WORK ORGANIZATION OF HEALTH CARE INSTITUTIONS PATIENT ADMISSION INTO HOSPITAL - BASICS

Healthcare institution

• Institution that provides health care services

Services of health care institutions

• • • • • • • • • Population health management Disease prevention Diagnostic Therapy Rehabilitation Employee education programs Health care programs conducting Waste disposal Improving quality of work

Health care services

• – – – – Health technologies technologies that are used in health care • • • prevention diagnostic treatment rehabilitation • • HEALTH TECHNOLOGIES proven safe checked APROVED BY MINISTRY OF HEALTH Aim: POPULATION HEALTH IMPROVEMENT

Health care institution may be founded by:

• • • • • Republic Autonomous province Municipality Legal entity Individual

Types of medical facility

• • • • • • • • Community health center ( Level III trauma center ) Hospital ( Level II trauma center ) Pharmacy Clinic Clinical hospital center Clinical center ( Level I trauma center ) Institute Public health institute

Conditions that healthcare organizations must meet:

• • • • • Type and number of health care professionals equipment facilities drugs Medical devices • Healthcare services are delivered on

levels three

HEALTH CARE LEVELS

• • • • •

Primary health care

Health protection and promotion Prevention and early diagnosis Therapy and rehabilitation of patients Health care of special social groups health education and counseling • •

Secondary health care

specialized consultative activities Hospital activities • • • •

Tertiary health care

The most complex specialized consultative activities Hospital activities science investigation activities

Traumatic injuries and levels of health care

Pyramidal structure of treatment URGENCY LEVELS

TERTIARY HEALTH CARE Urgency Level I 1,2 % Injuries Trauma center LEVEL I SECONDARY HEALTH CARE PRIMARY HEALTH CARE Urgency Level II 4,3% Injuries Trauma center LEVEL II Urgency Level III 94,3% Injuries Trauma center LEVEL III

Management of healthcare institution

• • •

BOARDS

DIRECTOR

organize work manage the activities - represent an institution

MANAGING BOARD

- Statute decisions on activities development program

SUPERVISING BOARD

Monitoring work and performance • • • • PROFESSIONAL BODIES

EXPERT COUNCIL

Questions of professional work Program of professional work Control and the quality improvement SENIOR STAFF professional and doctrinal stance

ETHICAL BOARD

ethics of medical work Research - approval patient - health worker advisory function relationship COMMISSION FOR IMPROVING THE QUALITY OF WORK Annual Program of checking the quality of work

CLINIC

• • • • • • tertiary health institution Patient health care to CERTAIN BRANCHES of medicine RESEARCH – EDUCATIONAL ACTIVITY EDUCATIONAL ACTIVITIES at the headquarters of the University with Faculty of Medicine activity of the General Hospital

• all as CLINIC + • • • • • LAB – services RTG - services anesthesiology resuscitation transfusion

INSTITUTE

MEDICAL CENTRE

• all as CLINIC + • • activity of ONE or MORE hospital activity branches of medicine

CLINICAL CENTRE

• • • • • It combines THREE OR MORE functional unit clinics in the specialized consultative activities patient health care educational activities research activities • HIGHEST LEVEL OF HEALTH SERVICES

PATIENTS ADMISSION into hospital

Patients admission into a health facility is result of the need to solve his medical problems.

Admitted patient

• • • • Should accept the proposals for diagnostic and treatment Should be adjusted to the program of diagnosis and treatment Needs to make difficult decisions about his health (major surgery, risky treatment, toxic drugs ...) abide by the house rules during his stay in hospital

Ways to admission

•

URGENT ADMISSION

– difficult general situation – Ambulance brings him – priority to establish and maintain vital functions – care of injuries

Ways to admission

•

CONDITIONAL EMERGENCY ADMISSION

– AFTER INSPECTION AT THE CLINIC – deterioration of general condition, if not admitted – an unpleasant surprise for the patient – doctor has to introduce a patient with health risks in the reception delay

Ways to admission

•

ELECTIVE (scheduled ) ADMISSION

– AFTER INSPECTION AT THE CLINIC – scheduled date of admission – the patient is mentally prepared – patient is medically prepared : previous examination by a specialist, LAB. examinations, additional diagnostic methods previously committed

Child admission to hospital

• • • • The unpredictable behavior child of the parent Separation of the child and parents stress The attitude during the admission (friendly, kindness, play, chat) Important constant communication and cooperation between parents and doctors

MEDICAL RECORD

MEDICAL RECORD

• • • • •

„Case"

place of patient – all records about patient at one 1st page - personal data and insurance information 2nd page Anamnesis and Clinical findings on admission 3rd and 4th page - "

Decursus morbi

" - description of the course of diagnosis and treatment and any changes in the patient - in chronological order - "

Epicrisis

" - a brief description of the course of treatment

MEDICAL RECORD

• • • • Disposal of any additional findings ( LAB., RTG, consultative findings, other additional findings) Forensic document!

It is kept in the archives for 10 years.

Electronic medical records - facilitates the monitoring of a disease, and scientific research

MEDICAL RECORD

• • • • Receiving for hospital admission - gives the physician that indicates acceptance - person responsible for the hospitalization and the treatment of the patient „Consent to hospitalization“ patient - Signature of A copy of the hospital dischargeu Epicrisis - Suggestions for further treatment, controls...

BASIS FOR ADMISSON OF PATIENTS IN HOSPITALS

BASIS FOR ADMISSON OF PATIENTS IN HOSPITALS • MEDICAL - need for DG, Th and rehabilitation • NONMEDICAL - social needs

Diagnosis

• • • Identification and determination of disease Parts: Anamnesis ( 70% ) Clinical findings ( 20%) Additional DG methods ( LAB, RTG, CT, MRI...) (10%)

Treatment

• application of the technology of modern medical science Aim : disease removal. Achieving a harmonious interaction of physical, mental emotional and cognitive needs of man

Rehabilitation

• • Aim : Avoiding the handicap or disability of the patient. achieve body maximum after an illness or injury MOTIVATION

HOSPITAL ADMISSION SOCIAL NEEDS

• • • • Often beyond the current physical condition elderly people with chronic illness, social welfare neurology, internal medicine, social psychiatry substance abuse, vocational rehabilitation...

Patient-illnes relations

• • • • Anxiety (suddenly emerged disease, severe pain ..) Regression - withdrawal on the depending level of others Depression Agression • Active-cooperating attitude • "fighter's stance" extremely combative • Capitulating attitude giving up, there is no energy to fight the disease • Avoiding attitude denies illness, does not accept the doctor's instructions

Evaluation of the patients condition

• External appearance • Head and Neck • Thorax • Abdomen • Extremities • VITAL SIGNS • Breathing • Heartbeat, circulation • Temperature • • • • CONSCIOUSNESS Somnolence Sopor Coma •

POSITION

• • Active Passive • Compulsive

• • •

Position of patient

ACTIVE PASSIVE – Difficult, immobile, dependent on someone else's care COMPULSIVE – dependent on the nature of the disease, DG and Th procedures • • •  TEMPORARY

Fovler

– half-sitting

Trendelenburg

- leg elevation

Koleman

- side •

Quincke

- knee-elbow • •  CONSTANT extension ophistotonus..

Consciousness

• • • •

SYNCOPE

heat stroke) short period (acute cardiac condition, sunstroke, SOMNOLENCE sleepy, verbal contact preserved SOPOR slow, brief partially wakes up on strong stimulus, verbal contact COMA – no response on strong stimulus, loss of motor and sensory function

Consciousness

•

Some causes of disorder :

• • • • • • • BRAIN TRAUMA LIVER, KIDNEY DISEASE, ENDOCRINE AND METABOLIC DISORDERS CEREBROVASCULAR DISEASE CARDIOVASCULAR DISEASE INTOXICATION NEUROLOGICAL DISEASE PSYCHIATRIC DISEASE

Eye response Eye opening

•

Glasgow Coma Scale

Motor response Painful stimuli

• 3-15 points

Verbal response Verbal command

COMA

Spontaneously In response to voice On painful stimuli No response Obeys commands Localizes painful stimuli Withdrawal to painful stimuli Abnormal flexion (decorticate) Extension (decerebrate) No response Oriented,converses normally Confused, disoriented Utters inappropriate words Incomprehensible sounds No response 2 1 5 4 3 4 3 2 1 6 5 4 3 2 1

PHYSICAL PARAMETERS

• • • CONSTITUTION looks and body shape , body fluids, the character, the response to the adverse effects HEIGHT - a combination of genetics and environmental influences, important in pediatrics, rising to the closure of epiphyseal cartilage, decreases after the 60-year life Mass of the body - bone, muscle, water, fat. Assessment of nutritional status, BMI

The level of nutrition

• According to BMI values ​​of the degree of nutritional status is as follows : • • • • • • malnutrition

Normal nutrition Overweight Obese class I Obese class II Obese class III < 18,5 kg/m 2 18,5 - 24,9 kg/m 2 25,0 - 29,9 30,0 - 34,9 35,0 - 39,9 ≥ 40,0

VITAL PARAMETERS

•

TEMPERATURE

•

BREATHING

•

BLOOD PRESSURE

TEMPERATURE

• • • • • elevation and lowering physiological and pathological thermoregulatory center ( toxins, products of protein metabolism ) > 37 C HYPERTHERMIA < 36 C HYPOTHERMIA mild : 32-35 – medium : 28-32 – „

controled-therapeutic

" ( postresuscitation syndrome)

ELEVATED TEMPERATURE

• Hyperthermia passes through the following phases: • • • • subfever - from 37.1

0 to 37.7

0 C fever - from 37.8

0 to 39.0

0 C high fever - from 39.1

0 to 40.9

0 C hyperpyrexia - over 41.0

0 C

Temperature measurement

• • • • • • • axillary inguinal popliteal oral rectal ( higher by 0.5 ) vaginal tympanic ( eardrum)

Temperature measurement

• • • • • twice daily thermometer with mercury digital thermometers entered in the TEMPERATURE CHART monitored its PROGRESS – Stadium INCREMENTI - increase – Stadium FASTIGII - maximum – Stadium DECREMENTI – temperature lowering: » » litical - gradual critical - abrupt (sweating)

Types of temperature curves

• • • • Febris

continua

oscillations of less than 1 C abrupt increase pneumonia, typhoid fever

Types of temperature curves

• • • • • Febris

remittens

oscillations greater than 1 C minimal >37 C pneumonia, typhoid fever TBC

Types of temperature curves

• • • • Febris

intermittens

oscillations 2-3 C minimal < 37 C malaria

Types of temperature curves

• • • • • • Febris

septica

oscillations 2-3 C max. very high temperature min. >37C sepsis Febris

hectica

abrupt fall to normal temperature

severe TBC

Types of temperature curves

• • • • • Febris

recurrens

high all day, then all day normal.

abrupt increase purulent focuses, malaria

Types of temperature curves

• • • • • Febris

undulans

gradual increase and gradual decrease to normal temperature shape of „wave" Brucelosis, MTU

BREATHING

• • The exchange of gases between alveolar and atmospheric air. Phases: • – Inspirium – breath – Expirium – expiration • – Pause – apnea Children : 20-22/min Adults : 18/min

BREATHING

• • • • • Determinated by the patient at rest .

Unobstructed breathing – eupnea Accelerated breathing – tahipnea Slow breathing - bradipnea Difficulty breathing – dispnea: • Inspiratory - barriers in large airways, injury to the chest wall and lungs • Expiratory – HOBP , Asthma bronchiale •

ORTOPNEA

– high sitting position of the patient who is dyspneic

Types of altered breathing

• • •

Kussmaul

breathing – “acidotično”, deep amplitude, audibly, forced (uremia, diabetes, methyl-alcohol poisoning)

Cheyne-Stokes

breathing - superficial and deeper to the maximum, then reduce the amplitude (conditions of hypoxia and anoxia, decreased excitability of respiratory center)

Biot

breathing – totally irregular rhythm, depth, length of apnea (meningitis, brain injury, heat stroke)

PULSE

• • • • • Reflection of heart rate in peripheral arteries Palpation of available arteries N = 60-90 / min.

Use the clock showing seconds Electronic Devices – Frequency – Rhythm – Size of pulse wave – Type of pulse wave

• • • • •

Types of altered pulse

Pulsus frequens

– rapid (> 90/min) - Tachycardia (infection, bleeding, hyperthyroidism, neurosis, some heart diseases, some drugs) “ febrile tachycardia ” – an increase in 10/min.

T 10 C - + “

relative tachycardia

” – an increase in T → ↗ expected pulse

Pulsus rarus

– slow (<60/min) - Bradycardia (influenza, meningitis, brain tumors, drugs, and normally when trained) “ relative bradycardia ”- decrease T → ↘ expected pulse (typhoid fever)

Types of altered pulse

• • • • • • Pulsus altus seu

magnus

bradycardia, aortic insufficiency) – “large” wave (effort, Pulsus

parvus

– small amplitude (hypotension, heart failure, mitral and aortic stenosis ) Pulsus

tardus

– “slow” rising wave and slow downfall (aortic stenosis , hypertension) Pulsus

celer

– “sharp” pulse – rapidly rising and decreases rapidly (fever, aortic insufficiency) Pulsus

durus

– “tough and intense” pulse Pulsus

mollis

– “soft” pulse, small pulse wave

PRESSURE

• The pressure exercised on the walls of the blood vessel. • • • •

Arterial

(systolic, diastolic, middle), Venous

Depends on :

the stroke volume of the left ventricle, the peripheral resistance of blood vessels, blood volume, blood viscosity Food, drink, nervous system, renal function, endocrine function, nervous system, psyche

PRESSURE

• • • • • • • Optimal – 120/80 mmHg Normal – 120-129 / 80-84 mmHg Elevated 130-139 / 85-89 mmHg Mild hypertension 140-159 / 90-99 mmHg Moderate hypertension 160-179 / 100-109 mmHg Severe hypertension >180 / > 110mmHg Isolated systolic hypertension > 140/ <90 mmHg

COLLECTING OF BLOOD, PATIENT MATERIAL AND EXCRETA

BLOOD

• • • • • • •

Veins, arteries, capillary blood

Factors that affect the result of the analysis: TIME as a factor - the biological rhythms The patient's CONDITION - diet, activity The patient's POSITION - lying-sitting, blood sugar, creatinine INJECTION SITE - Cleanser WAYS OF TAKING - a system infection NO!

Vacutainer tube system

BLOOD

• • • • • Advantages of Vacutainer system: Prevented contact with blood Prevented contact with air It can not be collected wrong - errors are less Various sizes and various colors - Purpose

BLOOD

• • • • • Anticoagulant! – important because of the selection process technology and interference General biochemistry - Li-heparinat Blood sugar - fluoride Se, PT, fibrinogen – Na-citrate Hematology - EDTA

• • • • • •

BLOOD

Collecting blood for SE analyzing – Na-citrate in the test tube Biochemistry and electrolytes blood - dry, 10ml of Blood type – dry , 4ml of blood KKS – EDTA in the test tube Blood cultures – sterile conditions, sterile tubes with culture medium, the stage of hyperthermia ( 38 0 C ) PH and gas analysis arterialized Arterial blood or

URINE

• • • • • • first morning urine sterile plastic sealed cup, catheter NO!

same for urine culture collecting 24 - hour urine ( diuresis ) test " three cups " in an act of urination

quantity, color, odor, density, sediment (endocrine, metabolic diseases, shock, dehydration, diarrhea, vomiting)

• • • • should NOT

FECES

bowl with a spatula be mixed with urine sterile coproculture macroscopic, microscopic, biochemical, bacteriological, protozoa, fungi ... • macroscopic - " residue of coffee " - bleeding slimy bloody bold and voluminous - ulcerative colitis - Pancreatic Insufficiency • microscopic occult blood (diet 3 days without meat, eggs and vegetables)

SPUTUM

• • • • • sterile container from the airways, not from the mouth!

macroscopic: color, appearance, odor, consistency Bacteriological - Petri dish (Lowenstein) 24 h - the container is preservative (prevents cytolysis of cells)

Vomit, drains

• special dishes for biochemical or bacteriological examination • sometimes a drained contents during 24 h.

SWABS

• • • • • • • surface of the body, cavities sterile test tube with swab, cotton wad at the top to take before folding, taken before the start of AB therapy as soon transported to the laboratory Thermostat (37 0 C) DOCUMENTATION!

Tissue cytology and histopathology

• • • • Biopsy

OPEN

,

PUNKCTIONAL

STERILE MATERIAL fixed to the alcohol, not the bone staining, freezing, cutting, observation ( pathologist ) • • etiological diagnosis - straight away of Th documentation for PH!