VOLGOGRAD STATE MEDICAL UNIVERSITY
CHAIR OF SURGERY
APPROVED
Head of the Chair
Professor ___________
"___"____________ 2008
MANUAL FOR PRACTICAL CLASSES IN SURGERY FOR SECOND -YEAR
STUDENTS OF THE GENERAL MEDICINE DEPARTMENT (ENGLISH-SPEAKING
MEDIUM)
Compiled by
Approved at the chair meeting “___”________2008
Approved by the Learned Council of the Department “___”_______2008
Volgograd, 2009
Management of patients
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Familiarize the students with the work of a patient care institution.
Develop students’ skills in patients’ care.
Show nursing manipulations and some doctor’s manipulations.
Familiarize the students with the rules of deontology and ethics.
Objectives
Making the students get acquainted with:
1. The basic rules and methods of patient care in various diseases.
2. The technique of nursing procedures.
3. The technique of basic doctor’s manipulations.
Syllabus for practical classes
1. Acquire skills as nurse’s assistant in extracurricular classes ( 72 hours- 4 hours a week).
2. Obtain the information on a nurse work and put it down in diaries.
3. Submit a diary and a report to a supervising teacher before the practical class.
4. Assess the student’s knowledge and skills.
Syllabus for practical classes in surgical and resuscitation department
1. Familiarize with the work of a patient care institution.
2. Acquire practical skills in nursing of surgical patients.
3. Develop skill in giving the first aid.
4. Learn sanitary standards of surgical service.
Practical skills to be acquired while receiving patients
1. Registering a patient.
2. Examination and washing a patient.
3. Admitting a patient to a hospital department (ward).
4. Explanation of the schedule and rules in a surgical department to a patient.
5. Listing personal things of an admitted patient.
6. Making 2 copies of a personal thing list (one copy is kept with the patient’s belongings; the
other one is given to the patient).
7. Keeping the patient’s clothes in a storage room.
Syllabus for practical classes in patients’ care in surgical department
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Master basic duties and working conditions of paramedical personnel.
Familiarize the students with basis of medical psychology, ethics and deontology.
Master general rules of nursing and differentiated care in a surgical clinic.
Study medical procedures and manipulations.
Syllabus for practical classes in patients’ care in dressing room
1. Acquire skills in removing a dressing, therapeutic manipulations, application of a new
dressing, therapeutic intervention.
2. Acquire skills in prevention of any infection in the wound.
3. Differentiate “clean” and “purulent” cases.
4. Practice careful handling with patients, especially while transporting grave bedridden
patients to a dressing room.
5. Learn the technique of patient management in a ward or dressing room.
6. Follow aseptic and antiseptic requirements.
7. Learn the technique of instrumental dressing.
8. Acquire skills in surgical manipulations.
9. Acquire skills in sterilization and disinfection of surgical instruments.
Syllabus for practical classes in patients’ care in a procedure room
1. Familiarize with the equipment of the procedure room.
2. Learn ways of instrument sterilization, paracentesis of peripheral veins, storage of
sterile instruments, drugs and blood samples.
3. Familiarize with various types of syringes and needles used in the procedure room.
4. Learn to determine if needles are usable, ways of their storage.
5. Acquire knowledge in sterilization of syringes and needles.
6. Familiarize with intramuscular, intravenous, subcutaneous injections, with duodenal
and gastric intubations.
7. Learn the technique of duodenal and gastric intubations.
Syllabus for practical classes in patients’ care in a resuscitation department
1. Familiarize with the equipment of an intensive care unit.
2. Learn indications for resuscitation procedures.
3. Study the course of a postoperative period.
4. Learn to give the first aid in unconsciousness state, acute mental disturbances, acute
hemorrhage, acute respiratory disorder, vomiting, regurgitation and aspiration of gastric
contents, collapse, terminal conditions.
5. Acquire skills in prevention and treatment of hiccups, vomiting, belching.
6. Acquire skills in the technique of oxygen inhalation, respiratory manupulations.
Syllabus for practical classes in patients’ care in a surgery unit
1. Familiarize with:
- sterilization of materials, gloves and instruments
- hand scrubbing before surgery, surgical manipulation
- performing an operation.
Themes of reports
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Specifics of patient’s care in a postoperative period.
Peculiarities of patients’ condition in case of abdominal surgery.
Peculiarities of patients’ condition in case of thoracic surgery.
Peculiarities of patients’ condition in case of urinary surgery.
Peculiarities of patients’ condition in case of operation on magisterial vessels of
extremities.
6. Specifics of patient’s care after trauma.
7. Cleansing enema (indications, technique of administration, possible complications
and their prevention).
8. Siphon enema (indications, technique of administration, possible complications and
their prevention).
9. Postoperative paresis of the intestine. Prevention and treatment.
10. Respiratory arrest. Ways of its prevention, first aid.
11. Cardiac arrest, first aid.
12. Medical deontology and doctor’s ethics.
13. Medical secrecy. Ethical and legal aspects of medical secrecy.
14. Deontology in surgery.
15. Applying of cups, mustard plaster, and their contraindications. Complications and
their prevention.
16. Gastric intubation. Indications and contraindications. Complications and their
prevention.
17. Prevention of hospital infection.
18. Personal hygiene as health principles.
19. Cold rubdowns as a way of preventing inflammatory diseases.
20. Ways of preventing the spread of AIDS.
21. The use of antibacterial medium in a surgical practice.
22. Oxygen therapy. Its’ use in a surgical practice.
23. The layout and regulations of medical care institutions.
24. Daily routine and nutrition of inpatients.
25. Ways of affecting blood circulation.
26. First aid in terminal conditions.
27. Defibrillation (indications, technique of administration).
28. Tracheostomy (indications, technique of administration, complications).
Questioning on the issue
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Rules of clinical hygiene.
Basic components of nursing care in surgery.
Rules of general and differentiated care.
Basis of medical personnel hygiene.
Peculiarities of surgical patients’ care.
First aid given in contact of the skin, mouth, nasopharynx, eyes or stomach with
disinfectants
7. Main syllabuses while receiving a patient in a surgical clinic.
8. Sanitary procedures performed in the admission department.
9. Hygienic preparation of a patient for an urgent surgery.
10. Disinfection of bathtubs, sponges, scissors.
11. Air hygiene in a surgical inpatient department.
12. Prevention of hospital infections in a surgical inpatient department.
13. Air disinfection in a surgical department, dressing room and operation theatre.
14. Nutrition of bedridden patients, enteral feeding, feeding through a gastrostoma.
15. Air hygiene in the operation theatre.
16. Putting the patient onto the operation table, taking him off it, transportation to his
department.
17. Zones of the surgery unit, their differences, the “rule of the red line”.
18. Therapeutic and conservative regimen at the department.
19. Preparation of a patient for a surgery.
20. Regimen rules of a surgical patient. Types of regimen.
21. Bedsores, their causes, prevention, treatment.
22. Changes of bed linen for a surgical patient. Ways of sanitary cleansing.
23. Aid in vomiting, aspiration of gastric contents.
24. Care of unconscious patients.
25. Handling a dead body.
26. Postoperative wound, its observation, signs of complications.
27. Drains, their cleaning.
28. Peculiarities of care for patients after abdominal surgery.
29. Peculiarities of care for patients after urinary surgery
30. Peculiarities of care for patients after thoracic surgery.
31. Prevention of pulmonary complications.
32. Enema, types of enema.
33. Technique of administering of cups, mustard plaster.
34. Catheterisation of the bladder.
35. Flatus tube, its introduction.
36. Taking body temperature.
37. Deontology in surgery.
38. Closed-chest and open-chest cardiac massage.
39. Artificial ventilation.
40. Ways of transporting the patient into the department.
41. The layout of the procedure room, its equipment.
42. Syringe pre-sterilization.
43. Technique of giving subcutaneous, intramuscular, intravenous injections.
44. Prevention of wound infection in the dressing room.
45. Rules of dressing, indications.
46. Measurement the pulse rate, arterial pressure and respiratory rate.
SKILLS TO BE ACQUIRED (requirements to the students)
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List of therapeutic and diagnostic skills
knowledge
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I. CARE OF PATIENTS
A. ADMISSION DEPARTMENT
Transportation of patients from the ambulance
car into the admission department
Medical records, filling in initial data in case
history
The registering clerk work
Anthropometry
General examination
Patient’s washing (trimming hair and nails,
giving a bath, shower or wiping)
Measuring the patient’s temperature at the
registry
Storage and use of thermometers
Filling in temperature sheets
Preparation of 0.5%, 1%, 10% solution of
chlorinated lime
Catheterisation of the bladder
Transportation of patients from the admission
department into the inpatient department
B.
WARD
Familiarization with the layout, organization of
work, and regimen of medical care institutions
Familiarization with the medical records, rules
of admitting and discharging patients out
WARD HYGIENE:
Wet cleaning of wards:
Preparation of 0.5-1% solution of chlorinated
Quality of
skills
attainments
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lime
Control of sanitary conditions of bedside tables
Airing the wards
Control of visiting and food brought by visitors
Disinfection and storage of spittoons
Transportation of patients with a drip stand or
drain
Making the bed
Change of linen and bed clothes
Placing the rubber ring or bedpan
Transportation and relaying of patients
Administering of mustard plasters and cups
NUTRITION OF PATIENT
Feeding the patient. Rules of dietotherapy.
Nutrition regimen
Feeding grave and bedridden patients
II. TECHNIQUE OF MANIPULATIONS
Transporting the patient to and from the dressing
room
Methods and techniques of changing a dressing
Applying of various dressing types
Sterilization of instruments
Dressing room cleaning
Skin care in case of fistula
Taking the temperature, filling it in the t0 sheet;
types of temperature curves. Storage of
thermometers. Care of patients in different
periods of fever
Blood circulation disorders: indications,
contraindications, administering of cups,
mustard plasters, hot water bottles, heat
compresses, ice packs; bloodletting; applying
the tourniquet
Oxygen therapy: operating on for oxygen
installation
Prescription, storage, use of drugs; monitoring
the use of poisonous and powerful drugs;
distribution of drugs for internal use
Indications, contraindications, technique of
administering enemas (cleansing, nutrient
medicinal, siphon enema)
Preparation of patient for x-ray examination of
gastrointestinal tract, gallbladder and biliary
ducts, kidneys and urinary tracts
Injections:
Sterilization of syringes and needles
Use of syringe
Taking blood sample from the vein
Giving intravenous injections
Indications, contraindications, technique of
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subcutaneous and intramuscular injections
Treatment of needles and syringes after use
Checking the sterility of needles and syringes
Infusion therapy
Preparing tubes for gastric juice and duodenal
intubation
Performing gastric lavage
Shaving the operative area
Sanitary washing of the patient
III. LABORATORY TESTS
Urine: Zimnitskiy’s test
Feces: physical properties, occult blood test
Gastric contents: methods and technique of
gastric intubation
Duodenal contents:
Methods and technique of duodenal intubation
Carrying out duodenal intubations
Blood:
Taking blood from the finger for a large drop
Taking blood from the finger for agglutination
time test
Blood grouping, Rhesus compatibility
Sputum: technique of sputum collection (general
test, for atypical cells, for microflora and
antibiotic sensitivity, daily amount)
Pleural fluid:
Preparing instruments for pleurocentesis
Pleurocentesis: indications, contraindications,
technique, performing pleurocentesis
Determining physical properties of pleural fluid
IV. BASIC DOCTOR’S MANIPULATIONS
Counting respiratory movements, filling them in
the temperature sheet
Pulse characteristics. Graphic representation of
pulse rate in the temperature sheet.
BP monitoring
V. URGENT CONDITIONS
Applying tourniquet on the extremities (acute
cardiac insufficiency)
Technique of external cardiac massage
Technique of artificial ventilation
Principles of defibrillation
Preparation and using of a catheter
Administering a flatus tube
Indications, contraindications, technique of
gastric lavage
VI. BASIC SURGICAL SKILLS
Nursing
Clinical hygiene of medical personnel in surgery
DIARY
practical training
student _____________________________________________________
second year of the General Medicine department
Volgograd State Medical University
Dates of practical training
from ______________ to _____________
Teaching hospital ______________________________________
Supervisor of practical training _________________________________________
Supervisor of practical training at VolSVMU ______________________________
Date of
duty
Work accomplished
Signature of a
nurse on duty
REFERENCE
of student ___________________________________________________
Signature of the supervisor
Signature of the head nurse
Examination mark