Introduction to surgery. The first information about the surgical manipulations has appeared at ancient times. For 2-4 thousand years BC various surgical procedures were performed in ancient Egypt, India, Babylon, ancient Greece and Rome, Byzantium and China. From the doctors of this period we can ditinguish Hippocrates, Galen, Celsius, Avicenna, who initiated the scientific surgery. From the Middle Ages physicians may be distinguished Paracelsus, Pare Ambruaz, Vezaliy and others. The rapid development of surgery starts at the 19th century after the discovery by Louis Pasteur agents of surgical infection, and its prevention method of Lister, which was the basis of antiseptics. Development of surgery is associated with such names like Peter the 1st, Lomonosov, Sklifosovskyy, Dyakonov, Pirogov. In Ukraine, the first medical institution was Kiev-Mohyla Academy, founded in 1671 Peter Mogila. In the second half of the nineteenth century surgical clinics of Kharkiv and Kyiv become real centers of surgical science and practice in Ukraine. Teaching surgery is performed here by such famous scientists as V.O.Karavayev, M.M.Volkovych and Y.Shymanovskyy. Many prominent surgeons came from educational institutions of Ukraine, some of them headed surgical department of universities. With such eminent surgeons as Volkovych M.M, Krymov A., Vishnevsky A.A., Petrovsky V.V., I. Ischenko, Kolomiychenko M. are connected organization of new surgical schools in Ukraine.
In 1957, a prominent surgeon Amosov M.M. established in Kiev, the first department of cardiac surgery, and in 1983 - organized the Institute of Cardiovascular Surgery. In 50th years of the previous century begins the formation of anesthesiological service in Ukraine. Anesthetics centers are organized at the leading surgical clinics. In 1957, the department of thoracic surgery was transformed into a Thoracic Surgery Department of the Kiev Institute of improvement of doctors led by Professor A.I.Treschynskyy. Important role in improving diagnosis and surgery for diseases of the abdominal cavity played Institute of Clinical and Experimental Surgery, which was created and headed by Academician Shalimov O.O.
Organization of surgical care in Ukraine. Surgical care is one of the most important forms of health care. The basis of modern surgical care system is inherited from the former USSR. This assistance is organized on a territorial basis and phasing of the population of country from lower stage to higher subordination. The organization provides maximum approximation to the residence of the patient and provides appropriate first regional medical institutions. Organization of surgical care includes ascending, primary health care, skilled and specialized surgical care. Surgical assistance is divided into rapid or emergency that requires patients with acute illnesses and injuries, and planned, carried out for patients with chronic illnesses. Primary emergency medical care for patients with acute surgical diseases and injuries is provided by ambulance, medical items and emergency doctors.
Qualified emergency and planned surgical assistance is provided in general surgical hospitals, central district of city and regional hospitals. Development of surgery led to a selection of self discipline traumatology, orthopedics, oncology, urology, pediatric surgery and others, thus, specialized assistance is available in these departments. Important role in providing skilled and specialized care for the population have a surgical clinic medical universities, which operate on the basis of general surgical departments of city and regional hospitals.
Structure of the surgical clinic Medical institutions, which provide surgical help to patients are divided into 2 types: outpatient and inpatient. To outpatient refer clinics, which have surgical rooms and offices, as well as ambulance and emergency care. Inpatient hospitals include multidisciplinary and specialized clinics. Inpatient hospitals can be designed to provide emergency assistance and to assist in a planned manner. The basis of the surgical inpatient hospital is the principle of respect for the rules of asepsis and antisepsis. It is necessary for prevention traumatic infection, creating conditions for operations, investigation and care of postoperative patients. The main surgical hospital departments are: admission department, medical-diagnostic department and operating unit.
Sanitary-epidemic mode of admission department at the hospital Admission department is part of the hospital in which the transmitting and registration of patients is held, also review, physical examination and initial diagnosis, sanitization, transportation of patients to the medical department, informational work is done here as well. In addition, if necessary in the admission department is provided emergency medical care. At centralized planning system of hospitals, practically all therapeutic and diagnostic departments, including admission department are located in one building. With decentralized (pavilion) system, admission department is located in a separate building or in the same medical building with the resuscitation, therapeutic or surgical department. In some hospitals there is no central admissionsdepartment, and each medical department receives patients themselves. Admission department should be placed near the entrance to the hospital and be easy to transport patients - have paved access paths, wide staircases and doors for the passage of a stretcher. Nurse of admission department prepares documentation for patients entering the hospital. In observation room, the doctor examines the patient; here is done thermometry, and sometimes other surveys (eg, electrocardiography). Patients with undentified diagnosis, place temporarily to the diagnostic rooms, and patients with suspected infectious disease are placed in prison. If necessary, at procedure rooms doctors provide emergency care to patients. Sanitization of patients, who enter to the hospital, is conducted in changing rooms.
Admission of patients in hospital and their registration To the admission department of the hospital patients arrive: 1) if sent by their doctor in case failure of outpatient treatment, the so-called planned hospitalization, 2) by emergency car in case of accidents, injuries, diseases or acute exacerbations of chronic diseases, 3) independently, without referral if the patient became ill on the street and he arrived to the admission department, 4) a transfer from other medical institutions. Depending on the patient's condition they are either hospitalized or provided with first aid and directed to be treated at home. Patients, who need help in the resuscitation department, for example, patients with myocardial infarction, enter the appropriate office, bypassing the admission department. Patients who arrive at hospital get inspected at the admission department by physician for the presence of infectious diseases and lice. The doctor examines the skin, hairy areas of the body, pharynx, and measures body temperature.
After resolving the issue of hospitalization, treatment and sanitary way to transport patient, the nurse at the reception of admission department prepares appropriate medical records: a cover page history (f. 003-u), "Magazine of registration of patients" (f. 001-u.) All data about patient nurse receives from the patient, persons who accompany him, or medical personnel of "emergency." Nurse also fills the "Statistical map of dismissed from the hospital" (f.066-u) that she puts in medical history. All data about patient nurse puts in alphabetical book, which is an important document for reference service.
Sanitary Processing During hospitalization of the patient to a hospital in changing rooms of the admission department is conducted sanitization, which includes the following procedures: a review of the body to detect infectious diseases, scabies, trichophytosis; review of the scalp and clothes of the patient to detect lice, if necessary - cutting of the nails, hair, shaving ; providing of hygienic bathing, showering or sponging, depending on the patient's condition, changing patient in a clean hospital gown. The need for sanitization and its volume solves the doctor. Changing rooms should be equipped with everything necessary for sanitary treatment of the patient: couches, cabinets for clean underwear and a tank for dirty linens, washcloth for washing patients, soap, hair clippers, razors for shaving, scissors, air and water thermometers, washcloth and brushes for the processing of bath, specially selected labeled equipment (buckets, mops) for cleaning and disinfection of premises of changing rooms, and plenty of disinfectant solutions.
Carrying out of treatment of patients with pediculosis is done under the order ¹ 410. In the changing room there is special kit, which includes the following items: magnifying glass, desk lamp, razor, scissors, clipper hair, bushy crest, put up karbofos, quart for solution of karbofos, 10% acetic acid, oilcloth for combing out hair and bucket for its combustion, and oilcloth kerchief, bag for clothes, sunglasses, two masks, gown and kerchief for staff. Depending on the patient's condition and approved by the physician type of sanitization method, patient gets hygienic bath, shower or sponging.
Debilitated patients or those who have been stayed in bed for long time and thus could have fainting, must be accompanied to the bathroom, and stay under control when sitting there and exiting from it. If the patient can not wash himself, nurses wash him. When washing it is necessary to constantly monitor the patient. In case of deterioration of health of the patient (dizziness, palpitations, pain in the heart, pallor) washing should be stopped. If possible, it's better to wash patients in the shower, while patients standing or sitting on a stool. If the tub and shower are contraindicated, patients get wiped with warm soapy water. After sanitization patient wears clean clothes and hospital slippers. On the front page of history nurse makes a note about conducted sanitization.
The room of admission department should be cleaned at least twice a day by wet method using disinfectant solutions (1% solution of chlorine bleach, 0.5% solution of bleach). From the admission department, the patient is transported to the appropriate department of the hospital. Medical department of the hospital consists of rooms for patients, treatment rooms - for injection, manipulation - for setting enemas and performing some other manipulations, pantry, ordynatory rooms (lab for doctors), cabinet of senior nurse, and room for storage of clean linen.
For every 25-30 beds of general hospital stands nursing post. It should be placed close to the rooms which are served. Post of the nurse should be equipped with a desk, cupboard for storage of medicines, medical instruments, safe storage of drugs (lists A and B), moving table to distribute drugs, a preparation table for the various manipulations, a refrigerator for storage of perishable items. The work of nursing post is organized according to hospital reigime. During the day the nurse takes the prescription of the doctor, preparing patients for various researches and accompanies them in diagnostic laboratories, distributes medication, does required injections, helps to feed the seriously ill patients. An important aspect of nursing is the acceptance and delivery of duty.
Nurse may not leave the post until it reaches its next change. Nurse who took the place of previos nurse, together with the one, who finished, bypass rooms, check sanitary status of the rooms, pay special attention to seriously ill patients. Nurse, which delivers duty, reports about the changes in the state of these patients during the duty, talks about the volume of appointments made, emphasizing those appointments that have to be done during the next duty.
