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the fetus through most of pregnancy. 10. Increased intake of milk could have provided more calcium and phosphate f or absorption.
24. Translat e the following sente nces into English:
1. Ученые уделяют много внимания новым методам оживления новоро-
жденных. 2. Данная публикация рекомендуется для тех, кто работает в дет-
ских отделениях реанимации. 3. Сейчас детские реанимационные отделения
оснащены современными приборами. 4. Врачи разработали несколько диаг-
ностических методов для раннего обнаружения пороков у новорожденных. 5.
Достижения современной медицины помогают сегодня повысить уровень
выживаемости даже для очень слабых младенцев. 6. Опубликованные данные
показали, что грудное вскармливание снижает восприимчивость к заболева-
ниям. 7. Доктор Петров всегда утверждал, что правильный диагноз необхо-
дим для соответствующего лечения. 8. Доктор Петров добавил, что правиль-
ный диагноз сделает многие операции, которые могут быть вредны для ре-
бенка, излишними. 9. Лечение младенца следует начинать под строгим меди-
цинским контролем. 10. Современные больницы должны иметь все необходимое оборудование для диагностики и лечения.
25. Read text III and give the abstr act of it:
Text III. Positive Pressure Ventilation
Infants with rates less than 100 beats per minute need high-quality ventilation
with oxygen-enriched gas immediately, as do infants who remain apneic for more
than one minute after birth. With effective ventilation, the heart rate should increase to over 100 beat s per minut e within 15 to 30 se conds . The fi rst few insu ffl ations may require pressure of 30 to 50 cm of water. Thereafter, lower pressures
should suffice unle ss lu n g dise ase is pre se n t.
Bag mask ventilation:
a) With the infant’s head slightly extended, the mask is grasped with the
thumb and first two fingers of the left hand and placed gently but firml y over the
182
infant’s mouth and nose. The other two fingers of the left hand are used to support
the chin.
b) We usually use our continu ous positive airway pressure (C PAP) device to
deliver oxygen-enriched gas and to ventilate newborns. Self inflating devices also
work well.
c) A ventila tory rate of 30 to 50 per minute is us ually adequate.
d) The effectiveness of ventilation is assessed by observation of chest motion
and a prompt increase in heart rate. Auscultation of the chest should reveal air entry bilaterally.
e) Gastric distention should be watched for and may be relieved by passing a
nasogastric or orogastric tube.
Endotracheal intubation. The need for intubation during resus citation of newborn infants has often been an artifact of the supine position. In this position, the
large occiput and tongue and small posterior pharynx combine to produce airway
obstructio n. En do tra c heal intubati on is ind i ca te d:
a) if bag and mask ventilation is ineff ective;
b) if airway obstruction is suspected (e.g., gointer or micrognathia);
c) if meconium aspiration is suspected;
d) if externa l cardiac massage is necessary;
e) if prolon ged ventilatory support is anticipated.
The majority of infants with cardiorespiratory depression may be resuscitated
by high-quality ventilation alone .
26. Read text IV and say what the main idea of the text is:
Text IV. Pharmacolog ical Therapy
1. Catheterization of the umbilical vein with a № 5 French catheter often pro-
vides the quickest vascular route for administering drugs and volume expanders.
2. If the heart rate does not respond promptly to resuscitation efforts, adminis-
ter epinephrine 1:10,000 (0.1 ml/kg). May be given via endotracheal tube or umbilical vein catheter.
183
3. The endotracheal tube is often the most accessible route for administering
epinephrine and is clearly a preferred alternative to intracardiac injection. Dilute
the epinephrine in 1-2 ml of saline to f acilitate delivery by this route.
4. If hypovolemia is suspected, administer 10 to 20 ml/kg of 0.9% saline, type
0 rh negative blood cross-matched against the mother, heparinized placental blood,
plasmanate or albumin (1 gm/kg) diluted to a 5% solution with saline.
5. If the infant remains pale and/or bradycardiac for four to five minutes after
beginning ventilation, he or she probably has metabolic acidosis and will benefit
from the administration of sodium bicarbonate so long as ventilation is adequate.
Use a 0.5 mEq/ml concentration and infuse 2-3 mEq/kg at a rate of 1 to 2
mEq/kg/min or less. Subsequent doses of sodium bicarbonate should be based on
blood gas analysis. In general, metabolic acidosis with a base deficit of 10 mEq/L
or greater should be corrected if the infant’s condition remains unstable after resuscitation.
6. Other drugs such as atropine (0.01 mg/kg) or 10 % calcium gluconate (0.5
ml/kg) are seldom used in the delive ry room a t this time.
7. Drug depression:
a) Narcotic antagonists, such as naloxone, 0.1 mg/kg (new dose, see formulary), should be administered for suspected drug depression only after appropriate
initial resuscitation has taken place and the infant continues to hypoventilate. Too
often, a narcotic antagonist is administered in lieu of assisting ventilation, and a
wait-and-see attitude prevail s to the detriment of the patient.
b) Knowledge of maternal heroin use is essential to avoid precipitation of seizures secondary to acute narcotic withdrawal.
c) Maternal general anesthesia may result in an anesthetized newborn who requires 10 to 15 minutes (occasionally longer) of manual ventilation to recover from
the anesthet ic.
27. Read text V and write out key-sentences from each passage:
Text V. Withdrawal of Ventilatory Support
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a) Weaning or withdrawal. Ventilatory support is a technique for testing the
infant to see how well he manages without the ventilator. “Weaning” is a misleading term because it inmplies that you may be able to teach the patient to get along
without the ven tilator.
b)
Individualization. A plan for withdrawal of ventilatory support is necessary. Reduce that parameter which is considered to be most excessive and most hazardous to the pati en t , and re as se ss arte r ia l bl ood gases.
c)
CPAP at 4 to 6 cm water alone usually can be tried when a rate of 10 to 12
per minute is tolerated by the infant. The inspired oxygen concentration is kept the
same or raised by 5%. At this point an arterial blood gas value is obtained in 20 to
30 minutes. Most infants who weigh is less than 1,250 gm do not tolerate CPAP,
but do well if extu bated when ve ntilator set tings are lo w (12-14 c m H
2O inspirato-
ry pressure and a rate of 12-14 per minute) .
d)
Caution. When using slow rates (10 to 15 breaths per minute), avoid excessive inspiratory times. An inspiratory time of 0.4 seconds should be adequate and
should not exceed 0.6 seconds. Thus, at a rate of 15 breaths per minute the I:E ratio
should be 1:3 to 1:10. Remember, slowing the rate by increasing the inspiratory
time increases mean airway pressure. When ordering a rate change, be sure to specify a change in inspiratory tim e, expiration time, or both.
e)
Deterioration of the infant’s blood gas status during the above process requires return to the previously effective ventilator settings. Reassess the infant for
complications of ventilatory therapy or for a new problem such as patent ductus
arteriosus, low hematocrit reading, cold stress, atelectasis, mechanical problem
with the ven tilatory system, etc.
28. Read and translate t ext VI with the help of t he dictionary:
Text VI. Oxygen Delivery
Blenders. Mixtures of oxygen and air may be delivered to an infant by means
of endotracheal tubes, nasal prongs, or tubes, masks, funnels and hoods. In general,
an oxygen blender should be used with these techniques. Usually, 100% oxygen is
185
administered via nasal cannulae or incubator flooding and the liter flow is adjusted
to achieve t he desired concentration of oxygen.
1. Delivered by endotracheal tube, nasal prongs or tubes, masks, funnels and
hoods.
a) In general, use an oxygen blender and set FiO
2 .
b) Warmed, humidified oxygen should be used.
c) The gas flow used may be dependent on the operation requirements of the
mixing device , or bl e nde r.
2. Delivered by nasal ca nnulae or incubator flooding.
a) In general, 100% O
2.
FiO
2 is used and the liter flow is adjusted to achieve desired
b) Humidified oxygen should be used.
Gas flow. Warmed, hum idified gas should be used whenever possible.
1. Head hood: A liter flo w 3 times the volume of the head hood, or ab out 6 to
8 L/min, is usually adequate to prevent rebreathing of exhaled carbon dioxide.
Higher flows may be necessary to as sure stable oxygen conc entrations.
2. Intubated patients: Gas flows 1 to 2 times greater than the estimated minute
ventilation are adequate in continuous f low systems with a reservoir to provide for
the peak inspiratory flow demand. Higher flows may be necessary to achieve the
desired lev el of CPAP.
29. Read text VII and give the abstract of it. Translate the last three passages into Ru ssian:
Text VII. The Health of British Children
The International Hospital Federation has this year expressed particular interest in four specific aspects of children’s health: growth monitoring, early rehydration, breast fee di n g, and im munization.
In Britain, growth monitoring has long been a basic element of pediatric practice. The Child Welfare Service, now better described as the Community Child
Health Service, was established in 1918 because the British government was be-
186
coming increasingly conscious of the importance of disease in childhood as the
precursor of later disability. One of the service’s main functions was monitoring
child health from an yearly age; this included growth measurements, usually height
and weight.
Basic growth measurements related to the norm for any population can be
plotted quickly on a growth chart – now part of the standard pediatric documentation used in hospital. Weight, height and head circumference are the parameters
usually measured. While single measurements are of some value, serial measurements are of greater value in demonstrating any change in the state of a child’s
health. Such a change may be induced by disease, but may also result from physical or emotional neglect. In the search for early evidence of childabuse, a deviation
in weight from a previously established regular growth pattern has come to be recognized as a n important sign.
Study of growth patterns has been an important element of pediatric research
in Britain. Growth patterns for different diseases have been established and agerelated var iations have been defined.
In addition to expacted growth measurements at different ages, the idea of
growth velocity has been developed. Growth at the time of birth is rapid. During
the first year of life an infant will treble its birth weight, but the rate of growth diminishes. It continues to decline until adolescence, when there is a spurt in velocity. The tim ing of the spurt and of the vari ous changes that occur in association with
sexual ma turation are important factors in t he eastablis hment of normal adulthood.
Studies over many years of growth standards achieved by the nation yield interesting information. Over the past fifty or sixty years the height and weight of
British children have been increasing.
30. Revision questions:
1. When and where should first aid to the newborn be given?
2. What has helped to prevent fatal neonatal disorders and improve the surviv-
al statistics for newborns with development al anomalies?
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3. Is asphyxia considered to be a dan gerous con dition for t he newborn or not?
1. equipment
Оборудование, инструментарий
2. thermometer (oral, mercury, elec-
Термометр (оральный, ртутный.
3. Centigrade temperature chart
Температурная шкала термометра
4. Fahrenheit temperature chart
Температурная шкала термометра
5. Temperature (oral, rectal, aux-
Температура (ротовая, ректальная;
4. What is the hallmark of the newbor n intensive care unit?
5. Is ventilation by bag and mask an effective means of establishing lung ex-
pansion?
6. Supplemental oxygen is an important form of therapy for many infants with
cardiopulmonary diso rders, isn’t it?
7. What is PVS?
8. How may the majority of infants with cardiorespiratory depression be re-
suscitated?
9. What can you say about pharmacological therapy?
10. What is a technique for testing the infant to see how well he manages
without the ven tilator?
11. What means may mixtures of oxy gen and air be delivered to an infant by?
12. What aspects of children’s health has the International Hospital Federation
expressed i nterest for?
Unit 10. How to Have Analyses Taken
Vocabulary Notes
tronic, glass, lubrical or rectal)
электронный; стеклянный; любри-
кальный/ ректальный)
Цельсия
Фаренгейта
188
iliary, tympanic); to read the tem-
perature
подмышечная; высокотональная);
6. Procedure; to make / fulfill differ-
Процедура; выполнять различные
7. Appropriate for
Подходящий для
8. Site
Местонахождение, местоположение
9. An infant
Младенец (до года)
10. A toddler
Ребенок (от 1 года), который учится
11. A preschoo ler
дошкольник
12. To deal with
Иметь дело с …
13. To obtain ne cessary data
Получить необходимые данные
14. Sterile/ nons ter i le
Стерильный/ нестерильный
15. A bulb
Шарик (термометра)
16. sheath
оболочка
17. To sound tone /to bee p
Звучать / издавать высокий корот-
18. To contaminate
Загрязнять, заражать
прочесть показания температуры
ent procedure s
процедуры
ходить
кий (тонкий) звук
Ex.1 a).Translate the following words and expr essions:
Temperature: oral temperature, rectal temperature, axillary temperature, tympanic
temperature; to take one’s temperature; false reading of temperature; to read the
temperature; Centigr ade temperature chart; Fahrenheit temperature chart.
Thermometer: oral thermometer; mercury thermometer; electronic thermometer;
glass thermometer; lu bri ca l or rec ta l thermometer; to shake down the the rmometer.
b) Study the necessary equipment for taking a temperature
189
Thermom eter appropriate for site (glass [m ercury] or electronic); l ubricant (rectal);
gloves, nonste ri le (re c ta l); tissue.
FIGURE 1 Centigrade and Fahrenh eit temperature chart.
FIGURE 2 Oral and rectal thermometers.
Ex. 2. Translate the fol lowing expressions into English:
1. измерять температуру у детей; 2. правила безопасности; 3. измерение тем-
пературы орально; 4. быть противопоказанным в следующих случаях; 5. про-
верить записи на предмет показания данной процедуры;6. кислородная терапия; 7. уменьшить (избежать) передачи микроорганизмов; 8. быть осторожным и помнить; 9. выбрать / приготовить термометр; 10. следовать инструкциям производителя; 11. считывать показания; 12. Обеспечить правильное
считывание; 13.
Ex.3 Read and translate the extract from a lecture. Find all the verbals. Define their syntactic fu nction:
190
–Good morning, guys! Today we are to discuss how to take the temperature in
children. Let’s begin with the oral temperature. Well, before starting to measure
the temperature you should remember a number of safety rules. First of all, oral
temperatures are contraindica ted in following circumstances:
a. uncooperati ve or unconscious children;
b. following oral surgery;
c. children under 2 years of age.
Secondly, oral temperatures are inaccurate in children receiving oxygen therapy.
Oxygen cools the mouth and tachypnea leads to a low reading. Thirdly, use a glass
thermometer for children over 6 years of age. As for the procedure, there are some
steps you are to t a ke:
1. Check record for baseline and factors (age, illness, medications, etc.) influencing vital signs for prov idi ng parameters a nd helping in devic e and site se lec ti on.
2. Gather equipment, including paper and pen, for recording vital signs in order to
promote organization and efficiency.
3. Wash hands to reduce tra nsmission of m icr oorg an isms.
4. Prepare child and family in a quiet and nonthreatening manner for enhancing
cooperation and participation and reducing anxiety and fear, which can affect readings. Be careful and keep in mind that infants and young children may be quiet and
more cooper ative if vital signs are obtained while child is sitting on caregiver’s lap.
2. Select thermometer: glass wit h oral bulb (usually blue t ipped) or electronic.
3. Prepare thermometer.
a. Glass the rmometer.
1. If stored in a chemical solution, remove from storage conta iner and rinse under
cool water for removing disinfectant, which can irritate oral mucosa an d have an
objectionable taste. Cool water prevents the expansion of mercury.
2. Use tissue to dry from bulb end toward fingertips for the purpose of wiping from
least to most contaminated.
3. Check mercury level. It should be 35° C (95° F) or below. It must be below
normal body temperature to ensure accurate reading.