General care for patients Turkina. Ministry of Health and Social Development of the Russian Federation. Successes of modern natural science Types of medical institutions
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General care for the sick. Turkina N.V., Filenko A.B.
General patient care. Textbook. Turkina N.V., Filenko A.B. In accordance with the program approved by the Ministry of Health of the Russian Federation, the textbook discusses the main issues of general patient care, raises the necessary issues of asepsis and antisepsis, desmurgy, emergency conditions including bleeding and techniques to stop it. The basic principles of patient care in surgical and therapeutic clinics are described. The issues of performing various manipulations are described in detail: all types of injections, catheterization, measurement blood pressure using all modern devices and their detailed description, thermometry using all modern thermometers, the algorithm for setting cans, mustard plasters and much more. Algorithms of actions are given when performing various manipulations, as well as the necessary set of tools and material for their implementation.
The textbook is illustrated with photos, diagrams, tables. When presenting the material, the authors focused on the results of modern scientific developments and new technologies.
The textbook was created under the ROXY project. Designed for students medical institutes and medical faculties universities.
a common part
1. Types of medical institutions
2. Structure of the hospital
2.1. Reception department
2.1.1. Duties of the duty nurse admission department
2.1.2. Pediculosis and anti-pediculosis treatment technology
2.2. The structure of the medical department
2.2.1. Nursing station equipment
2.2.2. Therapeutic and protective mode of the department
2.2.3. Ward (guard) nurse
2.3. Operating block structure
2.3.1. General requirements for the design of a modern operating unit
3. Requirements for the sanitization of instruments and equipment in medical institutions
3.1. Basic Sterilization Methods
3.1.1. Examples of disinfectants high level and sterlyants
3.2. Requirements for sanitizing surfaces
3.3. Requirements for the sanitization of the hands of medical personnel
3.3.1. Surgical hand sanitizer
3.3.2. Surgical hand antisepsis technique
3.3.3. The effect of antiseptics on the skin
4. Medical waste
4.1. Waste classification
4.2. General procedure for disinfection of waste and reusable equipment
4.3. Waste disposal methods
5. Method of general examination of the patient
5.1. Examination of the patient
5.1.1. Grade motor activity(position) of the patient
5.1.2. Physique score
5.1.3. Methodology for the implementation of the medical service "height measurement"
5.1.4. Skin
5.1.5. Consciousness assessment
5.1.6. Examination and evaluation of vital functions
5.1.7. Blood pressure
5.1.8. Breath
5.1.9. Determining the severity of the patient
6. Fever
6.1. thermoregulation
6.2. Temperature measurement rules
6.2.1. Temperature measurement with an electrothermometer
6.2.2. Methods for measuring body temperature with a liquid crystal thermometer
6.3. Types of fevers
6.3.1. The nature of the temperature curve
6.3.2. The effect of fever on the human body
6.4. Stages of fever
6.5. Some variants of fevers encountered in practice
6.6. Therapy of febrile conditions. Antipyretic drugs
7. Creating a state of comfort for the patient while observing bed rest
7.1. Change of bed linen
7.1.1. Change of linen for a bedridden patient who is allowed to turn in bed
7.1.2. Change of linen for a bedridden patient who is forbidden to turn in bed
7.2. Change of underwear
7.3. Assistance with defecation for a seriously ill patient
8. Basic hygiene procedures
8.1. Skin care
8.1.1. Carrying out a hygienic shower
8.1.2. Carrying out a hygienic bath
8.1.3. Seriously ill skin care
8.1.4. Washing feet in bed
8.1.5. Washing away the sick
8.2. oral care
8.2.1. Oral treatment
8.2.2. Oral irrigation
8.3. Ear care
8.3.1. Removing dirt and sulfur plug
8.3.2. Putting ointment in the ear
8.3.3. Drops in the ears
8.4. Nose care
8.4.1. Nasal processing
8.4.2. Instillation of drops in the nose
8.4.3. Help with nosebleeds
8.5. Eye care
8.5.1. Rubbing eyes
8.5.2. Eye wash
8.5.3. Other eye care procedures
8.5.4. Chemical burns to the eyes
8.5.5. Thermal burns eye
9. Transportation and shifting of the patient
9.1. Transportation on a wheelchair
9.2. Transportation of the patient to the department on a wheelchair
9.3. Stretcher transportation
9.4. Shifting the patient
10. Organization of feeding of patients
10.1. Therapeutic diets
10.2. Unloading diets
10.3. Organization of meals for patients in the department
10.4. artificial nutrition
10.4.1. Artificial nutrition through a gastric tube
10.4.2. Artificial nutrition through gastrostomy
10.4.3. parenteral nutrition
11. The simplest physiotherapy procedures in the organization of patient care
11.1. Segmental reflex therapy
11.2. mustard plasters
11.2.1. The mechanism of action of mustard
11.2.2. The use of mustard plasters
11.2.3. Mustard baths and wraps
11.3. Medical banks
11.4. Medical heating pads
11.4.1. Varieties of medical heating pads
11.4.2. Use of medical heating pads
11.5. Applying an ice pack
11.6. Compresses
11.7. Hirudotherapy
11.7.1. Anatomical structure medicinal leeches
11.7.2. The mechanism of the therapeutic action of leeches
Basic manipulation
12. Injections
12.1. Syringe
12.1.1. General information about medical syringes
12.1.2. Scheme of the structure of a disposable syringe
12.2. Medical needles
12.2.1. injection needles
12.2.2. Puncture force
12.2.3. Needle packaging
12.3. Safe manipulations (injections)
12.4. Injections
12.4.1. Preparing for an injection
12.4.2. Intradermal injections
12.4.3. Subcutaneous injections
12.4.4. Intramuscular injections
12.4.5. Intravenous injections
12.4.6. Catheter Care
13. Enema
13.1. Cleansing enema
13.2. Siphon enemas
13.3. Enemas hypertonic
13.4. Oil enemas
13.5. Emulsion enemas
13.6. Medicinal enemas
13.7. starch enemas
13.8. Chloral hydrate enemas
13.9. Drip enemas
13.10. Nutrient enemas
14. Gastric lavage
14.1. Gastric lavage by probe method
14.1.1. Probe length measurement
14.2. Insertion of a nasogastric tube
15. Urethral catheterization
15.1. Catheterization technique in men
15.1.1. Features of catheterization with a flexible Foley catheter
15.1.2. Features of catheterization with a metal catheter
15.1.3. Some techniques for difficult catheterization in men
15.2. Catheterization technique in women
15.3. Possible Complications and their elimination
16. Insertion of the gas tube
17. Introduction of suppositories
18. Bedsores
18.1. Formation of bedsores
Special part
19. Care of patients with diseases of the cardiovascular system
19.1. heartbeat
19.2. Pain in the region of the heart
19.3. Dyspnea
19.4. Edema
19.5. Acute myocardial infarction
19.6. Chronic heart failure
19.7. Increase in blood pressure
19.8. Lowering blood pressure
20. Care of patients with diseases of the respiratory system
20.1. Dyspnea
20.2. Respiratory failure
20.3. oxygen therapy
20.4. Cough
20.5. Hemoptysis and pulmonary hemorrhage
20.6. Basic principles of caring for a patient with pain in chest
20.7. Basic principles of patient care for chills and fever
21. Care of patients with diseases of the digestive system
21.1. Stomach ache
21.2. Dyspeptic disorders
21.3. Laboratory study of feces
21.3.1. Main normal performance laboratory study of feces
21.3.2. Stool collection rules
21.4. Preparation of patients for X-ray, endoscopic and ultrasound research digestive organs
22. Care of patients with diseases of the nervous system
22.1. Signs of defeat nervous system
22.2. Stroke
22.3. Traumatic brain injury
23. Care of patients with diseases of the kidneys and urinary tract
23.1. Symptoms of urological diseases
23.1.1. pain
23.1.2. urinary disorders
23.1.3. Changes in the quantity and quality of urine
23.2. Collection of urine for research
23.2.1. Determination of daily urine output
23.2.2. Determination of the concentration function of the kidneys
23.3. Features of observation, treatment and care of patients with certain kidney diseases
23.3.1. kidney failure
23.3.2. Acute urinary retention
23.3.3. Renal colic
23.3.4. Observation and methods of treatment of patients with urinary incontinence
23.3.5. Caring for Patients with Urinary Incontinence
23.4. Preparation of patients for instrumental studies of the urinary system
24. Care of operated patients
24.1. Classification postoperative complications
24.2. Care and monitoring of postoperative wounds
24.3. Drainage Care
24.3.1. Drainage and wound care
24.3.2. Pleural drainage care
24.3.3. Drainage care in urology department
24.4. Care of patients with fistulas of various organs
24.4.1. cervical esophagostomy
24.4.2. gastrostomy
24.4.3. Enterostomy
24.4.4. Cholecystostomy
24.4.5. Colostomy
24.4.6. Artificial anus
24.4.7. Tracheostomy
24.4.8. Care of patients with epicystostomy
24.4.9. Function monitoring respiratory system
24.4.10. Function monitoring of cardio-vascular system
24.4.11. TELA classification
24.4.12. Function monitoring digestive system
24.4.13. Observation of the function of the urinary system
24.4.14. Violation of carbohydrate metabolism
25. Hemostasis
25.1. Types of bleeding
25.2. Ways to stop bleeding
25.2.1. Temporary stop of bleeding
25.2.2. Stopping bleeding by applying Esmarch's tourniquet
25.2.3. Stopping bleeding with a pressure bandage
25.2.4. Stop bleeding by maximum flexion of the limb
25.2.5. Stopping bleeding with tamponade
25.2.6. Stop bleeding by squeezing the vessel for
25.2.7. Stopping bleeding by applying a clamp to a bleeding vessel
26. Transport immobilization
26.1. Gypsum bandage
26.2. Principles of transport immobilization
26.3. Transport immobilization in case of neck injury
26.4. Transport immobilization in case of spinal injury
26.5. Transport immobilization in case of damage to the shoulder girdle
26.6. Transport immobilization in case of damage to the upper limbs
26.6.1. Immobilization with ladder and plywood rail
26.6.2. When immobilized with improvised means
26.6.3. Forearm injuries
26.6.4. Injuries to the wrist and fingers
26.7. Transport immobilization in case of pelvic injury
26.8. Transport immobilization for injuries of the lower extremities
26.8.1. Immobilization with a Dieterichs bus
26.8.2. Immobilization with a ladder splint
26.9. Transport immobilization of the lower leg
27. Desmurgy
27.1. Dressing materials
27.2. Classification of dressings by type of dressing material
27.3. Classification of dressings according to their purpose
27.4. Classification of dressings according to the method of fixing the dressing material
27.4.1. bandage-free bandages
27.4.2. bandage bandages
27.5. Headbands
27.5.1. Bandage "cap"
27.5.2. Beanie, "Hippocratic cap"
27.5.3. Bandage for one and both eyes
27.5.4. Cruciform, or eight-shaped, bandage
27.6. Bandages on the chest area
27.6.1. Cross bandage on the chest
27.6.2. Bandage Deso
27.6.3. Velpo bandage
27.6.4. Bandage on the mammary gland
27.7. Bandages for the limbs
27.7.1. spike bandage on the shoulder area
27.7.2. "Turtle" converging bandage on the elbow and knee joints
27.7.3. Bandage ankle joint
27.7.4. Spiral bandage on one finger
27.7.5. Bandage "glove * on the brush
27.7.6. Spike bandage on the first finger of the hand
27.8. Scarf and tie bandages
27.8.1. Bandages on upper limb
27.8.2. Bandages on lower limb
27.8.3. Headbands
27.8.4. Bandages on the body
28. Terminal States
28.1. burns
28.1.1. Thermal burns
28.1.2. Chemical burns
28.2. electrical injury
28.3. bites
28.3.1. Animal bites
28.3.2. snake bites
28.4. Long crush syndrome
28.5. Frostbite and hypothermia
28.6. General cooling (freezing)
28.7. Drowning
28.7.1. Types of drowning
28.7.2. Urgent care
28.8. Acute poisoning
28.8.1. Diagnosis of poisoning
28.8.2. General principles treatment of acute poisoning
29. Resuscitation measures
29.1. Last stages of life
29.1.1. Preagonal state
29.1.2. Agony
29.1.3. clinical death
29.1.4. Circulatory arrest
29.2. resuscitation
29.2.1. Primary resuscitation
29.2.2. Basic resuscitation
29.2.3. Extended resuscitation
29.2.4. The ending resuscitation
29.2.5. Cardiopulmonary resuscitation in pediatrics
29.2.6. Legal Basis for Termination and Refusal of CPR
29.3. About the statement of biological death
Name: General nursing
Turkina N.V., Filenko A.B.
The year of publishing: 2007
The size: 33.2 MB
Format: djvu
Language: Russian
The training manual "General Nursing" edited by Turkina N.V., et al., considers the method of general examination of the patient, the principles of disinfection in various medical departments: surgical and therapeutic profiles. The principles of comfortable stay of the patient in conditions are presented. inpatient treatment during bed rest. Principles are described nursing care for patients in various hospitals with various pathologies. The main hygienic manipulations carried out in the hospital clinic for patients are presented. The main techniques for carrying out medical manipulations by sisters are outlined: injections, gastric lavage, urethral catheterization, transport immobilization.
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The year of publishing: 2015
The size: 6.5 MB
Format: pdf
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N.V. Turkina A.B. Filenko
General care
UNDER GENERAL EDITION
Academician of the Russian Academy of Medical Sciences I.N. Denisova
Corresponding Member of the Academy of Sciences of Higher School N.V. Turkina
St. Petersburg
Introduction
a common part
Types of medical institutions
Structure of the hospital
Reception department
Pediculosis and anti-pediculosis treatment technology
The structure of the medical department
Therapeutic and protective mode of the department
Operating block structure
Method of general examination of the patient
Fever
Temperature measurement rules
Types of fevers
The nature of the temperature curve
Stages of fever
Therapy of febrile conditions. Antipyretic drugs
Creating a state of comfort for the patient while observing bed rest
Change of bed linen
Change of underwear
Delivery of the vessel to a bedridden patient
Basic hygiene procedures
Skin care
Carrying out a hygienic shower
Carrying out a hygienic bath
Seriously ill skin care
Washing feet in bed
Washing away the sick
oral care
Ear care
Nose care
Eye care
Transportation and shifting of the patient
Organization of feeding patients
diet therapy
Organization of meals for patients in the department.
artificial nutrition
The simplest physiotherapy procedures in the organization of patient care
Segmental reflex therapy
mustard plasters
Medical banks
The use of a medical heating pad
Applying an ice pack
Compresses
Hirudotherapy
Basic manipulation
Injections
Characteristics of syringes
Needle specifications
Algorithm for performing manipulation
A set of medicinal solution from an ampoule
Intradermal injections
Subcutaneous injections
Intramuscular injections
Intravenous injections
Setting up enemas
Gastric lavage
Urethral catheterization
Insertion of the gas tube
Introduction of suppositories
bedsores
Special part
Caring for patients with diseases of the cardiovascular system
Care of patients with diseases of the nervous system.
Care of patients with diseases of the kidneys and urinary tract
Care of Operated Patients
Hemostasis
Types of bleeding
Ways to stop bleeding
Transport immobilization
Terminal States
electrical injury
Animal bites
snake bites
Long crush syndrome
Frostbite and hypothermia
General cooling (freezing)
Drowning
Acute poisoning.
Resuscitation measures
Applications
a common part
Types of medical institutions
In Russia, to provide medical care to the population, a wide network of medical and preventive institutions (TPU) has been created. There are the following types of medical institutions:
stationary
outpatient
sanatorium-resort
To stationary(HCF) are hospitals and hospitals. They are designed to provide emergency medical care, as well as planned treatment, perform complex and extensive diagnostic procedures and studies in cases where this is not possible on an outpatient basis for medical reasons or for technical reasons. There are monoprofile, i.e. specialized hospitals that are designed to treat patients with any one disease and multidisciplinary. A multidisciplinary hospital includes several departments, for example, surgical, therapeutic, gynecological, etc. Inpatient institutions also include maternity, whose functions include obstetric care, treatment of pregnant women, puerperas.
hospitals they mainly provide medical care to current and former employees of the "power" departments, war veterans, as well as to persons injured as a result of hostilities.
Clinic(clinical hospital) - a stationary institution in which, in addition to medical work, scientific research is carried out without fail, and students and specialists are trained.
In addition to stationary, there are also outpatient facilities, sanatorium-resort type and ambulance stations.
The functions of outpatient facilities are different.
Dispensaries carry out medical and preventive care for certain groups of patients (rheumatological, dermatovenereological, psychoneurological, anti-tuberculosis, oncological and other dispensaries). The scope of this assistance includes: active identification of profile patients among the population; systematic active monitoring of identified patients (patronage); provision of specialized medical care; prevention measures. In addition, the dispensary conducts a study of morbidity and sanitary and educational work among the population and patients.
Polyclinics – multidisciplinary medical and preventive treatment facilities (MPU) – designed to provide medical (including specialized) care and examination of patients according to the territorial-district principle.
outpatient clinics - these are health care facilities, unlike polyclinics, providing specialized medical care in a smaller volume. Doctors conduct appointments only in the main specialties. The principle of operation of outpatient clinics is also territorial-district, but they are located mainly in rural areas, not far from feldsher-obstetric stations.
Feldsher-obstetric station ( FAP)- an outpatient clinic in rural areas. It is organized in rural areas, if the settlement is more than 4-6 kilometers away from other medical institutions. Works on a district basis. Part of a rural or central district hospital. As a rule, the staff of the FAP: paramedic - midwife - nurse. FAP staff provides first aid at an outpatient appointment and at home. He is entrusted with the fulfillment of doctor's orders, the involvement of residents of the site for scheduled examinations, participation in the conduct of medical examinations of the population and the implementation of preventive measures. An important section of the work of the FAP is the provision of medical care during pregnancy and childbirth, obstetric care, monitoring of puerperas at home, after their discharge from the hospital, monitoring of children under the age of 3 years, medical care for preschool institutions and schools on the territory of the site. FAP employees provide early detection of infectious patients, carry out anti-epidemic measures, sanitary supervision of the territory of populated areas, industrial premises, water supply, public catering, trade, and communal facilities. FAP staff provide emergency and emergency first aid. The structure of the FAP provides beds for hospitalization of women in labor, as well as for temporary isolation of infectious patients. There should be a pharmacy for the sale of ready-made medicines and sanitary and hygiene items.
health centers usually they are not independent health facilities and are either part of polyclinics or medical units. They are usually located near the workplace of the serviced contingent (large workshop, construction site, etc.) and are of two types: medical and paramedical. They provide pre-medical and first medical aid for injuries, poisoning, sudden illnesses. The staff of the health centers is actively involved in medical examinations and sanitary-educational work.
Outpatient facilities also include women's consultations . Their functions include early detection, treatment and clinical examination of patients with gynecological diseases; dispensary observation, and, if necessary, treatment of pregnant women. An important place in their work is given to health education and training of pregnant women in the necessary skills for caring for newborns.
Medical unit (MSCh)- This is a complex of healthcare facilities designed for medical care of workers and employees of industrial enterprises and organizations. It operates on the principle of shop division and is as close as possible to the place of work of workers and employees. The MSU may include: a polyclinic, a hospital, health centers, a dispensary, etc. Functions of the medical unit: providing outpatient and inpatient medical care, conducting professional examinations, developing a set of preventive measures aimed at improving working conditions, identifying and monitoring occupational hazards.
Territorial medical association (TMO), as well as the medical unit, is a complex of healthcare facilities, however, TMO provides medical care not on a production basis, but on a territorial basis.
Ambulance stations - medical institutions that provide emergency medical care to the population around the clock (in case of injuries, poisoning, wounds, life-threatening sudden illnesses) on prehospital stage, as well as during childbirth, and hospitalization of patients in need of inpatient treatment, or women in labor in maternity hospitals. In large cities, there are linear ambulance substations and specialized ones, such as, for example, cardiological, resuscitation, psychiatric, etc.
To institutions sanatorium This type includes sanatoriums, dispensaries and other institutions whose activities are based on the use of predominantly natural healing factors (climate, healing mud, mineral springs, etc.) for the treatment and prevention of diseases, as well as diet therapy, physiotherapy and exercise therapy.
The hospital includes a reception department, medical and diagnostic departments, administrative and utility blocks.
Hospitalization - the placement in a hospital of a medical institution of persons in need of examination, treatment or obstetric care. Hospitalization can be of two types - emergency and planned.
Emergency hospitalization (as a rule, with the delivery of the patient to the hospital by linear and specialized ambulance and emergency teams) is carried out in cases where the patient's condition requires urgent qualified or specialized medical care in a hospital setting (patients with injuries, burns, acute or exacerbations of chronic diseases).
During planned hospitalization, the patient is admitted in the direction of a doctor of an outpatient clinic, in cases where the ongoing diagnostic and treatment measures are not effective or cannot be carried out at home. Depending on the severity of the patient's condition, his age, household factors, he can be taken to the emergency room by sanitary vehicles or come on his own: by transfer from another hospital after preliminary consultations of specialists, agreement and consent of the patient and the administration of these medical institutions.
In some cases, the patient may be transferred from another hospital.
The patient can also seek help without a referral, in cases where, for example, an accident occurred close to the hospital or the person felt unwell and independently turned to the nearest hospital.
Structure of the hospital
All departments of the hospital can be divided into 2 large groups:
Therapeutic and diagnostic;
administrative and economic.
The medical and diagnostic part includes:
reception department;
specialized medical departments (therapeutic, surgical, gynecological, etc.);
operblock;
diagnostic laboratories (clinical, biochemical, cytological, immunological, etc.);
diagnostic departments and offices.
The administrative and economic part includes:
sterilization department;
blood transfusion department;
boiler room.
offices of the chief physician and his deputies,
office;
accounting;
catering department;
laundry;
On admission to the hospital, in most cases the patient passes through admission department . Properly organized and well-executed work of the admission department largely determines the work of the hospital as a whole. The quality of care, the correctness and speed of triage of patients form their first (and often the main) impression of the hospital and its staff.
Reception department
The reception area consists of the following rooms:
Ancillary facilities (staff rooms, pantries, storage room for hospitalized patients, etc.).
Lobby (waiting room for relatives and accompanying persons);
Dispatching post (registration);
Examination rooms, incl. specialized (gynecological, surgical, traumatological, etc.);
Sanitary pass;
Isolators for infectious and socially dangerous patients;
procedural and dressing rooms;
Resuscitation room ("shock" ward);
Laboratory and X-ray room;
Receptionist Functions
Rendering emergency assistance and conducting antishock therapy;
Registration of patients;
Primary diagnosis;
Sorting and screening of infectious and non-core patients;
Taking tests;
Sanitization (full or partial);
Organization of transportation of the patient to the departments.
The sequence of work of the reception department:
Patient registration;
Careful examination to identify external signs acute infectious diseases and pediculosis;
Examination of the patient by the doctor on duty and making a preliminary diagnosis (in case of hospitalization not according to the profile - refusal to hospitalize, or transfer to a specialized hospital);
The doctor determines the type of sanitization and transportation (on foot, on a wheelchair, on a wheelchair);
Sanitization is carried out;
The patient is transported, accompanied by a nurse, to the specialized department of the hospital.
In cases requiring emergency care, this sequence is not followed, the patient's stay in the emergency department is reduced to a minimum, sanitization is either minimal (partial) or not performed.
Responsibilities of an Admissions Nurse
Registers patients in the "Journal of admission of patients and refusals to hospitalization" (form No. 001 / y), verifying the passport data and the referral data for hospitalization:
surname, name and patronymic of the patient;
year of his birth;
home address;
where and by whom the patient was delivered (type of hospitalization);
diagnosis of the referring institution.
In case of refusal of hospitalization, indicate the reason for the refusal and the measures taken (outpatient care provided, sent to another hospital);
Fills in the passport part of the “Inpatient Medical Record” (form 003 / y), repeating the entries made in the “Register of admission of patients and refusals to hospitalization”. She also enters information about the place of work and profession, phone number: home or relatives (friends), if the patient is a lonely person. Information about the existing disability is required. There are indications for hospitalization (emergency, planned, transfer from another hospital, “by gravity”). In case of emergency hospitalization, the time after which the patient was delivered by ambulance is noted.
Then the nurse fills in the passport part and the left side of the "Statistical card of the departed from the hospital" (form No. 066 / y).
Draws up an act on the money, valuables, clothes and personal belongings of patients accepted for storage, filling out a receipt - a sheet of the established order. Accepted documents and valuables of the patient are transferred to the hospital administration and stored there in a safe.
In the examination room, the nurse takes the patient's temperature, measures blood pressure, conducts anthropometric measurements, notes the results in the medical history.
Carefully examines the hairy parts of the body and the head of the patient in order to detect pediculosis, and the skin and mucous membranes - elements of the rash;
Provides first aid to patients, fulfills the appointment of a doctor on duty; if necessary, calls doctors - specialists and laboratory assistants, promotes their work.
After examining the doctor on duty and his records, the nurse completes the registration in the “Journal of Registration and Admission of Patients and Refusals in Hospitalization” (form No. 003 / y) see Fig.). She logs:
diagnosis of the doctor of the admission department upon admission;
the department where the patient was referred.
Upon enrolment
patients under the age of 16 without adult relatives
patients in an unconscious state or in a state that directly threatens his life, as well as in the event of his death in the emergency department, the nurse is obliged to give a telephone message to his relatives (if the phone number is known), making an entry in the "Telephone Log". In addition to these cases, the telephone message is transmitted to relatives if the patient is transferred from the emergency department to another hospital.
In case of a criminal nature of an injury, an injury received as a result of an accident and upon admission about accidents of adolescents under 16 years old, a telephone message is given to the internal affairs bodies (at the ATC duty officer). The nurse also gives a telephone message when unknown patients are admitted, indicating the signs of the unknown: gender, approximate age, hair color, height, physique, special signs - birthmarks, scars and scars; called the clothes he is wearing. The nurse must record in the “Telephonogram Log” the contents of her telephone message, the date and time of its transmission and by whom it was received at the police station.
Organizes and supervises the sanitary treatment of patients;
Organizes and controls the transportation of patients to departments;
Supports the sanitary and epidemiological regime of the emergency department.
In cases where the patient's condition is critical, he can go directly to the intensive care unit, bypassing the emergency department. Then the registration of all medical documentation is carried out by the nurse of the intensive care unit.
In cases where, after examination, observation by the doctor on duty of the patient who was admitted to the emergency department with a referral for hospitalization, it is established that there are no indications for hospitalization, the patient can be sent home. The nurse makes an entry about this in the “Journal of admissions of patients and refusals from hospitalization” (form “001 / y). If the patient entered by "gravity", and after examination by a doctor it is established that he does not need hospitalization, then he is assisted as an outpatient. He is released home, about which the nurse must make an entry in the “Outpatient Register” (form 074 / y).
Errors in the design of a medical history, a statistical card, a “Record Log”, a “Telephonogram Log”, a log for the hospital reference service, violations in their design can become a source of mental, moral and legal problems for the patient and medical staff. The admissions nurse must be very careful when filling out and maintaining medical records, an inventory of the receipt of documents and valuables from the patient, which are legal documents that may be required by insurance organizations, law enforcement and justice authorities.
Pediculosis and anti-pediculosis treatment technology
State budgetary educational institution higher professional education "Orenburg State Medical Academy" of the Ministry of Health and Social Development of the Russian Federation "Agreed" Vice-Rector of the UVSR Professor I.V. Miroshnichenko Approved by the CMC of the faculty Professor O.V. Bugrova "__" _________ 2011 "__" _________ 2011 Dean of the Faculty Professor T.V. Chernysheva Approved by the Academic Council of the Faculty Professor T.V. Chernysheva "__" _________ 2011 "__" _________ 2011 WORKING PROGRAM OF EDUCATIONAL PRACTICE CARE OF PATIENTS OF THERAPEUTIC AND SURGICAL PROFILE Department of Propaedeutics of Internal Diseases Direction of training - 060101.65 General Medicine QUALIFICATION (DEGREE) OF THE GRADUATE "SPECIALIST" Considered at the meeting of the Department of Internal Diseases April 25, 2011 Department, Doctor of Medical Sciences, Professor _____________K.M. Ivanov 1. Objectives of training practice: acquisition by students of general theoretical knowledge on the general care of therapeutic and surgical patients; teaching students qualified nursing, the basic principles of medical ethics and deontology; - learning how to use medical equipment and instrumentation. 2. Tasks of educational practice: formation of students' theoretical knowledge on the implementation of qualified patient care; formation of students' ideas about medical ethics and deontology; study by students of the basic principles of the work of medical institutions; study by students of the work of junior and middle medical personnel in the departments of therapeutic and surgical profile; mastering practical skills (medical manipulations related to caring for patients with diseases of various organs and systems). 3. The place of educational practice in the structure of the PEP: The educational practice "Care for patients with a therapeutic profile" refers to the cycle of educational and industrial practice(C5) disciplines of the Federal State Educational Standard in the specialty 060101.65 medical business of higher professional medical education, studied in the first and second semesters. a) Preceding disciplines and requirements for “input” knowledge: No. 1. Preceding disciplines Biology of general educational institutions Knowledge, skills, possessions a) know: - about biological objects, processes, phenomena, regularities, basic biological theories, ecosystem organization life, the relationship of the structure and functions of organs and systems of organs, the body and the environment; - structure human body(structure and functioning of organs and systems); - the impact of environmental and social factors, mental and physical labor, physical education and sports on human health; - about the harmful effects of alcohol, drugs, smoking on the human body and its offspring; - about the structure and activity of the human body to justify healthy lifestyle life, compliance with hygiene standards, prevention of injuries, diseases; - about socially significant and most common diseases in the human population, poisoning, injuries. b) be able to: - use educational, scientific, popular science literature, the Internet for professional activities; - prevent the emergence of bad habits (smoking, alcoholism, drug addiction). c) possess: - methods of biological research; - methods of personal and public hygiene; - methods of first aid, rational 2. Chemistry of general educational institutions 3. Physics of general educational institutions of organization of work and recreation. a) know: - about substances, their transformations and practical application; - conceptual apparatus and symbolic language of chemistry. b) be able to: - analyze and objectively evaluate life situations related to chemistry; - plan environmentally friendly behavior in order to preserve health and the environment. c) possess: the basics of chemical literacy, the skills of safe handling of substances used in Everyday life. a) know: - about the backbone role of physics for the development of other natural sciences, engineering and technologies; - the physical essence of natural phenomena (mechanical, thermal, electromagnetic and quantum), types of matter (substance and field); - the main ideas of the atomic and molecular theory of the structure of matter, elements of electrodynamics and quantum physics; - physical foundations and principles of operation of mechanisms, vehicles, household appliances, industrial technological processes, their impact on the environment; - awareness possible causes man-made and environmental disasters. b) be able to: - apply scientific methods of cognition, observe physical phenomena; - carry out simple experimental studies, direct and indirect measurements using analog and digital measuring instruments; - understand the inevitability of errors of any measurements; - plan your actions in everyday life using the acquired knowledge of the laws of mechanics, electrodynamics, thermodynamics and thermal phenomena in order to preserve health. c) possess: - the basics of the safe use of natural and artificial electric and magnetic fields, electromagnetic and sound waves, natural and artificial ionizing radiation in order to avoid their harmful effects on the environment and the human body. b) disciplines and practices for which the passage of this educational practice is necessary as a previous one: No. Name of the provided (subsequent) disciplines No. of modules of this educational practice necessary for studying the provided (subsequent) disciplines 1 2 3 4 + + 10. Otorhinolaryngology + + 11. Ophthalmology + + 12. Obstetrics and gynecology + + 13. general surgery, Radiation Diagnostics + + 15. Faculty Surgery, Urology + + 16. Hospital Surgery, Pediatric Surgery + + 17. Oncology, Radiation Therapy + + 18. Traumatology, Orthopedics + + 1. Dermatovenereology + 2. Neurology, Medical Genetics, Neurosurgery + + 3. Psychiatry, medical psychology + + 4. Propaedeutics of internal diseases, radiation diagnostics 5. Faculty therapy, occupational diseases + + 6. Hospital therapy, endocrinology + + 7. Infectious diseases + + 8. Phthisiology + 9. Polyclinic therapy + + 14. Anesthesiology, resuscitation, intensive care 19. Work practice "Assistant of junior medical personnel" + + + + 20 Work practice "Assistant of the ward nurse" + + + + 21. Work practice "Assistant of the procedural nurse" + + + + 4 Forms, place and time of the educational practice "Care for patients of a therapeutic and surgical profile": educational. - training simulation center OrGMA; - NUZ OKB at st. Orenburg. 1, 2 semesters. Terms of practice Duration of practice (in hours) 144 hours. Labor input of practice (in units) 6 credit units. Form of conducting practice Bases of conducting practice 5. Competences of the student, formed as a result of passing educational practice: A graduate in the specialty 060101.65 - general medicine with a qualification - a specialist, a special title - a doctor must have the following competencies: Competences Content according to the Federal State Educational Standard General cultural ability and willingness to analyze socially significant OK-1 problems and processes, use in practice the methods of the humanities, natural sciences, biomedical and clinical sciences in various types professional and social activities the ability and readiness to analyze worldview, socially and OK-2 personally significant philosophical problems, basic philosophical categories, to self-improvement junior medical staff, adults and adolescents, their parents and relatives the ability and willingness to conduct and interpret the survey, PC-5 physical examination, clinical examination, the results of modern laboratory and instrumental studies, morphological analysis of biopsy, surgical and sectional material, write a medical record of an outpatient and a hospital patient with the ability and willingness to apply aseptic and antiseptic methods, PC-7 to use medical instruments, to sanitize medical and diagnostic facilities of medical organizations, authorities develop patient care techniques with the ability and willingness to perform basic medical measures PC-19 in the most common diseases and conditions in the adult population and adolescents that can cause severe complications and (or) death: diseases of the nervous, endocrine, immune, cardiovascular, respiratory, digestive, genitourinary systems and blood, timely identify life-threatening violations (acute blood loss, respiratory failure, cardiac arrest, coma, shock), use methods for their immediate elimination, carry out anti-shock measures with the ability and willingness to use regulatory documentation, PK-27 adopted in healthcare (laws of the Russian Federation, technical regulations, international and national standards , orders, recommendations, terminology, international systems of units (SI), current international classifications), as well as documentation for assessing the quality and effectiveness of work medical organizations 6. Scope, structure and content of training practice: a) Scope of training practice and types of study work: Total hours I semester II semester Classroom classes (total) Including: Lectures (L) 144 64 80 32 16 16 Practical classes (PZ) 112 48 64 Type of study work Independent work (total) Including: Preparation of an oral answer for the current control 72 32 40 28 12 16 Independent work to develop practical skills 28 12 16 Doing homework in workbooks for independent work 4 2 2 Diary of educational practice» 6 3 3 Preparation for intermediate control 6 3 3 Test Type of intermediate certification. 216 hours 6 credit units Total labor intensity b) Structure of training practice: No. p / p 1. 2. 3. 4. Discipline module Organization of work of medical institutions of a therapeutic profile Care of a therapeutic patient Organization of work of medical institutions of a surgical profile for a surgical patient Credit From Weeks Types of educational work, including independent work of students and from a semester labor intensity (in hours) t Lectures Prakt. Self. r and busy. work I 1-5 8 20 12 I II II II 6 - 12 1-9 10 - 15 16 8 8 8 - 28 36 24 4 20 20 20 Milestone control points and final control (control forms) and week of carrying out Current control: - testing; - Practical skills. Midterm control (week 5): - testing. Current control: - testing; - Practical skills. Midterm control (12 weeks): - testing. Current control: - testing; - Practical skills. Midterm control (8 weeks): - testing. Current control: - testing; - Practical skills. Boundary control (15 week): - testing. Intermediate control Total 16 32 112 72 (week 16): - oral questioning on tickets; - acquisition of practical skills. Test at the end of the spring semester (week 16) c) The content of the modules of educational practice: No. Name of the p / p module of the discipline Total labor intensity 1. Organization of the work of medical institutions of a therapeutic profile 40 hours Content of the module (in didactic units) Competences Philosophy and theory of nursing. OK-1,2 History of nursing. Fundamentals of philosophy of nursing. Biomedical ethics in PC-1,7,27 medical practice. General principles of communication with the patient. Factors that promote and hinder communication. iatrogenic diseases. Medical secrecy. Moral and legal responsibility of medical personnel. Code of conduct. The structure of the hospital. Types of medical care. The main areas for providing medical care to the population: preventive, medical and diagnostic, medical and social, rehabilitation. Types of health care institutions. Medical institutions. Hospital, the main structural units. Types of nurses, their duties. Emergency room. The structure of the hospital. Reception structure. Receptionist functions. Responsibilities of an Admissions Nurse. Paperwork. Sanitation of patients. Pediculosis, sanitization of the patient in case of detection of pediculosis. Transportation of patients. Carrying, shifting the patient. The structure and functions of the therapeutic department. The structure and functions of the therapeutic department. Organization of work of the therapeutic department. Arrangement and equipment of wards, utility rooms. Postal nurse, her duties. Organization of the work of the nursing post: equipment, medical documentation, the procedure for receiving and handing over shifts. Anthropometry. Measurement of height, chest circumference of the patient. weight, Types of hospital regimens. Types of hospital regimes. Therapeutic and protective regimen: daily routine, ways to ensure mental and physical comfort, patient safety. Individual motor regimen: strict bed, bed, ward, general. Sanitary and epidemiological regime. The concept of nosocomial infection. pathogens nosocomial infection, transmission mechanism. Disinfection. Types of disinfection: preventive and focal. Disinfection methods. requirements for disinfectants. disinfection levels. 2. Catering in a medical institution. Basic principles rational nutrition healthy person. The main constituents of food are proteins, fats, carbohydrates, minerals, vitamins and water. Basic principles of clinical nutrition. Therapeutic diets. Catering. Distribution of food. Active nutrition. Passive nutrition: indications and contraindications, methods. Feeding the seriously ill. Artificial nutrition: enteral and parenteral nutrition. Feeding the patient through a gastrostomy, through a nasogastric tube. Rules for the transfer and storage of products in the department. Personal hygiene of the patient. Position in OK-1.2 Care of the bed. Oral care. Ear care. therapeutic nasal care. Eye care. PC patient care 56 hours skin care. Features of observation and care of 1,5,7,27 bedridden patients. Perineal care. The use of vessels and urinals. Change of bed and underwear. Bedsores: causes and stages. Skin care in the presence of bedsores and their prevention. Features of observation and care of patients of elderly and senile age. The simplest physiotherapy. Impact on the patient's body: the simplest physiotherapy. Mustard plasters. Compresses: cold compress, hot compress, wet warm compress, dry warm compress. Leeches. Heating pads. Ice pack. Hydrotherapy: baths, showers, douches. Indications and contraindications for use, algorithm of action, complications. Observation and care of patients with respiratory diseases. Complaints of the patient with diseases of the respiratory system: cough, chest pain, shortness of breath, asthma attack, hemoptysis, features of care. Counting the frequency of respiratory movements. Collection of sputum for laboratory research: general sputum analysis, sputum collection for mycobacterium tuberculosis, atypical cells, bacterial culture. Preparation for instrumental methods of examination of the respiratory system. Oxygen therapy: inhalation and non-inhalation methods. Observation and care of patients with diseases of the circulatory system. Complaints of a cardiac patient: pain in the heart, palpitations and interruptions, an increase and decrease in blood pressure, swelling, shortness of breath, an asthma attack, care features. Palpation of the pulse, pulse characteristics: symmetry, frequency, rhythm, filling and tension. Method for measuring blood pressure. Electrocardiogram technique. 3. Organization of work of medical institutions of surgical profile 64 hours Principles of organization of surgical OK-1,2 assistance to the population. Organization of surgical care to the population. Peculiarities of PC reception - 1,7,27 surgical patients. The structure of the surgical department, its layout, dressing room, surgical ward. The division of surgical nurses depending on the duties performed: dressing nurse, operating nurse. Asepsis and antisepsis in the surgical clinic. The concept of nosocomial infection in surgery, the ways of penetration of infection. Clinical environmental hygiene. Requirements for the sanitization of tools and equipment in medical institutions. Sterilization. Control of pre-sterilization treatment, control of sterilization. dressing room. Medical waste: types, disposal. Clinical hygiene of medical personnel in a surgical clinic. appearance requirements. Three levels of hand treatment. Safety rules for working with blood. HIV infection, ways of transmission, clinical manifestations, prevention. Ways of using medicinal substances. Dispensing and storage of medicines. Organization of distribution of medicines in the department. External use of medicines. Enteral drug administration. parenteral administration of drugs. Organization of the work of the treatment room. Discharge, storage of narcotic drugs. Types of syringes, needles and their device. intradermal injections. Subcutaneous, intramuscular, intravenous injections. Complications. First aid. catheter care. Caring for a patient with physiological disorders. Enemas, types of enemas. Indications and contraindications for enema, complications. Gastric lavage: indications and contraindications, possible complications. Installation of a gas outlet tube: indications and contraindications, possible complications. Observation of patients with diseases of the digestive system. Complaints of the gastric patient: pain, dyspeptic disorders, nausea and vomiting, features of care. Probing of the stomach: technique, indications and contraindications. Monitoring and care of patients with impaired renal function and urinary tract. Complaints of a renal patient: pain, swelling, increased blood pressure, urination disorder, care features. Urine collection for laboratory studies: general urinalysis, urine collection according to Nechiporenko, Kakovsky-Addis, Ambourzhe, Zimnitsky, dilution and concentration test. catheterization Bladder . Caring for an indwelling catheter. 4. Care of the surgical patient 52 hours for Care of the patient in the preoperative OK-1,2 period. Patient care in the preoperative period. Psychological preparation, preparation of PC-1.5, respiratory system, circulatory system, 7.27 digestion. Preparation of the operating field. Preparation of patients for planned operations. Preparation of patients for emergency operations. Care of the patient during the operating periods. Structure and equipment of the operating unit. Sanitary and hygienic regime in the operating unit. Patient care during the operating period. Responsibilities of the operating room nurse. Operating room cleaning. Treatment of medical equipment in the operating room. Patient care in the postoperative period. Care of the operating wound, drains, probes, catheters. Features of postoperative management and care of patients after various types of surgery in the abdominal cavity. Features of postoperative management and care of patients after various types of surgery. Desmurgy. Bandage materials. Classification of dressings by type of dressing material, by purpose, by method of fixation. Basic rules of desmurgy. Bandage-free and bandage bandages. Hemostasis. Types of bleeding. Ways to temporarily stop bleeding. Pressure bandage. Finger pressure. Maximum limb flexion. The imposition of a tourniquet. Tight tamponade of the wound. The imposition of a clamp on the vessel. transport immobilization. Principles of transport immobilization. Types of transport tires. Features of transport immobilization in case of damage to various parts of the body. Immobilization by improvised means. Gypsum bandage. General care for trauma patients with different localization of injuries depending on the methods of treatment used. d) Elements of competencies formed by this educational practice: OK-No. 1,2 PC-No. 1,5,7,27 natural sciences, biomedical and clinical sciences in various types of professional and social activities 1.1. Component - ability and readiness to analyze socially significant problems and processes 1.1.1. Content - in the course of professional activity, he is able to identify and analyze problems and processes that are relevant to society. Each section of educational practice analyzes the actual problems of modern medicine and society in order to form students' active professional and civic position, the ability to identify the essence of problems and processes that are relevant 1. 1.2. Technology - the organization of educational and independent work of students aimed at developing the skills of conducting discussions, public speaking, reasoned expression of one's opinion, analysis of educational and scientific literature, legal and ethical documents, solving situational problems, writing essays 1.1.3. Control - a survey in practical classes, seminars, evaluation of the solution (orally and in writing) of situational problems, testing, reviewing abstracts, editing speeches , to self-improvement 2.1. Component - ability and readiness for self-improvement 2.1.1. Content - able to constantly improve their cultural and professional level In each topic of educational practice, the need for self-education, constant work on oneself is emphasized in order to form students' understanding of the physician's duty to the patient and to society 2.1.2. Technology - the organization of educational and independent work of students aimed at educating the moral character of a doctor; study of the philosophy of medicine; use as an example of fiction, films and personal experience of the teacher 2.1.3. Control - individual and frontal survey at seminars, assessment of the solution of situational problems, checking workbooks, reviewing abstracts, editing speeches , adults and adolescents, their parents and relatives 3.1. Component - the ability and willingness to implement the ethical and deontological aspects of medical practice in communication with colleagues, middle and junior medical staff 3.1.1. Content - is able to observe the principles of medical ethics and deontology with colleagues in professional activities. At each lecture and practical lesson, the attention of students is focused on medical ethics and deontology in order to form in students such integral qualities of a doctor as honesty, devotion, selflessness, mercy, kindness and humanity, patience and tolerance, the ability to respect the work of colleagues, nurses, nurses 3.1.2. Technology - the organization of educational and independent work of students aimed at educating the moral character of a doctor: accuracy, sensitivity, goodwill, accuracy and commitment, self-control and self-control; use as an example of fiction, films, personal behavior of a teacher in practical classes in departments of medical organizations 3. 1.3. Control - individual survey at seminars, evaluation of solutions (orally and in writing) of situational problems, testing, terminological dictation, reviewing abstracts, editing abstracts of speeches 3.2. Component - the ability and willingness to implement the ethical and deontological aspects of medical practice in communication with the adult population and adolescents, their parents and relatives 3.2.1. Content - in professional activities, when communicating with children, adolescents, their parents, be guided by the principles of medical ethics and deontology. In the process of teaching at lectures, practical classes, the need to cultivate qualities conducive to mutual understanding with a sick child, his parents and other relatives is emphasized - disinterestedness, selflessness , devotion to the chosen profession, ability to receive moral satisfaction from one's work 3.2.2. Technology - the organization of educational and independent work of students aimed at educating the moral character of a doctor, studying the factors that contribute to and hinder communication; using as an example fiction, movies and personal experience teacher 3.2.3. Control - individual survey at seminars, evaluation of solutions (orally and in writing) of situational problems, testing, terminological dictation, reviewing abstracts, editing notes of speeches, assessment of students' behavior in the clinic 4. PC - No. 5 - ability and willingness to conduct and interpret the survey, physical examination, clinical examination, results of modern laboratory and instrumental studies, morphological analysis of biopsy, surgical and sectional material, write a medical record of an outpatient and inpatient 4.1. Component - ability and willingness to conduct and interpret the interview, physical examination 4.1.1. Content - able to collect patient complaints, ask relatives, assess the patient's general condition, consciousness, motor activity, skin, measure height, weight, body temperature, blood pressure, count the pulse rate and number of respiratory movements, assess the patient's ability to self-care educational practice deals with theoretical and practical aspects of physical research methods in order to form students' practical skills of clinical examination of patients 4.1.2. Technology - the organization of educational and independent work of students aimed at acquiring practical skills for collecting complaints, collecting and evaluating an anamnesis in therapeutic practice, methods of general examination of the patient, assessing the main vital signs and anthropometric data 4.1.3. Control - individual survey at seminars, testing, testing of practical skills 4.2. Component - the ability and willingness to write a medical record of an inpatient 4.2.1. Content - is able to draw up a medical card of an inpatient medical card of an inpatient patient, skills are acquired to fill in the title page of the inpatient medical record (U.F. 003), referral forms for laboratory and instrumental research methods, temperature sheet, entering their results into the medical record 4.2.2. Technology - the organization of educational and independent work of students aimed at acquiring practical skills in working with basic medical documentation in the emergency room and therapeutic departments 4.2.3. Control - individual survey at seminars, testing, registration of a "training" case history, temperature sheet 5. PC - No. 7 - the ability and willingness to apply aseptic and antiseptic methods, use medical instruments, sanitize medical and diagnostic rooms of medical organizations, own equipment patient care 5.1. Component - ability and willingness to use medical instruments 5.1.1. Content - able and ready to use medical instruments in the course of professional activities During the training practice, practical skills are developed in the use of medical instruments to perform various manipulations to care for a therapeutic patient (tube feeding, oxygen therapy, etc.) 5.1.2. Technology - organization of educational and independent work of students to develop practical skills using various medical instruments on the basis of a training simulation center and a clinic 5.1.3. Control - individual questioning at seminars, testing, testing of practical skills 5.2. Component - the ability and willingness to apply aseptic and antiseptic methods, to sanitize medical and diagnostic facilities of medical organizations 5.2.1. Content - able and ready to apply in the course of professional activity the basic rules of asepsis and antiseptics hygienic treatment of the hands of medical personnel, disinfection of medical waste in order to form students' concept of a "safe hospital environment" 5.2.2. Technology - the organization of educational and independent work of students aimed at mastering theoretical knowledge on issues of asepsis and antisepsis, disinfection, on the basis of which practical skills are formed: cleaning of premises, preparation of instruments for sterilization, hygienic hand washing, waste disposal 5.2.3. Control - individual questioning at seminars, testing, testing of practical skills 5.3. Component - master the technique of patient care 5.3.1. Content - able to create favorable conditions for the patient to recover, alleviate the patient's suffering, prevent the development of complications simple physiotherapy 5.3.2. Technology - the organization of educational and independent work of students aimed at mastering theoretical knowledge on the care of a patient of a therapeutic profile, on the basis of which practical skills of general and special care are formed 5.3.3. Control - individual survey at seminars, testing, terminological dictation, testing of practical skills death: diseases of the nervous, endocrine, immune, cardiovascular, respiratory, digestive, genitourinary systems and blood, timely detect life-threatening disorders (acute blood loss, respiratory failure, cardiac arrest, coma, shock), use methods for their immediate elimination, implement anti-shock activities 6.1.1. Component - the ability and readiness to perform basic therapeutic measures for the most common diseases and conditions in the adult population and adolescents that can cause severe complications and (or) death: acute blood loss, use methods for their immediate elimination, and take anti-shock measures 6.1.2. Content - is able and ready to apply methods of temporary stopping of bleeding, determine the type of bleeding and select the most optimal methods of temporary hemostasis, master the technique of applying a pressure bandage, applying a hemostatic tourniquet, digital pressing of the arteries to the bone, maximum limb flexion 6.1.3. Technology - organization of educational and independent work of students aimed at mastering theoretical knowledge on the use of hemostasis; demonstration of educational videos; development of practical skills using simulation equipment 6. 1.4. Control - individual survey at seminars, testing, terminological dictation, testing of practical skills , international systems of units (SI), current international classifications), as well as documentation for assessing the quality and efficiency of medical organizations 7.1. Component - the ability and willingness to use the regulatory documentation adopted in healthcare (laws of the Russian Federation, technical regulations, international and national standards, orders, recommendations, terminology, international systems of units (SI), current international classifications) 7.1.1. Content - able and ready in the course of professional activities to rely on orders, regulations and standards of the central and local levels for the provision of medical care to the population During the training, students get acquainted with the main regulatory documentation used in professional activities; learn to work with international and national standards; learn common terminology 7.1.2. Technology - the organization of educational and independent work of students aimed at mastering theoretical knowledge on the use of regulatory documentation; development of practical skills in patient care based on federal and regional standards 7.1.3. Control - individual survey at seminars, testing, terminological dictation, testing of practical skills e) The structure of modules and types of independent work of educational practice: No. p / p Topics of practical classes (seminars) Labor intensity (hours) Weeks in a semester 2 1 2 2 2 3 5 7 4 1 4 2 4 3 4 4 4 5 12 1-5 Module 1 Organization of the work of medical institutions of a therapeutic profile 1. Classroom work 1 2 3 4 1 2 3 4 5 a) Lectures Philosophy of nursing. Biomedical ethics in nursing practice. The concept of general care in therapeutic practice. Medical assistance to the population: organization and structure. Catering in a medical institution. b) Practical exercises Philosophy and theory of nursing. Biomedical ethics in nursing practice. The structure of the hospital. Reception department: functions and structure. Pediculosis. Medical department of the hospital. Types of hospital regimes. Nosocomial infection. Disinfection. Catering in a medical institution. c) Boundary control Control points: - testing. 2. Independent extracurricular work a) Mandatory *Forms of work 1. Preparation of an oral answer for the current control. 2. Independent work on developing practical skills. 3. Preparation for intermediate control. 4. Doing homework in workbooks for independent work. 5. Keeping a "Diary of educational practice". *Types of control 1. Checking theoretical and practical knowledge in a practical lesson, test. 2. Testing on given topics. 3. Checking workbooks and the "Diary of educational practice." b) Optional 1. Participation in the creation of visual teaching aids. 2. Create presentations. 3. Creation of educational films. 4. Carrying out sanitary and educational work (conversations) among patients (development of a health bulletin, posters). 5. Writing an abstract. Up to 20 hours 1-5 2 2 2 9 11 13 2 15 4 6 4 7 4 4 4 8 9 10 4 11 4 12 20 6-12 Up to 20 6-12 Module 2 Caring for the Therapeutic Patient 1. Classroom work a) Lectures 1 2 3 4 1 2 3 4 5 6 7 Personal hygiene. Supervision and care of the elderly patient. Observation and care of patients with diseases of the circulatory system. Observation and care of patients with respiratory diseases. b) Practical exercises Simulation module "Basics of caring for the seriously ill." Part 1. Personal hygiene of the patient. Caring for elderly and senile patients. Simulation module "Fundamentals of care for the seriously ill." Part 2. Personal hygiene of the patient. Features of observation and care of bedridden patients. Skin care in the presence of bedsores and their prevention. The simplest physiotherapy. Part 1. The simplest physiotherapy. Part 2. Observation of patients with diseases of the circulatory system. Observation of patients with respiratory diseases. c) Boundary control Control points: - testing. 2. Independent extracurricular work a) Mandatory *Forms of work 1. Preparation of an oral answer for the current control. 2. Independent work on developing practical skills. 3. Preparation for intermediate control. 4. Doing homework in workbooks for independent work. 5. Keeping a "Diary of educational practice". *Types of control 1. Checking theoretical and practical knowledge in a practical lesson, test. 2. Testing on given topics. 3. Checking workbooks and the "Diary of educational practice." b) Optional 1. Participation in the creation of visual teaching aids. 2. Create presentations. 3. Creation of educational films. 4. Carrying out sanitary and educational work (conversations) among patients (development of a health bulletin, posters). 5. Writing an abstract. hours Module 3 Organization of the work of medical institutions of a surgical profile 1. Classroom work 1 2 3 4 1 2 3 4 5 6 7 8 9 a) Lectures Asepsis and antisepsis. Clinical hygiene of a surgical hospital. Application methods medicines in surgical practice. Gastroenterological patient care in the surgical department. Observation and care of patients with impaired renal and urinary tract functions. b) Practical exercises Principles of organizing surgical care for the population. Clinical hygiene of a surgical hospital. Antisepsis and asepsis in the surgical clinic. Sterilization. Medical waste. Simulation module "Asepsis and antisepsis". Ways of using medicinal substances. Simulation module "Parenteral administration of drugs". Observation and care of patients with diseases of the digestive system. Simulation module "Probe manipulations". Simulation module "Enema". Observation and care of patients with impaired renal and urinary tract functions. Simulation module "Bladder catheterization". c) Boundary control Control points: - testing. 2. Independent extracurricular work a) Mandatory *Forms of work 1. Preparation of an oral answer for the current control. 2. Independent work on developing practical skills. 3. Preparation for intermediate control. 4. Doing homework in workbooks for independent work. 5. Keeping a "Diary of educational practice". *Types of control 1. Checking theoretical and practical knowledge in a practical lesson, test. 2 1 2 3 2 5 2 7 4 1 4 4 2 3 4 4 4 4 4 5 6 7 4 9 20 1-9 2. Testing on given topics. 3. Checking workbooks and the "Diary of educational practice." b) Optional 1. Participation in the creation of visual teaching aids. 2. Create presentations. 3. Creation of educational films. 4. Carrying out sanitary and educational work (conversations) among patients (development of a health bulletin, posters). 5. Writing an abstract. Up to 20 hours 1-9 2 9 2 11 2 2 13 15 4 10 4 11 4 4 4 12 13 14 4 15 20 9-16 Up to 20 hours 9-16 Module 4 Surgical patient care 1. Classroom work 1 2 3 4 1 2 3 4 5 6 a) Lectures Clinical hygiene of the surgical patient in the preoperative period and during the operational periods. Clinical hygiene of the surgical patient in the postoperative period. Hemostasis. transport immobilization. Care of trauma patients. b) Practical exercises Observation and care of patients in the preoperative and operational periods. Observation and care of patients in the postoperative period. Fundamentals of desmurgy. Simulation module "Desmurgia". Simulation module "Hemostasis". c) Boundary control Control points: - testing. 2. Independent extracurricular work a) Mandatory *Forms of work 1. Preparation of oral response to the current control. 2. Independent work on developing practical skills. 3. Preparation for intermediate control. 4. Doing homework in workbooks for independent work. 5. Keeping a "Diary of educational practice". *Types of control 1. Checking theoretical and practical knowledge in a practical lesson, test. 2. Testing on given topics. 3. Checking workbooks and the "Diary of educational practice." b) Optional 6. Participation in the creation of visual teaching aids. 7. Create presentations. 8. Creation of educational films. 9. Carrying out sanitary-educational work (conversations) among patients (development of a health bulletin, posters). 10. Writing an abstract. g) As a result of studying the educational practice, the student must master: No. p / p 1. Type of professional activity: general professional. 1.1. Professional task: general professional. PC-1 a) know: moral and ethical norms, rules and principles of professional medical behavior; - the rights of the patient and the doctor; duties, rights, place of a doctor in society. b) be able to: build and maintain working relationships with other members of the team; - Build and maintain relationships with patients and their families. a) possess: the skills of questioning and informing patients and their relatives in accordance with the requirements of the rules of "informed consent". 2. Type of professional activity: preventive. task: carrying out preventive and 2.1. Professional anti-epidemiological measures aimed at preventing the occurrence of infectious diseases. PC-7 a) know: signs of pediculosis; types of sanitary treatment of patients in the emergency department; types of sanitary treatment of patients in therapeutic and surgical hospital; types and methods of disinfection; types and methods of sterilization; - rules of asepsis and antisepsis; types and methods of pre-sterilization treatment of instruments; features of preoperative preparation for emergency and planned operations; features of observation and care of surgical patients in the pre-, peri- and postoperative periods; - basic rules of personal hygiene. b) be able to: change the patient's underwear and bed linen; carry out prevention and treatment of bedsores; carry out sanitization of the patient upon admission to the hospital and during the period of stay in the hospital; - to monitor and care for patients with diseases of the respiratory, circulatory, urinary systems; - Caring for stoma and drains. a) possess: methods of disinfection of medical instruments, materials and means of patient care; the main methods of caring for patients of a therapeutic profile; the main methods of care for the elderly and seriously ill patients. 3. Type of professional activity: diagnostic. 3.1. Professional task: diagnosis of diseases and pathological conditions in the adult population and adolescents on the basis of possession of propaedeutic research methods. PC-5 a) know: possible complaints patients with surgical pathology of the respiratory, cardiovascular, gastroenterological and urinary systems in the pre- and postoperative periods; possible complaints of patients with diseases of the respiratory, cardiovascular and urinary systems; - modes of physical activity; - types of consciousness; - the main characteristics of the pulse; normative values of arterial pressure. b) be able to: assess the general condition and consciousness of the patient; - assess the position of the patient in bed; - evaluate the condition skin; - make anthropometric measurements; - evaluate the condition postoperative wound , bandages. a) possess: general inspection skills; skills of palpation of the pulse on the radial and carotid arteries; - the skills of determining blood pressure; ability to determine the frequency of respiratory movements. 3.2. Professional task: diagnosis of emergency conditions in the adult population and adolescents. PC-5 a) know: the main complaints of patients with diseases of various organs and systems of patients with a therapeutic profile; the main complaints of patients with diseases of various organs and systems of surgical patients. b) be able to: identify clinical manifestations of emergency conditions in surgical patients; identify clinical manifestations of emergency conditions in patients with a therapeutic profile. a) possess: - the skills to identify the main complaints and clinical manifestations of emergency conditions in surgical patients; skills to identify the main complaints and clinical manifestations of emergency conditions in patients of a therapeutic profile. 4. Type of professional activity: rehabilitation. 4.1. Professional task: the use of physical therapy, physiotherapy, non-traditional methods of therapy (reflexology, herbal medicine, homeopathy) and the main resort factors in the adult population and adolescents in need of rehabilitation. PC-7 a) know: - the mechanism of action of the main physiotherapeutic factors. the basic principles of nutrition of a healthy and sick person; - medical tables. b) be able to: apply the methods of simple physiotherapy. a) master: - basic methods of simple physiotherapy in therapeutic and surgical practice; skills of feeding seriously ill patients; - the skills of feeding patients through a gastrostomy and nasogastric tube. 5. Type of professional activity: organizational and managerial. 5.1. Professional task: maintaining accounting and reporting medical documentation. PC-5, 27 a) know: medical documentation of the emergency room and nursing station. b) be able to: draw up the title page of the medical record of an inpatient; - draw up an insert in the medical history; - draw up a temperature sheet; - draw up a list of appointments; issue a portion requirement; draw up a register of reception and delivery of duty. a) possess: the skills of medical documentation of the emergency room and nursing station. Professional task: organization of measures for labor protection and technology 5.2. safety, prevention of occupational diseases, monitoring compliance and ensuring environmental safety. PC-27 a) know: occupational diseases transmitted through blood; safety rules when working with patient's biological fluids; types and methods of disposal of medical waste. b) be able to: organize the disposal of medical waste; to carry out a set of preventive measures in contact with the patient's blood. a) possess: skills to prevent occupational diseases when working with blood. 7. Types of independent work in educational practice: Mandatory extracurricular intermodular independent work - not provided. Additional extracurricular independent work: Type of work Participation in the creation of visual teaching aids Creation of presentations Creation of educational films Conducting health education work (conversations) among patients Writing an essay health bulletin; leaflet development; development of posters Protection of the abstract at a practical lesson. 4 Organization of certification based on the results of educational practice: Form of certification Labor-intensive Weeks in the awn of the semester (hours) Test c) Forms of control Stage 1 Analysis of the “Diary of educational practice”. Stage 2 Practical skills. List of practical skills 1. Subcutaneous injection. 2. Intramuscular injection. 3. Intravenous injection. 4. Technique for filling the system for intravenous infusion. 5. Catheterization of the female bladder. 6. Catheterization of the male bladder. 7. Ear care. 8. Eye care. 9. Instillation of drops in the ears, drops in the eyes. 10. Applying a wet warm compress. 11. Performing a cleansing enema. 12. Bandaging. Bandage Deso. 13. Bandaging. Spiral bandage on the forearm. 14. Bandaging. Divergent tortoise bandage for 0.5 2 (II semester) 16 week knee joint. 15. Bandaging. Converging tortoiseshell bandage on the elbow joint. 16. Applying a bandage "cap". 17. Applying a bandage on the finger. 18. Applying a pressure bandage. 19. Technique for introducing a gastric tube. Stage 3 Oral questioning on tickets. List of questions for the test: 1. Ethics, medical ethics, medical deontology. Sections of medical deontology. 2. Requirements for the appearance of a medical worker. Health worker hygiene. 3. Definition of the concept of general nursing. Components of general patient care. iatrogenic diseases. 4. Responsibilities of a junior nurse to care for patients. Responsibilities of a paramedical nurse to care for patients. 5. Reception department (rest) of the hospital. Types of reception rooms. Receptionist functions. 6. Structural and functional divisions of the admission department. 7. Reception department. Reception and registration of patients. types of hospitalizations. 8. Responsibilities of a nurse in the emergency department. 9. Medical documentation of the nurse of the admission department. 10. Technique of anthropometry of patients in the emergency department (thermometry, measurement of height, weighing, measurement of the circumference of the chest and abdomen). 11. Sanitary treatment of the patient in the emergency room. 12. Treatment of the patient upon detection of pediculosis. 13. Types and technique of transporting patients. Transfer of patients. 14. Organization of the work of the medical department of the therapeutic profile. Nursing organization. 15. Types of modes of motor activity of patients. 16. Duties of a ward nurse. 17. Catering in a medical institution. Participation of junior and middle medical personnel in catering for patients. 18. Basic principles of nutrition for a healthy and sick person. 1.5 19. Ways of eating. Passive nutrition: indications and contraindications, action algorithm. 20. Ways of eating. Parenteral nutrition: indications and contraindications, action algorithm. 21. Technique for measuring blood pressure by the Korotkov method. Normal blood pressure values. 22. Pulse. Palpation of the pulse. Characteristics of the pulse. 23. Documentation of the guard nurse. Transfer of duty of the guard nurse. 24. Sanitary and hygienic regime of the medical department. Nosocomial infection. Pathogens, ways of transmission 25. Disinfection. Types of disinfection. Disinfection methods. 26. The concept of occupational diseases. Methods for the prevention of occupational diseases when working with blood. 27. Features of caring for a cardiac patient. 28. Symptoms of an attack of angina pectoris. First aid. 29. Fainting. Collapse. First aid. 30. Nursing with acute infarction myocardium. 31. Features of care for seriously ill patients. 32. Bedsores. Etiology, pathogenesis. Prevention of bedsores. 33. Features of care for patients with pathology of the respiratory system. 34. Shortness of breath, types of shortness of breath. Attack of bronchial asthma. First aid. 35. Oxygen therapy. Types, technique of carrying out oxygen therapy from an oxygen cushion. 36. Sputum analysis: sputum collection technique for general analysis, for tuberculosis, bacterial culture. 37. Compresses, types. Cold compress, indications and contraindications, action algorithm. 38. Warming wet compress. Indications, contraindications, algorithm of action. 39. Hydrotherapy. The main factors of influence. Classification water procedures depending on the temperature of the water, the mechanism of action. 40. Mustard plasters. Indications, contraindications, mechanism of action, algorithm of action. 41. Oxygen therapy (inhalation method). Algorithm of action when supplying an oxygen-air mixture from an oxygen cushion. 42. Ice pack. Indications, contraindications, mechanism of action. 43. Symptoms of diseases of the kidneys and urinary tract. Features of care. 44. Types of urinary disorders in diseases of the kidneys and urinary tract. Help with acute urinary retention. 45. Urine sampling technique for general analysis, Nechiporenko samples, Zimnitsky samples. 46. Methods of urine sampling for bacteriological examination, carrying out stress functional tests. 47. Features of care for patients with diseases of the kidneys and urinary tract (mode, nutrition). 48. Thermometry. Measurement rules. Places of measurement. Factors affecting body temperature. 49. Stages of fever. Care of the patient in the first period of fever. 50. Stages of fever. Care of the sick in the second period of fever. 51. Stages of fever. Care of the patient in the third period of fever. 52. Clinical environmental hygiene of the surgical department. 53. The concept of nosocomial infection in surgery: pathogens, entry gates, penetration routes. 54. HIV infection, general concept, transmission mechanism. Prevention of occupational diseases when working with blood. 55. Rules for the issuance, storage and distribution of medicines. Routes of drug administration. 56. Post-injection complications. 57. Preoperative preparation of the patient for elective surgery, emergency surgery. 58. Operating block, structure, clinical hygiene of personnel. Features of the sanitary and epidemiological regime. 59. Postoperative period: periods, complications. Patient care in the postoperative period. 60. Features of the care of the surgical wound. Drainages: types, care. Stomas: types, care. 61. Equipping the intensive care unit. Documentation of the nursing station in the intensive care unit. 62. The main symptoms of gastrointestinal pathology. Vomiting of central and peripheral genesis. First aid for vomiting. 63. Gastric lavage. Indications and contraindications. Methods, technique. 64. stomach bleeding, Clinical signs. First aid for gastric bleeding. 65. Views instrumental methods research. Preparation of the patient for x-ray and endoscopic examination of the stomach. 66. Types of instrumental research methods. Preparation of the patient for X-ray and endoscopic examination of the large intestine. 67. Gastric sounding, indications, contraindications. Methodology. 68. Duodenal sounding, indications, contraindications. Technique of duodenal sounding. 69. Enemas. Types of enemas. Cleansing enema. Indications and contraindications. 70. Fundamentals of deontology of general patient care in surgery. Influence of the psychological component of care on the consequences of the treatment of a surgical patient. 71. The concept of asepsis and antiseptics, disinfection, their types, features. 72. Terminal states. Signs of clinical death. Signs of biological death. 73. Resuscitation measures: the technique of artificial respiration, chest compressions. 74. First health care with mechanical injuries in patients. Principles of transport immobilization. Plaster cast, possible complications. 75. Fundamentals of desmurgy. Classification of dressings and dressings. Possible errors when applying bandages. 76. First aid for thermal injuries in patients. 77. First aid for frostbite and hypothermia. 78. Bleeding: types. Ways to temporarily stop bleeding. 79. First first aid with bleeding. Ways to temporarily stop bleeding. Rules for applying a hemostatic tourniquet, possible errors when applying a tourniquet. 80. First aid for bleeding. Ways to temporarily stop bleeding. Digital pressure of the artery to the bone, anatomical places of pressure of the arteries. 81. Observation and care of a patient after transfusion of blood and its components. Hemotransfusion complications. Assessment of students' knowledge is carried out in accordance with the point-rating system developed at the department. 9. Educational-methodical and information support of educational practice: No. p/p 1. Bibliography a) basic literature: 1.N.V.Turkina, A.B.Filenko. General nursing: Textbook. M .: Association of scientific publications KMK, 2007, 550 p., color. ill. 2. V.N. Oslopov, O.V. Bogoyavlenskaya. General nursing in a therapeutic clinic: A textbook. - 2nd ed., corrected. and add.M.: GEOTAR-Media, 2005.- 400 p.: ill. b) additional literature: 1. V.N. Chernov, I.I. Taranov, A.I. Maslov. Care of surgical patients: Textbook.- Rostov n / D: Phoenix, 2006.- 224 p. (Medicine for you). 2. S.V. Petrov, A.N. Shishkin, O.V. Fionik, L.A. Blind. Introduction to clinical medicine(Fundamentals of nursing): Textbook.- St. Petersburg: Publishing House of St. Petersburg. un-ta, 2000.- 148 p. 3. A.A. Shevchenko. Clinical care for surgical patients. "Lessons of kindness": textbook. - M .: GEOTAR-Media, 2007. - 416 p., ill. 2 3 Teaching aids Databases, information and reference systems and search systems a) mandatory: 1. Yu.A. Yudaeva, L.A. Sergeeva, I.G. Yulmetov. Student's workbook for practical exercises on thermometry. Textbook.- Orenburg, 2011.- 23c. b) additional: 1. Yu.A. Yudaeva, L.A. Sergeeva, I.G. Yulmetov. Theoretical foundations of patient care. Textbook for 1st year students of the Faculty of Medicine. Orenburg, 2011.- 25 p. 2. Yu.A. Yudaeva, L.A. Sergeeva, I.G. Yulmetov. Catering in medical institutions. Textbook for 1st year students of the Faculty of Medicine. Orenburg, 2011.- 34p. Internet resources relevant to the subject of the discipline: - Student consultant ( digital library Medical University), www.studmedlib.ru. Head of the library N.I. Vereshchagin 10. Material and technical support of educational practice: № molule Logistic support 1 module Specially equipped office): office-ward. Technical equipment, dummies: 2nd module 3rd module 4th module - Metal stadiometer RM-1; - Bed metal general medical; - Janet's syringe; - Gastric tube. Specially equipped rooms): office-ward and office-manipulation. Technical equipment, dummies: - Tonometers IAD-01 "Adyutor"; - Electronic thermometers DT-632; - Bed metal general medical; - Electrocardiograph EK1T-1/3-07 "AXION"; - Mannequin for practicing nursing skills; - Polymer bedpan "NT MIZ"; - Rubber bedpan No. 2 SRP-"Alpha"; - Rubber heating pad No. 2 GR-"Alpha"; - Ice pack; - Facial oxygen mask; - Pillow oxygen; - Bandages; - Cotton wool; - Mustard plasters; - Banks. Specially equipped rooms (module 3): treatment room. Technical equipment, dummies: - 2-shelf instrumental table - LPMch-Oka-Medic trays - Hand model for injections - Buttocks model for intramuscular injections - Training overlay for intramuscular injections - Box KF-3 - Urethral catheterization simulator for men; - Simulator of catheterization of the urethra in women; - Intravenous stand ShDV-03-MSG - Medical couch - Syringes - Intravenous systems - APEXMED spatula - Tweezers - Clamps - Gastric lavage training model - Multifunctional nursing mannequin. Specially equipped rooms): office-ward and office-manipulation. Technical equipment, dummies: - Tonometers IAD-01 "Adyutor"; - Electronic thermometers DT-632; - Bed metal general medical; - Mannequin for practicing nursing skills; - Facial oxygen mask; - Pillow oxygen; - Bandages; - Cotton wool; - Ice pack; - Tool table 2-shelf; - Trays LPMch-"Oka-Medic"; - Medical couch; - Medical surgical gowns; - Spatula APEXMED; - Tweezers; - Clamps; - Hemostatic tourniquet; - Tire Kramer; - Tonometers IAD-01 "Adyutor"; - Facial oxygen mask. - Bandages. nine. Guidelines on the organization of the study of educational practice: 1. Order of the Ministry of Education and Science of the Russian Federation of November 8, 2010 N 1118 "On the approval and implementation of the Federal State Educational Standard of Higher Professional Education in the direction of training (specialty 060101 General Medicine (qualification (degree))" specialist")". 2. Appendix to the Order of the Ministry of Education and Science of the Russian Federation of November 8, 2010 N 1118 "On approval and implementation of the Federal State Educational Standard of Higher Professional Education in the field of training (specialty) 060101 medical business (qualification (degree ) "specialist")". 3. The basic curriculum of the Orgma State Medical Academy, specialty 060101 General Medicine. Orgma Department of Health and Social Development of Russia Department of Propaedeutics of Internal Diseases (place of work) Experts: Orgma State Medical Academy of the Ministry of Health and Social Development of Russia Department of Faculty Therapy and Endocrinology (place of work) External State Budgetary Educational Institution of Higher Professional Education "Samara State Military Medical University of the Ministry of Health and Social Development of the Russian Federation, Department of Propaedeutic Therapy (place of work) Associate Professor (position) Yu.A. Yudaeva (initials, surname) Host department Head of department, professor (position held) Head of department, professor (position held) R.I. Sayfutdinov (initials, surname) Yu.V. Schukin (initials, surname)
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