Children's polyclinic, tasks, structure. Features of the organization of medical care for children. Indicators of the work of the children's polyclinic. Children's clinics and pediatricians: what is important for parents to know How a pediatrician works in a children's clinic
Outpatient care for the children's population occupies a leading position in the general health care system and is carried out with the help of a wide network of children's polyclinics and polyclinic departments.
The children's polyclinic is a state institution. It can be an independent institution or be part of a children's city hospital, citywide or central district hospital.
The children's city polyclinic provides medical and preventive care to children from birth to 14 years old inclusive. The provision of medical care is carried out directly in the clinic, at home, in preschool institutions and schools.
The children's polyclinic performs the functions of organizing and conducting a set of preventive measures (dynamic medical supervision of children of various age groups, the frequency of their comprehensive examinations by doctors of narrow specialties); medical advisory care at home and in the clinic; rehabilitation with the use of sanatorium and resort treatment at the respective resorts, medical and preventive care in preschool institutions and schools; carrying out anti-epidemic measures and vaccination immunoprophylaxis.
The categorization of a children's polyclinic is determined by the number of children served, which is updated annually by a census conducted by district patronage nurses.
Currently, there are 5 categories of children's polyclinics, depending on the planned number of visits per day: the first category - 800 visits; the second category - 700 visits; third category - 500 visits; fourth category - 300 visits; fifth category - 150 visits.
The structure of the children's polyclinic should include departments such as pediatric, specialized care, medical rehabilitation, and a pediatric department for providing medical care in organized groups.
1. Pediatric department
Provides medical and preventive care to children both in the clinic and at home. This system creates optimal opportunities for continuous monitoring of children by the same doctor and nurse, makes it possible to accurately assess the development and health of the child in dynamics, taking into account the conditions in which he lives and is brought up. The work of the department is based on the district principle.
At the medical site, the number of children from birth to 15 years old should not exceed 800. For their service, 1 position of a pediatrician and 1.5 positions of a nurse are provided.
The main figure providing medical care to children in the polyclinic, despite a significant increase in the volume of specialized care, is the local pediatrician.
The goals of the district pediatrician: to achieve a reduction in morbidity and mortality in children of all ages; to carry out activities aimed at creating optimal conditions for the physical, mental, sexual and immunological development of the child, to carry out specific and non-specific prevention.
Tasks of the local pediatrician:
1) ensuring contacts and continuity in work with doctors of the antenatal clinic for monitoring pregnant women, especially those at risk;
2) visiting newborns in the first 3 days after discharge from the maternity hospital, as well as monitoring the patronage of newborns by the district nurse;
3) reception of healthy children in the clinic, assessment of their physical and mental development, appointment, depending on the age and condition of the child, of a regimen, rational nutrition, recommendations for specific and non-specific prevention of rickets, malnutrition, obesity, anemia;
4) organization at home and in the clinic of preventive monitoring of children, especially of early and preschool age; as necessary, sending them for laboratory research and consultation of other specialists;
5) drawing up a plan of vaccination work and monitoring its implementation together with the district nurse, dynamic monitoring of healthy and sick children, implementing, together with other specialists, the rehabilitation of registered children, analyzing the effectiveness of dynamic monitoring;
6) organizing the examination and rehabilitation of children before they enter preschool institutions and schools;
7) visits to the parents of children at home in case of their illness, the provision of medicinal and physiotherapeutic care, exercise therapy, if necessary, active monitoring of the patient at home until his recovery, hospitalization or permission to visit the clinic;
8) sending children for treatment to a hospital, if necessary, taking all measures for emergency hospitalization of the patient;
9) informing the management of the polyclinic about cases when, for some reason, a seriously ill child remains non-hospitalized;
10) timely and in the prescribed manner informing about the detection of an infectious disease or suspicion of it, comprehensive prevention of infectious diseases;
11) selection and appropriate accounting of children in need of sanatorium and resort treatment for health reasons.
The doctor and nurse working at the pediatric site carry out planned sanitary and educational work with the child's parents, promote a healthy lifestyle, explain the harm of alcoholism and smoking in families.
Each polyclinic usually organizes the work of the most necessary specialists: an otolaryngologist, a surgeon, an oculist, a neuropathologist, a cardiorheumatologist, and a dentist.
Narrower specialists, such as an orthopedist, urologist, nephrologist, endocrinologist, doctor of functional diagnostics, are introduced into the staff of one of the children's polyclinics of the district and serve all the children of the administrative territory.
Medical specialists should build their work in close contact with paediatricians and receive patients mainly according to their directions.
Certain types of specialized medical care for children are provided in dispensaries: psycho-neurological, dermatological, oncological, anti-tuberculosis, deaf and speech therapy, - in the states of which there are positions of children's doctors.
Also, the composition of the children's clinic must necessarily include a department of medical rehabilitation, containing rooms for physiotherapy, physiotherapy exercises, and massage. The main contingent of patients in the rehabilitation department are children with diseases of the respiratory system, nervous system, musculoskeletal system, and ENT pathology. Patients are referred to this department by heads of structural subdivisions of healthcare institutions. Reception and selection of patients are carried out by the medical advisory rehabilitation commission of the polyclinic. Patients are admitted to the department after stopping the acute period of the disease or its exacerbation, as well as disabled people with an individual rehabilitation program.
Tasks of the Department of Medical Rehabilitation:
1) a peculiar formation of an individual program of rehabilitation and the use of rehabilitation means and methods;
2) implementation of an individual rehabilitation program for the disabled and sick;
3) the use of a complex of all necessary methods and means of rehabilitation;
4) conducting explanatory work among the population and sick children about the means and methods of restoring and strengthening health.
Pediatric department for the provision of medical care in organized groups
To provide medical and preventive care to children in preschool institutions and schools, pediatric departments have been established. Their tasks include monitoring sanitary and hygienic conditions, the regime of educational work and labor education, protecting the health of children and reducing their morbidity, improving their physical education and hardening in preschool institutions and schools. Employees of such departments conduct scheduled preventive examinations in kindergartens and schools. Doctors of children's educational institutions carry out dispensary observation of sick children, are engaged in their rehabilitation: they control the alternation of classes and rest, nutrition and physical education of preschoolers and schoolchildren. They provide medical assistance to children attending kindergartens and schools.
2. The structure of the children's city polyclinic
In a children's city polyclinic, there should be provided: a filter with a separate entrance, an isolator with a box (at least two), a reception desk, a wardrobe, offices (pediatricians, doctors of narrow specialties, medical and diagnostic, first-aid appointments, for raising a healthy child, X-ray, physiotherapy, procedural, vaccination, physiotherapy, massage, social and legal assistance, statistics), laboratory, administrative part, other auxiliary premises.
In the clinic, in places convenient for viewing (halls, corridors), it is necessary to hang out colorfully designed posters, stands informing about the development and principles of raising a healthy child, disease prevention, visual impairment, hearing impairment, musculoskeletal system and other topics.
A special stand should contain up-to-date information on cases of infectious diseases and quarantine periods in preschool institutions and schools, which allows you to quickly implement anti-epidemic measures.
The registry is an important structural link both in organizing services for children in the polyclinic and in providing them with medical care at home. The main task of the registry is to ensure the mutually coordinated activities of all departments.
On weekends and holidays, doctors on duty work at the polyclinic, who conduct outpatient appointments and provide home calls. The number of doctors on duty depends on the number of children in the area of the polyclinic and the workload on these days; on Saturdays, receptions of specialist doctors are organized, and, if possible, procedural, vaccination, physiotherapy and other rooms work. To eliminate queues at the registry office and for the convenience of the population on the day of admission to the clinic, there is a preliminary appointment with doctors for all days of the week by phone, early issuance of coupons indicating the date and hour of appearance, as well as preliminary self-registration for an appointment.
In the latter case, a folder with self-recording sheets for a certain day is created for each doctor. Each line of the sheet contains the hours and minutes of the reception. When self-recording, parents choose the most convenient time for them and enter the child's passport information.
Doctor's house calls, transmitted by phone, during a personal visit to the registry or in the order of self-recording, are entered in the doctor's house call record book, separate for each section. When accepting a call to the house, the registrar necessarily specifies the patient's condition, main complaints, body temperature. He immediately informs the local pediatrician about cases of a serious condition, in the absence of the latter - to the head of the outpatient department or the head of the outpatient clinic.
Parents should know that a doctor should be called to the house in case of an acute infectious disease or suspicion of it, in a serious condition of the patient, in case of a primary disease, on an asset per child discharged from the hospital, in case of contact with an infectious patient.
The first aid room is an independent structural unit and reports to the senior nurse of the polyclinic.
Children and their parents turn to it for control feeding, treatment of microtraumas, issuance of certificates of the epidemiological situation at the place of residence, drawing up extracts from development histories and referrals for various types of research before determining children in preschool institutions or when entering school, leaving for children's sanatoriums and summer health facilities.
Anthropometric measurements, determination of body temperature and blood pressure in children before examination by a pediatrician are also carried out in the first aid room.
The office of a healthy child is a structural subdivision of the children's polyclinic and plays the role of a methodological center for carrying out preventive work among young children.
The main task of the healthy child's office is to teach young mothers theoretical knowledge and practical skills on care, upbringing, developmental features of healthy children of early and preschool age. For an office, it is advisable to have a bed for a young child with a set of bedding; the simplest arena; baby stroller; changing table; medical scales; stadiometer; children's table; high chair for children; a glass cabinet for baby care items (in which medical thermometers and for measuring the temperature of water and air are laid out on the shelves, a rubber pear, jars for cotton wool and pipettes, a gas tube, vaseline oil, potassium permanganate, an alcohol solution of brilliant green, boric acid in powder , baby cream, bottle of 30-100 ml for water, nipples for feeding and drinking; baby soap), a locker for baby clothes with folded undershirts, flannel diapers (100 X 120 cm), cotton (same size), diapers, scarf , bonnet, sliders; toy cabinet, baby food sample cabinet; baby bath.
Of the visual aids, stands are needed that contain information about the nutrition and regimen of a pregnant woman and a nursing mother, prevention of hypogalactia, prenatal care, daily routine, indicators of physical development, age-specific massage and gymnastics complexes, methods of hardening children in the first three years of life.
In the office of a healthy child, local pediatricians receive healthy children of the first year of life. Here it is advisable to organize group appointments for children of the same age or with the same deviations in health. The district nurse invites 3-4 children for one time (with a short interval).
When the doctor accepts the second child, the nurse of the office teaches the mother of the first examined baby how to massage and gymnastics, gives her instructions, and the district nurse prepares the next patient for the reception.
After receiving the last of the children invited for a group examination, the doctor conducts a conversation with mothers about the upbringing of children of this age or with this type of deviation in health.
The office is working on the prevention of rickets. In the classroom, parents get acquainted with the anatomical and physiological characteristics of the body of a one-year-old child, changes in his psychophysiological development.
The pediatric office is placed in a room isolated from noise with sufficient lighting, good ventilation and uniform air temperature (not lower than 20–22 °C). The office is equipped with a table for the doctor, chairs, a changing table for examining young children and a couch for examining older children, a sink with hot and cold water, a height meter, and baby scales. It should have a small table for medical instruments, a spatula, a centimeter tape, toys.
Currently, among low-income and socially disadvantaged families, the primary task for a pediatrician is to conduct preventive conversations about hygiene standards and rules of care, as well as raising children of different age groups.
The most relevant topics of sanitary propaganda for the local pediatrician, depending on the age of the child:
1) rules of care, rational feeding, a set of hardening measures, prevention of rickets - for parents with infants;
2) observance of the daily routine, methods of hardening measures, prevention of acute respiratory diseases, specific prevention of childhood infections - for parents of children of younger and older toddlers;
3) instilling personal hygiene skills, hardening methods and hygienic gymnastics, prevention of acute childhood infections, allergic and infectious-allergic diseases, childhood injuries - for parents with children of preschool age;
4) prevention of postural disorders, myopia, rheumatism and other infectious-allergic diseases, neuroses, issues of sexual education - for parents with school-age children, teachers and schoolchildren themselves. The effectiveness of health education is enhanced by the use of visual aids, as well as by providing parents with specially selected literature for self-study.
In sanitary and educational work on hygienic education, the organization of schools for young mothers, fatherhood schools, and public universities for parents at preschool institutions is widely practiced.
Particular attention in matters of hygienic discipline should be given to children who have already suffered serious illnesses and are in remission.
Dieting, limiting physical activity, physiotherapy exercises and moderate hardening procedures prevent relapses. In these cases, one should not neglect conversations with the child himself, explaining to him the need for these temporary measures, preventing unforeseen psychological breakdowns.
children's Hospital is the main healthcare organization that provides medical care to children when they contact the clinic, at home, in educational institutions in the service area.
Children's clinics are divided into:
- by capacity, determined by the number of visits per shift: 5 categories of polyclinics (from the 1st - 800 visits per day to the 5th - 150 visits per day)
– organizational principle: independent and united with the hospital.
Principles provision of outpatient medical care to the children's population:
– preventive orientation;
- availability;
– widespread use of the dispensary method;
– system of active patronage;
– continuity in the work of doctors providing medical care to children;
- phasing;
– hygienic education and training of both parents and children;
– precinct-territorial service;
- social orientation.
There are the following tasks children's clinic:
1. Provision of medical care to the children's population in the clinic and at home.
2. Organization and implementation of a set of preventive measures, including dynamic monitoring of healthy and sick children.
3. Organization and implementation of medical and preventive work in kindergartens and schools.
4. Organization and implementation of anti-epidemic measures (together with the CGE).
5. Organization and implementation of measures for hygienic education and training of the population, promotion of a healthy lifestyle.
6. Improving the organizational forms and methods of work of the polyclinic aimed at improving the quality and efficiency of diagnostic and treatment work and medical rehabilitation, introducing hospital-replacing technologies into practice.
7. Analysis of the health status of the child population.
Structure The children's polyclinic is represented by the following functional units:
1. Leadership.
2. Box filters for the reception of sick children who have a separate entrance from the inside and an exit to the outside (the Meltzer-Soloviev box).
3. Registration.
4. Medical departments or offices of pediatricians and medical specialists, an office for providing medical care to adolescents.
5. Healthy child's office(where parents are taught the rules of care, feeding habits, massage techniques, gymnastics complexes) 1 position per 10,000 people.
6. vaccination room.
7. Cabinet (department) of medical care for organized children ( 1 position per 600 preschool children or 2000 schoolchildren).
8. Teenager's office(The position of a doctor in the teenage office is introduced at the rate of 1,500 children aged 15–17).
9. Clinical laboratory.
10. Diagnostic rooms.
11. Department of medical rehabilitation.
12. Social and Legal Cabinet (1 position per 20,000 people)
13. Central sterilization department.
14. Administrative and economic part.
The area of activity of the polyclinic and the schedule of its work are established by the health authorities of the administrative territory. The district-territorial principle of the polyclinic ensures the division of the entire service area into separate sections, medical care for the children's population of which is provided by the district pediatrician and the district nurse.
In accordance with the resolution of the Council of Ministers of the Republic of Belarus
dated June 20, 2007 No. 811 "On approval of state minimum standards for public services" 1 position of a district pediatrician is calculated for 800 children. 1.5 positions of a nurse are being introduced per site (0.5 for patronage work). Fixing for medical care is carried out at the place of residence in accordance with Art. 14 of the Law of the Republic of Belarus "On Health Care".
During the working day, time is allocated for the implementation of the reception of patients in the clinic (3 hours) and home call service ( 3 hours). The distribution of time may be different depending on the epidemic situation, the remoteness of the site from the clinic, the age composition of the child population of the site. For one hour of work, a pediatrician must see 4 patients at an initial or follow-up appointment (15 minutes per
patient) or 6 people at a preventive examination (10 minutes per 1 child). The load rate for servicing calls is 2 calls per 1 hour.
The system of a single pediatrician, in which a pediatrician monitors a child from birth to 18 years of age, ensures continuity of observation at all stages of development. The appointment of the local doctor in the polyclinic is organized according to a rolling schedule so that parents can choose a time that is convenient for them. The children's polyclinic admits healthy, convalescent children and children suffering from chronic diseases. Patients with acute infectious diseases and those who fell ill for the first time in the acute period of the disease are served at home.
During the week, the pediatrician highlighted:
Reception of sick children in the period of convalescence (Monday Wednesday Friday). If children with infectious diseases accompanied by a rash or diarrhea come to an appointment, they are sent to filter boxes. The nurse calls the local pediatrician or infectious disease specialist. In boxing, the doctor examines the child, decides on hospitalization or prescribes home treatment.
Admission of children who do not have acute diseases is carried out in Tuesday and Thursday. The pediatrician visits healthy young children and children under 6 years old on Tuesdays, healthy child day .
Sick children who are registered with the dispensary visit the pediatrician at the invitation of the nurse on Thursdays.
Treatment of children in the clinic is carried out as a continuation of the treatment of the patient, started at home, or as an active rehabilitation process after discharge from the hospital. The Children's Polyclinic provides health care to children in educational institutions in the service area.
In each children's polyclinic, the work of specialist doctors is organized: an otolaryngologist, an oculist, a neurologist, a surgeon, a dentist, a cardiorheumatologist. The positions of other specialists (pulmonologist, allergist, hematologist, urologist, nephrologist, endocrinologist, gastroenterologist, gynecologist) are introduced into the staff of the advisory children's polyclinic of the city (region) or into the staff of the advisory offices of children's hospitals. Certain profiles of specialized care are provided in dispensaries (psycho-neurological, oncological, anti-tuberculosis, surdological, dermatovenereological, endocrinological, etc.).
Indicators:
1. Characteristics of the child population in the area of activity of the polyclinic:
a) the age composition of children at the end of the year:
b) the average number of children in one area:
c) the average number of children of the first year of life in the area:
ORGANIZATION OF THE WORK OF THE CHILDREN'S POLYCLINIC
Children's polyclinic - medical and preventive institution which is a structural subdivision of a children's hospital or an independent medical institution that provides out-of-hospital assistance to children in the area of operation.
The principles and procedures of a children's polyclinic are in many respects similar to those in an adult polyclinic, however, they have features that are characteristic only for this institution. The main principles of the children's clinic:
1. The principle of district (800 children in one territorial area).
2. Continuity in the work of doctors providing therapeutic and phylactic care to children.
3. Stages in treatment
4. Continuity of active dynamic monitoring of the child's health, starting from the antenatal period.
Children's clinic may be part of TMO, working in contact with other medical and preventive institutions
or district. The main tasks of the children's polyclinic: - organization and implementation of a complex of preventive measures among the child population, which includes: ensuring dynamic medical supervision of healthy children; conducting preventive examinations and medical examinations of children; carrying out preventive vaccinations; organizing the collection of breast milk and ensuring the smooth operation of its dairy kitchens and milk distribution points; holding lectures, talks, classes at the school of mothers, etc.
Medical and advisory care for children at home and in the clinic, incl. qualified specialized medical care;
Sending children for treatment in hospitals, hospitals for rehabilitation treatment in a sanatorium, their selection in specialized kindergartens, forest schools, etc.
Therapeutic and preventive work in preschool institutions and schools.
Anti-epidemic measures.
Legal protection of children.
In a children's city polyclinic, it is advisable to organize a methodological council for raising a healthy child, as well as a council of nurses who work in accordance with the current provisions of Part 1 of Art.
The structure of the children's clinic:
Filter with a separate entrance and insulators with boxes;
Offices of pediatricians and doctors of narrow specialties;
Office for preventive work with children (office
healthy child)
Rehabilitation department;
Treatment and diagnostic rooms;
Registry, cloakroom, other auxiliary premises, waiting rooms;
Administrative and economic part (in independent polyclinics).
In modern conditions, mainly large children's clinics for 600-800 visits per shift are being built in cities. They have all the conditions for the proper organization of medical and preventive work: the necessary set of premises for specialized rooms, exercise therapy rooms, swimming pools, water and mud clinics, rooms for light and electrotherapy, mobile physiotherapy rooms for preschool and school institutions.
In accordance with the current regulations, the children's clinic operates:
1. Medical staff (per 10,000 children):
Pediatrician (district) ■ 12.5 positions;
Doctors of narrow specialties - 4.64 positions.
2. Doctors of children's institutions:
Nursery - pediatrician - for 180-200 children;
Kindergarten - pediatrician - for 600 children;
School - pediatrician - for 2000 students.
3. Head of the pediatric department:
If there are 6.5 positions of doctors in the staff of the department - 0.5 rates;
If there are more than 9 specified positions -1.0 rate.
4. Nursing staff:
District nurses - 1.5 rates for each position of a pediatrician;
Nurses for preventive work with healthy children;
In a polyclinic serving up to 10,000 children - 1.0 position, more than 10,000 children - 2 positions.
The independent children's polyclinic is headed by the chief physician, and the polyclinic department of the united hospital is headed by the head of the department.
A doctor with experience in medical and organizational
1st job. Chief Physician directly manages the activities of the polyclinic and is responsible for the quality and culture of medical and preventive care for children, as well as the administrative, economic and financial activities of the polyclinic. He develops a plan for the work of the polyclinic on the instructions of medical and preventive care for children in the area of activity and ensures its implementation. J The chief physician selects and staffs the polyclinic with medical personnel and administrative and economic personnel and is responsible for their work, arranges personnel in the polyclinic, organizes advanced training for doctors and other polyclinic personnel, and takes measures aimed at improving the material and technical base of the polyclinic.
The rights and obligations of the chief physician of the children's city school clinic are regulated by the regulation on the chief physician of the children's city polyclinic.
Responsibility for the quality of medical and preventive care in the children's city clinic, the culture of the staff is also head of the pediatric department.
A pediatrician with experience in medical and organizational work in a polyclinic is appointed to the position of head of the pediatric department. He reports directly to the head physician of the institution.
The head of the pediatric department directly manages and controls the medical and preventive work of doctors; consults patients with severe forms of diseases that are difficult to diagnose; controls the validity of the issuance of disability certificates for the care of sick children; provides timely hospitalization of patients who need inpatient treatment. Treatment of children in need of hospitalization, but left at home for any reason, is carried out under the constant supervision of the head of the department. The head of the department ensures the implementation of measures to improve the skills of pediatricians and paramedical personnel.
The main task local pediatrician is to carry out preventive measures aimed at ensuring the harmonious physical and neuropsychic development of children living on the territory of the site, at reducing morbidity and mortality by providing timely and highly qualified medical care.
The rights and obligations of the district pediatrician are regulated by the regulation on the district pediatrician of the children's city clinic.
The local pediatrician works under the guidance of the head of the department, according to a plan drawn up on the basis of an analysis of the health status of children.
The district pediatrician has the right to issue certificates of ability to work, to give orders to subordinate middle and junior medical workers, to make proposals for encouraging these workers or imposing disciplinary sanctions on them for individual omissions in work or violation of internal regulations.
In the work of the local pediatrician, there are several main sections of work: preventive, anti-epidemic, medical, work on the formation of a healthy lifestyle, work with medical documentation.
ORGANIZATION OF THERAPEUTIC WORK
The medical work of the local pediatrician includes:
Home care for children with acute illnesses ratio of active visits to initial calls is 2 :1.
In the treatment of children, especially young children, timely initiation of treatment is of exceptional importance. District pediatricians, when making a call to a sick child, should have a set of necessary medicines with them and, if necessary, provide assistance to the patient at home immediately after the diagnosis is made, even if the child is immediately sent to the hospital. If necessary, the doctor must provide the child with medicines at one time.
District nurse fulfills the doctor's prescriptions for the treatment of a sick child at home, monitors the implementation by parents of medical recommendations on treatment, nutrition, regimen and care for a sick child.
At the request of the attending physician, the children's city polyclinic provides the sick child with the necessary laboratory, functional studies and consultations of doctors of narrow specialties at home.
Head of department The children's city polyclinic exercises control over the organization of treatment of sick children at home, and, if necessary, provides advisory assistance.
The local doctor, if necessary, organizes the hospitalization of the child and continues to monitor his health after the child is discharged from the hospital, pays special attention to those in need of aftercare - 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, past infectious diseases, information about the absence of contact of the child with infectious patients at home, in children's institutions and at school. If it is impossible to hospitalize a child (refusal of parents, lack of a place in a hospital, quarantine, etc.), a hospital is organized at home. At the same time, the child is provided with the whole range of necessary therapeutic and diagnostic measures, laboratory examinations in accordance with the severity and nature of the disease, post-medical
sister or her regular visit several times a day. At night, the child is assisted by an emergency or ambulance pediatrician. The local doctor visits the child daily until complete recovery. The child must be examined by the head of the department.
An important element of the work of the district pediatrician should be considered the examination of temporary disability in connection with the child's illness. When issuing certificates of incapacity for work, the district doctor is guided by the current instructions. Direct assistant to the local doctor - pedi-
a is district nurse. Responsibilities of the district nurse: - preventive work on the development and education of a healthy child; - providing medical care to sick children at home as prescribed by a doctor;
Carrying out prenatal patronage of pregnant women in their territorial area, actively identifying violations of the pregnant woman's well-being and timely information from the obstetrician-gynecologist of the antenatal clinic and the local doctor - v diatra;
Joint (with a local pediatrician) visit to newborns in the first 3 days after discharge from the maternity hospital;
Ensuring systematic monitoring of healthy and sick children;
Monitoring the implementation of medical prescriptions by parents;
Carrying out monthly planning of preventive vaccinations for children who do not attend preschool institutions;
Work on the timely organization of medical examinations of children registered in the dispensary;
Performing medical procedures prescribed by the doctor at home;
Assistance to the doctor during medical examinations of children;
Sanitary and educational work according to the established form;
Improving your qualifications.
Along with the local service, children's polyclinics organize specialized care, which is an integral part of a single chain of polyclinic - hospital - sanatorium.
Depending on the prevalence of diseases, specialized care can be provided:
In the form of specialized clinic rooms;
In the form of regional and inter-district specialized dispensaries.
In large cities, specialized centers are being created, which include: an outpatient unit (advisory outpatient reception), a specialized hospital, and a specialized sanatorium.
Depending on the capacity of the polyclinic, the volume of specialized care provided in it may be different.
Based on the prevalence of certain types of pathology, usually in the polyclinic, an appointment with a doctor of the following narrow specialties can be organized: ENT, surgeon, oculist, neurologist< патолог. Врачи-урологи-нефрологи, ортопеды, эндокринолог врачи функциональной диагностики и др. представлены район ными (в крупных городах) и межрайонными специалистами.
District specialists conduct reception on the basis of one of the children's polyclinics, inter-district specialists - in each of the attached districts.
Specialized rooms of polyclinics should be equipped with modern equipment for diagnostic and therapeutic measures.
The main tasks of doctors of narrow specialties:
Organization and implementation of medical and preventive work with children;
Reception of children with health problems and preventive examinations according to the schedule approved by the administration;
Providing counseling and medical care at home;
Dispensary observation of children with long-term illnesses and ensuring systematic observation and treatment until they are deregistered medically!-! indications, study of the effectiveness of clinical examination and treatment;
Carrying out sanitary ~ pgyusvetnitelnoy work among the population for the prevention of diseases;
Improving one's qualifications, participating in the work to improve the qualifications of doctors and paramedical personnel in their specialty;
Introduction into practice of the latest methods and schemes of diagnostics and treatment;
Completion of medical documentation;
Preparation of applications for the necessary medical equipment
medicines, tools and equipment. A doctor of a narrow specialty works in close contact with the doctors of the children's polyclinic, participates in health improvement in schools and preschool institutions.
ORGANIZATION OF PREVENTIVE WORK
The main goal of the preventive activity of the district
unit of sodium is to carry out activities that contribute to the strong physical and neuropsychic development of children, the introduction of hygiene skills into the daily life of the family.
The main method in preventive work is dispensary method - a method of active dynamic observation not only of sick, but also of healthy children.
The organization of preventive measures aimed at protecting the health of the child "actually begins before his birth. Monitor the health of a pregnant woman! jointly antenatal clinic and children's clinic. From the moment the pregnant woman is registered, the polyclinic organizes patronage of the pregnant woman, and together with the antenatal clinic, conducts classes for the school of young mothers.
At the direction and under the guidance of the district pediatrician, the district nurse of the children's polyclinic must conduct at least two prenatal visits. Target holding prenatal patronages:
Find out the state of health of the pregnant woman, the social status and psychological climate in the family, the living conditions of the unborn child.
The first prenatal care is carried out after admission
information about the pregnant woman from the antenatal clinic, the second is usually at 31-32 weeks of pregnancy.
In case of burdened obstetric anamnesis, unfavorable course of pregnancy, the district pediatrician conducts the third prenatal care, immediately before childbirth
According to the current situation, a pediatrician and a nurse at a children's clinic visit a newborn in the first 2 days after discharge from the maternity hospital. If the first child was born in the family, twins or the mother does not have milk, it is recommended to make a patronage visit on the first day after discharge. In the future, 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 district doctor visits the child at home again on the 14th day, then on the 21st day of life.
Twins, premature babies, children born with a large body weight, who received a birth injury, who were born to mothers with pathology of pregnancy and childbirth or who suffered from infectious diseases during pregnancy, children discharged from neonatal pathology departments, children from socially disadvantaged families - belong to risk groups and are under special supervision of the district pediatrician (according to an individual plan).
During a patronage visit at the 4th week of a newborn's life, the local nurse invites the mother to the first appointment at the clinic.
The district 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 the daily routine, hardening, physical education , prevention of rickets and other issues
The district nurse visits a healthy child of the 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 the individual characteristics of the child and the most critical periods in the life of children in the first year of life.
The district pediatrician provides preventive
observation of "unorganized" children and aged 3 to 7 years. During this period, the doctor examines children but less than once a year with a final medical examination before entering school. Anthropometry is performed in children aged 5 years and 6-7 years. Particular attention during this period is paid to the organization of the regimen, the neuropsychic and physical development of the child, and the readiness of children for school I.
To carry out preventive work with healthy young children as part of a children's polyclinic, the organization cabinetpreventivework with children(cabinet healthy child).
In the office of a healthy child, there is a paramedic or a nurse who has been trained in preventive work with children and sanitary and educational work with the population.
The work of the office is managed by the head of one of the pediatric departments.
The medical staff of the healthy child's office works under the control of the chief (senior) nurse of the children's city polyclinic.
The main tasks and office of a healthy child:
Promotion of a healthy lifestyle in the family;
Teaching parents the basic rules for raising a healthy child (mode, 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.
For this purpose, the medical staff of the office of a healthy child:
Provides assistance to district pediatricians in conducting classes for schools for young mothers and fathers;
Conducts individual and collective conversations with parents of young children, gives them instructions and methodological literature on the protection of the child's health;
Teaches parents how to care for children, how to organize a daily routine, age-related massage complexes, gymnastics, hardening procedures, how to prepare baby food, how to introduce supplementary feeding and complementary foods;
Carries out work on the prevention of rickets in children, give vitamin "D", organizes quartz children, etc.;
Together with the district pediatrician and the district nurse, he conducts individual preparation of children for admission to a preschool institution;
Trains district nurses on issues of preventive work with children, massage techniques, gymnastics, tempering procedures, etc.;
Informs district pediatricians and nurses about identified violations in the development of the child and mistakes made by parents in caring for children;
Communicates with the health center to study and disseminate new materials on the development and upbringing of a healthy child;
Completes materials for the design of the office, gardening and educational literature, tables, posters, manuals, memos, exhibitions on the main issues of preventive work with healthy children;
Ve d there is no necessary working documentation and accounting of instructive and methodological materials on the development and upbringing of young children.
The office of a healthy child should be provided with methodological materials on the development and upbringing of a healthy child, disease prevention
Children's doctor (pediatrician). When should you contact your pediatrician? How is the appointment with the pediatrician?
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!
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When is a pediatric consultation needed?
Consultation pediatrician may be planned or unscheduled. Routine pediatric visits are made to determine the health status of the newborn and growing child. Unscheduled consultations may be required if the child suddenly falls ill. Why do pediatric neonatologists examine newborns?
A neonatologist is a specialist who examines children of 1 month of age in order to identify all kinds of diseases and correct them. During the examination of a newborn, the doctor evaluates his general condition, as well as the functioning of all vital organs and systems. If any abnormalities are detected, the doctor can send the baby to a specialized neonatology department, where there is everything necessary for adequate treatment.The reason for transferring a child to the neonatology department may be:
- low body weight of the newborn;
- respiratory failure;
- disruption of the cardiovascular system;
- congenital malformations ( that could endanger the baby's life);
- septic ( systemic infectious and inflammatory) state of the child 1 month of life.
How does a pediatrician examine babies?
Children aged 1 month to 1 year are in the so-called breast period, which is extremely important for them. It is during 1 year of life that the most intensive development of all organs and systems occurs. Children begin to eat, talk, sit or even walk. All this is associated with heavy loads on the child's body. That is why it is extremely important that a specialist doctor regularly assesses the functional state of vital organs, promptly identifying and eliminating possible deviations.During examinations of a child of 1 year of age, the doctor must:
- Register anthropometric data- weight, height, head and chest circumference.
- Conduct a complete clinical examination– including examination of the respiratory, cardiovascular, digestive, nervous and all other systems.
- Order laboratory tests as needed- blood test, urinalysis and so on.
- Inform parents about the health of the child and give recommendations on how to care for him.
How often should I visit the pediatrician for prevention ( within 1 month, up to a year, after a year, after two years)?
The purpose of preventive examinations of the child is the timely detection and treatment of various diseases in the early stages of their development.For preventive purposes, the pediatrician should examine:
- newborn- within 3 days after birth, as well as weekly for 1 month of life.
- Baby ( baby) - monthly for 1 year of life.
- Children aged 1 to 3 years- Twice a year.
- Children aged 4 to 18- 1 time per year.
Is it necessary to consult a pediatrician during pregnancy?
During pregnancy, a woman needs to go through many specialists, including a pediatrician. Consultation of a pediatrician in this case is needed in order to assess the state of health of the mother, on the basis of which one can judge the health of the unborn child. During the consultation, the doctor records the woman's data, specifying the gestational age, what kind of pregnancy it is and what were the outcomes of previous pregnancies.If a woman already has children, the doctor may ask about their age, health status, as well as previous diseases. This will help to identify predisposition to certain pathologies ( for example, if a hereditary disease has been identified in already born children, it is highly likely that it will be transmitted to a newly born child). The doctor also assesses the health status of the expectant mother herself ( asking her about past illnesses). Based on the data obtained, he can suggest what pathologies can threaten a newborn baby. He must inform the woman about his findings, which will allow her to take appropriate preventive measures and, thereby, reduce the risk of morbidity in a newborn baby.
How to get a certificate from a pediatrician to kindergarten, school, swimming pool?
Quite common for visiting any public institution ( be it kindergarten, school, swimming pool, sports section and so on) you must submit a medical certificate of health. To obtain such a certificate for a child, you first need to contact the local pediatrician ( together with the child). The pediatrician will conduct a clinical examination of the baby, give him directions for the necessary tests ( complete blood count, tests for viral infections and helminthic infestations), as well as refer you for consultations to other specialists ( usually it is a dermatologist, ophthalmologist, otorhinolaryngologist and so on). Each of these doctors examines the child ( in terms of his specialty), while making an appropriate entry in his medical record.Having passed all the specialists and received the results of laboratory tests, you need to visit the pediatrician again. The doctor will analyze the research data and the conclusions of medical specialists, after which he will write his conclusion, which will indicate whether a particular child is allowed to attend certain classes, attend kindergarten, school, and so on.
If, during the examination, any contagious infectious diseases are detected in the child, access to public institutions will be closed to him, and the doctor will refer him to the appropriate specialist for additional diagnosis and treatment. After treatment, the child will have to go through all the examinations again. If their results are satisfactory, the pediatrician will issue him the necessary certificate.
How is the appointment with a pediatrician in the clinic?
When consulting patients in the clinic, the doctor conducts a clinical examination of the child, and also prescribes additional laboratory tests and tests. After that, he makes a diagnosis and prescribes treatment or sends the child to other specialists for additional diagnostics. Pediatric office equipment
The pediatrician's office should have all the tools necessary for a full and comprehensive examination of the child.The pediatrician's office should be equipped with:
- couch- for examination of older children.
- changing table- for examination of young children.
- measuring tape- to measure the circumference of the head and chest of the child, as well as the length of the body of young children.
- height meter- a special ruler designed to measure the height of a child or teenager.
- Medical thermometer- to measure the temperature of the child's body.
- Tonometer- a device for measuring blood pressure, which comes with a set of cuffs for children of different ages.
- scales- electronic ( for children up to a year) and ordinary ( for older children).
- Stethoscope- a device for listening to the lungs and heart of the child.
- Disposable spatulas- long sticks with which the doctor presses the patient's tongue during the examination of the throat.
- Emergency medical kit.
Examination and examination of the child by a pediatrician
After talking with the baby's parents and collecting data on his health problems, the doctor proceeds to an objective clinical examination, during which he assesses the functional state of various organs and systems of the child.During the examination, the doctor examines:
- The body type of the child.
- Skin- their color, elasticity, moisture, the presence or absence of age spots, cracks, rashes, edema, the condition of the eyes, eyelids, auricles, external auditory canals, and so on.
- The lymph nodes- for this, the doctor tries to probe the lymph nodes in various parts of the body ( normally, it is possible to determine only the submandibular lymph nodes, which are soft, elastic and painless).
- Skeletal system- the shape of the bones of the limbs, the head, the condition of the large and small fontanelles are assessed ( indentations in the area of the bones of the skull, which may be present in newborns, but overgrow during the first months of a child's life).
- muscles- their development and strength are evaluated.
- joints The range of motion in each joint is assessed.
- respiratory system- the doctor determines the shape of the chest, examines the baby's nose and throat, and then listens to the lungs with a stethoscope.
- Cardiovascular system- listening to heart sounds, measuring blood pressure, counting heart rate and pulse ( to determine the pulse, the doctor gropes for an artery in the area of \u200b\u200bthe baby’s arm).
- digestive system- examination of the oral cavity and tongue, examination of the anterior wall of the abdomen and palpation ( probing) abdominal organs.
- genitourinary system- inspection and percussion are carried out ( light tapping) in the lumbar region ( pain during the procedure may indicate kidney disease).
- Physical development of the child- for this, the doctor uses special tables and standards.
What tests does the pediatrician refer to?
Additional studies may be needed to clarify the diagnosis, as well as to exclude certain pathologies.The pediatrician may prescribe:
- General blood analysis- to detect anemia, signs of infection or inflammation.
- Biochemical blood tests- to assess the functions of the liver, kidneys, pancreas, metabolism and so on.
- General urine analysis- to assess the excretory functions of the kidneys.
- Fecal analysis- to identify the eggs of worms in it.
- Tests for hormones- to determine the concentration of certain hormones in the blood of a child.
- Sputum analysis ( secreted by coughing) - to identify the causative agent of upper respiratory tract infection.
- Serological tests- a blood test to detect antibodies to various infectious agents ( allows you to determine which infections the child has had).
- Sowing from the nose and throat- to detect pathogenic microorganisms in the upper respiratory tract.
- Study of the intestinal microflora- to detect pathogenic microorganisms.
Why does a pediatrician prescribe an ultrasound?
ultrasound ( ultrasonography) is a safe and easy way to assess the condition of the child's internal organs. The ultrasound machine works on the basis of sound waves, which, reflected from the tissues of internal organs, are recorded by special sensors, on the basis of which the doctor receives a visual image of the structures under study. This allows you to identify congenital malformations, pathological accumulations of fluid in the body cavities, structural disorders of various organs, impaired contractile activity of the heart, and many other indicators.The pediatrician may prescribe:
- Ultrasound of the heart;
- Ultrasound of the kidneys;
- Ultrasound of the liver;
- Ultrasound of the abdominal organs;
- Ultrasound of the pancreas;
- Ultrasound of large blood vessels Doppler ultrasound mode is used to assess the nature of blood flow through the vessels).
Does the pediatrician accept for a fee or for free?
Immediately after the birth of a child right in the hospital) he is examined by a pediatric neonatologist working there. This consultation is free. After discharge from the maternity hospital, parents need to issue a compulsory health insurance policy for their child as soon as possible. To obtain it, you need to register the child at the place of residence, as well as provide the insurance company with a birth certificate of the child and copies of the parents' passports.From the moment the policy is received, the child has the right to free consultations and examinations by a pediatrician and other specialists, free tests and instrumental studies, medical procedures, and so on. In addition, it is worth noting that all children under the age of 3 years ( and children from low-income or large families - up to 6 years) are entitled to receive free medicines included in a special list approved by the Ministry of Health.
At the same time, it is worth noting that today there are many private medical institutions that also employ pediatricians. A visit to such a specialist, as well as the performance of all studies assigned to him, will be paid.
Is it possible to call a pediatrician at home?
The duties of a pediatrician include regular examination of the child during the first months and years of his life. If the child suddenly falls ill and cannot visit the clinic on his own, the pediatrician can be called to the house. When visiting a child at home, the doctor will be able to conduct a clinical examination, assess the severity of the baby’s condition, make a diagnosis and prescribe the necessary treatment, indicating to the parents the date when they should come with the child to the clinic for control or re-call the doctor at home. If the child's condition is severe, the doctor may recommend that the child be admitted to a particular hospital department ( depending on the nature of the disease).It is worth noting that calling the local pediatrician to the house is also free ( with a policy). At the same time, parents will have to pay for the call of a pediatrician from a private clinic on their own.
Jokes about the pediatrician
The father complains to the pediatrician: -My wife went on a business trip three days ago, after which the child began to quickly lose weight. I follow all her instructions - I walk with him 3 times a day, I bathe every evening, I do massage, I make sure that I don’t catch a cold, I even turn on classical music for him in the evenings, and he keeps getting thinner and thinner!
- Hmm, what and how often do you feed your baby?
-A! That's it! Thank you Doctor! I knew that I would definitely forget something!
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A woman with her daughter at a pediatrician's appointment:
- Doctor, help me out, something is wrong with my girl! She has a smile from ear to ear, constantly “mumbles” something, and her eyes pop out of their sockets!
-Hmm, try loosening her pigtails a little...
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Call the pediatrician. A frightened male voice on the phone:
-Doctor, my three-year-old son drank a bottle of brilliant green!!!
-And what?
-Like what!? His whole mouth is green, his teeth are green, he shows his tongue to me - also all green! What should I do doctor???
The doctor, laughing, replies:
-Take pictures, then there will be something to remember!
