Storage of poisonous potent substances. Used for quantitative determination. Methods of obtaining tinctures
Introduction ................................................................................. ... 3
1. Indebate funds ............................................................ 4
2. Poisonous and potent drugs .................. .5
3. Rules for the storage and accounting of poisonous and potent
medicines………………………………………………………8
Conclusion .............................................................................. .11
Literature ...............................................................................1.1/12
Introduction
Drugs, substances used for the treatment, diagnosis and prevention of diseases. The list of drugs permitted and the production of drugs is set forth in the State Register
Currently known St. 5 thousand drugs manufactured in the form of more than 50 thousand one-component and combined dosage forms under non-specific (international) and patent (trade) names. Most often, they are divided into pharmacotherapeutic groups on the advantage of their influence on the functions of individual organism systems. Within each pharmacotherapeutic group, drugs are classified according to the main pharmacological effect (for example, drugs for anesthesia, anti-inflammatory, laxatives, etc.) or by pharmacotherapeutic principle (for example, anti-arhydramic, antidepressants, etc.).
All drugs, with the study of this toxic effect on the human body, with their improper use are divided into three groups. The list of these drugs is presented in the State Pharmacopoeia.
Drugs, appointments, use, dosing and storage of custom, due to high toxicity, are assigned to A (Venena - Yada), dosing, due to high toxicity, should be carried out with extreme caution. This list includes drug addiction.
To the list B (Heroica - potent) attributed drugs, appointment, use, dosing and storage of customs should be carried out by precautions due to possible complications when applied without medical control. Third Group - Medicinal preparations released from pharmacies without recipes.
1. Indebate funds
Independent agents, these are neutral, no extensive existing means in their composition, are prescribed mainly in the progressive stage of the disease.
In case of intravascular administration, the drug substance completely falls into the bloodstream. With oral, intramuscular, subcutaneous administration, it must pass through a number of biological membranes of cells (stomach mucosa, liver, muscles, etc.) and only part of it enters systemic blood flow. The effect of the drug depends largely on how large this part is. This indicator characterizes the bioavailability of the drug. When intravenous administration, bioavailability is 100%. With other ways of administration (even with intramuscular and subcutaneous), bioavailability almost never reaches 100%. On the bioavailability of the drug influence the path of administration of the drug, individual characteristics patient's body gastrointestinal tract, of cardio-vascular system, liver, kidneys, as well as biopharmaceutical factors (dosage form, its composition, features of the drug production technology). The latter are especially important in the use of drugs inside (enteral) in the form of tablets, capsules. As a rule, auxiliary substances that are part of the drug are indifferent and do not have any pharmacological effect, but sometimes they affect the bioavailability of the drug. To press the tablets and filling the capsules, substances can be used to adversely affect the rate of dissolution of the current connection. Dissolution medicinal substances A low dispersing capacity of the filler particles can prevent, and their disaggregations contribute to surfactant or other substances affecting the electrostatic properties of particles.
2. Poisonous and potent drugs
Among the extensive amount of medicines used in modern medicine, there is a group of drugs, whose physiological effect on the body appears already at small and very small one-time doses. Such drugs are called poisonous and potent.
Distinction between poisonous and potent means Mostly only quantitative: the first are usually applied in doses of the order of thousandth and ten-thousand fractions of a grams, and potent - in the hundredths and tenths of grams.
A number of specialists consider poisonous and potential drugs with potentially hazardous compounds that have a psychoactive effect on the human body, which, in abuse, cause symptoms of addiction and ultimately irreversible processes in the human body, up to death,
In classifying the substances to the category - potent and poisonous means, the degree of public danger and harm to health in abuse of them are also taken into account. data received from experts of medical, judicial and law enforcement agencies about the facts of their non-medical use; Toxicological and pharmacological assessment of the action of a particular potent substance.
What drugs are poisonous and which should be considered as potent - indicated in the pharmacopea. All poisonous drugs are assembled in special descriptions, called the list A, potently in the list B, placed in the "introductory part" of the pharmacopoeia. The accessories of the drug to one or another list says, in addition, in pharmacopoeia articles in the heading "Storage".
The potent substances include not only substances listed in these lists, but also dosage medicinal forms provided that the drug does not include other pharmacologically active substancesdefining the specific activity of the drug. If a specific composition combined tools Contains in addition to the main controlled substance and other pharmacologically active substances and are not listed in the lists, the question is solved by the expert. This position also extends to dosage forms in the form of candles (suppositories) and for prolonged forms (Long, Retard). Accordingly, if these dosage forms are not specified in the list to a specific substance, they also do not fall under the control of these lists.
After the expert opinion of the PCN that this particular composition of the drug or the corresponding dosage form (candles, retard, Long) is recognized as potent, from that time it is potent, and with the next edition of the revised lists, respectively, includes the recipe composition of the specific combined drug.
To solve the question of attributing a specific substance to the category of controlled substances, it is necessary that the proposal for this contains chemical characteristic Substances, and if this substance is vegetable, then its botanical characteristic.
To address the question of attributing a particular substance to a drug or psychotropic substance, it is necessary to have answers to the following questions:
1. Does this substance possesses the ability:
- cause a condition of dependence;
- to provide a stimulating or depressive impact on the central nervous system, causing hallucinations or impairment of motor function, or thinking, or behavior, or perception, or mood;
- lead to abuse and harmful consequencessimilar to any substance included in the lists I, II, III or IV of the Unified Convention on narcotic drugs 1961
2. There are sufficient evidence that there is an abuse of this substance or there is a likelihood of such abuse, which represents or may present a problem for public health and social problemwhich give the basis for applying to this substance of control measures.
With changes in the nomenclature of drugs, the content of the lists A and B. in the GFH is also changed to the list A, inclusive 116 names of poisonous drugs. Of the 116 items 26 are placed in the list with a sign of P. This sign marked narcotic and other substances to be vacated from pharmacies according to special instructions Ministry of Health. List B includes 326 items. Poisonous and potent drugs compared to the rest require particularly cautious circulation.
In order to prevent accidents, as well as abuses by the Ministry of Health of Russia, special "Rules for storing, accounting and vacation of poisonous, narcotic and potent drugs" have been established. The rules are provided, first of all, the inlet of poisonous and potent drugs from all others.
3. Rules for the storage and accounting of poisonous and potent drugs
Accounting for medicines leads the elder medical sister, which has a notebook with the seal signed by the Chief Doctor. Senior Sestrian registers the number of drugs released, marks the sickness of the patient, the number of the illness of the disease. The keys to the cabinet "A" and "B" are only in persons responsible for the storage of poisonous and potent drugs. For the night, the keys are transferred to the duty officer or duty medical sisterwhat makes the appropriate entry in a special journal; Pointing the reserves of medicinal veins, the person who accepted the key is painted in this magazine.
Drugs containing poisonous and narcotic substances in branches and cabinets are subject to objective and quantitative accounting in a special book, numbered, involved and fastened signature of the chief physician (in form). Books for the accounting of narcotic and ambulatory drugs should always be in perfect order and to be presented at the request of verification.
The drugs obtained from the pharmacy, comply with poisonous and potent drugs, should have an accurate and clear designation on the label: "internal", "outdoor", "for injections", "eye drops", etc., as well as The department (Cabinet), the pharmacy number, which made the medicine, the composition of the medicine corresponding to the register specified in the requirement, the date of manufacture and signature of the person who made the medicine that checked and released it. On the labels of drugs containing poisonous drugs, should be supplied with a stamp with black ink "A", on the labels of drugs containing potent lecturers, - a rubber stamp "B".
Poisonous drugs are stored in a separate metal or wooden closet under the lock, narcotic - in safes or iron cabinets. On the inside of the door of the cabinet should be the inscription "A" and a list of poisonous medicinal substances with an indication of higher one-time and daily doses.
Powerful drugs are stored in a separate cabinet under the lock. The reserves of poisonous and narcotic drugs in departments and kabinets should not exceed the 5-day need for them, and highly operating - 10-day needs. Responsible for the storage and issuance of patients with poisonous, narcotic and potent lespaces are the head of the department (Cabinet) and the Elder Medical Cine Sister. Medicines containing poisonous and narcotic substances should be issued in patients separately from other medicines.
In addition to the main - therapeutic effect, drugs can cause adverse negative reactions. Medical worker Must know what combinations of medicinal substances are not allowed to use. The negative reactions of the organism on some drugs are often easily eliminated with a decrease in the dose or after the first days of treatment. These reactions should be distinguished from intolerance, which is an expression of non-perception of the body of a drug substance and can lead to heavy complications. Medical worker should know the dosage of medicinal substances.
Dose of medicinal substances are prescribed depending on body weight and age (child, adult).
Distinguish a one-time dose - on one reception,
the highest one-time dose - the limit for one reception,
daily dose - the limit of medicinal substance during the day,
toxic dose - the limit, the excess of which leads to poisoning; and deadly.
The highest therapeutic doses (one-time and daily) for poisonous and potent drugs are given in the State Pharmacopoeia in articles on individuals, as well as in two consolidated tables in which the highest therapeutic doses for adults and children are represented separately. For children, they are given in accordance with age (for children up to 6 months., From 6 months. Up to 1 year, in 2 years, in 3-4 years, 5-6 years, 7-9 and 10-14 years). Range of therapeutic doses, i.e. The interval between the threshold and highest therapeutic doses is denoted by the term "therapeutic latitude". Since in practice, threshold doses are rarely used, then the therapeutic latitude of drugs are usually judged by the interval between the average and highest therapeutic doses. The greater the therapeutic breadth of the drug, the safer its use (less the risk of overdose).
Doses are usually indicated in grams or grams. With a small therapeutic latitude of drugs, they are sometimes dosed per 1 kg of body weight (for example, 1 mg / kg) or per unit of body surface (for example, 1 mg / m2). Doses of medicinal substances exceeding the highest therapeutic are denoted as toxic. In these doses, drugs can cause toxic effects dangerous to the body. In addition, deadly doses are isolated.
Conclusion
Drugs are called substances used in certain doses in order to treat some disease or to its prevention. The source of drug production is medicinal raw materials. The most common and long-known drug raw materials include many plants both wild and cultivated specialized farms. The second source of medicinal raw materials - organs and fabrics of pressing animals, the products of the vital activity of fungi and bacteria, from whether the hormones, enzymes, antibiotics and dpuugi biologically active substances. Third source - non-natural natural and synthetic derivatives. After appropriate treatment of medicinal raw materials, actively active substance. The medicinal substance is an ONO or a mixture of substances, good or synthetic origin used for the prevention and treatment of diseases. Drug Treatment - This is a drug in ready for use.
Belonging to lists A and B of all medicines manufactured under various branded or trade names and their various dosage forms is determined by their active ingredient. Accounting, storage, appointment, vacation and use of drugs related to the list A should be made with extreme caution.
Accounting, storage, appointment, vacation and use of drugs related to the list B should be carried out by precautions due to possible complications when applied without medical control.
Literature
1. Gaevy MD Pharmacotherapy with the basics of clinical pharmacology. Volgograd. 1996 - 22c.
2. Mashkovsky MD Drugs, t. 1-2. M., 1988;
3. Mikhailov I.B. Clinical pharmacology and therapy S.-Pb.: 1998 - 6c.
4. Toxicological chemistry. / Ed. N.I. Caletina. - M.: Goeotar-Media, 2008. - 116 p.
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Regulation of labor when storing the materials of POT RO-14000-007-98 (utensils of the Russian Federation from 25-02-98) (2017) relevant in 2017
7.8. Storage of poisonous and caustic chemicals
7.8.1. Depending on physico - chemical properties and the degrees of potential danger to poisonous and caustic chemical substances Must be stored in special warehouses or on specially equipped areas.
7.8.2. Most chemical materials should be stored separately, since when contacting each other, they can ignite, giving explosive mixtures, highlight poisonous gases, etc. Data on incompatibility of storage of chemical materials are shown in Table. five.
Table 5.
Chemical materials incompatible joint storage
| Name of chemical material | Substances that are invalid to jointly storing |
| Activated carbon | Calcium hydrochloride and all oxidative products |
| Ammonia (gas) | Mercury, chlorine, calcium hydrochloride, iodine, bromine, fluoride hydrofluoric acid (anhydrous) |
| Ammonium Azotokosloid (ammonium nitrate) | Acids, powdered metals, flammable liquids, chlorates, nitrates, sulfur compounds, flammable finely divided organic products |
| Acetylene | Chlorine, bromine, copper, fluorine, silver, mercury |
| Barium peroxide | Ethyl and methyl alcohols, acetic acid, acetic anhydride, aldehydes Basic, Seroublerod, Glycerin, Ethylene glycol, methyl acetate, Fourfurol |
| Bromine | Ammonia, acetylene, butane, methane, propane (or other oil gases), hydrogen, turbine, benzene, finely divided metal powders |
| Chloro dioxide | Ammonia, phosphates, sulfur gas, methane, iodine, mineral and organic acids, acetylene, ammonia, ammonia water, hydrogen |
| Metal potassium | |
| Suchloroic acid | Acetic anhydride, bismuth and its alloys, alcohol, paper, wood |
| Copper | Acetylene, hydrogen peroxide |
| Metal sodium | Tour chloride carbon, carbon dioxide, water |
| Hydrogen peroxide | Copper, chrome, iron, numerous metals and their salts, alcohol, acetone, organic products, aniline, nitromethane, all flammable liquids and combustible substances |
| Permangitrate potassium | Glycerin, ethylene glycol, benzaldehyde, sulfuric acid |
| Mercury | Acetylene, rattles acid, ammonia (gas) |
| Silver | Acetylene, concentrated nitric acid, ammonia compounds, oxalic acid, Vinnocamean Acid |
| Sulfuric acid | Potassium chlorat, potassium perchlorate, permanganate and other connections with light metal, similar sodium, lithium |
| Hydrogen sulfide | Nitric acid, oxidative gases |
| Hydrocarbons (butane, propane, benzene, volatile solvents, turpentine, etc.) | Fluorine, Bromine, Chromic Acid, Oxidifiers |
| Acetic acid | Chromic acid, nitric acid, ethylene glycol, peasant acid, peroxide, permanganate |
| Fluorine | Must be isolated from all active chemical materials |
| Fluoride hydrofluoric acid (anhydrous) | Acetic acid, aniline, chromic acid, cyanistic acid, hydrogen sulfide, flammable liquids and gases |
7.8.3. Poisonous and caustic chemicals should be kept in the container in the closed state. The main types of Tara are shown in Table. 6.
Table 6.
Package for storing poisonous and caustic chemicals
| N p / n | Substance | Packaging |
| 1 | Nitric acid: any concentration of medium concentration | Aluminum barrels and tanks of barrels and tanks from corrosion-resistant steel (for example, 12x18m9t) |
| 2 | Sulfuric acid | Barrels and tanks from corrosion-resistant steel (for example, 12x18m9t) |
| 3 | Salonic acid of any concentration | Steel gummed barrels and tanks |
| 4 | Plastic (hydrofluoric) acid | Ebonite bidones with a capacity of up to 20 liters, polyethylene cylinders with a capacity of up to 50 liters |
| 5 | Sodium hydroxide | Iron drums, barrels |
Notes. 1. Nitrogen and sulfuric acids in quantities of up to 40 liters can be stored in glass bottles.
2. On tanks with caustic soda (caustic), "dangerous - caustic" should be inscription.
7.8.4. The container with chemicals should be clear inscriptions, labels with the name of the substance, the GOST indication and the number of technical conditions.
7.8.5. It is prohibited to store caustic substances in basements, mixtures and upper floors multi-storey buildings.
7.8.6. Bottles with acids should be installed by groups (no more than 100 bottles in the group) in two or four rows with passages between groups of at least 1 m wide.
7.8.7. It is forbidden to install acid bottles on racks in more than two tiers in height. At the same time, the shelves of the second tier should be at a height of not more than 1 m from the floor.
7.8.8. Acid bottles are prohibited to be installed near the heating appliances.
7.8.9. When overflowing the acid from the bottle, special devices should be applied to the gradual tilt of the bottle and nozzles to prevent spill and splashing the acid.
7.8.10. When transporting and storing acids and other aggressive liquids, only the tapered bottles should be used, which need to be tightly packaged into conical baskets or wooden crates, on the bottom and from the sides of which the straw or chips should be laid.
7.8.11. When storing nitric acid, straw or chips must be saturated with solution calcium chloride or magnesium chloride.
7.8.12. Opening of acid tanks must be carried out carefully, because Possible release of steam and gases accumulated in the upper part.
7.8.13. To avoid breaking bottles during thermal expansion, they must be filled by no more than 0.9 of their volume.
7.8.14. Carrying filled bottles should be carried out at least two persons using special stretcher. Raise baskets with acid bottles per hand permitted only after preliminary checking the integrity and reliability of the bottom and pens of the basket.
7.8.15. The transportation of acid containers is allowed only on specially equipped trolleys.
7.8.16. When transporting caustic substances in a bottle of chips for their packaging in the crates should be impregnated with fire-resistant composition. Bottles should be filled with no more than 0.9 volume and carefully evacuated.
7.8.17. The carriage of acids should be carried out in special tanks having an inner acid-resistant lining.
7.8.18. Acids and other caustic liquids in shallow (up to 1 kg) packaging should be transported in the appropriate packaging that protects the container from combat and falling out. Glass packaging with caustic substances should be tightly clogged and packed in wooden or plywood boxes using lung packaging material. The weight of such boxes should not exceed 50 kg.
7.8.19. In storage warehouses and in places of use, acids should be backup tanks for an emergency drainage of acids.
7.8.20. In rooms where chemicals and solutions are stored, should be posted on prominent and accessible places instructions for safe handling.
7.8.21. It is forbidden to put a container with potent poisonous substances (dying) on \u200b\u200beach other and bulk. Drinking, packed in iron drums, allowed to be installed in height in two tiers.
7.8.22. Joint storage of poisons with other materials, as well as poisons of various categories is not allowed.
7.8.24. For transportation, digesting inside the organization should take out the outfit - admission as on the production of work of special danger.
7.8.25. Transportation is allowed only in a good, closed container, indicating the name of the nadogymicates and the inscription "poison".
7.8.26. Delivery while driving during rain or snowfall should be carried out with the shelter of their tarpaulter, which should be stored on similar cases In stock in a closed box.
7.8.27. Receiving a storage in the warehouse should be made only by an employee responsible for their storage, and in the presence of an employee responsible for their transportation.
7.8.28. Reception by drinking to the warehouse should be made on the day of the arrival of the cargo to the organization.
If the load arrived at night, then it is accepted on the warehouse in the morning.
Before admission to the warehouse, the cargo with sowing in a sealing form should be protected.
7.8.29. Before taking a cargo with driving to the warehouse, an employee responsible for storing while driving must carefully check the correctness and integrity of the packaging and marking of each individual location.
7.8.30. When the poisons are unloading, the employee responsible for storage by having sought, should monitor the observance of precautions, so that the packaging with having had was not damaged, it was not impaired, did not rush, did not move the wolves, etc.
7.8.31. In the absence of the stencils of the installed sample, the warehouse manager (the storekeeper) must restore them and mark it in the acceptance act.
7.8.32. When faults are detected, the poisons containers in a faulty container (without crossings) must be transferred to a new clean container bigger size And hermetically closed with a lid. All work should be made in a gas mask.
7.8.33. Over time, the room where the poisons are stored must be closed, sealing (seated) and put under protection.
7.8.34. The entrance to the storage room of poisons after a break in operation more than one hour is allowed only after the ventilation is turned on and its continuous operation for at least 30 minutes.
7.8.35. When storing cyanide salts, the sanitary rules for the design and content of warehouses for storing potent poisonous substances should be guided.
7.8.36. Store cyanide salts should be in isolated non-aggravated heated rooms, access to which is allowed only specially dedicated personnel.
7.8.37. Premises for storing cyanide salts should be dry and equipped with efficient ventilation. In a separate storage room, washbasins with hot and cold water, Cabinets for workwear, specialobuvi and other personal protective equipment, first aid kit, telephone.
7.8.38. In the storeroom for storing cyanide salts, scales, diverse, tool for opening containers, scoop, brush, waste collection packaging, which are prohibited from or ending with other premises, their neutralization should be made immediately.
7.8.39. A small tightly closing hole should be arranged in the storehouse door for the storage of cyanide salts to determine the presence of a cyanide hydrogen (sinyl acid), the presence of which is determined by a litmus paper introduced into the room through the specified hole before opening the door.
7.8.40. When the pantry presence of cyanide hydrogen is found in the air, the room must be used and the air sample is repeated.
Entrance to the premises of the pantry, where cyanide salts are stored, is allowed only in the absence of a reaction to cyanide hydrogen in the performed samples.
7.8.41. In emergency situations, the entrance to the storage storage of cyanide salts is permitted only in a gas mask.
7.8.42. The autopsy of the container, packaging or wrestling of cyanide salts should be made by specially trained workers - storekeepers.
It should be conducted strict accounting of the consumption and the arrival of cyanide salts with registration in a special journal.
7.8.43. Working with cyanide salts should be carried out necessarily with the use of personal protective equipment - rubber gloves, gas masks.
7.8.44. The autopsy of the container with a cyanistic salt should be carried out with an unconstructed tool in the exhaust cabinet.
7.8.45. Waking up cyanide salts should be carefully assembled and removed into a special metal closing container for waste, and the place where the prospects should be neutralized.
7.8.46. Dust, assembled from the equipment, should be neutralized in specially rejected places.
7.8.47. Only metal packaging with a tightly closing lid should be applied to store the nitrate. Storage Selitra in bags, wooden container is prohibited.
7.8.48. Store the sorrows-containing substances are necessary in dry and heated rooms, since these substances have high hygroscopicity.
Functional purpose:treatment
Terms of implementation: Ambulatory-polyclinic, stationary
Storage of narcotic, psychotropic medicinal substances is carried out in accordance with the type of technical strengthening, approved by the Order of the Ministry of Health of the Russian Federation No. 330 of 12.11.97, the same requirements apply to the storage of toxic and potent substances.
Storage should be carried out in technically fortified premises in the safes. Safes (metal cabinets) must be in a closed state. The keys to the safe are kept in financially responsible persons authorized on the order of the head of the LPU, and on the night, these keys are transferred to the duty officer, as the corresponding entry is made in a special journal, where the signatures of the transmitted and adopted keys are made, and the number of specified drugs. The list A includes poisonous and narcotic substances. To the list b - potent.
The reserves of narcotic and psychotropic drugs in the departments should not exceed the 3-day need (Ave. of the Ministry of Health of the Russian Federation No. 330 dated 12.11.97), poisonous drugs - a 5-time need, potent - 10-cudded need.
For rendering emergency In the evening and night time, a 5-cubic reserve of narcotic drugs is allowed to create in the receptions of the hospital. This reserve can be used in all hospital divisions.
On the inside of the door doors, a list of narcotic, psychotropic, poisonous and potent drugs indicating the highest one-time and daily doses should be specified. At the posts of nurses, there must also be tables of higher one-time and daily doses of poisonous, potent, narcotic and psychotropic drugs, as well as antidote tables in poisoning.
In the departments and cabinets of LPU subject to the subject - quantitative account:
1. Narcotic drugs and psychotropic substances of lists II and III, approved Decree of the Government of the Russian Federation No. 681 of 30.06.98.
2. Drugs included in the list of PACN No. 1 "potent substances"
3. Drugs included in the list of PACN No. 2 "Poisonous substances"
4. Medications of the list A, List b, ethyl alcohol.
Taking into account the above drugs is carried out in a special book, numbered, laid, signed by the head and bonded seal of the LPU. The form of the book approved by Appendix 5 of the Order of the Ministry of Health of the Russian Federation No. 330 - 1997
The medical staff, which, by virtue of his official duties, accesss drugs and psychotropic substances, should have admission to work with the above drugs in accordance with the Decree of the Government of the Russian Federation No. 892 of August 6, 1998. "On approval of the rules of admission of persons to work with narcotic drugs Means and psychotropic substances.
Nursing staff has the right to reveal the ampoule and introduce a patient a narcotic analgesic only after recording this appointment by a doctor in a medical card and in its presence. The appropriate entry in the "Medical Map" is made about the injection, certified by the patient doctor and m / s indicating the name, dose and time of administration of the drug. After the administration of a narcotic drug from the syringe tube is cut off its capsule.
1. Oral and outdoor reception of a narcotic drug is also carried out in the presence of a doctor and m / s and noted in the "Medical Map" on the same scheme.
2. Empty ampoules and syringe tubes from under narcotic drugs M / C does not emit, and keep them in a safe and daily gives the person to the person responsible for accounting and storage
3. When the duty is transferred, compliance with records in the accounting journal (the number of used ampoules and syringe tubes and the residue) with the actual amount of ampoules and syringe tubes are checked.
4. Empty ampoules and syringe tubes are destroyed only by the Special Commission approved by the head of therapeutic institution.
Master of key transfer and safe content.
Department _____________________________
The form of the book of discount of narcotic drugs in departments and in the cabinets.
_____________________________________________________
The name of the medical and prophylactic institution
BOOK
Accounting of narcotic drugs
In departments and cabinets
Name of funds _________________________________________
Unit of measurement_________________________________________________
For violation Federal Law RF "On narcotic drugs and psychotropic substances" officers And citizens of the Russian Federation are responsible in accordance with the legislation of the Russian Federation.
Ticket number 17.
Exercise 1
Task 2.
Task 3.
Care when vomiting.
Package of the examiner №19.
Exercise 1
Home is prescribed a patient with right-sided hemiplegia. The patient lives in an apartment with a 30-year-old daughter. The daughter loves his father and is confident that it will cope with the departure. She never cared for severely ill.
Violated needs: security need.
The problem of the patient: a shortage of knowledge of the care of the patient's seriously illness in relatives.
Purpose: Daughter will demonstrate sufficient knowledge of the organization home care After 4 days and will be able to ensure full-fledged father's care at home.
1. To analyze the ability of the patient to serve yourself together with the daughter.
2. Demonstrate daughter necessary subjects Care.
3. Explain the rules for the use of leases.
4. Acquaint my daughter with relevant literature on the organization of home care.
5. Organize training by day:
1 day - feeding hard patient, conducting morning Toilet
2 day - shipment of the vessel, urinary, care for outdoor sex
organs
3 day - a change of bed and underwear
Day 4 - various patient positions in bed, prevention
proleegoes
6. Confirm the information received on the eve every day.
Evaluation of care efficiency
The patient's daughter demonstrated knowledge of the care of seriously ill at home. The goal is achieved.
Task 2.
The mechanism of action of the siphon enema, indications, contraindications and possible complications.
Task 3.
Care when vomiting.
Help with vomiting
Functional purpose:medical
Terms of implementation: Ambulatory and Polyclinic, Stationary
Vomiting is a complex reflector act of involuntary discharge of the contents of the stomach.
There are vomiting of central and peripheral origin.
Central vomiting occurs when irritating the vomit in the cerebral cortex. There is no harbingers (salivation, urge on vomiting) and does not bring relief.
Peripheral vomiting arises when the gastrointestinal disease occurs, occurs with the forerunners and brings to the patient relief.
EQUIPMENT: 2 apron, oilcloth, gloves, pelvis, glass with water, tray, napkin (individual towel).
Algorithm procedures.
1. Soothe patient
2. Squeeze the patient (if the condition allows) and put the adhesive apron on it, put on the apron and gloves.
3. Put to the legs of the pelvis.
4. Adhere to the patient's head with vomit, putting his palm on my forehead, and with the other hand hold for my shoulder
5. After vomiting, let the patient rinse the mouth with water and spit into the tray.
6. Help the patient lie down
7. Take the pelvis with the contents of the Chamber, but leave the pelvic masses in the pelvis to show their doctor.
8. Conduct disinfective events.
Ticket number 20.
Exercise 1
Ø Determine the violated needs.
Ø Determine the patient's problems.
Ø Word goals and make a plan of nursing interventions.
Task 2.
Task 3.
Package of the examiner 20.
Exercise 1
Ksenia y, 18 years old, entered the clinic accompanied by Mother and Brigade Honey. Brothers who carry a patient on stretchers. The reason for the receipt is deterioration of well-being, no possibility to walk. In the patient a few years ago there was an operation on the head femoral bone. Medical diagnosis: Sarcoma of Jinga 4 degrees. As a result of the nursing survey, M / C found out that the patient cannot walk due to the overall weakness, immobility in the right hip joint. Mother is incredible next to his daughter.
1. Determine the violated needs.
2. Determine the patient's problems.
3. Word goals and make a plan for nursing interventions.
Patient Problem Solon
Violated needs: move, allocate, eat, dress, undress, be clean, work and learn.
The problem of the patient: restriction of mobility due to the disease of the hip joint and the shortage of self-turn. The risk of forming beds.
Purpose: the patient will not have breakdown and will be provided full care in the clinic.
Plan of nursing interventions
1. Training mother patient basics hygienic procedures, Preventing elements of the prevention.
2. Put a sick leg on the anti-terrestrial circle.
3. Maintain comfortable and safe conditions.
4. Soothe the patient.
5. Create a complete peace for reducing experiences about the disease and immobility.
6. Teach the patient complex LFK. and self-massage limbs.
7. Move the patient to get out of bed with an extraneous help.
Evaluation of care efficiency
Mother's patient commits daily necessary procedures Personal hygiene. The patient became more active, engaged in LFC, trying to get up with an extraneous help.
Task 2.
The mechanism of action of the cleansing enema, indications, contraindications and possible complications.
Task 3.
Preparation of the patient and setting the oil enema (on phantom).
Setting Oil Curizma
Oil enema - The oil introduced into the intestines is enveloped caliac masses. After an oil belief, the intestinal emptying occurs after 6-10 hours. After putting the oil belief, the patient must lie for several hours, otherwise the oil introduced into the intestine, flow. Therefore, it is more convenient to put the enema for the night.
Equipment: Pearless Ballon or Syringe Jana, Gauge Tube (Packaging), Spatula, Vaseline, Oil (Vaseline, Vegetable) 50-100 ml (for the appointment of a doctor), gloves, toilet paper, Napkins, Gloves, Diaper, Shirma, Tray, Water thermometer.
Algorithm Procedures
I. Preparation to the procedure:
1. To clarify the patient an understanding of the purpose and course of the upcoming procedure and to obtain its consent to the procedure. In the event of the patient's disgrace, to clarify the physician further tactics.
2. Heat the oil on the water bath to 38 0 C.
3. Check the oil temperature (and not water!) The thermometer.
4. Lower the headboard bed to the horizontal level and help the patient turn to the left side, its legs are bent in the knee and hip joints, to raise under the patient a linen with a diaper.
5. Dial to the pear-shaped balloon 50 (100) ml warm oil (by appointing a doctor). Lubricize vaseline gauge tube. Put the balloon and the tube in the tray.
II. Filling procedure.
6. To put on gloves. Introduce the gas feed tube at 20-30 cm. (If the patient's position is impossible on the left side, the enema is put in the patient's position "lying on the back")
7. Attach a pear cylinder to the tube and slowly enter the oil. Without scolding a pear-shaped cylinder, disconnect it from the gas pipe.
8. Remove the gas pipe and place it along with the pear-like cylinder into the tray.
9. Witch toilet paper (napkin) The area of \u200b\u200bthe anal hole (in women in the direction of the front-back) in the event that the patient is helpless.
III. Treatment of procedure.
10. Remove the slope, diaper, reset them into a waterproof bag.
11. Remove gloves, place them in the tray.
12. Hold the patient with a blanket, help him take a comfortable position.
13. Wash hands.
14. Make a record in the "Medical Map" on the procedure performed and the patient's reaction.
15. Conduct disinfective events.
16. Conduct an assessment of the effectiveness of the procedure after 6-10 hours and make an entry in the "Medical Map" about this.
Ticket number 22.
Exercise 1
Ø Determine the violated needs.
Ø Determine the patient's problems.
Ø Word goals and make a plan of nursing interventions.
Task 2.
Clear. Types of enema.
Task 3.
Package of the examiner №21.
Exercise 1
Kalashnikova ED came to the surgical department, about amputation lower limb. After the successful operation, the patient complains of phantom pain in the amputated limb area.
1. Determine the violated needs.
2. Determine the patient's problems.
3. Word goals and make a plan for nursing interventions.
Patient Problem Solon
Violated needs: maintain environmental safety.
The problem of the patient: experiencing phantom pain in the amputated limb area.
Objective: The patient will know how to overcome phantom sensations.
Plan of nursing interventions
1. Conduct a conversation with a patient, establish a trusting relationship.
2. Give the patient Tip: feeling to decrease if you look at the place of amputation.
3. Provide literature on persistent anesthesia techniques.
Evaluation of care efficiency
The patient knows how to overcome phantom sensations, successfully uses the resulting skills when phantom pain appears. The goal is achieved.
Task 2.
Clear. Types of enema.
Task 3.
Preparation of the patient and formulation of the cleansing enema (on phantom).
Page 1.
Storage of poisonous substances in open areas of open-air is prohibited.
Premises for storing poisonous substances must be provided with separate supply and extensive ventilation plants that are not associated with industrial premises.
Storage and storage of poisonous substances are carried out in special premises. The room intended for temporary storage of poisonous substances should be equipped with ventilation that ensures the content of harmful impurities in the air not higher than sanitary standards. It is allowed to store poisonous substances under the canopy.
Not allowed transportation and storage of poisonous substances in conjunction with food, bilboofer, perfume-cos-methoe, pharmaceutical cargoes, with medicinal plants, clothing, dishes and other objects of everyday help.
The transportation and storage of soybean poisonous substances is not allowed - locally with food, bolboofer, perfumery-copper, pharmaceutical goods, with medicinal, plants, clothing, dishes and other objects of everyday help.
In the premises intended for storing poisonous substances, warning inscriptions should be posted.
Expenditureable warehouse with VNCL and CZL for storing flammable and poisonous substances and samples should be located in compliance with fire gaps with the opposite part of these buildings opposite to the entrance.
Store in dry warehouses In compliance with the storage rules of poisonous substances.
Transport and stored in compliance with the rules of transport and storage of poisonous substances.
Transport and stored in compliance with the rules about the transportation and storage of poisonous substances.
Ethylene glycol should be kept and transported in compliance with the rules for the transportation and storage of poisonous substances.
IN yellow Caps of receiving and handouts (funnels), containers for storing poisonous substances, warning plate at the entrance to the warehouse are painted. To the right of the entrance is set to the shield on which the skull and crossed bones are depicted and the inscription is made, for example, methanol - poison. Below the inscriptions are the text about the toxic properties of a poisonous substance. Image, inscriptions and text are performed in black. Fencing pillars are painted in yellow, and barbed wire - black.
In yellow color, the caps of receiving-handanese wells (funnels), containers for storing poisonous substances, warning plate at the entrance to the warehouse. On the right of the entrance is set to the shield, which shows the skull and crossed bones and the inscription is made, for example, methanol - - poison. Below the inscriptions are the text about the toxic properties of a poisonous substance. Image, inscriptions and text are performed in black. Fencing pillars are painted in yellow, and barbed wire - black.