General care for children with surgical diseases. Caring for children in a surgical hospital

State budgetary educational institution of higher education
vocational education
"Siberian State Medical University" Ministry of Health and Social Development of Russia

Department of Pediatric Surgery

Abstract on the topic:
“General care for sick children in a hospital”

Performed:
Student
Faculty of Pediatrics, 1st year group 2103
Shevtsova Yulia Andreevna

Tomsk 2012
Content.

1. Introduction. 3
2. General patient care in the pediatric surgical department. 4
3.Preparing patients for emergency and planned surgery. 9
4. List of references. 13

1. Introduction.

Care for patients in a hospital is carried out by nursing staff, and at home - by the patient’s relatives and a nurse.

Care should be understood as:

Closely related to care is round-the-clock monitoring of the patient: changes in the manifestations of the disease, physical symptoms, and the patient’s mood. The nursing staff informs the doctor about all noticed changes, helping him to form a correct idea of the patient’s condition and correctly manage treatment.

Timely recognition of the disease, good care and proper treatment ensure the patient’s recovery.

2. General patient care in the pediatric surgical department.

Patient care (sanitary hypurgia - from the Greek "hipur-geo" - to help, to provide a service) is a medical activity to implement the requirements of clinical hygiene in a hospital, it is the implementation of components of the personal hygiene of the patient and the environment that the patient is not able to provide himself due to illness or surgery.
For this purpose, medical personnel use physical and chemical methods based mainly on manual labor. Physical methods of clinical hygiene include washing the body and surrounding objects, ventilating rooms, burning, using dry heat or water steam, boiling, and irradiation. Dressing material, drainages, tampons from purulent patients are destroyed by burning. When burning, there must be safe transportation of contaminated material and a special device for burning. Specially trained personnel must work in combustion plants and when assessing the material to be burned. Chemical methods include acids, alkaloids, heavy metals, oxidizing agents, halogens, phenol and its derivatives, chlorhexidine, quaternary ammonium and phosphonium compounds, surfactants, alcohols, aldehydes, dyes. All disinfectants allowed for use are listed in order 720 - chloramine B 0.5% solution, chloramine B with 0.5% detergent, 3% hydrogen peroxide solution, hydrogen peroxide with 0.5% detergent products, dezoxon-1, dezoxon-1 with 0.5% detergent, dichlor-1 (1%), sulfochloranthine (0.1%), 70% ethyl alcohol, chlordesine (0.5%). Washing powders are used as detergents.
Nursing is helping a patient in his frail state, the most important element of clinical and medical activity. In a surgical hospital, patient care is an extremely important element of surgical activity, which has a serious impact on the outcome of patient treatment.
Patient care includes:
1. accurate and timely implementation of doctor’s prescriptions;
2. assistance in satisfying the patient’s natural needs (eating, drinking, movement, emptying the bladder, etc.)
3. adherence to the principle of a protective regime (elimination of various irritants, negative emotions, ensuring silence and peace);
4. creation of a sanitary and hygienic environment in the ward, observation;
5. carrying out preventive measures (prevention of bedsores, mumps, etc.).

General care includes activities that can be carried out regardless of the nature of the disease. Special care includes additional measures carried out only for certain diseases - surgical, urological, etc.
Basic elements of general care:

The main officials providing care for patients in a hospital: nurse, barmaid, junior nurse. sister, nurse.
Hygiene of medical personnel.
Medical personnel of all ranks are the main object and subject of clinical hygiene. Hygiene of medical personnel is the strict observance by employees of medical institutions, especially surgical ones, of the rules of personal hygiene, aimed at preventing various complications in patients before and after operations. Medical staff can serve as a source of infection in a surgical hospital, spread it within the hospital, and also carry the infection beyond its boundaries.
The purpose of personal hygiene of medical staff is to protect personal clothing and the body of personnel from nosocomial surgical infection, protect the patient from the threat of infection, and protect people who come into contact with medical staff outside the hospital from nosocomial infection. The main objects of personal hygiene for personnel in surgery are: body and head (hair should be clean, cut short, carefully hidden under a cap or headscarf). There should be no discharge from the nose, eyes, ears, in the mouth - carious teeth, ulcers, inflammation, on the skin - rashes, wounds, abrasions, purulent-inflammatory diseases, especially on the hands. Fingernails and toenails must be cut short and painting is not permitted.
Environmental hygiene.
The importance of maintaining the necessary hygienic regime in a surgical hospital cannot be overestimated. The main environmental objects include indoor air, furniture, plumbing, and honey. equipment. There are natural and artificial methods of air disinfection in the hospital. These include regular ventilation of premises, the use of air filters with forced ventilation, chemical and physical (radiation) disinfection of air. The air temperature in the room should be between 17-21 degrees (“comfort zone”). The degree of humidity is of great importance. The air temperature in the wards rises in the summer. In such cases, the practice is to frequently mop the floors with a wet method, cover open windows with damp sheets, and use general and table fans.
Patient hygiene.
The main object of clinical hygiene is the patient, who is unable to ensure the hygiene of his body with his own resources and means in the hospital. Activities for the hygiene of the patient’s body should be planned and regular. The main measures and requirements for the hygiene of the patient’s body: cleanliness and absence of the threat of damage to the skin and mucous membranes. Depending on the disease and condition of the patient, there is a general regime, strict bed, semi-bed and individual. Strict bed rest in the supine position should be observed by patients with profuse gastric bleeding after major operations on the abdominal organs. Active bed rest with turning on the side, bending the legs at the knee joints, raising the head is indicated for most patients in the first days after operations on the abdominal organs. The patient should get up after surgery in the presence of a sister and with her help. A nurse or nurse should also accompany the patient to the toilet.
Hygienic care for patients with bed rest.
Carried out by a nurse or a nurse under the guidance of a nurse.
Semi-bed rest is prescribed to persons whose acute abdominal pain has subsided, emergency assistance has not been provided to them and they are subject to observation. An individual regimen includes the concept of an exception to the rules of the general regimen (walking in the air, staying on the balcony, a bath or shower before bed, etc.). Skin care under the general regimen can be carried out by the patient himself. In all cases, the patient must wash his hands before and after eating, and after visiting the toilet. Frequent hand washing is an important principle of hospital hygiene. The patient washes in the shower or bath at least once every 7 days. The water temperature in the bathroom should not exceed 37-39.
The duration of stay in the bathroom is determined by the patient’s condition and averages 15-20 minutes. The patient should not be left alone while taking a bath, even if his condition is satisfactory. At the same time, underwear and bed linen are changed. For washing, the patient receives a clean washcloth. If soiled, linens are changed more often. After washing, the washcloth and bath should be disinfected. After each patient, the bathtub is washed with running water and disinfected with a 2% chloramine solution or a clarified 0.5% bleach solution. Hand brushes, washcloths, rubber or foam sponges are disinfected by boiling for 15 minutes, or soaking for 30 minutes in 0.5% detergent solution and 3% hydrogen peroxide solution. After this, washcloths and sponges are rinsed with running water and dry.
All patients in the department must wash their face in the morning, wash their ears, brush their teeth, and comb their hair. Before going to bed, the patient should also brush his teeth and rinse his mouth. Once a week, while taking a shower or bath, patients need to wash their hair. During long-term hospital stays, it is better for both men and women to cut their hair short. Each patient should have their own comb for combing hair. Fingernails and toenails are cut with scissors or bitten off with nail clippers, or filed with a nail file. In this case, it is necessary to protect the periungual ridges from injury and the formation of hangnails. Disinfection of scissors, cutters, files is carried out by boiling for 15 minutes or soaking in a “triple solution” for 45 minutes, followed by rinsing in running water. Men should shave their facial hair daily.
The razor is disinfected by boiling for 15 minutes. or soaking in a triple solution for 45 minutes, followed by rinsing with water.
Hygiene of seriously ill patients.
Hygienic care of the skin, eyes, ears, nasal cavity and mouth of a surgical patient in an extremely critical or unconscious state has its own characteristics and is very important. The success of treatment often depends on this. Maintaining healthy skin is an important part of treatment.
When lying for a long time, as a result of compression of the soft tissues covering the bony protrusions, a local circulatory disorder occurs, which can result in the formation of bedsores. Bedsores are necrosis of the skin and subcutaneous tissue with a tendency to spread deeper. They usually occur in the area of the sacrum, shoulder blades, greater trochanters, elbows, heels, and spinous processes. The first sign of bedsores is pallor or redness and swelling of the skin, followed by detachment of the epidermis and the appearance of blisters. Accompanying infection can lead to infection and death. Therefore, preventing bedsores in seriously ill patients is the key to successful treatment.
Elements of pressure ulcer prevention:
1). Changing the patient’s body position several times a day if his condition allows;
2). Daily shaking off crumbs from sheets, straightening wrinkles on bed linen and underwear;
3). Placing an inflatable rubber circle placed in a pillowcase under the sacrum and buttocks;
4). Daily wiping of the skin in places of bone protrusions with camphor alcohol, 40% alcohol solution, cologne, vinegar solution (1 tablespoon per 1 glass of water) or warm water, followed by wiping dry;
5). When hyperemia occurs, brushing to improve local blood flow;
6) Washing the skin during maceration with soap and water, drying and dusting with powder;
7). Carrying out hygienic and breathing exercises according to indications.

Fingernails and toenails should be regularly cut off with scissors or bitten with pliers as they grow, protecting the periungual ridges from damage and hangnails.
Hair, as already noted, must be washed once a week, combed and styled in a hairstyle or braid. In seriously ill patients, it is preferable to have short haircuts. In seriously ill patients, it is necessary to wash the eyes to remove secretions that stick together the eyelashes.
Skin care consists of daily washing of the face, neck and hands with soap, daily wiping of the entire body with warm water and drying with a dry towel. The entire body should be washed at least three times a week. Nails are washed in a basin, the interdigital spaces are thoroughly cleaned of dirt, and overgrown nails are cut. In obese patients, especially women, special attention should be paid to the prevention of dermatitis and diaper rash on the mammary glands, in the inguinal folds and in the perineal area. These areas must be washed daily with weak disinfectant solutions (potassium permanganate, boric acid), dried and powdered with talc or special powder. Women undergo hygienic washing daily at night and in the morning. To do this, you need to have an oilcloth, a vessel, a jug with warm water and a disinfectant solution (30-35 degrees), a forceps and sterile cotton balls. The nurses place an oilcloth under the patient’s pelvis, on top of which a bedpan is placed between the thighs. Patients lie on their backs, legs bent and slightly spread. A disinfectant solution is poured from a jug onto the external genitalia and a cotton ball on a forceps is used to make cleaning movements from the genitals to the anus. After this, the skin is wiped with a dry swab from top to bottom.
Hygiene of the patient's linen.
Pajamas, dressing gowns, colored underwear are soaked in a 0.2% solution of chloramine B (240 min), 0.2% solution of sulfachlorantine (60 min.), 1% solution of chlordesine (120 min.), 0.5% solution of dichloro-chlorine 1 (120 min), 0.05 dezoxon-1 solution (60 min.), followed by washing in the laundry. Underwear and bed linen are washed in the laundry with boiling water. Underwear and bed linen are changed at least once every 7 days (after hygienic washing). In addition, linen must be changed if soiled. When changing underwear and bed linen, it is carefully collected in bags made of thick cotton fabric or containers with a lid. It is strictly forbidden to throw used laundry on the floor or into open receptacles. Sorting and dismantling of dirty linen is carried out in a special dedicated room outside the department.
After changing linen, items in the room are wiped with a disinfectant solution.
Mattresses, pillows, blankets are disinfected in paraformalin chambers using the steam-formalin and steam-air methods. It is preferable to use sterile linen during surgery. Clean linen is stored in the closets of the housewife, guard sister and nurse. The department should have a supply of linen for a day. Depending on the patient's condition, there are different changes of bed linen. A walking patient can change the bed himself.

3.Preparing patients for emergency and planned surgery.

The preoperative period is the time from the moment the patient is admitted to the surgical hospital until the start of surgical treatment. At the stage of immediate preoperative preparation, healing measures are carried out in order to identify the underlying disease and a favorable phase for surgical intervention, heal other existing diseases and prepare vital systems and organs.
A set of healing measures carried out before surgery to transfer the underlying disease to a more favorable phase, healing concomitant diseases and preparing vital organs and systems for the prevention of postoperative complications is called preparing patients for surgery.
The main task of preoperative preparation is to reduce operational risk and create good prerequisites for a favorable outcome.
Preoperative preparation is carried out for all patients. To a minimum extent, it is carried out only for patients undergoing surgery on the basis of emergency and emergency certificates.
On the eve of a planned surgical operation, public preoperative preparation is carried out. Her target:
1. Eliminate contraindications to surgery by examining the patient’s vital organs and systems.
2. Preparation of the patient psychologically.
3. thoroughly prepare the patient’s body systems, on which the intervention will have the greatest load during the operation and in the postoperative period.
4. prepare the surgical field.
General inspection.
Every patient admitted to a surgical hospital for surgical treatment must be undressed and the skin of all parts of the body examined. In the presence of weeping eczema, pustular rashes, boils or new traces of these diseases, the operation is temporarily postponed and the patient is sent for outpatient follow-up treatment. The operation on such a patient is performed a month after complete healing, because infection can manifest itself at the site of surgery in a patient weakened by surgical trauma.
Anamnesis collection.
Collecting an anamnesis makes it possible to find out and clarify previous diseases, to determine whether the patient suffers from hemophilia, syphilis, etc. In women, it is necessary to clarify the date of the last menstruation, since it has a huge impact on the vital functions of the body.

Laboratory research.
Planned patients are admitted to a surgical hospital after a laboratory examination in a clinic at their place of residence. They carry out a general blood and urine test, a urine test for sugar, the biochemical composition of the blood and the necessary X-ray examinations of the chest and abdominal organs.
Clinical observation.
It is necessary for the patient to get to know the attending physician and to establish relationships between them. To completely eliminate contraindications for surgery, choose a method of pain relief and take measures to prevent the following complications, it is necessary for the patient to fully open up to the doctor. If special preparation of the patient for surgery is not required, then the preoperative period of the patient in the hospital is traditionally 1-2 days.
Psychological preparation of the patient.
Trauma to the psyche of surgical patients begins in the clinic, when the doctor advises surgical treatment, and continues in the hospital during the immediate appointment of the operation, preparation for it, etc. Therefore, a sensitive, attentive attitude towards the patient on the part of the attending physician and staff is absolutely essential. The authority of the doctor contributes to the establishment of close contact with the patient.
On the day of the operation, the surgeon is obliged to pay maximum attention to the patient, encourage him, ask about his health, examine how the surgical field is prepared, listen to the heart and lungs, examine the pharynx, and reassure him.
The surgeon is fully prepared to wait for the patient, and not the other way around. During an operation under local anesthesia, a conversation must take place between the surgeon and the patient. With his calmness and encouraging words, the surgeon has a beneficial effect on the patient’s psyche. Harsh remarks addressed to the patient are unacceptable.
After the operation is completed, the surgeon must examine the patient, feel the pulse and reassure him. In this the patient will take care of him.
Everything in the ward must be ready to receive the patient. The main thing here is the elimination of pain with the use of painkillers, the implementation of measures aimed at improving breathing and cardiovascular activity, which prevents a number of complications. The surgeon is obliged to visit the patient he operated on more than once.
In a conversation with a patient, a doctor is obliged to explain to him the essence of the disease. If a patient with a malignant tumor continues to doubt and stubbornly refuses surgical treatment, then it is permissible to say that his disease may turn into cancer after some time. Finally, if there is a categorical refusal, it is advisable to tell the patient that he has an early stage of the tumor and delaying the operation will lead to advanced disease and an unfavorable outcome. The patient must understand that in this situation, surgery is the only type of healing. In some cases, the surgeon is obliged to explain to the patient the true essence of the operation, its consequences and prognosis.

Preparation of the patient's vital organs for surgery.
Respiratory preparation
Respiratory organs account for up to 10% of postoperative complications. Therefore, the surgeon must pay special attention to the patient’s respiratory system.
In the presence of bronchitis and emphysema, the risk of complications increases several times. Acute bronchitis is a contraindication to elective surgery. Patients with chronic bronchitis are subject to preoperative sanitation: they are prescribed expectorants and physiotherapeutic procedures.
Preparing the cardiovascular system.
With normal heart sounds and no changes in the electrocardiogram, special preparation is not required.
Preparation of the oral cavity.
In all cases, before surgery, patients require sanitation of the oral cavity with the assistance of a dentist.
Preparation of the gastrointestinal tract.
Before a planned operation on the abdominal organs, the patient is given a cleansing enema the evening before the operation. When preparing patients for surgery on the large intestine, it must be cleaned. In these options, 2 days before the operation, a laxative is given 1-2 times, the day before the operation the patient takes liquid food and is prescribed 2 enemas, in addition, another enema is given in the morning on the day of the operation.
Preparing the liver.
Before the operation, liver functions such as protein synthesis, bilirubin secretion, urea formation, enzymatic function, etc. are examined.
Determination of kidney function.
During the preparation of patients for surgery and in the postoperative period, the condition of the kidneys is traditionally assessed by urine tests, functional tests, isotope renography, etc.
Direct preparation of patients for surgery and rules for its implementation.
On the eve of the operation, the patient takes a bath. Before washing, the doctor pays attention to the skin, looking for pustules, rashes, and diaper rash. If detected, the planned operation is cancelled. The surgical site is shaved on the day of surgery to avoid cuts and scrapes that are prone to infection.
In accordance with the type of anesthesia, premedication is given 45 minutes before surgery as prescribed by the anesthesiologist. Before transporting the patient to the operating room, the patient is transported on a gurney. The operation is performed in the strictest silence. The conversation can be about the operation.
Preparing the patient for emergency surgery.
The patient is prepared for surgery as soon as possible. As directed by the doctor, if necessary, an urgent blood test, urine test and some other studies are performed. Carry out sanitary treatment (washing or wiping) of contaminated areas of the body. A hygienic bath and shower are contraindicated. Sometimes, as directed by a doctor, the stomach is emptied through a tube. The skin in the area of the surgical field is shaved dry without soaping.
Method of preparing a wound for surgery. In case of injury, the surgical field is treated as follows: remove the bandage, cover the wound with a sterile napkin, shave the hair around the wound dry, treat the skin around the wound with medical gasoline and then with alcohol. Treatment and shaving are carried out in the direction from the edges of the wound (without touching it) to the periphery. Lubricate the surgical field with an alcohol solution of iodine twice: first after mechanical cleaning of the skin, and then again immediately before the operation.
Patients with acute appendicitis, strangulated hernia, intestinal obstruction, perforated gastric ulcer, ectopic pregnancy, as well as penetrating wounds of the chest, abdomen and some other injuries require emergency operations.

4. List of references.

Preface…………………………………………………………………………………4

Introduction………………………………………………………………………………………..5

Chapter 1. General care for sick children………………………………………..6

Chapter 2. Procedures and manipulations of a nurse ……………………20 Chapter 3. Skills of a surgical nurse………………39 Chapter 4. First aid in emergency conditions …………………... 55

Appendix…………………………………………………………………………………...65

References……………………………………………………………...67

PREFACE

The practical training of students is the most important element in the training of a pediatrician; in the structure of the educational program of higher medical educational institutions, much attention is paid to this section of training.

The purpose of this teaching aid is to prepare 2nd and 3rd year students of the Faculty of Pediatrics for practical training.

The objectives of the educational manual are to improve students’ theoretical knowledge, provide information on the correct and high-quality performance of functional duties of junior and nursing staff, ensure the development of practical skills in caring for sick children, performing nursing manipulations and procedures, providing emergency first aid, filling out medical documentation .

The content of practical training of a specialist, set out in the manual, corresponds to the state educational standard of higher professional education in specialty 040200 “Pediatrics”, approved by the Ministry of Education of the Russian Federation on March 10, 2000, materials of the final state certification of graduates of medical and pharmaceutical universities in specialty 040200 “Pediatrics”, approved by the Ministry of Health of the Russian Federation (2000).

The need to publish this educational and methodological manual is due to the development at NSMA of a new end-to-end practical training program for students of the pediatric faculty with a list of skills necessary for mastering during the internship period. The peculiarity of this publication is the generalization and systematization of modern literary material, a clear presentation of the content of all practical skills in accordance with the approved program. No such publications have been previously published by NGMA.

The manual outlines the content of practical skills and abilities during practical training as an assistant to a ward and procedural nurse of a therapeutic and surgical profile, an emergency medical assistant, and indicates measures to provide first-aid care for the most common emergency conditions in children. The proposed manual is intended for self-training of students when studying the discipline “General child care” and undergoing practical training.

INTRODUCTION

This educational manual consists of 4 chapters.

The first chapter is devoted to the general care of a sick child as an essential part of the treatment process. The importance of care can hardly be overestimated; the success of treatment and the prognosis of the disease are often determined by the quality of care. Caring for a sick child is a system of activities, including the creation of optimal conditions for staying in a hospital, providing assistance in meeting various needs, correct and timely implementation of various medical prescriptions, preparation for special research methods, carrying out some diagnostic procedures, monitoring the child’s condition, providing care to the patient. first aid.

The decisive role in providing proper care is given to junior and nursing staff. The junior nurse cleans the premises, daily toilets and sanitizes sick children, assists in feeding the seriously ill and taking care of natural needs, monitors the timely change of linen and the cleanliness of care items. A representative of the mid-level medical level - a nurse, being a doctor's assistant, accurately carries out all assignments for examination, treatment and monitoring of a sick child, and maintains the necessary medical documentation. The chapters “Procedures and Manipulations of a Nurse” and “Skills of a Surgical Nurse” include information about various methods of using medications, collecting material for research, methods of conducting therapeutic and diagnostic manipulations and procedures, and rules for maintaining medical records. Some aspects of caring for surgical patients are covered.

The effectiveness of a complex of therapeutic effects depends not only on the proper organization of care and professional training of medical workers; it is also important to create a favorable psychological environment in the medical institution. Establishing friendly, trusting relationships, showing sensitivity, care, attention, mercy, polite and affectionate treatment of children, organizing games, walking in the fresh air have a positive impact on the outcome of the disease.

In emergency situations, a medical worker must be able to provide first aid correctly and in a timely manner. The chapter “First aid in emergency conditions” outlines emergency measures, the implementation of which in full, in the earliest possible time and at a high professional level is a decisive factor for saving the lives of injured and sick children.

At the end of each chapter there are control questions for students to independently test their knowledge of theoretical material.

The application contains a list of practical skills and abilities of 2nd and 3rd year students of the Faculty of Pediatrics during practical training.

Chapter 1. GENERAL CARE FOR SICK CHILDREN

Carrying out sanitary treatment of patients

Sanitary treatment of sick children is carried out in the emergency department of a children's hospital. Upon admission to the hospital, if necessary, patients take a hygienic bath or shower (for more details, see “Hygienic and therapeutic baths”). If pediculosis is detected, a special disinsection treatment of the child and, if necessary, underwear is performed. The scalp is treated with insecticidal solutions, shampoos and lotions (20% benzyl benzoate suspension, Pedilin, Nix, Nittifor, Itaks, Anti-bit, Para-plus, Bubil, Reed ", "Spray-pax", "Elko-insect", "Grincid", "Sana", "Chubchik", etc.). To remove nits, individual strands of hair are treated with a solution of table vinegar, the head is tied with a scarf for 15-20 minutes, then the hair is thoroughly combed with a fine comb and the hair is washed. If scabies is detected in a child, clothing and bedding are disinfested, the skin is treated with a 10-20% benzyl benzoate suspension, sulfur ointment, Spregal, Yurax aerosol.

Main literature:

1. Dronov A.F. General care for children with surgical diseases [Text]: textbook. allowance / A.F. Dronov. -2nd ed., revised. and additional -Moscow: Alliance, 2013. -219 p.

2. Caring for a healthy and sick child [Text]: textbook. allowance / [E. I. Aleshina [etc.]; edited by V. V. Yuryeva, N. N. Voronovich. - St. Petersburg: SpetsLit, 2009. - 190, p.

3. Gulin A.V. Basic algorithms for pediatric resuscitation [Text]: textbook. manual for students studying in the specialty 060103 65 - Pediatrics / A. V. Gulin, M. P. Razin, I. A. Turabov; Ministry of Health and Social Services development of Russia Federation, Northern state honey. University, Kirov. state honey. acad.. -Arkhangelsk: Publishing house of SSMU, 2012. -119 p.

4. Pediatric surgery [Text]: textbook. for universities / edited by Yu. F. Isakov, A. Yu. Razumovsky. - Moscow: GEOTAR-Media, 2014. - 1036 p.

5. Kudryavtsev V.A. Pediatric surgery in lectures [Text]: textbook for honey. universities / V. A. Kudryavtsev; North state honey. univ. -2nd ed., revised. - Arkhangelsk: IC SSMU, 2007. -467 p.

Additional literature:

1. Petrov S.V. General surgery [Text]: textbook. for universities with CD: textbook. allowance for medical universities/ S.V. Petrov. -3rd ed., revised. and additional -Moscow: GEOTAR-Media, 2005. -767 p.

2. Surgical diseases of childhood [Text]: textbook. for medical students universities: in 2 volumes / Ed. A.F. Isakov, rep. ed. A.F. Dronov. - Moscow: GEOTAR-MED, 2004.

3. Pediatric surgery [Electronic resource]: textbook / ed. Yu. F. Isakov, A. Yu. Razumovsky. - M.: GEOTAR-Media, 2014. - 1040 p. : ill. - Access mode: http://www.studmedlib.ru/.

4. Drozdov, A. A. Pediatric surgery [Text]: lecture notes / A. A. Drozdov, M. V. Drozdova. - Moscow: EKSMO, 2007. - 158, p.

5. Practical guide to outpatient orthopedics in children [Text] / [O. Yu. Vasilyeva [and others]; edited by V. M. Krestyashina. - Moscow: Med. information agency, 2013. - 226, p.

6. Makarov A.I. Features of examination of a child to identify surgical and orthopedic pathology [Text]: method. recommendations / A.I. Makarov, V.A. Kudryavtsev; North state honey. univ. - Arkhangelsk: Publishing house. center SSMU, 2006. - 45, p.

Electronic publications, digital educational resources

I. Electronic version: Surgical diseases in children: Textbook/" Edited by Yu.F. Isakov. - 1998.

II. EBS “Student Consultant” http://www.studmedlib.ru/

III. EBS Iprbooks http://www.iprbookshop.ru/

AGREED" "APPROVED"

Head Department of Pediatric Surgery, Dean of the Faculty of Pediatrics,

Doctor of Medical Sciences Turabov I.A. Doctor of Medical Sciences_Turabov I.A.

WORKING CURRICULUM
Elective course

By discipline _ Pediatric surgery

In the area of training__ Pediatrics _____063103______________

Course ____6_______________________________________________

Practical lessons - 56 hours

Independent work -176 hours

Type of intermediate certification ( test)_ __11th semester

Department of _Pediatric Surgery________

The labor intensity of the discipline is _232 hours

Arkhangelsk, 2014

1. Purpose and objectives of mastering the discipline

The specialty was approved by order of the Ministry of Education of the Russian Federation (order of the State Committee for Higher Education of the Russian Federation dated March 5, 1994 No. 180). Graduate qualification - Doctor. The object of professional activity of graduates is the patient. A doctor who is a graduate of the specialty “060103 Pediatrics” has the right to perform therapeutic and preventive activities. He has the right to occupy medical positions not related to the direct management of patients: research and laboratory activities in theoretical and fundamental areas of medicine.

The area of professional activity of specialists includes a set of technologies, means, methods and methods of human activity aimed at preserving and improving the health of the population by ensuring the appropriate quality of pediatric care (therapeutic and preventive, medical and social) and dispensary observation.

The objects of professional activity of specialists are:

children aged 0 to 15 years;

teenagers aged 15 to 18 years;

a set of tools and technologies aimed at creating conditions for maintaining health, ensuring the prevention, diagnosis and treatment of diseases in children and adolescents.

Specialist in the field of training (specialty) 060103 Pediatrics prepares for the following types of professional activities:

preventive;

diagnostic;

medicinal;

rehabilitation;

psychological and pedagogical;

organizational and managerial;

scientific research.

I. Goals and objectives of the discipline

The purpose of teaching the elective in pediatric surgery at the Faculty of Pediatrics: deepening students' theoretical and practical knowledge and skills on semiotics, clinical practice, diagnostics, differential diagnosis, treatment tactics and emergency care for developmental defects, surgical diseases, traumatic injuries, tumors, critical conditions in children of various age groups.

Objectives of studying an elective course in pediatric surgery at the Faculty of Pediatrics are to develop students’ skills:

Examine children with various surgical pathologies;

Diagnose developmental defects, surgical diseases, traumatic injuries, tumors, critical conditions in children;

Provide emergency assistance to them;

Resolve questions about the tactics of further treatment and observation;

Solve issues of preventing the occurrence of surgical pathology and its complications in children.
2. The place of discipline in the structure of the educational program

The program is compiled in accordance with the requirements of the State Educational Standard for Higher Professional Education in the field of training Pediatrics, studied in the eleventh semester.

The elective “Selected Issues in Pediatric Surgery” refers to an elective discipline

The basic knowledge necessary to study the discipline is formed by:

- in the cycle of humanitarianand socio-economicdisciplines(philosophy, bioethics; psychology, pedagogy; jurisprudence, history of medicine; Latin language; foreign language);

- in the cycle of mathematical, natural science, medical and biological disciplines(physics and mathematics; medical informatics; chemistry; biology; biochemistry, human anatomy, topographic anatomy; histology, embryology, cytology, histology; normal physiology; pathological anatomy, pathophysiology; microbiology, virology; immunology, clinical immunology; pharmacology);

- in the cycle of medical, professional and clinical disciplines(medical rehabilitation; hygiene; public health, healthcare, healthcare economics; operative surgery and topographic anatomy, radiation diagnostics and therapy, general, faculty and hospital surgery, traumatology and orthopedics, anesthesiology and resuscitation, pediatrics).

3. Requirements for the level of mastery of the discipline content

As a result of mastering the discipline, the student must:
Know:
1. Etiopathogenesis of surgical diseases, developmental defects, traumatic injuries and critical conditions in children of various age groups.

2. The clinical picture of the listed pathological conditions and its features depending on the age of the children.

3. Diagnostics (clinical, laboratory, instrumental) and differential diagnostics.

4. Surgical tactics of the pediatrician, rational terms of treatment.

5. Methods and techniques for feeding healthy and sick young children

6. Methodology for examining patients with certain pathologies

7 Features of emergency care and intensive care for surgical diseases and critical conditions in children of various age groups.

8. Clinical observation and medical rehabilitation for the diseases being studied.

Be able to:

1. Collect an anamnesis of the child’s life and illness.

2. Conduct a physical examination of children of various age groups.

3. Be able to carry out psychological and verbal contact with healthy and sick children.

4. Make a plan for a clinical examination.

5. Interpret data from clinical, laboratory, and instrumental examination methods.

6. Make a preliminary diagnosis and determine treatment tactics.

7. Determine the ward mode, treatment table, optimal dosage regimen, frequency and duration of drug administration for the pathology being studied.

8. Provide emergency care for surgical diseases and critical conditions in children of various age groups.

9. Provide resuscitation assistance at the prehospital and hospital stages.

10.Plan individual dispensary observation and medical rehabilitation for sick children;

11. Work independently with information (educational, scientific, normative reference literature and other sources);
Own(in accordance with the objectives of the discipline in the field of developing practical skills):

1. a professional algorithm for solving practical problems of diagnosis, differential diagnosis, treatment and prevention of acute and chronic diseases in children of different age and gender groups;

2. medical ethics and deontology;

3. skills to properly build your relationship with the parents of a sick child;

4. questioning technique (complaints, medical history, life history);

5. clinical research methods (examination, palpation, percussion and auscultation of the lungs and heart);

6. skills in assessing the results of instrumental research methods;

7. skills in assessing the results of clinical laboratory and microbiological examination of sputum, peripheral blood, gastric contents, bile, urine, feces;

8. prepare and evaluate the results of x-ray examination of the respiratory system, cardiovascular system, gastrointestinal tract, kidneys and urinary tract;

9. evaluate the results of biochemical studies of peripheral blood, urine, bile;

10. master the principles and techniques of emergency care and intensive care for various diseases in children.

4. Scope of discipline and types of academic work:

4.1Semester and type of reporting for the elective.

Semester	Reporting type
11	Test

p/p

Section Contents

1

2

3

1.

Surgical neonatology (NEC, abdominal cysts, gastrostomy) (KPZ lecture)

Surgical neonatology (anorectal anomalies, diaphragmatic hernias) lecture KPZ)

2.

Minimally invasive ultrasound-guided operations in children (KPZ lecture)

Echography of the hollow organs of the gastrointestinal tract in children (KPZ lecture)

3.

Pediatric urology-andrology

Urinary disorders in children (KPZ lecture)

4.

Pediatric oncology

Bone sarcomas in children (KPZ lecture)

Germ cell tumors (KPP lecture)

5.

Intensive care of the perioperative period (KPP lecture)

5.2. Sections of disciplines and types of classes

№ p/p	Name of the discipline section	Lectures (labor intensity)	Practical lessons
1	2	3	7
1.	Emergency neonatal surgery	4	10
2.	Ultrasound in the diagnosis and treatment of surgical diseases in children	4	10
3.	Pediatric urology-andrology	2	5
4.	Pediatric oncology	4	10
5.	Borderline issues of pediatric surgery and anesthesiology-reanimation	2	5
		16	40

5.3. Thematic planning

№ p/p	Name of the discipline section	lectures	Practical lessons
1	2		3
1.	Emergency neonatal surgery	Surgical neonatology (NEC, abdominal cysts, gastrostomy) Surgical neonatology (anorectal anomalies, diaphragmatic hernia)	1. Surgical neonatology (NEC, abdominal cysts, gastrostomy) 2. Surgical neonatology (anorectal anomalies, diaphragmatic hernia)
2.	Ultrasound in the diagnosis and treatment of surgical diseases in children	Minimally invasive ultrasound-guided surgeries in children Echography of the hollow organs of the gastrointestinal tract in children	1.Minimally invasive ultrasound-guided operations in children 2.Echography of the hollow organs of the gastrointestinal tract in children
3.	Pediatric urology-andrology	Urinary problems in children	1.Difficulty urinating in children
4.	Pediatric oncology	Bone sarcomas in children Germ cell tumors	1. Bone sarcomas in children 2.Germ cell tumors
5.	Borderline issues of pediatric surgery and anesthesiology-reanimation	Intensive care of the perioperative period	1. Intensive care of the perioperative period

7. Extracurricular independent work of students

№ p/p	Name of the discipline section		Types of independent work	Forms of control
1.		Emergency neonatal surgery

						Oral (speech presentation)
2.	Ultrasound in the diagnosis and treatment of surgical diseases in children				Preparation of a report on the topic of the lesson in the form of a presentation	Oral (speech presentation)
				Oral (speech presentation)
3	Pediatric urology-andrology		Analysis of a clinical case in the form of a presentation	Oral (speech presentation)
4.	Pediatric oncology		Preparation of a report on the topic of the lesson in the form of a presentation	Oral (speech presentation)
			Analysis of a clinical case in the form of a presentation	Oral (speech presentation)

5	Borderline issues of pediatric surgery and anesthesiology-reanimation		Analysis of a clinical case in the form of a presentation	Oral (speech presentation)

8.Forms of control

8.1. Forms of current control

Oral (interview, report)

Written (checking tests, essays, notes, solving problems).

The list of topics for essays, reports, collections of tests and situational problems is given in section 4 of the Educational and Methodological Complex of the discipline “C

8.2. Forms of intermediate certification (test)

Stages of the test

Semester	Interim certification forms
11	test

Questions for testing are given in section 4 of the educational and methodological complex of the discipline “Tools for assessing competencies”.
9. Educational and methodological support of the discipline

9.1. Main literature

1. Outpatient surgery of children: textbook / V.V. Levanovich, N.G. Zhila., I.A. Commissioners. – M.- GZOTAR-Media, 2014 – 144 p.: ill.

2. Pediatric surgery: textbook / edited by Yu.F. Isakova, A.Yu. Razumovsky. – M.: GZOTAR-Media, 2014.– 1040 pp.: ill.

3. Pediatric surgery: national hands/Association of medical quality organizations: edited by Yu.F. Isakova, A.F. Dronova - M.: GEOTAR - Media. 2009 – 1164 pp. (24 copies) 4. Isakov Yu.F. Surgical diseases of childhood: studies in 2 t – M.: GEOTAR – MED. 2008 – 632 p.

5. Kudryavtsev V.A. Pediatric surgery in lectures. Studies for medical universities, SSMU - Arkhangelsk: IC SSMU. 2007 – 467 p.

4. Anesthesiology and resuscitation: a textbook for students of medical universities / ed. O.A. Dolina – M.: GEOTAR-Media, 2007. – 569 p.

9.2. additional literature

1. Pediatric oncology. National leadership / Ed. M.D. Alieva V.G. Polyakova, G.L. Mentkevich, S.A. Mayakova. – M.: Publishing group RONC, Practical Medicine, 2012. – 684 p.: ill.

Durnov L.A., Goldobenko G.V. Pediatric oncology: Textbook. – 2nd ed. reworked and additional – M.: Medicine. 2009.
Podkamenev V.V. Surgical diseases of childhood: a textbook for medical universities - M.: Medicine. 2005. – 236 p. 3..F.Shir.M.Yu.Yanitskaya (Scientific editing and preparation of text in Russian) Laparoscopy in children. Arkhangelsk, Publishing center of SSMU, 2008.

4. Shiryaev N.D., Kagantsov I.M. Essays on reconstructive surgery of the external genitalia in children Part 1, Part 2. Monograph. – Syktyvkar, 2012. – 96 p.

5. Oncological and tumor-like diseases of childhood: a textbook for students of medical universities/ I.A. Turabov, M.P. Razin. - Arkhangelsk; From the Northern State Medical University, 2013. – 105 p.: ill.

6. Ultrasound examination of the hollow organs of the gastrointestinal tract in surgical pathology in children. Hydroechocolonography: monograph / M.Yu. Yanitskaya, I.A. Kudryavtsev, V.G. Sapozhnikov et al. – Arkhangelsk: Publishing house of the Northern State Medical University, 2013. – 128 p.: ill.

7. Hydroechocolography - diagnosis and treatment of colon diseases in children, methodological recommendations / M.Yu. Yanitskaya. - Arkhangelsk; From the Northern State Medical University, 2013. – 83 p.: ill.
9.3. Software and Internet resources

Department of Surgical Diseases of Children Presentation on the topic: “General care for children in the surgical department. Features of observation and care of patients after surgical interventions. Functional responsibilities of junior medical staff."

Slide 2

General care for children in the surgical department

In caring for children in the surgical department, their preoperative preparation, surgery and caring for children after it are important. Care also includes creating comfort for the patient, a favorable microclimate (a bright room, fresh air, a comfortable and clean bed, the necessary minimum of household items, in addition, drawings and paintings on stacks, a playroom), conditions for school activities. When caring for children, it is necessary : Strictly monitor compliance with the diet and natural bowel movements; Monitor the amount of fluid in and out (overhydration) or dehydration (dehydration); Monitor daily urine output (diuresis), which is one of the most important criteria for assessing the patient’s condition; Strictly monitor the temperature of the intravenously administered fluid and, if necessary, warm it up. The amount of care depends on the age and condition of the patient, the nature of the disease, and the regimen prescribed to him.

Slide 3

Monitoring patients after surgery

Observation of a postoperative patient includes: Assessment of appearance (facial expression, position in bed. Color of integument); Body temperature measurement; Pulse control; Blood pressure control; Breathing rate control; Control of the functioning of the excretory organs (bladder, intestines); Monitoring the bandage in the area of the postoperative wound; Monitoring the operation of drains with a note in the medical history; Attention to the patient’s complaints (timely pain relief); Control of drip infusions (in peripheral and central veins); Control of laboratory parameters.

Slide 4

Features of patient care after surgery:

Patient care is helping a patient in his frail state, the most important element of clinical and medical activity. In a surgical hospital, patient care is an extremely important element of surgical activity, which has a serious impact on the outcome of treatment. Care in the postoperative period is aimed at restoring the patient’s physiological functions, normal healing of the surgical wound, and preventing possible complications.

Slide 5

When caring for postoperative patients, it is necessary to: Monitor the condition of the bandage (sticker), do not let it slip off and expose the postoperative suture; If drainage tubes are installed, it is necessary to monitor the nature and amount of discharge through them, the tightness of the drainage system, etc.; Observe any change in the condition of the patient’s surgical field (swelling, redness of the skin in the wound area, increased body temperature, etc. indicate the beginning of suppuration of the wound); Monitor the function of the patient’s respiratory organs, if necessary, teach the postoperative patient to breathe deeply, cough and ensure that he lies in bed with his torso elevated; Take timely measures to detoxify the patient’s body (drinking plenty of fluids, oxygen therapy, ensuring the outflow of decay, etc.); Take the most active measures to eliminate physical inactivity, using a variety of methods of active and passive movements of the patient - physical therapy, massage, devices that help the patient sit down, etc.; Maintain patient hygiene.

Slide 6

Physical rehabilitation of patients after surgery Observation of a patient after surgery

Slide 7

Functional responsibilities of 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 the nurses. Nurses: the range of their responsibilities is determined by their category (ward nurse, barmaid, nurse, cleaner, etc.).

Slide 8

The general responsibilities of junior medical staff are as follows: 1. Regular wet cleaning of premises: wards, corridors, common areas, etc. 2. Assisting nurses 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. 3. Sanitary and hygienic treatment of patients. 4. Accompanying patients for diagnostic and treatment procedures. 5. Transportation of patients.

View all slides

Available in formats: EPUB | PDF | FB2

Pages: 224

The year of publishing: 2012

Language: Russian

The manual discusses the features of caring for children with surgical diseases in a hospital. The structure and organization of work of the children's surgical clinic, equipment and equipment of various departments are reflected. To reinforce the material and self-test, test questions are given at the end of each chapter.

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