School paramedic certification work essays and term papers. Work for the category of kindergarten nurse Certification report of a school paramedic for the highest category

I. Organizational events

II. Treatment and preventive work

III. Control of children's physical education

VI. Training

I. Organizational arrangements

1. Reconciliation of the lists of children enrolled in a preschool educational institution (hereinafter referred to as the preschool educational institution), and checking the availability of the following medical documents:

Card of preventive vaccinations (form No. 063/у);

Child development history (form No. 112/у);

Child's medical record (form No. 026/у-2000).

2. Preparation of the following reporting medical documents and journals that meet the established requirements:

weekly work schedule;

list and frequency of medical examinations, research and professional hygienic training;

journal for monitoring the sanitary condition of the preschool educational institution;

medical examination log;

log of general cleaning of the treatment room (isolator);

biological accident log;

logbook for recording and monitoring the operation of the bactericidal lamp;

temperature log of refrigeration equipment;

dispensary journal;

lice examination log;

book of contacts with carriers of acute infectious diseases;

infectious diseases register;

child observation log;

journal of anthropometric measurements;

children's movement log;

vaccination refusal log;

deworming log;

preventive vaccination planning log;

log of preventive vaccinations;

register of children sent to a tuberculosis clinic.

3. Analysis of the health of newly admitted children. drawing up child health sheets based on examination results.

4. Preparation for preventive examinations of children:

parent survey;

blood pressure measurement;

conducting anthropometry;

plantography;

Kern–Jerasik test.

Data on acute morbidity and exacerbations of chronic diseases and functional disorders in children attending kindergarten No. 22 "Orlyonok" are given in Appendices 1, 2.

5. Planning and drawing up the following documents:

comprehensive work plan for the year;

monthly work plan;

annual plan for preventive vaccinations;

vaccination planning table (when performing vaccinations, written parental consent is required).

6. Sending reporting documentation in the established form to Children's City Clinic No. 1 (hereinafter referred to as DGP No. 1).

7. Statement of funds necessary for the operation of the medical office:

medicines;

dressing material;

emergency medications.

II. Treatment and preventive work

1. Carrying out outpatient visits to pupils. 45 requests were registered regarding the provision of primary health care, including:

with symptoms of acute respiratory diseases;

nosebleeds.

2. Prevention of injuries:

instilling in children the ability to recognize traumatic situations and avoid them;

elimination of unfavorable environmental conditions in which the child lives.

3. Carrying out examinations of children for head lice, recording the examination results in a special journal.

4. Carrying out anthropometry, including:

carrying out anthropometric measurements of pupils;

recording data in a log of anthropometric measurements;

control over the compliance of the sizes of tables and chairs with the height of children.

5. Prevention of visual impairment in children:

conducting annual vision examinations for pupils;

entering data into medical documents;

conversations with parents, referral to a specialist;

6. Conducting routine preventive examinations of pupils:

– involvement of specialists from DGP No. 1:

neurologist;

ophthalmologist;

orthopedist;

otolaryngologist;

dentist;

dermatologist;

allergist;

– laboratory tests of blood and urine;

– conducting electrocardiography.

7. Entering the results of examinations into the medical documents of pupils, drawing up a report.

As a result of examination of 116 people, children with chronic diseases were identified. Referrals were given for additional examinations of children at their place of residence, and recommendations for their further improvement. Pupils with chronic diseases and frequently ill children (hereinafter referred to as FSD) were registered at the dispensary.

8. Carrying out clinical observation of children with health group III according to form No. 30/u-04.

9. Organization of examination for helminths.

116 children were examined. The disease has not been identified.

10. Organization of vaccination work.

The basis of this work is the availability of complete and reliable information about the health of children attending preschool educational institutions. For timely registration of children subject to vaccination, a log of preventive vaccinations is kept. The magazine for the current year is planned in accordance with the national calendar of preventive vaccinations, approved. Order of the Ministry of Health and Social Development of Russia dated January 31, 2011 No. 51n “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”

Data on vaccination in 2011 are shown in the table.

Vaccination of pupils of MBDOU - kindergarten No. 22 "Orlyonok" in 2011.

11. Organization of tuberculin diagnostics of pupils with identification of children at risk for tuberculosis, referral to a phthisiatrician for examination.

Work results:

9 people were sent for examination;

9 people were examined;

preventive treatment was provided for 5 people.

12. Monitoring compliance with the regulations:

study load;

duration of walks;

catering arrangements.

13. Carrying out health improvement for children in preschool educational institutions:

vitamin therapy;

hardening procedures;

classes to prevent postural disorders.

III. Control of children's physical education

1. Monitoring physical education in preschool educational institutions.

2. Distribution of children into physical education groups in accordance with the results of preventive examinations.

3. Formation of preparatory and special physical education groups, exercise therapy groups.

4. Monitoring the health and development of children, the functionality of the child’s body.

5. Monitoring the sanitary and hygienic condition of the premises and area where physical exercises are carried out with children.

6. Monitoring the sanitary and hygienic condition of sports and physical education equipment and inventory, the condition of children’s clothing and shoes.

7. Medical and pedagogical observations of the organization of the motor regime, methods of conducting various forms of physical exercise and their impact on the child’s body.

8. Control of hardening implementation.

9. Control of the selection of children to participate in sports competitions.

10. Organization and holding of Health Days in preschool educational institutions.

IV. Anti-epidemic work

1. Prevention of infectious diseases:

familiarization with sanitary and epidemiological rules "Organization of immunoprophylaxis of infectious diseases. SP3.3.2367-08", approved. Resolution of the Chief State Sanitary Doctor of the Russian Federation dated June 4, 2008 No. 34;

disinfection of preschool premises;

control of catering;

organization of immunization;

carrying out quarantine measures in connection with diseases of scarlet fever, chicken pox, acute intestinal diseases

2. Prevention of tuberculosis:

familiarization with sanitary and epidemiological rules "Prevention of tuberculosis. SP 3.1.1295-03", approved. Chief State Sanitary Doctor 04/18/2003;

tuberculin diagnostics of pupils;

organization of examination of children at risk referred to a TB specialist;

conversations with parents.

3. Prevention of intestinal infections:

familiarization with sanitary and epidemiological rules "Prevention of acute intestinal infections. SP 3.1.1.1117-02", approved. Chief State Sanitary Doctor of the Russian Federation 03/17/2002;

monitoring compliance with the sanitary and epidemiological regime in preschool educational institutions and catering units;

control of personal hygiene of pupils, staff, catering workers;

medical surveillance of contact persons;

carrying out disinfection.

4. Prevention of head lice:

familiarization with the order of the Ministry of Health of Russia dated November 26, 1998 No. 342 “On strengthening measures to prevent epidemic typhus and combat lice”;

Conducting a weekly examination of pupils in accordance with the sanitary and epidemiological rules and regulations "Sanitary and epidemiological requirements for the design, content and organization of the work regime in preschool organizations. SanPiN2.4.1.2660-10", approved. Resolution of the Chief State Sanitary Doctor of the Russian Federation dated July 22, 2010 No. 91.

5. Prevention of helminthiases:

examination of pupils;

sand processing in sandboxes;

covering sandboxes with animal-proof lids.

V. Sanitary education work

Organizing lectures and conversations with preschool staff, students and their parents (legal representatives).

1. Topics of lectures for children:

"We are for a healthy lifestyle";

"Learn to eat right";

"Personal hygiene of a preschooler";

"Learning to brush your teeth correctly";

"Prevention of enterobiasis - clean palms";

2. Topics of lectures for catering workers:

"Prevention of intestinal infections";

"Personal hygiene of catering staff";

"Organization of the catering department during quarantine";

"Staphylococcal infection";

"Yersineosis";

"Foodborne toxic infections";

3. Topics of lectures for the teaching staff:

"Injury Prevention";

"Air-thermal regime";

"Report on the results of medical examination and morbidity of children";

"Prevention of acute respiratory viral infections and influenza";

"Prevention of acute intestinal diseases";

"Prevention of enterobiasis";

“Providing first aid for fainting, heatstroke and sunstroke”;

"Scarlet fever";

"Chicken pox";

"Rotovirus infection";

"Prevention of tuberculosis";

4. Lecture topics for technical personnel:

“Sanitary condition of group premises, compliance with the disinfection regime”;

"Personal hygiene of technical personnel."

5. Topics of lectures for parents:

"How to detect pediculosis";

“What is a “button””;

"Prevention of tuberculosis";

"Prevention of colds";

"Hygiene of a preschooler";

"Prevention of flat feet and scoliosis at home";

“Vaccination in a child’s life”;

“Prevention of rotavirus infection”;

"Scarlet fever";

"Chicken pox";

"Enterobiosis".

VI. Training

Forms of advanced training used in preschool educational institutions:

1. Completion of cycles of specialization, improvement, professional retraining: training at Ulnovsky Medical College No. 2 within the framework of the thematic improvement cycle “Health of Children and Adolescents” in the amount of 144 hours (September 2010).

2. Attending lectures, seminars, and briefings at DGP No. 1.

3. Study of regulatory documents.

4. Use of reference and methodological literature; professional magazines.

(“Medical care and nutrition in pre-school educational institutions”, “Raising healthy children”, “Physical and health work in pre-school educational institutions”, “All about hardening”.)

Annex 1

Acute morbidity in children

Appendix 2

Exacerbations of chronic diseases

and functional disorders of children,

attending MBDOU - kindergarten No. 22 “Orlyonok”

Annual report on the activities of the head nurse of kindergarten No. 22 “Orlyonok”
January 14, 2012
I. Organizational events
II. Treatment and preventive work
III. Control of children's physical education
IV. Anti-epidemic work
V. Sanitary education work
VI. Training
I. Organizational arrangements
1. Reconciliation of the lists of children enrolled in a preschool educational institution (hereinafter referred to as the preschool educational institution), and checking the availability of the following medical documents:
Card of preventive vaccinations (form No. 063/у);
Child development history (form No. 112/у);
Child's medical record (form No. 026/у-2000).
2. Preparation of the following reporting medical documents and journals that meet the established requirements:

weekly work schedule;
list and frequency of medical examinations, research and professional hygienic training;
journal for monitoring the sanitary condition of the preschool educational institution;
medical examination log;
log of general cleaning of the treatment room (isolator);
biological accident log;
logbook for recording and monitoring the operation of the bactericidal lamp;
temperature log of refrigeration equipment;
dispensary journal;
lice examination log;
book of contacts with carriers of acute infectious diseases;
infectious diseases register;
child observation log;
journal of anthropometric measurements;
children's movement log;
vaccination refusal log;
deworming log;
preventive vaccination planning log;
log of preventive vaccinations;
register of children sent to a tuberculosis clinic.
3. Analysis of the health of newly admitted children. drawing up child health sheets based on examination results.
4. Preparation for preventive examinations of children:
parent survey;
blood pressure measurement;
conducting anthropometry;
plantography;
Kern–Jerasik test.
Data on acute morbidity and exacerbations of chronic diseases and functional disorders in children attending kindergarten No. 22 "Orlyonok" are given in Appendices 1, 2.
5. Planning and drawing up the following documents:
comprehensive work plan for the year;
monthly work plan;
annual plan for preventive vaccinations;
vaccination planning table (when vaccinations are performed, written parental consent is required).
6. Sending reporting documentation in the established form to Children's City Clinic No. 1 (hereinafter referred to as DGP No. 1).
7. Statement of funds necessary for the operation of the medical office:
medicines;
dressing material;
emergency medications.
up

II. Treatment and preventive work
1. Carrying out outpatient visits to pupils. 45 requests regarding the provision of primary health care were registered, including:
with symptoms of acute respiratory diseases;
nosebleeds.
2. Prevention of injuries:
instilling in children the ability to recognize traumatic situations and avoid them;
elimination of unfavorable environmental conditions in which the child lives.
3. Carrying out examinations of children for head lice, recording the examination results in a special journal.
4. Carrying out anthropometry, including:
carrying out anthropometric measurements of pupils;
recording data in a log of anthropometric measurements;
preparation of recommendations for seating children according to height indicators in order to prevent postural disorders;
control over the compliance of the sizes of tables and chairs with the height of children.
5. Prevention of visual impairment in children:
conducting annual vision examinations for pupils;
entering data into medical documents;
conversations with parents, referral to a specialist;
preparation of recommendations for seating children in a group.

6. Conducting routine preventive examinations of pupils:
– involvement of specialists from DGP No. 1:
neurologist;
ophthalmologist;
orthopedist;
otolaryngologist;
dentist;...

Content.
1. brief description of the institution;
2. brief description of the department, office in which the specialist works;
3. equipment and equipment of the workplace;
4. list of accounting and reporting documents used by a specialist in the workplace;
5. measures to comply with personal safety measures in the workplace;
6. volume of work performed, quantitative indicators;
7. qualitative analysis performance indicators for 1 year;
8. mastering new techniques and applying them in practice;
9. implementation of mentoring activities;
10. anti-epidemic measures taken in the workplace;
11. list of regulatory documents that guide the specialist in his activities;
12. assistance in case of emergency conditions characteristic of the work profile;
13. sanitary educational work;
14. participation in the work of the Council of Sisters and the public life of the institution;
15. conclusion outlining the problems facing the specialist in his work life and proposals for solving these problems;
16. Suggestions for improving work, plans for the future.

Characteristics of the institution.
Health care institution N is located at the address: N region, N, st. N, 77. The clinic includes therapeutic, surgical, outpatient departments and a day hospital with 15 beds (10 therapeutic, 5 surgical, of which 2 gynecological).
The clinic is legally registered and licensed in 11 specialties: therapy, surgery, obstetrics and gynecology, dentistry, dermatovenereology, ophthalmology, otolaryngology, neurology, narcology and psychiatry, physiotherapy; conducting preliminary and periodic medical examinations.
There are rooms: pre-medical, ultrasound diagnostics, functional diagnostics, where they are carried out; ECG, computer spirography, Holter monitoring, EEG, EM-ECHO, ultrasound of the abdominal organs, parenchymal organs, heart, blood vessels, gynecological examination, there is an endoscopic room where FGDS, colonoscopy, RRS and bronchoscopy are performed.
The population served by the clinic at the end of 2012 was 8,074 people.
Of them:
- employed - 3415 people.
- territorial population - 2071 people.
- pensioners - 1599 people.

The number of visits to the clinic in 2013 was 74,261 visits.
The structure of the clinic includes:
1. Medical areas.
2. Doctors of narrow specialties.
3. Auxiliary - diagnostic services.
4. Day hospital.
5. Health centers.

Consultative and diagnostic consultations are carried out by doctors of narrow specialties: ophthalmologist, surgeon, otolaryngologist, gynecologist, neurologist, psychiatrist - narcologist, cardiologist, dermatovenerologist, dentist.
At health centers with pre-trip medical examinations (PTM), paramedics conduct an examination of a professional group of drivers every time they start a trip. The main task of the PRMO is to identify medical contraindications for admission to a flight, as well as prompt dynamic monitoring.
Doctor staffing 91.3%
Ratio of doctors and nursing staff 1: 4.5
Staffing level of nursing staff 100%
Characteristics of the workplace.

The health center is a pre-medical stage of medical care, provides treatment, preventive and sanitary and anti-epidemic support, as well as pre-trip and post-trip medical examinations for 330 railway transport workers. There are 2 paramedics working at the health center.
The health center consists of three rooms:
? waiting rooms
? PRMO reception room
? treatment room
The health center is located at station N, on the first floor and close to the office of the depot duty officer. There are good access roads to the building, asphalt everywhere.
In the reception office there is a stand where the monthly new issue of san is placed. newsletter, as well as various information on medical topics. Equipped with telephone communication with the depot duty officer and locomotive crew supervisor. The health center is equipped in accordance with Appendix No. 1 of the Instruction of the Ministry of Railways of the Russian Federation dated May 1, 1998 N TsUVS-552 “On the procedure for organizing and conducting pre-trip medical examinations of locomotive crew workers.” The health center is equipped with furniture and medical equipment according to the list:
- medical couch
-Desk
- desk lamp
- coat hanger
- wardrobe for paramedics
- fridge
- stethophonendoscopes
- thermometers, medical spatulas
- devices for indicating alcohol vapor in exhaled air Lion alkometer SD-400 and Lion alkometer SD2
- express drug test Immuno Chrome – 5 multi-express – 14 sets
- a suitcase containing a set of medicines and medical supplies for emergency medical care
- tonometer - 1 piece.
- stopwatch - 1 piece.
There are also instructions for providing emergency care for myocardial infarction and hypertensive crisis. The “emergency aid” suitcase contains packages with the necessary medications.
Treatment room.

If necessary, I provide medical care, which is carried out in the treatment room, equipped with all the necessary equipment for carrying out the procedures. The walls in the office are tiled to the ceiling, the ceiling is painted with light oil paint. The floor is covered with linoleum.
The office lighting is natural and artificial (fluorescent lamps). The cabinet is also equipped with a bactericidal lamp for quartz treatment.
For hand washing and instrument rinsing there is a sink with cold and hot water, soap, 2 individual hand towels, 2 individual glove towels for each paramedic).
The office has a refrigerator and a medicine cabinet where injectable drugs and emergency medicine kits are stored. Patient couch. Desk for maintaining documentation.

The treatment room has a manipulation table for intravenous, intramuscular and subcutaneous injections, and there are also bins for sterilizing and maintaining the sterility of napkins, tweezers, and cotton balls. Rags that are sterilized in two-layer thick fabric bags.
The treatment room has trays, tweezers, forceps, scissors, a mouth speculum, a hemostatic tourniquet, and test tube racks.
A bedside table with three sections, in the first section disposable syringes for emergency care are stored, in the second section - towels and sheets, in the third section in marked containers disinfectants, soda, soap, powder.
The manipulation table has two planes: on one there are trays with sterile napkins, a tray for empty ampoules, a tray for a container with a disinfectant and a clip for removing the needle from a disposable syringe for its subsequent disinfection, a bottle with an antiseptic liquid, a hemostatic tourniquet and files for filing ampoules. On the second plane there are containers (marked) for used rags, surface treatment, treatment of work surfaces associated with blood, containers for disinfecting needles and containers for disinfecting cotton balls, a container for used gloves, a container for disinfecting used material when serving a patient whose direction has a marking.
The treatment room equipment should include a bactericidal lamp; in our office it is of the ceiling type. For cleaning the treatment room, there is cleaning equipment, it is also marked and stored in the places designated for it: two mops (for walls and floor), two buckets (for garbage categories A and B), a bucket for washing the floor, a bucket for preparing a hypochloride stock solution , two basins for general cleaning (washing walls and panels and disinfection).

Accounting and reporting documentation of the health center.
The health center is equipped with a job description, other regulations of the Ministry of Railways of Russia, the Ministry of Health of Russia, orders of the chief physician, and forms of accounting documentation.
Forms of medical records of the health center.

No. TsUVS - 552 FROM May 1, 1998 Ministry of Railways of Russia 1. Instructions on the procedure for organizing and conducting pre-trip medical examinations of locomotive crews.
Form NU-3 of the Ministry of Railways of Russia 2. Individual card of pre-trip medical examinations of a locomotive crew employee.
Form NU-4 Ministry of Railways of Russia 3. Record sheet for pre-trip inspections of locomotive crew workers.
Form NU-5 of the Ministry of Railways of Russia 4. Logbook for registering cases of suspension of locomotive crew workers from a trip.
Form NU-6 of the Ministry of Railways of Russia 5. Card for registering signs of the use of alcohol, narcotic drugs and psychotropic substances (state of intoxication).

In his work, the paramedic is guided by the following regulatory documents:
- order No. 408 of 1989 USSR Ministry of Health “On measures to reduce the incidence of viral hepatitis and AIDS”
- SanPiN 2.1.3.2630-10 Sanitary and epidemiological requirements for organizations engaged in medical activities.
- order No. 720 of 1978 Ministry of Health of the USSR “On improving medical care for patients with purulent-surgical diseases and strengthening measures for nosocomial infections”
- Order of the Ministry of Health of the Russian Federation No. 4 of 2003. “Recommendations for the prevention and diagnosis of arterial hypertension, features of the work of paramedics during pre-trip examinations”
- order No. 8tsz dated September 18, 1990. USSR Ministry of Railways "On approval of the Regulations on the peculiarities of the regime of working time and rest time, working conditions of certain categories of railway transport workers directly related to the movement of trains"
- sanitary rules 1.2.011-4 Rules for the collection, storage and disposal of healthcare facility waste
- Regulation No. 154 of January 26, 2011. On approval of the Procedure for conducting mandatory pre-trip or pre-shift medical examinations on public railway transport"
- letter No. 2510/9468-03-32 dated 08/21/2003. Ministry of Health of the Russian Federation “On pre-trip medical examinations of vehicle drivers”,
- methodological recommendations “Medical safety traffic" and etc.
- Rules for collection and storage of waste in health care facilities. San-PiN 21.7.728-99.
- SanPiN 2.1.7.2790-10 “Sanitary and epidemiological requirements for the management of medical waste.”
- Order No. 706 dated August 23, 2010 “On approval of rules for storing medicines.”
- Guidelines 3.1.2313-08 “Requirements for the disinfection, destruction and disposal of single-use injection syringes.”
- Resolution of the Chief State Sanitary Doctor of the Russian Federation dated January 11, 2011 N 1, Moscow “On approval of SP 3.1.5.2826-10 “Prevention of HIV infection” for the actions of a medical worker in an emergency.
- job description paramedic at the health center.

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.............
not provided

The functional responsibilities of a nurse in a preschool educational institution are determined by order of the Ministry of Health of Russia and the Ministry of Education of Russia dated June 30, 1992 No. 186/272 “On improving the system of medical care for children in education.” educational institutions".

Functional responsibilities of preschool medical workers

1
Kind of activity	Frequency of observation (control)
	nurse
Primary prevention
Monitoring sanitary and hygienic conditions in the institution Control and provision of methodological assistance in organizing the educational process (participation in drawing up a schedule, daily routine and classes)	Constantly Once a month
Monitoring the actual power supply and analyzing the power quality Monitoring compliance with natural standards Monitoring the sanitary and hygienic condition of the catering unit Participation in menu creation Rejection of finished products	Constantly Same –"– –"– –"–
Physical education
Distribution of pupils into medical groups for physical education Analysis of the effectiveness of physical education with assessment of children’s physical fitness Monitoring the organization of physical education and hardening activities	Twice a year Once a month
Hygienic education in children's groups
Recommendations for organizing and conducting hygiene education, developing healthy lifestyle skills, and preventing AIDS Organization of events to prevent myopia, caries, posture disorders, etc. Control of hygiene education	Once a month Same Constantly
Immunoprophylaxis
Vaccination planning and analysis Monitoring health status after vaccination, recording local and general reactions to vaccination	According to the vaccination plan, constantly
Measures to ensure adaptation to preschool educational institutions
Recommendations for children’s adaptation and its correction (together with the teacher) Monitoring the progress of adaptation and carrying out medical and pedagogical correction Carrying out medical and pedagogical activities to develop functional readiness for learning	Constantly Constantly Constantly
Clinical examination
Conducting preventive medical examinations Conducting (together with the teacher) screening tests to identify deviations in health status Recommendations for teaching staff on correcting deviations in health status. Monitoring their implementation Carrying out prescribed health activities and monitoring their implementation in educational institution and children's clinic	Once a year Same -"– Constantly

Medical documentation of the preschool educational institution

Case index	Case name	Document storage period	Note
1	2	3	4
0601	A copy of the license for medical activities serving the children's clinic	For the period of validity	–
0602	Medical records of pupils (form No. 026u)	During the child's stay in kindergarten	Issued to parents (legal representatives) upon departure of the child (to school, other institution)
0603	Cards of preventive vaccinations in a children's clinic (form No. 063u)	Same	Same
0605	Implementation plan and logbook for preventive vaccinations and tuberculin diagnostics	3 years	–
0607	Logbook for monitoring the sanitary condition of premises	3 years	–
0608	Children's attendance register	1 year	–
0609	Dispensary journal (form No. 030у)	1 year	–
0610	Journal of children's movements by health group	3 years	–
0611	Deworming log	1 year	–
0612	Journal of examination of children for pediculosis and skin diseases	1 year	–
0614	Morbidity register	3 years	–
0615	Journal of registration of infectious diseases (form No. 060у)	3 years	–
0616	Quarantine magazine	1 year	–
0617	Journal of registration of medical examinations and hygienic certification of employees	Constantly	–
0621	Logbook of preventive measures in the medical office	Constantly	–
0622	Cumulative statement of food consumption	1 year	–
0623	Raw product rejection log	1 year	–
0624	Prepared food rejection log	1 year	–
0625	Health magazine (food department workers)	1 year

All newly admitted children come to kindergarten with medical

a card in which, in addition to the health group, the group for physical education must be indicated. This is either the main group, when the child has no contraindications for physical education, or the preparatory group, when there are some restrictions that the doctor prescribes in the chart, or a special group, when the child, for health reasons, can only do physical therapy.

The task of the kindergarten nurse is to monitor the implementation

Analysis of the effectiveness of children's physical education can be traced from

using special programs that allow, based on certain indicators, to establish physical state child and give individual recommendations for working with him.

If there is no opportunity to examine the child at a professional level

in the conditions of a preschool institution, the results of monitoring (introduced by Decree of the Government of the Russian Federation of December 29, 2001 No. 916) are sufficient to determine the effectiveness of physical education in kindergarten.

The task of the preschool nurse is to protect children with groups III and IV from diagnosis

health and allow limited participation for children with visual impairment, flat feet, and hernia. A nurse and a teacher (instructor) in physical education, using a computer program installed in a preschool educational institution, prepare a monitoring report, which is sent to the education department.

At the beginning of each school year senior kindergarten teacher and nurse

compile a list of hardening activities that will be carried out with children, taking into account their state of health, age, and time of year.

As a rule, traditional and non-traditional forms are used

hardening with greater intensity in the autumn-winter-spring period. Here is a list of forms of hardening that are carried out in our institution.

Hardening activities carried out in preschool educational institutions throughout the year

Hardening Events	Time, group
	Autumn	Winter	Spring	Summer
Morning reception of children in the air	–	–	All groups	All groups
Morning exercises in the air	Senior, preparatory	–		All groups
Outdoor physical education	Middle, senior, preparatory	–	Middle, senior, preparatory	All groups
Sleeping with the windows open	All groups	–	All groups	All groups
Exercise in socks	Middle, senior, preparatory	Middle, senior, preparatory	All groups	–
Health and breathing exercises after sleep	All groups	All groups	All groups	All groups
Corrective walking along massage paths		All groups	All groups	All groups

A kindergarten nurse is required to carry out sanitary education workV preschool institution with children, staff and parents of pupils. As a rule, at all parent meetings and teacher councils she speaks with information determined by the annual plan.

It is very important to have a selection of literature in the medical office forconsulting teachers and parents on the following issues:

• childhood infections;
• vaccinations;
• hardening;
• nutrition;
• formation of healthy lifestyle skills.

By Order of the Ministry of Health and Social Development of Russia No. 673 of October 30, 2007,amendments to the order of the Ministry of Health of Russia No. 229 of June 27, 2001 “On the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”

In Appendix 1 "National calendar of preventive vaccinations"The above order provides recommendations for vaccinations.

We provide information regarding preschool children attending preschool educational institutions.

Child's age	Name of vaccination
3 months	Second vaccination against viral hepatitis B, first vaccination against diphtheria, whooping cough, tetanus, polio
4, 5 months	Second vaccination against diphtheria, whooping cough, tetanus, polio
6 months	Third vaccination of viral hepatitis B, against diphtheria, whooping cough, tetanus, polio
12 months	Fourth vaccination against viral hepatitis B (children at risk), vaccination against measles, rubella, mumps
18 months	First revaccination against diphtheria, whooping cough, tetanus, polio
20 months	Second revaccination against polio
6 years	Revaccination against measles, rubella, mumps
6–7 years	Second revaccination against diphtheria, tetanus
7 years	Revaccination against tuberculosis (BCG)
From 1 year, not sick, not vaccinated, vaccinated once against rubella	Immunization against rubella
All children attending preschool institutions	Flu vaccination

Clause 2 of Art. 11 of Law No. 157FZ “On Immunoprophylaxis of Infectious Diseases” states: “Preventive vaccinations are carried out with the consent of citizens, parents or other legal representatives of minors...”. It becomes clear that the doctor and nurse can only recommend that parents vaccinate their child and provide information about it. At the same time, the preschool nurse is obliged to inform parents (legal representatives) about vaccinations recommended by the “National Calendar of Preventive Vaccinations” appropriate to the child’s age.

In addition, according to the Law “On the Protection of Citizens’ Health,” parents of pupils have the right:

• to receive complete and objective information about the need for preventive vaccinations, the consequences of refusing them, and post-vaccination complications;
• choosing an institution where to get vaccinated (kindergarten or children's clinic);
• refusal of vaccinations, which must be formalized in writing.

If previously it was categorically prohibited to admit an unvaccinated child to kindergarten, now the law “On Immunoprophylaxis of Infectious Diseases” (clause 2 of Article 5) does not contain such a provision.

The nurse should be aware that when administering vaccinations to children, it is very important to:

• inform parents about vaccination and obtain their written consent for it;
• have permission to carry out vaccinations;
• comply with sanitary and hygienic requirements for receiving, transporting, storing the vaccine and administering vaccinations (the latter only in the presence of a doctor);
• monitor the child’s well-being and his reaction to the vaccine.

The delivery, storage and use of vaccines are determined by the Sanitaryepidemiological rules SP 3.3.2.124803 “Conditions for transportation and storage of medical immunobiological preparations”, approved by the Chief State Sanitary Doctor of the Russian Federation on March 20, 2003.

When entering kindergarten, all children experience adaptation stress, so it is very importanthelp the child overcome emotional stress and successfully adapt to the new environment.

Experts distinguish three periods of a child’s adaptation to kindergarten: acute, subacute, and compensation period.

The first two periods can be classified according to severity - mild, moderate,

heavy and extremely heavy.

The characteristics of all degrees of adaptation are described in specialized literature,therefore, we will focus only on the functions of the nurse during the adaptation period. Among them:

• working with medical records, if necessary, talking with parents to determine the child’s health group, understanding the history of its development, clarifying complications and prohibitions on certain medications and products;
• together with a psychologist and senior teacher of a preschool educational institution, preparation of recommendations on the mode of adaptation of a child to a preschool educational institution based on entries in the medical record;
• preventing children with viral infections and other current diseases from entering kindergarten, monitoring children’s health status and food intake;
• together with teachers, maintaining an adaptation sheet (continued until the child fully adapts to kindergarten).

Conducting a medical and pedagogical examination of a child a year before school is notwill only make it possible to determine his readiness for learning, but will also provide the opportunity to carry out, if necessary, a special set of corrective measures aimed at improving his health and eliminating educational deficiencies.

There are general (physical, personal, intellectual) and specialpreparing children for mastering the primary school course.

The basis of physical readiness is the child’s health status:

correct physique, good posture, timely development of motor skills and qualities, physical and mental performance. Therefore, the nurse’s task is to take all measurements, issue referrals for tests to medical specialists and fill out medical records by April 1.

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Flu can be prevented

Influenza and acute respiratory infections are common acute infectious diseases of a viral nature that are contagious. Flu and acute respiratory infections are one of the main risk factors in young children preschool age and children suffering from chronic diseases. The flu is especially dangerous due to its complications. The source of infection is a sick person. When talking, coughing, or runny nose, the patient secretes ambient air influenza virus. The disease develops quickly. It can take 4-5 hours from infection to the onset of illness. t0 rises sharply to 38-390, headache, chills, fatigue, aching joints, and a little later - catarrhal symptoms: cough, runny nose.

What needs to be done to prevent influenza and acute respiratory infections?

1. Vaccine prevention is the main fight against influenza, as a more widespread and effective measure.

2. Physical education – optimal physical activity in accordance with age and health status.

3. Hardening procedures – have no permanent contraindications. Efficiency is associated with adherence to the principles of hardening:

· gradual hardening effects;

· systematic;

· taking into account individual characteristics;

· positive emotions.

(walking in the open air, air baths with morning exercises, washing with water t0 14-16 0, contrast dousing, walking barefoot)

4. Taking multivitamins.

During the period of illness, it is necessary to follow the simplest rules:

Do not attend public events;

Cover your nose and mouth with a tissue when you cough or sneeze;

Avoid hypothermia;

Daily wet cleaning of the premises;

Ventilation;

Fresh air is very important and beneficial;

Morning exercises, hardening;

Rules of personal hygiene;

Vitamins, fresh vegetables, fiber, protein, milk, fish in the diet every day.

Don't self-medicate!

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How to treat cough in children.

In young children, coughing is a fairly common occurrence, since their immunity is not yet fully developed. Many parents have noticed that treating a child’s severe cough is almost useless. You can endlessly give your baby pills, feed him with mixtures and syrups, but even if the cough subsides for a while, then after a few days it reappears with new strength. Sometimes mothers notice that the child no longer has other symptoms of any ailment, but the cough invariably attracts attention, forcing parents to get nervous and contact doctors with the question of how to treat a severe cough in a child.

Often, fathers and mothers feel powerless and do not know how to effectively treat a severe cough in their child, because it interferes with peaceful sleep, is simply exhausting and even leads to vomiting and weight loss in infants. Before treating a severe cough, you need to understand the reasons for its occurrence, understand what kind of phenomenon it is and whether it needs to be dealt with. As you know, coughing is a protective reaction of our body, helping to cleanse the respiratory tract of foreign objects and pathogens. Cough itself is not a disease, but it is a symptom of many ailments, ranging from acute respiratory infections to tuberculosis. From this it becomes clear that it makes no sense to treat the symptom itself, that is, cough, but it is necessary to treat the underlying disease that caused it.

Often, doctors do not recommend getting too carried away in treating a child’s cough, since it, no matter how, helps to clear the baby’s airways of the accumulation of anything harmful, and, therefore, he recovers faster. In addition, the use of many medications will also not benefit a fragile body. Of course, there are exceptions, for example, a dry barking cough must be treated, since in any case it does not fulfill its protective functions, but only makes the condition worse.

Typically, 3 types of medications are used to treat cough in children.

1. Expectorants. Used to quickly remove mucus from the respiratory tract.

2. Antitussive drugs. Suppresses a strong, painful cough in a child, which is not physiologically justified. Such drugs affect certain areas of the brain and reduce the sensitivity of the receptors responsible for coughing.

3. Mucolytic agents. Such medications facilitate the removal of sputum by diluting it. Sometimes mucolytics are classified as expectorants.

If a child has a dry cough, he is usually prescribed antitussive drugs; in cases where the cough is wet, expectorants are used. It is contraindicated to use both drugs at the same time, since this can provoke the accumulation of sputum in the bronchi. There are certain cough medications that are not typically prescribed to children. These are codeine, ethylmorphine, dimemorphan. Only a doctor can prescribe such drugs to a child in exceptional cases; in other situations, with a severe cough, for example, due to pleurisy or whooping cough, non-addictive medications are prescribed.

In case of acute respiratory infections, bronchitis, pneumonia, a wet cough is most often observed; mucolytics are usually used for its treatment, among which the most popular are Bromhexine, ACC, Ambroxol, etc. Mucaltin, Pertussin, Solutan are used as expectorants. Many medicines are made from medicinal herbs, that is, they contain natural ingredients. A very effective cough remedy is licorice root, from which syrup can be found on sale. Coltsfoot, plantain, thyme are also used for coughs - all these herbs are sold in ready-made breast mixtures in pharmacies. However, in addition to any medications, compliance with other conditions will be very important for the treatment of cough. How to treat and what should be done if a child’s severe cough does not go away for a long time?

1. Most often, the cause of cough is respiratory diseases, and it is with their treatment that one should begin to get rid of such a symptom as cough. True, as everyone knows, even after recovery, a cough can remain for many days, so for complete healing you can use the special remedies mentioned above.

2. During the treatment period, the child should be warmly dressed. It has long been noted that socks or a vest made from goat or sheep wool perfectly retain heat in the body and prevent many diseases. This includes preventing coughing attacks.

3. We should not forget about ancient folk remedies, namely: tea with raspberry jam, hot milk with honey and butter. These wonderful natural remedies not only appeal to children for their sweet taste, but also help thin mucus and remove it. These are excellent diaphoretics that alleviate the general condition of the patient. However, it is necessary to remember that you should not give your child tea with raspberries if he has a high temperature.

4. Cough often worsens at night, so before going to bed it is useful to do compresses and other procedures that warm the chest. One way to use a warm compress is to take a cabbage leaf, spread honey on one side of it, and apply it to the chest. Cover the top with foil, secure with a bandage or diaper and leave overnight. You need to be careful to ensure that the child does not have an allergic reaction.

5. For diseases of the respiratory tract accompanied by a cough, it is usually recommended to inhale with mineral water, for which it is very useful to buy a special inhaler. It softens dry cough very well and helps alleviate the child’s condition.

Open Hearth Shopis one of the leading workshops of OJSC Magnitogorsk Iron and Steel Works, producing high-quality steel. The open hearth shop consists of the following sections:

1. furnace department;
2. bottling department;
3. mixing department;
4. charge yard;
5. train preparation department.

   Furnace department– the main department of the workshop where the steel-smelting furnaces are located. Sinter, limestone, scrap metal, liquid cast iron and other components (fuel + oxygen) are loaded into the furnace. The main hazards of this area: silicate-containing dust, metal aerosols, high temperature, thermal radiation, sudden temperature changes.

   Bottling department– serves for pouring finished steel into ladles and its further pouring from the ladle into the castings. Here, ladles are prepared for melting, they are lined with refractory bricks, steel chutes, sopors, slag bowls are prepared, slag is removed and received.

   Hazards of this area: silica-hazardous dust, metal aerosols, high temperature, light and thermal radiation, noise up to 89 dB.

   Mixing department serves for receiving and storing liquid cast iron received from the blast furnace shop, which is poured into mixing barrels. As needed, cast iron is poured from a barrel into cast iron ladles and delivered by electric locomotive to the furnace department for refueling steel-smelting furnaces. Hazards: metal aerosols, high temperature, thermal radiation, noise.

   Charge yard – designed for storing scrap metal and bulk production components. Harmful: noise, silica hazardous dust.

   Train Preparation Department engaged in the preparation of compositions for steel casting. Hazards: silica-hazardous dust, metal aerosols, high temperature, temperature changes.

   Number of employees in the workshop: 800, of which:

   steelworkers and helpers - 130 people.

   pourers and ladle workers – 95 people.

   crane operators – 163 people.

   fireproofers – 50 people.

   mechanics – 69 people.

   electricians – 36 people.

   gas welders – 34 people.

   train preparers – 38 people.

   others – 161 people.

   Engineers – 50 people.

   Of these, 65 are women.

   There are 145 people working from 16:00, 145 people on the night shift.

   Table 1

   Distribution of workers by observation groups

Number of employees	The first group is practically healthy	The second group – those at risk by profession	Group 2 B – endangered by diseases	DN	35 group ChDB

Health center open hearth shop is working around the clock. Health center staff: senior paramedic, 3 on-duty paramedics, 1 nurse. The health center is located on the 1st floor of the administrative building of the open-hearth shop, occupies an area of ​​122 m 2 .

The following offices are available:

Reception office - 13 m 2 , treatment room - 13m 2 , dressing room - 13 m 2 , massage room 18 m 2 , office F.T.L. - 18 m 2 , doctor's office 16 m 2, household 3 m 2, bathroom - 3 m 2.

The physiotherapy room is equipped with the following equipment: tube ultraviolet radiation; UGN-1 stationary mercury-quartz irradiator; UFO portable; UHF-66; "Iskra-1"; ultrasonic inhaler “Vulcan-1”4 mechanotherapy table; vacuum massager. Stockwith dressings, alcohol, a sanitary bag for emergency care, anti-shock packing, an artificial respiration apparatus, oxygen pillows, a set of splints, gastric lavage tubes, a sufficient amount of sterile containers for collecting vomit, a stretcher; breathalyzer, refrigerators for storing medicines, manipulation tables, couches, centralized oxygen supply, steam sterilizer GP-10- 1 , “Anti AIDS” first aid kits with a set of tools for AIDS prevention; a set of tablet and injection medications to provide I assistance and anti-relapse treatment; disinfectants and detergents.

I work in accordance with the orders of the Ministry of Health of the Russian Federation:

No. 408 dated 07/12/89. on measures to reduce the incidence of viral hepatitis in the country, paragraph 3.1. SP 958-00

No. 720 of July 31, 1978 on improving medical care for purulent surgical diseases and strengthening measures and combatingnosocomial infections.

OST 42-21-2-85 on sterilization of medical supplies. Quality control of pre-sterilization cleaning of instruments for the presence of blood: azopyram test, for the presence of a detergent - phenolphthalein test. From 2.88.

Order No. 254 of September 3, 1991 on the development of deconstruction in the country.

No. 28-6/13 dated 05/08/88. Quality control of pre-sterilization cleaning of medical products using azopyram.

In order to improveWhen diagnosing and preventing infectious diseases, I am guided in my work by the following regulatory documents.

Order No. 288 dated March 23, 1976. “On the sanitary and anti-epidemic regime of hospitals and medical services. institutions."

No. 475 of 16.89 “On measures to further improve the prevention of acute intestinal infections.”

No. 1089 dated 08/13/86. “On strengthening the fight against helminthiasis.”

No. 139 of 03/02/89 “On measures to reduce the incidence of typhoid and paratyphoid fever in the country.”

No. 171 dated 04/27/90. "On epidemiological surveillance of malaria."

No. 342 dated November 28, 1998. "About the futurestrengthening and improving measures for the prevention of typhus and the fight against pediculosis.”

No. 36 dated 02/03/97. “On improving measures for the prevention of diphtheria.”

No. 174 dated 05.17.99. "Prevention of tetanus."

SP 3.1096-96 Vet. Rules 13.3, 1103-96 “On the prevention of rabies.”

No. 297 M.Z. RF dated October 3, 1997 “On the procedure for preventing rabies.”

No. 324 dated November 22, 1995. “On improving anti-tuberculosis care,Instructions of the Ministry of Health of the USSR dated August 27, 1973.

No. 1142 “On the procedure for mandatory professional examinations, on the procedure for admitting persons with tuberculosis to work in certain professions.”

No. 286 dated December 7, 1993, guidelines dated August 29, 1968 No. 06 19/15 “On the prevention of scabies.”

No. 25 of January 27, 1998, Ministry of Health of the Russian Federation “On strengthening measures to prevent influenza and other ARVIs.”

No. 170 dated August 16, 1994 “On AIDS prevention.”

No. 295 dated 05/30/95. “On measures to improve the prevention and treatment of HIV. infections in the Russian Federation, on the introduction of rules for mandatory examination for HIV. infection."

Order No. 616 of September 29, 1989 “On pre-shift medical examinations.”

No. 198/64 dated 03/31/89. joint order between the plant and the city health department “On conducting pre-shift and pre-trip inspections.”

No. 141 dated 9.05.90 “On improving measures to prevent tick-borne encephalitis.”

No. 229 “On the national calendar of professional vaccinations”

No. 202 dated 9.03. 78. “On approval of instructions for professional vaccinations against tuberculosis.”

No. 90.409 Orders according to prof. examinations with the participation of narrow specialists.

№330 dated 11/12/97 Responsibility for obtaining N.L.S. and their accomplices. Organization of medication records.

No. 328 of 08.23.95 “On medicines subject to substantive and quantitative accounting”

No. 130 Appendix No. 6 dated 23.0694 “Regulations on the paramedic health center.

Job description dated 1.03. 99 according to MSCh OJSC MMK and A.G. Magnitogorsk, approved by the head. doctor “On the functional responsibilities of employees of health centers of the MMK medical unit” in accordancewith which it is necessary:

comply with the rules of sanitary-hygienic and anti-epidemic regimes, asepsis, properly store and handle, sterilize and use medical products for the patient and medical personnel.

I rationally organize my work in accordance with work quality criteria. I follow the rules of personal hygiene. I work in overalls: a clean robe, a cap, spare shoes. I take precautions when processing instruments: careful handling of sharp objects, using safety glasses, a mask, latex gloves of sufficient thickness, a waterproof apron, removing foreign organic and inorganic substances from the instruments using a brush and a cotton-gauze swab before disinfection in a disinfectant solution in 0.2% Javel Solida solution. Disinfection is carried out according to the classification of items according to the categories of risk of transferring H.B.I.

We carry out disinfection in Javel Solida solution. Working solutions are prepared in enamel, glass or plastic containers by dissolving Javel Solid tablets in water. A 0.1% solution of Javel Solida is obtained by dissolving 7 tablets in 10liters of water.02.% solution of Javel Solida - when dissolving 14 tablets in 10 liters of water.

0.06% solution of J.S. when dissolving 4 tablets in 10 liters of water

Medical products made of corrosion-resistant materials, glass, rubber, plastics (pipettes, probes, gloves, dishes, beakers, tubes) are disinfected in a 0.1% solution of Javel Solida for an hour with full immersion. Disposable syringes and instruments contaminated with blood are disinfected in a 0.2% Javel Solida solution with full immersion, filling all channels, placing a load on top for an hour. We recycle the syringes. Linen, dressings contaminated with 0.2% blood - within an hour. Indoor surfaces, couches, tables are treated with 0.06% Javel Solida solution. Exposure for an hour. Aqueous solutions of Zhevel Solida have a shelf life of 72 hours. Then the instruments are washed with running water until the disinfectant is completely removed.

Pre-sterilization treatment of instruments is carried out by soaking the instrument while completely immersed in a washing solution heated to 50 ° for 15 minutes. We wash the instruments in a washing solution with a brush or a cotton-gauze swab. We prepare the washing solution: 5.0 detergent: Lotus, Astra, Aina, Progress, Marichka, Zifa and 17.0 -33% perhydrol solution; add up to 1 liter of water. We use washing solution during the day.

Rinse the tools with running water until any remaining detergent is removed for 10 minutes.

Rinse with distilled water 2-3 times and dry.

According to Order 254 “On the development of disinfection in the country,” self-monitoring of the quality of processing is carried out daily, covering 1% or 3 products no less for residual or occult blood azopyram test. Azopyram with 3% solution N 2 O 2 in a 1:1 ratio, apply to the test products using a pipette. In the presence of traces of blood, immediately or no later than 1 minute after contact of the reagent with the contaminated area, a color appears, initially violet, then quickly, within a few seconds, turning into pinkish-lilac or brownish. Coloring occurring later than 1 minute is not taken into account.

Check for detergent residue with a 1% alcohol solution of phenolphthalein. If detergent is present, the clear phenolphthalein solution will appear pinkish-purple. The results are recorded in the quality log of pre-sterilization treatment. Honey. documentation F No. 366-4, approved by the Ministry of Health of the USSR on October 4, 1980. order No. 1030.

We carry out sterilization in a steam autoclave GK10-1. all products are autoclaved at a pressure of 2 atmospheres, temperature 132 ° for 20 minutes at

2-layer calico packaging in the form of pockets, for dressings, treatment rooms, eye tables and spatulas.

Shelf life 3 days.

We monitor the quality of sterilization using thermal-temporal paper indicators, comparing with the standard carried out by the head of the health center upon receipt of the indicator. The results are noted in the steam sterilizer operation log.

We chemically sterilize the tubes in a 6% hydrogen peroxide solution at a temperature of 18° for 6 hours with full immersion. After sterilization, rinse with running water until the hydrogen peroxide solution is completely removed for 10 minutes. Then rinse with distilled water for 2-3 minutes. Dry and store in a sterile box for 3 days.

The collection of sterile material is carried out using sterile tweezers and forceps, which are stored in a dry, sterile form.

Current disinfection is carried out according to order No. 288 3 times a day with 0.06% Javel Solida solution with irradiation with a bactericidal lamp in the dressing room and treatment room for 25 minutes based on the formula for irradiation. Procedural cubic capacity 46 m 3 and dressing room 45 m 3.

46 m 3 * 45 m 3 / 60 = 25 minutes

General cleaning is carried out once a week according to the schedule of the senior paramedic. Disinfection with 5% chloramine solution or 0.2% Javel Solida solution. Exposure 1 hour. Walls, ceilings, household items are treated, washed with a 0.5% detergent solution. Wash off with clean water. We irradiate with a bactericidal lamp for 25 minutes.

Quality control of the processing of instruments is carried out using azopyra, phenolphthalein samples, and thermal time indicators; the results of control are recorded in the appropriate logs, checked every shift by a senior paramedic.

Quarterly, the head of health centers takes testsfrom paramedics in their specialty and in sanitary epidemiology. regime according to a 5-point system, organizes visiting commissions with examination of dignity. epidemiological regime and examinationlabor activity of the health center with registration of examination results using a 5-point system in the journal of comments and suggestions for the health center. When re-departing, the commission checks the implementation of the recommendations given during the previous departure. The results of inspections are discussed in reports; sum up the results and outline an action plan to eliminate the identified deficiencies. Every year the work of the salary point is checked by the S.E.S. doctor. with control of sanitary epidemics. regime with the preparation of an inspection report, a copy of the report is transferred to the head physician, and the appropriate conclusions are drawn.

I take precautions against infection at work. I give myself preventive vaccinations against influenza, diphtheria, tetanus, and V. hepatitis. I wash my hands before and after any patient contact.

I consider the blood and liquid secretions of all patients as potentially infected and work with them only with gloves.

I carry out injections, dressings and disposal of waste materials in strict accordance with existing orders and recommendations. I use eye protection - goggles and masks to prevent possible splashes of blood and liquid secretions from getting into my face. I use waterproof aprons to protect the body from possible splashes of blood or liquid secretions. The most real risk of infection occurs when gloves are torn or punctured, which can expose contaminated material to the skin. Composition of a first aid kit for the prevention of HIV infections: 5% iodine solution, finger pads, gloves, bactericidal adhesive plaster, dry sample for preparing 0.05% potassium permanganate solution, glasses, 70° alcohol, 1% chloramine solution, 20% sodium sulfacyl solution - eye drops.

If the patient's discharge or blood gets on the skin, treat it with 70° alcohol, wash with soap and water, and re-disinfect it with 70° alcohol. Treat the mucous membranes with 0.05% potassium permanganate solution; Rinse your mouth and throat with 70° alcohol. Don't rub. For injections and cuts, squeeze the blood out of the wound with 1% chloramine solution, then with 70° alcohol and treat the wound with 5% iodine, seal it with a bactericidal adhesive plaster, and put on a finger cap. Make an entry in the Anti-AIDS journal indicating the date when contact with someone else's blood occurred, full name. persons with whom contact occurred. Face painting.

Help with anaphylactic shockmust be carried out as quickly as possible. An anti-shock set of medications and instruments necessary for providing emergency care is available at the health center: solution of adrenaline 0.1% in amp. No. 10, mezaton 1%, norepinephrine- 0,2 % -10 amp., Suprastin 2% -10 amp., Tavegil 0.1% -10 amp., solution of prednisolone 5 ml for IV - 10 amp, aminophylline 2.4% - 10 ml - 10 amp., solution korglykon - 0.06% in ampoules, sodium chloride solution 0.85% - 10 amps., glucose solution 40% in ampoules. No. 20, “hlosol” solution, air duct for mouth breathingin the mouth, artificial respiration apparatus, disposable sterile intravenous infusion system - 2 pcs., sterile syringes (20, 10, 5, 2 and 1 ml), needles for them, rubber tourniquet, ethyl alcohol70° - 100 ml., mouth dilator, tongue holder – 1 pc., gauze swabs for mucus removal, metal holder for tampons – 1 pc., scalpel, sterile scissors, oxygen cushion.

If a patient suspects anaphylactic shock, it is urgent to call a doctor through the staff on duty. Immediately stop administering the medication, place the patient on the couch (head below feet): turn the head to the side, extend the lower jaw, remove dentures (if any). In case of s/callergen injection, apply a tourniquet above the injection site (for 25 minutes). Inject the injection site with 0.3-0.5 ml of 0.1% adrenaline solution with 5 ml of saline. Solution. Apply a heating pad with cold water to the injection site for 10-15 minutes. Inject 0.3 ml of 0.1% adrenaline solution into the limb free from the tourniquet. When introducing an allergen intravenously, we immediately stop the injection and inject 0.15-0.5 adrenaline 0.1% with 9.0 saline into this needle with another syringe. solution, with suprastin or diphenhydramine. We measure blood pressure, P S . We give oxygen through the air duct. If blood pressure does not stabilize, we urgently begin intravenous drip administration of “chlosol” with norepinephrine. Glucocorticosteroid drugs are administered intravenously: prednisolone 60-120 mg, dexamethasone 8-16 mg, or hydrocortisone 125-250 mg. 2 ml of 0.1% tavegil solution or 2 ml of 2% suprastin solution are injected intramuscularly. For bronchospasm, intravenousinject 10 ml of 2.4% aminophylline solution into saline. solution. Cardiac glycosides - corglycone and respiratory analeptics are used according to indications.

If necessary, accumulated secretions and vomit are sucked out of the respiratory tract, and oxygen therapy is started. In case of cardiac and respiratory arrest, we perform indirect cardiac massage and artificial respiration, calling an intensive care ambulance through the staff. We are hospitalized on a stretcher.

Traumatic shock– severe reactive general condition of the body, developingsoon after injury, is characterized by a sharp decrease in tissue perfusion, which, without adequate treatment, quickly leads to generalized dysfunction of cells and death. The main symptoms of shock: skin – cold, pale, damp; “white spot” symptom - slow filling of skin capillaries after compression (more than 2 sec), tachycardia, first excitement, then lethargy, decrease in systolic blood pressure less than 100 mm Hg, decrease in pulse pressure less than 20 mm Hg, decrease diuresis. After examining the patient, call the resuscitation team. In case of breathing problems, clear the airways from mucus, blood, and vomit.

To improve the conductivity of the respiratory tract, the patient's head is thrown back as much as possible, lifting the chin upward and bringing the lower jaw forward. By opening the patient’s mouth, make sure that there are no food masses or foreign bodies in the oral cavity. If there are any, they are removed using a napkin. We insert the endotracheal tube, moving its end into the trachea by 5-7 cm. After making sure that the tube is positioned correctly, we fix it to the patient’s head and begin artificial ventilation of the lungs using an Ambu bag.

Stop the bleeding. In case of external bleeding, it is stopped by packing the wound, applying a pressure bandage, or clamping the bleeding vessel, as well as pressing it outside the wound. In case of arterial bleeding, we apply a tourniquet, indicating the time of its installation. We treat the edges of the wound with a 5% iodine solution. Apply an aseptic dressing

2. Disinfect. analgin 50% - 2.4 ml, baralgin, tramal, if there is pain.

3. Immobilize limbs for fractures.

4. We carry out intensive infusion-transfusion therapy. Crystalloid solutions (5% glucose solution 400, electrolyte mixtures such as Ringer's solution, Ringer-Locke - 800), colloid solutions - polyglucin, rheopolyglucin, while conducting a compatibility test in 3 stages of 15-25 ml every 5 minutes. We administer corticosteroid drugs: prednisolone, hydrocortisone, dexamethasone;antihistamines (suprastin, diphenhydramine). When the pressure drops, adrenaline is administered, which is diluted in 200-500 ml of liquid.

Transportation of a patient in a state of shock is carried out under the control of vital functions with the leg end of the stretcher raised. For an uncertain blood pressure level, jet infusion into two veinsin one - crystalloid solutions, in the other - polyglucin.

For hypertensive crisisa triad of signs is characteristic: a relatively sudden onset, an individually high rise in blood pressure, the presence of complaintscardiac, cerebral (cerebral) and general vegetative nature. After the examination, if there is a suspicion of: acute myocardial infarction, hemorrhagic stroke, with a convulsive form of crisis and pulmonary edema, with nosebleeds, a rapid decrease in blood pressure to individually “habitual” numbers is required, if they are not known, then to 160/90 mm Hg. We slowly administer clonidine 1 ml 0.01% solution intravenously per 9 ml solution NaCL under blood pressure control, if the pressure does not decrease, then we do Lasix 2 ml IM, diazepam 2 ml IM. For heart pain, we give nitroglycerin sublingually, make fentanyl 1 ml 0.005% solution with droperidol 1 ml IV diluted. For seizures - sodium hydroxybutyrate 10-20 ml 20% IV very slowly, Lasix. All patients with complicated crises are hospitalized (with heart failure, heart rhythm disturbances, cerebrovascular accidents, vascular complications, nosebleeds, hemorrhages in the eyes). If the hypertensive crisis is relieved and the patient’s condition is stable, he can be left at work with blood pressure re-measured after 3 hours.

If there is a lack of insulin in the body, a diabetic coma (hyperglycemic coma) may occur. Develops gradually. Its appearance is preceded by malaise, loss of appetite, and headache. In hyperglycemic coma, the patient is in a state of prostration, consciousness is darkened, the skin is pale, the mucous membranes and skin are dry, Kussmaul breathing is accompanied by a sharp deepening of the sigh and a decrease in the respiratory rate. Exhaled air smells of acetone. The pulse is weak, blood pressure is reduced 70-80 mm Hg (systolic). Collapse, vomiting, abdominal pain. The temperature is normal. There is a high concentration of sugar in the blood (27-30 mmol/l). emergency care: administered intravenously 40 units. insulin with 20mm 5% glucose solution. The patient is hospitalized in a hospital, where further treatment is carried out.

Hypoglycemic coma occurs in diabetic patients after injecting too much insulin.

Hypoglycemic coma develops acutely. Excitement, loss of consciousness, delirium, convulsions, increased skin moisture, and hyperemia occur. Breathing is unchanged, pulse is rapid, often arrhythmic. Blood pressure is reduced. The tone of the eyeballs is normal, the pupils are dilated. Blood sugar is 3 mmol/l or lower. With such a development of coma, loss of consciousness is preceded by the patient's appearance of hunger, weakness, sweating, dizziness, drowsiness, tachycardia, convulsive muscle twitching, transient speech disorders, parasthesia and paresis. Urgent Care. Inject 20-40 ml of 40% glucose solution with 6.8 units of insulin intravenously. For hypostasis, 4-6 pieces of sugar with hot tea. In severe cases, we administer 0.3-0.1% adrenaline solution intramuscularly. In severe hypoglycemic coma, emergency hospitalization in the therapeutic department is indicated.

In case of mass food poisoning: prohibit trade in the product suspected of being poisoned, weigh it, draw up a report. Notify heads. to the medical doctor about the incident and request the organization of assistance from specialized ambulance teams with sterile equipment and consultants.

Report epidemiological SES department, head doctor of SES tank. laboratory. At the same time, call the shop manager and ask for an order to organize work to identify victims, carrying out educational work among workers, avoiding panic and taking personal safety measures. Make lists of victims according to the form. With the help of activists, organize a) ongoing disinfection in the workshop, do not use the sink, dress according to the instructions. In case of food poisoning, when washing the stomach with 2% baking soda solution - up to clean rinsing water. Vomit is taken for bacteriological testing.study into sterile containers, tightly closed with lids. Attach an accompanying document in which they indicate: full name, age, diagnosis of the patient, date of collection of the material, nature of the material, surname of the medical specialist. employee.

Provide the patient with the necessary medical care. assistance with cases of moderate severity and heavy - intravenous saline solutions, in the lungs - saline solutions orally (Rehydron, tsitroglucosalan). Upon arrival, consultants provide basic information, hand over lists of victims, and issue referrals to the hospital.

If a patient experiences a myocardial infarction (ischemic necrosis of an area of ​​the heart muscle with loss of its ability to contract. This is an emergency condition requiring urgent hospitalization. Mortality is maximum in the first two hours). I'm calling the resuscitation team. I'm conducting an examination. I measure blood pressure, P S , I inhale oxygen, give aspirin 0.25 orally, chewed. When systolic blood pressure is more than 100 mm Hg. I give 1 t of nitroglycerin sublingually, after 5 minutes, if the pain has not stopped, then I repeat (under blood pressure control). If blood pressure is less than 100 mm Hg, then we do 50% - 4.0 analgin with diazepam 1 ml IV. If there is paindid not stop when systolic blood pressure is more than 100 mm Hg, we make fentanyl 0.005% 1 mlwith droperidol 1 ml IV diluted, and if blood pressure is less than 100 mm Hg, then we do fentanyl 1 ml - 0.005% IV diluted inhalation nitrous oxide with oxygen 1:1. Transport on a stretcher under monitoring of vital functions.

In 2001 I carried out the following work:

Received 4252 patients with the necessary examinations, providing first aid and sent 96 patients to medical institutions, of which to K.S.P. - 15; with information from the shop manager about persons who did not leave to work.

Conducted 7,715 pre-trip health examinations of workerswith measurement of blood pressure, P S , body temperature and psychological examination. Examined 460 people for pediculosis, 10 for athlete's foot.

Conducted an examination of 780 workers and repaired micro-injuries to 34 workers.

Monitored the sanitary and technical condition of the casting bay, the area around the workshop, the operation of ventilation, illumination of workplaces, the presence of drafts, the presence and correct use of personal protective equipment, the presence and condition of special equipment. clothes, industrial condition atmosphere. Drew up 11 reports with the H&S engineer, gave 18 proposals, of which 16 were implemented.

Checked the sanitary state of the drinking regime, with thermometrydrinking water, checked the presence of saline solution, gas. water, tea, illumination of drinking points, the presence of mugs, functioning of devices for washing glasses. She drew up 11 acts in the presence of the person responsible for the drinking regime, made 14 proposals, of which 13 were implemented.

Stated the dignity. condition of showers and washing facilities, work

washing and shower facilities, operation of sanitary equipment (washbasins, shower heads, toilet flushes), availabilityand the use of disinfectants and detergents funds.

Compliance with the rules for preparing disinfectants. Monitored the operation of supply and exhaust ventilation and heating systems, and the lighting of showers.

Checked the implementation of the plan for washing and repairing special equipment. Clothes. Quality washing repair special. Clothes. 11 reports were drawn up for the inspection of shower rooms, together with the work distributor responsible for the condition of the household premises. 15 proposals were given, which were implemented.

Conducted an inspection of the workshop canteen and made 72 suggestions, which were implemented immediately. During the inspection of the canteen, she checked compliance with sanitary rules for cooking,storage, tradefood products, the availability of disinfectants and detergents, the operation of technological and refrigeration equipment, the condition of kitchen and tableware, the rules for their use and processing, checkedcompliance with personal hygiene rules by canteen workers, availability and condition of special equipment. clothes. I checked the marriage magazine and the Health magazine. All examination results were noted in the sanitary journal of the canteen. Conducted individual interviews.

During the year, she registered 250 sick leaves with temporaryloss of ability to work, with individual conversations about the improvement and prevention of this disease, about a healthy lifestyle, and, if necessary, prescribed physiotherapeutic treatment.

Monthly, quarterly and annually, we analyzed the incidence of temporary disability by profession and compared the results with the previous year. The results of the morbidity analysis are brought to the attention of the workshop doctor and the workshop administrationand measures are taken to reduce morbidity, issues are resolvedon preparing workplaces for work in the autumn-winter and summer periods, maintaining drinking conditions, timely repair of ventilation units and air conditioners, inspection and repair of heating systems, sufficient lighting and safety of workplaces. Improving the health of workers in recreational facilities, health centers and resorts.

For the purpose of early detection of diseases, in particular occupational ones, as well as to resolve the issue of professional suitability, a periodic medical examination is carried out annually according to Order No. 90.

Professional examination according to order No. 90

year	Number of subjects	Number of people examined	% coverage	Identified endangered
				Quantity identified. with prof. pathology of the yoke	Taken under observation.	Identified with other diseases.	Taken under observation.
2001 (reporting)			98,36
2000			92,03%

After the medical examination, she monitored, together with the shop doctor, the implementation of recommendations, referred those in need for further examination to the diagnostic center, as well as for consultation with specialized specialists. The issue is resolved jointly with the workshop administration and the workshop doctor.on the employment of workers who are recommended to limit certain harmful working conditions.

Morbidity analysis for 2001

The morbidity rate for 2001 compared to the morbidity rate for 2000 in the open-hearth shop decreased in cases by 5% and in days of incapacity by 7%, which amounted to 584 cases of incapacity for work or 78.49 per 100 workers, 8889 days of incapacity for work or 1194.75 per 100 working. Drivers take the first place in terms of morbidity - 124 cases of morbidity

Of them:

According to the ageby experience

Up to 20 years – 5 peopleup to 5 years – 47 people

20-30 years old – 24 people5-15 years – 40 people

30-40 years – 50 people15-30 years – 32 people

40-50 years – 40 people30 or more – 5 people

50 years and older – 40 people

People over 30 years of age with little work experience are more often affected. The increase in this category of workers can be explained by the difficulties of the adaptation period to work in a hot shop, where sudden temperature changes, especially in winter, and drafts lead to a decrease in immunity.

Steelworkers and helpers take second place in the incidence rate- 83 cases n/s.

Of them:

According to the ageby experience

Up to 20 years – 4 peopleup to 5 years – 35 people

20-30 years old – 21 people5-15 years – 24 people

30-40 years – 30 people15-30 years old – 24 people

40-50 years old – 20 people

50 years and older – 8 people

Bottlers are in third place- 51 cases n/s.

Of them:

According to the ageby experience

Up to 20 years – 8 peopleup to 5 years – 8 people

20-30 years old – 12 people5-15 years – 14 people

30-40 years old – 6 people15-30 years old – 24 people

40-50 years old – 20 people30 or more – 5 people

50 years and older – 5 people

People over 40 years of age with more than 15 years of work experience are more often affected.

All types of injuries decreased in 2001. When drawing up the work plan for 2002, taking into account morbidity, measures were planned to improve the health of workers. It is necessary to pay attention to those professions (crane operators, steelworkers, pourers) as well as the DV group and risk group. Individual conversations are held with workers; when applying for sick leave, courses of treatment in a physiotherapy room and health improvement are prescribed if necessary. Together with the workshop administration, issues related to preparing workplaces for work in the autumn-winter and summer periods, compliance with the drinking regime, and timely repair of ventilation systems are resolved.installations and air conditioners, audit and repair of heating systems, adequate lighting and safety of workplaces.

The main work of a health center paramedic is to carry out treatment and preventive measures, provide pre-medical care assistance for injuries, sudden illnesses, occupational poisonings. I know the specifics of the open-hearth shop, the working conditions and occupational pathology of the workers in this area. I carry out an analysis of morbidity with temporary disability. I am proficient in the technique of subcutaneous, intradermal, intramuscular, intravenousinjections, I know how to put in an IV. I apply asepticfixing, immobilized bandages,tires. I am proficient in the production of small technical operations, such as catheterization, intubation and gastric lavage, and administration of enemas. I can take swabs from the throat, nose, stop nosebleeds, I know all types of conservativemedical assistance for diseases of the ear, throat, nose, eyes, I can remove floating foreign bodies from the eyes. I carry out measures to comply with dignity. epid. regime at the health center. I process and sterilize honey. instruments, dressings, preparing disinfectant solutions. I know how to operate the physiotherapeutic equipment at the health center.

One of the main points of preventive work is anti-epidemic measures. This scope of work includes preventive vaccinations against tetanus, diphtheria, and influenza.

Vaccination work

Name of vaccinations	Subject to		Made		% completed 2001	% completed 2000
	2001	2000	2001	2000
P.S.					100%	100%
Against tetanus					100%	100%
Against diphtheria					100%	100%
Against the flu					28,7%	6,09%

The workshop immunized workers against tetanus and diphtheria by 97.5%. We give vaccinations against tetanus and diphtheria for injuries. If more than 5 years have passed since the last revaccination, then we give 0.5 tetanus toxoid.

In 2001, flu vaccinations were given with “Grippol” - an effective anti-flu drug and it was popular among workshop workers.

Anti-tuberculosis work

The basis for the primary prevention of lung diseases are engineering and technical measures aimed at improving working conditions and reducing dust levels. It is mandatory to use personal respiratory protection against dust - respirators.

In the medical prevention of lung diseases, the leading role is played by preliminary and periodic fluorographic examinations, which make it possible to select individuals in need of preventive and therapeutic measures.

Four people with pneumosilicosis work in the workshop. All of them are employed in jobs that do not involve exposure to dust, toxic, irritating and allergenic substances, as well as adverse meteorological factors, with dynamic medical supervision 2 times a year. From the anamnesis, their professional route, the duration of work in conditions of increased dustiness, and the sanitary and hygienic characteristics of working conditions (quantitative and qualitative composition of dust) are ascertained. Certification of SES workplaces is carried out with the preparation of reports.

Gynecological examination

Year	Subject to F.G.	Inspected	% coverage	revealed	Registered for DN
2001			100%
2002			100%

There are 3 women in the workshop who are registered as DVs. Health center paramedics monitor working conditions and the attendance of dispensary patients to a gynecologist for anti-relapse treatment and recovery.

The main task of the health center is to carry out broad treatment and preventive measures. For this purpose, records are kept of the dispensary group of patients, emergency patients, risk groups, as well as measures to improve the health of these registration groups. All these activities are carried out jointly with the shop doctor, who conducts preventive appointments at the health center 3 times a month, and conducts the main appointment at the clinic. Dispensary patients are periodically prescribed examinations, and then, in accordance with this, anti-relapse treatment is carried out.

Twice a year, a day care center is organized at the health center. The close proximity to production sites has made this type of wellness popular among workers. In the daytime dispensary, patients with hypertension, peptic ulcer disease, coronary artery disease, as well as NHD, a risk group with borderline hypertension, at risk of coronary artery disease, and bronchitis undergo preventive treatment of DN. We actively promote health improvement in sanatoriums and health centers. Rehabilitation and preventive measures with BCH are carried out mainly at the health center. In the spring-autumn period, this category of workers is prescribed physiotherapeutic procedures: UV irradiation, both general and prolonged, inhalations with herbs, as well as vitamin therapy. Workers who often take sick leave with osteochondrosis undergo a course of mechanical massage to prevent exacerbations.

Improvement of accounting groups

Type of recovery		DN	Risk group by disease	Risk group by profession
	SKL Dispensary Day care center Health center F.T.L.

A major role in the preventive work of the paramedic is played by the work on hygienic education of workers. I attend shift meetings, where I hold conversations with workers on promoting a healthy lifestyle and preventing diseases, both acute and exacerbations of chronic ones. I organize visits to shift meetings by doctors with lectures on current topics. In promoting a healthy lifestyle, an important role is played by individual conversations with workers, which are carried out when workers contact the health center, as well as when I visit work sites.

Along with conversations, I distribute leaflets at workplaces, periodically update leaflets and brochures in health corners, and issue a health bulletin once a year. In 2001, it issued a sanitary bulletin. In 2001, she published the sanitary bulletin “Prevention of Osteochondrosis.” When attending shift meetings and work sites, in order to prevent skin and pustular diseases, I carry out sanitation of microtraumas.

Sanitation report work progress for 2001

№/№	Topics of conversation	Number of conversations
		Reporting period 2001		Previous year 2000
	Prevention of colds Prevention of cardiovascular diseases Prevention of AIDS, veins. diseases Prevention of alcoholism and drug addiction Prevention of O.Zh.K.Z. Prevention of diphtheria, tetanus On the advisability of health improvement in dispensaries Injury prevention Prevention of digestive diseases Prevention of tuberculosis Prevention of k/g diseases Prevention of tick-borne encephalitis About a healthy lifestyle Flu prevention Prevention of overheating Total	52	120 listen 860 listeners	45	136 listen 973 listener

According to the ten-day period for 2001. The path to health

Folder – selection

On smoking “Health Corner and Window”

Work on civil defense, prevention and response issues emergency situations at OJSC MMK is carried out annually in accordance with the plan of main activities approved by the head of G.O. A sanitary post has been created in the open-hearth shop. preparation of the medical post is carried out annually by paramedics of the health center according to a 15-hour special program, documentation is maintained:

1. combat training logbook;
2. Protocol of the lesson;
3. Alert scheme during working hours and non-working hours;
4. Diary of the Sanitary Post, which reflects the training events conducted by the Sanitary Post;
5. Visual propaganda.

   The creation of a medical post and its staffing is formalized by an order for the workshop and is equipped according to a single report card. San. The post took part in the civil defense competition in 2001. Providing self- and mutual assistance for injuries, burns, poisoning, frostbite is included in the training program for the medical post.

   Before being allowed to work in the workshop, each newly hired employee must be familiarized with industrial sanitation and personal hygiene rules; about the need for special clothing and protective equipment (helmets, balaclavas) and, depending on the type of work, individual protective equipment (glasses, dielectric gloves, dielectric boots, respirators, mittens, safety belts) should be used, with measures of self- and mutual assistance.

   Conducting initial and repeated briefings at workplaces

Examination of workers' disability when visiting a health center

	Reporting year 2001	Last year		Reporting year 2001	Previous 2000
Sent to the clinic Released until end of shift			Received b/l Received b/l

year 2001 out of 96 referred to the clinic there were 6workers diagnosed with embedded foreign bodiesinto the cornea of ​​the angle, which were removed by specialists without complications, and the workers were sent for further treatment to a health center.

In 2000 out of 89 referred to the clinic2 workers were diagnosed with an embedded foreign body.

Analysis of the work of a paramedic over the past year in comparison with the previous year

No.	Name	Reporting year 2001	Last year
	Accepted patients Served a call to the workshop Industrial injuries Eye injuries Injections done Physiotherapeutic procedures Call K.S.P.	4252 2 1 141 585 181 1118 15	3818 3 1 138 684 226 949 15

By organizing medical care for the workers of the open-hearth shop, my main goal is to reduce morbidity among them, strengthen their health and increase their efficiency.

I improve my business skills by attending medical conferences, reading medical press, and reviewing specialized literature. I take part in surveys in my specialty and take tests for readiness for work once a quarter according to the schedule.

FUTURE PLANS

1. Take advanced training courses in the cycle “Health Protection of Industrial Workers.” enterprises".
2. Monitor the implementation of the dignity. technical measures to improve working conditions for workers, namely the renovation of the canteen, shower rooms, and rest rooms.
3. Set up a “Health Window” in the workshop meeting room for shift meetings of workers with constant updating of the topic.

   Paramedic salary

   open-hearth shop Orlova N.E.

   ANO MSCh A.G. and OJSC MMK

   REVIEW

   For the certification work of a paramedic at the open-hearth workshop of the ANO MSCH A.G. and OJSC MMK Orlova N.E.

   The work covers all the main sections of the work of the health center. A description of production technology is given, indicating the main professions and factors affecting the health of workers.

   Sections on the work of the health center as a whole are covered in sufficient detail, and a detailed analysis of morbidity is given, taking into account age category, professions and work experience. The analysis indicates measures aimed at reducing morbidity and eliminating factors contributing to the increase in morbidity. Work with a group of DN patients, a risk group, is covered. This section reflects the state of health improvement and therapeutic measures carried out in close contact with the shop doctor.

   A full description is given of the preventive work of the health center paramedic, the implementation of health and medical measures, work on hygienic education of workers, as well as sanitary and hygienic measures. The joint work of the health center paramedic with the workshop administration and the workshop doctor is covered.

   The work is done clearly, informatively with a sufficient number of tables and their analysis.

   The review is submitted to the certification commission to confirm the highest category in the specialty: “General Medicine.”

   Head health centers

   ANO MSCh AG and OJSC MMK Retivykh G.A.

   Deputy chapters doctor according to Shevelin V.I.

   outpatient base

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