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The chair of the propedeutic of internal medicine




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1. /Topic 1 st admission departm.doc
2. /Topic 10 st nurses in the ICU.doc
3. /Topic 11 st policlinic.doc
4. /Topic 12 st fisioter.doc
5. /Topic 2 st vital sign.doc
6. /Topic 4 st terap dep.doc
7. /Topic 5 st Med_inst_utiliz.doc
8. /Topic 6 st pulm dep.doc
9. /Topic 7 st card dep.doc
10. /Topic 8 st revm depart.docx
11. /Topic 9 st gastro dep.doc
12. /Topic_13 st function depart.doc
13. /Topik 3 st etyc.doc
Methodical instruction for the third course students of the medical department
Methodical recommendations for the third course foreign students of the medical department
Ukraine ministry of health vinnytsya national medical university n a. M. I. Pyrogov
Ukraine ministry of health vinnytsya national medical university n. A. M. I. Pyrogov
Methodical recommendations
The chair of the propedeutic of internal medicine
Methodical recommendations for the third course foreign students of the medical department
Ukrainian ministry of public health vinnytsya National Medical University n a. M. I. Pyrogov
For the third course foreign students of the medical department
Methodical recommendations for the third course foreign students of the medical department
Ukraine ministry of health vinnytsya national medical university n. A. M. I. Pyrogov
The chair of the propedeutic of internal medicine
Methodical recommendations for the third course foreign students of the medical department

The chair of the PROPEDEUTIC of INTERNAL MEDICINE


Vinnytsya national medical university n.a. M.I. PyroGov


«APPROVED»

At the methodological meeting of the chair of the propedeutics of internal medicine

Chief of the chair

____________ prof. Mostovoy Y.M.

« 30 » august 2012 y.


Methodical instruction

for the third course students of the medical department



Subgect

Nursing practice

Module

1

Semantic module

4

Topic 1

Basic duties and professional actions of nurse of the admission department

Course

3

Department

Medical



Vinnytsya 2012


Methodical instruction for students has been listened and approved by meeting of the chair of the propedeutic of internal medicine of the Vinnytsya national medical university n.a. M.I. Pyrogov (protocol № 1 , “ 30 ” august 2012)



Chief of the chair, professor Mostovoy Y.M.

Methodical instruction for students has been listened and approved by meeting of the chair of the propedeutic of internal medicine of the Vinnytsya national medical university n.a. M.I. Pyrogov (protocol №_____,“_____”__________20__)


Chief of the chair, professor Mostovoy Y.M.

Methodical instruction for students has been listened and approved by meeting of the chair of the propedeutic of internal medicine of the Vinnytsya national medical university n.a. M.I. Pyrogov (protocol №_____, “_____”__________20__)



Chief of the chair, professor Mostovoy Y.M.

Methodical instruction for students has been listened and approved by meeting of the chair of the propedeutic of internal medicine of the Vinnytsya national medical university n.a. M.I. Pyrogov (protocol №_____, “_____”__________20__)



Chief of the chair, professor Mostovoy Y.M.

Methodical instruction for students has been listened and approved by meeting of the chair of the propedeutic of internal medicine of the Vinnytsya national medical university n.a. M.I. Pyrogov (protocol №_____, “_____”__________20__)



Chief of the chair, professor Mostovoy Y.M.


1. Concrete aims:

  • To own and concept about organization of work of admission department

  • To own and concept about the duties of the trained nurse of admission department

  • To own and concept about the requirements to knowledge and skills of the trained nurse of admission department


2. Base level of preparation


Name of previous discipline

Got skills

Pathological physiology


Pathophysiological mechanisms, which arise up at the diseases of different organs and systems


Propedeutics to internal medicine


Skills of questioning of patient, objective inspection on to the organs and systems.


Nosotrophy


Care of mouth cavity, eyes, nose, by ears, hair, prophylaxis of bedsores, change of the bed linen worn next to the skin and, implementation of injections and intravenous rout, preparation of patient to the instrumental methods of research, render of the first medical aid to the patients of therapeutic department



3.Organization of maintenance of educational material

Patients are hospitalized in any medical establishment through the admission department. They can be hospitalized in the admission department:

  • according to plan with the permit for hospitalization from the policlinics

  • by the ambulances,

  • independently

Task of admission department are: primary examination of the patients. sorting and direction of the patients in the different separations of hospital or on ambulatory treatment; to give help on the ambulatory stage; sanitization of patients which are enter to the admission department; registration patients in the document admission department; organization of reception and account of motion of the patients: connection with the station of first-aid and other medical establishments.

When the patients hospitalized to the medical establishment they arrived in to the admission department. Here medical personal perform their registration, examined them, perform sanitization and transporting of patients in other departments of the clinic.

The admission department is consist of:

  • hall

  • registration room

  • rooms for patients examination

  • sanitary department (locker room, bathroom).

  • chambers for storage of clothes;

  • manipulation room

  • diagnostically-medical department (surveying rooms for men and women, procedural rooms, laboratory, cabinet of x-ray examination, cabinet for performing endoscopic examinations, cabinet of ultrasound examinations).

Riggings of medical sister of admission department:

  • Table with locked boxes for storage of the medical document in saved (cases of history, sheets of the medical settings, temperature, procedural letters and others like that).

  • Special closets for storage of medicines: separately for the groups of «À» (poisonous) and «B» (drastic).

  • Metallic dinner-wagon for placing of sterile materials (cotton wool, bandage), capacities with disinfectant solutions.

  • Dinner-wagon for placing of medications to the patients.

  • Refrigerator, liquid facilities which deteriorate quickly are saved in which, are extracts, decoctions, vaccines.

  • Stand of the light signaling.

  • Telephone.

  • Facilities of emergency illumination.

  • Facilities of individual hygiene: wash stand, soap, towel.

Functional duties of induction centre

  • To prepare a workplace

  • To familiarize with direction of patient in to the hospital and to accompany him in a room for patients examination.

  • To measure to temperature of the patients body, to full fill
    passport part of the case of history.

  • to examine a patient for detection pediculosis and scabies.

  • To tell the patients about the rules of internal order of hospital.

  • Exactly in time perform the setting of duty doctor, and in the case of any complications immediately report to the doctor about it.

  • The nurse of department has right in cases threatening to life of patient,

independently to execute such medical manipulations and procedures:

  • supervision and adequate estimation on the state of the patient;

  • imposition of aseptic bandages on wounds;

  • stop of the external bleeding;

  • transporting immobilization;

  • imposition of gipseous bandages;

  • imposition of bandages at opened pneumotorax;

  • determination of blood and rhesus factor type;

  • all types of injections;

  • perform different kinds of transfusion;

  • perform artificial respiration;

  • perform massage of heart;

  • sounding of stomach and 12-falling bowel;

  • implementation of all types of enemas;

  • introduction of gas-freeing tubes;

  • application retraining of urinary bladder;

  • imposition of mustard plasters, jars, leeches, compresses;

  • measuring of blood pressure;

  • washing of external acoustic duct if it is necessary:

  • lead through of diagnostic skinning tests and prophylactic inoculations.




    • In good time to pass telephone messages in the department of militia, active calls in the policlinics of city, urgent reports in cause of infection diseases.

    • To be able to give urgent help including and reanimation help.

    • Expressly to conduct a registration document.

    • To organize the sanitization of patients, if necessary perform disinfections of their things.

    • To watch after the sanitary state in the admission department and to control work of nurse-assistant.

    • To register property of procedural cabinet: apparatus, tool,
      bandaging material.

    • To bring the results of researches from the hospital laboratories.

    • To control work of junior medical personnel.

    • To promote the level of professional qualification.

    • To keep the medical secret.


Each department is led by the manager of the department. He usually is one of the most experienced doctors, who organizes well-timed inspection and treatment of the patients, monitors the work of the medical personnel, is responsible for the rational use of the bed fund of department, medical equipment arid Pharmaceuticals. Physicians immediately carry out inspection and treatment of the patients and check their condition every day.

The senior nurse organizes and monitors the work of the nurses and of the nurse-assistants and of the senior nurse-assistant. She also keeps the medical equipment and Pharmaceuticals.

The senior nurse-assistant is responsible for well-timed maintenance of the department with soft and solid stocks, and also body-linens and bed-linens.

The nurse-assistants provide care for the patients, their power supply and the maintenance of a necessary sanitary condition in the department.

The patients, directed to hospital, first of all are admitted to the reception-department. There are received and registered of the patients, with the appropriate medical documentation, the medical examination with an establishment of character and gravity of disease, definition of department for the subsequent hospitalization of the patients, giving him if necessary an emergency medical care with cleansing.

The admissions department should have a waiting room, registration and inquiry offices, rooms for examination of patients, a room for special medical procedures, and a room for sanitary preparation of the patients.

The patients enter the hospital in several ways:

  • according to plan with permit for hospitalization from
    the polyclinic,

  • by the emergency,

  • independently.

The patient's name and other personal data are recorded in the admissions department, and then he is examined by the physician.

If a patient is admitted to the hospital according to a preliminary agreement with a policlinic or an outpatient department of another hospital, this means the taking of his case history, primary examination, and sanitary treatment are needed.

If the patient is in a critical condition or even unconscious (haemorrhage, shock, coma, dangerous cardiac arrhythmia, etc.), the patient is not questioned, nor is he given any special sanitary treatment. He is delivered immediately to the resuscitation or operating room, or a specialized department where he is given the necessary medical aid.

With the aim of making a specific diagnosis, the physician of reception-department can invite advice from appropriate experts. In such cases the laboratory and instrumental research will be carried out. In some cases the patient can be in a special diagnostic ward of the reception department within day for specification of the diagnosis. If after examination it is found out that bed care is not necessary, the patient is sent off to the home with proper references, after giving emergency first aid.

The case history is filled in for every patient admitted to the hospital. When recording a case history, the patient reports his name, age, position, address, and the address of his closest relatives. The data and time of admittance to the hospital are also entered in the case history. All this data is also recorded in a special admittance journal.

The nurse records the patient's personal data on a special chart, then the patient's height and weight are measured. The patient is given a superficial examination for possible pediculosis or signs of infectious diseases, and his body temperature is measured. All findings are recorded in the case history and the nurse accompanies the patient to the physician and then gives him sanitary treatment. Finally, the nurse accompanies the patient to the medical department.

The examination of the patient includes not only measuring his height and weight but also the girth of his chest, his muscular strength (dynamometry), and respiratory function (spirometry).

The methods and techniques used to assess the morphological conditions of people are called anthropometry.

The height of man is measured by a wooden or metal graduated plank fixed in a floor-mounted base.

A horizontal plank slides freely along the vertical plank to read the height. A special collapsible seat is provided to measure the sitting height (the length of the trunk). Another graduated scale starts at the level of the seat. In order to measure the height of a person, he is asked to stand barefoot on the floor plate and to take an erect position so that his back is pressed against the vertical plank; the head should be in a position where the tipper edge of the external auditory meatus is level with the outer angle of the eye.

The sliding horizontal plank is then lowered to come in contact with the patient's head and fixed in this position. The patient is asked to step out from the height meter. The lower edge of the sliding plank reads the height. The sitting height is measured in the same way expect that the patient is asked to sit.

The normal height of males varies from 165 to 180 cm and of females from 155 to 170 cm. Deviations on either side are connected with endocrine dysfunction.

Weight is measured on a special medical balance. Weighting should be done in the morning, on a fasting stomach, after defecation and urination. Whenever possible, the patient should be with no clothing or he should wear a light garment, or In order to follow changes in the patient's weight during treatment (in treatment of asthenia obesity, or oedema) repeated weighting should be done in the same conditions (with the patient either undressed or with the same clothes on) in order to rule out the error.

The weight of the human body depends mainly on the height arid the girth of the chest. The correlation between these two factors determines the proportionate constitution of man..

Normal weight can be calculated approximately by measuring the man's height and subtracting 100. For example the normal weight of a 180 cm high man should be 80 Kg (180-100).

This in only a tentative method since normal weight varies with age and many other factors. The patient usually loses weight with many diseases, especially those associated with malignant new growth, tuberculosis, acute infections, and gastrointestinal diseases. Fat tissue is lost first, than the patient loses weight at the expense of muscular tissues. Patients with oedema gain weight due to retention of moisture in the tissues.

The girth of the chest is measured by a tape passed under the angles of the shoulder blades on the back and across the 4th rib of the chest. The girth should be measured with quiet breathing and hanging hands freely at the patient's sides. The measurements are taken at the height of inspiration and expiration.


Sanitary and hygienic treatment of patients.

The amount of sanitary treatment needed depends on the patient's conditions. If the condition of the patient allows it, he receives a shower or a bath. The patient takes off his clothes in the examining room where he is prepared for the bath.

The patient's personal belongings are registered. A copy of the record is placed in the patient's file, while another copy is kept together with the belongings in a storage room. Money and valuables are registered separately by the senior nurse of the admissions department.

A bath is prescribed to clean the patient's skin from dirt
and sweat. A bath is not recommended for patients with skin diseases, wounds, and for those in a critical condition such as: hypertonic crisis, acute myocardial infarction, acute infringement of a cerebral circulation, tuberculosis in an active phase, the parturient woman, acute surgical pathology. In such cases the patient's skin is rubbed with a tampon, moistened by warm water with soap, then wiped with a dry tampon and the nails of the patients are shortly cut.

The bath should first be washed with hot water and soap and if the previous patient had a skin or infectious disease, the bath should be disinfected

The patient should be given a clean sponge and after he has taken the bath the sponge should be discarded into a "used sponge" container. Whenever possible, the patient should be given a sterile package containing a clean sponge and underwear.

In order to prevent the water from cooling, the bath should be filled immediately before use. To prevent steaming, the bath should first be filled with cold water and then hot water added to obtain the required temperature, which is measured by a thermometer in a wooden frame.

The water temperature in the bath should be 36-37° C, and the ambient air, 25-28° C.

The head is first washed, than follow the body and the legs. The bath takes 20-25 minutes. The bath is prepared by junior medical personnel, while the assistant physician or the nurse observes the patient's condition.

If the patient's condition does not permit taking a bath, he
is given a shower.

The preparations are the same as; for a bath. The shower
should be taken for 5-10 minutes. After a bath, the patient has his toe and fingernails cut and is given clean underwear.

Rooms intended for sanitary treatment of patients should be kept clean. The oilcloth covering the cot should be treated with a disinfectant solution (2 per cent chloramine solution). A clean sheet should be used to cover the cot for each new patient.

In detection of pediculosis the special cleansing of the patients will be carried out. Pediculosis is infestation with lice. Lice are associated with poor hygiene, crowded living conditions, and exposure to others with lice. Lice live on the skin, attaching their eggs (nits) to the hair. Itching and scratching are a response to lice bites. Lice are difficult to remove because the nits are attached to the hair by an adhesive substance. Pediculesis capitis, pediculesis pubis (crab lice), clother lice and pediculesis corporis (scabies) are differentiated.

Scabies refers to infestation of the body. Scabies may be treated with complete bathing, application of topical medication, and washing linen and clothing in very hot water.

Pediculesis capitis amazes a single hair of the head, attaching the nits to a hinge of a hair. There are some ways for dealing with pediculosis capitis. Usually the hair is oiled with a mixture of vegetable oil with kerosene and the head is covered the wax-paper and a triangular scarf for about 8-10 hours. Pediculosis capitis is treated by vigorously massaging the hair and scalp with gamma benzene hexachloride or other special medicines. After that the head is carefully washed out by warm water with soap. For removal of nits within several days the hair is repeatedly combed by fine comb with cotton wool moistened in hot 10 % solution table-Acetum.

Crab lice parasitizes on hair surfaces of pubic area, sometimes amazes a moustache, beard, brow, eyelash or axillary hollows (armpit). For destruction of crab lice the hair section of the affected areas is shaved off. Pediculosis pubis may be more resistive to treatment. The nits are difficult to remove from areas with heavy hair growth, apply the medication to the involved area and leave it on the body 12 to 24 hours. Then bathe the person thoroughly with soap and water. If crab lice are found, emphasize the need for treatment of sexual partners to prevent reinfestation.

Clothes lice causing affecting the skin are found often in pleats and seams of linen. They are carriers of typhus. The person is thoroughly bathed with soap and water. The linen and clothes of such patients are disinfected in special disinfectant chambers.

The detection of louse must be completely dealt with complete (washing of the patient with soap and water, destruction of insects in linen, bed accessories and inhabited rooms, i.e. disinfection) or partial (washing of the people and disinfection linen, clothes, footwear),

A special entry should be made in the case history and the sanitary and epidemiological station of the district where the pediculosis patient resides. He should be informed so that his family may be inspected and the appropriate disinfection measures be taken if necessary. The time of the report to the sanitary and epidemiological station should be recorded in a special journal of the admissions department.


Transportation of the patients

The type of transportation is defined by the physician. The patients in a satisfactory condition are transported to the department on foot accompanied by a nurse or nurse-assistant. Weak patients, invalids, elderly and senile patients are transported with a special chair — stretcher (arm-chair, wheel­chair). The seriously ill patients are transported uh a cart in a lying position.

The stretcher with the patient is carried by 2-4 men. In going upstairs the patient is carried with his head first, in going downstairs the patient is carried with his feet first, raising in both cases the foot end of a stretcher.

If patient is transported by one man, he clasps by one arm the chest of the patient at the level of the scapulas, and the other arm goes under his femurs. Thus the patient puts his arm around the nurse neck.

In removing the patient from the stretcher on the bed the stretcher is put perpendicularly to the bed so that the foot end of the stretcher was towards the head end of the bed or closely parallel to it.


4. Plan and organizational structure of lesson on discipline.





Stages of classes


Distribution of the time


Types of control


Facilities of studies


1.

Preparatory stage


15 min.








1.1.

Organizational questions











1.2.

Forming of motivation











1.3.

Control of initial level of preparation





Writing,

computer testing

verbal questioning

after the standardized list of questions


1.textbook for propedeutics of internal medicine

2.spirograms

3.cardiagrams

4. analyses of blood and urine

6.methodical

recommendations


2.

Basic stage

– questioning and vision of patients with different illnesses

interpretation of the information of additional methods of inspection

Learning the riggings and abilities of the nurse in the admission department

55 min.


practical skills of collection of anamnesis

practical skills near the bed of patient

practical skills from estimation of general laboratory and instrumental methods of inspection




3.

Final stage


20 min.








3.1.

Control of eventual level of preparation





tasks for control the eventual level;

writing of fragment of case of history





3.2.

General estimation of educational activity of student











3.3.

Informing froze about the theme of next employment












5. Method of organization of educational process on practical employment.

5.1 Preparatory stage.

To tell the main idea of theme of discipline and professional activity of nurses and forming of the motivation for purposeful educational activity. To explain for students concrete aims and plan of employment. To conduct the standardized control of initial level of preparation of students (tests are added).

5.2. Basic stage.

5.2.1. To specify basic principles of organization of work of admission department.

5.2.2. To outline the duties of the trained nurse of admission department within the limits of functionally-post instruction.

5.2.3. To specify the concept of sisterly post.

5.2.4. To specify the methods of grant of the first medical aid to the patients with the diseases of internal organs.

5.2.5. To decide situational tasks after the theme of employment.

5.3. Final stage.

Estimation of activities of each student during employment and standardized eventual control. The analysis of progress of students is conducted; estimation of activity of every student is declared and is proposed in the magazine of account of visits and progress of students. The head of group simultaneously adds marcs to the list of account of progress and attendance of marcs by students, a teacher notarizes them by the signature. Short information for students about the next class and methodical information for preparation to it.

6. Additions. Controls: tests tasks, situational tasks, controls questions practical tasks.

7. Recommended literature.

  1. Wilson Jean D. Harrison’s principles of internal medicine 12th edition [DNLM: 1. Internal medicine. WB 115 P 975] 1991.

  2. Patricia A. Potter, Anne Griffin Perry. Fundamentals of nursing: concepts, process, practice. Fours edition. –Mosby-year book, Inc., 1997.

  3. Jill Fuller, Jennifer Schaller-Ayears. Health assessment. A Nursing Approach. [DLMN: 1. Nursing assessment – methods. WY 100 F966h] RT48.F85 1990.

  4. Olga Kovalyova, Tatyana Ashcheulova. Propedeutics to internal medicine. Part I/ Diagnostics. – Nova Knyha. Vinnytsya 2006.

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