diagnostic procedures. Therapeutic and diagnostic process

Rules for preparing for diagnostic studies

For the most accurate diagnosis of diseases, the most modern laboratory equipment is not enough. The accuracy of the results depends not only on the reagents and apparatus used, but also on the time and correctness of the collection of the test material. If the basic rules for preparing for analyzes are not observed, their results can be significantly distorted.

Rules for preparing patients for laboratory tests.

1. Blood test:

The sampling of all blood tests is done before X-rays, ultrasounds and physiotherapy procedures.

If the patient has dizziness or weakness, warn the procedural sister about this - blood will be taken from you in the supine position.

Complete blood count, determination of blood type, Rh factor, biochemical tests are taken on an empty stomach, no less than 12 hours after the last meal.

1-2 days before the examination, exclude fatty, fried foods from the diet.

On the eve of the examination, a light dinner and a good rest.

On the day of the examination no breakfast (including the use of tea, coffee or juice), avoid physical activity, take medication and refrain from smoking.

If you experience difficulties with the withdrawal of drugs, then you must definitely agree with your doctor.

Drinking water does not affect blood counts, so you can drink water.

2 days before the examination, it is necessary to give up alcohol, fatty and fried foods.

Do not smoke for 1-2 hours before blood sampling.

• before a blood test, physical activity should be minimized as much as possible, emotional arousal should be avoided. You need to rest for 10-15 minutes. Before donating blood, you need to calm down in order to avoid an unmotivated release of hormones into the blood and an increase in their rate.
• you can not donate blood immediately after physiotherapy, ultrasound and x-ray examination, massage and reflexology.
• Before a hormonal blood test in women of reproductive age, you should follow the recommendations of your doctor about the day of the menstrual cycle on which you need to donate blood, since the result of the analysis is influenced by the physiological factors of the phase of the menstrual cycle.

How to prepare for the test for oncomarkers?

In order for the results of the analysis for oncomarkers to be reliable, be sure to first consult with your doctor. doctor and follow his instructions.

Basic rules for preparing for a blood test for oncomarkers:

• blood donation strictly in the morning on an empty stomach, i.e. after the last meal should be at least 8-12 hours.
• 3 days before the analysis, you should not drink alcoholic beverages, fatty foods.
• Cancel all physical activity.
• On the day of the test, refrain from smoking.
• Do not take medication.
• When analyzing for PSA, it is necessary to refrain from sexual intercourse for a week.

Patients undergoing cancer treatment are strongly advised to have the test several times a year.

2. Urine analysis

General clinical analysis of urine:

Only morning urine, taken in the middle of urination, is collected; - morning portion of urine: collection is made immediately after getting out of bed, before taking morning coffee or tea; - the previous urination was no later than 2 am; - before collecting a urine test, a thorough toilet of the external genital organs is carried out; - 10 ml of urine is collected in a special container with a lid, provided with a referral, the collected urine is immediately sent to the laboratory; - storage of urine in the refrigerator is allowed at t 2-4 C, but not more than 1.5 hours; Women should not pass urine during menstruation.

Collection of daily urine:

- the patient collects urine for 24 hours with a normal drinking regimen (about 1.5 liters per day); - in the morning at 6-8 o'clock, he empties the bladder and pours out this portion, then during the day he collects all the urine in a clean, wide-mouthed vessel made of dark glass with a lid with a capacity of at least 2 liters; - the last portion is taken at the same time when the collection was started the day before, the time of the beginning and end of the collection is noted; - the container is stored in a cool place (preferably in a refrigerator on the bottom shelf), freezing is not allowed; - at the end of the collection of urine, its volume is measured, the urine is thoroughly shaken and poured 50-100 ml into a special container in which it will be delivered to the laboratory; - be sure to indicate the volume of daily urine.

Urine collection for microbiological examination (urine culture)

Morning urine is collected in a sterile laboratory container with a lid; - the first 15 ml of urine are not used for analysis, the next 5-10 ml are taken; - collected urine is delivered to the laboratory within 1.5 - 2 hours after collection; – storage of urine in the refrigerator is allowed, but not more than 3-4 hours; - urine collection is carried out before the start of drug treatment; - if you need to evaluate the effect of the therapy, then urine culture is performed at the end of the course of treatment.

3. Analyzes in gynecology, urology

For women:

- you can not urinate for 3 hours before the test (smear, sowing); - it is not recommended to have sexual contact for 36 hours, especially with the use of contraceptives that can distort the result, as they have an antibacterial effect; - the day before, you can not wash yourself with antibacterial soap and douche; - You can not use antibiotics inside; - You can not take tests during menstruation.

For men:

- you can not go to the toilet 3 hours before the test; - you can not take inside uroseptics, antibiotics; - apply externally solutions that have a disinfectant effect, soap with an antibacterial effect; - It is not recommended to have sexual intercourse 36 hours before the test.

Sputum analysis

- the analysis is collected in a sterile laboratory container; Before collecting sputum, brush your teeth, rinse your mouth and throat.

4. Ultrasound examinations

Preparation for ultrasound of the abdominal cavity, kidneys

• 2-3 days before the examination, it is recommended to switch to a slag-free diet, exclude from the diet products that increase gas formation in the intestines (raw vegetables rich in vegetable fiber, whole milk, black bread, legumes, carbonated drinks, as well as high-calorie confectionery products - pastries, cakes );
• For patients with problems with the gastrointestinal tract (constipation), it is advisable to take enzyme preparations and enterosorbents during this period of time (for example, festal, mezim-forte, activated charcoal or espumizan 1 tablet 3 times a day), which will help reduce the manifestations of flatulence;
• Ultrasound of the abdominal organs should be performed on an empty stomach, if the study cannot be done in the morning, a light breakfast is allowed;
• If you are taking medications, notify the ultrasound doctor about this;
• It is impossible to conduct a study after gastro- and colonoscopy, as well as R-studies of the digestive tract.

Preparation for ultrasound of the pelvic organs (bladder, uterus, appendages in women)

• Transvaginal ultrasound (TVS) does not require special preparation. If the patient has problems with the gastrointestinal tract, it is necessary to conduct a cleansing enema the night before.

Preparation for ultrasound of the bladder and prostate in men

• The study is performed with a full bladder, so it is necessary not to urinate before the study for 3-4 hours and drink 1 liter of non-carbonated liquid 1 hour before the procedure.
• Before a transrectal prostate examination (TRUS), a cleansing enema should be given.

Preparing for an ultrasound of the mammary glands

• It is desirable to conduct a study of the mammary glands in the first 7-10 days of the menstrual cycle (1st phase of the cycle).

Ultrasound of the thyroid gland, lymph nodes and kidneys- do not require special preparation of the patient.

The patient must have:

- data from previous ultrasound studies (to determine the dynamics of the disease);

— referral to an ultrasound study (purpose of the study, presence of concomitant diseases);

- a large towel or diaper.

1. Functional diagnostics.
   Functional methods for examining the heart:

Echocardiography (ultrasound of the heart):

- The study is carried out after a 10-15 minute rest.

- Before research, it is not recommended to eat a heavy meal, strong tea, coffee, as well as conduct after taking medications, physiotherapy, physiotherapy exercises and other examinations that contribute to patient fatigue (X-ray, radioisotope).

- Know the exact weight.

Studies of the state of wall tone and vascular patency:

Rheoecephalography (REG), rheovasography (RVG of the extremities), ultrasonic dopplerography of the vessels of the brachiocephalic region and lower extremities, ultrasound-BCA, transcranial dopplerography.

— All these studies do not require special training. They are carried out before classes of therapeutic gymnastics, physiotherapy procedures, and taking medications.

1. Endoscopy

Fibrogastroduodenoscopy

how to properly prepare:

Appearance at least 5 minutes before the appointed time;

In the morning on the day of the study, before FGDS, it is FORBIDDEN:

- have breakfast and take any food, even if the study takes place in the afternoon

Take medication in tablets (capsules) by mouth

in the morning on the day of the study before the EGD, it is ALLOWED:

Brush your teeth

Do ultrasound of the abdominal cavity and other organs

For 2-4 hours, drink water, weak tea with sugar (without bread, jam, sweets ...)

Take medicines that can be dissolved in the mouth without swallowing or take with you

Give injections if a meal is not required after the injection and it is not possible to do it after FGDS

before the study, you need to remove removable dentures, glasses, and a tie.

The night before: an easily digestible (without salads!) dinner until 18.00.

No special diet before FGS (EGD) is required, but:

- exclude chocolate (chocolate candies), seeds, nuts, spicy dishes and alcohol for 2 days;

- in the study from 11 o'clock and later - preferably in the morning and 2-3 hours before the procedure, drink in small sips one glass of non-carbonated water or weak tea (without boiling, sweets, cookies, bread, etc.);

It is important that:

a) the clothes were spacious, the collar and belt were unbuttoned;

b) you did not use perfume, cologne;

You warned the doctor in a timely manner that you have a drug, food or other allergy.

The patient must have with him:

- constantly taken medications (taken after the examination, and under the tongue or spray for coronary artery disease, bronchial asthma .. - before the examination!);

- data from previous studies of EGD (to determine the dynamics of the disease) and biopsy (to clarify the indications for repeated biopsy);

- referral for EGD research (the purpose of the research, the presence of concomitant diseases ...);

- a towel that absorbs liquid well or a diaper.

If it is impossible to appear at the appointed time, please call the doctor in advance or where you made an appointment!!!

Respect yourself and take care of the doctor's time!

Colonoscopy

How to properly prepare:

Preparation for colonoscopy with the help of the drug "Fortrans"

The day before the test:

After breakfast until 17-00, it is recommended to drink enough liquid to cleanse the intestines - up to 2 liters (you can drink water, low-fat broths, fruit drinks, juices without pulp, tea with sugar or honey, compotes without berries). It is not recommended to take milk, jelly, kefir

At 17:00 you need to prepare a Fortrans solution

For this:

Dilute 1 packet of Fortrans in 1.0 liter of boiled water at room temperature.

The prepared Fortrans solution must be drunk within two hours (from 17:00 to 19:00). Fortrans should be taken in small portions, every 15 minutes, 1 glass, in small sips.

At 19.00, in the same way, drink the second package of the drug "Fortrans".

1-3 hours after the start of taking the Fortrans solution, you should have abundant, frequent, loose stools, which will contribute to the complete cleansing of the intestines.

If loose stools do not appear 4 hours after the start of the intake, or if there are signs of an allergic reaction, you should contact the medical staff and refrain from the next dose of the drug.

On the day of the study:

In the morning at 7.00 it is necessary to repeat the intake of Fortrans to completely cleanse the intestines from the contents (1 package of the drug "Fortrans").

Drink the resulting solution in separate small portions within 1 hour (07-00 to 08-00). You will again have loose stools, which should last until complete emptying and cleansing of the intestines.

By 12-00 you will be ready for the study. In preparation for the study with the drug "Fortrans", enemas are not required!

You need to have with you:

Referral for colonoscopy (if you are referred from another medical institution), conclusions and protocols of previously performed endoscopic studies, ECG (if you have cardiovascular diseases)

Proper preparation of the patient is the key to a successful colonoscopy. Preparation for the examination of the intestine begins 2-3 days before the scheduled date of the study. Recommended additional tools used to prepare the intestine for the study

To reduce the likelihood of discomfort during and after the examination, an intestinal antispasmodic (a drug that relieves intestinal spasm) Ditsetel 50 mg (1 tablet) 3 times a day a day before the examination and 50 mg immediately before the colonoscopy is prescribed. No-shpa, baralgin, spasmalgon and other similar drugs are ineffective.

How to behave after the study?

Immediately after the procedure, you can drink and eat. If the feeling of fullness in the abdomen with gases persists and the intestine is not emptied from the remaining air in a natural way, you can take 8-10 tablets of finely crushed activated charcoal, stirring it in 1/2 cup of warm boiled water. Within a few hours after the study, it is better to lie on your stomach.

1. PREPARATION OF PATIENTS FOR COMPUTED TOMOGRAPHY

You need to know that computed tomography of the abdominal organs after examining the stomach and intestines using a barium suspension can be performed no earlier than 3 days later.

STUDIES THAT DO NOT REQUIRE SPECIAL TRAINING

Brain

Research, as a rule, begins without contrasting. The question of the use of intravenous contrast is decided by the radiologist.

chest organs

Examined without contrast. The question of the use of intravenous contrast is decided by the radiologist and, if necessary, is injected intravenously by the attending physician directly on the tomograph table.

The study is performed on an empty stomach, without contrast. The question of the use of intravenous contrasting of the liver parenchyma of the vessels and ducts is decided by the radiologist.

Liver parenchyma

For contrasting the liver parenchyma and its vessels intravenously by the attending physician on the tomograph table.

bile ducts

A contrast agent is injected intravenously to contrast the bile ducts. The introduction is carried out by the attending physician on the table of the tomograph.

gallbladder

The study is performed on an empty stomach, as a rule, without contrast.
The question of the use of intravenous contrasting of the gallbladder is decided by the radiologist.

Pancreas

The study is performed on an empty stomach. Before the examination, the patient drinks 200 ml of mineral or boiled water, as well as a special mixture, which is prepared by the X-ray technician in the CT room immediately before the examination.

The study is carried out without contrast. The question of the use of intravenous contrasting of the parenchyma, pelvis, ureters is decided by the radiologist. If necessary, intravenous jet administration is carried out by the doctor directly on the tomograph table.

Abdominal aorta and inferior vena cava

The study is carried out without contrast. The question of the use of intravenous vascular contrast is decided by the radiologist. Intravenous inkjet is performed by a doctor directly on the tomography table.

RESEARCH AREAS REQUIRING SPECIAL TRAINING

Retroperitoneal lymph nodes

In the hospital 2 hours before the study, you must drink two glasses of water. 1 hour before the study and immediately before the study (in the CT room), the patient drinks one glass of the mixture prepared by the X-ray technician.

Bladder

5 hours before the study for 30 minutes. it is necessary to drink prepared from 1 liter of mineral water and the drug indicated by the doctor (if necessary). Before the study in the CT room, the bladder is emptied through the catheter, after which 150 ml of oxygen is injected into the bladder through the catheter. The catheter, clamped with a clamp, remains in the bladder for the entire period of the study.
All preparatory operations are performed by a urologist.

Female pelvic organs (uterus, appendages)

5 hours before the study for 30 minutes. 1 liter of mineral (without gases) or boiled water is drunk, if necessary with a mixture of a contrast agent prescribed by a doctor. Morning breakfast.
Immediately before the study, the bladder is emptied through the catheter, followed by the introduction into the bladder of a mixture consisting of 50 ml of distilled water and a contrast agent (if necessary). A gauze pad is inserted into the vagina up to the level of the cervix.
The question of the use of intravenous contrast is decided by the radiologist.
All preparatory manipulations are carried out by a gynecologist.

Male pelvic organs

5 hours before the study for 30 minutes. drink a mixture prepared from 1 liter of mineral or boiled water and, if necessary, a contrast agent indicated by a doctor.
The study is carried out with a full bladder. The question of the use of intravenous contrast is decided by the radiologist.
All preparatory manipulations are carried out by a urologist.

CT of the abdominal cavity is done on an empty stomach for the reasons that many organs after eating or a large amount of water, especially those containing gas-forming substances, change their shape and volume. The information turns out to be somewhat distorted and it is very difficult to describe the resulting picture. Before CT of the abdominal cavity, it is necessary to avoid eating food that causes gas formation!

8. RULES OF PREPARATION FOR DIAGNOSTIC EXAMINATIONS IN THE DEPARTMENT OF RADIOISOTOPE DIAGNOSIS (Scintigraphy of the kidneys, skeleton)

Dynamic renal scintigraphy and isotope renography are performed after a meal and 2 glasses of liquid (coffee is not allowed)

Skeletal bone scintigraphy is performed no earlier than 3 months after radiation and chemotherapy

Contraindications for studies in the FDC: relative - high fever, exacerbation of chronic diseases, breastfeeding, cachexia, children under 1 year of age; absolute contraindication is pregnancy.

9. Preparation of x-ray studies.

X-ray examination of the skull, cervical spine, paranasal sinuses - remove jewelry (chain, earrings, hairpins, piercing).

X-ray examination of the hands - remove jewelry (rings, bracelets, watches)

X-ray examination of the pelvis, CPS, lumbar spine - make an enema.

X-ray examination of the stomach and esophagus in the evening do not eat or drink a light dinner in the morning. X-ray examination of the intestine (irrigoscopy, irrigography) - a light dinner no later than 19.00, the night before and in the morning a cleansing enema is done to clean water. Exclude gas-producing foods (black bread, vegetables, fruits, carbonated drinks, sour - dairy products)

At purpose of survey and excretory urography careful preparation is required; within 2-3 days, a diet is observed to exclude gas-producing foods (black bread, vegetables, fruits, carbonated drinks, sour-milk products). On the eve of the study in the evening and in the morning - a cleansing enema to clean water. Light dinner, no later than 19.00.

Plain radiography of the abdominal organs will be performed without preparation, standing.

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Therapeutic and diagnostic process

Based on the case histories, the process of information interaction of all persons making or implementing decisions on the condition and management of patients in the area of ​​​​responsibility of a hospital, polyclinic (dispensary, antenatal clinic) or an ambulance station.

Under the histories here we mean both outpatient cards and ambulance call service cards, since they, like the hospital case history, are protocols of events in chronological sequence.

This term has been used in the literature since the 70s of the last century to refer to a new phenomenon generated by fundamental changes in the work of a doctor in the era of the information explosion. Already in the 60s, the growing specialization of medicine led to the fact that the doctor finally parted with the position of an independent and single-handed generalist. Each went deep into one particular area and became dependent on the help of specialists from other areas. The rapid development of examination and treatment facilities was accompanied by the emergence of specialized laboratories, diagnostic and treatment rooms, all of which became indispensable assistants to the attending physician. Medical institutions were enlarged, their tasks and forms of activity became more complicated, in the organization of the work of doctors both in a hospital and in a polyclinic, the role of department heads quickly increased, and at ambulance stations, the role of senior shift doctors. The role of the chief physician and his deputies in the rational use of available resources has increased significantly. The functions of controlling structures have sharply increased.

What was once done by a single doctor with his nurse is now taken on a daily basis by many people, each of whom has free will and has his own goals and objectives, and not just the task of satisfying an individual doctor. All these people are connected by information flows, the beginning and end of which are in the case histories. These flows form a system with many feed-forwards and feedbacks and with a dual purpose: to provide each patient with adequate medical care and to act in such a way that the available resources are enough for everyone.

In other words, a new complex purposeful system took shape. The relationships that form it are clearly divided into 3 conjugated subsystems: "doctor - patient", "doctor - medical institution" and "chief physician - medical institution". Each of them solves its own problems, but together they are directed towards the goal formulated in the previous paragraph.

It remains to emphasize the specificity of the described field of activity. It does not coincide with what the doctor decides and undertakes, establishing the diagnosis and selecting the treatment, with the area where the laws of nature and medical science rule. It does not coincide with the activities of health authorities, where decisions are based on human laws, scientifically substantiated or opportunistic, and the main subject is the relationship of medical institutions with each other and with higher authorities. The regularities of the treatment and diagnostic process are different. These are the laws of the so-called "large systems", the rules for the formation, transformation, storage and movement of information. Here decisions are prepared, provided with information, recorded, evaluated by results. Here the focus is on working with information as such. The laws of control based on information rule here.

Of course, this is primarily information obtained by doctors according to the rules of medical science. But in order to extract it, we still need organizational decisions and actions. And the extracted, it must be purposefully used: sorted, stored, compared in time and space, summarized, evaluated, prepared for making everyday decisions, directed to those who make or implement these decisions, that is, to everyone: from a doctor and nurse to the head physician. And one more thing - to the health authorities and those who finance the medical institution.

The treatment and diagnostic process is a system of targeted management and self-management based on feedback. Control here takes place at every link: the doctor controls the pathological process, and the events he observes control him. The doctor makes appointments that other departments must carry out, and they can influence him. The chief doctor is under pressure of information about events with patients, about costs, about problems with doctors, he orders - and is influenced by the results of his orders. Comparison of the received with the expected becomes the basis for the next decisions.

The stated essence of the diagnostic and treatment process is deformed by two circumstances. One is the discrepancy between the volumes of circulating information and the possibilities to comprehend and use this information in a timely manner. Both the handwritten presentation of information and the methods of its transmission - the same unreadable case history, memorandums, oral communications and statements - are extremely imperfect. To quickly obtain and summarize individual information, it is necessary to introduce documents secondary to the medical history (statements, coupons, maps, referrals, journals), which increase the burden on people and create conditions for discrepancies, and along the way downplay the value of the fundamental principle - the original document.

Another circumstance that deforms the diagnostic and treatment process is the vulnerability of its participants to the subjectivism, their different understanding of written and unwritten rules, their ability to violate elementary logic and deviate from common sense under the influence of various everyday factors.

Both circumstances lead to the fact that the information necessary for making decisions is distorted, delayed, lost, and its lack is made up for by "intuition" and "creativity", that is, personal impressions, motives and habits. Thus, the most important function of a modern medical institution is distorted and its special meaning is obscured. The way out is to transfer a significant part of the work with information to technology that can neither perceive ambiguity and uncertainty, nor distort data, nor lose it, nor break the rules. Purposeful use of computer information technologies is necessary.

Medical devices are devices with which you can obtain the necessary information about the state of the body, allowing you to make conclusions about the presence or absence of certain deviations from the norm and establish a diagnosis. Devices can be combined into three main groups: indicating, or indicator, registering and combined.

Indicating devices are called, with the help of which the value of the measured quantity can be determined visually by the reading device of the device. This group includes a medical thermometer, a tonometer for measuring blood pressure, etc.

In recording devices, the values ​​of the measured quantity are continuously or periodically fixed in one way or another, most often with ink on a paper tape or a light beam on a film. These devices are called recorders. Such devices include cardiographs for recording the biopotentials of the heart, encephalographs for recording the biocurrents of the brain, devices for recording the breathing curve, etc.

At present, digital devices have been created, where the measured value is induced or recorded in the form of numbers showing its value.

In combined instruments, both indication and registration of the measured value are carried out.

There are instruments and devices for analyzing recorded processes.

The main indicators of the quality of the functioning of the device are accuracy (or error), reproducibility (or variations in readings) and sensitivity. Any device gives the value of the measured quantity with some deviation from its actual value, and the value determined using the reference (exemplary) measure with great accuracy is taken as the real one. The difference between the indicators of the instrument and the actual value of the measured quantity is called the error of the instrument reading:

patient polyclinic medical diagnostic

where P-indications of the device; A is the actual value of the measured quantity.

The error calculated according to the above formula is called absolute. If the value of the absolute error is attributed to the value of the measured value and multiplied by 100, we get the so-called relative error (in percent):

Relative error is used as a measure of instrument accuracy.

The error of the device, obtained under normal conditions of its operation, is called the basic error. Under normal conditions understand the normal operating position of the device and normal environmental conditions: temperature 20±5°C and pressure 760±30 mm Hg. Art. Deviations from normal operating conditions cause additional errors.

The magnitude of the basic error is used to judge the accuracy class of the instrument. So, a device of the 1st class can have an allowable error of 1%, a device of the 4th class - 4%.

Reproducibility or variation in readings is the greatest difference between repeated readings of the instrument at the same value of the measured quantity under the same measurement conditions. The variation of the readings should not go beyond the permissible error.

The sensitivity threshold is the smallest change in the measured value that can be detected by the instrument. It should be noted that measuring instruments designed to control the quality parameters of medical devices are characterized by the same indicators. In this case, the accuracy of the measuring instruments must be several times higher than the accuracy of the measured parameter established by the specifications.

All of the above applies to instruments for measuring quantitative information. However, the information received from the body can be not only quantitative, but also qualitative. It is obtained with the help of instruments that allow you to see the state of certain organs or observe their work. Devices for inspection and observation are also classified as medical devices, although they often do not allow measurements of optical devices or 1 cm (for x-ray devices) serves as a resolution, i.e. the ability to transmit separately closely spaced structures. Resolution is usually expressed as the number of lines per 1 mm (for optical instruments) or per 1 cm (for X-ray instruments). So, if the resolution of an optical examination device (endoscope) is 10 lines per 1 mm, then it can be used to distinguish image details of 0.1 mm.

Medical devices - devices that generate energy of any kind (heat, light radiation, electricity) with the aim of influencing the body as a whole or selectively on a certain functional system or organ (group of organs). Devices also include products that replace certain functional systems of the body for a certain time. In this case, the energy of the device is aimed at maintaining the normal functioning of this system.

Devices include all devices that actuate tools that serve for mechanical action on organs and tissues, devices for resuscitation, anesthesia (anesthesia), etc.

The indicators that determine the quality of the functioning of the apparatus are most often the output power, which to a certain extent shows the dose of exposure to the patient or performance (the amount of agent supplied to the patient per unit time), the range of change in output power or performance (regulation accuracy).

A very important characteristic of the quality of the device is its safety for both the patient and the attendants.

Often, medical devices and devices are combined under the general name "medical equipment".

Medical equipment - a set of medical technical devices that ensure the creation of comfortable conditions (i.e., the greatest conveniences) for the patient and medical personnel during the treatment and diagnostic process, including compliance with asepsis conditions. The group of equipment includes devices designed to accommodate the patient and carry out the necessary manipulations associated with changing the position of his body or individual parts: operating and dressing tables, functional beds, chairs, dental, gynecological, etc., wheelchairs for transportation, devices for shifting patients etc., as well as devices that provide asepsis during treatment and diagnostic measures (sterilizers, disinfection devices, etc.).

Devices such as instrument cabinets and tables designed to accommodate instruments, devices, medicines are referred to as medical furniture. The quality of the functioning of the equipment is determined by how convenient it is, how it can withstand the given loads, how smoothly its parts move under the influence of the regulated efforts of the maintenance personnel or the corresponding engines. As a rule, the control of these indicators is carried out by testing each piece of equipment.

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A medical technological process is a health-improving-prophylactic or treatment-diagnostic process (LDP) of managing the body (changing structure and functions), which is implemented in space and time in order to improve its condition.

The ultimate goal of the health-improving and preventive process is the elimination of deviations in the patient's health status (with borderline, prenosological conditions and early manifestations of the disease), and the goal of LDP is the elimination of the pathology (in the case of an acute disease) or the transfer of the patient into remission (in the case of a chronic disease). Further, when considering LDP, we will keep in mind the health-improving and preventive process.

The treatment and diagnostic process is a special case of the control process in any technological system. In clinical medicine, the object of research and management is the patient's body and its external environment, the subject of management is the doctor.

An object is something to which cognitive activity is directed. The subject is the opposite of the object - the thinking "I". It should be noted that the opposition between the object and the subject is relative, since when cognitive activity is addressed to oneself (or colleagues), the subject becomes an object.

In relation to the patient's condition, the doctor is a decision maker (DM).

The management process includes four stages:

1) collection and processing of information about the state of the control object;

2) diagnostics, i.e. assignment of the state of an object to one of the known classes of states;

3) making a decision on the impact on the object;

4) implementation of the adopted decision.

These stages represent the control loop. Real control systems are more complicated, however, in general, such a control loop is applicable to any subject area, including the medical technological process.

The tasks that a doctor of any medical department solves are of the same type and come down to collecting information, solving diagnostic and therapeutic tactical issues, and maintaining medical records. The tasks solved by doctors of diagnostic and a number of other specialized departments stand somewhat apart, but in most cases they are a special case of the tasks facing the doctor of the medical department.

To solve the problems of the medical technological process, the doctor uses various clinical and diagnostic information: patient complaints, anamnesis, examination and physical examination data (palpation, percussion, auscultation), the results of instrumental and laboratory research methods. At the same time, with the exception of familiarization with medical documents of other institutions, the doctor receives information in three ways:

Verbal - from a conversation with the patient;

Sensitive - with the help of the doctor's sense organs and medical devices (phonendoscope, tonometer, etc.);

Objectified, based on the results of laboratory and instrumental studies.

(This division is somewhat arbitrary, since, for example, modern pressure measuring instruments belong to the third way of obtaining information.)

The process of obtaining information by a doctor can be quite lengthy, as it depends on the timing of receipt of the results of additional studies. Let's consider this on the example of a typical situation in a hospital. The doctor receives information about complaints and examination data at the first contact with the patient and in the process of monitoring the patient in the department, data from general blood and urine tests - during the 1st day of the patient's stay in the hospital, the results of electrocardiography are usually on the 2nd day, radiography, ultrasound - on the 3-4th day, etc.

Diagnostic tasks include recognizing the current state of the patient's body, making a detailed nosological diagnosis, and assessing the severity of the patient's condition. In addition, in the process of monitoring the patient, the doctor solves the problem of assessing the dynamics of the patient's condition and predicting the development of the pathological process, including the possibility and nature of complications, the outcome of the disease.

In the admission department, the patient is examined by the doctor of the admission department, who makes a preliminary diagnosis, prescribes a plan for examination and treatment, and directs him to the treatment department.

The diagnosis made in the admission department is one of the diagnostic hypotheses for the doctor of the medical department of the hospital, which must be confirmed or refuted. At the same time, the sequence of diagnostic studies, depending on the results obtained during the examination, can be corrected, and sometimes radically transformed.

The doctor's argumentation is aimed, on the one hand, at identifying signs that are characteristic of the diagnosis he is supposed to have, and on the other hand, at finding alternative signs that deny other diseases (for example, high growth is unambiguously denying diseases in which growth is necessarily significantly reduced), t i.e. arguments and counterarguments or facts "for" and "against" are used. In the most general form, we can say that simultaneously with the exclusion of one diagnosis, there is confirmation of another (or others) diagnosis (diagnostic hypothesis).

Based on the diagnostic working hypothesis, the doctor makes therapeutic and tactical decisions at each contact with the patient. In the course of examination and treatment, such hypotheses arise, replacing each other, until the latter, having withstood a series of tests, becomes the final and substantiated clinical diagnosis. The diagnostic process can be divided into three interrelated stages:

1) making a primary diagnosis (preliminary hypothesis);

2) construction of a differential diagnostic series (additional hypotheses);

3) final diagnosis (substantiation of the final hypothesis).

What is common is that the diagnostic process, built on reasoning about signs and their combinations, substantiating or rejecting a certain diagnostic hypothesis, is based on the logic of argumentation.

Treatment tasks include making decisions about drug and non-drug effects on the identified pathological condition, taking into account the individual characteristics of the patient's body and based on an assessment of the dynamics of his condition.

Among the tactical decisions of the doctor of the medical department are:

1) decisions to terminate the diagnostic search, if the severity of the patient's condition is such that it does not allow for complex diagnostic procedures;

2) decisions to transfer the patient to the intensive care unit, if his condition worsened (the course of the underlying disease became more complicated or a new one appeared, requiring intensive care);

3) decisions to transfer to another medical department, if a disease of a different profile (infectious, surgical, gynecological, etc.) is detected for the first time, the manifestations of which become leading in the clinical picture, or comorbidity comes to the fore. In this case, the doctor can make a decision on his own or invite a consulting doctor and make a joint decision;

4) the decision to discharge the patient under the supervision of a local doctor.

Maintaining medical records is one of the important components of the medical technological process. Information about all the components of the LDP of a particular patient should be recorded in the medical record or medical history. Record keeping takes a lot of doctor's time. An old and well-known problem is “medical” handwriting.

So, in the medical technological process, at the first stage of management, information about the patient and his condition is collected and processed using all the methods available in the arsenal of modern medicine. On the second, the state of the body is diagnosed - it can be nosological diagnosis, syndromic diagnosis, and finally, the diagnosis of a certain condition of the patient, to which it is necessary to respond. At the third stage, the selection of control actions is carried out on the basis of predicting the possible results of their application: the choice of therapeutic and preventive measures, the assessment of the risk associated with their implementation, the choice of tactical decisions, etc. At the fourth stage, control actions are carried out. After the implementation of the selected set of control actions, the collection of information about the patient's condition and (or) the external environment begins again to monitor the condition and timely make adjustments to the LDP. Thus, the medical technological process is cyclic. All stages of management in the LDP are carried out by the subject of management - a doctor (DM).

Gynecological examination- an obligatory stage in the medical examination system, which allows you to timely establish any disease of the genital area and at the same time prevent serious complications. Women should undergo a gynecological examination at least twice a year. If the doctor establishes a gynecological disease, the nurse draws up an outpatient card and systematically monitors the patient's compliance with the gynecologist's prescriptions.

Gynecological examination is the main method for diagnosing the morphofunctional features of the genital organs and their pathology. This type of research is carried out by a doctor or nurse wearing sterile gloves on a specialized gynecological chair. The patient at the same time is located on the back with the lower limbs bent and divorced to the sides. For convenience, a roller is placed under the sacrum. Previously, the patient must make a toilet of the external genital organs using antiseptic agents (for example, a weak solution of potassium permanganate), followed by drying with a sterile napkin. One of the functional duties of a gynecological nurse is to inform the patient that the examination is carried out only after the empty intestines and bladder.

Examination with the use of mirrors is carried out after the study of the external genital organs before conducting a vaginal and bimanual examination. This order of diagnostic procedures is mandatory, since digital examinations at the beginning of a local examination contribute to changes in the nature of genital secretions, tumor formations and erosions. To do this, I and II fingers of the left hand part the large and small labia and examine the vulva, lower urethra and ducts, into which the glands of the vestibule of the vagina and perineum open.

Then proceed to the examination of the vagina and cervix. To do this, a folding or spoon-shaped speculum is inserted in a closed position to the vaginal vault. Then the mirror is opened, which allows you to carefully examine the cervix. The mucous membrane of the vagina becomes available for inspection as the gradual removal of the mirror from the vagina. The most convenient and informative way to examine the cervix is ​​to examine it with the help of spoon-shaped mirrors. In this case, you must first enter the rear mirror, placing it on the back wall of the vagina, and slightly press on the perineal area. Then you need to enter the front mirror, lifting with it the front wall of the vagina.

The above research methods, as a rule, make it possible to identify numerous inflammatory diseases of the external genitalia, vagina and cervix.

Then a digital examination is performed, with the help of which the doctor reveals the muscular condition of the arch, walls of the vagina and cervix, and also examines the external pharynx. To do this, the large and small labia are parted with the II and III fingers of the left hand, and the II and III fingers of the right hand are inserted into the vagina, and the I finger should be directed upwards and IV and V should be pressed against the palm.

After examining the vagina, the doctor proceeds to a bimanual (two-handed) examination. In this case, the fingers that are inserted into the vagina should be in its anterior fornix, pushing the cervix backwards. At this time, the fingers of the left hand gently press the stomach to the small pelvis towards the fingers located in the anterior fornix of the vagina. Using this research method, the doctor determines the location, size and density of the uterus.

Then the doctor proceeds to examine the fallopian tubes and ovaries. In this case, the fingers of the doctor's hands move from the region of the lateral fornix of the uterus to the walls of the pelvic cavity. Completing the examination, the doctor must palpate the bones of the pelvic region (symphysis, etc.).

The next step in the examination of the patient is the study of the rectal method. This type of examination is indicated only if the patient has vaginal stenosis, various tumors, as well as an inflammatory process in the internal genital organs and the presence of blood and pus secreted from the rectum. In this study, the doctor puts on gloves and lubricates the examining finger with petroleum jelly, then injects it at the time of straining the patient. This type of examination allows you to determine the presence of tumors in the rectum.

Then it is necessary to palpate the cervix, ligamentous apparatus and tissue of the pelvic region. There is a rectal-abdominal examination, in which the left hand is added to the examination, pressing the anterior abdominal wall towards the pelvic region. This type of examination allows you to examine the uterine body and adnexal organs. There is also a rectal and vaginal examination, which is used to diagnose pathological processes of the vagina and rectum. In this case, the index finger is inserted into the vagina, and the middle finger into the anus. This study allows you to diagnose tumor diseases of the vagina and rectum.

The above methods of examination of gynecological patients are the main ones.

One of the additional methods of examination is probing the uterus, carried out by a gynecological instrument - a uterine probe. It is a flexible rod with a button on one end and a special handle on the other. This tool is used for measuring purposes, which is achieved by using a centimeter scale located on the rod. Examination using a uterine probe is carried out only in a gynecological hospital, strictly following the measures to prevent the occurrence and spread of infectious diseases. Direct probing of the uterus is preceded by the introduction of spoon-shaped mirrors and fixation of the cervix with bullet forceps. When performing the procedure, it is necessary to remember about the possible perforation of the uterus, for which the uterine probe must be inserted specifically: when the uterus is in anteflexio, its button end is directed forward, with retroflexio - posteriorly. This type of examination allows you to determine the pathology of the uterine cervical canal (stenosis, obstruction, etc.), the size, location and malformations of the uterus are specified. Conducting uterine sounding is prohibited in case of inflammatory processes in the uterus and its appendages and suspicion of pregnancy.

The second additional method of gynecological diagnostics is examination using bullet forceps, which complements the two-handed method of examination in case of detection of a tumor formation and clarification of its origin. First, mirrors are inserted, the cervix is ​​​​lubricated with an alcohol solution, and then with iodine. The anterior and posterior lip are fixed with bullet forceps, the mirrors are removed, and the nurse, gently pulling the bullet forceps, gradually moves the uterus area down. In this case, the finger of the doctor's right hand is inserted into the vagina, and the fingers of the left hand, by palpation of the abdominal wall, displace the lower part of the tumor formation upwards. In this case, the pathological focus is available for palpation. This type of examination allows accurate differential diagnosis of tumors of the internal genital organs.

The next type of diagnostic procedure is trial curettage of the uterine membrane, which plays a significant role in the diagnosis of uterine cancer. This type of study is carried out in the presence of remnants of the fetal egg, suspicion of an infectious disease of the uterus. Also, this method is used to establish the etiological causes of menstrual dysfunction. In this case, it is advisable to carry out diagnostic curettage with an examination of the uterine mucosa for histology. For this procedure, the nurse must prepare gynecological instruments: speculum, uterine probe, bullet forceps, a set of curettes and Hegar dilators. It is first necessary to treat the external genitalia and vagina with antiseptic solutions. First, gynecological mirrors are inserted, then with bullet forceps, fixing the cervix, anesthesia is performed by introducing an anesthetic. Next, the exact location of the uterus and its dimensions are established by probing. Then, the cervical canal is opened with the help of Gegar dilators (No. 3-10). The doctor holds this tool like a pen when writing and so that its twist corresponds to the position of the patient's uterus anteflexio or retroflex. The dilator is inserted carefully and so that a small part of it is in the uterine cavity. In this position, the tool should be no more than 10 s, and then it is removed, and an expander with a large number is immediately inserted. Then, direct curettage is carried out with a curette in the direction from the bottom of the uterine cavity to the cervical canal. Depending on the degree of accessibility to a particular section of the uterus, spoons of different sizes are used. The collected biomaterial is placed in a container, carefully examined, and then filled with an alcohol solution and transported to the laboratory department for histology. The nurse writes a referral with the obligatory indication of the basic data about the patient and her preliminary diagnosis.

One of the most common additional methods of gynecological examination is a biopsy, carried out, as a rule, with suspicion of a cancerous pathology of the genital organs. This procedure is performed under strict adherence to the rules of asepsis. The nurse prepares bullet tongs, spoon-shaped mirrors, a scalpel, catgut, antiseptic solutions. The most commonly used biopsy is the cervix. First, gynecological mirrors are introduced, and then, having selected a site on the cervix suitable for research, it is fixed on both sides with bullet forceps. Next, the damaged tissue is cut wedge-shaped with the capture of healthy tissue, followed by treatment with disinfectants and, if necessary, stopping bleeding, suturing or diathermocoagulation.

In modern conditions, the method of targeted biopsy using a colposcope is widely used. Puncture as an additional research method is used in the case of differential diagnosis of an ruptured ectopic pregnancy with inflammatory effusion in the uterine recesses. This procedure is carried out through the posterior fornix. If the doctor suspects a tumor formation of purulent content in the fallopian tubes, a puncture should be carried out only if the pathological foci are firmly attached. Following the removal of purulent contents, topical antibacterial drugs should be immediately applied. Pre-treatment of the external genitalia and cervix with antiseptic preparations. Then, spoon-shaped speculums are inserted and, having fixed the cervix with bullet forceps, they slightly pull it forward. The nurse puts a special puncture needle with a large lumen on the syringe. The puncture is carried out in the central part of the posterior uterine fornix by no more than 2 cm. Blowing out the fallopian tubes is a method for diagnosing their patency, which is used to clarify the etiology of infertility in a woman. The tubes become impassable due to inflammatory diseases of the genital organs, after which numerous adhesions and scars form in them. This procedure is carried out using a special apparatus, with the help of which a small amount of air is introduced into the uterus under low pressure. The obstruction of the fallopian tubes is indicated by the absence of air in the peritoneal cavity, which should normally enter there.

Today, the hysterosalpingography method is more common. In order to establish the same pathology, hydrotubation is widely used - the introduction of a 0.9% solution of sodium chloride into the uterine cavity with the addition of an antibiotic and an anesthetic using a device for blowing the uterine rough. This diagnostic method is widely used in the treatment of gynecological diseases.

Instrumental procedures for gynecological diagnostics include X-ray and endoscopic methods. Salpingography is used for suspected obstruction of the fallopian tubes, and metrography is used to determine pathological foci and clarify malformations of the uterus. To do this, a contrast agent is introduced into the uterus with a special syringe. Then the patient is laid on her back, and a series of images is taken. The doctor determines the obstruction of the fallopian tubes in the absence of the injected drug in the pelvic area and its delay in the uterine appendages. These procedures are carried out on the 15th day of the menstrual cycle and are not used for exacerbation of chronic gynecological diseases, acute inflammation and pregnancy.

Pneumopelviography- a method based on the introduction of a small volume of gas into the peritoneal cavity, which is used to determine tumors of the internal genital organs. This method is not used in the pathology of the nervous, cardiovascular, respiratory systems, as well as in the recurrence of chronic gynecological diseases. The nurse should inform the patient about the implementation of appropriate preparatory measures. On the eve and on the day of the study, the patient is cleansed of the intestines, the bladder is emptied. For 3 days before the examination, the patient must follow an appropriate diet. Pneumopelviography is performed by puncturing the outer wall of the abdomen and introducing oxygen, followed by a series of images.

One of the rarely used diagnostic methods is pelvic lymphography, used to establish the phase of malignancy. To do this, the doctor injects a contrast agent into the lymph flow through the vessels of the foot. This method is contraindicated in severe pathology of the respiratory and cardiovascular systems. Bladder catheterization is carried out with a special instrument - a catheter. Pre-treatment of the external genitalia with antiseptic solutions. Following the end of the procedure, it is necessary to thoroughly wash the bladder cavity with disinfectants. This method is used to determine the size and exact localization of vaginal fistulas, as well as to determine the capacity of the bladder.

One of the widely used methods of additional research in gynecology are endoscopic procedures. Colposcopy is performed using a special apparatus - a colposcope, the main elements of which are the moon, thanks to which the visibility of the object is increased tenfold, a tripod and a device for lighting. This method allows, as a rule, to accurately and correctly diagnose a malignant formation of the cervix and vagina. Using colposcopy, the doctor can accurately select the desired tissue site for diagnostic biopsy and histological examination.

Hysteroscopy- a method that provides examination and detection of pathological formations and diseases of the uterine region from the inside using a hysteroscope.

Cystoscopy- a method of examination, revealing mainly the pathology of the bladder. Previously, its cavity is filled with a preparation of bromine acid. In cases where there are fistulas of considerable size in the bladder, it is necessary to insert a swab into the vagina to prevent the entry of an antiseptic solution here.

Rectoscopy- a method used, as a rule, for suspected pathology of the rectum, as well as malignant formation of the cervix and ovary of a large size. This type of examination also takes place in inflammatory disease of the inner lining of the uterus, fistulas of the vagina and rectum.

One of the most informative and at the same time rarely used examinations in gynecology is laparoscopy. This type of instrumental examination is used for the purpose of differential diagnosis of diseases of the internal genital organs using a special optics device. This instrument can be inserted both through the peritoneal cavity and through the vaginal cavity (culdoscopy).

The above methods are not used for recurrence of chronic inflammatory diseases of the peritoneal cavity, pregnancy and the presence of malformations of the cardiovascular system. To carry out these procedures, the nurse must prepare a laparoscope (culdoscope), a trocar, gynecological mirrors, antiseptic and anesthetic drugs.

The most commonly used diagnostic method in gynecology is an ultrasound examination based on the ability of dense tissues to absorb and distribute ultrasonic waves differently on their surface. This method allows you to determine the exact size, location of the internal genital organs, as well as the presence of various pathologies in them. The gynecological nurse is obliged to inform the patient about the preparatory measures for the ultrasound examination. A woman must follow a slag-free diet three days before the study and come to the appointment with a full bladder, which causes the intake of non-carbonated liquid one hour before.

The next group of diagnostic gynecological measures are cytological examination methods. So, for example, in order to determine the functional state of the ovaries in relation to hormones, sequentially related methods of functional diagnostics are used. First, a scraping from the inner lining of the uterus is examined, then the level of hormones in the blood and urine is determined. The next step is a thorough examination of the cytology of the vaginal scraping. Currently, they resort to modern methods of functional diagnostics of the above stages, such as phase-contrast and luminescent studies. Biomaterial for cytological examination is discharge from the examined genital organs. So, for example, the material of the uterine cavity and pathological neoplasms is collected with a special syringe; vaginal discharge and the contents of the abdominal cavity - with a pipette with a built-in rubber bulb. The resulting smears are immersed in an alcohol solution and sent to a cytology laboratory.

Endocrinological study is an additional method used in gynecology to determine the violation of the hormonal function of the ovaries. Hormones that are often tested include progesterone (determined in the blood), pregnandiol (determined in the urine), estrogen, follicle-stimulating hormone (FSH), and glucocorticosteroids.

Currently, the method of computed tomography, which is based on the action of X-ray radiation, is widely used. This type of instrumental diagnostics allows you to obtain an x-ray picture of the transverse plane of the object under study. Tomography is used in gynecology mainly to establish pathological neoplasms of the internal genital organs (ovaries, fallopian tubes, etc.). The temperature test is of great diagnostic value in case of menstrual dysfunction. This procedure consists in measuring the rectal temperature reaction daily in the morning, without getting out of bed and in a balanced emotional state. This diagnostic method should be carried out for several months in order to establish the correctness or pathological course of the menstrual cycle. To do this, according to the obtained measurement results, a graph is built.

The main medical procedures carried out by the nurse include: douching, vaginal tamponade, providing sitz baths. Vaginal douching is the main method of therapy for adnexitis, bartholinitis, parametrosis and other infectious and inflammatory gynecological diseases. To carry out the procedure, it is necessary to use an Esmarch mug with a glass tip. Previously, the nurse is washing the patient with a warm disinfectant solution. In this case, it is necessary to observe a certain sequence and direction: first, the pubis and external genitalia are processed, and then the perineum and anus. Next, the nurse dries the skin with a sterile napkin in the same direction and stages of action, followed by lubrication of the external genital organs with petroleum jelly. Esmarch's mug with antiseptic liquid is suspended on a tripod to a height of no more than 1.5 m above the patient's bed. The glass tip of Esmarch's product is inserted into the vagina simultaneously with the extraction of an antiseptic solution from the posterior fornix. At the end of this therapy, the patient must observe strict bed rest for at least 1 hour. The vaginal bath is indicated mainly for inflammatory diseases of the external genital organs (for example, vulvitis). First, it is necessary to carry out vaginal douching using an antiseptic solution, followed by the introduction of a speculum and the extraction of the residual solution. At the same time, the nurse injects a disinfectant solution using a speculum until the area of ​​the cervix is ​​filled with it. After 20 minutes, gently rotating, the speculum is removed from the vagina. This procedure is carried out every three days. Vaginal tamponing is performed most often in cases of damage to the genital organs. This procedure is carried out using a cotton swab, which is a lump of cotton wool the size of an average orange and tied with long threads. The cotton swab should be systematically changed after at least 2 hours. Plugging, which is preceded by vaginal douching, is performed by introducing a swab into the posterior vaginal fornix, which is observed by means of gynecological mirrors, where it is located for no more than 10 hours, and then removed by the left thread.

Diathermocoagulation is a type of therapy in gynecological practice, which is based on the action of thermal energy arising from the passage of high-frequency electric current on organs containing fatty substances. This method of treatment is used in cases of erosive lesions of the vagina and cervix. This procedure is performed on the woman on the 15th day of her menstrual cycle in the position of the patient, as in a gynecological examination. At the end of diathermocoagulation, the patient must observe strict bed rest for an hour to avoid possible bleeding. The nurse is obliged to inform the patient about abstinence from sexual activity for 2 months.

Insufflation- a method of introducing various fragmented medical preparations through an insufflator. One of the main functional duties of a nurse in a gynecological hospital is the thorough preparation of the patient for surgery. These manipulations include: catheterization of the bladder, setting a cleansing enema, treatment of the external genital organs with antiseptic solutions and shaving the hair of the pubic area. One of the important moments of the preparatory procedures is drying with cotton swabs, followed by treatment with an alcohol solution of iodine of the surgical field and the tissues closest to it. It is necessary to remove removable prostheses from the patient's oral cavity, if any. In the postoperative period, the nurse should systematically monitor the cleanliness of surgical sutures and regularly change pads. In order to prevent divergence of surgical sutures, patients are not cleansed of the intestines and try to cause constipation for several days. Persistent fusion of perineal tissues occurs on average on the 7th day after surgery.

The setting of a warming compress and the use of a heating pad on the projection area of ​​the internal genital organs are often used in case of algomenorrhea (these are menstruation accompanied by severe pain). In this case, the nurse is obliged to remember the necessary sequence of these procedures. The warming compress exerts its therapeutic effect for at least 6 hours, after which the patient's skin should be dry and warm. The nurse fills a heating pad with 2 liters of hot water (not lower than 60 ° C) and puts it on the lower abdomen, followed by a repetition of this event several times.

In the syndrome of acute inflammation, bleeding from the genital organs and gynecological diseases of an infectious nature, an ice pack is widely used. The nurse puts a bubble wrapped in a diaper for no more than 2 hours, making half-hour intervals.

In order to obtain a good result of treatment, the patient should be provided with the most comfortable conditions for staying in a gynecological hospital. The ward should be systematically ventilated, have a sufficient amount of light, heat, and be subjected to regular sanitary and hygienic treatment with the use of disinfectants. The state of the nervous system of most gynecological patients is unstable, as a rule, there are signs of increased excitability, which leads to long-term treatment and an unfavorable outcome of the disease. In such cases, the doctor prescribes tranquilizers, sedatives and sleeping pills, the intake of which must be monitored by a nurse. For patients with reduced tone of the central nervous system, it is advisable to take drugs that have a tonic (stimulating) effect. One of the main duties of a nurse is to perform activities independent of the doctor's prescriptions - caring for the patient. The sister needs to pay attention to the hygienic condition of the patient's oral cavity: you should brush your teeth twice a day, to prevent the formation of cracks, wipe your lips and tongue with glycerin. Seriously ill women are systematically carried out alcohol rubbing of the skin in order to prevent bedsores. Most infectious and inflammatory secondary gynecological diseases, such as parametritis, inflammation of the pelvic peritoneum, are accompanied by symptoms of intense intoxication of the body. Therapy in these cases is complex, which corresponds to the clinical manifestation and pathophysiological changes in organs and tissues in these diseases: antibacterial, symptomatic, detoxification, physiotherapy, and, if necessary, surgical treatment. In order to restore disturbed water-salt homeostasis in the body, intensive detoxification therapy is indicated, usually carried out by parenteral administration of significant volumes of liquid. The patient should also consume more fortified drinks (juices, fruit drinks), which will significantly increase immunity. Important measures are taken to prevent constipation in a patient due to the risk of blood stagnation in the abdominal cavity. For this, the patient is recommended to take highly mineralized waters, fresh fruits, as well as fermented milk products. If there is no effect, the doctor prescribes laxatives, as well as an oil and cleansing enema. Most patients develop anemia as a result of a gynecological disease, which leads to the appointment of iron-containing drugs, as well as folic acid and B vitamins. A significant place in the successful treatment of a gynecological disease and the speedy recovery of impaired functions is given to the nutrition of the patient. As a rule, with the pathology of the gynecological sphere in cases of the absence of diseases and damage to the organs of the digestive system, a general dietary table is prescribed (No. 15). This diet provides the patient's body with a sufficient amount of proteins, fats and carbohydrates in their balanced ratio. Food should be highly vitaminized, consist of a variety of products, have good taste. The patient's diet is four times a day, fractional and systematic. If the patient has a diarrheal syndrome, diet table No. 4 is indicated, for constipation - table No. 5. Food should contain a large amount of protein, which ensures the speedy processes of epithelization in case of inflammatory damage to the internal genital organs.

One of the most important stages in the treatment of gynecological diseases is the use of antibiotics. In recent years, there has been a tendency to increase the resistance of many microorganisms to certain types of antibacterial drugs. In this case, it is advisable to use an antibiotic sensitivity test, which is performed by the nurse of the department. Therapy with the help of physiotherapeutic agents should be prescribed at the recovery stage, when there is no manifestation of an acute inflammatory process. These procedures are carried out with bleeding, normalization of menstrual function, elimination of pain syndrome, exposure to numerous adhesions resulting from an inflammatory reaction, and also in order to prevent possible postoperative complications. As a rule, it is advisable to recommend physiotherapeutic manipulations on the 6th day of the menstrual cycle in order to prevent unwanted reactions from the organs and systems of the patient. The nurse must systematically monitor the daily and correct implementation of these procedures. Physiotherapy procedures are used when a woman has menstruation only in the appropriate form, replacing the intravaginal effect (for example, rectal). Women who are prescribed these procedures are shown taking contraceptive medicines for the duration of treatment. Patients suffering from menstrual dysfunction should undergo a course of physiotherapy before a course of hormone therapy. Patients of pubertal age with the syndrome of pathological blood loss produce physiotherapy by electrophoresis with calcium. In cases of menstrual dysfunction with a laboratory-established elevated level of estrogen, the doctor recommends exposure to galvanic current with novocaine. In gynecology, vibromassage of the back area is widely used, as a rule, for girls of puberty who have constant blood loss.

Currently, among diseases in women, mastopathy is significantly common, in which the leading element of therapy is exposure to galvanic current of low voltage and low strength. Patients with bleeding of the uterus, etiologically due to dysfunction of the ovaries with a corresponding elevated level of estrogens, are prescribed electrophoresis with novocaine or galvanization. Patients with neurotic disorders are recommended aeroion treatment, massage of the collar zone, as well as various types of shower, which have both a tonic and a calming effect. If the patient's history includes inflammatory diseases of the brain, the doctor prescribes various types of baths, most often with iodine-bromine and coniferous extracts, as well as exposure to the facial area with galvanic current. Patients with a low level of estrogen in the blood associated with damage to the endocrine glands are recommended baths with hydrogen sulfide, carbon dioxide, turpentine components, as well as galvanic currents with copper. In the case of establishing a violation of the luteal stage of the menstrual cycle, iodine electrophoresis is widely used. Women in the period of menopause and postmenopause are shown aeroionotherapy and various options for water therapy that have a sedative effect. For patients with severe underdevelopment of the genital organs, the doctor prescribes therapy with helium, as well as stimulating types of water therapy (for example, a contrast shower). The intensity of the impact of physiotherapeutic methods is directly proportional to the severity of the pathology. So, in cases of a slight deviation in the size of the uterus from the norm and the presence of preserved functional activity of the gonads, it is advisable to prescribe various options for therapeutic mud, ozocerite, the intake of mineral waters with a hydrogen sulfide component, as well as inductothermy. Physiotherapeutic methods are most common in inflammatory diseases of the genital area. In this case, UHF, microwave, UV, UV radiation and electrophoresis with aspirin, magnesium, etc. are prescribed. The choice of this or that method is determined by the stage of the disease, the degree of damage and the condition of the patient. A successful therapeutic effect in the case of salpingo-oophoritis with the formation of an adhesive process is achieved by ultrasound, electrophoresis with an iodine component, as well as ozocerite procedures. An important stage in the restoration of impaired functions in the postoperative period are magnetotherapy and UHF treatment. These measures must be carried out on the fourth day after the operation.

One of the rarely used methods of treating gynecological diseases is gynecological massage. This procedure has a good therapeutic effect, especially in combination with physiotherapy procedures. Gynecological massage enhances blood and lymph flow, the flow of metabolic processes in the genitals. When carrying out this manipulation, the adhesions in the fallopian tube are softened and thinned, which determines its use after the transferred salpingo-oophoritis. Gynecological massage is also indicated after inflammatory damage to the membranes of the uterus, as well as pelvioperitonitis, due to the abnormal location of the uterine region and its significant mobility. This procedure is prohibited during pregnancy, the acute phase of an inflammatory disease, as well as a pathological neoplasm of the internal genital organs. The duration of the massage is no more than 5 minutes, which is due to a strong pain reaction from the body with the possible development of pain shock. The course of therapy is 15 procedures. Manipulation is carried out in certain stages. The nurse should monitor the blood test indicators, as well as the general condition of the patient, during the treatment by gynecological massage.

At present, the method of physiotherapy exercises is used even more rarely in the treatment of gynecological diseases. This type of treatment is used to strengthen the muscular apparatus of the abdominal and pelvic organs, ensure the correct position of the uterus, as well as in the postoperative period for the speedy recovery of impaired functions. Indications for physical therapy of the patient are the position of the uterus retroflex, a slight collapse of the uterine wall, as well as enuresis. The appointment of physiotherapy exercises in the postoperative period helps to prevent thromboembolic, bronchopulmonary, gastrointestinal, genitourinary and other types of complications.

One of the most common methods of treating gynecological diseases is surgical treatment. This type of therapy is prescribed only in cases where there is no effect from the use of other methods, such as hormonal and symptomatic therapy. So, in the case of endometriosis of the uterus with concomitant pain syndrome, its amputation without uterine appendages is indicated, with endometriosis of the cervix - electrocoagulation, isthmus - extirpation of the uterine region. The tactics of treating oncological gynecological diseases has its own characteristics. Therapy in this case is determined by the severity of the patient's condition, the stage of the disease and the prevalence of cancer. The doctor needs to pay attention to the functional state of the cardiovascular, respiratory, endocrine systems, as well as to the indicators of blood and urine tests. Diagnostic examination of cancer patients should be no more than two weeks. Patients with decompensated forms of pathology of cardiovascular activity are first corrected with cardiotonic drugs, cardiac glycosides, etc. If anemia occurs, patients are prescribed a course of taking iron-containing drugs. Amputation or electroconization of the affected organ is recommended for patients with a cancerous tumor that does not spread to other organs and tissues. After the implementation of these measures, a thorough histological examination of the removed tissues is necessary. If a tumor spread to adjacent organs and tissues is established, a radical operation is prescribed - removal of the uterus with appendages and peripheral lymph nodes.

Gynecological patients who underwent surgery for a malignant neoplasm are shown a course of radiation therapy. This type of treatment is carried out externally simultaneously with intracavitary exposure, which alternate with each other. The most important measure in the treatment of cancer patients is effective pain relief, which sometimes requires the introduction of significant doses of narcotic drugs. A nurse working with such patients should be as attentive, sensitive, patient and friendly as possible.

In gynecology, there are often cases of damage to the female genital organs, sometimes requiring emergency measures from medical workers. In the treatment of such cases, first of all, there is a fight against a shock state of traumatic genesis. With open-type lesions, antitetanus serum is administered, followed by wound stitching. In cases of formation of a progressive hematoma, its opening, ligation of damaged blood vessels, bleeding stop, followed by the establishment of drainage are indicated. A great danger to the life of the patient is damage to the clitoris, accompanied by massive blood loss. At the same time, an analgesic is injected along the periphery of the injury site. In the absence of a positive result, they resort to tamponade of the bleeding area, followed by the application of a T-shaped bandage.

In gynecological practice, the formation of fistulas is often found due to impaired tactics during childbirth, surgical intervention, cancerous neoplasms of the genital organs, as well as complication of infectious diseases. The tactics of treating this pathology depends on the etiology and localization of the fistulas, as well as the intensity of the lesion and other factors. Thus, in case of tuberculous fistula etiology, first of all, a course of appropriate antibacterial drugs is necessary, and then the closure of the pathological opening.

One of the most common gynecological emergencies is an ectopic pregnancy. Having established this diagnosis, the doctor should immediately hospitalize the patient in a gynecological hospital. Here, the patient undergoes emergency surgery to avoid a possible rupture of the fallopian tube. The ambulance nurse or department until the upcoming operation constantly monitors the patient's condition. If a woman experiences severe pain in the abdomen, the use of an ice pack and a heating pad, as well as a cleansing enema, are contraindicated for her.

An important feature of the activity of the nurse of the gynecological department is the conduct of sanitary and educational work, which carries the prevention of gynecological diseases and their complications. This duty includes conducting conversations and lectures among patients on current medical issues, as well as creating informative posters and bulletins containing fundamental information in the field of gynecology. Currently, there is a downward trend in the level of gynecological operations for abortion. This is a deliberate termination of pregnancy no later than 30 weeks. In our country, in view of the implementation of active measures to protect the mother and child, the issue of termination of pregnancy is entirely assigned to the woman. This operation is performed only in the conditions of a hospital department of a gynecological hospital in compliance with measures to prevent the spread of infection. Artificial abortion is contraindicated in inflammatory diseases of the genital organs, cervical erosion, as well as in gynecological pathology of gonorrheal etiology.

• Electrocardiography (ECG)- a method of graphic registration of electrical phenomena that occur during the work of the heart.
• Phonocardiography (PCG)- a method of graphic recording of sound phenomena that occur during the work of the heart.
• Polycardiography (PCG)– method of simultaneous recording of ECG, FCG and carotid sphygmogram.
• Sphygmography— graphic registration of oscillations of the arterial wall that occur when a pressure increase wave propagates through the vessels.
• Electroencephalography (EEG)- a method for studying the bioelectric activity of the brain.
• Rheovasoencephalography (REG)- a bloodless method for studying blood circulation in the system of carotid and vertebral arteries, based on graphic registration of changes in the electrical resistance of living tissues during the passage of an electric current through them (an increase in blood filling of blood vessels during systole leads to a decrease in the electrical resistance of the studied body parts).
• Electroneuromyography (ENMG), or stimulation electromyography (EMG)- methods for studying the bioelectrical activity of a muscle or nerve that occurs in response to electrical stimulation of the nerve.

Echography (ultrasound examination)

Ultrasound examination (ultrasound) is based on the effect of registration by the device of reflected ultrasonic radiation in the range of 5-7.5 MHz and the formation of a linear (static) or multidimensional (dynamic) image.

Ultrasound research methods include:

• echocardiography (ultrasound of the heart);
• echoencephalography (ultrasound of the brain);
• Ultrasound of internal organs.

Radioisotope diagnostics

Radioisotope diagnostics is based on the use of drugs labeled with radioactive isotopes. After the introduction of these drugs into the body, with the help of special devices - scanners and gamma cameras - they record the accumulation and movement of isotopes in an organ or system.

Radiation diagnostic methods

Radiological diagnostic methods include:

• radiological;
• magnetic resonance.

The group of radiological examination methods includes:

• fluoroscopy- translucence of the organ with x-rays behind the x-ray screen, which allows to study the state of the organ from a positive image;
• radiography– obtaining x-rays in various projections, which allows assessing the state of the organ from a negative image;
• fluorography- pictures on a small-format reel film illuminated by x-rays;
• teleroentgenography- radiography from a distance of 1.5-2 m;
• tomography- layer-by-layer radiography; the thickness of the detected section is 2-3 mm, the distance between the sections is usually 0.5-1 cm;
• computed tomography- study of transverse sections of the organ using a narrow x-ray beam with a circular motion of the x-ray tube;

Information about the density of various organs is recorded by special sensors, mathematically processed on a computer and reproduced on the display screen in the form of a cross section. Differences in the density of the structure of organs are automatically assessed using a special scale, which gives high accuracy of information about any area of ​​interest.

Computed tomography is the most informative method of X-ray diagnostics. The scope of its application is very wide.

Magnetic resonance diagnostics

Magnetic resonance imaging (MRI) is a new method of radiation diagnostics, successfully introduced into medical practice. It is based on the principle of nuclear magnetic resonance. A layered tissue image is formed by changing the reaction of hydrogen nuclei in tissue fluid or adipose tissue in response to exposure to radiofrequency pulses of a stable magnetic field.

The method allows obtaining a contrast image of soft tissues and detecting even foci of pathologically altered tissue, the density of which does not differ from that of normal tissue.

Currently, MR-tomography is the most informative method among the methods of radiation diagnostics. The scope of its application is practically unlimited.

Clinical and laboratory research

Clinical and laboratory studies involve the analysis of the morphological and biochemical composition of blood, urine, and, if necessary, other body media (cerebrospinal fluid, sputum, gastric contents, feces).

Laboratory research is carried out in the following areas:

• study of the general properties of the material under study - quantity, color, type, smell, presence of impurities, relative density, etc.;
  microscopic examination;
• a chemical study to determine certain substances - metabolic products, trace elements, hormones, compounds that appear only
  with diseases, etc.;
• bacteriological, virological and other types of research.

thermal imaging

Thermal imaging (thermography)- a method based on recording the temperature of the body surface by capturing infrared radiation. It allows you to detect superficially located tumors or monitor the effectiveness of the treatment of various diseases. The advantages of this method include its complete harmlessness and high resolution in determining the temperature difference.

Endoscopic methods

Endoscopic methods are based on the introduction of a special device into a hollow organ or cavity, which allows you to determine the shape and size of the organ under study, the condition of the mucous membrane (color, relief, i.e. the nature, height and width of the folds, the smallest changes in the surface of the mucous membrane - erosion, ulcers, polyps, tumors, submucosal hemorrhages, etc.).

endoscopic methods of examination include:

• bronchoscopy– endoscopic examination of the bronchi;
• gastroscopy(full name - esophagogastrofibroduodenoscopy) - examination of the esophagus, stomach and duodenum;
• colonoscopy- examination of the large intestine;
• sigmoidoscopy- examination of the sigmoid and rectum;
• cystoscopy- examination of the bladder;
• arthroscopy- Examination of the joint cavity.

The diagnostic value of endoscopic methods increases due to the possibility of taking material from the surface of its mucous membrane (to study the shape and structure of cells) or a piece of tissue (biopsy) during the study of an organ.

Functional testing

Functional testing is based on the assessment of changes in the functions and / or structures of individual organs or
body systems at the current moment under the influence of various disturbing influences.

Functional tests are most widely used for research purposes:

• of cardio-vascular system;
• systems of external respiration;
• autonomic nervous system;
• vestibular analyzer;
• general physical performance;
• energy potential of the body.