Thực hành cộng đồng 1

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

So tiet

Tong

sd

Ly .

thuyet

Thirc

hanh

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

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

14 0 14

To chifc va thirc hien kham va giai quyet cac benh thifdng

gap tai khoa Noi Nhi Lay

30 0 30

•

To chirc va thi/c hien kham va giai quyet cac benh thirdng

gap tai khoa Ngoai San

18 0 18

To chirc va hoat dong cua khoa Di/dc, xet nghiem, phong

ke hoach tong hdp.

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

10 0 10

Tien hanh GDSK de giai quyet 1 van de sifc khoe ifu tien d

cong dong

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

1

To 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

9 Can bo trung tam

y te di/ phong huyen

3 To chiic hoat dong khoa di/dc, Khoa xet nghiem,

phong ke hoach tong hdp benh vien huyen

12 Lanh dao benh

vien huyen

4 Thi/c hien kham va giai quyet cac benh thi/dng gap tai

Phong kham benh vien huyen

14 Bac si

phong kham

9

5 Thuc hien kham, giai quyet cac benh thi/dng gap khoa

Noi Nhi Lay

30 Bac sT khoa No*

hoac Nhi

6 Thuc hien kham, giai quyet cac benh thtrdng gap khoa

Ngoai San

18 Bac sT khoa Ngoai

hoac San

7

------— ■

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

2

Thi/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

5

Lap ke hoach cho mot buoi Truyen thong - Giao due

sifc khoe tai cong dong 10 Can bo TYT X

6

Thi/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

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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