Medical examination at the feldsher-midwife point

One of the most important types of preventive work of a paramedic is the prophylactic medical examination of the population.

The main elements of the medical examination are:

• active identification of patients with the initial stages of the pathological process;

• complete clinical examination;

• dynamic monitoring of the state of health;

• implementation of a complex of medical and recreational activities, including outpatient treatment, hospitalization, sanatorium treatment, dietary nutrition, employment;

• familiarity with working and living conditions in order to establish the connection between them and the identified diseases, develop measures to eliminate harmful environmental factors and ensure the most favorable conditions for human life;

• propaganda among the dispensary contingents of a rational diet, work and rest;

• periodic generalization of data on the effectiveness of clinical examination.

The objectives of the medical examination are:

• the definition and assessment of the health status of each person;

• ensuring the improvement of the level and quality of annual inspections and dispensary surveillance with the necessary amount of research;

• Expansion of the participation of various specialists and nurses in the prophylactic medical examination with the leading role of the district doctor;

• improvement of technical support for annual inspections and dynamic monitoring of public health using automated systems;

• Ensuring the necessary statistical accounting and reporting, the transfer of information about surveys and recreational activities to each person at the place of observation.

Preventive work of a paramedic should take 80% of the working time. The greatest urgency is the prevention of the onset, development of diseases and their transition to a chronic form.

By dispensary means a system of active measures that provides regular monitoring of health workers for healthy children with the provision of appropriate preventive measures, early detection of diseases and their treatment to the full restoration of the function of the affected organ, environmental sanitation. The World Health Organization defines health as "a state of complete bodily, mental and social well-being".Preventive medical examinations of the population are the initial stage of the dispensary surveillance system.

The medical examination includes:

• annual medical examinations of the population with the participation of average medical workers and the necessary laboratory and diagnostic and functional studies;

• additional examination of those who need modern diagnostic methods;

• carrying out the necessary medical and recreational activities;

• dispensary monitoring of patients and persons with risk factors.

The tasks of medical examinations are: active detection of common and occupational diseases in the adult population in their early stages;dynamic monitoring of the health of persons exposed to adverse factors;detection of diseases unfavorably taking place under the influence of certain factors, as well as pathology, which can contribute to the development of occupational disease;determination of deviations in indicators characterizing physical development and work capacity;development of recommendations aimed at improving working conditions, eliminating or significantly reducing unfavorable production factors;conducting individual treatment and prophylactic measures based on the results of a medical examination with the purpose of restoring the disturbed functions of the body and the ability to work of the sick.

Preliminary medical examinations are subject to children when they are admitted to a nursery, garden, school;students or students on admission to technical schools and universities;adolescents who are employed, as well as all persons who come to work in certain industries, agriculture, construction, transport, catering, etc.

Periodical medical examinations are carried out by the above-mentioned groups of persons during their entire work activity for the dynamic observation of theirhealth, preservation of work capacity and ensuring creative longevity.

Targeted medical examinations include the detection of diseases most common and endangering for work and life: tuberculosis, oncological, cardiovascular, etc.

In the conduct of mass medical examinations conditionally distinguish 2 stages: the preparatory and the actual worker.

During the preparatory period, the contingent of persons subject to preventive examinations, the time and place of the examinations, create teams of doctors and average medical workers and conduct instructional and methodological meetings and seminars with them. The contingents of workers and employees subject to preliminary and periodic inspections with indication of occupational hazards are determined by the SES, and in written form they request, in an approved form, lists of these persons from the heads of rural settlements and enterprises. The lists are made in triplicate( for the head doctor of the CRH, SES and the head of the agricultural enterprise);the head of the personnel department, with the participation of the engineer for occupational safety and safety, visits the documents, the head of the agricultural enterprise signs them, and they are certified by the seal. The SES is developing a schedule for conducting preventive examinations, indicating the composition of the medical team and the volume of laboratory examinations. The schedule of inspections must be coordinated and approved with the management of rural settlements and agricultural enterprises and brought to each medical institution.

All medical examinations are divided into: •

• preliminary;

• periodic;

• target.

The second, or actually the working, period consists in the direct organization and conduct of medical examinations, and as a rule, it begins in December, so that by the beginning of the mass field work all the recreational activities have been completed. The CRH issued an order specifying the specific tasks facing the team of doctors, appointed a senior doctor( usually a therapist).

Preventive examinations can be carried out on the basis of CRH, district hospital, medical dispensary. Brigades of doctors can directly travel to settlements, located on the FAP, in premises specially adapted for inspection. The order, time of the meeting and those responsible for attendance at the inspection are determined by the order of the head of the rural settlement.

Feldshers and midwives prepare premises, appropriate equipment, tools, check the lists of persons to be examined, which helps doctors to reduce the loss of working time, to study the working conditions of specific professional groups in more detail.

Radio broadcasts, publications in local newspapers, lectures, conversations, as well as individual invitations to patients' apartments by sanitary activists and paramedics can be arranged to attract the public to participate in the examinations. Responsibility for attendance at inspections of employees is entrusted to the heads of agricultural enterprises and trade union organizations.

Upon completion of preventive examinations, the final act for each enterprise is made.

Implementation of the annual prophylactic medical examination of the whole population is envisaged in two stages.

In preparation for the introduction of the annual medical check-up, the entire population living in the FAP service area is personally accounted for, in accordance with the "Instruction on the procedure for recording the annual medical examination of the entire population".In rural areas, the lists of residents are made up of medium-sized medical workers of the FAP for quarterly rounds, they are specified in village and village administrations and transferred to a district hospital( outpatient clinic).

For the individual registration of each resident, the average medical workers fill in the "Medical examination card" and number it in accordance with the number of the medical card of the outpatient( form No. 025 / y).After clarifying the composition of the population, all the "Clinical check-up cards" are transferred to the card file.

After the personal registration of the entire population, the following groups are distinguished:

• newborns;

• children of the 1st and 2nd year of life;

• children of preschool age in organized collectives;

• schoolchildren under 15;adolescents( schoolchildren, students of vocational schools and specialized secondary educational institutions, working adolescents aged 15-17);

• disabled people and participants of the Great Patriotic War, participants in the war in Afghanistan, liquidators of the consequences of the Chernobyl disaster;

• pregnant;

• workers in industry, construction, transport, communications;

• employees of municipal, medical and preventive, children's and other enterprises, organizations and institutions;

• machine operators, stockbreeders, field crop operators, indoor workers and other agricultural workers;

• students of higher education institutions and students of secondary special educational institutions;

• personal pensioners who are on medical care in this health care institution;persons who are under dispensary supervision;

• other population groups not included in the above list.

In rural areas( except district centers and registration areas), the following survey volume is recommended at the first stage of clinical examination.

Child population

1. Annual examinations by a pediatrician( in the absence of a pediatrician - by a therapist), a dentist( dentist).The pediatrician necessarily examines the children of the 1st and 2nd years of life, before going to school, the examination is performed by a pediatrician, neuropathologist and surgeon.

2. The average medical personnel conducts an anthropometric measurement, determination of visual acuity, determination of hearing acuity, preliminary evaluation of physical and neuropsychological development, takes tuberculin tests.

3. The following laboratory, diagnostic and instrumental studies: blood test( ESR, hemoglobin, leukocytes, erythrocytes);general urine analysis;analysis of feces for eggs of worms;measurement of blood pressure from 7 years;Fluorography of chest organs from 13 years.

Adult population

1. Annual examinations by a therapist, dentist, obstetrician-gynecologist( in his absence - a midwife), other specialists( according to indications).

2. The average medical personnel, including FAP, collects anamnestic data on a specially developed questionnaire;anthropometric measurement;measurement of blood pressure;gynecological examination of women with smear-taking( for cytological examination);definition of visual acuity;tonometry( persons over 40 years of age);determination of acuity of hearing, tuberculin tests( adolescents 15-17 years).

3. Laboratory, diagnostic and instrumental studies: blood test( ESR, hemoglobin);urine test for sugar, urine test for protein( express method);ECG( after 40 years);Fluorography( roentgenography) annually;cytology of the smear from 18 years in women;mammography( fluoromammogram) once every two years in women with 35 beds.

The scope of research carried out during the annual medical examination of agricultural workers in the main occupations includes the following groups:

• machine operators;

• workers of repair shops( locksmiths, turners, electric welders, batteries, blacksmiths, etc.);

• livestock keepers( milkmaids, cattlemen, pigs, calves, etc.);

• poultry farmers( poultry farmers, operators, egg sorters, slaughterhouse workers, etc.);

• plant protection agronomists, storekeepers of pesticide stores, greenhouses, plant protection workers;

• employees of the closed ground( greenhouses, agronomists, etc.).

For each profession, the order provides for the identification of an etiologic factor, examination by specialists( mandatory, according to indications) and laboratory tests, mandatory and according to indications.

The scope of medical examinations and diagnostic tests during pregnancy and in the puerperium includes the following nosological forms: physiological pregnancy in a healthy woman( postpartum period normal) - the frequency of observation by a doctor obstetrician-gynecologist, examinations by doctors of other specialties;name and frequency of laboratory and other diagnostic studies;the basic medical-improving actions, hospitalization.

Physiological pregnancy in a healthy woman. The frequency of observation by the obstetrician-gynecologist: during pregnancy 14-15 times;after the first examination turnout after 7-10 days with the analysis,

the conclusion of the therapist and other specialists, then in the first half of pregnancy - once a month;after 20 weeks of pregnancy - twice a month;after 32 weeks of pregnancy - 3-4 times.

Examinations by doctors of other specialties.therapist - 2 times( at the first appearance and on the 32nd week of pregnancy), dentist, surgeon, neurologist, ophthalmologist - 1 time at the first appearance, later on the indications, other specialists - according to the indications.

The name and frequency of laboratory and other diagnostic studies: a clinical blood test 2-3 times( at the first visit, with a period of 22 and 32 weeks of gestation);clinical analysis of urine( at each visit);bacterioscopic examination of the vaginal discharge( gonococci, trichomonas, fungi);blood type and Rh factor;with Rh-negative affiliation - examination of the husband for group and Rh-belonging;a blood test for Wasserman's reaction - 2 times( at the first visit and at 32 weeks of gestation);by indications - studies on toxoplasmosis, etc., determination of visual acuity, audiometry, measurement of arterial pressure, chest fluorography, ECG, colposcopy, eye pressure tonometry.

The basic medical-improving actions: hygiene of the pregnant woman, a mode of work and rest, a diet, психопрофилактическая preparation for sorts, UV О, vitaminization, a bandage.

Postpartum period is normal. The frequency of supervision by an obstetrician is 2 times. The first examination is 10-12 days after discharge from the hospital;the final - 6-8 weeks after delivery.

Examinations by doctors of other specialties: therapist, dentist, neurologist, surgeon, ophthalmologist( first examination) or final examination.

The name of laboratory and other diagnostic measures: external examination, blood pressure measurement, visual acuity determination, audiometry, chest X-ray, ECG, colposcopy, eye pressure tonometry, blood and urine analysis.

The basic medical-improving actions: personal hygiene, care of mammary glands, a mode of work( house), rest, a rational food, vitaminization, hygienic gymnastics, a bandage.

The entire population of the served territory is dispensed by a method based on the allocation of 5 dispensary groups:

In dispensary work, the periodicity of dispensary follow-up is necessary. There are three stages.

1. Planning work in connection with annual inspections of the organized and unorganized population( I stage).

2. Identification of contingents subject to follow-up( Stage II).

3. Active dynamic monitoring, treatment and rehabilitation and rehabilitation measures( Stage III).

Group 1 - healthy individuals subject to periodic examinations;

2nd group - persons transferred from the third group of accounts in the stage of stable compensation of the disease;

Group 3 - patients with compensated course of the disease. This group includes patients who have suffered acute diseases( infectious and non-infectious), for which they were on short-term follow-up, and persons at risk of developing chronic diseases as a result of frequently recurring acute pathological processes;

Group 4 - patients in the stage of subcompensation. In most cases, these patients periodically exacerbate the disease, and they often lose their ability to work;

Group 5 - the most severe category of patients with decompensated disease( abruptly suppressed adaptive ability of the body).In such patients, violations of physical and mental health are clearly manifested. They have been disabled for a long time, they need hospital treatment and intensive holding of a complex of health-improving measures.