Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 tai lieu vat ly tri lieu PHCN file 4 het

Ngat- N gat 13.tinh trang mat tri gia , mat cam giac trong thci gian ngan1-2 phut, lam giarn heat dong twin hoan h6 hap trong mot thoi gian nh at dinh, Ngat xay ra d9t ng9t, truce khi ng

- Ho ra mau gap trong benh hep tim 2 la (hep hai la -7 ho r~ mau).

- Xung huyet ph6i -7 ho khac ra mau

- Nh5i mau ph6i -7 ho +khac ra mau

'

4.4 Xanh tim

- Xanh tim la dau hieu phan anh tinh trang thieu oxy, lam cho da va

Liic d~u xanh tim khu tru d rnoi, cac d~u chi

- Khi suy tim nang xanh tim bi§u hien d mat va toanthan,

4.5 Danh tr6'ng ngl:/'c

Danh trong nguc la cam thay trdng nguc ,d~p ron rang Do la tiengd~p cua tim d6n d~p, tim d~p m~nh rna d ngudi binh thudng chi khi camd9ng, h6i h9P ho?c giing suc nhi€u mQi co

Tri~u chung nay c6 th~ giftptrong b~nh: thieu mau, cudng tuyen giap tr?ng

4.6 Dau vting trU'Gctim

- Dau vung truoc tim la cam giac dau nh6i d vung truoc tim voi muc d9khac nhau

- Dau xay' r~ d9t ng9t, c6 cam giac d ngl,tc va nhu bi de ngh~t sauxliong uc, ngudi b~nh hoang s<;lcam thuy nhu minh siip chet

- D6 la can dau thiit ngl,tc hoiftc can dau tim, tfnh chat dau am 1ho?cdau tung can Dau Ian len c6 hoiftc dau xliong vai canh tay trai, candau keo dai vai phut den hang gid

- Nguyen nhan: g?P trong b~nh:

+ Co thiit d9ng m~ch vanh

+ Nh5i mau cd tim

+ Viem mang ngoai tim

4.7 Ngat

- N gat 13.tinh trang mat tri gia , mat cam giac trong thci gian ngan1-2 phut, lam giarn heat dong twin hoan h6 hap trong mot thoi gian

nh at dinh,

Ngat xay ra d9t ng9t, truce khi ngat benh nhan thay hoa mat chong

mat, toat m6 hoi, tim dap nhanh, riga xuong hoi goi kh6ng biet gi

- Tim dap nhe hoac kh6ng dap, mach nhanh nhung kh6 bat

- Mat nhot nhat, narn bat dong

- Huyet ap giam,

5 Trieu chirnqthirc th~ trong b~nh tim mach

5 1 Kham toen than

- 'I'oan trang gfly hay beo cao hay thap (can nang, do ch ieu cao)

- Da niern mac binh thucng hay xanh nhot nhat hay tim tai,

- Hach ngoai bien tuyen giap co to hay kh6ng

- Ngon tay ngcn chan co dui trfing khong (g~p trong suy tim)

- Tam phe' man, tim b&m sinh

- Mong tay khum g$p trong viern mang trong tim

5.2 Khem mech mtiu

Tinh mach canh c6 n6i kh6ng

- Nghi~m phap phan h6i gan TInh m?ch ctta co kh6ng, nghi~m phapdUdng tinh g~p trong suy tim phai

- D9ng m?ch canh co d~p m?nh khong

- Do huyet ap d9ng m?ch va huyet ap tinh m?ch

5.3 Kham tim bang phuO'ng phap nhin, set, go, nghe

5.4 Kham c~n lam sang

5.4 1 ChVP tim d hai tu the':.

- Khi dieu tri phuc h6i benh nhan tim mach can nam viing nguyennhan gay benh, trieu chung benh, dien bien cua benh va cac bienchirng coth€ xay ra

- Theo H9i tim mach NEW YORK ' (NEW YO :R: i 'lI e"ar t association) de'xuat nhirng bang phan loai benh tim mach sau day:

6.1 Bang phan 10;# b~nh Iy

La bang phan loai benh tim mach thea nguyen nhan '

- Vi du: benh tim do cao huyet up, do xo cung d9ng mach, benh timb~m sinh

6.2 " Bang phan toe! ctusc nang

La bang phan loai thea trieu chung sinh 1yg6m 4 cap:

CapI: benh tim chua lam giarn sut kha nang ho?t d9ng th€ luc:berih nhan v~n heat d9ng binh thuong kh6ng gay rnet moi, h6i

Cap II: benh tim da lam giam sut nhe kha nang heat dong th€ luc,

- Benh nh~n thoai mai khi nghi ngoi va lam cong viec nhe "

- Nhung cam thay m~t moi, h6i h9P, kh6 thd, dau ng\ic k'hi g~~g suc, Cap III:b~nh tim da lam giam sut nhieu kha nang ho?t d9ng'th~l\1c,Khi nghi ngoi thi khong thay cac tri~u chung suy tim

- Ho~t d9ng th€ l\ic nh~ cung thay m~t moi h6i h9P, kh6 thd va dau

Cap IV: b~nh tim da lam cho ngudi b~nh hoi 'gllng suc da c6 tri~uchung suy tim, khi nghi ngoi cling thay ngudi' m~t' moi kh6 thd,dau ngl,ic

Luqng gia ngudi bi b~nh tim thudng do thap khop cap, h~p van 2 la,

hd van 2 lao Lo?n nhip tim do rung nhI

7 Nguyen t~c dieu trj VLTL b~nh tim m~ch,

7.1 Khi nao ca'n die ' u trj b~nh tim

- Nhung b~nh nhan chua co r6i lo<:tntim m<:tch

- Nhung b~nh nhan moi bi giam sut nh~ kha nang ho?t d9ng th€ h;ic

- Benh nhan mdi bi kh6 thd nhe, kh6 thd khi gl'ing sue thi chi can nghi

ngoi, uong thuoc an than, an han che muoi nude, chua can dieu trithuoc men

- Nhirrig benh nhan da bi~u hien suy tim thi phai dieu tr] bang:

+ Thuoc tro tim

+ Thucc lei ti~ul

giam trudng Ive ed, suy S\lP tinh th§.n ngudi b~nh

- Nghi ngdi tudng dOlt~i giudng: chI dinh cho cae trudng h<;Jp suy tim nh~:

- Cfln ?ieu tri them vitamin Bl lieu eao se lam eho Hnh tr?ng cua timkha len

7.4 Thuoc men

Dieu tri thtioc m\lc ruch tang clidng cung lUejng tim va giam u huyet

n o?i bien

7.4 1 Thuoc cLli:Jng tim

Tac d\lng tim d~p deu m?nh va nhip ch~m

Digitalin (bi~t dU9c Digitoxin, Digoxin)

1 02

- Strophantin (Uabain).

7.4.2 Thuoc tot tieu

- Thuoc lei ti§u c6 thuy ngan: Novurit

- Hoac lei ti§u Sulfamid, Furosemid

7.5 Thu6c an thfin va tam Iy ngiiiti b~nh

- Benh nhan tim mach thuong 10 lang xuS dong deu anh hucng denbenh tat

- Cftn coi md vdi benh nhan, d9ng vien benh nhan gat bo 10au ve benh,yen tam chua benh va thuc hien ke hoach trong tuong lai cua ho,

- Neu benh nang, dip tinh mdi dung thuoc an thftn;' cq th~ dung d~nxuat cua morphin hoac gardenan

7.6 Oxy Ii~u phap

Chi dinh dung oxy khi c6 suy tim nang, suy tim cap, kh6 tho, xanh

tim, benh nhan v:%ttva, me sang

7.7. Phuc h6'i chuc nang ngLf&i b~nh

- 'I'ruoc khi phuc h6i chuc nang benh nhan suy tim can lucng gia lamsang vdi cac dli kien,

+ Do mach, huyet ap, nhip tho, dau hieu xanh tim, di~n tim, khamtoan than cua b~nh nhan

+ Cac du ki~n tren 6n dinh mdi t:%tpluy~n v:%tnd9ng duqc

+ Khi dang t~p luy~n b~nh nhan xuat hi~n cac tri~u chung: dau ng\l'c,kh6 thd, tim tai, toat me)hoi thi ngung t:%tpluy~n ngay '

LUQNG GIA

1 Trinh bay nhling tri~u chung cd nang cua b~nh tim m~ch

2 Trinh bay cach ph an lo~i b~nh tim m::}.ch

3 Trinh bay nguyen d.c dieu tri VLTL b~nh tim m~ch

VAT LY TRI LIEU BENH rANG HUYET . - Ap

Ml)C TIEU

l Trinh bay duoc dinh nghia, ph an loai, nguyen nhan tang h uyet ap,

2 Trinh bay duoc tri~u chung tang huyet ap, tien tri~n, bien chirng

va dieu tr] tang huyet ap,

3 Trinh bay ducc muc dich, phuong phap phuc hoi chuc nang tunghuyet ap tai b~nh vien va tai nha

NQIDUNG

1 Dinh nqhla

Tang huyet ap la tinh trang huyet ap d<)ng mach toi da tren 150

mmHg (21,3 Kpa) va huyet ap d<)ng mach toi thieu tren 90 mmHg (12,7

Kpa) va c6 th~ gay bien chung tim, than, than kinh, m:'it

2 Huyet ap binh thltdng va tinh hinh m~c b~nh tang huyet ap

Theo T6 chuc Y te The gioi:

2.1 Huyet ap binh thU'iing

- Huyet ap d<)ng mach toi da tir: 90 mmHg - 140 mmHg (Huyet ap tamthu)

- Huy e t ap dong m~ch to'i thi~u tu: 60 mmHg - 90mmHg (Huyet aptam trudng)

- Huyet ap d9ng m~ch kh6ng co' dinh rna thay d6i trong ngay Ban dem

Theo tu6i:' huyet ap clla ngudi tre thap han clla ngudi gia.,

- Theo gioi: huyet ap clla nil thap han cua nam

- Huyet ap hic d6i thap hon huyet ap hic an no

2.2 Tinh hinh mac b~nh tang huyet ap 6'tren thl§' gici'i va Vi~t Nam

3. Phan leal va nguyen nhan tang huyet ap

3.1 Phen tos! tang huyet ep: tang huyet ap duoc chia lam 3 loai,

3.1.1 Tang huye't ap thuang xuyen

- Trong loai nay chung ta clin phan biet: '

+ Tang huyet ap lanh tinh

+ Tang huyet ap ac tfnh

~

3.1.2 Tang huyet ap con

Tren cd sd huyet ap binh thucng hoac g~n binh thuong benh nhan xuathien ct9t ng9t nhimg con tang huyet ap va khi d6 c6 th~ cotai hien xay ra

I

Huyet {lp bcnh nhiin luc tiing hie giarn, ca huyet ap t6i da va t6i thieu,

3.2 Nguyen nhan tang huyet ap

huyet ap trieu chung

+ Tien man kinh (huyet ap tang d giai do~n tien man kinh sau do 6 n

dinh va binh thudng),

+ H9i chllng Cushing,'to d~l.l chi

)

3.2 2 Bent: tang huye't ep (tang huyet ap nguyen phat hoac tang huyet ap

Lam viec trf 6c qua sue chiern 70% - 80%

-'- Ngl.idi cao tu6i

- Xo cung d9ng mach (h~ thong ti~u d9ng mach colai gay cao huyet ap)

thuong, dai khi thay bieu hien trieu chung co nang:

Benh nhan nhuc dfiu hai ben thai ducng, sau gay va dinh dfiu

- Hoa mat

4.2 1 Tri~u chung cO nang

- Nhuc dfiu sau gay ho~c dinh dfiu

- Dai khi c6 tru'dng hQp chay mau mlii (chay mau cam)

4.2 2 Tri~u chung thl/C the

cling ngo:1n ngheo)

106

4.2.3 Trieu ~hung cen lam sang

_ Xet ngh iern mau: u re rnau: binh thucng (0,2-0,4 g/lit) hoac hoi tang

cholesterol tang tren 5,1 7mmol/lit

Xet ngh iern nude ti~u c6: Protein ducng tfnh

H6ng cftu +

Bach cflu +

Tru hat +

Soi day mat: c6 hien tuong xuat huyet vong mac (Dongmach day mat

ph an arih tinh trang dong mach nao) ' ~ !

_ X quang tim: giai dean dflu binh thuong, giai dean sau tim to

X quang ph6i: binh thuong i

4.3 Giai do~n tang huyet ap bien chLi'ng

Do huyet ap toi da tang tren 160mmHg, huyet ap toi thi§u'tang tren

90 mmHg Benh nhan c6 th~ xuflt hien cac bien chung Sq_U:

4.3.1 BifI/n chung mtJt

- Phu gai mat

Xuat huydt vong mac, phu day mat

Dau hieu Gun (dong mach bat cheo tinh mach),

4.3.2 Bien chung tim

- Suy tim (that trai gian ~ suy tim trai ~ suy tim toan bo),

- Con da u thii t ngVc

- Nh6i mau cd tim

4.3.3 Bien chung th?n: chiem 20%, co th§ gay:

Viem cflu th~n cflp tinh, m?n Hnh

- Suy th~n m~n (ure mau tang)

4.3.4 Bien chung than kinh

- Neu nh~: gay co thiit d9ng m?ch nao, tiic d9ng m?ch nao, huyet khoiQ9ng m~ch trong S9

- Neu n~ng: gay nhun nao, xuflt huyet nao ~ li~t nlta ngtidi

5 Tien trien, bien chirnq

5.1. Tien trie'n: theo 3 giai doen

HA toi thi~u dudi 80mmHg

5.-1.2 Giai doen II: huyet ap gioi han (huyet ap gidi han la huyet ap d9ng

mmHg)

5 1.3 Giai aoen III: huyet ap cao thucng xuyen

toi thi~u tren 95 mmHg

Th{(t trai gian to ~ suy tim

+ Nhimnao ~.: ~ '" ~ :+Xw1t huyet nao ~ liet nua nguoi.

6 Dieu tr]

6.1. ouo trj tricu chUng

6.1.1 fJieu tti tang huy{/t ap nh£?-vue

_ N ghi ngci hoan toan, kh6ng gihig sire ve th~ luc, khong cang th~ng

tinh than

- An han che m uoi, n tick

Dung thuoc gian mach: Papaverin ha huyet up

- Dung thuoc an than: Seduxeh 5·10mg/ngay

6.1 2 Dh31l trf tang huyet ep thuong xuyen

- Dung thuoc ha huyet ap,

- Thuoc loi ti~u

Thuoc an than

- Thuoc chong xc cung dong mach

Thuoc gian mach

6.2 fJie'u trj nguyen nhan

Tuy thuoc vao nguyen nhan rna co cac phucng phap dieu tri khac nhau.·

~ /.

-.

-7 Ph6ng b~nh (5 bi~n phap phong b~nhtang huyet ap)

1 Tranh ding thang than kinh

2 An han che mu6i va chfft kich thich (rU<;1uca phe, thuoc la).,

3 T6 chuc kham suc khoe dinh ky cho ngudi 45 tu6i trd len) D~pha t hi~n h uye't ap cao

4 Dieu tri tich cvc khi phat hi~n du<;1Ctang huye't ap

5 Lao dQng chan tay ke't h<;1pvoi lao d(mg tri 6c h<;1p15'.

8 Thea doi - cham soc tang huyet ap

8.1 Theo d6i

- M~ch, nhi~t dQ, huyet ap, nhip thd ngay 1 llin

- Xet nghi~m nuoc ti~u, ure mau, cholesterol mau tu§.n 1 l:in

Theo d6i bien chu~g d~ x{t tri kip thdi

_' I ::

B.2. Cham soc

8.2 1 Ch{; cJ(; nghi ngo;

8.2.2 Che' a(; an u6ng

- An du chat va IU<;Jng

- Kh6ng dung chat kich thfch (ruou, bia, ca phe, che, thuoc la),

8.2.3 Che' a¢ thu6d men

- Dung thuoc dung lieu, dung chi dinh, bao gam:

9,1 ML}c dich

9.2 Phu,(1ng phap VL TL

- Van dong' nhe nhang cac chi

Xoa bop dftu mat c6

LUQNG GIA

1 Trinh bay nguyen nhan gay cao huyet ap thu phat va nguyen phat

2 Trinh bay tri~u chung, bien chung tang huyet ap

PHUC HOI . CHUC NANG SUY TIM

- Ve phan loai suy tim: do vi tri, cau true, chuc nang cua tim phai vatim trai khac nhau nen chi a ra suy tim phai va suy tim trai, m6i loaic6 nguyen nhan rieng, d:liccti@mva trieu chung khac nhau

- Ve Him sang: luc dftu suy tim phai hoac suy tim trai

- Dan dan c6 th@ suy tim toan bo

2 Trieu chang cua suy tim

2.1 Suy tim trei

2 1 1 Nguyen nhan

G6m cac b~nh gay u mau trong that trai lam cho that trai' phai lamvi~c nhieu nen gian that trai r6i suy tim

Do b~nh tang huye't ap

- Do b~nh van tim: h21van 2 la, hd hof;lc h~p 16 van d9ng m~ch chu

- B~nhtim b~m sinh: h~p eo d9ng m~ch chu bftm sinh, con 6ng d9ng m~ch

- T6n thudng cd tim: nh6i mau cd tim, viem cd tim

2.1.2 Tri{Ju chang

- Tri~u chung cd nang: tim trai suy, ti&u tUfrn hoan,bi Itmau, b9 ph?nchiu anh hUdng dfru tienla ph6i, n6ib~t len la tri~.u chung_~~i'ph§i '

Kh6 the: hie dciu kh6 thd khi gilng sue, ve sau kh6 tho nhieu, Benh

n ha n phai ng6i cho de the, khi suy tim nang kh6 thd th uong xuyen

cap, kern theo dau nguc, cam 'giac nhu bi b6p chet va de nghen sau

hong c6 bot chua nhieu albumin

+ Mom tim d?p lech sang trai

mom tim

+ Do huyet ap: huyet ap toi da giam, huyet ap toi thi~u binh thudng,

so huyet ap chenh l~ch nho

- Tri~u chung c?n lam sang:

Di~n tam d6:

X q uang tim ph6i:

+ Cung du6i ben trai phinh to

+ Ron ph6i d?m do u mau

2.2.1 Nguyen nhan

N6i b?t la tri~u chung u mau ngo:;ti bien, gan 1a b9 ph?n d~u tien chiu

Suy tim phai khong c6 cdn kich phat

B~nh dien bien tu tu ngay cang n~ng len

- Do nhung b~nh can trd mau ve tim va tu tim len ph6i

112

+ Benh ph6i man tfnh: hen phe' quan, viern ph{ quan man, gian phequan, lao ph6i, gu, veo c9t s6ng.

+ Benh van tim: hep van 2 la, hep van 3 la, hep van d9ng mach ph6i

+ Benh tim b£m sinh: thong lien nhi, thong lien th~t

2.2.2 Tri~u chung

- Xanh tim va kh6 tho:

+ Xanh tim: muc d9 rihe chi tim d moi, benh nirt~g:tim d mat, cac d:iuchi va toan than

+ Kh6 thd tu tu thuong xuyen tang dan, kh6ng cocon kh6 thd kich phat

b Trieu chung thia: the':

Tinh mach c6 nf)i rfi: dau hieu phan h6i gan tinh mach c6 duong tinh._ Gan to dudi bd suon phai: mat gan nhan, bd tu, mat d9 mern, an vaogan dau tuc

+ Khi mdi dieu trj gan nho l~i gQila gan dan xe'p

+ D:in d:in u mau lau, gan kh6ng thu nho du<;jc.Gan trd nen cung

_ Phu: hie d:iu phu d mi miit, mirtt, d:in d:in phu 2 chan va phli toan than (c6 th~ phli mang tim, mang b\lng, mang tinh hoan).:'./ Mang ph6i: u nuoc mang ph6i

+ Day that phai, day that trai

- X Quang tim ph6i:

+ Cung duoi ben phai phinh to

+ Tim phai to

+ R6~·-ph6i d~m do u mau

2.3 Suy tim toen br).

2 3.1 Nguyen nhtm

- Ngoai nhirng nguyen nhan suy tim phai va suy tim trai

vitamin B1•

2.3.2. tneo chung

a Tri e u chang cd nang: n6i bat la trieu chung cua suy tim phai

- Xanh tim d maio

b Tri e u chang thuc the:'

Gan to dudi bo siren phai

- Tinh mach c6 n6i, dau hieu phan h6i gan tinh mach c6 ducng tinh

- Phu mi mat, mat, dan dan benh nang phu d hai chan va toan than

- Unude mang phci, mang tim, mang bung va mang tinh hoan.

- Nghe tim: c6 tieng th6i tam thu hoac tieng rung tam trucng d mom tim

- Do huyet ap: huyet ap t6i da giam, huyet ap toi thi~u tang

c Tri?u chung c¢n lam sang:

- Di~n tam d6: thftt phai va that trai day Day nhi trai

- X quang tim to toan b9

- Kh6ng heat dong giing sue .

- Nghi ngci tai giuong tuy thea ~~c de) suy tim

An nhat hoan toan khi phu nhieu,

An han ~he'muoi (1· 2g/ngay) '

- Kh6ng an uong cac chat kich, thich: ca phe, thuoc lao

" -.- -' ~ : ~ ' ;.r' i!'.',

4.3. ens d9 thuoc

Dung thuoc tro tim

Dung thuoc lei ti~u

Th uoc an than

5 Phuc hoi chirc nang suy tim

5.1 MlIC diet: phuc ho"j chU'c nang

- Tang cuong luong mau cho tim

Chong utr~ tuan hoan ngoai bien

Chong kh6 thd

5.2 Phuong phap VL TL

- Tap thd bung, thd nguc,

- Van dong nhe nhang cac chi

- Xoa bop chan tay

?

LLfQNG GIA

tim trai, suy tim toan be)

2 Trinh bay rnuc dfch va cac phucng phap phuc h6i chuc nang suy tim

VAT LV TRI LIEU - PHUC HOI CHIIC NANG .

NHOI MAu CO TIM

Ml)C TIEU

l Nguyen nhan, trieu chung tien tri~n, bien chung cua nhdi rnau co tim

2 Muc dieh, chuong trinh VLTL-PHCN cho benh nhan nhdi mau co tim

2.1 Nguyen nhan cbinn

- Huyet khdi tai mot vung cua d9ng mach vanh da bi hep do xo vfradorig mach d~n den thieu mau nuoi dudng gay hoai tli

- Xuat huyet duci mang trong dong mach vanh cua mang xo vua

- T&c dong mach vanh do nghen mach, do C\lC rnau tir xa dua tdi (gaptrong viern n9i tam mac, trong h~p van 2 la)

- Coonnhip nhar:h, lo~n nhip hoan toano

- Lam vi~c tri ~c qua cang th~ng, xuc d9ng m~nh

- B~nh g?P d nam gidi nhieu hdn nil gidi, tu 50 tu6i trd len, tuy nhienv~n c6 th~ g?P d ngudi tre

3 1 Giai phau b?nh

nhi€u manh, xung quanh ehB nh5i mau c6 phan ling b~ch cflu ' -

116