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HOC Y KHOA THAI NGUYEN H iii NHA XUAT BAN Y HOC TR U O N G DAI HOC Y KHOA THAI NGUYEN THI/C HflNH CONG DONG ■ ■ NHA XU AT 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 giai doan hien ngiibi bac si khong nhiing co kien thiic toan dien, kha nang nghien cHu ma ho can nhiing ky nang lam viec dieu kien thiic te cua cong dong Cong dong la mon hoc 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 Mon hoc tao 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 15 thang 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 danh cho sinh vien Trong qua trinh bien soan cuon tai lieu ch in g 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 va ngoai niibc cung nhii cong dong dao tao Dong Hy va Phi LitOng Chung toi tran cam On nhiing y kien dong gop quy bau 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 MUC LUC Hi/dng dan sir dung tai lieu Mon hoc thiic hanh cong dong Hifdng dan thi/c hanh cong dong 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 c h u t chuyen tuyen 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 HlfONG d An Sir DUNG TAI LIEU • • Cuon tai lieu mon hoc cong dong 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 cung cap nhflng thong tin din thiet cho sinh vien de chu&n bi triidc 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 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 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 phu luc de thuc hien cac yeu cau dieu tra va hoan 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 co san d thu vien cua TrUdng va cd sd y te Nghien ciiu cuon tai lieu mot cach tong the triidc thUc hanh tai cong dong se giup sinh vien co cach nhin tong quat ve mon hoc va chu dong hoc tap Vi vav sinh vien nen nghien cilu ky va lap ke hoach chi tiet trUdc di thiic hanh tai y te tuyen huyen va xa MON HOC THI/C HANH CONG DONG ■ ■ ■ So DVHT: So tiet : 0/180 Ly thuyet: Ly thuyet: Thiic hanh: Thiic hanh: 180 So Ian thi: Thdi gian thiic hien: Nam thii (Hoc ky IX & X) MUC TIEU Sau ket thuc mon hoc, sinh vien co kha nang: Mo ta diictc chiic nang, nhiem vu va cac hoat dong cua TTYT dii phong huyen Kham va xii tri diictc mot so benh thiibng gap tai benh vien huyen Phan tich diic/c cac hoat dong chuyen mon cua mot so khoa phong cua benh vien huyen va TTYT dii phong huyen Mo ta diictc cac chiictng trinh y te Quoc gia dang thiic hien tai huyen va phan tich chi tiet hoat dong cua chiictng trinh muc tieu co hieu qua nhat tai huyen Mo ta diictc nhiem vu va qui trinh quan ly tram y te xa Mo ta diic/c cach thiic hien chiictng trinh y te Quoc gia tai xa va phan tich chi tiet viec thiic hien chiiOng trinh muc tieu co hieu qua nhat tai xa Phan tich dittfc he thong so sach, so lieu va he thong bao cao tai tram y te xa Phan tich hoat dong va cach dieu hanh y te thon ban tai xa 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 NOI DUNG So tiet TT Ten bai hpc Tap huan cac van de lien quan thuc hanh cong dong 1: Ly thuyet Thirc hanh Muc tieu, noi dung va cac yeu cau hpc tap cua mon hpc thuc hanh cong dong 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 Phifdng phap thirc hanh lam sang tai benh vien huyen va cac chi tieu hpc tap 1 Phifdng phap thuc hanh tai TYT xa va chi tieu hpc tap 1 Phifdng phap thuc hanh tai CD va cac chi tieu hpc tap 1 Phifdng phap viet bao cao thu hoach 1 To chifc hoat dong cCia TTYT dif phong huyen 9 To chifc va quan ly cac chifdng trinh y te quoc gia tai huyen 9 To chiic va thuc hien kham va giai quyet cac benh thifdng gap tai phong kham benh vien huyen 14 14 To chifc va thirc hien kham va giai quyet cac benh thifdng gap tai khoa Noi Nhi Lay 30 30 To chirc va thi/c hien kham va giai quyet cac benh thirdng gap tai khoa Ngoai San 18 18 To chirc va hoat dong cua khoa Di/dc, xet nghiem, phong ke hoach tong hdp 12 12 To chifc hoat dong cua tram y te xa 9 Giao ban tai tram y te 6 Quan ly hoat dong mang lifdi y te thon ban 6 Phan tich he thong sd sach bao cao tai tram y te xa 9 Thuc hien cac chifdng trinh Tiem chung md rong, Sot ret va Bifdu co tai TYT xa 6 Chan doan cong dong 27 27 Lap ke hoach GDSK de giai quyet van de Stic khoe ifu tien d cong dong 10 10 Tien hanh GDSK de giai quyet van de sifc khoe ifu tien d cong dong 15 15 To chifc chuyen tuyen san phu khoa 6 180 Thuc hanh tai TTYT duphdng huyen va BV huyen (2 tuan) • Tong sd Thuc hanh tai xa (2 tuan) Tong cong ; 174 TL/LJONG GIA Cong cu lifdng gia: thang diem Thang diem li/ong gia ky nang kham am ho va am dao bang mo vit Ndi dung TT Thang diem He so Chao hoi benh nhan - giai thich viec tham kham Cho benh nhan di tieu Chuan bj day du dung cu Cho benh nhan nam ngCra, boc lo tCr eo trd xuong tren ban kham dung tif the Thay thuoc thirc hien vo khuan tot Thay thuoc ngoi dung tif the tren ghe quay Quan sat bo phan sinh due ngoai, phat hien nhung dieu bat thifdng Dung ngon tay tro va giura ban khong thuan boc lo nhe nhang moi I6n, moi be, am vat va cac tuyen Sken - Bartholin Chon co mo vjt thi'ch hop 10 Difa mo vjt vao dung ky thuat (theo difdng doc 7h-1h) roi quay sang an vao sau 11 Md md vjt quan sat cd tif cung, cung dung ky thuat 12 Khep md vjt, rut nhe nhang, ket hop quan sat am dao qua khe van md vit tren difdng rut 13 Giup benh nhan ngoi day, xuong ban nhe nhang 14 Thong bao so bo ket qua kham Dan an can - Chao tam biet sau 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 so Chao hoi benh nhan - giai thich viec tham kham Cho benh nhan di tieu Chuan bj day du dung cu Cho benh nhan nam ngira, boc lo tif eo trd xuong tren ban kham dung tif the 64 Thang diem o Thay thuoc thi/c hien vo khuan tot Thay thuoc diing dung vj tri tham kham Tach hai moi nho bang hai ngon tro va cai ban tay ky thuat Dua ngon tro va giura da di gang da dupe lam trdn vao am dao dung ky thuat, nhe nhang Ban tay phai chuyen len dat vao bung difdi benh nhan 10 Lay dong cd tii cung bang hai ngon tay am dao ket hdp quan sat net mat benh nhan 11 Hai ngon tay am dao ket hdp vdi ban tay d ben ngoai kham xet tii cung dung ky thuat 12 Hai ngon tay am dao ket hop vdi ban tay d ben ngoai kham xet hai phan phu va cac cung dung ky thuat 13 RUt tay khoi am dao nhe nhang 14 Giup benh nhan ngoi day, xuong ban nhe nhang 15 Thong bao so bo ket qua kham Dan dd an can, chao tam biet sau benh nhan mac quan ao 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 Hifdng dan tif liidng gia Sau thiic hanh sinh vien sii dung bang thang diem de tii liidng gia theo hudng d in Sinh vien cung co the sii dung bang de ludng gia lan va rut kinh nghiem qua trinh thiic hanh Hl/CJNG dAn TIJ HOC, TL/ NGHIEN CLTU, VAN DUNG THUC TE 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 chan doan va thai xii tri Tai phong kham: hoi benh, tham kham benh nhan dieu kien thiic te ve dung cu va trang thiet bi cua cd sd y te de co kinh nghiem thiic te 65 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 cac budc va yeu c£u cua tUng budc tham kham benh nhan phu khoa Tai lieu tham khao TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa 1999 TrUdng Dai hoc Y Khoa Ha Noi - Bai giang san phu khoa tap II 2002 Day hoc tich cilc dao tao Y hoc NXB Y hoc 1999 Hudng d in Phat trien tai lieu hoc tap thiic hanh DA VN - HL Bo Y Te - Hudng dan chuan quoc gia ve cac dich vu CSSKSS 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 hoc xong bai nay, sinh vien co khd nang: H oi dittic benh sit, tien sit cua benh tieu chay Danh gid dittic cac dau hieu mat nittic tren benh nhan cu the Phan loai dittic mite m at nitdc, Dieu tri dittic benh nhan tieu chay theo phac 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 mat niidc va roi loan dien giai Can dieu tri dung va khan triidng d cac cd sd y te Tiep can chan doan benh nhi tieu chay Hoi: - So' tieu chay - Co mau phan khong Bang kiem hit&ng ddn hoi benh sit, tien sit lam benh an benh tieu chay STT j Noi dung Muc dich Yeu cau Chao hoi Giao tiep Tao long tin va hop tac Ly vao Tien li/gng Hoi dirge cac trieu chung kem theo So bj tieu chay Chan doan Xac djnh so So lan TC Tien liidng Xac djnh diidc so lan TC Tinh chat phan Chan doan Xac djnh mau phan Cac trieu chung khac Chan doan va tien ludng Xac djnh: Sot, khat niidc, tinh than 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 dau hieu sau de danh gia mat niidc: Dau hieu Khong mat nude Toan trang Mat trung Tinh tao Khong Khong khat Mat nhanh Khat Nep da Mat nUdc nang Co mat nude 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, mot cot co it nhat hai dau hieu, thi phan loai mat niidc d cot Bang kiem danh gid dau hieu mat niidc Noi dung TT Yeu cau Muc dich Giao tiep Hdp tac cua ba me Tao siitin tudng Danh gia toan trang Phan loai mat nude Nhan djnh dupe tinh than cua tre Dau hieu khat Danh gia mat nude Nhan djnh duoc the nao la khat uong hao hire Mat trung Phan loai mat niidc Quan sat va hoi ba me Nep da Phan loai mat nude Lam dung Sii dung hudng dan xii tri phdng to hoac Phac 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 hoac nhieu hdn cac dau hieu thuoc khung mau vang hoac mau hong Mot dau hieu khong du de chon phan loai khung hong hoac vang Neu benh nhan chi cd mot dau hieu khung nen tim d khung ke tiep * Chi phan loai la ly neu tieu chay cd mau phan Dieu trj benh nhan tieu chay 2.1 Dieu trj tieu chay cap khong mat nude: (phac A) Dam bao 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 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 Muc dich Noi dung 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 lit + pha ORS Pha dung nong dp Dong dung lit nifdc bang cac dung cu thong thudng Nem kiem tra Danh gia nong 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 B) Bu dich bang uong oresol: gid So'liidng: ■ Oresol = liidng cO the (kg) x 75 ml Co the tinh liidng dich ORS theo tuoi va theo can nang diia vao bang sau: Tudi < th - 11 th 12-23 th - tudi - tudi >_15 tudi Can < kg - ,9 kg 8-10,9 kg 11-15,9kg -2 ,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 tiep tuc uong Theo doi hang gid so' lifdng oresol uong diidc, so' lan ia va dau hieu mat nifdc Sau gid danh gia lai de thay doi phac dieu tri: neu tre mat nifdc, tiep tuc dieu tri phac B lan 2, neu khong mat niidc chuyen sang dieu tri phac A Triidng hdp ba me phai ve triidc gid can phat du lifdng ORS 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 Triidng hdp that bai: Tre ia nhieu, mat tren 15 - 20 ml niidc/ kg/ gid Tre non nhieu tren 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 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 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 Cong cu lifdng gia Thang diem danh gia pha ORS Diem chuan Noi dung RCra tay bang xa phong va nude sach Chuan bi du dung cu pha (binh.coc, ORS, Nude soi nguoi) Kiem tra ORS triidc pha Dong du nude lit + pha ORS Nem kiem tra Day binh nude ORS, dan mac ORS ngoai binh Tong so 10 Diem dat 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 Hoi benh - Thdi gian tre tieu chay - Tinh chat phan long, mau - Khat - Trieu chung kem theo: non, dau bung, sot, co giat - Da uong ORS, thuoc khang sinh, cam tieu chay Danh gia dau hieu mat nude - Toan trang: nhan djnh cu the - Khat nirdc: nhan djnh cu the - Nep da bung: nhan djnh cu the - Nude m lt: nhan djnh cu the - Mat trung: nhan dinh cu the Phan loai mat nude - Khong mat nude - Mat nude nhe - Mat nude nang 70 1 1 1 1 Diem dat Dieu trj - Tieu chay khong mat nifdc Cho uong d|ch An thiic an giau dinh dudng Khi nao diia den co sd y te lai - Tieu chay mat nude nhe Lupng ORS 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 Theo ddi cac dau hieu qua trinh truyen Xac dinh dupe lieu lupng thuoc cu the - Lieu biseptol/ngay/dpt - Khong dung thuoc cam tieu chay 2 Tong diem: 20 Danh gid: - 11- 13: dat 14- 18: khd 19-20: gioi Hifdng dan sinh vien tifli/dn g 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 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 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 B) Van dung thifc te Trong thiic te se gap nhiing ba me khong chiu cho benh nhan uong niidc ma chi muon cho diidc truyen dich, phai kien tri giai thich va hiidng dan ba me cho tre uong dung theo hiidng d in 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, men tieu hoa la khong can thiet Tai lieu tham khao Triidng Dai hoc Y khoa Thai Nguyen (2006) Thiic te tot nghiep tai cong dong (tai lieu danh cho sinh vien) Trifdng Dai hoc Y khoa Thai Nguyen (2006) Thiic te tot nghiep tai cong dong (tai lieu danh cho giang vien) Bo mon Nhi Triidng Dai hoc Y Ha Noi (2002), Bai giang Nhi khoa Tap 1, 2002 ChiiOng trinh CDD (1998) Hiidng dan dieu tri benh tieu chay Tai lieu doc them Be Van Ca!m (1996), Tinh hinh benh tieu chay tai phiidng Phan Dinh Phung, Thai Nguyen Luan van bac si chuyen khoa cap II 72 nhiI m khuan ho hap cap MUC TIEU Sau hoc xong bai nay, sinh vien co the: H oi va khai thac diidc benh sii nhiem khuan ho hap cap (N K H H C ) Kham va danh gid dung cac dau hieu N K H H C tre em Phan loai va x ii tr i dung N K H H C theo phac To chiic Y te The gidi 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 Tiep can chan doan benh nhan nhiem khuan ho hap cap 1.1 Hoi - Ho 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 s ifv a lam benh an benh nhan nhiem khuan ho hap cap Muc dich Yeu cau TT Noi dung Chao hoi, lam quen Thu tuc hanh chinh (hoan chinh theo mau BA Nhi) Giao tiep Tao long tin, hop tac Ly den kham (trieu chiing chinh) Tien liidng Hoi diidc trieu chiing bat buoc tre phai vao vien Benh sir Chan doan Xac djnh difpc so ngay, so lan, dSc diem cua cac trieu chiing chinh va cac trieu chiing kem theo 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 vao vien) 73 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 Thai (an can, niem no, tutin) Tien liidng Xac dinh dupe cac tien sir co lien quan den benh 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 Chao hoi, lam quen Hop tac cua ba me Tao sii tin tifdng Kham danh gia toan trang Phan loai benh Nhan dinh dirpc tinh than cua tre Cap nhiet Danh gia sot Nhan dinh di/pc mdc sot Can tre Danh gia phat trien the chat tre Nhan dinh dupe the trang cua tre Dem nhjp thd va danh gia (thd nhanh, thd cham, cdn ngUng thd) Danh gia mdc suy ho hap Phan loai dupe mdc suy ho hap Tim dau hieu rut lorn long ngiic/ co keo cd ho hap Danh gia mdc dp suy ho hap Phan loai dupe mdc suy ho hap Nhin va nghe tieng thd rit/ thd kho khel thd ren Danh gia mdc suy ho hap Phan loai dirpc mdc suy ho hap Tim dau hieu tim va danh gia mdc dp Danh gia mdc suy ho hap Phan loai dupe mdc dp suy ho hap Kham cd quan ho hap phat hien cac trieu chung benh ly: nhin, sd, go, nghe Phat hien diipc trieu chdng benh ly giup chan doan Kham dung va phat hien dupe trieu chdng co tren tre benh 10 Kham cac cd quan khac phat hien cac trieu chdng benh ly (tuan hoan, tieu hoa ) Danh gia mdc cua benh Kham dung va phat hien dupe trieu chdng co tren tre benh 1.3 Phan loai NKHHC Giang vien dung phac ( 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 cach phan loai: 74 1.3.1 Theo vi tri giai p h iu : lay nap quan lam ranh gidi Phan loai ft sii dung tren lam sang: - NKHHC tren gom: ho hoac cam lanh,viem hong, viem amidan,viemVA, viem xoang, cac benh nhe, it gay tii vong va chu yeu chi can dieu tri va cham soc d tai nha - NKHHC diidi gom: viem quan, viem 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 xii tri noi co cac bang phan loai Nhac ho ve nhiing diem sau: - Ph&n ldn cac bang phan loai hiidng dan danh gia va phan loai deu co khung - Moi mot khung diidc to bang cac mau khac 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 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 tai lieu chi vao tting khung moi 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 thd n im 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 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 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 - Giam ho va dau hong bang thuoc ho an toan - Dan ba me nao can diia tre den kham - Kham lai sau 2.3 Khong viem phoi (ho hoac cam lanh) - Giam ho bang cac thuoc an toan - Dan ba me nao can diia tre den kham - Kham lai sau ngay, neu khong tien trien tot - Xii tri van de hong (neu co) Bang kiem ky nang quyet djnh dieu tri benh nhan nhiem khuan ho hap cap STT Ndi dung Chuan bi benh nhan (can nang, nhjp thd, tim ), benh an Muc dich Yeu cau Chuan bi ve tam ly Tao sii tin tirdng, hop tac cua benh nhan Chao hoi, giai thich gia dinh 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 Cham soc, an uong, theo doi va dien bien cua benh 76 - Giup dieu trj co hieu qua hdn - Phat hien diidc thirdng cua tre benh cac bat Ty mi, chu dao TU LlfpNG GIA 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 Hoi benh - Thdi gian xuat hien benh: ho, sot, kho thd - Tinh chat ho, sot, kho thcf, tim - Trieu chung khac kem theo - Da dung thuoc gi d nha (hoac co so y te ) - Di§n bien cac trieu chiing chinh - Tinh trang vao vien - Tinh trang hien tai Kham - Dem nhjp thd - Quan sat rut lorn long ngiic - Nhin va nghe tieng thd rit - Cac dau hieu khac 2 2 Diem dat 1 1 1 Chan doan: (phan loai) - Khong viem phoi (ho hoac cam lanh) - Viem phoi - Viem phoi nang hoac benh rat nang Dieu trj: 4.1 Viem phoi nang hoac benh rat nang - Dieu trj suy hd hap - Khang sinh: lieu/ kg/ - 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 nam ngay: lieu dung/ ngay/ drt - Giam ho va dau hong bang thuoc ho an toan - Dan ba me nao can di/a tre den kham - Kham lai sau hai 4.3 Khong viem phoi (ho hoac cam lanh) - Giam ho bing cac thuoc an toan - Dan ba me nao can diia tre den kham - Kham lai sau nam ngay, neu khong tien trien tot - XCr tri van de hong neu cd Tong cong 3 4 36 77 Tong diem : 36 Danh gia: 20-26: dat 27-32: kha 32-36: gidi 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 c lu phai dat cua tiing phan va cho diem theo hiidng d in 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 TH I/C TE 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 nam yen Sii dung phac de chan doan (phan loai) cho benh nhan Thiic hanh doc phim tim phoi Chi dinh cac phac 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 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 N eu khong co dii dung cu, phildng tien va oxy cap ciiu suy ho hap thi can cho chuyen vien kip thdi Tai lieu tham khao Triidng Dai hoc Y khoa Thai Nguyen (2006) Thiic hanh cong dong (tai lieu danh cho sinh vien) Triidng Dai hoc Y khoa Thai Nguyen (2006) Thiic hanh cong dong (tai lieu danh cho giang vien) Bo mon Nhi Triidng Dai hoc Y Ha Ndi (2000), Bai giang Nhi khda, Tap Bo mon Nhi Triidng Dai hoc Y khoa Thai Nguyen (2005), Bai giang Nhi khoa Tap Tai lieu dpc them WHO (1998), Chiidng trinh ARI UNICEF - Bo Y te (2004), Hiidng dan xii tri long ghep tre benh 78 [...]... 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 i Hoat dong Trach nhiem cua y ta, dieu dudng 1 24 Lay benh pham thudng quy cua ngudi benh noi tru mang theo... 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... 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... 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 hocHa 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 D1 AJNG MUC TIEU Sau khi thiic hanh xong bai nay, sinh vien co khd nang: 1 Khai thac diidc benh sii, tien... TU LUONG GIA 1 Cong cu luung gia Chon cau dung nhat trong cac tinh huong sau: T in h h u o n g 1: mot benh nhan nam 65 tudi, huyet ap do nhieu lan va diidc xac dinh la 18 0/90mmHg, 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... 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 14 - 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... 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... 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 Noi dung TT Khong Co To chifc 1 Kham benh 2 Nghien ciiu... 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... 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 20 01 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