Junior nurse. An approximate daily routine for patients in the therapeutic department and the duties of a junior nurse in caring for patients. Responsibilities of a junior nurse in caring for patients.

1. This job description defines the functional duties, rights and responsibilities of a junior nurse in caring for patients.

2. A person who has primary vocational education in the specialty “Nursing” without requirements for work experience or secondary (complete) general education, additional training in the field of professional activity without requirements for work experience is appointed to the position of junior nurse for patient care. .

3. A junior nursing nurse should know: techniques for performing simple medical procedures; rules of sanitation and hygiene, patient care; rules for collection, storage and disposal of healthcare facility waste; internal labor regulations; labor protection and fire safety rules.

4. A junior nurse for patient care is appointed and dismissed by order of the head of the organization in accordance with the current legislation of the Russian Federation.

5. The junior nurse for patient care is directly subordinate to the head of his structural unit (head of the department) or the senior nurse.

2. Job responsibilities

Assists in patient care under the direction of a nurse. Performs simple medical procedures (placement of cups, mustard plasters, compresses). Ensures that patients and premises are kept clean. Ensures proper use and storage of patient care items. Changes bed and underwear. Participates in the transportation of seriously ill patients. Monitors compliance by patients and visitors with the internal regulations of the medical organization. Carries out the collection and disposal of medical waste. Carries out measures to comply with the rules of asepsis and antisepsis, conditions for sterilization of instruments and materials, and the prevention of post-injection complications, hepatitis, and HIV infection.

3. Rights

A junior nurse caring for patients has the right:

1. make proposals to management on the organization and conditions of their work activities;
2. use information materials and regulatory documents necessary to perform their official duties;
3. undergo certification in the prescribed manner with the right to receive the appropriate qualification category;
4. improve your skills.

A junior nurse caring for patients enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The junior nursing assistant is responsible for:

1. timely and high-quality implementation of the duties assigned to her;
2. timely and qualified execution of orders, instructions and instructions from management, regulations on its activities;
3. compliance with internal regulations, fire safety and safety regulations;
4. maintaining documentation provided for by current regulations;
5. promptly taking measures, including timely informing management, to eliminate violations of safety regulations, fire safety and other rules that pose a threat to the activities of the organization, its employees and other persons.

For violation of labor discipline, legislative and regulatory acts, a junior nurse caring for patients may be subject to disciplinary, material, administrative and criminal liability in accordance with current legislation, depending on the severity of the offense.

Nursing care is provided by nursing and junior medical staff.

Nursing staff

A nurse is a specialist with secondary medical education (graduates from medical college). A nurse is classified as a nursing assistant; she acts as a doctor’s assistant in medical institutions, carries out medical appointments and carries out the nursing process. According to WHO definition, the essence of the nursing process lies precisely in the provision of patient care.

The responsibilities of a nurse depend on the type and profile of the medical institution where she works, her position and the nature of the work performed. The following nursing positions exist.

· Chief nurse. Currently, he is a specialist with a higher medical education, graduating from the Faculty of Higher Nursing Education of a medical university. She deals with issues of rational organization of labor, advanced training of middle and junior medical staff of the hospital and monitors their work.

· Senior nurse assists the head of a hospital (polyclinic) department in administrative and economic matters, organizes and controls the work of ward nurses and junior medical staff.

· Ward nurse carries out medical appointments for patients in the wards assigned to her, monitors the condition of patients, provides care for them and organizes their meals.

· Procedural nurse carries out medical prescriptions (intravenous injections and infusions), helps with manipulations that only a doctor has the right to perform, takes blood from a vein for biochemical studies.

· Operating room nurse assists the surgeon during surgical interventions, prepares surgical instruments, suture and dressing material, and linen for the operation.

· Community nurse assists the local doctor in the reception of patients living in his area, carries out medical procedures at home as prescribed by the doctor and participates in carrying out preventive measures.

· Nurses who see patients with specialized doctors (ophthalmologist, otorhinolaryngologist, neurologist, etc.).

· Dietic nurse (diet nurse) under the guidance of a nutritionist, he is responsible for the organization and quality of medical nutrition, draws up menus, controls the culinary processing and distribution of food, as well as the sanitary condition of the kitchen and dining room for patients.

Despite a certain division of the functions of nurses, there is a range of responsibilities adopted for the mid-level medical level as a whole.

1. Carrying out medical prescriptions: injections, dispensing medications, administering mustard plasters, enemas, etc.

2. Implementation of the nursing process, including:

1. Nursing examination - initial examination of the patient, measuring body temperature, counting respiratory rate (RR) and pulse, measuring blood pressure, monitoring daily diuresis, etc.;

2. Correct collection of material for analysis (blood, sputum, urine and feces);

3. Providing care for patients - care for the skin, eyes, ears, oral cavity; control over the change of bed and underwear; organization of proper and timely nutrition for patients.

3. Providing first aid.

4. Providing transportation of patients.

5. Reception of admitted patients and organization of discharge of patients.

6. Monitoring the sanitary condition of the departments.

7. Monitoring patients’ compliance with the internal regulations of medical institutions and their compliance with personal hygiene rules.

8. Maintaining medical records. Junior medical staff

Junior medical personnel include junior nurses, housekeepers and nurses.

· Junior nurse(nursing nurse) helps the ward nurse in caring for the sick, changes linen, ensures that the patients and hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients’ compliance with the hospital regime.

· Sister-hostess deals with economic issues, receives and issues linen, detergents and cleaning equipment and directly supervises the work of nurses.

· Nurses: the range of their responsibilities is determined by their category (department nurse, barmaid, nurse, cleaner, etc.).

The general responsibilities of junior medical staff are as follows:

1. Regular wet cleaning of premises: wards, corridors, common areas, etc.

2. Assisting a nurse in caring for patients: changing linen, feeding seriously ill patients, hygienic provision of physiological functions of seriously ill patients - serving, cleaning and washing vessels and urinals, etc.

3. Sanitary and hygienic treatment of patients.

4. Accompanying patients for diagnostic and treatment procedures.

5. Transportation of patients.

Fundamentals of medical ethics (deontology)

Medical ethics (lat. ethics, from Greek ethics - the study of morality, ethics), or medical deontology (Greek. deon - duty; the term “deontology” has been widely used in the domestic literature in recent years) - a set of ethical standards and principles of behavior of medical workers when performing their professional duties.

According to modern ideas, medical ethics includes the following aspects:

· scientific - a section of medical science that studies the ethical and moral aspects of the activities of medical workers;

· practical - an area of ​​medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:

· medical worker - patient,

· medical worker - relatives of the patient,

· medical worker - medical worker.

Any medical worker should have such qualities as compassion, kindness, sensitivity and responsiveness, caring and attentive attitude towards the patient. Ibn Sina also demanded a special approach to the patient: “You should know that each individual person has a special nature inherent to him personally. It is rare or even impossible for anyone to have the same nature as him.” The word is of great importance, which implies not only the culture of speech, but also a sense of tact, the ability to lift the patient’s mood, and not to injure him with a careless statement.

Of particular importance in the medical profession are such universal norms of communication as the ability to respect and listen carefully to the interlocutor, demonstrate interest in the content of the conversation and the patient’s opinion, and correct and accessible construction of speech. The neat appearance of the medical staff is also important: a clean gown and cap, neat replacement shoes, well-groomed hands with short-cut nails.

Even in ancient Indian medicine, the doctor told his disciples-followers: “Now leave your passions, anger, greed, madness, vanity, pride, envy, rudeness, buffoonery, falsehood, laziness and all vicious behavior. From now on you will wear your hair and your nails short, dress in red clothes, and lead a clean life.” It is always necessary to remember that it is unacceptable for a physician to use perfumes and cosmetics without measure. Strong and pungent odors can cause undesirable reactions: from nervous irritation of the patient and various manifestations of allergies to an acute attack of bronchial asthma.

PRIMUM NON NOCERE (Latin) - FIRST OF ALL, DO NO HARM - this statement is the main ethical principle in medicine.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics. Incorrect diagnosis, treatment, and behavior of the doctor, representatives of nursing and junior medical personnel can lead to physical and moral suffering of patients. Such actions are unacceptable honey. employee, such as disclosure of medical confidentiality, refusal of medical care, violation of privacy, etc.

Caring for a patient involves, among other things, also observing certain rules of communication with him. It is important to pay maximum attention to the patient, reassure him, explain the need to adhere to the regimen, take medications regularly, and convince him of the possibility of recovery or improvement of his condition. Great care must be taken when talking with patients, especially those suffering from cancer, who are not usually told the true diagnosis. And today the statement of the great physician of antiquity, the father of medicine, Hippocrates, remains significant: “Surround the patient with love and reasonable consolation, but, most importantly, leave him in the dark of what threatens him.” In some countries, the patient is still informed about the seriousness of the disease, including the possible death (lat. le-talis- fatal), based on socio-economic considerations. Thus, in the USA, a patient even has the right to initiate legal proceedings against a doctor who hid the diagnosis of a cancerous tumor from him.

Iatrogenic diseases

Violation of the deontological principles of communication with a patient can lead to the development of so-called iatrogenic diseases (Greek: iatrogenic diseases). -iatros- doctor, -gepes - generated, arising). Iatrogenic disease (iatrogenics) is a pathological condition of a patient caused by careless statements or actions of a doctor or other medical worker that create in a person the idea that he has a disease or the particular severity of his disease. Inappropriate, wounding and harmful verbal contacts for the patient can lead to various psychogenic iatrogenies.

However, more than 300 years ago, the “English Hippocrates” Thomas Sydenham (1624-1689) emphasized the danger for the patient not only of the actions of a medical worker, which traumatize the patient’s psyche, but also of other possible factors - undesirable consequences of medical manipulations. Therefore, at present, any diseases the occurrence of which is associated with certain actions of medical workers are considered iatrogenic.

So, in addition to the psychogenic iatrogeny (iatropsychogeny) described above, there are:

· iatropharmacogenia: a consequence of drug effects on the patient - for example, side effects of drugs;

· manipulation iatrogenics: adverse effects on the patient during his examination - for example, complications during coronary angiography;

· combined iatrogenies: a consequence of the influence of several factors;

· so-called silent iatrogenies - a consequence of the inaction of a medical worker.

\Typical job description for a junior nurse for patient care

Job Description of a Junior Nurse for Patient Care

Job title: Junior nursing nurse
Subdivision: _________________________

1. General Provisions:

Subordination:
• The junior nurse for patient care reports directly to....................................
• The junior nurse for patient care follows instructions.................................................... ..........

(the instructions of these employees are followed only if they do not contradict the instructions of the immediate supervisor).

Substitution:

• The junior nurse for patient care replaces.................................................... .......................................
• Replaces the junior nurse for patient care.................................................... ....................................

Hiring and dismissal:
A junior nurse for patient care is appointed and dismissed by the head of the department in agreement with the head of the department.

Must know:

• nursing rules
• methods of cleaning and processing assigned premises with their equipment, inventory, utensils, etc.
• rules for operating small-scale mechanization equipment
• safety rules and compliance with sanitary and hygienic conditions in institutions (divisions).

• Nursing.
• Delivery of patients to treatment, diagnostic and other units.
• Providing assistance to doctors and paramedical workers during treatment and diagnostic procedures.
• Maintaining cleanliness of assigned premises with their medical, special and household equipment, soft equipment and furniture.
• Assisting a patient in need with dressing, undressing, washing, bathing, feeding, and putting to bed.
• Providing a bedpan to the patient, changing the patient's clothes and linen.
• Wet cleaning of premises.
• Processing of instruments, patient care items, dishes.
• Monitoring patients' compliance with internal regulations.

4. Rights

• The junior nurse for patient care has the right to give instructions and assignments to employees subordinate to him on a range of issues included in his functional responsibilities.
• The junior nurse for patient care has the right to monitor the implementation of production tasks and the timely execution of individual assignments by employees subordinate to him.
• The junior nursing nurse has the right to request and receive the necessary materials and documents related to his activities and the activities of his subordinate employees.
• The junior nursing nurse has the right to interact with other services of the enterprise on production and other issues included in his functional responsibilities.
• The junior nurse for patient care has the right to get acquainted with draft decisions of the enterprise management concerning the activities of the Unit.
• The junior nursing nurse has the right to submit proposals for improvement of work related to the responsibilities provided for in this Job Description for consideration by the manager.
• The junior nurse for patient care has the right to submit proposals for the consideration of the manager on encouraging distinguished employees and imposing penalties on violators of production and labor discipline.
• The junior nurse for patient care has the right to report to the manager about all identified violations and shortcomings in connection with the work performed.

• The junior nurse for patient care is responsible for improper performance or failure to fulfill his job duties provided for in this job description - within the limits determined by the labor legislation of the Russian Federation.
• The nursing assistant is responsible for violating the rules and regulations governing the activities of the enterprise.
• When transferring to another job or being released from a position, the Junior Nursing Nurse is responsible for the proper and timely delivery of cases to the person taking up the current position, and in the absence of one, to the person replacing him or directly to his supervisor.
• The junior nursing nurse is responsible for offenses committed in the course of her activities, within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.
• The junior nurse caring for patients is responsible for causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.
• The nursing assistant is responsible for compliance with current instructions, orders and regulations for maintaining trade secrets and confidential information.
• The junior nurse for patient care is responsible for compliance with internal regulations, safety regulations and fire safety.

Head of structural

Introduction

The decisive role in ensuring proper patient care is given to nursing and junior medical personnel.

Junior medical personnel are directly responsible for maintaining cleanliness in the wards, corridors, common areas and other premises, and their regular wet cleaning. Junior medical staff often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change underwear several times a day, carry out sanitary and hygienic treatment, and spoon-feed. Such patients are often a burden to others, and often to themselves. Caring for them requires enormous patience, tact, and compassion.

Junior nurses assist in feeding seriously ill patients, changing their underwear and bed linen, serving, cleaning and washing vessels and urinals, carrying out sanitary treatment, accompanying patients to various studies, and ensuring the delivery of tests to the laboratory.

The purpose of this work: study the main responsibilities of junior nurses when caring for patients.

Tasks:

1. Study the job responsibilities of junior nurses in caring for patients;

2. Consider the rights and responsibilities of junior nurses;

3. To study the technology of basic procedures performed by junior nurses in the performance of their functional duties.

Job responsibilities of a junior nurse for patient care

A person who has a secondary (complete) general education and additional training in courses for junior nurses in caring for patients without any work experience requirements or secondary (complete) general education, additional training in junior courses is appointed to the position of a junior nurse for patient care. nursing nurses and at least 2 years of experience in the field.

Appointment to the position of a junior nurse for patient care and dismissal from it is made in the manner established by the current labor legislation by order of the head of the healthcare institution. The junior nurse for patient care reports directly to the chief nurse.

A junior nursing nurse should know:

Laws of the Russian Federation and other legal acts regulating the activities of healthcare institutions;

Organizational structure of the healthcare institution;

Techniques for performing simple medical procedures;

Rules of sanitation and hygiene, patient care;

Fundamentals of the diagnostic and treatment process, disease prevention, promotion of a healthy lifestyle;

Basic methods and techniques for providing pre-medical care;

Ethical standards of behavior when communicating with patients;

Internal labor regulations;

Rules and regulations of labor protection, industrial sanitation, safety and fire protection;

Junior nurse for patient care:

1. Performs simple medical procedures, such as placing cups, mustard plasters and compresses.

2. Monitors the cleanliness and order in the premises of the medical institution.

3. Provides assistance in patient care under the direction of a nurse.

4. Monitors compliance by patients and visitors with the internal regulations of the healthcare institution.

5. Participates in the transportation of seriously ill patients.

6. Changes bed and underwear.

7. Monitors compliance with sanitary-hygienic and anti-epidemic regulations when using and storing patient care items.

CHAPTER 4 RESPONSIBILITIES OF JUNIOR AND MIDDLE MEDICAL STAFF

CHAPTER 4 RESPONSIBILITIES OF JUNIOR AND MIDDLE MEDICAL STAFF

In hospitals, there is a two-stage (doctor, nurse) and three-stage (doctor, nurse, junior nurse) system of patient care. Since 1968, in children's hospitals, instead of a nurse, the position of a junior nurse (nursing nurse) was introduced. With a two-stage system, the nurse not only carries out the doctor’s orders and carries out procedures, but also provides care for the patients. With a three-stage system, the junior nurse cleans the premises, monitors the timely change of linen, the cleanliness of care items, helps and cares for the sick.

In charge junior nurse includes:

Wet cleaning of wards, offices, operating rooms, corridors, common areas;

Change of underwear and bed linen;

Sanitary treatment of patients;

Daily toilet, care of skin, hair, ears, eyes, oral cavity of patients, etc.;

Supply of a vessel, urinal, their disinfection;

Prevention of bedsores;

Swaddling and washing children;

Monitoring the sanitary condition of bedside tables. Junior nurses are trained directly in hospitals, as well as at short-term courses organized by the Union of Red Cross and Red Crescent Societies

(SOKK and KP).

Nurse- representative of the middle medical level. This is a medical assistant in medical and preventive care, preschool and school institutions, an independent medical worker within the scope of his competence (care, manipulation, etc.).

Persons who have graduated from medical schools with a period of study of at least 2 years and have received a certificate of assignment of medical qualifications are appointed to the position of nurse.

nurses. Medical students who have successfully completed three full-time courses can work as nurses.

Ward nurse. To perform her duties, a nurse must possess a variety of skills. The nurse carefully and strictly carries out all orders of the attending physician, and in emergency cases, the doctor on duty. She is obliged to ensure that the child takes the prescribed medications, and if necessary, help wash them down with water, etc. At the same time, the nurse provides care for the sick and psychologically helps the sick child and his parents overcome the difficulties of the illness. She monitors the sanitary condition of the wards assigned to her, makes the necessary entries in the medical records of inpatients about the implementation of medical and hygienic appointments.

The nurse attends the medical rounds of patients, informs the doctor about the health status of the children, receives further instructions on caring for the patients and carries them out. The responsibilities of the nurse include measuring the patient’s body temperature and recording it in the temperature sheet of the inpatient’s medical record, counting pulse, respiratory rate, determining blood pressure, body weight, filling out specialist consultation logs, etc. As prescribed by the doctor, the nurse (with the help of a junior nurse ) measures the daily amount of urine and sputum.

As prescribed by the doctor, the nurse collects materials for tests (urine, feces, sputum, etc.), delivers them to the laboratory, receives research results and pastes answer forms into the medical records of inpatients. Accompanies children from one department to another (as prescribed by a doctor) for x-ray, endoscopic, radiological and other studies, transports patients (when transferred from department to department, etc.).

The nurse monitors the cleanliness, silence and order in the wards; teaches children and their parents the rules of personal hygiene; takes care of the timely supply of patients with everything necessary for treatment and care, provides hygienic baths, as well as changing underwear and bed linen.

The responsibilities of the nurse include monitoring medical nutrition, and, if necessary, personal participation in the distribution of food,

feeding seriously ill patients and young children; control over transfers to patients and their proper storage. Based on the doctor’s prescriptions, the nurse draws up portion requirements for the patients’ meals in 2 copies and transfers them to the catering unit and the buffet.

The nurse is entrusted with the responsibility of monitoring the compliance by patients, as well as junior medical staff, parents and visitors with the established internal rules of the hospital. During night duty, these duties are not duplicated by anyone.

The nurse is responsible for the exemplary maintenance of the nursing station, the good condition of medical and household equipment; complies with the rules for storing medicines; draws up requirements for medicines, dressings and child care items; monitors the timely return of medical records of inpatients from specialists, enters research results into them.

As prescribed by the head of the department or the attending physician, the nurse calls specialists from other departments for consultation and orders a car to transport the child to another medical institution.

The nurse receives newly admitted children to the department, examines the child’s skin and scalp to exclude infectious diseases and head lice, places sick children in the appropriate wards, and reports the newly admitted patients to the doctor. Her responsibilities include familiarizing newly admitted children with the internal rules, daily routine and rules of personal hygiene, and sanitary education work.

The distribution of work of the ward nurse during the day is presented in Table 9.

Table 9.Sample work plan for a ward nurse during

days

A nurse in the pediatric department of a hospital should

be able to perform the following manipulations:

1)feed the child, including through a tube, rinse the stomach;

2) give enemas of all types (cleansing, siphon, etc.);

3) insert a gas outlet tube;

4) carry out catheterization of the bladder with a soft catheter (in children over 1 year old);

5) apply mustard plasters, jars, compresses;

6) give medications by mouth;

7) rub in medications;

8) instill medicinal solutions into the eyes, nose, ears;

9) apply a plaster;

10) carry out intradermal, subcutaneous, intramuscular and intravenous (the latter with the doctor’s permission) infusions;

11) measure blood pressure;

12) perform indirect cardiac massage;

13) perform artificial pulmonary ventilation (ALV);

14) take swabs from the throat;

15) collect material for laboratory research (urine, feces, sweat, vomit, etc.);

16) carry out physiotherapeutic procedures (as prescribed by a doctor);

17) monitor the patient and notice deviations on the display;

18) perform gastric and duodenal intubation.

The work of the nurse is carried out according to a schedule approved by the head of the department. While on duty, a nurse has no right to leave her post or leave the department without the doctor’s permission.

Senior nurse. The head nurse organizes the work of nursing and junior medical personnel; in addition, her responsibilities include maintaining the sanitary and epidemiological regime in the department, training incoming new employees, and organizing classes to improve their skills. Its role is extremely important in the proper organization of child care, storage of baby food and strict implementation of all medical (medical) prescriptions. She draws up a duty schedule for nurses and payroll sheets, monitors the availability of medicines in the pharmacy, orders missing ones, and monitors the replenishment of the department with the necessary instruments and child care items. In case of illness, a nurse promptly finds a replacement for duty. In the neonatal department, the head nurse examines staff and mothers every day before starting work (measurement of body temperature, examination of the pharynx and skin).

Treatment room nurse. The staffing schedule of the department provides for the position of a treatment room nurse who performs the most complex medical procedures; it helps the doctor in carrying out those manipulations that only a doctor has the right to perform (blood transfusions, punctures, administration of contrast agents, etc.). In addition, there is also a position housewife sisters, responsible for household equipment, general cleaning of all premises, and changing linen.

Reception and delivery of duties- the most crucial moment of a nurse’s work. A nurse does not have the right to leave her post on her own, even if her shift does not show up.

Reception and transfer of duty by nurses is carried out covertly with visual control of the presence of each sick child. The nurse handing over the post introduces the nurse receiving the post to sick children and conveys the necessary information about the individual characteristics of their treatment and care. At the morning conference, the nurse gives a report on the work done.

When taking up duty, nurses (taking over and taking over the post) jointly conduct a round of patients, while paying special attention to seriously ill patients, the sanitary condition of the wards, and compliance with the rules of personal hygiene. The duty log records the amount of work unfulfilled for the previous shift for a particular patient, as well as medical prescriptions of the doctor on duty, data on the distribution of potent medications, preparation of children for laboratory and instrumental tests, etc. A nurse coming on duty receives thermometers, syringes, medications, care items (sippy cups, heating pads, bedpans, urinals, etc.), equipment, and keys to cabinets with medicines from the general list. She receives a pre-compiled list of research appointments and referrals to various laboratories and specialized rooms. Ensures there is sufficient clean linen for the entire shift.

Nurses should pay special attention to patients on bed rest and strict bed rest. If an individual post is not organized, then it is necessary to constantly approach and monitor the sick child, not to allow him to remain in the same position for a long time (for example, on his back), for which the patient should be turned from one side to the other from time to time. Changing the position of a sick child in bed must be done with great care and without sudden movements. Sometimes it is necessary to keep the child in bed, since children do not always realize the need to remain calm or are excited.

At the end of the shift, the nurse compiles a summary of the movement of patients: the number of patients in the department at the beginning of the day, the number of admissions, departures (separately: discharged, transferred to

other departments or medical institutions, deceased) and who were at the beginning of the next day. This information is transmitted daily to the hospital's emergency department.

Medical post- nurse’s workplace (Fig. 4).

Rice. 4.Nursing medical post

The medical post is located near the wards so that children, especially seriously ill ones, are under constant visual control. For this purpose, the walls of the chambers or the partitions between them are made of thick-layer or organic glass. The nurse's post must have the following necessary items:

A table with key-locked drawers for storing medical records of inpatients, forms, medical instruments, etc.;

Cabinet for storing medicines;

City and local network telephones;

Fridge;

Computer (with a computerized data processing system) or monitor for communication with patients;

Drinking water;

Desk lamp.

The nurse's workplace must be kept clean and stocked with necessary items. The effectiveness of a nurse’s work largely depends on the state of the workplace. The head nurse of the department, finishing the working day, supplies the nursing stations with everything necessary for the next day.

Medical documentation approved by the Ministry of Health and Social Development of the Russian Federation and used in medical institutions in the form of unified forms.

Inpatient medical record(f. ? 003/u) (medical history) - the main primary medical document that is filled out for each patient in a hospital hospital. All data about the patient, including the results of dynamic observation and treatment, are entered into the medical record of an inpatient patient. The results of laboratory, instrumental and other studies are pasted into it, morning and evening body temperature, pulse and respiratory rate, blood pressure, and, if necessary, the daily amount of urine (diuresis) are recorded daily. In the medical record of an inpatient, the nurse notes the time the patient was admitted to the department and the results of the examination for the presence of lice, and signs. In the prescription sheet, notes the time of dispensing the medicine, in the temperature sheet - the body weight and height of the child upon admission, the patient’s body temperature in the morning and evening, then once every 7-10 days, notes the days of taking a bath and changing linen, daily - the child’s stool.

An inpatient medical record is a legal document. It is stored for 25 years and therefore must be maintained strictly in accordance with the established form. No corrections are allowed in it; It is prohibited to paste over, erase, cross out what was previously written, or add to it. The nurse is responsible for the safety of medical records of inpatients, which are stored in a box or cabinet, locked with a key, out of the reach of children and their parents.

Referrals to the laboratory are filled out by a nurse. They indicate the surname, name and age of the child, the number of the inpatient’s medical card, the name of the department and a list of indicators that should be determined.

IN nursing sheets The nurse enters medical prescriptions for each patient from the medical records of inpatients.

mu. The filling form is optional. It is better to draw up individual nursing sheets for each child separately, but you can fill them out by type of manipulation, diet, medication, listing the names of the children.

IN change log(reception and transmission) duty note the number of children at the post, the names of newly admitted and discharged patients, indicating the diagnosis. In addition, febrile children are listed with an indication of body temperature, the dynamics of clinical symptoms in seriously ill patients are assessed, all unscheduled manipulations and assistance measures taken, performed by the doctor on duty and as prescribed, are listed. A separate list of children prepared in accordance with medical prescriptions for diagnostic and therapeutic procedures (endoscopic, X-ray, ultrasound, etc.) is provided.

IN patient movement log of the department information about the movement of patients is noted: the number of departures and admissions.

IN register of infectious patients record the last name, first name, age of the child delivered with an infectious disease, diagnosis, date, contacts and measures taken.

In the journal of accounting and consumption of narcotic drugs The nurse enters the necessary information about the drugs available and used during the shift. The same applies to accounting tools (this journal is sometimes filled out by the head nurse).

Emergency Notice about an infectious disease, food poisoning, acute occupational poisoning, an unusual reaction to a vaccination (form? 058/u) is compiled by a medical worker (nurse) and sent to the center for sanitary and epidemiological surveillance.

Admissions nurse fills in:

Cover page of an inpatient medical record

(form? 003/у);

Journal of hospitalization of patients (form? 011/у);

Log of refusal of hospitalization;

Journal of hospitalized patients (a list is compiled in alphabetical order for the reference service);

Journal of free seats in departments (traffic);

Register of infectious patients (plus emergency notifications);

Log of hospitalization of patients admitted unaccompanied with a description of the main external signs (neglected and street children).

Working with medicines. One of the most important responsibilities of a nurse is participation in the treatment process, which manifests itself primarily in the distribution of medications. Medicines have a variety of effects on the body, including local and general. However, in addition to the main therapeutic effect, they can cause side or undesirable effects. The latter decrease and even completely disappear after reducing the dose and discontinuing the drug. There may be cases of drug intolerance, leading to severe complications (for example, anaphylactic shock). The nurse must not only know about all possible adverse reactions to the administration of a particular drug, but also be able to provide emergency first aid.

Storage of medicines carried out in special locked cabinets under the control of a guard nurse. In the cabinet, medicines are placed in groups on separate shelves with the appropriate inscription: sterile, internal, external, eye drops, injection. Larger dishes are placed at the back wall, and smaller ones in front. This allows you to read the label and select the right drug without rearranging the medications. In addition, each shelf should be divided: for example, “internal” - into compartments for powders, tablets, medicines. You can place powders, tablets, capsules on one shelf, and potions, solutions, etc. on the other. This is how general list medications are stored. Storage of medicines without labels is unacceptable.

Particularly stringent requirements apply to poisonous and potent drugs. For them, small-sized safes or metal cabinets are allocated, which are constantly under lock and key.

The safe (cabinet) labeled “A” contains poisonous and narcotic drugs, and the safe (cabinet) labeled “B” contains potent drugs. On the inner surface of each safe there is a list of poisonous and potent medicines, indicating the highest one-time and daily doses.

ny doses (depending on the age of the child). There should also be tables of antidotes here. Supplies of poisonous and narcotic drugs should not exceed a 5-day requirement, and of potent drugs - a 10-day requirement.

To record the receipt and consumption of poisonous and potent medicines, a specially numbered, laced and sealed with wax seal of the medical institution journal is kept in the following form:

The log, as well as requirements for obtaining and dispensing poisonous and potent drugs, are kept in the department for 3 years. Then these documents are destroyed in the presence of the commission, about which a report is drawn up.

The keys to safes (cabinets) “A” and “B” are kept only by persons appointed by order of the medical institution. Usually this is the head sister of the department. Responsible persons bear criminal liability for failure to comply with storage rules and theft of medical drugs, especially for poisonous and potent drugs.

Nurses should be instructed on the timing and storage methods of each product used in the department.

Medicines that have a strong odor (iodoform, Lysol, ammonia, etc.) and are highly flammable (ether, ethyl alcohol) are stored in a separate cabinet. Coloring medications (iodine, brilliant green, etc.) are also stored separately.

The shelf life of factory-made medicines is usually 2-5 years, but can be longer. The shelf life is determined by labeling. Each industrial batch of medicines produced is assigned a factory series, which is marked with at least five numbers. The last two digits are on the right

VA is the year of manufacture, the two previous ones are the month of manufacture, the rest are the factory series.

Medicines prepared in a pharmacy have shorter expiration dates. All containers (boxes, jars, bottles) containing medicines manufactured in a pharmacy are provided with appropriate labels indicating the name, date of manufacture and shelf life.

The storage and sale periods for medicines prepared in pharmacies have been established: 2 days - for injection solutions, eye drops, infusions, decoctions, mucus; 3 days - for emulsions; 10 days - for other medications. Sterile solutions in bottles (not ampoules) can be stored for no more than 3 days. Signs of spoilage of medicines are changes in appearance, in particular the appearance of plaque, flakes, stains on tablets, additional odor, and color changes.

There should be no expired or unusable medications at the medical station.

When storing medicines, you must maintain certain temperatures and humidity, control the degree of illumination, the safety of the packages, etc. Liquid medicines, such as infusions and decoctions, quickly deteriorate and therefore should be stored in the refrigerator at a temperature of 2 to 10 ° C. The same requirements apply to the storage of emulsions, some antibiotics (penicillin, etc.), serums, solutions containing glucose, insulin, etc. Medicines that quickly degrade in light (bromine, iodine) should be stored in dark glass containers and in a dark room.

When storing medicines, it is prohibited to place them together with disinfectant solutions and products for technical purposes. The nurse does not have the right to pour medicine from one container to another, peel off and re-stick labels, or arbitrarily combine medicines (for example, tablets with powders, etc.).

Distribution of medicines carried out by a nurse in strict accordance with the doctor’s prescription, who indicates in the inpatient’s medical record the dates of prescription and withdrawal of medications. Medicines are taken before, during, after meals and before bedtime. The most common, simple and convenient way to administer a drug

is the enteral route, i.e. taking medication by mouth or orally. This method is reliably controlled. Solid dosage forms are mainly taken orally: tablets, dragees, powders, capsules (Fig. 5). Powders in sachet are intended for dilution with water. Less commonly, liquid dosage forms are prescribed internally: solutions, decoctions, mixtures, etc. It should be remembered that the younger the child is, the more widely the use of liquid dosage forms is used.

Rice. 5.Solid dosage forms:

a - tablets; b - dragee; c - powders (in sachet); g - powders or microspheres with an enteric coating in gelatin capsules

When starting to distribute medications, the nurse must wash her hands with soap, change her gown if necessary, and put on a mask. To avoid mistakes, you must be able to identify medications by shape, color, smell, taste. The child should take medications only in the presence of medical personnel - a nurse, a doctor.

There are several ways to distribute medicines in a children's department. You can use trays divided into cells indicating the names of patients. Medicines are laid out in them in advance. Before putting the medicine into the compartment, you should check the name indicated on the package.

forging, with the name of the drug in the inpatient medical record or nursing note. Then the nurse goes around all the wards with the tray. Another way is to use a mobile table on which medications for oral administration, a carafe of water, beakers, spoons, and clean pipettes are laid out. The nurse rolls this table into the room and moves it one by one to the bed of each patient if he is on bed rest. Walking patients independently approach the table, where they take medications under the supervision of a nurse.

When distributing powders, the paper in which the powder is packaged is unrolled and, giving it the shape of a trough, the powder is poured onto the child’s tongue, then they are offered to wash it down with water. You should not give medicines to a child, especially several tablets at once. It is important to follow the sequence of taking medications. After swallowing the tablet, you need to wash it down with liquid, taking small but frequent sips. This is explained by the fact that the tablet passes through the esophagus within 2-5 minutes. If you take a big sip, the water quickly passes by the tablet and the latter may stop in the esophagus. Frequent small sips of water or lumps of food help the medicine pass into the stomach more quickly.

Currently, a large number of medicines are produced in syrup. Children, especially younger ones, readily accept them. Children have difficulty swallowing tablets, and children under 3 years of age are almost never able to swallow them. Therefore, the tablets are crushed before taking. Sometimes a tablet or powder has to be dissolved in sweet water, syrup, given with food, etc. For infants, the prescribed dose of the drug in liquid form is often administered in small doses to prevent the child from choking. If the child does not want to take the medicine, then he has to forcefully open his mouth as follows: 1) gently press the cheeks with two fingers; 2) they pinch their nose and at this moment the child opens his mouth. Some medicines (which do not irritate the oral mucosa) can be given to children in the first months of life from a nipple.

Potions and decoctions are given in graduated cups with divisions of 5, 10, 15, 20 ml. In the absence of graduated dishes, take into account that the aqueous solution in a teaspoon is about 5 ml, in a dessert -

10 ml, in the dining room - 15 ml. Alcohol infusions, as well as liquid extracts, are measured using clean disposable pipettes. Using the same pipette to dispense different medications is prohibited.

Some heart medications (validol, nitroglycerin) are taken sublingually. If it is impossible to administer medications through the mouth, they are administered in the form of suppositories into the rectum. Only nurses administer suppositories to children. In the treatment of respiratory diseases, the inhalation method of administering drugs is actively used, which has numerous options in the form of aerosols and sprays, which require the presence of special packaging and a valve-distribution system.

Features of the technique of drug administration in infants. Typically, a measuring spoon is used, which is placed on the edge of the child's lower lip and tilted so that the medicine gradually flows into the mouth. The medicine can be administered using a special syringe. To do this, the tip of the syringe is placed in the corner of the mouth and the syrup is directed to the inside of the cheek, but not into the throat. The procedure is performed slowly so that the child has time to swallow the contents. In addition, the medicine can be administered through a special nipple. This device allows you to simultaneously treat the child and calm him down.

According to indications, the nurse has to use external methods of administering medications: instilling drops, injecting ointment or inhaling powder into the nose, instilling drops in the ear, instilling drops in the conjunctival sac of the eyes or placing ointment behind the lower eyelid, applying ointments to the skin. All these manipulations are performed individually and are usually separated in time from the distribution of drugs, as well as parenteral procedures associated with injections of drugs. However, their implementation is strictly regulated and requires constant attention and control from the nurse.

It is necessary to warn patients and their parents that when taking certain medications (bismuth, iron, quinoline, etc.), the color of urine and feces may change.

Responsibilities of a nurse in a clinic. Paramedical and junior medical personnel in a children's clinic have a special role. Less time is spent working directly with a sick child, as in a hospital, and more time is spent on medical

The nurse performs the functions of a doctor's assistant and clerical work. The functional responsibilities of a nurse are largely determined by the characteristics of the work of a doctor of a particular profile.

District nurse. The main form of work of a nurse is preventive monitoring of children's health. The method of dispensary control is used. The possibility of dispensary observation and assistance at its various stages is provided by the structure of the children's clinic.

A local nurse (under the supervision of a doctor) conducts prenatal care for a pregnant woman, the purpose of which is medical consultation of the expectant mother (parents) on pediatric issues: preparing the breast for lactation, balanced nutrition, combating bad habits, ensuring optimal living conditions, creating a favorable psychological environment, availability of child care items, formation of a new family lifestyle when a child appears, etc. The first visit to a pregnant woman is carried out immediately after she is registered upon receipt of information from the antenatal clinic (12-23 weeks). The second patronage is carried out at 32 weeks of pregnancy (during maternity leave), taking into account its normal course. The address where the young family will live after the birth of the child and the availability of a children's room (newborn corner) are specified.

Patronage of a newborn. According to the regulations, a pediatrician, together with a visiting nurse, visits a newborn at home in the first three days after discharge from the maternity hospital. If the child is the first-born in the family, then the visit occurs on the first day. An extract from the maternity hospital is studied, a thorough examination of the child is carried out with an assessment of his state of health. The nurse assesses the woman's lactation status and provides detailed instructions on breastfeeding techniques and child care. They carefully find out how the baby sucks at the mother's breast, what breaks are taken between feedings, whether there is vomiting, regurgitation, anxiety, and whether he can withstand a night break. An anthropometric study is carried out: body length and weight, head and chest circumference are measured. At the end of the examination, an individual plan for the management of the newborn is drawn up (number and timing of patronage, consultations with specialists, a set of health measures). Follow-up care of the newborn baby is carried out by a doctor and a nurse.

pour in one by one. Medical (patronage) the sister visits the newborn every 1-2 days during the first week, and then weekly during the first month, alternating visits with the pediatrician.

Dispensary observation. Once the child reaches the age of 1 month, the local doctor and nurse monthly assess the dynamics of physical development, give the necessary advice on the care and prevention of “controllable” diseases (rickets, anemia, iodine deficiency, etc.), and carry out preventive vaccinations.

Children of the second year of life are examined once a quarter. Physical and neuropsychic development is assessed, general urine and blood tests are prescribed according to indications, and feces are examined for worm eggs once a year. From the age of three, children are examined once every six months, and from the age of four - once a year. The doctor identifies groups of children at increased risk for the development of a number of diseases and sick children who need special monitoring, entrusting control over them to the local nurse. The nurse monitors the actual place of residence of the child.

Outpatient appointment. The district nurse prepares the workplace for receiving patients, prepares forms, selects outpatient and dispensary cards for the doctor, and ensures that all test results are entered into the outpatient card. Under the supervision of a doctor, the nurse writes various certificates, referrals for research, fills out statistical coupons (“Outpatient coupon”, f. 0325-12/u), emergency notification cards, sanatorium-resort cards, writes prescriptions under the dictation of a doctor, regulates the queue appointment with a doctor, carries out the necessary measurements (anthropometry, blood pressure measurement), etc.

The work of nurses in other offices (neurologist, cardiologist, endocrinologist, hematologist) has significant similarities with the work of a district nurse. In some cases, for example, at an appointment with an ophthalmologist, a special nursing area is allocated for the nurse, where she, according to a special program, examines children who come to see an ophthalmologist: checks visual acuity, measures intraocular pressure according to indications, etc. A nurse in an otolaryngology office is usually tasked with examining whispered and spoken speech, olfactometry, and taking smears from

pharynx, nose, external auditory canal, etc. Nurses in surgical and applied specialties (surgical, dental, physiotherapeutic, balneological, otolaryngological offices) pay great attention to the preparation of instruments.

Home care for patients. The main reason for a nurse to visit a sick child at home is to carry out medical prescriptions, mainly injections. District nurses are provided with special bags with sets of necessary supplies. While visiting a patient at home, the nurse is engaged in sanitary education work and gives the necessary recommendations for caring for the child. If it is necessary to organize a “hospital at home” and prescribe complex treatment, the nurse carries out intramuscular injections and intravenous infusions, visiting the patient several times a day.

Dispensing medicines to children in the clinic. If a sick child needs medications, the local doctor writes regular or discounted prescriptions (for children under 3 years of age, disabled people since childhood, disabled people due to illness), with partial or full payment. Nurses must know the main medications used in pediatric practice, indications and contraindications for their use, rules of use (forms of medications, connection with food intake), possible side effects. In addition, over-the-counter forms of medications are available for sale in domestic pharmacies, which allows the population to independently use certain dosage forms.

CONTROL QUESTIONS

1.What is a two- and three-stage system of care for children in a hospital?

2.List the responsibilities of a junior nurse.

3.List the responsibilities of the ward nurse.

4.What is the approximate work plan for the ward nurse during the day?

5.What manipulations should a nurse know?

6.What does the transfer and acceptance of duty in the children's department of the hospital involve?

7.How is the nurse’s station equipped?

8.What types of medical documentation are used in the therapeutic department?

9.What data is entered in the temperature sheet?

10.What are the requirements for storing medicines in the department?

11.Name the features of distributing medications taken orally to children of different ages.

12.How are the shelf life of individual medicines regulated?

General child care: Zaprudnov A. M., Grigoriev K. I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.