Data of physical and instrumental research methods. Introduction what is rehabilitation Patient examination data

Introduction

What is rehabilitation

“A good doctor does not heal a person, but helps a person to be cured,” the ancients said. But this truth is sometimes, to our common regret, forgotten by modern practitioners. Meanwhile, restorative medicine as a "science to resurrect" has existed for many centuries, helping to mobilize the body's hidden resources and activate its defense mechanisms. Thanks to gentle and pill-free methods of restorative (or rehabilitation - in the modern interpretation of the term) therapy, the human body, like a phoenix bird, rises from the ashes of losses, independently coping with illnesses and misfortunes: restores damaged tissues, returns diseased organs to normal functioning, splices bones ... In many cases, restorative medicine is more attractive to the suffering person than conventional medicine. And how could it be otherwise? After all, positive results are literally evident, and negative consequences are practically absent, which cannot be said about most chemical pharmaceuticals taken from the arsenal of official medicine. And time, precious time! Long-term practice of healing shows that the recovery period is significantly reduced, it is only necessary to apply one of the many methods of restorative medicine that suits the case.

What can rehabilitation medicine offer you? In what healing circle will an experienced rehabilitation doctor lead the patient (there is such a rare specialization in official medicine)? The basic methods used in restorative medicine are as old as our world. These traditionally include:

body cleansing. For example, bowel cleansing with hydrocolonotherapy (the famous "Hollywood diet"), blood plasmaphoresis, cleansing with medicinal herbs. Often such a cleansing is the first step to restore and improve the body;

hydrotherapy, or therapeutic baths and irrigation, such as mineral, turpentine, aromatic, hydrochloric, carbonic and others, as well as a sauna and bath, aqua-physical culture, therapeutic courses of mineral waters. Specially selected and prepared liquids wash and saturate tissues with nutrients, help restore the disturbed balance of substances and microelements in the body, treat many diseases - from gastrointestinal and to seemingly intractable female problems, not to mention the fact that they rejuvenate and lead to the desired tone. not only the body, but also the thoughts;

physiotherapy: electrophoresis, iontophoresis, phonophoresis, laser therapy, ultrasound therapy, magnetotherapy, myostimulation, vacuum therapy and so on. All of us at least once in our lives, but visited the physiotherapy department of the district clinic, and there is no need to list here all the available miracles of recuperation: activation of the defense system, metabolism, blood and lymph flow, accelerating regeneration and increasing the overall tone of organs and tissues;

hirudotherapy, or treatment with leeches;

reflexology, or impact on the active points of the human body, activating internal resources;

balneotherapy, or mud therapy;

Numerous therapeutic and restorative massage techniques;

herbal medicine, or herbal treatment, and much, much more.

Consult a doctor, choose a set of procedures for yourself and start working on restoring your health. And do not listen to those who will say that restorative medicine is akin to shamanism, or equate it with alternative medicine. Rehabilitation medicine is a serious direction in modern medical science and has nothing to do with unscientific and unreliable "grandmother's methods". Restorative medicine, using the achievements of modern science, advanced methods of studying the natural capabilities of a person, develops scientifically based techniques and technologies that contribute to the disclosure of the dormant resources of our body, which leads to the improvement of the functioning of all organs and systems, and not only those affected by the disease. And this is serious. All these methods act gently, excluding the paradox of the chemotherapeutic effect, when "we treat one thing and cripple the other." Rehabilitation therapy is based on a simple postulate: “The human body is able to cope with almost any disease on its own, you just need to help it, not interfere with it.” Rehabilitation therapy and helps him in this. Rehabilitation is currently understood as a system of complex measures of a medical, psychological and social nature, aimed at improving a person's adaptation to the requirements of everyday life, work loads. When is her healing support available?

Restorative medicine is appropriate for a very wide range of diseases and injuries. Here is an approximate, and therefore incomplete list of branches of official medicine where its methods are successfully applied: cardiology, neurosurgery, treatment of diseases of the male and female urogenital spheres, obstetrics, endocrinology, treatment of diseases of the gastrointestinal tract, nephrology, pulmonology, traumatology and surgery, treatment neurological diseases and psychiatry, otorhinolaryngology (ear, throat, nose), arthrology and orthopedics, dermatology. After major operations or conservative treatments that require serious intervention in the body, restorative medicine provides quick rehabilitation and helps complete recovery, and in milder cases, you can often do without the help of pills, injections and droppers, and even without the direct intervention of a surgeon.

When is rehabilitation required? As a rule, rehabilitation is needed for patients recovering from an acute illness, injury or surgery, people suffering from chronic diseases, and just those who are exposed to great physical and psycho-emotional stress at work or in everyday life. Moreover, the more serious and severe the disease, injury, surgery, the longer and more difficult the recovery.

Diseases that require rehabilitation:

Vegetovascular dystonia;

Ischemic heart disease, including acute myocardial infarction, condition after coronary bypass surgery;

Hypertonic disease;

Chronic forms of vascular diseases of the brain;

Condition after a stroke;

Chronical bronchitis;

Bronchial asthma;

Chronic gastritis;

Peptic ulcer of the stomach and / or duodenum;

chronic colitis;

Irritable bowel syndrome;

Urolithiasis disease;

chronic hepatitis;

Cirrhosis of the liver;

Chronic pancreatitis;

Diabetes;

Thyroid diseases;

Chronic pyelonephritis;

Diseases of the spine and peripheral nervous system;

Joint diseases;

Diseases of the vessels of the extremities (obliterating atherosclerosis, obliterating endarteritis);

Diseases of the prostate gland;

Breathing disorders during sleep (snoring, sleep apnea);

Insomnia;

Overwork;

chronic fatigue syndrome;

Obesity and many others.

Naturally, in our book we will not be able to consider all of the cases listed, so we will focus on the most, if I may say so, popular ones. Moreover, such an approach is justified by considerations of your safety: each specific case must be considered by a specialist in rehabilitation medicine, and the more severe the condition of a particular patient, the more thorough the medical approach to him should be.

This text is an introductory piece.

The main causes of injuries are road accidents (40%), falls from a great height (30%), and various kinds of injuries (10%). Each injury is fraught with dozens of complications up to death, for example, in the case of sepsis. Some complications make themselves felt instantly, while others are not detected immediately. To avoid serious consequences after injury, it is very important to properly spend the rehabilitation period.

Stages of medical rehabilitation after an injury

Unfortunately, none of us is immune from injury. With some of them, the body copes easily, others require long-term treatment and restoration of lost functions. This primarily applies to complex fractures, injuries to the head, limbs, joints, menisci and ligaments. The injured part of the body is usually motionless for a long time, so swelling occurs, blood circulation is disturbed, muscles atrophy. And this, in turn, causes a general weakening of the body and can provoke the emergence of new diseases. That is why it is so important to take the recovery period seriously.

Rehabilitation after fractures and injuries should take place according to an individual program, but in general it consists of the following stages:

Elimination of vascular changes and edema. These phenomena, alas, are inevitable with prolonged immobility of the limbs or the whole organism.
Increased elasticity and muscle tone. Before moving directly to physical activity, you need to make sure that the muscles are ready for this, otherwise the return to the usual way of life can become too painful.
Recovery of motor functions. The process should be progressive and not involve excessive physical exertion. This will avoid sprains and physiological stress.
Strengthening the general condition of the body - observing the daily regimen and nutrition, staying in the fresh air. These recommendations must be followed throughout all stages of rehabilitation, since the pace of recovery largely depends on this.

Abroad, medical rehabilitation began to develop in the middle of the 20th century, when it became necessary to restore and adapt to the life of participants in the Second World War. Later, this direction "took" elderly people, disabled people, patients who had serious illnesses and injuries under their care.
In Russia, the first rehabilitation clinic appeared in 1976. It was a specialized drug rehabilitation center. Since then, this area of medicine has been successfully developing in our country, developing its own methods and taking into account foreign experience.

Rehabilitation Therapy Methods

The main place in restorative medicine is occupied by physical rehabilitation. It involves the complex use of both physical exercises and influences, as well as natural factors. This type of rehabilitation is aimed at restoring the functions of damaged organs, adaptation after injuries, involvement in the usual way of life. Consider in more detail the methods of physical rehabilitation therapy:

Massage - one of the most common methods of rehabilitation after injuries. Most often used for strokes, fractures, osteochondrosis. Therapeutic massage is stroking, rubbing and kneading individual parts or the whole body. It stimulates blood circulation, relieves swelling, activates muscles and is an excellent preparation for exercise therapy. The course of therapeutic massage usually includes 10 sessions, it is recommended to conduct them daily or every other day.
Therapeutic exercise (LFK) - This is a specially designed set of physical exercises performed under the supervision of a specialist. They help eliminate degenerative changes in tissues and organs, and help to cope with atrophy. Exercise therapy contributes to the normalization of metabolism, improves the functioning of the cardiovascular system, strengthens muscles and, in general, “calms” the nervous system and improves mood. It is important not to overdo it: you should do it according to the program developed by the doctor.
Mechanotherapy is an addition to exercise therapy - these are the same exercises, but they are performed by the patient not independently, but with the help of special devices (Armeo, Locomat, Pablo, Gyrotonic designs). This allows you to improve the mobility of joints and muscles, cope with atrophic and degenerative processes, and restore functions lost as a result of injuries. Exercises should be performed under the supervision of a specialist. Only he can correctly install and fix the body segment on the structure, correctly select the load and correctly assess the pace of the movements performed.
Physiotherapy - this is a restoration with the help of physical factors: heat, magnetic radiation, electric current, light, air and others. The method involves the use of special instruments and apparatus.
In case of violation of motor activity, electrical stimulation is used, that is, current. Heat treatments, such as paraffin baths, are used in recovery from spinal injuries. Laser therapy helps eliminate pain and swelling, and magnetotherapy improves the general condition of the body. These procedures are painless, but some of them have a number of contraindications, so physiotherapy treatment is selected individually.
Reflexology - this method consists in influencing biologically active points on the patient's body. The direction originated several millennia ago in the East and is now popular all over the world. Reflexology has several methods: acupuncture (acupuncture), treatment with leeches (hirudotherapy), impact on the points of the auricles (auriculotherapy), acupressure, stone massage (snow therapy), cupping massage (vacuum therapy). The essence of reflexology is to mobilize the internal resources of the body and involve them in active participation in the healing process.
diet therapy - catering with the use of certain products for medicinal purposes. So, with fractures, collagen contributes to the process of bone fusion. It is found in jelly, aspic dishes of fish and poultry. Calcium is needed for bone formation. A large amount of it is present in dairy products, especially low-fat cottage cheese. And calcium absorption is promoted by vitamin D3, it is abundant in fish oil, caviar, sesame, egg yolk, nuts. And, of course, it is useful to eat fresh vegetables and fruits - they have a lot of vitamins and fiber. But it is better to forget about semi-finished products containing preservatives, alcohol and carbonated drinks: they cause great harm to the body, and not only during the rehabilitation period.

A special method of therapy after trauma is occupational therapy- a branch of medicine aimed at restoring and maintaining the necessary life skills. Literally, the term is translated as “treatment through labor, employment” (ergon (lat.) - labor; therapia (Greek) - treatment). After injuries and fractures and the immobility associated with this, the patient may lose basic self-care skills. He needs to re-learn how to dress, put on shoes, hold cutlery, and maintain personal hygiene. Often a person who has suffered a trauma also needs social adaptation. In this he is supported by an ergotherapist, who helps him re-learn fine motor skills, develop coordination, and adapt to everyday life. The doctor can ask the patient to draw a picture or tie shoelaces, and based on these mini-tests, he will determine what exactly the person needs help with, what movements need to be mastered. This rehabilitation method has been known in the West for over 60 years. But in our country, it has become widespread relatively recently.

Each of the methods described above is applied taking into account the nature and characteristics of the injury. We will talk about this further.

Features of rehabilitation after injuries of various nature

Spinal injury

They can be obtained as a result of bruises, falls, squeezing and other influences. This is one of the most dangerous types of mechanical damage, as it can lead to extremely serious consequences: disruption of the spinal cord pathways. The latter entails immobility and loss of sensation.

The program and terms of rehabilitation depend on the severity of the injury, as well as on the individual characteristics of the patient.

The initial stage of rehabilitation should be carried out in the first days after the injury. First of all, the patient must be helped to take the correct position on the bed, the occurrence of bedsores and congestion in the lungs should be prevented. Patients who have sustained a spinal injury are also immediately prescribed breathing exercises and dietary nutrition.

At the third stage, the set of exercises changes: swimming in the pool can be added to physiotherapy exercises, physiotherapy and mechanotherapy. To restore lost skills, classes are held with an ergotherapist.

Traumatic brain injury

The terms of rehabilitation and the complex of rehabilitation therapy for such injuries depend on the severity of the injury. With mild craniocerebral injuries - subject to the regimen, proper nutrition and physiotherapy - recovery usually occurs within a month and does not require additional rehabilitation measures.

As for severe and moderate craniocerebral injuries, they can cause difficulty in movement, it becomes difficult for patients to take care of themselves. Speech disorders may occur, vision may decrease. Massage, exercise therapy and physiotherapy will be effective already at the first stages of rehabilitation.

Injuries of the musculoskeletal system

This type of injury includes fractures, cracks, joint injuries, dislocations, ruptures of muscles and tendons, sprains. During the early rehabilitation period, patients are individually prescribed physiotherapy to help get rid of edema, exercise therapy and mechanotherapy. Therapeutic massage will also help.

As we have seen, rehabilitation after injuries and fractures is a complex process. It consists of a complex of methods of rehabilitation therapy. Only a specialist can create an individual program.

Introduction
What is rehabilitation

hirudotherapy, or treatment with leeches;

reflexology, or impact on the active points of the human body, activating internal resources;

balneotherapy, or mud therapy;

Numerous therapeutic and restorative massage techniques;

herbal medicine, or herbal treatment, and much, much more.

Diseases that require rehabilitation:

Vegetovascular dystonia;

Ischemic heart disease, including acute myocardial infarction, condition after coronary bypass surgery;

Hypertonic disease;

Chronic forms of vascular diseases of the brain;

Condition after a stroke;

Chronical bronchitis;

Bronchial asthma;

Chronic gastritis;

Peptic ulcer of the stomach and / or duodenum;

chronic colitis;

Irritable bowel syndrome;

Urolithiasis disease;

chronic hepatitis;

Cirrhosis of the liver;

Chronic pancreatitis;

Diabetes;

Thyroid diseases;

Chronic pyelonephritis;

Diseases of the spine and peripheral nervous system;

Joint diseases;

Diseases of the vessels of the extremities (obliterating atherosclerosis, obliterating endarteritis);

Diseases of the prostate gland;

Breathing disorders during sleep (snoring, sleep apnea);

Insomnia;

Overwork;

chronic fatigue syndrome;

Obesity and many others.

Chapter 1
How to quickly return the joy of life after the flu and colds

No one in the world is protected from the causative agents of influenza and other colds. Everyone catches a cold and flu: men and women, fair and dark, big and small. You can catch a cold at any time of the year, but most often the disease strikes in cold weather (“flu season”), when frost, rain, wind and slush knock us together, drive us into cramped rooms, and - always unexpectedly, at the wrong time. And it manifests itself differently for everyone, although it has a common feature: patients can often quite accurately indicate the beginning of their disease. The source of infection is usually a cold person, and not only during the period of illness, but also after his recovery, remaining a carrier of the virus for up to 5-7 days, and sometimes up to 10 days from the moment of illness. When coughing, sneezing, talking, particles of saliva, mucus, sputum with pathogenic microflora are ejected from the nasopharynx of a human carrier, and for a short period of time a zone of infection dangerous for others is formed around it with a maximum concentration of viruses in the air. In it, the infection of the contacting person occurs. In the language of specialists - "by airborne droplets."

The severity of a cold can be judged by the temperature curve of the patient:

mild form: moderate temperature, up to 38 ° C, general malaise, weakness, lethargy, sweating, headaches and muscle pain. On the second day, a runny nose joins, dryness and sore throat, cough may appear;

moderate form: the temperature rises to 39.5 ° C, there is a strong fever, chills, all cold symptoms increase;

severe form: high, up to 40 - 40.5 ° C, temperature. To the existing symptoms of a cold, signs of intoxication of the nervous system are added - convulsive seizures, hallucinations, mild impairment of consciousness, delirium. There may be nosebleeds, hemorrhages on the mucous membranes and vomiting.

In addition, one of the varieties of the common cold - the flu - is able to proceed in a lightning-fast form, in which there is a serious danger of a lethal (fatal) outcome for the patient. This form of influenza is characterized by a persistent increase in temperature to extremely high numbers and clinical manifestations similar to the symptoms of meningitis, but without an inflammatory reaction of the membranes of the brain, passing by infectious disease specialists under the term "meningism".

How not to treat a cold

Our attitude to colds, to put it mildly, is mostly frivolous. Here we are more like Carlson, for whom any trouble is “an everyday matter”, or those characters who seriously think that if you treat a cold, it will pass in seven days, and if not treated, then in a week. Therefore, first of all, let's say a few words about what should never be done with a cold.

You should not be treated on your own, you should definitely consult a doctor, as colds are dangerous with complications.

You should not go to work, college, school, visit public places, so as not to spread the infection among your friends and colleagues.

Antibiotics should not be taken without a doctor's recommendation. The common cold is a predominantly viral disease, it does not respond to antibiotics, and they can cause allergic reactions, stomach disorders, dysbacteriosis and other dubious joys of being.

We forget that if a cold is started on time and treated correctly, it can go away in a couple of days. To treat correctly means not to repeat the mistakes of others. Recall what they are.

The first mistake: we carry the disease on the run, and a cold body should be kept warm for at least the first days. Doctors also adhere to this opinion, which is why they write out an initial sick leave for three days. If you stoically endure the disease on your feet, then you can seriously harm yourself. The cold will pass, but its complications can stay with you for a long time.

The second mistake: promiscuity in means. Many drugs relieve only the symptoms of the disease: reduce fever, headache, cough, but do not eliminate the cause of the disease. In addition, medical statistics have long known that the risk of unpredictable effects of two simultaneously consumed drugs is 10%, three - almost 50%, and five or more - 90%. Hence the conclusion: it is necessary to take the disease not by quantity, but by the quality of treatment, which is hardly possible without medical advice.

The third mistake: we rarely read instructions. The same drugs work differently on different people. There are no identical people in nature, and therefore allergic and other adverse reactions when using any drug are not excluded. Information about such possible consequences is contained in the package inserts for the medicine. Read them carefully. If the drug is available without a prescription, the instructions usually indicate the period of its non-prescription use, after which its use should be stopped or consult with your doctor about your further actions.

The fourth mistake: self-administration of antibiotics. According to medical science, in half of the cases of colds, the use of antibiotics in the treatment is not justified. The danger of their abuse lies in the fact that the uncontrolled use of antibiotics causes the main strains of pathogens to become addicted to them. As a result, when the drug is really needed, it no longer works as it should. Of course, with serious complications, pneumonia or tonsillitis, antibiotics cannot be dispensed with, but a doctor should still prescribe them.

Fifth Mistake: Boundless faith in home remedies. Everything is good in moderation. For example, there are people who cannot tolerate raspberries, they should not take a decoction of its leaves, a recognized anti-inflammatory and diaphoretic.

The sixth mistake: self-diagnosis and self-treatment. Otherwise, it is easy to get into a situation where a person, suffering from pneumonia, thinks that he has caught a cold, and puts cups on himself, which in his condition may be contraindicated, and then is surprised that he ended up in a hospital bed.

The best option, of course, is when a person is not prone to colds. Which is quite within the power of any sane person. Everyone knows that for this you need to lead a healthy lifestyle, play sports, be in good shape, take vitamins. But what if you, for example, are very cold? How to deal with hypothermia?

There are many tips on how to warm up faster, but not everyone should be trusted. Many in such a situation try to warm themselves in a truly folk way - with the help of alcohol. But this is not quite the case when the truth is found in wine. The fact is that a frozen person can really drink about 40-50 grams of vodka or cognac, which will at least slightly help him warm up. And everything that will be drunk in excess of the specified amount of alcohol will only increase the hypothermia of the body. The mechanism of such a reverse effect is as follows: the vessels that have expanded after a stack cause an increase in blood flow through them, which leads to an increase in heat transfer - this is a medical fact. As a result, the body begins to lose the remnants of heat and freezes even more. So in no case should you abuse strong drinks. Not recommended for cold people and smoking. Nicotine, on the contrary, constricts small vessels, blood flow slows down, and tissues experience oxygen starvation, which further enhances the feeling of cold. What to do?

Dry heat helps a lot - a woolen blanket and several heating pads filled with hot water. One of them needs to be put at the feet, and sit on the other. At first glance, this is a rather strange advice, but it has a logical explanation. The fact is that cold easily provokes inflammation of the pelvic organs. The most vulnerable of them are the ovaries. Many women, having frozen, feel aching pains in the lower abdomen. This is nothing more than inflammation of the appendages. Often, cystitis, an inflammation of the bladder, also joins it. This body also reacts very painfully to hypothermia. There is frequent and painful urination, which takes only a few weeks. To prevent the occurrence of these symptoms, you need to properly warm the lower abdomen. A rubber heating pad filled with boiling water will come in handy here. A warm bath helps a lot. But it must be taken with caution. At first, the water temperature should not exceed 30 °C. Boiling water should be added gradually, so that after 20 minutes the temperature rises to 40 - 42 ° C. During this time, you need to drink some hot drink. It can be sweet tea, cocoa or strong broth.

But a simple warming up of the body can be combined with a real healing effect. Citrus baths are very well suited for this purpose. To make such a bath, you need to crush 120 - 150 g of dry peel of an orange, tangerine or lemon, pour the resulting powder with one liter of boiling water and leave it for 20 - 30 minutes. Then pour the infusion into the bath. To increase the effectiveness of the bath, you can add two to three drops of rose essential oil. You can also "enrich the composition" with lime juice.

For an orange-grapefruit bath, squeeze the juice from three large grapefruits and three oranges. Put the pulp in a cloth bag or wrap it in gauze, and then dip it in water to "feed" it.

For a lemon-honey bath, you need four to six lemons. They must be cut with a peel, pour hot water and leave for about an hour. Squeeze the lemon mass through cheesecloth into the bath and add a few tablespoons of honey.

Citrus baths are a very effective way to get rid of autumn colds. Baths enhance blood circulation, tone, strengthen and soften the skin, create a kind of barrier to pathogens. In addition, the essential oils found in citrus fruits help to cope with the onset of a runny nose and cough. These procedures are recommended to be carried out for 10 - 15 minutes at least twice a week.

Well, what to do if you still didn’t save yourself and caught a cold? Heal, of course! And not forgetting that in case of a cold, the simultaneous use of the means and methods of traditional and restorative medicine is especially effective. Moreover, for some patients, restorative therapy, a combination of natural and physical methods of treatment, can become an alternative to drug therapy. Physiotherapy (heating, magnetotherapy, ultrasound therapy, etc.) and reflexology (impact on active points on the skin) provide invaluable help to people with a cold. In the following sections, we will focus on methods of warming up at home and some methods of reflexology.

A history of blood transfusion and its preparations, parenteral administration of protein blood substitutes.

Reactions to transfusion of blood and its preparations, sera and vaccines, various medications (when, in what way it was expressed, it stopped on its own or any treatment was carried out).

Past illnesses, injuries and surgeries

Interrogate the patient in detail about all the diseases he has experienced, from early childhood to admission to the hospital, indicating the age of the patient, the year of transfer of each disease, the duration, severity, treatment in the hospital or on an outpatient basis. If the patient cannot accurately name the time of the disease, then one can confine oneself to approximate indications (“... about 10 years ago ...”). The main thing in this section is not the chronology of diseases, but a description of the consequences for the health of the patient in general and for the course of the present disease left by the disease.

Separately ask about the transfer of syphilis, viral hepatitis, tuberculosis. If there are no signs of these diseases in the anamnesis, note this fact in the medical history.

This section describes only transferred, that is, completed diseases. The description in this section of concomitant, currently existing diseases should be considered a serious mistake.

Family history and heredity data

The state of health or cause of death, indicating the life expectancy of close relatives. Pay special attention to the presence of tuberculosis, malignant neoplasms, syphilis, alcoholism, mental illness, endocrine diseases, diseases of the cardiovascular system in the family. With a number of diseases that have a hereditary predisposition, it is advisable to indicate the presence or absence of similar diseases in blood relatives.

Expert history

Indicate whether the patient was on sick leave in the current year, if so, when for how long. If possible, indicate the sick leave number and by whom it was issued. If the sick person is disabled, indicate the time the disability was established, the date for the next re-examination.

In the educational case history, this section may not be described (as directed by the teacher)

Patient's examination data

The patient's examination data can be described in one (Status praesens communis) or two (Status praesens communis and Status specialis) sections.

In a number of surgical schools, all examination data are described by organ systems in the form of one section “The general present condition of the patient (Status praesens communis)”. However, this can be inconvenient from a practical point of view - the surgeon often deals with a local problem, or has a local effect (performs an operation). Therefore, a more common option is to divide the results of the examination into two parts - a general one (Status praesens communis) and a special one, which describes in particular detail the organ system affected by the underlying disease (Status specialis). At the same time, the organ system described in Status specialis in Status praesens communis is not described (is omitted).

Quite often it is not possible to isolate the organ system affected by the underlying disease (diabetes mellitus complicated by angiopathy and trophic ulcers on the lower extremities - endocrine disorders led to vascular damage, as a result of which the musculoskeletal system was most affected). In this case, it is advisable to describe the special part not in the form of a Status specialis section, but in the Status localis section, which describes the affected anatomical region or regions (in the example above, the lower limbs).

V. 48. Pneumonia in children, Etiopathogenesis, classification. Clinic and treatment of an uncomplicated form of the disease. Order of the Ministry of Health of the USSR No. 725.

Haemorrhoids. Definition of the concept, classification. Etiology. Clinic. Pathogenesis. Diagnostics, differential diagnostics. Complications of the disease. Prevention. Treatment.

Athlete's personal hygiene. Rational daily regime. Pustular diseases.

4. Allergological history.

Allergic diseases: atopic dermatitis, eczema; neurodermatitis. At what age. The severity of the flow. Treatment.

Allergic reactions: food, drugs and others
Clinical manifestations and treatment.

5. Epidemiological history.

Preventive vaccinations: at what age which vaccinations
received (against tuberculosis, poliomyelitis, whooping cough, diphtheria, etc.;); their sequence; observance of terms of vaccination and revaccination; reasons for schedule violations. "Vaccination" reaction, its nature, severity.
Contact about tuberculosis patients in the family, apartment. Contact with patients with acute infectious diseases (what, where, when) is especially important in the previous three weeks!

INFORMATION ON THE HEALTH STATE OF THE CHILD'S PARENTS AND CLOSEST RELATIVES.

Age of parents (mother and father); their state of health; sick or suffering from any disease (tuberculosis; neuropsychiatric, endocrine diseases, malignant neoplasms, etc.; smoke or not; drink or not alcoholic beverages, etc.).

How many pregnancies the mother had, how they proceeded and how each of them ended (kinds of term, early, live or dead child, miscarriage, abortion). The state of health of other children in the family (if they died - the causes of death). The state of health of the closest relatives on the part of the mother and father of the child (hereditary factor). Genealogical tree diagram.

ANAMNESIS OF ILLNESS.

When and how the child fell ill, complaints, how the disease developed (acutely, gradually), the sequence of developed pathological symptoms. Changes in well-being, behavior, body temperature, appetite, stool, sleep; cough (character), vomiting (character), meningeal phenomena, etc.

Causes contributing to the child's illness (cooling of the body, violation of the diet, regimen, trauma, contact with the patient, etc.).
When the patient was first seen by a doctor and what was the preliminary diagnosis, what treatment was prescribed. On what day of illness the child
hospitalized, in what condition, with what pathological symptoms; what was the preliminary diagnosis and what treatment was prescribed.

CURRENT STATUS OF THE CHILD (date)

General condition: satisfactory, moderate, severe, extremely severe. Position of the patient: active, passive, forced. Weight, height, head circumference, chest.

Skin: dry, wet; color (normal, pale pink, cyanotic, rose-red, with an icteric tint, pale with a grayish tinge); the presence of a rash (character, shade, localization).

Subcutaneous fat layer: developed normally, weakly, excessively, evenly, unevenly (where). Tissue turgor: normal, weakened, (moderately, sharply). Edema: where, its severity and prevalence. Skin elasticity.

Lymph nodes: palpable (which groups); quantity, size, consistency, mobility, sensitivity.

Muscular system: developed satisfactorily, poorly; atrophy (where), tone, strength.

Bone system.
The shape of the skull, the condition of the fontanelles (size, tension), bone sutures. Thorax: shape (approaches cylindrical, barrel-shaped); squeeze from the sides, unfolding of its edges from below,
deformation (where). The spine: no changes, the presence of pathological curvatures (kyphosis, scoliosis, lordosis, kyphoscoliosis). Extremities: not changed, curvature, thickening (epiphyses, diaphyses). Joints:
not changed, looseness, deformities, range of motion, pain.

Respiratory system;
Type of breathing (thoracic; abdominal); Nasal breathing (free, "difficulty"; flaring of the wings of the nose; presence of discharge from the nose. Respiratory rate. Voice: clear, hoarse, aphonia. Cough: dry; wet, rough, barking. Breathing: uniform, uneven, noisy, stenotic, labored (dyspnea), retraction of compliant places of the chest, voice trembling, bronchophony Lungs: percussion sound (pulmonary, shortened with a box shade), borders, mobility of the pulmonary edge, chest excursion. , with a bronchial tone); rales and their characteristics (dry, wet, what caliber, crepitus).

Circulatory organs.
The region of the heart, the vessels of the neck, their severity; apical impulse (character, visibility by eye, localization). Limits of relative dullness of the heart (right, left, upper). Tones: sonorous, weakened,
deaf. Noises: character, localization, epicenter, distribution.
Pulse: frequency, rhythm, filling, tension, synchrony. Blood pressure in the arms and legs.

Digestive organs.
Lips: pink, cyanotic, dry, moist. Tongue: clean, furred, dry, moist, papillary, geographic. The mucous membrane of the cheeks, gums, oropharynx, nasopharynx. Condition of the tonsils: size,
hyperemia, looseness, severity of lacunae, their contents. The number of teeth, their condition. Abdomen: shaped, swollen, sunken, tense, painful. Condition of the umbilical ring; hernia (umbilical, inguinal, scrotal). Appetite, regurgitation (when, how many times, than).
Vomiting (character than, how often, before or after meals). Liver and spleen: dimensions, palpable at the edge of the costal arch, protrude from under the edge of the costal arch (by how many centimeters), consistency, density, soreness; edge - sharp "rounded; the surface of the liver and spleen (smooth, bumpy); not palpable.
Stool: character, consistency, color, impurities, including pathological, frequency; consistency, gas. Condition of the anus, tenesmus, etc.

Urogenital system.
The nature of urination (frequency, free, difficult, painful); symptom of Pasternatsky. Urine: color, smell, transparency. The state of the genital organs, the degree of development of secondary sexual characteristics.

Nervous and endocrine systems.
Sense organs: eyes - visual acuity, condition of the conjunctiva,
pupils; ear - hearing acuity, the condition of the shells, the external auditory canal; the child's reaction to pressure on the tragus.
In children of the first 4-6 months of life: smell, taste.

Consciousness, reaction to the environment, intellect, mood, speech. Reflexes: neonatal, mucosal, skin, abdominal, cremasteric; the presence of pathological reflexes; hyperkinesis, convulsions (tonic, clonic). Sensitivity (tactile, pain, temperature).
Autonomic nervous system (dermographism, sweating, Ashner's symptom, etc.). The state of the endocrine glands.

ASSESSMENT OF PHYSICAL AND NEURO-MENTAL DEVELOPMENT

CHILD.
Preliminary conclusion about the diagnosis.
Survey plan.

RESULTS OF LABORATORY STUDIES.
Analyzes: blood, urine, sputum, duodenal contents, cerebrospinal fluid, etc.;

Data from X-ray, biochemical, serological, immunological and instrumental studies.
Give a conclusion on the results of laboratory tests.

CLINICAL DIAGNOSIS AND ITS JUSTIFICATION.
Based on the anamnesis, the data of the primary examination of laboratory tests, a conclusion is drawn up on the diagnosis;

DIFFERENTIAL DIAGNOSIS (as applied to this patient).

TREATMENT AND ITS RATIONALE, DIET.
All drugs are prescribed in Latin with
accurate indication of the dose, frequency and method of administration; indicate the days of treatment.

OBSERVATION OF THE CHILD (diary).
In the history of the disease, the doctor daily notes the condition of the child;
the course of the disease in dynamics. Each symptom must be
tracked from start to finish. The diary entry should be
linked to all previous data. Appointment changes
celebrated daily.

FINAL OR STAGE EPICRISIS.
In the final or staged epicrisis, features are noted
the course of the disease, methods of treatment and their effectiveness, appropriate recommendations (mode, nutrition, treatment, care) for the further management of the patient are indicated.