Theme 9: Semiotics of defeats and basic diseases of the cardiovascular system in children
Theme of practical training: Semiotics of the congenital and acquired diseases of heart and vessels in children. Electrocardiography, phonocardiography, sonocardiography
Place: an educational room in the cardiologic department.
Professional orientation of students: Growth of cardiovascular pathology of children's age, especially congenital defects of heart is marked in recent years.The cardiovascular system of child has the row of morphological and functional features, which are necessary to take into account. Knowledge of pathological syndromes in cardiology is very important in work of doctor for the beginning of treatment in time.
Base level of knowledge and abilities:
| № | Discipline | To know |
| 1. 2. 3. 4. | Anatomy Normal physiology Histology Pathological physiology | Development of the cardiovascular system in intrauterine period. Anatomic structure of the cardiovascular system. Knowledge of principles of blood circulation in fetus and newborn Functioning of greater and lesser circulations Histological features of structure of myocardium in different age period of childhood. Basic compensating and adaptation mechanisms of the cardiovascular system. |
Plan of conducting of training:
| № | Elements of practical training | Time (minutes) |
| 1. 2. 3. 4. 5. 6. 7. | Verification of presents. Initial control and its analysis. Theoretical questioning of students. Students independently inspect children with pathology of the cardiovascular system and fill reports of inspection of patient. Working off the receptions of help on of prehospital stage at the sudden stopping of cardiac activity (on sprite). Final control of knowledge. Decision of situation tasks with substantiation of syndrome of disease. Analysis of the decided clinical tasks. Results and final estimation of knowledge and abilities of students and task for independent preparation to a next training. | 5 min. 20 min. 40 min. 60 min. 15 min. 15 min. 5 min. Total: 160 min. |
List of theoretical questions:
1. Basic signs of defeats of the cardiovascular system (cyanosis, bradycardia, tachycardia, shortness of breath, edemas, pain in the area of heart, fatigue ability).
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2. Semiotics of the congenital and acquired diseases of heard and vessels:
a) infringements of cardiac rhythm;
b) symtoms of carditis;
c) congenital heart defects: violation of hemodynamic and symptoms;
d) acquired defects of heart: violation of hemodynamic and symptoms.
3. Syndrome of acute vascular insufficiency:
a) syncope;
b) collapse;
c) shock.
4. Syndrome of acute cardiac insufficiency:
a) degrees of heaviness;
b) left- and right-ventricle types.
5. Help at acute vascular and cardiac insufficiency, sudden stopping of cardiac activity.
6.Care of patients with pathology of the cardiovascular system:
a) regime;
b) diet;
c) dynamic supervision;
Method of conducting of practical training:
1. After verification of presents and announcement of theme of training with pointing on its actuality a teacher conducts the writing initial control
2. Analysis of the executed tests and consideration of errors.
3. Theoretical questioning of students.
4. Students independently inspect children with pathology of the cardiovascular system and fill protocols of examination.
5. Students master skills of the care of children with pathology of cardiovascular.
6. A teacher demonstrates the methods of primary help at the sudden stopping of cardiac activity (on sprites).
7. Students work off tactic of primary medical help.
8. A teacher conducts the final control of knowledge of students on this theme.
9. Decision of clinical situation tasks with substantiation of clinical syndrome.
10. Analysis of the decided clinical tasks.
11. A teacher works out the results of training, gives estimation of knowledge and abilities of students, assigns for independent preparation to a next training.
Forms and methods of self-control.
Test tasks:
1. What auscultative changes characterize defect of ventricle membrane)?
1. soft systolic murmur in 3-4 intercostals on the left
2. systolic murmur in a 2 intercostals business
3. rough systolic murmur in 2 intercostals on the left
4. dyastolic murmur in 3-4 intercostals on the left
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5. rough systolic murmur in 3-4 intercostals on the left*
2. Organic cardiac murmurs differ from functional one by the following signs, except for:
1. intensity of murmur
2. localization of murmur
3. change of timbre depending on position of body
4. depending on rhythm*
5. depending on conducting to the back
3. What disease of cardiovascular system dyspnea-cyanotic attacks are characteristic for?
1. Transposition of the great vessels
2. Ventricular septum defect
3. open duct arteriosus
4. stenosis of pulmonary artery
5.Fallot’s tetralogy*
4.At cardiovascular insufficiency of the IIА degree in child of school age liver is determined:
1. not palpated
2. near the edge of costal arc
3. Enlarge on 2-3 cm*
4. Enlarge on 3-4 cm
5. Enlarge on 4-5 cm
5. What forced position in a bed occupies patient with pathology of the cardiovascular system in cases of decompensation of cardiac activity?
1. position on left side
2. with feet bent to the stomach
3. sitting, dropping feet from a bed*
4. semisitting, opposing on pillows
5.sitting, opposing by hands on thighs
Situation tasks:
Task №1.
3 years old child two weeks ago had respiratory viral. 3 days ago the state of child became worse, a weakness, sickliness, bad appetite appeared. At inspection: a skin is pale, perioral cyanosis. PR – 145 per min., RR – 42 per min. The left border of heart is determined on 3 cm outside from to the midclavicular line. At auscultation fine moist rales above the lungs, systolic murmur on an apex and in a 5 point, soft on a timbre is determined. A liver is on 1,5 cm below the costal arc. On ЕCG: sinus tachycardia, decline of retractive ability of myocardium. Define a pathological syndrome.
Task №2.
At the inspection of 7 years child doctor find following changes from the side of the cardiovascular system: tones of heart are loud, rhythmical, PR – 90 per min., on an apex and in a 5 point is heard short systolic murmur, soft on a timbre which increases in horizontal position and after exertion. A boy often has the respiratory diseases, has chronic subcompensated tonsillitis. What pathology of the cardiovascular system can be assumed? How to consider the auscultation changes?
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Task №3.
A 13 years girl appealed to the doctor with complaints on frequent headache, rapid fatigue ability. At the examinaton: pulse 104 per min., rhythmical, fill. АP – 130/90 mm Hg. An apex beat is determined in 5 intercostals on midclavicular line, resistent. Cardiac tones are loud, rhythmic. Define pathologic syndrome.
Standards of answers:
1. A child have the symptoms of myocarditis, cardiac falure on left-ventricular type of 2B stage
2. Functional murmur on a background of tosilogenic myocardial dystrophy.
3. A girl have the hypertension syndrome.
Hardwares and material providing of training:
1). Table: “Congenital defects of heart” (violation of hemodynamic).
2). Set of test tasks of entrance control (10 copies).
3).Set of situation tasks (10 copies).
4). Methodical developments: “Cardiovascular insufficiency”.
5). Sprites for the working of skills of primary medical help at the sudden stopping of cardiac activity.
Information sources.
А) Basic:
1. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 406-481
B) Additional:
1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. – С-Пб.: Фолиант, 2001. – С.397-424; 456-475.
Program of self-preparation of students to the theme:
1. To learn the basic signs of defeats of the cardiovascular system and know the symptoms of the congenital and acquired diseases of heard and vessels in children.
2. To be able to conduct the supervision after patients with the cardiovascular- diseases: to count up a pulse, frequency of cardiac reductions, breathing frequency and to measure arterial pressure.
3. To be able to give first aid at acute vascular and cardiac insufficiency, sudden stopping of cardiac activity.
4. Pay attention to the basic elements of care of children with the diseases of the cardiovascular system.
Semantic module 8. System of digestion in children
Concrete aims:
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• To collect anamnesis at a patient with diseases of the digestive system.
• To conduct objective examination of organs of digestion at a child, to interpret findings.
• To analyze the basic syndromes of defeat of the digestive system in children.
• To appoint the laboratory-instrumental methods of examination of digestive system.
Theme 10. Anatomic and physiologic features of the system of digestion in children, examination method.
Theme 11. Semiotics of defeats of organs of digestion.
Theme of practical training: Method of clinical examination of organs of digestion (inspection, palpation, percussion, auscultation). Semiotics of defeats of organs of digestion and basic diseases in children. Abdominal syndrome.
Place: an educational room in the gastroenterology department.
Professional orientation of students.There is growth of pathology of organs of digestion in children and teenagers in recent years.The organs of digestion of child have the row of morphological and functional features, without taking into account which the results of clinical examination and put clinical diagnosis cannot be correctly appraised. Knowledge of anatomic and physiologicfeatures of the digestive system enables to organize the rational food mode and care of baby. In work of doctor the important value have practical skills of the method of examination of the digestive system. Recognition of basic symptoms of defeat provides early diagnostics of pathology of digestive channel and allows to choose diagnostic algorithms. Raising of clinical diagnosis is based on the basis of clear knowledge of symptoms of defeats of the digestive system, that matters for the timely beginning of treatment.
Base level of knowledge and abilities:
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