Nurse assistant at the in-patient department

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MINISTRY OF EDUCATION AND SCIENCE OF RUSSIAN FEDERATION

Federal State Autonomous Educational Institution of Higher Education

«V. I. VERNADSKY CRIMEAN FEDERAL UNIVERSITY»

Medical Academy named after S. I. Georgievsky(structural subdivision).

ABSTRACT

Subject: Sanitary processing of patients at admission department.

Student: Jameema Saramma Mathew                                                               

Faculty:- International Medical Faculty

 Course:- Second Group 184B(LA-2)

Name of Practice:

Specialized Organization: Gynaecology

City(UrbanVillage) :- Simferopol

DURATION OF PRACTICE :- from 22nd June 2020 till 16^th July 2020

 Introduction:-

The admission department (emergency room) is intended for the reception of patients, delivered by ambulance, sent from clinics and outpatient clinics or seeking help on their own. The front desk includes a lobby, reception desk, information desk, examination rooms. The reception department has close functional contacts with laboratories, diagnostic units of the hospital, isolators, operating rooms, dressing rooms, etc.

Patient registration, medical examination, and the necessary minimum laboratory and instrumental examination are carried out in the admission department. When deciding on the issue of hospitalization, the patient undergoes a sanitary treatment and is transported to the appropriate medical diagnostic unit. If necessary, the patient from the admission department can be immediately transported to the operating room (wound of the heart, large vessels, etc.).

Duties of the nurse of the admission department:

Issuing a medical record for each hospitalized patient (filling out the title page, indicating the exact time of patient arrival, diagnosis of the referring medical institution);Examination of the skin and scalp to detect lice (lice), measurement of body temperature;

Fulfillment of doctor's prescriptions.

Duties of the doctor of the admission department:

l Examination of the patient, determining the urgency of the surgical intervention, the required amount of additional research;

l Filling out a medical history, making a preliminary diagnosis;

l Determination of the need for sanitary treatment;

l Hospitalization in a specialized department with a mandatory indication of the type of transportation;

l In the absence of indications for hospitalization, the provision of the necessary minimum of outpatient care.

l The admission department (emergency room) is one of the most important units of the surgical hospital. Its functions include registering the patient, setting up a preliminary diagnosis, providing first aid, sanitizing and transporting the patient to the ward. To perform these tasks, an appropriate structure is allocated in the form of a clearly planned room equipped with the necessary medical and diagnostic equipment. Reception departments are located on the ground floor, have an isolated, convenient entrance for patients, and have connections with all other hospital services. The following rooms are located in the reception department: waiting room, reception room (office of the nurse on duty), one or more examination rooms, treatment room, dressing room, isolation ward, sanitary inspection room, laboratory, X-ray room and others.

Main Part:

The waiting room is intended for walking patients and accompanying relatives. At the reception desk, the nurse on duty fills in the primary documentation for all incoming patients:

The nurse's responsibilities also include filling out the title page of the medical history: passport, date and time of admission, diagnosis of the referring institution, statistical coupon for the patient.

From the registry, the patient is sent to the examination room, where he is examined by a doctor. Inspection of the patient is carried out on a couch covered with oilcloth. After taking each patient, the oilcloth is wiped with a rag moistened with a disinfectant solution. Of other equipment, a desk is needed here to fill out a medical history and fill out other documentation.

For the correct diagnosis and determination of tactics, the doctor may need additional information. For this purpose, a laboratory, X-ray, endoscopy rooms, ECG room should be located on the territory of the admission department or next to it. In large clinics, diagnostic wards are allocated in the emergency room, where patients with an unclear diagnosis are located until the final decision on the need for surgical treatment; an isolation ward where patients suspected of having an infectious disease are placed. In the admission department there must be an opportunity for first aid to patients arriving in serious condition who do not require hospitalization, therefore there is a treatment room, a dressing room, and a small operating room.

After examining, making a diagnosis and resolving the issue of hospitalization, the patient is sent for sanitary treatment to the sanitary inspection room, which usually consists of an examination room, dressing room, bath-shower room and a room where patients dress. Nearby is a warehouse where patients’s personal clothing is placed during their stay in the hospital.

It is necessary to strictly observe the main direction of movement of patients from the viewing room through the bathroom to the dressing room, preventing the patients from returning to the "dirty" area of \u200b\u200bthe sanitary inspection room.

The sanitary inspection room is equipped with everything necessary for the treatment of the patient. There should be couches, cleaners and containers for dirty laundry, a cupboard or table with items for sanitary treatment, an oilcloth, bath soap, personal washcloths that are in a marked container, hair clippers, razors, scissors, thermometers for air and water temperature measurements, special washcloths and brushes for bath sanitization, marked buckets and mops for cleaning and disinfecting sanitary inspection rooms and other accessories.

Sanitary treatment the patient in the admission department includes the following activities:

1) pest control - the destruction of harmful insects (lice), if they are found during examination of the patient;

2) a hygienic bath, shower or rubbing the patient, cutting hair, nails, shaving; 3) dressing the patient in clean hospital underwear and clothing.

The question about the method and extent of sanitization is decided by the doctor, and it is performed by the junior medical staff under the guidance of a nurse.

Patients in extremely serious condition, as directed by a doctor, can be sent to the intensive care unit or to the operating room without sanitization, which is delayed after stabilization of the general condition of the patient.

In all other patients, the nurse of the admission department should begin sanitary and hygienic treatment with a thorough examination of the patient’s body, scalp, and his underwear to detect pediculosis (lice). Lice are especially often localized in the occipital and temporal regions (head lice) or in the pubic region (pubic lice). Body lice live and lay eggs mainly in folds of linen. The size of lice is from 1.4 to 4 mm, and their eggs (nits) are not more than 0.6-1 mm. The nits of head lice are oblong in shape, they are glued to the hair shaft with a special sticky mass, almost always located near the hair roots. Head and body lice are carriers of severe infectious diseases - rash and epidemic typhus, so when a lice or nite is found, the nurse immediately performs disinfestation. First of all, you need to wear an extra bathrobe and scarf. Hair on the head or pubis is treated with one of the solutions: 0.5% methylacetaphos solution or 0.25% dicresil emulsion. Then the hair is covered with a scarf for 20 minutes, washed with warm water. After this, the hair is combed out with a frequent comb for 10-15 minutes. The patient’s underwear is put in a bag and sent to a disinfection chamber. After disinfection of the patient, the room and objects with which he was in contact must be treated with the same disinfectant solutions using a hydraulic console. The dressing gown and scarf, in which the nurse treated the patient and the room, must be packed in a bag and sent to a disinfection chamber. Further, the patient is sanitized in the bathroom. Depending on the condition of the patient, sanitization may be complete (bath, shower) or partial (wiping, washing). The type of sanitization is prescribed by the doctor.

Patients in satisfactory condition take a shower on their own, more severe ones undergo hygienic treatment in the bath. Water temperature should be 36-40 ° С. The water level should only reach the xiphoid process. To prevent the patient from slipping below, in the foot end of the bath, a stand for stopping the legs is installed. Wash the patient with a washcloth with soap: first the head, then the trunk, upper and lower limbs, inguinal region, perineum. The duration of the procedure is no more than 20 minutes. The presence of a nurse is mandatory, she is always ready to provide first aid with a possible worsening of the patient's condition. To perform wiping, the patient is placed on a couch covered with oilcloth. A sponge moistened with warm water wipes the neck, chest, arms. Dry these parts of the body with a towel and cover them with a blanket. In the same way they wipe the stomach, then the back and lower limbs.

After sanitary treatment, the patient is put on underwear, hospital clean linen, a bathrobe (pajamas), slippers. Sometimes it is allowed to use your own linen, which should be changed according to the hospital schedule.

After this, the patient is transported to the hospital department. The method of patient delivery to the department is determined by the doctor depending on the severity of the patient's condition: on a stretcher (manually or on a gurney), on a wheelchair, on hands, on foot.

Theme 2.4.

Patient admission to hospital and patient sanitation upon admission to hospital the admission department is one of the most important medical and diagnostic departments of the hospital. The success of the subsequent treatment, and sometimes the patient’s life, depends on the organization of professional assistance by medical staff.

Ethical and deontological aspects of the work of the staff in the reception department

The nurse of the admission department is the first medical worker with whom a patient arrives for inpatient treatment, so often the psychological state of the patient depends on the behavior of the nurse.

Talking with the patient, the reception nurse should be patient, ask questions in the correct form and discreet in content.

The deontological aspects of the behavior of the nurse in the admission department imply the most rapid provision of medical care to the patient (calling a doctor on duty, consultants, laboratory assistants, quick paperwork, and often emergency care).

When receiving patients, there should not be any division according to social status (businessman or homeless person), all patients have the right to receive qualified medical care if necessary.

The device and functions of the front desk with a centralized hospital planning system, treatment and diagnostic departments are located in one building, and there is also a reception department. At the pavilion (decentralized) - reception department is located in a separate building or in separate medical buildings. On the basis of a centralized receiver, a referral service of the hospital is organized.

The main stream of patients enters through the central admission department. Reception of infectious patients, women in labor is carried out decentralized to the appropriate units (infection department, maternity hospital) in order to comply with the sanitary epidemiological regime. Patients requiring emergency care for health reasons are taken to the intensive care unit, bypassing the emergency room.

Ways to hospitalize patients

The admission department includes:

1. Waiting room - for patients accompanying them.

2. Registry - patient registration, documentation.

3. Examination rooms - examination of patients by a doctor on duty.

4. Treatment room, dressing room, small operating room - for emergency care.

5. Sanitary inspection room - for the sanitary treatment of patients (bath, changing room)

6. Isolator with a separate bathroom - for patients with an unclear diagnosis.

7. A bathroom.

8. Laboratory and X-ray room can be in the structure of the department or located nearby.

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