UKRAINIAN MINISTRY OF PUBLIC HEALTH
Dnepropetrovsk State Medical Academy
«APPROVED»
At the methodological meeting of the internal medicine propedeutics department
Chief of the department
____________prof. Khomazuk T.A.
« » 2013 y.
Guidelines
For Second-year Students of the Dentist Department
Subgect Propedeutics of the internal medicine
Module №
Enclosure module №
Topic №1
Main principles general and special nursing the therapeutic patients.
2 Course
Faculty
Dnepropetrovsk- 2013

Internal diseases are a field of clinical medicine studied etiology, pathogenesis and clinical presentation of diseases of the internal organs, elaborated methods of their diagnostics, treatment and prevention. The first doctor task is a recognizing disease which, on WHO definition, is a life disturbed with damage of structure and function of the body under the influence of internal and external factors despite mobilization of its compensatory mechanisms. The correct and opportune recognizing disease is a guarantee of its successful therapy. Therefore mastering principles and methods of the patient investigation by students is a very important. Logical analysis of the symptoms, semiotics, syndromes gives opportunity to finish diagnostic research with short doctor conclusion named diagnosis of the disease. The moral, ethical and deontological conditions of work with patient are important too. Studying structure, organization of work of the therapeutic, emergency department and rules of the recording medical cards allows learning propedeutics of the internal diseases and nursing patients.
General purpose – to learn structure and functions of the therapeutic departments, base principles of the general and special nursing therapeutic patients, algorithm of the clinical investigation of patients, to manage inquiring patient and summarize obtaining data.
Specific purposes:
1.
To know principles of the general and special nursing patients (personal hygiene, feeding patient, measuring body temperature.
2.
To learn structure and functions of the therapeutic department and its base branches.
3.
To use fundamentals of the medical deontology.
4.
To form at educational and occupational activity the main principles of the healthy life style and prevention of the harmful habits.
5.
To learn general principles of the diagnostics of internal diseases. Methods of the clinical examination of patients: inquiry, physical, additional, their role in diagnostics.
6.
To know definition of the symptom, syndrome, semiotics, diagnosis of the disease and be able to recognize them during patient examination. To learn the rules of recording patient cart.
7.
To obtain patient history and assess it.
8.
To know the structure of the medical institution
9.
To know the principles of organization the work of the therapeutic department.
10.
To know the structure of the therapeutic department

Topic content
Propaedeutic:
• Translating from Greek means preliminary study
• It is preface to clinical discipline that take base of knowledge for subsequent detailed studying of internal diseases clinic.
•
It teaches the essential and important additional methods of patient examination.
• It studies symptoms and signs of disease
Internal diseases (Morbi interni)
• Study etiology, pathogenesis and clinic manifestations of disease, develops methods of their diagnostics, treatment and prevention
• Join group of diseases which are characterized by two signs:
– localization of injury in the internal organs (heart, lungs, gastrointestinal tract, kidneys and others)
– Methods of therapy (conservative, but not surgery, prescribing of medical regimen and others)
Symptom of disease
•
All complains and feelings of patients, objective, physical and chemical phenomena, which we observe during physical examination.
• It’s new, not inherent in healthy person phenomenon. It is revealed with clinic methods of examination.
•
Syndrome - stable aggregates of symptoms with common pathogenesis.
•
Semiotics - studying of disease symptoms and syndromes, their diagnostic importance, origin mechanism, their correlation. It is the chapter of practical medicine.
• Diagnostics - learning about methods of disease recognition
Methods of clinical examination
1.
Subjective – interview (introgatio)
2.
Objective – physical examination
3.
Additional
History (anamnesis – recollection) aggregate of all findings during interview.
They are used to establish diagnosis
History parts:
1.
General questions
2.
Disease history
3.
Life history
Disease history (Anamnesis morbi):
Presenting complaint and history of presenting complaint

Additional interview about injury system
Interview about other organs and systems
Disease history
Life history (Anamnesis vitae)
1.
Previous diseases
2.
Operations
3.
Occupational history
4.
Family history
5.
Gynecological history
6.
Drug and allergy history
7.
Alcohol, recreational drugs, tobacco
Physical examination (inspectio)
1.
Visual inspection
2.
Palpation (palpatio)
3.
Percussion (percussio)
4.
Auscultation (auscultacio)
Diagnosis - medical conclusion about pathology condition of person that doctor does evaluating diagnostic importance of each symptoms, grouping them according to common causes, confronting relationship with consecution of their appearance
Diagnosis
1.
Presumptive
2.
Clinical
3.
Final: a.
basic b.
complications c.
concomitant
4.
Pathology-anatomical
It can be nosological or syndromal.
Plan of patient examination
• Common methods
–
Blood analysis
– Urine analysis
– Stool analysis
– electrocardiogram
–
X-ray of chest
•
Special methods
Methods of additional examination a.
Laboratory

b.
Instrumental c.
with invasion, without invasion d.
rontgenologic e.
radioisotopical f.
endoscopic g.
microbiological h.
morphological i.
bacteriological j.
Disease (morbus) by WHO definition : It’s life which stream has been disturbed by hurting of organism structure and functions under influence of external factors with mobilization of organism compensative mechanisms of organism. It may be acute or chronic.
Stages of disease development:
Latent – from moment of contact with pathological factors until the first clinical appearences
Prodromal – from the first clinical appearences until complete development of disease symptoms
Large-scale clinic – complete development of disease symptoms that is peculiar to certain disease
Outcome – recovery , remission, compensation, death.
Disease current may be pеrelapsing, or progressing, or complicated
Prognosis: life with recovery or control disease, progressing disease or death.
Nursing (hypurgia)
Complex of actions that are aimed at creating favorable conditions for successful treatment of patients, relieving their sickness, satisfying essential physiological needs
In medicine the concept "care of the patient " stands as an independent discipline and represents a whole system of measures including correct and welltimed performance of various prescriptions, carrying out of some diagnostic tests, preparation for the certain research, overseeing the condition of the patient, giving the patient first aid and conducting the necessary medical documentation. Quite often the success of the treatment and outcome of the disease are determined by the quality of care. Thus, the care of the patients is an obligatory component of all treatment processes, influencing no small degree of total efficiency.
Patient care is both general and specific.
General care implies carrying out medical and prophylactic procedures irrespective of the character of the particular pathology.

Special care requires carrying out procedures that are specific for a given disease (pulmonological, cardiological, gastroenterological, etc.).
Timely diagnosis, proper treatment, and adequate care are the necessary conditions for the recovery of the patient. To give qualified assistance to the patient, it is necessary to acquire proper medical knowledge and skills.
The profession of the physician involves hard labor, sleepless nights, doubts, tormenting experiences, patience, and self-control. At any time the doctor must be ready to give aid. The successful therapy greatly depends on the authority of the physician. This authority is won not only by selfless labor but also by profound knowledge, because an authoritative physician is always a competent physician.
However, the intense work of physicians and their assistants, becomes useless if medical personnel ignore the rules of doctor-patient relationships.
Appropriate conduct of the medical personnel between themselves and with the patients improves the efficacy of prophylaxis and treatment of patients.
Deontology (deon – suitable, logos – study) may be defined as the set of rules and principles of medical ethics, which governs a member of the medical profession in the exercise of his professional duties. The deontological principles should be followed by all medical workers. The main object of deontology is the relations between the doctor and the patient, between the nurse and the patient, and also between the physician, the nurse, and the patient.
A hospital is an unusual environment for the patient: a mother may be separated from her child, the child from its parents, etc. Some people may be greatly concerned about their job that they have to abandon. All these circumstances may generate fears and anxieties in the patient. A chronic patient may have psychic disorders. A disease upsets not only his social connections but also his mental equilibrium. Positive relations between the patient and the assistant physician or the midwife may accelerate recovery. The careful attitude of the physician, his assistant or a nurse toward the patient is mandatory for a normal atmosphere at a hospital or any other medical establishment.
The main deontological requirement is high medical skill and a constant drive to improve one's knowledge and skill. A good physician should know all recent advances in medicine and should also be acquainted properly with the problems of the neighbouring medical specialties. The authority of a physician largely depends on his attitude toward the patient. When examining the patient, the physician should show his compassion and interest, show his sympathy for the patient. If you are not serious, the patient will not feel confidence in you, nor in other medical students that might come next.
As soon as the physician has gained as much information as possible about the disease from clinical findings and results of examination, he must do his best to

quiet the patient, raise his spirits, and convince him that there are good signs for his recovery, without dwelling on the unfavourable symptoms of the disease.
While prescribing medicines and giving advice, the physician should explain the treatment schedule and its mode of administration. While discussing the case with his colleagues at the patient's bedside, the physician should avoid words and terms that might be unknown to the patient or might be misunderstood by him. An occasional thoughtless word from the physician may impair the mood of the patient, impair his sleep, appetite, and general condition and even may provoke disease. This is called jatrogenic diseases. Even in hopeless cases (cancer with multiple metastases, fatal heart disease, irreversible affection of the liver, or kidneys) the patient believes that he may recover, and the truth should therefore always be concealed from him. The duty of the physician is to persuade the patient by all possible means that his disease may be cured.
Medical deontology implies keeping medical secrets. All that the physician knows about his patient should be kept secret, otherwise the patient will suffer from moral and sometimes material loss. The patient's confidence in his doctor and other medical personnel is an important medical factor: the patient feels safe and believes that everything possible is being done to promote his recovery. This however does not hold for cases where keeping a secret may do harm to other people. For example, if the disease is infectious, the patient should be hospitalized because his isolation arrests the spreading of the disease and provides better conditions for treatment.
The problems of medical deontology are closely connected with professional ethics. The science of morals, rules and requirements for social conduct is known as ethics . Medical ethics implies the morals of medical workers, their attitudes toward each other and toward their patients. If a physician discovers an error in the prescriptions and methods of his predecessor, he must correct it tactfully so that the patient does not lose his faith in medicine and in his recovery.
The patient is usually very sensitive to the attitude of the medical personnel toward him and becomes very grateful to them. In long-standing diseases, and especially due to the special features of their character, some patients become very irritable and capricious. The attending personnel should not become involved in arguments with such patients. Some reassuring words usually help in such situations, but the medical personnel should be persistent in demanding that the patient fulfil medical orders and observe the existing rules.
In other words, each patient requires a special approach in treatment. Unless this is recognized, it is impossible to understand the patient properly and hence it is impossible to give him all possible medical attention.

MEDICAL INSTITUTIONS, ORGANIZATION THEIR WORK
Organization of the medical institution work is determined by the necessity to get medical aid to people.
A policlinic is an independent medicoprophylactic facility or a department at a hospital. A policlinic has some laboratory and diagnostic cervices. Physicians of all specialities receive patients at a policlinic. Laboratory studies, X-ray examinations and other functional studies are carried out at a policlinic. Patients are given there various procedures and treatment. A policlinic carries out prophylactic inspection of the population.
Emergency aid stations provide medical aid in critical cases and accidents.
The stations are open to patients 24 hours a day. Many emergency aid stations have their own vehicles (ambulances) equipped with modern equipment and instruments to give emergency aid and resuscitate patients on their way to the hospital.
A hospital is an institution for accommodating patients and supervising their treatment. It has an admissions, medical, and administrative departments.
There are both general and specialized hospitals. The latter treat patients with special diseases, e.g. tuberculosis, infectious diseases, etc. As a rule, those who serve in the army are serviced at a military hospital.
A clinic is a medical institution where patients receive medical attention in stationary conditions. Medical students are educated at clinics. Clinics are also centres of medical research.
A sanatorium is a stationary medical institution where an environment is provided for the sick to recover completely from their illness. As a rule, sanatoria
(health resorts) are located in areas with a good climate where mineral water and therapeutic muds are available.
1. What does propaedeutics of internal medicine study?
A.
*methods of examination
B.
etiology
C.
pathogenesis
D.
diagnostic significance
E.
treatment
2. Subjective examination includes:
A.
visual inspection
B.
taking a body temperature
C.
*inquiring
D.
measuring blood pressure
E.
measuring weight and height
3. Which information does passport part include?
A.
character of the disease course

B.
*patient’s home address
C.
data about treatment
D.
prognosis of the disease
E.
disease onset
4 What is a sign?
A.
a sign is aggregate of symptoms.
B.
a sign is a brief medical conclusion about the nature of a disease.
C.
*a sign is a feature, which characterizes the deviations from the norm frequently accompanying the disease.
D.
a sign is a laboratory test.
E.
a sign is nothing of mentioned above.
5. What is a diagnosis?
A.
a diagnosis is an aggregate of symptoms.
B.
*a diagnosis is a brief medical conclusion about the nature of a disease.
C.
a diagnosis is a feature, which characterizes the deviations from the norm frequently accompanying the disease.
D.
a diagnosis is a laboratory test.
E.
a diagnosis is nothing of mentioned above.
6. Additional investigation includes:
A.
visual inspection
B.
*full blood count
C.
pulse palpation
D.
additional inquiring patient’s relatives
E.
auscultation of the abdomen
7. Which system should inquiring about organs and systems be begun from?
A.
it is not matter
B.
from cardiovascular system due to its importance
C.
*from affected system according to patient’s complaints
D.
from respiratory system particularly in winter
E.
from digestive system
8. What does anamnesis morbi include?
A.
patient’s age
B.
patient’s home address
C.
patient’s occupation
D.
*disease onset
E.
features of heredity
9 Which purpose is inquiring patient about organs and systems made with?
A.
for prognosis of the disease
B.
for revealing disease onset

C.
for characteristics of the disease course
D.
*for revealing concurrent pathology
E.
for revealing harmful habits
10. Which purpose is anamnesis morbi made with?
A.
*for characteristics of the disease course
B.
for revealing harmful habits
C.
for discovering heredity changes
D.
for discovering previous diseases
E.
for obtaining family history
11. What is a syndrome?
A.
*a syndrome is an aggregate of symptoms.
B.
a syndrome is a brief medical conclusion about the nature of a disease.
C.
a syndrome is a feature, which characterizes the deviations from the norm frequently accompanying the disease.
D.
a syndrome is a laboratory test.
E.
a syndrome is nothing of mentioned above.
12. What does semiotics study?
A.
*symptoms and signs of disease
B.
etiology
C.
pathogenesis,
D.
diagnostic significance and their pathogenetic combinations
E.
syndromes.
13. Which purpose is patient’s occupation obtained with?
A.
for establishing harmful habits
B.
for characteristics of the disease course
C.
*for discovering occupational diseases
D.
for discovering previous diseases
E.
for revealing disease onset
14. Subjective examination includes:
A.
visual inspection
B.
taking a body temperature
C.
*inquiring
D.
measuring blood pressure
E.
measuring weight and height
15. Objective examination includes:
A.
laboratory investigation
B.
x-ray examination
C.
ultrasound examination
D.
*palpation, percussion, auscultation

E.
endoscopic examination
16. Additional investigation includes:
A.
visual inspection
B.
* full blood count
C.
pulse palpation
D.
additional inquiring patient’s relatives
E.
auscultation of the abdomen/
17. Which system should inquiring about organs and systems be begun from?
A.
it is not matter
B.
from cardiovascular system due to its importance
C.
*from affected system according to patient’s complaints
D.
from respiratory system particularly in winter
E.
from digestive system
18. What conclusions should be made after inquiring patient?
A.
assessment of the patient general condition
B.
form probable diagnosis
C.
*reveal affected system, acute or chronic disease course
D.
administer treatment
E.
perform visual inspection/
19. Which information does passport part include?
A.
character of the disease course
B.
*patient’s home address
C.
data about treatment
D.
prognosis of the disease
E.
disease onset
20. What does anamnesis morbi include?
A.
patient’s age
B.
patient’s home address
C.
patient’s occupation
D.
*disease onset
E.
features of heredity.
21. What does the medical deontology study:
A.
mutual relation between the medical workers and patient,
B.
*mutual relation between the medical workers and patient, and also his relatives, questions of a professional etiquette and debt;
C.
jatrogenic diseases.
D.
all mentioned above.
E.
nothing mentioned above.
22. What is a policlinic:

A.
*independent medicoprophylactic department.
B.
institution for accommodating patients and supervising their treatment.
C.
medical institution where patients receive medical attention in stationary conditions.
D.
stationary medical institution where an environment is provided for the sick to recover completely from their illness.
E.
medical institution.
23. What is a hospital:
A.
independent medicoprophylactic department.
B.
*institution for accommodating patients and supervising their treatment.
C.
medical institution where patients receive medical attention in stationary conditions.
D.
stationary medical institution where an environment is provided for the sick to recover completely from their illness
E.
medical institution.
24. What is a clink:
A.
independent medicoprophylactic department
B.
institution for accommodating patients and supervising their treatment
C.
medical institution where patients receive medical attention in stationary conditions
D.
stationary medical institution where an environment is provided for the sick to recover completely from their illness
E.
*medical institution.
25. What is sanatorium:
A.
independent medicoprophylactic department.
B.
institution for accommodating patients and supervising their treatment.
C.
medical institution where patients receive medicalAttention in stationary conditions.
D.
*stationary medical institution where an environment is provided for the sick to recover completely from, their illness.
E.
medical institution.
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1.
Diseases and disorders : a nursing therapeutics manual / Marilyn Sawyer
Sommers, Susan A. Johnson, Theresa A. Beery.—3rd ed.
2. Clinical Nursing Skills and Techniques: basic, intermediate and advanced. The
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4. Emergency Nursing: priciples and practice. The C.V. Mosby Company, 1985.-
715p.
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Philadelphia, 1989.-120 p.
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