5.3. The final stage

Assessment of action of each student during class and standardized end control. It conducted the analysis of student achievement, announced rating of each student and put in the book of visits and student achievement. Parish groups simultaneously puts rating in accounting performance and attendance of students. The teacher assures them his signature.

Brief information for students on the theme of the next lesson and instructional techniques to prepare for it.

Task 1

Patient N., 52 years old, entered the pulmonary department with complaints of fever to 38.5 0 C for 3 days, productive cough with purulent, yellow-green sputum, volume in approximately 10 ml per day, increasing shortness of breath. The patient smokes for about 25 years. The long period of cough and shortness of breath disturbed, expiratory dyspnea constantly progressed.

Skin pale, gray and clear. Blood pressure 130/80 mm Hg. Pulse 96/min, regular, satisfactory properties. Emphysematous thorax, intercostal spaces wide, horizontally arranged, additional muscles involved in breathing. RR 26/min. Vocal fremitus is weakened. Percussion sound is tympanic, the lower lungs border are shifted down. Auscultatory - vesicular breathing, sometimes weakened, dry rales and whistling wheezings.

The ECG: diffuse changes in the myocardium, overload of right heart. Chest X-ray: increased transparency of lung fields, enhanced pulmonary picture, the lower border of the lungs are shifted down. Spirometry: FEV1 - 56%, daily fluctuations - 7%, test Tyffno - 66%, a negative test with bronchodilators. CBC: Er - 4,5 ∙ 10¹²/l, Hb - 145 g/l, Leuk. - 15,0 ∙ 109 / L, eosinophils - 1%, segm. - 71%, lymph. - 16%, mon. - 12%, platelets - 240 ∙ 109 / l, ESR - 20 mm / h. Total sputum analysis: sputum purulent, yellow-green liquid; leukocytes: 47 in visual field, neutrophils: 36 in visual field.

Gases of blood: pO2 55 mm Hg, pCO2 48 mm Hg.

1. Make the diagnosis. Describe respiratory failure, which developed in this patient?

2.How pathogenetic methods of correction of respiratory failure in this clinical case?

Recommended literature:

А. Main:

1. Davidson’s Principles and Practice of Medicine, 2006.

Materials for self-control:

А. The questions for self-control:

A. Give the definition of respiratory failure. 2. What the pathogenetic mechanisms of respiratory failure do you know? 3. Discrabe the main clinical manifestations of respiratory failure and their characteristics depending on the pathogenic type. 4. Which methods of examination you will be use for patients with shortness of breath? 5. What approaches for correction of respiratory failure do you know?

Methodic chart made by M.D. Ostapchuk O.I.