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1) Scheme of division of methods of patient's examination 2) Rules and conditions of general check-up 3) Plan (succession) of general check-up

Lecture № 3Theme: «General examination (check-

up)»

The plan of lecture

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ReadingsSeverity degree

Satisfactory Moderate severity

Grave condition Emergency condition

1) State of consciousness

Clear consciousness

Clear or torpor Clear or clouded consciousness.

Sometimes conscious depression (torpor,

soporific state), delirium

Extremely depressed

(up to coma). Rarely – clear.

2) Position in bed

Active Forced or active;

self-service

Passive of forced patient's position. Inability to self-

service. Psychomotor excitation. Permanent

bedside nursing.

Passive. Motor excitation,

general convulsions.

3) Temperature Normal or subfebrile

temperature

High temperature

Hyperpyretic fever or hypothermia

Various

Severity of the state assessment

3

ReadingsSeverity degree

Satisfactory Moderate severity Grave condition Emergency condition

4) Skin and subcutaneous fat

Normal General oedema. Marked pale skin

or moderate cyanosis

Anasarca. «Chalk-like»

pallor or marked cyanosis.

Ashen (pallid) pinched shape

face with death-damp

(«Hippocratic face»)

5) Cardiovascular system

Normal: pulse 60-90 bpm,

blood pressure (BP)

110-140/60-90 mmHg

Tachycardia (pulse >90 bpm) or bradycardia (less than 60

bmp). Cardiac rhythm

disturbances. Hyper- or

hypotension.

Thread-like pulse, considerable rise or fall in blood pressure (BP).

Only carotid pulse available.

BP can not be detected.

6) Respiratory rate

16-20 per minute More than 20 per minute

Up to 40 per minute

(tachypnea)

Up to 60 per minute

Severity of the state assessment (continuation)

4

ReadingsSeverity degree

Satisfactory Moderate severity

Grave condition Emergency condition

7) Other symptoms

Symptoms of basic disease

Vomiting, diarrhea, gastro-intestinal bleeding.Rapid progress and serious adverse events are highly possible.

Uncontrollable vomiting, profuse diarrhea, massive gastro-intestinal

bleeding (vomiting

«coffe-ground», tarry stool –

melena).Diffuse

peritonitis.

Stertorous respiration during total

pulmonary oedema.Pinky foamy sputum.

Disturbances in respiration: Kussmaul

respiration, periodic Cheyne-Stokes

respiration.

8) Function vitals

Compensated

Decompensa-tion is not hazardous

Decompensation is hazardous and

may result in invalidity

Serious dysfunctions of vitals

Severity of the state assessment (continuation)

5

ReadingsSeverity degree

Satisfactory Moderate severity

Grave condition

Emergency condition

9) Character of disease

Mild form of the disease;

recovery period after acute diseases,

softening after exacerbation of

chronic diseases

Disease with objective and

subjective manifestations

Complications with marked

and progressive clinical sings

Rapid exacerbation,

dangerous acute

complications

10) Medical tactics

Indications for admission to

hospital

Emergency aid and

hospitalization

Urgent hospitalization; transfer to the Intensive Care

Unit (ICU)

Resuscitation department

Severity of the state assessment (continuation)