Manual and Diary

MANUAL AND DIARY

of on-the-job practical training as assistant to a ward nurse, treatment room nurse and dressing room nurse

for 2nd year General Medicine students

(in surgery)

VOLGOGRAD STATE MEDICAL UNIVERSITY

A.A.POLYANTSEV GENERAL SURGERY DEPARTMENT

MANUAL AND DIARY

of on-the-job practical training as assistant to a ward nurse, treatment room nurse and dressing room nurse

for 2nd year General Medicine students

(in surgery)

Compiled by:

A.A.Polyantsev,

Head of General Surgery Department

of Volgograd State Medical University

P.V.Mozgovoy, Assistant Professor

O.Y.Bosko, Associate Professor

V.A.Ievlev, Assistant Professor

Volgograd, 2009

GOALS OF ON-THE-JOB PRACTICAL TRAINING

Familiarising the students with the work of a patient care institution.
Learning the care of patients.
Learning nursing manipulations and some doctor’s manipulations.
Learning to observe the rules of deontology and ethics.

OBJECTIVES OF THE PRACTICAL TRAINING

The basic rules and methods of patient care in various diseases.
technique of nursing procedures
technique of basic doctor’s manipulations

FORMAT OF THE PRACTICAL TRAINING

On-the-job practical training of second-year students as nurse’s assistant takes place in extracurricular time, amounting to 72 hours. The students work 4 hours weekly. The practical training is supervised by the General surgery department of VolSMU. The immediate supervisors are head nurses of surgical departments.

The students keep diaries where they enter the description of work done on that day. The nurse supervising the student’s work certifies it with her signature.

To account for the practical training the student should submit the diary and a report. The supervising teacher talks with the student on the range of problems given in the appendix and gives the student his mark for the practical training.

THE CONTENT OF WORK IN SURGICAL AND RESUSCITATION DEPARTMENTS

During his on-the-job practical training each student should familiarize himself with the work of patient care institution, acquire practical skills of nursing surgical patients and giving first aid, and to learn the sanitary standards of surgical service.

I. ADMISSION OF PATIENTS AT THE ADMISSION ROOM OF A SURGICAL IN-PATIENT DEPARTMENT

The admission room of a hospital is intended for admission, registration, examination and cleansing of patients. It consists of 9 subdivisions:

Waiting-room
Office of the nurse on duty
Surgery and dressing room
Examination rooms
Treatment room
Sanitary inspection room
Clinical laboratory
Personnel office
Pre-hospitalisation ward.

The duties of the nurse include: accompanying the patient to the office, doing the registration paperwork, examination and cleansing of the patient, transportation to a hospital department. The nurse explains to the scheduled patients what they can take to the ward: toilet articles, slippers, a gown. Personal things of admitted patients are listed in an inventory, 2 copies of which are made. One copy is kept with the patient’s belongings; the other is handed to the patient. The clothes are put on hangers and transferred to the storage room.

The patients are admitted by the head of admission department of by the doctor on duty.

The patient is examined in the examination room on a couch covered with an oilcloth and sheet or disposable diaper. After each patient the oilcloth should be wiped with 1% chloramine solution. The patient’s skin integument and fauces are examined, body temperature should e taken. The used spatulas are washed in running water and boiled for 15 minutes. Thermometers are kept submerged in 0.5% chloramine solution. While examining the patient in the admission room attention should be paid to any skin diseases if present. A hospital stamp with the date and the nurse’s signature is put to the patient’s case history.

After the examination room the patient is taken to the bathroom. The average duration of a warm hygienic bath is 20-30 minutes, water t0 – 35-360C. If the bath is contraindicated in the patient’s condition, he takes a shower. If the patient’s condition is serious, the junior nurse wipes his body with a towel sponged in alcohol.

Then the patient is taken to a hospital department: he walks there or is transported in a wheel chair or on a stretcher.

Admission department includes a minor surgery room to give surgical aid. To disinfect the air a bactericidal lamp is used. The surgery is cleaned twice a day with a detergent and hydrogen peroxide.

The patient signs a form stating that he was familiarized with the regulations of an in-patient department and binds himself to observe them.

The head of the department and head nurse checks the compliance with sanitation requirements at he change of shift and during the day.

II. CARE OF PATIENTS IN A SURGICAL DEPARTMENT

Learning the basic duties and work conditions of junior and senior medical personnel.
Familiarising the students with the basics of medical psychology, ethics and deontology.
Learning the general rules of nursing and differentiated care in a surgical clinic.
Teaching medical procedures and manipulations to students.

The duties of the ward nurse include: doing doctor’s round together with the attending doctor, observing the patient’s condition, thermometry, control of dressings in operated patients, distribution of drugs, giving injections, preparing patients for surgery or investigation, sending blood and other samples for tests, control of test results, keeping medical records, ordering and collecting drugs from the pharmacy, care of bedridden and grave patients together with junior personnel, control of compliance with sanitary requirements.

The students should learn the design of wards, hospital furniture (beds, bedside tables, chairs), care of grave and bedridden patients: care of the skin, washing the feet and head, care of the oral cavity.

Students learn to give enemas, learn the types of enemas, the mechanism of their action, technique of administering.

Students learn the technique of gastric intubation, indications; they prepare patients for radiographic and endoscopic examination.

Students give subcutaneous and intramuscular injections.

III. DRESSING ROOM. CARE OF PATIENTS DURING DRESSING

Dressing is the process of removing the dressing, therapeutic manipulations in the wound, application of a new dressing.

Indications for dressing: if the dressing has shifted, soiled, or got wet, a need for therapeutic intervention.

The main objective of work in the dressing room: prevention of infection in the wound.

During the practical training students should note that patients are divided into “clean” and “purulent” cases with separate dressing rooms for each category.

Students should transport patients into the dressing room in wheel chairs, on stretchers; help walking patients. Note should be made of careful handling with patients, especially upon transporting grave bedridden patients to the dressing room. Students should learn the technique of relaying patients and changing beds. While in the dressing room students should stringently observe the requirements of aseptics and antiseptics.

Students take part in the dressing, learning the technique of instrumental dressing.

After the dressing the patient has to be taken back to the ward. During the dressing students assist in undressing the patient learning to do it painlessly.

In the clean dressing room students take part in surgical manipulations: taking out stitches, abdominal paracentesis, pleuracentesis, puncture of large joints.

Between dressings students should prepare instruments for sterilization, treat them after sterilization, disinfect the dressing table, take part in routine cleaning of the dressing room.

IV. TREATMENT ROOM. CARE OF PATIENTS

Students should familiarize themselves with the equipment of the treatment room, learn the methods of instrument sterilization, paracentesis of peripheral veins, storage of sterile instruments, drugs and blood samples.

Students will familiarize themselves with the structure and different types of syringes and needles used in the treatment room; they learn to determine if the needles are usable, how to care for them and store them.

Special attention is paid to sterilization of syringes and needles, careful observation of instructions.

Students familiarize themselves with intramuscular, intravenous, subcutaneous injections, with duodenal and gastric tubes. They take part in duodenal intubation, learn the technique of introducing duodenal and gastric tube for taking gastric juice or gastric lavage.

V. CARE OF PATIENTS IN RESUSCITATION DEPARTMENT

In the resuscitation department students familiarize themselves with the equipment of intensive care unit, learn the indications for resuscitation procedures, note the course of postoperative period, learn to characterize the pulse, respiration, to take BP.

In early postoperative period the patient’s respiration should be watched, especially in weak patients after anesthesia as respiratory failure can develop or airways can be blocked (by the tongue or emetic masses).

Students should learn to give first aid upon loss of consciousness, acute mental disturbances, acute hemorrhage, acute respiratory disorder, vomiting, regurgitation and aspiration of gastric contents, collapse, terminal conditions.

After surgery you should stay with the patient until he wakes completely if he was anesthetized, monitor his respiration, pulse, arterial pressure, prevent the arrival of gastric contents into the esophagus and mouth. Learn to prevent and treat hiccups, vomiting, belching. Upon doctor’s instruction you will intubate the stomach, introduce the flatus tube into the rectum.

Students learn the technique of oxygen inhalation, respiratory exercises.

Students monitor the condition of the tube, care for it, monitor the urine flow. Upon doctor’s instruction the bladder is catheterized.

VI. SURGERY UNIT

In the surgery unit students will familiarize themselves with:

-sterilization of materials, gloves and instruments

-scrubbing

-work of operation theatre taking part in surgery as assistant to scrub nurse.

THEMES FOR REPORTS

Specifics of patient care in postoperative period.
Specifics of patients with abdominal surgery
Specifics of patients with thoracic surgery
Specifics of patients with urinary surgery
Specifics of patients with surgery of magistral vessels of extremities
Specifics of care for trauma patients
Cleansing enema (indications, technique of administration, possible complications and their prevention).
Siphon enema. (Indications, technique of administration, possible complications and their prevention).
Postoperative paresis of the intestine. Its prevention and treatment.
Respiratory arrest. Ways of its prevention, first aid.
Cardiac arrest, first aid.
Medical deontology and doctor’s ethics.
Medical secrecy. Ethical and legal aspects of medical secrecy.
Deontology in surgery.
Cupping glasses, mustard plaster, contraindications. Complications and their prevention.
Gastric intubation. Indications and contraindications. Complications and their prevention.
Prevention of hospital infection.
Personal hygiene as foundation of health.
Hardening the body with cold water as a way of preventing inflammatory diseases.
Ways of preventing the spread of AIDS.
The use of antibacterial medium in surgical practice.
Oxygen therapy. Its use in surgical practice.
The layout and regulations of medical care institutions.
Daily routine and nutrition of inpatients.
Ways of affecting blood circulation.
First aid in terminal conditions.
Defibrillation (indications, technique of administration).
Tracheostomy (indications, technique of administration, complications).

QUESTIONS FOR A CONCLUDING TALK

The notion of clinical hygiene.
Basic components of nursing care in surgery.
The notion of general and differentiated care.
The basics of medical personnel’s hygiene.
The specifics of care for surgical patients.
First aid upon contact of disinfectants with the skin, mouth, nasopharynx, eyes or stomach.
The main objectives of admission department at a surgical clinic.
Sanitary cleansing of a patient in the admission department.
Hygienic preparation of a patient for urgent surgery.
Disinfection of bathtubs, sponges, scissors.
Hygiene of air at a surgical inpatient department.
Prevention of hospital infection at a surgical inpatient department.
Temperature, ventilation and disinfection of air at a surgical department, dressing room and operation theatre.
Nutrition of bedridden patients, enteral feeding, feeding through a gastrostoma.
Sterilisation of air in the operation theatre.
Putting the patient onto the operation table, taking him off it, transportation to the department.
Zones of the surgery unit, their difference, the “rule of the red line”.
The therapeutic and conservative regimen at the department.
Preparation of a patient for surgery.
The notion of regimen of a surgical patient. Types of regimen.
Bedsores, their cause, prevention, treatment.
Change of bed linen for a surgical patient. Ways of sanitary cleansing.
Aid upon vomiting, aspiration of gastric contents.
Care of unconscious patients.
Handling a dead body.
Postoperative wound, its observation, signs of complications.
Drains, their care.
Specifics of care for patients after abdominal surgery.
Specifics of care for patients after urinary surgery
Specifics of care for patients after thoracic surgery.
Prevention of pulmonary complications.
Enema, types of enema.
Technique of administering cupping glasses, mustard plaster.
Catheterisation of the bladder.
Flatus tube, its introduction.
Taking body temperature.
Deontology in surgery.
Closed-chest and open-chest cardiac massage.
Artificial ventilation.
Ways of transporting the patient in the department.
The layout of treatment room, its equipment.
Pre-sterilisation treatment of syringes.
Technique of giving subcutaneous, intramuscular, intravenous injections.
Prevention of wound infection in the dressing room.
The notion of dressing, indications.
Taking the pulse rate, arterial pressure and respiration rate.

LIST OF PRACTICAL SKILLS AND MANIPULATIONS

During the on-the-job training the student consolidates and deepens his knowledge and mastery of practical skills and manipulations. In the diary a note should be made of the type of skill and of the student’s progress in mastering it.

№ / List of therapeutic and diagnostic skills / Quality of
knowledge / skills / attainments
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
2.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
2.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
1.
2.
3.
4.
a.
b.
5.
a.
b.
c.
6.
7.
a.
b.
c.
1.
2.
3.
1.
2.
3.
4.
5.
6.
7. / I. CARE OF PATIENTS
A. AT THE ADMISSION DEPARTMENT
Transportation of patients from the ambulance car to the admission department
Medical records, filling out the front page of case history
Entering the patients into the register
Anthropometry
Examination of hair and skin integuments
Sanitary cleansing of patients (trimming the hair and nails, a bath, shower or wiping)
Entering the temperature in the register
Storage and use of thermometers
Filling out temperature sheets
Preparation of 0.5%, 1%, 10% solution of chlorinated lime
Catheterisation of the bladder
Transportation of patients from the admission department to the inpatient department
B. IN THE WARD
Familiarisation with the layout, organization of work, and regimen of medical care institutions
Familiarisation with the medical records, rules of admitting and discharging patients
WARD HYGIENE:
Wet cleaning of wards:
Preparation of 0.5-1% solution of chlorinated lime
Control of the sanitary condition of bedside tables
Airing the wards
Control of visiting and food brought by visitors
Disinfection and storage of spittoons
Transportation of patients with a drip stand or drain
Making the bed
Change of linen and bed clothes
Placing the rubber ring or bedpan
Transportation and relaying of patients
Administering mustard plasters and cupping glasses
NUTRITION OF PATIENTD
Feeding the patient. Notion of dietotherapy. Nutrition regimen
Feeding grave and bedridden patients
II. TECHNIQUE OF MANIPULATIONS
Transporting the patient to and from the dressing room
Methods and techniques of changing a dressing
Applying various types of dressing
Sterilization of instruments
Cleaning of the dressing room
Care of skin in the presence of a fistula
Taking the temperature, entering it into the t0 sheet; types of temperature curves. Storage of thermometers. Care of patients in different periods of fever
Affecting blood circulation: indications, contraindications, administering cupping glasses, mustard plasters, hot water bottles, heat compresses, ice packs; bloodletting; applying the tourniquet
Oxygen therapy: operating the oxygen installation
Prescription, storage, use of drugs; monitoring the use of poisonous and powerful drugs; distribution of drugs for internal use
Indications, contraindications, technique of administering enemas (cleansing, nutrient medicinal, siphon enema)
Preparation of patient for x-ray examination of gastrointestinal tract, gallbladder and biliary ducts, kidneys and urinary tracts
Injections:
Sterilization of syringes and needles
Filling the syringe from a vessel with sterile solution, from ampoules
Taking a blood sample from the vein
Giving intravenous injections
Indications, contraindications, technique of subcutaneous and intramuscular injections
Treatment of needles and syringes after use
Checking the sterility of needles and syringes
Filling a system for infusion therapy
Preparing tubes for drawing gastric juice and duodenal intubation
Performing gastric lavage
Shaving the operation field
Sanitary cleansing of the patient
III. LABORATORY TESTS
Urine: doing Zimnitskiy’s test
Feces: physical properties, occult bleeding test
Gastric contents: methods and technique of gastric intubation
Duodenal contents:
Methods and technique of duodenal intubation
Participating in duodenal intubation
Blood:
Drawing blood from the finger for a large drop
Drawing blood from the finger for agglutination time test
Participation in blood grouping, Rhesus compatibility
Sputum: technique of sputum collection (general test, for atypical cells, for microflora and antibiotic sensitivity, daily amount)
Pleural fluid:
Preparing instruments for pleurocentesis
Pleurocentesis: indications, contraindications, technique, participation in performing pleurocentesis
Determining physical properties of pleural fluid
IV. BASIC DOCTOR’S MANIPULATIONS
Counting respiratory movements, entering them onto the temperature sheet
Properties of the pulse. Their graphic representation of pulse rate in the temperature sheet.
Registering BP
V. URGENT CONDITIONS
Applying tourniquet to the extremities (acute cardiac insufficiency)
Technique of external cardiac massage
Technique of artificial ventilation
Principles of defibrillation
Preparation of a catheter, participation in catheterisation of bladder with a plastic catheter
Administering a flatus tube
Indications, contraindications, technique of gastric lavage, participation in gastric lavage
VI. BASIC SURGICAL SKILLS
Nursing
Clinical hygiene of medical personnel in surgery

DIARY