Theme: The elderly with urinary system diseases. Age-related changes that predispose to
diseases of urinary system
1. Location classes
Classroom-in clinic
Training-themed room.
-Study of GPs.
2. Flow chart classes
Stages of employment
Forms of employment
№
1
2
3
4
5
6
7
Introductory word teacher (ad themes
practice session, goals, learning
outcomes, the characteristics of the
classes of indicators and evaluation
criteria)
Discussion of practical classes, baseline
assessment of students' knowledge with
the use of new teaching technologies
Summary of discussion
Supervision of patients, execution skills
Hear and discuss students' independent
work
Determine the degree of achievement
based on the lessons mastered the
theoretical knowledge and the results of
the development of practical skills
Conclusion on the teacher's lesson.
Assessing the students on a 100 point
system
and
its
announcement.
Homework to the next class
an explanation
Continue
in minutes
5
30
5
100
30
in an oral examination,
case studies, discussion
45
Information. Questions for
self-preparation
5
Only 270 minutes - 45 = 235 - 15 = 220 minutes duration lessons
3. Duration of study subjects
6.9 hours
4. Purpose of the lesson
Teach GPs to the diagnosis and clinical manifestations of urinary tract disease in the elderly,
their early diagnosis and differential diagnosis
5. Pedagogical objectives:
1. Teach GPs - diagnosis and differential diagnosis of diseases of urinary system according to the
characteristics of the age norm.
2. Educate GPs correct diagnosis and dynamic observation of patients with this disease
3. Correctly identify the tactics of treatment of urinary tract disease in elderly and senile
6. Learning outcomes
The student should know:
1. The mechanism of development of urinary tract disease in the elderly
2. Clinical manifestations of diseases of urinary system
3. Differential diagnosis of diseases of urinary system
4. Of drugs used in the treatment of urinary tract disease in the elderly
The student should be able to:
-Diagnose, differentiated by the clinic to laboratory and instrumental studies of urinary tract
pathology in the elderly
-Choose the right tactics for elderly with abnormal urinary system
- Promotion of healthy lifestyles
- Preventive, health, sanitation and hygiene measures
- Rehabilitation of patients
7. Methods and techniques of teaching
The method of "group investigation" graphic organizer 8. Learning Tools
Manuals, training materials, ECG patients, slides, video, audio, medical history
9. Forms of learning
Individual work, group work, team
10. Conditions of Learning
Audience, the Chamber
11. Monitoring and evaluation
Oral control: control issues, the implementation of learning tasks in groups, performing skills,
CDS
12. Motivation
Considerable weight in the overall structure of disease pathology is the urinary system the
elderly than for the interest in a wide range of doctors to the problem. In this situation, the force
of a general practitioner (GP) is directed to the diagnosis of diseases caused by the functional
and organic changes with age, to address the issue directions to the consultation and
hospitalization, as well as for treatment in a hovercraft, or PRT. These circumstances are the
basis for the inclusion of this subject in the training of GPs.
13. Intra and interdisciplinary communication
Ongoing coordination of the problem with nephrologists, urologists, surgeons, physicians,
clinicians.
The knowledge gained in the classroom, will be used to examine the patient in the clinic, at
home visits and checkups.
14. Contents classes
14.1. The theoretical part
Primary aging is genetically determined and unchangeable. Secondary aging determined by
personal social factors, environmental conditions. Each society is a reflection of the aging of its
component individuals.
In the elderly, the following physiological changes in the kidney:
1. decline in kidney hemodynamics A.
2. changes in blood vessels of the kidneys - collagen, glucosamine accumulation - increases
urinary concentrating ability.
3. reduced osmolarity kidneys (even if no NC, is an accumulation of fluid in the
interstitial fluid space).
4. Atrophy SOUTH, this causes cell type "mode depot '\
5. interstinalnaya kidney tissue normally produces prostaglandin, and the old collagen and
glikozaminoglikopilyar - exacerbating sclerotic changes, slows renal blood flow.
6. reduces the production of aldosterone. but reactivity to it increases. So GPs in the treatment of
the elderly should be remembered:
1. to treat the underlying disease, although often attached secondary infection.
2. common complication, as diseases of old age are asymptomatic.
3. malosimptomno diseases.
4. changes in the elderly mental health, it should be considered in the diagnosis and treatment of
disease.
5. patients can not properly articulate the complaint, so the answers to questions doctor can
sometimes lead to misdiagnosis.
6. because of low reactivity, it is difficult to determine the symptoms of the disease.
For example, even when there is no cough lobar pneumonia, no pleural, abdominal
pain. Picture of many diseases is erased, and often there is urinary incontinence, nocturia,
reduced renal excretory function because of BPH and other In addition to the physiological aging
process is often observed, and other diseases AIM: BPH (causes stagnation of urine and hence
the retrograde infection AIM), the ICD tumors, etc.
In the elderly in the urinary system are observed following morphological changes:
sclerosis of small renal arteries and arteriaol;interstitial fibrosis of the medulla; focal
glomerulosclerosis. At age poezhilom common pyelonephritis and acute renal failure. Frequency
increases with pyelonephritis 70. Senile pyelonephritis is secondary, develops in the presence of
urinary tract obstruction. IBC. Diseases prostate. Causes of acute renal failure are hemodynamic
changes (if heart failure), acute respiratory failure, cancer disease.
Nephrotic syndrome in the elderly is caused by diabetic nefropatni, renal vein thrombosis, renal
glomerular filtration after four decades age is reduced by 1% per year. This means that from 40
to 80 years, the total number of glomeruli decreases by almost half.
Treatment of renal disease carried lincomycin, levomitsinom in combination with 5 - NOC or
nevigramon, recommended cytostatics.
The dosage of drugs excreted by the kidneys must be considered age reduced glomerular
filtration function of the kidney.
For the prevention of kidney lesions in elderly and old age should avoid fluid overload, loss of
electrolytes. Degidrotatsii, plummeting renal blood flow. Should refrain from salty and hot
spices in the food diet.
Therefore, GPs should take into account all of the above. There is no doubt that
medical expertise and experience to play a significant role in the critical evaluate the use of
diagnostic and therapeutic procedures for diseases of MIF in the elderly.
Rigorous peer review of diagnostic measures and therapeutic modalities in terms of the ratio of
"the risk - benefit" is the basis of studies and make recommendations, aimed at improving the
care of elderly patients and optimization of the projection and the focus students' attention on the
most effective strategies.
Interactive methods used to develop the theme:
Classes are conducted by "group investigation"
Group offers two themes polemical solution requires use additional references or evidence-based
data, Internet, scanned books. Capture Time 3-4 days. The best answer choice. Proven students
will receive the maximum score.
1. What are the optimal level of protein for the occurrence of nephrotic edema
and in combination with any possible pathology of the problem.
2. What changes are the organs and systems in the nephrotic syndrome.
14.2.Analitical part
The decision of situational problems
Task. 1
Patient 61 years, was admitted with complaints of headaches, swelling of the face, body,
shortness of breath, decrease in amount of urine, 20 days ago after hypothermia (dropped into the
hole with ice water) had a high temperature of 38-39. within 5 days of cough, runny nose, sore
throat. After treatment with antibiotics were improved, 5 days ago, suddenly noticed red urine,
swelling under eyes. 2 days swelling spread to the abdomen, lower back, the number was
reduced to 300 ml of urine per day, headaches, shortness of breath.
Objectively, puffy face pale. Swelling of abdominal wall, lower back. The lungs in the lower
obtuse, ausskultativno sharp weakening. Heart borders dramatically increase in the left to
1-2cm, heart sounds are muffled ^ bradycardia, 2 tone emphasis on the aorta, heart rate 56 bpm.
in min., regular, blood pressure 140/110. fluid in the abdominal cavity with a level of 2 cm
below the umbilical line. The liver is not increased. The kidneys are not palpable. Urine test: the
color of meat slops share in 1030, protein 9.9 ppm, Er-40-50, L-5-8/1, hyaline cylinders - 2-3/1,
3-4/1 grainy, urine testing for Specific weight Zimnitskiy 1026-1034, daily urine output 500ml.
QUESTIONS:
I. Put the correct diagnosis:
II. Laboratory and instrumental tests for differential diagnosis
ANSWERS:
1. acute glomerulonephritis *
2. Renal ultrasound
Task 2
Patient N., 65, turned to the GP complaining of swelling of the face, legs, headaches, aching
pain, general weakness, the appearance of muddy pink urine. Patients were considered
itself within 3 days. Past medical history: flu, two weeks ago, had a sore throat.
OBJECTIVE: Temperature 37,7 ° C. General state of moderate severity. Puffy face, swelling of
the feet and shins. Pale skin. Vesicular breathing. Cardiac rhythmic, muffled, the focus of the
2nd tone the aorta. Pulse 84 min., Regular, intense. Blood pressure 165/100 mmHg Language
clean. Stomach soft and painless. Sign Pasternatskogo Weakly on both sides:
QUESTIONS:
I.Predpolagaemy diagnosis:
P.Laboratorny instrumental research for the differential diagnosis:
III.Taktika GPs:
ANSWERS:
1. acute glomerulonephritis *
2. urinalysis on Nechiporenko, sample Zimnitsky *
3. hormones, cytostatics *
Task 3
Patient V., aged 65, went to a doctor complaining of GPs severe weakness, shortness of breath,
headache, nausea, swelling of the face. At age 15, suffered acute glomerulonephritis. Thereafter
were headache, weakness. The deterioration of ties with hypothermia.
OBJECTIVE: Temperature: 37,2 ° C. The general condition of moderate severity. The skin is
dry and pale, puffy face, swelling in the legs. The left border of the relative cardiac dullness is
determined by left mid-clavicular line. Cardiac rhythmic, muffled. HR 78 min., BP 180/100 mm
Hg Tongue moist, coated with a whitish bloom. The abdomen is soft and painless.
QUESTIONS:
I.Predpolagaemy diagnosis:
P.Laboratorny instrumental research for the differential diagnosis:
Sh.Taktika GPs:
ANSWERS:
1. chronic glomerulonephritis mixed form *
2. urinalysis on Nechiporenko, sample Zimnitsky *
3. hormones, cytostatics *
Task 4
Patient N., 66 years. asked the GP complaining of stunning chills, fever, aching pain on the right,
frequent painful urination. Connects with their disease hypothermia. • In the history of frequent
cystitis.
OBJECTIVE: temperature 38 ° C. General state of moderate severity. The skin is clean. Breath
vesicular. Heart sounds muffled, rhythmic, heart rate 92 min., BP 120/80 mmHg Language
clean. The abdomen is soft, there is pain on the outer edge of the right rectus at the level of the
costal arch, navel and groin. Sign Pasternatskogo positive right.
QUESTIONS:
I.Predpolagaemy diagnosis:
P.Laboratorny instrumental research for the differential diagnosis:
Sh.Taktika GPs:
ANSWERS:
1. chronic pyelonephritis in the stage of active inflammation *
2. Ultrasound of the kidneys *
3. nitrofurans *
Task 5
GP urgently summoned to the house of the patient K., 68 years old. Complained of severe pain
in the lumbar region and right part of the abdomen, radiating to the groin and right thigh. Notes
the frequent urge to urinate. A year ago, for the first time had a similar attack. Caused the "first
aid", injections and pain passed, but after this attack was red urine. '
OBJECTIVE: Temperature 36,4 ° C. General state of moderate severity. The patient is restless,
looking for comfortable position to relieve the pain. Part of the respiratory and cardiovascular
system no pathology. Pulse 76 min., Regular, blood pressure 120/60 mmHg The abdomen is soft,
with palpation tenderness in the right half. Sign Pasternatskogo strongly positive on the right.
QUESTIONS:
1.Predpolagaemy diagnosis:
PLaboratorny instrumental research for the differential diagnosis:
Sh.Taktika GPs:
ANSWERS:
1. urolithiasis with acute stage *
2. Ultrasound of the kidneys *
3. nitrofurans *
Task 6
67-year-old man complained of pain in his left side and change the color of urine (urine red). No
pain when urinating. Notes such an episode for the third time in the last 5 years, each episode has
been associated with an acute respiratory infection. In addition, patients worried headache not
associated with elevated blood pressure and kupiruemaya NSAIDs. Asthenic constitution. No
edema. Lungs: vesicular breathing. Heart: the rhythmic tones, heart rate 90 per minute. Blood
pressure 135/90 mm Hg. Art. The abdomen is soft and painless. The general analysis of blood
hemoglobin content in r / l, leukocytes 6 - 109 / L, erythrocyte sedimentation rate 20 mm / h
General urine analysis: relative density of 1.012, the protein content of 1.066 g / L, erythrocyte
20 25vpole view leukocytes 5-6 in the field of view, single hyaline cylinders. Antinuclear ATundetected. Creatinine 70 umol / L, glomerular filtration rate 95 ml / min.
QUESTIONS:
1.Select the correct diagnosis:
P.Metody research:
III.Taktika GPs
ANSWERS:
1. IA-nephropathy. *
2. immunomoduliny blood *
3. send to a specialist *
Tests
1. In the development of renal osteodystrophy Matter:
a) secondary hyperparathyroidism *
b) the lack of an active form of vitamin D3
c) hyponatremia
d) hypophosphatemia
d) hypercalcemia
e) metabolic acidosis and malabsorption of calcium in the intestine
2. In the development of anemia in patients with chronic renal failure are important:
a) decreased production of erythropoietin *
b) loss of blood
c) hypophosphatemia
d) iron deficiency and hemolysis
e) gipernatremiya
e) hypokalemia
3. Manifestations of bone and joint system in uremia can be:
a) secondary gout, fractures *
b) pseudogout and bone pain
c) arthrosis
d) migrating pain in large joints
e) disrupt the growth of bones in children
e) rachiopathy
4. Aggravate the course of chronic renal failure may:
a) surgery and tetracycline *
b) pregnancy and the use of phenacetin
c) the restriction of the use of protein
d) restriction of the use of salt
e) nekorrigiruemaya arterial hypertension
e) Use of calcium antagonists
5. In chronic renal failure is contraindicated:
a) sulfonamides *
b) penicillins
c) cephalosporins
D) nitrofurans
e) fenatsetinsoderzhaschie drugs
e) gold preparations
6. In the treatment of hyperkalemia in patients with impaired renal function, use:
a) calcium chloride *
b) soda
c) glucose with insulin
d) unitiol
d) sodium chloride
e) berlipril
7. For the treatment of nephrotic syndrome in a patient with renal failure, regardless
of its etiology should be used:
a) a diet with a high content of protein *
b) saluretiki
c) the restriction of salt and water
d) heparin
e) Glucocorticoids
e) cytostatics
8. The decrease in the relative density of urine can cause:
a) loss of renal tubules *
b) nephrogenic diabetes insipidus
a) chronic renal failure
d) uncontrolled diabetes
e) significant proteinuria
e) P-blockers
9. Cause of gross hematuria may be:
a) acute glomerulonephritis and hypernephroma *
b) urolithiasis
c) chronic pyelonephritis
d) Berger's disease
e) acute pyelonephritis
e) nephrotic syndrome
10. Metabolic alkalosis with prolonged use can cause:
a) thiazides *
b) furosemide
c) A new acid etakri
d) veroshpiron
e) triamterene
e) spirinalakton
11. Tubulointerstitial kidney disease may include:
a) hypercalcemia *
b) for hyperkalemia
c) with hypokalemia
d) for urate diathesis
e) with hypocalcemia
e) for hyponatremia
12. The characteristic signs of acute cystitis include:
a) High fever *
b) pain in the lumbar region
c) painful urination
d) false urge to urinate
e) frequent urination
e) hematuria
13. Which of the following is an indication for emergency dialysis for
treatment failure diuretics:
a) blood creatinine above 0.8 mmol / l. *
b) progressive hyperkalemia
a) hypertension
d) nausea
e) the progressive acidosis
e) vomiting
14. List the three main symptoms of acute glomerulonephritis?
a) swollen *
b) overgrowth
c) uric
d) cutaneous
e) hypertensive
15. Enter the 3 classic symptoms associated glomerulonephritis?
a) headache *
b) oliguria
c) local itching
d) makrogemoturiya and microhematuria
e) hypotension
e) piupiya
16. Name 3 localization of edema in acute glomerulonephritis?
a) fiber eye sockets *
b) the brain
c) the genital organs
d) phalanges
e) waist
e) the shoulder area
17. List the three hallmarks of renal edema from heart?
a) swelling with pale waxy tint *
b) slowly accumulate
c) can be easily moved for change of body position
g) soft
e) cold to the touch
e) In most cases, starting with the face
18. List the three main indicators of the blood of patients with acute glomerulonephritis?
a) hypoproteinemia *
b) giperlipedemiya
c) increasing serum iron
d) increase in the activity of ALT and AST
d) reducing the activity of fibrinolytic factors
e) increased activity troponin
19. List the three main clinical forms of chronic glomerulonephritis?
a) latent *
b) hematuric
c) asthenic
d) nephrotic
d) ulcerative
e) cutaneous
14.2.2. Graphic organizer
14.3. The practical part
The student must be skilled in health promotion, communication with patients, survey and
inspection, as well as the evaluation of the data, interpretation of results, the rationale for the
clinical diagnosis of elderly patients, inquiry, completed medical documentation, consulting,
audit work done and skills to work with the medical literature. During the class the reins clinical
examination of patients with the differential diagnosis and determine the tactics of GPs in the
pathology of urinary tract
Performance / interpretation
Examination of the patient
Complete blood count
lipid profile (cholesterol, HDL, LDL, triglycerides)
ECG
X-rays
Differential diagnosis
Staging diagnostics
Tactics GP
Preventive measures
Total
15. Control forms of knowledge, skills and abilities
- Orally
-Writing
Tests
-Case studies
Representation algorithms of action to implement skills
16. The evaluation criteria of the current control
Levels of
assessme
nt
Rating
Characteristics of student scores
96-100
The answer is original and of the highest quality, exceeding the
requirements of the program. High quality clinical thinking and
implementation of practical work, registration of medical records and the
availability of lecture notes, subordinators book and workbook,
presentation and active participation with the reports in the morning
conferences, use the responses to these activities on the Internet, and active
participation in clinical and case parsing duty and supervision of patients in
the hospital, as well as service calls in the clinic.
91-95
The high quality of the answer that exceeds the requirements of the
Fine
86-100%
program, good works and their design, the availability of lecture notes,
subordinators book and workbook, make presentations at the morning
conference, active participation in clinical and case parsing duty and
supervision of hospital and service calls in polyclinic high clearance
histories and outpatients.
86-90
Good
81-85,9
7185,9%
Satisfact
orily
Correct, appearances on the secondary literature, the proper execution of
practical skills, the availability of lecture notes, subordinators book and
workbook, proper management of medical records, and active participation
in morning conferences, clinical and case parsing duty and supervision of
hospital and service calls in the clinic.
Response to good quality, relevant programs, active implementation of
practical work, the availability of lecture notes, subordinators book and
workbook, timely and correct completion of the medical records and
hospital records, patients and quality Supervision duty in the hospital and
service calls in the clinic.
76-80
Answer well, basically meeting the requirements of the program. Good
performance skills, the availability of lecture notes, books subordinators
and workbook, timely and correct completion of the medical records and
hospital records, patients and quality Supervision duty at the hospital, call
service in the clinic.
71-75,9
The answer is above average, there may be some errors in the performance
of work or negligence in the design of protocols and lecture notes, books
subordinators and workbook, as well as record keeping in the hospital and
clinic.
Satisfactory answer to a high degree, having mistakes, some errors in the
execution of works, the reception of patients and service calls in the clinic,
duty, supervision of patients in the hospital, the availability of lecture
notebooks, subordinators book and workbook, but insufficient to maintain,
inaccurate and delayed clearance records in the hospital and in the clinic.
66-70,9
5570,9%
61-65,9
Moderately satisfactory answer, the answer is a serious error, an error in the
implementation of practical skills, record keeping in the hospital and in the
clinic, lecture notebooks, duty, supervision of patients in hospital and in the
clinic service calls made enough quality.
55-60,9
Satisfactory answer to low quality - has a serious error, the practical skills
is incomplete, when completing the documentation in the clinic and the
clinic, subordinators book and workbook mistakes, lack of lecture
notebooks, low-quality reception of patients and service calls in the clinic,
duty, supervision of patients in hospital.
unsatisfactory response - has Serious errors (not certified), is unable to
perform the practical skills, failure to fill, Serious errors in record-keeping
in the hospital and in the clinic, subordinators book and workbook, no
lecture notebooks, untimely performance jobs in the clinic. Reception of
patients, service calls, hospital patients and Supervision duty performed
poorly.
Not
20 - 54,9
satisfacto
ry
20
20 points of presence in the practical session. Lack of implementation of
any requirements imposed by occupation, lack of documentation and
delayed filling, bad duty, supervision of hospital and service calls in the
clinic.
17. Test questions
- The course of chronic pyelonephritis in the elderly
- Diagnostic tests of urinary tract diseases in the elderly
- Special treatment of chronic diseases of the urinary tract in the clinic
18. Recommended Reading
Summary:
1. -J. Murtagh. Directory GP. Moscow 1998.
2. -R.Heglin. Differenitsalny diagnosis of internal medicine. Moscow, 1997
3. Geriatrics, the activities of GPs. N.N.Nasriddinova, Tashkent, 2004
4. -Internal Medicine, ed. Kovalev YR St. Petersburg, Folio, 2004
5. -General medical practice, ed. F.G.Nazyrova, A.G.Gadaeva. Geother-Media, Moscow, 2005
6. Clinical recommendations and formulary. Gl.red.I.N.Denisov, Yu.L.Shevchenko,
F.G.Nazyrov. Geother-Media, Moscow, 2005
More:
1. -Mary. Sharp. Leaders in Medicine, Volume 2, The World, 1997
2. -Zaturoff. Symptoms of internal medicine. M., Workshop, 1997