A

Report on

HOSPITAL TRAINING-II
by
TONI SHAH
(Roll. No. 1400450051)

Faculty of Pharmacy
RAJA BALWANT SINGH ENGINEERING TECHNICAL CAMPUS,
BICHPURI, AGRA

to the

DR. A.P.J. ABDUL KALAM TECHNICAL UNIVERSITY,LUCKNOW

December-2017
 ACKNOWLEDGMENT
I wish to express my heart full gratitude to my institution faculty of pharmacy Raja Balwant Singh
Engineering Technical Campus, Bichpuri,Agra.

I praise god, the almighty, merciful and passionate, for providing me this opportunity and granting me
the capability to proceed successfully.

The appear in its current form due to the assistance and Guidance of several people. I would like to
offer my sincere thanks to all.

First and for most I would like to thanks to Dr. Akhand Pratap Singh, Director, R.B.S. Engineering
Technical Campus Bichpuri agra Dr. N. K. Yadav, Dean Faculty of Pharmacy. Dr. V. K. Srivastava,
Head Incharge Faculty of Pharmacy. Dr. Pratima, Head of department Faculty of Pharmacy.

They gave me an excellence opportunity to learn the subjects. I express my sincere gratitude to all
those who have directly or indirectly helped me in the completion of project.

I am highly Indebted to MrSumit Kaushik, Dr.Shyamveer Singh and my other teaching staff which
includes respected Mr.Krishna Kumar Agrawal, Mr. Tripanshu Gupta, Mr. Amit Yadav, Ms. Jyoti
Verma, Ms. Pooja Bharti, and other respected faculty members.

Above all I am Thankful to my parents who are the foundation stone of the Platform on which I am
standing on.

My work is the result of their blessings and hardship.

ALPNA RATHAUR
CERTIFICATE
 Table of Contents

Sr. No. TOPIC PAGE NO.

1. Introduction 1-2
2. Introduction Of First Aid 3-5

3. Burn 6-8
4. Different Routes of Injection 9-10
5. Artificial Respiration 11-14
6. Dressing of Wounds 15-16
7. Study of Patient Observation Chart 16
8. Prescription 17
9. Dispensing 18
10. Simple Diagnostics Reports 19

11. Conclusion 20
 Introduction: -

Fig. 1 (Overview of Hospital)

Hospitals:-A hospital is a health care institution providing patient treatment with specialized staff
and equipment. The best known type of hospital is the general hospital which has an emergency
department .a district hospital typically is the major health care facility in its region, with large number
of beds for intensive care and long –term care. Specialised hospitals include trauma centres,
rehabilitation hospitals include trauma centres, rehabilitation hospitals, children`s hospitals, seniors
hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems and
certain disease categories. Specialized hospital can help reduce health care costs compared to general
hospitals. The medical 0facility similar than a hospital is generally cared a clinic. Hospitals have a
range of department e.g., surgery, and urgent care, specialist units such as cardiology .some hospitals
have outpatient departments and some chronic treatment units .common support units include a
pharmacy, pathology, and radiology. Hospitals consist of departments, traditionally called wards,
especially when they have beds for inpatients, when they are sometimes also called inpatient wards.
Hospitals may have acute services such as anemergency department or specialist trauma centre, burn
unit, surgery, or urgent care. These may then be backed up by more specialist units such as the
following:

 Emergency department

 Free Ambulance service (24*7)

 Paediatric intensive care unit

 Isolated Tuberculosis check-up centre

In addition, there is the department of nursing, often headed by a chief nursing officer or director of
nursing. This department is responsible for the administration of professional nursing practice,
research, and policy for the hospital. Nursing permit every part of a hospital. Many units or wards have
both a nursing and a medical director that serve as administrators for their respective disciplines within
that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for
the medical staff and medical care while the nursing manager/director for the intensive care nursery is
responsible for all of the nurses and nursing care in that unit/ward.

Some hospitals have outpatient departments and some have chronic treatment units such as
behavioural health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and
physical therapy.

Common support units include a dispensary or pharmacy, pathology, and radiology. On the
non-medical side, there often are medical records departments, release of information departments,
information management), clinical engineering, facilities management, plant ops (operations, also
known as maintenance), dining services, and security departments.

Layout of Hospital

Fig. 2 (Layout of hospital)

Introductionof First Aid
First aid is the assistance given to any person suffering a sudden illness or injurywith care provided to
preserve life, prevent the condition from worsening, and promote recovery. Altitude sickness, which
can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of
the brain or lungs.

Anaphylaxis, a life-threatening condition in which the airway can become constricted and the
patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such
as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.

Battlefield first aid—this protocol refers to treating shrapnel, gunshot wounds, burns, bone
fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by
large-scale weaponry, such as a bomb blast.

Cardiac Arrest, which will lead to death unless CPR preferably combined with an AED, is started
within minutes. There is often no time to wait for the emergency services to arrive as 92 % of people
suffering a sudden cardiac arrest die before reaching hospital according to the American Heart
Association.

 Heart attack or inadequate blood flow to the blood vessels supplying the heart muscle.

 Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy
exercise in high humidity, or with inadequate water, though it may occur spontaneously
in some chronically ill persons. Sunstroke, especially when the victim has been
unconscious, often causes major damage to body systems such as brain, kidney, liver,
gastric tract. Unconsciousness for more than two hours usually leads to permanent
disability. Emergency treatment involves rapid cooling of the patient.

 Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal

bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let
air out but not in.
Fig. 3 (First Aid Kit)

First Aid Treatment

Poisoning
 Poisons are substances that cause injury, illness or death.

 These events are caused by a chemical activity in the cells.

 Poisons can be injected, inhaled or swallowed.

 Poisoning should be suspected if the person is sick for unknown reason.

 Poor ventilation can aggravate inhalation poisoning.

 First aid is critical in saving the life of victims.

Causes medication , Overdose , Occupational exposure ,cleaning detergent/paints , carbon monoxide

gas from furnace , heaters , insecticides , certain cosmetics , certain household plant , animals , food
poisoning

SymptomsBlue lips , skin rashes , difficulty in breathing , diarrhoea , vomiting/nausea, fever ,

headache , giddiness/drowsiness , double vision , abdominal/chest pain , loss of appetite/bladder
control , numbness , muscle twitching , seizures , weakness , loss of consciousness.

Treatment
 Try and identify poison if possible.

 Check for signs like burns around mouth breathing difficult or vomiting.

 Induce vomiting if poison swallowed.

 In case of convulsions, protect the person from self-injury.

 If the vomit falls on the skin, wash it thoroughly.

 Position the on the left till medical help arrives.

For Inhalational Poisoning

 Seek immediate medical help.

 Get help before you attempt to recues others.

 Hold a wet cloth to cover your nose and mouth.

 Open all the doors and windows.

 Take deep breaths before you begin the rescue.

 Avoid lighting a match.

 Check the patient`s and breathing.

 Do a CPR if necessary.

 If the patient vomits, take steps to prevent choking.

Steps to Avoid
 Avoid giving an unconscious victim anything orally.

 Do not induce vomiting unless told by medical personnel.

 Do not give any medication to the victim unless directed by a doctor.

 Do not neutralize the poison with lime juice/honey.

Prevention
Store medicines cleaning detergents, mosquito repellents and paints carefully.

 Keep all potentially poisonous substance out of children`s reach.

 Label the poison in your house

 Avoid keeping poisonous plants in or around house. Take care while eating products such as
berries, roots or mushrooms

3. Different Routes of Injection

An injection is an infusion method of putting fluid into the body, usually with a syringe and a hollow
needle which is pierced through the skin to a sufficient depth for the material to be administered into
the body.

 Intramuscular injection

Fig.4 (Intramuscular Injection)

In an intramuscular injection, the medication is delivered directly into a muscle. Many vaccines are
administered intramuscularly. Intramuscular injections are administered by a trained medical
 professional; however, prescribed self-administered intramuscular injections are becoming more
common for patients who require these injections routinely.

Intravenous Injection

Fig. 5 (Intravenous Injection)

the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ, a
substance so forced or administered; in pharmacy, a solution of a medicament suitable for
injection.Immunizing substances, or inoculations, are generally given by injection. Some medicines
cannot be given by mouth because chemical action of the enzymes and digestive fluids would change
or reduce their effectiveness, or because they would be removed from the body too quickly to have any
effect

 Intra-peritoneal injection

Fig. 6 (Intra-peritoneal Injection )

Intra Peritoneal injection is the injection of a substance into the peritoneum (body cavity). Intra
Peritoneal injection is more often applied to animals than to humans. In general, it is preferred when
large amounts of blood replacement fluids are needed, or when low blood pressure or other problems
prevent the use of a suitable blood vessel for intravenous injection.
Artificial Respiration

Fig. 7 (Artificial Respiration)

Victims of electrical shocks, drowning, gas poisoning or choking have difficulty in breathing and may
stop breathing altogether. Artificial respiration could save their lives. Since most people die within 6
minutes after they stop breathing, artificial respiration should begin as soon as possible after the
breathing difficulty is noticed.

Methods of Artificial Respiration:-

There are three methods of artificial respiration:

1. Mouth-to-mouth/ Mouth-to-nose
2. Chest pressure arm lift (Sylvester)
3. Back pressure arm lift (Holder-Nielsen)

The most practical method is the mouth-to-mouth/nose method.

Step 1: Evaluation

1. Check for responsiveness of the victim.

2. Call for help.
3. Position the unconscious casualty so that he is lying on his back and on a firm surface. If the
casualty is lying on his chest (prone position), cautiously roll the casualty as a unit so that his
body does not twist (which may further complicate a neck, back or spinal injury).

Follow the following steps for rolling the victim:

1. Straighten the casualty's legs. Take the casualty's arm that is nearest to you and move it so that it is
straight and above his head. Repeat procedure for the other arm.
2. Kneel beside the casualty with your knees near his shoulders (leave space to roll his body). Place
one hand behind his head and neck for support. With your other hand, grasp the casualty under his
far arm (See Figure above).
3. Roll the casualty toward you using a steady and even pull. His head and neck should stay in line
with his back.
4. Return the casualty's arms to his side. Straighten his legs. Reposition yourself so that you are now
kneeling at the level of the casualty's shoulders. However, if a neck injury is suspected, and the jaw
thrust will be used, kneel at the casualty's head, looking toward his feet.

Step 2: Opening the Airway-Unconscious and Not Breathing Casualty:-

If there is any foreign matter visible in the victim's mouth, wipe it quickly with your fingers or cloth
wrapped around your fingers.

1. Tilt the Head back so the chin is pointing upwards. The victim should be flat on his back. Pull or
push the jaw into a jutting out position for removal of obstruction of the airway by moving the base
of tongue away from back of throat..

Fig. 9

Fig. 10

Fig. 11
 2. Open your mouth wide and place it tightly over the victim's mouth. At the same time pinch the
victim's nostrils shut or close with your cheek. Or close the victim's mouth and place your mouth
over the nose. Blow into the victim's mouth or nose. (Air may be blown through the victim's teeth,
even if they are clenched). The first blowing method should determine whether or not obstruction
exists.

3. Fig. 12

Fig.13

Remove your mouth; turn your head to side and listen for the return rush of the air that indicate air
exchange. Repeat the blowing effort.
For the adult blow vigorously at a rate of about 12 breaths per minute. For a child, take relatively
shallow breaths appropriate for the child's size, at a rate of about 20 per minute.

4. If the victim is not breathing out the air that you blew in, recheck the head and jaw position. If you
still do not get air exchange, quickly turn the victim on his side and hit him sharply between the
shoulder blades several times in hope of dislodging foreign matter. Again sweep you finger
through the victim's mouth to remove foreign matter.
If you do not wish to come in direct contact with person, you may hold a cloth over the victim's
mouth or nose and breathe through it. Cloth does not greatly affect the exchange of air.
5. After giving two breaths which cause the chest to rise, attempt to locate a pulse on the casualty. Feel
for a pulse on the side of the casualty's neck closest to you by placing the first two fingers (index
and middle fingers) of your hand on the groove beside the casualty's Adam's apple (carotid pulse).
(Your thumb should not be used for pulse taking because you may confuse your pulse beat with
that of the casualty.) Maintain the airway by keeping your other hand on the casualty's forehead.
Allow 5 to 10 seconds to determine if there is a pulse (See Figure).

Fig. 14

1. If a pulse is found and the casualty is breathing --STOP; allow the casualty to breathe on his
own. If possible, keep him warm and comfortable.
 2. If a pulse is found and the casualty is not breathing, continue rescue breathing.
3. If a pulse is not found, begin chest compression.
1. Expose chest and find breast bone. Put the heal of one hand on breast bone and other
hand on top.
2. Compress the chest 15 times.

Fig.15

If a pulse is not found, seek medically trained personnel for help.

For infants and small children

If there is any foreign matter visible in the victim's mouth, wipe it quickly with your fingers or cloth
wrapped around your fingers.

1. Place the child on his back and use the fingers of both hands to lift the lower jaw from beneath
and behind, so that it juts out.
2. Place your mouth over the child mouth and nose, making a relatively leak proof seal and
breathe into the child, using shallow puffs of air. The breathing rate should be about 20/minute.
If you meet resistance in your blowing efforts, recheck the position of the jaw. If the air
passages are still blocked, the child should be suspended momentarily by the ankles, or
inverted over the arm and given two or three sharp pats between the shoulder blades, in the
hope of dislodging obstructing matter.

Stopped breathing due to Suffocation

After the person starts breathing give few doses of Camphor Q directly in mouth which provides
instant relief.

DRESSING OF WOUNDS:-
 Fig.16
A dressing is used by a doctor, caregiver and/or patient to help a wound heal and prevent further
issues like infection or complications. Dressings are designed to be in direct contact with the wound,
which is different from a bandage that holds the dressing in place.
Dressings serve a variety of purposes depending on the type, severity and position of the wound. Aside
from the major function of reducing the risk of infection, dressings are also important to help:
 Stop bleeding and start clotting so the wound can heal
 Absorb any excess blood, plasma or other fluids

Background
There are a number of different dressings and techniques available for managing wounds. The majority
of wounds in children are acute trauma or surgical wounds.

Objectives of wound dressing

 to reduce pain.
 to apply compression for haemorrhage or venous stasis.
 to immobilise an injured body part.
 to protect the wound and surrounding tissue.
 to promote moist wound healing.

Assessment:-
Elicit a careful history of injury

 mechanism of injury; associated blood loss; risk of contamination; deeper structure damage;
 tetanus status;
 consider Non accidentalInjury;
 Underlying chronic illness or disability.

Fully examine the injured part in particular checking for

 Underlying nerve, vessel and tendon damage. This requires assessment of movement while
exploring the wound (especially in palmer or hand wounds).
 Assess tissue damage or loss
Investigation:-
Request special investigations where appropriate

 x-ray for radiopaque foreign body or underlying fracture

 Ultrasound is useful for puncture wounds with a radiolucent foreign body such as thorn or
splinter.

Consider referral for plastic or general surgical opinion either in ED or as outpatient

Management:-

 Anaesthesia - see Analgesia and sedation guideline

 Cleansing - see Laceration guideline
 Wound closure - see Laceration guideline
 Dressing: in general keep dressings as simple as possibl

Study Of Patient Observation Chart:-

Fig. 17

Observation and Response Charts:-

Monitoring and documenting physiological observations is a key component of recognition and
response systems. An observation and response chart is a document that allows the recording of patient
observations, and specifies the actions to be taken in response to deterioration from the norm. The
purpose of these charts is to support accurate and timely recognition of clinical deterioration, and
prompt action when deterioration is observed. The way in which observation charts are designed and
used can contribute to both the poor recording of observations and failure to interpret them correctly.
 Prescription:-

Fig. 19

A prescription is a health-care program implemented by a physician or other qualified practitioner in

the form of instructions that govern the plan of care for an individual patient. A qualified practitioner
might be a physician, physician assistant, dentist, nurse practitioner, pharmacist, psychologist, or other
health care provider. Prescriptions may include orders to be performed by a patient, caretaker, nurse,
pharmacist, physician, other therapist, or by automated equipment, such as an intravenous infusion
pump. Formerly, prescriptions often included detailed instructions regarding compounding of
medications but as medications have increasingly become pre-packaged manufactured products, the
term "prescription" now usually refers to an order that a pharmacist dispense and that a patient take
certain medications. Prescriptions have legal implications, as they may indicate that the prescriber
takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and
safety.

Dispensing:-

Fig. 19

Dispensing: Dispensing includes the preparation and transfer of a medication for a client, taking steps
to ensure the pharmaceutical and therapeutic suitability of the medication for its intended use, and
taking steps to ensure its proper use.

It may also include accepting payment for a medication on behalf of a nurse's employer.

Dispensing occurs when the nurse gives medication to a client or their delegate for administration at a
later time. Examples of dispensing include when

The client is leaving the facility on a day pass and needs their medication while away;

The client is being discharged from the emergency department and needs medication started.

When taking steps to ensure proper use, nurses

Label the medication legibly with

Client’s name;
Medication name, dosage, route, and (where appropriate) strength;

Directions for use;

Quantity dispensed;

Date dispensed;

Initials of the nurse dispensing the medication and the name, address, and telephone number of the
agency from which the medication is dispensed.

Dosage regime, expected benefits, potential side effects, storage requirements and instructions required
to achieve a therapeutic response In recent times, the scope of pharmacy practice has extended beyond
the supply of medicines to include a range of professional health services such as medicine reviews,
chronic disease management and wound management support. Many pharmacies also provide
preventive health services including smoking cessation and weight management support. However, the
traditional dispensing of prescribed medicines still remains the important priority for most
pharmacists. As a complete process, dispensing requires the professional and clinical review by a
pharmacist. Some steps in the dispensing process can be completed by appropriately trained pharmacy
assistants under direct pharmacist supervision. Counselling is an essential element of the dispensing
process, ensuring patients or their careers have sufficient information to enable an understanding of
their medicines and the intended therapeutic effect, and to minimise the risk of adverse effects. As a
result of dispensing, patients or their carers should: receive clearly and correctly labelled medicines
understand how and when to use the prescribedmedicines understand how to store the medicines
have access to a pharmacist for professional counselling or advice The flow-chart on the following
page demonstrates that there is more to the dispensing process than stick.

SimpleDiagnostics Reports
`A diagnostic report is the set of information that is typically provided by a diagnostic service when
investigations are complete. The information includes a mix of atomic results, text reports, images, and
codes.

•Laboratory (Clinical Chemistry, Haematology, Microbiology, etc.)

•Pathology / Histopathology / related disciplines

•Imaging Investigations (x-ray, CT, MRI etc.)

•Other diagnostics - Cardiology, Gastroenterology etc.

CBC PATHOLOGY REPORT

 Fig.21

Fig. 22 (Blood Test Report)

Fig. 23 (X-Ray)
 Fig. 24 (MRI Scan)

Fig. 25 (CT Scan)

CONCLUSION
I would like to add the people those who helped me in my report my teachers and other
peoples.

I would like to conclude as I came to know about various kinds of measures on how we can
treat them and various machines which are used to treat our various internal problems.

I gather knowledge on how to study various diagnostic reports and then how to proceed the
upcoming treatment through the reports.

I came to know about various dispensing methods and how to dispense medicines from
pharmacy store present in the hospital.