Fundamentals of the legislation of the Russian Federation “On the protection of the health of citizens” in Art. 24 define the rights of minors in the interests of protecting their health.
These rights are ensured by a wide network of treatment and preventive institutions for children, which include: children's city hospitals, children's hospitals on railway transport, children's regional (territorial), district hospitals, specialized children's hospitals (infectious diseases, psychiatric, etc.), day care hospitals, children's consultation and diagnostic centers, perinatology centers, dispensaries, children's city clinics, children's dental clinics, children's homes, maternity hospitals, children's balneological and mud baths, children's sanatoriums, specialized year-round sanatorium camps, children's departments of hospitals and general clinics, children's clinics of research institutes, universities, etc.
The bulk of primary treatment and preventive care for children is provided by children's city clinics.
Organization of the work of a children's clinic
Children's clinic is a medical and preventive institution providing out-of-hospital medical care children from birth to 15 years old and students of educational institutions, regardless of age.
Children's clinics can be independent or be structural divisions of a children's hospital, a large city clinic, a central district hospital, etc.
The main activity of the children's clinic is security necessary conditions for the development and upbringing of a healthy child, carrying out primary prevention of diseases, providing medical care to sick children, organizing medical and health work with children with developmental and health problems.
Currently children's City Polyclinic provides in its area of operation:
1) organization and implementation of the complex preventive measures among the child population by:
Observations of newborns, conducting preventive examinations and medical examination of children;
Carrying out preventive vaccinations within the time limits established by the Ministry of Health;
Conducting lectures, conversations, conferences for parents, classes at mothers’ school, etc.;
2) medical and advisory assistance children at home and in the clinic, including qualified specialized medical care; sending children for treatment in hospitals, for rehabilitation treatment in sanatoriums; conducts selection of children for health institutions;
3) anti-epidemic measures(together with the center for sanitary and epidemiological surveillance);
4) therapeutic and preventive work in children's organized groups.
The structure of the children's clinic is built in accordance with the tasks assigned to it and includes:
Filter with separate entrance and isolators with boxes;
Offices of pediatricians and doctors of “narrow” specialties;
Room for preventive work with children (healthy child room);
Department of Rehabilitation Treatment;
Treatment and diagnostic rooms (X-ray, physiotherapy, physical therapy and etc.);
Vaccination office;
Registration, wardrobe and other auxiliary rooms, waiting rooms;
Administrative and economic part (in independent clinics.
IN modern conditions in cities, predominantly large children's clinics are organized and built for 600-800 visits per shift, having all the conditions for the proper organization of treatment and preventive work: the necessary set of premises for specialized rooms, gyms for physical therapy, swimming pools, water and mud baths, rooms for light and electrotherapy, mobile physiotherapeutic rooms for preschool and school institutions.
The leading figure in organizing out-of-hospital care for children is the local pediatrician at the city children's clinic. He carries out dynamic monitoring of the health status, physical and neuropsychic development of children; deals with the prevention of diseases and injuries among children; provides timely and high-quality diagnostics in order to identify premorbid conditions and early forms of diseases; treatment of sick children in the clinic and at home; selection of children in need of treatment by doctors of “narrow” specialties, hospitalization, sanatorium-resort treatment; Conducts preventive and therapeutic work in children's organized groups.
All activities of a local pediatrician are built in accordance with the objectives of the children's clinic in four main areas:
Preventive work;
Medical work;
Anti-epidemic work;
Treatment and preventive work in children's organized groups.
Preventative work
The main goal preventive activities The local pediatrician is to carry out activities that promote the correct physical and neuropsychic development of children, the widespread introduction of hygiene requirements into the daily life of the family.
The main method in preventive work is dispensary method- a method of active dynamic monitoring not only of sick, but also of healthy children.
The organization of preventive measures aimed at protecting the health of the child actually begins even before his birth. Monitoring the health of a pregnant woman is carried out jointly by doctors antenatal clinic and a children's clinic. From the moment a pregnant woman is registered, the local pediatrician organizes patronage for the pregnant woman and, together with the obstetrician-gynecologists of the antenatal clinic, conducts “School for Young Mothers” classes.
A pregnant woman should visit a healthy child’s office, a local pediatrician and a nurse conduct individual and group conversations, introduce the expectant mother to visual aids and newborn care items.
According to the current situation, a pediatrician and a nurse at a children's clinic visit a newborn in the first 3 days after discharge from the maternity hospital. If the family has the first child, twins, or the mother does not have milk, it is recommended to make a patronage visit on the first day after discharge. Subsequently, the district nurse visits the child at home every 1-2 days during the first week and weekly during the first month of life.
The local doctor visits the child again at home on the 14th day, then on the 21st day of life.
Children from the risk group are under special supervision of the local doctor:
Children from twins;
Premature;
Those born with a large body weight;
With birth trauma;
Born to mothers with pathologies of pregnancy, childbirth or who have had infection during pregnancy;
Discharged from the neonatal pathology department;
Children from unfavorable social and living conditions.
During a patronage visit at the 4th week of a newborn’s life, the local nurse invites the mother to her first appointment at the clinic.
A local pediatrician observes a healthy child in the first year of life once a month, preferably in a clinic. During the appointment, the doctor monitors the correct physical and neuropsychic development of the child, gives the necessary recommendations to the mother on feeding, organizing a daily routine, hardening, physical education, preventing rickets and other issues.
A progressive form of hygienic education for parents with children in the first year of life are group preventive techniques, which include not only examinations, but also a thorough survey of mothers regarding the child’s lifestyle, feeding and care.
A local nurse visits a healthy child in his first year of life at home at least once a month.
Medical monitoring of the development of children in this age group should be carried out taking into account both the individual characteristics of the child and the most critical periods in the life of children in the first year of life: discharge from the maternity hospital; Start specific prevention rickets; introduction of supplementary feeding, complementary feeding; carrying out preventive vaccinations; stopping breastfeeding; registration of a child in a child care facility, etc.
At the ages of 3, 6, 9, 12 months (decreed ages), the local doctor, based on a thorough examination of the child, anthropometric measurements, and a conversation with the mother, draws up a detailed epicrisis in which he assesses the child’s health, his physical and neuropsychic development over time, and also draws up a plan for observation and health measures, if necessary, for the subsequent period.
A local pediatrician observes a child of the 2nd year of life once a quarter (with anthropometric measurements), and he gives a detailed opinion on his state of health, assesses physical and neuropsychic development. This conclusion must be brought to the attention of parents, paying attention to shortcomings in the upbringing of the child, the implementation of certain assignments, recommendations for the further upbringing and improvement of the child.
The nurse must visit the child at home for the first 2 years of life at least once a quarter.
At the 3rd year of life, the child is examined by a pediatrician (once every six months) for preventive purposes and by a visiting nurse (once every six months). When conducting examinations of children of this age group, the main attention is paid to the organization of the regime, carrying out hardening activities, physical education, rational nutrition, development of movements, neuropsychic and physical development of the child. Twice a year the child is given anthropometric measurements. At the end of the 3rd year of life, when the most important period of the child’s development - the period of early childhood - ends, the doctor sums up the results of three years of preventive work with the child, assesses the state of health, the dynamics of physical and neuropsychic development, draws up a plan of health-improving measures for the subsequent period, and, if necessary, and treatment plan.
The local pediatrician provides preventive monitoring of disorganized* children aged 3 to 7 years. During this period, the doctor examines children at least once a year with a final medical examination before entering school. Anthropometry is carried out in children aged 5 years and 6-7 years. During this period, special attention is paid to the organization of the regime, the neuropsychic and physical development of the child, and the readiness of children for school.
To carry out preventive work with healthy young children as part of the nursery, the clinic is organized room for preventive work with children(healthy child’s office).
The main objectives of the healthy child’s office are:
Promoting a healthy lifestyle in the family;
Basic training for parents; rules for raising a healthy child (regime, nutrition, physical education, hardening, care, etc.);
Health education of parents on the issues of hygienic education of children, prevention of diseases and deviations in the development of the child;
Hygienic training and education of the child. Medical staff of the healthy child’s office;
Provides assistance to local pediatricians in conducting classes at “Schools for Young Mothers and Fathers”;
Conducts individual and collective conversations with parents of young children, gives them reminders and methodological literature on child health issues;
Teaches parents how to care for children, how to organize a daily routine, age-specific massage complexes, gymnastics, how to conduct hardening procedures, and cooking technology baby food, rules for introducing supplementary feeding and complementary feeding;
Conducts work to prevent rickets in children;
Together with the local pediatrician and local nurse, he conducts individual preparation of children for admission to a preschool institution;
Trains local police officers nurses issues of preventive work with children, massage techniques, gymnastics, hardening procedures, etc.;
Communicates with the health center to study and distribute new materials, design an office on the development and upbringing of a healthy child;
Maintains the necessary working documentation and records of instructional and methodological materials on the development and upbringing of young children.
The office of a healthy child should be provided with teaching materials and visual aids on the main issues of development and upbringing of a healthy child, and disease prevention.
Clinical examination is the main form of work of children's clinics and is carried out, firstly, according to age, regardless of the child’s condition, and secondly, depending on the existing disease.
The most important element in the medical examination of the child population is the organization of preventive examinations. The following types of preventive examinations are distinguished: preventive examination, which is carried out by a doctor serving the child at his place of residence or in a child care institution; in-depth preventive examination, in which the examination is preceded by certain functional diagnostic studies; comprehensive preventive examinations, during which the child’s health is assessed by a team of medical specialists.
In clinics, there are 3 groups of children who are subject to preventive examinations:
Children under 7 years of age who do not attend preschool institutions;
Children attending preschool institutions;
Pupils.
For the first group of children, the most appropriate is to allocate preventive days in clinics, when all specialists in the clinics see only healthy children. The number of such days of work largely depends on the capacity of the clinic.
Thus, in large city clinics, 2 days a week are allocated, and the clinic is open to healthy children and children of all ages who are under medical supervision. To streamline the work, mothers are given a memo about which specialists should examine the child at different age periods of his life. A well-executed certificate of similar content is posted in the lobby.
The frequency of preventive examinations by medical specialists is provided in such a way as to promptly identify deviations in the health status of children and organize the necessary medical and health measures.
Currently, preventive examinations of children attending educational institutions are carried out in the form of mandatory in-depth surveys in accordance with “decreed age groups”:
1) before entering a preschool institution;
2) one year before entering school;
3) before entering school;
4) end of the first year of study;
5) transition to subject teaching;
6) puberty (14-15 years);
7) before graduating from a general education institution - grades 10-11 (15-17 years old).
Upon completion of preventive examinations, a comprehensive assessment of the children’s health is carried out. For each child with identified diseases that are subject to dispensary observation, a “Dispensary Patient Control Card” is created (f. 030/u). The “control card,” along with performing signal functions (monitoring dispensary visits), reflects data about the patient that helps the doctor in conducting dispensary observation.
Each patient registered must be provided with careful monitoring and active treatment. The content of dispensary work should be reflected in individual plans dispensary observation, which are developed by doctors specifically for each patient and are included in the “History of Child Development”.
At the end of the year, doctors draw up a staged epicrisis for each registered patient, which assesses the state of health and the effectiveness of treatment and preventive measures. The criteria for assessing the results of the clinical examination are: recovery, improvement, unchanged condition, deterioration. This general assessment is made on the basis of data from the “Development History” records, complaints, and objective condition.
If the child is not removed from the dispensary register, then at the same time a plan of treatment and preventive measures for the next year is drawn up. After completing epicrises for all children taken under clinical observation, the local pediatrician conducts an analysis of the medical examination for individual nosological groups for the past year and presents its results to the head of the department, who draws up a summary report on the results of the clinical work for the past year. After analyzing the work done, activities are planned to improve the quality of dispensary services for children.
The dispensary method of work makes it possible to most fully implement one of the most important provisions of preventive work - not only to preserve, but also to improve the health of healthy people.
Therapeutic work
The medical work of a local pediatrician includes:
Treatment at home for children with acute diseases and exacerbations of chronic pathology until complete clinical recovery;
Reception in the children's clinic of convalescents of acute diseases that do not pose a danger to others;
Active statement of patients with chronic forms diseases on early stages, registering them, timely treatment and wellness;
Carrying out complex etiopathogenetic treatment of diseases using means of restorative treatment (physiotherapeutic methods, physical therapy, hydrotherapy);
Implementation of continuity in the treatment of sick children with preschool institutions, hospitals, sanatoriums;
Examination of temporary disability;
Organization of hospitalization.
The organization of reception of children in the clinic should provide them with qualified medical care in the shortest possible time.
A special feature of the children's clinic is that all sick children with acute illnesses are observed by a local doctor at home. The clinic receives mainly healthy children, as well as those suffering from chronic diseases, repeated patients with infectious diseases without acute phenomena and convalescents after acute diseases.
The local pediatrician actively (without calling) visits sick children at home until full recovery or hospitalization.
Daily observation by a doctor and nurse until recovery up to the age of 1 year with any disease left for treatment at home should be the rule of operation of children's clinics. On average, the ratio of active visits to initial calls is 2:1.
The district nurse carries out the doctor’s prescriptions for treating a sick child at home, monitors the parents’ compliance with medical recommendations for treatment, nutrition, regimen and care for the sick child.
At the request of the attending physician, the city children's clinic provides the sick child with the necessary laboratory tests at home, functional studies and consultations with doctors of “narrow” specialties.
The head of the department of a children's city clinic monitors the organization of treatment of sick children at home, in necessary cases provides advisory assistance.
If necessary, the local doctor will organize hospitalization the child and continues to monitor his health after the child is discharged from the hospital, paying special attention to those in need of follow-up treatment - systematic monitoring at home. When sending a child to a hospital, the attending physician indicates in detail the diagnosis of the disease, the severity of the condition, the duration and course of the disease, the treatment and examinations performed, the individual characteristics of the child, previous infectious diseases, information about the absence of contact of the child with infectious patients at home, in child care institutions or at school. If it is impossible to hospitalize a child (parental refusal, lack of space in a hospital, quarantine, etc.), a hospital at home. At the same time, the child is provided with the full range of necessary medical and diagnostic measures, laboratory examinations in accordance with the severity and nature of the disease, a nurse's post or her regular visits several times a day. At night, the child is treated by an emergency or ambulance pediatrician, and the local doctor visits the child daily until complete recovery. The child must be examined by the head of the department.
If a chronic pathology is detected in a child, he should be taken under dispensary observation either by a local pediatrician or a doctor of the appropriate profile.
An important element The work of a local pediatrician should be considered an examination of the temporary disability of one of the family members due to the child’s illness. When issuing certificates of incapacity for work, the local doctor is guided by the current instructions.
Anti-epidemic work
The structure and organization of work of the children's clinic provide for elements of the anti-epidemic regime: providing care at home, acutely ill people, allocating days for prophylactic intake, division by floor of the offices of local doctors and doctors of “narrow” specialties.
A child brought (brought) by the mother to an appointment must first be examined by a nurse in the filter in order to identify symptoms of an infectious disease. If one is detected or suspected, the child should be sent to a box directly adjacent to the filter and having a separate entrance, where he is seen by a doctor.
However, at present, most clinics are limited to separating entrances for sick and healthy children with a separate exit from the clinic.
In the activities of local pediatricians, the fight against infectious diseases and ensuring epidemiological well-being occupies a prominent place. This type of activity of local doctors is carried out under the guidance and control of the sanitary and epidemiological surveillance center. The main objectives of this work are: early detection and hospitalization of infectious patients, monitoring of a possible focus of an infectious disease, contact persons, convalescents and bacilli carriers. Doctors are responsible for the sanitary condition of the site and organize preventive vaccinations.
The local doctor provides early diagnosis infectious diseases, establishes monitoring of the health of children who have been in contact with sick people. A report of infectious diseases to the sanitary and epidemiological surveillance center is immediately transmitted by telephone. The clinic maintains a “Record of Infectious Diseases” (account number 060/u). Every month, a report “On the movement of infectious diseases” is compiled for the clinic as a whole.
Children with infectious hepatitis, meningitis, polio, diphtheria, as well as children with acute intestinal diseases are subject to mandatory hospitalization.
Children who have had infectious diseases are monitored at the dispensary. They undergo follow-up examinations,, if necessary, repeated courses of treatment, and health-improving measures.
The child is deregistered in accordance with the commission decision of the local pediatrician and epidemiologist.
The introduction of means of active immunization of the child population played a huge role in reducing infectious morbidity.
In cities, preventive vaccinations are carried out for children in vaccination rooms at children's clinics, and in rural areas in appropriate medical institutions. Children attending preschools and schools are vaccinated at these institutions. It is strictly forbidden to vaccinate at home.
Parents must be notified in advance about the dates of preventive vaccinations for children.
After vaccination, the local nurse must find out the nature of the reaction to the vaccine, inform the local pediatrician and record data on the child’s reaction to the vaccine in the “Child Development History”.
Registration and control over preventive vaccinations is carried out using the “Registration Card for Preventive Vaccinations” (registration form No. 063/u). Form 063/у is filled out for each newborn and each child newly arrived in the area where the children's clinic operates.
A vaccination card is generated from the “Preventive Vaccination Record Cards” in the children's clinic. An important section of the organization of vaccination work in the clinic is the complete and timely registration of children subject to vaccination and living in the area where the children's clinic operates.
The direct assistant to the local pediatrician is district nurse, whose responsibilities include:
Providing medical care to sick children at home as prescribed by a doctor;
Sanitary educational work (exhibitions, health corners, etc.);
Prenatal care for pregnant women in your local area;
Visiting newborns together with a local pediatrician in the first three days after discharge from the maternity hospital;
Ensuring systematic monitoring of healthy and sick children;
Monitoring parents’ compliance with treatment prescriptions;
Planning preventive vaccinations for children who do not attend preschool institutions and inviting them to be vaccinated at the clinic;
Work on the timely organization of medical examinations of children registered at the dispensary, according to the medical examination plan;
Assisting the doctor during medical examinations of children (conducts anthropometry, writes prescriptions, certificates, directions, certificates of incapacity for work, extracts, monitors the order of appointments);
Conversations with parents at the site and in the clinic on the development and upbringing of a healthy child and disease prevention.
Along with local service in children's clinics a wide range of specialized assistance, being an integral part of the “single chain” of polyclinic - hospital - sanatorium.
Specialized medical care can be presented in the form of:
Specialized clinic rooms;
District and inter-district specialized dispensaries.
IN major cities specialized centers are being created, which include an outpatient department (advisory outpatient visit), a specialized hospital, and a specialized sanatorium.
Depending on the capacity of the clinic, the scope of specialized care provided may vary.
District specialists conduct appointments at one of the children's clinics, and inter-district specialists - in each of the assigned districts.
Specialized clinic rooms must be equipped with modern equipment for conducting diagnostic and therapeutic measures.
A doctor of a “narrow” specialty works closely with other doctors at a children’s clinic and participates in the health improvement of children in schools and preschool institutions.
To carry out medical examinations of children and treat acutely ill patients, doctors of narrow specialties of children's clinics, as a rule, are assigned to certain pediatric areas, schools and preschool institutions located in these areas. This allows a specialist at a children's clinic to monitor the same groups of children for a number of years.
Upon reaching the age of 15 or completing their studies at an educational institution, children registered in a children's clinic are transferred for observation to clinics for adults.
With the aim of analysis, activities of the children's clinic, in addition to calculating generally accepted indicators characteristic of any outpatient clinic (indicators of workload, clinical examination, etc.), it is advisable to calculate:
Performance indicators of a children's clinic.
1. Coverage of children in the first year of life with systematic medical supervision:
The number of children in the first year of life who are
under the systematic supervision of a pediatrician 100%
2. Breastfeeding frequency (%):
Number of children under 3 months (6 months)
_______________breastfed ______________·100%
Number of children reaching one year of age in reporting year
3. Frequency of eating disorders in children of the first year of life (in%):
Number of children who during the first year of life
____________eating disorder identified ____________·100%
Number of children who reached one year of age in the reporting year
4. Frequency of active rickets in children of the first year of life (%):
Number of children with manifestations of active rickets during
__________________first year of life __________________·100%
Number of children who reached one year of age in the reporting year
Number of children who have never been sick during
__________________first year of life _______________·100%
Number of children who reached one year of age in the reporting year
6. Complete coverage of children with preventive examinations (%):
Number of children covered by preventive examinations ·100%
Number of children subject to preventive examinations
7. Complete coverage of children with preventive vaccinations (%):
Number of children covered with preventive vaccinations ·100%
Number of children to be immunized
8. Morbidity rate in children (per 1000 children):
Number of newly diagnosed diseases in children 100%
Average annual number of children living in
service areas of the children's clinic
In addition, in the children's clinic, indicators of congenital disability for caring for sick children, indicators of the volume, quality and effectiveness of dispensary observation are calculated.
A number of indicators characterizing the main parameters of children's health were described in the relevant chapters, and the basic formulas for their calculation were also given there.
- The principle of a single pediatrician. One doctor serves children from 0 to 17 years 11 months. 29 days. Since 1993, the child population can be served by two pediatricians under a contract.
- The principle of locality. Pediatric area size 800 children. The central figure of the outpatient clinic network is the local pediatrician; Now the responsibility of the local pediatrician is increasing within the framework of compulsory health insurance (CHI) and criteria for individual responsibility (or personification) are being sought.
- Dispensary method of work. All children, regardless of age, health status, place of residence and attendance at organized preschool and school institutions, must be examined as part of preventive examinations, which, like vaccinations, is carried out free of charge.
- The principle of unification, that is, antenatal clinics are united with maternity hospitals, children's clinics are united with hospitals.
- The principle of alternating medical care: at home, in a clinic, in a day hospital. Only healthy children or convalescents come to the clinic for outpatient appointments; patients are served at home.
- The principle of continuity. Carried out between the antenatal clinic, maternity hospital and children's clinic in the form of: prenatal care, visits to the newborn within 3 days after discharge from the maternity hospital, monthly examinations of the baby in the children's clinic for 1 year of life.
- For antenatal clinics - the principle of early registration at the dispensary (up to 12 months)
- The principle of social and legal assistance, that is, there is a lawyer’s office in a children’s clinic and antenatal clinic
10. Organization of outpatient care for children
The basic principles of treatment and preventive care for children are: continuity in monitoring the child’s health from the first days of life; continuity in the work of doctors providing medical and preventive care to children; stages in treatment – clinic, hospital, sanatorium.
To standard institutions providing medical and preventive care to children include: children's city and regional hospital, specialized children's hospitals (infectious diseases, psychiatric, tuberculosis, orthopedic-surgical, rehabilitation treatment), dispensaries, children's city clinics, children's dental clinics, institutions for the protection of motherhood and childhood (children's homes, maternity hospitals, dairy kitchens), children's balneological hospitals, mud baths, sanatoriums, specialized year-round sanatorium institutions, children's departments of hospitals and general clinics.
The children's city clinic in the area of operation provides: organizing and carrying out a set of preventive measures (dynamic medical observation of healthy children, preventive examinations, clinical examination, preventive vaccinations); medical and advisory assistance at home and in the clinic, including specialized medical care, referral of children to hospitals for treatment; therapeutic and preventive work in preschool institutions and schools; carrying out anti-epidemic measures together with territorial institutions of state sanitary and epidemiological supervision.
The children's clinic (outpatient department) provides medical care to children under 18 years inclusive. The provision of therapeutic and preventive care to children is provided directly in the clinic, at home, in preschool institutions, and schools.
IN The children's city clinic should be provided with the following premises: filter with separate input and isolators with boxes; offices of pediatricians and other medical specialists; room for preventive work with children (healthy child room); rehabilitation treatment department; treatment and diagnostic rooms (X-ray, physiotherapy, physical therapy, massage, treatment, vaccination, etc.); reception, wardrobe and other auxiliary rooms, waiting rooms; administrative and economic part (in independent clinics).
One of the priority organizational measures in a children's clinic should be the creation of a healthy child department, which includes rooms for preventive work. The main objectives of the healthy child’s office are to promote a healthy lifestyle in the family; training parents in the basic rules of raising a healthy child (regime, nutrition, physical education, hardening, care); health education of parents in matters of hygienic education of children, prevention of diseases and developmental disorders.
The main figure providing outpatient care to children is local pediatrician. According to the standards, there should be 750–800 children under 18 years of age in the area, including 40–60 children in their first year of life.
Medical examination of healthy children is carried out according to age. A special feature of services for children under 3 years of age is active patronage, which is carried out starting from the antenatal period.
Patronage monitoring of the newborn is established after he is discharged from the maternity hospital. According to the accepted situation at home, the first time the local pediatrician and nurse visit the child is in the first days after discharge from the maternity hospital. During the visit, the doctor carefully examines the child, gives advice on daily routine, feeding, and caring for the child.
In the 1st month of life, the doctor visits the child as needed, the nurse visits weekly, but at least twice.
By the 1st year of a child’s life, a pediatrician conducts a full clinical examination: measuring body weight, height, circumference chest, analyzes data from mandatory consultations with specialists (psychoneurologist, orthopedic surgeon, otolaryngologist, ophthalmologist, dentist), checks vaccinations and compiles a brief epicrisis of his health.
Preventive examinations of children aged 1 year to 3 years are carried out by a pediatrician once a quarter.
11. The structure of the children's clinic has its own characteristics, so, unlike clinics serving the adult population, the children's clinic has two entrances. Children who do not have symptoms of acute infectious diseases enter through the main entrance (entrance for healthy children). All sick children should be cared for at home, however, if parents, for one reason or another, bring a sick child to the clinic, they must enter the entrance for sick children, which leads to a room called a filter. An experienced nurse works there, who interviews, examines the child, diagnoses preliminary diagnosis and decides whether the child can visit the clinic or needs a doctor’s consultation and isolation. If there is a suspicion of infection, the child is placed in a box, where he is examined by a doctor called by a nurse. After being examined by a doctor and prescribing the necessary treatment measures, the child is sent home through a separate exit from the box or, if indicated, transported by ambulance to a hospital. The box in which the patient was located is disinfected.
NURSING
IN PEDIATRICS
Anatomical and physiological features of the child’s organs and systems.................................................. ........................................................ ....................................... 5
INTRODUCTION
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The nurse should:
Stages and periods childhood.
Sample answers
Nutrition for a healthy child
Sample answers
Newborn and caring for him
Sample answers
Premature babies
1. In extremely premature babies, the condition of the fontanelles
a) everything is closed
b) big open
c) big and small are open
d) open large, small and lateral
Rickets
2. Rickets in children develops due to vitamin deficiency
Sample answers
Diseases of older children
Respiratory diseases
1. Bronchial asthma in a child is characterized by
a) fever
b) convulsions
c) an attack of suffocation
d) swelling
2. Tactics of a nurse when there is a threat of laryngeal stenosis in a child outside a medical institution
a) referral to a clinic
b) urgent hospitalization
c) oxygen therapy
d) prescription of physiotherapeutic procedures
Sample answers
Diseases of the digestive system in children. Helminthiasis
1. If a child has gastrointestinal bleeding, the nurse will first provide
a) emergency transportation to hospital
b) gastric lavage with a solution of aminocaproic acid
c) carrying out hemostatic therapy
d) referral to FGDS
Sample answers
Diseases of the blood and hematopoietic organs in children
1. When colds should not be given to children with hemophilia
a) paracetamol
b) acetylsalicylic acid
d) diphenhydramine
2. Exclude from the diet of children with hemorrhagic vasculitis
a) animal fats
b) protein nutrition
c) sensitizing products
d) glucose and other sugars
Sample answers
Organization of child care for infectious diseases
1. The development of laryngitis with croup syndrome in children is observed when
b) parainfluenza
c) rhinovirus infection
d) respiratory syncytial infection
2. The leading sign of croup in children is
a) fever
b) facial hyperemia
c) inspiratory dyspnea
d) expiratory dyspnea
3. Previous bilateral orchitis due to mumps in children can lead to the development
a) glomerulonephritis
b) pyelonephritis
c) cystitis
d) infertility
4. The forced position of the child on his side with his head thrown back and legs bent is typical for
b) rubella
c) diphtheria
d) meningococcal meningitis
5. Darkening of urine in children with viral hepatitis A is noted towards the end of the period
a) preicteric
b) in full swing
c) post-icteric
d) convalescence
Sample answers
1 b, 2 c, 3 d, 4 d, 5 a
Tuberculosis in children
1. When performing the Mantoux test, tuberculin is administered to the child
a) intradermally
b) subcutaneously
c) intramuscularly
d) intravenously
Sample answers
TEST TASKS
ORGANIZATION OF MEDICAL CARE FOR CHILDREN
Organization of the work of a nurse
1. Children with chronic pathology in the stage of decompensation belong to the health group
Sample answers
Stages and periods of childhood.
Anatomical and physiological features of the child’s organs and systems
1. The child sits independently at age (months)
2. The newborn has physiological
a) hypertension of the extensor muscles
b) hypertension of the flexor muscles
c) hypotonia of the flexor muscles
d) normal muscle tone
3. The large fontanel in a child closes at age (months)
4. Bedwetting in a child is
a) anuria
b) oliguria
c) pollakiuria
d) enuresis
Sample answers
1 c, 2 b, 3 c, 4 d
Nutrition for a healthy child
1. The first application of a healthy newborn to the mother’s breast is carried out
a) immediately after birth
b) after 6 hours
c) after 12 hours
d) after 24 hours
2. Control feeding of the child is carried out to determine
a) body weight
b) the amount of milk sucked
c) amount of complementary foods
d) amount of supplementary feeding
3. When artificial feeding used as human milk substitutes
a) fruit juices
b) vegetable puree
c) fruit puree
d) infant formula
4. A sign of underfeeding infant is:
a) small weight gain
c) copious stools
d) fever
5. During natural feeding, the child’s intestines are dominated by
a) bifidobacteria
b) coli
c) lactobacilli
d) enterococci
Sample answers
1 a, 2 b, 3 d, 4 a, 5 a
Newborn and caring for him
1. The umbilical cord disappears in a full-term newborn at term (day of life)
2. Physiological decrease in body weight of a newborn is up to (in%)
2. Umbilical wound a newborn is treated with a solution
a) 2% sodium bicarbonate
b) 3% hydrogen peroxide
d) 5% sodium chloride
3. To cleanse the nasal passages of a healthy newborn, use
a) cotton swabs lubricated with sterile oil
b) cotton buds with furatsilin
c) cotton wool with baby cream
d) dry cotton wool
Sample answers
1c, 2a, 3b, 4a
ORGANIZATION OF CARE FOR SICK CHILDREN
Diseases of young children
Premature babies
1. A premature child is a child born at gestational age (weeks)
2. Vellus hair on the body of a newborn is
a) lanugo
b) stridor
c) sclerema
3. Transfer criterion premature newborn from tube feeding to bottle feeding
a) the appearance of a sucking reflex
b) weight gain
c) increase in Bisha's lumps
d) disappearance of physiological dyspepsia
Asphyxia of newborns
4. The goal of the first stage of resuscitation for asphyxia of a newborn is
a) artificial ventilation
b) closed heart massage
c) correction of metabolic disorders
d) restoration of airway patency
Birth injuries
5. The main prerequisite for birth trauma of the central nervous system in a newborn
a) hypoxia
b) hypercapnia
c) hypoproteinemia
d) hyperglycemia
6. External cephalohematoma is a hemorrhage
a) into the soft tissues of the head
b) above the dura mater
c) under the dura mater
d) under the periosteum
Hypotrophy
11. When treating dysbiosis in children, a eubiotic is prescribed
a) biseptol
b) bifidumbacterin
c) diphenhydramine
d) panzinorm
Rickets
12. When a child has rickets, metabolism is disrupted
a) potassium, magnesium
b) calcium, phosphorus
c) potassium, iron
d) calcium, iron
13. Prophylactic dose Vitamin D for a child is (IU)
Spasmophilia
14. Convulsions during spasmophilia in children are caused by changes in the blood
a) increased iron levels
b) decreased iron levels
c) increased calcium levels
d) decreased calcium levels
15. A strangled “cock” cry during inspiration in a child is observed when
a) bronchial asthma
b) bronchitis
c) laryngospasm
d) pharyngitis
Hereditary diseases
16. Brachycephaly, oblique eye shape, flat face, a transverse fold on the palm is characteristic of
a) Down's disease
b) phenylketonuria
c) hemophilia
d) rickets
Sample answers
1 g, 2 a, 3 a, 4 g, 5 a, 6 g, 7 b, 8 c, 9 g, 10 b, 11 b, 12 b, 13 c, 14 g, 15 c, 16 a
Respiratory diseases
1. Short-term cessation of breathing in children
b) bradypnea
c) tachypnea
d) asphyxia
2. To prevent attacks bronchial asthma used in children
a) pipolfen
c) aminophylline
d) ephedrine
3. When acute otitis media used in children
a) mustard plasters
c) cold compress on the ear area
d) warm compress on the ear area
Sample answers
1 a, 2 b, 3 d
Sample answers
1 g, 2 v, 3 g, 4 g
Sample answers
1 a, 2 b, 3 b, 4 d, 5 c, 6 d
Sample answers
1 a, 2 g, 3 a
Sample answers
1 b, 2 b, 3 b
Sample answers
Sample answers
1 g, 2 a, 3 g, 4 c, 5 g, 6 c, 7 g, 8 g, 9 g, 10 b, 11 a
Tuberculosis in children
1. The BCG vaccine is administered to children for prevention
a) diphtheria
b) whooping cough
d) tuberculosis
Sample answers
Sample answers
NURSING
IN PEDIATRICS
INTRODUCTION………………………………………………………………………………………………………………… 3
Requirements of the State educational standard for the level of training of specialists in the field of nursing in pediatrics for specialty 0406 Nursing, basic level of secondary vocational education........................................................... 3
ORGANIZATION OF MEDICAL CARE FOR CHILDREN………………………………………………… 3
Organization of the work of a nurse......................................................... ............................. 4
Nutrition for a healthy child........................................................ ........................................................ .. 5
Newborn and care.................................................................... ................................................. 5
ORGANIZATION OF CARE FOR SICK CHILDREN…………………………………………………. 6
Diseases of young children................................................................... ........................................... 6
Premature babies………………………………………………………………………………….. 6
Asphyxia of newborns……………………………………………………………………………………….. 6
Birth injuries………………………………………………………………………………………. 6
Hemolytic disease newborns…….…….…….…….…….…….…….…….…….……. 6
Purulent-septic diseases of newborns…….…….…….…….…….…….…….……. 6
Anomalies of the constitution (diathesis)…….…….…….…….…….…….…….…….…….…….……. 6
Hypotrophy…………………………………………………………………………………………………………… 6
Rickets…….…….…….…….…….…….…….…….…….…….…….…….…….…….…….…….… …. 6
Spasmophilia................................................................................................................................. 7
Hereditary diseases………………………………………………………………………………… 7
Diseases of older children.................................................................... ........................................... 7
Respiratory diseases………………………………………………………………………………………… 7
Diseases of the circulatory system in children ……………………………………………………… 7
Diseases of the digestive system in children. Helminthiases……………………………………. 7
Diseases of the kidneys and urinary system in children……………………………………………………….. 8
Diseases of the blood and hematopoietic organs in children………………………………………………………………. 8
Diseases of the endocrine system in children…………………………………………………………….. 8
Organization of care for children with infectious diseases.................................................... 9
Tuberculosis in children………………………………………………………………………………….. 9
Organization of nursing process in pediatrics…………………………………….. 10
INTRODUCTION
Dear Colleagues!
Teaching students in medical college(school) ends with a final certification, which includes pediatric issues with childhood infections. This manual will help you prepare for the upcoming certification. When preparing for certification you should:
1. Test your knowledge by answering tasks in test form for all sections, and compare your answers with standards. To assess your knowledge, use the following criteria:
91-100% of correct answers - “excellent”;
81-90% of correct answers are “good”;
71-80% of correct answers - “satisfactory”;
70% or less correct answers are “unsatisfactory”.
2. If the grade is unsatisfactory, the educational material should be re-worked.
3. Repeat solving problems in test form.
We wish you success!
Requirements of the State educational standard for the level of training of specialists in the field of pediatric nursing for specialty 0406 Nursing, basic level of secondary vocational education
The nurse should:
Know the system of organizing medical care for children;
Know the reasons clinical manifestations, diagnostic methods, complications, principles of treatment and prevention of diseases in children;
Be able to prepare the patient for special diagnostic methods;
Be able to implement and document individual stages of the nursing process when caring for children;
Be able to provide first aid at emergency conditions in children.
Security tests
ORGANIZATION OF MEDICAL CARE FOR CHILDREN
Stages and periods of childhood.
Anatomical and physiological features of the child’s organs and systems
1. The pulse rate of a 1 year old child is 1 minute.
Sample answers
Nutrition for a healthy child
1. Daily milk volume for children in the first 10 months. life should not exceed (l)
Sample answers
Newborn and caring for him
1. The water temperature for the first hygienic bath for a healthy newborn is (in °C)
Sample answers
Effective formation and maintenance of children's health is possible only through the interaction of medical and social measures and consistent state policy in the field of maternal and child health. The Russian Federation (RF) has adopted more than 100 legal acts aimed at protecting children. In accordance with the Constitution of the Russian Federation, motherhood, childhood and family are under the protection of the state, which means the creation of socio-economic and legal prerequisites for the normal development and upbringing of children. the federal law“On the Basic Guarantees of the Rights of the Child in the Russian Federation” (1998) provides for the establishment of indicators of the quality of life of children, including the minimum amount social services, guaranteed and accessible free education, social services, social protection of children, organization of health and recreation, provision of food in accordance with minimum standards, free medical care. In the Russian Federation, the UN Conventions “On the Rights of the Child” and “On the Elimination of All Forms of Discrimination against Women” have been ratified, and state social policy to protect children and women through the implementation of federal target programs “Children of Russia”, “Family Planning” and “Safe Motherhood”. These programs are aimed at reducing the number unwanted pregnancies and abortions (especially among teenage girls), reducing the level of gynecological diseases, reducing maternal and infant mortality, restoring reproductive function women suffering from infertility, preventing infertility in young men, introducing in the country monitoring of maternal and infant mortality, congenital malformations, as well as the development and implementation of federal standards for the provision of medical care. Achieving the effect of the adopted programs is possible subject to the improvement of the environment, the development of social infrastructure and the creation of conditions for a healthy lifestyle. Medical and demographic monitoring shows that the measures taken by the state do not restrain the negative impact of socio-economic factors on the quality of life of children; the system of benefits and allowances, including for disabled children, does not compensate for the growth rate of the cost of living. IN Lately note the deterioration of the health of children and adolescents, a decrease in indicators of their physical development and puberty, an increase in general morbidity and high level socially significant diseases. The latter are associated with unfavorable social and everyday factors and environmental influences, poor nutrition, untimely medical, psychological and pedagogical correction. In this regard, the introduction of low-cost and development of hospital-replacement technologies, the elimination of existing imbalances and the implementation of targeted programs can be considered promising. A developed network of perinatal centers has been created, in maternity hospitals Intensive care wards for newborns were opened, equipped with modern equipment, including devices artificial ventilation lungs (ventilation), for effective primary resuscitation newborns, being introduced modern technologies on caring for newborns with low body weight, issues of diagnosis and treatment of intrauterine infections (IUI) are being developed, prenatal diagnosis of congenital developmental anomalies and many hereditary diseases. Early diagnosis,
preoperative preparation and emergency surgical care children with congenital defects heart disease (CHD) significantly improves outcomes in this group of newborns. Newborns are examined for phenylketonuria, congenital hypothyroidism, cystic fibrosis, galactosemia, adrenogenital syndrome. There are medical and genetic departments and offices, consultative and diagnostic units, which makes it possible to improve medical care for pregnant women and children and prevent children from becoming disabled.
The strategic basis for giving birth and raising a healthy child is prevention. In this area, an important place in all age groups takes primary care medical care - pediatrician at the clinic. Preventive examinations are the first and mandatory stage of medical examination of the child population. Their goal is early detection of diseases and implementation of a complex of preventive, therapeutic, health-improving and medical-social measures. The scope and content of preventive examinations must correspond to the age-related physical and neuropsychic development of the child. Preventive examination is carried out in stages.
An important place in the work of a pediatrician is occupied by constant monitoring of the health of children in the 1st year of life: regular examinations with assessment of physical and mental development, nutritional recommendations, correction of identified disorders, and preventive vaccinations. The pediatrician examines the newborn at home during the first two days after the child is discharged from the maternity hospital, then one day after the first visit, on the 14th and 21st days of life and at the age of 1 month (in the children's clinic). During the neonatal period, according to indications, specialist consultations are provided at home and vaccination against tuberculosis is carried out if it was not given in the maternity hospital.
At 1 month, in a clinic, based on the findings of the neonatologist at the maternity hospital, the local pediatrician and specialists (neurologist, ophthalmologist and orthopedic surgeon), the child’s health group is determined. Mothers are trained in complex massage and methods of preventing rickets. Conduct awareness-raising work to ensure breastfeeding and rational supplementary feeding of children. If the mother does not have milk, the artificial feeding scheme is controlled.
In the subsequent months of the first half of life (also in a children's clinic), children are examined by a local pediatrician monthly (further at 8, 10 and 20 months). He corrects the child’s nutrition, preventive vaccinations, gives recommendations for hardening, and monitors neuropsychic development. If a child is sick, he must be consulted by specialists. If necessary
Difficulties are provided by active monitoring by a local pediatrician and 24-hour medical care doctors at home.
At 3 months, a screening laboratory examination is carried out, the child is examined by specialists (neurologist, ophthalmologist, orthopedic surgeon), and a conclusion is drawn up on the indications and contraindications for preventive vaccinations.
The local pediatrician, taking into account previous diseases and examination data from the same specialists, makes a new conclusion about the child’s health at 1 year of age.
In the 2nd year of children’s life, preventive examinations are carried out twice (at 1.5 and 2 years), and subsequently annually.
At the age of 3 years, before entering a preschool institution, children are examined by a pediatrician and medical specialists; They conduct a laboratory examination, assess neuropsychic and physical development, determine health groups and distribute them into medical groups for physical education. Then, at 5 and 6 years old, the same examination is carried out as at 3 years old, and the children’s functional readiness for school is determined. At 8 years old with full dispensary examination they assess adaptation to learning at school, and at the age of 8-14 they also monitor their health status as they progress through the school program. The program of preventive examinations for 6- and 12-year-old children includes electrocardiography (ECG).
A comprehensive examination by medical specialists (ophthalmologist, orthopedic surgeon, otolaryngologist, dentist, neurologist and other specialists if indicated) is mandatory for children aged 1, 3, 5, 6, 8, 10, 12 and 14 years. Every year, children are examined by a dentist and pediatrician, and doctors of other specialties - as indicated. Adolescents are monitored in full in a clinic until they are 17 years old, including the help of a psychologist.
Particular attention is paid to the prevention of gynecological and extragenital diseases in teenage girls; according to indications, they are examined by a pediatric gynecologist.
Improving consultative and diagnostic work with children consists of increasing their availability of qualified specialized medical care, reducing economic costs, organizing day hospitals to quickly clarify the diagnosis and reduce the length of hospital stay.
Dispensary observation is carried out especially carefully for children who have risk factors for diseases (second health group) and chronic diseases (third health group), including a set of preventive, therapeutic and health measures and medical and pedagogical correction. Rehabilitation
carried out in centers and departments of rehabilitation treatment, as well as in specialized sanatoriums.
Children with chronic diseases classified as risk groups and with unusual reactions and post-vaccination complications are given vaccine prophylaxis using optimal regimens after consultation with specialists and taking into account the results of clinical, functional and laboratory tests.
It is known that proper nutrition is essential for development child's body. Current negative trends include a decrease in the number of breastfed children and an increase in the prevalence of diseases gastrointestinal tract(Gastrointestinal tract). Promotion of natural feeding and application various types stimulation of lactation is an important link in the system of measures aimed at strengthening the health of children and reducing morbidity. This work uses the main provisions of the joint WHO/UNICEF Declaration on the Protection, Promotion and Support of Breastfeeding.
Dairy distribution points provide children with free dairy products based on doctor’s prescriptions. Due to the high prevalence of diseases of the digestive system, careful medical and sanitary supervision of the nutrition of schoolchildren is necessary. The development of the baby food industry makes it possible to provide the child population, especially the first 3 years of life and children with chronic diseases, with special food products, including medicinal ones.
If a child becomes ill, full observation and examination are provided at the prehospital stage; if necessary, the child is sent to a hospital, including specialized departments. In order to provide qualified assistance For children, there is a 24-hour home medical service, ambulance and emergency medical care stations available throughout the day.
Complete solution problems of organizing assistance to disabled children includes socio-pedagogical, psychological and medical aspects and contributes to the social orientation of children and their integration into society.
PART I ORGANIZATION OF WORK OF A CHILDREN'S TREATMENT AND PREVENTIVE INSTITUTION CHAPTER 1 TREATMENT AND PREVENTIVE CARE FOR CHILDREN IN RUSSIA
PART I ORGANIZATION OF WORK OF A CHILDREN'S TREATMENT AND PREVENTIVE INSTITUTION CHAPTER 1 TREATMENT AND PREVENTIVE CARE FOR CHILDREN IN RUSSIA
The state system of treatment and preventive care for children, adopted in our country, consists of three main functionally interconnected links: children's clinic - children's hospital - children's sanatorium.
The main types of children's treatment and preventive institutions (HCI): children's hospital (inpatient), children's clinic, children's sanatorium. In addition, medical care can be provided to children in specialized departments of hospitals and clinics for adults, children's departments of maternity hospitals, perinatal centers, consultative and diagnostic centers, centers and departments of rehabilitation treatment, etc. To help children who find themselves in urgent situations, there is a 24-hour home medical service, ambulance and emergency medical care stations.
Treatment and preventive care, mainly preventive, is also provided in educational institutions, such as an orphanage, a nursery complex, a school, a health camp (including sanatorium type) and etc.
Knowledge of the specifics of work and the purpose of each institution is necessary for the future pediatrician. In the system of children's treatment and preventive institutions, the children's hospital plays a special role. This is where seriously ill patients are hospitalized; modern technology is concentrated here. diagnostic equipment, highly qualified doctors and nurses work, and professional training of medical personnel is carried out.
Children Hospital- a medical and preventive institution for children and adolescents under the age of 17 inclusive, who need constant (inpatient) medical supervision, intensive therapy or specialized care.
There are different types of children's hospitals. By profile they are divided into multidisciplinary and specialized, by organizational system - into those combined with a clinic and unintegrated, by volume of activity - into hospitals of one category or another, determined by capacity
(number of beds). In addition, depending on the administrative division, there are district, city, clinical (if a department of a medical or research institute operates on the basis of the hospital), regional, and republican children's hospitals.
The main goal of a modern children's hospital is to restore the health of a sick child. To achieve this goal, the staff of the medical institution must provide the patient with multi-stage assistance, namely: diagnose the disease, carry out emergency treatment, the main course of treatment and rehabilitation treatment, including rehabilitation (social assistance measures).
Providing children with highly qualified medical care;
Implementation into practice modern methods diagnosis, treatment and prevention;
Advisory and methodological work.
Each children's hospital has an emergency department (emergency room), a hospital (medical departments), a treatment and diagnostic department or corresponding offices and laboratories, a pathology department (morgue), auxiliary departments (pharmacy, catering department, medical statistics office, medical archive, administrative economic part, library, etc.).
The development of inpatient medical care for children currently tends to centralize individual hospital services. Diagnostic and treatment centers, consultation centers, high-tech centers, pathology, sterilization departments and other services are being created to ensure the operation of several hospitals in the city and region.
The staffing table of the children's hospital includes the positions of chief physician, deputy chief physician for medical care, deputy chief physician for nursing staff, deputy chief physician for economic affairs, heads of departments, doctors (residents), senior nurses, nurses, junior nurses , whose responsibilities include providing highly qualified medical care and care for sick children. In large children's hospitals, there is a position of a teacher who conducts educational work with children. Staffs are allocated for individual economic and technical specialties (cooks, engineers, mechanics, accountants, etc.).
Work of the reception department (rest room). The first meeting of a sick child with medical personnel occurs in reception department. Its main task is to organize the reception and hospitalization of sick children. The success of subsequent treatment largely depends on the correct and efficient operation of this department. Upon admission of the patient, a preliminary diagnosis is established, the validity of hospitalization is assessed, and emergency medical care is provided if necessary.
The admission department consists of a lobby-waiting room, reception and examination boxes, isolation boxes for 1-2 beds, a sanitary checkpoint, a doctor’s office, a dressing room, a laboratory for urgent tests, rooms for medical personnel, toilets and other premises. The number of reception and examination boxes should be 3% of the number of beds in the hospital.
Employees of the reception department keep records of the movement of patients (registration of those admitted, discharged, transferred to other hospitals, deaths), conduct a medical examination of the patient, provide emergency medical care, carry out referrals to the appropriate department, sanitary treatment, and isolation of infectious patients. There is also a help desk in this department.
The presence of several reception and examination boxes allows for separate reception of therapeutic, surgical and infectious patients, children infancy and newborns.
The intensive care unit is usually located next to the emergency department, so when a patient is admitted in extremely serious condition, he is immediately placed in the intensive care unit, essentially bypassing the emergency room. All necessary documentation is completed “in the course” of the necessary intensive care. Emergency care for a child can also be provided in the intensive care ward, which is located in the emergency department.
Children are delivered to the hospital by ambulance or by their parents on the direction of a doctor at a children's clinic and other children's institutions or without a referral (“gravity”). In addition to the coupon (referral) for hospitalization, other documents are also submitted: an extract from the child’s developmental history, data from laboratory and instrumental studies, information about contacts with infectious patients at home from the local pediatrician and, if the child is “organized,” then from the school-preschool doctor
departments. Without documents, patients can be admitted to the hospital only in emergency conditions.
When a child is admitted to the hospital without the knowledge of the parents, the latter are immediately notified by the reception staff. If it is impossible to obtain information about the child and his parents, the patient’s admission is recorded in a special register and a statement is made to the police.
In large children's hospitals, patients are received by specially designated personnel, in small hospitals - by staff on duty. A sick child is admitted in a strict sequence: registration, medical examination, necessary medical care, sanitary treatment, transfer (transportation) to the appropriate department.
The nurse registers the patient's admission in the journal, fills out the passport part " Medical card inpatient", f. ? 003/у (medical history), enters the insurance policy number, measures body temperature, and reports the information received to the doctor.
After examining the child, the nurse receives recommendations from the doctor regarding the nature of sanitization. Typically, sanitization consists of a hygienic bath or shower; When pediculosis (lice) is detected or nits are detected, appropriate treatment of the scalp and linen is carried out. The exception is for patients in critical condition. They are given first aid and sanitary treatment is carried out only in the absence of contraindications.
After sanitary treatment, the child is transported to the medical department. So-called “planned” patients should not stay in the emergency room for more than 30 minutes.
When there is a mass admission of patients, a certain order of priority for hospitalization is observed: first, care is provided to seriously ill patients, then to patients in a moderate condition, and lastly to “planned” patients who do not need urgent treatment.
Children with signs of an infectious disease are placed in isolation boxes. Fill out the “Emergency notification of an infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination” (f. No. 058/u), which is immediately sent to the center for sanitary and epidemiological surveillance.
The reception department staff keeps logs of admission of hospitalized children, refusals of hospitalization, the number of free places in the departments, as well as an alphabetical book (for the help desk).
Children in the first years of life are hospitalized with one of their parents. The number of beds for mothers should be 20% of total number beds in a children's hospital. Newborns and infants are hospitalized with their mothers.
The reception staff accompanies the child when he is transferred to the medical department, warns the head of the department and the guard nurse about the arrival of a new patient, and informs them about the severity of the child’s condition and behavior during the admission. In the evening and at night (after 3 p.m.), all this information is transmitted to the guard nurse, and when seriously ill patients are admitted, to the doctor on duty.
The reception staff should be attentive and friendly with children and parents, taking into account the child’s condition and the parents’ experiences. We must strive to reduce the child’s adaptation time to a new environment.
A help desk (information service) is organized at the reception department. Here parents can find out about the health status of their children. The help desk must have daily information about the location, severity of the condition and body temperature of each child. This information can be provided to parents by telephone.
Transportation of children from the emergency room to hospital treatment departments can be carried out in several ways. The type of transportation is chosen by the doctor. Children who are in satisfactory condition go to the department themselves, accompanied by a medical worker. Young children and infants are carried in their arms. Seriously ill patients are transported on a stretcher mounted on a special gurney (Fig. 1, a). All stretchers and wheelchairs must be filled with clean sheets, and in the cold season - with blankets. The sheet is changed after each patient, and the blanket is aired.
Some patients, for example children with hemophilia with joint hemorrhage, are transported in a wheelchair (Fig. 1, b).
The emergency department is provided with the necessary number of stretchers and wheelchairs for transporting sick children to the departments. Children in extremely serious condition (shock, convulsions, massive bleeding, etc.) are sent immediately to intensive care unit
or intensive care unit.
In the ward, a seriously ill patient is transferred from a stretcher to a bed: one hand is placed under the shoulder blades, and the other under the hipsRice. 1.
Means of transporting sick children: a - stretcher-wheelchair; b - wheelchair
patient, while the child wraps his arms around the nurse’s neck. If the patient is carried by two people, then one supports the patient under the shoulder blades and lower back, the second - under the buttocks and legs.
The position of the stretcher relative to the bed is selected each time based on the optimal position for the patient (Fig. 2). Work of the medical department.
The main tasks of the medical staff of the treatment department are to make the correct diagnosis and carry out effective treatment. The success of treatment depends on clearRice. 2.
Options for positioning the stretcher in relation to the patient's bed
the work of doctors, paramedical and junior medical personnel, as well as compliance with medical and protective (sick leave) and sanitary and anti-epidemic regimes, and the coherence of the work of support services.
The hospital regime is determined by a number of factors and, first of all, the need to create conditions for full treatment, as well as the rapid social and psychological adaptation of the child to new conditions. To create comfortable conditions, the therapeutic regime includes psychotherapeutic influence and educational measures. Strict requirements are imposed on compliance with sleep and rest regimes. The environment (comfortable furniture, flowers, TV, telephone, etc.) must meet modern requirements.
The daily routine for sick children, regardless of the profile of the medical department, includes the following elements: getting up, measuring body temperature, following doctor’s orders, medical rounds, therapeutic and diagnostic procedures, eating, resting and walking, visiting children with parents, cleaning and airing the premises, sleep. Carrying out sanitary and anti-epidemic measures is essential.
The inpatient unit of the medical department consists of isolated ward sections with 20-30 beds each, and for children under 1 year of age - 24 beds. The ward section should not be a walk-through section. For ease of service, for every few wards, a nursing station. It is recommended to make glass openings in the walls and partitions facing the nursing station. For children of the first year of life, boxed and semi-boxed wards are provided: from 1 to 4 beds in each box. In wards for children over 1 year old, no more than 4-6 beds are allowed.
The system of boxes and separate sections makes it possible to prevent the spread of diseases in case of accidental introduction of infection. The latter usually occur if children are hospitalized during the incubation period of the disease, when there are no manifestations of the disease. For children's hospitals, special standards have been developed for the number of rooms in the medical department and their area, which are presented below (Table 1).
Table 1.List of premises of the medical department of the children's hospital
Premises for mothers should be allocated outside the medical department, but near the wards for children under 1 year of age. In recent years, the principle of a mother and a sick child staying together has also been practiced.
The equipment of wards and the equipment of departments depend on their profile, the specifics of the work of medical personnel and the need to create optimal conditions for the medical worker to perform his official duties.
The specificity of the work of the medical department lies in the need for maximum isolation and separation of children, constant work on the prevention of hospital-acquired infections (HAI). For this purpose, various types of screens are used in the wards, and boxes and half-boxes are provided. The departments are equipped with bactericidal lamps. Inventory and premises are periodically processed disinfectants. Staff and visitors comply with the sanitary and hygienic regime of the department.
To provide emergency care to children, intensive care and temporary isolation wards are organized in the medical department, which are serviced by specially trained nurses. Intensive care wards should be provided with a forced ventilation mode, centralized oxygen supply, devices for intravenous dosed administration of fluids, small surgical kits, electric suction units, sets of drugs for emergency therapy, care regimens for poisoning and emergency conditions, and treatment of toxicosis.
If necessary, it should be possible to quickly call a resuscitator and transfer the child from the medical department to the intensive care unit.
The staffing table of the medical department provides for the following positions: head of the department, doctors, head nurse, nurses, junior nurses, hostess sister.
In large hospitals, educators work in each department, whose functions include organizing classes and recreation for children. Children from the age of 6 study according to the school curriculum and study basic subjects: mathematics, Russian language, etc.; They are graded when they leave the hospital.
Upon recovery and sustained improvement in the child’s condition, the child is discharged from the hospital, and if necessary (providing special
alized care) are transferred to another treatment and preventive institution. Parents and the children's clinic are notified of the child's discharge. The doctor is preparing a discharge summary.
Wards for patients. Each ward usually contains 2-6 patients. According to accepted standards, one bed has 6.5-7.5 m2 of floor area with a ratio of window area to floor area of 1:6. The distribution of children in the wards is carried out according to age, gender or the principle of homogeneity of diseases.
The beds in the wards are placed so that the child can be approached from all sides. In many children's medical institutions, rooms are separated by glass partitions, which allows children to be monitored.
The design of the wards includes a centralized oxygen supply to each bed, as well as an alarm for the nursing station or in the corridor - sound (silent buzzer) or light (red light) to call staff.
In the wards for newborns, in addition to cribs, there is a changing table, scales, a baby bath, and oxygen is supplied; hot and cold water, be sure to install a bactericidal lamp. Instead of a changing table, you can use individual cribs with reclining backs.
Infants are distributed to wards taking into account the nature of the disease and the severity of the condition. The sequence of filling the wards is observed. Newborns and premature babies are placed separately. There are wards (boxes) for newborns with pneumonia, purulent-septic diseases, etc. Only uninfected children can be placed in one ward.
In addition to the mother, only medical personnel who strictly adhere to the sanitary regime (change of shoes, clean gowns, masks, etc.) have contact with sick newborns and premature children. Mothers are usually allowed to see the baby during the feeding period. If necessary, the mother takes part in caring for the child. Currently, in maternity hospitals, mothers are postpartum period is in the same room with the child.
Children's department boxes. The main purpose of the box is to isolate infectious patients and children with suspected infectious diseases in order to prevent nosocomial infections. There are open and closed boxes (half boxes). In open boxes, patients are separated by partitions that are installed
between beds. Isolation in open boxes is imperfect and does not protect against spread droplet infections. Closed boxes are a part of the room with a door, separated by a glass partition to the ceiling. Each box must have natural light, a toilet, and the necessary set of medical and household items to serve children.
The disadvantage of this isolation method is that the boxes have access to the common corridor of the department.
The most justified is the isolation of children in a closed, individual, or Meltzer box (proposed in 1906 by St. Petersburg engineer E.F. Meltzer) (Fig. 3).
The design of the Meltzer box provides for the elimination of any contact of the patient with other children throughout the entire period of treatment.
Rice. 3.Meltzer box plan:
1 - entrance for patients from the street; 2 - front box (front with vestibule); 3 - box; 4 - bathroom; 5 - gateway for personnel; 6 - entrance to the box for medical personnel; 7 - window for serving food; 8 - bed for the patient
A sick child enters the box designated for him directly from the street, and when transferred to another hospital or discharged, he leaves it the same way. New patients are placed in a Meltzer box only after it has been thoroughly wet disinfected.
Each individual box usually consists of the following rooms: an antechamber (front room with a vestibule); ward or examination room (here the child remains for the entire period of isolation); sanitary unit with hot and cold water, sink, bath and toilet; gateway for personnel.
Patients are prohibited from leaving the box into the internal corridor. The nurse (or doctor) enters the airlock from the inner corridor, closes the outer door tightly, washes his hands, puts on a second gown, cap or scarf if necessary, and then moves into the room where the sick child is. When leaving the ward, all operations are performed in reverse order. In order to prevent the spread of infection, it is necessary to ensure that when the door from the airlock to the internal corridor of the department is opened, the door leading to the room with the sick child is tightly closed. Food for the sick is passed through the food service window.
If there is a child in the box, the patient chicken pox, then there is a need for stricter isolation. In this case, the airlock doors facing the internal corridor of the department are tightly closed, and the door glass is sealed with paper. The staff enters the box from the street.
Modern requirements: a children's hospital must be equipped with forced ventilation, have washable floor, wall and ceiling coverings.
children's Hospital- a medical and preventive institution that provides out-of-hospital medical care in the area of operation to children and adolescents up to 17 years of age inclusive.
Sick children are seen at the clinic by pediatricians and doctors of other specialties. The clinic also conducts laboratory, x-ray and other types of studies. Primary ill children, especially those with elevated body temperature and suspected infectious disease, are provided with medical care by a doctor and clinic nurses at home. When children recover or improve their health, they visit a doctor at the clinic. In addition, healthy children are constantly monitored at the clinic. The doctor examines a healthy child in the first year of life monthly, then once a quarter, and children over 3 years old - once a year. The main purpose of such surveillance is to prevent disease. Doctors and nurses at the clinic advise parents on issues of raising, feeding and caring for their children.
All children are registered at the dispensary and are regularly examined not only by pediatricians, but also by doctors of other specialties. Many children's clinics have centralized emergency care centers operating around the clock.
The structure of the organization of a children's clinic includes pediatric departments, departments of rehabilitation treatment, organized childhood (school and preschool medicine), medical and social assistance, etc. In addition, there must be specialized rooms (they are attended by an otolaryngologist, an ophthalmologist, a neurologist, a traumatologist-orthopedist, surgeon, etc.), diagnostic rooms, physiotherapy and exercise therapy rooms, milk dispensing point (breast milk donor point). Each clinic operates treatment room, where vaccinations, injections are given, cupping is placed, and other therapeutic measures are carried out (a separate room is provided for the Mantoux test). The rehabilitation department may have a swimming pool, sauna, gym and a sports hall. An approximate list of premises of the children's clinic is presented in Table 2.
Table 2.List of premises of the children's clinic
Organization of the work of a district nurse in a pediatric area. Organization proper care caring for children in the pediatric area is determined by the level of theoretical training of the nurse and mastery of medical manipulation techniques.
The work of a local nurse includes the following sections:
Preventative;
Medical;
Organizational.
Preventive work. The struggle for a healthy child begins long before his birth, when the local nurse provides prenatal care. Patronage work with pregnant women is carried out jointly with the midwife of the antenatal clinic.
The nurse carries out the first prenatal visitation of a pregnant woman within 10 days from the date of receipt of information about the pregnant woman from the antenatal clinic. During the meeting with the expectant mother, a trusting relationship is established, which allows for a conversation about the great responsibility of being a mother and the need to necessarily continue the pregnancy. The nurse finds out the health status of the pregnant woman, factors that have an adverse effect on the health of the woman and child (bad habits, occupational hazards, hereditary diseases in the family, extragenital pathology), gives advice on the pregnant woman’s diet, daily routine, and invites the pregnant woman to mothers’ school.
At the 32-34th week of pregnancy, the local nurse conducts a second prenatal visit, during which she finds out the state of the pregnant woman’s health during the period that has passed between two visits; past illnesses; monitors adherence to daily routine and nutrition; clarifies the expected timing of the birth and the address where the family will live after the birth. Pregnant women are trained in the technique of breast massage, recommendations are given on the maintenance of the children's room, organizing a corner for the newborn, purchasing the necessary items for caring for the newborn and clothing.
An important part of preventive work with a newborn child is home visits by a nurse. The first patronage of a newborn is carried out jointly by a local pediatrician and a nurse for the first
3 days after discharge from the maternity hospital. Children from the “at-risk” group are visited on the day of discharge. The child is examined by a pediatrician, and based on the history and examination, a comprehensive assessment of the child’s health is carried out, in connection with which the pediatrician gives recommendations on the daily routine, nutrition and care of the child. The nurse treats the baby’s skin and umbilical ring, explains and shows the mother how to follow the doctor’s advice, teaches the mother the technique of free swaddling, using diapers, bodysuits, caring for the baby’s skin, eyes, nose, preparation and bathing techniques for the baby. If necessary, present during the first bath.
The nurse explains to parents the procedure for storing and caring for a newborn baby’s underwear, the procedure for organizing walks, the rules for breastfeeding, the rules for daily wet cleaning of the room, ventilation, temperature control, and careful hygiene when caring for the child; talks about the need to change the baby’s position in the crib; introduces the mother to the work schedule of the children's clinic.
Repeated visits to the child in the first half of life are carried out 2 times a month, in the second half of the year - once a month or more often - at the discretion of the local pediatrician. During repeated visits to a newborn and a child of the first year of life, the district nurse checks compliance with sanitary and hygienic requirements, examines the child, evaluates the mother’s compliance with recommendations and her skills in caring for the child, the child’s age-appropriate skills and abilities, teaches the mother how to perform massage and gymnastics
In preventive work with children of the second and third year of life, the leading place is occupied by the issues of hardening and physical education. In the second year of life, a nurse visits the child once a quarter, in the third year - once every six months. The purpose of patronage is to monitor the implementation of the local doctor’s prescriptions, conduct conversations on organizing a diet, hardening procedures, and physical exercises.
The preventive work of the district nurse also includes participation in medical appointments and immunoprophylaxis. The local doctor and local nurse are responsible for the medical examination of all children living in the pediatric area, especially children preschool age raised at home. If the clinic does not
preschool and school department, then the local nurse helps the doctor to carry out all necessary work By medical support organized teams.
Therapeutic work. Treatment work includes providing medical care to acutely ill children and children suffering from chronic diseases during exacerbations, as well as dispensary observation of children classified as “at risk”, as well as children suffering from congenital and chronic diseases.
The work of a nurse in providing medical care to seriously ill children for whom a “hospital at home” is organized is very important and responsible. This form of treatment is used when for some reason it is impossible to hospitalize a seriously ill child in a hospital. In such cases, the nurse regularly visits the child several times a day, carries out the necessary medical prescriptions, monitors laboratory and diagnostic tests carried out at home, examinations by specialist doctors, as well as the parents’ compliance with the recommendations of the attending physician. The nurse should explain to the mother in detail the signs indicating a deterioration in the child’s health and recommend that if they appear, immediately consult a doctor or call an ambulance.
When a child is sent to a hospital, a local nurse monitors (by telephone or during a direct visit to the family) the progress of hospitalization. If the child is not hospitalized for any reason, immediately notify the local pediatrician or the head of the pediatric department.
Organizational work. The nurse should be well acquainted with the accounting and reporting documentation used in work in the pediatric area. The main document filled out at the clinic is the “History of the child’s development” (form No. 112/u). The stories are stored in the registry, on the precise activities of which the rational organization of the reception of children depends. Middle and junior medical personnel are involved in working at the registry and maintaining records. In recent years, in some clinics, child development histories have been handed out to parents. This allows on-duty doctors and emergency doctors called to the house to more easily and quickly determine the severity of the condition and the nature of the child’s illness, and maintain continuity in the provision of medical care.
Are all children with chronic pathologies recorded according to the form? 030/у, which allows you to organize systematic active surveillance. The form includes the results of laboratory diagnostic examinations, anti-relapse treatment and health measures that prevent exacerbation and progression of diseases.
The work of the district nurse is carried out in accordance with a plan drawn up under the guidance of a pediatrician, based on an analysis of children’s health indicators and the results of treatment and preventive work at the pediatric site for the previous period (Table 3).
Table 3.Work plan of a district nurse for one
month
* - last name and list with addresses
The children's clinic carries out extensive sanitary education work. Parents are taught the rules of individual disease prevention. Serious attention is paid to the care of newborns. Doctors and nursing staff take part in this work. Vaccinations are given in accordance with the vaccination calendar.
Dispensary- a medical and preventive institution, the functions of which are active early detection of patients with certain groups of diseases, their registration and accounting, examination for the purpose of diagnosis, provision of specialized medical care, active dynamic monitoring of the health status of patients of a certain profile, development and implementation of necessary preventive measures diseases.
Children receive the necessary assistance in the children's departments of dispensaries. Depending on the nature of the activity, the following types of dispensaries are distinguished: anti-tuberculosis, oncology, psychoneurological, medical and physical education, etc. Similar functions can be performed by specialized centers created at individual children's hospitals: cardio-rheumatology, gastroenterology, pulmonology, genetics, hematology, etc. A significant role in the work of these institutions belongs to nurses who keep records of patients in a hospital or clinic, fill out the “Unified Statistical Coupon” (“Outpatient Coupon”) for each admitted
the patient, other necessary documentation, assist the doctor during the appointment, provide patronage to patients at home, and carry out sanitary education work.
District or city consultative and diagnostic centers(OKDC). In large cities, diagnostic centers equipped with modern equipment (Dopplerography, endoscopy, CT scan
, enzyme immunoassay, etc.). Their task is to examine children from a number of attached clinics (the “bush” principle) and determine the necessary treatment recommendations. Children's sanatorium - an inpatient treatment and preventive institution for carrying out treatment and rehabilitation, rehabilitation and general health measures among sick children, mainly using natural in combination with diet therapy, physical therapy and physiotherapy, subject to an appropriate treatment regimen, schooling and rest. Approximately a quarter of all children's inpatient beds are concentrated in children's sanatorium and resort institutions.
Children's sanatoriums are organized in specialized resort areas. In addition, there are so-called local sanatoriums and sanatorium-forest schools. They are located, as a rule, in suburban areas with favorable landscape and microclimatic conditions. Great importance is also given to the organization of treatment and recreation for children with their parents. Treatment of children in such cases is carried out in sanatoriums and boarding houses for mothers and children, sanatoriums, where special “mother and child” visits are organized during school holidays.
Children's home- a medical and preventive institution intended for the maintenance, education, and provision of medical care to orphans, children with defects in physical or mental development, children whose parents are deprived of parental rights. Children under 3 years of age are accepted into orphanages using vouchers from health departments. The capacity of orphanages is usually no less than 30 and no more than 100 places. Depending on the age of children, there are infant, toddler, middle and senior group. Children leave the orphanage to live with their parents, can be adopted, and upon reaching the age of 3-4 years are transferred to children's institutions of the social welfare type (disabled children).
Children's preschool institutions Depending on their purpose, they are divided into several types.
Nursery- a healthcare institution designed to educate children aged 2 months to 3 years and provide them with medical care.
Kindergarten- an institution for the public education of children aged 3 to 7 years, under the jurisdiction of public education authorities or other departments, enterprises, and private organizations. There is a combined type of preschool institution - nursery - kindergarten, where children are educated during the nursery and preschool periods.
Great importance is given to the work of nurses in preschool and school departments of children's clinics, providing therapeutic and preventive monitoring of children in addition to nurseries, kindergartens, in such educational institutions as schools, health camps(including sanatorium type), boarding schools
CONTROL QUESTIONS
1.What children's medical institutions do you know?
2.What are the main structural divisions of the children's hospital?
3.What accompanying documents must be submitted for hospitalization of a child?
4.What information can be obtained about a sick child through the help desk of the admissions department?
5.How is a seriously ill patient transported to the department?
6.List the main premises of the medical department of the children's hospital.
7.What is an individual (Melzer) box?
8.Name children's educational institutions in which treatment and preventive work is carried out.
9.List the main premises of the children's clinic.
General child care: Zaprudnov A. M., Grigoriev K. I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.
