🔙 Quay lại trang tải sách pdf ebook Thực hành cộng đồng 1 Ebooks Nhóm Zalo HOC Y KHOA THAI NGUYEN H i i i NHA XUAT BAN Y HOC TRUONG DAI HOC Y KHOA THAI NGUYEN THI/C HflNH CONG DONG 1 ■ ■ NHA XUAT BAN Y HOC HA NOI - 2007 CHU BIEN: PGS. TS. Dam Khai Hoan BAN BIEN SOAN: PGS.TS. Dam Khai Hoan ThS. Nguyen Phifdng Lan ThS. Nguyen Ngoc Diep ThS. Nguyen Thu Hien ThS. Nguyen To Uyen ThS. Nguyen Van Thoa ThS. Pham My Hoai BS. Le Thj Bay Ths. Ha Huy Phtfdng LOI Gldl THIEU Dap ling yeu cau cham soc siic khoe cho nhan dan trong giai doan hien nay ngiibi bac si khong nhiing co kien thiic toan dien, kha nang nghien cHu ma ho can nhiing ky nang lam viec trong dieu kien thiic te cua cong dong. Cong dong 1 la mon hoc trong chiidng trinh dao tao bac si da khoa he chinh quy cua Triibng Dai hoc Y khoa Thai Nguyen danh cho sinh vien nam thti nam, nham gop phan dat dtftic yeu cau do. Mon hoc nay tao ra nhiing cd hoi cho sinh vien thi/c hanh cac kien thiic da hoc dittfc ti( nam thii nhat den nam thii nam tai y te tuyen huyen va xa. Dita tren nhu cau thiic te va chiictng trinh giao due diia vao cong dong ban hanh theo quyet dinh so 272/YK-QD ngay 15 thang 7 nam 2005 cua Triicfng Dai hoc Y Khoa Thai Nguyen - Tap the giang vien Triibng da bien soan cuon tai lieu hoc tap mon hoc cong dong 1 danh cho sinh vien. Trong qua trinh bien soan cuon tai lieu nay ching toi da nhan diidc sii ho trcj cua Chiictng trinh Hop tac Y te Viet Nam-Thuy Dien, Vu Khoa hoc- Dao tao Bo Y te, y kien dong gop cua cac chuyen gia trong va ngoai niibc cung nhii cong dong dao tao Dong Hy va Phi. LitOng. Chung toi tran trong cam On nhiing y kien dong gop quy bau do. Tuy nhien Ian dau bien soan se khong tranh khoi nhiing khiem khuyet, rat mong cac dong nghiep va cac ban sinh vien gop y de Ian xuat ban sau hoan chinh hefn. c h Ci b i£ n PGS. TS. Dam Khai Hoan 3 MUC LUC Hi/dng dan sir dung tai lieu 6 Mon hoc thiic hanh cong dong 1 7 Hifdng dan thi/c hanh cong dong 9 To chifc hoat dong cua TTYT du phong huyen 16 To chifc va quan ly cac chUdng trinh muc tieu y te quoc gia tai TTYT dir phong huyen 19 To chifc va hoat dong cua khoa DUdc, khoa Xet nghiem, phong Ke hoach tong hdp tai benh vien huyen. 22 Tang huyet ap 29 Dai thao dudng 33 Hen phe quan 40 Lap so theo doi sifc khoe ba me tai nha 48 Giao due silfc khoe va tu" van cho nguoi mang thai 56 Kham phu khoa 60 Benh tieu chay 67 Nhiem khuan ho hap cap 73 To chirc hoat dong cua tram y te xa 79 Phan ti'ch he thong so sach bao cao tai tram y te xa 88 Thi/c hien cac chuong trinh Sot ret va tiem chung mo rang tai tuyen y te xa 92 Chan doan cong dong 96 Lap ke hoach Truyen thong-Giao due si/c khoe 106 Thi/c hanh Truyen thong - Giao due sifc khoe 114 To ch u t chuyen tuyen trong san phu khoa 120 Hirdng d in sinh vien tif hoc, tii nghien ciru va van dung thirc te mon hoc 126 Hi/dng dan danh gia mon hoc 127 Phu luc 129 5 HlfONG d An Sir DUNG TAI LIEU • • Cuon tai lieu mon hoc cong dong 1 la cuon tai lieu hudng d&n sinh vien thuc hanh tai cO sd y te. Bo" cuc tai lieu dUdc chia lam hai phan chinh: Phan 1: Hudng dan thuc hanh cong dong Phan nay cung cap nhflng thong tin din thiet cho sinh vien de chu&n bi triidc khi di hoc tai cong dong. Sinh vien doc lan ltfdt cac chu de de on tap lai ly thuyet co lien quan den mon hoc theo sU hudng dan, chuan bi cac tai lieu va trang thiet bi can thiet de san sang hoc tai cong dong mot cach chu dong theo ke hoach hudng dan. Phan 2. Cac bai thuc hanh tai cong dong Sinh vien nghien ciiu muc tieu bai hoc dtfdc gidi thieu phan dau cua moi bai de dinh hudng noi dung va phiidng phap nen ap dung cho moi chu de. Doc phan noi dung se hudng dan tifng btfdc cac hoat dong sinh vien nen lam de dat dtfdc muc tieu hoc tap. Sau khi hoc xong bai hoc, nhom sinh vien nen thao luan de tra ldi cho cac cau hoi lUdng gia. Khi co mong muon tU hoc, tu nghien cCfu va van dung thuc te nhiing kien thiic va ky nang da dat dUdc sinh vien co the tham khao phan hudng dan cuoi moi bai. Phan 3: Phu luc Sinh vien sU dung cac loai tai lieu trong phu luc de thuc hien cac yeu cau dieu tra va hoan thanh cac loai san pham lien quan den thuc hanh cong dong. Khi can tim kiem tai lieu tham khao cho mon hoc sinh vien co the xem danh muc cac tai lieu tham khao d phan cuoi cua tai lieu. Cac loai tai lieu nay co san d thu vien cua TrUdng va cd sd y te. Nghien ciiu cuon tai lieu mot cach tong the triidc khi thUc hanh tai cong dong se giup sinh vien co cach nhin tong quat ve mon hoc va chu dong trong hoc tap. Vi vav sinh vien nen nghien cilu ky va lap ke hoach chi tiet trUdc khi di thiic hanh tai y te tuyen huyen va xa. 6 MON HOC THI/C HANH CONG DONG 1 ■ ■ ■ So DVHT: 4 Ly thuyet: 0 Thiic hanh: 4 So tiet : 0/180 Ly thuyet: 0 Thiic hanh: 180 So Ian thi: 1 Thdi gian thiic hien: Nam thii 5 (Hoc ky IX & X) MUC TIEU Sau khi ket thuc mon hoc, sinh vien co kha nang: 1. Mo ta diictc chiic nang, nhiem vu va cac hoat dong cua TTYT dii phong huyen 2. Kham va xii tri diictc mot so benh thiibng gap tai benh vien huyen 3. Phan tich diic/c cac hoat dong chuyen mon cua mot so khoa phong cua benh vien huyen va TTYT dii phong huyen. 4. Mo ta diictc cac chiictng trinh y te Quoc gia dang thiic hien tai huyen va phan tich chi tiet hoat dong cua 1 chiictng trinh muc tieu co hieu qua nhat tai huyen. 5. Mo ta diictc nhiem vu va qui trinh quan ly tram y te xa. 6. Mo ta diic/c cach thiic hien chiictng trinh y te Quoc gia tai xa va phan tich chi tiet viec thiic hien 2 chiiOng trinh muc tieu co hieu qua nhat tai xa. 7. Phan tich dittfc he thong so sach, so lieu va he thong bao cao tai tram y te xa. 8. Phan tich hoat dong va cach dieu hanh y te thon ban tai xa. 9. Tien hanh chan doan cong dong va liia chon diidc van de siic khoe liu tien. 10. Xay di/ng ke hoach va to chiic thiic hien diictc mot buoi TT - GDSK tai cong dong 11. Xii tri diidc cac benh thiibng gap tai tram y te xa. 7 NOI DUNG TT Ten bai hpc 1 Tap huan cac van de lien quan thuc hanh cong dong 1: Muc tieu, noi dung va cac yeu cau hpc tap cua mon hpc So tiet Tong sdLy . thuyet Thirc hanh thuc hanh cong dong. 1 0 1 Phifdng phap thi/c hanh ve to chut quan ly va hoat dong cCia TTYT di/ phong huyen va cac chi tieu hpc tap. 1 0 1 Phifdng phap thirc hanh lam sang tai benh vien huyen va cac chi tieu hpc tap. 1 0 1 Phifdng phap thuc hanh tai TYT xa va chi tieu hpc tap. 1 0 1 Phifdng phap thuc hanh tai CD va cac chi tieu hpc tap. 1 0 1 Phifdng phap viet bao cao thu hoach. 1 0 1 2 Thuc hanh tai TTYT duphdng huyen va BV huyen (2 tuan) To chifc hoat dong cCia TTYT dif phong huyen 9 0 9 To chifc va quan ly cac chifdng trinh y te quoc gia tai huyen 9 0 9 To chiic va thuc hien kham va giai quyet cac benh thifdng gap tai phong kham benh vien huyen To chifc va thirc hien kham va giai quyet cac benh thifdng gap tai khoa Noi Nhi Lay To chirc va thi/c hien kham va giai quyet cac benh thirdng gap tai khoa Ngoai San • To chirc va hoat dong cua khoa Di/dc, xet nghiem, phong ke hoach tong hdp. 14 0 14 30 0 30 18 0 18 12 0 12 3 Thuc hanh tai xa (2 tuan) To chifc hoat dong cua tram y te xa 9 0 9 Giao ban tai tram y te. 6 0 6 Quan ly hoat dong mang lifdi y te thon ban. 6 0 6 Phan tich he thong sd sach bao cao tai tram y te xa 9 0 9 Thuc hien cac chifdng trinh Tiem chung md rong, Sot ret va Bifdu co tai TYT xa 6 0 6 Chan doan cong dong 27 0 27 Lap ke hoach GDSK de giai quyet 1 van de Stic khoe ifu tien d cong dong Tien hanh GDSK de giai quyet 1 van de sifc khoe ifu tien d cong dong 10 0 10 15 0 15 To chifc chuyen tuyen trong san phu khoa 6 0 6 Tong cong 180 6 ; 174 8 HUONG DAN THUC HANH CONG DONG MUC T liu Sau khi hoc xong bai nay sinh vien co kha nang: 1. Trinh bay diidc muc tieu, noi dung hoc tap tai cong dong 2. Mo ta diidc cac yeu cau cua deft hoc tap tai cong dong 1. Gidi thieu mon hoc ThUc hanh cong dong 1 la mon hoc danh cho sinh vien nam thii nam thuc hanh cac kien thiic va ky nang da tich luy dUdc trong suot qua trinh tu nam thii nhat den nam thii nam. Muc dich cua mon hoc nay nham tao ra cd hoi cho sinh vien thuc hanh cac ky nang trong dieu kien thuc te cua y te tuyen huyen va xa. Ngoai viec thuc hanh cac ky nang c&n thiet day la cd hoi tot cho sinh vien hoc hoi, quan sat cac van de siic khoe dang xay ra trong thuc te cong dong va cac yeu to" moi trUdng tu nhien. moi trUdng xa hoi anh hudng den viec cung cap va sii dung cac dich vu y te cua cong dong. 2. Muc tieu va chu de hoc tap Muc tieu va noi dung cua mon hoc dUdc chia lam 2 phan chinh: hoc tap ve to chiic, hoat dong cua y te tuyen huyen; hoc tap ve to chiic, cac hoat dong cua tram y te xa va cac van de siic khoe xay ra trong cong dong (ph&n nay sinh vien doc phan chUdng trinh chi tiet mon hoc). 3. Ke hoach thirc hanh tai tuyen huyen 3.1. Lich hoc Lich hoc cu the cua tiing ngay se do giao vien chu nhiem tai tuyen huyen thong bao cho nhom sinh vien. Noi dung va thdi lUdng cac chu de nhu sau: TT Noi dung Thdi gian (tiet) Can bo 1To chiic hoat dong cua trung tarn y te du phong huyen 9 Lanh dao TTYT du phong huyen 2 To chirc va quan ly cac chuong trinh muc tieu y te quoc gia tai huyen 3 To chiic hoat dong khoa di/dc, Khoa xet nghiem, phong ke hoach tong hdp benh vien huyen 4 Thi/c hien kham va giai quyet cac benh thi/dng gap tai Phong kham benh vien huyen 9 Can bo trung tam y te di/ phong huyen 12 Lanh dao benh vien huyen 14 Bac si phong kham 9 5 Thuc hien kham, giai quyet cac benh thi/dng gap khoa Noi Nhi Lay30 Bac sT khoa No* hoac Nhi 6 Thuc hien kham, giai quyet cac benh thtrdng gap khoa Ngoai San 7------— ■ 18 Bac sT khoa Ngoai hoac San Tl/ hoc theo chi tieu CB phong ke hoach (quan ly ldp) 3.2. Huang dan hoc tai trung tarn y te di/phdng huyen - To chiic hoat dong trung tarn y te du phong huyen: sinh vien dUdc nghe lanh dao cua trung tam y te du phong huyen gidi thieu ve to chiic nhan sii, cac nhiem vu cu the trong nam va cac hoat dong tien hanh thifdng quy. Ket hdp giiia phan gidi thieu cua lanh dao trung tam, quan sat cac hoat dong dien ra trong thdi gian thuc hanh va doi chieu vdi ly thuyet da hoc sinh vien tU rut ra nhan xet ve to chiic va hoat dong cua trung tam den thuc hanh. De hoc tot phan nay tai cong dong sinh vien can on tap ph&n ly thuyet to chiic hoat dong cua trung tam y te du phong huyen. - To chiic va quan ly cac chUdng trinh muc tieu y te quoc gia tai huyen: can bo phu trach tiing chUdng trinh se gidi thieu vdi sinh vien ve muc tieu, giai phap, cach chi dao tuyen xa hoat dong va quan ly cac chUdng trinh y te do. De dat diidc muc tieu khi hoc chu de nay sinh vien can on tap ph&n ly thuyet cua mon hoc cac chUdng trinh y te quoc gia. 3.3. Huang dan hoc tai benh vien tuyen huyen - To chiic hoat dong benh vien huyen va cac khoa phong: sinh vien dUdc nghe lanh dao benh vien gidi thieu ve to chiic nhan sii, cau true cac khoa phong cua benh vien tuyen huyen, chiic nang va nhiem vu cua benh vien. Ket hdp giiia phan gidi thieu cua lanh dao benh vien, quan sat cac hoat dong dien ra trong thdi gian thuc hanh va doi chieu vdi ly thuyet da hoc, sinh vien tu rut ra nhan xet ve to chiic va hoat dong cua benh vien den thuc hanh. De hoc tot ph&n nay tai cong dong sinh vien can on tap ph&n ly thuyet to chiic hoat dong benh vien tuyen huyen. - Thuc hanh tai cac khoa: giao vien phu trach ldp se chia sinh vien thanh nhom nho de thuc hanh luan khoa. Tai cac khoa sinh vien se chu dong hoc tap dudi sU gnip dd cua cac bac si trong tiing khoa. Khi thuc hanh tai cac khoa sinh vien can hoc ve cac to chiic mot khoa phong (bao gom: Phan cong cong viec cho tiing can bo, sfip xep khoa phong, trang thiet bi); tham gia kham chiia benh va tu van siic khoe cho benh nhan; tham gia trUc tai benh vien; nhan xet ve mo hinh benh tat va cach xii tri tai benh vien huyen trong thdi gian thuc hanh. De dat dUdc muc tieu hoc tap phan nay sinh vien c&n on tap kien thiic lam sang cua cac chuyen khoa da hoc. 4. Ke hoach thirc hanh tai tram y te xa (TYTX) 4.1. Lich hoc Lich hoc cu the cua tdng ngay se do tram trUdng (hoac ngUdi dUdc uy quyen) cua tram y te xa thong bao cho nhom sinh vien. Noi dung va thdi liidng cac chu de nhu sau: 10 TT Noi dung Thdi gian (tiet) Can bo 1 To chiic hoat dong cua tram y te xa 9 Can bo TYT X 2Thi/c hien chUdng trinh sot ret, tiem chung md rong tai tuyen y te xa 6 Can bo TYT X 3 He thong sd sach, bao cao tai TYTX 9 Can bo TYT X 4 Chan doan cong dong 27 Can bo TYT X 5Lap ke hoach cho mot buoi Truyen thong - Giao due sifc khoe tai cong dong 10 Can bo TYT X 6Thi/c hanh Truyen thong - Giao due sifc khoe tai cong dong 15 Can bo TYT X 7 To chifc chuyen tuyen trong san phu khoa 6 Can bo TYT X Tif hoc theo cac chi tieu Tram trudng (quan ly sinh vien) 4.2. Hudng dan hoc tai tram y te xa 4.2.1. Bifdc 1: gidi thieu va lam quen Hoat dong gidi thieu va lam quen giiia nhom sinh vien, can bo tram, y te thon ban va Uy ban nhan dan xa dUdc tien hanh ngay tu: buoi dau tien sinh vien co mat tai tram y te. Nhom trUdng lien he vdi tram trUdng de gidi thieu ve nhom. Tram trUdng tram y te se chu tri buoi gidi thieu cac thanh phan lien quan den qua trinh hoc tap cua sinh vien tai cong dong va cac nguyen tac sinh vien can thuc hien trong hai tuan lam viec va sinh hoat tai xa. 4.2.2. Bifdc 2: trinh bay ke hoach hoc tap cua nhom vdi tram y te xa Dua tren chUdng trinh thuc hanh da dUdc bo mon Y hoc Cong dong hudng d&n, nhom trUdng nhom sinh vien trinh bay ve muc tieu hoc tap va cac noi dung thuc hanh tai tram. Tren cd sd thao luan giiia tram y te va nhom sinh vien ve cac hoat dong can tien hanh, tram trUdng tram y te lap ke hoach day hoc chi tiet cho tiing ngay trong toan bo ddt thuc te. 4.2.3. Bifdc 3: lam viec, tham gia true tai tram v te va hoc cac noi dung theo yeu cau - ThUc hien cac hoat dong theo lich dUdc phan cong. - Chu dong hoc tap theo cac noi dung yeu cau - Lfing nghe sii trinh bay/gicli thieu cua can bo TYTX - Thu thap cac thong tin can thiet b&ng cac phUdng phap va cac kenh thong tin khac nhau. - So sanh giiia phan ly thuyet da dUdc hoc va thiic trang cua TYTX - Thao luan nhom cac van de theo hUdng dan cua tiing chu de - Trinh bay vdi giao vien nhiing diem chUa ro de dUdc giai dap (phUdng phap va noi dung cu the tham khao phan hu6ng dan hoc chi tiet tiing chu de) - Van dung nhiing kien thiic, ky nang da cd vao tiing hoan canh cu the tai tram y te 11 - Tham gia vao cac hoat dong cua Tram: trong thdi gian lam viec tai tram hoac tham gia trUc, sinh vien pho'i hdp cung cac can bo y te xvt tri cac trUdng hdp den kham va dieu tri. Moi nguyen tic kham chQa benh phai theo quy dinh cua tram y te xa. + Cong tac kham chCta benh: . Kham benh, chan doan, ke ddn . Kham thai, kham benh phu khoa . Tieu phau ddn gian . Sd, cap ctiu vet thUdng . Chuyen tuyen + Tham gia cac chUdng trinh y te trien khai tai tram + Cong tac dUdc: • Cap phat thuoc . Du tru, mua ban thuoc • Bao quan thuoc + Cac chUdng trinh y te trien khai trong xa . Tham gia vao chUdng trinh tiem chung mci rong. . Tham gia chUOng trinh IMCI . Tham gia vao cac chUdng trinh y te khac trien khai tai cong dong + Cong tac hanh chinh: . Ghi chep so sach, phieu kham ... . Thong ke so' lieu de bao cao dinh ky . Giao ban cung tram y te + Cong tac ngoai tram: • Dieu tra . Giao due siic khoe . Kham, theo ddi benh nhan tai cong dong 4.2.4. Bifdc 4: hoan thanh bao cao, cac loai giay td va thu tuc lien quan. - Phieu dieu tra tai tram y te. - Cac phieu dieu tra ho gia dinh (moi ngUdi 15 phieu), dien ket qua vao bang. - Bang ke hoach giao due siic khoe va ket qua - Bai tuyen truyen giao due siic khoe - Bao cao ket qua ddt thuc te 12 4.3. Hudng dan hoc tai cong dong 4.3.1. Thu thap thong tin tif cong dong Sinh vien sii dung cong cu dieu tra do bo mon hudng dan de thu thap thong tin c&n thiet tut ho gia dinh. Sinh vien trinh bay cach chon mau vdi can bo y te cua TYTX, can bo tram se hudng dan sinh vien cach tiep can vdi ho gia dinh. Viec lam sach so lieu can dUdc thiic hien ngay tai cong dong. Ngoai viec thu thap nhiing thong tin can thiet theo cong cu da hudng dan, sinh vien can tim hieu cac phong tuc tap quan, cac yeu to cd anh hudng den siic khoe cua cong dong nh&m cd day du thong tin can thiet cho xac dinh van de siic khoe va lua chon van de siic khoe Uu tien. 4.3.2. Truyen thong giao due sifc khoe Theo ke hoach hoc tap moi nhom sinh vien c&n to chiic mot buoi truyen thong giao due siic khoe cho cong dong. Chu de truyen thong la van de Uu tien c&n giai quyet d cong dong. Sinh vien can chu dong lien he vdi cong dong de to chiic buoi truyen thong, bao gom: lien he vdi ban nganh doan the cd lien quan vdi chu de truyen thong, mdi doi tUdng dich, lien he dia diem, chuan bi cd sd vat chat can thiet...(sinh vien nghien ciiu bai ke hoach truyen thong giao due siic khoe). 4.3.3. Tham gia vao cac hoat dong cua dia phi/ong Khi thuc hanh tai cong dong, ngoai viec thiic hien cac nhiem vu chuyen mon sinh vien nen tham gia vao cac hoat dong cua dia phUdng nham tao moi quan he v6i cong dong va tim kiem cd hoi de hieu phong tuc tap quan cua dia phUdng. 5. Noi quy hpc tai cong dong Sinh vien TrUdng Dai hoc Y khoa Thai Nguyen thuc hanh tai cong dong phai tuan theo cac quy dinh sau: 1. Sinh vien phai thiic hien tot moi noi quy, quy dinh cua dia phUdng va cd sd thiic hanh. 2. Sinh vien phai khiem ton hoc tap, le do trong quan he vdi can bo, nhan vien y te va nhan dan dia phUdng. 3. Sinh vien phai ton trong phong tuc tap quan cua dia phUdng. 4. Nghiem cam sinh vien tham gia hoat dong cac te nan xa hoi. 5. Sinh vien phai chiu sii quan ly cua can bo y te cd sd. 6. Sinh vien khong dUdc vang mat trong cac ddt thiic hanh, moi sii vang mat phai cd giay phep va dUdc sii dong y cua can bo y te cd sd. 7. Ket thuc ddt hoc tap, moi sinh vien phai hoan thanh cac chi tieu va ban bao cao ket qua ddt hoc tap theo quy dinh cua nha trUdng. 8. Moi sinh vien phai co trach nhiem thiic hien tot ban noi quy nay 13 6. Chuan bj 6.1. Kien thiic lien quan Sinh vien c&n nghien ciiu lai cac tai lieu co lien quan den nhiing noi dung sau: - Nhiem vu cua tram y te xa/ phUdng - Quan ly y te - Lap ke hoach y te - Giam sat hoat dong y te - Danh gia hoat dong y te - Quan ly nhan luc y te - Quan cd sd vat chat va trang thiet bi y te - Nguon kinh phi y te - Quan ly thong tin y te - Cac chUdng trinh y te quoc gia: muc tieu, giai phap. - Quan ly thong tin y te - Quy che ve thong ke y te (ban hanh kern theo quyet dinh cua Bo trUdng Bo Y Te so 379/2002/QD-BYT ngay 8/2/2002) - Nhiem vu y te thon ban - Ky nang giao tiep - On tap cac phan ly thuyet lam sang co lien quan den kham, dieu tri va xii tri benh nhan tai tuyen y te cd sd. 6.2. Phwong tien di lai Viec di chuyen tCf trUdng den cd sd y te do TrUdng to chiic, sinh vien can chu dong trong viec chuan bi phUdng tien di chuyen tii cd sd y te den nha dan. 6.3. Vat dung ca nhan can thiet Quan ao, tu trang, do dung ca nhan... 7. Cac loai tai lieu can nop cho bo mon sau khi ket thuc dot thirc hanh 7.1. Tap the nhom - Phieu dieu tra tai tram y te xa - Phieu dieu tra 10 chuan y te xa - Cac phieu dieu tra ho gia dinh (moi ngUdi 10 phieu), cung cac bang trong. - Ban ke hoach Truyen thong- Giao due siic khoe - Bai Truyen thong- Giao due siic khoe - Bao cao thu hoach cua nhom theo mau hu6ng dan 14 7.2. Ca nhan - Bang cham diem cho ca nhan cua Trung tam y te - Bang cham diem cho ca nhan cua can bo Tram y te 8. Nhumg diem can liru y Trong qua trinh thuc hanh tai tram y te, sinh vien tham khao phan phan cong trach nhiem cua tting ben lien quan den qua trinh thuc hanh (Y te tuyen huyen, tram y te. Uy ban nhan dan, Y te thon ban, giao vien TrUdng dai hoc Y khoa) de phoi hop co hieu qua. Nhiem vu cua cac ben lien quan nhu sau: - Can bo trung tam y te huyen va tram y te xa. + Quan ly sinh vien + Hudng dan sinh vien thuc hanh theo ke hoach cua trUdng + LUdng gia qua trinh thuc hanh. - Can bo giang bo mon Y hoc cong dong, Y hoc xa hoi va Dich te. + Chuan bi cong dong, xay dung ke hoach. + Tap huan cho sinh vien. + Giam sat trong qua trinh hoc tap. + LUdng gia khi ket thuc ddt thuc hanh cong dong - Can bo cac bo mon lam sang: + Giao chi tieu thuc hanh + Tap huan cho sinh vien. + Giam sat trong qua trinh hoc tap. Phu luc kem theo: 1. Phieu dieu tra 10 chuan quoc gia y te xa 2. Phieu dieu tra tai tram y te xa 3. Phieu dieu tra ho gia dinh 4. Bang trong 5. M&u bao cao 6. Phieu cham diem cua y te tuyen huyen 7. Phieu cham diem cua tram y te xa 15 TO CHUTC HOAT DONG CUA TRUNG TAM Y TE DU PHONG HUYEN MUC TIEU Sau khi hoc xong bai nay, sinh vien co kha nang: 1. Nhan xet diidc thiic trang to chiic hoat dong cua Trung tam Y te dii phong huyen ncfi sinh vien den thiic tap. 1. Bifdc 1: Gidi thieu Trung tam Y te dii phong huyen ndi sinh vien thiic te - Vi tri cua trung tam: la ddn vi sii nghiep triic thuoc Sd y te, chiu sii quan ly toan dien cua Giam doc Sd Y te, sii quan ly nha nUdc cua Uy ban nhan dan huyen va sii chi dao ve chuyen mon, ky thuat cua cac Trung tam thuoc he dii phong, cac Trung tam chuyen nganh tinh. - Cd cau to chiic cua Trung tam Y te dii phong huyen: + Bo may lanh dao: Giam doc, Pho Giam doc. Chiic trach nhiem vu cu the cua cac can bo lanh dao Trung tam. + Bo may giup viec Giam doc trung tam: cac phong chiic nang, giup viec. + Cac khoa chuyen mon cua trung tam. - Chile nang, nhiem vu va hoat dong cua Trung tam Y te dii phong huyen: + Xay diing ke hoach trien khai thiic hien cac nhiem vu chuyen mon ky thuat tren dia ban huyen. + To chiic trien khai thiic hien cac hoat dong chuyen mon, ky thuat ve phong, chong dich benh, HIV/AIDS, cac benh xa hoi, dinh dudng cong dong, an toan ve sinh thiic pham, truyen thong giao due siic khoe,... + Hudng dan va giam sat chuyen mon, ky thuat ve cac hoat dong thuoc linh viic phu trach doi vdi cac tram y te xa/phUdng, thi tran, cac cd sd y te tren dia ban. + Tham gia dao tao, dao tao lai, tap huan, boi diidng kien thiic ve chuyen mon nghiep vu cho can bo y te xa, nhan vien y te thon ban,... + Quan ly va to chiic trien khai thiic hien cac dii an thuoc chUdng trinh muc tieu y te quoc gia. + Quan ly can bo , che do chinh sach, quan ly tai chinh, tai san v.v.. 16 2. Bifdc 2: tham quan Trung tam Y te du phong huyen Cac phong lam viec cua Ban Giam doc; Cac phong chiic nang giup viec cho Ban Giam doc: phong hanh chinh tong hdp, phong truyen thong giao due siic khoe; Cac khoa chuyen mon nhU: - Khoa Y te cong cong; - Khoa Cham soc siic khoe sinh san; - Khoa Kiem soat dich, benh, HIV/AIDS; - Khoa An toan ve sinh thiic pham; - Khoa xet nghiem, v.v... Sinh vien can chu y tim hieu ve cO cau to chiic, hoat dong cu the cua cac phong ban nhU: - Co sd vat chat: so" phong lam viec, cac trang thiet bi,... - Nguon nhan luc cd bao nhieu ngUdi, du hay thieu? - Chiic nang nhiem vu cu the cua tiing thanh vien? - Ai phu trach chUdng trinh/hoat dong y te nao? Chiu sii dieu hanh, giam sat cua ai? - Tinh hinh thiic hien nhiem vu? Nhiing kho khan thuan ldi khi thiic hien nhiem vu dUdc giao? Cach khac phuc kho khan de hoan thanh nhiem vu? - Sinh vien xem, doc cac so sach, bieu mau bao cao thong ke va quan sat cach ghi chep, lam bao cao so sach. Trong khi can bo trung tam hudng dan, sinh vien can chu y quan sat, Mng nghe, ghi chep lai de cd dUdc nhiing thong tin can thiet. 3. Bifdc 3: thao luan nhom Sinh vien thao luan nhom theo 2 noi dung sau: 1. Thiic trang cO cau to chiic cua Trung tam y te dii phong huyen. 2. Hoat dong cua Trung tam Y te dii phong huyen. Sinh vien thao luan, so sanh giiia ly thuyet va thiic te de dua ra nhiing nhan xet cua minh ve thiic trang cd cau to chiic, sii phan cong cong viec, viec thiic hien cac nhiem vu va hoat dong cua Trung tam Y te dii phong huyen. Tim ra nhiing Uu diem can phat huy, nhiing bat cap can khac phuc de thiic hien tot cong tac du phong tai tuyen y te huyen trong cham soc va bao ve siic khoe nhan dan. TL/Ll/ONG GIA 1. Cong cu ludng gia 1. Thiic trang cd cau to chiic cua Trung tam y te du phong huyen co phu hdp vdi quy dinh cua he thong To chiic y te Viet Nam khong? 17 2. Su phan cong cong viec cho cac thanh vien d cac phong ban. khoa co phu hdp vdi chuc nang va nhiem vu cua ho khong? Tai sao? 3. Trung tam y te dii phong huyen co hoan thanh tot nhiem vu khong? Nhiing nhiem vu nao chua hoan thanh? 4. Nhung kho khan va thuan ldi trong qua trinh thiic hien nhiem vu cua Trung tam y te du phong huyen? Cach kh ic phuc kho khan de hoan thanh nhiem vu diidc giao? 2. Hirdng dan sinh vien tir lifdng gia Qua ket qua thao luan nhom. cac y kien thao luan dUdc thong nhat ngay sau buoi hoc chinh la phan dap an cho cac cau hoi tu ludng gia cua sinh vien. Trinh bay nhiing diem chua r5, con thac mac vdi can bo Trung tam hoac giao vien de dUdc giai dap. HUCING DAN TU HOC, TU NGHIEN CLfU, VAN DUNG THUC TE 1. PhUdng phap hoc Sinh vien doc tai lieu phan ly thuyet cd lien quan den cac noi dung hoc tap trong bai giang. danh dau nhiing diem con kho hieu hoac chua ro de thao luan vdi cac ban sinh vien khac trong khi hoc hoac hoi giao vien de dUdc giai dap. Sinh vien chu dong hoc hoi va de nghi vdi can bo Trung tam giup dd khi din thiet. 2. Van dung thuc te Qua thuc hanh tai Trung tam y te dii phong huyen, sinh vien tham quan tim hieu ve thuc trang to chiic hoat dong cua Trung tam dii phong huyen, tii dd sinh vien cd kha nang doi chieu so sanh giiia nhiing kien thiic dUdc hoc trong bai ly thuyet vdi thiic te dUdc chiing kien. dua ra nhiing nhan xet ve thiic trang cd cau to chiic, chiic nang. nhiem vu va hoat dong cua Trung tam y te dii phong huyen co phu hdp hay khong phu hdp vdi he thong y te Viet Nam hien nay. 3. Tai lieu tham khao 1. Bo Y te - UNICEF. Quan ly cham soc siic khoe ban d&u d tuyen y te cd sd. Nha xuat ban y hoc. Ha Noi. 2000. 2. Bo Y te - To chiic Y te The gidi. Du an phat trien he thong y te - Quan ly y te. Nha xuat ban y hoc. Ha Noi. 2001. 3. Bo mon Y xa hoi hoc. To chiic va quan ly y te. TrUdng Dai hoc Y khoa Thai Nguyen. 2006. 4. TrUdng Dai hoc Y khoa Thai Nguyen. Tai lieu day/hoc mon hoc Thiic hanh cong dong 1. 2006. 18 TO CHljrc VA QUAN LY CAC CHUtfNG TRINH MUC TIEU Y TE QUOC GIA TAI TRUNG TAM Y TE DU PHONG HUYEN MUC TIEU Sau khi hoc xong bai nay, sinh vien co kha nang: 1. Liet ke dittic ten cac chitting trinh muc tieu y te quoc gia dang trien khai tai Trung tam Y te dtf phong huyen ntii sinh vien den thiic tap. 2. Nhan xet dittic thiic trang to chiic chi dao, quan ly mot chitting trinh muc tieu y te quoc gia cu the tai Trung tam Y te dii phong huyen. 1. Bifdc 1: gidi thieu ve to chiic va quan ly cac chUdng trinh muc tieu y te quoc gia tai Trung tam Y te dii phong huyen: - Cac chiidng trinh muc tieu y te quoc gia hien dang dUdc trien khai tai Trung tam Y te dii phong huyen ndi sinh vien dang thiic tap. - Sii phan cong can bo phu trach cac chifdng trinh cu the, chiic nang nhiem vu cua cac can bo y te trong viec to chiic trien khai va quan ly cac chiidng trinh muc tieu y te quoc gia. 2. Bifdc 2: kien tap thiic hanh to chiic va quan ly cac chiidng trinh muc tieu y te quoc gia tai cac khoa chuyen mon cua Trung tam. - Chiidng trinh phong chong sot ret. - Chiidng trinh phong chong cac roi loan do thieu iot. - Chiidng trinh tiem chung md rong. - Chiidng trinh phong chong phong. - Chiidng trinh phong chong lao. - Chifdng trinh bao ve siic khoe tam than cong dong. - Chiidng trinh phong chong suy dinh diidng tre em. - Chiidng trinh bao dam chat lifdng, ve sinh an toan thiic ph&m. - Chiidng trinh phong chong HIV/AIDS. - Chu'dng trinh phong chong sot xuat huyet. Chu y tim hieu thiic te cac biidc to chiic chi dao hoat dong va cong tac quan ly dac biet la cong tac giam sat, danh gia cac chifdng trinh muc tieu y te quoc gia cua tuyen v te huyen doi vdi tuyen y te xa. 19 Tuy theo tiing chiidng trinh y te cu the ma co cac noi dung chi tiet, thong thifdng de to chiic chi dao thiic hien va quan ly mot chiidng trinh y te quoc gia tai tuyen y te huyen can thiic hien tot mot so" noi dung chinh sau: + Xay diing ke hoach, thanh lap Ban chi dao chiidng trinh, hop ban chi dao, tap huan ve chuyen mon ky thuat. + To chiic thiic hien ke hoach. + Quan ly nhan liic phuc vu cho chiidng trinh. + Quan ly thuoc, hoa chat, vacxin,... + Quan ly phiidng tien, vat tii va kinh phi lien quan den chiidng trinh. + Quan ly ky thuat chuyen mon thiic hien chiidng trinh. + Hiidng d in giam sat chuyen mon, ky thuat va danh gia chiidng trinh doi vdi cac tram y te xa/phiidng. + Tong hdp bao cao thong ke theo quy dinh cua tiing chiidng trinh v.v.. Trong khi can bo Trung tam hiidng dan, sinh vien can chu y quan sat, lang nghe, ghi chep lai nhiing thong tin can thiet. - Khi can bo trung tam gi6i thieu, hii6ng dan cho sinh vien cac loai so sach, cach ghi chep va cach lam cac bieu mau bao cao thong ke. Sinh vien nen xem chi tiet cu the cac bien ban ve cach thiic to chiic chi dao trien khai chiidng trinh, tham khao cach ghi chep cac so sach, bieu mau bao cao ve cac chiidng trinh muc tieu y te quoc gia. 3. BlTdc 3: thao luan nhom Sinh vien thao luan nhom theo 2 noi dung sau: 1. Hien cd bao nhieu chiidng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen? 2. Cac biidc to chifc chi dao hoat dong va cong tac quan ly cac chtfdng trinh muc tieu y te quoc gia tai Trung tam Y te dii phong huyen? Sinh vien thao luan nhom diidi sii hiidng dan, giam sat cua can bo Trung tam, sinh vien can so sanh giiia ly thuyet va thiic te de diia ra nhiing nhan xet cua minh ve thiic trang to chiic chi dao, quan ly cac chiidng trinh muc tieu y te quoc gia tai Trung tam Y te dii phong huyen. Til dd tim ra nhiing ifu diem can phat huy, nhiing bat cap c&n kh&c phuc de thiic hien tot cac chifdng trinh y te quoc gia tai tuyen y te huyen. TU LUONG GIA 1. Cau hoi luong gia 1. Hien co bao nhieu chifdng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen? Dd la nhiing chifdng trinh nao? 2. Cac bifdc de trien khai thiic hien 1 chifdng trinh muc tieu y te quoc gia cu the bao gom nhiing bifdc nao? Noi dung cua cac bifdc dd? 3. So sanh gnla thiic te va ly thuyet ve viec trien khai thiic hien chifdng trinh9 20 4. Ban co nhan xet gi ve cach ghi chep cac bien ban. so sach. bieu mau thong ke lien quan tdi cac chiidng trinh? Tii do rut ra nhiing kinh nghiem de co the giup cho viec to chiic va quan ly cac chiidng trinh y te quoc gia tai tuyen y te huyen diidc tot hdn. 2. Hudng dan sinh vien tir ludng gia Qua ket qua thao luan nhom. cac y kien thao luan diidc thong nhat ngay sau buoi hoc chinh la phan dap an cho cac cau hoi tu lifdng gia cua sinh vien. Trinh bay nhiing diem chiia ro, con thac mac v6i can bo Trung tam hoac giao vien de diidc giai dap. HlfCfNG DAN TU HOC, TU NGHIEN ClRJ, VAN DUNG THI/C TE 1. Phifdng phap hoc Sinh vien doc tai lieu phan ly thuyet co lien quan den cac noi dung hoc tap trong bai giang bao gom: - Muc tieu dinh hudng cua chiidng trinh. - Cac giai phap chuyen mon ky thuat de thiic hien chiidng trinh. - Cac biidc trien khai chiidng trinh muc tieu y te quoc gia. Trong khi doc tai lieu din danh dau nhiing diem con kho hieu hoac chiia r5 de thao luan vdi cac ban sinh vien khac trong khi hoc hoac hoi giao vien de diidc giai dap. Sinh vien chu dong hoc hoi va de nghi vdi can bo Trung tam giup dd khi can thiet. 2. Van dung thirc te Qua thiic hanh tai Trung tam Y te dii phong huyen, sinh vien tham quan kien tap tim hieu ve thiic trang to chiic va quan ly cac chUdng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen, tii do sinh vien co kha nang doi chieu so sanh giiia nhiing kien thiic dtfdc hoc trong bai ly thuyet vdi thiic te diidc chiing kien. diia ra nhiing nhan xet ve thiic trang viec thiic hien cac chiidng trinh muc tieu y te qudc gia, van dung diidc nhiing kinh nghiem thiic te de c6 the giup cho viec to chiic chi dao va quan ly chu'dng trinh y te quoc gia tai tuyen y te cd sd diidc tot hdn. 3. Tai lieu tham khao 1. Bo Y te - UNICEF. Quan ly cham soc siic khoe ban dau d tuyen y te cd sd. Nha xuat ban Y hoc. Ha Noi, 2000. 2. Bo Y te. Quan ly va hoat dong giam sat cua Trung tam Y te huyen. Trung tam nhan liic y te. Nha xuat ban Y hoc. Ha Noi, 1994. 3. Bo Y te. Quan ly cac chiidng trinh y te d tuven y te cd sd. Nha xuat ban Y hoc, 1990. 4. Bo mon Y xa hoi hoc. To chiic va quan ly y te. Triidng Dai hoc Y khoa Thai Nguyen. 2006. 5. Triidng Dai hoc Y khoa Thai Nguyen. Tai lieu day/hoc mon hoc cong dong 1. 2006. 21 TO CHUfC HOAT DONG KHOA DUDC, KHOA XET NGHIEM, PHONG KE HOACH TONG HOP TAI BENH VIEN TUYEN HUYEN MUC TIEU Sau khi hoc xong bai nay, sinh vien co kha nang: 3. Nhan xet dittic to chiic, hoat dong cua khoa dittic, khoa xet nghiem. 4. Mo ta to chiic hoat dong phong ke hoach tong htip tai benh vien tuyen huyen. 1. Cong tac quan ly duoc tai benh vien huyen 1.1. Btfdc 1: so sanh thiic trang to chiic hoat dong cua khoa diidc benh vien tuyen huyen v6i quy djnh TT Noi dung Co Khong To chut 1 Xay dung dam bao ve sinh, sach se, 2 Xay dung dam bao cao rao, an toan va phu hop vdi ti'nh chat cong viec. 3 Khoa difdc bo tri 6 dja diem thuan tien Hoat dong 1 Cong tac diitru mua, van chuyen, kiem nhap thuoc 2 Lap ke hoach thuoc, hoa chat , vat dung y te tieu hao hang nam dung quy djnh. 3 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nam theo dung djnh mCfc. 4 Mua thuoc dam bao so lifdng 5 Mua thuoc dam bao chat lifdng theo ke hoach 6 Thifc hien dung cac quy dinh ve mua sam 7 Thuoc phai bao quan theo dung yeu cau ky thuat 8 Van chuyen thuoc theo quy djnh 9 Kiem nhap thuoc theo quy djnh Quan ly thuoc, hoa chat va vat dung tieu hao y te tai cac khoa Thuoc ITnh ve phai dung trong ngay Thifdng trifc cap phat thuoc 24 h trong ngay Phieu Unh thuoc phai theo dung quy dinh.. 22 Cap phat thuoc, hoa chat theo cfung quy djnh Co lap sd sach, thanh toan theo quy djnh Thong ke bao cao ban giao theo quy djnh Cac khoa phong ban thuoc trong benh vien. Kiem ke thuoc, hoa chat dung cu tieu hao 1 Kiem ke theo djnh ky 2 Thanh lap hoi dong kiem ke theo quy djnh 3 Noi dung kiem ke: doi chieu sd xuat, sd nhap vdi chUng til 4 Doi chieu thuoc, hoa chat ghi trong sd sach v6i hien cd ve sd lupng va chat li/png.. Kho va cong tac bao quan, cap phat 1 Thiet ke theo quy djnh, an toan, sach se 2 Du phuong tien. 3 Du anh sang 4 Sap xep trong kho ngSn n£p 5 Kho cd du gia, ke 6 Cac thuoc va hoa chat trong kho dupe xep theo chung loai de lay, de thay 7 Tri/dc khi giao thuoc dirpc si thuc hien 3 kiem tra, 3 doi chieu 8 Thuc hien 5 chong: nham Ian, qua han, mdi mot, trom cap, tham hoa 9 To chUc chia thanh kho chinh va kho cap phat le 10 Khoa trang bj phuong tien cho phu hpp Cong tac dutru mua, van chuyen, kiem nhap thuoc 1 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nSm dung quy dinh. 2 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nSm theo dung djnh mUc. 3 Mua thuoc dam bao sd lupng 4 Mua thuoc dam bao chat lupng theo ke hoach 5 Thuc hien cac dung cac quy djnh ve mua sam 6 Thuoc phai bao quan theo dung yeu cau ky thuat 7 Van chuyen thuoc theo quy djnh 8 Kiem nhap thuoc theo quy dinh 1.2. BWO'C 2: sinh vien thao luan nhom theo cac cau hoi sau. Cau hoi 1: to chiic cua khoa nhif the nao, co phu hdp khong? tai sao? Cau hoi 2: cong tac da tru mua, van chuyen, kiem nhap thuoc cua benh vien co dung theo quy dinh khong? 23 Cau hoi 3: thuoc dUdc van chuyen nhu the nao? Cau hoi 4: kiem nhap thuoc co theo quy dinh khong? Cau hoi 5: quan ly thuoc, hoa chat va vat dung tieu hao y te tai cac khoa nha the nao? Cau hoi 6: viec kiem ke thuoc, hoa chat dung cu tieu hao thac hien nha the nao? (Khi nao kiem ke? thanh phan hoi dong kiem ke gom nhang ai? Noi dung kiem ke la gi? Cau hoi 7: kho va cong tac bao quan, cap phat nha the nao? Cau hoi 8: to chac chia thanh kho chinh va kho cap phat le khong? Cau hoi 9: lam the nao de hoat dong cua khoa dupe tot hon 2. Cong tac quan ly tai khoa xet nghiem tai benh vien tuyen huyen 2.1 Btfoc 1. so sanh thac trang to chac hoat dong cua khoa xet nghiem benh vien tuyen huyen vdi quy dinh STT Noi dung Co Khong To chifc 1 Khoa xet nghiem bo tri noi thuan tien cho ngudi benh noi tru va ngoai tru 2 Co noi chd benh pham 3 Co noi nhan benh pham 4 Co noi riTa chai Ip khir khuan 5 Co labo huyet hpc 6 Co labo hoa sinh 7 Co la bo vi sinh 8 i Co buong ve sinh du nude sanh de cac thanh vien trong khoa ve sinh. tay ue trudc khi ve 9 Tudng labo op gach men kinh chiu acid toi tran nha 10 Du anh sang theo yeu cau 11 Co cira thong gio 12 Nen nha cao rao thoang nude, lat gach men mau nhln khong tham nude 13 Mat ban xet nghiem lat gach men kinh chju acid 14 Co he thong chau rCra 15 He thong cong kin, va thoat nude nhanh Hoat dong I Trach nhiem cua y ta, dieu dudng 1 Lay benh pham thudng quy cua ngudi benh noi tru mang theo phieu 24 yeu cau xet nghiem co ghi du cac muc va chu ky cua bac sT 2 Dan nhan mau do vdi nhumg benh pham co kha nSng lay nhiem Trach nhiem cua trudng khoa xet nghiem 4 Cung cap day du phi/ong tien cho nhan vien trong khoa 5 Bo tri can bo de nhan benh pham thiidng quy dam bao sd luong va chatluong Nhiem vu KTV xet nghiem 1 Lay benh pham thudng quy den 10h sang, benh pham cap cuU nhan ngay 2 Lay benh pham tai giudng benh vdi benh nhan cap cUu 3 Lay benh pham tai khoa xet nghiem vdi benh nhan den kham hoac ngoai tru 4 Thuc hien ky thuat xet nghiem theo dung quy trinh ky thuat 5 Thiic hien cac ky thuat dam bao chinh xac va trung thuc 6 Ky thuat vien tra xet nghiem day du dung gid 7 Thiic hien thudng true theo quy che thudng true 8 Quan ly hoa chat theo dung quy che 9 Suf dung thuoc theo dung quy che 10 Sir dung trang thiet bj y te theo dung quy che 11 Thuc hien cong tac thong ke bao cao theo quy dinh 12 Quan ly va sir dung hoa chat, thuoc thir va trang thiet bj y te theo dung quy che 13 Dam bao an toan lao dong 14 Dam bao trat tu ve sinh va vo khuan theo quy djnh 2.2. Bifdc 2: thao luan nhom theo cac cau hoi sau Cau hoi thao luan Cau hoi 1: to chiic cua khoa nhii the nao co phu hpp khong? Cau hoi 2: triidng khoa va cac nhan vien trong khoa co thiic hien day du nhiem vu cua minh khong? co dung khong? Neu khong tai sao? Cau hoi 3: thiic hien cac ky thuat co dam bao chinh xac va trung thiic khong? Cau hoi 4: ky thuat vien co tra xet nghiem d&y du dung gid khong? Tai sao? Cau hoi 5: co thiic hien thiidng triic theo quy che thiidng triic khong? Cau hoi 6: cac ky thuat xet nghiem co dung theo cac yeu cau ky thuat khong? Neu khong tai sao? Cau hoi 7: quan ly hoa chat va sii dung thuoc va trang thiet bi y te theo dung quy che khong? 25 Cau hoi 8: co thiic hien cong tac thong ke bao cao theo quy dinh khong? Cau hoi 9: phong ke hoach tong hop benh vien da khoa tuyen huyen: Cau hoi 10: cac bo phan cua phong ke hoach tong hpp cua benh vien tuyen huyen ndi sinh vien thiic tap co gi giong va khac vdi ly thuyet? Tai sao? 3. Hoat dong cua phong ke hoach tong hop cua benh vien tuyen huyen 3.1. Bifdc 1: so sanh thuc trang to chiic hoat dong cua phong hanh chinh tong hop benh vien tuven huyen vdi quy dinh TT Noi dung Co Khong To chifc 1 Kham benh i2 Nghien ciiu khoa hoc ! 3 Chi dao tuyen 4 Hop tac quoc te 5 Bao cao thong ke, lull truf, Nhiem vu 1 Thiic hien cong tac thong ke bao cao theo quy dinh '2 Hirdng din cac khoa phong lap ke hoach thiic hien 3 To chirc dao tao lien tuc 4, Tong ket danh gia cong tac chuyen mon 5 To chirc dieu hoa, phoi hop trong cac khoa ! 6 Phoi hop vdi phong chi dao tuyen 7 To chiic thiic hien hop tac quoc te 8 Dam bao viec liiu trii, thong ke, khai thac ho sd theo quy dinh- 9 To chiic cong tac thifdng triic toan benh vien 10 Djnh ky sd ket tong ket 11 Chuan bj cac phifdng an phong chong thien tai, tham hoa-------------- 3.2. Bifdc 2: thao luan nhom theo cac cau hoi sau Cau hoi 1: Phong hanh chinh tong hdp da va dang thiic hien diidc nhiing nhiem vu gi? nhiing nhiem vu gi chiia thiic hien diidc? Tai sao? Cau hoi 2: Co giai phap gi de phong hanh chinh tong hdp cua benh vien lam tot hdn nua nhiem vu diidc giao? 26 TU LUONG GIA 1. Cong cu li/dng gia bSng cau hoi Khoa dupe 1. Vj tri khoa diidc d dau? Co hdp ly khong? tai sao? 3. Benh vien thuc hien cong tac du tru mua. van chuyen. kiem nhap thuoc cua benh vien co dung theo quy dinh khong? 4. Thuoc van chuyen co di thang t\jf ndi mua den thang kho khong? 5: Thuoc lav ve co dUdc kiem nhap ngay khong? tai sao? 6. Khoa co to chiic llnh. cap phat thuoc 24 gid trong ngay khong? 7. Co thuc hien viec ghi chep thong ke bao cao ban giao theo quy dinh khong? 8. Khoa co hoan thanh nhiem vu cua minh khong? Khoa xet nghiem 1. Vi tri khoa dUdc d dau? Co hdp ly khong? tai sao? 2. TrUdng khoa xet nghiem co thuc hien dung cac nhiem vu cua minh khong? 3. Y ta. dieu difdng khoa XN co thuc hien dung trach nhiem cua minh khong? 4. Ky thuat vien xet nghiem co thuc hien dung trach nhiem cua minh khong? 5. Viec thiic hien ky thuat xet nghiem co theo dung quy trinh ky thuat khong? Phong hanh chinh tong hop 1. Liet ke cac bo phan trong phong hanh chinh tong hdp 2. Co thuc hien to chiic dao tao cho cac nhan vien trong benh vien khong? 3. Co thuc hien tong ket danh gia cong tac chuyen mon khong? 4. Co to chiic dieu hoa. phoi hdp trong cac khoa 5. Co dam bao viec lUu tru. thong ke. khai thac ho sd theo quy dinh 6. Cd dinh ky sd ket tong ket? 7. Cd chuan bi cac phUdng an phong chong thien tai. tham hoa khong0 HUONG d An TU HOC, TU NGHIEN CLRJ, VAN DUNG THUC TE 1. Phirong phap hoc Sinh vien on tap cac phan ly thuyet co lien quan den to chiic, hoat dong cua khoa dUdc. khoa xet nghiem va phong ke hoach tong hdp cua benh vien da khoa tuyen huven. Cac van ban. quy che hudng dan quan ly trang thiet bi khoa dUdc khoa xet nghiem. tai san nhan luc cua benh vien da khoa tuyen huyen Bu'dc 1: so sanh thuc trang to chiic hoat dong cua khoa dUdc. khoa xet nghiem. phong hanh chinh tong hdp cua benh vien tuyen huyen vdi quy dinh 27 Budc 2: thuc hien thao luan nhom theo cau hoi thao luan Sinh vien chia nhom thao luan Budc 3: tu ludng gia bang cau hoi lupng gia; doi chieu nhiing kien thiic/ky nang da hoc dUdc vdi muc tieu bai hoc de ra tu! do rut ra nhiing kinh nghiem/bai hoc thuc te ve to chUc hoat dong khoa dUdc, khoa xet nghiem va phong hanh chinh tong hdp. 2. Van dung thirc te Qua nhiing nhan xet ve te ve to chiic hoat dong khoa dUdc, khoa xet nghiem va phong hanh chinh tong hdp ndi sinh vien thuc tap, rut ra nhiing bai hoc kinh nghiem. TU do giup sinh vien se hieu va thuc hien tot hdn viec quan ly tai khoa xet nghiem, khoa dUdc cung nhu phong hanh chinh tong hdp. 3. Tai lieu tham khao 1. Bo Y te -Vu to chiic can bo, Cac van ban quy dinh ve he thong To chiic y te dia phUdng va che do chinh sach doi vdi y te cd sd hien hanh. Ha Noi, 2002 2. Bo Y te. Du an phat trien he thong y te. Quan ly y te. Ha Noi, 2002 3. Bo mon Y Xa hoi hoc. To chiic va Quan ly y te. TrUdng Dai hoc Y khoa Thai Nguyen. 2004 4. Bo Y te. Quy che Benh vien. Nha xuat ban Y hoc, 2001 5. Quan ly hoat dong long nghep cham soc siic khoe ban dau. Quan ly va long nghep tram y te cd sd. Trung tam nhan luc y te Nha xuat ban Ha Noi, 1994. 6. TrUdng Dai hoc Y khoa Thai Nguyen. Tai lieu hudng dan thuc hanh CBE. 2004 28 TANG HUYET AP MUC Tl£u Sau khi thitc hanh xong bai nay, sinh vien co khd nang: 1. De xuat, doc ket qua mot so xet nghiem can thiet phu hdp vdi tuyen cd sd. 2. Chan doan va xii tri ban dau benh nhan tang huyet dp tai tuyen y te cd sd. 3. Chi dinh chuyen tuyen va to chiic chuyen tuyen nhiing triidng hdp tang huyet dp viidt qua khd nang cua y te cd sd. 1. Chuan bj Sinh vien doc trtfdc bai ly thuyet Tang huyet ap. hoi benh. tham kham. thu thap cac thong tin can thiet 0 benh nhan va lam benh an. 2. Thirc hanh cac ky nang 2.1. Hoi benh tai buong benh Sinh vien hoi day du cac van de sau tai buong benh - Khai thac benh sii - Sinh vien hoi benh. thu thap thong tin. + Cac trieu chiing dau dau, nhin md, te bi, kien bo ngon chi + Thdi gian xuat hien trieu chiing + Hoan canh xuat hien trieu chiing + Ti'nh chat cua trieu chiing - Hoi tien sU + Thdi gian bi tang huyet ap + Tien sii bi tang huyet ap cua gia dinh va benh nhan + Nhiing benh ma benh nhan da mac va tien sii dung thuoc. + Tien sU nghe nghiep. moi triidng song. 2.2. Ky nang kham va de xuat xet nghiem de phat hien dupe cac trieu chimg cua tang huyet ap tai buong benh 2.2.1. Ky nang kham Sinh vien thiic hanh kham de phat hien diidc cac trieu chiing cua tang huyet ap. phat hien ton thiidng cac cd quan dich. Cac sinh vien khac quan sat, sau dd dong gop y kien. 29 - Kham toan than: do huyet ap dong mach. Phat hien tinh trang thieu mau, kham tuyen giap. - Kham thifc the cac cd quan de phat hien cac trieu chiing benh ly va cac bien chiing da co. Chu y bien chiing tai tim, than kinh, than... 2.2.2. Ky nang de xuat xet nghiem Cac sinh vien cung tham gia de xuat cac xet nghiem va neu y nghia, muc dich cac xet nghiem do - Cac xet nghiem cd ban: + Cong thiic mau: de danh gia mile do thieu mau + X.Quang tim phoi: + That trai to do tang huyet ap + Cac ton thifdng khac kem theo (de chan doan phan biet va tien lifdng benh) . Sinh hoa mau: danh gia chile nang than giup cho dieu tri 9 . y . £ • Xet nghiem nifdc tieu: tim protein trong nifdc tieu. - Cac xet nghiem dac hieu; + Tham dd chiic nang than: creatinin mau, nifdc tieu 24h + Dien tim 2.3. Ky nang ra y lenh dieu tri cu the Sinh vien difa ra phac do dieu tri cho benh nhan. Cac sinh vien khac gop y kien de cd difdc phac do dieu tri thich hdp cho benh nhan cu the, phu hdp vdi dieu kien cu the cua benh vien tuyen huyen: bao gom cac thuoc ha ap, ldi tieu, an than va cac thuoc dieu tri trieu chiing - Tang huyet ap bufde 1: + Ngifdi tre dung Propranolon + Ngifdi gia dung ldi tieu hypothiazid - Tang huyet ap bifdc 2: ket hdp ca hai loai tren - Tang huyet ap bifdc 3: Ket hdp ca hai loai tren va them mot thuoc gian mach: + Aldomet + Niphedipin + Uc che men chuyen (Chi dinh, lieu lifdng xem cu the trong bai ly thuyet Tang huyet ap) 2.4. Tuvan phdng benh Sinh vien tuy theo tinh huong benh nhan cu the ma co bien phap giao due siic khoe va phdng benh phu hdp, co the thong nhat noi dung tif van tren benh nhan cu the: 30 - Tac dong cua moi triidng, gia dinh va xa hoi den benh nhan. - Tim cac yeu to" thuan ldi gay tang huyet ap de dieu tri triet de. - Hudng dan cho benh nhan biet phat hien cac dau hieu Tang huyet ap va cac dau hieu benh nang co bien chiing. - Can bo y te: ch&n doan s6m va xii tri dung theo phac do. - Cung co" mang liicii y te cd sd, trang bi thuoc thiet yeu va phiidng tien cap ciiu. 3. Thao luan nhom Sinh vien tom tat: - Cac trieu chiing xuat hien tren benh nhan - Cac xet nghiem da co trong dieu kien tai Trung tam Y te tuyen cd sd. - Phac do dieu tri cu the cho benh nhan. - Noi dung tii van, giao due siic khoe cho benh nhan. TU LUONG GIA 1. Cong cu luung gia Chon cau dung nhat trong cac tinh huong sau: T inh h u on g 1: mot benh nhan nam 65 tudi, huyet ap do nhieu lan va diidc xac dinh la 180/90mmHg, nghien riidu, nghien thuoc la rat nang, moi ngay uong 500ml riidu va hut ngay 20 dieu thuoc trong vong 15 nam. Xet nghiem midc tieu: Protein 0,8g/l, hong cau (+), tru hat (-); Dien tam do: day that trai. Hoi: 1. Benh nhan tang huyet ap loai gi? Giai doan may? 2. Benh nhan da co ton thiidng nhiing cd quan dich nao? 3. Bien phap dieu chinh loi song nao d benh nhan nay la quan trong de phong bien chiing nang them. T inh h u o n g 2 : benh nhan Nam 70 tudi, cao lm66 nang 75 kg, vao vien nhieu lan vi tang huyet ap. Hien tai huyet ap la 180/100 mm Hg. Dien tam do co day that trai, xet nghiem glucose/mau 200mg/dl, co tien sii nghien riidu va thuoc la rat nang. Cau 1: benh nhan nay co: A. Khong tang huyet ap B. Tang huyet ap tam thu ddn doc C. Tang huyet ap tam triidng ddn doc D. Tang ca 2 tri so" Cau 2: benh nhan nay trong tinh trang: A. Beo phi B. Qua can C. Nhe can D. Dat can nang ly tiidng 31 Cau 3: yeu to anh hiidng nhieu nhat den tang huyet ap cua benh nhan nav la: A. Dai diidng B. Beo phi C. Riidu D. Thuoc la 2. Hi/dng dan tu ludng gia Sinh vien tra ldi cac cau hoi theo hiidng dan, nen thao luan nhom de chia se kinh nghiem. Sau khi tii tra ldi sinh vien xem dap an cuoi tai lieu HUONG DAN TU HOC, TU NGHIEN CLTU, VAN DUNG THL/C TE 1. PhUdng phap hoc tap Sinh vien nen hoc tap tai phong kham Noi vi se co nhieu benh nhan, sinh vien se thiic hanh khai thac trieu chiing, tien sii va chan doan benh tang huyet ap. tii van cho benh nhan ve dieu tri va phong benh tang huyet ap d tai nha. - Danh gia cac trieu chiing: cua tang huyet ap va cac bien chiing cua tang huyet ap, Sii dung phac do de chain doan va dieu tri cho benh nhan. - Thiic hanh doc phim tim phoi - Chi dinh cac phac do dieu tri tang huyet ap - Thiic hanh dieu tri cac giai doan cua tang huyet ap - Thiic hanh hiidng dan cho benh nhan uong thuoc tai khoa - Phan giai doan va theo doi ket qua dieu tri va thay doi phan do 2. Van dung thuc te Hien nay benh tang huyet ap tiidng doi pho bien, chan doan nhiing khong pho bien tai cac benh vien tuyen huyen, do vay chan doan tang huyet ap chu yeu diia vao lam sang. Can liiu y hiidng dan benh nhan khong nen sii dung cac loai thuoc nam khi khong ro nguon goc va tac dung. Hien nay nhieu loai thuoc nam co pha tron ty le cao corticoid, khi benh nhan sii dung co the tang huyet ap do cac tac dung phu nang ne cua corticoid. 3. Tai lieu tham khao 1. Triidng Dai hoc Y Ha Noi. Trieu chiing noi khoa Tap 1, Nha xuat ban Y hoc - Ha Noi2000 2. Triidng Dai hoc Y Ha Noi. Benh hoc noi khoa Tap 1, Nha xuat ban Y hoc Ha Noi - 2000 3. Triidng Dai hoc Y Ha Noi. Dieu tri hoc Tap 1, Nha xuat ban Y hoc - Ha Noi - 2000 32 DAI THAO D1AJNG MUC TIEU Sau khi thiic hanh xong bai nay, sinh vien co khd nang: 1. Khai thac diidc benh sii, tien sii va nhiing yeu to lien quan d benh nhan dai thao diidng. 2. D i xuat xet nghiem phu hdp vdi tuyen y te cd sd va nhan dinh diidc ket qua xet nghiem. 3. Diia ra diidc phac do dieu tri phu hdp, chuyen tuyen tren nhiing triidng hdp viidt qua khd nang. 4. Tii van ve phong benh va che do an kieng cho benh nhan dai thao diidng tai tuyen y te cd sd, tai gia dinh va cong dong. 1. Chuan bj Sinh vien chon benh nhan dai thao diidng dang diidc dieu tri tai khoa Noi hoac phdng kham benh. tot nhat nen chon benh nhan ma sinh vien da gap trong tua triic cua ngay horn trade. Sinh vien: hoi benh. tham kham, thu thap cac thong tin can thiet d benh nhan va lam benh an. 2. Thuc hanh cac ky nang 2.1. Hoi benh: tai buong benh cua benh nhan dai thao diidng, sinh vien hoi benh nhan day du cac van de sau: 2.1.1. Khai thac berth sCr benh rthan dai thao dudng: - Tiep can benh nhan, tao ra sii tin cay giiia benh nhan va thay thuoc. - Hoi ky ly do vao vien. - Khai thac cac trieu chiing chinh nhii an nhieu, uong nhieu, dai nhieu, gay nhieu: + Thdi gian xuat hien. + Dieu kien xuat hien + Mute do + lie n trien + Moi lien quan + giiia cac trieu chiing 33 Khai thac cac trieu chiing khac di kem nha ngila ngoai da, nhilc dau, md mat, te bi, kien bo, dau tile ngac. kho thd, sot, phu.... - Qua trinh dieu tri tai nha va tai benh vien: + Thiic hien che do an. + Che do dung thuoc. - Tinh trang dap ang v6i dieu tri va tinh trang hien tai (sU tang giam cua cac trieu chang). 2.1.2. Khai thac tien sCr va yeu to lien quan - Khai thac ky tien sa ban than ve thdi gian phat hien benh dai thao dUdng. tien sa dung cac thuoc nha corticoid, tien sa san khoa, nhat la tien sa de con tren 4 kg. - Khai thac tien suf ve thoi quen an uong, sinh hoat. Tien sa nghien radu, hut thuoc la. - Khai thac tien sa gia dinh xem co ngadi bi dai thao dUdng, tang huyet ap, beo phi hay khong? 2.2. Ky nang kham va de xuat xet nghiem Kham thac the cac cd quan. chu y xac dinh huyet ap dong mach, chi so BMI, phat hien cac bien chang tim mach, than, than kinh, ton thadng khac... De xuat cac xet nghiem co the thac hien dUdc tai benh vien: neu cac xet nghiem, muc dich, phan tich cac ket qua xet nghiem. - Cac xet nghiem cd ban: danh gia tinh trang thieu mau, nhiem trung, ton thadng phoi, protein trong na6c tieu. - Xet nghiem thlch hop: + Dinh lapng dadng huyet luc doi: day la xet nghiem quan trong nhat, nham chan doan xac dinh. theo doi va danh gia ket qua dieu tri. Tai tuyen huyen co the sii dung may do dadng huyet ca nhan de xac dinh dadng huyet, thuan tien va cho ket qua chinh xac. + Dinh ladng dadng nieu: nham chan doan phan biet va danh gia ket qua dieu tri. Doi v6i tuyen y te cd sd co the xet nghiem dinh tinh dadng nieu bang giay thu. + Xet nghiem xeton nieu: giup chan doan the benh va tien ladng. + Dinh ladng cac thanh phan lipid mau. Day la roi loan rat hay gap d benh nhan tieu dadng. + Dien tam do: nham danh gia ton thadng dong mach vanh va tinh trang cd tim. nhat la d benh nhan dai thao dadng thadng khong co bieu hien dau ngilc ro rang. + Dinh ladng ure, creatimn mau: nhim danh gia chac nang cua than, phat hien suy than man tinh. 34 2.3. Ra quyet djnh dieu trj, xac djnh chuyen tuyen Can diia vao ket luan cha’n doan de co quyet dinh dieu tri cho phu hdp, can tinh tdi kha nang tai chmh cua benh nhan. nep song, thdi quen sinh hoat. dieu kien cu the cua benh vien. ngifdi benh va gia dinh benh nhan. - Difa ra nguyen tac dieu tri cu the. - Che do nghi ngdi, hoat dong the life phu hdp. che do an kieng. Can xay diing cho benh nhan mot thiic ddn chi tiet de benh nhan co the thiic hien de dang sau khi ra vien. - Dieu tri b&ng thuoc: + Can diia vao chan doan dai thao difdng type 1 hoac type 2, tinh trang benh kem theo cung nhif ham lifdng difdng huyet luc doi cua benh nhan de liia chon thuoc, lieu lifdng thuoc phu hdp nhat vdi tinh trang benh hien tai cua ngifdi benh. + Chu y sii dung cac thuoc dieu tri ma benh vien huyen dang co va dang sii dung cho benh nhan. - Muc dich cua dieu tri la duy tri rmic difdng huyet trong gidi han binh thifdng. han che cac bien chiing. - Chuyen tuyen: nhiing trifdng hdp benh nhan dai thao difdng cd nhieu bien chiing; suy tim. suy than, nhiem trung, tai bien mach nao, khong kiem soat diidc diidng huyet, ha diidng huvet thifdng xuyen. 2.4. Phdng benh, tuvan sue khoe Sinh vien diidc hiidng dan tuv theo tinh huong benh nhan cu the ma cd bien phap giao due siic khoe va phong benh phu hdp. Chu trong tdi tii van ve dieu tri tai cong dong, hifdng d in che do an cu the, cach phdng va xii tri tai bien ha difdng mau. - Sinh vien thiic hien tii van, thuyet phuc ngiidi benh va gia dinh ve cham soc. tii theo ddi danh gia ket qua dieu tri. kham siic khoe dinh ky, thiic hien che do an kieng va dieu tri tai nha. - Trong khi tii van can chu y tdi mot so diem sau day: + Tuoi cang ldn thi ty le dai thao difdng cang cao, ty le dai thao difdng cao d nhiing ngiidi beo. Tuy nhien d Viet Nam, thifdng gap d cac ddi tifdng gay. + Phat hien sdm benh dai thao difdng. dieu tri kip thdi, lien tuc, quan ly ngoai tru tich ciic nhlim de phdng bien chiing do benh gay nen. - Nhiing ngiidi tren 45 tuoi. neu difdng mau binh thifdng. cii 3 nam lam lai xet nghiem difdng m aul lan. + Can xet nghiem difdng mau cho nhiing ngifdi cd nguy cd cao (beo, cd ho hang d the he thii nhat vdi ngiidi bi dai thao dudng, phu mi sinh con cd can nang tren 4 kg. ngiidi tang huyet ap, nhiing ngifdi cd roi loan chuyen hoa lipid). + Benh nhan dai thao difdng dieu tri ngoai tru, 3 thang 1 lan nen theo ddi can nang. huyet ap. difdng huyet luc ddi, protein meu. 35 + Trong dieu tri can quan tam giam thap cac yeu to nguy cd nhii tang huyet ap, hut thuoc la, loi song it van dong cung cac yeu to nguy cd khac (cac yeu to stress oxy hoa). + De du phong va xii tri tai bien ha difdng huyet tai benh vien va gia dinh co hieu qua, tat ca benh nhan dai thao difdng can phai difdc giai thich de hieu biet cac trieu chiing ha difdng huyet, nhiing bien phap de co the phong va tu dieu tri difdc khi co tinh trang nay. 3. Thao luan nhom Sau khi thUc hanh tai buong benh, nhom sinh vien tien hanh thao luan nhom tai hoi trUdng. Tren cd sd cac thong tin thu dUdc, tii thiic te sinh vien co suy nghl de ra cach dieu tri, bien phap phong benh va phong bien chiing cho benh nhan d benh vien va cong dong. Noi dung thao luan bao gom: - Nhiing trieu chiing cd nang chinh va nhiing tien sii co lien quan d benh nhan. Nhiing diem giong va khac so vdi kinh dien, y nghia cua cac thong tin thu dUdc trong chan doan, tien lifdng va dieu tri benh. - Nhiing xet nghiem da dUdc de xuat, tinh kha thi, muc dich. Can phai phan tich cac ket qua xet nghiem da co, neu ifu diem va nhiing han che cua cac xet nghiem nay. - Tii chan doan, dUa ra phac do dieu tri thich hdp. Neu nhiing mat con han che khi thuc hien dieu tri tai benh vien huyen. Sinh vien can diidc thao luan ve muc dich ciia viec dung thuoc la gi? Lieu lifdng, cach dung insulin, cac sulfamid ha difdng huyet, cac thuoc phoi hdp. Nhiing tac dung chinh, tac dung khong mong muon co the xay ra, tudng tac thuoc, nhiing thuoc co the thay the cho phu hdp vdi tiing tuyen, co the sii dung thuoc nam (miidp dang) trong dieu tri. - Bien phap phong benh cu the cho benh nhan, dac biet lifu y phong bien chiing tim mach va bien chiing ha dudng huyet. - Tif van siic khoe du phong benh, xac dinh difdc thiic ddn cho benh nhan va cach thifc hien che do an kieng tai benh vien huyen va cong dong. TU LUONG GIA 1. Cong cu luong gia * Cau hoi trac nghiem khach quan va tinh huong 1. Dinh hiidng chan doan dai thao difdng d tuyen y te cd sd, chu yeu dUa vao: A. Tien sii gia dinh co ngifdi bi dai thao diidng B. Lam sang co bieu hien 4 nhieu C. Dinh lifdng diidng nieu D. Xet nghiem difdng mau luc doi bang que thif 2. Benh nhan nam 52 tuoi bi DTD type 2, da dieu tri tai benh vien dupe 5 ngay. Khoang 23 gid benh nhan met moi, dau dau, chong mat, va mo hoi, chan tay 36 lanh, 30 phut sau benh nhan lim di, goi hoi khong biet, Huyet ap 145/95 mmHg. Kha nang de xay ra nhat la: A. Hon me do tang ap liic tham thau B. Hon me do ha difdng huyet C. Nhoi mau cd tim D. Tai bien mach mau nao 3. Loai qua nao sau day co ham lifdng glucid thap nhat co the sii dung cho benh nhan dai thao difdng: A. Mit mat B. Na C. Difa hau D. Chuoi tieu 4. Nguyen tac dau tien khi xay dung che do an cho benh nhan dai thao difdng la: A. Dam bao du nang lifdng B. Giam bdt nang lifdng C. Can bang giiia nhung yeu to' sinh nang lifdng D. Dieu chinh nang lifdng phu hdp vdi tiing doi tifdng. 5. 0 benh nhan dai thao difdng cd tang huyet ap, thuoc ha huyet ap thich hdp nhat la: A. Trofurid B. Coversyl C. Adalat D. Aldomet 6. Trong cac loai thiic pham sau day, loai nao cd ham lifdng cholesterol thap nhat: A. Ca B. Thit ldn C. Thit bo D. Cua 7. Trong khi dieu tri cho benh nhan dai thao diidng typ 1 va typ 2, cd mot van de khac biet la: A. Che do an B. Dung insulin C. Dung sulfamid D. Che do luyen tap 37 8. Mot benh nhan nam 47 tudi bi dai thao dudng typ 2, da dieu tri tai benh vien huyen. diidng huyet on dinh. Sau khi ra vien. benh nhan tiep tuc dieu tri theo ddn cua bac si. Benh nhan thiidng than phien la hay met mdi. dau dau. chong mat, va mo hoi, chan tay lanh. nhat la ve buoi tdi. PhUdng phap xtf tri thich hdp nhat trong triidng hdp nay la: A. Uong thuoc ha ap B. Dung thuoc gian mach vanh C. Tiem glucose liu triidng tinh mach. D. Uong thuoc tang ciidng tuln hoan nao * Bang kiem liidng gia ky nang thUc hanh: Bang kiem danh gia ky nang thuc hanh tii van benh nhan thuc hien che do an kieng. ITT Noi dung kiemDiem 0 2 3 1 Chao, hoi benh nhan .. 2 Thiet lap moi quan he tin cay giOa thay thuoc va benh nhan 3 Thao luan ve cach thuc hien che do an kieng d benh nhan dai thao dudng 4 Bac sT cung cap thong tin day du cho benh nhan va ca ngudi nha benh nhan 5 I Benh nhan va ngudi nha benh nhan nhan thue dUdc ve nhCrng viec ma ho can thuc hien tai gia dinh 6 Bac sT giai thich ldi ich cua viec thuc hien che do an kieng trong dieu tri benh dai thao dudng. 7 Bac sT hoi xem ho cd the gap khd khan gi khi thuc hien che do an kieng 8 Bac sT da chi din cho benh nhan cach thdc vUdt qua khd khan 9 Bac sT hoi benh nhan xem ho cd cd gang thuc hien che do an kieng khong 10 Bac sT cd bo tri mot buoi gap khac de thao luan ve nhung tien bo va nhimg viec benh nhan da lam dUdc Tong sd. Thang diem: tu: 0 den 3 diem 0: khong lam 1: lam chiia tot 2: lam tot 3: lam rat tot < 20 diem: khong dat. 20 - 30 diem: dat yeu cau 38 2. Hudng dan tif ludng gia Sinh vien tra ldi cac cau hoi theo hiidng din, nen thao luan nhom de chia se kinh nghiem. Sau khi tii tra ldi sinh vien xem dap an cuoi tai lieu HUONG DAN TU HOC, TU NGHIEN ClfU, VAN DUNG THUC TE 1. PhUdng phap hoc tap Sinh vien nen hoc tap tai phong kham Noi vi se co nhieu benh nhan, sinh vien se thiic hanh khai thac trieu chiing, tien sii va chan doan benh dai thao diidng, tii van cho benh nhan ve dieu tri va phdng benh dai thao diidng d tai nha. Sinh vien can doc cac tai lieu hiidng dan xii tri dai thao diidng. - Danh gia cac trieu chiing cua dai thao diidng va cac bien chiing cua dai thao diidng. Sii dung phac do de chin doan va dieu tri cho benh nhan. Can biet: - Test nhanh diidng mau - Chi dinh cac phac do dieu tri dai thao diidng. - Thiic hanh dieu tri cac giai doan cua dai thao diidng. - Thiic hanh hiidng dan cho benh nhan uong thuoc tai khoa - Phan giai doan va theo doi ket qua dieu tri . 2. Van dung thuc te Hien nay benh dai thao diidng tiidng doi pho bien, chin doan khong kho, co nhieu xet nghiem giup chan doan nhiing khong pho bien tai cac benh vien tuyen huyen, do vay chan doan dai thao diidng chu yeu dUa vao lam sang.Viec theo doi niidc tieu 24 gid va test nhanh diidng mau cd y nghia rat quan trong trong chin doan va dieu tri benh nhan dai thao diidng tai benh vien tuyen huyen va tai cong dong. 3. Tai lieu tham khao 1. Vu Van Dinh (2000), Hoi siic cap ciiu, Nha xuat ban Y hoc, Ha Noi. 2. Thai Hong Quang (2001), Benh noi tiet, Nha xuat ban Y hoc, Ha Noi. 3. Tran Diic Tho (1990), Benh dai diidng, Bai giang benh hoc noi khoa, Tap I, Nha xuat ban Y hoc, Ha Noi. 39 HEN PHE QUAN MUC TIEU Sau khi thiic hanh xong bai nay, sinh vien co khd nang: 1. Hoi va khai thac diidc benh sii va tien sii cua hen phe quan. 2. Kham, chan doan va phan do 4 bac hen theo To chiic Y te The gidi. 3. Xii tri diidc cdn hen phe quan tai benh vien huyen. 4. Tii van diidc cho benh nhan cac bien phap dii phong va quan ly benh nhan hen phe quan tai cong dong. 1. Chuan bj - Sinh vien doc trade bai ly thuyet hen phe quan, hoi benh, tham kham. - Thu thap cac thong tin c&n thiet d benh nhan va lam benh an. 2. Thirc hanh cac ky nang 2.1. Hoi benh tai phdng benh Sinh vien se hoi cac van de sau day: Hoi ky ly do vao vien: khd thd, ho va khac ddm Khai thac benh sii: - Trieu chiing kho thd: (de chan doan xac dinh va nguyen nhan). + Thdi gian xuat hien khd thd + Hoan canh xuat hien kho thd + Tinh chat cua cdn khd thd + Tii the cua benh nhan de dd kho thd - Trieu chiing ho (de chan doan nguyen nhan va bien chiing) + Thdi gian xuat hien ho. + Hoan canh xuat hien ho. + Tinh chat cua ddm (neu cd): trang dinh (cdn hen thong thiidng); mau vang hoi (cd boi nhiem); trang cd lan mau (co the la hen tim); lien quan giua khd thd va ho. 40 - Trieu chiing dau ngiic (de chan doan phan biet) + Hoan canh xuat hien dau ngiic + Miic do cua dau ngiic: dau dii doi (co the la nhoi mau cd tim, nhoi mau phoi, tran khi mang phoi); dau am 1 ca hai ben, tang len khi ho va khd thd. - Trieu chiing sot (de chian doan nguyen nhan va bien chiing) + Xuat hien triidc hay sau cdn khd thd + Mile do sot + Tinh chat cua sot - Lien quan cua sot vdi ho va khac ddm - Cac trieu chiing khac kem theo Khai thac tien sii: (de giup chan doan xac dinh va nguyen nhan ) - Thdi gian bi benh hen - Tien sii di ling cua gia dinh va benh nhan. - Nhiing benh ma benh nhan da mac va tien sii dung thuoc. - Nhiing benh phoi ma benh nhan da mac triidc day. - Tien sii nghien thuoc la, nghe nghiep (bui phoi), moi triidng. 2.2. Ky nang kham va de xuat xet nghiem de phat hien diroc cac trieu chung cua hen phe quan tai phdng benh 2.2.1. Ky nang kham Mot sinh vien se thiic hanh kham benh nhan de phat hien diidc cac trieu chiing cua hen phe quan. Cac sinh vien khac quan sat, sau dd cd nhan xet va dong gop y kien de hoan thien ky nang kham va phat hien dung cac trieu chiing cd tren benh nhan: Kham toan than (Phat hien miic do suy ho hap): - Tii the benh nhan, nam go! dau cao hay phai ngoi day de thd. - Tinh than cd hot hoang vat va do thieu oxy nao khong? - Mau sac da cd tim tai khong? - Co phu khong (Tam phe man)? - Hach cd to khong (d nach, ho thiidng don) - Mach, huyet ap, nhiet do, nhip thd. Kham ho hap: - Nhin miic do co keo cac cd ho hap, di dong cua long ngiic. - Sd phat hien rung thanh xem miic do ii khi. 41 - Gd phat hien miic do a khi - Nghe thong khi phe nang phat hien cac ran rit, ran ngay, ran iam. (Chu y cac trifdng hdp mat RRPN ) Kham tim mach: Phat hien tieng tim benh ly, do huyet ap (phan biet vdi hen tim) Kham tieu hoa: - Cac benh ly d cd quan tieu hoa. - Xem gan cd to khong (Tam phe man?). Kham cac cd quan khac: Phat hien cac benh ly d cac cd quan khac de chan doan xac dinh va chan doan phan biet. 2.2.2. Ky nang de xuat xet nghiem: cac sinh vien cung tham gia thao luan de xuat cac xet nghiem ( neu y nghia, muc dich cac xet nghiem dd). Cac xet nghiem cd ban: - Cong thiic mau + Danh gia mile do thieu mau + Xem cd nhiem trung khong - X. quang tim phoi: + Tinh trang uf khi phe nang + Cd ton thiidng lao khong? + Tim to? + Cac ton thiidng khac kem theo (de chan doan phan biet, tien ladng) - Sinh hoa mau: + Dinh liidng ure, creatinin (danh gia chiic nang than giup dieu tri) - Xet nghiem phan va niidc tieu: tim cac benh kem theo Cac xet nghiem thich hdp benh vien tuyen huyen lam diidc + Xet nghiem ddm + Dien tim 2.3. Phan muc do can hen phe quan Sinh vien thiic hanh diia ra phan loai miic do hen tren benh nhan. Cac sinh vien khac nghe, quan sat, cho y kien danh gia xem phan loai nha vay dung hay sai, cd the bo sung y kien. 2.3.1. Phan do hen phe quan trudc day - Cdn hen mac do nhe: benh nhan khd thd nhe, nghe phdi thay co ran rit lan toa. 42 - Cdn hen mile do trung binh: benh nhan kho thd nhanh, nghe phoi co ran rit rd, co bieu hien suy ho hap nhe, P a02 giam, PaC 02tang. - Cdn hen miic do nang: bieu hien suy ho hap ro, ri rao phe nang mat. Tinh than lu l&n, mach dao ngiidc. P a02 giam nhieu. PaC 02 tang nhieu, pH mau giam. 2.3.2. Hien nay (Theo To chirc Y te The gidi) Dao Bac Trieu chumg Trieu chiing ve dem Liru li/dng dinh dong liru ludng dinh 1. Nhe cach quang 2. Nhe dai ding 3. Trung binh dai ding 4. N3ng dai ding < 2 lan/ tuan. - Khong trieu chiing va binh thiidng cac con dot phat. - Cac con dot phat ngan. > 2 lan/ tuan. - Cac con dot phat co the anh hi/dng den sinh hoat - Trieu chung xay ra hang ngay. - Sir dung thuoc cat con hang ngay. - Cac con dot phat anh huong den sinh hoat. - Con dot phat > 2 lan/ tuan va keo dai ca ngay. - Trieu chiing xay ra lien tuc. - Gidi han hoat dong hang ngay. - Cac con dot phat xay ra thi/dng xuyen. < 2 lan/ thang > 80% < 20% > 2 lan/ thang > 80% 20 - 30% > 1 lan / tuan > 60-80% > 30% Thiidng xuyen< 60% > 30% 2.4. Ra quyet dinh dieu tri, nhung trudng hop nang can chuyen tuyen Sinh vien diia ra phac do dieu tri cu the cho benh nhan. Cac sinh vien khac co y kien dong gop de xay diing phac do dieu tri phu hdp cho benh nhan, cu the: - Cdn hen nhe: + Thd oxy + Thuoc gian cd phe quan nhe: salbutamol, theophylin... + Thuoc an than - Cdn hen trung binh + Thd oxy + Thuoc gian cd phe quan: diaphylin, aminophylin.... + Thuoc long ddm + Khang sinh (neu co boi nhiem) - Cdn hen nang: + Thd oxy. khi dung 43 + Thuoc gian cd phe quan: diaphylin, amino phylin.... + Thuoc long ddm * Lieu phap corticoid + Boi phu niidc dien giai + Khang sinh (neu co boi nhiem) + Tap thd + Dieu tri tam phe man (neu co) - Chuyen tuyen: hen phe quan ac tinh (khong cat diidc cdn hen nang qua 48h) 2.5. Phdng benh Tuy theo tinh huong benh nhan cu the ma sinh vien co the tien hanh ta van cac bien phap phong benh phu hdp. Sinh vien thao luan, sau do cho nhan xet va tom t it cac bien phap dii phong tren benh nhan cu the. De thiic hien tot noi dung nay sinh vien can xem bai ly thuyet triidc de biet cac yeu to" sau co the la tac nhan gav ra hen phe quan: - Ve sinh moi triidng, chong khoi bui, cai thien nha d, nang cao m\lc song - Tranh sang tran tinh than. - Khong tiep xuc vdi di nguyen, tranh lanh. - Dieu tri nhiing benh ma benh nhan da mac va dung thuoc khong lam nang benh hen. - Bo thiic an ma benh nhan bi di ling. - Han che tiep xuc vdi bui. - Bo thoi quen hut thuoc la. - Dieu tri cac benh phoi va diidng ho hap tren. - Cach dieu tri khi nen cdn hen tai nha. 3. Thao luan nhom Sinh vien thao luan va tom tat: - Cac trieu chiing ma benh nhan co - Ket qua cac xet nghiem da co trong dieu kien tai Trung tam Y te tuyen huyen - Phac do dieu tri cu the cho benh nhan - Tii van siic khoe cho benh nhan TU LUONG GIA 1. Cong cu li/dng gia Chon cau tra ldi dung nhat trong cac tinh huong sau: Tinh huong: benh nhan nam 56 tuoi co tien sii bi benh hen phe quan 23 nam. Thiidng xuyen benh nhan co cdn hen phe quan xuat hien khi thay doi thdi tiet. 44 Khoang hai ngay nay benh nhan xuat hien cdn kho thd, d nha da diidc dung thuoc gian cd phe quan va dung khang sinh nhiing khong ket qua. Benh nhan diidc diia vao vien trong tinh trang: - Kho thd tim tai co keo cd ho hap ro. - Nghe phoi day ran ngay, ran rit, Sm. - Phu hai chi diidi, gan to vdi tinh chat gan tim. - Tim nhip nhanh 110 lan/ phut, huyet ap 100/60 mmHg. Khi cho benh nhan thd oxy phai: A. Thd oxy lieu thap lien tuc. B. Thd oxy lieu thap ngat quang. C. Thd oxy lieu cao lien tuc. D. Thd oxy lieu cao ngat quang 2. Trieu chumg chinh cua hen phe quan la A. Kho thd khi gang sufc B. Kho thd cap C. Kho thd lien tuc, keo dai D. Ca 3 loai tren deu sai 3. Chup Xquang phoi trong cdn hen thudng tha'y A. Md toan bo hai phoi B. Phoi sang hdn binh lithiidng C. Md hai day phoi lan len D. Ca ba deu sai Bang thang diem lilting gid ky nang thiic hanh ti( van phong benh hen phe quan Thang diem TT Cac budc thirc hien 1 Chao hoi, giai thich, thong cam vdi benh nhan 2 Thiet lap moi quan he tin cay giCra benh nhan va thay thuoc 3 Tii van trong dieu tri: - Kieng thirc 3n dj ung - Uong nhieu niidc - Tii the benh nhan de cho 6k thd. - Vo rung long ngiic 45 0 1 2 3 4 Tif van de phong benh: - Tranh sang tran tinh than - Khong tiep xuc vdi dj nguyen - Dieu trj nhurng benh ma benh nhan da m§c va dung thuoc khong lam nang benh hen - Bo thiic an ma benh nhan bj di ling - Han che tiep xuc vdi bui - Bo thdi quen nghien thuoc - Dieu tri cac benh phoi va diidng ho hap tren Tong sd diem Tieu chuan: Lam tot: 3 Lam dat: 2 Lam khong dat: 1 Khong lam: 0 4. Hiidng dan tii liidng gia Danh gid: Tot > 70% diem chuan Dat 50 - 70% Khong dat < 50% Sinh vien tra ldi cac cau hoi theo hiidng dan, nen thao luan nhom de chia se kinh nghiem. Sau khi tii tra ldi sinh vien xem dap an cuoi tai lieu. HlfCJNG DAN TU HOC, TU NGHIEN CLfU, VAN DUNG THI/C TE 1. PhUdng phap hoc tap Sinh vien nen hoc tap tai phong kham Noi vi se co nhieu benh nhan, sinh vien se thiic hanh khai thac trieu chiing, tien sii va chan doan benh hen phe quan, tii van cho benh nhan ve dieu tri va phong benh hen d tai nha. Sinh vien c&n doc cac tai lieu hiidng dan xii tri hen cua hoi hen - di ling. - Danh gia cac dau hieu: thd nhanh, rut lom long ngiic, thd rit khi nam yen ... Sii dung phac do de chain doan cho benh nhan - Thiic hanh doc phim tim phoi - Chi dinh cac phac do dieu tri hen phe quan - Thiic hanh dieu tri cac miic do hen phe quan - Thiic hanh hiidng dan cho benh nhan uong thuoc tai khoa - Phan do va theo ddi ket qua dieu tri va thay doi phan do 2. Van dung thiic te Hien nay chan doan hen tiidng doi rong rai, do liiu liidng dinh rat cd y nghia cho chan doan nhiing khong pho bien tai cac benh vien tuyen huyen, do vay chan doan hen chu yeu diia vao lam sang. 46 Nhiing benh nhan co tien sii di ling can than trong khi sii dung cac thuoc co nguy cd gay cdn hen nhii aspirin, khang sinh... Liia chon thuoc hen cung can ltfu y cac tac dung phu nhii gay tang nhip tim, run...Thiic hanh sii dung cac thuoc dang phun mu. Can liiu y hudng dSn benh nhan khong nen sii dung cac loai thuoc nam khi khong ro nguon goc va tac dung. Hien nay nhieu loai thuoc nam co pha tron ty le cao corticoid, khi benh nhan sii dung co the giam cdn hen nhiing se gay cac tac dung phu nang ne cua corticoid. 3. Tai lieu tham khao 1. TrUdng Dai hoc Y Ha Noi. Trieu chiing Noi khoa Tap 1, Nha xuat ban Y hoc - Ha Noi - 2000 2. TrUdng Dai hoc Y Ha Noi. Benh hoc Noi khoa Tap 1, Nha xuat ban Y hoc Ha Noi - 2000 3. TrUdng Dai hoc Y Ha Noi. X Quang cd quan ho hap, Nha xuat ban Y hoc - Ha Noi 1995 4. TrUdng Dai hoc Y Ha Noi. Dieu tri hoc Tap 1, Nha xuat ban Y hoc - Ha Noi - 2000 47 LAP SO THEO DOI Sifc KHOE DA ME TAI NHA MUC TIEU Sau khi hoc xong bai nay, sinh vien se co khd nang: 1. Lap so, ghi chep va theo doi diidc siic khoe ba me tai nha. 2. Lap bang theo doi va quan ly thai san. 3. Nhan thiic diidc tam quan trong cua viec quan ly, theo doi siic khoe cho cac ba me khi mang thai 1. Chuan bj - Chuan bi benh nhan: cac phu nQ co thai - Sinh vien: + Mac ao, doi mu, deo khau trang + Chuan bi trutfc bai giang ly thuyet: kham thai va quan ly thai nghen - Chuan bi ve phtfdng tien dung cu: so theo d5i siic khoe ba me tai nha, but ghi. dung cu de kham thai, phong de kham va ghi chep, bang go (giay kho AJ, keo cat giay, giay til dan (kim. chi khau). 2. Thirc hanh cac ky nang 2.1. Ky nang lap so theo ddi sifc khoe ba me tai nha Phieu kham thai Trang 1: PHIEU KHAM THAI So dang ky Ho va te n :....................................................................................................... N gay thang nam sin h:................................................................................. D an t o e .......................................................................................................... Trinh do van h o a :......................................................................................... I D ia chi:............................................................................................................ Thon, b a n :......................................................................................... X a h u y e n ......................................................................................... T in h :.................................................................................................... Ho va ten chong ......................................................................................... Ngudi lap phieu 48 Trang 2: Ngay thang nam lap phieu:....../....... /................. Tudi (khi co thai):................................. 18-35 <18 >35 Chieu cao:........................................... 145 cm 144 cm tra xuong Tien sir san khoa Sd lan da de 1-3 0 >4 Say thai 2 lan lien tiep Thai chet trong tuf cung San giat Chay mau trudc de Bang huyet sau de De kho Mo lay thai De con dudi 2500 g Con chet tuan dau sau sinh Vo sinh Tien sur benh Neu co benh thi ghi ro ten benh................................................................. T ran g 3: Cham soc hien tai Co thai lan thCf:........ De lan thuc........... Ngay dau KCC:........ Du doan ngay de: Tudi thai 1 -12 tuan Ngay tham thai 1 Can nang Thudng Bait thudng 2 Cao tCr Thudng cung Bat thudng 3 Tim thai Thudng Bat thudng 4 Ngoi thai Thudng Bat thudng 5 Huyet ap Thudng Bat thudng 6 Co phu 7 Da rat xanh 13- 27 tuan 28-32 tuan 33-37 tuan 38-41 tuan 49 8 Chay mau am dao --------- 9 Co protein nieu 10 Ngay tiem phong UV Mui 1 Mui 2 11 Uong vien sat/ Folic Tham thai it nhat 3 lan Tiem phong uon van du 2 mui Trang 4: Chuyen da de So vdi ngay dir kien Du thang Non thang Gia thang Thdi gian chuyen da Binh thifdng Keo dai Ngoi thai Chom Khac Cach de Thirdng Kho,...Fooc xep, giac hut Mo lay thai Bang huyet Khong Co San giat Khong Co Noi de Co sd y te De d nha, de roi Ngirdi dd Can bo y te Mu vi/dn Tirdd Rach, cat, khau TSM Khong Cd Tre so sinh Trai / gai De hoi....gid...... ngay.....thang.....nam....... So con khi de Mot Hai trd len Khoe Ngay Cham Thd Binh thi/dng Khd Mau da Hong Tim tai Can nang khi de > 2500g < 2500g Tinh trang con Song Chet... ngay Bu me Gid dau Sau mot gid dau T rang 5: Cham soc ba me sau de 2 Da rat xanh Co hoi tir cung San djch Bang huyet SCra me Sot, sot ret Uong VTM A Uong vien s it K C BT Cham BT Hoi K C K C K C K C K C T 1 T2 T3' T4 T5 T6 50 K: Khong. C: Co - Ghi cac yeu to can theo doi ba me trong 6 tuan dau sau de. - Neu co noi dung nao bat thiidng thi danh dau X vao cot do. Toi thieu phai cham soc 2 lan sau de. Can ghi ngay sinh de biet tuan thii may sau de 2.2. Lap bang theo ddi va quart ly thai san Cach lam bang: - Bang co 13 cot doc, cot dau ghi dia chi (thon, xom, to san xuat), cac cot sau ghi cac thang tii 1 den 12. - Cac o ngang, moi thon mot o. - Diidi cac thon la o cong thang. Sau khi da sinh, tom diiOc boc ra va chuyen xuong o sau de phia diidi de cham soc va theo doi sau de. 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 Tong sd Sau de Cach lam tom: - Tot nhat dung giay tii gian, hoac khau chi vao moi o de luon tom. - Kich thiidc tom va liiOng thong tin ghi tren tom, tuy theo cd bang, toi thieu bao gom: - Ho va ten thai phu. - Tudi thai phu. - Tien sii thai nghen: PARA (thii tii: so' lan de dii thang, so lan de thieu thang, so lan nao/ say thai, so” con hien song) - So dang ky thai (so" sd theo doi thai nghen) - Ngay dau tien cua ky kinh cuoi. - Ngay dii kien de. - Mau sac cua tom: tom xanh la con so, tom vang la con thii 2, tom do la con thii 3 tret len. 51 (Dan vao thang sinh) Mau tom nho: 1,5 cm x 6 cm v6i 4 tin Ho va ten:.......... .Tuoi:.......... KCC:.................. DKS:.......... x 8 cm vdi 6 tin Ho va ten:....... ...Tudi:.......... TSSK:...... ...Sd DKT:...... KCC:.............. ...DKS:.......... TSSK: tien sU san khoa (PARA) Ho va ten:...... Tudi:............... Oiachi:........... Da sinh ngay:. Quan ly sau de (Dan vao thang sinh) So DKT: so dang ky thai: Vi du 34/ 05 la so" dang ky thii 34 cua nam 2005. KCC: ngay dau tien cua ky kinh cuoi cung. DKS: ngay dii kien sinh. Ky hieu co nguy cC: danh dau hoa thi * vao dau ben phai cua tom. Tom diidc lam ngay khi dang ky thai va dan vao o tiidng iing cua thang dii kien sinh 3. Thao luan Nhom sinh vien thao luan ve cac van de: - Cach lap so theo doi thai phu tai nha - Cach lap bang theo doi va quan ly thai san. - Y nghia cua viec lap bang theo doi va quan ly thai san. Sinh vien rut ra bai hoc kinh nghiem: nhiing viec da lam diidc can phat huv. nhiing viec chiia lam tot can khac phuc de lam tot hdn. BAI TAP TiNH HUONG Bai tap 1 Hay lap bang quan ly thai san cho xa A vdi cac thong tin sau: Xa A co 5 thai phu: 52 Thon 1: chi Nguyen Thi M 24 tuoi, co thai lan 1, KCC ngay 20/2/2005. Thon 2: chi Le Thi N 36 tudi, co thai lan 2, KCC ngay 5/6/2005. lan 1 md lay thai. Thon 3: chi Lo Thi K 32 tudi, co thai lan 3, KCC ngay 4/5/2005, 2 lan triidc de thiidng. Thon 4: chi Pham Thi C 22 tudi, co thai lan 1, KCC ngay 3/7/2005. Thon 5: chi Nguyen Thu A 26 tudi, co thai lan 3, KCC ngay 26/4/2005, 2 lan say thai. Bai tap 2: nhan dinh tinh hinh thai san tai mot xa theo ket qua bang quan ly thai san nhii sau 1 2 3 4 5 6 7 8 9 10 11 12 1 • • • 2 • C2> 3 • 4 • K _> 5 Tong sd Sau de C 3 • Tl/LUONG GIA 1. Cong cu li/dng gia: bang kiem Bang kiem lap so theo sifc khoe ba me tai nha I Diem dat ! TT Noi dung Diem chuan ■1 Hoi benh va ghi vao noi dung phieu kham thai 2 2 1 0 2 2 Kham cho thai phu va ghi ket qua vao phan cham soc hien tai 2 3 Danh gia difoc ket qua kham thai binh thiidng hay bat thifdng 4 Danh gia tinh trang san phu va thai nhi sau de 2 5 Nhan dinh diroc hien tai thai nghen binh thiidng 2 hay cd nguy co Tong so 10 Danh gid 2. Tu thiic hien dung, ghi du noi dung vao phieu kham thai 1. Thiic hien dung co sii hiidng din 0. Khong lam hoac lam sai 53 Cach cho diem: < 50 %: khong dat 50 -7 5 %: Dat > 75 %: Tot Thang diem danh gia ky nang lap bang theo doi va quan ly thai san TT Noi dung Diem He Diem dat chuan so 2 1 0 1 Ke bang quan ly thai san dung quy djnh 2 1 2 Lam tom theo dung quy djnh 4 2 3 Ghi dung noi dung tren mau tom to 4 2 4 Dan tom vao o thich hdp 4 2 5Nhan biet so thai phu mang thai lan 1,2,3 tai mot xa 2 1 6Nhan biet so phu nCf chiia sinh va da sinh tai mot xa 2 1 7 Nhan biet so thai phu co nguy cd tai mot xa 2 1 Tong so 20 Danh gid: « 2. Tii thuc hien dung 1. Thiic hien dung co sii hudng dan 0. Khong lam hoac lam sai Cach cho diem'. < 50 %: khong dat 50 -7 5 %: dat > 75 %: tot 2. Huting dan tif lifdng gia - Sinh vien triic tiep lap phieu theo ddi siic khoe ba me tai nha cho mot thai phu cu the, sinh vien khac danh gia diia vao bang thang diem. Sau do thay the nhau de danh gia kha nang dat diidc cua moi sinh vien - Sii dung thong tin ve quan ly thai san tai xa de tii lap bang quan ly thai san diia theo bang thang diem tren. HlfCfNG DAN TL/ HOC, T l/ NGHIEN CLfU, VAN DUNG THL/C TE 1. Phifdng phap hoc tap Sinh vien hoc tap tai tram y te xa, benh vien huyen, se thiic hanh hoi benh va tham kham thai de phat hien dau hieu nguy cd. Sinh vien can doc tai lieu cach kham thai, thai nghen nguy cd. 54 - Danh gia cac dau hieu sau khi tham kham thai va xet nghiem can thiet. - Tu dien vao phieu kham thai sau moi lan kham thai phu. - Dua vao so' lieu quan ly thai nghen tai tram y te xa de lap bang theo doi quan ly thai san 2. Van dung thuc te - Sinh vien sii dung phieu kham thai cho moi doi tUdng thai phu khi quan ly thai nghen, ghi chep dung, phu hop vdi tUng tieu chi cua phieu kham thai. - Neu lap bang quan ly thai san trong dieu kien khong du phUdng tien nhu da trinh bay co the dung bang go co dan giay hoac boc vai, kim chi khau s in cho de cai tom. 3. Tai lieu tham khao 1. TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa 1999 2. TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa tap II 2002 3. Day hoc tich cUc trong dao tao Y hoc NXB Y hoc 1999. 4. Hudng dan Phat trien tai lieu hoc tap thuc hanh DA VN - HL 5. Bo Y Te - Hudng dan chuain quoc gia ve cac dich vu CSSKSS 6. Du an dao tao Y Khoa ve SKSS - TrUdng DHYK Hue - Bang hudng dan hoc tap cac ky nang lam sang giang day tai cd sd thuc dia 55 GIAO OUC Sifc KHOE VA TIT VAN CHO NGlfcl MANG THAI MUC TIEU Sau khi hoc xong bai nay, sinh vien se co khd nang: 1. Giao due siic khoe va tu! van diidc cho ngiidi mang thai 2. Nhan thiic diidc tam quan trong cua viec giao due siic khoe va tii van cho ngiidi mang thai. 1. Chuan bj - Chuan bi benh nhan: cac phu nut mang thai - Chuan bi dia diem tii van: phong tii van - Chuan bi dung cu de kham thai - Chuan bi ve kien thiic: + Doc triidc ly thuyet bai ky nang tii van, cham soc triidc de. + Co kien thiic va ky nang tii van cho phu nut mang thai 2. Tien hanh Sinh vien mang trang phuc chinh te, tap trung nghe, quan sat bac si tii van. Sau khi diidc kien tap sinh vien se thiic hanh diidi sii quan sat va hiidng d in cua bac si . Mot sinh vien thiic hanh tii van cho mot thai phu, cac sinh vien con lai se quan sat, nhan xet theo bang kiem lutdng gia ky nang giao due siic khoe va tii van cho ngiidi mang thai. 3. Thao luan Bac si tap trung nhom sinh vien thao luan ve cac van de: - Noi dung giao due siic khoe hay tii van: cac kien thiic dung va chiia dung - Thai do cua sinh vien khi giao due siic khoe hay tii van: thai do nao tot can khen ngdi, thai do nao chiia tot can rut kinh nghiem. 56 Bang kiem ky nang cham soc siic khoe va tit van cho ngitbi mang thai TT Noi dung cham soc va cac budc tu van Y nghia Yeu cau phai dat Chao hoi, lam quen: 1 2 4 4 5 Noi cho ngudi co thai biet can thiet phai kham thai djnh ky, nhac ho den kham lan sau dung hen, can noi cho ho ket qua cua lan kham Noi dung can tuyen truyen va ti/van Ve dinh dudng: noi cho thai phu biet viec can thiet cua dinh difdng - Dinh difdng: cung cap sifc de khang, tranh difdc thieu mau khi cd thai, con khong bj suy dinh difdng, cham phat trien ve tri tue, tir vong, phdng benh cho me. - T3ng khau phan an va tang chat lifdng khau phan Tif van ve che do lam viec khi cd thai: - Khuyen thai phu lam viec theo kha nang -Vao thang cuoi trifdc ngay dif kien de nen nghi ngdi - Ngu it nhat 8 gid trong ngay, ngu trifa 30’ den 1 gid Ve sinh than the: - Nang tam rifa hang ngay - Nang ve sinh bo phan sinh due - Lau dau vu hang ngay - Tranh tiep xuc vdi ngifdi om Sinh hoat trong khi co thai: Can thoai mai tranh cang thing lo lang trong sinh hoat, d ndi thoang mat, mac ao quan rong rai, sinh hoat tinh due can han che, nhe nhang Giao tiep giCfa thay thuoc va thai phu Giup thai phu hieu difdc tam quan trong cua dinh difdng doi vdi thai nghen Giup thai phu biet difdc can cd che do nghi ngoi hdp ly khi mang thai Giup thai phu biet difdc cach ve sinh khi mang thai Giup thai phu biet difdc che do sinh hoat khi mang thai Thai phu yen tam tin tifdng, hdp tac vdi thay thuoc Thong tin chinh xac, cu the , de hieu Thong tin chinh xac, cu the , de hieu Thong tin chinh xac, cu the , de hieu Thong tin chi'nh xac, cu the , de hieu 6Chuan bj sin sang cho cuoc sinh sap tdi Giup thai phu yen tam, chd ddn diia con chao ddi 7 Tiem chung va bo sung vi chat Phdng benh Cd lich tiem chung va uong thuoc cu the 8Giai doan sau cua thai nghen, tif van nuoi con bang sura me 9Tom tat va kiem tra thong tin thai Giup thai phu biet cach nuoi difdng tre sau sinh Thong tin chinh xac, cu the , de hieu Thai phu ndi lai difdc phu tiep nhan difocDanh gia difdc ket qua tif van nhCrng van de da difdc tif van 57 BAI TAP TlNH HUONG Tinh huongl: ban hay giao due stic khoe hay tu van cho mot thai phu sau khi kham thai hoi ban: can phai gin giut ve sinh than the trong luc co thai nhtf the nao de dam bao siic khoe cua ca me va con. Tinh huong 2: ban hay til van cho mot thai phu nong dan sau khi kham de nghi ban cho biet trong cong viec dong ang va cong viec gia dinh cua minh nen nhtf the nao de giut gin difdc siic khoe va an toan cho thai nghen. TU LUONG GIA 1. Cong cu lifcfng gia: bang kiem Thang diem danh gia ky nang cham soc siic khoe va til van cho ngiidi mang thai TT Noi dungDiem chuan Chao hoi, lam quen: Diem dat 2 1 0 Noi cho ngudi co thai biet can thiet phai kham 2 1 thai djnh ky, nhac ho den kham lan sau dung hen, can noi cho ho ket qua cua lan kham Noi dung can tuyen truyen va tif van Ve dinh dudng: noi cho thai phu biet viec can thiet cua dinh dirdng - Dinh dirdng: cung cap sifc de khang, tranh 2 difdc thieu mau khi cd thai, con khong bj suy 2 dinh difdng, cham phat trien ve tri tue, tir vong, phdng benh cho me. - TSng khau phan an va tang chat lifdng khau phan Tif van ve che do lam viec khi co thai - Khuyen thai phu lam viec theo kha nang 2 3 -Vao thang cuoi trifdc ngay dif kien de nen nghi ngdi - Ngu it nhat 8 gid trong ngay, ngu trifa 30 phut den 1 gid Ve sinh than the: - Nang tim rira hang ngay - Nang ve sinh bo phan sinh due 2 4 - Lau dau vu hang ngay - Tranh tiep xuc vdi ngifdi om Sinh hoat trong khi co thai: can thoai mai tranh cang thing lo lang trong sinh hoat, d ndi thoang 5 2 mat, mac ao quan rong rai, sinh hoat tinh due can han che, nhe nhang 6 Chuan bj sin sang cho cuoc sinh 2 7 Tiem chung va bo sung vi chat 2 8Giai doan sau cua thai nghen, tif van nuoi con bang sCfa me 2 9 Tom tat va kiem tra thong tin thai phu tiep nhan difoc 4 _ .Tong so ....../20 58 Danh gid: 2. Tu thvfc hien dung 1. Thvfc hien dung co sii hiidng dan 0. Khong lam hoac lam sai Cach cho diem: < 50 %: khong dat 50 - 75 %: dat > 75 %: tot 2. Hifdng dan tiflirong gia Sinh vien thtfc hanh tii van cho thai phu, cac sinh vien khac quan sat, liidng gia theo bang kiem. Khi khong co benh nhan thi sinh vien thiic hanh dong vai theo hai tinh huong da cho de thiic hien cham soc siic khoe va tif van cho ngiidi mang thai. Danh gia diia theo bang thang diem HU6NG DAN TlJ Hpc, TL/ NGHIEN CL/U, VAN DUNG THL/C TE 1. Phifdng phap hoc tap Sinh vien hoc tap tai tram v te xa, benh vien huyen, sinh vien se thiic hanh tii van cho cac thai phu cach cham soc thai nghen. Sinh vien can doc tai lieu ve ky nang tii van cho thai phu. thay doi giai phau khi co thai, cham soc ba me khi mang thai. - Triic tiep tren thai phu, sinh vien thiic hanh ky nang cham soc siic khoe va tif van cho ngiidi mang thai. - Diia vao bang kiem tii hoc de biet diidc y nghia va tieu chuan phai dat cua moi biidc sinh vien can thiic hien. - Sinh vien sii dung bang thang diem de tii danh gia minh trong qua trinh hoc tap de dan hoan thien ve ky nang cham soc siic khoe va tii van cho ngiidi mang thai. 2. Van dung thirc te - Sinh vien tii van cho thai phu can phu hdp vdi hoan canh cu the. dieu kien kinh ke. trinh do van hoa va phong tuc tap quan. 3. Tai lieu tham khao 1. Triidng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa 1999 2. Triidng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa tap II 2002 3. Day hoc tich ciic trong dao tao Y hoc NXB Y hoc 1999. 4. Hiidng dan Phat trien tai lieu hoc tap thiic hanh DA VN - HL 5. Bo Y Te - Hiidng dan chuan quoc gia ve cac dich vu CSSKSS 6. Dii an dao tao Y Khoa ve SKSS - Triidng DHYK Hue - Bang hiidng dan hoc tap cac ky nang lam sang giang day tai cd sd thiic dja 59 KHAM PHU KHOA MUC TIEU Sau khi hoc xong bai nay, sinh vien co khd nang: 1. Thiic hien va thao tac dung cac biidc tham kham phu khoa. 2. Nhan dinh diidc tinh trang co tii cung, am ho, dm dao va cac dau hieu bat thiidng cua cd quan sinh due. 3. Nhan thiic diidc tam quan trong cua viec kham phu khoa trong chan doan cac benh ly diidng sinh due. 1. Chuan bj 1.1. Dung cu - Ban kham phu khoa, ghe xoay - Den chieu sang - Mo vit vdi cac kich cd khac nhau - Kim dai sat trung - Kim cap co tii cung (Pozzi) - Que lay benh pham - Thifdc do buong tii cung - Ong hut hoac kim sinh thiet - Gang tay vo khuan 1.2. Hoa chat - Cac lo chiia cac dung dich can thiet - Chat boi trOn 1.3. Chuan bi benh nhan - Benh nhan phai difdc di tieu trudc khi kham, nam tren ban kham sau khi da difdc boc lo tii vung eo trd xuo'ng. - Nam ngiia, hai chan gac len gia dd chan theo tif the thich hdp, hai tay dat xuoi theo ngifdi. 1.4. Thay thuoc Mac ao. doi mu, deo khau trang, deo gang vo khuan. Ngoi khi kham bang mo vit, diing khi kham am dao bing tay. 60 1.5. Buong kham Gon gang, ngan nap, nen co ndi di tieu cho ngiidi benh va co cho kin dao cho ngudi benh thay quin ao. 2. Tien hanh 2.1. Kham am ho 2.1.1. Muc dich: phat hien dUOc tinh trang cua am ho va cac tuyen sinh due 2.1.2. Yeu cau: lam dung cac budc tham kham 2.1.3. Cac bifdc tien hanh - Nhin danh gia dUdc sU phan bo' long d tren ve, tinh trang moi ldn, moi be, am vat, cac nep gap giufa cac moi. - Tinh trang mang trinh (con nguyen ven hay rach) - Quan sat da vung nay co bieu hien sUng, do, trdt, loet hoac co khoi phong khong? - Nen nhd kham cac tuyen SKen, tuyen Bartholin bang dung hai ngon tay kep, bop vao tuyen va quan sat xem co chay dich, mu hay khong qua do co the danh gia dUdc tinh trang cua cac tuyen nay. 2.2. Kham am dao 1.2.1. Muc dich: phat hien dUdc tinh trang d am dao 1.2.2. Yeu cau: lam dung ky thuat 1.2.3. Cac bifdc tien hanh - Kham am dao b in g mo vit + Chon cd mo vit thich hdp vdi ngUdi benh + Cam mo vit b in g tay thuan, mo vit can dUdc boi trdn. Neu lam phien do thi khong dUdc boi dau trdn. + Khi dat phai tranh dau ngoai cua lo lieu dao va am vat vi vung nay rat nhay cam. + Dung cac ngon tay cua ban tay trai (ngon giUa va ngon tro) tach hai moi be ra, sau do dua mo vit vao theo tu the doc (true tut 7h - l h) an manh ra sau len mep sau cua am dao. Viia an mo vit vao vUa quay dan sang ngang. cut nhu vay cho mo vit vao theo hudng cd tii cung. + Md dan mo vit de tim cd tii cung va hudng mo vit lam sao cho cd tii cung nam giUa hai van mo vit de nhin cho ro co tvi cung. + Van oc vit de co dinh md vit + Quan sat: cac ton thudng d cd tii cung, dich tiet d cd tii cung. chat nh iy d cd tii cung (sd ludng va do trong) co the lay benh phim lam xet nghiem vi khuan va lam phien do cd tii cung neu can. 61 + Thao mo vit: khep ddn hai van mo vit lai va rut nhe nhang mo vit ra ngoai. Tren diidng rut thong qua khe hd cua hai van co the quan sat thanh triidc va thanh sau am dao. - Kham am dao bang tay: Co the tham am dao b&ng ngon tro hoac ngon tro va ngon giiia. Dung gang hai ngon tham am dao la tot nhat. + Thong bao vdi benh nhan viec tham kham am dao de cung pho'i hdp. + Dung dau trdn boi vao ngon giiia va ngon tro ban tay thuan sau khi da deo gang. + Dung ngon cai va ngon tro ban tay kia tach hai mdi be va diia hai ngon da di gang vao am dao bang cach: dau tien ty bd trong ngon giiia len mep sau am ho, day d&n ra sau va vao trong dong thdi diia ket hdp ngdn tro vao theo. Cac ngdn di theo hiidng thanh sau am dao hiidng ve tui cung sau. Khi tao ra mot goc 45° so vdi mat ban thi tiep theo hiidng ngdn tay len cao dan tdi diidng ngang. + Sau khi da dd dUdc hai ngdn tay trong am dao tdi vung tui cung, ban tay khong thang chuyen len dat tren thanh bung cua benh nhan de hd trd viec tham kham trong. + Kham co td cung sd nan va di dong cd td cung bang hai ngdn tay trong am dao qua dd danh gia the tich mat do hinh thu sU di dong va sU nhay cam cua cd tu cung. + Kham td cung: hai ngdn tay trong am dao dua vao cung do trUdc, cung dd sau va hai cung dd ben phoi hdp vdi tay ngoai (an td cung xuong hoac day td cung sang phai sang trai...). Qua dd danh gia ve mat do, the tich. tU the, sU di dong va do nhay cam cua td cung. + Kham hai ph&n phu va cac tui cung: Dung hai ngdn tay trong am dao dat vao cac tui cung ben phoi hdp vdi ban tay ngoai lam cac dong tac tham sau, dua len dua xuong, sang phai sang trai. Qua dd danh gia klch thich mat do hinh dang sU di dong sU cam nhan cua hai ph&n phu. + Dong thdi qua tham kham cung nhan dinh tinh trang cac tui cung ve do mem mai, do day dinh, cang day va do cam nhan khi bi klch thich . + Ket thuc cuoc tham kham: khep hai ngdn tay trong am dao va nhe nhang rut ra ngoai + Thong bao cho benh nh&n ket thuc viec tham kham va giup benh nhan ngoi day, xuong ban kham. + Thong bao sd bo ket qua tham kham cho benh nhan sau khi benh nhan da mac lai qu&n ao. Chu y: am ho, am dao, tu cung, phan phu cac tui cung binh thudng thi khong cd bieu hien dau . Khi dau la cd bieu hien benh ly. Nen viec tham kham tai cho ket hdp vdi quan sat ve mat benh nhan la rat can thiet. 62 Bang kiem kham phu khoa TT Noi dung Y nghia Tieu chuan dat 1 2 3 4 Chao hoi - Ttr gidi thieu ve minh - Hoi ten tuoi nghe nghiep - Thong bao, giai thich viec tham kham Chuan bj - Dung cu. - Benh nhan. - Thay thuoc Kham am ho - Boc lo ro cac phan cua bo phan sinh dung ngoai. - Quan sat moi I6n, moi be, am vat, cac nep gap giura chung. - Quan sat cac tuyen Skem, tuyen Bartholin. - Phat hien hinh anh bat thifdng nhi/ sung, do, chdt, loet hoac tiet djch, mu Kham trong bang mo vit - Chon cd mo vit phu hop, cam mo vjt blng tay thuan. - Bdi trdn mo vit bang dau tron. - Boc lo am dao bang ngon tro ngon giifa tay khong thuan. - Oat mo vit vao theo chieu doc (true 7h - 1h) vi/a an ra sau vi/a day vao, vifa quay dau sang ngang. - Me) mo vit boc lo cd tu" cung. - Van oc vit co dinh. - Quan sat co tdr cung. - Lay djch de xet nghiem, lam te bao. - Khep dan hai van md vjt rut ra ngoai. - Quan sat thanh am dao qua khe hdi giufa 2 van mo vjt. - Giup benh nhan ngoi day va xuong ban kham. - Oi/a ra ket qua so bo sau kham va giai thich cho benh nhan. Giao tiep giura thay thuoc, benh nhan. Chuan bi tot ve mat tam iy Thuan tien cho viec tham kham va danh gia dung benh. De quan sat ro tinh trang binh ti/dng va ton thi/ong benh ly neu co cua bo phan sinh due ngoai. De quan sat ro va danh gia dung tinh trang cac bo phan trong am dao va am dao. Tang moi thien cam giura thay thuoc va benh nhan. Benh nhan yen tam, tin tifOng. Sin sang hop tac vdi thay thuoc. - Du dung cu de tham kham. - Benh nhan nlim ngifa tren ban dung tif the, sau khi da boc lo tif eo tro xuong va da difdc di tieu. - Thay thuoc difng, ngoi dung tu" the. - Dong tac kham nhe nhang, dung ky thuat. - Thay thuoc ngoi dung ti/ the. - Dong tac nhe nhang. - Thao tac dung ky thuat. - Thay thuoc ngoi dung tif the. - Nhe nhang. - Cu the. - De hieu. 63 TL/LJONG GIA 1. Cong cu lifdng gia: thang diem Thang diem li/ong gia ky nang kham am ho va am dao bang mo vit TT Ndi dung He soThang diem 2 1 0 1 Chao hoi benh nhan - giai thich viec tham kham 1 2 Cho benh nhan di tieu 1 3 Chuan bj day du dung cu 1 4Cho benh nhan nam ngCra, boc lo tCr eo trd xuong tren ban kham dung tif the. 1 5 Thay thuoc thirc hien vo khuan tot. 1 6 Thay thuoc ngoi dung tif the tren ghe quay. 1 7 Quan sat bo phan sinh due ngoai, phat hien nhung dieu bat thifdng. 2 8Dung 2 ngon tay tro va giura ban khong thuan boc lo nhe nhang moi I6n, moi be, am vat va cac tuyen Sken - Bartholin. 2 9 Chon co mo vjt thi'ch hop. 1 10 Difa mo vjt vao dung ky thuat (theo difdng doc 7h-1h) roi quay sang an vao sau.2 11 Md md vjt quan sat cd tif cung, cung do dung ky thuat. 2 12 Khep md vjt, rut nhe nhang, ket hop quan sat thanh am dao qua khe 2 van md vit tren difdng rut. 2 13 Giup benh nhan ngoi day, xuong ban nhe nhang 1 14 Thong bao so bo ket qua kham. Dan do an can - Chao tam biet sau khi benh nhan mac quan ao 1 Tong diem Cach cho diem Cach danh gia 0: Khong lam, lam sai - Loai gidi: dat tif 34 - 38 diem 1: Lam nhiing khong dung hoan toan - Loai kha: dat tu: 27 - 33 diem 2: Lam dung hoan toan - Loai trung binh: dat tif 19 - 26 diem - Loai kem: dat < 18 diem Thang diem lifdng gia ky nang kham am dao bang tay STT Noi dung He soThang diem 2 1 o 1 Chao hoi benh nhan - giai thich viec tham kham 1 2 Cho benh nhan di tieu 1 3 Chuan bj day du dung cu 1 4Cho benh nhan nam ngira, boc lo tif eo trd xuong tren ban kham dung tif the. 1 64 -------- 5 Thay thuoc thi/c hien vo khuan tot. 1 6 Thay thuoc diing dung vj tri tham kham 1 7 Tach hai moi nho bang hai ngon tro va cai ban tay ky thuat. 1 8Dua ngon tro va giura da di gang da dupe lam trdn vao am dao dung ky thuat, nhe nhang. 2 9Ban tay phai chuyen len dat vao thanh bung difdi benh nhan. 1 10 Lay dong cd tii cung bang hai ngon tay trong am dao ket hdp quan sat net mat benh nhan. 2 11 Hai ngon tay trong am dao ket hdp vdi ban tay d ben ngoai kham xet tii cung dung ky thuat. 2 12 Hai ngon tay trong am dao ket hop vdi ban tay d ben ngoai kham xet hai phan phu va cac cung do dung ky thuat. 2 13 RUt tay ra khoi am dao nhe nhang. 1 14 Giup benh nhan ngoi day, xuong ban nhe nhang 1 15 Thong bao so bo ket qua kham. Dan dd an can, chao tam biet sau khi benh nhan mac quan ao 1 Tong diem Cach cho diem Cach danh gia 0: Khong lam, lam sai - Loai gioi: Dat tU 34 - 38 diem 1: Lam nhiing khong dung hoan toan - Loai kha: Dat tCr 27 - 33 diem 2: Lam dung hoan toan - Loai trung binh: Dat tii 19 - 26 diem - Loai kem: Dat < 18 diem 2. Hifdng dan tif liidng gia Sau khi thiic hanh sinh vien sii dung bang thang diem de tii liidng gia theo hudng din. Sinh vien cung co the sii dung bang nay de ludng gia lan nhau va rut kinh nghiem trong qua trinh thiic hanh. Hl/CJNG dAn TIJ HOC, TL/ NGHIEN CLTU, VAN DUNG THUC TE 1. Phifdng phap hoc Sinh vien tu hoc phan ly thuyet, tu hoc lam sang ve cach kham phu khoa, phat hien dau hieu bat thudng d dudng sinh due co sU hudng dan cua giao vien, thao luan vdi ban cung nhom nhflng van de chua ro de dua ra chan doan va thai do xii tri Tai phong kham: hoi benh, tham kham benh nhan trong dieu kien thiic te ve dung cu va trang thiet bi cua cd sd y te de co kinh nghiem thiic te. 65 2. Van dung thirc te Sinh vien van dung nhiing kien thUc va kinh nghiem da hoe diidc vao viec kham benh cho benh nhan phu khoa d cac cd sd y te. Tuy theo dieu kien thiic te d ma sii dung cac loai dung cu phu hdp vdi tUng budc tham kham nhung luon ton trong cac budc va yeu c£u cua tUng budc khi tham kham benh nhan phu khoa. 3. Tai lieu tham khao 1. TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa 1999 2. TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa tap II 2002 3. Day hoc tich cilc trong dao tao Y hoc NXB Y hoc 1999. 4. Hudng din Phat trien tai lieu hoc tap thiic hanh DA VN - HL 5. Bo Y Te - Hudng dan chuan quoc gia ve cac dich vu CSSKSS 6. Du an dao tao Y Khoa ve SKSS - TrUdng DHYK Hue - Bang hudng dan hoc tap cac ky nang lam sang giang day tai cd sd thuc dia 66 BENH TIEU CHAY MUC TIEU Sau khi hoc xong bai nay, sinh vien co khd nang: 4. Hoi dittic benh sit, tien sit cua benh tieu chay 5. Danh gid dittic cac dau hieu mat nittic tren benh nhan cu the 6. Phan loai dittic mite do mat nitdc, 7. Dieu tri dittic benh nhan tieu chay theo phac do 8. Hit&ng ddn dittic ba me dieu tri tieu chay tai nha Tieu chay la benh thiidng gap, diing hang thii hai sau nhiem khuan ho hap cap tinh. Neu khong xii tri kip thdi se dan tdi tii vong do mat niidc va roi loan dien giai. Can dieu tri dung va khan triidng d cac cd sd y te. 1. Tiep can chan doan benh nhi tieu chay Hoi: - So' ngay tieu chay - Co mau trong phan khong Bang kiem hit&ng ddn hoi benh sit, tien sit lam benh an benh tieu chay STT Noi dung Muc dich Yeu cau 1 Chao hoi Giao tiep Tao long tin va hop tac j Ly do vao Tien li/gng Hoi dirge cac trieu chung kem theo 2 3 So ngay bj tieu chay Chan doan Xac djnh so ngay 4 So lan TC Tien liidng Xac djnh diidc so lan TC 5 Tinh chat phan Chan doan Xac djnh mau trong phan 6 Cac trieu chung khac Chan doan va tien ludng Xac djnh: Sot, khat niidc, tinh than... 7 Tien sir: nuoi diidng, benh tat, dich te Tien lifdng Xac djnh tien sir benh tat va dinh diidng 67 Danh gia cac dau hieu mat niidc Theo To chile Y te The gidi diia vao 4 dau hieu sau de danh gia mat niidc: Dau hieu Khong mat nude Co mat nude Mat nUdc nang Toan trang Mat trung Khat Nep veo da Tinh tao Khong Khong khat Mat nhanh Kich thich, vat va Trung Khat, uong hao hire Mat cham Ly bi, met la Rat trung Uong it, khong uong duoc Mat rat cham Nguyen tac phan loai mat niidc: tu: phai sang trai, khi trong mot cot co it nhat hai dau hieu, thi phan loai mat niidc d cot do. Bang kiem danh gid dau hieu mat niidc TT Noi dung Muc dich Yeu cau 1 Giao tiep Hdp tac cua ba me Tao siitin tudng 2 Danh gia toan trang Phan loai mat nude Nhan djnh dupe tinh than cua tre. 3 Dau hieu khat Danh gia mat nude Nhan djnh duoc the nao la khat uong hao hire 4 Mat trung Phan loai mat niidc Quan sat va hoi ba me 5 Nep veo da Phan loai mat nude Lam dung Sii dung hudng dan xii tri phdng to hoac Phac do xii tri cua phan loai doi vdi benh tieu chay.Phan loai tieu chay hdi khac vdi phan loai ho hoac khd thd. Vi du: Tat ca cac tre bi tieu chay can dUdc phan loai ve mat nUdc. De lUa chon mot loai ve mat nUdc, tre phai cd 2 hoac nhieu hdn cac dau hieu thuoc khung mau vang hoac mau hong. Mot dau hieu khong du de chon phan loai trong khung hong hoac vang. Neu benh nhan chi cd mot dau hieu trong khung nay nen tim d khung ke tiep. * Chi phan loai la ly neu tieu chay cd mau trong phan. 2. Dieu trj benh nhan tieu chay 2.1. Dieu trj tieu chay cap khong mat nude: (phac do A) Dam bao 3 nguyen tac sau - Cho tre uong nhieu dich hdn binh thudng de phdng mat nUdc. - Cho tre an thUc an giau chat dinh dudng de phdng suy dinh dudng - Dua tre quay trd lai cd sd y te khi cd cac dau hieu benh nang Chu y: vi tieu chay khong mat nUdc dieu tri tai nha, nen can hudng d in cain than cho ba me cach pha va cach cho tre uong ORS, cach cho tre an, cac dau hieu can dUa tre den cd sd y te kham lai. 68 Bang kiem hoc cach pha ORS Noi dung Muc dich Yeu cau Rura tay bling xa phong va ni/dc sach Dam bao ve sinh Sach se Chuan bi du dung cu pha (Binh.coc, ORS, Nude soi nguoi) Hudng dan ba me Chuan bi du Kiem tra ORS triidc pha Danh gia chat liidng Goi ORS phai khong von, khong bien mau Dong du niidc 1 lit + pha ORS Pha dung nong dp Dong dung 1 lit nifdc bang cac dung cu thong thudng. Nem kiem tra Danh gia nong do Phai dam bao dung theo quy djnh (nhiivi cua nude mat). Day binh nifdc ORS, dan mac ORS ngoai binh De hudng dan ba me Ghi ro gid pha 2.2. Dieu tri tieu chay cap cd mat nude: (phac do B) Bu dich bang uong oresol: trong 4 gid So'liidng: ■ Oresol = trong liidng cO the (kg) x 75 ml Co the tinh liidng dich ORS theo tuoi va theo can nang diia vao bang sau: Tudi < 4 th 4 - 11 th 12-23 th 2 - 4 tudi 5 -1 4 tudi >_15 tudi Can < 5 kg 5 -7 ,9 kg 8-10,9 kg 11-15,9kg 16-29,9 kg > 30 kg ml 200-400 400 - 600 600 - 800 800- 200 1200-2200 2200 - 4000 Cach cho uong: uong tifng ngum hoac tiing thia, neu tre non dting lai 10 phut sau do tiep tuc uong. Theo doi hang gid so' lifdng oresol uong diidc, so' lan ia va dau hieu mat nifdc Sau 4 gid danh gia lai de thay doi phac do dieu tri: neu tre con mat nifdc, tiep tuc dieu tri phac do B lan 2, neu khong mat niidc chuyen sang dieu tri phac do A. Triidng hdp ba me phai ra ve triidc 4 gid can phat du lifdng ORS trong 2 ngay, hiidng d in ba me cach cho tre uong va phat hien cac dau hieu can diia tre den cd sd y te kham ngay. Triidng hdp that bai: Tre ia nhieu, mat tren 15 - 20 ml niidc/ kg/ gid Tre non nhieu tren 3 lan/ gid Tre chifdng bung, liet ruot Khong dung nap glucose Nhiing triidng hdp dung ORS that bai can truyen dich cho tre. 69 2.3. Dieu trj tieu chay cap mat nude nang: (phac do C) 2.4. Khang sinh Chi dung khang sinh cho tre mac ly hay ta: Tre mac ly cho uong biseptol 60 mg/kg/ngay x 5 nga> Tre mac ta nang cung diidc uong biseptol nhii mac ly Tre 16n mac ta cho uong tetraxyclin lieu 30 - 50 mg/kg/ngay TULlfONG GIA 1. Cong cu lifdng gia Thang diem danh gia pha ORS Noi dung Diem chuan Diem dat RCra tay bang xa phong va nude sach 1 Chuan bi du dung cu pha (binh.coc, ORS, Nude soi nguoi) 2 Kiem tra ORS triidc pha 2 Dong du nude 1 lit + pha ORS 3 Nem kiem tra 1 Day binh nude ORS, dan mac ORS ngoai binh 1 Tong so 10 Tong diem: 10 Danh gia: - 11- 13: dat 7-8: kha 9-10: gioi Thang diem danh gia benh nhan tieu chay Noi dung Diem chuan Diem dat 1. Hoi benh - Thdi gian tre tieu chay 1 - Tinh chat phan long, mau 1 - Khat 1 - Trieu chung kem theo: non, dau bung, sot, co giat 1 - Da uong ORS, thuoc khang sinh, cam tieu chay 1 2. Danh gia dau hieu mat nude - Toan trang: nhan djnh cu the 1 - Khat nirdc: nhan djnh cu the 1 - Nep veo da bung: nhan djnh cu the 1 - Nude mlt: nhan djnh cu the 1 - Mat trung: nhan dinh cu the 1 3. Phan loai mat nude - Khong mat nude 1 - Mat nude nhe 1 - Mat nude nang 1 70 4. Dieu trj - Tieu chay khong mat nifdc 2 Cho uong d|ch An thiic an giau dinh dudng Khi nao diia den co sd y te lai - Tieu chay mat nude nhe 2 Lupng ORS trong 4 gid Cach cho uong Theo doi roi loan tieu hoa, luong ORS uong va dau hieu mat niidc - Tieu chay mat nirdc nang Xac dinh luong djch truyen 2 Theo ddi cac dau hieu trong qua trinh truyen Xac dinh dupe lieu lupng thuoc cu the - Lieu biseptol/ngay/dpt - Khong dung thuoc cam tieu chay 1 Tong diem: 20 Danh gid: - 11- 13: dat 14- 18: khd 19-20: gioi 2. Hifdng dan sinh vien tifli/dng gia Sinh vien sii dung bang kiem lifdng gia de tif liidng gia qua trinh hoc bang cach doi chieu nhiing diem da lam difdc vdi yeu cau phai dat cua tiing phan va cho diem. Tiidng tif. sinh vien co the sii dung de lifdng gia ky nang cua sinh vien khac. HlfCJNG DAN TL/ HOC, TL/ NGHIEN ClTU, VAN DUNG THUC TE 1. Phifdng phap hoc Sinh vien nen hoc tap tai phong kham Nhi, tai day se gap nhieu benh nhan tieu chay khong mat niidc, sinh vien se thiic hanh khai thac trieu chiing, tien sii va phan loai mat niidc, tii van benh nhan dieu tri tieu chay tai nha, thiic hanh pha ORS tai goc ORS cua khoa. Danh gia cac dau hieu mat niidc, van dung bang danh gia, lifa chon cac dau hieu chinh va dau hieu phu, cach phan loai mat niidc tren lam sang, phan loai mat niidc d nhiing benh nhan dac biet (suy dinh diidng teo det, phu...). Chi dinh cac phac do dieu tri tieu chay theo phan loai mat niidc. Thiic hanh dieu tri tieu chay khong mat niidc. Theo doi It nhat mot benh nhan tieu chay mat niidc nhe (phac do B). 2. Van dung thifc te Trong thiic te se gap nhiing ba me khong chiu cho benh nhan uong niidc ma chi muon cho con diidc truyen dich, khi do phai kien tri giai thich va hiidng dan ba me cho tre uong dung theo hiidng din. Mot so benh nhan khong chiu uong ORS hoac khong co ORS, phai hiidng dan ba me nau niidc chao muoi, hoac niidc soi de nguoi. 71 Nhieu ba me rat muon cho tre sii dung khang sinh, men tieu hoa va thuoc d m ia, phai giai thich cho ba me viec sii dung khang sinh va thuoc cam ia se co nguy cd lam cho tre bi tieu chay keo dai, con men tieu hoa la khong can thiet. 3. Tai lieu tham khao 1. Triidng Dai hoc Y khoa Thai Nguyen (2006). Thiic te tot nghiep tai cong dong (tai lieu danh cho sinh vien). 2. Trifdng Dai hoc Y khoa Thai Nguyen (2006). Thiic te tot nghiep tai cong dong (tai lieu danh cho giang vien). 3. Bo mon Nhi Triidng Dai hoc Y Ha Noi (2002), Bai giang Nhi khoa Tap 1, 2002. 4. ChiiOng trinh CDD (1998). Hiidng dan dieu tri benh tieu chay. 4. Tai lieu doc them Be Van Ca!m (1996), Tinh hinh benh tieu chay tai phiidng Phan Dinh Phung, thanh pho Thai Nguyen. Luan van bac si chuyen khoa cap II. 72 nhiI m khuan ho hap cap MUC TIEU Sau khi hoc xong bai nay, sinh vien co the: 1. Hoi va khai thac diidc benh sii nhiem khuan ho hap cap (NKHHC) 2. Kham va danh gid dung cac dau hieu N K H H C tre em 3. Phan loai va xii tri dung N K H H C theo phac do To chiic Y te The gidi 4. Neu diidc cac bien phap phong benh N K H H C Nhiem khu&n ho hap cap co ty le mac benh va tii vong cao nhat. Neu phat hien, xii tri kip thdi se giam diidc cac bien chiing va tii vong d tre em 1. Tiep can chan doan benh nhan nhiem khuan ho hap cap 1.1. Hoi - Ho trong bao lau - Co bo bu hoac bu kem khong - Co non tat ca moi thii khong - Co co giat khong - Co sot khong Bang kiem hoi benh sur, tien sifva lam benh an benh nhan nhiem khuan ho hap cap TT Noi dung Muc dich Yeu cau 1Chao hoi, lam quen. Thu tuc hanh chinh (hoan chinh theo mau BA Nhi) Giao tiep Tao long tin, hop tac 2 Ly do den kham (trieu chiing chinh) Tien liidng Hoi diidc trieu chiing bat buoc tre phai vao vien 3 Benh sir 3.1. Dien bien trieu chiing sot 3.2. Dien bien trieu chiing ho, kho thd 3.3. Cac trieu chiing khac 3.4. Dieu trj tai nha (khang sinh, giam ho) 3.5.Tinh trang den vien (lien quan den ly do vao vien) Chan doan Xac djnh difpc so ngay, so lan, dSc diem cua cac trieu chiing chinh va cac trieu chiing kem theo 73 4 Tien sir 4.1. San khoa (ngat, vang da sau sinh) 4.2. Dinh difdng (bu me, Sn bo sung) 4.3. Phat trien (can nSng, chieu cao) 4.4. Benh (ho sot, kho thd da mac, tien sd di dng) 4.5. Tiem chiing md rong 4.6. Gia dinh, nha tre Tien liidng Xac dinh dupe cac tien sir co lien quan den benh 5 Thai do (an can, niem no, tutin) Giao tiep Ky nang giao tiep tot 1.2. Kham Bang kiem ky nang kham benh nhan nhiem khuan ho hap cap TT Ndi dung kham Muc dich Yeu cau 1 Chao hoi, lam quen Hop tac cua ba me Tao sii tin tifdng 2 Kham danh gia toan trang Phan loai benh Nhan dinh dirpc tinh than cua tre 3 Cap nhiet do Danh gia sot Nhan dinh di/pc mdc do sot 4 Can tre Danh gia phat trien the chat tre Nhan dinh dupe the trang cua tre 5 Dem nhjp thd va danh gia (thd nhanh, thd cham, cdn ngUng thd) 6 Tim dau hieu rut lorn long ngiic/ co keo cd ho hap 7 Nhin va nghe tieng thd rit/ thd kho khel thd ren 8 Tim dau hieu tim va danh gia mdc dp 9 Kham cd quan ho hap phat hien cac trieu chung benh ly: nhin, sd, go, nghe 10 Kham cac cd quan khac phat hien cac trieu chdng benh ly (tuan hoan, tieu hoa ...) 1.3. Phan loai NKHHC Danh gia mdc do suy ho hap Danh gia mdc dp suy ho hap Danh gia mdc do suy ho hap Danh gia mdc do suy ho hap Phat hien diipc trieu chdng benh ly giup chan doan Danh gia mdc do cua benh Phan loai dupe mdc do suy ho hap Phan loai dupe mdc do suy ho hap Phan loai dirpc mdc do suy ho hap Phan loai dupe mdc dp suy ho hap Kham dung va phat hien dupe trieu chdng co tren tre benh Kham dung va phat hien dupe trieu chdng co tren tre benh Giang vien dung phac do ( Hoac bang phan lo a i) thao dien phan loai mot liidt roi goi tting sinh vien thao dien phan loai benh nhan cua minh, cac sinh vien khac quan sat. Sau moi liidt thao dien lan liidt goi tCfng sinh vien gop kien: Co 2 cach phan loai: 74 1.3.1. Theo vi tri giai phiu: lay nap thanh quan lam ranh gidi Phan loai nay ft sii dung tren lam sang: - NKHHC tren gom: ho hoac cam lanh,viem hong, viem amidan,viemVA, viem xoang, cac benh nay nhe, it gay tii vong va chu yeu chi can dieu tri va cham soc d tai nha - NKHHC diidi gom: viem thanh quan, viem thanh khi phe quan, viem tieu phe quan, viem phoi, benh thudng nang. hay gay tii vong va can diidc dieu tri va theo doi d benh vien 1.3.2. Phan loai Hudng dan xCrtri long ghep cac benh thudng gap Dung hudng dan xii tri treo tiidng hoac Phac do xii tri noi co cac bang phan loai. Nhac ho ve nhiing diem sau: - Ph&n ldn cac bang phan loai trong hiidng dan danh gia va phan loai deu co 3 khung. - Moi mot khung diidc to bang cac mau khac nhau nhii mau hong, mau vang hoac mau xanh. - Mau sac cua cac khung se giup xac dinh nhanh chong lieu tre co bi cac benh nang can phai diidc xii tri gap hay khong. - Cac bang phan loai d khung mau hong co nghia la tre c&n diidc dieu tri dac hieu nhii cho dung khang sinh thich hop, uong thuoc sot ret hoac dieu tri bang cach khac. Dieu tri bao gom ca viec hiidng dan ba me cach cho tre uong thuoc hoac dieu tri nhidm khuan tai cho d nha. Can bo y te khuyen ba me cach cham soc tre bi benh tai nha va nhac nhd khi nao can diia tre den kham. - Cac phan loai d khung mau xanh co nghia la tre khong can dieu tri bang khang sinh hoac dieu tri dac hieu khac. Can bo y te hiidng dan ba me cach cham soc tre tai nha. Vi du, ban co the khuyen ba me cach nuoi diidng tre. - Chi vao cot cac dau hieu va cot phan loai. Khi ban noi ve cac biidc phan loai ho hoac kho thd trong tai lieu chi vao tting khung moi khi ban noi ve no. Vi du: - Hay nhin vao khung mau hong hoac khung tren cung. Tre co dau hieu nguy hiem toan than khong ? Tre co dau hieu rut lom long ngiic hoac thd rit khi thd nim yen khong? Neu tre co dau hieu nguy hiem toan than hoac bat ky mot dau hieu nao d khung mau hong hoac khung tren cung, hay chon phan loai nang. viem phoi nang hoac benh rat nang. - Neu tre khong co mot phan loai d khung mau hong, hay nhin vao khung mau vang hoac khung giiia. Tre co thd nhanh khong ? Neu tre co dau hieu nay va khong co mot phan loai nang, chon phan loai d khung mau vang hoac khung giiia, viem phoi. _ Neu tre khong co mot phan loai d khung mau hong va cung khong co mot phan loai d khung mau vang, hay xem khung mau xanh hoac khung diidi cung. Tre khong co dau hieu cua viem phoi va khong co dau hieu cua benh rat nang diidc phan loai theo khung mau xanh, khong viem phoi: ho hoac cam lanh. 75 Chu y: luon luon bat d lu tvr ph&n tren cung cua bang phan loai. Neu tre co cac dau hieu d khung mau hong hoac khung tren cung va co dau hieu d khung mau vang hoac khung d giiia. Chon phan loai nang hdn, viem phoi nang hoac benh rat nang. 2. Dieu trj benh viem phoi 2.1. Viem phoi nang hoac benh rat nang - Dieu tri suy ho hap - Khang sinh - Dieu tri trieu chiing: ho, sot, kho khe, non, tieu chay ... (neu co) - Cham soc, an uong, theo d5i dien bien cua benh 2.2. Viem phoi - Cho khang sinh thich hdp trong 5 ngay - Giam ho va dau hong bang thuoc ho an toan - Dan ba me khi nao can diia tre den kham ngay - Kham lai sau 2 ngay 2.3. Khong viem phoi (ho hoac cam lanh) - Giam ho bang cac thuoc an toan - Dan ba me khi nao can diia tre den kham ngay - Kham lai sau 5 ngay, neu khong tien trien tot - Xii tri van de hong (neu co) Bang kiem ky nang ra quyet djnh dieu tri benh nhan nhiem khuan ho hap cap STT Ndi dung Muc dich Yeu cau Chuan bi benh nhan (can nang, nhjp thd, tim...), benh an 1 Chao hoi, giai thich gia dinh Chuan bi ve tam ly Tao sii tin tirdng, hop tac cua benh nhan 2 Dieu tri 2.1. Chong suy ho hap (tuy theo mCrc do) chuan bj dung cu, thuoc... Giup dieu tri co hieu qua, an toan Dung, day du 2.2. Chong nhiem trung Chuan bi thuoc Giup dieu tri co hieu qua, an toan Dung, day du 2.3. Dieu trj trieu chung (sot, ho, kho thd, non, tieu chay...) chuan bj dung cu, thuoc Giup dieu trj co hieu qua, an toan Dung, day du Ty mi, chu dao 76 3Cham soc, an uong, theo doi va dien bien cua benh - Giup dieu trj co hieu qua hdn - Phat hien diidc cac bat thirdng cua tre benh TU LlfpNG GIA 1. Cong cu luttng gia Thang diem danh gid ky nang danh gid, phan loai, dieu tri. nhiem khuan ho hdp cap Noi dung Diem chuan Diem dat 1. Hoi benh - Thdi gian xuat hien benh: ho, sot, kho thd ... 1 - Tinh chat con ho, sot, kho thcf, tim ... 1 - Trieu chung khac kem theo 1 - Da dung thuoc gi d nha (hoac co so y te ) 1 - Di§n bien cac trieu chiing chinh 1 - Tinh trang khi vao vien 1 - Tinh trang hien tai 1 2. Kham - Dem nhjp thd 2 - Quan sat rut lorn long ngiic 2 - Nhin va nghe tieng thd rit 2 - Cac dau hieu khac 2 3. Chan doan: (phan loai) - Khong viem phoi (ho hoac cam lanh) 3 - Viem phoi 3 - Viem phoi nang hoac benh rat nang 3 4. Dieu trj: 4.1. Viem phoi nang hoac benh rat nang 4 - Dieu trj suy hd hap - Khang sinh: lieu/ kg/ ngay - Dieu tri trieu chung: ho, sot, kho khe, non, tieu chay... xac dinh lieu dung cu the cho tung loai thuoc - Cham soc, an uong, theo doi dien bien cua benh 4.2. Viem phoi: - Cho khang sinh thich hop trong nam ngay: lieu dung/ ngay/ drt 4 - Giam ho va dau hong bang thuoc ho an toan - Dan ba me khi nao can di/a tre den kham ngay - Kham lai sau hai ngay 4.3. Khong viem phoi (ho hoac cam lanh) - Giam ho bing cac thuoc an toan 4 - Dan ba me khi nao can diia tre den kham ngay - Kham lai sau nam ngay, neu khong tien trien tot - XCr tri van de hong neu cd Tong cong 36 77 Tong diem : 36 Danh gia: 20-26: dat 27-32: kha 32-36: gidi 2. Hudng dan sinh vien tir lifdng gia Sinh vien sii dung bang kiem liidng gia de tii liidng gia qua trinh hoc bang cach doi chieu nhiing diem da lam diidc vdi yeu clu phai dat cua tiing phan va cho diem theo hiidng din. Tildng tut, sinh vien co the sii dung de liidng gia ky nang cua sinh vien khac. Hl/CJNG DAN T l/ HOC, T l/ NGHIEN Cl/U, VAN DUNG THI/C TE 1. Phirong phap hoc tap Sinh vien nen hoc tap tai phong kham Nhi vi se co nhieu benh nhan khong viem phoi (ho hoac cam lanh), sinh vien se thiic hanh khai thac trieu chiing. tien sii va chan doan (phan loai). Til van cho ba me benh nhan ve dieu tri tai nha. Danh gia cac dau hieu: thd nhanh, rut lom long ngiic, thd rit khi nam yen ... Sii dung phac do de chan doan (phan loai) cho benh nhan. Thiic hanh doc phim tim phoi. Chi dinh cac phac do dieu tri viem phoi tre em. Thiic hanh dieu tri cac phan loai benh viem phoi. Thuc hanh hiidng dan cho ba me uong thuoc tai khoa. 2. Van dung thirc te Can chi dinh sii dung khang sinh dung dan, tranh lam dung khang sinh. Hiidng dan ba me che bien va sii dung thuoc ho an toan nhii quat hap mat ong, mat ong hap hoa hong bach...Neu khong co dii dung cu, phildng tien va oxy cap ciiu suy ho hap thi can cho chuyen vien kip thdi. 3. Tai lieu tham khao 1. Triidng Dai hoc Y khoa Thai Nguyen (2006). Thiic hanh cong dong 1 (tai lieu danh cho sinh vien). 2. Triidng Dai hoc Y khoa Thai Nguyen (2006). Thiic hanh cong dong 1 (tai lieu danh cho giang vien). 3. Bo mon Nhi Triidng Dai hoc Y Ha Ndi (2000), Bai giang Nhi khda, Tap 2. 4. Bo mon Nhi Triidng Dai hoc Y khoa Thai Nguyen (2005), Bai giang Nhi khoa. Tap 2. 4. Tai lieu dpc them 1. WHO (1998), Chiidng trinh ARI 2. UNICEF - Bo Y te (2004), Hiidng dan xii tri long ghep tre benh. 78