Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 1 )

1 страница

Тверская государственная медицинская академия

РУКОВОДСТВО К ПРАКТИЧЕСКИМ ЗАНЯТИЯМ ПО ОБЩЕМУ УХОДУ ЗА ХИРУРГИЧЕСКИМИ БОЛЬНЫМИ

под редакцией доктора медицинских наук профессора

Рекомендуется Учебно-методическим объединением по медицинскому и фармацевтическому образованию вузов России в качестве учебного пособия для студентов медицинских вузов

Тверь 2006

Составители:

проф. , проф. , доц. , доц. , канд. мед. наук , , канд. мед. наук , канд. мед. наук

Под редакцией доктора медицинских наук профессора

Рецензенты:

профессор кафедры хирургии Российского государственного медицинского университета

профессор кафедры хирургических болезней Московского государственного медико-стоматологического университета

Руководство к практическим занятиям по общему уходу за хирургическими больными / под редакцией профессора . – Тверь: Издательство 2004, – 000 с.

Руководство подготовлено преподавателями кафедры общей хирургии Тверской государственной медицинской академии. Оно отражает специфику ухода за хирургическими больными в лечебных учреждениях, освещая характер и порядок соответствующих действий медицинского персонала. Руководство предназначено для студентов медицинских вузов. Его содержание соответствует программе по общей хирургии с уходом за хирургическими больными, утвержденной Министерством здравоохранения России.

Ó Кафедра общей хирургии

Тверской государственной

медицинской академии

3 страница

Tver Sate Medical Academy

GENERAL CARE

THE MANUAL

Edited by professor E. M.Mohov

The book is recommended by the Educational and Methodological Association on Medical and Pharmaceutical training of Russia as a textbook for students of Medical Higher Educational Institutions

Tver 2006

4 страница

Russian text

Authors:

E. M.Mohov, MD; I. A.Kotov, MD; M. A.Muradaliev, V. A.Kadykov; F. V.Lvov, S. A.Morozov; M. E.Vishniakov; E. M.Askerov

Edited by professor E. M.Mohov

Publisher's readers:

V. A.Gorsky, professor, MD, Russian State Medical University

G. S.Rybakov, professor, MD, Moskow State Medical Stomatologic University

English text

Adaptation to English and editing: V. A.Kadykov

The manual was written by teachers of general surgery department Tver State Medical Academy. It contains data about general care of patients (nursing) in surgical department of medical establishments. The manual is intended for medical students. It content corresponds to official general surgery curriculum of Russian Public Health Ministry.

Chapter 1

THE STRUCTURE, EQUIPMENT AND THE ORGANIZATION OF SURGICAL DEPARTMENT. PROPHILAXIS OF HOSPITAL INFECTIONS

Surgical department

The surgical department is a part of hospital possessing more then 75 places. Usually in ordinary town hospitals there is one surgical department (40-60 places). As a rule in large medical establishments, as a rule, there are several different surgical departments. One of them must be intended for treatment of patients with purulent diseases and purulent postoperative complications. In such kind of hospitals the specialized surgical departments such as: traumatological, urological, cardiovascular surgery, etc also may be created.

For fulfillment of surgical operations there is a special complex of premises named a surgery block. There are two systems of allocation of a surgery block: uncentralized and centralized. At the first one each surgical department has separate surgery block, the second – one block for all surgical departments at the same place. The centralized system is preferable for using in the large hospitals having many surgical departments. The upper floor is usually destined for a surgery block.

Except surgery block the surgical department has wards for patients, sister posts, dressing, procedural room, a room for enemas, a doctors' room, a cabinet of the head of department, a room of the senior sister, place for sorting and storage of dirty bed-clothes and subjects for cleaning, canteen. In clinics there are rooms of the professor, the senior lecturer, on es for assistants, and educational rooms.

Allocation of patients at a surgical hospital is carried out according to character of their disease and their common condition. So in common surgery department there are two parts. Patients with purulent processes must be placed in separate part of department. In the other part the patients after operations without infectious complications and preparing for scheduling operations are allocated. It is done to prevent distribution of infection. Serious patients are placed in one - double wards, isolators. Especially serious patients are situated into reanimation department intended not only for surgical patients, but also for all other patients demanding intensive treatment (see chapter 14).

Wards of surgical department are supplied with the functional beds, which allow the patient to take various positions and move easily. Each patient should have a bedside-table for personal things. For patients with a bed care it is desirable to have elevating little tables. It is necessary that wards were supplied with the alarm device to call up the medical personnel.

The sister’s post is usually situated in a corridor to provide the proper review of wards. The distance from a post up to the most distant wards should not be more than 27-30 m. The post is equipped with cases for storage of medicines, subjects for patients’ care. Usually on a post there is also a special table with boxes for documentation (sheets of medical assignments, duty magazines, etc.). Also there should be a panel of alarm system with numbers of wards.

Dressings are intended for bandagings and other manipulations. In a common surgery department there are 2 dressing: "pure(clean)" and "purulent" which should be in corresponding parts of department.

About the organization of work in dressing and a surgery block it will be told below (see chapter 4).

Procedure room (treatment room) is a premise where taking of blood from a vein for analyses, intravenous injection of medicinal substances, preparation of systems for transfusions and infusions, blood typing, performance of individual compatibility blood tests are carried out. Procedural room should have the area not less than 15 sq. m., it must be light, supplied with warm and cold water. Walls and floor should be convenient for mechanical cleaning. The procedural equipment are: a case or a table for storage of medicines; drum-boxes with sterile dressings, syringes, needles; systems for intravenous injections; supports for infusions; test tubes for blood; a set for blood group definition; a refrigerator for storage of blood, serums and medicines.

The room for enemas - is a special premise for doing enemas. Here it is possible to do also washing of a stomach, a catheterization of a bladder. In a room the couch is put. It is supplied with the corresponding equipment (the device for enemas, Esmarch's irrigator, probes, rubber tubes etc.). In the same room it is expedient to have a separate bathroom with a toilet bowl.

Doctors' room - a workplace of doctors where they perform paper work and hold different conferences.

The room of the senior sister is usually used not only as her workplace, but also as a room for storage of medicines and other medical products. Therefore except the common furniture there are places for storage narcotic and strong drugs. Other medicines, and also new syringes, needles, probes, catheters and other subjects are in special cases and shelves. The senior sister deals with many important medical documentations.

The organization of reception on hospitalization of patients of a surgical structure

The first department where the patient directed to hospitalization comes into is the admitting department (reception). In the usual municipal hospital patients with various deceases are admitted to a reception.

In the admitting department is carried out survey, reception, registration, sanitary manipulations and transportation of patients. The admission department usually has the following premises: a hall for visiting, cabinets for examination and diagnostics, a room for registration of patients, sanitary room, ward for observation, procedural, dressing, laboratory for emergency analyses, a room for storage of clothes, a cabinet of the head, a duty doctor cabinet, a lavatory.

The surgeon examines the patients in a viewing cabinet. If it is necessary to check up the diagnosis the doctor directs to taking blood analysis appoints analyses of blood, urine and other researches or direct the patient to corresponding experts and special researches.

Sometimes diagnosis is not clear. In this case patient is placed in a special observation ward for differential diagnostics. Patients is observed and examined during several hours (not more than three) then the doctor comes to a decision.

On the basis of the results of examination of a patient the doctor makes this or that diagnosis. In accordance with indications the patient is hospitalized in a common or the specialized surgical department. If indications for hospitalization are not present, the patient is discharged with medical recommendations. The patient can be discharged home and after some medical procedures which are carried out in reception: a cleaning enema, washing of a stomach, bandaging, injections, etc.

Bandagings and small operations are carried out in dressing, other medical manipulations - in the treatment room. Principles of equipment and the organization of work dressing and procedural room, as well as in surgical departments also will be described below.

Registration of patients is carried out by the medical nurse. Every patient in hospital has the history case (special medical form), the sister fills in the title page of the case record, and write data on the patient in a log-book of admitted patients. If the patient is discharged from a hospital this fact is also put down into the log-book.