On June 265438+1October 2 1 day, I came to the Department of Orthopaedics of the Second Hospital of the City for an internship. During the internship, I will strictly abide by the rules and regulations of the hospital and orthopedics, abide by the law, respect teachers, unite students, and be strict in self-discipline, so as not to be late, leave early, be absent from work or leave my post without permission. Take good care of patients and be amiable. I try to combine theoretical knowledge with practical experience. During my internship, I constantly summed up my learning methods and clinical experience, and strived to cultivate my ability to think independently, solve problems independently and work independently. Internship life has also cultivated my lofty concept of serving the people wholeheartedly and the professional quality that medical workers must have. After nearly a month's internship, I have basically mastered the writing of all medical documents such as course records, consultation records and discharge records. Master the characteristics of clinical departments and the diagnosis and treatment of common and frequent patients in various departments; Master the diagnosis and differential diagnosis of common orthopedic diseases; I can skillfully perform basic surgical operations such as dressing change and stitches removal, and try my best to complete the learning tasks assigned by the teacher without any medical errors and medical accidents.
In just one month, I have learned a lot and made great progress in all aspects, but there are still many shortcomings, such as my professional knowledge and practical skills are not solid enough and need to be further strengthened.
Summary of orthopedic practice 2 Looking back on these days, there are joys and sorrows, sorrows and joys. Every day, I make rounds, change medicine, write down the course of disease, and write a discharge summary with the operation, so I spend my life repeatedly and busily. After nearly a month's orthopedic practice, I have learned more about myself. The dressing change in orthopedics is the most complicated, and the operation is almost the longest. Many of them are open fractures and machine injuries of limbs, and they often can't get off the stage for hours or even a day. Especially in the night shift, emergency patients will go to the stage as soon as they arrive, and the operation often lasts until midnight. Although I am very tired, I still feel very full. On the stage, I used to think it was not difficult to tie a knot surgically, but sewing a wound still needed some basic skills. For the first time, I know that seemingly simple operations are so difficult to implement. Every time I have an operation, no matter how late or tired I am, the teacher will insist that I sew the wound. I am slow, but he always teaches me patiently, telling me to practice hard, ask more questions and think more, and practice makes perfect.
In orthopedics, there are many types and locations of various fractures and injuries. Have a certain understanding of car accident injury, knife injury, machine injury, joint reduction, plaster external fixation, open reduction and internal fixation of limb fractures, and various debridement and suture. And improve the principle and operation of surgical infertility. After staying in a department for a long time, I feel that everyone really feels like a family. The care and instruction of teachers and the cooperation of the whole department make the busy work full and happy. Although I am only a student now, maybe my ability is limited, but I will use my efforts to enrich my knowledge and skills, study hard and practice more, and make persistent efforts.
Summary of orthopedic practice 3 orthopedic practice is coming to an end. During this month's internship, I abide by the laws and regulations of hospitals and hospital departments, respect teachers, be strict with myself, and strive not to be late, not to leave early, not to be absent from work for no reason, and not to leave my post without permission. Treat patients with a good attitude and strive to apply theoretical knowledge and basic skills to practice.
In a blink of an eye, I have been practicing for more than a month, and time flies. Looking back on my internship for more than a month, I learned a lot and felt a lot. Looking back on the first day of internship, I just entered the ward and always felt at a loss. I was in a relatively unfamiliar state with nursing work at that time, and I didn't have a formed concept of what I could do in such a new environment. Fortunately, we have teachers to introduce the ward structure, introduce the work of each class, and impart rich experience to teachers, so that we can quickly adapt to the nursing work and environment of various departments in the hospital.
Room 38 is the first department of my internship, which consists of orthopedics, spine and burn plastic surgery. When I first knew I was coming to this department, I was nervous and looking forward to it. On the first day in the department, the head nurse showed us the environment and layout of the hospital. Our department is on the eighth floor of the inpatient department. I have been in the department for a week, and I feel deeply at a loss and ignorant. Although the training is only the basic operation, we have done it in a mess. Although there is study in school, it is different. Times have been improving. More standardized, more strictly abide by the three checks and eight pairs. Abide by the aseptic concept and aseptic operation, and the teacher also emphasizes humanistic care, more communication with patients, more information about her illness, etc., so that patients can trust and actively cooperate with your work, and the nurse-patient relationship can be improved.
Orthopedics, accounting for more than half of the total number, mostly fractures. Femoral neck fracture is the most common in the elderly, and skin traction is more common in the elderly. The purpose is to prevent the nerve and blood vessels from being damaged as long as the joint is braked, the pain is relieved and the incarcerated fracture or other relatively stable fractures are corrected. You can also have surgery. The patients should eat and drink12 hours before operation, lie flat after operation, and give ECG monitoring according to the doctor's advice. For patients in bed, they must turn over at any time to prevent the occurrence of pressure ulcers, and observe the four senses movement and blood supply of limbs. The most common diseases in spine department probably refer to lumbar keyboard protrusion and scapulohumeral periarthritis. These diseases are common, and most of them are chronic and long-term.
In plastic surgery, the most common patients are scalds, burns, sulfuric acid splashing and so on. According to the burn area of patients, doctors can also divide them into three stages: mild (< 9%), moderate (10% 10 ~ 29%) and severe (30% ~ 49%). Burn patients need to eat some foods with high protein, calories and vitamins.
Now the nursing documents are written on the computer, and the temperature list looks simple and clear. Teachers also check the doctor's orders on the computer, then print them out and follow them. Some commonly used drugs can also tell their functions and usage.
I followed three teachers in the department, Miss Huang, Miss Zhu and Miss Liu. Excellent teachers in all aspects. They have solid basic knowledge, skilled technical operation and accumulated rich clinical experience. I'm at a loss. After the teacher's teaching, I am full now. Thanks to the hard work of all the teachers, we have such a good practice opportunity before we set foot on our posts. Clinical practice is the consolidation and strengthening of theoretical learning stage, the cultivation and exercise of nursing skills, and the best training before employment. Although this period of time is short, it is very important to each of us.
I have learned very little. I will continue to study hard, accumulate, make good use of this limited time and learn more. I will try my best to be an excellent medical staff.
Summary of Orthopedic Practice Part IV Orthopedic practice lasts for one month, and there are more than 20 large and small operations, which are worth three night shifts and one weekend day shift. It can be said that I have learned a lot through these operations and postoperative treatment. Not only in technology, but also in humanistic care. In this short 30 days, pain and happiness coexist. And the biggest pain is physical fatigue-in traumatic orthopedic surgery, there are many cases of limb fractures, and in limb fractures, lower limb fractures are particularly common. Fracture is classified according to different angles. Fracture can be divided into closed fracture and open fracture according to whether the broken end of the fracture is exposed to the outside world, in which open fracture must be surgically reduced, while closed fracture can be determined according to manual reduction and the severity of the disease. When open reduction of lower limb fracture is determined, the whole injured limb should be disinfected before operation. The process of disinfection is: firstly, use 2% iodine to disinfect, and then use 75% alcohol to remove iodine. The patient lies flat on the operating table. When we clean the front and side of our legs, you will find problems. How to disinfect the part of the leg that touches the operating table? Yes, your idea is absolutely right-just lift your legs and disinfect your back, but things are far from as simple as you think. Many people think it's no big deal just to lift their legs. But when the leg bone is broken, the broken end will become an extremely sharp knife. If the affected limb is simply lifted, the greater the angle of fracture and dislocation under the action of gravity, the greater the probability of peripheral vascular nerve damage. So you can't just lift the affected limb, but also pull the affected limb along the force line. There is a saying that arms can't twist thighs. Pull outward when lifting the affected limb to ensure that the body does not touch the operation. Hehe, does it hurt a little?
The requirement of aseptic concept in operating room is very strict, and the nurses in operating room are also extremely strict. Any action that does not conform to the aseptic specification will immediately arouse their dissatisfaction, so many interns are scolded a lot. Because of the strict training of simulated operating room and trainee, I rarely see their faces in the operating room, and because of my professional performance, they unconsciously stop treating me as a student, but as a standard surgeon.
My excellent performance naturally attracted the attention of Professor Li Zhengwei in our operation group, so he was particularly relieved of me and asked me to do some work. What excites me most is a femur operation. He is the chief surgeon, and there are five people on the stage. He, his resident, senior doctor, one of his graduate students and me, I am the youngest in terms of qualifications, but in this operation, I finished my first performance. The situation at that time was that the fracture site had been cut and the fracture was well aligned. Professor Li put the steel plate away. After he hit the first bone nail, he said to me, Xiao Yang, come on, you hit it. I am very excited. Under the envious eyes of the three doctors, I took an electric drill and drove the drill steadily into the femur, then fixed it with steel nails. The technology is very good, and the professor nodded with satisfaction. This is a great encouragement to me. In the dressing room after the operation, Professor Li Zhengwei expressed the hope that I would become an orthopedic surgeon. With the expectation and encouragement of this well-known orthopedic expert in China, I feel that my goal is more clear. ............
Summary of orthopedic practice. My orthopedic internship is coming to an end. During this month's internship, I abide by the laws and regulations of the hospital and various departments of the hospital, respect teachers, unite with my classmates, be strict with myself, and try my best not to be late, leave early, be absent from work for no reason and leave without permission. Treat patients kindly and emotionally, and try to apply the theoretical common sense and fundamental technology learned to practice. In this process, I constantly sum up my learning methods and clinical experience, strive to improve my ability to think independently, solve problems independently and operate independently, and constantly cultivate my lofty thoughts and excellent professional ethics of serving the citizens wholeheartedly.
During my internship in this department, I strictly abide by labor discipline, work hard, study hard, be good at asking questions, and apply the common sense I have learned from books to practice. Under the guidance of the teacher, I have mastered the nursing of some common diseases in orthopedics and some basic operations. It was my gradual transition from an intern to nursing that made me realize the particularity and necessity of clinical work. I studied theory on campus, and now I find that what I saw in my practical homework is not as simple as I imagined, nor as typical as what I wrote in the book. I often rely on my usual experience in my homework, so as long as I put it into practice, I can gradually accumulate experience by grasping my talent.
Summary of Orthopedic Practice 6 When I first came to the hospital, I had brought back some textbooks of my own, and I confidently wanted to read books when I got off work or went to work, but now? Seeing that the internship is coming to an end, in addition to the books on local anatomy system, some books have been flipped through occasionally, and some have been kept in the duty room and have not been taken out yet. The same is true of Mr. Liu's practical orthopedics. I can see as much as I want, and then I will continue to see the rest this winter vacation. Now I have read one or two hundred pages, and there is no follow-up. The two notebooks I bought also recorded a few pages, and the rest were all new. I read books in the office almost every night. Later, maybe I was lazy, maybe it was the environment. I've always wanted to go somewhere for a walk and chat, but I don't have much mind to read. Read for a while if you want, and turn over the books when you encounter problems.
In the operating room, I obviously feel much better than before. Before I cut the skin, I hardly knew what muscles, blood vessels and nerves were in the skin. Now I almost know 70% to 80%. It may have a lot to do with my local knowledge after I just learned it. I know almost all the instruments in the operating room, mainly from doctors and nurses, but I still write them down. The difference between bone peeling and periosteal cellophane is still relatively general. Vascular clamp and big bend are also a little general. On one occasion, Dean Liang performed decompression of lumbar spinal cord and pedicle fixation, and Dean Liang asked me to take the nail hook. I saw it then and took it. At that time, I was still wondering what a nail hook was. Let the nurse take the nail hook when listening for the first time. Dean Liang said it was a nail hook. Dean Liang also asked Mr. Liu if I had been on stage. I was thinking, I have five nails here. That nail hook is generally called a retractor, a retractor, or the name of Dean Liang is different. Later, I learned that there are many seemingly different instruments between nail hook and thyroid retractor, and the difference is still unclear. Studying medicine, you really can't be careless, let alone cheat. Those ambiguous things must be clarified one by one. What you are facing is not any goods or livestock, but all living life, not human life. Others are willing to see you because others believe in you, and others are willing to lie on the operating table and let you operate on him. It's because others believe you, and you can't be confused.
When doing surgery, I don't have much forward thinking, and sometimes I'm all thumbs. Although I probably know how to do many operations, after all, I have been on the stage so many times, so many of me should have advanced thinking. The key is to read more books and study more, without theoretical basis. Practice is like a castle in the air and a mirage, which is useless. From the moment the teacher took the knife, I first thought that the teacher would be specific. When the teacher does this step, he must understand the purpose of the teacher doing this step, why he should do it, and think of what to do next. If he wants to be a good assistant now, he will be a surgeon himself in the future, and he will be a good doctor in people's minds. As long as people mention you after dinner, they must think he is a good doctor. The doctor's level is ok, and he will not be a quack. Everyone wants to see you, everyone.
When changing a patient's dressing, asking about his medical history, or at any other time, as long as he faces the patient himself, he is very serious, with a kind tone and a kind attitude. Most patients are very willing to let you change his dressing or ask about his medical history. Sometimes, when dressing changes, few people swear, saying that they have hurt him and said one or two ugly words, although they are very unhappy. I know in my heart that I really hurt him. I should be gentle, or the wound really hurts. I should be lighter. He is also harmless. There is no need to lose your temper with him, let alone lose your temper with him.
In this internship day, I really feel that from the moment the patient comes, I have to learn everything from examining the patient, making doctor's orders, making rounds, surgical treatment, typing medical records and making necessary explanations when I leave the hospital. I feel that the road is still difficult to walk and there are many things to learn. I don't know when I will learn, but I will study hard and seriously. I will go back to school in a few days and start to learn clinical knowledge in an all-round way at once.
Summary of Orthopedic Practice 7 Practice Contents:
General nursing of orthopedic surgery; Plaster fixation nursing; External fixation support nursing; Traction nursing; Arthroscopic nursing; Nursing care of total hip replacement and artificial femoral replacement: nursing care of finger reconstruction by free toe transplantation: nursing care of free skin flap transplantation: nursing care of osteomyelitis and suppurative arthritis: nursing care of replantation of severed limbs (fingers): skin traction; Nursing care of brachial plexus injury and multi-group nerve displacement: nursing care of median nerve release (carpal tunnel syndrome): helping patients change their posture; Cardiopulmonary resuscitation; Bedridden patients change sheets; Drainage tube nursing; Bedsore nursing; Nursing care of convulsion; Orthopedic rehabilitation training standards; Shock nursing; Nursing care of tracheotomy; Graded nursing; Paralysis nursing; Nursing care of patients with high fever treated by reconstruction plate: negative pressure drainage ball, central negative pressure drainage; Skin preparation; Use microwaves and infrared rays; Coma care.
Personal summary:
"I looked for him a thousand times and suddenly turned around, but the man was in the dim light." Through the internship in orthopedics, I have a deeper understanding of some basic knowledge of orthopedics and a better grasp of many clinical orthopedic diseases and nursing knowledge.
During the internship, I strictly abide by discipline, unite with interns, respect teachers, go to work on time, never arrive late and leave early, stick to my post, never gather people to chat, work actively and have a correct attitude. The tasks assigned by the teacher are always completed to the letter.
I always adhere to the "people-oriented" service concept, take the patient as the center, take the patient's safety and comfort as the service purpose, constantly strengthen my own connotation, strive to improve the service quality and skills, do everything for the patient, do everything for the patient, make regular rounds, give patients various health education, make them understand the importance of promoting and maintaining health, take care of patients with patience, care and love, and sincerely impress patients.
My sincerity, care, love and modesty touched all patients and their families, won their high praise and praise, and was affirmed by all medical staff. I'm, I'm glad you came. You deserve to be an excellent intern! I will go further in my future internship!
Summary of Orthopedic Practice 8 Time flies! In a blink of an eye, we are about to end our internship in orthopedics. Looking back on these days, it is either bitter or happy, or sour or sweet. I believe that everyone has a taste of self in their hearts. Nearly a month's internship in orthopedics has made me know more about myself and my clinic, and I have benefited a lot in the process of orthopedic internship.
The third department of orthopedics is the first department in my clinic, which is completely different from the first department of anesthesiology in terms of working methods, working materials and working hours. I was very confused when I first came to orthopedics, and I needed teachers to teach me everything. The first day of remedial class, I don't know what to do. I followed the teacher and did what the teacher said I wanted to do. Before the teacher taught me, I didn't dare to do anything I didn't understand. The first operation in plastic surgery is dispensing medicine. I have only been trained in school before, and I have never really operated it. I'm afraid I'll make a mistake when I dispense medicine for the first time, and I'm afraid my hands will shake if I pollute them. Under the guidance of the teacher, after many exercises, I was finally able to operate it conveniently, but I was not very skilled.
The configuration of penicillin skin test solution is very common in hospitals. When patients first enter the hospital, they should know whether they are allergic to penicillin, which is convenient for later medication, but the most important thing is for the safety of patients. I watched the teacher operate a few times before. The teacher patiently taught me step by step. After work, I also read books and write down the configuration process one by one. When it was my turn to operate by myself, I was very nervous at first, afraid of taking the wrong dose. 1ml syringe is not easy to operate, and air often appears, so it is difficult to shake it well. After many times of practice, although it is not very skilled, it is not as laborious as it was at first, and the operation is more standardized. I believe I will do better in my future work.
Because there are more auxiliary courses and less clinical treatment, I also know the relevant clinical operations. Teachers always patiently explain the operation process to me, pay attention to matters, make mistakes, and patiently correct me when it is not standardized. This month, I learned intravenous infusion, skin test, intramuscular injection, skin traction, blood collection, perineal scrubbing and bladder irrigation; Understand how to indwelling catheter and the basic functions of some oral drugs and intravenous drugs; Understand some nursing information and education before and after patients.
In clinical practice, communication with patients is very important, but due to the lack of self-experience, some questions raised by patients are not always answered. They often ask the teacher and then go back to tell the patients. What is even more distressing is that when patients speak the local dialect, they are often embarrassed to explain to them that they don't understand Minnan. In a word, I have learned a lot and seen a lot during this month in orthopedics. Understand how to carry out related nursing work before and after operation, how to carry out health education for patients, learn work materials of different shifts, and master relevant clinical operations. Although the internship life is very tense and the work is very complicated, I believe I will stick to it and try my best to do everything well in clinic.
Summary of Orthopedic Practice 9 During the four weeks of orthopedic study, with the guidance of the teaching teacher and the help of other teachers and nurses, I can better link theory with practice. Under the careful guidance of my teacher, I learned to look at X-rays, CT films and MRI films. At the same time, the teacher also taught me how to basically determine the common fracture location, fracture type, fracture healing scene and joint scene. Moreover, every morning, when accompanying the director and the teaching teacher to make rounds, the theoretical knowledge will be further consolidated and expanded, and at the same time, a common habit of being good at thinking and summarizing will be formed, which will create conditions for better study in other departments in the future.
For four weeks, I changed the dressing for patients every morning, became familiar with the operation method of dressing change, strictly mastered the steps and precautions of dressing change, strengthened the concept of sterility during the operation, basically determined whether the wound was infected or healed, and mastered the time and precautions of stitches removal in various parts.
The purpose of dressing change:
Check the wound, remove the wound secretion and necrotic tissue, smooth drainage, control infection and promote wound healing.
Precautions for dressing change:
1. Strictly observe aseptic surgical techniques. If the dressing changer has touched the bandage and dressing of the wound, don't touch the dressing cart or sterile dressing bowl again. When things are needed, they can be supplied by nurses or taken after washing hands. All kinds of sterile cotton balls and sterile dressings shall not be put back in the original container after being taken out of the container.
2. To change the dressing, you should first change the clean wound, such as taking out stitches, then change the infected wound, and finally change the dressing for the seriously infected wound.
3. Pay attention to remove foreign bodies from the wound when changing medicine, such as thread ends, dead bones, shrapnel, carrion, etc.
And check whether the amount of drainage is correct.
4. Dressing should be gentle to protect healthy tissues.
5. After each dressing change, all instruments must be put back to the designated position, and the dressing can be changed for another patient only after washing hands carefully.
Indications for removing stitches after operation:
1. Sterile surgical incision
2. No abnormal local and systemic manifestations.
3. It's time to take out stitches.
4. The incision healed well.
5. Patients with obvious wounds such as redness, swelling, heat and pain should have their stitches removed in advance.
Contraindications for suture removal after operation:
1. Patients with severe anemia, emaciation and mild cachexia.
2. Severe water loss or electrolyte disorder
3. Elderly patients and infants
4. When the cough is not controlled, the sewing of the thoracoabdominal incision should be delayed.
General treatment for new patients when they arrive:
1. Patients with open trauma should undergo emergency surgery under general anesthesia, combined spinal-epidural anesthesia, epidural anesthesia and local anesthesia according to their specific conditions.
Disinfect the skin around the wound with iodophor first, and repeat it three times from the center to the periphery. Then wash the wound alternately with hydrogen peroxide and normal saline, which must be thoroughly cleaned for three times, and then suture layer by layer after removing foreign bodies and necrotic tissues.
2. Closed fracture and simple joint dislocation, plaster fixation or suspension fixation.
(When the plaster is fixed, the upper limb 12 layer and the lower limb 14 layer shall be soaked in hot water above 40 degrees. When there is no bubble again, remove the residual moisture, flatten the plaster, spread a towel and set it. )
3. There are indications for surgery, and the failure of manual reduction can be bandaged and fixed. After improving all kinds of preoperative examinations, arrange the operation. Strictly observe the aseptic principle and some basic operations during the operation.
In short, thanks to the teachers' careful teaching and the patient guidance of other teachers. I will walk into the next department with a more proactive working attitude, more solid operational skills and more profound theoretical knowledge, improve the theoretical basis of medicine, improve clinical work skills and treat my work with dedication!
Summary of Orthopedic Practice 10 Nursing matters especially exercise people's patience and psychological quality, and do it with your heart, so that your comprehensive quality can be improved in by going up one flight of stairs. There is always a feeling of comfort and joy in the face of patients suffering from illness and seeing that their families are extremely grateful for your careful care. Although my internship time is only about 6 months, it has become the most precious wealth in my life.
In more than half a year's nursing practice, under the careful guidance and patient teaching of the teaching teachers, I have carefully studied the Regulations on Handling Medical Accidents and its laws and regulations, actively participated in the training of medical accident nursing regulations organized by the hospital, and participated in the study of nursing staff many times. Through study, I realize that the legal system is becoming more and more perfect and the people's legal concept is constantly enhanced. It has become common sense for people to act according to law and safeguard their legitimate rights and interests. The concept of modern nursing quality is to make patients feel excited in all directions and in the whole process, so that people put forward higher and newer requirements for medical care services, thus enriching the knowledge of laws and regulations, enhancing the awareness of safety protection, making nurses know the law and usage according to law, and reducing the occurrence of medical accidents. The viewpoint and practical level have been improved.
During the internship, I strictly abide by the rules and regulations of the hospital, earnestly perform my duties as a nurse intern, be strict with myself, respect teachers, unite classmates, care for patients, arrive late and leave early, work hard, standardize nursing matters, improve skills and services, be flexible in basic nursing, make love activities regular, combine meditation with practice, and study meditation in a planned, focused, measured and recorded way. Always take "love, care and patience" as the foundation, strive to be "diligent in eyes, hands, feet and mouth", think about what patients think, deal with emergencies, and provide quality services wholeheartedly, thus establishing a good medical ethics. In the practice of each department, we can write all kinds of nursing documents in a standardized way, complete the successful handover record in time, do a good job in patient evaluation and nursing health education, do a good job in nursing common diseases and frequently-occurring diseases in each department, conscientiously implement aseptic operation procedures, prepare and guide before operation, and complete intraoperative and postoperative care and observation. In the process of things, can seriously analyze the problems found, deal with them in time, and skillfully hold internal and external meetings. Maternal and child care, intensive care and other nursing operations, strictly implement the three checks and seven correspondences, and actively participate in various case discussions and academic lectures to continuously enrich their professional knowledge. Through the study, I got a more comprehensive understanding of holistic nursing technology and ward management knowledge, and made a self-evaluation of my own affairs during the period.
Through more than half a year's internship, my viewpoint level and practice level have improved. In the future, I will continue to work hard, keep in mind the responsibilities of nurses, constantly strengthen ideological study and professional study, comprehensively improve my comprehensive level, and provide quality services for patients.