The Federal Agency in Health Protection and Social Development
The Stavropol State Medical Academy
The Department of General Surgery
MEDICAL SURGICAL CARE.
SURGICAL MANIPULATIONS.
For Students of General Medicine of the English-speaking Medium
Stavropol 2009
УДК 647.258:616-089(07)
ББК 54.5я73
С 33
УХОД ЗА ХИРУРГИЧЕСКИМИ БОЛЬНЫМИ (Для студентов лечебного факультета англо-язычного отделения). Ставрополь: Изд-во СтГМА. – 2009.
MEDICAL SURGICAL CARE. SURGICAL MANIPULATIONS. (For Students of General Medicine of the English-speaking Medium). Stavropol: St.SMA. – 2009.
Cоставители:
Владимирова О.В., ассистент кафедры общей хирургии Ставропольской государственной медицинской академии.
Линченко В.И., к.м.н., ассистент кафедры общей хирургии Ставропольской государственной медицинской академии.
Кораблина С.С., ассистент кафедры общей хирургии Ставропольской государственной медицинской академии.
Данное учебное пособие представляет собой комплекс наиболее необходимой информации для студентов 2 курса лечебного факультета при изучении ухода за хирургическими больными и основных хирургических манипуляций в рамках программы общей хирургии. Предназначено для студентов англоязычного отделения медвузов.
Рецензенты:
Лаврешин П.М., д.м.н., профессор, зав.кафедрой общей хирургии Ставропольской медицинской академии.
Знаменская С.В., к.пед.н., доцент, зав.кафедрой иностранных языков с курсом латинского языка, декан факультета иностранных студентов Ставропольской государственной медицинской академии.
УДК 647.258:616-089(07)
Рекомендовано к изданию Цикловой методической комиссией по англоязычному обучению иностранных студентов Ставропольской государственной медицинской академии
© Ставропольская государственная медицинская академия, 2009
Contents:
1. Introduction in to the surgical medical care.
2. The basic actions of the general care for patients.
3. Deontology of the medical care.
4. The international codex.
5. Problem of infection in surgery. The aim of care – to prevent infection.
6. Nosocomial infection.
7. Hygiene of natural and artificial feeding of the surgical patients.
8. Pain.
9. Venous and arterial catheterization.
10. Urinary catheterization.
11. Naso-gastral intubation.
12. Splinting
13. Care for ostomy patients.
14. Tracheotomy.
15. Thoracentesis.
Achievements of modern surgery are not possible without the qualified care of patients. In its realization in a surgical hospital the basic role is allocated to the average and younger medical personnel who work under a direct management of the doctors.
Distinguish:
- The general care which is carried out concerning all patients, irrespective of a kind and character of disease (distribution of medical products, injections, infusions, feeding, cleaning of premises and others);
- Special, carried out only to patients with the certain diseases: surgical (bandages, immobilization, preventive maintenance sore spot and others), gynecologic, urological.
In the separate (insignificant) group there are patients of the surgical branch, not requiring in operative intervention (make some kinds of trophy wounds, inflammatory diseases of veins, initial stages of disease of the artery, not complicated crises of edges and others) for which corresponding care also is necessary depending on weight of a condition, age and accompanying diseases.
To the basic actions of the general care of patients concern:
1. Creation and maintenance of a medical - guarding mode of medical institution.
2. Performance of medical purposes.
3. Rendering assistance is hard for patients at carrying out of actions of personal hygiene, and also during reception of food and physiological departures.
4. Carrying out of sanitary-and-hygienic processing (preventive maintenance and antisore spot treatment, a bath, souls, rubdown and others).
5. First-aid treatment at some conditions (a fever, a faint, pain in the heart, vomiting, a short wind and others).
Also, in surgical branch, alongside with the general care of patients include the complex of actions of preparation the patient for various researches, for operation and the prevention of complications which can arise during operation is carried out also, during a narcosis and in the postoperative period.
The basic purpose of care - simplification of sufferings the patient and creation the optimum conditions for treatment and recovery of the patient. Achievement of it is impossible without precise interaction of the surgeon, the average and younger medical personnel as many actions of care for the patient have medical character, and medical procedures serve as the integral component of care to patients. Harmonious and close interaction of the medical personnel in a surgical hospital has great importance in recovery of the patient that some times it is difficult to define, what actions are only medical and what concern to care for patients. For example, carrying out the care in the postoperative period behind a wound or drainage system, the medical personnel not only promotes the fastest healing of a wound, but also warns development of terrible complications. Depending on what bodies and systems operation is carried out, care of such patients has the feature.
Some patients cannot wash themselves; accept without assistance peep. The toilet of a skin, an oral cavity, perineum, the help to the hardly patients at the defecation act and urinary excretion, correct feeding the patients, maintenance of a dietary and drinking mode, duly change of the linen and other hygienic actions - all this enters into concept « care for the patients ».
Also, care includes supervision over changes in a condition of the patient and rendering to him the first aid in case of occurrence of a fever, pains in the field of heart, a short wind, an asthma and other changes.
It is necessary to remember, that care includes also a line of the sanitary – epidemiological actions carried out by the medical personnel and directed on maintenance of cleanliness in medical institution and the prevention of occurrence and distribution of infectious diseases. Regular cleaning and airing of the rooms, sanitary processing of the patients concern to such actions, their clothes, linen, subjects of care, some disinfection and others.
The important component of care for the patients is creation of the maximal physical and mental rest. Quiet in the rooms where the patients are, benevolent relation to them of the medical personnel, elimination of all adverse factors which can injure mentality of the patient, - some main principles of a medical - guarding mode of medical institutions on which in many respects efficiency of treatment of the patients depends.
Care of patients is a direct duty of the medical sister. Only separate manipulations of the general care with patients can be carried out by the younger medical personnel. But also this case the medical sister bears the full responsibility for correctness of performance of these manipulations.
For preparation of the qualified doctors care of surgical patients which basic purposes are is entered into the program of training in medical high schools: training of students to main principles of care of surgical patients, studying of sanitary-and-hygienic conditions of treatment of patients in a surgical hospital and works of the younger and average medical personnel.
Undoubtedly, the future doctor himself should be able to execute classically all necessary receptions of the care as in the subsequent its duties will include training to these receptions of the average both younger medical personnel and the requirement of their precise performance.
Deontology of the medical care.
Specificity of medicine consists first of all in the necessity of constant, everyday dialogue of the medical personnel with the patient and his relatives. Thus it is necessary to remember about observance medical deontology and ethics in each independent situation.
First of all it is necessary to remember, that the concept of medical secret is distributed to all medical workers, it is their professional duty.
In conversations with the patients and their relatives it is necessary to be extremely polite, attentive and not to suppose the development of iatrogenic - the unhealthy condition caused by activity of the medical worker.
Basis principle of medicine - not to cause harm, it should be observed by all without exception medical workers.
Important point is dialogue of students with patients during care of them, detour of patients by the attending physician, the teacher. As a rule, we represent students as the future doctors, therefore and students should feel themselves doctors, to be attentive, sensitive, quiet, empathizing a condition of the patient and his stay in the surgical clinic. Sometimes the top takes from students not reason, and a youth. Therefore it is possible to see, how in chamber or the other place of surgical clinic, students rustle, are dared, push each other, etc., forgetting, that beside the patients having in connection with disease of a deviation in mentality, perceive laughing and separate words of students on the account. It aggravates current of process and complicates recovery. Many other aspects of the surgical deontology, especially concerning care of heavy patients, for patients after operations it is not authorized to them to rise. Here not only there should be a compassion, mercy, understanding of a situation, but also to execute procedure without serious consequences appointed to the patient, it is more convenient to lay professional skill in bed, to correct bed-clothes, to help the patient to carry out physical departures. The request to remember, that you have no right to inform the patient or his relatives the any information about the state of health of the patient, to allow recommendations.
Sacred place in surgical clinic is operational. For all students and employees the cult of deep respect to operational, as to a solemn place where the destiny of health and a life of people daily is solved should be developed. In operational rules of behavior everything which is taking place in it of employees and students should be observed strictly. For the order and execution of rules of behavior in operational answers the operational sister. Therefore its orders should be carried out by all strictly, without any comments and conversations. Only the operating surgeon to whom the operating brigade submits speaks in operational. It is authorized to explain a course of operation to the teacher. In the operational-room there should be no unjustified movements, circulations. Students are obliged to stand silently, there, where they were put by the teacher, to observe of a course of operation, to listen to the teacher and the operational sister. All questions, opinions, etc. are solved outside of operational.
The international codex
It is accepted on the 3 General Assembly of the World Medical Association, Geneva, Switzerland, in October, 1949, Sydney, Australia, in August, 1968 and 35 the World Medical Assembly, Venice, Italy, in October, 1983 is added 22 the World Medical Assembly.
The general duties of doctors:
The doctor is obliged to always support the best professional standards.
Making of professional decisions, the doctor should start with reasons of the blessing for the patient, instead of from own material interests.
Without dependence from professional specialization, the doctor should regard as of paramount importance compassion and respect for human advantage of the patient and completely to be responsible for all aspects of medical aid.
The doctor should be fair with the patient and colleagues. He has no right to cover the colleagues deceiving the patients.
With norms of medical ethics are not compatible:
а) Self-advertisement if she it specially is not stipulated by laws of the country and the ethical code of National Medical Association.
б) Payment by the doctor of the commission for a direction to it of the patient, or reception of a payment or other compensation from any source for a direction of the patient in the certain medical establishment, to the certain expert or purpose of the certain kind of treatment without the sufficient medical bases.
The doctor should respect rights of the patient, colleagues, other medical workers, and also to keep medical secret.
The doctor can carry out the intervention, capable to worsen a physical or mental condition of the patient only in interests of the last.
The doctor should be extremely cautious, giving the information on the opening, new technologies and methods of treatment through nonprofessional channels.
The doctor should assert only that is checked up by him personally.
Duties of the doctor in relation to the patient:
With the purpose of preservation of health and a life of the patient the doctor should use all professional potential. If necessary inspection or treatment leaves for a level of opportunities of the doctor, it should address to more competent colleagues.
The death of the patient does not release the doctor from a duty to keep medical secret.
Rendering the urgent help - a human duty of the doctor.
Duties of the doctor under the attitude to each other:
In relation to the colleagues the doctor should behave how he would like, that they behaved in relation to him.
The doctor should not entice patients at the colleagues.
The doctor is obliged to observe principles of the Geneva Declaration approved by the World Medical Association.
Because medicine is a profession and doctors are professionals, it is important to have a clear understanding of what "professionalism" means. As a physician-in-training, you will be developing a personal sense of what it means to be a professional. This topic page outlines some common features. Please see the topic page on the Doctor-Patient Relationship for further discussion of the professional responsibilities of physicians.
What does it mean to be a member of a profession?
The words "profession" and "professional" come from the Latin word "professio," which means a public declaration with the force of a promise. Professions are groups which declare in a public way that their members will act in certain ways and that the group and the society may discipline those who fail to do so. The profession presents itself to society as a social benefit and society accepts the profession, expecting it to serve some important social goal. The traditional professions are medicine, law, education and clergy.
The marks of a profession are:
· competence in a specialized body of knowledge and skill;
· an acknowledgment of specific duties and responsibilities toward the individuals it serves and toward society;
· the right to train, admit, discipline and dismiss its members for failure to sustain competence or observe the duties and responsibilities.
What is the difference between a profession and a business?
The line between a business and a profession is not entirely clear, since professionals may engage in business and make a living by it. However, one crucial difference distinguishes them: professionals have a fiduciary duty toward those they serve. This means that professionals have a particularly stringent duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Professions have codes of ethics which specify the obligations arising from this fiduciary duty. Ethical problems often occur when there appears to be a conflict between these obligations or between fiduciary duties and personal goals.