School health examination can be divided into regular health examination and temporary health examination:
1. Regular health check-up: According to the regulations, all students at school must have a health check-up.
(1) Primary school: Freshmen receive their first health examination in the first semester after entering school. Except for height, weight and eyesight, other items are checked once every three years, that is, once every one or four school years. The format of the primary school health examination record card is shown in Example 3- 1.
(2) Ethnic Middle School: Freshmen receive health examination in the first semester after entering school.
(3) Senior middle schools, colleges and universities: check once when entering and graduating.
2. Temporary health check-up: During school, students are required to attend regular health check-ups. If teachers or medical staff think it is necessary, they can have a temporary health examination at any time, for example, under the following circumstances:
(1) When it is considered necessary to continue the inspection according to the results of regular inspection.
(2) Students who return to school after being seriously ill, seriously injured or suffering from infectious diseases.
(3) during the epidemic of infectious diseases, it is considered necessary to check.
(4) Before participating in strenuous sports or competitions and accepting long-term physical exercise.
(5) Students with poor academic performance or sudden decline in academic performance are proved to be caused by intellectual or physical and mental problems.
(six) other times when it is considered necessary to carry out temporary health examination.
(2) Health examination methods.
1. At school:
(1) School doctors or individual doctors or parents of students who practice medicine will come to the school for inspection.
(2) The Education Bureau will coordinate with the Health Bureau and regularly invite specialists to form teams to visit the school (at present, Taipei City, Kaohsiung City, Keelung City, Taipei County, Taichung County and Taichung City are handled in this mode).
(3) The school signs a contract with a hospital or a health check-up clinic, and after it is reported to the local government health bureau for verification, the medical staff will go to the school to handle it (at present, some colleges, high schools and higher vocational colleges are handled in this mode).
2. In the medical unit:
(1) Students go to the medical unit to check themselves, and then send the health check record card back to the school (the health check record card can also be printed by each school).
(2) The time is arranged by the school and the medical unit, and the students collectively go to the hospital for examination during the winter and summer vacations or after class.
(3) Preparation for school health examination.
Before the physical examination, everything should be carefully prepared to avoid being caught off guard and affecting the work.
1. Personnel arrangement: Health examination should be listed as an important work of school administration, so the principal should first have a deep understanding and arrange it on the important calendar of the school, hold a meeting in advance to convene relevant personnel to discuss the health examination plan, and more importantly, effectively supervise.
(1) leader of health group or sports health group: draw up a plan first, and the plan is responsible for preparation. The contents of the plan shall include the date and time of inspection, the number of people to be inspected, the order of inspection classes, the layout of the venue, the employment of inspectors (contacting relevant staff outside and inside the school), the budget of funding sources, inspection methods, recording methods, personnel arrangement, the production and interpretation of health record cards, and
(2) Class-level tutors or teachers: prepare class health examination record cards, and explain the significance, value and items of health examination to the whole class before the examination, so that students are willing to accept the examination, and take this as an opportunity to establish the concept that students attach importance to health examination. At the same time, have a comprehensive and correct understanding of the names and meanings of the items on the record card. If in doubt, you can ask the health team leader or medical staff in advance to guide the students at any time, and you should be present to maintain order.
(3) Nursing staff: arrange inspection places, prepare inspection equipment, organize students' files, hand over students with health problems to doctors for detailed inspection, and assist doctors in various inspections.
(4) Physician: The school doctor's examination is the most appropriate. If there is no school doctor, you can hire an off-campus doctor to participate, and the local health care hospital doctors or parents can provide the best support. Education authorities can also regularly invite experts (such as physicians in internal medicine, surgery, ophthalmology, otolaryngology, dentistry, etc.). ), according to the date of the tour (at present, Taipei City, Kaohsiung City, Keelung City, Taipei County, Taichung County, Taichung City all implement this method).
(5) Health team members: Senior health team members can assist in the inspection and improve their interest and enthusiasm for health services.
(6) Parents of volunteers: Parents of volunteers (volunteers) recruited by the school help school nurses to make all kinds of preparations and assist in the examination, so that they can have an overall health concept because of participating in the health examination, and then pay attention to their children's health, so as to promote the ideal of universal health care.
2. Layout of inspection site: If the campus health center is spacious or the number of students is small, it will be held in the health center, otherwise the auditorium or related classrooms can be used. However, attention must be paid to indoor lighting, ventilation and temperature to meet sanitary conditions. Indoor inspection equipment should be arranged according to the procedures of inspection items, and signs should be set. However, the order of inspection often affects the speed of work. For example, if it is necessary to take off your clothes, arrange them together to avoid unnecessary waste of time. Moreover, the inspection speed of various items is different, and if there is proper deployment, the efficiency can be improved. (See Figure 3- 1)
3. Preparation of inspection equipment: The inspection equipment should be prepared in advance by the nursing staff. First, check whether the instruments are complete, whether the quantity is sufficient, whether the instruments are correct, and whether the sterilized instruments have been disinfected. These must be checked in advance.
4. The arrangement of inspection time should be announced in advance according to the inspection order and predetermined schedule, so that students and teachers can be psychologically prepared. Teachers should call students five minutes in advance to explain matters needing attention, so that the work can proceed smoothly.
5. Inform parents of students to have health check-ups at school, and ask parents to help fill in the basic information, vaccination history, family history, personal history, pre-school health history and other necessary information in the health record card in detail.
The preparation mentioned above is very important. If it can be done, it can be said that it is a good start for physical examination, and it can also show that principals and teachers attach importance to students' health.
(4) Health examination items:
General school health examination items include: height, weight, vision, color discrimination, hearing, head web, tinea capitis, parasites, eyes, ears, nose, throat, spine, deformity, skin, limbs, hernia, cryptorchidism, heart, respiratory system, urine (urine protein, urine sugar, blood), mouth.
(5) Health examination methods
There are many items of health examination, each of which has certain techniques, methods and standards, some of which must be implemented by specialized medical personnel. However, some items, such as height, weight, vision, hearing, color discrimination, head webbed, etc., can be taken by the school health team leader, nurses and tutors, and students can check them regularly. Health check items and measuring points are as follows:
1. Height: measured once every semester, preferably in the morning. Key points of measurement:
(1) Let the students stand barefoot on the altimeter, with their heels closely connected and upright, so that the occipital bone, back, arms and heels are close to the measuring ruler, and their eyes look straight ahead. The horizontal plate of the altimeter slightly touches the top of the head, at right angles to the measuring ruler of the altimeter, and the ear line is parallel to the horizontal plate. (See Figure 3-2)
(2) The measurement result is in centimeters, rounded to one decimal place.
2. Weight: measured once every semester, the main points of measurement:
(1) It is best for students to take measurements two hours after meals. Take off your coat, shoes, hat, etc. Wear sportswear barefoot, first set the scale to zero, then stand on the scale and don't shake it.
(2) The measurement result is in kilograms, rounded to one decimal place.
3. Vision: Check your vision with an E-shaped eye chart or a C-shaped eye chart (also known as an international eye chart).
(1) The checkpoint is at the standard distance from the target (test distance: six meters in Snellen's E diagram and five meters in C diagram).
(2) Gently cover one eye with an eye patch (white paper, etc.). Be careful not to press the eyelid and remind the client not to close his eyes. It is customary to cover the left eye to measure the right eye first, and then cover the right eye to measure the left eye.
(3) Ask the examinee to read or compare the notch direction of the target pointed by the examiner. When indicating the sight, you can choose a straight sight from top to bottom until you confirm the smallest sight that the examinee can see, and then let the examinee confirm other sights in the same row. If everyone can see it, the visual value of the column (such as? Seven, six/eight? 5) It is the eyesight of candidates. If there are any unrecognized targets in a column, move the previous column (larger target) to continue the inspection.
(4) If the examinee puts the highest visual standard (○? 1) If you can't recognize them, your eyesight is below ○? One.
(5) Those who wear glasses should first take off their glasses to check their naked vision, and then measure their vision (corrected vision) in the same way. Because it is inconvenient to take and wear contact lenses, people only need to measure and correct their vision.
4. Listening: There are many ways to check listening. But no matter which inspection method is adopted, it needs to be carried out below 40 decibels. Common methods that are easy to implement in schools and have correct results are introduced as follows:
(1) tuning fork test method: use 5 12 Hz (C2) tuning fork (to test whether there is low-frequency hearing impairment) and 4000 Hz (C5) tuning fork (to test whether there is high-frequency hearing impairment). After hitting the tuning fork with a tuning fork, immediately put it three centimeters next to the ear bead of the subject and let him pay attention. If the subject hears the sound, raise his hand immediately, if not, put it down immediately. Because of the different impact force and test environment, the standard of listening "duration" can be determined by the average of listening duration of two or three normal hearing people. Recording method:
Left measurement seconds/normal seconds Right measurement seconds/normal seconds
Left measurement seconds/normal seconds Right measurement seconds/normal seconds
(2) Electric audiometry: It is a correct method to check listening with an electric audiometer. When testing, we should explain the steps to the subjects first, and then put headphones on their ears to make them concentrate. If you hear a sound, you should immediately raise your hand and press the button, and then adjust the loudness of the hearing tester frequency to test how loud they need to hear at a certain frequency. This is a binaural test, and the results are recorded in decibels (abbreviated as dB) on check card. There are usually seven frequencies (500Hz, 1000Hz, 2000Hz, 3000Hz, 4000Hz, 6000Hz, 8000Hz, etc. ) and 30dB are used as the standards for the school to check the children in groups. Students who can't hear within this standard should do further individual examination to determine their listening level.
5. Color discrimination: To check the color discrimination, you can use Ishihara's color blindness check book to read the numerical results in each chart and get the abnormal color discrimination. How to use this checkbook:
(1) Pay attention to the distance and lighting conditions when using various instruments.
Distance: 75 cm. If it is too close or too far away, the numbers in the table can't be seen clearly for the visually impaired.
10. Illuminance: 500Lux, not too high. Natural light or white fluorescent lamps are suitable. If light bulbs are used, transparent light bulbs are not allowed.
(2) When checking, the numbers should be selected from the chart 1 to the chart 12 in turn. Among them, chart 9 is read as 4, and if it can be seen more clearly from chart 8, it is normal.
(3) Read the figures within three seconds when reading the picture. If you find mistakes immediately after reading it, it is normal to correct them immediately. Charts 1 1 and 12 shall be drawn by the inspector according to the drawings, and the time shall be completed within 20 seconds.
6. Head check: once every semester or randomly, the main points are:
(1) Turn the subject's hair from the back of the neck to the front of the hair. If you find a white spot, flick it with your finger. If you can't bounce off, use your thumb and forefinger to pull out the white spot along your hair and press it with your nails. If there is water running out or a sound is heard, it is a webbed egg.
(2) In severe cases, slugs can be seen crawling.
7. Parasite inspection (at present, pinworm inspection is the main method), and its work points are as follows:
(1) Promote parasite control.
(2) Issue inspection supplies and list inspection items.
(3) Promote the use of adhesive tape for pinworm inspection.
(4) Check the administration twice every semester, and master the prescription. Those who are positive should take the medicine immediately and fill in the medication report within three days.
(5) Family members of pinworm-positive patients should make a notebook and give it to the health unit at the same time to prevent the environment from being infected again.
8. Urine screening, its key points:
(1) Be sure to contact the payee and inform the date and time of collection.
(2) Pay attention to whether the students really take home the leaflets informing parents about the matters needing attention in medical examination.
(3) List the students who have undergone physical examination, and pay attention to the reasons why the students have not been sent for inspection, and pay attention to the make-up exam at the same time as the students with positive re-examination.
(4) Pay attention to the preservation of specimens, and don't keep them in a cool place for too long, and pay attention to the authenticity of specimens (students often pretend to be water, tea and other things).
(5) Health education and follow-up for students who re-examine and need accurate urine test.
9. General inspection: In addition to the above inspection methods, the school health team leader or class tutor should also be familiar with and master the following two items. These methods are as follows:
(1) Body temperature: Body temperature can be divided into three types: oral temperature, anal temperature and axillary temperature. Generally, oral temperature is easy to implement and the result is correct. Unless it is not suitable for oral temperature (such as coma, children under six years old, etc.). ), changed to axillary temperature or anal temperature, usually measured by oral temperature. The measurement method is to drop a mercury column on the oral surface below 35C or 94F, then place the oral surface under the tongue root of the students to be measured, close the lips for two to three minutes, and take out the reading. At present, manufacturers have introduced ear temperature guns, and the detection time only takes one second. Schools that have obtained funding permission can purchase and use them.
(2) Pulse: Usually measure the radial artery near the wrist, that is, touch the radial artery on the thumb side of the wrist with the index finger and middle finger to measure the pulse number in one minute. The average pulse rate of adults is about 70-80 beats per minute.
(3) Blood pressure: Portable or vertical mercury sphygmomanometer can be used to measure blood pressure. Fix the pulse pressure band above the second finger of the elbow joint, gently place the stethoscope on the radial artery of the elbow joint, press the pressure ball until the sound stops, and then slowly deflate. Blood pressure is a kind of pressure caused by the impact of blood flow on the blood vessel wall. When the heart contracts, the pressure in the blood vessels increases. The first blood pressure measured at this time is called systolic blood pressure (commonly known as hypertension), and the pressure drops when the heart relaxes. The second blood pressure measured at this time is called diastolic blood pressure (commonly known as low pressure). Normal blood pressure: adult: systolic blood pressure is between 90- 140mm/Hg, and diastolic blood pressure is between 60-90mm/Hg. Children's systolic blood pressure is 90- 100 mm/Hg and diastolic blood pressure is 50-70 mm/Hg.