NEWLY DIAGNOSED PATIENTS PRECAUTIONS

FOR PATIENTS PATIENTS TO BE EXAMINED

ARE:

1. with symptoms of inflammatory bronchopulmonary disease:

with a prolonged cough (more than 2-3A prolonged cough (over 2-3 weeks) with sputum secretion;

hemoptysis and pulmonary bleeding;

chest pain associated with breathing;

2. With persistence for more than 2-3 weeksintoxicating symptoms:

elevated body temperature;

weakness;

increased sweating, especially at night;

weight loss

All persons with symptoms of respiratory disease are given a mandatory diagnostic minimum:

1. Clinical examination: examine complaints, medical history, conduct physical examination.

2. Laboratory examination: three times microscopic examination: sputum (if available) for acid-fast mycobacteria, Using Ziehl-Nelson staining.

3. Radiological examination of the organs Thoracic examina tion at a facility-accessible volume(optimum: use of (optimum: use of digital fluorography)

All persons with symptoms of respiratory disease are given a mandatory diagnostic minimum:

4. Additional methods of investigation are performed according to indications and require special equipment - lung and mediastinum tomography, protein and tuberculin tests, immunological tests (detection of specific anti- tuberculosis antibodies in blood serum), biochemical studies of proteinogram, study of fibrinogen, blood calcium, alkaline and acidic phosphatases, etc., bronchological studies (bronchoscopy, bronchography).

5. In complicated diagnostic cases, puncture biopsy, diagnostic surgery, angiopulmonography and other more time-consuming studies are used to help clarify the diagnosis

THIS IS IMPORTANT.

When starting objective examination of a patient, it is necessary to remember that tuberculosis is a disease of the whole body and can manifest both general and local symptoms, and besides, a tuberculosis patient can have any other accompanying disease. Therefore, when examining a patient, it is necessary to pay attention toall organs and systems of the body, applying generally accepted in the clinic of internal diseases examination methods

Factors contributing to tuberculosis

malnutrition

alcoholism

drug

addictionHIV

infectionpresence of concomitant diseases (diabetes, gastric and duodenal ulcers, nonspecific lung diseases)

1. PRINCIPLES OF CLINICAL EXAMINATION

ANAMNESIS:

contacts with tuberculosis patients, past tuberculosis, residual tuberculous changes in the lungs, mental and physical trauma, hyperinsulation, use of medical jars, treatment with steroid hormones and immunosuppressants, malnutrition, comorbidities (diabetes, peptic ulcer disease, pneumoconiosis, alcoholism, chronic)

1. PRINCIPLES OF CLINICAL EXAMINATION

TYPICAL COMPLAINTS:

1.WEAKNESS.

2.INCREASED FATIGUE.

3.WORSENING OF APPETITE.

4.LOSING WEIGHT.

5.IRRITABILITY.

6.LACK OF CAPACITY FOR WORK.

7.INCREASED BODY TEMPERATURE (FEVER).

8.INCREASED SWEATING (INCLUDING NIGHT SWEATS).

9.COUGHING.

10.PRESENCE OF SPUTUM.

11.PAIN IN THE CHEST.

12.HEMOPTYSIS (PULMONARY HEMORRHAGE).

1. PRINCIPLES OF CLINICAL EXAMINATION

PHYSICAL EXAMINATION:

deficiency of body weight, pale face, glossy eyes and wide pupils, dystrophic skin changes, long and narrow chest, widened intercostal spaces, acute supracostal angle, lagging (wing-shaped) shoulder blades - usually observed in patients with late stages of the tuberculosis process. On the fingers and toes - deformation of the terminal phalanges in the form of drumsticks and changes in the shape of nails (in the form of watchglasses). In children and adolescents, examination of scars on the shoulder after BCG vaccination

1. PRINCIPLES OF CLINICAL EXAMINATION

PALPATION:

skin, lymph nodes, often noted lagging of the affected half of the chest when breathing, soreness of pectoral muscles, atrophy of the shoulder girdle and chest muscles, significant displacement of mediastinal organs (palpation by tracheal position). Vocal trembling: normal, amplified (over an area of thickened lung in infiltrative cirrhotic tuberculosis, over a large cavern with a wide draining bronchus), weakening (if there is air or fluid in the pleural cavity air or fluid, atelectasis, massive pneumonia with bronchial obstruction)

1. PRINCIPLES OF CLINICAL EXAMINATION

PERCUSSION

reveals relatively coarse changes in the lungs and thorax in infiltrative and cirrhotic lobular lesions, fibro pleura, in the diagnosis of spontaneous pneumothorax, acute exudative pleurisy, pulmonary atelectasis (presence of boxy sound or shortened pulmonary sound)