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Ministry of Health of Uzbekistan TASHKENT MEDICAL ACADEMY "Approved" Vice Rector for Academic Affairs Department: PEDIATRICS GPs Item: P E D I A S T I TECHNOLOGY TRAINING the practical lesson number 12 on topic Cough. SARS bronchitis, treatment and rehabilitation. Uncomplicated pneumonia in children older than 2 years. Asthma, mild course. Diagnosis and treatment in a hovercraft. Rehabilitation and medical examination of children with severe asthma. Acute bronchiolitis, diagnosis, emergency care, and referral to a specialist. Rehabilitation and clinical examination. Compiled by: Yahyaeva KZ - Ass., PhD Medical Sciences Education technology approved: At the faculty meeting minutes № Subject: Coughing. SARS bronchitis, treatment and rehabilitation. Uncomplicated pneumonia in children older than 2 years. Asthma, mild course. Diagnosis and treatment in a hovercraft. Rehabilitation and medical examination of children with severe asthma. Acute bronchiolitis, diagnosis, emergency care, and referral to a specialist. Rehabilitation and clinical examination. 1. Location classes - Department of Pediatrics GPs, hospital. 2. Duration of study subjects Duration of study subjects - 315 minutes 3. Purpose of the lesson To consolidate and deepen the students' knowledge about pain in the abdomen, develop skills of early diagnosis, differential diagnosis and tactics GPs on remediation and clinical examination. 4. Pedagogical objectives: - To teach students the criteria for diagnosis. - Discuss the correct choice of drug correction of basic vital functions of organs and systems. - Demonstrate the principles of differential diagnosis. - Consider the criteria of possible complications. - Organization of specialized advice to the sick child. - To teach students draw up a plan recreational activities. - Introduce to prevention. 5. Learning outcomes The student should know: 1.Chasto common diseases occurring cough syndrome 2.Astmatichesky status, the principles of first aid 3.Printsipy treatment and prevention of bronchitis, pneumonia, asthma in SVP 4.Bronhialnuyu asthma, mild course. diagnosis, treatment in a hovercraft. Rehabilitation and medical examinations of children with severe asthma 7. Acute bronchiolitis, diagnostics, emergency care. Rehabilitation and clinical examination. The student should be able to: 1.Diagnostirovat acute bronchiolitis, to provide emergency assistance and referred to a specialist 2.Naznachit treatment depending on the clinical variant and current bronchitis in a hovercraft. 3.Sostavit plan follow-up and rehabilitation of children who have had bronchitis, pneumonia, asthma. 4. To provide emergency assistance in the attack of asthma 6. Methods and techniques of teaching Brainstorming, pen in the middle of the table, a graphic organizer - a conceptual table 7. Learning Tools Manuals, training materials, patient handouts, video, banner, KVP-Pediatrics. 8. Forms of learning Individual work, group work, team 9. Conditions of Learning Audience, the Chamber 10. Monitoring and evaluation Oral control: control issues, the implementation of learning tasks in groups, performing skills, CDS 11. Motivation Timely outpatient treatment of acute upper respiratory tract, lung flow bronhilnoy asthma, proper medical check-up and rehabilitation of patients with severe asthma, acute pneumonia significantly reduce their transition to severe and threatening condition requiring hospitalization in intensive care units. 12. Intra and interdisciplinary communication The knowledge gained in the departments of children's diseases, physical therapy, anatomy, physiology, allergy, GPs therapy will play a big role in the early diagnosis, timely hospitalization and treatment of children with acute bronchitis, pneumonia, asthma (mild course) in an outpatient setting, and prevent the development of severe complications and respiratory pathology. 13. Contents classes 13.1. The theoretical part Characteristic cough: cough - is a complex, multi-reflector and protective adaptive response of the body designed to disrupt the respiratory tract foreign bodies and / or pathologic tracheobronchial secretions and thus to maintain the effective conduct of the air stream to the respiratory tract. Cough - a dramatic expulsion from the lungs and respiratory air which is delayed before the closed glottis. Cough volume depends on the pressure of exhaled air, and its tone - on the properties and characteristics of the walls of the airways. Coughing occurs when changes in the pharynx, larynx, trachea, bronchi, and pleura and irritation cough center and ear canal. As a reflex act cough can be caused by irritation of the endings of the vagus and glossopharyngeal nerves, located in the mucous membrane of the respiratory tract: pharynx, larynx, trachea and larger bronchi. In the smallest bronchi and alveoli are no such endings, so there is no irritation of nerve endings and there is no cough reflex. Cough is one of the common complaints about which patients seek medical attention. It is generally regarded as pulmonary cough symptom, but you must remember that there are more than 53 causes of cough. Among them are not only bronchopulmonary pathology, but also heart disease, sinus, gastrointestinal tract, the effect of certain medications, and many other conditions. Cough is acute when the duration is less than three months. The main causes of acute cough are infections (pneumonia, acute bronchitis, acute respiratory infections - viral respiratory infections, whooping cough, pleurisy), toxic and mechanical effects (inhalation of toxic substances inhaled irritants - smoke, dust, foreign body bronchus, aspiration). To differentiate the causes of acute cough a careful survey of the patient and the identification of associated symptoms (presence of sputum, rhinitis, fever, fatigue, headaches, muscle aches, etc.). In most cases, acute cough is no difficulty in diagnosis, and short lightweight cough usually does not result in serious consequences. Difficulties arise, as a rule, determine the cause of chronic, poorly corrected by coughing. Duration of chronic cough is more than 3 months. The reasons for its diverse, bronchopulmonary disease (chronic bronchitis, bronchial asthma, bronchial cancer, interstitial lung disease, tuberculosis, postnasal wicking syndrome, lung cancer, metastatic tumors, etc.), extra-pulmonary pathology (tumors of the mediastinum, aortic, mitral stenosis, left ventricular failure , sinusitis, gastroesophageal reflux disease, psychiatric disorders), the side effects of drugs. Types of cough. See the handout Acute respiratory infections - Etiology: parainfluenza types 1 and W, adenovirus 1-W, Y, U11 types of RS-virus, rhinovirus, influenza viruses, and mycoplasma. Clinically manifest as acute rhinitis, acute otitis media, sinusitis, pharyngitis, laryngitis, tonsillitis. Treatment is symptomatic: the daily volume of fluid increases by 1.5-2 times, the room temperature up to 20 degrees. Toilet nose and vasoconstrictive nasal drops to 1-3 day illness. In the first 2 days of use leukocyte interferon 0.25 ml in both nasal stroke every 1.5-2 hours or 2 times a day to prevent contact children. The treatment of influenza A2 - rimantadine - 4.4 mg / kg per day - 2 times a day for children older than 1 goda.Shkolnikam arbidol 0.8 g / day - inside, prevention - 0.2g/sut. When bacterial etiology ARI - antibiotics orally. Bronchitis. - Acute (simple) bronchitis - Acute obstructive bronchitis, bronchiolitis - Acute bronchiolitis obliterans - Recurrent bronchitis (simple) - Recurrent acute oblitiriruyuschy bronchitis (asthma) - Chronic bronchitis obliterans Acute Bronchitis - common manifestation of SARS, occurs without clinical signs of bronchial obstruction. In children, the first half of bronchitis caused by Chlamydia. Preschoolers and school bronchitis accompanied mycoplasma infection - is it different: asymmetry rales, purely catarrhal symptoms of the upper respiratory tract, conjunctival redness century without discharge. Adolescents and bronchitis caused Chlamidia pneumoniae, sometimes as late onset asthma debut. Home treatment: antibiotics, expectorants (marshmallow root extract, potassium iodide, ammonia-anise drops) and mucolytic (mukodin, mukopront, bronkatar,) drugs. Acute obstructive bronchitis, bronchiolitis - proceeds syndrome of bronchial obstruction. For bronchiolitis is abundant finely wheezing and respiratory failure, for obstructive bronchitis - wheezing. Severity was associated with the degree of obstruction. Outpatient treatment to be children with mild. Acute bronchiolitis obliterans - a serious illness or adenovirus immunopathological nature, leading to the obliteration of the bronchioles and arterioles and chronic bronchiolitis with obliteration. The disease is very severe with the increase of respiratory failure, with the outcome in the obliteration after the acute period rales over the affected department does not disappear, and subsequently amplified during SARS. Recurrent obstructive bronchitis, obstructive bronchitis, which are repeated episodes against SARS. Unlike obstructive asthma episodes have paroxysmal character and develop in response to the impact of noncommunicable allergens. Sometimes recurrent episodes may be associated with chronic aspiration of food. In some children recurrent obstructive bronchitis is the debut of asthma. Usually recorded at the age of 3 years, after 4 years of diagnosis was changed to asthmatic bronchitis. Treatments such as the treatment of FIC. In remission - of antitreatment in pulmonary rehabilitation centers and sanatoriums.; Need conservative or operative rehabilitation cron. foci nasopharynx, oral cavity of a sick child and the surrounding family members. The principles of healthy frequently and chronically ill children see dispensing Textiles Bronchial asthma - definition of "repeated episodes of obstruction, which are reversible, either spontaneously or under the influence of therapy" is not quite appropriate for children, as early infancy and there is recurrent obstructive bronchitis. In contrast to the ROB in asthma exacerbations have a character attack and / or developed, at least in some cases, in response to the impact of noncommunicable allergens. In the development of asthma leading role played by bronchial hyperresponsiveness and allergic inflammation of the bronchial mucosa. Violation of bronchial patency is caused by spasm, mucosal edema, and mucus hypersecretion. Severe asthma is characterized by a high degree of airway hyperresponsiveness, high airway resistance to air flow and a sharp decline in the clinical efficacy of drugs bronchodilators. All three components of severe asthma are associated with inflammation in the airways. Diagnosis of asthma. If the medical history reveals: -Frequent bronchitis with allergic manifestations, communications cough or bronchitis sekspozitsiey allergen -Cough, shortness of breath on exertion, anxiety, hyperventilation, leaving the cold, persistent cough, especially the night; Capacity seasonal respiratory symptoms; - Improvements in the state of relocation and the deterioration in returning home; - Occasional feeling of constriction in the chest; - Extrapulmonary allergic manifestations clinically and in history. At present, the diagnosis, monitoring status, identify triggers and assess the effectiveness of therapy in asthma using individual portable peak flow meter, which measures the peak expiratory flow (PEF). Treatment: 1.Lechenie acute phase of asthma. 2.Bazisnoe treatment - Limiting exposure to the allergen, treatment of identified comorbidities that may be associated with the pathogenesis of asthma, pharmacological basic therapy, specific immunotherapy, supporting non-drug therapy, teaching children with asthma and their parents. Prevention of asthma. Primary - the exclusion of occupational exposures and diseases of the mother during pregnancy, prevention of repeated respiratory infections in children, breast-feeding, food-limited allergens, hypoallergenic organization of life and reduction of exposure to chemical agents in the home. Secondary - preventing the manifestation of asthma in children with severe manifestations of atopy (atopic dermatitis, small forms of respiratory allergy.) Tertiary - prevention of asthma worsening, disability and death, provides a set of measures of secondary prevention, effective treatment of the disease attacks and adequate basic therapy. Pneumonia - an acute inflammatory disease of the lung characterized by infiltration of the alveolar exudate and filling, physical and radiological data. Diagnosis: 1. Shortness of breath - 60 per minute in children 1 month. life, 50 min. in children 2-12 months., 40 days in a mine 4.1 years.2. Indrawing of the intercostal spaces, groaning (kryahtyaschee breath) nasolabial triangle cyanosis, signs of toxicosis ("sick" appearance, not eating and drinking, drowsiness, impaired consciousness, severe pallor, elevated body temperature), the state is regarded as a severe pneumonia is more likely. In these cases, you need to send to the hospital. Treatment: antibiotics, antipyretics, antihistamines, resolving and physiotherapy (see Pediatrics. Shabalov N.P.2005) Rehabilitation of children - a gradual increase in physical activity, exercise, combined with breathing exercises. Prevention: a set of socio-hygienic measures, good nutrition, hardening, environmental improvement home, preventing ARI pneumonia vaccination Dispensary observation subject: children with acute pneumonia, with recurrent bronchitis, chronic pneumonia, asthma, respiratory allergies. Acute bronchiolitis is one of acute obstructive bronchitis with the defeat of small bronchi and bronchioles are usually viral. Ill mostly children of the first 2 years: odyka 70-90 breaths per minute, difficulty exhaling with auxiliary muscles vtzheniem compliant places the chest, swelling of the nose, perioral cyanosis. Initially dry cough, haunting, rapidly absorbed into the wet. The chest inflated, over light background ea elongated mass exhalation auscultated fine moist rales. Treatment of hospitalization. First aid, see handout Clinical supervision for children with acute prnevmoniyu see handout Clinical supervision for children who have had recurrent bronhit.sm. the handout Medical check-up for children with asthma, see the handout Emergency care for respiratory failure. See handout USING "brainstorming" The goal: to deepen, expand, refine, consolidate knowledge, translate theoretical knowledge into mental and practical skills, professional skills. The main provisions of the method of "brainstorming." - There were no comments and criticisms, which remove the formation of ideas; - Greeting soaring thought, given that the unusual idea, the better it is; - The combination of ideas and their development; - Brief statement without arguments deployed. Questions: 1. Prevention and treatment of asthma 2. Methods of diagnosis of asthma 3. Treatment guidelines and patient education 5.Pravilo peak flow in patients with and interpretation of its parameters 6. Clinical examination and rehabilitation of patients with SARS, severe pneumonia, bronchitis 7. Clinical examination and rehabilitation of patients with bronchial asthma. Indications for hospitalization and referral to a specialist. 8.Neotlozhnaya help with asthma attacks of asthma in an outpatient setting USING "knob on the center of the table" Objective: ability to expand stereotype, abstract from sushestvenno restrictions develop dynamic mental activity. The main provisions of the method of "pen in the middle of the table" - It is proposed assignment to the group. Each student will write your answer and sends it to a neighbor, and put his pen into the middle. - The teacher controls the group and participation of each student. - The correct version is written in the notebook. The analytical part of - The decision of situational problems - Analysis of clinical cases Case studies: 1.U girls 8 years suddenly after playing with the cat came home wheezing and coughing, and chest ssadnenie. In history - allergic diathesis, grandmother asthmatic bronchitis. Question: How to remove the "spastic" state? Answer: Apply the emergency treatment for asthma attacks. 2. 8 month baby. For the 2nd day of increased cough, increased body temperature to 38 degrees, there was heavy breathing, became restless, refuses the breast. Assess the child. Administer first aid. Determine the location of treatment sick child. 3. Child is 6 months. 2nd day of coughing, increased body temperature to 37 degrees, not quickened breath, calm, from the chest does not give up. Calm sleep. Assess the child. Determine the location of treatment sick child. 3. 5 - year-old child was discharged from hospital with a diagnosis of complications of severe pneumonia. Determine the dispensary group. Make a plan for follow-up and rehabilitation. 4.Rebenok is followed up by a GP with a diagnosis of bronchial asthma is remission. What are the specific treatment, which is carried out in a period of remission. 5. During a night of sleep in 3 years. child appeared "barking" cough. Happy condition remained satisfactory. Your presumptive diagnosis and treatment plan in outpatient settings. 6. The child coughs long (about 1 month). What tactics doctor. 7. The child choking lasted for 1-2 hours. After administration of aminophylline / drip in an outpatient setting. What is your further action. 13.2.2. Graphic organizer. heart Defects diaphragmatic hernia heart failure gastroesophageal reflux Diseases of the cardiovascular system Diseases of the digestive system DDCT Respiratory tract diseases Respiratory diseases Cough iatrogenic causes The impact of drugs bronchial asthma Intubation anesthesia cough caused by kapoten Aspiration of a foreign body Systemic disease of the lungs viscidosis Smoking (passive) 13.3. The practical part Inspection, supervision of children in a doctor's office, who complain of cough. Step by step examination of an infant 14. Control forms of knowledge, skills and abilities - Oral - Decision of situational problems - Demonstration of practical skills - CDS 15. The evaluation criteria of the current control № progress in% 1 96-100% 2 91-95% mark The level of knowledge of the student Full correct answer to the questions on the etiology, pathogenesis, classification, clinic and treatment. Sums up and makes decisions, think creatively, independently analyzes. Situational problems solves correctly, with full justification of the Excellent "5" answer. Actively and creatively involved in interactive games, take the right decisions and summarize. Recipes are written in accordance with the dosage form and with a valid indication of the dose and indications for use. Full correct answer to the questions on the etiology, pathogenesis, classification, clinic and treatment. Excellent "5" Sums up and makes decisions, think creatively, independently analyzes. Situational problems solves 3 4 86-90% 81-85% 5 76-80% 6 71-75% 7 66-70% correctly, with full justification of the answer. Actively and creatively involved in interactive games, take the right decisions and summarize. Recipes are written in accordance with the dosage form is one grammatical error. Full correct answer to the questions on the etiology, pathogenesis, classification, clinic and treatment, but have 1-2 errors in the response. Own analyzes. Inaccurate decisions situational problems, but with the right approach. Excellent "5" Actively and creatively involved in interactive games, take the right decisions and summarize. Recipes are written according to the dosage form, but there are 2-3 grammatical errors. good "4" Full correct answer to the questions on the etiology, pathogenesis, classification, clinic and treatment, but there are 2-3 errors in the response. Own analyzes. Situational problems solved correctly, but not sufficiently justify the answer. Actively and creatively involved in interactive games, take the right decisions and summarize. Recipes are written according to the dosage form, but there are 2-3 grammatical errors. Right, but not the full coverage problem. Student knows the classification, indications for the use of drugs, but not fully versed in the mechanism of action and the development of side effects. Understands the good "4" issue, says confidently, is a faithful representation. Actively and creatively involved in interactive games, take the right decisions and summarize. Recipes are written according to the dosage form, but not completely given indications. Right, but not the full coverage problem. Student knows the classification, indications for the use of drugs, but not fully versed in the mechanism of action and the development of side effects. Understands the good "4" issue, says confidently. On case studies does not give complete solutions. Recipes are written according to the dosage form, but not completely given indications for use, there are 2-3 grammatical errors. The student knows the classification is satisfactorily "3" not complete lists the indications for the use 8 61-65% satisfactorily "3" 9 55-60% satisfactorily "3" 10 50-54% unsatisfactorily "2" of drugs, basic properties, but poorly versed in the mechanism of action. Understands the issue, said confidently, has accurate representations only on specific issues topic. Situational problems solved correctly, but there is no justification of the answer. Recipes are written with the correct indication of the dose, but not all are indications for use and there is an error in specifying the release form. The correct answer to half the questions. Errors in classification errors in testimony to the use of drugs. Tells not confident is accurate representations only on specific issues topic. Making mistakes in solving situational problems. Recipes are written with grammatical errors. The correct answer to half the questions. Errors in classification errors in testimony to the use of drugs. Says not sure there is a partial view on the subject. Situational problems solved is not true. Recipes are written with grammatical errors. Questions not answers. Student does not know the classification, properties of drugs. Does not know the mechanisms of action and side effects of drugs. Situational problems solved is not true. Can not write prescriptions. 16. Flow chart classes № stage of training forms of employment duration 1 Lead-in teacher (study subject) 2 Discussion of homework 3 4 5 6 7 8 Examination of the patient in the clinic or day hospital Improvement of practical skills, work with dummies, clinical and laboratory equipment, devices Discussion of the practical part of the training Discussion of the topic classes, abstract message, seminar, discussion Working in a group. Demonstration videos on the topic, analysis of situational problems, computer programs, business games, etc. The conclusion of the teacher in this lesson. Assessing the students on a 100 point system and its announcement. Dacha assignments to students for the next class (set of questions) Min. 10 The survey, an explanation Patient survey, work with outpatients Working with clinical and laboratory equipment The survey, an explanation Abstract messages, seminar discussion 30 60 60 15 60 Demonstration, interactive forms, 60 active and passive Information, questions 20 for self-study 17. Test questions 1. Prevention and treatment of asthma 2. Methods of diagnosis of asthma 3. Treatment guidelines and patient education 5.Pravilo peak flow in patients with and interpretation of its parameters 6. Clinical examination and rehabilitation of patients with SARS, severe pneumonia, bronchitis 7. Clinical examination and rehabilitation of patients with bronchial asthma. Indications for hospitalization and referral to a specialist. 8.Neotlozhnaya help with asthma attacks of asthma in an outpatient setting Tests: 1. Signs of acute pneumonia 1) cyanosis, shortness of breath * 2) finely wheezing * 3) Wired wheezing 4) Cough * 5) nasal discharge, fever 2. Signs of NAM 1) perioral cyanosis 2) Shortness of breath * 3) Rapid breathing * 4) Bradycardia 5) flushing of the skin 3. For bronchiolitis is characterized by: a) the general plight + b) absence of cough c) respiratory rate is 60 to 1 min + d) a box shade percussion e) the nostrils flaring with breathing + 4. When bronchiolitis appoint: a) humidified oxygen + b) fluid therapy c) + prednisone d) aminophylline d) heparin 5. Mark the correct statements about bronchiolitis: A) occurs only in children up to 2 years B) occurs in both children and adults + B) often expressed acute disease + D) changes in the type of obstruction light + D) all wrong Questions with correct answers for self 6. To a part of respiratory diseases in children predisposes FOLLOWING anatomical and physiological characteristics: - Narrow and short upper respiratory tract; - The relative dryness of mucous membranes; - Reduced drainage function of bronchi; shallow breathing; - A deep breath. - Wide and short airways - Moisture content of the mucous membranes - Increased drainage function of bronchi 8. AT atopic bronchial asthma asthma attacks can be triggered by: -Household dust; -Animal hair - Pollen - Aspirin - Antibiotic - Taking vitamins - Reception of sweets 9.TYAZHEST bronchial asthma is determined by: - Lung function; - The frequency of seizures; volume used drugs; duration of seizures. the presence of concomitant allergic skin diseases; inflammation of the intestine exacerbation of chronic tonsillitis allergies to pollen 10.K ASTHMA complications include: pneumothorax atelectasis. fibrosis status asthmaticus intussusception pulmonary heart 11.PRI asthma attacks of respiratory failure due to: bronchospasm hypersecretion swelling of the bronchial mucosa edema of the larynx pulmonary edema. swelling of the brain hypo-secretion bronchodilation 12. Features of the course of asthma attacks in young children ARE: minimum severity of bronchospasm; predominance vazosekretornogo component; abundance of moist rales in the lungs; significant expression of bronchospasm; Pneumonia is 13.POKAZATELYAMI GRAVITY pronounced cardiovascular changes severe respiratory failure the degree of toxicity cough localized wheezing deadened sound 14. Complications of pneumonia is pneumothorax myocarditis acute pulmonary heart cardiovascular changes severe respiratory failure the degree of toxicity Acute pneumonia is 15.SIMPTOMAMI dyspnea cyanosis grunting respiration cough fine moist rales rhinitis sore throat dry rales srednepuzyrchatye rales 16.DLYA streptococcal pneumonia is characterized by regional (bronchopulmonary) lymphadenitis expressed intoxication small bubbling rale suppurative complications (pleuritis, osteomyelitis) acute onset of SARS without prior lobe lesion obstructive syndrome blush on her cheek with one hand 17. According to the classification of bronchitis Divide for acute simple bronchitis for acute obstructive bronchitis for bronchiolitis for recurrent bronchitis of chronic bronchitis for asthmatic bronchitis on toxic bronchitis for allergic bronchitis 18. EASY FOR ACUTE BRONCHITIS Characteristic dry cough at the beginning of the disease cough for 4-8-day sickness dry rales on both sides large bubbling rale increased lung markings on chest radiograph small bubbling rale cough early in the disease deadened sound from one side 19. At a bronchiolitis notes serious condition cyanosis nasolabial triangle emphysema boxed shade percussion fine moist rales no cough respiratory rate no higher than 32 in 1 min bradycardia absence of emphysema 20. TYPICAL OF ASTHMA CLINIC IS ¬ expressed asthma Asthmatic Bronchitis allergic bronchitis Thrust spasmodic cough severe emphysema 18. Recommended Reading Summary 1. Lecture materials 2. Handout More 1. childhood diseases. Shabalov NP, SP, 2005 2. childhood diseases. Baranov AA., SP, 2006 3.Pediatricheskaya gastroenterology. Belousov, Yu.V., 2006 4. syndromic diagnosis in pediatrics. Baranov AA, Ivanovo, 1997 5.Modern drugs. Encyclopedic Reference, M., 2006