Case history plan. Traumatic lesions are caused by damage to the spine or intervertebral discs

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Medical history is important document, which has practical, scientific and legal significance, in which the doctor presents and analyzes all the factual material of a comprehensive examination of the patient, the dynamics of his illness, treatment and prognosis.

The purpose of writing a medical history by 4th year students in the faculty therapy cycle is, first of all, to master and consolidate specific skills of clinical thinking and its logical structure, that is, the methodology of the diagnostic process.

The specific tasks of the student when working on the medical history are:

1) correct and comprehensive examination of the patient;

2) assessment of the data obtained and their use in the logical structure of clinical thinking;

3) formulation and justification of the clinical diagnosis;

4) determining the prognosis of the supervised patient;

5) drawing up a treatment and rehabilitation plan for the patient.

The basic principles of constructing a medical history were developed by M.Ya. Mudrov, S.P. Botkin, G.A. Zakharyin.

The basis of the medical history is the systematic and step-by-step examination of the patient, the logic of clinical thinking in making a diagnosis, the correctness, timeliness and adequacy of prescribing therapy.

Writing a medical history begins with a statement of complaints and anamnesis. Then the data is described objective examination patient, a preliminary diagnosis is formulated, a plan for laboratory and instrumental examination of the patient and a plan for his treatment are outlined.

In urgent cases requiring assistance emergency care(for example, if the patient is unconscious), the order of the doctor’s work may change: first, a quick examination and assistance, and then collecting an anamnesis and a more detailed examination.

When collecting complaints, it is necessary to give the patient the opportunity to speak freely, then carry out a targeted survey of all systems and write them down, systematizing and characterizing each complaint in detail.

In the disease development section, it is necessary to outline the appearance of the first symptoms or syndromes of the disease and monitor their dynamics during the treatment process.

The life history should include not only traditional information about the patient (previous diseases, operations, work history, industrial hazards, bad habits), but also pay close attention to drug intolerance, metabolic disorders, and hereditary burden.

The objective study is based on the classical scheme of examining a patient, studied by students at the Department of Propaedeutics of Internal Diseases. We have supplemented this scheme in accordance with the tasks and requirements of senior courses (faculty and hospital clinics). Methods of direct examination of the patient retain their paramount importance. The examination must be carried out and recorded in a strict sequence: inspection, palpation, percussion, auscultation.

The diary should reflect the patient’s condition, the course of the disease, an assessment of the effectiveness of treatment, side effects of medications, and the immediate prognosis of the disease.

A very important stage of work in the clinic is making a clinical diagnosis and its formulation. To develop students' clinical thinking in making a diagnosis, it is recommended that the medical history chart reflect the stages of comprehension of the information obtained during the examination of the patient.

There are 5 stages in making a clinical diagnosis, in each of which certain tasks are sequentially set and methods for solving them are proposed. The most important task of clinical analysis of each clinical case and its presentation in the history of the disease is its “individualization”, highlighting the main thing, especially in the causes of the disease, its course, the possibility of immediate and long-term complications. The prescription of therapy should also be strictly individualized, specific and reflected in the treatment plan, diary and epicrisis.

Medical history plan.

A. Collection, analysis and synthesis of information.

1. Passport part.

2. Complaints at the time of supervision.

3. History of the present illness.

4. Life history of the patient.

5. The patient’s current condition.

B. Stages of logical structure, diagnosis and drawing up a plan for examining the patient.

1. Stage 1 of diagnosis. The leading syndrome is identified and localized pathological process. An examination is carried out to confirm this stage.

2. P stage of diagnosis. The nature of the pathological process is determined in the form of pathological and pathophysiological syndrome. An examination is carried out to confirm this stage.

3. Stage III of diagnostics. A preliminary diagnosis is made in the form of a nosological or syndromic hypothesis and a differential diagnosis plan is written (the diseases with which a differential diagnosis must be made are listed). The examination methods necessary for making a differential diagnosis are recommended.

4. IV stage of diagnosis. Justification of the clinical diagnosis using the conducted differential diagnosis, examination results and the effectiveness of the therapy.

5. V stage of diagnosis. The main clinical diagnosis in accordance with the modern classification, background diagnosis, complications of the main and background diagnosis.

B. Patient treatment plan.

D. Treatment of the patient (prescription sheet).

D. Epicrisis ( detailed description results of examination and treatment of the patient with substantiation of the diagnosis and recommendations for treatment outpatient setting).

E. List of literature used when writing a medical history.

Preparation of 1 page of medical history.

Voronezh State Medical Academy named after. N.N. Burdenko.

Department of Faculty Therapy.

Head of department:

Teacher:

MEDICAL CARD

FULL NAME. sick

Clinical diagnosis (detailed):

A) The underlying disease.

B) Complications of the underlying disease.

B) Background disease (if any).

D) Concomitant diseases.

Curator (full name, course, group)

A. COLLECTION, ANALYSIS AND SYNTHESIS OF INFORMATION ABOUT THE PATIENT

1. PASSPORT DETAILS

1.1. Full Name

1.2. Age

1.4. Nationality

1.5. Education

1.6. Place of work, profession

1.7. Home address

1.8. Date of admission to the clinic

1.9. Diagnosis of the referring institution

1.10. Last name, first name, patronymic of the attending physician - the patient's supervisor in the department.

2. COMPLAINTS OF THE PATIENT ON ADMISSION

First, the main complaints that forced the patient to see a doctor are collected and given detailed characteristics each of them. When a patient complains of pain, it is necessary to clarify the location, nature (sharp, dull, aching, burning, stabbing, squeezing, constant or paroxysmal), its duration, intensity, irradiation, connection with body position, exercise tolerance, anxiety, hypothermia, food intake, its character. The conditions accompanying pain are listed (feelings of fear, melancholy, cold sweat, dizziness, dyspeptic disorders: nausea, vomiting, heartburn; shortness of breath, cough, chills, etc.)

What alleviates, reduces or increases pain: taking medications (which ones), heat, a certain position, physical activity, etc.

Describe in detail other complaints: cough, shortness of breath, suffocation, hemoptysis, temperature, swelling, etc.

3. HISTORY OF THE PRESENT DISEASE

The development and course of the disease must be described from the moment of its onset initial signs illness until the day of supervision of the patient.

At chronic course The disease must be given a complete picture of its course in dynamics. Describe the frequency, seasonality of the course or continuity and increase in painful manifestations.

The medical history should reflect the following:

A) the onset of the present disease, its first symptoms, their characteristics;

B) under what circumstances did you get sick, the causes of the present illness: anxiety, physical stress, cold, injury, poor eating habits, contact with sick people or sick animals, birds, occupational hazards, taking medications and their tolerance;

C) the dynamics of the development of the disease. In chronological order, monitor changes in the main signs of the disease from the moment of their manifestation to the present, the manifestation of new symptoms, periods of exacerbations and remissions, possible reasons contributing to the exacerbation of the disease. The last exacerbation before admission to the clinic is described in detail;

D) what diagnoses were made and what treatment measures were taken during different periods of the disease, indicate the results of treatment, possible or obvious complications of drug (or any other) therapy.

4. LIFE HISTORY OF THE PATIENT

The question about the patient’s life begins with the place of birth, place of residence and the family environment in which he grew up and developed.

Infancy: birth at term or premature, whichever is the case. Was fed by mother's breast or artificially. When he started walking and talking. When teeth came through. Was there rickets?

Childhood and school years: living conditions (apartment is cramped, cold, damp, dry), terrain, nutrition (how many times a day, nature of food, quality), health and development (did he keep up with his peers), how he studied, whether it was easy or difficult to study , general development and beginning of maturation.

Occupational history: by whom, where, how long he worked, under what conditions, whether there were any occupational hazards. Current working conditions (duration, mental or physical labor, condition of the workroom, etc.). Are there conflicts at work? How to use weekends and vacations.

Bad habits: smoking (at what age has he been smoking and how many cigarettes or cigarettes per day), drinking alcohol (frequency, quantity), using drugs, medications (which ones).

List past diseases in chronological order, starting from childhood. Pay special attention to infections: tuberculosis, influenza, scarlet fever, typhus, dysentery, allergic diseases, neuropsychic injuries, poisoning and helminthic infestations. Ask about sexually transmitted diseases, hypertension, diabetes, body weight.

Family and sexual history: married, married, since what age. For women, the onset of menstruation, its nature and cycle, pregnancy, childbirth (term or premature, were there any stillbirths), abortions (were there any complications). Death of children, at what age, cause. Menopause was either calm or painful. Whether you were in military service (if not, indicate the reason). Participation in hostilities, wounds, shell shock (for men).

Heredity: health of father, mother, brothers and sisters. Health status of wife, husband, children, parents. If died, indicate age and cause. Among diseases among relatives, pay special attention to tuberculosis, malignant neoplasms, diseases of the cardiovascular system, alcoholism, syphilis, mental illness, diabetes, obesity.

5. PRESENT CONDITION OF THE PATIENT

General examination of the patient

Assessment of the patient's severity: satisfactory, moderate, severe.

Consciousness: clear, stuporous, comatose.

Position of the patient: active, passive, forced.

Facial expression: calm, excited, suffering, “mitral”, “renal”, “Hippocrates” face, etc.

Body type: asthenic, normosthenic, hypersthenic.

Height (in centimeters). Body weight (in kilograms). Body mass index.

General nutrition: normal, excessive, reduced, cachexia.

Skin: skin color is pale, red, cyanotic, earthy, bronze, yellow, flesh-colored (pale pink), indicate areas of color change. Pathological pigmentation, depigmented areas of the skin (vitiligo), complete absence pigment (albinism).

The presence of the rash and its nature: erythema, roseola, papules, pustules, scales, scabs, erosions, cracks, ulcers, scratches.

Hemorrhagic rashes: localization, character, severity, presence of spider veins, angiomas, scars. Skin turgor, elasticity. Dry skin, flaking, increased humidity. Nails their shape and fragility.

External tumors: atheromas, lipomas, xanthomas, etc.

Hair: development on the head, face, axillary region, on the pubis. Hair loss (specify where), fragility, graying, excessive (indicating the greatest fat deposits).

Edema: localization, prevalence, severity, constant or disappearing, time of appearance (morning, evening), connection with physical stress, fluid intake, color of the skin over them and temperature.

Lymph nodes: cervical, subclavian, submandibular, axillary, elbow, inguinal; their size, shape, consistency, pain, mobility, adhesion to the skin, to each other, and to subsequent tissues. Condition of the skin over them (discoloration, scars, ulcerations).

Muscular system: degree of development muscular system(normal, weak), muscle atrophy or hypertrophy (general, local), muscle tone, strength, presence of muscle soreness (which ones), trembling.

Skeletal system: examination of the head (shape, size), the presence of deformations and curvatures of the bones, pain when palpating, tapping. Presence of “drum fingers”. Deformation of the spine, the presence of pain when loading the spine.

Joints: shape, active and passive mobility, pain when moving, crepitus (crunching), color of the skin in the joint area, skin temperature over them, swelling.

Body temperature. Type of fever.

The order sheet for tests indicates the date of appointment, the name of the analysis and the date of completion.

D. DIARY OF A SICK

A patient's diary is a daily, brief, comprehensive record of all changes in the course of the disease. The diary is written daily and by each student independently. The diary first notes the patient’s complaints at the time of examination, the patient’s general well-being, the dynamics of the course of the disease, i.e. all changes that have occurred in the patient’s subjective state over the past 24 hours, and then are given in detail clinical assessment objective condition, laboratory and instrumental studies and an additional examination is prescribed.

IN temperature sheet The temperature in the morning and evening, the dynamics of blood pressure and pulse, the number of heartbeats, and the number of respirations are noted. Amount of fluid drunk and diuresis, amount of sputum (according to indications). The main therapeutic agents are indicated.

The diary also notes every change in the course of the clinical diagnosis, treatment, indicates the tolerance of physical activity and medications, and justifies the physical and mental rehabilitation of the patient.

Once a week, instead of a diary, students write a stage-by-stage epicrisis, which briefly evaluates the course of the disease over the past 7 days and the effectiveness of therapy, and also indicates changes in the diagnosis, sets goals for the future in the examination and treatment of the patient, and determines the prognosis of the disease.

D. EPICRISIS

An epicrisis is a brief summary of the entire medical history, which includes the following data:

1. Last name I.O. sick.

2. Age.

3. Profession of the patient.

4. Time spent in hospital.

5. Complaints of the patient upon admission (main, leading)

6. History (only what is relevant to diagnosis).

7. Objective research (what confirms the diagnosis).

8. Data from laboratory, radiological and other research methods (indicate deviations).

9. Attention is focused on diseases with which differentiation is difficult.

10. Rationale and detailed clinical diagnosis: nosological form, stages, activity, clinical variant, complications, concomitant diseases.

11. Features of the course of the disease, its immediate and long-term prognosis. history of illness complaint

12. Treatment provided (regimen, diet, medications, drug dose), physiotherapy, exercise therapy.

13. Dynamics of the disease during the stay in the hospital.

14. Evaluation of the effectiveness of treatment: recovery, improvement - as expressed, no changes. Deterioration.

15. The patient’s condition at discharge (satisfactory, moderate, severe)

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Voronezh State Medical Academy named after. N.N. Burdenko

Department of Faculty Therapy

CASE HISTORY OUTLINE

Voronezh 2001

UDC 616. - 1/4 - 001

Compiled by: Associate Professor G.G. Semenkova, professor V.M. Provotorov.

Intended as a teaching aid when writing a medical history for students and interns of higher medical institutions.

Reviewers:

Professor, Doctor of Medical Sciences V.L. Radushkevich

Professor, Doctor of Medical Sciences IN AND. Zoloedov

Published by decision of the Central Coordination Methodological Council of VSMA named after. N.N. Burdenko dated December 4, 2001.

A medical history is an important document of practical, scientific and legal significance, in which the doctor presents and analyzes all the factual material of a comprehensive examination of the patient, the dynamics of his illness, treatment and prognosis.

The specific tasks of the student when working on the medical history are:

correct and comprehensive examination of the patient;

assessment of the obtained data and their use in the logical structure of clinical thinking;

formulation and substantiation of clinical diagnosis;

determining the prognosis of the supervised patient;

drawing up a treatment and rehabilitation plan for the patient.

The basic principles of constructing a medical history were developed by M.Ya. Mudrov, S.P. Botkin, G.A. Zakharyin.

Writing a medical history begins with a statement of complaints and anamnesis. Then the data of an objective examination of the patient is described, a preliminary diagnosis is formulated, a plan for laboratory and instrumental examination of the patient and a plan for his treatment are outlined.

In urgent cases requiring emergency care (for example, if the patient is unconscious), the order of the doctor’s work may change: first, a quick examination and assistance, and then collecting an anamnesis and a more detailed examination.

In the disease development section, it is necessary to outline the appearance of the first symptoms or syndromes of the disease and monitor their dynamics during the treatment process.

There are 5 stages in making a clinical diagnosis, in each of which certain tasks are sequentially set and methods for solving them are proposed. The most important task of the clinical analysis of each clinical case and its presentation in the medical history is its “individualization”, highlighting the main thing, especially in the causes of the disease, its course, the possibility of immediate and long-term complications. The prescription of therapy should also be strictly individualized, specific and reflected in the treatment plan, diary and epicrisis.

Medical history plan.

A. Collection, analysis and synthesis of information.

Passport part.

Complaints at the time of supervision.

History of the present illness.

History of the patient's life.

The patient's current condition.

B. Stages of logical structure, diagnosis and drawing up a plan for examining the patient.

Stage 1 of diagnostics. The leading syndrome is identified and the localization of the pathological process is determined. An examination is carried out to confirm this stage.

P stage of diagnosis. The nature of the pathological process is determined in the form of pathological and pathophysiological syndrome. An examination is carried out to confirm this stage.

III diagnostic stage. A preliminary diagnosis is made in the form of a nosological or syndromic hypothesis and a differential diagnosis plan is written (the diseases with which a differential diagnosis must be made are listed). The examination methods necessary for making a differential diagnosis are recommended.

IV stage of diagnosis. Justification of the clinical diagnosis using the differential diagnosis, examination results and the effectiveness of the therapy.

V stage of diagnosis. The main clinical diagnosis is formulated in accordance with the modern classification, the background diagnosis, complications of the main and background diagnosis.

B. Patient treatment plan.

D. Treatment of the patient (prescription sheet).

D. Epicrisis (detailed description of the results of examination and treatment of the patient with the rationale for the diagnosis and recommendations for treatment on an outpatient basis).

E. List of literature used when writing a medical history.

Preparation of 1 page of medical history.

Voronezh State Medical Academy named after. N.N. Burdenko.

Department of Faculty Therapy.

Head of department:

Teacher:

MEDICAL CARD

FULL NAME. sick

Clinical diagnosis (detailed):

A) Main disease. B) Complications of the main disease. C) Background disease (if any). D) Concomitant diseases. Curator (full name, course, group) A. COLLECTION, ANALYSIS AND SYNTHESIS OF INFORMATION ABOUT THE PATIENT 1. PASSPORT DETAILS 1.1. Last name, first name, patronymic 1.2. Age1.3. Gender1.4. Nationality1.5. Education1.6. Place of work, profession 1.7. Home address1.8. Date of admission to the clinic 1.9. Diagnosis of the referring institution1.10. Last name, first name, patronymic of the attending physician - the patient's supervisor in the department.2. COMPLAINTS OF THE PATIENT ON ADMISSION First, the main complaints that forced the patient to see a doctor are collected, and detailed characteristics of each of them are given. When a patient complains of pain, it is necessary to clarify the location, nature (sharp, dull, aching, burning, stabbing, squeezing, constant or paroxysmal), its duration, intensity, irradiation, connection with body position, exercise tolerance, anxiety, hypothermia, food intake, its character. The conditions accompanying pain are listed (feelings of fear, melancholy, cold sweat, dizziness, dyspeptic disorders: nausea, vomiting, heartburn; shortness of breath, cough, chills, etc.)

What alleviates, reduces or increases pain: taking medications (which ones), heat, a certain position, physical activity, etc.

Describe in detail other complaints: cough, shortness of breath, suffocation, hemoptysis, temperature, swelling, etc.

3. HISTORY OF THE PRESENT DISEASE

The development and course of the disease must be outlined from the moment the initial signs of the disease appear until the day of supervision of the patient.

In the chronic course of the disease, it is necessary to give a complete picture of its course in dynamics. Describe the frequency, seasonality of the course or continuity and increase in painful manifestations.

The medical history should reflect the following:

A) the onset of the present disease, its first symptoms, their characteristics;

C) the dynamics of the development of the disease. In chronological order, monitor changes in the main signs of the disease from the moment of their manifestation to the present, the manifestation of new symptoms, periods of exacerbations and remissions, possible causes contributing to the exacerbation of the disease. The last exacerbation before admission to the clinic is described in detail;

4. LIFE HISTORY OF THE PATIENT

The question about the patient’s life begins with the place of birth, place of residence and the family environment in which he grew up and developed.

Infancy: birth at term or premature, whichever is the case. Was fed by mother's breast or artificially. When he started walking and talking. When teeth came through. Was there rickets?

Childhood and school years: living conditions (apartment is cramped, cold, damp, dry), area, nutrition (how many times a day, nature of food, quality), health and development (did he keep up with his peers), how he studied, easy or it was difficult to study, general development and the beginning of maturation.

Occupational history: by whom, where, how long he worked, under what conditions, whether there were any occupational hazards. Current working conditions (duration, mental or physical work, condition of the work premises, etc.). Are there conflicts at work? How to use weekends and vacations.

Bad habits: smoking (at what age has he been smoking and how many cigarettes or cigarettes per day), drinking alcohol (frequency, quantity), using drugs, medications (which ones).

5. PRESENT CONDITION OF THE PATIENT

General examination of the patient

Assessment of the patient's severity: satisfactory, moderate, severe.

Consciousness: clear, stuporous, comatose.

Position of the patient: active, passive, forced.

Facial expression: calm, excited, suffering, “mitral”, “renal”, “Hippocrates” face, etc.

Body type: asthenic, normosthenic, hypersthenic.

Height (in centimeters). Body weight (in kilograms). Body mass index.

General nutrition: normal, excessive, reduced, cachexia.

The presence of the rash and its nature: erythema, roseola, papules, pustules, scales, scabs, erosions, cracks, ulcers, scratches.

Hemorrhagic rashes: localization, character, severity, presence of spider veins, angiomas, scars. Skin turgor, elasticity. Dry skin, flaking, increased humidity. Nails their shape and fragility.

External tumors: atheromas, lipomas, xanthomas, etc.

Hair: development on the head, face, armpits, pubic area. Hair loss (specify where), fragility, graying, excessive (indicating the greatest fat deposits).

Edema: localization, prevalence, severity, constant or disappearing, time of appearance (morning, evening), connection with physical stress, fluid intake, color of the skin over them and temperature.

Muscular system: degree of development of the muscular system (normal, weak), muscle atrophy or hypertrophy (general, local), muscle tone, strength, presence of muscle soreness (which ones), trembling.

Joints: shape, active and passive mobility, pain when moving, crepitus (crunching), color of the skin in the joint area, skin temperature over them, swelling.

Body temperature. Type of fever.

Respiratory system

Nose: its shape, recession, defects (the presence of a saddle nose), whether there is redness or ulceration at the outer edge of the nostrils, herpetic rash. Pain when pressing and tapping at the root of the nose, in places frontal sinuses and accessory cavities (maxillary cavities).

Larynx: shape, presence of swelling, where and what size. Palpation of the larynx, painful or painless.

Inspection chest. The shape of the chest is normal, barrel-shaped, emphysematous, paralytic, cylindrical, rachitic, funnel-shaped, “chicken”, “shoemaker’s chest”. Deformation of the chest due to curvature of the spine. The presence of asymmetry: protrusions, recesses. Uniformity of excussion of both sides of the chest during breathing. Types of breathing: upper costal (thoracic), lower costal (abdominal), mixed. Frequency breathing movements in one minute. Breathing rhythm: regular, Cheyne-Stokes, Biot, Kussmaul. Depth of breathing movements (deep, superficial). Dyspnea, its severity and nature (expiratory, inspiratory, mixed).

Feeling the chest. The presence of rigidity or flaccidity of the chest muscles, soreness of the skin, muscles, and ribs. Determination of voice tremors (strengthening, weakening). Sensation of friction of the pleura upon palpation. Measurement of chest circumference during quiet movement, with deep inhalation and exhalation.

Percussion. Comparative percussion of the lungs: quality of percussion sound over the lungs - clear (pulmonary), dull, dull, tympanic, boxed, sound of “cracked peas”, indicate exactly the boundaries of sound change. Rauchfuss-Grock and Garland triangles, Damoiseau line, etc.

Topographic percussion: determination of the height of the apexes of the lungs in front above the collarbone (in centimeters), Krenig's fields on both sides, the lower borders of the lungs along all lines, separately indicate the boundaries of the right and left lungs. Active mobility of the lungs along the midclavicular, midaxillary, and scapular lines. Indicate places of limitation or lack of mobility pulmonary edges. Definition of the resulting Traube space. Determination of the sonority scale in front and behind.

Auscultation. Comparative auscultation: the nature of respiratory sounds - vesicular breathing, weakened, increased with prolonged exhalation, hard breathing, bronchial breathing, amphoric, mixed. Listening to adverse respiratory sounds: dry rales, their tonality, wet rales (small-medium or large bubbles, crepitus). Pleural friction noise. Bronchophony.

Circulatory system

Examination of the heart and blood vessels. The presence of protrusion of the chest in the area of the heart, “heart hump”.

Apex beat: localization, strength, distribution (spread out, limited). Limited protrusion of the chest and palpation in these places (aortic aneurysm). Epigastric pulsation. Musset's sign.

Palpation: determination of the properties of the apical impulse (strong, weak and resting line). Determination of systolic and diastolic tremor (“cat purr”). Retrosternal palpation of the aorta. Presence of pain on palpation.

Percussion: determination of the boundaries of relative and absolute dullness of the heart (upper, right and left). Percussion of the vascular bundle (in the second intercostal space), its width. Length and diameter of the heart according to M.G. Kurlov.

Auscultation. Heart sounds: their characteristics, strength (weakening, strengthening, flapping first sound at the apex). Frequency (tachycardia, bradycardia), rhythm (regular, irregular, three-membered, gallop rhythm, quail rhythm, pendulum rhythm, embryocardia), the presence of bifurcation and splitting of tones and accent of 2 tones (on the aorta, pulmonary artery). Heart murmurs: determination of the phase of cardiac murmur (systolic, presystolic, mesodiastolic and protodiastolic). The strength and nature of the noises (sharp, weak, soft, rough), the place of their maximum audibility, the conductivity of the noises, their intensification or weakening during physical activity, when the patient changes position (lying, standing, on the left side). Increased systolic murmur in the aorta with raised arms (Kukoverov-Sirotinin symptom).

Extracardiac murmurs: pericardial friction rub and pleuro-pericardial murmur.

Vascular examination. Examination of blood vessels (“carotid dance”, condition of veins, pulsation of veins).

Pulse: number of beats per minute, rhythm, filling, tension, shape, size, uniformity, pulse deficit. Condition of palpable arteries, tortuosity.

Blood pressure (maximum and minimum) on the brachial arteries, and, if necessary, on the femoral ones.

Digestive system

Oral cavity: breath odor (sour, putrid, acetone, alcohol, urea, etc.)

Lips: color, dryness, cracks, herpetic rash. The mucous membrane of the inner surface of the lips and cheeks, hard and soft palate, pigmentation, Filatov spots, ulcerations, aphthae, thrush, etc.

Gums: pale, loose, bleeding. Gray border on the gums due to occupational poisoning.

Teeth: are there carious, loose teeth, indicate which teeth are missing, false teeth.

Tongue: size, color, varnished, “velvet”, wet, dry, coating.

Pharynx: coloring, swelling of the mucous membrane, dryness, plaque.

Tonsils: their size, redness, swelling, plaque, looseness, presence of purulent plugs.

Pharynx: mucous color, dryness, swelling, plaque, defects, ulcerations, scars.

Abdominal examination. Size, shape (“frog belly”, retracted, sunken), bloating. Participation of the abdomen in the act of breathing, symmetry. The presence of peristaltic movements visible through the abdominal integument (gastric, intestinal peristalsis). Development of venous anastomoses on the abdomen (“jellyfish head”), postoperative scars, pigmentation after heating pads. Presence of hernia (linea alba, inguinal, femoral). Abdominal circumference measurement.

Palpation of the abdomen is performed with the patient standing and lying down:

A) superficial (approximate palpation) - local or diffuse pain, pain points, muscle tension are revealed abdominal wall, Shchetkin-Blumberg symptom, the presence of ascites, the condition of the inguinal and femoral rings are determined. Determination of local percussion pain in the epigastrium (Mendel's syndrome);

B) deep sliding, methodical, topographic palpation according to Obraztsov is carried out in the following order: palpation of the sigmoid, cecum, terminal segment small intestine, appendix, transverse colon, palpation of the ascending colon, greater and lesser curvature of the stomach and pylorus. Identification of appendicular pain points (McBurney, Lantz, Abrazhenov), symptoms (Rovsing, Sitkovsky, Blumberg-Shchetkin);

Examination of the liver: palpation determines the nature of the edge, the consistency of the organ, the presence of tuberosity, indentation. Liver pain on palpation. Palpation of the gallbladder. Painful symptoms indicating pathology of the biliary tract (Georgievsky-Mussy symptom, Ortner, Murphy, Kera, Courvoisier symptom). Percussion of the upper and lower borders, liver dimensions according to Kurlov.

Palpation of the pancreas. Pain in the Choledochopancreatic zone of Choffard, at Desjardins' point, in the left costovertebral angle (Mayo-Robson zone).

Percussion of the abdomen: percussion is performed in different positions of the patient (standing, lying on the back, lying on the sides). Identification of local areas of dullness of percussion sound in chronic productive peritonitis, tumors, cysts.

Auscultation: determination of the lower border of the stomach by auscultation and palpation-auscultation methods. Listen to friction sounds over the liver and spleen.

Examination of the spleen: palpation (determining the edge of the spleen, its consistency, pain, mobility), the boundaries of the spleen (upper, lower, posterior and anterior), determining the length and diameter of the spleen according to Kurlov.

Urinary system

Examination of the lumbar region: smoothing of contours, bulging, swelling of the renal region.

Palpation of the kidneys in the Obraztsov position (bimanual) and standing according to Botkin. Determination of kidney size, displacement, position, consistency, pain. Tapping of the lumbar region, Pasternatsky's symptom. Palpation and percussion of the suprapubic area (bladder).

Reproductive system: mammary glands in women - degree of development, presence of scars, tumors, mastopathy, in men the presence of gynecomastia.

Palpation of the lower abdomen, uterus and its appendages.

External genitalia in men: testicular underdevelopment, anorchidism, cryptorchidism, penile anomaly.

Endocrine system

Inspection and palpation thyroid gland: localization, size, consistency, pain, mobility. The shape of the palpebral fissures, bulging eyes, Graefe's symptom, Moebius's, Stellwag's, etc. Impaired growth, physique, proportionality of individual parts of the body. Expressiveness of secondary sexual characteristics. Presence of hirsutism, virilism.

Nervous system

Preservation of consciousness, speech, concreteness, logical thinking, preservation of memory for current and past events. Intelligence level. Mood (smooth, depressed, anxious, euphoric, etc.) Are there any obsessive ideas. Gait, tendon, skin and abdominal reflexes. Dermographism. The width and uniformity of the pupils, their reaction to light, the presence or absence of paresis and paralysis. Uniformity of pain sensitivity.

B. STAGES OF THE LOGICAL STRUCTURE OF DIAGNOSIS

Identification of the leading topological syndrome(s) and determination of the localization of the process (1st stage of diagnosis).

When identifying syndromes, you should know the definition of symptom and syndrome. A syndrome is a set of symptoms united by a single pathogenesis. Symptom - any sign of a disease, definable, regardless of the method used. The syndrome should be distinguished from a symptom complex - a nonspecific combination, a simple sum of several symptoms.

As a rule, the leading syndrome(s) allows us to determine the localization of the process:

in organs (“angina pectoris” - coronary vessels; catarrhal phenomena in the lungs - a process in the bronchopulmonary system; “jaundice” and “hepatomegaly” - most likely liver damage; epigastric pain and “rotten dyspepsia” - stomach damage, etc. );

in the system (bleeding - pathology of the coagulation system; allergic reactions, frequent infections- pathology of immunity, etc.);

in metabolism ( endocrine diseases, hypo- or avitaminosis, etc.).

Determining the nature of the process in the form of pathoanatomical and pathophysiological syndrome(s) - stage 2 of diagnosis.

After identifying the localization of the pathological process, the most likely pathological and pathophysiological essence of the process is determined in the form of syndrome(s):

inflammation (infectious, immune, combination),

dystrophy (for example, myocardial dystrophy, liver cirrhosis, pneumosclerosis),

tumor (oncological, primarily),

vascular (vasculitis, atherosclerosis, thrombosis, embolism),

congenital (genetically determined and innate),

functional (syndrome vegetative dystonia, “borderline” arterial hypertension, etc.)

When thinking about stages 1 and 2 of diagnostics, the possibility of involving various organs and systems, and combinations of various pathoanatomical and pathophysiological syndromes (for example, atherosclerosis - a vascular process with disturbances in blood rheology and lipid metabolism). It is necessary to try to determine the primary or secondary nature of the process, especially when diagnosing oncopathology.

At these stages of diagnosis, along with clinical data, laboratory and instrumental examination methods can be used, which are included in the list of mandatory examinations that do not require much time and are performed already in the process medical examination(ECG, chest x-ray, some biochemical and clinical tests: blood sugar, urine acetone, complete blood count, etc.)

3. Preliminary diagnosis in the form of a nosological or syndromic hypothesis and a differential diagnosis plan (III stage of diagnosis).

After the affected organ (or system) has been found and the pathological nature has been discussed, it is necessary to determine the disease. For this purpose, a modern classification of diseases of this organ or system is used. By comparing the clinical picture of a given patient’s disease with diseases of an established pathological group, the most likely nosological form of the disease is selected. In this case, all data that confirms this diagnosis is summarized, i.e. the diagnosis is substantiated. The above three stages make it possible to substantiate the nosological diagnosis and formulate it in the form of a short summary, which lists all the data that allows confirming the diagnostic hypothesis. At the same time, possible contradictions are noted, i.e. a differential diagnosis plan is outlined.

A plan for laboratory and instrumental examinations necessary for making a differential diagnosis is also drawn up.

Each patient must undergo a general blood test, urine test, stool test for helminth eggs, UMRS, electrocardiogram, and chest x-ray. Special laboratory tests (clinical, biochemical, immunological, bacteriological) and instrumental (spirography, bronchoscopy, gastroscopy, examination of gastric and duodenal juice, ultrasound, computed tomography, etc.) are carried out according to indications, depending on the disease.

All laboratory and instrumental studies of supervised patients are carried out in clinical laboratories and are written out by students from the clinical history of the disease.

4. To prove the established nosological diagnosis, there are two ways (1st stage of diagnosis):

identification of a pathognomonic syndrome or symptom

carrying out a differential diagnosis.

The finding of a pathognomonic syndrome in a disease finally confirms a certain nosological diagnosis, but such syndromes are few. I often use differential diagnosis to prove the correctness of the diagnosis. Differential diagnosis is carried out with all diseases of the affected organ, as well as with diseases of other organs that are similar in clinical picture. Differentiation is carried out sequentially, starting with less likely diseases. The more diseases included in the differential diagnosis, the higher the degree of reliability of the hypothesis, i.e. the diagnosis is more likely. In difficult cases, two or more diagnostic hypotheses are identified and further examination of the patient is planned to confirm or exclude any of them. The most likely form of the disease will be the one in favor of which there is the largest number of main or secondary signs of the disease. In some cases, two or even more hypotheses are proven, because the patient may have several diseases (for example, diabetes and coronary artery disease, pneumonia, COPD and pulmonary tuberculosis, etc.).

5. At stage - formulation of the clinical diagnosis

The clinical diagnosis includes the name of the underlying disease, its stages, phase, etiology, complication of the disease, functional state affected organ or system and concomitant disease. At this stage, the issues of etiology and pathogenetic mechanisms that caused the disease are examined in detail. When making a clinical diagnosis, a detailed explanation of the complications of the disease and the degree of dysfunction of the affected organ (or system) is given. Taking into account all the features of the course of the disease in the patient under study, a detailed clinical diagnosis is formed. After making a clinical diagnosis, the doctor must make sure that, firstly, the diagnosis is sufficiently substantiated by the facts, secondly, all the facts have been explained, and thirdly, not a single fact refutes the diagnosis.

B. MEDICAL DIRECTIONS SHEET

The prescription sheet (see table) indicates the date of prescription and discontinuation of medications. The name of the drugs is given in Latin transcription, indicating the dose, concentration of solutions, route of administration (orally, subcutaneously, intramuscularly, intravenously), time of administration or administration of drugs (morning, afternoon, evening, before meals, after meals - how many minutes).

The prescription indicates the regimen (diet, table number according to Pevzner), and physiotherapeutic procedures are prescribed.

Table

The order sheet for tests indicates the date of appointment, the name of the analysis and the date of completion.

D. DIARY OF A SICK

A patient's diary is a daily, brief, comprehensive record of all changes in the course of the disease. The diary is written daily and by each student independently. The diary first notes the patient’s complaints at the time of examination, the patient’s general well-being, the dynamics of the course of the disease, i.e. all changes that have occurred in the patient’s subjective state over the past 24 hours, and then a detailed clinical assessment of the objective condition, laboratory and instrumental studies performed, and an additional examination is prescribed.

The temperature sheet indicates the temperature in the morning and evening, the dynamics of blood pressure and pulse, the number of heart contractions, and the number of respirations. Amount of fluid drunk and diuresis, amount of sputum (according to indications). The main therapeutic agents are indicated.

D. EPICRISIS

An epicrisis is a brief summary of the entire medical history, which includes the following data:

Last name I.O. sick.

Patient's profession.

Time spent in hospital.

Patient's complaints upon admission (main, leading)

History (only what is relevant to diagnosis).

Objective examination (what confirms the diagnosis).

Data from laboratory, radiological and other research methods (indicate deviations).

Attention is focused on diseases with which differentiation is difficult.

Rationale and detailed clinical diagnosis: nosological form, stages, activity, clinical variant, complications, concomitant diseases.

Features of the course of the disease, its immediate and long-term prognosis.

Treatment provided (regime, diet, medications, drug dose), physiotherapy, exercise therapy.

Dynamics of the disease during hospital stay.

Evaluation of the effectiveness of treatment: recovery, improvement - as expressed, no changes. Deterioration.

The patient's condition at discharge (satisfactory, moderate, severe)

LITERATURE

A list of monographs and journal articles used for patient supervision and writing a medical history is given.

Social significance coronary disease hearts

The great social significance of IHD is due to the widespread prevalence of this disease, the severity of its course, the tendency to progress, the presence of severe complications and significant economic losses.

IHD is a coronary circulatory failure caused by atherosclerosis of the coronary arteries (CA) or their temporary stenosis, which is caused by spasm or thrombosis of unchanged coronary arteries.

Characteristics of clinical forms of IHD

Three main clinical forms of IHD:

1. Angina

1.1 Angina pectoris;

1.2. Spontaneous angina;

1.3. Unstable angina

2. Myocardial infarction

2.1. Large focal myocardial infarction

2.2. Small focal infarction myocardium

3. Post-infarction cardiosclerosis

Three main complications of IHD:

1. Sudden coronary death

2. Rhythm and conduction disturbances

3. Heart failure

Limitations of life activity due to coronary artery disease are caused by:

heaviness functional disorders(CHN, CHF, arrhythmia syndrome, morpho-functional, structural disorders);

the nature of the course of IHD, including its clinical forms;

contraindicated factors at work.

Depending on the:

stage and location of the rehabilitation course;

period of disease development;

level and severity of IHD;

rehabilitation potential;

There are clinical rehabilitation groups (CRGs).

KRG 1: early rehabilitation group.

acute manifestations of coronary artery disease (acute myocardial infarction);

after surgery treatment of ischemic heart disease, regardless of the primary or recurrent myocardial infarction, surgical intervention and from the presence and severity of disability to the present case of illness and surgical treatment.

These patients are being treated in “acute” hospitals (ICU, cardiac surgery, cardiology).

patients in the early phase of chronic ischemic heart disease (first-time exertional angina up to 1 month old)

SSN FC 1.2 (in the absence of indications for hospitalization);

newly diagnosed ischemic heart disease (up to 1 month old) in the absence or with mild consequences at the organ level.

These patients are undergoing outpatient treatment.

KRG:2: group of patients with chronic ischemic heart disease.

KRG2.1: patients with acute manifestations of coronary artery disease; after surgical treatment of coronary artery disease, located in the early medical rehabilitation department.

patients with chronic ischemic heart disease in the rehabilitation phase at the outpatient stage with manifestations of the consequences of the disease in the form of persistent limitations in life activity;

patients with myocardial infarction, after surgical treatment of coronary artery disease in the presence of contraindications to rehabilitation in the inpatient department of early medical rehabilitation.

KRG 3: recognized disabled people due to coronary artery disease.

KRG 3.1: patients with high rehabilitation potential.

KRG 3.2: patients with average rehabilitation potential.

KRG 3.3: patients with low rehabilitation potential.

Myocardial infarction remains one of the most common diseases in industrialized countries. Over the past 20 years, mortality due to myocardial infarction in men aged 35–44 years has increased by 60%. In the vast majority of cases (95%), acute myocardial infarction occurs as a result of thrombosis of the coronary artery in the area of atherosclerotic plaque.

pain syndrome;

changes in electrocardiography (ECG);

characteristic dynamics of serum markers.

In the case of cardiac rehabilitation, three main directions are defined in accordance with the 3 main phases of the rehabilitation process:

1. Inpatient (which includes the treatment and rehabilitation stage and the stage of early inpatient medical rehabilitation).

2.Early outpatient.

3. Long-term outpatient (outpatient or home rehabilitation stages).

Stages of rehabilitation of patients with myocardial infarction:

2-stage system rehabilitation is provided for patients who have contraindications for rehabilitation in the inpatient rehabilitation department, who refuse to undergo this stage in the inpatient rehabilitation department (inpatient, outpatient stage).

Hospital: 10-15 days

(10 days with 1 CT MI, 13 days with 2 CT MIs, 15 days with 3 CT MIs).

In case of complicated course – individually.

3 stage system is provided for patients who have reached the 3b level of activity, in the absence of contraindications for rehabilitation in the inpatient rehabilitation department:

hospital,

inpatient rehabilitation department,

outpatient stage.

Duration: hospital: 10-15 days (10 days for 1 CT MI, 13 days for 2 CT MI, 15 for 3 CT MI).

Inpatient rehabilitation department: 16 days.

Contraindications for referring patients with MI to the inpatient rehabilitation department:

Stage III CHF (according to Strazhesko-Vasilenko).

Severe rhythm disturbances (ES of high gradations according to Lown, paroxysms), except for the constant form of MA.

Uncorrected complete AV block.

Recurrent thromboembolic complications.

Aneurysm of the heart and aorta with CHF above stage IIa (according to Strazhesko-Vasilenko).

Thrombophlebitis and other acute inflammatory diseases.

Principles and objectives of rehabilitation:

Quitting smoking and drinking alcohol.

Reducing body weight.

Normalization of blood pressure.

Improved lipid profile.

Increasing exercise tolerance.

Optimization of load conditions.

Improvement of psycho-emotional state.

Prevention of target organ damage and the development of clinical manifestations.

Maintaining social status.

Disability prevention.

The most complete return to work.

MINISTRY OF EDUCATION OF THE RUSSIAN FEDERATION

Tula State University

Department of Physical Education and Sports

Abstract on the topic:

“Physical rehabilitation for hypertension”

Prepared by:

Checked by: Dubrovina O.V.

Causes and clinical course GB 3

Degrees, forms and symptoms of HD 4

Mechanisms of therapeutic effects of physical exercise 5

Basic principles of treatment and rehabilitation of patients with hypertension 6

A set of exercises for hypertension 14

Literature 15

PHYSICAL REHABILITATION FOR HYPERTENSION (H)

Hypertension is chronic illness, striking various systems body, characterized by an increase in blood pressure above normal, the most common disease of the cardiovascular system. It has been established that those suffering from hypertension account for 15 - 20% of the adult population according to various data. epidemiological studies. HD quite often leads to disability and death. The underlying cause of the disease is arterial hypertension. Arterial hypertension is one of the main risk factors for the development of coronary artery disease, cerebral stroke and other diseases.

Hypertension shows a steady upward trend and this is due, first of all, to the fact that hypertension is a disease of civilization, its negative aspects(in particular, the information boom, the increased pace of life, hypokinesia, etc.). All this causes neuroses, including cardiovascular ones, negatively affecting the body and its regulatory mechanisms, including the regulation vascular tone. In addition, neuroses and stress lead to excessive release of catecholamines into the blood and thereby contribute to the development of atherosclerosis.

Causes and clinical course of headache.

The causes of hypertension are atherosclerotic lesions of peripheral vessels and disruption of neuroendocrine regulation. There is no complete clarity in understanding the etiology of hypertension. But the factors contributing to the development of the disease are well known:

Neuropsychic overstrain, emotional stress,

Hereditary constitutional features,

Occupational hazards(noise, eyestrain, increased and prolonged concentration of attention),

Excess weight body and nutritional habits (excessive consumption of salty and spicy food),

Smoking and alcohol abuse,

Age-related restructuring of regulatory mechanisms (juvenile hypertension, menopause in women),

Skull injuries

Hypercholesterolemia,

Kidney diseases,

Atherosclerosis,

Allergic diseases, etc.

Since the level of blood pressure is determined by the ratio of cardiac (minute) blood output and peripheral vascular resistance, the pathogenesis of hypertension is formed due to changes in these two indicators, which can be the following:

1) increased peripheral resistance due to either spasm or atherosclerotic lesions of peripheral vessels;

2) an increase in cardiac output due to intensification of its work or an increase in the intravascular volume of circulating blood (increase in blood plasma due to sodium retention);

3) a combination of increased cardiac output and increased peripheral resistance.

Regardless of the clinical and pathogenetic variants of the course of hypertension, an increase in blood pressure leads to the development of arteriosclerosis of three main organs: the heart, brain, and kidneys. The course and outcome of hypertension depend on their functional state.

Degrees, forms and symptoms of headache.

The latest version of the classification of arterial hypertension, recommended by WHO experts (1962, 1978, 1993, 1996), provides for the identification of three stages of arterial hypertension (AH), which are preceded by borderline hypertension (labile or transient hypertension) of three degrees of severity.

I. Classification by blood pressure level:

Normal blood pressure is below 140/90 mm Hg. Art.;

Borderline hypertension - blood pressure is in the range of 140/90 - 159/94 mm Hg. Art.;

Arterial hypertension - blood pressure is 160/95 mm Hg. Art. and higher.

II. Classification by etiology:

Primary arterial hypertension (hypertension);

Secondary (symptomatic) hypertension.

Based on the nature of the progression of symptoms and the duration of hypertension, hypertension is divided into: benign hypertension (slowly progressing or non-progressive) and malignant hypertension (rapidly progressing). GB of crisis and non-crisis course is also distinguished. There is, in addition, a division of hypertension into three main degrees: mild (mild), moderate and severe - taking into account the severity and degree of sustainability of the increase in blood pressure. Each of these three degrees is characterized by its own limits for increasing diastolic blood pressure: 90/100, 100/115, 115 mm Hg. Art. respectively.

Central symptom- syndrome arterial hypertension- is the increase in blood pressure measured auditory method, according to Korotkov, from 140/90 mm Hg. Art. and higher. Main complaints: headaches, dizziness, blurred vision, pain in the heart, palpitations. Patients may have no complaints. The disease is characterized by an undulating course, when periods of deterioration are replaced by periods of relative well-being. Hypertension can lead to a number of complications: heart failure, coronary artery disease, stroke, kidney damage. The course of hypertension in many patients is complicated by hypertensive crises. They are characterized by a sharp rise in blood pressure and can occur at all stages of the disease, and nausea, vomiting, and blurred vision may occur.

Mechanisms of the therapeutic effects of physical exercise.

Physical exercises, being a biological stimulator of regulatory systems, provide active mobilization of adaptive mechanisms and increase the adaptive capabilities of the body and the patient’s tolerance to physical activity. It is also very important that performing physical exercises is usually accompanied by the emergence of certain emotions, which also has a positive effect on the course of the main nervous processes in the cerebral cortex.

The use of various means and techniques to reduce elevated muscle tone(elements of massage, passive exercises, isometric exercises followed by relaxation) can also be used to reduce increased vascular tone. The use of physical exercise has a positive effect on the well-being of a hypertensive patient: irritability, headaches, dizziness, insomnia are reduced, and work ability is increased.

Basic principles of treatment and rehabilitation of patients with hypertension.

Rehabilitation of patients with hypertension should be strictly individual and planned in accordance with the following principles:

1. Treatment of persons with borderline arterial hypertension and patients with stage I hypertension is carried out, as a rule, by non-drug methods (salt-free diet, physical therapy, autogenic training and etc.). Only if there is no effect, medications are prescribed.

2. In patients with stages I and II, the leading role in treatment belongs to systematic drug therapy, which should be comprehensive. At the same time, it is necessary to systematically implement and preventive actions, among which a significant place was occupied by means of physical culture.

3. The physical activity of patients must correspond to the patient’s condition, the stage of the process and the form of the disease.

Exercises are used for all muscle groups, the pace of execution is average, the duration of classes is 25-30 minutes. Patients with stage I are treated on an outpatient basis, as well as in dispensaries and sanatoriums. Typically, in people with borderline hypertension and in patients with stage I hypertension, loads are used in which the heart rate should not exceed 130-140 beats/min, and blood pressure should not exceed 180/100 mm Hg. Art.

In recent years, interest in exercises in patients with hypertension in an isometric mode (static exercises) has grown. The hypotensive effect of static loads is due to their positive influence on the vegetative centers with a subsequent depressor reaction. So, an hour after performing such exercises, blood pressure decreases by more than 20 mm Hg. Art. Exercises in isometric mode are performed in a sitting or standing position, they include holding in outstretched arms dumbbells (1-2 kg), medicine balls and other items. Exercises in isometric mode must be combined with voluntary muscle relaxation and breathing exercises. Typically, loads are used for the muscles of the arms, shoulder girdle, torso, legs, and less often for the muscles of the neck and abdominal muscles.

After several months of training, patients with borderline hypertension and stage I of the disease with persistent normal blood pressure can begin training physical culture in health groups, swimming, recreational jogging, some sports games, continuing to use muscle relaxation exercises.

In case of hypertension stage II A and B, the nature of the rehabilitation effect and the conditions in which it is carried out (clinic, hospital or sanatorium) depend on the patient’s condition, the severity of existing complications and the degree of adaptation to physical activity. At this stage big specific gravity do special exercises, in particular, to relax muscles. More attention is paid to massage and self-massage, especially the collar area. Dosed walking, swimming, moderate bicycle ergometer exercise, health path, games, and autogenic training are necessary and quite effective.

In case of stage III hypertension and after hypertensive crises, classes are usually held in a hospital setting.

Rehabilitation program at the inpatient stage for hypertension stages A&B. In a hospital setting, the entire rehabilitation process is based on three motor modes: bed: a) strict, b) extended; ward (semi-bed); free. With strict bed rest, PH is not performed. During extended bed rest, the following tasks are solved: improving the neuropsychic status of the patient; gradual increase in the body’s adaptation to physical activity; decreased vascular tone; activation of the function of the cardiovascular system by training intra- and extracardial circulatory factors. Classes therapeutic exercises carried out individually or in groups. Physiotherapy carried out in the form of therapeutic exercises, morning hygienic exercises, and independent exercises. Therapeutic gymnastics classes are carried out lying on your back with the head of the bed raised high and sitting (to a limited extent). Exercises are used for all muscle groups, the pace is slow. Perform basic gymnastic exercises for the upper and lower extremities without effort, with a limited and gradually increasing range of motion in the small and medium joints of the extremities, alternating them with breathing exercises (2:1). The number of repetitions is 4-6 times, the duration of classes is from 15 to 20 minutes. Classes include relaxation exercises, gradual training vestibular apparatus and diaphragmatic breathing. Therapeutic gymnastics is combined with massage of the feet, lower legs and collar area.

At the stage of ward (semi-bed) rest, the following tasks are solved: eliminating the patient’s mental depression; improving adaptation of the cardiovascular system to increasing loads through strictly dosed training; improvement of peripheral circulation, elimination stagnation; training in proper breathing and mental self-regulation.

Therapeutic gymnastics classes are carried out in sitting and standing positions (limited) for all muscle groups with slight muscle effort at a slow and medium pace. The patient performs basic physical exercises mainly for the joints of the upper and lower extremities with full amplitude; it is recommended to use exercises of a static and dynamic nature in combination with breathing (2:1). The total duration of classes is up to 25 minutes. Exercises are repeated 4-6 times. A massage of the collar area is prescribed, during which deep stroking, rubbing, and kneading of the trapezius muscles are performed. The patient is in a sitting position, the massage begins with the scalp, then massages rear end neck and end on the shoulder girdle. Session duration is 10-12 minutes. Muscle relaxation exercises are widely used.

During the free regime, the tasks of improving the functional state of the central nervous system and its regulatory mechanisms; increasing the overall tone of the body, cardiovascular adaptability and respiratory systems and the whole body to various physical activities; strengthening the myocardium; improving metabolic processes in the body.

This motor mode in a hospital setting is characterized by the greatest motor activity. The patient is allowed to walk freely around the department; it is recommended to walk up the stairs (within three floors) with pauses for rest and breathing exercises. Forms of exercise therapy: LG, UGG, independent studies; LH is carried out sitting and standing, with an increasing amplitude of movements of the arms, legs and torso. Includes exercises with objects, coordination, balance, and relaxation of muscle groups. During the lesson and at the end of it, elements of autogenic training are used. The ratio of breathing exercises to general developmental exercises is 1:3. The total duration of classes is 20-35 minutes.

Physiotherapeutic treatment is used (sodium chloride, carbon dioxide, sulfide, iodine-bromine and radon baths). If you have a pool, it is good to use therapeutic swimming.

Classes on bicycle ergometers in the introductory section begin with a low power load (10 W) and a low pedaling speed (20 rpm) for 5 minutes for the gradual development of the body.

The main section uses the interval training method, when intense pedaling for 5 minutes at a speed of 40 rpm at an “individual” load power alternates with 3-minute periods of slow pedaling without load at a speed of 20 rpm. The number of periods of intense pedaling in the main section of classes is 4. The pulse at the end of every 5th minute of intensive pedaling should be 100 beats/min. The final section of exercise on a bicycle ergometer is carried out with a load power of 15 W with pedaling at 20 rpm for 5 minutes to reduce the load on the body and restore the cardiovascular system to its original value. Exercises on a bicycle ergometer should be carried out in the presence of a doctor (especially at the beginning).

At the free-mode stage, in addition to massage of the head and collar area, segmental reflex massage of the paravertebral zones can be prescribed, with the patient sitting in a sitting position with the head resting on the hands or a pillow.

Physical rehabilitation of patients at the outpatient stage is an important part of it, since patients with borderline arterial hypertension, stage HD1, undergo treatment and recovery on an outpatient basis. Patients with other stages of hypertension upon completion rehabilitation treatment in hospitals and sanatoriums they also go to community clinics where they undergo the maintenance phase of rehabilitation. The outpatient stage of physical rehabilitation of patients with hypertension includes three modes of motor activity: gentle motor mode (5-7 days); gentle training regimen (2 weeks); motor training regimen (4 weeks).

Gentle motor mode. Objectives: normalization of blood pressure; increasing the functionality of the cardiorespiratory system; activation of metabolic processes in the body; strengthening the heart muscle. Means of physical rehabilitation: exercise therapy, training on exercise machines, dosed walking, massage, physiotherapeutic procedures.

LH classes are conducted in a group way in sitting and standing positions, exercises are prescribed for large and medium muscle groups, the pace is slow and medium. The ratio to breathing is 3:1, the number of repetitions is 4-6 times. The classes also include exercises for relaxation, balance, and coordination of movements. Lesson duration - 20-25 minutes. Morning hygienic exercises should be carried out throughout the entire period of classes, including 10-12 exercises, which should be changed periodically.

If exercise machines are available, exercise on them is most suitable for patients with hypertension: exercise bike, treadmill (slow pace); walking simulator. In this case, blood pressure should not exceed 180/110 mm Hg. Art., and heart rate - 110-120 beats/min. Measured walking is widely used, starting from the 2-3rd day - a distance of 1-2 km at a pace of 80-90 steps/min.

Massotherapy: massage of the paravertebral segments of the head, neck and collar area, duration - 10-15 minutes, course of treatment - 20 procedures. Useful are general air baths at a temperature of 18-19 C for 15 to 25 minutes, swimming in open reservoirs at a water temperature of at least 18-19 ° C, lasting up to 20 minutes. Physiotherapeutic procedures: electrosleep, hydrogen sulfide, iodine-bromine and radon baths. Ultraviolet irradiation.

Gentle training mode. Objectives: further normalization of blood pressure; activation of metabolic processes; strengthening and training the heart muscle; increasing adaptation of the cardiovascular system to physical activity; preparation for household and professional physical activity.

LH classes are more intense, longer - up to 30-40 minutes, mostly standing, for relaxation - sitting. When performing physical exercises, all muscle groups are involved. The range of motion is the maximum possible. The classes include bending and turning the torso and head, exercises for coordination of movements, and general developmental breathing exercises. The ratio of outdoor switchgear to remote control is 4:1. Additionally, exercises with weights are introduced (dumbbells - from 0.5 to 1 kg, medicine balls - up to 2 kg).

The means of physical rehabilitation are the same as in the gentle mode, but the intensity of the load and its volume increase. Thus, the distance of measured walking increases to 3 km. Dosed jogging is introduced, starting from 30 to 60-meter segments, which alternates with walking. The time of air procedures is extended to 1.5 hours, and bathing - up to 40 minutes. There are also exercise classes, massage sessions and physiotherapy.

Training motor mode. Objectives: training the cardiovascular and respiratory systems; promotion physical performance and endurance of the patient; extension functionality cardiorespiratory system; adaptation of the body to everyday and work stress; achieving maximum individual physical activity.

During HL classes, various starting positions are used, the amplitude of movements is maximum, the tempo is average, the number of repetitions of exercises is 8-10 times, the open range to the remote control is 4:1, the duration of classes is 40-60 minutes. For weights, dumbbells are used - from 1.5 to 3 kg, medicine balls - up to 3 kg. Exercises for coordination of movements, balance, training of the vestibular apparatus, and breathing exercises are widely used. Separate elements of sports games are used: throwing, passing the ball, playing through a net, but it is necessary to remember the emotional nature of the games and their effect on the body and, therefore, strict control and dosage.

The walking distance increases sequentially from 4 to 8 km, the pace is 4 km/hour. Dosed running over a distance of 1-2 km at a speed of 5 km/h. The duration of air procedures is 2 hours, bathing and swimming - 1 hour. In summer, cycling is recommended, in winter - skiing.

Sanatorium-resort treatment differs more favorable conditions for the effective use of a wide variety of therapeutic effects(physiotherapy, exercise therapy, health path, autogenic training, diet therapy, etc.).

Patients with stage II hypertension of a benign course without frequent hypertensive crises and with circulatory failure no higher than stage I can be treated in the same sanatoriums as patients with stage I hypertension. For patients with stage III hypertension, sanatorium-resort treatment is contraindicated. The best long-term recovery results and a significant increase in performance are usually observed in patients with hypertension who were treated at resorts and sanatoriums located in areas that differ little in climatic characteristics from their place of residence. Optimal time The seasons for referring HD patients to sanatorium-resort treatment are spring, summer and autumn. If a patient is diagnosed with stage I or II hypertension, then treatment in a sanatorium begins with drug therapy and is used only when blood pressure decreases. physical methods treatment. Balneotherapy for stage I and II hypertension can be combined with exercise therapy, massage, and electrosleep. Physiotherapy, hydrotherapy, etc. are widely used. Under the influence of physical factors, the mental stress, the functional state of the central nervous system improves, helping to reduce arteriolar tone, increase blood supply to organs and metabolic processes in tissues. Important role in complex spa treatment

water procedures are played.

Among other forms of climatotherapy, aero- and heliotherapy deserve attention, as they have a specific effect on the body. IN atmospheric air resorts contain a significant amount of phytoncides and other volatile substances of plant origin, light air ions, which increase the oxidizing properties of oxygen. In this regard, sleeping outside relieves overexcitation of the nervous system and normalizes the function of its parasympathetic and sympathetic departments. Heliotherapy leads to a pronounced change in physical and chemical processes in tissues, accelerates blood circulation in capillaries, and affects the formation of vitamins.

Electrosleep plays an important role in the normalization of impaired functions in patients with hypertension, causing a protective defensive reaction, causing a state similar to natural sleep. It helps to mitigate the manifestations of functional pathology (reduces insomnia), reduces arterial pressure, improves cortical neurodynamics and metabolic processes.

In almost all resorts, patients with hypertension are prescribed a certain set of physical exercises. Exercise therapy performed outdoors is especially effective. The influence of climatic factors, the picturesque landscape of the area, organically merging with the direct action of gymnastic exercises, allows you to achieve positive result. In patients with hypertension, during exercise, the strength and mobility of nervous processes increases, the overall tone of the body improves, excitability decreases, and neurotic manifestations are eliminated. In a resort setting, exercise therapy is also aimed at introducing hypertensive patients to an active lifestyle, teaching them various gymnastic exercises which they can do at home. A clear positive effect is observed with long-term and systematic use of exercise therapy, especially in an outpatient setting. Sanatorium-resort treatment can significantly improve the general condition of patients with hypertension, lower blood pressure and create a favorable background for subsequent therapy in a clinic.

A set of exercises for hypertension:

Exercises of the 1st stage:

I.P. sitting, head motionless.

1) Eye movements up, down, left, right.

2) Take a small object in your hand and move it 90 cm from your eyes. Bringing the ball closer to you up to 30 cm, watch its approach with your eyes.

Exercises of the 2nd stage.

I.P. standing, feet shoulder-width apart.

1) Rotational movements of the head left and right.

2) Place an object (ball) on the floor. Pick up the object while looking straight up.

3) Lean forward. Passing an object (ball) from one hand to another under the knees.

Exercises of the 3rd stage.

I.P. standing, feet shoulder-width apart. Hands on the belt.

1) Open and close your eyes.

2) Turns left and right.

Exercises of the 4th stage (with a partner).

1) Partners stand opposite each other. Feet shoulder width apart. Throwing the ball to each other.

2) Partners stand with their backs to each other. One of the partners passes the ball to the other between the legs. The second partner takes the ball and passes it back over his head. You need to do the exercises as quickly as possible.

Literature.

1. Popular medical encyclopedia. /Ed. V.I. Pokrovsky, 4th edition - St.: “Knigochey”, 1997, 688 p.

2. Magazine “Health” No. 5, 1984, M.: “Pravda”.

3. Magazine “Physical Culture and Sports” No. 3, 1987, Chekhov: “FiS”.