measurement
14.2. Insertion of a nasogastric tube
15. Catheterization of the urethra
15.1. Catheterization technique in men
15.1.1. Features of catheterization with a flexible Foley catheter
15.1.2. Features of catheterization with a metal catheter
15.1.3. Some technical techniques for difficult catheterization in men
15.2. Catheterization technique in women
15.3. Possible complications and their elimination
16. Insertion of gas tube
17. Administration of suppositories
18. Bedsores
18.1. Formation of bedsores

Special part

19. Care for patients with diseases of the cardiovascular system
19.1. Heartbeat
19.2. Pain in the heart area
19.3. Dyspnea
19.4. Edema
19.5. Acute myocardial infarction
19.6. Chronic heart failure
19.7. Increased blood pressure
19.8. Decreased blood pressure
20. Caring for patients with respiratory diseases
20.1. Dyspnea
20.2. Respiratory failure
20.3. Oxygen therapy
20.4. Cough
20.5. Hemoptysis and pulmonary hemorrhage
20.6. Basic principles of caring for a patient with chest pain
20.7. Basic principles of care for chills and fever
21. Care for patients with diseases of the digestive system
21.1. Stomach ache
21.2. Dyspeptic disorders
21.3. Laboratory examination of stool
21.3.1. Basic normal indicators of laboratory examination of stool
21.3.2. Rules for stool collection
21.4. Preparing patients for x-ray, endoscopic and ultrasound examinations of the digestive organs
22. Care for patients with diseases of the nervous system
22.1. Signs of damage to the nervous system
22.2. Stroke
22.3. Traumatic brain injury
23. Care for patients with kidney and urinary tract diseases
23.1. Symptoms of urological diseases
23.1.1. Pain
23.1.2. Urinary disorders
23.1.3. Changes in the quantity and quality of urine
23.2. Collecting urine for testing
23.2.1. Determination of daily urine output
23.2.2. Determination of renal concentration function
23.3. Features of observation, treatment and care for patients with certain kidney diseases
23.3.1. Kidney failure
23.3.2. Acute urinary retention
23.3.3. Renal colic
23.3.4. Observation and treatment methods for patients with urinary incontinence
23.3.5. Caring for patients with urinary incontinence
23.4. Preparing patients for instrumental examinations of the urinary system
24. Care of operated patients
24.1. Classification of postoperative complications
24.2. Care and monitoring of postoperative wounds
24.3. Drainage care
24.3.1. Drainage and wound care
24.3.2. Chest drainage care
24.3.3. Caring for drains in the urology department
24.4. Care for patients with fistulas of various organs
24.4.1. Cervical esophagostomy
24.4.2. Gastrostomy
24.4.3. Enterostomy
24.4.4. Cholecystostomy
24.4.5. Colostomies
24.4.6. Artificial anus
24.4.7. Tracheostomy
24.4.8. Caring for patients with epicystostomy
24.4.9. Monitoring the functions of the respiratory system
24.4.10. Monitoring the functions of the cardiovascular system
24.4.11. Classification of pulmonary embolism
24.4.12. Monitoring the functions of the digestive system
24.4.13. Monitoring the function of the urinary system
24.4.14. Disorders of carbohydrate metabolism
25. Hemostasis
25.1. Types of bleeding
25.2. Ways to stop bleeding
25.2.1. Temporary stop of bleeding
25.2.2. Stopping bleeding by applying an Esmarch tourniquet
25.2.3. Stop bleeding by applying a pressure bandage
25.2.4. Stopping bleeding with maximum flexion of the limb
25.2.5. Stopping bleeding with wound tamponade
25.2.6. Stopping bleeding by squeezing the vessel for
25.2.7. Stopping bleeding by applying a clamp to the bleeding vessel
26. Transport immobilization
26.1. Gypsum bandage
26.2. Principles of transport immobilization
26.3. Transport immobilization for neck injuries
26.4. Transport immobilization for spinal injuries
26.5. Transport immobilization for shoulder girdle injuries
26.6. Transport immobilization for upper limb injuries
26.6.1. Immobilization with ladder and plywood splint
26.6.2. When immobilizing using improvised means
26.6.3. Forearm injuries
26.6.4. Damage to the wrist joint and fingers
26.7. Transport immobilization for pelvic injury
26.8. Transport immobilization for injuries of the lower extremities
26.8.1. Immobilization with Dieterichs splint
26.8.2. Immobilization with a ladder splint
26.9. Transport immobilization of the lower leg
27. Desmurgy
27.1. Materials for dressings
27.2. Classification of dressings by type of dressing material
27.3. Classification of dressings according to their purpose
27.4. Classification of dressings according to the method of fixing the dressing material
27.4.1. Bandage-free dressings
27.4.2. Bandages
27.5. Headbands
27.5.1. Headband "bonnet"
27.5.2. Cap, "Hippocrates' cap"
27.5.3. Bandage for one or both eyes
27.5.4. Cross-shaped, or figure-of-eight, bandage
27.6. Bandages for the chest area
27.6.1. Cross-shaped bandage on the chest
27.6.2. Deso bandage
27.6.3. Velpeau bandage
27.6.4. Breast bandage
27.7. Bandages for the limbs
27.7.1. Spica bandage for the shoulder area
27.7.2. “Turtle” converging bandage for the elbow and knee joints
27.7.3. Ankle bandage
27.7.4. Spiral bandage for one finger
27.7.5. “Glove* bandage on the hand
27.7.6. Spica bandage for the first finger of the hand
27.8. Headbands and neckties
27.8.1. Upper limb bandages
27.8.2. Bandages for the lower limb
27.8.3. Headbands
27.8.4. Bandages on the torso
28. Terminal states
28.1. Burns
28.1.1. Thermal burns
28.1.2. Chemical burns
28.2. Electrical injury
28.3. Bites
28.3.1. Animal bites
28.3.2. Snake bites
28.4. Long-term crush syndrome
28.5. Frostbite and hypothermia
28.6. General cooling (freezing)
28.7. Drowning
28.7.1. Types of drownings
28.7.2. Urgent Care
28.8. Acute poisoning
28.8.1. Diagnosis of poisoning
28.8.2. General principles of treatment of acute poisoning
29. Resuscitation measures
29.1. Last stages of life
29.1.1. Preagonal state
29.1.2. Agony
29.1.3. Clinical death
29.1.4. Circulatory arrest
29.2. Reanimation
29.2.1. Primary resuscitation measures
29.2.2. Basic resuscitation measures
29.2.3. Advanced life support
29.2.4. End of resuscitation measures
29.2.5. Cardiopulmonary resuscitation in pediatrics
29.2.6. Legal basis for cessation and refusal of cardiopulmonary resuscitation
29.3. About ascertaining biological death

Name: General nursing
Turkina N.V., Filenko A.B.
The year of publishing: 2007
Size: 33.2 MB
Format: djvu
Language: Russian

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Russian Federation

N.V. Turkina A.B. Filenko
General care

UNDER GENERAL EDITION

Academician of the Russian Academy of Medical Sciences I.N. Denisova

Corresponding Member of the IAS VSh N.V. Turkina

Introduction

a common part

Types of medical and preventive institutions

Hospital structure

Reception department

Pediculosis and anti-pediculosis treatment technology

Structure of the medical department

Therapeutic and protective regime of the department

Operating block structure
Method of general examination of the patient

Fever

Rules for measuring temperature

Types of fevers

Character of the temperature curve

Stages of fever

Treatment of febrile conditions. Antipyretic drugs
Creating a state of comfort for the patient while maintaining bed rest

Change of bed linen

Change of underwear

Giving a bedpan to a bedridden patient

Basic hygiene procedures

Skin care

Carrying out a hygienic shower

Carrying out a hygienic bath

Skin care for seriously ill patients

Washing feet in bed

Washing the patient

Oral care

Ear care

Nose care

Eye care

Transporting and shifting the patient

Organization of feeding patients

Diet therapy

Organization of meals for patients in the department.

Artificial nutrition
The simplest physiotherapeutic procedures in organizing patient care

Segmental reflex therapy

Mustard plasters

Medical banks

Using a medical heating pad

Using an ice pack

Compresses

Hirudotherapy
Basic manipulations
Injections

Characteristics of syringes

Needle characteristics

Algorithm for performing the manipulation

Set of medicinal solution from an ampoule

Intradermal injections

Subcutaneous injections

Intramuscular injections

Intravenous injections
Administration of enemas

Gastric lavage

Urethral catheterization

Insertion of gas tube

Administration of suppositories

Bedsores
Special part

Caring for patients with cardiovascular diseases

Caring for patients with diseases of the nervous system.

Caring for patients with kidney and urinary tract diseases

Care of operated patients
Hemostasis

Types of bleeding

Ways to stop bleeding

Transport immobilization
Terminal states

Electrical injury

Animal bites

Snake bites

Long-term crush syndrome

Frostbite and hypothermia

General cooling (freezing)

Drowning

Acute poisoning.
Resuscitation measures
Applications

A COMMON PART

Types of medical and preventive institutions

In Russia, a wide network of medical and preventive institutions (HCI) has been created to provide medical care to the population. The following types of treatment and preventive institutions are distinguished:

stationary
outpatient
sanatorium-resort

TO stationary(health care facilities) include hospitals And hospitals. They are intended to provide emergency medical care, as well as planned treatment, perform complex and voluminous diagnostic procedures and studies in cases where this is not possible on an outpatient basis for medical reasons or for technical reasons. There are monoprofile ones, i.e. specialized hospitals that are designed to treat patients with a single disease and multidisciplinary. A multidisciplinary hospital includes several departments, for example, surgical, therapeutic, gynecological, etc. Inpatient facilities also include maternity, whose functions include obstetrics, treatment of pregnant women and postpartum women.

Hospitals They mainly provide medical care to current and former employees of law enforcement agencies, war veterans, as well as persons injured as a result of hostilities.

Clinic(clinical hospital) is an inpatient institution in which, in addition to medical work, scientific research is mandatory and training of students and specialists is carried out.
In addition to inpatient ones, there are also outpatient, sanatorium-resort and ambulance stations.

The functions of outpatient facilities vary.

Dispensaries provide therapeutic and preventive care to certain groups of patients (rheumatological, dermatovenerological, psychoneurological, anti-tuberculosis, oncology and other dispensaries). The scope of this assistance includes: active identification of specialized patients among the population; systematic active monitoring of identified patients (patronage); provision of specialized medical care; prevention activities. In addition, the dispensary conducts morbidity studies and health education work among the population and patients.

Clinics – multidisciplinary treatment and preventive institutions (HCI) – are intended to provide medical (including specialized) care and examination of patients on a territorial-precinct basis.

Outpatient clinics - These are healthcare facilities, in contrast to clinics, that provide specialized medical care on a smaller scale. Doctors provide consultations only in basic specialties. The principle of operation of outpatient clinics is also local, but they are located mainly in rural areas, not far from medical and obstetric centers.

Paramedic and midwife station ( FAP)– outpatient clinic in rural areas. It is organized in rural areas if the locality is more than 4-6 kilometers away from other medical institutions. It works on a local basis. Part of a rural or central district hospital. As a rule, the staff of a FAP is: paramedic - midwife - nurse. FAP staff provides first aid at outpatient appointments and at home. He is responsible for carrying out doctor’s prescriptions, attracting residents of the site for routine examinations, participating in medical examinations of the population and carrying out preventive measures. An important section of the work of the FAP is the provision of medical care during pregnancy and childbirth, obstetrics, monitoring of postpartum women at home, after their discharge from the hospital, monitoring of children under the age of 3 years, medical care of preschool institutions and schools on the site. FAP workers ensure early detection of infectious patients, carry out anti-epidemic measures, sanitary supervision of populated areas, production facilities, water supply, catering establishments, trade, and communal facilities. FAP employees provide emergency and emergency first aid. The structure of the FAP provides beds for hospitalization of women in labor, as well as for temporary isolation of infectious patients. There should be a pharmacy for the sale of ready-made medicines and sanitary and hygiene items.

Health centers Usually they are not independent health care facilities and are part of either clinics or medical units. They are usually located close to the workplace of the service population (large workshop, construction site, etc.) and come in two types: medical and paramedic. They provide pre-medical and first medical aid for injuries, poisoning, and sudden illnesses. Health center staff actively participate in medical examinations and health education work.

Outpatient facilities also include antenatal clinics . Their functions include early detection, treatment and medical examination of patients with gynecological diseases; dispensary observation, and, if necessary, treatment of pregnant women. An important place in their work is given to health education and teaching pregnant women the necessary skills to care for newborns.

Medical and sanitary unit (MSCh) is a complex of health care facilities designed for medical care of workers and employees of industrial enterprises and organizations. It operates on the principle of shop locality and is as close as possible to the place of work of workers and employees. The medical unit may include: a clinic, a hospital, health centers, a dispensary, etc. Functions of the medical unit: providing outpatient and inpatient medical care, conducting medical examinations, developing a set of preventive measures aimed at improving working conditions, identifying and monitoring occupational hazards.

Territorial medical association (TMO), like the medical unit, is a complex of health care facilities, but the medical center provides medical care not on a production basis, but on a territorial basis.

Ambulance stations – medical institutions that provide emergency medical care to the population around the clock (in case of injuries, poisoning, wounds, life-threatening sudden illnesses) at the pre-hospital stage, as well as during childbirth, and hospitalization of patients in need of hospital treatment, or women in labor in maternity hospitals. In large cities, there are linear ambulance substations and specialized ones, such as cardiology, intensive care, psychiatric, etc.

To institutions sanatorium This type includes sanatoriums, dispensaries and other institutions whose activities are based on the use of predominantly natural healing factors (climate, healing mud, mineral springs, etc.) for the treatment and prevention of diseases, as well as diet therapy, physiotherapy and exercise therapy.
The hospital includes an admissions department, treatment and diagnostic departments, administrative and utility blocks.
Hospitalization is the placement in a hospital of a medical institution of persons in need of examination, treatment or obstetric care. Hospitalization can be of two types - emergency and planned.

Emergency hospitalization (usually with delivery of the patient to the hospital by linear and specialized ambulance and emergency teams) is carried out in cases where the patient’s condition requires urgent qualified or specialized medical care in a hospital setting (patients with injuries, burns, acute or exacerbations of chronic diseases).

During planned hospitalization, the patient is admitted by a doctor at an outpatient clinic in cases where the ongoing diagnostic and treatment measures are not effective or cannot be carried out at home. Depending on the severity of the patient’s condition, his age, and household factors, he can be delivered to the emergency room by ambulance or come on his own: by transfer from another hospital after preliminary consultations with specialists, agreement and consent of the patient and the administration of these medical institutions.

In some cases, the patient may be transferred from another hospital.

The patient can also seek help without a referral, in cases where, for example, an accident occurred close to the hospital or the person felt unwell and independently went to the nearest hospital.
Hospital structure

All departments of the hospital can be divided into 2 large groups:

Treatment and diagnostic;
administrative and economic.

The diagnostic and treatment part includes:

reception department;
specialized medical departments (therapeutic, surgical, gynecological, etc.);
opera block;
diagnostic laboratories (clinical, biochemical, cytological, immunological, etc.);
diagnostic departments and offices.

The administrative and economic part includes:

offices of the chief physician and his deputies,
office;
accounting;
catering unit;
laundry;
pharmacy;
sterilization department;
blood transfusion department;
boiler room

Upon admission to the hospital, in most cases the patient goes through emergency department . Properly organized and clearly carried out work of the admission department largely determines the work of the hospital as a whole. The quality of care, the accuracy and speed of sorting patients form their first (and often the main) impression of the hospital and its employees.
Reception department

The reception department consists of the following premises:

Lobby (waiting room for relatives and accompanying persons);
Dispatch post (reception);
Examination rooms, incl. specialized (gynecological, surgical, traumatological, etc.);
Sanitary checkpoint;
Isolators for infectious and socially dangerous patients;
Procedural and dressing room;
Reanimation room (“shock” ward);
Laboratory and X-ray room;
Toilets;
Auxiliary premises (staff rooms, storage rooms, luggage storage for hospitalized patients, etc.).

Functions of the reception department

Providing emergency assistance and anti-shock therapy;

Patient registration;
Primary diagnosis;
Sorting and screening of infectious and non-core patients;
Taking tests;
Sanitation (full or partial);
Organization of patient transportation to departments.

Sequence of operation of the reception department:

Patient registration;
A thorough examination to identify external signs of highly infectious diseases and head lice;
Examination of the patient by the doctor on duty and making a preliminary diagnosis (in case of hospitalization not according to the profile - refusal of hospitalization or transfer to a specialized hospital);
The doctor determines the type of sanitization and transportation (on foot, on a wheelchair, on a gurney);
Sanitation is carried out;
The patient is transported, accompanied by a nurse, to the specialized department of the hospital.

In cases requiring emergency care, this sequence is not followed, the patient’s stay in the emergency department is reduced to a minimum, sanitization is either minimal (partial) or not performed.
Responsibilities of the duty nurse of the admission department

Registers patients in the “Register of admission of patients and refusals of hospitalization” (form No. 001/u), checking passport data and referral data for hospitalization:

last name, first name and patronymic of the patient;

the year of his birth;

home address;

where and by whom the patient was delivered (type of hospitalization);
diagnosis of the referring institution.

In case of refusal of hospitalization, indicates the reason for the refusal and the measures taken (outpatient care provided, referred to another hospital);

Fills out the passport part of the “Medical Card of an Inpatient” (form 003/u), repeating the entries made in the “Register of admission of patients and refusals of hospitalization.” She also enters information about her place of work and profession, telephone number: home or relatives (friends), if the sick person is alone. Information about any existing disability must be noted. Indications for hospitalization are noted (emergency, planned, transfer from another hospital, “gravity”). In case of emergency hospitalization, the time after which the patient was delivered by ambulance is noted.
Then the nurse fills out the passport part and the left side of the “Statistical card of a person leaving the hospital” (form No. 066/u).
Draws up an act for money, valuables, clothing and personal belongings of patients accepted for storage, filling out a receipt - a statement of the established procedure. Accepted documents and valuables of the patient are transferred to the hospital administration and stored there in a safe.
In the examination room, the nurse performs thermometry on the patient, measures blood pressure, takes anthropometric measurements, and notes the results in the medical history.
Carefully examines the patient’s hairy parts and head to identify lice, and the skin and mucous membranes to identify elements of the rash;
Provides first aid to patients, carries out the orders of the doctor on duty; if necessary, calls specialist doctors and laboratory assistants and assists in their work.
After examining the doctor on duty and his notes, the nurse completes the registration in the “Logbook of registration and admission of patients and refusals of hospitalization” (form No. 003/u) see figure). She writes in the journal:

diagnosis by the emergency department doctor upon admission;
department where the patient was sent.

On admission

patients under 16 years of age unaccompanied by adult relatives
patients in an unconscious state or in a condition that directly threatens his life, as well as in the event of his death in the emergency department, the nurse is obliged to give a telephone message to his relatives (if the telephone number is known), making an entry in the “Telephonogram Log”. In addition to these cases, the telephone message is transmitted to relatives if the patient is transferred from the emergency department to another hospital.

If the injury is of a criminal nature, an injury received as a result of an accident and when teenagers under 16 years of age are admitted due to accidents, a telephone message is given to the internal affairs bodies (the duty officer at the Internal Affairs Directorate). The nurse also gives a telephone message upon admission of unknown patients, indicating the signs of the unknown: gender, approximate age, hair color, height, physique, special signs - birthmarks, scars; called the clothes he is wearing. The nurse must write down in the “Telephone Message Log” the contents of her telephone message, the date, time of its transmission and who received it at the police department.

Organizes and controls the sanitary treatment of patients;
Organizes and controls the transportation of patients to departments;
Maintains the sanitary and epidemiological regime of the reception department.

In cases where the patient's condition is critical, he can be admitted directly to the intensive care unit, bypassing the emergency department. Then all medical documentation is completed by a nurse in the intensive care unit.

In cases where, after examination and observation by the doctor on duty of a patient who was admitted to the emergency department with a referral for hospitalization, it is determined that there are no indications for hospitalization, the patient can be sent home. The nurse makes an entry about this in the “Register of admissions of patients and refusals of hospitalization” (form “001/у”). If the patient was admitted “by gravity”, and after examination by a doctor it is determined that he does not need hospitalization, then he is provided care as an outpatient. He is sent home, about which the nurse must make an entry in the “Outpatient Registration Journal” (form 074/u).

Errors in the preparation of a medical history, statistical map, “Registration Journal”, “Telephone Log”, a journal for the hospital help desk, violations in their registration can become a source of mental, moral and legal problems for the patient and medical staff. The admissions department nurse must be very careful when filling out and maintaining medical documentation, an inventory of the receipt of documents and valuables from the patient, which are legal documents and may be required by insurance organizations, law enforcement and justice agencies.

Russian Federation

N.V. Turkina A.B. Filenko

General care

UNDER GENERAL EDITION

Academician of the Russian Academy of Medical Sciences I.N. Denisova

Corresponding Member of the IAS VSh N.V. Turkina

Saint Petersburg

Introduction

a common part

Types of medical and preventive institutions

Hospital structure

Reception department

Pediculosis and anti-pediculosis treatment technology

Structure of the medical department

Therapeutic and protective regime of the department

Operating block structure

Method of general examination of the patient

Fever

Rules for measuring temperature

Types of fevers

Character of the temperature curve

Stages of fever

Treatment of febrile conditions. Antipyretic drugs

Creating a state of comfort for the patient while maintaining bed rest

Change of bed linen

Change of underwear

Giving a bedpan to a bedridden patient

Basic hygiene procedures

Skin care

Carrying out a hygienic shower

Carrying out a hygienic bath

Skin care for seriously ill patients

Washing feet in bed

Washing the patient

Oral care

Ear care

Nose care

Eye care

Transporting and shifting the patient

Organization of feeding patients

Diet therapy

Organization of meals for patients in the department.

Artificial nutrition

The simplest physiotherapeutic procedures in organizing patient care

Segmental reflex therapy

Mustard plasters

Medical banks

Using a medical heating pad

Using an ice pack

Compresses

Hirudotherapy

Basic manipulations

Injections

Characteristics of syringes

Needle characteristics

Algorithm for performing the manipulation

Set of medicinal solution from an ampoule

Intradermal injections

Subcutaneous injections

Intramuscular injections

Intravenous injections

Administration of enemas

Gastric lavage

Urethral catheterization

Insertion of gas tube

Administration of suppositories

Bedsores

Special part

Caring for patients with cardiovascular diseases

Caring for patients with diseases of the nervous system.

Caring for patients with kidney and urinary tract diseases

Care of operated patients

Hemostasis

Types of bleeding

Ways to stop bleeding

Transport immobilization

Terminal states

Electrical injury

Animal bites

Snake bites

Long-term crush syndrome

Frostbite and hypothermia

General cooling (freezing)

Drowning

Acute poisoning.

Resuscitation measures

Applications

a common part

Types of medical and preventive institutions

stationary

outpatient

sanatorium-resort

TO stationary(health care facilities) include hospitals And hospitals. They are intended to provide emergency medical care, as well as planned treatment, perform complex and voluminous diagnostic procedures and studies in cases where this is not possible on an outpatient basis for medical reasons or for technical reasons. There are monoprofile ones, i.e. specialized hospitals that are designed to treat patients with any one disease and multidisciplinary. A multidisciplinary hospital includes several departments, for example, surgical, therapeutic, gynecological, etc. Inpatient facilities also include maternity, whose functions include obstetrics, treatment of pregnant women and postpartum women.

Hospitals They mainly provide medical care to current and former employees of law enforcement agencies, war veterans, as well as persons injured as a result of hostilities.

Clinic(clinical hospital) is an inpatient institution in which, in addition to medical work, scientific research is mandatory and training of students and specialists is carried out.

In addition to inpatient ones, there are also outpatient, sanatorium-resort and ambulance stations.

The functions of outpatient facilities vary.

Ambulance stations – medical institutions that provide emergency medical care to the population around the clock (in case of injuries, poisoning, wounds, life-threatening sudden illnesses) at the pre-hospital stage, as well as during childbirth, and hospitalization of patients in need of hospital treatment, or women in labor in maternity hospitals. In large cities there are linear ambulance substations and specialized ones, such as cardiology, intensive care, psychiatric, etc.

The hospital includes an admissions department, treatment and diagnostic departments, administrative and utility blocks.

Hospitalization is the placement in a hospital of a medical institution of persons in need of examination, treatment or obstetric care. Hospitalization can be of two types - emergency and planned.

In some cases, the patient may be transferred from another hospital.

The patient can also seek help without a referral, in cases where, for example, an accident occurred close to the hospital or the person felt unwell and independently went to the nearest hospital.

Hospital structure

All departments of the hospital can be divided into 2 large groups:

Treatment and diagnostic;

administrative and economic.

The diagnostic and treatment part includes:

reception department;

specialized medical departments (therapeutic, surgical, gynecological, etc.);

opera block;

diagnostic laboratories (clinical, biochemical, cytological, immunological, etc.);

diagnostic departments and offices.

The administrative and economic part includes:

offices of the chief physician and his deputies,

office;

accounting;

catering unit;

laundry;

sterilization department;
blood transfusion department;
boiler room

Reception department

The reception department consists of the following premises:

Lobby (waiting room for relatives and accompanying persons);

Dispatch post (reception);

Examination rooms, incl. specialized (gynecological, surgical, traumatological, etc.);

Sanitary checkpoint;

Isolators for infectious and socially dangerous patients;

Procedural and dressing room;

Reanimation room (“shock” ward);

Laboratory and X-ray room;

Auxiliary premises (staff rooms, storage rooms, luggage storage for hospitalized patients, etc.).

Functions of the reception department

Providing emergency assistance and anti-shock therapy;

Patient registration;

Primary diagnosis;

Sorting and screening of infectious and non-core patients;

Taking tests;

Sanitation (full or partial);

Organization of patient transportation to departments.

Sequence of operation of the reception department:

Patient registration;

A thorough examination to identify external signs of highly infectious diseases and head lice;

Examination of the patient by the doctor on duty and making a preliminary diagnosis (in case of hospitalization not according to the profile - refusal of hospitalization or transfer to a specialized hospital);

The doctor determines the type of sanitization and transportation (on foot, on a wheelchair, on a gurney);

Sanitation is carried out;

The patient is transported, accompanied by a nurse, to the specialized department of the hospital.

In cases requiring emergency care, this sequence is not followed, the patient’s stay in the emergency department is reduced to a minimum, sanitization is either minimal (partial) or not performed.

Responsibilities of the duty nurse of the admission department

Registers patients in the “Register of admission of patients and refusals of hospitalization” (form No. 001/u), checking passport data and referral data for hospitalization:

last name, first name and patronymic of the patient;

the year of his birth;

home address;

where and by whom the patient was delivered (type of hospitalization);

diagnosis of the referring institution.

In case of refusal of hospitalization, indicates the reason for the refusal and the measures taken (outpatient care provided, referred to another hospital);

Fills out the passport part of the “Medical Card of an Inpatient” (form 003/u), repeating the entries made in the “Register of admission of patients and refusals of hospitalization.” She also enters information about her place of work and profession, telephone number: home or relatives (friends), if the sick person is alone.

Information about any existing disability must be noted. Indications for hospitalization are noted (emergency, planned, transfer from another hospital, “gravity”). In case of emergency hospitalization, the time after which the patient was delivered by ambulance is noted.

Then the nurse fills out the passport part and the left side of the “Statistical card of a person leaving the hospital” (form No. 066/u).

In the examination room, the nurse performs thermometry on the patient, measures blood pressure, takes anthropometric measurements, and notes the results in the medical history.

Carefully examines the patient’s hairy parts and head to identify lice, and the skin and mucous membranes to identify elements of the rash;

Provides first aid to patients, carries out the orders of the doctor on duty; if necessary, calls specialist doctors and laboratory assistants and assists in their work.

After examining the doctor on duty and his notes, the nurse completes the registration in the “Logbook of registration and admission of patients and refusals of hospitalization” (form No. 003/u) see figure). She writes in the journal:

diagnosis by the emergency department doctor upon admission;

department where the patient was sent.

On admission

patients under 16 years of age unaccompanied by adult relatives

patients in an unconscious state or in a condition that directly threatens his life, as well as in the event of his death in the emergency department, the nurse is obliged to give a telephone message to his relatives (if the telephone number is known), making an entry in the “Telephonogram Log”. In addition to these cases, the telephone message is transmitted to relatives if the patient is transferred from the emergency department to another hospital.

Organizes and controls the sanitary treatment of patients;

Organizes and controls the transportation of patients to departments;

Maintains the sanitary and epidemiological regime of the reception department.

Errors in the preparation of a medical history, a statistical map, a “Recording Journal”, a “Telephone Log”, a journal for the hospital help desk, violations in their registration can become a source of mental, moral and legal problems for the patient and medical staff. The admissions department nurse must be very careful when filling out and maintaining medical documentation, an inventory of the receipt of documents and valuables from the patient, which are legal documents and may be required by insurance organizations, law enforcement and justice agencies.

Pediculosis and anti-pediculosis treatment technology