Module 1

June 3, 2024
0
0
Зміст

 

Methodological Instructions to Lesson 4 for Students

(practical lesson-6 hours)

Themes:

1.      Inquiry and general inspection of patients with pathology of cardiovascular system.

2.      Examination of pulse and blood pressure.

3.      Inspection and palpation of a heart region. Determination of relative and absolute cardiac dullness borders by percussion.

 

Aim: To study peculiarities of inquiry and general examination of patients with cardiovascular system diseases. To be able to make correct interpretation of signs of cardiovascular system disorders. To master methods of examination of pulse and taking arterial blood pressure by N. Korotkov. To perform auscultation of vessels and make interpretation of revealed data. To master in performance of inspection and palpation of big vessels and heart region as well determine relative and absolute heart borders, heart transverse diameter and width of vascular bundle by percussion. To make correct evaluation of obtained data.

 

            Professional Motivation:

 Professional orientation of the students: The fundamental of a propedeutics of inner diseases is physical examination (questioning, examination, palpation, percussion) of a patient, including patients with pathology of cardiovascular system. Cognition of real disease is impossible without detailed review and examination of the patient. It’s show the big value of data skills not only in therapeutic clinic but in the professional working of the doctors different specializations.  Every doctor must know how to measure the blood pressure and arterial pulse. It is impossible to put the right diagnosis without these investigations, especially, during the diagnostic of cardiovascular disorders.

 

І. Practical work – 900-1200

Visual Aids and Material Tools: Tables, slides, compact-disk

 

Methodics of Student s Practical Activitiy:

І. Inquiry and general inspection of patients with pathology of a heart and vessels.

Work 1. Students independently perform examination of a patient with disease of cardiovascular system, perform inquiry and general inspection of the patient

Work 2. Students record obtained data as a part of a Case History.

ІІ. Examination of pulse and taking blood pressure.

Work 3. Students examine pulse on radial artery each on other and measure blood pressure

Work 4. After mastering in skills of determination of pulse properties and measurement of arterial pressure in a healthy individual students have to  train these skills during examination of patients with various diseases of cardiovascular system and to record obtained results on a temperature paper.

ІІІ Inspection and palpation of precordial region. Determination of relative and absolute heart dullness borders by percussion.

Work 5. Under the teacher’s control students perform inspection and palpation of heart region and big vessels each on other, after that they determine heart borders, heart transverse diameter and width of vascular bundle.

During of execution of the procedure students are mastering in communicative skills:

1.Friendly facial expression and smile.

2.Gentle tone of speech.

3.Greeting and introducing

4.Physical examination of a patient

·         Taking patient’s concent for examination

·         Prepare for the examination (natural sufficiernt lighting in the room, clean and warmhands of a student, cut nales, dermograph, ruler)

·         Execution of patient’s examination: evaluate by percussion the width of heart vascular bundle with a ruler.

5.Explain to the patient results of his/her examination correctly and accessibly

6.Conversation accomplisment.

Work 6. Students make interpretation of obtained results and record them as a part of a case history.

Du2.ing of execution of the procedure students are mastering in communicative skills:

1.Friendly facial expression and smile.

2.Gentle tone of speech.

3.Greeting and introducing

4.Physical examination of a patient

·         Taking patient’s concent for examination

·         Prepare for the examination (natural sufficiernt lighting in the room, warm ambient temperature, silence, clean and warmhands of a student, cut nales, dermograph, ruler)

·         Execution of patient’s examination: by percussion determine the right border of relative cardiac dullness, the left border of relative cardiac dullness, the upper border of relative cardiac dullness, the right border of absolute cardiac dullness, the left border of absolute cardiac dullness, the upper border of absolute cardiac dullness.

5.Explain to the patient results of his/her examination correctly and accessibly

6.Conversation accomplisment.

 

Students¢ Independent Study Program

І. Inquiry and general inspection of patients with pathology of a heart and vessels

1.        Complaints typical for diseases of cardiovascular system.

2.        Forced postures and facial expressions typical for diseases of cardiovascular system 

3.        Changes of skin colour in these patients.

4.        Heart edema, their determination, control of dynamics.

5.        Principles of care of patients and first aid for patients with acute cardiovascular failure.

ІІ Examination of pulse and taking blood pressure

1.      What is arterial pulse and places of its palpation.

2.      Methods of examination of arterial pulse.

3.      Methods of examination of arterial blood pressure.

4.      Principles of blood pressure determination by Korotkov’s method.

5.      Normal and elevated level of blood pressure.

6.      Auscultation of vessels.

ІІІ Inspection and palpation of precordial region. Determination of relative and absolute heart dullness borders by percussion

1.      What is cardiac hump and its diagnostic value.

2.      Which peculiarities of apex beat may de examined by palpation?

3.      Changes of apex beat in exaggerated hyperthrophy of the left ventricle.

4.      What is absolute and relative heart dullness borders?

5.      Sequence of percussion of heart borders?

6.      Normal position of borders of absolute heart dullness?

7.      Normal position of borders of relative heart dullness?

8.      Width of vasscular bundle in norm?

9.      When square of heart dullness can change?

 

ІІ. Seminar Discussion of pracrical work – 1230-1400 (2 hours)

Examples of real-life situations.

1.                                                                                                                                                                  Patient K., 52 years, has critical condition. He has complaints of frequent attacks of suffocation. The face is swelling, yellow-pale with a touch of dark-blue, mouth is open, lips are cyanotic, and he can hardly keep his eyes open. What does the patient look?

2.                                                                                                                                                                  Draftee is growing pale and loss consciousness during the taking of blood analysis. What is testifying about? What is the first-aid treatment?

3.                                                                                                                                                                  Patient M., 62 years, has the chronic heart failure. The condition is critical. The posture in the bed: he stay in the bed supporting with pillows, foot are go down. What is the posture of this patient?

4.                                                                                                                                                                  Patient A., came to the clinic with diagnosis: hypertension disease, II stage, crises.  What are the properties of a pulse?

5.                                                                                                                                                                  Patient M., came to the surgical department with diagnosis: ulcer of duodenum, with hemorrhage. What are the possible properties of a pulse?

6.                                                                                                                                                                  Patient S., has systolic sound at a aorta during the auscultation. The pulse is small, slow. What will be arterial pressure?

 

Answers on real-life situations:

1.       The Karvizar’s face.

2.       About loosed consciousness.

3.       Orthopnoe.

4.       Pulse is hard, full.

5.       The pulse is thready.

6.       Decreasing of blood pressure.

 

§  Discussion  of theoretical questions

 

Final level of knowledges and skills

Students must know:

1.      Complaints typical for diseases of cardiovascular system, their pathogenesis.

2.      Peculiarities of general inspection of patients with cardiovascular pathology.

3.      Signs of heart edema and their pathogenesis.

4.      Physiological basis of the method of examination of arterial pulse and blood pressure.

5.      Rules of determination of  arterial blood pressure.

6.      Methods of determination of  arterial blood pressure.

7.      What is pulse pressure and its diagnostic meaning.

8.      Method of determination of absolute and relative heart dullness borders.

9.      Method of determination of vascular bundle width and heart transverse diameter.

 

Students should be able to:

1.      Examine a patient: take anamnesis, carry out inspection of a patient with diseases of cardiovascular system.

2.      Determine pulse and take its characteristics

3.      Measure blood pressure by Korotkov’s method and evasluate the results.

4.      Perform inspection and palpation of precordial region.

5.      Determine absolute and relative heart dullness borders, vascular bundle width and heart transverse diameter.

6.      Make interpretation of results obtained by physical examination of a patient with cardiovascular pathology.

ІІІ. Test control of students knowledge – 1400-1500 (1 hour).

 

Referenses:

Main:

1.      Propedeutics to internal diseases. – Vinnytsya : Nova knyha publ., 2011 .P. 1 : Diagnostics / O. N. Kovalyova, T. V. Ashcheulova. – 2nd ed. – 2011. – 424 p. : fig., tab.

2.      Propedeutics of internal medicine in questions and answers : educational textbook / O.V. Pishak, O. V. Glubochenko, N. M. Malkovych. – Вижниця : Черемош, 2011. – 448 с. 

3.      Barbara Bates. A Guide to Physical Examination and History Taking. 11th Edition, 2012.J.B.Lippincott Company. Philadelphia – PP. 253-284.

4.      Douglas G., Nicol F., Robertson C. Macleod’s Clinical Examination.12th edition , 2007. PP. 80-98, 110-121.

5.      Vasylenko V. Propaedeutics of internal diseases. Mosow, 1987.- PP. 192-205.

6.      Practical Classes Matetials.

7.      Lecture Materials.

 

Additional:

1.      Thompson J., Willson S. Health assessment iursing practice. 4th edition, 2008. – PP. 359-379.

2.      Short Textbook of Medical Diagnosis and Management (Third Edition). Mohammad Inam Danish. – Pakistan, 2002.. PP. 221-225, 269-278.

3.      Bogolubov I. Internal diseases. Moskow, 1987.- PP. 133-140.

 

Prepared by  N. Bilkevych

Is addopted at the chair sitting  07. 06. 2013., Minutes № 11

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Приєднуйся до нас!
Підписатись на новини:
Наші соц мережі