Examination ticket number 13

Certification of professional activity

PM02. Participation in medical diagnostic and rehabilitation processes

MDK _ 02.01. “Nursing care for various diseases and conditions”

MDK 02.02. “Fundamentals of Rehabilitation”

Specialty_ 060500 “Nursing”

GBOU SPO VO “Kovrov Medical College” Considered and approved at the meeting of the CMC “___” _____________. Approved by Deputy Director for SD ___________Nakhaeva N.P “___” ____________

Tasks for students

Assessed competencies PC2.1, PC 2.2, PC 2.3, PC 2.4, PC 2.5, PC 2.6, PC 2.7. PC 2.8

Conditions for completing the task the practical task is performed in the classroom using material resources, taking into account the requirements for labor safety when performing a medical service

Task completion time_ 30 minutes

Task number 1. Task

Instruction:

Read the assignment carefully.

Task completion time – 10 minutes

Patient R., aged 30, was admitted to the Nephrology Department with a diagnosis of exacerbation of chronic pyelonephritis.

Complaints of fever, nagging pain in the lumbar region, frequent and painful urination, general weakness, headache, lack of appetite. The patient has a history of chronic pyelonephritis for 6 years. The patient is restless, worried about his condition, doubts the success of the treatment.

Objectively: the temperature is 38.8°C. Moderate condition. Consciousness is clear. Hyperemia of the face. The skin is clean, subcutaneous fat is poorly developed. Pulse 98 bpm, tense, BP 150/95 mm Hg. Art. Tongue dry, covered with white coating. The abdomen is soft, painless, Pasternatsky’s symptom is positive on both sides.

The patient was scheduled for excretory urography.

Tasks

1. Identify the patient’s problems;

2. set goals

3. Make a nursing care plan for the priority problem, with the motivation for each nursing intervention.

4. Explain to the patient the nature of the upcoming procedure

5. Prepare the patient for the upcoming procedure.

6. Demonstrate the technique of urinary bladder catheterization in men on a model.

7. Complete the required medical documentation

Task number 2. Task

Instruction:

Read the assignment carefully.

Task completion time – 10 minutes

Active visiting of the child of 3 months of life. On artificial feeding from 1.5 months. age, suffers from constipation. There was no stool for two days, the child is restless, screams, presses his legs to his stomach, kicks his legs, the skin is clean. The abdomen is moderately swollen, the gases do not go away, the body temperature is 36.7º C, the pulse is 132 bpm, the respiratory rate is 44 per minute.

Tasks

1. Identify the patient’s problems;

2. set goals

3. Make a nursing care plan for the priority problem, with the motivation for each nursing intervention.

4. Have a conversation with mom about rational feeding.

5. Demonstrate the cleansing enema technique.

6. Complete the required medical documentation

Task number 3. Task

Instruction:

Read the assignment carefully.

Task completion time – 10 minutes

A 60-year-old patient was admitted for inpatient treatment in the skin department of the clinic with a diagnosis of herpes zoster.

Complaints of malaise, weakness, shooting burning pains in the right half of the lower back, the appearance of a rash, high fever, sleep disturbance.

Objectively: in the lumbar region on the right against an erythematous background, there are many grouped vesicular elements, 2-5 mm in size. Temperature 37.8 0 . Pulse is frequent, rhythmic. AD 110/60. The abdomen is soft, painless, physiological functions are normal.

Tasks

1. Identify the patient’s problems;

2. set goals

3. Make a nursing care plan for the priority problem, with the motivation for each nursing intervention.

4. Make a thesis plan for a conversation with the patient.

5. Have a conversation with the patient about the observance of the sanitary and hygienic regimen during the treatment period and after recovery

6. Demonstrate IM injection technique.

Ticket number 13 (sample answer)

Task #1

Patient problems

Real:

– Drawing pains in the lower back, dysuria, fever, general weakness, headache, lack of appetite, uncertainty about the favorable outcome of the disease, anxiety about one’s condition.

The priority problem is frequent, painful urination (dysuria).

Short-term goal : The patient will report a reduction in dysuria by the end of the week.

Long-term goal : the disappearance of dysuric phenomena by the time the patient is discharged and the patient demonstrates knowledge of the risk factors leading to an exacerbation of the disease.

Plan Motivation
1. Ensuring strict bed rest and rest. To reduce physical and emotional stress.
2. Providing dietary nutrition with limited salt (exclude spicy, salty, smoked foods from the diet). To prevent edema and reduce irritation of the pyelocaliceal system.
3. Monitoring the appearance and condition of the patient (pulse, blood pressure, respiratory rate). For early diagnosis and timely provision of emergency care in case of complications.
4. Providing the patient with a plentiful drink up to 2-2.5 liters per day (mineral water, cranberry juice, rosehip infusion) To create forced diuresis contributing to the relief of the inflammatory process.
5. Ensuring personal hygiene of the patient (change of linen, washing). To create comfort for the patient and prevent secondary infection.
6. Providing the patient with care items (duck, heating pad). To ensure patient comfort and reduce pain.
7. Conducting a conversation with relatives about providing a complete and dietary food with an enhanced drinking regimen. To increase the immunity and defenses of the patient’s body.

Evaluation: the patient notes a significant improvement in the condition, pain in the lumbar region has disappeared, there are no dysuric phenomena. The goal has been reached.

The student teaches the patient how to prepare for excretory urography.

The student demonstrates the technique of urinary bladder catheterization in men on the model in accordance with the generally accepted algorithm

Task #2

Patient problems:

– violation of bowel movements (constipation);

– malnutrition;

– anxiety.

Priority problem: violation of bowel movements (constipation).

Short-term goal: the patient will have a chair at least 1 time per day (time is individual).

Long-term goal: Relatives know how to prevent constipation.

Plan Motivation
1. Provide a sour-milk-vegetarian diet (cottage cheese, kefir, vegetable broth, fruit juices and puree) To normalize intestinal motility
2. Ensure sufficient fluid intake (fermented milk products, juices) depending on appetite To normalize intestinal motility
3. Try to develop a conditioned reflex in the patient to defecate at a certain time of the day (for example, in the morning after eating) For regular bowel movements
4. Provide massage, gymnastics, air baths To improve the general condition of the patient
5. Provide a cleansing enema, gas tube, as prescribed by a doctor For bowel movements
6. Record daily stool frequency in medical records To monitor bowel movements
7. Educate relatives about the peculiarities of nutrition for constipation For the prevention of constipation
8. Recommend expanding the mode of physical activity To normalize intestinal motility

Evaluation : the patient’s stool is normal (1 time per day). The goal will be reached.

The student conducts a conversation with the mother about rational feeding.

The student demonstrates the technique of conducting a cleansing enema on a dummy.

The student completes the required medical documentation

Task #3

Patient problems

Real: fever, skin rash, sleep disturbance, irritability, neuralgic pain.

Potential: risk of secondary infection, prolonged neuralgic pain.

Priority problem: neuralgic pains and skin rashes.

Short-term goal: The patient will have less pain by the end of the week.

Long-term goal: The patient will not complain of shooting, burning pains. The integrity of the skin will be restored by the time of discharge.

Plan Motivation
1. Provide physical and mental rest 1. To reduce physical and mental stress
2. As prescribed by the doctor, give painkillers for pain 2. To relieve pain
3. Avoid contact of the patient with children 3. To avoid possible spread of infection
4. Prohibit water procedures 4. To prevent spreading process
5. Change bedding and underwear more often 5. For the prevention of secondary infection

The student demonstrates the correctly chosen method of communication with the patient, clearly, competently argues and explains:

– factors contributing to the occurrence of herpes;

– observance of the sparing mode;

– modern methods of treatment;

– the need for examination by an oncologist;

– prevention of colds and viral diseases.

The student demonstrates the technique of intramuscular injection on a model according to the manipulation algorithm.

Prepare: a syringe with an antibiotic solution and an IM needle, sterile cotton balls, alcohol.

– Remove air from the syringe by holding the cannula with your index finger.

– Take the syringe in your right hand so that the 5th finger is on the cannula of the needle, and the 1st, 3rd and 4th fingers are on the cylinder, the 2nd is on the rim.

– Palpate the injection site.

– Treat the injection site with a cotton swab moistened with alcohol, making smears in one direction.

– Fix a cotton ball between the 4th and 5th fingers of your left hand.

– With the free fingers of the left hand, stretch the skin in the injection area.

– Holding the syringe perpendicular, at an angle of 90 degrees, insert the needle into the muscle, leaving 0.5-1 cm from the cannula.

– Place your left hand on the plunger and inject the drug, making sure that the needle does not enter the blood vessel.

– Remove the needle, press the injection site with a cotton ball moistened with alcohol for 15 seconds, massaging lightly.

– Place the used cotton ball for disinfection in a 3% solution of chloramine for 1 hour, the syringe and needle in container No. 1 to remove the remnants of the drug and blood.

– The student completes the required medical documentation

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