Lesson № 2Topic: "The organization and structure of

therapeutic and surgical departments"

Виды терапевтических отделенийTypes of medical departments

There are 2 types therapeutic department:

1.General therapeutic department

2. Specialized therapeutic departments:

•Cardiological             

•Gastroenterological

•Endocrinological

•Nephrological etc.

It's the most common types of medical departments.

The staff of the therapeutic department:

• Head of Department• Аttending doctor - clinical intern.• Senior nurse• Ward nurse• Treatment nurse (procedural nurse)• Barmaid • Junior medical nurse • Matron• Orderly

Структура терапевтического отделения

The structure of the therapeutic department: 1. Wards for patients.

2. Hall.

3. Office of the head of department.

4. Staff room - Doctor’s room.

5. Office of the senior nurse.

6. Office of matron.

7. Nurse’s room.

8. Treatment room.

9. Manipulational room - Cabinet for medical procedures (such as enema, sensing and other manipulation).

10. Shower room.

11. WC (toilet room).

1. Палаты для больных.2. Холл.3. Кабинет заведующего

отделением.4. Кабинет старшей

медсестры.5. Кабинет сестры-хозяйки.6. Сестринская.7. Процедурный кабинет.8. Манипуляционная 8. Ординаторская.9. Манипуляционная.10. Столовая.11 Душевая.13. Туалет.

Обязанности медицинского персонала отделения

Duty of the medical staff of the Department:

Head of Department – Leader, the most experience doctor; organizes the work of the whole Department. Its function:•organization and control the work Department; •counseling patients;•correction of the patient's treatment during hospitalization;•registration of medical documentation.

Аttending doctor - clinical intern. Its function:•examination and treatment of patients;•registration of medical documentation.

Senior nurse - the most experience nurse of department. Its function: •organizes the work of nurses and junior medical personnel;•Scheduling work nurse;•regularly provide of department by medicine, subject of patient care, medical instruments•monitors compliance of the sanitary-epidemiological regime•strict accounting of consumption of narcotic and toxic drugs•takes part in patient care.

Ward nurse. Duties of nurse:1.Reception patients admitted to the hospital and organization discharge of patients.2.Carry out of nursing examination - initial examination of the patient, thermometry, measurement of blood pressure and pulse.3.Providing of transportation in hospital.4.Сomfortable accommodation the patient in the ward.5.Performing doctor’s appointments - injections, the distribution of medicine, put on of mustard plasters, compresses, etc.

5. Assisting to doctor in performance medical manipulations.

6. Practical realization of pharmacotherapy - distribution of medicine to patients.

7. Proper collection of material for analysis (blood, sputum, urine, feces).8. Providing nursing for the seriously ill, old patients.

9. Control of patient's nutrition, of feeding patients.

10. Рreparation of the patient to instrumental study.8. Give first aid.9. Control for the sanitary condition of department.10. Control for sanitary and hygiene regime. 11. Control of Therapeutic- protective regime.12. Control of Individual motor regime.13. Taking over duty, hand over (passing) of duty.14. Recording medical documents.

15. Isolation of moribund and infectious patients.

16. Control visits of patients, control products, which bring the relatives of the patient.

17. Training of relatives - to carry out the care for patient.18. Conducting health education (talks, posters).

Junior medical personnel. Duties of junior medical personnel: 1.Regular wet cleaning of rooms.2.Help to nurse with care for the patients.3.Sanitary and hygenic processing of the patients.4.Escorting patients to diagnostic and medical procedures.5.Transportation of patients to hospital.

6. Perform simple medical procedures, such as feeding the patient, enemas, measure of personal hygiene etc.

7. Preparation of disinfectant solutions.

8. Disinfection of used subjects of care for patient.

9. Сollecting and disposing of medical waste. 

Treatment nurse (procedural nurse). Its function: 1. perform doctor’s appointments (subcutaneous, intramuscular, intravenous injections, intravenous infusion) 2. helps the doctor during manipulation (for example, determination of blood group).3. take of a blood from a vein for biochemical research and send (deliver) to the laboratory4.ensuring of strict accounting and storage of medicines

5. serve and assess the condition of the patient during intravenous infusion.

6. perform the disinfection of used syringes, needles.

7. perform the current and general cleaning treatment rooms.

8. prepare to work a medical sterile tray.

Matron. Its function:•controls the work of junior medical personnel, helps the senior nurse of department.•receive, store and give out bed clothes (for patients).•provide the medical staff by detergents, medical special clothing•send (deliver) the dirty linen for disinfection, washing.•make a request for repair of premises, equipment, control the repair.

Barmaid. Its function:

•Get ready meals in the kitchen.

•give out to the patient of the food according to the menu and the prescribed diet.

•produce heating of food (if necessary)

•washing dishes, cleaning the pantry and dining room

•systematic cleaning of refrigerators for storing food of sick.

•оbservance of sanitary-hygienic regime in the dining room.

Orderly. Its function:•carry out cleaning of the rooms, •help to ward nurse.•Preparation of disinfectant solutions.•Disinfection of used subjects of care for patient.•Recycling of wastes.•Transportation of biological materials of the patient to the laboratory for testing (blood, urine, sputum, feces)  

Оборудование палат Equipment of the hospital wards

1. Beds (4 -6)2. Bedside tables.3. Table and chairs.4. Screen.5. Clothes rail.6. Wall bedside lamps.7. Ultra-violet lamp.8. Signalization (If seriously ill patient lies in the ward.).9. Sink for washing.10. Trash bin.

Beds are located at a distance of 1 meter from each other. For one patient in a general ward accounted for 7 square meters, and in a single ward (cubicle) - 9 square meters.

Mode of day inpatient departments06.00 —awakening, the temperature measurement.06.20-07.00 — morning hygiene, bring order in bedside tables, cover the bed. The cleaning hospital ward, the aeration ward (Orderly).07.00-08.00 — collection of biological material for analysis (blood, sputum, urine, feces); receive of medications, injections - morning dose (if the doctor prescribed). Cleaning of inpatient department (Orderly carries out). Replacement of nursing and medical staff. 09.00 - 09.20 — breakfast.09.20-10.00 — examination by a physician.10.00- 1.00 — perform of therapeutic and diagnostic procedures.1.00-1.30 — receive of medications, injections - (if the doctor prescribed).1.30 - 2.00 —lunch.2.00-4.00 — daytime sleep.

4.00 — awakening, receive of medications, injections (if the doctor prescribed).6.00 – 7.00 — dinner.7.00 - 9.30 — performing medical procedures;

receive of medications, injections - evening dose (if the doctor prescribed).

The cleaning hospital ward, department, the aeration ward (Orderly carries out).

10.00 — sleep.

But also with 4.00 to 7.00  — free time (pedestrian walk, visiting relatives).

Surgical department

There are 3 types surgical department:

• General surgical department • «Purulent» surgical

department• Casualty department• Specialized surgical

departments: • Thoracic• Proctology• Urologic• Сardiac surgery and other

The staff of the surgical department: • Head of Department• Аttending doctor - clinical intern.• Senior nurse• Ward nurse• Treatment nurse (procedural nurse)• Dressing nurse (there is only in the

surgical Department)• Оperating nurse (there is only in the

surgical Department)• Matron• Barmaid• The junior medical nurse • Orderly

Структура хирургического отделенияThe structure of the surgical department

1. Hospital wards for patients.2. Hall.3. Office of the head of department.4. Staff room - Doctor’s room. 5. Office of the senior nurse.6. Office of matron.7. Small operating room.8. Dressing room. (there is only in the surgical

Department)9. Treatment room.10. Special rooms - profile (examination room, gypsum

room, manipulational room)11. Dining room.12. Shower room or bathroom.13. WC (toilet room).

Duty of Dressing nurse • Prepare the dressing material, put in the sterilization box,

transport in sterilization room.• Perform the disinfection used surgical instruments, dressing

material.• Prepare the sterile table with bandages and surgical instruments.• Assist to physician during the bandaging of the postoperative

patients. • Assisting to doctor in performance small surgical manipulations.• Be able to apply all types of bandages.• Accompany seriously ill after manipulation to the ward.• Perform systematic sanitary control over in the dressing room. • Provide systematic replenishment, registration, storage and

distribution of medicines, dressing material, surgical instruments and special clothes.

• Registration of medical documents.• Рerform the collecting and disposing of medical waste.

Dressing room. Device, equipment and principle of operation:

Dressing room is obligatory element of any surgical department. There are should be two dressing room - for «clean» and «purulent» bandagings.

Following manipulation are carried out in dressing room: - bandaging, - puncture,- small operations- endoscopic studies- procaine blockade, and other operations.

Sanitary and epidemiological regime in dressing room.

5 types of cleaning is performed:1. Pre-cleaning is carried out before the start of the working day.2. Current cleaning service is carried out during the day.3. Cleaning after each operation or manipulation.4. Final cleaning is at the end of the day. 5. General cleaning is carried out once in 7 days.

Equipment dressing room:• "dressing table" for the location of the

patient. It is located in the centre of the dressing room.

• surgical lamp• "sterile manipulation table" with sterile

bandages and surgical instrument• table for solutions used at bandage;• cupboard for storage of antiseptics;• сontainers for disinfection of used surgical

instruments, dressing material.• germicidal lamps for disinfection of air;• sterilization box with sterile material.

Organization the work of nursing station

• Nursing station (office) - It is workplace of nurse, located in the hall.

Оборудование сестринского постаEquipment nursing station

• 1. Desk with drawers.2. Chairs (2 - 3)3. Medical capboard for medicines and objects of care for patients.4. Refrigerator for medicines. 5. Refrigerator for foodstuff.6. Telephone.7. Table lamp.8. Clock.9. Signalization.10. Medical scales.11. Medical stadiometer (height meter).

Медицинская документацияMedical documentation of nursing station

1. Journal of movement of pations - registration is hospitalized and discharged patients.2. Sheet of doctor’s appointments.3. Temperature sheet.4. Journal of appointments for laboratory and instrumental examination.5. Journal of registration narcotic, potent drug  and poisonous substances.6. Journal of reception and passing duty.7. Journal of general cleanings.8. Journal quartz-processing.9. Journal of control temperature in a refrigerator.

1. Журнал движения больных - регистрации и выписки больных.

2. Лист врачебных назначений.

3. Температурный лист.

4. Журнал назначений на обследование.

5. Журнал учёта наркотических, сильнодействующих и ядовитых веществ.

6. Журнал приёма и сдачи дежурств.

7. Журнал генеральных уборок.

8. Журнал кварцевания.

9. Журнал контроля температуры в холодильнике.

Equipment treatment room:

• The medical couch• Сupboard for medicines• Sink for washing hands

and sink for washing tools (or double sinks)

• Paper or cloth towel• Dispenser with liquid

soap• Dispenser with skin

antiseptic

Workplace nurses of the treatment room:• «sterile table»;• manipulation table for injection;• set venous rubber harness; • set of pillows for intravenous

injection• alcohol;• sterile syringes;• sterilization box with sterile

dressing material;• containers with disinfectant

solutions for used syringes, needles, bandages, gloves;

• "alarming" medical kit (The kit is used at contact with blood of a patient).

An algorithm for the measurement of body weight

Equipment.

• Medical electronic scales

• Oilcloth (or disposabl napkin)

• GlovesMedical documentation (temperature sheet)

• Сontainer for disinfection

Algorithm:

• Explain to the patient the purpose and procedure course. Obtain patient’s consent.

• Conduct hygienic washing hand and processing hand. Put the gloveson.

• Put on the surface of scales the oilcloth (or disposabl napkin).

• The patient must remove their shoes.

• The patient must carefully stand on the center platform on the oilcloth.

• Remember result.

• Ask the patient get off on the floor carefully.

• Offer the patient put on shoes and walk to the ward.

• Conduct disinfection used material (or utilization napkin).

• Take the gloves off and put them in the container for disinfection.

• Wash hands hygienic way.

• Make a record of results in a medical documentation (temperature sheet).

Algorithm measurement the growth of the patient

Equipment.• Medical stadiometer• Oilcloth (or disposabl napkin)• Gloves• Medical documentation (temperature sheet)• Сontainer for disinfection Algorithm:• Explain to the patient the purpose and procedure course. Obtain patient’s consent. • Conduct hygienic washing hand and processing hand. Put the gloves on.• You must cover the platform of the stadiometer with an oilcloth (or disposabl napkin). The patient

must remove their shoes and cap.• Ask the patient to stand on a platform of stadiometer, covered with oilcloth.• Explain what patient must strengthen your back during the measurement of growth, to touch vertical

strips by four points: neck, shoulders, buttocks and heels.• Check the position of the patient's head. The line connecting the external corner of the eye and upper

edge of ear must be horizontal.• Lower the measuring bar on the top of the head of the patient. To fix the bar with hand.• Ask the patient get off on the floor.• Offer the patient put on shoes and walk to the ward.• Conduct disinfection used material (or utilization napkin).• Take the gloves off and put them in the container for disinfection.• Wash hands hygienic way.• Make a record of results in a medical documentation (temperature sheet).