hospital training project

Hospital training project

AtJeevan Deep Hospital, Bhadohi

Under the guidance of Mr.A. K. Gupta

Submitted By;-Manish KumarSahu

Roll Number ; 1465750055

B.pharma 3rd year

Department of PharmacyKrishanarpit institute of pharmacy ,Allahabad

krishanarpit institute of pharmacy


2016-2017

CERTIFICATE

This is to certify that this project report entitled “……….Hospital Training Project……………..” submitted to Krishanarpit Institute of Pharmacy , Allahabad, is a bonafide record of work done by “…..Manish Kumar Sahu………” under my supervision from “…10/06/2016..” to “ ..25/07/2016”

SUPERVISOR Head of Department

Mr.Parjanya Kumar Shukla Mr. M. P. Singh Assistant Professor Associatant ProfessorKrishnarpit Institute of Pharmacy Krishnarpit Institute of Pharmacy

…………………………….EXTERNAL EXAMINER



Place- AllahabadDate- 25/07/2016

ACKNOWLEDGEMENT

It has my proud privileges to be attached to Jeevan Deep

Hospital,Bhadohi.A highly professionalized hospital with modern

outlook.I have learned a lot during my training duration of 45 days and

contain has been fortunate in getting and opportunity of working in this

hospital.

I would like to thanksMr. A. K. Gupta providing necessary training

facilities and guidance during entire period of my training.

I would to thanks Mr. A. K. GuptaWho helped me very much and all

trainees & staffs without whom support and guidance it was impossible for

me to complete the project successfully

Manish Kumar Sahu

Roll no. 1465750055



1 Object 12 Introduction 23 Emergency wards 3-84 General wards 8-105 Surgical wards 10-126 Injection room 13-157 Pathology reports 16-208 Diagnostic report 21-229 Dispensing section 23-2410 Conclusion 2511 Reference 26



Objective of Training

Hospital training is an observational oriented procedure in which a person is able

to learn practically from their theoretically knowledge.”

Hospital training provides practical knowledge to the student.

Hospital training helps to study closely the ground level problem regarding their

job profile.

Hospital training promotes an environment in which student are induced to adapt

themselves quickly to changed circumstances.

Training provides practical knowledge to the students.

Training puts the students in real life situation.

Training removes the hesitation of the student regarding their working skill and

personality development.

Training is mandatory as per A.I.C.T.E. and affiliating universities and pharmacy

council of India.

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INTRODUCTION

JeevanDeep hospital Bhadohi, which is popularly Hospital is about 1000 miters East from Bhadohi Railway Station situated in busy area of city, Indra Mill Chauraha, at Jaunpur road Bhadohi. Bhadohi is one of the ancient cities famous for Carpet City in the world the biggest carpet exporter. It is one of the oldest Pvt. Ltd. hospitals of the city more than 20 years, with advancement of technology and with increasing demand of health sector this hospital is keeping pace and fulfilling the demand of needy people. It is equipped with modern Lab facilities, ECG, 2D,ECHO, XRAY, ULTRASOUND 3D COLOR DOPLAR, 24 hours running blood bank with blood.

JEEVAN DEEP has General Medicine, Surgery (General as well as Laparoscopic), Gynecology, Pediatrics, Nephrology, Cardiology, Orthopedics, ENT, Dermatology, Neurology, Ophthalmology as OP departments. Other facilities include 24 hrscausality service with an attached OT, Trauma care, Dialysis center, computerized lab, ICU, PICU and NICU with isolation ward, 5 state of the art major OT’s, spacious general wards with adequate privacy, deluxe rooms, premium rooms and private rooms and a 24hrs ambulance service.

SECTION IN JEEVAN DEEPHOSPITAL :-1) OPD (Out Patient Department)2) Emergency wards3) General wards4) Surgical wards5) ICU (Intensive Care Unit)6) NICU (Nursery Intensive Care Unit) 7) Injection Room8) Pathology9) Dispensing10) Diagnostic center11) Operation Theater12) Blood Bank

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EMERGENCY WARDS:-

An emergency department(ED), also known as anaccident & emergencyDepartment (A&E),emergency room(ER )orcasualty department.

An emergency is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care.The emergencydepartments of most hospitals operate 24 hours a day, although staffing levels may be viridian attempt to reflect patient volume.

FIRSTAIDSFirst aid is the assistance given to any person suffering a sudden illness or injury, with care provided to preserve life, prevent the condition from worsening, and/or promote recovery.`Aims:-

The key aims of first aid can be summarized in three key points, sometimes known as 'the three P's

*.Preserve life: the overriding aim of all medical care, including first aid, is to save lives and minimize the threat of death

*.Prevent further harm: also Sometimes called prevent the condition from worsening, ordanger of further injury, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent.

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worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.

*.Promote recovery: first aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound.

Key Skills:-

In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of first aid, which focus on critical life-saving intervention, must be renderedbefore treatment of less serious injuries.

ABC stands for Airway, Breathing, and Circulation. The same mnemonicis used by all emergency health professionals. Attention must first bebrought to the air way to ensure it is clear. Obstruction(choking) is a life-threatening emergency.

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Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary. Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse

checks may be done on less serious patients.

Some organizations add a fourth step of "D" for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments, as required. Some organizations teach the same order of priority using the"3Bs":Breathing, Bleeding, and Bones(or "4Bs":Breathing, Bleeding, Burns, and Bones). While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of bothartificialrespirationandchest compressionsto someone who is not breathing and has no pulse, and theconsideration ofcervical spineinjuries when ensuring an open airway.

Preserving life:-

In to stay alive, all persons need to have an open airway—a clear passage where air can movein through themouthornosethrough thepharynxand down into the lungs, withoutobstruction.Consciouspeople will maintain their own airway automatically, but those who areunconscious (with aGCSof less than 8) may be unable to maintain a patent airway, as thepart of the brain which automatically controls breathing in normal situations may not befunctioning.

If the patient was breathing, a first aider would normally then place them intherecovery position, with the patient leant over on their side, which also has the effect ofclearing the tongue from the pharynx. It also avoids a common cause of death in unconsciouspatients, which is choking on regurgitated stomach contents.

The airway can also becomeblocked through a foreign object becoming lodged in the pharynx or larynx, commonlycalledchoking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as artificial breathing, the first aider would undertake what is probably the most recognized first aid procedure—cardiopulmonary resuscitation or CPR, which involves

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breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting recovery:-The first aider is also likely to be trained in dealing with injuriessuch as cuts, grazes or bone fracture. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Conditions that often require first aid:-Medical emergency

*.Altitude sickness, whichcan begin in susceptible people at altitudes as low as 5,000 feet, can cause potentiallyfatal welling of the brain or lungs.

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

*.Battlefieldfirst aid—Thisprotocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seeneither in the ‘traditional’ battlefield setting or in an area subject to damage by large-scaleweaponry, such as abombblast.

*.Bone fracture, a break in a bone initially treated bystabilizing the fracture with asplint.

*.Burns, which can result in damage to tissues and lossof body fluids throughthe burn site.

*.Cardiac Arrest, which will lead to death unless CPRpreferably combined with an AED, is started within minutes.There is often no time to wait forthe emergency services to arrive as 92 percent of people suffering a sudden cardiac arrestdie before reaching hospital according to the American Heart Association.

*.Choking, blockageof the airway which can quickly result in death due to lack ofoxygenif the patient’s tracheais not cleared, for example by theHeimlich maneuver.

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*.Heart attack, or inadequate blood flow to the bloodvessels supplying the heart muscle.

*.Heat stroke, also known as sunstroke orhyperthermia,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 whenthe victim has been unconscious, often causes major damage to body systems such asbrain,kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads topermanent disability. Emergency treatment involves rapid cooling of the patient

*.Hair Tourniquet, a condition where a hair or other thread becomes tied around a toe or fingertightly enough to cut off blood flow.

*.Heavy bleeding, treated by applying pressure (manually andlater with apressure bandage) to the wound site and elevating the limb ifpossible.

*.Hyperglycemia(diabetic coma) andHypoglycemia(insulin shock).*.Hypothermia, orExposure, occurs when a person’s core body temperature falls below 33.7 °C (92.6°F). Firstaid for a mildly hypothermic patient includes rewarming, which can be achieved by wrappingthe affected person in a blanket, and providing warm drinks, such as soup, and high energy food, such as chocolate. However, rewarming a severely hypothermic person could resulting a fatal arrhythmia, an irregular heart rhythm.*.Insect and animalbitesandstings.*.Joint dislocation.

*.Poisoning, which can occur by injection, inhalation, absorption, or ingestion

*.Seizures, or a malfunction in the electrical activity in the brain. Three typesof seizures include a grand mal (which usually features convulsions aswell as temporaryrespiratory abnormalities, change in skin complexion, etc.) and petit mal (which usuallyfeatures twitching, rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratoryabnormalities).

*.Muscle strains and Sprains, a temporarydislocationof ajointthat immediatelyreduces automatically but may result in ligament damage.

*.Stroke,a temporary loss of bloodsupply to the brain.

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*.Toothache, which can result in severe pain and loss of the tooth but isRarelylife-threatening, unless over time the infection spreads into the bone of the jaw and Startsosteomelitis.

*Wound sand bleeding, Includinglacerations,incisionsandabrasions,Gastrointestinal bleeding,avulsionsandSuckingchest wounds, treated with anocclusive dressingto let air out but not in.

GENERAL WARDS:-

A general ward is a large room in a hospital where people who need medical treatment stay general in the wards.

Intravenous simple mean within vein.therapies administered intravenously are often included in the designation of specialty drugs .Intravenous infusions are commonly referred to as drips because many system administration employ to a drip, which prevent air from entering the blood stream and allows as estimation of flow rate .Intravenous therapy may be used to correct electrolyte imbalance, to deliver medication, for blood transfusion are as a fluid replacement to correct,for example dehydration intravenous therapy can also be used for chemotherapy.

Compare with other route of administration, the intravenous route is the fastest way to deliver fluids and medication throughout the body. Thebioabilability of the medication is 100% in IV therapy .

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During intravenous therapy,it use are as follows:-i) Administration of drips

ii) Administration of cannula

iii) Administration of injection

iv) Measurement of blood pressure and temperature

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v) provides oxygen

SURGIACL WARDS:-

Surgical wards contain diffent types injured patients, accidental patient ,etc

Surgical wounds can be classified as follows:CleanClean contaminated: a wound involving normal but colonized tissueContaminated: a wound containing foreign or infected materialInfected: a wound with pus present.Close clean wounds immediately to allow healing by primary intentionDo not close contaminated and infected wounds, but leave them open toheal by secondary intentionIn treating clean contaminated wounds and clean wounds that are morethan six hours old, manage with surgical toilet, leave open and then close48 hours later. This is delayed primary closure.

Dressing techniques

The following dressing techniques are easy to do and require no sophisticated equipment. Clean technique is usually sufficient. Pain medication may be required as dressing changes can be painful. Gently cleanse the wound at the time of dressing change.

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A.Wet-to-dry

Indication: to clean a dirty or infected wound.

Technique: Moisten a piece of gauze with solution and squeeze out the excess fluid. The gauze should be damp, not soaking wet. Open the gauze Photo A and place it over top of the wound to cover it Photo B. You do not need many layers of wet gauze. Place a dry dressing overtop. The dressing is allowed to dry out and when it is removed itpulls off the debris. It’s ok to moisten the dressing if it is too stuck.

How often: Ideally, 3-4 times per day. More often on a wound in need of debridement, less often on a cleaner wound. When the wound is clean, change to a wet-to-wet dressing or an antibiotic ointment.

B. Wet-to-wet

Indication: to keep a clean wound clean and prevent build-up of exudates.

Technique: Moisten a piece of gauze with solution and just barely squeeze out the excess fluid so it’s not soaking wet. Open the gauze and place it overtop of the wound to cover it. Place a dry dressing overtop. The gauze should not be allowed to dry or stick to the wound.

How often: Ideally, 2-3 times a day. If the dressing gets too dry, poor saline over the gauze to keep it moist.

C. Antibiotic ointment

Indication: Antibiotic ointment is used to keep a clean wound clean and promote healing.

Technique: apply ointment to the wound- not a thick layer, just a thin layer is enough. Cover with dry gauze.

How often: 1-2 times per day.

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D. When to do which dressing

Remember, the goal is to promote healing. We know that a moist environment facilitates healing.

For a clean wound, it is best to use a wet-to-wet or ointment based dressing For a wound in need of debridement the wet-to-dry technique should be done

until the wound is clean and then change to a different dressing regimen.

Sharp Debridement

When a wound is covered with black, dead tissue or thick gray/green debris, dressings alone may be inadequate. Surgical removal- sharp debridement– is necessary to remove the dead tissue to allow healing.

Technique:-

Sedation or general anesthesia may be required. However, usually the dead tissue has no sensation, so debridement may be done at the bedside or in the outpatient setting.

Photos A & B: Using a forceps, grasp the edge of the dead tissue and use a knife or sharp scissors to cut it off of the underlying wound.

Bleeding tissue is healthy, so cut away the dead stuff until you get to a bleeding base.

The patient may only tolerate this for a short period of time. Additionally, you don’t want to cut off tissue that may be viable. So, you may have to do this a little at a time, and repeat this procedure as needed until all of the necrotic tissue has been removed.

Photo C shows the wound after three weeks of wet-to-dry dressings.

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INJECTION ROOM:-

In a word, an injecting room is a place where drug users can inject narcotic substances in a supervised environment withoutrisking police interference. But services provided by injecting rooms can also be expanded to include hygiene-enhancing information,offering clean injection equipment, the presence of trained health workers and injection advice. When the setting up of injecting rooms is discussed in Norway,what is meant is specially outfitted rooms either standing alone or as part of a wider activity and/or care service for drug users, where heroin users can inject under the supervision of trained health staff and where guidance and advice is readily available. ‘Health room’ may therefore be a more apt designation of the possible future function of this initiative, and, in the Norwegian debate, the two names are used more or less in equal measure. One essential precondition underlying the establishment of injecting/ health rooms is that the people who make use of them shall avoid risk apprehension by police authorities in connection with the injection process (possession and use of drugs).

FIG;-different route of injection

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INTRAVASCULAR:- ( IV , IA )

Placing a drug directly into blood stream;-May be intravenous (into a vein) or intra-arterial (into an artery).Drug solution in injected directly into the lumen of a vein so that it is diluted in the venous blood. The drug is carried to the Heart and circulated to the tissues. Drugs in oily vehicle or those that cause haemolysis should not be given by this route.Since the drug is introduced directly into blood, the desired concentration of the drug is achieved immediately which is not possible by any other procedure. This route is of prime importance in emergency. Also certain irritant drugs could be given by this route.

Also this is the only route for giving large volume of drugs e.g. blood transfusion

fig; intravenous injection in vein

Advantages: precise, accurate and immediate onset of action ,100% bioavailability

Disadvantages: risk of embolism, high concentration attained rapidly leading to greater ,risk of adverse effect.

INTRAMASCULAR:-( into the skeletal muscle )(I.M.)

In humans, the best site is deltoid muscle in the shoulder or the gluteus muscle in the buttocks. This method is suitable for the irritating substances that cannot be given by subcutaneous route.

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Fig:-intramascularinjection in deltoid and gluteal muscles

The speed of absorption from site of injection is dependent on the vehicle used, absorption is quick from aqueous solutions and slow from oily preparations. Absorption is complete, predictable and faster than subcutaneous route.

Advantages:-

- Suitable for injection of drug in aqueous solution ( rapid action) and drug in suspension or emulsion (sustained release )

Disadvantages:-

- -pain at the site of injection

SUBCUTANEOUS ROUTES:-( Under the skin)

The drug is dissolved in a small volume of vehicle and injected beneath the skin from where the absorption is slow and uniform. Substances causing irritation to the tissues should not be injected otherwise they will cause pain and necrosis (deadening of tissues) at the site of injection.

This method is particularly useful when continuous presence of the drug in the tissues is needed over a long period. The usefulness of this method is enhanced by the use of depot preparations from which the drug is released more slowly than it is from simple solution rosis (deadening of tissues) at the site of injection. e.g. insulin

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INTRADERAMAL ROUTE:-(into the skin )

Drug are injected into papillary layer of skin. For example tuberculin injection for mantoux test and BCG vaccination for active immunization against tuberculosis.BCG: Bacillus-Calmette-Guerin

INTRATHECAL ROUTE:-(into the spinal canal )

Blood brain barrier often prevents the entry of certain drugs into the central nervous system.Also the blood CSF barrier prevents the approach of drugs to the meninges. Thus when local and rapid effects of drugs on meninges are desired the drugs are injected into Subarachnoid (between arachnoidsmaterandpiamater)space and effects of the drugs are then localized to the spinal nerves and meninges e.g. intrathecal injection of streptomycin in tuberculosis and meningitis used to be used by this route but with the invention of third generation cephalosporin’s it is not used any more to treat these conditions. The injection of local anesthetics for the induction of spinal anesthesia is given by this route.(the three membranes covering the brain and spinal cord from outside to inward are Duramater, arachnoids mater and piamater) e.g. sinal anesthetics

INTRAPERITONEAL ROUTE:-( into the peritoneum cavity)

The peritoneum offers a large absorbing surface area from which drugs enter circulation rapidly but primarily by way of portal vein. Hence First-Pass effect not avoided. This is probably the most widely used route of drug administration in laboratory animals. In human, it is very rarely employed due to the dangers of infection and injury to viscera and blood vessels. e.g. peritoneal dialysis in case of renal insufficiency.

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PATHOLOGYPathology is the branch of medical science primarilyconcecerning the examination of organ, tissue and bodily fluids in order to make a diagnosis of disease.

Hospital pathology concerns the laboratory analysis of blood, urine and tissue sample to examine and diagnose disease.typically ,laboratories will process samples and provides result concerning blood counts, blood clotting ability or urines electrolytes.

In Pathology Lab , Blood Test Report:-

Blood tests allow a doctor to see a detailed analysis of any disease markers, the nutrients and waste products in your blood as well as how various organs (e.g., kidneys and liver) are functioning. Below, I’ve explained some of the commonly measured indicators of health. During a physical examination, your doctor will often draw blood for chemistry and complete blood count (CBC) tests as well as a lipid profile, which measures cholesterol andrelated elements. Here is a brief explanation of the abbreviations used in measurements followed by descriptions of several common test components.

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Deciphering Blood TestMeasurements:-

Blood tests use the metric measurement system andabbreviations such as the following:-

cmm-----------------cells per cubic millimeter fL (femtoliter)-----fraction ofone-millionth of a liter g/dL-----------------grams per deciliter IU/L-----------------international units per liter mEq/L---------------mille equivalent per liter mg/dL----------------milligrams per deciliter mL--------------------milliliter mmol/L--------------mill moles per liter ng/m------------------Lnanograms per milliliter pg(Pico grams)-------one-trillionth of a gram

Complete Blood Count (CBC):-The CBC test examines cellular elements in the blood, includingred blood cells, various white blood cells, and platelets. Here is a list of the components thatare normally measured, along with typical values. If your doctor says you’re fine butyourtests results are somewhat different from the range shownhere, don’t be alarmed.Some labs interpret test results a bit differently from others, so don’t consider thesefigures absolutes.WBC (white blood cell) leukocyte count Normal range: 4,300 to 10,800cm White blood cells help fight infections, so a high white blood cell count could be helpfulfor identifying infections. It may also indicate leukemia, which can cause an increase in thenumber of white blood cells. On the other hand, too few white blood cells could be caused by certain medications or health disorders.WBC (white blood cell) differential countNormalrange:

Neutrophils ------40% to 60% of the total Lymphocytes ----20% to 40% Monocytes--------2% to8% Eosinophils ------1% to 4% Basophils---------0.5% to 1%

This test measures the numbers,shapes, andsizes of various types of white blood cells listed above. The WBC differential count also showsif the numbers of different cells are in proper proportion to each other. Irregularities inthis test could signal an infection, inflammation, autoimmune disorders, anemia, or otherhealth concerns.

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RBC (red blood cell) erythrocyte countNormal range: 4.2 to 5.9 million cm ,We have millions of red blood cells in our bodies, and this test measures the number ofRBCs ina specific amount of blood. It helps us determine the total number of RBCs and givesus an idea of their lifespan, but it does not indicate where problems originate. So if thereare irregularities, other tests will be required.Hematocrit (Hct)Normal range: 45% to 52% for men; 37% to 48% for womenUseful for diagnosing anemia, this test determines how muchof the total blood volume in the body consists of RBC Hemoglobin (Hgb)Normalrange:

13 to 18 g/dL for men 12 to 16 g/dL for women

Red blood cells contain hemoglobin,which makes blood bright red. More importantly, hemoglobin delivers oxygen fromthe lungs tothe entire body; then it returns to the lungs with carbon dioxide, which we exhale. Healthyhemoglobin levels vary by gender. Low levelsof hemoglobin may indicate anemia.

Mean corpuscular volume (MCV)Normal range: 80 to 100 femtolittersThis test measures the averagevolume of red blood cells, or the average amount of space each red blood cell fills.Irregularities could indicate anemia and/or chronic fatigue syndrome.

Mean corpuscularhemoglobin (MCH)Normal range: 27 to 32 PicogramsThis test measures the average amountof hemoglobin in the typical red blood cell. Results that are too high could signal anemia,while those too low may indicate a nutritional deficiency.

Mean corpuscular hemoglobinconcentration (MCHC)Normal range: 28% to 36%The MCHC test reports the averageconcentration of hemoglobin in a specific amount of red blood cells. Here again, we arelooking for indications ofanemia if the count is low, or possible nutritional deficiencies if it’shigh.

Red cell distribution width (RDW or RCDW)Normal range: 11% to 15%With this test, weget an idea ofthe shape and size of red blood cells. In this case, “width” refers to ameasurement of distribution, not the size of the cells. Liver disease, anemia, nutritionaldeficiencies, and a number of health conditions could cause high or low RDW results.

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PlateletcountNormal range:150,000 to 400,000 mLPlatelets are small portions of cells involved inblood clotting. Too many or too few platelets can affect clotting in different ways. Thenumber of platelets may also indicate a health condition.

Mean Platelet Volume (MPV)Normalrange: 7.5 to 11.5 femtolitersThis test measures and calculates the average size ofplatelets. Higher MPVs mean theplatelets are larger, which couldput an individual at risk fora heart attack or stroke. Lower MPVs indicate smaller platelets, meaning the person is atrisk for a bleeding disorder.

AST (aspartate aminotransferase)Healthy range:10 to 34 IU/LThis enzyme is found in heartand liver tissue, so elevations suggest problems may be occurring in one or both of thoseareas.

Bilirubin, Healthy range: 0.1 to 1.9 mg/dLThis provides information about liver andkidney functions, problems in bile ducts, and anemia.

BUN (blood urea nitrogen)Healthy range:10 to 20 mg/dL.This is another measure of kidney and liver functions. High values mayindicate a problem with kidney function. A number of medications and a diet high inproteincan also raise BUN levels.

BUN/ creatinine ratioHealthy ratio of BUN to creatinine: 10:1 to20:1 (men and older individuals may be a bithigher)This test shows if kidneys are eliminatingwaste properly. Highlevels of creatinine, a by-product of muscle contractions, are excretedthrough the kidneys and suggestreduced kidney function.

Calcium, Healthy range: 9.0 to 10.5mg/dL (the elderly typically score a bit lower)Too much calcium in the bloodstream couldindicate kidney problems; overly active thyroid or parathyroid glands; certain types ofcancer, including lymphoma; problems with the pancreas; or a deficiency of vitamin D.

Chloride, Healthy range: 98 to 106 mEq/LThis mineral is often measured as part of anelectrolyte panel. A high-salt diet and/or certain medications are often responsible forelevations in chloride. Excess chloride may indicate an overly acidic environment in the body.It alsocould be a red flag for dehydration, multiple myeloma, kidney disorders, or adrenalgland dysfunction.CreatinineHealthy range 0.5 to 1.1 mg/dL for women0.6 to 1.2 mg/dL formen (the elderly may be slightly lower)

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The kidneys process this waste product, so elevationscould indicate a problem with kidney function.

Fasting glucose (blood sugar), Healthy range: 70to 99 mg/dL for the average adult (the elderly tend to score higher even when they arehealthy)Blood sugar levels can be affected by food or beverages you have ingested recently,your current stress levels, medications you may be taking, and the time of day. Thefastingblood sugar test is done after at least 6 hours without food ordrink other thanwater.

Phosphorus, Healthy range: 2.4 to 4.1 mg/dLPhosphorus plays an important role in bonehealth and is related to calcium levels. Too much phosphorus could indicate a problem withkidneys or the parathyroid gland. Alcohol abuse, long-term antacid use, excessive intake ofdiuretics or vitamin D, and malnutrition can also elevate phosphorus levels.

Potassium, Healthyrange: 3.7 to 5.2 mEq/LThis mineral is essential for relaying nerve impulses, maintainingproper muscle functions, and regulating heartbeats. Diuretics, drugs that are often takenfor high blood pressure, can cause low levels of potassium.

Sodium, Healthy range: 135 to 145mEq/LAnother member of the electrolyte family, the mineral sodium helps your body balancewater levels and helps with nerve impulses and muscle contractions. Irregularities in sodiumlevels may indicate dehydration; disorders of the adrenal glands; excessive intakeof salt,corticosteroids, or pain-relieving medications; or problems with the liver or kidneys.

LipidPanel (or Lipid Profile), The lipid panel is a collection of tests measuring different typesofcholesterol and triglycerides (fats) in your bloodstream.

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DIAGNOSTIC REPORTA diagnostic report is the set of information that is typically provided by diagnostic service when investigations arecomplete. The information includes a mix of atomic result, text report, images and codes. The diagnostic report resources suitable for the following kinds of diagnostic reports;*laboratory (clinical chemistry,hematology, microbiology etc.)*pathology/histopathology*image investigation (x-ray CT,MRI etc.)*other diagnostics-cardiology.

REPORT-1 Jeevan Deep hospital, Bhadohi

Name of patient; Anand Gupta Ages:-19year Sex:-MaleRef. By ; Dr. A. K. Gupta Date…….HAEMATOLOGY REPORT

Report by;Dr………… ******* End of the report*****

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Report-2cheast x-ray

Report-3 ECG

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DRUGS DISPENSINGDrugs dispensing is often portrayed as merely being the process of giving a drug product to a patient in the hospital.

Dispensing procedure• Ensure that the prescription has the name and signature of theprescriber and the stamp of the health centre.• Ensure that the prescription is dated andhas the name of the patient.• If the prescription has not been written in a known (local)health centre, the prescriber of the centre should endorse it.• Avoid dispensing without aprescriptionor from an unauthorized prescriber.• Check the name of the prescribed drugagainst that of the container.• Check the expiration date on the container.• Calculatethe total cost of the drug tobe dispensed on the basis of the prescription whereapplicable.• Inform the patient about the cost of the drug.• Issue a receipt for allpayments.

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Dispensing prescriptions on part-paymentWhere a patient does not have enough money topay for all the drugs as prescribed, the dispenser is faced with adifficult situation.Consider the following scenario to resolve this situation:(a.) Cotrimoxazole 400/80 mg tab2 bd × 5 days(b.) Chloroquine 150 mg tab 4 stat, then 2 tab bd × 2/7• Either dispense allthe 20 tablets of cotrimoxazole or the 10 tablets of chloroquine as prescribed and insistthatthe patient completes the dose dispensed.• In case a patient is unable to pay for allthe prescribed drugs, go to the prescriber and ask which of the two drugs should bedispensed first.• Do not dispense a few tablets of cotrimoxazole and a few tablets ofchloroquineas the patient will not come back to complete the prescription if he feelsbetter.• When the temporary relief passes, the cotrimoxazole or chloroquine may notBeeffective again in that particular condition.

Guiding principles in dispensing on cash basis• Dispense drugs only on payment.• Do notgive free drugs to any person in the community, no matter what the person’s socialstanding.• Issue receipts for drugs sold.• Display a price list of drugs for transparencyand accountability, and tohelp patients crosscheck.

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CONCLUSION

The project Hospital Training is the working in a hospital. The process takes care of all the requirements of an average hospital and is capable to provide easy and effective storage of information related to patients that come up to the hospital.

It generates test reports; provide prescription details including various tests, diet advice, and medicines prescribed to patient and doctor. It also provides injection detail and billing facility on the basis of patient’s status whether it is an indoor or outdoor patient.

The system also provides the facility of backup as per the requirement. Patients who are non-local language speakers or come from migrant populations or ethnicminority groups often are not able to communicate effectively with their clinicians to receive complete information about their care. At the same time, clinical staff is oftennot able to understand the patients’ needs or to elicit other relevant information from the patient.

Professional interpreter services should be made available whenever necessary to ensure good communication between non-local language speakers and clinical staff.

The task force brings together practitioners, managers, scientists and community representatives with specific expertise and competence in policy-relevant knowledge in the field.

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REFRENCES1.âbc"Injection safety ".Health Topics A to Z. World Health Organization. Retrieved 2011-05-09.2.^David Healy. Psychiatric Drugs Explained: Page 19.3.Ûsichenko, TI; Pavlovic D; Foellner S; Wendt M. (2004). "Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study". Anesthesia and Analgesia99(3): 952–3.doi:4.^Thomas, AC; Wysocki, AB (February 1990)."The healing wound: a comparison of three clinically useful methods of measurement." .Decubitus3(1): 18–20, 24–5.PMID 2322408. Retrieved15 June2013.5.âbcFernandez R, Griffiths R, (15 February 2012). "Water for wound cleansing" .Cochrane Database of Systematic Reviews2: CD003861.doi:10.1002/14651858.CD003861.pub3.PMID 22336796.3.^Simple wound managementon patient.info website, viewed 2012-01-08 6.^Maton, Anthea; Jean Hopkins; Charles William McLaughlin; Susan Johnson; MaryannaQuonWarner; David LaHart; Jill D. Wright (1993).Human Biology and Health. Englewood Cliffs, NewJersey, USA: Prentice Hall.ISBN 0-13-981176-1.7.^Purves, William K.; Sadava, David; Orians,Gordon H.; Heller, H. Craig (2004).Life: The Science of Biology(7th ed.). Sunderland, Mass:SinauerAssociates.p. 954.ISBN 0-7167-9856-5.8. help to department of hospital staff

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