CHAPTER 3

ADMISSION TO HOSPITAL

SPEAKING
PAIN. A patient presents to your consultation room with acute pain in the knee. What
questions will you ask him/her in order to establish a correct diagnosis?

Type of pain:
1…………………………………
2…………………………………
Site of pain:
1…………………………………
2…………………………………
Characteristics
1…………………………………
2…………………………………
Radiation
1…………………………………
2…………………………………
Timing
1…………………………………
2…………………………………
Relieving factors
1…………………………………
2…………………………………
Aggravating factors
1…………………………………
2………………………………….
Severity
1…………………………………
2…………………………………

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Insert the following adjectives in the right column:

relaxed calm apprehensive relieved

anxious confused nervous unconcerned

Negative feeling Positive/neutral feeilng

Identify which of the following group of words is the odd one out:

anxious apprehensive concerned relieved

to resolve to bother to trouble to disturb
anxious relaxed relieved unconcerned
throw up pass out be sick vomit
pharmacy midwife locum registrar
get someone play someone up give someone bring
down trouble someone
round
surgery paramedic ward pharmacy

Match the comments (1-10) with the supplies that are needed in performing the medical actions
(a-j):

1 I can't catch my breath. a table and head-rest paper

Prepare the examining table for the b thermometer
2 next patient.

3 We'll have to get a blood sample. c oxygen mask

4 I need to sterilize the wound. d hypodermic needle

5 We'll have to feed him with liquids. e bandage scissors

6 Let's find out your weight. f Scales

I need to examine the patient in g eye chart
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private.
8 Let's check your vision. h Antiseptic

9 Let's see if you are running a fever. i IV bag

10 Can you cut this gauze for me? j privacy screen

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PROJECT

Motivational interview. Research and make an oral/PP presentation on motivational

interviewing. Then try to apply the techniques on your colleague/patient in order to increase
behavior change e.g: smoking, diabetes care, safe sex or other situation when it is challenging
to convince people to do what is better for them in terms of their health.

Patient-centered interviewing. Research about model and techniques

LISTENING
Listen to the interview Building Efficiency and Effectiveness through Patient-centered
Interviewing between doctor and pneumonia patient and put in the right order what the doctor is
doing:

1. What do you think will happen in the interview?

2. Emotional context
3. Remove barriers to communication (sit down, same language, warm persona)
4. Obtain list of all issues patient wants to discuss.
5. Welcome the patient. Use patient name.
6. Open-ended beginning question and then additional data from non-verbal sources (doctor
silent, patient voice)
7. Personal context (tired, unhappy,
8. Introduce yourself and identify specific role.
9. Empathy skills (NURS)
10. Indicate that both content and style of enquiry will change
11. Symptom story by the doctor

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COMMUNICATIVE ACTIVITY

In groups, role-play describing the pains illustrated in the figures below. Use the Types
of Pain chart and the pain management table :

CASE 1

CASE 2

4
CASE 3

CASE 4

5
 CASE 5

CASE 6

Pain management table

Indicate where the pain is located

Rate the intensity of symptoms over the past 24 hours.

0 = no pain, 10 = emergency pain, requires an ambulance.

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 Mild – however, it interferes with activities
Moderate – interferes with activities
Severe - disabling
Describe th pain (e.g. sharp, shooting, st
abbing)
Describe the pain frequency (e.g. constant, intermittent):
What relieves the pain (e.g. rest, medication):
What makes the pain worse (e.g. lifting, sitting, bending)
Since the symptoms began, they have:
increased
decreased
not changed
When is the pain the worst?
morning afternoon sleeping
same all day increases during the day

TYPES OF PAIN Chart

Flickering Jumping Pricking Sharp

Quivering Flashing Boring Cutting
Pulsing Shooting Drilling Lacerating
Throbbing Electric like Stabbing Tingling
Beating Tugging Hot Itchy
Pounding Pulling Burning Smarting
Pinching Wrenching Scalding Sickening
Pressing Searing Stinging Suffocating
Gnawing Tender Tiring Annoying
Cramping Taut Exhausting Troublesome
Crushing Rasping Wretched Nagging
Dull Splitting Blinding Nauseating
Sore Punishing Miserable Agonizing
Hurting Grueling Intense Dreadful
Aching Cruel Unbearable Torturing
Heavy Vicious Cool Tight
Fearful Killing Cold Numb
Frightening Spreading Freezing Drawing
Terrifying Radiating Squeezing
Penetrating Tearing
Piercing Intermittent

LISTENING

Abdominal examination
Listen to the doctor’s instructions and actions and fill in the missing information:
1. As the`patient is popping onto the couch, the doctor is watching for signs of
discomfort, ease of movement or breathlessness, …………………………. or
abdominal distension
2. The hands are examined first. In the nails there might be signs of ………………,
leukonychia, koilonychia, palmar erythema, Dupuytren contractures (diupatran)
3. In the pulse the…………….. and rhythm are important.
4. If the patient is jaundiced and the doctor suspects …………………….., the
………………………….. is tested.

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 5. The eyes …………………… are inspected for anemia and the …………………..
(yellow) for jaundice.
6. The mouth is inspected for ulcers, …………………….. and tongue disorders.
7. The ……………………………. need to be carefully palpated paying particular
attention to the left side.
8. The Wirchow’s node is associated with …………………
9. The patient should be positioned …………………. for the abdominal examination
10. Patients have to be exposed from above the costal margins to the …………… and
hands by the side.
11. The first step of abdomen examination is the inspection for scars, asymmetry,
…………….. dilated veins, and ………………………….
12. All nine areas of the abdomen are palpated first ……………………….., then deeply.
13. The correct position is at the same level as the patient in order to……………………...
14. Superficial palpation is done with the ……………………., bending at
the…………………., not digging in.
15. In the deep palpation, the abdomen is checked for masses in terms of………,
…………. and position.
16. ………………….. is tested by pressing deeply and releasing the hand. If pain is
……………., it is a sign of peritoneal irritation.
17. The liver is not normally palpable but if it is felt, the size, edges should be assessed by
………….. to see if it is hard, soft, ………….. or tender.
18. Spleen is not normally palpable but enlarges along the line of the ninth rib and moves
downwards and inwards in inspiration and has a …………………..
19. To palpate the left kidney you …………………………………… and ask the patient
to roll a little towards you.
20. If the abdomen is distended and ……………………. is suspected, the doctor tests the
shifting dullness and ………………………...
21. Abdominal areas are percussed paying particular attention to any masses that may be
felt. Regions should be…………………….. rather than dull.
22. ……………………… bowel sounds are characteristic of bowel obstruction.

You have a patient for abdominal examination. Invite him/her to:

1. Look up
2. Open the mouth
3. Stick out his tongue
4. Lie flat
5. lift up her top and slip the skirt down
6. take a few deep breaths in and out

Tell the patient what you are going to do including some of the steps in the listening on
“Abdominal examination” above:
- auscultation
- lymph node palpation
- …………………….
- ……………………..

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VOCABULARY PRACTICE
Presenting to the hospital. Match the terms (1-7) with their definition (A-G):

1. clubbing A. an indentation at the edge of any structure.

2.erythema B. a state in which pain is felt on the release of pressure over a part.
3.sclera C. condition characterized by fluid building up inside the abdomen
4.supine D.bulbous swelling of the terminal phalanges of the fingers and toes,
giving them a “club” appearance;
5.rebound E.redness of the skin caused by congestion of the capillaries in the lo
tenderness wer layers of the skin. It occurs with any skin injury, infection, or
inflammation.
6.notch F.lying on the back
7.ascitis G.the tough white fibrous outer envelope of tissue covering all of the
eyeball except the cornea.

Medical Supplies and Tools. Here is a list of some of the most common supplies found in doctor's
office, operating room, and medical kits. Study the vocabulary and try the matching exercise:

1.antiseptic a.the pouch that contains liquids to be pumped into a patient's body

2.bandage b. sharp pointed metal piece that pricks the skin (attached to a
syringe), used for taking blood or administering medicine

3.dressing c. a device used for looking into a patient's ears

4.elastic tape d. a small bottle or container used for storing liquids

5.eye chart e. a cloth covering that is placed over a wound to prevent bleeding,
swelling and infection

6.gauze f. paper that is placed on an examining table or head-rest to prevent

the spread of germs

7.hypodermic needle g. a poster of letter, word, and number combinations of various

sizes used to test a person's eyesight

8.IV bag h. liquid used to sterilize (clean) the surface of the skin

9.otoscope i. a thin roll of stretchy material that is sticky on one side

10.privacy screen j. glass cylinder that is filled with blood or other liquids and can be
capped and placed in a storage area

11.table and head- k. thin, netted material used for dressing wounds
rest paper

12.test tube l. an object that is used to separate the doctor and patient from
others in an open room

13.vial m. protective covering that is placed over a wound

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A Day in the Life of a Medical-Surgical Hospital Nurse (adapted from
http://www.vault.com/medical-surgical-hospital-nurse/day-in-a-life):

1. How many shifts do doctors/nurses work in a hospital?

2. Which shift is the busiest/most difficult?
3. What kind of uniform do doctors/nurses wear? Is this different for different units?
4. What time of the day are patients usually discharged from hospital?
5. What is the nurses’ and doctors’ continuing education and how is it accomplished?

Read the text and then do the multiple choice comprehension check below:

Jim R., RN, BSN, works rotating shifts at the medium sized (220 beds) Good Samaritan General
Hospital. For two weeks, Jim works 7 a.m. to 3:30 p.m., the next two weeks will be 3 to 11:30 p.m.,
and the next two weeks will be 11 p.m. to 7:30 a.m. (The 30 minutes overlap between shifts gives the
nurses who are leaving some time to report the important events that pertain to each patient to the
nurses taking over.) Jim graduated six months ago and this is his first position in a medical-surgical
unit. Today, Jim is working the day shift, 7 a.m. to 3:30 p.m. The day shift is busy because this is
when physicians come in to see their patients and many diagnostic tests and therapies are scheduled.
6:45 a.m. Jim arrives a few minutes early so he can change into his hospital-supplied scrub suit and
get himself organized for the day.
7:00 a.m. Jim's supervisor gives him a list of eight patients to care for. He knows two of the patients
from his previous shift; six of the patients are new. They range in age from 25 to 85 and their
diagnoses include: diabetes mellitus, congestive heart failure, two days post-stroke, and acute renal
failure.
7:05 a.m. Jim listens to the report of all the nurses going off shift, paying particular attention to his
eight patients. Because the report is tape recorded, any questions must be asked of the night shift
leader.
7:30 a.m. Jim goes to the patients' records to check each care plan, describing tasks and schedules for
the day. Each patient's physician will be coming in early to go around to see his/her patients. Jim will
check on any discharges scheduled and any therapy or diagnostic testing that requires the patient to
travel to another area of the hospital. Then he plans his day around these events and the medication
and care schedule for each patient.
8:00 a.m. Jim accompanies the physicians to report on any changes in the past 24 hours and to gather
information on what is next in the physician's plan. He discovers that the diabetic patient is to be
discharged to home and he will meet with family members to reinforce the self-care needed to balance
treatment for diabetes: exercise, nutrition and medication. Also, one of the post-stroke patients is
going to be moved to a rehabilitation facility. Jim talks with those family members to answer
questions, provide reassurance and explain the goals of rehab. He shows them a web site, where they
can find specific information about stroke, appropriate rehabilitation, safety and homecare, and any
medications that may be prescribed later.
9:00 a.m. Jim receives and stores the single-dose medications for his patients who have been brought
to the unit by a pharmacy technician. He has to check the physicians' documentation for new orders
and authorize them and set them in motion for each of his eight patients. The day goes very quickly,
even without any real crises arising. Medications and treatments must be given before patients go to
their therapy with rehabilitation or before they go to have radiology testing or treatments.

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10:00 a.m. Most of the patient discharges occur before noon. The patients who are going home need
to have specific discharge instructions, as well as an escort to leave the hospital safely. As soon as one
patient leaves, another is admitted, so Jim greets the new patient and completes paperwork setting up a
nursing care plan.
11:00 a.m. Jim "rounds" on his patients again before lunch to check blood pressures and other vital
signs and to keep an eye on everyone.
12:00 noon This is a good day, Jim gets to relax and eat lunch with a colleague. They discuss a
continuing education program on diabetes that they will attend over the weekend. According to their
state Board of Nursing regulations, they need 30 hours of continuing education every two years in
order to renew their license to practice.
12:30 p.m. Jim and his colleague return to work. He sees that one of his patients has called for help.
When he goes to the patient's room, he finds that she became dizzy and fell on her way to the toilet.
He helps her back to bed and assesses her condition. Fortunately, she appears to have no broken bones
and the dizziness has passed. He cautions the patient not to stand up quickly, but to give herself a
couple of minutes sitting at the bedside before standing and walking. He also encourages her to seek
assistance when she wants to get out of bed. After checking the patient's medication list, Dan phones
the patient's physician and suggests some medication changes that may decrease the patient's tendency
toward dizziness. Dan knows that the circumstances around this event are very important because his
hospital is working to decrease the overall rate of falls and patient injuries.
1:30 p.m. By this time, Jim must administer another round of medications and treatments to his
patient group. He checks the physician orders to find if new IVs, blood tests and referrals were
ordered. Jim checks with the unit secretary to see that these were ordered. Jim talks with one of the
medical school students about patient falls and how to prevent them.
2:30 p.m. Jim speaks with a nursing school faculty member on the telephone. She is looking for a
clinical practice site for students in the summer rotation. He agrees to work with undergraduate student
nurses and to recruit fellow staff nurses to take other nurses. He does a final round to check each
patient's condition before he leaves for the day.
3:00 p.m. Jim gives a report to the group of nurses coming on for the next shift. He speaks to his
supervisor regarding his preference for next month's schedule that is being planned. (Some hospitals
have made self-scheduling available to the nursing staff.) Then, Jim has a few moments to document
the care he provided during the past eight hours. He enters data into a computerized record that
contains easy templates for routine care. After that, it is time to relax for a moment!

1....................... is in charge with liaising with the patient’s relatives about the home care plan.

a) the doctor b) the nurse c) Both a and b

2.The nurse reports on patients from previous shift to:

a) the doctor b) the next shift nurse c) Both a and b

3. The diabetes continuing education programme is:

a) 30 hours b) over the weekend c) 30 hours over the weekend

4. Changes in medication are made by:

a) the doctor b) the nurse c) both a and b

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5. Nurses are admitted to the summer rotation:

a) after previous practice b) by agreement with university staff

c) both a and b

Find words in the text that mean:

a) a clinical assignment for students in a specific clinical area.

b) the outer, protective clothing worn by operating room personnel. Usually prepared within the
hospital’s sterilizing facility to minimize contamination in the surgical suite

c) treatment designed to facilitae the process of recovery from injury, disease, to as normal a condition
as possible

d) a non-emergency medical service provided by the ambulance; it offers an appropriate care and
transportation

e) self rostering

Choose the correct word (a-c) to fill in the gaps (1 - 7) below:

Eighteen months ago, things were a lot different in the nursing units at St. Francis Hospital in
Columbus, Georgia. Like so many hospitals, St. Francis was having staffing problems that forced their
own nurses 1)…………………… between units when they didn't want to.
Implementing self-scheduling has 2)……………………….., according to the nurse manager. Without
hiring any additional employees, St. Francis Hospital no longer has 3)……………………….. in its
schedules, he says.
Self-scheduling can be used positively to offer nurses more control over their schedules and to
enhance patient care. But if nurses see this as an individual 4)…………………………. instead of a
balance between individual and unit benefit, everyone loses. Miscommunication of rules and lack of
5)…………………… to self-scheduling guidelines can bring forth mixed feelings of tension and
anxiety to the nurse manager as well as the nursing staff.
I think it would be best if we 6)………………….a software system/online system where nurses can
actually see what days other nurses 7)……………………… and how many nurses are scheduled for
that day.

1. A. to change B. to leap C. to float

2. A. deserved B. paid off C. been claimed
3. A. wholes B. holes C.windows

4. A. entitlements B. ownership C. requests

5. A. closeness B. vicinity C. adherence
6. A. will receive B. got C. will get
7. A. are working B. worked C. had worked

DISCHARGE FROM HOSPITAL. Choose the best item a-c to fill in the gaps below:

1. I would like to see you in six months for a routine...................and evaluate if your
blood test results are within normal ranges.
a) visit b) check-up c) consultation

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 2. When you get home, you can take two ....................pain killers every four hours in
case of discomfort.
a) enemas b) pain killers c) antihistamines
3. If you are feeling ..................light-headed again, lie down and call me.
a) light-headed b) strong-headed c) down in the mouth
4. The toddler was so dehydrated that the doctor decided to get him on a/an......... IV.
a) ventilator b) incubator c) i.v.
5. The doctors will be................................. monitoring her for any internal bleeding.
a) Screening b) following c) monitoring
6. She will remain in the .............................. until she can breathe on her own.
a) ICU b) CAT c) ENT
7. Flowers are not allowed in the ward to avoid the risk of ......................... being
brought in.
a) germs b) polen c) antibody
8. People who have the ........................ should not visit hospital patients.
a) flu b) hemophilia c) eneuresis
9. You will have to wear a ...................... to fix the dislocated shoulder.
a) bling b) sling c) fling
10. He will have to use ........................ after the knee operation.
a) stretchers b) crutches c) braces
11. As your son has a fracture, we will have to apply a long leg …………………
a) dressing b) sling c) cast
12. The ............................ ruled out a number of illnesses.
a) biopsy c) injection c) vaccine
13. Your blood count is abnormal so you may have...............................................
a) cholecistectomia b) thrombocitopenia c) anemia

Colloquial expressions with parts of the human body. Insert the following colloquial expressions
in the sentences below:

keep one’s hair on be back on one’s feet again

be all fingers and thumbs pull someone’s leg

keep your chin up bite someone’s head off

to pay only lip service to the idea see eye to eye with you

1. I told her to ........................ in spite of the accident

2. You’ve got the flu, so you sould drink a lot of liquids and stay in bed for a couple of days.Yes,
I…………………………….., doctor ( see eye to eye with you - agree)
3. I guess he’ll soon.......................................after the crisis and be able to go to work again.
4. He hammered himself because he ...........................
5. The doctor told him to ………………………………… during that stressful situation.
6. I asked what was wrong but he simply………………………………
7. We dismissed the patient as he confessed of a severe problem issue at home but later we found
our he …………………………
8. How’s your grandma? Well, she claims to be in favour of the treatment but so far she
……………………………

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