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Sura avd 0 fBojowjeyrydo s vone>ypaut sospayaau spaupapis —— Buuoyuow zwde Gewieyd » aumpius anoge; yuna — ue foubuaig x09 ADIN, ard soun9}s90 soseiyd 04 jas fq uossiuipy Z ord psinu 38e)— wouissesse a8eu) OUIe9N IpRH de gay Aq uorssiupy t 5951 / 519 fpog 7 swoyduiks —21e>juayyeq puesuBis — gol Aw 5.4) s}U9}U0)‘Admin bank p52 4 Prescriptions 9 Neurology « p68 Alleen Bowles Glasgow coma “paediatric scale neurology nurse 10 Coronary ® p74 Givingan ECG The circulation of ‘the blood 11 Surgery © p80 ‘Matthew Binns Post-operative theatre nurse complications 12 Infectious diseases © p86 Talking about Describing changinga symptoms dressing 13 Renal e p92 ‘Merja Halonen The kidney renal nurse 14 Psychiatry © p98 Encouraging Interpreting test patientstotalk results ‘Manifestations of ‘mental disorders 15 Outpatients © p.104 Martha Farrell Language that “practice nurse indicates levels Speaking activites» p10 HISLEF = 18 Ndi Me 5 Extracts from an ophthalmic nursing manual 6 Laboratory report 7 Reflective writing 8 Diagnostic questionnaire Researching head Injur Treatments for heart problems Researchinga| procedure Infectious diseases How the kidney works Types of suicide ‘An unconscious patient Heart failure Preparing the patient for Surgery Barrier nursing Instructions on home dialysis ‘A psychiatric case conference ‘Common conditions | Appointments treated in outpatients ‘diary Examining child Grammar reference © p16 Case study-a head injury Patient notes Keyhole surgery ‘pandemic FAQs about ‘organ donation Suicide ‘The problem of missea ‘appointments {9 Neurological observation chart 13. Record of care 10 Nursingcare plan 1. Pre-op document 14 Paychiatrc case history 12. sepsis list of rules ‘Admin bank key p67 Finding out what went Giving youropinion First and Second Common wrong Self-help for the heart Discussing what people should do Staff meeting Deciding what to do ‘Mental heath issues Deciding who should hhave an appointment ‘Abbreviations © p12 onmedical cases Conditional medical adjectives Patient notes Verbs followed __ Abbreviations by toring form ease study Futureforms Suffixes Anatice to patients | Passive ‘Word-bulding andthelrvisitors sentences Explaining Relative clauses Verbs for treatments operating equipment Joumalentry | Present Perfect Word-building imple and Present Perfect Continuous [Anemail about an |usedtodo/ be Appointments appointment used to doing / get used to doing Listening scripts © p.125 Glossary © p.132 415 Interdepartmental communication Contractions saying abbreviations ‘Word stress Cchangesin, stress4 Unit) 1 Admission by A&E Scrub up 3 Anelderly man has collapsed in a supermarket and anambulance is sent out. Discuss which items of 1 Label the equipment that goes into the ambulance, equipment will probably be needed. cardiac monitor oxygen regulator 4 You arrive at an accident in an ambulance with a defibrillator drug box pa rae per marae Wee driver and find four seriously ill people who all need here ces See to go to hospital. There are no other ambulances a scene available and there is only room for three people in ees aa your ambulance. Discuss what you should do 2. Explain to a partner what each item of equipment is for. A.cardiac monitor shows what the heart is doing,Admission by A&E 5 Neen ‘An emergency call 1. Workin pairs. Discuss what questions an emergency operator asks when a call comes through and in what order the questions are asked. 2. @ Listen toan emergency ambulance call-out. Compare your answers to1 with what you hear. 3. @ Listen again and complete this record of the telephone call CITY HOSPITAL Emergency call lo Time of eal 01.26 hours ‘Code number: (| = non-serious 4 = emergere)) Caller’s number: 3 Caller’s namé : Location of incident —__* ‘Type of incident: (V7? al rom hei RTA (Road Trafic Acciders) Pale transport accident Fre Co Acsautt 1 Seleharm (accidental and intentions) Cress unknown beet INFORMATION ABOUTVICTIMS ‘Number of injured: —___* Extent of injuries: Patient ; Patient 2 “Tic or inflammatory materials ivohed in incident. 4 Discuss what is an emergency and what isn’t. (Think, of examples of when someone should call for an ambulance and when they should not) In this w ‘@ emergency equipment ‘© abbreviations ‘© narrative tenses @ language of triage Vocabulary Abbreviations 1 Use the abbreviations key to read the information sent to the ambulance paramedics in Listening. MBO. ambulance AMI acute myocardial infarction (heart attack) ATA actual time of arrival BHT blunthead trauma © cttical Cat category CPR cardiopulmonary resuscitation VA cerebrovascular accident (stroke) Dod dead on arrival ox ETA time of arrival Fx fracture ICU Intensive Care Unit N/A not appropriate pos possible pt patient RTA Road Trafic Accident SHO Senior House officer SIN StaffNurse UNK Unknown 2. complete this written version using full words. The ambulance was called cut on the fteenth of Marek at "40 a serious —___? ater someone had made an enerqenci call. A ‘tanker carruing petrol had erashed into the wall of a shop. The anbuiance's P was 1.40 a.m. but 4s $ was earlier. There were tuo casualties. $ was a nndle, He 8os nok moving and possibly Sub fering an 8. He was categorized — * was a female. Blood from her head indicated that she was su€fering a[A triage nurse usually assigns each patient with a chief complaint rather than a diagnosis, Which of the following isa chief complaint? a loss of consciousness b overdose € stable condition Writing Accident report 1 @ Listen toa police officer talk toa nurse about the RTA in Listening. Take notes about what happened. 2 Write a report about the accident, Describe what happened (draw a diagram if necessary) Inctude in the report your own opinion about whether or not the driver should lave been driving. Say what, if anything, could have been done to avoid the accident. Make recommendations for what should be done to reduce the number of RTAs in your country. It’s my job 1 Without looking at the list of abbreviations in Vocabuilary on p 5, say which of these abbreviations are medical problems and which are medical staff. Fx SHO. S/N CVA 2 Read the text and answer the questions. ‘Why does Heidi not mind the stress of her job? ‘Why is ‘triage nurse’ a suitable job title? What is Heldt’s rank? What is the A&E doctor's rank? What does Heidi like best about the job? Why will the patient with the eye problem not be keeping his medicines in his desk drawer in future? oo Rene 3 Have you heard any stories of strange or stupid accidents and emergencies? Tell your partner. Admission by ARE 7 Neen eRe Heidi Vettraino A repetitive job is my idea of a nightmare, which is ‘why Iwork in A&E. It’s stressful, sometimes shocking, and often very upsetting, but I wouldn't change it for anything, I specialize in emergency triage. Triage’ means ‘sorting’ and that's what I do. [sort out patients in A&E according to the nature and severity of their iliness so that the doctors see the most severe cases first and ‘we don't waste precious time on non-emergencies, ‘You could say that's like specializing in everything, You don't know what's going to pop up next ~it could be an accident with multiple Fx, a sick baby, or a CVA. ‘The day before yesterday a farming accident came in—aman had cut his hand off with a chainsaw. When the ambulance brought the patient in, he was haemorthaging badly and we had to open up an airway and get him on a ventilator immediately. He's ‘OK. He's in ICU, but not on the critical list any more. ‘That was the same day a woman came in complaining of terrible pain in her feet, Iwas the S/N on duty and I categorized her as a non-emergency. She sat waiting for four hours before finally seeing the SHO. You'll never guess what the problem was. Her shoes were too tight! ‘The best thing about A&E work is the people you work with. Everyone pulls together, we're all equal, and everyone shares the same sense of humour, which is essential. Sometimes you've got to see the funny side or give up all hope for human beings. Last week, for example, an ambulance brought a man in who was unable to open his eyes. Being short-sighted, he had reached for his eye drops and didn’t see that he had picked up a tube of superglue instead. Poor man! ‘We bathed his eyes for an hour and very slowly separated his eyelids. He was able to laugh about it with the A&E staff afterwards, but in ‘the future he won't be keeping his medicines in his desk drawer.8 Unit? In 1917,an Australian outback farmer seriously injured himself ina fall. Because the nearest doctor was 3,000 km away, the local postmaster operated on the farmer's bladder using a penknife whist receiving Morse code instructions by telegraph. The patient survived the ‘operation, but not the journey to hospital later. What famous Australian medical service was created because of incidents like this? Reading Air ambulance 1 Discuss with a partner the advantages of air ambulances like the one in the picture. 2. Read the text and compare your ideas with what the article says 3 Read the text again and choose the correct answer. 1 The idea of an air ambulance came from the need to limita patient's movements b_ move treatment fast to sick people © move patients fast but gently. 2 Letting wounded soldiers die is a. cheaper than evacuating them by helicopter b economically necessary inefficient. RESCUE FROM When you cannot move treatment quickly to sick people, you have to move sick people quickly to treatment. The problem Is that when someone is severely inured, movement can Kill and so anything that can both speed up the journey and ‘minimize the shock isa lifesaver. This is why, over @ hundred | years ago, a long time before the development of aircraft, someone came Up with a design for an “aie ambulance’. The idea was to put wounced people on a stretcher which was held in the ar by balloons and pulled along by horses. Warfere hes encouraged progress in ambulance technology. | _Itis expensive and wastoful to let soldiers cle on a battlefield ‘and saving ther lives justifies the expense of using ‘aircraft (particulary helicopters) to transport casvatties to hospital n fact, the rst time a 3 The first medical rescue by helicopter was a aresponse to an accident b amilitary exercise © after a battle. 4 The equipment in a Sikorsky YR-4 helicopters a elementary sophisticated © complex. 5 The main problem for helicopter pilots is that they a cannot see where they are flying b cannot fly when they cannot see © cannot use VFR © Airambulances are best employed for patients who. a arenon-emergencies b will probably die ¢ may live THE AIR Even today, helicopters are limited by weathar and darkness. Unlike aeroplanes, which have radar and computers, many helicopters have only essential fight equipment and pilots have to fly VFR (Visual Fight Rules) which means they can ‘only fly when they can see. However, the great value of a helicopter is that it can land and take off vertically and Drovide speed and comfort, which are not hxuries when it comes to saving ives and a helicopter can make a huge difference in a rural area where response time 's normally slow. Air ambulances can increase the chances of survival of patients whose injuries are severe but survivable Important factor to consider when sending one out. helicopter was used for a medical. ‘rescue was in Butma in 1945 by the American military. A soldier on a jungle-covered mountain accidentally shot Fimseif with a machine gun, There were no medies ‘and the area was so wild that it would have taken ten days for a rescue party to reach the wounded ‘man. A Sikorsky YR-4 helicopter very basic % ‘by modern standards was sent out. It had (ear nga ye i ‘but the pilot completed his mission a lite was saved, ji‘Admission by A&E 9 EE Speaking Triage dilemmas Work in pairs. Read the scenarios and answer the questions. Then compare your opinions and decisions with other students in your class. 1 Youare about to save a patient's life with alarge dose of a scarce drug - the patient will certainly die without it. Its the only supply of the drug that the hospital has. Suddenly three more patients are brought in to A&E. Each one needs one third of the Grug and without it they will probably (though not Gefinitely) die. Who should have the drug? 2. The ICUis full, but there is one patient who is relatively stable though still requiring ICU for optimum care. A new patient is brought in. These | are his notes | CLINICAL RECORDS of renal fare. Grave condi urgent requires intensive care There isa bed inn ICU in another hospital 80 kilometres away but moving a patient from an ICU early increases risk of complications and death Should you transfer the new patient to the other hospital or move the existing patient out of ICU? 3. Ina high-speed car chase, a criminal crashes into | a police car. The police officer suffers a fractured femur. The criminal hits the windscreen with his head ~a serious BHT. The air ambulance has room for one. Who should it be? Project Research one of the following subjects and give a short presentation to the other students. START (Simple Triage And Rapid Treatment) © advanced triage © what to do when there are mass casualties © battlefield triage Checklist ‘Assess your progress in this uni statements which are true. ick (V) the I can name emergency equipment | can understand some medical abbreviations I can complete a written report about an emergency call-out Ican discuss triage iia] Key words Adjectives blunt critical grave optimum semi-urgent stable survivable Nouns casualty complaint, ramp self-harm stress witness Verbs collapse haemorrhage Look back through this unit. Find five more ‘words or expressions that you think are useful.10 Unit2 Scrub up 1 Read the ward notice and say if you think the rules are good ones. NOTICE TO PATIENTS ‘We want to make your stay on the ward ‘5 pleasant as possible and we believe that every patient is an important individual regardless of race, religion, or age. However, all patients must obey the following rules: No peta are allowed within the hospital ‘No smoking anywhere in the hospital Wo aloohol ‘Visitors are only allowed during visiting hours (6.30 p.m. ~ 8.80 pm.) unless on children's ‘ward (under the age of 12) Wo excessive noise Wo mains-powered electrical equipment 2 Decide ifitis fair to make these patients obey the hospital rules. Frances has terminal cancer and is expected to live only a few weeks. There is no one to take care of her at home and her pet cat Bly is the ‘most important thing in her life Dave is thirteen and isin hospital for about a month, The most important things in his life (in order of 4 importance) are: his girlfriend, who he is in love ‘with, his electric guitar, and his mates. Pierre needs to smoke (he has tried several times to give up) and if he doesh’t | havea drink, he shakes, sweats, and is sick. He isin hospital for treatment 4 unrelated to his addictions. 2 Admission by referral Vocabulary Collocations 1 Join the words to make collocations. 1 dietary —_ a care 2 hearing consent 3. informed ¢ difficulties 4 medical 4 effects 5 overnight © examination 6 physical f history 7 presenting g infection § round-the-clock hi requirements © side i stay 10 wound J. symptoms 2 Complete this case history with collocations from 1 ‘Mr Aguilera injured himself with a saw and five days later went tohis doctor with “of jaw discomfort It is more than ten years since his last tetanus booster and the patient has no significant ‘2, There were also no significant findings » ofhead and neck and his lungs froma ‘were clear. The diagnosis was tetanus with secondary "so the wound was cleaned and hydrogen peroxide applied. The patient's doctor referred him for an___3 in hospital for observation. After the treatment was explained to him, the patient signed a form which gave his "and he was then given anti-tetanus immunoglobulin. He responded well and there were no or complications. The patient said that because he was a vegetarian, he had special. # and could not eat hospital food. Also, he lived with his mother who is severely disabled, with #,andneeds . Mr Aguilera asked to be discharged and Dr Hashim gave his authorization.Patient care Polite phrases Replace each underlined phrase in the dialogue with an alternative polite phrase from the list. ‘would you mind if asked you to it’s important to know about can you tell me how you are —_ could you tell me if you take | Ym sorry, can't remember 1 Ineed to know if you have 2 can you let me have Tallike to check may lask why — Thave to ask 2 Nurse I've forgotten’ yourname ‘MasStein It's Mrs Stein. Nurse Of course, Mrs Stein. Give me* your letter of referral MrsStein Hereitis Nurse Thanks. So, Mrs Stein, you've come in for removal of varicose veins? MrsStein Yes. The operation is this afternoon, Nurse Confirrn’ one or two things. First, are you on* any medications? MrsStein Yes, take Venlafaxine, Nurse What for? MrsStein I take it for depression, Nurse OK. Now, tell me* about your lifestyle. Report’ any alcohol or drug problems you have. MrsStein None, don’t drink and I don't take drugs. Nurse Also, tell me if you have* had any contact with HIV in the past six months, MrsStein Thaven't had any contact with HIV, no. Nurse Fine, and who's* paying for treatment? MrsStein I'm covered by medical insurance. Nurse Great, and lastly, you must™ take off your ‘make-up and your rings. Admission by referral 11 — In this u ‘© getting information politely ‘© getting informed consent ‘@ reporting what patients say ‘© understanding a letter of referral Listening Getting verbal consent ‘Work in pairs. Discuss these questions 1 When is it necessary to get a patient's verbal ‘informed consent’? 2. When should a patient sign a consent form and ‘when is it not necessary? 3. Listening to a heart beat through a stethoscope is a medical procedure ~ does this need the patient's, informed consent? 2 @ listen tonurses informing four different patients about medical procedures. Identify which nurse (a-d) is 1 listing the possible risks of a procedure eS 2. describing altematives to a procedure a 3. explaining the possible benefits of a procedure bee 4 getting agreement with the patient. ah. 3. @ Listen again. In which situation (a-d) is the nurse talking to 1 apatient who has a melanoma? a4 2. apatient who has been in an accident? ah 3 apatient who has psychiatric problems? a 4 a patient who is going tohave major surgery? 4 Discuss this situation with a partner. ‘A 64-year-old woman with MS is admitted, The doctor thinks she should be placed on a feeding tube. In the ‘morning the patient is confused, A nurse talks to her about the feeding tube and she consents, However, Jater in the day when the tube is going to be placed, the patient says she doesn't want it in. ‘The following morning, the patient is vague and the nurse tries once more and again the patient consents to the procedure, Is the patient able to decide? Should the nurse place the feeding tube or not?a eee ee Hippocrates, the father of medicine’ would not have agreed with the idea of consenting to treatment’ He thought that giving information +o patients was harmful, and advised doctors to ‘conceal most things ‘rom patients, turn their attention away from what s being done to them, and reveal nothing of their future or present condition’ Do you think there are ever times when its necessary to lie to patients or not tell them certain things? Speaking Getting a patient’s informed consent Workin pairs. Student A, you have been suffering e Language spot Reported speech 11 Study the cartoons and complete the dialogues, chest pains on and off for the past three months. You don’t know what's wrong and the recommended test is cardiac catheterization, Go to p.110, where you will read about details of yourself as well as your doubts about this test. 1. Present tense reporting De 7 [7] am Sendin hO @ patient fo E&Y observation. Student B, you are a nurse. You must first check that ‘the information you have about the patient below is complete and correct. Then you must give the patient information about cardiac catheterization and answer any questions before getting consent for the procedure. Information about the test is on p.112. Nurse Dr Weston says she’s sending a patient for observation. We have a bed available: ‘The consent form must be fully understood and agreed before itis signed, Ward manager CITY HOSPITAL Nurse The ward manager says they Patient's details a : —<—<—s_sr"""—~ DiWeston Good, thank you. [suspect he has Name: concussion. i Sarah The doctorsays—____ Address: 2 Past tense reporting Family history: Father has hear doosee Patient’s medical history: Chichood astna. appendectomy tage 18. Nonsmoker CONSENT FOR MEDICAL AND SURGICAL PROCEDURES. z Lime ben ge fl ration abot my conten. Lundersand syny cardia catheterization is the recommended procedure and what the alternatives are. | understand what the procedure sang that it imvohes rks The next day Nurse _ Last night she told me she was in pain | authorize ths procedure to be performed. Doctor Where did she have the pain? Nurse ____»inher chest. = Doctor How bad was it? Srture of patent Nurse * unbearable, Doctor Were there any other symptoms? Nurse Yes, __ stomach-ache as wellAdmission by referral 13 LL ‘My consultant ance took a man who had been complaining about ‘waiting to the resuscitation room and showed him five beds full } of five exceedingly ll patients, and demanded to know: ‘Which of ‘these five people would you like me to boot out so we can urgently deal with the lump on your wrist? Dr Michael Foxton Confessions of «Junior Doctor 3. Reporting yes / no questions 2 @ Listen toa patient giving information on admission to hospital. Take notes of what the patient says and write a report using reported speech. ‘The first sentence of the report is given as an example. The patient said her name. was Akiko Tanaka and that she was 23. She said that anal peter er Signs and symptoms General symptoms Nurse He asked if could help him get out of bed. Doctor I see. Did he ask for any more help? Nurse Yes, he asked me __* get dressed. Complete the sentences by forming an adjective from Doctor Isee, and then? the our in/bracketa Nurse He askedme_______P open a bottle of 1 The bandages were all___ (blood) and saedeine needed changing. 2 Hefelt. —— (nausea) from the medication. pee 3. Her finger was __ (swelling) and sore. 4 Afterher husband's death, she became (apathy) and lost all interest in life. 5 An______ (infection) wound is dangerous, 6 Ifyour child is __ (fever), take him toa doctor immediately. 7 ‘Yes, it’s ____(pain) when I cough. 8 Ihave a______ (burn) sensation when I goto the toilet 9 People with ___ (phobia) disorders have irrational fears, 10 Yournust not scratch it 4.00 even ifit feels Patient He asked me what my date of birth was, Visitor Did he? What else did he ask you? (itch) Patient He asked mewhere = Visitor So you told him your address. Anything else? Patient Yes, he asked me when __*I told him that I first became ill in July.14 Unit2 Hand-held computers These are now in common us in hospitals. Although they can be used for recording progress and procedures performed on patients survey in 2004 showed that almost no medical staff used themn for that purpose. They dd, however use them to get information on drug dosages, formulae, and practice guidelines Do you use them? Do they have disadvantages as well as advantages? Reading Letter of referral 1. Workin pairs. Discuss what you would expect to read ina letter from a GP when referring a patient toa specialist at a hospital 2 Read the referral letter and check your answers 3 Which ofthese problems does the patient definitely suffer from? asthma nervousness depression obesity heart disease poisoning HIV suicidal tendencies iegular heartbeat 4 Use the information in the letter to complete this admission form. CITY HOSPITAL Admission form _stostanieaiscc eres tenet Name of patient: ___ Age Siblings: Relevant family medical history: Purpose of referral: Presenting symptoms: ‘Other symptoms and conditions: Bm. a Past treatments: Presene medication: Beeches Medical Practice Markottane, Midtown, Sussex 35 7 3th May My ref EAPMARE Re patient Pichae Marcucil.21 years of age Tor Dr}. Nayar lam referring this pant to yeu for astsamnt He is aulflerng Fm attach of tations and breatheszness. ‘The patie isa ster He hassle from ans since he was thiteen He told me tht when he was achid Ne was very ara tha hs parents weuld de He came to sce me sx monte aga He expressed fears about having heart isease Those far are based an the fc tht both his brothers aris ther have heart cordon, "Wen things are going bale ets to much Cones he i overweight ‘th a BE 32, which par explains his breathlessness Ure anasis nestes the onset of ype 2 cidbetes He snd that he had une weight recent asa resut ofthe shock of los hs pat-ime job trough on severe palpation hypeventiaton, and pan tacks and he had tobe sedate. He beteres he wassup to become engaged to hs frend becave he has ‘motional and personality problems He regret this elstonsp and they have frequent rows nich make he symptoms worse bo the pst the patient has bean treated with the antidepressant Lefepaine ‘eventhough there are no car spams of depression itis ossbl that weiht sin and trednes are sce aes ofthe artideprstant 0 I have advised him 12 op tang them (Othe physical symtoms ince jon sing chest pair, muscle pans nd Aizsness He tld me that he hs mero! thoughts but do not tink he has suc intersions Hes recehig Dizopam 2 mg ds. fo annoy Bocuse he has history of adh, [pave noted beta blockers Yours sncerely DeRTOBHen 5. Decide with a partner where to send the patient —the coronary unit, the psychiatric unit, the renal unit, weight loss and exercise classes, or home.Admission by referral 15 Checklist ‘Assess your progress in this unit. Tick (/) the statements which are true I can get information politely | can obtain informed consent | can report what patients say Writing I can understand a letter of referral ‘Arvemallgeauesins informa fees TT eee] read te oS ; Key words 5S ES TR iectber Rocettal otehtiet tour kasi in the, Adjectives eee ar errr eee eel ater apathetic So boa eae nay Tire gee TES DP ANTE ASE a spar aa a a aA oa } information about the patient: personal details, round-the-clock medical history, family details, and history of the significant presenting problem. hea authorization breathlessness consent palpitations presenting symptoms referral tendency Verb sedate jowlesk e[s ¢/@ © ]1iirlae 8) Look back through this unit. Find five more ‘words or expressions that you think are useful Dear DeVan Rin ar [ay who you ae, who the patients and why you are wwtng) “The patients. [Say what you know about the patient] I would be gratflf you cul. (sy what you wa Devan Rin to do) Project Research one of these issues and report back to the rest of the class, giving statistics. © deaths from medical errors © emergency admissions compared with planned admissions for adults and children ‘© most common reasons for admitting children to hospital ‘© most common reasons for hospital admissions in your country © compulsory admission to hospital ‘© admissions because of physical violence