Dispensary observation of gynecological patients. Organization of dispensary observation of gynecological patients
There are several types of health: Somatic - current state organs and systems of the body, physical level growth and development of organs and systems, Mental - the state of the psychological sphere, Moral - a system of values of behavior in society, a complex of motivations for the need-information sphere of activity
From the position medical practice the definition of health must meet the following criteria: Have a personal value that is significant for a person; Characterize in the body what is opposite to disease; Provide the possibility of its quantitative measurement; Have a morphophysiological substrate that is accessible to study and influence.
A healthy lifestyle is a type of life activity that is aimed at maintaining and strengthening health. The lifestyle includes: increasing motor activity, presence or absence bad habits, nutrition, neuro-emotional state, daily routine, personal hygiene, level of medical literacy, level medical activity
Today, maintaining public health is a state task. Implementation of the “Health” project: promoting a healthy lifestyle, combating smoking and alcoholism, improving oncological care, equipping outpatient clinics, introducing birth certificates, increase cash payments primary care workers, additional medical examination Organization of “Health Centers” for the population, 502 centers operate in the regions of Russia, a website is running on the website of the Ministry of Health, work has begun on compiling a health passport.
The purpose of medical examination is to create unified system, providing assessment and dynamic monitoring of a woman’s health status. Medical examination means: active identification of sick women early stages diseases, dynamic observation and conducting complex treatment, implementation of measures to improve working and living conditions, prevent the development and spread of diseases, and strengthen working capacity.
Prevention is the main direction of healthcare, medical examination is the method by which this preventive direction is being implemented. Clinical examination includes observation of certain groups healthy women, for the purpose of carrying out preventive, sanitary and hygienic and social events, ensure proper physical development and maintaining health and monitoring patients suffering from long-term chronic forms diseases.
From among the healthy, female workers are subject to dispensary observation in accordance with the list of industries and professions for which preliminary examinations upon admission and periodic examinations are required for the purposes of labor safety and prevention occupational diseases, service workers, female students, schoolchildren, athletes, etc., as well as persons who are ill for a long time and often, suffering from chronic diseases in the stage of compensation and decompensation
The selection of patients subject to dispensary observation is carried out by doctors: For current visits to outpatient clinics for any reason: for a certificate, advice, health resort card etc. During preventive medical examinations of certain groups of people. When analyzing accounting documentation, obtaining information from hospitals, and preparing various documents.
The effectiveness of medical examination is ensured by establishing an accurate diagnosis of the disease - the main one, for which the patient will be under clinical observation and related ones. Therapeutic measures should be aimed at the complete recovery of the individual, taking into account all changes in the body Comprehensive examination both during registration and subsequently Frequency of observation to prevent progression of the process Consultations with doctors of various specialties, since the disease can cause changes in the different organs and systems
Maternity clinics and specialized dispensaries participate in annual preventive examinations of the population, carry out dispensary observation for all identified patients, the necessary medical treatment is carried out diagnostic measures, evaluate the effectiveness of dispensary observation, carry out sanitary and hygienic and educational work among the population, carry out continuity with territorial treatment and preventive institutions.
All women over 18 years of age living in the area of operation are subject to preventive gynecological examinations antenatal clinic For the adult population, annual examinations with an obstetrician-gynecologist are mandatory. Currently, primary health care is focused on outpatient services, care is patient-centered, the outpatient doctor is trusted, coordinates the continuity of care, coordinates actions. Medical care must be effective, safe, and meet needs patients and society, easily adapt to changed circumstances Outpatient unit for the provision of specialized gynecological care– the central link of health care.
At the first stage of medical examination, gynecological patients who need treatment, systematic examinations and examinations are identified, and an “Outpatient Medical Card” f.025 and a follow-up follow-up card f.030 are filled out. After treatment is completed, the card is transferred to the cell of the month for which it is prescribed. next visit. The duration, frequency, timing of visits are determined for each patient individually, depending on clinical manifestations disease, age and other factors
The remaining women are considered practically healthy. Some practically healthy women may experience some deviations in the condition of the genital organs, but they do not complain, do not need treatment or systematic observation, their ability to work is not impaired and there is no threat to health. These women only need preventive examinations and some recommendations. There is no special documentation for them and they are not given diagnoses.
Practically healthy women include: - with prolapse of the walls of the vagina and uterus of the 1st degree, - unfixed deviation of the uterus, - uncomplicated menopause, - menstrual cycle disturbances within 1-2 months after an abortion, - infertile marriage with undetermined infertility of women, - who have suffered in the past an inflammatory process of the appendages without exacerbation and dysfunction.
The provision of outpatient care to women with gynecological diseases is regulated by orders of the Ministry of Health Russian Federation and government bodies of the Irkutsk region. The order of the Ministry of Health of Russia from “On the improvement of obstetric and gynecological care in outpatient clinics” and order 786 from the city “On approval of patient management protocols” of the Main Directorate of the Irkutsk Region Administration regulate the procedure and completeness of examination and treatment of patients with a wide variety of pathologies. The relevant sections provide, according to the diagnosis, a list of diagnostic procedures used in establishing a diagnosis, examination by doctors of other specialties, a list of diagnostic procedures carried out during the process of observation and treatment, therapeutic and recreational measures, frequency of re-examinations, indications for inpatient treatment, criteria for deregistration
Gynecological diseases subject to dispensary observation Children's gynecological diseases Infectious pathology in gynecology (genital herpes, bacterial vaginosis, urogenital trichomoniasis, urogenital chlamydia, tuberculosis of the female genital organs) Inflammatory diseases pelvic organs Benign diseases of the cervix Oncological diseases Endocrinological pathology (DMC, PCOS, premature failure ovaries, post-variectomy syndrome, menopausal syndrome severe course, postmenopausal osteoporosis) Hyperplastic processes and benign tumors of the uterus, appendages and mammary glands Infertile marriage Urogenital disorders (genital prolapse and urinary incontinence)
Preparation of documentation for a dispensary patient: Epicrisis of a patient registered at a dispensary, in which, after the examination, a diagnosis is made, indications for clinical examination are determined, anamnesis, complaints and objective examination data are reflected. A dispensary observation plan is attached; it reflects the purpose of the examinations, treatment of the disease, and the frequency of examinations. The plan is agreed upon with the patient, a date and signature are placed, the patient’s consent. In case of deregistration, or at the end of the calendar year, an epicrisis and a plan for next year
The examination during a medical examination includes: anamnesis, general physical examination, palpation of the mammary glands, speculum examination, cytology of smears "PAP test" Referral for ultrasound of the pelvic organs Referral for mammography: years 1 time in 2 years, after 50 years 1 time per year. At high risk cancer from 35 years of age, ultrasound of the mammary glands for complaints up to 40 years of age Colposcopy (order 50) is a non-screening method, carried out based on the results of a cytological examination
Basic principles for monitoring women using COCs Annually gynecological examination, including colposcopy and cytological examination of the cervix. Examination of the mammary glands, mammography once a year in premenopause. Regular blood pressure measurement: when diastolic blood pressure increases to 90 mm Hg. Art. – stopping taking COC B special examination according to indications (if side effects develop, complaints arise) In case of violations menstrual function– exclusion of pregnancy and transvaginal ultrasound scanning uterus and appendages
Monitoring of patients using an IUD During the first week after insertion, an IUD is not recommended sex life and intensive physical activity A doctor's follow-up examination is carried out after 7-10 days and an ultrasound is performed to clarify the location of the IUD in the uterine cavity. Subsequent examinations should be carried out after 1 month, then at least once every 6 months, then annually with a bacterioscopic examination of the discharge of the cervix, ultrasound according to indications . NB!!! The patient should be taught to check for the presence of threads after menstruation so as not to miss the expulsion of the IUD.
Cervical ectopia Cervical ectopia is a displacement of the boundaries of the columnar epithelium to the vaginal part of the cervix. ICD-10 does not include ectopia of the cervix. In the colposcopic nomenclature adopted in Rome (1990), ectopia is classified under item 1 “normal findings of colposcopic examination.” The uncomplicated form of cervical ectopia has no specific manifestations. Does not require treatment. Dispensary observation is indicated for the purpose of timely detection of deviations in clinical course: examinations once a year with colposcopy and bacteriological research Contraception with COCs is not contraindicated.
Complicated form of cervical ectopia In complicated forms, ectopia is combined with inflammatory processes of the cervix, dysplasia varying degrees severity Use bacterioscopic, bacteriological methods, PCR Differential diagnosis is made with cervical cancer, true cervical erosions
Complicated cervical ectopia Treatment goals for cervical ectopia: Elimination accompanying inflammation Correction of hormonal and immune disorders Correction of vaginal microbiocenosis Destruction of pathologically altered cervical tissue Examination of the cervix and colposcopy are carried out no earlier than 4-6 weeks after surgical treatment
Ectropion Ectropion - eversion of the mucous membrane cervical canal Goals of treatment for ectropion: restoration of the anatomy and architectonics of the cervix Elimination of concomitant inflammation Correction of vaginal microbiocenosis Surgical treatment on an outpatient basis with release from work for 1-2 days; for reconstructive plastic surgeries performed in a hospital setting, the patient is given a sick leave for 7- 10 days Follow-up examination after 6-8 weeks
Leukoplakia of the cervix Leukoplakia of the cervix - pathological process, associated with keratinization of multilayer squamous epithelium(synonymous with cervical dyskeratosis) ICD code cervical leukoplakia Extended colposcopy allows you to clarify the size and nature of the lesion Targeted biopsy and curettage of the cervical canal with histological examination is the main diagnostic method Differential diagnosis with cervical cancer, consultation with an oncologist in case of a combination of cervical cancer and CIN3, consultation with an endocrinologist in case of complex hormonal disorders Treatment of concomitant inflammatory diseases of the genital organs, destruction of pathologically altered tissue of the cervix (in the presence of CIN1-2) After treatment of cervical cancer without atypia, dispensary observation is indicated, including colposcopic and cytological examination, testing for HPV - once every 6 months for 2 years, with satisfactory results – transfer to the usual screening regimen
Treatment goals Removal of atypically changed epithelium Antiviral therapy Immunomodulatory therapy for CIN2-3 should be treated with amputation, conization, or destruction. The choice of the extent of the operation depends on the woman’s age, the nature and extent of the process; CIN1 is determined individually; observation every 6 months for 2 years is indicated. After destructive treatment methods, examination and colposcopy after 6-8 weeks, then once every 3 months during the first year and 2 times a year thereafter
Exo-endocervicitis The term exocervicitis refers to inflammation of the vaginal part of the cervix. Endocervicitis is an inflammation of the mucous membrane of the cervical canal of the cervix. Differential diagnosis from cervical ectopia, cervical cancer, specific cervicitis (gonorrhea, syphilis, tuberculosis)
Treatment goals: Relief of the inflammatory process by etiotropic treatment Elimination of predisposing factors (presence of atrophic colpitis in menopause) Treatment concomitant diseases Drug treatment: etiotropic therapy and restoration of normal vaginal microbiocenosis Surgical treatment in combination with other diseases of the cervix (dysplasia, elongation, scar deformity etc.) Patients are at risk for STIs and cancer cervix. Follow-up after adequate treatment once a year.
Inflammatory diseases of the pelvic organs Minimum criteria for PID according to WHO: Pain on palpation in the lower abdomen Pain in the appendage area Painful traction of the cervix If these signs are present and there is no other cause of the disease, it is necessary to treat all sexually active young women of reproductive age! !!
PID Additional criteria according to WHO (to increase the specificity of diagnosis): Body temperature above 38 Pathological discharge from the cervix or vagina Leukocytosis, changes leukocyte formula, increase in ESR and C-reactive protein levels Laboratory confirmation of cervical infection caused by STIs
PID Defining criteria: Pathomorphological confirmation of endometritis with endometrial biopsy, Thickening of the fallopian tubes, presence in abdominal cavity free liquid or tubo-ovarian formation according to ultrasound, Deviations corresponding to PID detected during laparoscopy.
PID - stages of treatment: Causal therapy - antibiotics wide range actions of immunomodulatory therapy in chronic phase Physiotherapy and spa treatment Contraception Clinical observation 3 months after recovery or stable remission
Treatment of hyperplastic processes in the endometrium The first stage is therapeutic and diagnostic curettage of the uterine mucosa under the control of hysteroscopy The second stage is therapeutic measures aimed at preventing relapse (COCs, gestagens, antigonadotropins, GnRH agonists, depot forms of gestagens) Diet combined with drugs that regulate carbohydrate metabolism At the end of hormone therapy - control hysteroscopy with endometrial biopsy. In women with infertility, the next stage is ovulation induction. Observation once a year with ultrasound.
Retention cysts - screening and primary prevention To prevent re-education functional cysts restoration of the menstrual cycle is indicated, taking into account hormonal status. If chronic inflammatory processes are identified that provoke cyst recurrence, anti-inflammatory treatment is indicated
Ovarian tumors The second stage lasts the first 2 years, regular examinations with ultrasound every 6 months The third stage of the year after surgery. Gynecological examinations and ultrasound every 4-6 months The fourth stage - observation is carried out every six months with ultrasound of the pelvic organs
Endometriosis Endometriosis is a benign disease characterized by the growth outside the uterine cavity of tissue that is morphologically similar to the endometrium and undergoes cyclic changes according to the menstrual cycle - ICD The examination and treatment plan for the patient is individual depending on the location of the endometrioid lesions
Edometriosis Differential diagnosis with: Uterine fibroids Chronic endometritis Hyperplastic processes in the endometrium Ovarian tumors Metrophlebitis Malignant formations genital organs Tuboovarian formations of inflammatory etiology Differential diagnosis of cervical endometriosis is carried out with cervical carcinoma Chronic endocervicitis Cervical cysts with hemorrhagic contents According to indications - consultation with specialists: urologist, gastroenterologist, psychiatrist
Endometriosis Treatment goals: relief clinical symptoms, removal of endometriosis foci, restoration reproductive function Treatment of endometriosis mainly consists of a combination of surgery and hormone therapy Drug therapy carried out in antenatal clinic B rehabilitation treatment includes: Physiotherapy aimed at improving blood flow and cell metabolism, enhancing phagocytosis and enzymatic activity, stimulating tissue repair Supporting vaginal normobiocenosis Restoring a two-phase menstrual cycle after the end drug treatment Observation in the antenatal clinic for 1 year after the end of treatment, once every 3 months during organ-saving operations with ultrasound control
Uterine fibroids Uterine fibroids are a benign solid tumor of monoclonal origin, arising from the smooth muscle cells of the myometrium and containing different quantity connective tissue. Uterine leiomyoma is formed as a result of poorly controlled proliferation of individual smooth muscle cells in combination with dilation of blood vessels and excessive extracellular deposition of collagen ICD-10 D 25-D 25.3
Uterine fibroids The management plan for a patient with uterine fibroids depends on the location and size of the node, the patient’s age, reproductive plans, and symptoms of fibroids. Clinical minimum, Colposcopy, transvaginal ultrasound, Diagnostic curettage or aspirate from the uterine cavity, Consultations of related specialists to identify concomitant pathology, Observation 2-4 times a year
Uterine fibroids Screening and primary prevention - ultrasound once a year Watchful waiting is justified in patients with uterine fibroids who are not interested in preserving reproductive function (premenopausal and postmenopausal) without clinical manifestations of the disease and absence of tumor growth Dynamic observation is carried out once every 6 months with ultrasound and blood tests
Uterine fibroids Indications for surgical treatment: Fast growth uterine fibroids (by largest node) Acute violation nutrition in the myomatous node Suspicion of sarcoma Growth of the myomatous node in postmenopause Uterine fibroids large sizes(14-16 weeks of pregnancy) “Born” myomatous node Disturbance of the function of neighboring organs Unfavorable locations of nodes: submucosal, cervical, intraligamentary, subserous on the pedicle
Uterine fibroids - UAE Advantages of UAE compared to surgical treatment: preservation of the uterus, absence of intraoperative blood loss, simultaneous effect on all myomatous nodes, lower risk of complications, more short term disability (1-2 weeks) Observation after UAE: after 3.6 months FSH ultrasound after a month Contraindications to UAE: subserous node
Infertility Infertility (infertility) is the inability of spouses of childbearing age to conceive a child with regular sexual activity without contraception for 12 months ICD, 46 male infertility The frequency of infertility in marriage ranges from 8 to 29%
Screening and primary prevention Prevention of infertility lies in improving the quality of care medical care, and also general culture population. Reducing the number of abortions and their complications Timely diagnosis and treatment of STIs Promoting a healthy lifestyle Combating stress Refusal of unreasonable surgical interventions on the pelvic organs Timely planning of reproductive function Development of pediatric and adolescent gynecology and andrology Improvement endoscopic surgery Improving hormone therapy endocrine disorders
Diagnosis of infertility: Quick (up to 3-6 months) determination of the cause of infertility: gynecological examination, ultrasound monitoring of follicle growth, STIs, assessment of the condition of the fallopian tubes, direct visualization of the pelvic organs Exclusion of male and female immunological infertility
Treatment of infertility In the absence positive effect from the ongoing traditional way treatment for 2 years, and in patients over 35 years old, no more than a year, it is advisable to use methods of AUXILIARY REPRODUCTIVE TECHNOLOGIES (IVF, ICSI) Medical genetic counseling mandatory for infertile married couples over 35 years of age planning a pregnancy, in addition, if there is a history of the birth of children with developmental defects, stillbirth, recurrent miscarriage, late menarche, delayed sexual development, with severe pathozoospermia in the husband.
Clinical examination of gynecological patients is carried out according to to the following groups(order No. 50):
D1 - dispensary healthy persons with a medical examination once a year with a mandatory smear for atypical cells at any age.
D2 - practically healthy.
- 1. Prolapse of the genitals.
- 2. Fibromatoses of the uterus.
- 3. N.M.C. after an abortion, more than 2 months (anti-inflammatory therapy, resorption therapy, physiotherapy).
- 4. Infertility.
- 5. Women who have had inflammation of the appendages are currently residual effects(after exacerbation, NMD).
- 6. IUD - 1-2 times a year with cytology.
- 7. Persistent stage of endometritis with the onset of menopause.
- 8. Ovarian tumors - after surgical treatment.
- 9. Patients after surgery for uterine fibroids.
- 10. Changes after hydatidiform mole.
- 11. Infertility, over 35 years old, because this group often disappears from view, and at this time ovarian cystoma and uterine fibroids appear, which also cause infertility.
- 12. Patients after treatment for cervical pathology: erosion, etc.
- 13. Every woman after a medical abortion for 1 month.
D31 - chronic diseases in the compensation stage.
D32 - survivors of acute illnesses.
D33 - chronic diseases in the stage of decompensation.
D3a - compensated flow:
- 1. Group of patients after surgery for uterine fibroids for the first 6 months.
- 2. Group of patients after surgery for ovarian tumors for the first 6 months.
- 3. Group of patients, after inpatient treatment regarding inflammation of the appendages.
- 4. A group of patients with endometriosis who require hormonal treatment.
- 5. Patients with average degree climacteric syndrome.
- 6. Patients with a high risk of developing chorionepithelioma.
- 7. Patients after surgical treatment for cervical pathology (erosion - the first 6 months).
Observed once a quarter.
D3b - decompensated course:
- 1. Pathology of the cervix requiring surgical treatment
- 2. Uterine fibroids requiring surgical treatment.
- 3. Ovarian cysts and cystomas.
- 4. Spicy inflammatory processes genitalia or exacerbation of chronic ones.
- 5. Infertility requiring surgical and hospital treatment.
- 6. Patients in the stage of subcompensation of hydatidiform mole.
- 7. Severe forms climacteric syndrome.
- 8. Patients with severe pain syndrome who require surgical treatment due to their somatic status, but have contraindications to surgery:
A) prolonged infiltrates after surgery;
b) frequent relapses inflammation of the uterine appendages, pain syndrome with endometriosis.
Observed once a week:
Quality control of medical care for gynecological patients is carried out by chief physician(Head) of the antenatal clinic. For this purpose, it is reviewed for a month medical documentation about 50% of patients taken by a doctor An obstetrician-gynecologist conducts an examination of the maintenance of “Dispensary Observation Control Cards” and “Outpatient Medical Records.” At the same time, compliance with the regularity of examinations, the volume of preventive, diagnostic and therapeutic measures carried out, the presence of epicrises, as well as the effectiveness of the treatment carried out are assessed.
For the purpose early detection malignant neoplasms It is recommended to conduct annual preventive examinations of women, which include examination and palpation of the mammary glands, examination and palpation of the abdomen, regional lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the uterus and appendages, digital examination rectum for women over 40 years of age or if there are complaints.
If cancer is suspected, the obstetrician-gynecologist refers the woman for a consultation to an oncologist at her place of residence, who subsequently monitors her.
Dynamic monitoring of gynecological patients is carried out in accordance with the Protocols (standards) for examination and treatment of gynecological patients in outpatient clinics and inpatient conditions, approved by Order of the Ministry of Health of the Republic of Belarus No. 126 dated
05/29/2001, as well as in accordance with the Standards for examination of pregnant and gynecological patients in the Grodno region.
Due to the high frequency of RD disorders in women of childbearing age, one of the most important areas in the activities of obstetrician-gynecologists should be GI timely detection any type of obstetric and gynecological pathology, its treatment and prevention, carried out at the primary care level. The form of the report on the clinical examination of gynecological patients in the residential complex of the Grodno region is presented in Fig. 2.3.
Treatment procedures prescribed by an obstetrician-gynecologist are performed by a midwife (procedural nurse).
It is advisable to organize the functioning of the treatment room of the residential complex, for which a special nurse is allocated, in 2 shifts. Control of its work rests with the senior midwife. Procedures are registered in the "Procedures Log" (f 029/u).
In the LC, outpatient and specialized appointments by obstetrician-gynecologists can perform the following: gynecological operations and manipulations recorded in the “Recording Log” outpatient surgeries” (f 099/u):
1. Aspiration of the contents of the uterine cavity for cytological examination.
2. Introduction and removal of the intrauterine contraceptive device.
3. Termination of pregnancy early dates by vacuum aspiration method.
4. Knife biopsy of the cervix.
5. Diathermocoagulation, cryodestruction or laser vaporization of the cervix.
6. Removal of small vaginal cysts.
7. Separate curettage cervical canal and uterine cavity.
8. For these purposes, the residential complex should organize small
operating room and room for temporary stay of patients after surgery or day hospital.
| Nosologies | Number registered diseases | including diagnostics installed for the first time | Was registered at the beginning | Placed under surveillance | of which were identified for the first time | Removed from all registers | incl. With recovery |
| Fibroids | |||||||
| Ovarian cysts | |||||||
| Ovarian cystomas | |||||||
| Salpingitis, oophoritis | |||||||
| Cervical polyps | |||||||
| Cervical erosions | |||||||
| Menstruation disorders | |||||||
| Menopausal disorders | |||||||
| Colpitis | |||||||
| Dysplasia | |||||||
| Endometrial hyperplasia | |||||||
| Endometriosis | |||||||
| Mastopathy | |||||||
| Oncological diseases |
2.3. Report form on clinical examination of gynecological patients.
Patients for whom treatment is indicated day hospital LCD or gynecological hospital, the obstetrician-gynecologist issues a referral for hospitalization with a note on the results of a preliminary examination and notes the date of referral to the hospital.
After the patient is discharged from the hospital, the LC doctor decides on the methods and timing of follow-up treatment, taking into account the recommendations of the hospital. A clear continuity of interaction in the work of outpatient clinics and inpatient medical facilities increases the CMP.
The basic principles of rehabilitation of gynecological patients are:
1. Beginning rehabilitation measures at the earliest stages of the disease.
2. Individual approach.
3. Continuity in carrying out rehabilitation activities.
4. Sequence and continuity of activities at various stages of rehabilitation.
5. Active and conscious participation in the rehabilitation process of the patients themselves.
The level of morbidity with VL plays an important role in the formation of the final indicators of GI activity.
The form of the quarterly structural analysis of morbidity with VN in residential complexes of the Grodno region is presented in Fig. 2.4.
The analysis of morbidity with VN is carried out according to the following indicators:
1. Number of cases of VL per 100 workers (total or for specific groups of diseases).
2. Number of VN days per 100 workers (total and for individual disease groups).
3. Average duration of one case of VN.
4. Indicators of the morbidity structure ( specific gravity cases and days of disability due to this disease among all cases and days of disability).
When issuing an outpatient VN certificate, the obstetrician-gynecologist is guided by the Resolution of the Ministry of Health of the Republic of Belarus and the Ministry of Labor and social protection Republic of Belarus No. 52/97 dated July 9, 2002 “On approval of the Instructions on the procedure for issuing certificates of incapacity for work and certificates of VN and Instructions for filling out certificates of incapacity for work and certificates of VN.”
Rice. 2.4. Form of quarterly structural analysis of morbidity with VN in
More on the topic Medical examination of gynecological patients:
- Preventive examinations and organization of clinical examination of gynecological diseases in adolescence.
Clinical examination- active dynamic monitoring of the health status of the population, including a complex of preventive, diagnostic and therapeutic measures.
Initially, the principles and methods of D. were used to combat social dangerous diseases- tuberculosis, syphilis, trachoma, etc. Subsequently, the dispensary method was used for monitoring pregnant women, children, workers in leading industries and agriculture. production, patients suffering from chronic diseases.
The goal of D. is the formation, preservation and strengthening of public health, the prevention of diseases, the reduction of morbidity, disability, mortality, and the achievement of active longevity. D. is included as an integral part in a broad system of measures for the prevention of diseases carried out by the state, society, and healthcare. Nationwide efforts are aimed at improving working, living and rest conditions, ensuring rational balanced nutrition, the fight against physical inactivity, smoking, drinking alcohol, i.e. for the formation of a healthy lifestyle. In this set of measures important role is assigned to a healthcare system that uses a dispensary method that synthesizes prevention and treatment, aimed at identifying diseases in the earliest stages and preventing them through systematic medical supervision for the health of the population.
Clinical examination includes: annual medical examination with laboratory and instrumental studies to identify diseases in the early stages, as well as examination of persons with risk factors for developing diseases; additional examination of those in need using modern methods diagnostics; determining the health status of each person; implementation of a complex of therapeutic and recreational measures for patients and persons with risk factors and subsequent systematic monitoring of their health status.
The use of all existing diagnostic methods during mass examinations within the framework of D. seems unjustified, since, along with small economic efficiency this would lead to overload of medical institutions and to negative reaction population for excessively frequent tests, functional and other studies. Therefore, a relatively narrow range of laboratory and instrumental studies has been defined, which nevertheless allows us to identify or suspect the presence of the most common diseases of medical and social significance.
The local therapist (both territorial and workshop) annually examines the entire adult attached population. A pre-medical examination is carried out, which includes measuring height and body weight, blood pressure, determining hearing and visual acuity, and pneumotachometry. Gynecological examination women with mandatory cytological examination Conducted from 18 years of age; electrocardiography - from 15 to 40 years, once every 3 years, after 40 years - annually; measurement intraocular pressure- annually after 40 years; women - mammography once every 2 years after 40 years. Fluorography chest differentiation is carried out, but not less than once every 3 years, with high level incidence of tuberculosis in the corresponding territory - annually.
Dispensary observation groups: D-I - healthy, incl. persons with so-called borderline conditions, which showed minor deviations from established standards in blood pressure and other characteristics; D-II - practically healthy persons with a history of a disease that does not affect vital functions important organs and does not affect the ability to work; D-III - patients in need of treatment.
After a clinical examination, persons assigned to the first two groups are registered in the prevention department (office). Identified patients are given appropriate treatment, a plan of health and rehabilitation measures is outlined and implemented.
The main accounting document is the “Dispensary examination record card” (form No. 131/u-86), which, in addition to passport data, includes information about the dispensary observation group determined by the doctor, undergoing an annual dispensary examination, and conducting research to the required minimum. In expanded form, the results of examinations, laboratory and functional studies, information about medical and recreational activities is entered into medical card outpatient (form No. 025/y), history of the child’s development (form No. 112/y). For persons suffering from chronic diseases, convalescents after suffering acute diseases, usually belonging to groups observations D-I I and D-III, the dispensary observation checklist is filled out (form No. OZD/u).
Date added: 2014-12-11 | Views: 2463 | Copyright infringement
| | | | | | | | 9 | | | | | | | | | | | | | | | | | | | | | | | | |
Clinical examination of gynecological patients
Clinical examination- active dynamic monitoring of the health status of the population, including a complex of preventive, diagnostic and therapeutic measures.
Initially, the principles and methods of diagnostics were used to combat socially dangerous diseases - tuberculosis, syphilis, trachoma, etc. Subsequently, the dispensary method was used to monitor pregnant women, children, and workers in leading industries and agriculture. production, patients suffering from chronic diseases.
The goal of D. is to form, maintain and strengthen the health of the population, prevent diseases, reduce morbidity, disability, mortality, and achieve active longevity. D. is included as an integral part in a broad system of measures for the prevention of diseases carried out by the state, society, and healthcare. Nationwide efforts are aimed at improving working, living and rest conditions, ensuring a rational, balanced diet, combating physical inactivity, smoking, drinking alcohol, ᴛ. ᴇ. for the formation of a healthy lifestyle. In this set of measures, an important role is given to the health care system, which uses a dispensary method that synthesizes prevention and treatment, aimed at identifying diseases in the earliest stages and preventing them through systematic medical monitoring of the health of the population.
Clinical examination includes: an annual medical examination with laboratory and instrumental studies to identify diseases in the early stages, as well as examination of persons with risk factors for developing diseases; additional examination of those in need using modern diagnostic methods; determining the health status of each person; implementation of a complex of therapeutic and recreational measures for patients and persons with risk factors and subsequent systematic monitoring of their health status.
The use of all existing diagnostic methods during mass examinations within the framework of D. seems unjustified, since, along with low economic efficiency, this would lead to overload of medical institutions and to a negative reaction of the population to excessively frequent tests, functional and other studies. For this reason, a relatively narrow range of laboratory and instrumental studies has been defined, which nevertheless makes it possible to identify or suspect the presence of the most common diseases of medical and social significance.
The local therapist (both territorial and workshop) annually examines the entire adult attached population. A pre-medical examination is carried out in advance, which includes measuring height and body weight, blood pressure, determination of hearing and visual acuity, pneumotachometry. Gynecological examination of women with mandatory cytological examination is carried out from the age of 18; electrocardiography - from 15 to 40 years, once every 3 years, after 40 years - annually; measurement of intraocular pressure - annually after 40 years; women - mammography once every 2 years after 40 years. Chest fluorography is differentiated, but not less than once every 3 years, with a high incidence of tuberculosis in the corresponding territory - annually.
