Lesson 1

Department of propedeutical pedaitrics Subject: propedeutical pediatrics

Propedeutical pediatrics Module 1: Children development Module 2: Children clinical investigation Module 3: Children nutrition

What do you need? Wrightg book Pen, pencil Phonendo-stetoscope Tape-line (centimetr) White coat Comfortable shoes Mask

Lecture ??????????? Practical classesOff-class job

Topic 1 -The age periods in childhood, and adolescent, their characteristic. -The peculiarities and principles of patients case history collection. -The methods of clinical investigation healthy and sick children. -The whole inspection of healthy and sick child. -The criteria of estimation of whole health state in sick children.

Periods of childhood Prenatal Postnata l Germinative Embrional Fetal Neonatal Infancy Toddlerhood Preschool Schoolage

Subjective data interrogation Complaints Anamnesis morbi (present history) Anamnesis vitae (past history)

Subjective data Complaints: Specific Non-specific

Subjective data Present history: Why When What’s happened What did he do What’s medicines All other…

Examiner asks: 1. Do you have a cough ? And… When did it start? Was it gradual or sudden? How long have you had it? How often do you cough?

Examiner asks: 1. Do you have a cough ? And… Do you cough at any special time of day or just on arising? Does the cough wake you up at night? Do you bring up any phlegm or cough up any sputum? How much? What colour?

Examiner asks: 1. Do you have a cough ? And… Do you cough up any blood? Does this look like streaks or frank blood? Does the sputum have a foul odor?

Examiner asks: 1. Do you have a cough ? And… How would you describe your cough: hacking, dry, barking, hoarse, congested, bubbling? Does the cough seem to come with anything: activity, position, fever, congestion, talking, anxiety?

Examiner asks: 1. Do you have a cough ? And… Does activity make it better or worse? What treatment have you tried? Prescription or over-the-counter medications, vaporizer, rest, position change? Does the cough bring on anything: chest pain, ear pain? Is it tiring? Are you concerned about it?

Another complaints: Ever had any shortness of breath, or hard breathing spells? What brings on it? How severe is it? How long does it last? Do you have any chest pain with breathing? Please point to the exact location.

Another complaints: Any past history of breathing trouble, or lung diseases like bronchitis, emphysema, asthma, pneumonia? Are there any environmental conditions that may affect your breathing?

Additional questions: Has the child had any frequent or very severe colds? Is there any history of allergy in the family? At what age were new foods introdused? Was the child breat-fed or bottle-fed?

Additional questions: Does the child have a cough? Does the child seem congested? Does the child have noisy breathing or wheezing? What measures have you taken to child- proof your home? Yard? Is there any possibility of the child inhaling or swallowing toxic substances?

Subjective data Past history: Pregnancy and Delivery Neonatal period Infancy period Growth and development Family history Social history Epidemic history Alergological history

Inspection The method of observation is used during physical examinations. Inspection, or "looking at the patient," is the first step in examining a patient or a body part.

Palpation The method of "feeling" with the hands is used during physical examinations. The examiner touches and feels the patient's body part with his hands to examine the size, consistency, texture, location, and tenderness of an organ or body part.

Percussion A method of "tapping" of the body parts during physical examination with fingers, hands, or small instruments to evaluate the size, consistency, borders and presence or absence of fluid in body organs. Percussion of a body part produces a sound (like playing a drum) that indicates the type of tissue within the organ. Lungs "sound" hollow on percussion because they are filled with air. Bones and Joints "sound" solid. The abdomen "sounds" like a hollow organ filled with air, fluid, or solids.

Auscultation This method used to "listen" to the sounds of the body during a physical examination can be performed by listening with the ear but is usually done by listening through a stethoscope. Health care providers routinely auscultate a patients lungs, heart, and intestines to evaluate the frequency, intensity, duration, number, and quality of sounds. Health care providers also use auscultation to listen to the heart sounds of unborn infants.