Клиническое обследование (КО). Clinical investigation. Лекция 1

Содержание

Слайд 2

КО состоит из: CI components: Сбор жалоб Aнамнез болезни и жизни

КО состоит из: CI components:

Сбор жалоб
Aнамнез болезни и жизни
Физикальный осмотр
Клиническая диагностика

и постановка предварительного клинического диагноза
(аналитическая и синтетическая часть работы)

Complaints
History of the disease and life
Physical examination
Clinical (primary) diagnostic and conclusion (analysis and synthesis)

The purpose of the physical examination is to look for the presence, or absence, of physical signs that confirm or refute the differential diagnoses you have obtained from the history.

Слайд 3

The clinical encounter (контакт с пациентом) (acquaintance, meet) CE between a

The clinical encounter (контакт с пациентом)

(acquaintance, meet)
CE between a patient

and doctor lies at the heart of most medical practice.
At its simplest, it is the means by which people who are ill, or believe themselves to be ill, search for the help of a doctor.
(Traditionally the clinical encounter is conducted face to face, although non-face-to-face or remote consultation using the telephone or digital technology is possible and increasingly common)
Слайд 4

Showing empathy (демонстрация эмпатии) Being empathic is a powerful way to

Showing empathy (демонстрация эмпатии)

Being empathic is a powerful way to build your

relationship with patients.
Empathy is the ability to identify with and understand patients’ experiences, thoughts and feelings.
Being empathic also involves being able to convey that understanding to the patient by making statements such as ‘I can understand what are you feeling and I quite worried about what this might mean.’
Слайд 5

Starting consultation (начало общения) Introduce yourself and anyone who is with

Starting consultation (начало общения)

Introduce yourself and anyone who is with you,

shaking hands if appropriate.
Confirm the patient’s name and how they prefer to be addressed.
If you are a student, inform patients; they are usually eager to help.
Write down facts that are easily forgotten, such as blood pressure or family tree, but remember that writing notes must not interfere with the consultation.
Слайд 6

Basic knowledge about Disease and Symptoms

Basic knowledge about Disease and Symptoms

Слайд 7

Disease,illness / болезнь Manifestation of the diseases: Symptoms – clinical signs

Disease,illness / болезнь

Manifestation of the diseases:
Symptoms – clinical signs of the

disease
sources: complaints, physical examination
Laboratory findings
Instrumental procedures results
Слайд 8

Symptoms (примеры/examples) Стенокардия - angina pectoris ишемическая боль Изжога - heartburn

Symptoms (примеры/examples)

Стенокардия - angina pectoris ишемическая боль
Изжога - heartburn
Зуд – rush
Кровотечение

– bleeding
Боль , дискомфорт – pain
Слайд 9

We have to know the normal human status !

We have to know the normal human status !

Слайд 10

Clinical examination : Сбор жалоб и анамнеза болезни и жизни Физикальный

Clinical examination :

Сбор жалоб и анамнеза болезни и жизни
Физикальный осмотр
Клиническая

диагностика и постановка предварительного клинического диагноза
(аналитическая и синтетическая часть работы)

Complaints and history of the disease and life
Physical examination
Clinical (primary) diagnostic and conclusion (analysis and synthesis)

The purpose of the physical examination is to look for the presence, or absence, of physical signs that confirm or refute the differential diagnoses you have obtained from the history.

Слайд 11

What are you complaining of? На что жалуетесь? or What is

What are you complaining of? На что жалуетесь?

or What is your main

problem? / Что Вас беспокоит?
3 rules of complaint collection / 3 правила :
Passive collection(hearing)
Active (asking)
Detail of complaints (ask more about each complaint)
Детализация жалоб
Слайд 12

Example Chest pain – passive Precise location – active detail increased

Example

Chest pain – passive
Precise location – active detail
increased by deep breath

in and coughing – active detail
Conclusion: pleural pain
Слайд 13

Characteristics of the pain, Socrates (характеристики боли) Локализация: соматическая боль –

Characteristics of the pain, Socrates (характеристики боли)

Локализация: соматическая боль – четко

локализованная, висцеральная боль – разлитая
Начало – скорость развития боли
Характер – резкая/тупая, жгучая, мучительная/колющая, разрывающая/тянущая
Иррадиация (отдача)
Ассоциированные (сопутствующие) симптомы
Слайд 14

Длительность: однократная, повторяющаяся, постоянная Факторы усиления или ослабления: приём пищи, положение

Длительность:
однократная, повторяющаяся,
постоянная
Факторы усиления или ослабления:
приём пищи,

положение тела,
лекарства
Тяжесть (интенсивность) - субьективная характеристика
Зависимость от времени суток, связь с менструальным циклом.

Characteristics of the pain, Socrates

Слайд 15

Active complaints questions

Active complaints questions

Слайд 16

Active complaints questions

Active complaints questions