Job description of a junior nurse in the operating room. Responsibilities of a nurse in caring for patients

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 junior was introduced nurse(care nurse). 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 temperature sheet medical record of an inpatient, 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 daily amount 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 children younger age; 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 storage rules 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 Bladder soft catheter (in children over 1 year);

5) apply mustard plasters, jars, compresses;

6) give medications by mouth;

7) rub in medications;

8) bury medicinal solutions in 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)conduct indirect massage hearts;

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 in proper organization caring for children, storing baby food and strictly following all medical (medical) prescriptions. She prepares the nurses' duty schedule and time sheets. wages, monitors the availability of medicines in the pharmacy, orders missing ones, 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 not completed 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. Checks availability sufficient quantity 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- workplace nurse (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, the time of dispensing the medicine is noted, in the temperature sheet - body weight and the child’s growth 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, they list febrile children with an indication of body temperature, assess the dynamics of clinical symptoms in seriously ill patients, list all unscheduled manipulations and Taken measures assistance performed by the doctor on duty and as prescribed by him. 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 department 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);

Magazine free seats in departments (movement);

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 is obliged not only to know about all possible adverse reactions to administer 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 inner surface Each of the safes contains a list of poisonous and potent medicines, indicating the highest one-time and daily

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 medical supplies, 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 strong odor(iodoform, lysol, ammonia etc.) and highly flammable (ether, ethanol), 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.

More short time Medicines prepared in a pharmacy are valid. 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 what younger age child, 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- nurse, 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 medical record of the inpatient or nursing sheet. 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 in production a large number of medicines 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 is liquid form 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. Usually use a measuring spoon, which is placed on the edge lower lip child and tilt it 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 inside cheeks, but not in 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, the availability of child care items, the formation of a new family lifestyle when a child is born, etc. The first visit to a pregnant woman is carried out immediately after she is registered upon receipt of information from 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 maternity hospital, a thorough examination of the child is carried out to assess 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 outpatient card All test results were entered. 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, health resort cards, under the dictation of a doctor, writes prescriptions, regulates the queue for appointments 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 according to indications intraocular pressure etc. The otolaryngology nurse is usually tasked with examining whispering and colloquial speech, olfactometry, 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 prescribes the usual or discounted prescriptions(children under 3 years old, disabled since childhood, disabled due to illness), with partial or full payment. Nurses should know the essential drugs 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 medical documentation 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.

Introduction
Chapter 1. Job responsibilities of a junior nurse for patient care
Chapter 2. Rights and responsibilities of a junior nurse in caring for patients
Chapter 3. Deontological aspects of nursing
Chapter 4. Techniques for performing the basic functional duties of a junior nurse
4.1. Sanitary and hygienic treatment of patients
4.2. Transportation of patients by junior nurses to medical departments of the hospital
4.3. Changing hospital linen
4.4. Supply of bedpan and urine bag
4.5. Treatment of bedsores
4.6. Feeding seriously ill patients
Conclusion
List of sources used

Introduction

Decisive role in ensuring proper care Nursing care for patients is assigned 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 impairments motor functions, urinary and fecal incontinence, who have to change underwear several times a day and 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 sanitization, accompany patients to various studies, ensure delivery of tests to the laboratory.

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

Tasks:

Explore job responsibilities junior nurses for patient care;
Consider the rights and responsibilities of junior nurses;
To study the technology of basic procedures performed by junior nurses when performing their functional duties.

Chapter 1. Job responsibilities of a junior nurse for patient care

A person with a secondary (full) education is appointed to the position of junior nurse for patient care. general education and additional training in courses for junior nurses in patient care without requirements for work experience or secondary (complete) general education, additional training in courses for junior nurses in patient care and work experience in the profile of at least 2 years.

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;

– basics of the diagnostic and treatment process, disease prevention, propaganda healthy image life;

– basic methods and techniques for providing pre-medical care 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:

Conducts simple medical manipulations, such as placing cups, mustard plasters and compresses.
Monitors cleanliness and order in the premises of the medical institution.
Assists in patient care under the direction of a nurse.
Ensures that patients and visitors comply with the internal regulations of the healthcare facility.
Participates in the transportation of seriously ill patients.
Changes bed and underwear.
Monitors compliance with sanitary-hygienic and anti-epidemic regulations when using and storing patient care items.

Chapter 2. Rights and responsibilities of a junior nurse in caring for patients

A junior nurse caring for patients has the right:

Make proposals to the management of the enterprise on the optimization and improvement of medical and social care, including on issues of their work activities.
Demand that the management of the institution provide assistance in the performance of their official duties and rights.
Receive information from enterprise specialists necessary for effective implementation their job responsibilities.
Enjoy your labor rights in accordance with Labor Code Russian Federation

The junior nursing nurse is responsible for:

For the proper and timely performance of the duties assigned to him, provided for by this job description
For organizing your work and qualified execution of orders, instructions and instructions from the management of the enterprise.
For ensuring that employees subordinate to him comply with their duties.
For failure to comply with internal rules and safety regulations.

For those committed during the process therapeutic measures wrongdoing or omission; for errors in the process of carrying out their activities that entailed serious consequences for the health and life of the patient; as well as 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.

Chapter 3. Deontological aspects of nursing

Any specialty is characterized by the existence of its own specific ethical standards and rules of behavior. In this regard, medical deontology (from the Greek deon, deontos - duty, due; logos - teaching) is the science of the professional duty of medical workers. Close in meaning is the concept of medical ethics, the science of the moral and ethical aspects of medicine.

Deontological aspects of nursing are currently becoming increasingly important. Unfortunately, callousness, rudeness, irritability, indifference, and selfish motives have become frequent phenomena in the work of medical personnel.

Quite a lot important has a decline in the prestige of the work of paramedical workers. Over the past 20 years, the category of junior medical personnel has practically disappeared in our country.

All this has made it extremely urgent to improve the care of the elderly, the seriously ill, and the disabled, as well as to increase the prestige of the profession of junior nurse and nurse.

The range of problems that medical deontology deals with is extremely diverse. These are various issues relating to the relationship between the doctor and the patient, the doctor and the patient’s relatives, and medical workers among themselves. Many areas of medicine also have their own deontological characteristics. Certain deontological problems arise in connection with the wider introduction of the results of scientific and technological progress into medicine.

Such human qualities as sensitivity, responsiveness, kindness, cordiality, care, attention are required from medical workers every hour in their daily work and when caring for patients. Junior nurses often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change linens 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.

Deontological principles also determine certain requirements for appearance junior medical personnel caring for patients. At work, you must use replaceable shoes, your robe must be immaculately clean and ironed, your nails must be cut very short, and it is recommended that your hair be carefully tucked under a cap or scarf. Stale robe, street shoes, dirty hands, poorly trimmed nails are unacceptable from the point of view of sanitation and hygiene and, in addition, make a depressing impression. It is necessary to use cosmetics and perfumes very carefully and in moderation, since in patients with allergies they can cause a worsening of the condition - provoke an attack bronchial asthma, urticaria.

Nursing also requires certain rules for communicating with patients. It should be borne in mind that sick people often become excitable, irritable, hot-tempered, capricious, and sometimes, on the contrary, depressed and indifferent. When caring for them, it is important to show maximum attention, reassure them, explain the need to follow the regime, regular intake medications, to convince of the possibility of recovery or improvement of the condition.

Great care must be taken when talking to patients suffering from oncological diseases, to whom it is not customary to communicate the true diagnosis, especially in cases poor prognosis. Such patients often suspect that they have malignant tumor and everyone strives possible ways confirm your assumptions. Therefore, it is necessary to carefully ensure that examination data indicating the tumor diagnosis and medical history do not fall into the hands of patients. For the same reasons, you should not communicate the results of patient examinations over the phone.

The deontological aspects of patient care also include the need to strictly maintain medical confidentiality. Medical workers may sometimes become aware of information about a patient that is of a deeply personal, intimate nature, which they do not have the right to disclose. This requirement in no way applies to those situations when, in the process of monitoring a patient, circumstances are revealed that may pose a danger to other people (information about infectious and venereal diseases, poisoning, etc.). In such cases, medical workers, on the contrary, are obliged to immediately report the information received to the relevant organizations.

Chapter 4. Techniques for performing the basic functional duties of a junior nurse

4.1. Sanitary and hygienic treatment of patients

Junior nurses take part in the sanitary treatment of patients. Sanitary and hygienic treatment is carried out in the sanitary inspection room reception department.

The sanitary inspection room of the emergency department usually consists of an examination room, a dressing room, a bath-shower room and a room where patients dress.

In the examination room, the patient is undressed, examined for lice and prepared for sanitary and hygienic treatment.

If the linen is clean, it is put in a bag, and outerwear is hung on hangers and put into a storage room. The list of things (receipt receipt) is made in two copies: one is handed over to the storage room, the other is glued to the medical history and upon discharge, things for the patient are received from it. Available valuables and money are handed over to the senior nurse against receipt to be stored in a safe.

If the patient is diagnosed infection, the laundry is placed in a tank with bleach or chloramine B for 2 hours and sent to a special laundry. If linen is infested with lice, it is pre-treated with a disinfectant solution and sent to a disinfection chamber for special treatment. Bags with such clothes should have the appropriate inscription - “Pediculosis”.

Stages of sanitary and hygienic treatment of patients.

Examination of skin and hairline sick.
Hair cutting, nail cutting, shaving (if necessary).
Washing in the shower or hygienic bath.

Examination of the patient's skin and hair

Signs of pediculosis:

the presence of nits (lice eggs, which are glued by the female to the hair or fibers of fabric; Fig. 2-2) and the insects themselves;
itching of the skin;
traces of scratching and impetiginous (pustular) crusts on the skin.

If pediculosis is detected, the patient is subjected to special sanitary and hygienic treatment; the nurse makes an entry in the “Pediculosis Examination Journal” and puts a special note (“P”) on the title page of the medical history, and also reports the detected pediculosis to the sanitary-epidemiological service. Partial or complete sanitary and hygienic treatment can be carried out. Partial sanitary and hygienic treatment consists of washing the patient with soap and a washcloth in the bath or shower, disinfecting and disinfesting his clothes and shoes. Full sanitary and hygienic treatment means the treatment of bedding and living quarters.

All data on the processing of an admitted patient must be recorded in the medical history so that the ward nurse can re-process it in 5-7 days.

Stages of sanitary and hygienic treatment:

1) disinfestation (lat. des– a prefix denoting destruction, insectum– insect; destruction of arthropods that act as carriers of pathogens of infectious diseases);

2) hygienic bath (shower, wiping);

3) cutting hair and nails;

4) dressing the patient in clean linen.

There are several types of disinfectant solutions. 20% benzyl benzoate emulsion solution. Special shampoos (for example, Elko-insect). Special lotions (for example, Nittifor).

The order of the procedure.

Prepare for sanitary and hygienic treatment: lay out the necessary equipment and put on protective clothing.
Lay an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper.
If necessary, cut the hair above the prepared basin.
Treat your hair with a disinfectant solution, tie your head with a plastic scarf and top with a towel, leaving it for a certain time specified in the instructions.
Untie your head and rinse with warm running water, then with shampoo.
Dry your hair with a towel and treat your hair with a heated 6% acetic acid solution.
Tie your head again with a plastic scarf and a towel on top, leaving for 20 minutes.
Untie your head and rinse with warm running water, dry with a towel.
Tilt the patient's head over the white paper and carefully comb the hair strand by strand with a fine comb, then re-examine the patient's hair.
Burn the cut hair and paper in a basin.
Place the patient's clothing and the nurse's protective clothing in an oilcloth bag and send it to the disinfection chamber. Treat the comb and scissors with 70% alcohol, and treat the room with a disinfectant solution.

The use of disinfectant solutions is contraindicated during pregnancy, women in labor and breastfeeding, children under 5 years of age, as well as for diseases of the scalp.

The procedure for performing disinsection in the presence of contraindications to the use of disinfectant solutions.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment and put on protective clothing.

2. Place an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper, if necessary, cut the hair over the prepared basin

3. Treat the hair (not the scalp) with a heated 6% vinegar solution, mechanically selecting and destroying lice.

4.Tie your head with a plastic scarf and a towel on top, leaving for 20 minutes.

5.Untie your head and rinse with warm running water, then with shampoo, and dry with a towel.

6. Tilt the patient’s head over the white paper and carefully comb the hair strand by strand with a fine comb, then re-examine the patient’s hair.

7.Burn the cut hair and paper in a basin.

8.Place the patient’s clothing and the nurse’s protective clothing in an oilcloth bag and send it to the disinfection chamber. Treat the comb and scissors with alcohol (70%) and the room with a disinfectant solution.

Hair cutting, nail cutting, shaving

Haircut

Necessary equipment.

Scissors, hair clipper.
Basin for burning hair, matches.
Alcohol (70%).

The order of the procedure.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment.

2. Place an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper.

3. Remove hair with a hair clipper; in case of skin disease of the scalp, cut the hair over the prepared basin

4. Burn your hair.

5. Treat scissors and razor with alcohol.

Shaving

Required equipment:

Latex gloves.
Razor, brush and shaving cream.
Napkin, towel, water container.

The order of the procedure.

1 . Prepare for sanitary and hygienic treatment: lay out the necessary equipment, put on gloves.

2. Heat water (up to 40–45 °C), soak a napkin in it, wring it out and cover the patient’s face.

3.Remove the napkin and apply shaving cream with a brush.

4. Shave the patient, pulling the skin with the other hand in the opposite direction to the movement of the razor.

5.Blot your face with a damp, then dry cloth.

6. Treat the razor with alcohol.

7.Remove gloves, wash hands

Nail cutting

Necessary equipment.

Latex gloves.
Scissors and nail clippers.
Warm water, liquid soap, hand and foot cream, alcohol (70%).
Basin and tray for water, towels.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment, heat the water, put on gloves.

2.Add liquid soap to a tray with warm water and soak the patient’s hands in it for 2–3 minutes (alternately as you trim the nails).

3. One by one, removing the patient’s fingers from the water, wipe them and carefully trim the nails.

4. Treat the patient’s hands with cream.

5.Add liquid soap to a basin of warm water and soak the patient’s feet in it for 2-3 minutes (alternately as the nails are trimmed).

6.Put your foot on a towel (alternately as you trim your nails), wipe it and trim your nails with special tweezers.

7. Treat your feet with cream.

8. Disinfect scissors and tweezers with alcohol.

9.Remove gloves, wash hands.

4.2. Transportation of patients by junior nurses to medical departments of the hospital

Transportation – transporting and carrying patients to the place of medical care and treatment.

The method of transporting the patient from the emergency room to the department is determined by the doctor conducting the examination.

Mobility aids (gurneys, stretchers) are provided with sheets and blankets. The latter must be changed after each use. Patients who move independently are admitted from the emergency department to the ward, accompanied by junior medical staff (junior nurse, orderlies or orderlies).

Patients who cannot move are transported to the department on a stretcher or in a wheelchair.

Transporting a patient on a stretcher manually

The patient should be carried on a stretcher without haste or shaking, moving out of step.

The patient should be carried down the stairs feet first, with the foot end of the stretcher raised and the head end slightly lowered . In this case, the person walking behind holds the handles of the stretcher on his arms straightened at the elbows, while the person walking in front holds the handles on his shoulders.

The patient should be carried up the stairs head first, also in a horizontal position. . In this case, the person walking in front holds the handles of the stretcher on his arms straightened at the elbows, and the person walking behind holds them on his shoulders.

Transferring the patient from a stretcher (gurney) to a bed

Transfer order.

Place the head end of the stretcher (gurney) perpendicular to the foot end of the bed. If the room area is small, place the stretcher parallel to the bed.
Place your hands under the patient: one nurse places his hands under the patient’s head and shoulder blades, the second - under the pelvis and top part thighs, the third - under the middle of the thighs and lower legs. If transportation is carried out by two orderlies, one of them places his hands under the patient’s neck and shoulder blades, the second - under the lower back and knees.
At the same time, with coordinated movements, lift the patient, turn with him 90° (if the stretcher is placed parallel - 180°) towards the bed and lay the patient on it.
When the stretcher is located close to the bed, hold the stretcher at the level of the bed, two (three) of you pull the patient to the edge of the stretcher on the sheet, slightly lift it up and transfer the patient to the bed.

Transferring the patient from the bed to a stretcher (gurney)

Transfer order.

Place the stretcher perpendicular to the bed so that its head end approaches the foot end of the bed.
Place your hands under the patient: one orderly places his hands under the patient’s head and shoulder blades, the second - under the pelvis and upper thighs, the third - under the middle of the thighs and lower legs. If transportation is carried out by two orderlies, one of them places his hands under the neck of the patient’s shoulder blade, the second - under the lower back and knees.
At the same time, with coordinated movements, lift the patient, turn 90° towards the stretcher and lay the patient on it.

The method of transporting and placing the patient on a stretcher depends on the nature and location of the disease.

Features of transporting patients

Nature and location of the disease	Types of transportation
Brain hemorrhage	Lying on your back
Unconscious state	The patient's head must be turned to the side; make sure that when possible vomiting vomit did not enter the respiratory tract
Cardiovascular failure	In a half-sitting position, cover well, put heating pads on your legs and arms
Acute vascular insufficiency	Lay the patient down so that the head is below the level of the legs
Burns	Place on the undamaged side if possible, cover the burned surface with a sterile bandage or sterile sheet
Skull fracture	On a stretcher in a supine position with the headrest of the stretcher lowered and without a pillow; around the head there is a cushion made of a blanket, clothing or a cushion pad moderately inflated with air
Fracture of the thoracic and lumbar spine	Rigid stretcher - lying on your back face up (not to the side), regular stretcher - lying on your stomach face down
Fractured ribs	In a half-sitting position
Pelvic fracture	Lying on your back, placing a pillow, cushion, etc. under your spread knees.

Moving the patient in bed

The patient is moved in bed in stages.

Stage 1. Assess the patient's ability to participate in the procedure, namely: his mobility, muscle strength, adequate reaction to words.

Stage 2 . Raise the bed to the height that is most comfortable for working with the patient.

Stage 3. Remove pillows and other objects from the bed that interfere with the patient's movement.

Stage 4. If necessary, seek the help of a nurse or doctor.

Stage 5. Explain to the patient the meaning of the procedure in order to reassure him and encourage cooperation.

Stage 6. Give the bed horizontal position, fix the wheels.

Stage 7. To reduce the risk of infection, carry out the procedure with gloves.

Stage 8. After moving the patient, lower the bed and raise the handrails to ensure the patient's safety.

Stage 9. Check the correct position of the patient's body. The back should be straight, any curvature or tension should be avoided. Find out if the patient is comfortable.

Moving a helpless patient in bed

Turn the patient onto his back, check the correct body position.
Lower the head of the bed to a horizontal position.
Place a pillow at the head of the bed to prevent the patient from hitting his head on the headboard.
Stand facing the foot of the bed at an angle of 45 0 and move the patient's legs diagonally towards the head of the bed.
The procedure begins with moving the legs, because... they are lighter than other parts of the body and easier to move.
Move along the patient's thighs.
Bend your legs at the hips and knees so that your arms are level with the patient's torso.
Move the patient's hips diagonally towards the head of the bed.
Move along the patient's torso parallel to his upper body.
Place the hand closest to the head of the patient under the patient’s shoulder, clasping his shoulder from below. The shoulder must be supported at the same time with the hand.
Place your other hand under your upper back. Head and neck support ensures proper alignment of the patient's body and prevents injury, while torso support reduces friction.
Move the patient's torso, shoulders, head and neck diagonally towards the head of the bed.
Raise the side rail of the bed to prevent the patient from falling out of bed and move to the other side of the bed.
Moving from one side of the bed to the other, repeat the procedure until the patient’s body reaches the desired height.
Move the patient to the middle of the bed, in the same way alternately manipulating three parts of his body, until the goal is achieved.
Raise side rails to ensure patient safety.
Remove gloves, wash hands.

4.3. Changing hospital linen

Hospital linen includes sheets, pillowcases, duvet covers, diapers, shirts, scarves, gowns, pajamas, etc.

Clean linen is stored in the linen room located in the department, on shelves painted with oil paint and covered with medical oilcloth. Shelves for clean linen are regularly treated with a disinfectant solution.

Dirty laundry is stored in a special room in marked oilcloth bags.

All linens must have a department tag and stamp.

The junior nurse carries out regular linen changes and timely dispatch dirty laundry to the laundry room.

Once every 7-10 days there is a bath day with a change of linen, but if there are seriously ill patients in the department with involuntary urination or defecation, then the linen is changed as it gets dirty.

Due to the fact that the patient spends most of his time in bed, it is important that it is comfortable and neat, that the mesh is well stretched and has a smooth surface. A mattress without bumps or depressions is placed on top of the mesh. Depending on the season, flannelette or wool blankets are used. Bed linen must be clean. The sheets should not have scars or seams, and the pillowcases should not have knots or fasteners on the side facing the patient. At the same time with bed linen the patient receives 2 towels.

The bed of patients with involuntary urination and fecal discharge should have special devices. Most often, a rubber bed is used, and the mattress is covered with oilcloth. Bed linen for such patients is changed more often than usual - as it gets dirty.

If a sick woman has copious discharge from the genitals, then to keep the bed clean, an oilcloth is placed under the patient and a small sheet on top, which is changed at least 2 times a day, and if necessary, more often, a pad is placed between the thighs, which is changed as needed. pollution.

The patient's bed must be changed regularly - in the morning, before the day's rest and at night. The junior nurse shakes the crumbs off the sheet, straightens it, and fluffs the pillows. The patient can be seated on a chair during this time. If the patient cannot get up, then move him together to the edge of the bed, then, straightening the mattress and sheet on the vacant half, remove the crumbs from them and transfer the patient to the cleaned half of the bed. Do the same on the other side.

Changing bedsheets for seriously ill patients requires a certain skill from the staff. If the patient is allowed to turn on his side, first, carefully lift his head and remove the pillows from under it. Then they help him turn over on his side, facing the edge of the bed. On the vacant half of the bed, located behind the patient’s back, a dirty sheet is rolled up so that it lies in the form of a roll along his back. A clean, also half-rolled sheet is placed on the vacant space. Then the patient is helped to lie on his back and turn to the other side. After this, he will find himself lying on a clean sheet facing the opposite edge of the bed. Next, remove the dirty sheet and straighten the clean sheet.

If the patient cannot make active movements, the sheet can be changed in another way. Starting from the head end of the bed, roll up the dirty sheet, lifting the patient's head and upper torso. In place of the dirty sheet, place a clean one rolled up in the transverse direction and straighten it in the vacant space. Then a pillow is placed on a clean sheet and the patient’s head is lowered onto it. Next, lifting the patient’s pelvis, the dirty sheet is moved to the foot end of the bed, and a clean sheet is straightened in its place. After this, all that remains is to remove the dirty sheet.

Shirts for a seriously ill patient are changed as follows: slightly raising the upper part of the body, collect the shirt from the back to the neck. Raising the patient's arms, remove the shirt over the head, and then release the arms from the sleeves. If one of the patient’s arms is injured, the sleeve is removed first from the healthy arm, and then from the sick one. They put a clean one on reverse order: First, starting with the sore arm, put on the sleeves, and then put the shirt on over the head and straighten it along the back.

4.4. Supply of bedpan and urinal.

A vessel is one of the most necessary items for caring for seriously ill patients. Patients on strict bed rest must be provided with a bedpan when defecating, and men must be provided with a urinal when urinating.

Vessels are made of earthenware, enamel-coated metal, rubber, and various plastics. The vessels come in a variety of shapes, with a large round hole at the top and a relatively small hole in the tube coming off one side of the vessel. The large hole at the top is equipped with a lid. A clean vessel is stored in the toilet room, in a specially designated closet or under the patient’s bed on a stand.

If a patient has a need to empty the intestines, he should, first of all, be fenced off from other patients with a screen. The vessel is rinsed before use. warm water and leave some water in it. An oilcloth with a diaper is laid under the patient at a corner, the blanket is thrown back, the patient is asked to bend his knees and help him, placing his left hand under the sacrum, to raise the pelvis. Holding the open vessel by the tube with your right hand, bring it under the buttocks so that the perineum is above the large hole, and the tube is between the thighs towards the knees. Covering the patient with a blanket, leave the patient alone for a while. Then the vessel is removed from under the patient, covered with a lid and taken to the restroom, where it is emptied of its contents, thoroughly washed with a brush, disinfected, rinsed and put back in place. The patient must be washed after defecation.

A rubber bedspread is often given to weakened patients or patients with urinary or fecal incontinence to prevent the formation of bedsores. When the vessel is parked for a long time, it is necessary to wrap it in a diaper or put a cover on it (to avoid skin irritation from contact with the rubber). The rubber vessel is not tightly inflated using a foot pump. It is disinfected in the same way as an enamel vessel. To eliminate odor, the rubber vessel is rinsed with a weak solution of potassium permanganate.

Patients on strict bed rest are forced to urinate in bed. For this purpose, there are special vessels - urinals. They are made of glass, plastic or metal and have an oval shape with a hole elongated into a short tube. The shape of the tube - the opening of the female and male urinals is somewhat different. Women more often use a bedpan rather than a urinal. Urinals, just like bedpans, must be individual. They should be served clean and heated, and immediately freed from urine. Disinfection of urinals is carried out in the same way as vessels. Since urine is often a sediment that adheres to the walls in the form of plaque and produces an unpleasant ammonia odor, urinals must be washed from time to time with a weak solution of hydrochloric acid followed by rinsing with running water.

4.5. Treatment of bedsores.

Bedsores are dystrophic ulcerative-necrotic processes that occur in weakened patients, long time in bed. Most often, bedsores form in the area of the shoulder blades, sacrum, greater trochanter, elbows, occipital region, and back of the heels.

The formation of bedsores contributes to poor care skin care, uncomfortable bed, infrequent re-making. One of the first signs of bedsores is pale skin and wrinkles, followed by redness, swelling and peeling of the epidermis. Then blisters and skin necrosis appear. Infection can lead to sepsis and cause death.

Prevention of bedsores:

turn the patient on his side several times a day, if his condition allows (change the patient’s position);
shake off the sheets several times a day so that there are no crumbs in the bed;
ensure that there are no folds or patches on bed linen and underwear;
for seriously ill patients who have been in bed for a long time, place an inflatable rubber circle with a pillowcase on it, so that the sacrum is above the hole in the circle;
wipe the skin daily with a disinfectant solution: camphor alcohol, vodka, cologne, and in their absence, wipe the skin with a towel moistened with warm and soapy water, and wipe dry, lightly rubbing the skin.

To wipe, moisten the end of a clean towel with a disinfectant solution, wring it lightly and wipe the neck, behind the ears, back, buttocks, front surface of the chest and armpits. Special attention should be paid to the folds under the mammary glands, where obese women can develop diaper rash. Then the skin is wiped dry in the same order.

These procedures are carried out by nurses every day at night for patients who cannot take a weekly hygienic bath, as well as for patients in unconscious. Thus, with proper care, the patient’s skin should always be dry and clean.

4.6. Feeding seriously ill patients

Caring for seriously ill patients requires enormous patience, skill and compassion from the nurse. Such patients are very vulnerable, often capricious in their desires, and impatient. All these changes do not depend on the patient himself, but are associated with the influence of the disease on the patient’s psyche and behavior. These should be regarded as symptoms of a serious illness. For a sick person, food and drink become especially important, often determining either recovery or progression of the disease. Poor nutrition several times increases the risk of developing bedsores, slows down recovery, and contributes to the progression of the underlying disease.

Before you start feeding, it is necessary to carry out all medical procedures and carry out the patient’s physiological functions. After this, it is necessary to ventilate the room and help the patient wash his hands. A nurse can help the nurse with this. It is best, if the condition allows, to give the patient a semi-sitting position or raise the head of the head. If this cannot be done, then it is necessary to turn the patient's head to the side. Great help in feeding seriously ill patient is a functional bed equipped with a special over-bed table. If there is none, then instead of a table you can use a bedside table. Cover the patient's chest with a napkin, and if necessary. put some oilcloth on it. Food should be semi-liquid and warm.

Conclusion

Every doctor knows well how great the importance of junior nurses is in caring for patients.

Junior nursing nurse

The duties of a junior nurse include:

Regular wet cleaning of premises: wards, corridors, common areas, etc.
Assisting a nurse in caring for patients: changing linen, feeding seriously ill patients, hygienic provision of physiological functions of seriously ill patients - feeding, cleaning and washing vessels and urinals, etc.
Sanitary and hygienic treatment of patients.
Accompanying patients for diagnostic and treatment procedures.
Transportation of patients. helps the ward nurse in caring for the sick, changes linen, ensures that the patients themselves and the hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients’ compliance with the hospital regime.

Junior nurses often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change linens several times a day, carry out sanitary and hygienic treatment, and spoon-feed.

Caring for them requires enormous patience, tact, and compassion.

List of sources used

Kazmin V.D. “Handbook for nurses and aides” (in questions and answers), 2009.
Mukhina S. A., Tarnovskaya I. I. “Practical guide to the subject “Fundamentals of Nursing” Moscow Publishing Group “Geotar-Media” 2008.
Mukhina S.A. Tarnovskaya I.I. Theoretical foundations of nursing: Textbook. – 2nd ed., rev. and additional – M.: GEOTAR – Media, 2008.
Obukhovets T.P., Sklyarova T.A., Chernova O.V. Fundamentals of Nursing. – Rostov e/d.: Phoenix, 2002.
Petrovsky B.V. – “Deontology in medicine.” - M.: Medicine, 2010.
Order of the Ministry of Health and social development Russian Federation (Ministry of Health and Social Development of Russia) dated July 23, 2010 No. 541n “On approval of the Unified Qualification Directory of positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the field of healthcare”
Professional standard “Junior nurse for patient care” 2010.
Guide for paramedical workers / Ed. Yu.P. Nikitina, V.M. Chernysheva. – M.: GEOTAR-Media, 2007.
Nurse's Handbook. – M.: Eksmo Publishing House, 2006.
Khetagurova A.K. “Problems of ethics and deontology in the work of a nurse” Supplement to the journal “Nursing” No. 1, 2008.

The functional responsibilities of a nurse, girl or woman, whose actions are directed by a doctor, include the implementation of the basic rule: caring for the patient as directed by the authorities and only by him. Other important instructions for her come from this.

What should the nurse know?

The nurse's knowledge must be quite broad. She should not only familiarize herself with the laws related to the health care system, but memorize them, as well as the rights related to her immediate work and the work in which she is engaged. Such a girl or woman should know the basics of fire safety, the tasks of a nurse and the organization of healthcare institutions very well. She should be guided in her activities by the law, orders of her immediate supervisor, materials related to medical issues, the charter of the institution, hygiene and labor regulations and job descriptions (exclusively this one).

This list basically includes the following: caring for patients and sick people, providing medical care before the doctor arrives; sterilization of instruments, dressings and other items for treatment; control over the storage, consumption and use of drugs and preparations, their accounting. The nurse is also involved in ensuring that the patient undergoes procedures exclusively correctly, as well as recording data on the patient’s condition. She administers IVs and injections in the hospital, takes a blood sample, prepares instruments and medications before surgery; measures blood pressure and temperature, gives injections, applies bandages, etc. This is especially true for representatives of this profession working in emergency rooms, schools and traumatology departments.

IN functional responsibilities Nurses in children's clinics also include patronage - monitoring the child's condition and special consultations with parents on how to care for him at home. The district nurse keeps records of people who come to see a doctor, as well as patients who go to the hospital. The nurse's responsibilities include filling out medical cards and checklists, and filling out certificates. In the operating room, a girl of this specialty monitors the integrity and completeness of drugs and instruments, helps the surgeon, giving him the necessary instruments at his request with the necessary efficiency. In schools and nurseries preschool institutions she is also responsible for seasonal and routine vaccinations.

Responsibilities of a junior nurse

Her responsibilities include carrying out simple manipulations medical nature(associated with cups, compresses, heating pads); change of underwear and bed linen; assistance to a senior employee; transportation of seriously ill patients; monitoring patients' compliance with the rules of the institution, cleanliness, and order. In addition, the nurse's functional responsibilities include replacing the head nurse when she goes on vacation or is on sick leave.

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.

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.

Nursing care is provided by nursing and junior medical staff.

Nursing staff

Nurse - 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 nursing process is precisely 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 medical university. She deals with issues rational organization labor, advanced training of nursing 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 helps the surgeon with 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 working with specialist doctors to receive patients(ophthalmologist, otorhinolaryngologist, neurologist, etc.).
Dietary nurse(nutritionist) under the guidance of a nutritionist is responsible for the organization and quality therapeutic nutrition, draws up a menu, 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:

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

correct collection of material for analysis (blood, sputum, urine and feces);

providing nursing care 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 internal regulations

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

Placement of cups for the patient

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Installation of mustard plasters

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Job description of a junior nurse in the operating room. Responsibilities of a nurse in caring for patients

CHAPTER 4 RESPONSIBILITIES OF JUNIOR AND MIDDLE MEDICAL STAFF

Job responsibilities of a junior nurse for patient care

Nursing staff

Junior medical staff

Placement of cups for the patient

Installation of mustard plasters