Author: Обуховец Т.П. Склярова Т.А. Чернова О.В.
Tags: общественное здоровье и гигиена санитария защита от несчастных случаев и их предупреждение социальная гигиена и организация здравоохранения в прежнем ссср (снг) медицина
ISBN: 5-222-06273-2
Year: 2005
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MllZpa llJl - nepeMeIl.\cHHe miCeJIeHH.H no 'l'CPPHTOPI-II-r,
KOTopoe H3MemIeT ero 'iHCJIeHHOCTb B onpe,l\eJIeUHbIH ncpno,l\
BpeMeHH.
7
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TeppUTOpll1l38. OnpeAeJIeHHblM npoMe:myTOK BI)(,MI'"'' (l<anCH-
AapHblH rOA). Ha nOKa3aTenb cMepTHocTH BnllJlIO'r TIll! I!JaK-
Topa (IO.TI. JIHCHqI-IH, 1992 r.): AeTCKaJl (Mnll/lf'II'!I'('I{aJl),
nepHHaTanbHaJl H 06m;aJl CMePTHOCTb. )J;eTCI{aJl (Mn.I,l\CH'IeC-
KaJl) CMePTHOCTb - nOKa3aTeJIb CMepTHOCTH ncpnoro rOA8
:mH3HlI. TIepHHaTaJIbHaJl CMepTHOCTb - nOKa3aTenb CMCPTHO-
CTH B nepllHaTaJIbHblM nepHOA, KOTOpblM Ha'lHHaeTCJl C 28
HeAenb 6epeMeHHocTlI, BKJIIO'IaeT nepHoA pOAOB H 3aKaH'IHBa o
eTCJl '1epe3 7 flOJIHblX AHeM :mH3HH HOB6po:mAeHHoro.
(MepTHOCTb HaceneHMSI B PC!I (Ha 1000 HaceneHMR)
TIoKa3aTenn cMepTHocTH 3aBHCJlT OT opraHn3aqHH MeAH-
Ko-cOIJ;HanbHoii nOMo.m;H HaCeJIeHHIO, COCTOJlHHJl oKpy:maIO-
.m;eM cpeAbI, 3KOHOMH'IeCKHX <paKTopoB H 06pa3a :mH3HH. CHH-
:meHHe AeTCKoii cMepTHoCTH 3aBHCHT OT MepOnpllJlTHH no x-
paHe nnoAa, YJIyq:IIIeHlIIO Ka'leCTBa MeAHqHHcKOH nOMOm;H Ae-
TJlM B B03pacTe AO rOAa, pa3pa60TKH paqHOHaJIbHblX MeToAoB
BCKapMJIHBaHHJl AeTeM, npo<PHnaKTHKH H ne'leHHJl 3a60neBa-
HHM Y AeTeii nepBoro rOAa :m1l3HH.
PO:HCiJaeJlfOCmb - '1HcnO POAHBIIIHXCJl Ha 100 :mnTeneM B
eAlIHHqy BpeMeHlI (KaneH,l\apHbIH rOA). Cno:mHaJl COqHaJIbHO
- 3KOHOMH'IeCKaJl cHTyaqHJl B POCCHH H PJlA APyrHx npH'IHH
npHBenH K K8TaCTpO<l>H'IeCKOMy na,n;eHHIO po:m,l\aeMocTH. Ce-
roAHJl 2/3 ceMeM HMeIOT OAHOro pe6eHKa. K03<P<PlIqHeHT po:m-
AaeMOCTH - OTHOIIIeHHe BenH'IHHbl po:mAaeMOCTH K ero cpeA-
HeM '1HCneHHOCTH. 06.m;HH K03<p<pHqHeHT po:m,l\aeMocTlI COCTa-
BHn B 1999 r. 8,4A (B 1990 r. - 13,4A), B 2000 r. - 8,7A.
TIoKa3aTenb pO»<,l{aeMOCTH HMeeT 3THH'IeCKHe pa3nH'IlISI. Bbl-
COKHH ypoBeHb po:mAaeMOCTH COXpaHJleTCJl B pecny6nHKax
)J;arecTaH H TyBa.
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HHe '1HCna POAlIBIIIHXCJl K '1Hcny YMepIIIHX. )J;nJl npOCToro
BocnpOH3BOACTBa HaCeneHHJl He06xOAHMO, '1T06bl pO»<,l{aJIOCb
210 AeTcH Ha 100 :mHTeneM POCCHH (2-3 pe6eHKa B ceMbe).
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06.m;eM 3a60neBaeMOCTH naCeneHHlI BblpOC Ha 15 %. EbICTPbl-
MH TeMnaMH paCTeT 3a60neBaeMocTb Bpo:mAeHHblMlI aHOMaJIlI-
lIMH (nopoKaMH pa3BHTHJl), 60ne3HlIMH MO'lenOnOBOM CHCTe-
Mbl, 60ne3HlIMH CHCTeMbI KpoBo06pam;eHHlI, a TaK:me 60JIe3-
HlIMH HepBHoM CHCTeMbI H opraHOB '1YBCTB. POCT nOKa3aTeJIeii
3a60neBaeMOCTH Ha6nIOAaeTClI npaKTH'IeCKH no BceM KnaccaM
60ne3HeH. TIpH aHanH3e 06m;eii 3a60neBaeMOCTH Bbl'lHCnlIIOT-
ClI cneAYIOm;He nOKa3aTenH: nepBH'IHOM 3a60neBaeMocTH, no-
Ka3aTenb pacnpOCTpaHeHHOCTH 60ne3Heii, 3a60neBaeMOCTb
60ne3HJlMH CHCTCMbl KpOB006pam;eHHlI HAP. 60ne3Heii no B03-
pacTHblM, nonoBblM, npo<peccHOHaJIbHblM rpynnaM, HccneAY-
eTClI CTpYKTypa 3a60neBaeMOCTH. Ha1l60nee TO'lHbIC nOKa3a-
TenH nonyq:aIOT y AHcnaHcepHOM rpynnbl HaCeneHHlI nYTeM
BbI60pO'lHbIX HCCne,l\OB8HHH.
BOJle3Hb - 3TO TaKoe H3MeHeHHe B <PH3HonOrH'IeCKOM,
nCHXOnOrH'IeCKOM H AYXOBHOM COCTOlIHHH '1enOBeKa, KOTopoe
ron 1i13Me-
Pern- HeHHe
OH 1992 1993 1994 1995 1996 1997 1998 1999 e%
(+;-)
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neBaHHlI, AelITenbHOCTH H T. A.). ITo AaHHblM 3a 1998 rOA
OCHOBHblMH npl-t'lHHaMH 06m;eM cMePTHOCTH JlBnlIIOTClI: 60-
JIe3HlI CHCTeMbI KpoB006pam;eHHH, B TOM '1HCne HIIIeMH"IeCKOM
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CTBeHHble HOBo06pa30BaHHJl, TpaBMbI, OTpaBneHHJl H APyrHe
nOBpe»<,l{eHHJI, BbI3BaHHbIe BHeIIIHHMH npH'IHHaMH, H3 KOTO-
pbIX BeAym;HMH JIBnJIIOTCJl HeC'IaCTHble cny<laH, CBJl3aHHble C
TpaHCnOpTOM, OTpaBneHHlI aJIKOrOneM, caMoy6HHcTBa H y6HH-
CTBa. li3 APyrHx 3a60neBaHHM, npHBOAJIlIJ;lIX K neTaJIbHOMY
HCXOAY, 06pam;aIOT Ha ce6JI BHHMaHue 60ne3HH opraHOB AbI-
XaHHJI, nHlIJ;eBapeHHJI, HH(peI{qI-IoHHbIe H napa3HTapHble 60-
ne3HH, B TOM '1HCJIe Ty6epKyne3.
CpeiJHJlJl npOaOJl:HCUmeJlbHOCmb :JICU3HU B 2000 rOAY COCTa-
BlIna y My:m'lllH 60 neT, B 2001 roAY - 58 neT H ceiiqac OHa
B POCCHH CaMaJI BblCOKaJI B MHpe. Y :meHm;lIH - 72 rOAa.
8
9
npHBO,l\lIT K CHlI:meHlIlO ero B03MO:mHOCTeH 11 npO,l\On:mllTenb-
HOCTn :m1l3HH. (TBa)\enn, 1977).
HHBaJluBHocmb. ::ho HapYlIIeHue 3,l\OpOBb.H co cToiiIuIM pac-
CTPOHCTBOM 'I}:JYHK lIH opraHu3Ma, 06ycnOBJIeHHoro 3a60JIeBa-
HlI.HMU, nocne.z:\CTBU.HMlI TpaBM nnH ,l\el}:JeKTaMu, npI-IBO,l\.H ee
K OrpaHH'IeHlIlO :m1l3He,l\e.HTenbHOCTlI 11 BbI3bIBaIOll{ee He06xo-
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TlI'IHa.H YTpaTa qenoBeROM cnoc06HoCTlI lInll B03MO:mHOCTlI
ocyU(eCTBJIJiTb caMo06CJIY:mllBaHlIe, caMOCTO.HTe.JIbHO nepe,l\BlI-
raTbC.H, oplleHTlIpOBaTbCJi, 06 aTbc.H, ROHTponllpoBaTb CBoe
nOEe,l\eHlIe, 06y<IaTbC.H 11 3aHlIMaTbCJi TPY,l\OBOH ,l\e.HTenbHOC-
TblO (3aROII 0 CO lIanbHOH 3all{lITe lIHBanll,l{OB B P , npllH.HT
B 1995 ro,l\Y).
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B POCClIlI xapaRTep1l3yeTC.H HeraTlIBHbIMlI nORa3aTen.HMlI co-
CTO.HHlIJi 3,l\OpOEb.H HaCeneHHJi: YBenU'IlInllCb nOKa3aTeJilI 3a-
60neBaeMocTlI, cMepTHocTlI, YMeIlblIIlInaCb cpe,l\H.HJi npO,l\on-
:lKlITenbHOCTb :lK1I3HlI. M3BecTHo, qTO e:IKerO,l\Ho B cTpaHe pe-
rllcTpllpyeTC.H 155-185 MnH. cnyqaeB 3a60neBaHlIH Hacene-
HlI.H OCTpbIMlIlI XpoHH<JecKlIM1I60ne3HJiMlI, U3 KOTOpbIX OKO-
no 100 MnH. C BnepBble YCTaHOBneHHbIM ,l\lIarIl030M.
B 60nblIIlIHcTBe :3KOHOMlIqeCKlI pa3BlITbIX CTpaH ,l\OCTlIr-
HYTbI 3HaqllTenbHble ycnexlI B CHlI:lKeHlIlI 3a60neBaeMocTn 11
cMepTHocTlI OT OCHOBHbIX XPOHlIqeCKlIX HellHl}:JeK 1I0HHbIX
3a60neBaHlIH. IIpll :3TOM B caMOM 3,l\paBooxpaHeHun :3TlIX
CTpaH nepBlIqHaJi npol}:JlInaKTlIKa (npol}:JlInaKTlIKa, KOTOpa.H
HanpaBneHa Ha YKpenneHlIe 3,l\OpOBb.H, nOBbIlIIeHlIe 6naroco-
CTOJiHlI.H HaCeneHlI.H) .HBJIJieTCJi npllopllTeTHbIM Hanp8.BneHlI-
eM ero ,l\e.HTenbHOCTlI. ,lJ;n.H Toro, '1T06bI B POCClII! cJIY:1I<6a
nepBlIqHOH npol}:JlIJIaKTlIKlI B npaKTlIqeCKoM 3,l\paBooxpaHe-
HlIlI cipopMlIpoBanacb 11 :3l}:JqJeKTlIBHO I}:JYHK HoHlIpoBana, He-
06XO,Z:\lIMO HaJIH"IlIe CTPYKTYP no BbIJiBJIeHlIIO OCHOBHbIX l}:JaK-
TOpOB pnCKa (lCa611HeTOB ,l\oBpa'le6HOrO CKpllHlIHra 11 no,l\-
pa3,l\eneHlIH no ,l\lIarHOCTlII<e OCHOBHbIX l}:JaKTOpoB pllCKa 11
HX lCoppeI< lIl1 C rpynnOH cooTBeTcTBYIO lIX cne HanllCTOB
n C He06xo,l\I-IMbIM oCHa eHlIeM), lICnOJIL30BaHHe COBpeMeH-
H:bIX :3c:}JqJeKTlIBHbIX MeTO,Z:\OB BbI.HBJIeHlI.H, ,l\narHOCTHlClI lIlCOp-
peK UlI Bcex OCHOBHbIX l}:JaI<TopOB pI-ICKa, a He qaCTlI HX
(apTepllanbHa.H rllnepTOHlI.H, caxapHbIH. ,l\lIa6eT Hnll Hapy-
lIIeHlIe TonepaHTHOCTlIlC rnIOK03e, 1I36bITOqHa.H Macca Tena,
MeTa60JilI'IeclClIii ClIH,/(pOM, rllnOKlIHe311Ji, nClIXO-:3MO 1I0HaJIb_
HbIH CTpecc, lCypeHlIe, 3noynoTpe6neHlIe aJIlCOroneM); HanH-
que lCa)\pOB B :3TlIX CTPYKTypax, cne lIanbHO 06Y'leHHblx ,l\nJi
pa60TbI no nepBlI'IHOH npol}:JlInaKTlIKe 3a60neBaHlIH, MaTe-
pHanbHOH 3allHTepecoBaHHoCTlI Me,l\lI lIHCKlIX pa60THlIKOB,
yqacTBYIOll{lIX B nepBlI'IHOH npol}:JlInaKTlIlCe 3a60neBaHlIH;
HaJIlIqlle lIHl}:JopMa 1I0HHOH ClICTeMbI MOHnTOpllHra :3nll,l{eMlI-
onOrllqeClCOH clITya lIl1 no 3a60neBaHlIJiM. CO lIaJIbHO _
:3lCOHOMlI'IeClClIH lCp1l311C, nOpa311BlIIlIH POCCUIO, 3Ha'lllTenb-
HO 1I3MeHlIn YPOBeHb :lK1I3HH HaCeneHlIJi. CHlI:meHne peanb-
HbIX ,l\OXO,l\OB HaCeneHlI.H, YXY,l\lIIeHlIe lCaqeCTBa :lK1I3HlI, 6e3-
pa60TlI a, CY:lKeHlIe B03MO:mHocTeH pa3BlITlI.H 1'1 lICnOnb30Ba-
HlI.H nOTeH lIana 3,l\OpOBb.H - Bce :3TO HeraTlIBHO BnllJieT Ha
nOKa3aTenll, xapaKTepJi3YIO lIe COCTO.HHlIe 06 ecTBeHHoro
3,l\OpOBb.H 11 cpe,l\bI 0611TaHlI.H qenOBelCa.
rocy apCTBeHHble opraHM3aqMoHHbie CTPYKTYPbl,
3aHMMalOtqMecR BonpocaMM cecTpMHcKoro ena
rOCY,l\apCTBeHHOH opraH1I3 1I0HHOH CTPYKTyPOH, 3aHHMa-
!Oll{eHC.H BonpocaMlI cecTPllHcKoro ,l\ena, .HBn.HeTC.H MlIHlIcTep-
CTBO 3,l\P8.B00xpaHeHlI.H P . C 1991 ro,l\a B ycnOBlIJiX pe-
1}:J0PMlIpOBaHlI.H Ha'lnHaeTCJi nO,l\rOTOBKa cecTpuHclCoro nep-
cOllana B lConne,l\:lKax no 4-rO,l\lIqHOH nporpaMMe 06Y'IeHI-I.H, a
C 1997 ro,l\a no 3-rO,l\lIqHOH nporpaMMe 06yqeHlIJi, 3aTeM C
2002 rO,l\a - no HOBOMY rOCY,l\apCTBeHHOMY 06pa30BaTenb_
HOMY cTaH,l\apTY.
C 1991 rO,l\a B POCCHlI cy ecTBYIOT l}:JaKynbTeTbI BbIClIIero
cecTpnHcKoro 06pa30BaHHH. IC 1994 ro,l\Y B POCClIlI cl}:J0PMlI-
pOBaJIaCb MHorOYPoBHeBaJi ClICTeMa cecTpllHcKoro 06pa30Ba-
HlI.H (CM. BbIlIIe).lCa:IK,l\OMY ypOBHIO cOOTBeTcTByeT CBOH rocy-
.n;apcTBeHHbIH 06pa30BaTenbHbIH cTaH,l\apT. .
B POCClIH npe,l\YCMOTpeHa ClICTeMa 3.n;paBooxpaHeHlI.H C
pa3nll'lHbIMlI 1}:J0pMaMlI c06cTBeHHoCTlI: rocY,l\apcTBeHHa.H,
MYHlI lInaJIbHaH 11 '1aCTHaH. OHa lIMeeT, KalC 11 B ,l\Pyrllx
,l\eMOKpaTHqeClClIX roCY,l\apcTBax, TPll YPOBH.H: MmmCTepCTno
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10
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2. OxpaHa MaTepHHCTBa H ,l\eTCTBa.
3. Pec}>opMa I}:JHHaHcHpoBaHRH (Me,l\H HHcKoe CTpaxoBauHe,
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7. TIO,l\rOTOBKa Ka,l\pOB.
8. MHl}:JopMaTH3a HlI 3,l\paBooxpaHeHH.H.
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CHH nJIaHHpOBaJIHCh C KOH a 80-x ro,l\OB npOlIInoro CTone-
THlI, HO YPOBeHh pa3BHTHlI HayqHhIX npHH HnOB opraHH3a-
HH cecTpHHcKOH npaKTHKH 3HaqHTeJIhHO OTCTaeT OT pa3BH-
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.HTenhHOCThlO. IC Haqany 90-x ro,l\OB B 60nhlIIlIHcTBe cTpaH
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n03BonHBlIIee Me)K,l{YHapo,ll;HbIM opraHH3a H.HM H cOBeTa.M -
B03 (BceMHpHoM opraHH3a HeM 3,l\paBooxpaHeIIH1I), Me)K,l{y-
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pa3BHTHe HayqHbIx MeTO,l\OB oprauH3a I1H ceCTpHHCKoro ,l\ena
B POCCHH. C 1966 rO,l\a BbICKa3hIBaJIaCh H,l\elI, KOTOpa.H onH-
caHa B CepJIH ,l\OKJIa,l\OB B03, N! 347, c.13, qTO «Me,l\CeCTpbI
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BaTh npol}:JeccHoHanhHoe MbIlIIneHHe ,l\nlI npHHlITHlI caMOCTO-
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KlIX H opraHH3a HOHHbIX npH3HaKax.).
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npOTOKonOM,CTaH,l\apTOM.
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TIpaBOBalI H IOpH,l\H'leCKa.H 6a3a ceCTpHHCKoro ,l\ena 06ec-
ne'IHBaeTClI OCHOBHhIMH 3aKOHa H H HopMaTHBHhIMH aKTaMH.
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pe:m,l\eHHIO Me,l\H HHcKHX pa60THHKOB OT npaBOHapYlIIeHHH H
KOHcpnHKTOB C na HeHTaMH.
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KHX nOHlITHJi, TaKHX KaK npecTynneHHe, BHHa, 060CHO-
BaHHbIH pHCK 11: T.,l\. PaccMaTpUBalOTClI ol}:JH HaJIhHhIe ,l\0-
KYMeHTbI, 3aK(\HhI POCCHHCKOH rI>e,l\epa HH Me:>K,l\YHapO,l\-
Horo npaBa;
2) OCHOBhI 3aKOHO,l\aTenhCTBa Prt> 06 oxpaue 3,l\OpOBblI rpaJK-
,l\aH, ,l\onyclca K Me,l\H HHcKoM ,l\elITenhHOCTH, aTTeCra HlI
cepTHI}:JHKa HlI, aKKpe,l\HTa HlI H JIH eH3HpOBaHHe Me,l\H-
HHCKHX Y'lpem,l\eHHM H pa60THHKOB. Onpe,l\emleTClI npa-
BO Ha 3aHlITHe 'lacTHoM Me,l\H HHcKoM ,l\e.HTeJIhHOCThlO, OT-
BeTCTBeHHOCTh 3a npH'lHHeHHe Bpe,l\a 3,l\OpOBhlO, a TaK:me
npaBOBalI H CO HaJIhHalI 3am;HTa Me,l\pa60THHKOB;
3) TPY,l\OBOe 3aKOHO,l\aTenhCTBO PrI> H ,l\e.HTenhHOCTh Me,l\I1 HHC-
KHX pa60THHKoB: 3aKJIlt)'leHHe TPY,l\OBOro ,l\OrOBopa, onpe-
IZ
13
AeJIeUHe pa60'lero BpeMeHH, OTBeTCTBeHHOCTII :11\ napyme-
HH.H TPYAOBOH.D.MC HnJIHHbI, pemeHMe 1'pY.D.0BbIX cnopOB;
4) rpa:>KAaHCKOP 3aIWII0.D.aTCJIbCTBO P<P 1-1 .D.e.HTeJIbHOCTb Me-
.D.H HHCI(HX pa60THHIWB. PaccMaTpHBaeT BonpOCbI npaB H
06.H3aHHOCTeH Me.D.HI{HJlCKMX pa6OTHHKoB, OTBeTCTBClIHOC-
TH 3a npH'lHHeHHbIM BpC.!! 3.D.OpOBbIO, MOpaJIbHbIH Bpe.D.;
5) a.D.l\1HHHCTpaTI'IBHOe 31lK0IlO/l,aTeJIbCTBO H OTBeTCTBeHHOCTb
MeAH HHCKl!X pa60THHKOB 3a HapymcHH.H, cOBepmeHHble
npH BblIIOJIHeIrn:H HMH npol}:JeccHOHllJIhHbIX 06.H3aHHocTeM;
6) yrOJIOBHoe 3aKOHO.D.aTeJIbCTBO H OTBeTCTBCHHOCTh Me.D.U HH-
CKHX pa60THHIWB 3a npeCTYnJIeHH.H, COBepllIeHHble npH BhI-
nOJIHeHIrn: npol}:JeCCHOHllJIhHblX 06.H38.RHocTeM - HeOCTOpO:>K-
Hoe npwnIHe He T.H:>KKOrO H cpe.D.Hero BpeAa 3.D.OpOBhIO:
3apa:>KeH Ie B:Mq-HH(}JeK HeM, KpHMHHaJIhHhIH a60pT, Heo-
Ka3aHHe nOMo H 60JIhHOMY, OTKa3 rpa:m.n;aHHHY B npe.D.oc-
TaBJIeHHH HHl}:JopMa HH, npecTYnJIeHHe npoTHB 6e30naCHO-
CTH, napYllIeHHe caHHTapHoro 3nHAeMHOJIOrHqeCKOro pe-
:>KHMa, npaBHJI 06paU(eHH.H C 6HoJiorHQeCKUMH areHTaMH
(KpOBhIO n HeHToB H ApyrHMH BhI.D,eJIeHH.HMH, .D.OmKHoCT-
Hhle npeCTyJIJIeHll.H (B3.HTKa, XllJIaTHOCTb II T. .D..);
7) npaBOBa.H OTBeTCTBeHHOCTh 3a Bpa'leBaHHe, omH6KH, npa-
BOHapYllIeHH.H B 06JIaCTH oxpaHhI 3.D.OpOBb.H. IC HHM OTHO-
C.HTC.H: O'fCYTCTBlle 06rrWM KYJIhTYPbl, HeBHHMaTeJIhHOCTh,
6ecTaK'fHocTb, HeOCTOpOJKHOCTh B BhICKa3bIBaHH.HX, 3Ha-
KOMCTBO C HCTopHeM 60JIe3HH na HeHTOB, He3HaHHe OCHOB
Me.D.H HHCKOM nCHXOJIOrHH HAP.
Bech KOMn.aeKC npaBOBOH H IOPH.D.HQecKOM 6a3hI ceCTpHHC-
Koro .D.eJIa HanpaBJIeH H8 C03.D.aHHe YCJIOBllH coxp8HeHH.H 3.D.0-
pOBh.H HaCeJIeHH.H, 06ecne'IeHHe BhICOKOro Ka'IeCTBa CeCTpI'lHC-
IWM nOMOII.'(1'l, 3aKOHHOH 3a HTbI JIH'IHOrO p,OCTOHHCTB8 naW'!-
eHTa H Me.u.H HHCKOM ceCTpbl.
IC Y'lpe:m.o,eHH.HM CT OHapHoro Tuna OTHOC.HTCR: 6oJIbHH-
bI, KJIHHHKH, rocnHTIlJIH, po.D.HJIbHhle .D.OMa, CaHaTOpHH, XOC-
nHChI. B eJI.HX nOBhIllIeHH.H KaQeCTBa JIe'le6HOH H npol}:JHJIaK-
THQeCKOH pa60Tbi C 1947 roAa B POCCHH npOBO.D.HTC.H ome.!!H-
HeHHe nOJIHKJIHHHK C aM6YJIaTOpH.HMH H 60JIhHH aMH. TllKa.H
opraHH3 H.H pa60ThI cnoc06cTByeT nOBhIllIeHHIO KBIlJIHcl>HKa-
HH Bpa'leM, a TeM CaMbIM H YJIy<IllIeHHIO Ka'leCTBa 06cJIy:>KH-
BaHH.H HaCeJIeHHH.
OCHOBHble TMnbl
ne'fe6HO-npmjJMnaKTMocecKMx y"pe>KAeHMM
Pa3JIH'IaIOT 2 OCHOBHhIX THna JIe'le6Ho-npoclJHJIaKTH'leCKHX
Y'Ipe:m.o,eHHM: a.M6YJlamOp1lDZO U cma llOHapHozo. n: YQpe:>K-
.D.eHH.HM aM6YJIaTOpHoro THn8 OTHOC.HTC.H: aM6YJIaTOpHH, no-
JIHKJIHHHKH, Me.D.IfKO-C8-'iHTapHble 'laCTH, ,l\HCnaHCepbI, KOH-
cyJIbTa HH, CT8lI HH CKOpOM nOMOIW-f.
YCTpOMCTBO M OCHOBHble YHK4HM 60nbHM4
P83JIH'laIOT 06:U(He, pecny6JIHKaHCKl'le, 06JIaCTHble, KpaeBble,
ropO.D.CKHe, paMoHHble, CeJIbCKHe 6oJIbHH bI, KOTopble pacnOJIa-
r8IOTC.H 'l e B eHTpe 06cJIy:>KHBaeMOM TeppHTOpHH. CneW'!a-
JIH3HpoBaHHble 6oJIbHH I (oHKOJIOrwlecKHe, TYf)epKYJIe3Hble H
T..D..) paCnOJIaraIOTC.H B 3aBHCHMOCTH OT cBOero npoclJIDI.H, '1 e
Ha OKplillHe HJIH 3a ropOAOM, B 03eJIeHeHHOM plilioHe.
Cy ecTBYIOT 3 OCHOBHblX THna C1'pOHTeJIbCTBa 60JIbHH :
naeUJlbOHHblU, qe1lmpaJlU30eaH1lblU H C.MelUa1l1lblu.
llPH naBHJIbOHHOM CHCTeMe Ha TePPHTOpHH 60JIbHH bI pa3-
Me aIOTC.H He60JIbllIHe O eJIbHble 3.D.aHH.H. IJ;eHTpaJIH30BaH-
HblH THn CTpOHTeJIbCTBa xapaKTepH3yeTC.H TeM, '1TO 3AaHHH
coe.D.HHeHbI KpblTblMH H8)I3eMHblMH MJIH nO.D.3eMHbIMH KOpH.D.O-
paMH. qaU(e Bcero B POCCHH CTpOHJIHCb CMellIaHHoro THna
60JIbHH bI, r.D.e OCHOBHble HeHHl}:JeK HoHHble OT.D.eJIeHl!H pa3-
Me aIOTCH B O.D.HOM KpynHoM 3.D.aHHI1, a HHl}:JeK HoHHble oTAe-
JIeHH.H, X03.HMCTBeHHble nOCTpOHKH H T..D.. paCnOJIaraIOTC.H B
HeCKOJIbKHX He60JIbllIHX 3.D.aHH.HX.
Y'IaCTOK 60JIbHH bI .D.eJIHTC.H Ha TpH SOHbl: 3.D.aHH.H, 30Ha
X03.HHCTBeHHoro .D.Bopa 1-1 3a:U(HTHa.H 3eJIeHa.H 30Ha. JIeQe6HaH
H X03.HMCTBeHHa.H 30HbI .D.OJI:>KlIbl HMeTb OT.D.eJIbHble B'De3,lJ;bI.
BOJlb1lU a cocmoum U3 CJleaylO ux o6-oeKmoe:
1. CTa HOHap co Cne HIlJIH3HpOBaHHbIMH OT.D.eJIeHH.HMH H
nllJIaTaMH.
2. BcnoMoraTeJIbHble OT.D.eJIeHH.H (peHTreHoBcKHH Ka611HeT,
naTOJIOrOaHaTOMH'IeCKoe) H JIa60paTopHH.
3. AnTeKH.
4. llOJIHI(JIHHHKH.
5. llH e6JIOK.
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7. MHHHcTpaTHBHbIe H ,l{PYI'He nOMe eHH.H.
BOJIbHH bI npe,l{Ha3HaqeHbI ,l{JI.H nOCTO.HHHOI'O JIeqeHH.H H
YXO,l{a 3a na HeHTaMH C onpe,l{eJIeHHbIMH 3a60JIeBaHH.HM:H, Ha-
npHMep, XHpypI'HqeCKHMH, TepaneBTHqeCKHMH, HH<peK HoH-
HbIMH, nCHXOTepaneBTHqeCKHMn n T.,l{.
CTa HoHap 60JIbHH bI .HB.n.HeTC.H HaH60JIee Ba:IKHbIM CTPYK-
TYPHbIM nO,l{pa3,l{eJIeHHeM, KY,l{a npHHHMaIOT na HeHTOB, Tpe-
6yIO ux cOBpeMeHHbIx, CJIO:IKHbIX MeTO,l{OB ,l{HarHOCTHKH H
JIeqeHH.H H OKa3bIBalOT JIeqeHne, YXO,l{ H ,l{PYI'He KYJIbTYPHO-
6bIToBbIe YCJIYI'H.
"YCTPOMCTBO cTa HoHapa JII0601'O npoc}:JHJI.H BKJIIO'IaeT na-
JIaTbI ,l{JI.H pa3Mell{eHH.H na HeHTOB, x03.Hi1:cTBeHHbIe nOMell{e-
RH.H H caHHTapHbIH Y3eJI, Cne HaJIH3HpOBaHHbIe Ka6HHeTbI
(npO e,l{ypHbIH, JIeqe6HO-,l{HaI'HOCTHqeCKHH), a TaK:lKe 0p,l{H-
HaTopCKYIO, cecTpHHcKYIO KOMHaTbI, Ka6nHeT 3aBe,l{YIO eI'0
OT,l{eJIeHHeM.
060PY,l{OBaHHe H OCHa eHHe naJIaT cooTBeTcTByeT npQ(lm-
JIIO OT,l{eJIeHH.H H caHHTapHbIM HopMaM. Pa3JIH'laIOT,0,l{HOMeC-
THbIe H MHOI'OMeCTHbIe naJIaTbI. B naJIaTe nMeIOTC.H KpOBaTH
(06bIqHbIe HJIH I}:JYHK HOHaJIbHbIe), npHKpoBaTHbIe TYM60'lKH
H CTOJIHKH HJIH CTOJI, CTYJIb.H, llII<al}:J ,l{JI.H O,l{e:lK,l\bI na HeHTa,
XOJIO,l{HJIbHnK, YMbIBaJIbRHK. KpoBaTH CTaB.HT I'OJIOBHbIM KOH-
OM K CTeHe Ha paCCTO.HHHH O,l{HOI'O MeTpa Me:lK,l\Y KpOBaT.HMH
,l{JI.H Y,l{06CTBa nepeKJI bIBaHRH na HeHTa C KaTaJIKI-I HJIH HO-
CHJIOK Ha KpoBaTb H YXO,l{a 3a HHM. CB.H3b na HeHTa C nOCTOM
Me,l{H HHcKOH cecTpbI ocy eCTBJI.HeTCJi C nOMO bIO nepeI'o-
BOpHOI'O YCTpoHcTBa HJIH cBeTOBoH CHI'HaJIH3a HH. B cne Ha-
JIH3HpOBaHHbIx OT,l{eJIeHH.HX cTa HoHapa Ka:IK,l{aJi KOHKa 06ec-
ne'leHa YCTPOHCTBOM ,l{JIJi eHTpaJIH30BaHHoH nO,l{a'lH KHCJIO-
pO,l{a H ,l{PYI'OH Me,l{H HHcKOH annapaTYPoH.
OCBe eHHe naJIaT cooTBeTcTByeT caHHTapHbIM HopMaM (CM.
CaHITHH 5). OHO onpe,l{eJI.HeTC.H B ,l{HeBHoe BpeM.H CBeTOBbIM
K03<P<lm HeHTOM, KOTOpbIH paBeH OTHOllIeHHIO IIJIO H OKOH
K nJIOll{ H nOJIa, COOTBeTCTBeHHO 1:5-1:6. B BeqepHee BpeM.H
naJIaTbI OCBew:aIOTC.H JIIOMI'lHec eHTHbIMH JIaMnaMH HJIH JIaM-
naMH HaKaJIHBaHHJi. KpoMe 06ll{eI'0 OCBe eHH.H HMeeTC.H H HH-
,l{HBH,l\YaJIbHoe. B ROqHOe BpeM.H naJIaTbI OCBe aIOTC.H HOqHbIM
CBeTHJIbHHKOM, yCTaHOBJIeHHOM B HHllIe OKOJIO ,l{BepH Ha BbICO-
....
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Te 0,3 M OT nOJIa (KpoMe ):(eTCKHX CTanHOHapOB, r):(e CBeTIlJIb-
HHKH YCTaJIaBJIHBaIOTCJi Ha,lI, ):(BepHbIMH npoeMaMH).
BeHTIfJIJinHH miJIaT npoBO):(HTCJi C nOMOIl.\bIO npHTO'lHQ-
BbITJi:lf<HOH CHCTeMbI KaHaJIOB, a TaJOKe ilIpaMyr H ilIOpTO'IeK H3
paC'IeTa 25 M 3 B03):(yxa Ha O):(Horo 'IeJIOBeKa B 'lac. KOHneHTpa-
nHH yrJIeKHCJIOrO ra3a B B03):(ynIHOH cpe):(e naJIaTbI He ):(OJI:lKHa
npeBbIllIaTb 0, 1 %, OTHOCHTeJIbHaJi BJIa:IKHOCTb 30-45% .
TeMnepaTypa B03AYXa B naJIaTaX B3pOCJIbIX He npeBbIlliaeT
20°C, 11.JIJi ):(eTeH - 22°C. .
B OT):(eJIeHHH HMeIOTCJi pa311.aTO'lHaJi H CTOJIOBaJi, 06ecne-
'IHBaIO:r.nHe o):(HoBpeMeHHbIH npHeM nH:r.nH 50% nanHeHTOB.
KOPH):(OP OT):(eJIeHHJi 11.OJI:lKeH o6eCne'lHTb cBo60):(Hoe nepe-
11.BH:lKeHHe KaTaJIOK, HOCHJIOK. OH CJIY:IKHT ):(onOJIHHTeJIbHbIM
pe3epByapoM B03):(yxa B CTanHOHape H HMeeT ecTeCTBeHHoe H
HCKYCCTBeHHOe OCBeIl.\eHHe.
CaHHTapHbIH Y3eJI COCTOHT H3 HeCKOJIbKHX OT):(eJIbHbIX no-
Me:r.neHHH, CnenHaJIbHO 06opy):(oBaHHblx H npe):(Ha3Ha'leHHbIX
11.JIJi ocy:r.neCTBJIeHHJi JIH'lHOH rHrHeHbI nanHeHTa (BaHHoH KOM-
HaTbI, KOMHaTbI ):(JIJi YMbIBIlHHJi), copmpOBKH rpJi3HOrO 6e-
JIbJi, xpllHeHHSI 'IHCTOrO 6eJIbH, ):(e3HHilIeKnHH H xpaHeHHJi
cy):(eH H MO'lenpHeMHHKOB, xpaHeHHJi y60po'lHoro HHBeHTapJi
Ii cnenO):(e:lK):(bI 06CJIY:IKHBaIO:r.nero nepCOHaJIa.
MHcpeKnHoHHbIe OT):(eJIeHHJi 60JIbHHn.HMeIOT 60KCbI, nOJIY-
60KCbI, 06bNHble naJIaTbI H COCTOHT H3 HeCKOJIbKHX OT):(eJIb-
HbIX ceKnHH, 06eCne'lHBaIO:r.nHX ilIYHKnHOHHpoBIlHHe OT11.eJIe-
HHJi npli YCTaHOBJIeHHH KapaHTHHa B O):(HOM H3 HHX.
KB.)K):(oe OT):(eJIeHHe HMeeT B YCTaHOBJIeHHOM nopH):(Ke 06Ji-
3aTeJIbHbIH 11.JIJi nepCOHaJIa H nanHeHTOB BHYTpeHHHM pacno-
pJi11.OK OT):(eJIeHHH, KOTOpbIH 06eCne'lHBaeT nanHeHTaM C06JIIO-
11.eHHe JIe'le6HO-OXpaHHTeJIbHOrO pe:IKHMa: COH H OT):(bIX, ):(He-
TH'leCKoe nHTaHHe, CHCTeMaTH'IeCKOe Ha6JII011.eHHe H YXO):(,
BbInOJIHeHHe JIe'le6HbIX npone):(yp H T. 11..
6 - 7 'lac
7 - 8 'lac
8 - 10 'lac
IIo):('beM, H3MepeHHe TeMnepaTYPbI TeJIa
TyaJIeT
3aBTPaK
10 - 12 'lac 06xo):( Bpa'leH
1-2 - 14 'lac BbInOJIHeHHe Bpa'le6HbIX Ha3Ha'leHHH
14 - 15 'lac 06e.n;
15 - 17 'lac THXHH 'lac (OT):(bIX)
17 - 18 'lac IIporyJIKH, noce:r.neHHH po):(CTBeHHHKaMH
18 - 19 'lac M3MepeHHe TeMnepaTYPbI Te.TJa
19 - 20 'lac Y:lInffi
20 - 22 'lac CB06o):(Hoe BpeMJi
22 'lac OTXO):( KO CHY
OCHoBHble HanpaBneHHSI neSiTenbHOCTH
cpenHHX MenH4HHCKHX pa60THHKOB
B pa3nH..HblX OTneneHHJlX nny
Co):(ep:IKaHHe ):(eJiTeJIbHOCTH Me):(HnHHCKHX ceCTep COCTaB-
JIHeTCH a,lI,MHHHCTPanHeH JIe'le6Ho-npOCpHJIaRTH'leCKOrO yqpe:IK-
):(eHHH (JIIIY) Ha OCHOBllHlm TapHCpHO-KBaJIHilIHKanHOHHOH xa-
paKTepHCTHKH cpe):(Hero Me):(HnHHCKoro pa60THHKa C yqeTOM
KOHKpeTHbIX oc06eHHocTeH pa60TbI Toro HJIH HHoro JIe'le6HO-
ro yqpe:IK):(eHHJi.
K ilIYHKnHOHaJIbHbIM 06Ji3aHHOCTJiM Me,!\ceCTpbI CTanHOHa-
pa OTHOCJiTCH CJIe):(YIO:r.nHe 06Ji3aHHocTH: C06JIIO):(eHHe JIe'le6-
HO-OXpaHHTeJIbHOrO pe:IKHMa OT):(eJIeHHJi, CBoeBpeMeHHoe BbI-
nOJIHeHHe Bpa'le6HbIX Ha3Ha'leHHH, YXO):( 3a naI{HeHTaMH, no-
MO:r.nb nanHeHTY BO BpeMJi OCMOTpa Bpa'lOM, Ha6JIIO.n;eHHe 3a
06:r.nIfM COCTOJiHHeM nanHeHTOB, OKa3aHHe nepBoH ):(oBpa'le6-
HOH nOMOIl.\H, C06.IIIO):(eHHe CaHHTapHO-npOTMB03nH}J;eMH'leCKOrO
pe:IKHMa, CBoeBpeMeUHaJi nepe):(a'la 3KCTpeHuoro H3BeIl.\eHHJi B
U;rc3H (neHTp rOccaH3m 11.Ha,lI,30pa) 06 HHc):>eKnHOHHOM 60JIb-
HOM, nOJIyqeHHe JIel apCTBeHHbIX cpe):(CTB H 06ecne'leHHe HX
xpaHeHHJi H yqeTa, a TaR:lKe PYKOBO):(CTBO MJI8,lJ;llIHM Me):(H-
nHHCKHM nepCOHaJIOM OT):(e.neHHJi. Me):(HnHHcKHe ceCTpbI 06H-
3aHbI CHCTCMaTH'IeCKH nOBbIllIaTb KBamiillHKanHIO, noce:r.naTb
3aHJiTHJi H KOHilIepeHnHH, opraHH3yeMbIe B OT):(eJIeHHH H JIe-
'Ie6HOM yqpe:IK.n;eHHH.
Y'IaCTKOBaJI (ceMenHaH) Me):(HnHHCKaJI ceCTpa nOJIHKJIHHH-
KH, pa60TaIOIIJ;aJI.Ha npHeMe C Bpa'lOM, nOMoraeT eMY, oillop-
MJIJieT pa3JIH'IHYIO 11.OKYMeHTanHIO, o6yqaeT nanHeHTOB no):(-
rOTOBKe K pa3JIH'IHbIM npone.z;;ypaM, JIa60paTOpHbIM H HIICT.
PYMeHTaJIbHbIM HCCJIe):(OBaHHHM. Me):(n.nHHCKaJI cecTpa nOJII1-
K1IHHHKH OCYIl.\eCTBJIJieT pa60TY Ha ):(OMY: BblnOJIHJieT Bpa 1 l(..>6.
npHMepHblM BHYTpeHHHM pacnopSiAoK
TepaneBTH4ecKoro OTAeneHHR
'B
19
HbIe Ha3Ha'leHHH, 06yqaeT pO CTBeHRHKOB Heo6XQ HMbIM 3JIe-
MCHTaM YXO R, aeT peKOMeH HH no C03 aHHIO KOM<pOpT-
HbIX YCJIOBHH JIH nanHeHTa C neJIblO Y OBJIeTBOpeHHH ero
:lKH3HeHHO-Ba:IKHbIX, <pH3HOJIOrH'IeCKHX nOTpe6HOCTeH, OKa3bI-
BaeT nCHXOJIOrH'IeCKyro nOMep:IKKY nRnHeHTY Hero ceMbe,
OCYIl'\eCTBJIHe"T MepOnpHHTHJi no npo<lJHJIaKTHKe OCJIO:IKHeHHM
H YKpenJIeHHIO 3 OpOBbH CBOHX nanHeHTOB.
Kpyr 06H3aHHOCTeH <PeJIb llIepa OCTaTO'lIlO llIHpOK, B OCO-
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KOH 06ll.\HHOH, KOTOpa.H B aJII,HeHmeM CTaJIa npo06pa30M
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KpbIMY 60JIhWOM KpeCT H3 6eJIoro MpaMopa B naMHTh 0 no-
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B 1863 ro y B llIBeM apHH opraHH30DaH MeJK YHapo -
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nepeHMeHOBaH B 1876 ro y B MeJK.ZJYHapo HbIM KOMHTeT Kpac-
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KpacHoro KpecTa.
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XapaKTepy cBoeM MHCCHH 3aKpenJIeHHoii: B JKeHeBcKHx KOH-
BeH HHX, JiBJI.HeTCH MeJK.l\}'Hapo]J;HoM OpraHH3an;HeM. Ero wTa6-
KBapTHpa HaXO):(HTCH B JKeHeBe.
Cero HH, nOM HMO MKKK, cymecTByroT Han;HOHaJIblll>Ie 06-
Il.\eCTBa KpacHoro KpecTa H KpacHoro nOJIYMeCHn;a.
3a CBOIO eHTeJIhHOCTb MKKK 6bIJ1 Y.l\OCToeH qeTbIpeX Ho-
6eJIeBCKHX npeMHM, AHPH .ZJ;IOHaH, OCHOBaTeJIh MKKK, nOJIY-
'I1fJI nepBYIO H06e.neBCKYIO npeMHIO MHpa. 3a nepHO C 1919-
1944 rr., MKKK HarpaJK.l\aJICH 3a rYMaHHTapHYIO eJiTeJIb-
HOCTh B nepHo.l\ MHpOBhIX BOMH, a B 1963 ro y BMeCTe C
JIHroM 06w;ecTBa KpacHoro KpecTa H KpacHoro lIoJIYMecHn;a
- K CTOJIeTHeMY 106HJIeIO BHJKeHHJi. B Ka'leCTBe OTJIH'IHTeJIh
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B ]J;aJIhHCMWeM nOHBHJICH KpacllbIii: KpeCT Ha 6eJIOM <lIoHe, I<aK
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KpacHhlM lIoJIYMecHn; JiBJIJieTCH MYCYJIhMaHCKHM aHaJIorOM
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SI. TOp>KeCTBeHHO nepeA 60roM 101 B npHcyrcTBI1H :noro c06pa-
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npoBecTH MOIO >KH3Hb B 'jHCTOTe 101 BepHO Cl1y>KHTb MoeH no-
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24
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JIHCb K 3TOH: np06JIeMe CnOKOH:HO, HHKOro H3 HHX He B03MY-
aJIa sM6JIeMa C XPHCTHaHCKHM CHMBOJIOM. C ecTByeT H
,npyraR sM6JIeMa - KpaCHbIM KpeCT Ha 6eJIOM (pOHe H BbIBep-
HyTbIM HaH3HaHKY nOJIYMeCRD;. STO sM6JIeMa Me)K,l\yrIapo.l(HOH:
qJe,nepan;HH, C03,naHHOM B 1919 ro,ny no HHHD;HaTUBe AHrJIHH,
qJpaHD;uH H CIlIA, B HeM pa6OTaIOT npe,ncTaBHTeJIH Bcex cTpaH
MHpa (paHbille OHa Ha3bIBaJIaCb JIHroM 06meCTB KpacHoro
KpeCTa H KpacHoro IIoJIYMeCJ:I[(a). qJe,l\epan;HR pa60TaeT O"leHb
onepaTHBHO, Ha ,n06poBOJIbHbIX Ha"laJIax, oc06eHHo BO BpeMR
CTHXHMHbIX 6e,l\CTBUM H.1IH BOOpYJKeHHbIX KOHcPJIHItTOB. 3apn-
JIaTy nOJIY"laIOT TOJIbKO «IIITaTHbIe e,nuHHD;bI» - KOMaH,nHp
OTPR,l\a Hero 3aMeCTUTeJIH.
06 eCTBO KpaCHoro KpeCTa nocJIe peBOJl1OD;HH npeTepne-
JIO JIHKBH,naD;HIO, npH3HaHHe B 1921 ro,ny H B03pOJK,neHue B
1925 ro,ny.
1938 ro,n HMy ecTBo KpacHoro KpecTa nepe,naHO pa3JIH"l-
HbIM HapKOMaTaM.
TeM He MeHee, ,neRTeJIbHOCTb 06 eCTBa B TpH,nn;aTbIe ro,nbI
6bIJIa KHnyqeM. IImIBHJIHCb OTpR,nbI rco (rOTOB K caHHTap-
HOM 060pOHe) ,lJ;JIR B3pOCJIbIX H BrCO (6y,nb rOTOB K caHHTap-
HOM 060pOHe) ,nlHI ,neWM. B03HHKJIH caHHTapHbIe ,nPY:IKHHbI,
caHnOCTbI, HaCeJIeHHe 06yqaJIOCb Sl1eMeHTaM yxo):(a, OKa3a-
HHIO ,noBpa"le6HOM nOMO H. Cero.n;HH, HaBepHoe, HaCel1eHHe
HY:IK,naeTCR B Me,nHD;HHCKHX 3HaHHHX H He XO"leT OrpaHH"lH-
BaTbCJi TOl1bKO BbI30BOM CKOPOM nOMO H.
PonbH e Bonpoc AnH caMonoAroToBKH
1. KTO BnepBble J\aII Hay'moe onpe.qelleHHe cecTpHHcKoro Aella?
2. Korp,a B03HMKIIO cecTpHHcKoe p,ello B POCCHM?
3. B 4eM 3aKllto4atoTcSI OCHOBHble 3aAa4H BceMHpHoH OpraHH3aLlHH
3p,paBooxpaHeHMSI?
4. Ha30BHTe p,aTY c03AaHHSI COto3a 06Ll\eCTB KpacHoro KpecTa 101
KpacHoro nOIlYMeCSll!a.
5. nepe4HCl1HTe CCHOBHble HanpaBlleHHSI pecpopMHpOBaHMSI cecTpHH-
CKoro Aella B POCCHH.
6. PaccKIDKHTe 0 3aAa4ax Acc04HaLlHH PoccHikKHX MeAcecTep.
26
(
npeAnOCblnKH, CYLQ,HOCTb H OCHOBH e HanpaBneHHH
pecl>opM CeCTpHHcKoro Aena B POCCHH
CecTpHHcKoe ,nel1O HBl1JieTCH Ba:IKHeMWeM cocTaBHoM qac-
TblO CHCTeMbI 3,npaBooxpaHeHHH, 0611aCTblO ,neHTeJIbHOCTH,
HanpaBl1eHHOM Ha peweHHe np0611eM HH,lI,HBH,lI,yaJIbHOrO H 06-
meCTBeHHoro 3,l1,OpOBbJi HaCel1eHHJi B MeHJiIOIl'\HXCH YCl10BHJiX
OKpY:IKaro eH: Cpe,nbI.
M3BecTHo, qTO pOl1b H 3a):(a"lH Me,ll,CeCTpbI onpe,ll,eJIJiIOTCH
HCTOpH"leCKHMH, COl{HaJIbHbIMH H KYl1bTypHbIMH (paItTopaMH,
a TaK :lKe 06mHM ypOBHeM COCTOHHHJi 3,l1,OpOBbJi Toro Hl1H HHO-
ro 06 ecTBa. KaK HaYKa ceCmpUllCKOe ae.no onHpaeTcH Ha
3HaHHH, npoBepeHHbIe Ha npaKTHI<e. u
Ha npOTH:lKeHHH HeCKOJIbItHX ,lI,eCJiTHl1eTHH B POCCHH Bon-
pocaM cecTpHHcKoro ,nel1a He y,ll,el1HJIOCb ,nOJI:lKHOrO BHHMa-
HHJi. Pa3BHTHe ceCTpHHCKHX TeXHOl1OrHM C yqeTOM COBpeMeH-
HOH: HayKH B pa3BHTbIX CTpaHax npHBel10 K pe3KOMY OTCTaBa-
HHIO ceCTpHHCKoro ,lI,eJIa B POCCHH.
IIpeanocbtJIKa.1lf.U peljJop.1lf.bl ceCTpHHCKoro ,lI,el1a, ero pa3BH-
THH, HBl1HIOTCJi: HeraTHBHbIe Me.n;HKO-,lI,eMorpa(pH"leCItHe npo-
n;eCCbI, B oc06eHHOCTH CHH:lKeHHe pO:IK,naeMOCTH H CTapeHHe
HaCel1eHHH, YXY,ll,weHHe COCTOJiHHJi 3):(OpOBbH HaCel1eHHJi, XPO-
HH3a[(HJi naTOJIOI'H'IecItHX npOn;eCCOB'B opraHH3Me, pacnpOCT-
paHeHHe HOBbIX 3a6011eBaHHH:, TaKHX KaK. BMq, ysel1HqeHMe
CTOHMOCTH Me,ll,H[(HHCKHX yc.rryr. IIocTeneHHo CHHJKaeTCH 06ec-
neqeHHOCTb l1e"le6HO-npOcPHl1aKTHqeCKHX yqpe:IK,lI,eHHM ceCT-
pHHCKHM nepCOHal1OM. )J;BYXCTyneH"laTbIM MeTO,ll, 06Cl1Y:IKHBa-
HHJi 6011bHbIX (Bpaq, Me,ll,H[(HHCKaH ceCTpa) npHBeJt K CHH:lKe-
HHIO npOcPeCCHOHaJIbHOM KOMneTeHD;HH Me,nHn;HHCKHX ceCTep,
BbInOJIHeHHIO He CBOMCTBeHHbIX HM cPyrIKD;HM. CHH:lKaeTCJI 06ec-
ne"leHHOCTb. JIIIY JIeKapCTBeHHbIMH cpen;CTBaMH, npe,ll,MeTaMH
yxo,na, HHcTpYMeIlTapHeM. YBeJIH"lHBaeTCJI ,lI,Hc6aJIaHC B COOT-
HoweHHH Me:IK,lI,y Bpa"laMH H Me,ll,H:[(HHCKHMH cecTpaMH, KaIt
CJIe,ll,CTBHe, YXY,ll,WHJIOCb Ka"leCTBO OI<83bIBaeMoM nOMOmH H
yxo,ll,a.
PeljJopMa cecmpuJtCKOZO aeJla B HaweM CTpaHe Ha"la.;IaCb B
1993 ro,ll,Y. Ha Me:IK,lI,YHapo,ll,HoM IWHcPepeHD;HH «HoBbIe ceCT-
pbI ,lI,l1H HOBOM POCCHH» 6bIJIa npHHHTa cPHJIOCOcPHJi cecTpHHc-
Koro ,lI,eJIa, nOJIO:IKHBWaJI Ha"laJIO 3TOMY npon;eccy. IIocTaHoB-
JIeHHeM IIpaBHTeJIbCTBa PtIJ OT 05.11.97 r. N2 1387 «0 Me-
21
pax no :Ta6HJIH3ar:(lUi H pa3BHTHIO 3 paBooxpaHeHHJi H Me H-
HHCKOH HaYKH B pq,» npe YCMOTpeHO OC eCTBJIeHHe pe-
<pOPMhI, HanpaBJIeHHOH Ha nOBhIweHHe Ka'leCTBa, OCTynHOC-
TH H SKOHOMH"leCKOH s<p<peKTHBHOCTH MeJlHIJ;HHCKOH nOMOlI.\H
Ha<.:eJIeHHJi B YCJIOBHHX <POPMHpOBaHHH phIHO"lHhIX OTHowe-
HHH.
Cyut1l0Cmb perjJopMbl 3aKJIIO"laeTCJi B oCYlIJ;eCTBJIeHHH He-
06XO HMhIX H3MeHeHHH B K POBOH nOJIHTHKe Ha OCHOBe Ha-
y<IHo-060CHOBaHHhIX nO XO OB K n.naHHpOBaHHIO, no rOTOBKe
H HCnOJIh30BaHHIO ceCTpHIICKHX K pOB, 06eCne"leHHH paIJ;HO-
HaJIhHOro COOTHoweHHH H napTHepCTBa Me y Bpa"laMH Ii
cecTpHHCKHM nepCOHaJIOM, B03pO:IK.n;eHHIO IQiTerOpHli MJI Wero
Me H HHCKoro nepCOHaJIa, opraHH3aIJ;HH HOBhIX BH,l\OB nOMO-
IIJ;H, CBJi3aHHhIX He TOJIbKO C 60JIe3HHMH HJIH naTOJIOrH'leCKH_
MH COCTO.HHH.HMH, HO H C np06JIeMaMH coxpaHeHHJi H nOMep-
:lKaHI'IJi HH HBH,l\yaJIhHoro H 061IJ;eCTBeHHoro 3 OPOBhH. B Ha-
CTOHlIJ;ee BpeM.H B HaweH CTpaHe H3Y"laeTCJi Me YHapO HhIH
onhIT, npOBO HTC.a: ero rJIy60KHH aHaJIH3, KoppeI< HH H an-
TaIJ;H':; K COIUiaJIhHO-SIWHOMH'leCKHM YCJIOBH.HM C y<IeTOM Tpa-
HIJ;HH Hapo.n;OB POCCHHCKOH «I>e epaIJ;Hli.
TIpHKa30M MIIHHcTepcTBa 3 paBooXpaHeHHjI P<I> N2 4 OT
9 JiHBapJi 2001 ro a YTBep:IK eHa oTpaCJIeBaJi nporpaMMa PM-
BHTHJi cecTpHHCIwro eJIa B P<I>, oTpamaIOlIJ;a.H CYIIJ;HOCTh pe-
<POpMhI cecTpHHcKoro ):(eJIa. CecTpHHcKoe eJIO pacnOJIaraeT
3Ha"lHTeJIhHl>IMH Ka.n;pOBhIMH pecypcaMIi H peaJIbHhIMH nOTeH-
HaJIhHhIMH B03MO:IKHOCT.HMH. Cero):(HJi B POCCHH OI<OJIO 1,5
MJIH. cpe HHX Me II IIHCKHX pa6OTHHKOB. ::ho caMa.a: Macco-
BM Me HIJ;HHCKaJi npo<peccHH.
OC1l061lbiMU eJlJl.1lf.U U 3aaattaMu perjJop.1lf.bl cecTpHHcKoro
,l\eJIa HBJIHIOTCH:
1. «I>opMHpoBaHHe OnTHMaJIhHhIX YCJIOBHH ,l\JIH nOBhIwe-
HHH SCP<PeKTHBHOCTH II YCHJIeHII.H pOJIIi cpe HHx Me H-
D;HHCKHX pa60THIiKOB, cOBepweHcTBoBaHHe CHCTeMhI
ynpasJIeHHJi.
2. C03 aHlie HOBOM KOHIJ;enTYaJIbHOH POCCHMCKOH MO eJIH
ceCTpllHCKoro ):(eJIa. B KB.)K OH MO eJIH OTpa:IKlUOTc.a: oc-
HOBHhIe npHH HnhI nepBH"lHOH Me KO-CO lIaJIhHOM no-
M0lI.\1I (TIMCTI). ElIJ;e cero HH eMCTByeT Me H HHCKaH
(Tpa,l\II IIOHHaH) MO eJIh, aBTopOM KOTOpOM HBJIHeTCH
(I>. HaMTHHreMJI. B aHHoH MO eJIIi O HIIM 113 COCTaBJI.H-
IOIIJ;HX SJIeMeHTOB JiBJIJieTCJi pOJIh Me ceCTphI KaK no-
MOIIJ;HHI<a Bpa'la C I<paHHe OrpaHH'leHHOH npo<lJeccHo-
HaJIhHOH caMOCTOJITeJIhHOCThIO.
3. BHe peHHe HOBhIX TeXHOJIOrHH B ceCTpHHCKOM eJIe,
6HOSTH'leCKHX, npocpeCCHOHaJIhHhIX nO XO):(OB, cnoc06-
HhIX Y):(OBJIeTBOpHTh nOTpe6HocTh HaCeJIeHHH B ):(OCTyn-
HOH I\le H HHCKOM nOMOIIJ;H;
4. YCHJIeHHe npo<pHJIaKTH'leCKOH HanpaBJIeHHOCTH 3,l\pa-
BooxpaHeHH.H.
5. IIpoBe eHHe CHCTeMHhlX npe06pMoBaHHM B ceCTpHHCKOM
,l\eJIe - B 06JIaCTH 06pa30BaHHH, Hay<IHbIX IICCJIe,l\OBaHH-
HX, npaKTH"leCKOM 3]J;paBooxpaHeHHH, CO eMCTBHe H pa3-
BHTHC npocpeCCHOHaJIhHhIX ceCTpHHCKHX acCO mi.IJ;HM.
6. TIoBhIweHHe CTaTyca ceCTpHHCKoro nepCOHaJIa KaK npo-
cpeCCHOHaJIhHOrO, TaK H CO lIaJIhHOrO, 06eCne"leHHe co-
lIaJIhHOH 3alI.\Hw;eHHOCTH CneIJ;HaJIHCTOB ceCTpHHCKoro
eJIa H MHoroe pyroe.
OC1l061lbl.MU llanpa6JlfflUJlJltu perjJop.1lf.bl ceCmpUllCKOZO aeJla,
peaJIH3al{HH OTpaCJIeBOH nporpaMMhI JiBJIHIOTC.H:
1. HopMaTHBHo-npaBoBoe 06eCnC'leHHe cecTpHHcKOH ,l\eJi-
TeJIbHOCTH, oxpaHe Tpy a B yqpe:IK eHHHx 3 paBooxpa-
HeHII.H.
2. Co3):(aHHe CTaH,l\apTOB (npoTOKOJIOB npo<peccHOHaJIhHOH
cecTpHHcKOH eHTeJIhHOCTH), HX anp06a HJi H ]J;aJIhHen-
wee BHe]J;peHHe B npaKTHKY.
3. Pa3pa60TKa MeTO H"lCCKHX peKOMeH aIJ;HM no Be eHHIO
ceCTpHHCKoro npo ecca, KaK HayqHoro MeTO]J;a Opral!H-
3a HII cecTpHHcKOH PaKTHKH, cecTpllHcKOH AOKyMeH-
TaIJ;HH Ha6JIIO eHHJi 3a naIJ;HeHTOM.
4. Pa3pa6OTKa MeTO,l\H"lecKHX peKoMeH IIM no nepeCMOT-
PY <pc}JepeH HpOHaIIHOM Harpy3KH Ha CecTpHHCKHH nep-
COHaJI JITIY.
5. TIepecMoTp MeTO IiKII OnJIaThI Tpy):(a CneIJ;HaJIhHOCTH
ceCTpHHCKoe AeJIO B 3aBHCHMOCTH OT Ka'leCTBa 06'l>eMa
BhInOJIHHeMOM pa60ThI H ypOBF.H 06pa30BaHIUI Ha OCHO-
Be HOBhIX TeXHOJIOrHM ceCTpllHCKoro eJIa.
28
29
YPOBH no..qrOTOBKH Me HqHHCKHX ceCTep B POCCHH
eCTpHHCKHe nepHO H eCKHe H3 aHHR .
E 1994 I'o.n;y B POCCMJf C$OPMMPOBaJI Cb MHOI'OypoBHeBaR:
CMcTeMa cecTpMHCKOI'O 06pa30BaHMR::
3-H ypOBeHb
Bblcwee CeCTpl1HCKoe 06paJOBaH le (BY3)
· HaY"lHO-npSKTM"leCKMH mYPHaJI «Me.n;HnMHCKaR: no-
MOII.{b», KOTOpbIH BbIXO):(MT C 1993 I'.;
· B 1995 I'. BbIllIeJI mYPHaJI .CecTpMHcKoe .n;eJIo».;
· mypHaJI «Me):(MnMHcKWf cecTpa» li3.l\aeTCR: C 1999 I'., rJIaB-
Hbm pe.l\aKTOP mypHaJIa - npQ(»eccop TIeplpMJIbeBa r.M.;
· "CecTpa MMJIOCep):(MR:», M3):(aeTCR: C 200Ir.
t
2-" ypoBeHb (Konne.qIK)
(pe.qHce Net;I1IjI1HCKoe npo.pecCHoHanbHoe
06paJOBaHI1e
i
1-" ypoBeHb (Ne.qI1IjI1HCKOe Y<4l1nI1Uje)
(peAHee MeAl1ljl1HCKoe
npo.peCCl10HanbHoe 06paJOBaHI1e
Ponb, qenH H 3a a H
AccoqHaqHH pOCCHHCKHX Me HqHHcKHX ceCTep
B POCCMM B 60JIbllIMHCTBe ropO):(OB 6bIJIM T}>a):(MnMOHHO 06-
pa30BaHbI I'OpO):(CKMe COBeTbI Me):(MnMHCKMX cecTep, r):(e 06-
cym):(a.nMcb, pellIa.nMCb np06JIeMbI cecTpMHCKOH npaKTIiKM, HO
B 60JIblliMHCTBe CJIytJaeB OHM OCTaBaJIMCb TOJIbKO Ha 6YMare.
He orqy:m;aJIaCb pea.nbHaJi nO):(.l\epmI<a BbIllieCTOR:II.{HX MHCTaH-
nMH, TaR. Ka.K COBeTbI Me,o;HnMHCKHX ceCTep OCTaBaJIHCb no.n;Be-
):(OMCTBeHHOH opraHM3anMeH.
TIepBoii: aCCOnManHeii:, C03,o;aHHoii: B POCCMM 20 MaR: 1992
ro,o;a, R:BJIR:eTCR: MOcKOBCKaR: aCCOnManMR: Me,o;MnMHCKMX cec-
Tep (MAMC). MocKoBcKaR: aCCOnManMR: Me.n;MIIMHCKHX cecTep
R:BJIR:eTCR: CaMOCTOR:TeJIbHOH npm»eccMOHaJIbHOH: OpI'aHM3anM-
eH:, KOTOpa.fl 3aHMMaeTCR: no,o;I'OTOBKOH ceCTpMHCKMX K pOB,
3aII.{MToii: npmpeCCMOHaJIbHbIX npaB, YJIytIllIeHMeM YCJIOBMH:
Tpy,o;a, nOBbIllIeHMeM 3apa60THOH: nJIaTbI H T.):(. )];aHHWf opI'a-
HM3anMR: He ,o;y6JIMPyeT pa60TY npmpcoI03a Me;J;MnMHCKllx pa-
6OTHMKOB MJIM MHbIX 06II.{eCTBeIUlbIX opraHM3anHH. Ee KpaT-
KOCPO'lHbIe neJIM HMeIOT 3 HanpaBJIeHMR:: no,o;HJITMe npecTMma
npOl}>eccMH Me):(MI.W:HcKOH cecT}>bI, 3 Ta npO<»eccMOHaJIbHbIX
npaB, YJIytIllIeHHe YCJIOBHH: Tpy,o;a M nOBbIllIeHMe 3apa60THoii:
nJIan,I. II TpeTbe HanpaBJIeHMe - 06pa30BaHMe Me,o;MnMHCKMX
cecTep, B TOM 'IMCJIe, M nOBbIllIeHMe KBaJIM<pMKaUMM npaKTM-
KyIO:rnnx Me):(ceCTep.
Cpe,o;M ):(OJIroCPO"lHbIX neJIeH HaH60JIbllIyIO BamHOCTb npe):(-
CTaBJIR:IOT HaytI'HbIe HCCJIe,o;OBaHMR: M pa3pa60TKM B 06JIaCTM
ceCTpMHCKoro ):(eJIa, C03.n;aHMe npaR.Tlf'leCKHX CTaH,o;apTOB.
TIo,o; srH,o;OH aCCOnManIlli npOlliJIH POCCMHCKo-AMepHKaHC_
KMe ceMMHapbI no np06JIeMaM $HHaHCMpOBaHIiR: H3):(aTe.'IbC-
KOM ):(eR:TeJIbHOCTIi, npMBJIe'leHHJi HOBbIX 'IJIeHOB.
eT : MY ypOBHIO nO):(:OToBRM cnenMa.nMCTOB COOTBeTcTBY_
6 BOM J. oCY.l\apCTBeHHbIM 06pa30BaTeJIbHbIM cTa apT (Tpe-
OBafmR: K MHHMMYMy co):(epmaHMR: nO.l\rOToBKH fio CnenMaJIb_
Hocm). JJ:MCnMnJIHHbI onpe.n;eJIR:IOT OCHOBHbIe HanpaBJIeHHR:
nO):(I'OTOBKM BbInYCKHMKOB.
TIepBbIi1: BbInycK cnenMa.nMCTOB C BbIC.lUMM cecTpHHCKMM
06pa30B3HMeM COCTOR:JICR: B 1995 I'O" y rI' 2002
- f-\ . "'" ro.l\y tJMCJIO
POCCMMCRMX BY30B, B KOTOPbIX OTKPbITbI llIaRYJIbTeTbI BbIC.lUe-
I'O cecT}>MHCKOI'O 06pa30BaHMR: COCTaBHT 34 a 06 rn ee v
CTBo BbI ' ....... -"OJIMtJe-
nycKHI1KOB - CBbI.lUe 2,5 TbICR:"l MeHe):(mepoB B 06JIac-
™ cecT}>MHcKoro .l\eJIa.
JlliJ1;epOM ceCTpHHCKOI'O ,o;eJIa. HHHnMaTopOM C03,o;8HMR: cpa-
KYJIbTeTa BbIc ero CeCTpl1HCKOI'O 06pa30BsHHJi B MOCROBCKoii:
Me.l\MnMHcROH ar,a.l\eMMM MM II M C
.... M . . . e'leHOBa R:BJIR:eTCR:
J.. . ITepCPMJIbeBa, npollleccop, J1;eKaH !J>aKYJIbTeTa BbICllIel'O
cecTpMHcKoro 06pa30BaHI1R:.
B HaCTOR::m;ee BpeMR: B POCCMHCKOH <Pe,n;epanI1M BbJ:XOJ1;R:T'
COBe .lUeHHO HOBbIe nepMO,o;M"leCKMe M3J1;aHHR: MR: npenoJ1;aBa_
Te eH YtJe6HbIX MeJ1; M nHHcRHX 3a:ae.n;eHHM, npaRTH'leCKlix Bpa-
tJeM, Me,n;HnHHcKHX cecTep, llIeJIb,n;mepOB, aKymepoR opraHM
3aTopOB M ,n;Pyrl1x pa60THHKCB 3.n;P BooxpaHenHR:. OCHOBHbr
MM M3 HHX JiBJIR:IOTCR::
30
31
CeCTpHHCKHe aCCOnHanHH B pa3BHTbIX CTpaHaX 06Hl1HCb
MHOrHX npHBHl1erHi!: l1H CBOHX 'WeHOB, TaK KaK OHH cy:r.ne-
CTBYIOT HeCKOl1bKO eCHTHl1eTHM.
Ha 3ana e Me CeCTpa ei!:cTByeT B paMI<ax 3aKOHa napal1-
l1el1bHO C BpaqOM, He nO MeHHH ero H pa60TaH C HHM B O Hoi!:
KOMaH e. Y Haillei!: Me ceCTpbI HeT HHKaKHX 3aKoHHbIX npaB
Ha caMocTOHTel1bHOCTb. Onpe]J;el1eHHe cero]J;HHillHHX I<aTero-
pHi!: BeCbMa YCl1OBHO.
TaKHM 06pa30M, y<IHTbIBaJi HaCTOHrnee nOl1O:IKeHHe Me H-
nHHCKHX ceCTep, B 1994 ro]J;y C03]J;aHa MeJKpCrHOHa.IIbHaH ac-
COnHanHH Me]J;ceCTep B POCCHH. Ba:IKUeHillHM ]J;oKYMeHTOM,
HHHUHaTopOM C03 aHHH KOTOporo HBl1HeTCH 3Ta aCCOnHan HH ,
CqHTaeTCH :3THqeCKHi!: Ko eKc Me HnHHclwi!: ceCTpbI POCCHH,
npHHHTbIi!: B 1997 ro y. B HaCTOHIIJ;ee BpeMH B POCCHH cy:r.ne-
cTByeT OKOl1O 50 - H perHOHal1bHblX cecTpHHcKHX accon a-
n HH , 06'be]J;HHHIOIIJ;HX OKOl1O 42 TbICHq Ql1eHOB--aCCOnHaU HH .
B 1998 r. y<IacTHHKaM (Me HnHHCKHM ceCTpaM H aKYlUep-
KaM) MIOHxeHcKoi!: KOH epeHnHH 6bI1I0 npe l1O:IKeHO nO]J;nH-
caTb Kl1m'BY npHBep:IKeHua nOl1HTHI<H 3 opoBbe - 21 H pac-
npocTpaHHTb ee B cBoei!: cTpaHe.
CTaHAap n13a 4a.UI AeATenbHocTH B cecT HHcKOM Aene
AnA KOHTpoml Ka..ecTBa ceCTpHHCKOH npaKTHKH
CTaHiJ;apT - 3TO 3TaJIOH, 06pa3en, HopMa, MO eJlb - eiJ;H-
Hbli!: H 06H3aTel1bHbli!:, npHHHMaeMbIH 3a HCxo]J;Hoe l1H conoc-
TaBl1eHHH C HHM ]J;pyrHx no 06ubIx 06'beI<ToB, ]J;eacTBHH H T.n.
Cero]J;HH onpe]J;eJIeHbI OC1W6HbLe npuHIl,UnbL crnaHaapmu3a-
Il,uu. OHH MorYT 6blTb cBe eHbI K Cl1e ylOrnHM nHTH nYHKTaM:
. cTaH apTbI OJI)i<HbI 6bITb ]J;HC])(pepeHnHpoBaHbI C y<Ie-
TOM B03MO)i<HOCTeH JIllY;
. npH pa3pa60TKe CTaH apTOB CJIC yeT Y'lHTblBaTb .cyrn e -
CTBYIOIIJ;He peIWMeU]J;anHH (MeCTHble, TeppHTopmUIbHl>Ie,
HanHOHaJIbHbIe);
. yTBep:IK eHHe CTaH apTOB Cl1e yeT npOBO HTb nOCl1e
KJIHHHQeCKHX HcnbITaHHi!:;
. CTaH]J;apTbI He06xo]J;HMI? nepHO]J;H'IeCKH 06HOBJIHTb;
. npH npHMeHeHHH CTaH apTOB He06xo]J;11MO c06mo eHHe
pH a 06.R3arne.nbHbLX yc.no6uil. K HHM OTIIOCIITCH:
32
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1. BbI60p CTa apTa OJI:lKeH COOTBeTCTBOBaTb KJIHHH-
'IeCKoi!: CHTyanHH.
2. YpoBeHb OKa3aHHH nOMo:r.nH Ol1:lKeH COOTBeTCTBO-
BaTb KBaJIH HKanHH nepCOHaJIa H B03MO:IKHOCTHM
JIllY.
3. Me HnHllcKaH ceCTpa 06H3aHa 3HaTb H nOHHMaTb
CTall apT B neJIOM (YMeTb 060cHoBaTb Ka:IK Oe ]J;eH:-
CTBHe cTaH]J;apTa).
4. Ha oClione CTaH apTOB ]J;OJI:lKHbI COCTaBJIHTbCH HH H-
BHl\yal1bHble WIaHbI YXo a 3a nanHeHTaMH;
5. Yxo , COrJIaCHO cTaH apTY, OKa3bIBaeTCH B MaKCH-
MaJIbUO paHHHe CpOKH B MHHHMaJIbHO ]J;OCTaTO'IHOM
o6'beMe;
6. CBoenpeMeHHbIH: BbI30B Bpa'Ia, opraHH3anHH KOHCYl1b-
THpOBaHHH HBl1HeTCH HeOT'beMJIeMbIM YCJIOBHeM co-
6JIIO eHHH CTaH apTa.
CJIe yeT YQHTbIBaTb, 'ITO nonbITKH CTaH apTH30BaTb JIe-
Qe6HbIH: nponecc, cecTpHHcKHi!: nponecc BbI3bIBalOT onpe e-
JIeHHbIi!: HeraTliBH3M y MHorHX KJIHHHUHCTOB, ceCTpHHCKoro
nepCOHaJIa. CJIOBO «CTaH apT» no pa3YMeBaeT I1aJIH'IHe CTaH-
ap'l'HbIX CHTYanHH, 3a60JIeBlUiHH: H nanHeHTOB, KOTOpbIX, KaK
H3BeCTHO, He 6bIBaeT. YMeIIHe npHMeHHTb «CTaH apT» HBJIH-
eTCH npo eCCHOHaJIbHbIM OJIrOM Me HnHIICKoi!: ceCTPbI.
COBepllIeHHO O'IeB HO, QTO 4ICTaH]J;apTbI» HBJIHIOTCH HH-
CTpYMeUTOM ynpaBJIeHQeCKOH eHTeJIbHOCTH, 6JIarO apH CTaH-
apTaM COKparnaeTCH BpeMH OKa3IlHHH nOMo:r.nH H yxo]J;a, YJIyq-
llIaeTcn Ka'IeCTBO OKa3bIBaeMOH: nOMornH, 06'beKTHBHO OneHH-
BaeTCH Tpy Me HnHHCKOH ceCTpbI.
BHJJ:bl CTaH,ll;apTOB:
a) CrnaHaaprnbL npotjJeCCUOHa.nbHoil ae.Rrne.nbHocmu. OHH
onHCbIBIUOT 06H3aHHOCTl1 npaKTHKyro:r.nHX Me HUHHCKHX
ceCTep, onpe eJIHIOT c060i!: 6a3y OneHKH npaI<THQeCKoi!:
eHTel1bHOCTH, onHCbIBalOT OTBeTCTBeHHOCTb Me HnHHC-
IWi!: ceCTpbI nepe 06rneCTBOM H nanHeHTOM.
6) CmaHaaprnoM nOBeaeHU.R MeaUU,UHCKUX cecmep HBJIHeT-
(,H « STIi'-IeCKHH: Ko eI<C Me]J;HJ HHCKOH: ceCTpbI», oTPa-
JKalOlL\HH OCHOBHbIe npHHnHnbJ cecTpHHcKOH eOHTOJIO-
rHH H (PHl1OCO HH cecTpHHclwro eJIa.
2. 38<_ 291
33
K CTaH.lI:apTaM npm}>eCCHOHaJILHOB .lI:eHTeJILHOCTH OTHO-
CHTCH:
. crnallaapmbt npou,eayp, IWTOphIe ,lI,OJDKHhI CO,ll,ep:IKaTb neJIH,
nOKa3aHHH,npOTHBOnOKa3aHHH,OCH eHHe,06H3aTeJIbHhIe
YCJIOBHH BbInOJIHeHHH npOne,ll,YP, ,lI,OJI:lKlIhI onHChIBaTb STa-
nhI npOne,ll,YPhI - no,nrOTOBKY, BhInOJIHeHHe, 3aBepllIeHHe
npOne.n.yphI;
. crnallaapmbt nJ/.alla no yxoay 3a nau,UeHmOM - OTpa:IKalOT
6a30BbIii: YPOBeHb KatIeCTBeHHoro CCCTpHHCKoro YXO,ll,a no
onpe,ll,eJIeHHOB npo6JIeMe nanHeHTa BHe 3aBHCHMOCTM OT KOH-
KpeTHOB KJIHIIH'IeCKOH CHTYanHH.
. crnallaapmbt OlW3allUJl CKopoii U lleornJlo:J/Clloii nOMOll{U lla
aozOCnUrnaJlb1l0M amane - STO nepetIeHb CBoeBpeMeHHbIX,
nOCJIe,ll,OBaTeJIbHbIX, MHHHMaJIbHO ,lI,OCTaTOtIHhIX MeponpHH-
THM ( ,nHarHOCTHtIeCKHX, JIetIe6HhIX, a TaK)i<e MepOnpHHTHM
no yxo.n.y), npHMeHHeMhIX B THlIHtIlIOii: KJIHHHtIeCIWH CHTya-
nUH. O,nHHM H3 06H3aTeJIbHb!X YCJlOBHii: npHMeHeHHH CTaH-
,napTOB HBJIHeTCH HX COOTBeTCTBHe KJIHHHtIeCKoii: CHTyanHH.
)J,JIH SToro COCTaBJIHeTCH HH,lI,HBH,nyaJIbHhIii: nJIaH yxo,na -
nHCbMeHHoe PYROBO,nCTBO no yxo,ny. llo,npo6Hoe nepetIHCJIe-
HHe ,lI,eii:cTBHM Me,ll,HnHHCKoii: ceCT}>hI, Heo6xo,nHMoe ,nJIH ,lI,OC-
TH:lKeHHH neJIeB YXO,ll,a no onpe,ll,eJIeHHOM np06JIeMe nanHeH-
Ta. CaHKT-lleTep6yprCKaH aKa,neMHH nOCJIe,ll,HnJIOMHOrO 06-
pa30BaHHH npe,ll,JIaraeT npH pa3pa60TKe CTaH,napTOB yqH-
ThIBaTb yp061lU OKa3allUJl a06pa'l.e61loii nOMoU{u:
- KOHCYJIbTaTHBHaH nOMOInb;
- caMonoMOInb, ,lI,OCTynHaH nanHeHTY;
- HeOTJIO:IKHaH nOMOInb H T. n.
,l];JIH "lJ:ero HymHLI cTau;:J;apTLl?
CTaH,ll,apThI n03BOJIHIOT 06WI<THBHO Ol\eHHBaTb KatIeCTBO
pa6OThI. Kam,ll,oe ,lI,eHCTBHe CTaH,!I;apTa no.n.n:aeTCH KOJIH'IeCTBcn-
HOMY yqeTY, HanpHMep, B 6aJIJIax, npOneHTax. Tpe60DaIlHH
rocy,napCTBa no opraHH3anHH pa60ThI B STOll 06JIac 1'1'1 OI'ODO-
peHhI B npHKa3e (19.01.98r. :N!! 12/2 4106 opraIln31\1 1II2 pa-
60ThI no CTaH,lI,apTH3anHH B 3,npaBooxpaHCHIfIi H «()l'UUIJIIbIX
nOJIO:IKeHHHX CTaH,napTH3anHH B 3,l1,paBOOXpaJll'JlIIIJ..
34
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OlleHKa KalfeCTBa pa60Tbi MeAMIIMHcKOH cecTpbl
06eCnetIeHHe BbICOKoro KatIeCTBa Me,nceCTpHHCKoro yxo,ll,a
HBJIHeTCH O,ll,HOM H3 Ba:IKHeMllIHX 3a,natI cecT}>HHcKoro ,neJIa B
POCCHH. llpH onpe,ll,eJIeHHH 3a,ll,atI H co,nep:IKaHHH cecTpHHcKOM
,lI,eHTeJIbHOCTH no y.rryqllIeHHIO Ka'leCTBa YX0,ll,a, sI<cnepThI B03
peKoMeH,ll,YIOT opHeHTHpoBaTbcH na tIeThIpe KOMnOHeHTa:
. BhIIIOJIHelllie npocl>eccHoHa.m,HbIX Q)YHKnIDf no CTaH,lI,apTY;
. HCnOJIb30BIUme peCYPCOB;
. CHH;)fteHHe pHcKa,nJIH nanHeHTa B pe3YJIbTaTe ceCTpHHC-
KOB nOMOIIJ;H;
. Y,lI,OBJIeTBOpeHHocTb nanHeHTa cecTpHHcKOM nOMOInblO,
YXOJJ;OM.
Ka:IK,lI,bIU: KOMnOHeIIT ,lI,OJImeH cO,ll,ep:IKaTb MHO;)f,eCTBO KpH-
TepneB H OneHOK Ka'leCTBa YXO,ll,a, BamneMllIHMH H3 KOTOpbIX
HBJIHIOTCH:
. BbInOJIHeHHe Tpe60BaHHH caHHTapHO - snHJI.eMHtIeCKOrO
na,n30pa;
. cBoeBpeMeHHOCTb BhInOJIHeHHH BpatIe6HhIX Ha3Ha'leHHll;
. cBoeBpeMeHHocTb H npaBHJIbHOe OKa3aHHe cecT}>HHcIWM
nOMOInH;
. cBoeBpeMeHHocTb H npaBHJIbHOe OKa3aHHe ,lI,oBpa'le6HOM
nOMOInH;
. coxpaHeRHe Me,ll,HnHHCIWM Taii:HbI;
. C06JIIOJJ;eHHe T}>e60BaJmM 3THtIeCKOrO KO,ll,eKCa Me,ll,HnHH-
CKOB ceCTphI, npHHnHnOB MeJJ;HnHHcKoii: STHI<H H JJ;eOH-
TOJIOrHH;
. opraHH3anHH pa60ThI no YTBep:;K,lI,eHHhIM B YCTaHOBJIeH-
HOM nOpH,lI,Ke Me,ll,HKO - TeXHOJIOrHtIeCKHM npOTOKOJIaM
(aJIroPHTMaM) ceCTpHHCKHX MaHHnYJIHnHii:;
. C06JIIO,lI,eHHe Ha3HatIeHHOrO pe:IKHMa nHTaHHH;
. opraHH3aUHH 06yqeHHH, npOBe,ll,eHHe ece,ll" KOHCYJIbTH-
pOBaHHH nanHeHTOB H tIJIeHOB HX ceMbH;
. ocyrn;ecTBJIeHHe MeponpHHTHM no npoQ)HJIaKTHKe OCJIO:IK-
HeHHM H YRpenJIeHHIO 3,l1,OpOBbH nanHeHToB.
3TH H MlmrHe ,lI,PyrHe KpHTepHH peKOMeH,lI,yeTCH npHMe-
HHTb JJ;JIH c03,l1,aHHH CHCTeMhI KpHTepHeB KatIeCTBa pa60ThI
Me,ll,H[(HHCKOM cecTphI Ha Kam,ll,OM pa60tIeM MeCTe. CerO,ll,HH
OCHOBHOM 3a,natIeM KOJIJIeKTHBOB JIllY HBJIHeTCJI C03,l1,aHHe e,ll,H-
2*
35
HOM CHCTeMhI OD;eHKH Ka"IeCTBB B pa60Te Me HD;HHCIWii CeCT-
PhI. }J,JUI STOrO He06xo HMO:
· npOBeCTH CTaH.n;apTH3aD;HIO pa60QHX MeCT B COOTBeT-
CTBHH Tpe60BaHHM CTaH.n;apTOB C yqeToM peCypCOB;
· C03 aTb S(j)(peKTHBHhIe CTaH apThI Ka"IeCTBa CeCTpHIIC-
KOM nOMoID;H H yxo a, pa3pa60TaTb H BHe pHTb B eH-
TeJIbHOCTb JITIY KpHTepHH KOHTpOJIH Ka"IeCTBa Ha Kam-
.n;OM pa60"IeM MeCTe;
· npOBO HTb aHaJIH3 01lIH60K no npHHD;Hny «xopomyIO
pa60TY MomHO C eJIaTb eID;e JIyqme», OTKa3hIBaHCh OT
MHeHHH, "ITO HeB03MomHO pa60TaTb 6e3 omH60K. rJIaB-
HaH D;eJIb pa60ThI Ha omH6KaMH He HaKa3aHHe, a 06y-
QeHHe I;IeAHD;HHCKHX ceCTep C D;eJIhIO HCnpaBJIeHHH CBO-
HX OillH60K, C03 aHHe aTMoccPephI B KOJIJIeKTHBe pa60-
TaTh 6e3 CTpaxa nepe KOHTpOJIeM.
o Ka"IeCTBe pa60ThI JlwryT CB eTeJIhCTBOBaTb H MHorHe
KaK 06'heKTHBHhIe (CTaTHCTH"IeCKIie), TaIt H cy6'heKTHBHhIe (CO-
6ece.n;OBaHHH C naD;HeHTaMH, HX pO CTBeHHHKaMH, IWJIJIera-
MH) KpHTepHH. O"IeHb BamHO, "IT06hI ocToiiHoe Ka'IeCTBO ce-
CTpHHCKOii pa60ThI nOOID;pHJIOCb H B03Harpam,1l;aJIOCh.
TaKHM 06pa30M, 06eCnC"IeHHe BhICOKoro Ka'IeCTBa ceCTpHH-
CKOM .n;eHTeJIhHOCTH Tpe6yeT OT pyKOBo IiTeJIeM H opraHH3a-
TOpOB ceCTpHlICKoro ,IIeJIa KOMrureKca opraHU3aD;HoHHhIX, per-
JIaMeHTHpyron\I1X H BOCnHTaTeJIhHhIX MeponpHHTHM, 06yqe-
HHH, KOHTpOJIH, OCTaTO"IIlOro oCIIaID;eHHH pa60"IHX MecT,
JIeKapCTBeHIIOro 06eCne"IeHI1SJ H p.
YMeHHeM, TaK H TepneHHeM Me.n;hD;HHcKoro nepCOHaJIa, npe:;K-
e Bcero cecTep, aKymepoK.
B cOBpeMeHHhIx YCJIOBHHX HOBbIX no.n;xo,lloB H co.n;epmaHHA
Tpe6YIOT cPYHKD;HOHaJIhHhIe 06H3aHHocTH Me cecTep, aKyme-
POIt. TIOJIOmeHHH, KOTOphIMH onpe,lleJIeHhI 06H3aRHOCTH, npa-
Ba, OTBeTCTBeHHOcTh CneD;HaJIHCTOB co cpe HHM npexpecCHo-
HaJIhHhIM 06pa30BaHHeM B HacToHID;ee BpeMH nepecMaTpHBa-
IOTCH. TIepcneKTHBHhIM H aKTyaJIhHhIM B 3TOM CBH3H HBJIHeT-
CH pa3pa6OTKa KJIHHH"IeCItHX cTa apToB npaKTH"IeCKHX YMe-
HHM H HaBhIKOB Me cecTep, aKymepoK.
Cc}JopMHpOBaJIaCh MHoroypoBHesaH CHCTeMa npoqJeCCHOHaJIb-
Horo 06pa30BIlHHH. Oc06eHHoCTbIO cOBpeMeHHhIx Tpe60BaHHM
K npocPeccHH cPeJIh mepa, Me HD;HHcKOM ceCTphI, aItymepKH
HapH y C JIe"Ie6Ho-.n;uarHOCTH"IecItHMH MaHHnyJIHD;HHMH HB-
JIHeTCH BJI eHHe HaBhIKaMH 06ID;eHHH, 3HaHHe OCHOB ncnxo-
JIOrHH, ysameHHe npaB H .n;OCTOHHCTBa naD;neIITa. }J,eHTeJIb-
HOCTh Me ceCTphI, cl>eJIh mepa, aKymepKH HanpaIJJIeHa Ha CO-
xpaHeHHe 3 OpOBhH HaCeJIeHHH, 06eCne"IeHHe BhICOKoro Ka"Ie-
CTBa ceCTpHHCKOM nOMoID;H.
3Ha..eHMe npOBe,qeHMH HaY..HblX M3blCKaHMH
M nepcneKTMBbi pa3BMTMH
ceCTpMHCKoro ,qena B POCCMM
CPOpMHpOBaIIHe OTeQeCTBeHHOM HayqHoH 6a3hI HCCJIe.n;ona-
HHi! B 06JIaCTH ceCTpHIICKoro eJIa, C03 aHHe HonhlX TeXHOJIQ-
rHH HBJIHeTCH Ba:;KHeMmeM 3a.n;aQeM OTpaCJIeBOM nporpaMMhI
pa3BHTlIH ceCTpIiHCKoro eJIa. CyID;eCTBeHHO MeIIHIOTCH cl>YHK-
D;HH Me HD;nHCIwro nepCOHaJIa npH BHe,!\peHHH B esrreJIhHOCTb
COBpeMeHHhIX TeXHOJIOrHM, HOBhIX JIe"Ie6HO- HarHOCTI1"ICCKHX
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36
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CECTPHHCKOrO .4EM
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eHTOM, ero 3,n;opOBbeM, HaYKa II: llCKYCCTBO, HanpaBJIeHHbIe Ha
pellIeHlle cy ecTBYlO HX II nOTeH HaJIbHbIX np06JIeM co 3,A0-
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42
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nOMOll\ll. 9TO MOpaJIbHOe Tpe60BaHlle OTpameHO B KJIHTBe rHn-
nOKpaTa, jKeHeBCI<OH ,ZJ;eKJIapaI\HH II B ,ZJ;pyrllx ,ZJ;OKYMeHTax,
XOTH Bpa'lll HapYilialOT 3TH KaHOHbI (r<pHl\IepOM 3TOMY cnymI1:T
'1aCTHaH Me,ZJ;lIL(llHa - Kor,ZJ;a Bpa'l YCTpaHHeTCH OT Me,ZJ;llL(llHC-
KOH nOllIOll\ll 60JIbHOMY, ecnll He nOJIy'IaeT 3a liee rOHopapa).
Ha npoTHmeHllll 25 BeKOB B eBponeHcKoH KYJIbType c}Jop-
MlIpOBaJIHCb, CMeHHJIll APyr ,ZJ;pyra pa3JIll'IHhIe MOpaJIbHO-3Tll-
'1ecKlIe npllHL(llnhI, npaBllJI8, peKoMeH,ZJ;aL(HH. Pa3HoBH,ZJ;I!OC-
TblO 3THKH HBJIHeTC.H 6UOMeOUijUHCKaJL amUKa. OHa BbIllOJI-
H.HeT COI\HaJIbnylO c}JYHKL(111O 3aIIJ;llThI .Im'lHOCTll Me,ZJ;llL(HHCKO-
ro pa60THHKa, ero npaBd nocTynaTb He TOJIbKO no 3aKOHY, HO
II no COBec'rll, BbIllOJIHHH CBOH npoc}JeCCllOHB.'1bHbIH ,ZJ;OJIr.
CerO,ZJ;HH (,6HOMep.llL(llHCKaH 3TIIKa& cyux;eCTByeT B 'IeThIpeX
c}JopMax llJIll MO,ZJ;eJI.HX:
1. MooeJ/b runnoKpama. OCHOBHOH npHHL(Hn 3TOH MOJJ;eJIH
- ('He HaBpe,ZJ;H&. Bpa'l3aBOeBbIBaeT COL(llaJIbHOe ,ZJ;OBepHe na-
ltlleHTa. IIpHHD;HnbI Bpa'leBaHHH, 3aJIOmeHHble OTD;OM Me,ZJ;H-
D;llHhI rllnnOI<paTOM (460-377 rr.), JIemaT y llCTOI<OB Bpa-
'1e6HOH 3TllKll H OTpameHbI B 3HaMeHllTo'H (,KJIHTBe&, KOTO-
paH H cerOjJ;HH aKTYaJIbHa.
2. MOOeJlb lIapaijeJlbca (1493-1541 rr.) - (..r:(eJIaTb ,ZJ;06-
PO&, CJIOmllJIaCb B cpe,ZJ;HHe BeKa. OCHoBHoe 3Ha'leH e HMeeT
3MOD;1l0HaJIbHhIM I<OHTaKT Bpa'la C naD;lleHTOM, Ha OCHOBe KO-
Toporo CTpOllTCH BeCb JIe'Ie6HhIH npoD;ecc.
3. j{eolLmOJlOZU'l.eCKaJl MooeJ/b llJIll Bpa'le6HaH 3THKa, KO-
TopaH B03HHKJIa B 1840 r. (aBTop IIeTpoB). OCHOBHbIM npl1H-
D;llnOM HBJIHeTCH « HpaBCTBeHHaH 6e3ynpe'lHocTb &, (, c06JIIO,ZJ;e-
HHe ,ZJ;O.lIra&. OHa 6a311pyeTcH Ha CTpomaHllieM llcnOJIHeHllll
(, KO,ZJ;eKca '1eCTll &, YCTaHaBJIllBaeMOro Me,ZJ;HD;HHCKllM co06ll1,e-
CTBOM, a TIll<me c06CTBeHHbIM pa3YMOM Bpa'la ,ZJ;JIH 06H3aTeJIb-
Horo llCnOJIHeHHH.
4. BuoamuKa - COBpeMeHHa.H c}JopMa TP3AHD;lloHnoH 6HO-
Me,ZJ;HD;HHcKOH 3TllKH; OCHOBHbIM npHHJ.{llnoM KOTOpOH HBJIH-
eTCH npHHD;Hn ('YBameHllH npaB II ,ZJ;OCTOllHCTBa '1eJIOBeI<a&.
44
45
Bli03TliKa npe,lJ;CTaBJUIeT C060H BIUi\:HYIO TO'lI,Y c}JHJIOCOc}JC-
KOrO 3HaHH.H, CB.H3aHHOrO C rpaH,lJ;li03HhIMli H3MeHeHli.HMH B
TeXHOJIOrH'leCKOM OC a eHHH COBpeMeHHOH Me,lJ;H HHhI, B03-
HHKHOBeHHH HaYKH reHHOH HHJKeHepHH, TpSHCnJIIlHTOJIOrHH,
nO.HBJIeHHH 060PY,lJ;OBaHH.H ,lJ;JI.H COXpaIIeHH.H H nO,lJ;,lJ;epJKaHH.H
JKH3HH na HeHTa H HaKOWIeHH.H COOTBeTCTBYIOW;HX npaKTH-
'1eCKHX H TeOpeTH'IeCKHX 3HaHHiL CerO,lJ;H.H Cy ecTBYIOT 3TH-
'1ecKHe np06JIeMhI a60pTa, 3a'laTH.H, HCKYCCTBeHHOrO OnJIO-
,lJ;OTBOpeHH.H,KJIOHHpOBaIIH.H,CeKCOJIOrHH,3BTaHa3HH.BceaTli
npO eCCbI 060CTpHJIH MOpaJIbHhIe np06JIeMhI, BCTalO He ne-
pe,lJ; Bpa'loM, pO}J;cTBeHHHKaMH na HeHTa, nepe,lJ; Cpe,lJ;HHM M<!'
"H HHCKHM nepCOHaJIOM. B OTJIH'IHli OT ,lJ;eOHTOJIOrH'IeCKOH
3THKli, r,lJ;e pe'lb H,lJ;eT 06 OCTOpOJKHhIX BblCI<a3bIBaHH.liX npH
na HeHTe .0 3aBOOBaIIHH ,lJ;OBepH.Ii&, «0 pOBHOM, cnOIwHHoM,
pa3YMHOM nOBe,lJ;eHHH Bpa'la, 3a60TJIliBOM, BHHMaTeJIbHOM K
n HeHTY», B 6HosTHKe OCHOBHbIM CTaIIOBHTCH KOHc}JJUlKT npaB,
B ,lJ;aHHOM CJIY'Iae (CnpaBa nJIo,lJ;a Ha JKli3Hb», npaBOM JKeH H-
HhI Ha a60pT (npepbIBalIHe 6epeMeHHocTH), npaBOM Ha 3BTa-
Ba3HIO (6YI<BaJIbHO (',lJ;06pa.H, XOpOIIIa.li CMepTb&). 3,lJ;ecb npa-
BOBoe C03HaIIHe n HeHTa «npaBa Ha ,lJ;oC'rynnylO CMeprb» BCTy-
naroT B npOTHBOpe'lHe C npaBOM JIH'IHOCTH Bpa'la HCnOJIHHTb
He TOJIbKO npoc}JeCCHOHaJIbHOe npaBHJIO - «He HaBpe,lJ;H&, HO H
3anOBe,lJ;b - «He y6HH&.
B COBpeMeHHOi1: Me,lJ;H HHe pe'lb H,lJ;eT YJKe He TOJIbKO 0 «no-
MOW;H 60JIbHOMY&, HO H B03MO>KHOCTHX ynpa6:nenUJ£ npo ec-
caMH naTOJIOrHH, 3a'laTH.H H YMHpaHII.H C BeCbMa np06JIeMa-
TII'IHhIMH HpaBCTBeHHhIMH nOCJIe}J;CTBHHMII aToro ,lJ;JIH '1eJIOBe-
'1ecIWM nonYJI.H lIli B u;eJIOM.
CerO,lJ;H.H Me,lJ;IIU;IIHa CTpeMHTC.H c,n;eJIaTb >K1I3Hb 'leJIOBeI,a
}J;OJIrOH, C'IaCTJIHBOi1: H JIllIIIeHHOM 60JIe3HeM, HO Bcer}J;a Ha
nyrH CTO.HT JIIO,lJ;II, ,lJ;BII>KIIMble >KaJK}J;OH BJIaCTII H 3apa>KeHHhIe
TOTaJIIITapHOH H,lJ;eOJIOrlleiL II03TOMY H B03HIIKJIa TaKa.H c}Jop-
Ma Me,lJ;IIU;IIHcKOI"1: 3TIIKH, I,aK 61103TllI<a, KOTOpa.H paCCMaTpH-
BaeT Me,lJ;IIU;IIHY B KOHTeKCTe npae 'Le:n06eKa. :3TO MeH.HeT OC-
HOBHOH Bonpoc Me,lJ;UI.lHHCKOH 3TIII,H - Bonpoc 06 OTHOllieHIIII
Bpa'la II naU;lIeHTa. HeocnopIIMhIH npllOpllTeT Bpa'Ia B peIIIe-
HIIII np06JIeM n lIeHTa rerO,lJ;H.Ii BO MHorHX CTpaHaX He cy e-
cTByeT.
nOHSITMe M cjJYHKqHM 06U4eHHSI
0611{enue - 3TO CJIO>KHbIH COU;HaJli>HO-nCHXOJIOrH'IeCKHH
npou;ecc B3aHMonOHHMaHH.H Me>K,lJ;Y JIIO,lJ;bMH, npOHCXOJl:H HH
C nOMoW;blO CJIOBeCIIOH (Bep6aJIbHoM) H 6eCCJIOBecHoM (HeBep-
6aJIbHOH) HHc}JOpM HH.
B nOCJIe,lJ;Hlie rO,lJ;hI B HaYKe HCnOJIb3yeTC.H BMeCTO' CJIOBa
(.06w;eHHe& TepMHH (.KOMMYHHK .H&.
Bep6aJIbHa.H HHc}JopMaU;H.H OTpa>KaeTC.H B BhICKa3bIBaHHHX
HJIH HanHcaHHbIX (nHCbMo) '1YBcTBax, MhICJIHX, Ha6JIIO}J;eHH-
HX. , eBep6aJIbHa.H HHc}JopMa H.Ii OTpa>KaeT nOcTYnI,H HJIH
nOBe,lJ;eHHe TOro, I,TO nepe}J;aeT HHc}JopMa HIO 6e3 HCnOJIb30Ba-
HHH pe'lH HJIH HanHcaHHH (nHCbMa).
OCHOBOH }J;JIH KOMMYHHKa Hli cJIy>KaT TllItHe c}JaKTOpbI, KaK
cOnepe>KHBaHHe, YBa>KeHHe li HCKpeHHocTb, 06JIer'lalO lIe
B3aHMHoe 06w;eHHe. IJ;eJIblO npo ecca nOHHMaHH.H ,lJ;JIH Me,lJ;-
cecTep ryMaHHCTH'IeCKOrO CI,JIa,lJ;a .HBJI.HeTCH H3Y'leHHe Tan-
HbI, IWTOpOH OCTaeTC.H na HeHT. B pe3YJIbTaTe TaKoro H3Y-
'leHHH, a He (cpa3rap;KH>i>, MOJKHO 60JIbilie Y3HaTb O}J;HOBpe-
MeHHO 060 Bcex, KTO OKpY>KaeT na HeHTa, H 0 caMOM ce6e.
06 eHHe B ceCTpHHCKOM }J;eJIe - 3TO npou;ecc, nopO>K,lJ;ae-
MhIH nOTpe6HOCT.HMH cOBMecTHoH ,lJ;eHTeJIbHOCTH n HeHTa H
Me,lJ;H HHCKOn ceCTpbI, HCKYCCTBO B03,lJ;eHCTBHH Ha JIH'IHOCTb
na HeH a C eJIblO ap;anT HH (npHcnoc06JIeHH.Ii) K H3MeHe-
HHHM B >KH3HH B CB.H3H C H3MeHeHH.HMH COCTO.HHH.H 3,lJ;OpO-
Bb.H.
HaBbIKH 06 eHHH B ceCTpHHCKOM ,lJ;eJIe Tpe6YIOT cne HaJIb-
HbIX 3HaHHi1: H YMeHHH, nOTOMY '1TO Me,lJ;HU;HHCKOM cecTpe He-
06XO,lJ;HMO yqHThIBaTb COCTO.HHHe 3}J;OpOBb.H na HeHTa, ero
c}JH3H'lecKoe H nCHXH'leCKOe COCTOHHHe.
AnH 0I<a3aHH.H MaKCHMaJIbHOH nOMOW;H H nO,lJ;,ZJ;ep>KKH na-
u;neHTa Me,lJ;cec-rpe J:Ieo6XO,lJ;HMhI KOMMYHHKaTHBHble H npoc}Jec-
CHOHaJIbHble 3HaHHH, YMeHHe CJIYIIIaTb, 3a,lJ;aBaTb BonpOCbI,
COnepe>KHBaTb, npOHBJUITb BHHMaHHe H 3a60TY.
06w;eHHe C na HeHTOM H BceMH, KTO Y'laCTBYeT B YXO,lJ;e,
Tpe6YeT nOHHMaHHH, YBa>KeHHH H BepbI B BhI3,lJ;OpOBJIeHHe.
YHHI,aJIbHOCTb ceCTpHHCIwro 06 eHHH B TOM, '1TO naU;HeHT
}J;OJI>KeH BepHTb B }J;06POTY H CHJIY, cnoc06HOCTb Me}J;ceCTphI
PYKOBO}J;liTb npou;eccoM a,lJ;anTallHH.
46
47
IJ>yHKl{11H 06ll\eHHn. Pa3JIH'IalOT CJIemrlOlI\He <PYHK HH 06-
ll\eHHH:
1. KonmaKmnaJ/.- YCTaHOBJIeHHe COCTOHHHH B3aHMHoii ro-
TOBHOCTH I{ 06 eIIHlO.
2. H1iljJopJltaijU01maJ/. - 06MeH HH<popMa Heii, co06 eHH-
HMH.
3. lIo6yiJume.nb1iaJl- CTHMYJIH nH aI{TnBHOCTH napTHepa.
4. Koop(}unaijuonnaJ/.- B3aHMHoe opneHTHpOBaHne H co-
rnaCOBaHne COBMeCTHoii ,ZJ;eHTeJIbHOCTH.
5.lIonu.ManuJ/.- a,ZJ;eKBaTHoe nOHHMaHHe CMhICJIa CKa3aH-
Horo, ,ZJ;eiicTBHii, COCTOHHHH CBoero napTHepa.
6. :JJlWmU61iaJ/. - 06MeH 3MO HHMH Me:1K,ZJ;Y napTHepaMH.
7. Ycman06Jle1iUe omnowenuu - OC03HaHHe MeCTa CBoero
napTHcpa B CHCTeMe Me:1KJIH'IHOCTHbIX, ,ZJ;eJIeBhIX H npo-
H3BO,ZJ;CTBeHHhIX OTHOllIeHHHX.
8. OKa3anue 6JlUJ/.1iUJ/. - H311'IeHeHne nOBe,ZJ;eHnH, COCTOH-
HHH, 3HaHHii, npe,ZJ;cTaBJIeHHii napTHepa.
06lI\erme, I<aK <PYHI{ HOHaJIbHaH 3JIeMeHTapHaJ1 e,ZJ;HHH a,
H3 KOTOphIX CKJI8,ZJ;bIBaeTCH BCH CHCTeMa 06 eHHJ1 JIH'IHOCTH B
onpe,ZJ;eJIeHHbli1: nepHO,ZJ; :1KH3HH: «Bonpoc-o'!'BeTJi>., PYKonOJ!ta-
THe, MHOr03Ha'lHTeJIbHhIii B3rJIJI,ZJ;, MI1:MH'IeCI<oe ,ZJ;BH:1KeHHe B
OTBeT T .e. OHO BKJIIO'IaeT pe'leBYlO Ii Hepe'leBYlO ,ZJ;eJ1TeJIbHOCTb
KaK rOBOpHlI\ero, TaK H c.rryIllaIOlI\ero.
YpOBHH 06a.qeHHSI
llCHXOJIOrH.H '1a e Bcero BbI,ZJ;eJIHeT TpH YPOBHH 06 eHHH.
BnympuJlU'l.1tocm1ioe - l<Or,ZJ;a CJIOBa He npOH3HOC.HTCH BCJIyX,
a '1eJIOBeI{ MhICJIeHJ:IO 06 aeTC.H C caMHM c060ii.
Me:JIClLU'lnOCm1tOe - 06lI\eHHC Men<,ZJ;Y JIlO}J;bMH C onpc,ZJ;eJIeH-
Hoii eJIblO, Kor,ZJ;a KOMMYHHKalWH npH06peTaeT OTKpbITO B3a-
HMHhIii XapaKTep, r,ZJ;e OHa npe,ZJ;CTIlBJIHeT c060ii B3aIIMHYlO
nepe,ZJ;a'lY H npHHHT:ae HH<popMa HH: 06 eHHe Ha onpe}J;CJIeH-
HYlO TeMY no pellIeHHlO 06lI\eii 3Il}J;a'lH. KOMMYHHKa H.H MO-
:1KeT npHHHMaTb XapaKTep HH<pOpMHpoBaIIHH, cnpaIllHBaHHH,
06yqeHHH, HHCTpYI{Ta:1Ka, npHKa3hIBaHH.H H T.}J;., 06ec!Ie'lH-
Ba.H CJIa:1KeHHOCTb cOBMecTHoii pa60ThI. 06Mell HH<popMa HeM
nO}J;'1HHeH 3,ZJ;eCb COBMecTHOMY peIlleHHlO 38,l\a'IH - nOJIyqeHHlO
HY:1KHbIX cBe,ZJ;eHHii (B npo ecce 06CJIe,ZJ;oBaHHH na HeHTa), YC-
BoeHHlO Y'Ie6HOrO MaTepHaJIa B npo ecce 06yqeHHH H T.,ZJ;.
TaKoe 06Y'IeHHe MO:1KeT 3aKOH'IHTCH B O,ZJ;HH ceaHC HJIH nO'l'pe-
6yeT HeCI<OJIbIW BCTpe'l.
0614ecm6ennoe - 06lI\eHHe O,ZJ;Horo '1eJIOBeKa C aY,ZJ;HTopH-
eii. 06lI\eHHe Ha 3TOM YPOBHe Tpe6yeT C06JIlO,ZJ;eHHH onpe,ZJ;e-
JIeHHbIX npaBHJI, TP8,l\H Hii, npHH.HTbIX HOpM.
CpeACTBa 06a.qeHH
K Bep6aJIbHhIM cpe,ZJ;CTBaM 06 eHHH OTHOCHTC.H pe'lb, KO-
TopaH O,ZJ;HOBpeMeHHO BbICTynaeT Ii KaK HCTO'IHHK HH<popMa-
HH, II I{aK cnoc06 B03,ZJ;eiicTBHH Ha c06ece,ZJ;HI1:Ka. He CJIe,ZJ;yeT
3a6bIBaTb CJIOBa ,ZJ;peBHero n03Ta CaIl,l\H: (cYMeH TbI HJIH rJIyn,
BeJIHK TbI HJIH Ma.n, He 3HaCM MhI, nOKa ThI CJIOBa He CKa3aJIJi>.
Me,ZJ;H HHCI{aH ceCTpa ,ZJ;OJI:1KHa YMeTb pa36HpaTbCH B MaHe-
pe rOBopHTb H o eHHBaTb ee. MaHepa rOBopHTb MOJ!{eT OTpa-
:1KaTb HH,ZJ;HBH,ZJ;YaJIbHhIe oc06eHHOCTH na HeHTa, ero TeMnepa-
MeHT. Pe'lb rpOMKa.H ,ZJ;OJI:1KHa Ha eJIHTb Me,ZJ;ceCTPY Ha MbICJIH
o HaPYllIeHHOM C:llyxe na HeHTa. Me,ZJ;H HHCI<a.!'I ceCTpa ,ZJ;OJI:1K-
Ha 3HaTb, '1TO MaHepa rOBopHTb MO:1KeT 3aBHCeTb OT naTOJIO-
rHH C03HaHH.H, MhIIlIJIeHHH, pe'leCOMaTH'leCKHX H nCI!XOHeB-
pOJIOrH'IeCI<HX 3a60JIeBaHHii. HanpHMep, npH O,ZJ;bIIliKe na H-
eHT rOBopHT 06pbIBKaMH, TH:1KeJIO, npH naTOJIOrHn C03HaHHH
(raJIJIlO HHa HH, conop, KOMa) , HeI<OTOphIX COMa'rH'IeCI<IIX
3a60JIeBaHHHX n HeHT He OTBe'laeT ua nOCTaBJIeHHhIe Bonpo-
CbI (He8,l\eKBaTHaH peaI{ HH na HeHTa).
Pa3JIH'IalOT pe'lb 6hICTPYlO, MC,ZJ;JIeHHYlO, 3anHHalO YlOC.H,
3MOD;HOHa.m.UYlO, MOHOTOHHyro, rpOMKYIO, llIenOTHYlO, HeBHHT-
HYlO, C 06e,ZJ;HeHHeM CJIOBapHOro 3anaca.
B HopMe C'IHTaeTCJ1, '1TO MaHepa rOBopHTb ,ZJ;O.lD{,Ha 6bITb
nJIaBHOii,cnOl<OMHOii,pa3MepeHHOM.
Pe'lb '1eJIOBeKa paCKpbIBaCT HanpaBJIeIlHOCTb JIH'IHOCTH -
ee HHTCpechI, nOTpe6HOCTH, y6e:1K,ZJ;eHH.H, H OTHOCHTC.H K .HBJIe-
HHHM ero ,ZJ;YXOBHOii KYJIbTYPhI. Pe'll> HBJI.HeTCn CHJIbHeiiIllHM
cpe,ZJ;CTBOM 06 eHHJ1, cpe,ZJ;CTBOM B03,ZJ;eMCTBHH Ha 'ICJIOBeKa.
«CJIOBO JIe'lHT - CJIOBO paHHTJi>. C nOMO blO pe'IH Me,ZJ;ceCTpa
,ZJ;aeT COBeThI H HHCTPYKJ.{HH, B03,ZJ;eiicTBYeT Ha 3MOJ.{HOHaJIbHOO
COCTO.HHHe na I1:(,HTa, a 'Iepe3 Hero Ha }J;e.HTeJIbHOCTb BHyr-
peHHHX OpraHOB.
48
49
QT06I,I nOJII,30B8TI,CS! CJIOBOM - Hap;O 3HaTI, nCHXOJIOrHIO
pe'lH, nOMHHTI, 0 pa3S1I eH H HC eJIS!IOI eH CHJIe CJIOBa, He
3a6I,IBaTI, 0 caMOI<OHTpOJIe.
RcnoJIb3YS! pe'II, KaK TepaneBTH"'IecKoe cpe,/\CTBO 06IQeHHS!,
Me,/\cecTp8 npHMeHS!eT SJIeMeHTbI nCHXO'1'epanHH: pa3'bS!CHe-
HHe, y6e:IKAeHHe H T.,/\.
IIpaK'fH'lecKH B K8JK,l\OH 6ece,l\e C n HeHTOM Me,/\cecrpa nhI-
Tae'l'CS! HCnpaBHTb 0llIH60'IHoe CY:lKAeHHe n HeHTa, nopom.neH-
Hoe HenpaBHJII,HOH o eHKOH CBoeI'O 60JIe3HeHHoro COCTOllHHS!.
IJ;eJII, TaKHX 6ece,v; l'rIOmHO C'IHTaTI, ,n;OCTHrHYTOH, eCJlli n HeHT
npH06peJI YBepeHHOCTb B ce6S!, OOPY B BhI3,qOpOBJIeHMe.
HCCJIe,/\OBIlHHS! nOl<a3I,IBaIOT, '!TO B eJKe,l(lIeBHOM aKTe KOM-
MYHHKaI{HH 'IeJIOBeKa CJIOBa COCTaBJISlIOT - 7%, 3BYKH H HH-
TOJia.I{HH - 38%, Hepe'IeBOe B3/ll1Mo,/\eHcTBHe 53%.
Ie HeBep6aJII,HhIM Cpe,l\CTBIL"\i 06IQeHlUI OTHOCS!TCS! BHellIlUfe
npOS!BJIeHHS! 'IeJIOBe'leCI<'HX 'IYBCTB If SMOI{HH.
Hepe'IeBoe 06 eHHe. CJIOBa, KOTOpI,IMM MhI IiOJIL3yeMCS!,
npOH3HOCS!TCS! Ha c}JOHe HeBep6aJII,HI,IX cpe,/\CTB KOMMYHHKa-
I{HH. :3TO 3HaKH H CHMBOJII,I, npH,l\alOm;He 3Ha'IeHHe CJIOBaM,
KOTophIe MI,I CJII,IllIHM. ,
TalmM 06pa30M, nepe,n;aIOTCS! HaCTpoeHHe, xapaKTep H 0'1'-
HOllIeHHe: BamHo He TOJII,KO TO, 'ITO TI,I rOBopMIlII" a K8K
TbI rOBopHIlII,».
3plfTeJlI,HI,lH KOHTaKT, BI,IpameHHe JIHI{a, n03a H nOJIome-
HHe B 3Ha'IHTeJII,HOH creneHH nOKa3I,IBalOT HaIIIH MI,IC.lIH H
'IYBCTBa. C'lHTaeTCS!, 'ITO HeBep6aJII,HaS! KOMMYHHKaI{HS! B
'IeTI,Ipe pa3a CHJII,Hee, 'IeM Bep6/lJII,HaS!.
}:(YMaS! 0 HeBep6aJII,HOH KOMMyHHK HH, Bcer,/\8 nOJIC3HO no-
MIrnTb O,/\HO npaBHJIO: 'lTC-TO BCeI',/\a npoHCXO,/\HT. HeBCp6aJIJ>-
Hble CHrHaJIhI rOBopSlT 60.1Thme, 'IeM CJIOBa. 1\1e,/\cecTpa ,nO.IIJKHa
CJIe,ll;HTI" He pacxo,nmcS! JIH C.IIOBa C STMMH CHI'HaJIaMH.
MHMHKa - ,nBHmeHHS! MI,IIIII{ JIHI{a. JI ecTHKa - MOTOpHI<a
Bcero TeJIa, I<OTopaS! npOS!BJIS!eTCS! B H3MeHeHHS!X n03, noxo,n-
1m, ocaHKH, cBoe06pa3HhIx ,nBHmeHHii PYK, a TaKme ,l(PyrHx
HeBep6a'II,HhIX cpe,nCTB 06m;eHHS!, TaKHX, KaK npHKOCHOBe-
HHS!: PYKOnomaTHS!, nOI{eJIyn, ,nOTparHBBHHS!, nOrJIamHBaHHS!,
OTTaJIKHBaHHS! H ,np.
MHMHI<.a OTpamaeT BHYTpeHHee SMOI{HOHaJII,HOe COCTOS!IlHe
H HeceT 60JIee 70% Hml'lopMal\HH 0 TOM, 'ITO nepemHBaeT
'IeJIOBel<.
meCT},) n03BOJIS!IOT JIyqIIIe pa36HpaTI,Cs! B JIIO,n;S!x.
BblpameHHe JlHI{a OTpamaeT nCHXH'IeCl<oe COCTOS!HHe 'Ie-
JIOBeKa. Ha6JIIO,naS! 3a BHeIIIHHM BH,/\OM naI{HeHTa, Me,l\CeCTpa
onHCI,IBaeT BbIpameHHe JIHI{8: 3JI06HOe, HcnyraHHOe, anaTH'I-
Hoe, pacrepS!HHoe, H ,np. B HopMe BbIpameHHe JIHI{a 6e3 OCo-
6eHHocTei1:, YPaBHOBeIIIeHHoe.
Qepe3 MHMHKY, mecThI, 3pHTeJII,HI,Iii I<OHTaKT, TOH rono-
ca, n03Y, ,n;BHmeHHS! H BhIpameHHe JIHI{a Me,ncecTpa ,nOJImHa
YMeTI, paCIllHIPPOBI,IBaTI, HHc}JopMaI{HIO 0 MI,ICJIS!X, 'IYBCTBax,
OTHOIIIeHHH naI{HeHTa K OI<Py){.;:eHHIO, no,n;,D;epmHBaTI, CBS!3I, C
naI{HeHTaMH, He cnoc06HhIMH K Bep6/lJII,HOMY 06m;eHHIO.
OCHOBHble CTHnM 06 eHHSI
QT06hI BH,neTb ,n;eTa.IIH» KOMMYHHKaTHBHoro npOI{ecc8,
HaY'IHTbCS! no I{eJIOCTHOMY Bne'laT.lIeHHIO OT CH'fyaI{HH 06IQe-
HHS! nOJIY'IaTI, He,nOCTalO YIO HHIPOpMaJ.{HIO, CBH38TI, I<OMno-
HeHTbI 06 eHHS! B onpe,neJIeHHbIii CTHJII, 06 eHHS! H npe,n;CTa-
BHTI" l<aK TOT HJIH HHOH CTH.III, BJIHHeT Ha OTHOIIIeHHS! Mem,ny
JIIO,nI,MH, IIa HX 3,nopOBI>e Heo6xo,nHMO YMeTI, ,n;HaI'HOCTHpO-
BaTI, (pacn03HaBaTb) CTHJIH 06m;eHHS!;
. KOHBeHI{HaJII,HhIH (,n;eJIoBoii);
. npHMHTHBHI,Iii:;
. MaHHny JIS!TliBHhIii;
. aKTYaJIH3HpOBaHHI,rn.
KOHoeHijUaJlbHblU (,n;eJIOBOM) CTHJII, npe,nnOJIaraeT ,nOBOJII,-
HO 60JII,llIYIO ,nHCTaHI{HIO MeJK,l(Y JIlO,nI,MH. BbIpameHHS! SMO-
I{Hii npH STOM OrpaHH'IeHI,I. Y'IaCTHHKH 06 aIOTCS! KaK HOCH-
TeJIH onpe,neJIeHHhIX c.rryme6HI,Ix c}JYHKI{HH.
npUJlf.UmU6HblU CTHJII, 06m;eHHS! npe,nnOJIaraeT HaJIH'lHe
Mem,l\Y JIIO,nI,MH TeaTpaJII,HhIX» HJIH 06hI,l\eHHI,IX» OTHome-
HHH. :3MOI{HH npH STOM BI,IpamaIOTCS! B 3aBHCHMOCTH OT CHTY-
aI{HH H no,n'IHHeHHOCTH. IIpaBHJIaMH B3aJIIMo,neiicTBHS! CTaHO-
BHTCS! npHMHTHBHhIe OTHOllIeHHS!: O.!J:HH 06pI,IBaeT ,nPyroro,
npOH3HOCHTCH penJIHI<.H, BI,IpamalOTCH arpeCCHBHbIe 'IYBCTBa.
Y'IaCTHHKH 06 aIOTCH «Ha ny6JIHKY».
MaHllnYJlRmUOHblU CTHJII,. :3TO BH,n .neCTPYKTHBHoro nOBe-
,neHHH B 06m;eHHH, KOTOPbIii OKa3I,IBaeT nary6Hoe BJIHHHHe Ha
50
5'
3,ZJ;OpOBbe 'IeJIOBeKa. 'IeJIOBeK BhI6HpaeT 3TOT CTHJIb 06m;eUH.H
TOr,ZJ;a, KOrna eMY BhIrO,ZJ;UO npeYBeJIH'IHBaTb CBOIO CHJIY HJIH
,ZJ;eMOHCTpHpOB8Tb CBOIO cJIa60cTb.
AKmYUJlU3UPOOUHHbtU CTHJIb ,ZJ;eMOHCTpMPYeT MOTHBHPOBaH-
BhIe, rrpO'IYBCTBOBaHHhIe ,ZJ;OBO,ZJ;bI nOBe,ZJ;emI.H. 'IeJIOBeK npH-
HHMaeT pellIeHH.H CnOKOHUO, 6e3 06H,ZJ;, BbICKa3bIBaHH.:I ,ZJ;eJIa-
IOTCH B ,ZJ;06pOmeJIaTeJIbHOM c}JOpMe, TaKOMY 'IeJIOBeKY MOmHO
BepHTb, OH MOmeT 6bITb rJIa3aMH ('CJIen a;). 3TO BH,ZJ; KOHCT-
PYKTHBHOrO nOBe,ZJ;eHH.H 'IeJIOBeKa.
TOCTb, caMOpaCKpbITHe HBJIHeTCH 06.H3aTeJIbHhIM YCJIOBHeM ,ZJ;JI.H
06m;eHHH H OCym;eCTBJIeHHH pa3JIH'IHbIX TepaneBTH'IeCKHX
npo e,ZJ;YP B npo ecce JIe'IeHH.H.
OTKpbITble B3aHMOOTHOI!IeHHH npe,ZJ;nOJIaralOT npH.HTMe,
cOnepemHBaHHe, yqacme B npo ecce 06m;eHHH. llpHHTHe CPO,ZJ;-
HH npOm;eHHIO: Me,ZJ;cecTpa B3BellIHBaeT nOBe,ZJ;eHHe ,ZJ;Pyroro
'IeJIOBeKa, npHHHMaeT BO BHHMaHHe nOJIOjltHTeJIbHhIe H OTpH-
aTeJIbHble c}JaItTOphI 3TOrO nOBe,ZJ;eHHH, C03H8TeJIbHO He npH-
,ZJ;aeT 3Ha'IeHH.H OTpH aTeJIbHbIM c}JIlKTOplL"\i, 8 Ha nOJIOmHTeJIb-
HhIe c}JllItTOphI nOBe,ZJ;eHHH, cnoc06CTBYIOm;He p83BHTHIO CTpeM-
JIeHH.H It 3,ZJ;OpOBblO, 3aOCTpHeT BHHMaHMe, HO He HaBH3hIBaeT .
eMY HanpaBJIeHMH, B KOTOpbIX OHM p;OJImHbI pa3BHBaTbCH;
BMecTO 3TOro OHa n03BOJIHeT c06ece,ZJ;HHKY onpe,ZJ;eJIHTb xapaK-
Tep 06m;eHHH, pe8It 1I1O H Bce, 'ITO HMeeT 3Ha'IeHHe ,ZJ;JIH Ta-
IWH peaK HH. llpHHMMa.H n8 HCHTa, ceCTpa K8K 6hI n03BOJI.H-
eT eMY npHHHTb CIL"\ioro ce6.H.
OTKpbIThIe B3aHMOOTHOllIeHHH npep;nOJIaraWT n conepe-
mHBaHHe, T.e. cnoc06HOCTb TO'IHO BocnpHHIiMaTb BHYTpeH-
Hee COCTOHHHe ,ZJ;Pyroro 'IeJIOBeKa, ero eHHOCTHYIO opHeHTa-
W'f1O.
ConepemHBarom;aH ceCTpa .HBJI.HeTCH OTpameHHeM na HeH-
Ta, ,ZJ;eMOllCTpHPY.H 'IYBCTBO npMCYTCTBH.H.
B aTMoc<pepe B3aHMonOHHMaHHH nll1l;HeHTY JIe1"le HIlI1:TH
ce6H, HaHTH HOBbIe eHHOCTH B npo ecce a,ZJ;anTa HH, 60JIee
npaBHJIbHble H nOJIOmHTeJIbHble.
HCKpeHHocmb .HBJIJIeTC.H He06xo,ZJ;IiMhIM YCJIOBHeM ,ZJ;JI.H YC-
TaHOBJIeHH.H p;OBepHTeJIbHhIX OTHOIlleHHiL HCKpeHHOCTb 03-
Ha'iaeT, 'ITO 06m;eHHe rapMOHH'IHO. HCKpeHHHH HJIH rapMO-
HH'IHbIM 'IeJIOBeK - aTO TOT, KTO nOHHMaeT CBOH BHYTpeHHHe
'IYBCTBa H MbICJIH H npaBHJIbHO HX BblpamaeT, KaIt CJIOBeCHO,
TaK H B HHOH c}JopMe.
RCKpeHHOCTb cnoc06cTByeT B03HHKHOBeHHIO H nO,l\,ZJ;epma-
HHIO p;OBepH.H K caMOMY ce6e, a TaItme Mem,ZJ;Y C060H H ,ZJ;PyrH-
MH, nepepaCTalOm;eMY B cB060,ZJ;Hoe H OTKphIToe 06m;eHHe.
YOU:JICeHue nO,ZJ;pa3YMeBaeT TenJIOTY, pacrrOJIOmeHHe H npH-
.HTHe ,ZJ;Pyroro 'IeJIOBeKa ItllK ,ZJ;OCTOHHYIO JIH'IHOCTb, HeB3HpaH
Ha ee He,ZJ;OCT8TKH. Om;ym;eHHe Toro, 'ITO Te6H YBamIlIOT, He-
06XO,ZJ;HMO ,ZJ;JIH pa3BHTHH H nop;p;epmaHHH 3,ZJ;OpOBbH.
MaCTepCTBO 06lqeHHSI Me,qceCTpbl
1.. EOMnOHeHTLI, cnocoGCTBY10m;lle )'MeHHIO CJIyuIaTb H
TIOlIlIM8Tb.
Y'tucmue. RCTHHHoe 3H8'IeHlie yqacTIIH - aTO BHHMaHHe K
'IYBCTBIL"\i ,ZJ;Pyroro QeJIOBeI<8, npH.HTHe, HIITepec. YqaCTH.H
HeJIb3H ,ZJ;06HTbC.H cpa3Y, ,ZJ;JIH ero pa3BHTHH Tpc6YeTCH BpCMH.
YJlleHue CJlywumb 03Ha'iaeT OTltphITOCTb MHPY, MbICJIHM H
'IYBCTBIL"\i ,ZJ;PyrHx JIIO,ZJ;eH, OTKphITO BblpameHHbIM HJIH nO,ZJ;pa-
3YMeBaeMhIM. 3TO aKTHBHble, C03UaTeJII,HhIe YCHJIHH no c}Jop-
MHpOBaHlI1O yqacTHH, 8 He npOCToe naCCHBHoe BocnpHHTMe.
AJIH nOHHMaHIiH CMhICJIa npOH3HOCHMbIX C.lIOB 'l'pe6YIOTCH
cocpe,ZJ;OTO'IeHHOCTb, OTCYTCTBHe npe,ZJ;y6emp;eHUOCTH, 3aHHTe-
peCOBaHHOCTb. llOHHMaHHe ,ZJ;Pyroro 'IeJIOBeKa BItJIIO'IaeT no-
HHMaHHe ero TO'IKH 3peHHH.
CocpeiJomO'tumb 6HUJl1.UnUe - 3Ha'IHT nO,ZJ;aBIiTb c06CTBeH-
HhIe npe,ZJ;paCCY,ZJ;Kll, npep;yoeml\eHHH, 'IYBCTBO 03a60'IeHHOCTH
H JII06ble HHhIe BuyTpeHHHe HJIH BHellIHHe c}JaKTOphI.
Me,ZJ;ceCTpa, YMelOm;aH CJIYllIaTb, JIe1"le paCn03HaeT nOTpe6-
HOCTH na HeHTa, He TOJIbIW CJIhIllIHT TO, '!TO roBOpHT na H-
eHT, HO H 06pam;aeT BHHMaHHe Ha nOBTOpHIOm;HeCH «TeNfhI;) B
BbICKa3bIBaHHHX naW'feHTa.
npOR6JleHUe 6ecnOKOUClnOU 0 ,ZJ;PyroM 'IeJIOBeIte 03Ha'meT
OKa3aHHe nOMOm;H H CO,ZJ;eHCTBHe B C8MOpeaJIH3a HH. 06m;e-
HHe Me:JK,/\Y Mep;CCCTpOH H nIl1l;HeHTOM, a TaKme Bcex, KTO yqa-
cTByeT B ceCTpHHCKOM npo ecce, ,ZJ;OJImHO BKJIIO'I8Tb nOHHMa-
HHe,TepnCHHe,'IeCTHOCTb, HCKpeHHOCTb,,ZJ;oBepHe, Ha,ZJ;em,ZJ;Y
H MYmecTBO.
Oml<pbtmOCmb - aTO pacKpbITHe CBoero BUYTpeHHero (.H;)
,ZJ;pyroMY 'IeJIOBeKY; OHO npe,ZJ;rIOJIaraeT B3aHMHOCTb. OTKPbI-
52
53
Bee I<OMnOHeHTbI a<P<PeKTHBHoH KOMMyHHKarQiH C03,ZJ;aIOT 6JIa-
rOnpH.1ITHyro aTMOC(pepy ,ZJ;JI.1I nOHHMaHU.1I. OHH CJIY>KaT OCHo-
BOH ,ZJ;JI.1I YMeHU.1I CJIYIIIaTb U nOHUMaTb.
3Ha.1l 3TU KOMnOHeHThI, Me,ZJ;cecTpa CMO>KeT nOH.1ITb pH,ZJ;
BIi>KHbIX acneKTOB ceCTpUHCKoro 06IQeHu.!I, I<OTopble He06xo-
,ZJ;UMO y<!UThIBaTb ,ZJ;JIH C03,l1;aHH.1I COOTBeTCTBYIOIQUX YCJIOBH.H
npOBe,ZJ;eHUH ceCTpHHCKOro npo ecca. OHU nOMorYT naqueHTY
,ZJ;OBepHTb ceCTpe '1aCTHYIO HHIPOpMa HIO.
11. Conepe>KHBaHTe. IIocTaBI>Te ce6.11 Ha MeCTO ,ZJ;Pyroro '1eJIO-
BeKa, '1T06bI nOHHTb ero nOCTYIIKH. 3T0 nOMO>KeT BaM YBH-
. ,ZJ;eTb MUP TaKHM, KaKUM ero BU,ZJ;HT OM.
06ll\He npHHlJ;UllbI }'MeHH.1I 3 4>eKTHBHO CJIyruaTb
1. IIepecTaHbTe rOBopHTb, cocpe,ZJ;OTO'lbTe BHUMaHue Ha na-
ueHTe, He npephIBaHTe ero.
2. 'YcTpaHuTe OTBJIeI<alOm;ue IPaKTophI: OTBJIeI<aTb MOryT Te-
JIeIPOHHhIe 3BOHKH, ,ZJ;pyrne JIIO,ZJ;H, IIIYM.
3. CMoTpHTe Ha rOBOp.1lIQero. }:(aHTe '1eJIOBeI<Y nQIIHTb, '1TO
Bac UHTepecyeT TO, '1TO OH rOBopHT. BY,ZJ;bTe MaI<CHMaJIbHO
BHUMaTeJIbHbI U npOHBJIHHTe yqacTue.
4. CTapaHTecb YJIOBHTb OCHOBHYIO H,l\elO. 'Y.IIOBHTe TeMY 6ece-
,ZJ;bI, a He ee ,ZJ;eTaJIH.
5. BCJIYIIIuBaHTeCb, KaK nO,l\aeTCH CYTb. 06paTuTe BHUMaHHe
H Ha TO, KaK rOBopUTCH. O eHUTe 3MOJ.{UOHaJIbHhIe peaK-
UU H '1YBCTBa. CnpocuTe ce6H, I<aK ::!TOT '1eJIOBeK BocnpH-
HUMaeT CUTYa lflO.
6. OT,ZJ;eJI.1IHTe '1eJIOBeKa OT H,ZJ;eu. MbI 60JIee nOJIO>KUTeJIbHO
pearupyeM Ha MhICJIH JIIO,ZJ;eH, KOTOphIX JII06HM, '1eM Tex, K
I<OMY PaBHO,ZJ;YIIIHbI. CTapaii:Tecb npaBUJIbHO BocnpHHHMaTb
TO, '1TO roBOpUTCH.
7. 'Y JIOBUTe TO, 0 '1eM na ueHT u36eraeT rOBopHTb. CnpoCHTe
ce6H, He onYCTHJI JIU 3TOT na HeHT B CBoeM paCCKa3e I<a-
KYIO-Hu6Y,ZJ;b CYIQeCTBeHHYIO '1aCTb, cKphIBaeT JIH na H(mT
CBOU 'lyBcTBa UJlli '1e.n:OBeKa, KOTOpbIM urpaeT Ba>KuyIO pOJIb
B ero >KU3HU.
8. OT,ZJ;eJIHTe 3MO Ui'! OT peaI<l{HH. M36eraMTe rneBa U ne'laJIU,
CHJIbHbIX 3Mo uH, KOTophIe MOryT MeIIIaTb BHUMaTeJIbHO
CJIYIIIaTb H nOHUMaTb.
9. BY,ZJ;bTe OCTOpO>KHbI C UHTepnpeTa H.fIMu. He CY,ZJ;UTe H He
npe,ZJ;noJIarai-iTe nocneIIIHO. CTapaihecb YJIOBHTb IPaKTbI.
10. 'YBa>KaHTe na ueHTa Kar, '1eJIOBeI<a. IIpoHBJIHHTe HCKpeH-
Hee YBa>KeHUe, UHTepec U 3a60TY.
Cl>aKTopbl, cnoc06cTBYlOtQMe o6U1eHHIO
OKa3bIBIl.1I nOMO na HeHTaM, Me,ZJ;cecTpe He06xo,ZJ;uMO HC-
nOJIb30BaTb eJIbIH apCeHaJI JIU'IHhIX Ka'leCTB U HaBhIKOB,
npHeMOB U MeTO,ZJ;OB 06m;eHH.1I ,ZJ;JI.1I YCTaHOBJIeHUH ,ZJ;OBepUH C
naqueHToM H '1JIeHaMH ero ceMbU C eJIblO nOUCKa 3IP(peKTHB-
Horo peIIIeHUH np06.lIeM na ueHTa.
3TU JIU'IHble I<a'leCTBa 3Ha'lUTeJIbHO 06JIeI"lalOT 06IQeHUe II
peIIIeHue np06JIeM na ueHTa.
Ie JIU'IlibIM Ka'lecTBaJ\>I Me,ZJ;ceCTphI, OKa3hIBaIOIQeH nOMOIQb,
OTHOC.!ITc.1I:conepe>KuBaHHe,ucKpeHHocTb,npoHBJIeHue3a60-
ThI, YBIDKeHHH.
06ml,ll;a.1l 3TUMH Ka'IeCTBaMU, Me,ZJ;ceCTpa ,ZJ;OJI>KHa YCTaHO-
BUTb ,ZJ;OBepHTeJIbHbIe B3/lHMOOTHOIIIeHHH. K HHM OTHOCHTCH:
eJIeHanpaBJIeHHaH 6ece,l\a, ,ZJ;OBepue U I<OHTaKT, C03,ZJ;aHue YC-
JIOBHH jJ,1IH Ca.TI10BhIpa>KeHH.1I.
IJ;eJIeHanpaBJIeHHa.1l 6ece,ZJ;a opHeHTupOBaHa Ha npe,ZJ;eJIeH-
HYIO eJIb. OHa C'IUTaeTCH KpHTepHeM YMeJIOrO 06m;eHuH, no-
MoraeT naqueHTY OCB060,ZJ;uTbcH OT I1anpH>KeHH.1I H BOJIHeHU.1I.
'YCJIOBUH, C03,ZJ;aBaeMbIe Me,ZJ;ceCTpoii, 06ecne'luBaIOT KOHIPH,lI;eH-
HaJIbHOCTb H C03,ZJ;aIOT om;ym;eHHe nO,l\,ZJ;ep>KKU.
}:(OBepue U I<OHTaKT - aTO O'leHL Ba:;KHhIe 3JIeMeHThI. OHH
B03HUI<aIOT, eCJIU na ueHT y6e>K,ZJ;eH B HCKpeHHOCTH HaMepe-
HUH Me,ZJ;ceCTpbI, ee TenJIOM U Henpe,ZJ;B3HToM OTHOIIIeHUH K
HeMY. C ,ZJ;oBepueM CBH3aHa KOHIPu,ZJ;eH UaJIbHoCTb.
C03,ZJ;aHue YCJIOBJIIH ,ZJ;JI.1I caMOBhIpa>KeIluH: Me,ZJ;cecTpa C no-
MOIQblO u;e.n:eHanpaBJIeHHoH 6ece,ZJ;hI npe,ZJ;oCTaBJIHeT naqueHTY
B03MO>KHOCTb CIL"\iOBblpa>KeHuH. He06xo,ZJ;HMo c03,ZJ;aTb TaKHe
'CJIOBU.1I, KOTopble n03BOJIHT naqueJITy MhICJIUTb, 'lyBCTBoBaTb
UJIU peIIIaTb CBOU np06JIeMbI KaK 6bI CIL"\iOCToHTe.lIbHO, nOMO'lb
na lfeHTY BhIpa:mTb ce6H H COXPaHHTb HHH uaTuBY.
K IPaKTOpaM, cnoc06CTBYIOIQUM 06m;eHHIO, OTHOCHTCH II:
HaBhIKH no OKa3aHUIO nOMOm;H, KOTophIe MorYT nOMO'lb na-
HeHTY pa306paTbCH B CBOUX np06JIeMax II: paCCKa3aTb 0
HHX.
54
55
PaCCMOTpUM mrn60JIee cy eCTBeHHI,le U3 HUX:
· HaBhIKU 06 eHUS!;
· HaBI,IKU pearUpOBaHUS! U nOCTaHOBKU BOnpOCOB;
· HaBhIKU IIJIaHUpOBaHUS! l1:e.neH;
· HaBhIKU MO,ZJ;eJIUpOBaHUS!, ,ZJ;eMOHCTpal1:UU C l1:eJII,IO 06y-
'1eHUS! nal1:UeHTa;
· IWHCYJII,TUpOBaHUe, npSI{TU'IecKue 3aHS!TUS! C l1:eJII,IO
OBJIa,v;eHUS! HOBI,IMU HSBhIKIlMU.
K ,ZJ;PyrnM nOJIe3HhIM HaBI,IKIlM, IWTOphIe nOMOrYT nal1:UeH-
11' pa306paTbCS! B CBOUX np06JIeMaX U paCCI<a3aTI, 0 HUX OT-
HOCS!TCS! HaBhIKU:
· IWHc}JpOHTal1:US! (HanpUMep, IWr,ZJ;a n8.l1:UeHT ,ZJ;YMaeT, '1TO
OH HUKOMY He HY>KeH, S Me,ZJ;ceCTpa, YCTaHOBUB XOpO-
llIue OTHOllieHUS! C pO,ZJ;CTBeHIIUKaMU, npOS!BJIS!IO UMU
3a6011' 0 nal1:ueIlTe, y6e>K,ZJ;aeT nal1:ueIlTa B 06paTHOM);
· nO,l\,ZJ;ep>KI<a (I1anpUMep, CepI,e3I1hIe np06JIeMI,I, OCJIO>K-
I1UBIlIMe COCTOS!Hue nSl1:UeIlTa, HO, Iwr,ZJ;a OIl y6e>K,l\aeT-
CS!, 'ITO BUHI,I Bpa'la B STOM HeT, ero '1YBCTBa MorYT
npUHTU B nOJIHOe CMS!TeHUe, U 3,l\eCI, O'leHI, Ba>KHYIO
pOJII, urpaeT Me,ZJ;ceCTpa, npOS!BJIS!IO aS! conepe>KUBa-
Hue, nOHUMaHUe U nO,ZJ;,ZJ;ep>KKY);
· MOJI'IaHUe (HanpUMep, CMepTI, 6JIU3KOrO '1eJIOBeKa BI,I-
3hIBaeT Y nal1:ueHTa CUJII,HI,le 3MOl1:1Ui, CJIe3hI. B 3TOM
CJIYtIae '1aCTO JIY'Illie nOMOJI'IaTI, U npOCTO «6I,ITI, pS!-
,ZJ;OM& C nal1:UeHTOM);
· npUKOCHOBeHue (HanpUMep, 3S,ZJ;ep>KaTI, PYKY Ha nJIe'le
nal1:UeHTa, Iwr,ZJ;a eMY TPY,ZJ;HO, nOl{a3I,IBaS!, '1TO Me,ZJ;cec-
Tpa nOHUMaeT BCIO TPY,ZJ;HOCTI, CU11'al1:UU U 0l<a3hIBaeT
eMY nO,l\,ZJ;ep>KI{Y).
TaKUM 06pa30M, 3C:].Jc}JeKTuBHoe 06 eHue 3aBUCUT OT npo-
c}JeccuOHIlJIU3Mall: JIU'IHI,IX Ka'leCTB U YMeHuM, npueMoB U
MeTO,ZJ;OB 06 eHuS! Me,ZJ;cecTpI,I, IWTopbIe B ceCTpUHCKOM ,ZJ;e.ne
TecHO B3aUMOCBS!3aHI,I.
T.OH cUTyal1:UU, no nOBO,ZJ;Y KOTOpoii Me,ZJ;cecTpa 6ece,ZJ;yeT C na-
l1:UeHTOM. ECJIU COBeT Me,l(ceCTpI,I OTJIU'IaeTCS! OT Toro, KOTO-
phIii XO'leT CJIhIllIaTb nal1:U HT, TO 3TO MO>KeT BhI3BaTI, '1YB-
CTBO npOTUBOpe'lUS! Y Hero.
l103TOMY, eCJIU nal1:ueHTY XO'leTCS! YCJIhIllIaTb COBeT Me,ZJ;ce-
CTpI,I, cnpOCUTe Y Hero: .qTO 6hI BhI XOTeJIH YCJII,IllIaTI,?
}:(aBaiiTe norOBopUM 06 3TOM n060JII,llIe&.
2. Pe3KaS! CMeHa npe,l\MeTa pa3rOBOps MO>KeT npepBaTI,
HUTI, B3/lUMOnOHUMaHUS!. PeKoMeH,ZJ;YeTcS! ,ZJ;eJIaTb '1aCTble nay-
3I,I BO BpeMS! pa3rOBopa C UCnOJIb30BaHueM nepeXO,ZJ;HI,IX c}Jpa3.
Hs c}JoHe OTBeTOB U penJIUK B03HI1KHeT B03MO>KHOCTI, ,ZJ;.IIS! 06-
,DyMhIBaIUlS!.
3. 3aIl1:UTa JIIO,ZJ;eH, KOTOpI,IX KpuTuKyeT nSl1:ueHT. Y nal1:U-
eHTa B03HUKHeT npe,ZJ;nOJIO>KeHUe, '1TO Me,ZJ;ceCTpa oCY>K,l\aeT
ero, II: 3TO 6Y,ZJ;eT npenS!TCTBOBaTI, ,ZJ;IlJII,HeiillIeMY BhIpa>KeHUIO
'1YBCTB BO BpeMS! 6ece,ZJ;I,I.
4. llpeYMeHI,llIeHue 'lYBCTB nal1:ueHTa. II8.l1:ueHT, BhIpll>KllJI
03a60'leIlHOCTI" >K,l(eT OT Me,l(ceCTphI nOHUMaHUS! U CO'lYBCTBUS!.
He HaCTaUBaHTe Ha TOM, '1TO HU'IerO CTpalliHoro He CJIY'IU-
JIOCI" He CTOUT 6ecnOKOUTI,CS!. TaKue penJIUKU ,ZJ;eMOHCTpUpy-
lOT OTCYTCTBue nOHUMaHUS! UJIU CO'lYBCTBUS!.
5. 06eIl1:aHuS! nal1:ueH11'. rOBOpS!: «Bce 6Y,ZJ;eT XOPOIlIO&,
Me,l\CeCTpa OTpUl1:aeT pellJII,HOCTb CU11'al1:Uu, B KOTOpOH Haxo-
,l\HTCS! BMeCTe C nal1:UeHTOM, 3aCTaBJIS!eT nal1:ueHTa npS!TaTI,
CTpax U 6ecnoKoiicTBO, IWTopI,le S!BJIS!IOTCS! 06hI'IHhIMU '1eJIO-
Be'leCKUMU peaKl1:US!Mli U Tpe6YlOT cecTpuHcKoro BMemaTeJII,-
CTBa.
6. llocnellIHhIe 3aKJIIO'IeHUS! MOryT BI,I3BaTI, npOTUBO,l\eii-
CTBue co CTOpOHI,I nal1:ueHTa. BY,ZJ;I,Te MY,ZJ;phIMU, npOBepI,Te
c}JaKTI,I. HanpuMep, He npe,ZJ;noJIaraiiTe, '1TO '1eJIOBeK, CTpa,v;a-
IO UH 3JIOl{a'IeCTBeHHOH onYXOJII,IO, aBTOMaTU'IeCKU CorJIa-
CUTCS! Ha ee onepaTUBHoe Y,ZJ;aJIeHHe.
7. KYJII,TYPHhIe OTJIU'IUS!: S!3I,IK, HOpMI,I 06 eHuS!. Pa3JIU-
'1HS! KYJII,11'P BJIUS!lOT Ha TO, I<aK MOryT 6I,ITb nOHS!TI,I Bep-
6aJII,IlI,le U HeBep61lJII,HhIe cpe,ZJ;CTBa 06Il1:eHuS!. HanpuMep,
S!nOHl1:I,I BhIpa>KalOT pa,n;OCTI" IlIUpOKO paCI{phIB rJIa3a. B CJIa-
BS!HCIWH KYJII,Type 3TO BI,lpa>KaeT '1YBCTBO cTpaxa. KYJII,Typa
BJIuS!eT H Ha nOBepI,s!, nOBe,ZJ;eHue, CBS!3SHHI,Ie CO 3,l\OpOBI,eM:
MaruS!, PUTYIlJII,I, ynoTpe6JIeHUe onpe,l\eJIeHHOii nu u. llo-
Cl>aKTopbl, npenSlTCTBYIO Me o6 eHMIO
1. COBeThI nal1:ueH11' UJIH BI,lCKa3I,IBaHue CBoero MHeHUH
Me,ZJ;cecTpoti MOryT OTpUl1:aTeJII,HO nOBJIUS!TI, Ha npUIIS!Tue pe-
llIeHUS! naJ.{ueHTOM. qacTo naJ.{ueHTI,I 3HaIOT, '1TO ,ZJ;eJIalOT B
56
57
STOMY B8)KlIO onpep;enHTb 3THH'IeCKYIO OpHeHTa HIO '1eJIOBeKa
H paCCnpOCHTb ero 06 y6e.iKp;eHHHX, 06pa3e .iKH3HH.
8. CTHnH 06m;eHHH. Ha cnOBeCHoe H 6eCCJIOBeCHOe 06m;e-
HHe BnHHeT KYJIbTypa H BocnHTaHHe, Tpap;H HH H HopMbr.
"tlT06bI ap;anTHpoBaTbcH K CTHnlO 6ecep;bI, He06xop;HMO npH-
HHMaTb BO BHHMaHue KynbTypHble oc06eHIIoCTH Hal\HH. Ha-
npnMep, npHKOCHOBeHHe -B HeKOTopbIX KynbTypax HBnHeTCH
npOHBneHHeM BHHMaHHH, p;pyrHe C'IHTa1OT npHKOClIOBeHHH
ceKCyanbllbIMH -llpOHBJIeHHHMH.
9. Pa3JIH'IHH B B03pacre. B03pacT '1eJIOBeKa MO.iKeT BnH-
HTb Ha cnoc06 Bep;eHHH 6ece.zu,I, oc06eHHo eCJIH Me.iKp;y c06e-
cep;HHKaMH HMelOTCH 60nbIlIHe pa3nH'IHH B B03paCTe. .D:nH
pe6eHKa p;o 6 neT 06bI'IHO He06xop;HMa 6ecep;a C pop;HTenHMH
HnH OlleKYHOM, XOTH y<lHTbIBaeTCH H nOBep;eHHe caMoro pe-
6ellKa. "tlacTO pop;HTenH CqHTalOT ce6H BHIIOBaTbIMH B Hapy-
meHHHX COCTOHHHH 3P;OpOBbH p;eTeH. B TaKHX cnyqamc: HY.iK-
HO npHMeHHTb HeOCY>Kp;alOm;He BonpoCbI, qT06bI nonyqHTb
HY.iKHble CBep;eHHH. HanpHMep, BonpOCbI THna «Korp;a BbI 3a-
MeTHnH nepBble npH3HaKH nOBbUlIeHIU! TeMnepaTypbI?» 60-
nee nop;xop;HT, qeM TaROH Bonpoc: dIo'leMY BbI He p;OCTaBH-
nH ere B 60nbHH y paHbwe?» IIpoHBnHHTe COqYBCTBHe pO,D;H-
renHM H 0I(a3bIBaHTe TeM CaMblllt'HM nOAAep.iKKY H YTeweHHe.
C p;eTbMH CTapwe 6 neT 6eCe,AyIOT Henocpep;CTBeHHO. Mrpa H
PHCYHlW HBJI.!lIOTCH aJIbrepHaTHBHbIMH cpep;CTBaMH n().)'l)"leHHH
HHq:.opMa H. He 06pau\aHTeCb C HHMH KaK C MaJIbIWaMH, He
rOBopHre CBbICOKa. BeCe,AyHTe C HHMH TaR .iKe, KB.K H CO B3poC-
JIbIMH. EcnH npHCyTCTBYIOT pop;HTenH, Ha6nlOp;aHTe 3a BHYT-
pHceMeHHblMH OTHOWeHHHMH. Ec.r.rn pop;HTenH P;OMHHHpyroT B
pa3reBope H HHCTPYKTHPYIOT pe6eHKa, KB.K eMY Hap;O OTBe-
'1aTb, Mep;ceCTpa MO.iKeT 06pam;aTbCH npHMO K pe6eIIKY C IWM-
MeHTapUHMH THna «Tenepb H 6bI xorena YC.ilbIWaTb, KaR TbI
'1YBCTByewb ce6H B 3TOH CHTYal\HH?» MCnOJIb3YHTe STOT npH-
eM H npH 6ecep;e C nO.iKHJIbIM qenOBeKOM. He06xop;HMO BbIHC-
HHTb, HeT nH Y Hero npo6neM co CJIYXOM. M36eraHTe llOBbI-
waTb rOJIOC, p;a.iKe ecnH Y na lleHTa np06neMbI co cnyxoM.
I'poMKHe CJIOBa MOryr 6bITb pa3J\ProKa1Om;HMH H p;a.iKe 06HP;-
HbIMH.
Y nO;){(HJIbIX nlOp;eH C nOTepeH cJIyxa 06blqIIO He BocnpHHH-
MalOTCH 3BYKH BbICOIWH TOHaJIbHOCTll, H nOBbIweHHe Bawero
rOJIOca 06blqHO nOBblwaeT BbICOTY 3BYlta. Y6ep;HTeCb nepep;
HaqaJIOM 6ecep;bI, qTO Y n HeHTa HeT np06neM co C.rryXOM.
EcnH na HeHT nnoxo cnbIlliHT, TO CHJJ;bTe HanpOTHB na HeH-
Ta, rOBopHTe Mep;neHHO H qHCTO, 3TO nOMO.iKeT 06nel"lHTb
06m;eHHe C HHM, B03MO.iKHO, OH MO.iKeT qHTaTb no ry6aM.
J1y<1WHe B3aHMOOTHOweHHH 06eCne'laT BaM xopowee OCBe-
m;eHHe, OTCyTCTBHe nOCTOpOHHHX 3ByKO (pap;HO, TeJIeBH30p).
.D:JIH 6ecep;bI C nomHnbIMH nIOp;bMH OJ\Hon 6ecep;bI HeJ\OCTaTOq-
HO - yp;enHHTe HM 60nblIIe BpeMeHH. "tlacTO nO.iKHnble nlOp;H
He p;orOBapHBalOT, C'IHTa:iOT, qTO HeKOTopbIe CHMnTOMbI HB-
nHIOTC.H B03paCTHbIMH oc06eHHOCTHMH, He HMelOm;HMH 60JIb-
woro 3HaqeHHH. YCTaHoBneHHe p;oBepHH, B3aHMonoHHMaHHH,
YBa.iKeHHe B03pacTa - ep;HHCTBeHHbIH nYTb K npeop;oneHHIO
npenHTCTBHH B 06m;eHHH. OP;HH H3 3q:.q:.eKTHBHbIX cnoco60B
YCTaHoBHTb B3aHMonOHHMaHHe C nO.iKHnbiM '1enOBeKOM - 3TO
p;aTb B03MO.iKHOCTb BcnOMHHTb npOWJIble P;IlH H CBOH 6bIBwHe
3ac.rryrH.
KpMTepMM 3c1>cI>eKTMBHOCTM o6aqeHMSI
YcnewHoMY 06m;eHHIO nOMoraeT 3MnaTIIH - cnoc06HoCTb
nOHHMaTb H 'IyBcTBoBaTb 3MO HOHaJIbHOe COCTOHHlle P;Pyroro
'IenOBeKa, cOnepe.iKHBaTb eMY. 3MnaTHH - npoTHBOnOnO.iK-
HOCTb paBHoP;ywHIO H roueHTpH'IHOCTH. YpoBeHb ::MnaTHH
3aBHCHT OT HaCJIep;CTBeHHocTH, BocnHTaHHH, YCJIOBHH .iKH3HH
H MO.iKeT 3Ha'lHTenbHO nOBblweH npH eneHanpaBneHHoH pa-
60Te Hap; C060H.
Hanny<lWaH CTparerHH J\enOBOH 6ece.zu,I - 3TO nonO.iKH-
TeJIbHaa, 3aHHTepeCOBaHHaa, YBa.iKHrenbHaH yCTaHOBKa. Bonb-
wyIO ponb HrpalOT CaMble nepBble npOH3HOCHMble cnOBa. :/Ke-
naTeJlbHO Y3HaTb HM.H n OT'IeCTBO Bawero c06ecep;HHKa P;O
pa3rOBopa C HHM. EcnH 3Toro HeB03MomHO Cp;eJIaTb, He06xo-
P;HMO npHMO cnpOCHTb ere.. IIocTapaHTecb He 3a6bITb ero nMH
H OT'IeCTBO. IIoMHHre, 'ITO caMbIH .iKeJIaHHbIH jJ,nH 'IeJIOBeKa
3BYK - 3TO 3BYK ero c06cTBeHHoro HMeHH, ero npaBHnbHoe
(6e3 HCKa.iKeHHH) ynoTpe6neHHe B Ha'laJIe H B xOJ\e pa3roBopa!
3anoMHHTe caMble BamHbIe jJ,aHHbIe 0 c06ecep;HIIKe, B03-
MO.iKHO, H3 Me,D;HUHIICKOH J\oKyMeHTaUHH, a 3aTeM 6YJ\ere CCbI-
naTbCH Ha HHX B xOJ\e 6ecep;bI.
58
59
Ha'umaiiTe 6ece,D;Y C TaK Ha3bIBaelllOrO «BbI - nO,l\xo,D;a.).
nonbITaiheCb nOCTaBHTh Ce6H Ha MeCTO C06eCe,D;HHKa, Illpe,D;-
CTaBHTh ce6e ero HHTepeCbI. 3TO OTpa3HTCH Ha CO,l\epmaHHH H
q:.opMe BaWHX BbICKa3bIBaHH.H. CpaBHHTe, HanpHMep:
.H 6bI XOTena... BbI XOTHTe...
MewI HHTepecyeT... :?To ,D;onmHo 6bITb J1,JIH Bac
HHTepeClIO...
.H c.nenana BbIBO,D;I.I, BaM 6Y,D;eT HHTepeCHO Y3HaTh...
'ITO....
BI.I6epHTe onpe,D;eneHHI.I.H CTHnb Be,l\eHHH 6eCe,l\bI: BI.ICOTY
TOlla, TeM6p, rpOMKOCTI., J1,JIHTenbHOCTI., 'IaCTOTY naY3, CKO-
pOCTI., HanH'IHe H XapaKTep naY3, meCTOB, HHTOHa 1O H T.
n. HeCOOTBeTCTBHe CTHnH 6eCe,D;I.I MomeT npHBeCTH K oTKa3y
co6ece,D;HHKa yqaCTBOBaTI. B pa3rOBope. AHanH3Hpyi1Te npH-
'IHHbI H3MeHeHHH nOBe,l\eHHH C06eCe,D;HHKa, nO.HMHTe npHtlH-
HbI TPY,D;HOCTe.H, no B03MomHOCTH, KOHltpeTHO onpe,l\enHTe
CTHneBble H ,D;pyrHe paccornaCOBaHHH. McnonI.3Y.HTe ,D;nH ,l\H-
arHOCTHKll cHTya HH Hepe'IeBoe (HeBep6anI.Hoe) nOBe,D;eHHe H
BbIpameHlle qYBCTB, KOTOpble 'IaCTO OKa3blBalOTCH npaB,l\HBee
cnOB. IIonomHTenI.Hble 3MO HH nlO,D;H He CKpI.IBalOT H 31'0 BI.I
onpe,l\enHTe no BI.lpaJiteHHIO nH a. KOHeqHq, MHMIIKY MomHO
C03HaTenbHo KOHTpOnHpOBaTI., Olla 3aBHCHT 01' HaI.\HoHanbHI.IX
H KynI.TypHI.IX CTepeOTHnoB. 3TO npe,D;CTaBnHeT 3HaqHTenI.-
HbIe TPY,l\HOCTH. rOpa3,l\0 60nee «npaB,l\HBbIMH» oKa3bIBalOTCH
MHorHe ,D;pyrHe HepeqeBble 3HaKH: n03a, :>ItecTbl, B3aHMHoe
pac?:onomeHHe, paCCToHHHe Mem.v;y C06eCe,D;HHKaMH, 3pHTenb-
HbIH KOHTaKT H ,D;p.
3q,q:.eKTHBHOCTb 06.w;eHHH 3aBliCHT H 01' YCJIOBH.H 6eCe,D;bI -
MeCTa, Bpel\1H, HanH'IHe nOMex ( WYM, HanHqHe nOCTOpOH-
HHX, 6eCnOpH,D;OK B KOMHaTe H T. ,D;.). CTOHT nOMHHTI., '11'0
THmeno 6onI.HO.H 'IenOBeK He MomeT cnywaTI. nO-HaCTOHll.{e-
MY BHHMaTenI.HO, B TaKOi1 cHTya HH 06m;eHHe CTaHOBHTCH
q:.opManI.HbIM H He 3I:prpeKTHBHbII\I. KpOMe Toro, He06xo,l\HMO
nOMHHTI., 'ITO 'IenOBeK CKJIOHeH He cnbIwaTI. Toro, '11'0 eMY
HenpHHTHO HnH HHTepnpernpoBaTh 31'0 B 60nee 6naronpHHT-
HOM ,D;nH ce6H CMbIcne.
TaKHM 06p8.301\I, MomHO C,D;enaTI. BI.IBO,l\I.I, 'ITO Bna.neHHe
TeXHHKO.H npmpeCCllOHanbHoro 06m;eHHH MmKeT cnymHTI. siP-
q:.eKTHBHbIM Cpe,D;CTBOM nOMOm;H nlO,D;HM B a,D;anTa HH K mH3-
HH B CBH3H C H3MeHeHHHMH B COCTOHHHH HX 3,D;OpOBbH.
;zI;eCHTb «;zI;a» TepaneBTH'IeCKOrO 06.w;eHHH
1. 06pam;ai1TeCb K na HeHTY no HMeHH - OT'IecTBYH Ha <,Bbl».
2. Ha'lHHaHTe 6ece,l\y C YKa3aHliH Bawero HMeHH - OT'IeCTBa
H ,D;O;TmHOCTH.
3. CMoTpHTe na HeHTY B rna3a Ha O,l\HOM YPOBHe, ynI.I6a.H-
TecI.; ecnH na HeHT nemHT, npHCH,D;bTe Ha cTyn, CTOHIUH.H
}»I,D;OM.
4. 06eCne'IbTe KOHq:.H,l\ell HanI.HocTI. Bawei1 6eCe,D;bI. IIoMHH-
Te, 'ITO KOHq:.H,D;eH anI.HocTI. HBnHCTCH ycnoBHeM C03,D;a-
HHH ,D;OBepHTenI.HbIX oTHOWeHH.H C na HeHTOM.
5. IIoom;pHihe BonpOCI.I Bawero n HeHTa.
6. rOBOpHTe HeTOpOllJIHBO, ,D;OXO,l\'IHBO, nonI.3Y.HTeCI. HCltnlO-
qHTeJII.HO nOJIOmHTenI.HO.H HHToHa Hei1 Bawero rO;'lOca.
7. C06nlO,D;a.HTe nplIH nbI 3(i)(peltTHBHoro yMeHHH cnywaTI..
8. IIpOHBnH.HTe MaCTepCTBO 06.w;eHHH Me,D;lI HHCKO.H ceCTpI.I C
naI.\HeHTOM.
9. IIpoHBnHiiTe HenpepbIBHYIO HHH llaTHBY B C03,l\aHHH nClI-
XOnOrllqeCKOrO MHKpOKnHMaTa npH 06m;eHHH C na HeH-
TOM.
10. BY,l\I.Te eCTeCTBeHHbI npH pa3roBope, C03,l\a.HTe aTMOC(pepy
B3aHMonOHHMaHHH ,D;OBepHH.
2.3. nompe6Hocmu "lelioBelia
B 3gopoBbe U 60lle3HU
nOHRTMe nOTpe6HocTeM
HopManI.HaH mH3He,l\eHTenI.HOCTI. 'IenOBeKa, KaK CYll.{eCTBa
06wecTBeHHoro, npe,D;CTaBnH'IOll.{erO eJIOCTHYIO, ,D;HHaMll'IeC-
KYIO, caMoperym1:pYIOI1U'IOCH 6HOnOrH'IecKYIO CliCTeMY, 06ec-
nC'IHBaeTCH cOBOKynHocTI.IO 6nonorWIecKHx, nCHxocounaJlI.HbIX
H ,l\YXOBHbIX nOTpe6HOCTei1:. "Y,l\OBJIeTBopeHne 3THX nOTpe6HoC-
Tei1: onpe,D;enHeT pOCT, pa3BHTlle, rapMOHHJO qenOBeKa C OKPy-
malOm;eft cpe,D;O.H.
mH3He,l\eHTenI.HOCTb qenOBeKa 3aBHCHT 01' MHorHX rpaKTO-
POB, KOTOpI.le ynopH,l\OtleHI.I BO BpeMeHH H npOCTpaHCTBe H
nOAAepmHBalOTCH CliCTeMaMH mH3He06ecneqeHHH opraHH3Ma
qenOBeKa B ycnoBHHX oKpymalOm;e.H Cpe,D;bI.
60
61
ITo'l'pe6UOCT.b - aTO OC03HaHLIll nCHXOnOrH'leCKHM HJIH H-
3HOnOrH'IeCKHH .l\e H HT 'lero-nH60, OTplUKeHHbIH B BocnpWl-
THH 'IenOBeKa, KOTOpbIH OR HcnbITbIBaeT Ha npOT.HJKeHIIH BceH
CBoeH JKH3HH. (rnOCCapHH MARro no.l\ pe.l\B.K HeH r.M. ITep-
llm,eBOH).
OCHOBHble reopMM
M KnaCCM4»MKaqMM nOTpe6HOCTeH
ABTopaMH nOTpe6HOCTHO-HH opMa HOHHOH TeopHH, KOTO-
paR 06bRCH.HeT npH'IHHLI H .l\BHJKYII.{He CHnLI nOBe.l\eHIIR '1e-
nOBeKa, RBJIRIOTC.H OTe'IeCTBeHHbIe yqeHbIe CHMOHOB H Ep-
IIIOB. CYII.{bHOCTb TeopHH COCTOHT B TOM, 'ITO nOTpe6HOCTH
n06YJK,lI;RIOTCJl ycnOBH.HMH CYII.{eCTBOBaHHJl opraHH3Ma B no-
CTOJlHHO MeRHIOII.{eMCJl OKPYJKalOm;eH cpeJ\e.
ITepexoJ\ nOTpe6HOCTH B nOCTynKH H .l\eHCTBHJl conpOBO <-
J\aeTCJl 3MO H.HMH.
3MO HH - 3TO HHJ\llI<8TOpbI nOTpe6HOCTeM. OHH MOryT 6L1Tb
nOnOJKHTenbHLIMH H OTpH aTenbHbIMH Ha YJ\OBneTBopeHHe
nOTpe6HOCTeH. CHMOHOB H EPiliOB Bce nOTpe6HOCTH pa3J\enH-
nH Ha TpH rpynnbI:
1 rpynna - BHTanbHbIe (noTpe6HocTh JKHTb H 06eCne'lH-
BaTh CBOIO JKH3Hb).
2 rpynna - CO HanhHLIe (noTpe6HocTh 3aHJlTb onpeJ\eneH-
Hoe MecTO B 06II.{ecTBe)
3 rpymi:a - n03HaBaTeJIbHLIe (noTpe6HocTb n03HaBaTb BHe-
IIIHHH H BHYTpeHHHH MHp).
AMepHKaHcKliH nCHxo H3Honor A.MacJIqy, PYCCKOro npo-
HCXOJKp;eHHJl B 1943 roJ\Y BbIJ\enHn 14 OCHOBHbIX nOTpe6Hoc-
TeM 'IenOBeKa H paCnOnOJKHn HX cor naCHO nJlTH CTyIIeH.HM
(CM. cxeMy).
11. AB..raTbC>l.
10. 1136eraTb
onacHoCTH. 601le3He 1
CTpecCOB
9. &"Tb 3AOPOBblM.
8. nOAAepIK..BaTb
TeMnepal}'PY.
III
COl\..anbHble nOTpe6Hoc-
nt. npIt1HCW,ne)t(HocTb
7. OABBaTbcR,
pa3ABBaTbCR.
6. 6b1Tb ....CTblM.
5. Cnarb,
AblXaTb,
4. BbIABnRTb.
3. n"Tb,
2. ECTb.
1. Ab'WaTb.
II
n0Tpe6HoCT" B HB,!1B>KHQCTM -
6e30naCHOCTb
I
cI>"3HOnOn1YeClO1e OCHOBHble
nOTpe6HOCTM_ Bbl)K BaHIo1S
1. CIIIt3..onOrlt"eCKlte nOTpe6HOCTIt - 3TO Hlt3Wlte, ynpaBnReMble opraHaMIt Tena
nOTpe6HOCTIt, TaKlte KaK AblxaHlte, nltllleBa1I, ceKcyanbHiUI, nOTpe6HoCT B caM03a1llHTe.
II. nOTpe6HOCTIt B HaAeJKHOCTIt - cTpeMneHlte K MaTepltanbHOIt HaAe)/(HOCTIt,
3AoPOBbIO 06ecne"eHItIO cTapOCTIt It T.A.
III. (OI\It nbHb'e nOTpe6HOCTIt - YAoBneTBopeHlte 3TO nOTpe6HOCTIt Heo6beKTltBHO
It TpYAHoonltcyeMo. OAHoro "enOBexa YAoBneTBopRIOT o..eHb HeMHorlte KOHTaKTbl C
APyrltMIt nlOAbMH, B APyroM ..enOBexe 3Ta nOTpe6HOCTb B 06111eHltH Bblpa)/(aeTC1I
O"'CHb CHnbHO.
IV. nOTpe6HoCTb B YBa)/(eHItIt, OC03HaHItlt c06CTBeHHoro AOCTOItHCTBa, - 3Aecb
HAeT pe"b 06 YBa)/(eHItIt, npeCTIt)/(e, COliltanbHOM ycnexe. BpRA nit 3TH nOTpe6HOCTH
YAOBneTBopRIOTC1I OTAenbHblM nltl\OM, AJlR 3TOro Tpe6YlOTCB rpynnbl.
V. nOTpe6HOCTb B pa3BltTltH nlt"HOCTIt, e OCYllleCTBneHHIt caMoro ce6R, B
caMopeanH3al\ltH, caMoaxTyanlt3al\HIt, B OCMblCneHlt1t CBoero Ha3Ha"eHItB B Mltpe.
epapx S! nOTpe6HOCTe (CTyneH pa3B"T"J1) no A. Macnoy
C HOC'l'.b TeopHH nOTpe6HOCTeH A. MaCJIoy.
XapaKTCpIIC'l'HKH OCHOBHbIX nOTpe6HocTeH 1fe,1IOBeKa
mH3Hh, 3J\opOBbe, C'IaCTbe, 'IenOBeKa 3a.BHCHT OT YJ\OBJIeT-
BOpeHHJl nOTpe6poCTeH B nHm;e, B03J\yxe, CHe H T,J\. 3TH no-
Tpe6HOCTH 'lenOBeK caMOCTOJlTenbHo YJ\OBneTBOp.HeT Ha npo-
T.HJKeHHH Bcen JKH3HH. 06eCne'IHBalOTCJl OHH YHKD;HeH pa3-
nH'IHLIX opraHoB H CHCTeM opraHH3Ma. 3a60neBaHHe BLI3bI-
Ba.H HapYIIIeHHe YHK HH Toro HnH HHoro opraHa, TOM HJIH
HHOH CHCTeMbI, MelliaeT Y.l\oBneTBopeHHIO nOTpe6HOCTeM, npH-
BOJ\HT K J\HCKOM OPTY.
B 1943 r. aMepHKaHcKHM nCHXOJIOr A. MacJIoy pa3pa6o-
Tan: OJ\HY H3 TeopHH HepapXHH nOTpe6HOCTeH, onpeJ\enJlIO-
m;HX nOBeJ\eHHe 'IenOBeKa. ITo ero TeOpllH, O.l\HH nOTpe6HOCTH
J1,JIJl 'IeJIOBeKa 60nee cym;ecTBeHHbI, 'IeM J\pyrHe.3TO n03BOJIH-
JIO l{]IaCCH HIJ,HpOBaTb HX no HepapXH'leCKOH CHCTeMe; OT (!m3H-
OnOrH'1eCI<HX J\O nOTpe6HOCTell 13 CaMOBLIpaJKeHHH.
B HaCTO.Hm;ee BpeMJl B CTpaHaX C BbICOKHM ypOBHeM COD;H-
aJIbHO - 3KOHOMH'leCKOrO pa3BHTHJl, rJ\e 3Ha'lHTenbHO H3Me-
62
63
HMJIHCb npHOpHTeTbI B Y,D;OBReTBOpeHHH OCHOBHbIX nOTpe6Hoc-
TeH OHa He CTORb nonymlpHa. Ami HaIIIHX YCROBHH cero,D;HH
3Ta TeopHH OCTaeTCH nonYRHpHOH.
QT06bI mHTb, tIeJIOBCKY He06xo,D;HMO Y,D;OBReTBopHTb IlIH3H-
OROrHtIeClm:e nOTpe6HOCTH B B03P;yxe, nHm;e, BO,D;e, CHe, BbI,l\e-
ReHIlH npO,D;YKTOB mH3He,D;eHTeRbHOCTH, B B03MomHOCTH ABU-
raTbCH, 06ll.{aTbCH C oKpymalOll.{HMH, Om;Yll.{aTb npHKOCHOBe-
HHe H Y,D;OBReTBOpHTb CBOH ceKcya.'lbHbIe HHTepeCbI.
IIOTpe6HOCTb B KHCRopo.n;e - HOpMaJIbHOM ,D;bIXaHHH, O,D;Ha
H3 OCllOBHbIX IlIH3HOROrHtIeCKHX nOTpe6HOCTeH '1CROBeKa.
AbIxaHHe H mH3Hb - Hcpa3p;eRHMbIe nOHHTHH.
IIpH HeAoCTaTKe KHCRopop;a p;LIxaHHe CTaHOBHTCH tIaCTLIM
H nOBepXHOCTHLIM, nOHBRHeTCH O,D;bIlliKa KallieRb. IIpO,D;OR-
'K.I'ITeRbHOC YMCllbIIICHHe KOHD;eHTpaD;HH KHCRopop;a B TKaHHX
npHBo,nHT K D;HaH03Y, Koma II BH,D;HMLIe CRI13nCTbIC npIm6pe-
TalOT CHHIOIIIHbIM OTTCHOK. IIo,D;,D;epmaHHe 3TOH IIOTpe6HOCTH
,D;ORmHO CTaTb ,D;RH Me,D;HD;HHCKoro pa60THHKa IIpImpHTCTHOH
3a,na'lefI. QeRoBcK, Y,D;OBReTBopHH 3TY nOTpe6HOCTb, nop;,D;ep-
mHBaeT HC06XO,D;HMLIH ,D;RH mH3HH ra30BLIM COCTaB KpOBH.
lloTpe6HocTb B nllm;e TalUKe HMeeT BamHoe 3HatIeHHe ,D;RJI
COXp8HellnH 3,D;OpOBbH H xopomero Ca.MO IynCTBHH. PanHOHaJIb-
Hoe H ap;eKBaTHOC nHTaHHe nOMoraeT HCKRlOtIHTb llIaKTopbI
pHCKa MHorHX 3a60ReBaHHM. HanpHMep, HIlleMn'leCKaJl 60-
Re3Hb cep,nna 06ycJIoBJIeHa perymlpHbIM ynOTpe6ReHHeM nnll.{H,
60raTOH HaCbIll.{eHHbIMn :IltHBOTHbIMH mHpaMH H XOReCTepH-
HOM. PaD;HoH, cO,D;epmam;HH 60Rbmoc KOJIHtIeCTBO Kpyn H pa-
CTHTeRbHLIX BOROKOH, CllHmaeT pHCK pa3BHTHJI paKa TORCTQ-
ro KHIlletIHHKa. BbICOKoe CO,D;epmaHHe 6eJIKa B nHll.{e cnoc06-
cTByeT 3a:lltHBReHHlO PaR.
Me.n;HD;HHCKliH pa60THHK p;OJImeH 06yqHTb na..n;HeHTa H p;aTb
peKOMeH,D;aD;HH no paD;HOHaJIbHOMY H a,ZJ;eKBaTHoMy.nnTaHHIO
,D;RH YAOBReTBopeHHH nOTpe6HOCTH tIeROBeKa B nHm;e.
PelCOJlteniJyemcsr.: e:me,D;HeBHO ynoTpe6JIHTb IlIpYKTbI H OBO-
ll.{n, K3.IIIH, MOJIO'IHbIe npop;yKTbI, 06e3mHpeHHbIe MHCO, pbI6y,
nTHD;Y, MHHHMaJlbHOe KOJIn'leCTBO CJIHBOtIHOrO MaCJIa, CJIFIBOIt.
OzparrU'lUmb: ynoTpe6JIeHHe HH'IHbIX meJIT OB, caxapa,
CJIaAKHX npop;yKTOB, COJIH, aJIKOrOJIbHbIX HanHTltoB.
IIHJ.D;Y JIyqIlle BapnTb, ne'lb, HO He mapnTb.
Hc06xo,D;HMO nOMHHTb, '1'1'0 llCY,D;OBJICTBOpCHHaH nOTpe6-
HOCTb B nHll.{e, npHBop;HT K HapYIlleHlIIo 3P;OpOBbH '1eJIOBeKa.
64
IIoTpc6HOCTb B :1KH.n;KOCTH - 3'1'0 BbIITHBaHHe mH,D;KOCTH
1,5-2 JIIITpa emep;HeBHO - Bop;a, Ko(iJe, tIaH, MOJIOKO, cyn,
IlIpYKTbI, OBOm;H. TaKoe KOJIHtIeCTBO BOCnOJIHHeT nOTepH B
BH).\e BbI,D;eJIeHHH MOtIH, KaJIa, nOTa, HcnapeHHH npH ).\bIxa-
HHH. QT06bI coxpaHHTb BO,D;HbIH 6aJIaHC, '1eJIOBeK ,D;OJImeH
ynoTpe6JIHTb mHAKOCTH 60JIbIlle, tIeM OH BbI).\eJIHeT, B npo-
THBHOM CJIyqae nOHBJI.HIOTCJI npH3HaKH 06e3BomHBaHHH, HO
He 60JIee 2 JIHTpOB, tIT06bI He BbI3BaTb HapymeHHJI IlIYHKD;Hn
MHorHX opraHOB H CHCTeM. 0'1' YMeHHH Mep;HD;HHCKOH CeC'l'pbI
npep;BHAeTb onaCHOCTb 06C3BOmHBaRHJI HJIH 06pa30BaHHJI OTe-
KOB 3aBHCHT B03MomHOCTb naD;HeHTa H36emaTb MHorHX OC-
JIO:mHeHnM.
IIoTpe6nocTb B BbI,lJ;eJIeHIIH npO TOB :1KH3ne.n;eH'l'eJIbHO-
CTH. HenepeBapeHHaJl tIaCTb IInm;H BbIBO,D;HTCH H3 opraHH3Ma B
BHAe MO'ln, KaJla. PemHMbI BbI,l\eJIeHHJI Y KaJK).\oro tICJIOBeKa
HH,l\HBHP;YaJlbHbI. "Y ,D;OBJIeTBOpeHHe P;PyrHx nOTpep;HOCTeH MO-
meT 6bITb OTJIOmeHO, HO HeJIb3H OTJIOmHTb BbI).\eJIeHHe npo-
P;YItTOB mH3He,D;eJlTeJIbHOCTH Ha ).\OJIroe BpeMJI. MHorHe naD;H-
eHTbI C'IHTaIOT nponecc BbI,l\eJIeHHJI npO,D;YKTOB mH3HeAeJlTeJIb-
HOCTH FIHTHMHbIM H npe.n;nO'InTaIOT lIe 06cym).\aTb 3TH Bonpo-
CbI. IIpH Y).\OBJIeTBOpellHH HapymeHHoM nOTpe6uoCTH Mep;H-
D;nlICKaJl ceCTpa ,D;OJI:mIIa 06eCnetIH'!': eMY B03MomHOCTb ye).\H-
HeHlm, YBamaTb npano mU.I,neIiTa Ha KOHIlIHp;eHD;HaJlbHOCTb.
lloTpe6HocTb B ClIe H OT.n;bIxe - npn He,D;OCbInaHHH YMeHb-
maeTCH ypOBeHb rJIIOK03bI B KpOBH, YXY).\IllaeTCJI mITaHHe M03ra
H 3a.Me).\JIHIOTCH MLICJIHTeJIblILIe npOD;eCCbI; paCCeImaeTCJJ. BHH-
MaHHe, YXYAlliaeTCH KpaTKOBpeMeHHHaJl naM.HTb.McCJIep;OBa-
HHH, npOBe).\eHHbIe aMepHKaHCKHMH CneD;HaJIHCTaMH CBHp;e-
TeJIbCTBYIOT, '1'1'0 Y tIeJIOBeKa, KOTOpbIH He CIIaJI nOJIHOtIH,
Bp;Boe YMeHbmaeTCH KOJIH'IeCTBO KJIeTOK KpOBn, OTBe'lalOll.{HX
3a llIaroD;HT03. BOJIbHOMY '1eJIOBeKY COH 60JIee He06xop;HM,
nOCKOJIbKY cnoco6cTByeT YJIyqmeHHIo ero CaMO'IyncTBIm. He-
CMOTpJl Ha TO '1TO BOCnpHHM'IHBOCTb 'IeJIOBeIta K BHemHHM
pa3APOmHTeJIJlM BO BpeMJI CHa CHHmeHa, 3'1'0 ).\OCTaTOtIHO aK-
THBHoe COCTOJlHHe. B peaYJIbTaTe HCCJIe,D;OBaHHH BbI,l\eJIeHO
lIeCKOJIbKO CTa,ZJ;Hiir CHao
CmaiJusr. 1 - Me,D;JIeHHbrn COH. JIerKHH COH H p;JIHTbCH Bcero
lIeCKOJIbKO MHHYT. IIpH STOM CTa,ZJ;HH npoHcxoP;HT cnap; c:IJH3HO-
JIOrH'IeCKoiir aKTHBHOCTH OpraRH3Ma H nOCTeneHHoe CHHmeHIIe
,D;eHTeJIbHOCTH mH3HeHHO Ba:mHbIX opraHoB, 06MeHa Bem;ecTB.
3. 38..291
65
qe.;IOBeKa MO:HmO nerno Pa:36Y,D;HTb, HO eCJIH )Ke COH He npepbI-
BaeTCH, TO BTOpaH CTa,zJ;HH HacryllaeT 'lepe3 15 MHHYT.
CmaallS/. 2 - Me,D;neHHbIH COH. Herny60KHH COH, Ilpo,D;on-
:HtaeTCH 10-20 MHHYT. mH3HeHbIe YHKUHH npO,D;On:HtaIOT oc-
na6eBaTb, HacTynaeT nonHoe paccna6neHHe. Pa36Y,D;HTb 'leno-
BeKa TPY,D;HO.
CmaallS/. 3 - Me,D;neHHbIH COH. CTa,D;HH caMoro rny6oKoro
CHa, npO,D;onmaIOIl{8.H 15-30 MHHYT, pa36yp;nTb CIlHI.l.{ero TPY,D;-
HO. IIpo,D;on:HtaeTcH ocna6neHHe :HtH3HeHHO Ba:HtHbIX YHKUHH.
CmaallS/. 4 - Me,D;JIeHHbrn COH. rny60KHH COH, Ilp0.l\on:HtalO-
HMCH 15-30 MHHYT, pa36Y,D;HTb cnH ero O'leHb TPY,D;HO. IIpH
3TOH rpa3e npOHCXO,D;HT BoccTaHoBneHne H3H'leCKHX CHn.
mH3HeHO Ba:HtHhle YHKUHH BblpameHbI ropa3,D;0 cJIa6ee, 'leM
BO BpeMH 6o,D;pCTBOBaHHH. BCJIe,D; 3a 4 cTap;neH BHOBb HaCTY-
naeT 3-H H 2-H CTa,D;HH, nOCJIe 'lero cnH HH nepeXO,D;HT B 5-10
CTa,zJ;HIO CHao
CmaallS/. 5 - 6bICTpbIH COH. B03MO:HtHbI HpKHe, UBeTHble
CHOBe,D;eHHH 'lepe3 50 - 90 MHHYT nOCJIe nepBoH CTa,D;HH. Ha-
6JIIO,D;aIOTCH 6blcTpbIe ,D;BH:HteHHH rna3, H3MeHeHHH 'laCTOTbI
Cep,D;ue6HeHHH H ,D;.bIXaHHH, a TaK:Hte YBenWleHHH HJIH KOJIe6a-
HHH apTepHaJIbHOrO ,D;aBJIeHHH. CHH:HtaeTCH TOHYC CKeJIeTHbIX
MbIIIIU. IIpH 3TOH a3e BOCCTaHaBJmBaIOTCH nCHXll'JeCKHe YH-
KUHH <reJIOBeKa, pa36Y,D;HTb cnH ero OqeUb TPY,D;HO. IIpo,D;on-
:HtHTenbHOCTb 3TOM CTa,zJ;HH OKono 20 MHHYT.
nOCJ1.e 5-il cmaiJllu CHa Ha KopOTKoe BpeMH HacrynalOT 4,
3; 2-H, 3aTeM BHOBb 3, 4 H 5-H CTa,D;HH, T. e. Cne,l\YIO HH
JJ;HKJI CHao
Ha COH 'leJIOBelta MOryT OKa3bIBaTb BnHHHHe HeCKOJIbKO
aKTOpOB; H3H'leCKOe He,D;OMaraHHe, JIeKapCTBeHHbIe cpe.l\-
CTBa H HapKOTHKH, 06pa3 :HtH3HH, 3MOJJ;HOHHa.JIbHbIH CTpecc,
OKPY:HtalO aH cpe,D;a H H3H'leCKaH Harpy3Ka. JII060e 3a60JIe-
BaHHe, COIIpOBom,ll;alO eeC.!I 60JIblO, H3H'leCKHM He,D;OMOra-
HHeM, TpeBorOH H ,lI;enpeCCHeH, npHBO,D;HT K HapymeHHIO CHao
Me,ll;HUHHCKaH ceCTpa ,lI;On:HtHa 03HaKOMHTb naJJ;HeHTa C ,lI;eH-
CTBHeM Ha3Ha'leHHhIX neKapCTBeHHbIX Cpe,D;CTB H HX BJIIUIHTIH
Ha COHo
OrJJ;bIX - COCTOHHHe nOHH:HteHHOH H3H'leCKOH H nCHXH-
'leCKOM aKTHBHOCTH. OT,D;bIXaTb MO:HtHO He TOnbKO JIe:ma Ha
,lI;HBaHe, HO H BOBpeMH .n;JIHTeJThHOM nporynKH, 'lTeHHH KHHr
HJIYI npH BbmOJIHemm CneuH8.JThHbIX peJIaKcHpylO HX ynpam-
66
t
,
IIE-IIllH. B JIe'le6HOM Y'Ipe:Ht,D;eHHH OT,lI;bIXY MO:HteT nOMemaTb
rpOMKHH myM, HpKHH CBeT, npHCYTCTBHe ,D;pynrx JIIO.l\eM.
He06xo.n;HMOCTb OT,D;bIXa H CHa ,D;JIH :HtH3He.l\eHTeJIbHOCTH
'IeJIOBeKa, 3HaHHe ero CTa,zJ;HH H B03MO:HtHbIX npH'lHH, BbI3hI-
BalO HX HapymeHHe npHBbI'lHbIX YHKJJ;HM 'lenOBe'leCKOrO
opraHH3Ma, .n;a.l\YT B03MO:HtHOCTb ceCTpe OKa3aTb naUHeHTY
nOMO b H Y,D;OBneTBopHTb ,D;ocTynHbIMH eM Cpe,D;CTBaMH ero
nOTpe6HocTb B CHe.
IIoTpe6nocTb B JJ;BH:lKeHHH. OrpaHll'JeHHe nO.l\BH:HmOCTH HJIH
He nO,D;BH:HtHOCTb C03,D;aIOT MHoro np06JIeM ,D;nH 'le.TIOBeKa. Ta-
Koe COCTOHHHe 6bIBaeT npO,D;OJI:HtIlTenbHbIM IIJIII HenpO,D;OJI:HtIl-
TeJIbHbIM, BpeMeHHbIM HJIII IIOCTOmIHbIM. OHO MOmeT 6bITb 06yc-
JIOBJIeHO TpaBMOH C nOCJIe.n;YIO IIM HaJIO:HteHlIeM mllHbI, BbITH-
:HteHHeM KOHe'lHOCTeM C npHMeHeHHeM cneUHaJIbHhIX annapa-
TOB. BonblO Ilpll Hanll'llle XpOHII'leCKIIX 3a60neBaHlIH, OCTa-
TO'lHLIX HBneHHH HapyrneHIIH M03roBOro KPOBo06pa eHIIH.
HenOJJ;BH:lKHOCTb - O.n;IIH 113 aKTOpOB pllCKa pa3BHTII.!I
npOJIemHeH, HapymeHlIe YHKUIIII onopHO - ,D;BlIraTeJ!bHoro
annapaTa, pa60TbI cep.l\ua II nerKIIX. IIpH ,D;JIHTeJIbHOM He-
nO,D;BlImHOCTII Ha6JIIO,D;aIOTC.!I H3MeHeHHH B CIICTeMe nll eBa-
peHHH; ,D;IICnenCHH, MeTeopH3M, aHopeKCIIH, nOHOC Hnll 3ano-
PbI. liHTeHCIIBHoe Hary:HtIlBaHHe BO BpeMH aKTa ,D;e<1>eKaJJ;III1,
K KOTOPOMY naUlIeT ,D;On:HteH npll6eraTb, MO:HteT npHBeCTII K
reMOppolO, HH apKTY MHOKap,D;a, OCTaHOBKe cep,D;ua. Heno,D;-
BII:HtHOCTb, oc06eHHO B JIe:Hta'leM nOnO:HteHHH, HapymaeT MO-
'1eBbI,D;eneHHe H MO:HteT npHBeCTH K HH eKUHH MO'leBOrO ny-
3bIpH, K 06pa30BaHHIO KaMHeM B MO'leBOM nY3bIpe H nO'lKax.
Ii rnaBHaH np6neMa naUneHTa, OH He MomeT 06 aTbCH C
OKpy:HtalO eH CPe,l\OH, KOTOpa.!I OKa3bIBaeT 3Ha'lHTenbHoe BJIH-
HHlIe Ha OpMHpOBaHHe JIH'1HOCTH 'lenOBeKa. OT CTeneHH H
npO,D;On:HtHTeJIbHOCTH COCTOHHHH HenO,ll;BH:HtHOCTH Y naJJ;HeHTa
MOryT nOHBIITbC.!I Te HnH HHble np06neMbI B nCHXOCOUHaJIbHOH
c epe; H3MeHHIOTCH cnoc06HOCTb K 06Y'leHHIO, MOTHBaJJ;HH,
<rYBCTBa H 3MOUHH.
CeCTpHHcKaH nOMO b HanpaBJIeHHaH Ha MaKCHMaJIbHO B03-
MO:HtHoe BOCCTaHOBneHHe nO,D;BHmHOCTIIJ:, caMOCTOHTeJIbHOCTH
npH .l\BH:HteHIIH C HCnOJIb30BaHHeM KOCTbIJIeH naJIOK, npOTe-
30B, HMeeT orpOMHoe 3Ha'leHHe ,D;nH YJIyqmeHHH Ka'leCTBa
:HtH3HH nauHeHTa.
CeKcyanLHan nOTpc6uoCTb. OHa He npeKlJa aeTCH ,D;a:Hte
IlpH 3a60JIeBaHHH HnH ,D;OCTH:HteHHHH IlpeKnoHHoro B03paCTa.
3.
61
Ha CeKCYaJIbHOe 3AOpOBbe 'IeJIOBeKa np.HMO M.r.:H KOCBeHHO MOryr
BnM.HTb ero 60ne3Hb, p;ecpeKTbI pa3BMTM.H. Ho TeM He MeHMe
MHorne nlOp;H rOBOp.HT Ha aTY reMY HeOXOTHO p;a)Ke.npH HanH-
'IHH cepbe3HbIX ceKCYaJIbHbIX np06neM.
PemeHHe p;e.HCTBHTenbHbIX HnH nOTeHUHanbHblx ceKcYaJIb-
HbIX np06neM MO>i\eT nOMO'Ib naUHeHTY P;06HTbCH rapMoHHH
BO Bcex acneKTax 3P;OpOBbH.
H e06xoiJuJltO npu 6eceiie c naqueHmOJlt:
. Bblpa60TaTb 'l'BepP;YIO HaY'IHYIO OCHOBY p;nH nOHHMaHHH
3P;OpOBO.H ceKCYaJIbHOCTH M HaH60nee pacnpoCTpaHeH-
HblX ee HapymeHMH H P;HCCPYHKUHH;
. nOHHMaTb, KaK BnHHeT Ha ceKcYaJIbHOCTb ceKcYaJIbHaH
opHeHTaUHH, KynbTypa, penHrH03Hble y6emp;eHHH 'Ie-
JIOBeKa;
. HayqHTbCH onpCAeJI.HTb npo6neMbI, BbIXop;H Me 3a paMKM
ceCTpMHCKOH KOMneTeHUHH, H peKoMeHp;oBaTb naUHeH-
TY nOMoIUb cooTBeTcTBYIOIUero cneUHanHcTa.
TIoTpe6HOCTb B 6e30naCHOC'l'H. ,l];n.H 60nbmeHCTBa nlO-
,n;e.H 6e30naCHocTb 03Ha'IaeT Hap;emHocTb H YP;06CTBO. Kam-
P;bIH H3 Hac Hymp;aeTcH B KpOBe, op;emp;e H B TOM, KTO MO-
meT OKa3aTb nOMO b. IIaUHeHT 'IYBCTByeT cc6.H B 6e30IIac-
HOCTH, ecnH KpoBaTb, Kpecno-KaTanKa, KaTanKa 3acpHKCH-
pOBaHbI, nOKpbITHe nona B nanaTe H B KopHp;ope cyxoe H
Ha HeM HeT nOCTopOHHHX npep;MeTOB, nOMeIUeHHe B TeMHoe
BpeM.H CyTOK p;OCTaTO'lHO OCBeIUeHO; npH nnOXOM 3peHHH
eCTb O'iKH. 'lJenoBeK op;eBaCTC.H COOTBeTCTBeHHO norop;e, a B
mHnH.w;e p;OCTaTO'lHO TeIIno, H npH He06xop;HMOCTH eMY 6y-
p;eT OKa3aHa nOMO b. IIaUHeH'l' p;onmeH 6bITb YBepeH, '1'1'0
OR B COCTO.HHMH He TOnbKO 06ecne'UlTb CBOIO 6e30naCHOCTb,
HO H He IIpH'lHHHTb Bpcp;a oKpymalO HM. H36eraTb CTpec-
COBbIX cHTyaUHH.
C01\HaJIbHbIe nOTpe6110C'l'1f - aTO nOTpe6HOCTH B ceMbe,
P;PY3bHX, HX '06.w;eHHe, 0p;06peHMe. npHB.H3 HHOCTb, m060Bb
H T.p;.
JIIOP;M XOTHT 'lT06bl MX n106MnM, nOHHManH. HHKTO He
menaeT 6!>ITb nOItHHYTbIM, HenlO6HMbIM H OP;HHOKHI\ . EcnH
3'1'0 cnY'lHnOCb, 3Ha'lHT, COUHanbHble nOTpe6HOCTH 'lenOBeKa
He yp;OBneTBopeHbI. _
IIpH T.Hme.iIoi-i 60ne3HI , HeTpyp;ocnoc06HOCTH HnM B npe-
I\JIOHHO B03paCTe 'laCTO B03HHKaeT BaKYYM, COUHanbHbIe
KOHTaKTbI HapymaIOTC.H. K comaneHHIO, B TaKHX cnY'Ia.HX
nOTpe6HOCTb B 06IUeHHI1 He YP;OBneTBopeHa, oc06eHHO Y no-
)[mnbIX H OP;HHOKHX nlOp;eH. Cnep;yeT Bcerp;a nOMHHTb 0 COUH-
anbHbIX nOTpc6110CT.HX 'IenOBeKa p;ame B Tex cnyqa.HX, Korp;a
OH npe.l\IIO'lHTaeT He rOBopnTb 06 3TOM.
IIoMora.H naUHeHTY pemHTb COUHanbHYIO np06neMY, Mom-
HO 3Ha'IHTenbHO ynyqmHTb Ka'IeCTBO ero mH3HH.
IIoTpe6Hoc'l'b B caMoYBameHIIH II YBameHHH. 06IUaflcb C
JIIOP;bMH, Mbl He MomeM 6blTb paBHo.zurmHbIMM K OUeHKe CBoe-
ro ycnexa CO CTOpOHbl oKpymalO MX.
Y 'lenOBeKa nOHBn.HeTC.H nOTpe6HOCTb B YBameHMH H caMO-
yBameHHH. Ho p;n.H 3TOro He06xo.n;HMO, 'lT06bI TPYP; eMY npH-
HOCHn yp;OBneTBopeHHe, a OTP;bIX 6bIJI HaCbI eHHbIM H HHTe-
pCCllbIM, qeM Bblme YPOBeHb COUHanbHo-aKOHOMH'IeCKoro pa3-
BHTH.H 06.w;eCTBa, TeM 60nee nonHO yp;OBneTBOp.HIOTC.H nOTpe6-
HOCTH B caMOYBameHMH. HeTpy.n;ocnoc06Hble H nomHnble na-
UHeHTbl Tep.HIOT 3TO 'IYBCTBO, TaK KaK 60nbme HH .n;n.H Koro
He npe.n;CTaBn.HIOT HHrepeC&, HeKOMy nopap;OBaTbC.H HX ycne-
xy, a n03TOMY y HHX HeT B03MomHOCTli yp;OBneTBopHTb CBOIO
nOTpe6HOCTb B YBameHHH.
IIOTpe6HOC'l'b B caMOBblpameHIIH - 3'1'0 HaHBbIcmHH ypo-
BeHb nOTpe6HocTH 'lenOBeKa. Y.n;OBneTBOpmI CBOIO nOTpe6HOCTb
B caMOBblpameHHH, Kamp;bI.H BepHT, '1'1'0 OH .n;enaeT nY'lme
'1eM p;pyrHe. An.H O.l\Horo caMOBblpameHHe - 3'1'0 HanHcaHHe
KIUlrH, p;nH .l\pyroro - 3'1'0 BblpaCTHTb cap;, .n;n.H TpeTbero BOC-
nHTaHHe .n;erefl HT.p;.
HTaK, Ha Kam.n;OM ypoBHe nepapXHH y naUHeHTa MOryr 6bITb
op;Ha HJIH HeCKonbKO Heyp;OBneTBopeHHblX nOTpe6HOCTe.H. Me-
P;HUHHCKa.!l ceCTpa COCTaBn.!l.!l nnaH yxop;a 3a naUM mTOM, p;on-
mHa nOMO'Ib eMy peaJIH30BaTb XOT.!I 6bI HeKOTopble H3 HHX.
Y cnOBHfl II 4'aK'l'OpbI, BnllHlOlUHe Ha cnoc06 H 34'4'eK-
TIIBHOC'l'b YAOBne'l'BOpeHlIH nOTpe6110cTeii:.
LLT06bl mMTb B rapMOHHH C oKpymalO e.H cpeP;OH, 'lenOBe-
Ity Hap;o nOCTO.!lHO yP;OBneTBop.!lTb CBOM nOTpe6HOCTH:
. c06nlOp;aTb 3P;OpOBbIH 06pa3 mH3HH;
. mMTb B rapMoHHM C coUHanbIlbIM H KynbTypHbIM OKPy-
meHHeM;
. nOBblmaTb MarepHanbHble H .l\yxoBHble ueHHocTH.
IIcpexop; JII060H nOTpe6HocTH B p;e.HCTBH.!I HnM nocTynKH
conpoBomp;aeTC.H H3MeHeHHeM B nCHx03MoUHoHanbHofI, no-
69
68
3HaBaTenbHOH, nCHXOMOTOpHOH C(pepe qenOBeKa H 3aBHCHT OT
CBOHCTB nHQHOCTH, B03paCTa qenOBeKa, ypOBHa ero 06pa30-
BaRHH H cnoc06HOCTH OC03HaTb p;e Hr:tHT 'lero-nH60.
IIoTpe6HocTH BnHHIOT Ha nepeJitHBaHHH, BonlO qenOBeKa,
OPMHPYIOT HanpaBJIeHHOCTb nHqHOCTII. ,l];OMHHHpYIOID;aH no-
Tpe6HOCTb nop;aBnHeT OCTMbHble nOTpe6HOCTH, onpep;enHeT
OCHOBHoe HanpaBneHHe p;eHTenbHOCTH qenOBeKa. qenoBeK CO-
3HaTenbHO perynHpyeT nOTpe6HOCTH H 3'l'HM OTnHqaeTCH OT
Ji<HBOTHbIX.
PerynHPYH nOTpe6HOCTII, Heo6xoP;HMO yqHTbIBaTb BHennme
aKTOpbI.
K BHemHHM aK'l'OpaM, OT KOTOpbIX 3aBHCHT CTeneHb yP;OB-
neTBopeHHH IIOTpe6HOCTe.H, OTHOCHTCH ycnOBHH oKpymaIOll.{e.H
qenOBeKa CpeP;LI.
K aKTOpaM KOTopble H3MeHHTb Henb3H, OTHOCHTCH B03-
paCT, non qenOBeKa, Hacnep;CTBeHHOCTb.
ct>aKTopbI pHCKa, BnHHIOm;ue Ha 06pa3 Ji<H3HH qenOBeKa
MOryT npHBecTH K HapyweHHIO- YP;oBneTBopeHHH nOTpe6Hoc-
Te.H. K HHM OTHOCHTCH; 3KonorHH, rHnOp;llHaMHH, H36bITOtJ:-
HbI.H Bec, Bpep;Hble npHBLIqKH, cTpeccoBble cHTya HH H P;PY-
rHe, KOTOpbIe MOJi<HO crpynnepoBaTb cnep;yJ:oll.{HM 06pa30M.
1 2 3
reHentKa,6MOno- 18-22 npeAPaCnono eHHoCTbK
rHS! 'IenOBeKa HacneJ\CTBeHHbIM 6one3HS!M
npeAPacnono eHHoCTb K
AereHepaTMBHblM 60ne3H5IM
BHewH5IS! cpeAa. 17-20 3arp513HeHMe B03,Qyxa
npMpoAHO- KOHLlepareHaMM
KIlMMaTM'IeCKI<Ie 3arp5l3HeHMe BOAbl
ycnoBMS! 3arpS!3HeHMe nO'lBbl
Pe3KMe CMeHbl aTMocxpepHblx
51BneHMiii
3ApaBooxpaHeHMe 8-10 He3cpcpeKTMBHOCTb
npocpMnaKTM'IeCKIo1X Meponplo151TIo1iii
HIo13Koe l<a'leCTBO MeAIo1L1Io1HCKOiii
nOMOlljlo1 HecBoeBpeMeHHoCTb
MeAIo1L1Io1HCKOiii nOMOlljlo1.
3Ha'ieHlo1e
AnSI rpynnbl cpaKTopoB
Cl\lepbl 3J;\OpOBbSi.
npll MepHo
B'Yo
1 2 3
06pa3 )1(113HIo1 49--53 KypeHMe. ynorpe6neHIo1e anKOron51
nOTpe6neHile HapKOT\IIKOB
3noynorpe6neHIo1e na<apcTBaMIl
OTKa3 OT nplo1eMa na<apCTBeHHblx
cpeACTB
BpeAHble ycnOBII5I TPYAa
CTpeccoBble CHryaLl10111
Hec6anaHcIo1poBaHHOB nMTaHlo1e
A,QIo1HaMMS!,rnnoAIo1HaMIIS!
r1noxlo1e MaTeplo1anbHo-6blToBbie
ycnOBII5I
HenonHa51 CeMb51
OAIo1HO'-IeCTBO
HH3I<Miii 06pa30BaTenbHbliii '"
KYnbTYPHbliii ypoaeHb
l.Ipe3MepHo BblCOKlo1iii ypoBeHb yp6a-
HIo13aLllo1101
Ponb MeAMqMHcKOM ceCTpbl B BOCCTaHOBneHMM
M nOAAepmaHMM HeaaBMCMMOCTM naqMeHTa
B YAOBneTBopeHMM nOTpe6HOCTeM
IIoTpe6HocTb B ceCTpHHCIWM yxoAe YHHBepcanbHa, OHa
He06xop;HMa qenOBeKY OT pOJi<p;eHHH AO CMepTH. Mep;H HHC-
KaH ceCTpa AOJIJi<Ha aKTHBHO npHBneKa'l'b na HeHTa, qJIeHOB
ero ceMbH B YP;OBneTBopeHHH nOTpe6110CTe.H B caMoyxop;e,
nOMoraa eMY COXPaHHTb CBOIO caMOCTOHTeJIbHOCTb, He:3aBHCH-
MOC'I'b.
TepMHH «caMoyxoiJ» ynoTpe6mleTCH, Korp;a peqb HAeT 0
Ae I'l'enbHOCTH CJIYJi<6 3)ij)aBooxpaHeHHH, yqaCTHli qJIeHOB ce-
MbH n Hen:Ta, ero APY3e.H, rpyrrn caMonOMOID;H H B3aHMono-
MOID;H. CaMOYXOP; npep;nonaraeT yqacTHe caMoro na eHTa Ha-
npaBneHHYIO Ha YP;OBneTBOpeHHe ero Ji<H3HeHHO BaJi<HbIX nOT-
pe6HOCTe.H, B pe3ynbTaTe qero 06ecneqHBaeTCH p;OCTaTOqHbI.H
p;nH Hero ypOBeHb 3AOPOBbH.
10
11
TIOMomh nal\HeHTY
B y.n;OBJIe'l'BOpeJlHH 4'H3HOJIOrHQeCleJlX nOTpe6noCTeii
llOMOII\b naI.\HeHTY
B y.n;OBJIeTBOpeHHII nOTpe6HOCTeii B 6e30naCHOCTH
nOTpe6HoCnt CeCl'pI-1HCl<l-1e BMeWaTenbCTBa npM
y,qOBl1eTBOpeHMM HapyweHHoH nOTpe6HOCTM
B B03A}'Xe nOAH5ITb 1-13rOnOBbe I<pOBaTM, npMAaTb
na41-1eHTy nOnO>KeHl-1e «<3>aynepa». 06}/'11-1Tb
na4l-1eHTa:
- TeXHl-1l<e K3wn5l, AbIXarenbHblM ynpa>KHeHI-151M
- npl-1eMaM caMonOMOl1.\1-1 npl-1 npl-1cryne YAYWbR
- caMOCT05ITenbHO nonb30BaTbCSlI-1HranmooOM.
Bnl-1l1.\e nOMO'Ib na4MeHT)' npl-1HI-1MaTb nl-1l1.\Y.
06}/'11-1Tb na4MeHTa a,qeI<BaTHOM}' nl-1TaHI-1IO.
AaTb pe1<OMBH,qa41-11-1 na41-1eHTY M ero POACT-
BeHHl-1l<aM no c061110AeHMIO AI1eTbl.
B )!(I.1,qKOCTM nOMO'Ib na41-1eHTY nl-1Tb. 06ecne'lI-1Tb
AOCTaTO'lHbIM KOI1I-1'1eCTBOM
BI-1TaMI-1HM31-1POBaHHOH >KI-1AKOCTI-1.
B BblAeneHl-11-1 npOAYK- 06eCne'lMTb na41-1eHTa 1-1H,qI-1BI-1AyanbHbIM CYAHOM
TOB >K1-13HBAeRTenbHO- 1-1 MO'Ienpl-1eMHI-1KOM.
CTI-1 Hay'lI-1Tb na41-1eHTa M ero pOACTBeHHMKOB
n0l1b30BaTbCR naMnepCaMl-1, KanOnpl-1eMHI-1KOM,
MO'lenpMeMHI-1KOM.
nOMO'Ib naLll-1eHT)' AOHTI-1 AO TyaneTa.
06ecne'lMTb na41-1eHTY 6B30naCHOCTb 1-1
yeAMHeHl-1e BO BpeM5I aKTa Ae<Pet<a41-11-1 1-1
MO'leI-1CnVCKaHI-151.
BCHe 06eme'lI-1Tb KOM<poprHble ycnOBI-1R AJlR CHa.
Bbl5lCHMTb npl-1'1I-1Hbl HapYWBHI-151 CHao
06}/'11-1Tb na41-1eHTa HaBblKaM, cnoco6cTBytOl1.\I-1M
perynl-1pOBaHMIO CHa (CTaKaH Tennoro MOnOKa C
nO>KKOH MeAa, nporyl1Kl-1 nepeA CHOM).
06}/'11-1Tb na4MeHTa COCTaB/1eHI-1IO pe>KI-1Ma
AH5I ('1aCTa51 CMeHa AcsrrenbHocTl-11-1 OT.!\blxa).
B .!\BI-1>KBHI-1M Onpe.!\enI-1Tb. HaCKonbKO OrpaHI-1'1€Hl-1e no-
.QBM>KHOCTI-1 Bl1I-151eT Ha COCTOSIHl-1e 3aBI-1CI-1MOCTI-1
'1enOB€I<a.
06}/'11-1Tb na41-1eHTa M ero POACTBeHHI-1KOB
nepeMel1.\eHI-1IO B nocrenM, npl-1eMaM Il<3>K
npl-1 pa3peWeHI-11-1 nal\l-1eHT)' .QBl-1raTbCR, 06}/'11'1Tb
npl-1eMaM BCTaBaHM5I C nOCTenM, XO)I(,QeHI-1IO Ha
KOCTblnRX I-1nl-1 C nanKOH.
B npl-1KOCHOBeHl-11-1 EieceAYR C nal\l-1eHTOM, B3SlTb ero 3a pyl<}',
nonpaBI-1Tb oAeslno I-1nM nOAYwl<}'.
nOCoBeToBaTb 6nl-13KI-1M '1al1.\e ero o6HI-1MaTb.
nOTpe6HOCTM CecTpMHcKMe BMewaTenbCTBa
npM y,qoBl1eTBOpeHMM HapyweHHoH nOTpe6HOCTI-1
B HaAe>KHOCrn OnyCTl-1Tb 1<p0BaTb Ha MaKCI-1ManbHO HI-13KI-1H ypoBeHb.
P€I<OMeH,qOBaTb BCTaBaTb 1-1 nepe.QBl-1raTbCSl C .
nOMol1.\blO MeAceTpbl W1M POACTB€HHI-1KOB.
06}/'1MTb na41-1eHTa nonb30BaTbCR nanO'IKOH npl-1
XOAb6e.
B 3al1.\l1Te OnpCACnl-1Tb COCT05lHI-1C 3aBI-1C1'1MOCTM na41-1eHTa OT
OKPYJKalOl1.\l-1.x <!>aKTOpOB, Bb13b1BalOl1.\I-1X np06neMbi B
OTHOWCHI-1I-1 nOAACp>KaHI-1R 6e30naCHOCTI-1
ol<pYJKalOl1.\eM c<l>epbl. 06}/'11-1Tb na4MeHTa 1-1 cro
POACTBCHHI-1KOB MepaM nOAAepJKaHI-1R 6e30nacHocTM
OI<pYJKalOl1.\cH CpCAbl.
nOMO'Ib Bblpa6aTbiBaTb a,qcKBaTHOB OTHOWCHIo1"C
na41-1cHTa K np06ncMaM, KOropblC HeB03MO>KHO
PCWMTb.
B KpOBC npM Bblnl-1CKe 1-13 CTaLli'10Hapa HC06XOAI-1MO y6cAI-1TCR,
'1TO y na41-1CHTa eCTb AOM. Ecnl-1 na41-1CHT nMWOH
KpoBa. n06eCnOK0I-1TC5I 0 HanpaB/1CHMI-1 na4MeHTa B
.!\OM AJl5ll-1HBanl-1AOB M CTaOMKOB.
B OAe)I(,QC OnpCAcnMTb <p1-131-1'1eCKl-1e 1-1 YMCTBCHHblC cnoc06HOCTI-1
na4MCHTa 3aBI-1CI-1Tb OT APyrnx npl-1 Bbl60pe OAe)I(,Qbl.
nOMO'Ib na4MCHTY OACBaTbCR 1-1 pa3,QeBaTbCR.
nOOl1.\p5ITb >KCnaHMe na4MCHTa B caMOYXOAe, B
OACBaHMI-1 M CHRTI-1I-1 OAe)I(,Qb'.
llOl\IOmh nal\JleHTY
B y.n;OBJIe'l'BOpeHHH COI\UaJIhHhlX nOTpe6HocTeli
nOTpe6HOCTb CeCTpl-1HCKOe BMewaTenbCTBO
npM YAODI1CmOpCHMI-1 HapyweHHoH nOTpe6HOCTM
B OA06pCHI-11-1 nOOWp5ITb na4MCHTa npl-1 AOCTI-1>KCHI-1I-1 ycnexa B
AOCTI-1JKCHI-1M nOCTaB/1eHOH Llcnl-1. B >KenaHI-1I-1 caMOCTO-
5ITcnbHO npOBOAI-1Tb caMOvxOA.
B nOHI-1MaHl-11-1 Bbl6paTb MCTOA 06l1.\eHI-1R C na4MCHTOM.
CnywaTb na41-1CHTa np05lB/15151I-1HTCpCC, BHI-1MaHMC
1-1 COCTDa,qaHI1e K ero no06nCMaM.
B npl-1BS13aHHOCTM 06bRCHI-1Tb pOACTBCHHI-1KaM 0 HC06XOAI-1MOCTM
M nlO6BI-1 npOSlBf1RTb BHI-1MaHI-1C M nlO60Bb K 6nl-13KOMY I,M
'1CnOBel<}'. nocel1.\aTb pcrympHo, npORBl1RR 3a60ry
o cro COCT05lHMI-1.
B ceMbC AaTb nOH5ITb na41-1CHTY, '1TO OHM )l(,Qyr cro
Bbl3,QOpOBneHI-151 1-1 >KCnalOT B 3TOM }/'IaCTBOBaTb.
nOMO'Ib nal!v,CHTV n03BOHI-1Tb .!\OMOHl-1nl-1 ,JJDV3b5lM.
72
73
IIoMomb na HeHTY B Y,lJ.OBJIeTBOpeHlm nOTpe6HOC'l'eH
B CaMOYBa:/KeHHH H YBa:/KeHHH
Oc060e MeCTO OTBO,D;H'l'C.H YKpenJIeHIHO CeMbH. CeMbH pac-
CMaTpHBaeTC.H KaK Ba)KHeHmaH .!i'IeHKa 06m;eC'l'Ba, B paMKax
KOTOpOH Me)l;H HHCKHe pa60THHKH CMOryT pelllaTb He TOJIbKO
COMaTH'IeCKHe np06JIeMbI n HeHTOB, HO H yqHTbIBaTb nCHXO-
JIOrH'IeCKHe H CO aJIbHble iPaKTopbI, onpe,D;eJI.HIOm;ne COCTO.H-
HHe HX 3,D;OpOBLH H Ka<leCTBO :/KH3HH.
3,D;OpOBoe Ha'IaJIO :/KH3HH, CKopee Bcero, MO:/KHO 06ecne-
qHTb B YCJIOBH.HX 3,D;OpOBOH ceMLH, OHO C03,D;aeT iPYH,D;aMeHT
,D;1lSf. xopolliero 3,D;OpOBb.H Ha npOT.H:/KeHHH BceH :>KH3HH. Ha
OCHOBaHHH Bcero BbIllie H3110:>KeHOrO ,D;ellaeTC.H BbIBO,lJ., 'ITO OPH-
eHT HSf. Ha ceMLIO - STO scP<PeKTHBHbIH no,D;XO,D; K H3MeHeHHIO
He3,D;opOBoro 06pa3a :>KH3HH.
POllb Me,D;H HHCKOH ceCTpbI B npoiPHll8.KTH'IeCKHX Mepon-
pHSf.TH.HX onpe,D;eJUle'l' HaJIH'IHe Bpe,D;HbIX C'l'peCCOBbIX iPaKTO-
pOB Hllll HHbIX nary6Hblx ,D;1l.H 3,D;OpOBbH B03,D;eHCTBHH H npH-
HHMaeT 8.KTHBHble MepbI ,D;1l.H Toro, '!TooLl npe,D;OBpaTHTb HX
BllH.HHHe Ha 3,D;opoBbe ceMbH. OHa nOMOrae'l' ceMbe YCHllHTb
pe3HC'l'eHTHOCTb K 60JIe3H.HM, npe,D;OCTaBmm He06xo,lJ.HMYIO
nOMep:/KKY H npOBO,D;.H COOTBeTCTByIOrqyIO caHHTapHo-npOCBe-
TH'l'ellbHYIO pa60TY, a TaK:>Ke nOMOraSf. <meHaM ceMbH M06HllH-
30BaTb CBOH c06CTBeHHbIe pecypCbI. BllarO,lJ.ap.H 3HaHH.HM 0
ceMbe H ,D;oBepHTeJIbHbIM OTHOllleHHeM C 'IlleHaMH ceMbH, Me-
,lJ.H HHcKaa cecTpa CMO:>KeT BbISf.Bll.HTb np0611eMbI na HeHTa co
3,D;OpOBbeM Ha caMOM paHHeM STane HX I}>opMHpOBaHH.H H 6y-
,D;eT CO,D;eHCTBoBaTb npHH.HTHIO HeOTllO:>KHbIX Mep ,lJ.ll.H Toro,
'IT06LI CBeC'l'H K MHHHMYMY B03,D;eHCTBHe STHX np0611eM Ha
naJJ;HeHTa HllH Ha ceMLIO.
Bce ,D;eHCTBH.H Me,D;H HHCKOH ceCTpLI ,D;Oll:>KHbI 6LITL OCHOBaHbI
Ha BLICOKHX nplm nax HpaBCTBeHHOCTIf H CnpaBe,lJ.llHBoCTH.
POllIo Me,lJ.HJJ;HHCKOH ceCTpLI Onpe,D;ell.HeTCa n;eIDlMH cecTpHH-
CKoro ,lJ.ella, KOTopbIe B pa311H'lHOH CTeneHH ,D;Oll:>KHbI pa3,D;e-
ll.HTL H ,D;PyrHe pa60THHKH CHCTeMLI 3,D;paBOOXpaHeHHa. K Ta-
KHM n;eJIHM OTHOC.HTCa CJlep;yIOm;He.
. IIOMOm;b na HeHTY, ero ceMLH B Onpe,lJ.elleHHH H ,D;OCTH-
:>KeHHH iPH3H'IeCKOrO, YMcTBeHHoro H COD;HaJILHOrO 3,lJ.0-
pOBbSl B CB.H3H C HX COD;HaJILHLIM H 3KOJlOrH'IeCKHM OK-
PymeHHeM.
. YKpenlleHHe H coxpaHeHHe xopolliero 3,D;OpOBL.H, a TaK-
:>Ke npoiPHllaKTHKe ero OTKJlOHeHHll.
nOTpe6HOCTb CeCTpl'lHCKOe BMewarenbCTBO npl'l
YAOBneTBopeHl'I1'I HapyweHHoiil nOTpc6HOCTlII.
B YBaJKeHI'IK 06pal1laTbCH K nal\I'I6HTY no I'lMeHK 1'1 OT'leCTSY
He3aBI'ICI'IMO OT era COLll'lanbHOrO nOnO>KeHI'I5I.
AaTb nOH5ITb nal\l'IeHTy. '1TO Bce BonHYIOI1II'Ie ero
npo6neMbl O'leHb Sa>KHbl, KaK An51 naLll'leHTa. TaK 1'1
An sac.
I--
B caMoysa>KeHI'II'I nOMO'Ib naLlLo1eHTY OC03HaTb Sa>KHOCTb SbinOnHeHI'I
Toiil MaHl'lnyn l\Lo1I'1, KOTOpa51 COCTaSMna An
nal\l'IeHTa TPYAHOCTb. HO 6blna I'IM SblnonHeHa.
B ycnexe nOXSanl'lTb nal\I'IBHTa npl'l ycnewHoM SblnOnHeH1'I1'I
MaHl'lnYMLll'liiI no caMoyXOAY ero pOACTSeHHI'IKaM I'Inl'l
APYrl'lM nal\l'IeHTaM, I'Inl'l AaTb B03MO>KHOCTb
nOAenl'lTbC caMOMY CBOI'IM ycneXOM.
Ponb MeAMLlMHCKOM CeCTpbl
B 03AOpOBneHMM 06pa3a *M3HM
naqMeHTa M e.-o CeMbM
B nporpaMHLIX ,lJ.OKYMeH'l'ax B03 ceCTpHHCKHH nepCOHaJi
paCMaTpHBaeTC.H KaK peaJlLHaa CHlla, cnoc06HaJI Y,D;OBlleTBO-
pHTL paCTYm;He nOTpe6HOCTH B ,D;OcTynHoH Me,lJ.HD;HHcKoi-i no-
MOm;H. IIO.!IBJI.!UOTca HOBLle BH,lJ;bI nOMOm;H, CB.H3aHHbIe He TOJlL-
KO C 60Jle3H.HMH HJIH nO'l'OllorH'IeCKHMH COCTOaHH.HMH, HO H C
np0611eMaMH coxpaHeHH.H H nOMepmaHH.H HH,lJ.HBH,lJ.yaJILHOrO
H 06m;eCTBemIOrO 3,lJ.OpOBLH MHorHe np0611eMLI 3,D;OpOBL.H CB.H-
3aHLI C 06pa30M :>KH3HH H npHBbI'lKaMH ceMLH, llIO,lJ.H Hym,lJ.a-
IOTC.H B COBeTax no BonpocaM npoiPHllaKTHKH 3a6011eBaHHH,
3,lJ.OpOBOro 06pa3a :>KH3HH.
B npO,D;Oll:>KeHHH npOBO,D;HMOll B03 rJl06aJThHOH nOllH'l'HKe
B 0611aCTH 3,D;paBOOXpaHeHH.H MHpOBblM C006m;eCTBOM npHHSf.-
Ta HOBaa nporpaMa 3,D;opOBLe ,lJ.llSf. Bcex B 21 CTOlleTHH ,
KOTopaa HanpaBlleHa Ha YKpenlleHHe H oxpaHY 3,lJ.OpOBb.H llIO-
,l\eH Ha npOTameHHH BceH HX mH3HH, a He TOJiLKO B onpe,D;e-
lleHHLle ee nepHO,lJ.LI. IIpH 3TOM'3,lJ.OpOBLe onpe,D;eJI.HeTC.H K8.K
npaBO Bcex llIO,D;eH H He06xo,D;HMoe YCJlOBHe ,D;lla 611aronoJIy-
<IllSf., BLICOKOI'O Ka'IeCTBa :>KH3HH. H YCTOll'IHBOrO SKOHOMH'IeC-
KOro pa3BHTHK.
74
75
II BOi3JIeqeHHe naUHeRT!/. B 3a60TY 0 CBoeM 3,nopOBbe.
. Y,nOBneTBopeHHe nOTpe6HOCTeii B rpH3HqeCKOii, 3MOUHO-
HanblIOii HJUI couHanbHoii 3a60Te B cnyqae He3,nopOBbJI,
HeMOIUbHO<::TH HnH CMepTH.
2.4. Mogellu cecmpuHclioro gella
Mo.n;enb - 31'0 06pa3eu, no KOTOPOMY 'lTO-TO ,l\OmKHO 6bITb
C,l\enaHO. Mo,nenb ceCTpHHCKoro ,l\ena - 3TO HanpaBneHue Ha
,l\OCTHmeHHe UenH.
3HaqeHHe MO,l\e'Ieii ceCTpHHCKoro .nena .l\nJI pa3BHTHJI ceCT-
pHHCIWf! cnCUHanbHOCTH OqeHb BennKO, OHO nOMoraeT no .l\PY-
roM)' B3rmmYTb Ha rpyIIKUHH Me.n;m{HHCKOM ceCTpbI. ECJIH paHb-
me OHa TOnbKO yxamHBana 3a TJImen060nbHbIMH nauHeHTa-
MH, TO CeMqaC ceCTpHHCItHH nepCOHan COBMeCTHO C ,npyrHMIf
cneu l:anHCTaMH BH.l\HT rnaBHYIO 38,l1aqy B nO.l\.l\epjKaHHU 3,n0-
pOBbJI, npC.l\ynpC:>K.l\eHHH 3a60neBaHHn, 06ecneQeHHH MaKCH-
ManbHOH He3aBHCHMOCTH QenOBeKa B COOTBeTCTBHH C ero HH-
.n;HBH.n;yanbHLIMH B03MOmHOCTJIMH.
,ZJ;eii:cTBYJI no.n;o6HbIM 06pa30M, HOBaJI KOHueIIUHJI 3aMeHHT
,l\aBHO YCTaHOBHBlllYIOC1I HepapXH'leCKYIO H 6IOpOKpaTHQeCKYIO
CHCTeMY opraHH3auHH ceCTpHHCKOro ,ncna npocpeCCHOHanbHOM
l\1O,l\enbIO. BbICOKOKBanm}mUHpOBaHHaJI npaKTHKYIOm;aJI ceCT-
pa ,l\onmHa HMeTb ,l\OCTaTOQnO 3Hamin H HaBbIKOB, a TaKme
YBepeHHOCTH, QT06bI nnaHHpOBaTb, ocym;ecTBnHTb H OUeHH-
BaTh pe3ynbTaTLI yxo.l\a, OTBeQaIOm;erO nOTpe6HOCTJIM KOHK-
peTHoro mUJ,HCHTa. IIp1-! 3TOM ,nenaeT OC06bIM aKueHT Ha YHH-
KanbHOCTb BKn8,lla ceCTpHHCKoro yxo.l\a B BbI3,l\OpOBneHHH,
BOCTaHOBnCHHH 3,l\OpOBbJI.
Ha pa3BHTHe ,l\eMCTBYIOm;HX CCCTpHHCKHX MO,l\eneii OKa3a-
nH BnHJIHHe HCCne,l\OBaHHJI H OTKpbITHJI B 06naCTH (1)H3Hono-
rHH,COUHonorHH,nCHxonorHH.
B Ita'Kp,OH MO,l\enH no pa3HOMY OTpameHO IIOHHMaHHe cym;-
HOCTH naIJ,HeHTa KaK 06beKTa ceCTpHHCKOH .l\eJITeJIbHOCTH, ueJIH
yxo,l\a, Ha60pa ceCTpHHCKHX BMemaTenbCTB H OUeHKH pe3YJIb-
TaTOB-CeCTpHHCKoro yxop,a.
MO,l\enH ceCTpHHcKOro yxop,a Ha3bIBaIOT KOHUenTyanbHbI-
MH nOCKonbIty OHH Bb!CTpaHBaIOTCH Ha OCHOBe pa3nH'1HbIX
nOHJITHH H KOHIJ,enuHM. CornaCHO onpep,eneHHIO BapHYM 1990
rO,l\a, Ha3HaQCHHe TeopHH ceCTpHHCKoro ,l\ena 3aKnIOQaeT B
16
.,
CTpeMneHHH OrIHCaTh HnH 06bJICHHTb c1>eHoMeH (npoIJ,ecc, JIB-
neHHe, c06LITHe) HMeHyeMbIii ceCTpHHCKHM ,l\enOM.
BenHKO 3HaqeHHe TeOpHH ceCTpHHCKoro ,l\ena ,l\nJI HaYQ-
HOM, 06pa30BaTenbHoii H npaKTH'1eCIWH ,l\eJITenbHOCTH.
B OCHOBe TeOpHH ceCTpHHCKoro ,nena nemaT OCHOBononara-
IOIUHe nOHHTHH, KOTopbIe onpe,l\enJIIOT cym;bHOCTb ceCTpHHC-
Koii npaKTHKH. K HHM OTHOC1lTCJI:
. nauHeH'l' KaK O,l\HH H3 06beKTOB ,l\eJITenbHOCTH ceCTpHH-
CKoro nepCOHana;
. HCTO'1HHK np06neM nal{HeHTa;
. HanpaBneHHOCTb ceCTpHHCKoro BMemaTenbCTBa;
. uenb yxo,na;
. cnoc06bI ceCTpHHcKoro BMemaTenbCTBa;
. ponb ceCTpbI;
. oueHKa Ka'1eCTBa H pe3ynbTaToB YXO,l\a.
Kam,l\oe H3 3THX nOHJITHM npe,l\CTaBneHHO H onHcaHO B
pa60Tax TeopeTHKOB ceCTpHHCKoro ,nena, H XOTJI 3TH nOHJI-
THH npHcyrcTBYIOT BO Bcex TeOpHJIX ceCTpHHCKoro .l\ena, HX
TonKOBaHHe H cnoc06b1 B3aHMO,l\eMCTBHJI Mem,l\Y C060M CYIUe-
CTBeHHO pa3nHQaIOTCJI.
Pa3pa60TaHO HeCIwnbKO pa3nHQHbIX MO,l\eneH. Co,l\epma-
HHe Kamp,OIl MO,l\enH 3aBHCHT KaK 01' YPOBHJI 3KOHOMH'1eCKOrO
pa3BHTHJI TOM HnH HHOii cTpaHbI, ee nonHTHKH, 06IUenpH3Ha-
HbIX ueHHoCTeM, CHCTeMbI 3,l\paBooxpaHeHHJI, penHrHH, TaK H
01' <!>HnocmlmH H y6em.n;eHHii KOHKpeTHoro QenOBeKa HJIH rpyn-
nbI nIO.n;eH, pa3pa6aTbIBaIOIUHX TY HnH HHYIO MO.l\enb.
CerO.l\HH He cym;eCTByeT e,l\HHOH MO.l\en1-! ceCTpHHcKOro .l\ena,
HO H e.l\HHoro MHeHHJI 0 He06xo.l\HMOCTH Hcnonb30BaHHJI O,l\-
HOn HnH HCCKonbKHX MO,l\enen.
BCBH3H C BbIllle 13nomeHLIM npe,l\JlaraeM 0630P HeKoTopblX
MO.l\eneii cecTpHHcKoro .l\ena.
OCHOBHble nonO)KeHMR MOAeneM ceCTpMHCKoro Aena.
MOAenb H.Poynep, B. nOraH, A.TaM3pHM
MO,l\enb npe.n;nomeHHaH H. Poynep B 1976 r, ,l\OnonHeH-
HaJI B 80 rO,l\bI B.JIoraH H A. TaiispHH. ABTOPbl .l\aHHOM MO-
,l\enH CQHTaIOT, '11'0 Me,l\HUHHCKaH ceCTpa .n;onmHa COCpe,l\OTO-
'1HTb CBoe BHHMaHHe Ha Ha6nIO.n;aeMbIX CTopOHax nOBe.n;eHHJI
'1enOBeKa, oueHKa ceCTpHHCKOii ,l\eJITenbHOCTH OCHOBb!BaeTCJI
11
Ha BH,D;HMLIX, H3MepHeMLIX H nO,D;aIOll{HXCH O eHKe pe3y.TJ:b-
TaTOB.
ABTOPLI MO,D;eJIH YCTaHOBJoI.TJ:H 12 BH,D;OB nOBCe,D;HeBHOM :mH3-
He,D;eHTe.TJ:bHOCTH, KOTopLIe HBJIHIOTCH nOTpe6HocTHMH 'IeJIO-
BeKa. qacTb H3 HHX HMeeT 6HOJIOrJol'IecKYIO OCHOBY, ,lJ,PyrHe -
KYJIbTYPHYIO H CO H8JIbHyro. CTeneHb Y,D;OB.TJ:eTBOpeHHH no-
Tpe6HocTeH 'leJIOBeKa 3aBJoICHT OT B03paCTa , ere CO HaJIbHOrO
CTaT}'Ca H Ky.TJ:bT}'pHoro YPOBHH.
IIpommeHHe nOBCeAHeBHOH mH3HeJJ;eHTeJIbHOCTH.
1. TIoMep:maHHe 6e30nacHoH oKPy:maIOll{eH cpeALI
2. 06ll{eHHe
3. )J;LIXaHHe
4. TIoTpe6.TJ:eHHe nHII.{H H JKH,D;KOCTH
5. BLIBe,D;eHHe npO,D;}'KTOB :mH3He,lJ,eHTe.TJ:bHOCTH
6. TIoMep:maHHe JIH'IHOH rHrHeHLI H OnpHTHOCTH B O,D;eJK,lJ,e
7. Pery.TJ:HpOBaHHe TeMnepaTypLI Te.TJ:a
8. )J;BHraTeJIbHaH aKTHBHOCTb
9. Pa60Ta, ,lJ,ocyr H paB.TJ:e'leHHe
10. CeKCYaJIbHOCTb
11. COH
12. YMHpaHHe
OcHOBHble HanpaBneHHocTb
ABTOp nonOJKe- IIICTO'lHMK npo6neM ceCTpMHCKoro
MO.QenM HMSI MOAe- naLjMeHTa BMewaTe.nbCTBa
nM
Poynep H. 4enOBeK 5 4JaKTOpOB, KOTOpble CecTpa COBMeCTHO
floraH B. KaK 06beKT MOryr Bbl3BaTb nOTpe6- C nal.\MeHTOM
T aM3pHM A CecrPMH- HOCTb B CBCTpMHCKOM OUeHMBaeT era
CKOH .QeSl- yxoAe: B03MO)t(HOCTM B
TenbHOCTM - MHBaJ1I1,qHOCTb M CBSI- YAoBneTBopeHMM
3aHHOe C 3T"'M Hapy- HapyweHblX
weH",e <!>'''3'''OnOl101'1e- nOTpe6HOCTej;j,
CK"'X 4JYHKl.\I'Ij;;; YCTaHaBn"'BaSI
- naTOnOrn'leCK"'e M AEJi;icTB"'TeJlbHble
AereHepaT"'BHb'e M3Me- nOTeHLI"'anbHble
HeH"'SJX B TKaHSlX; npo6neMbi
- Hec4acTHblj;j cny4aj;j; nal.\I'IBHTa._
- "'H4JeKLjMoHHoe 3a60-
neB8H",e:
- nocneACTB",e BnMSlHHSI
cjJM3"''1eCKMX, na.txono-
rn'leCKI'IX '" COl.\",anbHblx
4JaKTOpOB OKpyJKalO j;j
CDe.Qbl.
78
CeCTpMHCKoe OLjeHK3 Ka4eCTB3 Ponb MeAMLjMH-
Uenb YX0,Aa BMewaTenb- M pe3ynbTaTa cKoj;j cecTpbl
CTBO vxo.Qa
Ha'l"'HaeTC5I nocne 06cy- Kp"'Tep"'f1MM Ol.\eH- ABTOPbl A3HHOj;j
C nepBI'I'IHoj;j >K,QeH"'SI C K'" Ka'leCTBa M pe- MOAenM BM,QSIT
Ol.\eHKIo1 co- nal.\MeHTOM 3ynbTaToB yxo.Qa ponb Me,Q"'Lj"'HCKOj;j
CTOSlHMSI LleJlM yxoAa SlBnSJeTCSI YAoBne- cecTpbl KaK He3a-
naLjMeHTa Me,Ql'll.\MHCKaSl TBOpeH"'e Ka>K,Qolii BMCI1MYIO, 3aB"'CI'I-
COBMecTHo C cecTpa BbI6M- HapyweHHoj;j no- MillO, B3a"'M03aB",-
nal.\",eHTOM paeT cnoc06bl Tpe6HOCT'" B COOT- C"'MytO.
Me,Ql'll.\l'lHCKaSI ceCT- p"'HCKO- BeTCTB"'''' C no- HeaaB"'C"'Ma51
cecTpa on- ro BMewa- CTaBneHblMM l.\e- pol1b - 3aKnlO'la-
peAen5leT TenbCTBa, nSlMl4. ECI1M >l<e- eTCSI B Ol.\eHKe COC-
LIen", YX0.Qa. HanpaBneHHO- naeMblj;j pe3ynbTaT TOSlH"'SI 3AOPOBbI'I
ra Ha YAOBne- He AOCTIIrHyr, Me- nal.\"'HTa, COBMe-
TBopeH"'e AM- LI"'HCKaSl ceCT- CTHO C nal.\"'eHTOM.
nOTpe6HO- pa BMeCTe C naLlM- 3aBMC"'MaSI POIlb-
cTej;j. eHTOM nepeCMaT- 3TO BblnOIlHeHMe
p",eaeT l.\eIl'" M Ha3Ha'leHMj;j epa-
npeAnpMHSlTble '1a. B3a"'M03aBM-
paHbwe BMewa- CMMaSI pOIlb - 3TO
TenbCTBa. pa60Ta B 6p",raAe
C APyr"'M14
cne U",anMCTaM"'.
-
npHMeHeHHe MOJJ;eJIH Poynep, JIOl'aH, TaHapHH
B CeCTpUHCKOM npo:Qecce
Ou,eH.l1:a COCmOJl.H.UJl, nau,ueH.ma.
TIepBH'IHaH cecTpHHcKaH O eHKa npoBO,D;HTCH ,ZJ,J.IH c60pa
,D;aHHLIX 0 Kroit,D;OH nOTpe6HOCTH, 3aTeM Me,D;H HHCKaH ceCTpa
YCTaHaBJIHBaeT:
. 'ITO na HeHT MO:meT ,D;e.TJ:aTb B HaCTOHll{ee BpeMH;
. 'ITO na HeHT B 06LI'IHOH cHTya HH BbmOJIHHeT 6e3 3aT-
PY,D;HeHHH;
. KaKHe ,lJ,eMCTBHTe.TJ:bHbIe np06.TJ:eMbI CYll{eCTByroT B Ha-
CTOHll{ee BpeMH;
. KaRHe nOTeH miJIbHLIe np06JIeMbI MOryT pa3BHTbCH.
TIPH nJIaHHpOBaHHH YXO,lJ,a Me,D;H HHCKaH ceCTpa 3arrnCLI-
BaeT ,D;eHCTBHTe.TJ:bHbIe H nOTeHIumJIbHbIe npo6.TJ:eMbI, e.TJ:H yxo-
,lJ,a H ceCTpHHCKHe BMellIaTeJIbCTBa.
CeCmpUH.CKUe 8M.eWameJlbCm8a.
)J;OJI:mHLI:
. npe,lJ,ynpe,D;HTb pa3BHTHe nOTeHI.\.HaJIbHLIX np06JIeM;
. YMeHbllIHTb TpeBOry na HeHTa;
79
. npe,D;OC'l'ciBHTb b03MO:IKHOCTb 06pall{aTbCH 3a nOMOll{bIO
H npJolHeMaTb ee ,D;JIH Y,D;OBJIeTBOpeHHH HapYllieHOM no-
Tpe6HOCTH
. nOMOqb pellIHTb ,D;ef.icTBHTeJIbHbIe np06JIeMbI.
Oije1t1W Ka'lecm6a u pe3y.nbmamoo yxoaa.
TIPH npOBe,D;eHJoIH JoITOroBOM o eHKH Me,D;IU.\JoIHCKaH ceCTpa
YCTaHaBJIHBaeT, ,D;OCTHrHYTbI JIIoI nOCTaBJIeHHbIe u;eJIJoI 101 Ha-
CKOJIbKO nOJIe3HOM H 3Cl>cPeKTHBHof.i OKa3aJIaCb ,D;aHHaH MO,D;eJIb
CecTpHHCKOro ,D;eJIa B pellIeHHH ,D;ef.icTBHTe.rrbHbIX np06JIeM.
HanpUMep:
TIa HeHTKa HaXO,D;Hll{aHCH Ha nOCTeJIbHOM pe:IKHMe, OTKa-
3bIBaeTCH OT npHeM3. nHll{H H3-3a Toro, qTO ef.i npHXO,D;HTCH
npOCHTb nOMOll{H npH cPH3HOJIOrHqeCKHX OTnpaBJleHHHX.
TIPH npOBe,D;eHHH nepBJoIqHOM ceCTpHHCKOM o eHKH MbI BbI-
HCHJoIJIJoI :
- qTO naU;JoIeHTKa MO:IKeT ,D;eJIaTb B HaCTOHll{ee BpeMH;
- KaKJoIe ,D;eMCTBHTeJIbHbIe np06JIeMbI CYll{eCTBYIOT B Ha-
CTOHll{ee BpeMH.
TIpH nJIallJolpOBanUH ceCTpIiHCKoro BMellIaTeJIbCTBa Me,D;H-
U;HHCltaH ceCTpa ,D;OJI:lKHa:
- nOMOqL pellIHTb ,D;eMCTBHTeJIbHble np06JIeMbI;
" - npe,D;OCTaBHTb naU;HeHTKe B03MO:/KHOCTb 06pall{aTbCH 3a
nOMOll{bIO H npHHeMaTb ee ,D;JIH Y,D;OBJIeTBOpelIHH Hapy-
llIeHHof.i nOTpe6HOCTH.
qeJIOBeK HMeeT 7 rJIaBHbIX nO,D;CI1CTeM, KOTOpble H3MeHn:DT
ero nOBe,D;eHJoIe.
nOACMCTeMa Cyn. nOBe.QeHMfI B paMKax no,qCMCTeMbl
nOBe.QeHMSI
AOCTM>KeHMe KOHTponb HClA CaMI<1M c060i1 M CBOMM OKp}'JKe-
(BbinonHeHMe) Hl<1eM
npl<1COeAl'1HSlIOLLlCIfI 6nl<131<1-1e B3a:.lMOOTHOweHMSI C l1PyrnMM nlOAbMI<1
(ycTaHaBnMBaIOLLlaSl)
ArpeCCI<1SHaSi CaM03aLLll<1Ta OT yrp03bl, ca 1OyrBep)f(,QeHMe
3aBMCMMaSi 3aBi'lC!.1MOCTb OT APyrl-lx
BblAenlITeJlbHa51 BblABneHl<1e npOAYKTOB );(1'13He,QeSlTenbHOCTI-I
nl-lLLleeapeHl-le nO,IJ,Qel»KaHl-le LlenOCTHOCTI-I OpraHI-I3Ma, COCTO-
SlHl-le TeneCTHOro YAOBonbCTBI-I5I
CeKcyBnbHaSi CeKcyanbHoe YAOBOnbCTBl-le
ABTOp OCHOBHble IIICTO'lHMK HanpaBneHHocTb
nOnOJKeHI-ISI npo6neM CeCTpl!1HCKOro
MO.Qenl<1 MO.Qenl-l naLlI-IBHTa BMewaTenbCTBa
A>KOHCOH A. naLll-leHT - 3TO 60ne3Hb, He06xoAl'1MO
MHAI-IBI-IA 1-13MeHeHl<1e OLleHI-ITb COCTOSIHMe
\I1MeIOU\I'Ii1 Ha60p 06pa3a JK1<13- naLll-leHTa OTHO-
B3al-lMOCBSl3aH- HI-I,MOryr CI-ITenbHO KID!<,QOi1
HblX pa36anaHcM- nOACI-ICTeMbl.
CI-ICTeM nOBeAe- poBaTb nOA- 31"Y OLleHKY ocyu\eCT-
HI-ISI '1BnOBeKa, CI<1CTeMbl BnSlIOT B ,QBa 3Tana:
npl-l'leM Ka>i\AaSl nOBeAeHI-ISI - onpeAemllOT, no-
1-13 HI-IX CTpe- '1enOBeKa 3BonHeT nl-l nOBeAe-
MI-ITbCSI K 6anaH- Hl<1e naLll<1eHTa npeA-
cy M paBHOBeCl-l1O nOnOJKI-ITb Hapywe-
BHyrpl-l ce651. Hl-le paBHoBecMSI B
KaKoi1-nl-l60 1-13 nOA-
CIo1CTeM;
- onpeAenHIOT npl-l-
'1MHY 3TOro Hapywe-
HI-IH.
Mo,qenb A. AmOHCOH
,ZJ;. ,ZJ;:lKOHCOH onpe,D;eJI.!IeT ,D;ef.icTBJoIe KIDK,D;OM nO,D;CJoICTeIl7bI B
CTpeMJIeHHH qeJIOBeKa Ha OCIIOBe npIlIJIoro OnbITa, ,!IOCTHqb
Onpe,D;eJIeHHbIX eJIeM
:3TOT pe3YJIbTaT 3aBHCHT OT TOro, KaK na HeHT BOcnpHHe-
MaeT CBoe nOBe,D;eHlie, KaK OH nOHHMaeT CBOH B03MO:IKHOCTH B
H3MeHeHIUoI nOBe,D;eHHH.
,ZJ;.,ZJ;:lKOHCOH pa3JIHqaeT,,D;Ba OCHOBHbIX THna nOBe,D;eHU.!I qe-
JIOBeKa.
. YCTaHOBKa, C03,D;aBaeMaH ,D;eMCTBH.!IMH H 06beKTaMH He-
nOCpe,D;CTBeHHO BOKpyr qeJIOBeKa;
. YCTaHOBKa, C03,D;aBaeMaH npOIliJIbIMH npHBbIqKaMH. .
Llenb
oAa
BOCTa-
HOBneHl-le
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e3 nbTaTOB o.Qa
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80
Ponb MeAI<1l\I<1H-
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Ponb M9AI-ILlI<1HC-
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81
npliMCHeHHe MOAeJIH )I..)I.'KOHCOH
B CeC-rpHHCKOM npo ecce
Oije1tlCa .cocmOJlnUJl naijuenma
Ha nepBOM a-rane CeCTpMHCKOrO npo ecca npoBO,!\JoITCH nep-
BH'lHaH O eHI<:a COCTOffilHH naIJ;HeHTa. Me,!\HIJ,MHCKaH ceCTpa on-
pe,!\CJIHeT, cy eCTByroT JIH np06JIeMhI, CBH3aHHble C nOBe,!\eHMeM
naIJ,HeHTa. Ha BTOpoM a-rane CeCTpHHCKOrO npo ecca H3y<1aJOTCH
nO,u;CHCTeMbI, Bbrrne,!\IIIHe JoI3 paBHOBeqHH: ,n:.,n::mOHCOH npe,WIara-
eT BbI,!l;eJIHTb OT,!\eJThHO CTpyKTYPHbIe (OpraHH'IeCKHe) H clJyHKIJ,M-
OHHaJibHbIe H3MeHellliH, IIbI3bIBBJOlW'Ie npo6JIeMY. Me,!\HW1HCKaR
cecTpa peIllaeT, Ha 'ITO ,u;OJI:lKHO 6bITb HanpaBJIeHO CecTpHHCKoe
BMeIllaTCJIbCTBO, ,D;JIH 3T01'O He06xo,!\JoIMO nOJIy<lJolTb ,!\onOJIHJoITeJIb-
HYIO MH<}>opMaIJ;HIO OT po,u;CTBeHHHKOB H JIe'laIIWI'O Bpa'la.
ABTOP ,!\aHHOH MO,!\eJIH YTBep:m,!\aeT, HapYIlleHHe paBHOBe-
CHH B O,u;HOH nO,!\CHCTeMe OKa3bIBaeT BJIJoIHHHe Ha B3aHMOCBH-
aHHbIe nO,!\CHCTeMbI.
IIJIaHHpoBaHHe yxo,!\a.
YCTaHOBJoIB HapYIlleHHe paBHOBeCHH B KOHKpeTHbIX nO,!\CH-
CTeMaX, Me,u;H JoIHCKaR CeCTpa BMecTe C naD;P1eHTOM onpe,u;eml-
eT eJIb yxo,u;a.
ECJIH np06JIeMa na JoIeHTa CBH3aHa C q)YHK HOHaJibHbIMM
HapYIIICHHHMJoI, Me,!\H HHCKaH CeCTpa onpe,!\eJIHeT BMeIllaTeJIb-
CTBO, HanpaB.'leHHbIe Ha 113MeHeHHe oKPymaIO eii: Cpe,!\bI, H3-
MeHeHJoIe MOTHBaIJ,MH naIJ;HCHTa.
,n:JIH OCy ecTBJIeHMH nJIaHa yxo,!\a YCTaHaBJIHBaIOTCH KpaT-
KOCpO'IHbIe. npOMe:mYTO'IHbIe H ,u;O.'lrOCpO'IHbIe e.'nI BOCCTa-
HOBJIeHHH paBHOBeCHH B nO,u;CHCTeMax.
CeCmpUnClCUe eMeWameJlbCmea:
- OrpaHH'IeHHe nOBe.u;eHHH;
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- COTPY,!\HH'IeCTBO Me,!\JoI MHcKOii: CecTpbI C naD;JoIeHTOM. TIa-
HeHT .u;OJI:meH npe,u;CTaBJIHTb CBOIO pOJIb, CBOH ,!\eii:cTBHH
B BOCCTaHOBJIeHHH 3,!\OpOBbH.
On;eHKa Ka'leCTBa n peaYJIbTaTOB yxoAa. Me.u;M HHCKaH
CeCTpa OnJolCbIBaeT pe3YJIbTaTbI CeCTpJolHCKMX BMemaTeJIbCTB,
YKa3bIBaH O,!\HH H3 ,u;BYX THnOB nOBe,u;eHHH, 3apaHee npe,u;BH-
,!\eTb B03MomHoe nOBe.l\eHHe nan;HeHTa, TaR KaK OHO onpe,u;e-
JIHeT, 'ITO BMeIllaTe.'lbCTBO 6bIJIO ycneIIIHbIM H D;eJIb ,!\OCTHr-
HYTa.
ECJIIo! o:mJol,!\aeMbIe pe3YJIbTaTbI He ,!\OCTHrHYTbI, Me,!\M HHC-
KM cecTpa npOBo,u;HT nepeo eHKY nOBe,u;eHJoIH na HeHTa B npe-
,u;eJIax Kam.l\oii: nO,!\CHCTeM.
H anpUMep:
TIa HeHT HaXO,!\JoITCH Ha JIe'IeHIU1 B TpaBMOTOJIOrH'IeCKOM
OT,!\eJIeHHH no nOBO,!\Y nepeJIOMa npaBoro 6e,!\pa. TIocJIe CKe-
JIeTHOI'O BbITHmeHJoIH, Bpaq Ha3Ha'IHJI na JoIeHTY, y<lHTbCH xo-
,!\HTb C nOMOIl(bIO KOCTbIJIeH. XO.u;HTb Ha KOCTbIJIHX eM)' TPY -
HO, HO OT nOMO H po,!\cTBeHHKoB OH OTKa3bIBaeTCH He meJIaH
HX BH,!\eTb.
TIPIo! nepBH'IHoii: OD;eHKe COCTOHHHH Ha6JIIO,!\aeTCH HapYIlle-
HHe B arpeccHBHoii: H 3aBHCHMOH nO,!\CJoICTeMax.
TIpH nJIaHHpOBaHHH ceCTpHHCKoro BMeIllaTeJIbCTBa, ceCTpe
npe,!\cTOHT peIIIHTb, Ha 'ITO ,u;OJImHO 6b!Tb HanpaBJIeHO BMe-
maTeJIbCTBO. l1.JIH 3TOI'O eii: He06xo,!\HMO nOJIY'IHTb ,u;onOJIHFf .
TeJIbHYIO HHQ.>opMa MIO OT po,!\cTBeHHHKoB.
Me,!\H JoIHCKaH ceCTpa ,!\OJI:mHa onpe.u;eJIHTb, OKa3bIBaJiCH JIH
naD;HeHT B no,!\06HoH CHTyau;HM npem.l\e ('1pe3MepHbIii: CTpax
I.(enb CeCTp HCKOe eHKa K3'1eCTB3 Ponb Me.Q LI H-
vxo.Q3 BMeWaTenbCTBO De3VnbT3TOB vxo.Qa CKOM CeCTJ>bl
MeJt<,QY - KOHTpOnb ..m TE!MM n HbIM HO He 33B C"'"
H M . orpaHl<l'leH e CTpyKTYpHblM 3Me- OT Hee. CecTpe
lo1:3MeH5ISI nOBeAeHIo1S! Ka- HeHIo1S!M B opraHlo13- OTBeAeH3 ponb
Te n KI-1MIo1-TO paMKa- Me '1enOBeKa. Ecn CneLjManlo1CT3,
Io1Hbie {/JaK- M ; pB3ynbT3T CB5I3aH C BOCCTaHaBn -
TOpbl OK- - 3a T3 OT 3ann3HIo1pOBaHHblMIo1 BalOLLlero P3B-
Py>K31O- yrp03 101 ApyrHX 3MeHeH 51MIo1 OKPy- HOBeClo1e nose-
LLleM cpe- {/JaKTOpOB, Bbl- >KaIOLLleM CpeAbl, OLle- AeH4ecKI-1x no.Q-
Abl. 3blB31OLLlIo1X HIo1BaeTCS! 3MeHeHlo1e CIo1CTeM n3Ljlo1eH-
CTpecc; nOBeAeH S!. o6y- Ta BO BpeMS!
cnoeneHHOe ceCT- ncw<onorlo1'1e-
-TOpMOJKeHHe p HCKHM BMeW3Tenb- CKOro n <!> -
(noAaBneH e) CTBOM H3npaBneHbiM 3M4eCKoro KP -
He3<p<!>eIffi1BHblX Ha OKPy>KeH e B CBS!- 3 ca.
peaKLjIo1M: 3 C <PYHKLI OHallb-
- CTHMyn po- HbIM 3MeHeHIo1S!M .
BaHHe K 3Me- Ecn HeT pe3ynbT3T3
HeH 1O nOBeAe- BHOBb <POpM PYIOTCS!
H S!, napTHepCT- HOBbie Ljen 101 HOBbie
BO, nOMOLLlb B BMeWaTenbCTB3.
BIo1Ae one KH.
83
BZ
AAanTa4MOHHaA MOAenb
ceCTpMHCKoro Aena K. POM
MOp;eJIb K.Pon c03AaHHaH B 1976 roAY HCnOJIb3yeT AOCTH-
:meHHH B 06JIaCTH cPH3HOJIOrHH H CO HOJIOrHH. K.Pon nOJIara-
eT, qTO KaK AJIH cPM3HOJIOrJolqecKHX, TaK H AJI51 nCIIXOJIOrH-
lecKHX CHCTeM CYll(eCTByeT COCT051HHe OTHOCHTeJIbHOrc. paB-
HOBecH.H, IWToporo CTpeMHTCH ,nOCTHqb qeJIOBeK, TO eCTb Ka-
Kon-TO AHan030H COCT051HHM, B KOTOpOM JIIOA" MoryT aAeK-
BaTHO CnpaBJIHTbCH CO CBOHMH nepe:IKI1BaHHHMH. )J;JIH KIDlt,nO-
ro IeJIOBeIta 3TOT AHana30H YHHKaJIeH.
COrJIaCHO 3TOii MOAeJIH, eCTb onpeAeJIeHHbIi-i ypoBeHb a,!\an-
Ta HH, H Bce pa3Apa:mHTeJIH nona,!\aIOll(He B 3TOT ,nHana30H,
BCTpeqaIOT 60JIee 6J.larOnpH51THYIO peaK HIO, 'IeM Te, KOTopbIe
OKa:mYTCH 3a ero npe,ne.TJ:ar.m.
K.POM Ha3bIBaeT l}>aKTopbI, BJIHHIOll(He Ha ypoBeHb a,!\an-
Ta HH, pa3Apa:IKHTeJIHMH, OHH 6bIBaIOT Tpex THnOB:
. O'IaroBbie - Haxo,nHTCH B oKPy:meHHH qeJIOBeKa
. cHTya IlOHHbIe - B03HHKaIOT npH OKa3aHHH cecTpHHc-
Kon nOMOll(H PHAOM C OqarOBbIMH H OKa3bIBaIOT Ha HHX
BJIHHHHe.
. OCTaTOqHbIe - pe3YJIbTaT npOIliJIbIX nepe:mHBaHlIn, Be-
pOBaHHn, B3aHMooTHollIeHHn. IIPH COqeTaHHH C oqaro-
BbIMH H CHTY 1I0HHbIMH OHH BJIHHIOT Ha ypoBeHb a,!\an-
Ta HH. IIpeA.TJ:araeTCH qeTbIpe cnoc06a aAanTa HH 1013-
MeH.HIOll(HX nOBeAeHHe:
. clm3HoJIorH'occKHn;
. .H-KoH en HH;
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«I>H3HOJIOrHqeCKHn cnoc06 a,!\anTa HH - 3TO peaR HH 'IeJIO-
BeKa Ha TeMnepaTYPY, BJIa:IKHOCTb, aTMocc}:!epHoe AaBJIeHHe,
nHll(Y, :lKHAKOCTb, KHC,JIOPOA. Cnoc06HOCTb CnpaBJIHTbCH C
HenpHBbl'IHbIMH, cPH3HOJIOrHqeCKHMH pa3,npa:IKHTeJI51MH 3aBH-
CHT OT B03MO>KHOCTen cPH3HOJIOrH'IeCKOM CHCTeMbi a,!\anTa HH
KOHKpeTHOrO qeJIOBeKa.
.H-KoH en Hfl - 3TO :meJIaHHe qeJIOBeKa nOHHTb caMoro
ce6H: KaR c06CTBeHHoe nOBe,neHHe, TaIt 101 TeJIeCTIIbIn 06pa3.
STOT cnoc06 a,nanTa HH nOMoraeT qeJIOBeKY cnpaBHTbCH C
H3MeHeIIHHMH ero nCHXOJIOrHqeCKHX H TeJIeCHbiX «51». STOT
cnoc06 a,!\anTa HH 3c})(}:!eItTHBeH npH no,nrOTOBKe na HeHTa K
onepa HH, oc06eHHo npH onepa HHX H3MeHHIOll(HX ero TeJIO;
aMnyTa HH KOHeqHOCTen, MaCT03KTOMHH, Han:O:IKeHHe CTOMbI.
POJIb-cl>YHK HH npeAnOJIaraeT H3MeHeHHe pOJIH na HeHTa
B ceMbe Ha pa60Te B3aBHCHMOCTH OT Tex HJIH HHbIX 06CTOH-
Te.TJ:bCTB.
AKTHBHbIn, AeHTeJIbHbIM 'IeJIOBeK, 3aHHMaIOll(Hn onpeAe-
JIeHHOe nOJIO:IKeHHe B 06ll(eCTBe, OIta3bIBaeTCH B JIeqe6HOM y<I-
pe>i\:,ll;eHHH H BbIHY:lKAeH aAanTHpOBaTbCH K nacHBHon pOJIH
n HeHTa.
B3aHM03aBHcHMoCTb - 3TO CTpeMJIeHHe qeJIOBeKa AOCTHqb
COCTOHHHH OTHOCHTeJIbHOrO 6an:aHca B pa3JIHqHbIX B3aHMOOT-
HOllie1lI1HX. CeCTPHHCKOMY nepCOHan:y CJIe,nyeT y<IHTbIBaTb 01'-
paHHqeHHOCTb B03Mo:mHocTen aAanTa HH B cHTya HHx, Kor-
,na na HeHT, OKa3aBIlIHCb nOJIHOCTbIO 3aBHCHMbIM OT nepCOHa-
JIa, HcnbITbIBaeT IYBCTBO AaBJIeHHH, npe3peHHH, OAHHOqeCTBa,
l}>aMHJIbHpHOCTH.
3a CBOIO 6e30nacHocTb). ECJIH OK83bIBaJICSI, TO Y na HeHTa
CTPYKTYPHbIe (opraHHqecKHe) H3MeHeUHH. ECJIH nOBeAeUHe He
THnllqHO AJIH na HeHTa MO:IKHO c,neJIaTb CJIe,nYIOll(Hn BbIBO,n,
qTO 3TH H3MeHeHHH C}>YHKUHOHaJIbHOn npHpO,nLI.
IIpH nJIaHHpOBaHHH YXOAa MeAceCTpa COBMecTHO C na H-
eHTOM onpe,neJIHeT eJIb YXOAa.
ECJIH np06JIeMa na HeHTa CBH3aHa C cPYHK HOHan:bHbIMH
HapYllIeHHHMH, Me,nceCTpa onpeAeJIHeT BMellIaTeJIbCTBa, Ha-
npaBJIeHHbIe Ha H3MeHeHHe oKpy:maIOll(en cpeAbI, H3MeHeHHe
MOTHBaIJ;HH na HeHTa. IIaIJ;HelITY He06xOAHMO 3anJIaHHpOBaTb
nCHXO.TJ:OrH'IeCKYIO nOMep:mKY H KOHCYJIbTlIpoBaHHe, n03BO-
JIHIOll(ee YMeHbllIHTb HeonpaB,naHHbIM CTpax nepeA XOAb60i1:
Ha KOCTbIJIHX.
CeCTpHHCKoe BMellIaTeJ.IbCTBO:
- 3all(HTa na HeHTa OT He6JIarOnpHmHbIX c}:!aKTopOB OK-
Py:maIOll(en cpe,nbI (nopeKOMeHAOBaTb po,nCTBeHHKaM He
yqaCTOBaTb H He HaCTaHBaTb Ha OKa aHHH nOMOll(H na-
HeHTY npH XOAb6e).
- no,naBJIeHHe Hea,!\eKBaTHbIX peaK HM na HeHTa( MeAH-
HHCKaH ceCTpa MO:meT TOpM03HTb ero HeaAeKBaTHoe
nOBe,neHHe, y6e:m,u;aH na HeHTa, qTO ero CTpax npe-
YBeJII1qeH).
84
85
ABTOp OCHOBHble CTO'lHMK Hanp3BneHHOCTb
MO.QenM nOnOJKeHL1f1 np06neM _ CeCTpMHCKOrO
MO.qenH n3LlMeHT3 BMeWaTenbCTB3
K. PO nal!L1eHT-aTO nOTpe6HOCTb B npL1 06Cne.qOBaHL1L1
MH.qL1BL1A. CecTpMHCKOM yxo.qe naLlMeHTa Cne.qyeT YC-
MMelOlLlM.;! B03HL1KaeT B TOM TaHOBL1Tb acjJcjJeKTMB-
Ha60p B3aM- CflY'Iae. KOr.Qa B Hble CnOC06bl a.qama-
MotBfl3aHHblX OKPYJKe4MM '1enOBB- LlL1L1 B TeX cnY4 x,
6L1onorM'Ie- Ka HeAOCTaTOK L1nM KOr.qa ero nOBe.qeHL1e
CKO , nCMXO- L136bITOK cpe.qCTB M p;2eT nOBO.q AIl51 6ec-
nOrM'IeCKO , B03MOJKHOCTe AIlfl nOKO CTBa. CeCTpa
M COLlL1anbHO McnOnb30BaHL1f1 onpe.qeJlfleT CTeneHb
CL1CTeM, TOro L1nL1 L1HOrO BnMflHL1f1 aTora paa-
BnL151lOlLlL1X Ha cnoco6a a.qama- ,Qpa>Kl1TeJlS! Ha nOBB-
nOBe.qeHL1e. l!L1M. AeHL1e nal!L1eHTa.
npHMeHeHHe MOAeJIIi Ie.Poii B cecTpHHcKOM npol(ecce
O e1tKa CocmOJl1tuJ/, na ue1tma.
Me,!\Hl(HHCKaH cecTpa ,!\OJI:mHa onpe,!\eJIHTb, ,!\aeT JIH nOBe-
,!\eHHe nal(HeHTa B .'11060M H3 'IeTblpeX cnoc060B 8,!\anTal(HH
nOBO,!\ AJIH 6ecnoKoiicTBa. ECJIH nOBO,!\ ,!\JIH 6ecnoKoiicTBa ecTh,
Me,!\Hl(HHCKaH cecTpa ,!\OJI:mHa BblHCHJoITb, '1eM 06YCJIOBJIeHbI
np06JIeMbl a,!\anTal(HH nal(HeHTa: O'iaroBblMJoI, cHTya HoH-
HblMJoI HJIH OCTaTO'IHblMJoI pa3,!\po:mHTeJIHMH.
Me,!\Hl(HHCKaH cecTpa HCnOJIb3YlOIl(aJI STY Mo,!\eJIb, onpe,!\e-
JIHeT npe,!\eJIbl YPOBHH a,!\anTal(HJoI ,!\JIH Ka:m,!\OrO '1eJIOBeKa,
TO, '1TO HB.'meTCH pa3,!\po:mHTeJIeM H C03AaeT npo6JIeMbl ,!\.iIH
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C03,!\aeT HHKaKHX npo6JIeM.
I!Jla1tupoea1tue ceCmpU1iCKOZO yxoaa.
Me,!\Hl(HHCKaH ceCTpa BblHBHB pa3,!\pamHTeJIJoI, BbI3blBalO-
Il(He Y nal(HeHTa Hea,!\eKBaTHble peaKl(HH, COBMeCTHO C nal(H-
eHTOM onpe,!\eJIHeT l(eJIH:
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BeHb a,!\anTal(HH HJIH YCTpaHJoITb pa3,!\pa:mHTe.'lb;
- ,!\O.'lrOCpO'lHaH l(eJIb yxo,!\a nOMo:meT nal(HeHTY a,!\anTH-
pOBaTbCH K nocT6HBHO H3MeHHlOIl(eHcH oKpymaIOIl(eH
cpe,!\e.
CecTpHHcKoe BMemaTeJIbCTBO no Mo,!\eJIIo! R.POH. I1peJJ;no-
JIaraeT, 'ITO Ka:m,!\bIH -qeJIOBeK CTpeMHTbCH K COCTOHHHlO
nCHXOJIOrH'IecKOro H JoI3HOJIOI'H'IeCKoro paBHoBecHH. CecT-
pJolHCKOe BMemaTeJIbCTBO ,!\OJI:mHO H3MeHHTh pa3,!\pamHTeJIb
TaK, '1T06bl OH ,!\eHCTBOBaJI B npe,!\eJIax ypOBHH a)\anTal(HH H
6blJI HanpaBJIeH Ha O'iaroBbIe pa3,!\pa:mHTeJIIo!.
O ellKa 3(j}(peKmU61iOCmU ceCmpU1iCKOZO yxoaa.
CecTpHHcKoe BMemaTeJIbCTBO s eKTHBHo TOJIbKO B TOM
C.'IY'lae, eCJIH ,!\OCTHrHYTa l(eJIb B KOHKpeTHbIX 8,!\anTHBHblX
cnoc06ax.
HanpuM.ep:
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OHa no,!\aBJIeHa H He meJIaeT HHKoro BH,!\eTb H3 nOCeTHTeJIeH,
KpOMe 6.'lH3KHX pOACTBeHHHKOB.
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npe,!\nOJIo:mH.'la np06JIeMY a)\anT HH B CHCTeMe .H-KOHnen-
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nOSTOMY nal(HeHTKa He Mo:meT nonpe:mHeMY no,!\p;ep:mHBaTh
OTHomeHHH C oKpy:maIOIl(HMH.
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Hea.qeKB3THoe YT06b1 L13MeHL1Tb nOnOJKMTenbHb e nepL1o.q 3,110-
nOBe.qeHL1e, ceCT- 11)(, MIlL1 'lT06bl <+IBL1rM B TOM poBbfI L1 60-
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OKPYJKalOw.ei:'i H8 paCWL1peHL1e B 30HY Tora
cpe.qe. ypOBHfI a.qama- L1nL1 L1HOra
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eMY B03MQ)f(- TBLlL1L1.
HOCTb Cnp3BMTb
C L1MelOlLlL1MMCfI
pa3,Qpa>Kl1TeJlS!-
MH.
86
87
MeAH HHCKaR cecTpa COBMec'I'HO C na HeHTKOn OnpeAeJIR-
eT KpaTKOCpO'lHYIO eJIb YXO.l(a, n03BOJIRIO IO pellIHTb ypo-
BeHb aAanTa HH. B AaHHOM CJIy<lae, .l(.rm na HeHTKH o YI.U;e-
HHe ce6R B COCTORHHH npOBecTH KaKOe-TO BpeMR B 06I.U;eCTBe
.l(PY3en.
CeCTpHHcKOe BMellIaTe.rlbCTBO AOJI:mHO H3MeHHTb O'iarOBbln
pa3.l(pa:mHTeJIb TaK, 'IT06bl OH AeMCTBOBaJI B npeAeJIaX YPOB-
HR aAanTa HJoI.
MeAHlJ,HHCKaH cecTpa He CMO)l{eT YCTpaHHTb O'iarOBbIn pa3-
Apa:mHTeJIb - OTCYTCTBHe MOJIO'lHOn :meJIe3bl Y naI.\HeHTKH, HO
OHa CMo:meT paCllIHpHTb ypOBeHb ee aAanTa HH, n03HaKOMHB
c JIHTepaTypon onHCbIBaIO en cHTya HIO B KOTopon HaXO.l(HT-
CR na HeHTKa HJIH n03HaKOMHTb C .l(PyrHMH na JoIeHTKaMH
KOTopble y:me aAanTHpOBanHCb B nO.l(06HOn cHTyalJ,HH.
. BpeMR OAHHO'leCTBa C6aJIaHCJoIpOBaHO co BpeMeHeM B 06-
I.U;eCTBe .l(pyrHx JIIOAen.
YpoBeHb y.l(OBJIeTBOpeHHR Ka:mAon H3 BOCbMH nOTpe6HOC-
Ten AJIR KIDKAore 'IeJIOBeKa HHAHBfI.l(yaneH.
qJaI{TOpbI BJIHRIOI.U;JoIe Ha 3TJoI nOTpe6HOCTH: B03paCT, nOJI,
CTa.l(HH pa3BHTH.H, COCTO.HHHe 3AOPOBb.H, ypOBeHb KYJIbTYPbl,
CO Ha.TJ:bHa.H cpeAa, HHaHCOBble B03MO:mHOCTH.
2. nOTpe6HocTH CBH3aHHLIe co CTa,l.l;Heii pa3BIITHH.
. 3TH nOTpe6HOCTH YAOBJIeTBOp.HIOTC.H BceMH B3pOCJIbIMH
JIIO.l(bMH (naI.\HeHTOM, ero pOACTBeHHJoIKaMJoI) nOMaIOI.U;I1-
MHCH 06y<leHHIO H BocnHTaHHIO.
3. nOTpe6HocTH CBH3aHHLIe C HapyweliHeM 3,1.1;OpOBbH.
B 3Ton rpynne Bbl.l(eJIeHO TpJol BHAa HapyweHHn:
. aH8.TOMH'IecKHe H3MeHeHH.H (OTeKH, o:morH, paHbI H T.A.)
. «l>YHK HoHanbHble cPH3HOJIOrn'lecKI.J:e H3MeHeHH.H (O.l(bIIlI-
Ka, TyronO.l(BH:mHOCTb cycTaBa)
. H3MeHeHHe nOBe.l(eHH.H HJIH nOBCe.l(HeBHblX :mH3HeHHbIX
npHBbI'IeK('IYBcTBO 6e3pa3JII.J:'IH.H, 6eCCOHHI.\a, BHe3an-
Hble H3MeHeHH.H HaCTpOeHJoI.H).
MORenb J,\. OpeM
MOAeJIb npeAJIo:meHHa.H ,ZJ;.Op3H B 1971reAY, paCCMaTpJol-
BaeT 'IeJIOBeKa KaK e.l(HHOe eJIoe. OHa OCHOBaHa Ha npHHI.\H-
nax caMOYXOAa. B MO.l(eJIH YAeJI.HeTC.H 60.TJ:bllIOe 3Ha'leHHe JIH'I-
Hon OTBeTCTBeHHOCTH 'IeJIOBeKa 3a COCTO.HHJoIe c06CTBeHHore
3AOPOBb.H.
CecTpHHCKOMY BMeIlIaTeJIbCTBY YAeJI.HeTC.H 60JIbIlIOe 3Ha'le-
HJoIe B npo«l>HJIaKTHKe 3a60JIeBaHHM TpaBM H 06Y'IeHHIO naI.\H-
eHTa H ere pO.l(CTBeHHJoIKOB.
B MOAeJIH BblAeJIHHbI TpH rpynnbl nOTpe6HocTen B caMO-
yxoAe:
1. YHHBepCaJIbHbIe:
. .l(OCTaTO'lHOe nOTpe6JIeHHe B03.l(yxa;
. .l(OCTaTO'IIioe nOTpe6JIeHHe :mJol.l(KOCTI.J:;
. .l(OCTaTO'lHOe nOTpe6JIeHHe nH H;
. .l(OCTaTO'lHa.H B03MO:mHOCTb Bbr,n:eJIeHJoIH H nOTpe6HOCTJoI,
CBH3aHHr:.Ie C 3THM npo eccoM;
. coxpaHeJIHe 6aJIaHCa Me:m.l(y aKTHBHOCTbIO H OTAbIXOM;
. npe.l(ynpe:m.u;eHJoIe onaCHOCTH .l(JI.H :mJol3HJoI, HOpMaJIbHoi%
:mH3HeAe.HTe.TJ:bHOCTH, xopOlliero caMO'lYBCTBH.H;
. CTHMYJIHpOBWme :meJIaHI.J:.H COOTBeTCTBOBaTb onpe)J.eJIeH-
HOM COI.\HaJIbHOn rpynne B COOTBeTCTBflH C HHAHB y-
aJIbHbIMH cnoc06HOCT.HMH 101 OrpaHJoI'IeHHHMH.
ABTOp OCHOBHble IiICTO'lH K HanpaBneHHocTb
MO.r:len nOnO)KeH fI npo6neM ceCTp HCK X
MO.r:len naLl eHTa BMewaTenbCTB
A.OpeM naLjMeHT - Ecn I1aLjMeHT HanpBneHo Ha BblflBneH-
eA Hafl He MOJKeT CO- Hblr:1 Aecplo1L1Io1T caMOYXOAa
CPyiiKLlIo10- XpaH Tb paBHO- 101 ero npM'I Hbl.
H8nHafl BeClo1e Me>K,QY np '1 HaMIo1 Aecp LjIo1Ta
CIo1CTBMa, CBO MIo1 BOMOJK- MOryr 6b1Tb:
MeIOUlaSl HOCT5IM 101 no- - OTcyrcB e 3HaHIo1(;;
MOTHBaLjlo11O Tpe6HOCTflM B
K caMOYXO- caMOYXO.Qe, a - HeYMeHlo1e BblnonHflTb
p,y. nOTpe6HocT OTAenbHble .Qe(;;CTB fI no
caMOYXOAa npe- caMOYXOAY HenOH MaH e
BblwalOT B03- BaJKHOCTIo1 caMOYXOAa.
MO>f<HOCTIo1 caMO- AnSI peWeHIo1f1 Bonpoca 0
ro naLllo1eHTa, - He06xOA MOCT ceCTpMH-
B03HIo1KaeT He- CKOro BMewaTenbCTBa
06xOAIo1MOCTb B cecTpa AOn>f<Ha:
cecTplo1HcKOM - onpeAen Tb ypOBeHb
nOMOUlIo1. no- Tpe60BaHIo1r:1 caMoro naLl -
MOUlb 0CYUleCT- eHTa K caMOYXO.Qy;
BnSleTcfl nplo1
aKTIo1BHOM yYa- - OLleHIo1Tb B03MO>f<HOCTIo1
CTIo1 naLj eHTa 101 naLl eHTa YAOBneTBOplo1Tb
ero pOAcTBeHHIo1- 3TIo1 Tpe60BaHIo1f1;
I«>B.
88
89
ABTOp OCHOBHble IIIcTo'lHMK HanpaBneHHOCTb
MO.QenH nOnOJKeHM!'! np06neM CeCTpMHCKMX
MO.QenM naLlMeHTa BMeWaTenbCTB
- OLleHMTb B03MOJKHOCTM
naLlMeHTa 6e30naCHO OCY-
\1IeCTBf'!'!Tb caMOYXOA;
- OLleHHTb B03MOJKHOCTIII
BOCCT8HOBneHIot!'I
caMovxoAa B 6VAv\1leM.
npJl:lfeJIeHHe MOJJ;enH .n;.OpeM B CeCTpeHCKOM npo ecce
Kam,D;LIH '1enOBeK, 3.n;OpOBbrn UnH 60JIbHOH, ,D;On:meH HMeTb
pru3HOBeCHe B nOTpe6HocTHX B CaMOYXO,D;e H B B03MO:mHOCTHX
era ocym;ecTBJIHTb.
II ep6U'lliaJl. ou,eliH;a nompe61iocmeii. U 603MO:JfC1iOCmeii. na-
u,ue1ima 6 caMoyxoae.
Me,D;H HHCKaH cecTpa onpe,D;eJIHeT TepaneBTJoI'IeCKH He06-
XO,D;HMOe nOBe,D;eHHe na JoIeHTa npif caMOYXO,D;e - paBHOBeCHe
Me:m.ll;Y nOTpe6HOCTHMJoI H B03MomHOCTHMH ocym;ecTBnHTb ca-
MOYXO,D;. llPOBO,D;H nepBJoI'IHOe 06cne,D;oBaHHe COCTOHHHH na H-
eHTa, Me,D;JoI HHCKaJi CecTpa onpe,D;enHeT, HymHa nH ee nOMOm;b.
}1,,Ym 3TOrO OHa ,D;OJImHa .c06paTb ,D;OnOnHHTeJIbHYIO JoIH OpMa-
HIO H BbIHCHHTb, nO'IeMY B03HHK ,D;eiPHl\HT caMOYXO,D;a. Oc-
MOTp H Ha6nIO,D;eHHe, 6ece,D;a nOMoryT en nOHHTb np06neMY
na HeHTa:
- He,D;OCTaTOK 3HaHHH JoI YMeHHH;
- MOTHBa I'!jJ;
- OrpaHH'IeHJoIe (PaMOK) nOBe,D;eHHH, npO,D;JoIKTOBaIIHoro 06-
m;ecTBeHHbIMH H KynbTYpHbIMH HopMaMH.
I!Jtallupo6a1iue cecmpwicKoZO yxoaa.
CecTpHHcKHH YXO,D; nJIaHHpyeTCH B 3aBHCJoIMOCTH OT B03-
MO.mHOCTeH caMoyxO,D;a caMoro na HeHTa JoI ero pO,D;CTBeHHKOB.
Oqe1iKa 3(j}(jJeKmU61iOCmU cecmpU1iCKOZO yxoaa.
O eHHBaR 341 eKTJoIBHOCTb cecTpHHCKoro YXO,D;a, npem,D;e
Bcero yqHTLIBaeTCR, '1TO ,D;OCTJoIrHYTO caMHM na JoIeHTOM It- Ha-
3Ha-QeHHOMY H.1\Ui COBMeCTHO BpeMeHH. CeCTpHHCKHH YXO,D; C'IH-
TaeTCH 3(}:! eKTHBHLIM, ecnH y):(aeTCH COXpaHJoITb HJIJoI BOCTaHQ-
BHTb paBHOBeCHe Memp;y B03MomHOCTHMH H nOTpe6HOCTHMH B
caMOYXO,D;e.
llpUMep:
lla HeHT HaXO,D;HTCH Ha JIe'leHHH B TpaBMOTOJIOrH'IeCKOM
OT,D;eneHHH C ,D;HarH030M nepeJIOM KOCTen JIeBOH rO.TJ:eHH, na-
HeHTY HanmKeH rHnc. .
llPH nepBH'IHOM 06cJIe,D;OBaHHH na.I.:(HeHTa Me.n;H4HHCKaR ce-
cTpa Mo:meT npe.n;nO.TJ:OmHTb, '1TO na.I.:(JoIeHT He B COCTOjJ}IHH cpa-
3Y nepep;BHraTbCJi Ha KOCTLIJI.HX 6e3 nOCTopOHHeH nOMOm;H.
B ,lJ;aHHOM CJIyqae, HMeeTC.H HapYllIeHHe pru3HOBeCHH Mem.n;y
neKOTopLIMH YHHBepCaJIbHbIMH nOTpe6HOCTHMH na JoIeHTa H
Llenb YX0A<! CecTpMHcKoe OLleHKa Ponb
BMeWaTenbCTBO Ka'leCTBa M Me,QMLlMHCKOM
pe3ynbTa- cecTpbl
TOB vxoJ1a
BbleBneHMe CeCTpMHCKOe BMewa- Bo3MOJK- MB.QMQMHCKa!'!
101 o6cy?I<,Qe- TenbCTBO HanpaBJleHO HOCTb na- cecTpa nOMOra-
HMe C naLlIII- KaK Ha pacwMpeHMe LlMeHTa M eT, 06y'-lacT
eHTOM B03- B03MOJKHOCTeM caMO- era ceMbIll B naLlMeHTa ocy-
MOJKHOCTM no yxoAa, YaK M Ha M3Me- nocneAyIO- UjecTBnS!Tb ca-
caMoyxOAY. HeHMe ypOSH!'! nOTpe6- UleM oCY- MoyxOA- nOMO-
l\em>1 no HocTeM B HeM. UleCT BIIITb raeT naLlllleHTY
OpeM p,e- A.OpeM Bbl,Qen!'!eT 6 caMoyxoA. coxpaHMTb 3AO-
n5lTC!'! Ha cnoC060B ceCTpMHCKIIIX poBbe,cnpa-
BMTbCSI C no-
KpaTKocpO'l- BMeWaTenbCTB: . cnB.QCTBM!'!MM
Hble, npoMe- - J1enaTb '1To-nM60 3a TpaBMbI MnM
JKYT0'lHble, naLlllleHTa; 60ne3HIII.
p,onrocpo'l- - PYKOBOAIIITb naLlllleH-
Hble. TOM, tianpaBn!'!Tb ero
AeMCTBI1!'!;
- OKa3blBaTb <jJM3H'1ec-
KYIO nOAC\epJKt<y:
- OKa3b1BaTb nCMxonOM-
'1eci<y1O nOAQepJKt<y;
- C03,lJ,aeaTb cpeAY Af1!'!
06ecne'leHM!'! ca-
MOYXOA8:
- 06 aTb naLlMeHTa 101
era poAcTBeHHMKoB.
naLlMeHT AOnJKBH CTpe-
MMTbCSl K caMOYXOro,
XQTeTb M 6blTb rOTOBbiM
I nonYAMTb ceC1pMHCKyIO
nOMOUlb.
90
9.
ero B03MO»:HOCT.!IMn OCYLl.{eCTBJI.!ITb caMOYXO,D; (aKTlo!BHO ,D;Bn-
raTbC.!I, nOCeLl.{aTb TyaJIeT, npnHeMaTb '!\YIII), TO eCTb na neHT
Hy»:,!\aeTC.!I B nOCTopOHeiil nOMOLl.{n.
IIJIaHnpoBaHne cecTpnHcKoro yxo,!\a 6y,!\eT B paMKax 'laC-
TH"'IHO KOMneHcnpYlOLl.{eiil Ii 06yqalOLl.{eiil cnCTeM. IIa o!CHT CMO-
,')fteT CaMOCTO.!ITeJIbHO Y,D;OBJIeTBOpnTb YHnBepCaJIbHbIe nOTpe6-
HOCTH B B03,!\yxe, nnLl.{e, »:H,D;KOCTn, HO OH Hy»:,!\aeTC.!I B no-
MOLl.{n npH nepe,!\BH»:eHnn ,!\JI.!I Y,!\OBJIeTBOpeHn.!I '!\Pyrnx
YHnBepCaJIbHbIX nOTpe6iiOcTeiil. Me,!\n nHCKa.!I cecTpa nJIaHn-
PYeT 06Y'IelIne na neHTa 6e30naCHbIM HaBbIKaM nepe,D;BH»:e-
Hn.!I, 'IT06bI npe,!\ynpe,D;nTb pnCK nOBTopHOiil TpaBMbI.
CeCTpHHCKoe BMeIIIaTeJIbCTBO HanpaBJIeHO Ha BOCCTaHOB-
JIeHne paBHOBeCn.!I Me»:,D;y B03MO»:HOCT.!IMn n nOTpe6HOCT.!IMn
B caMoyxo,!\e. Me,D;n nHCKa.!I cecTpa 'IaCTH'IHO nOMOraeT o,!\e-
BaTbC.!I n pa3,D;eBaTbCH na neHTY, O,D;HOBpeMeHHO OHa 06Y'IaeT
ero 6e30naCHOMY nepeMeLl.{eHnlO Ha KOCTbIJI.!IX, a TaK»:e HO-
BbIM yrvieHH.!IM n HaBbIKaM, n03Bo.'lHlOLl.{nM CO BpeMeHeM o,!\e-
BaTbC.!I n nepeMeLl.{aTbC.!I caMOCTO.!ITeJIbHO.
2. YnoTpe6JI.!ITb ,D;OCTaTO'IHOe KOJIn'IeCTBO nnLl.{n n mH,D;KOCTn.
3. BbI,!\eJI.!ITb n3 opraHIo!3Ma npO,D;YItTbI mn3He,!\e.!ITe.'IbHOCTn.
4. )J;BnraTbC.!I n nO,D;,!\epmnBaTb HymHoe rrOJIOmeHne.
5. CrraTb, OT,!\bIxaTb.
6. CaMOCTO.!ITeJIbHO o,!\eBaTbCH H pa3,!\eBaTbCH, BbI6npaTb
o,!\emJ\Y.
7. IIo,D;,D;epmHBaTb TeMrrepaTYPY TeJIa B HOpMaJIbHbIX npe,D;e-
JIax, nO,D;6npaH cooTBeTcTBYlOLl.{YlO o,D;em,!\y n n3MeH.!IH OK-
pym8lOLl.{YlO cpe,D;Y.
8. C06JIlO,D;aTb JIH'lHYlO rnrneRy, 3a6OTHTbC.!I 0 BHeiliHeM Bn,!\e.
9. 06ecrre'InBaTb CBOlO 6e30rracHocTb n He C03,D;aBaTb orraCHOC-
Tn ,!\.'I..!I ,!\pyrnx JIlO,D;eiL
10. IIoAAepmnBaTb 06Ll.{eHne C ,D;pyrnMn JIlO,!\bMn, BbIpamaH
CBon nMO Hn, MHeHne.
11. OTrrpaBJI.!ITb peJInrn03HbIe 06p.!I,D;bI B COOTBeTCTBnn co cBoeiil
Bepoiil.
12. 3aHnMaTbcsr JII06HMOiil pa60Toiil.
13. OT,!\bIxaTb, npnHHMaTb yqaCTHe B p83BJIe'IeHnsrx n nrpax.
14. Y,!\oBJIeTBOp.!ITb CDOlO JIlO603HaTeJIbHOCTb, nOMOralOLl.{YlO
HOpMaJIbHO pa3BnBaTbC.!I.
Mo,qenb B. XeH,qepcoH
IIpe,1(JIomeHHasr Bnp,D;mnHneiil XeH,D;epCOH B 1960 ro,!\y B
CiliA, a 3aTeM ,!\orrOJIHeHM B 1968 I'O,!\Y. JJ:aHHasr MO,D;eJIb
aIt eHTnpyeT BHH 'IaHne cecTpnHcKoro nepCOHana Ha cPII3no-
JIOrn'IeCKHe nOTpe6HocTn, a 3aTeM Ha ncnXOJIOrn'IeCKne n co-
naJIbHbIe nOTpe6HocTn, KOTopbIe MorYT 6bITb y,!\OBJIeTBope-
HbI 6JIaro,!\ap.!I ceCTpHHCKOMY YXO,D;Y. rJIaBHOe B 3TOiil MO,D;eJIn
- Y'IaCTHe caMoro na neHTa B nJIaHnpOBaHnn n OCYLl.{ecTBJIe-
HnH yxo,D;a.
B. XeH,1(epcOH npe,!\JIaraeT 14 nOTpe6HocTeiil ,D;JI.!I I10Bce,!\-
HeBHoiil mH3Hn. 3,!\OpOBbIH 'IeJIOBeK He HcnbITbIBaeT TPY,!\HO-
CTeiil npn Y,!\OBJIeTBOpeHnH 3Tnx nOTpeHocTeiil, B TO me BpeMsr,
60.'lbHOiil 'IeJIOBeK He B COCTO.!IHnH Y,D;OBJIeTBOpHTb 3Tn no-
Tpe6HOCTn CaMOCTO.!ITe.'lbHO.
B. XeH,!\epCOH YTBepmJ\aeT, 'ITO ceCTpHHCKHiiI YXO,!\ ,!\OJI-
meH 6bITb HanpaBJIeH Ha CKopeMIIIee BOCTaHOBJIeHne He3aBn-
cnMOCTn 'IeJIOBeKa.
nOTpe6HOCTlI nOBceAHeBHOH mH3HH no B. Xeu,;:J;epcoH.
1. HOpMaJIbHO ,!\bIIIIaTb.
92
ABTOp OCHOBHble CTO'lHMK HanpaBneH-
np06neM HOCTb ceCTpMH-
MO.QenM nOnOJKeHMJI MO.QenM CKoro BMewa-
nal.jL1eHTa
TenbCTBa
B. XeH- nal.jL1eHT MMeer QJ\fH- np06neMbi B03HL1- npL1 06cneAoBa-
AepCOH AOMeHTanblibie '1eno- KalOT B TOM CIl}l'lae, HMM nal.jMeHTa,
Be'leCKMe nOTpe6HO- Kor,Qa '1enOBeK B Me,IJ,MI.jMHCKafl
CTM, S!BIlS!IOIlIMeCfI cl'ony onpeAeIleH- ceCTpa o6cyJK-
OAL1HaKOBbIML1 AIlfl HbiX 06CTOJITenbCTB ,QaeT C HL1M yc-
Bcex IlIOAeM. BHe (60Ile3Hb, Mna,QeH- IlOBMS! OKa3aHL1S1
3aBL1CL1MOCTL1 OT TOro, 4eCKL1(;; L1nL1 CTap'le- CecTpI1HCKOM
60neH '1eIlOBeK L11lM CKL1M B03paCT) He B nOMOIllL1.
3AOpOB, ceCTpa ace- COCTOflHL1L1 oCYllle-
CTBL1Tb YXOA 3a
rAa AOfl>'<Ha L1MeTb co60;;. np06neMbi
BL1P,y JKL13HeHHO Ba)'(-
Hble nOTpe6HOCTL1 Moryr nOJlBL1TbCfI BO
'1enOBeKa B nL1ll1e, BpeMfI ebl3Aopoa-
!<pose, OAe>K,D,e, B neHL1f1 L1nL1 .QnL1-
nlO6mt L1 A06poJKeIla- TenbHoro YML1paHL1f1.
TSnbHOCTL1, B '1yecTse -
Heo6xo,IJ,MMOCTL1 L1
S3aL1M03aSL1CL1MOCTL1
B ycnosL1J1x 061l1eCT-
seHHb'X oTHOlUeHL1M.
93
Llenb YXOA3 CeCTpa.1HCKOe O eHKa Ka'le- POnb
BMeWaTenb- CTBa ... pe3ynb- MeAa.1 "'HCKOiii
CTBO TaTOB yxoAa CeCTpbl
MeA"1 HCKaSl ABTOp A8HHO(;i Ol\eHa.1Tb pe- POnb CeCTpbl B
CeCTpa Aon>t<Ha MOAena.1 C'I"'Ta- 3ynbTaT... Ka'le- MOAena.1 npeA-
CTaBIHb TOnbKO eT. 'ITO CeCTp"'H- CTBO yxoAa 3a CTaBneHa ABOSI-
AOnraCpO'lHble CKa.1iii yxo,q Aon- nal\...eHTOM KO:
en... B BOCCTa- JKeH 6blTb CBI'I- MO>t<HO TOnbKO - 3TO caMOCTOSI-
HOBneH...a.1 He- 3aH C neKapCT- TorAa. KorAa TenbHbliii ... He-
3aB...Ca.1MOCTM BeH-Hoiii Tepa- YAOBneTBopeHbI 3aB...Ca.1Mbliii cne-
nal\...eHTa B n...e(;i ... C npo e- BCe nOBCeAHeB- l\a.1an...CT B a.tC-
YAoBneTBOpe- AYPaM.... Ha3Ha- Hble nOTpe6HO- TeMe 3ApaBO-
Ha.1......M 14 no- '1aeMbIM'" Bpa- CTa.1. B OTHOlue- oxpaHeH...SI...
BCeAHeBHblx 'laM.... Ha.1... KOTOpblX BbinOnHSllOwa.1iii
nOTpe6HocTe(;i. AnSI oCyll!eCTB- 6b1no npeAnp...- Te QJyHKl\...a.1.
KpaTKOCpO'lHble neH...SI CecTP"'H- t61TO ceCTp"'H- KOTopble He
... npo>t<yrO'lHble CKI'IX BMewa- CKoe BMeWa- MOJKeT Bblnon-
l\en.... TonbKO TenbCTB MOJKeT renbCTBO. Hlo1Tb nal\MeHT,
nplll3KCTpeHbiX no-rpe60BaTbCSI '1T06bl '1YBCTBO-
COCTOSlHIIIS!X yYaCTl'le CeMbl'l BaTb Ce6S1 He3a-
(WOK,nl'lXO- nal\I'IeHTa. BI'ICI'IMbIM:
p8AKa. KOMa. ... - 3TO nOMOIllHI'IK
T-A.). Bpa'la, Bblnon-
HSlIO\l!I'I" era
H33Ha'leHI'IR
IIOCTaBJIeHHaH ueJIb ,!\OJI:mHbI 6bITb peaJIIo!CTH'IHOi.j H H3Me-
PHMOiil, ''!T06bI MO:mHO 6bIJIO OueHHTb ycnelliHoCTb HJIH Heyc-
nelliHOCTb CecTpHHCKOro BMeIlIaTeJIbCTBa.
CecmpWtCl1:Oe 6.MelUameJtbCm60.
O!lO HanpaBJIeHO Ha YKpenJIeHRH 3,!\OpOBbH naUHeHTa, nOJI-
HOe pemeHHe 3a,!\a'l, nOCTaBJIeHHbIX nepe,!\ HHM. B KOHe'lHOM
HTore BMeIlIaTeJIbCTBO npe,!\nOJIaraeT nOMOW;b naUHeHTY B ,!\O-
CTH:meHHH HM He3aBHCHMOCTH HaCKOJIbKO STO B03MO:mHO.
IIpliMeHeHHe MO.l{eJIH B. Xell.!{epCOH
B ceCTpHHCKOM npouecce
Mo,!\eJIb B.XeH,lI;epCOH npH,D;ycMaTpHBaeT HenpeMeHHoe yqa-
CTHe naIJ;HeHTa BO Bcex sTanax cecTpHHcKoro npouecca.
Ha nepBoM STane ceCTpHHcKOro npouecca Me,D;HUHHCKaH ce-
CTpa COBMeCTHO C naUHeHToM YCTaHaBJIIo!BaeT, KaKHe R3 14
nOBce,n;HeBHbIX nOTpe6HocTeiil CJIe,D;YeT Y,D;OBJIeTBOpHTb B nep-
BYIO O'lepe,D;b. IIpHHHMaTb peIlIeHHH 3a naIJ;HeTa, Me,!\In HHC-
KaH ceCTpa MO:meT TOJIbKO B TOM CJIY'lae eCJIIo! nRUHeHT He B
COCTOHHHH :rroro c,!\eJIaTb.
IIJtanupoeanue yxoaa.
ABTOP ,!\aBHO" MO,D;eJIH C'IHTaeT, 'ITO naJJ;HeHT ,D;OJI:lKeH nOJI-
HOCTblO H caMOCTOHTeJIbHO Y,!\OBJIeTBOpHTb CBOR nOBCe,D;HeB-
HbIe nOTpe6HocTH, nOSTOMY ,!\OJIrocpO'lHaH ueJIl. YX0,D;R 3aK-
JIIO'laeTCH B TOM, 'IT06bI ,!\06HTbCH Y naJJ;HeHTa MaKCHMaJIbHOH
He3aBHCl'IMOCTH.
Ou,e1t1w pe3YJtbmamo6 yxoaa.
HTorOBYIO OIJ;eHKY BbInOJIHeHHH nJIaHR no YXO,!\y, Ha'IHHa-
lOT C oueHKH Kam,!\oiil nOBCe,D;HeBHoiil nOTpe6HoCTH, npH Y,!\OB-
JIeTBOpeHHH KOTOpoiil 6bIJIH BbIHBJIeHbI np06.TJ:eMbI. IIPH He-
,n;ocTH:meHHH ue.TJ:H, H3MeHHIOT «l>OPMYJIIo!pOBKH ueJIH H nJIaHH-
PYIOT HOBbIe cecTpHHcKHe BMeIlIaTeJIbCTBa.
HanpuMep:
IIaUHeHT HaxO,D;HTCH Ha JIe'IeHIm B TepaneBTH'IecKoM OT,D;e-
JIeHHH, B Te'leHHH Tpex ,!\HeM Y Hero HapYllieH COH.
IIPH nepBH'IHoiil oueHKe COCTOHHHH naUHeHTa, Me,!\HUHHC-
KaH ceCTpa ,n;OJI:mHa BbIHCHHTb npH'IHHY HapyweHHH CHa (
. neY,D;06HaH nOCTe.TJ:b, HenpOBeTpHBaeMoe nOMeW;eHHe, xpan
coce,!\a no naJIaTe, 6ecnoKoiilcTBO nepe,D; 06CJIe,!\OBaHHeM HJIH
onepaUHeiil).
IIJIaHHpOBaHHe YXO,D;a 3a naUHeHTOM npe,!\YCMaTpHBaeT;
06yqeHHe ynpa:mHeHHHM no paCCJIa6JIeHHIO, npOBeTpHBaHHe
nOMew;eHHH nepe,!\ CHOM, nporYJIKH nepe,D; CHOM, nepeBO,D; na-
IJ;HeHTa B '!\PyrylO na.TJ:aTY.
CeCTpHHCKoe BMeIlIaTeJIbCTBO npe,!\no.TJ:OraeT nOMOID;b na-
UHeHTY B ,!\OCTH:meHHH HM ne3aBHCHMoCTH HaCKOJJbKO STO B03-
MO:mHO.
MO,Renb M. AnneH
IIpe,D;CTaBJIHeMaH Mo,!\eJIl. BCTpe'laeTCH B JIHTepaType no,D;
HeCKOJIbKHMH Ha3BaBHHMH - MO,D;eJIb MaKI'1fJIa, KOTOPYIO Bnep-
BbIe BHe,!\pHJIH B YHHBepCHTeTe MaKrHJIa B MOHpHaJIe H B
HaCTOHw;ee BpeMH C'IHTaeTCH OCHOBHOiil TeopHTH'IeCKOM MO,D;e-
JIblO, TaK me STY Mo,!\eJIb Ha3bIBalOT Mo,!\eJIblO M. .ArrJIeH - no
HMeHH aBTOpa, OHa nOHBHJIaCb B Ha'laJIe 70-x rO,!\OB, Kor,!\a
94
95
nOJIytIIUIa npII3HaHHe KOH em: HH nepBIItlHOH Me,!\HKO-CaHH-
TapHOH nOMOr.qII.
npHMeHeHue MOACJIH 11.. AJIJIeH
B CeCTpHHCKOM npo ecce
Ou,e1tlW COCmOJl.1tUJI. nau,ue1tma.
MeJJ;H foIHCKaH cecTpa Ha6mo,D;aeT 3a nOBe,!\eHHeM na HeH-
Ta, a TaK:me HCnOJIb3YeT nOJIytleHHYIO HH«l>opMa HIO OT tIJIe-
HOB ceMbH, BbIHBJIHeT CHJIbHbIe CTOpOHbI ceMbH H Cyr.qecTBYIO-
foIe np06JIeMbI CBH3aHHbIe CO 3,!\opOBbeM na HeHTa. Onpe,D;e-
JIHeT npHOpHTeTbI H OTHonreHfoIe tVleHOB ceMbH na HeHTa K
onpe,!\eJIeHHbIM CcPepaM ,D;eHTeJIbHOCTH, ee .n;YXOBHbIX eIlHOC-
THX H y6e:IK'!\eHHHX.
I!Jw1tupo6a1tue ceCmpU1tCKOZO yxoaa.
Me,!\H HHCKaH ceCTpa BbIjJCHHeT, '1TO ,!\YMaeT, '1YBCTByeT ,
B '1eM Hy:m,D;aeTCH na HeHT Hero ceMbH B CBH3H C npe,!\CTOH-
IIJ;HM ,!\JIHTeJIbHbIM nepHO,D;OM JIe'leHHH na HeHTa. OHa ,!\OJI:m-
Ha onpe,D;e.'IHTb BpeMH npO'Be,!\eHHH Tex HJIH HHbIX MeponpfolH-
THH nmUla, PYKOBO,D;CTBYHCb npH 3TOM pe3YJIbTaTaMH Henpe-
pbIBHOM o eHKH reTOBHOCTH K HfoIM CO CTOpOHbI na foIeHTa H
ero ceMbH. na HeHT ,!\OJI:meH OC03HaTb H HCnOJIb30BaTb no-
TeH Ha.nbHbIe B03MO:IKHOCTH CBOH H CBoeM ceMbH ,!\JIH TOro,
'lT06bI pa3pa60TaTb nJIaH ,!\eMCTBHM. nJIaHbI ,D;O.'I:mHbI 6bITb
H eJIeHbI Ha penreHHe BceX 3a.n;a'l, BbIHBJIeHHbIX Me,!\H foIHCKOM
CecTpOH B npo ecce pa60TbI C ceMbeM.
CeCmpU1tCKOe 6MeUlameJlbCm60.
Me,D;H HHCKaH cecTpa ,D;OJI:lKHa onpe,D;eJIHTb, KaKHe no,!\xo-
,D;LI K npeO,!\OJIeHHIO np06JIeM npe,!\nO'lTHTeJIbHbI ,!\JIH na HeH-
Ta H ere ceMbH, foI o eHHTb HX 3cPcPeKTfoIBHOCTb. OHa ,!\OJI:lKHa
nOCTOHHHO pa60TaTb Ha,!\ nJIaHaMH ,!\eMCTBHM, HCXO,n;H H3 CH-
Tya HH B ceMbe.
Ou,e1tKa afj}(peKmU61tOCmU ceCmpU1tCKOZO yxoaa.
Me,D;H HHCKaH ceCTpa «l>foIKCHPYeT o eHKH na HeHTa Hero
ceMbIo! B OTHonreHIUo! nJIaHa MeponpHHTHM foI BHOCHT B Hero
He06xo,!\HMbIe H3MeHeHHH, OCHOBbIBaHCb Ha MHeHHH ceMbH 0
B03MO:IKHOCTH ,D;OCTH:meHIUI O:IKfoI,!\aeMbIX pe3Y.'lbTaTOB. OHa
0606m a eT pa60TY, npOp;eJIaHHYIO '1JIeHaMH ceMbH.
HanpuMep:
na HeHT nocTynfol.'1 B TepaneBTH'IeCKOe OT,D;eJIeHHe C ,D;Har-
H030M rHnepTOHHtleCKHM KPH3, B cOnpOBO:IK,D;eHfoIH :lKeHbI Ii
ABTOp OCHODHble no- IiICTO'lHMK npo- HanpaBneH ocTb
MO.QenM nOJKeHMSI MO.Qe- 6neM naLlMeHTa ceCTpMHCKoro
11M BMeluaTenbCTBa
M. AnneH naLlMeHT - 3TO Am BOcnOnHeHI1S1 C03AaHMe 6naro-
6MOnOrM'IeCKOe OrpaHM'IeHHbIX npMSlTHoW AflS! 06y-
CYlIIecTBO, AYXOB- B03MO)f(HOCTeW '1eHMSI cpe.Qbl, KO-
HaSi M cpM3M'Ie- '1enOBeKa j:\eWCT- TOpas! 6b1 CTMMynM-
a<aS1 CYlllHOCTb eOBaTb caMO- pOBana,npMBneKa-
KOToporo Hepa3- CTOS1TenbHO B na M 3aMHTepeco-
AenMMbl. CMTyaLlMSIX CBS1- BbiBana ceMblO. B
3aHHbIX co 3fJ,0- Ka'leCTBe nonHO-
pOBbeM, KOTopoe npaBHoro yYaCTHM-
OH Mor 6b1 06ec- Ka npOLlecca 06y-
ne'lMTb ce6e caM, '1eHMSI M YKpenne-
eenM 6b1 MMen HMS1 3AOPOBbS1 na-
AnSI 3TOro CI1nbl, LlMeHTa. B3aMMo-
>KenaHMS1 M 311a- OTHOlueHMS! MeAM-
HMSI. LlMHCKOW cecTpbl M
n8LlMeHTa AOfl>l<Hbl
CTpoMTbCS1 Ha OC-
HOBe AorOBOpeHHo-
CTew, COTPYAHM'le-
CTBa M KooPAMHa-
l\MM AewcTBMw.
Llenb YXOAa CeCTpMH- OLlCHKa Ka'leCTBa POllb
CKoe BMewa- 101 pe3ynbTaToB Me.QMLlMHCKOM
TenbCTBO yxo.Qa CecTJ)bl
HanpaBneHHa nOM04b na- MeAMLlI1HCKaS1 ce- AOnOnH5IeT AeSl-
Ha AOCTMJKe- LlMeHT)' M eTpa npM npoBeAe- TenbHOCTb APyrHx
HMe )i(M3HeH- eeMbe ye- HMM Tex MnM MHblX CneLlM8nMCTOB
HblX LleneM, newHO cnpaB- MeponpMm 1w nna- 3APaBOOXpaHeHI1S!.
M06wU13a- nSlTbC5I c Ha YXOAa, PYKOBO- J].aHHaSi MOAeIlb
LlMIO M nOA- pa3nH'IHb1MM ACTByeTcS1 pe3YIlb- n03BonS!eT MeAl'!-
p,epJKaHMe Ha np05neMaMM, TaTaMM HenpepblB- LlMHCKMM ceCTpaM
AOnJKHOM CBS13aHHbIMM HOM oLleHKM rOTOB- nonHOCTblO pea-
YPoBHe CHn M co 3AopOBb- HOCTM K HMM KaK IlM30BaTb CBOIO
pecypcOB eMM nal.\MeHTa TaK M ero ponb B 06IlacTM
IlIiNHOCTM B03HMKalO- ceMbM. 3.QPaBooxpaHeHMSI.
WlM ceMbM. lIIMMM Ha
npOTSI)f(eHMM
Beere >KM3-
HeHHO ro
LlMKIla ceMbM.
96
4.38..291
97
,tIBYX Cb!HOBeiL lIPH 06CJIe,tlOBaHHH Me,tlHD;HHCItaJI. CeCTpa OT-
Me'IaeT Y naI\HeHTa H36:bITO'IHYIO Maccy TeJIa, naD;HeHT 06ec-
nOltoe CBOHM COCTO.HHHeM.
IIPH nepBH'IHOH OD;eHKe COCTO.HHH.H naI\HeHTa Me,tlHD;HHC-
Ka.H CeCTpa C06HpaeT CBe,tleHH.H 0 naD;HeHTe HerO ceMbe. Ka-
KHe np06JIeMbI CO 3,t10pOBbeM H 3a60JIeBaHH.H 6.bIJIH B ceMbe
paHbwe,. KaK CeMb.H pewaJIa 3TH np06JIeMbr, KaRHMH CpeA-
CTBaMH npH 3TOM nOJIb30BaJIaCb, KaKOH 6bIJI BKJIa.zt KamAOro
'IJIeHa ceMbH B peweHHe 3THX np06JIeM. KpOMe 3Toro OH
,tIaeT onHcaHHe CBoeH nOBCe,tlHeBHOH mH3HH, T.e. pa60Ta, nH-
TaHHe, cpH3H'IeCItHe ynproKHeHH.H, CeMb.H.
IblaliUp06aliue cecmpUliclCOZO yxoiJa. Me,tlHD;HHCKa.H ceCT-
pa BMeCTe C naD;HeHToM OnpeAeJI.HeT cy eCTBYIO YIO Y HerO
np06JIeMY - TY, 'ITO .HBHJIaCb npH'IHHOH ero rOCnHTaJIM3aI\MM,
onpe,tleJIHTb npMopIITeTbr II OTHoweHHe 'IJIeHOB ceMbH K onpe-
,lI;eJIeHHbrM c4JepaM ,tIe.HTeJIbHOcTM. ,l(aHHa.H np06JIeMa AOJI-
rOBpeMeHHa.H M npe,tlcTOHT ,lI;JIMTeJIbH:bIH nepIIoA, B Te'IeHMII
KOTOpOI'O npM,tIeTC.H HanpaBMTb Bce YCH!IM.H Ha npeOAOJIeHMe
npM'IIIH, Bbr3BaBIIlHX np06JIeMY.
lIaD;MeHT II ero CeMb.H ,tIOJImHbI 3TO nOH.HTb M OC03HaTb.
IIan;IIeHT AOJI teH nCnOJIb30BaTb nOTeHD;HaJIbHble B03MomHOC-
TI1 CBon n cBoei!: ceMbn J1,JI.H Toro, 'ITo6br pa3pa6oTaTb nJIaH
,tIeHCTBMH.
CeCTpHHCKoe BMeWaTeJIbCTBO npe)(YCMaTpMBaeT CJIe,t\YIO ee:
- 06pa3 mM3HM nan;HeHTa (KaK 3a60JIeBaHMe MomeT OTpa-
3MTbC.H Ha npoqJecCMOHaJIbHOH ,tIe.HTeJIbHOCTM);
- CTpecc (eCJIM CMeHMTb MeCTO pa60Tbr He npe,tlCTaBJI.HeTC.H
B03MOmlffiIM);
- AMeTa n KOHTpOJIb 3a MaCCOH TeJIa;
- <l>M3M'IeCKne ynpa>ItHeHMSr;
- Bpe,tlHbIe npHBbI'IKH - KypeHMe.
03Ha.IWMMBWMCb C HeCKOJIbKM.i 1H MO,tleJI.HMH M3 MHOnWCTBa
cy eCTBYIOJ.n;IiX MbI BMAMM, 'ITO e,tlnHOH MO,tleJIH Ha cero,tl-
H.HIllHHMH ,tIeHb He cy ecTByeT.
IIpaI<TMKYIO Me CeCTpb! BO MHorMX CTpaHax O,tlHOBpeMeH-
HO nCnOJIb3YlOT HeCKOJIbKO MO,tleJIeH, npM'IeM BbI60p MO,tleJIM
3aBHCMT OT HeB03MomHOCTM nauneHTa YAOBJIeTBOpMTb Te nJIH
HHbIe nOTpe6HOCTM.
OCMbrCJIeHHe yme pa3pa60TaHHbIX MOAeJIeH nOMOraeT Bbr6-
paTb Te, KOTopble npMrOAHbI ,tIJI.H KOHKpeTHoro nan;MeHTa.
MOAeJIb cecTpHHcKoro yxo,ll;a nOMOraeT aKD;eHTMpoBaTb BHH-
MaHMe Me,tlHD;MHCKOH ceCTpbI npH 06cJIeAOBaHMM naI\HeH'ra,
nOCTaHOBKM ,tIMarH03a H nJIaHnpOBaHM.H cecTpIiHCKoro BMe-
WaTeJIbCTBa.
B3aHMOCBII3b OCHOBHblX nOTpe6HocTeH '1enOBelca
no A.Macnoy H BHAOB nOBceAHeBHoH AellTenbHocTH
no BHPAmMHHH XeHAepcoH
B paMKax CTpYKTYPbI B03 peKoMeHAyeTC.H MCnOJIb30BaTb
MO,tleJIb BHPAmMHnM XeH,lI;epCOH, 'ITO He MCKJI 'IaeT HCnOJI:-
30BaHMe MO,tleJIell: H. Poynep,B. JIoraH, A. TaH3pHM, K. Po ,
,l(. Op3M, M. AnJIeH. CJIe,tlyeT nOMHMTb, 'ITO Jl106a.H MOAeJIb'
HenOCTO.HHHa, OHa Momf;T npMTepnMBaTb M3MeHeHM.H, OTpa-
ma.H B3rJI.H,tIbI, npaKTM'IeCKYro ,tIe.HTeJIbHOCTb, 3a.zta'IIi ceCTpMH-
CKoro AeJIa Ha onpe,tleJIeHOM OTpe3Ke BpeMeHM.
B.XeH,tIepCOH, pa3pa6aTbIBa.H CBOro MO,tleJIb, OCHOBbIBaJIaCb
Ha TeopMH aMepMKaHCKoro nCMXOJIOra A. MacJIoy 06 Mepa p :
XMM OCHOBHbIX 'IeJIOBe'IeCKHX nOTpe6HocTeH. lIOTpc6HocTeH
no B.XeHAepcoH 3Ha'IHTeJIbHOMeHbIl1e B KaJK)(OM ypoBHe, 'IeM
no A.MacJIoy. 3T0 06b.HCH.HeTC.H TeM, 'ITO B cepe,tlHHe 60-x
rOAOB, Kor,tla 6bIJIa C03,l1;aHa 3Ta MO,tleJIb ceCTpMHCKoro ,tIeJIa,
peaJIbH:bIe B03MomHOCTH MeAMI\MHCKOll: ceCTpbI B CIIIA 6bIJIH
OrpaHM'IeID,:r Ae.HTeJIhHOC'Th1O no YAOBJIeTBOpeHHIO HMelfHO 3T01'O
OrpaHIi'IeHHOrO nepe'IH.H nOTpe6HOCTeH.
IIpo6JIeMbI Tpe6YIOiW'Ie ceCTpMHCKoro BMeWaTeJIbCTBa, B03-
HMKalOT B TOM CJIY'Iae, KOr,ll;a 'IeJIOBeK B CMJIY onpe,tleJIeHHbIX
06CTO.HTeJIhCTB (60JIe3Hb, MJIa.zteH'IeCKHH MJIM CTap'IeCKMH }l03-
paCT) He B COCTO.HHHM ocy ecTBHTb YXO,tl 3a c060ll:. -rrp06JIe-
MbI MOryT nO.HBMTbC.H BO BpeM.H Bbr3,t1opOBJIeHH.H HJIH AJIH-
TeJIbHOrO YMMpaHM.H.
B. XeH,Z:\epCOH yrBepm)(aeT, 'ITO cnoc06HocTb 'IeJIOBeKa y,tIOB-
JIeTBOp.HTb CBOM eme,tlHeBHble nOTpe6HoCTM MeH.HeTC.H B 3aBM-
CMMOCTM OT ero TeMnepaMeHTa H 3MOD;MOIlaJIbHOrO COCTO.HHM.H.
98
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CecTpHHcKHH npo ecc .HBJI.HeTC.H OAHHM H3 OCHOBHbI'!: H
HeOT'beMJIeMbIX nOH.HTHH COBpeMeHHbIX Mo}.\eJIeH ceCTpHHCKO-
ro AeJIa. IToH.HTHe 0 ceCTpHHCKOM npo ecce pOAHJIOCb B CiliA
B cepeAHHe 50-x ra,tlOB. B HaCTO.H ee BpeM.H OHO nOJIYtlH.iIO
wHpoKoe pa3BHTHe B cOBpeMeHHoH aMepHKaHcKoH, a C 80-x
rOAOB - B 3an HoeBponeHCltHX Mo,tleJI.HX cecTpHHCKoro AeJIa.
HeAocTaTKoM B pa3BHTHH cecTpHHcKoro ,tIeJIa B POCCHH ce-
rOAH.H .HBJI.HeTC.H OTCYTcTBHe ,tIJI.H Bcex Me,tlH HHCKHX pa60THH-
KOB eAHHoH TepMHHOJIOrHH H onpe,tleJIeHHH HeKoTopbIX nOH.H-
THH. qacTo COBn aIOT 3Ha'IeHI1.H TaKHX nOH.HTlIH, KaK npo-
6JIeMa, nOTpe6HocTb, CHMnTOM. 3TO npHBO,tlHT K nYTaHH e. y
Bpa'ieM CerOAH.H cyr.qecTByeT MemAYHapoAHbIH KJIaCcH<l>Hlta-
TOp 60JIe3Heii, KOTOpbIH n03BOJI.HeT HM nOHlIMaTb ,tIPyr ,tIpyra.
y Me,tlH HHCKHX ceCTep POCCHH nonbITKH YHl1(pH HpOBaTb H
CTaHAapTH3HpOBaTb npocpeCClIOHaJIbHbIH .H3bIK nOKa pe3YJIb-
TaTOB He HMeeT.
B paMKax EBpone:ikKoro perHOHa B03 ceCTpaM, KOTopble
nJIaHHpYIOT npHMeH.HTb ceCTpHHCKHH npo ecc, peKOMeHAYeT-
C.H HCnOJIb30BaTb Mo}.\eJIb, npe,l1JIOmeHHYIO BlIp,tl:1KlIHHeH XeH-
,tIepCOH, oCHoBaHHYIO C yqeTOM CP1I31I0JIOrlI<recKHx, nCHXOJIO-
rHv.:eCKHX H COn;HaJIbHbIX nOTpe6HocTeH, On;eHHBaeMblx NeJ.\H-
HHCKHMH CeCTpaMH.
ITo MHeHHIO rocnomH XeH,tIepCOH, cyr.qeCTByeT 14 6Ua08
n06ceiJH.e6H.OU iJe.R.meJ1bH.OCmU, Ha Kam,tlbIH H3 KOTOpbIX BJIH.H-
lOT CO HaJIbHble, KYJIbTYPHble H 3KOHOMlf'lecKHe YCJIOBIDI mH3HH
'IeJIOBeKa. rJIaBHbIM KOMnOHeHTOM MOAeJIH XeH,tIepCOH .HBJI.H-
eTCH B03MomHOCTb n HeHTa (FiJIH ero ceMbH) npHHHMaTb yqa-
CTHe B npon;ecce YXO,tla.
BH)];bI nOBCe)];HeBHOH )];e.HTe.'lbllOCTH
1. HOPM'lJIbHOe AbIxaHHe.
2. eKBaTHaH BOAa H nHTbe.
3. HOpMaJIbHble OTnpaBJIeHH.H opraHH3Ma.
4. )J;BHmeHHe H pa3JIH'IHble n03bI.
5. COH H OTAbIX.
6. BbI60p cooTBeTcTBYIOI.qeM oAemAbI, O,tleBaHHe H pa3,l1e-
BaHHe.
He06xo,l1HMOCTb BHeApeHH.H cecTpHHcKoro npo ecca B cec-
TPHHCKoe 06pa30BaHHe H cecTpHHCItYIO npaKTHKY B POCCHII
B03HHKJIa B CB.H3H C nOHHMaHHeM HeJ.\OCTaTIWB 06r.qero yxo-
,l1a 3a 60JIbHbIMH, KaIt ,tIJIH caMoro 60JIbHOrO, TaK H A.iI.H Me-
,tIH HHCKOM ceCTpbr, a TaKme pa3BHTH.H ceCTpHHCKoro ,tI€JIa B
MHpe. HC,tlOCTaTKaMH 06r.qero YXOAa 3a 60JIbHbI:\tH .HBJI.HIOT-
C.H, npemAe Bcero, 6IOpOKpaTH'IeCKHH nO,tlxOA K ceCTpHHCKO-
My YXO,tly, OCHOBaHHbIH Ha nOCTaBJIeHHOM B YCTaHOBJIeHHOM
nOp.H.l\Ke MeAHn;HHCKOM ,tIHarH03e, IwrAa Me,tlM HnCKa.H ceCT-
pa 3HaeT, tITO Ha3Ha'IHJI Bpa'i nan;HeHTy H CTporo BbInOJIH.H-
eT 3TH Ha3Ha'IeHH.H 6e3 oc060ro yqeTa nCHXOJIOrHv.:eCKHX,
COn;HaJIbHbrx H AYXOBHbIX nOTpe6HOCTeH lIa nCHTa B YXOAe.
QT06bI yv.:UTbIBaTb 3TH nOTpe6HOCTH MeAH HHCKOi ceCTpe,
KaK Cnen;HaJIHCTY, He06xOAHMbI He MHTYMTHBHble, a AOnoJI-
HHTeJIbHble 3HaHH.H B 06JIaCTH cOBpeMeHHoH CPHJIOCOCPHII, Me-
TOAOJIOi'lIH cecTpHHclwro ,tIeJIa, nCHXOJIOrHH 'IeJIOBeKa, cno-
c06Horo K ne,t\arOrH'IeCKOH H HCCJIeAOBaTeJIbCKOH ,tIe.HTeJIbHO-
CTH. 3TH 3H£lHH.H 06eCne'IaT nOBbIIlleHHe npocpeCCHOHaJIbHO_
1'0 pOCTa Me,tlceCTep, nOBbIC.HT KatJeCTBO nOMOI.qH, 06eCne'IaT
cHcTeMaTH'IeCKHM nOAxoA K cecTpHHCIWMY yxo}.\y, BoccTaHo-
B.HT YTpatIeHlIble npo<l>eCCIWHaJIbH:ble n;cmlOcTH Me,lIHn;HHcKHx
cecTep.
Ho AJI.H BHe,t\peHH.H cecTpHHcKoro npo ecca nOTpe6YIOTC.H
KOHKpcTHble H3MeHeIIM.H He TOJIbKO npocpeCCHOHaJIbHOro, HO H
opraHH3a HOHIIoro xapaKTepa. QT06bI TaKlIe nepeMeHbI npo-
H30IllJIH, O'ICHb BamHO npH3naHHe Hc06XO,tlHMOCTH 3TlIX H3-
Mep.:eHHH B 3aIWHOAaTeJIbHOM nOp.HAKe. CCrOAH.H oCYll.\eCTBJIe-
HIIC ceCTPHHcKoro npo ecca .HBJISIeTC.H OJ.\HOll H3 eJIeH pa3BH-
TH.H ceCTpHHCKoro ,tIeJIa B POCCHH. .
100
101
7. ITO,lt1\epmalUIe TellmepaTypbI TeJIa Ha HOpMaJIbHOM ypOBHe
IIyTeM n0,1160pa COOTBeTCTBylO eii O,11em,!l;bI H H3MeHeHH.H.
8. CO,tlepmaHHe TeJIa B qHCTOTe H YXO,11e, 3a60Ta 0 BHeIllHO-
CTH.
9. CnOC06HOCTl, H36eraTb onaCHble <l>W{TOPbI oKPymaIOI.qeii
Cpe.l\bI H He H8Bpe,tlHTb .l\pyrHM.
10. 0614eHHe C APyrHMH, Bblpa)I{eHHe 3MO Hii, Hym,!l;, CTpa-
xa H MHeHH.H.
11. CoxpaHeHHe cooTBeTCTBYlO14HX peJIHrH03HbIX MlIeHHii.
12. Pa6OTa, npI-iHOC.H14a.H pe3YJIbTaTbI.
13. Mrpa HJIH yqaCTHe B APyrHx <l>opMax OTp;blxa.
14. IT03HaHue, OTKpbITHe HJIH YAOBJIeTBOpeHHe JIlO60nbIT-
CTBa, Bep;yI.qHe I{ HOpMaJIbHOMY pa3BHTHlO H 3AOPOBblO
MCnOJIb30BaHHe HII'[elOI.qHXC.H cpe,tlCTB YKpenJIeHH.H 3AO:
pOBb.H.
B lIaCTO.HI.qee BpeM.H cecTpHHcKHii npon;ecc (CJIOBO npo ecc
03Ha'iaeT XOA C06bITHii, ero 3TanbI) H .HBJI.HeTC.H cepA eBHlIoH
cecTpHHcKOro 06pa30BaUH.H H C03,11aeT TeOpeTH'IecKYlO Hayq-
HYlO 6a3Y CecTpHHcKOi-i nOMOI.qH B POCCHH.
CecTpHHcKHii npon;ecc - 3TO HaY'lHbIii MeTOA opraHH3a HH
H OKa3alIH.H cecTpHHcKOii nOMOI.qH, cHcTeMaTHqeCKHii nYTb
onpe,l1eJIeHHH cHTYa HH, B KOTOpoii HaXO.l\HTC.H nan;HeHT H
Me,l1CeCTpa, H B03HHKalO Hx B 3TOll cHTya HH np06JIeM, B
eJI.HX BbInOJIHeHH.H nJIaHa yxop;a, npHeMJIeMOrO ,l1JI.H 06eHx
CTOpOH. CecTpHHCKHii npo ecc - ,l1HHaMH'IH:ui-i, HKJUNHbIH
npo ecc.
l(eJIblO CecTpHHCKOro npon;ecca .HBJI.HeTC.H nO,lt1\epmaHHe H
BOCCTaHOBJIeHHe He3aBHCHMOCTH nan;HeHTa B y,l10BJIeTBOpeHHH
OCHOBHbIX nOTpe6HocTeii OpraHH3Ma, Tpe6YlOI.qerO KOMnJIeKC-
Horo (XOJIHCTH'IeCKoro) nOAxoA8 K JIH'IHOCTH' nan;HeHTa.
,l];ocTHmeHHe n;eJIH cecTpHHcKoro npon;ecca ocy eCTBJI.HeT-
C.H nYTeM pCrneHH.H CJIe,l1YlOl HX 3a,l1a'I:
. c03AaHH.H 6a3bI HlI(l>opMa HOp.HbIX AaHHbIX 0 na HeHTe.
. onpep;eJIeHH.H nOTpe6HocTeH na HeHTa B cecTPHHcKO
YXO,l1e;
. 0603Ha<wHH.H npHopHTeToB B cecTpHHcKOM 06CJIymHBa-
HHH, HX nepBOO'Iepe,11HOCTH;
. onpep;eJIeHH.H eJIeii H COCTaBJIeHH.H nJ.laHa YXO,l1a, MO-
6HJIH3a HH He06xo,11HMbIX pecYPcoB;
. peaJIH3a H.H nJIaHa, T.e. OKa3aHHH cecTpHHcKOii nOMO-
I.IJ;H np.HMO H KOCBeHHO;
. o eHKH 3<l><l>eKTHBHoCTH npo ecca yxop;a 3a nan;HeHToM
H AOCTiDKeHH.H :n;eJIH yxoAa.
CecTpHHcKHii npon;ecc HeceT HOBoe nOHHMaHHe pOJIH MeAH-
HHCKOii ceCTpbI B npaKTH<IecKoM 3p;paBooxpaHeHHH, Tpe6y.H
OT Hee He TOJIbKO HaJIHqH.H TeXHH'IeCKOii nop;rOTOBKH, HO H
YMeHH.H TBOp'IeCKH OTHOCHTbC.H K YXOAY 3a nan;HeHTaMH, yMe-
HH.H HHp;HBH,!I;YaJIH3HpOBaTb H CHCTeMaTH3HpOBaTb YXOA C n;e-
JIblO npeAYTIpe}K,lJ;eHWI, YMeHbllIeHH.H, JlliKBH,D; H Y Hero npo-
6JIeM B YXO,l1e.
KOHKpeTHO, OH n0,11pa3YMeBaeT HCnOJIb30BaHHe HaY'IHbIX
MeTOAOB onpe,l1eJIeHH.H MeAHKo-caHHTapHbIX nOTpe6HOCTen na-
n;HeHTa, ceMbH HJIH 06 eCTBa, H Ha 3TOii OCHOBe OT60p Tex H3
HHX, KOTopble MOryT 6bITb HaH60JIee 3CP<l>eKTHBHO YAOBJIeTBO-
peHbI nocpe,!l;CTBOM ceCTpHHCKoro yxop;a C HenpeMeHHbIM yqa-
CTHeM nan;HeHTa HJIH qJleHOB ero ceMbH.
"
nOHIITHe 06 :itTanax cecTpHHCKoro npol.\ecca
B 3TOM pa3,l1eJIe onHCbIBalOTC.H 5 OCHOBHbIX 3TanOB ceCT-
pHHcKoro npo:n;ecca.
113BecTHo, 'ITO AO cepe,tlHHbI 70-x rOAOB B CIlIA cecTpHHc-
KHii npo:n;ecc HMeJI 4 3TaTIa (06cJIeAOBaHHe, nJIaHHpOBaHHe,
BbIl10JIHeHHe, On;eHKa). 3Tan p;HarHocTHpOBaHH.H 6bIJI BbIBe-
,tIeH H3 3Tana 06CJIep;OBaHH.H B 1973 rop;y B CB.H3H C YTBepm,!l;e-
HHeM CTaHAapToB ceCTpHHCKOii npaKTHKH AMepHKaHcKoii ac-
con;H Heii Me,l1Hn;HHCKHX ceCTCp.
I 3Tan - cecmpuH.ClCoe 06cJLeaoaaH.ue HJIH On;eHKa cHTya-
n;HH C n;eJIbIO On;eHKH KOHKpeTHblx nOTpe6HocTeii nan;HeHTa H
He06xo,l1HMbIX AJI.H cecTpHHCKoro yxop;a peCypCOB.
I 3TaTI cecTpHHcKoro npo ecca BKJIIO'IaeT B ce6.H npoqecc
oqeHlCu cumyaquu MeT0,l10M ceCTpHHCKOro 06CJIeAOBaHH.H. ITpH
06CJIeP;OBaHHH Me,!l;Hn;HHCKa.H ceCTpa C06HpaeT He06xo,tlHMYIO
HH(pOpMan;HIO MeTOAoM onpoca (CTPYKTYPHpoBaHHoe HHTep-
BbIOHpoBaHHe) nan;HeHTa, pOAcTBeHHHKoB, MeAH:n;HHcKHX pa-
60THHIWB, nOJIb3yeTC.H cBeAeHH.HMH H3 HCTOpHH ero 60JIe3HH
H p;pyrHx HCTO'IHHKOB HHcpopMan;HH.
102
103
104
KYMeHTHpOBaTb .n;aHHbIe 06CJIe.n;OBaHH.H naIJ,HeHTa, 06CJIep;OBa-
HHe, KaK npaBHJIO, .HBJI.HeTC.H ycneIlIHbIM.
II STan - cecmpUHCIWSl (JUaZHOCmUlW HJIH BbI.HBJIeHHe
np06JIeM naI\HeHTa. STOT STan MOmeT HOCHTb H ,tIpyroe Ha-
3BaHHe: nOCTaHOBKa ceCTpHHCKHX .n;HarH030B. AHaJIH3 nOJIY-
'IeH OH HI{I}}OpMaIJ,HH .HBJI.HeTC.H OCHOBaHHeM P;JI.H 1}}0PMYJIHpO-
BaHH.H npc6;IeM naI\HeHTa CYII\eCTBYIO HX (HaCTO.HIIJ;HX, .HB-
HbIX) HJIH nOTeHl\HaJIbHbIX (CKpbITbIX, KOTopbIe MOryT no-
.HBHTbC.H B 6YP;YII\eM). IIpH onpep;eJIeHHH npHopHTeTHuOCTH
Me.n;HI\HHCKa.H ceCTpa .n;OJImHa onHpaTbC.H Ha Bpa'Ie6HbIH .n;H-
arH03, 3HaTb 06pa3 »GI3HH nan;HeHTa, cpaKTopbI pHCKa, yxy.n;-
IlIalOII\He ero COCTO.HHHe, nOMHHTb 0 ero SMOI\HOHaJIbHOM H
nCHXOJIOrH'IeCKOM COCTO.HHHH H .n;pyrHx acneKTax, nOMoraIO-
IIJ;HX eM npHHHMaTb OTBeTCTBeHHoe pellieHHe - onpep;eJIeHHe
np06JIeM naD;HeHTa HJIH nOCTaHOBKa cecTpHHcKHX .n;HarH030B.
IIpon;ecc COCTaBJIeHH.H cecTpHHCKoro )J;HarH03a O'IeHb BameH,
Tpe6yeT npol}}eccHOH8JIbHbIX 3HaHHM, yMeIlHH Haxo.n;HTb CB.H3b
Mem.n;y npH3HaKaMH OTKJIOHeHHH B COCTO.HHHH naI\HeHTa H
npH'IHHaMH, HX BbI3bIBalOIIJ;HMH.
CecTpHHcKHH AHaru03 - STO COCTO.HHHe 3.n;OpOBb.H naI\H-
eHTa (HbIHeIlIHee H nOTeHI\HaJIbHoe), YCTaHOBJIelIHoe B pe3YJIb-
TaTe npOBe.n;eHHoro ceCTpHHCKoro 06CJIe.n;OBaHH.H H Tpe6ylO-
IIJ;ee BMeIlIaTeJIbCTBa co CTOpOHbI ceCTpbI.
CeBepOaMepHK8HCKa.H aCCOI\HaIJ,H.H ceCTpHHCKHX J];HarH030
NANDA (1987 r.) H3.n;aJIa nepe'IeHb p;HarH030B, KOTOpbIH
06YCJIOBJIeH np06.neMoM naIJ,lIeHTa, npH'IHHOM ee B03HHKHOBe-
HH.H H HanpaBJIeHHOCTbIO p;8JIbHeMIlIHx lIeMcTBHM Me.n;ceCTpbI.
HanpUMep:
1. TpeBora, CB.H3aHHa.H C 6ecnoKoiicTBOM IIaIJ,HeHTa no no-
BOllY npe.n;CTO.HIIWii onepaIJ,HH. .
2. PHCK pa3BHTH.H npoJIemHeii, 06YCJIODJIeHHbIii p;JIHTeJIb-
HOM HMM06HJIH3aIJ,HeM.
3. HapyweHHe I}}YHKI\HH onopOmHeHH.H KHWe'IHHIta: 3a-
nop, 06YCJIOBJIeHHbIM He.n;ocTaTO'IHbIM ynoTpe6JIeHHeM
rpy60M nHIIJ;H.
Mem.n;YHapo.n;HbIM COBeT Me.n;ceCTep (MCM) pa3pa60TaJI
(1999 r.) Mem.n;YHapollHbIM KJIaCcHI}}HKaTop cecTpHHcKOM
npaKTHKH (MKCII) - STO npol}}eccHOHaJIbHbIM HHc}JOpMaIJ,HOH-
HbIM HHcTpyMeHT, He06xo.n;HMbIM .n;JI.H cTaH.n;apTH3:J.I\HH npo-
105
MeTo.n;aMH 06CJIe.I\OBaHH.H .HBjJ.HIOTC.H: Cy6'beKTI!BHbrH, 06'beK-
THBHbIii H .n;onOJIHHTeJIbH:Ue MeTO.n;bI 06CJIe.n;oBaHH.H nan;HeHTa
,tIJI.H onpe.n;eJIeHH.H nOTpe6HocTeM nan;HeHTa B yxo.n;e.
1. C60p He06xo.n;HMoM HHc}JopMaI\HH:
a) cy6'beItTHBHbIX .n;aHHbIX: 06 HX cBe.n;eHHM 0 naI\HeHTe;
maJI06 B HaCTO.HII\ee BpeM.H - I}}H3HOJIOrH'IeCKHX, nCH-
XOJIOrH'IeCKHX, COI\HaJIbHblX, .n;YXOBHblX; OII\yw;eHH.HX
nan;HeHTa; peaKI\H.HX, CB.H3aHHbIX C ap;anTan;HOHHbIMH
(npHcnoc06HTeJIbHbIMH) B03MOmHOCT.HMH; cBe.n;eHHM 0
Hey.n;oBjJeTBopeHHbIx nOTpe6HOCT.HX, CB.H3aHHbIX C H3-
MeHeHHeM COCTO.HHH.H 3.n;OpOBb.H HJIH H3MeHeHHeM Te'Ie-
HH.H 3a60JIeBaHH.H;
6) 06'beKTHBHbIX ,tIaHHbIX. K HHM OTHOC.HTC.H: pOCT, Macca
TeJIa, BbIpameHHe JIHI\a, COCTO.HHHe CooHaHH.H, nOJIO:1Ke-
HHe nan;HeHTa B nOCTeJIH, COCTO.HHHe I<omHbIX nOItpO-
BOB, TeMnepaTYPa Te.r.:a naIJ,HeHTa, .n;bIxaHHe, nYJIbC, AJJ.,
eCTeCTBeHHbIe OTnpaBJIeHH.H H .n;pyrHe .n;aHHbIe;
B) OI\eHlta nCHXOCOI\HaJIbHOM cHTyan;HH, B I<OTOpoii Haxo-
J];HTC.H nan;HeIlT:
- OI\eHliBaIOTC.H COn;HaJIbHO-SKOHOMH'IecKHe .n;aHHbIe, on-
pe.n;e.n:.HIOTC.H cp.aKTopbI pHCKa, .n;aHHbIe 06 oKpymalO-
ru;eM cpe.n;e, BJIH.HIOII\He Ha COCTOHHHe 3,l\OpOBb.H na-
I\HeHTa, ero 06pa3 mH3HH (KYJIbTypa, YBJIe'IeHH.H,
x066H, peJIIlrH.H, Bpe.n;HbIe npHBbI'IKH, HaIJ,HOHaJIbHbIe
oc06eaHocTH), ceMeMHoe nOJIOmeHHe, YCJIOBH.H pa60-
TbI, MaTepHaJIbHOe nOJIOmeHHe H T. .n;.;
- onHCbmaeTC.!I Ha6JIIO.n;aeMoe nOBe.n;elille, .n;HHaMHKa SMO-
n;HOHaJIbHOii c(1)epbI.
C60p He06xo.n;HMOM HHcpopMaI\HH Ha'IHHaeTC.H C MOMeHTa
nOCTynJIeHH.H naI\HeHTa B JIIIY H npo.n;OJImaeTC.H ,l\0 BbInHCKH
ero H3 Hero.
2. AnaJI.U3 c06pannoii. untjJop.Maquu. I(eJIblO aHaJII13a .HD-
JI.HeTC.H onpe.n;eJIeHHe npHOpHTeTHbIX (no CTeneHH yrp03bI .n;JI.H
mH3HH) HapyweHHblx nOTpe6HocTeii HJIH npo6JIeM naI\HeHTa,
CTeneHb ne3aBHCHl\tOCTH naU,neHTa B yxo.n;e.
IIpH C06JIIO.I\eHl1H YMeHHi H HaBbIKOB MemJIH'IHOCTHOro
06II\eHH.H, STH'<!eCKHX H ,tIOOHTOJIOrH'IeCKHX npHHI\HnOB, Ha-
BbIKOB onpoca, Ha6JIIO.n;eHH.H, On;eHI<H .COCTO.HHH.H, YMeHH.H .n;o-
vv
cPeCCHOHaJILHOrO .H3LIKa Mep;CeCTep, }J.JI.H C03}J.aHH.H e}J.HHOro
HHcPOpMan;HoHHoro nOJI.H, }J.JI.H }J.OI<YMeHTHpOBaHH.H CeCTpHHC-
KOi1: npaKTHI<H, Y'IeTa H On;eHKH ee pe3YJIbTaTOB, nO,ZJ;roToBI<H
R pOB H T.}J..
B KOHTeI<CTe MKCII no}J. CeCTpHHCRHM .D;HarH030M nOHH-
MalOT npOcpeCCHOHaJIbHOe YJK)WHHe Me}J.CeCTpLI 0 .HBJIeHHH,
CB.H3aHHOM CO 3}J.OpOBbeM HJIH COn;HaJIbHLIM npOn;eCCOM, npe}1.-
CTaBJL'IIOln;HM 06'beI<T CeCTpHHCKHX BMeIllaTeJIbCTB.
He}J.OCTaTKaMH 3THX }J.OKYMeHTOB .HBJI.HeTC.H CJIOJKHOCTb .H3bI-
Ka, OC06eHHOCTH KYJILTYPbI, HeO}J.H03Ha'iHOCTb nOH.HTHii H }J.p.
Cero}J.H.H B POCCHH HeT YTBepJK}J.eHHbIX CeCTpHHCI<HX }J.Har-
H030B.
III3Tan - OnpeaellenUe qelleu cecmpunclCOzo 6.MeWamellb-
Cm6a, m. e. onpe}1.eJIeHHe BMeCTe C nan;HeHTOM JKeJIaeMbIX pe-
3YJILTaTOB yxop;a.
B HeI<OTOpbIX MO}J.eJI.HX CecTpHHcKOrO }J.eJIa 3TOT 3Tan HO-
CHT Ha3BaHHe nllanUp06anUe.
IIo}1. nJIaHHpOBaHHe H O nOHHMaTb npon;ecc cPOpMHpOBa-
HH.H n;eJIeii (T.e. :meJIaeMLIX pe3YJIbTaTOB yxo}J.a) H nJIaHHpO-
BaHH.H ceCTpHHCKHX BMeIIIaTeJILCTB, Hoo6xo}J.HMLIX }1.JI.H }1.0C-
THJKeHH.H 3THX n;eJIeii. IIJIaHHpOBaHHe pa60TLI Me}1.CeCTp:u no
Y}J.OBJIeTBOpeHHIO nOTpe6HOCTeii He06xo}J.HMO ocyrn;eCTBJI.HTb B
nOp.H}J.I<e npHopHTeTHOCTH (nepBOO'Iepe,nHOCTH) np06JIeM na-
n;HeHTa.
IV 3Tan - nllaltUpo6anue 06oe.Ma cecmpunclCux 6.MeWa-
mellbcm6 H peaJIH3an;H.H (BLIllOJIHeHHe) nJIaHa cecTpHHcI<HX
BMeIllaTeJILCTB (yxo}J.a).
B MO}J.eJI.HX, r}J.e nJIaHHpOBaHHe OTHOCHTC.H 1< TpeTLeMy 3Ta-
ny, '<!eTBepTLIM 3TanOM .HBJI.HeTC.H peaJIH3an;H.H nJIaHa.
IIllanup06anue BKJIIO'IaeT B ce6.H:
1. Onpe}1.eJIeHHe THnOB CecTpHHCKHX BMeIllaTeJIbCTB.
2. 06cYJK}J.eHHe C nan;HeHTOM nJIaHa yxo}J.a.
3. 3HaKOMCTBO }J.Pyrnx C nJIaHOM yxo}J.a.
Pea.n.u3aijU.R - 3TO:
1. BLIllOJIHeHHe nJIaHa YXO}1.a B YCTaHOBJIeHHbIe CpOKH.
2. KOOp}1.HHan;H.H ceCTpHHCKHX YCJIyr B COOTBeTCTBHH C co-
rJIaCOBaHHbIM nJIaHOM.
3. KOOp}1.HHHpoBaHIie YXO}1.a C y<IeTOM JII06oro npe}J.OCTaB-
JI.Her.-mro, HO He 3anJIaHHpOBaHHoro yxo}J.a HJIH 3anJIa-
HHpOBaHHoro, HO He npe}1.0CTaBJI.HeMOrO YXO}J.8.
106
" 3Tan - On;eHKa pe3YJlbTaTOB (HToroBa.H On;eHKa ceCTpHH-
CKoro YXO}1.a). On;eHI<a 3<lxPeKTHBHOCTH npe}1.0CTaBJIeHHoro yxo-
}J.a Hero KoppeKn;H.H B CJIy<Iae He06xoP;HMOCTH.
V 3Tan - BKJIIO'IaeT B ce6.H:
1. CpaBHeHHe p;OCTHrHYToro pe3yJILTaTa C 3anJIaHHpOBaH-
HbIM.
2. On;eHKY 3il$eKTHBHOCTH 3anJIaHHpOBaHHoro BMeIllaTeJIb-
CTBa.
3. AaJIbHeiiIIIYlO On;eHKY H nJIaHHpOBaHHe, eCJIH JKeJIae-
MbIe pe3YJIbTaTbI He p;ocTHrHYTbI.
4. KpHTH'IeCKHii aH8.JIH3 Bcex 3TanOB cecTpHHcKoro npo-
n; ca II BHeceHHe He06xop;HMbIX nonpaBoK.
MHcpopMan;H.H, nOJIY'IeHHa.H npH On;eHKe pe3YJILT TOB yxo-
JIJKHa JIe'Ib B OCHOBY He06xo}J.HMbIX H3MeHeHHII, nOCJIe-
}J.a,p;o
P;Y1OID;HX BMeIIIaTeJIbCTB (p;eiicTBHii) Mep;Hn;HHCKOH ceCTpbI.
AOKYMeHTan;H.H Bcex 3TanOB cecTpHHcIwro npon;ecca OCY-
ID;eCTBJI.HeTC.H B cecTpHHcKOii KapTe Ha6JIIOp;eHH.H 3a COCTO.H-
HHeM 3P;OpOBb.H nan;HeHTa H H3BeCTHa KaK cecTpHHCKa.H HCTO:
pH.H COCTO.HHH.H 3P;OpOBbH HJIH 60JIe3HH nan;HeHTa, COCTaBHOH
'IaCTbIO KOTOpoii .HBJI.HeTC.H KapTa cecTpHHcKoro yxo}J.a. B Ha-
CTO.HID;ee BpeM.H TOJILKO pa3pa6aTLIBaeTC.H cecTpHHCKa.H P;OKY.
MeHTan;H.H.
3 Z neps",ii 3man cecmpuHchoro npoqecca:
. . cy6belimuSHoe cecmpuHchoe o6cAegosaHl!e
C60p ..Hfj)opMal.\....
C60p HHcPopMan;HH O'IeHb BaJKeR, II p;OJIJKeH OCYID;eCTBJI.HTbC.H
B COOTBeTCTBHe C TaKoii CTpyKTypoii, KOTOpa.H uonHcLIBa TC.H B
MOp;eJIH ceCTpHHcKOro }J.eJIa, peKoMeHJJ:OBaHHoH.EBponeHcKHM
PerHOH8.JIbHbIM 61OpO B03 }J.JI.H ceCTep. IWTopble nJIaHHPYlOT
HCnOJIb30DaTb cecTpHHcKHM npon;ecc. .
AaHHLIe 0 naUHeHTe P;OJI)!{HbI 6LITb nOJIHbIMH H TO'IHLIMH H
HOCHTb onHCaTeJIbHbIM xapaKTep.
MmpopMan;HlO 0 COCTO.HHHH 3}J.OpOBb.H naUHeHTa MOJKHO co-
6HpaTb pa3JIH'IHbIMH cnoc06aMH H H3 pa3JIH'IHbIX HCTO'IHH-
. 101
KOB: OT n HeHTOB, 'IJIeHOB HX ceMeii, 'IJIeHOB emypHoii CMe-
HbI, H3 Me H HHCKOii OKYMeHTa HH, I}}H3H'IecKHX OCMOTpOB,
,nF!8I'HOCTWIecKHX TeCTOB. OpraHH3 H.H HHI}}OpM OHUoii 6a3bI
Ha'IHHaeTC.H co c60pa cy6'beKTH:BHOH HHcpOpMa:qHH nYTeM on-
poca nal\HCHTa, B npOl\eccc KOTOpOrO Me CeCTpa nOJIY'IaeT
npe,l\CTaBJIeHHe 0 COCTO.HHHH I}}H3IItJecKoro, nCHXOJIOrH'IeCKO_
ro, CC HaJIbHOrO, 3MO HOHaJIbHOrO, HHTeJIJIel{TY8.JIbHoro H
YXOBHOro COCTO.HHH.H na HeHTa, ero oc06eHHOCT.HX. Ha6JIIO-
,t\aR nOBeAeHHe H o eHHBa.H BHeWHH:ii BH na HeHTa Hero
B3aHMOOTHOIlleHH.H C oKpymalOr.qeii cpe oj\i, Me H HHCI{a.H ce-
CTpa MomeT onpe eJIHTb, cOOTBeTcTBYeT JIH paCCI{a3 na HeH-
Ta 0 ccGe ,l1aHHLIM, nOJIY'IeHHbIM B pe3YJIbTaTe Ha6JIIO eHH.H.
B npo ecce c60pa HH(l>opMa HH Me cecTpa HCIIOJIb3YeT l}}aK-
TOphI, cnoc06CTnYIOr.qHe 06lT. eUHIO (06CTaUOBKa, BpeM.H 6ece-
,l\bI, MaHepa rOBopHTb H T. .), KOTopble nOMoryT YCTaHOBHTb
'IynCTBO OBepH.H H KOH(l>H eH HaJIbHbIe OTHOIlleHH.H. Hap.H)J;Y
C or.qyr.qeHHeM npmpeCCHOHaJIH3Ma MeAHI\HHCKOii ceCTpbI 3T0
C03,l\aeT TY ,l\06pOmeJIaTeJJ:bHYIO 06CTaHOBKY Mem)J;y cecTpoii H
lIa HeHTOM, 6e3 KOTOPOH HeB03MomeH a.z\eKBaTHbIH TepaneB-
TH<recKHH 3cPcPeI;:T.
CO,l\cp:JKaUHe cy6'beKTHBHOH HII(I)opMa HH:
1:1 06r.qne CBC,l\eHH.H 0 nal\HeHTe;
.. paccnpoc nal\HeHTa, HUcPopMa H.H 0 na1\HeHTe;
.. maJI06bI na HeHTa B HaCTO.Hr.qee BpCM.H;
· HCTOpH.H 3,l\OpOBb.H HJIH 60JIe3HH na HeHTa: COI\Ha.ilbHbIe
CBe,l\eHH.H H YCJIOBH.H mH3HH, CBe eHH.H 0 npHBbltJKax,
8.JIJIe p rOaHaMHe3,rHHeKOJIOrH<reCKHii(YPoJIOrH'IecKHH)
H 3nH eMHOJIOrn'IecKHi1: aHaMHe3;
· 60JIb: JIOKaJIH3a H.H, xapaKTep, HHTeHCHBHOCTb, JIIi-
TeJIbHOCTb, peaKI\H.H Ha 60JIb.
3.3. nepBblii 3man cecmpuHclioro npoLfecca:
o6'belimUBHoe cecmpuHclioe o6cllegoBaHUe
Me H HHCKa.H cecTpa nOJIYtJaeT HHIJ.>OpM HIO C nOMor.qblO
opraHOB 'IYBCTB (3peHH.H, CJIyxa, 060H.HHH.H, BOCnpH.HTH.H Ka-
caHHeM), HHCTPYMeHTaJIbHbIX H JIa60paTopHbIX MeT0,l10B HC-
CJIe,t\OBaHH.H. .
108
Cooep3ICaHue 06oeKmU6Hoil UHljJOP.M quu:
. OCMOTp nal\HelITa: 06II\Hii - rpy HoH KJIeTKH, TYJIOBHII\a,
M - 7r eT 8.JIbHbIM OCMOTp (y<IaCTKOB TeJIa 110
:1KHBOTa, 3aTe ,..
06JIaCT.HM): rOJIOBa, JIHI\O, Ille.H, TYJIOBIlII\e, KOHe'IHOcTH:
Koma, KOCTH, CYCTaBbl, CJIH3HCTble 060JIO'II<H, BOJIOC.HHOH
nOKpOB;
. cP H3H 'IeCKHe aHHble: pOCT, Macca TeJIa, OTeKH (JIOKaJIH3a-
H.H);
. BbIpameHHe JIIID.a: 60JIe3HeHHoe, O,l\YTJIOBaTOe, TpeBomHoe,
6e3 oc06eHHOCTeii, CTpaAaJIb'IeCKOe, HaCTopomeHHoe, Tpe-
BomHoe, cnoKoiiHoe, 6e3pa3JIH'IHOe HAP.;
. COCTO.HHHe C03HaHH.H: B C03HaHHH, 6e3 C03HaHH.H, .Hcnoe,
HapyweHHoe: cnyrauHoe, cTynop, conop, KOMa, pyrHc pac-
cTpoiicTBa C03HaHH.H - r8.JIJIIOD.HH HH, 6pe,l\, nO,l\aB.'leHHocTb,
anaTH.H,,l\enpeCCH.H;
. nOJIOmeHHe naIJ.HeHTa: aKTHBHoe, naCCHBHoe, BbmY:1K eHHoe
(CM. CTp. 248-249);
. COCTO.HHHe KO>KHbIX nOI<poBoB H BHJ{HMbIX CJIH3HCTbIX: D.BeT,
Typrop, BJIamHOCTb, Ael}}eKTbl (CbInb, py6D.bl, paC'IeCbl, I<pO-
BonOJ{TeKH (JIOKaJIH3aD.H.H», OTe'IHOCTb HJIH naCT03HOCTb.
aTpocpH.H, 6JIe,l\HOCTb, rHnepeMH.H (noKpacHeHHe), D.HaH03 (CH-
HIOWHOCTb), nepH(pepHtJecKHii D.HaH03 (aKpOI\HaH03), meJI-
TYWHOCTb (HKTepH'IHOcTb), CYXOCTb, Ille.nyIlleHHe, nHrMeH-
TaD.H.H, H p:p.
. IWCTHO-MblwetJHa.H CHCTeMa: Ael}}opMa H.H CKeJIeTa, CYCTa-
BOB, aTpoqm.H MblillD., MbIWe'IHbIM TOHYC (coxpaHeH, nOBbl-
IlleH, nOHH:1KeH)
.. TeMnepaTypa TeJIa: B npe,l\eJIax HOpMbI, cy6cpe6pl'lJIbHa.H,
cy6HOpM8.JIbHa.H, (l>e6pHJIbHa.H (JIHXopa.z\Ka);
.. ,l\blxaTeJIbHa.H CHCTeMa: qAA (xapaKTepHCTHK ,l\blxaHFUI
(pHTM rJIy6uHa, TIm», THn (rpy,l\HOM, 6PlOWHOH, CMeIllaH-
HbIi1:), 'PHTM (pHTMH'IHOe, apHTMn'IHoe), r.ny6HHa (nonepXHO-
CTHoe, rJIy6oKoe, MeHee rJIy60Koe), TaXHnH03 (YCIar.qeHHoe,
pHTMH'IHOe, nOBepXHOCTHoe), 6pa,l\HnH03 (ype>l<eHHoe, PHT-
Mn'IHOe, yrJIy6JIeHHoe), B HopMe (16-18 AbIX. ,l\B. B 1 !\tHH.,
nOBepxHocTHoe, PHTMHtJHoe); .
. AJ1,: Ha ,l\BYX PyKa..X, rHnOTOHH.H, HOpMOTOHH.H, rHnepTOHH.H,
. IIYJIbc: KOJIHtJeCTBO y apoB B MHHyTY, PHTM, HanOJIHeHHe,
Hanp.HmeHHe HAP. xapaKTepHCTHKH, 6pa HKapAH.H, TaXH-
Kap H.H, apHTMH.H, B HopMe;
109
· eCTeCTBellHble OTnpaBJIeHHSI: MO'IeBbI.l\eJIeHHe ('1aCTOTa, KOJIH-
'1ecTBO, He.l\ep>KaHHe MO'lH, KaTeTep, C8MOCTO.HTe.IlbHO, MO'len-
PHeMlIHK), CTYJI (C8MOCTO.HTeJIbHblii, peryJI.HpHbIH, XapaKTep
cTYJIa, He,l1ep>KaHHe I<aJIa, KaJIOnpHeMHHK, I<OJIOCTOMa);
· OpraHbI '1YBCTB (CJIYX, 3peHlle, 060H.HHHe, OC.H3aHHe, pe'lb),
. naM.HTb: COXpaHeHa, HapyweHa;
· HCnOJIb30BaHHe pe3epBOB: O'lKH, JIHH3bI, C.rryXOBOH anna-
paT, C'beMHble 3y6Hble npOTe3bI;
. COH: nO'l'pe6HOCTb cnaTb AHeM;
· cnoc06HOCTb K nepeABH>KeHHlO: caMOCTO.HTeJIbHO, npH no-
MOl H nOCTopOHHHX HAP.;
· cnoc06HOCTb eCTb, nHTb: anneTHT, HapyweHHe >KeBaHHH,
TowHOTa, pBoTa, pe3epBbI.
O.lteHKa nCHxOC0.ltHaJILHOro COCTO.HHIUI nan;HeHTa:
. onHcaTb MaHepy rOBopHTb, Ha6JIlOAaeMOe nOBe.l\eHHe,
3MOn;HOHaJIbHOe COCTO.HHHe, "nCHXOMOTopHble H3MeHeHHH,
IYBcTBa;
. C06HpaIOTCH COn;HaJIbH0-3KOHOMHv.:eCKHe AaHHble;
.q>aKTopbI pHcI<a;
III npOBOAHTCH On;eHKa nOTpe6HOCTeii nan;HeHTa, onpeAe-
JI.HIOTCH HapyweHHble nOTpe6HOCTH.
npH npoBep;eHHH nCHXOJIOrH'IeCKOH 6eceAbI CJIeAYeT npH-
,wp>KHBaTbCH npHHn;Hna YBa>KeHHH JIH'IilOCTH naD;HeHTa, H3-
l5eraTb I<aKHX-JIH60 On;eHO'lHbIX CY>K,l1eHHH, npHHHMaTb nan;H-
eHTa Hero np06JIeM)' TaKHMH, KaKHe OHH eCTb, rapaHTHpo-
'3aTh KOHq>HP;eHn;HaJIbHOCTb nOJIy<IeHHoH HHq>opil'l:an;HH, Tep-
"aeJIHBO ero BbICJIywaTb.
Ha6JI1o eBHe 3a COCTO.HHHeM nan.HeJlTa
J(e.IITeJIbHOCTb Me,l\CeCTpbI npeAYCMaTpHBaeT Ha6JIIO,l\eHHe 3a
BceMH H3MeHeHHHMH B COCTOHHHH nan;HeHTa, cBoeBpeMeHHoe
BbI.l\eJIeHHe HX, On;eHlta, co06 eHHe Bpa'iY.
Ha6JIIO,l\aH 3a nan;HeHTOM, Me,l\cecTpa ,l\OJI>KHa 06pa aTb
BHHMaHHe Ha:
. COCTOHHHC C03HaHHH;
. nOJIO>KeHHe nan;HeHTa B nOCTeJIH;
. Bblpa:meHHe JIHn;a;
. n;BeT KO:mHbIX nOKpOBOB H BH,l\HMbIX CJIH3HCTbIX;
. COCTOHHHe opraHOB KpoBo06pa eHHH H AbIXaHHH;
. QJyJlKn;HIO opraHOB BbI,l\eJIeHHH, CTYJI.
COCTO.HHHe C03HaHH.H 6
1. 5IcHoe C03HaHHe - naI(IIeHT OTBe'laeT Ha BonpOCbI hICT-
po H KOHKpeTHo. CbI
2. CnyTaHHOe C03HaHHe - naI(HeHT OTBe'laeT Ha Bonpo
npaDH.'lbHO, HO C on03AaHHeM.
3 CTynOp - COCTOHHIIe OrJIyweHHH, O.lteneHeHHH, lIa Bon-
. pOCbI naI(HeHT OTBe'laeT C On03.l\aHHeM H HeOCMbICJIeHHO.
4 Conop - naTOJIOrH'IeCKHi1: rJIy60KHii COH, nan;HeHT 6e3
. C03HaHHH, He coxpaHeHbI pe<})JIeKCbI, rpOMKHM rOJIOCOM
ero MOJitHO BbIBecTH H3 3Toro COCTOHlIHH, HO OH BCKope
BHOBb Bna):\aeT B COHo .
5 KOMa - nOJIHOe yrHeTeHHe q>YHKn;HH IJ;HC. C03HaHHe
. oTcyTCTByeT, Mblwn;bI pacc.r..a6JIeHbI, yTpaTa '1YBCTBH-
TeJIhHOCTH H peQJJIeKcoB. BbIBaeT npH KPOBOH3JIHHHH
B M03r, caxapHoM AHa6eTe, nO'le'lHOM H ne'leIIO'lHOH
Hep;OCTaTO'lIIOcTH.
6. BpeA H rIUlJIIOn;HHan;HH - MOryT Ha6JIIop;aThCH npH Bblpa-
:melIlIOH HHTOKCHKalI,HH (HH«PeKII,I-IOHlIble 3a60JIeBaHHH, TH-
)KeJIOe Te<IeHHe -ry6epKy.rre3a JIen<HX, Bocna.neHH.fl JIentHx).
BLlpaJiteHHe JIHn;a
CooTBeTcTByeT xapaKTepy Te'leHH.H 3a60JIeBaHHH, Ha Hero
BJIHHIOT nOJI H B03paCT nan;HeHTa.
Pa3JIHtJaIOT: u
. JIH.ltO rHnnOKpaTa - npH nepHTOHHTe «<OCTPbIH :mH-
BOT») ]J,JIH Hero xapaKTepHO CJIeAYIO ee Bblpa:meHHe
JIHn;a; 3anaBwHe rJIa3R, 3aOCTpeHHbIH HOC, 6JIeAHOCTb C
n;Hall030M, KanJIH XOJIOAHOrO nOTa;
. Op;YTJIOBaTOe JIHn;O npH 3a60JIeBallH.HX nO'IeK II AP. 60-
JIe3HHX- JIHI O OTe'lHOe, 6JIe.l\Hoe.
. JIHxopaAO'lHOe Jllin;O npH BbICOKOH TeMnepaType - 6JIecK
rJIa3 rHnepeMH.H JIHn;a.
. MHT JIbHbIH «PYMHHen;» - n;HaHOTwlUble eKH Ha 6JIeA-
HOM JIHn;e.
. nyr-IerJIa3He, ApO)ItaHI e BeK - npH rHnepTHpc03e HAP.
. 6e3yqacTHocTb, CTpa.n;aHHe, TpeBora, CTpax, 60JIe3HeH-
Hoe Bblpa:meHHe JIHn;a H np. 0"
BbIpa:meHHe JIHn;a AOJI:mHO 6bITb On;eHeHO Mep;ceCTpOH, 06
H3MeHeHHHX KOToporo OHa 06H3aHa AOJIO:mHTb Bpa'iY.
Ko:mHLle nOKpOBLI H DHl);IIMble CJIH3HCTLIC 060.110'lKH
MOryT 6bITh 6JIe,llHble, mnepeMMpOBaHHble, :meJITyIliHbIe, CH-
lIlOwHble (n;HaH03), aKpOn;HaH03, 06paw;aTh BHHMaHHe Ha ChInh,
CyxOCTb KO:mH, yqaCTKH nHrMeu'raI(HH, HaJIIf'IHe OTeKOB.
II'
I
I
liD
.
IIocJIe OI\eHKH pe3y.m.TaTOB Ha6JIIO.n;eHH.!I 3a n HeHTOM Bpa'l
.n;eJIaeT 3aKJIIO'leHHe 0 ero COCTO.!IHHH, a Me.n;ceCTpa - 0 KOM-
neHcaTopHbIX B03MOmHOCT.!IX nan;HeHTa, ero cnoc06HOCTH K
oCYJJ. eCTBJIeHHIO CaMoyxop;a. ,
OI\ellKR COCTOmIH.H naI{HeHTa C l\e.m.JO OI\ellKH caMoyxop;a
1. Y.n;oBJIeTBOpHTe.r.:bHoe - nan;HeHT aKTHBeH, BbIpameHHe
JIHn;a 6e3 oc06eHHocTeii, C03HaHHe .!ICHOe, HaJIHv.:He na-
TOJIOrH'leCKHX CHMnTOMOB He MernaeT OCTaBaTbC.!I al,-.
THBHbIM.
2. COCTO.!IHHe cpe.n;Heii T.!ImeCTH - BblpamaeT maJI06bI,
MOmeT 6bITb BbIHym.n;eHHoe nOJIOmeHHe B nOCTeJIH, aK-
THBHOCTb MomeT YCHJII:IBaTb 60JIb, BbIpameHHe JIHn;a
60JIC3HeHHOe, BbIpameHbI naTOJIOrH'leCKHe CHMnTOMbl co
CTOpOHbI CHCTeM H opraHoB, H3MeHeH I\UeT l<omHbIX no-
KpOBOB.
3. T.!I:meJIoe COCTO.!IHUe - naCCHDlIOe nOJIOmeHHe B nOCTe-
JIH, aKTHBHbIe .n;eiiCTBH.!I COBeprnaeT C Tpy.n;OM, C03Ha-
HHe MomeT 6bITb H3MeHeHHbIM, H3MeHeHO B:blpameHHe
JIHn;a. BbIpameHbI HapyrneHH.!I QJyaKn;Hii .n;bIxaTeJIbHOM,
cepp;e'llIo-cocy.n;HCTOii H [(HC.
HapYlUeli1lbte nompe6nocmu (nOartepICllymb):
1) .n;blrnaTb;
2) eCTb;
3) nHTb;
4) BbIp;eJI.!ITb;
5) cnaTb,oTp;bIxaTb;
6) 6bITb'lHCTbIM;
7) op;eBaTbC.!I, pa3,l1eBaTbC.!I;
8) no.n;.n;ep)1<HBaTb TeMnepaTYPY TeJIa;
9) 6bITb 3P;OpOBbIM;
10) H36eraTb onacHocTH;
11) ,l1BHraTbC.!I;
12) 06 aTbC.!I; n Ok.. b-O
13) HMeTb mM3HeHH:ble QeHHOCTH MaTepHaJII,H"Jgfe H ):O'XoBHbIe;
14) HrpaTb, y<!HTbC.!I, pa60TaTb;
OqenICa caJlfoyxoiJa
Onpe.n;eJI.!IeTC.!I CTeneHb He3aBHCHMOCTH nan;HeHTa B YXO,l1e
(He3aBHc M, 'laCTH'lHO 3aBHcHM, nOJIHOCTblO 3aBHcHM, C no-
MO blO Koro).
1 C06paB He06xo.n;HMYIO cy6'beKTHBHYIO H 06'beKTHBHYIO HH-
. QJopMan;HIO 0 COCTO.!IHHH 3.n;OpOBb.!I nan;HelITa, ceCTpa .n;OJI-
mHa nOJIy<IHTb 'leTKoe npe.n;cTaBJIeHHe 0 nan;HeHTe .n;o Ha-
'laJIa nJIaHHpOBaHH.!I yxo.n;a. .
2 IIonbITaTbC.!I onpe.n;eJIHTb, 'lTO HOpMaJIbHO .n;JI.!I 'leJIOBeKa,
. KaK OIl BH.n;HT CBoe HopMaJIbHOe COCTOSIHHe 3.n;OpOBMI H
KaKYIO nOMOlD;b MomeT ce6e OKa3aTb caM.
3. Onpe.n;eJIHTb HapymeHHble nOTpe6HoCTH 'leJIOBeIta H no-
Tpe6HocTH B yxo.n;e.
4. YCTaHoBHTb sl}}l}}eKTHBHoe 06rn;eHHe C naQHeHTOM H npH-
BJIe'lb ero K COTpy.n;HH'lecTBY.
5. 06Cy.n;HTb C nan;HeHTOM nOTpe6HocTH B yxo.n;e H OmHJ\aeMble
pe3YJIbTaTbI. _
6 06ecne'lHTb yCJIOBH.!I, npH KOTOpOM CecTpHHCI,HH yxop; y<IH-
. TbIBaeT nOTpe6HocTH naQHeHTa, npO.!IBJI.!IIOTC.!I 3a60Ta H
BHHMaHHe K naQHeHTY.
7. 3anOJIHHTb .n;oItYMeHTaI\HIO C n;eJIbIO ee HC OJIb30BaHHH B
Kav.:eCTBe OCHOBbI .n;JI.!I cpaBHeHH.!I B .n;aJIbHeHmeM.
8. He .n;onycKaTb B03HHKHOBeHH.!I HOBbIX npo6JIeM y naI\HeHTa.
AHTPonOMETPYlJ1
ho KOMnJIeKC MeTo.n;OB H3YQeHH.!I MOp(pOJIOrH'leCKHX oco-
6eHIIOcTeii 'leJIOBe'lCCKOrO TeJIa, H3Y'leHHe H3MepHTeJIbHbIX H
onHCaTeJIbHbIX npH3HaKoB. E H3MeplITeJIbHbIM MeTo.n;aM OT-
HOC.!ITC.!I onpe.n;e.r.:eHHe MaCCbI TeJIa, pOCTa, H3MepeHHe OKpym-
HOCTH- rpy.n;Hoii KJIeTKH H HeKOTopbIe p;pyrHe.
Onpe,ll;eneHHe MaCChI Tena na.n;HeHTa
[feRb:.n;HarHOCTH'leCKa.!I.
IIolCa3anUR: BbI.!IBJIeHHe .n;eI}}HI\HTa Beca, OmHpeHI'Ul, CKpbI-
TbIX OTeKOB, Ha6JIIO.n;eHHe 3a .n;HHaMHKoii Beca, OTeKOB B npo-
I\ecce JIe'leHH.!I, nocTynJIeHHe naQHeHTa B CTan;HOHap.
IIpomU60nolCa3anuJt:
- T.!I)KeJIOe COCTO.!IHHe naQHeHTa;
- nOCTeJIbHbIii pejKHM.
OC1W.14enue:
- BeCbI Me.n;Hn;HHCKHe;
112
113
a
6
B
AHTponOMeTpl1S1:
a - v.3MepeHl-1e pOCTa; 6 - 83BeWI1BaHl-1e;
B - H3MepeHHe OKPY>KHOCTH rPYAHoi1 KJ1eTKH
- 'lHCTan npo e3HHq>HQHpoBaHHan KJIeeHKa 30 x 30 CM Ha
nJIOI.l.\ KY BeCOB; /'
- eMKOCTb C e3paCTBopOM JIn .n;e3HHcpeKQHH KJICeHKH.
nep'laTOK;
- 5% -HbIH paCTBOp XJIOpaMHHa C 0,5% -HbIH paCTBopOM
MOIOI.l.\erO cpe.n;CTBa;
- BeTOillb .n;JIn .n;BYKpaTHoH 06pa60TI<H KJIeeHKH;
- nep'l8TKH JIaTCI{CHbIe.
06.R.3ameJlbHOe YCJl06ue:
- B3BeWHBaHHe npOBO HTcn B3pOCJIbIX naQHeHTOB;
- HaTOI.l.\3K YTPOM, B O.n;HH H Te me 'laCbI;
- nOCJIe npe,ZJ;BapHTeJIbllOrO onopomHeHH.H MO'IeBoro ny3blpn;
- nOCJIe oCB060m eHH.H KHWe'lHHKa;
- B H3TeJIbHOM 6em.e.
3Tanbl I 060CHOBaHlile
n0020mOBK8 K npol.{eoype
1. YCTaHoBIiITb AOBepl1TenbHble 06ecne4eHl1e 0C03H8HHOro
OTHOWeHI151 C naLilileHTOM; 06b- yY8CTIiI5I B npoLleAype, np8Ba
51CHIiITb Llenb iii xOA npoLleAYPbl; naLll1eHTa Ha IiIHcpopMaLlI1IO.
nonyYl1Tb cornacl1e naLll1eHT8.
114
3Tanbl I 06ocHoBaHMe
n0020moBK8 K npol.{eoype
2. BblMblTb iii OCYWIiITb PYKIiI, 06eCne4eHlile IiIHcpeKLlI10HHoi1
H8AeTb nep4aTKI-I. 6e30naCHOCTIiI.
3. OmycTIiITb 3aTBOp BeCOB. He06xOAI1MO y6eAIiITbc5I, 4TO
BeCbI np8BlilnbHo pa60TalOT.
4. YCT8HOBIiITb rl1plil BeCOB B
HyneBoM nOnO>KeHIiII1, oTpery-
nlilpoB8Tb BeCbI, 3aKpblTb 3a-
TBOp.
5. 3aCTenl1Tb KJ1eeHKY Ha 06ecne4eHI1e IiIHcpeKLlIiIOHHoi-1
nnoUl8AKY BeCOB. 6e30n8cHocTIiI.
6. npep,nO>KI1Tb naLllileHTY OCTO- He06xoAIiIMoe ycnOBl-le An51
pO>KHO BCT8Tb B LleHTpe nno- B3BCWI1BaHI151.
Ul8AKIiI Ha KJ1eeHKY (6e3 Tano-
4eK).
7. OTKpblTb 3aTBop iii nyreM nonyYeHlile pe8nbHbix AOCTO-
nepeABIiI>KeHI151 pa3HoBecoB BepHblx pe3ynbTaToB MaCCbI
YCT8HOBI1Tb paBHoBeclile. Tena.
8. 3aKpblTb 38TBOp. npocpl1naKTIilKa c6051 BeCOB.
9. npeAnO>KlilTb n8LllileHTY OCTO-
pO>KHO COi1TI-I C BeCOB.
10. 3anlilcaTb A8HHble B3BeWI1- 06ecne4eHlile KOHTpOn51 MaCCbl
BaHI151 B TeMnep8TYPHbli1 nIilCT. Tena naLll1eHTa 11 npeeMCTBeH-
HOCTIiI B nepeA84e I1HcpopMa-
l\liIliI.
OKOH'I8HUe npOl.{eoYPbl
1. CH5ITb KJ1eeHKY iii 06pa60TaTb 06eCne4eHi-le npocplilnaKTIiIKIiI
ee MeToAoM ABYKP8THOro npo- rplil6KoBbIX 3a60neB8HIili-1.
TI1paHIiI5I 5%-HbIM paCTBOpOM
XJ10p8MIiIHa C O,5%-HbIM pac-
TBOpOM MOIOUlero cpeAcTBa.
2. CH5ITb nep48TKI-I, norpY31i1Tb B 06ecne4eHi-le IiIHcpeKLlliloHHoi-1
eMKOCTb An51 Ae31i1HcpeKLll11i1, 6e30naCHocTI1.
BblMblTb iii OCYWI1Tb PYKI1.
115
H3MepCHHe pOCTa naI\HeliTa
IfeRb: HarHOCTHqecKaH.
II OKa3WlUR: o»mpe -
p., npHeM na HeJlTa I:: ;= ::'HHe QJYHK HH nmOcPH3a H
OCllaU{euue:
- pOCTOMep BepTHKaJILHbIH'
= qHCTaH npo e3HHcpH HPo aHHaH KJIeeHKa 30x30 CM'
eMKOCTL C e3paCTBopOM; ,
- 5%-HbIH paCTBOp XJIOpaMHHa C 05%
MOIOlT. erO cpe cTBa; , 0 -HbIM pacTBopoM
- BeTOIllb JIH 06pa60TKH KJIeeHKH, pocToMepa'
- nep'IaTKH JIaTeKCHLIe; ,
- 6YMara, PY'IKa.
H :3:::::: :;c::::ee :: e O JI 6 em e pOCTa B3pOCJIOro na-
YBH H rOJIOBHOrO y60pa
3Tanbl 06OCHOeaHI1H
npoeeiJeHue npolleiJYPbl
4. npeAJlO>KI1Tb na l1eHTY COOTI1 C
nnoU!ClAKI1 pOCToMepa.
5. no WKane pOCToMepa onpeAe- - 06eCneyeHIo1e npeeMcTBeHHOCTI1 B
nl1Tb pOCT na l1eHTa, 3anl1CaTb pe- nepeAa4e I1HcjJopMa l1l1.
3ynbTaT: I =
6. C006U!I1Tb na VleHTY 0 pe3ynbTa- 06ecne4eHI1e npaBa na VleHTa Ha
Tax 113MepeHI1!!. I1H<!>OpMa IO.
OKOH'laHUe npolleiJypbl
1. Y6paTb KfleeHKy 11 npoTepeTb 06ecnB4eHl1e np0<!>l1naKTI1KI1 rpl16-
ABYKpaTHo 5%-HbIM pacTBopoM KOBbiX 3a60neBaHI1a:;.
xnopaMI1Ha C O,5%-HbIM paCTBOpOM
MOIOU!ero cpeAcTBa.
2. CH!!Tb nep4arKI1, norpY311Tb B 06ecnB4eHl1e I1HcjJeK l;IoHHOa:; 6e30-
eMKOCTb AJl!! Ae3I;1Hct>eK I1I;1, BbI- naCHOCTI1.
MblTb 1;1 0CYWI;ITb PYKI;I.
3Tanbl 06ocHoaaHI;IR
noi'JeomoBKa K npolleiJype
1. YCTaHoBI;ITb AOBepl;lTenbHble 06eCne'leHl;le OC03HaHHoro yyaCTI;I!!
OTHOWeHI;I!! C na eHToM; 06b!!C-
HI;ITb lIenb I;IccneAOeaHI;I!!1;I nono- B npo eAype, npaBa na eHTa Ha
>KeHl;le Tena BO BpeM!! npOllBAYPbI. I;IH<!>opMa l;IlO.
2. BblMblTb PYKI;I, HaABTb nep'laTKI;I. 06ecne4eHI1e I1H<!>eK l;IoHHOa:; 6e30-
3. 3aCTenl1Tb KlleeHKY Ha nnou!B,QKY naCHOCTI;I.
pocToMepa.
4. BCTaTb C60KY OT pocToMepa 1;1
nOAH!!Tb nnaHKy Bblwe npeAllona-
raeMOro pOCTa na l1eHTa.
npoeeiJeHue npOlleiJypbl
1. npe,qnO>KI;ITb na eHTY BCTaTb Ha t:\ocTI;IJKeHl;le AOCTOBepHOCm AaH-
nnoU!aAKy pocToMepa Ha KfleeHKY
Ta 4T06bl OH KacanC!I BepTI;IKanb- HblX I1cCneAOBaHI;IH.
HOI;I nnaHKI;I pocToMepa 3aTbinKOM
nonaTKaMl;I, HroAl1l.1aMl;I, nHTKaMI;I. '
2. YCTBHOBI;ITb ronoBY na I;ICHTa 3TO 06eCne'lI;lT npaBl1JlbHOO nono-
TaK, 4T06bl HaPY>KHbla:; yron rna3HI;I-
l\bIl;I HaPY>KHbla:; cnyxoBoa:; npoXOA >KBHl;le ronoBbl no OTHOWeHl11O K
6blnl1 Ha OAHOM ropl;l30HTanbHOM nnaHKe pocTOMepa.
ypoBHe.
3. OnyCTI1Tb nnaHKY POcToMcpa Ha
TeM!! nB I1CHTa.
OUEHKA
YHKU OHAnbHOrO COCTOHH H nAU EHTA
llYJILC Hero xapaKTepHCTHKa
Pa3JIHqaIOT apTepHaJIbHbIH, KanHJIJIHpHbIH H BeH03HbIH
nYJIbC.
ApmepUaRbllblU nYRbC - 3TO PHTMHqHble KOJIe6aHHH CTeH-
KH apTepHH, 06yCJIOBJIeJlHbIe BbI6poCOM KpOBH B apTepHaJIL-
HYIO cHcTeMY B TeqeHHe OAHoro COKpalT. eHHH cep n;a. Pa3JIH-
qaIOT eHTpaJIbHbIH (Ha aopTe, COHHbIX apTepHHX) H nepHcPe-
pHqeCKHH (Ha JIyqeBOH, TbillLHOH apTepHH CTonbI H HeKOTO-
pbIX pyrHx apTepHHX) nYJIbC.
B AHarHOCTHqeCI<HX ueJIHX nYJIbC onpe eJIHIOT H Ha BHCOq-
HOH, 6eApeHHOH, nJIeqeBOH, nO KOJIeHHOH, 3a.n;HeH 60JIbIlle-
6epn;OBOH H pyrHx apTepHHX.
qaI.qe nYJIbC HCCJIe YIOT y B3pOCJIbIX Ha JIy>leBOH apTepHH,
KOTopaH paCnOJIQ)KeHa nOBepXHOCTHO Mem,1J;y IllHJIOBHAHbIM
OTpOCTKOM JIY'leBOH IWCTH H cyxomHJIHeM BHYTpeHHeH JIy>le-
BOH MbIIII bI.
I1cCJIe H apTepHaJILHbIH nYJIbC, BamHO onpe eJIHTb ero
qaCTOTY, pHTM, HanOJIHeHHe, HanpHmeHHe H pyrHe xapaK-
116
111
nOnO>KeHMe PYK>'I
T04KM nanbqeBoro npM>KaTI1J1 apTepliM
BHJIbHbIH). "Y 3AOpoBOrO IeJIOBeKa COKpaIIWHHe cepAl\a H nYJIb-
COBa.fl BOJIHa CJIeAYIOT APyr 3a APyroM Iepe3 paBHbIe npOMe-
m}'TKH BpeMeHH. ECJIH OCTb pa3HHl\a Me:>KAY KOJIH IecTBOM cep-
AeYIHbIX GOKpall\eHHH H nYJIbCOBhIX BOJIH, TO TaIWe COCTO.flHHe
Ha3bIBaeTC.fI aetjJuu,UmO.M nyJlbca (npH Mepl\aTeJIbHOH apHT-
MHH). TIOAC IeT npOBOA.fIT ABa IeJIOBeKa: OAllH CYII1TaeT nYJIbC,
APyron BbICJIYIlIHBaeT TOHbI cepAl\a. _
HanOJIHeHHe nYJIbCa onpeAeJI.fIeTC.fI no BbIcoTe nYJIbCOBOH
BOJIHbI 11 3aBHCHT OT C11CTOJIH IeCKOI'O 06'heMa cepAl\a. ECJIH
BbICOTa HOpMaJIbHa HJIH YBeJIHYIeHa, TO npo ynbIBaeTC.fI HOp-
MaJIbHbIH nYJIbC (nOJIHbIH); eCJIH HeT - TO nYJIbC nYCTOH. Ha-
np.fl:>KeHHe nYJIbCa 3aBHCHT OT BeJI11'lHHbI apTepHaJIbHOI'O AaB-
JIeHH.fI H onpeAeJI.fIeTC.fI no Ton CRJIe, KOTOPYIO He06xOAHMO
npHJIO:>KHTb AO HC Ie3HOBeHH.fI nYJIbca. TIpH HOpMaJIbHOM AaB-
JIeHHH apTepH.fI CAaBJIHBaeTC.fI yMepeHHbIM YCHJIHeM, n03TOMY
B HopMe nYJIbC YMepeHHoro (YAOBJIeTBOpHTeJIbHoro) Hanp.fl-
:>KeHH.fI. TIPH BbICOKOM AaBJIeHHH apTepH.fI CAaBJIHBaeTC.fI CHJIb-
HbIM HaAaBJIHBaHHeM - TaKon nYJIbC Ha3bIBaeTCH Hanp.fl:>KeH-
HbIM. Ba:>KHO He 0llIH6HTbC.fI, TaK KaI< caMa apTepH.fI MO:>KeT
6bITb CKJIep03HpOBaHa. B TaKOM CJIyqae Heo6xOAHMO H3Me-
pHTb AaBJIeHHe H y6eAHTbC.fI B B03HHKllIeM npeAnOJIOmeH11H.
TIpH HH3KOM AaB..lIeHHH apTepH.fI CAaBJIHBaeTCH JIeI'KO, nYJIbC
no Hanp.fl:>KeHHIO Ha3bIBaeTC.fI M.fII'KHM (HeHanp.fl:>KeHHbIM).
TIYCTon, HeHanpH:>KeHHbIH nYJIbC Ha3bIBaeTC.fI MaJIbIM HH-
TeBH,l\HbIM.
J]:aHHbIe HCCJIeAOBaH11.fl nYJIbCa c1?l1KCHPYIOTC.fI ABYM.fI CIIO-
c06aMH: l\Hc1?poBbIM - B MeAHl\HHCKOH AOKYMeHTal\HH, :>KYP-
TepHCTHKH. XapaKTep nYJIbCa 3aBHCHT H OT 3JIaCTH mOCTH
CTeHKH apTepHH.
l{acmoma - 3TO KOJIH'leCTBO nYJIbCOBbIX BOJIH B 1 MHHYTY.
B HopMe Y B3poCJIOrO 3AOpoBOro IeJIOBeKa nYJIbC 60-80 YAa-
poB B M11HYTY. "Y'la eHHe nYJIbCa 60JIee 85-90 YAapoB B MH-
HYTY Ha3bIBaeTC.fI maxuu;apaueii. "Ype:>KeHHe nYJIhCa MeHee 60
YAapoB B M11HYTY Ha3bIBaeTCH 6paiJuu;apiJueii. OTCYTCTB11e rryJIb-
ca Ha3bIB eTC.fI acucmoJlueii. TIPH nOBbIllIeHHH TeMnepaTypbI
TeJIa Ha 1 C nYJIbC YBeJI11'lHBaeTC.fI Y B3pOCJIbIX Ha 8-10 Y,l:\a-
pOB B MHHYTY.
PHTM nYJIbCa onpeAeJI.fIlOT no HHTepBaJIaM Me)K.n;y nYJIbCO-
BbIMH BOJIHaMH. ECJIH OHH OAIfHaKOBbIe - nYJIbC p11TMH IHbIn
(npaBHJIhHbIH), eCJIH pa3HbIe- - nYJIbC apHTMHYIHbIH (Henpa-
118
119
HaJIaX, H rpaclJH IeCKHM - B TeMnepa'lYPHOM JIHCTe KpaCHIoIM
KapaH,l\aIIIOM B rpaclJe ll» (nYJIIoC). Ba'f{Ho onpe,l\eJIHTIo D.eHY
,l\eJIeHH.H B TeMnepaTYpHOM JIHCTe.
llO;:J;C'IeT apTepHaJIIoHOrO nyJIbCa Ha JIyqeBoH apTepJlH
H Onpe,l\eJIeHJle ero CBOHCTB
QeJlb: Onpe,l\eJIHTb OCHOBHIoIe cBoikTBa nYJIIoCa - IaCTOTY
pHTM,HanOJIHeHHe, Hanp.H>KeHHe. .,
nOU;a3anU.R.: OD.eHKa clJYHKD.HOHaJIIoHOrO C0CTO.HHH.H opra-
HH3Ma.
Ocnaw,enue: IaCIoI HJIH CeKYH,1\OMep, reMnepaTYPHIoIH JIHCT
pyqKa C KpaCHIoIM Crep>KHeM. '
3rnnbl I 060CHOB3HI111
1700aomOOK8 K npoljeoype
1. YCTaHOBl1Tb AOBepl1TeflbHble 06ecne4eHI1e OC03HaHHoro }"IacT\o1I1
OTHOWeHI151 C naljl1eHTOM.
2. 06bllCHI1Tb cyrb 11 XOA npoljeAY- B cOBMecTHoj;j pa6OTe.
nCI1XOnOrl14eCKBR nOAroToaKa na-
pbl. ljl1eHT3.
3. non}"ll1Tb cornacl1e naljl1eHTa Ha Co6moAeHI1e npaB naljl1eHTa.
npOljeAYPY.
4. nOAroTOBL1Tb He06xoAI1MOe oc-
H81ljeHl1e.
5. BblMblTb 11 Ocywt.1Tb PYKt.1. 06eCne'leHt.1e nt.1'1Hoj;j rt.1rt.1eHbI.
BblnollHeHue npoL(eiJYPbl
1. npl'f,llaTb naljt.1eHTy YA06Hoe 00- C03AaHt.1e KOM<!>0pTHoro nonOJKe-
nO>KeHl-1e Cl-lAil t.1nl-1 fleJKa. HI-1I1, C ljeflbKJ o6eCne4eHI-111 AOCTO-
2. OXBaTI-1Tb OAHoBpeMeHHo KI-1CTI1 BepHoro pe3ynbTaTa.
CpaBHeHl-1e xapaKTepl1C1I1K nynbca
naljl-1eHTa nanbljaMI1 CBOI-1X PYK Ha 06el-1x PYKax AJ1R ab11lCHeH1111
Bblwe n}"le3anllCTHoro cycTaBa TaK, COCTOIIHI1I1 apTepl111 11 onpeAeneHl111
'1T06bl 2, 3 11 4-j;j nanbljbl HaXOAI1- 60noo 'leTKOj;j nynbCaljl1H 2-j;j (YKa-
nl1Cb HeA n}"leBoo apTepl1ej;j (2-j;j 3aTenbHblj;j) nanelj RBnlleTCII Ha':
nanelj y OCHOBaHl111 6onbworo 60nee '1YBcTBI1TenbHblM, OO3TOM\
nanblja). CpaBHI1Tb Kone6aHI151 ero pa nOnaraKJT HBA n}"leBoj;j op
CTeHOK apTepl1j;j Ha npaBoj;j 11 neBoj;j TepHel1 y OCHOeaHl1n 6onbworo
PYKax. naflblja.
3. npoBecT\o1 nOAC4eT nynbcoBblX 06eCne'leHt.1e TO'IHOCTI1 onpeAene-
BonH Ha TOj;j apTepl-1l1, rAe OHI1 nY4- HI1I1 'laCTOTbi nynbca.
we Bblpa>KeHbl B T8'leHl1e 60 ce-
KYHA.
4. OljeHI1Tb t.1HTepSanbi Me>KAY Anll onpeAeneHl111 pt.1TMa
nynbCoBblMI1 BOnHaMI1. nynbca.
120
3Tanbl 06ocHOBaHI111
BblnOflHeHUB npo eoypb'
5. OljeHI1Tb HanonHeHl;le OnpeAeneHl;le Benl;l'lI;lHbl o6beMa .
nynbca. aprepl;lanbHoj;j KPOBI;I, 06pa3YKJlljej;j
nynbcOBYKJ BonHY.
6. CAaBl1Tb n}"leBYKJ apTepl;lKJ AO Ann npeAcTaBneHI;I1I 0 Benl1411HB
I;IC4e3HOBeHl;ln nynbca 11 OL\eHl1Tb apTepl;lanbHoro ABBneHI;III.
Hanpll>KeHl;le nynbca.
OKOH'/8Hue npo eoypb'
1. npoBecTI1 pBrl;lcTpaljl1KJ cBci1cTB Ii1cl<mo4aeTcn oWl;l6Ka npL1 AOKy-
nynbca B TeMnepaTypHOM nl;lcre MeHTl-1pOBaHI;II;I pe3ynbTaToB l;Iecna-
rpa<!>1;I4ecKliIM, a B nl;lCTe Ha6nKJAe- AOBaHI;I1I nynbCB.
HI;I5I - ljl;l<!>POBbIM cnoc060M.
2. C006LljL1Tb naljl1eHTy pe3ynbTaTbi npaBo naljl-1eHTa Ha I;IH<!>0PMBljI;lKJ.
I;IccneAoBaHI;III.
3. BblMblTb 11 OCYWI;ITb PYKI;I. C06nKJAeHl;le nl;l'lHoj;j mrl;leHbl.
H3MepeHHe apTepHaJIbHOrO ,D;aBJIeHH.H
ApTepHaJIIoHbIM Ha3IoIBaeTC.H ,l\aBJIeHHe, KOTopoe 06pa3Y-
eTC.H B apTepHaJIIoHOH cHcTeMe opraHH3Ma npH COKpa eHH.HX
cep,l\D.a H 3aBHCHT OT CJIO>KHOH HepBHO-ryMOpaJIIoHOH peryJI.H-
D.HH, BeJIH'IHHIoI H CKOpOCTH cep,l\e'IHorO BIoI6poca, IaCTOTIoI H
pHTMa cep,l\e'IHIoIX COKpa eHHH H COCY,l\HCToro TOHyca.
Pa3JIH IalOT CHCTOJIH'IeCKOe H ,l\HaCTOJIH ICCKoe ,l\aBJIeHHe.
CucmoJlu'tecu;u.1It Ha3IoIBaeTC.H ,l\aBJIeHHe, B03HHKalO ee B ap-
TepH.HX B MOMeHT MaKCHMaJIIoHOro nO,l\'beMa nYJIbCOBOH BOJIHbl
nOCJIe CHCTOJIIoI >KeJIY,l\O IKOB. ,naBJIeHHe, nO,l\,l\ep>KHBaeMOe B
aprepHaJIIoHIoIX cocY,l\ax B ,l\HaCTOJIY >KeJIY,l\O IKOB, Ha3IoIBaeTC.H
auacmOJ/U'leClw.1It.
llYJIIoCOBOe ,l\aBJIeHHe npe,l\CTaBJI.HeT c060H pa3HHD.Y Me>K,l\Y
CHCTOJIH'leCKHM H ,l\HaCTOJIH IecKHM ,l\aBJIeHHeM.
M3MepeHHe apTepHaJIIoHOrO ,l\a.BJIeHH.H npOH3BO,l\HTC.H Henp.H-
MIoIM 3BYKOBIoIM MeTO,l\OM, npe,l\JIO>KeHHIoIM B 1905 ro,l\Y PYC-
CKHM xHPyproM H.C. KOPOTKOBIoIM. AnnapaTIoI ,l\JI.H H3Mepe-
HH.H ,l\aBJIeHH.H HOC.HT CJIe,l\YlO He Ha3BaHH.H:- annapaT PHBa-
PO I'IH, HJIH TOHOMeT}J, HJIH cclJHrMoMaHo..>!:eTp.
B HaCTO.H ee BpeM.H HCnOJIIo3YIOTC.H H 3JIeKTpOHHIoIe anna-
paTIoI, n03BOJI.H1O He Onpe,l\eJIHTIo M He3BYKoBbIM MeTO,l\OM.
,nJI.H HCCJIe,l\OBaHIDI All. Ba>KHO yqHTbIBaTb cJIe,l\YlO fle clJaK-
TOpbI: pa3Mep MaH>KeTKH, COCTO.HHHe MeM6paHIoI H Tpy60K
clJC)}IeH,l\OCKOna, KOTopIoIe MorYT 6IoITIo nOBpe>K,l\CHIoI. 4/HKca-
121
TOHOMeTpbl
ll.H MaHOMeTpa ,lIOJDKHa 6bIT:b lIa ypOBHe MamICeTKll, HeJI:b3.H
CllJI:bHO HamllMaT:b rOJIOBKOM <pOHeH,l\OCKOna Ha 06JIacT:b apTe-
Pllll, BC.H npo e,llypa ll3Mepemi.H M npO,llOJImaeTC.H 1 MllHY-
TY. .llpll HapymemUI 3TllX <paKTOPOB apTepllaJI:bHOe ,l\aBJIeHHe
MOmeT 6:bIT:b He.v;ocTOBepH:bIM.
B HopMe apTepllaJI:bHOe ,lIaBJIeHHe KOJIe6.rreTC.H B 3aBllCFlMO-
CTll OT B03paCTa, YCJIOBllll BHelIIHeM cpe,l\:bI, HepBHoro II (}:>ll3ll-
qeCKOrO Hanp.HmeHll.H.
Y J!3poCJIoro '1eJlOBeKa nopMa CHCTOJIll'1eCKOrO .v;aBJIeHll.H
KOJIOOJIeTC.HOT 100-105,[\0 130-:135 MM pT. CT. (,l\OnYCTH-
Moe - 140 MM pT.CT.); ,lIllaCTOJIH IecKoro - OT 60 ,lI0 85 MM
pT.CT. (,l\OnycTllMoe - 90 MM pT. CT.), nYJI:bCOBOe ,lIaI3JIeHlle B
HopMe COCTaBJI.HeT 40-50 MM pT. CT.
llPll pa3JIll'lH:bIX ll3MeHeHll.HX B COCTO.HHllH 3,l10pOB:bH OT-
KJIOHeHll.H OT HOpMaJI:bH:bIX nOKa3aTeJIeM M lIa3:bIBaIOTCH ap.
TepllaJI:bHOM rllnepTeH3lleH, HJIll rllnepTOHHeM, eCJIH ,lIaBJIe-
HHe nOB:bImeHO. llOHllmeHHe M - aprepUaJI:bHOM rHnOTeH3H-
eM IIJIH I'HnOToHHeM.
I{eJlb: onpe,lleJIHTb I!OKa3aTeJIH apTepllaJI:bHOrO ,l\aBJIeHll.H
H o eHllTb pe3YJIbTaT:bI HCCJIe,llOBaHHH.
nOu;a3anU.R.: no Ha3HaqeHHIO Bpa'1a.
Ocn a 14enue: TOHoMeTp, <poHeH,l\OCKOn, pyqKa C cUHeM nac-
TOM, TeMnepaTypH:bIH JIllCT, 70%-H:brn cnHpT, BaTHbIe mapllKU.
122
3Tanbl I 060CHOBaHI1f1
nOOzom06Ka K npoljeoype
1. YCTaHOBI1Tb AOBepl1TellbHble MOTI1BaLjI1" naLjl1eHTa COTpYAHI1-
OTHOWeHI1" C nBLjl1eHToM. '1eCTBY.
2. 06b5lCHI1Tb CYTb 11 XOA npeA-
CTO"U\I1X Aei1cTB.,i1. C06JlIOAeH.,e npaB naLjl1eHTa.
3. nony411Tb cornacl1e naLjl1ema Ha
npOLjeAYPY. nC.,XOJlOrI14eCKa" 11 3MOLjI10HaJlb-
4. npeAynpeAIo1Tb nBlIlo1eHTa 0 npeA- Ha" nOAroToBKa nalllo1eHTa K MaHIo1-
.cTo"U\ei1 npOLjeAype 3a
15 MI1HYT AO ee Ha'lana. nyn"IIIo1".
5. nOAroToBIo1Tb He06xoAIo1Moe oc- AOCTlo1lKeH.,e 3(jJ(jJeKTIo1BHOrO npoBe-
HaU\eH.,e. AeHIo1" npoLjeAYPbl.
6. BblMblTb 101 OCYWIo1Tb PYKIo1. C06JlIOAeH.,e JlIo1'1Hoi1 rlo1rneHbl MeA-
cecTpbl.
BbfnonHeHue npOljeoYPbf
1. npl1AaTb nalllo1eHTY YA06Hoe no-
JlOlKeHlo1e CIo1A" I1nlo1 JlelKa: 06ecne4eHIo1e Halo1JlY'IWero pa3rlo1-
2. YJlOJKIo1Tb PYKY naLjlo1ema B pa30-
rHYTOM nOIlOlKeHlo1101 naAoHblO Bsepx, 6aHIo151 KOHe'lHOCTIo1. YCIlOB.,,, AJl"
HaXO <AeH"51 nYJlbCa 101 nlloTHoro
nOAnoIKIo1B Banlo1K nOA JlOKOTb. nplo1neraHIo1" rOIlOBI<\o1 (jJoHeHAocKona
K KOIKe.
3. HaJlOIK.,Tb MaHlKeTKY TOHoMeTpa 06ecne'leHlo1e Aoc,oBepHOCT" pe-
Ha 06HaIKeHHoe nne'lo naLjlo1eHTa Ha 3YJlbTaTa.
2-3 CM Bb,we JlOKTeBoro crlo16a TaK,
'1T06b' Me <AY HIo1MIo1 npoxoAIo1Jl 1
naneLj.
nplo1Me4aHlo1e: OAe>K,Qa He AOJlIKHa
CAaBJlI1BaTb nJle'lO Bb,we MaIlJKeTKIo1.
Ii1cKJlIO'IaeTC" nIo1M(jJOCTa3, B03HIo1-
KaIOU\Io1i1 np" HarHeTaHlo111 B03Ayxa B
MalllKeTKY 101 nepelKaT.,101 COCYAoa.
4. TPy6KI1 MaHlKeTI<\o1 06paU\eHbl
BHIo13.
5. Coe.QIo1HIo1Tb MaHoMeTp C MaH>KeT-
KOi1, YKpem1B ero lIa MBHlKene.
6. npoBeplo1Tb 110JlO)l(eHIo18 cTpe':KIo1
Ma oMeTpa OTHOCIo1TeJlbHO «0"-11
OTMeTKIo1 UIKaJlbl.
7. Ol1peAeJlI1Tb naJlbLjaMIo1 nYJlbCa- Onp8AeJleHIo1e MeCTa Afl" nplo1K11a-
LjIo1IO B nOKTeBoi1 "MKe, nplo1JlOlKlo1Tb AbiBaHIo1" rOJlOBI<\o1 (jJOH8H.QoCKona 101
Ha :no MeCTO Q>OHBHAOCKon. BbICJlywIo1BaHI1" YAapoB nYJlbCa,
8. 3aKpblTb BeHTlo1nb rpYWlo1, HarHeTaTb 06eCne'lBHlo1e AocTOBepHblx pe-
B03AY>< B MaHlKeTKY AO Io1C'Ie3HOBeHIo1" 3YJlbTaTOB Io1CCJleAOBaHIo1" AA.
nyru,caLj''101 B f10KTeBoi1 ap-replo1" +20-
30 MM pT. CT. (T.e. HeCKOJlbKO Bb'we
npBAnOJlaraeMOro AA).
'23
HanO>KeHlle MaH>KeTKIl
3Tanbl 060CHOBaHMR
BblnonHeHUe npo e(JYPbl
9. OrKpblTb BeHTIo1nb, MeAJ1eHHO 06eCne'leHIo1e He06xoAL1MO CKOpo-
BblnycKaTb B03,qyX, Bblcnyw IBa51 CTIo1 BblnYCKaHIo1" B03,qyxa 1013 MaH-
TOHbI, CneAL1Tb 3a nOl<a3aHIo151MIo1 IKeTKIo1, KOTopa51 ,qOmKHa COCTaBn"Tb
MaHoMeTpa. 2 3 MM pT. CT. s ceKYHAY.
10. OTMeTIo1Tb I.\I1<!>PY n05lSneHIo1" Or.pe,qeneHMe nOKa3aTenei1 apTe-
nepsoro YAapa nynbcoBOi1 sonHbl, plo1anbHoro ,qaBneHIo1".
cooTseTCTsYIOl1jYIO cIo1crom1'lecKoMY
AA.
11. Bb,nycKaTb MeAJ1eHHO 1013 MaH-
IKeTtrn B03,qyX.
12. «OTMeTIo1Tb» Io1C4e3H08eHMe
TOHOB, '1TO COOTseTcTByeT AL1aCTO-
nlo1'1eCKOMY AA.
npMMe'laHIo1e: B03MOIKHO ocna6ne-
HIo1e TOHOB, 'lT0 TOJKe COOTBeTC1ByeT
AL1aCTOnlo1'1eCKoMY AA.
13. BblnycTIo1Tb seCb B03,qyX 1013
MaHIKeTKIo1.
14. nOBTOplo1Tb npol\e,qypy '1epe3 5 npose,qeHIo1e KOHTpOn51 r.OKa3aTenei1
MIo1Hyr. AA.
OKOH'IaHUe npo eiJYPbl
1. CH"Tb MaH>KeTKY.
2. YnOIKt.1Tb MaHoMeTp s 4exon. Ycnoslo1" xpaHeHIo151 TOHoMeTpa.
3. npOAe3101H4>Io1l\Io1posaTb ronosKY 06eCne'leHIo1e Io1H<!>eKl\Io10HHoi1 6e3O-
<!>oHeHAOCKOna MeTo,qOM ,qSYKpaT- naCHOCTIo1.
HOro npoTIo1paHIo1R 70% cnlo1pToM.
4. Ol\eHIo1Tb pe3ynbTaT.
5. C006l1j"Tb nal\Io1eHry pe3ynbTaT 06eCne'leHIo1e npasa nal.\l1eHTa Ha
"3MepeH"51. Io1H<!>0pMal\Io1IO.
124
3Tanbl 06ocHoBaHMR
OKOH'IaHue npo e(Jypbl
6. nposecTIo1 perlo1C"lpal\Io11O pe3ynb- AOKyMeHTIo1posah"e pe3ynbTaTOB
TaTa B BH,qe AP06101 (B '1101Cnlo1Tene - 06ecne'lMBaeT npeeMcTseHHocTb
CIo1CTOn"4eCl<OO AaBneHIo1e, s 3HaMe- Ha6nlO,qeHIo151.
HaTene - AMacronlo14eCKoe) B He06-
XO,qMMOO ,qOKYMeHTal\Io1101.
7. BblMblTb 11 OCYWI1Tb PYKIo1. Co6nlO,qeHv.e fll1'1HOi1 rl1rl1eHbI Me-
,qlo1l\I1HCKOi1 ceCTpbl.
Ha6nlOAeHMe 3a AblXaHMeM
Ha6JIIOAaH 3a .AbIXar-IlWM, oco6oe BHMMaHMe CJIeAyeT YAe-
JIHTb M3MeHeHMIO D.BeTa KO'KHbIX nOKpOBOB, onpC.ZJ;eJIeHMIO qa-
CTOTbl, pMTMa, rJIy6MHbi AbIXaTe..'ibHbIX .ZJ;BHmeHMH M OD.eHMTb
TMIl AbIXaHMH.
,nbIxaTeJIbHOe .ZJ;BHmeHMe OC eCTBJlHeTCH IepeAOBaH11eM
B.ZJ;oxa 11 Bbl.ZJ;oxa. KOJIH IeCTBO Ab1xaHMH 3a 1 MIiHYTY Ha3bIBa-
lOT qaCTOTOH .ZJ;blxaTeJIbHbIX ,!\B11meH11H (q,n,n).
Y 3AOPOBOI'O B3pOCJIOro qeJIOBeKa HopMa .ZJ;blxaTeJIbHblX
.ZJ;BlnKeU11H B nOKoe COCTaBJI.fIeT 16-20 B M11HYTY, Y meH l1H
OHa Ha 2-4 .ZJ;blxaHM.fI 60JIbllie, '!eM Y Mym'll1H. 3aB11CHT q,n,n
He TOJIbKO OT IlOJIa, HO II OT nOJIOmeHM.fI TeJIa, COCTO.flHM.fI
HepEHOH C11CTeMbl, B03paCTa, TeMnepaTYPbl TeJIa 11.T..ZJ;.
Ha6JIIOAeHUe 3a .ZJ;bIxaHueM CJIe.ZJ;yeT npOBOAUTb He3aMeTHO
.ZJ;Jm naD.11eHTa, TaK KaK OH MomeT npOH3BOJIbHO U3M£:HMTb 'la-
CTOTY, PUTM, I'JIy6MHY .ZJ;bIxaH11.fl. qM OTHOCUTC.fI K qCC B
cpeAHeM KaK 1:4. TIPM nOBbIlliemm TeMIlepaTypbI TeJIa Ha rc
.ZJ;blXaHue ytIa:w;aeTC.fI B cpeAHeM Ha 4 .ZJ;bIXaTeJIbHbIX ABM'KeHu.fI.
B03MO)KHhle H3MelleHHH xapaKTepa ,D;bIXaHHH
Pa3JIIiqalOT .ZJ;blxaHMe n06epxHocmnoe H ZJLy601we. TIoBep-
XHOCTHoe .ZJ;bIXaHHe MomeT 6blTb HeCJIblIIIHbIM Ha paCCTO.flH11U
MJIM CJIerKa CJIbIIIIHbIM. OHO qaCTO CO'leTaeTC.fI C naTOJIOI'l1'leC-
KMM ytIaIIJ;€HMeM AblxauM.fI. rJIy6oKoe .ZJ;blxaH11e, CJIblIIIUMOe
Ha paCCTO.flHMM, qaIIJ;e BCeI'O CB.fI3aHO C naTOJIorIi'leCKMM ype-
meH11eM AblxaHu.fI.
E q,M3110JIOrnqeCKHM nmaM .ZJ;:bIXaHH.fI OTHOC.fITC.fI rpy,nnoii,
6PlOlliHOH 11 CMelliaHHbIM Tun. Y meH l1H qa e Ha6JIIo.ZJ;aeTC.fI
rpY.ZJ;HOH Tun .ZJ;bIxaH11.fl, y MY)l{'IMH - 6plOlliHOH. TIpIi CMe-
125
llIaHHOM TIme AbIXaHlUJ npOMCXOAHT paBHOMepHoe pacllIMpe-
HMe rPYAHOll KJIeTKH Bcex YIaCTell JIerKOrO BO B.cex HanpaBJIe-
HM.fIX. THnbI AbIxaHM.fI Bblpa6aTbIBaIDTC.fI B aaBHCMMOCTM OT
BJIH.fIHH.fI KaR BHellIHeii, TaR H BHYTpeHHell CpeAbI OpraHM3Ma.
IIpH paCCTpOHCTBe IaCTOTbI pHTMa M r.rry6HHbI AbIxaHH.fI
B03HMKaeT OAbIlliKa. Pa3JIHYIalOT HHcnHpaTopHYIO OAbIlliKY -
31'0 AbIXaHMe C 3aTpYAHeHHbIM BAOXOM; 3KcnHpaTopHYIO -
AbIXalIMe C 3aTpYAHeHHbIM BbIJ\OXOM; M CMellIaHHYro - AbIxa-
HHe C 3aTpYAHeHHbIM BAOXOM H BbIAOXOM. BbICTpO pa3BHBalO-
UW.flC.fI CHJIbHa.fl OAbllIIKa Ha3bIBaeTCH YAYWbeM.
IIaTonoI'Jl1lecKHe THIThI )J;bIxaHHH
Pa3Jl1NaIDT:
. 60JIbllIOe AbIxaUMe KYCCMaYJIH - peAKoe, r;ry6oKoe, llIYM-
Hoe, Ha6JIIOAaeTC.fI npM rJIy6oKoH KOMe (AJIMTeJIbHa.fl IIOTep.fl
C03HaHI-I.fI);
. AbIxaHMe BMOTTa - nepHOAMYIeCKOe ,nbIxaHHe, npM KOTO-
pOM npOHcxo,nHT npaBMJIbUOe qepe,nOBaHHe nepHOAa nOBepx-
HOCTHbIX AbIXaTeJIbHbIX ABHJKeHHH H naY3, paBHbIX no npo-
AOJIJKMTeJIbHOCTH (OT HeCKOJIbKHX MHHYT AO MHHYTbI);
. AbIxaHHe qeHHa-CTOKca - xapaKTepH3yeTC.fI nepHoAoM
HapaCTauHH YIaCTOTbI M rJIy6HHbI AbIxaHH.fI, KOTopoe AOCTHra-
eT MaKCHMYMa Ha 5-7-M ,nblxaHHH, C nOCJIeAYIOU\MM nepMO-
AOM y6bIBaHMH IaCTOTbI M rJIy6MHbI AbIxaHMH H OYIepe,nHOH
,nJIHTeJIbHOH naY30H, paBHOH no npOAOmKHTeJIbHOCTH (OT He-
CKOJIbKMX ceKYHA AO 1 MMHYTbI). Bo BpeMH naY3bI na HeHTbI
nJIOXO opMeHTMPYIOTC.fI B oKPYJKalO ell cpeAe HJIH TepHIOT
UopManbHoe
AblXClHlle
AblxaHlle
"IeMHa-CToKca
AblxaHlle
6110Ta
AblxaHlle
KyccMaynJl
'26
r--... /"'\. F"'\.. /'\.
- -
. . A nfl/'li1/\ Ci\;;-Tii"!);;;-
n f\
VV
naTOnOrl1'1eCKlle Tl1nbl AblxaHI1J1
OCTaHOBKa
AblxaHI1J1
(anHo3)
OCTaHOBKa
AblxaHI1J1
(anHo3)
C03mUIMe, KOTopoe BOCCTaHaBJIHBaeTC.fI npH B0306HOBJIeHH H
AbIXaTeJIbHbIX ABM:lKe o H c M Ta ll oBKa "bIXaHMH BCJIeACTBHe npeKpa-
ACtjJUKCU.R. - 3TO M
oC T}' nJIeHHH KHCJIOpoAa.
I.U,eHHH n Tf'\TllIb.fl UJIH OAbIlliKH JIerOYIuoro
Acm.'lta - 3TO npY,CTyn YMJ
HJIM cepAeYIHorO npoMCXO:IKAeHM.fI.
IIoiI;CqeT qaCTOTbI, pHTMa,_rny6HIIbI
AbIXaTenbHbIX )J;BH eHHH (q;JJ.I.)
IJ;eJ!b' onpeAeJIMTb OCHOBHble xapaKTepMCTHKH AbIxaHHH.
IIOK 3aHu!!: OD.eHKa cPYHKll.HOUaJIbHOrO COCTO.flHM.fI opra-
HOB AbIxaHM.fI. - TypHbIH
OcnQ14 enue : IaCbI C ceKYHAHOll CTpeJIKOH, TeMnepa
JIMCT, PY'lKa C CMHMM CTep:IKHeM. n BO MTC.fI 6e3
0 6!!3ameJ!bHoe yCJ!06ue: nOAC IeT q):JJ( po A
6 BaHMM YIaCTOTbI .D;bI-
HHq,OpMHpoBaHHH naD.HelITa 0 HCCJIeAO .
XaIIM.fI.
3Tanbl 060CHOBaHI111
noi)eomo6K8 K npo eiJype
1. C03AaTb Aoeepl1TenbHble OTHO-
weHIo151 C naL\lo1eHToM. OTBne'leHlo1e aHIo1MaHIo151 OT npOLje-
2. 06bllCHIo1Tb naLjlo1eHTY He06xoAl1- AYPbl nOAc4eTa 4/J,A C LjenblO npo-
MOCTb nOAc4eTa nynbca. nonY4101Tb <!>lo1naKTIo1KIo1 npOI13BOnbHoro 1013MeHe-
cornaclo1e Ha npOL\PAYPY. HIo151 AblxaHIo1I1.
3. BblMblTb 101 OCYWIo1Tb PYKL1. 06eCne'leHlo1e Io1HQ>eKLllo1oHHOIii 6e30-
naCHOCTL1.
BblnOnHeHUe npo ei)YPb'
1. npL1A3Tb naLjL1eHTY YA06Hoe no- He06xoAl1MOB ycnOBL1e AIlII npose-
nOJKeHL1e (ne>Ka I1nL1 CL1A11). AeHL151 npoLjeAYPbl.
npI1Me4aHL1e:He06xQAL1MOBH A eTb
sepxHlO1O 4aCTb ero rpYAHolii KIleTKI1
L1nL1 >KL1S0Ta. OTBne4eHL1e BHL1MaHL151 OT npOLje-.
2. B311Tb PYKY naLjL1eHTa, K8K AIlII AYPbl, Ha6nlOAeHL1e 3a 3KcKypclo1eL1
L1ccneAOBaHL111 nynbca. ero rPYAHolii KIleTKL1.
3. nonO>KL1Tb CBOIO L1 naLjL1eHTa PYKL1 06ecne4eHL1e AocTosepHoro L1C-
Ha rpYAb (npL1 rpYAHOM T\o1ne Ablxa- cneAosaHL1I1.
HL1I1)' L1nL1 3nL1raCTpanbHYIO o6nacTb
(npL1 6pIOWHOM TL1ne AbIXaHL1S1) na-
L\L1eHTa, L1ML1T\o1PYII L1ccneAoS8HL1e
nynbca.
'27
3Tanbl 060CHOBaHHfI
npL1MC'IaHL1C: ACp>KaTb PYKY Ha
3anflCTbC naLlL1CHTa.
4. nOAC4L1TaTb 4v.cno BAOXOB 3a OnpcAcncH 1c '1L1cna AbixaTenbHblX
MIo1HYT}', nonb3YRcb ceXYHAOMCpOM. ABIo1>KeHL1Iii.
5. OLl03HIo1Tb '1acTOry. rny6L1HY. pL1TM OnpeACneHL1C xapaKTCpL1CTIo1X Abl-
, run AblxarenbflblX ABL1>KCHL1Ci. xaTenbHblX ABL1>KCHL1Iii.
6. 06"bS!CHL1Tb naLl!1eHry. '1TO CMY Co6nlOAeHIo1C npaB naLlL1CHTa.
CQC<IL1TaflL1 '1aCTory AblxaTcnbHblX
ABL1>KeHIo1>;.
7. BblMblTb 11 OCYII.IL1Tb PYXI1. 06eCnC'ICHI1C I1H<!>CXLlIo10HHO>; 6C3O-
naCHOCTI1.
OKOH'I8HUe npo eoypbl
1. npOBCCTL1 pcnlCTpaLlL110 AaHHblX B 06eCnC'IeHIo1C ;JpCCMCTBeHHOCrn B
TeMneparypHoM nL1CTe (LjL1CPpOBbIM pa6oTc. XOHTponR 3a AbixaHIo1CM.
L1 rpa<!>L14CCKL1M cnoco6oM).
H3MepeHMe CYTO HOrO AHype3a
H onpeAeneHMe BOAHorO 6anaHCa
)J;nype30M Ha3b!BaeTCH npon;ecc 06pa30BamfH 11 BbI,l\e..lleHIIH
MOtU1..
CYTO'lHbIM ,lIIIype30M Ha3bIBaeTCH o6lIJ;ee KOJIH'IecTBO MOtI11,
BbI,lIem)HHOH naU;HeHToM B TetIeHUe CYTOK.
CyTOtIllbdi ,nUYPC3 Y B3pOCJIbIX KOJIe6JIeTCH OT 800 MJI ,lI0
2000 MJI H 3aBUC11T OT B03pacTa, Te!vmepaTypbI II BJIa.mllOCTH
oKpy:mmOlIJ;eH Cpe,l\bI, YCJIOBIIH n11TaHH.fI, <p113H'IeCK11X Harpy-
30K 11 ,lIpyrHx c1?aKTopoB H ,lIOJI:mell COCTaB.ll.flTb 75-80% OT
KOJIHtIeCTBa BbmHTofi :m11,llKOCTH, 20-25% :mH,lII<OCTH BbIBO-
,lIIiITCH C nOTOM, ,lIbIxaHHeM H CTYJIOM.
CYTOtlIlbIH BO,llllbIH 6aJIallc - 3TO cOOTHorueHHe Me:n<,l\y KO-
JIH'IeCTBOM BBe,nelllloH B oprall1I3M :mH,lIKOCTH H KOJIHtIeCTBOM
BbI,l\eJleHIIOH :mII,l\KOCTH H3 opralUl3Ma B Te'lellMe CYTOK. YtIH-
TbIBaeTCH :mH,l\KOCTb, CO,l\ep:malIJ;a.flC.fI BO c1?PYKTaX, cyn8x, OBO-
lIJ;ax 11 T.,l\., a TaIOKe' 06'beM napeIuepa.n:bllO BBO,l\IIMbIX pa-
CTBOpoB.
Y"ICT BO,l\HOrO 6anauca
QeJ!b: 06eCnetIeH11e KatIeCTBelllloro y<IeTa KOnHtleCTBa no- I
CTyn11BmeH 11 BbIJ\en11BmeHC.fI H3 oprallH3Ma :mH,nKOCT11 B Te-
'1eH11e CyrOK.
'28
[JOIW3anU.R.: Ha6mo,l\eHIIe 3a m\ll,HeIlTOM C OTeKaM11. BbI.fIB-
JIell11e CKpbITbIX OTeKOB, HapaCTalUf.fl OTeKOB H KOIITpOJIb 3a
,lIefICTB11eM ,lI11ypeT11tIeCKHx cpe,llCTB.
Ocna14enue: Me,n11U;l1HCKHe BeCbI, Meplla.fl CTeKJIHlllla.fl rpa-
,lIYHpoBaHlla.fl eMKOCTb ,lIJI.fI c60pa MO'lH, JIHCT y<leTa BO,l\1I0rO
6a.n:allca. u
06!L3ameJ!bH.Oe YCJ!oBue: y<leTY KOJIH'IeCTBa BbI,lIeJIeIlIlOH
:mII,llI<OCTH nO,l\BepraeTC.fI lie TOJIbKO MOtIa, 110 H pBoTllbIe Mac-
CbI, 11cnpa:mlleIlH.fI nan;lIeHTa.
3Tanbl I 060cHOBaHL1e
nOoaomoBK8 K npo eoype
1. YCTaHoBIo1Tb AOBCpL1TCnbHblc OTHO- . 06eCnc4eHL1C OC03HaHHoro
WCHL151 C naLjL1cHToM. OLlCHI1Tb ero cno- Y4aCTL1R B cOBMecTHoo pa60Tc.
C06HOCTL1 x caMocToS!TcnbHoMY npoBc-
ACHL110 npoLlcAypbl.
2. Y6cAIo1TbCR. '1TO naLjL1eHT CMO>KCT
npOBOAIo1Tb Y4eT >KIo1AXOCTI1.
3. 06b5lCHL1Tb l\cnb L1 XOA L1CCnCAOBa- 06eCnC'ICHlo1e npaBa nal\L1eHTB
HL151 11 nOnY4"Tb cornacl1c nal\L1CHTa Ha Ha I1HcpopMaLlI1IO.
npoLleAYPY.
4. 06bS!CHI1Tb naLlI1CHTY Heo6xOAL1- 06cCnC'ICHL1C AOCTOBCpHOCTL1
MOCTb co6nIOACHL151 06bl'lHOro BOAHO- pe3ynbT8TOB Y4cTa.
nL1U1eBoro L1 ABl1raTCnbHoro pC>KL1Ma.
5. Y6CAL1TbCR. '1TO naLlL1CHT HC npI1HL1- 06Y4eHL1C naLlL1CHTa.
Man AL1ypeTlo1xlo1 B Te'leHL1C 3 AHe>; AO
L1CCneAOBaHL1R.
6. AaTb nOAPo6HYIO I1HcpopMaLl1011O 0
nop5lAKe 3anL1cclii B nL1CTC Y4eTa BOAHO-
ro 6anaHca. y6CAL1TbCR B YMeHI'L1 3a-
nonHRTb nIo1CT.
7. 06bRCHI1Tb npL1MCpHOC npoLlcHTHOC 06eCnC'ICHlo1e 3<!><!>CKTL1BHOrO
COACp>KaHI1C BOAbi B npoAYKTaX nl1Ta- npoBeAcHIo1R npOl\CAypbl.
HL1R AnR 06nCI'ICHI1R Y4cTa BOAHOro
6anaHca.
npL1MC'IaHI1C: TBCPAblC npoAYKTbl
nL1TaHI1R Moryr cOACp>KaTb OT 60 AO
80% BOAbl.
8. nOArOTOBI'!Tb OCHaUlCHl1e.
BbmonHeHue npoLleoypbl
1. 06bS1CHL1Tb. '1TO B 6-00 Hco6xOAL1MO IIi1CKnI04CHL1C L13 CyrO'lHOro AI1Y-
BblnycTI1Tb MO'lY B YHL1Ta3. pC3a 06pa30BaBwcliicS! 3a HO'Ib
MO'lL1.
5. 380.291
'29
3Tanbl 060C JOBaHL1e
Bblnonueuue np04eoYPbl
2. C06L1paTb MO'lY nocne Ka>t<,Qoro MO- YcnOBL1e npoBeAeHL1S1 npOLjeAY-
'1eL1CnycKBHL1S1 B rpBAYL1pOBBHHYIO eM- pbl.
KOCTb. L13Me Tb AL1ype3.
3. <I>L1KCL1pOBaTb KOnL1'1ecTBo BblAeneH-
Hoi1 >KL1AKOCTL1 B nL1CTe yYeTa.
4. <I>L1KCL1POBBTb KOnL1'1eCTBO nocTynL1B-
wei1 B OpraHL13M >KL1,D,KOCTL1 B flL1CTe
yYeTa.
5. 06bSlCHL1Tb, '1TO He06XOAL1MO YKa3b1-
BaTb BpeMfI npL1eMa WIL1 BBeAeHL1S1
>KHAKOCTL1. B TBKJKe BpeM5I BbiAeneHL1f1
>KL1AKOCTL1 B nL1CTe yYeTa BOAHoro 00-
naHca B Te'leHv.e cyTOK, AO 6-00
cneAYIOLljero AH5I.
6. 8 6-00 cneAylOLljero AHSI CABTb flL1CT
yYeTa MeAL1LjL1HCKoi1 cecTpe.
OKOfII./BHUe npoljeoYPbl
1. OnpeAenL1Tb MeAL1LjL1HCKoi1 cec1pe, PBC'IeT yYeTa BOAHOro 6anaHca
KaKoe KOnL1'1eCTBO >KL1AKOCTL1 AOn)f(HO onpeAenSleTcSI no <I>oPMyne:
BbIAenL1TbCSI KOnL1'1ecTBo BbiAeneHHoi1 MO-
C MO'IOi1 (B HopMe). '1L1 x Ha 0.8 (80%) = KOnL1'1eCTBY
MO'lL1, KOTopoe AOn>KHO
Bb'AenL1TbCSI B HopMe.
2. CpaBHL1Tb KOnL1'1eCTBO BblAeneHHoi1
>KL1,D,KOCTM C KOnL1'1eCTBOM paCC'lL1TaH-
HOi1 >KHAKOCTL1
(B HOp Me).
3. C'IL1TaTb BOAHbli1 6anaHc OTpL1Lja-
TenbHblM, ecnL1 BbiAenSleTCSI MeHbwe
>KI1AKOCTL1, '!eM paCC'lMTaHO (B HopMe).
npL1Me'laHMe: OTeKL1 HapaCTalOT (MnL1
eCTb).
4. C'IL1TaTb BOAHbli1 6anaHc oono>l<l1-
TenbHblM. ecnH BblAeneHO 60nbwe
>KL1AKOCTL1, '1eM paCC'IL1TaHO.
npL1Me'l3HL1e: aTO MO>KeT 6b1Tb pe-
3ynbTaTOM Aei1cTBL1S1 AL1ypeTL1'1eCKliIX
neKapCTBeHHblX cpeACTB, ynoTpe6ne-
HL1e MO'lerOHHbIX npOAYKTOB nL1TaHL1S1.
enL1S1HL1S1 xonOAHoro BpeMeHL1 rOAa.
5. CAenaTb 3anL1CL1 B nL1CTe yYeTa BOA-
HorO 6anaHc3.
'30
J
I
npltMeLlaHlte. nOnO>KHTellbHblH BOAHblH 6al1aHC cBHAeTellb-
cTByeT 06 3cpcpeKTHBHoCTH lIe4eHHSI 101 CXO>K,QeHHH OTeKOB. OT-
pHLIaTellbHblH BOAHblH 6al1aHC CBHAeTel1bCTByeT 0 HapaCTaHHH
OTeKOB HIIH He3cpcpeKTHBHocTH A03bl AHypeTH4eCKHX CpeACTB.
06pa3eu,
milCT Y4ET A BO,QHOro 6AIlAHCA
,Q8T8
HaHMeHoBaHHe 60J1bHlIIlIbl
OTAeneHHe
n8n8T8 NIl
<1>1110 1I16aH06 nemp CepZee6U'l
B03pacT 45 nem Macca Tena 70 KZ
,Q1II8rno3 06cneiJo6aHue
Kon-BO Bbl.qeneHO
BpeMR BblnlllTO BpOMR MO'itt B Mn
)l(H.QKOCTM (.qtlype3)
9.00 3aBTpaK 250,0 10.40 220,0
10.0 BIB KanenbHO 400,0 12.00 180,0
14.00 06eA 350,0 17.00 150,0
16.00 rIon.<\HtlK 100,0 20.00 200,0
18.00 Y"'tlH 200,0 3.00 170,0
21.00 Ke<j>tlp 200,0 6.00 150,0
3a CyrKtI Bcero 1500.0 Bcero 1070,0
BblnHTO Bbl,QeneHO
Pacllem: B HaIIIeM npMMCpe CYTOYIHbIH AMypea AOJUKeH CO-
CTaBJUITb: 1500xO,8 (80% OT KOJI-Ba BbInMTOH :JKMAKOCTM) =
1200 MJI, a OH Ha 130 MJI MeHbIIIe. 3HaYIMT, BOAHbIH 6aJIaHC
OTpM aTeJIbHbIH, ITO YK83bIBaeT Ha He3<l><l>eKTMBHoCTb JIe Ie-
HM.fI HJIH HapaCTaHMe OTeKOB.
5.
np"MEPHbIH n"CT
CECTP"HCKOrO .A"HAM"4ECKOrO HA6nlO,AEH"JI
06cneAoBaHMe: AHM Ha6nIOAeHMi1
onpoc, Ha6nlOAeHL1e, OLleHKa. (YKa3aTb AaT)', 'lac, ML1H.)
BbIBOAbl.
10. M Ha ASYX PYKax:
nesaR:
npasa5l:
11. OpraHbl '1YSCTS:
-cnyx,
- 3peHL1e,
- 060HRHL1e,
- OC5I3aHL1e,
- BKYC,
-pe'lb:
12. OCMOTp nOnOCTL1 PTa:
- HanL14L1e npOTe30S
13. npMeM nL1lJ.jL1:
- N2 AMeTL1'1eCKOrOCTOfia
- anneTL1T: (coxpaHeH, nOSb\-
weH, noHL1JKeH):
- nL1Tbe:
orpaHL1'1eHHOe,06L1nbHoe,
6e3 L13MeHeHL1i1
- caMOCTORTenbHO nbeT
- C nOMOlljblO nOL1nbHL1Ka
L1 T. n.
- rnOTaHL1e(cBo6oAHoe,
3aTpYAHeHHoe,
OTCYTCTsyeT)
- AP. CBeAeHL1R
14. XapaKTep cTyna
15. XapaKTep MO'lL1, M04eSblAe-
neHL1e
16. ABMraTeflbHaR aKTL1SHOCTb:
- TpeMop PYK
- HapyweHMe nOXOAKL1
- nape3bl, napaflL1'1H
N2 06cneAOBaHL1e: AHL1 'Ha6nIOAeHMi1
onpoc,Ha6nlOAeHHe,oLleHKa, (YKa3aTb AaT)', 'lac, MMH.)
BbIBOAbl.
1. }l(ano6bl B HaCT05Illjee BpeM5I
- 60nb (noKanL13aLlL1R, xapaK- .
Tep,L1HTeHCL1SHOCTb,AflL1Tenb-
HOCTb, peaKl!L151 naLlL1eHTa Ha
6onb)
2. Co3HaH"e
3. 8blpaJKeH le nL1L1a
4. 3MOl\L10HanbHbIM CTaryc (Ha-.
CTpOeHL1e,ane'laTnL1TenbHOcTb,
ceHTL1MeHTaflbHOCTb L1 Ap. cs-sa
nL1'1HOcm)
5. CoH
- noTpe6HocTb cnaTb AHeM
- HapyweHL1R CHa
6. CocTORH"e KO>KL1 L1 CnL13MCTbIX
- HanL1'1L1e OTeKOB (YKa3aTb
flOKanL13aLlL11O ):
7. TeMneparypa Tena -
- yrpOM
- Be4epoM;
8. AbIXaHL1e:
CaMOCT05lTeflbHOe,
113MeHeHL1e rcnoca, '1"cno
AblxaTenbHblX ABL1>KeHL1M,
xapaKTep"CTL1Ka AbIXaHL1R, ,
xap-Ka 0AbIWKL1,
xap-Ka MOKpOTbI, xap-Ka KawnR,
KpOSOXapKaHbe
9. I nynbc, erc xapaKTepL1CmKa
- (Kon-so S 1 ML1HYTY, pMTM,
IlianOflHeHL1e, HanpS1>KeHL1e;
'32
B03MOJKHOCTb n3L1L1eHTa AHM Ha6nIOAeHM
06eCne'lL1B3Tb (yt<a3aTb AaT)', 'lac, MMH.)
JKL13HeHHble cPYHKLlML1:
17. MO'IeBblAeHL1e:
- caMocTORTenbHO
- HeAep>KaHL1e
- MO'IenpL1eMHL1K
- KaTeTep
18. Cryn:
-caMocTORreflbHbl
- HeAep>KaHVoe
- c nOMOl1jb1O 1<I1L13M
- cYAHO,
- KanOnpL1eMHL1K
- KOflOCTOMa L1nM AP. CTOMbl
19. mensis (y >KeHl1jL1H)
20. Cnoco6HoCTb K nepeABL1>KeHL1IO:
- caMOCTORrenbHO XOAMT
- nOBOpa4L1BaeTCR B nOCTeflL1
- nepeABL1raeTCR npL1 nOMOI4L1
110CTOpOHHL1X
- L1CnOflb3YIOTCR pe3epBbI (KOC-
TblflL1, KOflRCKa L1flL1 AP.).
- XOAMT no nanaTe
- XOAMT TonbKO AO TyaneTa
- pa3peweHO rvflRTb
21. 06I4eHL1e:
- naMRTb( coxpaHeHa,
HapyweHa)
- O>KL1AaHL151 B CBR3L1 C
nOCel4eHL1RML1 -
(KOro >KAeT npL1 nOCel4eHL151x)
22 HepBHO-nCL1XM'IeCKOe
COCTORHL1e nal\L1eHTa:
- onMcaHL1e Ha6fllOAaeMoro
COCT05lHL1R:
(ypaBHOBeweHHocTb, n03a,
>KeCTbl, peaKl\L1R, HacTpoeHMe,
3M0l.\l10HaflbHoe COCTORHL1e,
oplo1eHTal\Io1R B MeCIe, BpeMeHL1,
OKpy>KBlOl4eo; o6cTaHOBKe
L1 c06cTBeHHo flL14HOCTM
'34
23 HapyweHbl nOTpe6HocTM: AHI1 H36flIOAeHI1
(YK33aTb AaTY, 'lac, MI1If.)
- AblwaTb
- eCTb
- Bbl.QeflRTb
- cnaTb, oTAblXaTb
- 6b1Tb '1L1CTbIM
- oAeaaTbcR, pa3AeBaTb
- nOAQep>K\'lBaTb reMnepaTYPY
Tefla
- 6blTb 3AOPOBbiM
- L136eraTb onacHOCTL1
- ABl1raTbCR
- 06I4BTbCR
24 CTeneHb He3aBI1CIo1MOCnl nal\lo1-
eHTa B yxoAe CaMoyxoA (cTe-
neHb He3aBl1CI1MOCTL1)
- caMocTOfITenbHblo; YX0A--
- '1aCTI1'1HO 3aBL1CI1M
- c nOMOl4blO (Koro)
- nOflHOCTblO 3aBL1CIo1M
3.4. Bmopoii Elman cec:mpuHclsoro npoqecca -
i. cecmpuHclias guarHocmulia
AHarHocTHpoBaHlle npH3HaHO YCTaHOBHTb np06JIeMb1, B03-
HllKalOIW'Ie y mU.\HeHTa, aKTOpbI, cnoc06cTBYIO He HJIH BbI-
3b1BalOlI\lle 3Tll npo6JIeMb1 H CllJIbHble CTOpoHbI nal\lleHTa,
KOTopble cnoc06CTBOBaJIll 61.1 npe,Ilynpem,I\eHlllO HJIll pa3pe-
meHlllO npo6JIeM.
HBHb1e (naCTO.fIlI\He) HJIll nOTeHl\HaJIbHble (KoTopble MOryT
B03HllKHYTb) np06JIeMb1 qeJIOBeKa 3aHOCHTCH B nJIaH cecTpllH-
CKoro yxo,Ila B Bll,I\e qeTKllX H KpaTKllx BbIKJIa,n:oK-cym,I\eHlli"l.
B JIllTepaType 3Tll cym,I\eHH.fI Ha3b1BalOT cecTpllHcKllM ,IlH-
aI'H030M. R;OHl\enl\ll.fI cecTpllHcKOro ,Illlarn03a Bce e e HOB a,
O,IlHaKO no Mepe HaKOnJIeHll.fI 3HaHUU B 06JIacTll CecTpllHCKOro
'35
,lIeJIa paCTeT M nOTeH MaJI paaBMTM.H CecTpMHcKorO ,lIMarH03a.
IIoSTOMY He CTOJIb BamHO, KaK Ha3BaTb BTOpOH STan ceCT-
pMHCKoro npo ecca: onpe,lleJIeHMe np06JIeM na MeHTa, ceCT-
pMHCKMM ,lIMarH030M, ,lIHarHOCTMpoBaHMeM.
qacTo n eHT caM OC03Haer CBOM aKTYaJIbHbIe np06JIeMbI,
HanpMMep, 60JIb, 3aTPY,l\HeHHOe ,lIbIxaHMe, nJIOXOH anneTMT.
KpoMe Toro, Y na MeHTa MorYT 6bITb npo6JIeMbI, 0 KOTOpbIX
Me,llCeCTpa He ,lIOra,n:bIBaeTCH. CeCTPa Tome Momer BbI.HBMTb
np06JIeMbI, 0 KOTOpbIX caM 06cJIe,l\yeMbIH He ,lIOra,llbIBaeTC.H,
HanpMMep, YtUlI eHHbIH nyJIbC wm npM3HaKM IUI(peK HH.
Me,llM MHCKa.H cecTpa ,lIOJImHa 3HaTb MCTOtIHMKH B03Mom-
HbIX np06JIeM n MeHTa: MMM .HBJI.HIOTC.H:
1. OKpymalOlI\a.H cpe,lla M Bpe,l\HbIe q,aKTOpbI, B03,l\eHcTBY-
lO11we Ha tIeJIOBeKa.
2. Me,llM MHCKMH ,lIMarH03 na MeHTa MJIM Bpaqe6HbIH ,l\M-
arH03.
BpaQe6HblH AHarH03 onpe,lleJI.Her 3a60JIeBaHMe Ha oc-
HOBe Cne MaJIbHOH o eHKH q,l13HqecKMX npM3HaKOB, HC-
TOPMM 3a60JIeBaHM.H, ,lIMarnoCTMtIeCKMx TeCTOB. 3a,lla-
qeH Bpaqe6HoH ,l\Ma,I'HocTMKM .HBIDIerC.H Ha3Ha t IeHMe JIe-
qeHM.H na MeHTY.
3. JIeqeHMeqe.noBeKa, KOTopoe MomeT MMeTb He.meJIaTeJIb-
Hoe n06otIHoe ,lIeHCTBMe, caMO no ce6e Momer CTaTb npo-
6JIeMOH, HanpHMep, TOIIIHOTa, pBOTa, npH HeKOTopbIX
BM,lIax JIetIeHIUI.
4. BOJIbHHtlHa.H 06CTaHOBKa MOmeT T8.MTb B ce6e onacnOCTb,
HanpMMep, 3apameHHe BHYTPM60JIbHMtIHOH HHq,eK MeM
<IeJIOBeI<.a.
5. JIMqHbIe 06CTO.HTeJIbCTBa tIeJIOBeKa, HanpMMep HM3KMH
MaTepMaJIbHbIH ,l\OCTaToK na MeHTa, He n03BOJI.HIOlI\MH
eMY nOJIHO eHHO nMTaTbC.H, tITO B CBOIO Oqepe,llb MomeT
yrpomaTb erO 3,l\OpOBblO.
IIocJIe npoBe,lleHHOH o eHKH COCTO.HHH.H 3,l10pOBb.H na MeH-
Ta Me,l\eeCTpa ,l\OJImHa Cq,OPMYJIMpoBaTb ,l\Marn03, peIIIMTb, KTO
H3 npoc}:JeCCHOHaJIbHbIX pa6OTHMKOB 3J\paBOOXpaneHM.H Momer
nOMOtIb na MeHTY.
IIp06JIeMbI, KOTOpbIe Me,nceCTpa MomeT caMOCTO.HTeJIbHO
npe,l\ynpe,l\MTb MJIH pa3peIIIMTb, Ha3bIBaIOTC.H ceCTpMHCKMMH
JmarnOaaMH.
CeCTpe He06xo,llHMO OqeHb qeTKO ct}:IOPMYJIMpoBaTb AHar-
H03bI H YCTaHOBMTb MX npHopHTeTHOCTb H 3Ha t IMMOCTb ,lIJIg
na MeHTa.
llCTopM.H Bonpoca Ha<IaJIaCb B 1973 ro,l\Y. B CIlIA COCTO-
.HJIaCb I HaY<IHa.H KOHc}:JepeH M.H no KJIaCcHq,HKa MM CecTpHH-
CKMX ,lIHarn030B C eJIblO onpe,lleJIeHM.H q,YHK MH Me,llCeCTpbI
M pa3pa60TKM CMCTeMbI KJIaCcHq,MKa HH cecTpMHcKMX ,l\Har-
H030B.
B 1982 ro,llY B Y<Ie6HMKe no ceCTpMHCKOMY ,lIe.ny KapJICOH
Kpac}:JT M MaK Ilope, B CB.H3M C H3MeHeHM.HMH B3rJI.H,lIOB Ha
ceCTpMHCKoe ,lIeJIO, npe,l\JIOmeHO CJIe,llYIOlI\ee onpe,lleJIeHMe:
Cecmpu1tcu;uii iJuazNo3 - aTO COCTO.HHHe 3,l\OpOBWI na HeH-
Ta (HbIHeIIIHee M nOTeH MaJIbHoe), YCTaHOBJIeHHOe B pe3YJIL-
TaTe npOBe,l\eHHOrO ceCTpMHCKoro 06CJIe,llOBaHM.H M Tpe6ylO-
lI\ee BMeIllaTeJIbCTBa co CTOpOHbI ceCTpbI.
B ] 991 ro,l\Y npe,llJIOmeHa KJIaCcHq,MKa M.H ceCTpMHCKMX
,l\HarH030B, BKJIlOtIalO a.H 114 OCHOBHbIX HaMMeHoBaHHH, B
<IHCJIe KOTOpbIX rMnepTepMM.H, 60JIb, CTpecc, CO MaJIbHa.H ca-
MOM30JI.H M.H, He,llOCTaTOtIHa.H caMorMrMeHa, ,lIeq,M MT rHrMe-
HMqecKMX HaBbIKOB M caHMTapHbIX YCJIOBMH, 6ecnoKoHcTBO,
nOHMmeHHa.H c}:JM3H<IecKa.H aKTMBHOCTb H ,l\p.
B EBpone C MHM MaTHBoH C03,l1aHM.H 06 eeBponeHcKoH e,llM-
HOM KJIaCcMq,MK HM ceCTpMHCKMX ,l\HarH030B BbICTYIIHJIa AaT-
CKa.H Ha MOHaJIbHa.H opraHM3 M.H ceCTep. B HO.H6pe 1993
rO,lla no,ll arM,lIoH AaTcKoro HaytIHO-HCCJIe,l\OBaTeJIbCKOrO HH-
CTHTYTa 3,l1paBOOXpaHeHl-I.H M ceCTpMHCKOI'O ,lIe.na B KoneHra-
reHe COCTO.HJIaCb I Mem,llYHapO,llHa.H HaY<IHa.H KOH<pepeH H.H
no npo6JIeMaM ceCTpMHCKMX ,l\HarH030B. B KOHq,epeH HH Y<Ia-
CTBOBaJIO 60JIee 50 CTpaH MHpa. BblJIO OTMetIeHO, qTO YHMq,H-
I<.a H.H H CTaH,lIapTM3a M.H, a TaKme TepMMHOJIOrM.H, nOKa oc-
TaeTC.H cepbe3HoH np06JIeMoH. O'IeBM,lIHo, qTO 003 e,l\HHOH KJIac-
CMq,MK ilM M HOMeHKJIaTypbI CecTpIIHCKMX ,l\MarH030B no npH-
Mepy Bpaqe6HbIX, ceCTpbI He CMorYT 06 aTbC.H Ha nOH.HTHOM
,lIJI.H Bcex npoq,eCCMOHaJIbHOM .H3bIKe.
S'ran nOCTaHOBKM ceCTpMHCKHX ,lIMarH030B H 6y,!\eT 3aBep-
IlleHMeM ceCTpMHCKoro ,l\MarHOCTMtIeCKoro npo ecca.
CeCTpMIICKHH ,lIHarH03 CJIe,l\yeT OTJIMqaTb OT Bpa<Ie6Horo:
. Bpa t Ie6HbIH ,l\MarH03 onpe,l\eJI.HeT 60Jie3Hb, a ceCTpMHC-
KMH - Ha eJIeH Ha Bbl.HBJIeHMe peaK MH opraHM3Ma Ha
CBoe COCTO.HHMe;
'36
137
. Bpa'Ie6HbIH .lIHarH03 MOJKeT OCTaBaTbCJI EeH3MeHHbIM B
Te'IeHHe BceH 60JIe3HH. CeCTpHHCKHH .lIHarH03 MOJKeT
MeHHTbCJI Ka)K,l\bIH .lIeHb HJIH .lIaJKe B Te'IeHHe .lIBJI no
Mepe TOro, KaK H3MelUIIOTCJI peaK HH opraBH3Ma;
. Bpa'Ie6HbIH .lIHarH03 npe.llnOJIRraeT JIe'leHHe B paMKax
Bpa'Ie6HOH npaKTHKFI, a ceC'rpHHCKHH - cec'l'pHHCKHe BMe-
maTeJIbCTBa B npe.lleJIax ee KOMneTeH HH H npaKTHKH.
. Bpa'Ie6BbIH .lIHarH03, KaK npaBHJIO, CB.H3aH C B03HHK-
mHMH naTO-<}>H3HOJIOrHqeCKHMH H3MeHeBHJIMH B opra-
BH3Me. CeC'l'pHHCKHH - qaCTO CBJI3aH C npe.n:CTaBJIeHHJI-
MH na HeBTa 0 COCTOJIHHFI cBoero 3.l10pOBbJI.
CeCTpHHcKHe .lIHarB03bI OXBaTbIBalOT Bce c4JepbI JKH3HH
na HeBTa. Pa3JIH'IaIOT (jJU3UOJlOZU'leCKue. nCUXOJlOZU'leCKue.
COijUaJlbllble U iJYX08llbte iJuazli03bl.
CeCTpHHCKHX .lIHRrHOOOB MOJKeT 6bITb HeCKOJIbKO. 5-6, a
Bpaqe6HbIH. qa e Bcero, TOJIbKO O.llHH.
Pa3JIH'IaIOT .HBHbIe (HaCTOJIII\He), nOTeH HaJIbHbIe H npH-
OpHTeTHbIe ceCTpHBCKHe .lIHarH03bI. CecTpHBcKHe .lIHarH03bI,
BTOpra.HCb B e.llHHbIH 'ne'Ie6HO-.lIHarHOCTH'IeCKHH npo ecc, He
,l{OJIJKBbI paCqJIeHJITb ero. He06xo.llHMO oc03BaBaTb, qTO O.ll-
BHM H3 OCHOBHbIX npHH HnoB Me.llH HHbI .HBJI.HeTCJI npHH Hn
eJIOCTHOCTH, T.e. nOHFlMaBHe 60JIe3HH KaK npo ecca, OXBa-
TbIBaIOII\ero Bce CHCTeMbI H ypoBHFI opraHM3Ma (KJIeTO'IHbIH,
TKaHeBoH. OpraHHbIH FI opraBH3MeHHbIH). AHaJIH3 naTOJIOrH-
qeCKHX JIBJIeHHH C y<ieTOM npHB Hna eJIOCTHOCTH n03BOJIEeT
nOHJITb npoTHBOpe'IHBbIH xapaKTep JIOKaJIH3a HH 60JIe3HeB-
BbIX npo eccoB, KOTOpbIH HeJIb3JI npe.llCTaBHTb ee6e 6e3 y<ieTa
06 HX peaK HH opraBH3Ma.
IIpH nOCTaHOBKe cecTpHBcKHX .lIHarH030B Me.llCeCTpa HC-
nOJIb3yeT 3BaHHJI 06 opraHH3Me 'IeJIOBeKa, nOJIy'IeHHbIe pa3-
JIH'!HbIMH HaYKaMH. IIoSToMY B OCHOBY KJIaCCH(1)HKa HH CecT-
pHHCKHX .lIHarH030B nOJIO:IKeHbI BapymeHHJI OCHOBHbIX npo-
eCCOB JKH3He eJITeJIbHOCTH opraHH3Ma, OXBaTbIBaIOII(He Bce
c<}>epbI JKH3HH na HeHTa, KaK HaCTOJI He, TaK H nOTeH H-
aJIbBbIe. ::ho n03BOJIHJIO YJKe cero.n:HJI pacnpe,l\eJIHTb pa3Ho06-
pa3HbIe ceCTpHHCKHe .lIHRrH03bI B 14 rpynn. 3'1:0 ;J;HarB03bI,
CBJI3aHHbIe C HapymeHHeM npo eCCOB:
. ,l\BHJKeHHJI (cHH:lKeHHe .lIBHraTeJIbHOH aKTHBHOCTH, Ba-
pymeHHe KOOP.llHHaI\HH .lIBHJKeHHH HAP.);
138
,
. .lIbIXaHHJI (3aTpY.llHeHHOe .lIbIXaHHe, KameJI npo KTHB-
HbIH H HenpO.llYKTHBHbIH, Y.llYllibe HAP.);
. KPOB006paII(eHHJI (OTeKH, apHTMHJI HAP);
. nHTaHHJI (nHTaHHe, 3Ha'IHTeJIbHO npeBbImalOII(ee no-
Tpe6HOCTH opraHH3Ma, YXY.lIIIIeHHe nHTaHHJI HAP);
. nH eBapeHHJI (HapYIIIeBHe rJIOTaBHJI, TomHOTa, pBO-
Ta, 3anop HAP.);
. MOqeBbI.lIeJIeHHJI (3B.,ZJ;epJKKa MO'IH OCTpa.H H XpOBH'IeC-
Ka.H, He.llep:IKaHHe MO'IH HAP.);
. Bcex BHAOB I'OMeOCTa3a (rHnepTepMHJI, rHnOTepMHJI,
06e3BO:IKHBaHHe, CHHJKeHFle HMMYHHTeTa H .AP.);
III nOBe.lleBHJI (OTKa3 OT npneMa JIeKapCTB, CO HaJIbHa.H
caMOH30JI.H HJI, CYH H.A HAP.);
. BOCnpHJITHJI H o yru;eHHJI (BapymeBHe cJIyxa, Hapyme-
HHe 3peHH.H, HapymeHHe BItyca, 60JIb HAP.);
. BHHMaHHJI (npoH3BOJIbHOro, BenpOH3BOJIbHOrO HAP.);
. naMJITH (rHnOMHe3HJI, aMBe3HJI, rHnepMHe3H.H);
. MbImJIeBHJI (CHH:lKeHHe FlHTeJIJIeKTS, BapymeHFle npo-
CTpaBCTBeHBOH opHeHTa HH);
. H3MeHeHHJI B aMO HOHaJIbBOH H qYBCTBHTeJIbHOH c<}>e-
pax(cTpax,6ecnOKOHCTBO,anaTHJI,aH<}>opHJI, O'l'pH a-
TeJIbHOH OTBomeHHe K JIHqBOCTH MeAH HHCKoro pa6OT-
BFlKa, OKa3bIBalO ero nOMO b, K Ka'IeCTBY npOBO.llH-
MbIX MaHHnYJIJI HH, O.llHHO'IeCTBO FI .liP.);
. H3MeHeHHJI rHrHeHH'IeCKHX nOTpe6HOCTeH (He.llOCTaTOK
rHrHeHHqeCKHX 3HaHHH, BaBbIKOB, np06JIeMbI C Me,l\H-
HHCKHM 06cJIy:IKHBaHHeM FI .lip.).
IIpH3HaKaMH BapymeHHJI OCHOBBbIX npo eCCOB :lKH3He.lleJI-
TeJIbHOCTH opraHH3Ma JIBJIJIIOTCJI aBaTOMO-<}>H3HOJIOrHqeCKHe,
nCHXOCO Ha.m,HbIe H XOBHbIe H3MeHeHH.H B JKH3HH qeJIOBeKa.
Oc060e 3HaqeHHe B ceCTpHHCKOH .lIHarHOCTHKe Y.lleJIJIeTCJI
YCTaHOBJIeHHIO nCHXOJIOrHqeCKoro KOHTaKTa, onpe.lleJIeBHIO
nepBH'IHoro nCHXOJIOrH'IeCKoro .lIHRrH03a.
Ha6JIIO.lIa.H H 6ece,l\YJI C na HeBTOM Me.llCeCTpa OTMeqaeT
BaJIH'IHe HJIH OTCYTCTBne nCHXOJIOrH'IeCKOH HanpJIJKeHHOCTH
(HeY.llOBJIeTBOpeHBOCTb C060H, qYBCTBO CTbI.lIa H T.n.) B ceMbe,
Ba pa60Te:
. .lIBH:lKeHFI.H 'leJIOBeKa, ero MHMHKa, TeM6p raJIOCS FI TeMn
pe'IH, CJIOBapHbIH 3anac .ASIOT MHoro pa3Ho06pa3HOH
HH<Ix>pMa HH 0 na HeHTe;
139
. fl3MeHeHfUI (AflHaMflKY) SMOlJ;fluHaJIbHOH clj)epbI, BJlfl.H-
Hfle 3MOlJ;flH Ha nOBeAeHfle, HaCTpoeHfle, a TaK:lKe Ha
COCTO.HHfle opraHfl3Ma, B 'IaCTHOCTfi Ha flMMYHflTeT;
. HapYlIIeHfI.H nOBeAeHfI.H, KOTopble He cpa3Y AfiarHOCTfI-
PYIOTC.H fI '1aCTO CB.H3aHbI C nCflXOCOlJ;flaJIbHbIM He,l\Opa3-
Bl1TfleM, B 'IaCTHOCTl1, OTKJIOHeHfle OT 06ru;enpflH.HTbIX
HOpM Ij)fl3f10JIOrfl'leCKfiX OTnpaBJIeHflH, aHOMaJIbHbIe
npflBbI'IKfI B eAe (fl3Bparu;eHHbIH anneTflT), HenOH.HT-
HOCTb pe'Ifi BCTpe'IaIOTC.H HepeAKO.
IIalJ;fleHT YTpa'lfiBaeT nCflXOJIOrfl'IeCKOe paBBOBeCfle, no-
.HBJI.HIOTCH TpeBora, 60JIe3Hb, CTpax, CTbIA, HeTepneHfle, Aen-
peCCHH fI APyrfie OTpfllJ;aTeJIbHbIe SMOlJ;flfI, .HBJI.HIOII(fleCJI TOH-
KfiMfi HHAfiKaTOpaMH, MOTl1BaTOpaMfi nOBeAeHflH nalJ;fleHTa.
MeAfllJ;l1HCKaH ceCTpa 3HaeT, 'ITO nepBH'IHbIe, 3MOlJ;HOHaJIb-
BbIe peaKlJ;flH B036Y:lKAaIOT Ae.HTeJIbHOCTb nOAKopKOBblX COCY-
.l\HCTO-BereTaTl1BHbIX fI SHAOKpflHHbIX lJ;eHTpOB.
II03TOMY npH BbIpa:IKeHHbIX 3MOlJ;HOHaJIbHbIX COCTO.HHflHX
'leJIOBeK 6JIeAHeeT HJIH KpaCHeeT, B03HHItalOT H3MeHeHHH PHT-
Ma CepAe'IHbIX COKparu;eHHH, CHH:lKaeTCH HJIH nOBbIlIIaeTCH
TeMnepaorypa TeJIa, MbIlIIlJ;, MeHHeTCH AeHTeJIbHOCTb-nOTOBbIX,
CJle3HbIX, CaJIbHbIX HAP. :lKeJIe3. "Y HcnyraHHoro '1eJIOBeKa
paClIIflpHIOTCJI rJIa3HbIe II(eJIH H 3pa'IKH, nOBbIlIIaeTCJI apTe-
pHaJIbHOe AaBJleHHe. BOJIbHbIe B COCTO.HHHfI AenpeCCHH MaJlO-
nOABH:lKHbI, yeAHHHIOTCH, pa3JIH'IHbIe pa31'OBOpbI AJIH HHX
THI'OCTHbI.
HenpaBHJIbHOe BocnflTaHfle AeJIaeT 'IeJIOBeKa MCHee cno-
C06HbIM K BOJIeBOH Ae.HTeJIbHOCTl1. MeAceCTpa, KOTOPOH npH-
XOAflTbCH npHHHMaTb Y'IaCTHe B 06Y'leHflH nalJ;fleH a, AOJI:IK-
Ha Y'IfiTbIBaTb STOT cpaKTOp, TaK KaK OH BJIHHeT Ha npOlJ;ecc
YCBOeHHH.
TaKfiM 06pa30M, nCHXOJIOrwlecKflH AHarB03 OTpa'Kaer nCH-
XOJIOrH'IecKYIO AHcrapMOHHIO nalJ;HeHTa, nonaBlIIero B Heo-
6bI'IHYIO cflTyalJ;fllO.
l'IHlj)opMalJ;flH 0 nalJ;HeHTe flHTepnpeTflpyeTCH MeAceCTpOH
fI OTpa:IKaeTCH B ceCTpHHCKOM nCHXOJIOrfl'IeCKOM AfiarH03e C
TO'lKH 3peHHH nOTpe6HOCTeH nalJ;HeHTa B nCflXOJIOrH'IeCKOH
nOMoru;H.
H anpwnep: ceCTpflHCItflH AfiarH03:
- nalJ;HeHT HcnbITbIBaeT 'IYBCTBO CTbIAa nepeA nOCTa-
BOBKOH O'lHCTl1TeJIbBOH KJIfl3MbI;
- nalJ;fleHT flcnbITbIBaeT TpeBory, CB.H3aHHYIO C HeB03-
MO:IKHOCTblO 06CJ1Y:IKflBaTb ce6.H.
IIcHxoJIorH'IeCKa.H AfiarHOCTfiKa TeCHO CB.H3aHa C COlJ;H-
aJIbHbIM CTaoryCOM nau;HeHTa. OT COlJ;flaJIbHbIX lj)aKTopoB 3a-
BflCflT H nCflXOJIOrH'IeCKOe, fI .n:yXOBBoe COCTO.HHfle nalJ;HeBTa,
KOTopoe MO:IKeT .HBHTbC.H npH'IflHOH MHorHX 3a60JIeBaHHH.
IIoSTOMY MO:IKHO 06'beAHHflTb nCHXOJIOrU'IeCKoe fI COlJ;flaJIbHOe
AHarHOCTHpOBaHflE1 B nCHXOCOlJ;flaJIbHoe. ROHe'lHO, B HaCTO.H-
II(ee BpeM.H HeAOCTaTO'IHO nOJIHO pelIIalOTC.H np06JIeMbI nalJ;fI-
eHTa B nCHXOCOlJ;flaJIbHOH nOMoru;fI, TeM He MeHee, MeAfllJ;UHC-
KaH cecTpa Y'lHTbIBaH COlJ;flaJIbHO-SKOHOMH'IeCKHe cBeAeHH.H 0
nalJ;HeHTe, cOlJ;flaJIbBbIe c}>aKTOpbI pficKa, MO:IKeT AOCTaTO'IHO
TO'IHO AHarHocTflpoBaTb peaKlJ;HIO nalJ;l1:eBTa BR" CBoe COCTOH-
BHe 3AOPOBbH. IIocJIe 1j)0PMY JIflpOBaHflH Bcex cecTpflHcKfiX
AHarH030B MeAcecTpa YCTaHaBJIfiBaeT fiX npHOpHTeTHOCTb,
Onflpa.HCb Ha MHeHfle nalJ;fleHTa 0 nepBOO'lepeAHOcTH OKa3a-
BHH nOMOII(H nalJ;fleHory.
npMMepHblM 6aHK npo6neM
naqMeHTa MnM ceCTpMHCKMX AMarH030B
1. qYBCTBO TpeBorfl, CBH3aHHoe Coo. (c YKa3aBfleM BepOHTHOM
npH'IHHbI 60JIe3HeHBoH peaKlJ;HH).
2. qYBCTBO OT'IaHHHH H 6e3HaAe:IKHOCTfI, CB.H3aHBOe c... (Ha-
npHMep, AJIHTeJIbHbIM 3a60JIeBaHHeM).
3. HeAocTaTo'lHoe nHTRHfle, He COOTBeTCTBYIOII(ee nOTpe6HOC-
THM opra- Hfl3Ma.
4. M36bITO'IHOe nHTaHHe, npeBbIlIIalOII(ee nOTpe6HocTfi opra-
HH3Ma.
5. CHH:lKeHfle 3aII(HTHbIX Ij)YHKlJ;HH opraHfl3Ma, B CB.H3f1 C...
6. BecnoKoikTBO, CBH3aHHoe Coo. (COCTO.HHHeM 3AOPOBbH)
7. OTCYTcTBHe caHHTapHbIX YCJIOBflH (6bITa, pa60TbI, CTau;flO-
Hapa).
8. .l!:ecpfllJ;HT (OTcYTCTBHe) 3HaHHH-H BaBbIKOB AJIn ocyru;eCTB-
JIeHHH... (HanpfiMep, rflrHeHfI'IeCKHX MCpOnpI1:.HTflll).
9. "YCTaJIOCTb (06ru;aH CJla60cTb).
10. CHfI:meHHe 3MOlJ;HOHaJIbHOrO TOHyca (lj)oHa) B CB.H3f1 co
CTpaXOM (cTpeccoM H T.n.).
'40
'4'
11. CHflmeHfle (OTCYTcTBHe) <}>fl3f1tJ:ecKoH aKTflBHOCTH (no -
BHmHocTfI).
12. He060cHoBaHHbIH OTI<a3 OT npfieMa JIeKapCTB.
13. He.llOCTaTotJ:Ha$l CaMOrHrHeBa.
14. He06xo)J;HMOCT:b nCHXOJIOrfl"lecKoH nO)J;)J;epmKfI.
15. He06xo I1MocTb yqaCTH$I B yxo e... (KOro, peiliaeT'n HeHT).
16. O HHotJ:ecTBo.
17. He,L\OCTaToK 3HaHHH 0 3,L\OpOBOM 06pa3e mfl3HfI.
18. CTpax H 6e3Ha,L\emHocTb, CB$l3aHHbIe C H3BecTHeM 0 HeH3-
JIetJ:HMOM 3a6oJIeBaHHH (CTIn,lO.
19. COCTO$lHHe nCHXOJIOrHtJ:eCKoro HapYIIIeHH$I (HeraTfiBBoe
OTHOIlIeBHe K CBOeH npo6JIeMe):
. naIJ;HeHT He OOIJ;eHHBaeT TIDKecTh COCTOHHH$I;
. naIJ;HeHT OTpHIJ;aeT <}>aKT 3a60JIeBaHH.H;
. Y nartHeHTa HMelOTCH npeYBeJIHtJ:eHHble onaCeHH..H 3a CBoe
3 opoBbe, HO npeO,L\OJIeTh CBOHX onaceHflH OH He MomeT;
. naIJ;HeHT norpymaeTC$I, .YXO,L\HT& B 60JIe3H:b;
. Ha (pOHe 60JIe3HfI Y naIJ;HeHTa 3Ha<iflTeJIbHO B03paCTaeT
TpeBora;
. naIJ;HeHT CTaBHT CBOH CTpa,L\aHfI$I BbIIIIe Bcero OCTaJIb-
Horo, Tpe6yeT oc060ro BHHManfl$l po,L\CTBeHHflKOB, OCO-
60H 3a60TbI;
. naIJ;HeHT C<iHTaeT, 'ITO 60JIe3Hb $lBJI$le.TC.H pe3YJI:bTaTOM
3.1101'0 YMbICJIa, CTaHOBHTC$I DO,L\03pflTeJIbHbIM npH BC$I-
KHX Ha3Ha<ieHH$lX JIeKapCTB, npoIJ;e,L\YP;
. naIJ;fleHT CTaHOBflTC.H BceM He OBOJIbHbIM, 3JI06HbIM, no-
poH arpecCflBHbIM.
20. COCTO$lHfle SMOIJ;HOHaJIbHOH HeycTOH<iflBOCTH (BbITeKalO-
m;ee H3 n03f1IJ;HH H IJ;eHHOCTeH naIJ;fleHTa).
21. CHHmeHfle n03HaBaTeJIbHbIX Ij)YHKIJ;flH (orpaHHtJ:eHHe HH-
TeJIJIeKTa, YMCTBeHHOrO cTaTyca, BOCnpH.HTH$I).
22. HapYIIIeBHe nOBe,L\eHH$I (HapYIIIeHHe'06m;eBHH, c06JIIO,L\e-
RJm Tpa,L\HIJ;flH fI T.,L\.).
23. CTpax 3a CBoe 6y ym;ee (nepe OnepaI\fleH).
24. BecnoKOHCTBO no nOBO Y... (oTHoIlIeBHH B CeM:be).
25. He,L\ocTaTOK 3HaHflH... (0 60JIe3HfI).
26. TIaIJ;fleHT He CnpaBJI$leTC$I C np06JIeMOH CBoeH 60JIe3HH.
27. HapYIIIeHHe KOMlj)opTHoro COCTO.HHfI$I (He,L\epmaHHe MOtJ:fI,
KaJIa, TOiliHOTa, pBoTa).
142
. ,
i
28. ,lI;e(}>HIJ;HT caMOYXO,L\a, CB$l3aHHbIH C nOHflmeHHOM Ij)H3H-
tJ:eCIWH aI<THBHOCT:bIO.
29. KOH(PJIHKTHaJI cflTyaIJ;H$I B CeMb€.
30. B03HHKHoBeHHe ceMeHHbIX np06JIeM, CB$l3aHHbIX C ... (Ha-
npfiMep, C JIflTeJIbHbIM npe6bIBaHHeM B CTaIJ;floHape).
31. HeYMeHfle yxamfiBaTb 3a HHBaJIH OM B ceMbe.
32. CTpax nOTepH... (ceM:bfl, pa60TbI fI T. .).
33. HeB03MOmHOCT:b ocym;eCTBJIeHH.H caMoyxo a, CBJ'I3aHBa$l
co ... (cJIa- 60CTblO, nOHflmeHHOH Ij)fl3f1'leCKOH aKTHBHOC-
T:b1O fI T ..11.).
34. BeccoHHHIJ;a.
35. HapYIIIeHH.H CHao
36. HapYIlIeHfle KOMIj)OpTHOro COCTO$lHH$I:... (60JI:b, CB$l3aH-
Ha.H c...).
37. HapYIlIeHflH onopOmHeHH$I KflIIIetJ:HHKa (3anop, nOHoc).
38. 3y Komfl BOJIOCHCTOM <iaCTfirOJIOBbI, CBJI3aHHbIH C ne,L\H-
KYJIe30M.
39. HapYIIIeHHe IJ;eJIOCTHOCTH KO;)KHbIX nOKpOBOB (npo.n:emHfI).
40. PHCK nO$lBJIeHH.H... (npoJIemHeH, onpeJIOCTeH) y T$lmeJIO-
60JIbHbIX.
41. qyrJCTBO cTpaxa Y n HeHTa nepe ... (noCTaHOBKOH Illi.HBOI<).
42. PHCK nepeoXJIaJK,L\eHHJ'I n HeHTa npH BO HbIX npOIJ;e,L\ypax.
43. JIHxOpa,L\Ka... B 3-eM nepHO,L\e, I<pH3f1C.
44. YCflJIeHHOe ra3006pa30BaHHe B KHIIIe<iHHKe (MeTeopfl3M).
45. qYBCTBO JIOmHOrO CTbI,L\a.
46. qYBCTBO Ij)fl3f1<ieCKOH YTpaTbI.
47. HHIj)HIJ;flpOBaHHe H nOBpem,ZJ;eHfle CTOMbI B CB.H3f1 C Benpa-
EflJIbHbIM YXO,L\OM.
48. PBOTHbIH pelj)JIeKc.
49. OTKa3 OT npOIJ;e ypbI.
50. qYBCTBO BHHbI Y 6JIfl3KHX 06petJ:eHHoro 'IeJIOBeKa.
51. HeYMeHfle 6JIH3KHX yxamlIBaT:b 3a 06pe'IeHHbIM.
52. qpe3MepHa.H enpeCCH$I Y naIJ;HeHTa B CBH3H ... (c npe -
CTO$lm;eH nOTepeH).
53. HenO,L\BflmHOCT:b.
54. qYBCTBO OTtJ:a$lHH.H fI 6e3Ha,L\emHOCTI1:, CB$l3aHHOe C H3Bec-
THeM 0 6JIH3KOH CMepTH.
55. COIJ;HaJIbHa$lq caMOJ-I30JI$lIJ;HH (H30JI$lIJ;H$I).
56. TpeBora, CBJI3aHHa$l C He06xo,L\flMOCT:b1O nOCTopoBHero
yxo a.
143
57. IIoBbIIlIeHIie AJJ..
58. IIpHcTyn YAYIlIb.H.
59. B03HIiKHoBeHIie npoJIe:IKHeH.
60. KpoBOTe'leHIie (:lKeJIYAmlHoe, JIerO'lHoe).
cI>parMenT Ii3 cecTpllHcKOH UCTOpliU
CecTpuHcKue AIiarH03bI UJIU np06JIeMbI naI.J;UeHTa
cD.M.O.
,:laTa,
'lac. MHH.
HaCTOJlUjHe
nOTeHLlHanbHble
npHOpHTeTHble
3.5. Tpemuii 3man cecmpuHclioro npoqecca -
onpegeiteHUe qeiteii cecmpuHclioro
BMeWameitbCmBa
BII.D;bI II 3JIeMeHTbI eJIeH ceCTpUHCKoro YX0;J;a
(BMcWaTeJIhCTB)
IIOCTaHOBKa I.J;eJIeH yxoAa He06xoAuMa no ABYM npUtIHHaM:
1. OnpeAeJI.HeTC.H HanpaJ3JIeHUe UHJ\UBIiJ(yaJIhHOro ceCTpIiH-
CKOro BMellIaTeJIbCTBa.
2. MCnOJIb3YIOTC.H AJI.H o peAeJIeHU.H CTeneHlI allJ<lJeKTlIBHo-
CTU BMeIlIaTeJIbCTBa.
IIaI.J;UeHT aKTUBHO BOBJIeKaeTC.H B npOI.J;eCC nJIaHnpOBaHU.H
I.J;eJIeH. OAHoBpeMeHHo MeAceCTpa MOTuBuPyeT naI.J;IieHTa Ha
ycnex, y6e)K,l\a.H ero B AOCTU:lKeHUH I.J;eJII1 Ii BMeCTe C naI.J;l1eH-
TOM onpeAeJI.HeT nYTH I1X AOCTU:lKeHU.H.
,n:JI.H I<a:IKAOH AOMl1lIaHTHOH nOTpe6HoCTI1: I1JIU CecTpIiHCKO-
1'0 AuarH03a 3anucbIBalOTcH B nJIaRe ceCTpIiHCKoro yxoAa OT-
p;eJIbHble I.J;eJIu, KOTopbIe paCCMaTpl1BalOTCH KaK :lKeJIaeMbIH
pe3YJIbTaT yxoAa.
IIo cpoKaM CYII.J;eCTBYIOT 2 BI1Aa I.J;eJIeii:: I<paTKocpo'lHble,
KOTOpbIe AOJI:lKHbI 6bITb AOCTl1rHyrbI B Te'lelll1e Hep;eJII1 H AOJI-
rOCpO'lHbIe, KOTopble AOCTl1raIOTC.H nOCJIe BbInl1CKU 113 CTa-
I.J;110Hapa.
144
Ka:IKAa.H I.J;eJIb B 06H3aTeJIbHOM nopHAKe BI<JIlOqaeT 3 KOM-
nOHeHTa:
1. McnOJlHemIe (rJIaroJI, AencTBl1e).
2. KpuTepHH (AaTa, BpeMH, paccToHHue).
3. "YCJIOBUe (c nOMOII.J;blO KOro- I1JII1 'Iero-JIu60).
Hanpu.llt.ep: naUHeHT 6VlIeT CUJIeTb B nOCTeJII1 C nOMOiliblO
nOlIVilieK Ha 7 -on lIeHb .
1 J
Tpe60BaHHH K nOCTaHoBKe eJIeH
1. IJ;eJIu AOJI:lKHbI 6bITb peaJIbBbIMH, AOCTH)KHMbIMH.
2. He06xoAHMO YCTaHoBHTb KOHKpeTBbIe CpoKH AOCTH)Ke-
HHH Ka)K,l\oH I.J;eJIH.
3. IIaI.J;HeHT AOJI)Keu Y'lacTBoBaTb B 06CY:lKp;eHHH Ka:lKAOH
u;eJIH.
IIo cpoKaM cYII.J;eCTBYIOT 2 Im:Aa eJIeii:
1. ICpamKocpo'lH.bte, AOCTH)lWHHe I<OTOpbL"{ OCYW;ecTBJIHeTCH
B TeqeHHe OAHOH neAeJIH 11 60JIee.
2. oJtzOCpO'tH.bte, KOTopbIe AocTHralOTcH B TeqeHHe AJIH-
TeJIbHoro nepl1o:u.a, 60JIee HeAeJIH, qaCTO nOCJIe BbInHC-
KH naI.J;ueHTa U3 CTaI.J;HOHapa.
IIpUMephIl\eJIeH
. KpamKocpO'tH.b.J..
1. "Y naI.J;HeHTa K. He 6YAeT YAYIlIbH 'Iepex 20-25 MHHyr.
2. Co3HaHHe naU;HeHTa BOCCTaHOBHTC.H B TeqeHHe 5 MH-
HYT.
3. "Y naI.J;HeHTa A. 6YAeT KynHpoBaB 60JIeBOH npHcTyn B
TeqeHHe 30 MHHYT.
4. "Y naI.J;HeHTa JI. IICqe3HYT OTeKU Ha HH)KHHX KOHe'lHOC-
TJIX 1< I<OHI.J;Y HeAeJIu.
. iJoJtzOCpO'tH.btX:
1. "Y naI.J;HeHTa K. HC'Ie3HeT OAbIIlIKa B nOlwe K MOMeHTY
BbInHCKH.
2. "Y naI.J;HeHTa M. cTa6HJIH3H'PYIOTC.H nOKa3aTeJIH AJl. K
10-MY AHIO.
3. IIaI.J;HeHT 6YAeT nCHXOJIOrIitJeCKH nOArOTOBJIeH K )K113HH
B ceMbe K MOMeHTY BbInHCKH.
145
3.6. "Iemsepmblil 3man: nJtaHuposaHue o6beMa
cecmpuHcliux SMewamellbcms
. ne3a6UCUMbte:
1. Ha6mo,l\aTb 3a peaKIJ;fleH Ha JIe'leHl1e. OKa3aTb ,l\OBpa-
'le6HYIO nOMOIIJ;b. ocym;ecTBflTb MepOnpIDITfiJI no JIfI'l-
"HOH rfirfieHe. npOBO,l\flTb MepOnpfiJITfiJI no npmlmJIaK-
TfiKe BHYTPfl60JIbHfI'lHOH flH<!JeKIJ;flfI, opraHfl30BaTb ,l\0-
cyr. ,l\aTb COBeTbI nau;HeHTY. 06Y'lflTb naIJ;fleHTa...
. 63aUJIt03a6UcUMbte:
1. CoTPY,l\HfltIecTBO C ,l\pyrmrn pa60THflRaMR C IJ;eJIbIO yxO,lIa.
OKa3aHflJI nOMOIIJ;H. nO,l\.n;epmKfI.
2. KOHCYJIbTflpOBaHfle.
IIoCJIe !lJOpMYJIflpOBI<fI IJ;eJIfi no npfiOpfiTeTHOMY ,l\HarH03Y
B CecTpflHCKOM nJIalle yxo,l\a npOBO,l\HTCJI nJIaHflpOBaHHe 06'be-
Ma CecTpflHCKfiX BMf'WaTeJIbCTB. IIJIaH CecTPflHCI<HX BMewa-
TeJIbCTB npe.n;CTaBJIJIeT co60H nfiCbMeHHoe PYKOBO,l\CTBO. no,l\-
p06Hoe nepe'lflCJIeHfle CneIJ;flaJIbHbIX .n;eHcTBflH Me,l\ceCTpbI.
He06xo.n;flMbIX .n;JIJI ,l\OCrnmeHflJI IJ;eJIeH yxo,l\a.
Pa3JIfI'laIOT 3 Tflna ceCTpflllCKfiX BMeWaTeJIbCTB: 3a6UCU-
Mbte, ne3a6UCU 1tbte U 63aUM03a6UCUJ1tbte aei1cm6uR.
3a6ucuJ1tbtJ1tU Ha3bIBaIOTCJI ,l\eHCTBI'IJI Me.n;ceCTpbI. BbInOJI-
HJIeMbIe no lIa3Ha'leHflIO Bpa'la fI no,l\ ero Ha6JIIO,l\eHl'leM.
He3a6UCUMbte .n;eHcTBflJI Me,l\HIJ;HHCKaJI ceCTpa ocym;ecTB-
JIJIeT caMa. B Mepy CBoeH KOMneTeHIJ;flfI. K He3aBHCflMbIM OT-
HOCJITCJI .n;eHCTBflJI no Ha6JIIO,l\ellflIO a peaKIJ;fleH lIa JIe'leHfle.
a,l\anTaIJ;fleH naIJ;fleHTa K 60JIe3HfI. OKa3aHflIO .n;OBpa'le6HoH
nOMOIIJ;fI. ocym;eCTBJIeHIiIO MepOnpfiJITflH no JIIi'lHOH rflrHeHe.
npo<!JflJIaKTflKe BHYTPH60JIbHfI'lHOH HH<!JeKIJ;flfI. opraHfl3aIJ;flJI
,l\ocyra, COBeTbI COBeTbI naIJ;HeIITY. 06Y'leHIie.
B3aUM03a6UCUJltbtJltU Ha3bIBaIOTCJI .n;eHCTBIiJI Me,l\cecTpbI no
cOTpy.n;HIi'leCTBY C ,l\pyrfiMfi pa60THflI<aMfi C IJ;eJIbIO OKa3aHIiJI
nOMOIIJ;fI, yxo,l\a. K HfiM OTHOCJITCJI ,l\eHCTBflJI no no.n;roToBKe
K Y'laCTflIO flHCTpYMeHTaJIbHbIX, JIa60paTopHbIX HCCJIe.n;oBa-
HflJIX. Y'laCTHe B KOHCYJIbTflpoBaHflfI: JIcpK, ,l\HeTOJIOra, <!JH-
3f10TepaneBTa H .n;p.
Tpe60BaHHJI K onpe)];eJIeIIIUO 06'LeMa
ceCTpHHCKHX BMeWaTeJILCTB:
1. He06xo,l\flMO onpe.n;eJII'ITb TfinbI ceCTpflHCKfiX BMewa-
TeJIbCTB: 3aBflCflMbIe, He3aBflCflMbIe, B3aHM03aBHCflMbIe.
2. IlJIaHflpOBaHfle CecTpflHCKHX BMeWaTeJILCTB OCYIIJ;ecTBJIJI-
eTCJI Ha OCHOBe HapyweHHbIX nOTpe6HOCTeH naIJ;l'IeHTa.
3. IIpfi WIaHflpOBaHfIfi Ofh.eMa CeCTpl'lHCKfiX BMewaTeJIbCTB
Y'lIiTbIBaIOTCJI MeTO.n;bI ceCTpflHCI<flX BMeWaTeJIbCTB.
npHMCpLI ceCTpHIICKfiX BMeWaTeJILCTB:
. 3a6UCUJltbte:
1. BbIllOJIHJITb Ha:matJ:eHflJI Bpa'J.li. ,l\OKJIa.z\bIBaTb 06 fl3Me-
HeHflJIX COCTOJIHHJI 3,D;OpOBbJI naIJ;MeHTa.
MeTO)];LI CeCTpl'lHCKJIX BMeWaTeJILCTB
CeCTpJilHCKaJI nOMOm;b nJIaHflPyeTCJI Ha OCHOBe HapyweH-
HbIX nOTpe6HocTeH naD;JileHTa C IJ;eJILIO fiX YAOBJIeTBOpeHflJI, a
He Ha OCHOBe MeAflIJ;HHcKOro AfiarH03a. T.e. 3a60JIeBaHIiJI.
MeTo.n;bI ceCTpflHCKfiX BMeWaTeJIbCTB MOryT JIBJIJITbCJI fI
cnoco6aMfi Y,l\OBJIeTBOpeHflJI HapyweHHbIX nOTpe6HOCTeH.
K MeTOAaM OTHOC.aTCJI:
1. OI<a3aHl'le ,l\oBpa'le6HOH nOMOm;n.
2. BbInOJIHeHfle Bpa t Ie6HbIX Ha3Ha"<!eHflH.
3. C03AaHfle I<OM!POpTHbIX YCJIOBflH ,l\JIJI mI'l3He,l\eJITeJIbHO-
CTfi C IJ;eJIbIO YAOBJIeTBOpeHflJI OCHOBHbIX nOTpe6HocTeH
naIJ;I1:eHTa.
4. OI<a3aHfle nCflXOJIOrH"<!ecKoH nOAAepmKfI fI nOMOm;fI.
5. BbIllOJIHeHfle TeXHfI'leCKHX MaHflnYJIJIIJ;flH.
6. Meponpl'lJITfiJI no npo<!JflJIaKTl'IKe OCJIOmHeHflH fI YKpen-
JIellflIO 3AOpoBbJI.
7. OpraHfl3aIJ;flJI 06Y'leHflJI 1'1 KOIICYJIbTflpOBaHflJI naIJ;fleH-
Ta fI 'lJIeHOB cro ceMbfl.
3.1. PeifJtU3a14UR o6beM
cecmpuHcliux SMewameJtbcms
COrJIaCHO onpCAeJIeHflIO 003 STan peaJIfl3aIJ;HfI OnpeAeJIJI-
eTCJI KaK BbInOJIHeHfle AeMcTBflH. HanpaBJIeHHbIX Ha .n;ocTflme-
Hl'le CneIJ;mpfl'leCKfiX IJ;eJIeH.
146
141
Tpe6oBaHH:R K peaJIH3a HH DJIaHa
1. CHCTeMaTH'leCKH BbInOJIH.HTb nJIaH.
2. OCYII(eCTBJUITb KOOPAHHaI.J;HIO HaMetJ:eHHblX AeikTBHM.
3. BOBJIeKaTb naI.J;HeHTa B npOI.J;ecc 0I<a3aHIUI nOMOII(H, a
TaKme <lJIeHOB eI'O ceMbH.
4. TIJIaHHPyeMbIH YXOA MomeT 6bITb H Be OKa3aH, eCJIH
H3MeHHJIHCb 06CTOJITeJIbCTBa.
5. .l!:oBpatJ:e6Ha.H nOMOII(b OKa3bIBaeTC.H no CTaHAapTaM ce-
CTpHHCKOM npaKTHKH C yqeTOM HHAHBHP;YaJIbHOCTH na-
I.J;HeHTa.
6. CecTpHHcKHe MaHHnYJIJII.J;HH OCYII(eCTBJIJIIOTC.H no aJII'O-
pHTMaM (npoTOKOJIaM CecTpHHCKHX MaHHnYJI.HI.J;HM).
. PeaJIH3aI.J;HJI nJIaHa YXOAa OTMetJ:aeTC.H B KapTe ceCTpHH-
CKOI'O yxoAa C Y'lJ:eTOM nepHoAHtJ:HOCTH BbInOJIHeHH.H,
I<paTHOCTH C oTMeTKoM 0 BpeMeHH BbIDOJIHeHH.H H OI.J;eH-
KH peaKI.J;HH naI.J;HeHTa Ha OKa3aHHbIM YXOA.
llpuMep pea.nu3aijuU oihwzo U3 Jlt.emooo6 ceCmpW-lC1WX
6Jlt.el.UameJlbCm6:
BbInOJIHeHHe Ha3HatJ:eHHM Bpaqa.
IIJI3.HHpOBaHue
1. TIoAroToBHTb na-
I.J;HeHTa K Y3M opraHOB
6PIOWHOM nOJIOCTH
OTQET 0 PEAJIII3AU;IUf IIJIAHA YXO.l(A
cI>.M.O. naI.J;HeHTa
OTAeJIeHHe:
TIaJIaTa:
PeaJIH3a H:R DJIaHa
1. MCKJIIOtJ:HTb H3 nHTaHHJI ra-
3006pa3YIOII(He npOAYKTbI (MOJIOtJ:-
HbIe, OBOII(H, <lJPYKTbI B CBemeM
BHme, qepHbIM xJIe6, Ij)PYKTOBbIe
COKH, Apo»<»<eBbIe npoAYKTbI, c,,'Iak
KYIO nHII(Y, Ta6JIeTH3HpoBaHHbIe
CJIa6HTeJIbfjbIe 3a 2-3 AH.H AO HCCJIe-
AOBaHHJI.
2. B Te'leHHe 2-3 AHeM AO HC-
CJIeAOBaHH.H npHHHMaTb Kap60JIeH
(aKTHBHpOBaHHbIM yrOJIb) no 2 Ta6-
JIeTKH TpH pa3a B AeHb no Ha3HatJ:e-
HHIO Bpa<Ia.
3. 3a 18-20 qaCOB AO nCCJIeAO-
BaHH.H - rOJIOAaHHe.
4. lIaI.J;HeHT, HanpaBJIeHHbIM Ha
Y31f, AOJI:meH HMeTb HCTOpHIO 60-
JIe3HH,nOJIOTeHI.J;e,npoCTbIHb,CMeH-
HYIO 06YBb.
AaTa. YXOA KeM PeaKLllII1II nOAnlllcb
acJ (npOLlI!AYPbl, BblnOnHeHO naLlllleHTa, M/c,
MIilH. ceCTp"HCKle Ha61110AeHIIIJI M/c OTBeTCTB.
BMewaTenbcTBa) nocne npOLl&AYP, 3a YXOA
BMeWaTel1bCTB.
;
3.8. nRmblU 3man cecmpuHclioro npoqecca -
oqeHlia pe3yitbmamOB.U lioppeliquR yxoga
J];eJIbIO HTOI'OBOM OI.J;eHKH JIBJIJIeTCJI onpeAeJIeHHe pe3YJIb-
TaTa cecTpHHcKOM nOMOII(H. OI.J;eHKa OCYll1eCTBJI.HeTC.H Benpe-
pbIBHO, HatJ:HHaJI C OI.J;eHKH AOMHHHPYIOII(eM nOTpe6HoCTH AO
BbInHCKH HJIH CMepTH naI.J;HeHTa.
MeAHI.J;HHCKaJI cecTpa nOCTOJIHHO C06HpaeT, KpHTHtJ:eCKH
aHaJIH3IipyeT HH<lJopMaI.J;HIO, AeJIaeT BbIBOAbI 0 peaKI.J;HH naI.J;H-
eHTa Ha YXOA. 0 peaJIbHOM B03MomiiOCTH OCYII(ecTBJIeHHJI DJlaHa
YXOAa Ii HaJIHtJ:HH HOBbIX npo6JIeM, Ha KOTopbIe He06xoAHMO
06paTHTb BHHMaHHe. TaI<HM 06pa30M, MomHO Bblp;eJIHTb oc-
HOBHbIe aCneKTbI OI.J;eHKH:
. AOCTH:meHHe I.J;eJIH;
. peaKI.J;HJI naI.J;HeHTa Ha ceCTpHHCIwe BMeWaTeJIbCTBO;
149.
. aKTHBHbIM nOHCK H OI.J;eHKa HOBbIX npo6JIeM, HapYIIIeH-
HbIX nOTpe6BOCTeM.
ECJIH nOCTaBJIeHHbIe I.J;e.i.IH ,l\OCTHrHYTbI H np06JIeMa peIIIe-
Ha, Me,l\CeCTpa OTMe'IaeT B nJIaHe, 'ITO I.J;eJIb ,l\OCTHrHYTa no
,l\aHHOM np06JIeMe, CTaBHT ,l\aTY, 'lac, MHHYTbI H nO,l\nHcb.
ECJIH I.J;eJIb cecTpHHcIwro npoI.J;ecca no ,l\aHHOM np06JIeMe
He ,l\OCTHrHYTa H Y naI.J;HeHTa COXpaHHJIaCb nOTpe6HOCTb B
ceCTpHHCIWM yxo,l\e, Heo6XO,l\HMO npoBecTH nepeOI.J;eHI<Y, "ITO-
6bI YCTaHOBHTb npH'IHHbI YXY,l\IIleHHJI COCTOJIHHJI HJIH MOMeHT,
KOr,l\a BHKaRHX Y.nytIIIleBHM B COCTOJIHHH naI.J;HeHTa He Hacory-
nHJIO. BamHo npHBJIe'Ib caMoro naI.J;HeHTa, a TaKme nOJIe3HO
nOCOBeTOBaTbCJI C KOJIJIeraMH OTBOCHTeJIbHO ,l\aJIbHeMiliero nJIa-
BHjJOBaHHJI. rJIaBBOe, YCTaHOBHTb npH'IHHbI, nOMeiliaBiliHe
,l\OCTHmeHHlO nOCTaBJIeHHOM n;eJIH.
B pe3YJIbTaTe MomeT H3MeHHTbCJI CaMa I.J;eJIb, BHeceHbI H3-
MeHeHHJI B nJIaH CecTpHHCKOro BMeIIIaTeJIbCTBa, T.e. npOH3-
BO,l\HTCJI KOppeKI.J;HJI YXO,l\a.
On;eHKa pe3YJlLTaTOB H KoppeKn;H:R n03BOJl:RIOT:
. onpe,l\eJIHTb Ka'IeCTBO YXO,l\a;
. 06CJIe,l\OBaTb OTBeTHYIO peaKI.J;HIO naI.J;HeHTa Ha ceCTpHH-
CKoe BMeIIIaTeJIbCTBO;
. HaMTH HOBbIe npo6JIeMbI nan;HeHTa.
CHCTeMaTH"IecKHM npoI.J;eCC OI.J;eHKH Tpe6yeT OT Me,l\CeCTpbI
YMeHHJI MbICJIHTb aHaJIHTH'IeCKH npH cpaBHeHHH O"tH,l\aeMbIX
pe3YJIbTaTOB C ,l\OCTHrHYTbIMH H CBOeBpeMeHHO npOBO,l\HTb IWp-
peKI.J;HIO nJIaHa BMeIIIaTeJIbCTBa C I.J;eJIblO ,l\OCTHmeHHJI 60J1ee
S(lx}JeKTHBHOM nOMOII\H nan;HeHTY. ,
OI.J;eHKa nJIaHa npOBO,l\HTCJI Ha OC HOBe aHaJIH3a pe3YJIbTa-
TOB ,l\OCTHmeHHJI nOCTaBJIeHHOH I.J;eJIH. COCTOJIHHe nan;HeHTa B
pe3YJIbTaTe cecTpHHCKoro BMeIIIaTeJIbCTBa CJIYmHT OCFtOBOM p,JIJI
npHHJITH.H peIIIeHHJI 0 He06xo,l\HMOCTH KoppeKI.J;HH nJIaHa.
IIpuMep oijemw pe3YJlbmamo6:
IIaI.J;HeHT nO,l\roTOBJIeH K Y3M opraHOB 6plOiliHOM nOJIOC-
TH. ,lJ;aTa, "lac, MHH., pocnHCb.
KoppeKI.J;H.H YXO,l\a npoBO,l\HTCH, ecJIH I.J;eJIb He ,l\OCTHI'HYTa no
,l\aHHOM np06JIeMe, npOBO,l\HTC.H nepeOn;eHKa Bcex STanOB CecT-
pHHCKOro npon;ecca, YCTaHaBJIHBaeTCJI npH'IHHa YXY,l\IIIeHH.H CO-
CTO.HHHJI HJIH MOMeHT, KOr,l\a HHI<aRHX y.rry<IIIIeHHM He HaCTYTIH-
JIO. BHOC.HTC.H H3MeHeHHJI B nJIaH CecTpHHCKOro npOI.J;ecca.
3.9. JJoliYMeHmaquR cecmpuHclioro npoqecca
,lJ;oKyMeHTaI.J;HJI npoBO,l\HTCJI B CecTPHHCIWM HCTOpHH COCTO-
JIHH.H 3,l\OpOBb.ll HJIH 6oJIe3HH nan;HeHTa. 3anOJIHeHHe ,l\OKYMeH-
Tan;HH Tpe6yeT BpeMeHH H He ,l\OJImHO 6bITb CJIOmHbIM. cI>OpMbI
He ,l\OJImHbI MeIIIaTb pa60Te, npeBparu;a.llCb B OT,l\eJIbHbIll BH,l\
,l\eJITeJIbHOCTH, eII(e O,l\HH npOH3BO,l\CTBeHHbIM PHTYaJI.
He06xo,!\HMOCTb ,!\OKYMeHTaI.J;HH ceCTpHHcKOro npOI.J;ecca CO-
CTOHT B TOM, 'IT06bI OT HHTYHTHBHOro nO,l\xo,!\a no OKa3aHHIO
nOMOII(H nan;HeBory Me,l\CeCTpa nepeiliJIa Ha npo,!\YMaHHbIii:,
cljJopMHpoBaHBbIii:, paCC'IHTaHBbIM Ba Y,l\OBJIeTBOpeBHe Hapy-
IIIeHHbIx nOTpe6HocTeii: YXO,l\. KOHe'lBO, Be Bce Me,l\HIlHHCKHe
ceCTpbI CMorYT ,l\OKYMeHTHpOBaTb ceCTpHHCI<Hii: npOI.J;eCC 'IeT-
KO, JICHO, npoljJeccHOHaJIbHO, Ba,l\O Bce npO,l\YMaTb: 1jJ0pi\IaT,
TO"lHOCTb, KpaTKOCTb H3JIOmeHHii: H ,l\p. BameH H CaM npOI.J;eCC
MbIIIlJIeHHJI Me,l\cecTpbI, YCJIOBHJI pa60TbI, ee KOMneTeHTHOCTb.
B03MOJKHO nOTpe6yeTCJI BpeMJI ,l\JIJI 1jJ0pMHpOBaHH.H HaBbIKOB
Be,l\eHHJI 3anHceii:. He06xo,l\HMa pa3pa6OTKa OnTHMaJIbHO Y,l\06-
HOii: ,!\OKYMeHTan;HH.
Ha,l\o nOMHHTb, 'ITO CJIe,!\YeT H36eraTb nOBTOpOB H nOHH
MaTb CHCTeMY 1jJ1IKcaO;HH HHc}>opMaI.J;HH, BO nOCJIe,l\Hee CJIOBO
3a BceMH Y'laCTHHI<aMH ceCTpHHclWro npon;ecca.
llpHHn;lInLI Be eHHJI )J;oKYMeHTan;HH:
1. qeTKocTb B BbI60pe CJIOB H B caMHX 3anHC.HX.
2. KpaTKoe H He,l\BYCMbICJIeBBOe H3JIOmeHlIe HHljJopMaI.J;HH.
3. OXBaT Beeii: OCHOBHOii: HHljJopMaI.J;HH.
4. MCnOJIb30BaHHe TOJIbKO 06 enpHH.HTbIX COKpaII(eHHM.
5. Kam.z\OM 3anHCH ,l\OJImHa npe.z\IIIeCTBOBaTb ,l\aTa H Bpe-
MJI, a B KOHI.J;e 3anHCH CTOJITb no,!\nHCb ceCTpbI, COCTaB-
JIHIOII(eii: OT'leT.
IIepHo,l\ BHe,l\peHHJI ceCTpHHCKoro npOI.J;eCca ,!\OCTaTO'lHO
,l\OJIrHll, n03TOMY MorYT B03HHKHYTb CJIe.l\YIOII\He np06JIeMbI,
CBJI3aHHbIe C ,!\oKYMeHTan;Heii::
1. HeB03MomHocTb OTKa3a OT CTapbIX MeTO,l\OB Be,l\eHHJI
,!\OKYMeHTaI.J;HH.
2. ,lJ;y6JIHpoBaHHe ,l\OKYMeHTan;HH.
3. IIJIaH yxo,!\a He ,l\OJImeH OTBJIeKaTb OT rJIaBHOrO - «OKa-
3aHHJI nOMOII\H». QT06bI STOro He 6bIJIO, BamHO pac-
ISO
151
CMaTpHBaTb .n:OKYMeHTaIJ;HIO KaK eCTeCTBeHHOe pa3BH-
THe HenpepbIBHOCTH nOMOIIJ;H.
4. .l!:oKYMeHTaIJ;HJI OTpamaeT HAeoJIOrHIO CBOHX pa3pa60T-
'1HKOB H 3a.BHCHT OT MOAeJIH ceCTpHHCKoro AeJIa, nOSTO-
MY MOmeT H3MeHJITbCJI.
BonpOCbl AnA caMonoAroToBKH:
PeKOMe a 1I1I no BeJJ;eHHIO .D;0KYMeHTaU;HII
1. OnHcbIBaj;iTe npo6JIeMbI naIJ;HeHTa ero c06cTBeHHbIMH
CJIOBaMH. 3TO nOMOmeT BaM 06cymAaTb C HHM BonpOCbI
yxo.n:a, a eMy JIY'Iwe nOHJITb nJIaH yXo.n:a.
2. Ha3bIBaiiTe IJ;eJIJIMH TO, '1ero XOTHTe A06HTbC.H BMeCTe c
naIJ;HeHTOM. YMeiiTe CcPOPMYJIHpoBaTb IJ;eJIH, HanpHMep:
Y naIJ;HeHTa 6YAYT OTCYTCTBOBaTb (HJIH YMeHbWaTbCJI)
HenpHJITHbIe CHMnTOMbI (YI<amHTe, KaKHe), Aanee, YI<a-
mHTe CPOK, 3a KOTOpbIM, no BaweMY MHeHHIO, IIpO-
H30M.n:eT H3MeHeBHe B COCTOJIHHH 3AOPOBbJI.
3. CoCTaBJIJIMTe HHAHBH.n:yanbHbIe IIJIaHbI YXOAa 3a naIJ;H-
eHTOM, OIIHpaJICb Ha CTaH.n:apTHbIe nJIaHbI yxoAa. 3TO
COKpaTHT BpeM.H HaIIHCaHHJI nJIaHa H onpe.n:eJIHT Hayq-
HbIH nOAXOA K ceCTpHHCKOMY nJIaHHpOBaHHIO.
4. XRaHHTe IIJIaH YXOAa B TYM60'lKe IIaIJ;HeHTa (HJIH B APY-
rOM MeCTe, y.n:06HOM .n:JIJI Bac, naIJ;HeHTa H Bcex, KTO
yqacTByeT B CecTpHHCKOM npOIJ;ecce), H TOr,na JII060M
'1JIeH 6pHI'aAbI (CMeHbI) CMomeT HM BOCnOJIb30BaTbCJI.
5. OTMe'laMTe CpOK (.n:aTY, CpOK, MHHYTbI) peanH3aIJ;HH
nJIaHa, YKa.JKHTe, '1TO nOMO 6bIJIa OKa3aHa B COOT-
BeTCTBHe C nJIaHOM (He Ay6JIHPYMTe 3annCH, SKOHOMbTe
BpeMJI). IIocTaBbTe nOAnHCb B KOHKpeTHOM pa3AeJIe
nJIaHa H BHeCHTe TY.n:a AOnOJIHHTeJIbHYIO HHcPopMaIJ;HIO,
KOTOpaJI He 6bIJIa 3anJIaHHpOBaHa, HO IIOTpe60BanaCb.
IIpoBe.n:HTe KoppeKU;HIO nJIaHa.
6. IIpHBJIeKaMTe naIJ;HeHTa K BeAeHHIO 3anHceM, CBJI33.H-
HbIX C caMOIIOMOIIJ;bIO HJIH, HanpHMep, C yqeTOM BOAHO-
1'0 6anaHca CYTO'lHOro AHype3a.
7. 06Y'IHTe Bcex yqacTByIOIIJ;HX B yxo.n:e (po.n:cTBeHHHI<OB,
BCnOMOl'aTeJIbHbIM nepcoHan) BbIIIOJIH.HTb onpe.n:eJIeHHbIe
SJIeMeHTbI yxo.n:a H pel'HCTpHpOBaTb HX.
1. 4eM OTIIH4aIOTCSI"HOBble onpeAelleHHS1 cecTpHHcKoro Aella OT on-
peAelleHHSI, AaHHoro <PllopeHc Ha THHre 1I B 1860 roAY B KHHre
«3anHCKH 06 yxo,Qe,} ?
2. 4TO SlBIISleTCSI ellblO ceCTpHHcKOro npo ecca?
3. nepe4HcIIHTe OCHOBHble 3ap,a4111, KOTopble He06xoAHMO peWHTb
MeAH HHcKoj.1 ceCTpe C ellblO ocy ecTBlleHIIISI cecTpHHcKoro npo-
4ecca? .
4. Ha30BHTe.nSlTb 3TanOB ceCTplllHCKoro np04ecca.
5. nOKa>KHTe Ha npHMepe B3aHMOCBSl3b 3TanOB cecTpHHcKoro npo-
4ecca.
6. ,lJ,onollHHTe He06xo,QHMOCTb BHeApeHIIIS1 cecTplllHcKoro np04ecca
(Ha npHMepe >KHTe CKo cHrya4HH).
7. 4TO Ha3blBaeTCSl CTaH,QapTHbIM nllaHOM no YXOAY?
8. 4eM oTIIH4aeTcSlIIIH,QHBHAyallbHbl nllaH YXOAa OT cTaH,QapTHoro?
152
Pa3gelli V
[ f'\ I 06Y'1EHHE
B CECTPHHCKOM J1EAE
06yqeHHe B CeCTpHHCKOI\l JJ;eJIe - STO opraHH30BaHHbIii:
Me,l\HIJ;HHcKoii: ceCTpOii: npOIJ;ecc AJUI peIIIeHHJI np06JIeM naIJ;H-
eHTa, CBJI3aHHbIX C ,l\ecpHIJ;HToM 3HaHHii:, YMeHHii:.
3aJJ;a1Jsl\IlI o6yqeHHJI B cecTpHHcKOM ,l\eJIe JIBJIJIIOTCJI nOA-
I'OTOBKa naIJ;HeHTOB K caMoyxo,l\Y C IJ;eJIblO Y,l\oBJIeTBOpeHHJI
HapYIIIeHHbIx nOTpe6HOCTeii:, pa3BHTHe Y HHX HHTepeca K no-
BbIIIIeHHIO Ka1JeCTBa mH3HH, YJIyt!IIIeHHIO COCTOJIHHJI 3,l\OpO-
BbJI HJIH a,u;aIITaIJ;HH K H3MeHeHHoMY COCTOJIHHIO.
CO.D;epmSHHel\l o6yqeHH:R naIJ;HeHTa Hero pOAcTBeHHHKoB
an:eMeHTaM cecTpHHcKoro yxoAa .HBJI.HeTC.H nOAAepmaHHe on-
pe,l\eJIeHHoro YPOBHJI 3AOPOBb.H naIJ;HeHTa, I<a'leCTBa mH3HH,
KOTOpoe 06eCne1JHT AOCTOHHYIO mH3Hb B HOBbIX AJI.H naIJ;HeHTa
YCJIOBHJIX, CB.H3aHHbIX C 3a60JIeBaHHeM. Oc060e 3Ha1JeHHe npH-
06PCTaIOT C(}JOpMHpoBaHHbIe C nOMoIIJ;blO MeAcecTpbI H BceMH
yt!aCTBYIOlIJ;HMH B npoIJ;ecce 06Y"leHH.H YMeHHH H BaBbU<H ,l\JI.H
BOCCTaHOBJIeHHJI YTpa'leHHbIX 4JYHKIJ;HH OpraHH3Ma, c03AaHHIO
YCJIOBHii: AJIJI rapMoHHH JIH1JHOCTH C OI<PymalOIIJ;eH cpeAOH.
Me,l\HIJ;HHCKa.fl cecTpa, BbInOJIBJI.H. pOJIb ne,l\arOI'a-BocnHTaTe-
JIJI, BceI'Aa AOJImHa nOMHHTb 0 HeOT'heMJICMbIX SJIeMeHTax ce-
CTpHHcKOro ,l\eJIa - Me,l\HIJ;HHCKoii: sTHKe, AeOHTOJIOrHH H ceCT-
pHHCKOH 4JHJIOCmpHH, OTJIH'laTbCJI KYJIbTYPOH 06IIJ;eHH.H H BbI-
COKHM TBOp1JecKHM nOTeHIJ;HaJIOM.
B nepHoA peclJOPM cecTpHHcKoI'o 06pS30BaHHJI, paCIIIHp.H-
IOTCJI c}>YHKIJ;HH MeAHIJ;HHcKOH cecTpbI. H3MeHeHHJI, npoHcxo-
,l\JIIIJ;He B pa3JIH1JHbIX c4Jepax HaIlIeI'O 06lIJ;ecTBa, onpe,l\eJIJIIOT
cTpaTernlO ceCTpHHcKOH Ae.HTeJIbHOCTH. HaCI<OJIbKO rpaMOTHO
H npocpeccHOHaJIbHO Me,l\cecTpa 6Y,l\eT BbInOJIHJITb CBOH 06.H-
3aHHOCTH, HaCTOJIbKO acl)(peKTHBHbIMH 6Y.l\YT cecTpHHcKaJJ: no-
MOIIJ;t, H CecTPHHCKHii: IIP0U;ecC B JIe1Je6Ho-npocpHJIaKTH1JecI<OM
yqpemJ\eHHH.
CecTpHHCKHii: npoIJ;ecc cpopMHPyeT KapTHHY 6YAYIIJ;eH CecT-
pHHCKOH pa60TbI, r,l\e.O,l\HHM H3 MeTOAoB ceCTpHHcKoii: ,l\eH-
TeJIbHOCTH (BMemaTeJIbCTBa) .HBJIJIeTCJI 06yt!eHHe naIJ;HeHTOB
H HX pOAcTBeHHHKoB, HenocpeAcTBeHHoe 061IJ;eHHe.
ECJIH npoc}>eccHOHaJIbHYIO KBaJIH(pHKaIJ;HIO MeAcecTpbI He
Bcer,l\a MorYT pacn03HaTb naIJ;HeBT Hero 6JIH3KHe, TO HpaB-
CTBeHHbIii: 06JI K 06HamaeTcJI 003 TPY,l\a. MOPaJIbHO-HpaBCTBeH-
HaJJ: HeYCTOii:1JHBOCTb, OTCYTCTBHe STH1JeCKHX H AeOHTOJIOrH-
1JeCKHX HOpM nOBe,l\eHH.H Y MCAcecTpbI HeCOBMeCTHMbI C H3-
6paHHOii: npo4JeccHeii:. ConepemHBaHHe H MHJIOCepAHe AOJIm-
HbI CTaTb BHYTpeHHHM cOAepmaHHeM, CTepmHeM MeAHIJ;HHC-
Koii: ceCTpbI.
CcI>epbl 06Y'leHHSI
q T06bI HaY1JHTb IIaIJ;HeHTS BbIIIOJIHJITb Aeii:cTBHJI, HanpaB-
JIeHHbIe Ha pa3BHTHe YTpa'leHHbIX B CBJI3H C 60JIe3HblO cno-
Co6HOCTeH 06CJIymHBaTL ce6.H, eCJIH HeT AJI.H SToro npOTHBO-
nOKa3aHHii:, MeAcecTpe Heo6xoAHMbI 3HaHHJI ccpep 06yt!eHHJI
1JeJIOBeKS (nSIJ;HeHTa), Ha KOTopbIe OHa CMOmeT npo4JeccHo-
HaJIbHO B03,l\eii:CTBOBaTb.
1. n03HaBaTeJILHa:R - HanpaBJIeHHa.H Ha YMeHHe nau;HeH-
Ta aHaJIH3HpOBaTb H CHHTe3HpOBaTb, a TaKme a6cTpaKTHo
MbICJIHTb, HCnOJIb3YJI nOJIyt!eBHbIe H3 OI<PymalOIIJ;eH cpeAbI
3HaHHJI,Bne1JaTJIeHHJI.
2. 3MOl.\HOHaJIbHS:R - xapaI<TepH3yeT HaCTpoeHHe, 3aBH-
CHT OT SMOIJ;HOHaJIblibIX CBOii:CTB JIH1JHOCTH: Bne1JaTJIHTeJIbHO-
CTH, ceHTHMeHTaJIbHOCTH, OT3bIB'lHBOCTH, 1JepCTBOCTH H T.A.
Ha6JIIO,l\aJJ: 3a naIJ;HeHTOM, Me,l\cecTpa OTMe'laeT H3MeHeHHJI
BHeiliHero BH,l\a:
. 3Jlo6H.btu - YKa3bIBaeT Ha HapYIIIeHHe nOTpe6HocTH 06-
lIJ;aTbCJI, Hapy IIIeHHe SMOIJ;HOHaJIbHC'M C(pepbI, nCIIXH-
1JeCKHe 3a60JIeBaHHJI, ,l\ecpeKTbI xapaKTepa H BocnHTa-
HHJI, caMO'IYBCTBHe;
. ucnyzallH.btU - YKa3bIBaeT Ha CTpax, nCHXH1JeCKHe co-
CTOJIHlIJI (cp06HH, HeBp03 HAP.), TeMnepaMeHT (MeJIaH-
XOJIHI<). MHHTeJIbHOCTb, JIa6HJIbHOCTb;
. anamU'lH.btU - 1JaIIJ;e no TeMnepaMenp:y « 4JJIerMaTHK&,
MorYT 6bITb naTOJIOrH1JeCKHe H3MeHeHH.H CcpepbI (ana-
TH.H). naTOJIOrH.H BOJIH (a6YJIHJI HJIH rHn06YJIHJI), S
TaKme HH,l\HBHAYaJIbHbIe oc06eHHOCTH xapaKTepa;
154
155
\.
. paCmepSlH.HblU - YKa3bIBaeT Ha HHAHBHAYaJIbHbIe OCO-
6eHHOCTH, CTpaX (He3HaHHe CYTH npeACTOJI HX 06cJIe-
AOBaHHM, nJIaHa JIe<ieHHJI, nporH030B 60JIe3HH H T.A.);
. He JIW:JICem H.aumu ce6e Mecma - TpaK'rYeTC.H Kal< nCH-
XOMOTopHoe B036y:lK,l\eHHe, CTpax nepeA npeACTOJI H-
MH 06CJIeAOBaHHJIMH, onepa HJIMH, MaHHnYJIJI HJIMH H
.lip., 60JIb , aMO HOHaJIbHbIM IIIOI<;
. cocmOSlH.ue atjJtjJeKma - BcnbIIIlKa aMO HOHaJIbHOM c<lJe-
pbI, KpaTl<OBpeMeHHoe no BpeMeHH;
. ypa6H.06el.UeH.HbIU - JIBJIJIeTC.H HOpMOH nOBeAeHHJI, YC-
TOM<iIiBOrO aMO HOHaJIbHOrO COCTOJIHHJI;
. npU3H.aKU mpe60:J/C1lOCmu - nOTHpaHHe PYK, HanpJI:lKeH-
HOCTb B n03e, rOJIOce - .HBJIJIIOTC.H npH3HaKaMH Heyc-
TOM<iHBOrO aMO HOHam,Horo COCTOJIHHH HJIIi oc06eHHOC-
TJIMH xapaKTepa (MHHTeJIbHOCTb), YI<a3bIBaIOT Ha Ha-
JIH<iHe CTpaxa nepeA MaHIirrYJI.H H.HMH, npeACTOJI HM
06CJIeAOBaHHeM H T.A.
3. IIcIixoMoTopHaJI c<lJepa - XapaKTepH3YeT H3MeHeHHe Ha-
CTpoeHHJI, 'IYBCTB, ABHraTeJIbHYIO aKTHBHOCTb na HeHTa, 3aJm-
CHT OT rrCHXOMoTOpHOro pa3BHTHJI JIIi<iHOCTH, 06 ero CaMO<i}'B-
CTBH.H, HepBHOnCHXH'IeCKHX H COMaTH<iecl<HX 3a6oJIeBaHHll.
Ta611H a 1
"3MeHeHHSI HaCTpoeHHR
Ha6l1IOAeHllle TpaKTOBKa
'JYBcTBa
6e3blcxoAHocnt naT0l101V151 3MOl\IIIa;1 (AenpeccIIISI),
COCT05lHIIIB o6peyeHHblX 11 YMlllpalO-
UjIllX 6ol1bHb1X, HeBp0l101Vl'leCKI1e 11
nCl1x3a60l1BsaHI1R
P33APaJKlIITenbHOCTI1,HenepeHoclII- HeBpOTlIIyeCKI1B COCT05lHI1R, naTOl1o-
MOCTIII AfllllTenbHoro OJKI1AaHIIISI, <!>11- rIIIR 3Mol\110HanbHoa;1 c<!>epbl, OTHo-
311yeCKOrO I1nl1 nCI1XHyeCKOrO HanpSl- weHllle K CBoeMY COCTOSlHIllIO 3AOPO-
JKBHI151 Sb!l
TpeBOrlil Hesponl'leCKlile COCTOSlHIIIR, naTono-
rlllR 3MOl\110HMbHOH c<fJepbl, OTHO-
weHllle K CBoeMY COCTORHIllIO 3AOPo-
Sb!l
nOSblweHHaR YYBCTBIIITenbHOCTb, Kone6aHI151 HaCTpoeHIIIR, naronolVlSl
3MOl\IIIOHanbHaSi HeycToH'IlilBOCTb 3M0Lll1H (3Mol\lIIoHanbHaR l1a6I1m,-
(YYBcTBa nal\lIIeHTa l1BKKO CMeH5IIOT HOCTb), 3<J60neSaHI1R r0/10BHOrO
APyr APyra) M03ra.nClllxonaTIIIIII
rHeBnlllSOCTb, 3l106a, nal\lIIeHT rnes- naT0/101V151 3MOl\I1H, nCI1X3a60l1esa-
HO, C B03M}'UjeHI1BM pearlilpyeT Ha HIIIRIilAP.
KaKl1e-nlll60 clilTyal\11111
COCTOSlHllle OCTporo B036y>KAeHIII5I. naT0/10lVlR C03HaHlilSi (Aenl1pIIIH),
6ecnoKoa;1CTBa,COnpOBo aeMoe HeSpOTI1'1eCKllle COCTORHI151 (ncl1xo-
crpaXOM. nnayeM CTeHIIISI. HeBpo3 HaBSl3YIIIBbIX COCTOSl-
HI1a;1, IIIcTeplllR), nCI1X3a60nesaHIilR.
naTonOIVlR 3MOl\I1a;1 (6ecnoKoHcTBO,
crpax)
yrplOMOCTb, nQAaSl1eHHOCTb, OTCyr- naT0/101V151 3MOLjllla;1111 Ap.
CTBlile IIIHTepeca K OKpyJK31OUjeMY
Ha6l1IOAeHllle TpaKToBKa
HacTpoeHllle
COCTOPilile Mpa'iHoro H8,[\OBOl1bCTBa. HerarlilSHOe, He6l1aronplll!lHOe OTHo-
rHesnlllBOCTIII, 3n06bl. HeroAoSaHI151, WeHI1B K CSOeH clilryal\I1H, naronOIVl51
3MOl\IIIOHanbHoa;1 c<!>epbl (AI1C<PoPI151)
nOSblweHHoe PaAOCTHoe, "COl1HB'I- npl1nlllB CMn. Bblpa>KeHllle PaAOCTIII no
Hoe" HaCTpOeHl1e nOBOAY cBOea;1 Clilryal\I1I11, HO III naTO-
nomR 3MO-l\IIIOHanbHOH c<fJepbl (3a;1-
<!>OpIllR)
rpeBO>K AenpeCCI1BHOe HeysepeHHOCTb S csoeM n0/10>KeHI1I1,
OC06blH nln TeMnepaMeHTa (MenaH-
XOl1I11K), TpeBora, naTonorl1Sl 3MOl\IIIH,
nCl1x3a60nesaHIIIR (<!>0611111)
COCTOSlHllle nOl1Horo 6e3pa3l1111YIII5I K naTonolVl51 3MOl\IIIOHal1bH0a;1 c<fJepbl
npOI1CXOASlUjeMY, paSHOAYWIIIB (anaTIIIR)
IIIHepIVIYHOB HacrpoeHllle HopMa nOBBAeHI151
MeAceCTpa o eHIiBaeT KaK na HeHT CH HT, XOAHT, CTOHT
BO BpeMH 6eceAbI, <iaCTO JIH MeHJIeT nOJIO:IKeHlie TeJIa. TaKa.H
AeSITCJIbHOCTb 3aBHCHT OT 06II(ero CaMO'lYCTBHJI, nClIXH'IeC-
KHX H :JMO HOHaJIbHbIX COCTO.HHHM (aH<}JopHJI), nCHx3a60JIeBa-
'HI-lii, COM3TH'IeCKHX 3a60JIeBaHHM, naTOJIOrHH C03HaHHJI (Ae-
JIHlmii, raJIJIIO HHa HH).
gCJIH DO npeM.H pa3rOBopa na HeHT IIbITaeTCJI AOTPOHYTb-
CJI J O Bac, TO :JTO MQ)KeT HBJIJITbC.H HHAHBHAyaJIbHOH oc06eH-
HOCTbIO JIH'IHOCTH, HJIH Ha HOHaJIbHbIMH oc06eHHOCT.HMH (XO-
JIepm<), rraTOJIOrHeH OII(y eHIiM, IICHX3a60JIeBaHHeM, TaI<TH-
I<OH nMpU:lKeHHJI OTHOIIIeHHJI K c06eceAHHKY.
156
157
'.
IlacTo naIJ;HeHTbI aKTHBHO meCTHKYJIHPYIOT. "<ITO He COOT-
BeTcTByeT XOP;Y pa3rOBopa. a aKTHBHa.f! meCTHKYJI.f!IJ;HH B03-
HHKaeT B OTBeT Ha BHYTpeHHee Hanp.f!.1KeHHe. TaRoe COCTO.f!-
HHe MOJ!:(eT YKa3aTb Ha HepBHo-nC.HXH IeCKoe 3a60JIeBaHHe.
naTOJIOrHIO p;BHraTeJIbHO-BOJIeBOH c!}>epbl. 3MOIJ;HOHaJIbHOH
c!}>epbl (3H!}>OPH.f!. HCTepH.f!). ,n:BHraTeJIbHa.f! CIWBaHHOCTb MO-
meT .f!BHTbC.f! pe3YJIbTaTOM naTOJIOrHH onpHo-p;BHraTeJIbHOrO
annapaTa. naTOJIOrHH C03HaHH.f! (conop. OrJIYlIIeHHOCTb). na-
TOJIOrHH BOJIH (CTynop). naTOJIOrHH 3MOIJ;HOHaJIbHOH c!}>epbI
(p;enpeCCH.f!. TOCKa. YHbIHHe) MbllIIe IHoro CTonopa. COMaTH-
"<IeCKMX H nCHXH'IeCKHX 3a60JIeBaHHH.
:>KecTbI nJIaBHble. nOP; IepKHBalOm;He CMbICJI CKa3aHHoro
.f!BJI.f!IOTC.f! HOpMOH nOBep;eHM.f!.
K nCHXOMOTOpHOH c!}>epe naIJ;HeHTa OTHOCHTCS! H MaHepa
rOBopHTb.
MeP;ceCTpa p;OJImHa YMeTb pacn03HaTb MOHepy rOBopHTb H
p;aTb TpaKTOBKY pe m naIJ;HeHTa:
Ta6J1Hl\a 2
Ha6nlOAeH&.1e TpakTOBKa
MaHepa rOBopHTb
pe'lb: HH,IJ.&.1B\1AYanbHble cc06eHHCCT&.1, TeMnepaMeHT (xo-
6blCTpaA n.ep&.1K), naTOnornA 3MCLI&.1 (3 <!>CP&.1A)
MeATTeHHSA HH,IJ.&.1B&.1AyanbHble cc06eHHccT&.1, TeMnepaMeHT
(<J>nerMaT&.1K), naTcncrnA 3M0l\&.1 , nSToncrnA C03Ha-
H&.1A (crnyweHHCCTb, concp), CCMST&.1'IeCK&.1e &.1 nC&.1X&.1-
'1ecK&.1e3a60neBaH&.1A
3anHHalOIlISACA - naTOnarn51 C03HSH&.151 (crnyweHHcCTb), naTOncrnR
Mb'WneH&.1R, pe'l&.1 (S<!>S3&.1R)
3MOLl&.1CHSnbh<lA &.1H,IJ.&.1Bl1AyanbHble oc06eHHCCT&.1, TeMnepSMeHT, na-
TOncrnR 3M0Ll&.1 (3 <!>OP&.1R), HeBpOT&.1'!eCK&.1e &.1 nC&.1X-
3s60neBsH&.1A
MCHCTCHHSA naToncrnR pey&.1 101 MblWneH&.1R, nC&.1x3a60neBaHHA
rpOMKaA &.1H,IJ.&.1Bl1AyanbHble oc06eHHCCTH. TeMnepaMeHT, Ha-
pyweH&.1e cnyxa, naTcncrnR 3MCl\&.1 (3 <!>OP&.1A). HeB-
poT&.1'IeCKI1e 101 nC&.1x3a60neBsH&.1R
wenOTHSR nC&.1x3a60neBaH&.1A,sqpsH&.1A
HeBHRTHaR nSToncrnR MblWnBHHR, pe'lH. C03HaHOIA (6peA).
nC&.1x3a60neaseH&.1R
c6eAHeH&.1e cncBap- HeACCTaTCK &.1n&.1 nSTOncrnR &.1HTenneKTa &.1 MblWI1e-
Hcrc 3anscs H&.1R (AB6WlbHCCTb. &.1M6eLl&.1nbHoCTb), CrnpyeCKSR
AeMeHLI&.1R. naToncrnR pey&.1, &.1H,IJ.&.1Bl1AyanbHble cco-
6eHHccrn
158
Ha6nlOAeH&.1e TpakTOBKa
rOBCp&.1T C5pbIBKaM&.1, naTcncrnA C03HaH&.1A, MbIWneH&.1R, pe'l&.1. COMaT&.1'1e-
TA>Kenc CK&.1e 3a60neBaH&.1R (oAblwKa), HeBpOnCr&.1'1eCK&.1e &.1
nC&.1x3a6cneBaH&.1R
He OTBe'laeT Ha no- nC&.1X&.1'1eCK&.1e HapYWeH&.1A &.1 3a60neBaH&.1R. naTCnCr&.1R
CTaBneHHbie Bcnpo- BCCnp&.1RT&.1A &.1 C03HaH&.1R (rannIOLI&.1HaLl&.1H. cT)'ncp,
Cbl: (HeaAeKBaTHaR KOMa), CCMaT&.1'1eCKl1e 3a6cneBaH&.1R
peaKLI&.1R naLl&.1eHTa)
4. COIJ;HaJIbHO-nCHXOJIOrH'IeCKaH ccpepa OTpamaeT rpa)l(-
p;aHCKYIO n03HIJ;HIO naIJ;HeHTa. ero JIH'lHOCTHbIe H p;eSJTeJIbHble
oc06eHHOCTH. TO eCTb cnoc06HOCTH. HHTeJIJIeKT. CaMOOIJ;eHKY.
opHeHTaIJ;HIO. pa60Tocnoc06HOCTb OTHOlIIeHHe K 06Y IeHHIO H
p;pyroe. Pa3BHTHe JIH"<IHOCTH nOJIyqaeT CBoe Ha IaJIO B ceMbe.
CeMb.f! BJIH.f!eT Ha !}>OpMHpOBaHHe nCHXH IeCKOrO COCTO.f!HH.f!
naIJ;HeHTa. CeMb.f! B COBpeMeHHOH COIJ;HaJIbHOH cHTyaIJ;HH -
STO IJ;eHHOCTb. nOTep.f! KOTOPOH p;oporo 06XOP;HTbC.f! JIIOP;llM.
p;e!}>opMHpy.f! HX mH3Hb H cYP;b6y H MomeT npHBeCTH K T.f!me-
JIblM 60JIe3HeHHblM COCTO.f!HH.f!M.
Mep;ceCTpa. OIJ;eHHBall COIJ;HaJIbHO-nCHXOJIOrH IeCKYIO c!}>epy
nau;HeHTa. onpep;eJI.f!eT ero CaMOOIJ;eHKY. Pa3JIH IaIOT ap;eKBaT-
Hyro H Heap;eKBaTHYIO CaMOOIJ;eHKY.
Ta6J1Hl\a 3
I
i
Ha6nlOAeH&.1e T pakTOBKa
CaMoolleHKa
(aAeKBaTHaA.HeaACXBaTHaA)
nonHOe OTpl1L1aH&.1e CBoero 3a60ne- cneACTB&.1e nC&.1X&.1\ieCKI1X 3a60neBa-
BaH&.1R H&.1 , npl1 HOBOO6pa3CBaH&.1RX. T)'6ep-
Kyne3e
HenonHQe CC03HaH&.1e CBoe 6one3- MOJKeT 6blTb np&.1 nC&.1X&.1'1ecKl1x 3a60-
H&.1, c6palllaeTcA K MeApa6OTH&.1Ky C neBaH&.1RX, &.1HTOKCI1KaLl&.1RX, COMaT&.1-
npocb6c ncMO'Ib, HC CTp&.1L1aeT Ha- YeCKI1X3a60neBaH&.1RX,np&.1rl1nCKC&.1&.1
n&.1Y&.1e 60ne3H&.1 roncBHoro M03ra
Han&.1'1&.1e cnCC06HCCT&.1 K npaBHnbHo CWlbHble, YPCBHCBeweHHble, nC&.1X&.1-
CLleHKe C&.1ryaLl&.1&.1, YMeH&.1e nOHRTb '1eeKl1 3penble nlOA&.1, C6b1'1HC npa-
CBC&.1 B03MCIKHCCT&.1 &.1 Bbl6paTb npa- B&.1nbHO pearnpYIOT 11 a,QeKBaTHO
B&.1nbHOe peWeH&.1e CLleH&.1BaIOT3a60neBaH&.1e,cTpeMRTcR
Ha TI1 BblXOA &.13 C&.1ryaLl&.1&.1, c03AaH-
HO 6one3HbIO
np&.13HaH&.1e qpaKTa CBoe 60ne)H&.1, HC COM3TI1'!eCKI1e 3a60neBaH&.1R, HeBpo-
naLl&.1eHT C6B&.1HAeT B He Koro-n&.160 T&.1'1eCKl1e &.1 &.1ncxCHAP&.1yeCK&.1e CO-
CTOAHOIA
t
159
BMAbl y eHMR M cnoco6 o6y eHMR
Y IeHHe CKJI blBaeTC.f! H3 onpeJJ;eJIeHHblX JJ;ellCTBlIH, 3aBlI-
C.f!Ll(HX OT Toro, Kar<ylO !}>YHKIJ;HIO BblnOJIH.f!eT 06Y IaeMblll (na-
IJ;HeHT HJIH IJIeHbI ero ceMbH) B neJJ;arorH IeCKOH CHTyaIJ;HH:
. naCCHBHoro BOCnpH.HTH.f! I'! OCBOeHH.f! H3BHe HHqJOpMa-
IJ;HH;
. aKTHBHoro caMOCTO.f!TeJIbHorO nOHCKa H HcnOJIb30BaHH.f!
HH(POpMaIJ;HH;
.opraHH3yeMoro H3 BHe HanpaBJIeHHOrO nOHCKa H HC-
nOJIb30BaHH.f! HH!}>opMaIJ;HH.
B nepBOM cJIY'!ae B OCHOBe HayqeHH.f! JIe)f<HT npenoJJ;aBaIme
naIJ;HeHTy rOTOBOH HH!}>opMaIJ;HH, rOTOBblX 3HaHHH H YMelmH
Ha OCHOBe MeTOJJ;OB: C006ll1;eHHe, pa3'b.f!CHeHHe, nOKa3 H Tpe-
60BaIUle K onpeJJ;eJIeHHbIM JJ;eHCTBH.f!M naIJ;HeHTa.
Y"<IeHHe CKJI bIBaeTC.H H3 TaKHX JJ;eHCTBHH, KaK nOJJ;pama-
HHe, JJ;OCJIOBHOe HJIH CMblCJIOBOe BOCnpH.f!THe H nOBTopeHHe,
BocnpOH3BeJJ;eHHe, TpeHHpOBKa, ynpamHeHHe no CTaHJJ;apTaM
H npaBHJIaM.
Bo BTOpOM CJIyqae naU; IeHT (HJIH IJIeHbI ero ceMMI) pac-
CMaTpHBaIOTC.f! KaK cy6'beKT, !}>OpMHPYIOll1;HMC.f! nOJJ; B03JJ;efl-
CTBHeM C06CTBeHHbIX HHTepeCOB H u;eJIeH. STO BlIJJ; eCTeCTBeH-
Horo caMoHayqeIlH.f!, HanpaBJIeHHOrO Ha YJJ;OBJIeTBOpeHHe CBO-
HX nOTpe6HOCTeH H HHTepeCOB.
B TpeTbeM c.nyqac MeJJ;ceCTpa opraHH3yeT BHeIIIHHe HCTO I-
HHKH nOBeJJ;eHH.f! (Tpe60BaHiI.H ,0'KJIIJJ;aHH.f!, B03MomHOCTH) TaK,
"<ITO OHI'! !}>OpMHpYIOT He06xo,llHMbIe HHTepeCbI naU;HeHTa (HJIH
'1JIeHa ero ceMbH), a yn<e Ha OCHOBe STHX HHTepeCOB naIJ;HeHT
H ( IJIH) "<IJIeHbI ero ceMbH OCYll1;eCTBJI.f!IOT aKTHBHbIH OT60p H
HcnOJIb30BaHHe He06xoJJ;HMOH HII<lJopMaIJ;HH.
B OCHOBe HayqeHH.f! B TpeTbeM CJIY'!ae JIen<HT PYKOBOJJ;CTBO
npOIJ;eCCOM C nOMOll1;b1O CJIeJJ;yIOll1;HX MeTOJJ;OB: nOCTaHOBKa cec-
TpHHCKHX npo6JIeM, 06cymJJ;eHHe nOCTaBJIeHllblX IJ;eJIeH BMec-
Te C naI\HeHTOM H "<IJIeHaMH ero ceMbH, JJ;HCKYCCH.f!, COBMeCT-
Hoe nJIaHHpOBaHHe, JJ;eHCTBH.f! naIJ;HeHTa, OIJ;eHKa PC3YJIbTa-
TOB, 06CY)K)J;eHHe np06 H OIIIH60K.
ITOJJ; ceCT})HHCKHMH MeTOJJ;aMH (cnoco6aMH) o6yqeHHJI no-
HHMalOT nOCJIeJJ;OBaTeJIbHOe IepeJJ;OBaIme cnoc060B B3aHMOJJ;eH-
CTBHfl MeJJ;ceCTpbI H naIJ;HeHTa, HanpaBJIeHHOe Ha JJ;OCTHmeHHe
U;eJIeH ceCTpHHCKoro npOIJ;ecca nocpeJJ;CTBOM npopa6OTKH yqeb-
Horo MaTepHarra.
MeTOJJ; (no-rpe IeCKH - <lnyrb K Ie!il:ry JIH60») - cnoc06
JJ;OCTHmeHH.H u;eJIH, cnoc06 npHo6peTeHH.f! 3HaHH.f!. B" ceCT-
pHHCKOH neJJ;arorHKe HCnOJIb3YIOTC.H B OCHOBHOM MeTOJJ;bI Tpa-
JJ;HIJ;HOHHoro 06Y'leHH.H: 06'b.HCHHTeJIbHO-HJIJIIOCTpaTHBHblM H
penpOJJ;YKTHBHblH, OCHOBHa.H CYll1;HOCTb KOTOpbIX CBOJJ;HTC.H K
npou;eccy nepeJJ;a m rOTOBbIX H3BeCTHblX 3HaHHH naIJ;HeHTaM
HJIH IJIeHaM HX ceMeH C IJ;eJIblO 06Y'leHH.H. BbI60p MeTOJJ;OB
3aBHCHT OT CJIeJJ;YIOll1;HX YCJIOBHH: cOJJ;epmaHlI.f! 06yqeHH.f!, 3a-
JJ;a'l 06Y IeHH.f!, BpeMeHH, KOTOpblM pacnOJIaraeT MeJJ;ceCTpa H
nau;nCHT, oc06eHHOCT.HMH naIJ;HeHTa, HarrH m.H cpeJJ;CTB 06yqe-
IIH.f!. MeJJ;C'eCTpa BbI6HpaeT H3 06ll1;ero Ha60pa MeTOJJ;OB Te,
KOTopble HaH60JIec cnoc06CTBYlOT peIIIeHHIO KOHKpeTHOH 06y-
IalOll1;eH 3aJJ;a m Ha KOHKpeTHOM STane 06y<IeHH.:I.
Oc06eHHOCTblO ceCTpHHCKOM neJJ;arorHKH .f!BJI.f!eTC.H HHJJ;H-
BHJJ;yarrbHbIH nOJJ;xoJJ; pa3BHTH.f! YTpa IeHHbIX, B CB.f!3H C 60JIe3-
HblO, cnoc06HOCTeH naIJ;HeHTa 06CJIymHBaTb ce6.f!, eCJIH HeT
JJ;JI.f! SToro npOTHBonOKa3aHHH.
Ha !}>OpMHpOBaHHe YMeHHH H HaBblKOB, He06xOJJ;HMblX JJ;JI.f!
BOCCTaUOBJIeHH.f! 3JJ;OpoBb.f! naIJ;HeHTa H JJ;OJImHbI 6b1Tb HanpaB-
JIeHbI npaKTH IeCKHe JJ;eHCTBH.f! MeJJ;ceCTpbl.
nepBblM 3Tan npoqecca o6y eHMR
.----
Ou;eHKa nOTpe6110CTeH naU;HellTa
H (HJIH) ero ceMbH B o6yqellHH
QT06b1 mHTb B rapMOHHH C oKpymalOll1;eH cpeJJ;OH, IeJIOBe-
KY He06xoJJ;HMO nOCTO.f!HHO yJJ;OBJIeTBOp.f!Tb CBOH nOTpe6HOC-
TH. CYll1;eCTBYIOT HeCKOJIbKO TeopHM 0 nOTpe6HOCT.f!X, H3Y-
IaTb KOTopble MbI 6YJJ;eM B CJIeJJ;YIOLl(eH rJIaBe.
ITPH HapYIIIeHHH YJJ;OBJIeTBOpeHH.H XOT.f! 6b1 OJJ;HOH H3 no-
Tpe6HOCTeH Y naIJ;HeHTa pa3BHBaeTC.H 60JIe3HeHHoe COCTO.f!HHe.
MeJJ;CeCTpa 3HaeT, ITO HapYIIIHTb nOTpe6HOCTH IeJIOBeKa
Moryr !}>aKTopbl pHCKa. Mx 60JIee JJ;eC.f!TH. HeKOTopble H3 HHX
MorYT B03HHKaTb B onpeJJ;eJIeHHblX YCJIOBH.f!X mH3HH IeJIOBe-
Ka. rJIaBHOe, eCJIH lIeB03MomHO HX YCTpaHHTb, He06xOJJ;HMO
HaflTH cnoc06 a.z\anTaU;HH '1eJIOBeKa K mH3HH B HOBblX YCJIO-
BH.f!X, HayqHTb IeJIOBeI<a mHTb C !}>aKTopaMH pHCKa.
'60
6.3.. 291
'6'
Ha nOTpe6HOCTb na HeHTa H (HJIM) ero ceMbH B 06Y IeHHH,
KOTOpyro OH HCnblTbIBaeT B onpe.l\eJIeHHbIii: MOMeHT cBoeii: )lm3-
Hli MomHO aKTHBHO BJIH.HTb C eJIbIO YJIytUUeHH.H 3.l\OpOBb.H, H
3Ha'lHTeJIbHa.H pOJIb B aTOM npHHa,l\JIe:>imT Me.l\ceCTpe.
AJI.H SToro Me.l\ceCTpe He06xo.l\HMO:
1. O eHHTb 06pa3 :>KH3HH na HeHTa - cnoc06 Y.l\OBJIeTBOpe-
HH.H OCHOBHblX nOTpe6HOCTeH na HeHTa.
2. Onpe,l\eJIHTb nOTpe6HoCTb B 06yqeHHH CaMOYXO.ny, y.nyqille-
H1IIO COCTO.HHH.H 3.l\OpOBb.H, T .e. 'leM}' 06yqaTb nau.mmTa.
3. O eHHTb COU;HaJIbHOe H KYJIbTypHoe oKpymeHHe naU;HCHTa,
ero BJIHSIHHe Ha npo ecc 06yqeHH.H na HeHTa, T.e. peUIHTb
Bonpoc KTO H KaK 6Y.l\eT o6yqaTb naU;HeHTa.
4. O eHHTb oc06eHHocTH 06Y IaeMblx: nCHXH IeCKOe pa3BHTHe
(YMcTBeHHoe, COU;HaJIbHOe, BOJIeBoe), OTHOilleHHe K 06yqe-
HHIO H .l\PyrHe HH.l\HBH.l\YaJIbHO-nCHXOJIOrH IeCKHe oc06eH-
HOCTH naU;HeHTa: BHHMaHHe HHTepcc K 06Y'IeHHIO, OCMbIC-
JIeBaHHe, nOHHMaHHe, 3anOMHHaHHe H .l\p.
MOTHB - aTO TO, '1TO onpe.l\eJI.HeT, CTHMYJIHpyeT, n06Y:>K,l\aeT
-qeJIOBeKa K COBepilleHHIO KaKOrO-JIH60 .l\eHCTBH.H.
MOTHBbI K 06yqeHHIO naU;HeHTa MOryT 6bITb BHYTpeHHHMH
H BHeIIIHHMH. K BHeIIIHHM MOTHBaM OTHOC.HTC.H Tpe60BaHH.H,
O:>KH.l\aHHe BbI3.l\OpOBJIeHH.H, MarepHaJIbIia.H BbIrOfJ;a, HaKa3a-
HHe, Harpa.l\a H T..l\. K BHYTpeHHHM MOTHBaM OTHOC.HT TaKHe,
KOTOpbIe n06Y:>K.l\aIOT na HeHTa K Y'leHHIO, K HenOCpe.l\CTBeH-
HOH l eJIH ytleHHH, K nOTpe6HOCTH B aItTHBHOCTH 11 HOBoro
COCTO.HHH.H, K CTpeMJIeHHIO nOBbICHTb .l\OCTHrHyTblM paHee ypo-
Bellb 3HaHHH, YMeHH" H HaBbIKOB. nOTpe6HOCTb na HeHra B
IeM-JIH60 BbIpa:>KaeTC.H nocTynKaMH H nOBce.l\lIeBHblM nOBe.l\e-
HHeM.
Hau60JIee nOJIHblM HBJI.HeTC.H onpe.l\eJIeHHe MOTHBa COrJI3C-
HO JI.lI.BorJIoBH'I, B Ka-qeCTBe MOTHBOB MorYT BblC11'naTb
npe.l\MeTbI BHeIIIHero MHpa, npe.l\CTaBJIeHH.H, H.l\eH, IYBCTBa H
nepe:>KHBaHHH, CJIOBOM Bce TO , B 'leM HaillJIa BOnJIOll1;eHHe
nOTpe6HOCTb.
CYll1;eCTBYIOT 4 CTpYKTypIibIX KOMnOHeHTa MOTHBaU;HH:
1. Y.l\OBOJIbCTBHe OT CaMO" .l\e.HTeJIbHOCTH;
2. 3Ha-qHMocTH .l\JI.H JIH'IHOCT1I HenOCpe.l\CTBeHHoro ee pe-
3YJIbTaTa;
3. «MoTHBHpYIOll1;a.H» CHJIa B03Harpa:>K,l\eHH.H 3a .l\e.HTeJIb-
1I0CTb;
4. nplI11Y)i(.l\aIOll1;Ce .l\aBJIeHHe Ha JIH IHOCTb.
OU;CHKa HCXOroIoro ypOBHJI 3HalmH
H YMeHH" naU;HeHTa
Pe3YJIbTaTOM npou;ecca 06yqeHH.H .HBJI.HIOTC.H YMeHH.H.
YMeHHe - aTO cnoc06HOCTb OCYll1;eCTBJIjiTb 11' HJIH HHYIO
.l\e.HTCJIbHOCTb Ha OCHOBe HMeIOll1;L!XC.H 3HaHH" B H3MeH.HIOll1;L!XC.H
YCJIOBH.HX. 3HaHH.H CJIY:>KaT KaK 6b1 HHCTpYMeHTOM npH OCBO-
eHHH YMeHHH. Ho 6e3 31IaHH" YMeHH" He 6bIBaeT.
Ka:>K.l\b1H 06yqaIOll1;L!HC.H 06JI8,l\aeT HH.l\HBH.l\YaJIbHblMH JIH I-
HOCTHbIMH H .l\e.HTeJIbHbIMH oc06eHHOCT.HMH, OTHOIIIeHHeM K
06yqeHHIO, 06YQaeMOCTbIO.
Kam.l\b1f, B03paCT HJIH nepHO.l\ xapaKTepH3yeTC.H onpe.l\e-
JIeIiHbIMH nOKa3aTeJI.HMH, no KOTOpbIM MomHO onpe.l\eJIHTb
HCXO.l\HblH ypOBeHb 3HaHH", YMeHHH naU;HeHTa. O.l\HaKO pe-
3YJIbTaTbI Cneu;mi.JIbHbIX HCCJIe.l\OBaHHH nOKa3bIB8IOT, -qTO 60JIb-
IIIHHCTBO JIIO.l\eH He YMeIOT CJIYIIIaTb, Y Tex KTO CTpeMHTbC.H
Y'lHTbC.H. ytIe6a He BCer.l\a H.l\eT XOpOIIIO.
MOTHBa JI.H - nepBbI" IWMnOHeHT npo ecca o6yqeHHJI
MOTHBaU;H.H - «3aKOH rOTOBHOCTH» 3.TopH.l\aHKa, nepBbIH
06.H38TeJIbHblH aTan <POpMlIpOBaHH.H YMCTBeHHbIX .l\eHCTBHH.
Ou;eHKa cnoc06nOCTeil: na HeHTa
H (HJIn) '1JIeHOB ero ceMbH K o6yqellHIO
Cnoc06HOCTH -qeJIOBeKa TeCHO CB.H3aHbI C ero HH.l\HBH.l\Y-
aJIbHo-nCHXH IeCKHMH oco6eHHOCT.HMH. Cnoc06HOCTH qeJIO-
BeKa MOryT 6bITb pa3JIH IHbI H OTpa:>KaIOT CTeneHb n03HaBa-
TeJIbHOH aKTHBHOCTH, KOTOpa.H 3aBHCHT OT B03paCTa, CO-
CTOHHH.H 3.l\OpOBb.H, JIH IHOCTH B u;eJIOM, ee XapaItTepa, .l\PY-
rHX CBOHCTB.
Me.l\cecTpa 0u;eHHB8eT COCTO.HHHe OT.l\eJIbHblX nCHXH IeCKHX
(I)YIII(U;H i (n8M.HTb, MblIIIJIeHHe, BHHMaHHe, pe Ib H .l\p.) H U;e-
JIOCTHble XapaI(TepHCTHKH BH.l\OB ,l\e.HTeJIbHOCTH (TPY.l\OBOH,
ytIe6HOH), 06ytleHHOCTH H BocnHTaHHOCTH nau;HeHTOB H (HJIH)
IJIeHOB HX ceMeH, H3Y IaeT HX peaJIbHbIe B03MO:>KHOCTH, JIH I-
16Z
6.
163
HOCTHble Ka IeCTBa, BbI.f!BJIHeT He TOJIbKO Ha IaJIbHbIH ypOBeHb
cnoc06HOCTeH, HO 11: npep;nOJIaraeT cTyneHH pOCTa, pa3BHTH.f!
YlIIeHHH naQHeHTa. MeP;ceCTpa npep;BH HT B03MO:»<HbIe H Y'IH-
TblB8eT THnH IHble 3aTpYP;HeHI1.f! 06Y'laeMblX, HCXOP;HT H3 MO-
THBaQHH caMHX 06y'taeMblX npH nJIaHHpOBaHHH H opraHH3a-
wm 06Y IeHH.f! no HHp;HBH,AyaJIbHblM nJIaHaM, 06ecne IIiBaeT
YCJIOBH.f! P;JI.f! caMoperyJI.f!UHH JIH IHOCTH 06y'taeMblX.
CO,Aep:»<aHHe 06yqeHH.f! OTpa:»<aeTC.f! B HHP;HBHP;YaJIbHOM
nJIaHe 06yqeHH.H. OCHOBHbIM HanpaBJIeHHeM B cop;ep:»<auHH
06Y IeHH.f! n8QHeHToB P;JI.H Mep;ceCTpbI .f!BJI.f!eTC.H coxpaHeHHe
3P;OpoBb.H, nop;p;ep:»<aIIHe onpep;eJIeHHOrO ypOBH.H 3P;OpOBb.H HJIH
onpep;eJIeHHOrO YPOBH.f! Ka IeCTBa :»<H3HH. }
ill-V :nan - nOCTaHOBKa qe.neH 06YLleHHR,
nnaHHpOBaHHe 06YLleHHR, oqeHKa ero KaLleCTBa
It 3$cI>eKTHBHOCTb 06YLleHHR
OQeHIIB nOTpe6HOCTH naQHeHTa, ero ceMbH B 06yqeHHH,
BblnOJIHHB MHO'KeCTBO Tpe60BaHHH, onpep;eJI.HeMbIX nCHXOJIO-
ro- nep;arorH IecKHMH HaYKaMH, BbI.f!BHB np06JIeMbI nB.IJ:HeH-
Ta, CBSI3UHHbIe C p;e!}mQHTOM 3H8IIHH, Mep;HQHHCK8.H cecTp8
tlJoPMYJIHpyeT QeJIH 06Y'IeHH.H. qJYHKQHH nOCTaBJIeHHbIX Qe-
JIeH MHoro06pa3HbI. B ceCTpHHcKOM p;eJIe OP;HOH H3 rJIaBHbIX
.HBJI.f!IOTC.H MOTHBaQHoHH8.H H BocnHTaTeJIbH8.H !}>YHKQHH. OHH
onpep;eJI.HIOT HanpanJIeHHOCTb p;eHcTBHH Mep;HQHHCKOH ceCT-
pbI, YKa3b1BaIOT nO'lel\ty H P;JI.f! 'lero naQHeHTY HY:»<HO BbInOJI-
HHTb KOHKpeTHoe p;eHCTBHe. I eJIH P;OJI:»<HbI 6bITb KOHKpeTHbI-
MH, npOCTO H P;OXOP;'lHBO C$OPMYJIHpOBalIbI H peaJIH30BaHbI B
!}>opMe BHp;OB p;e.f!TeJIbHOCTH. qJOPMYJIHpOBaHHe QeJIeH 06yqe-
HH.H P;OJI:»<HbI OTBe IaTb 06lQHM Tpe60BaHHSIM, npep;'b.HBJI.f!e-
MbIM K !}JOPMYJIHpOBaHHIO QeJIeH B ceCTpHHCKOM npoQecce.
MCP;HQHHCK8.f! ceCTpa nJIaHHpyeT 06yqeHHe, HCnOJIHeHHe
(peaJIH3aQHIO), KOHTpOJIb H OQeHKY npoQecca 06yqeHH.f!, ero
Ka IeCTBO H s!}xJ?eKTHBHOCTb. IlnaHHpOBaHHe 06yq:eHH.f! 06cy:»<-
p;aeTC.H COBMeCTHO C nB.IJ:HeHTOM, C yq:eTOM ero HHP;HBHP;YaJIb-
HOCTH, BbI60pa BpeMeHH 06yqeHH.H.
Mep;ceCTpa yqHTblBaeT 06cTaHOBKY P;JI.H 06Y'leHlI.H: THIIIH-
HY, OCBeIQeHHe, BeHTHJI.HQHIO, C03p;aBa.H 6JIarOnpH.HTHYIO TeM-
nepaTYPY B03P;yxa, C03p;aeT yq:e6Hble cHTyaQHH, CTaBHT 3ap;a-
'1H .f!CHbIe H 0P;H03H8 IHbIe, KOTopble XapaKTepH3YIOTC.f! TeM,
'1TO nB.IJ:HeHT HJIli 06yqaeMblH nOJIY'IaCT 38 aHHe Ha YCBoeHHe
C Y IeTOM TeMn8 06y'IeHH.f!. PeIIIeHHe yq:e6HOH 3ap;a m 06ecne-
mBaeTC.H MeP;ceCTpOH nocpep;CTBOM yqe6HbIx p;eHCTBHH, KOTO-
pbIC npHHHMaIOTC.H 06yqaeMblM. Me,ACeCTpa OCYlQeCTBJI.HeT
nOCTO.f!lllIbIH KOHTpOJIb p;e.HTeJIbHOCTH 06yqaeMbIx, nepeXOp;.H-
IQHH B caMOKOHpOJIb H OQeHKY (caMOOQeHKY). AKTHBHoe yqa-
CTHe naQHeHTa B npoQecce 06Y IeHH.f! nOOIQP.HeTC.H Mep;ceCT-
II 3Tan - HHTepnpeTaqHR npo6neM naqHeHTa,
CBR3aHHbiX C Aecl>HqHToM 3HaHHM.
OnpeAeneHHe COAep>KaHHR 06YLleHHR
llocJIe npOBep;eHHOH OQeHKH Mep;ceCTpa p;OJI:»<Ha CI}JOpMY-
JIHpOBaTb np06JIeMbI naQHeHTa, CB.H3aHHbIe C p;eqmQHTOM 3Ha-
HHM, YMeHHH H peIIIHTb, KTO H3 npo!}>eCCHOHaJIbHbIX pa60T-
HHKOB MO:»<CT nOMO Ib naQHeHTY. llp06JIeMbI, KOTopble Mcp;ce-
CTpa Mo:»<eT CaMOCTO.f!TeJIbHO pa3peIIIHTb, Ha3bIBaIOTC.H ceCT-
PHHCItUMH p;HarH03aMH. CeCTpe He06xop;HMO HX IeTKO C(pop-
MYJIHpOBaTb H YCTaHOBHTb HX npHOpI1TCTHOCTb H 3Ha IHMOCTb
P;JI.H naQJIeHTa.
I1H!}>opMaQH.H 0 naQHeHTe HHTepnpeTHpyeTC.H Mep;ceCTpOH
H OTpa:»<aeTC.H B ceCTpHHCKOM HCTOpHH C TO IKH 3peHlISI no-
Tpe6HOCTefi naQHeHT8 B 06yq:eHHH.
Onpc.n:eJICIIHe co.n:cp"taJIIUl 06yqellJui
Me]\HQHHCKa.H ceCTpa, onpep;eJI.HeT cop;ep:»<aHHe 06yqeHH.f!,
T.e. «'leMY Y'UITb». ,D:JI.f! SToro olla p;OJI:mHa pa36HpaTbC.H B
HOBbIX TeXHOJIOrH.HX 06Y IeHH.f!, YMeTb BbIp;eJI.HTb KJIIO IeBbIe
Hp;eH npoQecca 06yq:eHH.f!, HCnOJIb30BaTb nOH.f!TH.H, TepMHHbI,
p;ocTynHbIe naQHeHTY H (HJIH) IJIeHaM cro ceMbH.
llOCJIep;OBaTeJIbHOCTb, cHCTeMaTH IHOCTb, rJIy6uHa co06ru;a-
eMblX 3HaHHH H YMeHHM onpep;eJI.HeTC.H B03paCTHblMH B03MO:»<-
HOCT.f!MH, COCTO.HHHeM 3P;OpOBb.H, CTeneHblO n03HaBaTeJIbHOH
8KTHBHOCTH JIH'lHOCTH naUHeHTa.
B npoQecce 06Y'leHH.f! Y naQHeHTOB !}>OPMHPYIOTC.H Yl\iCHH.H
11: lIaBblKH 06paIQeHH.H C HeKOTopbIMH npep;MCTaMH YXO,Aa, OKa-
3aHH.f! HeOTJIO:»<HOH ,AoBpa'le6HOM nOMOIQH, BJIap;eHHe H8BbI-
KaMH caMoyxop;a H T.p;. llaQHeHTbI aItTHBHO BOBJIeKaIOTC.H B
pa3Ho06pa3HYlO npaKTH'leCKYIO p;e.HTeJIbHOCTb, ITO aItTHBHO
!}>opMHPyeT Y HHX HHTepeCbI, CKJIOHHOCTH, nOTpe6HoCTH.
164
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HOCTH.
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YCBoeHHIO onpe)\eJIeHHbIX 3ap;aHHM. Me)\HIJ;HHcKa.f! cecTpa npH
STOM )\OJI»CHa HMeTb He06xo)\HMble KOMMYHHKaTHBHble HaBbI-
KH, 06JIap;aTb ne)\arOrH IeCKHM TaKTOM, 3HaTb TeOpeTH IecKHe
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Pa3gell V
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. liOIlbHH'IHAR CPEJJA
KOHTponbHble Bonpocbl AnR caMonoAroToBKM:
5.1. HHt/JelfquoHHblU IfOHmpOlib.
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HepBHoe HCTOII1;eHHe.
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pHaJIOB B03 no ceCTpIiHCKOMY )\eJIY - npoeKTe «LEMON» H
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STOM 80% CJIy IaeB - CaJIbMOHeJIJIe3.
1. 4TO 04eHHBaeT MeAcecTpa, opraHH3YSl np04ecc 06Y4eHHSI na4HeH-
Ta?
2. Kal(He cnoc06bl 06Y4eHHSI Hcnollb3yeT MeAcecTpa?
3. KaK 04eHHTb nOTpe6HocTb na4HeHTCI 101 ero ceMbH B 06Y4eHHH?
4. KaK Bbl nOHHMaeTe TepMHH «MOTHBa4I1R» 06Y4eHHSI?
5. B 4eM COCTOHT COAep>KaHHe ceCTpHHCKoro 06Y4eHHSI?
6. nepe4HCJ1HTe neAarorH4eCKHe npHeMbl, KOTOpblMH MO>KeT nOllb30-
BaTbCSI MeAH4HHCKa51 ceCTpa B np04ecce 06Y4eHHSI.
7. KTO npoBoAHT 04eHKY 3cpcpeKTHBHoCTH 06}14eHHSI na4HeHTa 10111101
ere ceMbH?
8 Ha KaKOM 3Tane npoBOAHTCSI 04eHKa 3cpcpeKTHBHoCTH 06}14eHHSI?
167
RnlulHHe Ha B03HHKHOBeHHe BEM OKa3b1BaIOT CJIe IOLl(He
c}>aKTOpbl:
.. CHH:»\eHHe COnpOTHBJI.f!eMOCTH opraHH3Ma;
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MHKpoopraHH3MOB;
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JIa6JIeHHI>IX;
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yxo)\e 3a nan;HeHTaMH;
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TKaHeH opraHH3Ma) MaHHnYJI.f!JJ;HH;
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STanOB O'lHCTKH, B TOM mCJIe npe)\CTepHJIH3aJJ;HOHHOH.
nOHHTHe «HHcl>eKJJ;HOIIHLIH npon;eCC» onpe)\eJIHeT B3aHMQ-
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HHKHOBeHHIO HH<peKJJ;HOHHOH 60JIe3HH B pa3JIH IHblX <popMax:
OCTPOH, XpOHH"'IeCKOH, JIaTeHTHOH, a TaK»Ce HOCHTeJIbCTBO.
rJIaBHI>IM YCJIOBHeM B03HHKHOBeHH.f! HH(l>eKJJ;HOHHoro npo-
n;ecca HBJIHeTCH HaJIH me B036Y)\HTCJIH 60JIe3HH.
8036YAMTenM 86M
OCHOBHbIMH BH)\aMH MIllipOOpl'aHI13MOB, BbI3l>lBaIOLl(MX BEM,
HBJUlIOTCH: 06JIHraTHble naToreHHbie MHKpOOpraHH3MbI, Bbl3b1-
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<pHJIOKOKKH, 30JIOTHCTblH cTacPHJIOKOKK, CTpenTOKOKKH, CH-
HerHOHHa.f! naJIO IKa, nCeB)\OMOHa)\I>I, rpaMOTpHn;aTeJII>HbIe
168
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Horo 3apameHH.f! rpH6KoBOH HH<peKJJ;HeH, BMq-lIH<peKJJ;HeH,
JJ;HToMeraJIOBHpYCOM, npe)\CTaBHTeJIHMH npOCTeHIIIHX.
B036Y)\HTeJIH HH<PeKJJ;HH HaXO)\HTCH B pe3epByapax (HCTO'l-
HHKax) JoIUtPeKJJ;HH.
Pe3epDyapoM(HCTO'lHHKOM)BI PH60JII>HH'lHOH(rocnHTaJIl>-
HOM) HH(lJeKJJ;HH HBJI.f!IOTCH:
.. PYKH nepCOHaJIa;
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BOJIOCbI, nOJIOCTI> pTa KaK naJJ;HeHTa, TaK H nepCOHaJIa;
.. OltPymalOI.JJ;aH cpe)\a: nepCOHaJI, nbml>, BO)\a, npO KTbI
nHTaHHH;
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TMnMLlHble MeCTa o6MTaHHR 86M
B Me)\HJJ;HHCKHX Y'lpe:>K,!l;eHHHX HMH .f!BJIHIOTCSI H3)\eJIHH H3
pe3HHI>I (KaTeTepbl, )\peHamHbIe TPy6KII), npH60pbI, B KOTO-
pl>IX HCnOJII>3yeTC.f! BO)\a H aHTHCenTHKH ()\HCTHJIJIHTOpbI. HH-
raJIHTOpbI, HOHH3aTOpl>I H liP.), annapaTbI )\JI.f! HCKYCCTBeH-
1101'0 )\bIXaUHH, HJICTPYMeHTapHH.
B Opl'UIIH3Me IeJIOBeKa npeHMYIJJ;eCTBeHHI>IMH MeCTaMH 06H-
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nYTH, nOJIOCTH - pTa, HOCorJIOTKH, BJIaraJIHI.JJ;a, KHIIIe'lHHKa.
qepe3 PYKH nepCOHaJIa nepe)\aIOTcH: 30JIOTHCTblH CTa<pH-
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CI1JIbMOHeJIJIa, cHHerHoMHaH naJIO IKa, aHasp06HbIe 6aKTepHH,
rpnu pOlla Kall)\ll)\a, npocToH repnec, BHPYC nOJIHOMHeJIHTa,
BIIPYC renaTHTa A.
3a6oneBaHMR, OTHOCRtqMeCR K 86M
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lOIJJ;lle:
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169
.. Y naI\l1eHTOB, no.nyqanlill:lx nOMO mm 06paTHBIIllIXCSI
3a HeM B ]lpyrne JIe Ie6Ho-IIP<><l>HJI8l<TWlecIille }"Ipem)\ellli.f!
(JIIIY);
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3aHI111 nOMOll1;11 naD;l1eHTaM B CTaD;HOHape, nOJII1KJIHHII-
Ke, B YCJIOBI1.f!X CKOpOH (HeOTJIOmHOH) nOMOll1;11 11 .v;py-
rl1x JIITY.
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KpacHyxa, napOTI1T 11 .v;p.), KI111Ie'IHble I1H<peKD;1111 ( CaJIbMO-
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611pCKa.f! .f!3Ba, "<IYMR, 6plOlliHOH TI1<p 11 .v;p.), Bl1pYCHble I1H-
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MexaHM3Mbi nepe,qaLlM 85"
Pa3JII1 IaIOT aSp030JIbHblH (B03.v;YIlIHO-KaIIeJIbHblM), KOIITaK-
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npOCTpaHCHl111 BEll 11 B03HI1KalOll1;l1e npl1 KOHTaKTe C KpOBblO
11 .v;PYI'MMI1 6110JIOrl1'IeCI{I1MH ml1.v;KOCT.f!MI1.
cI»aKTopDl, BJIH.f!IOID;He Ha BOcnpI1HM"<II1BOCTL
X03HHHa K HHcl>eKD;I1H
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arHOCTI1'IeCKI1X npoD;e.v;yp, XpOHI1 IeCKl1e 3a60JIeBaHI1.f! opra-
HI13Ma, CKOnJIeHl1e B036y.v;I1TeJIeM BEll 113-3a HapYllIeHI1H ca-
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11 aHTI1CenTI1KI1, HapYllIeHl1e npanl1JI .v;e311H<peKD;lul 11 CTepl1-
JII13aUl111 Me.v;I1D;I1HCKOrO I1HCTpYMeHTapl1.f! 11 npl160poB.
Mepbl KOHTponR M 6e30nacHocTM
B npocl>MnaKTMKe 85"
06CJIymI1BalOll1;I1M nepCOHaJI CTaD;110HapOB .v;OJImeH HMeTb
KOMnJIeKT CMeHHOH pa60'leH o.v;em)\bI: XaJIaTbI, TanO IKI1, CMeH'
170
HYIO 06YBb B KOJIWlecTBe, 06ecne"<lI1BaIOIII;eM e.me.v;HeBHYIO CMe-
HY CaHI1TapHOH O]\em.v;bI. XpaHeHl1e ee Ha.v;JIe:>KHT OCYll1;eCTB-
JISITb B I1H.v;I1BI1.v;YaJIbHblX uIKa<p mKax. B HaJIl1"<1l1l1 .v;OJI:>KeH
6b1Tb KOMnJIeKT CaHl1TapHOH o.v;e:>KjI;bI .v;JISI sKcTpeHHoH ee 3a-
MeHbI B CJIY'lac 3arp.f!3HeHI1SI.
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6e3YKopl13HeHHo onpSITHa 11 aKKypaTHa. KpaSI pa60 IeH (ca-
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JIe Ie6Horo yqpem]\eHI1SI 3anpeLl(aeTC.f!.
Ory.v;eHTbI, 3aHI1MalOll1;l1eCSI B OT.v;eJIeHI1SIX po.v;OBcnOMO:>Ke-
HI1SI, I1HcPeKD;110HHblX OT.v;eJIeHI1SIX, onepaD;110HHbIX 6JIOKaX,
.v;OJI:>KHbI 6bITb 06eCne"<leHbI CMeHHOH cneD;o.v;e>K,!l;OH.
Bpa"<ll1, Me.v;cecTpbl, aKYllIepKI1 .v;OJIJKHbI 06.f!3aTeJIbHO MbITb
PYKI1 nyreM .v;BYKpaTHoro HaMbIJII1BaHH.!I nepe.v; OCMOTpoM Ka:>K-
]loro naUl1eHTa I1JII1 BbITIOJIHeHl1eM npoue.v;yp, a TaK:>Ke nOCJIe
BbITIOJIHeHK.f! «rpSI3HblX» npOD;e.v;yp (y60pKI1 nOMeLl(eHI1H, CMe-
HbI 6CJIbSI, nOCeIII;eHI1SI T}'aJIeTa 11 T..v;.)
npaBMna nonb30BaHMR 3al1\MTHOH o,qe>K,qOH
XaJI3TLI, (flapTYKH - I1CnOJIb3YlOTCSI .v;JISI yxo.v;a, npe.v;yn-
pem]\alOll1;ero nepe.v;a IY I1HqJeKD;I1I1, 11 no.v;JIe:>KaT CMeHe nOCJIe
Ka"t]\OH TaKOH npOD;e]\ypbl, KaK CMeHa nOCTeJIbHOrO I1JII1 Ha-
TeJIbiioro 6eJIbSI naD;l1eHTa.
nep'laTKH - I1CnOJIb3YIOTC.f! mCTble I1JII1 CTepl1JIbHble. llx
Ha)\eBaIOT:
· npl1 KOHTaKTe C JII060H 6110JIOrH'lecKoH JKI1.v;KOCTblO (Kpo-
BblO. ceMeHHOH 11.v;KOCTblO HJII1 BJIaraJIl1ll1;HblM ceKpe-
TOM, OT.v;eJI.f!eMbIM CJII1311CTbIX Hoca 11 .v;p., CJIIOHOH, CJIe3-
HOH :>K11.v;KOCTblO, a TaKme MO IOH, <peKaJIl1.f!MI1, CnI1HO-
M03rOBOH )im]\KOCTbJO. sKccy.v;aTOM, TpaHccy.v;aTOM;
· npl1 HapYllIeHl111 ueJIOCTHOCTI1 KO:>K11 KaK naD;l1eHTa,
TaK 11 Me.v;I1D;I1HCKorO pa60THI1Ka;
· npl1 He06xo.v;I1MOCTI1 pa60TaTb C MaTepMaJIaMI1 11 npe]\-
MeTaMI1 Me.v;I1D;I1HCKOrO Ha3Ha IeHI1.f!, 3arp.f!3HeHHbIMH
KpOBblO I1JII1 .v;pyrm'l:H 6110JIOrl1 t IeCKI1MI1 :>K11.v;KOCT.f!MI1.
j 11
MacKH - 06eCne nlBalOT MHHHMaJIbHYIO 3all1;HTY OT MHKpO-
OpraHH3MOB (OKOJIO 10%), nepe.n;alOll1;HXC.H B03AyuIHO-KaI1eJIb-
HblM nYTeM. MCnOJIb3yroTC.H '1eTblpeXCJIOMHble MapJIeBble Mac-
KH, MaCKH H3 MarepHaJIa, 06ecne IHBaIOLl(erO XOPOIlIYIO !}>HJIb-
TpaIJ;lIIO MHKpoopraHH3MOB (H3 HeTKaHHoro MaTepHaJIa), HO
HX 3all1;HTHble CBoHcTBa Tep.f!IOTC.H npH HenJIOTHOM npHJIera-
HHH MaCKH K JIHIJ;Y.
MacKY Bce paBHO HY'KHO Hap;eBaTb, HO HOCHTb ee Henpc-
pblBHO MomHO He 60JIee ABYX IaCOB. IIpH YBJIamHeHHH OT
BblAblxaeMoro B03Ayxa ee CJIeAyeT CMeHHTb paHbllie.
06YJu, H Me,n:HU;HHCKHe llIanO'lKH - He 3all1;Hll1;aIOT OT HH-
<l>eKIJ;IIH.
3all\WJ'Hble O'IKH IIll\HTKH - 3aIIJ;Hll1;aIOT rJIa3a, pOT, HOC OT
nonap;aHH.H B HHX KpOBII II .n:pyrHX 6HOJIOl'H'lecKHX mHAKOCTeH.
U nonb3YRCb 3al.qHTHOM OAe)1(AOM, npaBHnbHO CHHMaMTe
ee, IfTo6bJ He 3arpR3HHTb CBOH PYKH, 0Ae)1(AY H OKPY-
)1(alOl.qHe npeAMeTbI!
YpOBHM o6pa6oTKM PYK MeAMqHHcKoro pa60THMKa
BbIACJI.H1OT mpu yp061l.R o6pa6orn1cu PYle: COU;HaJIbHbIH, rH-
I'HCHlI'IeCKlIH (.I\e3HmpeKu;H.f! KHcTell PYK), xHPypmqeCKHH (.1\0-
CTHraeTC.H CTepHJIbHOCTb KIIcTeH PYK Ha onpeAeJIeHHOe BpeM.H).
Cou;mUlbHLlll ypoBeHb 06pa60TKH PYK
QeJIb: Y aJIHTb MHI<po(I)JIOpy C nOBepxHocTH PYK MexaHH-
'1eCKHM MeToAoM. 06eCne"<lllTb HH!}>eKIJ;HOHHYIO 6e30nacHocTb
naIJ;HeHTa H nepCOHaJIa.
IIoKa3aHH.H: COIJ;HaJIbHa.H 06pa60TKa PYK .f!BJI.f!eTC.H npo-
CTblM cnoco60M MLITb.H PYK H npoBOAHTC.f!: nepeA H nOCJIe
BbInOJIHeHH.H JIe le6Hblx npou;eAYP B nep IaTKaX H 6e3 HHX;
nepeA H nOCJIe npHeMa nllll1;lI, KOpMJIeHH.H naIJ;HeHTa; nOCJIe
nOCell1;eHH.f! TyaJIeTa; nepeA H nOCJIe yxoAa 3a naIJ;HeHTOl'iI,
eCJIH PYKH He 3aI'p.H3HeHbI 6HOJIOrH recKHMH mIIAKOCT.f!MH nau;H-
eHTa. B npOTHBHOM CJIY'Iae PYKH 06pa6aTblBalOTC.f! Ha rHrHe-
IIH IeCKOM YPOBHe (CM. HHme).
OCHall\eHHe: MbIJIO X03.HHCTBeHHoe (mHAKoe) AJI.H OAHopa-
30Boro npHMeHeHH.H, IaCbI C ceKYHAHoii CTpeJIKOH, TenJIa.f!
upOTO IHa.H BOAa, CTepHJIbHble CaJI!}>eTKH Ha 1I0TKe, HHAHBH-
-17Z
AyaJIbHOe nOJIOTeHue (SJIeKTpOCYIlIHJIKa).
06J13aTeJIbHOe YCJIOBHe: 3AOpOBa.f! Koma PYK, HorTH He
60JIee 1 MM, 6e3 nOKpbITH.f! JIaKOM. IIepeA npou;eAYPoH Bbl m-
CTHTb nOA HOrT.HMH, BblMblTb nOA npoTO IHOM BOAOH.
nOAI'OTOBI a K npou;e.n:ype
1. CH.HTb KOJIbu;a C naJIbD.eB, npOBepHTb IJ;eJIOCTHOCTb KomH
PYK.
2. 3aBepHyrb PYKaBa XaJIaTa AO JIOKT.H, CH.HTb IaCbI.
3. OrKpblTb KpaH, OTperyJIHpoBaTb TeMnepaTYPY BOAbl (35-
40°C).
BblnOJIHeHHe npou;e.n:ypbl
1. HaMbIJIHTb PYKH H 06MblTb BOAonpoBoAHbIM KpaH C
MblJIOM (JIOKTCBOH KpaH He 06MblBaeTC.H, eCJIU HCnOJIb3yeTC.f!
KYCOK MbIJIa, 06MblTb ero, nOJIOmHTb Ha IMCTYIO CaJI!}>eTKY
HJIH B pellIeT IaTYIO MblJIbHHIJ;Y).
2. BblMblTb PYKH C MblJIOM npoTo IHOii BOAOH AO 2/3 npeA-
nJIe'lb.f! B Te IeHHe 30 ceKYHA, YAeJI.f!.H BHHMaHlIe !}>aJIaHraM H
MemnaJIbueBbIM npocTpaHcTBaM KHcTeM PYK, 3aTeM BblMbITb
TblJI H JIa,n:OHb KamAoH KHCTH H BpaLl(areJIbHblMH ABHmeHH.H-
MH OCHOBaHH.H 60JIbililiX naJIbIJ;eB PYK.
npHMe'laHHe: :noro BpeMeHH AOCTaT04HO AI1R AeKOHTOMHHaUHH
PYK Ha cOl\Hal1bHOM ypoBHe, eCI1H nOBepXHOCTb KO>KH PYK HaMblI1H-
BaeTCR TU\aTel1bHO H He OCTaBI1RIOTCR rpR3Hbie Y4aCTKH KO>KH PYK.
3. OnOJIOcHyrb PYKH nOA npoTo IHOH BOAOH AJI.H YAaJIeHH.H
MbIJIbHOM neHbl.
npHMe'laHHe: Aep>KHTe PYKH nal1bl\aMH BBepx TaK, 4T06bl BCAa
CTeKal1a B paKOBHHY C I1CKTeH (He npHKacaiheCb K paKOBHHe). HaH-
6ol1ee '1HCTbIMH AOI1>KHbl OCTaBaTbCR <!>al1aHrH nanbl\eB PYK.
4. IIOBTOPUTb MblTbe PYK B TaKoH me nOCJIeAOBaTeJIbHOCTH.
OltOllqalme npou;e.n:ypbl
1. 3aKpblTb KpaH, nOJIb3yncb CaJI!}>eTKoii (JIOKTeBOH KpaH
3aKpblTb ABHmeHlIeM JIOKT.f!).
2. IIpOCyllIHTb PYKH CYXHM HlCTbIM HHAHBHAyaJIbHbIM no-
JIOTeHIJ;eM HJIH CYIlIHJIKOH.
rHI'JlCHH'ICClmii ypoBeJib 06pa60TKH PYK
BOJIee s!}>!}>eKTlIBllbIM .HBJI.HeTC.H rllrHeHHqeCKHH cnoc06 06-
pa60TKH PYK.
173
IJ;eJIb: o6eCne IeHHe ,l\eKOHTaMHHa mi PYK Ha I'HrHeHH IeC-
KOM YPOBHC.
llOlUI32,HJUI:
- nepC,l\ H:t,l\eBaHHeM H nOCJIe CH.HTH.H nep'laTOK;
nOCJIe I(OHTaKTa C 6HOJIOrH IeCKHMH mH,l\KOCT.HMH OpraHH3-
Ma H nOCJIe B03MO:»<HOrO MHKp06HOro 3arp.H3HeHH.H;
- nepe,l\ Y:W,l\OM 3a naI\JIeHTOM C ocna6.rreHHblM HMMYHHTeTOM.
OCJlaUleHHe: MblJIO X03.HMCTBeHHOe, IaCbI C CeKYH,l\HOM
CTpeJIKOfl. TenJIa.H npOTO'IHa.H BO,l\a, CrepHJIbHbIe: nHH eT,
BaTHbIe mapUKH, CaJI!}>eTKH. EMKOCTb ,l\JIH c6poca C ,l\e3pa-
CTBOpOM.
06nZ3TeJI1>JlOe YCJIOBHe: OTCYTCTBHe Ha PYKaX nOBpem,l\e-
HHM KO:1l<Ji.
3TaJ1bl I 060CHOBaHIo1e
-
nOiJ20moeKa K npo4eiJype
-
1. CHRTb !:<)nbl\a C nanbueB PYK. nOAroToBKa K c6pa60Tl<e Heo6xCAI1-
MOW nOBepXHCCHI PYI<I1.
2. 3aBepH!fTb PYKaBa xanaTa Ha 2/3 06eCneyeHMe MH<!>eKl\MOHHOW 6e3D-
npeAnneYbR, CHRTb '1aCb!. naCHCCTM MeAceCTpbl.
3. OrKpblT" KpaH. Ii1cncnb3yeTcfI npOTC'IHaR BCAa.
BblnOnHeHUe npo4eiJYPbl
1. BblMblTb PYI<l1 C MblnCM npOTCYHCW 06ecne'leHMe HaM6cnbwe01 CTeneHM
QOAOW ACt 2/3 npe,qnneYbfl. YAenRR AeKCHTaMMHal\MM nanbueB PYK. CO-
BHMMaHMIJ <t>anaHraM 101 Me>Knanb- 6nlOAeHMe nplo1HuMna c6pa60TKM no-
l\eBbiM npoCTpaHCTBaM KMcTei1 PYK B BepxHoCTei1 «OT '1MCTOrC K rpR3HcMY».
Te'leHMe 10 ceK}'HA.
2. Oncnc.cHyrb PYI<l1 nOA npcTOYHOW
BOA()/;j AJIR YAaneHIo1R MblnbHow neHbl.
3. nOBTClplo1Tb MblTbe Ka>KAcw PYI<l1 AO
5-6 pa3
3aeepweHue npOl.{eiJYPb/
-:-=-- <!>- 06eCne'leHMe MHcj>eKl\MCHHOW 6e30-
.1. OCYldMTb PYI<I1 can eTKOM.
naCHOCTM.
-,.
npMMe'laHHe: npM OTCYTCTBMM He06xoAMMbiX YCl10BMH AI1R rMrMe-
HM4eCKcro MblTbR PYK, MC>KHO c6pa6oTaTb MX C nOMOl1.\blO 1-
.. MI1 aHTHcenTMKa B Te'leHMe 2 MHHYT_
174
06pa6oTKa PyK Ha xHpyprU'IeCKOM ypoBHe
Cnoco6 o6pa60lnICu PYIC O,5%-1lbt.M cnupmo6bt.M
paCm60pO.M xJtopzeICcu8uua 6UzJtIOIC01lam::
IJ;eJIb: ,l\OCTWIb CTepHJIbHOCTH PYK Me,l\H HHCKOH cecTpbI.
lloKaSaHH.f!:
- He06xoAHMOCTb HaICpbITH.f! CrepHJIbHOrO CTOJIa;
- Y'IaCTHe B onepa HH, nYHK HH;
- YtIaCTHe B pO,l\ax.
llpOTJmOnOKaSaHH.f!:
- HaJIH'IHe Ha PYIcax H TeJIe rHoMHH IKOB;
- Tpell1;HHbI H paHeHH.f! KomH;
- KomHble 3a60JIeBaHH.f!.
OCHa eHHe:
- MbIJIO X03.HHCTBeHHoe 0,l\HOpa30Boe;
- neCO lHbIe IaCbI 1 MHH, 3 MHH.
- 0,5%-HbIH cnHpTOBofl paCTBOp XJIOpreKcH,l\HHa 6HrJIIQ-
KOHaTa 20-30 MJI;
- CTepHJIbHbIH JIOTOK C KopH aHrOM; .
- CTepHJIbHblH 6HKC C eJIeBOH YKJIa,l\KOH ,l\JI.f! HaKpblTH.f!
CTepHJIbHOrO CTOJIa.
06.HSaTeJIbJlOe YCJIOBHC: pa60Ta ocy eCTBJI.HeTC.f! B 30Hax
cTporoH HJIH OC060H CTepHJIbHOCTH.
BblnOJIHeHHe npO e,l\ypbI ,l\OCTHraeTC.H C nOMOll1;bIO nOMOll1;-
HHKa, nO,l\aIOll1;erO CTepHJIbHbIH MaTepHaJI H3 6HKca C C06JIIO-
.nelUleM npaBHJI acenTHKH.
3ranbJ nplo1Me'laHIo1R
noiJ20mo6Ka K np04eiJype
1. BblMblTb PYKIo1 npocTblM cnccc6oM. 06eCne'leHMe MH<t>eKUMcHHOW 6e3D-
naCHOCTM.
2. nCCTaBMTb cTepHnbHblw 6HKC C 06ecneyeHMe MH<!>eKl\MoHHOrc KOH-
6enbeM, YKpenlo1Tb era, npoBepMTb TponR.
MapKMpcBKY M cTepMnbHcCTb 6MKca no
BHewHeMY BMAY.
3. OrKpblTb 6MKC C nOMCUlblO neAanM C06nlOAeHMe lo1t!<f>eKuMoHHOW 6e30-
MnM nOMcUlHMKa. naCHOCTM.
4. \I13BneYb MHAMKaTopbl cTepMnbHo- npoBeAeHMe KOHTponR KayeCTBa CTe-
CTM, oueHMTb MX COCTCRHMe. pMnM3aUMM.
5. B3RTb M3 6MKca C nOMCUlblO KOpH- Co6nlOAeHMe cTepMnbHocTM.
uaHra nocneAoBaTenbHc cTepl1nbHylO I I
KCCblHKY. 3aTeM MacKY. HaAeTb MX.
175
3Tanbl nplo1Me'laHIo1A
6. nCnOJf'MTb KCpHl4aHr B nOTCK. 06eCne'leHlo1e MH<!>eKl4I-1oHHC 6e30-
naCHOCTM.
BblnonHeHue npOl{eoYPbl
1. BblMblTb Pyl<I1 C MblnOM npOTc'IHO AocTMraBTcA rnrMBHM'leCK\1 ypOBBHb
BOAC AO noKTBBCro cr\16a B TB'IBHMB 06pa60TK\1 PYK.
1 MHHyrbl. YABnAA BHMMaHMe <!>anaH-
raM M MB>KnanbUBBbIM npOCTpaHCTBaM
K\1CTB pyK.
2. OnonocHyrb PYI<I1 ncA npOTC'IHC
BCAC Af1A YAanBHMA MblnbHc nBHbl
OT HorrBBblX <!>anaHr AO nCKTBBCrO
cr\16a.
3. Bblcyt1JMTb PYKM crepMnbHblM nono-
TBHI4BM.
4. 06pa6oTaTb Ka>KAYIO PYI<Y ManblMM AocTMraeTcA x\1Pypr\14BCK\1ii! ypCBBHb
CTBp\1nbHbIMM can<!>e1KaMM. CMC'leH- c6pa60TI<I1 PYK.
HblMM O.5%-HbIM cnMpTcBblM paCTBO- CneA"1Tb no 'IaCaM.
paM xnoprBKC\1A"1Ha OT HorrBBblX
4>anaHr AO nOKTBBcro crM6a ABYKpaT-
HC B Te'lBH\1e 3 MMHyr.
3aeepweHue npol{eoYPbl
1. Ha,QBTb CTep\1nbHYIO CAB>KAY. nBp- C06nlOABHMe aCBnTMI<I1.
'1aTK\1.
X.,Pypr.,,,eCKI1ii1 YPOBeHb o6pa6oTKI1
PYK (Ha4anbHbliil3Tan)
npaBHna HaAeBaHHR CTepHnbH!>IX nep'laTOK
1. B3.HTb nep IaTlnl B CTepHJIbHOH ynaKoBKe, pa3BepHYTb.
2. B3SITb nep IaTKY l1.JI.H npaBoH PYKH 3a OTBOpOT TaK, "<ITU-
6b1 naJIbIJ;bI He KaCaJIHCb BHYTpeHHeHnOBepXHOCTH nep IaTKH.
3. CoMKHYTb naJIbIJ;bI npaBOH PYKH H BBeCTH HX B nep IaTKY.
4. Hal1.eTb nep IaTKY, He Hapyma.H ee OTBopOTa, pa30MK-
HYB naJIbIJ;bI npaBO" PYKH.
5. B3.HTb nepqaTKY ]l.JI.H JIeBOH PYKH BTOpblM, TpeTbHM H
qeTBepTblM naJIbIJ;aMH npaBoH PYKH (B nep'IaTKe) 3a OTBOpOT
TaK,. "<IT06bI naJIbIJ;bI He KaCaJIHCb BUYTpeHHeH nOBepXHOCTH
nep IaTI(H.
6. COMKHYTb naJIbIJ;bI JIeBOH PYKH H BBeCTH HX B nep IaTKY.
7. PacnpaBHTb OTBOpOTbI Ha JIeBOH, 3aTeM npaBoH nep-
IaTKe, HaTHHyB HX na PYKaB.
npaBHna CHRTHSI CTepHnbHblx nepLiaToK
1. B3.HTb naJIbIJ;aMH npaBoH PYKIi B nep IaTKe 3a OTBOpOT
Ha JIeBOH nep IaTKe, I(aCaSICb ee C HapY>KHOH CTOpOHbI, Cl1. e -
JIaTb OTBOpOT.
2. B3.HTb naJIbIJ;aMH JIeBOH PYKH B nep'IaTKe 3a OTBOpOT Ha
npaBoH nep IaTKe, KaCa.HCb ee C HapY>KHOH CTOpOHbI, Cl1.eJIaTb
OTBOpOT.
3. CH.HTb nep'laTKY C JIeBOH PYKH, BblBOpaqHBa.H ee HaH-
3HaHKY H l1.ep>Ka 3a OTBOpOT B npaBoH PYKe.
4. JIeBoH PYKOH B3.HTb nep"<IaTKY Ha npaBoH PYI(e 3a OTBO-
pOT C BHYTpeHueH CTOpOHbI H CH.HTb, BblBopa mBa.H ee HaH-
3HaHI(Y (JIeBa.H nep'IaTI(a OKa3aJIaCb BUYTPH npaBoH).
5. ITorpY3HTb 06e nep IaTKH B eMKOCTb C l1.e3HHI}mIJ;HPYIO-
ru;HM pacTBopoM.
npHMe'l3HHe: nBp'laTKH OAHCKpaTHoro npHMBHBHMS! nOCltB AB3MH-
<!>BKlI\1\1 YTHltM3MpYIOTCS!, 3 nep'laTKH MHorOKpaTHoro npMMeHBHMS!
06pa6aTbIBaIOTcS! KaK M3ABIlMS! MBAMlIHHCKcro HaJHa'lBHHA.
npocl>Hnal(THKa BHYTpH60nbHHLlHbiX HHcI>eK'-'HM
C IJ;eJIbIO np()(}mJIaKTHKH BHYTPH60JIbHH IHblX HH!}>eKIJ;HH B
yqpe>K]l.eHH.HX 3l1.paBOoxpaHeHH.H ocyru;eCTBJI.HeTC.H CJIel1.YIOuJ;HH
KOMnJIeKC MepOnpH.HTHH.
1. C06JIIol1.aeTc.H caHHTapHo-rHrHeHH IecKHH pe>KHM.
177
I
2: C06JI10 aeTC.R: nOp.R: OR npHeMa naQHeHTOB B cTaQHoHap
(OCMOTp H 06pa60TRa npH BhI.R:BJIeHHH ne HRYJIe3a, H3Mepe-
HHe TeMnepaTyphI, B3.R:THe Ma3ROB H3 BOca II 3eBa Ha CTaq,H-
JIORORR).
3. Y60pRa, HCnOJIh30BaHHe, e3HHq,eRQH.R: y60po'IHoro HH-
BeHTap.R:, ero XpaHeHHe npOBO .R:TC.H COrJIaCHO npHRa3aM M3
N2 288 CaH IIHH 5 179-90 r.
4. C06JIIO aeTC.R: nopSl OR xpaHeHHH pa60'IeM o elli,n;hI.
5. CaHF1TapHaH 06pa60TRa naQHeHTOB B OT eJIeHHll H CMeHa
6enhJi npoBO,WITCH O HH pa3 B ceMh ,n;HeM H no He06xo,n;HMocrH.
6. Co6JIIo,n;aeTCSI nopSl OR xpaHeHHSl rp.fi3IlOrO 6eJlhH, JIH'I-
HOH o,n;em)J;hI naQHeHTa.
7. Ae3HHcpeRQHSl, npc cTepH.r.m:3aQHoHHaH O'IHCTI<a H CTe-
pHJIH3aQHH npe,n;MeTOB MC,WIUHHCIooro Ha3Ha'IeHHSl, npe.D;MeTOB
yxo a npoBo,n;SlTC.R: COrJIaCHO npHRa33M M3: OCT 42-21-02-85
r. H npHRa3Y N2 408, a TaR>Re MeTO M'IeCRHM YRa3aHHSlM no
,n;e3HHq,eRQHH, npe,n;cTepHJIH3aUHOHHoH O'lliCTRe H CrepHJIH3a-
UHH npe MeTOB Me,n;HQHH-SlCRoro Ha3Ha'IeHHSl, YTBepm)J;eHHhIX
M3 POCCHH 30 eRa6pSl1998 r. M MY - 287-113.
8. IIpoBo.D;HTC.R: aRTMBHoe BhI.R:BJIeHHe HHq,eRUHoHHhIX na-
QHeHTOB (no 03peHHe Ha RHIne'IHYIO HHq,eRUHIO, 6plOilIHOH
THq" ,n;m}:ITepMIO, BHPYCHbIH renaTHT), c06JI1o,n;alOTcSl CpORH
Ha6JIIO eHHSl 3a ROHTaRTHhIMH 60JIhHhlMH.
9. C06JIIO aeTCH pemHM nHTaHHH: OCHa eHHe pa3.D;aTO'I-
HhIX, 6yq,eTHhIX, BpeMSl peaJI1.l3au;HH rOToBoH nH , nOpSl.D;OR
c60pa H y,n;aJIeHHH nM eBhIX OTXO OB, nopSl,n;OR 06pa60TRH
nocy,n;hI, BeTOIlIH, y60pO'IHhIH HHBeHTaph Hero xpaHeHHe, no-
pH OR xpaHeHHSl nepe,n;a'I.
10. Ha CJIY'IaH BhI.R:BJIeHMSl naUHeHTOB RapaHTMHHhIMH H
oc060 onaCHhIMH HHq,eRUHSlMH B OT eJIeHHHX HMelOTCSl cxe-
MhI-naMSlTRH nOBe,n;eHMSl Me nepCOHaJIa npH BhI.R:BJIeHHH no-
03pHTeJIhHhlX naQHeHTOB, ORa3aHHH nepBoH nOMO H, cxe-
MhI onOBe eHHSl, YRJIa RH no oco(5o onaCHhIM HHclJeRUHHM.
11. C06JIIO aIOTCSl npaBHJIa c60pa, xpaHeHHSl H y aJIeHHSl
OTXO OB B JIe'Ie6Ho-npOl}JHJIaRTH'Ie-CRHX Y'Ipelli eHHSlX (CaH.
IIMH 2.1.7.728-99).
06aqMe Mepbl 6e30nacHocTM MeAMLiMHcKOM cecTpbl
Ha pa60'leM M CTe
Me1J:HUHHCRaH ceCTpa o6s3aHa:
1. C06JIIO a1'h ypOBHH MhIThH PYR.
2. Ha,n;eBaTh nep'IaTRH npH ROHTaRTe C 6HOJIOrH'IeCRMMH
>RH,n;ROCTHMH, B TOM 'IHCJle C RpOBhlO.
3. MhlTh PYRH cpa3Y nOCJIe CHSlTHH nep'IaToR. u
4. HeMe.D;JIeHHO y6HpaTh npo.r.m:ThIH HJIH npocbmaHHhIM
HHclmQl1pOBaHHhIH MaTepHaJI.
5. Ae3HHq,HQHpoBaTh HCnOJIh30BaHHhIH MHcTpYMeHTapHH,
npe.D;MeThI yxo,n;a, 060py,n;oBaHHe H nepeBSl30'IHhIH MaTepHa
cpa3Y nOCJIe HcnOJIh30BaHHH B COOTBeTCTBHH C HopMaTHBHoH
.D;ORYMeHTauHeH, perJIaMeHTHpYIO eii cnoco6hI, pelliHMhI H
cpe CTBa ,n;C3HHcpeRUHH.
CxeMa npoBeAeHMR Ae3MH$eKLiMM
npM BH)'TpM6onbHM'IHbIX MH$eKLiMRx
1. IIaQlIeHTa BpeMeHHo H30JIHpOBaTh, nepeBecTM B HHq,eR-
UHoHHoe oT,n;eJIeHHe HJIH B H30JIHTOp (B 3aBMCHMOCTH OT BH a
HHq,eRUHoHHoro 3a60JIeBaHHSl).
2. IIpHroToBHTh e3HH(1mUHpYIO Me pacTBophI HYlliH H
I<OlIueuTpau;HH.
3. IIpHroToBHTb npoMapRHpOBaHHhIi% y60pO'IHhIH MHBeHTaph.
4. 06c33apa311Tb OCTaTRH nM , nocy,n;y.
5. YJIOlliHTh B RJIeeH'IaThIH MellIOR Be ,n;JUI RaMepHOH
.D;e3HHlpeRQlIM.
6. Me6eJIh OTO BHHyTh OT CTeH, npoBecTH 3aKJIIO'IMTeJIh-
HYIO e3HHq,eRUHIO MeTO OM opollIeHHSl (npH oCTp03apa3HoH
HHq,eRQHH) HJIM ,n;BYRpaTHhIM npOTMpaHHeM C 3Rcn03HUHeH -
30-45 MHH (npH rHoHHo-cenTH'IeCROH HHq,eRUIm).
7. OpOCHTh OTOnHTeJIhHhIe 6aTapeH, nJIHHTycbI, CTeHhI,
ORHa; ,n;BepH, nORphIThIe MaCJISlHOH RpacRoH, npOTepcTh 'IMC-
TOH BeTOllIhlO, CMO'IeHHOii B e3HHq,HUHpylO eM pacTBope.
8. Mycop co6MpalOT R BhIXO y, CRJIa,D;hIBalOT B Be po M
ClliHralOT HJIH 06e33apamHBaJOT.
9. IIoCJIe 06pa60TRH CTeH H npe,n;MeToB 06CTaHOBRM npOBO-
,n;SlT nOBTOpHoe 06HJlhHOe opollIeHMe nOJIa e3MHq,HQHpYIO HM
paCTBopOM.
178
179
10. 06e33apamHBaHHe p83JIH'IHbIX 06'beKTOB npOBO .HT e-
3HHq,HQHpYIO MH, MOIO MH, 'IHCT.H MH cpe CTBaMH, co-
oTBeTcTBYIO HX KOHUeHTpaQHH JIH aHHoH HHq,eKQHH (np.
M3 CCCP .N2 916, 1983 r.).
11. "YJIOmHTb B KJIeeH'IaTbIH MelliOK cneQo,D;em y JI.H Ka-
MepHoH e3HIIq,eKQHH.
IIpoTHBOne HKYJIe3HaH 06pa60TKa npOH3Bo,D;UTC.H Ha MeCTe
BbI.HB.JIenH.H C HCnOJIb30BaHHeM co epmHMoro CneUHaJIbHOH
YKJIa.z:\KH (CM. BbIllIe). Be H naQHeHTa nO,D;BepraIOTcH KaMep-
HOH 06pa60TKe.
1. IIOBTOpHbIH OCMOTp BOJIOCHCTOH 'IaCTH rOJIOBbI naUHeH-
Ta npoBO HTC.H 'Iepe3 7 .n;HeH. IIpH He06xo HMOCTH npoH3Bo-
,D;HTC.H nOBTOpHa.H caHHTapHa.H 06pa60TKa.
2. IIpH 06HapymeHHH nJIaT.HHbIX BllIeH He06xo.n;HMO CpO'I-
HO BbI3BaTb cneQHaJIHCTOB u;rC3H .n;JI.H 06pa60TKH JIIO efl.
3. IIpH 06HapymeHHH JI06KOBbIX BllIeH npOBO .HT caHHTap-
HyIO 06pa60TKY rOp.H'IeH BO OH C MbIJIOM H MO'IaJIKOH C noc-
JIe.n;yIO eH cMeHoH 6eJIbH. C COrJIaCH.H naQHeHTa B CJIY'Iae
He06xo,D;HMOCTH c6pHBalOT BOJIOCbI.
4. IIpH 06HapymeHHH nJIaTHHbIX BllIeH KHnHTHT 6eJIbe,
npOrJIIUKHBalOT rOp.H'IHM YTlOrOM IlIBbI, CKJIa.z:\KH o em,D;bI. He
no.n;JIe,I<allJ;eH KHn.H'Iemuo.
B Jle'le6nOM omaeJlenuu cmau,uonapa:
. naQHeHT, caHHpOBaHHbIH B npHeMHOM OT eJIeHHn no ne-
HKYJIe3Y, npH nocTynJIeHHH B JIe'Ie6HOe OT,/I,eJIeHHe OCMaTpH-
BaeTC.H IIOBTOPHO;
. Bce naQHeHTbI, HaXO .H HeCH Ha JIe'IeHHH, CHCTeMaTH-
'IeCKH OCMaTpHBaIOTC.H Ha ne HKYJIe3 Kam bIe ceMb HeH.
. B CJIyqae BbI.HBJIeHH.H ne,D;HKYJIe3a 06pa6OTKa npOBO HTCH
B OT,D;eJIeHHH C HCnOJIb30BaHHeM npOTHBone HKYJIe3HOH YK-
JIa,D;KH npHeMHoro OT,D;eJIeHHH.
U BHHMaHHe! OCMOTp 101 Ae3HHceKl\H5I T5I>Kel106ol1bHOro nal.\H-
. eH a npOH3BOA5ITCS! nOCl1e OKa3aHIo'51 3KCTpeHHOH MeAHl\HHC-
KOH nOMOI1.\H.
CaHHTapnag o6pa6oma naUueHTa npH ne,/l,J1KYJIe3e
OCYlQeCTBJI.HeTCH B caHnponyCI<HHKe npHeMHoro OT eJIeHHH
H BKJIIO'IaeT:
1. ,l(e3HHceKQHIO - YHH'ITOmeHHe Bpe,D;HbIX HaceKOMbIX
(BllIeH), eCJIH OHH 06HapymeHbI npH OCMOTpe naQHeHTa, npo-
BO HT KOMnJIeKCIIO, YHH'ITOma.H BllIeH B mo60H CTa.z:\HH pa3-
BHTH.H Ha TeJIe naQHeIITa, Ha 6eJIbe, o,D;em):\e H pyrI1X npe -
MeTax KaK XHMH'IeCKHM, TaK H MeXaHH'IeCKHM cnoco60M.
2. rHrneHH'IecKYIO BaHHY, HJIH 06THpaHHe naQHeHTa,
B 3aBHCHMOCTH OT ero COCTO.HHHH 3AOPOBb.H.
3. CTpmKKY BOJIOC H HorTeH naQHeHTa.
4. IIepeo,D;eBaHHe naQHeHTa B 'IHCTOe 6eJIbe H o em,D;y.
OpraHH33UHH npOTHBone;:J;HltYJIe3Hb1X
IIlepOnpJlHl'HH B CTaIJ;HOHape
,l(eHCTBH.H nepCOHaJIa npH BbI.HBJIeHIIH ne,D;HKYJIe3a perJIa-
MeHTHpylOTC.H npHKa30M M 320 M3 CCCP OT 05.03.87 r.
.OpraHH3aQHH H npoBe eHHe MepOnpH.HTHH no 60Pb6e C ne-
HKYJIe30M». B npHeMHOM OT eJIeHHH CTaUHOHapa oCYlQeCTB-
JI.HeTCH 06.H3aTeJIbHbIH OCMOTp Ha ne.n;HKYJIe3 Bcex nocTynaIO-
IQHX. Pe3YJIbTaT. OCMOTpa q,HKcHpyeTC.H B HCTOpHH 60JIe3HH H
mypHaJIe OCMOTpa Ha ne,D;HKYJIe3 HJIH .:}KYPHaJIe Y'leTa HH-
q,eKQHoIIHbIX 3a60JIeBaHHH».
IIpH o6HapymeHHH ne HKYJIe3a npOH3BO,D;.HT:
· perHCTpaUHIO B mypHaJIe (q,-60);
· OTnpaBJIHeTC.H 3KCTpeHHoe H3BeIQeHHe 06 HH(peKQHoH-
HOM 3a60JIeBaHHH (q,-058jy) B u;rC3H JI.H pemCTpa-
UHH ne HKYJIe3a no MeCTY mHTeJIbCTBa naQHCHTa;
· eJIaeTC.H OTM;eTI<a Ha JIHQeBOH CTopOHe HCTOpI1H 60JIe3HI1;
· npOBO HTC.H caHHTapHa.H 06pa6OTI<a naUHeHTa, ,D;e3HH-
CeKUH.H H e3HHq,eKUH.H nOMelQcHHH H npe,D;MeTOB, C KO-
. TOpbIMH KOHTaKTHpOBaJI naQHeHT.
,AE3J1H«I>EKI..I,J1S1 J1 CTEPJ1I1J13AI..I,J1S1
,D;e3J1 H clI eK UHg - 00'0 yHH'ITOmeHHe B oKpymaIOlQeH 'IeJIOBC-
Ka cpe e naToreHHbIX H YCJIOBHO-naToreHHbIX MHKpoopraHH3-
MOB. IIpH ,D;e:mHq,eKUIIH rH6HY'f TOJIbKO BereTHpYlOlQHe <PoPMbI
MHKpOOpI'aHH3MOB, 3arpH3H.HIO e 06pa6aTbIBaeMbIe npe eTbI.
,l(06HTbC.H YHH'ITOmeHI1.H MHKpoopraHH3MOB MomHO nyTeM
B03 eHCTBH.H KaK q,n3H'IeCKHX q,aKTOpOB, TaK H XHMH'IeCKHX
cpe CTB, npI1'IeM B 3aBHCHMOCTH OT npO OJImHTeJIbHOCTH B03-
180
181
.n;eHCTBH.H (3KCfi03HQHH) H HHTeHCHBHOCTH (KOHQeHTpaQlm) .n;e-
3HH(lmUHPyroll(Hx cpe.n;CTB.
CTepHJIH3aQH.H - 3TO YIUSqTOmeHHe He TOJIbKO Bcex Bere-
THpYIOll(HX <!>OpM MHKpOOpraHH3MOB, HO H HX cnop, KOTO-
pble, KaK H3BeCTHO, OTJIHqaIOTc.H OC060H YCTOHqHBOCTblO K
B03.n;eHCTBHIO BHemHeH cpe.n;bI.
. oCB060m.n;eHHe nOMell(eHHH OT nbIJIH C nOMOll(blO nbIJIe-
coca, n06eJIKa H OKpaCKa nOMeIl(eHHH;
· MbITbe PYK.
H3U'leCKHe MCTO,ZJ;bI (TepMH'IeCKue) ,ZJ;e3uHcI>eKIJ;HH. K
<!>H3HqeCKHM MeTo.n;aM .n;e3HH<!>eKQHH OTHOCSITC.H C.11e.n;YIOll(He
MeTO.n;bI:
. HCIIOJIb30BaHHe COJIHeqHbIX .11Y'leH;
. 06.rryqeHHe ym.Tpa.cpHOJIeTOBbIMH H3.rryqaTe.11.HMH .n;.11.H 06e3-
3apamHBaHH.H B03.n;yxa H nOBepXHOCTeH B nOMell(eHH.HX (PY-
KOBO.n;CTBO P 3.1 683-98);
. npOrJIamHBaHHe rOpHqHM YTlOroM, 06mHr, npOKaJIHBa-
HHe;
. CmHrai'me Mycopa H npe.n;MeTOB, He HMeBlIIHX ueHHOCTH;
. 06pa60TKa KHnH'rKOM HJIH HarpeBaHHe .n;o I{HneHH.H;
· naCTepH3aU;HH;
. THH.n;aJIH3aQH.H (.n;p06Ha.H naCTepH3aQH.H B TeqeHHH 6-7
.n;HeH npH 60 .C, 3Kcn03HQH.H - 1 'lac);
. KHn.HqeHlIe B .n;HcTHJI.1:mpOBaHHOH Bo.n;e - 30 MHH., a C
.n;06aBJIeHHeM HaTpHH .n;ByyrJIeKHC.11OrO (nHTbeBoH CO.n;bI) - 15
MHH. npH nOJIHOM norpymeHHH. nepe.n; KHn.H'{eHl eM H3,11;eJIH.H
OqHll(aIOT OT opraHH'IeCKHx 3arp.H3HeHHH B oT.n;e.11bHOH eMKOC-
TH, npoMbIBaIOT, C c06.11IO.n;eHHeM Mep npoTHBo:mH.n;eMHqeCKOH
3aU\HTbI, npoMbIBHble BO.n;bI .n;e3HH<lmQHpYIOT H BbIJIHBalOT B
KaUaJI113aQHIO. OT'leT BpeMeHH KHnHqeHH.H HaqHHalOT C MO-
MenTa 3aI{HnaHH.H BO.n;bI;
. B03.n;YlIIHbIH MeTO.n; .n;e3HH<!>eKUHH (6e3 ynaKoBKH, B cyxb-
mapOBOM lIIKa(py npH r - 120 .C, 3Kcn03HU;H.H 45 MHHYT C
MOMeHTa .n;OCTHmeHHH 3a.n;aHHoH TeMnepaTypbI) HCnOJIb3yeT-
CH, eC.11H H3.n;e.11HH H3 CTeK.11a, MeTa.11.11OB, pe3HHbI, .11aTeKCa,
TepMocToHKHX nOJIHMepHblx MeTa.JIJIOB He 3arp.H3HeHbI opra-
HU<ieCKHMH Bell(eCTBaMH;
. napoBoll MeTO.n; HCn0.11b3yeTc.H, eCJIH Te me H3.n;e.11HH He
Tpe6YlOT npe.n;BapHTeJIbHOH O<iHCTKH. .D:e3HHclmQHpYIOll(HH
areHT: BO.n;.HHOH nap no.n; H36bIToqHbIM .n;aB.11eHHeM B 0,5 aTM..
PemHM .n;e3HH<!>eKQlm: TeMnepaTypa -110 "C, 3I{Cn03HQH.H-
20 MHH., B CTepH.11H3aQHoHHbIX Kop06Kax - 6m cax H .n;e3Ka-
Mepax, aBTOK.11aBe. MCnOJIb3yeTC.H OqeHb pe.n;KO.
<I>H3HqeCKHH MeTO.n; - caMbIH Ha.n;emHbIH H 6e3Bpe.n;Hbrn 1I..11H
nepCOHaJIa. EC.11H n03BOJI.HIOT yCJIOBH.H, a HMeHHO 060py.n;oBa-
BMA Ae3MHcI>eKqMM
Pa3.11HqaIOT npo<!>IDIaKTll'IecKYIO H O<IaroByro .n;e3Im<!>eKUHIO.
1. np0<!>H.11aKTHqeCKaH .n;e3HHQ.JeKU;H.H OCYIl(eCTBJI.HeTCH C
u;e.11blO npe.n;ynpem.n;eHH.H BHYTPH60.11bHH<IHbIX HH<!>eKU;HH.
2. OqarOBaH .n;e3HHQ.JeKQH.H .n;e.11HTCH Ha OqaroByro TeKYIl\YIO
lIe3HH<PeKQHIO, KOTOpa.H OCYll(eCTB.11HeTCH B oqare HH<!>eKQHH,
y nOCTe.11H HH<!>eKQHoHHoro 60JIbHOrO, npOBO.n;HTCH MHorOKpaT-
HO, H OqaroBYIO 3aI{JIIO'IHTe.11bHYIO .n;e3HH<!>eKQHIO, KoTopaa npo-
BO.n;HTC.H o.n;HOKpaTHO nOC.11e H30.11.HQHH, rOCnHTaJIH3aUHH B
lclH<!>eKQlloHHoe OT.n;eJIeHHe, BbI3.n;opOB.11eHHH H.11H CMepTH 60.11b-
HOro C Qe.11blO nOJIHOrO oCB060m.n;eHHH HH<}>eKQHOHHoro oqara
OT B036y.n;HTe.11eH 3a60JIeBaHHH.
B JUlY npoBe.n;eHHe .n;e3HH<!>eKQHoHHbIX MeponpHHTHH, B
OCHOBHOM, B03JIaraeTC.H Ha cpe.n;HHH Me.n;HQHHcKHH nepCOHaJI,
KOTOpbIH .n;OJImeH PYKOBo,Z\CTBOBaTbCH HHCTPYKTHBHO-MeTO.n;H-
qeCKHMll .n;oKYMeHTaMH: npHKa3aMH MHH3.n;paBa POCCHH 0 npo-
Be.n;eHHH .n;e3HHQ.JeKUHoHHbIX MepOnpH.HTHii B JUlY onpe.n;e.11eH-
Horo npoQ.JHJI.H; MeTo.n;HqeCKHMH yr<a3aUHHMH no npoBe.n;eHHIO
.n;e3HH<!>eKQHoHHbIX MepOnpH.HTHH npH OT.n;e.11bHbIX BH.n;ax HH-
<!>eKQHoHHbIX 3a60.11eBaHHH; MeTo.n;H'leCKHMH YKa3aHH.HMH no
npHMeHeHHIO KOHKpeTHblx cpe.n;cTB H MeTo.n;oB'.n;e3HH<!>eKQHH.
MeTOAbi Ae MHclJeKqMM
Pa3JIHqalOT MeXaHlr<ieCKHe, <!>H3H'leCKHe H KOM6HHHpoBan-
Hble MeTO.n;bI .n;e3HH<!>eKQHH.
l\IexaHHqeCKHe MeTO,ZJ;bI,ZJ;e3J1HtPeKQHH. K HHM OTHOCHTCJl:
· BJIamHaH y60pKa nOMeIl(eHHH H 06cTaHoBKH;
· BbIKO.11aqHBaHHe o.n;em.l\I>I, nOCTe.11bHOrO 6e.11bH H nOCTeJIb-
HbIX npHHa,Z\.11emHOCTeH;
182
183
HHe, HOMeHKJIaTypa I13 eJIHH - CJIe.I\VeT OT aTb npe.I\nO'ITeHHe
STOM)' MeTO Y.
XHMH'IeCKHe MeTO bl e3HHcI>eKIJ;IIH
HaI160JIee lliHpOKO B JUlY HCnOJIb3yeTC.H XHMH'IeCKI1H Me-
TO e3HHcpeKIJ;HH cnoc060M nOJIHOrO norpymeHH.H. ,l(JI.H H3J(e-
JIHH H HX '1aCTeH, He conpHKaCalOIl(HXC.H C naUHeHTOM, HC-
nOJIb3yeTC.H MeTO J(BYKpaTHoro npOTHpaHH.H cam)JeTKOH H3
6.H3H, MapJIH. CMO'leHHOH B e3HHqmIJ;HpyIOIlWM paCTBope.
HeJIb3.H HCnOJIb30BaTb JI.H npOTHpaHH.H cpe CTBa e3HH-
t}JeKUHH: caH eKc"t}JOpMaJIHH, rJIYTapaJI, 6HaHO.'l, J(e30KcoH-1
H J(p., TaK KaK OHH OKa3bIBalOT n060'lHOe TOKCH'IeCKOe eH-
CTBHe Ha oprallH3M 'IeJIOBeKa. IIpHMeH.HTb B JIHY MomHO
TOJIbKO Te e3HHt}JHUHpyroIIJ;He cpe CTBa, KOTopble O<)JHUHaJIb-
HO pa3pemeHbI enapTaMeHToM roccaHsnH Ha 30pa MHH3 -
paBa POCCHH, 3aperHCTpHpOBaHbI B ElOpo no perHCTpaUHH
JIeKapCTBeHHbIX cpe cTB, H Ha KOTopble HMeIOTC.H: .CBHJ(e-
TeJIbCTBO 0 rocy apcTBeHHOH perHCTpaUHH», «CepTH<)JHKaT CO-
OTBeTCTBH.H CHCTeMbI rOCT» H .MeTo H'leCKlie YKa3aHH.H» no
npllMeHeHHlO, yrnepm.I\eHHble enapTaMeHTOM rOCCaHSnH.I\H -
30pa MHH3J(paBa Poccml.
K XHMH'leCKHM MeTo aM J(e3HH<)JeKIJ;HH OTHOC.HTC.H:
· opomeHHe;
· npoTHpaHHe;
· nOJIHOe norpymeHHe;
· paCnbIJIeHHe.
KOMUHHllpOBaHHble MeTGi1,bl JJ;e311J1cpeKIJ;HH
IIpH KOM6HHHpOBallHOM MeTo e e3HH<)JeKUH.H oCYlIJ;eCTB-
JI.HeTC.H B CneIJ;HaJIbHbIX e3HHt}JeKIJ;HOHHbIX KaMepax.
IIap0603aYWHbtU- YBJIamHeHHbIM B03,n;YXOM npH TeMne-
paType e3HH(peKIJ;HH t" - 110 .C, aBJIeHm1 0,5 aTM., SKcno-
3HIJ;HH 20 MUH.
IIapotjJop.M.aJtuH06btu: B pemHMe 0,5 aTM., t" - 90 T, SKC-
n03HUH.H 30 MHH.
CyIIJ;HOCTb KaMepHoH e3HH<)JeKIJ;HH 3aKJIlO'IaeTC.H B nporpe-
BaHHH co,n;epmMMoro KaMep rOp.H'IHM B03 YXOM (napoM) ,n;o on-
pe e.neHHOH TeMnepaTypbI M npM H36bITO'lIlOM .naBJIeHHH, a npH
184
Heo6xo,n;HMOCTH YCHJIeHH.H B03,n;eHCTBH.H napa - B ,n;onOJIIIHTeJIb-
HOM BBe,n;eHHH B KaMepy <PoPMaJIb erH,n;a (<PopMaJIHHa).
Ae3MH(lnILiMPYlOlqMe cpeACTBa
B POCCHH CYlIJ;eCTByeT rocy,n;apCTBeHHa.H CHCTeMa CaHHTap-
Ho-snH,n;eMH'IeCKOrO HOpMHpOBaHH.H, KOTOpaJI H3,n;aeT O<)JHIJ;H-
aJIbHble ,n;oKYMeHTbI no npo<)JMJIaKTHKe MHt}JeKIJ;HOHHbIX 60JIe3-
HeH. B HaCTO.HlIJ;ee BpeM.H pa3pemeHbI K npHMeHeHHIO 242
cpe,n;cTBa .ne3MH<)JeKUHM M CTepMJIH3aIJ;HM, pa3JIH'Ia101IJ;HeC.H
<)JH3HKO-XHMH'IeCKHMH CBOHCTBaMH, cneUH<)JH'IeCKOH 6HOJIOrn-
'IeCKOH (aHTHMHKp06HOH) aKTMBHOCTblO, TOKCH'IHOCTblO, Ha-
3Ha'iCHHeM, c<)JepoH npHMeHeHH.H.
.D:JI.H ,n;e3HHt}JeKIJ;HH B JIIIY npHMeH.HlOT cpe,n;cTBa, OTHOC.H-
Il(HeC.H K rpynnaM:
1. raJIJIOHJJ;coJJ;epma He: XJlOpCoaep:J/Ca14 ue - XJIOpHa.H
H3BeCTb; rHnOXJIOpH,n; KaJIbUH.H HeHTpaJIbHbIH; rHnOXJIOpHT
HaTpH.H; maBeJIb aKTHBHbIH; aHaJIHT; KaTaJIHT; lIeHTpaJIb-
HbIH aHaJIHT. OpraHM'IeCKHe XJIopco epmaIl(He coe,n;HHeHH.H:
XJIOpaMHH, XJIOpCenT; npecenT; HOXJIOp; raJIJIOH,n;co.nepma-
Il(He: Ha OCHOBe 6pOMa - aKBa60p; Ha OCHOBe iloaa - HO,n;O-
HaT H ,n;p.
2. KHCJIOpoJJ;coJJ;epmalll,He: nepeKuCHbte coeaUHeHU.R (ne-
peKHcb Bo,n;opo a 33% -3%, nep<)JopM, IIBK, IIBK- 1 H .lip.);
Ha,n;KHCJIOTbI (. IIepBoMyp», «,l(e30KcoH-1», «,l(e30KcoH-4»,
(/BHPKOH» H ,n;p.).
3. AJILJJ;erJfJJ;coJJ;ep aIll.He: t}JopMaJIb,n;erH , cenTO,n;op, caii-
CKC, ,n;IOJIb6aK, rJIYTapaJI, rHracenT, JIH30<)JOPMHH-3000, J(e-
301lJ0PM, 6HaHOJI, ,n;eKOHeKC, TeppaJIHH, aJIL 8.3aH-2000 H p.
3TlI cpe CTBa peKoMeH OBaHbI AJI.H H3,n;eJIHH H3 CTeKJIa, Me-
TaJIJIOB, pe3HH, nJIaCTMacc. He.I\OCTaTKoM MHorHX cpe CTB 3TOH
rpynnbI .HBJI.HeTC.H HX cnoc06HoCTL c):IHKcHpoBaTL OpraHH'IeC-
KHe 3arp.H3HellH.H Ha nOBepXHOCTH H B KaHaJIaX H3,n;eJIHi , TO
eCTL He06xo,n;HMO CHa'laJIa OTMbITL 3al'p.H3HeHH.H, a 3aTeM e-
3HH<)JHIJ;HpOBaTb.
4. c1JeHOJICoJJ;epmaw.ne coe.zomeIIHJI: aMOIJ;H,ZJ;, aMoll,H.Il-2000.
5. nOBepxllOcTHo-aKTHBHLle ne eCTBa (nAB): al\'lt}Jo-
JIaH, aJIaMHIIOJI, ,n;eopOJI, ,n;IOJIL6aK, KaTaMHH, rH6HTaH, BeJI-
TocenT H ,n;p.
185
6. CnHpTI>I: cnHpT 3THJIOBbIH 70%, carpOCe.'1T, acen'IHHOJJ,
KyracenT, OKTHHeCeIIT, aMHcenT, cO«!>TacenT, Olt'reHH,n;epM H
p. llpHMeHeHHe cnHpTa peKOMeH OBaHO TOJIbKO JIH H3 eJIHH
H3 MeTaJIJIa, HO cnHpT TaKme «!>HKcHpyeT 3arpH3HeHHH.
7. ryaHIf)J;HIIbl: rH6HTaH, eMOC, KaTaMHH AB, JIH3eTOJI,
nOJmceIIT, <l>yrOl H .
8. CpeJJ;CTBa Ha OCHOBe nepeKHCH: nepOKCHMe,n;, llBK H
p. npe Ha3Ha'IaIOTCH JIH H3 eJIHH H3 KOPp03HHHOCTOHKHX
MeTaJIJIOB, pe3HHbI, nJIaCTMaCC, CTeKJIa.
XHMH<IeCKHe cpe,n;CTBa e3HH<l>eKQHH, 06JIa,n;alOIl\He CHJIb-
HbIMH OKHCJIHIOIl\HMH cBoi1cTBaMH, HcnOJIb3yroTCH B BH e BO -
HbIX pacTBopoB, 3MYJIbCHH, nopOIliKOB H .n;p. I'pynna e3HH-
«!>m. HPYIOIl\llX cpe,n;CTB C MOIOIl\HM 34:>«!>eltToM (,n;e3HH«!>eKQHH H
npe,n;cTepHJIH3aQHoHHaH O'IHCTlta npOBo,n;HTCH B O,n;HOM npo-
Qecce) COCTOHT H3 CJIemrlOIl\HX Cpe CTB: llepoKCHMe &, «BHP-
KOH&, HeHTpaJIbllble aHaJIHTbI, .CenTO.n;Op-«I>opTe& H ,n;p.
OCHOBHLle npHKa3bl
no caHHTapHo-npOTHBoanH)J;eMH<IeCKO!\ty pemHM)' JIIlY,
peKOMeH)J;aQHH
B HaCTOHIl\ee BpeMH )J;JIH BbInOJIHeHHH caHHTapHo-npOTH-
BoonH,n;eMH'IeCKOrO pemI'lMa JIllY eHCTBYIOT CJIe.n;YIOIl\He .n;o-
KyMeHTbI.
1. CaHHTapHble npaBHJIa YCTpoHcTBa, 060Py,n;oBaHHH H 3K- _
cn.nyaTaQIUI 60JIbHHQ, pO ,n;OMOB, .n;p. JIe'Ie6HbIX cTaQHoHapoB
(CAR llHH 5 179-90 r. M3, M.,1990 r.), onpe eJIHIOIl\He
caHHTapHOC co,n;ep:acaHHe pa3JIH'IHbIX nOMeIl\eHHH CTaQHOHa-
pa, 060PY OBaHHH, HHBeHTapH, JIH'IHYIO rHrHeHY naUHeHTOB
H 06c.nymHBalOIl\erO nepCOHaJIa.
2. OTpaCJIeBOii CTaH apT 42 21-2-85, onpe eJIHIOIl\HH Me-
TO bI, cpe CTBa H pemHM e3HH«!>eKQHH H CTepHJIH3aQHH H3-
eJIHii Me HQHHCKoro Ha3Ha'IeHHH (IlInpHQeB, HrJI, HHCTpy-
MeHTapHH).
3. ITpHKa3 M 408 OT 12.07.89 r. O Mepax no CHHmeIUlIO
3a60JIeBaeMOcTH BHpYCHbIM renaTHTOM B CTpaHe&, r e 'IeTKO
YIta3aHbI MepbI no np0«!>HJIaKTHKe npo<l>eccHOHaJIbHOrO 3apa-
meHHH B npOQe.n;ypHOM Ka6HHeTe.
4. llpHKa3 M 720 OT 31.07.78 r. 06 YJIY<IllIeHHH Me.n;H-
IJ;HHCKOii nOMOIl\H 60JIbHbIM rHoHHbIMH xHpyprH'IeCKHMH 3a-
'86
UOJIeBaIrnHMH H YCHJIeHHH MeponpHHTHii no 60Pb6e C BHYTPH-
60JIbHH<IHOii HH<l>eKQHeH&.
5. MeTO H'IeCKHe peKoMeH aQHH no nOBbIIneHHIO Ha)J;em-
HOCTH CTepHJIH3aUHOHHbIX MeponpHHTHii B JIllY no CHC'l'eMe
.1.JHCTbIii HHCTPYMeHT» (1994 r.) H HeKOTopble PyrHe HHCT-
PYKQHH H peKoMeH aUHH.
6. llpHKa3 M 916 OT 04.08.83 1'. «06 YTBepm.n;eHHH HHCT-
PYKqHH no caHHTapHo-npoTHB03nH eMH'IeCKoMY peJKHMY H
oxpaHe Tpy,n;a nepCOHaJIa HH«!>eKQHoHHbIX 60JIbHHQ».
7. MeTo,n;H'IeCKHe YKa3aHHH no e3HH«!>eKQHH, npe cTepH-
JIH3aQHoHIIOii O'IHCTKe H CTepHJIH3aQHH npe MeTOB Me HU:HH-
CK01'O Ha3Ha<IeHHH, YTBepm,n;eHHbIe M3 POCCHH 30 .n;eKa6pH
1998 1'. N2 MY - 287-113.
8. MHCTPYKQHH M 154.021.98 Mll no npHMeHcHHIO «MH-
WIKaTopoB CTepHJIH3aQHH 0 Hopa30B01'O npHMeHeHHH MC-120,
MC-132, MC-160, HC-180» JIH KOHTpOJIH napaMeTpoB pe-
mHMOB pa60TbI napoBbIx H B03 YIlIHbIX CTepHJIH3aTopoB.
9. PYKOBO.n;CTBO P 3.1.683-98 no <<l1cnOJIb30BaHHIO YJIbT-
pa«!>HOJIeTOBOro 6aKTepHQH,n;Horo H3JIy'IeHHH JIH 06e33apamH-
BaHHH B03,n;yxa H nOBepxHocTeii B nOMeIl\eHHHX». 1\11:3 Poc-
CHH, MocKBa, 1998 H ,n;p.
3a HeBbInOJIHeHHH aHHbIX npHKa30B, HHCTPYKQHii H pe-
KOMeIl aQHH Me,n;nepCOHaJI HeceT IOpH,n;H<IecKYIO OTBeTCTBeH-
HOCTb no CTaTbHM Y1'OJIOBHOrO Ko eKca.
XapaKTepHCTHKa OCHOBHLIX cpeJJ;cTB JJ;e3HII<}IeKIJ;HH
OCHOBHbIMH cpe cTBaMH ,n;e3HH<l>eKQHH HBJIHIOTCH XJIOpCO-
,n;('pmaIl\He, KHCJIOpo,n;co epmaIl\He, nOBepxHocTHo-aKTHBHble
CJIC/l.CTBa, 1'yaHH.n;HHbI, aJIb erH oco epmaIUHe, cnHpTbI, <l>e-
HOJICO,n;('p4l<aII He cpe CTBa.
B MeTo,n;H<IeCKHX YKa3aHHHX no e3HHcPeKQlm, npe,n;CTepH-
JIH3au;HOHHOii O'HlCTKe H CTepHJIH3aQHH npe MeTOB Me HQHH-
CKoro Ha3Ha<IeHHH, YTBepm,n;eHHbIx M3 POCCHH 30 .n;eKa6pH
1998 l' M MY- 287-113, aH nepe'IeHb OCHOBHbIX cpe,n;CTB
e3HHcPeKUHH H HX xapaKTepHCTHKa. Han60JIbllIee 3Ha'IeHHe
H3 HHX HMelOT CJIe.n;YIOIl\He cpe cTBa.
XJIOpHaH H3BeCTb npe CTaBJIHeT_ C060H nopOIliOK 6eJIoro
UBeTa, Il\eJIo'IHoii peaKUHH, HMelOIl\Hii pe3KHii pa3,n;pamaro-
'87
HM 3anaX. Ka'IeCTBO XJIOpHOH H3BeCTH 3aBHCHT OT co epma-
HH.H aKTHBHOrO XJIOpa (CI-) B KOJIH'IeCTBe 25 % no aKTHBHO-
MY xnopy. IIpHcHHmeHHH aKTHBHOCTH xnopa o 15% XJIOp-
Ha.H H3neCTb K npHMeHeHHIO He npHrO Ha.
IIpHMeH.HeTC.H n.H 06e33apa.lKHBaHH.H BO bI, nocy,n;bI, no-
Me eHHH, BbI eneHHH naIJ;HeHTa, TYaJIeTOB H ,n;p. B BH e 0,5-
10% BO HbIX p-pOB H B CYXOM BH e. CYXOH xnopHoH H3Bec-
TblO 3aCbInalOT TOnbKO BbI eneHH.H mU HeHTa, OCTaTKH nHr:qH,
npOMbIBHble BO,n;bl B COOTIIOllIeHHH 1:5 (200 r CYXOH XJIOpIlOH
H3BeCTH Ha 1 n 6HOJIOrH'IeCKHX mH KocTeH).
XJIOpaMHH-E. AKTHBHOCTb - 26% no Cl-. MCXO,n;HbIM npo-
,n;YKTOM n.H H3rOTOBneHH.H xnopaMHHa-B .HBn.HeTC.H 6eH30n
(XJIOpaMHHa-T - TOnyon). XnopaMHH-B paCTBopHM B Bo,n;e,
ero paCTBopbI He nOpT.HT H He 06ecIJ;Be'IHBaIOT TKaHH. rOp.H-
'IHe paCTBopbI (50, 60°C) H aKTHBHpOBaHHble pacTBopbI XJIO-
paMHHa 06n8J\a1OT 60nee BblCOKHM 06e33apamHBalO HM eH-
CTBHeM.
IIpHMeH.HeTc.H XnOpaMHH n.H e3HHcPeKU;HH npe MeTOB Me-
HIJ;mlcKoro Ha3Ha'IeHH.H, npocPHnaKTH'lecKoii H O'IarOBOH e-
3HH<!JeKU;HH (KHllIe'IHble, KanenbHble HHcPeKU;HH 6aKTepHaJIb-
HOH H BHPYCHOH 3THonorHH, Ty6epKyne3e, rpH6IwBbIX 3a60-
neBaHH.Hx).
rHnOXJIOplf)J; KaJIbIJ;Hn HeHTpaJIbHblii. AI<nIBHOCTb 52%
aKTHBHoro Ct-. B JIe'Ie6HbIX Y'lpem eHH.HX HCnOJIb3yeTC.H no-
POlIllw06pa3HblH rnnOXJIOpH KaJIbIJ;H.H (.D:TCrK - 2/3-oCHOB-
HaS! conI, rHnoxnopH,na KaJIbU;H.H) 6enore IJ;BeTa. 06pa3yeTcH
CJIerKa MYTHbIH pop, KOTOpbIH MomHO Hcnonb30BaTb 'Iepe3 30
MHH nOCJIe npHrOTOBneHH.H. CToeK npH XpaHeHHH, MaJIO rnr-
pOCKOnH'IeH H,D;a.IKe Ha B03 xe COXpaH.HeT aKTHBHOCTb no Cl-.
ritnoxJIopHT HaTpHn, nonY'IaeMbIH 3neKTpOXHMH'IeCKHM
MeTO OM (YCTaHOBKH 3JIMA-l, 3MY-l, 3JIMCA, Y,l(P-Ol p.)
H3 paCTBOpa nOBapeHHoH COJIH (60 r Ha 1 JI BO,n;bI) MeTOAoM
3JIeKTpOJIH3a B BH,n;e KOHIJ;eHTpHpOBaHHbIX OCHOBHblX paCTBO-
pOB C co,n;ep:acaHHeM aKTHBHoro XJIopa 1-3 %. CpOKH ro,n;HOC-
TH paCTBopa 3aBHC.HT OT TIIna YCTaHOBKH nSl HX nOJIy'IeHH.H.
Pa60'IHe paCTBopbI 0,5 % IWHIJ;eHTpaIJ;HH HCnOJIb3YIOT npH
BHPYCHOH HHcPeKIJ;HH C 3KCn03HIJ;HeH 60 MHH. npH nOJIHOM
norpymeHHH ,WI.H H3,n;eJIHH H3 CTeKna, nJIaCTMaCC (IIBX), CH-
nHKoHoBOH pe3HHbI. Pa60'IHe paCTBopbI 0,25 % KOHu;eHTpa-
'88
IJ;HH HCnOJIb3YlOT npH 6aKTepHaJIbHOH HH<l>eKIJ;HH (KpoMe TY-
6epKyne3a) C 3Kcn03HI.I,lleH 15 MHH. npH nOJIHOM norpyme-
HHIt, a pacTBopbI 0,3% KOHu;eHTpaU;HH - npH ,n;epMaTocPHTHH
B Te'IeHHe 15 MHH.
.D:JI.H ,n;e3HHcPeKIJ;HH nOMe eHHH B npHcYTCTB m nlO eH pa3-
pelliaeTC.H Hcnonb30BaTb pacTBopbI 0,125% KOHIJ;eHTpau;HH C
npHMeHeIIHeM MOIO HX cpe,n;cTB «JIOTOC», «AcTpa», .IIpo-
rpecc» B 0,5% KOHu;eUTpaU;HH. HOpMbI pacxo,n;a p cTBopa
0,125% KOHu;eHTpau;ml npH c3HHcPeI<I.I,llH nOMe eHHH - 200
Mn Ha 1 M 2 . .D:n.H 3aMO'IKH 6e.'Ib.H npH HH<l)eKI.I,llH (KpoMe TY-
6epKYJIe3a) - 4 JI Ha 1 Kr. IIOCy,n;bI - 2 JI Ha 1 KOMnJIeKT.
XJIOpl'eKclf}J;HH 6nl'JIlOKOHaT «.rH6HTaH») - (npoH3Bo -
CTBO cPHpM AHrnHl1 H IIOJIbIlIH) np03pa'IHbIH 20% paCTBop
He HMeeT 3anaxa. OC06bIX YCJIonHii xpaHeHH.H He Tpe6yeT.
OTHOCHTCSI K KJIaccy TaK Ha3biBaeMbIX nOBepXHOCTHO-aKTMB-
HblX Be eCTB. XOpOIliO paCTBopHM B Bo e, cnHpTe, He U3Me-
H.HeT CBOHX CBOM.CTB npH ,n;JIHTeJIbHOM xpaHeHHH, HMeeT ,n;nH-
TeJIbHbIH aHTHMHKp06HbIH 3cPcPeKT, 06JIa aeT BblpameHHbIM
e30,n;opHPYIOr:qHM ,n;eHCTBHeM, He BbI3bIBaeT .HBHOH IWpp03HH
MeTaJIJIOB npH KpaTKoBpeMeHHoM (2-3 MHH) npe6bIBaHHH
HHcTpYMeHToB B p-pe.
Ha npoTeii, KHCJIOTOYCTof!'IHBble naJIO'IKH, BHPYCbI Ii cno-
pbl npenapaT eHCTBH.H He OKa3bIBaeT.
rrp Ha3Ha'IeH 11.JISI 06e33apa.IKMBalill.H xnPYprI1'IecKoro HH-
CTpYMeHTapHSI, PYK xnpypra, Me,n;ceCTep, aKy:rn:epOK. MCnOJIb-
3yeTC.H B Ka'IeCTBe JIe'Ie6HOrO, IlliTMcenTH'IeCKOrO cpe,n;CTBa, a
TaKme 11.JIH TCKYIIJ;eH H 3aKJIIO'IIITeJIbHOM ,n;e3HllcPeI<IJ;HH.
nepeKMCb BO}J;opO)J;a (H 2 0 2 ) OTHOCHTC.H K rpynne OKHCJIM-
TeJIeH. BbInycKaeTC.H npOMbIIlIJIeHHOCTblO B BH e Bo,n;Horo pa-
CTBopa 29-30% KOHIJ;eHTpau;HH no,n; H8.3BaHMeM neprH pOJIb.
UpcAcranmlCT C060H mH KOCTb 6e3 3anaxa H U;BeTa, ropbKO
BHmy:rn;ero Dl<YC3. OU!IMaeT BbICOI<HMIi 6aKTep!'lI.l,ll,wib1MH CBOM-
CTBaMH. PacTBopbl nepeKHcH Bo,n;opo a B KOJIH'IeCTBe 0,5-
6% KOHIJ;eHTpaIJ;HH He nopTHT npf',n;MeTbI, He KOPP03HPYlOT
J.1eTaJIJIbI, ManOTOKCH\IHbl. IIpMMeH.HIOTC.H B 3-4% KOHIJ;eHT-
pau;ml, C 3Kcn03HU;Hel! OT 80 ,n;o 180 MHH C MOIOIIJ;HMH cpe -
CTBaMH (.Uporpecc» H 11.p.), n03BOn.HeT 06'be,n;HHl'ITb npou;ecc
XHMH'IeCKOrO 06e33apa:acHBaHH.H nOCJIe OTMbIBaHH.H KpOBM C
MeXaHH'IeC!wii: O'IHCTI<OM, B pe3YJIbTaTe 'Iero YCHnHBaeTC.H e-
JI
I
'89
3HHq,HI\HPylO HH 3q,q,eKT; 0,5% KOHl\eHTpal\HH C 0,5% MO-
IO HM cpe CTBOM JIJI npe CTepHJIH3aI\HOHHOH O'lHCTKH npH
TeMnepaType 45-50.C, 3KCn03HWIJI 15 MHH.
P-pbI nepeKHcH Bo opo a XpaHJITCJI B TeMHOM npOXJI8J\HOM
MeCTe, He ocTynHoM JIJI 06 ero nOJIb30BaIlHJI. B}'TbIJUI C nep-
rHAPOJIeM OJImHbI HMeTb Komyx. IIepeHocHTb oCTopomHo.
AJIanIJIHOJI (.HHonHK», POCCRH) OTHOCHTCJI K rpynne IIAB
(noBepXHocTHo-aKTHBHbIX Be ecTB). 06JI8J\aeT BbICOKHM aH-
THM1IKp06HbIM eHcTBHeM npOTHB 6aKTepHH, BHPYCOB, rpH-
6oB. 06JI8J\aeT MOIOIl\HMH CBoHcTBaMH. HCnOJIb3yeTCJI JIJI e-
3HHq,e K I\HH nOBepxHocTeH nOMeIl\eHI1H, npe MeTOB yxo a 3a
naU;HeHTaMH, CaHHTapHO-TexHH'IecKoro 060PY1\OBaHHJI, npe -
CTepHJIH3al\HOHHOH O'lHCTKH I1l1cTpYMeHToB H' p. npe MeToB
Me HI\HH-CKOro Ha3Ha'leHI1JI (cToMaTOJIOrH'IeCKHX, rn6KHx H
meCTKHX 3H,D;ocKonoB). BbmycKaeTCJI B BH e KOHl\eHTpaTa.
HcnOJIb3yeTCJI JIJI e3HHllJcKI\HH H npe CTepHJIH3aI\HoHHoH
O'lHCTltH, COBMe eHHbIX B O HOM npol\ccce npoTHB BHPYCHOH
HHqJeKI\HH B BH e 5-8% pa60'Iero paCTBopa (3aBHcHT OT KOH-
CTPYKI\HH npH60pa), 3Kcn03Hl\HJI 60 MHH., npH KOMHaTHOH
TeMnepaType, 3aTeM MOHKH B TOM me paCTBope B Te'lellHe 0,5
- 1 MHH., H OnOJIaCKHBaHHJI npOTO'lHOH nHTbcBoH BO,n;OH B
Te'leHHe 3 MHH. H3 eJIHH H3 CTeKJIa, pe3HH, nJIaC;:TMacc, Me-
TaJIJIOB (HCKJIIO'laJI yrJIepO HCTYIO CTaJIb), B T. 'l. CTOMaTOJIO-
rH'leCKHe HHCTpyMeHTbI. IIpH 6aKTepHaJIbHOM HHq,eKI\HH, a
TaKme Ty6epKYJIe3e, KaH H,n;03ax, epMaToqJHTHH HcnOJIb3Y-
IOTCJI 5% KOHl\eHTpal\HH pa60'lHX paCTBopOB. 3TanbI 06pa-
60TKH He H3MeHSlIOTCJI.
Cema6HK (<<A6mt», H3paJlJIb) OTHOCHTCJI K rpynne IIAB
(nOBepXHOCTHO-aKTHBHbIX BeIl\eCTB). 06JI8J\aeT BbICOKHM all-
THMHKp06HbIM ,n;eHCTBI1CM npOTHB 6aKTepHH, BHpYCOB, rpH-
60B. 06JI8J\aeT MOIOIl\HMH CBOHCTBaMH. BbmYCKaeTCJI B BH e
KOHl\eHTpaTa H nopOlliKa. HcnOJIb3yeTCJI ,n;JIJI ,n;e3HHq,eKI\HH H
npe,n;CTepllJIH3aW'IOHH0I1 O'lHCTKH, COBMeIl\eHHbIX B O,D;HOM npo-
l\eCce npOTHB BHPYCHOH, 6aKTepHaJIbHOH HHq,eKWIH. KaH H,n;o-
3ax, epMaToq,HTHH B BH e 1 % pa60'lero pacTBopa, 3Kcn03H-
WIJI 60 - 120 ceK., (3aBHcHT OT KOHCTPYKI\HH npH60pa), npH
KOllUIaTHOH TeMnepaType. IIpH Ty6epKYJIe3e HCnOJIb3yeTCJI 3%
paCTBOp cema6HKa B Te'IeHHe 60 MHH. MeTo,n;OM nOJIHOrO no-
rpymeHHSl, 3aTeM MOHKH B TOM me paCTBope B Te'leHHe 0,5 - 1
'90
MHH., H OnOJIaCKHBaHHJI npOTO'lHOH nHTbeBoH BO OH B Te'le-
HHe 3 MHH. H3,n;eJIHH H3 CTeKJIa, pe3HH, nJIaCTMaCC, MeTaJIJIOB,
CTOMaTOJIOrWieCKHX HIfCTpYMeHTOB, 3H,nOCKonOB.
BHJU,I KOHTpOJIlI npuro1J:HOCTH
JJ;e3HH(lmU;Hpyroll\HX cpeJJ;cTB
1. BH3YaJIbHbIH KOHTpOJIb npoBo,n;HT COTpy,n;HHK (JIa60paIlT,
Bpa'l) ,n;e3. CTaHI\HH.
2. BaKTepHOJIOrn'lecKHH KOHTpOJIb ocyru;ecTBJIJIeT JIa60paHT
,n;e3. CTaHl\HH (B3JITHe CMbIBOB B KOJIH'leCTBe 1% OT 'lnCJIa
IIInpHI\OB, HrJI H T.,n;.).
3. XHMH'leCKHH KOHTpOJIb, npH KOTOpOM oT6HpalOT npo-
6bI cyxoro BeIl\eCTBa H ,n;e3HHq,HI\HpyIO Hx p-pOB H ,n;OCTaB-
JIJIIOT B ,n;e3. JIa60paTopHIO, r,n;e onpe,n;eJIJIIOT B np06ax co,n;ep-
maHHe aItTHBHoro CI- H ,n;eJIalOT 3aKJIIO'leUHe 0 npaBHJIbIIOC-
TH npHrOTOBJIeUHJI pacTBopoB (KOHTpOJIb OCTaBKH np06 OCY-
I11:eCTBJIJIeT CTapIIIaJI Me HI\HucltaJI ceCTpa oT,n;eJICHHSl).
CpeJJ;CTBa npOBeJJ;eHHlI
JJ;e3Hucl>eKI\HOHHLIX MeponpHJlTHH
,l(JIJI npOBe,n;eHHJI e3HHq,eKI\HOHHbIX MepOnpmlTHH HCnOJIb-
3}'IOT TOJIbKO TO 060Py,n;OBaHHe (Moe'IHble MaIIIHHbI, eMIWCTH C
3Mam..ponaUHbIM nOKpbITHeM, nJIaCTMaCCOBbIe KOHTeHHepbI, CTe-
pHJIH3aTopbI), KOTopble pa3peIIIeHbI B YCTaHOBJIeHHOM nOpJI,n;Ke.
Tpe60BaHMA K 060PYAOBaHMIO
AnA Ae3MHcI>eKLiMM
1. EMKOCTH .n;OJImHbI HMeTb KpbIlIIKH.
2. EMKOCTH H KpbIlIIKH MapKHpYIOTCJI H ,n;OJImHbI HMeTb
'IeTKHe Ha.n;m-lCH C YKa3aHHeM Ha3BaHHJI cpe,n;CTBa, ero KOH-
l\eHTpal\HH, Ha3Ufi'leHHJI, aTbI npHrOTOBJIeHHJI. ,l(JIJI paCTBO-
pOB MHorOKpaTHoro HCnOJIb30BaHHJI YKa3bIBaIOT aTY H 'lac
HcnOJIb30BaHHJI cpe CTBa.
3. ,l(oporOCTOJIIl\lle H3 eJIHJI (3H,n;ocKonbI, HHCTpYl\leHTbI K
rn6KHM 3H,n;ocKonaM) C3HH(l>]-II\HPYIOTCJI no .n;onOJIHHTeJIbHbIM
HHCTPYKTHBHo-MeTo.n;H'leCKHM OKYMeHTaM.
4. BbI60p 060Py,n;OBaHHH JIH e3HHq,eKI\HH 3aBHCHT OT oco-
6eHHocTeH H3.n;eJIHH Hero Ha3Ha'leHHH.
'9'
,l(JI.H npOBe eHIUI ,l\e3HH<}JeKQHOHHbIX MepOnpH.HTHH He06-
XO,l\HMO HMeTb CJIC )'lOlQee OCHalQeHHe:
· rH pOnYJIbT (C 'IeXJIOM);
· Be pa 3MaJIMpOBaHHbIe HJIH eMKOCTM C OTMeTKaMH Ha
1-5 H 10 JI;
· KJIeeH'laTbIe l\7ellIKH JI.H TpaHcnopTHpOBKH BelQeii B
e3HH{peKJ.I,HoHHyro KaMepy (c06JIIO,l\aiiTe MapKHpoBKY!);
· Tapy JIH e3HH{pHU;HPYIOIQHX cpe,l\CTB;
· 'IHCTYIO 06e33apa:aceHHYIO BeTOllIb;
· ItJIeeH'IaTbIe MellIKH JI.H HCnOJIb30BaHHoll BeTOllIH H
HCnOJIb30BaHHbIX KOMnJIeKTOB cneQO,l\e:w.: bI;
· pac<pacoBaHHbIe e3HHcPiIQHpYIOIqHe cpe CTBa;
· cneQo e:w.: y: XaJIaTbI, KOJInaI'H, pecnHpaTopbI, 3aIQHT-
HbIe O'IKH, pe3HHOBbIe nep'IaTKH.
npaBMna oxpaHbl TpYAa npM pa60Te
c Ae3MH«pMLiMPYIOIlIMMM cpeAcTBaMM
1. C06JIIO Clme nproUlJI xpaHeHHH XllMH'IeCIUIX Cpe,l\CTB
e3HHcPeKQHH.
2. "YnaKoBKa cpe CTB e3HHq.eKQHH OJI:w.:Ha HMeTb rrac-
nopT C YKa3aHHeM Ha3BaHH.H, Ha3Ha'IeHH.H, aTbI npHrOTOBJIe-
HH.H H cpOKa rO HOCTlI.
3. C06JIIO,l\eHHe npaBHJI JIH'IHOH rHrHeHbI npH npHrOTOBJIe-
HHU e3uHq.HQHpyIOIQHX paC1'DopOB (cneQxanaTbI, KOCbIHKa,
pecnHpaTOp, 3aIQHTHbIe O'IKH, pe3HHOBbIe nep'IaTKH, CMeH-
HaH 06YBb).
4. TIpHrOTOBJIemle ,l\e3HIIq.HQHPYIOIQHX paCTBopOB, pacq.a-
COBKY npOH3BO .HT B B:DITH:w.:HOM llIKa«:J.JY HJIH nOMelQeHHH C
npHTO'llIO-BblT.H:w.:HOH BeHTHJI.HQHeH.
5. TIpH nona,n;amm Ha KO:w.:y Cpe,l\CTB e3HHq.eKQHH HeMe -
JIeHHO CMbITb HX BO,l\Oll.
6. TIpu nona,n;aHHH B rJIa38 - npOMbITb 2% CO OBbIM p-
pOM, npH He06xo UMOCTH 3aKanaTb aJIb6YQH OM 30%, eCJIH
60JIb He YTuxaeT - rJIa3HbIe KanJIU C HOBOKaUHOM 2%.
7. TIpH pa3 pa:w.:eHHH blXaTeJIbHbiX nYTeH - HeMe,l\JIeHHO
BbIllTlI B pyroe, npoBeTpHBaeMoe nOMelQeHHC, HJIU Ha CBe-
:acHH B03,l\YX, npHHHTb TenJIOe MOJIOKO C CO,l\OH, npoBecTIi no-
JIOCKaHHe nOJIOCTH pTa 2% CO OBbIM p-pOM, no He06xo,l\HMOC-
192
TU H8.3Ha'laIOTCH Cep e'IHble, ycnOKaMBaIOlQHe H npoTHBoKallI-
. JIeBbIe cpe.n;cTBa.
r
XpaHeHMe 101 npMroTosneHMe
xnopcoAep)t(alllMx npenapaToB
1. XpamlTb B TeMHOM, CYXOM, npOXJIa HOM H XOpOllIO
npOBeTpCHHOM nOMelQeHHH Ha CTeJIJIa:w.:ax, B nJIOTHO 3aKpbI-
TOll Tape, T. K. npH HenpaBHJIbHOM xpaHeHHH OHH 6bICTpO
pa3JIaralOTCH, C nOTepeH aKTHBHOro XJIopa. TIpenapaT OJI-
:w.:eH UMeTb CTaH apTHYIO ynaKoBKy C YKa3aHHeM Ha3BaHH.H
npenapaTa, aTbI npHrOTOBJIeHH.H H cpOKa rO HOCTU. He o-
nYCKaeTCH xpaHeHHe B :w.:eJIe3HOH Tape.
2. KOMHaTa QeHTpaJIH30BaHHoro npUrOTOBJIeHU.H e3HH«:J.m-
QHPYIOIQHX pacTBOpoB 060py yeTC.H npHTO'lHO-BbIT.H:w.:HOH BeH-
THJI.HQueH H CJIe YIOIl(HM HHBeHTapeM:
· ,l\Be eMKOCTU, pacnOJIo:w.:eHHbIe Ha pa3HbIX YPOBHHX (3Ma-
JIHpOBaHHbIe, nJIaCTMaCCOBbIe, CTeKJI.HHHbIe);
· BeCbI JI.H B3BellIHBaHHH npenapaTOB;
· CUTO KanpOHOBoe UJIU MapJI.H JI.H npOQe:w.:UBaHHH Ma-
TO'IHOrO p-pa;
· epeB.HHHa.H JIOnaTO'IKa, 3MaJIHpOBaHHbIH KOBllI.
CIleJ OAe:w.:1J:a:
· ,l\JIHIIHbIH XaJIaT, llIanO'IKa, pe3HIIOBbIe canOrI", I<JIeeH-
'IaTbIH <}:IapTYK;
· pe3HHOBbIe H x/6 I1ep'IaTKH, pYKaBHQbI;
· pecnHpaTopbI PTIr-67 HJIH P"Y-60 M;
· 3aIQUTHbIe O'IKH THna TIO-2, TIO-3;
· Me,l\HQHHCKaH aIlTe'IKa.
,l!;()JtYMcUTaJ.\IUI:
· )KypnaJI Y'IeTa paCXO OBaHHH ,l\e3HH<}:IHQHPYIOIQHX
cpe CTB;
· :w.:ypHaJI npHrOTOBJIeHH.H MaTO'IHOrO p-pa;
· nanKa C pe3YJIbTaTOM XUMH'lecKoro KOHTpOJIH cyxoro npe-
I1apaTa Ii e3. p-pOB Ha co ep:w.:aHHe aKTIlBHOrO XJIopa;
· HHCTPYKQHH no npHrOTOBJIeHHIO ,l\e3. p-pOB.
7. 3aK.291
193
TeXHMKa npMrOTOBneHMR
Ae3MHcI> M 4 M PYlOIL\MX paCTBopOB
npHI'OTOBJ.leHMe 10% OCHOBHOI'O OCBeTJIeUHOI'O pacTBopa
XJIOPHOii: H3BeCTH (10 JI)
U;eJIL: HCnOJIb30BaHHe JIH npHrOTOBJIeHHH pa60'IHX pa-
CTBOpOB pa3JIH'IHOH KOHQeHTpaIJ;HH JIH ,n;e3HHq,eKIJ;HH nOMe-
lQeHHH, nocY bI, TYaJIeTOB, BbI,n;eJIeHHH naIJ;HeHTOB H p.
OCllaIQenlle:
_ cneQo e,K a - JnIHHbIH XaJIaT, llIanO'IKa, q,apTYK H3
KJIeeHKH, nep'IaTKH Me,n;HIJ;HHCKHe, pecnHpaTop, 3alQHTHbIe
O'IKH, CMeHHaH 06yBL;
_ cyxa.H XJIOpHa.H H3BecTb B cTaH apTHoH ynaKoBKe C YKa-
3aHHeM Ha3BaHHH, aTbI npHrOTOBJIeHH.H, cpoKa ro,n;HocTH,
8KTHBHOCTH no Cl- (XJIOPY);
_ eMKOCTJiI JIH e3pacTBopoB (3MaJIHpOBaHHbIe, nJIaCTMaC-
COBble, H3 TeMHoro CTeKJIa) C COOTBeCTByroIQeH MapKHpOBKOH;
_ OKyMeHTan;HH: mypHaJI npHrOTOBJIeHHH 10% p-pa XJIOp-
HOH H3BecTH, mypHaJI KOHTpOJI.H cyxoro npenapaTa no aK-
THBHOMY XJIOpy;
_ ,n;epeB.HHHaH JIOnaTKa ,n;JI.H p8.3MeIlIHBaHHSI pacTBopa;
_ cpe cTBa JIH'IIiOH rHrHeHbI: MbIJIO, HIi,n;HBH YaJIbIiOe no-
JIOTeHIJ;e.
061I3aTeJIbHLIe ycnoBHH:
_ co,n;epmaHHe aKTHBHOro xJIopa COOTBeTcTByeT 25%;
_ npHrOTOBJIeIiHe oCYlQecTBJI.HTb B KOMHaTe C IIpHTO'IHO-
BbIT.HmHOH BCHTHJI.HQHeH, cneQHaJIbHblM HHBeHTapeM H OCHa-
lQeHHeM, npH OTCYTCTBHH JIlo,n;eii.
3Tanbl npI1MO'laHI1R
nOd20moeKa K npol,!edype
1. HaAeTb cne oAe>;;Ay. C06nlOAeHI1e 6e30nacHOcTI1 cecTpbl
Ha pa60'!eM MeCTe, npo<!>W1aKTI1Ka
B03AeHCTBI1R TOKCI1'1HblX Bel1\eCTB Ha
opraHI13M MeAI1 HCKOH ceCTpbl.
2. nOAroTOBt-1Tb oCHaU\eHt-1e. 06ecne>;eHt-1e >;eTKOCTt-1 B pa60Te.
3. OTMeTI1Tb opeMR Ha>;ana npOlieAY- C06n1OAeHt-1e MeToAt-1KI1 npl1rOToone-
Pbl. Ht-1R pacTBopa.
4. Hanl1Tb B eMKOCTb He60nbwoe npeAynp e >KA eH t-1e paCnblneHI1R no-
KOnl1>;eCTBO BOAbl. pOWKa 113 xnopHOH 113BeCTI1.
'94
/
\
3Tanbl I npl1Me'laHI1R
nOd20moeKI! K npOl.jeiJype
.J. UblcblnaTb 1 Kr CYXOH xnOpHoH C06nlOAeHI1e MeTOAt-1KI1 npl1rOTOBne-
".IUOCTI1, pa3MeWI1BaR AepeBRHHoH HI1R pacTBopOB
nonaTKoH 11 p03MI1HaR (npt-1lca3 NR 916).
KOMO"'KI1.
1\. nomm. "oIlOH 11010 nI1TpOB, ne-
'" Mn""1hR I AO OIlHOpOAHOH MaCCbl.
o 311KpblTb OMKOCTb KpbIWKOH.
npI1MO'laHI10: xnopHaR 113BeCTb Ha
coeTY TepReT CBOI1 6aKTepl1 I1AHble
cBoHCTBa.
8. CllenaTb oTMeTKY Ha 611pKe 0 Bpe- C06nlOlleHI1e npeeMCTBeHHOCTI1 B
MeHI1 npl1roTooneHI1R, nOCTaol1Tb pa60Te 11 06eCne'l6Hl1e nl1'1HOH OT-
CBOIO nOAnl1Cb. BeTCTBeHHOCTI1.
9. CHATb cne OAe>I\,QY.
10. BblMblTb PYXI1, nl11./0 C MblnOM, C06nlOAeHI1e 6e30naCHOCTI1 CCCTpb'
BblTepeTb HaC'fXo. Ha pa6o...eM MeCTe.
11. 3aKpb'Tb Ha 3aMOK KOMHa-ry. C06nlOAeHI1e npaBl1n oxpaHbI TPYAa
npl1 pa60Te C lIe3cpBllcTBaMI1. Co-
6nlOABHI1e npaBl1n XpaHBHI1R IIB3-
CPBACTB.
12. nepeMeWI1BaTb pacTBop HBcxonb- 06eCne'lBHt-1B nonHoro paCTBopeHI1R
KO pa3 B Te'leHl1e CyroK. cyxoro BBU\eCTBa B BOAe.
3aeepWBHue npol.jedYPbl
1. HalleTb cnB Olle>I\,QY. C06nlOAeHI1B 6e30naCHocTI1 CBCTpbl
Ha pa60...eM MCCTe.
2. Cnl1Tb ...epe3 24 'laca OTCTOSlBWt-1H- C06nlOAeHI1B MBTOIlI1KI1 npl1rOTOBne-
CR paCTBOp B IIPyrylO eMKOCTb C Map- HI1R pacTBopa. 06eCnB4BHI1B nl1...HoH
Kl1poBKOH: 10%-HbiM OCHOBHOH OCBeT- OTBBTcTBeHHOCTl1,npBeMcTBeHHOCTI1
nmltlb'H pacTBop xnOpHOHI13BeCTI1 B pa60TB.
(MOIO"lIbll1), nOCmOI1Tb lIaT}' npViro-
" 1111111111" OTMOll1rb 0 lI<ypllone Y'IC-
III, no '1011111"" cunlO nOIlIlI1Cb.
3, CHRTb cnOLlOIIO>I\,QY.
., BIIMblTb pytel1, BblTepBTb Co6nlOAeHI1B nt-1>;HoH rl1rl1OHbl.
lUll yxo.
! J :\ ""11 ITb II,"' 33MOK KOMHaTY Co6nlOIIBHI1e npaBt-1n oxpaHbI TpYAa.
C06n1OAeHt-1e npaol1n XpaHeHI1R
xnopcoJ1epll<aU\t-1x npenapamB.
v
1
.,..
195
npJlrOTOBJIeUHe 1 % pa6o'lero paCTBopa
XJIoplloii H3BeCTH (10 JI)
l{CJIb: llCnOJIb30BaTb 11.JI:fI e3llH<l>eKUHll nOMe eHllM, Tya-
JIeTOB, npe.n;MeToB yxo.n;a, nocY bI (cOrJIaCHO npllKa3aM no co-
6mo.n;eHHlo CaHllTapHO-npoTHBo:mll eMll'leCKOrO peJKllMa);
OCHa eHHe:
- cneuo.n;eJK.n;a - JIHHHbIM aJIaT, llIanO'lKa, <l>apTYK ll3
KJIeeHKll, nep'laTKll Me.n;llUllHcKlle, CMeHHa:fl 06YBb, pecnllpa-
TOp, 3aIl\llTHble O'lKll;
- eMKOCTH .n;n:fl e3paCTnopOB C COOTBeTCTBYlO eii MapKll-
pOBKOM;
- 10% oCBeTneHHbIM pacTBop H3 XJIOpHOM ll3BeCTll (Ma-
TO'lHbIft);
- MepHa:fl nocy a C MapKllpoBKOM eMKOCTblO 1 n H 10 JI
(Be.n;po);
- Bo.n;a, 9 JI;
- epeB:fIHHaH JIOnaTKa;
06H3aTeJIbHlde yCJIOBIIH:
- cO epJKaHHe aKTHBHoro XJIopa .n;OJIJKHO COOTBeTCTBOBaTb
0,25% B npllrOToBneHHoM pacTBope;
- paCTBOp npllMeHHeTC:fI nOCJIe npI1rOTOBJIeHlIH O HOKpaTHO.
31"1m"1 npHMe'laHI1f1
BblnOflHeHUe npOI./eOYPbl
'I, I ,'JMeWaTb pacTBop AepeBflHHO
IIOlldTKO .
.J. 3iJKPblTb KPbIWKoCI, npOBepl1Tb Map- IlI1"1Hafi OTBeTCTBeHHOCTb. 06ecne"le-
Kl1pOBK}', nOCT .IOI1Tb AaTY npl1rOTOB- Hl1e npeeMcTBeHHOCTI1 B pa6oTe.
lilli'"'' pnCTI10p(111 nOAnI1Cb.
3aeepweHue npOljeoYPbl
I I.1m I/IhJOBaTb AIlR Ae3I1HcpeKL\I111 C06nlOAeHl1e npHKa30B NR 408. 916.
'" 110 peACTBeHHO nocne npl1rOTOBne-
IlLotR.
npl1Me'laHHe: COAepJKaHl1e aKTI'-BHD-
ro xnopa CHI1>KaeTCR npl1 AIll1TenbHOM
XpaHeHI111.
2, CHRTb CneL\OAe>KAY, BblMblTb PYKI1, Co6111OAeHI1e I1I1"1HO rnrneHbI MeAce-
BblTBpeTb Hacyxo. CTpbl.
3Tanbl I npI1Me'laHI1S1
nooeomoeKB K npoljeoype
1. HaAeTb CneL\oAe>KAY. Co6111OAeHI1e 6e30naCHOCTH ceCTpbl
Ha pa60"leM MeCTe, npO<\Jl1l1aKTI'-Ka
B03Ae CTBI1R TOKCI1>;HbIX BeUleCTB Ha
opraHl13M.
2. nOArOTOBI1Tb OCHaUleHl1e. 06ecne>;eHl1e >;eT1<OCTI1 B pa6oTe.
3. npoBepl1Tb MapKl1poBKY MaTO'IHOrO Ill1>;Ha5I OTBeTCTBeHHOCTb.
pacTBopa, BeAPa AIlR pa60'1ero pac-
TBopa.
BblnoflHeHue npOljeoYPbl
1. B3RTb MepHb' COCYA Ha 111, Ha- Co6111OAeHI1e MeTOAI1KI1 npl1rOTOBne-
l1IHb B eMKaCTb 1 11 1 O%-HO O OCHOB- HI1I1 pacTBOpoB npoL\eHTHO KOHL\GH-
HOfO OCBeTneHHoro paCTBopa xnop- TpaL\l1l1.
HO I13BeCTI1 (MaTO'IHOro),
2. nepel111Tb B eMKOCTb AIlR
1%-HOro pa6oyero pacTBopa (BeAPO).
3. IJ.:Jnl1Tb BOAO AO 10 11.
npHrOTOBJIeHlle 1 % pacTBopa XJIOpaMHHa (1 JI)
l{eJIb: JIcnOJIb30BaTb JI.H e3llH<l>eKLI,llll COrJIaCHO npllKa-
3aM no c06nlO eHHlO caHHTapHo-npoTllBOanH)WMll.qeCKOrO pe-
JKUMa.
OCHa cHlle:
- cneuo.n;eJK.ZJ,a;
- 118neCIta cyxoro nopolliKa xnopaMHHa 10 r;
- f'MIWCTh JISI BO bI C MapKllpoBKOH 11.0 1 n;
- ('MIWI'I'S, linn C3paCTBopa;
- /l.CPCUJIJIIIIUI nonaTKa.
06naa'l'CJlbllbie ycnoBllH:
- cO.ZJ,epJKaHlle aKTllBHoro XJIopa cooTBeTcTByeT 0,25%;
- paCTBOp npllMeH.HeTC.H nOCJIe npllrOTOBJIeHllH o.n;HOKpaTHO.
3Tanbl I npHMe'laHI1S1
nooeomoeKB K npoljeoype
I. ";JAOIb CneL\OAe>KAY. 06ecne>;eHI1e 6e30naCHOCTI1 Ha pa-
60<1eM MeCTe.
2. nOAroTOBI1Tb OCHallteHl1e, npOBe- Co6nlOAeHI1e >;eTKOCTI1 B pa6oTe.
,,"n MdpKl1pOBKY. 06ecne<!eHl1e I1I1>;HO OTBeTCTBeHHD-
CTI1.
BblnOflHeHue npOl./eOypbl
1. Hanl1Tb B eMKOCTb He60nbwoe npeAynpe>K,qeHI1e paCnblneHI1R no-
KOnl1"1eCTBO BOAbl. pOWKa.
'96
'97
3Tanbl I np Me'la",l
BblnonHeHue npOl!eoYPbl
2. nOMeCTi-1Tb B eMKOCTb HaBecKY C06!lIOABH.re MeTOAl'lKi-1 np rOTOB!le-
Hi-1 pacTBoPOB npOl\eHTHO KOHl\eH-
cyxoro nopOWKa X!lOpaMi-1Ha Tpal\i-1 .
(10 r).
3. Aon Tb BOAb! AO MeT1(i-1 1 n.
4. nepeMeWaTb pacTBop AepeB HHo
nOnaTKo .
5. 3BKpbITb Kpb'WKO .
6. npOBepl-lTb Mapl<l-lpoBKY eMKOCT
6i-1pKi-1. 06ecne4eHI1e npeeMcTBeHHOCT a
7. nocTaB Tb AaTY npv.roToeneHi-1 pa60Te c Ae3pacTBopaM . ni-14Ha
pacTBopa. pOCnl1Cb. oTBeTcTBeHHOcTb.
3aaepweHue npof.!BoYPbl
1. V1CnO!lb30BaTb CBe>Kenp rOToBneH- Co6nlOAeHI1e np Ka3a N2408.
Hbl pacTBop oAHOKpaTHO. Co6n\OAeHi-1e n 4Ho rI1r11eHbI MeAi-1-
2. CH Tb cneLlOABMY. BblMblTb PYKi-1. L\ HCKoro pa60TH Ka.
BbiTepeTb Hacyxo.
OC06EHHOCTa.1 ra.1ra.1EHa.14ECKO Y60PKa.1
nOMEw.EHa.1 CTAL\a.10HAPA
Hecb y60PO<JlIbIR RIIBelITapb (Be,l\pa, T8.3bI, BeToIIIb, IIIBa6-
pM 11 ,l\p.) ,l\OJIJKeH HMeTb <JeTKYIO MapKHpOBKY C YKa3aHHeM
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llOMen,emUl
. TepanHSI: 1% p-p XJIopHoil H3BeCTH HJIH 1% p-p XJIOp8-
:MHHa H 2% MbIJIbHO-CO,Il,OBbIH npH TeMnep8Type 45 .C uc-
nOJIb30B8Tb npH Ka>K,II,OH 06pa60TKe 2 pa3a B CYTKH.
. MCKJIIO'leHHSI COCTaBJISIIOT rHoi%Hble OTJJ;eJIeHIUI, H8JIH'Il'ie
llHiPeKIJ,HH, Heo6xoJJ;HMOCTb JJ;onOJIHHTeJIbHOH y60pKH.
Y60pO'lHbIH MaTcpHaJI
. 1% pop OCBeTJIemlOR xJIOpnOH H3BeCTH HJIH 1% p-p
XJIOpaMI'IHa.
. IIoJIHoe norpymeHHe Ha 2 'I, nOJIOCK8HHe, cTHpKa, cym-
K8. Xp8HHTb B CYXOM MeCTe B CneIJ,HaJIbHOH yn8KOBKe.
06yBb
. 25% p_p iPOpMaJIHHa HJIH 40% p-p YKCYCHOH KIICJIOTLI,
YJIOmHTb B nOJIHSTHJIeHOBLIR naKeT Ha TpH '18Ca, npoBeTpuTL
l1,0 HC'lIe3HOBeHHSI 3anaxa.
KBa'lH
. B Ty8JIeTe HMeTb 2 ropmKa ,Il,JIlI KB8'l1eH (He MeHee JJ;BYX
KB8'leH B 3% p-pe OCBeTJIelI1IOH XJIOpHOH H3BecTH), MeHSITb
JJ;Ba paa8 B JJ;eHb H IIpH He06xoJJ;HMOCTH.
CYJJ;Ha,MO'IenpHeMHHK
. TepanHH - 3% OCBeTJIeHHLIH p-p XJIOpHOH H3BeCTli - 1 'l.
204
· IIoJ!Hoe norpY>KeHHe, nOCJIeJJ;YIO ee OnOJIaCKUBaHHe xpa-
HeHHe B CYXOM BH,II,e. '
rpeJIKH, nY3bIJm JJ;JIlI JThJJ;8, pe3HHOBble KPY:lKKH
: .l!:BYKpaTHoe npOT p8HHe 1% p-pOM XJIOp8:MHHa.
IIpOMLITb ropSI'IeH BOJJ;OH C MbIJIOM, OnOJIOcHyrL, BLICY-
llIHTb, Xp8HHTb B CYXOM MecTe.
I1a:,rone'llnmH I,JIH3MelIJILle, KaTeTepbl
· 3 Yo paCTBOp XJIOpaMIUla - 60 MHH,
· 0,5% MOIO I'IH paCTBOp npH TeMnepaTYpe 45 .C - 15
MHH., HJIH KHnSI'lIeHHe B 2% CO,Il,OBOM pope - 15
nOCJIeJJ;YIO eH MOHKOR. MHHYT C
· ABTOKJIaBHpOBaHHe.
MeH3ypKH
· 1% p-p XJIOp8MHHa - 60 MHH., OnOJIaCKHB8HHe, HJIH
KHnSI'leHHe - 30 MHH.
lIocTeJIbHOe, HaTeJIbHOe 6eJThe
· CTHpKa B npa<le'lHOH C KHnSI'leHHeM B 2% COJJ;OBOM -
15 MHH KaMepHaSI 6 6 P pe
TeH." 0 p8 OTKa nOCTeJIbHLIX npHH8JJ;JIe>KHOC-
· MellioK 38Ma'lHBaeTCSI B 1% p-pe XJIOpaMHH8 Ha 1
1I0cYJJ;a ' 'l.
· MOHKa - 06e3>KHpHB8HHe (200 I' COJJ;LI H8 10
0,5% MOIOlIJ,HM) JI BOJJ;LI C
3 · MOHKa - JJ;e3HH(}JeKIJ,HSI B 0,5% paCTBope XJIOpaMHHa -
o MHH., 0,5% p-pe XJIOpHOH H3BeCTH - 30 MHH., HJIH 0,1 %
te CYJIb(!JoXJIOpMeTHJIa, 1% p-pe ,Il,HXJIop-1 HJIH KHnSI'leHHe
MHH. JIomKH, BHJIKH - KHnSI'leHHe 30 MHH
· MOHKa-onoJIacKHBaHHe B rOpSI'leH npOTO'l OM BOJJ;e n p o-
cymHBaHHe. '
BeTollib JJ;nn nocYJJ;bl
· KUnlI<ICHUe B 2% co - 15
o 50;' JJ;e MHH., 3aTeM norpY>KeHHe B
, ° p-p XJIOpHOH H3BeCTH lIa 1 'l JJ;JISI oTGeJIHB8HHn C
K8, CYlliKa. ' THP-
· IIpoM8pKHpoBaHHLle eMKOCTH - « BeTOllib <IHCTaH
TOlliL rpSI3Han». », (CBe-
Tene mH
· 1 % pop XJIOp8MHHa, JJ;BYKpaTHoe npOTHpaHHe JJ;O nOJIHO-
1'0 BbICLIX8HHSI.
205
I1pOJ..(eJJ:YPHbIH KaOHHeT
. 1% p-p XJlOpaMHHa C 0,5,}0 p-pOM MOIOm: HX Cpe,l\CTB,
aKTiiBHpOBaHHbIM 10% HaruaTblpHbIM ClIHpTOM. reHepaJlb-
HaSJ y60pKa: 6% nepeKHcb BO,l\opO]\a C 0,5 l' MOIOm;eI'O p-pa B
1 Jl nepeKHcH BO,I:\opO,D;a.
. 06$13aTCJlbHOe KBapIJ;eBaHHe, B 3aBHCHMOCTH 01' 31}>1}>eK-
TMIIHOC'TH 6aKTepHIJ,H,D;HbIX 06JlyqaTeJleH nOCJle reHCpaJIbHOH
y60PKH:
J1ep'laTKII
..3% p_p XJlOpaMMHa - 60 MHH. HJlII ,l\pyroH perJlaMeHTH-
poaaHHbIH ,D;e3pacTBop, nOJlHOe norpymeHMe.
.. 0,5% MOIOlIJ,MH pacTBop - 15 MHH.
.. ABTOKJlaBHpOBaHHe, lIJ,8,lI;.flm:HH pemHM.
nHneTKH rJla3HbIe
. KMn.fl'leHHe B ,I:\MCTHJlJlMpOBaHHoH BO,I:\e - 30 MHH., CTe-
pH.IIH3aIJ;H.fl B m:8,lI;.flm:eM pe>KHMe aBTOKJlaBa B pa306paHHOM
mI,J,e.
06pa60TKa pyK
. CnHpT 80%, 0,5% pop XJlopaJ>uma, MJlH 0,5% cnMpTo-
Boii pop XJlopreKcH,I:\HHa, «IIepBoMYP-C-4» 110 npOTOKOJlY «XH-
p'yprH'IeCI-:HH ypoBeHb 06pa60TKH PYK».
npMlle'laHMe: Ae3HH<!>HL\HpYIOl1\He pacTBopbl Heo6xOAI>1MO MeHRTb
Ha AI>YrHe perllaMeHTHpyeMble pacTBopbl C L\ellblO npo<!>HllaKTHKH
B03HIIKHOBeHHR yCT0l14HBbiX <!>OPM MHKpoopraHH3MoB (rocnHTaJlb-
HblX lJTaMMoB).
Ae3Iim})eKIJ;HH npe,l\Me1'OB yxop;a 3a naIJ;HeH1'oM
(Kxeenlw, ny3btpb iJ.ltR .ltbiJa, zpe.nKa, cyiJno,
.MoilenpUe.MnUK U iJp.)
OCHalIJ"eHHe: cneIJ;o,I:\em,I:\a, MCnOJlb30BaHHbIH npe,l\MeT yxo-
,a; 1% (HJlH 3%) p-p XJlOpaMHHa HJlH ,!!.pyroe ,lIe3H H I}>HIJ;HPY-
1Om: e cpe,I:\CTBO, pa3pemeHHoe K npHMeHeHHlO B P<1> (nepe-
'leHb OCHOBHbIX Cpe,l\CTB ,I:\e3HHl}>eKIJ;HH H HX XapaKTepHCTHKa
,l\8B B «MeTO,l\H'leCKHX yKa38BH.flX no ,l\e3HHl}>eKIJ;HM, npe,l\CTe-
pMJlH3aIJ;HOHHOH O'lHCTKe H CTepHJlM3aIJ;I'lM npe,I:\MeTOB Me,rUI-
IIHHCICOro H83HaQeHH.fl», yrBepm,D;eHHbIX M3 POCCHH 30 ,D;C-
Ka6p.fl 1998 l' M M¥ - 287-113) (KOHIJ;eHTpaIJ;H.fl p-pa, 3I{C-
n03UIJ;H.fl II cnoc06 06pa60'rI{H BbI6MpaIOTC.fl B 3aBHCHMOCTH 01'
206
HaJlH'IH.fl KpoBH H 6HOJlOrH IecKHx BbI,l\eJleHHH naIJ;HeHTa Ha
npe,llMeTax yxo a); BeTOIllb - 2 IllT.; eMKOCTb ,l\Jl.fl ,l\e3HHl}>eK-
IJ;HH C KpbIIllKOH H MapKHpoBKOH.
06H3aTeJlbHOe yCJlOBHe: npe,l\MeTbI YXO,l\a ,I:\e3HHI}>HIJ;HPy-
lOTC.fl cpa3Y nOCJle HCnOJIb30BaHH.fl. .
nOJ];ro1'oBI<a K npoIJ;e,!J,ype
1. H8,lI;eTb cneIJ;o,I:\em,I:\y, nep'laTKM.
2. IIO,l\I'OTOBHTb OCHalIJ,eHHe.
3. 3aJlHTb B eMKOCTb ,l\e3HHI}>HIJ;HPYlOlJ:(H U U
IJ;elITpau;HM. H pop HY>KHOH KOH-
4. BbInOJIHHTb npoIJ;e,l\ypy C HCnOJlb30BaHHeM
yxo,I:\a. npe,l\MCTa
HH::LlnOJlHeHHe J];e3HHlj)eKIJ;HII MeTOJ];OM nOJIlIoro norpyme-
1. IIor pY 3:TL 1I0JlHOCTblO npe,I:\MeT YXO,l\a, 3anOJIII$Lfl ero
nOJlOCTH B 1 Yo p-p XJlOpaMHHa ( HJlH 3 0/
HJl /0 p-p XJlOpaJ>!HHa
H ,l\pyroH ,l\e3HHI}>HIJ;HPYlOlIJ,HH pacTBOp). '
2. CH.flTb nep'laTKH.
3. OTMeTHTb BpeM.fl Ha'laJIa ,l\e3HHl}>eKIJ;HH'
4. BLI.l\ep>KaTb 60 MUH. (HJlH He06xo,l\HMO; BpeM.fl n 0 ec
3 c a a ,lIe3HHl}>eKIJ;HH ,I:\aHHbIM cpe,I:\CTBOM) (CM. MeTO,D;H'leCK Y a
HH.fl no ero npHMeHeHHlO).
5. I-I.l,l\eTb nep'laTKH.
6. BI.IMbI'rb npC,D;MCT YXO,I:\a no,l\ npOTO'lHOH BO.qOH, HCnOJlb-
"Y.fl MOIOlJ:(He Cpe,I:\CTBa, BLICYIllHTb.
OKOH'IaHHe npoIJ;ep;ypLI
3au; IJIHTb ,I:\e3HHI}>HIJ;HPYlOm: H H p-p B paKOBHHY (KaHaJIH-
2. XPaHHTL npe,I:\MeT YXO,l\8 B CneIJ;HaJIbHO OTBe,l\eHHOM MecTe
3. CH.flTb cneIJ;O,l\e>K,I:\Y, BLIMbITb H OCYIllHTb PYKH. .
MeToJ]; ABYKpaTHoro npo1'HpaHHH:
10/. 1. IIpoTepe1'b nOCJle,I:\OBaTeJlbHO, ,I:\BYKpaTHo, npe,l\MeT YXO,lla
° p-pOM XJlOpaMHHa (HJlH 3% p-pOM XJlOpaMHHa' HJlH
rHM ,l\e3HHI}>HIJ;HPYIOlIJ,HM p-pOM) C , PY-
(CM. «MeTO,l\H'lD npOMe>KyrKoM B 15 MHH.
CKHe YKa"aHHH 110 npHMeHeHUIO ,l\e3HH 'HnH-
PYlOlIJ,ero Cpe,l\CTBa» ). 't' ......
m,;Jle,l\HTb, '1T06bI He OCTaBaJlOCb He06pa60TalIHbIX npOMe-
J . KOB Ha npe,llMeTe YXO,l\a.
2. AaTb BbICOXHYTb.
201
3. BbIMbITb npe,l\MeT YXO,l\a no,l\ npOTOqlIOH BO,l\OH, MCnOJIb-
3Y5I MOIOW;Me Cpe,l\CTBa, BbICYIIIMTb.
OKo aHHenpo e LI
1. BbIJIMTb ,I:\e3HlII}:nuJ,MPYI011\UH paC1'BOp 13 paKOBMHY (Ka-
HaJUI3aIJ,ulO).
2. XpaHHTb npe,l\MeT yxo,l\a 13 CneIJ,MaJIbHO OTBe,zWHIIOM MecTe.
3. CH5ITb cne O,l\e)K,I:\Y, BbIMbITb M OCYIIIUTb PYKM.
npO$MnaKTHKa npoct>eccHoHanbHoro
3apa)l(eHMR B npoqeAypHoM Ka6HHeTe
IIpM pa60Te 13 npo e,I\YPlIoM Ka6MHeTe HeB03MO>K1I0 3HaTb
06 Mll(l>eK MoHHOM cTaTyce na MeHTa, n03TOMY B pa60Te CJIe-
,I:\YeT PYKOBO,l\CTBOBaTbC5I npaBMJI8MM npe,I:\OcTopO>KIIOCTH, pC-
KOMelI,l\OBaHHbIMM B npMKa3e N2 408 01' 12.07.89 r.
..0 Mepax no CHM>KeIIMIO 3a60JIeBaeMOCTH BMPYCHLIMM renaTM-
TaMM B CTpaHe't.
1. B pa60Te meJIaTeJIblIO MCnOJIb30BaTb MIICTpYMeHTbI 0,1\-
Hopa30BOrO nOJIb30BaHM5I.
2. IIIICTPYMeHTbI 06pa6aTbIBaTb COrJIaCHO OCTy-42-21-2-
85 M oMeTo,l\MqecKHM YKa3aIIM5IM no ,I:\e3HHcl>eKIJ,HM, npe,l\CTe-
pMJIM3aIJ,MOIIHOH OqMCTKe M CTepMJIM3a MH npe,l\MeTOB Me,l\M-
MIICKoro 1Ia3lIaqeIIM5I&, YTBep)K,IJ;elIlIblx M3 POCCHM 30 ,I:\e-
Ka6pn 1998 r N2 MY - 287-113.
3. Bce MaHMnYJI5I HM, npM KOTOpbIX MO)KeT npoM30HTM
3aproKeHMe KpOBblO MJIH 6MOJIOmqeCKMMH mH,I\KOCT.HMM n8.l(M-
eIITOB, He06xo,l\M1\10 npOBO,l\MTb B nepqaTKax (JIaTeKClIbIX),
MaCIW, KJIeelIqaTOM cl>apTYKe M 13 npMcYTcTBMM ,l\Pyroro cne-
MaJIHCTa, KOTOPbIH CMO>KeT B CJIY'lae lIe06xo,I:\HMOCTH 3aMe-
IIHTb nocTp8AaBIIIero.
4. HeJIb35I MbITb PYKH W;eTKaMH.
5. Pa360PKY, MOHKY HHCTpYMeIIToB, conpHKac8lOIl\I1XC5I C
KpOBbIO H ,l\PyrHMH cpe,I:\aMI1 OpraHH3Ma, npOBO,IJ;HTb nOCJIe
npOMbIBaHH5I HX ,I:\e3. p-pOM.
6. Pa60qHe MeCTa ,l\OJUKlIbI 6bITb o6ec11eqelIbI cBemenpuro-
TOBJIelIHbIMH ,l\e3. p-paMH }J,JI5I ,l\e3HH!}:>eK HH BaTlIblX IIIapH-
KOB, np06HpoK, IIInpH eB, HrJI H T.,I:\.
7. B npO e,I:\ypHoM K86HHeTe ,I:\omKH8 6bITL anTeqKa npH
8BapH5IX.
708
8. BJIalIKH lIanpaBJIeHHH B JIa60paTopHIO lIeJlb35I nOMe-
w;aTb 13 npo6HpKY, HY)KHO npHKJICHBaTb HX K BHeUllleH CTO-
pone np06HpKH (JIyqIIIe npOH3BeCTH HYMepaIJ,HIO np06upoK H
lIanpaBJIeHHH).
IIO,l\03pHTeJIblIbIMH Ha BIIq CqHTaIOTC5I 6UOJIOrHQeCKHe
mH.l\KOCTH:
· KpOBL H ee KOMnoHcHTbI; cnHHHO-M03rOBaH ( epe6po-
C11HlIaJIbHM) mH.l\KOCTb; aMHHOTH'IeCK8JI >KM.l\KOCTb; ce-
MelIH8H )KH,I:\KOCTb;
· rpY}J,lIoe MOJIORO; .B8I'HHaJIblIble BbI.l\eJIelIH5I; MOQa; CJIIO-
lIa; CJIe3H8JI )KHp;KOCTb; KaJI; meJIY.l\OQHOe CO,IJ;ep)KHMoe.
)
Oco6eHHOCTH pa6oT MeAHqHHcKoM
ceCTpbl B ycnoBHRx pHcKa HHct>HqHpOBaHHR
BHPYCHOM H 6aKTepHanbHoM HHcI>eKqHeM
,
nepeAalOlqeHcR epe3 KpOBb
HnH APyrHe 6HonorH ecKHe )l(HAKOCTH naqHeHTa
IIpH 11ona.l\aHHH 6HOJIOrH'IecI>:Hx cy6cTpaToB BO BpeM5I BbI-
nOJIHenH5I MaHHnYJIH HH Ha Komy KHCTeH PYK, lIa CJIH3UCTyIO
rJIa3a, lIa CJIU3HCTYlO 1I0ca, Ha KO)KY JIH a Me,l\HIJ,HIICKOH cec-
TPbI, 11a o,l\e>K,l\Y Me}J,H HIICKOH ceCTphI He06xO,l\I1MO BOCnOJIb-
30BaTbC5I anTeQKOH npH aBapmIX.
AnTe111 a npH 8Bapllnx
B COCTaB anTC'IKM npM aBapM5IX BXO,l\HT:
1. IIepeus!30'lHLIH MaTepHaJI Ca,iIIpeTKH, BaTHble
B Kpal}JT-naKeTe TaMnOHLI, TYPYHAbl
2. IIHneTKH rJla31!ble B Kpal}JT-naKeTe (cTepmlbl!ble)
4 liT.
3. EMKOCTH AJlS! pa3BeAel!W! (cTepWlbHble) 3 liT.
p-POB H3 HaBeCKH (CM. HInKe)
4. YI!AHHKa (cTaKaH'IHK AJlS! I!pOMbmaHHS! (cTepI!Jlbl!b!e) 2 liT.
rJla3 )
5. 70. 3THJlOBb!H cnHpT 100 MJI
6. 5% HOA 10 MJI
7. 0,05% KamrS! nepMallrallaT 10 MJI
8. 1 % npOTapl'OJi lOM.'r
Z09
9. 6% nepeKHCb BOJJ;opoJJ;a 100 MJI
10. Pe3HHoBbie lIan8JIb'lIHlKH 2 3 liT.
11. BaKTepm.\IIJJ;lIb1H JIellKOnJIaCTblpb 2 3 liT.
12, HOiKIIHl\bl 1 ll1T.
nOcne BblnOJIHemIOH MaH,Hnyn1lIQlH
MeAH HHCKa1l CeCTpa o6113aHa:
1. IIpoAe3HHcpH HpoBaTb HHCTPYMeHTapHH H nep B1I30<1-
HbIH M8TepHaJI B O,l\HOM H3 npe,l\JIO>KelIHblx pacTBopoB. .
· 3% pacm60p XJlopaM.una - SKCn03HIJ,HSI 60 MHH.,
· 5% pacm60p aJLaM.unOJla - SKCn03HIJ,HJ! 60 MHH.;
· 2% pacm60p iJlOJlb6mcu (H npe,l\CTepHJIH3 HOHHaSI
O<1HCTKa COBMew;eHbI B O,l\HOM npo ecce) - SKcn03H SI
45 MHH.; 0
· 1,5% zunoxJlopuiJa KaJ/.b UR - SKcn03H HH 6 MHH.;
· 4% nepeKucb 6oiJopoiJa - SKcn03H Hn 90 MHH.;
· 1% pacm60p cenma6UKa (npe.l\CTepHJIH3aIJ,HOHHaR O'lli-=
CTKa COBMelIJ,eHbI B OAHOM npo ecce) - SKcn03H lln 60
120 ceK.;
· 2% pacm60p 6upKona - sKcn03H HSI 10 MHH.;
· 0,06% pacm60p neiimpUJ/.bnozo anaJ/.U1na - SKcn03H-
IJ,Hn 60 MHH.
2. IIOABepI'lryTb npe,l\CTepHJIH38IJ,HOlUIOH 06pa6OTKe H CTepH-
JIH3 HH COrJIaCHO OCTy 42-21-2.85 HJIH «MeTO,l\H ecKHM YEa-
3aHHSIM no ,l\e3HHI}:JeKIJ,HH, npeACTepHJIH3 01UIOH O"'lHCTRe H
CTepHJIH3 H npe,l\Me--rOB Me,l\H HCKOro Ha:ma<IeHHSI&, YTBep-
m,l\eHHbIX M3 POCCHH 30,l\eI<a6pSI 1998 r N MY - 287-1!3.
3. IIoBepxHocTb pa60<1ero CTOJIa nOCJIe Bb!II JIHelUIOH Ma-
HHnYJIn H 06pa6OTaTb BeTOlliblO, CMO<1eHHOH 3 Yo p-pOM XJIO-
paMHHa (,l\BYKpaTHo) HJIH OAHHM H3 npe,l\JIOmeHHbIX p-pOB.
4. CHSITb pe3HHOBble nep<1aTKH C PYK nOCJIe MbITbSI B eM-
KOCTH C ,l\e3HHcpH1{HPYIOW;HM p-poM.
5. IIoMecTHTb pe31UIOBble IIep<1aTKH B eMKOCTb C ,l\e3HucpH-
HPYIOW;HM pacTBopoM.
6. CHSITb XaJIaT. MacKY H nOMeCTUTb B pe3HHOBbIH MellIOK
AJIn rpsr3Horo 6eJIbSI.
7. BbIMbITb PYEH C MbIJIOM no,l\ npOTO<1HOH BO,l\OH. ,l\BY-
KpaTlIO, BbICYllIHTb PYEH cpeHoM nJIH <1HCTbIM 0,l\HOpa30BbIM
1l0JIOTeHIJ,eM.
npHMe'laHHe: npH 3arpJl3HeHHH pa6o<jero CTOlla I<poBblO BO BpeMJI
BblnOllHeHHJI MaHHnYllJlI.\HH He06xo.qHMO HeMe.qJ1eHHO o6pa6oTaTb
CTOll BeTOWblO, CMO<jeHI10H B 6% p-pe nepel<HCH BO.qopOl\a C 0,5%
MOIO HM cpeACTBOM C HHTepBallOM B 15 MHH. nOBepxHocTb pa60-
<jHX CTOllOB nOClle OI<OH<jaHHJI pa60Tbi npoTHpalOT BeTowblO, CMO-
4eHHOH B 3% pope XI10paMHHa ABYl<paTHo. BeTowb nOClle o6pa-
60TI<H nOMeCTHTb B eMKOCTb C 3% P-pOM XllopaMHHa Ha 60 MHH.
(HllH APyroM p-pe, comaCHO aeTy 42-21-2-85 HllH «MeTo.qH4ec-
KHM YKa3aHHJlM no .qe3HHcpeI<I.\HH, npe.qcTepHlIH3aI.\HOHHOH O<jHCTl<e
H cTepHlIH3al.\HH npeAMeTOB Me.qHI.\HHCKOro Ha3Ha<jeHHJI», YTBep>K-
AeHHblX M3 POCCHH 30 l\eKa6pJl 1998 r N2 MY - 287-113.
HeKOTopble aHTHCenTH<1eCKHe Cpe.1.lCTBa. MorYT xpaHHTb-
CJI B HaBecKax H rOTOBHTbCSI B MOMeHT IIpHMeHeHHSI. K HHM
OTHOCSITCJI:
1. IIpoTaproJI 0.1 r 3 yn.
2. KaJIHSI nepMaHraHaT 0,005 r 3 yn.
3. CTepHJIbHaH AHCTHJIJIHpO- 6 aMnYJI
B8HHaJ! BO,l\a no 10 MJI
nona.n;aHHe KpOBllllnll Apyrllx 6110nOrH<IeCKIIX :lKlf,lJ;KoCTeH
nau;lIeHTa Ha o.n;e:IK.n;y II KO:IKY Me.n;IIIJ;IIHcKOH cecTpLI
IIpH 1l0IlaJJ;aHHH KpOBH HJIH ,l\PyrHX 6HOJIOrH<1eCKHX )KHA-
KocTeH naIJ,MeHTa Ha o,l\em,l\Y H Komy Me,!:\H HHcKOH cecTpbI
Heo6xoJJ;MMO:
1. CHSITb HCna<1K8HHYIO cneIJ,OAem,l\Y JIHIJ,eBOH CTOPOHOH
BHYTpb.
2. IIorpY3JITb B 3% \>-p XJIOpaMHHa H8 1 <1 (HJIM AP. p_p
CM. BbIIIle).
3. IIOKPbITL CaJIcpeTKoH. CMO<1emIOH B 3% p-pe XJIOpaMH-
Ha. HCna<IKaHHoe MeCTO JIH HOH O,l\emAbI Ha 60 MHH., C noc-
JIe,lQ'IOw;eH CTHpKOH B rOpJI"'IeH BO,l\e.
4. B35ITb B PYKY TaMnOH. 06JIJIbHO CMO<1eHHbIH 70° p-pa
cnHpTa STHJIOBoro.
5. Y,l\aJIHTb C Ko:»m OCTaTl<H 6HOJIOrH<1eCKOH mH,l\KOCTH HB
MeCTe npoMOKaHHn JIH<1HOH o,!:\em,l\bI lIJ,HIl8lOlIJ,HM ABJUKeIU1eM
naJIbIJ,eB PYKH. JICnOJIb3YSI .n;alUIbIH TaMIlOH.
6. C6POCHTb TRMnOH B eMKOCTb. AJISI oTpa60TaHHoro MaTe-
pHaJIa.
ZIO
ZII
IIOII8)J;aIlHe 6HOn rH'IeCKHX cy6CTPaTOB IIa HeHTa
Ha CnH3HCTYIO rn 3a
TIpH nOn alIHH 6HOnOrH'leCKHX cy6cTpaTOB n HeHTa lIa
CJIHaHCTYIO rJIaaa Me,llH HHCKOMY pa60THHKY lIeo6XO,llHMO npH-
HHTb CJIe.z\YIOIIJ;He MepbI:
npHrOTOBHTb: anTe'lKY npH aBapHHX, CrepHJIbHbIe: 2 JIOT-
Ka, KOplI aHI'.
1. BaHTb KpacpT-naKeT C nHneTKaMH H KpacpT-naKeT C ne-
peBHaO'IHbIM MaTepHaJIOM, YH,l\HHKH ,l\JI1/. npoMbIBaHHH rJI83a
H yJIO)KHTb B JIOTOK.
2. BaHTb H3 anTe'IKH 0,05% p-p KaJIH1/. nepMalII'alIaTa.
3. HaJIHTb B YlI,l\HIIKH 0,05% p-p KaJIHH nepMaHraHaTa H
npoMbITb rJIa:3a.
4. TIpOMbITb rJIaa, HaKJIOHHB rOJIOBY BnepeA, IIJIOTHO npH-
maB YH,lJ;HHKY C p-pOM K JIH Y H ,l\CJIaH MOpraTeJIblIbIe ,l\BH)Ke-
lIHf! BeKfu'\l:H.
5. Y6paTb YH,l\HHI<Y.
6. BbITepeTb rJIaa CTepHJIblIbIMH CaJIcpeTKaMH H3 KpacpT-
naKeTa ,l\BHmeHHeM OT HapY)KlIOrO yrJIa rJIa3a K HOCY.
npHMe'laHHe: rna3Hbie nHneTI<H nocne Hcnonb30BaHHJI npOKHnJl-
THTb B 2% COtiOBOM p-pe B Te4eHHe 15 MHH. HnH B tlHCTHnnl1pOBaH-
HOi1 BOAe 30 MHH. \i1cnonb30BaHHble MapneBble TaMnOHbl npotl e -
3HHcpHI HpoBaTb B 3% p-pe xnopaMHHa HnH 3% p-pe xnopHoi1 1013-
aeCTH B Te"leHv.e 60 MI'HYT (HnH APyroM pernaMeHTHpoBaHHoM Ae-
3HH<!>H HpYIOu<eM p-pe).
HCIIonb30BaHHe aHTHCenTH'leCKHx cpeJJ;CTB
B H8BeCKax JJ;nn o6pa6oTl>H rna3.
IIonaJJ;81IHe 6HOnOrH'IeCKHX cy6CTpaToB IIa HeHTa
Ha cnH3HCTYIO rna3a
IIpHroToBHTb: anTe'lKY npH 8BapH1/.x: aHTHCenTH'leCKHe
cpe,l\CTBa B lIaBeCKaX, aMnYJIbI C ,l\HCTHJIJIHPOBaHHOH BO,llOH,
CTepHJIbHble KOpH aHI', JIOTOK H eMKOCTH ,l\JIH pa3Be,l\elIHH 81I-
THcenTH'IeCKHX cpeAcTB.
1. BaHTb Kpal}:JT-naKeT C nHneTK8MH, KpacpT-naKeT C nepe-
BH30'llIbIM MaTepHaJIOM, eMKOCTH ,l\JIlI. paaBe,l\eHHH aHTHcen-
TH'leCKHX cpe,l\CTB.
2. BCKPbITb naKeT C nepMalIraHaTOM KaJIHH H npHI'OTO-
BHTb aMnYJIY C ,l\HCTHJIJIHpOBalIHoH B01l;0H.
3. BbICbInaTb 0,005 r KaJIHH nepMaHI'aHaTa B eMKOCTb ,l\JIH
paaBe,l\elIHH H aaJIHTb c1:epHJIblIOH ,l\HCTHJIJIHpOBaHlIoH BO,l\On
B 06'beMe 10 MJI, nOJIY'IHTCH p-p 0,05% KOlI elITpaJ.\HH.
4. 3aKPbITb eMKOCTb np06KoH H Ba60JITaTb AO nOJIHOI'O
paCTBopelIHH alITHCennI'leCKOrO cpe,l\CTBa.
5. HaJIHTb B YHAHlIKY npl-rroTOBJIelI1IbIH pop KaJIHH nep-
MalIraHaTa AJIH npoMbIBaHHH rJIa3 (npH lIe06xo,l\HMOCTH npo-
MbIBaIOT 06a rJIaaa, nOJIb3YHCb 06eHMH YlIAHlIKaMM).
6. TIPOMbITb I'JIaa, lIaKJIOHHB rOJIOBY BnepeA, nJIOTHO npH-
)KaB Y1I,l\HHKY C P-pOM K JIH Y H ,l\eJIaH MOpI'aTeJIblIbIe 1I;BHme-
HHH BeKaMH (npM lIe06xo,l\HMOCTH npOMbIBaIOT 06a I'JIaaa,
IIOJIbaY1/.Cb 06eMMH YII,l\HHKaMH).
7. Y6paTb YII,l\MHKY.
8. BbITepeTb I'JIa3 CTepHJIblIbIM MapJIeBbIM TaMnOHOM, ,l\BM-
)KeHHeM OT HapY)KHOrO YrJIa rJIaaa K 1I0CY.
7. BbIMbITb KO>KY C MbIJIOM.
8. TIOBTOpHTb YAaJIeHHe C KomH OCTaTKOB 6HOJIOrH'leCKOH
mH,l\KOCTH 06HJIblIO CMO'lelIHbIM TaMIIOHOM B aHTHCenTH'leC-
KOM paCTBope.
9. C6pOCHTb TaMIIOH B JIOTOK ,l\JIH OTpa60TaHlIOrO MarepHaJIa.
npHMe4aHHe: oTpa6oTaHHbie TaMnOHbl onYCTHTb B eMKOCTb 101 31-
I1HTb 3% p-pOM xnopHoH H3BeCTH Ha 60 MHH. «HnH Hcnonb30BaTb
tlPyroH pernaMeHTHpoBaHHblH Ae3HH<!>H HPYIOU<I1H pop); nOTOI< no-
MeCTI1Tb B Ae3I1HcpH HPYIOU<HH P-P. 3Kcn03H HJI B 3aBHCHMOCTH OT
Bbl6paHHoro Ae3HHcpl1 HPYIOu<ero p-pa. Cne OAe>t<J\Y nocne tle-
3HHcpeK 1111 nOMeCTHTb B KJ1eeH4aTb1H MeWOK ,!\J1J1 rpJl3HOrO 6enbJl
101 OmpaBHTb B npa4e4HYIO ,!\J1J1 AanbHeHwei1 MaWHHHOH CTl1pKH B
ropJl4ei1 BOAe.
IIOII8)J;aHHe 6HonorH'IeClmx cy6cTpaToB na HelITa
Ha IW:lKy nllI a I{ ry6b1
TIPH nona.l\aHHM 6HOJIOrH'IeCKHX cy6cTpaTOB na HeHTa Ha
Komy JIH a H ry6bI, Me,l\H HHCKOH CecTpe lIe06xO,l\HMO:
npHrOTOBHTb: CTepMJIbHble 2 JIOTKa, CTepMJIbHbIH KOpH-
I aHr, 8nTe'lI>Y npM aBapH1/.X.
1. Ball.Tb H3 anTe'lKH KpacpT-naKeT C nepeB1/.aO'lHbIM MaTe-
pHaJIOM H nOJIOmHTb B JIOTOK.
2. BaHTb Ha anTe'lKH 70 0 cnHpT HJIH 0,05% pop KaJIHlI.
nepMaHralIaTa.
212
213
llonaAamle 6HOnOrH'IeCKJlX cy6CTpaTOB
Ha CnIl3HCTYJ<) HOCa
llpH nOnaAaHMM 6MOJIOrM'leCKMX cy6cTpaTOB Ba CJIMSHC-
TYro HOCa MeJUi HHCKOrO pa60THHKa He06XOAMMO:
npHrOTOBHTL: CrepMJILHble 2 JIOTKa, CTepMJIbHblll KOpH-
aHr, anTe'lKY npM aBapMHX.
1. B3HTb KpacpT-naKeT C nMIIeTK8MM M KpacpT-naKeT C ne-
peBHSO'lHbIM MaTepMaJIOM M YJIO>KMTb Ha JIOTOK.
2. AOCTaTb M3 aIITe'lKM 1% paCTBOp npOTaprOJIa.
3. BJIo:a<HTb nMneTKY M3 Kpal}:JT-naKeTa BO cpJIaKOH C 1 %
pacTBopoM npOTaprOJIa.
4. AaTL B PYKM JIOTOK.
5. 3aKanaTb HOC 1 % pacTBopoM fnpOTaprOJIa 1'1 OIIYCTMTL
rOJIOBY BHMS (COAep>KMMoe MCTeKaeT B JIOTOK).
6. 3aKaIIaTb nOBTOpnO HOC 1 % paCTBOpOM npoTaprOJIa M
OnYCTMTb .rOJIOBY BHM3 (COAepmMMoe 1'1CTeKaeT B JIOTOK).
7. TIpOMOKH}TTb HOC CTepMJIbHbIM MapJIeBblM lllapMKOM.
npHMe4aHHe: JlOTOK noclle HcnOllb30BaHHJI npOAe3HH<!>H HPO-
BaTb B 3% pacTBope XIIopaMHHa B Te4eHHe 60 MHH. \!1cnollb30BaH-
HblH nepeBJl304HblH MaTepHaJ1 3allHTb B eMKOCTH 3% p-pOM XIIOp-
HOH H3BeCTH Ha 60 MHH. (HIIH APyroM perllaMeHTI1pOBaHHoM Ae3HH-
<!>HLIHpYIOti.\eM pacTBope).
HCn0JIb30BanHe aHTHCenTII'IeCKHX cpe,ZJ;cTB B naBeCKax
Ann o6pa6oTKII nonOCTH Boca
llpHrOTOBHTL: aHTMCenTM'leCKOe cpellCTBO B HaBeCKe, EO
cpJIaKOH'lMKe - npOTaprOJI 0,1 r, CTepMJIbHa.H JUICT1'1JIJIMpO-
BaIUIa.H BOAa - 10 MJI, CTepMJIbHble 2 JIOTKa, CTepMJIbHbIll
KopH aHr, CTepHJIbHaH eMKOCTb AJIH paSBeAeHH.fi aHTMcemM-
'leCKOrO CpeACTBa.
1. BSHTb MS anTe'lKM KpacpT-naKeT C nnneTKaMH, KpacpT-
naReT C nepeBflSO'lHbIM MaTep1'1anoM, CTepMJIbHYro eMKOCTb
p,JIH paSBep,eHMH aHTHCenTM'leCKOrO cpep,CTBa 1'1 YJIOm1'1Tb Ha
JIOTOK.
2. BCKPblTb cpJIaKOH'lMK C npOTaprOJIOM.
3. BJIMTb B eMKOCTb C 0,1 r npOTaprOJIa 10 MJI CTepUJIb-
HOM AMCTHJIJIMpOBaHoll BOAbl MJIM MCnOJIbSOBaTb CTepUJIbHYro
eMKOCTb p,JIH pasBeAeHMH aHTMCenTn'lecKOro cpe.n;CTBa.
4. 3aKPblTb eMKOCTb IIp06KO:H M Bs60JITaTb AO IIOJIHOro
pacTBopeHMH aHTMCenTM'leCKoro cpeACTBa.
5. BSHTb nMneTKY MS Kpal}:JT-naKeTa, nOMeCTMTb BO cpJIa-
KOH C npUrOTOBJIeHHblM paCTBopOM, AaTb n ueHTY JIOTOK B
PYKU.
6. 3aKanaTb B HOC U onYCTUTb rOJIOBy BHUS (COAep>KUMoe
CTeKaeT B JIOTOK).
7. 3aKanaTb nOBTOpHO HOC U onYCTUTb rOJIOBY B1ms (CO-
Aep:a<HMOe CTeKaeT B JIOTOK).
8. TIPOMOKH}TTb HOC CTepUJIbHblM MapJIeBblM IIlapHKOM.
3. CMO'lHTb CTepHJIbHbIll MapJIeBblH mapUK 70. cnMpTOM
UJIU 0,05% p-poM KaJIUH nepMaHraHaTa U YAanHTb C KO>K1'1
JIu a U ry6 6uoJIOrH'leCKUll cy6cTpaT n HeHTa IWinaTeJIb-
HblM ABumeHueM nanb eB, C6POCUTb oTpa6OTaHHblll nepeBH-
SO'lHblll MaTepuan B JIOTOK VlJIH oTpa6OTaIUIOrO MaTepUaJIa).
4. TIOBTOpHO 06pa6OTaTb CTepUJIbHbIM MapJIeBblM lllapu-
KOM, CMO'leHHbIM 700 cnMpTOM 1'1JIU 0,05% p-pOM KaJIMH nep-
MaHraHaTa Komy JIu a U ry6.
5. TIponOJIOCKaTb nOJIOCTb pTa 70° cnupToM UJIU 0,05%
p-pOM KaJIUH nepMaHraHaTa.
npHMe4aHHe: Hcnollb30BaHHblH nepeBJl304HblH MaTepHall npOAe-
3HHcpH HpoBaTb B eMKOCTH C 3% p-pOM XIIOpHOH H3BeCTH B Te4e-
HHe 60 MHHYT (10111101 B APyroM pernaMeHTHpoBaHHoM Ae3HHcpH HPy-
lOti.\eM p-pe).
PaHeHlle nanL eB KHCTH
nOTe anLHo HBllull1;HpoBaHHbIM IlHcTpYMeHTOM
TIpu paHeHuu nanbl1;eB K1'1CTU nOTeH ManbHo 1'1HC]ml1;npo-
BaHHblM 1'1HCTpYMeHToM He06xoAuMO:
llpHrOTOBlITb: anTe'lKy npu aBap1'1flx, CTepUJIbHblH 61'1KC
2 JIOTKa, CTepUJIbHbIH KopH aHr. '
1. He CHUMaH nep'laTKU, BblAaBUTb M3 paHKJI KpOBb, sa-
TeM CHHTL pesnHOBble nep'laTKH, C6POCUTb B eMKOCTL C 3'70
p-pOM XJIOpaMUHa.
2. BSHTb us anTe'lKU Kpal}:JT-naKeT C nepeBHSO'lIiblM MaTe-
p1'1anOM U YJIO>KUTb Ha JIOTOK.
u 3. -AocTaTb MS anre'lKU 70° STUJIOBbIll cnHpT, 5% pacTBop
nOAa.
214
215
4. 06pa6oTaTb paHeBYJO nOBepxHocTb CTepHJIblIbIM mapH-
KOM, 06Ji'1JIblI0 CMO'IeHHbIM 70° 3THJIOBbIM cnHpTOM H C6POCHTb
B JIOTOK AJISI oTpa60TaHlIOrO MaTepH8JIa.
5. TIpoMbITb BOAOll C MbIJIOM, lIe OCTalIaBJIIiBaSI KpOBOTe-
'lelIne.
6. BblCYIIlliTb CTepHJIbHbIM lliapHKOM palIeBYJO nOBepxlIocTb
H C6pOCHTb B JIOTOK AJISI OTp860TalIHoro MaTepHllJIa.
7. 06pa6OTaTb paHeBYIO nOBepxlIoCTb 70" cnHpTOM nOBTOp-
HO, 3aTeM o6pa60TaTb 5% p-pOM lloAa H C6POCHTb B JIOTOK
oTpa6OTalIHbIll nepeBSI30'lHbIll MaTepHaJI.
8. HaJIOmHTb 1I8 pa..'ieBYJO nOBepxlIocTb 6aKTepH HAlIbIll
nJIaCTblpb.
9. HaAeTb pe3HlIoBbIlllIanaJIb'lHHK nOCJIe lIaJIO)KeHHSI no-
BSI3KH H3 6aKTepH H,l\HOrO nJIaCTblpSI, 1I8,lI;eTb nep'laTKH.
10. TIpoAe3HIII}:JH pOB8Tb HCnOJIb30BalIHble npe,l\MeTbI H
nepeBSI30<ulbIll MaTepHaJI COrJI8ClI0 ,l\ellcTBYI01W1M HIICTpYK-
lI,HSIM (CM. BblIIIe).
11. H8,lI;eTb CTepHJIblIble nep'laTKH.
12. 3anOJIlIHTb HCnOJIb30BalIlIble pe3HHoBble nepqaTKH ,l\e-
3HHI}:JH npYIOIIJ;HM p-poM (3% pacTBopOM XJIOpaMHlIa) H oc-
TaBHTb B eMKOCTH lIa 60 MHII.
npHMe'laHl1e: OTpa6oTaHHblH nepeBR304HblH MaTepHan 3anHTb B
eMKOCTH 3% p-pOM xnopHOH H3Becrn Ha 1 4. EMKOCTb C npOMblB-
HblMH BOAaMH 3aCblnaTb CYXOH xnOpHOH H3BeCTbIO Ha 1 4 (H3 pac-
4eTa 200 r Ha 1 n). JlOTKH nOMeCTHTb B eMKOCTb C Ae3HH<!>H HpylO-
ti.\HM p-pOM. 3Kcno3H HR B 3aBHCHT OT Bbl6paHHoro Ae3HHcpH H-
PYIOti.\ero p-pa.
HlIlj)eK HOHHaH 6eaonaCHoCTb
ocne OK8aaHHH nOMOm;H BH'I-HHIj)UlI,HpOB8HHOMY
HnH 6OJlbJlOMY CTIH}J,OM na eJlTY
TIoCJIe OKa3aHHSI nOMO H ImH JIe'lelIHn Bll'l-HIII}:JH HpO-
BaHlIoro HJIH 60JIblIOrO CTIMAoM na HeIITa, Me,l\H IUICKOMY
pa60TlIHKY He06xo,l\HMO:
1. 06pa6OTaTb PYKH B nep<IaTKax B eMKOCTH C 3% p-pOM
XJIOpaMHHa (HnH ,l\p. perJIaMelITHpOBaHHOM p-pe).
216
2. CHSITb nepqaTKH H onYCTHTb B ,l\PyrylO eMKOCTb C TeM
)Ke p-pOM, 3&rrOnHHTb nepqaTKH ,l\e3HHI}:JH HPYIOIIJ;HM p-pOM.
3. H8,lI;eTb 'lHCTble pe3HlIOBble nepqaTKH.
4. 3anonlIHTb CIISITble pe3HlIOBble nep'laTKH ,l\e3HHI}:JH H-
PYIOIIJ;HM p-pOM.
5. CIISITb xarraT H cnO>KHTb nH eBoH CTOpOIIOll BHYTPb.
6. "YJIO:aCHTb XaJIaT B Kneelr<IaTbIll MelliOK ,l\nSI rpSI31I0ro
6enbSI (MellioK npoMapKHpoBaH).
7. C1UITb nep'laTKH.
8. ClInTb MaCKY.
9. CMelIHTb 06YBb.
10. BbIMbITb PYKH Tm;aTeJIbHO MbIJIOM no,l\ npOTOqlIOll BO-
AOll ,l\BYKpaTIIO, BblTepeTb lIacyxo nOJIOTeH eM.
IIocne BLlnOJIHeJlHH MalIHnynmvt:H n HeHTaM, 60nbHbIM
CIIH}J,oM H BH'I-HHIj)II HpoBaIlHLIM, Jle06xoJJ;HMO:
1. TIoMecTHTb HIICTpYMeHT nOCJIe BbIIIonHelIHOll MalIHny-
JUI HH B O,l\HH H3 npe]J;JIO)KeHlIbIX ,l\e3HHI}:JH HPyI6IIJ;HX p-poB:
HaaBaHHe cpeJJ;CTBa
Hero KOHll,eJlTDall,HH 3Kcn03HlI,HH
3% paCTBOp xnopaMHHa 60 MHHYT
3 % paCTBOp nepeKHCH
BO,l\OpO,l\a 180 MHIIYT
4 % paCTBOp nepeKHCH
BO,l\OpO,l\a 90 MHHVT
rJIYTapan (6e3 pa3Be,l\eHHSI) 15 MHH
2% paCTBOp BHpKOlIa 10 MHHYT
(SH,l\OCKOnbI 30 MHH)
1 % paCTBOp cenTa6HKa 1 MHHYTa
(KpoMe CTOMaTOnOrHqecKoro
HHcTPYMeHTapHfl)
2. TIO,l\BepnryTb npe,l\CTepHnH3aIJ,HOIIHOll 06pa60TKe H CTe-
pHnH3a HH cornaCIIO OCTy 42-21-2-35 H «MeTo,l\HqeCKHM
YKa3alIHnM no ,l\e3HlIl}:JeK HH, npe,l\CTepHnH3a HoHHOll O'lHC-
TKe H cTepHnH3a H npe,l\MeTOB MeAH HHCKoro lIa3HaqeHHn&,
YTBep)K,l\eHHbIM M3 Pocclm 30 .l\eKa6pn 1998 r M MY -
287 -113.
Zil
3. TIoBepXHOCTb pa60qero CTOJIa nOCJIe BbInOJIHeHHo:i1 Ma-
HHllYJI.Hl.J;llll 06pa60TaTb BeTOWbIO, CMO'ICHH0:i13% p-poM XJIO-
paMHHa J\BYKpaTHo (llJIll J\pyrllM CpeJ\CTBOM, pa3peweHHbIM
J\Jl.ll J\eoHH$eKl.J;llll MeTOJ\OM npOTHpWill.H).
4. CH.HTb pC3llHoBbIe nepqaTKH C PYK nOCJIe MbITb.H B CM-
KOCTll C J\e3llH$llI.J;HPYIO llM p-poM.
5. TIOMecTllTb pC3llHoBble nepqaTKll B eMKOCTb C J\e3HH$H-
UHpYIOIIUiM p-pOM.
6. ClI.HTb XaJIaT, MaCKY H nOMeCTHTb B pe3HHoBbI:i1 MCWOK
J\JI.H rp.H3HOrO 6eJIb.H.
7. BbIMbITb PYKH C MbIJIOM nOJ\ npOTOqHoii: BOJ\O:i1, J\BY-
KpaTHO, BbICYWHTb PYKH $eHoM HJIH 'JHCTbIM OJ\Hopa30BbIM
nOJIOTeHl.J;eM.
npItMe'laHlte: npl-l 3arpst3HeHHH pa60"lero CTO/1a KpOBblO BO BpeMSI
BbInO/1HeHI-ISI MaHl-lnY/1J1 1-I1-I He06xo,l\HMO HeMe,!VIeHHO 06pa60TaTb
CTO/1 BeTOWblO, CM04eHHOH B 6% p-pe nepeKI-ICI-I BOAOpo,!\a C 0,5%
MOIO I-IM Cpe,l\CTBoM C I-IHrepBil/lOM B 15 MI-IH. nOBepxHoCTb pa60"ll-lx
CT0/10B nocne OKOH4aHI<1S1 pa60Tbi npOTHpalOT BeTOWblO, cM04eHHoH B
3% pacTBope XllOpaMI<1Ha ABYKPaTHO. BeTOWb nocne 06pa60TKI<1 no-
MeCTHTb B eMKOCTb C 3% p-pOM X/10paMI-IHa Ha 60 MHH.
CxeMa :nanOB o6pa6oTKM M3AenMM
MeAMqMHcKoro Ha3Ha eHMR
l-u 3man. .n;e3HH eKI.J;HJI npe.z:s;MeToB
Me.z:s;UI.J;JlHCKOrO Ha.3Ha'leHMJI
ilpeJ\MeTbI MeJ\ul.J;MHCKOro Ha3HaqeHH.H nOCJIe npHMeHCHH.H
nO,l\BepraIOTCH J\C3HHIl>eKI.J;HH MeTO,l\aMH KHn.H'JeHH.H, XMMH'lec-
KHM, napOBbIM H B03J\YWHbIM MeTOJ\aMH, COrJIaCHO OCTy 42-
21-2-85 r.: nOJIHOC norpymcHHe B 3% p-p xJIOpar.'IHHa Ha I
'lac UJIH 4% p-p nepeKHcH BOJ\opOJ\a Ha 90 MHH., HJIH 1,5%
pop rHnOXJ10pHJ\a KaJIbI.J;H.H Ha 1 'I, HJIH KHn.H'JeIlHe B 2%
COp,OBOM p-pe B TCqeHHC 15 MHH., HJIH J\HCTHJIJIHpOBaHHoii:
BOJ\e B TeqeHHe 60 MHH.
CorJIaCHO «MeTOJ\UqCcltHM YKa3aHH.HM no J\e3HHIl>eKuHH,
npcJ\crepHJIH3aI.J;HOHHo:i1 OqHCTKe H CrepHJIH3au IH npeJ\MeTOB
218
3% pop X/10paMI-IHa- 60 MI-IH.
AE3It1H 1 <1>EKLlIt1f1 "'4% pop nepeKI<1CI-I BOAopoAa - 90 MI-IH. (6%-
60 MI-IHYT)
,5% p-p rl-lnOX/10pI<1Ta KaIlb l-I5I - 60 MI-IH.
Kl-lnSl4eHl-le - 15 MI<1H B 2% COAOBOM p-pe 1-1l11li
npOMblBAHIt1E KI<1nSl4eHI<1e 30 MI-IH B ,QI1CTI-IIlnHpoBaHHoi1 BOAe
npOT()LjHOIiI .
BOAOIiI OT AE3-
PACTBOPOB nOIlHoe norpy>KeHl-le B MOIOUjl-li1 pop npl-l TeMne-
! / parype 50°C, 3KCn031-1 I-ISI- 15 MI-IH.
EpweBaHHe B MOIOUjeM p pe Ka)!(,Qoro npeAMe-
Ta - 30 c. n0/10CKaHl-le B npoT04Hoi1, 3aTeM B
nPEACTEPIt1- AI-ICTl-lnIll-lpoBaHHoi1 BOAe. -
filt13ALlIt10HHAA
OYIt1CTKA npOCYWI<1BaHl-le B C)f(W npl<1 TeMneparype 85°C
I I-Inl<1 OTKpblTblM cnoco60M.
..,
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npEACTEPIt1- /n p 06a Hnl-l a30nl-lpaMOBaSl npo6a.
filt13ALlIt10HHOIiI napoB03AYWHbli1 MeTOA (KoHTponb CTepl-lnbHOC-
OYIt1CTKIII TI-I- It1C - 120°C, 1,1 aTM,_ 45 MI-IH; It1C -
t < 1320C, 2 aTM, 20 MI-IHyr 4JI<1PMbI «BI-IHap»).
CTEPlt1fiIt13Al\1t1f1
B03AYWHbli1 MeToA (KoHTponb CTepl-lnbHOCrn-
TepMOI-IHAI-IKaTOp 180°C, 60 MI-IHYT <!>l<1pMbI
«BI<1Hap»).
3Tanbl o6pa6oTKM M3AenitH ME!AM(\ItHCKOrO Ha3Ha'leHMR
MCJ\HI.J;HHCKOro Ha3HaqCHH.H», YTBepmJ\cHHbIX M3 POCCHM 30
J\eKa6p.H 1998 r. J\I1! MY - 287-113, MomHO HCnOJIb30BaTb
6% Pop nepeKHCH BOJ\opOJ\a B TeqeHHe 60 MUll. HJIH J\PyrHe
pcrmll eHTHpOBaHHbIe p-pbl .lIJIJI J\e3HH$eKl.J;HH.
OCTaTKM KpOBH H 6HOJrorH'JeCKHe JKHJ\KOCTH J\e3HH(IJ1U H-
PYIOTC.H MCTOJ\OM 3aCbInaHHSI cyxoii: XJIOpHO:i1 H3BeCTH HJIH
XJIOpaMMHOM B COOTHOlIIeHHM 1:5, 3Kcn03MI M.H - 1 q.
B HaCTO.H Ce BpCM.H cy ecTBYeT rpynna- J\c3im$HI.J;HpyIO-
IIUiX cpe)J;CTB, n03BOJI.HIO MX npOBCCTH J\e3HH$eKI.J;HIO M npc,l\-
CTepHJUI3al.J;HOHHYIO O'JHCTKY OJ\HOMOMeHTHO: .BHpKOH»,
..n:IOJTh6aK , .TICPOKCHMCJ\& M .lip.
219
.n;e3Im4>eK IUIIIHCTPYMeHTapHSI
MeAII HHCKOro Ha3Ha'leHIIH
l\eJIL: 06ecne'leHHC HHcl>eK UOHHOH 6C30naCHOCTH.
OCHaUJ,Cmle:
_ 3% p-p XJIopaMHHa (HJIH ,l\pyroH perJIaMeHTHpoBaHHbIH
Ae3HHcl>11I\HPYIOUJ,l1H pacTBOp);
_ nOJIl1MepHbIH KOHTcHHep AJISI ,l\e3HHcl>cK HH HJIH ,l\BC eM-
KOCTH C COOTBeTCTBYIOUJ,eH MapKHpOBKOH H ,l\e3HHcl>H HPYIO-
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. 1J,JISI npOMbIBaHHSI HHCTPYMeHTOB OT KpOBH H ,l\pyrHx
6HOJIOm'lecKHx JKH,l\KOCreH;
. ]J,JISJ. 1J,e3HHcl>eK HH HHCTPYMeHTap I$I;
_ HHCTpYMCHTbI nocne l1CnOJIb30BaHHSI (B c06paHHOM BH,l\C);
- JIOTKH;
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06H3aTeJILHLIe YCJIOBlm:
_ C06JIIO,l\eHHe OTpaCJIeBoro CTaH1J,apTa 42-21-2-85, onpc-
,l\eJISIIOIr(ero MeTO,l\bI, cpe,l\CTBa H peJKHM ,l\e3HH(])eK HH H CTC-
pHJIH3a HH H3,l\eJIl1H MC,l\l1 HHCKOro Ha3Ha'leHHSI H HHCTpYK-
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3Tanbl npl<lMe'laHI-ISI
noiJzomo6K8 K npol.{eiJype
1. HaAeTb cnel\oAs>t<J:\Y: xanaT. C06moAaeTcSI 6e30nacHoCTb MeA-
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naKTI-IKa B03Aei;jcTBI-ISI TOKCI<I'IHb'X
Bell\eCTB.
2. npl<lroTOBI<ITb 3%-Hbli;j pop xnopa- C06nlOAaeTcSI OTpacneBoi;j CTaH-
MI-IHa (I<Inl-l APyroi;j pernaMeHTl<lpO- AapTa 42-21-2-85, npeeMcTBeH-
BaHHbli;j pacTBop), cAenaTb oTMeTKY HOCTb B pa60re, nl<l'lHaSi OTBeTCT-
Ha 61<1pKe 0 BpeMeHI<I npl-lroTOBne- BeHHOCTb.
HI<ISI, nOCTaBI<ITb nOAnl-lCb.
3. nOAroTOBI<ITb OCHall\eHl<le.
4. Hanl<lTb npl<lroroBneHHbli;j pac- -
TBOp B eMKocrn.
BbinonHeHue npol.{eiJYpbl
1. B nepBo>; eMKOCTI-I:
a) 3anOnHI<ITb BHyrpeHHl<le KaHa- npBAynpe>t<AI<ITb pa36pbl3rl<lBaHl<le
nbl wnpl<Il\eB, I-Irn, I-IHCTpYMeHTapI<lSl nOTeHl\l<IanbHO I<IH<jJ1<I41-1poeaHHoro
HenocpeACTBeHHo nocne I<ICnOnb30- BHyrpeHHero cOAep>t<I<IMoro wnpl<ll\a
BaHI<IR; I-Inl<l APyroro I<IHcTpYMeHTa.
220
3Tanbl I 06ocHoBaHHSI I
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2. Bo BTopoi1 eMKocrn: 3cj)<!>eKTI-IBHoi;j Ae31-1Hcj)eK41-11-1.
a) 3anOl1HI-ITb BHyrpeHHl-le KaHa-
nbll-lHCTPYMBHTapl-lSl.wnpl-l4eB,I-Irn;
6) pa306paTb, norpY31<1Tb Bce
nOl1HOCTblO.
3. 3a!<pblTb eMKocn'!<pblwKoi;j Ha 1 AOCT\;\raeTCSI 3cj)cj)eKTI-IBHOCTb 06e3-
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Hoe BpeMSI). CHa.1JKaeTCR aKTI-IBHOCTb xl10pa B
paCTBope.
4. CMeHI-ITb nep4ana-l, norpY31-1Tb B
eMKOCTb C AB3paCTBopoM.
5. CJ:\e11aTb OTMeJKy Ha 6"'PKB 0 AnSI co611IOAeHI-ISI CpOKOB npoBeAB-
BpeMBH.., AB31-1Hcj)eK41-11-1. HI-ISI Ae3\;\H<!>eK41-11-1.
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1. 1113Bne'1b I-IHCTPYMeHTbll-t3 Ae3pa-
creopa no HCTB'IeHI-II-I BpeMeH..,
Ae31-1H<!>eK41-11-1.
2. Cno>t<\;\Tb B J1OTOK.
3. nOAl"OTOBI-ITb MHoropa30Bbli;j
..,HcTpyMeHTap..,i;j AIlSi AanbHei;jwei;j
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ro!<paTHO. 6bIX 3arpSl3HeHl-li;j AIlSi AanbHei;jwei;j
06pa60TK!o1 B LlCD He npl-lHI-IMaeTcSI.
5. Bbl11I-ITb I-ICnOnb30BaHHbli;j Ae3pa- Ae3pacTBopbl np..,MeHSIIOTcSI OAliO-
CTBOp B KaHan\;\3aLlI<lIO. !<paTHO.
6. CHSlTb nep'1aTK!o1, BblMblTb PYKI<I, C06n1OAeH\;\e 111<l4HOi;j m;"'CHbi.
OCYW\;\Tb.
2-11 3man. npCACTepIIJI1I3 U 1I0J1HaSI
O'lHCTICa FlIfCTpYMCHTOB
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3aBHCIlT T '1HCTOTbI CrepIIJIH3yeMblx 06'beKTOB. HaJIu'Il1e 3ar-
pSI3HeHUIi opraHl1'1OCKoro H HcopraIUI'IeClwro xapaKrepOB (oc-
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KpOBH I-H Ha CTp. 86, H .liP.), C03J\81OIl\HX BOKPyr_ MHKpOOp-
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HOCTb KaK TepMH'IeCKOH, T8K H XHMH'IeCKOH CTepHJnI38 HH.
BOT nOqeMY npeJ\CTepHJIH3aIJ;HOHHOH 06p86OTKe npHJ\ae fC.H B
H8we BpeM.H 60JIbWOe 3HaqCHHe. u
IJpeJ\CTCpHJIH3a HOHHOH OqHCTKe, BbInOJIII.HeMOH B CTpO-
rOH nOCJIeJ\oBaTcJ!bHoCTH, onpeJ\e.neFHoH npHKa30M M3 CCCP
N 208, OCT 42-21-2-85 r., nO.l{BepraIOTC.H HHcTpYMeHTbI,
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H8.H H npoJ\OJDKHTeJIbHa.H pa6OTa, KOTOpyro BbInOJIH.HIOT B nep-
'J8TKax.
nOpH,lJ;OK 06pa6oT1m: °
1. 3aMO'!HTb B rOp.HqeH BOJ\e (50-60 C) 1J,Jl.H pa3M.HI"IeHH.H
CMa30'JHoro M8TepHaJIa (MaCJIa).
2. O'IHCTHTb '1HCTOH Tp.HnKOH CMa3I(Y J\O nOJIHOrO YJ\8JIe-
HH.H, pa306paB HHCTPyMCHT Ha COCTaBHbIC qaCTH (He nepeny-
T8Tb J\eT8JIH).
3. 3aMOqHTb O'lHIl\CHHbIe HHCTpyMcHTbI H8 15-20 MHH. B
rOp.H'ICM pope 1 % MOIOIl\ero p-pa. u
4. OnOJIOcHYTb HJIH npoTcpcTb Tp.Hno'JKoH, CMO'leHHOH B
KepocHHe HJIH a eTOHc, J\06HB8.HCb nOJIHOro YJ\aJICHH.H OCTaT-
KOB CMa3KH. o/c
5. O'lH eHHbIe J\O 6JICCKa F1HCTPYMeHT;I KHn.HTHTb B 2
p-pc HaTpH.H 6HKap60HaTa u (COJ\bI) HJIH u B 1 Yo MOIOIl\eM pope
1'1 BHOBb npOTepeTb '1HCTOH Tp.HnOqKoH.
6. TIpH Heo6xoJ\HMOCTH 06pa60TKY KepocHHoM HJIH a eTO-
HOM nOBTopHTb.
MncTPYMeHTbI, 6bIBWHe B ynoTpe6JIeHHH, nOJ\BepralOTC
npeJ\c epHJIH38 HOHHOH O'lHCTKC ne CXCMe, pa3pa60T8IIHOH
COTpYJ\HHKaMH D;HMI1AMC H pClwMeHJ\oBaHHoH OC'rOlvr H np.;
.i 3 M 20-87 r OC060H TCXHOJIOrHH npeJ\cTepHJIH38IJ;HOHHOH
O'lHCTKH Tpe6YlOT pC3HHoBbIe KHWe'lHbIe Tpy61(H, KaTcrepbI,
J\peHa>KHbIe TPy6KH, 30HJ\bl.
TIocJIe J\e3HHcl>cK HH B 4% p-pe nepeKHcH oJ\opoJ\a (9
MHH.) pC3HHoBbIe Tpy61(H npoMblBalOT rOp.H'JeH npOTO'lHOH
zzz
BOJ\OH. TpYOKH p83MHH8lOT n8JIb 8MH, p8CT.HrHB8IOT, MeH.H-
lOT HanpaBJIeHHC CTPYH.
B COOTBCTCTBHH C HHCTPYK HeH CHTp8JIbHOrO HHCTHTYTa
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BOJ\opOJ\a C 1% p-pOM C MOIO cro cpeJ\CTBa HJIH CMCCblO paB-
HbIX q8CTCH 1% p-pa HaTpH.H rHJ\poKap60HaT8 1'1 1% p-pa
8MMH8Ka. Tpy6KH .l{OJIJKHbI 6bITb nOJIHOCTblO 3anOJIHCHbI 1'40-
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npOTOqHOH BOJ\OH C nOBTopHblM pa3MHHaHHeM naJIb aMH 1'1
CMCHOH Hanp8BJICHH.H CTPYH H KHn.HT.HT 30 MHH B J\HCTHJIJIH-
pOBaHHoH BOJ\e, eIl\e pa3 npOMbIB8lOT 1'1 nOBTopHO KHn.HT.HT B
J\HCTHJIJIHpOBaHHoH BOJ\e 20 MHH.
MCJ\cecTpa pa60T8eT B MaCKe, B nep'laTKax. JIFI a, nepe-
HeCWHC rHOHHbIe 3a60JIeBaHH.H, It pa60Te HC J\onYCK8IOTC.H.
Pe3HHOBbIe TPy6KH npOBCp.HIOTC.H (HeT JIH ncperH60B, TpC-
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3aBCpTbIB8lOT B J\BYCJIOHHYIO 6.H3eBYIO C8JI«l>CTKY, CJIeJ\.H npH
aTOM, qT06bI pe3HHOBbIe Tpy6KH HC neperH6aJIHCb, T.K. Ha
MecTe ncperH6a npH CTepH.JIH38IJ;HH MOJKCT 06pa30BaTbC.H CTOH-
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My peJKHMY CTepHJIH3 H.
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nO.HBJIeHHH p030BOH OKpaCKH), HO He 60JIce IUCCTH p83.
.BHOJIOT& npHMeHHIOT npH PY'lHOH MOHKe B KOH eHTpa-
HH 0,5%, npH MaIIIHHHOH - 0,3%.
KOMnJICKC nepCKHCH BOJ\OPOJ\8 C MOIOIl\H:M CpCJ\CTBOM co-
J\epJKHT 0,5% ncpeKHcH BOJ\opoJ\a H 0,5% l'iIOIOIl\ero CpC,l\-
CTB8 (CooTHoweHHe 1:1), 06JI8,l\acT BbICOKOH MOIOIQeH IlKTHB-
HOCTblO, pa3pbIXJI.HCT pa3.JIH'lHOro pOJ\a 3arp.H3HCHHJl, HC BJIH.HCT
Ha KaqeCTBO CTeKJIa, p.HJ\a MCTaJIJIOB, nOJIHMCpHbIX MarepHa-
JIOB H JICrKO CMbIB8eTCH. TIcprHJ\po.'lb, BbrnycKaeMbIH npo-
MbIIllJIeHHOCTblO, COJ\CpJKliT 30-33% nepCKHCH BO,l\OpoJ\a. B
ZZ3
KaqCCTBC MOIOIl\flX Cpe,lJ;CTB npfiMCH.HIOT «TIporpecc», ACT-
Py», JIOTOC», «AHny».
TIpe,lJ;CTepflJUl3a IIOIlHYIO 06pa60TKY npOBO,lJ;.HT P}"lHbIM 101
MeXaIUIqecKFIM cnOC06aMFI.
B U.CO npoBO,lJ;flTC.H BeTHaH peaK fI.H Ha CJIC,lJ;bI ,lJ;e3f1H(])eIt-
TaHTOB, nO,lJ;TBCpJK,lJ;alOIl\aH, qTO nOCJIe flCnOJIb30BaHflSI HHCT-
PYMeHTapHH npOIlIeJI ,lJ;e3f1HIlJeK HIO. TIpfi ,lJ;e3HHcPCKIUiH XfI-
MflqeCKHMfI CpC,lJ;CTBaMH, HC CO,lJ;epJKaIl\flMH XJIOP, 3Ta peaK-
fI.H He npOBO,lJ;flTCH.
llpep;CTepHJIH3aIVfOHHaH O'.lHCTKa IlIlCTpYMeHTOB
OCHaUJ,eHHe: XaJIaT, MaCIta, nepqaTKfI. MOIOm flH pacTBop
0,5% KOH eHTpaIUiFI fl3 nepeKHcfI BO,lJ;OpO,lJ;8 101 MOIOIl\erO cpe,lJ;-
CTBa, q8CbI Ha 15 MHH. (ncCOqHbIe, 3JIeKTpflqeCKHe), epIlIH
HJIH MapJICBbIe TaMnOHbI, JIOTKfI, eMKOCTb C ,lJ;flCTflJIJIflpOBaH-
HOH BO,lJ;OH, CYXO)K8POBOH IlIKa<l>, HHcTPYMeHTapflH.
1. Ha.z\eTb XaJIaT, MaCKY, nepqaTKH.
2. TIO,lJ;OrpeTb MOIOI.I\HH 0,5 % pop nepeKflcH Bo,!\opO,lJ;a C
MOIOIl\flM Cpe,lJ;CTBoM ,lJ;0 50"C.
3. TIoMecTHTb HHcTPYMeHTapHH B pa306palIHoM BfI,lJ;C B
0,5% MOIOIl\HH pop Ha 15 MflH., npe,ABapHTCJIbHO nponycTFIB
p_p qepe3 nOJIOCTFI HHcTpYMeHTapH.H, 3aKpbITb KpbIIlIKO i
4. 06pa60TaTb CpIlIOM (MapJIeBbIM T8MnoHoM) B MOIOIl\erlI p-
pe, Kam,lJ;bIH npe,lJ;MeT B TeqeHfle 30 CCK. ('Iepc3 HrJIbI nponyc-
TflTb MOiOIl\flH pacTBop). 'YJIO)KHTb HHcTPYMeHTapflH B JIOTOK.
5. TIpOMbITb no,lJ; npOTOqHOH BO,lJ;OM B TeqCHFIe 30 eeK. KaJK-
,lJ;bIH npe,lJ;MeT, nponycK8.H BO,lJ;Y qepe3 nOJIOCTFI flHcTpYMeHTa-
pfl.H. 'YJIOJKHTb B JIOTOK.
6. TIpOMbITb HHcTPYMeHTapHH B ,lJ;flCTHJIJIflpOBaHHoH BO,lJ;e,
npocyIlIflTb B cyxOJKapOBOM IlIKa(])y npfl TeMnepaType 85°C
,lJ;0 nOJIHOrO flCqe3HOBeHfI.H BJIarfi.
3-u 3man. KOHTpOJIL Ka'.leCTna
npep;cTepUJIlI3alVfOHlioH O'.lHCTKH
TIpOBO,lJ;HTC.H nOCJIe npOBe,lJ;eHH.H npe,lJ; TepfiJIfl3a flOHlIoH
OqflCTKfI HIICTPYMCHTOB 101 ,lJ;p. npe,lJ;MeTOB MC,lJ;H flHCKoro H8-
3H8qeHH.H H8 CYXflX npe,lJ;MeTaX B KOJIHqCCTBC 1 % OTpa60TaH-
HbIX flHCTpYMeHToB. TIpflMeH.HIOT CJIe,lJ;YIOIl\fle np06bI: OpTOTO-
.rryH,lJ;HHOBYIO, 8MfI,lJ;OnflpflHoBYIO - (Ha KpOBb), 101 IlJeHom])Ta-
ZZ4
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pHJIH3a HH nOJ\BcpralOTC.H CYXHe H3AeJIH.H B ynaKoBK X 1013
6YMarH MeIIIO'lHOH HcnponHTaHHOH, 6YMarH MeIIIO'lUOI1 BJIa-
rOnpO'lHOH, 6YMarH J\JI.H ynaKoBbiBaHlUI npOJ\YK I1H Ha aBTO-
MaT8X MapKI1 E I1JII1 6e3 ynaKOBKI1 (B OTKpbITbIX CMKOCT.HX).
M3J\eJII1.H, npOCTepHJIH30BaHHbIe B 6YMare, MOryT xpaHHTbC.H
Tpoe CYTOK; H3J\CJIH.H, npOCTepHJIH30BaHHbIe 6e3 6YMarH, J\OJI-
)!(IIbl 6b1Tb HCnOJIb30B8HbI HenocpeACTBeHHO nOCJIe CrepHJIH-
3a IH. 0
Pa60'la.H TeMnepaTYpa B CrepHJIH3aIJ;HOUHOH KaMepe - 18
.C, BpeM.H BbIAepJKKH - 60 MHB. TIaKeTbI 1013 6YMarH rOTOB.HT
npY'IHYIO HJlH 3aBOJ\CKHM cnoc060M. illBbI Ha 6YMa)KHbI na-
IWTUX 3aKJIeHBalOT KJIeeM 1013 5% KpaXMaJIa. CBo60J\UbIH KO-
IIC nOCJIC 3aKJIeHBaHH.H neperH6alOT TPH)KJ\bI 101 repMCTH'IUO
38I<JIeHBaIOT.
231
IIopJlJJ:oK pa60TbI Ha B03,!1;ynIHblX
CTepHJlH3aTOpaX (cYXO:IfCapOBbIC IUI a bI)
1. 3arpy3Ka npOH3BOAHTCJI B XOJIOAHbI i CTCpHJIH3aTop.
2. HarpeBaHHe.
3. CTepHJIH3a IJI: OTC<JeT BpeMCHH CTCpHJIH3aIJ;HH HatIH-
HaTb OT AOCTHJKeHH.H HYJKHOH TeMnepaTypbI CTCpHJIH3a HH
(180 'C) AO HCTetIeHH.H cpoKa 3Kcn03H HH (60 MHHYT).
4. OXJIa:iK,l\eHHc: AO 40-50 'c.
5. Pa3rpY3Ka.
«Ae30KCOH-l» 06mlJ aeT BbIpa:IfCCHHbIM KOpp03HOH HbIM AeH-
CTBHeM, a n03TOMY He BcerAa npHroAeH AJI.H CTepHJIH3aIJ; ur HH-
CTpyMCHTOB. Pa60TaIOT, C06JIIOAa.H MepbI npeAOCTOpO>KHOCTH.
CTepMnM3aLlMR paCTBopaMM XMMM'IeCKMX BeaqecTB
IIepeKIICb BO,!l;opO,!l;a 06JIMReT BbIpaJKCHHbIM 06ecnJIOJKH-
BaIOlI(HM CBOHCTBOM. AJI.H CTCpHJIH3a HH HCnOJIb3yeTC.H 6%
nepCKHCb BOAopOAa - 3Kcn03H HSI 180 MHH., TeMnepaTypa
50'C; npH nOJIHOM norpY>KeHHH AJISI CTepHJIH38 HH H3AeJIHH.
H3 nOJIHMcpoB, pe3HHbI, CTeKJIa H Kopp03HHHo-HecTOHKHx Me-
T8JIJIOB 3Kcn03H H.H - 360 MHH. npH TeMnepaType 18 'c.
1I0 OKOH<JaHHH cpOKa 3Kcn0311 ur H3AeJIH.H npOMbIBalOT
ABYKpaTHo CTepHJIbHOH BOAOH 11 nepeHOCSIT B CTepHJIbHbIe
KOHTeHHcpbI, HanpHMep, CTepHJIH3aIJ;HOHHble Kop06KH, BbICT-
JI HHbIC CTepHJIbHOH npocTbIHeH (nOJIOTeH eM). H nJIOTHO 38K-
pbIBaIOT (CpOK CTepl1JIbHOCTH Tpoe CYTOK) HJIH BbIKJI8AbIBaIOT
Ha CTepHJIbHbIH HHCTPYMcHTaJIbHbIH CTOJI AJISI HCnOJIb30B8-
HHSI.
«}J;e30KcoH-l,) - 6ec BeTHaSI JKHAKOCTb C xapaKTepHbIlII
38naXOM YKCYCHOH KHCJIOTbI, XOpOIlIO pacTBopHMa B BOAe,
cnHpTe. BbInycKaeTCSI BO (])JIaKOH8X H3 TCMHoro CTeKJIa H npH
TeMnepaType 10°C Coxp8HSIeT aKTHBHOCTb B TetIeHHe rOAa.
AJISI CTepHJIH3a HH HCnOJIb3YIOTCSI p860tIHC p-pbI 1% (no
HaAYKcycHOH KHCJIOTe), AJISI tIcro B BOAonpoBoAHoii: BOAe pa3-
BOASIT 200 MJI npenapaTa .B 800 MJI BOAbI, 3Kcn03H HSI 45
MHH npH TeMncpaTYPc 18°C, p-p rOACH OAHH CYTKH, HCnOJIb-
3yeTcSI TOJIbKO OAHH p83.
IIpOCTepHJIH30BaHHbIe H3AeJIHSI npoMbIBaIOT B CTepHJIb-
HOH BOAe norpYJKeHHeM Ha 5 MHH C Tpoe-KpaTHoH CMeHOH
BOAbI, 8 38TeM nOMelI(aIOT B CTepHJIbHYIO CTepHJIH3a HOHHYIO
Kop06KY Ha CTepHJIbHYIO npOCTbIHIO. XpaHHTb MOJKHO TpOC
CYTOK.
CTepMnM3aLlMR ra3aMM
CTepHJIH3a HJI npOH3BOAHTCSI B CTa HOHapHOM ra30BOM
CTepHJIH3aTope. OCT peKOMeHAyeT BbITIOJIHSITb ra30BYIO CTe-
pHJIH3an;HIO pSIAa MeAH HHcKHX H3AeJIHii: OKHCbIO 3THJICHa I1JII1
CMecbIO OB.
CTepHJIH3a HH nOABepraIOT onTHKY, K8PAHOCTHMYJIHTOpbI,
H3AeJIHH H3 nOJIHMCpHbIX MaTepHaJIOB, pC3HHbI, CTCKJIa, MC-
TaJIJIa, nJIaCTMaCCOBbIX tIaCTeH pa3JIHtIHbIX annapaToB.
IIp8KTHtIecKoe ocymeCTBJIeHHe 3Toro MeTOAa BCTpetIaeT
3HatIHTeJIbHbIe TPYAHOCTH, n03TOMY ra30BaH CTepHJIH3a HSI
He nOJIY'IHJIa cme Toro pacnpOCTpaHeHHSI, KOTopoe OHa 3ac-
JIYJKHBaCT no CBOHM B03MO>KHOCTHM.
KOHTponb CTepMnbHOCTM
IIpoH3BOAHTCH 68KTepHOJIOrHtIeCKHMH, TeXHH<JecKHMH Ii
TepMHtIecKHMH MeTOAaMH.
EaKTepHOJlOrH'leCKHe MeTOJJ:LI caMbIC TO<JHbIe, HO Tpe6y-
IOT BpeMeHH HCnOJIHCHHH H n03BOJI.HIOT KOHTpOJIl1pOBaTb 3(P-
cPCKTHBHOCTb pa60TbI CTepHJIH3aTOpa. TeXHH'leCKHe MeTOAbl
KOHTpOJI.H CBOA.HTCH K nepHOAHtIeCKOH npOBepKe TeMncpaTY-
pbI nYTeM pa3MCmeHHH B KaMepe MaKCHMaJIbHbIX TepMOMeT-
pOB, KOHTpOJIH pa60TbI M8HOMeTpOB H T.A.
EOHTpOJIb TepMH'leCKOrO MeTOAa CTepHJIH3aIJ;HH npOBO-
AHTC.H nOBceAHeBHO. OH OCHOB8H Ha CBOHCTBe pHAa nopOIlIKO-
06pa3Hb!X BemeCTB MCHHTb CBOii: BeT H nJIaBHTbCH nOA B03-
)!NiCTBHCM onpeAeJIeHHoii: TeMnepaTYpbI.
AJIH KOHTPOJIH HCnOJIb3yIOT cpeACTBa H3McpeHHH TeMnepa-
TYPbI, AaBJIeHHJI, BpeMeHH, XHMHtIeCKHC TeCTbI, TepMOXHMH-
tIeCKHe HHAHKaTOpbI H 6HOTeCTbI.
HCnOJIb3YIOT CJIeAYIOmHe BemCCTBa:
· MO'IeBI1Ha (132'C).
. AJIH KOHTPOJISI 3a CYXO:mapoBOH CTepHJIH3a HeH Hcno-';h-
3YIOT: THOMOtIeBHHY (180'C); HHTapHYIO KHCJIOTY (180-192 C)
HAP.
Z3Z
Z33
B H8CTOSIlIwe BpeMSI CHCTeM8 . qHCTbIH HHCTpYMeHT» npcJ\-
nOJIar8<IT HCnOJIb30B8HHe J\JISI onep8THBHoro KOHTpOJUI TOJIbKO
H HK8TOPOB HHTcrpHpoB8HHOro .lIcikTBflSI MC-160, MC-180,
MC-120 H MC-132 !}>HpMbI «BHH8P», H3MeHSIIO flX OKP8CKY
J\O BCT8 3T8JIOH8 TOJIbKO npH B03J\CHCTBHH H8 HHX TeMne-
p8'rYPbI CTepHJIH38 HfI B TeqCHHe BceH CTepHJIH38 HH. TIpH
HCnOJIb30B8HflH B KOMnJICKTe C 6HOJIOrHqeCKflMH H !}>H3Hqec-
KHMH MeTOJ\8MH 3q,!}>eKT CTepfIJIfl38 HH. r8p8HTflPYCTCSI.
TIOJIOCKFI HH,l\HK8TOp8 3aKJI8,l\bIB8lOTCSI B KOHTpOJIbHbIe TOq-
KH CTepfIJIH3aTOpa npH KroKJ\OM HKJIe CTepfiJIHaawUI COrJIaCHO
flHCTPYK H. KOJIHqeCTBO 30H, B KOTOpbIC 3aKJI3,l\bIBaIOT HH,l\fI-
KaTOpbl, 3aBHCHT OT eMKOCTFI K8MepbI B03.l\YIIIHoro HJIFI napOBO-
1'0 CTepHJIH38Topa. ECJIH eMKOCTb cyxomapOBoro lllK8!}>a COCT8B-
JIJIeT 80 JIHTpOB, TO KOJIWIeCTBO F1H,l\HK8TOpOB paBHO nSITH.
OTp860T8HHbIe HHJ\HK8TOPbI nO,ll,KJIeHB8lOT B mypH8JI }"IeT8
CTepHJIH3an;HH B BbIJ\eJIeHHble J\JISI 3Toro KOJIOHKfI. MHJ\HK8TO-
pbI, 38JIOmeHHble B ynaKOBKe, npOBepSIeT MeJ\H IHcKHH nepco-
H8JI nepe,l\ npOBeJ\CHFIeM npO e.l\YPbl. M3J\eJIHC pa3pelII8CTC.H
HCnOJIb30B8Tb, eCJIH L(BeT flH.Z\flR8TOp8 He CBeTJIee 3T8JIOH8.
TIpfirOTOBJIeHfle 1118pHKOB: M8JIeHbKHe 1II8pHKH rOTOBSIT H3
M8pJIH 6x8 CM, Cpe,l\HFle - 8x10 CM. KYCoqKH M8pJIfI, B3SI-
TbIe J\JISI npHrOTOBJIeHHSI 1II8pHKOB, CBOP8qHB8lOT T8KHM 06-
P830M, qT06bI 06p830B8JICSI M8pJIeBblH KOMOK B BH,l\e Tpey-
rOJIbHoro KOHBepT8. TIpH 3TOM fl3 1II8pHK8 He J\OJImHbI TOp-
q8Tb HflTKfI.
H8f160JIce p8cnpocTp8HeH CJICJ\YlOlI\fIH cnoc06 cBepTbIB8-
HHSI 1II8pHKOB, COCTOSI HH 1'13 3 MOMCHTOB: npOTHBOnOJIOm-
HbIe CTOpOHbl M8pJIeBOH C8JI(])eTKfI 38rH68lOT H8 2 CM, nOJIY-
q8SI M8pJIeBYlO nOJIOCKY; M8pJIeBYlO nOJIOCKY YKJI8,l\bIB8IOT H8
HOI'TeBbIe q,8JI8HI'H 2-1'0 H 3-1'0 n8JIbL(eB np8BoH KFiCTH; CBO-
60,l\HbIe KOH bI BKJI8,l\bIB8IOT OJ\HH B JlPyroH, H nOJIyq8eTCSI
M8pJIeBbIH 1II8pHK.
TyPYHJ\bI (nOJIOCKfI) ,l\eJI8IOT 1'13 KYCKOB 6 IHT8 lllHPflHOH 5
CM fI J\JIHHOH 40-50 CM, KOH bI 6f1HT8 nOJ\Bop8qflB8lOT BH}'Tpb
H8 1-1,5 CM, 38TeM Kp8SI 6HHT8 coeJ\HHHIOT pyr C APyroM,
CKJI8,l\bIB8IOT eme p83, nOJI}"IeHHYIO nOJIOCKY H8M8TbIB8lOT H8
3 n8JIbL(8, 8 CB060J\HbIH KOHe nO,l\BOp8qflBa1OT BHYTPb 0'>P8-
30B8BlIIerOCH n8JIbL(8.
nOArOTOBKa nepeBH30 Horo MaTepMana
AnH CTepMnM3a MM
(cancperOK, raMnOHOB, wapIo1KOB, ryPYHA)
rOTOBSIT ncpeBSI30qHbIH M8TepH8JI H8 CneL(H8JIbHOM CTOJIC
lIHCTbIMH pYKaMH. )];JIH p860TbI B npo e.l\YPHOM K86f1HeTe 1'0-
TOBSIT M8JIbIe C8JIq,eTKfI, 8 T8K>Ke T8MnOHbI M8pJIeBbIe H B8T-
Hble 1118pflKfI. T8Mn0HbI, 1II8Pfll<H H C8JI(}>eTKH HCnOJIb3yroT J\JISI
y,l\8JIeHfI.II KpOBfI, npflm8THSI KPOBOTOq8lQcro COCYJ\8 fI T.n.
TIPHroTOBJICHHe MaJIbIX CaJI!}>eTOK: Bce Kp8SI M8pJIfI, P83-
MepOM 20x15 CM, ,l\OJImHbI 6bITb nO,l\BepHYTbI BHYTpb C8JI!}>eT-
KH. TIepBbIMH nOJ\Bop8qHB8lOT Kp8SI 60JIblIIHX CTOpOH TaK,
lIT06bI OHH 38XO,l\HJIFI HeCKOJIbKO ,l\Pyr 38 ,l\PYI'8, 38TeM nOJ\BO-
paqflB8lOT, MeHblIIHe CTOpOHbI BHYTPb J\O conpHKOCHOBeHHSI
J\Pyr C .lIpyroM, fI C8JIq,eTKY CKJI8,l\bIB8IOT nOnOJI8M. M3 Tex mc
K CKOB M8pJIH rOTOBSIT T8MnOHbI: 60JIblIIfle, cpeJ\HHe, M8JIble,
8H8JIorHqHO C8JI!}>eTK8M, 38 HCKJIlOqeHfleM nOCJIeAHHX M8HH-
nYJISI flH. )];JISI C03J\8HHSI T8MnOH8 06P830B8HHYlO nOJIOCKY
CKJI8.l\bIB8IOT nOnOJI8M B npOJ\OJIbHOM fI nOnepCqHOM Hanp8B-
JlCHHHX.
YKJIaJJ;Ka B CTepUJIH3aL(HOJlHble Kop06KII
nepeBH30'lHOrO MaTepHaJIa
l\eJIL: YKJI8J\K8 AJISI CTepHJIH38L(flH B aBTOKJI8Be H COXP8-
HCHHe CTepHJIbHOCTH B npOL(eCce Xp8HeHHSI B TCqeHfle peI'JI8-
MeHTHpOBaHHoro BpeMeHH.
OCU8meJllfe:
- ,l\e3p8cTBOP: 1 % pop XJIOp8MHH8 (fiJIH J\pyroH perJIallIeH-
THPOB8HHbIH p-p);
- BeTOllib C M8pKHpOBKOH «,l\JISI 6f1KCOB» - 2 IIITYKH;
- eMKOCTH J\JISI J\e3HHq,eK HH BeTOlIIfI, nepq8TOK;
- nepqaTKH, M8CK8;
- 60JIblIIaH nOJIOTHSIH8.II (6.II3CB8H) C8JIq,eTK8 AJI.II BbICTH-
JI8HfI.II BHYTpCHHCH nOBepxHocTH 6f1KC8;
- ncpeBH30qHbIH M8TepH8JI B M8pJIeBbIX MelIIOqK8X (C8JI-
(1II'Tlm. TYPYHJ\bI, B8THble 1II8pfIRH H T.J\.);
- HIIJ\HKaTopbI CTepHJIbHOCTH - no 3 IIIT. H8 K8>Kl!bIH
6f1I<C;
- 6f1pK8 C YK838HHCM OTJ\eJIeHHSI (K86f1HeT8), cOJ\ep>KIIMo-
1'0 6HKC8, J\8TbI YKJI8J\KfI H ,l\8TbI CTepHJIH38 HfI H nycrbIMH
2 3 4
Z3S
KOJIOHKaMH J1.1ISI nOCTaHOBKH nOAnHCeM MeAH IHCKOM CeCTpbI,
npOH3BOAHBilleM YKJI8,r(Ky H OTBeTCTBeHHOM 3a CrepHJIfl3aIJ;HIO.
Heo6xoJJ;HMLIe yCJIOBHJI: Kop06KfI CrepfIJIH3aIJ;HOHHLIC (EC)
C cl>HJrbTPOM (E<I» HJIH 6C3 cl>HJILTpa pa3HOM eMKOCTH H cl>op-
Mbl.
3Tanbl npHMe4aHIiIR
noi'JzomoBKa
1. BblMblTb pyKIiI, BbIOCYWIiITb.
2. npoBepliITb IiIcnpaBHOCTb 6li1Kca.
3. HaAeTb nepyaTK1-1, MaCKy. 06ecneYIiITb 6e:!OnacHocTb MeAI1-
LtI1HCKOi;j cecTpbl Ha pa60yeM MeCTe.
4. 06pa60TaTb OOKC 1-13Hyrplillil CHa- ComacHO OCTy 42-21-2-85 Ae3I-1H-
py>K11 Ae3pacTBopoM nocneAoBa- 4JeK41-11i1 nOABepralOTcS1 Bce 1-13Ae-
TenbHO. ABYKPaTHO, pa3Hoi;j BeTO- nl-l5l, nOAfle>Ka\lll'le CTepWl1il3a41-11-1.
WblO. C06nlOAaTb npl1H4Hn o6pa6oTKI-I
«or 41-1CTOro K rpS13HOMY».
. C6poCI1Tb BeTOWb AflS1 Ae3lilH-
<!>eK41-11-1 B 1 %-Hbli;j pacTBop XIlopa-
MI1Ha Ha 60 MI-IHyr.
6. CHS1Tb nep4aTKIiI, norpY311Tb B
Ae3paCTBop.
7. CHS1Tb MaCKy.
8. BblMblTb PYKI-I, BblTepeTb Hacyxo.
9. nOAroToBIiITb nepeBS1304Hbli;j 3TO S1BnS1eTCS1 ycnoBlileM npOBeAe-
MaTepl-lan K YKflaAKe B COOTBeTCT- HI-IS1 CTepl-lnl-l3a41-11-1.
BIiIIiI C HOpMaMI-I 3arpY3K1-1 61-1KCOB 101
BIiIA3 YKflaAKI1 (BIilAOBOi;j, 4eIleBoi;j 1-1
YHI-IBepCanbHoi;j).
10. OrKPblTb cen<y 61-1KCa (683 YcnoBlile npOBeAeHI-I5I CTep1-lIl1il3a-
4Jl-lnbTpa). 4lil1il B ooKcax 6e3 4JIiIIlbTpa. OTBep-
CTI-IR 61-1KCa AOnJKHbl OCTaBaTbCSl
OTKpblTblMI-I AO KOHlja CTepl-lIll-l3a-
Ltl-ll-l.
BblnOnh'eh'ue
1. BblcTeIlIiITb caIl<!>eTKoi;j AHO 1-1
KPaS1 61i1KCa 6e3 4Jl-lnb Tpa TaK, yro6b1
OHa CBI-ICana Ha 2/3 BblCOTbl ooKca.
2. nOMeCThTb Ha AHO 61-1KCa 06eCne4li1BaeTCS1 KOHTponb Ka4eCT-
(B TOYKY KOHTponS1) I-lHAI1KaTOp CTe- Ba CTeplilnlil3aljl111 Ha AHe 6l1Kca.
pl1IlbHocrn.
3. YnOJKI-ITb nepeBSI304Hbli;j MaTepl+ 06ecne4I-1BaeTCS1 paBHoMepHoe
an nocIloi;jHO: npOHI-IKHOBeHl-le napa npl-l CTepl-lnl-l-
3aljl-ll-l, BHyrpb 6l-1Kca.
236
"
3rnnbl np1-IMB4aHI-IS1
BblnOnh'eHue
a) ceKTOpanbHo: 06ll\11i;j nOp5lAK C06Il1QAaeTCS1 B
61-1KCe npl-l1-l3BneyeHI-II-I MaTepl-laIla.
6)BepTI-IKanbHo(nepne KY- YKflaAKa npOIil3BOAlilTCS1 napanIlenb-
nS1pHO KPblwKe): HO ABI1JKeHl11O napa.
B) pblXllO.
4. nOMeCTI1Tb I-IHAI-lKaTOp CTepl-lnb- KOHTJ)OIlb KayeCTBa CTep11Il1il3a41-11i1.
HOCTI-I B LteHTpanbHYIO 4aCTb 6l1Kca.
5. HaKpblTb can<!>eTKoi;j, CBI-ICalOll\ei;j
C KPaeB 6I1KC , BeCb ynOJKeHHbli;j
MaTepl1an.
6. nOIlO>KlilTb nOA KpblWKY 611Kca KOHTponb KayeCTBa CTepl-lIllil3aLtl-ll-l
IiIHAIiIKarop CTepl-lnbHOCTI-I. nOA KpblwKOi;j 6li1Kca.
7. 3aKPblTb Kpblwt<y 61-1KCa Ha 3aMOK. 06ecne<llilBaeTCS1 repMeTI-IYHOCTb
CTepl-lnbHOrO ooKca.
OKOh''lah'Ue
1. npl-lBS13aTb K PYYKe ooKca 6Ii1PKY. Co6nIOAaBTCS1 npeeMCTBeHHoCTb B
pa60Te C 6I1KCOM.
2. nOCTaBIiITb Aary YKflaAKIiII-I nOA- nOAroToBIleHHble K CTeplilnl13aljl-ll-l
nl-lCb OTBeTCTBeHHoro 3a YKflaAK}'. 611KCbl AOCTaBnS1IOTCS1 B LlCO B
MOTHOM BIlarocToi;jKOM MeWKe.
MeWOK nOAflB>i<IiIT CTeplilnl-l3aLtl11i1 B
LlCO iii I-IcnoIlb3yeTcS1 AflS1 3<!>4JeK-
TI1BHOi;j TpaHcnoprnpOBKI1 61i1KCOB 1i13
LlCO
I(eJIeBaSI yKJIa a
JJ;JIn HaKpLITHJI CTepHJILHOrO CTOJIa
I(eJIL: ynaKoBI<a AJISI CTepHJIH3a fIfi B aBTOKJIaBe, coxpa-
nCHHe CTepfIJIbHOCTFI B npo ecce xpaHeHflSI B TeqeIIHe perJIa-
MCU'fHpoBaHHoro BpeMeHH.
Oc'nau eHHe:
- Ae3 IHcl>H I1pyroIQHM pacTBop J1.1ISI 06pa60TKH 6f1KCa (1 %
pnCTBOp XJIOpaMHHa HJIH APyroH perJIaMCHTHpoBaHHbIH pa-
C'TJlOp );
- neTOIIIL AJISI Ae3f1Hcl>eK MH 6f1KCa - 2 lIlT.;
- CMI<OCTH C Ae3HHcl>H flPYIOII\HM paCTBopOM AJISI BeTOIIIH
H IICp<IRTOK;
- nepqaTKH, MaCKa;
- 60JIblIlaSl CaJIcl>eTKa AJISI BbICTH1IaHflH 6HKca 6e3 CpflJILTpa;
237
- MH.n;MRaTOp CTepMJIbHOCTM - 3 IliT., coe.n;MHeHHble TeceM-
ROM, paBHOM .n;JIMHe 6MRca.
U;eJIeBaH YKJI Ra:
- npOCTbIHb 6H3eBaH;
- xMpyprM'IeCRMM XaJIaT;
- MaCRa, ROCbIHRa (MJIM IlianO IRa);
- nep'laTRM M3 JIaTeRCa;
- nOJIOTeH e MJIM 60JIbIliMe CaJIcpeTRH .n;JIH YRJIa.n;RM;
- MaJIble CaJIcpeTRM;
- nOJIOTeH e JIM'IHOe .n;JIH BbITHpaHMH PYR.
BMpRa C YRa3aHMeM OT.n;eJIeHMH (Ra6MHeTa), co.n;ep.mMMoro
6HRca, .n;aTbI YRJIa.n;RM, no.n;nMCM Me.n;M MHCROM ceCTpbI, BbI-
nOJIHMBIlieM npo e.n;ypy YRJIa,n;RM, H BpeMeHM.
Heo6xo.l1:HMbIe YCJIOBHH:
- Rop06RM CTepMJIM3a MOHHble .n;OCTaTO'lHOM BMeCTMMOCTM
M pa3HOM CPOpMbI;
- 6eJIbe B ROJIM'IeCTBe, COOTBeTCTBYIO ee HOpMaM 3arpY3-
RM 6MRCOB.
3Tanbl I npHMB'IaHI1R
nOoaomoBKa K npoLjeoype
9. CnOJKI1Tb xl1pyprl1'1BcKI1C1 xanaT
TeCeMKaMI1 BHyrpb, 113HaHK0C1 Hapy-
>KY, cBepHyrb npOAonbHO HeCKOnbKO
pa3 AO OOnl1411HbI BblCOTbl 611Kca,
3aBepHyrb B pynoH, '1T06bl nerKO
paCKpyYHBaflCR.
10. nOArOTOBI1Tb nep4aTKI1 naTeKC-
Hble:
a) npOTaflbKOBaTbTaK.'1T06bl He
6b1JlO KOM04KOB TanbKa:
6) BnO>KI1Tb BHyrPb Manble can-
!j>eTKI1:
B) npOnOJKl1Tb can<!>eTKOC1 Me>K,Qy
naI1bl.l<lM14 neP'laTOK:
r) 3aBepHyrb can!j>eTKY TaK, '1To-
6bl nep'laTKI1 He KaCanl1Cb APyr
APyra.
npHMB'IaHI1B: npeAynpe>K,QaeTCR
CKJleHBaHHe nepyaTOK, '1TO HeAO-
nYCTHMO npl1 cTepHnl13allHI1.
11. CnO)Kl1Tb nonOTeHlIe npOAOnb-
HO, 3aTeM nOnepBYHo. cBepHyrb B
pynOH pblxnO.
npHMe'laHI1B: I1cIlOnb3yeTcR AIlR
BblTl1paHI1A PYK npl1 XI1pyprl14ecKOM
cnoc06e MblTbR.
12. nOAroTOBI1Tb 4-6 MapneBbiX He06xoAI1MOe KOnl1'1eCTBO can<!>e-
can<!>eTOK. TOK AIlR ABYKpaTHOC1 06pa60TKI1 PYK
aHTl1CemI1KOM.
13. nOp,rOTOBHTb yeTblpexcnoC1HYIO
MaCK}'. 3aBepHyryK> B KOCbIHK}' (OT
KOHIIOB HOWeHI1R K BepxywKe) I1nl1
KOnnaK.
14. OTKpblTb ceTK}' 6HKca.
npI1MB'IaHI1R: OTBepCTI1R 611Kca
AOn>KHbI OCTaBaTbC5I OTKpblTblMI1 AO
KOHI a CTepl1nl13alll1l1.
15. BblCTenl1Tb 611KC can!j>eTKoC1 TaK, 06eCne'lHBaeTC5I repMeTI1YHOCTb
'1T06bl ee KOHlIbl CBI1Canl1 Ha 1/3 ynaKOBKI1 nocne CTepl1nH3alll111 AIlR
BbiCOTbl 6l1Kca: COXpaHeHI1R CTepl1nbHOCn1.
BblnonHeHue npoLjeoYPbl
1. noMeCTI1Tb Ha AHO 611Kca I1HJ1HKa-1 KOHlponb KayeCTBa CTepl1nl13al.ll111 B
TOp Crepl1nbHOCTI1. KOHTponbHblX TO'lKax
611Kca.
3Tanbl I npHMB'IaHHR
nOoaomOBKa K npoLjeoype
1. npoBepl1Tb I1CnpaBHOCTb 6l1Kca.
2. H;!AeTb nep4aTKl1, MaCK}'. 06eCneYI1Tb 6e30nacHoCTI1 Ha pa-
60yeM MeCTe.
3. 06pa60TaTb 611KC H3Hyrpl111 CHa- 06ecne4l1Tb I1H<!>eKl.II1oHHytO 6e30-
PYJKH Ae3pacTBopoM nocneAOBa- naCHOCTb.
TeJlbHO, ABYKPaTHO, pa3H0C1 BeTO-
WblO.
4. C6poCI1Tb BeTOWb AIlR Ae3I1H-
<!>eKI.II1I1 B eMKOCTb C Ae3pacTBopOM.
npHMB'IaHI1B: BeTOWb I1CllOnb3yeT-
C5I oAHOKpaTHO 11 nOABepraeTcR
Ae3HH<!>eKl.ll1I1.
5. CHATb nep'IaTKI1, norpY311Tb B C06nlOAaeTcR HH<!>eKII110HHaA
Ae3paCTBOp. 6e30nacHOCTb.
6. CHRTb MacK}'.
7. BblMblTb PYKI1, BblTepeTb Hacyxo Co6nlOAaercR nl1'IHaA rl1lV1eHa Me-
nl1YHblM nonoTeHlIeM. AI1I1I1HCKOC1 cecTpbl.
8. CnOJKI1Tb npoCTbIHb B 4eTbipe nOArOTOBneHHaA TaKl1M 06pa30M
cnOR, 3aTeM corHyrb KOHlIbI, 3aBep- YKJl;!AKa 3aHI1MaeT MeHbwe MeCTa B
Hyrb B pynOH PbIXllO. 'IT06bl nemo 611Kce, nerKO pa3BOpaYI1BaeTCR 11
paCKpyYI1BaJ10cb. paBHOMepHo nponycKaeT nap. CIlO-
c06CTByeT CTepl1J1113alll1l1.
Z38
Z39
3Tanbl npI1MB'IaHI1S1
Bblf10nHeHUe npoLjeoYJ!bl
2. YnOIKI1Tb B 611KC BepTI1KanbHO, Yt\o5HaSl <!>opMa YJ<f1<IAK11 6enbSl 11
Pb'xnO xanaT. rOpnOBI1"O K KpblW- xanaTa, TaK KaK cOKpal1laeTCSI Bpe-
Ke. MSI B3S1TI1S1I1X 113 CTepl1nbHoro 611K-
" ca, Heo6xoAHMoe ycnoBl1e AIlSl
3<!>cjJeKTI1BHO crepl1nl13alll1l1.
3. npOCTblHSI.
4. MacK}', 3aBepHyrylO B KOCbIHK}',
nOBepxHocTHO, Me>K,Qy xanaToM 11
npocTblHe .
5. JlaTeKcHble nep4aTKI1 B ynaKoBKe
cBepxy 6enbSl.
6. Manble cancjJeTKl1 p5lAOM C
nep'IaTKaMI1.
7. nonoTeHlIa I1nl1 can<!>eTKI1.
8. nOMeCTI1Tb HHAI1KaTOp CTepl1nb- KOHTponb Ka4eCTea CTepl1nl3all"11 B
HOCTI1 B lIeHTpanbHYIO ',aCTb 6l1Kca. KOlnponbHblX T04Kax
6l1Kca.
OKoH"aHue npOLjeaYPbl
1. HaKpblTb caml>eTKo . CBHCalOl1Ie
C KpaeB 611Kca, Becb ynQ)KeHHbl
Marepl1an.
2. nOllO>IG1Tb not\ KpblWK}' 611Kca KOHTpOnb Ka4eCTBa CTepl1nl138111111 B
11HJ\I1KaT0P CTepl1nbHOCTI1. KOHTponbHblX T04KaX
6l1Kca.
3. 3aKpblTb KpbIWK}' &1KCa Ha 3aMOK.
4. npl1BSl3aTb K PY4Ke 611Kca 6I1pK}'. 06ecne'lI1BaeTCSI npeeMCTBeHHocTb
AIlSl pa60Tbl C 6I1KCOM. .
5. nOCTaBI1Tb Aary YJ<f1<IAKI1I1 noA- JlH'IHaSl OTBeTCTBeHHOCTb.
nHCb OTBeTCTBeHHOI'O 3a YJ<f1<IAK}'.
6. ,QOCTaBHTb &1KC B LlCO B nnOT-
HOM enarocTo KOM MeWKe.
npHMB'IaHl1e:MeWOKnOAfle>KMT
cTepl1nl13a1l1111 B LlCO I1l1cnonb3Y-
eTCSI AIlSl 3<!><l>eKTl1BHO TpaHcnop-
Tl1pOOI{1,1 6HKCOB 113 LlCO.
TIo.u;rOTOBKa K npOl.\e.u:ype
1. TIOCT8.BMTb CrepMJIbHbIe 6MKCbI C 6eJIbeM, YKpenllTb, npo-
BepMTb MapKMpoBKY, CTepMJIbHOCTb 6MKca no BHelIIHeMY BMJG'.
2. OTKpbITb 6MKC C nOMO blO neAaJIll MJIM nOMO HMKa.
3. M3BJIe'lb MHAMKaTopbI CTepMJIbHOCTll, OI.J;eHMTb MX co-
CTO.Hlme.
4. B351Tb H3 6HKca CrepHJIbHYIO KOCbIHKY M MaCKY C nOMO-
II.J;blO CTepMJIbHOrO KOpHI.J;aHra, 3aKpbITb 6HKC.
5. HaAeTb CrepllJIbHYIO KOCbIHKY M MaCKY.
6. BbIMbITb PYKM Ha xMpyprM'IeCKOM ypoBHe, 06pa6oTaTb
PYKM 0,5% cnMpToBbIM pacTBopoM XJIOpreKcH,lIHHa (CM.
BbIme).
BbmOJIHeHHe npOl.\e.u:ypbI
1. M3BJIeqb XaJIaT M3 6MKca.
2. Pa3BepHYTb XaJIaT. Aep Ka Ha BbIT.HHYTbIX PYKax TaK,
'IT06bI OH He I<aCaJIC.H oKpymalO Hx npe,llMeTOB M JIM'IHOH
O,llem,llbI.
3. B3.HTb 3a cnMHHbIe laCTM Y BopOTHMKa, nOBepHYTb BHYT-
peHHeH CTOpOHOH K ce6e, ,lIepmaTb Ha ypoBHe JIMI.J;a.
4. B,lIeTb 06e PYKH O,llHOBpeMeHHo B PYKaBa, nO,llH.HB PYKH
BBepx H pa3BecTH B CTOpOHbI.
5. 3aB.H3aTb 3aB.H3KH Ha PYKaBax CaMOCTO.HTeJIbHO.
6. TIO,llaTb KOHI.J;bI nO.Hca nOMO HHKY (noMOII.J;HllK 3aB.H3bI-
BaeT C3a,l1M 38.B.H3KH. M no.HC He KaCa.HCb HH PYK, HM XaJIaTa).
7. Ha,lIeTb CTepMJIbHbIe nep'laTKM.
HaKpblTHe CTepHJIbHOrO CTOJIa t
U;eJIb: co:!.'paHeHMe CTepMJIbHOCTH MHcTpYMeHTapH.H H ne-
peB.H30'lHOrO MaTepMaJIa Ha CTOJIe B TeqeHMe 6 'IaCOB npM
YCJIOBMM C06JIIO,lIeHM.H npaBHJI acenTMKM.
OCHaII.J;eHMe: MaHMnYJI.HI.J;MOHHbIH CTOJI; 1 % p-p xJIopa-
MMHa, 2 eMKOCTH ,lIJI.H ,lIe3paCTBopa; 6HKCbI co CTepMJIbHbIM
6eJIbeM, nepeB.H30qHbIM MaTepMaJIOM, CTepMJIbHbIe MHCTpy-
MeHTbI.
TIo.u;roToBKa K npol.\e.u;ype
1. Ha,lIeTb cneI.J;O,llemAY: xanaT, lIIanOqKY, MaCKY, nepqaTKll.
2. 06pa60TaTb CTOJI BeTOlIIblO, CMOqeHHOH ,lIe3MHC}mI.J;Hpy-
IOll{MM pacTBopoM ,lIBYKpaTHo, Ha'lMHa.H C paMbI, 3aTeM noc-
H eBaJlJle CTepHJIbHOrO XaJIaTa
U;eJIb: BbmOJIHeHMe MaHMnYJI.HI.J;MH co CTepMJIbHbIMM npe,ll-
MeTaMM Me,llllI.J;MHcKOro Ha3HaqeHM.H.
OCHaII.J;eHHe: CTepMJIbHbIH 6MKC C 6eJILeM.
240
241
JIeJ\OBaTeJIbHO, HaKJIap;bIBa.H OJ\MH Ma30K Ha J\pyrOH TaK, qTO-
6bl He OCTaBaJIMCb npOMeJKYTKM MeJKJ\Y HMMM.
3. ,l:t;aTb BbICOXHYTb.
4. BbIMbITb PYKM C MbIJIOM nOJ\ npOTOqHOH BOJ\OH Ha XM-
PyprM'IeCKOM ypoBHe (CM. BbIlIIe);
5. Hap;eTb CrepMJIbHbIH XaJIaT (CM. BbIlIIe).
BbIllOJIHeHJfe npOn;e,llJ'PbI
1. ,l(ocTaTb CJIOJKeHHYIO B 4 CJIO.H npOCTbIHIO PYKaMH B
nep'IaTKaX M3 CTepHJIbHOrO 6MKca.
2. HaKpblTb nOBepxHocTb MHCTpYMeHTaJIbHOrO CTOJIa TaK,
qT06bI Kpa.H npocTbIHM CBHCaJIM C Hero Ha 15 - 20 CM C Tpex
CTOpOH.
3. TIOJ\H.HTb J\Ba BepXHMX CJIO.H npOCTbIHM, CKJIap;bIBa.H ee
.rapMoIIIKOH.).
4. 3aKpbITb nOCJIeJ\HMM CJIOeM .rapMOIIIKMi> Bce npeJ\bIJ\Y-
Me CJIOM TaK, 'ITo6bI BHYTpeHH.H.H cTopoHa npocTbIHH Haxo-
J\HJIaCb cBepxy, a KPaH 6bIJIM OTKMHYTbI Ha3ap;, OT ce6.H.
5. Pa3JIOJKMTb CTepMJIbHbIH MHcTPYMeHTapnH no rpynnaM
M nepeB.H30'IHbIH MaTepMaJI Ha CrepMJIbHOM CTOJIe C nOMO blO
CrepMJIbHOrO KopHI aHra.
6. TIpMKpenMTb n;anKM 3a J\Ba BepXHMX CJIO.H npocTbIHM.
7. 3aKpbITb CTOJI J\BYCJIOHHOH npocTblHeH C nOMo blO n;a-
nOK TaK, qT06bI Kpa.H ee 6bIJIM BbIllie Ha 3 - 5 CM.
OKOH'laHHenpOn;e ypM
TIpMKpenMTb 6MPKY K npaBOH n;anKe C J\aTOH M BpeMeHeM
ero HaKpbITM.H, nOCTaBMTb nOJ\nMCb MeJ\ceCTpbI, HaKpbIBIlleH
CTOJI.
4. TIpMKpenMTb 6HPKY C YKa3aHMeM J\aTbl M BpeMeHH Ha-
KpbITM.H CTepMJIbHOrO CTOJIa.
BbmOJIHeHHe npOn;e,llJ'PbI
1. TIpoBepHTb 6npKY CTepMJIbHOCTM CTOJIa H JIOTKa C KOp-
H HrOM.
2. OTKpbITb CTepHJIbHbIH CTOJI.
3. B3.HTb CTepMJIbHbIM KOpHn;aHroM JIOTOK co CTOJIa M Ha-
KpbITb CTepMJIbHOH CaJIcpeTKoH, CJIOJKeHHOH B 4 CJIO.H.
4. TIOJIOJKMTb nOJ\ J\Ba BepXHMX CJIO.H CaJIcpeTKM He06xoJ\M-
MbIH MHcTpYMeHTapMH B pa306paHHoM BMJ\e, nMHn;eT.
5. TIOJIOJKMTb nOJ\ BepxHMH CJIOH CaJIcpeTKM CTepMJIbHble
BaTHble TaMnOHbI (lIIapMKM), MaJIble CaJIcpeTKM.
6. TIOJIOJKMTb CTepMJIbHbIH KOpHn;aHr B JIOTOK J\JI.H KOpH-
n;aHra nOJ\ J\Ba CJIO.H CaJIcpeTKM.
7. 3aKpbITb CTepMJIbHbIH CTOJI.
5.Z. D6ecne.,eHUe 6e30naCHOCmU nal.lUeHma
U MeguquHclfoii CeCmpbl
TIO]l;rOTOBKa K pa60Te CTepHJIbHOrO JIOTKa
]l;JI.H BbIllOJIHeHH.H I\laHunyJI.HD;HH co CTepHJIbHMMH
npe eTaMH Me]l;IIn;HHCKoro Ha3HaQeHH.H
nO OToBKa K npon;e,llJ'Pe
1. HaKpbITb CTepMJIbHbIH CTOJI C MHcTpYMeHTapMeM, nMH"
n;eTaMM, JIOTKaMM, nepeB.H30 IHbIM MaTepMaJIOM H CaJIcpeTKa-
MM, CJIOJKeHHbIMM B 4 CJIO.H (J\JI.H HaKpbITM.H JIOTKOB).
2. HaKpbITb CTepMJIbHbIH JIOTOK 60JIblIIOH CaJIcpeTKOH, CJIO-
)KeHHOH B qeTblpe CJIO.H.
3. TIOJIo)KMTb nOJ\ J\Ba BepXHMX CJIO.H CaJIcpeTKH KopHn;aHr
)J.JI.H pa60TbI co CrepMJIbHbIM CTOJIOM.
nOHJlTMe ne'le6HO-OxpaHMTenbHoro pemMMa,
ero ::meMeHTbl, 3Ha'leHMe
JIeQe6HO-OxpaHHTeJIbHMH peJKIIM - :ITO KOMnJIeKC JIe Ie6-
Ho-npocpMJUlKTH'IeCKMX MeponpHHTMH, HanpaBJIeHHbIX Ha 06ec-
neqeHMe cpM3M'IeCKOrO M nCHXMqeCKOrO nOKO.H nan;MeHTa. B
ocHoBe.3Toro peJKHMa JIeJKHT npaJillJIbHO opraHn30BaHHblH YXOJ\
3a nan;MeHTOM B OTJ\eJIeHMH, C03J\aHMe 6JIarOnpM.HTHOH 60JIb-
HH'IHOH 06CTaHOBKH, JIMKBMJ\an;M.H TpaBMMpyIO MX cpaKTopoB,
OpralIM3an;M.H J\ocyra nan;MeHTa.
PeJKHM 60JIbHMn;bI .l\OJIJKeH 6bITb opraHH30BaH TaK, 'ITo6bI
06eCne'IMTb nan;MeHTbl nOKOH. Hap;o CTapaTbC.H Y.l\aJIHTb OT
nan;MeHTa Bce, 'ITO MOJKeT ero pa3.l\paJKaTb, BOJIIIOBaTb.
XOpOIliO M3BeCTHO, 'ITO ycnex JIe leHM.H BO MHorOM 3aBMCMT
o T COCTOHHMH .l\yxa nan;MeHTa.
TIpeJK)J.e Bcero He06xo)J.MMO C03)J.aTb YIOT B naJIaTe, OT)J.eJIe-
HHM: Y)J.06HaH KpOBaTb, CTeHbI, oKpalIIeHHble B CBeTJIble TOHa,
Kap'I'nHbI )KM3HeYTBepJK)J.alO ero xapaKTepa.
242
243
rHeTy ee BneqaTJIeHHe H OTpHl aTeJIbHbIH 3MOI.J;HH Ha na-
I.J;HeHTa MorYT OKa3bIBaTb 3pHTeJIbHbIe pa3ApaJKHTeJIH: OKpO-
BaBJIeHHbIe KYCKH MapJIH, nmpHI.J;bI, CKaJIbneJIb co CJIe.naMH
KpOBH, JIOTOK C oTpa60TaHHbIM nepeB.f130qHbIM MaTepHaJIOM.
Ie orpamp;eHHIO nau;HeHTa OT no.n06HbIX 3MOI.J;HH CJIepyeT CTpe-
MHTbC.H C MOMeHTa ero nocTynJIeHH.H B 60JIbHHI.J;Y.
BOJIbIlIOe 3HaqeHHe HMeeT nOBe.n;eHHe Mep;HI.J;HHCKHX ceCTep
y nOCTeJIH naI.J;HeHTa. C 60JIbHbIM qeJIOBeKOM Ha.z:\O 06pa Tb-
C.H oc060, Y'lHTbIBa.H ero nCHXOJIOrHIO H HeYCTOH'IMBYIO He-
pBHYIO CHCTeMY. Mep;HI.J;HHCKa.H cecTpa .n;OJIJKHa YMeTb pa3ro-
Bapl'1BaTb C nau;HeHTOM, npO.HBJI.H.H OC06bIH TaKT B 06 eHHH
CHHM.
Pa3JIHqHbIe nepeJKHBaHH.H, TpeBorn, onaCeHH.H, CTpa.z:\aIUf.H,
nOCTO.HHHbIe MbICJIH 0 60JIe3HH H3MeH.HIOT nCHXHKY 60JIbHOrO
qeJIOBeKa.
M3BeCTHO, qTO B B03HHKHOBeHHH 3a60JIeBaHH.H, ero Teqe-
HHH H Hcxop;e 60JIbIlIOe 3HaqeHHe HMeeT COCTO.HHHe HepBHOH
CHCTeMbI. II03ToMY Me.n;HI.J;HHCKa.H ceCTpa p;OJIJKHa, npeJK.n;e Bce-
1'0, OKa3:bIBaTb 6JIarOTBOpHoe BJIH.HHHe Ha HepBHYIO CHCTeMY
nau;HeHTa. Ha.z:\o nOMHHTb, 'ITO C HHM He CJIe.nyeT cnopHTb,
BCTynaTb B npepeKaHH.H, nOBbIIlIaTb rOJIOc. Ha.z:\o 06pa aTb-
C.H C nau;HeHTOM pOBHO H cnoKoHHo, .n;aJKe eCJIH OH B036YJK.n;eH
H rpy6. CJIe.n;yeT CTapaTbC.H ycnoKoHTb naI.J;HelITa H .naJKe B
qeM-TO YCTYnHTb eMY, HO B TO me BpeM.H TBep.n;o H HaCTOHqH-
BO Tpe60BaTb BbInOJIHeHH.H Bcex He06xo.n;HMbIX MepOnpH.HTHH
H BbInOJIH.HTb cYII.J;ecTBYIO HH pacnOp.H.n;oK H npaBHJIa. ECJIH
naI.J;HeHT He .n;HCI.J;HnJIHHHpOBaH, He BbInOJIH.HeT Ha3HaqeHH.H
Bpaqa, TO K HeMY MomHO npO.HBHTb CTporOCTb.
BOJIbIlIOe BHHMaHHe CJIepyeT yp;eJI.HTh 60pb6e C 60JIblO, CTa-
paTbC.H BbInOJIH.HTb npOI.J;ep;ypbI H MaHHnYJI.HIUfH 6e360JIe3HeH-
HO. IJ;eJIbIH P.H,ZJ; 60JIeBbIX O YIIWHHH, CB.H3aHHbIX C 3a60JIeBa-
HHeM, MOJKHO YCTpaHHTb HJIH YMeHbIlIHTb, c03p;aB naI.J;HeHTY
KOMcpOpT: yp;06Ho YJIOmHTb ero B nOCTeJIH, y<IHTbIBa.H xapaK-
Tep ero 3a60JIeBaHH.H, BOBpeM.H CMeHHTb H HcnpaBHTb p;aB.H-
II.J;YIO nOB.H3KY, npHMeHHTb TenJIO, XOJIo.n HJIH c.n;eJIaTb Mac-
cam.
rJIaBHOH cocTaBHoH qaCTblO JICqe6HO-OXpaHHTeJIbHOrO pe-
mHMa .HBJI.HeTC.H cTporoe C06JIIO.n;eHHe paCnOp.Hp;Ka P;H.H H nOJI-
Hoe B3aHMonOHHMaHHe Memp;y naI.J;HeHTOM H Me.n;HI.J;HHCKHMH
pa60THHKaMH. IIpaBHJIbHO nocTpoeHHbIi\: peJKHM npe.nnoJIa-
raeT XOpOIlIHH OTp;bIX, peryJI.HpHOe nHTaHHe, Bpa'le6HOe Ha-
6JIIOp;eHHe, CBoeBpeMeHHoe BbInOJIHeHHe Bpa'le6Hb!X H AHarHo-
CTHqeCKHX npOI.J;ep;yp.
C03p;aH He B 60JIbHHI.J;e onTHMaJIbHoro JIe'le6HO-oxpa:iHTeJIb-
Horo peJKllMa .HBJI.HeTC.H 3a.na'leH B peIlIeHHH KOTOpOH p;OJIm-
HbI Y'lacTBOBaTb Bce c.nym6bI oT.n;eJIeHH.H, 60JIbHHI.J;bI.
BMAbl pemMMoB ABMraTenbHoM aKTMBHOCTM
1 0614 UU (c60608H.btU) - naI.J;lleHT npe6bIBaeT B OT.n;eJIe-
Hll 6e3 orpaHH'leHH.H p;BHraTeJIbHoi\: aKTHBHOCTH B npep;eJIax
CTaI.J;HOHapa H TeppHTOpHH 60JIbHHI.J;bl. Pa3pemaeTC.H cB060p;-
Ha.H xo.n;b6a no KopHllOPY, nop;'beM no JIeCTHHI.J;e, nporyJIKa no
TeppllTOpHll 60JIbHHI.J;bl.
2. IIaJtamH.btu - naI.J;lleHT MHoro BpeMeHH npoBop;HT B no-
CTeJIH pa3pemaeTC.H cB060.n;Ha.H xop;b6a no naJIaTe. Bce Me-
POnp .HTH.H no JIH'!HOi\: rHrHeHe oCYII.J;eCTBJI.HIOTC.H B npep;eJIax
nanaTbI.
3 IIoJtynocmeJtbH.btu - naI.J;HeHT Bce BpeM.H npoBop;HT B
noc;enH MomeT Ca.z:\llTbC.H Ha :Kpai\: nOCTeJIH HJIll CTYJI 1J,n.H
npHeMa Hrn;H, npoBe.n;eHH.!l YTpeHHero Tyane:a H MomeT xo-
1J,HTb B TyaJIeT B conpoBomp;eHH H MeAHI.J;HHCKOH cecTpbI.
4. IIocmeJtbH.btU - naI.J;HeHT He nOKHp;aeT nOCTeJI , M JKeT
CHp;eTb, nOBopa'lHBaTbC.H. Bce MepOnpH.HTH.H no JIH !HOll rll-
rlleHe ocy eCTBJI.HIOTC.H B nOCTenH Mep;HI.J;HHCKHM nepCOHaJIOM.
5. CmpozuU nocmeJtbH.btU - naI.J;HeHTY :KaTerOpH'leCKH 3an-
pe aIOTC.H aKTHBHbIe 1J,BHmeHH.H B nOCTenH, p;ame nOBopa'lH-
BaTbC.H C 60KY Ha 60K.
BMAbl nonomeHMA naLl,MeHTa B nOCTenM
IIpH 3a60JIeBaHH.HX nau;HeHT npllHHMaeT pa3JIH'lHbIe nOJIO-
meHH.H B nOCTeJIH.
Pa3JIHqaIOT:
1. AKTIIBHoe nOJIOmeHHe - naI.J;HeHT JIerKO H cB06op;Ho
BbInOJIH.HeT npOH3BOJIbHble (aKTHBHble) .n;BHmeHH.H.
2. llaccHBHoe nOJIOmeHHe - naI.J;HeHT He MomeT BbInOJI-
H.HTb npOH3BOJIbHble p;BHmeHll.H, COXpaH.HeT TO nOJIOmeHHe,
245
244
KOTopoe eMY npM,l\8JIM (HanpMMep, npM nOTepe C03HaHM.H, HJIM
eMY 3anpeTMJI Bpa'l MX BbIllOJIH.HTb, HanpHMep, B nepBbIe 'laCbI
nOCJIe MHcpapKTa).
3. BbIlIY:lKJJ;eHHOe nOJIO:IKeHMe - na HeHT npMHHMaeT caM
C IJ;eJIblO YMeHbllIeHM.H (cHM:lKeHM.H ypOBH.H) 60JIH M ,l\PyrMx
naTOJIOrM'leCKHX CHMnTOMOB.
TIOJIO:IKeHMe naI.J;MeHTa B nOCTeJIM He Bcer,l\a COBna,zJ;aeT C
Ha3Ha'leHHbIM eMY Bpa'lOM ,l\BHraTeJIbHbIM pemHMOM.
6e30naCHaA TpaHcnopTMpOBKa naqMeHTa
Ha KaTanKe, Kpecne-KaTanKe, Ha HOCMnKax, Ha PYKax
TIpM YXO,l\e 3a T.HmeJIO 60JIbHbIM naIJ;HeHTOM Ha Me,l\M H-
CKyro ceCTpy JIOmMTC.H 3Ha'lMTeJIbHa.H cpM3H'1eCKa.H HarpY3Ka M
OTBeTCTBeHHOCTb 3a 6e30naCHOCTb na MeHTa. 3TO nepeMeIl.{e-
HMe naIJ;MeHTa B KpOBaTH, nepe,l\BMmeHMe KaT8JIKM, KpeCJIa-
KaT8JIKM, HOCMJIOK C naIJ;MeHTOM, a npM OTCYTCTBHM TpaHC-
nopTHbIX Cpe,l\CTB MomHO nepeHOCMTb na MeHTa Ha PYKax Ok
HMM, ,l\BYM.H MJIM TpeM.H Me,l\MIJ;MHCKMMM pa6OTHMI(aMM.
BM,l\ TpaHcnopTMpOBKM onpe,lleJI.HeT Bpa'l B 3aBMcMMoCTM
OT T.HmeCTM COCTO.HHH.H naIJ;MeHTa. CJIe,llyeT nOMHMTb 0 6e30-
naCHOCTM M Ha,llemHocTM naIJ;MeHTa npM TpaHcnopTMpoBKe Ha
HOCMJIKaX M C06JIIO,lIaTb onpe,lleJIeHHble npaBMJIa:
. TIa eHT ,lIOJImeH 3HaTb BeCb XO,ll npe,llCTO.HIl.{eM onepa-
M;
. TIO,l\HMMaTb M onycKaTb HOCMJIKM CJIe,llyeT OCTopomHO,
Y,lIepmMBa.H MX B ropM30HT8JIbHOM nOJIO:1KeHHFI, 'lT06bI
He ypOHMTb na eHTa;
. M,lITM CJIe,llyeT He B Hory, KOpOTKMMM llIaraMM, He p C-
Ka'lMBa.H HOCMJIOK, rOJIOBOM Bnepe,l\;
. Mp;YIII;HM C3a,zJ;M ,lIOJImeH Ha6JIIO,lIaTb 3a COCTO.HHMeM na-
IJ;MeHTOM M CnpaBJI.HTbC.H Y Hero 0 ero CaMO'lYBCTBMM;
. TIPM nO,ll'beMe no JIeCTHMIJ;e HeCTH HOCMJIKM rOJIOBHbIM
KOHIJ;OM Bnepe,ll, nO,llHMMa.H HomHOM KOHeIJ; HOCMJIOK M
Y,lIepmMBa.H HOCMJIKM ropM30HT8JIbHO;
. TIpM cnYCKe no JIeCTJIMIJ;e - HeCTM HOCMJIKM HOraMM Bne-
pe,l\, npMno,l\HMMa.H HomHoM KOHeIJ; HOCMJIOK;
. ECJIM KTO-JIM60 M3 Me,llnepCOHaJIa YCT8JI, TO He06xO,llM-
MO 06 3TOM cpa3Y me CKa3aTb LlPyrMM Me,llMIJ;MHCKMM
246
Cel.TpaM, OCTaHOBMTbC.H H onYCTMTb HOCMJIKM. a MHa'le
YCTaBllIMe naJIbIJ;bI PYK MorYT paCCJIa6MTbC.H H HOCMJI-
KH ynap;yT. v
TpaHcnopTMpoBKa Ha KaT8JIKe, HaM60JIee YA06HbIH H Il.{a-
,l\.HID;MH cnoc06. TIaIJ;MeHTa nOMeIII;aJOT Ha KaTaJIKY Ii Y,l\06HOM
nOJIOmeHMM, y<lMTbIBa.H XapaKTep 3a60JIeBaHM.H HJIM nOBpem-
,lIeHMH. TaKoe nOJIOmeHHe n03BOJI.HeT nOJIHOCTblO paCCJIa6MTb
MYCKYJIaTYPY TeJIa, He Tpe6yeT YCMJIMH OT na HeHTa M 06ec-
ne'lHBaeT OnTMM8JIbHble YCJIOBM.H TpaHcnopTMpoBKH.
MomHo MCnOJIb30BaTb KpeCJIO-KaT8JIKY. 06'b.HCHMTb na H-
eHTY, B eJI.HX 6e30nacHocTM, KaK npaBHJIbHO ceCTb B KpeCJIO-
KaT8JIKY:
. HaKJIOHMTb KpeCJIO-KaTaJIKY Bnepe,l\, HacTynHB Ha no,l\-
CTaBKY ,lIJI.H Hor; .
. TIonpocMTb naIJ;MeHTa BCTaTb Ha nO.l\CTaBKY .l\JI.H Hor,
3aTeM, nOMepmMBa.H ero YCa,zJ;MTb B KpeCJIO; .
. OnyCTHTb KpeCJIO-KaTaJIKY B MCXO.l\HOe nOJIOmeHMe,
. TIpM.l\aTb naIJ;MeHTY HymHoe nOJIOmeHMe (CH.l\v.H MJIM no-
.nyJIema) C nOMoID;blO paMKM, pacnOJIOmeHHOH 3a cnMH-
KOM KpeCJIa-KaTaJIKM;
. CJIe.l\MTb, 'lT06bI pyKM naIJ;MeHTa ne BbIXO.l\MJIH 3a npe-
. .l\eJIbI nO.l\JIOKOTHMKOB KpeCJIa-KaT8JIKM BO BpeM.H TpaHC-
nopTMpoBKM;
. TIOMO'lb naIJ;MeHTY nepececTb na KpoBaTb B naJIaTe;
. TIpo,l\M3eHcpeIJ;HpOBaTb KpeCJIO-KaTaJIKY.
lI:aT8JIKM M HOCHJIKH .l\OJImHbI 6bITb ocnaIII;eHbI MaTpa eM,
061lIMTbIM KJIeeHKOH H 3aCTeJIeHHbIM npocTbIHeM, no.l\ I'OJIOBY
nOJIOmMTb nO.l\YllIKY (B KJIeeH'laTOH HaBOJIO'lKe, a cBepxy B
MaTep IaTOH). 'YKpbIBaIOT naIJ;MeHTa B 3aBMCMMOCTH OT BpeMe-
IIH rO.l\a (B XOJIO.l\HOe BpeM.H rO,l\a - O.l\e.HJIOM, B enJIoe -
npocTbIIIcii). ,l(JI.H npocpMJIaKTMKM BnyTpM60JIbHH'lHOM MHcpeK-
IJ;HM 6eJIbe CJIe,l\yeT MeH.HTb nOCJIe Kam,llOrO na MeHTa H c6pa-
CbIBaTb B MelliOK ,l\JI.H rp.H3HOrO 6eJIb.H, a MaTpaIJ; M nO,l\Y .KY
He06xo.l\MMO npoTMpaTb .l\BYKpaTHo BeTOlliblO, CMO'leHHOM B
,l\e3. pacTBope.
Oc06enHocTH TpaHcnopTMpOBI(M naIJ;MeIITa 3aBMC.HT OT xa-
paKTepa M JIOKaJIM3a MM 3a60JIeBaHM.H. _
II: npMMepy, naIJ;MeHTOB C KpOBOM3JIM.HHMeM B rOJIOBnOH
M03r YKJIa,zJ;bIBaIOT Ha HOCMJIKM, TpaHcnopTHpYIOT B nOJIome-
247
HMM JIema Ha CnMHe. ITpM TpaHCnOpTMpOBKe nOCTp 8.BlIIerO,
HaXO.n;,Hl erOCH B 6eCC03HaTeJIbHOM COCTO.HHHM, Heo6xo.n;MMO
CJIe.n;MTb, '1T06bI npM pBOTe pBOTHaH Macca He nonaJIa B .l\bI-
XaTeJIbHbIe nYTM.l1.JI.H 3TOro rOJIOBY na MeHTa nOBOpa'lHBaJOT
Ha 60K.
ITa HeHTa C CepAe'lHO-COCYAHCTOM He.n;OCTaTO'lHOCTblO M3-
3a CMJIbHOM o.n;bIIliKe TpaHcnopTMpYIOT B nOJIYCM.l\.H'IeM nOJIO-
meHMM. TaK KaK OHM oco6eHlfO '1YBCTBMTeJIbHbI K XOJIOAY, MX
Heo6xo.n;MMO XOpOIliO YKPbITb, nOJIOmMTb K HoraM M PYKaM
rpeJIKM. TpaHcnopTMpOBKa na lleHTOB C OCTpbIM MH4>apKToM
MllOKapAa .n;OJImHa 6bITb I.U; HI.U;eM M OCTopomHOM.
ITpM TpaHcnopTMpOBKe na MeHTOB C OCTpOM COCy.n;MCTOM
HeAOCTaTO'lHOCTblO MX YKJI bIBaIOT TaK, '1T06bI rOJIOBa 6bIJIa
HMme Hor.
T.HmeJIo6oJIbHbIX na MeHTOB HymHo YMeTb OCTopomHO ne-
peHeC M C KaTaJIKM Ha KpoBaTb. Heo6xo.n;MMO 3apaHee npo-
.n;YMaTb, KaK nOMeCTMTb KaTaJIKY OTHOCMTeJIbHO KpoBaTM BO
M36emaHMM Hey.n;06HbIX M JIMIIIHMX .n;BMmeHMM, 6eCnOKORI.U;HX
na HeHTa.
KaTaJIKY CTaHOB.HT napaJIJIeJIbHO KpoBaTM, TaK '1T06bI ro-
JIOBHOM KOHe KaTaJIKM paCnOJIOmMJICH K HomHOMY KOH Y
KpOBaTM (CM. cxeMY .N'21); Me.n;M MHCKMM nepCOHaJI CTaHOBMT-
C.H Mem.n;y HOCMJIKaMH M KpOBaTblO JIM OM K na MeHTY, B.n;BO-
eM MJIM BTpoeM no.n;HMMaIOT n MeHTa M, nOBepHYBIIIMCb Ha
IBO.C, KJI YT ero Ha KpOBaTb.
l1.JI.H Y.l\06CTBa nepeHOCKM na MeHTa KaTaJIKY MomHO CTa-
BHTb no OTHOlIIeHHIO K KpOBaTM nOA np.HMbIM yrJIOM (CM. cxe-
MY M 2), nOCJIe.n;OBaTeJIbHO M BnJIOTHYIO (CM. cxeMY M 3,4).
ITOJIb30BaHMe 4>YHK MOHaJIbHOii KpoBaTblO oCYll\eCTBJI.HeT-
C.H Me.n;M MHcKOii ceCTpOM C eJIblO 06eCne'leHM.H THmeJI06oJIb-
HOMY y.n;o6Horo nOJIOmeHll.H M ABMraTeJIbHOrO pemMMa.
CI
2
1
I
U I
4
3
Cl»YHKI4MOHanbHaA KpoBaTb
ct>yHK MOHaJIbHa.H KpOBaTb npe.n;CTaBJI.HeT C060M CneIUfaJIb-
Hoe YCTpoiicTBO, COCTO.HI.U;ee H3 HeCKOJIbKMX ceK Mii, nOJIome-
HHe KOTOpbIX MeH.HeTC.H nOBopOTOM COOTBeTCTBYIOI.U;eM PY'lKH
ynpaBJIeHHH. rOJIOBHOM M HomHoii KOH bI KpOBaTM 6bICTpO
nepeBO.l\HTC.H B HymHoe nOJIOmeHMe.
3m KpoBaTM MOryT MMeTb Cne MaJIbHbIe BMOHTMpOBaHHbIe
npHcnoco6JIeHMH: npHKpoBaTHbIe CTOJIMKM, IIITaTMBbI .n;JIH
K8IIeJIbHM , I'He3Aa .n;JIH XpaHeHH.H MHJ];HBM.n;yaJIbHOrO no.n;KJIIIJ];-
Horo cy.n;Ha M MO'lenpHeMHMKa.
PacnOnO>KeHMe HOCMnOK M KpoBaTM
npM nepeK1lilAblBaHMM naql-leHTa
1 - napallllellbHO, 2 - nOA yr1l0M, 3 - nOClIeAOBaTellbHO, 4 - BnlloTHYIO
248
249
YAep>KMBaHMA, nOMoaqb npM xOAb6e, nepeMeaqeHMA
M pa3MeaqeHMA nal4MeHTa B nOCTenM
PaCCMOTpMM HeKOTopble MeTo.n;MKM 6e30naCHOCTM 06cJIy:»m-
Barow;ero nepCOHaJIa npM yxo.n;e 3a naI.J;MeHTaMM.
HenpaBMJIbHOe 06paw;eHMe C naU;MeHTaMM .HBJI.JIeTC.H npe-
06JUi,l aIOw;eH npWlMHOH TpaBM cnMHbI. B03HMKHOBeHM.H 60JIeH
Y Me.n;MI.J;MHCKOH ceCTpbI B npOI.J;eCce npe.n;OCTaBJIeHM.H yxo.n;a.
TI03TOMY BIDKHO nOJIb30BaTbC.H MeTo.n;aMM 06paw;eHM.H. KO-
Topble pa3pa60TaHbI .n;JI.H Toro, '1T06bI YMeHbIIIMTb .n;aBJIeHMe
Ha n03BOHO'lHMK M TYJIOBMw;e npM TpaHcnopTMpOBKe, nepe-
Mexu;eHMM M nepeKJIap;bIBaHMM naI.J;MeHTa.
TIpeJK.n;e, '1eM Ha'laTb nepeMew;eHMe naUI1eHTa, He06xo.n;M-
MO onpe.n;eJIMTb:
· u;eJIb nepeMew;eHM.H;
· COCTO.HHMe 3.n;OpOBb.H naU;MeHTa, B03MOJKHOCTM .n;JI.H CO-
Tpy.n;HWleCTBa;
· HaJIM me BcnOMOraTeJIbHbIX MeXaHI1'1ecKMx cpe.n;CTB .n;JI.H
nepeMew;eHM.H (TpOCTb, KOCTbillM, XO.n;YHKM);
· onpe.n;eJIMTb pOJIb PYKOBo.n;MTeJI.H, KOTOpbIH CMOJKeT .n;a-
BaTh .HCHbIe, '1eTKI1e KOM8H.n;bI M o6'b.HCHeHM.H nau;MeHTY.
TIpM BbInOJIHeHMM pa3JIM'IHbIX nepe.n;BMJKeHMH, no.n;H.HTMH,
nepeMew;eHMH 06CJIYJKMBarow;eMY nepCOHaJIY He06xo.n;MMO no-
MHMTb:
· nepe.n; TeM, KaK no.n;HI1MaTb naI.J;MeHTa, HyJKHO npMBeCTM
ero B 6e30naCHoe, y.n;06Hoe nOJIOJKeHMe;
· 06CJIyJKMBarow;eMY nepcomUIY 38HHTh 6e30naCHoe, y.n;06-
Hoe nOJIOJKeHMe C C06JIIo.n;eHMeM paBHOBeCM.H B OTHOIlle-
HMM Beca naI.J;MeHTa M HanpaBJIeHM.H .n;BMJKeHMH;
· MCnOJIb30BaTb Bec c06CTBeHHoro TeJIa .n;JIH CH.HTM.H Ha-
np.HJKeHM.H, BbI3bIBaeMoe .n;BMJKeHMHMM PYK, oc06eHHO.
eCJIM He06xo.n;MMO .n;eJIaTb HeCKOJIbKO paCKa'lMBalOW;MX
.n;BM:meHMH, '1T06bI C03.n;aTb He06xo.n;MMYIO .n;BM:myW;YIO
CMJIY l!oJI.H no.n;H.HTM.H naI.J;MeHTa (paCKa'lMBalOW;Me .n;BM-
:meHM.H .n;eJIaHTe O'leHb OCTOPOJKHO);
· Ha'lMHa.H no.n;H.HTM.H, y6e.n;I1TeCb, '1TO BallIM Horn 3aHM-
MaIOT YCTOH'IMBOe nOJIOJKeHMe;
· y6e.n;MTeCb, '1TO BbI BbI6paJIM caMoe JIY'IllIee nOJIo:meHMe
.n;JlH y.n;ep:maHMH nau;MeHTa, .n;epJKI1Te cnMHy npHMO, nOJ];-
xo.n;MTe K naI.J;MeHTY TaK K 6JIM3KO, HaCKOJIbKO 31'0 B03-
MO:mHO M BbInOJIH.HHTe .n;BMJKeHMH B TOM :me pMTMe, qTO
M OCTaJIbHble nOMOW;HMKM.
TIoMHMTe, '1TO nepe.n;BM:meHMe naI.J;MeHTa MOJKeT 6UTb YC-
neIIIHbIM TOJIbKO npM corJIaCOBaHHoCTM .n;eHCTBMH B 6pMrap;e:
. BbI6epMTe JIM.n;epa, KOTOpUll 6y.n;eT PYKOBo.n;MTeJIeM 6PM-
rap;bI M 6y.n;eT .n;aBaTb KOMaH,ZJ;bI;
. BbI6epMTe caMYIO JIY'IIIIYIO MeTo.n;MKY 06paIIJ;eHM.H C na-
I.J;HeHTOM;
. onpe.n;eJIMTe, KTO npMMeT Ha ce6H CaMyro T.HJKeJIYIO pa-
60TY, a MMeHHO y.n;ep:maHMe 6e.n;ep M TYJIOBMw;a nau;MeH-
Ta (31'0 .n;OJI <Ha 6bITb CaMaR CMJIbHaH M 3.n;opOBaH Me.n;M-
I.J;MHCKaH ceCTpa, He3aBMCMMO OT .n;OJI:mHOCTM).
Y.u;ep:mHBaHlle nal.\HeHTa
MeTo.u;oM «3axBaT 'Iepe3 PyKY')
( 6btnOJlH.JlemcJ/. oanou Meacecmpou. naijuenm ;,w:J/Cem 1WJftOlI.b)
llOKaaaJIII.H: no.n;.n;epJKKa M nepeMeW;CHHe K3ap;M naI.J;HeHTa
(cnMHKe CTYJIa), cnoc06Horo OKa3aTb co.n;eHCTBMe.
3Tanbl npMMe'laHHH
nO roTOBKG K npo e ype
1. YCTaHOBI<1Tb AOBep TenbHble
OTHOweHI<151 C na l<1eHTOM;
2. OlleH Tb COCTOIJHl<1e 06ecne4HTb aKTHBHoe Y'IaCT e
na HeHTa B03MO HOCTb na eHTa B nepeMeU,\eHH .
nOMOU,\1<1 C ere CTOpOHbI;
3. 06bSlCH Tb na eHry enb
YAepJK BaHI<1S1, nonY'II<1Tb ere
com aCHe, 06bSlCHHTb nocneAo-
BaTenbHoCTb Ae cTBH ;
4. O eHHTb oKpYJKalOU,\YIO 06eCne'lI<1Tb 6e30nacHocTb
06cTaHoBKY (BnaJKHOCTb nona, nalll<1eHTa.
nocTopoHHHe npeAMeTbi Ha
nony, TanO'IKH 6e3 3aAHHKa).
BblnOllHeHJ4e npo e YPbl
1. nonpocHTb nall eHTa 3TO nOMOJKeT 06ecne'lI<1Tb
npHJKaTb CBO PYK K Teny 1<1 6HoMexaH KY Tena nalll<1eHTa.
<!>I<1Kc pOBaTb HX Ha Heo6xoAI<1- Ecnl<1 y nalll<1eHTa <!>YHKII 51
MOM YPOBHe; OAHO PYKI<1 ocna6neHa na HeHT
3axsaTbiBaeT 60nee Cl<1nbHO
PYKO cna6ylO PYKY.
250
25'
3Tanbl npMMe'laHMH
BblnOllHemlE nDOUe.llVDbI
2. 3a TH co CTOpOHbI cnHHbl TaKo 3aXBaT 06eCne'lHT
naLlHeHry (n03aA KpeClla llH npaBHllbHYIO 6HoMexaHHKY Tella
CTylla, Ha KOTOPOM OH CHAHT), MeAcecTpbl, HaAeJKHOCTb
npocYHYTb CBO PYK B YAep>KaH R, <!> KcaLl 1O Tella Ha
nOAMbiWe'lHble BnaA Hbl npeAnlle'lbRX MeAcecTpbl np
naLlHeHry C3aA . YXBaTHTb pyKH B03MOJKHOM naAeHHH. Hellb3R
naLlHeHTa Y 3anRCTbSI, Y'I TbIBa51 AonycKaTb B03HHKHOBeH R
601le3HeHHble MeCTa Ha-pYKax. 601le Y naLl eHTa.
OKOH'IBHJ4e npoue YPbl
1. C006U,\ Tb naLl eHTy 0
3aBepweHH npoLleAypbl;
2. Y6eAHTbcR B 6e30nacHoM naLl eHT AOllJKeH y6eA TbcR B
n01l0JKeH H naLlHeHTa, paCLle- CBoe 6e30nacHocT . Ou'\YTHTb
n Tb BbIBeCT PYK MeAceCT- 3Ha'lHMOCTb CBoe nOMOU,\ .
pbl, n061laroAap Tb naLlHeHTa
3a nOMOU,\b B YAepJKaH H,
060APHTb;
3. BblMblTb PYK . BbICYW Tb. 06ecne4 BaeTcR HH<!>eKLlHoH-
Ha!J 6e30nacHocTb.
llOJJ,D;ep:mHBaHHe nal.\lleHTa npH xO,lJ;L6e
(6btnOJlH.RemC.R OaHOU cecmpou)
llOKa3aHH.H: nOMO L npH XOAb6e nOCJIe HHCYJIbTa, TpaB-
MbI, T.n.
3anbl npMMe'laHMH
BblnOllHeHJ4e npoue YPbl
npaBYIO PYKY naLl eHTa onHpaeTC5I llaAOHblO Ha llaAOHb
CBoe npaBO 1l lleBYIO B ceCTpbl np COMKHYTblX B «3aMOK"
lleBO ; 601lbWHX nallbLlax.
2. nOAAepJK BaTb APYro 06eCne'lHTb 6e30nacHocTb
PYKO naLl eHTa nOA 1l0KOTb naLlHeHTa.
1l nOAMbIWe'lHYIO 061laCTb,
Hll 06xBaT Tb naLl eHTa 3a
Tall lO;
3. BCTaTb K naLl eHry KaK 3TO 06eCne'l T YAepJKaH e
MOJKHO 61l JKe, nOAAepJK BaTb naLll1eHTa OT naAeH 51, np
ero KOlleH HOro , y6eA TbcR, M HHMallbHblX YCHll flX.
'1TO naLl eHT '1YBCTByeT ce6R
YBepeHo;
4. nepeABHraTbc5I PRAOM C 06eCne'l Tb 6e30nacHocTb
naLlHeHTOM. naLlHeHTa.
OKOH'IBHJ4e npoue YPbl
1. BblMblTb BblCYW Tb PYK . 06eCne'l Tb H<!>eKLI oHHYIO
6e30nacHocTb.
3anbl npMMe'laHHH
nO roTOBKa K npoue ype
1. YCTaHoB Tb AOBepHTellbHble
OTHOWeHH5I c naLlHeHTOM;
2. OLleH Tb COCT05lHHe naLlHeH- 06eCne'l Tb aKTHBHoe
Ta 101 B03MOJKHOCTb nOMOU,\H C Y'IaCT e naLl eHTa B nOAAep-
ero CTOpOHbI, HyJKHbI 1l eMY JKaH H.
BcnOMOraTellbHble cpeAcTBa;
3. OLleHHTb oKpYJKalOU,\YIO 06eCne'lHTb 6e30nacHocTb
06cTaHoBKY naLlHeHTa.
BblnOllHBHJ4B npoue YPbl
1. BCTaTb PRAOM c naLlHeHToM, 06eCne'lHTb 6e30nacHoCTb
np MeH Tb «3aXBaT 601lbW M naLl eHTa.
nallbLlaM lla.D.OHe ", AepJKaTb PYKa naLl eHTa np5lMaR,
llepeMelI\eHlle nal.\HeIlTa "3 nOJIo:meHH.H «JIe:ma Ha 60KY')
B nOJIo:meJlHe «CH,lJ;.H C onyIl{eHIILIMJI HoraMH.)
( 6btnOJlH..R.emC.R OaHOU .JIteaCecmpOU)
llOKa3aHH.H: BbIHy.mp;eHHoe, naCCHBHoe nOJIo:meHHe, CMeHa
nOJIo:meHH.H TeJIa naI.J;HeHTa npH pHCKe B03HHKHOBeHH.H npo-
JIe:mHeii.
3Tanbl npHMe'laHHH
nO rOTOBKa K npoue ype
1. YCTaHoB Tb AOBep TellbHble
OTHoweH R C naLlHeHTOM;
2. OLleH Tb COCT05lHHe naLl - 06eCne'lHTb aKT BHoe Y'IaCT e
eHTa B03MOJKHOCTb nOMOU,\H naLlHeHTa B nOAAepJKaH .
C ero CTOpOHbI;
3. OLleH Tb oKPYJKalOU,\YIO 06eCne'lHTb 6e30nacHocTb
06cTaltOBKY. naLl eHTa.
BblnOllHeHJ4e npoue YPb'
1.0nycT Tb 60KoBbie nOpY'lH 06eCne'lHTb AocTyn K naLl eH-
(ecll OH eCTb) C TO CTOpO- TY ero 6e30nacHocTb.
HbI, rAe HaxOA TCR MeA LI HC-
KaR ceCTpa
252
253
IIepell1elJ enHe nan;lIeHTa U3 nOJIO:meIlHH
«CH));H Ha CTYJIe.) B nOJIO:meHHe «JIe:ma Ha KpOBaTII.)
( 6btnOlln.R.emCJ/. oanoii .JIteacecmpoii)
3Tanbl npMMe'laHMH
BblnOllHeHJ4e npo e ypbl
6e30naCHOCTI<1 na l<1eHTa
1<1 CeCTpbl npl<1 nepeMellle-
HHH. Aena Te 3TO MeA-
neHHo!
2. flOCTaBHTb na HeHTa Ha C'IeT IiICKllIO'II1Te pl<1CK naAeHI151
«TpH» Ha HOrl<1 (noBOpa'lI<1Ba TeCb na HeHTa, CB5I3aHHOro C
oAHoBpeMeHHo C HI<1M, Hora K Hore, B03MOJKHOCTbIO nOTepl1
nOKa OH He nO'lYBCTByeT Kpa paBHOBeCHR.
KpOBaTH);
3. flocaAHTb na HeHTa Ha KpoBaTb. AnR 06eCne'leHI1H npa-
BCTaTb nH OM K na HeHTY C60KY OT Bl<1nbHO 6110MexaHI<1KI<1
Hero 6nHJKe K H3ronoBblO. PaCCTa- Tena ceCTpbl 11 6e30nac-
BI<1Tb HorH Ha Wl1pHHY 30 CM; HOCTH na l1eHTa
4. Pa3BepHYTb CBOIO HOry, pacnono-
JKeHHYIO 6nl<1JKe K 1<13ronoBblO,
KHapYJKH;
5. AepJKaTb Cnl1HY npRMo;
6. flpoBecTH OAHY PYKY nOA KOneHI<1
na l1eHTa. OXBaTI1Tb I<1X CBepxy,
APyro PYKO OXBaTHTb nne'lH
na HeHTa;
7.floAHRTb HOrl<1 na HeHTa Ha YnOJKHTb na l<1eHTa Ha
KpoBaTb, nOBOpa'lHBaR ero ryno- KpoBaTb.
BHllIe npH 3TOM BOKpyr OCI<1 Ha 90 °
101 onYCKaR ero ronOBY Ha nOAYwKY.
- OKOH aHJ4e npo e ypbl
1. YKpblTb na l1eHTa, y6eAI1TbCR, '1TO
OH neJKHT YA06HO 101 KOM<!>OPTHO;
2. BblMblTb 101 BbiCYWHTb PYKI<1
3Tanbl npMMe'laHMH
BblnOllHeHJ4e npo elJ.ypbl
2. BCTaTb HanpOTI1B na l1eHTa, He HaKlloHRTbCR! CorHYTb
neBYIO PYKY nOABeCTI1 nOA ero Horl1 B KoneHRX AIlR co6nlO-
nne'lI1, npaBYIO PYKY nOA KOneHI<1. AeHI1R npaBl<1nbHO 6110Mexa-
OXBaTblBaR HX cBepxy. HI1KI1 Tena.
3. flOAHRTb na HeHTa, onycKaR nOMHI1Te 0 c06nlOAeHI1H
ero HorH BHI13 11 oAHoBpeMeHHo npaBHnbHo 6HoMexaHHKH
nOBOpa'lI<1Ba51 ero Ha nOCTenl<1 B Tena cecTpbl 101 na l1eHTa!
ropl130HTanbHo nnOCKOCTI<1 nOA
yrnoM 90 o.
4. YCaAl1Tb na l1eHTa. npOAOnJKa51 IiICKllIO'IHTe pl1CK naAeHI1R
CTORTb K HeMY nH OM 11 YAepJKI1- na l1eH ra, CBR3aHHoro C
BaR ero neBO PYKO 3a nne'lo a B03MOJKHOCTbIO ronOBOKpYJKe-
npaBO - 3a Kopnyc Tena: ' HI151.
5. Y6eAI1TbCR, '1TO na l1eHT CHAHT
YCTO 'IHBO 11 YBepeHHo.
6. flOAIlOJKHTb ynop nOA Cnl1HY IiIcnonb3Y Te nOAywKH 11
na l1eHTa. APyrHe cpeAcTBa AIlS! ynopa.
OKOH aHJ4e npo e YPbl
1. HaAeTb na l<1eHry TanO'IKH 11 Ii1cKnlO'IHTb onaCHOCTb
nOCTaBI1Tb nOA HOrl1 cKaMe KY; nepeOxnaJKAeHI1R 1<1 OTBHca-
HHR CTon.
2. BbiMblTb 11 BbiCYWI>1Tb PYKI1.
IIoKa3aHH.H: nepeMemeHHe nan;HeHTa B TOM CJIY'lae, eCJIU
nan;HeHT MO:meT nOMO'lL.
3Tanbl npMMe'laHMH
nO rOTOBKa K npo e ype
1. YCTaHOBI>1Tb AOBepHTenbHble
OTHoweHHR C na l1eHTOM;
2. O eHHTb COCTORHl1e 06eCne'lI1Tb aKTI1BHOe Y'!aCTl<1e
na l1eHTa 101 B03MOJKHOCTb na l1eHTa B nepeMeiL!eHI1I1.
nOMOlll11 C ero CTOPOHbI;
3. O eIIHTb oKPYJKalOllIYIO 06eCne'll1Tb 6e30nacHocTb
06cTaHoBKY. na l1eHTa.
BblnOllHeHJ4e npo e YPbl
1. flpeAynpeAI1Tb na l1eHTa. Ha KaJKAbI C'IeT cnerKa
'ITO Ha C'IeT «Tpl1» Bbl nOMOJKe- paCKa'lL-1Ba TeCb BnepeA-Ha3aA,
Te eMY BCTaTb; C03AaBaR HHHep L-11O Tena AnR
IIepeMeIu;eHHe nan;HeHTa C KpoBaTH Ha CTYJI
MeTO));OM «no.u;IlHTlle nJIe'lOM')
(6btnOIlH.J/.emcJ/. a6Y.JItJ/. UIlU 60llee Jl10ab.JItU naquenm MO:HCem
CUaemb, no ne .JItO:HCem nepea6uzambcJ/.
ca.JItOcmoJ/.mellbno c nOMoutb1O noz)
3Tanbl npMMe'laHMH
nO roTOBKa K 14P0 e ype
1. YCTaHOBI1Tb AOBepHTenbHble
OTHOweHH5I C na HeHTOM;
2. O eHI1Tb COCTORHHe na l1eHTa 06eCne'lI1Tb aKTL-1BHOe
101 B03MOJKHOCTb nOMOIllL-1 C ero Y4aCTL-1e na L-1eHTa B nepeMe-
CTOpOHbI; llIeHI1L-1.
254
255
3Tanbl I npMMe'laHHH
nO,llroTOBK8 K npol./et!ype
3. OlleHI1Tb oKpYJKalOUlYIO
06cTa.loBKY ,
4. nOCTaBHTb CTyll P5IP.OM C
KpoBaTblO.
BbinOnHeHJ4e npol./e,llYPbl
1. flepeMeCTI1Tb nalll1eHTa 101 C03AaTb B03MOJKHOCTb Aallb-
ycaAI1Tb B nOll0JKeHHe co HeC1wero nepeMeUleHI1R.
C 060AHO CBI1CalOUlI1MI1
HoraMH;
2. BCTaTb C 06eHx CTOPOH OT YMeHbwaeTcR HarpY3Ka Ha
nalll1eHTa 1111110M K HeMY; cecTpy, HCKlllO'IaeTC5I TpaBMa
CTonbl nallHeHTa.
3. floABecTI" 611I1JKaC1wylO K 06e cecTpbl 6epyr APyr
nalll1eHTY PYKY nOA ero 6eApa; APyra 3a PYKH "3anRCTHbiM
3aXBaTOMn.
4. flO,D.AepJKI1BaTb nalll1eHTa 3a
6eAPa KaK MOJKHO 611HJKe K
RroAl1l1aM;
5. floAcTaBHTb nlle 11 B nOAMbI- 06e cecTpbl ClleA!JT 3a
We'lHble BnaAI1HbI nalll1eHTa, a c0611IOAeHl1eM npaBHllbHoC1
nallHeHT YKllaAblBaeT CBOH PYKI1 6HoMexaHHKI1 CBoero Tella C
Ha Cnl1Hbl MeAHIIHHCKI1X cecTep; lIellblO npo<!>HllaKTI1KI1 TpaBMbI
cnHHbl.
6. Ii1cnollb30BaTb cB060AHYlO AepJKHTe HorH BP03b, KOlleHI1
PYKY, corHYB B 110KTe. B Ka'leCTBe corHYTbI.
onopbl, OnHpa5lCb elO Ha KpoBaTb
n03aAH RroAH na l1eHTa
7. OTAaTb KOMaHAY OAHOC1 113 06ecne HBa1OTCR CHHXpOHHble
ceCTep; AeC1cTBI1R.
8. Ha C'IeT "Tpl1» BblnpRMllRTb
KOlleHI1 11 110KOTb, nOKa ceCTpbl
He BCTaHYT npRMO.
9. flepeMecTHTb na l1eHTa Ha
CTYll. nO,D.AepJKHBaR ero cnHHY
cB060AH0C1 PYKoC1.
10. PaCnOll0JKI1Tb YAepJKI1BalO- 06ecne eHHe 6e30nacHocTI1
UlYIO PYKY Ha nOAll0KOTHHK 1011111 nallHeHTa, npaBI111bHOC1
CI1AeUbe cTYlla 6110MexaHHKI1 Tena cecTpbl
11. OnycTHTb nallHeUTa Ha CTyll, Pa3roBapHBaC1Te MeJKAY c060C1,
f;rH6aR KOlleHH 11 110KOTb. '1T06b1 y6eAI1TbCR, '1TO Bbi
onycKaeTe nalll1eHTa Ha CTYll
oAHoBpeMeHHo.
256
3Tanbl npMMe'laHMH
BbinOnHeHJ4e nDouenVDbI
Y6eAI1TbCR. '1TO Cryll He
HaKIIOHReTCR Ha3aA (OAHa 113
ceCTep MOJKeT npl1AepJKHBaTb
Cnl1HKY CTYlla).
OKOH'i8HJ4e npol./e,llYPbl
1. Y6eAHTbcR. TO na l1eHT
CI1AI1T YA06HO 11 KOM<!>OpTHO.
2. BblMblTb 101 BbiCYWHTb PYKH.
Y.u;ep:il,MBaUMe nan;MeHTa MeTo.u;OM
«3aXBaT npH no.u;HHToM JIOKTe.)
( 6btnOJlnnemcJ/. oonoii Jlteacecmpoii, nUl uenm .JIw:J/Cem nO.MOllb)
llOKa3aHHH: nOMep:»<Ka M nepeMe eHMe nan;MeHTa, cno-
c06HOrO OKa3aTb nOMo b.
3Tanbl npMMe'laHMH
nO,llrOTOBKa K npol./e,llype
1. 06bflCHHTb na l1eHTY lIellb 11
)(OA npO eAYpbl 11 nOllY'IHTb ero
COrllaCl1e;
2. OlleHHTb COCT05lHI1e nalll1eHTa
11 B03MOJKHOCTb nOMOUlH C ero
CTOPOHbl:
3. OlleHI1Tb oKpYJKalOUlYIO
06cTaHoBKY, y6eAI1TbcR. '1TO HeT
BcnOMoraTellbHblX cpeACTB.
BbinOnHeHJ4e npol./e,llYPbI
1. BCTaTb C60KY OT nalll1eHTa, C0611IOAaIOTcR Tpe60BaHI1R no
C IARUlero Ha cTYlle (HI13KOC1 6e30nacHocH1 na l1eHTa 101
KpOBaTl1), llH OM K HeMY; cecTpbl.
2. nOCTaBI1Tb OAHY Hory P5IP.OM Y6eAI1TeCb, '1TO Bbl Bbl6pall11
co CTyll0M, APyrylO, CllerKa llY'IWI1C1 cnoc06 YAepJKHBaHHR
pa3BepHYB cTony, BnepeAI1 Hor na eHTa 11 Y Bac eCTb
nallHeHTa, <!>HKCHPVSl cBoeC1 B03MOJKHOCTb cB060AHO
HoroC1 ero KOlleHH; nepeMeUlaTb Bawy Maccy Tella
C OAHOC1 HOrl1 Ha APyrylO, 11
Bbi CTOHTC YA06HO.
3. nonpocHTb na l1eHTa 1011111 Y6eAl1TbCR, '1TO na l1eHT
nOMO'Ib eMY HaKll0HHTbCR YBepeH B BaWI1)( Aei'cTBI1RX 101
BnepeA OT 6eApa TaK, T06b1 ero cnOKoeH.
nlle o, HaXOJ\RUleeCR 611I1JKe K
BaM, TBep/\O ynHpallocb B Bawe
TYll0BHIIIC;
9. 3.. 29\
257
3Tanbl npHMe'laHHH
BblnOflHeHUe npOI./e.o.ypbl
4. HaKl10HHTbCSI Cl1erKa BnepeA 3a<!>HKcHpoBaTb TYI10BHU(e
epe3 cnHHY na HeHTa 101 KpenKO na HeHTa.
OXBaTHTb ero 3a 110KTH, KaK 6b1
nOAD.epJKHBa51 HX CHI'I3Y; 3aJKMHTe B «3aMOK» Aal1bHee
5. PaCn0l10JKHTb CBoe nl1e o TaK,
T06bl Aal1bHee OT Bac nl1e o OT Bac nl1e o na HeHTa. 3TO
na HeHTa ynHpal10Cb B Bawy PYKY. 06eCne'lHT HaAeJKHY
<!>I'IKCa l1 TYI10BHU(a
na HeHTa npH nepeMeU(e-
HHH C el1b ero 6e30nac-
HOCTH, He 6YAeT AaBl1eHI1S1
Ha rol10BY 101 we na HeHTa.
OKOH'i8HUe n oue.o.YPbl
1. C006l1\1'1Tb na l1eHTY, TO OH fla l1eHT AOI1JKeH y6eAHTbcSI
HaXOAHTCSI B 6e30naCHOM_nOI10- B cBoe 6e30nacHocTH,
JKeHHH 101 rOTOB K Aal1bHel1WeMY OU(YTI'ITb 3Ha'lHMOCTb cBoe
nepeMeU(eHH ; nOMOU(H.
2. flepeMecTHTb B HyJKHOe MecTO;
3. BblMblTb 101 BblCYWI1Tb PYKH.
Y,lI;epJKHBaIlHe nal.\lfeHTa MeTO,ll;OM
«nO,ll;l'IlbIWe'lIl:bIU 3aXBaT')
( BbtnOltH.RemC.R OiJHOii. .M.eiJUqUHC1COii. cecmpoii., -naqueHm
.M.O:JICem nO.M.O'lb)
IIoKa3aHIfH: nOMepmlta H nepeMeru;eHHe naI.\HeHTa, cno-
c06Horo OKa3aTb CO,ll;euCTBHe.
3Tanbl I npHMe'laHHH
nO.o.roTOBKa K npoue.o.ype
1. YCTaHoBHTb AOBepHTel1bHbie
OTHOWeHH5I C na HeHTOM;
2. O eHI1Tb COCTOSlHHe na HeH- 06ecne HTb aKTHBHoe
Ta 101 B03MOJKHOCTb nOMOU(11 C y acTHe na HeHTa B nepeMe-
ero CTOpOHbl; U(eHHH.
3. O eHHTb oKpyJKa U(y
06cTaHoBKY
BblnOflHeHUe npoue.o.YPbl
1. BCTaTb C60KY I1H OM K
CHASjU(eMY na I'IeHTY; <DHKCa l1S1 KOl1eHe 06ecne-
2. flocTaBHTb OAHY Hory P5lA0M,
a APyry , Cl1erKa pa3BepuYB HT 6e30nacHocTb na "'eHTa, I
CTony, BnepeAH Hor na HeHTa, CHH3HT pl1CK naAeHHSI. I
<!>I'IKC.IPY? era KOlleHH.
258
I
3Tanbl I npHMe'laHHH
BbinoflHeHue npoueP,YPbl
3. flpOCYHyrb OAHY, AallbH KHCTb AallbH KHCTb -B
B nOAMblwe Hble BnaAHHbl na HeH- HanpaBlleHI1H cnepeAH
Ta. Ha3aA, llaAOHb BBepx,
601lbWO nalle BHe
nOAMblwe HO BnaAHHbl.
flPOCOBblBaHTe KHCTH KaK
MOJKHO Aallbwe.
4. flpOCYHyrb APYry KHCTb - B 6011bWO nal1e HaXOAHT-
HanpaBl1eHHH C3aAH 101 K nepeAH, CSI cHapyJKH, BHe nOAMbl-
l1aAOHb BBepx. we HO Bna.QHHbI.
5. Y6eAHTbCSI, TO Y Bac eCTb
B03MOJKHOCTb cB060AHO nepeMe-
U(aTb Maccy Bawero Tel1a C OAHO
HorH Ha APyry 101 Bbl CTOHTe
YA06HO.
6. flonpOCHTb na HeHTa 10111101 nOMO'Ib Y6eAHTbcSI, TO na HeHT
eMY HaK110HHTbCSI BnepeA OT 6eApa YBepeH B BaWI1X AeHcTBHSlX
raK, T06bl ero nl1e o, HaXOASjU(eec5I 101 cnOKoeH.
611HJKe K BaM, TBepAO ynHpaIlaCb B
Bawe TYI10BHU(e.
OKOH'i8Hue npouep,YPbl
BblMblTb 101 BblCYWHTb PYKH. 06eCne'leHl1e HH<!>eK H-
OHHO 6e30nacHocTH
l'II:\MI'II t'llIIt' lJal IICIITa B nOJIOJKeHHH cI>aYJIepa
("IIIl10J//fJ/('lI/C.R oiJHOii. .M.eilcecmpoii.)
Mml<CT DLmonllnTbcH KaK lIa CPYIIKl.\HOHaJIbHOU, TaK H Ha
uh',l'lIIoii ItpoBaTH
IIOIea3a1l1fH: pHCK pa3BlfTlfH nponemlleu, lIe06XO,ll;HMOCTb
IIIII.monOrJt'leCKIfX OTnpaBJIelllfU B nocrenH, BbIllymJJ;eHlIoe no-
JIII)I,I"II11C n8I HeIlTa.
IlnJ I'()TODIea Ie npOl.\e)J;ype
I. Ofi'I>JICIIHTb I.{enb H XO,ll; pa3Meru;ellHH, nonY'lHTb corna-
."Ul'.
2. Ilo/lroToBHTb lIe06XO,ll;lfMOe ocnaru;eHHe: nO,ll;ynlKH, Ba-
'1I1Im 11.1 0/le1lJI, ynop ,lI;nH 1I0r.
:I. O'II'III1'I'!, COCTOHIIHe naI lfellTa If oKpymalOru;ylO 06cTa-
IIUlIICY. a,IICpClllfTb TOPM03a KpOBaTIf (eCJIH OIlH eCTb).
BI,IIIOJlllelllfe npOl.\e)J;ypbl
1. OnycTIfTb 60KoBble nopY'l1l1f (ecJIIf OIlH eCTb) C TOU CTO-
plllll>l. r)J;e HaXO,ll;lfTCn Me,ll;CeCTpa.
O'
259
I
6. TIoAJIOJKHTh naI HeHTY no.l\ nOHCHHQY nO.l\YlIIKY.
7. TIoAJIOmHTh He60JIhlIIYIO nO.l\YlIIKY HJIH BaJIHK no.l\ KO-
JIeHH naI HeHTa.
8. TIO.l\JIO»<HTh He60JIhIIIYIO nO.l\YlIIKY nan;HeHTa nOA nHTKH.
9. 06eCne'IHT:b ynop AJIH nO)lJ:\epmaHHH CTon no.l\ yrJIOM
90° (eCJIH He06xo.l\HMO).
OIWWIaHue npoQe):(yP:bI
1. Y6eAHT:bCH, 'ITO naQHeHT JIe)I<JfT Y.l\06HO. TIO.l\HHT:b 60-
KOBble nopyqHH.
2. blMhIT:b H BblCYlIIHT:b PYKH.
RbinOJIHeHUe npoQeA)'p:bl
1. OnYCTHT:b 60KoBhIe nopyqHH (ecJIu OHH eCT:b) C Ton r.TO-
rlOHbI, r.l\e HaXO.l\HTCH Me,ll;CeCTpa.
2. Y6e.l\HThCH, 'ITO, naQueHT JIemHT Ha cnHHe nOCpC.l\HH",
KpOBaTH H y6paTh nO.l\YlIIKH.
3. TIepeBecTH U3rOJIOBhe KpOBaTH B ropU30HTaJIhHOe nOJIO-
meHHH.
4. TIepeMeCTHT:b naQHeHTa K KpalO KpoBaTH.
5. TIepeMeCTUT:b naI HeHTa B nOJIOmeHHe JIema Ha 60KY H
'IaCTHqHO Ha mHIIOT.
6. TIO.l\JIOmHTh nO.l\YlIIKY no.l\ I'OJIOBY naI HeHTa.
7.11011 cornYTYIO, HaXO.l\HW;YIOCH cBepxy PYKY nOMeCTHTh
!l1J/{y"my !In ypOBIIe nJIe'Ia. L(PyryIO PYKY naI HeHTa nOJIO-
)lUI'I'I, Ha npOC'I'I,UIIO.
8. rIO.l\ corIlYTYIO, (tBepXHIOIO& HOry nO,ll;JIOmHTh nOl\YlIIKY
TaR, 'IT06hI Hora OKa3aJIaCh Ha ypOBHe 6e.l\pa.
9. Y nO.l\OlIIBhI CTonhI nOJIOmHT:b MelIIO'IeK C neCKOM.
OKOH'IaHHe npOQeA)'p:bl
1. Y6e.l\HThCH, 'ITO naQueHT JIemUT Y.l\06HO. PacnpaBHT:b
I1pOCThIHIO H nO.l\KJI HYIO neJIeHKY.
2. TIO.l\HHTh nopyqHH.
3. Ih.IMI,ITI, H BhICYlIIHTh PYKH.
2. Y6e.l\HT:bCH, qTO naI HeHT JIemHT Ha cnHHe nOcpe.l\HHe
KpoBaTH H y6paT:b nO.l\YlIIKH.
3. TIoAHHTh H3rOJIOBhe KpOBaTH no.l\ yrJIOM 45-60° (90 0 -
BblCOKoe (paYJIepOBO nOJIOmeHHe, 30° - HH3Koe (paYJIepOBO
nOJIQ)I,eHHe) HJIH nO.l\JIOmHTh TpH nOAYlIIKU: qeJIOBeK, npHMO
CH.l\HW;Hn Ha KpOBaTH, HaXO.l\HTCH B nOJIO)I(eHHH <l>aYJIepa.
4. TIOAJIO)I<HTh nO.l\YlIIKY HJIH CJIOmeHHOe o.l\eJIJlo nOA I'OJIe-
Hli naI HeHTa.
5. TIOJIOmHTh no.l\ npe.l\nJIeqhe H KHCTH nOAYlliKY (eCJIH
naI HeHT He MomeT caMOCTOHTeJI:bHO .l\BHraT:b PYKaMH).
npHMeotaHHe: npeAnl1e4bll 101 3anllCTbll AOI1>t<HbI 6bITb npiomoAHIITbl
11 pacn0l10>KeHbl l1aAOH5IMI1 BHI13.
Pa3MeIQeHUe naIJ;HeHTa B nOJIOJKeHHH CHMca
MomeT BhInOJIHHThCH KaK Ha (PYHKI HOHaJI:bHOH, TaK H Ha
06hI'IHOn KpOBaTH.
3T0 nOJIOmeHHe HBJIHeTCH npOMemYTOqHhIM MemAY nOJIO-
meHHeM Ha mHBOTe H Ha 60KY: naI HeHT MOmeT nOMO'Ih JIlillih
'IaCTH'IHO. Pa3MeW;eHHe BhInOJIHHeTCH .l\BYMH Me.l\HQUHCKHMH
CeCTpaMH.
nOl,a3aHHH: BhIHY»<.l\eHHOe, naCCHBHOe nOJIOmeHHe, pHCK
pa3BHTHH npOJIemHeH.
TIO,ll;I'OTOBKa II: npoQeA)'pe
1. 06'b.HCHHTb QeJIh H XO.l\ pa3Meru;eHHe, noJIytJHTh COrJIaCHe.
2. TIoAroToBHTh He06xo.l\HMOe OCHaru;eHHe: 2 nO.l\YlIIKH,
BaJIHK, ynop .l\JIH Hor (MelIIOqeK C necKoM).
3. OI eHHTh COCTOJIlllfe naQlieHTa H oKPymalOIIJ;Y1O 06CTa-
HOBKY. 3aKpenHTh TopM03a KpOBaTH.
CJ}aICTopbl pMCKa B pa60Te MeAceCTpbl
}, lIcpeMew;cHlie TH)KeCTen.
2. 3arpH3HeHHe aTMOC(pepHoro B03.l\yxa.
3. B03AencTBHe IIIYMa.
-1. IIeoTBe'IaIOW;He Tpe60BaHuHM, cHa6meHHe nliTheBon BO-
IIOH, Y.l\aJIeHHe OTXO.l\OB.
{j, I1apYllieHuH caHHTapHhIX npaBHJI H UHCTPYKI HiL
(j. B03.l\eHcTBHe TOKCHqeCKUX Bew;eCTB.
7. 1303l\CHcTBHe HOHH3HPYIOw;en p liaI HH.
8. B03.l\eiicTBHe KaHI eporeHHhlx Beru;eCTB.
(). OfiCCJIY)I(UBaHUe H36b1TOqHOrO KOJIH'IeCTBa naQHeHTOB.
] O. OTCYTcTBlie KOMHaT nCHXOJIOrH'IeCKOH pa3rpY3KH B
JITIY.
..
Z60
Z61
Pa3gell VI
\ £) \
nPHEM
nAUHfHTA B CTAUHOHAP
6.1. nOJtHaR caHumapHaR o6pa6omlia naqueHma
B 3aBHCHMOCTH OT COCTOlIHHlI nal\l'IeHTa caHHTapHalI 06pa-
60TKa Mo»<eT 6bITb nOJIHOM HJIH 'laCTH'IHOM. XapaKTep caHH-
TapHoM 06pa60TKH onpe.l\eJIlIeT Bpa'l. K nOJIHOM ucaHHTapHoM
06pa60TKe OTHOClITClI BalIHa, .l\YIll. 'laCTH'lHO - 06MbIBa-
HHe, 06THpaHHe. TIepe,l\ caHHTapHOH 06pa60TKoH Me.l\HI.J;HHC-
KaH ceCTpa npHeMHoro OT.l\eJIeHHlI 061I3aHa T aTeJIbHO oc-
MOTpeTb BOJIOCHCTYIO 'laCTb TeJIa naQHeHTa .l\JIH BbInBJIeHH.H
ne.l\HKYJIe3a (rOJIOBHbIX BIlleM).
CaHMTapHaR o6pa6oTKa naqHeHTa
npH BblRBI1eHHH neAlmyne3a
v
IJ;eJIb: YHH'lTo»<eHHe BIlleM H rHH,l\ Ha BOJIOCHCTOM 'laCTH
rOJIOBbI (npo(lmJIaKTHKa CblnHoro Tmpa).
Ocuam;eHHe:
1. YKJIa,lIKa 3aW;HTHOM O.l\e»<)l.bI H 6eJIbH B 6HKce - Me)l.H-
IJ.llHCKHM XaJIaT, KOCbIHKa, MaCKa, KJIeeH'laTbIM (papTYK, nep-
'laTKH. llOJIH3THJIeHOBbIe KOCbIHKH - 2 IllT., I(JIeeH'laTa.H ne-
JIepHHa, nOJIOTeHl:.{a - 2 tIllT., BaTHbIe TaMnOHbI, cTep»<cHb,
IllaMnYHb, 6% pop YKcyca, nO.l\OrpeTbIM .l\0 30°C; KJIeeH'Ia-
TbIM MeIllOK, HC»<HHI.J;bI, 'laCTbIH rpe6eHb.
2. Ta3 ,l\JIlI C)ImraHHlI BOJIOC, cnH'lKH.
3. O)l.HH H3 ,l\e3HHceKTHl\H,l\HbIX (ne.l\HKYJIOl\H,l\HbIX) p-pOB:
a) 20% pop 3MYJIbCHU 6eH3HJI6eH30aTa HJIH HHTTH<l?Op;
6) 0,5% p_p MeTHJIaI.J;eTo<l?oca B paBHbIX KOJIU'leCTBaX C
YKcycnoM 6% KHC.ilOTOM;
B) 0,25% p-p .l\HKpe3HJIa.
4. t.IHcToe HaTeJIbHOe 6eJIbe.
5. llC'l'OpHIO 60JIe3HH naI.J;HeHTa UJIH aM6yJlaTopHYlO KapTY
H )I<YPHaJI OCMOTpa Ha ne.l\HKYJIe3.
262
G. 3I(CTpeHHoe H3Be eHHe 06 HH<l?eKl\HOHHOM 3a60JIeBa-
111111.
061I3aTeJIbHLIe YCJIOBHH: C06JIIO.l\aTb npOTHBonOKa3aHHlI.
It HHM OTHOCHTC.H 06pa60'l'l<a 6epeMeHHbIx, po»<eHHl\, pO,l\HJIb-
HHI.{ H KOpM.Hm;HX MaTepeM, .l\eTeM .l\0 nHTH JIeT, naI.J;UeHTOB
npH 3a60JIeBaHHlIX KO»<H roJIOBbI.
06pa60TKY npOBO.l\HTb B cnel\HaJIbHOM, XOpOIllO BeHTHJIH-
PyeMoM nOMe eHIIH.
C06JIIO.l\aTb npaBa naI.{HeHTa, KOH<l?U.l\eHI.{HaJIbHOCTb, HH-
£l>eKI.{J:lOHHYIO 6e30nacHocTb.
TIO]l.rOToBI\:a K npOl\eA)'pe
I. ('IIII(jU\HTb naI.J;HeHTY 0 HaJIlf'IHH ne.l\HKYJIC3a H nOJIY-
'111'1'10 ('II('JIII('IIC Ha 06pa60TKY.
2. 11111\1"1'(, IlonOJIHHTeJIbHbIM XaJIaT, KOCbIHKY, TanO'lKJ:I,
nCp'I'1'I'IUI, MUCKY, (ImpTYK.
3. Yca.l\HTb naI.{HellTa Ha KYIlleTKY, nOKpbITYIO KJIeeHKoM.
4. YKpbITb nJIe'lH naI.{HeHTa KJIeeH'laTOM neJIepHHoM.
BblnOJIHeUHe npol\eA)'pLl
1. 06pa60TaTb BOJIOChI O.l\HHM H3 .l\e3HHCeKTHI.J;H.l\HhIX pa-
("I'BOPOB COrJIaCHO HHCTPYKI.J;HH K .l\e3HHCeKTIll\H,l\HOMY cpe,l\-
CTBY (HanpHMep, CMO'lHTb BOJIOCbI H BTepeTb 20% 3MYJIbCHlO
61'1I3HJI6eH30aTa U OCTaBUTb Ha 30 MHH. HJIU HHTTH<l?OP ua 40
MIIII).
npHMe4aHHe: Cl1eAI1Tb, 4T06bl cpeACTBO He nonaIlO B rl1a3a nal\l1-
eHTa, a B0l10CbI 6bll1H paBHOMepHO CM04eHbl.
2. HaKpblTb BOJIOCbI naI.{HeHTa nOJIH3THJIeHOBOM KOCbIH-
Iwii, 06B.H3aTb nOJIOTeHI.{eM (20 MHH.).
3. TIPOMbITb BOJIOChI TenJIOM BO.l\OM, 3aTeM C MOIO HM cpe.l\-
('1'1I0M, OCYIllHTb nOJIOTeHI.J;eM.
,I. Obl),\60TaTb BOJIOCbI naI.J;HeHTa nO.l\orpeTbIM 6% p-pOM
('I'IIJIOIIOI'O YKcyca.
5. I1aI(PbITb BOJIOCbI nOJIH3THJIeHOBOM KOCbIHKOM, 06BlI-
JaTb nOJIOTeHI.J;eM Ha 20 MHH.
6. IIpoMbITb BOJIOCbI TenJIOM npOTO'lHOM BO.l\OM, BhICYIllHTb
nOJIOTI'IIl.{CM.
7. BbI'lecaTb BOJIOCbI 'laCTbIM rpe6HeM, HaKJIOHHB rOJIOBY
11U.l\ GeJIOM 6YMaroM, nOCJIe,l\OBaTeJIbHO, pa3.l\eJIHlI BOJIOCbI Ha
IIPlI.l\H H Bb1'1eCbIBalI Ka»<.l\YIO np.H)J;b.
263
8. MOTPeTbBOnOCblnanHeHTanOBTopBo.¥6e TbCfi,qTO
BmeH H rHH11. HeT.
OKo aHHenpo e bl
1. C)I,eQb 6YMary.
2. CHfiTb H cnomHTb 6enbe H o11.e»<11.Y naIJ;HeHTa, cne o-
11.em11.Y Me.l\CeCTpbl B KneeH'IaTblH MemOK.
3. OTnpaBHTb MemOK B 11.e3KaMepy, o6pa6OTaT rpe6eHb
MeT011.OM npoTHpaHHfi 70° cnHpToM HnH 0611.aTb KHn.flTKOM,
o6pa6OTaTb nOMe eHHe HHceKTH H11.HbIM Cpe11.CTBOM.
4. C11.enaTb OTMeTKY Ha THTynbHoM JIHCTe HCTOpUH 60JIe3-
HH nal.{HeHTa (Me.l\Hl.{HHCKOH KapTbI CTa HoHaplIOrO 60JIbBO-
ro), c.l\eJIaTb oTMeTKY 0 BLIfiBJIeHBOM ne11.UKYJIe3e (.P.) UJIU
B aM6YJIaTOpHOH KapTe H B mypHane OCMOTpa Ha neABKYJIe3.
5. OTnpaBHTb 3KCTpeHHoe H3Be eBHe 06 HH K HOHBOM
3a60neBaHHH B :u;rC:3H, 3aperHCTpupoBaTh ct>aKT BLI.fIBJIeBHfi
ne11.HKyne3a no MecTy mHTeJIbCTBa naIJ;HeBTa.
6. llOBTOpHTb OCMOTp BOJIOCHCTOH QaCTH rOJIOBLI naIJ;HeH-
Ta 'Iepe3 ceMb ,/\HeH. llPH He06xo11.HMOCTH npoBeCTH CaHHTap-
HYIO 06pa6OTKY.
npHMe4aHHe: eCI1H Heo6xOAI1MO nOACTpl14b B0l10Cbl, Ael1alOT 3TO
H3A T330M 11 B0l10CbI C>t<l1raIOT.
06pa6oTKa BonocMcToM lIaCTM ronOBbl
npM neAMKyne3e MexaHMllecKMM cnoco6oM
IJ;eJIb: YHH'ITOmeHHe BmeH H rHH11. Ha BonocHcToH 'IaCTH
rOJIOBbl (npo(lmnaKTHKa CbIllHoro TH£pa) Y nal.{HeHTOB npH 3a-
60JIeBaHHnx KomH ronOBbl, 6epeMeHHblx, pQ)I,eHH , p011.Hnb-
HP H KOpMnIIJ;HX MaTepeH, .l\eTeH.l\O nnTH JIeT.
OCHaw;eHHe:
1. YKna.l\Ka 3all.{UTHOH o11.em)l.bI H 6enbn B 6HKce - Me.l\H-
HHCKHH XaJIaT, KOCbIHKa, MaCKa, KneeH'IaTblH (papTyK, nep-
'IaTKH. llonH3THJIeHOBLIe KOCbIHKH - 2 mT., KJIeeH'IaTan ne-
JIepHHa, nOJIOTeHl.{a - 2 mT., BaTHble TaMnOHbl, cTepmeHb,
maMnYHb, 6% p-p YKcyca, nO.l\OrpeTblH .l\0 30°C; KneeH'la-
TbIH MemOK, HQ)I<HHl.{bI; 'laCTbIH rpe6eHb, BaTHble mryTHKH
HJIH HHTKa.
2. Ta3 .l\nn cmHraHHfi BOJIOC, CnH'lKH.
264
3. .l\ ;3 11.e3HHceKTH H)l.HbIX (ne.l\HKyno H.l\HbIX) p-pOB'
6) 0 ,,0/. pop 3MynbcHH 6eH3Hn6eH30aTa HnH HHTTH£POP:
,0 0 P-Pu MeTHnaD;eTo£poca B paBHbIX KOnH'leCTBaX
YKCYCHOH 6% KHcnOTOH'
B) 0,25% p-p .l\HKpe3HJIa '
4. QHcToe HaTeJIbHOe 6enbe .
" .
H o. HCTopHn 60ne3HH naD;HeH:ra HJIH aM6ynaTopHafi KapTa
mypllaJI oCMoTpa Ha ne.l\HKyne3.
HH:" :3KcTpeHHoe H3Bell.{eHHe 06 HH(peKD;HOHHOM 3a60neBa-
06n3aTeJIbHbIe YCJIOBHfi:
- 06pa60TKY rrpOBO.l\HTb B CrreD;HaJIbHO
JIIII'Yl'MOM nOMell.{eHHH' 1'4, xopomo BeHTH-
, \
- ('()(imo11.aTb rrpaBa naIJ;HeHTa KOH(PH eH
lm;1I01lIlYIO 6e30nacllocTb. ' A D;HaJIbHOCTb, HH-
nOAroTom\:a K npo1te.n;ype
1. Co06lL\HTb nal.{HeHTY 0 HaJIH'IHH n
'lHTb COrJIaCHe Ha 06pa60TK Y HJI H ep;HKYJIe3a H nony-
II cTpHmKY Bonoc
pu onuca3e om cmpu:JfCICu: .
2. Ha11.eTb .l\OnOnmlTenbHbIH x
nep'laTKH, MaCKY, £papTYK. anaT, KOCbIHKY, TanO'lKH,
3. Yca11.HTb nal.{HeHTa Ha K
4 YK ymeTKY, nOKpbITYIO KJIeeHKOH
Ii pblTb nne'IH naD;HeHTa KneeH'IaTOH rrenepHHOH .
LIDOJIlieliHe npo ep;ypbl .
t . 06pn60TaTb BOJIOCbl a He Kom
111,11'4 YIWYCOM, BbI6Hpa.II M X Y rOJIOBbl TenJIbIM CTOJIO-
MW Dw e " aHH'leCKHM cnoc060M mHBble """ p -
H H YHH'lTOma.II HX. 'i'"
: :'4 : :: P C:: : e ' p 4 H T o 06 c bl YKCYC He non3l1 B rl1a3a naLll1eHTa. a
MO'leHbl.
2. IIIII(J)!,ITb BonOCbI rral HeHTa nOJIH3THne u
l(fII1. OfiUJI:JUTb nOJI OTeH (20 HOBOH KOCbIH-
l eM MHH )
3. 1IJ1()UYCTHTb Ba'I'HbIH mr TH "
'IUCToro rpe6Hn 06Hn bHo CMO Y K nH HHTKY CKB03b 3y61 hI
, 'leHHbIH YKC Y CO
'nlTI, 06HnbHo YKCYCOM. 1'4, H TaKme CMO-
4. n JlOMbITb BOJIOCbl TennoH BO u
CTD M, ocymHTh rronoTeHI eM. .l\OH, 3aTeM C MOIOll.{HM cpe11.-
o. BbI'leCaTb BonOCbI 'laCTbIM 6
lIa.l\ 6enoH 6YMaroH no rpe HeM, HaKnOHHB ronOBY
, cne11.OBaTeJIbHO, pa3.l\en.IIn Bonocbl Ha
265
npHMe4aHHe: eCJ1H Heo6xoAHMO nOACTpH4b B0J10Cbl, AeJ1alOT 3TO
HilA Ta30M 101 B0J10Cbl C>t<HraIOT.
3. fIpe11.ynpe11.HTb nan;HeHTa 0 B03MO:>KHb1X Hen H
ow;yw;eHHHx (cep11.I e6HeHHe, 011.b1llIKa H T n ) u 0 p 6 H -rHb1X
MOCTH co 6 6 . . n Heo X011. H -
o W;HTb 0 aT01\1 Me11.cecTpe.
4. YC8lJ.HTb naQHeHTa B BaRHY, n011.11.ep:>KHBaH ero
:Z: JIOKTH TaK, qT06bI HorH ynHpaJIHCb B n011.CTaBKY : OH
b B011.b1 11.0X011.HJI 11.0 MeqeBH11.Horo OTpOCTKa rpY JT H bI na -
QHCHTa. -
5. fIpe11.JIO:>KHTb naI HeHTY Mb1TbCH CaMOCTOHTeJIbHO CCJIH
OH aTO MO:>KeT C11.eJIaTb caM. '
BbillOJIHCIIUe npoQeAYPbl
1. H8lJ.eTb rI>apTYK.
2. BblMb1Tb naQHeHTa (eCJIH OH He MO
,,1'01'0 CI\<'JIUTb) B CJIeJT Y IOTTT e ;; :>KeT caMOCTOHTeJIbHO
n nOCJIe11.0BaTeJIbHOCTH'
I'YJIIIII I III \<', ncpXHHe KOHeqHO CT . rOJIOBa,
H, HH:>KHHe KOHeqHOCTH
XUIIIIJI 06JIUC'I'b, npOMe:?KHOCTb, HCnOJIb ' na-
I\YUJIbllY10 H 11.YllI. 3YH MOqaJIKY HH,/IHBH-
3. HOMOTIb naQHeHTY Bb1MTH H3 BaHHb1.
OlwlITlallue npoQC,lI;ypbl
:; ::: : :1:::: :; : =:;::: C C; :I;::B: : :
. 1TepeTb naQHeHTa B TOM :>Ke nOCJIe11.0BaTeJIbHOcTH.
. C11.HTbCH, qTO KO:>Ka B eCTeCTBeHHb1X CKJI8lJ.Kax H Me
lIaJIbI aMH cyxaH. :>Kl1.Y
:. g011. CT PHqb HOI"I'H naQHeHTY Ha PYI ax H Horax.
6' oOMOqb naQHeHTY npHqeCaTbCH, H8lJ.eTb 011.e:>K11.Y H 06YBb
. 11.eTb naQHeHTa B qHCTOe 6eJIbe .
11. a , 7 a ; e3HHrI>HI HPOBaTb HCnOJIb30 aHHb1e npe11. M eTb1 yxo-
npHMe4aHHe: npOAOJ1>KHTeJ1bHOCTb BaHHbI - He 6oJ1ee 25 MHH.
IIpHJ\H H Bb1qeCb1Ba.H Ka:>K11.YIO npH11.b. 06pa60TaTb rpe6eHb
MeT011. 0M npoTHpaHHH 70 o -M cnHpToM HJlli 0611.aTb KHnHTKOM.
6. fIpoMb1Tb BOJIOCbI TenJIOM npOTOqHOM B011.0 M , Bb1CyrnHTb
1I0JIOTeHI eM.
OKOH'laHUe npoQeAYPbl
1. C:>Keqb 6YMary.
2. OCMoTpeTb BOJIOCb1 naQHeHTa nOBTOPHO. Y6e11.HTbCH, qTO
Bwers H rHH11. HeT.
3. CHHTb H CJIO:>KHTb 6eJIbe H Ol1.e:?K11.Y naQHeHTa, cneno-
1P:>K11.Y Me11.CeCTpb1 B KJIeeHqaTb1M MelliOK.
4. OTnpaBHTb MellIOK B 11.e3KaMepy, 06pa60TaTb nOMeW;e-
HHe HHceKTHl H11.Hb1M Cpe11.CTBOM.
5. C11.eJIaTb oTMeTKY Ha THTYJIbHOM JIHCTe HCTOpHH 60JIe3-
HH naQHeHTa (Me11.HQHHCKOM KapTb1 cTan;HoHapHoro 60JIbHO-
ro), C11.eJIaTb OTMeTKY 0 BbIHBJIeHHOM ne11.HKYJIe3e «lp';) HJIH B
uM6YJIaTOpHOM KapTe H B :>KypHaJIe OCMOTpa Ha ne11. HK YJIe3.
6. OTnpaBHTb 3KcTpeHHoe H3Bew;eHHe 06 HHrI>eKQHoHHOM
3a60JIeBaHHH R n.I'C:3H, 3aperHcTpHpoBaTb IpaKT BbIHBJIemtH
ne11.HKYJIe3a no MeCTY :?ImTeJIbCTBa nUQHeHTa.
7. fIOBTOpHTb OCMOTp BOJIOCHCTOM qaCTH rOJIOBbI naQHeH-
Ta 'I 'pe3 ceMb 11.HeM. llPH He06xo11.HMOCTH npoBecTH caHHTap-
HYIO 06pa6OTKY.
rMrMeHM eCKaA BaHHa
IJ;eJIb: npe,l\Ynpe:>Kp;eHHe BHYTPH60JIbHWIHOM HH(peKI HH.
OCHam;eHHe: BOl1.HHOM TepMoMeTp, HO:?I<HHQb1, nOJIOTeHQe,
.4bIJIO H MOqaJIKa HH11.HBH11.YaJIbHb1e, qHCTOe HaTeJIbHOe H no-
CTeJIbHOe 6eJIbe, KJIeelf'laTb1M rI>apTYK.
06H3aTeJIbHble yCJIOBUH: HCKJIlOqHTb CKB03HHKH, 06H3a-
TeJIbHOe Ha6JII011.eHHe Me11.CecTpb1, TeMnepaTypa B0311.yxa B BaH-
HOll KOMHaTe He MeHee 25°C, Ha nOJIY pe3HHoBb1ll KOBpHK,
TeMnepaTypa B011.b1 - 35-37°C.
llO,ll;rOTOBKa K npoQeJQ'Pe
1. 06':bHCHHTb nan;HeHTY X011. npe11.CTOSlw;ell npoQe11.ypbI H
nOJIy<IHTb ero COrJIaCHe.
2. HanOJIHHTb BaHHY B011.0ll Ha nOJIOBHHY ee 06':beMa, TeM-
nepaTypa paBHa 35-37°C.
rMrMeHM eCKMH AYW
O u;eJIb: npe11.ynpe:;K11.eHHe BHYTPH60JIbHHqHOll HHlnCK"HH
Cllaw;eHue' B011.SlHO - i' ..... .
MbIJIO H MOTIaJI a HH11.HB ;; : :eTP' IIO:>KHHQb1, nOJIOTeHQe,
CTeJIbHOC 6eJIbe, ImeeHqaTb1ll IPa; K:: ::::: eJIbHOe H no-
OOH3aTeJIblu,le YCJIOB .
feJIbHOe Ha6JII011.eHHe Me UH. HCKJIlOqHTb CKB03HHKH, 06H3a-
11. CeCT pb1, TeMnepaTypa B0311.yxa B BaH-
267
266
HOM KOMHaTe He MeHee 25.C, Ha noJIY pe3HHOBbIM KOBpHK,
TeMnepaTypa BO,/:\bI - 35-37. C.
llO,ll;rOTOBKa K npoD;ep;ype u
1. 06'blICHHTb naD;HeHTY XO,/:\ npe,/:\cTOlIru;eH npoD;e,/:\ypbI H
nOJIy<IHTb ero COrJIaCHe.
2. llocTaBHTb B BaHHY CKaMee'lKY H yca,/:\HTb Ha Hee naD;H-
eHTa.
3. nOMO'lb naD;HeHTY CTaTb B BaHHY, nOMepmHBaH ero
C3a,D;H no,/:\ JIOKTH, H 3aTeM ceCTb Ha CHAeHHe.
4. ll06ymAaTb naD;HeHTa K caMOCTOlITeJIbHOMY MbITblO.
IIpe,/:\JIaraTb nOMOIIJ;b B TOM CJIY'lae, eCJIH OHa He06xOAHMa.
BbInOJIHeHlle npOD;C,lI;ypbI
1. Ha,/:\eTb c)?apTYK, BbIMbITb roJIOBY naD;HeHTY:
- CJIOmHTb neJIeHKY B HeCIWJIbKO pa3 H nonpOCHTb na-
I HeHTa npHI<pbITb rJIa3a;
- CMO'lHTb BOJIOCbI, IIOJIHBaH HX BO,/:\OM H3 ,/:\YllIa;
- HaHeCTH HeMHoro llIaMnYHlI Ha BOJIOCbI naD;HeHTa;
- BbIMbITb rOJIOBY 06eHMH PYKaMH, 6epemHO MaCCHpo-
BaTb roJIOBY, nOKa Bce BOJIOCbI He 6YAYT nOJIHOCTblO
HaMbIJIeHbI;
- CMbITb MbIJIbHYIO neHY BOJ(OM;
- BbITepeTb BOJIOCbI nar HeHTY.
2. llOMO'lb naI HeHTY, npH He06xoAHMOCTH, BbIMbITb TeJIO
B TOM me nOCJIe,/:\oBaTeJIbHOCTH, KaK npH npoBeAeHHH rHrHe-
HH'leCKOM BaHHbI.
3. nOMO'lb naD;HeHTY BCTaTb C CH,/:\eHblI (npH He06xOAHMO-
CTH OKa3bIBaMTe nOMOI.IJ;b B,/:\BoeM, HCnOJIb3YlI npaBHJIbHYIO
6HOMexaHHKY TeJIa).
OKOH'laUUC npOD;C,lI;ypLI
1. llOMO'lb naD;HeHTY BbIMTH H3 BaHHbI.
2. BbITepeTL TeJIO B TOM me nOCJIe,/:\OBaTeJIbHOCTH.
3. llOMO'lb naI HeHTY nplf'leCaTbCll, Ha,D;eTb OAem.ltY H 06YBb.
4. llOACTPH'lb HorTH naD;HeHTY Ha PYKax H Horax.
5. llOMO'lb naD;HeHTY HaAeTb 'lHCTOe HaTeJIbHOe 6eJILe H
O,/:\C:?I<.ltY.
6. CHlITb c)?apTYK H C6POCHTb ero B HenpoMoKaeMbIM Me-
llIOK, BbIMbITL H BbICYllIHTb PYKH.
7. CpeJIaTb 3anHCb 0 BbInOJIHeHHOM npoD;eAype H 0 peaK-
D;HH naI HeHTa.
/
a
6.2. MeguliaMeHm03Hoe Ae'leHue
B cecmpUHclfoii npalfmulfe
CaHMTapHaR o6pa6oTKa naqMeHTa:
a - B BaHHe, 6 - nOA AYweM
nOpRAOK BblnMCblBaHMR M nonYl.feHMJI
neKapcTBeHHblx cpeAcTB
1. Tpe60BaHHlI JIe'le6HO-npoc)?HJIaKTH'leCKHX y<Ipem.lteHHM
Ha nOJIY'leHHe H3 anTeK JIeKapCTBeHHbIx cpe,/:\cTB BbInHCbIBa-
IOTClI B 4 3K3eMnJIHpax.
6
Z68
t.,
269
Ha H.v;OBHTbIe, HapKOTH'leCKHe, CHJIbHO .v;eMCTBYlOru;He MC-
.v;HKaMeHTbI, cnHpT 3THJIOBbIM BblnHCbIBaIOTCH Ha O.v;HH 3K3eM-
nJIHp 60JIbIlle.
2. Bce Tpe60BaHHH BbIllHCbIBalOTCH 3a no.v;nHcHMH pacno-
PMHTeJIeM Kpe.v;HToB H 3aBepHlOTcn neqaTblO yqpe:>K.v;eHHn. B
Tpe60BaHHHx B 06n3aTeJIbHOM nopn.v;Ke YKa3bIBalOTcH B 06n-
3aTeJIbHOM nopH.v;Ke YKa3bIBaeTcH nOJIHOe HaHMeHOBaHHe Me-
.v;HKaMeHToB, nepeBH30qHblX cpe.v;cTB H npOqHX TOBapOB, HX
pa3MepbI, (paCOBKa, JIeK(pOpMa, l\03HpoBKa, KOJIl1'leCTBO H Ha-
3HaqeHHe BIB, B/M, BHYTpeHHee, KanJIH B HOC, npHMOqKa,
nOJIOCKaHHe H T. .v;.
3. Tpe60BaHHH JIeqe6Ho-npO(pHJIaKTl1'leCKHX yqpe:>K,l.l;eHHM
Ha H.v;oBHTbIe, HapKOTH'IeCKHe cpeAcTBa, cnHpT 3THJIOBbIM Bbl-
nHCbIBalOTCH Ha JIaTHHCKOM n3bIKe Ha OT.l\eJIbHbIX 6JIaHKaX co
IIITaMnOM, neqaTblO H no.v;nHcblO PYKoBo.v;HTeJIn yqpe:>K.v;eHHH
HJIH ero 3aMeCTHTeJIn no JIeqe6HOM qaCTH.
B Tpe60BaHHH 06H3aTeJIbHO .v;OJI:>KHO 6bITb YKa3aHo HaHMe-
HOBaHHe oT.v;eJIeHHH HJIH Ka6HHeTa, KOHQeHTpaQHn cnHpTa, a
TaK:>Ke HaHMeHOBaHHe JIeKapCTBa ( .v;JIH HH'beKQHM, .v;JIn Ha-
PY:>KHOrO npHMeHeHHn, BHYTpeHHero ynoTpe6JICHHn, rJIa3Hble
KanJIH H T. A. ).
4. B TPe60Bamulx Ha nOJIy<IeHHe H3 aIITeK MOBHTbIX, HapKe-
TWleCKMX, OCTpo.v;eqmQHTHbIX, p8,L\HOaKTHBHbIX H30TOnOB H npe-
napaTOB .v;JIH KJIHHHqeCKHX HcnbITaHHM H HCCJIe.v;OBaHHM
yKa3blBaIO'l'CH HOMepa HCTOpHH 6oJIe3HH, «l>8MRIDi H , liMn, OT'IeCTBO
6oJIbHbIX, 1J,JIJI KOTOpblX BbITlliC8HbI JIeK8.pCTBeHHbIe Cpe.v;CTBa.
5. JIeKapcTBa, npe.v;Ha3HaqeHHbIe .v;JIJI JIeqeHHn 60JIbHbIX B
cTaQHoHapHblX YCJIOBHnX, OTnycKalOTcH anTeKaMH Me.l\HQHH-
cKoM ceCTpe HJIH .v;e:>KypHoMY (peJIb.v;Illepy TOJIbKO B 3aBo.v;cKoM
HJIH anTeqHOM ynaKoBKe no Tpe60BaHHJIM.
6. TIpH nOJIyq:eHHH JIeKapcTBeHHbIx cpe.v;cTB H3 X03paCqeT-
HOM anTeKH pa60THHK yq:pe:>K,l\eHHJI npe.l\'bJIBJIJIeT .l\OBepeH-
HOCTb no (pOpMe M-2a (pa30BaJI HJIH nocTonHlIan).
7. [Jpe.l\CTaBl1TeJIb JICqe6HO-npo«l>HJIaKTHqeCKOrO yq:pe:>K.l\e-
lIHn, nOJIyq:aH JIeKapCTBa, 06n;!aH npoBepHTb COOTBeTCTBHe
ero C nponHcblO B Tpe60BaHHH H nO.l\TBep:>K.l\aTb nOJIyq:eHHe
TOBapa cBoeM nO.l\nHcblO Ha Bcex 3K3eMnJIHpax.
8. TpalICnOpTHpoBKa JIeKapCTBeHHbIx (POPM AJIn HOBopmI,-
.l\eHHbIX ocyru;eCTBJIneTCn B CTepHJIbHbIX HaBOJIOqKaX HJIH 60K-
cax, nOMew;eHHbIX B KOHTeMHepbI, KOTopbIe CHCTeMaTHqeCKH
06pa6aTblBalOTcn .l\e3paCTBOpaMH.
nopRAOK xpaHeHMR,
Yl.feTa neteapCTBeHHblx cpeAcTB
1. TIPH xpaHeHHH JIeKapCTBeHHblx Cpe.l\CTB He06xo.l\HMO
PYKOBO.l\CTBOBaTbCH OCHOBHbIM npHHI:(HIIOM: pa3Meru;eHHe JIe-
KapCTBeHHbIX Cpe.l\CTB B cTporoM COOTBeTCTBHH C TOKCHKOJIO-
rHqeCKHMH rpynnaMH: cnHCOK A (n.l\OBHTble H HapKOTHqeC-
KHe C e.l\CTBa), cnHCOK B ( CHJIbHO.l\eMcTBYlOru;He Bew;ecTBa)
06W;HH cnHCOK. '
2. OTBeTcTBeHHocTb 3a xpaHeHHe H paCXO.l\ JIeKapCTB, a
TaK:>Ke 3a nOpn.l\OK Ha MeCTax xpaHeHHn, C06JIIO.l\eHHJI npa-
BHJI BbI,l.l;aqH H Ha3HaqeHHe JIeKapCTB Hecih 3aBe.l\YlOru;HM OT-
.l\eJIeHHeM (Ka6HHeToM).
Henocpe.l\CTBeHHbIM HCnOJIHHTeJIeM OpraHH3aIJ;Irn xpaHeHHH
H paCXO.l\a HBJInCTCn CTapIllaJI Me.l\ceCTpa.
3. OTBeTcTBcHHbIM 3a xpaHeHHe HapKOTHqeCKHX, n.v;OBH-
TbIX H CHJIbHO.l\eMcTBYlOru;HX JIeKapCTBeHHbIX Cpe.l\CTB HBJIH-
IOTCH rJI BHbIM Bpaq (ero 3aMeCTHTeJIH), a TaK:>Ke JIHI a,
YTBep:>K.v;eHHbIe npHKa30M no yq:peJK.l\eHHIO.
4. HapKOTHqeCKHe JIeKapCTBeHHble Cpe.l\CTBa .l\OJI:>KHbI xpa-
HHTbCH B YKpenJIeHHbIX ceM«l>ax, Ha BHYTpeHHeM CTopOHe .l\Be-
pOK .l\OJI:>KeH 6bITb nepeqeHb HapKOTHqeCKHX JIeKapCTBeHHbIX
cpe cTB C YKa3aHHeM BbICIIIHX pa30BbIX H CYTOqHbIX .l\03.
..,. .H.l\OBHTbIe H CHJIbHO.l\eMCTBYIOIIJ;He JIeKapCTBeHHble cpe.l\-
CTBa .l\OJI:>KHbI xpaHHTbCH B OT.l\eJIbHOM MeTaJIJIHqeCKOM HJIH
.l\epeBnHHOM IllKa(py C 3aMlWM.
6. 3anacbl HapKOTHqeCKHX JIeKapCTBeHHbIX Cpe.l\CTB B OT-
.l\eJIeHIIHX (Ka6HHCTax) He .l\OJI:>KHO npeBbIIllaTb 3-.l\HeBHOM no-
Tpc6110CTH B HHX, H.l\OBHTbIX - 5-.l\HeBHOM, a CHJIbHO.l\eMCTBY-
IOru;HX - lO-.l\HeBHOM nOTpe6110CTH.
7. EJIlOqH OT IllKa«l>a «Ai) H «Bi) xpaHHTCH Y JIHQ, Ha3Ha-
qeHHbIX npHKa30M no .r.:eqe6110MY yq:pe:>K.l\eHHIO, OTBeTCTBeH-
HbIX 3a xpaHeHHe H BbI.l\aqy H.l\OBHTbIX H CHJIbHO.l\eMcTBYIO-
ru;HX cpe.v;CTB, a Ha HOqb 3TH KJIlOqH nepe.l\alOTCn .l\e:>KypHOMY
Bpaqy, 0 'IeM .l\eJIaeTCn COOTBeTCTBYIOw;aH 3anHCb B cneQH-
aJIbHOM :>KypIIaJIe, CTaBHTCH no.v;nHCH nepe.l\alOW;erO H npH-
HHBIllero KJIlOqH H YKa3aHHble JIeKapCTBeHHbIe Cpe.l\CTBa.
211
210
8. B MeCTax xpaHeHH.H H Ha nOCTax .l\emypH:blX BpaqeM H
ceCTep .l\OJI»<Hbl 6bIT:b Ta6JIH1.{bI BblCllIHX pa30BbIX H CYTOqH:b1X
.l\03 HapKOTHqeCKHX, .H.l\OBHTblX H CHJIbHo:J;eMcTBYIOW;HX
JIeKapCTBeHHbIx Cpe.l\CTB, a TaKme Ta6JIHUblrrpOTHBO.HAHM npH
OTpaBJIeHIDix.
9. JIeKapcTBeHHble cpeAcTBa AJI.H napSHTepaJIbHOrO npHMe-
HeHH.H, BHYTpeHHero yrroTpe6JIeHH.H H HapymHorO npHMeHe-
HH.H .l\OJImHbI xpaHHTbC.H pa3AeJIbHO, Ha OTAeJIbHblX rrOJIKax.
10. PacTBop KaJIH.H XJIOpH.l\a AJI.H HH'beKQHM He06xo.l\HMO
xpaHHTb no cnHCKY (lB,;.
11. TepMOJIa6HJI:bHbIe nperrapaTbI AOJImH:b1 xpaHHT:bC.H B
XOJIO.l\HJIbHHKaX, cBeTOqyBcTBHTeJIbHble - B TeMHbIx 3aKpbI-
TbIX llIKa(pax.
12. fIaxy'me H KpaC.HW;He npenapaTbI XpaH.HTC.H oT.l\eJIbHO
OT npOqHX, B nJIOTHO 3aKpbIBalO1l.{HXC.H .HW;HKax.
13. MecTa xpaHeHH.H JIeKapCTB Tpe6YlOT C06JIIO.l\emm CTpO-
roro caHHTapHo-rHrneHH'leCKOrO pemHMa.
14. JIeKapcTBeHHbIe nperrapaTbI H (POPMbI CJIeJ.{YeT HCnOJIb-
30BaTb B npeAeJIax YCTaHOBJIeHHbIX CpOKOB rOAHocTH.
15. B OTAeJIeHH.HX H Ka6HHeTax JIe'le6HO-rrpO(pHJIaKTw.J:ec-
KHX yq:pe)I<AeHHM nOAJIe)l<aT KOJII'l'leCTBeHHoMY yq:eTY Bce Hap-
KOTUqeCKHe H .H.l\OBHT:b1e JIeKapCTBeHHbIe cpeAcTBa, cnHpT
STHJIOBbIM B qHCTOM BHAe, a TaKme nepe'leHb JIeKapCTBeHHbIx
cpeAcTB H rrepeBH30qHbIX H3AeJIHM, YTBepm.l\eHHbIM rrpHKa30M
M3'CCCP OT 27.12.84 r. N21474.
16. YqeT CJIe.l\yeT BeCTH B CneQHaJIbHOM KHHre, npoHYMe-
pOBaHHoM, npolliHYPOBaHHoM H CKperrJIeHHOM rrOArrHCblO rJIaB-
Horo Bpa'Ia H neqaTblO Jle'le6HO-npmpHJIaKTHqeCKOrO yq:pem-
,neHHH.
3. fIpHMeHeHHe HapKOTHqeCKHX JIeKapCTBeHHbIX Cpe.l\CTB
no Ha3Ha'leHHIO Bpa'la npOH3BOAHTClI npoQeAYPHoM HJIH na-
JIaTHOM cecTpoM B npHCYTCTBHH Bpaqa C OTMeTKOM 0 npOBe-
AeHHoM HH'beKQHHB HCTOpHH 60Jle3HH H JIHCTe Ha3Ha'leHHlI.
4. fIepOpaJIbHbIM npHeM HapKOTHqeCKHX cpeACTB .l\OJImeH
npOH3BO.l\HT:bCH TOJl:bKO B npHCYTCTBHH MeAHQHHcKOM CecTpbI.
n 3AnPEutAETCSI:
1ii11. .D.e3cpeAcTBa, pacTBopbl AIlSl TeXHH4eCKHX l!elleH ( 06pa-
60TKH PYK, HHcTpYMeHToB, Me6enH, 6ellbSl 101 T. A.) xpaHHTb
BMeCTe C MeAH4HHCKHMH npenapaTaMH, npeAHa3Ha4eHHblMH AIlS!
l1e4eHHS! na4HeHTOB.
2. BblAaBaTb l1eKapCTBa 6e3 Ha3Ha4eHHSI Bpa4a, 3aMeHSlTb OAHH
l1eKapcTBa APyrHMH, npeABapHTellbHo paCKIla,c,blBaTb npenapa-
Tbl B Sl4eHKH, MeH3ypKH, naKeTbl HAP.
3. BblnHCblBaTb, OcpOpMIlSlTb 101 xpaHHTb l1eKapCTBa nOA YCIlOB-
HblMH 0603Ha4eHHSlMH. HeYTBep>KAeHHbIMH cpapMaKoneHHblM
KOMHTeTOM.
4. OmycK lleKapCTBeHHblx cpeACTB 1013 ameK AIlSI lle4e6HO-
npocpHIlaKTH4eCKHX Y4pe>KAeHHH npH OTCyrCTBHH AOBepeHHO-
CTH Ha HX n0I1Y4eHHe.
5. KaTeropH4ecKH 3anpe aeTcSI nOIly'!eHHe l1eKa!?CTB 1013 anTe-
KH nOAc06HbIM nepCOHaIIOM (caHHTapKaM, wocpepaM 101 AP.).
nopRAOK BblAal.fM
neKapCTBeHHblX cpeACTB naqMeHTy
1. Bbl.l\Uqa naI.{HeHTaM JIeKapCTBeHHbIX cpe.l\CTB, COAepma-
11.{l1X .HAOBHTbIe H HapKOTHqeCKHe cpe.l\CTBa, .l\OJI)I<HO npOH3-
BO.l\HTbC.H TOJIbKO OTAeJIbHO OT npo'mx MeAHKaMeHToB.
2. Eo H36e)l<aHHe 01lIH6KH, nepe.l\ BCKpbITHeM a..YlinyJIbI, yna-
KOBKH, CJIeAYeT BCJIYX npOqeCT:b Ha3BaHHe npenapaTa, .l\03H-
POBKY, CBepHTb C Ha3HaqeHHe H nOCJIe SToro OTnYCTHTb naQH-
eHTY.
l-IapY>KHbIM nYTb
BBeAeHMR neteapCTBeHHblX cpeACTB:
lIapYJ/CHblU nymb 66eiJe1tUR JteKapcm6eHHblX cpeiJcm6: qe-
pe3 KomHbIe nOKpOBbl, CJIH3HCTbIe 060JIOqKH H AblXaTeJIbHbIe
nYTlI. OKa3bIDaeT MeCTHoe .l\eMCTBHe. Ha Komy HaHOClIT Ma3H,
SMYJIbCHH, nopOllIKH, 60JITYllIKH, HaCTOMKH. Ha CJIH3HCTbIe
060JIOqKH rJIa3 npHMeHlIlOTClI KanJIH H Ma3'tI, B 1I0C BB0.l\.HT
JIeI<apCTBa B BH.l\e nopOlliKOB, napOB, paCTBopOB (KanJIU) Ma-
3eM. BCaCbIBaHHe qCpe3 CJIH3HCTble 060JIOql(H rrpOXO.l\HT OqeHb
SHeprWIHO.
B YlliH JIeKapCTBeHHbIe Cpe.l\CTBa 3aKanbIBalOT nHneTKOM,
MaCJI.HHbIe paCTBopbI nOAorpeBalOT.
213
272
l
}J.JUJ. MeCTHOrO B03.n;eMCTBHH Ha CJIH3HCTYlO 060JIO'lKY BJIa-
raJIHw;a npHMeHHIOT IlIapHKH, TaMnOHbI, nOpOIlIKH, paCTBO-
pbI .n;JIH CnpHHQeBaHHM.
8Hmepa.n.bHbtU nymb 66eiJeHUS/, JteICapCm6: 'lepe3 pOT, nO)];
H3bIK, 'lepe3 npHMYIO KHIlIKY. BcaCbIBaHHe B KpOBb ocyru;e-
CTBJIHeTCH 'lepe3 nHru;eBapHTeJIbHbIM TpaKT. Qepe3 pOT ynoT-
pe6JIHlOT nopOIlIKH, Ta6JIeTKH, nHJIIOJIH, KanJIH, MHKCTYPbI,
KOTopbIe OKa3bIBaIOT 06w;ee .n;eMCTBHe Ha opraHH3M H MeCTHoe
Ha :>KeJIy.n;O'lHO-KHIlIe'lHbIM TpaKT. fIpeHMyw;ecTBa aToro cno-
c06a 3aKJIIO'laIOTCH B npHMeHeHHH MHoro06pa3HH JIeKapCTBeH-
HbIX CPOPM, npocToTe HX npHMeHeHHH, a Ta.K:>Ke npHMeHeHHH
cpe.n;cTB B HeCTepHJIbHOM BH.n;e.
HeiJocmamlCaMu 3Hmepa.n.bHozo nymu 66eiJeHuS/, HBJIHIOTCH:
1. Me.n;JIeHHOe BcaCbIBaHHe, KOTOpoe npoHcxo.n;HT B KHIlIe'l-
HHKe.
2. OTpHI. aTeJIbHOe .n;eMCTBHe :>Ke.rry.n;O'lHOrO, KHIlIe'lHOrO co-
KOB, :>KeJI'lH Ha JIeKapCTBeHHoe cpe.n;CTBO.
3. HenOJIHoe BCaChIBaIlHe JIeKapcTBeHHoro cpe.n;CTBa B KpoBb,
B pe3YJIbTaTe 'lero Tpy.n;HO YCTaHoBHTb .n;03HPOBKY.
E npeHMyru;ecTBaM cy6JIHHrBaJIbJlOrO nYTH BBe.n;eHHlI (no.n;
H3bIK) OTHOCHTCH TO, 'lTO JIeKapCTBeHHoe cpe.n;CTBO 6bICTpO
BcaCbIBaeTCH, He pa3pYIlIalICb, nocTynaeT B KpOBb, MHHYH
ne'leHb H nHru;eBapHTeJIbJlbIM TpaKT. :3TH cnoc060M npHMe-
HHIOT npenapaTbI TOJIbKO 6bICTporo .n;eMCTBHH, H3rOTOBJIeH-
HbIe B Ta6JIeTKaX, KancYJIax, paCTBopax (HHTpOrJIHQepHH,
BaJIH.n;OJI).
JIeKapcTBeHHbIe cpe.n;cTBa, BBe.n;eHHbIe B npHMYIO KHIlIKY
(peKTaJIbHO) OKa3bIBalOT KaK pe30p6THBHoe .n;eMCTBHe Ha opra-
HH3M, BcacbIBaHcb 'lepe3 reMoppOH.n;aJIbHbIe BeHbI, TaI( H Mec-
THoe, - Ha CJIH3HCTYlO npHMOM KHIlIKH. PeKTaJIbJlO BBO.n;HT
:»m.n;KHe (OTBapbI, paCTBopbI, Ma3H), a TaK:>Ke TBep.n;bIe JIeKap-
CTBeHHbIe cpe.n;CTBa, KOTopbIe CTaHOBHTCH :»m.n;KHMH npH TeM-
nepaType TeJIa (3T0 cynn03HTopHH). fI03TOMY nepe.n; BBe.n;eJlH-
eM B nplIMYIO KHIlIKY JIeKapCTBeHHbIX cpe.n;CTB CJIe.n;yeT O'lHC-
THTb KHIlIe'lHHK.
BBe.n;eHHe JIeKapCTBeHHbIX cpe.n;CTB B .n;bIxaTeJIbHbIe nYTH,
nYTeM HX B.n;bIXaIlHH, Ha3bIBaeTClI HHraJIHQHeM. JIeKapcTBeH-
Hoe cpe.n;CTBO Haxo.n;HTClI BO cpJIaKOHe-HHraJIHTOpe B Bli)J;e aapo-
30JIlI. HHraJIHTOpbI 6bIDaIOT CTaI HOHapHbIe, nopTaTHBHbIe,
:
ffr
I J 'J)
I /.- h
1; J'
.& .
c.............:........ -.....
jJ11}JJ
ijf' '1
Jy:.. ""
ACTMonEHT
20ml
A3P030Jlb
lI03HPOBAHHblA
npaBHna nonb30BaHKR
KapMaHHblM KHranRTopOM
214
KapMaHHbIe. C nOMOW;blO HHraJIlI-
Topa JIeKapCTBeHHoe cpe.n;CTBO BBO-
.n;lIT 'Iepe3 pOT HJIH HOC.
np.anHJIa nOJIb30BaHHH l\:apMaH-
HLIM HnraJUlTOpOM
(6aJIJIOII'IHIWM)
1. CHHTb C 6amlOH'IHKa 3a-
ru;HTHbIM KOJIna'lOK, nOBepHYB fiaJI-
JIOH'IHK BBepX .n;HOM.
2. XOPOIlIO BCTplIXHYTb 6aJI-
JIOH'lHK C aap030JIeM.
3. C.n;eJIaTb rJIy60KHM BbI.n;OX.
4. OxBaTHTb ry6aMH MyJI.n;IIITyK
6aJIJIOH'IUKa, rOJIOBY CJIerKa 3aD-
POKHHYTb Ha3 .
5. C.n;eJIaTb rJIy60KHM B.n;OX H
O.n;HOBpeMeHHO nJIOTHO Ha:>KaTb Ha
.n;HO 6aJIJIOH'IHKa: B 3TOT MOMeHT
BbI.n;aeTCH .n;03a aap030JIH.
6. 3a.n;ep:>KaTb .n;bIxaHHe Ha 5-
10 ceKYH.n;, 3aTeM BbIHYTb MYH.n;IlI-
TYK 6aJIJIOHQHKa H30 pTa H c.n;e-
JIaTb Mc.n;JIeHHbIM BbI.n;OX.
7. fIocJIe HHraJIlII HH Ha.n;eTb Ha
6aJIJIOH'lHK 3aW;HTHbIM KOJIna'lOK.
D nOMHHTe: 4eM rny6>Ke BBO,D,HT-
CSI p,03a a3p030nSl, TeM OH 3cp-
cpeKTHBHee.
npHMe.4aHHe: npH BBeAeHl111
A03bl a3p03011S1 B HOC Heo6xo-
AI1MO nOMHI1Tb, 4TO r0l10Ba AOI1-
>t<Ha 6blTb HaKl10HeHa K npOTl"BO-
n0I10>t<HOMY nl1e4Y 11 3anpOKI1HY-
Ta Cl1erKa Ha3a,l\. npl1 BBeAeHl111
B npaBYIO H03}:\plO l1eKapCTBeH-
HOro CpeACTBa Heo6xo}:\I1MO
npl1>KaTb l1eBoe Kpbll10 HOCa K
neperOpO}:\Ke.
215
BBeAeHMe neKapCTBeHHbIX. CpeACTB B rna3a, HOC, YWM
TyaJIeT nOJIOCTIi HOCa B3pOCJIOrO naQUeHTa
C nOMOm;:b1O MaCJI.fIH:bIX paCTBOpOB
IJ;eJI:b: Y.l\aJIUTl. cO.l\epmUMOe nOJIOCTU HOCa.
OCHam;eHUe: CTepllJI:bHl.le nUneTKII, Ba3eJIliHOBOe MaCJIO
(UJIU paCTUTeJI:bHOe), BaTH hIe TYPYHAhI Ha JIOTKe, MaJIl.le CaJI-
(peTKU, pe3UHOBl.IM 6aJIJIOH'lliK uJIu 3JIeKTpoOTCOC, MaCKa, nep-
'laTKU.
IIO,ll;rOTOBKa K npoU;e,zJ;yPe
1. ¥cTaHoBuTl. .l\06pOmCJIaTeJIl.Hl.le OTHOllIeHlIlI C IIau;ueH-
TOM, 06'h.flCHUTl. u;eJIl. U XOA npOQeAypl.I, nOJIy<IIITl. ero CorJIa-
CRe Ha ee Bl.IIIOJIHeHUe.
2. IIonpocuTl. JIe'l:b IIau;ueHTa U CJIerKa 3anpoKuHYTl. ro-
JIOBY.
3. BhIMhITl. PYKU, Ha.l\eT:b MaCKY, nep'laTKII.
B:bInOJIHeHHe npou;e,ll;yp:bl
1. Ha6paTl. B nuneTKY 4-5 KaneJI:b MaCJI.fIHOrO pacTBopa
(npO'lUTaT:b Ha3BaHlle, onpe.l\eJIIiTl. CpOK rOAHocTII) .l\JI.fI Kam-
.l\OM nOJIOBuHl.I Hoca.
2. fIpunOAH.fIT:b KOH'lIiK Hoca.
3. 3aKanaTl. B 06e nOJIOBuHl.I Hoca no 2-3 KanJIU JIeKap-
CTBeHHoro cpe.l\CTBa.
4. llonpocuTl. naQl1eHTa nOJIemaTl. 2-3 MuH.
5. B3.f1Tl. TYPYH.l\Y, BBeCTU B HumHuM HOCOBOM XO.l\ OAHOM
H03.l\PU, YAaJIUTl. CO.l\epmuMoe.
6. CMeHIITl. TYPYH,IJ;Y, Y.l\aJIUT:b cOAepmuMoe APyroM H03A-
pu C nOMoIII;l.lO BaTHoM TYPYHAhI uJIU nonpocuTl. naU;lIeHTa
Bl.ICMopKaTl. 6e3 Hanp.flmeHU.fI OTAeJI:bHO KamP;YIO H03APIO.
npHMe'laHHe: 6011bHblM. HaXO,l\SI Io1MCII B TII>KeIlOM COCTOIIHIo1\o1, co-
,l\ep>KIo1MOe nOlloCTH Hoca YAalll1eTCI1 311eKTpOOTCOCOM.
4. fIpou3BecTli perUCTpaI UIO npOu;e.l\ypbI U peaKI UIO Ha
Hee naQueHTa B Me.l\uI IIHCKOM KapTe.
.. 3aKan:blBaHHe KaneJIb B rJIa3a, HOC, yuIH
OCHam;eHHe: CTepUJIbHhIe - JIOTOK, nuneTKU, MapJIeBl.le
llIapliKII, BaTH hIe TaMnOHl.I, TYPYH.l\hI, rpym:eBII)J;Hl.IM 6aJIJIOH-
'1uK.
He06xo,ll;uMOe YCJIOBHe: JIeKapCTBeHHoe cpeAcTBo npoBe-
pliTl. Ha npllrO.l\HOCTl. B COOTBeTCTBuu C Ha3Ha'leHueM Bpa'la:
Ha3BaHue, KOHI eHTpaQulO, CpOK rOAHocTU, I eJIOCTHOCTl. (pJIa-
KOH'lliKa C JIeKapCTBeHHl.IM Cpe.l\CTBOM; oQeHUT:b BHellIHIIM BII.l\
npUMeHlIeMOrO JIeKapCTBeHHoro Cpe.l\cTBa.
.. 3al,anblBaHHe l,aneJI B rJIa3a
1. IIoAorpeTl. KanJIu .110 36-37 .C.
2. YCap;UTl. naI ueHTa JIUI OM K CBeTY co CJIerKa 3anpOKU-
HYTOM roJIOBOM IlJIu YJIOmIlT:b Ha cnUHY 6e3 nO.l\YWKIi.
_3. Ha6paTl. JIeKapCTBeHHoe Cpe.l\CTBO B nlineTKY npaBoM PY-
KOU, a B JIeBYIO PYKY B3.f1T:b CTepUJIl.HhIM MapJIeBhIM TaMilOH.
4. OTT.fIH}'Tl. HumHee BeKO JIeBOM PYKOM C nOMoIII;l.lO Map-
JIeBOrO TaMnOHa.
5. fIpeAJIOmUTl. naQueHTY nOCMOTpeTl. BBepx (ecJIIi 3T0
B03MomHo).
6. Bl.IIIYCTliTl. Me.l\JIeHHO 1-2 KanJIU JIeKapCTBeHHoro cpeA-
CTBa B KOIl'hIOHKTUBaJIl.Hl.IM MellIOK, 6JIume K HOCY.
. fIpeAJIOmUTl. naQlleHTY 3aKpl.ITl. rJIa3a (JIeKapCTBeH-
Hl.IU paCTBOp He AOJImeH BhITeKaTl.).
8. OnYCTuTl. nuneTKY B eMKOCTl. AJI.fI Kun.fl'leHUlI.
.I
3aKan:bIBaHUe l,aneJI:b B noc
OIWWIaHue npoU;e,zJ;yPbI
1. nOMO'll. nau;ueHTY BCTaT:b (npll He06xOAuMOCTII), pac-
cnpOCIIT:b 0 CaMO'lYBcTBUU.
2. fIorpY3uTl. nuneTKY, pe3uHoBbIM 6aJIJIOH'lUK, 3anOJIHUB
nOJIOCTU, a TaKme TYPYH.l\bI B .l\e3. p-p.
3. CH.fIT:b MaCKY, npO.l\e3UH(pUQllpoBaTl. nep'laTKU, CH.fIT:b
uX, BbIMhITl. U ocymllT:b PYKU.
1. fIoAorpeT:b KanJIU .110 36-37 .C.
2. O'lUCTUTl. HOCOBl.le X0.l\l.I.
3. Yca.l\uT:b naI l1eHTa co CJIerKa 3anpoKuHYTOM rOJIOBOM
HJIu YJIOmUTl. Ha cnUHY 6e3 nO.l\ym:KH.
4. B3.f1Tl. BaTHhIe llIapliKu B npaBYIO PYKY, npumaB UX K
JIa,L\OHIi MU3UHI eM.
5. B3.f1T:b nlineTKY B npaaylO PYKY, Ha6paTl. JIeKapCTBeH-
Hoe Cpe.l\CTBO.
Z11
Z16
v
6. lIpliTIOnmITb KOH'lHK Hoca na HeHTa 60JIbllIHM naJIb-
eM JIeBOH PYKH.
7. BBeCTH nHneTKY B HOCOBOM XO):l Ha r.1IY6HHY 1-1,5 CM,
CTapa.HCb He KaCaTbC.H ero CTeHOK.
8. 3aKanaTb 4-5 KaneJIb Ha CJIH3HCTYIO ncperopOnKH Hoca.
9. lIpmKaTb TaMnOHOM KpbIJIO Hoca K neperopo):lKe.
10. HaKJIOHHTb rOJIOBY na HeHTa B TY CTOPOHY, Kyna BBe-
neHO JIeKapCTBeHHOe cpen CTBO .
11. 3aKanaTb'lepe3 1-2 MHH. B npyroH HOCOBOH Xon JIe-
KapCTBeHHoe cpe):lCTBO B TOM me nOCJIenOBaTeJIbHOCTH.
12. lIpone3HH(PHD;HpOBaTb nHneTKH.
3aKanLIBaHHe KaneJlb B yXO
U;eJlL: JIe'le6Ha.H.
lIOKa3aHHH: 60JIeBbIe orn;yrn;eHH.H H BOCnaJIHTeJIbHbIH npo-
ecc B yxe. .
OCHaIIJ;eHlle: JIeKapcTBeHHOe cpenCTBO B ame'lHOH ynaKOBKe,
CTepHJIbHbIe nHneTKa, JIOTOK; JIOTOK nJI.H oTpa60TaHHoro Ma-
TepliaJIa; BaTHbIe llIapHKH; pe3HHOBbIe nep'laTKH; BOn.HHa.H
6aH.H; BaTHbIe mryTHKH (TYPYHn bI ).
llOp;roToBKa K npo enype
1. lIonrOTOBHTb Bce He06xonHMoe OCHarn;eHHe.
2. YCTaHOBHTb n06pOmeJIaTeJIbHbIe OTHOllIeHWI C naIUieHTOM.
3. 06'b.HCHUTb n HeHTY eJIb H XO):l npo e,D:ypbI, nOJIY-
'lHTb COrJIaCHe.
4. lIo):lroToBHTb PYKH K pa60Te, HaAeTb nep'laTKH. .
5. lIonorpeTb JIeKapCTBeHHbIH paCTBop no TeMnepaTYPbI
TeJIa Ha BO,D:.HHOH 6aHe.
BLmOJIHelJlle npo enypbI
1. YC81\HTb na HeHTa Ha KYllieTKY (Ha cTYJI).
2. rOJIOBY nOBepHYTb Ha 3nOpOBYIO CTOPOHY.
3. lIpH HaJIH'lHH OT):IeJI.HeMOrO H3 yxa - o'mCTHTb CJIYXO-
BOM npOXon BaTHbIMH mryTaMH (TYPYH):IaMH).
4. C6pOCHTb TYPYHnbI B JIOTOK C ne3HHcpH HpYIOrn;HM pa-
CTBOpOM.
5. Ha6paTb B nHneTKY JIeKapCTBeHHoe Bern;eCTBO, onHY Kan-
JIIO KanHYTb ce6e Ha TbIJIbHYro CTOPOHY KHCTH PYI<H. 6. OT-
T.HHYTb JIeBOM PYKOM MO'lKY yxa nalQ'leHTa B CTOPOHY H BBepx,
218
npaBOH PYKOH nepmaTb nHneTKY H OTC'lHTbIBaTb KanJIH (2 _
3 KanJIH B yxo).
7. BBecTH B HapymHoe YXO na HeHTa BaTHbIM TaMnOH.
8. lIa HeHT HaxO):lHTC.H B naHHOM nOJIOmeHHH 10 - 15
MHH.
OKoWIaHHe npo:u;e.ZJ;ypLI
1. lIHneTKY C6POCHTb B JIOTOK C ne3. p-pOM.
2. CH.HTb nep'laTKH, BbIMbITb H BbICYllIHTb PYKH.
BBeneHHe MaaH B HOC
U;eJIL: 06eCne'leHHe TepaneBTH'lecIwro 3cpcpeKTa.
OCHarn;eHlle: BaTHbIe TYPYHnbI, JIOTOK, CaJIcpeTKH, Ma3b.
llOnrOTOBKa K npo:u;eAYpe
1. Y CTaHoBHTb n06pOmeJIaTeJIbHbIe OTHOllIeHH.H C naU;HeH-
TOM, 06'b.HCHHTb eJIb H Xon npOu;e):lypbI.
2. ,ZJ;aTb HHcpopMa HIO na HeHTY 0 JIeKapCTBeHHOM cpe):l-
CTBe Hero n060'lHbIX neHCTBH.HX H nOJIyqHTb COrJIaCHe naU;H-
eHTa Ha Bb!nOJIHeHHe npo CnypbI.
3. lIonpocHTb JIe'lb na HeHTa (HJIH CecTb) H CJIerKa 3anpo-
KHHYTb rOJIOBY.
4. BbIMbITb PYKH, HaneTb MaCKY, nep'laTKH.
5. lIonpoCHTb na HeHTa OCB060):lHTb HOCOBYIO nOJIOCTb 0'"
CJIH3H, HCIIOJIb3Y.H CaJI(peTKH (BbIcMopKaTbC.H 6e3 Hanp.Hme-
HH.H, noo'lepenHO H3 KamnOH H03):1PH).
BLIIIOJIHeHHe npo:u;enypLI
1. HaHecTH Ha nBe BaTHbIe TYPYH):IbI Ma3b, nOJIOmHTb B
JlOTOK.
2. lIpHnonH.HTb KOH'lHK Hoca na HeHTa.
3. BBecTH TYPYHJ\Y Bp aTeJIbHbIM ):IBHmeHHeM B HHmHHH
HOCOBOH Xon C O):lHOM CTOpOHbI Ha 2-3 MHH.
4. lIoBTopHTb nYHKTbI 2, 3 ):IJI.H BBe):leHH.H Ma3H B npyrylO
nOJIOBHHY Hoca.
OKOH'laHHe npo:u;enypLI
1. lIoMo'lb nalQ'leHTY BCTaTb (npH He06xo):lHMOCTH), pac-
cnpOCHTb 0 CaMO'lYBcTBHH.
2. lIorpY3HTb TYPYH):IbI B ):Ie3. p-p C MOIOrn;HM 3cpcpeKToM.
3. CH.HTb MaCKY, npO):le3HHcpH llpoBaTb nep'laTKH, CH.HTb
HX, BbIMbITb H BbICYllIHTb PYKH.
219
3aIUlaJJ;LIBaHHe
rJIa3HOH M83H B KOH'LIOHKTHBaJILHLIH MeillOK
U;eJIL: OKa3aHMe TepaneBTM'leCKOrO acpcpeKTa.
OCH eHMe: LIe IIlapM-
1 Ha CTepHJIbHOM JIOTKe - CTepMJIbHLIe MapJIeB
. IIlap " K M CTe p MJIbHLIe rJIa3Hble naJIO'lKM C «ny-
KM, BaTHLIe n,
rOBKOHI> Ha O HOM KOH e.
2. rJI83HM M831> - 110 B83BalleBmo Bpalla - B TI06HKe HlIB
m>yroH yna:KOBKe.
3. JIOTOK /1,JISI HCII0JU.30BaBBoro MarepH8JIa.
nOJJ;l'OTOBKa Ie I1po eJJ;ype
1. YCTaHOBHTL 06pomeJIaTeJII>BLIe oTHomeBHSI C IIa.IJ;HeB-
TOM, 06'LSlCHHTL eJIL H XO npo e,qypLI.
2. lI,aTL HHCPOPMa.IJ;mo IIa.IJ;HeBT}' 0 JIeKapCTBeBBOM cpe -
CTBe Hero 1I060llHLIX eHCTBHax B II0JIY'lHTL COrJIaCHe II _
eHTa Ha BLIIIOJIBeBHe llpo e,qypLI.
3. nOllpOCHTI> IIat\HeBTa JIe'll> BJIB CecTL.
4. BLIMLITL PYlCH, eTI> MacKY, lIeplIaTKB.
5. nO OI'peTL M83L o TeMuepaTypLI TeJIa Ba 8O.qmroH 6aBe
BJm corpeD B PYRe.
BIoIIIOJIBeBHe DpO e.z.yp..
1. B HTl> H3 TI06HKa BJIB Ba6paTI> rJIa3DyIO M83L (B
p&3Mepe CIIB1Ie'IHOH l'OJIOBKB) CTepBJILHOH rJIa3BOH I18JIO"IKOH
(co CTOPOHLI UIyroBKH.).
2. n BecTH 08JI01lKY co CTOpoHLI BHCRa K rJIa3BOH IlteJIB
(B OPIlBLIH rJIa3 - JIeBOH PYROH, B JIeBLIH rJI83 - OpllBOH
PYKOH).
3. OTTSlHyTL 60JILmUM 08JIb eM cBo60 HoH PYRH HHmHee
BeKO rJIa3a BHH3.
4. lloMecTMTb rJIa3HYIO Ma3L B HMmHHH KOH'bIOHKTHBaJIb_
HbIH CBO):l.
5. BbmecTH rJIa3HYIO naJIO'lKY H3 KOH'LIOBKTHBam.HOro CBO.l{a
Bp aTeJIbHbIMH nBUmeHM.HMM, no HaOpllBJIeHHIO K Hapym-
HOH cnaHKe BeK, O):lHoBpeMeHHO OTnYCTHTb HH:HaIee BeKO H
OOOPOCMTb na.n;MeHTa 3aKpLITb rJIa3.
6. llpoH3Becrn JIerKMH KpyroBOH Maccam 'lepe3 COMKHY-
Tble BeKM CTepMJIbHbIM BaTHbIM IIlapHKoM.
7. llpoTepeTb BeKM OT HapymHoro K BHYTpeHHeMY yrJIy
rJIa3a CTepMJIbHLIM MapJIeBLIM TaMnOHOM 'lepe3 5 MMH.
OKOIl'laHHe opo eJJ;ypLI
1. lloMo'lb naIUieHT}' BCTaTb (npH Heo6xonMMocTM), pac-
cnpOCMTb 0 CaMO'lYBCTBMM.
2. llorpY3MTb TaMOOHLI B ):Ie3. pacTBop.
3. CH.HTb MacKY, npOne3MHcpH HpoBaTb nep'laTKH, CH.HTb
HX, BbIMbITb H BLICYIIlMTb PYKH.
4. llpoH3BecTM perHcTpa MIO npo e YPLI M peaK MIO Ha
Hee na MeHTa B Me M MHCKOH KapTe.
4. npOH3BeCTu pel'HCTpa.n;ulO IIponero'PLI H peaK HH Ha
Bee Oa.IJ;UeHTa B Me M MHCKOH KaPTe.
BBe.n;eHBe oopODIKa B OOJIOCTL BOCa
U;e : 06ecne'leBMe repaneBTH'leCKOrO acpcpeKTa.
OCBatneBHe: OOpoIIlKOBJU'B&TeJID, JleKapcTBeHHOe cpeJJ;CTBO.
06n3aTeJILBoe YCJIOBBe: IIpOBecTH Ty8JIeT HOCOBLIX XO):lOB
(CM. BLIIIle).
nO.n;roTOBKa Ie I1po eJJ;ype
1. YCTaBOBHTL 06J1O'KeJIaTeJILHLIe OTBOIIleHMSI C na MeH-
06'L$ICHHTL eJIL H XO.n; IIpOnero'pLI.
TO .n TI> BHIl><>PMa.IJ;H1O Oa.IJ;HeBTY 0 JIeKapCTBeHHoM cpe -
. a o6o n HLIX neHCTBH$IX H OOJIY'lHTb COrJIaCHe na.n;H-
CTBeHeroo .. M
eBTa Ha BLIDOJIHeHUe opo eAYPLI.
3. nOOpocUTL o eBTa JIe'lL HJIH ceCTL.
4. BLIMLITI> PYKH, B eTL MaCKY, Oep'laTKH.
BWIIOJIHeHBe npo 1d
1. 3anOJIHHTL OOpoIIlKoBAYBaTeJIb JleKapcTBeHHbIM cpe -
CTB MnonPOCHTL na.IJ;HeBTa CJlerKa 3anpOKHHYTL rOJIOBY.
3: BBeCTU HaKOHe'lHHK nopoIIlKOB yBaTeJI.H B npe):lnBepMe
HOC:: HamaTL pe:3MHOBbIH 68JIJIOH'lMK nOO'lepenHO B KamnYIO
H03):1plO.
OKOll'laBHe IIpo eAYPId )
1. llOMO'lb na MeHT}' BCTaTb (npu He06xo):lMMOCTH , pac-
COpOCMTb 0 CaMO'lYBCTBMM. p
2 llorPY3MTb HaKOHe'lHMK OOpOIIlKOB):IyBaTeJI.H B ne3. p- .
3: CH.HTb MaCKY, opo e3HHcpM MpoBaTb nep'laTKM, CH.HTb
MX BbIMbITb M BLICYIIlMTb PYKM. HM HR
'4. llpoM3BecTM pernCTpaIUiIO npo enYPbI M peaK
Hee na MeHTa B Me MIUiHcKOH Kapre.
280
281
OCJIOmBelllUi H1'11 napeHTepaJIbBOM npHMeBeHHH
JIeKapCTBeBHblX cpeACTB
HaH60JIee aCTblMH OCJIOmHeHHHMH HBJIHIOTCH: HHIPHJIbT-
paTbl, a6Cl.\eCCbl, IPJIerMOHbl, HeKp03bI, aJIJIeprH'lecKaH peaK-
l.\HH. TIpH'lHHOH 3TOM)' CJIymHT HapyIIIeHHe aCenTHKH: HC-
nOJIb30BaHHe HeCTepHJIbHblX llmpHl.\eB, He):lOCTaTO'lHaH o6pa-
60TKa PYK MenHlJ;HHCKOH CecTpbl, a TaKme HapY1l1eHHe TeXHH-
KH BBeneHHH JIeKapCTBelIHblX cpe,n:CTB, He3HaHHe aJIJIeprOJIO-
rH'leCKoro aHaMHe3a. Oc06oe BHHMaHHe HymHo o6paTHTb Ha
HH'beKl.\HH paCTBopOB aHaJIbrHHa, 3YIPHJIJIHHa, KOp):lHaMHHa,
KOKap6oKCHJIa3bl, KaMIPOpbl, ,n:H6a30JIa, nanaBepHHa, BHTa-
MHHa B6' HO-lllnbl H oc06eHHo 25% p-pa CepHOl<HCJIOH MarHe-
3HH.
ECJIH me HapYllleHbl npaBHJIa acenTHltH npH BBeneHHH
JIeKapCTBeHHoro Cpe):lCTBa, TO yme B nepBble CYTKH OTMe'la-
IOTCH npH3HaKH BOCnaJIHTeJIbHOrO HHIPHJILTpaTa. TIOHBJIH-
eTCH 60JIe3HeHHoe ynJIOTHeHHe B MeCTe HH'beKl.\HH, nOKpac-
HeHHe KomH, MeCTHaH TeMnepaTypHaH peaKl.\HH. 0 B03HHK-
HOBeHHH OCJIOmHeHHH Heo6xonHMO CpO'lHO C0061l.\HTb Bpa-
'lY. Bpa'l MOmeT Ha3Ha'lHTb corpeBalOll.\He KOMnpeCCbI, YBq.
CJIH nOMOll.\b He OKa3aHa, MomeT pa3BHTbCH a6cl.\ecc -
rHOHHoe paCnJIaBJIeHHe TKaHeH. OTMe'laeTCH 061l.\aH TeMnepa-
TYPHaH peaKl.\HH, CHJIbHaH 60JIb nOCTOHHHoro xapaKTepa,
BbIpameHHaH rI:mepeMHH, I}J.moKT}'aIJ;HH. Heo6xo):lHMO BbI3BaTb
Bpa'la-xHpypra, TaK KaK JIe'leHHe 3Toro OCJIOmHeHHH TOJIbKO
XHpyprH'lecKoe.
IIpoctmJIaKTHKa HllclJHJILTpaTOB, a6c eCCOB:
1. Me):lHl.\HHCKaH ceCTpa npOl.\e):lYPHoro Ka6HHeTa ):IOJImHa pa-
60TaTb B cnel.\onemne, C06JIIOnaTL npaBHJIa aCenTHKH H aH-
THcenTHKH npH BblnOJIHeHHH HH'beKIUiH.
2. IIpaBllJIbHo BbInOJIHHTb TeXHHKY HH'beKl.\HH, 6paTb nJIHH-
HYIO TOHKYIO HrJIY (8 CM) COOTBeTCTBeHIIO TOJIll.\lme no,n:-
KomHo-mHpOBoro CJlOH ,n:JIH BHyrpHMbl1l1e'lHOH HH'beKl.\HH.
3. MlI'beKl.\HH BbInOJIHHTb TOJIbKO CTepHJIbHbIMH o,n:Hopa30Bbl-
MH lllnpHl.\aMH.
4. IIepe):l BbInOJIHeHHeM HH'beItl.\HH Tll.\aTeJIbHO npOnaJIbnHpO-
BaTb TKaHH. ECJIH ecTb rJIy6oKoe ynJIOTHeHHe, TO B 3TOM
MeCTe HeJIb3H neJIaTb HH'beKl.\HIO.
5. HeJIb3H BBOnHTb HrJIY B TKaHH «lllJIenKOMI>, TaK KaK Ha-
pyIIIaeTCH CTepHJIbHOCTb, HeB03MomHO TO'lHO Bbl6paTb Me-
CTO npOKOJIa H BBeCTH HrJIY Ha ):IOCTaTO'lHYIO rJIy6HHY.
6. IIpH BBe):leHHH MaCJlHHbIX paCTBopOB, cycneH3HH nOCJIe npo-
KOJIa TKaHeH Heo6xonHMO nOTHHYTb nopllleHb lllnpHl.\a Ha
Ce6H, 'lTo6bl y6e):lHTbCH, 'lTO HrJIa He nonaJIa B COCY):l.
7. HeJIb3H BBO):lHTb XOJIOnHble paCTBOpbI (H3 XOJIO):lHJIbHHKa).
MaCJlHHble pacTBopbl nOnorpeBalOTcH):IO 37-38 .C.
8. IIocJIe HH'beKl.\HH peKOMell):lyeTcH npHMeHHTb TenJIO ):IJIH
YJIY'l1l1eHHH BcaCbIBIDIHH JIeKapCTBa.
9. rnnepTOHH"tfeCKHe pacTBopbl (aHaJIbrHH, cepHOItnCJIaH Mar-
He3HH) CJIe):lyeT pa3BO):lHTb HOBOKaHHOM HJIH IPH3HOJIOrH-
'leCKHI\I paCTBopOM nJiH 6blcTporo BcaCblBaHHH.
napeHTepanbHblM nYTb
BBeAeHMJI neKapcTBeHHblx cpeAcTB
IIapeHTepaJIbHoc BBe,n:eHHe JIeKapCTBeHHblx cpen CTB (MH-
HYH nHll.\eBapHTeJIbHblH TpaKT) OCYIlJ;eCTBJIHeTCH nocpenCTBOM
HH'beKIUiH: BHYTpHKomHoH, nonKomHoH, BHYTpHMblllle'lHOH,
BHyrpHBeHHOH, BHYTpHaprepHaJIbHOH, B 6pIOlllHYIO, nJIeBpaJIL-
HYIO nOJIOCTH, B cep,n:l.\e, B cnHHHoMo3roBoH KaHaJI, B 60JIe3-
HeHHblH O'lar, B KOCTHblH M03r.
IIpeHMYIIJ;ecTBaMH napeHTepaJIbHOrO nYTH BBe):\eHHH HBJIH-
mCH: 6blCTpOTa ):IeHCTBHH, TO'lHOCTb ):I03HpOBKH, nocTynJIe-
HHe JIeKapCTBeHHoro cpe):lCTBa B KpoBb B HeH3MeHHoM BH):Ie.
He):lOCTaTKaMH BBe,n:eHHH HBJIHeTCH: 06H3aTeJIbHOe y-qaCTHe
06y-qeHHoro MenHl.\HHCKoro nepCOHaJIa, C06JIIO):IeHHe acenTHKH
H aHTHCenTHKH, 3aTpy,n:HeHHe HJIH HeBo3MomHoCTb BBe,n:e"HHH
JIeKapCTBeHHoro npenapaTa npH KpOBOTO'lHBOCTH, nOBpem,n:e-
HHH KomH B MeCTe HH'beKl.\HH.
,ZJ;JIH HH'beKIUiH nOJIb3YIOTCH lllnpHl.\aMH H HrJIaMH. CYll.\e-
cTByeT ,n:Be MapKH lllnpHl.\eB ):IJIH HH'beKl.\HH: .PeKop,n:1> H
.JIlOepl> , HMeIOIIJ;Hx He3Ha'lHTeJIbHble pa3Jlli'lHH. BMeCTHMOCTb
lllnpHl.\eB nJiH HH'beKl.\HH - 1, 2, 5, 10, 20 MJI.
llepe,n: C60pKOH lllnpHl.\a H BblnoJIHeHHeM HH'beKl.\HH Me):lH-
l.\HHCKaH ceCTpa nOJImHa TIIJ;aTeJIbHO BbIMblTb PYKH C MblJIOM
TenJIOH npOTO'lHOH BO):lOH (c06JIIO,n:aeTcH rHrHeHH'leCKHH ypo-
BeHb MblTbH PYK), BblTepeTb HX HH):IHBH):IyaJlbHbIM nOJIOTeH-
l.\eM, HaAeTb nep'laTKH. CTepHJIbHblH MaTepHaJi 6paTL TOJIb-
KO CTepHJIbHblM nHHl.\eTOM.
283
\
"
,
,
Z8Z
10. CTporo c06mo):laTb caHHTapHo-npoTHBoanH):IeMH'IeCKHH
pe:1KHM.
"llarn;e Bcero nOCTHH'beKIJ;HOHHbIe a6CIJ;eCCbI JIOKaJIH3YIOTCH
B 06JIacTH HrO):lHIJ;bI, npeHMyrn;ecTBeHHo Y :1KeHIIJ;HH, oc06eHHo
HMeIOII\HX H36bITO'IHbIH Bec. MHor):la BBO):lHT JIeKapCTBa B no-
HCHH'IHYIO 06JIaCTb, 06JIaCTb Ta306e.zq>eHHoro cycTaBa, 'ITO He-
):IOnYCTHMO.
06 aJIJIeprH'IeCKOH peaKIJ;HH (KpanHBHHIJ;a, OCTpbIH Ha-
CMOpK, OCTpbIH KOH'bIOHKTHBHT, OTeK EBHHKe) CJI yeT He-
Me):lJIeHHO C006I1\HTb Bpa'IY!
CaMOH rp03HOH cl:IOPMOH aJIJIeprH'IecKoH peaKIJ;HH HBJIHeT-
CH aHacl:lHJIaKTH'IeCKHH IIIOK. OH MO:1Ke1' B03HHKHYTb npH BBe-
):IeHHH aHTH6HOTHKOB, BaKu;HH, pa3JIH'IHbIX 6eJIKOBbIX npena-
paTOB 11 ):Ipyrnx JIeKapCTBeHHbIX CpenCTB.
v nOMOIIJ;L npll aHaclmJIaKTII'leCKOM mOKe
nOKa3aHIIH: npeKpaTHTb nocTynJIeHHe aJIJIepreHa B opra-
HH3M. BoCCTaHOBlITb cl:IYHKIJ;HIO :1KH3HeHHO-Ba:1KHbIX opraHOB.
06H3aTeJILHLIe YCJIOBHH: Ha6JIIO,D:eHHe 3a nan;HeHTOM B Te-
IeHHe C}'TOK (BO H36e:1KaHHe pen;H,D:HBa).
nnAH CECTPMHCKOrO 060CHOBAHME
BMEWATEnbCTBA
1. OI,\eHI1Tb 1'5I>KeCTb COCT05lHI151 .
naUHeHTa 11 06eCne4I1Tb Bbl30B
BpaYa.
? HeMe neHHo npeKpaTI1Tb HanO>KI1Tb >Kryr Bblwe MeCTa
B p.V Hl1e annepreHa. I1HbeKUl111 (ecnl1 31'0 KOHey-
HOCTb).
3. YnO>KI1Tb naUl1eHTa 11 3a<!>I1K- An51 npe ynpeJK eHI151
cl1pol<an, 513b1K: ronOBY Ha 60K, aC<!>I1KCI1I1.
BblJJ,BI1HYTb HI1JKHIOIO yenlOCTb, An51 ynYYWeHI151 KpoBocHa6-
YAanl1Tb 3y6Hble npOTe3b1, JKeHI151 ronOBHoro M03ra 11
npl1nO H5ITb HOJKHO KOHeu YBenl1yeHI151 npl1TOKa KpOBI1 K
KpoBaTH. cep,lJ,UY.
4. BblnOnH5ITb Ha3HayeHI151 Bpaya: An51 cYJKeHI1R KpoBeHocHblx
BBeCTI1 0, 5 Mn 0, 1% pacTBopa COCY OB 11 3aMe neHI1R
a peHanl1Ha C 5 Mn <!>113paCTBo- BcaCblBaHI151 annepreHa
pa.
5. nO aTb ny3b1pb co nb OM. Xono Ha MeCTO I1HbeKUl111
'f ZB4
nnAH CECTPMHCKOro 060CHOBAHME
BMEWATEnbCTBA
6. 06eCneYI1Tb ocTyn CBe>Kero YnYYWaeTC5I OKCl1reHaUI1R
B03 yxa. nO aTb YBna>KHeHHbl TKaHe .
KI1CnOpo,lJ,.
7. !l0 rOTOBI1Tb I1HCTpYMeHTa- An51 CH5ITI1R anneprl1YeCKO
pl1l1 11 Bce He06xO I1Moe:
- CI1CTeMY A/151 BIB BBe eHI151, peaKUl1l1, BOCCTaHOBneHI151
cep eYHO ,lJ,e5lTenbHOCTI1 11
Wnpl1Ubl I1rnbl AI151 B/M, n/K nOBblWeHI1R A/J., nR CH5ITI151
I1Hbe" I1H;
- annapaT MBn, Ha60p n51 OTeKa CnI13I1CTO BepXHI1X
I1H"':.y6aUI1I1 Tpaxel1, CTBH,lJ,apT- blxa.enbHbIX nyre 11 npO<!>I1-
Hbll1 Ha60p neKapCTBeHHblX na':.TI1KI1 B03MO>KHbIX OCnO>KHe-
cpe CTB (YKnA/J.KY .nOMOll.\b HI1I1.
nPM AHA$MnAKTMYECKOM
WOKE»).
8. 06eCneYI1Tb BIB BBe eHl1e npl1 He06xo I1MOCTI1 nOBTO-
neKapCTBeHHblX cpeACTB no
Ha3Ha'leHHIO Bpa'la. p5lTb yepe3 Ka>K,lJ,ble 10 - 15
- n/K BBeCTI1 0,5 - 1 Mn 0,1% MI1HYT BBe eHl1e a,D,peHanI1Ha.
pacTBopa aApeHanl1Ha B MeCTe
BBeAeHI151 annepreHa 11
KanenbHO.
9. BBecTH KOpTI1KOCTepOI1AbI An51 CHRTI151 anneprl1YeCKO
napeHTepanbHo: 30 - 60 Mr ( O
150 Mn) npeAHI130nOHa I1nl1 peaKUI1I1.
150 - 300 Mr rH,lJ,pOKOPTI130Ha B
10 - 15 M11 5% pacTBopa
rnIOK03b1.
10. BBecTI1 aHTl1rl1CTaMI1HHble An51 CHRTI1R OTeKa CnI13I1CTO
( eceHcI16I1n 11311 PYIOLltl1e)
cpe CTBa: BepXHI1X ,lJ,blXaTenbHblX nyre 11
1 % cynpaCTl11t 2 0 - 4 0 M11' C eceHcI16I1nI13I1pYIOLlte
0,25% nl1nOnb<j)e'H 2,0 :.. 4,0' Mn; uenblO.
1% AI1Me,D,pon 2,0 - 5 Mn.
napeHTepanbHo.
11. no nOKa3aHI151M BBeCTI1 npl1 n05lBneHI111 npl13HaKOB
cep eYHble rnI1K0311 bI:
cTpo<!>aHTI1H 0,05% - 0,5 Mn B Cep eYHO He oCTaTOYHOCTI1.
10 Mn <!>113110nOrl1yeCKOro
paCTBopa BIB'
0,06% - 1 Mn' KOprnl1KOHa B 10
Mn <!>113110nOrl1yeCKOro pacTBo-
pa BIB OyeHb MeA/1eHHO'
MOyerOHHble: na311KC (<!>ypace-
MI1A) 40 - 60 M11 pacTBopa BIB.
12. 2,4% pacTBop 3Y<!>l1nnl1Ha npl1 aC<!>I1KCI1I1 11 y YWbl1.
10,0 BHyrpl1BeHHO 10 Mn
<j)113110nOrl1yeCKOro pacTBopa.
i!85
nnAH CECTPMHCKOrO 060CHOBAHME
BMEWATEnbCTBA An51 BOCCTaHOBneH R cepAe Ho
13. BeCTH KOPA aMI1H 2,0,
Ko<!>el1H 2,0. AeRTenbHOCTH 11 nOBblWeHH5I AA
14. npOBeCTI1 peaHI1MaUI10H: npl1 He06xOAI1MOCTI1
Hble Meponpl151TI1R (3aKpblTblH
MaCCaJK cepAua, HCKYCCTBeH-
Hoe AblxaHl1e, HHTy6aUl11O
6pOHXOB).
15. rOCnl1Tan 3l1poBaTb B
peaHI1MaUl10HHOe OTAene-
Hl1e.
Ha60p JIeKapCTBeHHoro paCTBopa
H3 allffiYJILI (cflJIaKOHa)
.QeJIL: napeHTepaJIbHOe BBeTJ,eHMe JIeKapCTBeHHoro Be e-
CTBa MH'beKI.{HOHHbIM cnoco6oM.
OCHa eHHe: JIeKapCTBeHHoe cpeTJ,cTBo B RMnYJIe, CTCpMJIb-
HbIH IImpHI C MrJIaMM, cnMpT 70%, BaTHbIe llIapMKM, 1 JIO-
TOK, nep'laTKM, CTepMJIbHbIH nMHl.{eT, 6MKC co CTepMJIbHbIMM
CaJIcpeTKaMM.
06JI3aTeJILHOe YCJIOBHe:
1. CBepMTb Ha3Ha'leHM.H B JIMCTe Bpa'le6HbIx Ha3Ha'leHMM.
2. IIpo'lMTaTb BHMMaTeJILHO Ha3BaHMe JIeKapCTBeHHoro
cp CTBa, TJ,03Y, CpOK rOTJ,HOCTH, onpe,1\eJIMTb rO,1\HOCTb no BHellI-
HeMY BMTJ,Y, npe:1KTJ,e 'leM BCKpbITb aMnYJIY MJIM cpJIaKoH. 37 .C
3.IIoTJ,orpeTb Ha BO,1\.HHOH 6aHe JW TeMnepaTypbI
n py rMM p-pOM (CM. aHHOTa-
aMnYJIY C MaCJI.HHbIM p-pOM MJIM "
I.{MIO K JIeKapCTBeHHOMY cpeACTBY).
llo):(rOToBKa K npol.{enype .
1. BbIMbITb PYKM, BbITepeTb Hacyxo, o6pa6oTaTb aHTMcen-
TM'leCKMM p-pOM.
npHMe'laHHe: crepl1nbHble ner aTKI1 Ha,[leBaIOTCR HenocpeAcTBeH-
HO nepeA I1HbeKljl1ei1.
2 Co6paTb CTepMJIbHbIH llInpMI.{.
3. IIpe:1KAe 'leM BCKpbITb aMnYJIY, BHMMaTeJIbHO npO'lM-
TaTb' Ha3BaHMe JIeKapCTBeHHoro cpe,ZJ;CTBa, TJ,03Y, CpOK rOA-
HOCTM.
BLIUOJIHeHHe npo:u;eJJ;ypLI
1. GJIerxa BCTp.HXHYTb aMny.rry, 'lTo6bI BeCb p_p OKa3aJIC.H
B ee llIMPOXOH 'laCTll.
2. 06pa6oTaTb OAMH pa3 Y3KYZO 'laCTL 8JlimYJIbI cnMpTOM
TaK, 'lT06bI He CTepeTb Ha3BaHM.H.
3. IIo)\nMJIMTb nOA Y3KOH 'laCTbIO aMnYJIbI nMJIO'lKOH, 06-
pa60TaTb nOBTopHO, OTJIOMMTb 31'OT KOHel.{ aMnYJIbI.
4. B3.HTb RMnYJIY Me:1KAY BTOpbIM II TpeTbMM naJIbn;aMM
JIeBOH PYXM, paCnOJIQ;)KMB AHO aMnYJIbI K TbIJIbHOH nOBepXHO-
CTM, a Y3KYIO 'laCTb - x JIa.n;oHHOH.
5. OCTOpomHo BBeCTM B aMnYJIV MrJIY M Ha6paTb HY)KHOe
KOJIll'leCTBO p-pa (Ha6Mpa.H pa-p, MO)KHO nOCTeneHHO nOAHM-
MaTb AHO aMnYJIbI, HO TaK. 'lTOObI pop HP OMbIBRJI Kpa.H aMny-
JIbI).
6. BbInycTMTb B03)\yx (a He p-p) M3 llInpMn;a, y)\epmMBaJi
llInpMn; B CTpOro BepTMKaJIbHOM nOJIOmeHMM.
7. CH.HTL MrJIY, KOTOPOH Ha6MpRJIM pop, M HaAeTb MrJIY
AJI.H MH'beKn;MM (eCJIM 31'0 oAHopa30BblH llInpMn;, TO HCnOJlb3Y-
eTC.H APyra.H CTepMJIbHa.H MrJIa B ynaKOBKe).
OxOWlRHHe npo:u;enypLI
1. Ha.n;eTb Ha MrJIY KOJIna'lOK, co6JIIO)\a.H YHMBepCaJIbHble
MepbI npeAOCTOpO)KHOCTM,
2. IIoJIQ;)KMTb B naKeT llInpHn; (HrJIOH B KOJIna'lKe BIIM3),
3aTeM HecKOJIbKO BaTHbIX llIapMKOB MJIM CaJICPeTOK }J.JI.H 06pa-
60TRM MH'beKI.{MOHHoro nOJI.H.
3. Y JIOmMTb B JIOTOK, HaKpbITb CTepHJIbHOH CRJIcpeTKoH,
eCJIM npon;eAypa BbInOJIH.HeTC.H B naJIaTe.
npHMe'laHHe: eCI1H BbI c0611paJ111 wnpHlj MHorOKpaTHoro npl1Me-
HeHI151 co CTepl1l1bHOro CTOl1a Ha CTepl111bHbli1 110TOK 101 n0l1b30Ba-
1111Cb 4eTblpeXCI10i1Hoi1 CaJ1<!>eTKoi1, TO n0110>KI1Te wnpl1lj no,[l BTO-
poi1, a BaTHbJe WapHKI1 no,[l nepBbli1 C110i1 CaJ1<!>eTKH B 110TOK.
BHYTpMKO)f(HaJi MH'beK4MJI
I:(eJIL: AMarHOCTM'leCKa.H, npMMeH.HeTC.H AJI.H npOBeAeHM.H
RJIJIeprOJIOrMTleCKMX npo6, npocpMJI8.KTMTlecKHX npHBMBOK.
OCHa eHHe: llInpMn; Ty6epKYJIMHOBbIH MJIM llInpMI.{ O}J.HO-
KpaTHoro npMMeHeHM.H, BMeCTMMOCTLIO 1 MJI, MrJIa ,ZJ;JIMHOH
15 MM, Ce'leHMeM 0,4 MM, CTepHJIbHa.H MrJIa B ynaKoBKe AJI.H
Ha60pa JIeKapCTBeHHoro Cpe)\CTBa, JIeKapCTBeHHoe Cpe)\CTBO,
286
281
cnHPT 3THJIOBbIH 70% (HJIM- pyrOH KomHbIH aHTHcenTHK),
JIOTOK, 3 TPH CTepHJIbHbIX BaTHbIX llIapHKa, MaCKa, nep'IaT-
KH JIaTeKCHbIC, e .qKOCTH JI:ff. e3HHl}JeKn;HH HCnOJIb30BaHHbIX
llInpHn;eB, HrJI H BaTHbIX mapHKOB.
llo.n:roToBKa K npon;e.u;ype
1. YCTaHoBHTb ,o;06pOmeJIaTeJIbHbIe OTHOllIeHHJI C nan;HeH-
TOM.
2. 06'b:ff.CHHTb nan;HeHTy n;eJIb H XO npon;enypbI, YTO'I-
HHTL HH<}JopMHpoBaHHocTh 0 JIeKapCTBeHHOM cpe CTBe, nOJIY-
'IHTh COrJIaCHe, y6e HThC:ff., 'ITO HeT npoTHBonoKa3aHHH JI:ff.
npHMeHeHH:ff. aHHoro cpe,o;CTBa.
3. H8,!\eTh MaCKY, no rOTOBHTh PYKH K pa60Te, H8,!\eTb
nep'IaTKH.
4. IIpoBepHTh npHro,o;HOCTh JIeKapCTBeHHoro cpe CTBa (npo-
'IHTaTL HaHMeHOBaHHe, ,o;03Y, CpOK rOnHOCTH Ha ynaKoBKe,
onpe eJIHTh no BHellIHeMY BHAY).
5. CBepHTh Ha3Ha'IeHH:ff. Bpa'Ia.
4. HaT:ff.HYTh Komy B MecTe HH'beKn;HH naJIhn;aMH JIeBOH
PYKH. BBecTH B Komy TOJIhKO cpe3 HrJIbI no yrJIOM 5° K
nOBepXHOCTH TeJIa nan;HeHTa.
5. 3aI}JHKcHpoBaTh BTOpbIM naJIhn;eM Hr JIY, npHmaB ee K
Kome.
6. IIepeHecTH JIeBYIO PYKY Ha nopllIeHh II BBeCTH JIeKap-
CTBeHHoe cpenCTBO.
7. M3BJIe'Ih HrJIY 6bICTPbIM nBHmeHHeM, np epmHBa:ff. ee
3a KaHIOJIIO.
8. B3:ff.Th BaTHbIH llIapHK, CMO'IeHHhIH CTIHpTOM, H JIerKHM
KaCaTeJIhHbIM BHmeHHeM 06pa6OTaTh MeCTO HH'beKn;HH.
npHMe4aHHe: He nplo1>KIo1MaTb K MeCTY Io1HbeK41011o1 CTeplo11lbHYIO Bary,
CM04eHHYIO cnlo1pTOM.
npHMe4aHHR: l1eKapCTBeHHble cpeACTBa C Io1CTeKWHM CpOKOM rOA-
HOCTIo1, C nOBpe>K,[\eHIo1S1MIo1 aMnYl1, tPl1aKOHOB, 1013MeHeHIo1S1MIo1 BHeWHe-
ro BIo1Aa cn0l1b30BaHIo11O He nOAJ1e>KaT.
IIpoBepHTL, HeT JIH BbI eJIeHH:ff. KpOBH H3 MeCTa npOKOJIa.
OKOH'laHHenpOn;e.u;ypLI
1. 06'b:ff.CHHTh nan;HeHTY, 'ITO Ha MeCTO HH'beKn;HH He ,o;OJI-
mHa non8,!\aTh BOna O onpe.n;eJIeHH:ff. peaKn;HH (ecJIH HH'beK-
l\H:ff. BbInOJIH:ff.JIaCh C ,o;HarHOCTH'IecKOH n;eJIhlO).
2. IIpoBecTH ,o;e3HHl}JeKn;HIO mnpHn;a, HrJI, BaTHbIX Tallmo-
HOB.
3. CH:ff.Th nep'IaTKH, nOMeCTHTh B ,o;e3HHI}JHn;HPYIOID;HH p_p.
4. BbIMhITh H BbICYllIHTh PYKH.
5. C eJIaTh 3anHCh 0 BbInOJIHeHHH npon;e,o;ypbI B JIHCTe Ha-
3IIa'IeHH:ff..
6. 06pa60TaTh meHKY aMnyJIhI (KpbIllIKY I}JJIaKOHa) TaM-
nOHOM, CMO'IeHHbIM cnHpTOM.
7. BCKpbITh naKeT, c06paTL mnpHn;.
8. Ha6paTh B umpHn; He06xo,o;HMoe KOJIH'IecTBO JIeKap-
CTBeHHoro cpe,o;CTBa.
9. C leHHTh HrJIY. Ha,o;eTh Ha KOHYC mnpHn;a HrJIY ,o;JI:ff.
BHVTpHKomHoH HH"t>PKnHH. BbInYCTHTb B03 YX H3 llInpHn;a
TaK, 'IT06hI B mnpHn;e OCTaJIaCh 3a,zraHHa:ff.. ,o;03a. Ha,o;eTh KOJI-
na'IOK.
10. IIoJIomHTh umpHn; Ha CTepHJIhHbIH JIOTOK HJIH B CTe-
pHJIhHYIO ynaKoBKY.
- BLInOmJeHHe npOn;e pLI
1. Yca HTh nan;HeHTa, nOJIO>I<HTh PYKY nepe,o;HeH nOBepx-
HOCThIO npe nJIe'Ih:ff. BBepx.
2. B3.HTh llInpHn; B npaByro PYKY cpe30M HrJIbI BBepx, CH.HTh
KOJIna'IOK.
3. 06pa60TaTh nBa>KJ\bI pa3HhIMH TaMnOHaMH Komy B 06-
JIaCTH cpeAHeH TpeTH nepe HeH nOBepX-HOCTH npennJIe'lh:ff.
naJIhn;aMH JIeBOH PYKH, C6POCHTh llIapHKH B ,o;e3. p-p.
nOAKomHaH MH eKqMH
IJ:enL: BBe eHHe JIeKapCTBeHHbIx cpe CTB C JIe'Ie6HOH n;e-
JIblO.
OCnall.\eHHe: mnpHn; (1-2 MJI) o HoKpaTHoro npHMeHeHH:ff.;
HrJIa (20 MM), Ce'leHHeM 0,4 MM, OnOJIHHTeJIhHa:ff. HrJIa AJI:ff.
Hu60pa JIeKapCTBeHlIoro CpenCTBa; JIOTOK CTepHJIbHbIH, HaKpbI-
TbIH CTepHJIhHOH CaJII}JeTKOH, CJIOmeHHOH B 4 CJIO:ff., C Mapne-
BbIMH TaMnOHaMH no nepBbIM, a nHHn;eTOM no,o; BTOpbIM CJIO-
eM; 70 % 3THJIOBbIH cnHpT; aMnYJIa C JIeKapCTBeHHhIM cpe -
CTBOM; nep'laTKH; eMKOCTh C e3HHI}JHn;HPYIOIl.\HM p-pOM.
llo.n:rOTOBKa K npon;e.n:ype
1. YCTaHOBHTb n06pOmeJIaTenhHbIe OTHOmeHH:ff. C nan;HeH-
TOM, On;eHHTb COCTO:ff.HHe.
288
10. 3.K. 291
289
8. H8,!\eTb HrJIY l1.JI:ff. nOl1.KOJKHOH HH'beK HH, BbInYCTHT.>
B03,zwX.
9. H8,!\eTb -KOJIna'lOK Ha HrJIY.
BblllOJIHeHHe npo:u;e bl
1. YC8,!\HTb n HeHTa Ha KyuIeTKY HJIH YJIOJKHTb.
1. 3mtAepMltc
2. COCO'lKOBblii cnoM AepMbI,
nOBepxHocTHble COCYAbi AepMbI
3. CeT'IaTbiM CI10M AepMbI
4. nOAKO>KHO-)!(l1pOBal! Kl1eT'laTKa
5. rl1y60Klie COCYAbi AepMbI
6. Mblwl\bI
npHMeoIaHHe: nOl1O>KeHlte aaBHCI1T OT MeCTa BBeAeHIt51 101 cocrOI!-
Hltl! nal.\l1eHTa.
2. IIponaJIbnHpoBaTb MecTO HH'beK HH.
npHMeoIaHHe: MeCTa BBeAeHI-IR AflR nOAKO>KHOH ItHbeKl.\1t1-l - Ha-
py>KHiUI nOBepXHOCTb nl1e'la, nepeAHe-6oKoBiUI noBepxHoCTb 6eA-
pa, nOAflOnaT04Hbie 0611acTI1, nepeAHe-60KOBiUI nOBepXHOCTb 6plOw-
HOH creHKIt C pa3BI1TOH nOAKO>KHo->Kl1pOBOH KlIeT4aTKoH, OTCyr-
CTDl1eM KpynHblx KpOBeHOCHblX COCYAOB.
. MeCTa BBeAeH...JI nOAKO)f(HbIX ...H1>eKq....,
3. ('SUITb KOJIna'lOK co IImpH a, BbInYCTHTb B03l1.YX.
4. 06pa6oTaTb l1.BaJKl1.bI KOJKY nepel1.HeHapYJKHOH nOBepx-
1I0CTII nJIc'm cnHpTOM (TaMnoHbI C6POCHTb B eMKOCTb C 3% p-
pOM XJIOpaMHHa).
npHMe'laHHe: BHa4aJ1e 06pa6aTblBaeTC5I 6011bWiUI 30Ha, npl-lMep-
HO lOx 10 CM, 3aTeM TOl1bKO MeCTO HHbeKl.\I-IIt, OAHItM Ma3KOM.
2. 06'b:ff.CHHTb na HeHTY ueJIb H X0l1. npo el1.ypbI, yTO'l-
HHTb HHcpOpMHpoBaHHocTb 0 JIeKapCTBeHHOM Cpel1.CTBe, no.ny-
'lHTb cor JIaCHe Ha npouel1.YPY.
npHMe4aHHe: y6eAI1TbclI, 4TO HeT npOTI-IBOnOKa3aHI1H K AaHHOMY
l1eKapCTBeHHOMY CpeACTBY.
3. HaAeTb MacKY, nOl1.rOTOBHTb PYKH K pa6OTe, Hal1.eTb
nep'laTKH.
4. BcKpbITb naKeT H c06paTb IImpH .
5. 06pa6oTaTb II1eHKY 8MrryJIbI T8MnOHOM, CMOqeHHbIM cnHp-
TOM, lI.ByKpaTHO.
5. Co6paTb KOJKY B CKJI8,!\KY nepBbIM H BTOpbIj'Yt naJIbU8MH
nCDoH PYKH.
npHMe'laHHe: onpeAel1HTb TOl1lJt11HY nOAKO>KHD->KHpoBoro cnOIl.
6. BDeCTH Hr.ny B OCHOBaHHe CKJI8,!\KH nolI. yrJIOM 45 0 Ha
2/3 cc lI.JIHHbI.
7. BBecTH JIeKapCTBeHHoe CpelI.CTBO nepBbIM naJIbueM JIe-
DOH PYKH.
npHMe4aHHe: PYKH He MeHIITb C ljel1blO npo<!>Hl1aKTs.1KH OCnO>KHe-
tiltH - nOBpe>KAeHI1R Hr110H nOAfle>KaLltliX TKaHeH.
npHMe4aHHe: np04ItTaTb Ha3BaHlte MaCn5lHOrO l1eKapCTBeHHoro
cpeAcTBa, CBepl1Tb C 1111CTKOM Ha3Ha4eHIt51 A03Y, onpeAel1ltTb CpOK
rOAHOCTI-I.
H. IlPI'IJIV>I<HTb CTE'pHJIbHbIH TRMnoH, CMO'leHHbIH CTIHp-
TOM. 1m 06JIaCTb HH'beK HH.
9. M3BJIC'lb HrJIY 6bICTPbIM lI.BHJKeHHeM, npH):\epJKHBa:ff. ee
38 ItnInOJIlO.
10. C):\eJIaTb JICrKHH MaccWK MeCTa HH'beK HH, He OTHH-
Ma:ff. TaMnOH OT KOJKH.
npHMe4aHHe: aTO cnoC06CTByeT BcaCblBaHl110 p-pa.
6. Ha6paTb JIeKapCTBeHHoe CPel1.CTBO B II1npHU B HYJKHOH
l1.03e.
npHMe4aHHe: A03a onpeAel1ReTCIl TOlIbKO Bpa'lOM!
7. CU:ff.Tb HrJIY, C6POCHTb B eMKOCTb C ):\e3. p-pOM.
290
10'
291
HHcynHH - 6ecIJ;BeTHaH mM KOCTb, co epmalIJ;aH 40, 80 H
100 EA. B 1 Mn, BblnycKaeTcH BO I}JnaKOHax, 'laI.I:.(e no 5 Mn. B
TepanMM caxapHoro Ma6eTa npMMeHHeTCH npocTOH MHcynMH
(6-8 'lac) M MHcynMH npo neHHoro ,neHcTBMH (12-36 'lac).
AeHCTBMe MHcynMHa OIJ;eHMBaeTCH no M3MeHeHMIO YPOBHH
rnIOK03bI KpOBM, yqMTbIBaeTcH TaKme M3MeHeHMe caxapa B
MO'le.
AnH BBe):leHMH MHcynMHa Mcnonb3YlOTCH CneIJ;miJIbHbIe
umpMIJ;bI BMeCTMMOCTblO 1-2 Mn, KOTopbIe MMelOT ,D:ononHM-
TenbHbIe eneHMH ,D:nH TO'lHOrO ):I03MpOBaHMH npenapaTa. Ha-
6MpalOT B umpMIJ; MHcynMH Ha 1-2 ):IeneHMH 60nbIIIe, 'leM He-
06XO,nMMO ):InH BBe):leHMH. Aa.nee, npM BbmYCKaHMM B03):1yxa
H3 IIInpMIJ;a nepe):l BBe):leHMeM M ):IOBO HT KOnM'leCTBO HHcynM-
Ha o HymHoro.
HHcynMH BBO):lHT nO):lKOmHO B HapymHYIO 06naCTb nneTlR M
6e):lpa, no nOnaTO'lHYIO 06nacTb, HMmHlO1O 'laCTb mMBOTa,
nrO,D:HI{Y. Komy npoTMpaIOT cnMpTOM, aBaH eMY BbICOXHYTb.
Hrna ,nJIH MH'beKIJ;MH ):IOnmHa 6bITb OCTpOH. MeCTa BBe,D:eHMH
HHcynlIHa MeHHIOT no npromny 3«Be3):10'lKIII> , no 'laCOBOH CTpen-
Ke.
BBO):lHT MHcynMH B 3aBMCMMOCTM OT THmeCTM 3a60neBaHMH
1-3 pa3a B CYTKM 3a 15-20 MMH AO eALI. llPM Ma6eTMTlecKoH
ICOM(' 11I11'1{('IIIIP IUlcynIlHa npO,ll;JIeHHOrO ):IeHCTBMH npOTHBono-
1<11,1111111.
O('JIO)I\lJ('uun: anJICpI'M'IeCKMe peaKIJ;MM, nMno,D:McTpOllmM,
OTI'ICII. 1'(, II1CTI'II'I'HOCTb (He'lYBcTBMTenbHocTL) K MHcynMHY,
I'UIIIII'JIMItl'MII'ICClcaH KOMa.
AnJ1eIJl'H'lecKHe peaK:IJ;HH: npOHBnHIOTCH ynnoTHeHMeM
IW>I(Io1 B MecTe MH'beKIJ;MII, KpanMBHMIJ;eH, OTeIWM KBHHKe, aHa-
IlmJII1ICTM'IecKMM IIIOKOM.
1I01\101I{L: IIc06xo,ll;MMO npMMeHMTb pyroH npenapaT MHCY-
nllllll crl'OI'o no Ha3Ha'leHMIO Bpa'la.
JhIllO){UCTpm)nm: Ha MeCTe MH'beKIJ;lIM 06pa3YlOTcH Y'laCT-
1m l1'1'pOpljlMH IfnM rMnepTpol}JMM nO):lKomHo-mMpoBoro cnOH.
",'3ucreIlTlIocTL: Heo6xo,ll;MMO YBenH'lHTb 03Y HHcynHHa
'''11")( II no III1:JIII1'ICHMIO Bpa'la.
1'lIIlIm"lIIltCl\lIl'IeCKaH KOMa: B03HMKaeT npM nepe):l03MpOB-
1<1' IIlIcynmm. TIOMOlIJ;b OKa3bIBaeTCH no CTaH apTY ,lI;oBpa'le6-
IIlJIi 1I0MOIl{M M Ha3Ha'leHMIO Bpa'la.
OKOH1JaHHe npo:u;e.u;ypLI
1. IlInpHIJ; II HrnbI nOMeCTHTb B eMKOCTb C 3% p-pOM xno-
paMMHa. .
npHMe4aHHe: npeABaplo1TellbHO Heo6xOAI1MO npOMblTb Wnpl14 OT
lleKapCTBeHHOrO cpeACTBa B npOMblBHblX BOAax 1011111 Ae3. p-pe.
2. CHHTb nep'laTKM, nOMecTMTb B ):Ie3MH<!JHIJ;lIPYIOlIJ;MH pop.
3. BbIMbITb H BbICYIIIMTb PYKH.
4. llOMO'lb naIJ;HeHTy 3aHHTb y):l06HOe nonomeHHe.
5. OIJ;eHHTb peaKIJ;HIO naIJ;MeHTa Ha npoIJ;e):lYPY.
npHMe'laHHe: B HopMe peaK411R na4HeHTa Ha np04eAYPY ilAeKBaT-
HM.
6. C):IeJIaTb OTMeTKY 0 npo,neJIaHHOH npOIJ;e,ll;ype B JIMCTe
aa3Ha'leHMH.
npHMe'laHHe: 3TO RBIlReTCR 06513aTellbHblM YCIlOBl1eM AI151 KOHT-
pOIlR KOllH4ecTBa BblnOIlHeHHblX I1HbeK4 I1H .
TeXH...Ka nOAKO)f(HOM ...H"beKq......
npaBHl1bHOe n0l10JKeHHe
wnpH4a B PYKe
Oco6eHHOCTH npHMeHeHHH HHcynHHa
HHcynHH HBnHeTCH ropMOHOM nO):lmenY):lO'lHOH mene3bI M
OKa3bIBaeT BbIpa>KeHHoe BnHHHHe Ha yrneBO,ll;HbIH 06MeH. Cno-
c06cTByeT YCBoeHHIO rnlOK03bI KneTKaMH TKaHeH opraHM3Ma
(MbIIlle'lHOH, mMpoBoH), 06neI"IaH TpaHcnopT rnIOK03bI 'lepe3
KneTO'lHbIe MeM6paHbI, CTHMynMpYeT 06pa30BaHHe M3 rnIOKO-
3bI rnMKoreHa H OTnomeHMe ero B ne'leHH.
IIplmleHeHHe: Mcnonb3yeTcH npH ne'leHMM caxapHoro ,lI;Ha-
6eTa (3aMecTMTenbHaH TepanHH) cpe):lHHX M THmenbIX <!JOPM
3a60JIeBaHMH.
292
293
npHMe'laHHe. AaJ1b'leHWl1e Ae Cr 'is! rpe6YlOr :"06nIOAeHI1S1 'lpa
BI1l1 aCeml1KI1.
BBeAeHMe MHcynMHa
U;eJIL: BBe eHHe TO'lHOH 03bI llHCYJIHHa JISI. CHHmeHHSI.
YPOBHSI. rJIIOK03bI B KpOBI'I.
OCHall(eHHe: clJJIaKOH'lMK C paCTBopOM HHCYJIHHa, co ep-
maIl\MH B 1 MJI 40 E):( (80 E)]; HJIM 100 E):(); cnMpT 70';
CTepMJIbHbIe: JIOTOK, nMHIJ;eT, BaTHbIe IIIapMKM, 0 Hopa30BbIe
MHcyJIMHOBbIe IIInpMIJ;bI.
npOTHBonOl_a3aHHH: rMnOrJIMKeMWIeCKaSl. KOMa, aJIJIeprM-
'leCKaSl. peaKIJ;MSI. Ha aHHbIH MHCYJIMH.
nO roToBKa K npo:u;e,l.{ype
1. Y6e MTbcSI., 'lTO HeT npoTMBonoKa3aHMH K npMMeHeHMIO
aHHOrO MHCYJIMHa.
2. Y6e MTbcSI. B npMrO HOCTM MHCYJIHHa )J.JISI. nO KomHoro
BBe)J.eHMSI.. llpo'lMTaTb Ha)J.nMCb Ha clJJIaKoHe: Ha3BaHMe, 03Y,
CpOK rO HOCTH, npoBecTH BM3YaJIbHbIH KOHTpOJIb Ka'lecTBa
clJJIaKOH'lMKa C MHCYJIMHOM.
3. llo)J.orpeTL clJJIaKOH'lMK C MHCYJIMHOM o TeMnepaTYPbI
TeJIa 36-37 'c B BO Sl.HOH 6aHe. MomHo nO)J.epmaTb clJJIaKOH-
'lMK B PYKe 3-5 MMHYT.
4. B3S1.Tb MHCYJIMHOBbIH IIInpMIJ; B ynaKoBKe, npOBepMTL
rO HOCTb, repMeTM'lHOCTb ynaKoBKH, BCKpbITb naKeT. Onpe-
)J.eJIMTb IJ;eHY eJIeHMSI. IIInpHIJ;a.
5. BCKpbITb KPbIIIIKY clJJIaKOH'lMKa, npMKpbIBalOII\Y1O pe-
3MHOByro npo6KY.
294
6. llpoTepeTb pe3MHOBYIO npo6KY BaTHbIMM IIIapMKaMM co
cnMpTOM ,l.{BYKpaTHO, oTcTaimTb cpJIaKOH'lMK B CTOPOHY, aTb
BbICOXHYTb cnMpTY. llona,l.{aHMe cnMpTa B paCTBOp MHCYJIMHa
npMBO MT K ero HHaKTMBaIJ;MM.
7. lloMo'lb n MeHTY 3aHSl.Tb y 06Hoe nOJIOmeHMe.
8. Ha6paTb B IIInpMIJ; 38,!\aHHYIO ,l.{03Y MHCYJIMHa B E):( M3
clJJIaKOH'lMKa H ono:nHMTeJIbHO Ha6paTb 1-2 E):( MHCYJIMHa,
H8,!\eTb KOJIna'lOK, nOJIOmMTb B JIOTOK. ):(onOJIHMTeJIbHbIe 1-2
E):( Ha6MpaIOTCSI. ,l.{JISI. Toro, "'lTo6bI He }'MeHbIIIMTb ,l.{03Y npH
BbInYCKaHMM B03,l.{yxa M3 IIInpMIJ;a nepe,l.{ MH'beKIJ;MeH.
BbInOJIHeHHe npo:u;eJ.{ypLI
1. 06pa6oTaTb MecTO MH'beKIJ;MM nOCJIe OBaTeJIbHO BYMSI.
BaTHbIMM TaMnOHaMM, CMO'leHHbIMM cnHpTOM: BHa'laJIe 60JIb-
IIIYIO 30HY, 3aTelll Henocpe CTBeHHO MeCTO MH'beKIJ;MM. ):(aTb
Kome BbICOXHYTb.
2. CHSl.Tb KOJIna'lOK co IIInpMIJ;a, BbInYCTMTb B03 YX.
3. B3S1.Tb Komy B CKJI8,!\KY 1 H 2 naJIbIJ;aMM JIeBOH PYKH.
Onpe,l.{eJIMTb TOJIII\MHY nO,l.{KomHo mMpOBoro CJIOSI. B CKJI8,!\Ke.
4. BecTM 6bICTPbIM ,l.{BMmeHMeM Mr.rry no yrJIOM "30-45'C B
Cepe,l.{MH)' nO)J;IwmHO JKHpOBOrO CJIOSI. Ha ,l.{JIMHY MrJIbI, epma ee
Cpe30M BBepx. YrOJI BBe eHMSI. MHCYJIMHa MomHO M3MeHHTb B
3fiBMCMMOCTH OT TOJIII\MHbI nO,l.{KomHO JKHpOBOrO CJIOSI. (,l.{O 90).
5. OCBo6o MTb JIeBYIO PYKY, OTnYCTMB CKJI8,!\KY.
6. BBecTM M JIeHHO MHCYJIMH.
7. llpMmaTb CYXOH CTepMJIbHbIH BaTHbIH wapMK K MecTy
MlI'bCKl{MM M 6bICTPbIM ,l.{BMmeHMeM M3BJIe'lb Hr.rry.
OKOH'laHHenpo:u;eJ.{ypLI
1. HaKopMMTb naIJ;MeHTa.
2. llpo e3MHclJM MpoBaTb IIInpIm M BaTHbIe IIIapMKM, CHSl.Tb
n{'p'IaTKM M nOJIOmMTb B eMKOCTb ,l.{JISI. ,l.{e3MHclJeKIJ;MM. ):(e3MH-
(}JCIO{MSI. npOBO,l.{MTCSI. CorJIaCHO ,l.{eHCTBYIOII\MM npMKa3aM.
MeCTa MHbeKqMi; MHcynMHa
(noKa3aHbl WTPHXOBKOM)
BBeAeHMe renapMHa
U;eJIb: CHM3MTb CBepTJ.IBaeMOCTb KpOBM M BBeCTM TO'lHYIO
,l.{03Y renapMHa.
OCHall\eHlle:
· cpJIaKOHbI C paCTBopOM renapMHa, CO,l.{epm He B 1 MJI 5
TbIC. E,lI;;
295
· aHTarOHMCTL' renapMHa: CYJILCPaT npoTaMMHa 1%, ,IIMqM-
OH 1 - 2 MJI BIB wm B/M.
. mnpMq 1 - 2 MJI O,llHOKpaTHoro npMMeHeHM.H; HrJIa 20
MM, Ce'leHMeM 0,4 MM, nOnOJIHHTeJILHa.H MrJIa ,llJI.H Ha60pa
JIeKapCTBeHHOrO CpenCTBa; JIOTOK CTepMJILHLIll, HaKpLITLIll cre-
pMJILHOll can.peTKoll, CJIO:IKeHHOH B 4 CJIO.H, C MapJIeBLIMH
TaMnOHaMM non nepBLIM, a nMHl.{eTOM non BTOpLIM CJIOeM; 70
% STMJIOBLIll cnMpT; aMnYJIa C JICKapCTBeHHLIM cpenCTBOM;
nep'laTKM; eMKOCTL C ,l{e3HH.pMqMPYIO M paCTBOpoM.
llpoTIIBonoKa3aHIIH: aHeMM.H, .H3BeHHa.H 60JIe3HL, 3a6oJIe-
BaHM.H KpOBM, cOnpOBO:IK):IalOmMeC.H 3aMe):lJIeHMeM ee cBepTLI-
BaHM.H.
llonroToBKa K npo:u;e.u;ype
1. Y CTaHOBMTL ,l{o6pO:IKeJIaTeJILHLIe OTHOIlleHM.H C nal.{MeH-
TOM, Ol.{eHMTL ero COCTO.HHMe.
2. 06'L.HCHMTL nal.{MeHTY l.{eJIL M XO,l{ npOl.{enypLI, YTO'l-
HMTL MH.pOpMMpOBaHHOCTL 0 JIeKapCTBeHHOM cpenCTBe, nOJIY-
'lMTL COrJIaCMe Ha npOl.{e,llYPY.
3. Ha,lleTL MaCKY, nO,llrOTOBMTL PYKM K pa6oTe, Ha):leTL
nep'laTKM.
4. BcKpLITL naKeT M co6paTL nmpMI.{.
5. 06pa60TaTL KPLIIllKY .pJIaKOHa TaMnOHOM, CMO'leHHLIM
cnMpTOM, nBYKpaTHO. llpo'lMTaTL Ha3BaHMe, CBepMTL C JIMCT-
KOM Ha3Ha'leHM.H ,l{03Y, onpe,lleJIMTL CpOK rO,llHOCTM.
A03a onpe):leJI.HeTC.H TOJThKO Bpa'lOM!
6. Ha6paTL JIeKapCTBeHHoe Cpe,llCTBO B IllnpMI.{ B HY:lKHOH
,l{03e, nO,l{H.HB .pJIaKOH BBepx ):IHOM.
7. CH.HTL MrJIY, C6POCMTL B eMKOCTL C ,IIe3paCTBopOM.
8. H eTL MrJIY ,llJI.H nO,l{KO:IKHOH MH'LeKI.{MM, BLInYCTMTL
B03m'X.
9. Ha,lleTL KOJIna'lOK Ha MrJIY.
BLmOJIHeHHe npo:u;e.u;ypLl
1. YC MTL nal.{MeHTa Ha KYWeTKY MJIM YJIO:IKMTL.
2. CH.HTL nep'laTKM, nOMeCTMTL B ,l{e3MH.pMI.{MPYlOmMH pa-
CTBOp.
3. BLIMLITL M ocynIMTL PYKM.
4. lloMo'lL naqHeHTY 3aH.HTL Y,l{o6Hoe nOJIO:IKeHMe.
5. Ol.{eHMTL peaKI.{MIO nal.{MeHTa Ha npOl.{e,l{YPY.
6. CJI MTL 3a I.{BeTOM MO'lM, I.{BeTOM KO:IKHLIX nOKpOBOB,
3a nYJILCOM, AJl., MeCTaMH HH'LeKI.{Mll. TIpM Heo6xo,l{MMOCTH
no Ha3Ha'leHMIO Bpa'la BBeCTM aHTarOHMCTLI renapMHa: CYJIL-
.paT npOTaMMHa 1 %, ,l{MI.{MOH 1 - 2 MJI BIB MJIM B/M.
IIpu e03HwaweeHUU OCJL03fCHeHUU HeMe,l{JIeHHO C006mMTL
JIe'laIl.{eMY Bpa'lY. CBoeBpeMeHHo BLI.HBJI.HTL reMOpparM'leCKMe
OCJIO:IKHeHM.H: KOHTpOJIL KoarYJIOrpaMMLI - OCHOBHOH nOKa3a-
TeJIL (BpeM.H CBepTLIBaHM.H KpOBM). OCJIO:IKHeHM.H rOBOp.HT 0
nep 03MpOBKe renapMHa H B03HHKHOBeHMM BHYTpeHHHX KpO-
BOTe'leHMH-.
7. C,l{eJIaTL oTMeTKY 0 npO):leJIaHHOH npol.{e):lype B JIMCTe
Ha3I1a'leHMH H peaKl.{MM Ha Hee.
npHMe4aHHe. nOllO>KeHl1e 3aBI1CI1T OT MeCTa BBeAeHI1R 11 COCTOR-
HliR nalll-leHTa.
Oco6eHHOCTM npMMeHeHMH renapMHa
renapHH - aHTMKoarYJI.HHT np.HMOrO ,l{eHCTBM.H: TOpM03MT
06pa30BaHMe TpoM6MHa, npen.HTCTBYeT cBepTLIBaHMIO KpOBM.
TIpMMeH.HeTC.H ,l{JI.H npo.pMJIaKTMKM H TepanMM TPOM60SM-
60JIH'IecKMX OCJIO:IKHeHMH npH OCTpOM MH.papKTe MMOKap,lla.
Onepal.{M.HX Ha cep):ll.{e M cocY):Iax, TPOM6oSM6oJIM.HX JIerO'lHLIX
M M03rOBLIX COCY,l{OB, TpoM6o.pJIe6MTaX KOHe'lHOCTeH.
)];03LI YCTaHaBJIMBalOT MH,IIMBM,l{YaJILHO: 5 000 E)J; 'lepe3 4-
6 'laCOB, BBO):l.HT BIB MJIM B/M, MO:IKHO n/K rJIy6oKo, B Ha,l{-
'lpeBHOH 06JIaCTM ,llJI CTMMYJI.HI.{MM BLIpa60TKM sH):IoreHHoro
renapMHa.
O('JIO)IClIeIlHB. llpM npMMeHeHMM renapMHa MOryT B03HMK-
JlYTb rCMOpparM'leCKMe OCJIO:IKHeHH.H: reMaTYpM.H IKpoBb B
MOlle/, KpOBOM3JIM.HHM.H B CYCTaBLI, :lKeJIY):IO'lHO-KHIIIe'lHLIe
KpOBOTe'leHM.H, reMaTOMLI B MeCTe BBe,l{eHM.H n/K M B/M.
B03MO:IKHLI aJIJIepm'lecKMe peaKI.{MM: KpanMBHMl.{a, aCTMa,
PFIIUiTLI, CJIe30Te'leHMe.
ITPH nepe):lo3MpoBKe renapMHa B Ka'leCTBe ero aHTarOHMC-
Ta BBO,l{.HT BIB 5 MJI 1 % paCTBopa npoTaMMHa cYJIbePaTa, nM-
I.{MHOH 1-2 MJI BIB MJIM B/M.
2. BLInOJIHMTL nO,l{KO:IKHYIO MH'LeKI.{MIO.
OKOHTlaHHe npol.{e,l{ypLl
1. IlInpMI.{-M MrJILI nOMeCTMTL B eMKOCTL C 3% paCTBopOM
XJIOpaMMHa.
296
291
pHJIbHOH CaJIlJ!eTKOH B qeTbIpe CJIOH, C MapJIeBbIMH TaMnOHa-
MH no nepBbIM CJIOeM H nHH eTOM nO.l\ BTOpbIM CJIOeM CaJI-
IJ!eTKH; 70 % 3THJIOBbIH cnHPT; aMnYJIa C JIeKapCTBeHHbIM
Cpe.l\CTBOM; nepqaTKH JIaTeKCHbIe, CTepHJIbHbIe; eMKOCTH C .l\e3.
p-paMH.
IIo,lJ;I'oToBKa K npo e.n;ype
1. 'YCTaHOBHTb ,lJ;06pome.naTeJIbHble OTHomeHHH C n HeHTOM.
2. 06'bHCHHTb na HeHTY eJIb H XO.l\ npo e ypbI, YTo"tJ-
HHTb HHIJ!OPMHPOBaHHOCTb 0 JIeKapCTBeHHOM cpe CTBe, noJIY-
qHTb COI'JIaCHe.
3. Ha eTb MaCKY, nO I'OTOBHTb PYKH K pa60Te, Ha eTb
nepqaTKH.
4. IIpoBepHTb npHI'O.l\HOCTb JIeKapCTBeHHOI'O cpe.l\CTBa (npo-
qHTaTb HaHMeHOBaHHe, .l\03y, CpOK I'O HOCTH Ha ynaKoBKe,
onpe.l\eJIHTb npHI'O HOCTb no BHeWHeMY BH Y).
5. 06pa60TaTb weHKY aMnYJIbI TaMnOHOM, CMOqeHHbIM
cnHPTOM, H nHJIHTb weHKY aMnYJIbI, 06pa60TaTb nOBTopHO.
6. BCKpbITb aMnYJIY, nOCTaBHTb aKKypaTHo Ha MaHHnYJIH-
HOHHbIH CTOJI.
7. BCKpbITb naKeT, c06paTb wnpH .
8. Ha6paTb B wnpH He06xo HMoe KOJIHqeCTBO JIeKap-
CTBeHHOI'O cpe CTBa.
npHMe4aHHe: cneAHTe 3a A030H neKapCTBeHHoro cpeACTBa B
wnpHlIe - TonbKO no Ha3Ha4eHHIO Bpa4a!
n nOMtIH!
g 1. lle4eHHe renapHHOM npoBOAHTCSI no,Q KOHTpolleM KOaryIlOrpaM-
MI>' ( aHal1H3a KpoBH, OCHOBHOH nOKa3aTeJ1b - BpeM CBepTblBaHH5I
KpOBH), He 60llee 7 AHeH CTporo no Ha3Ha4eHHtO Bpa4a.
2. Ha6l1tOAai1Te 3a na4HeHTOM AII CBoeBpeMeHHoro Bbl B-
lIeHH reMOpparH4ecKHx OCIIO>KHeHHH.
3. He06xoAHMO AellaTb e>Ke,QHeBHO aHallH3 M04H 0614HH H
CIle,QHTb 3a ee 4BeTOM.
IIpOTHBonOKa3aHHH K IIpHMeHeHHIO I'enapHHa:
1. AHeMliH.
2. .H3BeHHaH 60JIe3Hb meJIY.l\Ka H 12-nepcTHoH KHIIIKH.
3. 3a60JIeBaHHH, conpOBomAaIOIqllecH 3aMe JIeHHbIM CBep-
'f.bIBaHHeM KpOBH H .l\p.
BHYTpMMbIWe'lHaR MH'beKI.IMR
IJ;eJIb: BBe.l\eHHe B Mb:rW Y JIeKapcTBeHHOI'O p-pa JIH OKa-
38HH.!! JIeQe6HOI'0 s4JlJ!eKTa npH JIeKapCTBeHHoH TepanHH.
OCHalI\eHHe: CTepHJIbHble - wnpH O.l\HOKpaTHOI'O npHMe-
HeHHH (5-10 MJI), C HI'JIaMH JIH HH'beK HH .l\JI. 60-80 MM,
CeqeHHeM 0,8-1,0 MM. H HI'JIOH JI.!! Ha60pa JIeKapCTBeHHOI'O
Cpe.l\cTBa B ynaKOBKe; JIOTOK CTepHJIbHbIM, HaKpbITbIH CTe-
1. 3m1AepMI1c
2. 6a3a1lbHaJl MeM6paHa
3. ,l1epMa
4. nOAKO)f(HO-)f(HpOBa
KneT4aTKa
5.lI>ac4 11 J1
6. MbIW4b1
9. CHSlTb HI'JIY C KOHyca wnpH a.
10. H8AeTb Ha KOHYC wnpH a PyrylO CTepHJIbHYIO HI'JIY
JIH BHYTpHMbIWeqHOM HH'beK HH, 3aKpenHTb no qaCOBOH
CTpeJIKe, BbInYCTHTb B03.l\YX H3 mnpH a TaK, qT06bI H3 HI'JIbI
BbI.l\eJIHJIOCb TOJIbKp 1-2 KallJIH JIeKapCTBeHHoro Cpe.l\CTBa,
Ha eTb KOJInaqOK Ha HI'JIY.
11. IIoJIomHTb wnpH Ha CTePHJIbHbIH JIOTOK HJIH B CTe-
pHJIbHyIO ynaKOBKY.
BbInOJIHeHHe npo e.n;ypbI
1. 'YJIOmHTb na HeHTa B Y 06HYIO n03Y.
2. B3HTb wnpH B npaBYIO PYKY HI'JIOH BHH3, IJ!HKCHPYH
KOHYC HI'JIbI MH3HH eM.
3. Onpe eJIHTb MeCTO JIH BHYTpHMbImeqHOH HH'beK HH.
4. IIponaJIbnHpoBaTb MeCTO HWbe H, 06pa60TaTb Bam.zu,:J
pa3HbIMH TaMnOHaMH Komy naJIb aMH JIeBOH PYKH, C6POCHTb
TaMnOHbI B .l\e3. p-p.
Z9a
BBeAeHHe Hrnbl B MblWqy
Z99
5. PaCTHHYTb Komy B MeCTe HH'beK HH naJIb aMH JIeBoii:
PYKH.
6. BBeCTH HrJIY no.l\ npHMbIM yrJIOM Ha rJIy6HHY 5-6 CM K
nOBepXHOCTH TeJIa na HeHTa.
7. BBecTH JIeKapCTBeHHoe cpe.l\CTBO, Ha.l\aBJIHBIlJI Ha nop-
meHb, nepBbIM naJIb eM JIeBoii: PYKH.
8. IIpHJIomHTb CTePHJIbHbIii: TaMnOH, CMO'leHHbIii: CnHp-
TOM, K MeCT}' HH'beK H.
9. M3BJIe'lb HrJIY 6bICTpbIM .l\BHmeHHeM, npH.l\epmHBIlJI ee
3a KOHIOJIIO.
10. IIpH.l\epmaTb TaMnOH, He OTHHMa.ll ero OT KomH, 1-
2MHH.
OKOl£'laHHe npo eAYPbI
1. IIpoBecTH .l\e3HHqJeK HIO wnpH a, HrJI, BaTHbIX TaM no-
BOB.
2. CH.lITb nep'laTKH, nOMeCTHTb B .l\e3HH«l>1l llPYIOIl{Hii: pop.
3. IIoMo'lb na HeHTY 3aH.IITb Y.l\06HOe nOJIOmeHlle.
4. BbIMbITb H BbIcyWHTb PYKH.
5. C.l\eJIaTb 3anIiCb 0 BbInOJIHeHHll npO e.l\YPbI II peaK HH
J: HeHTa Ha npo e.l\YPY B JIllCTe Ha3Ha'leHll.ll.
PaClfeT, pa3Be eHMe M BBe eHMe
aHTM6MoTMKOB BHYTpMMblwelfHo
IJ;e.m.: .l\JIH .l\OCTllmeHHH TepaneBTH'leCKOI'O s«l>«l>eKTa.
OCHaII\eHHe:
· CTepHJIbHbIe: wnpH O.l\HOKpaTHoro npHMeHeHHH (5 -
10 MJI.), C HrJIaMH .l\JIH llH'beK llll .l\JI. 60 - '80 MM, Ce'leHller,\
0,8 - 1,0 MM. II llrJIoii: .l\JI.II Ha60pa JIeKapCTBeHHoro cpe.l\-
cTBa;
· JIOTOK CTepllJIbHbIii:, HaKPbITbIii: CTepllJIbHoii: CaJI<peTKoii:
B 4 CJIOH, C MapJIeBbIMll TaMnOHaMll no.l\ nepBbIM CJIOeM, II
nllH eTOM no.l\ BTOpbIM CJIOeM CaJI«l>eTKll;
· 70 % 3TllJIOBbIii: cnllpT;
· aMnYJIa C JIeKapCTBeHHbIM Cpe.l\CTBOM;
· nep'laTKll JIaTeKCHbIe, CTepllJIbHbIe;
· eMKOCTll C .l\e3paCTBopaMll.
3TAIIbI
IIo,ll;roToBKa K npo eAYPe
1. 'YcTaHoBllTb .l\06pOmeJIaTeJIbHbIe OTHoweHllH C na lleH-
TOM. 06'b.llCHllTb n lleHTY eJIb II XO.l\ npo e,[\YPbI, YTO'lHllTb
llH4>opMllpoBaHHOCTb 0 JIeKapCTBeHHOM cpe,[\CTBe, nOJIY'lllTb
COrJIaCHe.
2. Ha).\eTb MaCKY, nO.l\rOTOBllTb PYKll K pa60Te, Ha).\eTb
nep'laTKH.
3. IIpoBepllTb npllrO.l\HOCTb aHT1l611oTllKa II paCTBOpHTeJIH
(npO'lllTaTb HallMeHOBaHlle, .l\03Y, CpoK I'O.l\HOCTll Ha ynaKoB-
Ke, npOBepllTb npllI'O,[\HOCTb no BHeWHeMY Bll.l\Y).
4. 06pa60TaTb weii:KY aMnYJIbI (KpbIWKY «l>JIaKoHa) TaM-
nOHOM, CMO'leHHbIM cnllpTOM.
npHMe'laHHe. 06pa60TKe nOA11e>KaT aMnYl1a 10111101 <!Jl1aKOH C pa-
CTBOpHTel1eM 101 <!Jl1aKOH'IIo1K C aHTIo161010THKOM ABYKpaTHo Ka>KAbIH.
OnpeAeneHHe BepXHeHapY>KHOrO KBaApaHTa JlrOAHijbl
5. BCKPbITb aMnYJIY C paCTBOpUTeJIeM, nOCTaBllTb aKKY-
paTHO Ha MaHllnYJI.II llOHHbIii: CTOJI.
npHMe'laHHe. fJ.11J1 pa3BeAeHHJI aHTIo16HOTIo1KOB nplo1MeHJlIOTCJI CI1e-
AYIOUllo1e pacTBOpbl: 1. BOAa A11J1 HHbeKIIHH B aMnYl1ax. 2. PacTBOp
Xl10plo1Aa HaTpHJI 0,9 % (H30ToHH4ecKHH, <!J1013H0I10rlo1'1eCKHH) BO
<!Jl1aKOHaX 101 aMnYl1ax. 3. PacT-BOp HOBOKalo1Ha 0,25 % 0,5 % BO
<!Jl1aKoHax 101 aMnYl1ax.
300
301
6. BCKPbITb n8.KeT, c06paTb nmpHI:(.
7. Ha(ipaTb B WnpHI:( He06xo.l\HMOe KOJIH'leCTBO paCTBO-
pHTeJI.II.
IIPAB 1 t1JIO PA3BEJ];EHM.H. Ha 100000 EJ]; (O,lr) neHH-
I:(HJIJIHHa HJIH CTpenTOMHI:(HHa 6epeTc.II 1 MJI paCTBOpHTeJI.II.
Bce .l\PYrJxe aHTH6HOTHKH pa3BO.l\.IITC.II COOTBeTCTBeHHO aHHO-
TaI:(HH K HHM.
8. B3S1Tb <l>JI8.KOH C CYXHM aHTH6nOTHKoM B JIeBYIO PYKY, a
B npllBoH PYKe ,[\epmaTb WnpHI:( C paCTBOpHTeJIeM.
9. IIpoKOJIOTb np06KY B I:(eHTpe <l>JIaKOHa no.l\ yrJIOM 90° 1'1
BBeCTH Hr JIY BO <l>JI8.KOH Ha 1 - 2 MM.
npHMe4aHHe. nepeMe14eHHe Hrl1b1 BHYTPH <!Jl1aKOHa npHBOAI1T K
HapyweHl110 CTepHl1bHOCTI1 l1eKapCTBeHHoro CpeACTBa. B03paCTa-
eT B03MO>KHOCTb OCJ10>KHeHHH (I1H<!JHIIHpOBaHHJI) y nallHeHTa.
4. IIpOnaJIbnHpOBaTb MeCTO HH'LeKI:(HH, 06pa60TaTb .l\Bam-
.l\bI pa3HbIMH TaMnOHaMH Komy naJThI:(aMH JIeBOH PYKH, c6po-
CHTb B .l\e3paCTBOp.
npHMe'laHHe. nal1bnallHJI MeCTa HHbeKlIltH npOH3BOAI1TCJI C lIeJ1blO
BblJlBl1eHHJI ynI10THeHHH. 60l1e3HeHHocTI1, 4TO CBHAeTel1bCTByeT 06
OCI10>KHeHHI1. ,/J.el1aTb HHbeKlIl1H B ynl10THeHHbie It 60l1e3HeHHbie
MeCTa npOTI1BOnOKa3aHo!
10. BBecTH paCTBOpHTeJIb 1'13 WnpHI:(a BO <l>JI8.KOH, CH.llTb
<l>JI8.KOH BMeCTe C HrJIOH, nOJIOmHTb mnpHI:( B CTepHJIbHbIH
JIOTOK HJIH CTepHJIbHYIO ynaKOBKY.
11. OCTopomHo BCTp.llXHYTb <l>JI8.KOH .l\0 nOJIHOrO paCTBO-
peHH.II aHTH6HOTHKB..
12. Hap;eTb HrJIY C <l>JIaKOHOM Ha KOHYC wnpHI:(a, nO,[\H.IITb
<l>JIaKOH BBepx ,[\HOM, Ha6paTb HymHYIO ,[\03Y JIeKapCTBeHHoro
cpe,[\CTBa, CBepHTb C Ha3HaqeHHeM Bpaqa.
13. CHHTb HrJIY C <}maKoHoM C KOHyca WnpHI:(a.
14. Hap;eTb Ha KOHYC WnpHI:(a ,[\PyrylO CTepHJIbHyIO HrJIY
,[\JIH BHYTpHMbIWeqHOH HH'LeKI:(HH, 38.KpenHTb no qaCOBOH
CTpeJIKe, BbInYCTHTb B03,[\yX H3 wnpH[(a T8.K, 'iT06bI 1'13 HrJIbI
BbI,[\eJIHJIOCb TOJIbKO 1 - 2 KanJIH JIeKapCTBeHHoro Cpe.l\CTBa,
Ha,[\eTb KOJInaqOK Ha HrJIY.
15. IIoJIomHTb WnpHI:( Ha CTepHJIbHbIH JIOTOK HJIH B CTe-
pHJIbHyIO ynaKOBKY.
BbillOJIIIeHHe npoI:(e bI
1. YJIOmHTb naUHeHTa n Y.l\06HYIO n03Y.
2. B3.11Tb WnpHI:( B npllBylO PYKY HrJIOH BHH3, <l>HKCHPYH
KOHYC HrJIbI MH3HHueM.
3. Onpe,[\eJIHTb MecTO 1J.JIH BHYTpHMbIWe'lHOH HH'LeKI:(HH.S-
TO BepXHHH HapymHbIH KBap;paHT HrO,[\HUbI, HapymHaJI no-
BepXHOCTb 6e,[\ep, npH He06xo,[\HMOCTH - Cpe.l\HSI.II TpeTb nJIe-
qa (06JIaCTb .l\eJIbTOBH,[\HOH MbIIIIUbI).
5. PacTHHYTb Komy B MeCTe HH'beKI:(HH naJIbUaMH JIeBOH
PYKH.
6. BBecTH HrJIY no.l\ npgMbIM yrJIOM Ha rJIy6HHY 5 - 6 CM K
nOBepXHOCTH TeJIa naUHeHTa B cepe,[\HHY MbImeqHOI'O CJIO.ll.
7. BBecTH JIeKapCTBeHHoe Cpe.l\CTBO, Hap;IlBJIHBa.ll Ha nop-
weHb, nepBbIM naJIbUeM JIeBOH PYKH. He MeHSlHTe PYKH npH
BBe,[\eHHH JIeKapCTBeHHOI'O cpe1J.CTBa.
8. IIpHJIOmHTb CTepHJIbHbIH TaMnOH, CMOqeHHbIH cnHp-
TOM, K MeCTY HH'LeKUHH.
9. M3BJIetlb HrJIy 6bICTPbIM .l\BHmeHHeM, npH,[\epmHBaJI ee
3a KOHIOJIIO.
10. IIpH.l\epmaTb TaMnOH, He OTHHMaJI ero OT KomH 1 - 2
MHH. MomHo C.l\eJIaTb JIerKHH Maccam MeCTa HH'LeKUHH ,[\JIH
YJlY'lweHH.II npoueCCOB BCaCbIBaHH.II JIeKapCTBeHHOI'O paCTBO-
pa. IIpoBepHTb, HeT JIH BbI,[\eJIeHHH KpOBH 1'13 MeCTa npOKOJIa,
npH He06xo1J.HMOCTH - CMeHHTb TaMnOH 1'1 npH1J.epmaTb elI.{e
HeCKOJIbKO MHHYT.
OKOH'laHHenpoue bI
1. IIpOBeCTH ,lI;e3HH<l>eKI:(HIO mnpHI:(a, HrJIbI, BaTHbIX TaM-
nOHOB. J];ei3HH<l>eKUHH npOBO,[\HTCH B O,[\HOM 1'13 perJIaMeHTHpO-
BaHHbIX paCTBopOB, HanpHMep: WYo pop XJIOpaMHHa. KyweT-
Ka B npoue,[\ypHOM Ka6HHeTe 06pa6aTbIBaeTcH 1% p-pOM XJIO-
paMHHa, ecJIH OHa He HMeeT CJIe.l\OB KpOBH. B npOTHBHOM
cJIY'lae - 3% p-pOM XJIOpaMHHa.
2. CH.IITb nepqaTKH, nOMeCTHTb B ,[\e3HH<l>HUHpYIOlI.{nH pa-
CTBOp.
3. BbIMbITb H ocymHTb PYKH.
4. IIoMoqb naUHeHTY 3aH.IITb y,[\06Hoe nOJIOmeHHe.
5. C.l\eJIaTb 3anHCb 0 BbInOJIHeHHH npOue.l\YPbI B JIHCTe Ha-
3HaqeHHH 1'1 pe8.KUHH naUHeHTa Ha npoue,[\ypy.
302
303
OcobeHHOCTM npMMeHeHMH 6M MnnMHa
IIpHMeHHeTcH JIH JIHTeJILHOrO JIe'leHHH H npOclmJIaKTH-
KH pa3JIH'IHbIX 3a60JIeBaHHH: CHclJHJIHCa, npoclJHJI8.KTHKH peB-
MaTH3Ma, HHI};Ie HOHHI,IX OCJIOmHeHHH.
BH HJIJIHH-1: H6eH3HJI3TImeHJ.\HaMHHOBa.!I com. neHH HJI-
JIHHa, nJIOXO paCTBOpHMIl.!I B Bo e. OKa3I,IBaeT npOTHBOMHK-
p06Hoe eHCTBHe B Te'IeHHe 7-14 HeH.
BH HJIJIHH-3: KOM6HHHpoBaHHbIll npenapaT. CMecI, KaJIHe-
BOH (HaTpHeBoH)"COJIH neHH HJIJIHHa. HOBoKaHHoBOH COJIH ne-
HH HJIJIHHa, 6H HJIJIHHa-1 B paBHbIX OTHOlIIeHHHX. OKa3bIBa-
eT ellcTBHe B nepBbIe 'IaCbI nOCJIe BBe eHH.!I, JIHTeJII,HOCTI,
eHCTBH.!I 4-7 Hell.
BH HJIJIHJI-5: CMecI, HOBOI<aHHoBoH COJIH neHHIJ;HJIJIHHa,
6H HJIJIHHa-1 B OTHOlIIeHHH 1:4. IIpO.l\OJImHTeJII,HOCTI, eH-
CTBH.!I 4 He eJIH.
BH HJIJIHJI pa3BO)J;HTCH BO)J;oii )J;JIH HH'beK Hii CTporo ne-
pe)J; BBe)J;eHHeM! IIocJIe pa3Be.l\eHH.!I 6HIJ;HJIJIHHa 06pa3yeTC.!I
B3BecI,. B MeCTe HH'beK HM 06pa3yeTC.!I JIeKapCTBeHHoe .l\eno,
H3 KOToporo JIeKapcTBeHHoe Bell{ecTBO nocTynaeT B KpOBI, JIH-
TeJII,HOe BpeM.!I.
BHIJ;HJIJIHH BBO.l\HTC.!I TOJII,KO B/M, JIY'IIIIHM MeCTOM JISI
HH'beKIJ;Hn .!IBJI.!IeTCH 6e po: npH xO I,6e HpKYJIH n.!I KpOBH
YCHJIHBaeTCH, 'ITO cnoco6cTBYeT XopomeM)' paCCaCbIBaHHIO e-
nOHHpyeMoro y<IaCTKB..
MrJIa JI.!I HH'beK HH OJImHa 6I,ITI, C IIIHpOKnM npOCBe-
TOM. IIpOXO OCTb Hrm.I npe BapHTeJII,HO HYmHO npOBepnTI"
nponYCTHB 'Iepe3 Hee BO Y JI.!I HH'beKIJ;nll.
IIocJIe BB eHH.!I nrJIbI B MbIIII Y noplIIeHI, He06xo.l\HMO
nOT.!IHYTI, Ha ce6H, 'IT06bI y6e.l\HTI,C.!I He nonana JIn Hr JIa B
COCY.l\.
Ha MeCTO HH'beKIJ;HH nOJIOmHTI, TenJIO. CJIe.l\HTI, 3a COCTO.!I-
HHeM naqneHTa.
3. IIepe BBe.l\eHHeM paCTBopa B MbImIJ;Y noplIIeHI, IIInpn-
a He06xo nMo nOT.!IHYTI, Ha ce6.!I, 'IT06I,I y6e HTI,CH, He no-
nana JIH HrJIa B KpOBeHOCHbIll COcy .
4. IIocJIe HH'beK HH npHJIOmHTI, TenJIO K MecT}' BBe.l\eHH.!I
paCTBopa.
Oco6eHHOCTM BBe eHMH MacnHHblX pacTBopoB
1. MaCJIHHI,Ie paCTBopbI (MaCJIHHbIll paCTBOp KaMclJopI,I,
nporecTepoH) BBO .!ITC.!I TOJIbKO B/M.
2. IIepe BBe eHneM MaCJIHHbIe paCTBopbI He06xo.l\HMO no-
.l\OrpeTI, o TeMnepaTYPI,I 35-38°C Ha BO HHOH 6aHe.
304
BHYTpMBeHHaH MHbeK MH
IJ;eJII,: CTPYllHoe BB eHne JIeKapCTBeHHoro pacTBopa B KpO-
BHHoe PYCJIo.
IIoKaaaHHH: Ha3Ha'IeHnH Bpa'Ia.
OCHall{eHHe:
. CTepHJILHbIll IIInpHIJ; O.l\HOKpaTHoro npnMeHeHHH eMKOC-
TblO 10 HJIH 20 MJI, .l\JInHa HrJIbI - 40 MM, Ce'IeHHe - 0,8 MM;
. JIOTOK, HaKpbITbIM 'IeTbIpeXCJIOHHOll CTepHJII,HOH 6H3e-
BOH canclJeTKoll, nHH eT, CTepHJII,HbIe canl};leTKH - no.l\ nep-
BbIM CJIOeM. nHH eT - no BTOpI,IM CJIOeM canclJeTKH;
· JIeKapCTBeHHoe Cpe.l\CTBO;
. cnHpT 70%. BaTHI,Ie lIIapHKH, mryT, KJIeeH'IaTbIll Ba-
JIHK, nep'IaTKH.
· eMKOCTH C e3. p-paMH.
IIoAroToBKa K npo e.n;ype
1. IIo rOTOBHTI, Bce Heo6xo.l\HMOe OCHall{eHHe.
2. "YcTanoBnTI, 06pOmeJIaTeJII,HbIe OTHOlIIeHHH C na neH-
TOM.
3. 06'bfiCHHTI, naIJ;HeHT}' IJ;eJII, H XO npo e YPbI, nOJIY-
'IHTI, COrJIaCHe.
4. Ha eTI, MaCKY. no rOTOBHTI, PYKH K pa60Te, Ha.n;eTI,
nep'IaTKH.
5. BCKpbITI, naKeT. c06paTI, IIInpH . 06pa60TaTI, lIIeHKY
aMnYJII,I TaMnOHOM, 06pa60TaHHbIM cnnpTOM, .n;BYKpaTHO.
6. Ha6paTI, JIeKapCTBeHHoe cpe CTBO ( 03Y. Ha3Ha'IeHHYIO
Bpa'IOM).
7. ClIHTI, HrJIY, C6POCHTI, B eMKOCTI, C e3. p-pOM.
8. Ha.n;eTI, Hrny JIH BHYTpHBeHHoH HH'beK HH. BbInYCTHTI,
B03 YX, Hap;eTb KOJIna'IOK Ha HrJIY.
9. IIOJIOmHTI, IIInpHIJ; B JIOTOK.
10. YCap;HTI, naqHeHTa Ha KYlIIeTKY HJIH YJIOmHTI,.
305
11. HaJIOmHTb BeH03HbIH mryT Ha llJIe'iO, nOKpbIToe CaJI-
cl>eTKon.
12. TIO.l\ JIOKOTb nOMeCTHTb KJIeeH'iaTYIO nO.l\ynIKY.
13. MCCJIe.l\OBaTb BeH}'.
14. Cmq)TOM 06pa60TaTb .l\Ba)KJ.\bI Komy BH}'T-peHHeH no-
BepXHOCTH JIOKTeBOro crH6a cnHpTOM (TaMnOHbI C6POCHTb B
eMKOCTb C 3% p-pOM XJIOpaMHHa).
15. B3.11Tb Ilmp , CH.IITb KOJIna'iOK.
16. TIpoBepHTb OTCyTCTBHe B03.l\yxa B mnpHl e, .l\epmaTb
mnpH cpe30M BBepx, cl>HKCHPY.II HrJIY YKa3aTeJIbHbIM naJIb-
eM 3a KOHIOJIIO.
BbInOJIHeHHe npo e.llJlPbl
1. 3aclJHKCHpOBaTb BeHY 60JIbmHM naJIbueM JIeBOH PYKH,
npOKOJIOTb Komy, BOHTH B BeHY Ha 1/3 .l\JIHHbl HrJIbI, napaJI-
JIeJIbHO BeHe.
2. OrT.IIH}'Tb nopmeHb Ha ce6.11, YBH.l\eTb nO.llBJIeHHe KpOBH.
3. CH.IITb mrYT.
4. BBeCTH JIeKapCTBO Me.l\JIeHHO, Ha.l\aBJIHBa.ll Ha nopIlIeHb
nepBbIM naJIb eM JIeBOH PYKH.
5. TIonpocHTb n HeHTa corHYTb PYKY B JIOKTeBOM CYCTaBe
(MomHo 3aclJHKCHpOBaTb mapHK 6HHTOM.
OKowlaHHenpo e.llJlPM
1. TIPOMbITb mnpH , He CHHMa.ll HrJIbI. B .l\e3HHcl>H HPYIO-
lqeM p-pe.
2. TIorpY3HTb mnpH B .l\e3HHcl>H HPYlOlqHn p-p, HaxO.l\.II-
lqHnC.II B .l\Pyron eMKOCTH. 3anOJIH.II.II nOJIOCTH IlInpH a H pa?-
6Hpa.ll ero.
3: BMTb Y na HeBTa tlep P 3 1 - 2 MHH. BaTHbIH mapHK
4. CH.IITb nep'laTKH.
5. BbIMbITb PYKH, BbICYIlIHTb.
6. Ha6JIIO.l\aTb 3a COCTO.llHHeM na HeHTa.
7. TIPOBeCTH perHCTpa HIO npOBe.l\eHHOH npo e.l\YPbI H pe-
aK HIO naI\HeHTa Ha Hee.
HanO>KeHHe >KryTiI
BHYTpMBeHHoe KanenbHoe
BBe eHMe *M KocTeM
IJ,eJIb: Me.l\JIeHHOe, 40 - 60 KaneJIb B MHHYTY, nocTYIIJIe-
BHe B KpOBeHOCHoe PYCJIO JIeKapCTBeHHbIX paCTBopOB.
TIOKa3aml.ll: BOCCTaHOBJIeHHe ofueMa I\HPKYJllipyIOlqen Kpo-
BH; HOpMaJIH3a H.II BO.l\HO-SJIeKTpOJIHTHOrO 6aJIaHCa H KHC-
JIOTHO-lqeJIO'iHOrO COCTO.llHH.II OpraHH3Ma; YCTpaHeHHe .IIBJIe-
HHn HHTOKCHKa HH; napeHTepaJIbHOe nHTaHHe.
OCHa eHHe:
· CmepUJLbH.bte: JIOTOK, 6.113eBa.ll CaJIcl>eTKa CJIOmeHHaJI B 4
CJIO.ll H HaKpbIBaIOlqaJ'! JIOTOK, nHH eT, CaJIcl>eTKH MaJU>le, BaT-
HbIe IlIapHKH. MaCKa, nep'iaTKH, XaJIaT;
· 0.l\HOpa30Ba.ll CHCTeMa .l\JI.II KaneJIbHOrO BBe.l\eHH.II mH.l\KO-
CTeH; IlITaTHB .l\JI.II KaneJIbHH bI, .l\JIHHonl-l,5 M Ha.l\ KpOBa-
TblO, KJIeeH'iaTaJI nO.l\YIlIetlKa, JIeHKOnJIaCTbIpb - 2 JIeHTbI
.l\JIHHOn 3-4 CM H mHpHHoH 1 CM;
· .l\e3HHcl>HUHPYIO H paCTBOp B eMKOCT.IIX .l\JI.II .l\e3HH-
cl>eK HH (!KaneJIbHH bIl>, HrJIbI, BaTBbIX mapHKOB H caJIcl>e-
TOK, mrYTa, KJIeeHtlaTOH nO.l\YmetlKH, JIeHKOnJIaCTbIpR, Be-
TomH, npO e.l\ypHOI'O CTOJIa, KynIeTKH.
· BeTOmb ,c MapKHpOBKOH.
. CnHpT 70°.
TIO,ll;rOTOBKa K npo e.llJlPe
1. V CTaHOBHTb .l\OBepHTeJIbHbIe KOHcl>H.l\eB HaJIDHbIe OTHO-
meBH.II C naI\HeHTOM (eCJIH OH B C03HaHHH).
2. 06'b.llCHHTb eJIb BBe.l\eHH.II JIeKapCTBeHHOI'O pacTBopa
na HeHTY, XO.l\ H Cyrb npO e.l\ypbI, nOJIy'lHTb eorJIaCHe nanH-
eHTa HJIH ero P0.l\CTBeHHHKOB Ha npo e.l\YPY.
3. 06pa60TaTb PYKH Ha rHrHeHHtleCKOM ypOBHe, Ha.l\eTb
CTepHJIbHbIH XaJIaT, MaCKY, neptlaTKH.
306
307
KanenbHoe BnHBaHHe
14. 3anOJIIIHTb KaneJIbHHI:(Y npHMepllo HanOJIOBHHY.
15. OnycTHTb KOlleI:( CHCTeMbI BHH3 If 3anOJIHHTb TPy6KY
pacTBopoM, 3aKpbITb 3amHM.
16. H eTb Hr.ny C KOJInaqKOM.
BbInOJIHeHHe npOI:(e.u;ypbI
1. 'YJIOmHTb naI:(HeHTa B y 06Hoe nOJIOmeHHe.
2. TIOJIOmHTb no JIOKOTb nan;HeHTa KJIeeHqaTYIO no y-
WeqKY, HCCJIe OBaTb BeHY.
3. 06epHYTb nJIeqo CaJI!tJeTKOll H HaJIOmHTb BeH03HbIH mrYT
Ha cpe HIOIO TpeTb nJIeqa. MCCJIe OBaTb BeHY.
4. 06pa60TaTb MeCTO nyIIKI:(HH BeHbI 70% cnHpTOM BY-
KpaTIIO pa3HbIMH BaTHbIMH WapHKaMH. C6POCHTb BaTHbIe
wapHKH, B e3HH!tJHI:(HPylOI[(Hll paCTBOp (3% paCTBOp XJIO-
paMHHa).
5. CIIHTb HrJIY C KOJInatlKOM C CHCTeMbI, 3aTeM KOJInaqOK
C HrJIbI.
6. cI>HKcHpoBaTb BeHY 60JIbIIIHM naJIbI:(eM JIeBOH PYKH HHme
MeCTa BBe eHH.II. )J:epmaTb Hr.ny npanoll PYKOH 3a KaHIOJIIO.
C06JIIO,lI;aTb CTepHJIbIlOCTb!
7. TIpe JIOmHTb nan;HeHT}' cmaTb KYJIaK.
8. BBeCTH HrJIY B BellY Ha 1/3 ee JIHHbI, nO JIOmHB no
KaHlOJIIO CTepHJIbHYIO CaJI!tJeTKY. 'Y6e HTbc.II, qTO KpOBb H3
KaHlOJIH BbI eJI.IIeTC.II KanJIeH Ha CaJI!tJeTKY.
9. CH.IITb mrYT.
10. OTKPbITb 3amHM Ha CHCTeMe. C aBHTb TPy6KY CHCTe-
MbI naJIbn;aMH npaBOll PYKH.
11. TIpHcoe HHHTb CHCTeMY K KaHIOJIe HrJIbI, CMeHHTb CaJI-
<PeTKY. C6POCHTb CaJI!tJeTKY B e3HH!tJHlI.HpyroI[(I1ll paCTBOp (3%
paCTBOp XJIOpaMHHa).
12. O:rperyJIHpOBaTb CKOpOCTb nocTynJIeHH.II KaneJIb 3a-
JiGlMOM.
13. 3aKpenHTb HrJIY JIellKOnJIaCTbIpeM H npHKpbITb CTe-
pHJIbHOH CaJI!tJeTKOH MecTO BBe eHH.II.
14. Ha6JIIO aTb 3a COCTO.llHHeM H CaMOqYBCTBHeM naI:(HeH-
Ta BO BpeM.II BHYTpHBeHHoro BJIHBaHH.II.
OKolJ1Iamle npOn;e.u;ypbI
1. TIpHmaTb K MeCTY HH'beKI:(HH BaTHbIH wapHK (CaJI!tJeT-
KY) C KomHbIM aHTHcenTHKOM, H3BJIeqb HrJIY.
2. TIonpocHTb nan;HeHTa corHYTb PYKY JIOKTeBOM CYCTane
(MomHo 3a!tJHKcHpoBaTb wapHK 6HHTOM).
4. TIo roToBHTb 0 Hopa30BYIO CHCTeMY JI.II KaneJIbHOrO
BBe.l\eHH.II. TIpoBepHTb CpOK rO HOCTH H repMeTHqHOCTb yna-
KOBKH, c aBHB ee C 06eHX CTOpOIl.
5. TIo rOTOBHTb CTepHJIbHbIH JIOTOK C CaJI!tJeTKaMH, BaT-
HbIMH WapHKaMH H nHHI:(eTOM.
6. TIO I'OTOBHTb !tJJI8.IWH C JIeKapCTBeHHbIM paCTBopOM .l\JI.II
HU!tJ!tJY3HH.
7. CH.IITb C !tJJIaKOHa MeTaJIJIwrecKHll KOJInaqOK HOmHHIJ;aMH.
8. 06pa60TaTb np06KY !tJJIaKOHa BYKpaTHO cnHpTOM.
9. 3aKpbITb aamHM Ha CHCTeMe.
10. TIepeBepHYTb !tJJIaKOH BBepx AHOM, nO BecHTb lIa wTa-
THEe.
11. TIepeBepIIYTb KaneJIbHHI:(y, CH.IITb HrJIY C KOJInaqKOM,
nOJIOmHTb B CTepHJIbHbIll JIOTOK.
12. 3anOJIHHTb KaneJIbHHn;y paCTBopOM, epma JIHHHbIll
KOHeI:( CHCTeMbI BbIwe nepeBepHYToll KaneJIbHHn;bI. Bo !tJJIa-
KOH 6y eT BXO.l\HTb B03 YX JI.II BbITeCHeHHSI paCTBopa H3!tJJIa-
KOHa.
, 13. CJIe HTb, '!T06bI Kane.n:bHHn;a OKa3aJIaCb Ha O HOM YPOB-
He C !tJJIaKOHOM.
308
309
3. 3aKpLITL HrJIY KOJInatlKOM, c06JIlo aH YHHBepCaJILHble
np8.BHJIa npe OCTopQ)KHOCTH. IIo BecHTL Tpy6KY CHCTeMLI Ha
WTaTHBe.
4. IIorPY3HTL CHCTeMY C HrJIOll B eMKOCTL C e3paCTBO-
pOM, pa3pe3aTL HOmHHI:(aMH B e3paCTBope, npH nOJIHOM no-
rpymeHHH.
5. B3HTL Y naI:(HeHTa (tlepe3 5 - 7 MHH) BaTHLIH wapHK,
KOTOpLIM OH npHmHMaJI MecTO HH'LeKI:(HH.
npHMe'laHHe. He OCTaSI1J1HTe saTHblH WapHK. 3arpJl3HeHHblH KpoBblO,
y nClllHeHTa. n0I10>KHTb WapHK B Ae3paCTBop Hl1H 110TOK (naKeT H3-
nOA OAHOpa30BorO wnpHLla) A11J1 nOCl1eAYI014eH Ae3HH<!>eKLlHH.
6. CH.HTL nepqaTKH.
7. BLIMLITL PYKH, OCYWHTL.
8. Ha6JIlo aTL 3a COCTO.HHHeM n HeHTa. CMeHHTL nOJIO-
meHHe naII;HeHTa B nOCTeJIH, peKOMeH OBaTL He BCT8.BaTL B
TeqeHHe 2 qaCOB.
9. IIpoBecTH perHCTpaII;HIO npOBe eHH.H npOII;e YPLI H pe-
aKII;HH naII;HeHTa Ha npoI:(e yPY.
It mHpopaCTBopHMLIM OTHOC.HTC.H .l\HrHTOKCHH, II;eJIaHH ,
HrOKCHH. It BO.l\OpaCTBopHMLIM - cTpOlpaHTHH, KOprJIHKOH.
CTPOcPaHTHH BLInYCKaeTCJI B aMnYJIax no 1 MJI 0,025%
HJIH 0,05% paCTBOp.
KOprJIHKOH BLInYCKaeTC.H B aMnYJIaX no 1 MJI 0,06% pa-
CTBOp.
Ha3HaqalOT CTporo no Ha3HaqeHHlO Bpaqa no 0,3-0,5 MJI
BIB Me JIeHHO B 10-20 MJI cPH3HOJIorHqeCKoro pacTBopa HJIH
KaneJILHO.
nOKa3aHHH: Cep.l\eqHaH He OCTaTOqHOCTL, TaXHKap H.H,
MepII;aTeJILHaH apHTMH.H H p.
npOTHBonoKa3awm: 6pa,n;HKap HH, aTpHOBeHTpHKYJI.HpHaJI
6JIOKa,n;a pa3JIH'lHOH CTeneHH, npH npHCTynaX MOpraHLH-A.z\aM-
ca-CToKca.
BB eHHe ceMe"llHLIX rJIHK03H,!J;OB OCyIII;eCTBJIHeTCH no CTpo-
rHM KOHTpOJIeM 06II:(ero COCTO.HHHH H Cep eqHO-coCY HCTOll
eHTeJILHOCTH.
qYBcTBHTeJILHOCTL Cep eqHOH MLIWII;LI K Cep eqHLIM rJIH-
K03H aM 3aBHCHT OT CO epmaHHH B KpOBH H MHOKap.l\e HOHOB
KaJIHH,HaTpHH,MarHHH,KaJILI:(HH.O HoBpeMeHHoeHa3Haqe-
HHe HYPeTHKOB rpynnLI canypeTHKOB (rHnoTHa3H . HaKap6,
cPypoceMH ) conpOBOm aeTCH nOTepell KaJIHH, qTO YBeJIHqH-
BaeT onaCHOCTL rJIHK03H HOH HHTOKCHK HH, npoHBJI.HIOII:(ellCH
apHTMHHMH.
Oco6eHHOCTH npHMeHeHHH
cepAe H x rnHKo3HAOB
Cep eqHLle rJIHK03H LI - BeII:(eCTBa paCTHTeJILHOrO npo-
HCXOm.l\eHHH, OKa3LIBaIOIII;I:Ie H36lipaTeJILHOe CTHMYJIlipYIDII:(ee
BJIH.HHHe Ha MLImII;Y cep I:(a. B pe3YJILTaTe OHH YCHJIHBalOT
COKpaII:(eHHH cep.l\II;a npH Cep eqHOH He OCTaTOqHOCTH. ):(eH-
TeJILHOCTL 3 opOBoro cep I:(a OHH MaJIO H3MeHHIOT.
KpoMe SToro, Cep eqHLle r JIHK03H.l\LI ypemalOT COKpaII:(e-
HWI cep I:(a, BLI3LIBaIOT 6pa HKap HIO. '
B pe3YJlhTaTe npliMeHeHWI cep e'lHLIX rJIHK03H,!J;OB YBeJIH'lH-
BaeTCH Cep etlHLIll BLI6poc, 'iTO Be eT K YMeHLweHHIO 3aCTOH-
HLIX HBJIeHHH, OTeKOB H Y.nytlmeHHIO cPYHKII;HH Bcex OpraHOB.
O HaKO He06xo HMo nOMHHTL 0 TOKCHqeCKHX s«PcPeKTax
Cep eqHLIX rJIHK03H OB, KOTopLIe npOHBJIHIOTCH B BH e H3Me-
HeHHll co CTOpoHLI meJIy OqHO-KHWeqHOrO TpaKTa, II;eHTpaJIL-
HOH HepBHOH CHCTeMLI, 3pHTeJILHLIX cPYHKII;HH, HapymeHHH
Cep eqHOI'O pHTMa Ii npOBO HMOCTH.
Cep.neqHLle rJIHK03H LI cnoe06HLI paCTBOpHTLCH B mHpax
(XOpOWO BCaCLIBaIOTCH B KHWeqHHKe) H B Bo e (BBO .HTCH
napeHTepaJILHO, xopomo BLIBO.l\.HTCH nOqKaMH).
6.3. AU'lHaR rurueHa naqueHma
CMeHa nOCTenbHoro H HaTenbHoro 6enbH
CMeHHTL nOCTeJIbHOe 6eJILe MomHO BYMH cnoc06aMH.
IIepBLIll cnoc06 npHMeHHIOT B CJIyqae C06JIIO eHHSI.naII;H-
eHTOM nOCTeJILHOrO pemHMa npH YCJIOBHH pa3peweHHH nOBO-
paqHBaTLCH B nOCTeJIH.
BTOPOll cnoc06 npHMeHHIOT B CJIyqae C06JIIO eHH.H CTporo-
1'0 nOCTeJILHOrO pemHMa npH YCJIOBHH 3aI1peII:(eHHH naI:(HeHTY
BLInOJIHHTL aKTHBHLIe BHmeHHH B nOCTeJIH.
C nOBpem eHHoll np8.BOll PYKOH HaTeJILHOe 6eJILe MeHHIOT
B nOJIOmeHHH (/JIema Ha cnHHe. CJIe.l\YIOII:(HM 06pa30M.
310
311
npOAonbHblH cnoco6
nOnepe4HblH cnoco6
.. !
_ ---:::-.- J- .=.
CMeHa nOCTenbHOrO 6enbJl
31Z
Ocy eCTBJUI.H yxo 3a na[(HeHTaMH, HaXO .Hm;HMHC.H Ha
CTpOI'OM nOCTeJIbHOM pe:IKHMe, npH He06xo HMOCTH onopo:IK-
HHTb KHlIIeqHHK H MOqeBOM nY3bIpb B nOCTeJIb nO aeTC.H cy -
HO H MOqenpHeMHHK, :lKeH HHbI npH MOqeHCnYCKIlHHH qa e
nOJIb3yIDTC.H CY HOM. IIpHMeH.HIOTC.H MeTaJIJIHqeCKHe C 8MaJIH-
pOBIlHHbIM nOKpbITHeM, nJiaCTMaCCOBbIe HJIH pe3HHOBbIe CY -
Ha. IIpH no aqe CY Ha C06JIIO aIOTC.H npaBHJIa HHltJeK[(HOH-
HOM 6e30naCHOCTH, 06ecneqHBalOTC.H KOHItJH eH[(HaJIbHOCTb BO
BpeM.H MOqeHCnYCKaHH.H H E$eK , a TaK:IKe He3aBHCHMOCTb
H C06JIIO eHHe JIH'iHOM rHrHeHbI.
CMeHa aTenbHoro 6enbJl
313
'\J'v
V CTaHOBJIeHbI TPH OCHOBHbIX l};IaKTOpa, npHBO.l\.II HX K 06-
pa30BaHHIO npOJIemHeH: .l\aBJIeHHe, (/Ope3bIBanlOll{aJII> CHJIa H
TpeHHe.
l1.a6J1.ellUe - no.l\ .l\ellCTBHeM c06cTBeHHOI'O Beca TeJIa npo-
HCXO.l\HT C):IaBJIeHHe TKaHeH OTHOCHTeJIbHO nOBepXHOCTH, Ha
KOTOPYIO onHpaeTC.II 'leJIOBeK. IIpH C):I8.BJIeHHH TKaHeH ):IHa-
MeTp COCY):IOB YMeHbmaeTC.II, B pe3YJIbTaTe HweMHH HacTyna-
eT rOJIO):laHHe TKaHeH. IIpH nOJIHOM C):I8.BJIeHHH B Te'leHHe .l\BYX
'laCOB 06pa3yeTc.II HeKp03. C):IaBJIeHHe Y.II3BHMbIX TKaHeH ell{e
60JIee YCHJIHBaeTC.II nO):l ):IellCTBHeM T.IImeJIOro nOCTeJIbHOI'O 6e-
JIb.ll, nJIOTHbIX nOB.II30K, O):lem,l\bI.
(CCpe3bt6alOll{aJl cUJl.a» - pa3pyweHHe H MeXaHH'lecKoe no-
Bpem):leHHe TKaHell npoHCXO):lHT nO):l ):IeHCTBHeM Henp.llMOrO
):IaBJIeHH.II. QHO BbI3bIBaeTC.II CMell{eHHeM TKaHeH OTHOCHTeJIb-
HO onopHoH nOBepxHocTH. MHKPO HPKYJI.II HSI B HHmeJIema-
HX TKaH.IIX HapywaeTc.II, H TKaHb norH6aeT OT KHCJIOpO):l-
HOH He):lOCTaTO'lHOCTH. CMell{eHHe npOHCXO):lHT, KOr):la na H-
eHT 4C'be3maeT& no nOCTeJIH BHH3 HJIH nO):lTSlrHBaeTCSI K ee
H3rOJIOBblO.
YXOA 3a KO)l(eM
BamHeHIIIHMH YCJIOBH.IIMH HOpMaJIbHOH ):IeSlTeJIbHOCTH KomH
.IIBJISleTC.II ee 'lHCTOTa H eJIOCTHOCTb. )];JI.II COXpaHeHHSI ynpy-
rOCTH, M.IIrKOCTH H rH6KocTH KomH BamHoe 3Ha'leHHe HMeeT
I};IYHK HH CaJIbHbIX H nOTOBbIX meJIe3. IIpH HapyweHHH HX
I};IYHK HH npOHCXO):lHT aarp.ll3HeHHe KomH BbI):IeJIeHH.IIMH H3
CaJIbHbIX H nOTOBbIX meJIe3, porOBbIMH 'lemYHKaMH, nbIJIblO,
oc06eHHo B nO):lMbIme'lHbIX Bna):lHHax, CKJIa):lKax KomH, nO):l
MOJIO'lHbIMH meJIe3aMH y .meHll{HH. Koma npOMemHOCTH ):10-
nOJIHHTeJIbHO 3arp.ll3H.IIeTC.II BbI):IeJIeHH.IIMH H3 MO'lenOJIOBbIX
OpraHOB H KHWe'lHHKa. 3arp.ll3HeHHe KomH BbI3bIBaeT oxqy-
eHHe 3Y):la, 3Y):l Be):leT K paC'leCaM, 'lTO B CBOIO O'lepe):lb cno-
c06cTByeT npOHHKHOBeHHIO B rJIy6b KomH MHKpOOpraHH3MOB,
HaXO):lHll{HXC.II Ha ee nOBepXHOC'l'H.
VXO):l 38. KomeR HMeeT eJIblO 06ecne'lHTb ee 'lHCTOTY H
eJIOCTHOCTb. B CB.II3H C 8THM Me):lH HHCKa.ll ceCTpa ):IOJImHa
CJIe):lHTb, 'lT06bI na HeHTbI C06JIIO):IaJIH npaBHJIa JIH'lHOR rH-
rHeHbI, H nOMoraTb HM BbInOJIHHTb Heo6xo):lHMbIe MaHHnYJI.II-
HH no cO):lepmaHHIO KomH B 'lHCTOTe. MHTYH H.II, nOHHMa-
HHe H Ha6JIIO):IaTeJIbHOCTb Me):lH HHCKOll cecTpbI nOMorYT ell B
8TOM.
IIpH nJIOXOM yxo):le 3a KomeH H pe3KOM OCJIa6JIeHHH opra-
HH3Ma n HeHTa Ha ytlaCTKaX KomH, nO):lBepralOll{HXCH ):IaB-
JIe!lHIO HJIH TpeHHIO TeJIa, B03HHKaIOT npOJIemHH.
YXOA M npocjJMnaKTMKa npOne)l(HeM
IIpoJIemeHb - 81'0 r.ny60KHe nOpameHH.II KomH H M.IIrKHX
TKaHeH BnJIOTb):lO HX OMepTBeHH.II B pe3YJIbTaTe ):IJIHTeJIbHOrO
C):IaBJIHBaHH.II. K npe):lpacnOJIaralOll{HM l};IaKTopaM OTHOCHTCH
HapyweHH.II MeCTHoro KPOB006pall{eHHH, HHHepBa HH H nH-
TaHH.II TKaHeH. IIpoJIemHH MOryT 06pa30BbIBaTbC.II Be3):1e, r):le
eCTb KOCTHbIe BbICTynbI. IIpH nOJIomeHHH na HeHTa Ha cnHHe
81'0 - KpecTe , nHTKH, JIOnaTKH, HHOr):la 3aTbIJIOK H JIOKTH.
IIpH nOJIOmeHHH CH):I.II81'0 - Ce):laJIHll{HbIe 6yrpbI, CTonbI Hor,
JIOnaTKH. IIpH nOJIOmeHHH JIema Ha mHBOTe 8TO - pe6pa,
KOJIeHKH, naJIb bI Hor C TbIJIbHOii CTOpOHbI, rpe6HH nO):lB3):10W-
HbIX KOCTeH.
e.e
.
.
. . .
314
MeCTa HaH6onee'lacroro 06pa30BaHHJI npOne>KHeM
315
Tpellue - .IIBJUleTC.II KOMnOHeHTOM (/Cpe3bIBalOll.{ell& CHJIbI,
OHO BbI3bIBaeT OTCJIOllKY pOrOBOrO CJIO.ll KmKH H npHBO.l\HT K
H3'L.II3BJIeHHIO ee nOBepXHOCTH. TpeHHe B03paCTaeT npH YB-
JIaJlmeHHH KOmH. Han6o.n:ee nO.l\BepmeHbI TaKOMY B03.l\ellCTBHIO
na HeHTbI C He.l\epmaJIHeM MO'iH, YCHJIeHHbIM nOTOOT.l\eJIeHH-
eM, BO BJIamHOM H He BnHTbIBaIOll.{eM BJIary HaTeJIbHOM 6eJIbe,
a TaKme paCnOJIaralOll.{HCC.II Ha He BnHTbIBalOll.{HX BJIary no-
BepXHOCT.IIX.
TIpH3HaKaMH npOJIemHeH .IIBJI.IIeTC.II nO.llBJIeHHe yqacTKa.
KomH CHHIOIliHO-I<paCHOI'O BeTa 6e3 'ieTKHX rpaHH . 3aTeM I
CJIYll.{HBaeTC.II SnM.l\epMHC, 06pa3ylOTc.II nY3bIpH. ,lJ;aJIee npOHC-
XO.l\HT HeKp03 TKaHell, pacnpOCTpaH.IIIOll.{HllC.II Br.ny6b H B CTO,
pOHbI. JIe'ieHHe npOBO.l\HTC.II B COOTBeTCTBHH co CTeneHblO no-
plUKeHH.II.
CTeneHb I - OrpaHH'IeHa SnM.l\epMaJIbHbIMH H KomHbIMH
CJIO.llMH. KomHbIll nOKpOB He HapymeH. Ha6JIIO.l\aeTCSI YCTOH-
'iHBIUI rHnepeMH.II C CHHIOIlIHO-KpaCHbIMFI n.llTHaMH, He npo-
XO.l\.IIll.{a.ll nOCJIe npeKpall.{eHH.II .l\8.BJIeHHSI. JIe'ieHHe KOHcepBa-
THBHoe.
CTeneHb II - HerJIy60KHe nOBepXHOCTHbIe HapYIlIeHH.II e-
JIOCTHOCTH KomHbIX nOKpOBOB, pacnpOCTpaH.IIIOll.{Hec.ll Ha no.l\-
KomHbIll mHpOBOll CJIOH. COXPaH.IIeTC.II CTOllKIUI nmepeMH.II C
CHHIOIliHO-KpaCHbIMH nSlTHaMH. TIPOHCXO.l\HT OTCJIOHKa snH-
.l\epMHca. JIe'ieHHe KOHcepBaTHBHoe.
CTeneHb III - nOJIHOe pa3pYllIeHHe KomHoro nOKpOBa BO
BCIO ero TOJIll.{HHY .l\0 MbIIlIe'iHOrO CJIO.ll C npOHHKHOBeHHeM B
CaMy MbIllI Y.
CTeneHb IV - noplUKeHHe BCex M.IIrKHX TKaHeH. 06pa30Ba-
HHe nOJIOCTH C nOBpem.l\eHHeM B Hell HHmeJIemall.{HX TKaHeH
(cyxomHJIH.II, BnJIOTb.l\O KOCTH).
TpeTb.ll H 'ieTBepTa.ll creneHH JIeqaTC.II npH nOMOll.{H XH-
pyprH'IeCKOrO BCKpblTH.II H y.l\aJIeHH.II OMepTBeBIlIHX TKaHell.
IIpocJ.mJIaKTHKa npOJIemHeH
---;;.
I.( eJl.b:- npe.llynpem.l\eHHe 06pa30BaHH.II npOJIemHeH.
IIOIfa3allUJl: .l\JIHTeJIbHbIH nOCTeJIbHbIll pemHM, noplUKeHHe
ueHTpaJIbHOH HJIH nepHltJepH'IeCKOll HepBHOll CHCTeMbI, Hapy-
llIeHHe 06MeHHbIX npo eCCOB B OpraHH3Me, HapYIlIeHFle «l>YHK-
Hll BbI,l\eJIHTeJIbHOH CHCTeMbI.
3'6
OCH.aU{ellue (CTepHJIbHO): JIOTOK, CaJI«l>eTKH, nHH eTbI, CTeK-
JIHHHa.ll 6aHKa; lO%-HbIll paCTBOp KaM«l>opHoro cnHpTa HJIH
40% -HbIH paCTBOp STHJIOBOI'O cnHpTa; HaTeJIbHOe H nOCTeJIb-
Hoe 6eJIbe, nOpOJIOHOBbIe KpyrH B H8.BOJIO'iKe, nOpOJIOHOBbIe
BaTHO-MapJIeBbIe KOJIbUa.
06Jl3ameJl.b1l0e YCJl.06ue: eJIOCTHOCTb KomHbIX nOKpOBOB.
3Tanbl I 06ocHoBaHHe
noiJzomo6Ka K npol.{eiJype
1. YCTaHOBItTb AOBepHTenbHble 06eCne'leH\I1e OC03HaHHoro Y'laCTI.1R
OTHOWeHHR C na41.1eHTOM, ecnH 3TO B coBMecTHo pa6oTe.
B03MO>KHO.
2. 06bRCHHTb na4HeHT}' 4enb npo- Co6nlOAeHI.1e npaBa nal\l.1eHTa Ha
4eAypbl, nonY'lI.1Tb ero comaCHe, HH<!>0pMa4\l1IO, OC03HaHHoro Y'la-
06bRCHI.1Tb nocne,QooaTenbHOCTb CTI.1R B COBMeCTHO pa60Te.
Ae cTBH .
3. OCMaTpHBaTb eJKeAHeBHO KO>t<y B BH3yanbHOe onpe,QeneHl.1e Hapywe-
MecTax B03MO>KHOrO 06pa30BaHI.1R HH5I 4enOCTHOCTI.1 KOJKHblX nOKpOBOB.
npOne>KHe : KpecT4a, n5ITOK, nOAbl- CHI.1>KaeTCR pl.1CK B03H\I1KHOBeH\I1R
>KeK, nonaTOK, nOKTe , 3aTblnKa, npone>KHei1.
60nbworoBepTena,6eAPeHHO
KOCTH, BHyrpeHHI.1X nOBepxHocTe
KoneHHblX cYCTaBoB C 4enbIO Ol\eH-
KI.1 COCTORHH5I KO>tG1 npl< Ka>K,qOM
nepeMeUleHHl.1, H3MeHeHI<I< COCTOR-
HI<R.
npHMe'laHl<e: npH 06HapyJKeHI.1H
no6neAHeBWHx 101 nOKpaCHeBWI.1X
Y'lacTKOB KO>KH He06XOAl<MO Bbl-
3BaTb Bpa'la I< HeMeAneHHO Ha4aTb
npo<J>I.1naKTI<4eCKHe I< ne4e6Hbie
Meponp1.151THR.
4. YCTpaHRTb HepOBHOCTl.1, YCTpa- C06nlQAeHI.1e nH'IHO rl.1rneHbl Me-
HRTb CK11aAKI.1 Ha nOCTenbHOM 101 AI.14HHCKOO cecTpbl.
HaTenbHOM 6enbe.
5. CTpRXI.1BaTb KpoWKI.1 C npocTblHH
nocne KopMneHI.1R.
6. BblMblTb I< OCYWI<Tb PYKI.1.
BblnonHeHue npOl.{eiJYPbl
1. 1I13MeH5ITb nonOJKeHl<e Tena na- CHHJKaeTCR npoAOn>KI.1TenbHOcTb
4\I1eHTa B nOCTenl< KIDl<,Qble AaBneHI.1R.lI1cK11104aeTc5ITpeHl.1e
2 4aca B Te'leHl.1e cyrOK, npl.1nOAHH- KOJKH nepeA nepeMeUleHHeM.
Ma51 ero Ha,t:\ nOCTenblO, YK11aAbIBa51
nOO'lepeAHo Ha 601<, >tG1BOT, B nono-
JKeHHe CHMca, B nOnOJKeHl.1e Cl>ay-
nepa.
3'1
lJexon 1013 TKaHH
l<11eeHKa
neneHKa
np04WlnaKTMKa npOne>KHeM
3Tanbl I 060CHoBBHHe
BblnonHeHue npO/.jeOYPbl
npHMe'lBHMe: rpa<!>IIK nepeMel1le-
HHSI o6ecne'lHT npeeMCTBeHHOCTb
Aei'icTBHi'i CeCTpHHCKoro nepcoHanB.
2. 06MblBaTb 2 pa3a B cyTKI1 (yrpoM ()cyUIecTBneHHe YX0Aa 3a KO>Kei'i,
101 Be4epoM) MeCTa B03MOJKHOrO coxpaHeHHe ee enOCTHOCTI1. npe-
06pa30BaHl1S1 npol1e)KHei'i TeMOH MTlPB>I\AeHHe HH<I>H lIpoBaHHSI.
BOAOO C HempanbHblM MbUIOM.
3. BbmlpaTb Hacyxo nOIlOTeH eM PacwHpeHlle nOBepXHOC1HbIX Ka-
(AenaTb npOMOKaT9l1bHble AaMJKe- nM11T1J1poB, yn}l'lweHHe KpoBoo6pa-
HII5I), 3aTeM 06pa60TaTb can$!T- l1IeHIISI B KOJKB, o6ecne'leHlo1e nHTa-
KOH, CMO'IeHHOH B TeMOM KaM<l>oP- HIISI KOJKl1.
HOM cnHpTe HnH 3TWlOeOM cnlo1pTe.
4. HaHecrn 3aI1lIlTHbli'i KpeM.
5. PBCTHpaTb MSlflG1e TKaHH B ec- Yn}l'lWeHHe PKYnSl HH KpoBH.
Tax B03MOJKHOro 06pa3oBaHIISI npo-
ne>KHei1 npHeMaMit Macca>Ka. He
AenaTb MaCC3>K B 06nacTIo1 BbleT}'-
nalOI1IHX KOCTHbiX }I'IaCTKoB.
31S
3Tanbl I 060CHOBaHHe
BblnonHeHue npo/.jedYPbl
6. nOp,nO>KHTb noponoHoBblH KPyr B YMeHbweHHe AaBneH1011'1 Ha
HaBOnO'lKe nOA KpecTe na eHTa. KOJKy.
7. nOp,nO>Klo1Tb noponoHoBble KPYJ'I
nOA nOKTH 101 nSlTKH na eHTa.
8. L!lcnonb30BaT;, npHcnoco6neHHSI,
yMeHbwalOl1II1e ABBneHHe Ha KOJKy,
npH Io1X HBnlo1 HH.
9. 06}1'1HTb pOACTBBHHIo1KOB 101 Bcex, 06eCne'IBHHe nQCTOSlHHOro YXOAB
KTO }I'IacTByeT B yxoAe, MepaM 3a na eHTOM.
npo<f>HnaKTHKII npOne>KHeH.
3aeepweHue npo/.jedYPbl
1. BblMblTb PYKH, OCYWHTb. 06ecne'leHl1e HH<!>eK oHHoi'i 6e30-
naCHOCnI.
YXOA 3a nonOCTblO pTa
B nOJIOCTH pTa CKanJIHBaeTClI MHoro MHKp060B, KOTopbIe
npH OCJIa6JIeHHH opraHH3Ma MoryT BbI3BaTb 3a60JIeBaHHlI no-
JIOCTH pTa H YXYAIIIHTb 06II:(ee COCTOlIHHe 'IeJIOBeKa.
IIa HeHTbI, Y KOTOpbIX 06II:(HH pe>KHM, CaMOCTOllTeJIbHO
CJIeAlIT 3a nOJIOCTblO pTa. TlI>KeJI060JIbHbIM nOCJIe KamAoro
npHeMa nHII:(H MeAH HHCK8.lI ceCTpa HJIH pOAcTBeHHHKH 06pa-
6aTbIBalOT nOJIOCTb pTa.
Y TJI>KeJI060JIbHbIX 'IaCTO pa3BHBaeTClI CToMaTH'rlJ- BOC-
naneHHe CJIH3HCTOH 060JIO'lKH nOJIOCTIi pTa. IIOllBJIJIIOTClI 60JIb
npH npHeMe nHIT(H, CJIIOHOTe'leHHe, nOBbIlliaeTClI TeMnepaTY-
f pa. IIpH'lHHOH TaKoro COCTOllHHlI lIBJIlIeTClI nJIOXOH YXOA 3a
nOJIOCTblO pTa. MHorAa y' na HeHToB nOllBJIJIIOTClI CYXOCTb
ry6, 60JIe3HeHHbIe TpeII:(HHbI B yrJIax pTa. AJIlI 06JIeI'"'leHHJI
COCTOllHHlI Ha ry6bI HaKJIa)l;bIBaIOT MapJIeBYIO canllJeTKY, CMO-
'IeHHYIO BOAOH, a nOTOM CMa3bIBalOT ry6bI KpeMOM. IIa HeH-
TaM He peKoMeHAyeTClI IIIHpoKO OTKpbIBaTb pOT, AOTparH-
BaTbClI AO TpeII:(HH H cpbIBaTb 06pa30BaBlIIHeClI KOpO'lKH,
nOJIb30BaTbClI 3y6HOH II:(eTKOH. IIoJIocKaTb pOT CJIeAyeT nOCJIe
Ka>K)I;oro npHeMa nHII:(H.
IIa HeHTaM, HMelOII:(HM 3y6m:.Ie npoTe3bI, He06xoAHMO HX
CHHMaTb Ha HO'lb, TII:(aTeJIbHO npoMbIBaTb C MbIJIOM H AO YTpa
xpaHHTb B 'IHCTOM HH.D:HBHAYaJIbHOM CTaKaHe, a YTPOM npo-
MbITb no.D: npOTO'lHOH BO.D:OH H Hap;eTb.
319
e,l/.b: npe.n;ynpem.n;eHMe pa3BMTMlI CTOMaTMTa.
II OKa3anUJl: TlImeJI06oJIbHbIM, OCJIa6JIeHHbIM, JIMXOpa.n;lI-
II:(MM n MeHTaM.
OCnautenue (CTePMJIbHO): JIOTOK, 2 nMHQeTa, can!peTKM, 2
nmaTeJIlI, rpynieBMJJ;HbIM 6aJIJIOH MJIM nmpMQ :ffi:aHe, Ba3e-
JIMH, !pJIaKOH C 2% -HbIM paCTBOpOM rH.n;poKap60HaTa HaTpMlI,
1 % -HbIM pacTBop 6pMJIJIMaHTOBoM 3eJIeHM, MeH3ypKa; nOJIO-
TeHQe, CTaKaH C BO.n;OM, JIOTOK, eMKOCTb C .n;e3MH!pMQMPYIO-
II:(MM paCTBopoM.
06Jl3ameJ1bnoe YCJ/.o6ue: TIOJIOCKaTb pOT nOCJIe Kam.n;oro
npMeMa nMII(M H peryJIlIpHO, He peme 2 pa3 B .n;eHb, 'IHCTMTb
3y6bI. TJImeJI060JIbHbIM CJIe.n;yeT 2 pa3a B .n;eHb npOTHpaTb
CJIM3MCTYIO 06oJIo'lKY nOJIOCTM pTa H 3y6bI aHTMCenTH'IeCKHM
paCTBOpOM.
3ranbl I 060CH08aHH>1
nOOzomOBKa K npo/.jeoype
1. YCTaH08H1b A06po)KellaTellbHbl8 06eCnB'leHHe OC03HaHHDrO yYacTH>1
OTHOWeHH>1 C na eHToM, 06"b5lC- 8 npo eAype, 06eCne'leHHe npa8a
HI1Tb na HeHTy efJb 101 XOA npo e- Ha HH<!>OPMa IO.
Aypbl, nonyYl1Tb cornacl1e.
2. Halll1Tb 8 MeH3YPKY aHTHCenTl1- 06eCne'leHHe I1Hcf>eK OHHO;; 6e30-
'ieCKI1;; paCTBOp. naCHOCTH.
3. noMO'Ib na l1eHTy n08epHyn, 06ecne'lH8aeTCR '1I1CTOTa HaTellb-
rol108Y Ha 6oK, welO 101 rPYAb Ha- Hero 6enbR.
KPbJTb KIleeHKO;;, nOA nOA60pOAOK
nOACTa8HTb nOTOK.
4. BbiMbITb PYKI1, H8AeTb nep4aTKI1. 06eCne'leHl1e HHcf>eK 110HHO;; 6e30-
naCHOCTH.
5. nonpoCI1Tb na eHra COMKHyrb 06ecne'l118aeTCR YA06cTBO npH
3y6bl (CH>1Tb 3y6Hbie npOTe3bl, eCIlH np08eAeHI111 npo eAypbI.
OHH eCTb).
BblnoflHeHUB npo/.jeoYfJbl
1. OToA8HHyrb wnaTeneM lJ.jeKY npeAynpe>K,QaeTCR non8AaHHe HH-
na HeHTa 101 nHH eTOM C Mapne8b1M cf>eK I1H B ClllOHHble )Kelle3bl.
Wapl1KOM, CMO'IeHHblM 8 aHTHcen-
TI1'ieCKOM paCT80pe, 06pa60TaTb
Ka>K,QbI;; 3y6 OT AeCHbl, Ha'lHHaSi OT
KOpeHHblX 3y608 K pe3 aM C HapYJK-
HOO CTOpOHbl, Clle8a.
2. C6pOCHTb wapHK 8 nOTOK, npHro- 06eCne'leHHe HHcf>eK OHHO;; 6e30-
T08111b H08b1;; 101 np08eCTH 06pa60T- naCHOCTH.
KY 8 TOil! >Ke nOCIleA08aTellbHOCTH
cnpa8a.
320
f
3Tanbl 060CHOBaHH>1
BblnOflHeHUB npo/.jeoYfJbl
3. nonpoCl1Tb na eHTa OTKpblTb 06eCne'ieHHe nH'IHOII! rnrHeHbl no-
pDT 11 CMeHl1Tb MapneBbl1l! wapHK, nOCTI1 pTa.
CMO'lHTb B aHTI1CenTl1'ieCKOM pac-
Toope. 06pa6oTaTb Ka>K,Qblll! 3y6 OT
AeCHbl, Ha'lHHa>1 OT KOpeHHblX K
pe3 aM, C BHyrpeHHell! CTopOHbl.
4. CMeHI1Tb MapneBbllI! wapHK, CMO- 06eCne'leHHe HH4>eK 110HHOII! 6e30-
'1HTb B aHTHCenTH'IeCKOM pacT80pe. naCHOCTH, 06eCne'ieHl1e nH'JHOII!
06pa60TaTb >13b1K TR>Keno60nbHoro. rnrl1eHbl nonOCTH pTa.
5. C6POCHTb nHH eT 8 l1OTOK. 06ecne'leHl1e HHcf>eK HOHHOO 6e30-
naCHOCTH.
6. nOMO'Ib na HeHTY npononocKaTb 06ecne'lH8aeT MeXaHI1'1eCKOe 8bl-
pOT I1nH np08eCTH opoweHHe C no- Mbl8aHHe '1aCTI1 nl1l1\11, rHO>1.
MOlJ.jblO rpyweBl1AHOrO 6anl1OH'IHKa.
OTT>1Hyrb wnaTeneM yron pTa 101
nOO'lepeAHO npOMblTb neBoe, a 38-
TeM npa80e 3alJ.je'lHOe npOCTpaHCT-
80 CTpyell! paCT80pa nOA YMepeH-
HbJM ACl8neHl1eM.
OKOH'IaHUe npou,eoYPbl
1. BbITepeTb KO)Ky BOKPyr pTa cYXOII! 06nel"-laeT COCTO>1Hl1e npl1 npHeMe
can4>eTl<oll!, CMa3aTb ry6bl8a3enH- nl1IJ.jH.
HOM, TpelJ.jHHbl o6pa60TaTb 1%-HbiM
paCTBOpOM 6pl1nnl1aHT08011! 3eneHH.
2. nOMeCTHTb HHcTpYMeHTbI 101 Map- 06ecne'leHHe HH4>eK OhHOII! 6e30-
neBble WapHKI1 nocne o6pa60TK'" 8 naCHOCTH.
eMKOCTb C Ae3"'H4>H PYIOIJ.jI1M
pacT80poM.
3. CH>1Tb nep'laTK'" 101 nOnOJKI1Tb B 06ecnB'leHHe HHcf>eK OHHOO 6e30-
eMKOCTb C Ae3HH4>H "'PYlOIJ.jHM naCHOCTH.
paCTBOpoM.
4. BblMblTb '" OCYWHTb PYKI1. Co6nlOAeHl1e n"''1HOII! rnrl1eHbl.
YXOA 3a rnuaMM
,
IIoKa3anUJl: TlIJKeJIOe COCTOlIHMe n HeHTa.
Ocnautenue (CTepMJIbHO): JIOTOK, nMHQeT, MapJIeBbIe Illa-
PHKH, yH.n;HHKH (68.H0'lKH onpe.n;eJIeHHOM !pOpMbI .n;JIlI npoMbI-
BaHlIlI rJIa3, paCTBOp !pypaQMJIHHa 1:2000, Ba3eJIHHOBOe Mac-
JIO, MeHaypKM, !pH3MOJIOrH'IeCKMH paCTDOp. nMneTKM, nep'laT-
KM; eMKOCTM C .n;e3MH!pMQMPYIOII:(MMH paCTBopaMM.
11.381(.291
3Z1
3Tanbl I 060CHoBaHIo1S1
nOOZOmOSKa K npoqeoype
1. YCTaHOelo1Tb Aoeeplo1TellbHblB 06ecne'leHHe OC03HaHHoro Y'lacTIo1S1
OTHoweHHSI C na eHTOM (10111101 ero e coeMBcTHoi1 pa60Te.
pOAcTeBHHHKaMH).
2. 06b5lCHIo1Tb naLllo1eHTY Llellb npo- C061llOAeHHB npaea naLlHBHTa Ha
LlBAypbl, nOIlY'lIo1Tb Bro ComaCi'Se HHc!>opMaLlIo1IO.
(WlH era pOAcTeeHHHKoe), 06bSlC-
HHTb nocllBAoeaTellbHOCTb ABi1CT-
eHi1.
3. OcMOTpeTb ma3a, OLleHHTb co-
CT05IHHB.
4. BblMblTb PYKH, H3AeTb ne'laTKM. Co61llOAeHHe HHcf>eKLli'SOHHOO 0030-
naCHOCTi'S.
5. npHraToeHTb OCHalJ.jeHHe. 06ecne'leHi'SB '1eTKOCTi'S
B pa60Te.
6. HallHTb e OAHY MeH3YPKY CTe- Co61llOAeHHe aCenTI1Ki'S.
pMllbH08 ea3ellHHoeoe MaCllO, e"
APyrylO pacTBop <!>ypaLlMnHHa.
7. CMOYHTb wapHK C nOMOlJ.jblO nHH-
LleTa B Ba3enHHOBOM MaClle, cllen<a
Onkae era 0 CTeHKi'S MeH3YPKH.
BblnonHeHue npoqeoYPbl
1. B3RTb wapMK B npaeylO PYKY 101 06BCne'lHBaBTCR pa3MSll"-leHIo1e 101
npOTepBTb OAHO eBKO no HanpaBnB- oTclloi1KarHoi1H XKOpo'l
HHIO OT Hapy>KHorO yrna rnaJa K
eHyrpeHHeMY.
2. npoTepeTb eeKO CYXi'SM wapHKOM 06eCne'lHeaBTCR YAalleHHB OTCIlD-
e TOM >Ke HanpaBlleHMIo1. Hewl1XCR KOpO'leK.
3. CMO'IIo1Tb wapHK B paCTeope <!>y- 06ecneYIo1BaBTC5I 06pa60TKa ma3
paLlHnHHa TaKi'SM >Ke 06pa30M 101 aHTI1cenTHYeCKHMM cpeACTBaMM.
noeTopHTb npoTMpaHHe e TOM JKe
HanpaeneHHH.
4. nOBTOpHTb npoTHpaHMe Co61llOAaeTCSI Io1Hc!>eKUMOHHcm 6e30-
4-5 pa3 pa3HblMH Wapi'SKaMM. naCHOCTb.
5. npi'S HanH'IHe rHoeBHAH x eblAe- 06ecne4MeaeTcR o6pa60TKa KOHb-
Il8HHi1 B yrnax rna3: IOHKTi'SeaIlbHoi1 nonocrn.
a) npOMblTb KOHbIOHKTi'SBaIlbHylO
nOIlOCTb <!>H3i'Sonori'S'leCKMM paCTBD-
pOM, pa3ABMra51 BeKi'S YKaJaTellbHblM
101 60nbWHM naIlbLiaMi-I neeoi1 PYKi'S,
a npaeoi1 PYKOi1 npoeecrn opowe-
HHe KOHblOHKTHeanbHoro MeWKa C
nOMOlJ.jblO nMneTKi'S HnM
YHAMHKM:
3Tanbl I 06oCHOBaHMSI
BblnonHeHue npoqeoYPbl
6) npoTepeTb BeKO CyxHM wapi'S-
KOM B TOM >Ke HanpaBIl8HHIo1;
e) 06pa60TaTb'BTOpoi1 rna3 Ta-
KHM >Ke cnoco60M.
3asepweHue npOqeOypbl
1. nOMecTHTb oTpa6oTaHHbie wapi'S. 06eCne'leHlo1e HH<!>eKLlHoHHoi1 6e30-
KM, nHHLleT, MeH3ypKM, YHP'HHKY 1011111 naCHOCTIo1.
nHneTKM e eMKOCTb C Ae3i'SHc!>HLli'S.
PYIOIJ.jI1M paCTBopOM.
2. CH5ITb nep'laTKM nOMeCTHTb B
OMKOCTb C Ae3i'SHc!>i'SLli'SPYIOIJ.jI1M
11111' roOpoM.
3. BI.tMblTh PYKi'S, OCYWi'STb.
YXOA 3a HOCOM
Y T.!I)!{eJI060JIbHOrO Ha CJIH3HCTOM 060JIO'lKe Hoca CKanJIH-
BaeTClI 60JIblIIOe KOJIH'IeCTBO CJIH3H H nbIJIH, '1TO 3aTpy,n;HlIeT
,n;blxaHHe H OTlIrOlI:(aeT COCTOllHHe naIJ;HeHTa. OCJIa6JIeHHbie
JIaIJ;HeHTbI He MoryT oCB060m,n;aTb HOCOBble XO,n;bl caMOCTOll-
TeJIbHO, Me,n;HIJ;HHCKall cecTPa ,n;oJIJKHa eJKe,n;HeBHo y,n;aJUlTb 06-
p!130B!1BllUleClI KOpO'lKH.
[{l'Jlb; npe,n;ynpem,n;eHHe HapYlIIeHHlI HOCOBoro ,n;blxaHHlI.
lllJ/C(l.JallllJl: TlImeJIoe COCTOJIHHe naIJ;HeHTa, HaJIH'IHe Bbl-
,lJ;1>n(,lIt11.1 H3 nOJIOCTH Hoca.
OCltauteltlle (crepHJIbHo): JIOTOK, MeH3YPKa, nHHIJ;eT, Ba3e-
JII HOBOe MaCJIO, BaTHble TYPYH,n;bl, nep'laTKH; JIOTOK, eMKOC-
TH C ,n;e3HH(lmIJ;HpyrolI:(HM pacTBopoM.
06Jl,1omeJ/.bliOe YCJ/.o6ue: HeJIb3H HCrrOJIb30BaTb OCTpbIe rrpe,n;-
M 'rlo! yxo,n;a.
3ranbl 060CHOBaHHSI
nOO20mOOKa K npOl.jeiJype
1. YCT"UtOeMTb AoeepMTellbH e 06ecne'leHHe OC03HaHHoro Y'lacn1S1
OTII' UlOIIM5I C naLli'SeHTOM (HnH ero B coeMeCTHoi1 pa60Te.
""II' 'III IIHi'SK'IMM).
2. (JIj\.llCl'MTb Llonb npoLiBAypbl, Co6nlOAeHMe npaea naLli'SeHTa Ha
nOIlY'IMTb era (MX) cornaCi'Se, 06bRC- MH<I>opMaUMlO, OC03HaHHoro Y'la-
IIi'S 'b nOClleAOBaTellbHOCTb Aei1cT- CTIo151 e coeMeCTHoi1 pa60Te.
DHi!.
JZ2
11"
323
3Tanbl I 060CHOSaHHSI
noaZOmOeKa K npou,eaype
3. BblMblTb III OCYWHTb PYKH, C06mo.qeHllle 11H4H0l1 rHrllleHbJ
Ha):\eTb nep4aTKH. MC):\lIIljIllHCKOI1 CeCTpbJ.
4. Ha11IIITb B MeH3YPKY cTepH11b- A11 pa3M r4eHH Kop04eK B
Hoe Ba3emiHoBoe MaC11O. HOCOBblX xo.qax.
5. B3 Tb TYPYH):\y nlllHljeTOM, C06mo):\aeTc HHcpeKljIllOHHa
CM04I11Tb B Ba3e11IIIHOBOM Mac11e, 6e30nacHocTb.
C11erKa OTJKaTb.
BblnonHeHue npOU,eaypbl
1. nepe110>KHTb TYPYH):\Y B npa- 06ecne4HBaeTcSI pa3M r4eHllle
BylO PYKY 101 BBeCTIil BpaLl.\aTe11b- Kop04eK B HOCOBblX xo.qax.
HbJMIi1 .qBH>KeHH MIII B HOCOBOH
xo.q Ha 1-3 MIIIHyrbl, npHno.qHIII-
Ma KOH4111K Hoca naljHeHTa 11e-
BOH PyKOI1.
2. J.13B11e4b ryPYHAY BpaLl.\a- 06ecne4HBaeTCSI y.qa11eHHe
Te11bHblMH .qBIIIJKeHIo1 MH 1113 Ho- Kop04eK 1113 HOCOBblX Xo.qOB.
COBOro xo.qa.
3. 06pa60TaTb .qpyroH HOCOBOH
xo.q TaKIilM >Ke cnoco60M.
3aeepweHue npOU,eaypbl
1. nOMecTHTb oTpa6OTaHHbie 06ecne4eHHe HHcpeKljlllOHHOI1
ryPYHAbI, nlllHljeT, MeH3YPKY B 6e30naCHocTH.
eMKOCTb c .qe3I11HcpHljIllPyIOLI.\HM
pacTBopoM.
2. CHSlTb nep4aTKIiI, npo.qe3I11H-
cpli1ljlllpOBaTb.
3. BblMblTb PYKIiI, OCYWIIITb. Co611lO.qeHllle 11H4H0l1 rHrllleHbl.
IfeJlb: npe.D;ynpem.D;eHMe CHMJKeHMJI CJIyxa M3-3a CI<onJIeHMJI
1''"''101.
IlolCa3anuR: TJImeJIoe COc'rOJIHMe naIJ;MeHTa, Haxo.D;JIIIJ;ero-
r}l lIa nOCTeJIhHOM peJKMMe. _
[JpomU60nOlCa3anUR: BOCnaJIMTeJIhHhle npOIJ;eCChI B ymHoH
plIIWlIIl1Ie, IIUPYJKHOM c.nyxOBOM npoxo,ne.
()CIIClIl,elllle: CTepHJIhHhle: JIOTOK, nHIIIJ;eT, MeH3YPKa, BaT-
111,11' 'ryJ>YII,nbI, nep'IaTKM; 3% paCTBOp nepeKHCH Bo,nopo,na,
nO'l'OI<, CMI<OCTM C ,ne3I1H!PMIJ;HPYIOIIJ;MMM pacTBopaMH.
YXOA .3a ywaMM
B HapYJKHOM CJIYXOBOM npoxo,lle BhI,lJ;eJIJIeTCJI JKeJITOBaTO-
KOpH'IHeBaJI Macca - cepa, CKOnJIeHMJI KOTOPOR MoryT 06pa-
30BaTh cepHhle np06KH H nOCJIYJKMTh npH'IHHOR CHHJKeHMJI
CJIyxa. YXo,n 38 3,nOpOBhIMH ymaMH BhlpamaeTCJI B perYJIJIp-
HOM MhIThe HX TenJIOR BO,nOR C MhIJIOM. HH B KoeM CJIyq:ae He
CJIe.nyeT 'IHCTHTh HaPYJKHbIR CJIYXOBOR npoxo,n OCTphIMH npe,n-
MeTaMH. TaK MomHO nOBpe,nHTh 6apa6aHHYIO nepenOHKY HJIH
C'I'eHKY CJIyXOBoro npoxo,na. ECJIM 06pa30BaJIaCh CepHaR np06Ka,
ee y,naJIJIeT Me,nHIJ;HHCKaJI cecTpa noon Ha6JIIO,neHMeM Bpa'Ia.
324
3Tanbl I 060CHOBaHHSI
noiJzomo8K8 K npol.jeiJype
1. Y<. 1,11100101 rb A08epHTenbHbie 06ecne48HHe OC03HaHHoro Y'lacTH5I
11I1I()IIIOIlIo1 C n"' lo1eHToM (10111101 ero 8 C08MecTHol;1 pa60Te.
, olllll11l1l1l1l<OMI1).
2. QG""ClIl1lb unb npo eAypbl, Co6moAeHHe npa8a na l1eHTa Ha
nOllY'II1Tb oro (l1x) cornaCHe, 06b C- I1H<J>opMa l1lO, oco3HaHHoro Y'la-
11101'10 III CI101100dTenbHOCTb AeI;1CT- CTI151 8 C08MecTHol;1 pa60Te.
111111.
3. Bb'MblTb pyKl1, 0CYWI1Tb. AOCTl1raeTC rnrneHH4eCKI11;1 ypo-
8eHb MblTb51 pyK.
4. Hanl1Tb 8 CTepHnbHYIG , eH3ypKY
3%'Hbll;1 paCT80p nepeKI1C11 BOAOPO-
Aa.
5. npl1roTo8HTb eMKOCTb
C MlomhllllM paCTlJopoM.
o OllMLl1b PYKH, OCYWHTb, Ha.qeTb C06n1OAaeTC5I HHcf>eK 110HHa51
n P'IIIH(Io1. 6e30nacHocTb.
BblnonHeHue npOI.!eiJYPbl
1. CMO'll1Tb callcf>eruy B MblnbHOM 06eCne'lH8aeTCSI rnrneHa YWHOI;1
paCToope 101 npoTepeTb YWHYIO pa- paKo8HHbl.
K08HHY, 8blCYWHTb cyxol;1 cancf>eT-
KOI;1.
2. B3 Tb nI1H eTOM 8aTHYIO TYPYHAY 06ecne'l118aeTC pa3M5If'-IeHHe
11 CMCI'II1 rb 8 3%-HbIM paCTBOpe cepbl 8 cnYX080M npoxoAe.
", I" K t( 101 DOAopoAa.
.1, Ilnpono)t(HTb TYPYHAY B npa8YIO
PYKY.
4. OTTJ1l1yrb 11e801;1 PYKOI;1 YWHyK> 06eCne'l118aeTC5I AOCTyn 8 Hapy>K-
pllKonl1l1Y T IK, '1T06bl 8blpo8H5ITb Hbll;1 cnYX0801;1 npOXOA.
XOIIOI1 n,>oXOA.
b. [Junc,,, TypyH.lIY 8palliaTenbHblMI1 Ycn08He npo eAypbl.
AIIHJKeIlH MH 8 Hapy>KHbll;1 cnYX0801;1
npoxoA Ha rny611HY He 60nee 1 CM
'10 2-3 MHHyrbl.
325
.
3ranbl 060CHOBaHHR
BblnonHcmue npo/.jedypbl
6. 1I13Bne'ib. TYPyHAY BpalllaTenbHbI- 06eCne'lHBaeTCR YAaneHHe Cepbl 113
MI1 ABH>KeHHRMH 1013 Hapy>KHorO cny- cnYXOBoro npoxoACI.
)(OBoro npoxoAa.
7. 06pa60TaTb APyrol;1 cnyxoBOI;1
npoxoA TaKI1M JKe cnoco60M.
3aeepweHUB npol.jedypbl
1. nOMeCTl1Tb oTpa60TaHHble ry- 06ecne'leHHe HHcf>eKLjHOHHOI;1 6e30-
PyHAbl, nHHLjeT, MeH3YPKY B eMKOCTb naCHOCTI1.
C Ae311HcfJI1Ljl1PYIOIl\I'IM PaC'TBOpOM.
2. CHRTb nep'lBTKI1, npoAe3HH<!>1141"-
pOBaTb.
3. BblMblTb PYKI1, OCYWI1Tb. Co6nlOAeHl1e nH'IHol;1 rnrneHbl.
BIIJIOCbI CJIe eT paC'IeCbIBaTb eme,ll;HeBHO, 'lT06bI Y,lI;aJIHTb
IlIoJJII> H nepXOTb. AJIH STore 6epYT '1aCTbIM rpe6eHb. KOpOT-
IUI(' UOJIOCbI paC'IeCbIBalOT OT KopHeM K KOHQaM. a ,lI;JIHHHbIe
po:lJ\CJImo'r Ha npH,lI;H H Me,ll;JIeHHO paC'leCbIBalOT C KOHQOB K
IC()!>IIHM. CTapaHCb He BbI,lI;eprHBaTb HX. rpe6eHb, CMO'leHHbrn
n I'JI(''!'J\()IJ(' YKcyca, XOpOIIIO BbI'IeCbIBaeT nepXOTb H nbIJIb.
MI,I'I"", l'OJlOllbI, CTpHmKa HOrTeM npOBO,ll;HTCH O,ll;HH pa3 B 7
\""11,
YXOA 3a BonocaMM
TIaQHeIITbI, HaxO,ll;HII(HeCH ,lI;JIHTeJIbHOe BpeMH B nOCTeJIH,
Hym,ll;aIOTCH B nOCTOHHHOM yxo,ll;e 3a BOJIOCaMH. He06xo,ll;HMO
CJIe,ll;HTb, '1T06bI B BOJIOCax He 06pa30BaJIaCb nepXOTb H He
nOllBHJIHCb HaceKOMbIe (BIIIH). Mym'lHH CTpHrYT KOpOTKO H
pa3 B He,ll;eJIIO MOIOT HM rOJIOBY BO BpeMH rHrHeHH'leCKOM BaH-
_ HbI. TeM naQHeHTaM, KOTOpbIM BaHHbI 3anpem;eHbI, MomHO
BbIMbITb rOJIOBy B KpOBaTH, eCJIH COCTOlIHHe HX n03BOJIlIeT.
rOpa3,l1;0 CJIOmHee CJIe,ll;HTb 3a '1HCTOTOM rOJIOBbI y meHII(HH,
HMelOlI HX ,lI;JIHHHbIe BOJIOCbI.
nOAMblBaHMe >KeHLqMHbI B nOCTenM
(IC/lall(CIIIU' (CTcpHnbHO): JIOTOK, KopHQaHr, caJI TKH, nep-
'I"TIUli ICJI('CIIICfi. ncneHKa, MbIJIO, CY,ll;HO, KyBlIIHH C BO,ll;OH
(I"'MIII'I'II I'YI'II J\()J\1oI 37-38"C) HJIH KPYJKKa 3CMapxa.
I. Y""IIIIIIIIIITb J\oupOmeJIaTeJIbHbIe, KOH.pH,lI;eHQHaJIbHbIe
0'1'11111111'111111.
2, BI,IM"''!'', PYICH, OCYIIIHTb.
: . III1J\cTb [lpp'laTKH.
4. 1I0,ll;cTCJIHTb KJIeeHKY H nOCTaBHTb CY,lI;HO no,ll; KpeCTeQ
TJUlccn060JIbHOM Ha KJIeeHKY.
MblTbe ronOBbl nl>Keno6onbHoro B nOCTenM
nOAMblBaHMe 6onbHoM
"26
327
5. TIonpOCMTh corHYTb HorM B KOJIeHJIX M CJIerKa pa3BeCTM
MX B CTOpOHbI.
6. BCTaTb cnpaBa 01' naIJ;MeHTKH.
7. B3JITb pe3MHoByIO Tpy6KY OT KPY:>KKM 8cMapxa MJIM KYB-
IIIHH B JIeBYIO PYKY, a KopHIJ;aHr C MapJIeBOM CaJI!lJeTKoM B
npaBYIO PYKY.
8. 06pa60TaTh Hapy:mHbIe nOJIOBbIe opraHbI M npOMe:m-
HOCTh, HaMbIJIHBaJI HX H nOJIHBaJI paCTBOp, B CJIe,ll;YIOlI:(eM noc-
JIe,ll;OBaTeJIbHOCTM: 06JIaCTb JI06Ka, Hapy:mHbIe nOJIOBbIe opra-
HbI, npOMe:mHOCTh, 06JIaCTb 3a,D;Hero npOxo,ll;a B HanpaBJIeHMH
OT Hapy:mHbIX nOJIOBbIX OpraROB K 3a,ll;HeMY npQxo,ll;Y, MeHJIJI
nOCJIe,ll;OBaTeJIbHO can!lJeTKH.
9. BbITepeTb KO:my Hacyxo B TOM :me nOCJIe,ll;OBaTeJIbHOCTH
Ii HanpaBJIeHHH, MeHJIJI CaJI!lJeTKH.
10. Y6paTb CY,lI;HO, KJIeeHKY, nep'IaTKH ,lI;JIJI nOCJIe,ll;YIOm;eM
,lI;e3HH£}>eKIJ;IDi.
11. PacnpaBHTb nOCTeJIbHoe 6eJIbe, YKpbITb'naIJ;MeHTKY.
12. BbIMbITh, OCYIIIMTb PYKH.
Bna*Hoe o6TMpaHMe
(JcllllLu,enue: KJIeeHKa, neJIeHKa, nO'IKo06pa3HbIM JIOTOK,
I'IIIIJIIIJI BO,ll;a, CTOJIOBbIM YKCyC 6% -HbIM MJIM cnMpT, 60JIblIIaJI
CIIJII\lcTI{a HJIM nOJIOTeHIJ;e, CMeHHoe HaTeJIbHOe H nOCTeJIbHOe
('('.11"1', III'P'I!1'I'I{H.
I, Y 1'1',11111111-1'1'1. ,lI;06po:meJIaTeJIbHbIe KOH!lJM,lI;eHIJ;HaJIhHbIe 01'-
nO"MbIBaHMe MY*'IMHbl
IIoAroToBKa K npou;e.z:s;ype
1. TIO,D;rOTOBKa K npOIJ;e,ll;ype TaKaJI :me, KaK Y :meHlI:(MHhI;
BbInOJIHeHHenpOIJ;e,ll;YPbI
2. B3JITb O,ll;HOH PYKOM nOJIOBOM 'IJIeH, OTTJIHYTh KpaMHlO1O
nJIOTb;
3. BbIMbITb rOJIOBKY nOJIOBOrO 'IJIeHa KpyrOBbIMM ,lI;BH:me-
HHJIMH B HanpaBJIeHHH 01' MO'IeMcnYCKaTeJIbHOrO KaRana K
06JIaCTM JI06Ka, OCYIIIHTb;
MeHJITb can!lJeTKM TaK :me, KaK npM BbInOJIHeHHH npoIJ;e-
,lI;YpbI Y :meHlI:(HHbI.
(Y,lI;06Hee nOJIb30BaTbCJI BaTHbIMH TaMnOHaMH BMeCTO can-
!lJeTOK).
4. BepHYTb KpaMHlO1O nJIOTb B eCTeCTBeHHoe nOJIo:meHHe;
5. Tm;aTeJIbHO 06pa60TaTb, OnOJIOCHYTb H BbICYIIIHTI> oc-
TanbHYIO 'IaCTb nOJIOBoro 'IJIeHa, KO:my MOIIIOHI{M, aHaJIbHOrO
OTBepCTHJI;
OKOHlJaHlie npOIJ;e.z:s;ypbI
6. OKOH'IaHHe npOIJ;e,ll;yphl TaKoe :me, KaK y :meHm;HHbI.
11111111'111111. ,
2. Ih.IM".'l'b PYKH, OCYIIIMTb, Ha,ll;eTb nep'IaTKH.
:1. I h) CTeJIMTb no,ll; naIJ;HeHTa KJIeeHKY C neJIeHKoM.
4. IIUJIH'l'b B JIOTOK TenJIOM BO,ll;bI (MO:mHO ,D;06aBMTb CTOJIO-
UYI\) JIO)l{l{Y CTOJIOBOrO YKcyca Ha 1 JI BO,ll;bI HJIH cnMpTa).
r,. ()(iIllUl{HTb BepxHlO1O 'IaCTb TeJIa naIJ;MeH'l'a.
h. ('MO'III'l'b CaJI!lJeTKY liJIH 'IaC'l'b nOJIOTeHIJ;a, CJIerKa 01'-
)1(1111.
7. II JlII'I'''PI''l'b naIJ;HeHTa B CJIe,ll;YlOlI:(eH nOCJIe,ll;OBaTeJIbHOC-
'I'll: JIIII II. 1111'10, PYKH, cnHHY, rpY,lI;b.
M. Jh.JI'CPC'l'b CYXHM KOHIJ;OM nOJIOTeHIJ;a TeJIO naIJ;MeHTa B
Tofi )I{C 1I0CJIe,ll;OBaTeJIbHOCTH H npMKpbITb npOCThIHeM.
H. O(hCpCTb TaKMM :me 06pa30M :mMBOT, 6e,ll;pa, HorH.
10. TIO,ll;CTpH'Ib HorTH Ha PYKax (npM He06xo,ll;HMOCTH).
Bna>KHOe o6TMpaHMe
328
. .
.L1. CMeHMTb HaTeJIbHoe M nOCTeJIbHOe 6eJIbe (npM He06xo-
,lI;MMOCTM).
12. CmlTb nep'IaTKM.
13. BbIMbITb M OCYIIIMTb PYKM.
6.4. Memogbl npocmeiiweii t/Ju3uomepanuu
<I>M3MoTepaneBTM'IeCKMe npo e,ll;ypbI OTHOClITClI K MepaM
B03,l1;eHCTBMJI Ha KpoBo06pa eHMe. H3BeCTIIO, '1TO KO:llia cHa6-
)l{eHa 60JIblIIMM KOJIM'IeCTBOM HepBHbIx OKOH'IaIlMH, nosTOMY
MomHO B03,l1;eHCTBOBaTb lIa KpOBo06pa eHMe no npMH Mny
pe!PJIeKTOpllbIX peaK MH C KomM Ha BHYTpeHHMe opraHbI. TIPM
pa3,l1;pameHMM HepBHbIx pe enTopOB TenJIOM - KpoBeHOCHbIe
COCY,lI;bI paCIIIMplllOTClI, a npM KpaTKOBpeMeHHoM B03,l1;eHCTBMM
XOJIO,ll;OM - KpoBeHocllbIe COCY,lI;bI cymMBaIOTClI.
TenJIOBbIe npo e,ll;ypbI ,lI;eHCTBYIOT npoTMBoCna3TM'IeCKM M
t50JlrYTOJIlIIO e. BJIMJIHMe TenJIa lIa MbIIII bI npM ,lI;JIMTeJIbHOM
1III,I/wiu"l'JlIUl npOllBJIlIeTClI paCCJIa6JIeHMeM MX TOHyca M no-
11I,IIIII'IIIIt'M YCTaJIOCTM. PeaK MJI Ha B03,l1;eHCTBMe TenJIa He pac-
IIJl0f,;l'JI.JIIJICTCJI lIa BeCb opraHM3M, a B03,l1;eHCTByeT TOJIbKO Ha
\1111\111'>1(1\11\11(' TKaHM.
\ "'HlU\IUI opraHM3Ma Ha XOJIo,ll; COCTOMT M3 Tpex !Pa3:
. B ncpnyIO !Pa3Y npoMcXO,ll;MT cymeHMe COCY,lI;OB, Koma
6JIe,ll;Hee'l', CTaHOBMTClI XOJIO,ll;HOH Ha o ynb, KpOBb ne-
peMell\UeTCJI K BHYTpeHHMM opraHaM, YMeHblIIaeTCJI 60JIb;
. oTOpall .pa3a HacTYnaeT '1epe3 1 MMHYTY MJIM MeHblIIe,
Kor,ll;a npOMCXO,ll;MT paCIIIMpeHMe COCY,lI;OB, Koma npM06-
peTaCT p030BO-KpaCHYIO OKpaCKY M CTaHOBMTClI TenJIOH
uu Oll\Yllb;
. ('(' JIM CfiC'1'BMe xOJIo,ll;a npO,ll;OJImaTb, HUCTYnaeT TpeTbll
11111,,", IWr,ll;a Koma CTUIIOBMTClI 6arpOBO-KpaCHOH, CM-
11111 III 1I0ii , XOJIO,ll;HOH M nOHMmaeTCJI B036Y,lI;MMOCTb lIe-
\lBOO, nOllBJIlIeTClI «rYCMHall!) Koma.
PI'UI<QMlI HU XOJIO,ll;OBbIe npo e,ll;ypbI pacnpOCTpalllleTClI Ha
11('10 nonrpXIIOCTb TeJIa.
M"'I'II/I!.' IIpOCTeHilieH !PM3MOTepanMM pe!PJIeKTOpHO BJIMJI-
111'1' 1111 III'I'!. Olll'UUM3M, B TOM '1MCJIe Ha BHYTpeHHMe opraHbI.
Iln , I'IIM OCIIOIJUHO npMMeHeHMe rOp'lM bI, 6aHOK, llMlIBOK,
XIIJII)I\I1, TCllJIU, CBeTO- M BO,ll;OJIe'leHMlI.
MblTbe Hor B nOCTenM TR>Keno6onbHOMY
Ocnaw,enue: KJleeHKa, TU3 C TenJIOH BO,ll;OH, MH,lI;MBM,lI;YaJIb-
HhIe MbIJIO, ry6KU, nOJIOTeH e, HomHMQbI, nep'laTKM.
1. "Y CTaHOBMTb ,lI;06pOmeJIaTeJIbIlbIe KOH!PM,lI;eHQMaJIbHbIe
OTHOlIIeHMlI C naQMeHTOM.
2. BbIMbITb PYKM, OCy:IIIMTb.
3. Ha,n;eTb nep'laTKM.
4. 3uKaTaTb BaJIMKOM MUTpaQ no,ll; KOJIeHM na MeHTa.
5. TIO,ll;CTeJIMTb KJIeeHKY, nOCTaBHTb Ta3 C TenJIOH BO,ll;oii
Ha ceTKY.
6. BbIMblTb B Ta3Y Horn na MeHTY C nOMOll\blO MH,lI;MBM,D;y-
aJIbHOii ry6KM M MbIJIa.
7. BbITepeTb HorM MH,lI;MBM,lI;YUJIbHbIM nOJIOTeHQeM ,lI;JIlI Hor.
8. TIO,ll;CTPM'Ib HorTM.
9. CMeHMTb HUTeJIbHoe M nOCTeJIbHoe 6eJIbe (1 pa3 B 7-10
,lI;Heii M npM He06xo,ll;MMOCTM).
10. TIpO,ll;e3MH!PMQMpOBaTb HomHMQbI.
11. "Y6paTb Bce npe,ll;MeTbI ,lI;JIlI MbITbll Hor.
12. CHlITb nep'laTKM, BbIMbITb M OCYIIIMTb PYKM.
MblTbe HOrnl>Keno6onbHoro B nOCTenM
nOCTaHOBKa 6aHoK
1(('Jlb: yJIy'llIIeHMe paCCUCbIBaHMlI BOCnaJIMTeJIbHbIX npo ec-
C'IIU IJ IIUAJIema MX opraHax M TKaHlIX, YMeHblIIeHMe 60JIM.
330
33'
II01W3aHUR: 3aCTOMHbIe .fIBJIeHM.fI B JIerKMX, BOCnaJIMTeJIb-
HbIe 3a60JIeBaHM.fI MbIIIIIJ; M HepBHbIX CTBOJIOB, nOBbIIIIeHMe
A,D;, MM03MTbI, HeBpaJIrMM.
IIpOmU60n01W3aHUR: KPOBOTO'IMBOCTb, nCMXM'IeCKOe B03-
6y:>K,lI;eHMe, OnYXOJIM, 3a60JIeBaHM.fI KO>KM, Ty6epKYJIe3, nOBbI-
meHHa.fI '1YBCTBMTeJIbHOCTb KO>KM, rMnepTepMM.fI.
OCHaU{eHUe:O
- 6aHKM 10-20 IIITyK;
- MeTaJIJIM'IeCKMM CTepJKeHb 12-15 CM MJIM KopHIJ;aHr;
- BaTa, '1T06bI HaMOTaTb Ha CTep>KeHb;
- cnMpT 96° 20 MJI;
- Ba3eJIMH;
- CnM'IKM;
- eMKOCTb C ,lI;e3MH!PMIJ;MPYI01IJ;MM paCTBOpOM (3% -HbIM pa-
CTBOp XJIOpaMMHa);
- MapJIeBbIe CaJI!PeTKM;
- nOJIOTeHIJ;e;
- neJIeHKa;
- CTaKaH C BO,ll;OM ,lI;JI.fI TyIIIeHM.fI !pMTMJI.fI.
06R3ameJlbHble YCJW611R: BO BpeM.fI nOCTaHOBKM 6aHoK He-
,lI;onYCTMMbI CKB03H.fII{M. Co6JIIO,lI;aeTC.fI TeXHMKa 6e30nacHocTM
npM pa60Te C orneM.
Mecma nocmaH06KU: 6aHKM CTaB.fIT Ha rpY,lI;HylO KJIeTKY,
Cnepe,ll;M M C3a)J;M Ha yqacTKM TeJIa 6e3 KOCTHbIX 06pa30BaHMM.
HeJIb3.fI CTaBMTb 6aHKM Ha JIOnaTKM, MOJIO'lHbIe >KeJIe3bI, no-
3BOHO'lHMK, 06JIacTb nO'leK, 06JIaCTb cep,ll;IJ;a, pO,ll;MMbIe n.fIT-
Ha.
3Tanbl I 060CHOBaHHB
noiJzomOOK8 K npol.{eiJype
1. YCTaHOel-1Tb AOBepHTenbHble 06eCne'leHHe nYTI-1 npeOAoneHI-1S1
OTHoweHI-1S1 C na HeHTOM. npenSlTCTeHI;1 e 061ljeHI-11-1, OC03HaH-
Horo Y'laCTH5I e npo eAype.
2. 06b5lCHHTb enb 101 XOA npo eAY- 06eCne'leHHe npaea na eHTa Ha
pbl, YTO'lHHTb HX nQHHMaHHe. HH4><>pMa HIO.
3. nonY'lHTb cornacl-1e Ha npo eAY-
PY.
4. npOeepl-1Tb enOCTHOCTb 6aHOK npeAynpe>K,QeHHe nOep6>KAeHHSI
KO>K1-1 na l-1eHTa.
5. noAroTOBHTb l'Ie06XOAHMOe DC- 06eCne'leHl-1e 'IeTKOCTI-1 101 3cfxfJeK-
HalljeHHe. Tl-1eHOCTI-1 BbInOnHeHI-1S1 npo eAypbl.
332
310mbl I 060CHOB3HHB
npoeeoeHue npo/.jeiJypbl
3. nOA)/{e'lb cfwITHnb
4. B3S1Tb 6aHKY B neeyte pYJ<Y. a C03AaeTCSI OTpl-1/.jaTenbHoe Aaene-
npaBol;1 Ha KopoTKoe epeM5I (0,5-1 HHe eHYTpH 6aHKI-1, nOToMY 'lT0 ero-
C8K) eeeCTH e 6aHKY roPSlIljHI;1 cf>H- paeT KHcnopOA. 6aHKa nerKO np..ca-
Tl-1nb, nocne '1era npHCTaeHTb ee K CbleaeTCSI K nOBepXHOCT" Tena.
Teny (nocTaeHTb Heo6xOAHMoe
Kon"'IeCTeO 6aHoK).
5. noraC..Tb cf>HT..nb B eMKOCTH C 06eCne'leHHe TeXH"K" 6e30nacHo-
BOAOI;1. CTI-1.
6. HaKpblTb na HeHTa nonoTeH eM, 06eCne'leHHe coxpaHeHH5I Tenna.
,.' TOM OJle5lnOM.
. CIIIITb 6aHKH '1epe3 06eCne'leHHe pecf>neKTOpHOrO
1 -20 M"HYT. en..SlHHSI Ha KpoeOCHa6)/{eHHe nOA-
ne)/{allj"x TKaHel;1 101 opraHOB.
8. BblMblTb pYf<". OCYWHTb. Co6nlOAeHHe nH'IHol;1rnrneHbI Me-
A.. ..HCKOI;1 ceCTpbl.
OKOH4aHUB npotjeOypbl
1 CH5ITb 6aHKY, OTKIlOHHe ee OAHOI;1 Bo3AYX nocTynaeT BHYTpb 6aHK",
PYKol;1 cnerKa e CTOPOHY. nanb aMH ypaeHoeeWHea51 AC\BneH..e eHYTpH
lIpyroi1 PYKI-1 H8AaBHTb Ha KOJKy C 6aHKI-1 1-1 cHap)IJKI-1, 6naroAapSi '1eMY
"I o,..eonono)/{Hoi1 CTopOHbI y KPaSi 6aHKa nerKO CHHMaeTCSI.
h U'KW.
2. ('11.11" ece 6aHKH, KOJKY BblTepeTb
IIIIHI JlLo1I1I.
I IIIIMII'II, nml..OItTY OAeTbCSl,
HllrIlUJ 1111'11
" YKIJlIII 1I1I11..l1I1Ta OAe5lnOM. 06eCne'leHHe coxpaHeH..SI
Tenna.
I, Ilpf lIy"peA..Tb, '1TO 6arpoeble
I1Il1l1n nOCTelleHHO HC4e3HYT.
I . npUOCCTH Ae3HH<!>eK "1O MeA"- 06eCne'leHl-1e HHcf>eK HoHHoi1 6e30-
II'"'' 11")( GUliCK. naCHOCTI-1 cornaCHO OCTy 42-21-2-
85.
11I.IMI.llhL1( YU'''Tb PYK". Co6nlOAeHI-1e n"'1Hoi1 rl-1rneHbl Me-
AH HHCKOI;1 cecTpbl.
nOCTaHOBKa CorpeBalOlqerO KOMnpeCCa
l(t'J/I': JlIoI3BaTb ,lI;JIMTeJIbHOe M paBHoMepHoe pacIIIMpeHMe
f'O 'Y"UlI, clluc06cTBOBaTb YJIyqIIIeHMIO KpOBoo6pam;eHM.fI B TKa-
1111 X. t1lCll3!1Tb 60JIeyToJI.fI101IJ;ee M paccacbIBalOII(ee ,lI;eMCTBMe.
333
1l0lW3anllJl: JIeqeHMe MeCTHbIX MH!PMJIbTpaTOB (nOCTMH'b-
eK MOHHbIX), BOCnaJIMTeJIbHbIX npO eCCOB B MbIIII ax M CYC-
TaBaX, JIOP-3a60JIeBaHMlI, YIIIH6bI Ha BTOpble CYTKM.
[JpOmU60nOKa3anUJl: KpoBOH3JIMlIHHlI, rHOMHble 3a60JIeBa-
HM:'! KOJKM, HapymeHHe eJIOCTHOCTH KOJKHbIX nOKpOBOB, ony-
xOJrn Pa3JIn:qHOM 3THOJIOrMM:TpaBMbI H ynm6bI B nepBbIe CyTKM.
OCH.a/4enue:
- MapJIeBall CaJIlPeTKa, CJIO:>KeHHall B 6-8 CJIoeB;
- paCTBOp l1.JIlI CMa'IHBaHHlI TI<aHH (BOl1.a KOMHaTHoM to,
cnlipT 40' MJIH pacTBop YKcyca 6% -Horo - 1 qaiiHa.!l JIO:>KKa
YFcyca Ha nOJI-JIHTpa BOl1.bI);
- KJIeeHKa MJIM BOlI:(aHall 6YMara;
- BaTa;
- 6MHT;
- HO:>KHHlU>I.
3r.mbl 060CHOB3HIo1R
noiJzomOBKa K npol.!eCJype
1. YCTaHOBmb AOBepl1TenbHble 06eCne'leHl1e OC03HaHHOfO Y'laCTI1R
OTHoweHIo151 C na eHTOM, 06bRC- B npOljeAype, npaea naljl1eHTa Ha
HI1Tb ljellb 101 XOA npOljeAypbl, nOIlY- Io1H4>oPMaljl1lO.
'1l1Tb cornacl1e Ha npOljeAYPY.
2. noArOTOel1Tb Heo6xoAI1MOe oc- 06eCne'leHl1e a<!><!>eKTl1eHOCTI1 npo-
HalljeHl1e. ljeAypbl.
3. BblMbITb 101 oCYWI1Tb pyKl1, Haj:\eTb 06eCne'leHHe 6e30nacHocTH Mej:\H"
nep'laTKI1. ljHHCKOti cecTpbl.
4. OCMOTpeTb KO>KHble nOKPoebl Y6ej:\HTbcR, '1TO HeT npOTHeonOKa-
naljl1eHTa Ha MeeTe nOCTaHOBKI1 3aHl1ti K nOCTaH08Ke corpaealOlljero
KOMnpecca. KOMnpecca.
npoeeCJeHue npOl.!eCJypbl
1. HanO>KI1Tb Ha KOJKy MaplleeylO 06eCne'leHHe AeticTeH5I pacTBopa
canlj>eTl<Y, CnO>KeHHYIO e Ha KOJKy 101 nOAl1e>Kal1jl1e KPOBeHOC-
6 - 8 cnoee, CM04eHHYIO OAHHM 1013 Hble COCYAbI e Te'leHHe pernaMeH-
paCTBOpoe 11 xopoWO OTJKaTYIO. Tl1poeaHHoro epeMeHI1.
2. noKpblTb TKaHb K}'CKOM BOlljaHoti Be H36eJKaHHe BblCblX3HI1R caIl<!>eT-
6YMarH (KIleeHKI1), KOTOpaR Ha 1,5 KI1.
- 2 CM WHpe Bna>KHoti canlj>eTKH.
3. nOnO>KHTb cnoo eaTbl (pa3MepoM 06eCne'leHHe corpeeaHI151.
60nbwe npeAbiAYlI.\ero cnOR KOM-
npecca Ha 1,5 - 2 CM).
4. 3a<!>HKcHpoeaTb KOMnpecc 611H-
TOM.
334
3Tanbl 060CHOBaHIo1S1
npoeeCJeHUB npol.!eCJypbl
5. 3acpHKCl1poeaTb epeM5I: KOM- Ha3Ha'leHHe Bpa'la.
npecc Aep>KaTb OT 6 AO 12 'lacoe.
6. BblMblTb pyKl1. C06nlOAeHl1e nl1'1Hoti rnrneHbl Me-
Al1ljHHCKOti cecTpbl.
7. l.Jepe3 2 '1aca npocYHyTb nanelj npoeepmb npael1nbHOCTb HaIlOJKB-
nOA KOMnpecc, y6eA"'TbcR, '1TO HI1R KOMnpecca.
campeTKa ellaJKHa5l, a KO>Ka TenllaR.
npHMB'IaHHe: EcnH '1epe3 1,5 - 2
'1aca canlj>eTKa cyxaR, TO KOMnpecc
HaIlO>KeH HenpaeH/lbHo.
OKOH'IaHUe npotjeCJypbl
1. CHRTb KOMnpecc, KOJKy npOTepeTb npej:\oTBpall.\eHHe Maljepa H KO>K-
Tenlloti eOAoti, npocYWHTb caIl<J>eT- HblX nOKPoeoe: I1CK11lO'1eHlo1e pa3-
KOti: yKyTaTb Ten/lO MeCTO nOCTa- APaJKeHHR KOJK"'.
HOBK'" KOMnpecca.
2. BblMblTb PYK"'. C061llOAeHHe /lH'IHOti rHrneHbl Me-
Al1lj"'HCKOti ceCTpbl.
npMMeHeHMe rpenKM
r(eJ/.b: npOBeCTH TenJIOByro npo el1.Ypy.
IIoKa3anUJl: aCCaCbIBaHHe BOCnaJIMTeJThHbIX npOI.\eCCOB, co-
rpeBaHMe TeJIa, 60JIeYTOJI.!IIOlI:(ee l1.eMCTBMe.
IIpomu6olwKa3aUUJl: oCTpble BOCnaJIHTeJIbHble npo eCCbI H
GOJIM B 6PIOIllIIOH nOJIOCTH, onYXOJIH, KpOBOTe'IeHHlI, YIIIM6bI B
IwpnhJ(' '111('1.1, 1I'\PYIIIeHHe eJIOCTHOCTH KO:>KHbIX nOKpOBOB.
()('I/(II/(C'II11C':
- l'pCJIKa pC3HlIOBall 1,5-2 ;11;
- Bo,/\a t' - 60-70'C;
- nono'reH e JIH'IHOe;
- "Mlm<:'l'b C 1 % -HbIM paCTBopOM XJIOpaMHHa;
1111'1'1111110 (J\BC CaJI!PeTKH l1.JIlIl1.e3HH!PeK HH rpeJIKH);
- 'rt'JlMoMeTp l1.JIlI M3MepeHHlI TeMnepaTypbI BOl1.bI.
3rnnbl 060CHoBaHHR
noCJzomoeKa K npol.!eCJyp
1 YCTaHOeHTb Aoeepl1TenbHble 06eCne'leHHe OC03HaHHoro Y'laCTI151
OTilOwet 10151 C nalj"'eHTOM, 06bRC- e npoljeJ:\YPe, npaea nalj"'BHTa Ha
I1I1Tb ljellb 101 XOA npoljBAypbl, nony- HHcpopMaljl1lO.
'1I1rb cornacl1e Ha npoljeAYPY.
335
3Tanbl 060CHOB3HHSI
nOiJ2omosKa K npOl.-/eiJype
1. YCTaHOB\oITb AOBepHTellbHble 06eCnB'leHHe OC03HaHHoro Y'laCT\oI
OTHOWeH\oI5I C na HeHToM, 06b C. B npo et:\ype, npaBa na \oIeHTa Ha
HHTb enb \01 XOt:\ npo eAypbl, nony- \oIHc!>opMa HIO.
'I\oITb comaC\ole Ha npo et:\ypy.
2. nOt:\roToBHTb Heo6xot:\Io1MOe oc- 06eCne'leHHe '1eTKOCTH npOBet:\e-
HallleHHe. HH np eAypbl.
3. Han\olTb rop '1yoo (60°C) BOAY B
rpelll<y.
4. BblnycTHTb B03t:\yx C>KaT\oIeM l.JT06b1 rpBIlKa conpHKacallacb C
BepxHei1 TpeTH rpellKlo1, 3aBHHTHTb nOBepXHOCTbIO Tella Bcei1 nOBepx-
npo6KY_ HOCTblO, 6bllla «06TeKaeMrn1».
5_ OnpoKHHyrb rpelu<y np06Koi1 06eCne'lHBaeTC5I repll.'eTIo1'1HOCTb
BHH3, BblTepeTb rpelll<y Hacyxo. rpellKIo1.
6. 3aBepHyrb rpelll<y B nOIlOTeH e 101 06ecne'lIo1BaeTC KOMcPopnloe
OTAaTb na \oIeHTY. 0lllYllIeHlo1e na lo1eHTa.
BblnoflHeHue npou,eiJYPbl
1. npHIlO>KlfTb Ipelll<}' K HyJKHOi1
061laCT\oI Tella Ha 20 M\oIHyr.
np\olMe'laH\oIe: npH AIlHTellbHOM
npHMeHeHIo1H no Ha3Ha'leH\oI1O Bpa'la
ABllaTb 1Q-15-M\oIHyrHbli1 nepepblB,
MeH BOAY.
2. Aep>KaTb rpBIlI<y fJP OCTbIBaHH5I. CoxpaHeH\oIe a<l><l>eKTa npo eAypbl
3aBIo1CHT OT ee AIl\olTBllbHocrn.
3asepweHue npo/.jeiJypbl
1. Y6paTb rpellKY, OTKPbn b ee \01
Bbllllo1Tb BOA .
2. OCMOTpeTb KO>t<y na lo1eHTa, no- npO<!>lo1llaKTHKa OJKOra I<OJKIo1.
MO'Ib na \oIeHTY nB'lb B YA06Hoe
nOIlOJKeHHe, YKPblTb.
3. BblMblTb, OCYWlfTb PYKIo1, Ha,QBTb 06eCne'leHHe 6e30naCHocrn MeAl+-
nep'laTK\oI. Io1HCI<Oi1 cecTpbl.
4. 06pa6araTb lpellKY BBTOWblO, 06ecne4eHHe Io1Hc!>eK "oHHoi1 6830-
CMO'IeHHoi1 B 1 'Yo-HOM pacTBope naCHocrn.
XIlopaMHHa (ABYKpaTHo C HHTBpBa-
110M 15 MHHyr).
5. BblMblTb BOt:\Oi1, BblCYWHTb \01
xpaHIo1Tb B cne lo1allbH0 oTBet:\eHHoM
MeCTe.
6. CH Tb nep'laTK\oI, BblMblTb 101 oCY- Co6lllOAeH\oIe IlIo1'1HOi1 rnr..eHbl.
WHTb PYK\oI.
336
npMMeHeHMe nY3blPR co nbAOM
r(eJlb: cYJKeHHe KpOBeHocHbIX COCYAOB KOJKH H 60JIee rJIY-
60KO paCnOJIOJKeHHbIX opraHoB H TKaHeM, CHHJKeHHe '!YBCTBH-
TeJIbHOCTH HepBHbIx pe enTopOB.
IIOIW3aHUR: KpOBOTe IeHHJI, oCTpbIe BOCnaJIHTeJIbHbIe npo-
ecCbI B 6plOUIHOM nOJIOCTH, yum6bI (nepBble CYTKH), BbICO-
Ka.!I JIHXopa.n;Ka, nOCJIeOnepa HOHHbIM nepHO,lJ;.
OCH.aut eHue :
- nY3bIpb JIJI JIb.n;a, npe.n;BapHTeJIbHO npOBepeHHbIM Ha
eJIOCTHOCTb;
- JIe.n; KycO'IKaMH, Bo.n;a (14-16°);
- nOJIOTeH e JIH'IHOe;
- eMKOCTb C .n;e3HHIlJH HpylOII(HM pacTBopoM (1 % -HbIM pa-
CTBOpOM XJIOpaMHHa);
- BeTOllib.
06R3ameJ/.bHoe YCJl06ue: opraHH3a HJI nOCTOJIHHOrO KOHT-
pOJIJI npo e.n;ypbI.
3Tanbl 060CHOBaHHe
noiJzomol3Ka K npoqeiJype
1. YCTaHOB\oITb AOBepHTellbHbie OTHowe- 06ecne4eHHe OC03HaHHoro
H" C na HeHToM. Y'lacTH B npo et:\ype.
2. 06b CHIo1Tb ellb 101 XOA npo BAYpbl, 06eCne'leHHe npaBa na lo1eHTa
yr04HIo1Tb nOH\oIMaHHe, nOIlY'lHTb corna- Ha HH<!>opMa \oIIO.
clo1e Ha npo et:\YPY.
3. noAraroBHTb He06xot:\Io1Moe ocHallle- 06eCne'leHHe a<!><!>eKTIo1BHOCrn
HHe npOBeAeHH5I npo eAypbl.
BblnonHeHue npo/.jeiJYPbl
1. 3anollHHTb nyablpb AIl5lllbt:\a MellK\1M\oI AocTlo1raeTc paBHoMepHoe
K¥CO'IKaMH IlbAa, 3allHTb HX XOIlOAHrn1 3anOllHeHHe nY3blp5lIlbt:\OM.
BOt:\Oi1. npH np\olMeHeHIo1H nyablp51 AIl
Ilbt:\a, 3aMOpoIKeHHoro B MOpO-
3\o1nbHoi1 KaMepe, MOIKeT B03-
HHKHyrb OTMOpOJKeHHe Y'laCTKa
Tella.
2. nOIlO;KIo1Tb nyaLlpb Ha ropH30HTallbHYIO BbITeC!-I5IeTC B03AYX 1013
nOBepXHOCTb, 3aB\oIHTHTb np06KY. nY3blpR
3. 3aBepHyrb nyablpb B nOIlOTeH e (ne- npoc!>W1aKTIo1Ka MeCTHoro 06-
lleHKY). MOpOJKeHHR
4. nplo11l0JKIo1Tb Ha Hy>KHbli1 Y'lacToK Tella
(061laCTb rOIlOBbI Ha 5 MHH. (c \oIHTBpBa-
110M 5 M\oIH.), Ha 06llacTb 6plOW\oIHbi Ha
15-20 M\oIH. C HHTepBalloM 30 MHH.).
331
a
3Tanbl I 060CHOBaHlf8
3aeepWeHUe npoL(eaYpbl
1. Y6paTb nY3blpb co nbAoM, BbI- Heo6xoAlfMOB ycnOBI18 nplf 3aBep-
nl1Tb 80AY If YAanl1Tb OCTaTKI1 nbAa. WeHI1H npolleAypbl.
2. na411eHTy C03AaTb nOKo" 11 YA06-
Hoe nOnOJKeHl1e.
3. 06pa6oTaTb ny.3blpb AIlSl nbAa 06ecne'leHHe IfH4JeKlII10HHO" 6e30-
BeTOWblO, CMO\jeHHOH B Ae3paCTBD- naCHOCTIf. C06nIOAeHI19 npl1Ka3a Ng
pe (1%-HOM paCTBope xnopaMl1Ha 408,720,916.
(ABYKpaTHo C IfHTepeanoM 15 MI1-
Hyr). npl1 HapyweHl111 4enoCTHocrn
KOJKHblX nOKpoBoB npl1MeHHTb
3%-HblH pacT80p xnopaMI1Ha).
4. BblMblTb If oCYWI1Tb PYKI1. Co6nlOAeHl1e nlNHOH rnrneHbI Me-
Al1l111HCKO" ceCTpbl.
6
npMMelfaHMe: npH HapyweHIfH eI10CTHOCTIf KO>KHbIX nOKpo-
BOB MeAH HHCKOH ceCTpe He06xOAHMO Hap,eTb nep4aTKH ne-
peA Ha4anOM npo eAypbl. a nocne OKOH4aHlfSl - CHSlTb HX If
npo,[\e3IfHcpH lfpoBaTb B 3%-HOM pacTBope Xl10paMHHa HnH
APyroM pernaMeHTlfpyeMoM Ae3paCTBope.
fleA
c&:
b
t 14-16°C
npMMeHeHMerpenKM:
a - HanOJlHeHl1e rpeJlKI1 BOAoi1; 6 - BblBeAeHl1e B03AYxa 113 rpeJlKI1; B -
npOBepKa Ha repMeTI1'1HOCTb; r - nOAa'la rpenKIi 6onbHOMY
.
3T3nbl 060CHoB3HI1e
BblnonHeHue npOljeoYPbl
5. 3a<!>I1KCl1p0BaTb BpeMSl.
npIfMe'laHlfe: 06lL!ee BpeMSI 803-
Ae"CTBI1S1 He AomKHO npeBbiWaTb 2
'laCOB C }"IeTOM HHTepsanoB.
6. no Mepe Ta5lHHSI nbAa BOAY cnl1- 06ecne\jeHl1e Aei1cTBI1S1 xonOAa Ha
BaTb 101 nOAKIlClAblBaTb HOBbie KYCO'l- KO>Ke.
KI1 nbAa.
338
20 MHH
IpMMeHeHMe nY3blpSl co nbAoM
339
2 MHH
rOp'lM'IHMK MMeeT OCTpbIM 3anax rOp'lM'IHOrO Macna M He OCbI-
naeTC.II.
( ,. V'\
"'-J
t 14-16°C
."
.......... )1
2 - il
../ .1
/: -..: I
I,
3Tanbl I 060CHOBaHHe
nooeomoBK8 K npoljeaype
1. YCTBHOBHTb AOBepl1TenbHble 06eCnE!\leHI1e OC03HaHHoro }"IaCTI1S1
OTHOWeHH5I C na l1eHTOM. B npo eAYPe.
2. 06bSlCHI1Tb enb 101 XOA npo eAY- 06eCnEJ'4eHHe npaBa na l1eHTa Ha
pbl, yr04Hl1Tb I1X nOHI1MaHl1e, nony- HH<!>0pMa4l11O.
\jI1Tb cornacl1e Ha npo eAYPY.
3. nOAroTOBI1Tb Heo6xOAI1MOe oc- 06ecnE!\leHHe \jeTI<OCTH 101 3<!><!>eK-
Ha eHl1e. TI1BHOCTH npOBeAeHI1S1 npo eAypbl.
4. BblMb'Tb 11 OCYWI1Tb PYKH. 06ecne\jeHl1e nl1\jHOi1 rl1rl1eHb'.
5. nOMOYb na4l1eHry 3aHSlTb YA06- He06xOAI1MOe ycnOBl1e npOe6AeHI1S1
Hoe Heo6xoAHMOe nOnOJKeHl1e. npo eAypbl.
BblnonHeHue npOljeoYPbl
1. OCMOTpeTb KO>KHble nOl<poBbi rOpYI1\jHI1KI1 CTaBSlTCSI Ha HenoBpe-
na l1eHTa Ha MeeTe nOCTaHOBKI'I >l<,D.eHHYIO KOJKY.
rop\jI1\jHI1KOB.
2. 1t13Mepl1Tb TeMneparypy BOAb' npl1 60nee H1131<oi1 TeMneparype
AJ1SI CMa\jI1BaHI151 roP\jI1\jHI1I<OB (40- 3cjJI1pHOe Macro He BblAenSleTCSI,
45°C). npl1 6anee BblcoKOi1 - pa3pywaeTcSI.
3. CMOYI1Tb ropYI1\jHI1KI'I B BOAe B 06ecne\jeHl1e Aei1CTBI1S1 ropYI1 bl Ha
TeyeHl1e 5 ceK Ka>I<,D.bli1, CTpSlXHyYb 11 KO>KY na l'IeHTa, aKTI1BI1311pyeTcSI
npl1nO>KI1Tb Ha HyJKHbli1 }"IaCTOK 3<J>l1pHOe Macno.
KO>K11 ropYI1 ei1 BHI13: cBepxy none-
>KI1Tb nonOTeH e.
4. YKpblTb na l1eHTa oAeSlnoM. 06ecne\jeHl1e coxpaHeHHSI Tenna.
5. Aep>KaTb roP\jI1\jHI1KI'I C03AaHI1e ycnoBI1S1 AIlSl 06ecnENe-
10-15 MI1Hyr. HI151 pecjJneKTOpHOrO Aei1cTBHSI rop-
\jI1\jHI1KOB.
3eeepweHue npOljeaypbl
1. CHSlTb ropYI1\jHI1KI'I, C6POCI'ITb HX B
nOTOK AIlSl OTpa60TaHHoro MaTe-
pLUIII..1.
J Ill" II "I'OTb KO>KY na l1eHTa BnaJK- YCTpaHl1Tb B03MO>KHble OCTaTKI1
III 101 J IIIIIOi1 M.llJnCBoi1 can<J>eTKoi1, rop'll1 bI Ha KO>Ke 101 npeAynpeAHTb
m 110pOTb Hacyxo. B03MOJKHbie OJKorH.
3. nOMO'Ib H8AeTb 6enbe, yn())l(l'ITb
B YAouHoe nOnc»KeHl1e.
4. YKpblTb nB l1eHTa, pCKOMeHAO- CoXpaHeHl1e Tenna 11 o6eCneyeHI1e
BaTb nocTenbHbli1 pe>KI1M 30-60 OTAbixa.
MI1Hyr.
5. BblMblTb 101 OCYWI1Tb py'" C06nlOAeHl1e nl1\jHOi1 rl1rl1eHb' Me-
AH4I1HCKOi1 cecTpbl.
npHMeHeHHenpHMO KH
nOCTaHOBKa rOpQHqHHKOB
MeXaHU3.M. 603aeucm6uS/. ZOp'l.UZibl: npOHMKa.ll B Komy na-
MeHTa, sqmpHoe 1'0p'lM'IHOe Macno pa3 pamaeT ee M pacnIM-
p.lleT KomHbIe KpoBeHocHbIe COCY bI, npMBo MT K pell>neKTop-
HOMY paCnIMpeHMIO KpOBeHOCHbIX COCY OB BHYTpeHHMx opra-
HOB.
IIOICa3aHU.R.: npM 60n.llx, OCTpbIX BocnanMTenbHbIX npo-
eccax opraHOB bIXaHM.II: nHeBMOHMM, 6POHXMTbI, nneBpM-
TbI. 3a60neBaHM.II MbIIII , HepBHOM CMCTeMbI, HeBpanrMM, He-
BpMTbI, OCTeOXOH p03, rMnepTOHM'IeCKMM KpM3, npM 60n.llx B
cepMe.
IIpomu6onolca3aHUR: KpOBOTe'leHM.II, 3a60neBaHM.II KomM,
onyxonM pa3JIM'IHOM STMononm, anneprM'IeCKMe pe8.K MM Ha
sll>MpHbIe MaCJIa, HapYlIIeHMe enOCTHOCTM KomHbIX nOKpo-
BOB, rMnepTepMM.II.
OCHaw,ellue:
- rOp'lM"lHMKM;
- nOTOK C BO OM t" 40-45'C;
- nOTOK n.ll OTpa60TaHHOl'0 MaTepMana;
- nonOTeH e;
- MapneBbIe ca.rrll>eTKM;
- TepMOMeTp n.ll M3MepeHM.II t" BO bI.
06.R.3ame.nbHoe YCJl06ue: nepe npMMeHeHMeM cne . >f. npo-
BepMTb Ka'leCTBO rOp'lM'IHMKOB, CpOK rO HOCTM; npMI'O HbIM
340
341
OKCHrEHOTEPAm1J1
3T3nbl 060CHOB3HH5I
BbinOnH8HU8 npolj8CJypbl
1. OnpeAenl1Tb AflI1HY BBOAI1MOIA 06ecne4eHI1e nOnaAaHI1S1 CTpYI1
4aCTI1 KaTeTepa (pacCToSlHHe OT Kl'lcnopoAa B oepXHl1e AblxaTenbHble
K03enKa YWHOIA paKOBI1HbI AO BxoAa nyrn.
B HOC - npl16nl1311TenbHo 15 CM),
nOCTaBI1Tb
MeTK)'.
2. 06nl1Tb CTepl1nbHblM Ba3en11HO- npeAynpe>I<,D.eHHe TpaBMbI Cn11311-
BbiM MaCIlOM I1nl1 ml1 epl1HOM BBO- CTOIA HOca.
AI1MYIO 4aCTb KaTeTepa.
3. BoeCTI1 KaTeTep B HI1>KHI1IA HOCO- 06eCne'leHI1e HaxO>I<,D.eHI1S1 KaTeTe-
BOlA XOA AO MeTKI'I. pa B Ab,xaTenbHblX nyr5lx.
4. OCMOTpeTb 3eB. npHAaBI1B wna-
TeneM KOpeHb Sl3b'Ka. Y6eAl1TbcSI.
'ITO KOH411K KaTeTepa BI1AeH npl1
oCMoTpe 3eBa.
5. C6poCI1Tb wnaTenb B Ae3I'1H4JH- 06ecne4eHI1e I1H<!>eK 110HHOIA 6e30-
PYIO 111A pacTBop. naCHoCTH.
6. 3a4JI1KCl1p0B8Tb HapyJKHYIO 4aCTb 06ecn848Hl1e noCToSlHHOro nonD-
KaTeTepa TeCeMKaMI1 6l1ma. >KeHI1S1 KaTeTepa AflSl YA06cTBa na-
eHTa, np0<!>l1naKTI1Ka Ma epa 1111
KOJKI1 nl1 a.
7. COeAI1HI1Tb C annapaToM 606po- L-1cKfl104a1OTcSI BblCblXaHl1e CJl11311-
Ba. 3anOnHeHHblM AI1CTl1nnHpOBaH- CTblX HOca 11 OJKor AbixaTenbHblx
HOIA BOAOIA I1nl1 96%-HbiM Cnl1pTOM, nyrelA.
Hnl1 APyrl1M neHOraCI1TeneM.
8. OrKpbITb BeHTl1nb I1CT04HI1Ka no Ha3Ha4eHI11O Bpa4a.
KI1CJ10pOAa, oTperynl1pOB8Tb CKO-
pOCTb nOAa411 KI'ICJ10poAa.
9. OCMOTpeTb CJl11311CrylO Hoca na- .Qn51 Bb'SlBI1eHI1S1 B03MOJKHOrO pa3-
l1eHTa. APa>KeHI1S1 CJl1'1311CTOIA HOca.
OKOH'laHUe npoljeCJYPbl
1.. npOBeCTI1lfToroBYIO o eHK)' CO- nOATBep>I<,D.aeTCR nonO>KI1TenbHa51
CTOSlHI1S1 na eHTa AflSl YMeHbwe- AI1HaMI1Ka, T.e. YMeHbWeHl1e npl1-
1111" CI1MmOMOB, CBSl3aHHblX C rH- 3HaKOB rHnoKCI1I1.
nOKCI101A.
2. YAanl1Tb KaTeTep.
3. npoAe3I1H4JI1 l1pOBarb KaTeTep, 06ecne'leHI1e I1H<!>eKLlI10HHOIA 6e30-
wnaTenb, annapar 606poBa MeTD- naCHOCTH.
AOM Kl'lnSl4eHH5I.
4. BblMblTb 11 OCYWl1lb iJ
nOAaqa YBn8)f(HeHHOro KMcnopOAa qepe3
HOCOBOM KaTeTep
lfeJlb: YMeHbillHTb nmOKCHIO TKaHeH.
IIOIca3aHUS/.: Ha3Ha1:J:eHH.II Bpa1:J:a npH 3a60neBaHH.IIX opl'a-
HOB KPOBoo6p eHH.II H )1;bIxaHH.II.
OCHaw,eHue: annapaT B06pOBa, )1;HCTHnnHpOBaHH8..11 BO,l!;a,
HnH 2% -HbIH paCTBOp HaTpH.II I'H,l!;pOKap60HaTa, HnH cnHpT
96%-HbIH. CTepHnbHo: nOTOK, HOCOBOH KaTeTep, Ba3enHHO-
Boe Macno, illoaTenb, 6HHT, neHKonnacTbIpb.
3Tanbl 060CHOBaHHSI
noCJzomOOKa K npoljeCJype
1. YCTaHOBl1Tb AOBepHTenbHble 06eCne'leHI1e Cna>KeHHOCTI1 COBMe-
OTHOWeHI151 C na l'IeHTOM, eCJ111 3TO CTHOO pa6oTbl.
B03MO>KHO.
2. BblSlBHTb Y na l'IeHTa npK3HaKI1 101 rHnOKCI151 MOJKeT npl1BeCTI1 K TaXI1-
CI1MmOMbI, CBSl3aHHble C rHnOKCl1elA KapAHI1 (Y'la eHI1IO nynbCa), 6pa-
11 Hanl1411eM MOKpoTbl B AbixaTenb- Al1apl1TMl111 (ype>KeHHIO nynbCa).
HbiX nyrSlx.
3. 06bSlCHHTb na l1eHry (B TOM
cn}t'iae. KorAa B03MO>KHO) 101 ero
6nl13KI'IM enb OKCl1reHOTepanl1l1,
nocneAQB8TefbHOCTb npo eAypbll1
nonY4HTb ero (I1X) camacl1e Ha npo-
eAypy.
npI1Me'laHHe: na l1eHT ycnoKaHsa-
eTCSI, 'ITO npl1BOAIfT K YMeHbWeHHIO
nOTpe6neHI1S1 11M KI1CJ10p0Aa 11
ynY4waeT B3aHMOAelACTBI1e Me>K,D.y
HHM 11 MeAH I1HCKOIA cecrpoi:i.
4. BblMblTb 11 oCYWI1Tb PYKl1. HaAeTb 06eCne4eHl1e HH4JeK I'IOHHoi1 6830-
cTepl1nbHble nep4aTKI'I. naCHOCTI1.
5. nOArOTOBl1Tb K pa60Te annapaT
606poBa:
a) Hanl1Tb B 'II1Cly1O CTeKnSlHHYIO Cnl1pT 96%-HbllA CJlyJKl1T neHOraCI1-
BMKOCTb AI1CTl1nnHpOBaHH}'IO BOAY. TeneM I111cnonb3yeTcR npl1 Hanl1'lHI1
I1flH 2%-HbilA pacTBop HaTpHSI rl'lA- OTeKa nerKl1x.
pOKap6oHaTa, I1nl1 Cnl1pT 96%-HbM
2/3 06beMa, TeMf1eparypa 30-
40°C;
6) 06ecne'll1Tb repMeTI'I'IHOCTb
coeAl1HeHI1i:i npl1 nOMOUll1 BI1HTa Ha
npo6Ke.
npl1Me'laHl1e: npOAOl1>KI'ITel1bHOCTb I1HranSl I'IH 40-60 MHHYT no
rpa<!>HKY, Ha3Ha'leHHOMY Bpa'iOM. KaTeTep MO>KeT OCTaBaTbCi! B
n0l10CTH Hoea He 6ol1ee 12 'IaCOB.
342
343
.
nOAa'la YBna>KHeHHOro KMcnopOAa
143 KMcnopOAHOM nOAYWKM
r{eJtb: nOBbIllieHMe co epmaHM.II KMcnOpO,lta B TKaH.IIX.
llOlCa3aIlUJl.: pa3nM'IHbIe HapYllieHM.II,ltbIXaHM.II, Y,ltyurbe (ac-
Il>m<CM.II), OTpaBneHMe ra3aMM, OTeK nerKMX.
OCllar.qellue:
- KMCnOpO,ltHaH nO,ltYlliKa cO 2 ;
- BopOHKa (MYH,ltlliTYK);
- MapneBa.ll canll>eTKa, cnO:1i\.t!HHa.ll B 4 cno.ll;
- MelliOK ,ltn.ll oTpa60TaHHoro MaTepMana;
- eMKOCTb c ,lte3paCTBopOM (3%-Hbrn pacTBop xnopaMMHa).
06Jl.3ameJtbll0e ycJto6ue: c06nro,lteHMe TeXHMKM 6e30nacHo-
CTM npM Ha6MpaHMM KMcnopo a (KMcnOpO.n; HaHOCMT omorM Ha
cnM3McTbIe).
3Tanbl 060CHOBaHI<1e
BblnonHeHue npo eOypbl
3. HClAaBnl<1BaTb Ha nOAYWK}' 1<1 CBo- 06ecne'1eHI<1e nOCTynneHI<1 KI<1Cno-
pa'1l<1B8Tb C npOTI<1BOnOnO>KHoro pOAa nonHOCTblO.
KOHlja, nOKa KI<1CnOpOA He BblAenl1T-
C nonHOCTblO.
3aeepweHue npo eCJypbl
1. Y6paTb nOAYWK}', oTCOeAl1Hl1Tb
MYHAWTYK.
2. Can<!>eTK}' C6POCI<1Tb B /lOTOK An51 06ecne'1eHHe I<1H4JeKljI<10HH0I1 6e30-
oTpa6oTaHHoro MaTepl<1ana. naCHOCTI<1.
3. MYH,QWTyK nOMeCTI<1Tb B Ae3. pac-
TBOp Ha 60 MI<1HYT.
4. BblMblTb 101 oCYWI1Tb PYKI<1.
3Tanbl 06ocHoBaHHe
nOCJzomo6Ka K npo eOype
1. 06b CHl1Tb ljenb 1<1 XOA npOljeAY- 06ecne'1eHI<1e npaBa naljl1eHTa Ha
pbl naljl<1eHTy, nOflY'll<1Tb cornacl<1e I<1H4JopMaljl<1lO.
Ha npoljeAYPY.
2. 3anonHI<1TbnOAYWK}'Kl<1cnOPOAOM An51 BBeAeHI<1R Kl<1cnOpOAa naljl<1eH-
1<13 6annOHa: Ty.
a) CoeAI<1HI<1Tb pe31<1HOBYIO TPy6K}' TeXHI<1Ka Ha6l<1paHI<1 Kl<1cnopoAa.
noAYWKI<1 C peAYKTopOM Kl<1cnOPOA-
HOro 6annoHa;
6) OTKpblTb BeHTl111b Ha Tpy6Ke 06ecne'1l<1Tb nocrynneHl<1e Kl<1cnOpo-
ITOAYWKH, 3aTeM Ha 6annoHe: fJ(3 B nQAywK}'.
B) HanOI1HI<1Tb nOAYWK}' Kl<1cnOpo-
ADM;
r) 3aKpblTb BeHTl<1nb Ha 6annoHe, C06nKJAeHI<1e TeXHHKI<1 6e30nacHo-
3aTeM Ha nOAywKe: CTI<1.
A) oTcoeAl1HI<1Tb pe31<1HOBYlO
TPy6K}' OT peAYKTopa 6annOHa.
3. nOACOeAI<1HI<1Tb MYHAWTYK Ha
TPy6K}' 6annoHa.
4. 06epHyrb MYHAWTyK (BOPOHK}') YBna>KHeHl<1e Kl<1cnopOAa 101 npeAY-
BnaJKHOI1 MapneBOI1 can<!>eTKOI1. npeJKAeHl<1e OJKora cnl13HCTblX Ablxa-
TenbHblX nYTel1.
BblnOnHeHUe npo eCJYPbl
1. npl<1JKaTb BOpOHK}' KO pTy naljl1eH- !I1CKnlO'1l<1Tb nOTeplO Kl<1cnopoAa.
Ta 101 OTKpblTb KpaH Ha nOAYWKe.
2. OTperynl<1pOBaTb CKOpOCTb nOAa- 06ecne'1eHI<1e 3cjJ<!>eKrnBHOCTI<1 npo-
'11<1 Kl1CnopOAa (4-5 n B MI<1Hyry). ljeAypbl.
\.
nOAillfa YBl1amHeHHoro
KHcnopOAa
344
345
rMPYAOTepamtSl
IIPU31laICU npU20aHocmu nUS/.601C:
1. I1oBepxHOCTb nH.IIBKH On:lKHa 6blTb rna.n;KOH, 6necT.II-
m;eH.
2. HpKO BblpameH pell>neKc npHKOCHOBeHH.II (Teno nH.IIBKH
npH npHKocHoBeHHH CTaHOBHTCH KOpOTKHM, TonCTblM, ynpy-
rHM).
3. AKTHBHOCTb.
Mecma npulCJtaiJbt6anUJl. nUJl.60IC:
1. 06nacTb coc eB Horo OTpOCTKa, no BepTHKanbHoH nH-
HHH, oTcTynHB Ha 1 CM OT YUIHOH PaROBHHbl.
2. 06nacTb cep a B 3-5-M Mempe6epb.llX, oTcTynHB OT
rpY HHbl Ha 1 CM.
3. 06nacTb ne'IeHH B onb pe6epHoro Kpa.fI.
4. I1PH TpoM60ll>ne6HTe (no xo y BeH, OTcTynHB OT BeHbY
Ha 1 CM C 06eHx CTOpOH).
5. BHCO'IHa.ll 06nacTb Ha ypoBHe pa3pe3a rna3 no ropH30H-
TanbHOH nHHHH (npH rnayKoMe).
6. 06nacTb KOn'IHKa H BOKpyr 3a.n;HenpOXO Horo OTBep-
CTH.II (npH reMoppoe).
IIpomu6onolCa3aHuJl.:
1. KpOBOTO'IHBOCTb.
2. Bone3HH OpraHOB KpOBeTBOpeHH.II.
3. MHll>eK HoHHble 3a60neBaHH.II.
- Me HI{HHCKa.fI 6aHKa.
- Il>naKoH co cnHpTOM 70.;
- 40%-HbIH paCTBOp rnIOK03bl;
- HamaTblpHbYH CDHpT HnH xnopH H8TpH.II;
- rOpH'IaH Bo a B eMKOCTH;
- 6-8 nO)J;BHmHbIX nHHBOK.
06Jl.3ameJtbnoe ycJto6ue: npHMeH.fITb TonbKO no Ha3Ha'Ie-
HHIO Bpa'Ia.
lfeJtb: MeCTHoe .KpOBOH3Bne'IeHHe, CHHmeHHe CBepTbIBae-
MOCTH KpOBH.
IIolCa3aHuJl.: rHnepTeH3H.II apTepHanbHa.ll, BeH03HblH 3ac-
TOH B ne'IeHH, HmeMH'IeCKa.ll 6one3Hb cep a, TpOM603 BeH H
TpOM60ll>ne6HT,reMoppoH.
IIpomu6onolCa3aHuJl.: aHeMH.II, CHHmeHHe CBepTbIBaeMOCTH
KpOBH, nOBblmeHHa.ll 'IYBCTBHTeJIbHOCTb KomH, cencHc, Kom-
Hble 3a60neBaHH.II.
Ocnaw,enue \CTepHnbHo):
- nOTOK;
- nHH eTbl;
- TaMnOHbl;
- canll>eTKH;
- nepeB.II30'IHblH MaTepHan )J;n.ll aB.IIll.WH nOB.II3KH;
1
3Tanbl 1 06OCHOBaHlfSi
nOdeom06K8 K npoljedype
1. YCTaHoBIfTb AOBeplfrenbHble 06ecne\jeHHe OC03HaHHoro Y4acTlf51
OTHOweHIf51 C na4lfeHTOM, 06bflC- B npo4eAype.
HIfTb 4enb If XOA npo4eAypbl, nony-
\jl1Tb cornaclfe Ha npo4eAYPY.
2. nOAroTOBMTb Heo6xoAlfMoe oc-
Ha eHlfe.
3. BblMblTb If OcywlfTb PYKI>1, HaAeTb 06eCne'leHlfe IfH<!>eK4HOHHOIA 6630-
nep\jaTKI>1. naCHOCTIf.
BblnonHeHue npOljedYPbl
1. nplfAaTb nal\l1eHTY YAo6Hoe no- 06ecn6'lHBaeTCfI KOMq,OpTHOCTb
nO>l<eHlfe. npoBeAeHIf51 np046Aypbl.
2. OCBo6oAlfTb HYJKHbl1A Y4acToK
Tena, OCMOTpeTb KO>l<Y, nplf Heo6xo-
AIfMOCTIf c6plfTb BonOCbI.
3. BblMblTb KO>l<Y ropfl\jelA BOAOIA 101 YCJ10BHe AJ1fI nplfcaCblBaHIf51 nlffl-
pacTepeTb AO IlOKpaCHeHlffl. BOK
4. npoTepeTb KO>t<y cnlfpTOM, 3aTeM
T8MnOHOM, CMo'-teHHblM B TennOIA
BOAe, OCYWIfTb KO>t<y.
5. npOTepeTb MeCTO noCTaHOBl<If YCKopfleTcfI nplfcacblBaHlfe nlfflOOK
nlfflBDI< 40%-HbiM pacrOOpOM rmo-
KO bl.
6. 8351Tb nlfflBK}' nlfH4eTOM If noMec-
THTb B 6aHK}' XBOCTOBOIA \jaCTblO.
nOAHeCTlf K Mecry np11I10JKeHH!I
6aHK}' C nlfflBKOlA, HanpaBIfTb nlfflBK}'
K cooTaeTCTB elA TO\jKe.
7. OCBo6oAlfTb nHflBK}' OT cocYAa,
KaK TonbKO OHa npOK}'CHT KO>t<y If
nOflBflTCfI oonHoo6pa3Hble ABH>I<e-
Hlffl B nep6AHe171 ee \jacTIf.
8. nOArlO>l<lfTb nOA 38AH101O nplfcoc- npeAynpe>K,qeHlfe nplfcacblB8Hlffl
K}' CTepl1I1bHYIO can<!>eTK}'. 3aAHelA nplfCOCKOIA K KOJKe C LlenblO
YBemNeHlffl al<Ta;,BHOCTIf mlflBKIf.
346
347
3T3nbl I 060CHOB3HI1A
3aeepWeHUe np04eOYPbl
3. CHATb nep\j8TKI'I, BblMblTb 101 ocy-
WI1Tb PYKI1.
4. CMeHI1Tb nOBA3K}' '1epe3 npeAYnpe>l<AeHl1e KpoBOTe\jeHI1A.
CyrKI'I.
npHMe'laHl1e: npl1 npOMOKaHI1H
I1OBA3KI1 CHATb TonbKO BepXHl1e
cnOH 101 nQA611HTOBaTb HOBbli1 cnoi1
BaTHO-M8pneBoi1 nOBR3KI'I. Ha6mo-
p,BTb 3a COCTORHl1eM nOBR3K11.
3Tanbl 06ocHoBaHI1S1
BbmOnHeHUe npOljeoypbl
9. nOCTaBHTb Bee nHRBKI'I TaKI'IM >Ke
06p830M.
10. nOACTaBl1Tb nOTOK K MecT)' npl1- AnR I1cnonb30BaHHbiX nI1RBOK.
nOJKeHI151 nHRBOK.
11. llpoBecTI1 B8TOi1, cMo\jeHHoi1 06ecne'leHl1e 11Op,BI1>KHOCTH nI1RBOK.
rennoi1 BOAQi1, no Teny nl1RBOK, KaK
TonbKO OHI1 TepRIOT aKTJ.1BHOCJb.
12. >K,Q8Tb, nOKa nl1RBI<I1 caMH om8-
pYT, 111111 CH5ITb 11><, npl1KOcHyoWI1Cb
K Teny nHRBKI'I TaMnOHOM, CMO\jeH-
HbiM H8W8TblpHbiM Cnl1pTOM.
npl1Me'laHHe: BpeMA nOCTaHOBKI1
nv.51BOK COCTaBIlReT He 60I1Be 20-30
MI1Hyr.
13. nOMeCTl1Tb Hcnonb30BaHHbie 06ecne\jeHlo1e HH<!>eK4HOHHoi1 6e30-
nl1RBKI'I B Ae3I1H<!>I1 I1PYIO I1i1 pac- naCHOCTI1.
TBOp.
3aeepweHue npo4eOYPbl
1. HanOJKI'ITb H8 MecTO YK}'COB CTe- npeAynpe>K,D.eHl1e KpoBOTB\jeHI1R.
pl1nbHb'e can<jJeTKI'I, nOBepx can<!>e-
TOK - acernl'l\jecJ<yIO BaTHO-
MapneBYIO AaBAlL\Y nOBR3K}' 11
38QJI1KCI1pOBaTb 611HTOM Ha CyrKI'I.
2. npoAe3l1HQJI1 l1pOBaTb I1CnOI1b- 06ecne\jeHI1e I1H<!>eK 110HHoi1 6e30-
30BaHHbie npeAMeTbl. naCHOCTIo1.
.,.
::- .. ., . -
r_".
npMMeHeHMe xonOAHOM npMMO KM
eJIb: BbI3BaTb OXJIam eHMe KomM M cymeHMe KpOBeHoc-
HbIX COCY OB, OKa3aTb 60JIeYTOJUIIOIl\ee eMcTBMe.
nOKa3aHHH: BTOPOM nepMo JIMXOPa.AKM, HOCOBoe KpOBO-
Te'IeHMe, nepBbIe 'IaCbI nOCJIe YUIM6a M T. ,It.
npOTHBonoKa3aHHH: onYXOJIM pa3JIM'IHOM 3TMOJIOrMM,
TpaBMbI M ynm6bI BO BTopble CyrKM, HapYIlleHMe n;eJIOCTHOCTM
KomHblX nOKpOBOB B MeCTe nOCTaHOBKM.
OCHa eHHe: Be MapJIeBble MJIM 6.H3eBble campeTKM, CJIO-
meHHble B 6-8 CJIOeB; paCTBOp ,ltJI.H CMa'iMBaHM.H TKaHM (t
BO,ltbI 14 - 16°C); KYCO'IKM JIb,lta; TepMOMeTp ,ltJI.H M3MepeHM.H
TeMnepaTYPbI BO,ltbI.
IIo,ltroToBKa K npOn;e,ltype
1. Y CTaHOBMTb oBepMTeJIbHble OTHOIlleHM.H C nan;MeHTOM,
06'b.HCHMTb n;eJIb M XO,lt npOn;e,ltypbI, nOJIy<IMTb COrJIaCMe Ha
npon;e1Q'PY.
2. IIo,ltroToBMTb He06xo MMoe oCHaID;eHMe.
3.. BbIMbITb M ocyIllMTb PYKM.
4. OCMoTpeTb KomHble nOKpoBbI nan;MeHTa Ha MeCTe no-
CTaHOBKM npMMO'IKM.
5. Y6e MTbC.H, 'ITO HeT npoTM-BoI.oKa3aHMM K nOCTaHOBKe
corpeBaIOIl\erO KOMnpecca. IIoMHMTe, 1:J:TO npM npOBe eHMM
npOn;e,n;ypbI BbI He OJImHbI OTJIyqaTbC.H OT nan;MeHTa!
BbmOJIHeHHe npon;etO'PbI
l.CMO'IMTb ca.rrll>eTKY B XOJIO,ltHOM BO,lte, OTmaTb, CJIO-
mMTb B HeCKOJIbKO CJIOeB.
2. npMJIOmMTb ca.rrll>eTKY K nOBepXHOCTM KomM.
Cnoco6 nOCTaHOBKH nHSlBOK
348
349
6.5. TepMoMempuR. Yxog npu Jluxopaglse
TepMOMeTpHH - 3TO H3MepeHHe TeMnepaTypbI Tena 'Ieno-
IICI<a. M3MepeHHe npOBO HTCH C nOMO blO:
- Me Hn;HHCKoro MaKCHManbHoro TepMOMeTpa no IJ;enb-
cmo;
- 3neKTpOTepMOMeTpOB (TepMOIIJ;ynoB);
- pa.n;HOKancyn, cHa6meHHbIX aT'IHKaMH, nepe aro HMH
Cl1rHanbI 06 113MeHeHHH TeMnepaTypbI Tena Hnl1 OT enbHbIX
oprallOB, KOTopbIe Il>HKCHPYIOTCH COOTBeTCTBYIOIIJ;HMH npH60-
l U \MI1;
- TennOBH eHHH I1nH TepMorpall>l1H.
llpaoURa u3Mepenul£ meMnepamypbt me/l.a 'lA!lW6exa: TeM-
I1C'Jlllrypy 113MCpS/IOT 2 pa3a B eHb - yrpOM, HaTo aK (7-8
'1111'1111). U II("II'POM, nepe nOCne HI1M npHeMOM nHIIJ;H (17-18
1111('1111), II 01'J\CnbHbIX cnyqaHX Kam bIe 2-3 'Iaca.
ftolecma u3MepenUJI, meMnepamypbt memi onpe enHIOT B
.lUIIIICI1MOCTI1 OT xapaKTepa 3a60neBaHHM. M3MepeHHe TeMne-
IIIITYPbI Tena c llOJltO blO MeiJuqunc1Cozo mepMOJltempa npo-
III1J\HT:
- B nO MbIllIe'lHOM Bna.n;HHe;
- naXOBOM CKna.n;Ke (y eTeM);
- nonOCTH pTa (nO 'bH3bf<lHOM 06nacTH);
- npS/MoM KHllIKe;
- nnaranl1 e.
(' 'WJltO blO mepJlto yno6 TeMnepaTYPY Tena H3MepS/IOT:
- 1\ 1I0nOCTHX Tena 'IenOBeKa (nHIqeBo e, meJIy Ke, KH-
1111"111111«' 11 p.).
(' '/IIAf() blO menJl06uiJenuJ/, Hnl1 mepJltozpaqJUu:
- IIIIJt O'larOM nopameHHH, r e Ha6nlO aeTCH YBenl1'1eHHe
III1TI'II<'IIBIiOCTH TennOBoro H3nyqeHHH, CBH3allHoro C R3MeHe-
IIIII'M 1(1)()no06pa eHI1H H 06MeHHbIx npOn;eccOB B nopameH-
111,1 K I"IUlIUIX.
JhnnlJl\)1;lta - 3TO nOBbIllIeHHe TeMnepaTypbI Tena cBepx
IIIIJlMII,III.lIhIX ItlfllJp Bcne cTBHe HapyureHHH TepMoperynHn;HH
II 1'II","rl'ulic-I'1I11 6anaHca Mem y TeWIonpo YKn;HeM 11 Tenno-
1I1'/tll'lI ii.
1\ MUln' I'YlltCCTByeT OKono 276 BH OB nHxopa OK.
V.' '11111 II IIJI ItJIaCCHIl>HKaIJ;HH nHxopa OK:
I 1111 III,II'OT(':
- .'v(nln'upnnbliaH - t" 37,1-38°C;
IIIIJltllS/ (lJc6pHnbHaH - t" 38,1-39°C;
3. CMO'lHTb BTOpyro canll>eTKY B eMKOCTH C xono HoM BO-
,l!;OM, OTmaTb, cnomHTb B HeCKonbKO cnoeB.
4. 3aMeHHTb nepByro canll>eTKY BTOpOM Kam bIe 2-3 MHH.
npO onmHTenbHocTb BceM npOn;e YPbI 3aBHCHT OT COCTOHHHH
nan;HeHTa
OKOll'laBHe npo e.u;ypJ>J
1. CHHTb canll>eTKy, Komy npocyurHTb canll>eTKoM.
2. BbIMbITb PYKH, OCYllIHTb.
TeMneparypa Tena H ee H3MepeHHe
TeMnepaTypa Tena 'IenOBeKa HBnHeTCH nOKa3aTeneM Ten-
nOBoro COCTOHHHH OpraHH3Ma H OCTaeTCH OTHOCHTenbHO no-
CTOHHHOM. I1oJUJ;epmaHHe nOCTOHHCTBa TeMnepaTypbI Tena
06eCne'lHBaeTCH npOn;eCCaMH TepMoperynH HH: TennonpO YK-
n;HeM H TennOOT a'leM.
B BopMe TeMnepaTypa Tena 'IenOBeKa, H3MepeliHaH B no -
MbIllIe'lBOM Bna.n;HHe, Kone6neTcH B npe,l!;enax 36,4-36,8 'c.
Pa3JlU'lalOm:'
1. Cy6BopManbHYlO TeMnepaTYPY (HHme 36°C);
2. Cy61l>e6pHnbHYlO TeMnepaTYPY (37,1-38'C);
3. 4>e6pHnbHYIO TeMnepaTYPY (60nee 38,1'C).
JIeTanbHM MaKCHMaJIbBM TeMnepaTYPa Tena 'IenOBeKa (T .e.
npH KOTOPOM Hac-rynaeT cMepTb) COCTaBnHeT 43'C.
JIeTanbBM MHHHManbBaH TeMnepaTypa Tena 'IenOBeKa
Kone6neTcH B npe enax 15-23°C. 4>H3HonOrH'IeCKHe Kone6a-
HHH TeMnepaTypbI Tena COCTaBnHIOT O,2-0,5'C npH H3Mepe-
BHH TeMnepa-rypbI Tena B nO MbIllIe'lHOM 06nacTH.
TeJltnepamypa meJla 'leJl06e1Ca 3a6ucum om:
- MeCTa H3MepeHHH;
- BpeMeHH CyrOK;
- B03paCTa;
- npHeMa nHIIJ;H;
- CHnbHoro 3MOn;HOHanbHoro HanpHmeHHH.
TaK, y nomHnbIX nlO eM TeMnepaTypa Hepe KO Cy6HOP-
ManbHaH, a y HOBopom eHHbIx, HanpHMep, OHa OCTHraeT
'V rIPH H3MepeHHH B nO MbIllIe'lHOM Bna.n;HHe 37,2'C.
35,0
351
\'
\
.D.e3IfHlj>eK4HSI B 3aKpblTOW eMKOCTH
'---"
'
. ,
XpaHeHlfe B CYXOM BHlle
OnOllaCKHBaHHe npOTO'IHOif BOIIO£\
113MepeHHe TeMnepaTYpbl Tella B npRMO£\ KHWKe
35Z
Cy6HOpMaAbHaJI
35-35.9
,fttl. 1....\1,111111\"1.1 \8"("
......... 1..tI._ .IIU \",1 \0"'('
.... IMI." 1"''''10110101,''.. \V.I 40"("
1".."1111.......11111&1 -n.l"(:
MaMOAeTIIU 2 qaca
onpu lSAllcii .
. 0C1'pU -oT'""rfu:u: AO 2 AB i
UOAOc:.l')JUI OT 10 AD 45 AYCU
xpo.a'u a1C > 45 AII ii.
BH1\bIIlHXOpa1\OK
aocro......
.uoe.u6.\JDO
JlCIDOUUOtq,.... rerr
IInpaIQ.iCRRU
a11Ioa.Qeau..t:
IOtq,
aOAuooEipuBU
AJI'JIIC
ap1D1J1:
- BblCOKa.1I c1>e6pMJIbHa.1I - to 39,1-41"C;
- rHnepnMpeTM'IeCKa.ll - t" CBblIue 41,1" C.
II. 110.n;nMTenbHocTM:
1) MHMOneTH8..11 - .n;o .n;BYX 'JaCOB;
2) OCTpa.ll - OT HeCKonbKMX 'IaCOB .n;o 15 .n;HeM;
:!) OCTpa.ll, 3c1>eMepH8..11 - OT HeCKOnbKMX 'JaCOB .n;0 .n;BYX
JIIII'li;
4) lIo.n;ocTpa.ll - OT 10 .n;HeM .n;o 45 .n;HeM;
4) XpOHFI'IeCKa.ll - CBbllUe 45 .n;HeM.
III. 110 xapaKTepy Kone6aHFIM TeMnepaTYPbI.
(' lI/'pBblX MFIHYT CBoero nO.llBJIeHFI.II nMxopa.n;Ka .IIBn.lleTC.II
11I1I II'I'II()-KOMneHcaTopHoM peaKII;HeM opraHM3Ma, B pe3ynb-
1'11'1'1' hOI'Opo i nOBbllUaeTC.II 6aKTepMII;M.n;HOCTb KpOBM, rM6HYT
IIIIJlYCI.l H MHI<p06bI.
([('M BblIIIe TeMnepaTypa Tena, TeM 60JIbIIIe B03pacTaeT
"'(lIIII'IIIUI nOTpe6HocTb B KMcnopOAe, pa3BMBaeTC.II rMnOKCM.II,
11'1' IW'I'0l'oii n ncpnylO O'Iepe.n;b CTpa.n;aeT IJ;HC (II;eHTpaJIbHan:
II"IIIIIIUJI ('HI'Tf'MU). I1pl-I 3TOM B03MomHO B03HHKHOBeHMe 6pe-
I{II. 1'''JIJIl()J 11II.1I m':j, cy.n;opor, CB.II3aHHblX C MHToKcMI<aII;MeM
"I'.'IIIIII,IMU. IIPM nOBbllUeHMM TeMnepaTYPbI Tena, pa3BMTMM
,.... ...111 UI
353
He6JIarOIlPM.IITHbIX CMMnTOMOB He06xo MMO CpO'lHO BbI3BaTb
Bpa'la M OKa3aTb HeOTJIO>KHyJO nOMO b.
I1oMHMTe, 'ITO npM nOBbImemiM TeMnepaTYPbI TeJIa Ha Kam-
bIM rp yc no IJ;eJIbCMIO BbIme 37°C, 'IaCTOTa bIXaTeJIbHbIX
BMmeHMM (Q)J,LO yJ3eJIwumaeTC.II Ha 4 bIXaHH.II, KaK Y B3pOC-
JIbIX, TaR H Y eTeM, a nYJIbC YBeJIIi'lMBaeTC.II - Y B3pOCJIbIX
Ha 8-1 0 y apoB B MMHYTY, a Y eTeM o 20 y apoB B MMHYTY.
113MepeHMe TeMnepaTypbl Tena
B nOAMbiWe'lHOM o6nacTM
Lfe.nb: Onpe eJIMTb TeMnepaTYPY TeJIa B3pOCJIOro n MeH-
Ta.
IIolca3aHu.R.: Ha6JIIO eHMe 3a I}>YHKIJ;MOHaJIbHbIM COCTO.HHM-
eM OpraHM3Ma, npQ(}mJIaRTMKa BHYTPM60JIbHM'UlOM MHl}>eIw;MH.
IIpomu6onOlca3aHU.fl: OnpeJIOC'fM, BOCnamiTeJThHbIe npOIJ;ec-
CbI B nO MbImeqHOM 06JIaCTM.
OCHal eHue: Me.n;MIJ;MHCKMM TepMOMeTp; MH MBM YaJIbHaSI
caJl(l)eTKa, eMKOCTb C e3MHI}>IiIJ;MPYIOIIJ;MM pacTBopOM, TeMne-
paTYPHbIM JIMCT, PY'lKa C 'IepHbIM CTepmHeM, qaCbI, TeMnepa-
TYPHbIM mYPHaJI.
3Tanbl I 06ocHoBaHHe
nOCJeom08K8 K npoljeOype
1. YCTaH08I<1Tb Ao6po>KenaTenbHble 06eCne'feHl<1e OC03HaHHoro y-IaCTI<1S1
OTHOWeHI<1S1 C na l<1eHTOM. 06bS1C- B npo eAype, o6eCne'leHHe npaBa
HI<1Tb na l<1eHTY enb 101 XOA npo e- Ha I<1H4JopMa lO.
Aypbl, nony-ll<1Tb cornacl<1e.
2. BblMblTb 101 OCYWI<1Tb PYKI<1. 06ecne'leHHe I<1H4JeK 1<10HHoi1 6e30-
naCHOCTI<1.
3. AOCTaTb TepMOMeTp 1<13 <!>yrnS1pa. IIIcxOAHoe COCTOS1Hl1e PT}fTHOro
BCTpS1XHyrb ero TaK, 'fT06bl PT}fTHbli1 cTon6l<1Ka.
CTon6111< onycTl<1nCR HI<1>Ke 35"C.
4. OCMoTpeTb nOAMb'We'lHYIO Bna- IIICI<T1IO'feHl<1e noepe>I<AeHI<1i1 KO>KI<1.
AI<1':Y.
5. BblTepeTb Hacyxo K0>KY B nOA- Bnara 1<13M2HReT nOKa3aHI<1S1 repMo-
MblWe\JHoi1 Bn<IA 1He can<!>eT1<oi1. MeTpl<1l<1, TaK KaK oxna>KA8eT pTyrb.
BbmonHeHue npOljeBypbl
1. nOMeCTI<1Tb TepMoMeTp PT}fTHbiM 06eCne'feHl<1e ycnOBI<1i1 AJlS1 nony-
pe3epByapoM B nOAMblwe\JHy\o '1eHI<1S1 AocToBepHoro pe3ynbTaTa.
Bn8Al1HY TaK, 'fT06bl OH co Bcex
CTOpoH COnpl<1KaCanCS1 C KOJKei1.
354
3Tanbl 060cHoBaHI<1e
BbmonHeHue npoljeBYPbl
2. <!>I<1KCl<1pOBaTb pyl<Y na l<1eHTa. Ecnl<1 COCTOS1Hl<1e na l<1eHl a 110300-
npl<1JKaB ee K rpYAHoi1l<T1eTKe, "'nl<1 nReT 310 CAenaTb.
nOl1pOCI<1Tb na4l;1eHTa YAepJKI<1BaTb
f( pMoMeTp npl<1>KaTl<1eM corHyroi1
IIYKI<1.
1, l'I1KCl<1pOBmb BpeM5I1<13MepeHI<1S1
I..MII p.I1YPbl.
4. 1113Bne'lb TepMOMeTp 'lepe3 10
Ml<1l1yr.
6. Ol\OIlI<1TL p03ynbTaT.
I . ('U fiUjI1Tb nd4l;1ellry pe3ynbTaT. 06eCne'feHl1e npaBa Ha I1Hlj>opMa-
111O.
- OKOH'IaHUe npOljeOYPbl
I Iml1( n Ih nOKB3aHHR 4I;1<!>POBbiM 06eCne'feHl1e peri.1cTpa 11 AaHHblX
( ", r"f)nM II fUMnopmYPlloM >KYP- B I1CTOpl11<1 60nrolll<1. npeeMCTBeH-
1111111 (11(,1("1 ,,,,lirnoJ.\ulIl1i1).38TeM HOCTb B pa60Te MeAI1 I1HCKI1X cec-
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( '\l11031<141;1S1 3aBI<1CI<1T ar I1cnonb-
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6. CH Tb nep4aTKI'I.
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8. nOMeCTHTb TepMoMerp B <!>YT- XpaHeHl'le TepMOMeTpoB.
n p.
9. BblMblTb 1'1 ocYWI'ITb PYKI'I. C06nlOAeHl'le nH4HOi1 rl'lrl'leHbl.
PerHcTpaqMSI AaHHblX TepMOMeTpMM
B CTa HoHapHbIx YCJIOBH.IIX pe3YJIbTaTbI H3MepeHH.II TeM-
_ nepaTypbI Il>HKCHPYIOTC.II B mypHaJIe y<leTa, r e YKa3bIBaIOTC.II
ll>aMHJIHH H HHH HaJIbI n HeHToB, .n;aTbI H BpeMSI H3MepeHIi.ll
TeMnepaTypbI (YTPO, Be'lep).
.n;aHHbIe H3MepeHH.II TeMnepaTypbI TeJIa nepeHOC.IITC.II B HH-
.n;HBH YaJIbHbIH TeMnepaTYPHbIH nHcT, BKneeHHbIH B HCTOpHIO
6oJIe3HH (Me H HHCKYIO KapTY na lieHTa).
110 OCH a6c licc TeMnepaTypHoro nliCTa OTMeqaroT aTY
H2MepeHH.II TeMnepaTYPbI, eHb 60ne3HH, a no OCH op HHaT H
IlliCaJIe» T» YTPOM H Be'lepOM CTp .IIT rpa(lmK TeMnepaTYPHOH
KplIBOH COOTBeTCTBeHHO HIl>POBbIX 3am'!ceH B )icypHane. He-
06XO H1I1O nOMHHTb, '1'1'0 Kam.n;oe eJIeHHe Te:\mepaTYPHOH CBT-
KH no OCH op HHaT COC'faBJI.IIeT 0,2 rpa yca C, a TOqICa, COOT-
BeTCTBYIO a.ll TeMnepaType TeJIa na HeHTa, perHcTpHpyeTC.II
tlepHbIM (HJIH CHHHM) CTepmHeM B rpall>e «Y» HnH rpa(pe «B')
cTporo no eHTpy KJIe'TO'lKH.
3TH TOqKH coe HHSIIOT Memmr C060H. rpa(pHK TeMnepaTYP-
HOH KpHBOH npH HaJIH'IHH nHxopa.n;KH OTpamaeT TOT HnH
HHOH ee THn.
B TeMnepaTYpHOM nHCTe B IllKa..'1e «11» CTpO.llT KpHBbIe
'IaCTOTbI nynbca, a B IllKaJIe «AfJ,» - apTepHaJIbHOrO aBne-
HH.II.
B HHmHeH 'IaCTH TeMnepaTypHoro ;IHCTa OTpamaIOT aH-
HbIe nO C'leTa 'I8CTOTbI IJ,bIXaHH.II B 1 MHH, Maccy Tena, KonH-
'IeCTBO BbIllHTOH 3a CYTKH mH KOCTH B Mn, CYTO'lHOe I\OJIH'Ie-
CTBO MO'IH. HanH'me CTYJIa H aHHbIe 0 npoBe.n;eHHoii: CaJIH-
TapHoH 06pa60TKe OTMeqaIOT 3HaKOM «+».
356
nOMOutb npH nmepTepMMH (n IxopaAKe)
IJ;enL: CHH3HTb TeMnepaTYPY Tena B Te'leHHe 3-5 HeM W
1I0pMaJIbHOH.
nnaHIlpOBaHHe ceCTpllHCKoro yxo.n;a
nJlAH 06OCHOBAHIIE
1. !I13Mep Tb TeMneparyPY Tena Ka>K- KOHTponb 3a TeMnepaTypoi1 Tena
Able 2-3 4aca. AJl51 paHHei1 Al'larHOCTI'IKI'I ocnOJK-
o;eHI'li11'1 OKa3aHI'I cooTBercTBYIO-
ei1 nOMO 1'I na l'Ie--/Ty.
2. CorpeTb na4l1eHTa (Tennble rpe,'KI'I Ocy ecTBn5leTC B nepl'lOA oo5lB-
K HoraM, Tenno YKPblTb, AaTb Tennb,i1 neHI'I 03H06a (npl'l nOBblWeH1'I1'I
I'f"'J\KHi14ai1). I'Inl'l CHl1>KeHI'IH TeMneparypbl) AJl51
corpeBaHI'I5I na l'IeHTa, YMeHbwe-
HI'I5I TennOOTAa41'1.
3. OheCne'lI'lTb BI'ITaMI'IHI'I31'1pOBaHHoe An CHI'I>KeHI'I I'IHTOKCI'IKa l'Il'I.
nl'l1l e (COKI'I. Tennbli1 4ai1 C nHMOHOM,
""I"UlI'I CMOPOAI'lHOi1, HaCToeM WI'I-
11I1I1I"1t\.I)
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ryGbI BOAoi1, CMa3b1BaTb Ba3en1'lHO- CTOi1 pTa 1'1 ry6.
D"IM MacnoM, 20% P-POM 6ypbl B rnlol- Jle4eHH5I Tpe I'IH Ha ry6ax.
ljt InlHe, 06pa6aTb'BaTb Tpe I'IHbI Ha
Iyfiax 1% p-pOM 6pl'lnnl'laHToBoi13e-
nOHI'I. .
.J II L TO HIIO Ha6moAaTb 3a na4l1eH- An51 npeAynpe>I<,QeHI'I TpaBM.
111M IIJlI'I upeAe 1'1 rannlOljI'lHa x,
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IIIII'.II I"I,
, !11,M. 1"11" AfJ.1'I nynbc, 4aCToTY .Qn paHHei1 Al'larHOCTI'IKI'I ocnO>K-
II' !KIIlIl'Ili. HeHI'li1 (T_enoi1 AbixaTenbHoi11'1
CePAe4Hoi1 HeAoCTaT04HOCTI'I1.
I. "ClII'1CTpl'lpOBaTb AaHHbie B nl'lCTe An 06eCne4eHI'I npeeMcTBeHHo-
"..hnIOI\OHI'IR CTI'I B pa60Te, Ha6n1OAeHI'I 3a
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1\ '"" III ".nb cMeHy HaTenbHoro 1'1 An npeAynpe>KAeHI'I HapyweHI'li1
IIiU IIIII"'IUI ) O'II ". ryaneT 1<O)f( . Bbl,C\enl'lTenbHoi1 4>YHK HI'I KO>KI'I,
npocPl'lnaKTI'IKI'I nponen<Hei1.
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XUII"II'" '1'1 KOMnpecc Ha welO 1'1 ronoBY CTOpOHbI 4HC (oTe'lHOCTI'I M03ra,
"1'1'1 '1'1111 I'IUJlMI'II'I. npeAynpe>I<,QeHI'I5I HapyweHIo1i1 C03-
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nJ1AH 060CHOBAHIIIE
- Bbl3 R aTb Bpa'la;
- 06nOJKI'ITb TennblMI'I rpenKaM"'. YK-
pblTb, ,QaTb Tennbli1 'lai1:
- CMeH"'Tb 6enbe, npoBeCTI'I BnaJKHoe np",roTOBlo1Tb 1 0% p-p KotPe"'Ha,
06T"'paH",e. 10% pop cynbcj:JoKaM<!>OKa"'Ha;
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:J R
39
38
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CMelia 6el1bS1
III
npOBeTp"BaH"e
,Q"BTa N. 15
YXOA B pa3nH4Hbie nepl10Abi nHxopaAKH:
1 - nepl'loA nOAbeMa, 2 - nepl10A pa3rapa,
3 - nep",oA Kpl'lTI'I'IeCKoro CHI'I>KeH"'!I
358
6. 6. numaHue u lfopMAeHue nallueHma
IblTaHHe SIBJISIeTCSI :1KH3HeHHOM nOTpe6HocTblO opraHH3-
Ma. OHO 06eCne'IHBaeT '1eJIOBeKa 3HeprHeM, BO,D;OH, MaTepHa-
JIOM ,D;JISI nOCTpoeHUSI KJIeTOK U YBeJIH'lIiBaeT COrrpOTHBJISIe-
MOCTb opraHH3Ma K 3a60JIeBaHH.lIM. Ba:1KHO, '1T06bl nHTaHHe
6bIJIO paIJ,UOHaJIbHbIM. IIHTaHHeM T.e. nOJIY'leHHeM H3 OKPY-
:1KaIOIQeH Cpe,D;bI pa3JIWIHbiX nHIQeBbIX Be eCTB, oeym;ecTBJUI-
10TCSI mpu :JfCU31tqHHbte ipYHKijUU:
1. [lJt.acmu'lec aJl - 06eCne'leHHe pa3BHTHSI H HenpepblB-
uoro 06HOBJIeHHSI KJIeTOK H TRaHeM.
2. ,'JllepzemU'teCKaJl- nOCTYnJIeHHe 3HeprnH Heo6xo,D;HMOM
lI.nn R()('I\O.nUPIIHSI ::mcpr03aTpaT .opraHU3Ma B nOKoe H npH
Jll06011 IInl'PY31ce.
3. Pl'zYJ1.UPYlOlU,YJl -,D;OCTaBKa B opraHH3M BeIQeCTB, He06-
XOJ{I-IMbIX l!JI.II 06pa30BaHHSI q,epMeHToB, ropMOHOB H ,D;PyrHx
P,'I'YJlnTOpOB 06MeHHbIx npOIJ,eCCOB.
()('IIOllllble COCTaBHble '1aCTU nHIQH - 3TO 6eJIKH, :1KHpbI,
yrJIf'nO,D;bI MIIHepaJIbHbIe BeIQeCTBa, BHTaMHHbI H BO,D;a.
HeJII_" - :1KH3HeHHO He06xo,D;HMbIe Be eCTBa, 06ecne'IHBa-
1011 {He pOCT, pa3BHTHe H 06MeH Be eCTB B opraHH3Me. EeJIKH
('JIY>IU1T MarepHaJIOM ,D;JISI nOCTpoeHHSI KJIeTOK, TKaHe i H op-
1'1111011, lIJ1n 06pa30BaHHSI cpepMeHTOB, ropMOIfOB, reMorJI06H-
1111, I1MMYIIUbIX TeJI. He06xo,D;HMO nOMHHTb, '1TO opraHH3M
1I0'iTiI III' 06JIH,D;aeT pe3epBaMH 6eJIKOB, a H3 ,D;pyrnx nH:r.qe-
III IX IHlrpl'l{HPIITOB 6eJIKH He 06pa3YIOTCSI.
I :"JIIWM oc06eHHO 60raTbi MSICHble H pbl6HbIe npo,D;YKTbl,
1'IIIIpor, Cblp, 6060Bble, I_pynbl, MaKapOHbl, xJIe6, SIHu;a.
JICllpLI (JIHnH,D;bI) - 06JIa.n;a1OT H3 Bcex nHIQeBblX BelIJ,eCTB
IInlll'lnJII,l1lell 3IlepreTWIeCKOH u;eHHOCTbIO. OHH BXO,D;SIT B CO-
I 11\11 IO'f"r01_, Y'IaCTBYSI B 06MeHHbIX npOIJ,eCcax; SIBJISIIDTCSI
II' I II 1111 hiM 1'(',JeIIBOM 3HepreTH'IeCKoro MaTepHaJIa; CJIY:1KaT
IIJlIIIIOJ{IIIIIWMII UlITaMHHOB A, D, E, JIeU;HTHHa, KpOMe HeHa-
.",111\, 11111 IX >IUlllllbiX KHCJIOT; 06eCne'lHBa1OT BcaCbIBaHHe H3
11II11II'1J1ll1<U pnlla nHIQeBblX BeIQeCTB. IIHIQeBaSI IJ,eHHOCTb
"111"'11 nIlJlI'}{I'JlHeTCSI HX COCTaBOM, TeMnepaTYPoH IlJIaBJIe-
111111, IIII.II'I'II11'M UP3aMeHHMbiX nHIQeBbIX Be:r.qeCT , CTerreHbIO
"111';111"'1'11, IIlCY('OJlI>IMH Ka'leCTBaMH.
I h'l'OlllllllmMli :1KHpOB SIBJISIIOTCSI paCTHTeJIbHbIe MaCJIa,
\1111111111',11' MfiCJIa, CJI,HBICH, CMeTaHa, MSICHOH :1KHp, 6060BbIe.
359
YrJleBOALI - HBJlIDOTCH OCHOBHbIM HCTO'IHHKOM 3HepI'HH B
OpraHH3Me. Pa3JIWI8lOT npOCmble yz.neeoObl (npe CTaBJIeHbI rmo-
K030H, c})PYKT030H, caxapo30ii:) H CJlO:J/CHble yz.neeoObl(rrpeACTaB-
JIeHbI KJIeTIIaTKOH, KpaXMaJIOM, rJIHKOreHOM, neKTHHalI'IH).
VrJleBO,l(bI He06xo,l(ID\tbI 1J,JIH 06eCne'IeHruI pa60TbI MbIIIII ,
M03ra, ,l(JIH HOpMaJIH3aIJ;HH c})yHKIJ;HH KHIlle'IHHKa H KHCJIOMO'
JIO'IHOH KHIlle'IHOH c})JIOpbI; OHH YCHJIHBalOT BbIBe,l(eHHe XOJIe-
CTepHHa H nOBbIIllalOT meJI'leOTAeJIeHHe; cnOC06CTBYIOT 3IDKHB-
JIeHHIO H pereHepaIJ;HH CJIH3HCTOH KHIlle'IHHl<a.
VrJIeBOAbI cO,l(epmaTCH B OBOIIJ;ax, c})PYKTaX, Me,l(e, KOII,l(H-
TepCKHX H3,l(eJIHHX, XJIe6e,CJIa,D;KHX HarrHTKax, Kpyrrax, 6060-
BbIX, rpH6ax, opexax.
MHlIepaJlblILIe BeII.J;eCTBa. B 3aBHCHMOCTH OT cO,l(epma-
HHH B opraHH3Me H nHlIWBbIX npo,l(yKTaX nOApa3,l(eJIHIOT Ha
MaKpo- H MHKp03JIeMeHTbI.
MaKpoa.ne.MeHmbl CO,l(epmaTCH B ,l(eCHTKaX H COTHHX MHJI-
JIHrpaMMOB Ha 100 I' npOAYKTa nHTaHlIH.
MUKpoa.ne.MeHmbl npHcyrCTByJOT B KOHIJ;eHTpaIJ;HHX paB-
HbIX ,l(OJIHM MHJIJIHrpaMMa.
K MaKp03JIeMeHTaM OTHOCHTCH KaJIbIJ;HH, c})occ})op, KaJIHH,
MarHHH, HaTpHH, XJIOP, cepa.
K MHKpo3JIeMeHTaM OTHOC.lITC.II meJIe30, Me,l(b, MapraHeIJ;,
IJ;HHK, K06aJIbT, HO,l(, c})TOP, XPOM, MOJIH6AeH, BaHaAHH, HH-
KeJIb,OJIOBO, KpeMHHH,CeJIeH.
MaKp03JIeMeHTbI IaCTBYIOT B nOCTpoeHHH TKaHeH, pery-
JIHIJ;HH KIiCJIOTHO-OCHOBHOI'O COCTO.IIHHH opraHH3Ma, BO,l(HO-CO-
JIeBOrO 06MeHa, OCMOTH'IeCKOrO AaBJIeHHH H T.,l(. MHKp03JIe-
MeHTbI BXO,l(HT B COCTaB HJIH aKTHBHPYIOT ,l(eHCTBHe c})epllteH-
TOB, ropMOHOB, BHTaMHHOB, H TaKHM 06pa30M Y'IaCTBYIOT B
06MeHHbIx npOIJ;eCcax, B npoIJ;eCcax KpOBeTBOpeHH.II H KOCTe-
06pa30BaHH.II H T.,l(.
K Mal<p03J1eMeIITaM OTHOC.HTC.II:
Ka.nbijUU - c})opMHPyeT KOCTHYIO TKaHb, BJUl.IIeT Ha B036y-
AHMOCTb HepBHoH TKaHH H COKpaTHMOCTb MbIIIIIJ;, y<IaCTByeT B
cBepTbIBalIHH KpOBH, YMeHbiliaeT npOHHIJ;aeMOCTb CTeHOI< co-
CY,l(OB. JIy<IIIIHe HCTO'IHHKH JIernOYCBOHeMoro KaJIbIJ;H.II - 11'10-
JIO'IHbIe npO,l(YKTbI.
Ka.nuu - HrpaeT 60JIbIIIYIO pOJIb B peryJI.lIIJ;HH BOAHO-COJIe-
BOI'O 06MeHa, OCMOTH'IeCKOI'O ,l(aBJIeHH.H, KHCJIOTHO-OCHOBlIoro
360
COCTO.IIHHH; OH He06xo,l(HM ,l(JIH HOpMaJIbHOH ,l(eHTeJIbHOCTH
MbIlIIIJ;, B TOM 'IHCJIe MHOKap,l(a; cnoc06cTByeT BbIBe,l(eHHIO H3
opraHH3Ma BO,l(bI H HaTpHH. KaJIHH CO,l(epmHTCH B CYXOc})PYK-
TaX, MOpCKOH KanYCTe, Kaporoc})eJIe, 6060BbIX, nepeHKax, OB-
C1IHOH I<pyne.
MazHu;1- aKTHBHpyeT pH,l( c})epMeHTOB, nOHHmaeT B036y
,l(HMOCTb HepBHOH CHCTeMbI, CTHMYJIHpyeT ,l(BHraTeJIbHyJO c})YH-
KIJ;HIO KHIlle'IHHl<a H meJI'IeOT,l(eJIeHHe, 06JIa,D;aeT aHTHCnaCTH-
'IeCKHM ,l(eHCTBHeM, cnoc06cTByeT BbIBeAeHHIO H3 KHIlle'IHHKa
XOJIeCTepHHa. MarHHH MHoro B nIlleHH'IHbIX OTPy6HX, cyxo-
clJPYKTax, nilieHe, OBCHHOH Kpyne, 6060BbIX.
c1>ocCPOp - y<IaCTByeT B 06pa30BaHHH KOCTHOH TKaHH, Hr-
paeT pOJIb B npoIJ;eCcax mH3He,l(eHTeJIbHOCTH opraHH3Ma, OCO-
6elIIl0 B 06MeHe Bem;eCTB B HepBHOH, MbIIlle'IHOH TKaHHX, B
ne'IelIH H nO'IKax.
(I)oc(\>opa MHOI'O B CbIpe, TBopore, HHIJ;aX, MHce, PbI6e, HKpe.
Ilampuu n x'ROp - nocTynalOT B opraHH3M B BHAe nOBa-
\JCIIIIOH COJIH. HaTpUH HMeeT 60JIbiliOe 3Ha'IeHHe BO BHYTPH-
l(JIeTO'IHOM H Me:>KTKaHeBOM 06MeHe, Y'IaCTByeT B BO,l(HOM 06-
Melle, peryJIHpyeT KHCJIOTHO-OCHOBHoe COCTOHHHe. XJIOP Y'Ia-
rTByeT B 06pa30BaHHIi COJIHHOH KHCJIOTbI )KeJIY,l(O'IHOrO cOKa.
MUKp03JIeMeHTbI
JICe.ne30 - 06eCne'IHBaeT KpoBeTBopeHHe H TKaHeBOe ,l(bIxa-
Imc B opraHH3Me, BXO,l(HT B COCTaB reMorJI06HHa 3pHTpOIJ;H-
1'111\, MHOrJI06HHa MbIIIIIJ;,. Ba:>KHeHIIIHX c})epMeHTOB. JIY'IIIIHH
1\,"I'U'llIHK meJIe3a - MHCHbIe npO,l(YKTbI (H3 HHX YCBaHBalOTCH
"()-25 % meJIe3a), KpynbI, 6060BbIe, xJIe6, HHIJ;a; MeHbilie -
III\JYl<TbI.
liiJa - IacTByeT B 06pa30BaHHH ropMona m;HTOBHAHOH
1'1' '...aI.!. MO,l(OM oc06eHHO 60raTbI MOpCKa.II pbI6bI H npO,l(YK-
"., MII">I: KpeBeTKH, MH,l(HH, MopCKaH KanYCTa H T.,l(.
'/'/I/11J1l1c06XO,l(HM 1J,JIH nOCTpOeHIi.ff IWC:rUOH, oc06eHHo 3y6-
111111 '1"1(111111. (I>Topa MHoro B MOpeKOH pbI6e H npO,l(YKTax MOpH.
At II" Y'IaCTByeT B KpOBeTBopeHHH H TKaHeBOM ,l(bIXaHHH.
\II' '"'1I1I1It3Mli Me,l(H HBJI.HIOTCH M.lICO, pbI6a, MOpenpO,l(YKTbI,
""YIII.., IUI"'fOlpeJIb, a6pHKOCbI, rpYIIIH, KpbI:>KOBHHK".
I {/I III, 1I('06XO,l(HM ,l(JIH HOpMaJIbHOH c})YHKIJ;HH 3H,l(OKpHH-
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361
IUiSI. IJ;HHKOM 60raTbI MHCO. BHYTpeHHHe OpraHJ>1 mHBOTHbIX.
FHI.J;a. pbI6a, rpH6bI.
MapZaHeij aKTHBHpyeT npOn;eCCbI KOCTe06pa30BaHlIH, KpO-
E.eTBOpeHHH; BJIHHeT mi ijJYHKI.J;HH 3H.nOKpHHHbIX meJIe3. JIy<I-
LUHe HCTO'lHHItH MapraHI.J;a - paCTHTeJIbHbIe npo.nyKTbI.
BHTaMHHbI. HnJIHJOTCH perYJIHTOpaMH 06MeHa BeID;ecTB H
pa3HOCTOpOnHe BJIlIHJOT na BCJO mH3He.neHTeJIbHOCTb OpraHH3-
Ma: pa3BHTHe KJIeTOK H TKaneH, ijJynKI.J;HH OpraHOB H CHCTeM,
COnpOTHBJIHeMOCTb K He6JIaI'OnpH.lITHbIM ijJaKTOpaM BHeIIIHeH
Cpe,nbI. BlITaMHHbI ,1\eHCTByJOT Ha 06MeHHble npOI.J;eCCbI CaMO-
CTOHTeJIbHO HJIH BXO,nH B COCTaB ijJepMeHTOB. BOJIbLUHHCTBO
InrraMHHOB He 06pa3yeTC.H B OpraHH3Me IfJIH 06pa3yeTcH B
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Bpa'la. CBe,l(eHHH naJIaTHbIX Me,l(ceCTep CYMIIUIpYeT CTapIllaH
MeAceCTpa OT,l(eJIeHHH, KOTopaH COCTaBJIHeT nop HOllHHK lla
nHru;e6JIOK H nO,l(nHCbIBaeT Y 3aBe1\YlO ero OT,l(eneHHeM.
COCTaBJIeHHe MelIlO, KOHTpOJIb 3a Ka'leCTBOM npo.n:YKTOB,
HX 3aKJIaP;Koii: OCYlQeCTBJIHeTCH Bpa'lOM p;HeTOJIOrOM MJIH .n:H-
eTceCTpoM.
Pe>KHM nHTaHHR
PemHM nHTaHHH npe,l(ycMaTpHBaeT:
1. Onpe,l(eJIeHHOe '1HCJIO npHeMoB nMlQH B Te'leHHe ,l(HH.
2. Orrpep;eJIeHHYIO P;JIHTeJIbHOCTb npoMe:1KyrKoB Me:1K,I1y npH-
eMaMH nm.l. H.
3. BpeMH npHeMOB mU.I.(M.
4. KOJIH IeCTBeHHoe H Ka'lCCTBeHHoe pacnpep;eJIeHHe CYTO I-
Horo pa HOHa Me>K,l(Y OT,l(eJIbHbIMH npHeM8.lI'IM nHlQH.
OnTHMaJIbHbIH npOMeX<YTOK Mem,l(Y npMeM8.lI'IM nHI H pa-
BeH 4 '1aCaM. HO'IHOM nepepbIB p;OJImeH COCTaBJIHTb 10-11
<IaCOB, H 3a 2 '1aca p;o CHa nHlQY npHHHMaTb He peIWMeH1\YCT-
CH. TIpH nHTHKpaTHOM nHTaHHH OpraIIH3yeTcH BTOpOM 3aBT-
p,aK, npH IlleCTHKpaTHOM - nOJI,l(HHK.
OpraHM3aLiHSI nMTaHHSI
Pa3JIH'IaIOT rpynnoBoe nMTaHHe no lla3Ha'leHHOH ,l(HeTe M
HH,1\HBH,D;yaJIbHoe.
368
MH,l{MBH,l(yanbHaH p;HeTa Ha3Ha IaeTCH, eCJIH Y na HeHTa
OTcyrcTByeT anneTMT HJIM HMeeTCH anJIeprlfH Ha KaIme-JIH60
npO,l(YKTbI, a TaIOKe HMeeTCH HCToru;eHMe, conYTCTBYIOru;ee OC-
HOBHOMY 3a60JIeBaHHIO. llpH STOM H3 CTaH,l{aPTHoro CTOJIa HC-
KJIIO IaIOT OP;HH, a BBOP;HT ,l(pyrHe 6JIIO,l(a. MHOr,l(a He06xo,l(HMO
eme,l(HeBHO COCTaBJIHTb MelIlO Ha CJIe,l(yJOlQHM p;eHb, yqMTbIBa.a
BKYCbI na!J;HeHTa H Mep;H MHcKHe nOKa3aHHH, HanpHMep, noc-
JIeOnepa HOHHbIM nepHO,l(.
WCKYCCTBeHHoe nMTaHHe
Kor,l(a eCTeCTBeHHbIM nyreM nHTaHHe HeB03Mom1I0, nHlQY
BBOP;HT B meJIYP;oK HJIH KHIlle IHHK '1epe3 30H,l( HJIH CTOMY
nocpe.v;CTBOM KJIH3MbI. ICorp;a H TaKoe BBe,l(eHHe HeB03MO>KHO,
Torp;a BBO,l(HT nHTaTeJIblIbIe Beru;ecTBa H BO,l(Y B npHMYIO KHIll-
KY HJIH napeHTepaJIbHo.
TIpn HCKYCCTBeHHOM nHTaHHH eyTO'llIaH KaJIOpHMHOCTb
nHlQH COCTaBJIHeT OKOJIO 2000 ItanOpHM, COOTHOIlleHHe 6eJI-
KOB - mMpOB - yrJIeBOp;OB: 1:1:4.
Bo,l(Y na HeHT nOJIY'IaeT B BH,l(e BO,l(HO-COJIeBbIX paCTBopOB
B Cpe,l(HeM 2 JIHTpa.B CyrKI1.
BHTaMHHbI ,l(06aBJIHIOT K nHru;eBbIM CMeCHM MJIH BBOP;HT
napeHTepanbHO. Qepe3 30H,l( HJIH c})MCTYJIY MomHO BBOP;HTb
TOJIbKO >KH,l{KyJO nMlQY: MOJIOKO, 6YJIbOH, CJIHBKH, CbIpbIe HM a,
paCTOnJIeHHOe MaCJIO, CJIH3HCTbIM HJIH npoTepTbIH OBOru;HOH
cyn, mHp;KHM KHCeJIb, c})PYKToBbIe COKH, 'laM, Koc})e.
Pe cnTbI nnTaTeJIbHbIX cMeceM:
1. :lKH,l(KaH nUTaTeJIbHaH CMeCb: 2000-2500 MJI BO,l(bI 250
r cyxoro MOJIOKa, 200 r caxapa, 4-6 r COJIH.
2. CMecb CnacOItYKOD;Koro: 400 MJI TenJIOrO MOJIOKa, 2
CbIpbIX Hii a, 50 r caxapa, 40 MJI cnMPTa, HeMHoro COJIH.
BO,l(HO-COJIeEbIe paCTBOpbI: KOH eHTP HH COJIeH B HMX Ta-
KaH me, KaK B nJIa3Me KpOBH '1eJIOBeKa.
1. TIpocTeMIIIHM pacTBop BOP;HO-COJIeBOii 0,85%-Horo H30-
TOHH IeClwro HaTpHH XJIOpHp;a.
2. PacTBop PHHrcpa-JIoKKa: HaTpMH CI - 9 r, KCl - 0,2
r, CaCl - 0,2 r, HCO a - 0,2 r, rJIlOK03a - 1 r, H 2 0 - 1000 JI.
KOpMJIeBHe naD;HeHTa '1epe3 Ha30raCTpaJIbHbIH 30HA
lfe.nb: BBe.n:eHHe 30H,l(a H KOpMJIeHMe n MeHTa.
IIo1ro3anUR: TpaBMa, nOBpem,ztemre H OTeK .H3blIta, rJIOTKM,
369
ropTaHH, nHil\eBO,lla, paCCTpORCTBO rJIOTaHHH Ii pe'llI (6ym,6y-
H.blli napa.Jlli'i), 6ecco3HaTeJIbHOe COCTOmme, OTKa3 OT llpH
nCHXH'IeCKHX 3a6oJIeBallliJiX, Hepy6 aJ'ICH H3Ba :>KeJIy,l(Ka.
IIpOmU80n01W3anU.R.: H3BeHHaR 60JIe3Hb :>KeJIY,l(Ka B CTa-
,l(IIH 06OCTpeHlIR.
Ocnaw,enue (CTepHJIbHO): 30H,l( 8-10 MJI B ,l(Ha!l!:eTpe, BO-
pOHKa 200 MJI HJIM mnpH maRe, rJIFI epHH, can:l}JeTKM, pa-
CTBOp l}JypaU;HJIHHa 1:2000, 3a:>KHM, 1}J0HeH,l(OCKOn, 3-4 CTa-
KaHa TenJIOR nHlQH.
Ha 30HiJe aeJl.a1Om MemKY: BXO,l( B nH eBO,l( 30-35 CM, B
:>KeJIY,l(OK 40-45 CM, 12-nepcTnylO KHIIIKY 50-55 CM. na H-
eHT Ca,l(HTCH, eCJIM HeT npoTMBonOKa3aHHH.
xoa 30naUp08anU.R.: OCMOTp HOCOBbIX XO,l(OB, 30H.n; CMa3bI-
BalOT Ba3eJIHHOM H BBO.n;HT.
EcJl.u na! uenm 6e3 c03nanU.R.: IIOJIO:>KeHHe JIe:>Ka, rOJIOBY
nOBOpa'IHBaIOT Ha 60K. 30H.n; OCTaBJIHIOT Ha BeCb nepHO,l( HC-
KYCCTBeHHoro nMTaHHH, HO He 60JIee 2-3 He.n;eJIb. npOBO.n;.lIT
npoqmJIaKTHKY npoJIe:>KHeH CJlli3HCTOH.
3Tanbl I 060CHOBaHI1e
BblnonH6Hue npoljooY{)bl
1. H eTb nep'laTK . 06ecne'leH"'B I1Hcj)BK OHHOI1 6e30-
naCHOCTl1.
2. BBeeTl1 '1epe3 HOCOBOI1 XOA TOH- 06eCne'lI1BaeTCfI cB060AHOe npo-
KI1I1 >Kel1YAO'lHbI1130HA Ha rny6HHY ABI1>KeHl1e 30HAa B >KBnYAOK.
15-18 CM, 3aTeM npl1AaTb na4l1eHT)'
nOnO>KeHHe Cl>aynepa (nonycl1.QH) 11
npeA/lO>KI1Tb 3arnaTblBaTb 30HA AO
MCTK .
3. Ha6paTb B wnpH4 }!(aHe B03AYX
30-40 Mnl1 npHcoeAI1Hl1Tb ero K
30HAY.
4. BBeeTl1 B03AYX '1epe3 30HA B BblcnYWHBalOTcSI xapaKTepHble
>KBnYAoK nOA KOHTponBM <!>oHeHAo- 3BYKI1, cBl1,/:\eTenbCTBYIOI1\"'e 0 Ha-
CKona. XO>KABHI1'" 30HAa B >Keny,QKe.
5. OTcoe,Q"'H"'Tb wnpH4 '" HanO>K"'Tb npeAYnpe>KAaeTCfI BbiTeKaHI1e co-
3a>Kl1M Ha 30H,Q, nOMeCTI1B Hapy>K- Aep>KI1Moro >KenY,QKa.
lbll1 KOHe430H,Qa B nOTOK.
6. 3acj)"'Kc"'poBaTb 30HA oTpe3KoM 06eCne'lI1BaeTC5I cj)"'Kca l151 30HAa.
6"'HTa 11 3aBSl3aTb ero BOKpyr n"'l!a 11
ronoBbi na HeHTa.
7. CHSlTb 3aJK M C 30H,Qa, nOACDe- Bo3AYX BblXOAI1T 113 JKenYAKa.
AI1HI1Tb BOpoHKY I1n'" I1CnOnb30BaTb
wnpl1 }KaHC 6e3 nOpWHfll1 onyc-
TI1Tb AO YPOBHfI >KenY,QKa.
8. HaKlloHIoITb cnema BOpoHKY '" npe,Qynpe>f(,t\eHl1e non aHI151 B03-
Hanl1Tb B Hee nO.QroToBneHHYIO Ayxa B >KenY,QoK.
nl111\Y (nop,orpeTb Ha BOAflHOI1 6aHe
AO 38 - 40 °C, nOCTeneHHO nOAHI1-
MaTb BOPOHKY AO Tex nop, nOKa
nl1l1\a He OCTaHeTC5I TonbKO B YCTbe
BOpOHK .
9. OnycTI1Tb BOPOHKY AO YPOBH5I npeAynpe>KAaTb BbiTeKaHl1e COAep-
>KenYAKa '" nOBTOpl1Tb BBe,QeHl1e >K MOrO >'IenYAKa B BOpOHKY.
n"'l1\l1 B >KenYAOK.
10. npoMblTb 3OH,Q 'laeM ",nl1 Kl1nSl-
'1eHOI1 BOAOI1 nocne KOpMneHI151.
3aBepweHue npoljeoypbl
1. HanO>Kl1Tb 3aJK M Ha KOHe4 30H-
Aa, CH5ITb BOPOHKY 11 06epHyrb KO-
He430HAa CTBpWlbHOI1 cancj)cTKOI1,
3acjJI1KC poBaTb.
2. nOMeCTI1Tb KOHe 30HAa
C 3aJK MOM B noTOK I1n'" 3acjJHKCI1-
pOBaTb nemel1 611HTa Ha wee nal.\l1-
eHTa AO cneAYlOl1\ero KOpMneHI151.
3ranbl 060cHoBaHI1e
noiJzomooKa K npoljeoype
1. YCTaHoB"'Tb AOBep"'TenbHble 06eCne'leH e oco3HaHHoro }"IacTl1f1
OTHoweH"'fI C na4 eHTOM (I1n B cOBMeCTHoI1 pa60Te.
C ero pOAcTBeHHI1KaMI1).
2. 06b5lCHI1Tb 4enb npo eAYpbl, Co6nlOAeHI1e npaBa na4HeHTa Ha
non}"l"'Tb ero (l1x) cornaCl1e, 06bSlG- HH<!>0pMa411IO, OC03HaHHoro }"Ia-
HI1Tb nocneAoBaTenbHOCTb AeI1CT- CTI151 B COBMeCTHoI1 pa60Te.
BI1I1.
3. BblMblTb PYKI1, OCYWI1Tb. Co6moAaeTcSI nl1'1Ha51 rnrneHa Me-
AI1411HCK0l1 ceCTpbl.
4. OnpeAenl1Tb A/l"'HY BBOAI1Moro He06xoAl1Moe ycnOB",e A/l51 BBeAe-
30HAa, 113Mepl1B paCCTOSlHl1e OT HI1f1 30HAa B JKenYAoK.
nonocTl1 pTa AO J/(enYAKa (WlI1 APY-
r"'M cnoco60M, Hanpl1Mep, poCT B
CM - 100), nOCTaB"'Tb MeTKY.
5. HamlTb B nOTOK pacTBop cjJypa- CMa'lI1BaHl1e 30HAa 06nel"'laeT BBe-
l1nl1Ha 1:2000", norpY311Tb B Hero AeH",e ero B JKef1Y,QOK.
30HA,Q0 OTMeTKI1.
6. YnoJK"'Tb naL\l1eHTa Ha cn"'HY, YcnOBI1f1, 06eCne'l"'BalOl1\l1e CBo-
nOA/lO>Kl1B noAYWKY nOA ronoBY 11 60AHoe npoxo>KAeHl1e 30H,!\a B 06-
welO, nOMeCTI1B Ha rpYAb cancjJeTKY. naCT'" HOCOrnOTKI1.
370
371
3Tanbl I 060CHOBaHI1e
3aeepWeHUe npOL(coyP'"
3. CH Tb nep'JaTKI1, npo.r:\e3I1Hcjm411- I 06ecne'leHl1e I1Hcj)eK4110HHo.:i 6e3o-
posaTb naCHOCTIol.
4. BblMblTb PYI<I1, OCYWI1Tb. I
06pa3e1.4
Halo1MeHOBaHlo1e Y4pe>K,QeHIo1S1
nOPU OHHOETPE60BAH E
Ha nlo1TaHlo1e 60llbHbiX TepaneBTIiI4eCKOrO
OTAelleHIo1S1 Ha
Ta: ... cno. MeCSILL. ro,Q
CBeAeHHSI 0 HallH4HH 60llbHblX
no COCTOSlHIo1IO Ha 12-00 'lac.
II.U1Cno. MeCSILL. ro,A
HaI1MeHO- KOll-BO B TOM "!HClle no AHeTaM
BaHHe na4HeH- 15 1 7a 5 10
nallaT TOB 9
7 2 1 1
8 6 3 2 1
9 4 2 2
10 7 5 2
Bcero 19 10 1 1 2 1 4
CTapwaSl M/c
3aB. OTAelleHlo1eM
.£laTa COCTaBlleHI151 nop4110HHIo1Ka
nallaTHaSl M/c
IPocnl1Cbf
IPocnl1Cbf
IPocnl1Cbl
KOpMlIeHl1e TSI>Kello6ollbHblX
COCTaBneHHe nOpl.\HOHHOro Tpe60BaHMR
Ha pa3AaTOlfHYIO
eJ1.b: OpraHll3a UI nHTaHHH CTporo no Ha3Ha"IeHHIO Bpa-
'la.
rra.n:aTHaH Me,l(ceCTpa e>Ke,l(HeBHO YTPOM COCTaBJIHeT cnH-
COK na llCHTOB, HaXO,l(.HIQllXC.H Ha CTa llOHapHOM JIe"IeHHll,
r,l(e OTMe'laeT HOMep na.n:aTbI, <D.H.O. na MeHTa, HOMep ,l(He-
TH'leCKOrO CTOJIa, Ha3Ha'leHHOrO Bpa<IOM.
rrop HqHHoe Tpe60BaIme COCTaBJI.HeTC.H B 2-x 3K3eMnJIH-
pax: Ha pa:3,l(aTO'lHYIO H cTapweH Me,l(CeCTpe.
COCTaBneHMe nOpl.\HOHHoro Tpe60BaHHR
Ha nHaqe6noK
rrOp HoHHoe Tpe60BaHHe Ha nHlIw6.n:OK COCTaBJI.HeTCH CTap-
weR Me,l(CecTpoH OT,l(e.n:eHllH. CTapwaH Me,l(CeCTpa CYMMllpyeT
nop HOHHbIe Tpe60BaHHH na.n:aTHbiX Me,l(CeCTep H COCTaBJIHeT
nop HOHHHK no c})opMe;No 1-84.
37Z
373
06pa3e",
6. CaHHTapKH, 3aHHTbJe y60pKOM nOMelQeHHM, K pa3,l(a'le
nH He ,l(OnycKaIOTcH.
7. KaTerOpH'IeClm: 3anpelQaeTCH OCTaBJUITb OCTaTKH nH:r.qH
H rpH3HyJO nocy,l(Y-Y nOCTeJIH naI.J;HeHTa.
HalllMeHOBaHllle OTAeIleHIllSI
nOPU OHHOETPE60BAH E
Ha pa3,QaT04HYIO Ha
AaTa: '4MC110, MecRLL. r
1P0cnlllcbl
nnaHMpOBaHHe Heo6xoAHMOH nOMO H na HeHTY
npM B03HHKHOBeHMM npo6neM,
CBR3aHHbiX C KopMneHMeM
1. llpoBecTH nepBM'IHYIO OI.J;eHKY peaKI.J;HM naI.J;HeHTa npH
KOpMJIeHHH (B TOM '1HCJIe H HCKyccTBeHHoM).
2. OKa3aTb nCHXOJIOrM'IeCKYIO nOMepmKY naI.J;HeHTY MeTO
,l(aMH pa3'b.HCneHHH, y6e:1K,l(eHHH, 6ece,l( TaKHM 06pa30M, '1TO-
6bI naI.J;HeHT CMor coxpaHHTb CBoe AOCTOHHCTBO.
3. llOMO'lb n HeHTY cnpaBHTbCH co CBOHMH '1YBCTBaMH,
,l(aTb B03MO:1KHOCTb BbICKa3aTb CBOH '1YBCTBa, 3MOI.J;HH no no-
BOJ\Y KOpMJIeHHH.
4. Y6e,l(HTbCH B HanH'IHH HHc})OpM MoHHoro COrJIaCHH Ha
KOpMJIeHHe nau;HeHTa.
5. OpraHH30BaTb KOpMJIeHHe, no.n:I'OTOBMTb Bce He06xo,l(H-
MOO.
6. OKa3bIBaTb nOMOlQb BO BpeMH nplfeMa nHlQH.
7. OrpeMHTbcH nO,l(,n:ep:1KHBaTb KOMc}x>PTHbIe H 6e30nacHbIe
YCJIOBHH npH KOpMJIeHHH.
8. OpraHH30BaTb 06yqeHHe naI.J;HeHTa Hera po,l(CTBeHHH-
KOB, eCJIH aTO He06xo,n:HMO, npe,l(OCTaBHTb HHc})opMaI.J;HIO 0
npaBHJIaX nHTaHHH, KOpMJIeHHH.
9. OI.J;eHHBaTb peaKI.J;HH naD;HeHTa Ha KopM.'IeHHe.
lO.YcTaHoBHTb Ha6JIIO,l(eHHe 3a naI.J;MeHTOM nOCJIe KOpMJIe-
HM.H.
nallarn Ne 7
1. <1>1010 - AllleTa N2 1
2. <1>1010 - AllleTa N2 7a
naIlaTa Ne 9
1. <1>1010 - ,QllleTa N2 10
2. <1>1010 - Aillera NQ 10
3. <1>1010 - AllleTa N2 15
4. <1>1010 - Aillera NQ 15
nanaTa N!! 8
1. <1>1010 - AllleTa N2 5
2. <1>1010 - ,QllleTa N2 5
3. <1>1010 - AllleTa N2 9
4. <1>1010 - ,QllleTa NQ 15
5. <1>1010 - AllleTa N2 15
6. <1>1010 - AllleTa N2 15
nallarn N!! 10
1. <l>1010-AllleTa NQ 10
2. <1>1010 - AllleTa NQ 10
3. <1>1010 - AllleTa NQ 15
4. <1>1010 - AIiIeTa N!! 15
5. <1>1010 - AllleTa NQ 15
6. <1>1010 - Aillera N2 15
7. <1>1010 - AllleTa N215
Bcero: 19 "IeIlOBeK
naIlaTHaSl M/c
Pa3Aalia nH M
1. Pa3,l(a'lY nHlQH ocy:r.qecTBJI.HIOT 6yc})eT'urI.J;a (pa3,l(aT'IH-
I.J;a) M nanaTHa.H Me.n:cecTpa B COOTBeTCTBHM C ,l(aHHbIMH rrop-
D;HoHHoro Tpe60BaHH.H.
2. KOpMJIeHHe T.H:1KeJI060JlbHbIX OCYlI.J;eCTBJIHeT Me,l(CeCTpa
Y nOCTeJlH naI.J;HeHTa.
3. TIaI.J;HeHTbI, HaXO,l(HlQHeCH Ha 06meM pe:1KHMe, npHHH-
lttalOT IIMID;Y B CTOJIOBOM.
4. llaI.J;HeHTaM, Haxo.n:HlQHMCH Ha,nanaTHOM pe:1KMMe, 6y-
c})eT'IHI.J;a H nanaTHaH Me,l(CeCTpa ,l(OCTaBJlHIOT nlf:r.qy B naJlaTY
Ha CneI.J;HanbHbIX CTOJlHKax.
5. llepe,l( pa3,n:a'leM nHlQH Me,l(CeCTpa If 6yc})cT'mI.J;a ,n:OJI:1K-
HbI Ha,l(eTb XaJIaTbI, MapKHpOBaHHbIe <',l(JlH pa3,l(a'lH nl'llQH&,
BbIMbITb PYI<H.
nOMOUJ;b BO BpeMH npHeMa nHUJ;H
1. CnpocMTb naD;HeHTa, B KaKoM nOCJle.n:OBaTeJlbHOCTH OH
npe,l(nO'lHTaeT npHHHMaTb nHlQY.
2. llpoBepHTb TeMnepaTYPY I'OpH'lHX HanHTKOB, KanHYB
HeCKOJlbKO KaneJlb ce6e Ha TbIJIbHYIO CTOPOHY PYKH.
3. JIyqrue nHTb HanHTKM '1epe3 Tpy60'lKY.
5. TIHTb :1KH,l(KOCTb, KOr,l(a HeT BO PTY TBep.n;oM nH:r.qH.
374
375
KopMneHMe TR)f(eno6onbHblX
II01W.3aHUJl: nOCTeJIbHbIH pe>KMM, TH>KeJIOe COCTO.IIHMe na-
MeHTa.
1. 3aKOH'lMTb Bce JIe'le6Hble npo e ypbI, y60PKY naJIaT,
npOBeTJ)MBaHMe nOMeIQeHMH.
2. BbIMbITb CBOM PYKM M PYKH na HeHTa (HJIH nporepeTb
BJIa>KHbIM nOJIOTeH eM), OCYIlIMTb.
3. llOKpbITb rPY b MJIH IlIelO na MeHTa ca.n:c})eTKoH MJII1
nOJIOTeH eM.
a
6
--
KopMneHl1e TSI)I{ello6ollbHblX:
a - 113 nOl>!nbHI>!Ka; 6 - 113 nOJKKI1
376
1
I
4. llocTaBMTb Ha TYM60'lKY MJIM npMKpoBaTHbIH CTOJIMK
TemIYlo el1.Y (cTaBMTb TapeJIKY C nMIQeH Ha rpY b na MeHTY
HeJIb3H).
. 5. llpM aTb n HeHTY y 06Hoe nOJIO>KeHHe (eCJIM aTO B03-
MQ)KHO) - CMl1.H'lee HJIM nOJIyCM SI'lee.
6. llO HHTb JIeBOH PYROH I'OJIOBY na MeHTa BMecre C no-
,l\YIlIKOH (eCJIM CM H'lee nOJIO>KeHMe HeB03MO>KHO), a npaBoH
PYKOH nO HeCTM JIO>KKY HJIH nOHJIbHHK C nHIQeH KO PTY).
7. HaKopMMTb na MeHTa.
8. llpoTepeTb CMO'leHHbIM BO OH (BJIa>KHbIM) nOJIOTeH eM
ry6bI M no 60po OK naItHeHTY, BbITepeTb CYXMM KOH OM no-
JIOTeH a.
9. Y6paTb nocy y, CTPHXHYTb KpolIIKM C nOCTeJIH, YJIO-
>KMTb na HeHTa B y 06Hoe nOJIO>KeHMe.
10. BbIMbITb H OCYIlIMTb PYKM.
CaHHTapHo-rMnteHMileCKaR y60pKa nHLqe6noKa
M 6y(j:IeTHb!X B OTAeneHMRX cTaLiHoHapa
1. CTJ)oro C06JIIO aeTC.H pe>KMM MbITbH CTOJIOBOH, KYXOH-
HOH M CTeKJIHHHOH noey,l(bI.
2. Y60PO'lHbIH MHBeHTapb nOCJIe MbITbH nOJIOB ,l(e3HHc})M-
HPYeTCH B TOM >Ke Be pe, KOTOpoe MCIIOJIb30Ba.n:OCb Jl,JI.II y60PKH
(B 0,5% -1 % OCBeTJIeHHOM pacTBope XJIOpHOH 1f3BeCTM - 60
MHHYT, ,l(aJIee npOnOJIaCKMBaIOT B BO,l(e M cyrnaT).
3. E>Ke,l(HCBHO npOBO,l(HTC.II MbITbe creH, oCBeTHTeJIbHOH ap-
MaTYpr.r, O'lHCTKa CTeKOJI OT nbIJIM. AJIH ,l(e3MHc})eK MM nOMe-
IQeHHH (nOJIOB, creH, ,l(BepeH M T.n.) npMMeHHIOT 1%-HbIH
OCBeTJIeHHb!H paCTBOp XJIOpHOH M3BeCTM MJIH XJIOpaMMHa. Becb
y60PO'lHbIH MHBCHTapb ,l(OJI>KeH 6bITb npoMapKMpoBaH 11 xpa-
HMTbCH B Cne MaJIbHO OTBc eHHOM MeCTe.
Byc})eT'm bI ,l(OJI)KHbI MMeTb caHMTapHble KHH>KKM.
KOHTponb 3a noceLqeHMeM naLiHeHToB
M nepeAalieM npoAYKTOB
eRb: npoc})MJIaKTHKa BHYTPM60JIbHH IHbIX MHc})eK Mii, co-
6JIIO,l(eHMe Ha3Ha'leHHOH ,l(MeTbI.
1. llOCeTMTeJIH ,l(OnYCKaIOTC.H B OT,l(eJIeHMe K n8l.\MeHTaIlI B
CTporo onpe,l(eJIeHHOe BpeMH, YRa3aHHOe B pe>KMMe OT,l(eJIeHl'f.II.
2. Me,l(CeCTpa 0.6H3aHa CJIe nTb:
3?7
a) '<ITo6bI nOCeTHTeJIH HMeJIH CMeHHYIO 06YBb H Me,lJ;HI\HHC-
KHH XaJIaT;
6) 'IT06bI noceTHT<!JIH He yTOMJIHJIH naI\HeHTOB ,lJ;JIHTeJIb-
HbIMH pa3rOBOpaMH. He CaAHJIHCb Ha KpOBaTb. He I\eJIO-
BaJIH HX. He coo6Il\aJIH HenpHHTHble HOBOCTH;
B) Me,lJ;CeCTpa npOBepEeT nepe,lJ;aBaeMbIe npo,lJ;YKTbI. OHH
,lJ;OJImHbI COOTBeTCTBOBaTb ,lJ;HeTe naI\HeHTa, HaXO,lJ;HTbCH
B YUaKOBKe co CpOlWM rO,lJ;HOCTH 11 B u;eJIJIo$aHOBOM
KYJIbKe.
KOHTponb 3a caHHTapHblM COCTOAHHeM TyM6o'leK,
xonoAHnbHHKOB, CpOKOM xpaHeHHA
nHaqeBblx npOAYKTOB
:QeJlb: C06JIIO,lJ;eHHe caHHTapHo-npOTHB03nH,lJ;eMJ'I'leCKOro
pemm.!:a. npo.pHJIaKTHKa BHyTpH60JIbHH<IHbIX HHtPeKI\HH. nH-
Il\eBbIX OTpaBJIeHHH.
B TYM60'<lKax pa3pemaeTCH xpaHHTb MbIJIO. 3Y6HYIO naCTY.
3y6HYIO Il\eTKY B .pYl'JIHpe, paC'<IeCKY B (lJYTJIHpe HJIH B I\eJIJIO-
.paHOBOM KYJIbKe. mypHaJIbI, ra3eTbI. KOH(lJeTbI, BapeHbe. ne-
'<IeHbe xpaHHT Ha ,lJ;pyrOH nOJIKe TYM60'<lKH.
tflpyKTbI H CKopOnOpTHIl\HeCH npO.l\yKTbI XpaHlITCH B XO.
JIO,lJ;HJIbHHKe. !{:HCJIble, MOJlO'<lHble npO,lJ;YKTbI xpaHRTCH B XO-
JIO,l:\HJIbHHI<e He 60JIee 2 CYTOK.
HeJIb3:a: XpaHHTb B XOJIO,lJ;HJIbHHKe KOHcepBHpoBaHHble M:a:C-
HLle. pbI6Hble npO,ll;YKTbI. .
TIaJIaTHaH Me,lJ;CeeTpa o6H3aHa:
1. OCYIl\eCTBJIHTb eme,lJ;HeBHbIH KOHTpOJIb 3a caIIHTapHbIM
COCTo:a:HHeM TYM6o<IeK. XOJIO,lJ;HJIbHHKOB H HX CO,lJ;epmHMbIM.
2. OCYIl\eCTBJIHTb eme,l:\HeBHbIH KOHTpOJIb 3a ,lJ;e3HH(lJeKI\H-
eH TYM6o'<leK, KOTOpa.H ,lJ;OJImFa npOBO,lJ;HTbCH eme,lJ;HeBHO YT-
pOM H Be'<lepOM 1% -lIbIM paCTBopOM XJIOpaMHHa.
3. TIPOH3BO,lJ;HTb pa3MopamHBaHHe XOJIO,lJ;HJIbHJlKa 1 pa3 B
He,lJ;e.JI1O (no rpalpHKY) C nOCJIe,l1;YIOIl\eH ,lJ;e3HHc:peI< HeH 1 % -HbIM
paCTBopOM xJ.lOpaMHHa.
4. YMeTb nJIaHHpOBaTb Heo6xo,lJ;HMYIO nOMOIl\b naI\HeHTY.
318
XapaKTepHCTHKa ne'le6HblX AHeT
)];HeTa M 0
IIOIW3anU.1l: ,lJ;HeTY Ha3Ha<Ia1OT B nepBble ,lJ;HH nOCJIe onepa-
I\HH Ha opraHax nHIl\eBapeHHH. a TaKme npH npeKOMaT03-
HbIX COCTOHHHHX (TpaBMbI rOJIOBHOrO M03ra. HHCYJIbT. JIHXO-
pa,lJ;Ka).
06l1{a.1l xapaKmepucmuKa: ,lJ;HeTa COCTOHT H3 mH,lJ;KHX.
meJIenO,lJ;06nbIX 6JIIO,lJ;. CJIH3HCTbIX OTBapOB. JIerKOrO MHCHoro
6YJIbOHa, mH,lJ;KHX npOTepTbIX Kalli. KHCeJIen H ,lJ;p.
Pe:JICUM numanu.1l: nHIl\Y ,lJ;alOT m>06HbIMH nOpI\HHMH '<Iac-
TO. ,Z:(HeTY Ha3Ha'<laIOT. I<aK npaBHJIO. Ha HeCKOJIbKO ,lJ;HeH.
,n;HeTa M la \/
IIoKa3anu.1l: H3BeHHaH 60JIe3Hb meJIY,lJ;Ka H ,lJ;BeHaAI\aTH-
nepCTHOH KHlliKH B nepHO,lJ; pe3Koro 060CTpeHHH H BblpameH-
HOH CHMnTOMaTliKH. XpOHH'<IeCKHe raCTpHTbI C coxpaHeHHOH
CeKpeTOpHOH (lJYHKI\Heii B nepHO,lJ; 060CTpeHHH.
06l1{a.1l xapaKmepucmUKa: (lJH3HOJIOrH'IeCKaH ,lJ;HeTa C CO-
,lJ;epmaHHeM 6eJIKa. mHpa. yrJIeBO,lJ;OB. orpaHll'IeHHeM nOBa-
peHHOH COJIH. XHMH<IeCKHX H MexaHH'IeCKHX pa3,lJ;pamHTeJIeH
CJIH3HCTOH 060JIO<IKH H peI\enTOpHoro annapaTa meJIY,lJ;Ka H
,l:\BeHa.n;u,aTHnepCTHOH IHilliKH. CTHMYmITOpOB meJIY,I:\O'IHOH ceK-
pe:WiH, BeIl\eCTB, KOTopbIe npO,lJ;OJImHTeJIbHO 3aAepmHBalOTCH
B meJIY,l1;Ke.
KYJlunapnG..Jt o6pa60mKa: Bee 6JIIO,I:\a BapeHble HJIH npHI'OTOB-
JIeHHble Ha napy. mH,lJ;KOH H KaIlIJiII\e06pa3HOH KOHCHCTeIIIJ,HH.
PeJICUM numanu.1l: nHIl\Y ,lJ;aIOT 5-6 pa3 B CyTKH.
)];JleTa M 16
06l1{a.1l xapaKmepucmuKa: ,lJ;HeTa CO,lJ;epmHT (lJH3HOJIOrH-
'<IeCKOe KOJIH'<IeCTBO 6eJIKa. mHpa: OrpaHH'<IHBaeTCH nOBapeH-
HaH COJIb. yrJieBO,lJ;bI. BeIl\eCTBa, 06JIaAalOIl\He CBOHCTBOM pa3-
,lJ;pamaTb CJIH3HCTYIO 060JIO'<lKY H peI\enTOpHbIH annapaT me-
JIY,lJ;O'<lHO-KHme'IHoro TpaKTa, CTHMYJIHTOpbI meny,lJ;O'<lHOH ceK-
peI\HH. CO,lJ;eHcTByeT 3amHBJIeHHIO E3B, 3p03JIH. YMeHblliaeT
BoCn HTeJIbHble npOI\eCCbI.
319
KYllunapnaR- o6pa6omH:a: nHIIJ;Y .n;a1OT B n1Ope06pa3HOM,
mH.n;KOM BH.n;e C I1IHpOKHM HCnOJIb30BaHHeM MOJIOKa H MOJIO'<l-
HbIX npO)J;YKTOB. Bce 6JI1O.n;a npHrOTaBJIHBa1OTcH B BapeHOM
BH.n;e HJIH Ha napy.
Pe:HCUM. numanUJl: 6-7 pa3 B cyrKH.
)];HeTa M 1
IIoH:a3anUJl: H3BeHHaa: 60JIe3HI> meJIY,l\Ka H ,l\neHaAU;aTH-
nepcTHoM KHlUKH B nepHO,l\ 060cTpeHHH, XpOHH'<IeCKHe raCT-
pHTI>I C coxpaHeHHoM ceKpeU;HeM B nepHO,l\ 06ocTpeHHH.
06l1{aJl xapaH:mepucmuH:a: .n;HeTa C (lJH3HOJIOrH'<IeCKHM co-
.n;epmaHHeM 6eJIKOB, mHpOB H yrJIeBO,l\OB, OrpaHH'<IeHHeM no-
BapeHHoM COJIH, YMepeHHbIM orpaHH'<IeHHeM MeXaHH'<IeCKHX H
XHMH IeCKHX pa3.n;pamHTeJIeM CJIH3HCTOM 060JIO'<lKH H peu;en-
Topnoro annapaTa meJIy.n;otJHo-KHlUe'<lHOrO TpaItTa, CTHMyJIH-
TOpOB meJIy.n;o'<lHOM ceKpeU;HH, BeIIJ;eCTB, .n;JIHTeJIbHO 3a,u.epmH-
Ba1OIIJ;HxcR B meJIy.n;Ke.
KYllunapnaJl o6pa60mH:a: nce 6JlIo.n;a rOTOBHTCH B Bape-
HOM nH,l\e HJIH Ha napy. ,Z:(onycKa1OTcH OT,l\eJIbHl>Ie 6JI1O.n;a B
3ane'<leHHOM BIme.
Pe:HCuM. numanUJl: 5 - 6 pa3 B cyrKH.
.lI.lIeTa M 2a
IIoH:a3anUJl: OCTpl>Ie raCTpHTbI, 3HTepHTbI H KOJIHTbI B ne-
pHO.n; pelwIIBarrecu;eHU;HH KaK nepexo.n; K pau;HoHaJIbHoMY nH-
TaHH1O; xpOHH'<IeCKHe raCTpHTbI C ceKpeTopHoii He,l\OCTaTO'<l-
HOCTb1O, 3HTepHTbI, KOJIHTbI B nepHO.n; CTOMKOM peMHccHH 6e3
CODyTCTBY1OIIJ;HX 3a60JIeBaHHM ne'<leHH, meJI'<IeBbIBo.n;HIIJ;eM CH-
CTeMbl, no.n;meJIy.n;O'<lHOM meJIe3bI, raCTpHTbI C coxpaHeHHoM
celtpeIJ,HeM.
06l1{QJl xapaH:mepucmuH:a: ,l\HeTa C (lJH3HOJIOrn'<leCKHM co-
.n;epmaHHeM 6eJIKOB;mHpoB H yrJIeBo.n;OB, OrpaHH'<IeHHeM no-
BapeHHoM COJIH, YMepeHHbIM OrpaHH'<IeHHeM MeXaHH'<IeCKHX H
XHMH'<IeCKHX pa3,l\pamHTeJIeM CJIH3HCTOM 060JIO'<lKH H peu;en-
TopHoro annapaTa me_'lY,l\O'<lHO-KHlUe'<lHoro TpaKTa, CTHMYJIH-
TOpOB meJIy.n;o IHOM ceKpeU;HH, BeIIJ;eCTB, .n;JlHTe.JIbHO 3aA e p:mH-
BaroIIJ;HXCH B meJIY,l\Ke.
380
KYllunapnaJl o6pa6omH:a: Bce 6JI1O.n;a rOTOBHTCH B Bape-
HOM BH.n;e HJIH Ha napy (npoTepTble), Herpy6l>Ie copTa MHca H
pl>!61>I rOTOBHTI> KYCKOM. ,Z:(onycKa1OTcH OT.n;eJIbHble 6JI1O.n;a B
3ane'<leHHOM BH.n;e 6e3 rpy60M KOpKH. CB060.n;HaH mH.n;IWCTb -
,l\0 1,5 JI, nOBapeHHaH COJII> - 8-10 r.
Pe:JICuM. numanUJl: 4-5 pa3 B CYTKH.
)];lIeTa .]\;'!! 2
[JOH:a3anUJl: OCTpble raCTpHTbI, 3HTepHTbI H KOJIHTbI B ne-
pHO,l\ BbI3.n;opOBJIeHlm; XpOHH'<IeCKUe raCTpHTbI C ceKpeTopHoM
Ue,l\OCTaTO'<lIlOcTb1O, 3UTepHTbI, KOJIHTbI B nepHO.n; peMHCCHH
6e3 conYTCTB -roIIJ;HX 3a60JIeBaHUM ne'<leHH, meJI'<IeBbIBO.n;HIIJ;UX
nyreM, no.n;meJIy,l\O'<lHOM meJIe3bI.
06l1{aJl xapaH:mepucmuH:a: .n;HeTa (lJH3HOJIOrn'<lecKH nOJIUO-
u;eHuaH, C paU;HOHaJIbHOM KYJIHHapUOM 06pa60TKoM npo.n;Ylt-
TOB, 3a nCKJI1O !eHHeM npo.n;yRTOB H 6.'11O,l\, HBJIH1OIIJ;HXCH Ha-
rpY30'<lHbIMH ,l\JIH meJIY,l\O'<lUO-KHlUetJuoro TpaKTa, .n;OJIro 3a-
,l\epmHBa1Oru;HXCR B meJIy,l\Ke, TPY.n;UO nepeBapHBaeMbIX, pa3-
.n;pama1OIIJ;HX CJIH3HCTY1O 060JIO'<lKY H peu;enTopHblM annapaT
meJIY,l\O'<lHO-KHlU€'<IUOrO TpaKTa; cBo60.n;I!aH mH,l\KOCTI> - 1,5
JI, nOBapernraH COJIb .n;o 15 r.
Pe:JICuM. numanu:/.: 5-6 pa3 B CYTKH.
)];lIeTa M 3
[J0H:a3anUJl: xpOUn'<leCKHe 3a6oJIeBaHHH KHlUe'<lHHKa C npe-
06JIa,u.auHeM CHU,l\pOMa ,l\HCKHHe3HH (3anopbl) B nepHO,l\ uepe3-
Koro 060cTpeuHE H peMHCCHH, a TaKme npH CO'<leTaHHH 3THX
3a6oJIeBaHHM C nopameHHCM meJIY,l\Ka, ne'<leHH, meJI'<IeBbIBO-
,l\HIIJ;HX nYTeM, no.n;meJIy.n;o'<lHoii meJIe3bI.
06l1{aJl xapaH:mepucmuH:a: ,l\UeTa (lJH3HOJIOrH'<IeCKH nOJIHo-
u;eHHaR, C nOBbllUCHlIbIM BBe.n;eHHeM McxaHUtJeCKHX H XHMH-
'<IeCKHX CTHMYJIHTOpOB MOTOPHOM (lJYHKU;HH KHlUe'<lHHKa, C HC-
KJI1O'<leHHeM npo.n;yKTOB tI 6JI1O,l\, YCHJIHBa1OIIJ;HX npou;eCCbI 6po-
meHHH H rHHeHHH B KHme'<lHHlte, H CHJIbHbIX CTHMY_'lRTOpOB
meJI'<IeoT.n;eJIeHH , ceKpeU;HH meJIy.n;Ka H nO,l\meJIy.n;O'<lHOM me-
JIeSbI, BeIIJ;eCTB, OTpHu;aTeJIbHO BJIH.H1OIIJ;HX Ha (lJYHKU;HOHaJIb-
HOC COCTOHHHe ne'<leHH H opraHOB meJI'<IeOT.n;eJIeHHH (npO,l\YK-
TbI, 60raTble 3llmpHbIMu MaCJIaMH, XOJIeC"TepHHOM.
381
.lI.lIeTa .M 4
lIoKa3aH.uR-: OCTpble H XpOHH'JeCKHe 3a6OJleBaHHH KHIlle'J-
HHKa B nepHO,!:\ npol}>Y3IibIX nOHOCOB H pe3KO BblpaJKeHHbIX
AHcnen ieCKRX SIBJIeHHH.
0614aR xapaTcmepUcmUKa: AReTa C orpanHtJeHHeM JKHpOB,
yrJIeBO,!:\OB 11.0 HHJKHeii rpaHH bI I}>H3HOJIOrI1"leCKOM HOpMLI H
HOpMaJIbHbIM cOAepJKaHHeM 6e.JIKOB, rnnOXJIOpH,!:\HaH, C pe3-
KHM OrpaHH"leHHeM MeXaHHtJeCKHX H XHMH"leCKHX pa3ApaJKH-
TeJIeH CJIH3HCTOM 060JIOtJKH H pe enTopHoro annapaTa JKeJIY-
,!:\O'illO-ItHIlletJHoro TpaKTa, C HCKJIIOtJeHHeM JIpO,!:\YKTOB JI 6.nIOA,
YCHJIHBaIO X npo eccbI 6pOJKeHllH H I'HHeHHSI B KHIlle"lHH-
Ke, a TaKJKe CHJIbHbIX CTHMYJISITOpOB JKeJI"leoTAeJIeHHH, ceK-
pe HH JKeJIYAKa H nO,!:\JKeJIYAotJHOH JKeJIe3bI, BeW;ecTB, pa3-
ApaJKaIO x netJeHb.
Pe:JICUM numanUJl: 5-6 pa3 B CYTKH.
.lI.HeTa .M 5a
IToKUSaH.UR-: OCTpble renaTHTbI H XOJIe HCTIlTbI, 06ocTpe-
HHH XpOHH"leCKHX renaTHTOB, XOJIe HCTHTOB II JKeJI"l-
HOKaMeHHoM 60JIe3HH.
0614aR- xapaKmepucmuKa: AHeTa 1}>1l3HOJIOrH"leCKH nOJIHO-
eHHM, C YMepeHHbIM orpaHl1"leHHeM JKHpOB H nOBapeHIioM
COJIH, MeXaHH"leCKIlX H XHMlltJeCKHX pa3APaJKHTeJIeH CJIH3IlC-
TOM 060JIOtJKH H pe enTopHoro annapaTa JKeJIYA0tJHO-KHIlletJ-
Horo TpaKTa, C HCKJIIOtJeHHeM npOAYKTOB H 6JIIOA, YCHJIHBaIO-
W;HX npo eccbI 6pOJKeHHSI H I'HHeHHH B KHIlletJHHKe, a TaKJKe
CHJIbHbIX CTHMy.JI.HTOpOB JKeJI"leoTAeJIeHHSI, ceKpe HH JKeJIYA-
Ka, nOAJKeJIYAO"lHOM JKeJIe3bI, BeUJ;ecTB, pa3ApaJKaIOW;HX ne-
tJeHb (3KCTpaKTHBHbIe Bew;ecTBa, opraHHtJecKHe KHCJIOTbI,
POAYKTbI, 60raTbIe 3llmpHbIMH MaCJIaMH, JKapeHble 6JIIOAa,
co,!:\epJKaW;He npOAYKTbI HenO.1IHOrO pacw;erureHHH JKHpa, aJIb-
AerHAbI H aKpOJIeHHbI, TyroruraBKHe JKHpbI, npoAYKTbl, 60ra-
Tble XOJIeCTepHHOM, nYPHHaMH).
Pe:JICU,l,f nUmaH.UR: 5-6 pa3 B CYTKII.
.lI.ueTa .M 5
[JOKaSaH.UR: xpom'ItJeCKI1e renaTHTbI, XpOIiH"leC'KHe XOJIe-
IlCTHTbl, JKeJI'JHOK8MeHH8H 60JIe3Hb; OCTpble renaTHTbI H xo-
JIe HCTHTbI B nepHOA BbI3AOpOBJIeHHH.
382
0614aR xapaKmepucmUKa: AHeTa 1}>1l3HOJIOI'M'leCKH nO.1JHO-
eHHaH. KOJIlltJeCTBO 6eJIKOB, JKHpOB H yr'JIeBOAOB OnpeAeJIH-
eTCH 1}>1l3.HOJIOrn'JeCKIlMH nOTpe6HOCTHMH opnUiH3Ma; HCKJIIO-
tJalOTCSI CHJIbHble CTHMyJIHTOpbI ceKpe HH JKeJIYAKa H nOAJKe-
JIYAOtJHOH JKeJIe3bI (3KCTpaKTHBHble Bew;eCTBa, npOAYKTbl, 60-
raTble 31}>HpHbIMH MaCJIaMH), TYI'OnJIaBKHe JKHpbI, JKapeHble
6JIlOAa, npOAYKTbI, 60l'aTbIe XOJIeCTepHHOM, nypHHaMH; AHeTa
060raW;aeTCJI OBOW;aMH II I}>PYKTaMH, 3a CqeT tJero YCHJIHBae'i'-
CH JKeJItJerOHHoe AeMcTBHe APyrHX nHw;eBbIX Bew;eCTB, YCHJIH-
BaeTCSI nepHCTaJIbTHKa KHIlle'<lHHKa, 06ecnetJHBaeTcSI MaKCH-
MaJIbHOe BbIBeAeHHe XOJIeCTepHHa C KaJIOM.
Pe:JICUM nUmaH.UR: 5-6 pa3 B cyrKH.
)];lleTa .M 6
[JoKaSanUJI.: nOAarpa H MotJeKHCJIbIM AHaTe3; 3pHTpeMHH H
APYI'He 3a60JIeBaHHH, npH KOTOpbIX nOKa3aHO HCKJIlOtJeHHe
MSICHbIX H pbI6HbIX npOAYKTOB.
0614aR xapaKmepucmUKa: HCKJIlOtJalOT npO,!:\YKTbI, 601'a-
Tble nYPHHOBbIMIl coeAIlHeHHHMH; BBOASIT npOAYKTbI, COAep-
JKaUJ;He w;eJIotJHbIe pa,zJ.HKaJIbI (OBOW;H, I}>PYKTbI, HroAbI, MO-
JIOKO), YMepeHHO Ol'paHH'<IHBalOT nOBapeHHYlO COJIb; 60JIbHbIM
C H36bITO'<lHOM MaCCOM TeJIa OrpaHH'<IHBalOT H YI'JIeBOAbI.
Pe:JICuJ"tt numaH.UR-: 5 pa3 B CYTKH; 06HJIbHOe nHTbe 11.02-
2,5 JI mHAKOCTH B BHAe '<IaH, I}>PYKTOBbIX H HrOAHbIX MOpCOB,
ll\eJIO'lIIbIX BOA.
,lI;lIeTa .M 7 a
[JOKasanUR: 'OCTPbIH rJIOMePYJIOHel}>pHT llOCJIe npOBe,!:\eH-
HbIX PHCOBO-H6JIotJHbIX, KapTol}>eJIbHbIX HJIH caxapHblx AHeM;
xpoHHtJecKHH Hel}>pHT B cTaAHH notJe'<lHOH HeAOCTaTo'<lHocTH.
0614aR xapaKmepucmuKa: AHeTa C pe3K1lM OrpaHH'<IeHHeM
6e.JIKOB; JKllpbI H YI'JIeBOAbI B npeAeJIaX I}>H3HOJIOrn'<leCKOH HOp-
Mbl; 6eCCOJIeBaSI, rHnoHaTpHeBaSI ,!:\HeTa (nHW;y rOTOBHT 6e3
COJIH, Cne H8JIbHO BbIlleKaIOT 6eCCOJIeBOH xJIe6); co,!:\epJKaHHe
HaTpHH B npoAYKTax llHTaHHH COCTaBJISIeT 400 MI', - '<ITO COOT-
BeTcTByeT 1 I' nOBapeHHoM COJIH; 60JIbHbIM C HeAOCTaTO'<lHOC-
TblO I}>YHlt HH nO'<leK npH HaJIH'<IHH a30TeMHH no Ha3HatJeHHlO
JIe'<law;ero BpatJa Ao6aBJIHlOT 1-3 r nOBapeHHoM COJIH, HM pa3-
383
pelllaIOT ,l\aBaTb CTOJIbKO :HU!AKOCTH, CKOJIbKO BbIAe.JlCHO MO H
3a npe.n;bI.n;YlI\He CyrKH.
KYllUH.apH.aJl o6pa6omKa: 6e3 MeXaHH eCKOrO Ir(a.meHHH;
OBOlI\H, (}>PYKTbI H HrO,l\bI HCnOJIb3YIOT B ,l\OCTaTO HOM KOJIH-
'leCTBe, 'laCTO B CbIpOM BH.n;e.
:3H.epeou,eH.H.OCmb U cocmae: 2500-2600 KKaJI; 6eJIKOB -
25-30 r; .mHpOB - 80-100 r; yrJIeBO,l\OB - 400-450 r; B
nOBbIllleHHOM KOJIH'leCTBe BBO.n;HT BHTaMHHbI C H B.
Pe:JICuM. numaH.UJl: 5 pa3 B .n;eHb.
,l(lIeTa .M 76
[JOKa3aH.UR: OCTpbIM Heq)pHT nOCJIe AHeTbI Mia; 060cTpe-
HHe XpOHH'leclwro HecPpHTa C OTeKaMH, nOBbIllleHHbIM apTe-
pHaJIbHbIM .n;aBJIeHHeM, HO C coxpaHeHHoM cPYHKl\HeM nO'leK.
06U{aJl xapaKmepUCmu.I(;a: CO,l\ep:;I<:aHHe mHpoB H yrJIeBO-
.n;OB B npeAe1Iax I}>H3HOJIOrH'leCKOM HOpMbI, 110 KOJIH'leCTBO
6eJIKOB YBe1IH'leHO,l\O 45-50 r, C A06aB1IeHHeM O.l\HOM IIOPl\HH
OTBapHoro MHca U1IH oTBapHoM pbI6bI H 200 r M01IOKa H1IH
Kel}>Hpa; B OCTaJIbHOM IIO Ha60py npo.n;YKTOB H xapaKTepy KY-
1IHllaplIOM 06pa60Tlill AHeTa TaKaH .me, KaK H N2 la; co.n;ep.ma-
HHe IIoBapeHHoM COJIH B npO,l\YKTax YBeJIH'lHBaeTCH,I\O 1,5 r.
Pe:JICuM. numanUJl: 5-6 pa3 B CyrKH.
,l(lIeTa .M 7
[JoKa3allUJl: OCTpbIM Heq)pHT B nepHO,l\ BbI3J.\opOBJIeIIHH;
XpOHH'leCKHM HecPPHT C MaJIO BbIpa.meHHbIMH :H3MeHeHHHMH B
oca,l\lte MO'lH: rnnepTOHH'leCKaH 60JIe3Hb H APynre cHTyal\HH,
KorAa He06xoAHMa 6eCCOJIeBaJi .n;HeTa; Hel}>ponaTHH 6epeMeH-
HbIX.
06U{aR xapaKmepucmUKa: 6eCC01IeBaJl, no Ha60PY npo.n;YK-
TOB H xapaKTepy KYJ.mHapHoii 06pa60TKH TaKaH :Hte, Kart H
,l\FleTbI 7a II 76, HO KOJIH'leCTBO 6eJIKOB YBe1IH :HBaeTCH AO 80 r
nyre!\t ,l\06aB1IeHHJI MHca HJIH pbI6bI B OTBaplIOM BlI,I\e, a TaK.me
TBopora; co.n;ep:HillHHe nOBapeHHoM COJUI B npO.D.YI\TaX OK01IO 2
r; B nOBbIllleHHOM K01IH'leCTBe .n;aIOT BliTaMHHbl C, P H rPYJInbI
B; .n;JIJI 60JIbHbIX C Ha}>poTH'leCKHM CHH,l\pOMOM H coxpaHeHHoM
q,ynKl\HeM IIO'leK Ha3Ha'la1OT ,l\HeTY J>& 7 C nOBbIliIeHllbIM co-
384
,l\ep.maHHeM 6eJIKa (,1\0140 r), JIHnOTpOnHbIX q,aKTopoB, nOJIH-
HeHaCbIlI\eHHbIX :HillpHbIX KHC1IOT H BHTaMHHOB.
Pe:HCUM. numanUJl: 5-6 pa3 B CYTKH.
,l(HeTa .M 8
[JoIW3aH.UJl: o.mHpeHHe npH OTCYTCTBHH 3a601IeBaHHM op-
raHOB nHlI\eBapeHHH, ne'leHH H cep.n;e'lHO-cocy.n;HCTOM CHCTe-
MbI, Tpe6YIOlI\HX cnel\HaJIbHbIX pe.mHMOB nHTaHHH.
06U{aJl xapaKmepucmuKa: OrpaHH'leHHe KaJIOpHMHOCTH
nHlI\H, rJIaBHbIM 06pa30M, 3a C'leT yrJIeBo.n;OB H OT'laCTH 3a
C'leT .mHpOB; CO,l\ep.maHue 6eJIKOB BbIllle cPH3HOJIOrH'leCKOM
HOpMbI; BBOAHT OBOlI\H H I}>PYKTbI B ,l\OCTaTO'lHOM K01IH'le-
CTBe: OrpaIlH'lHBaIOT nOBapeHHyIO COJIb; HCKJIIO'laIOT BKYCO-
BbIe npHnpaBbI H a30THCTbIe 31WTpaitTHBHbIe BelI\eCTBa, B03-
6y.m,l\aIOll\He anneTHT; YMepeHHO OrpaHH'lHBaIOT BBe,l\eHHe CBO-
60,l\HOM .mH,l\KOCTH.
Pe:HCuM. numanUJl: 'laCTbIe npHeMbI MaJIOI<aJIOPHMHOM nHIl\H
.n;OCTaTO'lHOrO 06'heMa, YCTpaHHIOlI\Fle 'lYBCTBO rOJIo.n;a.
AHeTa .M 9
[JoKa3aH.UR: caxapHbIM .n;Ha6eT npH OTCYTCTBHH al\H,l\03a H
conyrcTBYIOID;HX 3a60JIeBaHHM BHYTpeHHFlX opralIOB.
06U{aJl xapaKmepucmuKa: AHeTa C cOAep.maHHeM 6eJIKOB
BbIllle (}>H3HOJIOrH'leCKOM HOpMbI, YMepeHHbIM orpaHH,eHHeM
.mHpOB H yr1IeBo.n;OB; JIeI'ROYCBOHeMbIe yrJIeBO,l\bI HCKJIIO'laIOT:
B ,l\HeTY BBO,l\HT BelI\eCTBa, OKa3bIBaIOlI\He JIHnOTpOnHoe ,l\eM-
CTBHe; nHlI\a CO,l\ep.mHT .n;OBOJIbHO Mlloro OBOlI\eM; OrpaIIHQH-
BaIOT COJIb H npO,l\YKTbI, 60raTbIe XOJIeCTepHHOM.
Pe:HCuM. numanUJl: npHeM nHlI\H 6 pa3 B ,l\eHb; yrJIeBo.n;bI
pacnpC,l\e1IJlIOT Ha BeCb ,l\eHb; cpa3Y nOC1Ie HH'heKl\HH HHCYJIH-
Ha H Qepe3 2-2,5 'I nOCJIe Hee 60JIbHOM ,l\OJI.meH n01IY'laTb
nHlI\Y, cO,l\ep:HilllI\YIO yrJIeBOAbI.
,l(HeTa.M lOa
[JoKa3aH.UJl: 601Ie3HH CepAl\a C He.n;OCTaTO'lHOCTbIO KpOBO-
06palI\eHHH II-III CTaAHH; rHnepTOHHQeCKaH 60JIe3Hb C He,l\O-
CTaTO HOCTbIO KpoB006palI\eHHH FlJIH HapYllleHHeM M03rOBoro
.3 3a<.291
385
KPOB006palI\eHIoUI; HHc1JapKT MHOKap a B OCTpOM HJIH no o-
CTpOM nepHO e.
06w,a.fl xapmcmepucmwcu: cO ep»<:aHHe 6e.JlKOB B npe e-
JIaX HH»<:HeH rpaHHI\bI <]>H3IiOJIOrIi'leCKOH HOpMbI, YMepeHHoe
OrpaHH'leHHe »<:Hpa H yrJIeBO OB; BCIO nHlI\Y rOTOBHT 6e3 COJIH,
HCnOJIb3YIOT CneI\HaJIbHbIH 6eCCOJIeBOH xJIe6; BBeAeHHe CBO-
60 HOH »<:H KOCTH OrpaHH'lHBaIOT; Bce npO YKTbI rOTOBHT B
BapeHOM BH e HJIH Ha napy; nOBapeHHOH COJIH B npO,/:\YKTax
nHTaHHH He 60JIee 1,5-1,8 r.
Pe:JICUM numanUJl: He MeHee 6 pa3 B ,/:\eHb, B He60JIbllIOM
06'beMe.
J{YllunapnaJl o6pa6omlCa: 06bf'lHaH C COXpaHeHHeM a30TH-
CTbIX 3KcTpaKTHBHbIX BelI\eCTB; npHHocTH pa3pemeHbI.
Pe:J/CuJw' numanUJl: 4-5 pa3 B AeHb.
,lI;lIeTa .M 13
,lI;HeTa .M 10
IIolCa3anuJ/,: 3a60JIeBaHHH Cep e'lHO-coCY,/:\HCTOH CHCTeMbI
(peBMaTH3M If nopOKIf cep,/:\I\a, rlfnepTOHIf'leCKIUI 60JIe3Hb,
IfmeMIi'leCKaH 60JIe3Hb cep'/:\I\a), 3a6oJIeBaHIiH HepBHoH CIiCTe-
Mbl, XpOHH'leCKFlH He(lJpFlT Ii nFleJIOHe(lJpFlT TOJIbKO C H3MeHe-
HFISIMFI B oca Ke MO'IFI.
06w,asz xapalCmepucmulCa: ,/:\HeTa C OrpaHFI'leHFleM nOBa-
peHHoH COJIH (5 r), FlCKJIIO'leHFleM a30TFlCTbIX 3KCTpaKTFlBHbIX
BeIr(eCTB H nPJIHOcTeH; BBo m npO YKTbI, peryJIFlPYIOlI\Fle ,/:\eH-
CTBFle KFlllIeqHHKa, - OBOlI\H, (lJPYKTbI, HrO,l(bI, co ep»<:alI\Fle
Herpy6yIO paCTFlTe.JlbHYIO I<JIeT'IaTKY, a TaK»<:e nmeHH'lHbIH
xJIe6 C OTpy6HMH If P»<:IDWH.
J{YllunapnaJl o6pa6olnlCa: C YMepeHHbIM MeXaHH'<IeCKFlM
lI\IDKeHFleM.
Pe:JICuJIf. numan!lsz: npFleM nFllI\FI 5-6 pa3 B eHb B YMepeH-
HOM KOJIH'<IeCTBe, Y»<:HH 3a 3 '<IaCTFI AO CHao TIPFI cep,/:\e'<lHO-
COCY,l\FICTblX 3a60JleBaJIHHX BBe eHIie CB060AHOH »<:FI,W(OCTFI 01'-
paHFI'lFlBaIOT ,/:\0 1000-1200 MJI.
IIolCa3anu.fl: HHC!JeKI\HOHHbIe 60JIe3HH B OCTpOM JIHXOpa-
.n;O'lHOM nepHOAe; aHrHHbI. ..
06w,aJl xapalCmepucmulCa: co.n;ep»<:aHHe 6e.JlKOB Ha HH»<:HeH
rpaHFlI\e (lJFl3HOJIorJoL'leCIWH HOpMbI, YMepeHHoe OrpaJIFI'<IeHFle
»<:HpOB, yrJIeBO OB; BBOAFITCH nOBblllieHHoe KOJIH'leCTBO ;»tH,D;IW-
CTFI D B e BFlTaMHIIFl3HpOBaJIHbIX HallliTKOB; mil1\Y ,/:\aIOT B npo-
TCJI'I'OM lIHJ\C C YMepeHllbIMH XFlMFI'leCKFlMH pa3,lJ;paJKHTe.JlHMH.
J>e:JICUM lWmaIlU.fl: He MeHee 6 pa3 B ,/:\eHb, B OrpaHH'leH-
110M I OJIH'ICCTDC.
,lI;ucTa.M 14
lIolCaJanusz: <}JOcc1JaTYPFlH C lI\eJIO'lHOM peaKI\HeM MO'IFI FI
BblIIa,u.eHHeM oca,/:\Ka IjJocc1J0pHO-KaJIbI\FleBbiX COJIeH.
06w,aJl xapalCmepucmulCa: B AHery BBO,/:\HT npo.n;yJ<:TbI, cno-
co6cTByIOlI\He Ii3MeHeHFlIO peaKI\FIFI MO'lIi B KHCJIYIO CTOPOH ;
FlCKJIIO'laIOT npo.n;YKTbI, OKa3blBaIOlI\Fle OlI\eJIa'<lFlBaIOIr(ee .n;eH-
CTBHe FI 60raTbie KaJIbn;HeM (MOJIOKO, TBopor, CbIp); 06lI\ee
KOJlH'ICCTBO cB060AHOM »<:FI,/:\KOCTH 1,5-2 JI.
KYJ/l/1lapnaJl o6pa6omlCa: 06bI''lHaH.
PeJlwM. numallUJl: 4-5 pa3 B .n;eHb.
,lI;HeTa .M 15
,lI;lIeTa .M 11
IIolCa3anusz: Ty6epKYJIe3 JIerKHX npH OTCYTCTBFlH 3a6()JIe-
BaHIiH BHYTpeHHFlX opraHOB.
06w,asz xapalCmepucmulCa: I<aJI0pHI1HaH AHCTa C nOBbIllIeH-
HbIM COAep»<:aHHeM 6e.JlKOB FI BFlTaMFlHOB, YMepeHHblM YBe.JlFl'
qeHFleM »<:rspOB H yrJIeBO OB; B nHlI\eBOH paunOH BKJIIO'laIOT B
,/:\OCTaTO'IIlOM KOJIIi'leCTBe MO.r.:O'<lHbie npO,/:\YKTbI, 60raTbIe
KaJIbI\FleM; nOBapeHHaH COJIb Ii »<: KOCTb B npelleJIax HOpMbi.
II OlCa3anusz: pa3JIH'lHbIe 3a60JreBaJIHH npH OTCYTCTBHH no-
Ka3aHHH ,/:\JIH Ha3Ha'<leHFlH cneI\FlaJIbHOH JIe'<le6HOH AFleTbI H
npFl HOpMaJIbHOM COCTOHHFIFI OpraJIOB nHIr(eBapeHFlH.
06w,asz xapalCmepucmulCa: co ep»<:aJIFle 6e.JlKOB, mHpOB, yr-
JIeBOAOB FI KaJIOpFlHHOCTb COOTBeTCTByJOT HOpMaM nFlTaJIHH 3 0-
paBOro 'leJIOBeKa, He 3amITOrO (lJH3H'leCKFlM TPY OM; BHTaMHHbI
_ B nOBbImeHHOM KOJIFI'leCTBe; nFllI\a COCTOHT H3 pa3Ho06pa3-
HbIX npo.n;yKTOB; HCKJllO'laIOT TPY HonepeHOCFlMbIe mHpHbIe 6JIIO-
a, c.n;06Hoe TeCTO; npHHOCTFI B }'!.!:epeHHOM KOJIFl'leCTBe.
J{YllunapnaJl o6pa6omlCa: _06bI'lHaH, paI\FlOHaJIbHaH, C
coxpaHeHHeM BFlTRMHHOB.
Pe:JICUM numanu.fl: 4-5 pa3 B eHb.
386
13*
381
6.1. KAU3Mbl. ri1300msogHaR mpy6lfa
Kn.u3Ma - JIe'ie6HO- arHOCTHqeCKaH MaIDmYJIH HH, npe,ll;-
CTaBJIHIOIIJ;aH C060H BBe,!:\eHHe B HH:>KHHH OTpe30K TOJICTOM
KHlliKH pa3JIHqHbIX :>KH,!:\KOCTeM.
B 3aBHCHMOCTH OT eJIH pa3JIH'IaIOT ,lI;Ba THna JIe'tJ:e6HbIX
KJIH3M:
- OqHCTHTeJIbHble H nOCJIa6JIHIOIl Me KJIH3MbI.
- JIeKapCTBeHHbIe H nHTaTe.JIbHble.
BBO,ll;HMa.fl :iKH,l\KOCTb npH nOCTaHOBKe O'iHCTHTeJlbHOM KJIH3-
MbI, OKa3bIBaeT MeXaHHqCCKOe, TeI\mepaTYPHoe H XHMUqeCKoe
B03,l\eMCTBHe, YCHJIHBaeT nepHCTaJIbTHKY, pa3pbIXJIHeT I<aJIO-
Bble MaCCbI H 06JIerqaeT HX BbIBe,!:\eHHe.
MeXaHH'ieCKOe ,!:\eMCTBHe KJIH3MbI TeM :ma'iHTe.iIbHee, qeM
60JIbllie KOJIHqeCTBO :>KHJJ;KOCTH. KpOMe MexaHH'IecKoro B03-
,l\eMCTBHH YCHJIeHHIO nepHCTaJIbTHKH cnoc06CTBYE!T TeM epa-
TYpa BBO,!:\HMOM :iKH.QKOCTM. TIPH aTOHH'ieCKOM 3anope TeMne-
paTypa :>KM,lI;KOCTH + 12°C. TIPH CnaCTH'IeCKOM 3anope npHMe-
HHIOT TeIIJIble HJIH rOpHqHe KJIH3MbI, TeMncpaTypa :>KH,!:\KOCTH
37°-40°-42°C, paCCJIa6JIHIOIIJ;He rJIa,zJ.KYIO MycI<YJIaTYPY KHlli-
KH.
- TpeIIJ;HHbl B 06JIaCTM 3a,ll;HerO npoxo,l\a;
- BbIIIa.n;eHHe npHMoH KHlliKH.
OCHal1{eHue: .
- cmepullbHbte: JIOTOK, KJIH3MeHHbIH HaKOHeqHHK, CaJIIjJeT-
KH, nHH eTbI;
- KPY:>KKa :3cMapxa, lliTaTHB, KJIeeHKa, neJIeHKa, eMKOCTb
C BO,l\OH B KOJIH'ieCTBe 1,5-2 JIHTpa, eMKOCTb C ,lI;e3HHIj>H HPY-
IOIIJ;HM pacTBopoM, CY,lI;HO, BO,l\HHOH TepMOI\teTp, Ba3eJIHH, CaJI-
(j)eTKH MaJIbIe, llinaTeJIb ,lI;JIH CMa3bIBaHHH HaKOHe'iHHKa Ba3e-
JIHIIOM;
- cne o,!:\e:iK,lI;a: JIaTeKCHble nepqaTI<H 0,ll;HOpa30Bble, Me,!:\H-
I\HHCI<HH XaJIaT, KJIeeHqaTbIH lj>aPTYK, CMeHHaH 06YBb.
OfiJl.wmeJ/.bHbte YCl106UJl: to BO,l\bI, BBe,l\eHHOM B KHllie'tJ:-
11111<, l\OJI:>KHa COOTBeTCTBOBaTb CJIe,l\YIOIIJ;HM nOKa3aTeJIHM BO,!\-
1101'0 TepMoMeTpa:
. - npH aTOHHqeCKOM 3anope - 12°-20°C;
- np... cnRCTH'leClWM 3anope - 37°-40°-42°C;
- npH 3Rnopc - 20°-25°C.
- '\ O'lHCTHTenbHaR KnJt3Ma
L(eJ/.b: ,!:\06HTbCH OTXO:>K,lI;eHHH KaJIOBbIX Macc, H ra30B.
II OlW3aHUJl:
- nO,ll;rOTOBKa na HeHTa K peHTreHOJIOrHqeCKoMY HCCJIe,l\o-
BaHHIO OpraHOB nHIIJ;eBapeHH.H, MO'ieBbI,l\eJIeHHH H opraHoB
MaJIOrO Ta3a;
- nO,ll;rOTOBKa na HeHTa I( 3H.U.ocRonH'tJ:ecKoMY HCCJIe,ll;OBa-
HHIO TOJICTOH KHlliKM;
- npH 3anopax, nepe,l\ nocTaHoBKoH JIeKapCTBeHHOH H nH-
TaTeJIbHOH KJIH3MbI;
- nO,ll;rOTOBKa K onepa MM, pO,l\1iM.
II pomu6onOlw3aH UJl:
- KpoBoTe'lelIHe 1I3 m'lIIJ;eB8pHTeJIbHOrO TpaKTa;
- oCTpble BOCnaJIHTe.iIbHble M H3BeHHble npo eCCbl B o6JIac-
TH TO.i.iCTOM KHlliKH H 3a,zJ.Hero npoxo,ll;a;
- 3JI('IKa'leCTBeHHble HOBoo6pa30BaHHH np.HMOll KHlliKH;
- nepBbIe ,l\HH nOCJIC onepa HH Ha opraHax nHIIJ;eBapH-
1 CJIbHOrO TpaKTa;
388
3Tanbl 060CHoeaHHe
nooaomOBK8 K npoLJeiJype
1. YCTaHOBI1Tb AOBCpl1TCnbHblc 06CCne'lCHHe nYTI1 npeOAOIleHI151
KomjJl1AeH l1anbHble OTHOWeHI1f1, npenflTCTGI1a;i B 06U1eHI1H, OC03H8H-
o6eCne'lI1Tb 1130Il5l I1IO, KOMtPOPT- HOro }"I8CTI151 B npo eAypc.
HblB ycnOBI1f1 OCYUlBcTBnCHI1f1 npo-
CAYPbl.
2. YTO'lHI1Tb Y na l1eHT8 nOHI1M8HI1C 06ecnc4HBacTcfI npaBo n8 I1BHT8
.t\CIlI1 101 XOA8 npBACTOflUlca;i npo c- H8 I1HcjJopMa l1lO.
Aypbl.
3. HaABTb xan8T, KIlBCH'I8Tbl cjJ8p- 06CCnC'ICHI1B I1HQ>eK l1oHHoa;i 6830-
T)'K, nCp'laTIM. n8CHOCTI1.
4. H<lIlI1Tb B KpYJKh'Y 3cMapxa 1,5-2 KOIlI1'1CCTBO BOAbl, Hc06xOAI1MOC
nl1tpil BOAbl. Anfl O'II1U1CHI1f1 KI1WC'IHI1Ka.
5. nQABBCI1Tb KPy>KKY 3cMapxa Ha C03AacTcfI AaBncHl1c, Hc06xOAI1-
WT8TI1B. Ha OAI1H MCTp OT ypoBHfI MOC Anfl nOCT)'nncHHfI BOAbl B 1<\01-
nOlla. WC'IHI1K.
6. CMa3aTb KIlI13MCHHbla;i HaKOHC4- 06nc!'!cHl1c BBCACHI1f1 HaKOHB'IHI1-
III1K Ba3BIll1HOM, COCAl1l1l1Tb C CI1C- Ka B npflMYIO KI1WKY. npeAynpc c-
TBMoa;i, Hl1e B03HI1KHOBeHI1f1 HBnpl1f1THblX
oUlYUleHI1a;; B 06IlacTI1 Hapy>KHoro
CcjJl1HKTCpa np5lMOa;; KI1WI<\o1.
389
3rnnbl 060CHOB3HI1e
nooaomOSK8 K npoljeoype
7. 3anOnHI1Tb CI1CTBMY: OTt<pbfTb BeH- npeAynpe>K,!\eHJole BBBAeHI1f1
Tl111b HB CI1CTBMe, BblnycTI1Tb 803AYX, B03Ayxa B np5lMYIO KI1WK}'.
3at<pblTb BBHTl111b.
8. YnO>l<l1Tb naLjl1BHTa Ha neBbla;i 60K, Y4BT BHaTOMI1'1eCKOrO pBcno-
HOrl1 cornyrb B KonBH5IX 11 cnerKa npl1- nO>KeHI1f1 np5lMoa;i Cl1rMOBI1AHOI1
BBcm K >I<I1B01)'. KI1WKI1.
npI1Me'l3HHe: Bcnl1 naljl1eHTB ynOJKI1Tb
Ha 60K HBnb3f1, KIll13MY CTalmT B nono-
>KBHI1I1 naljl1eHTa Ha Cnl1He.
9. nOAJlOJKI1Tb nOA flrOAl1ljbl naljl1eHTB Anfl npBAynpB>K,!\BHI151 3arp513-
KIleeHK}'. not<pblTylO 60nbwoa;i cancjJeT- HeHI151 nOCTenbHoro 6enbfl,
KQa;i. C03AaHI1f1 KOM<!>oPTHblX ycno-
BI1a;i.
r/poseoeHue npoljeoYPbl
1. Pa3ABIo1Hyrb flrOAl1ljbl Y4eT aHaTOMloI'IeCKOrO pacno-
1 - 2 nanbljaMI1 neBoa;i PYKI1, a npBBoa;i nO>KeHI1f1 np5lMoa;i KI1WIG1I1 cl1r-
PYKot1 OCTopmKHO BBeCTI1 HBKOHB4HI1K B MOB\.1,qHOa;i KI1WKI1.
aHanbHoe OTBepcrnB, BHa4anB no HB-
npaBneHl110 K nyn"Y (3 - 4 CM), B 3aTBM
napannenbHO no380HO'lHI1I:)' Ha rny6l1-
Hy8-10CM.
2. OTl<pbITb BBHTl1nb HB CIo1CTBMB. BOAa nOC1)'naBT B KI1UJe'lHI1K.
3. nonpoc&-ITb nBljl1BHrn AblWBTb >K118O- YMeHbwalOTcfI Henplo151THbie
TOM, Ha6nlOABTb 3a COCTOSIHl1eM OUjYUjeHI1f1 nplo1 BBeAeHI1&-1 BOAbl
nBljl1eHTa. B KI1WB4HI1K, paccna6nfllOTCfI
MblWljbl >KI1BOTa.
npocjJl111aKTI1Ka OCnO>KHeHI1a;i.
OKOH'/8Hue npOljeoYPbl
1. 3aKpbITb BBHTl1nb Ha CI1CTBMB. OCTO- npeAynpe>K,D.eHl1e 803H\o1KHOBe-
po>KHO 113BnB'Ib HaKOHe'lHI1K &-13 npflMoa;i HI1f1 Henpl1f1THbiX OUjYUjeHI1a;i.
KI1WK\o1 (HBKOHB4HI1K nOMeCTI1Tb B nOTOK
AJlfl oTpa6oTaHHoro MBTBpl1ana).
2. nOnpOCI1Tb naljl1eHTa B TB'IBHI11110 BpeMfi AJlfl pB3JKI1>KeHI1f1 Kane-
MI1Hyr nOne>KaTb HB Cn&-lHe 11 YABp>KaTb BblX Macc &-I YCl111eH&-Ifi nBpH-
BOAY B KI1WB'lHI1Ke, 3aTBM OnopOJKH&-ITb CTanb TI1KI1.
IG1UJe'lHI1K Ha YHI1T83B 111111 CYAHe.
3. CHflTb KIlI13MeHHbla;i HaKOHB'IHI1K C 06ecnB4eHI1e I1HcjJeKl.jI10HHOa;i
CI1CTBMbI, nep4a1lG1. <!>ap1)'K nOMBCTI1Tb 6e30nacHocTI1.
B BMKOCTb C AB311HcjJI1ljl1PYlOlJ.II'1M
paCTBopOM.
4. CMBHI1TI- ><anaT, nep'laTK\o1, cjJapTYK. 06ecnB4eHl1e &-IHcjJBKljI10HHOa;i
6e3onBcHocrn.
S. nOAMblTb nBljl1eHTB (CM. npOLlBAYPY 06ecne'lBHl1e KOM<!>opTHoro
nOAMblBaHI.1SI TflJKeno6onbHoro). COCTOflHHfI nocne npOljBAYPbl.
1'1
I
;
2
nOCTaHOBKa O'lHCT'1TenbHOM KJlH3Mbl:
1- BBeAeHHe HaKOHe4HHKa,
2 - nOIlO>KeHHe HaKOHe4HHKa npH npo4eAype
B Tex CJIYtJaHX, Kor.n;a 06bI'<IHble O'lHCTHTeJIbHble ItJIH3Mbl
III' J\.UOT mIJ(lJeKTa, HaHJIY<lIlIHM HBJIHeTCH MeTO,!\ cH<pOlIHoro
IIjJIIMJ.lB8HHH KHllIe'<lHl1Ka. B OCHOBe CH<pOHHOrO npOMbIBaHHH
JIC)ICH'1' npIUI Hn C006U-WroIIJ;HXCH COCY,!\OB. O.n;HHM H3 COCY,!\OB
JIDJIHeTCH KHme'lHHK, ,!\pyrHM - BopOHKa Ha HapymHoM KOH-
I e PC3HHOBOM Tpy6KH, BBe,!\eHHOM B npHMYro KHllIKY.
390
391
TIPH nOCTaHOBKe CHll>OHHOM KJIH3MbI C TOKOM mH):\KOCTH
BbIBO):\HTCH H3 KFIIlle'<lHHKa ra3bI, KaJIOBbIe KaMHH H mH,lJ;KHe
KaJIOBbIe MaCCbI. He06xo.l\HMO nOMHHTb, '<ITO cHIlJoHHaH KJIH3-
Ma - 3TO THmeJIaH npOl{e,lJ;ypa ,lJ;JIH nan;HeHTa. TI03TOMY BO
BpeMH npOBe,lJ;eHHH npOl{elJ,ypbI He06xo,lJ;HMO CJIe,lJ;HTb 3a 06-
W;HM COCTOHHHeM nal{HeHTa FI BbInOJIHHTb ee B npHCYTCTBHH
Bpa'Ia.
H eo6xoau.Jnoe YCl106u.e: CJIeIJ,HTb, '<IT06bI H3 KHIlle'<lHHKa
BbIlJ,eJIHJIOCb He MeHblile mHIJ,KOCTH, '<IeM 6bIJIO BBelJ,eHO.
3Tanbl I 06ocHoBaHI1e
nOoaomo6K8 K npo eiJype
5. nOAIlO>KI1Tb nOA SlrOAl1ljbl KIleeHK}' npeAynpe>K,!:\eHl1e 3arpSl3HeHI1S1
TaK. '1T06b1 OHa CBI1Cana B Ta3 WlSl nOCTenbHoro 6enb51.
npOMb'BHblX BOA, cBepxy KIleeHKI1
nOCTem-ITb neneH"Y.
6. npl1rOTOBI1Tb CI1CTeMY, CMa3aTb 06ne!'!eHl1e BBeAeHI1S1 HaKOHe'lHI1-
cnenoiii KOHelj 30HAa Ba3enl1HOM Ha Ka B npSlMyiO KI-IWK}'. npeAynpe>K,!:\e-
npoTSI>KeHI-II-I Hl-le B03HI1KHOBeHWI Henpl-lSlTHblX
30-40 CM. OI1lYl1l eH l-liii.
npo6eiJeHue npOljeiJypbl
1. Pa3ABI-IHyrb 51rOAl-Iljbl naljl-leHTa Y'IeT aHaTOMI-I4eCKOiii oc06eHHoCTI-I
1-2-M nanbljaMI1 neBoiii PYKI-II1 BBe- pacnOnO>KeHI-ISI npSlMoiii 1-1 Cl-lrMo-
CTI-I cnenoiii KOHelj 30HAa B KI-IWe'l- B"'AHOiii KI-IWKI1.
HI-IK Ha rny61-1HY 30-40 CM.
2. B3S1Tb BOpoHKy, npl-lcoeAI-IHeliHYIO npeAynpe>K,!:\eHl-le nonaAaHI-ISI B03-
K 30HAY. Aep>t<aTb ee cnerKa Ha- Ayxa C BOAOiii B KI-IWB'lHI-IK.
KIl0HHO lIa ypoBHe SlrOAl-Ilj naljl1eHTa
11 3anOnHI-ITb BOAOiii B KOnl-l'leCTBe 1
nl-lTpa.
3. nOAHSlTb DOPOHKY TaK, '1T06b1 npeAynpe>K,!:\eHl1e nOn8AaHI-ISI B03-
BQAa yxoAl-lna B KI1We'lHI-IK nl1Wb AO Ayxa C BOAoiii B KI1We'lHI-IK.
ee YCTbSl.
4. OnycTI-ITb BOpOHK}' HI-I>Ke ypoBH5I npl-l TaKOM nono>t<eHI1I-1 BOpOIlKI-I
naljl-leHTa, YAep>t<I-IBaSl ee HaKIlOHHO xopowo BI-IAHbl nY3blpbKI-I B03Ayxa,
11 Bblnl-lBaSl COAep>KI1MOe B eMKOCTb KOMO'lKl1 Kana.
An51 npoMblBHblX BOA.
CHcI>oHHaJl KnH3Ma
ellb: ):\06HTbCH OTXOm.l\eHHH KaJIOBbIX Macc, raSOB H3 BbI-
COKHX OT):\eJIOB KFIIlle'<lHHKa.
II OH:a3aHue:
- OTCyTCTBHe 3Q>Q>eKTa OT O'IHCTHTeJIbHOM KJIH3Mbl;
- BbIBe,lJ;eHHe H3 KHIlle'<lHHKa H,lJ;OBHTbIX Bew;eCTB;
- nOlJ,03peHHe Ha KHIlle'IHYIO HenpOXO.l\HMOCTb.
OCHaw,eHue:
- cmepWzbHble: CHCTeMa .l\JIH CH<POHHOM KJIH3MbI (TOJICTbW
meJIY,lJ;O'<lHbIM 30H,ll, COelJ,FIHeHHbIM C pe3HHOBOM Tpy6KOM C no-
MOW;bIO CTeKJIHHHOM Tpy6KH, JIOTOK, Ba3eJIHHOBOe MaCJIO, BO-
pOHKa eMKOCTbIO 1 JIHTp, nep'<laTKH JIaTeKCHble; eMIWCTb C
BO.l\oii B KOJIH'<IeCTBe 10-12 JIHTpOB, KOBill eMKOCTbIO 1 JIHTp,
eMKOCTb .l\JIH npOMbIBaHI-m, KJIeeHKa, 60JIblillUi neJIeHKa, Ba3e-
JIHH, MaJIbIe CaJI<peTKH IJ,JIH CMa3bIBaHFIH CJIenoro KOHl{a 30H,lla.
A l r; fJ
3Tanbl I 060CHOBaHl-le
noiJzom06K8 K npOljeiJype
1. YCTaHOBI-ITb AOaepl-lTeflbHble 06eCne'leHl-le nyrl1 npeoAoneHI-ISI
KOHcjJl-IAeHljl-lanbHb'e OTHOWeHI-ISI C npen5ITCTBl-liii B 06111eHI-II-I, OC03Ii<JH-
naljl-leHToM. 06ecne'll-lBaeTCfll130- Horo }"Iacm51 B npoljeAype.
nSlljl-1!1 naljl-leHTa.
2. YTO'lHI-ITb y naljl-leHTa nOHI-IM8HI1e 06eCne'lI-lBaeTC5I npaBo naljl-leHTa
ljefll1l1 XOAa npCACTOSll1leiii npOlje- Ha I1H<!>opMal<l-IlO.
AVPbl.
3. HaAeTb xanaT. KIlBBH'IaTbliii <pap- 06eCne'lI-lBaeTCSI I1HcjJeKljI-lOHHa51
Tyi<. naTeKCHble nep'laTKI-I. 6e30nacHocTb.
4. Y'lO>t<I-ITb naljl-leHTa Ha neBbliii Y'IeT aHaTOMI-I'IeCKOiii oc06eHHocm
6OK. HOrl1 corHyrb B KOneHSlX 1-1 cner- pacnOnOJKeH hp5l oiii KI-IWKI-II1
Ka npl-lBBCT101 K >t<I-IDOTY. Cl-lrMoBI1AHoiii KI1WKI-I.
nOCTaHOBKa 01<f!OHHOHIUII13Mbl:
a - oCHallleHl1e AIlII Cl1ljJOHHoiii KI-I3Mbl, 6 - TeXHI1;<a npOBeAeHI111
192
393
3ranbl I 060CHOe3HI1e
npooeiJeHue npoLjeiJYPbl
5. nOBTopl1Tb npOMbiBalil1e AO '1I1C- AOCT\o1raeTCS1 nonHoe 0411U1eHl1e
TblX npoMblBHblX BOA, HO C I1cnOnb- KI1W8'lHI1Ka.
30Balil1eM He MeHee 10-12 nl1TpOB
BOALI.
OKoH'laHue npo eiJYpbl
1.1I13Bne'lb MeAllBIiHO 3OHA, norpy- 06eCn8'lI1eaBTCJ1I1H<!>eK 1.10HHail
311Tb B eMKOCTb C AB3I1HcjJl.1 I.1PYIO- 6e30naCHOCTb.
UlI1M pacTBopoM.
2. npoeecT\o1 TyanEn aHanbHoro 06eCne'leHl1e KOM<!>0pTHoro co-
OTBepCTH5I. CT05lHI1f1 nocne npo eAypbl.
3. CHflTb nep'laTKl.1, (j:JapTYK, X3naT, 06ecn8'll1BaeTCfI I1HcjJeKL\110HHafi
nOMeCT\o1Tb B eMKOCTb C Ae3I1HcjJI1- 6e30nacHoCTb.
I1PY\OUlI1M pacmopOM.
ECJIH BBe.n;eHHe JIeKapCTBeHHblx Bew;ecTB "<Iepe3 pOT He-
B03MO>KHO HJIH npOTHBonOKa3aHO, HX MmKHO BBO,l\HTb "<Iepe3
npHM}'IO KHIUKY C nOMOW;bIO JIeKapCTBeHHbIX KJIH3M. JIeKap-
CTBeHHble KJIH3MbI OKa3bIBaIOT KaK MeCTHoe, TaK H o6w;ee
,l\eiiCTBHe.
KJIH3MbI MeCTHOrO ,l\eMCTBHH npHMeHHIOT npH BOCnaJIUTeJIb.
HbIX npo eccax, JIOKaJIH30BaHHbIX B TOJICTOM KHillKe. K .KJIH3-
MaM MeCTHOrO ,l\eMCTBHH OTHOCHTCH rHnepTOHI-!'leCKaH H Mac-
JIHHaH.
rHnepTOHH eCKaA KnH3Ma
eJlb: BbI3BaTb xopOIUee nOCJIa6mlIOw;ee .n;eMCTBHe 6e3 pe3-
KOM nepFlCTaJIbTHKH KHlIIe"tIHHKa.
IIoKa3anue: OTeRI-! pa3Horo npOHCXO)K.l\eHIUI.
IIpOmu.60nOKa3anue:
- OCTpble BOCnaJIHTeJIbHble H H3BeHHble npo eCCbI B HFI)K-
HHX OT,l\eJIaX TOJICTOM RHIUKH;
- TpeW;UHbI B 06JIaCTH aHaJlbHOro OTBepCTlUI.
Ocnaw,enue:
- CTepI-!JIbHble: rpYIUeBFI.n;HbIM 6aJIJIOH'lHR HJIH IUnpHIJ;
JRaHa, ra300TBO,l\HM TPy6Ra, 10%-HbIM paCTBOp HaTpmI XJIO-
pH.n;a B KOJIHQeCTBe 100-150 MJI, nep'laTRH JIaTeRCHble, Ba3e-
JIHHOBOe MaCJIO, JIOTOK, KJIeeHRa, 60JIbIUa.H neJIeHKa, eMKOCTb
C .n;e3HlI(lJH HPYIOIIJ;HM pacTBopOM.
394
3Tanbl I 060CHoe3HI1e
nOOaomoBK8 K npo eiJype
1. YCTaHOBI1Tb AOeepl1TenbHb'e 06eCn8'leHI1B nynl npeOAvneHH5I
OTHOWeHI151 C naLllo1eHTOM. npenfITCTBl1ii1 B 06U1eHIo1I1, OC03HaH-
Horo }"I8CTIo151 B npOLlBAype.
nOOi30mOBK8 K npo eiJype
2. Y6eAIo1TbcfI B Hanl1'1l1l1 Io1H<I>op a- 06eCne'lI1BaeTCfI npaBO na l1eHTa
LlI1OHHOro cornaCI.1f1 na lo1eHTa Ha Ha Io1H<I>oPMa lo1lO.
npOLleAYPY.
3. nOAorpeTb <!>naKoH C neKapCT- OCYUlecTBnfleTcfI BBeAeH\o1e pac-
BeHHblM cpeACTBOM Ha «BOAflHOiil TBOpeB B TennOM BIo1Ae C enblO
6aHB» AO 38°C. npo<!>l1flaKTl1KIo1 MexaHH'lBCKoro,
TepMIo14eCKoro 11 XI1MI14eCKoro pa3-
Apa>KeHIo1f1 KI.1We'lHIo1Ka.
4. Ha6paTb B rpyweBl1AHbliil 6annoH 06ecne411BaBTCfI AOCTaTOYHOe Ko-
100 (200) Mn nOAorpeToro paCTBO- nlo1yecTBO rnnepTOHIo1'1eCKOrO pac-
pa. TBopa Aflfl nOCTaHOBKIo1 K/l1013MbI.
5. noMOYb naLllo1eHTY ne'lb Ha neBbliil Y4eT aHaTOMH'leCKOiil oc06eHHocTIo1
60K, npaBafi Hora AOmKHa 6blTb pacnOnO>KeHIo1f1 np51Moiil 101 Clo1rMQ-
corHyra B KonBHB 101 npl1>KaTa K >1<11- BIo1J\HOiiI KI.1WKI.1.
BOTY.
npI1Me'laHl1e: npl1 He'103MO>KHOCTIo1
ynO>K\o1Tb na l.1eHTa Ha neBbliil60K,
K/l1013MY CTaBflT B nOnOJKeHlo111 ne>Ka
Ha cnlo1He.
6. H3AeTb xanaT, nep'laTI<Io1. 06ecnB411BaeTcfI Io1HcjJeKL\1.10Hliafi
6B30naCHOCTb.
7. nOnO>l<l1Tb nOA naLllo1eHTa K/leeH- Bo 1136e>KaHIo1f1 3arpfl3HeHIo1f1 no-
KY, 60nbwyIO cancjJeTKY. CTeJlbHOro 6enbfl.
npooeiJeHue npo eiJYPbI
1. Pa3ABIo1Hyrb flroAIo1 bl BBBeTIo1 Y'IeT aHaTOMIo14eCKOfO pacnono>Ke-
ra30oTBoAHYIO TPy6KY B npflMYIO HIo151 npSlMoiil KI.1WKIo1.
I<Io1wKY Ha rny6Io1HY 20-30 CM.
2. npl1COeAIo1HIo1Tb K 'fPy6Ke rpywe- npeAynpe>K,qeHlo1e pa3BI1TI.1f1 Henpl1-
BIo1AHbliiI 6annOH'IIo1K, BbinycTIo1B B03- flTHblX oUlYUleHIo1ii1, BBeAeHI'!51 B03AY-
fJ.YX 113 Hero, I'! Mep,neHHO BBeCTI'! xa B KI.1We'lHI1K.
nOAorpeTbliil paCTBOp.
3. OTCOBAHHI'!Tb, He pa3JKHMa5l, npeAOTBpaUleHl1e nocrynneHl'!fI
rpYWBBl1AHbliil 6annOH or ra3OQT- BOAbl11 COAepJKIo1MOrO I<Io1W8'lHIo1Ka
BOAHoiiI Tpy6bl, 3aTeM 1013Bne'lb ee. 06paTHO B 6annOHYI.1K.
OKOH'/aHue npo eiJYPbl. -
1. nOMecTIo1Tb Io1cnonb30BaHHbie 06ecnB'IeHlo1e Ae3Io1HcjJeK lo1oHHO i
npsAMeTbl MeAI1L1Io1HCKOro Ha3Ha4e- 6e30nacHocT\II.
HI1SI B eMKOCTb C Ae3I1H<!>I1 Io1PYIO-
U Io1M pacTBOpoM.
395
3T3nbl I 060CHOB3HHe
OKOH'/aHUe npo eiJYPbl
2. HanoMH Tb naljl1eHTY, '1To6b1 OH 06eCne'lI1BaeTCfI pa3>KI1>KeHl1e Ka-
38.l1ep>Kan pacTBOp B KMWe'lHI1Ke B nOBblX Macc 11 YCl1Jll1BaeTCfI nepl1-
TB'IeHl1e 15-20 MI1Hyr. CTanbTI1Ka.
3. Y6eAI1TbCfI, '1TO npoljeAypa npo- KOHTpOnl1pyeTCfI creneHb 0'l11111e-
BeAeHa ycnewHo, ocMoTpeB Bbl,Qe- HI151 KMWe'lHI1Ka_
neHI1f1.
4. 06pa60TaTb aHanbHoe oTBep- 06eCne'leHl1e KOMcjJOPTHorO CO-
CTlo1e naljl1eHTa. CTOflHI1f1 nocne npoljeAypbl.
5. CHflTb nep4aTKIo1, nOMeCT\o1Tb B 06ecne'lI1BaeTCflI1H<!>eKljl10HHafi
eMKOCTb C Ae3I1H<!>l1ljI1PYIOI1II1M 6e30naCHOCTb.
paCTBOpOM, BblMblTb PYK\o1.
MacnRHaR KnH3Ma
eJ/.b: 06HTbCH OTXO:iKAeHHH KaJIOBblX Macc, ra30B.
II OKa3aHUR:
- B nepBble ,lJ;HH nocJle onepa HH Ha opraHax 6PIOilIHOH
nOJlOCTH;
- nocJle pOIJ,OB;
- npH He3(vc1JeKTHBHOCTH O'<lHCTHTeJlbHOH KJlH3Mbl.
IIpomu6onoKa3aHuJl:
- KpOBOTe'IeHHe H3 nHIneBapHTeJlbHOrO TpaKTa.
- 3J10Ka'<leCTBeHHbIe HOBo06pa30BaHHH npHMoH KHIllKH;
- BbIn8,l\eHHe npHMoH KHlUlm;
- H3BeHHbie npo eCCbl B 06J1aCTH TOJICTOH KHIllKH H 3a -
Hero npoxo a.
OCHO.Ul,eHue:
- cmepUllbHble: rpYllleBH,lJ;HbIii 6aJIJlOH'<IHK, ra300TBOlJ,HaH
Tpy6Ka, JlOTOK, nep'<laTI(H JlaTeKCHble, MaCJlHHblH paCTBOp B
KOJIH'<IeCTBe 100-150-200 MJI, Ba3eJlHHOBOe MaCJlO, nepeBH-
30'IHbIH MaTepHaJl;
- eMKOCTb C ,!:\e3HHc1JH HpyIOInHM paCTBopoM.
06Jl3ameJ/.bHble YCl106UJl: nocJle nOCTaHOBKH MaCJlHHOH
I<JlH3MbI na HeHT IJ,OJl:iKeH Jle:iKaTb HeCKOJlbKO '<IaCOB, TaK KaI(
MaCJlO, BBe eHHoe B I<Hllle'<lHHI<, nOCTeneHHO 06BOJlaKHBaeT
KaJlOBble MaCCbl H npH xO,!:\b6e n eHTa MO:iKeT BblTel<aTb H3
I<Hllle'IHHKa.
396
3Tanbl 060CHOBaHI1e
nOOzom06Ka K npo eoype
1. YCTaHOBI1Tb AOBepl1TenbHble
KOH<!>I1AeHljHanbHble OTHOWeHI1f1 C
naljl1eHTOM.
2. Y6eAI1TbCfI B Hanl1'1I1I1I1HtPopMa- 06eCne'lI1BaeTCfI npaBo naljl1eHTa
ljlo10HHOro cornaCIo151 naljl1eHTa Ha Ha I1HtPopMaljl1lO.
npoljeAYPY.
3. nOAorpeTb Macno Ha BOAflHa;; Bo 1136e)f(aHl1e MeXaHI1'1eCKOrO Tep-
6aHe AO 38°C. MI1'1eCKOrO 11 XI1MI1'1eCKOrO pa3APa-
)f(eHI151 KHWe'lHI1Ka.
4. Ha6paTb B rpyweBi'lAHbI" 6an- Heo6xOAI1MOe KOnl1'1eCTBO Anfl
nOH'II1K 100 (200) Mn Tennoro Mac- nOCTaHOBKIo1 acjJ<jJeKTI1BHO" Macnfl-
na. Ha;; KIlI13MbI.
5. CMa3aTb Ba3enl1HOBbiM MacnOM 06ner'leHl1e BBBAeHI1f1 HaicoHe'lHI1-
ra30oTBoAHYlO TPy6KY, nOnOJKIo1Tb Ka B npfiMYIO KI1WKY.
6annOH'II1K 11 Tpy6KY B nOTOK.
6. nOMO'Ib naljl1eHTY ne'lb Ha neBbI" Y'IeT cjJI13110n0n.1'1eCKOrO pacnona-
60K. npaBafi Hora A0J1)f(Ha 6blTb )f(eHI1f1 nI»lMO" KHl!J{101 11 Clo1rMbi.
comyra B KoneHe 11 npl1)f(aTa K )f(*
BOTY.
7. HaAeTb nep'laTKM. 06eCne'lHBaeTCfI I1H<!>eKljI10HHafi
6e30nacHocTb.
8. Pa3ABI1Hyrb flroAl1ljbl nalj eHTa 11 npeAynpe>K,!:\eHl1e pa3BI1TI1f1 Henpl1-
BBeCT\II ra30oTBoAHYlO TPy6KY B SlTHbiX ol1lyt1leHI1".
npflMyIO KI1WKY Ha rny6I1HY 20-30
eM.
npI1Me'laHl1e: npl1 HeB03MO>KHOCTI1
ynOJKl1Tb naljl1eHTa Ha neBbl" 601<,
Knl13MY CTaBflT B nOnO>KeHI1I1 ne)f(a
lIa Cnl1He.
10. nplo1COeAI1HI1Tb K ra30oTBOAHO" npBAynpe>K,!:\eHl1e BBeAeHI1f1 B03AY-
Tpy6Ke rpyweBHAHbl" 6annOH'II1K 11 xa B npSlMyIO KI1WKY.
MeAneHHO BBeCTI1 Ha6paHHbI" pac-
mop.
11. OrCOCAl1l1l1Tb, He pa3JK11Mafi. npBAOTBpal1leHl1e BcaCblBaHI1f1
rpyweBI1AHbI" 6annOH OT ra300T- BOAbi 06paTHO B 6annOH'II1K.
BOAHO" TPy6KIo1.
12. 3anOnHI1Tb rpyweBI1AHbl" 6an- "B03AyuJHbl" 3aMOI<I> cnoc06cTByeT
JlOH'II1K B03AYXOM, npl1COeAIo1HI1Tb K YAepJKaHl110 MacnflHoro pacTBopa B
ra30oTBOAHO" Tpy6Ke 11 MeAneHHO np5lMO" KMWKe.
BBeCTI1 B03A}1X.
13. OTcceAI1HI1Tb, lie pa3>KI1Mafl, npeAynpe>K,!:\aeTCfI BblBBACHl1e BO-
rpyweBI1AHbl".6annoH'lI1K OT ra3a- Abl o6paTHo B 6annOH'II1K.
OTBOAHO" Tpy6:<11, 3aTeM 113Bne'lb
ra30OTBOAHYlO TPy6t<y.
391
3Tanbl 060CHOSaHI1e
OKOH'laHUe npoqeOYPbl
I. nOMeCTI1.Tb ra300TBOAHYlO Tpy6- 06eCne411BaeTCSJ IHcpeK41<10HHaSJ
K}', rpyweBl1AHbI 6annOH411K, nOTOK 6e30naCHOCTb.
B eMKOCTb C Ae3I1H<!>114I1PYIOU4I<1M
paCTBopOM.
2. CH5ITb nep'laTKI.1 nOMecnUb B 06ecne4l1BaeTCSJ IH<!>eKLlI<IOHHaSJ
eMKOCTb C Ae3I<1H$1411PYIOI1\I<IM 6e30naCHOCTb.
paCTBOpoM.
3. nOMO'Jb na4l1eHT}' 3aH5ITb YAo6- Macno He BcaCblBaeTCSJ B KI.1We4Hs.I-
Hoe nOnOJKeHs.le B nOCTen.." npeAY- Ke, pa3JKI<I>KaeT KanOBbie MaCCbl I
npeAl'lTb, 4TO a<!>cj>eKr HacTyns.lT Bb13b1BaeT neps.lCTanbTs.lK}'.
4epP31D-124aCOB.
TIpH 3a60JIeBaHH.aX, Kor a nHTaTeJIbHLIe Be eCTBa HeJIb3.a
BBO,l\HTb 'Iepe3 pOT, HX MOJKHO BBO,l\ilTb Qepe3 np.aMYIO KHIlI-
KY. TIpHMeHeHHe nHTaTeJIbHLIX KJIH3M O'leHb OrpaHH'IeHO. B
HHJKHeM OT eJIe TOJICTOH KHIliKH BcaCbIBaeTC.a TOJIbKO BO,l\a,
H30TOIIH'IeCKHH paCTBOp XJIOpH,l\a HaTpH.!I, paCTBopbI rJIIOKO-
3bI H cnHpTa, 'IaCTH'IHO BcaCbIBaIOTC.a 6eJIKH H aMHHOKHCJIO-
TbI. 06'i>eM nHTaTeJIbHblX KJIH3M He OJlJKeH npeBLIllIaTb 200-
250 MJI. Jl,JI.a JIY'IllIel'O y epJKaHH.a paCTBopa B KHllIe'lflHI<e,
06aBJI.!IIOT 5-10 KaneJIb HacTOHKH onH.a. CTaBHTb nHTaTeJIb-
HbIe KJlH3MLI peKOMeH,l(yIOT He'1:J:a e 1-2 pa3 B eHb, TaI< KaK
MOJKHO BLI3BaTb pa3 paJKeHHe np.aMoH KHIliKH. ECJlH JKe OHO
B03HHKJIO, Ha,rJ;O C eJlaTb nepepbIB Ha HeCKOJlbKO ,l\HeH.
JIY'IllIe BCel'O nHTaTeJlbHLIe KJlH3MLI BBO HTb KaneJlbHLIM
nYTeM, 31'01' MeTO HMeeT HeKOTOpble npeHMy ecTBa:
- JKH KOCTb, nocTyna.H B Kl'IllIe'lHHK no KanJl.!IM, JlY'lllie
BcaCbIBaeTC.H;
- KHllIe'lHHK He paCT.aI'HBaeTC.!I, H He nOBLIllIaeTC.a DHYT-
pH6plOiliHoe aBJleHHe;
- He BbI3bIBaeT nepHCTaJlbTHKY KHllIe'IHHKa;
- He npen.aTCTBYeT Bbl.!\eJIeHHIO ra30B;
- He BLI3bIBaeT 60JleH.
KanenbHaH KnM3Ma
;qe.Rb: BBeCTl1 JleKapCTBeHHbIH npenapaT 1:J:epe3 np.aMYIO
<HIlIKY H 06ecne1:J:HTb ero BCaCLIBaHHe.
1I00waa1tue: 60JlbllIa.H nOTep.!I JK KOCTH B OpraHl'I3Me. B
.'ex CJIY'Iaax, KOr,l\a nHTaTeJlbHble Be eCTBa HeJlb3.H BBO HTb
Ia eHTY 'Iepe3 pOT.
398
IIpomU60nOlwaaHUJ/ :
- KpOBOTe'leHHe H3 nH eBapHTeJlbHOrO TpaKTa;
- OCTpble BOCnaJIHTeJlbHble H .H3BeHHbIe npOD;eCCLI B 06JIa-
CTH TOJICTOH I<HIlIKH H 3a,rJ;nero npOXO,l\a;
- 3J10Ka'lecTBeHHLIe HOBo06pa30BaHH.a;
- Tpe HHLI B 06J1aCTH 3a,rJ;Hero npoxo,l\a HJlH BLIna,rJ;eHHe
np.HMOH KHIliKH.
OCHaw,eHue:
- CmepU.RbHbte: KJlH3MeHHLIH HaKOHe'lHHK, JlOTOK, Ba3e-
JlHHOBOe MaCJlO, JleKapCTBeHHLIe paCTBopLI, nep'IaTKH JlaTeK-
CHLIe;
- CHCTeMa JI.a nOCTaHOBKH O'll'ICTHTeJIbHOH KJIH3MLI, CO-
e HH.aIO a.aC.!I C HaKOHe1:J:HHKOM KaneJlbHHD;LI H 3aJKI'IMOM Ha
IIITaTHBe.
IIpeaMembl yxoaa: KJleeHKa, 60JlbllIa.H neJleHKa, BO .aHOH
TepMOMeTp. rpeJlKH t - 40°-45°C.
06Jl3ame.RbHbte YC.R06UJl: CTaBHTb JleKapcTEeHJIyIO KJlH3MY
tlepe3 30-40 MHHYT nocJle 01:J:HCTHTeJIbHOH. BBO HMLIH pa-
CTBOp OJlJKeH 6b1Tb onpe eJleHHOH to, paBHoH 40°-42°C.
3Tanbl 060CHOBaHI1e
nOoaom06Ka K npoqeoype
1. YCTaHOBs.lTb AOBepmenbHble
KOH<!> eH4s.1anbHble OTHOWeHs.l5I C
na4s.1eHTOM.
2. YT04HI1Tb Y naLls.leHTa nOHs.lMaHs.le 06ecne4s.1BaeTC5I npaBo naLls.leHTa
Llons.l s.I xOAa npeAcTcSJU\e npoLle- Ha s.lH<!>0pMaLls.llO.
AYPbl.
3. nOMeCntTb q,naKoH C neKapcT- Bo s.l36eJK8Hs.le MexaH"'4eCKoro.
BeHHblM cpeAcTBoM B eMKOCTb AI151 repMs.l4eCKOro .., Xs.lMI14eCKOro pa3-
npOBeAeHs.l5I.BoASJHOO 6aHH I no- APa>KeHs.l5I KHWe4HHKa.
AorpeTb AO I 40° -42°C.
4. 3anonHs.lTb C ICTeMY neKapCTBeH- nOMep>KaHs.le TeMnepaTYPbl BBO-
HblM BeU4eCTBOM, YKpenwTb wranlB As.lMOrO pacTBopa B npeAenax 3
Ha BblCOTe 1 M, nps.lKpens.lTb rpenK}' K 38°C.
3aAHe I nepeAHe nOBcpxHocnl
Cs.lCTeMbl.
5. nOM04b na4l<1eHT}' ne4b Ha neBbl Y4eT <!>s.l3I-10nOrs.l4ecKoro pacnono-
601<, npaea51 Hora A0J1)KHa 6blTb JKeH I5I npSJMo KI.1WKH 11 Cs.lrMbl.
cornyra B KoneHe 101 npl-1JKaTa K _-
BOT}'.
399
3Tanbl 060CHOBaHHe
n0020mOOKa K npOL{eoype
npI'lMB'IaHl'le: npl'l HeB03MO>KHOCU1
ynOJKl1Tb nallHBHTa Ha nBBb,a;; 60K,
KIlH3MY CTaB T B nOnOJKeHWH nB>Ka
Ha cnWHe.
6. CMa3aTb HaKOHB4HWK CWCTeMbI 06nBf'./BHHB BBe,QeHH5I HaKOHe4HW-
Ba3BnWHOBb'M MacnOM. Ka B np MYIO KWWKy.
7. Ha,QBTb nBp4aTKH. 06ecnB4HBaBTC5I 6B30naCHaR
6onbHw4Ha51 cpe,qa.
8. nOnOJKWTb no,Q nallWBHTa KIleeHKy Bo w36e>KaHWe 3arp 3HeHw no-
w 6onbwylO can<!>eTKy. CTenbHoro 6enb5l.
npoeeoeHue npOL{eoYPbl
1. OrKpbrrb 3a>KHM Ha CWCTeMe W Bcacb'BaeTC nyYwe >KI1,QKOCTb,
oTperynwpOBaTb '1aCTOTY Kanenb nOCTynalOl1\a51 B KI1WB4HWK no Kan-
BBO,QWMOro I1eKapCTBeHHOro cpe,Q- n M.
CTBa (60-80 Kanenb B MWHyry).
2. Pa3,QBwHyrb 51ro,QWlIbI nal.ll1eHTa Y4wTblBaeTc (jJH3wonOrWv,ecKoe
1-2 nanbllaMw 101 BBeCn! cnenGi pacnOnOJKeHWe TonCToro KHwe4HW-
KOHell pe3WHOBoro HaKOHe'lHHKa B Ka.
KI1we4HWK Ha rny6wHY 20-30 CM.
3. CH Tb nep4aTKI1, nOMeCTl'ITb B 06ecne4wBaeTc wH(jJeKI.II10HHaR
eMKOCTb C ,Qe3wH<!>l1l1 W PYlOUjWM 6e30nacHocTb.
pacTBopoM.
OKOH'laHue npOLjOOYPbl
1. Ha,QeTb nep4aTKI1 no I4CTe4eHWH 06eCne'MBaeTC 6e30nacHa
BBe,QeHw neKapcTBeHHoro BeUjeCT- 6onbHw4Ha51 cpe,Qa.
Ba.
2. 3aKpblTb 3a>KWM 1'1 Me.Q1leHHO npe,Qynpe eHl1e B03HwKHOaeHW5I
W3aJle4b HaKOHe4HWK CWCTeMbl 1013 HenpH THblX 0I1\YUjeHWa;;.
aHBIlbHOfO OTBepcTw .
3. 06pa6oTaTb aHanbHoe oTBep- 06ecne4eHwe KOM<!>0pTHoro co-
CTwe nallweHTa. CTO HW5I nocne npoBe,QeHHOa;; npo-
lIe,qYPbl.
4. nOMecTwTb HaKOHe<fHWK W nOTOK B 06ecne4wBaeTC wH<!>eKl.II1oHHa51
eMKOCTb C ,Qe3wH<!>WI.II1PYIOI1\WM 6e30nacHocTb.
paCTBDpOM.
5. CH5ITb nep4aTKI1, nOMeCTl-ITb B 06ecne4wBaeTc HH<!>eI( WOHHa
eMKOCTb C ,Qe3HH<!>WlI W PYIOI1\I1M 6e30nacHocTb.
pacTBopoM.
400
ra300TBOAHaR Tpy6Ka
\
;qeJ/.b: BbIBe,neHHe ra30B H3 KlulletlHHKa.
1I00waaHue: MeTeopH3M.
IIpoTHBonOKa3aHHe:
- KHllIeqHble KpOBOreqemUI;
- BbIna.z\eHHe npHMOH KHIIII<H.
OCHa.lUseHue:
- CTepHJIbHaH I'a300TBO,nHaH Tpy6Ka;
- CTepHJIbHbIH JIOTOK;
- CTepHJIbHOe Ba3eJIHHOBOe MaCJIO;
- CTepHJTbHbIH nepeBH30qHbIH MarepH!lJI;
- CTepHJIbHble nepqaTKH;
- llIHpMa, KJIeeHKa, 60JIbllIaH CaJI<}>eTKa, Cy,nHO.
06.RaameJ/.bHbte YCJ/.06UJl: ra30OTBo,nHaH Tpy6Ka CTaBHTCH
Ha 1 'lac.
I
3Tanbl I 060CHOBa we
n0020m06Ka K n.ooLjeoype
1. Y6e):\wTbC B Hanw4wwwH(jJ0pMa- 06ecne4v.aaeTc npaBo nalll4eHTa
ljI1OHHOrO cornacl'I nal.ll1eHTa Ha Ha wH(jJopWaljl'110
npolle,QYPY.
2. nOcTaBwTb WWPMY Y KpoBaTw \I130nwpoBaTb OT oKpy>t<alOIljWX B
nalll'leHTa. nanaTe.
3. nOM04b nallweHTY nB4b 6nw>Ke K .Qn51 nyYwero OTXO eHI'I5I ra30B 1'13
KpalO KpOBaTI'I Ha neBbla;; 6oK, Horl'l KI'IWB4HI'IKa.
npW>KaTb K )KI'lBOTY.
npHMB'IaHI'I2: ecnl'l nal.ll1eHTY npo-
TWBOnOKa3aHO nOnOJKeHWe Ha neBOM
6oK}', npl1,QaTb nOnOJKeHWe ne>Ka Ha
cnWHe.
4, Ha):\eTb nep4aTKI'I. 06ecne4WBaeTC5I npo<!>wnaKTI'IKa
npo<!>ecCli10HanbHblx 3apa>KeHI'la;;.
5. nOnOJKI'ITb no,Q ro.Ql1l1bl nallweH- Bo w36e>KaHl'le 3arp 3HeHI'I5I no-
Ta KIleeHK}', a Ha Hee can<!>eTKy. CTenbHoro 6enb5l.
6. nOcTaBwTb Ha cTyn p5l):\OM C na- 06ecne4WBaeTC5I 6e30naCHa51
lIl'1eHTOM CY,QHO C He60nbwwM KonH- 60nbHH4Ha51 cpe,Qa.
4ecTBoM BO,QbI.
7. CMa3aTb Ba3enWHOM 3aKpyrneH- 06nef'./eHwe BBe,QeHW5I HaKOHe4HW
Hbla;; KOHell TPy6K:1 Ha npoHuKeHww Ka B np MYIO KWWKy.
20-30 CM.
8. neperHYTb Tpy6KY no cepe,q11 le, npe,qynpe eHwe B03MOJKHOro Bbl-
3aJKaTb cB060,QHbla;; KOHell 4-M 1'1 5-M TeKaHW5I cO,Qep>KI'IMoro Kwwe4HWKa
natlbllaMW, a 3aKpyrneHHbla;; KOHell BO BpeM Bse,QeHW5I ra300TBo,QHO
B3RTb, KaK nwwYlljee nepo. Tpy6KI'I.
401
...
3Tanbl 060CHOBaHs.1e
npOeeOeHUe npotjeOYPbl
1. Pa3ABs.1Hyrb RrOAs.1l.!bl 1- Y4s.1TblBaeTCR !j>s.13s.10nors.14eCKOe
2 nanbl.!aMs.1 neBOs;, PYKs.1, npaBOs;, paCnOnOJKBHs.1e ToncToro Ks.1We4Hs.1-
PYKos;, BBecrn ra300TBOAHYIO TPy6KY Ka.
Ha rny6s.1HY 20-
30CM.
2. OnycTs.1Tb CBo60Alibls;, KOHel.! ra- BMeCTe C ra3aMs.1 Moryr Bb1Aen5lTbC5I
300TBOAIiOs;, Tpy6K B CYAHO. 101 >Ki4AK1.1e KanOBblB MaCCbl.
np Me'laH e: npH nonO>KeIi s.1 na-
l.!s.1eHTa ne>Ka Ha cns.1lie KOliel.! ra3O-
OTBQAHOs;, Tpy6K1.1 3aBepliyrb a KIle-
eliKY s.1 can!j>eTKy I'! OCTaBHTb Me>K,C\y
HOraMs.1 nal.! eHTa.
3. CH5ITb nep'laTK1.1, nOnO>K Tb.B 06eCne4s.1BaeTCR HIi<!>eKIIs.10IiHa51
BMKOCTb C AB3 H!j> lII'IPYIOIljI.IM 6e30nacliocTb.
pacTBopoM.
OKOH'laHUe npotjeoYPbI
1. HMeTb nep4aTKM.
2. 1i13Bne4b ra300TBoAHYIO Tpy6KY s.13 npeAynpe>K,C\eHHe pa3Bs.1T 51 ocnOJK-
aHanbHoro oTBepCT R no s.1CTB'lelis.1s.1 Helis.1s;, (npOne>KHR).
3aAaHlioro BpeMeHs.1 (1 'lac).
3. nOMeCTs.1Tb ra30oTBoAIiYIO Tpy6KY 06ecne4eHs.1e s.1H!j>eKI.!s.10HHOs;, 6e30-
B eMKOCTb C AB3s.1H!j>s.1I.! PYIOIJ.Is.1M naCHocnl.
paCTBOpoM.
4. 06pa60TaTb aHanbHoe oTBep- 06ecnB4elis.1e KOM<!>OPTHbIX ycno-
crne, BnOJKs.!Tb MB>J\qy 51roAs.1l.!aMs.1 Bs.1s;" npeAynpB>K,C\eHs.1e pa3Apa>Ke-
can<!>eTKY, cMo4eliHyJO Ba3ens.1IiO- Hs.1R B 06naCTs.1-alianbHoro oTBep-
BblM MacnOM. cum.
5. Y6paTb KIleeHKY s.1 can<!>eTKY s.1 06ecne4s.1BaeTC5I HIi<!>et<l1s.10IiHaR
nOMeCTs.1Tb &.IX B lienpoMoKaeMbls;, 6e30nacHocTb.
MeWOK.
6. CHRTb nep4aTK1.1 101 nOMecT&.ITb B )
eMKOCTb C Ae3s.1H!j> lII'IPYIOIJ.I M
pacTBopoM, BblMblTb PYKI1.
KaTeTepJi3an;JIa - BBe eHlle KaTeTepa B MO<IeBOM ny3LIpb.
lJ;eJIJI KaTeTepll3aIJ;l'Ill MO'leBOrO nyabIp.!I CJIep;yIO He.
. llepBaa nOMO b npll OCTpOM 3a.z\cpmKe MO'leUcnycKa,
HllR.
. C UaI'HOCTll'IeCKOM D;eJIbIO npll npOBe eHllll 3H OCRO-
Illi'lecKllX llCCJIe OBaI.mM
. C JIe'le6HOM D;eJIbIO, npOMbIBaIme MO'leBOI'O nY3bIp.!I, BBe-
elIlle B Hero JIeKapCTBeHHbIX Cpe,RCTB.
. llOCJIeOnepaIJ;llOHHbIM nepllO Ha OpI'aHaX MO'leBOM II
nOJIOBOM CllCTeMLI. .
npOTJlBOIlOKa3aHHH: pa3pbIB ypeTpLI, KaTeTepll3aD;llR 1;10-
<IeBOI'O nY3bIpR CTporo npOTHBonOKaaalIa, TaK RaK OHa 'Ipe-
BaTa YI'P030M OnOJIHllTeJIbHOM TpaBMLI, YCllJIeHHIO KpOBOTe-
<IeHll.!I, HH(}mD;llpOBaHllR paHbI.
OCJIO:IKneHHH:
. llpll pe3KOM nepenOJIHeHHH MO'leBOrO nY3bIp.!I (CKOnJIe-
Hlle B HeM 1 JIllTpa II 60JIee MO'lll) ero onopOmHeHl'Ie
OJImHO npOHCXO llTb nOCTeneHHO BO ll36e)i(aHHe 6bICT-
POM CMeHbI aBJIeHHR B ero nOJIOCTll, KOTOpa.!I MomeT
npllBeCTll K pe3KOMY KpOBeHanOJIHeHHIO paCIllHpeHHbIX
:n CKJIepOTll'leCI<ll ll3MeHHeHbIX BeH MO<IeBOrO nY3LIpR,
llX pa3pbIBY H KpOBOTe<IeHllIO. llo:3ToMY He06xo,n;HMo ono-
pomHRTb MO<IeBOM nY3bIpb OT eJIbHbIMll nOpD;H.!IMll no
300 - 400 Mr.. nepemllMaR B npOMemYTKax KaTeTep Ha
2-3 MllHYTLI.
. KpOBOTe<IeHlle ll3 MO<Ie:ncnYCKaTeJIbHOI'O KaHaJIa nOCJIe
npoBe eHoM RaTeTepll3aD;llll, '1a e TaROe OCJIamHeHlle
HacTynaeT y Mym'lliH npll pa3pLIBe CTeHKll MO'le:Hcnyc-
KaTeJIbHOrO KllliaJIa C 06pa30BRHlleM JIOmHOrO xo a (npH
HeYMeJIOM HCnOJIb30BaHHll MeTaJIJIll'leCKoro KaTeTepa).
. BOCnaJIeHlle npM aTKa .!Ill'IKa Y MYm'lHHbI, CB.!I3aHHaR C
npoHMKHOBeHMeM llm}>eKD;llH <Iepe3 nOBpem eHHyro CJIll-
3llCTYIO 060JIo'my ypeTpbI.
. BHeceHHe llHlj)eKD;MH npl'I KaTeTepll3aD;llll, npOllCXO llT
npH HapyrneHllll npaBllJI acenTllKll.
BllAbI KaTeTepoB:
- KaTeTepbI MHoropa30BOI'O M 0 Hopa30Boro I'ICnOJIb30Ba-
Hll.!I. MHOI'Opa30BbIe KaTeTepLI - H3 pe3UHLI II MeTaJIa, O HO-
pa30BLIe- ll3 nOJIllMepHLIX MarepllaJIOB, pa3HLIX HOMepOB II
MMeIO He pa3JIll'lHbiM HaMeTp npOCBeTa.
Kamemep TUMUlUta- llMeeT cYJf(ellHbIii, KJllOBOBll HbIM KO-
He!!;, I'ICnOJII>3yeTcH npll ORa3aHllll nOMOlD;H nau;neHTaM C a.z\eHo
MOM npe CTaTeJIbHOM jKeJIe3bI lIpll 3a.z\ep:>KI(e MO'lellcnycKaHHR.
Kamemep c!JO.RU C Ha.z\YBHbIM 6aJIJIOHOM llCnOJIb3YIOT KaK
nOCTORHbIM KaTeTep. Kamemep He.Ramona llMeIO I'IM YTOJI-
6.8. KamemepU3al.4UR MO"leSOro ng3blpR
402
403
w;eHHbIM KOHel\ H MO:/I<eT 6LITb HCnOJIb30BaH 06yqeHbIM nB.l\H-
eHTOM lJ,JISi CaMOKaTeTepH3al\HH.
,[(JI.!I KaTeTepH3al\HH MO<IeBOI'O nY3bIp.a JKeHIl\HH npHMeH.a-
lOT KOPOTKHH KaTeTep lJ,JIHHOH 15 CM. .
,[(JI.a KaTeTepH3al\HH MO<IeBOI'O nY3blp.!I MYJK<IHH npHMeH.a-
lOT KaTeTepbI lJ,JIHHOH 25 CM.
BH,lI,bl CLeMHblX MO'lenpHeI\IHHKOB.
,[(JI.!I nau;HeHTOB C HelJ,epJKaImeM MO<IH CYW;ecTBYIOT oco6LIe
MO<IenpHeMHHKHH3I'OTOBJIeHHble H3 :maCTH<IHOI'O JIeI'KO MOIO-
w;eI'OC.!I MaTepHaJIa; pe3HHbI, nOJIHMepHblX Ma pHaJIOB - HeH-
JIOHa, KanpOHa.
MO<IenpHeMHHK COCTOHT H3 KaTeTepa, lJ,peHaJKHOI'O MelllKa
COelJ,HHSiIOw;eI'OC.a C KaTeTepOM. ApeHaJKHbIH MelllOK KpenHT-.
c.a HR 6elJ,pe nl\HCHTa (y :/I<eHIl\HH), HJIH Ha I'OJIeIlH (y MYJK-
<IHH) HJIH Ha paMe KpOBaTH T.aJKeJI060JIbHOrO nal\HeHTa.
B HaCTo.aIl\He BpeMSl BMeCTO nOCTO.!IHHorO MO<IenpHeMHHKa
npH HelJ,epJKaHHH MO<IH MOJKHO HCnOJIb30BaTb naMnepCbI lJ,JI.a
B3pOCJIbIX OHH H emHbI H KOM(}>OpTHbI BHe 3aBHCHMOCTH OT
CTeneHH HaCbIIl\CHH.!I JKHlJ,KOCTblO 6JIarolJ,ap.!I HaJIH<IHIO aHTH-
Il>HKaJIbHbIX 6apbepOB. BnHTbIBalOID;He npOKJI KH, BlJYTpeH-
H.a.!I CTopoHa KOTOpbIX H31'0TOBJIeHa H3 I'HlJ,po(}>o6HOI'O HeJKHD-
1'0 MaTepHaJIa, He pa3lJ,paJKalOT KOJKY.
llpOMbIBaHHe MO<IeBOI'O nY3blp.a npOBOlJ,HTC.a C l\eJIblO Me-
XaHH<IeCKOI'O YlJ,aJIeHH.!I npOlJ,yKTOB pacn a TKaReH, I'HO.a HJIH
MeJIKHX KaMHeH, a TaKme nepelJ, 3HlJ,OCKOTIH<IecKHMH HCCJIelJ,O-
BaHH.!IMH Opl'aHOB MO<IeB eJIeHHH. llpelJ,BapHTeJIbHO nepelJ,
npOMLIBaHHeM MO<IeBOrO ny3blp.!I On eJISiIOT ero BMecTHMOCTb
nYTeM H3MepeHH.a KOJIH<IeCTBa MO<IH, BbIlJ,eJIeHHOH 3a OlJ,HO
MO'leHcnYCKaHHe.
3. BBecTH paCTBOp (}>ypal\HJIHHa B MO<IeBOH nY3blpb (npH
aHypHH paCTBOp B MO<IeBOH nY3blpb nocTynaeT CBo6olJ,HO, npH
CBOpa<IHBaHHH KaTeTepa paCTBOp BbITeKaeT 06paTHo MemlJ,Y
KaTeTepOM H cTeHKoH MO<IeHcnYCKaTeJIbHOI'O KaRaJIa, npH 06-
TYPB.l\HH KaTeTepa BBeCTH B Hero JKHlJ,KOCTb HeB03MOJKHO). .
4. "YlJ,aJIHTb KaTeTep npH aHypHH.
5. OTT.!IHYTb H BHOBb BBecTH KaTeTep B MO'leHcnYCKaTeJIb-
HbIH KaHaJI npH CBOpa<IHBaHHH el'o B HeM.
6. llpHI'OTOBHTb CTepHJIbHblH IllnpHl\ npH 06Typal\HH Ka-
TeTepa H nonbITaTbC.a OTcocaTb TO, <ITO 3aKpLIJIO npOCBeT
KaTeTepa; eCJIH 3TO He nOMOraeT - CMeHHTb KaTeTep.
BBeAeHMe KaTeTepa H<eHU\MHe
06Jl3ameJl,b1tble YCJI,06UJl: npOl\elJ,ypa BBelJ,eHH.a KaTeTepa
npOBOlJ,HTC.a npH CTpOI'OM C06JIIOlJ,eHHH acenTHKH, TaK KaK
CJIH3HCTa.a' 060JIO<IKa MO<IeBOI'O nY3LIp.a 06JI aeT CJIa60M CO-
npOTHBJI.aeMOCTblO K HHll>eKl\HH. llpol\elJ,YPY BbInOJIHHeT ll>eJIb-
lJ,IIIep HJIH cnel\HaJIH3HpOBaHHaH MelJ,Hl\HHCKa.a cecTpa.
llpol\elJ,ypa npOBOlJ,HTC.!I B nOCTeJIH (B03MO)IUIO npOBelJ,eHHe
npOn;elJ,ypbI Ha rHHeKOJIOI'H<IeCKOM KpeCJIe).
npOBepKa npOXOH<AeHHR KaTeTepa
npM BBeAeHMM ero B MOileSOH nY3blpb
llpuzomo6umb: 2 IllnpHl\a eMKOCTblO 20 MJI, paCTBOp Il>Y-
pal\HJIHHa 1:5000 - 50 MJI, CTepHJIbHYIO eMKOCTb lJ,JI.a pa-
CTBopa.
1. Ha6paTb B IllnpHl\ paCTBOp (Pypal\HJIHHa B KOJIW eCTBe
10-15 MJI.
2. llOlJ,cOelJ,HHHTb IllnpHl\ K HapymHOMY KOHl\Y KaTeTepa,
BBelJ,eHHOro B MO<IeHcnycKaTeJIbHbIH KaHaJI.
3Tanbl 060CHOBaHl'le
nOozom06Ka K npotjeoype
1. YCTaHoBIo1Tb AOBeplo1TenbHble 06eCne'leHlo1e OC03HaHHoro Y4acTIo1R
KOH(jJl'!AeHljlo1anbHble OTHoweHIo151 C B cOBMecTHOa;; pa60Te.
naljlo1eHTOM. 06ecne4lo1BaeTCR 10130-
nRLlIo151 nalllo1eHTa.
2. YT04HIo1Tb Y naLllo1eHTK1.1 nO Io1Ma- 06eCne'lIo1BaeTC5I npaBo naljlo1eHTK1.1
Hlo1e L1enlo1 101 xOAa npeACT05IUlea;; Ha I'IH(jJopMaljl1/O.
npoLleAypbl, nonY4Io1Tb ee cornaclo1e.
3. HaAeTb nareKCHbie nep'laTK1.1, 06ecne4101BaeTcR Io1H(jJeKLllo1oHHaR
6e30nacHOCTb.
4, YnmK 1Tb naLllo1eHTKY Ha Cnl'lHY. Y4eT aHaTOMIo1'1eCKG; oc06eHHoCTI'I
Horlo1 corHyTb B KOneH5IX 101 cnell<a pacnOnO>KeHI'I5I M04eBoro nY3b1p5l.
pa3seCTIo1 B CTOpOHbl.
5. nOAnmKIo1Tb nOA 51rOAlo1ljbl naLlIo1- npeAynpe>KAeHlo1e 3arp5l3HeHIo1R
eHTKt.1 KIleeHKY C can(jJeTKOa;;. no- nOCTenbHoro 6enb5l.
Bepx BblCT}'na/OUlero KpaR KIleeHK1.1
nOCTaBIo1Tb CYAHO.
6. nplo1roTOBIo1Tb OCHaUleHlo1e Af]51 06eCne'lI'lBaeTCR 3<jJ(jJeKTlo1aHOCTb 101
nOAMblBaHlo1R naLllo1eHTKIo1. '1eTKOCTb BbinonHeHIo1R npoLleAypbl.
.
405
404
3Tanbl I 060CHOBaHs.1e
nOiJzomoeK8 K npot<eiJype
7. npeBeCTII nO,QMbI8aHs.1B: BCTaTb 06eCne'ls.1BaeTC5I 3<j)(jJeKTI1BHOCTb s.1
cnpaBa OT nalls.1eHT1<III, B neBYIO PYKY '1eT1<OCTb BbinOn"AHs.151 npoIlB,Qypbl.
B351Tb eMKOCTb C pacTsopoM AIl51
nO,QMbIBaHs.151, B npaBYIO KopHlIaHr C
can<J>eTKaMs.1.
8. nO,QMblTb nalls.1eHTKY ,QBs.1JKeHs.151- 06eCne4eHs.1e mn-leHbl nonOBblX
Ms.1 cBepxy SHs.13, nocne,QOBaTBnbHO opraHoB.
(OT n06Ka K aHanbHoMY OTSepCTIlIO).
9. CMeHs.1Tb canQ>eTKs.1. 06ecne4s.1BaeTC5I s.1HQ>eKlll'loHHa51
6e30nacHOCTb.
10. Bblcyws.1Tb KOJKY B TO JKe no-
cne,QoBaTenbHOCTs.1,c6poCs.1TbCan-
<!>eTKs.1 B eMKOCTb AIl51 ,Qe3HHcjJeK-
l\I'1s.1.
11. CMeHl1Tb nep4aTK1.1, nps.1rero- 06ecneYs.1BaeT acjJcjJeKTs.1BHOCTb s.1
Bs.1Th oCHa eHs.1e AIl51 KaTeTeps.13a- 4eTKOCTb BblnOnHeHs.151 npoIlB,Qypbl.
l\I'1s.1, B351Tb ns.1HlIeT B npaByKJ PYKY. -
npoeeiJeHue npot<eiJYPbl
1. Paa,QBs.1Hyrb neBo pYKO none- 06eCne'ls.1BaeTC5I s.1HQ>eK4s.10HHaR
BbiB ry6bl, npaBo PYKO C nOMO- 6eaonacHOcTb B 06naCTs.1 MO"Ies.1C-
bIO ns.1HlIeTa Ba5lTh MapneBbie nycKaTeflbHOrO I<i!Hana.
cancjJeTI<I1, CMO'leHHble pacTBopoM
<!>ypal\l'1ns.1Ha.
2. 06pa60TaTb MO'Ies.1CnYCKaTenb-
Hoe OTSepCTIle ,QBHJKeHs.1eM cBepxy
BHHa Me>K.QY ManblMH nonOBblMH
ry6aMs.1.
3. CMeHs.1Tb MapneBbl TaMnOH.
4. nps.1nO)l(IIITb TaMnOH, CMO"IeHHbl 06ecneYs.1BaeTc5I 06eaaapaJKHBaHs.1e
S pacTBope <!>ypal\l'1nns.1Ha K oTsep- OTBepCTIl5I M04es.1CnycKaTenbHoro
CTIlIO MOyes.1CnycKaTenbHOI"o KaHana KaHana...
Ha O,QHY Ms.1Hyry.
5. C6pOCs.1Tb TaMnOH B pacTBop AIlR 06eCne4s.1BaeTCR 1HQ>eKl\I'10HHa51
.Qeas.1HcjJeKl\I'1s.1, CMeHs.1Tb ns.1H4eT. 6e30nacHocTb.
6. BaRTb ns.1H4eTOM KIlIOB MRn<Oro 06eCneYs.1BaeTC5I CTeps.1nbHOCTb
KaTeTepa Ha paCCTORHs.1s.1 4-6 CM KaTeTepa Ha paCCT05IHs.1s.1
OT ere KOHlIa, KaK ns.1wyl1\Be nepe. 4-6 CM.
7. 06eecTII HapY)l(Hbl KOHe4 KaTe- He06xo,Qs.1MOe nOnOJKeHs.1e KaTeTepa
Tepa Ha,Q K1.1CTblO 101 aa)l(aTh MeJKA}' nps.1 npOBe,QeHs.1s.1 np04eAypbl.
4-M H 5-M nanbllaMH npaBO;':; PYKs.1.
8. 06ns.1Tb KIlIOB KaTeTepa CTepWlb- 06nerYeHs.1B BBe,QeHs.151 KaTeTepa B
HblM Baaens.1HOBbiM MacnoM. MO"Ies.1CnycKaTenbHbl KaHan.
3Tanbl 060CHOBaHs.1e
npoeeiJeHue npot<eoYPbl
9. Paa,QBs.1Hyrb neBO" PYKo nono- MoYes.1CnYCKaTenbHbl KaHan )l(eH-
Bble ry6b1, npaBO OCTOpOJKHO BBe- lIII'1HbI KopeTl<I1ii, ero AIls.1Ha CoCTas-
CTs.1 KaTeTep Ha AIlHHY 4-6 CM AO nReT 4-6 CM.
n05lBnBHs.1R MO'ls.1.
10. Onyc's.1Tb CB060.QHbl KOHe4 IiIcKIlIO'IaeTc5I aarp5laHeHs.1B no-
KaTeTepa B eMKOCTb AIl51 c60pa CTeI1bHOrO 6enbR.
MOYs.1.
11. C6pOCs.1Tb nHH4eT B nOTOK AIlR 06ecne'ls.1BaeTCR HHcjJeKIIHOHHa51
nocne,QYIO e Aeas.1HcjJBK4s.1s.1. 6eaonacHocTb.
OKOH'IaHUe npot<eaypbJ
1. Ha,QaBs.1Tb neaoii PYKoii Ha ne- 06ecnev,s.1BaeTc5I 06MbIBaHs.1e 1.10-
pe,QHIOIO 6plOWHYIO cTeHKY Ha,Q no6- 4es.1CnycKaTenbHOro KaHana OCTaT-
KOM, O,QHOBpeMeHHo s.1aBSleKaR KaTe- KaMs.1 MO"Is.1, T.e. BCTeCTBeHHblM
Tep, noone npel<pa eHs.1R caMO- nY1:eM.
CT05lTenbHOro Bbl.QeneHs.151 M04s.1 13
KaTeTepa.
2. liIaBne4b OCTOpO)l(HO KaTeTep
nocne npeKpa eHs.151 MO'IeBbl.Qene-
Hs.151.
3. C6poCs.1Tb B eMKOCTb AIl51 nocne- 06ecne'ls.1BaeTc5I HHcjJeK4s.10HHa51
AYIO eii Aeas.1HcjJeKl\I'1s.1. 6eaonacHocTb.
4. CHRTb nep4aTKs.1, nOMeCTIIITb B 06eCne4s.1BaeTCR HHcjJeK4s.10HHa51
eMKOCTb C Aeas.1HcjJs.1l1s.1pYIO s.1M 6eaonacHoCTb.
paCTBOpoM.
5. BblMblTb PYKs.1, ooYWs.1Tb. C06n1OAeHs.1e ns.14HoU rs.1rllleHbl Me-
As.14s.1HCKO cecTpbl.
6. 06ecne4s.1Tb cjJs.1as.14eCK1.1 H nCl;1- C06nIOABHs.1e nB4e6Ho-
Xs.14eCKs.1ii nOKoii nal\l'1eHTKH. OXpaHs.1TenbHOro pe)l(s.1Ma.
BBeAeHMe KaTeTepa MY)l('iI1He
3Tanbl I 060cHoBaHHe
noOzomoeK8 K npot<eiJype
1. YCTaHoBHTb AOBeps.1TenbHble 06ecne4eHHe OC03HaHHoro Y4acTH5I
KOH<!>s.1.QeH4s.1anbHble OTHOWeHs.151 C B cOBMeCTHo pa6oTe.
nalls.1eHTOM. 06eCne'ls.1BaeTCR l<1ao-
n5l4s.151 na4s.1eHTa.
2. YTO"IHl1Tb Y nalls.1eHTa nOHs.1MaHs.1e 06eCne'ls.1BaeTCR npaso na4s.1eHTa
lIens.1 s.1 xO,Qa npe,QcTOR eii npolle- Ha s.1HcjJopMal\l'1lO.
AYpbl, nonY4HTb ero CornaCs.1e.
3. Ha,QeTb nareKCHble nep'laTI<I1. 06eCne"ls.1BaBTC5I HHcjJBK4HOHHa51
6eaonacHoCTb.
406
401
3ranbl 060CHOBaHs.1e
f70azomoeKa K npou.eaype
4. YnO)KIHb nau.s.1eHTa Ha Cns.1HY, Y4eT aHaTOM 14eCKOa;; oc06eHHOCTs.1
HOn-! corHyrb B KoneHm< s.1 pa3BeCTII pacnOnOJl<eHs.1S1 M04eBoro nY3b1pSl.
B CTOpOHbI.
5. nOAllOJl<s.1Tb nOA RroAs.1U.bI nau.11- . npe):\ynpeJI<ABHs.1e 33rp5I3HeHs.151
eHTa KIleeHKY C neneHKOa;;. nOBepx nOCTenbHoro 6enb5l.
BblcTYnalO ero Kpa51 KIleeHI<1.1 no-
CTaBs.1Tb CY):\HO.
6. nps.1rOTOBs.1Tb OCHa eHs.1e AIlSl 06eCne4s.1BaeTCSI acjJ<!>eKTs.1BHOCTb 101
nOAMbiBaHs.151 nau.l<leHTa. 4eTKOCTb BbinonHeHs.151 npOlle):\ypbl.
7. npOBeCTs.1 nOAMbiBaHs.1e: BCTaTb 06eCne4s.1BaeTCSI I1s.1'1Ha5I n-!meHa
cnpaBa OT nau.s.1eHTa, B neBYIO PYKY n3u.l<leHTa.
B3S1Tb cTepHnbHYIO can<!>eTKY, 06ep-
Hyrb elO nonoBOa;; 4I1eH Hs.1J1<e ronoB-
1<1.1.
8. B3S1Tb n0I10BOa;; 4neH MeJKAy 3-M 06eCne4s.1BaeTCSI OTKpbITs.1e HapYJK-
s.1 4-M nanbu.aMs.1 neBoii PYKs.1, c):\a- Horo OmepCTs.151 MO'les.1CnycKaTenb-
Bs.1Tb cnell<a ronoBKY, 1-M 112-M Horo KaHana.
nanbu.aMs.1 cnerKa OTO):\3s.1Hyrb Kpaii-
HIOIO nnOTb.
9. B351Tb ns.1Hu.eToM, 3aJK3TbiM B 06eCnB4HBaeTC5I s.1HcjJeKu.s.10HHa51
npaBoii PYKe, MapneBblii TaMnOH, 6e30nacHocTb.
cM0411Tb B pacTBope cjJypau.s.1ns.1Ha s.1
06pa60TaTb ronoBKY nonOBoro 4ne-
Ha cBepxy BHs.13 OT M04es.1CnycKa-
TenbHoro KaHana K neps.1<!>eps.1s.1,
MeHSl5I TaMnOHbl.
10. Bns.1Tb HeCKonbKO Kanenb CTe- 06ne eHs.1e BBe):\eHs.1S1 KaTeTepa,
ps.1nbHOrO Ba3ens.1HOBOro Macna B npocjJs.1naKTs.1Ka Henps.151THbiX o y-
OTKpblTOe HapYJKHOe OTBepCTs.1e eHs.1a;; nps.1 BBe):\eHs.1s.1 KareTepa.
MO'Ies.1CnycKaTenbHOfo KaHana.
11. CMeHs.1Tb nI1Hu.eT. 06eCne'leHs.1e s.1H<!>eKl\I'10HHOa;; 6e30-
naCHOCTs.1.
BblnonHeHue npou.eaYpbl
1. B3S1Tb Creps.1nbHblM nHHu.eTOM, He06xo):\s.1MOe ycnOBs.1e: c06n/QA3Tb
3aJl<aTbiM B npaBOa;; pYKe, KaTerep Ha Creps.1nbHOCTb KaTeTepa Ha pac-
paCCTOSlHs.1s.1 5-7 CM OT ero KIlIOBa CT05lHs.1H 20 CM.
(KIlIOB KaTeTepa ony eH BHs.13), 06-
secTs.1 KOHeu. KaTeTepa Ha,lj I<1.1CTblO
s.1 3aJl<3Tb MeJKAY 4-M s.1 5-M nanb-
u.aMs.1 (KareTep pacnonaraBTCSI Ha,lj
Ks.1CTblO B Bs.1Ae Ayrs.1).
2. 06ns.1Tb K3reTep CTeps.1nbHblM 06ne eHs.1e BBe):\eHs.151 KareTepa B
Ba3ens.1HOablM MacnoM Ha AIls.1HY MO'Ies.1CnYCKaTenbHblii KaHan.
15-20 CM HaA nOTKOM.
3Tanbl 06oCHOBaHs.1e
BblnOnHeHUe npou.eaYPbl
3. BBeCTs.1 KaTeTep ns.1Hu.eToM, nep- Y4eT aHaTOMs.14eCKt.1X oc06eHHocTeii
Bble 4-5 CM, YABpJKs.1BaSl 1-2 nanb- M04es.1CnYCKaTenbHoro KaHana y
u.aMs.1 neBoii PYKs.1, cjJs.1KCs.1PYIO s.1Ms.1 MYJK4s.1H.
ronoBKY nonoBoro 4neHa.
4. nepeXBaTs.1Tb ns.1Hu.eTOM KaTerep AOCTl<lraeTCSI ypoBeHb BBeAeHs.1S1
e e Ha 3-5 CM OT ronOBI<1.1 s.1 MBA- K3Terepa B M04eBOa;; nY3blPb.
neHHO norpYJKaTb B M04es.1CnycKa-
renbHblii KaHan Ha AIls.1HY 19--20 CM.
5. OnycKaTb o):\HoBpeMeHHo neBoii 3TO cnOC06CTByBT npo):\Bs.1J1<eHs.11O
PYKoii nonoBOa;; 4neH MYJK4s.1Hbl. KaTeTepa no M04es.1CnYCKaTenbHoMY
KaHany C y4eTOM ero aHaTOMs.14e-
CKs.1X oco6eHHocrea;;.
6. norpY3s.1Tb OCTaBWs.1iicSI KOHeu. npe):\ynpeJKAeHs.1e 3arpSl3HeHs.151
KaTerepa B eMKOCTb AIlR c60pa nOCTenbHoro 6enb51. .
MO'IH.
OKOH'laHUe npou.eaypbl
1. \I13BSle4b OCTOpOJl<HO KaTBTep npe):\ynpeJKAeHs.1e B03Hs.1KHOBeHH5I
ns.1Hu.erOM, BnOJKeHHblM B npaBYIO Henp 1SITHb'X o Y1IIeHs.1ii.
PYKY (B o6paTHoa;; nocne):\OBaTenb-
HOCTs.1) nocne npeKpa eHs.1S1 M04e-
Bbl):\eneHs.1S1.
2. Ha,QaBs.1Tb Ha nepeAHlO1O 6plOw- 06ecne4s.1BaerCSI o6MblBaHHe MO-
HYIO CTeHKY HaA n06KOM neBoii py- 4es.1CnYCKaTenbHoro KaHana OCTaT-
KOO, nocne npeKpa eHs.151 BblAene- KaMs.1 MO'Is.1, T.e. ecTeCTBeHHblM
Hs.151 MO'Is.1 s.13 KaTerepa. nyreM.
3. CHSlTb nep'laTKs.1, nOMeCTIlTb B 06eCne'ls.1BaeTCSI s.1HcpeKl\I'10HHaSl
eMKOCTb C AB3s.1H<I>s.1l\1'1PYIOLl!I'1M 6e30nacHocTb.
paCTBopoM.
4. BblMblTb PYKI1, OCYWs.1Tb. C06nlO):\eHs.1e ns.14HOii rs.1rs.1eHbI Me-
AI'IU.I<IHCKOa;; cecrpbl.
5. 06eCnB4s.1Tb cjJs.13s.1'1eCKs.1ii s.1 ncs.1- C06nIOAeHs.1e I1e4e6Ho-
Xs.14eCKs.1a;; nOKoii nau.s.1eHry. OXpaHs.1TenbHOro pe>Ks.1Ma.
npIfMe'laHHe: npOl eAypa BbtnOI1HSleTCSI Bpa40t-1 HJlH cne4H-
anbHO 06Y4eHHOH MeAH4HHCKOH ceCTpOH.
408'
409
YXOA 3a npOMe)l(HOCTblO na HeHTa (na MeHTKM)
C MOlleBblM KaTeTepOM
I(eJ/.b: C06JIlO,l\eHHe JUi'IHOM I'HI'lleHbI n lleHTa, npoqmJIaK-
TllKa BOCXO,l\.!I eM llHiPeK llH MOqeBbIBO,l\IDW1X nYTeM.
OCUaute1lUe: KaI{ ,l\JI.!I nOJ.\MbIBaHll.!I n eHTa (CM. BbIIlle).
nOp,I'OTOBlta K npon;ep,ype
1. 06'b.!ICHHTb nal lleHTY XO,l\ npOn;e,l\ypbI, 06eCneqll'l'b nllCh-
MeHHOii llH<l)OpMa lleii, eCJIH HMeTC.!I TpY,l\HOCTll B 06yqeHllll;
2. PaCCKa3aTb naIJ;HeHTy npaBHJIa yxo,l\a 3a KRTeTepoM II
MOqenplleMHllKoM (,l\peHa*HbIM MeIllKoM), npoMemHocTbJO. B
nJIaH 06yqeHll.!I BKJIIO'fllTb CJIe,l\YIO He CBe,l\eHH.!I:
- YCTpoiicTBO CllCTeMbI «KaTeTep - .npeHa*I-Iblii MeIllOK»;
- BonpOCbI JIllqHOii I'llI'lleHbI, C06JIIO,l\eHll.!I acenTllKll;
- Y,l\aJIeHHe MOqH II oqllCTKa MO'fenplleMHHKa;
- coneTbI no c06JIIO,l\eHHIO nHTbeBOrO pe)IWMa II ,l\HeTbI II .np.
( )J;a.rree nO,l\rOTOBKa K npOn;e,l\ype TaKa.!I me, KaK ,l\JI.!! DO,l\-
MbIBaHll.!I).
BLlnOJIHeHlle npOn;ep,ypbl
3. BbIMbITb nOJIOBble OpI'aHbI II npOMe*HOCTb no npHH.!ITOM
MeTO,l\HKe;
4. BbIMbITb BaTHbIMll TaMnOHRMll, 3aTeM BbICYIllllTb 10 CM
KaTeTepa (OT Y'IaCTKa, r,l\e OH BbIXO,l\llT H3 YPeTPbI);
5. OCMoTpeTb 06JIacTb ypeTpbI BOKpyI' KaTeTepa; "Y6e,l\HTb-
C.!I, qTO MOqa He nO,l\TeKaeT.
ECJIll npOHCXO,l\llT nO,l\TeKaHlle MOqll MllMO KaTeTepa: npo-
BepbTe, He 06pa30BaJIHCh JIH MOqeBble KaMHll BHYTPll KaTeTe-
pa.
n Coo6U4lfTe Bpa..y, ecnH ApeHa>K 3aKynopHncR, 3aMeHH-
iii Te KaTeTep.
6. OCMOTPeTb KO*y npOMejKHOCTll lIa npe,l\MeT npH3HaKOB
llH<}>el{n;llH. rllnepeMllH, OTeqHOCTb, Man;epa ll.!I KO*ll, I'Hoii-
Hoe OT,l\eJI.!IeMOe .!IBJI.!IIOTC.!I npll3HaKaMlI llm}>eI{IJ;llll.
(;()(){) llTb Bpaqy 0 nO.!IBJIeHllll npll3HaKOB llH(}>eK!J;llll.
7. "Y6e,l\llTbC.!I, qTO npOllCXO,l\llT ,l\peHHpOBaHlle (OTTOI{) MO'IH
ll3 MO'feBOI'O nY3blp.!I no CllCTeMe «KaTeTep - ,l\peHa*I1bIH Me-
IllOI(» IIpoBepbTe, He CKpyqeHbI JIll Tpy6Kll CHCTeMbI.
410
ECJIH Tpy6Ka KaTeTepa HaT.!IHYTa, He06xo,l\llMo OCTOPO*HO
CHH.Tb nJIaCTbIpb, CMeHllTb eI'O H npllKJIellTb K 6e,l\py Ha ,l\PY-
I'oe MeCTO 6e3 HaT.!I*eHll.!I (HJI-ll KpoBaTll).
8. YCTpaHllTb ,l\pyrlle B03MomHbIe HapYllIeHll.!I B pa60Te
CHCTeMbI «KaTeTep,- ,l\peHajiUibIH MellIOK».
n npH HanlflUfH KpOBIf B MOlle IfnH B03HHKHOBeHMif 60nH
iii B MOlleBOM nY3blpe HeMeAneHHo C006U4IfTe BpallY!
9. "Y6e,l\HTbC.!I, qTO TPy6Ka KaTeTepa npllKJIeeHa nJIaCTbI-
peM K 6e,l\py H He HaT.!IHYTa; ECJIH TPy6Ka KaTeTepa HaT.!IHY-
Ta, He06xo,l\llMO OCTopomHO CH.!ITb nJIaCTLIpb, CMeHllTb eI'O II
npllKJIellTb K 6e,l\py Ha ,l\pyroe MeCTO 6e3 HaT.HmeHll.!I.
OKOll'laHHe npou;ep,ypbl
10. "Y6e,l\llTbC.!I, qTO ,l\pCHa*Hblii MellIOK npllKpenJIeH K
KpoBaTll llJIll 6e,l\py;
11. 3aKOH'fllTb npo!J;e,l\YPY TaK *e, I<8K npll nO,l\MbIBaHllll.
6.9. MaHunYARquu.
CBR3aHHbie C YXOgOM 3a cmOMaMU
YXOA 3a na MeHTOM C racTpocTOMOM
)J;.IIH cnaCeHH.!I mll3HH naD.lleHTa C HenpOXO,l\llMOCTbIO nll-
eBO,l\a, B03HllKllIeii BCJIe,l\CTBlle py6n;oBOI'O cy*eHll.!I, onyxo-
JIeii, o*orOB llJIll paHeHllH, Ha *e.rry,l\OK HaKJIa,fJ;bIBaeTCn CBll
- raCTpOCTOMa, qepe3 KOTOpblii no BBe,l\eHHOii Tpy6Ke npOll3-
BO,l\llTC.!I nHTaHHe 60JIbHOI'0. 3Ha'fHTeJIbHO pe*e, npll HeB03-
MomHOCTH nllTaHM.!I qepe3 *e.rry,l\OK, aHaJIOrnqHbIii CBll -
elOHOCTOMa - Hal{JIa,l\bIBaeTC.!! Ha TO YIO KHIllJCy. B 060llX
CJIyqa.!IX B nOJIbIii OpI'aH (*eJIY,l\oK, To aH KllIllKa), nO,l\llIll-
TbIil K nepep,Heii 6pIOllIHOii CTeIII{e, BBO,l\llTC.H pe3llHOBa.H TPy6-
Ka, KOTopa.!I TaKme KpenllTC.!I K nepe,l\Heii 6pIOUIHOM CTeHKe -
IllBOM RJI.M nOJIOCaMH JIeihroIIJIacTLIp.!! ,l\JIllHOM 15-16 CM. Tpy6-
Ka BBO,l\HTCH ne,l\aJIeKO OT OCHOBHOM JIanapOTOMK'IeCKOii paHbI,
3allIllToi-i HarJIYXO.
Bo BpeMJI nepeB.!!3KH HY*HO CJIe,l\llTb, 'iT06bI Mem,l\y 06ell-
MH paIlaMH He 6bIJIO KOHTaI{Ta, TaK KaK JIanapOTOMllqeCKa.!I
411
paHa OJI)RHa 3amnTb nepBHqHbIM HaTHmeHHeM, a TaM, I' e
BbIBe eHa Tpy6Ra, cnYCTH HeROTopoe BpeMH HaqHHaeTCH Ha-
I'HOeHHe RaR pe3YJIbTaT pa3 pameHn.!I TRalleii: HHOpO HbIM
TeJIOM - pe3HHoBoii: Tpy6KOii:. MHor a PMOM C Tpy6ROii: no
RaHaJIY B 6PIOIIIHOii: CTeHKe npOCaqnBaeTC.!I me.rrY OqHOe H
RnIIIeqHOe co epmnMoe.
B npon;ecce nepeB.!I3KH lleo6xo HMO BHHMaTeJIbHO CJIe HTb
3a nOJIOmeHHeM Tpy6RH, y epmHBaH ee Ha MeCTe oc06eHHO BO
BpeM.!I CMeHbI nOJIOCRH 6HHTa, (}>nRCHpYIO eI'O Tpy6KY. ECJIn
Tpy6Ra BbmaJIa, TO H006xo HMO CPOqHO C006 HTb 06 STOM
Bpa'IY. CJIOmHOCTb yxo a 3aKJIIOqaeTCH B TOM, qTO Roma BORpyr
raCTpOCTOMbI H eIOHOCT?MbI nO Bepl'aeTC.!I Mau.epau.nH.
/
KOpMJIeHHe naD;HeHTa C raCTpocTOMoii:
I(eRb: 06ecne'IHTb paD;nOH8./IbHoe nHTaHHe.
II OIwaaltuJ/.-
- HenpOXO HMOCTb nH eBo a BCJIe CTBHe Q)IWI'OB H paHe-
HHii:;
- onYXOJIH nnw;eBo a, meJIY Ra.
OC1Ul/4eltue:
- CTepHJIbHaH CTeRJI.!IHHa.!I BopOHKa;
- CTepHJIbHbIe C8./I(}>eTKH;
- 38mnM;
- eMROCTH C renJIoii: nH eii:, BbICORORaJIOpI1HHoii:, nOJIY-
mH Roii: n TBep oii: ROHCnCTeHD;HH.
06JlaameRb1l0e YCJ/.OBue: nOCJIe Ram OI'O ROpMJIeUn.!I H006-
xo nMO npOBO HTb TyaJIeT B 06JIaCTH CTOMLI.
3Tanbl I 060CHOBaHI'I5I
noiJzomosKB K npotjeC!ype
1. 06M1CHI'ITb XOA npoBeAeHI'I5I 06ecne4l'1BaeTC5I npaBo naljl'leHTa
KOpMneHI'I5I 4epe3 CTOMY. nony4I'1Tb Ha I'IHcPopMal\l'llO.
cornacl'le.
2. npl'lAaTb naljl'leHT)I nonYCI'IARyee 06eCne'lI'lBaeTC5I y4aCTl'le naLll'leH,a
nOnOJKeHl'le. B npl'leMe nl'lLLlI'I.
3. npl'lroTOBI'ITb eMKOCT.., C mnnoi;; npe;:\ycMaYp..,BaeTcR nepe>KeBbIBD-
n"'LLlei1. nOnYJKI'IAKOi;; .., TBepAoi;; H..,e nl'll,L11'1 naljl'leHTOM.
KOHC..,CTeHlj"'l'I.
4. BblMblTb pyK1.1. Ha,l\eTb nep'laTla.1. 06ecneYI'IBaeTcR 6e30nacHocTb
nepCOHana.
412
3Tanbl 060CHOBaHI'IR
noC!zomosKa K npotjeC!ype
5. CH5ITb C pe3..,HoBoi;; Tpy6K1.1 can- 06ecne'lI'lBaeTC5I CS060;:\Hbli;; BXOA
<!JeTI<}', 3aKpblBalOLLlY'O BXOA, .., 3a- B >KBnYAoK.
>K"''''.
6. BCTaBbTe B KOHeLl pe311HoBOi;; 06ecnB\.l..,saeTC5I B03MO>KHOCTb
Tpy6KI'I CTeKIl5lHHYIO BOpOHKY. BBe;:\eH..,51 n..,UII'I B >KenYAoK.
nposeC!eHue npotjeC!ypbl
1. nOAHRTb BOpOHKY Beepx, cnen<a npeAynpB>KAeH..,e B03MOJKHOro Bbl-
HaKIlOHI'ITb B CTOPOHY nalj..,eHTa. TeKaHI'I5I COAep>KI'IMoro >KenYAKa.
2. J].aTb naLl..,eHT)I nl'lLLlY (cyxapl'l, 06ecneY"'BaeTcR oLLlYLLleHl'le BKYca
KapTO<!>enb 1'1 T. A.) AIl51 nepeJKeBbl- n..,UII'I, AIl51 CMa'lHBaHI'I5I n"'LLlI'I cnlO-
BaH"'51. Hoi;; 101 B036y>K,D,eHI'IR nI'lLLleBap"'-
TenbHblX >Kene3.
3. npeAllO>Kl1Tb naljl'leHT)I nepeno- Bo 1'136e>KaH..,e rnOTaH"'51 nepe>Ke-
>KI1Tb (BblnnIOHyYb) nepe>KeBaHHYIO BaHHGi n"'LLI"'.
nl'lLLlY ..,30 pTa B BOPOHKY.
4. 3an..,Tb nepe>KeBaHHYIO n"'LLlY 06ecnB\.lI'lBaeTCR BBeAeH..,e B >Ke-
Tennoi;; >K1'I,AKoi;; n"'UleBoi;; CMeCblO. nyAOK nl'lLLll'I, BMeCTe C TOKOM JKI'IA-
Koi;; CMec"'.
5. npOMQi;;Te eopOHKY 101 pe3..,HQBYIO Bo ..,36e>KaHl'le rHl'leH..,R OCTaTKOB
TPy6KY nocne KopMneH..,R TennblM n"'LLlI'I B pe3..,HoBoi;; TPy6Ke.
'1aeM. HaCTOBM w..,nOBHI'IKa.
OKOH'laHUe npotjeC!YPbl
1. CHRTb BOpOHKY. nOMeCTI'ITb B 06eCneyeH..,e ..,HcPeKl.jI'lOHHOi;; 6e30-
eMKOCTb C AB3..,H<!J"'l\I'IPYIOLLI..,M naCHOCTI'I.
pacmopoM.
J
KopMneHMe 4epe3
"aCTpOCTOMY
413
06pa6oTKa raCTpOCTOMbl
;qeRb: JIeqe6Ha.a.
ITOIw3a1l.UJl: COCTo.aHlle nOCJIe onepaD;llll.
OClla{4e1/.ue (CTepllJIbHble npe MeTbI Me MD:HHCKOI'O Ha3Ha-
qeHl:I.!I):
- nMHD;eTbI 3-4 IIIT.;
- HOJKHMD;bl KyHepa;
- nepeB.H30qHblH MaTepMan;
- nepqaTI<M;
- JIOTOK;
- IImpHD; :>RaRe;
_ IPJIaKOH C 0,5% -HbIM pacTBopoM KanH.H nepMaHl'aHaTa;
- IIInaTeJIb;
- naCTa JIaccapa B nO Ol'peTOM BH e.
HecTepHJlbHble npe MeTbI MeAMD;HHCKOI'O Ha3Ha'IeHH.a:
- JIeHKOnJIaCTbIPb; .
- JIOTOK JI.a OTpa60TaRHOl'0 nepeB.H30'IHOrO-MaTepHarra;
- eMKOCTH C Ae3HH(l>HD:HpylO HM pacTBopoM.
06.1/,3ameRb1l.bte YCR06U.1/,: nOCJIe nepeB.H3KH Heo6xoAMMO
y6e,l\HTbC.a B TOM, qTO Tpy6Ka npOXO MMa H BeAeT B JKeJIy OK,
AJI.a <Iero IImpHD;eM JKaHe MJIH 'lepe3 BOPOHKY BJIHBalOT B
Tpy6KY He60JIblllOe KOJIHqeCTBO CTepHJIbHOrO pacTBopa. IIpM
HenpoxoAHMOCTH HJIn BbmaAeHHH pe3HHoBoH Tpy6KH H3 CTO-
MbI Heo6xc HM.0 coo6m;HTb Bpa'IY.
3Tanbl I 060CHOBaHs.151
nOCJzomoeK8 K npol<eCJype
1. Y6et\s.1TbC5I B HaIls.1<js.1s.1 s.1HCPOPMaIls.1- 06eCne'ls.1BaeTCSI npaBo nalls.1eHTa
OHHoro Cornacs.1S1 nalll-IeHTa Ha npollB- Ha s.1HcpOPMalllo1lO.
AYPY.
2. YnO>Kv.Tb naUs.1eHTa Ha Cns.1HY. 06ecne<js.1BaeTc5I YA06Hoe nono-
>KeH le AllSi npOBBAeHs.1S1 nepeB5I3-
1<11.
3. BblMblTb PYKH, H<!AeTb nep4aTKIo1. 06ecne<js.1eaeTC5I 6e3onacHocTb
nepcoHana.
f7poeeCJeHue npOl<eCJYPbl
1. nps.1roTOBs.1Tb nOnOCKs.1 ns.1nKOro nna- npe;:\ynpe>I<,QeHs.1e BblnSAeHs.151
CTblpSi AIls.1HO He MeHee 15 - 16 CM, pe3s.1HOBO TPy6Ks.1 s.13 CTOMbl.
06epHYTb Tpy6KY HSA KOJKe s.1 nps.1KJlB-
s.1Tb KOHlIbl nnaCTblp51 K KO>Ke nalls.1eHTa.
2. 06pa60TaTb KO>KY BOKpyr CTOMbl 06ecne<jeHs.1e s.1H<!>eKljs.1OHHO
Waps.1KOM, CMO'leHHbIM O,5%-HbIM pac- 6e30naCHOCTs.1.
TBOPOM Kans.1S1 nepMaHraHaTa, BbICY-
Ws.1Tb TLl\aTenbHO CYXs.1M Waps.1KOM.
3. HaHeCTII wnaTeneM Ha KO>t<y BOKpyr npeAynpeJKAeHs.1e Maljepaul'Is.1
CTOMbl TOnCTbl cno no;:\orpeTo nac- KOJKH BOKpyr CTOMbl.
Tbl Jlaccapa.
4. HanO>Ks.1Tb nOBepx naCTbl CTeps.1nb- npeAynpeJKAeHs.1e s.1HCPs.1ljlo1pOBa-
Hble cancpeTKs.1, pa3pe3aHHble no nlny Hs.151 B oGnaCTs.1 CTOMbl. 06ecne<je-
«WTaHs.1WeK') (nepBaSi carnpeTKa YKJla- Hs.1e s.1HcpeKl\s.10HHO 6e30nacHo-
AbiBaeTCSI pa3pe30M KHs.13Y, eTOpBSI - CTs.1.
pa3pe30M KBepxy, TpeTbSl- cneBa.
4eTBepTaSi - cnpaBa.)
5. YnO>Ks.1Tb nOBepx CTeps.1nbHblX can- npe;:\ynpe>I<,QeHs.1e CMeLl\eHs.1S1
cpeTOK 6onbWYlO cancpeTKY c aTBepCTs.1- CTeps.1nbHbiX can<!>eToK co CTOMbi.
eM B UCHTpe (AIlSI BbIBBACHs.151 Tpy6KH).
OKOH'IBHUe npol<eCJYPbl
1. 06BSl3BTb nnOTHO nonOCKO 6s.1HTB npe;:\ynpeJKAeHs.1e BblnSAeHs.151
pe3s.1HoBY10 Tpy6KY, BbiBeABHHYIO 4epe3 pe3s.1HOBO Tpy61<11 s.13 CTOMbl.
OTBepCTs.1e B 60nbWO cancpeTKe, s.1
3aBSl3aTb BOKpyr Tans.1s.1, KaK noSlC, Ha
Aea }'3na. YKpens.1Tb 3TOT noSiC BTOPO
nOIlOCKO 6s.1HTa.
2. nOMeCTI<1Tb oTpa60TaHHbI nepeBSI- 06eCn8'leHs.1e s.1H<!>eKUs.10HHO
3<NHbli! MaTeps.1an. s.1HCTpYMeHTbI B 6e30naCHOCTs.1.
eMKOCTb C Ae3s.1Hcps.1w.1PYfOLl\I'1M pacTBD-
pOM.
3. CHSlTb nep<jaTI<I1, nOMeCTs.1Tb B eM- 06ecne'leHs.1e s.1HcpeKl\I'1OHHoi!
KOCTb C Ae3s.1Hcps.1I1s.1PYIOU\s.1M pacTBO- 6e30nacHocm.
poM.
:;).-anbl 06CCHOOBHs.151
OKoH',aHue nlJOl<eCJvPbl
2. HaOO>KlITb Ha KOHell pe3s.1HOBO npe;:\ynpeJKAeHs.1e BblTel:aHs.151 co-
Tpy6KH CTeps.1nbHYIO can<!>eTKY s.1 AepJKs.1t.<oro >KenYAKS.
3aJKaTb 3a>Ks.1MOM.
3. 3acplo1KCs.1paeaTb 3B>Ks.1M AIls.1HHOO npe;:\ynpeJKAel's.1B Bblna):leHs.151 pe-
neTnei! 6s.1HTa, 3aBc.neHHo 3a welO 31<1HOeoi! Tpy.6KIo1 s.13 CTOMbi.
nalll-IeHTa.
4. CH5ITb nep'laTKIo1, ncMeCTs.1Tb B 06ecne<jeHs.1e s.1H<!>eKUlo1oHHO 6e30-
eMKOCTb C Ae3Io1Hcplo1l1s.1PYIOLl\I'1M naCHOCTs.1.
paCTBOpoM.
5. AaTb nal\s.1eHTY CTaKaH C BO;:\O I 06ecne<jeH le rs.1rs.1eHs.1<jecKOro KOM-
nOTOK All51 06pa60TKs.1 nonOCTs.1 pTa. IjJopTa.
415
414
, ! 0 ' 7
(
-..=- j
YXOA 3a raCTpOcTOMOM
y,nepmrom.a. MCnOJIb30BaHHe no,n06HbIX cpe,ncTB ''\eCneqHBa-
eT naD;HeHTY B03MomHOCTb Ha ,nOJII'He ro,nbI coxpaHHTb COD;H-
aJIbHYIO H Tpy,nOBYIO aKTHBHOCTb.
BamHo npaBHJIbHO yxamHBaTb 3a KomeM BOKPYI' KaJIOBOrO
cBHID;a BO H36emaHHH MaD;HpaD;HH. ITPH npaBHJIbHOM yxo,ne OT
naD;HeHTa HeT HenpH.aTHOI'O 3anaxa, oKpymrooID;a.!I CBHID; Koma
He pa3,npameHa. ITOCKOJIbKY CJIH3HCTa.!I 060JIOqKa KHIlleqHHKa
OqeHb HemHa H paHHMa, yxo,n sa CTOMOM - :aT0. npem.n;e Bcero
C06JIIO,neHHe npaBHJI I'HrneHLI H 3aID;HTbI'CTOMbI OT TpaBM. TeM
He MeHee ,name npH CaMOM TIIJ;aTeJIbHOM yxo,ne H3 CTOMLI nepH-
o,nHqeCKH B03MomHO BbI,lJ;eJIeHHe KaneJIeK KpOBH. IIau;HeHT ,nOJI-
meH 6LITb HH!}>OpMHpoBaH 06 STOM H He nyraTbC.a, HHKaKHX
OC06bIX Mep B no,n06HOM CJIyqae He Tpe6YeTC.!I. EaK npaBHJIO,
CTOMa Ha,D;emHO 3aID;HID;eHa OT TpaBM KaJIOnpI1eMHHKOM.
06MbIBaTb CTOMY H Komy BOKPYI' Hee KpyrOBbIMH CnHpaJIb-
HbIMH ,nBHmeHH.aMH TenJIOM BO,nOM C MbIJIOM (.neTCKHM, X03.!IM-
CTBCHHbIM), CMbITb MbIJIO TenJIOM BO,nOM H BbICYIIIHTb npOMa-
KaTeJIbHbIMH ,nBHmeHH.aMH Komy BOKpyr CTOMbI CYXOM M.aI'-
IWH C,lJIc»eTKOi1. MomHO HCnOJIb30BaTb ,nJI.a CYIIIKH KomH BOK-
PYI' CTOMl>I CIICII HO npH6JIHmaTb nOTOK TenJIOro Bos,nyxa 6JIH3-
IW K CTOMe lIe peKOMCH,nyeTC.!I. CMa3aTb BOKpyr CTOMbI nac-
TOM CTOMaI'e3HB H Ha CJIHSHCTYIO KHIIIeqHHKa HaHeCTH
naSCJIIlII, npe.n;ynpe,nHB nepeCbIXaHHe CJIH3HCTOM H no.aBJIe-
HHC I<poBOTOqaID;I1X TpeIIJ;HH.
B lIacTo.!IID;Ce BpeM.!I npe,qJIaraeTC.!I GOJIbIIIOM BbI60p cpe,ncTB
no yxo,ny 3a KomeM BOKpyr CTOMbI. ITacTa (,A6YD;e.!I» npe,n-
HaSHaqeHa ,nJI.!I saID;HTLI KomH H py6D;YIDID;eMC.!I TKaHH BOKpyr
CTOMbI. ITacTa 06JIa,D;aeT paHOSamHBJI.!IIOIIJ;HMH CBOMcTBaMH.
«CTaTHH - nopOIIIKoo6pa:3Hoe nepeB.!I30qHOe cpe,nCTBo, npH-
MeH.!IeTC.!I ,nJI.a 06pa60TKH KomH BOKpyr CTOMbI B KaqeCTBe
paH03amHBJI.!IIOID;erO cpe,ncTBa. ITpH OTCYTCTBHH peKOMeH,nye-
MbIX naCT MomHO HCnOJIb30BaTb rycTble HeMTpaJIbHbIe CMa3-
KH; D;HHKOBYIO Masb, naCTY JIaccapa.
ITpH KHIIIe'IHOM Henpoxo,nHMOCTH npoHsBo,n.!IT onepaD;HIO,
B peSYJIbTaTe KOTOpOM JIHKBH,nHpyeTCn Henpoxo,nHMOCTb KH-
IIIe'IHHKa nYTeM aMnYTaD;HH yqacTKa TOHKOI'O KHIlleqHI1Ka
(eIOHOCTOMa), CHI'MOBH,nHOM KHIIIKH (HJIeoCToMa), np.!IMOM KHIII-
KH (npOTHBoeCTeCTBeHHbIM 3a,D;HHM npoxo,n) C nOCJIe,nYIOID;HM
HaJIOJKeHHeM CTOMbI. OCTaBIIIYIOc.a qaCTb KHIIIeqHHKa CJIH3HC-
TOM 060JI qKH no,nIIIHBaIOT K OTBepCTHIO B 6PlOIIIHOM CTeHRe B
npaBoM H.TIR JIeBOM nOJIOBHHe mHBOTa H (}>OPMHPYIOT BbICTyna-
IOID;YIO CJIH3HCTYlO 060JIO'IKY B BH,ne «P030qI<H . ITo STOMY
HCKycCTBeHHoMY oTBepcTIIIO BbITeKaeT ,nOBOJIbHO mH,nKoe CO-
,nepmHMoe H3 TOHKoro KHIIIe'IHHKa, a H3 HHmHHX oT,neJIOB
TOJICTOM KHIIIKH BbI,neJI.!IeTC.!I o!}>opMJIeHHbIM KaJI.
Y JIIO,neM co CTOMOM Macca np06JIeM COD;HaJIbHO-SKOHOMH-
qeCKOrO II MS,nHD;HHcKoro xapaK'repa. OHH Hy:»<.Z\aIOT".H B npa-
BHJIbHOM no,n60pe cpe,nCTB yxo,na 3a CTOMOM, y HHX B03MomHbI
OCJIO:»<HeHH.!I (06pa30BaHHe napaKOJIOCTOMHqecKHx rpbI:»<, BbI-
na,neHHe CTOMbI, pas,npameHHe KO,KH BOKpyr CTOMbI), H HM
HaMHoro CJIO,KHee mHTb, qeM S,nOpOBbIM JIIO,n.aM.
AKTY3JIbHOCTb npQ6JIeMbI KON:rureKcHoM pea6HJIHTaD;HH CTO-
MHpOBaHHbIX naD;HeHToB OqeBH.n;Ha. CeMqaC HaMeTHJIC.!I npo-
rpecc 6JIaro,nap.a nO.!IBJIeHHIO HOBbIX ,nJI.a HallieM CTpaHbI npo-
H3BO,nHbIX TeXHOJIOI'HM, n03BOJI.!IIOID;HX 06eCneqHTb STHX na-
D;HeHToB COBpeMeHHbIMM cpe,nCTBaMH yxo.n;a 3a CTOMOM. 3TH
cpe,nCTBa 06ecne'IHBa.a Ha,D;emHOCTb KpenJIeHH.!I K TeJIY, rep-
MeTHqHOCTb coeJ(HHeHH.H H 3aID;HTY KO,KH OT KOHTaKTa C OT,ne-
JI.!IeMbIM, npaKTHqeCKH nOJIHOCTblO KOMneHcHpyeT YTpa1:JeH-
HYIO B pe3YJIbTaTe onepaTHBHOI'O BMeIllaTeJIbCTBa (}>YHKD;HIO
Oeo6emIOcTii nHTaHHH
npH HaJUI'IUH CTOM nHIIJ;eBapHTeJIbHOrO TpaltTa
IToCJIe Onepa!I;HH OCHoBHoe OTJIHqHe CTOMI1pOBaHHOI'O na-
D;HeHTa OT JIlO60ro ,npyroro qeJIOBeKa COCTOHT B TOM, qTO OH
JIHIIIeH B03MomHOCTH ynpaBJI.!ITb ,ne.!ITeJIbHOCTblO CBoero KH-
416
14. 3aK,291
411
me'IHlm:a, OC ecTBJISITb I}JYHKl\MJO y,n;epmaHli.H KaJIOBbIX MaCC
H ra3a. O,n;HaKO, BbInOJIHSISI HeCJIOmHbIe peKOMeH,n;al\HH M MC-
nOJIb3YSI COBpeMeHHbIe Cpe,n;CTBa yxo,n;a 3a CTOMOH, MomHO He
TOJIbKO COXPIlHMTb npMBbf'IHbIH 06pa3 mM3HM, HO M B HeKOTO-
pbIX CJIy<JaSIX BepH}'TbCSI Ha pa60TY.
TIal\MeHT M ero 6JIM3KMe ,n;OJImHbI 3HaTb, 'ITO xapaKTep M-
TaHMSI OKa3bIBaeT pemaWll\ee BJIMSIHMe Ha 'IaCTOTY ero CTYJIa.
TIMmY He06xo,n;MMO npMHeMaTb 'Iepe3 onpe,D;eJIeHHbIe npoMe -
EM BpeMeHH, eCTb Me,ll;JJeHHO Tll\aTeJIbHO ee nepemeBbIBaSI.
TIal\MeHTaM C MJIeOCTOMOH B Te'IeHMM 4-6 He,n;eJIb nOCJIe
Onepal\MM He06xo,n;HMO M36eraTb 60raTbIX KJIeT<IaTKOll M ,n;alO-
ll\HX B KaJIe MHoro HenepeBapMBaeMbIX 'IaCTHl\ npo,n;YKTOB. B
nOCJIep;YWll\eM 60raTbIe KJIeT'IaTKOll npo,n;YKTbI MOryT ,n;06aB-
JISITbCSI B pal\MOH B Hc60JIbIIIHX KOJIM'IeCTBax.
B Te'IeHHH ,n;HSI CJIe,n;yeT OT,n;eJIbHO OT TBep,n;oii nHIT\H ynoT-
pe6JISITb He MeHee 1500-2000 MJI. mM,n;KOCTH H 6-9 r COJIM.
rOJIo,n;aHHe MJIM orpaHWIeHHe KOJIWIecTBa npMHeMaeMoll nHIT\I1
Bep;YT K 'Ipe3MepHOMY 06pa30BaHM1O ra30B M nOHOCY. "YmH-
HaTb JIy'IIlle paHO M npHHeMaTb nHIT\Y B He60JIbIIIOM KOJIH'Ie-
CTBe, 'ITO npMBe,n;eT K YMeHbIlleHHIO KOJIM'IeCTBa BbI,ll;CJIeHHll
'Iepe3 CTOMY B HO'IHOe BpeMSI.
TIpO)J;YICTbl YCKopmOll\lIe onopO"meJlHe KlIWe'IHHKa: ca-
xapMCTbIe Bell\ecTBa( caxap, Me,n;, qJPYKTbI). COJIeHbSI MapHHa-
,n;bI, KOn'IeIiOCTM. BoraTbIe paCTHTeJIbHOll KJIe'IaTKOll; 'IepHbIll
xJIe6, CbIpbIe OBOll\H M qJPYKTbI, mHpbI (B T.'I. paCTMTeJIbHOe
MaCJIo), 3eJIeHaSI qJaCOJIb. wnHlIaT. MOJIOKO, CBemHll Keqmp,
COKM XOJIo,n;HbIe 6JIIO,n;a M HanMTKM, MopomeHoe.
"YCKOPSIIOT onopomHeHHe KMIlle'IHMKa BOJIHeHMe, TOpOnJIM-
BaSI e,n;a M no,n;beM TSImecTM.
IIpO)J;yKTbl 3a)J;ep'KHBalOll\He onopomHeHMe KHlUe'IHHKa:
BSIm Me M JIerKoycBaMBaeMbIe 6JIIO,n;a, 6eJIbIe cyxapH, 3JIaICM,
TBopor, CJI1I3MCTbIe cynbI. KYKypY3a. npOTepTble KaIIIH, M3IOM,
pMC, KMCMJIH, KpemCMll 'Iall, KoqJe, Kroeao.
R 3anopaM TalOKe Be,n;eT MaJIOno,n;BHmHbIll 06pa3 mH311H
nal\HeHTa, ynoTpc6JIeHHe orpaHH'IeHHOrO KOJIH'IeCTBa mH,n;KO-
CTH, a TaKme HeKOTopble JIeKapCTBeHRbIe Cpe,D;CTBa ( 60JIeYTO-
JISIWIT\He. aHTM,n;enpHccaHTbI H ,n;p.)
TIpO)J;yKTbl He BJIHSIIOll\He Ha OnOpO:IKlIeHHe KHlUe'IHlIKa:
napOBoe M py6JIeHHOe MSICO, pbI6a, M3MeJIb'IeHHbIe q)PYKTbI M
OBOll\M 6e3 KomypbI H KOCTO'IeK.
ICcJ)lcypa nOMM,n;opC' , SIbJIOK, a TliKme KYKYPY3a, opexM.
III'YI"\r.I, MSIKOTb l\MTPYCOBbIX BbI3bIBa1OT cna3MbI KMIlle'IHM-
ICII, IIJ1HnoJ{SIT K 60JISIM B mMBOTe.
OmUlItO CJIe,n;yeT nOMHMTb, 'ITO peaKl\MSI Ha npMHeMaeMbIe
IIIIlI CIII.IC IIpOJ{YKTbI HH,n;MBM,n;yaJIbHa, CJIe,n;OBaTeJIbHO,KIDK,n;bIH
1111/111111'"(' I' C'I'UP ,D;HeTY caMOCTOSITeJIbHO.
l'I'I\IIMI'IIJ <Il\IIH no nHTaJlHIO )J;JISI naI.{HeHTOB C KOJIOCTO-
nllll\ ('III'I HUJIbHOll ,n;MeTbI ,n;JISI nal\MeHTa C KOJIOCT.OMOll He
I'VII I'('I'JlYCT. I1,n;eaJIbHbIM SIBJISIeTCSI B03Bpall\eHMe nOCJIe one-
1'/lI IJII K IIpHBbI'IHOMY pal\MOHY H pemHMY nHTaHHSI npM YC-
1'/lIIIIIIIIIIIIICMCSI peryJISIpHOM onopomHeHHM KHIlle'IHMKa.
1'11,11111'1'111' 3anopOB SIBJISIeTCSI aKTYaJIbHbIM BonpOCOM ,lI;JJSI
111111.111'11'1'1111 I' ICOJIOCTOMOll. Cne,n;yeT peKOMeH,n;OBaTb CJIep;yIOll\Me
IIJlIIJIVI' 1'1,1; IIlIICIIU'lIIbIll M pmaHOll xJIe6, xJIe6 M3 MyKM rpy6o-
I'll IIIIMllml, fiJJl{)J a M3 HemMpHoro MSIca, PbI6bl, nTMl\bl, CBemMe
11111111 II II cl'IIYI(TbI B HaTYpa.1IbHOM MJIM CJIa60npoBapeHHOM BH,lI;e,
Mil IIII{II (IIIIIIIII'PCIIOCHMOCTM), He KpenKHll 'Iall MJIM KoqJe.
II"I(O'I'IIP"'(' rrpo,n;YI(TbI npM,n;alOT l}JeKaJIMSIM rHMJIOCTHbIll
11111 IX. :)'I'O-CbIP. SIlll\a, pbI6a, qJaCOJIb, JIYK, 'IeCHOK, KanYCTa,
1'1'11[0[«(' IICIWTopbIe BHTaMMHbI M JIeKapCTBeHHbIe cpe,n;CTBa.
YMCIlr.III1UOT lIenpHSITlibIll 3anax clJeKaJIHll; KJIIOKBeHHbIll
MIIP". fi))YC'IIU'lliblii COIC (nOCJIe e,n;bI ,n;HeM), llOryPT, Kel}JMp
y I'JlIIM 1111 I'()II III(.
I\IIII II M())[U"r 6blTb npMrOTOBJIeHa B JI1060M BM,n;e, COJIb
I "II/lil IIIC"I'C'JJ 1111 nICYCY, 06beM nOTpe6JISIeMOH mM,n;KOCTH - He
"11'11"1', I,ll J[. II J\I'lIb. PeIWMell,n;yeTcSI npMueMaTb nHIT\Y He
III' Ilc' .1 - .1 II/Ia II JlI'lIb B 0,n;1I0 M Tome BpeMSI.
III'IIIJXO/ IIM() 1l0MHHTb, 'ITO npaBMJIbHOe nH'J,'aHMe npM Ha-
JIII'IIlIl crOMbI XOTSI M He,n;o KOHl\a peIllaeT Bce B03HHKalOll\Me
IIJlllfiJJ('M"'. TCM He Menee, SIBJISIeTCSI Heo6xo,n;MMbIM YCJIOBHeM
I IIII II"/ "IIIIJ[ 1l0JIII0l\CHHOll mM3HM.
IhIJ J.I IC,IJIOIIIIIICMIIHKOB H npaBHJIa paGoTbl C HMMH
'ImUII 1I0M()'Ib IIal\MeHTY B no,n;60pe KaJIOnpMeMHMKa, uym-
IIII'U"'IW IIPI'/ CT.lDJISITb C KaKHi:.IM BapMaHTaMM ICOJIOCTOM Mom-
1111 III'I'III"I'U ['LI'SI. ICOJIocTOMa MomeT B03BbIIllaTbCSI Ha,n; YPOB-
IIC'M IWilm II MO)l(eT 6bITb 06COJI1OTHO nJIOCKOll.
('Y" I'I'I'IIYI'I' IICCICOJIbKO TMnOB KaJIOnpHeMHMKOB; O,n;:nOKOM-
I/OIII'IITIII.IC, ,n;BYXKOMnOHeuTHbIe, np03pa'IHbIe. MaTOBbIe C
C).IIJlr.TPUMH Ii 6e3 qmJIbTpOB.
418
14'
419
.---
PeKOJIten8aquu no npuJltenenUlo K.nelOll1,eZOCR 08nOKoJltno-
;-tenmnozo KaJlOnpUeJltnUKa.
1. BbIMbITb T aTeJIbHO Iwmy BOKpyr CTOMbI TenJIOll BO Oll
C HCllTPaJIbHbIM MbIJIOM, O'IMCTMTb Komy OT BOJIOC.HHOrO
nOKpOBa.
2. Y aJIMTb 06epTO'IHYro 6YMary Ha KaJIOnpMeMHMKe.
3. PaCnOJIOmMTb l{eHTp OTBepCTM.H Ha.D; CTOMOll ( eCJIM na-
I{MeHT caM npMMeH.HeT KaJIOnpMeMHMK, TO He06xo M-
MO MCnOJIb30BaTb aepKaJIbl{e JI.H npOBepKM HymHoro
nOJIOJKeHM.H.
4. TIpHmaTb paBHOMepHO M y6e MTMTbC.H B TOM, qTO nJIac-
TMHa r.na Ka.H M He MMeeT MOp MHOK, CKJIa OK.
5. TIpoBepTe npaBMJIbHOe pacnOJIOmeHMe peHamHoro OT-
BepCTM.H MelilKa ( OTBepCTMe BHMay).
6. Y6ep;MTecb, qTO qJMKCaTOp HaxO MTC.H B aaKpblTOM no-
JIOmeHMM.
PeKoJlten8aquu no npuJ"I1.enenulO KJlelOll1,eZOCR 8eyxKoJltno-
Henmnozo KaJlOnpUeJltnUKa.
1. BbIMbITb Komy BOKpyr CTOMbI TenJIOll BO Oll C HellT-
paJIbHbIM MbIJIOM, OqMCTMTb Komy OT BOJIOC.HHOrO no-
KpOBa.
2. TIo 06paTb paaMep OTBepCTM.H no npMJIaraeMOMy IIIa6-
JIOHY co CTaH apTHbIMM OTBepCTM.HMM, COOTBeTCTBYro-
Mll MaMeTpy CTOMbI.
npHMe'laHHe: EC/lH CTOMa HMeeT HenpaBH/lbHYIO CPOPMY, MO>KHO
H3MeHHTb CPOPMY OTBepcnUI B Tpa4>apeTe C nOMOl.1\blO HO>KHHlj.
3. BbIpeaaIiHOe OTBepCTMe, OJImHO npeBbIIIIaTb pa3MepbI
CTOMbI Ha 3-4 MM. (y naI{MeHTOB, HaXO .H MXC.H Ha
nOCTeJIbHOM pemliMe, HMmHMll KOHel{ KaJIOnpMeMHliKa
OJImeH 6bITb HanpaBJIeH He K HoraM, a K cnMHe).
4. HaJIOmMTb IIIa6JIOH C BbIpe3aHHbIM OTBepCTMeM Ha aa-
liTHoe 6YMamHoe nOItpbITMe KJIeeBOrO CJIO.H KaJIOnpM-
eMHliKa Ii, eCJIIi OHO He COBna,n;aeT HM C O HOll Ma HaHe-
ceHHbIX JIMHMll, 06BeCTM KapaH.D;aIIIOM MJIM pyqKOll KOH-
TYP BbIpeaaHOro OTBepCTIi.H.
5. BbIpeaaTb OTBepCTMe B KJIeeBOM CJIoe no HaHeCeHHOMy
KOHTYPY, CJIe .H, 'IT06bI He npopeaaTb KaJIOnplie HliK
HaCKBOOb.
6. CH.HTb 3aIT\MTHoe 6YMamHoe nOKpbITlie C HaHeceHHoll
paaMeTIWll M, He TOpOn.HCb, COBMeCTMTe HlimHMll Itpall
BbIpeaaHHoro OTBepCTIi.H C HMmHell rpaHMl{ell CTOMbI.
7. IIplIKJIellTe KaJIOnpMeMHMK K Kome, HaqMHa.H C HlimHe-
I'U Kpa.H nJIaCTMHbI, CJIe .H, qT06bI Ha KJIelln:Oll nJIaCTIi-
lie He 06paaOBaJIMCb CKJIa.D;KIi, qTO MomeT npMBeCTM K
IlerepMMTIi'IHOCTIi KaJIOnpMeMHMKa.
8. TIpmtJIeMBaTb KaJIOnpMeMHMK K Kome B TeqeHMM 1 MIi-
IIYTbI, npMmMMa.H PYKOll Kpall oTBepCTM.H, npliJIema-
II lilllt CTOMe. .
9. ClIMMaTb KaJIOnpMeMHMK B 06paTHoM nOp.H.D;Ke, HaqM-
lIa.H C BepXHero Kpa.H.
ICUJIOnplieMHMK HaKJIeMBaeTC.H Ha Komy TOJIbKO O HH paa,
lion ropllo(, ero MCnOJIbaOBaHMe He onYCKaeTC.H.
1':1' 111-1 11011 KJIeeBbIM CJIOeM BOaHMKJIO O YIT\eHlie mmeHIi.H,
IInllCl III'MI'IIJICIIIIO CH.HTb KaJIOnpHeMHHK, TaK KaK, BoaMomHO,
IICI,lIIlIItJl1I 1l11JICprMqeCKa.H peaKI{M.H.
111I1l{JeJJlee 'laCmbte npU'lUnbt napywenuR zepJltemU'lnOCmu
/mJlIIf//JlleJltItUlca. I
. IIJlOxoe npMKJIeMBaHlie K KOme OKOJIO CTOMbI.
Y 1 ()('TUIICp'nICb, 'ITO Koma BOKpyr CTOMbI cyxa.H M qMCTa.H.
I IpmltMliTe HaKJIeMBaeMbIll naKeT K Kome TenJIOll PYKOll M no-
lI('p>ltliTe 1 MliHYTY .D;JI.H oOOCneqeHIi.H xopOIIIero HaKJIeMBaHIi.H.
. HenpaBMJIbHO nO 06paHHbIll paaMep oTBepCTIi.H KaJIOn-
1lIlI'MIIHlta.
I':"JIII pa3Mep CTOMbI liaMeHMJIC.H (HanpMMep, MaMeHMJIC.H
""C' 'I'C',Im 1I.IIIliCIITa), a paaMep BblpeaaHHoro OTBepCTliSI oc-
I'll 111'11 II PI'>ltliliM, <lTO MomeT nOCJIymMTb npli'IMHOll nO TeKa-
IIIIJlI'Cl/I"l))!UIMOrO no KJIeeBYro nJIaCTliHY.
. 1ll'lwrYJI.HpIloe onopomHeHMe KaJIOnplieMHMKa.
OfiJ.ItlUO KaJIOnpMeMHMK onOpOmH.HeTC.H npM aanOJIHeHMM
1111 1/3-1/2 06beMa. Hec06JIro eHMe <!Toro npaBliJIa MomeT
IIPIIl!('C'I'1i It nona aHMro co epmMMoro no KJIeeBOll CJIOllli
CI'I'I( IJI'II1111 IIIIIO IU\JIOllpM(,MIIMKa. _
. 'IPI':IIII.l'llIiillo DblCOKa.H TeMnepaTypa.
:h'"'JIITI'JILIlUC nODblIlleHlie TeMnepaTYPbI TeJIa nan;MeHTa
11l11I CI/(PY>luuoIT\ero B03 yxa MomeT npMBeCTM K MaMeHeHliro
C"I'PYlt I'YpI.I KJICCBOrO CJIO.H. TIpM no 06HbIX cMTyal{li.HX CJIe y-
"'(' 'IIIII C' MC'lUlTb ItaJIOnplieMHliK.
. IklllMlIlIJlLllUe xpaneHMe M MCnOJIbaOBaHMe KaJIOnpM-
('MllllltOIl C liCTeltlIlliM CpoKOM rO HOCTIi.
4Z0
4Z1
06pa60TKa KaJIOBOrO CBH a
I..{ eJlb: e<Ie6HaH.
llOIW3allU.R: COCTOHHHe nOCJIe OnepaJ:(HH.
OCllall1,ellue (CTepHJIhHble npe)'(MeTbI Me)'(HIJ;HHCKoro Ha3Ha-
<IeHHH):
- nep<IaTKH;
- nHHIJ;eTbI 3-4 IIIT.;
- HO:iKHHIJ;bI;
- JIOTOK;
- Ba3emmOBoe MaCJIO;
- nepeBH30<IHbIll MaTepHaJI;
- O,5%-HbIll paCTBOp KaJIHH nepMaHraHaTa;
- IIInaTeJIb;
- qJJIaKOHbI;
- naCTa JIaccapa.
HecTepHJIbHble npe,llMeTbI Me,llMIJ;HHCKOro Ha3Ha<IeHHH:
- eMKOCTb C MbIJIbHbIM paCTBopOM B KOJIH<JeCTBe 1-1,5
JIHTpa;
- JIOTOK ,lIJIH oTpa60TaHHoro nepeBH30<IHOrO MaTepMaJIa;
- KJIeeHKa;
- eMKOCTb C ,lIe3MHqJHIJ;HPYlOlW'IM paCTBopOM.
06.R3ameJlbllbte YCJl06U.R: nepHO)'(M<IeCKH Ha,110 C<IH aTb
naCTY C KO:iKM B OKpY:iKHOCTH CBHli.\a H 06pa6aTbIBaTb 3%-
hbIM paC'IBOpOM nepeKHcH Bo)'(opo)'(a H 70%-HbIM cnHpToM.
3Tanbl I 060CHoaaHHI'I
npoeeoeHue npOl/eoYPbl
1. 06pa6oTaTb KO>KY BOKpyr CTOMbl npeAynpeJKAeH&.1e HHCP&.1L1HpOBaH&.11'1
cna6blM pacTBopoM KanHI'I nepMaH- B o6nacTH CTOMb.. 06eCneyeH&.1e
l'aHaTa, Mcnonb3y1'l CTep&.1nbHblii HHcj>eKLI&.10HHOii 6e30naCHOCTII.
n&.1HLleT 101 nepeBR30YHblii MaTepHan.
BJICYW&.1Tb KO>K}' BOKpyr CTOMbl.
2. HaHecTM CTep&.1nbHblM wnaTeneM npeAynpeJKAeHHs MaLlepaLl&.1&.1 KO>KH
Ha CTep&.1nbHble can<!>eTK&.1 rycToii BOKpyr CTOMbl.
cnoii nOAorpeToii naCTbI Ilaccapa.
3. HanO>K&.1Tb can<!>eTKH C Ma3blO Ha npeAYnpa>KAeH&.1e MaLlepaLl&.1H KO>K&.1
KO>KV BOKpyr KanOBOrO CBMllIa. BOKpvr CTOMbl.
4" npOII&.1T.1lb 6onbwvIO cancj>eTKY npeAvnpeJKAeH&.1e BblCblxaHIIIR CllH-
" pmll,lI"M Ba3en&.1HOBbIM MacnOM 3&.1CTOii 060nOYK&.1 K&.1We4-
M ,"""')1(&.111. Ita BblcT)'nalOlLIYlO cn H&.1Ka.
1&.1' 'V'" "OU/IO'IKY CTOMbl cBepxy
I 1' tJ II ,It, 10 Cdn<!>eTK&.1.
" 31111"'.1 &.11 ODaTb cBePXV 6onbwoii npeAynpeJKAeH&.1e CMellleH&.1R CTe-
'" "1'1" IKOii, CnOIKeHltoii MHoro- pHnbHblx can<!>eTOK co
, III &.1ItO, 101 VI<POIlHTb nOBR3KY 6&.1H- CTOMbl.
uM,
OKOH'laHUe npol/eoypbI
1, nOMeCT&.1Tb orpa60TaHHblii nepe- 06eCneyeH&.1e &.1H<!>eKljI1oHHOii 6e30-
111130YHblii MaTepMan B eMKOCTb AJlR naCHOCTH.
oTpa60TaHHoro MaTep&.1ana.
2. nOMOCTHTb &.1HCTpYMeHTbl, nOTOK 06eCne"leH&.1e &.1H<peKLI&.10HHOii 6e30-
1111"110 o6pa60TK&.1 KanOBoro CB&.1ll1a B naCHOCT&.1.
MK" 110 C Ae3HH<P&.1L1&.1PYIOIlI&.1M
Iml 'fU)(OM.
,I YhpIIlI,l<JlOOfIKV H3-nOA naLl&.1eHTa 06eCneyeHHe HH<!>eK oHHoii 6e30-
II III1M.,.. I &.111. D eMKOCTb C Ae3&.1H<pH- naCHOCT&.1.
III1PVK "1&.1M paCTBOpOM.
,., CUlII"b nep'laTK&.1 &.1 nOMeCT&.1Tb B 06eCneyeH&.1e &.1H<peKljI1oHHoii 6e30-
MK' J(. II. C A03&.1H<!>&.1L1&.1PYIOIlI&.1M naCHOCTM.
,m 1m (OM.
3Tanbl I 060CHOBaHMI'I
noiJaomoBKa K npOl/eoype
1. 06bRCHHTb naljl1eHT)' Llenb 06- 06eCne'lHBaeTCR npaBO Ha &.1H<POP-
pa60TK&.1 KanOBoro CB&.1I1.1<1. Maljl1lO, yYaCT&.1e B npOLleAvpe.
2. BblMblTb PYK&.1, HaAeTb nep4aTKH. 06eCneY&.1BaeTCR 6e30nacHOCTb
nepcoHana.
3. nOAJlOIK&.1Tb nOA 60K naljl1eHTa co npeAYnpeJKAeHHe 3arpR3HeH&.1R
cropoHblcToMblKlleeHKY,cBHcalO- nOCTenbHOro 6enbR.
IlIVIO C KpoBaTH,
4. 06MblTb KO>K}' nOA CTOMoii, HC- 06ecne4HBaeTCR n&.14HaR rnrHeHa
naYKaHHYIO <!>eKan&.1RM&.1, &.1CnOnb3yJ1 naljl1eHTa.
nHHLleT, MapneBble Wap&.1KH 101
MblnbHblii paCTBOp. BblcyWMTb KO>K}'
CVX&.1M MapneBblM Wap&.1KOM.
5. CMeH&.1Tb n&.1HLleT. 06eCne'leHMe &.1H<peKLI&.10HHOii 6e30-
naCHOCTH.
IIm'I'lliltIllI,a CII4>OHHOii KJIII3MbI nal{lIeHTY
I' ICOJIOCTOMOH npll 3a)J;Cp:iKKe CTYJIa
I (I'J/I,: \lIlJHTI,CH OTXO:iK,lIeHHH KaJIOBbIX Macc, ra30B.
"""'1,/(/11/1 I: 3allCp:iKKa CTYJIa 60JIee 24 <JaCOB.
11"1/1///("1/1/1'
I' ""1"1 1I,IIhU' IIpC,lIMeTbI Me)'(HIJ;HHCKOro Ha3Ha<IeHHSI:
- 1I....lln....tM;
"lI"U'Ma ,lIJIH nOCTaHOBKIi CHI})OHHOll KJIH3MbI;
4ZZ
4Z3
- Ba3eJIMHOBOe MaCJIO;
- nepeB.H30<IHblii MRTepMaJI;
- nMHIJ;eTbI;
- JIOTOK.
HeCTepMJIbHble npe MeTbI Me MIJ;MHCKOrO HR3H8<IeHM.H:
- KJIeeHK8:
- CY HO;
- eMKOCTb C Bo oii B KOJIM<IeCTBe 5-10 JIMTpOB;
- eMKOCTb C e3MH<l>MIJ;Mpyro MM pRCTBOpOM.
06.R3ameJlb1lble YCJl06UJl: CJIe MTb 38 KOJIM<IeCTBOM BBe eH-
HOM M BbIBe eHHOii mM KOCTM M3 KMIUe<IHMKR.
3Tanbl I 06ocHoBaHHR
OKOH'lBHUe npoLjeoYPbl
J.. Y6paTb KIleeHKY 1-1 nOMeCTI-1Tb B 06ecne4eHI-1e I-1H<!>eKljIo1oHHOi'i 6e3O-
MKOCTb C Ae3HH<!>HljIo1PYIOll\a.1M naCHOCTH.
paCTBopoM.
3. CHRTb nep4aTKI-1 101 nOMeCTI-1Tb B 06ecne4eHHe I1Hcj>eKUI>10HHoi'i 6e30-
OMKOCTb C Ae3HH<!>l>1lj101PYIOll\a.1M naCHOCTI1.
pacTBopOM.
3Tanbl 060cHoBaHHR
noozomosKB K npoLjeoype
5. CMa3aTb YK333TenbHbl0! naneu OnpeAenReTCR HanpaBneHl1e Bbl-
npaBOIii PYKI1 Ba3enl1HOM, BBeCTI-1 B wene>KaLUero OTAena KI-1WENHI1Ka.
CBI-1LU naneu.
6. CHRTb nep4aTKY 101 3aMeHI1Tb HO- 06ecne4eHI1e I-1H<!>eKljIo10HHoO! 6e30-
BOO!. naCHOCTI-1.
7. 33nOnHI-1Tb CI-1CTeMY BOAoO! B npeAynpeJKAeHl-1e BBeAeHI-1R B03AY-
KOnl-14eCTBe 1000 Mn. Ha KOHeu xa B KI>1We'lHHK.
pe31>1HOBoi'i TPy6ta.1 HanO)l(I-1Tb 3a)l(I-1M
(CI-1CTeMY nOMoraeT AepJK3Tb accl-1-
cTeHT).
nposeiJfmue npOLjeoYPbl
1. BBecTI-1 OCTOpOJl<HO B CBI-1LU 38- Y4eT pacnOnOJKeHI-1R KI-1WENHHKa
KpyrneHHblO! KOHelj 30HAa H3 pac- nocne onepaUI-1I-1.
CTORHl-1e 10 CM, CHRTb 3aJl<I-1M.
2. nOAHRTb BOpOHKY Bblwe ypOBHR 06eCne41-1BaeTCR pa3JKI-1)1(eHI-1e 1-1
6onbHoro: KOrAB BOAa Aoi'iAeT AO yAaneHHe KanOBblX Mace 1-13 KI-1We4-
YCTbR BOpOHKl>1, MeA/leHHO onYCTI-1Tb HHK3.
B HCXOAHOO nOnO)l(eHl-1e 101 Cnl-1Tb B
CYAHO npOMblBHble BOAbl, Hanon-
HI-1BWl-1e BOpoHKY.
3. nOBTOpl-1Tb npoMblBaHl-1e AO 41-1C- 06eCne4HBaeTCR 04I-1LUeHl-1e KI-1-
TblX npoMblBHblX BOA. WENHI-1Ka.
4. CHRTb BOpOHKY C CI-1CTeMbl, onyc- 06eCne41-1BaeTCR BblTeKaHHe oc-
TI>1Tb KOHelj 30HAB B CYAHO Ha 10 TaBwei'icR )l(I-1AKOCTI1 1-13 KHWENHI-1K3.
MI-1HyT.
5. MeA/leHHO 1-13Bne4b 30HA 1-13 KO- npeAynpeJKAeHl-1e HenpHRTHbiX
nOCTOMbi. npoeecTH 06pa60TKY OLUYLUeHI-1O!.
CTOMbl.
OKOH'lBHUe npOLjeoypbl
1. nOMeCTI-1Tb cI-1cTeMY B eMKOCTb C 06ecnENeHI-1e I-1Hcj>el<ljIo10HHOIii 6e30-
Ae31-1Hcj>I-IUl-1PYlOlI.\I-1M pacTBopoM. naCHOCTH.
llOCT8HOBKa raaOOTBOAHOH Tpy6KM B KOJIOCTOl\ry
If"Jlb: BblBe eHHe raaOB li3 KMIIIeQHliI{8.
11f)/((/.IlI11ue: MeTeopli3M.
( I('II,II/(,'IIlle
('I'I'I'IIJILJlLle npe,l\MeTbI Me,l\liIJ;liHCIWI'O Ha3Ha<IeHM.H:
IJ('P'IlITIUI;
l'aJOOTBO,l\Ha.H Tpy6Ka;
IIn:lCJIUHOBOe MaCJIO;
III'PCI1II30'UIbIll MaTepliaJI.
) 1",- r"jlllJILJlble npe,l\MeTbI Me,l\liIJ;liHCKOI'O aa3Ha<Ieali.!I:
I{JIeeHIm;
- 60JIbIlla.!I CaJI<l>eTl{a;
- GUilT.
()f5 r./lIm"JllJlIlJle YCJI06UJI: ra300TBO,l\HaH Tpy61{R BBO,l\liTC.H B
"I'IIMY 1111 1 'mc.
3T.lnLI I 060CHOBaHHR
nOOzom06Ka K npoLjeoype
I, VII I1I-1'bC I 0 113/11>141-11-1 I-1H<I>oPMa- 06eCne41-1BaeTCR npaBO naljlo1eHTa
111-1"'11101"0 cornaCHR n3lj101eHTa Ha Ha I-1H<!>opMaljl-1lO.
/II> )\ IP-AYpy.
2. YIIO)l(l-1Tb naljl-1eHTa Ha Cnl-1HY, npeAynpe>K,[1eHHe 3arp513HeHHR
1II1I1/1()>KI-1Tb KneeHKY. nOCTenbHoro 6enbR.
.\ CM 13 Ilb 33KpyrneHHbl0! KOHelj 06nel"leHI-1e BBeAeHH5I ra300TBOA-
'I'yIlKI>1 R,I3enHHOM Ha A/lI>1HY 20 CM. HOO! Tpy6KI>1.
4, 11"lloTL pe31-1110Bble nep4aTKI-1. 06eCne4eHl-1e I-1H<!>eKUI-10HHOi'i 6e30-
naCHOCTI-1.
II CM,I.Imb YK33aTenbHbli'i nanelj OnpeAenReTCR HanpaBneHHe Bbl-
"1"111' "PYI<1-1 Da3enl-1HOBbiM MacnOM. weneJl<all.\ero oTAena KI-1We4HHK3.
I 11,11 U ('UIAU, nllne .
(',IJIrI, /lOP'llITKY 101 3aMeHI-1Tb Ho- 06eCne4eHl-1e I-1Hcj>eKUI-10HHOIii 6e30-
Un,"". naCHOCTl1.
424
425
"-
......
r .--<-.. "
........ r Jr;.;"1:""
I. ;-;
o \r
/ -y
3Tanbl I 060CHOBaHHI'I
npoeeiJfJHue npo4eoypbl
1, BBBCTH OCTOpO>KHO ra300TBoAHYIO npBAynpB)f(ABHMB B03HHKHOBBH&.11'1
IJly6K}' B KonocToMY Ha p,IlHHY 20 HBOp&.1I'1THbIX Ol.1\Yl.1\BHHI;!.
CM.
2. 06BI'I3aTb OCTaBwMI;!C5I KOHBlj npBAynpB)f(ABHMB BbIOaABH&.11'1 ra30-
ra300TBOAHol;! Tpy6K&.1 6HHTOM 101 OTBOAHOO Tpy6KH.
3a<!>I'IKC&.1poeaTb BOKpyr 6BABp oa-
lj&.1BHTa.
3. 3aBBpH}'Tb KOHBlj ra300TBoAHoi'i 06BCnB4BH&.1B KOM<pOpTHblX ycno-
Tpy6K&.1 B KOBBHK}' 101 MHorocnoi'iHo B&.1i'i B CnY'laB BbITBKaH&.11'1 BMBCTB C
CIIOpH}'TY1O carnpBTK}'. ra3aMH K&.1WB"IHOrO COAep>lG1MOro.
OKOH'IaHUe npOlj/30YPbl
I \I1.moo'ib OCTOp())l(HO ra300TBOA- npBAynpB>KABH&.1B B03H&.1KHOBBH&.11'1
"Y'tI IJlyrKY 1013 KonocTOMb'''IBpB3 1 OpOneJKHei'i.
"I L.
2, Otlp.l(5oTaTb KonOCTOMY 101 Hana- 06BCOB4eHHB rWvleHM4BCKoro KOM-
1I<&.11h 00BI'I3K}'. <!>opra.
3, 11t1McnMTb ra300TBOAHYlO TPy6K}' 06BCOB"IBHHB &.1H<!>BKlj&.10HHol;! 6e30-
IMIIII( 1" C Ae3MH<!>I'Ilj&.1PYIOl.1\&.1M oaCHOCT&.1.
IlIIrlIlOpOM.
4. nOMBCT&.1Tb KOBBHK}' &.1 cao<!>BTK}' B 06BCnB"lBH&.1B HH<!>BI<lj&.10HHOI;! 6B30-
MKOCTb C Ae3&.1H<!>l'Iljl'lpylOl.1\&.1M naCHOCTH.
JlIIL1BopOM.
5. CIU. n. lIop',arK&.1 &.1 nOMBCTMTb B 06BcnB4BH&.1B MH<peKlj&.10HHoi'i 6B30-
'MK( "10 C A03MIICII&.1ljMPYIOl.1\&.1M naCHOCT&.1.
1"111 'I'M.
2S ' tt
AI- J '. 0 \
J
I r:::
(
III'Ullllo1n,ll11l(, MO'lcnOrO nY3LIpSi '1epe3 l{HCTOCTOMY
lIfJIUUmOlJltl1lb: 1000 MJI paCTBopa qJypal\HJIJIHHa B npo-
II"I" IUI 1:5000, CTepHJILHLIll rnnpHI{ eMKOCTLIO 50-100 MJI
II Jill IIIII\JHI jICaue, CTepliJILHLIll JIOTOK, CTepliJILHLI;ii qJJla-
111111, 1111 1/3 1I11110JIIIellllLIll aUTHCenTH'IeCKHM paCTBopOM,eM-
I((II'I'I'IVIII diopn rrpoMLIBHOll mH,!\KOCTH.
2. 11"/ I'o'I'omiTL nmpHI{ C pacTBopoM t}JypaI{HJIliHa.
a. BlII'CTIi pncTBop qJypal\HJIHHa '1epe3 ,!\peHam O,!\HOMO-
MI'IITIIO, 11(' MCIICC 150-200 MJI, BO H36emaHlie CTOllKoro co-
1C1'1I1I 1'1I1IJ1 H CMOpll.{HBaHHSI CTeHKH nY3LIpSl.
I. OI'('ue/ IIIIHTL rnnpHI{ OT ,!\peHa,)iCa.
.J. 1I.1ICJIOIIHTL KOHel{ ,!\peHama BHli3 Ha,!\ eMKOCTLIO ,!\JISI
(' /)".I IIpOMLIBIlOll mli,!\KOCTIi
nOCTaHOBKa ra30oTBoAHOM Tpy6KM B KonocToMY
425
427
6. TIOBTOPMTb npOMbIBRHMe HeCKOJIbKO pR3, l1.0 nO.HBJIeHM.H
'IMCTOH mMl1.KOCTM.
7. OnycTMTb l1.peHRmHYIO Tpy6KY nOCJIe npOMbIBRHM.H BO
qJJIRKOH C aHTMCenTM'IeCKMM paCTBopOM M 3aKpbITb I}JJIaKOH
np06KOH C OTBepCTMeM l1.JI.H Tpy6KH.
8. TIOl1.B.H3aTb I}JJIaKOH K KpOBRTM nRIJ;MeHTR MJIM YKpenMTb
Ha TeJIe naIJ;MeHTa nOB.H3KoH.
npHMe4aHHe: AllSi YAaneHHSI 3anaxa HeobxoAHMO Tl aTenb-
HO MblTb M04enpHeMHblH COCYA HeCKonbKO pa3 B AeHb 101
A06aBI1S1Tb HeCKOllbKO KpHCTallnHKOB nepMaHraHaTR KaIIHSI.
6.10. 30HgoBbie MaHunYARquu
!Y
npOMblBaHHe )t(enYAKa
IfeJlb: Yll.IlJIMTb M3 meJIYl1.Ka ero COl1.epmMMoe 'Iepe3 nmIJ;e-
BOA.
Ilolw3anu.R: OTpaBJIeHMe Hell.06pOKa'IeCTBeHHOH nMIIJ;eu.
JIeKapCTBRMM. aJII<orOJIeM.
Ilpomu6onoKa3anu.R: KpoBOTe'IeHM.H M3 mET, BOCnaJIliTeJIb-
liMe 3a60JIeBaHli.H C M3'b.H3BJIeHM.HMM B nOJIOCTIi pTR Ii rJIOTKIi.
OcnaU{enue:
- JIOTOK l1.JI.H oTpa60TaHHoro MaTepliaJIR;
- CTeKJI.HHHR.H BopOHKa eMKOCTblO 0,5-1 JI;
- 2 TOJICTbIX JiceJIYl1.0'IHbIX 30Hl1.a;
- CTPKJI.HHHR.H TPy6Ka, COel1.liH.HIOw;a.H 30Hl1.bI;
- nOlla KOMHaTHoH TeMnepaTypbI - 10 JI;
- ICOIIIII;
- '1'1\.1 ItJlJl IIpOMbIBHbIX BOA;
C/!lIP'('YIC ICneeH'lRTbIH - 2 lIITYKIi;
- JlO'l'OIC ll.JI.H oCHaw;eHIi.H;
MUpJIeBbIe caJ!cpeTKM;
- ('MI<OCTb C ll.e3pacTBopOM;
C'YXIUI XJIOpHa.H li3BeCTb;
- III',,'UITICR JIaTeKCHbIe.
(IfIJI./I/lI/('JI"1I0e YCJlOBue: npM BBel1.eHMIi 30Hl1.a He06xoll.liMO
....VII\I'I.I'IIJIJII.1o 1<OIITpOJIb cB060l1.HOro npOXOmll.eHM.H 30Hl1. R B
)I(tt.lIY"OIC.
,- - /
7;iJ -" - -/
'?-. e' \' :f /
C '--:::.-:':, ......
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- .-
'- -- >
--_-<:.._:_1__-.- _.J
:/
3Tanbl I 06OCHOBaHMe
nOCJzom06Ka K npou,eCJype
, Yc ,. """IHTb AOBeIJl'lTenbHble 06ecne4eHHe npaBa Ha MHcj>opMa-
1I1I10"'IIIMII,OUbACHMTb XOA npo- MIO. y<1aCTMe B npo eAYpe.
IIIIIY,III. nUI1Y'IMTb cornaCHe Ha
II' III IIYPY.
J. "UIIICIfOI1MTb He06xOAMMoe oc- 06ecne4MTb 4eTKOCTb BblnOnHeHH5I
IIlIIltlltlAO. npo eAypbl.
I ""fI"TIo cfnpTYK.
" I II IMIIII 101 OCYWMTb PYKM. Ha,qeTb 06ecne4eHMe MHcj>eK MOHHoi1 6e30-
II"I'UI'"". naCHOCTM.
II. YCII/IMIL nU MeHTa Ha cTyn. 1'0- Heo6xOAMMoenono eHMeBOBpeMA
lIuny IIOMlloro HaKllOlJMTb BnepeA. npo eAYPbl ATlA 3<!>cj>eKTMBHOro
npoXO>K,[1eHMA 30HAa B nMll!eBOA.
npOMblBaHMe MO'leBOrO nY3blpSi '1epe3 LLMTOCTOMY:
a - BBeAeHl1e paCTBopa, 6 - CI1I1B npoMblBHblX BOA
42B
429
3Tanbl 060CHOBaH&.1e
nOOitomoeKa K npOf.jBoype
6. np&.1CTaBHTb Ta3 K HoraM naLl&.1eH- Cll&.1BaTb npoMblBHble BOAbl.
Ta.
7. HaAeTb <!>ap1)lK naLl&.1eH1)I. 06ecne4HTb &.1HcjJeKLI&.10HHYIO 6e30-
naCHOCTb, n&.1 HYIO rWvleHY naLl&.1eH-
1)1.
BbinonHeHue npOU,eaYPbl
1. \I13MepHTb 3OHAOM paccT05lH&.1e AO YCllOBHI'I A1151 nona,QaH&.11'1 30HAa B
H<BllYAKa (OT Me eB&.1J\HOrO OTpocTKa >KenYAoK.
AD KOH4HKa Hoca &.1 M04K&.1 yxa).
2. CoeAl1HHTb 30HAbi CTeKllRHHO';; 06ecne4HTb AOCTaTO HYIO All&.1HY
TPy6KO';;. 30HAa.
3. CM04&.1Tb Clleno';; KOHeLl 30HAa 06eCne &.1Tb npOXO>KAeH&.1e 30HAa B
BOAD';;. >KenYAoK MeTOAOM CKOllb>KeH&.1R.
4. naLl&.1eH1)I npeAllOJKIHb OTKpblTb
pOT, B3RTb 30HA B npaBYIO PYK)' Ha
paCCTORH&.1&.1 10 CM OT 3aKpyrneHHoro
KOHLI3, BBeCHt 30HA AO KopHR R3bl-
Ka.
5. npeAnOJKI1Tb naLl&.1eH1)I AenaTb Heo6xOA&.1MOCTb Y4aCT&.1R naLl&.1eHTa
rnOTaTenbHble AB&.1JKeH&.1R, 30HA B npoLleAype.
BBeCT&.1 B >KenYAoK AO MeTK&.1.
6. np&.1COeAl1H&.1Tb K 30HAY BOpOHK)' &.1 COAepH<lo1MOe >KenYAKa BbITeCH&.1T
onycT&.1Tb ee HloI>Ke ypOBHR H<ellYAKa B03AYX &.13 C&.1CTeMbi 3OHAOB.
(HeMHoro HaKllOH&.1B ee).
7. Han&.1Tb BOAY B BOPOHK)'. KOn&.1 eCTBO BOAbl AOnH<HO COQTBeT-
CTBOBaTb pa3Mepy >KenYAKa, npH-
MepHo 1 ll.
8. MeAlleHHO nOAHRTb BOpOHK)' Ha BOAa nocTynaeT B JKellYAOK.
25-30 CM Bblwe pTa naLl&.1eHTa.
9. ClleA&.1Tb, 4T06bl B YCTbe BopOHKH np&.1HLI&.1n «coOOll\3IOll\&.1XCR cocY-
OCTanaCb BOAa. ADB»:npeAynpe>KAeH&.1enona,QaHHR
B03Ayxa B H<enYAOK.
10. bblCTpO nepeBeCT&.1 BOpOHK)'
H&.1JKe YPOBHI'I KoneH naLl&.1eHTa 101
Cll&.1BaTb cOAep>K&.1MOe >KenYAKa B
Ta3.
11. nOBTOp&.1Tb npOMblBaH&.1e He- 06ecne eH&.1e 3<!><!>eKT&.1BHOCT&.1 npo-
CKOllbKO pa3, AO nonY4eH&.11'1 4&.1CTbIX LlBAypbl.
npOMblBHblX BOA.
3aeepweHue npol.{eoYPbl
1. 1i13Bne b OCTOpO>KHO 30HA &.13
>KellYAKa naLl&.1eHTa.
430
3Tanbl 060CHOBaHHe
3aeBpWBHue npOU,eaYPbl
2. nOMeCT&.1Tb 30HA C BOpOHKO';; B 06eCne"leH&.1e &.1H<!>eKLI&.10HHO';; 6e30-
eMKOC'Tb C AB3&.1H<!>HLI&.1PYIOUI&.1M naCHOCTH.
paCTBOPOM.
3. AaTb naLll1eHty npononOCKaTb
pOT, 06TepeTb BOKpyr pTa cancjJeT-
KO';;.
4. 06ecne4HTb <!>&.13H4eCK&.1';; 101 nCI1-
X&.14eCKI1';; nOKo';; naLl&.1eHTY.
5. OrnpaB&.1Tb B lla60paTOpHIO nop- Ha3Ha'leH&.1e Bpa"la.
LI&.11O (oKono 200 Mn) npOMblBHblX
BOA Ha HCCnBAOBaH&.1e.
6. npOBeCT&.1 Ae3&.1Hcj)eKLI&.11O npo- 06eCne eH&.1e &.1H<!>el<LI&.10HHO';; 6e30-
MblBHblX BOA B eMKOCT&.1 (3aCblnaTb naCHOCT&.1. C06n1OAeH&.1e pernaMeH-
cyxo';; xnopHO';; H3BeCTbIO &.13 pac e- T&.1PYIOUI&.1X np&.1Ka30B no CaH&.1TapHo-
Ta 1:5). npOT&.1B03n&.1J\eM&.1"1eCKoMY pe>K&.1MY
llllY .
7. 06pa6oTaTb &.13Aen&.1R MeA&.1L1&.1H-
CKoro Ha3Ha4eH&.1R, npeAMeTb' yxo-
Aa, nOp4aTK&.1 B eMKOCTH
C A03&.1H<!>&.1Lj&.1PYIOUlI1M pacTBopoM.
f'
'l i
1L ff, J
npOMblBaHMe >KenYAKa
431
CbpaK4HOHHoe 30HAHpOBaHHe menYAKa
TOHKHM 30HAOM
BMecTO TOHKoro 30H a JIY'lIue MCnOJIb30BRTb BaKYYMHbIll
RcnMpaTOpHbIll OTCOC MJIM npOBeCTM PH-MeTpmo.
Ife./lb: MCCJIe,llOBaHMe CeKpeTOpHOll qJYHKI{MM meny,llKa.
[JOIW3anU.R: MarHOCTMKa H3BeHHOll 60JIe3HM, XpOHM'IeC-
Koro raCTpMTa.
Ocnaw,enue: CTepMJIbHO!
- JIOTOK, CclJOpMMpOBIlHHbIll ,lIJIH nO,llKOmHOll MH'1>eKI{MM;
- TOHKMll meJIY,lIO'IHbIll 30H,lI;
- mnpMI{ 20 MJI;
- 3amMM;
- 9-11 MapKMpoBaHHblx 6aHOK eMKOCTblO 0,2;
- nO'IKo06pa3HbIll JIOTOK;
- npo6HbIll 3aBTpRK.
06.R3ame./lbnOe YC./106ue: MCCJIe,llOBaHMe npOBO MTCH YTPOM
HRTOII{aK.
3Tanbl I 06OCHOBaHHC
BblnonHeHue npOLjeoYPbl
4. B3SHb 30HA B npaBYIO PYK}' Ha 06nel"lCH&.1e BBeAeH&.1A 30HAa B
paCCTOS1H&.1H 10-15 CM OT cnenoro >KenYAoK; cBo60AHbl';; KOHe 30HAa
KOH a, CMOY&.1Tb BQAO';;, neBo';; PYKO';; He AOn>KeH KacaTbCA OI<py>KalOlI.\&.1X
nOA£1ep>K&.1BaTb CBo60AHbl';; KOHeLj. npeAMeTOB &.1nH OAe>K,Qbl na &.1eHTa,
c06nlOAaeTCA HH<!>eK &.10HHaA 6e30-
naCHOCTb.
5. npeAflOJK&.1Tb na &.1eHT}' OTKpblTb npoAB&.1JKeH&.1e 30HAa AO >KenYAKa
pOT, nOnOJK&.1Tb cneno';; KOHe 30HAa B03MO>KHO TOnbKO npH Y4aCT&.1&.1 na-
Ha KopeHb A3b1Ka; naLj&.1eHT B :no &.1eHTa.
BpeMA AenaeT rnOTaTenbHble AB&.1-
>KeH&.1A, npOAB&.1raA 30HA B JKenYAOK
AO MeTK&.1, npCAflOJK&.1Tb na &.1eHT}'
rny60Ko AblwaTb 4epe3 HOC.
6. \I1CK1lICH&.1Tb npenATCTBHA npoxo- np&.1 Han&.14H&.1 np\JnmCTB&.1';; - Heo6-
>K,QeH&.1A 30HAa. XOAHMO 30HA YAan&.1Tb.
7. np&.1COeA&.1H&.1Tb K cBo60AHOMY He06xoAl'1Mo npH nOnY4eH&.1&.1 >Keny-
KOHLjY 30HAa wnp&.1 , &.13BnENb Bce A04Horo cOAep>K&.1MOrO HaTOll.\aKO-
COACp)Kl.1MOe >KenYAKa B 6aHK}' BO';; nopLj&.1&.1.
(nop &.1A NQ1).
8. 1I13BneKaTb JKenYAOYHoe cOAep- Co6&.1paeTCA >KenYAOYHbl';; COK-
>K&.1MOe 4epc3 Ka>K,Qble 6a3anbHaA ceKpe A.
15 M&.1HyT B TeyeH&.1e 1 yaca (nopLj&.1&.1
Ng 2. 3. 4. 5).
9. BBecTH 3HTepanbHbl';; pa3ApaJK&.1- He06xOA&.1MOe ycnOB&.1e AflA CT&.1MY-
Tenb Yepe3 30HA. Ha Hapy>KHbl';; nALj&.1H JKenYA!>4Ho';; CeKpe &.1&.1.
KOHC 30HA<l HanOJK&.1Tb 3a>K&.1M.
10. \.lepe3 10 M&.1HyT &.13Bne4b
10 Mn >KOnYAOYHOfO cOAep>K&.1MOrO
(nopLj&.1A Ng 6).
11. 4epe3 15 M&.1HyT H3Bne4b Bce '
JKenYA04Hoe COAep>K'.1MOe (nOpLj&.1A
Ng7).
12. 1I13BneKaTb Bce >KenYAOYHoe C06&.1paeTCA CT&.1Myn&.1pOBaHHbl';;
COAep)!(l.1MOe '1epe3 Ka>K,Qble 15 >KenYA04Hbl';; COK - CT&.1Myn&.1pOBaH-
M&.1HyT B Te4eH&.1e 1 4aca (nop &.1 Ng HaA ceKpeLj&.1S1.
8.9, 10,11).
13.1I13ene'lb 30HA 1013 >KenYAKa. AaTb C06n1OAeH&.1e n&.14HO';; mrneHbl na-
naLj&.1eHT}' npononOCKaTb pOT, 06Te- &.1eHTa.
peTb KOJKy BOKpyr pTa cancj>eTKo';;.
14. OmpaB&.1Tb B na60paTOp&.11O 10 npOBOA&.1TCA &.1ccneAoBaH&.1e K&.1CnOT-
nop ';; (nop &.1&.1 NQ 2-11) >Keny- Hocm >KenYAOYHOrO COKa
AOYHOro COAep)Kl.1MOro. conpoBo-
AI'1Tb HanpaBneH&.1eM.
\
\.
.
3Tanbl I 06oCHOBaH&.1e
nOoeomoGKa K npof.jeoype
1. YCTaHOB&.1Tb AOBep&.1TenbHble 06eCne4eH&.1e npaBa Ha MH<!>opMa-
oTHOWeH&.1A, 06bACH&.1Tb XOA npo e- MIO. Y4aCT&.1e B np eAype.
AYPbl. nonY4MTb CornaC&.1e Ha npo-
eAYPY,
2. nOAl"OTOBHTb Heo6xoAl'1MOe oc- 06ecne4HTb 4eTKOCTb BblnonHeHMA
Hall.\eH&.1e. npoLjeAYpbl.
3. HaAeTb nep4aTK&.1. AOnOnH&.1Tenb- 06eCnENeH&.1e MI-Kj>eK oHHo';; 6e30-
Hbl';; xanaT. naCHOCTM.
BbmonHcHue npOf.jeoypbl
1. 1I13Mep&.1Tb Afl&.1Hy BBOAl'1MO';; 4ac- He06xOA&.1MOe ycnOB&.1e A/lA nona-
m 30HAa B JKenYAOK (poeT naLj&.1eHTa AaH&.1A 30HAa B JKC1lYAOK.
- 100).
2. YC<JAI'1Tb na &.1eHTa Ha cT}'n, 06eCne4&.1Tb YA06Hoe nOnO>KeH&.1e
CHSHb 3y6Hble npoTe3bl (ecnH OH&.1 na &.1eHT}' M HenOnaAaHHe 30HAa B
eCTb). cnerKa HaKf10HMTb ronoBY AblxarenbHble nyT&.1. TaK KaK Manbl';;
BnepeA. A3b140K OTKpblBaeT BXOA B n&.1l1.\eBOA
np&.1 HaKflOHe ronOBbl BnepeA.
3. np&.1KpblTb welO 101 rpYAb naLj&.1eHTa 06eCnENeH&.1e n&.14Ho';; r&.1rMeHbl na-
nonOTeH eM. A<lTb B PYK&.1 can<!>eT- eHTa.
KY.
432
433
j
AYOAeHanbHoe 30HAHpOBaHHe
OCltall1,enue:
1. CTepMJIbHble: YO,l\eHaJIbHbIH 30H.l{, 3a)f<MM, nmpMI{ 20
MJI, nO<IKo06pa3HbIH JIOTOK, 10-15 JIa60paTopHbIX np06M-
pOK.
2. TIOJIOTeHI{e, CaJIclJeTKa, pe3MHOBble nep<IaTKM, HanpaB-
JIeHMe B JIa60paTopMJO, rpeJIKa, MHrKMH BaJIMK MJIM nO,l\YIII-
Ka, IIITaTMB ,l\JIH np06MpoK, HM3I<aH cKaMeHKa, pa3,l\pamM-
TeJIb (nOJIY'lMTb B anTeKe 50 MJI 33% -Horo pacTBopa MarHMH
cYJIbqJaTa, MJIM 40%-Horo paCTBopa rJIJOK03bI (KCMJIMT, Cop-
6MT) MJIM paCTMTeJIbHOe MaCJIO 40-60"C, CTaKaH C TenJIOH
BO OH.
[JoiJzomoeKa naquenma: 30H,l\MpOBaHMe npOBO,l\MTCH YTPOM,
HaTOII{aK, HaKaHYHe - JIernMH ymMH, MCKJIIO'iMTb npO,l\YKTbI,
BbI3bIBaJOII{Me MeTeopM3M, Ha HO'lb - rpeJIKa Ha 06JIaCTb npa-
Boro no pe6epbH, CTaKaH O'ieHb CJIa,l\KOrO 'iaH (eCJIM HeT npo-
TMBonoKa3aHMH).
1. Ha eTb nep<IaTKH, OnOJIHMTeJIbHbIll XaJIaT.
2. M3MepliTb ,l\JIliHY 30H a OT MO'lKM yxa ,l\0 pe3I{OB, OT
pe3I{OB o nynK8, C,l\eJIaTb MeTKY N2 I, npM6aBMTb ,l\JIMHY
JIa,l\OHH naI{MeHTa. C,l\eJIa'Ib MeTKY N2 2 (,l\aJIee C,l\eJIaTb MeTKM
'iepe3 KIDK bIe 10 CM).
3. BBeCTM ,l\yo eHaJIbHbIll 30H,l\ ,l\0 nepBoH MeTKM TaK me,
KaK TOHKMH meJIY,l\O'iHbIH 30H,l\. Ha cB060,l\HbIH KOHeI{ HaJIO-
mliTb 3IDKliM.
4. YJIOmMTb naI{MeHTa Ha KylIIeTKY 6e3 nO,l\YIIIKM Ha npa-
BbIH 60K. no,l\ Ta3 nO,l\JIOmMTb BaJIliK MJIIi nO,l\YIIIKY. no,l\ npa-'
Boe nO,l\pe6epbe - rpeJIKY.
5. CHHTb 3IDKMM. OnyCTMTb CBo60,l\HbIH KOHeI{ 30 a B O,l\HY
M3 np06MpoK. CTOHIT\MX Ha IIITaTIiBe ua Uli3KOH cKaMeHKe
pH,l\OM C KYlIIeTKoH; BbI,l\eJIHeTCH MYTHoe. CBeTJIOe co,nepmM-
Moe meJIY,l\Ka (KMCJIOH peaKI{MIi).
6. TIpe,nJIOmliTb naI{MeHTY Me JIeHHO 3arJIaTbIBaTb 30H,l\ ,l\0
BTOpOH MeTKM. Iepe3 20-60 MMHYT 30H,l\ nona,n;eT B 12-nepcT-
HYJO KliIIIKY. Ha'iHe'r BbmeJIHTbC.H 30JIOTMCTO-meJITOe co epmM-
Moe II{eJIO'iHOH peaKI{Mli. ::ho nOpI{liH A. ,lIYO,l\eHaJIbHaJI meJI'lb.
7. Y JIOmliTb naI{MeHTa Ha cnMHY, BBeCTIi pa3 pIDKHTeJIb
'iepe3 30H,l\. liCnOJI-b3YH IIInpliI{ KaK BOPOHKY. HaJIOmliTb 3a-
mMM Ha cB060,l\HbIH KOHeI{ 30H,l\a ua 5-10 MliHYT.
8. YJIOmMTb naI{MeHTa Ha npaBbIH 60K (CM. n. 4), CHHTb
3IDKMM. OnyCTliTb CB060,l\HbIll KOHeI{ 30H,l\a B np06lipKM no-
O'lepe HO - BbI,l\eJIHeTCH TeMHO-OJIMBKOBaH meJI'ib M3 meJI'i-
Horo nY3blpH. 3TO nopI{MH B, nY3blpHaH meJI'ib.
9. TIepCJIOmMTb 30H,l\ B CJIe,llYJOIT\Me np06MpKIi. KOr,l\a Ha'i-
nCT BbI CJIJ1TbCJI np03pa'lHaH, 30JIOTMCTO-meJITaH meJI'ib. 3TO
1I{)l'ltlUl C, I1C'ICIIO'lHaH meJI'lb.
lO. M3BJIe'lb 30H,l\, ,l\aTb npOnOJIOCKaTb pOT BO,l\OH.
11. TIpoMapKMpoBaTb no O,l\HOH np06lipKe M3 Kamp;oH nop-
I{MIi. OI}JOPMIiTb HanpaBJIeHMe, oTnpaBMTb B JIa60paTopuJO.
12. 06pa60TaTb UCnOJIb30BaHHble U3,l\eJIMH Me,l\UI{MHCKoro
Ha3Ha'ieHMH. npe MeTbI yxo,l\a B eMKOCTM C t\e3MHclJMI{MPYJO-
II{MM pacTBopoM.
npHMe'laHHe:
1. nOClle nOlly<1eHI>151 nop l>11-1 C 4epe3 30HA MO>KHO BBeCTI>1 lleKap-
CTBeHHble cpeACTBa.
2. CmoHY, BbiAellAIOLl\YIOCA BO BpeMA npo eAypbl. He06xoAI-IMO
cnlleBblBaTb B CaJlcpeTKY.
3. ECllI-I AyoAeHaJlbHOe 30HAl-lpOBaHl>1e npoBOAI-IllOCb C ellblO 06-
Hapy>KeHI-IA llAM6lll-li:!, TO:
a) rpellKa Ha H04b He npI>1MeH5IeTC5I;
3ranbl I 060CHOBaHHe
3aeepweHue npOf.jeoypbl
1 06pa60TaTb I>1CnOnb30BaHHble 06ecne4eHl-le I-IH<!>el< 1>10HHoj;j 6e30-
H3AenHA MeAHa3Ha4eHI>1A, nepYaTKI>1. naCHOCTH. Co6nlOAeHl-le pernaMeH-
Tl>1pytOLl\I1X nplo1Ka30B no CaHI>1TapHo-
np0Tl1BO-3nI>lAeMH4ecKoMY peJKIo1MY
Ilny.
n BHHMaHHe!
g 1. npl111CnOnb30BaHHH napeHTepallbHoro pa3JJ,pa>KHTellSl ero
Heo6xoJJ,HMO BBeCTH nOJJ,KO>KHO nocne 5-H nop4HH, 3aTeM 4e-
pe3 Ka>K,!J,ble 15 MHHYT H3BlleKaTb nop4HH N2 6, 7, 8, 9 101
AOCTaBIISlTb B na60paTOpHIO.
2. 1-13Blle4eHHe >KenYA04Horo cOJJ,ep>KHMOrO He06xoJJ,HMO
npoBoAHTb MaKCHMaJ1bHO nOIlHO 101 HenpepblBHO.
OCJw:HCnenuJl: me.ny O'lHoe KpOBOTe'ieHlie. 06MOPOK, KOJI-
JIanc M ,l\p.
435
434
6) nOp &.1H H)?KHO AOCTaBI1Tb B lla6oparopl11O B TenllOM BI1Ae, All'"
4ero np06l1pK&.1 nOMel.1\aIOTC5I B CTaKaH C TenllOH BOAOH 37'C.
4. 1-13Bll eH&.1e AyoAeHallbHoro cOAep>K&.1Moro C ellblO o eHKH
<!>YHK I1H nOA>KellYAo4HOH >Kelle3bl npOBOAI1TCI'I no cne l1allbHoi1
MeTOAliKe.
YXOA npH pBOTe
IJ;eJIb: OKa3aTb nOMoIT\b npM PBOTe.
OCHall.\CIIMe: Ta3, KJIeeH'IaTbIH qJapTYK, KJIeeHKa (MJIM no-
JIOTeHIW), MaJIbIe CaJIqJeTKM JI,JISl YXOJI,a 3a nOJIOCTbJO pTa, pa-
CTBOp JI,JISl nOJIOCKaHMSl nOJIOCTM pTa: 2% paCTBOp HaTpMSl
6MKap60HaTa MJIM 0,01 % pacTBop KaJIMSl nepMaHraHaTa, :meK-
TpOOTCOC MJIM rpymeBMJI,HbIH 6aJIJIOH'IMK.
na ue1tm 6 C031ta1tUU.
IIOArOTOBKa K npo eJI,ype
1. "YcaJI.MTb na HeHTa, rpyJI.b npMKpbITb KJIeeHKoH.
2. ,Z:(aTb nOJIOTeH e, nOCTaBliTb K HoraM Ta3.
3. .Co06IT\MTb Bpa'IY.
BLlnOJIHeHMe npOl{eAypbl
1. TIpMJI.epmMBaTb rOJIOBY na MeHTa BO BpeMSl aKTa pBO-
TbI, nOJIOmMB Ha ero JI06 CBOJO JIaJI,OHb.
2. 06ecne<IMTb nOJIOCKalme nOJIOCTM pTa BOJI.OH nOCJIe Kam-
JI.oro aKTa pBOTbI;
3. BbITepeTb JIM O na MeHTa CaJIqJeTKoH.
OKoH aHHenpOl{eJI,ypLl
OCTaBliTb pBOTHbIe MaCCbI JI.O npMXOJI.a Bpa'Ia.
naque1tm oCJla6Jle1t UJlU 6e3 C031ta1tUR.
IIoAroToBKa K npol{eJJ;ype
1. TIoBepHYTb na MeHTa Ha 60K, eCJIIi HeB03MomHO M3Me-
HMTb nOJIOmeHMe.
2. TIoBepHYTb roJIOBY Ha60K BO M36emaHMe acmlpa 1i1i (no-
naJI,aHMSl) pBOTHbIX Macc B JI.bIxaTeJIbHbIe nYTIi.
3. CpOqHO BbI3BaTb Bpa'ia.
4. "Y6paTb nOJI.ymKY.
5. "YJI.aJIMTb 3y6HbIe npOTe3bI (ecJIIi OHIi eCTb).
6. HaKpbITb KJIeeHKOH meJO M rpYJI.b na lieHTa (liJIII nOJIO-
TeH eM).
7. TIOJI,CTaBliTb KO PTY noQKo06pa3HbIH JIOTOK.
a
6
YXOA 3a na4MeHTOM npM pBoTe:
a - nOllomeUHe na HeHTa C&.1Aft; 6 - nO/lOmeHHe nall&.1eHTa /lema
BbInOJIHeHHe npO eJI,ypbI
1. OTCocaTb aneKTpooTCOCOM liJIIi rpymeBMJI.HbIM 6aJIJIOH-
'11IItoM H3 nOJIOCTIi pTa, Hoca pBoTHbIe MaCCbI (npli He06xoJI.M-
MOl' I'll).
2. (kYII (,CTBIiTb YX0JI, 3a nOJIOCTbJO pTa Ii Hoca nOCJIe Kam-
1'01'0 1\1('1'1\ pnoTbI.
C )IWII'sallne npo eAYPbl
OC'I'UBliTb pBOTHbIe MaCChI JI.O npMXOJI.a Bpa'Ia.
6.' , . Aa6opamopHbie Memogb' uccliegosaHuR
JIa60paTOpUbIe liCCJIeJI,OBaHMSl SlBJISlIOTCSl JI.OnOJIHMTeJIbHbIM
MeTOJI.OM OJI,HOH M3 BamHeHmMX 'IaCTeH 06CJIeJI,OBaHliSl na M-
eHTa. B pSlJI,e c.nyqaeB liX JI.aHHbIe OKa3bIBaJOT pemaJOll\ee 3Ha-
'IeHlie npli nOCTaHOBKe JI.MarH03a, o eHKe COCTOSlHMSl na lieH-
Ta M KOHTpOJIe 3a npOBOJI.liMbIM JIeQeHMeM.
Pe3YJIbTaTbI JIa60paTopHoro MCCJIeJI.OBaHMSl BO MHorOM 3a-
BMCSlT 0'1' npaBMJIbHOCTM TeXHMKIi c60pa 6liOJIOrM'IecKoro Ma-
TepliaJIa, nOJI.JIemaIIJ;ero liCCJIeJI.oBaHliJO.
436
437
MCCJIe,l(yJOT KpOBb, BbI,I(eJIeHfUi (MO'lY, KaJI, MOKPOTY), CO-
,l(epmMMOe meJIY,I(Ka, ,l(BeHa aTMrrepCTHOM KMIlIKM, meJI'lb,
CrrMHHOMOSrOByJO mM,I(KOCTb, SKCCY,I(aTbI, TpaHCCY,I(aTbI, rrYHK-
TaTbI, HaJICTbI Ha CJIMSMCTOii SeBa M Hoca, a TaKme rrp.HMOM.
KMIlIKM. Cne,l(yeT rrOMHMTb, 'lTO 'laCTb MCCJIe,l(OBaHMM npOBO-
,l(MTC.H BceM 6es MCKJIIO'leHM.H n MeHTaM, OT,I(eJIbHble MCCJIe,li;o-
BaHM.H rrpOBO,l(.HT CTporo no nOKaSaHM.HM B saBMCMMOCTM OT
,l(MarHosa.
J B3J1THe KpOBH H3 BeHbI Ha HclJA
(HMMYHo4JepMeHTaTHBHbIH aHaJIH3 Ha BHQ-uH4:!eKn;HlO)
OC1iaU{e1iue:
1. CTepMJIbHbIM 6MKC co crre O,l(em,l(OH.
2. CTepMJIbHbIH JIOTOK C rrepeB.HSO'lHbIM MaTepMaJIOM (llIa-
pMKM, campeTKM) U nMH eTOM.
3. CTepMJIbHbIe CTeKJI.HHHble rreHM MJIJIMHOBble cpJIaKOHbI
6es KOHcepBaHTa C pesMHoBoM rrp06KoH. .
4. KOHTeMHep, JIMrrKa.H JIeHTa, BO,l(HHa.H 6aH.H 45 C, rrapa-
CPMH, KMCTO'lKa, 6MKC ,l(JI.H TpaHcrropTMpoBKM KOHTeHHepa C
BaToM MJIM nOpOJIOHOM, KapaH,I(am rro CTeKJIY.
5. CnHpT 70., BeHosHbIM mrYT, BaJIMK, 3%-HbIH pacTBop
XJIOpaMMHa, JIOTOK.
6. HarrpaBJIeHMe B ,l(BYX SKSeMrrJI.HpaX M eJIJIocpaHoBbIH
rraKeT ,l(JI.H HHX.
nOclIeaoeameJ/.b1iOCmb aeiicmeuii:.
1. Y CTaHOBMTb ,l(OBepMTeJIbHbIe KOHcpM,I(eH MaJIbHble OTHO-
IlICHM.H C rra HeHTOM.
2. 06'b.HCHHTb na HeHTY n;eJIb M XO,l( npo e,l(ypbI.
3. Y6e,l(MTbC.H B HaJIM'lHM MHcpopMa MoHHoro COrJIaCM.H Ha
rrpo e.l\YPY .
4. BbIMblTb M OCYIlIMTb PYKM.
5. Ha eTb crre O,l(em,l(Y.
6. ilo,l(rOTOBHTb OCHa eHMe.
7. ilOMO'Ib na MeHTY saHHTb Y,I(06HOe nOJIOmeHMe JIema
MJIH CM,I(.H ,l(JI.H BeHerrYHK MM.
8. BCKpbITb 0,l(HOpa30BbIM IlIrrpM , c06paTb ero, BbIIIYC-
TMTb BOS,I(YX M3 IlIrrpH a.
9. BblrrOJIHMTb BeHerryHKlQiIO (CM. rrpOTOKOJI - B3.HTMe KpOBM
Ha R('Ubl Ha MCCJIe,l(OBaHMe).
10. B3HTb MS BeHbI 3-5 MJI KpOBM, M3BJIe'lb MrJIY, rrpM-
maTI, MeCTO rrYHK MM CTepMJIbHbIM TaMrrOHOM Ha 3-5 MMHYT.
11. iloMecTMTb KpOBb B CTepMJIbHbIM rreHM MJIJIMHOBblM
cpJIaKOH, SaKpbITb cpJIaKOH CTepHJIbHOH pe3MHoBoH np06KoH M
rrpoHYMepoBaTb ero.
12. 06pa60TaTb rrp06KY cpJIaKOHa paCrrJIaBJIeHHbIM (Ha BO-
,I(.HHOH 6aHe) rrapacpMHoM C rrOMO bIO KMCTO'lKM.
13. YCTaHoBMTb cpJIaKOH B MeTaJIJIM'leCKMH KOHTeHHep B
.H'leHKY.
ccneAOBaHMR KpOBM
Pa3JIH'laIOT 06 eKJIMHM'lecI<Me, 6HOXHMM'leCKMe II. MMMY-
HOJIOrM'leCKMe MCCJIe,l(OBaHM.H KpOBM (CM. rrpMJIOmeHMe).
IJ;eJIb 06 eKJIMHH'leCKOrO MCCJIe,l(OBaHM.H KpOBM - KOJIM'le-
CTBeHHoe II. Ka'leCTBeHHoe MsyqeHMe cpopMeHHbIx SJIeMeHTOB
KpOBM (SpMTpO MTOB, JIeMKO MTOB, TpoM60 nToB), orrpe,l(eJIe-
HMe KOJIM'leCTBa reMorJI06MHa (HB), CIWpOCTM OCe,l(aHM.H SPMT-
pO MTOB (COS).
KJIeTO'lHblH COCTaB KpOBn 3,1(OpOBOro 'leJIOBeKa ,l(OCTaTO'lHO
rrOCTO.HHeH, rr03TOMY ero MSMeJH!HM.H }'Ka3bmaIOT Ha Te HJIM HHble
rraTOJIom'leCKMe rrpo eCCbI B OpraHMSMe (CM. rrpMJIOmeHMe).
O,l(HaKo ,l(ame Y 3,1(opOBOro 'leJIOBeKa MoryT Ha6JIIO.ltaTbC.H
HeKOTopbIe KOJIe6aHM.H COCTaBa KpOBM B Te'leHMe CyTOK no,l(
BJIM.HHMeM rrMI.qM, cpMSM'leCKOH HarpYSKM, KOJIM'leCTBa rrpMH.H-
TOH mMJ(KOCTM M T.,I(. ,[(JI.H YCTpaHeHM.H BJIM.HHM.H 3TMX cpaKTo-
pOB KpOBb ,l(JI.H MCCJIe,l(OBaHM.H CJIe,l(yeT 6paTb npH O,l(MHaKO-
BbIX YCJIOBM.HX B O,l(HO II. TO me BpeM.H (YTPOM, HaTo aK) MS
rraJIbn;a (BOSbMeT JIa60paHT).
BHOXMMM'leCKOe MCCJIe,l(oBaHMe KpOBM SaKJIIO'lae-rC.H B orr-
pe,l(eJIeHMM CO,l(epmaHMH B KpOBM HeKOTopbIX Be eCTB (rJIIO-
K03bI KpOBM, 6MJIMpyGMHa, XOJIeCTepMHa, 6eJIKa, KpeaTMHa M
,l(p.). Mx CO,l(epmaHMe MSMeH.HeTCH rrpM Tex MJIM MHblX sa60JIe-
BaHM.HX (YBeJIH'lMBaeTC.H MJIM YMeHbllIaeTC.H), 'lTO rrOSBOJI.HeT
MCrrOJIbSOBaTb 3TM ,l(aHHbIe ,l(JI.H rrOCTaHOBKM ,l(MarH03a, a TaK-
me KOHTpOJI.H sa rrpOBO,l(MMbIM JIe'leHMeM.
KPOBb ,l(JI.H 6MOXMMM'leCKOrO M MMM.YHOJIOrM'leCKOrO MCCJIe-
,l(oBaHH.H 6epeT Me,l(HlQiHCKaJI ceCTpa B rrpo e,l(ypHOM Ka6MHe-
Te MS JIOKTeBOM BeHbI YTPOM HaTo aK, B 'lMCTYIO CYXYIO eH-
TpMCPymHYIO rrp06MpKY, 5-7 MJI. OcpopMJI.HeTC.H HarrpaBJIeHHe
B KJIHHM'leCKYIO JIa60paTopMIO.
438
439
14. 3aKpl>ITI> KOHTeHHep, repMeTMsMpOBaTI> ero JIMrrKOH
JIeHTOH.
15. C6POCMTI> TaMrrOH B ,l(e3paCTBOp, y6e,l(MTI>C.H, 'lTO KpOBI>
He BI>I,I(eJI.HeTC.H M3 MeCTa rrYHKIUiM BeHI>!.
16. llOMO'l1> rra MeHTY BCTaTI> MJIM JIe'll> Y,I(06HO.
17. YCTaHOBMTI> KOHTeHHep B 6MKC, yrrJIOTHMTI> BaToH MJIM
rrOpOJIOHOM, cBepxy rrOJIOmMTI> eJIJIocpap.oBI>IH rraKeT C Ha-
rrpaBJIeHM.HMM, SaKpl>ITI> 6MKC.
18. CH.HTI> cne o,l(em,l(Y.
19. BI>IMI>ITI> M OCYIllMTI> PYKM.
npHMe<laHHe: AOCTaBHTb 6HKC C KpOBblO TpaHCnOpTOM ne4e6-
HOro 3aBep,eHHSI B HMMYHonorH4ecKYlO na60paTOpHIO.
OcnaU{enue: 'lMCTaJI CTeKJI.HHHaJI IllMpOKOrOpJIOBaJI 6aHKa
M3 rrp03pa'iHOrO CTeKJIa, HarrpaBJIeHMe, ,l(eSpaCTBop 5% -HI>IH
pacTBop XJIOpaMMHa, 2% -HI>IH pacTBop 6MKap60HaTa HaTpM.H.
ccneAOBaHMe MOKpOT
BamHoe MeCTO B ,l(MarHOCTMKe Sa60JIeBaHMH opraHOB ,l(I>IXa-
HM.H 3aHMMaIOT JIa60paTOpHI>Ie MeTO,l(I>I MCCJIe,l(OBaHM.H MOKpO-
TI>I, rrOSBOJIHIOIl\Me CY,I(MTI> 0 xapaKTepe rraTOJIOrM'leCKOrO rrpo-
ecca.
llpM HaJIM'lMM MOKpOTI>I He06xo,l(MMO orrpe,n;eJIMTI> ee CY-
TO'lHOe KOJIM'leCTBO, KOTopoe MomeT KOJIe6aTI>C.H OT 10-15
MJI (rrpM XpOHM'leCKOM 6poHxMTe),I(0 1 JI M 60JIee (rrpM 6POH-
xOSKTaTM'leCKOH 60JIeSHM).
llPM HaJIM'lMM Y rra MeHTa MOKpOTI>I BOSHMKaeT He06xo,l(M-
MOCTI> B ee rrOBTOpHI>IX MCCJIe,l(OBaHM.HX - MMKpOCKOrrM'leC-
KMX, 6aKTepMOJIOrM'IecKMx M T.,I(.
HaM60JIee ,l(OCTOBepHI>Ie pesYJII>TaTI>! rrOJIyqaIOTC.H B Tex
CJIY'laJIX, Kor,l(a MOKPOTY rrOJIY'laroT rrpM 6POHxocKorrMM. llPM
STOM B Hee He rrorra,l(ae-r CJIIOHa, MMKpoopraHMSMI>! rrOJIOCTM
pTa (CM. rrpMJIOmeHMe).
3T3nbl I 060CHoa3HHe
nooaomOBKa K npou,eoype
1. YCTaHOB"'Tb AOBep"'TenbHble 06ecne'leH"'e cna>t<eHHOCT'" COBMe-
OTHoweH"'51 C na4",eHTOM. cTHolii pa6oTbI.
2. npeAynpeA"'Tb '" 06b5lCH"'Tb na- Co6nlOAeH",e npaB na4",eHT8 Ha
ljIIIeHTY CMblcn '" Heo6xoA"'MOCTb HH<!>oP Ma 4"'1O.
npeAcT05Il4erO ",ccneAOBaH"'SI '"
nonY4"'Tb cornac",e Ha ",ccneAOBa-
Hl1e.
3. 06ecne411Tb na6opaTOpHolii no- YcnOBl1e Ka4ecTBeHHolii nOArOTOBKl1,
cYAolii, HanpasneHl1eM HaKaHYHe I1C1<1l104eHI1e OWI1604HOro pe3ynb-
Be4epoM. npoBecTH I1HCTpYKTaJK. TaTa I1ccneAOBaHI151, 4TO 06nef'.ll1T
YKa3aTb, K KaKI1M nocneACTBI151M Al1arHocTI1KY 101 ne4eHl1e.
npl1BeAeT HapyweHl1e peKoMeHAa-
411£1 MeAl1411HCKOlii cecTpbl.
4. n04HCTI1Tb 3y6b1 YTPOM 3a 2 4aca rl1rl1eHa poTOBolii nOnOCTI1 npeAo-
AO c60pa MOKpOTbI, npononocKaTb XpaH5IeT OT nonaJ¥lHI151 MI1KpOOpra-
POT '" rnOTI<)' KI1nSl4eHolii BOAOIii He- HI13MOB poToBolii nOnOCTI1 B MOKpO-
nocpeACTBeHHo nepeA C60poM. ry.
BblnonHeHue npou,eoYPbl
1. OTKaWn5lTb 11 co6paTb MOKPOTY B YcnOBl1e HccneAoBaHI151.
411Cl)'10 6aHI<)' B KOnl14eCTBe He
MeHee 3-5 Mn.
OKOH'I8HUe npou,eoYPbl
1. npl1Kpenl1Tb HanpaBneHl1e 11 AOC- YcnOBI151. BnH5IlOl4l1e Ha pe3ynbTaT
T8BI1Tb B K/lI1HI14eCI<)'IO na6opaTo- HccneAOBaHI151.
pl1lO B Te4eHl1e 2 4aCOB.
440
BaKTepHOJIOrH'IeCKOe HCCJJe)J;OBaHHe MOKpOTI>I
TIpOBO,n;IITC.H C eJII>IO BI>IHBJIeHM.H Bos6y,n;MTeJI.H Sa60JIeBa-
HM.H, a TaItme rro,n;60pa acpcpeKTMBHoro aHTM6MOTMKa. llo,n;ro-
TOBKa rra MeHTa rrpOBo,n;MTC.H TaR me TIl\aTeJII>HO, KaK M ,l(JI.H
06m;ero KJIMHM'leCKOrO aHaJIMsa.
llocy,I(Y ,l(JI.H c60pa CJIe,n;yeT BS.HTI> B 6aKTepMOJIOrM'leCKOH
JIa60paTopMM, :'ho ,l(OJImHa 61>ITI> CTepMJII>Ha.H IllMpOKOrOpJIa.H
6aHO'IKa C Kpl>IIllKOH MS KpacpT-6YMarM, SarrOJIHeHHaJI COOT-
Be-rcTBYIOm;eH rrMTaTeJII>HOH Cpe,l(OH, - KpOB.HHI>!M arapoM, ca-
XapHI>!M 6YJII>OHOM M ,l(p. llalQieHTY He06xo,l(MMO 06'1>.HCHMTI>,
'lTO MOKpOTY c06MpaIOT YTPOM, HaTOm;aK, ,1(0 HaSHa'leHM.H aH-
441
Co6Mpalme MOKpOThI
06IQMH KJIMHH'IecKHH aHaJIII3 MOKpOTI>!
eJ/.b: 06eCrre'leHMe Ka'leCTBeHHoH rrO,l(rOTOBKH K MCCJIe,n;o-
BaHMIO, MHcpOpMMpoBaHMe M 06Y'leHMe, 06eCrre'lMTI> xpaHeHHe
M ,l(oCTaBKY MarepMaJIa Ha MCCJIe,l(OBaHMe.
nmW3anUJl: 3a60JIeBaHMe opraHoB ,l(I>!XaHM.H M cep,l(e'lHO-
COCY,I(MCTOH CMCreMI>I.
TM6MOTHKOB. Bo BpellU! c60pa MOKpOTbI OH He ,l(OJImeH Ka-
caTbCH KpaeB CTepMJIbHOll nOCY,I(bI PYKaMH, pTOM, a nOCJIe
OTKaruJIMBaHMH MOKpOTbI ,l(OJImeH CPMY me SaKpbITb ee KpbIIII-
KOll, C06mO,l(aH CTepMJIbHOCTb. MCCJIe,l(YIOT MOKp011' He no-
3,1(Hee 1-1.5 'laca nOCJIe c06MpaHMH. B 6aKJIa60paTopHIO ,l(OC-
TaBJIHIOT B KOHTellHepe Cne Tp8.HCnOpToM.
HCCJle OnaHHe MOKpOTbI Ha BK-MeTo oM c}JJlOT HH
AJIH MCCJIe,l(OB8.HMH Ha MHK06aKTepMM TY6epKYJIeSa MOKpO-
11' c06MpalOT B '1MCTYIO eMKOCTb B Te'IeHMe CyrOK, a npn He06.
XO,l(MMOCTM (MaJIOe KOJIM'IeCTBO MOKPOTbI) B Te'IeHII.e 3 CYTOK,
coxpaHHH ee B npOXJIa,l(HOM MeCTe.
TaK npM c60pe MOKpOTbI ,l(JIH MCCJIe,l(OBaHMH Ha MMK06aK-
TepMM Ty6epKYJIeSa He06xo,l(MMO MMeTb B BII.,I(Y, 'ITO OHM 06Ha-
Pymll.BalOTCH TOJIbKO B TOM CJIY'Iae, eCJIM II.X CO,l(epmaHII.e B 1
MJI MOKpOTbI COCTaBJIHeT He MeHee 10000. llO:3TOMY npM c60-
pe MOKpOTbI ee HaKanJIMBalOT B Te'IeHMe 1-3 CyrOK M ,l(OCTaB-
JIHIOT B KJIII.HM'IeCKYIO JIa60paTopMIO B KOJIM'IeCTBe He MeHee
15-20 MJI.
npHMe'laHHe: 6aKTepHocKonlofSi npOBOAIofTCSI TpoeKpaTHO.
HCCJIe OnaHHe MOKpOTbI Ha AK -
aTHllH'IHbIe KJIeTKH
llPM BSHTMM MOKpOTbI Ha aTMnM'IHbIe (onyxOJIeBbIe) KJIeT-
KM CJIe,n;YeT nOMHMTb, 'ITO 3TM KJIeTKM 6bICTpO paspYIllalOTCH,
noaTOMY MCCJIe,l(yJOT CBemeBbI,I(eJIeHHyJO MOKp011'.
AJIH 60JIbIIIell BepOHTHOCTM nona.n;aHII.H onYXOJIeBbIX KJIe-
TOK B MOKPOTY MHor,l(a npMMeHHlOT npe,l(BapMTeJIbHbIe II.Hra-
JI.JmMM C npOTeOJIMTM'IeCKMM <}>epMeHToM TpMnCMHOM, cnoc06-
CTByJO MM BbIXOm,l(eHMIO MOKpOTbI MS HaM60JIee rJIy60KMX
OT,n;eJIOB 6pOHXMaJIbHOrO ,l(epeBa.
TIo,l(roTOBKa na MeHTa M npaBM'Ia c60pa MOKpOTbI TaKMe
me, KaK ,l(JIH 06 ero KJIMHM'IeCKOrO aHaJIMsa.
D BHHMaHHe! naLlHeHTaM Hap,O YKa3aTb Ha TO, 4TO HccneAoBa-
HHIO nOA11e>KHT TOnbKO MOKpOTa, OTAellSilOlI.\aSlCSI npH Kawne, a
He npH OTxapKHBaHHH!
442
Ae3HHc}JeKI\HH MOKpOTbI H nOCYAbI
AJIH 06esSapamll.B8.HMH MOKpOTbI M nOCY,I(bI, B KOTOpOH OHa
Haxo,n;MTCH, MCnOJIbsYeTCH: 1 OJ. u
I cnoc06 - 5% -HbIll pacTBop XJIopaMMHa MJIM 0 -lIbIH
OB8.HHbIll paCTBop XJIOpaMMHa, aKcnOSM MH - 4 '1aca.
aKTI Bc:c06 _ KHn.H'leHMe B 2% -HOM pacTBope 6HKap60HaTa
HaTpMH B Te'leHMe 15 MMHyr.
Ma30K M3 3eBa M Hoca Ha BL
llPOMSBO,n;MTCH YTPOM, HaTOII\aK, B cTepMJIbHYIO np06Mp-
aKpbIBa IOTTn7 IOCH BaTHo-MapJIeBbIM TaMnOHOM,
KY, nJIOTHO S ""'-'
c06JIIO,I(aH npaBMJIa acenTMKM.
Ma30K H3 3ena
ITpuzomo6umb: CTepHJIbHbIll IIInaTeJIb M np06HpKY C TaM-
nOHOM C MeTKoll 3» (seB).
1. Y ca,n;MTb na lI.eHTa JIM OM K MCTO'IHMKY CBeTa.
2. B3HTb B JIeBYIO PYKY IllnaTeJIb M np06npKY.
3 llpe,l(JIOmHTb naI\MeHTY OTKpbITb pOT. _"
4 Ha.n;aBII.Tb IllnaTeJIeM Ha KopeHb H3bIKa, a paBOM PY-
KOH MSBJIe'Ib MS np06HpKH 3a np06KY CTepll.JIblIbIH TaMnoH.
$I no " y mKaM HOCOrJIOT-
5 BSHTb MaSOK TaMnOHOM, npOBe,l( ,..,
KM He6HbIM MMH,I(aJIII.HaM, lIe KacaHCb CJIMSMCTOll 060JIO'IKII.
nOJIOCTII. pTa (en paBa M CJIeBa), MSBJIe'Ib TaMnOH. u
6. BBeCTM TaMnOH B np06MpKY, He KacaHCb HapymHoM no-
BepXHOCTM np06npKM.
7. llocTaBMTb np06MpKY B IIITaTMB.
8. llpoBecTII. ,n;esMH<l>eK MIO IllnaTeJIH.
Ma30K H3 Hoca
npUzomo6umb: CTepMJIbHYIO np0611.pItY C TaMnOuHoM.
1. Y ca,n;MTb na MeHTa co CJIerKa sanpoKMHyroM Hasa,n; ro-
JIOBOll. ) PY K Y a
2. B3.!ITb np06MPKY C MeTKoll «H» (HOC B JIeBYIO ,
npasoll PYKOll MSBJIe'lb M3 Hee TaMnOH. __
3 llpMno,n;HHTb KOH'IMK Hoca na MelITa JIeBOII. PYKOM, a
npa Oll - BBeCTM TaMnOH JIerKII.M Bparu;aTeJIbHbIM ,l(BMmeHMeM
443
21
CTl1pHnbHble
np0611pKI1
CTHpl1nbHble WnaTenl1
H 3
B3J1TMe Ma3KOB M3 3eBa M Hoca
H3 63KTepMOnOrM'IeCKOe MccneAoB3HMe
B HIDKHMH HOCOBOH xOA C O,l(HOH, 3aTeM C ,l(pyroH CTOpOHI>I Ha
rJIy6MHY 1,5-2 CM, M3BJIe'll> TaMnOH.
4. BnecTM TaMnOH B np06MpKY, He KaCa.!ICI> HapymHl>Ix
nOBepXHOCTeH np06MpKM. -
5. O<POpMMTI> HanpaBJIeHMe.
444
ccneAOBaHMR MO M
MCCJIe,l(oBaHM.!I MO'lM n03nOJI.!IIOT onpe,l(eJIMTI> <pM3M'leCKMe
CBOHcTBa, XMMM'leCKMH COCT-aB, MMKpOCKonMIO OCa,l(Ka M YKa-
31>IBaIOT Ha COCTO.!IHMe nO'leK M MX <PYHK MIO, a TaKme n03BO-
JI.!IIOT CY,l(MTI> 0 HaJIM'lMM nopameHM.!I p.!I,I(a ,l(pyrnx opraHoB M
CMCTeM. n03TOMY OHM .!IBJI.!IIOTC.!I COCTanHOH 'laCTI>IO B 06m;eM
06CJIe,l(OBaHMM naII;MeHTa (CM. npMJIOmeHMe).
06p a3e 4
HAnPABnEH E
B
Ila60paTOpHIO
6aKmepUOCKOnU'IecKYIO
(KaKYIO)
Ma30K U3 3eea (3) U Hoca (H)
Ha iJucPmepulO
(4enb I1cCneAOBaHI1R)
l1eaHoe Cepeeu l1eaHoeu'-/
40 nem
6CMn, UHcPeKu,uoHHoe omiJ.
HanpaBIl5leTC5I
AIl51 IiIccIleAoBaHIiISI
<1>1110 naLll1eHTa
B03paCT
MecTo Haxo>KAeHIi1S1 naLll1eHTa
AaTa. '-lac 20 MaR 2003 e. 8 'lac. 40 MUH.
nOAnl1Cb B351Bwero aHaIlli13
06lII;MH aHaJIII3 MO'lH
eJlb: nOJIyqeHMe ,l(OCTOBepHoro pe3YJII>TaTa.
n01W3aHUJl:
- OI eIIIta <pM3H'leCKMX cnoHcTB, XMIIUI'leCKOrO COCTaBa MOqM
1'1 Ml-llq)()CIWnI1M oca.l\Ka MO'ln;
- o6uwe 06CJIe,l(oBaHMe na HeHTa.
OCHau eHue: eMKOCTl> 200 MJI (cTeKJI.!IHHa.!I 6aHKa (6YTI>IJI-
Ka», KMn.!I'leHa.H BO,l(a, MI>IJIO, rnrHeHWleCKa.H CaJI<pe'l'Ka, 3TM-
KeTKa (HanpaBJIeHMe).
npHMe'laHHe: npl1MeHeHl1e KOHcepBl1pYIO I1X Be ecTB He>+<el1aTe!1b-
HO, HO AonYCKaeTC5I B BI1Ae I1CKl1IO'IeHI1S1, eCI1H aHa!1113 He Mo>+<eT
6 Tb np0l13BeAeH B n0l10>+<eHHoe BpeMSI (A06aBI1S1eTC5I KpI1CTa!1-
I1I1K TI1MOl1a Ha 10-150 MI1 MO'-lI1) 11 6aHKa XpaHI1TCSI B npoXI1a,!:\HoM
MeCTe.
445
3Tanbl I 060CHOBaHI1e
nOOaOm06Ka K npoLteoype
1. C03AaTb .qoBepliiTenbHbJe KOHqJl1- 06ecne4eHI1e Oco3HaHHoro yYaCTI151
AeHLll1anbHble OTHOWeHW5I C naljl1- B npoLle.qype, 06ecne4eHwe nyrn
eHTOM. npeo.qoneHH5I npenSlTCTBI1H B 06Uje-
HWW.
2. 06b5lCHI1Tb Llellb Hccne.qOBaHW5I 06ecne4eHI1e npaB8 naljweHTa Ha
W nonyYl1Tb cornaCl1e naljl1eHTa. WHqJ°PMaL\l1IO.
8) 6 aM6ynamOpHbiX ycno6URX:
- 06yYHTb naljWeHTa npaBWnbHO
nOArOTOBHTb cocy.q AIlSi c60pa MO,
'111;
- nOArOTOBIrrb CYXYIO, '1WCTyIO
CTeK1lSlHHYIO 6aHKY C KpbIWKOi1 eM-
KOCTblO 200.0 Mn:
- 06yYWTb naljweHTa TeXHWKe 06ecne4eHwe .qOCTOBepHOCTI1 pe-
rl1rl1eHH'IeCKOH npOljeAypbl (noAMbl- 3ynbTaTa wccne.qOBaHwSI 101 OC03HaH-
B8HI151) yrpoM, HaKaHYHe HccneAe- HOro yYaCTW5I B c60pe MO'lW AIl51
BaHWSI: aHanH3a.
. npHroTOBHTb TennYID IG1n5l'le-
HYIO BOAY C MblnOM B eMKOCTI1:
. no.qMblTb HapY>KHble nonOBble
opraHbl W npOMe>KHOCTb, nonw-
Ba51 BOAY B cne.qYIOUjeH no-
cneAoBaTeIlbHoCTH:06Il8CTb
n06Ka, HapY>KHble nOIlOBble op.
raHbl, npOMe>KHOCTb, 06IlacTb
38.qHero npoxo.qa B HanpaBlle-
HI1W OT ypeTpbl K 38AHeMY npe-
XOAY;
. BblTepeTb KO>KY H8cyxO B TOi1 HanH'Iwe aneMeHTOB KpOBW B M04e
w,e noclle.qoBaTeIlbHOcTW W Ha- WCKaw,aeT pe3YIlbT8T I1cclleAoBaHwR
npaBlleHWH (ecllW Y naljl1eHTKI1
B aTOT MOMeHT MeHcTpyaLlw5I,
nocoBeTyi1Te ei1 3aKpblTb 06-
Il8CTb BnaranwUja BaTHe-
MapneBblM TaMnOHOM):
- O<!>oPMHTb HanpaBlleHwe Ha 06ecne4WBaeTCSI yeepeHHoCTb B
0611111H aHanW3 MO'IH B K1lWHl14ecKYIO nonyYeHWW 6b1CTpOro pe3ynbTma.
na60paTOpwIO
no <!>oPMe;
- 06bS!CHI1Tb naL\l1eHTy I1nw ero
pOACTBeHHWKaM, KY.qa W B KaKoe
BpeMS! OTHecrn eMKOCTb C Mo40H W
HanpaBlleHwe.
446
I 060CHOBaHHe
3Tanbl nooaom06Ka K nDOLteOVOe
6) 6 ycno6uRX CmaLtUOHapa:
- O<!>0PMI1Tb HanpaBlleHl1e Ha
0611111i1 aHaIll13 MOYI1 B K1lI1HI14ecKYIO
na6opaTopl11O
no <!>opMe; 06ecne411BaeTcSI AOCToBepHoCTb
- AaTb n8L1l1eHTy 411CTYIO. CYXYIO aHaIlW3a.
6aHOYKY eMKOCTblO 150-200 Mn C
HanpaBlleHl1eM; no aIlropl1TMY.
nOAMblTb naljl1eHTa yr M HaKa-
HYHe npoLle.qypbl. BbmonHeHue npOljeoYPbl
B oM6ynamopHbiX u CmaLtUOHapHblX
ycnoGllRx: 06eCne4HBaeTC5I AocToBepHocTb
1 06yYI1Tb naljl1eHTa TeXHI1Ke c6e- pe3ynbTaTa 11 OC03H8HHoe yYaCTl1e
p M0411 Ha K1lI1HI14eclG1i1 aHanl13: naLll1eHTa B npoLleAype.
_ yrpOM. nOClle nOAMbIB8HI151 Bb: -
nl1 rb nopoylO CTpylO MOYI1 B YHH
Ha C4eT «1, 2»:
3aAepJKaTb M04ewcnycKaHHe;
OTl<pblTb 6aHKY:
- coGpaTb B 6aHKY 150-200 Mn
MO"" (npl1 ue06xOAI1MOCTI1 3aBe -
WHII> M(J'lOl1cnycKaHHe B YHI1Ta3).
- 3'1KPblTh 611HKY KpbIWKOi1. I
Bb/nonHeHue npOljeoYPbl
B DM6ynamopHb/x u cmauuoHapHblx
ycno6uRx: 06ecne4I1BaeTc5I AocToBepHoCTb
1 06yYI1Tb n8ljl1eHTa TeXHWKe c60- pe3ynbTaTa 101 oco3HaHHoe yYacTHe
1';, M04l1 H8 K1lI1HI14eCKI1i1 aHaIll13: naljl1eHTa B npolje.qype.
VTr OM nocne nOAMblBaHHSI BblAe-
U"II, IInimylO CTPYIO M0411 B YHI1Ta3
IUI ('It f (1. 2));
- n/10,)>KaTb M04el1cnycKaHl1e; -
- ITI<phlTb 6aHKY:
11.1' Hh D 6aHKY 150-200 Mn
MII'II1 (nl'l1 uoo6xOAI1MOCTI1 3aBep-
'111111, MU'IUl1cnycKaH"e B YHI1Ta3); I
- IIKI'I.ITb fil1HKY KpblWKOi1.
447
3Tanbl I 060CHOOaHHe
BblnOnHeHUe npou,eiJYPbl
2. nonpoCI1Tb nal<l1eHTa nOBTopl1Tb
BCIO nonY'leHHYIO OT Bac I1H<I>oPMa-
1<1110 (06ecne4bTe nal<l1eHTa nl1Cb.
MeHHOIA I1H<!>opMal<l1elA, ecnl1 OH
I1MeeT TPYAHOCTI1 B 06Y'1eHHH).
3. 06b5lcHI1Tb nal<l1eHTy, rAe OH 06ecne4eHI1e cBoeBpeMeHHOIA AOC-
AOn>KeH OCTaBI1Tb eMKOCTb C MO'IOIA TaBKI-t MaTepHana B na60paTopl1lO.
11 HanpaBneHl1eM 11 KOMY COO61J.!11Tb XpaHeHl1e MO'I11 .£10 I1ccneAOBaHI151
06 3TOM. AonycKaeTcR TonbKO B xOnOAl1nbHL-I-
Ke He 60nee 1,5 '1aca.
06Y'Iellue na HeHTa nOJJ;rOToBKe H c60py MO'IH
Ha caxap B CYTO'lHOM KOJUI.'IeCTBe
eJlb: 06eCne'leHUe Ka'leCTBeHHoll nO,!lroToBKU ,!IJIS! nOJIY-
'lCHUS! ,n;oCTOBepHoro peSYJIbTaTa uCCJIe,!loBaHHS!.
II01W3aH.UJl: He06xo,!lHMOCTb KOJIH'leCTBeHHoro onpe,!leJIe-
HHS! caxapa B CYTO'lHOH MO'le.
OCH.aU{eH.ue: 2-3-JIHTPOBaJI 'lHCTaJI CTeKJIS!HHaJI 6aHKa C
KpbIlllKOH, 6aHKa, BMeCTHMOCTbIO 200-250 MJI, HanpaBJIeHHe.
3Tanbl I 060CHooaHI1S1
noiJzomoeKa K npou,eiJype
1. C03.QaTb AOBepl1TenbHble KOH<!>I1- 06eCne'leHl1e oc03HaHHoro Y'laCTI151
AeHI<L-IUnbHble OTHOWeHI151 C nal<l1- B npol<eAype. 06eCne'leHHe nyrl1
eHTOM. npeoAoneHI151 npen5ITCTBL-IIA B 06 e-
HI1I1.
2. 06bRCHHTb I<enb I1ccneAoB8HI151 06ecne4eHI1e npaBa nal<I1eHT8 Ha
11 nonY'lI1Tb cornaCHe nal<l1eHTa. HH<!>opMal<l1lO.
3. 06bRCHI1Tb nal<HeHTy, 4TO OH 06eCne'leHHe AocToBepHocTI1 pe-
Aon>KeH C06nlOMlTb 06bl4HbiIA BOA- 3ynbTaTa HccneAOBaHI151.
Ho'nl1 eBOIA 11 ABl1raTenbHblIA pe-
>KL-IM 11 co611paTb M04Y B Te4eHI1e
cyrOK.
a) 6 aM6ynamopHblX ycnoeuRX
- 06Y'111Tb nal<l1ema npaBl1naM EMKOCTb 6aHKI1 AIl51 c60pa M0411
nOWOTOBKI1 nOCYAbl AIl51 c60pa Me- 3aBl1C11T OT 06bl'lHOra cyr04Horo
4101 11 eMKOCTI1 AIl51 AocTaBKI1 B na6e- Al1ype3a.
paTOpl-tIO: nOArOTOBI1Tb 411CTylO
CTeKflRHHYIO 6aHK)' eMKOCTblO 2-3
nl1Tpa 11 6aHK)' eMKOCTbIO 200-250
Mn AIl51 AocraBKI1 M0411 B na60paTe-
pL-lIO.
448
3Tanbl I 060cHooaHL-ISI
BblnOnHeHue npou,eiJYPbl
B aM6ynamopHbix U cmau,uoHapHblX
ycnoeuRx:
1. 06Y'111Tb nal<",eHTa TeXHL-IKe c60-
pa MO'II1 AIlR I1CCneAOBaHI151:
- B 6-00 npeAIlo>K1;1Tb nal<l1eHTy MO'Ia. CKOnl1BWa5lCR 38 H04b B MO-
BbinycTI1Tb M04Y B YHI1Ta3: 4eBOM nY3blpe, He Y'lI1TbIBaerC5I.
- co6paTb BCIO BblAen5leMYlO M04y B
6onbWYlO 6aHK)' B Te4eHI1e CyrOK
(Ao 6.00 cneAylO ero AH5I);
- 113Mepl1Tb 06 ce KOnl1'1eCTBO
MII'II1 (CYT04I1b1IA Al1ype3);
- IIIIIOMOIUUTb (u360nTaTb) Cyr04-
1100 KOnH40CTDO M0411 B 6aHKe:
- OTnl1Tb OKono 200 Mn M0411 B OT-
AenbHO npl1raToBneHHYIO 6aHO'IK)'
AnR AOCTaBKI1 B na60paTopL-lIO.
OKOH'IaHUe npOu,eiJypbl
1 11I'I1Kpenl1Tb HanpaBneHl1e C YKa- 06eCne'leHl1e KOnl1'1eCTBeHHora
3n11HIIM cyr04Hora AI1ype3a (cyrO'l- onpeAeneHI151 caxapa B Cyr04HOIA
IIlIm KOnl1'1eCTBa M04L-1) Ha 6aHO'IK)' M04e.
Mt«()("U.IO
lO )-2!>0 Mil.
2. 1111111'01.11 Tb nal<l1eHTa nOBTOpl1Tb YcnOBL-Ie a<!><!>eKT"'BHOCTI1 06Y4eHI1I1.
" I I 1II1IIY'IIIIIHYIO OT Bac I1H<I>oPMa-
'1"'0 ("r., (IIO'lbTe nal<l1eHTa nHCb-
M' 1111 1l1l1lulJOpMaljlllelA. ecnl1 OH
"'Mil' I I 'VII"OCTI1 B 06 HHH).
" 'M"VIIII"" l"blX ycnoeURX:
I Jill II 111111'" IITY HanpaBneHL-Ie H8 06eCne'leHL-Ie OC03HaHHora Y'laCTl1e
'" , "' II' IIUII110, 3anOnHI1B era no nal<Hema B I1CCneAOBaHHI1.
'I' I'M'
(u.t ... II III IItILl eHTYt t<y.q,a B EMKOCTb AIl51 c60pa M04'" xpaH"'TcR B
.' .".." "II"MII Oil I1nl1 era 6nl13KI1e npoxn8.QHOM MeCTe.
1"'/1' """III"'KI11101l>KHbl npl1HeCTI1
n"'''I'II'Y ( MO'IOI1I1 HanpaBneHl1eM C
V" I ""''''"M cyro4HOra Al1ype3a.
II ('III1/1I/RX cmfllJ'JOHapa:
I ()/ 'hSlCltl1Tb nal<l1eHTy, K)'Aa OH 06ecne'leHl1e CBoeBpeMeHHOIA AOC-
1I01l>KOH co611paTb MO'IY B TB'leHl1e TaBKI1 MaTepl1ana B na6opaTop"'lO.
. YIOK 11 KOMY C006 I1Tb 06 OKOH4a-
111111 cfopa M04I1.
I . 3.. 281
449
3Tanbl 060CHOBaHI1S1
OKOH'laHUe npou,eaYPbl
npI1Me'laHl1e: onpe,qeneHl1e Cyr04- BbinOnHeHl1e <!>YHK4l1oHanbHbIX 0651-
HOro ,ql1ype33, nepeMeWI1BaHl1e Me- 3aHHOCTe.:i Me,qCeCTpbl.
411, OTnI1B3HlAe B 6aH041<}' eMKOCTbIO
200-250 Mn 11 o<!>opMneHl1e HanpaB-
neHH5I BbinOnHl1eT Me,qI1"'I1HCKa51 (na-
naTHa5l) Me,qcecTpa.
y/ 06yqeHHe naqHeHTa nop;roToBKe II. c60PY MO'IH
p;JUI HCCJJep;OBaHHH no He'lHnOpelIKO
IJeJ/.b: no.nyqeHMe p;oCToBepHoro pe3YJIbTaTa MCCJIe,uoB8.1UUI.
nOlW3aHUJl: He06xo,uMMOCTb KOJIH'leCTBeHI-IOrO onpe,ueJIe-
HM.H q:,opMeHHbIX SJIeMeHTOB B MO'le.
OCHaU{eHue: 'lHCTa.H, cyxa.H CTeKJI.HHHa.H 6aHKa eMKOCTblO
100-200 MJI, HanpaBJIeHMe no q:,opMe.
4J/.Jl noilMbl6aHUJl: KYBIIIMH MJIM KpymKa SCMapxa, CTe-
pMJIbHbIe CaJIq:,eTKM, KopHqaHr, KJIeeHKa, neJIeHKa, CY,l(HO,
- CJIa6bIll paCTBOp nepMaHrauaTa KaJIM.H (p030Boro qBeTa).
3Tanbl I 060CHOBaHHe
nOO2om06Ka K npou,eiJype
1. YCTaHoBHTb ,qosepHTenbHble, 06ecne'leHlAe nyrH npeo,qoneHI151
KOH<!>I1,qeH",HanbHble OTHOWeHl111 C npenl1TCTBl1ii e 06U(eHI1H.
na"'l1eHTOM.
2. 06b5lCHI1Tb na"'l1eHT}' ",enb 101 xo,q 06eCne'leHl1e npaea Ha I1HqJopMa-
npe,qCT05IU(ero I1CCne,qoeaHI1I1, no- "'1110. 06eCne'leHI1e coTpy,qHl14ecTBa
ny<!l1Tb cornacl1e na"'l1eHTa Ha npe- C na"'l1eHToM (4neHaMH CeMbl1),
",e,qypy, yr04HI1Tb I1X nOHI1MaHl1e. OC03HaHHoro Y'laCTI151 B npo",e,qype.
a) 6 aM6ynamopHblX YCno6U11X
- 06y<!I1Tb na"'l1eHT<J npaBl1naM Hanl1411e Mblna 101 BO,qbl B 6aH04KI1
nOAroTOBKI1 nocy,qbl,qJlSl c60pa Me- I1CKa3101T pe3ynb TaTbl I1CCne,qOBaHI151.
411: no,qrOTOBHTb CyJ<YIO, 411CT}'1O TaK KaK npl1BOAIo1T K pa3pYWCHI11O
CTeKll5lHHYlO 6aHOYI<}' eMKOCTblO <!>opMeHHblX 3neMeHTOB B MO'Ie.
100-
200 Mn, BblMblT}'1O C cOAoi1 (6e3
MbLlla);
- 06y<!I1Tb na"'lo1eHTa TeXHI1Ke 06eCne'leHI1e ,qocToBepHOCTl1 pe-
no,qMbleaHI151 nepeA C60POM M041A: 3ynbTaTa HccneAoeaHI151.
. nplo1rOTOB.1Tb TennylO Kl1nl146-
HYIO BO,qy C MblnOM;
4_50
3Tanbl I 060CHOBaHIAB
nOO20m06Ka K npolleaype
. no,qMblTb IA ononocHyrb Ha-
py>t<Hble nonOBbie opraHb' 11
npoMe>KHOCTb B cneAYIOU(ei1
nocneAoBaTenbHOCTIA:26nacTb
n06Ka, Hapy>KHble nonOBble op-
raHbl, npoMeJKHOCTb, 06naCTb
3aAHero npoxoAa B Hanpaene-
HI1I1 OT ypeTpbl K 3a.QHeMY npe-
XOAY;
. BblTepeTb KO>t<y Hacyxo B Toii
)l(e nocne,qoeaTenbHocrn (ecnl1
y na"'l1eHTKI1 MeHCTpya",H5I -
'oo6U(I1Te Bpa4Y):
- O<l>oPMI1Tb HanpaBneHHe Ha 06eCne'leHl1e TO'lHblX CBeAeHI1i1 0
I1ccne,qoBaHl1e: na"'lo1eHTe 11 COI<paU(eHl1e nOI1CKOB,
KaK na60paTopHI1, TaK 11 AOI<}'Mema-
"'1111 na"'l1eHTa.
- o(ibllrHHTb na"'l1eHTy I1nl1 ero
I' '11'-1111 '"I1'K8M, I<}'Aa 11 B KaKoe
'I UM" OIHecm 6aHI<}' C M040i111
l!anpaDneHl1eM.
.) 6 ycnoauRX cmau,UOHapa:
- O<!>oPMIATb HanpaeneHl1e Ha Ha3Ha'leHl1e Bpa4a.
IALCn0l10nnll110 no <!>opMe:
111111 '1I1CTYlO CYXYIO CTeKllI1H- 06ecne4eHHe AOCTOBepHOCTIo1 pe-
"VICI Ii "'CI'IKY, OMKOCTblO 100-200 3ynbTara I1CCneAODaHI151. Hanl1411e
Mil, c' IUlillumnOH eM; eo,qbl B 6aH041G1 npI1BO,qHT K pa3py-
weHHIO <!>opMeHHbiX 3neMeHToe B
MO'ie.
"'I,,"Ulb>lO no,qMblTb na"'l1eHTa L-1CKf1104aeTC5I nonaAaHl1e 60nbworo
flIl OA c60I)OM MOYI1 (CM. npoTOKOn: Koml4eCTea MI1Kpo(jmopbl, BTllA5IiO-
nOAMblDalll1e na"'l1ema). U(ei1 Ha AOCTOBepHOCTb pe3ynb Ta-
TOB I1CCne,qOBaHI151.
BblflonHeHue npOu,eaYPbl
J" IM(1y"lllrlO/J1I/ IX U cmau,uollap- 06eCne'leHHe He3aBI1CHMOCTI1 na-
II/,'_y' ">l/UIIX: ljI1eHTa, OC03HaHHoro Y'l8CTI151 na-
"'l1eHTa B npo",e,qype.
I, OIJY'II1Tb na"'l1eHTa TeXHIAKe c60-
'''' M _" t 1101 HCCJleAOBaI!He.
II! ,.11 1111.110 nOJIMblTb Ilapy>t<Hble OEeCne'leHl1e AOCTOBepHOCTIo1 pe-
""''' III '" 01)' f1Itbi nt'peA c60POM 3ynbTaTa I1CCneAOBaHHSI.
MU'IU.
-
:/. OblJlonHTb nopoylO CTPYIO M0411 e
YItIAT " ( 1Jl11 cy,qHO) Ha C'-IeT «1, 2».
I'
451
3T3nbl 060CHOa3H"'e
BblnOnHeHUe npou,eoYPbl
4. 3aACplf<aTb M04e"'cnycKaH"'e.
5. BblAeI1"'Tb M04Y B 6aHO'IK)' B
KOnl1'leCTBe He MeHee 10 Mn.
6. 3C1Aep>l<aTb MO'le",cnYCKaH",e,
OTCTaBWTb 6aHO'lK)'.
7. 3aBepUJl1Tb MO'leWcnycKaHwe B
YHwTa3.
OKOH'IaHUe npou,eoYPbl
1. 3aKpblTb 6aHK)' KpbIWKOi1. 06ecne4eHwe WH<!>et<U,WOHHoi1 6e30-
naCHOCTW.
2. nonpocwTb nau,weHTa nOBTOpwTb 06eCne'leHHe 3<!><!>eKTWBHOCTW 06y-
BCIO nonY'leHHYto wH<!>opMau,wlO 4eHW5I, YBepeHHOCTb MeAl1u,wHcKoi1
(06eCne'lWTb nWCbMeHHoi1 WH<!>0P- cecTpbl B AOCTW>KeHWW u,enH.
Mau,wei1, eCllW naLlweHT WMeeT TPYA-
Hocm B 06Y'1eHw",).
a) 6 ycnoeuRX cmau.uOHapa:
1. 06bl1CHWTb naLlweHTy (wnw ero 06ecne4eHwe cBOeBpeMeHHOi1 AOC-
POACTBeHHHKaM), rAe OH AOn>KeH TaBKW M3Tepwana B na60paTOpwlO.
OCTaB"'Tb 6aHK)' C MO'Ioi1 1.1 Hanpas- XpaHeH",e AonYCKaeTC51 B xonoAHoM
neHweM 101 KOMY C006l1\WTb 06 aTOM. MeCTe He 60nee '1aca.
0) 6 aMoynamopHblX ycnoeuRx:
1. 06bl1CHHTb naLlweHTy, K)'Aa 1.1 B
KaKoe BpeMR AOCTaBWTb 6aHo'lK)' C
MO'lOi1 1.1 HanpaBneHweM.
1.r 06Y'IeHHe na HeHTa nO rOTOBKe H c60py MO'III
JUI HCCJIe OBaHHH no 3HMHH KOMY
IJeJ/.b: o6ecne'leHHe Ka'leCTBeHHOll nO,llroToBKH JI,JlSI nOJIY-
'feHHSI ,lIOCTOBepHoro peSYJIbTaTa HCCJIe,llOBaHHSI.
II O1W3anUJI.: Heo6xo,llHMOCTb HCCJIe.n;OBaHI!ISI BbI,ll;eJIHTeJIbHOll
H KOH eHTPa HOHHOll <PYHK HII. nO'IeK.
Ocna enue: 8 '1IICTbIX, CYXIIX CTeKJISIHHblX 6aHOK eMKOC-
TblO 200-300 MJI C STIIKeTKall7II C YKasaHlIeM HOMepa nop-
II.I!I, 2-3 ,lIonOJIHIITeJIbHbIe CTeKJISIHHbIe 6aHKII..
3Tanbl I 060CHoa3HHC
noozomo6Ka K npou,eoype
1. C03AaTb ,qooepwTenbHble, KOH- 06eCne'leHWe OC03HaHHOrO Y'laCH\51
<!>lIIJ\eHLlHanbHble OTHOWeHW5I C B npoLle,qype, 06eCne'leHWe nyrw
naLlweHTOM. npeo,qoneHW5I npen5lTCTBwi1 B 0611\e-
HWW.
452
3Tanbl I 060cHoaaHwe
noozomoeKa K npou,eoype
" C03AaTb AOaepHTenbHble, KOH- 06eCne'leH"'C OC03HaHHoro Y'lacTWI1
cl''''AolILlwanbHble OTHOWeHW5I C B npoLleAYpe, 06eCne'leHWe nyr"w
ndl,.,eHTOM. npeoAoneHwl1 npenl1TcTBwi1 B 0611\e-
HHH.
2. 06bRCHWTb Llenb 101 XOA WCCJleAo, 06eCne'leHWe npaBa naLlweHTa Ha
1I:lII.,R. yrO'lHWTb HX nOHWMaH"'e. wHqJ0pMaLlwlO.
3. 06bRCHHTb naLlweHTY, 'lT0 OH He 06eCne'leHWe ,qOCTOBepHOCTW pe-
/lO/llf<eH W3MeHRTb BOAHo.coneaoi1, 3ynbTaTa wccneAoaaHW5I: BOAHO-
III"'r3TenbHbli1 pelf<"'M, a TalOKe coneBoi1 1.1 ABwrarenbHbli1 pelf<HM
n.,TaHwe, He npWHWMaTb AHypeTWKW BnWRIOT Ha BblAenWTenbHYIO 101 KOH-
(MO"OroHHbIC ). LleHTpaLlWOHHYIO <!>YHKLlWIO nO'leK,
AWypeTWKI1 WCKalf<81OT cyTO'lHbli1
AWype3.
'I" tlM(jynamopHb/X ycnoeURX:
- oGY"WTb naLlweHTa npaBwnaM 06eCne'leHWe wccneAOBaH.,R BblAC-
nOllrOTOOKW nOCYAbi ,qn51 c60pa MO- nWTenbHoi1 1.1 KOHLleHTpaLlwoHHOi1
'1101, nQAroToBwTb 8 '1HCTbIX CTeKllRH- !PyHKLlWH nO'IeK Ka>KAbie 3 4aca B
,,,,'x 6."'OK OMKOCTblO 25D-500 Mn C Te'leHWe cyrOK.
""'KOIKnMH. oq,opMneHHblMw no
IlmpMo, C YK83aH"'eM BpeMeHH c60-
po M04W: 6.9, 9.12,12-15,15-18,
18.21,21-24,24.3,3.6 '1aCOB;
- npHroToBHTb 2-3 AononH"'- 06eCne'leHWe nOCYAoi1 naLlweHTa
10/10.111010 '1HCTble CTeKll5lHHbie 6aHoK npw B03HWKHOBeHWH '1aCTbIX M04e-
OMKOCTblO 250-500 Mn. wcnyCKaHwi1 wnw 06pa30BaHwl1
60nbwero KOnW'IeCTBa MO'lW, KorAa
eMKOCTb OCHOBHOi1 6aHKw HeAOCTa-
T04Ha ,qn51 KOHKpeTHoi1 nOPLlww Mo-
'1101.
BblnonHeHue npOu,eoYPbl
U uM6ynumopHb/x U cmau,uoHapHblx
YCIIOOlIRX:
lor;, J1CHWTb naLlweHTY, '1TO c60p
Mil'''' I\V/IOT npOXOAl1Tb B Te'leHWe
VII..!!:.
1\ I 1111 npOl1nOIf<HTb nallHeHTY Y'IeT apeMeHW 06pa30BaH"'11 M04H B
.. IIIVt ..,1.1 h MO'IY B ytU1Ta3. ,qeHb wccneAOBaHWR
C 6-00, no:nOMY 06pa30BaBwYlOc5I
MO'ly 3a HO'Ib He06xoAwMO BbIllYC-
T.,Tb B YHwTa3.
, ( 11r."'IIII1.. t<n>KAbIO 3 aca B aT-
III IIIIIYII. rulilitY.
453
3Tanbl 060CHOOaHI1B
BblnOnHeHUe npou,eoypbl
4. 06b5lCHI1Tb, '1TO npH 4aClbiX Mo-
'!eI1CnYCKaHI1S1X I1nH BbIAeneHI1H
60nbwera KOnl14ecTBa MO'!11 c0611-
paTb MO'Iy B AOnOnHI1TeflbHYIO no-
CYAY C }'Ka3aHl1eM COOTBeTCTB)IIO-
l1!era BpeMeHHoro npoMe>K)ITKa.
5. 06b5lCHI1Tb, 4TO npl1 OTCyTCTBI1I1
MO'!11 3a epeMeHHoCi npOMe>KyrOK,
cooTBeTCTBYlOl1!a5I 6aHKa OCTaeTCSI
nycToCi, Ha 3TI1KeT1<e OTMe4aeTCSI
«OTcyrcTBl1e nopu,1111 M04M» 101 OHa
AOCTaafl5leTCSI BMeeTe C OCTanbHb/-
1.111 B na60paTOpl1lO.
6. npep.ynpeAl1Tb na411eHTa, 'lTO
H04blO era pa36YASlT An51 c60pa
cooTBeTCTBYlOl1!eCi nOP41111 M0411
(poAcTBeHHI1Kl1l1nl1 Me.QcecTpa).
7. 06bSlCHI1Tb 11 noKa3aTb, KYAa
CTaBl1Tb 6aHKI1 C MO'IOCi.
8. 06b5lCHI1Tb KaK }"I11Tb/BaTb BCIO 06eCne'leHl1e }"IeTa KOnl14eCTBa
IKI1AKOCTb, npHHSlT}'1O 3a CyTKI1. Bb/nI1TOCi 11 BbI,C\efleHHOCi IKI1AKOCTI1
3ac}fTl<l1.
9. BeeTI1 nl1CT }"lara BOAHora 6a- CTaH.QapT }"IeTa BOAHora 6anaHca.
naHca.
OKOH'laHUe npou,eoYPbl
1. nOnpOCI1Tb na411eHTa nOBTOpHTb YCJ1OBl1e 3<!><peKTI1BHOCTI1 06}"1e-
BCIO non}"leHHYIO OT Me.Ql1lj11HcKOCi HI1S1.
CeCTpb/I1H<!>opMa4111O (06eene'lb Te
na411eHTa nl1CbMeHHOCi I1H<I>oPMa-
411eCi, ecJ111 OH I1MeeT TPYAHOCTI1 B
06}"1eHI1I1).
B aM6ynamopHblx ycnoeuRx:
1. C6b5lCHI1Tb naljl1eHTY, KYAa 11 B 06ecne4eHI1e cBoeBpeMeHHoCi AOC-
KaKoe BpeM5I OH I1nl1 era pO.QcTBeH- TaBKI1 MaTepl1ana B na60paTopHIO.
HI1KI1 AOflJKHbI npl1HeCTI1 Bee nop41111
C HanpaBfleHl1eM, aanOnHI1B era no
<I>oPMe.
B ycnoeuRX cmau,uoHapa:
1. AOCTaBI1Tb Bce nop41111 B na60pa-
TOP!1 IO .
5'r
IIcCJIeJJ;oBaHHe MO'IH Ha MHKpmlmopy H '1yBCTBHTeJIbHOCTh
K aHTH6HOTHKaM H CYJILc})aHHJIaMHJJ;aM
1. Ha3Ha'iaeTC.H l1.0 npMeMa aHTM6uOTMKOB, ypocenTMKOB M
(lJopCMpoBaHHoro l1.Mype3a npM HOpMaJILHOM nMTbeBoM pemM-
Me.
2. C06MpaeTC.H cpel1.H.H.H nopIJ;M.H CTPYM MO'lM nOCJIe TID;a-
TeJIbHOrO TyaJIeTa nOJIOBbIX opraHOB B cyxyro CTepUJIbHYro
6aHO'IKY C KpbIIIIKOH MS Kpa<}>T-6YMarM.
3. MccJIel1.YeTc.H KaK MomHO 6bIcTpee, 'lT06bI Ms6emaTL pas-
MHOmeHM.H q)JIOpbI, nonaBIlleH B MO'lY liS BOSl1.yxa M MO'IeMC-
nYCKaTeJIbHOrO K8.HaJIa.
npHMe'laHHe: n0/1Y4aTb M04Y npSlMO 113 M04eBoro ny3blpSl no-
380/151IOT KaTeTepl13a411S1 11 Ha.Qfl06KOBaSI aCnI1Ca4H5I, OAHaKO K 3TI1M
MBTO.QaM npH6eralOT CTporo no nOKa3aH'iSlM.
MCCJIe.o;OBaHHe n'I0'l1l Ha .o;HaCTa3Y
}J,JISI HCCJIel1.0BaHM.H c06HpalOT B 'lll.CTYro cyxyro nocyl1.Y 50
MJI cBemeBbIl1.eJIeHHOH MO'IM M l1.0CTaBJI.HroT B JIa60paTopll.ro B
TPnJIOM BHl1.e. MccJIel1.YeTc.H cpasy npM nocTynJIeHMM, n03TOMY
CJIel1.yeT npeJJ;ynpeJJ;MTL JIa60paHTa.
I1ccneAOBaHMR Kana
PI':lYJIbTaTbI MCCJIel1.0BaHM.H SaBMC.!IT OT npaBMJIbHOH nOl1.ro-
'l'OIlIUl 1I,1IJ;I1CHTa, npaBMJIbHOrO c60pa, xpaHeHM.H M l1.0CTaBKM
MIII'qlUIIJIa IIa MCCJIel1.0BaHM.H.
I1cCJIel1,oBaTb KaJI Heo6xolJ,HMO He n03l1.Hee 8-12 'laCOB nOCJIe
nI.Il\CJIeHM.H npM YCJIOBMM xpaHeHM.H npll. TeMnepaType 3-5.C.
CofiupaTb KaJI HaJJ;O B 'lMCTYro cyxyro nocYJJ;Y, meJIaTeJILHO
C 1'('I<JIflIIUYIO.
H.1U('raTb npllMeCII. MbIJIa, BbIJJ;eJIeHMH nOJIOBbIX opraHOB.
PU3JIIl'laIOT 06ID;MH MJIM IWnpOJIOrM'leCKMH aHaJII-IS I<aJIa,
ImJI un CKPbITYro KpOBb, KaJI Ha .HII', 6aKTepIl.OJIOrU'leCKOe
m'C'JIC1\OnaHMe KaJIa, KaJI Ha npocTeHIllMe (CM. npMJIOmeHII.e).
IfCCJIeJJ;OBaHHe KaJIa Ha KonporpaMMY
I I ('ObXOl\II.MO OTMeHII.TL Mel1.II.KaMeHTbI, MSMeH.HroID;lI.e BHe-
IIIlIlUi IHIJJ; (peKaJIMH M YCMJIMBarom;He nepHCTaJIbTMKY: CJIa6M-
455
.\
TeJIbHbIe, BarO- M CMMrraTOTpOrrHbIe Cpe,l\CTBa: a<}>e,l\pMH, rrpo-
sepMH, KaOJIMH, 6apMH CYJIb<}>aT, rrperrapaTbI BMCMYTa, :meJIe-
sa M rrperrapaTbI, BBO,l\MMbIe B peKTaJIbHbIX CBe'1aX, rrpMro-
TOBJIeHHbIX Ha :mMPOBOH OCHOBe.
3a 3 ,l\HH ,l\0 MCCJIe,l\oBaHMH He06xo,l\HMO Ms6eraTb IIMlD;e-
BbIX rrpO,l\YKTOB, cO,l\epJK8.I.qHX :meJIe30: MHCO, pbI6a, Bce BM,l\bI
SeJIeHbIX oBo eH. ECJIM He06xo,l\MMO MSyqMTb CTeneHb YCBoe-
HMH rrHI.qH, eJIec006pasHo npMMeHMTb ,l\MeTbI; cO,l\ep:maI.qMe
TO'1HO ,l\OSMpoBaHHbIe onpe,l\eJIeHHbIe Ha60pbI rrpO,l\YKTOB.
npMMe'laHMe: H8H60llee p8cnpOCTpaHeHHbie AHeTbl WMI1AT8 (06-
8J1 KaIlOPI1"HOCTb 2250 KKaIl) 101 neB3Hepa (06 M K8110PH"HOCTb
3250 KKM). H83H8481OTCJ1 3a 4 -5 AHe". AH811113 c0611paeTCSI Ha
3-4-5-" AeHb TpoeKpaTHO C Y'leTOM e>KeAHeBHoro OnOpO>KHe-
HI1S1 KI1We4HHK8.
/Juemo WMUamo - U{OaRU{OR auemo:
. YTPOM - 0,5 II MOIIOK8 1111101 4aJ1, 6ellblH xlle6 C M8CIIOM 101 I1HLjO
BCMSlTKY;
. 38BTP8K - 0,5 II OBCI1HOH K8WI1, cB8peHHoH H8 MOlloKe;
. 06eA - 125 r TO ero MSlC8, CllerK8 06>KapeHHoro (BHYTPH Cbl-
poro), 200-250 r K8pTo<!>ellbHoro nlOpe;
. nOIlAHI1K - 0,5 II '1M 111111 MOIIOK8, xlle6 C M8CIIOM;
. }'>KI1H - 0,5 II MOllOKa 111111 >KI1AKOH OBCSlHOH K8WI1, 6ellblH xlle6 C
MaCIIOM 101 SlI14HHLj8 (1-2 SlHLj8).
B HopMe: rrMI.qeBbIe OCTaTKM B KaJIe He 06Hapy:meHbI.
TpoeKpaTHoe MCCJIe,l\OBaHMe ,l\aeT rrpe,l\CTaBJIeHMe 0 <}>YHK-
MOHaJIbHOM COCTommM rrMI.qeBapMTeJIbHOro TpaKTa.
HCCJIe OBaHHe KaJIa Ha npOCTeHWlle
)J;OCTaBJIHeTCH B TenJIOM B",l\e (B OCTbIBweM _ BereTaTMB-
HbIe <}>OpMbI rM6HYT, " HeBOSMO:mHO OTJIM'1MTb rraToreHHbIe
CPOPMbI OT HerraToreHHbIX). B Oq:,OpMJIeHHOM KaJIe BCTpe'1alOT-
CjI TOJILKO IJ;MCTbI, B KOMKax CJIMSM Mo:mHO HlUhM M BereTa-
TMBHbIe CPOpMbI.
IIpM BS.!IT"M KaJIa BO BpeMH peK'ropOMaHOCKOrr"H MO:mIIO
06Hapy:mMTb B MaTepMaJIe aMe6bI (HeJIb3:II CMa3bIBaTb peKTOC-
Kon BaSeJIMHOM - 31'0 saTpY,l\HHeT MMKpOCKorrMlO).
mH,llKMe KaJIOBbIe MaCCbI "CCJIe,l\YlOT He 60JIee '1eM '1epes
30 MMHyT rrOCJIe ,l\eq:,eKaIJ;"M, OCPOpMJIeHlIbIe - lIe 60JIee '1eM
'lepes 2 '1aca.
)J;JIH BSHTHH KaJIa MCnOJIbsYlOTCH 0,l\Hopa30BbIe ,l\epeBHH-
HbIe rraJIO'1KM.
16:6
HCCJIe OBaHHe KaJIa
Ha SHIJ;a I'JIHCTOB
B HaweH CTpaHe cy ecTByeT HeCKOJIbKO ,l\eCHTKOB BM,l\OB
'lCpBeH napaSHTMPYlOI.q"X B TeJIe '1eJIOBeKa.
OH"' BbISbIBalOT TOKCM'1eCK"e " TOKCHKO-aJIJIeprM'1eCKHe
JfBJIeH"H (aTO aCKapM,l\bI, TpMXMHeJIJIbI), TpaBlImpYlOT CTeHKY
R"We'1HHKa, BbISbIBalOT KpOBOTe'1eHMH (aHKMJIOCTOMbI), MO-
rYT saKpbITb BbIBO,l\HbIe rrpOTOKM, npOCBeTbI K"illOK, pa3BM-
BnHCb B TKaHHX opraHOB - paspYillalOT MX (aXMHOKOKK, IJ;MC-
THIJ;epK).
Bce reJIbM"HTbI rrp"BO,l\HT K MCTOIIJ;eHMlO (McrrOJIbSYlOT rrH-
K a ) nerrHM - K aBMTaM"H03Y, B
1'U 1'('JIblibIe BeI.qeCTBa '1eJIOBe , ....
B rr p M "HBaS"M illMpOKMM JIeH-
'lliCTIlOCTM, R aBMTaMHHOSY 12 _
T('ltQM (aHeMMH TMrra rrepHMIJ;HOSHOM); HeKOTopbIe HHcpeKIJ;M-
OllilbIe Sa60JIeBaHMH, HarrpMMep, 6aKTepMOJIOrM'1eCKaJI ,l\HseH-
TepHH, rrpOTeKaeT TH:meJIee M TpY,l\Hee, rrOMaeTCH JIe'1eHMlO
npH I1aJI"'lH" reJIbM"HTOB.
,Z:(JIJf aHaJIMSa KaJI ,l\OCTaBJIHeTCH B K MHH'1eCKYlO _JIa60pa-
TOpMlO B He60JIbillOM KOJI"'1eCTBe B CYXOM CTeKJIHHHOM 6aH0'1-
Ke 6es nO,l\rOTOBKM naIJ;"eHTa.
06yqeHHe nal.{HeHTa
c60py KaJIa Ha CKpLITyro KpOBL
IfeJ/.b: 06eCrre'1MTb Ka'1eCTBeHHYlO nOArOTOBKY K "CCJIe,l\o-
1111111110, npaBHJIbHbIH c60p, xpaHeHMe M ,l\OCTaBKY MaTepMaJIa
I1U IICCJIe,l\OBaHMe.
IIOfw3aHuJ/.: CKpbITbIe KpOBOTe'1eHMH rrpM 3a60JIeBaHMHX
opraHOB n"IIJ;eBapeH"H.
OClloU{eHue:
- CYJlHO; _
- 'mCTaH, cyxaH CTCKJIHHHaH 6aHKa C KpbIillKOH;
- narrpaBJIelIMe; _
- illrraTeJIb ,l\epeBHHHbIH O,l\HopaSOBbIM;
- nep'1aTKM JIaTeKCHbIe.
06J/.3ameJ/.bHoe YCJ/.06ue: MCKJIlO'1"Tb nona,l\aHMe KpOBM M3
nOJIOCTM pTa, HOCOBoe KpOBOTe'1eH"e, TP_aBMbI " Sa60JIeBaHMH
nOJIOCTM pTa, KpOBoxapKaHbe, reMoppOM, MeHcTPyaIJ;"M.
451
3Tanbl I 060CHOBaHM"
nOiJaom08Ka K npo/.{eiJype
1. YCTaHoBMTb ,QoBepMTenbHble, 06eCne'leH"'e nYTM npeO,QoneH"'1'I
KOHcjJM.QeHljManbHble OTHoweHMH C npenHTCTB"'" B 06UjeHMM, OC03HaH-
na1jMeHTOM. HOI1 COBMeCTHOI1 pa60Tbl.
2. 06bHCH"'Tb na1jMeHTY ('1neHaM CoTPYAHM'IeCTBO C na1jMeHTOM
CeMbM) CMblcn '" He06xo,QMMOCTb ('1neHaMM CeMb"'). MOTMBaljMH no-
npe,QCTOHUjerO MCCne,QOBaHMH. Be,QeHMH.
3. nonY'l"'Tb cornaCMe naljMeHTa C06mo,QeHMe npaB naljMeHTa.
MnM ero pO,QCTBeHHMKOB Ha npolje-
,QYPY.
4. 06bHCH"'Tb XO,Q '" CMblcn npe,Q- 06ecne'leH"'e COTPY,QHM'IeCTBa C
CToHUjel1 noro-oTOBKM K Mccne,QoBa- na1jMeHToM ('1neHaMM ceMb"').
HMIO.
5. \I1CKI1IO'1"'Tb B Te'leHMe 3 06eCne'lCH"'e ,QocToBepHocrn pe-
4 ,QHel1 nepe,Q Mccne,QOBaHMeM 1013
nMUjM 5Il1lja, MI'ICO, pbl6y, H6nOKM, 3ynbTaTa Mccne,QOBaHMI'I.
3eneHbie OBOUjM, neKapCTBa, "'3Me-
H5IIOUjMe ljBeT Kana 101 co,Qep>KaUjMe
>Kene30, B"'CMYT.
6. .QaTb peKoMeHJjalj"'M, n03BonHIO- 06eCne'leH"'e JjOcToBepHoCT'" pe-
UjMe MCKlJIO'IMTb nona.qaHMe KpOBM B 3ynbTaToB Mccne,QoBaHMI'I.
cjJeKanMM, B cnY'lae HanM'IMH MHoro
"'CTO'lHMKa KpOBOTe'leHMH.
BblnOnHeHue npOljeiJYPbl
1. 06Y'1MTb nalj",eHTa TeXHMKe c60-
pa Kana Ha "'ccne.qOBaHMe.
2. C06paTb cjJeKanMM p,nl'l Mccne,QO- rlpM npo.qonJKMTenbHOM xpaHeHMM
BaHMH YTpOM. cjJeKanMI1 npM KOMHaTHOI1 TeMnepa-
Type CHl1>KaeTCH ,QOCTOBepHOCTb
pe3ynbTaTa.
3. OnoPO>KHMTb KMW6'lHMK B CY,QHO Bo.qa npMBo,QMT K reMonM3Y aplHpo-
(6e3 BO.qbl), a He B YHMTa3. ljMTOB, KOTopble MOI)'T cO,QepJKaTbCH
B cjJeKanMHx.
4. Ha.qeTb nep'laTKM nepe,q B3HTMeM 06eCne'leHMe "'HcjJeK4MOHH0I1 6e30-
cjJeKanMI1. naCHOCTM.
5. B3HTb wnaTeneM 5 10 r cjJeKanMI1 06eCne'leHMe ,QOCToBepHoCT'" pe-
"'3 TeMHblX pa3HbiX Y'laCTKOB Kana B 3ynbTaTa.
CYXYIO 6aHKY.
OKOH'IaHue npOljeiJYPbl
1. 3aKpblTb KpblWKOI1 6aHK}' C cjJeKa- 06eCne'leHMe MHcjJeK4MOHHOI16e30_
nMHMM. naCHOCT"'.
2. nonpoC"'Tb na1jMeHTa nOBTop"'Tb 06eCne'leH"'e acjxjJeKTMBHOCTM 06y-
BCIO nonY'leHHYIO "'H<!>0pMa1jMlO. '1eHMH. YBepeHHoCTb Me,QMljMHCKOI1
ceCTpbl B ,QOCT"'JKeHMM ljen",.
458
3Tanbl 06ocHoBaHM"
OKOH'IaHUa npOljeiJypbl
3. CHHTb nep'lmK"'. npoBecTM Jje- 06eCne'leHMe "'HcjJeKlj"'OHHOI1 6e30-
3MHcjJeKljMIO ,QepeBHHHoro wnmenH naCHOCT"'. f1114a rnMCTOB. KOTopble
C>K"'raHMeM. CTeKl1HHHbl11 wnaTenb nOTeH1jManbHO MOI)'T HaXOJj"'TbCl'I B
101 nep'laTK'" npo,Qe3MHcjJl11jMpoBaTb cjJeKan"'5IX, o6e33apaJKl1BalOTCH
KMr15I'IeHl1eM B 2%'HOM paCTBope TonbKO KMnH'leHMeM I1n", norpYJKe-
611Kap60HaTa HaTp"'5I B Te'leH"'e 15 HlieMB
M"'HYT I1nl1 nOrpYJKeH",eM B 10%-Hbll1 paCT BOp nl130na, aKcno-
10%'Hbll1 pacTBop nl130na B Te'le- 3"'lj"'51 6 '1aCOB.
Hlie 6 '1aCOB.
4. BblMblTb PYK"'. .QOCTaB"'Tb B na- 06eCne'leH"'e cBoeBpeMeHHOI1 ,Qoc-
6opaTopl11O eMKOCTb C <J>eKan"'HM'" 101 TaBKI1 MaTep"'ana. XpaHeHMe ,Qo-
HanpaBneHl1e Ha "'ccne,QOBaHlie MnM nycKaeTCI'I B XOnOAHOM MeCTe He
06b5lCH"'Tb naljl1eHTY (I1nl1 ero POJj- 60nee 'lace 101 ,Qoc-raBnHeTC5I B na-
CTBeHH"'KaM), K}'Jja 11 B KaKoe BpeM51 60pmopMIO B nlO60e BpeM5I.
OTHecrn 6aHK}' C KanOM 11 HanpaB-
neHl1eM.
6aKTepMonorM ecKoe MccneAooaHMe
I3epeTcSI peKTaJIbHbIM Ma30K C qeJIblO BbISlBHTb B036Y HTe-
JISI HH<J!eKqHoHHoro 3a60JIeBaHHSI - mET.
M3 6aKJIa60paTopHH OCTaBJISleTCSI CTepHJIbHaSl np06HpKa
C nHTaTeJIbHOM cpe OM. 3a60p ocy eCTBJISleTCSI aKTHBHbIM
MeTO OM C nOMO blO peKTaJIbHOM neTJIH. B JIa60paTopHIO O-
CTaBJISleTCSI HeMe JIeHHO.
CocKo6 Ha 3HTepo6Mo3
COCK06 npOH3BO HTCSI Me ceCTpOM C aHlUlbHbIX CKJIa OK
naqHeHTa YTPOM 003 npe BapHTeJIbHOrO nO MbIBaHHSI. BepeT-
cn np03pa'IHaH JIHnKaSl JIeHTa, KycO'IeK ee npHKJIa bIBaroT K
aHaJIbHoMY oTBepcTHIO, 3aTeM npHKJIeHBalOT Ha CTeKJIO H OT-
npaBJISlIOT B KJIIIHH'IecKYIO JIa60paTopHIO.
6.' Z. HHcmpYMeHinaltbHble
Memogbl UCCitegoBaHuR
E HHCTpYMeHTaJIbHbIM OTHOCSlTCSI MeTO bI, npHMeHSI.H .to-
TopbIe HCnOJIb3YIOT pa3JIH'IHbIe annapaTbI:
· peHTl'eHOJIOrH'IeCI<He (Ro-cKonHSI, Ro-rpa<J!HSI, RO-TOMor-
pa<J!HSI, KOHTpaCTHaH aHrHOrpa<J!HSI, <J!JIIOOporpa.pHSI H p.);
459
Ro-rpa<lmSI - MeTO .poTorpa(lmpoBaHHSI C nOMO blO Ro-
JIyqeM.
TOMOrpa.pHSI - nOCJIOMHaH RO-rpa.pHSI.
<I>JIlOOpOrpa.pHSI - 3TO MeTO nOJIyqeHHSI CHHMKOB OpraHOB
rPY HOM KJIeTKH, YMeHbllleHHbIX B pa3Mepax, a CJIe OBaTeJIb-
HO, YMeHbllleHO KOJIH'IeCTBO RO-JIyqeM, '1TO MeHee onaCHO JISI
'1eJIOBeKa.
PeHTreHOAliarHOCTIiKa
npliMeHeHlle peHTreHOKOIIT})aCTHbIX Cpe.n;CTB
RO-HCCJIe OBaHHe nOJIbIX opraHOB npOBO SIT C npHMeHeHII-
eM KOHTpaCTHbIX cpe CTB JISI nOJIyqeHHSI HX '1eTKOrO H306pa-
meHHSI.
RO-HCCJIe OBaHHe meJIY O'lHO-KHllIe'lHOrO TpaRTa npOBO-
HTCSI C HCnOJIb30BaHHeM 6apHeBOM B3BeCH; 6POHXOB - MO O-
JIHnOJIa; B ypOJIOrHH - HH HrOKapMHHa 0,4%-Horo, TpHOM6-
paCTa 60% -Horo (76% -Horo); meJI'IHOrO nY3bIpSI H meJI'IeBbI-
BO rn;HX nYTeM - MonarnocTa, 6HJIJIHrHOCTa 50% -Horo H PY-
rHX peHTreHoKoHTpacTHbIx cpe CTB.
Mo co epmarn;He KOHTpaCTHbIe cpe CTBa MorYT BbI3BaTb
aJIJIeprH'IeCKHe OCJIOmHeHHSI. l1.JISI IIX npo.pHJIaRTHKH He06-
XO MO c06paTb aJIJIeprOJIOrH'IeCKHM aHaMHe3, npOBecTH np06y
Ha 'lYBcTBHTeJIbHOcTb.
· pa HOH3OTonHbIe (PaAHOMeTPHSI, PaAHorpa(lmSI, CKaHH-
pOBaHHe);
· 3H OCKOnH'leCKHe (6pOHxocKonHSI, 330.parocKonHSI, raCT-
pocKonHSI, yo eHocl<onHSI,peKTopoMaHocKonHSI,KOJIOHOCKO_
nHSI, qHcTocKonHSI, JIanapOcKonHSI);
· .pYHKqHoHaJIbHbIe (SKr -3JIeKTpOKap Horpa.pHSI, ssr-
3JIeKTp03Hqe(l>aJIorpa.pHSI, 3JIeKTpOracTpocKonHSI, 3JIeKTpOMH-
orpa.pHSI, ocqHJIJIOrpa(l>HSI, peorpa.pHSI, cnHporpa.pHSI, nHeB-
MOTaXOMeTpHSI, <I>Kr -.poHoKapAHorpa.pHSI).
npoBe eHHe HHCTpYMeHTaJIbHbIX MeTO OB HCCJIe OBaHHSI
Tpe6YeT cneqHaJIbHOM no rOTOBKH naqHeHTa, OT KOTOpOM 3a-
BHCSIT ocToBepHocTb II HH<J.x>PMaTHBHocTb nOJIyqeHHbIx pe-
3YJIbTaTOB.
PeHTreHOJlOrll'leCKOe IICCJIe OBaHHe meJly,a:Ka
II ,a:BeHH3J];qaTllnepcTHoii KHIIIKIl
1. npOBO TCSI HaTOrn;aK.
2. B RO-Ka6HHeTe BBO HTCSI per os B3BeCb cYJIb.paTa 6apHSI
150-200 MJI.
PeHTreHonorM eCKMe MeToA MccneAooaHMR
MCnOJIb30BaHHe peHTreHOBCKHX JIY'leM B HarHOCTHKe oc-
HOBaHO Ha cnoc06HOCTH HX npOHHKaTb Qepe3 TKaHH. STa cno-
C06HOCTb 3aBHCHT OT nJIOTHOCTH opraHOB H TKaHeM, HX TOJI-
HH I, XHMH'leCKoro COCTaBa. n03TOMY npoHHqaeMocTb Ro-
JlY'leH pa3JIH'lHa H C03 aeT pa3JIH'lHYIO nJIOTHOCTb TeHeM Ha
8KpaHe annapaTa.
npI1Me'laHl1e: B HeKOTopblX Cl1Y'1aJ1X no Ha3Ha4eH 1O epa'la npo-
BOAHTCR npOMblBaH e >t<el1YAKa 04 CT Tel1bHaJI Kl1 3Ma.
OCHOBHble BlI,ZJ;bl
peHTl'eHOJlOrll'leCKIiX MeTO,a:OB IICCJIep;OBaHHH
Ro-cKonHSI (scopo - CMOTplO) - npOCBe'lHBaHHe 'leJIOBe-
1:JeCKorO TeJIa RO-JIyqaMH, n03BOJISIIO ee Ha6mo aTb Ha 3Kpa-
He H306pameHHe OpraHOB. .
nOp;rOTOBKa naqlleHTa K IIpplirOCKonlll1 (peHTreHOJIOnl'leC-
KOMY IICCJle,a:OBallillO TOJICTOM KIIIIIKII)
lJeJ/.b: 06eCne'lHTb Ka'leCTBeHHYIO no rOTOBKY K HCCJIe O-
BaHHIO, HH.pOpl'vlHpOBaHHe H 06yqeHHe naqHeHTa, YCTpaHeHHe
MeTeopH3Ma H oCB06OJK):\eHHe KHllle'lHHKa OT KaJIOBbIX Macc
JISI npOBe eHHSI 3.p<lJeKTHBHoro HCCJIe):\OBaHHSI.
460
461
Ocna14enue: CM. CTaH,lI;apr nOCTaHOBKIi O'lIiCTHTeJIbHOM KJlli3-
MI.I, KpymKa SCMapxa Ii 1,5 JI cYJII.l!>aTa 6apHJI (36-37'C)
3ranbl I 060CHosaHMe
noiJaomoBKa K npo/.{eiJype
1. YCTaHOSHTb ,QoBepMTenbHble 06eCne'leHMe Cna>KeHHOCTM COSMe-
OTHoweHMR C naljMeHTOM. CTHOM pa60Tbl.
2. 06bRCHMTb nBljMeHTY ljenb 101 XO,Q 06eCne'leHlo1e npasa naljMeHTa Ha
Mccne,QOBaHIo151 101 nonY'lMTb corna- MH<!>0pMaljMIO, OC03HaHHoro Y'la-
CMe.
3. \I1CKIlIOYMTb 1013 mnaHMR 3a 2-3 CTMR S npolje,Qype.
,QHI1 ,QO Io1ccne,QosaHMR ra3006pa- AnR pe,QoTspaUleHMR ra3006pa30-
aylOUllo1e npo,QYKTbl (OBOUIM, cjJPYKTbl. SaHMIo1.
M011()\! ble. ,Qpo)f()f(esble npop,yKTbl,
'1epHblM xne6, cjJPYKTOBble COKM).
4. AaTb naljMeHTY 3D-60 Mn KacTO- 06ecne'leHMe o'iMUleHMI1 BepxHMx
posoro Macna B 12-13 '1acos ,QH5I OT,QenOB ToncToM KMWKM.
HaKaHYHe Mccne,QOBaHMR.
npMMe'laHMe: npOTMBonOKa3aHO
ecnM Y naljMeHTa nOHOC. '
5. nOCTasMTb O'lMCTMTenbHble KIlM3- 06eCne'leHMe TlJ.I3TenbHoro O'iMUIe-
Mbl Be'lepOM HaKaHYHe Mccne,Qosa- HM5I HMJKHMX OTAenos TonCToM KMW-
HMR ,Qsa>K,QbI, C Io1HTepsanoM B 1 'lac KM.
yrpOM, M 3a
2 '1aca ,QO Io1ccneAosaHMR CAenaTb
,Qse O'-IMCTHTenbHble KI1M3Mbl C MH-
TepsanoM s 1 'lac.
6. AaTb na1jMeHTY yrpOM B ,QeHb
' ccneAosaHIo1R nerKlo1H 6enKoBbiM
3aBTpaK.
.,. npOBOAMTb naljlo1eHTa B peHrre- 06eCne'leHMe cBoespeMeHHoro
HOnOrl1'1eCKIo1M Ka6MHeT K Ha3Ha'leH- npoBeAeHIo151 npolje,Qypbl.
HOMY BpeMeHM.
8. BsecTM C nOMOUlbIO KIlM3Mbi
cynbcjJaT 6apMR (36-37°C) ,QO
1,5 n s peHTreHKa6MHeTe.
PeHTI'eHOJIOnl'leCKoe IICCJIeJ.J;oBaHlle meJl'lHOrO nY3I.lPH
II meJI'IeBbIBOJ.J;H IIX n)'TeM
STOT eTO,n: OCHOBaH Ha cnoc06HOCTH ne'leHH BbI,n:eJIHTI. C
A<eJI'II.IO Ho,n:co,n:epJKaIl\lIe Bern;eCTBa, BBe,n:ellllbIe B OpraHH3M
KOTOpI.Ie, HaRanJIHBIUICI. B JKeJI'IHbIX nYTHX, ,n:alOT B03MOJK
HOCTI. nOJIY'lHTI. HX H306pameHHe.
XOJIe:U;IICTorpacJmSI - OpaJII.HaSI XOJIerpaI!>HSI, KOHTpaCT-
Hoe BeIl\eCTBO npllHHMaeTCSI BHYTPI. (6HJIHTpaCT, 6HJIHCeJIeK-
462
TaH, TeJIeHaR, MonarHOCT, XOJIeBH,n:) II HaKaTIJIHBaeTCSI B meJI-
'IHOM nY3I.Ipe H npoToKax.
IIo8zomo61w naquenma:
1. HaTOIl\aK.
2. OCB060,n:IITI. KHIlle'lHHK OT co,n:epJKHMoro.
3. KOHTpacTHoe BeIl\eCTBO npHHHMaeTcSI 3a 14-17 'IaCOB
,n:o HCCJIe,n:OBaHHSI ,n:P06HbIMH nop:U;HSIMH B Te'leHHe 1 'Iaca,
'Iepe3 KaJK,n:bIe 10 MHH, 3anHBaeTCSI CJI KHM 'IaeM (no aHHO-
Ta:U;HH)
4. YTpOM ,n:eJI81OTCSI 0630pHbIe CHHMKH, nOCJIe 'Iero na:U;H-
eHT npHHHMaeT meJI'IerOlIHI.IM 3aBTpaK (2 HH'IHbIX meJITKa,
COp6HT - 20 r).
5. CepHIO CHHMKOB ,n:eJIalOT 'Iepe3 10, 20, 30, 45 MHH.
nOCJIe meJI'IerOHHOro 3aBTpaKa, a 3aTeM 'Iepe3 20 MHHYT B
Te'leHHe 2 qaCOB.
npMMe'laHMe: B HaCTORlLlee BpeM5I O'lMCTl-tTel1bHble KI1l-t3Mbl, KaK 101
>Kel1'lerOHHblM 3aBTpaK, He Ha3Ha'iaIOTCR.
XOJIerpacJuU( - RO-HCCJIe,n:OBaHne JKe.wlHoro ny3bIpSI H JKeJI'
'IHbIX nYTeM nOCJIe BIB BBe,n:eHHSI KOHTpaCTHoro cpe,n:CTBa (6H
JIHrHOCT, 3H,n:orpaI!>HH, 6I1JIHrpaqJHH).
IIo8zom061W naquenma:
1. llpOBeCTH np06y Ha 'IYBCTBHTeJIbHOCTb K peHTreHOlWH-
TpaCTHOMY cpe,n:CTBY 3a 1-2 ,n:HSI ,n:o HCCJIe,n:oBaHHSI.
2. OCB060,n:HTb KHIlle'lHHK OT co,n:ep)Kl1MOro H r8.30B.
3. 'YTpOM HaTOIl\aK B peHTreHKa6HHeTe BIB BBeCTH 30-
40 MJI KOHTpacTHoro cpe,n:cTBa, B HymHoM KOH:U;eHTpa:u;HH H
no,n:orpeToro,n:o 37°C, Me,n:JIeHHO B Te'leHHe 5-8 MHH. B ropH-
30HTaJII.HOM nOJIOJKeHHH na:u;HeUTa.
4. C,n:eJIaTI. cepHIO CHHMKOB cnYCTSI 15 MHH.
n BHHMaHHe! XOlle4HCTorpacpHSI He npoBOAHTCSI npH TSl>KellblX
g noproKeHHSlX ne4eHH, .?CTPbIX BOCnall_HTellbHbIX 3a60lleBaHHSlX
ne4eHH C nOBblweHHOH TeMnepaTypoH Tella.
PellTl'eHOJIOrll'leCKlle IICCJIeJ.J;OBanIiH B ypOJIOrlll.
q8IIJ;e Bcero npOBo,n:SIT:
a) 0630PHYIO peHTreHorpa.pHIO nO'leK H MO'leBbIX nYTeM;
6) BIB (3KCKpeTopHYIO) yporpa.pHIO, npH KOTOpOM KOHTpa-
CTHI.IM npenapar BbI,n:eJISIeTCSI nO'lKaMH nOCJIe BIB BBe,n:eHHSI.
463
n08Z0m06/(a naquellma /( pellmzello.nozuveC/(OMY
ucc.ne806allUlO nove/(
l(eJlb: 06eCne'IHTb Ka'IeCTBeHHYIO nOArOTOBKY K HCCJIeAO-
BIUIHIO, HH.pOPMHpOBIUIHe H 06y<IeHHe TIlU{HeHTa.
OCllal4ellue:
- IImpHl.{bI OAHOp8.30Bble 20 MJI'
- 30%-HbIH pacTBop THOCYJIb.p Ta HaTpHSI;
- Bce He06xoAIIMoe AJISI O'IHCTHTeJIbHOH KJIH3MbI"
- R-KoHTpacTHbIH npenapaT: (yporpa.pHH H;H Bepo-
rpacpIIH) no Ha3Ha'IeHHIO Bpa'Ia.
3Tanbl I 060CHOBaHMB
nooaom06Ka K npoljeoype
1. Y CTaHOBMTb ,QoBepMTel1bHble 06ecne...eHMe Cna>KeHHOCTM COBMe-
OTHOWeHMR C naljMeHToM. CTHO" pa60Tbl.
2. 06b5lCHMTb na1jMeHTY ljel1b, XO,Q 101 06ecne'leHMB npaBa naljMeHTa Ha
CMblcn npe,QcTORlllero Mccne,QoBa- MH<!>opMa4Mto, ocoaHaHHoro Y'la-
HMR 101 nonY'lMTb cornaCMe. CTMSI B np04e,Qype.
3. IIICKlTto'lMTb Ma nMTaHMR B Te'leHMe AnR YCTpaHeHMSI MeTeopMaMa, 0'1101-
3 ,QHe" ,QO Mccne,QoBaHMR raao06pa- lIIeHMR I<I1WENHMKa.
aYtolllMe npoAYKTbl (OBOIIIM, <!>PYKTbl,
M0l10'lFtble, ,Qp())f()f(eBble npoAYKTbI
'1epHbI" xne6 cjJPYKTOBble COKM). '
4. npMHMMaTb npM MeTeopMaMe no AnSI YCTpaHeHMSI MeTeopMaMa, MC'
Haa.Ha'leHMto Bpa...a aIm1BMpOBaH' Ka>KeHMR peaYl1b TaTOB Mccne,QOBa-
HblH yrOl1b. HMR.
5. \I1CKlTIO'IMTb npMeM nMIIIM aa
18-20 '1aCOB AO Mccne,QoBaHMR.
6. 06eCne'lMTb npMeM cna6MTel1b-
Horo cpeAcTBa no HaaHa'leHMto Bpa-
'1a HaKaHYHe nepeA 06e,QoM.
7. nOcTaBMTb O'lMCTMTel1bH)IIO KlTMa- OCB060)I(,IJ.eHMe KMWe'lHMKa OT Ka-
MY Be...epOM, OK0l10 22 ...acoB, 101 nOBbiX Macc.
yrpOM aa 1,5-2 '1aca AO MccneAo-
BaHMR.
8. He npMHMMaTb nMIIIY, >KM,[IKOCTb,
l1eKapCTBa, He KYPMTb, He ,Qel1aTb
MHbeKljMM M ,QPyrMe np04eAYPbl
YTPOM nepe,Q Mccne,QoBaHMeM.
9. OCB060AMTb MOyeBO" ny3b1pb \I1CKlTto'leHMe MCKaJKeHM" peaYl1bTa-
Hel1OCpeACTBeHHonepe,Q TOB MccneAoBaHMR.
Mccne,QoBaHMeM.
464
3Tanbl 06ocHoBaHMe
nOOaOm06Ka K npoljeoype
10. Y6e,Ql1TbCSI B npaBMl1bHOCTM An51 y6e)!(,O,eHMR, '1TO MHcjJopMaljMI1
nOHI1TOii MH<!>opMa4MM, nonpOCMTb nOHI1Ta BepHO. ycnewHoro 06}"-1e-
na4MeHTa nOBTopMTb MeTOAMKM HMR.
nOAroToBKlI, AaTb nMCbMeHHYto MH-
CTPYKljMto.
11. YKaaaTb, K Kal<l1M nocneACTBMRM HapyweHlle ycnOBM" nOAroTOBKM
npMBeAeT HapyweHlle peKoMeH,Qa. npMBeAeT K oWM60"'HbiM peaynbTa-
1jMii MeAMljMHCKOii ceCTpbl. raM IIccneAOBaHIII1, '1TO aaTpYAHMT
AMarHOCTMKY 101 ne'leHlle.
12. npoBOAMTb (TpaHcnopTllpoBaTb) 06eCne'leHlle cBoeBpeMeHHoro
na1jMeHra B R-Ka6I1HeT B HaaHa'leH- npoBeAeHlI11 np04eAYPbl.
Hoe BpeMR.
BblnonHeHUe npoljeoypbl
1. CAel1aTb 06aOpHbl" CHMMOK. YcnOBMI1 MccneAOBaHMR.
2. BBecTM no HaaHa'leHMto Bpa'la
BHyrpllBeHHo Me.QJleHHO 20-40-60
Ml1 peHrreH-KoHTpaCTHoro npenapa-
Ta.
3. CAenaTb cepMto CHIIMKOB_
OKOH'IaHUe npOljeoYPbl
1. npoBecTII naljMeHTa B nal1aTY. npOcjJMnaKTIIKa OCnOJKHeHMii.
2. 06eCne'lMTb Ha6l1toAeHMe 101 no-
Koii.
u
BHHMaHHe! R-KOHTpaCTHble cpeACTBa, COAep>Kall\l1e HOp" MOryT
AaBaTb n0604Hbie peaK4HH, BnnOTb AO KOllllanca 101 WOKa.
n03TOMY B R-Ka6HHeTe BcerAa AOII>KHO 6blTb Bce He06xoAH-
Moe AnSI OKa3aHHSI HeOTlTO>KHOH nOMow.H. AHTHAOTOM K HOA-
cOAep>Kaw. HM R-KOHTpaCTHbIM cpeAcTBaM SlBIISIeTCI1 30%-HbIH
paCT BOp THOCYllbcpaTa HaTpHI1.
3HAOCKOn" eCKMe MccneAooaHMR
3H,11;OCKOlllm (a1l80-61lympu, c/(onO-CMomplO) - MeToA BH-
3YaJIbHOrO HCCJIeAOBaHHH C nOMOII{blO onTHI<O-MeXIUIH'IeCKHX
oCBeTHTeJIbHbIX npH60pOB. P8.3pa60TKa BOJIOKOHHOH onTHItH
, II C03AaHHe Ha ee 6a3e .pH6poCKonOB (rH6KHX SHAOCKonOB)
CAeJIaJIII STOT MeTOA 6e30naCHbIM H s<J.xl>eKTHBHbIM He TOJIbKO
AJISI AHarHOCTHKH, HO H JIe'IeHHSI MHorHX naTOJIOrH'IeCKHX
COCTOSlHHH.
465
3Tanbl 060CHOBaH e
nOOZOmOBKa K npoL/eoype
3. npoBecTM npeMeA Kalj 1O TpaH- 06ecne...eH e ycnoKa BalOUlero
KB lT 3aTOpaM no Ha3Ha'leH 1O 3cjJcjJeKTa.
Bpa...a.
4. \I1CK11IO'I Tb HaKaHytie YTPOM np - 06eCne'leH e B03MO>KHOCT npoBe-
eM n UI , BOAbl, He KYP Tb. AeH 5I ccneAOBaH 5I HaTOUlaK C
ljelTblO CK11IO'IeH 5I 3aTpYAHeH 11
ccneAoBaH I1.
5. OnOpOJKH Tb MO'leBO n)'3blpb \I1CK11IO"'eH e 3aTpYAHeH 11 ccne-
IG1We'lH K HenocpeAcTBeHHo nepeA AOBaH 5I.
cCl1eAoBaH eM.
6. nOAroToB Tb npoBecT npeMe- npet:\oTBpaT Tb B03MO>KHble OcnO>K-
t:\I<Kalj 1O no Ha3Ha'leH 1O Bpa'la HeH R.
not:\KOJKHO O,1%'HbI paCTBOp aTpo-
n Ha - 1 MlT
1%:Hbl paCTBOp t:\ Met:\pOlTa -1 Mn
3a 15-40 M H t:\o OCMOTpa.
7. npOBOt:\ Tb nalj eHTa B 3Ht:\OCKO- 06eCne'leH e cBoeBpeMeHHoro
n '1eCK Ka6 HeT. npoBet:\eH R ccnet:\OBaH R
BblnOI1HeHUe npOL/eoYPbl
1. YCa,Q Tb nalj eHTa Ha CT)'lT. 06eCne'leH e Yt:\06HOro nOlTOJKe-
H I1.
2. nOt:\roToB Tb npoBecTM aHeCTe- 06eCne'leH e 06e360lT BaH R.
3 1O BepXH X t:\blxaTelTbHblX nYTe.:1
...epe3 HOC (pOT).
np Me...aH e: nocne np06bl Ha
nepeHOC MOCTb np MeHRIOT Ot:\HO
3 lTeKapCTBeHHblX cpet:\CTB - 10%-
HbI paCTsop HOBoKa Ha, 5%-Hbl
pacTBop Tp MeKa Ha. 2%'Hbl pac.
TBOp lTl<t:\OKa Ha.
3. Spa'! BBOt:\ T 6poHXOcjJ 6pocKon 06ecne...eH e ...eTKoro BbinolTHeH R
...epe3 HOC lT pOT, MeA lj HCKaR ccnet:\OBaH I1.
cer:Tpa acc cT PyeT.
OKOH'IaHUe npo/.{eoYpbl
1. npoBet:\eH e t:\e3 HcjJeKlj HCT- 06eCne'leH e H<I>eKlj OHHO 6e30-
pyMeHToB (B 3%-HOM paCTBope naCHOCTM.
Xl1opaM Ha).
2. SblMblTb OCYW Tb PYK , CHRTb
nep'laTK .
6pOHxocfll16pocKon BF-B3R JlnOHCKOM cfIl1PMbl «Olimpus»
EpOHXOCKonlUl - MeTo BH3YaJIbHOrO HHCTpYMeHTaJIbliOrO
HCCJIe OBaHHH TpaxeH, 6POHXOB KpynHoro H cpeWIero KaJIH6-
pa C nOMOrn;blO 3H ocKonoB, BBO HMbIX B bIXaTeJIbHbIe nYTH
na eHTa.
MCnOJIb3YlOTCH rH6KHe II meCTKHe 6POHXOCKonbI. BbI60p
TOro HJIH HHoro HHCTpYMeHTa onpe eJIHeTCH KaJKAbIM KOHK-
peTHbIM CJIy'(aeM.
1l0.n;roToBKa nan;lIellTa K 6POHXOCKonilif
l(eJ/.b: 06eCne'lIlTb Ka'leCTBeHHYIO no rOTOBKY K HCCJIe O-
BaHHIO, HH<J.x>PMHpOBaHHe H 06Y'leHHe nau;HeHTa.
OCllal4ellue:
- 6POHXOCKon;
- eMKOCTb C e3paCTBopOM;
- IIInpHD;bI 0 Hopa30BbIe;
- 0,1 %-HbIll paCTBOp aTponHHa, 1 %-HbIM pacTBop AHMeA-
pOJIa, 1 %-HbIll paCTBOp HOBOKaHHa, 5% -HbIll pacTBop TPH-
MeKa IHa.
3Tanbl I 060CHOBaH e
noozomoBKa K npOl-/eoype
1. YCTaHoB Tb t:\oBep TelTbHble 06ecne...eH e CnaJKeHHOCTIi COBMe-
OTHOweH R C na eHToM. CTHO pa60Tbl.
2. 06bI1CH Tb naljl-1eHTY ljelTb, XOt:\ 06eCne'leHl<e npaBa na eHTa Ha
CMblcn npet:\cTOI1U1ero ccnet:\OBa- HcjJopMalj lO. OC03HaHHOro Y"a-
. H R n011Y" Tb cornacl-1e. CT 11 B npoljeAype.
c1JII6p0330cl>aro 'aCTpo.n;y0.n;eHOCKOllHH (cI>3r)J;C) - 3HAOC-
KOnH'leCKOe H'cCJIC OBaHHe nHID;eBoAa, )KeJIYAKa H 12-nepcT-
HOM KnIIIKH. II03BoJIHeT BH3yaJIbHO onpe eJIRTb naTOJIOrHlr
, I
461
466
'.
..._.. ""'-'"
«6)
,..
, ". "
.
-
(xeMa 6pOHXOCKOnl111 meCTKI1M 6POHXOCKOnOM
3THX OpraHOB, npOBeCTH 6HOnCilIO nOpaJKeHHOM TKaHH, Ol{eH-
KY 3qxJ)eKTHBHOCTH JIe'IeHHSI.
nO.n;rOTOBKa nar(lIeHTa K cl>1I6pora&T})0.n:y0.n;eHOCKOnlili
l(eJ/.b: 06eCne'IHTb Ka'IeCTBeHHYIO nO,!J;rOTOBKY K HCCJIe,!J;O- -
BaHHlO, HH.pOpMHpOBaHHe H 06Y'IeHHe nar(HeHTa.
06.n3ameJ/.bHble YCJ/.06U.n: oCB060m,!J;eHHe meJIY,!J;Ka OT CO-
,!J;epmHMOrO.
OCHauteHUe:
- .pH6poCKOn, nOJIOTeHl{e; CM. CTaH,II;apT npOMbIBaHHe me-
JIY,!J;Ka.
3Tanbl I 060cHoBaHIo1e
noiJzomo6Ka K npol{eiJype
1. YCTaHOBI>1Tb AOBepl>1TenbHble 06eCne'leHlo1e OC03HaHHoro }"IacrnR
OTHOWeHI>151 C na I>1eHTOM. B coBMecTHo pa60Te.
2. 06b5lCHI>1Tb na lo1eHTY enb, XO):\ 1>1 06eCne'leHlo1e npaBa nal\lo1eHTa Ha
CMblcn npeAcTOR4Iero Io1ccneAOBa- Io1H<I>opMa lo1lO.
HIo151 1>1 non}"llo1Tb cornacI>1e.
3. \I1CKnIO'll>1Tb HaKaH}'He YTPOM nplo1- 06eCne'leHlo1e B03MOJKHOCTIo1 OCMOT-
eM nM I>1, BOAbI, neKapCTBeHHblX pa Cnl>13Io1cTo.:1 o60no'lKlo1 HaTo aK.
npenapaTOB, He KYPIo1Tb, He '1Io1CrnTb
3y6bl.
4. npOMblTb JKenYAOK:xI 1,5-2 '1aca
AO Io1ccneAOBaHIo1R (npl>1 He06xOAI>1-
Mocrn).
5. B351Tb C co60.:1 nonoTeH e. Ii1CKnIO'IeHMe AMcKoM<I>opTa, CB5I-
3aHHoro C Canl>1Ba I>1e .
468
3Tanbl I 060cHoBaHIo1e
noiJzom06K8 K npol{eiJype
6. npeAynpeAIo1Tb, '1TO Henb3R pa3- HapyweHlo1e aKTa rnOTaHMR B CBR3101
rOBapl>1BaTb M rOOTaTb cnlOHY. C BBe,[leHlo1eM 3H):\OCKona 101 aHeCTe-
31011>1.
7. npOBOAI>1Tb na1jMeHTa B 3HAOCKO- 06eCne'leHI>1e cBoeBpeMeHHoro
nl>1'1ecKIo1 Ka6Io1HeT. npOBe,[leHIo151Io1CCne,[lOBaHIo151.
8. nOAroToBIo1Tb Bce He06xoAIo1Moe 06eCne'leHlo1e 06e36onlo1BaHIo1R.
AflR aHeCTe31011>1 pOTOrnOTKIo1.
9. YnOJKI>1Tb na I>1eHTa Ha CTon Ha 06eCneyeHIo1e He06xoAIo1Moro nono-
neBbl 60K C COrHYTblMIo1 HoraMIo1. >KeHIo151 nplo1 npoBBAeHlo1101 Io1ccneAD-
rpYAb YKPblTb nonOTeH eM. BaHIo1R.
11
BHHMaHHe! npeMeAHKaLjHSI n/K H3MeHSIeT COCTOSlHHe HCClle-
AyeMoro opraH a, n03TOMY, no nocneAHHM AaHHblM, He npHMe-
H5IeTCSI.
PeKTopOMaHOCKOllim (RRS) - 3H,!J;OCKOnH'IeCKOe HCCJIe-
,!J;OBaHHe npSlMoM H .cHrMoBH,!J;HOM KHIllKH. ll03BOJISleT 06Hapy-
mHTb BOCnaJIHTeJIbHbIe npOl{eCCbI, reMoppoM, HOBo06pa30Ba-
HHSI, nOJIy<IHTb Ma3KH, cocK06bI, npOBeCTH 6HonCHIO.
llPOBO,!J;HTCSI C nOMoru;blO peKTOCKona - meCTKoro 3H,!J;OC-
Kona.
nO.n;rOTOBKa nal{lIeHTa
1. HaToru;aK.
2. O'IHCTHTeJIbHaH KJIH3Ma 3a 2 'Iaca,!J;o HCCJIe,!J;OBaHHSI.
3. OnopomHHTb MO'leBOM nY3bIpb Henocpe,!J;CTBeHHO nepe,!J;
HCCJIe,!J;OBaHHeM.
4. PeKTocKon BBO,!J;HTCSI B npSlMYIO KHiliKY Ha 25-30 CM B
KOJIeHHO-JIOKTeBOM nOJIOmeHlI1I nar(HeHTa (rH6KHM B nOJIome-
HIIH Ha cnHHe C npHnO,!J;HSlTbIMH H pa3,!J;BHHYTbIMH HHmHHMH
KOHe'IHOCTSlMH).
KOJIOIIOCKOnIlSl- 3TO 3H,!J;OCKOnll'IeCKOe HCCJIe,!J;OBaHHe BbI-
COKOpaCnOJIOmeHHbIX Y'IaCTKOB TOJICTOrO KHIlle'IHHKa. O'IeHb
BamHa TIl{aTeJIbH8JI nO,!J;rOTOBKa, 'IT06bI Ha CTeHItaX TOJICTOM
KHIllKH He OCTaJIOCb CO,!J;epJKHMOrO, KOTopoe CHHmaeT ,!J;OCTO-
BepHOCTb HCCJIe,!J;OBaHHSI.
469
I10.n;rOTOBKa nal{UeHTa
1. 3a 3 H.H o HCCJIe OBaHH.H 6ecIIIJIaKOBa.H HeTa M 4.
2. B Te'leHHe 2 HeM o HCCJIe OBaHH.H Ha3Ha'laIOTC.H CJIa-
6HTeJIbHbIe cpe CTBa (KacTopoBoe MaCJIo).
3. Be'lepOM, HaKaHYHe HCCJIeAOBaHH.H, cqe.naTb O'lHCTHTeJIb-
HYIO KJll!3MY.
4. HaTo aK, B eHb IICCJIe OBaHH.H, C eJIaTb O'lHCTHTeJIb-
HYIO K,IIH3MY 3a 4 H 2 'laca o HCCJIe OBaHII.H.
5. IIpoBecTH npeMe HKa:U;HIO 3a 20-30 MHHYT o HCCJIe O-
BaHH.H (0,1 %-HbIM paCTBopOM aTponHHa - 1 MJI).
6. IIpoBecTH aHeCTe3HIO 06JIaCTH 3a.z\Hero npoxo a nepe
BBe eHHeM KOJIOHOCKOna (3% -HOM HKIil!HOBOM Ma3bIO).
7. MCCJIe.noBaHHe npOBO):\HTC.H B nOJIOJKeHHH JIeJKa Ha JIe-
BOM 60KY.
OCJ/.o:J/CllellUJl npH npoBe eHHH 3MOCKOnH'leCKHX HCCJIe O-
BaHHM B03HHKaIOT 'lame npH npHMeHeHHH meCTKHX 3H OCKO-
nOB (0,1 %), a npH HCCJIe OBaHHH qm6pocKonaMlI He npeBbI-
IIIaIOT 0,003%.
3H OCKOnH'leCKHe HCCJIe OBaHH.H MorYT BbI3BaTb TpaBMY
opraHOB, KpOBOTe'leHH.H, .pYHK:U;HoHaJIbHbIe paccTpoMcTBa,
HH.pH:U;HpOBaHHe nOJIOCTeM H OpraHOB, aJIJIepI'H'IeCKHe OCJIOJK-
HeHH.H. l1.JI.H HX llpo.pHJIaKTHKH He06xo HMO CTporo C06JIIO-
aTb MeTO HKY HCCJIe OBaHHM.
:7mUlw U 8eollmoJ/.ozuJl B 3H OCKonHH npO.HBJI.HeTC.H B ox-
paHe nCHXOJIOrn'leCKOrO COCTO.HHH.H n8l{HeHTa, B coxpaHCHHH
Bpa'le6HoM TaMHbI, TaR KaK B03HHK8IOT CHTYaIU1H, Kor a nymHo
06'b.HCH.HTb CYTb H3MeHeHH.H COCTO.HHH.H 3 OpOBb.H n8l{HeHTa.
3TO OJImeH eJIaTb Bpa'l.
I10.n;rOTOBKa na:u;ueHTa
Y3H-3xorp a 4J HR
Y3H-3xorpa4>IUI - aTO YJIbTpa:3BYKOBbIe HCCJIe OBaHHH,
OCHOBaHHbIe Ha pernCTpa:U;HH YJIbTpa3BYKOBbIX BOJIH Ha 3Kpa-
He BH eOMOHHTopa, .pHKC8l{HeM Ha .pOTOnJIeHKe. 'Y JIbTpa3BY-
KOBbIe BOJIHbI OTpamaIOTC.H OT rpaHH:U; TKaHeM C P8.3JIH'lHOM
llJIOTHOCTbIO, n03BOJI.HIOT nOJIY'lHTb npe CTaBJIeHHe 0 xapaK-
Tepe naTOJIOrH'leCKHX H3MeHeHHM B JII060M opraHe, OT JIH'lHTJ
llJIOTHOe 06pa30BaHHe OT nOJIOCTII C mH KOM cpe OM (ony
XOJIb, KHCTY, nOJIHKHCT03, rHAPOHe.pp03 H p.).
. I1peHMy ecTBa 3Toro MeTo a: B OpraHH3M He BBO .HT
KaRHe-JJH60 Be eCTBa, 6e3Bpe HOCTb H 6e30naCHOCTb, B03Mom-
HOCTb npOBO HTb B JII060M COCTO.HHHH n8l{HeHTa, MrHOBeHHoe
nOJIyqeHHe pe3YJIbTaTOB.
3HAOCKonH eCKHe HccneAOBaHHR B yponorHH
U;UCTOCKOnIUI - 3H OCKOnH'leCKOe HCCJIe OBaHlIe nOJIOCTH
MO'leBOrO nY3bIp.H. IIPOBO IITC.H B nOJIOJKeHHII JIeJKa Ha ypo-
JIOrn'leCKOM KpecJIe.
XPOMOl{UCTOCKonIUl - :U;HCToCKOnH.H C B/B BBe eHHeM 5
MJI 0,4 % -Horo paCTBopa HH,D;HrOKapMIIHa (MeTHJIOBbIM CHHIIM).
BpeM.H H HHTeHCHBHOCTb BbI eJIeHH.H KpaCKH 1I3 MO'leTO'lHH-
KOB .HBJI.HIOTC.H nOKa3aTeJI.HMH .pYHK:U;HH nO'leK H BepXHHX
MO'leBbIX nYTeM.
1. HaTOmaK.
2. 'YTPOM, HaRanyHe HCCJIe OB8HH.H - O'lHCTHTeJIbHa.H KJIH3-
Ma.
3. OnopomHHTb MO'leBOM nY3bIpb Henocpe CTBeHHO nepe
HCCJIe):\OBaHHeM.
4. 06pa6OTaTb HapymHoe OTBepCTlIe ypeTpbI aHTHcenTHKOM.
5. IIepe BBe eHHeM :U;HCTOCKona Mym'lHHaM aHeCTe3Hpy-
lOT MO'leHcnYCKaTeJIbHbJM KaHaJI. IJ,IICTOCKOn nOJIHBaIOT CTe-
pHJIbHbIM rJIH:u;epHHOM.
6.IJ,HcTocKonHIO npOBO HT Bpa'L, M/C accHcTHpyeT.
7. IIocJIe HCCJIe OBaHH.H na:U;HeHT AOJIJKeH C06JIIO aTb nu-
CTeJIbHbJM pemHM HeCKOJIbKO 'laCOB.
,;,0
I10.n;roToBKa nal{ueHTa K Y3H opraHOB 6plOllIHOii nOJIOCTU
(ne'leHb, meJI'lHLlii nya1>IpL, no.n;meJIy.n;O'lHaH meJIeaa,
CeJIeaeHKa) U nO'leK
eJ/.b: 06eCne'lHTb Ka'leCTBeHHYIO no rOTOBKY K HCCJIe O-
BaHHIO, HH.pOpMHpOB8.HHe 06yqeHHe n eHTa, YCTpaHeHHe
MeTeopH3Ma lJ,JI.H npOBe eHHSI 3<J.xJ>eKTHBHoro HCCJIe OBaHHSI.
OCllal4ellue: CM. CTaH apT nOCTaHOBKH O'IHCTHTeJIbHOH
KJIH3MbI.
411
3Tanbl I 060CHOBaHIo1e
no020mOBKa K npoljeiJype
1. YCTaHOBIo1Tb AOBeplo1TenbHble 06eCne<ieHlo1e CnaJKeHHOCrn COB Me-
OTHoweHIo1R C na1jlo1eHTOM. CTHOi1 pa6oTbi.
2. 06bRCHIo1Tb na1jlo1eHTY ('1neHaM 06eCne'leHlo1e npaBa naljlo1eHTa Ha
ceMblo1) ljenb Io1CC/1eAOBaHIo1R 101 nony- Io1HcIJOpMa1jlo11O. OC03HaHHoro Y'la-
'IIo1Tb cornaclo1e. crnR B npoljeAype.
3. \I1CKnIO'IIo1Tb 1013 nlo1TaHIo1S1 B Te'leHlo1e AnSI YCTpaHeHM5I MeTeopM3Ma, 0'1101'
3 AHei1 AO MccneAOBaHIo1R ra3006pa- eHIo1S1 KIo1We'lHIo1Ka.
3YIO lo1e npoAYKTbl (OBO Io1. cjJPYKTbl.
MOnO'lHble, A(0)fOl(eBble npoAYKTbl,
'IepHbli1 xne6. <!>PYKToBble COKIo1).
T a6neTIo1poBaHHbie Cna6lo1Tel1bHble.
4. nplo1HIo1MaTb nplo1 MeTeopM3Me no AnR YCTpaHeHIo1S1 MeTeoplo13Ma, Io1C-
Ha3Ha'ieHIo1IO Bpa'la aKTIo1Blo1pOBaH- Ka>KeHHSI pe3ynbTaTOB Io1ccneAoBa-
Hbli1 yrOlTb. HIo1I'1.
5. \I1CKnIO'IIo1Tb nplo1eM nlo1 101 3a 18- \I1CKnIO'IIo1Tb HenpaBMnbHYIO TpaKTOB-
20 '1aCOB AO Io1ccneAoBaHIo151. KY AaHHblX Io1ccneAOBaHIo1S1.
6. nOCTaBIo1Tb OYIo1CTIo1TenbHYIO Kn1013- OCB060>K,QeHlo1e KIo1We'lHIo1Ka OT raaOB
MY Be'lepOM HaKaH}'He Io1ccneAOBa- 101 KanOBblX Macc A11R AOCTIo1JKeHIo1S1
HIo1I'1. AOeTOBepHOcrn pe3ynb TaTOB Io1C'
cneAoBaHIo1S1.
7. He Kyplo1Tb nepeA Io1ccneAoBaHIo1- KypeHlo1e Bbl3blBaBT COKpa eHlo1e
eM. JKelNHoro nY3blp51.
8. B3S1Tb C co60i1 Ha Y31i1 cMeHHYIO Co6nlOAeHIo1e caHSnlo1Ape>KIo1Ma 101
06YBb. nOI1OTeHlje, npoCTblHIO. nlo1'1Hoi1 rlo1rneHbl.
9. YKa3aTb K KaKlo1M nocneACTBIo1RM Ii1CKnlOyeHlo1e oW10160K.
nplo1BeAeT HapyweHlo1e peKoMeH,Qa-
ljlo1Ci MeAlo1ljlo1HCKOCi CeCTPbl.
Y3M opraHOB MaJIOI'O Ta3a (MO'.leBOI'O nY3bIPH, MaTKII,
HII'.IHIIKOB, npe.n:CTaTeJILHOii meJIe3bl)
. :}l{:eJIaTeJIbHa nO,ll;rOToBKa KaK npH "Y31iI opraHOB 6p1OIll-
Hot'! nOJIOCTH + HanOJIHeHHb1H MO'IeBOH nY3b1pb.
. 3a 2-3 'Iaca,ll;O HCCJIe,ll;OBaHHSI BbIllHTb 1-1,5 JI mH,II;KO-
CTH (KHnSI'IeHOH BO,ll;b1).
. B03MomHa nO,ll;rOTOBKa C HCnOJIb30BaHHeM MO'IerOHHb1X
npenapaToB.
Y3M nO'.leK, cep,lJ;n;a II cocy.n:OB
. OC060H nO,ll;rOTOBKH He Tpe6yeTCSI.
IIaI.{HeHT, HanpaBJIeHHb1H Ha "Y31iI, AOJIJKeH HMeTb CMeH-
HYIO 06YBb, HCTOpHIO 60JIe3HlI (aM6YJIaTopHYIO KapTY), nOJIO-
TeHI.{e, npOCTbIHIO.
IIoJIomeHIIH naI.{lIeHTa npll Y3H
. Y3H nO'leIC
IIpoBO,ll;HTCH B nOJIOJKeHHH naI.{HeHTa JIeJKa Ha mHBOTe,
JIHI.{OM BHH3 (MOJKHO CH,II;H). )J;aT'IHK YCTaHaBJIHBaeTCSI co CTO-
pOHb1 cnllHb1 HJIII 60KOBb1X nOBepXHOCTeH ?KHBOTa.
Y3M C onpe,lJ;eJIeHlleM COKpaTIITeJIbHOii cnoc06HOCTil
meJI'lHOI'O ny3bIpH
. IIoAroToBKa COOTBeTcTByeT nO,ll;roTOBKe K "Y31iI OpraHOB
6plOIllHOii nOJIOCTH.
. B Ka6HHeT "Y31iI B3SITb meJI'IerohHbIH 3aBTpaK (2 SIH'I-
Hb1X JKeJITKa B Cb1pOM BH,II;e).
. IIepBH'IHb1ii OCMOTp npOBO,ll;HTCJi tlaTOIl{aK, 3aTeM npH-
rlHMaeTCSI JKeJI'IeroHHb1H 3aBTpaK.
. IIOBTOpHb1H OCMOTp npOBO,ll;HTCSI Llepe3 50-60 MHH.
. B npOMemYTKe Me y OCMOTpaMH HCKJIIO'IeH npHeM
JII06b1X npoAYKTOB!
. Y3H ne'lellU, no8:JICeJ/.y8o'lllou. :JICeJ/.e3bt
IIpoBo,ll;HTCH B nOJIOJKeHHH naI.{HeHTa JIeJKa Ha cnHHe, Ha
npaBOM HJIH JIeBOM 60KY. ,D;aT'IHK HaKJIa,zJ;bIBaeTCSI Ha CMa3aH-
HyIO Ba3eJIHHOM HJIH CneI.{HaJIbHbIM reJIeM Komy COOTBeTCTBeHHO
Tonorpa.pHH HCCJIe.n:yeMoro opraHa.
. Y3H :JICellc/(ou. nOJ/.oeou ccjJepbt
IIpOBOAHTCSI B nOJIOJKeHHH Ha cnHHe, npH nOJIHOM MO'1e-
BOM nY3b1pe. ,D;aT'IHK HaKJIa,zJ;bIBae'I'CSI Ha nepe,ll;HIOIO 6PIOIll-
HYIO CTeHKY, CMa3aHHYIO Ba:3eJIHHOM.
412
t
413
6.13. Cepge'lHo-Jlero'lHaSi peaHUMal.lUSI
npH3HaKH KI1HHH'IeCKOM cMepTH:
1. OTCYTcTBHe nYJIbCaqHH Ha KpynHbIX MarHCTpaJIbHbIX
cocy ax (COHHOM, 6e peHHoM, nJIe'leBOM apTepHH).
2. IIoTepSl C03HaHHSI
3. PacIIIHpeHHe 3pa'lKOB.
4. IIoSlBJIeHHe KJIOHH'leCKHX H TOHH'leCKHX cy opor.
5. IIpeKpaIl.\eHHe I.IXIUIHSI
HH O HH H3 3THX CHMnTOMOB He SlBJISleTCSI OCTOBepHI.IM
npH3HaROM npeKparqeHHSI KPOBo06parqeHIISI, TaK KaK B 3KCT-
peHHI.IX cHTyan;HSlX CYJK eHHe 0 npH3HaKax KJIHHH'leCKOM
CMepTH MOJKeT 6bITI. cy61,eKTHBHO no MHOI'HM npH'lHHaM: npH-
eM naqHeHToM ce aTHBHI.IX H HapKOTH'IeCKHX cpe CTB, Y na-
qHeHToB CTapllIero B03paCTa H npH BBe eHHH MopqJHHa rH -
pOXJIOpH a, npH nOJIHOM OCTaHOBKe KpOB006parn;eHHSI 3pa'l-
KH He paCllIHpSlIOTCSI, B03MOJKHO coxpaHeHHe I.IxaHHSI Tep-
MHHaJII.HOrO THna. Cy oporH MorYT 6I.ITI. nepBI.IM npH3HaKOM
KJIHHH'leCKOM CMepTH H e30pHeHTlIpYIOT Me HqIlH-CKHM nep-
COHaJI npll YCTIUIOBJIeHHH HarH03a.
a
6
AliarHOCTIiKa KI1I1HI1'1eCKO" CMepTI1:
a - onlJeAeneHl1e nynbca Ha COHHO apTepl1l1; 6 - onpeAeneHl1e
COCTOIIHI111 3pa\jKa
OCHOBHI.le npJUIl\JITILJ OKaaaHHSI nOMoID;H.
1. 06eCne'IlITI. cB060 HYIO npOXO HMOCTI. bIXaTeJII.HI.IX
nyTeH.
2. IIpoBecTH HCKyccTBeHHYIO BeHTHJISlqHIO JIerKHX (IIBJI)
H BOCCTIUIOBHTI. I.IxaHHe.
3. IIpoBecTH 3aKpI.ITI.IH HenpSlMoH MaCCaJK cep qa (3MC)
H BOCCTaHOBHTI. KPOB006paIl.\eHHe.
414
BOCCTaHOBneHHe npoxoAHMOCTH
AblxaTenbHblx nYTeM
"Y JIOJKHTb nocTpa.z\aBllIero ropll30HTaJII.HO Ha meCTKYIO no-
BepXHOCTI.. PaccTerHYTI. CTeCHSllOrqylO o eJK Y, OTKpbITI. no-
JIOCTI. pTa (C'beMHI.le 3y6HI.le npoTe3bI Y aJIIITb) H MaRCHMaJII.-
HO 3anpoKHHyrI. rOJIOBY nocTpa.z\aBllIerO (nOJIOJKHB JIeBYIO PYKY
Ha JI06, a npaBYIO no llIelO). B CJIy'lae aCnHpaqHH JKeJIY O'l-
a
6
PeaHI1Maql1J1 npl1 3aKynopKe
AblXaTel1bHblX nYTe" I1HOPOA-
HblM TeIlOM: a - nOCTpaAaBwl1 B
BepTI1KanbHOM nonOmeHHI1. BCTaTb
c3aAI1, HeCKonbKO C60KY. OCHOBaHI1-
eM KI1CTI1 HaHeCTH 3-5 6blCTpblX
pe3KI1X, Cl1nbHblX YAapoB B Mem-
nonaTo\jHoi:1 06j1aCTI1; 6 - no-
CTpaAaBwl1 B BepTI1KanbHOM nono-
B >KeHI1I1. BCTaTb C3aAI1, 06XBaTl1Tb
pYKaMI1 Ha ypOBHe BepXHero OTAena IKI1BOTa. COMKHYTb PYI(11 B 3aMOl<. CAem!Tb
3-5 6b1CTpblX pe3Kl1x. Cl1nbHblX Ton\jKoB-ClKaTI1i:1 B 3nl1raCTpanbHo 06nacTI1; B
- nOCTpaAaBwl1i:1 B nOnOlKeHl111 neJKa Ha nony. BcraTb Ha KOneHI1 Y OAHOro 113
60KOB (nY\jwe - Y npaBoro). nOBepHYTb nocTpaABBwero Ha 601<. nv.40M K
oKa3blBalOllleMY nOMolllb, AOnOnHI1TenbHO AOBepHyB ellle Ha 30°, 4>I1KCl1pOBaTb
PYKO 3a nne\jo. OCHOBaHl1eM APyro KI1CTI1 HaHeCTI1 3-5 6blCTpblX pe3KI1x,
Cl1nbHblX YAapoB B MelKnonaro\jHo 06nacTI1. 2,3 nanb4BMI1 npOBepl1Tb nonOCTb
pTa, rnOTKl1, yslanhTb I1HopoAHoe Teno.
j
415.
---.
IIocJIe rJIy60Koro B OXa peaHHMaTOP: nJIOTHO npH:lKaB CBOH
pOT :K nOJIYOTKPbITOlIty PTY nOCTpa,n;aBIIIerO, COBepIIIaeT .pOP-
CHpOBaHHbIH BhI OX (B Te'IeHHe 1 ceK.). O HOIJpeMeHHo CJIe-
HT 3a rpY HoM KJIeTKOM, KOTopaSl OJIJKHa cB060 HO H JIerKO
npHno HHMaTbcSI, a nOCJIe OTKpbITHSI nOJIOCTH pTa II Hoca
npOIlCXO HT naCCHBHbIH BbI OX C THnll'IHbIM 3BYKOM BbI bIxa-
eMoro B03 yxa.
IIpH H8.JIH'IIIH npll3HaKOB cna3Ma JKeBaTeJIbHOH MYCKYJIaTY-
phI (B nepBbIe ceKYH bI nOCJIe BHe3anHOH OCTaHOBKH KpOBo06-
p eHHSI) BB eHHe pOTopaCIIIHpHTeJISI He Bcer a B03MOJKHO.
CJIe yeT Ha'IHHaTb IIBJI MeTO OM (!H30 pTa B HOC;>. KaK H npH
bIxaHHH H30 pTa B POT;> eJIalOT TO JKe cm.me, TOJIbKO PYKa
peaHHMaTopa, nOMepJKIIBaro aSl no,l\6opo OK, 60JIbIIIHM H YKa-
3aTeJIbHbIM n8.JIbqaMH npHKpbIBaeT pOT nOCTpa aBIIIero.
IIaCCHBHbIH Bb OX ocy eCTBJISleTCSI npeHMy ecTBeHHO 'Ie-
pC3 pOT nOCTpa,n;aBIIIero.
qacToTa B YBaHHM B03 yxa paElIa 12 - 15 B MIIH.
MeTo (!1I30 pTa B pOT H HOC;> - npOIl3BO HTCSI Y eTeH
nepBOro ro a JKH3HH. Ofu,eM B oxa OJI:meH 6bITb TeM MeHbIIIe,
'IeM MJIa,n;IIIe pe6eHOK. qacToTa B YBaHHH Y eTeM 15 - 20
B MHHYTY.
06bI'IHO npn 3KcnnpaTopHbIX MeTo ax MBJI npHMeHSlIOT
MapJIeBYIO CaJI.peTKY, HOCOBOM nJIaTOK. OHn, KaK npaBHJIO,
6bICTpO c6nBalOTcSI, HaMOKalOT II MellialOT npoBeJ\eHnlO MBJI,
MorYT npenSlTcTBoBaTb npoxom eHnlO B03J\yxa B BepxHHe
J\bIxaTeJIbHbIe nYTn nOCTpa,n;aBIIIero n He SlBJISlIOTCSI MepaMn
nH.peKqnoHHoM 6e30naCHOCTH npH MBJI.
Horo COJ\epmHMoro Heo6xo nMO T aTeJIbHO O'IHCTHTb nOJIOCTb
pTa C qeJIblO npo.pHJIaKTHKH TSlJKeJIbIX nOCTpeaHHMlU.{nOHHbIX
OCJIOJKHeHHH. C nOMOIW>1O n8.JIbqeB, 3amIlMOB, CaJI.peTKn H3-
BJIe'Ib OCTaTKH nll 1I H PyrHe BH IIMbIe nOCTopOHHne npe -
MeTbI. aTO cnoc06cTByeT nOJIHOMY OTKpbITHIO BepXHHX bIxa-
TeJIbHbIX nYTeM.
O'IHCTI:fTb POTOBYIO nOJIOCTb JIy<IIIIe C nOMOIIJ;blO 3JIeKTpO-
OTcoca. 3aTeM He06xoJ\HMo y6e HTbCSI B npOXO HMOCTH bIxa-
TeJIbHbIX nYTeM no 3KCKypCHH rpY HOM KJIeTKH, C eJIaB 3-5
BbIp;oxa peaHHMaTopa B Te'IeHHe 3-5 ceKYH .
IitCKYCCTBeHHaR BeHTMnRqMR nerKHX
BbI60p MeTO HKH HCKyccTBeHHoM BeHTIIJISlqHH JIKrKH3X
(IIBJI) 3aBHClIT OT MbIIIIe'IHOM peJIaKcaqHH (pacCJIa6JIeHHSI) n
npOXO HMOCTH BepXHHX bIXaTeJIbHbIX nYTeH.
IIpH OCTaTO'IHOH MbIIIIe'IHOH peJIaKCan;MH H cB060J\HOM
nOJIOCTH pTa JIy<IIIIe ocy eCTBJISlTb J\bIXaHHe 3KcnHpaTopHbIM
MeTO OM IIBJI (!H30 pTa B POT;>: J\JISI 3Toro peaHHMaTOp .pHK-
cHpyeT rOJIOBY B 3anpOKHHYTOM nOJIOJKeHHn, O HOM PYKOM
BbI BHraeT Knepe 1I HHmHlO1O 'IeJIIOCTb, a YKa3aTeJIbHbIM H
60JIbIIIHM n8.JIbqaMH PyroH PYKn nJIOTHO 3aKpbIBaeT HOC no
CTpa,n;aBIIIeMY.
TeXHI1Ka YAaneHI1S1 B03Ayxa 113 >KenYAKa.
OTcyrcTBl1e AblXaTel1bHblX ABl1lKeHI1i1 nepeAHei1 rpYAHoi1 CTeHKI1. pa3AYBaHI1e
HaA peBHoi1 06l1aCTI1 CBI1AeTel1bCTBYIOT 0 nonaAaHl111 B03Ayxa B lKel1YAOK
BCl1eACTBl111 HeAoCTaTo Horo pa3rlo16aHIo1!1 ro110Bb1111111113-3a 60l1bWOrO 06beMa
B03AYxa. B03MOJKHa acnlo1paL\ !I COAepJKIo1MblM JKeI1YAKa.
1. nOBepHyrb r0l10BY 60l1bHOrO Ha6oK.
2. HalKaTb Clo1l1bHO Ha 3nlo1raCTpal1bHYlO 0611aCTb.
3. nOBepHyrb nal\l1eHTa Ha cnl1HY 101 npOAOI1JKaTb B/1.
416
IitCKYCCTBeHHaR BeHTMnRqMR nerKMX
MeToAoM «H30 pTa B POT»
nO roToBKa K npoqe pe
1. "Y JIOJKHTb nOCTpa,n;aBIIIero ropH30HTaJIblI0 Ha JKeCTKYIO
nOBepxlIocTb. }J,JISI YJIy'IllieIIHSI npoxoJ\IIMOCTH bIXaTeJIbHbIX
nyTeH.
2. PaCCTerHYTb CTeCIISlIOIIJ;YIO oJ\eJK.l\Y .
3. MaKCHM8.JIbHO 3anpOKHHYTb roJIOBY nOCTpa,n;aBIIIero -
JIeBYIO PYKY nOJIOmllB lIa JI06, a npaBYIO - no IIIelO.
4. IIO JIOJKHTb B8.JIHK no nJIe'IeBOM noSlc.
411
"----
6
MeTOAbl paCKpblTI1S1 pTa: 0 - nepeOHUM
3OX80mOM. c1Jl1KCl1pOBaTb ro/lOBY B nO/lO>KeHI1I1
pa3rI16aHI1J1. BBecTI1 1 na/le4 B pOT cnepeAI1.
3aXBanITb 11M HI1>KHIOIO 'je/lIOCTb HI1JKe
A OCHOBaHI1J1 nepeAHl1x 3y6oB, 2-M na/lb4eM - 3a
. nOA6opoAo'jHYIO o6/1acTb. c1Jl1KCl1pOBaTb 3-5-M
na/lb4aMI1. OTTE!CHI1Tb HI1>KHIOIO 'je/lIOCTb KHI1Jy
CMeCTI1Tb KnepeAI1 - OTKpblTb pOT. 6 - 601l08b/M 30X80mOM. c1JI1KCl1pOBaT
rO/loBy B nO/lO>KeHI1I1 pa3rI16aHI1J1. BBeCTI11 na/le4 B pOT C60KY, Me>KAY 3y6aMI1;
3aXBaTljTb 11M HI1>KHIOIO 'je/lIOCTb 113HYTpl1, HI1JKe 3y60B. 2-5-M na/lb4aMI1
Ij>I1KCl1pOBaTb HI1>KHIOIO 'je/lIOCTb. PaBHOMepHO OTTeCHI1Tb ee KHI13Y, CMeCTI1Tb
KnepeAI1. 8 - 30X80mOM 8em8eu HU}/(HeU "elllocmu. OCHOBaHI1J1 KI1CTeii
pacnO/lO>KI1Tb Ha o6el1x BeTBJlX HI1>KHeii 'je/lIOCTI1. l-e na/lb4bl pacnO/lO>KI1Tb B
nO/lO>KeHI1I1 ynopa B nepeAHl1x OTAe/lax 'je/lIOCTI1. 2-5-M na/lb4aMI1
Ij>I1KCl1pOBaTb ee BeTBI1 CHI1Jy. ( ynopoM Ha l-e na/lb4bl OTTeCHI1Tb HI1>KHIOIO
'je/lIOCTb KHI13Y, CMeCTI1Tb KnepeAI1.
478
5. BbIABHHYTb HHJKHIOIO 'ICJIIOCTb BncpCA (3a nOA60poAOK,
YWH), OTKpbITb pOT nocTpa.z:\aBwcMY.
6. O'IHCTHTb POTOBYIO nOJIOCTb H rJIOTI(Y MCXaHH'IeCKH HJIH
C nOMO bIO OTCoca.
7. Ha.z:\aBHTb pe6POM JICBOH JIaAOHH Ha JI06, 60JIbWHM H
YKa3aTCJIbHbIM naJIb CM 3aJKaTb HOC nOCTpa.z:\aBWCro.
BbInOJIHCHHC npOn;C bI
1. BAOXHYTb rJIy60Ko, nJIOTHO npHJKaTb CBOH pOT KO PTY
nocTpa.z:\aBWCro.
2. 3HCprH'IHO BbIAOXHYTb BCC COACpJKHMOC CBOHX JICrKHX.
3. CACJIaTb naY3Y. 06CCnC'IHBaCTCH naccHBHbIH BbIAOX.
4. OnpeACJIHTb HaJIH'IHC 3KCKypCHH rpYAHoH KJICTKH Iepea
3 - 5 «BAoxa» nocTpa.z:\aBwcro C CJIbIO KOHTpOJIH 3a npoxo-
AHMOCTbIO AbIXaTeJIbHbIX nYTcH.
OKOH'laHIIC npOn;Cp;ypbI
ACJIaTb pHTMH'IHbIC .BAOXH» nOCTpa.z:\aBWCMY 12 -18 pa3
B MHHYTY AO nOHBJICHHH caMOCTOHTCJIbHOrO AbIxaHHH HJIH
npHC3Aa .CKOpOH nOMO H», HJIH npH3HaKoB 6HOJIOrH'lC-CKOH
CMCpTH.
I
I
J
3aKpblTblH HenpHMoH MaCCaH< cepALla
y B3pocnblx lot nOH<lotnblX
IJ;CJIb: BOCCTaHOBHTb ACHTCJIbHOCTb CCPA a, BOCCTaHOBHTb
KpoBoo6pa cHHc.
IIoKa3aHHc: KJIHHH'ICCKaH CMCpTb.
06n3aTCJIbHOC yCJIOBHC: C06JIIOAaTb nOCJICAOBaTCJIbHOCTb
CCPAC'IHO-JICrO'IHOH pcaHHMa HH (CJIP): BOCCTaHOBHTb npo-
XOAHMOCTb AbIXaTCJIbHbIX nYTcH, 3aTCM HcnpHMoH MaCCaJK
CCPA a AOJIJKCH CO'lCTaTbCH C HBJI (HCKYC-CTBCHHOH BCHTHJIH-
n;HH JICrKHx), TOJI'IOK npoH3-BOAHTCH BO BpCMH BbIAoxa nOCT-
pa.z:\aBwcro. Ka>KAbIc 2 MHHYTbI - KOHTpOJIb nYJIbCa Ha COH-
HOM apTcpHH H 3pa'iKOBOH pcaK HH.
IIop;roToBKa K npon;cp;ypc
1. BbI3BaTb .CKOpyIO nOMO b» C nOMOLW>IO OKPYJKaIO HX
JIIOACH HJIH caMOCTOHTCJIbHO.
2. HCMCAJICHHO Ha'IaTb CJIP.
3. YJIOJKHTb nOCTpa.z:\aBwcro Ha TBCPAYIO nOBcpXHOCTb.
4. Y6CAHTbCH, 'ITO rOJIOBa nocTpa.z:\aBwcro HIDWAHTCH Ha
OAHOM ypOBHC C CCPA eM HJIH HHJKQ Hero.
479
5. PaCCTerHYTb CTeCH.HIOII:(YIO OAC:mAY.
6. BCTaTb Ha KOJICHH C60KY OT nocTpaJlaBmCro, Y rpYAHoH
KJIeTKH.
BbInOJIHCJlIIC npOn;C,D;ypbI
1. nOMCCTHTb OAHY PYKY npOKCHMaJIbHOH '1aCTbIO JIaJloHH
Ha HH:mHIOIO TpeTb rpYAHHbI, APYryIO - Ha TbIJIbHYIO CC no-
BCPXHOCTb.
npltMeqaHlte. 06eCne4J.1BaeTCR ,!\OCTaTO'IHiUI nllollla,!\b ,IJ,J1R KOMn-
peccJ.1 . Hellb3R nOMelllaTb PYKH Ha,[\ PYKORTKOIO rPY,!\J.1Hbl, KOTo-
paR MO>KeT llerKO CllOMaTbCR 101 6blTb npJ.14J.1HO TpaBMbl ne<JeHH It
MRrKJ.1X TKaHe
2. 06ecnC'IHTb MaKCHMaJIbHOC pa3I'H6aHHC B JIY'lC3aruICT-
HbIX CYCTaBax B BHAC «6a60'lKH».
3. BbInP.HMHTb PYKH B JIOKTCBbIX CYCTaBax.
4. Hap;aBHTb Ha HH:mHIOIO TpCTb rpYAHHbI TaR, '1T06bI CMC-
CHHC rpYAHHbI BrJIy6b COCTaBJI.HJIO 3,8-5 CM. 3To 06ccnc'lH-
BaeT AOCTaTO'lHOC AaBJICHHC Ha rpYAHYIO KJICTKY, AJI.H B03-
HHKHOBeHH.H HCKYCCTBCHHOH CHCTOJIbI.
5. nOMCp:mHBaTb nOCTO.HHHbIH pHTM DDcpx-mIlI3» 6C3
naY3 MC:mJlY KOMnpCCCH.HMH.
npltMeqaHlte. YCltlleHJ.1e ,!\aBlleHJ.1R MO>KeT npJ.1BeCTH K nepellOMY
pe6ep, rpY,!\ItHbi. Clla60e ,!\aBlleHlte He 06ecne<JHT ,!\aBlleHlte KpOBH
no KPyraM KpoBo06pallleHJ.1R.
t
I1BR 11 HapymHblH MaCCa>K cepALIa OAHI1M pCaHI1MaTopOM.
(OOTHOWeHl1e peaHI1MaLll1112 : 15
480
B
6
<] I
)-
r
a - pa604a!l 'IaCTb KI1CTI1 npl1 Ha-
PY>KHOM Maccame cepAlIa - ee oc-
HOBaHl1e; 6 - nOnO>KeHl1e OCHOBa-
Hl1e KI1CTI1 Ha rpYAI1He. eTpOrO no OCI1
rpYAI1Hbl. Ha 2 nonepe'lHI1Ka nanblla
Bblwe Me'leBI1AHoro OTpoCTKa; B -
nOnO>KeHl1e KI1CTe" Ha rpYAI1. OCHO-
BaHl1e nepBO" KI1CTI1 pacnOnO>KI1Tb
A Ha rpYAI1He, BTOPO" KI1CTI1 - Ha Tb,ne
nepBO", nOA yrnoM 90°. nanbllbl Bbln-
p!lMI1Tb; r - nOnO>KeHl1e KI1CTe" Ha rpYAI1He (BI1A C60KY). nanbllbl bl; :
. nonOJKCHI,e MeApa60THI1Ka npl1_ npoBeAeHl111 HapY>KHOr
Hbl. 1\ - ax Macca>K oCYlI\eCTBn!lTb BceM
CeJll\lld. 8blll P !lMI1T 6 b pyKI1 B nOKT: ; T : B pl1TMe 60 (AO 70) KOMnpeCCI1"
KopnycoM, C nporl1 aHl1eM rpYAI1H
B 1 MI1I1.
16.30. JI
481
6. CO'leTaTh 15 KOMnpeccHH B Te'leHHe 9-11 ceK. C ABYMH
BAhIXaHHHMlI B nocTpaAaBllierO, eCJIH peaHHMaIJ;HIO npoBoAHT
OAHH'IeJIOBeK.
npItMe'laHlte. 06ecne'leHlte OnTltManbHOro OTHOWeHItR 'IaCTOTbi
AbIXaTeJ1bHbIX AI!M>KeHItH 101 4aCTOTbi cepAe4HbiX COKpall\eHItH.
7. Co'leTaTh 4-5 KOMnpeccHH C OAHHM BAblxaHHeM B nOCT-
pap;aBmero, eCJIH peaHlIMaIJ;HIO npoBoAHT ABa 'IeJIOBeKa.
8. KOHTpOJIHpOBaTh actJctJeKTHBHoCTh HenpHMoro Maccama
cepA a qepe3 1-2 MHIJyTbI, onpeAeJIHH nYJIhC Ha COHHOH ap-
TepHH H 3paQKoBYIO peaK HIO, AO nOHBJIeHHH nyJIbCa H B03-
HHKHOBeHHH AblxaHHH JIH60 AO nOHBJIeHHH 6HOJIOrnQeCKOn
CMepTH.
npItMe'laHlte. nplt OTCyrCTBlt1t nYllbca 3pa4KIt paCWltpeHbl, npo-
AOll>KaIOT C11P. npH Hallit'lite nynbca 3pa'iKIt Cy>t<aIOTCR, nORBllReT-
CR AbixaHlte. npOAOll>KalOT I1B11.
OIWH"IaJlHe npo eAYPbl
1. lloAAepmHBaTh AbIXaTeJIbHhIe nYTH no-cTpaAaBmero OT-
KpbITbIMH npn HaJIH'IHH nYJIbCa H CaMOCTOHTeJIhHOrO AbIxa-
1J:HH AO npHe3Aa «CKOpOH nOMO H».
2. Ha6JIIO,lJ,aTh 3a AhIXaHHeM H nYJIhCOM.
npItMe'laHlte: nplt3HaKit 3<1>cI>eKTltBHOCTit peaHItMaLlItOHHblX Mepon-
pItRTItH:1. nORBneHlte nynbCaLllt1t Ha COHHblX It nY4eBbiX apreplt-
Rx.2. Cy>KeHlte 3pa4KoB.3. BOCCTaHOBneHHe AA.4. YMeHbWeHlte
6neAHocTIt. LlltaHo3a.5. BOCCTaHOBneHloie caMOCTORTenbHoro Abl-
xaHHR.
OCJlO:JfCnenuJI. npu peanuJlta4uu:
1. llepeJIOM:bI pe6ep H rpYAHHbI.
2. llOBpe:m,l.\eHHH JIerKHX, cep,l.\ a, neQeHH, CeJIe3eHKH, >Ke-
JIY,lJ,Ka.
IIpotjJUJlaKmUlW ocJlo:JfCnenuil:
1. llpaBHJIhHble npHeMbI peaHHMa HH.
npM3HaKM 6MOnOrMQeCKOM cMepTH
BIIOJIOrll'leCKaa CMepTb - aTO Hoo6paTHMoe npeKpa e-
HHe mH3HeAeHTeJIbHOCTH opraHH3Ma. Ee npH3HaKH: nOJIHOe
npeKpa eHHe AbIXaHHH, OTcyTCTBHe nYJIhCa, cepA e6HeHHH,
HC'-le3HOBeHHe pectJJIeKcoB, MepTBeHHaH 6JIeAHOCTh KO>KHbIX no-
482
KpOBOB, pacCJIa6JIeHHe MYCK JIaT
'IeJIIOCTH, HC'Ie3HOBeHHe 6JIe Y ypbI, ony- eHHe HHmHeH
HHe TeJIa, nOHBJIeHHe TPyn' CI(8 rJIa3, nOCTeneHHoe OXJIamAe-
HbIX nHTeH, TPynHoe OKO'lf>HeHJfC.
I
npaBHna 06pal1leHHH C TpynoM
1. C Tpyna CHHM8IOT OAe:m,lJ, H
IJ;eHHocTH C YMepmero CHHMBlO: B YKJI8AhIB8IOT H8 cnHHY.
peA8IOT pOACTBeHHHKaM no " npHC}'TcTBHH Bp8'1a H ne-
2 ,..., pacnHcKY.
. IIOABH3bIB8IOT HHJKHIOIO 'I
KpbIB8IOT npocThIHen H OCTaB eJIIOCTh 2 , cnYCKaIOT BeKH, Ha-
g Ha JIHIOT Ha 'Iaca.
. 6eApe YMepmero 3anHCbIBaIOT ([:IRO
pHH 6<)Jle3HH. H HOMep HCTO-
4. B conpoBOAHTeJIhHOH 3anHCKe
ro, M HCTOpHH 60JIe3HH "li 8 OTMeQaIOT ([:IRO YMepme-
5 Tp ,,..., rH03 H ,lJ,aTY CMepTH
. ynbI B cOnpOBOJK,lJ,eHHH M u'
JIjIIOT B naTOJIOrOaHaToMH'I ecKoe e,lJ,H HHCKOU CecTpbI AOCTaB-
OT,lJ,eJIeHHe.
i
16'
Pa3gell VII
I I
nOTEPH. CMEPTb. rOPE
1.1. npuHqunb' o6cllyilfUsaHuR naqueHmoB
B YCIIOBURX xocnuca
XocnUCbt - JIe'le6HbIe Y'lpem)J.eHHH, B KOTOpbIX Bpa'IH,
Me)J.I-U.\HHCKlie ceCTpbI npOBOAHT MeponpIiHTH$I no YCTpaHe-
HHIO Y HeH3JIe'IHMO 60JIbHbIX JIIOAeM (lm3H'IecKHx H )J.yUIeB-
HbIX cTpa,n;aHHH. lla HeHTaM xocnHca OKa3bIBaeTCH ncnXOJIO-
rH'I€CKaH H MeAH HHCKaH nOMepmKa. D;eJIb xocnHCOB - AaTb
60JIbHOMY '1eJIOBeKY B03MomHOCTb YMepeTJ, cnOKOMHO H 6e3
cTpa,naHHM; npHHeCTH ero pOAHbIM, l1POXOAHll.\HM '1epe3 TH-
meJIbIe HcnbITfiHHH, )J.YllIeBHoe 06JIerqeHHe.
llepBbIll xocnHC COBpeMeHHoro THna 6bIJI C03AaH B AHrJIHH
.l\OKTOpOM CeCHJIHeH CoHAepc B 1967 rOAY. CeroAHH B STOH
CTpaHe cYlI.\eCTByeT 06lI.\eHa HOHaJIbHaH ceTb xocnHCOB. C
Ha'laJIa 1980 rOAOB HAeH xocnHCHoro ABHmeHHH Ha'lHHaIOT
pacnpOCTpaH$ITbCH no BceMY MHPY H CTaJIH nOHBJIHTbCH B
POCCHH.
OCHOBY xocnHCHore ABHmeHHJl COCTaBJIHIOT npHH I1nbI nM-
JIHaTHBHoH MeAH HHbI ( MeAH HHbI BpeMeHHore nOAAepma-
HHH 3AOPOBbH H 06JIerqeHHH 60JIH).
KOMaHAbI BceX xocnHCOB pa3BHBalOT npHH unbI, KOTopbIe
nO,ll,lJ,epmHBa€T BceMIIpHaH OpraHH38I.\HH 3ApaBooxpaHeHHH:
. YTBepmAaeT mH3Hb H paCCMaTpflBaeT CMepTb KaK HOP:
MMbIlbIM npo ecc;
. Fe YCKOpHeT H He 3aMeAJIHeT CMepTb;
.06ecneqHBaeT nCHXOJIOl'HqecKHe H AHeBHbIe acneKTbI
YXOAa 3a 60JIJ,HbIMH;
. 06eCne'lHBaeT 06JIerqeHHe 60JIH H APyrHx 6ecnoKOHll.\I1X
CHMnTOMOB;
. npeAJIaraeT CHCTeMY nOMepmKH, QT06bI nOMO'lb 60JIb-
HbIM mHTb aKTHBHOH mH3HblO AO KOH a;
484
.
. npeAJIaraeT CHCTeMY nOAAepmKH, '1T06bI nOMO'lb C:JMb-
$IM CnpaBHTbCH C TPYAHOCTHMH BO BpeMH 60JIe3HH POA-
CTBeHHHKa, a TaK me nOCJIe ero CMepTfI.
1.Z. nompe6HOCmU YMupalOUlero l/elioBelfa.
ero ceMbU U 611U3lfUX
I
I
3a THmeJI060JIbHbIMH H YMHpaIOlI.\HMH Tpe6YeTCH nOCTOHH-
1I0e lIa6JIIOAeHHe AHeM H HO'lblO. TaK KaK B JII060e BpeMH
MOmeT npOH30HTH YXYAllIeHHe COCTOHHHH 60JIbHOrO '1eJIOBeKa
HJI" HacTynHT CMepTb.
Jh060M na HeHT omHAaeT, BO-nepBbIX, MeAH HHCKOH KeM-
JlPTt'IITHOCTH, a BO-BTOpbIX, Hamero '1eJIOBe'leCKoro OTHOllIe-
IUln K HeMY.
.D;JIH 06ecneQeHHH yxoAa H naJIJIHaTHBHoro JIeQeHH$I CJIe,llY-
eT Y'IHTbIBaTb nOTpe6HoCTH YMHpaIOll.\ero na HeHTa:
. XOPOllIHM KOHTpOJIb 3a npOHBJIeHHHMH 60JIe3HH ( CJIe-
AHTb 3a BHellIHHM BHAOM na HeHTa, AbIxaHHeM, nYJIb-
COM, apTepHaJIbHbIM AaBJIeHHeM H !lJH3HOJIOrHQeCKHMH
OTnpaBJIeHHHMH);
. Oll.\Yll.\eHHe 6roonacHoCTH (no B03MomHOCTH He OCTaB-
JIHTb na HeHTa O.l\HOro);
. meJIaHHe QYBCTBOBaTb Ce6H HymHbIM H HHKOMY He 6bITb
B THreCTb;
. QeJIOBe'leCKoe 06lI.\eHHe (KOHTaKT) 6JIarOCKJIOHHOCTb;
. B03MOmHOCTh 06cY:m.l!aTb npo ecc YMHpaHHH;
. B03MomHOCTb npHHHMaTb YQaCTHe B pellIeHHHX (QYB-
CTBO c06CTBeHHoro AOCTOHHCTBa);
. meJIaHHe, HecMOTpH Ha JII060e HaCTpoeHHe, 6bITb nOHH-
ThIM. .
PO.l\HbIe H 6JIH3KHe n8I.\HeHTa HcnbITbIBaIOT QYBCTBO YTpa-
TbI, IIY:m.l!aIOTCH B 3a60Te BO BpeMH TeQeHH$I 3a60JIeBaHHH na-
HeHTa, BO BpeMH ere CMepTH H nOCJIe CMepTH n8I.\HeHTa. CMepTb
HBJIHeTCH THmeJIbIM nOTpHceHHeM AJIH pOAHbIX H 6JIH3KHX, a
nOTOMY K HHM CJIeAyeT OTHecTHCb C OC06bIM BHHMaHHeM. 3a60-
Ta 0 pOACTBeHHHKax 6oJIbHoro QeJIOBeKa, 6eceAbI C HHMH HBJIH-
IOTCH HeoT'beMJIHMOM '1aCThIO nMJIHaTHBHoro yxoAa.
PO.l\CTBeHHHKH CTpa,n;aJOT, nepe>KHBaIOT. He 3HaIOT '1TO H
KaK rOBopHTb Ge3Ha,nemHOMY 60JIbHOMY '1eJIOBeKY. 3aMaJI'IH-
485
BaR He BbI3bIBaeT AOnOJIHHTeJIbHYIO HanpHJKeHIfOCTb. HeKOTO-
pbIX pOACTBeHHHKOB He06xOAHMO npOKOHCYJIbTHpOBaTb, KaK
npaBHJIbHO BeCTH ce6H BO BpeMH BH3HTOB. )J;,):[.fl 06pe'leHHoro
qe.nOBeKa 'laCTO 6bIBaeT BaJKHO caMO npHCYTCTBHe pOACTBeH-
HHKOB, 6JIH3KHX, orqyrqeHHe, qTO OH He OAHHOK.
BJIH3KHe YMHpalOrqero qeJIOBeKa npOXOAHT Te JKe CTa.n;HH
ropeBaHHH, KOTopbIe npOXOAHT caM 06peqeHHbIM. rOpeBaHHe
HaqHHaeTC.fl AO HacTynJIeHHH CMepTll H npOAOJIJKaeTC.fl B Teqe-
HHll HeCKOJIbKHX MeCHIWB HJIH AaJKe HeCKOJIbKHX JIeT nOCJIe
CMeJYI'H.
POACTBeHHHKaM Tpe6yeTC.fl nCHXOJIOrH'IeCKaH nOAAepJKKa.
Pa3rOBapHBaTb C HHMH CJIeAyeT TaKTllqHO, He HaB.fl3bIBaTb HH
HM, HH n HeHTY CBOH c06CTBeHHbIe OJKHAaHHH B CBH3H C
nepeJKHBaeMbIM ropeM. OKPY;)fteHHbIe BHHMaHHeM, 3a60TOM,
nOMCpJKKOM pOAcTBeHHHKH H 6JIH3KHe 06peqeHHoro qeJIOBe-
Ka CMorYT JIerqe nepeJKHTb nOTeplO.
nl)WIHH H BO Bcex HanpaBJIeHHHX. Ho CJIeAYeT K n HeHTY
OTIlOCHTbCH C nOHHMaHHeM, YAeJIHTb BpeMH H BHHMaHHe, H OH
CKOpO CTaHOBHTCH 60JIee cnoKoMHbIM H MeHee Tpe6oBaTeJIb-
HbIM.
TpeTbn cTa)J;lIn - neperOBopbI C CYAb60M. B nepBoM CTa-
AHll na HeHT He B CHJIax npH3HaTb CJIyqHBilleecH, BO BTOpOM
- CCOpHTCH C BorOM II C MHpOM, a B TpeTbeii: nbITaeTCH
OTCPOqHTb HeH36eJKHoe. nOBeAeHHe na eHTa HaIIOMHHaeT no-
BeAeHHe pe6eHIta, KOTOpbIij BHaqaJIe Tpe60BaTeJIbHO HaCTaH-
BaJI Ha CBoeM, a nOTOM, He nOJIyqHB JKeJIaeMOrO, BeJKJIHBO
npOCHT, 06e aH npH STOM 6bITb noc.nyillHbIM: . rOC nOAH,
eCJIH TbI He Aaeillb MHe BeqHOM JKH3HH Ha 3eMJIe II Bce Moe
HeroAOBaRHe He ll3MeHHJIO TBoero pemeHHH, TO, 6bITb MOJKeT,
TbI CHH30MAeillb K MoeM npocb6e!>. rJIaBHbIM JKeJIaHlIeM CMep-
TeJIbHO 60JIbHOrO qeJIOBeKa nOqTH BcerAa OCTaeTCH npoAJIe-
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AHTEPATYPA
16. HOBble CTaHAapTbl cecTpHHCIWH npaKTHKH /H3 onblTa
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37. 30JlomyxulLa-A6oJluna E.B. Kypc JIeKI.:(HH no 3THKe. Poc-
TOB-Ha-11.oHY. .cI>eIlHKc». 1999 r.
38. Myxuna C.A., Tapll.OOCKaSl H.H. TeOpeTH'IeCKlIe OCHOBbI
cecTpHHcKoro ,neJIa., Y'Ie6HOe noc06He. M.: PO,nHHK 2001.
39. AKono6 B.H. MeAHI.:(HHCKOe npaBO B Bonpocax 11 OTBe-
Tax. M.: «M3,n. llPMOP», 2001.
40. Bazun H. llCHXOJIOI'H.fl mH3HH H CMepTH. Cll6.: llHTeP,
2001.
1/
I I COIJEPJKAHHE
npeAHCIIOBHe ......................................... ............ .................. ........ 3
PA3AEn I.
BBE.QEH"E B nPEAMET
(\OCHOBbl CECTP"HCKOrO AEIIA» .............................. 5
1.1 npeAMeT, MeCTO H ponb o6114ecTBeHHoro
3ApaBooxpaHeHHR H 3AOPOllbR.
CHCTeMa 3ApaBooxpaHeHHR B POCCHH ............................ 5
3AopoBbe HacelleHHSI, nOHSITHSI, KpHTepHH OL1.eHKH ..................... 5
OCHoBHble MeAHKo-AeMorpacpH4ecKHe H APyrHe nOKa3aTeIlH
COCTOSlHHSI 06L4eCTBeHHoro 3AOPOBbSi 101 cpeAbI 06HTaHHSI
4enOBeKa ........................... .................. ............. . ................. .... 7
MeAHKo-AeMorpacpH4ecKaJ'I CHTYalIHSI
B PoccH kKOH Q:leAepaL1.HH ...................................................... 7
r ocyp,apcTBeHHble opraHH3a4HoHHbie CTPYKTYpbl,
3aHHMalOL4HeCSI BonpocaMH ceCTpHHcKoro Aella .................... 11
npaBoBaSI 101 IOpHAH4eCKaJl 6a3a ceCTpHHCKoro Aella .............. 13
OCHOBHble THnbll1e4e6Ho-npocpHllaKTH4ecKHx Y4Pe>t<,qeHHH .... 14
YCTpOHCTBO 101 OCHOBHble cpYHK4HH 60llbHH4 ..........:.............. 15
OCHoBHble HanpaBlleHHSI AemenbHOCTH cpep,HHX
MeAHL1.HHCKHX pa60THHKOB B pa311H4HbiX OTAelleHHSlX Jlny ..... 19
KOHmpoflbHble Bonpocbl aflR cOMonoazomoBKu ........................ 26
npeAnocblnKH, CYL4HOCTb 101 OCHOBHble HanpaBneHHSI
pecpopMbl cecTpHHcKoro Aella B POCCHH ............................... 27
YpOBHH nOAroToBKH MeAH4HHCKHX cecTep B POCCHH.
CecTpHHcKHe nepHoAH4ecKHe H3p,aHHSI .................................. 30
Ponb, 4ellH 101 3aAa4H ACC04HaL1.HH pOCCHHCKHX
MeAH4HHCKHX cecTep ............................................................. 31
CTaHAap"TH3a4HSI AeSITellbHOCTH B CecTpHHCKOM Aelle
AllSi KOHTpOllSi Ka4eCTBa CecTpHHCKOH npaKTHKH. ..................... 32
04eHKa Ka4eCTBa pa60Tbi MeAH4HHcKOH ceCTpbl .................... 35
3Ha4eHHe npOBeAeHHSI HaY4HbiX H3blcKaHHH
101 nepcneKTHBbl pa3BHTHSI ceCTpHHCKoro Aena B POCCHH ........ 36
495
PA3AEJlI\.
TEOPET"'-IECK"E OCHOBbl CECTP"HCKOro AEnA .. 38
2.1. cJ>HnococpHR ceCTpHHCKoro Aena ................................. 38
CeCTpHHcKaSI p,eOHTOlIorHSI .................................................... 40
nSlTb cpYHAaMeHTallbHblX npHHL\HnOB ME!AIoiL\HHCKOH 3THKH,
ne>t<alllHe B OCHOBe aMepHKaHcKoH MOpallH ........................... 42
2.2. 6Ho3THKa. 06114eHHe B cecTpMHcKOM Aene .................. 43
nOHSITHe 6H03THKH ................................................................ 43
nOHSITHe 101 cpYHKL\HH 061l1eHHSI .............................................. 47
YpOBHH 06Il1eHHSI.................................................. .. . 48
C .............
peACTBa o61l1eHHSI ............................................ 49
OCHoBHble CTHIIH 061l1eHHSI ................................::::::::::::::::::: 51
MacTepcTBO 061l1eHHSI MeAcecTpbl ......................................... 52
<!>aKTOpbl, cnoco6cTBYIOIlIHe 061l1eHHIO ................................... 55
<!>aKTOpbl, npenSlTcTBYIOIlIHe 06ll1eHHIO.................................... 56
KpHTepHH 3cpcpeKTHBHoCTH 061l1eHHSI ..................___................ 59
2.3. nOTpe6HocTM lfenOBeKa B 3AopOBbe H 6one3HH ......... 61
nOHSITHe nOTpe6HOCTeI1 ...................................___................... 61
OCHoBHble TeopHH 101 KllaccHcpHKaL\HH nOTpe6HocTeH .............. 62
CVIlIHOCTb TeopHH nOTpe6HocTeH A. Matnoy.
XapaKTepHCTHKH OCHOBHblX nOTpe6HocTeH 4ellOBeKa ......... 62
Ponb MeAHL\HHCKOH ceCTpbl B BOCCTaHOBlleHHH
101 nOAAep>KaHHH He3aBHCHMOCTH naL\HeHTa
B yp,oBlleTBopeHHH nOTpe6HocTeH ..................................... 71
POllb MeAHL\HHCKOH cecTpbl B 03p,opoBlleHHH o6pa3a >KH3HH
naL\HeHTa 101 ero MeMbH .................................................... 74
2.4. MOAenH cecTpHHcKoro Aena ........................................ 76
OCHoBHble nOIlO>KeHHSI Mop,elleH ceCTpHHcKOro Aella.
MOAenb H.Poynep, B. JloraH, A.T aH3pHH ........................... 77
MOAenb fl.. fl.>KOHCOH ............................................................ 80
Ap,amaL\HOHHaSI MOAellb ceCTpHHcKOro Aella K. POH ............. 84
Mop,ellb fl.. OpeM .................................................................. 88
MOAenb B. XeHAepcoH ........................................................ 92
MOAellb M.AlllleH ................................................................. 95
B3aHMOCBSl3b OCHOBHblX nOTpe6HocTeH 4enOBeKa
no A.Matnoy 101 BHp,OB nOBcep,HeBHoH p,emellbHOCTH
no BHPA>KHHHH XeHAepcoH ............................................. 99
3.2. nepBblH 3Tan cecTpHHCKoro npo4ecca:
cy6'beKTHBHoe cecTpHHcKoe o6cneAoBaHMe ................ 107
3.3. nepBblH 3Tan cecTpHHcKoro npo4ecca:
06'beKTMBHoe cecTpHHCKoe o6cneAoBaHMe .................. 108
AHTponoMeTpHSI .................................................................. 113
OnpeaefleHue MOCCbl meflO .......................................... 113
113MepeHue pocmo nou,ueHmo ...................................... 116
OL\eHKa cpYHKL\HOHallbHOrO COCTOSlHHSI naL\HeHTa ................. 117
nYflbC u ezo xopoKmepucmuKo .................................;.. 117
noac'Iem opmepuoflbHoZO nYflbco HO flY'IeBou
opmepuu u onpeaelleHue ezocBoucmB................... 120
113MepeHue opmepuoflbHOZO aOBlleHuR ........................ 121
H06fllOaeHue 30 ablXOHueM ......................................... 125
113MepeHue cymO'IHOZO auype30
U onpeaefleHue BOaHOZO 601l0HCO .......................... 128
Y'lem BOaHOZO 60flOHCO ............................................... 128
npHMepHblH IIHCT cecTpHHcKoro p,HHaMH4ecKoro
Ha61110AeHHSI .. ........... ............... ......................... .................. 132
3.4. BTOpOH 3Tan cecTpHHCKoro npo4ecca -
cecTpHHcKaR AHarHocTMKa ........................................... 135
npHMepHblH 6aHK npo611eM
naL\HeHTa HnH cecTpHHcKHX p,HarH030B ........................... 141
<!>parMeHT 1013 ceCTpHHCKOH HCTOpHH .................................... 144
3.5. TpeTHH 3Tan cecTpMHcKoro np04ecca -
onpeAeneHMe 4eneH cecTpMHcKoro BMewaTenbCTBa ... 144
3.6. 4eTBepTblH 3Tan: nnaHHpoBaHHe 06'beMa
cecTpHHCKHX BMewaTen bCTB ................................... ...... 146
3.7. PeanH3a4HR 06'beMa cecTpHHcKHX BMewaTenbCTB..... 147
3.8. nRTblH 3Tan cecTpHHcKoro npo4ecca -
04eHKa pe3ynbTaTOB M KoppeK4HR yxoAa ................... 149
3.9. AOKYMeHTa4HR cecTpHHcKoro npo4ecca ................... 151
Bonpocw allR cOMonoazomoBKu ........................................ 153
496
PA3AEn IV.
06Y4EH"E B CECTP"HCKOM AEJ1E.......................... 154
Ccpepbl o6y4eHHSI................................................................ 155
BHAbl Y4eHHSI 101 cnoco6bl o6y4eHHSI..................................... 160
nepBblH 3Tan npoL\ecca o6Y4eHHSI ....................................... 161
1\ 3Tan - HHTepnpeTaL\l'1S1 npo611eM naL\HeHTa,
CBSl3aHHbiX C AecpHL\HTOM 3HaHHH.
OnpeAelleHHe COAep>KaHHSI o6Y4eHHSI ............................. 164
497
PA3AEn III.
CECTP"HCK"H npO'-'ECC .......................................... 100
3.1. CecTpHHcKHH np04ecc.
OCHOBHble nOHSlTHR H TepMHHbl ................................... 101
III-V 3Tan - nOCTaHOBKa LleneH 06Y'feHH",
nIIaHHpOBaHHe 06Y4eHHSI, OLleHKa ero Ka4eCTBa
101 3cpcpeKTHBHOCTb 06Y'feHHSI .......................................... 165
KOHmpoflbHble Bonpocbl aflR cOMonoazomoBKu ...................... 166
PA3,QEJ1 V.
5E30nACHAH 50nbH"LfHAH CPE,QA ....................... 167
5.1. "HcI!eKqMoHHblM KOHTponb.
"HcI!eKqHoHHaR 6e30nacHocTb .................................... 167
B036YAHTellH B61-1 ............................................................. 168
T HnH4Hbie MeCTa 06HTaHHSI B61-1......................................... 169
3a60IleBaHHSI, OTHOCSlIJ..IHeCSI K B61-1...................................... 169
MexaHH3Mbi nepeAa4H B61-1 ................................................ 170
(J)aKTopbl, BIIHSllOlJ..IHe Ha BocnpHHM4HBOCTb X03S1HHa
K HHcpeK4HH .................................................................. 170
Mepbl KOHTpOIlSi 101 6e30nacHocTH B npocpHllaKTHKe B61-1...... 170
npaBHlla nOllb30BaHHSI 3alJ..lHTHOH OAe)KAOH ......................... 171
YpOBHH 06pa60TKH PYK MeAHLlHHcKOro pa60THHKa.............. 172
npaBHlla Hap,eBaHHSI CTepHllbHblX nep4aToK .......................... 177
npaBHlla CHSITHSI CTepHllbHblX nep4aTOK ............................... 177
npOcpHllaKTHKa BHyrPH60llbHH4HbiX HHcpeK4HH .................... 177
061J..1He Mepbl 6e30nacHoCTH MeAH4HHcKOH cecTpbl
Ha pa604eM MeCTe.......................................................... 179
CxeMa npoBeAeHHSI Ae3HHcpeK4HH
npH BHyrpH60llbHH4HbiX HHcpeK4HSlx ............................... 179
CaHHTapHa51 06pa60TKa na4HeHTa npH nep,HKYlle3e ............... 180
OpraHH3a4HSI npOTHBonep,HKYlle3HbIX MeponpHSlTHH B
CTaltHOHape ................. .... .............. ................................ 180
,lJ.e3HHcpeK4HSI 101 CTepHIIH3a4HSI ........................................... 181
Buaw ae3uHcpeKu,uu ...................................................... 182
MemOabl ae3UHcpeKu,uu ................................................. 182
XUMU'IeCKUe MemoBbl ae3UHcpeKu,uu ............................ 184
KOM6uHUpoBoHHble MemOabl ae3uHcpeKu,uu ................. 184
/Je3uHcpllu,uPYIO/J4UeCpeocmBa ..................................... 185
OcHoBHble npuK03w nocoHumopHo-
npomuB03nUaeMU'leCKOMY pe:J/CuMY flny,
peKOMeHaOU,UU ........................................................ 186
XopoKmepucmuKo oCHoBHblxcpeacmB ae3uHcpeKu,uu... 187
BUabl KOHmpoflR npuZOaHocmu
ae3UHcpuiJ,uPYIO/J4UXCpeacmB .................:................ 191
f98
)
CpeacmBa npoBeaeHuR ae3uHcpeKu,uoHHblX
MeponpuRmuu .......................................................... 191
Tpe60BaHuR K 060pyaoBoHuIO aflR ae3uHcpeKu,uu ........ 191
npOBUflO OXPOHbl mpyao npu p060mec
ae3uHcpuu,UPYIO/J4UMUCpeacmBoMu .......................... 192
XpoHeHue U npuzOmOB/leHUe XflOpCOaepJIC o /J4 ux
npenopamoB ............................................................ 193
T eXHUKO npuzOmOB/leHUR ae3uHcpuu,UpylOU4 ux
pocmBapo8.............................................................. 194
Oc06eHHocmu zUZUeHU'IeCKOU y60pKU nOMe/J4eHUU
cmou,uoHopO ............................................................ 198
COHumopHo-zUZUeHU'IeCKOR y60pKO nU/J4e6flOKO
U 6ycpemHblx B omaefleHuRx cmou,UOHOpO ............ 199
E5eflbeBou pe:J/CuM cmou,UOHOpO ................................... 200
flU'IHOR zuzueHO nou,ueHmoB ........................................ 201
KOHmpoflb KO'lecmBa meKY/J4eu
U 30KfllO'IUmenbHOu ae3uHq;eKu,uu .......................... 202
npOcpufloKmU'IeCKOR (meKY/J40R) ae3uHq;eKu,uR ............ 202
npOcpufloKmU'IeCKOR ae3uHcpeKu,uR ucmepuflu30U,UR
p03flU'IHblX 06beKmoB mepoileBmu'IeCKOZO
omaefleHuR .......................... ..... .......... ..................... 203
lIe3uHcpeKu,uR npeaMemoB yxoao 30 nou,ueHmOM ....... 206
npOcpufloKmuKo npocpeccuoHoflbHOZO
30po:J/CeHuR B npou,eaYPHOM K06uHeme .................. 208
Oc06eHHocTH pa60Tbi Mep,H4HHcKOH ceCTpbl B YCIIOBHSlX pHCKa
HHcpH4HpoBaHHSI BHPYCHOH 101 6aKTepHallbHOH HHcpeK4 H eH,
nepeAalOlJ..leHCSI 4epe3 KpOBb 10111101 APyrne 6HonorH4ecKHe
)KHAKOCTH naLlHeHTa ....................................................... 209
CxeMa 3TanOB 06pa60TKH H3AeIlHH MeAH4HHcKOro
Ha3Ha4eHHSI ................................................................... 218
nOHSITHe 0 CTepHIIH3a4HH, MeTOAbl
101 cnoc06bl cTepHIIH3aLlHH .............................................. 228
MemOabl cmepuflu30U,UU .............................................. 229
nOHRmue 06 oBmoKfloBupoBoHUU ................................ 229
CmepUflu30U,UR ZOPRl.fUM B03aYXOM Bcyxo:J/CopoBoM
WKOq;y. B03aYWHblU MemOacmepUflU30U,UU ............ 231
nOpRaOK P060mbl HO Ba3aYWHblX
cmepuflu30mopox (cyxO:J/CopoBble WKOcpbl) ........... 232
Cmepuflu30U,UR pocmBapoMu XUMU'IeCKUX Be/J4ecmB... 232
Cmepuflu30U,UR Z030MU ................................................. 233
499
PA3,QEI1 VI.
np"EM nAQ"EHTA B CTAQ"OHAP .......................... 262
6.1. nonHaR caHHTapHaR o6pa6oTKa naqHeHTa ................ 262
CaHHTapHa51 06pa60TKa na4HeHTa
npH Bbl5lBlleHHH neAHKYlle3a ........................................... 262
06pa60TKa BOIIOCHCTOH 4aCTH rollOBbl
npH neAHKYlle3e MexaHH4ecKHM cnoc060M ...................... 264
r HrHeHH4eCKaSI BaHHa .......................................................... 266
rHrHeHH4ecKHH AYW............................................................ 267
6.2. MeAHKaMeHT03Hoe ne'leHHe B cecTpHHcKOii npaKTHKe .. 269
nOp5lAOK BblnHCblBaHHSI 101 nOllY4eHHSI
neKapCTBeHHblx Cpep,CTB ................................................. 269
nOpSiAOK xpaHeHHSI, }"/eTa neKapCTBeHHblX Cpep,CTB .............. 271
nOp5lAOK BblAa4H neKapCTBeHHbtX cpeACTB na4HeHTy............ 272
Hapy>KHblH nyrb BBeAeHHSI neKapCTBeHHblx cpeACTB: ............. 273
npOBUflO nOflb30BaHuR KOpMOHHblM uHzoflRmopoM
(60flflOH'IUKOM) .......................................... ............. 275
BBeaeHue fleKopcmBeHHblxcpeacmB B Zfl030,HOC,yWU 276
napeHTepallbHblH nyrb BBeAeHHSllleKapCTBeHHblx cpeAcTB.... 282
OCflo:J/CHeHuR npu nopeHmepoflbHoM npuMeHeHuu
fleKopcmBeHHblxcpeacmB............................. ........... 282
nOMOU4b npu OHocpUflOKmU'IeCKOM WOKe ...................... 284
Ho60p fleKopcmBeHHozo pocmBopo U3 oMnYflbl
:i:.7:E:::::::::::::::::::::::::::::::::::::::::::::: :;
Oc06eHHocmu npuMeHeHuR UHCyflUHO.......................... 292
: :: : : ;: :::::::::::::::::::::::::::::::::::::::::::::: ::::::
Oc06eHHocmu npuMeHeHuR zenopuHo .......................... 297
BHympuMblwe'lHoR uHbeKu,UR........................................ 295
Poc'lem, p03BeaeHue U f3f3eaeHue oHmu6uomuKoB
BHympuMbiWe'lHO .............................. ........... ........... 301
Oc06eHHocmu npuMeHeHuR 6UU,UflflUHO ....................... 304
Oc06eHHocmu BBeaeHuR MOCflRHblX pocmBopoB ........ 304
BHympuBeHHoR uHbeKu,UR ............................................. 305
BHympuBeHHoe KoneflbHoe f3f3eaeHue :J/CUaKocmeu ...... 307
Oc06eHHocmu npuMeHeHURCepae'lHblX ZflUK03UaoB .... 310
6.3. I1H'IHaR rHrHeHa naqHeHTa ........................................ 311
CMeHa nOCTellbHoro 101 HaTellbHoro 6ellbSl ........................... 311
YxoA 3a KO>KeH ................................................................... 314
YXOA 101 npocpHllaKTHKa npOlle>KHeH ...................................... 314
T :.:::..:::::::::. :: : ::::.::::::::::::::: ::::::: ::: !
nOAMblBaHHe >KeHIlIHHbl B nOCTellH ...................................... 327
= : ::; : :.:::::::::::::::::::::::::::::::::::::::::::::::::::::::
MblTbe Hor B nOCTellH TroKell060llbHOMY .............................. 330
6.4. MeToAbl npocTeiiweii cIIM3HoTepanHM ........................ 331
nOCTaHoBKa 6aHOK .............................................................. 331
nOCTaHoBKa corpeBalOllIero KOMnpecca ............................... 333
npHMeHeHHe rpellKH ........................................................... 335
50'
KOHmpOflb cmepUflbHocmu ........................................... 233
noazomoBKo nepeBR30'lHOZO MomepUOflO
aflRcmepHII H3au,uu ........ ......... ....................... ........... 234
YKfloaKo B cmepuflu3ou,uoHHble Kop06KU
nepeBf/30'lHOZO Momepuoflo ..................................... 235
l!efleBaR YKflOaKO
aflR HOKpblmuR cmepuflbHoZO cmOflO ...................... 237
Hap,eBaHHe cTepHllbHoro XaIIaTa ......................................... 240
HaKpblTHe CTepHllbHoro CTQlla ............................................ 241
nOAroToBKa K pa60Te cTepHllbHoro 1I0TKa
AIISI BblnOIlHeHHR MaHHnYll5l4HH co cTepHllbHblMH
npeAMeTaMH MeAH4HHCKoro Ha3Ha4eHH5I ........................ 242
5.2. 06eCne'leHHe 6e30nacHocTH naqHeHTa
H MeAHqHHcKoii cecTpbl ............................. ................. 243
nOHSlTHe lIe4e6HD-OXpaHHTe/lbHOrO pe>KHMa,
ero 3IIeMeHTbl. 3Ha4eHHe ................................................ 243
BHAbl pe>KHMOB ABHraTenbHOH aKTHBHOCTH .......................... 245
BHAbl nOIlO>KeHHSI na4HeHTa B nOCTellH ................................ 245
Eie30naCHa51 TpaHcnopTHpoBKa na4HeHTa
Ha KaTallKe, KpeCIle-KaTaIIKe. Ha HOCHIIKax, Ha PYKax ......... 246
a>YHK4HOHallbHaSI KpOBaTb ................................................... 248
Y Aep>KHBaHH5I. nOMOlllb npH xOAb6e, nepeMell.leHHSI
101 pa3MellleHHSI na4HeHTa B nOCTellH ............................... 250
a>aKTopbl pHcKa B pa60Te MeAceCTpbl.................................. 261
500
npHMeHeHHe nY3blpSi co nbAOM .......................................... 337
nOCTaHOBKa rop4H4HHKOB .................................................... 340
OKcHreHoTepanHJ'1 .......... ................................ .......... ............ 342
nOAa4a YBIla>KHeHHoro KHcllopoAa 4epe3 HOCOBOH KaTeTep . 342
nOAa4a YBIla>KHeHHoro KHCIIOpOAa
1013 KHCIIOpOAHOH nOAYWKH ............................................. 344
r HpYAOTepanHSI ................................ ........ ..... ................. ..... 346
npHMeHeHHe xonoAHoH npHM04KH ...................................... 349
6.5. TepMoMeTpHR. YXOA npH nHxopaAKe ......................... 350
T eMneparypa Tella 101 ee H3MepeHHe ..................................... 350
1-13MepeHHe TE'Mneparypbl Tella B nOAMbIWe4HOH 06naCTH ..... 354
PerHcTpa4 H SI p,aHHbIX TepMoMeTpHH ..................................... 356
nOMOUJ,b npH rHnepTepMHH (nHxopap,Ke) .............................. 357
6.6. nHTaHHe H KopMneHHe naqHeHTa .............................. 359
OCHoBHble npHH4Hnbi ne4e6Horo nHTaHHSI........................... 366
Pe)l(l1M nHTaHHSI................................................................... 368
OpraHH3a4HR nHTaHHSI......................................................... 368
I-1cKycCTBeHHoe nHTaHHe ...................................................... 369
KopMlleHHe na4HeHTa 4epe3 Ha30raCTpallbHblH 30HA ............ 369
CocTaBneHHe nop4HoHHoro Tpe60BaHHSI Ha nHUJ,e6noK ........ 372
COCTaBlleHHe nop4HOHHoro Tpe60BaHHSI Ha pa3AaT04HYIO.... 373
Pa3Aa4a nHUJ,H .................................................................... 374
nllaHHpoBaHHe Heo6xoAHMOH nOMOUJ,H na4HeHry
npH B03HHKHOBeHHH np0611eM, CBSl3aHHbiX C KopMlleHHeM 375
nOMOUJ,b BO BpeMSI npHeMa nHUJ,H ........................................ 375
KopMlleHHe TSl>Kell060nbHbix ............................................... 376
CaHHTapHo-rHrHeHH4eCKM y60PKa nHUJ,e6110Ka
101 6ycpeTHbix B OTAelleHHSlX cTa4HOHapa .......................... 377
KOHTpOllb 3a noceUJ,eHHeM na4HeHTOB
101 nepeAa4eH npOAYKTOB ..........................................._.... 377
KOHTPOllb 3a caHHTapHblM COCTOSlHHeM ryM604eK,
XOIIOAHllbHHKOB, CpOKOM xpaHeH SI nHUJ,eBbiX npOAYKTOB . 378
XapaKTepHCTHKa lIe4e6Hblx AHeT .......................................... 379
6.7. KnH3Mbl. fa30oTBoAHaR Tpy6Ka ................................. 388
04HcTHTellbHaJ'1 KllH3Ma ....................................................... 388
CHcpoHHaJ'1 KllH3Ma .............................................................. 392
r HnepToHH4eCKaSI KllH3Ma .................................................... 394
MaCIIJ'1HaJ'1 KllH3Ma ............................................................... 396
KanellbHaSI KllH3Ma .............................................................. 398
r a300TBOAHaSI Tpy6Ka .......................................................... 401
502
6.8. KaTeTepH3aqHR MO'IeBOrO nY3blPR ............................. 402
npoBepKa npoxo>K,D.eHHSI KaTeTepa
npH BBeAeHHH ero B M04eBoH ny3blpb ............................ 404
:: :::: ::::: : :::::.:::::::::::::::::::::::::::::::::::::::::::::: :g
YxoP, 3a npOMe)l(HOCTblO na4HeHTa (na4HeHTKH)
C M04eBbiM KarerepoM .................................................... 410
69 MaHHnynRlIHH CBR3aHHbie C YXOAOM 3a CTOMaMH .... 411
. YXOJl 3a mU-lHeHT M C raCTpoCToMOH ................................... 411
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