Download higher nurse education

BUKOVINIAN STATE MEDICAL UNIVERSITY
DEPARTMENT OF PATIENTS CARE AND
HIGHER NURSE EDUCATION
“APPROVED”
on the methodical conference of department
of patients’ care and higher
nurse education
“ ” ________ 200_ protocol N __
Chief of department, associate professor
I.A. Plesh
METHODICAL INSTRUCTION
FOR SELF-PREPARATION OF STUDENTS
TO PRACTICAL CLASS №1
THE SCHEME OF EVALUATION OF SURGICAL PATIENT’S GENERAL
CONDITION. THE MAIN STEPS OF NURSE’S DIAGNOSTIC. PLANNING OF
CARE. NURSE’S DOCUMENTATION.
Discipline:
nursing in surgery
for 3nd year students
of medical faculty №4,
specialty "nurse business''
Methodical instruction was prepared by:
Assistant Riabyi S.I.
Chernivtsi - 2010
1. Topic: THE SCHEME OF EVALUATION OF SURGICAL PATIENT’S
GENERAL CONDITION. THE MAIN STEPS OF NURSE’S DIAGNOSTIC.
PLANNING OF CARE. NURSE’S DOCUMENTATION.
(The scheme of evaluation of surgical patient’s general condition. The main steps of
nurse’s diagnostic. The problems of patients: real and potential. The nurse’s evaluation
of cardio-vascular system’s condition. The nurse’s evaluation of respiratory system’s
condition. The nurse’s evaluation of digestive tract’s condition. The nurse’s evaluation
of urogenital system’s condition. The nurse’s evaluation of nervous system’s condition.
The nurse’s evaluation of endocrine system’s condition. The nurse’s evaluation of
locomotorium apparatus’ condition. Planning of care. Nurse’s documentation.)
2. Duration of the class: 2 academic hour.
3. Study aim:
3.1. The student should know:
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the scheme of evaluation of surgical patient’s general condition.
the main steps of nurse’s diagnostic.
the problems of patients: real and potential.
the nurse’s evaluation of cardio-vascular system’s condition.
the nurse’s evaluation of respiratory system’s condition.
the nurse’s evaluation of digestive tract’s condition.
the nurse’s evaluation of urogenital system’s condition.
the nurse’s evaluation of nervous system’s condition.
the nurse’s evaluation of endocrine system’s condition.
the nurse’s evaluation of locomotorium apparatus’ condition.
planning of care.
nurse’s documentation.
3.2. The student should be able:
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to use modern methods of examination of surgical patients;
to analyze results of additional methods of surgical patients’ examination;
to take care of surgical patients;
to make out of nurse’s documentation.
3.3. The student should master practical skills:
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to collect complaints of patients;
to do observation of skin;
to do palpation;
to do percussion;
to do auscultation;
to collect patterns of blood, urine, stomach juice, bile etc;
to make out of nurse’s documentation/
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4.
Advice for students:
In the duties of medical nurse careful implementation of rules of medical deontology are sciences
about principles of behavior of medical personnel.
The care of patients requires both ability to execute different hygienically and medical measures and of,
high moral standards, honest and merciful attitude toward a patient. He must be and highly professional, and
deontological self-possessed. Merciful humane attitude toward a patient is no less important, than
professional trade. The mental condition of patient is always low-spirited in connection with influence on the
central nervous system anatomic and functional disorders in an organism and the transition (often sudden
and protracted, as it is at traumas and sharp surgical diseases) forced through illness in unusual position
(exceptions from an ordinary atmosphere and labor activity, domestic inconveniences and limitations, and
often even inability to self-service and realization of physiology acts). Creation at the sick good, optimistic
mood, faith in the favorable flow of illness which in a large measure becomes firmly established by good
examination sensitive attitude toward a patient, is the honorable duty of medical workers of hospitals and
policlinics
Large value in creation of favorable stay of patient in medical establishment has the mutual relations
between personnel, patient and his relatives. The special attention is spared to the conduct of medical nurse.
Sensitiveness, attention, exactness, readiness always to come for help to the patient, ability to console by his
word, to lodge at him. Cheerfulness, a confidence in the favorable result of treatment are important qualities
of medical nurse.
Exactness and tidiness of medical sister and junior nurse, cleanness to the dressing-gown and little caps must
be reported with the conduct, that differs by affability, willingness to give help immediately.
The mutual relations of middle and junior medical personnel must show up mutual respect. Appeal
possible only after the name and patronymic. It is impossible in the presence of patients to discuss errors
which were assumed at implementation of those or other procedures and manipulations.
A medical nurse must apply to the patient for the name and patronymic. Careful attitude toward a
patient, that enters separation, is instrumental in setting of trust, mutual respect contact. During a talk with a
patient a medical personnel must strictly watch not only on maintenance broadcasting but also after
intonation, mimicry, gesticulation.
The special carefulness needs at the attempts of patients to get elucidation in relation to a diagnosis,
features of disease, possible complications future researches and others like that. A doctor must help
personnel to make tactical, quiet answers with recommendation to apply with these questions to the treating
doctor.
At implementation to the patient of that or other procedure a medical personnel not must conduct
between itself talks on the abstracted themes. It is needed to remember, that it is considered to the patients as
display of inattention to him and is not instrumental in the increase of authority of personnel. Quite not
possible discussion at the patient (at the beginning of anesthesia or on the stage of awakening) of questions
of flow of his illness, possible complications and others like that, as estimation by the patient of heard can be
inadequate.
The careless talks of medical personnel at a patient can stipulate the origin at them of the so-called
iatrogenic illnesses. It for a consuetude is related to that a patient finds at itself the signs of those illnesses
about which he by chance heard from a personnel, and to convince him in future there is enough heavily. In
such cases patients quite often insistently require medications or procedures for treatment of illnesses which
at him is absent.
Question of ethics in the relations of personnel and patient are numerous and varied. The decision
they must be carried out taking into account character and feature of illness, degree of violation of function
of organs and systems of sick organism features of treatment, and on an end, taking into account character of
patient. Mildness, tactful, solicitude, high professionalism implementation of ethics codes of conduct of
medical personnel, matter very much.
State information and conduct of patient a doctor gets from a medical nurse for a day long, not only
during a morning consultation. Sometimes even little the noticeable changes of the state of patient can
testify, to the necessity, of conducting of urgent operation. That is why level of knowledge and responsibility
of medical nurse of surgical department must be especially high. Youths, inexperienced medical nurses not
must feel shy to inform the supervisions about the state of patient to the treating or duty doctor or to consult
by more experimental medical nurse.
Errors of medical nurse at estimation of changes of the state of patient, at implementation of
procedures on examination or at introduction of accounts can result in heavy complications or even death of
patient. That is why, honesty, must be basic qualities of nurse. A medical nurse must at once put into
consideration about that happened, treating a doctor intervention from which will help to warn heavy
complication or even lethal result. A medical nurse never must undertake responsibility for rising of
diagnosis and treatment of patient without settings of doctor.
The surgical department consists of chambers, bandaging, manipulation cabinet and operating block.
That the department is parted on two halves is the feature of surgical department, or consists of two separate
departments - clean and festering. For patients with purulent wounds a separate chamber section is deleted or
separate chambers in the separate wing of separation, on possibility far from an operating block. For these
chambers is separately selected festering bandaging and all patients are served by a special personnel. At
presence of one bandaging patients with running sore bandage oneself after the conducted "clean" bandaging
with subsequent careful treatment of apartment and equipment by disinfectant solutions.
An operating block is basic of treatment - diagnostically subsection of surgical separation that
consists of operating-rooms and also complex of auxiliary apartments and apartments of providing, intended
for conducting of surgical operations. With the purpose of observance of terms of asepsis in general lines a
type operating block must have two isolated impassable parts is aseptic, clean and septic, festering with
severe zoning of internal apartments and separate for each of them by the auxiliary apartments. All
apartments of operating block depending on the degree of observance of rules of asepsis and fight against an
internal - clinical infection is functionally divided into four areas: sterile, severe mode limited mode and in
general lines hospital mode.
Streams in an operating block are divided into “sterile” for surgeons and operating nurses, clean – for
patients, anesthesiology, technical personnel and must not intersect, or to clash.
The sanitary – hygiene mode of surgical establishment is directed on the exception of the negative
influencing of factors of hospital environment on patients and personnel, providing to the patient of complete
hygienically, somatic and psychical comfort, and personnel – optimum terms of labor. The sanitary –
hygiene mode foresees the observance of norms of capacity of hospital chambers, providing of optimum
microclimate, chemical and bacteriological composition of air environment mode of ventilation and
illumination of apartments, of high quality drinkable water supply, timely and complete delete and
disinfecting of wastes, providing of patients by the rational and balanced feed, cleaning up of apartments,
elimination and replacement of linen, observance of rules of the personal hygiene, and others like that.
The anti – epidemic regiment of surgical department is directed on prevention, origin and distribution of
inter – hospital infections. The substantive provisions of anti – epidemic regiment are regulated by the order
720.
Personal hygiene and clothes of medical personnel in the surgical department
Personnel that look after patients above all things must be hygienically formed, healthy and neat. Each of
participants of care of patients must well know hygienically rules within the limits of functional. Without
this requirement he can become a mediator in the transmission of infection
to the patient, both outwardly, in particular from itself and from other patients, that inwardly – hospital.
At personnel systematic check up the state of health. Patients and bacillicarrieres are shut out to
work, while they will not get better. Medical nurses and junior nurse, before becoming of work, must change
clothes in a hospital form in the separate, taken for these purpose apartments. It is not allowed to execute
personnel the functions in a shoe and clothes which they use out of hospital.
The clothes of the trained nurse or junior nurse must be neat: a dressing gown and triangular scarves
is clean, ironed; hairs – it is hidden under a triangular scarf or cap; shoes are soft and clean. Decorations on
hands (fingers) and manicure is not allowed. Nails must be shortly cut. The hygiene of personnel maters
exceptional for prevention of inters – hospital infection.
Duties of medical nurse:
1. Care of patients and supervision after the sanitary state of the chambers fasted after the nurse.
2. Record and exact implementation of the medical and sanitary – hygiene settings of treating
doctor.
3. Presence at a consultation by a treating or duty doctor, notification of information about the
state of health of patient.
4. Measuring of temperature of body to the patients, record of results of thermometry of
temperature form, measuring of pulse, frequencies of breathing, diurnal diuresis, amount of
sputum, skidding of this information, in a hospital chart.
5. Supervision after cleanness, quiet and order in chambers, after implementations to the
patients of rules of the personal hygiene, care about the timely grant to the patients of need
for their examinations and treatment.
6. Grant of first aid to the patient.
7. Collection of materials for the analyses, delivery them in a laboratory, timely receipt of
results of researches and pasting them into a hospital chart.
8. Supervision after implementation by patients, by a junior medical personnel and visitors of
the set rules of internal order of hospital.
9. Drafting of apportion requirements and supervision after patient’s appointed diet.
10. To provide maintenance of good condition of medical and economic equipment.
11. Drafting of requirements for the accounts, bandaging material and articles of patient’s care.
12. Direction and accompaniment of patients on purpose of doctor to diagnostic and treatment
rooms, timely returning of medical document from the auxiliary room.
13. Reception of patients, which enter department, verification of the sanitary treatment that must
be done in the registration – room, placing of patients in chambers.
14. Acquaintance of patients with the rules of internal order, mode of day and rules of the
personal hygiene.
15. Transporting of patients in the department and in medical and diagnostic rooms.
Documents, which a medical sister writes down:
1. Hospital chart (passports information, results of laboratory investigation, temperature form
and sheet of supervision after heavily ill patient, pointing about sanitary treatment, records
about injections of strongly operating or narcotic medicines.
2. Sheet of settings (records about implementation of those or other settings).
3. Manipulation form.
4. Requirement on the dietary of patients.
5. Report about motion of patients in the department.
6. Form of transmission of duty.
7. Form of account of strongly operating and narcotic matters.
8. Form of registration of injections against a stupor, hydrophobia, and others like that.
9. Form of account of the general cleanings in chambers.
Registration of patient that enters surgical department is written down in the form of patients’
motion.
- The surname, name, patronymic.
- Date of birth.
- Residence.
- Profession and job.
- Date and time of receipt into the department.
- Diagnosis at the receipt.
- Final diagnosis.
- Information about insurances, possible privileges.
Method of making thermometric
Thermometric in the department is done by medical mercury thermometer. It is most often taken
temperature in the area of axillaries space, rare – in an inguinal fold (at children), in a mouth, in a rectum, in
a vagina.
Before measuring of temperature wipe the area of axillaries space till dry (in opposite case the
thermometric can be understated). In the process of measuring of temperature a patient must densely pin a
shoulder against a thorax, here heavily ill patients to retain a hand in necessary position must be actively
helped.
During process of thermometric in a rectum a patient comes back on a side, preliminary oil
thermometer by Vaseline, enter in the road clearance of rectum on a depth 2-3 cm. In those cases, when
temperature is taken in a mouth a thermometer is placed under a tongue.
The term of measuring of temperature makes 7-10 minutes. Thermometric must be done in the morning
(from 6 to 8 hour) and in the evening (from 17 to 19 hours). In certain cases, for example, at the fever there
is a necessity in more frequent measuring of temperature of body (in every 2-3 hours).
Keep thermometers in the special jar or glass, on the flour of which lay the layer of cotton wool and
pour on 1/3 of jar solution of antiseptic substance, for example a 0,5% solution of chloramines, 70% solution
of alcohol, triple solution.
For the graphic image of days’ fluctuations in the temperature of body fill temperature forms. Step a
temperature form by the proper points is inflicted by the results of thermometric, measured twice per day.
These points are connected between it, creating a temperature curve that represents that or other it’s kind at
presence of fever. In to the temperature form writes down the control of arterial pressure, frequency of
breathing and pulse, diurnal diuresis, also. Write down a temperature form for every patient at the receipt
and keep together with a hospital chart.
Temperature of body, his certain areas is possible to measure with the help of termalabile strips,
a electro thermometer, radio capsules.
Types of fevers:
- After the degree of increase of temperature: subfebrial (to 38 C), moderate (38-39 C),
high (39-41 C), surplus or hyperpyretical (more than 41 C).
- After the term of flow: instantaneous (to a few hours), sharp (to 15 days), sub sharp
(15-45 days), chronic (more than 45 days).
- After the type of temperature curve: permanent, purgative, alternated, hectic,
disfigured, wrong, reverse, undulating.
Lay – out and distributing of medicines to the patients:
Distribution of medicines to the patients must be done 3 times per day before a meal. More frequent
use the trays, parted on barns, in which the last name of patient is indicated, medicines.
Sometimes use mobile dinner – wagons on which place all medicines. Before distribution of
medicines a medical nurse must ascertain in their fitness. Before the lay – out of accounts it is necessary to
check up a label on them (name, dose, term of their fitness). During distributions of medicines the trained
nurse must explain to the patients, when and how correctly to take the medicines, to help heavily ill patients
to take them.
It is impossible to give out to the patient at once all day’s dose of medicines. A medical nurse does
not have a right to change setting, and also to give the medicines without setting of doctor.
The cases of sudden violation of the state of patient can lead to the exception. The trained nurse
looks after the reaction a patient with medicines and seeing the signs of not portable, must keep from
implementation of setting and to report about it to the doctor. The trained nurse must look after that the
medicines were accepted. If a patient wants to know, what medicines and for what, it is necessary to answer
his question, executing all rules of deontology.
Transporting of patients into the departments and into diagnostic or treatment rooms
A doctor decides a question about the method of transporting of patient. The choice of correct method
of transporting matters very much. At the certain pathological states even minimum mobile activity can
considerably make their state worse.
Patients in the satisfactory state move independently or escorted by a medical nurse. The heavily ill patients,
invalids, some patients of old years often transport on the special invalid – chairs. Heavily ill patients are
transported on invalid chairs or carry on loads.
Loads with a patient can carry two or four men which go out of step, by short steps. At getting up on the tails
of patient carry by a head ahead, at lowering of a head, here levitate in both cases the tender end of loads.
Transference of patient on hands and his shifting can execute one, two or three men. If a patient is
carried by one man, he must engulfs the thorax of patient at the level of shoulder – blades by the one hand,
and the second hand is tricked into by one of his thigh, here a patient in the turn engulfs that carries him, for
a neck. At shifting of patient from loads on a bed it is better to dispose them at right angles to the bed that a
lower end of loads was nearer to the main end of bed. Heaving up a patient, bring him at a half – turn to the
bed and inlay on a bed. If after technical reasons such location of loads appears impossible, loads put
parallel, personnel here is between loads bed.
5. Study questions:
1. The scheme of evaluation of surgical patient’s general condition.
2. The main steps of nurse’s diagnostic.
3. The problems of patients: real and potential.
4. The nurse’s evaluation of cardio-vascular system’s condition.
5. The nurse’s evaluation of respiratory system’s condition.
6. The nurse’s evaluation of digestive tract’s condition.
7. The nurse’s evaluation of urogenital system’s condition.
8. The nurse’s evaluation of nervous system’s condition.
9. The nurse’s evaluation of endocrine system’s condition.
10. The nurse’s evaluation of locomotorium apparatus’ condition.
11. Planning of care.
12. Nurse’s documentation.
6. The literature:
6.1. Basic :
1. Textbook of basic nursing / Caroline Bunker Rosdahl. – J. B.Lippincott Company. Philadelphia. - 6th
ed. –1995.– 1518 p.
2. Fundamentals of nursing /Taylor Mary Carol, Mary Carol, Lillis Carol– J. B.Lippincott Company.
Philadelphia. - 1989.– 1356 p.
6.2. Аdditional:
1. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.
2. P. of Brown. Operating block. Operating brigade. – Kharkov, 1997. – with. 1-32.
Methodical instruction was prepared by
Assistant
Riabyi S.I.
A review is positive, associate professor
Chomko O.J.