MINISTRY OF EDUCATION & SCIENCE KYRGYZ REPUBLIC

OSH STATE UNIVERSITY

INTERNATIONAL MEDICAL FACULTY
DEPARTMENT OF «CLINICAL DISCIPLINES 2»

«Disscussed» - «Recommended by » -
in meeting of the department «CD 2» Academic councilor in the department «CD2»
prot.№___from_____2019, G.S. Tashieva
head of department, ______________
c.m.s.,assoc.prof.,
M. M. Bugubaeva________

PLAN for PRACTICAL CLASS

TOPIC № 13:APFoftheskin, subcutaneousfatlayerinchildren..

TOPIC №14:The methodology for studying the skin and semiotics of its main changes.

DISCIPLINE: “Child diseases (propaedeutic)”

For students, who is studying in direction : (560001) - «General medicine» (GM)
PREPARED BY: Osmonova G.Zh., Mamytova Zh.T., Alimova N.A.

Оsh, 2020.
TOPIC № 13:APFoftheskin, subcutaneousfatlayerinchildren..
TOPIC №14:The methodology for studying the skin and semiotics of its main changes

Plan of practical class:

1. List the anatomical and physiological features of the skin and pancreas, lymph nodes in children of different ages.
2.Explain the age-related features of the skin appendages (hair, nails, sebaceous, sweat glands).
3. Demonstrate methods of research of skin, subcutaneous fat, lymph nodes in children
4. What are the methods of research of the skin
5. Demonstrate methods for determining edema.
6. Describe and demonstrate methods for determining the thickness of fatty acids in children.

The goal of class:

To study the anatomical and physiological features of the skin and subcutaneous fat in children. To study methods of studying the skin and
subcutaneous fat in children.
Form of Class: subgroup lesson

Type of class: practical class

Equipments used in class: laptop, PPT, a list of test questions, pictures.

Interdisciplinary communication: general anatomy, normal physiology, faculty pediatrics.

Intrasubject communication: Lecture № 13,14

Learning outcomes (LO) and competencies formulated in the process of studying the discipline " Child diseases (propaedeutic)" in the process of
mastering the discipline, the student will achieve the following learning outcomes (LO) and will have the appropriate competencies:
Code of LO in GEP and its
wording
LO-5 - Able to assess
morphofunctional,
physiological conditions and
pathological processes and
apply research methods for
sick adults and children to
solve professional problems
Competencies
of GEP
AC-3 - is able and ready to assess
morphological and functional and
physiological states and pathological
processes in the human body, taking into
account their age and sex groups for solving
professional problems;
Code of LO of the discipline (LOd) and its
wording
LOd-5: capable and ready to evaluate
morphofunctional and physiological
physical conditions and is able to
interpret the survey, physical
examination, clinical examination,
write a medical record of outpatient
and inpatient
sick adult and child and is ready to
conduct pathophysiological analysis
of clinical syndromes;
Learning outcome of the topic
Can describe the anatomical and
physiological features and
functions of the skin and
subcutaneous fat layer of the skin
(PFA) in children. Can explain and
demonstrate the methods of
determining the skin's texture and
elasticity.Methods for determining
libraries.

The synchronous part (ZOOM)

№ Stages Aim of Lecture Actions of Actions of Methods Results of study Equipments Time
teacher students used
1 Organizational Greeting, identifying absentees, Introduction, Writing topic & Ans-Ques pay attention to the lesson Zoom, PPT 5 min
moments organizing attention, discussion of its questions
introduction to new topic, the topic's
checking connecting to the relevance
Zoom conference
2 Survey of material on Generalization of students Asking Selectively Answer the Recalling materials of prerequisites, Ques-answers 5 min
prerequisites knowledge of the materials questions and answer questions contributing to self preparation Application
studied and establish a link with discussing with questions one №1
a new topic. students by one.

3 Motivation for new Enhance students' mental Showing Freely unnamed Focusing students on the issues , Pictures 5 min
topic activity, develop critical pictures participate in pictures about participating in team discussions, ,Zoom
thinking the discussion, today’s topic freely express their opinions Application
the ability to №2
work in a team
4 Foundation of new determination and analysis Showing & Listening& Presentation A theoretical base of knowledge PPT, Zoom 15 min
topic of the assimilation of the explaining writing notes of slides and skills for use in practical
slides exercises.
passed material

5 Conclusion of new Definition and analysisof the Demonstration Solving the tests Solving tests Independently use the knowledge PPT, Zoom 10 min
topic and summing material covered, making of tests gained on the topic, formation of
up changes to its content competence

The asynchronous part (all tasks are sent over the Internet)
6 Homework The main questions of the next Explain how to Writind down Show in PPT Prepare answers for specific Zoom, ppt 10 min
topic prepare the assignment questions
in notebooks
7 Associate To analyze the education of Submit Send the WhatsApp, Application 20 min
students situational answers Google №4
issues classroom,
Googl form
8 Checking the students Teach students to self-esteem Correction Answer each Questioning Getting information about how Examples & 10 min
and their knowledge other to specific and checking much students understood the new questions
questions asked. each other topic.

Criteria for keeping points:

Attendance Absent-Present 0 points

Notes Absent-present 0-5 points
Active participation in the lesson Discussing the topic, answering for questions, 0-15 points
PPT
MCQ, crosswords, puzzle, clinical cases, According to results of work 10 points
khahoot, practical skills

Application №1
1. What is the subcutaneous fat layer of skin?
2. What is the role of the subcutaneous fat layer?
What are the layers of human skin?
How deep is the subcutaneous layer of skin?
Is subcutaneous fat good?
Where is subcutaneous fat found?

Application №2
 Facts about the skin
The skin is the body's largest organ. It covers the entire body. It serves as a protective shield against heat, light, injury, and infection. The skin also:

 Regulates body temperature

 Stores water and fat

 Is a sensory organ
 Prevents water loss

 Prevents entry of bacteria

 Acts as a barrier between the organism and its environment

 Helps to make vitamin D when exposed to the sun

Your skin takes on different thickness, color, and texture all over your body. For example, your head contains more hair follicles than anywhere else. But the soles of your
feet have none. In addition, the soles of your feet and the palms of your hands are much thicker than skin on other areas of your body.

The skin is made up of 3 layers. Each layer has certain functions:

 Epidermis

 Dermis

 Subcutaneous fat layer (hypodermis)

Epidermis The epidermis is the thin outer layer of the skin. It consists of 3 types of cells:

 Squamous cells. The outermost layer is continuously shed is called the stratum corneum.

 Basal cells. Basal cells are found just under the squamous cells, at the base of the epidermis.

 Melanocytes. Melanocytes are also found at the base of the epidermis and make melanin. This gives the skin its color.

Dermis The dermis is the middle layer of the skin. The dermis contains the following:

 Blood vessels

 Lymph vessels

 Hair follicles

 Sweat glands

 Collagen bundles

 Fibroblasts
  Nerves

 Sebaceous glands

The dermis is held together by a protein called collagen. This layer gives skin flexibility and strength. The dermis also contains pain and touch
receptors.

Subcutaneous fat The subcutaneous fat layer is the deepest layer of skin. It consists of a network of collagen and fat cells. It helps conserve the body's heat and protects
layer the body from injury by acting as a shock absorber.

Skin.
The functions of the child's skin are mainly due to their anatomical features.
Functional features of the skin include:
- the respiratory function of the skin is most intensively developed in a child, in a newborn it is 8 times stronger than in an adult;
- secretory function-vitamins, enzymes, and biologically active substances are formed in the skin;
- pigment-forming function-melanin production;
- (absorption) function in infants is more intense, which should not be forgotten when prescribing skin medications;
- skin-sense organ; - excretory function of the skin in young children is underdeveloped; in adults, 700-1300 ml of sweat is released;
- the thermoregulatory function of a newborn child is poorly developed, which should be remembered when caring for the baby (bathing, swaddling);
this function fully enters into its activity only a few months after birth;
- the skin is a protective barrier, but this function is poorly expressed in children;
- for the doctor, the skin is a sign of violations of the state of internal organons (hyperthermia, water metabolism disorders)

Anatomical and physiological features of the skin in a child have pronounced differences from an adult, as well as in children of different ages. It
consists of two main layers (the English layer): the epidermis (basal, granular, and Horny layer) and the dermis.
Distinctive feature:
- the thickness of various layers of the child's skin is 2-3 times less than that of outdated faces.;
- a feature of the basal layer of the newborn's epidermis is incomplete formation of melanin, which is due to a lighter skin co lor immediately after birth
(and in newborns of the black race immediately after birth, it is light and has a reddish hue);
- the granular layer of the epidermis in newborns is very weak. and newborns do not have keratogyalin in their cells, which gives the skin a white
color, all this is due to the transparency and pink color of the baby's skin.
-In young children, the stratum corneum is thin, consists of 2-3 layers of keratinized cells; it is loose, subject to slight injury, and saturated with water;
- the dermis in children has the advantage of cellular elements. in an adult, it has the advantage of a fibrous structure. Only at the age of 6 years does
the histological structure of the skin approach that of an adult.

Skin color and appearance

In a newborn, the skin is pale cyanotic color, somewhat edematous (English oedema), in the area of the shoulder blades are covered with downy hair
(germ down=lanugo), After birth, the surface of the dermis is covered with a thick layer of raw primordial lubricant (vernix caseosa), which includes
the exfoliated epidermis, fat, cholesterol, etc. The skin is cleaned of grease and a few hours after birth becomes reddish with a slight cyanotic tinge -
this is called physiological catarrh of the newborn (physiological erythema-neonatorum). It is expressed in the first two days of a child's life and is
especially characteristic of premature babies.
On the second or third day of life, most children's skin becomes yellowish - physiological jaundice of the newborn (= icterus neonatorum transient
hyperbilirubinemia). Hiperbilirubinemia is an increase in the amount of bilirubin in the blood serum (observed in newborns due to the physiological
destruction of red blood cells and the formation of bilirubin from the isolated hemoglobin, an important role is played by immaturity (English,
unlripeiness) of the liver enzyme systems). On the 3-4 day of a child's life, the amount of bilirubin on average is 100-140 mmol/l. in 1/3 of newborns,
this figure is less than indicated, in 1/3 it increases to 170 mmol/l.
Jaundice of the skin is observed in about 2/3 of children. It occurs in full - term newborns when the amount of bilirubin exceeds 50 mmol/l, in
premature infants-more than 85-100 mmol/l.
Icterus neonatorum disappears on the 7th-10th day of life.
The delay of physiological jaundice until the end of the first month of life (it is called conjugation jaundice) requires additional examination and
treatment.

The methodology for studying the skin

The conclusion about the condition of the skin, subcutaneous tissue and partially the muscular system is made on the basis of examination and
palpation (those tactile sensations when pressing the skin with your fingers - English palpation, touching) of the child .
- first visually under the influence of light, placing the child at the window and turned him around face to the window (if it is not contraindicated by
the state) around the skin on the face, torso, limbs, behind the ears, and mucous membranes of the eyes, and it turns out the color of the skin,
distribution of fat tissue. In addition, the growth and distribution of hair is established;
- then the following indicators are evaluated by palpation: humidity or dryness, velvety, heat and touch, tissue elasticity, thickness of the
subcutaneous fat layer and tissue turgor. dryness, velvety/

Humidity or dryness, velvety, heat is determined by stroking the back of the fingers of all skin areas, paying special attention to the palms and soles.
Normally, the skin is moderately moist, velvety and warm.
Increased humidity-in older children, this is a characteristic manifestation of vegetative-vascular dystonia, some endocrine diseases (increased
thyroid function), at an early age it can be when the child is overheated.
Dry skin occurs when the body is dehydrated, significant hypotrophy, prolonged intoxication, and some endocrine diseases (decreased gland
function),

List of recommended literature
Main literature
1. Propaedeutics childhood diseases childcare: Textbook / Ed. TV Captain. - M.: MEDpress - Inform, 2006 -704 p.
2. Propaedeutics childhood diseases: Textbook / Ed. RR Kildiyarovoy, VI Makarova. - M.: GEOTAR Media, 2012. - 680 p.
3. Propaedeutics childhood diseases: Textbook / Ed. NA Geppe, NS Podchernyaeva - M: GEOTAR Media, 2009. - 464 p.
4 .Mazurin AV Propaedeutics childhood diseases / AV Mazurin, IM Vorontsov - SPb .: Tome, 2001.- 928 p.
Additional literature
5.Poliklinicheskaya pediatrics: medical examination of children: ucheb method. Manual / Under the general editorship. IN Gaymolenko, OA Tihonenko - Chita: IPC
GOU VPO Chelyabinsk State Medical Academy, 2010. - 106 p.
6.Shabalov NP Childhood diseases. - SpetsLit: Saint-Petersburg. - 2007 - 628
7.Kildiyarova RR Pediatrician for every day: a handbook / RR Kildiyarova. - 6 th ed., Rev. and add. - M.: GEOTAR Media, 2009. - 160 p.
8. Children's illnesses. The textbook for doctors - pediatricians / ed. VAShcherbak. - ChitaExpress - publishing, 2008. - 800 p.