Regulations 

Stock of medicines in the departments of hospitals. Medical and pharmaceutical merchandising

Accounting and storage rules medicines. Features of the introduction of drugs in children.

MINISTRY OF HEALTH OF UKRAINE

NATIONAL MEDICAL UNIVERSITY

named after A.A. Bogomolets

"Approved"

at a methodological meeting

Department of Pediatrics No. 2

and medical genetics

Head of Department

Professor A.P. Volosovets ____________

"____" ___________________ in 200

METHODOLOGICAL INSTRUCTIONS

FOR INDEPENDENT WORK OF STUDENTS

IN PREPARATION FOR A PRACTICAL (SEMINAR) LESSON

1. Relevance of the topic:

2. Specific goals:

  • Know general rules storage of medicines in the hospital
  • Know the classification of medicines and their distribution into groups for storage.
  • Know the rules for storing potent and narcotic substances.
  • Know what is equipped workplace nurses to store medicines.
  • Be able to give your child oral and rectal medications
  • To know the features when conducting intramuscular, intravenous and s / c injections in children
  • Be able to put drops in the ear and nose of the child.
  • Be able to inhale a child using a stationary inhaler.

3. Basic knowledge, abilities, skills necessary to study the topic (interdisciplinary integration)

2. Normal anatomy

3. Fundamentals of psychology. Fundamentals of Pedagogy.

4. Latin Calculate the required amount of substance and solvent for preparing solutions of different concentrations

Apply knowledge about the structure of the digestive organs, ear, nose, muscles, subcutaneous fat, respiratory organs.

Analyze the patient's emotions interpersonal relationships, children's behavior.

Own medical terminology, be able to interpret Latin medical terms

4. Task for independent work while preparing for the lesson.

4.2. Theoretical questions to the lesson:

1. Rules for the storage of drugs, depending on their group affiliation, form of release and the possibility of mutual arrangement in the cabinet. Carrying out quality control of medicines in medical institutions.

2. Accounting for potent and narcotic substances and the rules for their storage.

3. A place to store medicines at the post nurse.

4. Technique for the use of tablets, powders, mixtures, syrups, solutions for internal use by a child.

5. Technique for using suppositories for insertion into the rectum.

6. Features of intramuscular, intravenous and subcutaneous injections for children.

7. Features of the use of eye and ear drops in children.

8. Features of inhalation for a young child.

4.3. Practical work (tasks) that are performed in class

1. Acquaintance with the equipment of the place for storing medicines in the hospital, with the head nurse and at the post of the nurse on duty.

2. Familiarization with the documentation regarding the accounting of potent and narcotic substances in a children's hospital.

3. Give your child oral medication.

4. Conduct inhalation to the child using a stationary inhaler.

5. Drop drops in the child's ear and nose.

6. Supervision of intramuscular, intravenous and subcutaneous injections to children.

Rules for the storage of medicines depending on their group affiliation, form of release and the possibility of mutual arrangement in the closet.

Accounting for potent and narcotic substances and the rules for their storage.

A place to store medicines at the nurse's post.

Selective provisions of the order of the Ministry of Health of Ukraine No. 584 of December 16, 2003 "On approval of the rules for the storage and quality control of medicines in a medical institution"

  1. Input quality control of drugs (drugs) in a medical facility (treatment and prophylactic institution) is carried out authorized persons(head / head nurses, pharmacists or pharmacists of hospital pharmacies) appointed by order of the head of the medical facility responsible for the quality of medicines.
  2. State quality control of drugs in health care facilities is carried out by the State Inspectorate for Quality Control of Drugs of the Ministry of Health of Ukraine (hereinafter referred to as the State Inspectorate) and territorial inspectorates.
  3. Requirements for the premises of health facilities intended for the storage of medicines:

- the operation of the equipment of the premises of the medical facility intended for the storage of medicines must ensure the preservation of their quality throughout the entire useful life. The number of areas and premises for storage is determined by the number of drugs that are stored in them, taking into account their toxicological, pharmacological groups and physical and chemical properties;

- the premises are provided with security and fire-fighting equipment;

- the premises must ensure the protection of drugs from dust and foreign odors;

- in the premises they must maintain the temperature and humidity of the air, which meet the requirements of the instructions, to monitor these parameters there must be thermometers and hygrometers;

- the premises must be equipped with exhaust ventilation or vents and transoms;

- premises must be provided necessary quantity racks, cases, refrigerators, pallets, podtovarnikov. It is forbidden to store drugs on the floor;

- rooms are cleaned wet way at least 1 time per day using approved detergents and disinfectants.

  1. General requirements for the organization of storage of medicines in the premises of healthcare facilities:

- drugs should be stored separately according to pharmacological groups, depending on the method of their administration, taking into account the physicochemical properties of drugs, in accordance with the requirements of the instructions for the use of drugs;

- during storage, at least once a month, a complete visual control of the state of the container, the appearance of drugs is carried out. Signs of spoilage of drugs are a change in appearance (the appearance of plaque, spots on the tablets), the appearance of an additional smell, a change in color;

- if the container is damaged, the defects are immediately eliminated. Transferring, pouring into another container, packaging or hanging drugs, replacing their labels in health facilities is prohibited;

- in the event of a change in the appearance of drugs, the health facility applies to the territorial inspection at its location to determine their suitability for use

- Medicines whose expiration date has passed, or in respect of which there are doubts about their quality, should be seized and placed in a "quarantine" - a clearly separated area, to prevent their erroneous use;

- The following drugs need special storage conditions:

  1. which require protection from light (bromine, iodine) are stored in dark glass containers
  2. that require protection from moisture;
  3. which require protection against evaporation;
  4. that require protection from elevated temperature(liquid drugs, such as infusions, decoctions deteriorate quickly, so they must be stored in the refrigerator at a temperature of 2 to 10 0 C). The same requirements for the storage of emulsions, some antibiotics, serums, insulin.
  5. which require protection from the action of reduced temperature;
  6. which require protection from the action of gases contained in the environment;
  7. smelling (iodoform, lysol, ammonia), paints (iodine, brilliant green)
  8. disinfectants;
  9. medical, immunobiological preparations;
  10. flammable (flammable) substances.

The shelf life of drugs is determined by labeling. Each industrial batch of medicines has a factory series, which is indicated by 5 digits. The last two on the right are the year of manufacture, the next two are the month of manufacture, the last are the factory series.

Selected provisions of the KMDKL Order No. 2 No. 27 dated January 27, 2006 “On Approval of the Procedure for Circulation of Narcotic Drugs, Psychotropic Substances and Precursors in the KMDKL No. 2”

  1. Transportation (delivery) of narcotic, psychotropic drugs and precursors from a pharmacy to a hospital is carried out only on official vehicles provided by the administration.
  2. Responsible persons should receive narcotic and psychotropic drugs and precursors only in the form of finished dosage forms manufactured by the pharmaceutical industry or a pharmacy

They must have the following details:

- number (name) of the pharmacy where these dosage forms are made;

- accurate and high-quality designation on the signature or label (internal), ointment, for injection, eye drops, and the like.

- The name of the department (office) for which the manufactured dosage forms are intended;

- The composition of the dosage form that meets the prescription specified in the requirements submitted to the pharmacy;

- Date of manufacture of the dosage form;

— Signature of persons who manufactured, checked and issued dosage forms from the pharmacy

  1. Storage rules:

— store narcotic drugs only in the intensive care unit in a specially equipped room, psychotropic drugs in accordance with the Standard Requirements - in closed fireproof safes. The supply of narcotic and psychotropic drugs should not exceed a three-day requirement.

- At the posts it is allowed to store narcotic and psychotropic drugs in closed fireproof safes or, in their absence, in closed metal cabinets securely attached to the floor or walls, in an amount that does not exceed the daily requirement, and on weekends (holidays) two days. On the doors for toxic (narcotic) substances, the letter “A” is placed in black, for potent, the letter “B” is red. These medicines are placed either in separate cabinets or on separate shelves in a safe. A list of narcotic and potent drugs and information on the highest single and daily doses (depending on the age of the child) are placed on the inner surface of each of the safes. In addition, tables of antidotes are placed.

  1. Rules for appointment and use

- The use of narcotic drugs for a period of more than three days by inpatients must be decided by the commission on the expediency of prescribing narcotic drugs with the obligatory approval of this decision by the chief physician or his deputy for the medical unit.

  1. Leave and accounting rules.

- older sisters responsible for the storage of narcotic and psychotropic drugs should store empty ampoules for 10 days. The destruction of empty ampoules is carried out 1 time in 10 calendar days by the commission, about which an act is immediately drawn up, which is signed by all members of the commission.

To account for the profits and expenses of narcotic and potent drugs, a special numbered, laced journal is kept, which is sealed with a wax seal of a medical institution. The journal, as well as the requirements for receiving and dispensing narcotic and potent drugs, is kept for 3 years. Then these documents are destroyed by the commission, about which an act is formed.

At the post, the nurse has a cabinet for storing medicines. On each shelf of the cabinet there should be inscriptions “Internal”, “External”, “For injections”. Near rear wall place large containers, in front - smaller ones. This allows you to read the label without moving the drugs and select the necessary drug. In addition, each shelf should be divided: for example, "internal" - into a compartment for powders, tablets, potions. You can also place powders, tablets, capsules on one shelf, potions, solutions on the other. This is how medicines of the general list are stored.

At the medical post there should not be drugs that have expired.

Technique for the use of tablets, powders, mixtures, syrups, solutions for internal use for a child. Technique for the use of suppositories for rectal administration.

Features of intramuscular, intravenous and subcutaneous injections in children. Features of the use of eye and ear drops in children.

Features of inhalation for a young child.

Enteral route of administration medicinal substances

Oral (through the mouth) administration of drugs.

The most common, simple and convenient method, although it has some disadvantages, namely: incomplete absorption of drugs in the digestive canal, partial destruction of them by digestive enzymes and inactivation in the liver, which does not make it possible to accurately determine the concentration. Pills, dragees, capsules, granules, powders, liquids (drops, potions, infusions, decoctions) are used.

Before distributing medicines, the nurse selects the medicines she needs according to the prescription list, carefully reads the name of the medicines and arranges them in the order in which they will be given to sick children. Particular attention is paid to the observance of the correct doses. The nurse should know how to take medication: how many times a day, before meals, after meals or during meals, in what doses. There are several ways to distribute drugs in a children's hospital. You can use the trays, which are divided into cells indicating the name of the patient. Another way is to use a mobile table on which medicines for taking, a decanter of water and beakers are laid out. The nurse rolls this table into the ward and moves it in turn to the bed of each patient.

Powders and drops are diluted in a small amount of sweet tea and given from a spoon or beaker. children infancy the prescribed "dose of liquid medicines" is best given not immediately, but in parts. It is not necessary to give medicines to children out of hand and allow them to be taken in the absence of adults. For a child of the first year of life, the nurse presses two fingers on the cheeks, opening the mouth, and carefully pours the medicine. You can also pinch your nose and the child will open his mouth.

Drops are measured with a pipette or simply dripped from a bottle into a glass or glass, or they use a special bottle - a dropper. Having collected the required number of drops, add a little boiled water and drink. The medicine should be drunk with a spoon. If there is an insoluble precipitate in the mixture, shake it before use. A teaspoon corresponds to 5 ml of drugs, a dessert spoon - 10 ml and a tablespoon - 15 ml. It is better to use special graduated glasses for pouring potions - beakers, on which divisions are applied - 5, 10, 15, 20 ..

Powders are poured onto the tongue, closer to the root, where there are fewer sensitive taste buds, and washed down with a small amount of water. If the powders are very unpleasant in taste, you can add a little powdered sugar to them or drink it with sweet tea. children younger age do not prescribe medicines in the form of tablets, capsules or pills. Liquid medicines are given to them from a spoon, powders are also poured into a spoon.

Rectal route of drug administration.

With this method of administration, drugs are absorbed into the blood through the hemorrhoidal veins and act on the entire body. However, due to the lack of enzymes in the rectum, medicinal preparations of a protein, fatty and polysaccharide nature cannot penetrate its wall and act only locally. Candles for rectal administration have the shape of a cylinder with a cone-shaped end. The pharmacy produces candles in wrappers. For the introduction of a candle, the child is placed on his left side with half-bent legs and slightly fixed in this position. Before the introduction of the candle, it is removed from the wrapper and inserted into the anus with a cone-shaped end with two fingers and then pushed through the sphincter with one finger. Before the introduction of the candle, it is necessary to put a cleansing enema.

parenteral administration of drugs. The introduction of medicinal substances is possible intradermally, subcutaneously, intramuscularly, into the spinal canal using a syringe. This method requires strict adherence to asepsis rules.

intradermal injections.

Indications for use: for intradermal diagnostic tests (presence of hypersensitivity to drugs).

Technique: use a syringe together with a thin injection needle with a diameter of 0.4 mm. The needle must be kept with a cut to the top, almost parallel to the skin, it should be inserted to a shallow depth so that a papule in the form of a "lemon peel" is formed when the drugs are injected.

Subcutaneous injections.

Indications for use: the introduction of medicinal substances for the local (center of inflammation, local anesthesia) and general action.

Technique: subcutaneous administration of medicinal substances is carried out in the outer surface of the shoulder, thigh, subscapular region, anterior wall of the abdomen, in a place that requires local treatment or pain relief. At the injection site, the skin is treated with alcohol, then it is taken into a fold and pulled off with the fingers of one hand, and with the other, the skin is pierced with a needle at an angle of 30 ° to the surface dressed on a syringe and drugs are injected. When piercing the skin, the lumen of the needle should always be turned up.

Intramuscular injections.

Indications for use: the introduction of medicinal substances.

Technique: the introduction of medicinal substances is carried out in the upper outer quadrant of the gluteal region or the anterior outer region of the thigh. The skin at the injection site is treated with alcohol, fixed with fingers, a needle 6-8 cm long, dressed on a syringe, with a decisive movement, the needle with the syringe is inserted into the middle skin fold to a depth of 7-8 cm, leaving 1 cm above the sleeve, since in this place the needle most often breaks. The skin is pierced perpendicular to its surface, the plunger of the syringe is pulled towards itself, checking the extravascular placement of the needle, and drugs are injected.

Intravenous injection technique

With this method of administration, the drug enters directly into the blood and provides an immediate effect. The introduction of drugs into a vein provides a more accurate dosing of drugs, and also makes it possible to administer drugs that are not absorbed from gastrointestinal tract or irritate its mucous membrane.

Place of injection: more often in the vein of the elbow, in children of the first years of life - veins in the area of ​​the wrist joint, saphenous veins of the head, veins of the ankle joint.

Equipment: Sterile needle and syringe disposable with a capacity of 10 or 20 ml in a package, sterile disposable rubber gloves in a package, medicines in ampoules and vials, a nail file, 70% solution of ethyl alcohol, cotton balls, tourniquets, linen napkin (towel), tray for used tools and materials, tweezers in triple solution.

Procedure preparation

  • Thoroughly wash your hands twice with soap and water, dry with a towel, treat with a 70% solution. Provides infection control.
  • Check the inscription on the ampoule with the doctor's prescription, pay attention to the expiration date.
  • Release the disposable syringe and needle from the packaging.
  • Draw the solution from the ampoule into the syringe.
  • Remove air bubbles from the syringe. Prevention of embolism formation.
  • Put the syringe with collected substances on the tray. Provides infection control.
  • On this tray put 3 cotton balls soaked in 70% solution of ethyl alcohol. Provides infection control.
  • Conduct psychological preparation patient. Encourage the patient to cooperate.
  • When performing injections, the patient should lie in bed. Prevention of fainting.
  • The patient's arm should be placed on the table in a comfortable, maximally extended position at the elbow bend.

II. Execution of a procedure.

  • Mark the injection site. It is most convenient to perform an intravenous injection into the veins of the elbow bend. This is due to the good fixation of the vein in the subcutaneous base, which does not allow it to move and collapse during the injection.
  • Apply a rubber tourniquet to the shoulder above the elbow bend; put under the harness linen napkin. Tie the tourniquet in such a way that the free ends are directed upwards and do not interfere during the injection, and also so that it can be easily untied with the left hand. Clear competition of venous trunks and creation of artificial venous spasm are provided.
  • Invite the patient to vigorously clench and unbend his fist several times. Rub the flexor surface of the forearm with your hand in the direction from the hand to the elbow. Provides increased venous congestion.
  • With the tip of the index finger of the right hand, palpate the veins of the elbow bend and select a large and inactive vein. Proper nursing care is ensured.
  • Invite the patient to make a fist. A clear contouring of the vein is provided.
  • Wipe the injection site twice with sterile cotton balls soaked in 70% ethanol. Provides infection control.
  • Take a syringe filled with medicines right hand so that the 2nd finger supports the needle sleeve, 1, 3, and 4 fingers support the syringe barrel, and the 5th finger is placed on the piston.
  • With the first finger of the left hand, pull the skin down from the intended injection site. Provides precise fixation of the vein.
  • Set the syringe needle at an acute angle to the skin surface in the direction of blood flow. The cut of the needle should be up. Carefully pierce the skin and wall of the fixed vein. Proper nursing care is ensured.
  • Lower the syringe and pass the needle another 5-10 mm through the vein cavity. At correct position needle in a vein, dark venous blood will appear in the syringe. In patients with low blood pressure blood in the syringe will be after the syringe plunger is slightly pulled towards you. If the first time it was not possible to get into the vein, you need to pull the needle a little towards yourself or insert it a little deeper, but so that it remains in the subcutaneous base.
  • Before injecting the solution with the left hand, carefully remove the rubber tourniquet applied to the shoulder, invite the patient to straighten his fist. Ensures correct and rapid entry of drugs into the bloodstream.
  • Without changing the position of the syringe with the first finger of the left hand, press the plunger handle and slowly inject the drug. When administered slowly, the drug does not cause adverse reaction organism.

III. End of procedure

  • After the end of the administration of the medicinal substance, apply a sterile cotton ball moistened with a 70% solution of ethyl alcohol to the injection site. Infectious safety is ensured; fainting prevention.
  • Instruct the patient to flex the arm elbow joint and hold a cotton ball with alcohol for 3-5 minutes. Prevent the patient from standing up abruptly after the injection. Infectious safety is ensured; preventing fainting.
  • Soak used cotton balls in 5% chloramine solution in a container marked “For used cotton balls” for 1 hour. Provides infection control.
  • Soak the used syringe in a 5% chloramine solution, in a container marked “For soaking disposable syringes and needles” for 1 hour. Provides infection control.
  • Wash your hands twice with soap under running water, dry. Provides infection control.
  • Make a note of completion. Proper nursing care is ensured.

Intravenous drip infusions allow large amounts of fluid to be injected without overloading cardiovascular system. The fluid that is injected must have a composition that does not change the osmotic pressure of the blood, does not contain strong drugs, be thoroughly sterilized and heated to 40°C.

- After mixing the contents of the vial, treat its cork with alcohol or iodine, freeing the needle from the protective cap, insert it into the cork of the vial as deep as possible.

- The bottle is placed upside down, fixed on a tripod and filled in the usual way system.

- The air is forced out of the filter and the dropper, the dropper is turned so that the nylon filter is at the top and the dropper tube is at the bottom. The dropper is filled halfway with the solution that is being injected, then it is lowered and air is forced out of the lower part of the tube until the solution begins to flow from the needle in a jet. A clamp is placed on the tube in front of the needle.

- Before puncture, the skin is treated with alcohol. If there is absolute confidence in the correct puncture of the vein (blood flow through the needle), the system is connected to the needle and the solution is injected into the vein.

- Within a few minutes, they observe whether the liquid enters under the skin (swelling may appear), then the needle is fixed with a sticky patch in the direction of the vein, and the puncture area is covered with a sterile napkin. The successful completion of the procedure largely depends on the correct fixation of the limbs or head of the child. The angle between the needle and the skin is carefully filled with sterile gauze pads, which are also fixed with two long wide strips of adhesive plaster. The immobility of the limb is ensured by its immobilization in the splint.

- During the introduction of the solution, it is necessary to monitor the operation of the entire system, whether the bandage gets wet, whether an infiltrate or swelling has formed in the infusion area as a result of fluid entering past the vein, whether the fluid flow has stopped due to kinking of the system tubes or blockage of the vein.

— The nurse during the procedure must monitor appearance patient, pulse, respiratory rate, pay attention to his complaints. At the slightest deterioration in her condition, she urgently calls a doctor.

- The introduction of the solution can be jet and drip. Jet injections (not more than 50 ml of liquid) are resorted to, if necessary, to quickly replace the volume of circulating fluid (massive blood loss during surgery, shock or collapse).

- With the drip method, the solution that is injected slowly, drop by drop, enters the bloodstream; the number of drops is regulated by a dropper.

IN Lately with drip infusions, disposable droppers, butterfly needles and special catheters for intravenous infusions are used. To maintain the patency of the needle or catheter, if there is a need to temporarily stop the drip and prevent blood clotting, a so-called heparin lock is made. To do this, mix 1 ml of heparin and 9 ml of isotonic sodium chloride solution, inject 1 ml of this mixture through a cannula or needle and close the cannula of the needle with a special rubber cap.

External use of medicinal substances

In the nose, medicinal substances are administered in drops. Before the introduction of drops, the child's nose is cleared of mucus and crusts. The child is placed horizontally, the assistant holds him, the drug solution is drawn into the pipette and, then, without touching the pipette to the nose, 2-3 drops are injected into one nostril and the child's head is immediately turned to the side of this half of the nose. After 1-2 minutes, the same amount of solution is injected into the second half of the nose.

The introduction of drops into ear.

Previously, the ear canal is cleaned of sulfur, crusts, secretions. Drops are heated to body temperature. The child is placed on its side, with the left hand pulled auricle back and up, and with the right hand, from the pipette, carefully instill the medicines into the ear canal so that the drops fall on the wall of the ear canal and flow down it to the eardrum. The child should lie on this side for 10-20 minutes. If the medicine needs to be dripped into both ears, then this is not done at the same time.

In case of eye diseases, by order of the doctor, instillation of drops or rubbing ointments. Before the procedure, the nurse thoroughly washes her hands with soap and a brush, wipes them with alcohol. The pipette for instillation of drops and the spatula for laying the ointment are boiled before use.

For instillation of the eyes, a drug is drawn into the pipette. index finger slightly retract the lower eyelid, with the other hand slowly release one drop from the pipette (closer to the nose). The patient must look at opposite side. Then they instill the second eye and ask the child to close his eyes. After use, the eyedropper is rinsed warm water and placed in a special case.

Eye ointment is applied with a glass spatula. To do this, the lower eyelid is taken away and ointment is placed on the conjunctiva, the child closes his eyes and the ointment is rubbed with careful movements of the fingers over the eyelids.

Inhalations - it is a method of administering drugs through the respiratory tract. You can inhale finely dispersed substances (aerosols), gases (oxygen, carbon dioxide, and others). For their formation, special devices are used - inhalers. During inhalation, the sick child should breathe calmly and deeply.

In connection with the localization pathological process V respiratory tract most effective way applications medicines with bronchopulmonary diseases - inhalation. This eliminates the effect of "first pass" and reduce the activity of the drug in the liver. A significant advantage of inhalation therapy is high concentration drugs in the respiratory tract with a small total amount of the drug and low level concentration in the body as a whole.

Basic rules for taking inhalations.

Inhalations are carried out 1-1.5 hours after eating, physical activity.

Inhalations are taken in a calm state.

In case of diseases of the nose, nasopharynx, inhalation and exhalation must be done through the nose (nasal inhalation). In this case, it is recommended to use special nasal nozzles for nebulizers.

In case of diseases of the pharynx, larynx, trachea and bronchi, it is recommended to inhale through the mouth.

· When inhaling, it is necessary to take a slow deep breath, holding the breath at the end of the breath for 2 seconds, and then exhale through the nose.

Frequent deep breathing may cause dizziness, therefore it is recommended to take short breaks.

Patients are not allowed to take expectorants before the procedure.

The volume of liquid for inhalation, in most cases, is 2-5 ml. In some cases, saline is added to the drug. To do this, you can not use distilled water, hypo- and hypertonic solutions, as this can lead to bronchospasm.

After inhalation, rinse the oropharynx to prevent systemic action and development side effects drug, especially in the case of inhaled glucocorticosteroids.

Materials for self-control:

Control questions.

1) List the requirements for the premises of health facilities intended for the storage of medicines.

2) Which medicines need special storage requirements?

3) List the basic rules for the storage and accounting of drugs in health facilities.

4) The main advantages of the oral route of drug administration.

5) Features of the use of powders, syrups, drops in young children.

6) The main advantages of the rectal route of drug administration.

7) Technique for intradermal injections.

8) Technique for subcutaneous administration of medicinal substances.

9) Features of the use of intramuscular injections in pediatric practice

10) Features of the use of intravenous injections in pediatric practice

11) What are the features of the external administration of drugs: instillation of drops into

ear, nose, conjunctival sac?

12) Basic rules for inhalation in children.

Tests for self-control

1. The main disadvantages of oral administration of drugs include, except:

A. Incomplete absorption of drugs in the alimentary canal

B. Partial destruction of drugs by digestive enzymes

C. Inability to accurately determine the concentration medicinal product in blood.

D. The need for strict adherence to the rules of asepsis and antisepsis

2. Before dispensing medicines, the nurse must be aware of the medicine:

A. The frequency of taking drugs per day

B. Relationship with food

C. The dose of the drug

D. All of the above.

3. What is the amount of liquid medicine in a dessert spoon?

A. 5 ml B. 10 ml C. 15 ml E 20 ml

  1. When administering drugs through the rectum, it is necessary:

A. Put the child on the right side, with half-bent legs, fix in this position, push the candle behind the sphincter with one finger.

B. Make a cleansing enema, put the child on his left side, with half-bent legs, fix in this position, push the candle behind the sphincter with one finger.

C. Make a cleansing enema, put the child on the right side, with half-bent legs, fix in this position, push the candle behind the sphincter with one finger.

  1. The parenteral route of drug administration includes except

A. Intradermal B. Subcutaneous C. Into the external auditory meatus

D. Intramuscular E. Into the spinal canal with a syringe

  1. 6. Subcutaneous administration of drugs is usually carried out, except

A. To the outer surface of the shoulder B. To the outer surface of the thigh

C. In the subscapular region D. In the upper outer quadrant of the gluteal region

E In the anterior wall of the abdomen

7. Medicines should be stored:

A. Depending on the pharmacological group

B. Depending on the method of their introduction

C. Taking into account the physico-chemical properties

D. All of the above

8. Narcotic drugs in the department must be stored:

A. In the office of the head nurse

B. In a closet, in a specially equipped room

C. In a specially equipped room, in a closed safe

D. In a specially equipped room, in a closed fireproof safe.

9. What types of quality control of medicines exist:

A. Input

V. State.

C. Monthly visual inspection of containers

D. All of the above

  1. The main advantages of the intravenous route of administration of drugs include, except:

B. Possibility of administering agents that are not absorbed from the gastrointestinal tract

C. The possibility of introducing such agents that irritate the mucous membrane of the gastrointestinal tract.

D. Accurate dosing.

E. Immediate action.

  1. What is the minimum length of the needle above the sleeve should be left for intramuscular injection of drugs?

A. 0 cm B. 0.5 cm C. 1 cm D. 1.5 cm E. 2 cm

  1. The basic rules for inhalation in a child include:

A. Inhalations are carried out 1-1.5 hours after eating

B. Inhalations are carried out after physical activity.

C. Inhalations are taken in a calm state.

E. Clothing should not compress the neck, as this all complicates breathing.

F. All of the above are correct.

STANDARDS OF ANSWERS TO TESTS

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    O. A. MELNIKOVA, Assoc. Department of Management and Economics of Pharmacy

    SBEE HPE "Ural State Medical Academy"

    Ministry of Health of Russia, Yekaterinburg

    The storage of medical and pharmaceutical products is an important merchandising operation that ensures the preservation of their consumer properties with a minimum change in the initial parameters, and is regulated by regulatory legal acts.

    The main regulatory documents in this area are as follows:

    · Federal Law of 01.01.2001 N61-FZ "On the Circulation of Medicines";

    · Decree of the Government of the Russian Federation of 01.01.2001 N 1148 “On the procedure for storing narcotic drugs, psychotropic substances and their precursors”;

    · order of the Ministry of Health and Social Development of Russia dated 01.01.2001 N1198n "On approval of the rules in the field of circulation of medical devices":

    · order of the Ministry of Health of Russia dated 01.01.2001 N 377 "On approval of the Instructions for the organization of storage in pharmacies of various groups of medicines and medical products" (hereinafter - order N 377);

    · order of the Ministry of Health and Social Development of Russia dated 01.01.2001 N706n "On approval of the Rules for the storage of medicines" (hereinafter - order N 706n);

    · Sanitary and epidemiological rules SP 3.3.2.1248-03 "Conditions for the transportation and storage of medical immunobiological preparations", approved. Decree of the Chief State Sanitary Doctor of the Russian Federation of 01.01.2001 N22 (as amended by Amendments and Additions N1, approved by Decree of the Chief State Sanitary Doctor of the Russian Federation of 01.01.2001 N9);

    · Sanitary and epidemiological rules SP 3.3.2.1120-02 "Sanitary and epidemiological requirements for the conditions of transportation, storage and distribution to citizens of medical immunobiological preparations used for immunoprophylaxis, pharmacies and health care institutions, approved. Decree of the Chief State Sanitary Doctor of the Russian Federation dated 01.01.2001 N15

    * For previous articles in the series, see: Chief Nurse. 2013. N 3. p. 59-66; N 4.

    pp. 55-64; Ng 5, pp. 42-51.

    ** Not registered with the Ministry of Justice of Russia, in connection with which the text of the order is advisory in nature.

    Basic principles for the storage of medicines* and medical devices

    When distributed according to storage locations, medicines can be divided into several categories:

    1. Medicines for which certain control measures are established in accordance with the legislation of the Russian Federation: narcotic drugs, psychotropic substances, their precursors, drugs subject to quantitative accounting (strong and toxic substances under international control in accordance with international legal norms).

    2. Medicinal products of the general list, in respect of which the government agencies No specific control measures have been established.

    3. Immunobiopogic preparations.

    4. Disinfectants.

    When placed in storage, preparations are allowed to be distributed taking into account the pharmacological properties (vitamins, antibiotics, cardiovascular agents, etc.), method of application (for external, internal use), form of release (tablets, ointments, injections, etc.), state of aggregation - in the case of pharmaceutical substances (solid, liquid, gaseous), factors environment that affect the physico-chemical properties (requiring protection from light, moisture, volatilization and drying, increased or low temperature, environmental gases, as well as odorous and coloring, etc.).

    Medicinal products for which certain control measures are established, in accordance with the legislation Russian Federation stored in accordance with the requirements (Decree of the Government of the Russian Federation of 01.01.2001 NQ 1148 "On the procedure for storing narcotic drugs, psychotropic substances and their precursors").

    Storage of medical devices is carried out depending on their belonging to one of the following groups:

    1. Rubber products.

    2. Plastic products.

    3. Dressings.

    4. Medical instruments.

    6. Auxiliary materials.

    · See also: features of the circulation of drugs in lpu: answers to some questions1/ Chief Nurse. 2013. NQ 4, pp. 34-40; YaroshentoMA. Yaroshenko NL.Features of storage of medicines in medical

    Authority I/Chief Nurse. 2012. NQ 5, pp. 48-53; No. 6. S. 32-36.

    General requirements for premises FOR the storage of medical and pharmaceutical products

    The device, composition, size of storage areas for medical and pharmaceutical products must ensure their safety. The room provides for heating (air temperature + 18 °C, unless otherwise provided by the storage conditions for specific drugs), ventilation, natural air exchange.

    COMPLIANCE WITH AIR TEMPERATURE AND HUMIDITY PARAMETERS

    Storage rooms must be maintained at a certain temperature and humidity, in accordance with the requirements of manufacturers indicated on the primary and secondary packaging. Premises for the storage of medicines should be equipped with air conditioners, racks, cabinets, pallets, storage boxes. decoration of premises for the storage of medicines ( internal surfaces walls, ceilings) must be smooth and allow for wet cleaning.

    The parameters of the air in the room are recorded by devices (thermometers, hygrometers (electronic hygrometers) or psychrometers. The measuring parts of these devices must be placed at a distance of at least 3 m from doors, windows and heating devices, in an accessible medical staff place at a height of 1.5-1.7 m from the floor.

    Currently, hygrometers VIT-1 and VIT-2 are often used in healthcare facilities. They have different specifications:

    Specifications of the hygrometer

    8IT-1

    8IT-2

    Relative humidity measurement range (%)

    20-90

    Humidity Measurement Temperature Range (OC)

    5-25

    15-40

    Temperature measuring range (OC)

    0-25

    15-40

    Scale division value (OS)

    0,20

    Limit of permissible absolute error of the thermometer (OS)

    ±0.2

    thermometric liquid

    Toluene, methyl carbitol

    Thus, it is seen that fundamental difference of these hygrometers lies in the measured temperature range temperature and humidity. The use of the VIT-2 hygrometer is advisable indoors, if the temperature at the installation site of the device during the entire period of relative humidity measurements does not fall below 15-20 °C (for example, in winter) and does not exceed 35-40 °C (in summer). Otherwise, it is advisable to use a VIT-1 hygrometer.

    The determination of humidity according to these devices occurs on the basis of a psychometric table, a fragment of which is presented below:

    Dry

    thermometer

    Difference between dry and wet thermometer readings

    TO

    Gr. WITH

    ABOUT

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    11

    288

    +15

    289

    +16

    290

    +17

    291

    +18

    73

    The method of measuring relative humidity with a psychometric hygrometer is based on measuring the difference between the readings of "dry" and "wet" thermometers.

    Example

    Let's say the readings of a "dry" thermometer + 18gr. C, "humidified" - + 15g. C, the difference between temperatures, respectively, is 3g. C = 3). We determine the relative humidity, for which we find in the table above the line with the indication of the dry thermometer, + 18g. C "And look for its intersection with a column in which the difference between the readings of dry and wet thermometers is 3. Thus, the relative humidity of the air at the given parameters is 73%.

    The readings of these devices must be recorded daily in a special log (card) of registration on paper or in in electronic format with archiving (for electronic hygrometers), which is maintained by a responsible person.

    The log (card) of registration is stored for one year, not counting the current one. Control devices must be certified, calibrated and verified in the prescribed manner.

    If the requirements for the storage of medicines specified by the manufacturers are not observed in the nurse's room, then the room must be equipped with air conditioners to maintain necessary conditions. A properly selected air conditioner can maintain the temperature inside the room at + 20 -22 degrees. C at an outdoor temperature of +30 -35gr. C. Naturally, for the storage of thermolabile drugs that require cool storage conditions, the use of an air conditioner is not sufficient, refrigerators are needed.

    EQUIPMENT OF PREMISES WITH EQUIPMENT FOR STORAGE OF MEDICINES

    The head nurse's office should be adequately equipped with shelving, cabinets, pallets, storage boxes for storing medicines and medical products. Medical furniture should be arranged in such a way that it is freely accessible.

    Racks, cabinets, shelves intended for storage of medicines must be identified.

    Example

    Storage areas for medicines should have appropriate

    records: “Drugs for the treatment of diseases associated with impaired acidity”, “Antithrombotic agents”, “Drugs for the treatment of heart diseases”, “Antifungal drugs for the treatment of skin diseases”, etc. For identification, you can use pharmacological, nosological, anatomical and therapeutic, chemical classification.

    To store thermolabile medicines in the nurse's office, two types of refrigerators are provided: for storing medicines at cold temperature(from +2 to +8 OS) and for storing medicines at a cool temperature (from +12 to +15 OS). Temperature changes are recorded in a special journal attached to the refrigerator. We present a fragment of such a log:

    Date, month

    (Temperature readings with)

    January

    December

    Storage of immunobiological preparations is carried out in separate refrigerators equipped with thermometers at a temperature ranging from +2 to +8 °C, medical immunobiological preparations are stored in industrial packaging and arranged in such a way that each package has access to cooled air, and preparations of the same name are stored by series, taking into account expiration dates.

    Temperature control in the refrigerator, which stores immunobiological preparations, is carried out twice a day; readings are recorded in the register temperature regime in the following form:

    Date, time of day, t

    January

    February

    September

    October

    November

    December

    Note. U - morning; In - evening.

    For the storage of flammable and explosive substances in the office of the head nurse, there must be a metal fireproof, lockable cabinet in which it is allowed to store this group of medicines weighing no more than 10 kg.

    Strong and poisonous medicines that are not under international control and for which certain control measures are not provided by the legislation should be placed in a separate safe (lockable metal box).

    Strong and poisonous medicines under international control and for which certain control measures are provided by the legislation are stored according to the same rules as narcotic drugs and psychotropic substances*.

    ___________________________________________________________________________

    With On August 7, 2013, Decree of the Government of the Russian Federation dated 01.01.2001 NQ 78 "On Amendments to Certain Acts of the Government of the Russian Federation" comes into force, which amends the list of psychotropic substances (list 111), supplementing it with new positions from the nomenclature of potent and toxic substances.

    Sanitary and hygienic requirements for storage rooms

    The finish of the senior nurse's office (internal surfaces of walls, ceilings) should be smooth and allow for wet cleaning. Finishing materials must be certified.

    Stored medicines can be identified using a rack card:

    Medicines

    Unit

    measurements

    Qty

    units

    measurements

    Price

    receipts

    series

    Data

    about quality

    (declaration no.

    about compliance or

    certificate)

    date

    expiration

    term

    validity

    Name

    manufacturer

    CODE

    OKP

    Thus, the rack card carries the following information about the stored medicinal product: name, manufacturer, release form, dosage, quantity, batch number, expiration date, data on documents confirming the quality of the goods, the expiration date of the drug. It is advisable to fill out the rack card electronically.

    DRUG STORAGE

    Among the factors external environment and conditions that affect the quality of medical and pharmaceutical products, we can distinguish temperature, humidity, sunlight. In this regard, drugs and medical products, depending on their physicochemical properties and the influence of environmental factors, can be divided into several groups:

    1. Decaying in the world. These medicinal products are stored packed in primary and secondary (consumer) packaging, in cabinets or on racks, provided that measures are taken to prevent direct sunlight or other bright directional light from reaching these medicinal products.

    light (use of reflective film, blinds, visors, etc.). Pharmaceutical substances of this group are stored in containers made of light-protective materials that do not allow penetration sun rays.

    2. Changed by moisture. Medicines are stored in primary and secondary packaging. Pharmaceutical substances from this group - in a cool place in a tightly closed container, i.e. from materials impervious to water vapor.

    H. Requiring protection from volatilization and drying out. Finished medicinal products are stored in the primary and secondary (consumer) packaging of the manufacturer. Pharmaceutical substances - in hermetically sealed glass, metal and thick-walled plastic containers; if indicated on the manufacturer's packaging - in a cool place.

    4. Thermolabile drugs are divided into two groups: those requiring protection from exposure to elevated temperatures and those requiring protection from exposure to low temperatures. In both cases, it is necessary to comply with the temperature regime specified by the manufacturer.

    5. Changing under the influence of carbon dioxide contained in the air. Medicines are protected from carbon dioxide in the air by packaging. Special attention should be given to the storage of pharmaceutical substances in hermetically sealed containers made of materials impervious to gases, if possible filled to the top.

    6. Odorous and coloring. Odorous drugs (pharmaceutical substances, both volatile and practically non-volatile, but possessing strong smell) should be stored in a hermetically sealed, odor-tight container. Coloring should be stored in a special cabinet in a tightly closed container in order to avoid indelible stained traces.

    7. Flammable and explosive substances are stored separately from other drugs (most often in a metal cabinet) in a tightly sealed glass or metal container to prevent evaporation of the liquid. Storage takes place in one row in height, away from flammable substances. Shaking is not allowed. Shocks, friction, storage near heating appliances. The distance to the heating element must be at least 1 m.

    8. Disinfectants stored in a hermetically sealed container, in an insulated cabinet with opaque doors, away from plastic, rubber and metal products.

    9. Medical immunobiological preparations, which in general case can be classified as thermolabile.

    STORAGE OF MEDICAL DEVICES

    The storage of medical devices is determined by the physical and chemical properties of the materials from which they are made.

    Store rubber products in a place protected from light room temperature from heating appliances, avoiding direct sunlight, fluid

    air, mechanical damage(bending, twisting, etc.). Due to the fact that rubber is subject to various types of aging, it is necessary to maintain a certain humidity (at least 65%). Rubber products must not be laid in multiple layers to avoid processes such as "caking and gluing". Because of these processes, hollow rubber products(warmers, ice packs) should be stored in a slightly inflated state, and long rubber products should be placed along their entire length in a storage box. The completeness of preservation of consumer properties of rubber is influenced by the following types aging:

    Thermal and light aging. As a result of this aging, isoprene is released, the color of the product changes, and it becomes sticky. In order to prevent these processes, it is necessary to avoid direct sunlight on such objects, lay out rubber products in cabinets and drawers.

    Oxygen aging. As a result of this aging, cracks appear on the surface of the rubber. To avoid the development of this process, rubber should not be stored in drafts.

    Aging under the action of metals of variable valence. In connection with this type of aging, joint storage of rubber and medical instruments is not allowed. In addition, sulfur released from the rubber can cause darkening of the tools.

    Aging due to mechanical stress of the material. It occurs during repeated deformations (squeezing, bending, twisting, stretching) of rubber products during operation. In order to avoid these processes, it is impossible to place the product in several layers, since it is compressed and compressed in the lower layers.

    In connection with the foregoing, hemostatic rubber tourniquets, gastric and duodenal probes, Esmarch's irrigatory mug are stored suspended on removable hangers located under the cabinet lid, or in a cabinet drawer in a straightened state.

    Plastic products stored at room temperature, at a distance of more than 1 m from heating systems with an air humidity of not more than 65%. At higher humidity and temperature, the plastic darkens. Violation of the primary and secondary consumer packaging, which provides the products with the necessary sterility, is not allowed.

    dressings store in a dry, ventilated area at room temperature. Due to the flammability of these products, they should not be stored near heating devices, and due to the good absorbency of dressings, they should not be stored in rooms with high humidity. Sterile dressings are stored in their original packaging, preventing damage. Non-sterile dressings are stored in thick paper.

    Medical instruments stored in dry, heated rooms at room temperature. Low temperature and high air humidity (more than 60%) are not allowed, since these factors cause corrosion of the tool metal. To prevent corrosion, tools are recommended to be lubricated with an anti-corrosion

    lubricated, packed in thin parchment paper and sealed in a special polyethylene cell. Cutting tools are stored in special boxes or pencil case nests, which make it possible to maintain the sharpness of the cutting edge of the tool. It is not allowed to store medical instruments together with rubber products, since the sulfur used in the vulcanization of rubber products causes darkening of the metal and initiates corrosion processes.

    Medical equipment products stored at room temperature in dry, heated rooms, in accordance with the requirements specified by the manufacturer on the package. Particular attention should be paid to cutting new and plastic parts of medical equipment.

    Auxiliary materials (usually this is different kinds packaging material) are stored in well-ventilated rooms in separate cafes in sanitary and hygienic conditions.

    Practical tasks

    Let us analyze the features of storage in LPv of the listed groups of medicines, as well as medical devices, solving practical problems.

    Task number 1.At the department on demand-invoice received the following drugs Magnesium sulfate solution for intravenous administration 25% 10.0 ml; "Analgin" - a solution for intravenous and intramuscular injection 50% 2.0 ml - 20 packs; indomethacin ointment for external use 10% 40.0 ml - 5 packs. How should these drugs be placed in their storage places in the LPV?

    Correct answer. In order to distribute medicines to places of storage, it is necessary to divide them according to the forms of release. IN this case the department received two forms of release: injection (magnesium sulfate and "Analgin") and soft (indomethacin ointment).

    Injection forms should be placed on a shelf in a cabinet designed for storing solutions for injection, distributing them according to their pharmacological properties: magnesium sulfate - to vasodilators, antihypertensive drugs, and "Analgin" - to non-narcotic analgesics. cool temperature (from + 12 to + 15gr. C).

    Thus, the requirements of clause 8 of order N706n will be observed, which regulates placement in accordance with the requirements of the regulatory documentation indicated on the packaging of the medicinal product, taking into account the physicochemical properties of drugs, pharmacological groups, method of application (internal, external), aggregate states of pharmaceutical substances (liquid, bulk, gaseous).

    Task number 2.The department received the following drugs: Furosemide solution for injection 1% 2.0 ml - 3 packs; Mannitol solution for infusion 15% 400.0 ml - 5 vials. Place drugs in storage areas.

    Correct answer. The department received finished dosage forms. Both drugs are used as diuretics and belong to the same pharmacological group. However, their joint placement will be erroneous, since they differ in the way they are used. Mannitol has a larger volume and is used as a solution for infusions, furosemide (ampoules) - for injections. In this regard, it is advisable to place them separately on different shelves in the closet (requirements of clause 8 of order N 706n).

    Task number 3.Looking to the head nurse, the head nurse saw in one drawer of the cabinet Amiodarone tablets of 0.2 ml N 30; Diazepam tablets 2 mg N 20. Can these drugs be stored in this way?

    Correct answer. In this case, clause 9 of order N 706n was violated, which regulates the storage separately, in technically fortified premises that meet the requirements of the law, of narcotic drugs, psychotropic substances, potent and poisonous drugs that are under control in accordance with international legal norms. Diazepam derivatives belong to this group of drugs.

    Task number 4.When checking the procedure for the circulation of drugs in the infectious diseases department of the hospital, the head nurse found in the drawer of the cabinet of the guard nurse the vials with ampicillin in the form for preparing a solution for intramuscular injection, located as far as the look goes by expiration dates: 12/01/2014, 07/01/2014 , 09/01/2013, 02/01/2013. Are medications placed correctly?

    Correct answer. In the drawer of the nurse's cabinet there are medicines of one group (antibiotics), one active substance, With the same forms release, which is absolutely true. It is also correct to place them in a cabinet drawer, since these medicines decompose in the light and therefore need to be protected from light. Incorrect is the order of the arrangement of drugs in accordance with the expiration dates. Medicines with a close expiration date should be placed in a drawer of the cabinet as accessible as possible in order to ensure their issuance to departments in a timely manner. Medicines with a long shelf life with its control according to the rack card are placed at subsequent levels (clause 11 of order N 706n).

    In this problem, there is a drug ampicillin with an expiration date of 02/01/2013, i.e., at the moment, the expiration date is this drug expired. Expired medicinal products must be stored separately from other groups of medicinal products in a specially designated and designated (quarantine) area (clause 12 of Order N 706n) until destroyed by an enterprise licensed for this type of activity.

    Task number 5.The department received an antiseptic from the group of antioxidants - hydrogen peroxide, a solution for local and external use. Specify the conditions for storage of this medicinal product.

    Correct answer . Hydrogen peroxide is a drug that requires protection from light because light catalyzes the breakdown of peroxide molecules.

    With an increase in storage temperature, the rate of decomposition of the drug increases, which leads to leakage adverse reactions and the formation of degradation products that easily volatilize. As a result, hydrogen peroxide solutions should be stored in a hermetically sealed container in a cool, dark place (clauses 24, 30, 32 of order No. 000n).

    Task number 6.You've been approached by a neurology nurse on duty for advice on storage issues. Recently, the medicinal product "Valerian rhizomes with roots" was received by her in the department for the treatment of patients. dosage form"raw vegetable - powder", completeness of the powder is 1.5 g in filter bags. What would you advise this nurse?

    Correct answer. Valerian rhizomes with roots are a type of pharmaceutical substances (packaged in filter bags) that require protection from moisture due to their hygroscopicity and the possibility of dampening processes. The drug must be stored in a dry, dark place (clauses 27, 28 of order N706n), in the primary and secondary (consumer) packaging of the manufacturer. Opened packages must be placed in glass container or insulating container.

    Task number 7.Let's say you work as a chief nurse in a polyclinic that serves a very large and difficult city area. For the implementation of vaccination activities in vaccination room organized storage of vaccines. What advice would you give to the nurse in the vaccination room?

    Correct answer. Storage of immunobiological preparations is carried out in refrigerators equipped with thermometers at a temperature of 5 ± 3g. C (within +2 to +8 degrees C), medical immunobiological preparations are stored in industrial packaging and arranged in such a way that each package is provided with access to cooled air, and preparations of the same name are stored in batches, taking into account expiration dates . In the case of a small amount of receipts, it is possible to store vaccines in the same refrigerator on different marked shelves. The vaccine diluent is also stored in refrigerators. In the freezer of the refrigerator, it is necessary to provide a supply of cold elements.

    It is strictly forbidden to store medical immunobiological preparations on the door panel of the refrigerator for safety reasons, as well as due to the fact that the temperature regime on the door does not match the temperature in the refrigerator volume.

    Control over the temperature regime of storage of medical immunobiological preparations is carried out 2 times a day. The thermometer readings are recorded in the temperature register of the refrigerator. Visual control of immunobiological preparations should be carried out at least once a month (SP 3.3.2.1120-02).

    Task number 8.In winter, the department received insulin - a suspension for subcutaneous administration. Upon delivery from the pharmacy, it was found that the drug was frozen. Is it possible to take this drug to the department?

    Correct answer. Insulin is a drug that requires protection from exposure to low temperatures. Freezing of insulin preparations is not allowed (clauses 33, 34 of order No. 000n).

    Task number 9.The hospital has a new rehabilitation department. To provide medical care the department has a supply of non-sterile bandages 7 x 14 cm (150 pcs.), hemostatic tourniquets (5 pcs.) and catheters for peripheral veins (200 pcs.). These medical devices were in one drawer of the cabinet. Analyze the situation, is the storage carried out correctly?

    Correct answer. The storage of these medical devices is carried out, in accordance with clause 3.5 of Order N 377, separately by groups: rubber products, plastic products, dressings. In this case, it is necessary to restructure the storage facilities by groups: tourniquet - rubber products; bandages - dressings; catheters - plastic products.

    Task number 10.In the summer, Lidocaine 10% aerosol, 38 g in 50 ml vials, was admitted to the department of the medical institution. The air temperature in the compartment due to climatic conditions rose to 2g. C. Is it possible to store this drug under these conditions?

    Correct answer . This drug, due to its aerosol packaging, belongs to the group of flammable and explosive drugs that require protection from elevated temperatures. In this regard, storage at the temperature specified in the task is not allowed. The temperature in the room must be lowered, for example, by air conditioning or the preparations should be put in the refrigerator.

    Task number 11.For sanitary treatment of surfaces, the department received next remedy- chloramine 1 kg. Where should this tool be placed and what rules should be followed?

    Correct answer. This remedy belongs to the group of disinfectants and requires storage in a hermetically sealed container in a separate cabinet away from the storage of plastic, rubber and metal products (clause 39 of order N 706n).

    Task number 12.The head nurse kept a lined oilcloth in a roll, it lay horizontally in two rows. When checking, a remark was made on compliance with storage conditions. Was it done right?

    Correct answer. According to clause 8.1.7 of order N 377, rubberized fabric (one-sided and two-sided) is stored horizontally in rolls suspended on special racks. Rubberized fabric may be stored stacked in no more than 5 rows.

    In our case, oilcloth was stored in two rows, which does not exceed the regulated limit of 5 rows. Thus, the remark by the inspectors was made incorrectly.

    Task number 13.The department received non-sterile compressive cotton wool in bags. Head nurse I decided that cotton wool should be stored in cabinets. Is there another way to store cotton wool?

    Correct answer. Cotton wool belongs to the group of dressings, the storage of which depends on the types (ophthalmic, surgical, hygienic) and types of containers (rolls, packs, bales), sterility and non-sterility. Sterile dressing material is stored in its original packaging. Do not store in the original opened packaging. Non-sterile dressings (and in this case, cotton wool belongs to this type of dressings) are stored packed in thick paper or in bales (bags) on racks or pallets (clause 10.3 of order N 377). Thus, non-sterile compressive cotton wool does not need to be placed in cabinet drawers.

    Task number 14.When checking the intensive care unit, the head nurse found a batch of rubber hemostatic tourniquets in a bent state, lying on the windowsill of the staff room, there were medical instruments on top of the tourniquets, and a stream of warm air was flowing into the room from the open window. Were these rubber products stored correctly?

    Correct answer. Harnesses are rubber products, and they are known to have the property of aging. In this case, during such storage, thermal and light aging, oxygen aging, aging under the action of metals of variable valence, and aging under the action of mechanical stresses are observed.

    Task number 15.The loader, by order of the head nurse, carried cylinders with perhydrol weighing 10 kg. To do this, he took the upper part of the balloon and, swinging it, transferred it to the room indicated by the nurse. Did the shipper do the right thing?

    Correct answer. Perhydrol refers to explosive and flammable means, in connection with this, movement in this way is unacceptable. The movement of cargo must be carried out with a forklift, on a trolley or in a container.