Nursing Assistant - Integrated Project 2020-1

TCAE Integrated Project - Course 2019/2020 Antonio Manuel Villamor Galván
INDEX
Block 1 - Introduction P. 5
1.1 Presentation of the integrated project P. 5
1.2 Hospitales Universitarios Virgen del Rocío: Hospitals that compose it P. 5
1.3 Objectives and functions of the Hospital P. 9
Block 2 - Plant Infrastructure and Technical Organization P. 24

2.1
Enumeration and description of the elements that make up the patient unit.
P. 25
2.2 Types of warehouses and operation: Organization of materials and
warehouse personnel P. 26
2.3 Explanation of the order procurement system used in the plant: Difference
between standard and express system. P. 24
2.4 Documentation used in the different nursing care and management
activities, highlighting those corresponding to the T.C.A.A.E. P. 27
Block 3 - Plant Assistance Activities P. 30

3.1 Specialties and main pathologies of the plant P. 30
3.2 User typology: gender, age, origin, lifestyle, ... P. 30
3.3 Staffing and shift organization P. 31
3.4 Tasks: standardized activities differentiated by shifts P. 31
3.5 Protocols of the most frequent nursing techniques: 3 different types P. 32
Block 4 - Patient Follow-up P. 37

4.1 Brief introduction to the medical record P. 37
4.2 Explanation of the pathology and treatments administered. P. 38
4.3
Nursing care applied to the patient from the point of view of basic needs.
P. 38
4.4 Personal assessment of follow-up P. 41
Block 5 - Sterilization Services (section not yet required by the tutor) P.
Block 6 - Assessment and Evaluation P. 42

6.1 From each plant P. 42
6.2 Learning achieved P. 42
1
pg. 3
6.3 Relationship with the healthcare team P. 42

6.4 Observed treatment of patients and family members P. 42
Block 7 - Annexes P. 43
7.1 Bibliography and references P. 43
7.2 Vocabulary with 30 medical terms P. 43
7.3 Supplementary documentation P. 45
Acknowledgments P. 47
p. 5
BLOCK 1 - INTRODUCTION
1.1 Presentation of the integrated project
The purpose of this project is the culmination of the studies carried out during 2 years in the I.E.S.
Punta del Verde, with the purpose of obtaining the regulated qualification of T.C.A.E.
Once the theoretical part is completed, the final part of the course is dedicated to the realization of an
internship in a work environment, which in my case has been carried out in the "Hospital
Universitario Virgen del Rocio", in the "2nd Floor, 2nd Control North area of Internal Medicine".
This is intended not only to project to your colleagues and yourself everything we have learned
throughout the course, but also to reaffirm whether this is the branch to which we want to devote
ourselves, if we have enough empathy to deal with users and their families, as well as to see now
that we have the most recent studies, what are the possible failures we see in the older staff, so as not
to fall into the same, in addition to other aspects.We can also see now that we have the most recent
studies, what are the possible failures we see in the older staff, so as not to fall into the same, in
addition to other aspects.
Likewise, at the end of this project I will reflect my personal evaluation of the whole experience
from a global point of view, which will help you to generate your own evaluation. The points we
will address throughout the project are as follows:
• History of the Virgen del Rocío University Hospital

• Buildings that form it
• The types of assistance offered and their objectives
• Infrastructure and plant organization
• The patient unit
• Warehouse types
• Types of orders
• Documentation used in all care activities
• Specialty of plant and personnel
• Follow-up of a patient
• Assessment and evaluation
• Annexes
1.2 Hospitales Universitarios Virgen del Rocío: Hospitals that compose it
History of the Hospital
The General Hospital was inaugurated on January 22, 1955, which means that it has been attending
patients for more than half a century and has been training residents for more than half of that time.
From 1938 to 1963, the stage known as the harmonization and development of "Social Security"
took place in our country, with the creation of the "Compulsory Health Insurance" (S.O.E.), the
mutual insurance companies, the "Institute of Medicine and Hygiene at Work", etc. Between the
general regime and the special regimes of the Social Security, a high percentage of the population
became beneficiaries of the health services of the "Seguro de Enfermedad" (Sickness Insurance).
In order to meet the needs of the insured with their own means, a series of hospitals were built
p. 6
throughout the country, which became known as "Residencias Sanitarias", to differentiate them from
the "Centros Sanitarios de Internamiento de la Beneficencia" called "Hospitales". The "Residences"
were also called "Closed Institutions", which differed from the "Open Institutions" (clinics and
outpatient clinics) because of the closed regime of internment (hospitalization) in which the patients
were treated. They were generally located in the capitals of each province. The one in our city was
located in the southern area, on the grounds of the old 1929 Exposition.
The center was called "Residencia García Morato" until 1984, when it was renamed "Hospital
General" (HG). It had eleven floors and 690 beds, assigned to Internal Medicine, Surgery and
Specialties, Gynecology and Pediatrics. Subsequently, coinciding with the progressive increase in
demand, which exceeded the hospital's capacity, new centers were built and incorporated.
On June 16, 1968, the "Hospital de Rehabilitación y Traumatología" (HRT) was inaugurated, with
325 beds and new specialties. Since the start-up of this second hospital, the complex has been called
"Ciudad Sanitaria Virgen del Rocío". Other services were added, such as the "School of Nurses"
(interns) located in the current "Laboratory Building".
He soon had postgraduate MIR training. The first graduating class joined on May 2, 1969 and
consisted of 24 interns, some of whom are still active.
Then the "Maternal Hospital" was built, inaugurated on April 16, 1971, with 356 beds and the
"Children's Hospital", inaugurated on May 1, 1971, with 352 beds. It has buildings such as a thermal
power plant, laundry and warehouses. Subsequently, the "Centro de Diagnóstico y Tratamiento"
(CDT) and "Anatomía Patológica" (AP) buildings were built and opened on February 1, 1978.
Since 1986, as a result of the decree regulating hospitals and their governing bodies published that
year, the "Ciudad Sanitaria" was renamed "Hospital Virgen del Rocío".
Since October 29, 1987, when the agreement with the University of Seville was signed and
undergraduate medical teaching began (in application of the University Reform Law of 1986), it has
been called "Hospital Universitario Virgen del Rocío".
On March 2, 1992, the former "Hospital Oncológico Provincial Duque del Infantado" (which in
1929 was the Basque Pavilion of the Ibero-American Exposition) was incorporated into the hospital
and is now in general use, with special areas for Major Outpatient Surgery and Palliative Care, with
more than 100 beds.
In addition to the care of patients assigned to the hospital area, all these centers of the healthcare
complex provide undergraduate medical and nursing education, specialized nursing training,
continuing education for all levels (healthcare and non-healthcare) and specialized postgraduate
medical training in 43 accredited teaching units (physicians, pharmacists, psychologists, biologists,
biochemists, biochemists, biochemists and biochemists).In all these centers of the health complex, in
addition to the care of patients assigned to the hospital area, there is undergraduate medical and
nursing teaching, specialized nursing training, continuing education for all levels (health and non-
health) and specialized postgraduate medical training in 43 accredited teaching units (physicians,
pharmacists, psychologists, biologists, biochemists and radio physicists).
In 2006, the "Instituto de Biomedicina de Sevilla" (IBIS) was created by virtue of an agreement
signed by the Department of Health of the Regional Government of Andalusia, the Department of
Innovation, Science and Enterprise of the Regional Government of Andalusia, the Andalusian
Health Service, the University of Seville and the Higher Council for Scientific Research.
p. 7
Incorporated an innovative project that allows the training and development of translational research
and MIR training at the Center, the HUVR-IBIS MIR program. The strategic objective is to generate
synergies and research alliances between the different care services and the research groups based at
IBIS by creating the figure of the MIR-researcher.
p. 8
Buildings that compose it
- Hospital
- Peripheral Specialty Center
- Mental Health Center
CENTER ADDRESS
Main Campus Avda. Manuel Siurot, s/n. 41013 Seville
Hospital
- General
- Hospital from
Rehabilitation y
- Women's Hospital
- Children's Hospital
- Diagnostic and Treatment Center
- Laboratory Center
- Anatomic Pathology Center
- Clinical Documentation Center
- Government Building
- Resource Management Building
- Seville Institute of Biomedicine
- University of Seville Teaching
Pavilion
p. 9
- Kitchen
- Laundry
p. 10
Duques del Infantado Hospital C/ Sor Gregoria de Santa Teresa, s/n. 41012
Seville
C. P. E. Dr. Fleming C/ Juan de Padilla, nº 8. 41005 Seville
C. P. E. Virgen de los Reyes C/ Marqués de Paradas, nº 35. 41001 Seville
Mental Health Centers:

- Virgen del Rocío Mental Health Avda. Manuel Siurot, s/n. 41013 Seville
Hospitalization Unit
- Virgen del Rocío Inanto-Juvenile Day Avda. Dr. Fedriani, No. 56. 41013 Seville
Hospital
- Mental Health Hospitalization Unit
H.
San Lazaro
- Virgen del Rocío Mental Health Day Avda. de Jerez, s/n (Former Hospital Vigil de
Hospital Quiñones). 41013 Seville
- Virgen del Rocío Mental Health Avda. Kansas City, No. 32. 41007 Seville
Rehabilitation Unit
C/ Conde de Osborno, nº 3. 41007 Seville
- Therapeutic Community of
- Therapeutic Community from Avda. de Jerez, s/n (Former Hospital Vigil de

Quiñones). 41013 Seville
Health
- East-Nervión Community Mental Health C/ Juan de Padilla, nº 8, 4th floor. 41005 Seville
Unit
- Guadalquivir Community Mental Health C/ Marqués de Paradas, nº 49, 1st floor. 41001
Unit Seville
- Mairena del Aljarafe Community Mental C/ Clara Campoamor, nº 10. 41927 Mairena del
Health Unit Aljarafe
- Sanlúcar la Mayor Community Mental Avda. Príncipe de España, s/n. 41900 Sanlucar la
Health Unit Mayor
C/ Cueva de la Pileta, s/n 41020
- East Community Mental Health Unit
Avda. de Manuel Siurot, s/n 41013 Seville
- South Community Mental Health Unit
p. 11
1.3 Objectives and functions of the Hospital
Octivioao Osirtencial
CONSULTATIONS - ADMISSIONS - EMERGENCIES - CHILDBIRTHS - TRANSPLANTS

- SURGICAL INTERVENTIONS - DIAGNOSTIC IMAGING - ANALYTICAL
DETERMINATIONS
Its objective: To meet the health care needs that citizens have presented at any given time, ensuring
the achievement of levels of excellence and guaranteeing that this care has been developed in a
humane environment and with the highest levels of effectiveness, safety and quality of care.
The intense healthcare activity carried out has made it possible to meet this objective, both in the
surgical and outpatient areas and in the emergency and hospitalization areas. The volume of
transplants performed demonstrates the hospital's clear leadership among the country's public health
care institutions.
This important healthcare activity is carried out within the framework of the consolidated
organizational model of clinical management. Multidisciplinary teams of professionals from
different centers have organized their activity in inter-center clinical management units, sharing care
objectives and clinical protocols, as well as generating and managing knowledge jointly, which puts
much more than the isolated sum of resources within the reach of the citizen, due to the important
synergies produced.
Orienting services to offer better levels of accessibility implies effort and commitment at all levels of
the organization and requires adequate coordination, given its strategic importance.
Assistance Activity
Interventions
Con/ulta/ Surgical/
1 .156.507 43,427 Engineer//

Surgical time
Port time
in con/ulta/ of AP rerposit
49.054
41 day/ 92 day/
Average gross weight U7
Stontium medium ojustododo -7 ZE

Determinacioner for operation /
Urgency/ analytical/
295,122 17.489.160 Transplonter

Delivery/
| 453
Average time in
urgency/
Diagnostic
2.2 hour/
Imaging 5 ,666
Percentage of
ce/area/
653.708 23.79
p. 12
DIETARY SERVICE - LINEN PROCESSING - SURFACE CLEANING - CHILDREN'S

SCHOOL - INVESTMENTS IN EQUIPMENT AND COMFORT - SECURITY
General services are those non-health services that are necessary for the development of the
organization's main activity.
Its objective: To provide comfort to patients during their hospital stay, identifying those aspects that
allow improving the quality of care.
The general services, through the security service, have intensified the number of actions and
improved the equipment: surveillance cameras, emergency buttons, etc.
The Hospital has increased the availability of single rooms by 28%, which contributes to improving
patient comfort and privacy, as well as the food, textile and cleaning areas.
It is remarkable the good work of the professionals, both in our own services: Food unit and textile
unit, as well as external services: cleaning, security, control and protection, etc.
Unkersitario Hospital
Virgin of El Rocío
General Jervices/
Diet/boiled procced/
Actions of
347.788 processed soup
Jeguridad
2,28
mili, kilos 337.594
Cleaning surface child/ attended/
289.700m2 at the E/school
1.246
Investments in
equipment and comfort
221.740€
p. 13
Clinical Oerting Units
38 CLINICAL MANAGEMENT UNITS

21 CERTIFIED UNITS
705 PROFESSIONALS ACCREDITED AND IN PROCESS
Reference Centers
23 S.S.P.A. REFERENCE UNITS AND PRODUCTS
17 CENTERS, SERVICES AND REFERENCE UNITS S.N.S.
Teaching Commitment
156 SPECIALIST RESIDENT INTERN TUTORS
1067 CLINICAL TUTORS
Its objective is to promote the involvement of professionals in their commitment to improve the
health of citizens, achieving a high level of co-responsibility, facilitating transparency and maximum
dissemination of data and information as necessary tools for resource management.
Multiple actions will be established, including the transfer of autonomy to the CMUs, which means
enhancing co-responsibility, one of the values that we strongly defend in our institution.
Clinical Management Units
R&D&I
21 /. 705
38 Unidoder
certificates
Professionals
accreditation and
566
in procero Enrayor Clinicor
Unidoder from
Clinical
Management 256
8 Project/ octivor
with Hnoncioclon
public
Commitment
Impact Factor
Reference units
156
Cumulative
1 / Center/, services and reference unit
(CFUR) fitemo ñocionol of folud
Tutorer Speciolistor 3.114,398
23 Unidoder and Reference Products of Internal/ fieri dente/ 697 pubücocioner
the Public Pike Pond Janitorium
1.076
Ctínicor Tutor
p. 14
Qsirtenciol Quality
<T
13 CLINICAL COMMISSIONS
8 IMPROVEMENT GROUPS
4 EUROPEAN NETWORKS
PATIENT SAFETY OBSERVATORY RECOGNITIONS
It ensures that each patient receives the most appropriate set of diagnostic and therapeutic services to
achieve optimal health care, taking into account all factors and the knowledge of the patient and the
medical service, thus achieving the best outcome with the minimum risk of iatrogenic effects and
maximum patient satisfaction with the process. When speaking of quality of care, it is necessary to
address the elements that constitute it: effectiveness, efficiency, professional competence,
accessibility, satisfaction, appropriateness, continuity and safety, all framed by the humanization of
health care.
The Quality Plan of the Hospital Virgen de Rocío is part of one of the strategic lines of the center
that incorporates quality in all its areas, with the sole purpose of optimizing people's care.
Its objective is to guide strategies and actions to guarantee a health care where humanization is very
present, based on accessibility, equity, safety, efficiency in the use of resources and innovation. In
addition, always with a clear and permanent indication towards the patient and his care process,
aspiring at all times to excellence in professional practice. The concept of "continuous quality
improvement" has become an essential axis of the hospital's quality management performance. It is a
strategy based on the definition, development and evaluation of processes to obtain results that
ensure quality standards and periodic modifications, thus producing continuous improvement.
Assertive Quality
University
Virgin of El Rocío
23
13 System Reference Units and |8|
Procedures Group/ of
Clinical Committees/ onitorio Público de improvement
with 251 proferionaler Andalucía
Procero/ 21 .
Aristencioles Unit Proferionaler Recognition of the Patient
Integrated certified ocreditor and Safety Observatory's
en procero mentor
Centror, services and reference

units (C/UR). national
health system European
Redeemer (ERn)
p. 15
/¡/themo/ of Information
MEDICAL RECORDS - TECHNOLOGICAL INFRASTRUCTURE

CIE10 CODING - MANAGEMENT TOOLS
The Digital Health Record is the backbone project of our organization and is currently at a high level
of development and consolidation.
Its objectives: They are now focused on achieving an adequate and complete use of the different
corporate modules: diagnostic imaging tests (PDI), citation for all tests Web Appointment,
analytical tests module (MPA) and hospital prescription, among others. The aim is to obtain a
unique, comprehensive and high quality digital history.
Information systems are basic decision-making tools for our professionals. To this end, it is essential
that the registries have a high level of quality, correctly reflecting the reality of the patients.
Information technologies are, in turn, relevant in other hospital areas that are not strictly healthcare-
related, and can contribute to the sustainability of the system, the generation of knowledge and
healthcare management.
Information Jirtems University

Virgin of Rocio
Digital Health Record

Technological infrastructure
Report/ of high Hojor 1OO fi/ico/ serverer and 300 virtualer
in horpitolizoción Obrtétricor
95.6%. 92.2%. 250 rwitcher and 1 0,000 element/ connected/ over 1 00
applica/
Petition/ Report/ of pot
Electronic/ PDI in urgency/
92%
95%.
Ge/ tion Tool

HIREO CP Mondo Panel
ICD 10 coding M
HUVR
But half average of average of
GRD procedure/
diognosticor
1,17 1,95
6.06
Portal of Pre-budget
Accessibility Portal
p. 16
R&D Research, Development and Innovation
They are a fundamental part of the development of the Virgen del Rocío University
Hospital, as drivers of the generation and incorporation of new knowledge and innovations that
allow us to address the challenges of health and social welfare of citizens.
The Andalusian Plan for Research, Development and Innovation 2020 of the Regional Government
of Andalusia recognizes research and innovation as key elements that will contribute in a decisive
way to guarantee the sustainable growth of the economy, ensuring the competence of the business
and industrial fabric, as well as of the human capital in the territory.
To this end, continuing with the efforts to maintain and improve the level in this area, actions linked
to the I+i in Health Strategy 2014-2018 for Andalusia and the Andalusian Plan for Research,
Development and Innovation (PAIDI) 2014-2020 have been implemented, among which the
following stand out:
• Policy for the promotion, retention and incorporation of talent: Intensification of

professionals, R&D&I training programs, etc.
• Definition of lines of research in the management agreements of the CMUs, as well as the
establishment of objectives linked to R&D&I activities (projects, scientific production, etc.).
• Singular programs and specific health research and innovation projects: Health Innovation
Program, Clinical Research Program, Andalusian Initiative for Advanced Therapies (IATA),
Digital Health Record as a research platform, Public Health Research Center.
The Hospital's commitment to excellent research and innovation and to efficient and quality R&D&I
management is shared with the different structures involved in the R&D&I management process
(Seville Biomedicine Institute, Research and Innovation Platforms, the FISEVI Foundation, etc.).
In this line, it is worth highlighting in 2017 the obtaining, in principle for the field of technological
innovation developed by the Hospital, of the AENOR certification in accordance with the UNE
166002:2014 standard for R&D&I management by the Virgen del Rocío University Hospital and
the Institute of Biomedicine of Seville (HUVR-IBiS).
This is a prestigious distinction that recognizes that the company has a competitive and quality
R&D&I management system, and endorses good practices in this area, always striving for
continuous improvement and favoring a high level of quality in the R&D&I actions and projects
carried out.
This certification has enabled the implementation of new procedures that improve aspects such as
technological surveillance, competitive intelligence and the identification/monitoring of innovative
ideas developed at the Virgen del Rocío University Hospital and the Institute of Biomedicine of
Seville.
The UNE 166002:2014 standard establishes the requirements and practical guidelines for the
formulation and development of R&D&I policies, for the establishment of objectives in line with the
activities,
p. 17
products and services specific to each organization, and for the identification of emerging
technologies or new technologies not applied in the sector. In this way, it lays the foundations for the
transfer that facilitates the generation of projects, the enhancement of products, processes or
services, and the improvement of competitiveness.
This strategic initiative is intended to be a management mechanism that covers all R&D&I activity
insofar as it will improve management, enhance the intelligent growth of such activity and increase
the success rate of such projects.
This certification joins the accreditation that the Institute of Biomedicine of Seville has had since
2009 by the Carlos III Health Institute, under Royal Decree 339/2004, of February 27, on the
accreditation of health research institutes.
Regarding some performance indicators, it is worth noting the funding obtained during the 2019
fiscal year according to the types of R&D&I activity.
my 7=
l+D+i
University
Madonna del
Re
Impact Factor
Cumulative
231 697
Researcherer 3.114,398 Publications
principal with Impact
projector public/ Factor Guide/ of
nationaler
Clinical Practice
or internationaler
that have re
566 revirado o
Enrayo/ Clinical/ publicado
21 active/
new regirtror
of the Intellectual and
Industrial Property
FINANCING OBTAINED
Origin Financing
Obtained (€)
4.357.996 €
R&D&I projects competitive funding
1.307.200 €
Research support grants
Career research contracts 1.766.385 €
Collaboration agreements and 311.751 €

arrangements
Service contracts 65 541 €

Clinical trials 16.719.285 €
Observational studies 675.280 €
Total 25.203.438 €
256
8 40 Project activation
with national public funding
Peder and Platform Researcher AENOR
career or international funding
=and Teaching
R&D&I
Manageme
nt
UNE
166002
Undergraduate and graduate
p. 18
The teaching of Health Sciences, Medicine, Nursing, Physiotherapy and Podiatry is directly
related to hospital practice, hence the link with university hospitals to promote both knowledge
(experimental and empirical science) and professional training (diagnostic, prognostic, therapeutic
judgments and practical skills in nursing).The teaching of Health Sciences, Medicine, Nursing,
Physiotherapy and Podiatry is directly related to hospital practice, hence the link with university
hospitals to promote both knowledge (experimental and empirical science) and professional training
(diagnostic, prognostic, therapeutic judgments and practical nursing skills).
The evolution of these practices, from a past in which the University had to use charitable hospitals,
to the present marriage that occurs with university hospitals, endowed with teaching capacity, an
intellectual and scientific community, as well as a high technological level, have made possible
agreements of actions that guarantee the excellence of undergraduate and postgraduate
teaching. All this, within the general regime of agreements between universities and health
institutions.
We are not university students because we have classrooms, nor because we have professors. We
are a university because we have students, one of our raisons d'être. To teach is to transmit
knowledge in everything we do, to build the future. And that is the responsibility of each and every
one of us. In our DNA, D is Teaching.
Environmental Sustainability
The management of the Virgen del Rocío University Hospital is firmly committed to respecting
the environment and to this end, an Integrated Environmental Management System (SIGA) is
implemented and kept up to date, in accordance with the requirements of the international standard
UNE-EN ISO 14001.2015 and the European Regulation EMAS III (Eco-Management and Audit
Schemes).
p. 19
The role of the Environmental Management Unit (UGA), which reports to the Engineering and
Maintenance Sub-Directorate, should also be highlighted for its work in maintaining the
Environmental Management System, promoting initiatives focused on reducing the impact that the
healthcare center has on the environment as a result of its activity (hazardous healthcare waste;
consumption of energy, water, paper, etc.), as well as planning and executing training actions aimed
at promoting environmental awareness and good practices among the center's personnel.) as well as
planning and executing training actions aimed at promoting environmental awareness and good
practices among the center's personnel.
To achieve these objectives and goals, the organization establishes and maintains an Environmental
Management Program (EMP) which includes the responsibilities assigned to each level of the
organization, as well as the means required and the time distribution in which they are to be
achieved. The EMP is prepared each year taking as a minimum reference the environmental health
objectives of the Hospital's Contract Program.
Examples of environmental objectives in recent years include:

• Maintain the center's environmental certificates.
• Implementation of an energy management system based on the UNE-EN-ISO 50001.2011
standard.
• Reduction in the generation of hazardous waste.
• Segregation of organic matter.
• Reduction of energy, water and paper consumption.
• Increased online training for staff.
• Elaboration of the greenhouse gas inventory.
The UGA continuously monitors compliance, following up on the characteristic indicators and
applying the necessary corrective measures to achieve the objectives.
The existing discharge points at the Hospital Universitario Virgen del Rocío are as follows:
p. 20
NO. CENTERS LOCATION PROVENANCE CLASSIFICATION

POINTS OF THE DRAFT OF THE DRAFT
1 Campus P1 H.R.T. Control Laundry, Cen. Thermal Industrial

H.I., H.M., H.R.T.
Cafeteria. and
Stormwater
2 Campus P2 H.R.T. H.R.T. Industrial
3 P3 Campus Behind the C.D.T. A. Pathology, Industrial

Diagnostic and Mental Health,
Treatment Center Government Building,
offices and warehouses,
storm water, etc.
4 Campus P4 Behind the Kitchen Kitchens Industrial
5 P6 Campus H. General, C.D.C.A., Industrial

Avd. Manuel Siurot
storm water, storm water
2 H. Duke of the Sister Gregoria de Entire Building Industrial

Infantado Santa Teresa St.
1 C.P.E Virgen de C/ Marques de Entire Building Industrial

los Reyes Parada
The entire building,
1 C.P.E Doctor C/ Juan de Padilla Industrial
except for the scupper
Fleming
next to C.
T. discharging into
Pasaje Agustín Argüelles
St.
p. 21
ENVIRONMENTAL MANAGEMENT POLICY

OF THE ANDALUSIAN HEALTH SERVICE
The Andalusian Public Health System's Environmental Policy is part of its general intention to protect
and respect the environment, to minimize the effects of climate change and its commitment to
sustainable development and improved energy performance. The Environmental Policy provides the
environmental framework within which all Andalusian Public Health System Centers must develop
their activities.
The Management of the Andalusian Health Service defines the Environmental Policy on the basis of
the following principles:
Document, implement and keep up to date an Integrated Environmental Management System

integrating
management, periodically checking its effectiveness, as a basis for the
for continuous improvement of environmental and energy performance.
Communicate the Environmental Policy to the professionals, as well as guaranteeing its availability to the
.e int.a-.
Comply with applicable environmental legal requirements, as well as those related to energy use and
consumption and energy efficiency.
/ 2 "<
Comply with other environmental requirements to which the organization subscribes voluntarily and, as
far as possible, anticipate future legal requirements.
Prevent contamination and minimize the environmental impacts produced by the activity of the different
Centers, especially those due to the generation and management of health care waste, as well as those
derived from the use of energy resources.
To carry out its activities with the criterion of minimizing the consumption of natural resources (water,
fuels and energy).
Promote the acquisition of energy-efficient products and services, as well as design to improve
energy performance.
Periodically monitor the environmental aspects of the facilities, adopting corrective actions when
necessary, both in normal operation and in emergency situations.
Establish and periodically review objectives and goals for

improvement.
To promote the progressive implementation in the different Centers of an Integral Environmental
Management System in accordance with ISO 14001, ISO 50001, EMAS criteria, as well as those issued
by the Andalusian Health Quality Agency as a technical reference.
Promote among Center professionals, providers, users and other stakeholders
to promote the actions of ii of lucation and lies in its

reference. (,P foi
the Andalusian Health Service
Senate ^niAs of Saud

HEALTH
COUNSELORATE
p. 22
1
Economic Sustainability
The evolution of our National Health System, based on public financing, universality and free health
services, has allowed it to be recognized worldwide as an avant-garde system and a fundamental
pillar of the Welfare State.
We currently find ourselves in a context in which the aging of the population and the need to
incorporate innovations in healthcare technology with new therapeutic solutions and new drugs,
which are undoubtedly leading to an increase in healthcare spending, oblige public authorities to
rigorously analyze the foreseeable effects and to implement, at all levels, national, regional and
local, different measures or reforms to guarantee sustainability, improving efficiency in
management.The public authorities must rigorously analyze the foreseeable effects and implement,
at all levels, national, regional and local, different measures or reforms to guarantee sustainability,
improving management efficiency, taking advantage of the opportunities offered by new
technologies or encouraging the use of economies of scale.
Within this framework, the Virgen del Rocío University Hospital works continuously to contribute
to the economic sustainability of the system, within its scope of action.
p. 23
The table below details the impact on thesustainable economic management of the Hospital with
the main items that make up its expenditure and investment structure, as well as describing the
impact of the hospital on its surroundings, highlighting its role as a generator of direct employment
and its contribution to the business development of the province.
mili. €
Investment
Training
Gartos de fármacor
mili. €
Provincial impact
Employm Wealth mili. € Equipment and
ent Infrastructure
working population
mili. €
Hospital
Economic Jortenioiliooo
. /) Universitario V " Virgen del
Rodo
Total Perronal Gartor

financialresources
p. 24
Jortenability Jociol
Efficient approach to accessibility: Ensuring the best possible accessibility in all scenarios will be
a key part of the Hospital's operation. It is not a matter of simply asking for more resources, but of
ordering all the circuits, making the most of what we do and doing only what is truly indicated on
the basis of scientific evidence. In this regard, several initiatives have already been launched and are
bringing about many improvements, such as the Comprehensive Oncology Plan or PRIODI. Two
key elements of this line are training and renewed relations with primary care.
Emergencies are not just emergencies: Apart from emergencies, the most important thing about
the ED is not the emergencies, but what they represent, i.e., important areas for improvement in our
capacity for resolution and the relationship between the different CMUs. The involvement of all the
CMUs in the emergency department is essential.
Empathize more with patients: This line is perhaps the most cross-cutting of all. It is to put oneself
much more often in the place of the patient and their families. Humanize treatment, take care of
intimacy, smile more, introduce ourselves with our name when we attend to a new patient. How do
we like to be treated when we are users?
Plan for the little things: We launched a plan to take care of the details. Low cost and high impact
on the perception of our patients and their families. To this end, a mailbox has been activated on the
intranet so that each professional can make their contributions.
p. 21
Other/ Groups
of Interest
The importance of two of these groups, citizens and professionals, has been especially emphasized.
In the first case, because of the role they play so directly with the center and because they are the
reason and axis of the system and for which they work on a daily basis. In the second, because
without them nothing would be possible as they are the engine that sets this gear in motion.
Suppliers are another important group, and the economic sustainability block includes information
aimed at responding to their main concerns.
Another relevant group of interest are the related teaching and research entities. Some of these
entities, such as the University of Seville and the Institute of Biomedicine of Seville, have
infrastructures integrated within the campus.
Scientific Societies and Professional Associations
The training and specialization of healthcare professionals is what guarantees the improvement of
healthcare practice, being the hospital center, directly or with its professionals, the one that shares
the nexus of union with the scientific societies and associations in which they participate as
members of the scientific committees, speakers at national and international congresses, part of the
working groups of publications or of the societies themselves. Likewise, the specialization of
professionals or their research work on numerous occasions supports the establishment of
collaboration agreements or the development of meetings, conferences, workshops, courses,
scientific publications, etc.
These actions are expressed in the objectives of the clinical management agreements that each Unit
maintains with the center and which, on many occasions, are proposed by the Scientific Societies to
be included in the SAS Contract Program. The response of these is the recognition of the
relationship through the awarding of prizes, awards and honorable mentions from both national and
international societies.
Media and Communications

The development of the Communication Plan has facilitated compliance with the basic information
guidelines in relations with the media, with accessibility, agility, confidentiality and transparency
being the fundamental pillars for fluid and quality communication.
The Virgen del Rocío University Hospital, in compliance with the applicable legal framework,
intends to maintain at all times a policy of egalitarian communication that meets the needs and
specificities of the healthcare context.
The Communication Unit periodically issues press releases and organizes press conferences and
meetings with the media to communicate the activities and news that take place in the Hospital.
At the same time, there is a Social Networking Plan that sets the guidelines for dissemination in
p. 26
this medium, through which the activities carried out at the Hospital are disseminated, as well as
information on prevention, health promotion in general, which is of quality and useful for all citizens
and helps to improve their quality of life. The Editorial Committee of the Hospital Universitario
Virgen del Rocío has been created to propose and validate initiatives in this area.
p. 27
BLOCK 2 - INFRASTRUCTURE AND TECHNICAL ORGANIZATION OF THE PLANT
A map of the organization of the spaces in the plant can be seen below.
Types of Warehouse:
1 Machinery (pumps, etc.)
2 Pillows
3 Soiled sheets and linens
4 Biological garbage bags
5 Consumables and medicines
6 7 8 9 Various
p. 28
2.1. Enumeration and description of the elements that form the patient unit.
• 1 toilet: Shared by the 2 patient and family units, consisting of a washbasin, a sink, a
toilet, one shower tray, two bottles with the number of each bed for diuresis collection and
two bedpans.
• Articulated bed horizontally and vertically adjustable in height, pillow, bedside table with a
door and drawers that also serves as a dining table, seat for when the patient is prescribed to
sit, TV, a double closet with two independent parts, one corresponding to each unit
(consisting of a bar for hangers and shelves). The wall where the head of the bed is located
has an individual lamp for each unit, a switch with which the patient can alert the control, a
telephone, an IV stand and an oxygen diffuser, a secretion aspirator and a curtain to provide
the patient with privacy.
• 1 large window for the room that makes up the 2 patient units, and which provides
p. 29
natural light. In addition to the window, each room has artificial lighting located on the
ceiling.
• The room that forms the 2 patient units has white walls, a rubber floor and mattresses with
plastic covers for easy washing.
2.2. Types of warehouses and operation: Organization of materials and warehouse personnel
Each control center has a series of storerooms where all the materials, medicines and supplies
needed to provide patient care are kept.
According to the map shown at the beginning of Block 2 on the organization of the plant, we find
the following warehouses:
1 Apparatus: This is a restricted access warehouse (locked door) where all electrical apparatus
of high economic value, such as pumps, electrocardiograms and other machinery, are kept. It
is available to nurses and nurse practitioners.
2 Pillows: This is dedicated exclusively to store new pillows. Its door is locked and has
exclusive access to the TCAE.
3 Dirty linen: Dirty linen must be deposited in white bags provided for this purpose and
placed in collection carts for dirty linen (sheets, linen, etc.). Once filled, they are double
knotted and deposited in the warehouse. It is used exclusively to store the dirty clothes that
are generated throughout the day, until the staff collects them at night to take them to the
laundry. Access is free, so the door has no lock, but its use is exclusive to the TCAE,
although sometimes the orderlies can also have access. Of course, the laundry staff agrees to
be in charge of picking up the laundry.
When isolation is performed, the soiled linen is placed in a white bag inside a black
hard plastic container with a green cap that is bolted to the body of the container.
4 Biological waste: This storage area is exclusively used for all waste containing some type of
material or body fluid (diapers, medical materials, etc.) that is generated throughout the
workday until it is collected during the night shift. They are double black bagged and are
accessible to the TCAE, orderlies and waste collection personnel.
5 Medications and expendable materials: All psychotropic materials and medications that
are normally prescribed by the physician for administration are kept in this warehouse, which
is why it is a locked warehouse.
In the Control Center there are also several metal cabinets as a safe, which are opened by a
computer that opens each of the doors where the medication is located, while recording the
name of the nurse who removes it and the stock they contain.
Access in both cases is exclusive to nurses and pharmacists who are in charge of
replenishing them.
- 7 - 8 - 9 Miscellaneous: These are undefined stores of miscellaneous items.

There are also
other unused warehouses for when needed.
p. 30
2.3 Explanation of the order procurement system used in the plant. Difference between
standard and emergency systems
Hospital procurement is carried out digitally, using different platforms, with the exception of linen,
which arrives daily on a trolley and is placed in the warehouse designated for this purpose.
• Office supplies are ordered through a digital platform called SIGLOS (Integrated Logistics
Management System). The person in charge of placing the order is the supervising nurse and
the nurse in cases of emergency. The TCAE is in charge of receiving the goods, checking the
order and its correct storage.
• Drug orders are placed with the ATHOS (Hospital Technical Application) program. When an
order is ready, in the case of the most common drugs, both the TCAE and the order taker can
be in charge of its withdrawal. However, for psychotropic and restricted drugs, once the
pharmacy notifies that the order is ready, it is exclusively the TCAE who goes for its
withdrawal and who signs the delivery note.
• The consumables are checked weekly for replenishment and are brought in by the Hospital's
deliverymen.
Any new material brought in is placed behind the older material to promote stock rotation and avoid
expiration.
p. 31
Urgent supply system
In the case of urgent drug orders, the nurse is the person in charge of filling out the urgent order
form, which is placed in a plastic tank that is introduced into an air duct that pushes it to the
pharmacy warehouse so that it can be processed immediately, without having to be requested by the
computer systems. Once it arrives at the hospital pharmacy, it will be processed immediately so that
the order is delivered as soon as possible to the ward by the orderly or the TCAE who has been sent
for the order.
In cases where the urgency is for linen, we call the laundry so that they can upload the requested
items as soon as they can.
2.4 Documentation used in the different nursing care and management activities, highlighting
those corresponding to the TCAE.
In order to implement the universality of Medical Records within the S.A.S. (Andalusian Health
System), the paper Medical Records were replaced by the implementation of a computerized
registration and follow-up system called DIRAYA.
The DIRAYA care module allows the consultation of a patient's health data when requested by
health professionals anywhere in Andalusia, avoiding the waste of time, the use of paper and the
possible deterioration of paper records.
However, for some procedures, and especially on the hospital floor, a series of paper documents are
still used, which facilitates the daily attention of users.
These are:
Patient identification sheet: Where only the

patient's room and bed number are indicated, with
the patient's name and without surname, the name of
the nurse and the TCAE who receives the patient on
the day of admission is also reflected.
p. 32
Fasting sheet: It is placed at the edge of the user's

E . Room/Bed:
bed, when he/she has to undergo a blood test,
Patient:
surgery, radiology, etc. The room number and bed
i FASTING number are written on it. The name and surname of
REASONS: the user to be tested are written on the back of the
□ ANALYTICS
card.
- RADIOLOGY
□ SURGERY
□ OTHERS:____________________
TCAE control sheet: It is used to control and register all plant users
during the working day, to be later uploaded to the computer system.
The temperature is recorded in the morning, afternoon and evening; the
diuresis control and observations (if the patient uses a diaper, collector,
has any test, etc.).
• Charts: They are made automatically by entering the data from the TCAE's control sheet into
the digital platform.
• Diet sheet: It comes out of the patient's care plan, it is made daily for each patient on the floor
and sent to the kitchen, especially for patients who are prescribed food without salt, easy to
swallow or diabetic, among other considerations.
BLOCK 3 - CARE ACTIVITIES OF THE PLANT
p. 33
3.1 . Specialties and main pathologies of the plant
The Internal Medicine Unit is characterized by promoting a comprehensive care model centered on
the person and developed in collaboration with primary care and other health and social services.
This is why we have adopted the name Unidad Clínica de Atención Médica Integral.
Being a national and international reference in the development of continuity of care for chronic
patients based on the figure of the referral internist working in collaboration with primary care
teams.
It has also been led:
• The development and implementation of thecare processfor multi-pathological patients,

contributing to the design of a new model of care for these patients, based on the principle of
autonomy and their active participation in decision-making.
• The palliative care assistance process , with the development of assistance devices at all
levels of reference for palliative care: Hospitalization, home care support teams and
consultancy to other services, including the participation of a psychosocial care team that is
formed by psychologists, physiotherapists and social workers who collaborate in the
comprehensive care of patients with advanced chronic diseases.
• A functional unit is created to care for patients with systemic autoimmune diseases and
minority diseases, collaborating especially in the transfer of these patients from pediatric to
adult age.
• It is also a reference in vascular risk, especially in the care of patients with familial
hypocholesterolemia and arterial hypertension, including pregnancy hypertension.
• In recent years it has become a reference in clinical ultrasound, with an important teaching
activity in this field, and has developed a powerful line of clinical epidemiology from which
it collaborates in the development of clinical guidelines with numerous services and
institutions.
• It is currently developing a powerful line of humanization of medicine, promoting the

global vision of the sick patient, both in undergraduate and postgraduate teaching, in close
collaboration with the Andalusian School of Public Health.
3.2 User typology: gender, age, origin, lifestyle, ...
Patients on the Internal Medicine ward are usually elderly (over 70 years of age) with pathologies of
all types.
They are bedridden and dependent patients who will need a lot of care and attention.
1
A
Young users with terminal illnesses (cancer) are also often admitted, but these are the smallest cases.
3.3 Staffing and shift organization
The plant is organized in two shifts:

p. 34
Shift D1 (from 8:00 am to 20:00 pm). Composed of:
• 3 TCAE, one of them is fixed in the morning from 8:00 am to 15:00 pm, from Monday to
Friday, from 8:00 am to 15:00 pm.
Friday. The other two work rotating day and night shifts. The first shift day is from 8:00 am
to 8:00 pm, the second shift day is from 8:00 pm to 8:00 am, and the following three days are
rest days.
• 3 nurses.
• 4 physicians.
• 1 orderly.
• Interns.
D2 shift (from 20:00 pm to 8:00 am). Composed of:
• 2 TCAE.
• 2 nurses.
• 1 doctor on call.
• There is no warden, but he can be called if needed.
3.4 Tasks: Standardized and differentiated activities by shifts
Shift D1 from 8:00 am to 8:00 pm:
• Temperature measurement.
• Clothes delivery.
• User cleanliness.
• Replenishment of hygiene carts and restocking of material.
• Control of suction system and humidifiers.
• Warehouse stock control.
• Dieting.
• Diaper changes.
• Control of diuresis.
• Food delivery.
• Pick up discharge rooms.
• Postural changes.
D2 shift from 20:00 pm to 8:00 am:
• Temperature measurement
• Diaper changes.
• Prepare income.
1
• Prepare fasting.
• Snack and dinner delivery.
• Change of diuresis bag.
p. 35
• Mobilization of the patient.

• Diuresis control at 21:00 pm. Another one will be held at 24:00 hours.
• Postural changes.
3.5 Protocols of the most frequent nursing techniques: 3 different types
Diuresis control
• Objectives: To control the amount of urine produced by a patient in a given period of time.
• Materials: Gloves, urine bag for catheterized patients, bottle, pen, black marker and TCAE
control sheet.
• Procedures:
1. Wash hands and put on gloves.
2. Upon arrival at the unit, we say good afternoon and explain to the user that we are going
to collect diuresis data.
3. Data collection:
➢ For NON-catheterizedpatients : Each patient unit, in the bathroom of the room, has a
diuresis collection canister, where autonomous patients have to refill as they urinate.
The steps are:
a. We entered the bathroom.
b. We take the urine collection canister.
c. We note the measurement of urination on the TCAE control sheet.
d. The diuresis collection canister is washed in the shower in the en-suite bathroom.
e. It is then returned to the same place from where it was taken.
➢ For catheterized patients the steps are:

a. We stand at the side of the bed, where the diuresis bag is hanging from its hook.
b. We leaned over so we could see the measurements printed on the bag.
c. We look at the maximum point that marks the urine in the measurement of the
bag.
d. And it is noted on the TCAE's control sheet.
In case it is too full, we have to change it. To do so, we will go to the waste store to
pick up a new diuresis bag, noting on the bag with a black marker, the number of the
room, the number of the user's unit, the date of the day the change is made and the
time.
We pinch the catheter with our fingers to be able to extract the mouth of the urine
output bag that is full and with the other hand, without wasting time, we introduce
the distal end of the new urine output bag into the catheter, remove the bag full of
urine from the hook and place the new bag.
We do not take this bag to the disposal store to empty it down the conventional drain
and dispose of the plastic in the organic waste bin.
p. 36
4. We said goodbye to the users and left the room.
5. We go to the control center.
6. We took off our gloves and washed our hands.
7. At the end of the shift, we enter the data in the Diraya program to save the graph.
Care of bedridden patients
• Objectives: To provide comfort and well-being to the patient, keeping him/her in the best
possible conditions, paying more attention to the integrity of the skin in the areas where the
bones rest on the bed, in order to avoid wounds, pressure ulcers and other pathologies.
• Materials: Gloves, plastic bag, soapy sponge, clean bed sheets, clean pajamas or nightgown,
diapers, soaker, paper for drying, dressings, oils or creams.
• Procedure:
1. We put on our gloves.
2. We wet several soapy sponges with water and put them inside a plastic bag.
3. We take clean sheets, several soakers, a diaper and paper to dry.
4. We enter the room of the unit of the patient we are going to change by knocking on the
door, saying good afternoon and explaining the procedure we are going to perform.
5. We politely ask all family members accompanying the two patient units to step out into
the hallway.
6. We pull the curtain of the patient unit to be changed.
7. We lower the headboard, the leg part of the bed to place the patient in the supine
position, lower the bed rails and remove the pillow (the bed must be at a height that
allows us to work without having to have the back bent).
8. We uncover the patient and see if he/she has a clean gown to leave it on or change it.
9. We peel off the soiled diaper, resting the top of the diaper on the bed.
10. We take a soapy sponge and start washing the genital area, taking care of hygiene in the
folds. When we finish with the genitals, we leave the soapy sponge in a ball between his
legs, this prevents the genital area from getting dirty again when he changes position.
11. We dry with the paper.
12. We raise the handrail on the side to which we are going to move the patient and place the
patient in lateral decubitus, encouraging the patient to hold on to the handrail as much as
he can to facilitate our work.
13. We detach the diaper from the patient's bottom, so that it lies on the bed.
p. 37
14. We remove the dirty soapy sponge ball that we had used for the hygiene of the genitals
and it is kept in the plastic bag (it is placed inside the plastic bag from where we took it
clean, at the opposite end of the bag from where the clean soapy sponges are and as long
as the amount of excrement allows it, otherwise we will go for another bag).
15. We proceed to clean the patient's bottom, taking extreme care with hygiene in the folds,
while we leave the dirty soapy sponges in the corner of the bag intended for this purpose
or inside the soiled diaper itself.
16. We make a roll with the diaper and put it in the space between the patient and the bed.
17. We dry with the paper.
18. We roll up the soaker and also put it in the space between the patient and the bed,
pushing it inwards.
19. We remove the bottom of the sheets from under the mattress and together with the tuck-
in, we roll them up using the entire length of the bed, in the direction from the edge of
the bed towards the patient's back and leave them tucked in the space between the patient
and the bed, pushing them inwards.
20. We open the clean underpad by placing it along the entire length of the bed and unroll it
from the edge of the bed towards the patient's back. We do the same with the underpad,
the soaker and the diaper (the flap of the diaper that will remain under the patient is
rolled up).
21. We turn the patient in right lateral decubitus, to supine decubitus, and then to left lateral
decubitus.
22. We raise the railing on our side and encourage the patient, within his or her ability, to
hold on tightly to the railing.
23. We moved to the opposite side of the bed from the one we were on, lowered the rail on
that side, finished taking off the dirty underpad and tucked it into the laundry cart bag.
24. We remove the other part of the soiled diaper that the patient was wearing and put it in
the garbage bag.
25. We unroll the fitted sheet and the tuck-in sheet, which we had left rolled up under the
patient, stretching it all over the bed, so that the mattress is covered.
26. The same is done with the clean diaper, leaving it open on the bed.
27. The patient is placed in the supine position.
28. We put on the diaper, leaving it on tightly and glued.
29. Stretch the bottom sheet again to ensure that there are no wrinkles under the patient.
30. The ends are tucked under the carton.
31. We raise the patient to the bedside if necessary, we place the pillow, raising the feet with
p. 38
the bed or a pillow to prevent the patient from sliding down again and we raise the
headboard to provide more comfort.
32. We cover the patient.
33. We collect the biological waste garbage bag.
34. We collect the dividing curtain from the patient unit.
35. We left the room, inviting family members to come in.
36. We go to the waste storage room to dispose of the waste bag and leave the laundry cart in
the aisle to be used again, until the bag is full and we remove it.
Enema administration
• Objectives: Elimination of feces through the administration of a prepared or commercial

solution inside the rectum.
• Materials: Gloves, soaker, wedge or diapers, lubricant, rectal probe, prepared or commercial
solution and garbage bag.
• Procedure:
1. We wash our hands and put on gloves.
2. We knock on the door of the room to let them know of our presence.
3. We explain the procedure we are going to do and invite all visitors who are inside the
room to leave for a moment.
4. We pulled the user's curtain to give him/her privacy from the other patient in the other
unit.
5. We place the patient in the left lateral decubitus position (in case the patient has a diaper,
we take it off while in supine decubitus).
6. We place a soaker on the bed to avoid possible stains.
7. We lubricate the rectal probe.
8. We introduce it into his anus, taking care not to hurt him and inviting him to relax so that
it can enter better.
9. We place the bottle containing the solution in the rectal probe and introduce the whole
solution.
10. We instruct the patient to cooperate and try to keep the solution inside as long as
possible.
p. 39
11. The patient is placed in the supine position with legs bent and the wedge is placed under
the buttocks. In the case of a diaper, it is reattached and left on.
12. We throw all leftovers in the trash.
13. We left the room to keep him quiet and give him time for the enema to take effect.
15. Once administered, we will wait several minutes without stopping to ask if the procedure
had its effect.
BLOCK 4 - PATIENT FOLLOW-UP
4.1 Brief introduction to the medical record
Anamnesis
• Admitted on 02/01/2020 on the second floor, 2nd Control North Zone of Internal Medicine
II, a 61-year-old male M.G.C., retired merchant seaman, with family history (brother of
unknown origin, 44 years old).
• She has no known drug allergy.
• Former occasional cigar smoker since 2015.
• Drinker of less than 1 liter of beer per day and 2-3 glasses of wine per day.
• Hypercholesterolemia. Erectile dysfunction assessed in 2011 by Urology.
• Intervened in 2014 for CVI lesion.
• Non-malignant CVD leukoplakia.
• Study by digestive in 2019 for anemia with internal hemorrhoids.
• Two millimetric polyps of adenomatous aspect at 32 and 30 cm from the anal margin,
resected.
• Endoscopic findings compatible with gastritis of the body.
• Peptic ulcers of the gastric antrum.
• Biopsy / Peptic bulbitis.
Current treatment
• Tardyferon 1 per day - Metformin ½ every 12 hours - ASA 100 mg 1 per day - Irbesartan /
Hydrochlorothiazide 300 / 25 mg 1 every 24 hours - Lecarnidipine 20 mg - Simvastatin 20
mg.
Current disease
• Patient habitual drinker, who in the last 6 days has given up the habit and has followed a
hypocaloric diet with a loss of 6 kg, as reported.
• Yesterday she felt general malaise of non-specific origin, without referring symptoms,
because she remains in bed.
• This morning, while walking, he presented a general malaise with subsequent loss of muscle
tone without falling, with loss of consciousness (he was sitting), with a blank stare, no
abnormal limb movements, no sphincter relaxation. On recovery he has bilateral sub-
calvicular pain, although he denies pre-coidral pain, without irradiation to the back or limbs.
The symptomatology lasted 10 minutes.
p. 40
• Refers sub-mammillary pain pointing to fingertip, not oppressive.

• At the time of consultation, he refers interscapular pain, with no central thoracic or limb
pain.
• He reports nausea that does not lead to vomiting.
• For approximately 3 weeks he has presented deterioration of his general condition with tests
compatible with chronic liver disease and anemic syndrome of digestive origin, in addition
to chronic cor pulmonale (left atrial dilatation and right ventricle).
4.2 Explanation of the pathology and treatments administered.
Reason for admission
• CC (chronic heart failure) + ARF (acute renal failure) in pac. enolic hepatopathy.
NON-pharmacological treatment
• Low sodium diet / Water restriction / Low calorie diet.

• Weight control.
• Eliminate the habit of tobacco and alcohol.
• Adapted exercise.
• Flu vaccination is advised, and that the partner-worker maintains the previous one.
Pharmacological treatments
• Angiotensin-converting enzyme inhibitors.

• Beta-blockers.
• Diuretics.
• Antialdosterone.
• Digoxin.
• Angiotensin receptor antagonist.
• Hydralazine and isosorbide dinitrate.
• Other drugs (calcium antagonist, amiodarone, ivabradine, oral anticoagulants).
Diagnostic tests
• Volume control ofurine excretion.

• Urinalysis.
• Blood tests.
• Diagnostic studies by image.
• Removal of a sample of kidney tissue for testing.
4.3 Nursing care applied to the patient from the point of view of basic needs.
TCAE PATIENT CARE CHART
• Functional level of activity and mobility: Requires another person for assistance.
• Functional capacity for bathing and general hygiene: Requires another person for
assistance.
p. 41
• Toilet use: Requires another person for assistance (catheterization).

Day 1
The patient is accommodated in the unit, the functioning of the unit is explained (cleaning, meals,
treatment, medical visits, etc.) and the diet is sent to the kitchen. At 9:00 p.m. dinner is served.
Day 2
Temperature and urine output are taken, diapers are changed, he is informed that tomorrow he will
have a blood test, diaper is changed and dinner (diet) is given to the child to be given to him.
Day 3
Temperature and urine output are taken (density and color are reported), diapers are changed and
dinner (diet) is given to the child to be given to him/her.
Day 4
At 16:00 hours the orderly is called to take him for a RS test with narrow QRS supraventricular
extrasystoles and dinner (diet) is given to the son to be given to him.
Day 5
The diuresis bag is changed and a sample is taken for analysis. The child's temperature is taken,
diaper is changed, oil is put on the skin, postural changes are made, and the child is given dinner
(diet) to eat.
Day 6
His temperature is taken, a change of treatment is performed, I bring him the new drugs, a blood gas
Hb 8.9 (GSV: Hp 7.39, pCO2 32, HCO3 20) is performed and dinner (diet) is given to the son to be
given to him.
Day 7
His temperature is taken, urine output is collected in a bag and I go to the nurse because he wants me
to see how to take a midline to facilitate the analytical test tomorrow. Dinner (diet) is given to the
son to give to him.
Day 8
Temperature is taken and diuresis is collected in a bag. He has been sleeping all day so we try to
disturb him as little as possible. Dinner (diet) is given to the son to give to him.
p. 42
Day 9
His temperature is taken, diuresis is collected in a bag, his diaper is changed when he presents
continuous colitis, he is hydrated with saline and dinner (diet) is given to the child to be given to
him.
Day 10
His temperature is taken, diuresis is collected in a bag, he has severe abdominal pain, so we try not
to move him or bother him too much, and dinner (diet) is given to the son to be given to him.
Day 11
I arrive and he has been taken for an abdominal ultrasound, where a puncture point is marked in FID
in case it is necessary, upon arrival I take his temperature, collect diuresis, give him a snack because
his son is not here and in the afternoon he is changed diapers because he has colitis again.
Day 12
His temperature is taken, his diaper is checked for the presence of colitis, his bladder catheter is
removed, his abdominal pain improves and he is prescribed to start sitting him for short periods of
time in the chair.
Day 13
His temperature is taken, diuresis is collected in a bottle, he is marked with the card for another
analysis tomorrow, he is cleaned and given dinner (diet) encouraging him to take it alone (in any
case, the son is with him).
Day 14
His temperature is taken and diuresis is collected in a bottle, and he is given a snack and dinner.
Although he has not regained fluid mobility, with the help of his son he is gradually acquiring more.
Day 15
This morning the doctor discharged him, and he is in his unit waiting for the ambulance to arrive so
he can go home.
4.4 Personal assessment of follow-up
The choice of the patient for follow-up was determined by the fact that he presented pathologies
specific to the plant, as well as having a favorable response to the treatment, achieving the objectives
set for his integral care, until he was much better than when he came in at the time of his discharge.
Our main objective as TCAE was:
p. 43
• To prevent the appearance of pressure ulcers, since he was a bedridden patient.
• Keep a strict control of your diuresis (volume, consistency, tone).
• And above all, to make his stay as easy and comfortable as possible, being polite to him,
informing him every time we entered his unit about everything we were going to do to him,
reminding him how he is improving every day and empathizing with him.
p. 44
BLOCK 6 - ASSESSMENT AND EVALUATION
6.1 From each plant
In general terms, my assessment exceeds the best expectations I already had of the Hospital Virgen
del Rocío, complementing my training phase in a very productive internship period.
One issue that I must highlight and that you become aware of when you are part of the healthcare
team, is how well organized and protocolized everything is. Organization and protocolization
contribute to offering good quality assistance, otherwise it would be very complicated due to the
high volume of people the plant serves.
6.2 Learning achieved
I have been able to put into practice all the care protocols studied. However, I must admit that many
of the steps to be performed have to be modified in order to facilitate and save time in their
application. In this regard, it should be noted that this does not mean a loss of effectiveness, but
simply the need to reduce time.
6.3 Relationship with the healthcare team
The relationship with the work team has been very good, and I have felt like one of the group at all
times.
By way of anecdote and illustrative of the good treatment received, I have to comment that the first
day, starting in something unknown to me, it was difficult to avoid the feeling of nerves, but in less
than fifteen minutes the work team began to make me feel part of it, making it easier for my nerves
to disappear.
On the flip side, there were a couple of people to whom I had to show that I, rather than being a
hindrance to the performance of their duties, was going to be a support they could rely on to ease
their workload. In this regard, once they saw him, everything was perfect.
6.4 Observed treatment of patients and family members
The treatment of patients and their families has been very appropriate, timely and polite, always
seeking to be empathetic and in accordance with the health situation in which each one was, so that
in general terms we can say that the best for them was sought.
On the other hand, I have noticed that day by day the trust and confidence of patients and their
families has increased towards the healthcare personnel. Probably, the routine of having the same
person every afternoon and at approximately the same time, as was my case because I had a fixed
afternoon shift from Monday to Thursday, contributed to this emotional stability. Such is the case,
that on some occasions, some patients came to address me before the other TCAE's on the team.
p. 45
BLOCK 7 - ANNEXES
7.1 Bibliography and references
• Virgen del Rocío University Hospital website: https://www.hospitaluvrocio.es/
• Memory of the Hospital Universitario Virgen del Rocío:

https://www.hospitaluvrocio.es/wp-content/uploads/2019/02/Memoria-2018.pdf
• For pathologies and their treatments:

https://www.sergas.es/gal/publicaciones/docs/atespecializada/pdf-2057-ga.pdf
https://www.mayoclinic.org/es-es/diseases-conditions/kidney-failure/diagnosis-
treatment/drc-20369053
7.2 Vocabulary with 30 medical terms
1º Allergy: State of hypersensitivity to a generally innocuous environmental antigen as a result of

the interaction between that antigen and antibodies.
2º Algia: Pain.
3º Analgesic: Drug used to relieve pain.
4º Anemia: Insufficient number of red blood cells in the blood or insufficient hemoglobin in these
cells.
5º Anorexia: Loss or lack of appetite.
6º Antibiotic: Drug used for the treatment of a bacterial infection.
7º Antipyretic: A drug used to reduce fever.
8º Antibacterial: Destroys bacteria or prevents them from multiplying.
9º Dressing: Therapeutic material applied to a lesion.

10º Goiter: Abnormal enlargement of the thyroid gland.
p. 46
11º Biopsy: Obtaining a tissue fragment for microscopic study.
12º Bradycardia: Abnormal slowness of the heartbeat, less than 60 beats per minute.
13º Venous catheter: A soft plastic tube placed in a vein or artery used for the administration of
medication.
14th Headache: Headache.
15º Cyanosis: bluish color of the skin and mucous membranes due to insufficient oxygenation of the
capillary blood.
16º Dermatitis: Inflammation of the skin.
17º Diabetes: A chronic disease that develops when the body loses its ability to produce enough
insulin or to use it effectively.
18º Diagnosis: The art of distinguishing one disease from another or of determining the nature of
the disease.
19º Eczema: Skin disease characterized at the beginning by inflammation, redness, papules, reduced
vesicles, exudation and intense itching, followed by crusting and desquamation.
20º Electrocardiogram: Test that determines the heart rhythm pattern.
21º Fagia: Action of eating.
22º Gastritis: Inflammation of the stomach.
23º Glucosuria: Presence of glucose in the urine.
1
24º Hematemesis: Expulsion of blood from the digestive tract through the mouth.
25º Opportunistic infections: Infections produced by usually harmless germs that take advantage
p. 47
of the immunodeficiency of the organism to produce disease.
26º Melena: Dark stools with blood.
27º Parenteral nutrition: Intravenous nutrition, used in cases where oral intake is not possible.
28º Otitis: Inflammation of the ear.
29º X-ray: Developed photographic plate showing body images obtained with x-rays.
30º Syncope: Sudden loss of consciousness, usually brief and reversible.
7.3 Complementary Documentation
• Annex I: Anamnesis Sheet

• Annex II: Initial Assessment
p. 48
ACKNOWLEDGMENTS
My greatest and sincere thanks to the teachers of I.E.S Punta del Verde in Seville, for the
complete and great training I have acquired through them. Of which I have been able to be fully
aware
to develop my professional practices in the Hospital Universitario Virgen del Rocio.
1st of T.C.A.E.
Mª Dolores Francis Thillet (Tutor & T.B.E / H.M.H. Teacher)
Maria Sanchez Martínez (Professor of Anatomy / H.M.H)
Victoria Expósito Escobar (F.O.L. Teacher)
Estrella Suárez del Cerro (S.S.A. Professor)
p. 49
2nd of T.C.A.E.
Pepa Vazquez Rodriguez (Tutor & P.P.P / O.A.S. Teacher)
Ana Montes García (T.A.O. Teacher)
Juan Jesús Mármol Suarez (Professor of R.E.T.)
I must also conclude by thanking the work of our internship tutor, Dr. Angulo,
and his team, the team of the 2nd North Zone Control of the 2nd floor of Internal Medicine, for
facilitating my integration into their unit, for the teaching I have received from them and for the
empathy
shown with me from the first day.
p. 50
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TCAE Integrated Project - Course 2019/2020 Antonio Manuel Villamor Galván

Block 2 - Plant Infrastructure and Technical Organization P. 24

Block 3 - Plant Assistance Activities P. 30

Block 4 - Patient Follow-up P. 37

Block 5 - Sterilization Services (section not yet required by the tutor) P.

Block 6 - Assessment and Evaluation P. 42

6.3 Relationship with the healthcare team P. 42

1.1 Presentation of the integrated project

• History of the Virgen del Rocío University Hospital

1.2 Hospitales Universitarios Virgen del Rocío: Hospitals that compose it

History of the Hospital

Buildings that compose it

Main Campus Avda. Manuel Siurot, s/n. 41013 Seville

C. P. E. Dr. Fleming C/ Juan de Padilla, nº 8. 41005 Seville

C. P. E. Virgen de los Reyes C/ Marqués de Paradas, nº 35. 41001 Seville

Mental Health Centers:

- Therapeutic Community from Avda. de Jerez, s/n (Former Hospital Vigil de

1.3 Objectives and functions of the Hospital

CONSULTATIONS - ADMISSIONS - EMERGENCIES - CHILDBIRTHS - TRANSPLANTS

1 .156.507 43,427 Engineer//

Stontium medium ojustododo -7 ZE

295,122 17.489.160 Transplonter

DIETARY SERVICE - LINEN PROCESSING - SURFACE CLEANING - CHILDREN'S

Clinical Oerting Units

38 CLINICAL MANAGEMENT UNITS

Clinical Management Units

Centror, services and reference

MEDICAL RECORDS - TECHNOLOGICAL INFRASTRUCTURE

Information Jirtems University

Digital Health Record

Ge/ tion Tool

R&D Research, Development and Innovation

• Policy for the promotion, retention and incorporation of talent: Intensification of

Collaboration agreements and 311.751 €

Service contracts 65 541 €

Undergraduate and graduate

Examples of environmental objectives in recent years include:

NO. CENTERS LOCATION PROVENANCE CLASSIFICATION

1 Campus P1 H.R.T. Control Laundry, Cen. Thermal Industrial

2 Campus P2 H.R.T. H.R.T. Industrial

3 P3 Campus Behind the C.D.T. A. Pathology, Industrial

4 Campus P4 Behind the Kitchen Kitchens Industrial

5 P6 Campus H. General, C.D.C.A., Industrial

2 H. Duke of the Sister Gregoria de Entire Building Industrial

1 C.P.E Virgen de C/ Marques de Entire Building Industrial

ENVIRONMENTAL MANAGEMENT POLICY

Document, implement and keep up to date an Integrated Environmental Management System

Establish and periodically review objectives and goals for

to promote the actions of ii of lucation and lies in its

the Andalusian Health Service

Senate ^niAs of Saud

Total Perronal Gartor

Scientific Societies and Professional Associations

Media and Communications

BLOCK 2 - INFRASTRUCTURE AND TECHNICAL ORGANIZATION OF THE PLANT

1 Machinery (pumps, etc.)

3 Soiled sheets and linens

4 Biological garbage bags

5 Consumables and medicines

- 7 - 8 - 9 Miscellaneous: These are undefined stores of miscellaneous items.

Urgent supply system

Patient identification sheet: Where only the

Fasting sheet: It is placed at the edge of the user's

3.1 . Specialties and main pathologies of the plant